Complete_BPA_Solicitation_Documennt_-Brooklyn_and_NY.pdf

Overview

Services are required to be provided in accordance with the Performance Work Statement included in this request/resulting BPA. Contractors are required to submit, a completed copy of the Schedule of Items.

Pricing Methodology

Except for services based on session rates, price quotes will be calculated from benchmarks utilizing Medicare reimbursement methodologies. For each category of service to be provided, contractors 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 BPA shall not be construed as participation in the Medicare program; BPA 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 quoter; contractors 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 BPA performance, it is determined that a necessary BPA 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 Code 35614, Urban Areas – New Jersey City-White Plains, NY-NJ. The Basic DRG calculation shall not include any provider-specific adjustments allowed under actual Medicare participation. Contractors may quote 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 01 Manhattan, New York. The benchmark charges shall be those established for participating providers. Contractors may quote 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 Code 35614, Urban Areas – New Jersey City-White Plains, NY-NJ. Contractors may quote a discount from or a premium to the benchmark charges.

Estimated Quantities

Estimated quantities for the Blanket Purchase Agreement (BPA) period is detailed below. The estimated quantities provided are not a representation to the contractor that the estimated quantities will be required or ordered or that conditions affecting requirements will be stable or normal.

Inpatient and Outpatient Facility and Physician Services

Metropolitan Detention Center (MDC)

Inpatient Days: Estimated 450 Days (per year) Outpatient Visits: Estimated 730 Visits (per year)

Metropolitan Correction Center (MCC)

Inpatient Days: Estimated 250 Days (per year) Outpatient Visits: Estimated 910 Visits (per year)

Schedule of Items (Pricing is to be provided in the following section.)

Schedule of Items For MDC Brooklyn:

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

For FCC New York:

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

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

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

SPECIAL BPA CONDITIONS

Description of Agreement: The Federal Bureau Of Prisons anticipates a single BPA resulting from this request to satisfy comprehensive medical services requirements for MDC Brooklyn and MCC New York. Either party may cancel by giving a 2 week written notice of such cancellation.

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

BPA.

Individuals Authorized to Purchase Under the BPA: All contracting officers authorized to purchase for MDC Brooklyn and MCC New York are authorized to place orders under the BPA.

Orders issued under the resulting BPA will be issued through a BPA Call.

Non-Personal Services Status. Award of this BPA will result in an 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 nonpersonal in nature, 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 BPA 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 the resulting BPA. 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.

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 BPA 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.

BPA 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 resulting BPA.

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 resulting BPA 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 resulting 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 resulting BPA. 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 MDC Brooklyn/MCC New York 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 the resulting BPA 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 the resulting BPA, 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 contractor’s employee, regardless of the final judicial decision, the physician may lose his/her privileges to practice at the MDC Brooklyn/MCC New York.

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 the resulting BPA; 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 MDC Brooklyn and MCC New York, to provide health care and report requested medical record and financial information to the 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 MDC Brooklyn and MCC New York. The contractor must forward all other requests for information to the COR.

Authorized Users. MDC Brooklyn and MCC New York 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.

Submission of Quotes

In addition to a hard copy quote, contractors are encouraged to submit a CD/CDs containing a copy of the quote, in a Portable Document Format (PDF).

Quotes shall be submitted on or before the quote deadline, which is June 26, by 2:00 PM central time. Quotes shall be submitted to the following address:

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

Mailed and hand-carried quotes must be delivered to the Contracting Officer at the address shown above no later than the time specified as the deadline for receipt of quotes. The official point of receipt for hand-carried offers will be at the first floor mail room of the address listed above.

Quotes received after the deadline will be processed pursuant to FAR 52.212-1(f).

PERFORMANCE WORK STATEMENT (PWS)

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. 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 is to establish a BPA that will provide necessary professional and facility services for both inpatient admissions and outpatient encounters.

The Metropolitan Detention Center Brooklyn and Metropolitan Correctional Center New York (hereinafter referred to as MDC/MCC) located in Brooklyn and New York, NY, intends to make a single BPA to a responsible entity for the provision of Comprehensive Medical Services as set forth in this document. The MDC/MCC currently houses male and female inmates (pre-trial and designated inmates). The MDC/MCC is presently a multi-care level facility (Care Level 1-4), on a four level scale where Care Level 1 represents the healthiest inmates and Care Level IV represents inmates with serious health issues. Criteria for categorizing an inmate in the Care Level II category is included as Attachment #2. Despite this description of the general health of the inmate population, however, needs for inmate healthcare may arise at any time, in any specialty, and any level of complexity. Classification and designation of inmates is the sole responsibility of the BOP and may be changed at any time without consideration to the Contractor.

In evaluating 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 MDC/MCC. Although a mileage restriction has not been placed on this acquisition, the Government reserves the right to determine that the proposed driving distances/conditions to community-based providers pose an unacceptable cost or security risk and to find such 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 MDC/MCC. A potential organizational conflict of interest may arise if the awardee is an entity which also holds or participates in a separate contract/agreement with the BOP as a medical claims adjudicator. A possible conflict of interest may exist if the awardee has dual responsibilities for the submission of proper medical claims for services rendered under the resulting BPA and for the adjudication of those medical claims under a separate contract/agreement with the BOP.

Quotes 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. Quotes received from any firm which holds or participates in a separate contract/agreement for BOP medical claims adjudication services which fail to adequately address/resolve potential conflicts of interest will be rejected without further consideration. This limitation on the eligibility of offerors has been imposed as authorized by Federal Acquisition Regulations (FAR) 9.506.

III. Statement of Output

Within this PWS, necessary services are described in terms of output rather than specific task assignments. The BOP desires to create a single BPA with the contractor 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 create a BPA for any or all line items, may withhold creating a BPA of any or all line items or may create a BPA with a contractor who quotes 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.

Contractors are encouraged to submit comprehensive quotes committing to provide all output listed in the solicitation. Contractors who quote 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 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 #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

BPA provider, BPA facility, and the Government regarding the BPA services.

IV. Compliance with BPA Requirements

The Contractor’s efforts under the resulting BPA 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 the resulting BPA. The Contractor’s performance will be measured by the Government utilizing the outcome measure indicators provided in Attachment #3.

The Contractor is responsible for all management and quality control actions necessary to meet the quality standards set forth by the resulting BPA. Prior to commencing performance, the Contractor shall develop and submit a quality control plan (QCP) for the MDC/MCC’s approval. Once the QCP is approved by the MDC/MCC, the Contractor shall utilize the QCP to guide and rigorously document the implementation of the required management and quality control actions to achieve the specified output.

V. Specific Requirements

Output #1: Provide inpatient and outpatient facility services which conform to community standards and all local, state and Federal laws and regulations applicable to the delivery of health care to members of the general public.

Output #1 is an optional deliverable. However, if the contractor quotes to provide these services, the following minimum requirements apply.

If quoted, 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 MDC/MCC’s preference to obtain the services of facilities that are accredited by the Joint Commission.

Contractors utilizing facilities which maintain accreditation by the Joint Commission shall submit a copy of the current accreditation certificate as part of the contractor’s technical quote. If a contractor intends to utilize a facility which is accredited or certified by any other recognized professional accrediting body, the contractor shall submit documentation validating this accreditation or certification as a part of its quote.

The contractor’s technical quote shall discuss in detail the diversity of services, as well as the proximity of facility providers to the MDC/MCC, 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 contractor 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 MDC/MCC pharmacy, BPA 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 contractor’s technical quote shall discuss in detail the diversity of services, as well as the proximity of professional providers to the MDC/MCC, that it is capable of providing to achieve Output #2.

Institution-Based Services

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

If the Contractor performs on-site specialty clinics at the MDC/MCC, the following minimum requirements shall apply. BPA services shall be provided on-site within the Health Services Unit of the MDC/MCC. Consultations shall be limited to the chief complaint on the BOP consultation form. Services shall include diagnosis and treatment of medical conditions with appropriate referral, if necessary, to a specialist at the BPA medical facility. Scheduling of clinics shall be subject to the mutual agreement of the MDC/MCC and the BPA provider. Scheduling of inmates for on-site clinics shall be performed by the MDC/MCC.

Providers performing institution-based services shall be licensed to practice medicine in the State of New York.

Providers performing these services shall apply for clinical privileges at the MDC/MCC. All clinical privileges shall be appropriate to the qualifications of the provider and the resources of the facility where care is provided. Any clinical privileges granted based on the resulting BPA shall be contingent upon the continuation of the resulting BPA and upon the provider’s continued affiliation with the Contractor or any subcontractor. Continuation of privileges at the MDC/MCC shall be at the sole discretion of the MDC/MCC. Non-professional providers shall maintain active licenses from the State of NY, as applicable.

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

All BPA personnel providing services within the confines of the MDC/MCC shall have a complete background investigation conducted in accordance with BOP Program Statement 3000.03, "Human Resource Management Manual." See also "Contract Security/Investigative Requirements" contained in Section 4-1 of this solicitation. All BPA providers and other applicable staff who will enter the MDC/MCC to perform services on a recurring basis shall be required to attend a four-hour institution orientation course held at the MDC/MCC or a mutually acceptable site. A "refresher" orientation must be completed annually. The Contractor's costs for BPA 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 BPA 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 the resulting BPA. For the purpose of the resulting BPA, 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 resulting BPA, including the payment rate structures specified in the BPA.

Invoice/Medical Claims Adjudication. The MDC/MCC will employ a process of invoice/medical claims adjudication to ensure, at a minimum, that the services billed by the Contractor were properly authorized and ordered by the MDC/MCC, are appropriately coded in compliance with Medicare coding policies (where applicable), are properly priced in accordance with the terms and conditions of the resulting BPA, and do not represent duplicate billings for payments already made. In addition, the MDC/MCC may utilize the services of a third-party medical claims adjudicator to review invoices submitted by the Contractor under the resulting BPA.

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

Invoice Definitions.

Line Items 1a and 1b - Inpatient and Outpatient Facility Services, 2a and 2b- Inpatient and Outpatient Physician Services. At the outset of the resulting BPA, an invoice for services rendered under Line Items 1a, 1b, 2a, and 2b shall be a paper version of an invoice containing not more than 50 individual medical claims. Each invoice shall be supported with paper copies of Universal Billing (UB) 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 MDC/MCC, an invoice for services rendered under Line Items indicated above 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 BPA 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 MDC/MCC for all services represented by that medical claim.

Provider Information.

Submission of Provider Data to the BOP’s Medical Claims Adjudicator. Within ten calendar days after notification that a third party medical claims adjudication service will be utilized by the MDC/MCC, the Contractor shall provide the BOP's medical claims adjudicator with a complete list of provider information, which will enable the medical claims adjudicator to accurately identify the correct payable amount for any provider performing services under the resulting BPA. Provider information supplied to the BOP’s medical claims adjudicator should be appropriately marked to identify the data as proprietary information so that it may be adequately protected by the BOP and its contracted medical claims adjudicator. Provider information shall be submitted directly to the BOP’s medical claims adjudicator. As individual providers are added to the Contractor's network, the Contractor shall provide the information listed in Attachment #5 to the medical claims adjudicator no less than three business days prior to filing medical claims electronically for services rendered by such new providers.

National Provider Identifier (NPI) Numbers. The Contractor shall utilize only those providers who have a current National Provider Identifier (NPI) number.

Electronic Trading Partner Agreement. The BOP will execute the Electronic Trading Partner Agreement with the medical claims adjudicator (Attachment #5). The Contractor shall participate in the medical claims adjudication process described herein as a “Business Associate” of the BOP. As a Business Associate, the Contractor agrees to abide by all terms of the Trading Partner Agreement as it pertains to Business Associates.

Technical Data for Submission of Medical Claims. Prior to the submission of an invoice to the MDC/MCC, the Contractor shall electronically transmit the information found on each individual invoiced medical claim via ANSI 837 format only, to the BOP’s medical claims adjudicator. After the Contractor’s electronic transmission to the BOP’s medical claims adjudicator, the Contractor shall promptly submit a paper copy of the invoice to the MDC/MCC. The Contractor will also post the ANSI 837 file in an FTP site set up and maintained by the BOP’s medical claims adjudicator. The only exceptions to the electronic filing requirement shall be corrected medical claims for professional 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 MDC/MCC. 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.

Professional/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 MDC/MCC. 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 proposal or reflect the credit amount due for the corrected medical claim submission.

Payment by the MDC/MCC. The MDC/MCC 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 MDC/MCC will take an administrative deduction from the invoice. The MDC/MCC will provide written notification to the Contractor when an administrative deduction is taken from an invoice payment.

If the Contractor is in disagreement with the paid amount of a medical claim, the Contractor will provide written notification to the MDC/MCC of the disagreement along with supporting documentation for why the Contractor believes the medical claim was paid incorrectly. The MDC/MCC 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 MDC/MCC, 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 the resulting BPA. 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 re-submission , 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 MDC/MCC 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 BPA facility and/or BPA providers. Inmate medical records will be subject to review by the MDC/MCC for validation of payment and verification of services rendered. Release of information shall only be made in accordance with community standards, Joint Commission regulations, and the Privacy Act of 1974. Any request(s) for copies of an inmate's medical records by the inmate or a third party shall be directed to the COR for processing.

Notwithstanding the above restrictions on the release of information, medical record information shall be provided to the MDC/MCC in order to enhance inmate recovery as well as continuity of care. At the completion of treatment, the Contractor shall provide the MDC/MCC with documented discharge instructions, as provided by the attending professional. A written report by the attending professional 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.

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

The Contractor shall provide a Point of Contact (POC) who shall be responsible for facilitating the Contractor’s delivery of health services under the resulting BPA. 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 resulting BPA. 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 MDC/MCC to ensure that only those services ordered by the institution are provided, unless required for intervention in a life-threatening emergency. In the event of a life-threatening emergency, the Contractor shall contact the COR within a 24-hour time period or the next normal working day. All MDC/MCC referrals shall be the sole responsibility and decision of the Government. No inmate may be transferred to another medical facility, with exception of emergency cases, without advanced approval by authorized MDC/MCC medical staff.

VI. Enhancements to the Basic BPA Requirements

Contractors are encouraged to quote enhancements to the basic BPA requirements which will facilitate the MDC/MCC’s ability to conform to the BOP’s stated mission. Due to security concerns inherent in transporting an inmate into the community for medical care, it is the MDC/MCC’s preference to treat inmates within the confines of a secure perimeter whenever possible. Offerings which assist the MDC/MCC in mitigating security concerns are considered beneficial to the Government and will be evaluated for merit. Enhancements are not additional line items. Offerings of enhancements that are separately-priced line items will not be considered or accepted. The Government reserves the right to reject any quoted enhancements that are determined not to be in the best interest of the Government.

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

VII. Inmates who Release from BOP Custody

Contractors 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 BPA 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 BPA hospital, the inmate’s place of conviction and/or legal residence is outside the local area, and there are no other entities assuming custodial responsibility for the inmate, the BOP will accept financial responsibility for the inmate’s medical care until the BOP can satisfy its…