specialconditions.docx

SPECIAL BPA CONDITIONS

Description of Agreement: The (Insert Name Here ie., hospital or third party) agrees to provide comprehensive medical services to the inmates located at The Federal Correctional Institution (FCI) and Federal Prison Camp (FPC), Danbury CT. The period of performance for this BPA shall be open ended until canceled.

Extent of Obligation: The Federal Correctional Institution and Federal Prison Camp Danbury is only obligated to the extent of authorized purchases actually made under the BPA.

Purchase Limitations: There is no specific dollar limitation for each individual purchase under this BPA.

Individuals Authorized to Purchase Under the BPA: All warranted contracting officers located at FCI Danbury are authorized to place orders under the BPA. However the dollar limitation of each purchase is based on the authority granted to the contracting officer to obligate the government. A Certificate of Appointment is subject to the limitations of the delegation.

Non-Personal Services Status. Award of this BPA will result in a contractual arrangement only and shall not be construed as a personnel appointment with the Bureau of Prisons. The services shall not constitute an employer/employee relationship. Payments to the Contractor shall be based on the provision of an end product or the accomplishment of a specific task. Results to be obtained are within the Contractor's own unsupervised determination. The Contractor will not be subject to Government supervision but its efforts will be monitored for quality assurance.

Pursuant to Federal Acquisition Regulation (FAR) 37.401, the resulting BPA shall be a non-personal health care services contract as defined in FAR 37.101, under which the contractor is an independent contractor. The Government may evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of services rendered (e.g., professional judgments, diagnosis for specific medical treatment). The contractor shall indemnify the Government for any liability producing act or omission by the contractor, its employees and agents occurring during contract performance. The contractor shall maintain medical liability insurance in the amount specified in this BPA. The contractor is required to ensure that its subcontracts for provision of health care services contain the requirements of the clause at FAR 52.237-7 entitled "Indemnification and Medical Liability Insurance," including the maintenance of medical liability insurance.

Reviews The Contracting Officer or designee is authorized to review by on-site survey, review of records, or by any other reasonable manner, the quality of services rendered under this contract. All records shall be subject to review by the Contracting Officer or other representative of the Bureau of Prisons.

Payments will be denied when such service does not support the charges or if the service is deemed not necessary or appropriate. Such determinations may be made by the Contracting Officer or COR, whichever is appropriate. The provider shall furnish medical information including a narrative summary when requested by the Contracting Officer or designee. Adequate records shall be maintained to reflect accuracy with respect to claims submission as well as for quality and appropriateness of care. All records shall be subject to review by the Contracting Officer or other delegated representatives of the BOP.

BPA Administration. Contracting Officer Responsibility: Authority to negotiate changes in the terms, conditions, or amounts cited in this BPA is reserved to the Contracting Officer. This responsibility may be delegated to an Administrative Contracting Officer by the Contracting Officer.

Ordering Official: BPA orders may be issued only by the Contracting Officer, Administrative

Contracting Officer or an Ordering Official for FCI Danbury with an appropriate Certificate of Appointment subject to the limitations of the delegation.

Contracting Officer's Representative: The Contracting Officer will designate in writing a COR who shall be responsible for:

a) Monitoring technical progress, including surveillance and assessment of performance and issuing technical changes;

b) Interpreting the scope of work;

c) Technical evaluation as required;

d) Technical inspection and acceptance;

e) Assisting in the resolution of technical problems encountered by the service provider during contract performance;

f) Monitoring funds available for obligation;

g) Ensuring that BPA orders are issued in accordance with appropriate terms;

h) Ensuring that invoices and payments are processed in a timely manner;

i) Assisting in the resolution of administrative problems encountered by the service provider during the BPA performance.

Contract Security/Investigative Requirements. The employees of the contractor entering the institution shall meet certain security requirements to receive an institutional pass as required by Bureau of Prisons Program Statement 3000.03 dated December 1997. Primary concerns are the amount of contact that may occur between the Contractor and his/her employees with the inmate population during the performance of the contract.

The program manager at the institution is responsible for conducting the appropriate vouchering, law enforcement checks, and ensuring that fingerprinting is completed on all Contractor staff that may need access inside the confines of the secure perimeter. The personnel department will establish a security file that will be maintained on each of the contractor’s employees from the beginning of the contract through its duration. The following investigative procedures will be performed:

National Crime Information Center (NCIC) check; DOJ-99 (name check);

FD-258 (fingerprint check):

Law Enforcement Agency checks; Vouchering of Employers; Resume/Personal Qualifications;

Completed Contractor Pre-Employment Form OPM-329-A (Authority for Release of Information);

National Agency Check and Inquiries (NACI) check (if applicable); and Urinalysis Test (for the detection of marijuana and other drug usage)

By submitting a quote, the contractor and its employees agree to complete the required documents and undergo the listed procedures. An individual who does not pass the security clearances will be unable to perform services under the BPA. The final determination and completion of the security investigation procedures will be made at the sole discretion of the institution. All persons are advised that a urinalysis test for the detection of marijuana and other drug usage shall be performed. Any person(s) testing positive shall be disqualified from performing under the resulting BPA. Any individual employed by the Contractor deemed not suitable by the Bureau of Prisons requirements will not be granted access to perform services under the contract. This is a condition of the BPA. The Contractor must be in compliance with Department of Justice regulations at 8 CFR 274a regarding the employment of aliens. A copy of this directive is available upon the Contractor's request.

In addition, each contractor employee must attend an orientation program at the institution. The purpose of this program is to familiarize contractor employees with FCI Danbury operations, the institution, and general rules of conduct and procedures inside the institution. Contractor employees shall adhere to all institution regulations regarding conduct and performance. Contractor employees will be allowed access to the institution at the sole discretion of the Chief Executive Officer (CEO). Any individual performing under this BPA may be removed if it becomes apparent that his/her conduct does not reflect the conduct of that prescribed for those people performing under non-personal service contracts.

Schedule of Required Insurance. As required by FAR clauses 52.228-5 entitled "Insurance-Work on a Government Installation," and 52.237-7 entitled "Indemnification and Medical Liability Insurance," the contractor shall, at its own expense, provide and maintain during the entire performance of the resulting BPA, at least the kinds and minimum amounts of insurance required as listed below:

Workers Compensation & Employers Liability: $100,000. The required workers compensation insurance shall extend to cover employer's liability for accidental bodily injury or death and for occupational disease with a minimum liability of $100,000.

Comprehensive General Liability: $500,000 per accident or occurrence for bodily injury. This insurance shall include contractor's protective and liability.

Automobile Liability: $200,000 per person and $500,000 per occurrence for bodily injury and $200,000 per occurrence for property damage.

Before commencing work under this BPA, the contractor shall certify to the Contracting Officer in writing that the required insurance has been obtained. The policies evidencing required coverage shall contain an endorsement to the effect that any cancellation or any material change adversely affecting the Government’s interest shall not be effective (1) for such period as the laws of the state in which this contract is to be performed, or (2) until 30 days after insurer or the contractor gives written notice to the Contracting Officer, whichever period is longer.

The contractor shall insert the substance of this clause, including this paragraph, in agreements under this BPA that require work on a Government installation and shall require subcontractors to provide and maintain insurance required in the schedule or elsewhere in the BPA. The contractor shall maintain a copy of all subcontractor's proofs of required insurance, and shall make copies available to the Contracting Officer upon request.

Medical Malpractice. Except as provided elsewhere in this contract, the contractor shall provide and maintain medical malpractice and such other insurance during the period of this BPA. Refer to Federal Acquisition Regulation (FAR) 52.237-7, Indemnification and Medical Liability Insurance.

If the contractor or physician who is providing services under this BPA has pending litigation or administrative proceedings that may affect his/her license to practice medicine or standing as a fellow member in a professional organization, full disclosure shall be provided to the COR and CO within five calendar days upon official notification.

If it is determined by the medical legal review that the standard of care has not been met or there is substantial evidence of negligence on the part of the Contractor or contract employee, regardless of the final judicial decision, the physician may lose his/her privileges to practice at FCI/FPC Danbury.

Contractor Training and Courtesy Privileges. Contractor training and courtesy privileges may be extended to BOP medical staff and will be limited to care and treatment of Federal inmates to ensure continuity of care.

Quality of Patient Care/Non-Discrimination. The hospital and professional service providers will provide BOP patients under the terms of this BPA the same or equal services to those provided to non-BOP patients. Professional service providers shall be provided within accepted professional standards.

The contractor agrees to make no distinction among patients under this BPA on the basis of race, color, creed, national origin, or physical condition. For this BPA, distinctions on the grounds of race, color, creed, national origin, or physical condition include but are not limited to the following: denying any service or benefit or availability of a facility; providing any service or benefit to a patient which is different; or if provided in a different manner or at a different time from that provided to other patients under this contract; subjecting a patient to segregation or separate treatment in any manner related to his receipt of any service; restricting a patient in any way in the enjoyment of an advantage or privilege enjoyed by others in determining whether he satisfies any admission, enrollment quota, eligibility, membership or other requirement or condition which an individual must meet in order to be provided any service or benefit; the assignment of time or places for the provision of services on the basis of race, color, creed, or national origin of the patients served.

Third Party Liability. Public Law 87-693 (42 U.S.C. 2651} provides that the United States shall be entitled to recover the reasonable value of hospital and medical care and treatment furnished or to be furnished to a person who suffers any injury or disease under circumstances indicating the Third Party's Liability involves the potential legal liability of another person for the injurer disease in question. This other person is commonly referred to as the "third party" since his/her negligent act or failure to act caused an injury or disease to the "first party'' requiring medical treatment by or at the expense of the United States, the "second party''.

Privacy Act Notification. This BPA requires the contractor, on behalf of FCI Danbury to provide health care and report requested medical record and financial information to the Bureau of Prisons (BOP). The contractor must provide the information requested by task orders issued under this BPA. The BOP will use the information for financial, legal, research, and health care procedures.

Disclosure of this information may be made by the BOP to: fiscal intermediaries; the Office of Workers' Compensation Programs, Department of Labor; the Department of Justice for their representation of the United States; and for Congressional inquiry; quality assessment; medical audit or utilization review; billing third parties for the payment of care; analytical and evaluation studies; to federal or state agencies as required by law; and research purposes supported by the BOP.

Disclosure of the appropriate medical record information without prior consent of the subject patient may be made by you to: another provider of health care treating the same patient; a federal or state agency as required by law such as the reporting of communicable diseases, births, deaths, or the commission of crimes (e.g., gunshot wounds, rape, child abuse or neglect, alcohol or drug abuse, etc.}; designated fiscal intermediaries; and billing third parties for the payment of care not reimbursed by FCI Danbury. The contractor must forward all other requests for information to the COR.

Authorized Users. FCI Danbury reserves the right to grant permission allowing other Federal Correctional Facilities (i.e. Mint Program} to utilize this BPA.

The contractor shall "direct bill" the applicable institution for any services that are provided under this section.

Ordering Procedures. Orders issued under the resulting BPA will take the form of a BOP purchase request, purchase order, or purchase card acquisition form. BPA orders may be issued only by the Contracting Officer, Administrative Contracting Officer, Contracting Officers for FCI Danbury with an appropriate certificate of appointment, or authorized credit card holders.

BPA orders will be issued after providing each awardee with a fair opportunity to be considered for each order exceeding $3,000.00. Exceptions to the fair opportunity process include emergency referrals, situations where only one awardee is capable of providing the required services, task orders which are issued on a sole-source basis as a logical follow-on to a previously issued task order (e.g., continuity of care).

In implementing the fair opportunity process, the ordering official shall consider the diversity of services offered by the awardees, proximity of the contract facilities to FCI Danbury and price. In addition, the ordering official may consider the awardee's past performance on previous task orders for similar services. Having considered this information, the ordering official shall issue the task order to the awardee whose contract represents the best value for the services required by the task order. Procedures for BPA order selection shall be as follows:

(i) When the ordering official or contracting officer determines that the price of a particular task order is of primary concern, the contractor offering the lowest price shall be selected.

(ii) When the ordering official or contracting officer determines that the proximity of services of a particular task order is of primary importance, the contractor offering the nearest provider shall be selected.

(iii) When the ordering official or contracting officer determines that the primary concern for a specific task order is specific expertise or quality, and qualifications of each contractor are apparent, the task order may be placed with the contractor whose qualifications for the specific task(s) exceed those of the other contractors. Contact with all contractors is not required.

(iv) When an ordering official or contracting officer determines that the primary concern for a specific task order is "best value", and the awardee is not apparent, the task order shall be competed on a "best value" basis between all contractors of the multiple award group. In this case, the Contracting Officer or ordering official will evaluate technical information and prices submitted by the contractors for the specific task order.

Overview

Services are required to be provided in accordance with the Performance Work Statement included in this solicitation/contract. Offers’ are required to submit, a completed copy of the Schedule of items:

Pricing Methodology

Except for services based on session rates, price proposals will be calculated from benchmarks utilizing Medicare reimbursement methodologies. For each category of service to be provided, offers’ 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, copayments, or coinsurance. 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; offers’ 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 14860, Bridgeport-Stamford-Norwalk in Connecticut. The Basic DRG calculation shall not include any provider-specific adjustments allowed under actual Medicare participation. Offers’ may propose a discount from or a premium to Basic DRG rates.

Medicare Part B Physician and Non-Physician Services. The Medicare benchmark to be utilized for all physician services and non-physician services covered by Medicare Part B shall be those rates established in the most current Medicare Part B Fee Schedule for Payment Locality 0 for Connecticut. The benchmark charges shall be those established for participating providers. Offers’ 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 14860, Bridgeport-Stamford-Norwalk Connecticut. Offers’ may propose a discount from or a premium to the benchmark charges. Estimated quantities for the Blanket Purchase Agreement (BPA) period is detailed below in the form of a yearly estimate. 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. The BPA period will remain in effect until canceled.

Inpatient and Outpatient Facility and Physician Services

BPA Period- until canceled. Estimates are based on a year timeframe.

Inpatient Days: Estimated 20 Days Outpatient Visits: Estimated 450 Visits

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. Oral Surgeon and Optometrist services shall be paid based upon the provision of defined sessions. The estimated quantities are not a representation to an offeror or contractor that the estimated quantities will be required or ordered or that conditions affecting requirements will be stable or normal.

Optometrist: Session Duration - 4 hours Visit Quantity- 24 per contract year

Neurologist: Session Duration - 4 hours Session Quantity - 12 per contract year

Orthopedic Surgeon: Visit Duration- 4 hours (Approximate) Visit Quantity- 36 per contract year

Dermetologist: Visit Duration - 4 hours (Approximate) Visit Quantity- 30 per contract year

Urologist: Visit Duration- 4 hours (Approximate) Visit Quantity- 12 per contract year

Podiatrist Visit Duration- 4 hours (approximate) Visit Quantity- 24 per contract year

Note: Session priced items which exceed the established session or are less than a full session shall be prorated to the nearest quarter hour. Session prices for oral surgery shall be for evaluations only. Contract rates for procedures covered by Medicare reimbursement methodologies shall be covered by line items 2c1, Other Physicians.

Offerors shall complete the following Schedule of Items.

Schedule of Items BPA Period Date of Award through cancellation

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:

2b. Outpatient Physician Services:

2c. Outpatient Institution Services:

______Discount or +_______Premium to Medicare Part B

________Discount or +________Premium to Medicare Part B

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

NOTE: IF OFFERING A VARIANCE FROM THE BENCHMARK MEDICARE RATE, INSERT APPLICABLE"-/+" PERCENTAGE. IF NO VARIANCE, ENTER "0".

2-2 PERFOPRMANCE 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 238,000 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 professional and facility services for both inpatient admissions and outpatient encounters.

FCI Danbury located in Danbury, Connecticut, intends to make a single/multiple Blanket Purchase Agreements (BPAs) to a responsible entity for the provision of Comprehensive Medical Services as set forth in this solicitation/contract. The FCI currently houses male inmates and female inmates at FPC Danbury. The FCI is presently identified as a Care Level II BOP Facility. Care Level II is an intermediate classification on the four level scale where Care Level I represents the healthiest inmates and Care Level IV represents inmates with serious health issues.

Multiple BPAs may be issued. Institutional Based Services will be awarded under one BPA. No BPAs will be awarded where there is an overlapping of providers/facilities among Quoters. In order to keep the continuity of care for Institutional Based Services and Hospital/Facility quoted, only one out of the possible multiple BPAs awarded will contain Institutional Based Services. Institutional services will not be broken out as a separate BPA, however a separate BPA for those institutional based services defined as session rates which don't require to be privileged at a facility for continuity of care may be issued.

The FCI is located at 33 ½ Pembroke Rd, Danbury, CT 06811. In evaluating offers, the Government will evaluate the proximity of the proposed community-based providers, in addition to other factors, and give preference to those providers located nearest the FCI. Although a mileage restriction has not been placed on this acquisition, the Government reserves the right to determine that the proposed driving distances/conditions to community-based providers pose an unacceptable cost or security risk and to find such offers unacceptable.

II. Organizational Conflict of Interest

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

Offers received from any firm which holds or participates in a separate contract/agreement for BOP medical claims adjudication services must address any potential organizational conflict of interest that may arise and must provide a detailed explanation of how such conflicts will be avoided. Offers received from any firm which holds or participates in a separate contract/agreement for BOP medical claims adjudication services which fail to adequately address/resolve potential conflicts of interest will be rejected without further consideration. This limitation on the eligibility of offers’ has been imposed as authorized by Federal Acquisition Regulations (FAR) 9.506.

Ill. 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 Quotes committing to provide all output listed in the solicitation. Offers’ who propose less comprehensive approaches will be evaluated accordingly.

Output #1:

Output #2:

Output #3: Output#4:

Output#5:

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

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

Submit properly-priced invoices for services rendered.

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

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

IV. Compliance with Contract Requirements

The Contractor's efforts under this contract shall be monitored to ensure that the required output is achieved. The Government reserves the right to inspect and evaluate in a reasonable manner all services rendered during the performance of this contract

The Contractor is responsible for all management and quality control actions necessary to meet the quality standards set forth by 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.

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 FCI's preference to obtain the services of facilities that are accredited by the Joint Commission. Offers’ utilizing facilities which maintain accreditation by the Joint Commission shall submit a copy of the current accreditation certificate as part of the offeror's Quote. 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 Quote.

The offeror's Quote shall discuss in detail the diversity of services, as well as the proximity of facility providers to the USP, that it is capable of providing to achieve Output #1.

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

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

Community-Based Services

Professional services resulting from a BOP referral are necessary to be performed in a community-based setting (e.g., hospital facility, surgical center, physician's office, etc.). If proposed, the 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 professional services.

For prescriptions to be filled by the FCI pharmacy, contract providers 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 Representative (COR), who shall obtain the required approvals. As part of the Discharge Instructions, the issuance of sample medication to any Federal inmate shall be prohibited.

The offeror's Quote shall discuss in detail the diversity of services, as well as the proximity of professional providers to the USP, that it is capable of providing to achieve Output #2.

Institution-Based Services

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

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

Providers performing institution-based services shall be licensed to practice medicine in the State of Connecticut. Providers performing these services shall apply for clinical privileges at the FCI. All clinical privileges shall be appropriate to the qualifications of the provider and the resources of the 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 provider’s continued affiliation with the Contractor or any subcontractor. Continuation of privileges at the FCI shall be at the sole discretion of the FCI. Non-physician providers shall maintain active licenses from the State of Connecticut, as applicable.

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

Dermatologist Optometrist Orthopedic Surgeon Neurology Podiatry Urology

In the event it becomes necessary for the Government to cancel a scheduled visit, the FCI 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 FCI (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 COR, in accordance with the security and privileging requirements of this contract.

All contract personnel providing services within the confines of the FCI 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 providers and other applicable staff who will enter the FCI to perform services on a recurring basis shall be required to attend a four-hour institution orientation course held at the FCI or a mutually acceptable site. A "refresher" orientation must be completed annually.

The Contractor's costs for contract staff to attend this training shall be the responsibility of the Contractor.

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

Invoice Definitions. Line Items 1a -Inpatient Facility Services, 1b- Outpatient Facility Services, 2a - Inpatient Physician Services, 2b - Outpatient Physician Services and 2c1-0utpatient 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 USP, 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 medical claim included on the invoice, the Contractor shall reference, at a minimum, the following information: YREGDOC number, inmate name and register number, date of service, provider of service, billed code, and contract amount billed. Medical claims detailed in the invoice shall be listed first in descending order by the YREGDOC number, second in alphabetic order by the inmate's last name, and third by ascending date of service (i.e., earliest to latest) when more than one medical claim is present for the same inmate within the same invoice.

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

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.

Procedures for Filing Corrected Medical Claims.

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

Physician/Professional Services: If it becomes necessary to file a corrected medical claim for physician/professional services, the Contractor shall submit the corrected medical claim in hard copy (i.e., paper} format to the BOP's medical claims adjudicator. The word "CORRECTED" shall be prominently displayed on the paper medical claim. After the Contractor's submission to the BOP's medical claims adjudicator, the Contractor shall promptly submit a paper copy of the invoice or credit memo, as applicable, to the FCI. Invoices for corrected medical claims shall be clearly marked as such and shall be separate from routine invoices. Invoices or credit memos for corrected medical claims shall detail information pertaining to the original medical claim submission (including any amount(s} previously paid and the associated invoice numbers} and shall bill only for the corrected medical claim submission or reflect the credit amount due for the corrected medical claim submission.

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

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

Timeliness of Medical Claims. Medical claims shall be submitted/invoiced within 90 calendar days after an inmate's discharge or outpatient encounter or other service provided under this contract. Medical claims which are submitted/invoiced beyond the 90-day requirement shall constitute a performance deficiency under this output and shall be documented in the Contractor's performance evaluations.

Medical claims which are submitted/invoiced within the acceptable time period, but are found to contain errors or require further justification, will be rejected and shall be resubmitted/reinvoiced by the Contractor within 30 calendar days from the date of rejection. Upon resubmission, invoices for corrected medical claims shall bear the new date of submission.

No later than November 1 of each year, the Contractor shall stimulate the billing process by reviewing its records, including those of subcontracted providers, to determine an estimated amount of outstanding charges for services provided through September 30 of that year. Based upon information generated through this review process, the Contractor shall provide a written estimate to the FCI of outstanding fiscal year obligations, supported by adequate documentation. This estimate and supporting documentation shall be provided to the Contracting Officer no later than December 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 providers. Inmate medical records will be subject to review by the USP 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 COR for processing.

Notwithstanding the above restrictions on the release of information, medical record information shall be provided to the FCI in order to enhance inmate recovery as well as continuity of care. For inpatient admissions, a faxed report documenting treatment plans will be submitted to the FCI Medical Records Department no later than 8 am each day. This form with the requested information will be provided to the Contractor by the FCI. At the completion of treatment, the Contractor shall provide the FCI with documented discharge instructions, as provided by the attending physician. Copies of all lab, x-ray, ekg, progress notes and emergency room working notes shall also accompany the patient or be faxed immediately to the COR. A written report by the attending physician which documents the circumstances of the inpatient treatment, outpatient procedure, or other consultation shall be provided to the COR within ten business days of the inpatient discharge, outpatient procedure, or other consultation. All lab and consultations pending at time of discharge shall be faxed to the COR upon receipt but not later than 10 calendar days past discharge.

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

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

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

VI. Enhancements to the Basic Contract Requirements

Offerors are encouraged to propose enhancements to the basic contract requirements which will facilitate the FCI's ability to conform to the BOP's…