Attachement_I_-_Performance_Work_Statement.pdf

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RFQP04021500003

ATTACHMENT I

PERFORMANCE WORK STATEMENT

I. Background

The Federal Bureau of Prisons (BOP) was established in 1930 to provide more progressive and humane care for Federal inmates, to professionalize the prison service, and to ensure consistent and centralized administration. Today, the BOP is responsible for the custody and care of approximately 218,000 Federal offenders. The Federal prison system is a nationwide system of prisons and detention facilities for the incarceration of inmates who have been sentenced to imprisonment for Federal crimes and the detention of individuals awaiting trial in Federal court. It is the mission of the Federal Bureau of Prisons to protect society by confining offenders in the controlled environments of prisons and community-based facilities that are safe, humane, cost-efficient, and appropriately secure, and that provide work and other self-improvement opportunities to assist offenders in becoming law-abiding citizens.

As an agency under the Executive Branch of the United States Government, the BOP receives an annual appropriation of funds to accomplish its assigned mission. The public trust demands that this annual appropriation be prudently managed. Thus, dollars spent to maintain the health of the inmate population must reflect the agency’s best efforts to obtain cost-effective health care consistent with community standards.

In meeting the health care needs of a growing inmate population, the BOP provides essential medical, dental, and mental health services to Federal inmates with BOP resources. When a medical need arises which cannot be provided within prison walls by BOP resources, referrals are then made to community-based providers. It is the goal of this solicitation to establish a blanket purchase agreement that will provide necessary professional and facility services for both inpatient admissions and outpatient encounters.

The Federal Prison Camp (hereinafter referred to as FPC) located in Duluth, MN, intends to award a single Blanket Purchase Agreement (BPA) to a responsible entity for the provision of Comprehensive Medical Services as set forth in this solicitation/BPA. The FPC currently houses male inmates.

The FPC 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 V represents inmates with serious health issues. Criteria for categorizing an inmate in the Care Level II category is included as Attachment V. Despite this description of the general health of the inmate population, however, needs for inmate healthcare may arise at varying levels of complexity.

The FPC is located at 4464 Ralston Drive Duluth, Minnesota 55811. In evaluating quotes, the Government will evaluate the proximity of the proposed community-based providers, in addition to other factors, and give preference to those providers located nearest the FPC. Although a 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 FPC. A potential organizational conflict of interest may arise if the awardee is an entity which also holds or participates in a separate contract/agreement with the BOP as a medical claims adjudicator. A possible conflict of interest may exist if the awardee has dual responsibilities for the submission of 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

Page | 2 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 quoter has been imposed as authorized by Federal Acquisition Regulation (FAR) 9.506.

III. Statement of Output

Within this Performance Work Statement (PWS), necessary services are described in terms of output rather than specific task assignments. The BOP desires to make an award to the quoter who can provide the best value, considering the diversity of available services and price. Therefore, the Government may award any or all line items, may withhold award of any or all line items, or may award to a quoter who proposes less than the full complement of services contained in this solicitation. Accordingly, output items 1 and 2 are optional deliverables while output items 3, 4, and 5 are applicable to all services provided.

Quoters are encouraged to submit comprehensive proposals committing to provide all output listed in the solicitation. Quoters who propose less comprehensive approaches will be evaluated accordingly.

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

Output #2: Provide 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.)

Output #3: Submit properly-priced invoices for services rendered.

Output #4: Manage medical record information in a manner which promotes continuity of care while observing restrictions on the release of information.

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

IV. Compliance with Contract Requirements

The BPA Holder’s efforts under this 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 this BPA.

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

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 quoter proposes to provide these services, the following minimum requirements apply. Throughout the performance of this BPA, the BPA Holder shall not utilize any provider that appears in the List of Excluded Individuals/Entities (LEIE) maintained by the U.S. Department of Health & Human Services.

If proposed, the BPA Holder 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.

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It is the FPC's preference to obtain the services of facilities that are accredited by the Joint Commission.

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

The quote shall discuss in detail the diversity of services, as well as the proximity of facility providers to the FPC, that it is capable of providing to achieve Output #1.

Output #2: Provide 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 quoter proposes to provide these services, the following minimum requirements shall apply. Throughout the performance of this BPA, the BPA Holder shall not utilize any provider that appears in the List of Excluded Individuals/Entities (LEIE) maintained by the U.S. Department of Health & Human Services.

Community-Based Services

Professional services resulting from a BOP referral are necessary to be performed in a community-based setting (e.g., hospital facility, surgical center, physician’s office, etc.). If quoted, 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 BPA Holder 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 FPC pharmacy, BPA Holder 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 quote shall discuss in detail the diversity of services, as well as the proximity of professional providers to the FPC, that it is capable of providing to achieve Output #2.

Output #3: Submit properly-priced invoices for services rendered.

Overview. Upon completion of a treatment encounter, the BPA Holder shall prepare and submit proper invoices for services rendered under this BPA. For the purpose of this 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 BPA, including the payment rate structures specified in the BPA.

Invoice/Medical Claims Adjudication. The FPC will employ a process of invoice/medical claims

Page | 4 adjudication to ensure, at a minimum, that the services billed by the BPA Holder were properly authorized and ordered by the FPC, are appropriately coded in compliance with Medicare coding policies (where applicable), are properly priced in accordance with the terms and conditions of the BPA, and do not represent duplicate billings for payments already made. In addition, the FPC may utilize the services of a third-party medical claims adjudicator to review medical claims submitted by the BPA Holder under this BPA. When requested by the FPC, the BPA Holder shall comply with all reasonable requests for additional invoice/medical claim/medical record documentation. All invoice payments shall be made by the FPC and any disagreements regarding the paid amount of any invoice shall be resolved directly with the FPC.

Invoice Definitions.

Line Items 1a - Inpatient Facility Services, 1b - Outpatient Facility Services, 2a - Inpatient Physician Services, and 2b - Outpatient Physician Services: At the outset of this BPA, 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 BPA Holder by the Contracting Officer that a third-party medical claims adjudication service will be utilized by the FPC, an invoice for services rendered under Line Items 1a, 1b, 2a, and 2b shall be a paper invoice detailing not more than 50 individual medical claims which have been electronically transmitted to the BOP’s medical claims adjudicator via American National Standards Institute (ANSI) 837 format that also conforms to Medicare and Health Insurance Portability and Accountability Act of 1996 (HIPAA) electronic billing standards. For each medical claim included on the invoice, the BPA Holder 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.

If the BPA Holder proposal encompasses the provision of community-based oral surgery and/or dental procedures, only those medical claims which represent adjunctive dental care will be submitted by the BPA Holder to the medical claims adjudication contractor for processing. Oral surgery and/or dental procedures which are not considered to be adjunctive dental care will be submitted to the FPC for verification.

The BPA Holder shall not submit a medical claim for processing that the BPA Holder 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 BPA Holder and not submitted until such time as all lines are deemed to be accurate and complete. At that time, the BPA Holder may proceed with submitting the medical claim for processing and invoicing the FPC 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 FPC, the BPA Holder 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 BPA. Provider information supplied to the BOP’s medical claims

Page | 5 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 X to the medical claims adjudicator no less than three business days prior to filing medical claims electronically for services rendered by such new providers.

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

Electronic Trading Partner Agreement. The BOP will execute the Electronic Trading Partner Agreement with the medical claims adjudicator. The BPA Holder shall participate in the medical claims adjudication process described herein as a “Business Associate” of the BOP.

As a Business Associate, the BPA Holder 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 FPC, 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 BPA Holder’s electronic transmission to the BOP’s medical claims adjudicator, the BPA Holder shall promptly submit a paper copy of the invoice to the FPC. The BPA Holder 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. Information for the submission of a paper medical claim to the BOP’s medical claims adjudicator will be provided, along with other pertinent details.

Procedures for Filing Corrected Medical Claims.

Facility Services: If it becomes necessary to file a corrected medical claim for facility services, the BPA Holder 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 BPA Hodler’s electronic transmission to the BOP’s medical claims adjudicator, the BPA Holder shall promptly submit a paper copy of the invoice or credit memo, as applicable, to the FPC. 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 BPA Holder 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 BPA Holder’s submission to the BOP’s medical claims adjudicator, the BPA Holder shall promptly submit a paper copy of the invoice or credit memo, as applicable, to the FPC. 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 FPC. The FPC will pay all invoices directly to the BPA Holder. If the invoiced amount of a medical claim exceeds the adjudicated amount of that medical claim, the FPC will take an administrative deduction from the invoice. The FPC will provide written notification to the BPA Holder when an administrative deduction is taken from an invoice payment.

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If the BPA Holder is in disagreement with the paid amount of a medical claim, the BPA Holder will provide written notification to the FPC of the disagreement along with supporting documentation for why the BPA Holder believes the medical claim was paid incorrectly. The FPC will interface between the BPA Holder and the medical claims adjudicator to bring resolution to any disagreements. If it is determined that a medical claim was paid incorrectly by the FPC, 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 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 BPA Holder’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 BPA Holder 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 one month after the BPA is terminate by either party, the BPA Holder 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 BPA Holder shall provide a written estimate to the FPC of outstanding fiscal year obligations, supported by adequate documentation. This estimate and supporting documentation shall be provided to the Contracting Officer no later than three months after the termination of the BPA. The BPA Holder shall put forth its best efforts to ensure the accuracy of the 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 Holder facility and/or BPA Holder providers. Inmate medical records will be subject to review by the FPC for validation of payment and verification of services rendered. Release of information shall only be made in accordance with community standards, Joint Commission regulations, and the Privacy Act of 1974. Any request(s) for copies of an inmate's medical records by the inmate or a third party shall be directed to the COR for processing.

Notwithstanding the above restrictions on the release of information, medical record information shall be provided to the FPC in order to enhance inmate recovery as well as continuity of care. For inpatient admissions, a faxed report documenting treatment plans will be submitted to the FPC Medical Records Department no later than 8 am each day. This form with the requested information will be provided to the BPA Holder by the FPC. At the completion of treatment, the BPA Holder shall provide the FPC 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 ten calendar days past discharge.

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

The BPA Holder shall provide a Point of Contact (POC) who shall be responsible for facilitating the BPA

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Holder’s delivery of health services under this BPA. The POC shall have sufficient clinical knowledge to enable preliminary technical consultation, with referral to a specialist if necessary. The BPA Holder shall designate this individual in writing to the Contracting Officer prior to the start date of the BPA. Alternate POC’s may be designated; however, the BPA Holder 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 BPA Holder, its representatives, and the FPC to ensure that only those services ordered by the institution are provided, unless required for intervention in a life-threatening emergency. In the event of a life-threatening emergency, the BPA Holder shall contact the COR within a 24-hour time period or the next normal working day. All FPC referrals shall be the sole responsibility and decision of the Government. No inmate may be transferred to another medical facility, with exception of emergency cases, without advanced approval by authorized FPC medical staff.

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

VI. Enhancements to the Basic BPA Requirements

Quoters are encouraged to quote enhancements to the basic BPA requirements which will facilitate the FPC’s ability to conform to the BOP’s stated mission. Due to security concerns inherent in transporting an inmate into the community for medical care, it is the FPC’s preference to treat inmates within the confines of a secure perimeter whenever possible. Quotes which assist the FPC in mitigating security concerns are considered beneficial to the Government and will be evaluated for merit. Enhancements are not additional line items. Pricing for quoted enhancements must be absorbed in the line item structure established within this solicitation. 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 quote shall discuss in detail any such enhancements proposed, including relevant terms and a detailed discussion of the merits of offered enhancements.

(End of Performance Work Statement)

I. Background