pensacola-RFQ31201-0012-08.pdf

SOLICITATION/CONTRACT FORM

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SECTION: A

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A.1 BLOCK 20 - STATEMENT OF WORK

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 200,000 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 Prison Camp (hereinafter referred to as FPC) located in Pensacola, Florida, 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 FPC currently houses male inmates. The FPC is presently identified as a Care Level I BOP facility. Care Level II is an intermediate classification on the four-level scale where Care Level I represents the healthiest inmates and Care Level IV represents inmates with serious health issues. Criteria for categorizing an inmate in the Care Level I category is included as Attachment V. 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 quotes, 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 FPC. Although a mile-radius 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 quotes 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 FPC. 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)

Page: 2 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

Performance of these comprehensive medical services are defined within this Statement of Work utilizing a "performance-based" approach. Thus, required services are described in terms of output rather than specific task assignments. The BOP desires to make an award to the quoter who can provide the best value, considering the diversity of available services and price, among other criteria specified in Section A.18.3.2. Therefore, the Government may award any or all line items, may withhold award of any or all line times, or may award to a quoter 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. Quoters are encouraged to submit comprehensive quotes committing to provide all outputs listed in the solicitation. Quoters 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.

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.

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Output #1 is an optional deliverable. However, if the quoter 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 FPC's preference to obtain the services of facilities that are accredited by the Joint Commission. Quoters utilizing facilities which maintain accreditation by the Joint Commission shall submit a copy of the current accreditation certificate as part of the quoter's technical submission. If an quoter intends to utilize a facility which is accredited or certified by any other recognized professional accrediting body, the quoter shall submit documentation validating this accreditation or certification as a part of its quotation.

The quoter's technical submission shall discuss in detail the diversity of services, as well as the proximity of facility providers to the FPC, 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 quoter 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. Physicians performing under this contract shall be currently privileged at the contract facility or have the capability of obtaining privileges within 60 days of a contract award.

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 FPC 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.

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The quoter's technical submission shall discuss in detail the diversity of services, as well as the proximity of physician providers to the FPC, 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 FPC. If the resulting contract does not provide for telemedicine consultation or all of the on-site clinics listed, the BOP reserves the right to pursue such contracts. The BOP 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 FPC determines to be reasonable and appropriate.

If the contractor performs on-site specialty clinics at the FPC, the following minimum requirements shall apply.

Contract services shall be provided on-site within the Health Services Unit of the FPC. 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 FPC and the contract physician. Scheduling of inmates for on-site clinics shall be performed by the FPC.

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

Physicians performing these services shall apply for clinical privileges at the FPC. 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 FPC shall be at the sole discretion of the FPC. Non-physician providers shall maintain active licenses from the State of Florida, as applicable.

The following specialty clinics/sessions may be conducted at the FPC, contingent upon an acceptable offer. The BOP reserves the right to award some or not award of the following on-site clinic: Optometrist.

In the event it becomes necessary for the Government to cancel a scheduled visit, the FPC 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 FPC (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 FPC shall have a complete background investigation conducted in accordance with BOP Program Statement 3000.3, "Human Resource Management Manual." See also "Contract Security/Investigative Requirements." located in Section A.19 of this solicitation/contract. All contract physicians and other applicable staff who will enter the FPC to perform services on a recurring basis shall be required to attend a four-hour institution orientation course held at the FPC 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

Page: 5 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. Each invoice shall also reference the contract number assigned to any resulting contract and shall also contain a unique invoice number which the FPC will reference when making payments under the contract.

Invoice/Medical Claims Adjudication. The FPC 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 FPC, 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 FPC may utilize the services of a third-party medical claims adjudicator to review invoices submitted by the contractor under this contract. When requested by either the FPC or the BOP's contracted medical claims adjudicator, the contractor shall comply with all reasonable requests for additional invoice/medical claim/medical record documentation. All invoice payments shall be made by the FPC and any disagreements regarding the paid amount of any invoice shall be resolved directly with the FPC.

Invoice Definitions.

Line Items 1a - Inpatient Facility Services, 1b - 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 1a, 1b, 2a, 2b shall be a current paper version of the Universal Billing (UB) 92 form or Centers for Medicare and Medicaid Services (CMS) 1500 form, as applicable. Following written notification to the contractor by the Contracting Officer that a third-party medical claims adjudicator service will be utilized by the FPC, an invoice for services rendered under Line Items 1a, 1b, 2a, and 2b shall be an electronically transmitted billing 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. The Contracting Officer will also provide written direction to the contractor specifying all pertinent technical information to accomplish the contractor's submission of an electronically transmitted invoice directly to the BOP's third party medical claims adjudicator. Each invoice, whether submitted in hard copy or electronically, shall identify the inmate by his/her individual BOP inmate register number and shall reflect the patient's relationship to insured as "self."

Line Items 2c1 - Outpatient Institution Services - Optometrist: An invoice for services rendered under Line Items 2c1 shall be a paper invoice detailing the date(s) sessions were provided, the number of sessions provided, the unit pricing applied, and the extended total amount due. The BOP will not use the services of a third party medical claims adjudicator for verification of these services.

Timeliness of Invoices.

Invoices shall be received at the designated point of receipt within 90 calendar days after an inmate's discharge or outpatient encounter or other service provided under this contract. Invoices which are submitted beyond the 90-day requirement shall constitute a performance deficiency under this output and shall be documented in the contractor's performance evaluations. Invoices which are submitted within the acceptable time period, but are found to contain errors or require further justification, will be rejected and shall be resubmitted by the contractor within 30 calendar days from the date of rejection. Invoices submitted after December 31 of the year after the year services were rendered will be rejected and will not be paid.

No later than October 5 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 FPC of outstanding fiscal year obligations, supported by adequate documentation. This estimate and supporting documentation shall be provided to the Contracting Officer no later

Page: 6 than November 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 FPC for validation of payment and verification of services rendered.

Release of information shall only be made in accordance with community standards, Joint Commission regulations, and the Privacy Act of 1974. Any request(s) for copies of an inmate's medical records, by the inmate or a third party shall be directed to the COTR for processing.

Notwithstanding the above restrictions on the release of information, medical record information shall be provided to the FPC in order to enhance inmate recovery as well as continuity of care. At the completion of treatment, the Contractor shall provide the FPC 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 FPC 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 FPC 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 FPC medical staff.

VI. Enhancements to the Basic Contract Requirements

Quoters are encouraged to propose enhancements to the basic contract requirements which will facilitate the FPC'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 FPC's preference to treat inmates within the confines of the FPC's secure perimeter whenever possible. Offerings which assist the FPC 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 in Section A.2. Offerings of enhancements that are separately-priced line items will not be considered or accepted. The Government reserves the right to reject any offered enhancements that are determined not to be in the best interest of the Government.

The quoter's technical submission shall discuss in detail any such enhancements proposed, including relevant terms, pricing, and a detailed discussion of the merits of offered enhancements.

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VII. Inmates Who Release from BOP Custody

Quoters 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 and the inmate's place of conviction and/or legal residence is outside the local area, 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.

A.2 BLOCKS 19 THROUGH 24 - CONTRACT PRICING/SDB PARTICIPATION

A.2.1. Overview

Services are required to be provided in accordance with the Statement of Work included in Section A.1 of this solicitation/contract. Quoters are required to submit, as a part of their quote, a completed copy of Section A.2.4.1, Schedule of Items, and Section A.2.4.2, Target for Participation of Small Disadvantaged Business Concerns.

A.2.2. Pricing Methodology

Except for services based on session rates, quotes will be calculated from benchmarks utilizing Medicare reimbursement methodologies. For each category of service to be provided, quoters will be allowed to quote 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. This structuring of the pricing methodology is not intended to be restrictive of any quoter;

quoters need only to quote 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 Core-Based-Statistical-Area (CBSA) 37860 Pensacola, Florida. The Basic DRG calculation shall not include any provider-specific adjustments allowed under actual Medicare participation. Quoters may quote a discount from or a premium to Basic DRG rates. (Refer to Attachment III of this solicitation)

Medicare Part B Physician Services The Medicare benchmark to be utilized for all physician services covered by Medicare Part B shall be those rates established in the most current Medicare Part B Fee Schedule for Payment Locality 99 for Florida. The benchmark charges shall be those established for participating providers. Quoters may quote a discount from or a premium to the benchmark charges.

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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 37860, Pensacola, Florida. Quoters may quote a discount from or a premium to the benchmark charges.

A.2.3. Estimated Quantities

Estimated quantities for the base year and all option periods are detailed below. This estimate is not a representation to a quoter or contractor that the estimated quantity 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: Inpatient days - 100 estimated Outpatient: Outpatient Visits - 240 estimated

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

Inpatient: Inpatient days - 100 estimated Outpatient: Outpatient Visits - 240 estimated

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

Inpatient: Inpatient days - 100 estimated Outpatient: Outpatient Visits - 240 estimated

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

Inpatient: Inpatient days - 100 estimated Outpatient: Outpatient Visits - 240 estimated

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

Inpatient: Inpatient days - 100 estimated Outpatient: Outpatient Visits - 240 estimated

Outpatient Institution Services

Estimated quantities shall remain constant for the base year and all option periods. Optometrist services shall be paid based upon the provision of defined sessions.

Optometrist: Session Duration - 4 hours Session Quantity - 100 per contract year (estimated)

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A.2.4. Schedule of Items/Target for Participation of Small Disadvantaged Business Concerns

Quoters shall complete the following Schedule of Items and Target for Participation of Small Disadvantaged Business Concerns. All quoted pricing and participation target will be evaluated in accordance with Section A.21, "Evaluation of Quotes" of this solicitation.

A.2.4.1. Schedule of Items

BASE YEAR

Date of Award Through 12 months from Effective Date of Award (EDOA)

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

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

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

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

2c. Outpatient Institution Services:

2c1. Optometrist: $_____________per session

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

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

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OPTION YEAR 1

13 months Through 24 months from EDOA

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

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

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

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

2c. Outpatient Institution Services:

2c1. Optometrist: $_____________per session

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

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

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OPTION YEAR 2

25 months Through 36 months from EDOA

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

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

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

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

2c. Outpatient Institution Services:

2c1. Optometrist: $_____________per session

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

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

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OPTION YEAR 3

37 months Through 48 months from EDOA

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

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

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

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

2c. Outpatient Institution Services:

2c1. Optometrist: $_____________per session

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

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

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OPTION YEAR 4

49 months Through 60 months from EDOA

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

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

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

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

2c. Outpatient Institution Services:

2c1. Optometrist: $_____________per session

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

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

A.2.4.2. 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 quoter 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 acccordance 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.

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CONTRACT CLAUSES

A.3 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):

www.acquisition.gov/far/index.html

I. FEDERAL ACQUISITION REGULATION (48 CFR CHAPTER 1) CLAUSES

NUMBER DATE TITLE

52.212-4 FEB 2007 CONTRACT TERMS AND CONDITIONS-- COMMERCIAL ITEMS

A.4 ADDENDUM TO FAR 52.212-4, CONTRACT TERMS AND CONDITIONS-- COMMERCIAL ITEMS

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.

The following clauses are incorporated by reference, pursuant to FAR 52.252-2:

52.204-4 AUG 2000 PRINTED OR COPIED DOUBLED-SIDED ON RECYCLED

PAPER

52.204-9 SEP 2007 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR

PERSONNEL

52.224-1 APR 1984 PRIVACY ACT NOTIFICATION

52.224-2 APR 1984 PRIVACY ACT

52.228-5 JAN 1997 INSURANCE - WORK ON A GOVERNMENT INSTALLATION

52.232-18 APR 1984 AVAILABILITY OF FUNDS

52.237-2 APR 1984 PROTECTION OF GOVERNMENT BUILDINGS, EQUIPMENT,

AND VEGETATION

52.253-1 JAN 1991 COMPUTER GENERATED FORMS

The following clauses are incorporated into this solicitation/contract by full text as follows:

A.5 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.

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(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]

A.6 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--

(1) Any order for a single item in excess of the estimated quantities identified in Section A.2.3

(Estimated Quantities) within the current performance period;

(2) Any order for a combination of items in excess of the estimated quantities identified in Section

A.2.3 (Estimated Quantities) within the current performance period; or

(3) A series of orders from the same ordering office within 30 days that together call for quantities exceeding the limitation in subparagraph (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 if that 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]

A.7 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 by this contract. Except as this contract may otherwise provide, if the 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.

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(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 if the Contractor will not accept an order providing for the accelerated delivery, the Government may acquire the urgently required goods or services from another source.

(f) 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]

A.8 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 prior to the expiration of the current performance period.

A.9 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 prior to expiration of 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, but excluding the exercise of any option under the clause 52.217-8, Option to Extend Services, which is incorporated into this contract in full text, shall not exceed 5 years.

[End of Clause]

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A.10 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. The Government's obligation for performance of this contract beyond that date is contingent upon the availability of appropriated funds from which payment for contract purposes can be made. No legal liability on the part of the Government for any payment may arise for performance under this contract beyond September 30 of the base year or any option year exercised, until funds are made available to the Contracting Officer for performance and until the Contractor receives notice of availability, to be confirmed in writing by the Contracting Officer.

[End of Clause]

A.11 52.237-7 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE (JAN 1997)

(a) It is expressly agreed and understood that this is a nonpersonal services contract, as defined in Federal Acquisition Regulation (FAR) 37.101, under which the professional services rendered by the Contractor are rendered in its capacity as an independent contractor. The Government may evaluate the quality of professional and administrative services provided, but retains no control over professional aspects of the services rendered, including by example, the Contractor's professional medical judgment, diagnosis, or specific medical treatments. The Contractor shall be solely liable for and expressly agrees to indemnify the Government with respect to any liability producing acts or omissions by it or by its employees or agents. The Contractor shall maintain during the term of the contract liability insurance issued by a responsible insurance carrier of not less than the following amount(s) per specialty per occurrence: $1,000,000. However, if the contractor and/or subcontractor is an entity or a division of a state that either provides for self-insurance and/or is limited by law to the amount of liability insurance that may be purchased by State entities, then the insurance requirement of this contract shall be fulfilled by incorporating the provisions of the applicable State law.

(b) An apparently successful offeror, upon request by the Contracting Officer, shall furnish prior to contract award evidence of its insurability concerning the medical liability insurance required by paragraph (a) of this clause.

(c) Liability insurance may be on either an occurrences basis or on a claims-made basis. If the policy is on a claims-made basis, an extended reporting endorsement (tail) for a period of not less than 3 years after the end of the contract term must be provided.

(d) Evidence of insurance documenting the required coverage for each health care provider who will perform under this contract shall be provided to the Contracting Officer prior to the commencement of services under this contract. If the insurance is on a claims-made basis and evidence of an extended reporting endorsement is not provided prior to the commencement of services, evidence of such endorsement shall be provided to the Contracting Officer prior to the expiration of this contract. Final payment under this contract shall be withheld until evidence of the extended reporting endorsement is provided to the Contracting Officer.

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(e) The policies evidencing required insurance shall also contain an endorsement to he effect that any cancellation or material change adversely affecting the Government's interest shall not be effective until 30 days after the insurer or the Contractor gives written notice to the Contracting Officer. If, during the performance period of the contract the Contractor changes insurance providers, the Contractor must provide evidence that the Government will be indemnified to the limits specified in paragraph (a) of this clause, for the entire period of the contract, either under the new policy, or a combination of old and new policies.

(f) The Contractor shall insert the substance of this clause, including this paragraph (f), in all subcontracts under this contract for health care services and shall require such subcontractors to provide evidence of and maintain insurance in accordance with paragraph (a) of this clause. At least 5 days before the commencement of work by any subcontractor, the Contractor shall furnish to the Contracting Officer evidence of such insurance.

A.12 CONTRACTING OFFICER'S TECHNICAL REPRESENTATIVE (COTR) (JAR 2852.201-70) (JAN 1985)

(a) Frank Kaufmann of FPC Pensacola, 110 Raby Avenue, Pensacola, Florida, 32509, 850-457-1911, is hereby designated to act as Contracting Officer's Technical Representative (COTR) under this contract.

(b) The COTR is responsible, as applicable, for: receiving all deliverables, inspecting and accepting the supplies or services provided hereunder in accordance with the terms and conditions of this contract;

providing direction to the contractor which clarifies the contract effort, fills in details or otherwise serves to accomplish the contractual Scope of Work; evaluating performance; and certifying all invoices/vouchers for acceptance of the supplies or services furnished for payment.

(c) The COTR does not have the authority to alter the contractor's obligations under the contract, and/or modify any of the expressed terms, conditions, specifications, or cost of the agreement. If as a result of technical discussions it is desirable to alter/change contractual obligations or the Scope of Work, the Contracting Officer shall issue such changes.

[End of Clause]

A.13 UNSAFE CONDITIONS DUE TO THE PRESENCE OF HAZARDOUS MATERIAL (JAR 2852.223-70) (JUN 1996)

(a) "Unsafe condition" as used in this clause means the actual or potential exposure of contractor or Government employees to a hazardous material as defined in Federal Standard No. 313, and any revisions thereto during the term of this contract, or any other material or working condition designated by the Contracting Officer's Technical Representative (COTR) as potentially hazardous and requiring safety controls.

(b) The Occupational Safety and Health Administration (OSHA) is responsible for issuing and administering regulations that require contractors to apprise its employees of all hazards to which they

Page: 19 may be exposed in the course of their employment; proper conditions and precautions for safe use and exposure; and related symptoms and emergency treatment in the event of exposure.

(c) Prior to commencement of work, contractors are required to inspect for and report to the contracting officer or designee the presence of, or suspected presence of, any unsafe condition including asbestos or other hazardous materials or working conditions in areas in which they will be working.

(d) If during the performance of the work under this contract, the contractor or any of its employees, or subcontractor employees, discovers the existence of an unsafe condition, the contractor shall immediately notify the contracting officer, or designee (with written notice provided not later than three

(3) working days thereafter) of the existence of an unsafe condition. Such notice shall include the contractor's recommendations for the protection and the safety of Government, contractor and subcontractor personnel and property that may be exposed to the unsafe condition.

(e) When the Government receives notice of an unsafe condition from the contractor, the parties will agree on a course of action to mitigate the effects of that condition and, if necessary, the contract will be amended. Failure to agree on a course of action will constitute a dispute under the Disputes clause of this contract.

(f) Nothing contained in this clause shall relieve the contractor or subcontractors from complying with applicable Federal, State, and local laws, codes, ordinances and regulations (including the obtaining of licenses and permits) in connection with hazardous material including but not limited to the use, disturbance, or disposal of such material.

[End of Clause]

A.14 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) (See Note i) entitled "Personal Identification Verification (PIV) for Federal Employees and Contractors," Phase I.

(…