Sol_1605C3-21-R-00011_Amd_0004.pdf

(x)

1605C3-21-R-00011 x x

1 copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted ; or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVED AT

THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted , such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

x

Washington DC 20210

CAS

S-4307 200 Constitution Ave, NW Customer Acquisition Services US Department of Labor

09/27/20210004

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS. IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

12. ACCOUNTING AND APPROPRIATION DATA (If required) is not extended.is extended, Items 8 and 15, and returning

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended , by one of the following methods: (a) By completing

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

FACILITY CODE CODE

10B. DATED (SEE ITEM 13)

10A. MODIFICATION OF CONTRACT/ORDER NO.

9B. DATED (SEE ITEM 11)

9A. AMENDMENT OF SOLICITATION NO.

CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and ZIP Code)

7. ADMINISTERED BY (If other than Item 6)CODE 6. ISSUED BY

PAGE OF PAGES

4. REQUISITION/PURCHASE REQ. NO.3. EFFECTIVE DATE2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO. (If applicable)

1. CONTRACT ID CODE

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

08/24/2021

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority) appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

E. IMPORTANT: Contractor is not, is required to sign this document and return __________________ copies to the issuing office.

ORDER NO. IN ITEM 10A.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

This is a solicitation for Non-FECA Pharmacy Benefits Management (PBM) Services on behalf of the U.S. Department of Labor (DOL), Office of Workers' Compensation Programs (OWCP).

The purpose of Amendment 0004 is as follows:

1. The following sections in the PWS have been updated to provide revised language and/or additional requirements. Revised sections throughout the PWS are highlighted in yellow. It is imperative that the entire PWS is reviewed thoroughly to ensure all updated sections have been addressed.

Revised PWS Sections:

Continued ...

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)15A. NAME AND TITLE OF SIGNER (Type or print)

15C. DATE SIGNED 16B. UNITED STATES OF AMERICA 15B. CONTRACTOR/OFFEROR 16C. DATE SIGNED

(Signature of person authorized to sign) (Signature of Contracting Officer)

Elvis R. Colbert

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA

FAR (48 CFR) 53.243

NSN 7540-01-152-8070

Previous edition unusable

Except as provided herein, all terms and conditions of the document referenced in Item 9 A or 10A, as heretofore changed, remains unchanged and in full force and effect .

TEL: EMAIL: 202-693-4595 Colbert.Elvis.R@dol.gov

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

2 77

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

1605C3-21-R-00011/0004

• 1.9.17 (System Security)

• 1.11 (Special Qualifications/Requirements:

PBM billing/costs);

• 5.3. (Customer Support)

• 5.5 (Eligibility Verification, Processing Claims for Payment);

• 5.6 (Fee Schedule)

• 5.7.4 (Fraud, Waste and Abuse Monitoring)

• 5.16 (System Audits)

• Technical Exhibit 2-Deliverables Schedule

2. The updated FAR Clause 52.212-5 Contract Terms and Conditions Required to Implement Statutes or

Executive Orders-Commercial Products and

Commercial Services (JAN 2022) has been incorporated into the solicitation in full text.

3. The Government will only accept revised technical proposals from vendors who responded timely to the original proposal submission due date of October 19, 2021. Vendors shall submit final technical proposal revisions addressing each of the revised PWS sections. If changes to the technical proposal result in changes to the price proposal, vendors shall submit revised final price proposal revisions. Revised proposals shall be submitted via email to Helen Williams at

Williams.Helen.A@dol.gov and Jubner Severe at

Severe.Jubner@dol.gov no later than 5:00pm ET on

Friday, April 8, 2022.

4. The Government will only accept and respond to questions from vendors who responded timely to the original question submission due date of

August 31, 2021. Clarifying questions regarding

Amendment 00004 shall be submitted via email to

Helen Williams at Williams.Helen.A@dol.gov and

Jubner Severe at Severe.Jubner@dol.gov no later than 12:00pm ET on Monday, April 4, 2022. The

Government will reply to questions via an amendment posted on Sam.gov only.

5. The Government will accept revisions to the following volumes: Volume I-Technical

Proposal-Subfactor 1-Understanding of the

Requirement, Subfactor 2-Security Requirements

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 77

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

1605C3-21-R-00011/0004 and Volume III-Factor 3-Price/Discounts.

*Updates to Volume II- Past Performance will not be accepted.

Period of Performance: 04/29/2022 to 04/28/2023

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110

Solicitation No. 1605C3-21-R-00011 DOL/ Office of Workers’ Compensation Programs (OWCP) NON-FECA Pharmacy Based Management

Section C-Description/Specification/Performance Work Statement

Performance Work Statement (PWS)

Non-FECA Pharmacy Benefits Management Services Department of Labor (DOL)

Office of Workers’ Compensation Programs (OWCP) Division of Coal Mine Workers’ Compensation (DCMWC) and Division of Energy Employees Occupational Illness

Compensation (DEEOIC)

1.1. Description of Services/Introduction:

In accordance with Federal Acquisition Regulation 37.401, the services required are for non-personal services to manage and provide comprehensive Pharmacy Benefits Management (PBM) services in accordance with this Performance Work Statement (PWS).

The Government will provide guidance within the general scope of the PWS and within contract terms and conditions but the Government will not exercise any supervision (or control) over the contractor’s employees.

Such contract employees shall remain under the contractor’s direct supervision (and control) at all times during the entire performance period. This also applies to the subcontracted service providers utilized in performance of these services.

Such service providers will be considered independent subcontractors responsible for performing the required services. All subcontracted service providers shall be accountable solely to the Contractor who, in turn is responsible to the Government to ensure services are managed and rendered in accordance with the general scope and within contract terms and conditions.

1.2. Background:

The U.S. Department of Labor’s (DOL) Office of Workers’ Compensation Programs (OWCP) administers four occupational illness/injury compensation programs which mitigate (through the provision of wage replacement, cash benefits, medical treatment, vocational rehabilitation and other benefits) the financial burden on certain covered workers or their dependents or survivors when resulting in work-related illness, injury, disease, or death.

Although the OWCP administers four (4) Programs, The Division of Coal Mine Workers’ Compensation (DCMWC) and The Division of Energy Employees Occupational Illness Compensation (DEEOIC) are the sole programs included in this Performance Work Statement.

The Division of Coal Mine Workers' Compensation (DCMWC) also known as Federal Black Lung Program administers claims filed under the Black Lung Benefits Act. The Act provides compensation to coal miners who are totally disabled by pneumoconiosis arising out of coal mine employment and their survivors whose deaths are attributable to the disease. The Act also provides eligible miners with medical coverage for the treatment of lung diseases related to pneumoconiosis;

The Division of Energy Employees Occupational Illness Compensation (DEEOIC) administers the Energy Employees Occupational Illness Compensation Program Act (EEOICPA) which provides lump sum compensation and medical benefits to employees or survivors of eligible Department of Energy (DOE) nuclear weapons workers including employees, former employees, contractors and subcontractors as well as, certain survivors of deceased workers.

EEOICPA was enacted to provide compensation and medical benefits to employees who worked at certain Department of Energy (DOE) facilities, including contractors and subcontractors at those locations, and certain of its vendors. EEOICPA also covers individuals who received an award from the Department of Justice (DOJ) under the Radiation Exposure Compensation Act (RECA) and individuals that worked in a mine, mill, or as an ore transporter at a facility covered by the RECA; and

GENERAL INFORMATION

The Office of Workers’ Compensation Programs, National Office for each of the aforementioned programs coordinates the activities of all District Offices. These District Offices have direct responsibility for processing claims. The District Office functional operations include: adjudicating incoming claims to determine eligibility for compensation payments;

managing claims in which eligibility has been established; determining wage-loss compensation payments for covered disability; and processing payments for allowed medical and vocational rehabilitation services incurred in the treatment of injured workers covered under the Acts.

Each of the programs are unique and each of the programs have statutory requirements that cover medical care and compensation for wage loss and permanent physical impairment to employees who are injured in the performance of duty. The medical evaluation of workers who submit compensation claims is part of the adjudication and case management process. A medical evaluation may be necessary: (1) to determine the causal relationship between work factors and the disease or injury; (2) to assess the extent and duration of the physical impairment or disability; (3) to determine the appropriateness of therapy, including some surgical procedures;

or (4) to determine when recovery has occurred and a return to work is feasible.

The PBM Services requirement as defined in this Performance Work Statement (PWS) represents new services.

As a result, there is no incumbent contractor currently providing full PBM Services to any of the two (2) compensation programs administered by DEEOIC, and DCMWC. The two programs do not have a formal formulary or have any formal prior authorization requirements currently in place. The two programs currently utilize a system that matches accepted conditions to drug uses. If a billed drug is not normally used for the accepted condition it will deny and the claimant’s prescribing physician would then have to request an exception. The DCMWC is the only program that has a covered drug list which it uses to make payments for pharmaceuticals.

1.3. Objectives:

The Government’s objective is to obtain Comprehensive PBM Management services the DEEOIC and DCMWC Programs administered by the Office of Workers’ Compensation Program (OWCP). This includes claimants that require prescription medications and durable medical equipment (DME) as a result of work related injuries or illnesses as stipulated under the statutes administered by DEEOIC or DCMWC.

1.4. Scope:

The contractor shall implement and operate a Pharmacy Benefit Management Program in the United States and surrounding territories for the DEEOIC and DCMWC Program Divisions administered by the Office of Workers Compensation Program (OWCP). This includes claimants that require prescription medications and durable medical equipment (DME) as a result of work related injuries or illnesses as stipulated under the statutes administered by DEEOIC or DCMWC.

Services required are as follows:

• Provide Comprehensive PBM Services;

• Provide full prescription coverage for accepted conditions;

• Provide DME for accepted conditions; and

• Provide a pharmacy card system to claimants once claim eligibility is determined by the programs

1.5. Period of Performance:

Period of Performance: The anticipated period of performance shall be for one (1) base period of 12 months with four (4) 12-month options. The Period of Performance are as follows:

Base Period: April 29, 2022 – April 28, 2023 Option Period I: April 29, 2023 – April 28, 2024 Option Period II: April 29, 2024 – April 28, 2025 Option Period III: April 29, 2025 – April 28, 2026 Option Period IV: April 29, 2026 – April 28, 2027

Milestone dates within the period of performance include:

• Contemplated Contract Start: April 29, 2022 (based on estimated contract award of April 28, 2022)

• Full Implementation: No later than 180 days after contract start date

1.5.1 Contract Type: The Government anticipates award of a fixed-price contract

1.6. Quality of Deliverables/Services:

The contractor’s quality control program is the means by which the contractor assures the government that all work performed will comply with the requirements of the PWS. Therefore, the contractor shall develop, maintain and implement quality control procedures that are consistent with the requirements of the PWS and that address the areas identified in Technical Exhibit 1, “Performance Requirements Summary” and Technical Exhibit 2 “Deliverables Schedule. As defined in Part 2 “Definitions and Acronyms” a written quality control plan (QCP) shall be submitted for government review and approval prior to implementation.

The contracting officer will notify the contractor (in writing) upon government approval of the QCP or when there are proposed change(s) to the contractor’s proposed QC procedures. The contractor shall have the opportunity to correct all unsatisfactory services or deficiencies within five calendar days or another agreed upon timeframe. In no case shall the contractor invoice or bill for non-forming deliverables or services.

Work Plan/Project Plan: The contractor shall have a full work plan/project plan to meet and complete all available tasks and deliverables.

Quality Assurance:

The government will evaluate the contractor’s performance in accordance with the method of surveillance identified in the government’s Quality Assurance Surveillance Plan (QASP) to ensure deliverables and services are performed in accordance with the performance work standards and Technical Exhibits 1 and 2. The document defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s). In no case shall the government pay for non-forming deliverables or services.

1.7. Recognized Holidays:

The Department of Labor will be closed on the following holidays however, the contractor shall ensure services continue on each holiday in order to provide services 365 days per year:

New Year’s Day Labor Day Martin Luther King Jr.’s Birthday Columbus Day President’s Day Veteran’s Day Memorial Day Thanksgiving Day Independence Day Christmas Day Juneteenth National Independence Day

1.8. Hours of Operation/Place of Performance:

The contractor is responsible for conducting PBM services at contractor facilities. The contractor must at all times maintain an adequate work force for the uninterrupted performance of all tasks defined within this performance work statement. When hiring personnel, the contractor shall keep in mind that the stability and continuity of the work force are essential. The contractor’s system and web portal shall be available 24 hours per day, 7 days per week except for 5 hours of maintenance per week. Maintenance periods shall be coordinated to occur at off-peak times and must be approved by OWCP. The contractor shall provide notice when the system is down for maintenance (e.g. web portal message that system is temporarily down for maintenance).

1.8.1 Phase In/Phase Out Period

The Contractor shall develop and initiate a phase-in plan that minimizes any decreases in productivity and prevents possible negative impacts on additional services. The Contractor shall submit the phase-in plan to the COR within 15 business days of award.

During the phase-in period, the Contractor shall:

• Become familiar with performance requirements in order to commence full performance of services on the contract start date.

• Coordinate efforts with the COR, and Federal Program Manager (PM) to meet the requirements of the PWS.

Reference PART 5.2 of this PWS for additional information on basic requirements.

• Negotiate in good faith a plan with the incumbent (if applicable) to determine the nature and extent of the phase-in services required. For the purposes of this task order, an incumbent is defined as the predecessor company recently performing similar requirement services at the designated OWCP/WHD locations.

As directed by the Contracting Officer, the Contractor shall develop and initiate a phase-out plan that minimizes any decreases in productivity and prevents possible negative impacts on additional services. The Contractor shall submit the phase-out plan to the COR within 15 business days of request.

During the phase-out period, the Contractor shall:

• Coordinate phase-out efforts with the COR, and Federal PM.

• Negotiate in good faith a plan with the successor to determine the nature and extent of the phase-out services required.

These phase-in and phase-out plans will be subject to COR/Contracting Officer’s approval. The Contractor shall recognize that the services under this task order are vital to OWCP, and shall continue operations without interruption during the period of performance of this call order, and, upon call order expiration, a successor may continue them.

Notice to the Government of Delay

Performance delays are to be reported immediately to the CO or COR verbally, followed by a written notification within 24 hours of occurrence.

Support Contractor Agreement

The Contractor shall fully cooperate with other contractor (s) occupying the same workspace or collaborating on other projects (as identified by the Contracting Officer, COR/ other authorized government official) to support the agency’s mission.

Continuity Of Operations Planning (COOP)

The Contractor shall be prepared to continue the performance of essential services off-site during a natural, man-made or technological event that would disrupt or interfere with operations at, or access to, facilities where services ordinarily take place. The definition for essential services and natural, man-made or technological events can be found in Part 2.1.

Within 30 days of award, the Contractor shall submit a Continuity Of Operations Planning (COOP) to be approved by the CO and the COR. The COOP must consider, at a minimum, the continuity of all essential services for a period of between one and sixty days during a natural, man-made or technological event that would limit access to facilities where services ordinarily take place.

All basic services required under this PWS (Reference PART 5) and resulting contract are considered essential and paramount to support OWCP’s mission. However, some of the required services can only be performed on-site. Thus, the COOP plan should take into consideration the services’ compatibility with off-site/telework performance.

At a minimum, the COOP plan shall address the following outline elements:

• The Contractor shall identify suitable types of telework and off-site workplaces (i.e contractor employees’ homes, Contractor operated locations/offices, etc.).

• The Contractor shall identify the positions/labor categories that would become essential and potentially allowed to perform work off-site.

• The Contractor shall provide the alert and notification procedures for mobilizing and communicating with the Department and with the identified essential personnel, and for communicating expectations to its personnel regarding their roles and responsibilities during the event.

• The Contractor shall provide a list of telephone numbers and email addresses (with alternates if available) for all managers currently performing under the requirement.

• The Contractor shall provide the standard processes and requirements for the identification, training, and preparedness of essential personnel who would be capable of relocating to alternate facilities or performing work from home.

• The Contractor shall identify any additional measures to ensure quality control of staff performing off-site duties.

• The Contractor shall address if Contractor Employees’ approved to telework/perform services off-site, will need to keep or print hardcopy documents with PII information at the approved telework/off-site location. If so, the Contractor shall provide additional protocols ensuring the appropriate handling of hardcopy documents with PII information.

• The Contractor shall identify if additional support or resources are required to allow Contractor employees’ to perform off-site duties (i.e. access to certain Government locations at least 24 hours before the contingency plan is activated to pick up materials, etc.).

• The Contractor shall identify if additional funds may be needed to comply with the contingency plans.

The Contractor shall comply with the CO and/or COR’s request to edit the contingency plans throughout the period of performance, as needed. All changes to the contingency plans require approval by the CO and/or COR.

During an event that merits the activation of the COOP plan, the Contractor shall work with each of the Program Directors or representatives and the COR to update the related plans per the particular event circumstances. The Contractor shall submit to the COR, at a minimum, an updated employee register/roster by task area and copies of signed telework agreements and related documents. Approval for telework/off-site performance is on a case-by-case basis as the request must demonstrate staff’s availability, readiness, and telework compatible duties in scope with the contract.

1.9. Security Requirements:

All references to keys include keys or key cards that may be required to gain access to data or material necessary in performance of this contract. The contractor shall develop a Quality Control Plan that includes security procedures to ensure no keys received from the Government shall be duplicated. Such procedures shall also include return of any key(s) issued to personnel who no longer require access to locked areas, data or material. The Contractor shall immediately report all occurrences of lost, stolen, damaged or duplicate keys to the COR.

Key Use - When applicable, the Contractor shall prohibit the use of Government issued keys/key cards by any persons other than the Contractor’s employees. The Contractor shall prohibit the opening of locked areas by Contractor employees to permit entrance of persons other than Contractor employees engaged in the performance of assigned work in those areas, or personnel authorized entrance by the Contracting Officer.

Physical Security - When applicable, the contractor shall be responsible for safeguarding all Government Furnished Property identified and provided for contractor use (See Part 3 – Government Furnished Property). At the close of each work period, all government facilities, equipment, and materials shall be secured appropriately (when applicable).

Key Control - When applicable, the Contractor shall establish and implement methods of making sure all keys/key cards issued to the Contractor by the Government are not lost or misplaced and are not used by unauthorized persons.

Lost Keys - In the event keys, other than master keys, are lost or duplicated, the Contractor shall, upon direction of the Contracting Officer, re-key or replace the affected lock or locks; however, the Government, at its option, may replace the affected lock or locks or perform re-keying. When the replacement of locks or re-keying is performed by the Government, the total cost of re-keying or the replacement of the lock or locks shall be deducted from the monthly payment due the Contractor. In the event a master key is lost or duplicated, all locks and keys for that system shall be replaced by the Government and the total cost deducted from the monthly payment due the Contractor.

Lock Combinations - When applicable, the Contractor shall establish and implement methods of ensuring that all lock combinations are not revealed to unauthorized persons. The Contractor shall ensure that lock combinations are changed when personnel having access to the combinations no longer have a need to know such combinations. These procedures shall be included in the contractor’s proposal.

All references1.10 to “days” shall be read as “calendar days”.

1.9.1 INFORMATION SECURITY: The contractor shall be responsible for safeguarding all government information provided for contractor use.

1.9.2 The contractor shall be responsible for ensuring compliance by its employees with the security regulations of DOL and other government installations or contractor facilities where work is performed under the resulting contract. The contractor shall ensure the security of all DOL property, building ID badges, key cards and standard keys issued to contractor staff. For employees leaving the project permanently or for an extended period, the contractor shall return all badges, property, key cards, parking placards, and keys the same day the employees leave the project.

1.9.3 For any contract employees and/or sub-contractors who regularly work at government facilities, the contractor is responsible for the safekeeping and display of a government-provided photo ID badge while these employees are in federally owned or leased property as described in Section 4, Place of Performance.

1.9.4 PERSONAL INFORMATION AND PRIVACY: The contractor shall provide personal information and privacy support to ensure compliance to the Privacy Act and other Federal Privacy related policies including, but not limited to, OMB Memorandum M-06-16, Protection of Sensitive Agency Information, and M-07-16, Safeguarding Against and Responding to the Breach of Personally Identifiable Information. The contractor shall evaluate their existing privacy-related policies and procedures to ensure they comply with federal privacy-related policies – including the 1-hour notification timeframe for security incidents. Where the contractor’s policies and procedures do not comply, the contractor shall perform the necessary updates/revisions to bring the documents and/or system into compliance as requested by the Contracting Officer or COR at no additional cost to the Government. The contractor shall also ensure that all identified privacy vulnerabilities and areas of noncompliance have been documented and resolution tracked.

1.9.5 The contractor shall ensure conformance to the most recent DOL implementation of Federal information security guidelines, currently defined as:

• The Freedom of Information Act, as amended (5 USC 522), which provides for the disclosure of information maintained by Federal agencies to the public, while allowing limited protection for privacy.

• The Privacy Act of 1974, as amended (5 USC 522a), including the Computer Matching and Privacy Act of 1988 (Public Law 100-503)

• The Federal Information Security Modernization Act of 2014 (FISMA), 44 USC § 3551 et seq.

• OMB Circular A-130, Management of Federal Information Resources, which provides instructions to

Federal agencies on how to comply with the fair information practices and security requirements for operating automated information systems.

• OMB Memorandum M-07-16, Safeguarding Against the Breach of Personally Identifiable

Information, May 22, 2007.

• OMB Memorandum M-06-19, Reporting Incidents Involving Personally Identifiable

Information and Incorporating the Cost for Security in Agency Information Technology Investments, July 12, 2006.

• OMB Memorandum M-06-16, Protection of Sensitive Agency Information, June 23, 2006.

• OMB Memorandum M-06-15, Safeguarding Personally Identifiable Information, May 22, 2006.

• FIPS PUB 199, Standards for Security Categorization of Federal Information and

Information Systems: http://csrc.nist.gov/publications/fips/fips199/FIPS-PUB-199-final.pdf

• FIPS PUB 200, Minimum Security Requirements for Federal Information Systems:

http://csrc.nist.gov/publications/fips/fips200/FIPS-200-final-march.pdf

• NIST Special Publication (SP) 800-171, Protecting Controlled Unclassified Information in Nonfederal Systems and Organizations

• US DOL Computer Security Handbook (DOL’s implementation of NIST SP 800-53).

(Reference Attachment 25 - Computer Security Handbook)

• DLMS – 7 – Chapter 1100, DOL Safeguarding Sensitive Data Including Personally Identifiable Information (Reference Attachment 26 – Department of Labor Manual Series (DLMS) 7 Chapter 1100)

1.9.6 Prior to the deployment of the web portal, the contractor shall provide the following documentation regarding the security of the information system(s) that will be used to provide services under this contract: a System Security Plan (SPP), Contingency/Disaster Recovery Plan, and an Incident Response Plan. The government shall review the documentation and make a risk-based decision before granting permission for the full production deployment of the web portal. The vendor shall fix any issues that are discovered during the review, specifically issues that arise from non-compliance with NIST 800-171 and/or the DOL Computer Security Handbook.

1.9.7 Privacy Responsibilities:

1.9.8 The contractor shall ensure that every employee completes all mandated Federal security-training requirements prior to the employee’s first day of work under the contract unless the Government provides a signed waiver agreement.

1.9.9 The contractor shall ensure that all information and reports generated under the terms of the resulting contract are, and shall always remain, the property of the Government.

1.9.10 The contractor shall protect the personally identifiable information (PII) of all claimants, providers, and Government employees from unauthorized disclosure.

1.9.11 The contractor shall use a government-approved incident reporting form to notify the Government (via zzowcpsecurity@dol.gov) of all security incidents, disclosures, breaches, disasters involving personally identifiable information (PII) within one (1) hour of becoming aware of the incident, whether suspected or confirmed. This written notification shall describe the security incident, disclosure, breach or disaster in detail and state the measures taken to protect the confidentiality, integrity, and availability of OWCP information.

Upon notification, the contractor shall investigate the suspected or actual incident to discover the facts about the incident. As additional information becomes available, the contractor shall complete the Incident Report form and provide to zzowcpsecurity@dol.gov.

1.9.12 The contractor shall have a process in the event of a breach or disclosure that also includes corrective action to ensure that a similar breach does not occur in the future. The contractor shall submit a privacy disclosure or breach of personal information plan to the Government in their proposal.

1.9.13 In the event of a breach, the contractor is not to contact the claimant(s) and/or his/her authorized representative until authorized by the Government. The Government will make first notification to the claimant(s).

1.9.14 In the event of a confirmed PII breach by the contractor, the contractor shall provide, at its own cost, one year of credit monitoring services for the affected claimant(s).

1.9.15 The contractor shall be responsible for any liability resulting from its security incident, disclosure or breach involving a claimant’s PII, including financial harm to the Government.

1.9.16 The Government shall approve the contractor’s resolution to the incident.

1.9.17 SYSTEM SECURITY:

1.9.17.1 The contractor shall comply with Binding Operational Directive 18-01 “Enhance Email and Web Security”, and OMB M-15-13 “The HTTPS-Only Standard”.

1.9.17.2 In addition to the security guidelines listed above, the contractor shall adhere to DOL and Federal security standards as they apply for “moderate” systems (defined by FIPS PUB 199). At a minimum, the contractor shall ensure compliance with the following federal guidance documents:

• NIST SP 800-18 Guide for Developing Security Plans for Information Technology Systems

• NIST SP 800-30, Risk Management Guide for Information Technology Systems

• NIST SP 800-37, Guide for Applying the Risk Management Framework to Federal Information Systems: A Security Lifecycle Approach

• DLMS 7 – Chapter 400, IT Security

• NIST SP 800-63-3, Digital Identity Guidelines as found at http://nvlpubs.nist.gov/nistpubs/SpecialPublications/NIST.SP.800-63-3.pdf

1.9.17.3 The contractor shall ensure that the PBM System uses a Federal Identity, Credential, and Access Management (FICAM) compliant authentication method for authenticating external users. The Contractor may leverage the DOL FICAM solution to meet this requirement.

1.9.17.4 The contractor shall ensure they comply with NIST SP 800-63-3, Digital Identity Guidelines for Identity Assurance Level (IAL) 2 and Authenticator Assurance Level (AAL) 2 when identifying and authenticating their employees to systems that contain OWCP data. Contractors may leverage the DOL FICAM solution to meet this requirement.

1.9.17.5 The contractor shall successfully pass security audits that may be conducted by government third-party contractors on the facilities, personnel, hardware and software used to process OWCP claims.

1.9.17.6 The contractor shall fill out the DOL Third-Party Security Monitoring Checklist on an annual basis.

The initial DOL Third-Party Security Monitoring Checklist shall be submitted along with the final system security plan prior to deployment. On a quarterly basis, the contractor shall also provide proof of monthly audit log reviews, user account reviews, vulnerability scans and additional security documentation as required. This is part of DOL’s third-party security monitoring program.

1.9.17.7 All contract staff working in DOL office space and/or using the DOL LAN/WAN and computer systems to perform duties under this PWS shall agree to and sign the DOL Rules of Behavior for Computer Use and a Non- Disclosure Agreement. A copy of each signed and witnessed Non-Disclosure Agreement shall be submitted to the COR prior to the employee performing any work under any task order.

1.9.17.8 The Contractor will establish a secure VPN connection between DOL and the WCMBP as the solution for providing site-to-site connections using only registered IP addresses. The VPN solution will connect geographically diverse field locations to the main processing center in the WCMPB Data Center. The purpose of the secure connection is to facilitate file transfers between DOL and WCMBP. Interface files will be transmitted to the WCMBP ‘Landing Zone’, a secure FTP server within the Contractor’s private network.

1.9.17.9 The Contractor will also provide proactive Network Operations Center (NOC) monitoring capabilities.

The Contractor will record end-to-end response times to and from network devices, services, and applications, to aid in pinpointing areas of excessive network latency or identifying service outages..

1.9.17.10 Data will be encrypted with cryptography methodology that is compliant with FIPS 140-2 and any new NIST or DOL requirements.

1.9.18 BACKGROUND INVESTIGATIONS:

1.9.18.1 The contractor perform a background investigation on all employees who will have access to OWCP data. The background investigation should be thorough enough to establish the trustworthiness of an individual to handle federally owned, Controlled Unclassified Information.

1.9.18.2 The contractor shall provide the following documents to the Federal Project Manager or COR two weeks prior to entry on duty (EOD):

• Signed Computer Security Training

• Signed non-disclosure agreement (NDA)

1.10. Conservation of Utilities:

The contractor shall instruct employees in utilities conservation practices. The contractor shall be responsible for operating under conditions that preclude the waste of utilities, which include turning off the water faucets or valves after using the required amount to accomplish cleaning vehicles and equipment.

1.11. Special Qualifications/Requirements:

PBM Billing/Costs - The Contractor shall provide all of the services included herein with the only costs to the Government being the “Net Proposed Price/Discount” (CLINS 0001- 4001) for PBM services. The Contractor shall pay the rendering provider directly and invoice OWCP in accordance with OWCP’s medical bill processing procedures. The contractor shall factor all of these requirements, as well as the cost of obtaining the necessary medical support services, into the total discount that it can provide to the government for those services. The Contractor shall be required to adhere to all applicable laws / regulations irrespective of the Price / Discount structure utilized.

1.11.1 The contractor shall continue to make system and clinical improvements to keep pace with industry standards. Such improvements shall be included under the existing contractual discounts.

Specific System Requirements –

In order to view and/or print PDF documents you must have a PDF viewer. It is highly recommended that you have the most current version (click on Adobe Acrobat Reader to download the most recent version) available on your workstation. The Form(s) in the list below may be received manually via the print form option or electronically via the electronic fill option:

Form Number Description

OWCP-1500 Health Insurance Claim Form with Instructions

OWCP UB-04 Uniform Health Insurance Claim Form OWCP - 915 Claimant Medical Reimbursement

UCF NCPDP Universal Claim Form

1.12. Post Award Conference/Periodic Progress Meetings:

The Contractor agrees to attend any post award conference convened by the contracting activity or contract administration office in accordance with Federal Acquisition Regulation Subpart 42.5. The contracting officer, Contracting Officers Representative (COR), and other Government personnel, as appropriate, may meet periodically with the contractor to review the contractor's performance. At these meetings the contracting officer will apprise the contractor of how the government views the contractor's performance and the contractor will apprise the Government of problems, if any, being experienced. Appropriate action shall be taken to resolve outstanding issues. These meetings shall be at no additional cost to the government.

1.13. Contracting Officer Representative (COR):

The COR shall be identified by separate letter. The COR monitors all technical aspects of the contract and assists in contract administration. The COR is authorized to perform the following functions: assure that the Contractor performs the technical requirements of the contract: perform the oversight necessary in connection with contract performance: maintain written and oral communications with the Contractor concerning technical aspects of the contract: issue written interpretations of technical requirements, monitor Contractor's performance and notifies both the Contracting Officer and Contractor of any deficiencies. A letter of designation issued to the COR will be issued stating their responsibilities and limitations. A copy will also be forwarded to the Contractor outlining those responsibilities and limitations, especially with regard to changes in cost or price, estimates or changes in delivery dates. The COR is NOT authorized to make changes to any of the terms and conditions of the resulting contract. Changes shall only be made by the Contracting Officer.

1.14. Personnel:

Although the position titles may be different than those listed below, and the functional responsibilities may be distributed differently (i.e., one position may perform multiple functions or several positions may share functions), the Contractor at a minimum must have key personnel available to assign who possess the qualifications listed below and are able to fulfill all of the functional responsibilities and perform each of the tasks described in Part 5 of this PWS. The Staffing Plan must include:

• Chart/matrix showing ALL proposed personnel (including outside consultants or Subject Matter Experts) by task and by hours. The staffing plan shall include names of proposed key and non-key personnel mapped to the proposed labor categories, project roles and appropriate tasks that support the strategic communications initiatives;

• Qualifications and experience of any proposed professional non-key personnel (plus outside consultants) including any relevant education, skills and previous similar work experience specifically with respect to their proposed task responsibilities;

• Minimum qualifications/standards for each proposed labor category that is not included among the key personnel; and

• Reporting relationships.

The contractor should clearly specify the role and responsibilities of each proposed staff and discuss the qualifications of the individuals proposed for specific tasks. The proposal should identify the labor category for each individual, as well as a summary of the individual’s experience and qualifications, and an explanation of how the individual’s experience and qualifications relate to the tasks for which he or she will be utilized.

The contractor shall indicate the current employment status of personnel proposed for work (i.e., whether these personnel are currently employed by the contractor, a subcontractor, a consultant or future hire). If subcontractors or outside assistance are proposed, organizational control and specific responsibilities with respect to all tasks shall be clearly delineated so as to demonstrate and ensure responsiveness to the needs of the Government. The Contractor will submit a Staffing Plan within thirty (30) days of the contract award date.

1.15. Key Personnel:

The follow personnel are considered key personnel by the government:

• Program Manager (PM)

• Alternate PM

• Lead Clinical Pharmacist (Pharm.D.)

• Lead Fraud, Waste, and Abuse Expert

• Technical Manager

The Contractor shall notify the Government of vacancies in Key Positions within three (3) business days of any vacancy.

The Contractor shall provide the Government with resumes of all candidates for Key Position replacements. The Contractor shall ensure that no Key Position remains unfilled for more than 30 days.

Qualifications for all key personnel are listed below:

Program Manager (PM) / Alternate PM

The contractor shall provide a full-time Program Manager and a full-time alternate PM who shall be responsible for the performance of the work. The name of this person and an alternate who shall act for the contractor when the manager is absent shall be designated in writing to the Contracting Officer’s Representative (COR). The Program Manager or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of the resulting contract and be the primary interface with OWCP management and the point of contact on all OWCP claims and contract performance matters. The Program manager or alternate shall be available, Monday thru Friday, except Federal holidays or when the government facility is closed for administrative reasons.

The Program Manager (PM) and alternate PM must have at least five (5) years’ experience managing a state, federal, or commercial PBM program of similar volume to these requirements. The proposed PM and alternate PM must hold a current Project Management Professional (PMP) credential, and a bachelor's degree is preferred.

Lead Clinical Pharmacist (Pharm.D.)

The contractor shall provide a designated Lead Clinical Pharmacist (Pharm.D.) to support the contract. The position requires a doctoral degree in Pharmacy that is recognized by the Accreditation Council for Pharmacy Education (ACPE) or an accrediting body recognized by the U.S. Department of Education at the time the degree was granted. The Lead Clinical Pharmacist must also have passed the North American Pharmacist Licensure Examination (NAPLEX) and the Multistate Pharmacy Jurisprudence Examination (MPJE), and be currently licensed to practice pharmacy in a state, the District of Columbia, the Commonwealth of Puerto Rico, or other territory of the United States. The Lead Clinical Pharmacist must also have completed a Postgraduate Year One (PGY1) pharmacy residency or have additional advanced degrees.

The Clinical Pharmacist shall have 5 years’ experience providing pharmaceutical information and modeling, and assisting with policy development, implementation, oversight, evaluation, and reporting.

While not a requirement for acceptability as “Key Personnel”, OWCP seeks a clinical pharmacist that has actual or equivalent experience providing support to roles such as OWCP senior leadership, Chief Medical Officer, Clinical Pharmacist, and program fraud and integrity analysts regarding PBM operations.

Lead Fraud, Waste, and Abuse (FWA) Expert

The contractor shall provide a Lead Fraud Waste and Abuse Expert to support all aspects of the proposed FWA solution. The Lead FWA Expert shall have 7 years of experience identifying FWA in the areas of prescription drugs, DME, and shall have a health care fraud investigator (AHFI) designation from the

National Health Care Anti-Fraud Association or an equivalent certification. The Lead FWA Expert will interface with DOL’s Office of Inspector General (OIG), OWCP Program specific program integrity units, and other FWA analysts with OWCP as needed to investigate various FWA matters.

Technical Manager

The contractor shall provide a Technical Manager to support all technical and system engineering aspects of the Contractor’s PBM solution. Under the guidance of the Program Manger, the Technical Manager is responsible for the overall management of the design, development, implementation, and operation of all OBM systems and their subsystems used to execute PBM requirements. The Technical Manager analyzes user needs to determine functional and cross- functional requirements; performs functional allocation to identify required tasks and their interrelationships; identifies resources required for each task; ensures that the technical solutions and schedules are implemented in a timely manner; performs integration planning and interfaces to other functional systems.

1.16. Other Personnel

The Contractor shall, in accordance with Part 5 of the PWS provide sufficient personnel, both in number and qualifications to manage contract performance for PBM Services. The contractor shall provide healthcare professionals licensed or registered by the applicable state agency and certified by the applicable professional organization along with other necessary staff to perform all services, including those personnel deemed key.

The contractor shall develop a Staffing Plan. The Staffing Plan must include:

• Chart/matrix showing ALL proposed personnel (including outside consultants or Subject Matter Experts) by task and by hours. The staffing plan shall include names of proposed key and non-key personnel mapped to the proposed labor categories, project roles and appropriate tasks that support the strategic communications initiatives;

• Qualifications and experience of any proposed professional non-key personnel (plus outside consultants) including any relevant education, skills and previous similar work experience specifically with respect to their proposed task responsibilities;

• Minimum qualifications/standards for each proposed labor category that is not included among the key personnel; and Reporting relationships.

The contractor should clearly specify the role and responsibilities of each proposed staff and discuss the qualifications of the individuals proposed for specific tasks. The proposal should identify the labor category for each individual, as well as a summary of the individual’s experience and qualifications, and an explanation of how the individual’s experience and qualifications relate to the tasks for which he or she will be utilized.

The contractor shall indicate the current employment status of personnel proposed for work (i.e., whether these personnel are currently employed by the contractor, a subcontractor, a consultant or future hire). If subcontractors or outside assistance are proposed, organizational control and specific responsibilities with respect to all tasks shall be clearly delineated so as to demonstrate and ensure responsiveness to the needs of the Government. The Contractor will submit a Staffing Plan within thirty (30) days of the contract award date.

The contractor shall provide a minimum of 4 FTE pharmacists (not including the Clinical Lead Pharmacist) for PBM related services; not limited to, completing prior authorization, held, or rejected prescription processing, reviewing letters of medical necessity, and performing…