A.09.03_Solicitation_Attachment_4_Questions_Responses_Amendment_0001.doc

ATTACHMENT 4

QUESTIONS / RESPONSES

Certified Registered Nurse Anesthetists Services for the Brooke Army Medical Center (BAMC), JBSA Fort Sam Houston, Texas.

(if applicable)

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Question: In which File/Section/Factor does the plan go in?

The apparent successful offeror will be required to submit the written plan as required by DFARS 252.237-7024(b) prior to award.

Question: Are offerors to submit only page 1 of the SF 1449, or to include the Section SF 1449 - CONTINUATION SHEETS as well?

Offerors to submit page 1 of the SF 1449 to include pages 3 – 10. Attachment 6, Pricing Worksheet shall consist of the same information of pages 3 – 10.

Question: Are offerors required to address subsections 1 through 14 of pages 59 through 10 in the proposal?

The Supplement to the PWS addresses additional information to offerors to comply with after contract award.

The Offeror shall submit PPIs to the Government that reference the exact same projects addressed in the PPQs that were completed by other Government agencies and private sector companies.

Offerors shall complete and provide Past Performance Information (PPI) Sheet, Attachment 2 on at least two (2) but no more than five (5) recent task orders or stand-alone contracts for a Government or commercial client.

- the 5 individual file sections are not 5 electronic files but sections with the 1 original electronic file that is to be submitted, Is this correct?

- does the Government have a preferred filename convention for the 2 electronic proposal files?

Offerors shall submit one email; with individual file sections: Administrative, Total Compensation Plan, Managerial Approach (one (1) original and one (1) redacted), Past Performance, and Price.

Filename conventions shall be easily recognizable and correspond with the required file.

Proposal Preparation Instructions

Proposal Preparation Instructions, File 2, Section II, Total Employee Compensation, Attachment 1 Will the Government please provide guidance on the following?

- confirm the compensation plan whether the hourly rates are to be based on 2,080 hours?

- confirm fringe/Other Direct Cost benefits can be changed/added (i.e. CEU, bonus)

- Since the Excess hours is a reference to price and are not a typical element of a compensation plan Can you confirm what is to be included for Excess Hours?

- Can you please confirm if we can add a line for converting the total compensation hourly rate to 1,920 productive hours before adding G&E Costs and Profit to get to a Billable Hourly Rate on the compensation plan?

The compensation plan is based 2,080 hours. The solicitation and Attachment 1, Sample Total Employee Compensation Plan, will be corrected by Amendment 0001 and posted on www.fbo.gov.

Offeror shall annotate fringe/Other Direct Cost benefits and can be changed/added (i.e. CEU, bonus) on Attachment 1, Sample Total Employee Compensation Plan. Note: The items listed as fringe benefits in the sample compensation plan should not be considered as either mandatory or all inclusive. They are only examples of fringe benefits that might be included in your compensation package paid directly to the employees.

Excess Rate on the Total Employee Compensation Plan has been removed. Excess Hours are priced as the same rate as Regular Hours and is annotated as 2,000 hours on Attachment 6, Pricing Worksheet. See Amendment 0001 for changes.

A line for the total compensation hourly rate of 1,920 is already annotated before G&A Costs and Profit Rate to get to a Billable Hourly Rate.

Proposal Preparation Instructions, File 4, Section IV, Factor 2 Past Performance There are no explicit guidelines regarding past performance provided by a major subcontractor (performing at least 25% of the work effort). Will the Government please clarify the following?

- How many PPIs can be provided by the subcontractor?

- Does the major subcontractor need to provide evidence of external funding, ie. A financial letter?

Offerors shall complete and provide the Past Performance Information (PPI) Sheet (Attachment 2) on at least two (2) but no more than five (5) recent task orders or stand-alone contracts for a Government or commercial client that they consider most relevant in demonstrating their ability to perform the proposed effort.

Indicate whether PPQ is for the Prime, Subcontractor, Teaming Partner, or Joint Venture. The PPI sheets prepared shall reference the exact same projects addressed in the PPQs.

The solicitation does not request that a major subcontractor needs to provide evidence of external funding, ie. a financial letter.

File 4, Section IV, Factor 2 Past Performance Will the Government please confirm that a PPQ for work performed as a subcontractor can be completed by an employee of the Prime?

The Offeror will send blank PPQs to Government agencies and private sector companies requesting past performance information on applicable projects.

This is the end user that is receiving the services.

File 4, Section IV, Factor 2 Past Performance Will the Government accept past performance that is for a Physicians-Anesthesiology contract or is this too high level?

The relevancy of recent past performance information will be evaluated to determine how closely the services performed under those contracts relate to this requirement. As described in the Addendum to FAR 52.212-2, relevancy is defined in terms of scope and magnitude of this effort and the complexities of this requirement.

File 4, Section IV, Factor 2 Past Performance It is our understanding that the POC completing a PPQ is to directly email the PPQ to the Government by the proposal due date. If so, will the Government please clarify the following instruction:

“An electronic copy of the Offerors PPQs shall be submitted with the Offerors proposal. (Do not refer Government personnel to a previous PPQ without enclosing a copy).”

Only Government agencies and private sector companies (end user) shall send PPQs to requesting past performance information to arlisa.t.harley.civ@mail.mil via email no later than 7 August 2018, 12:00 PM CST.

File 5, Section V, Factor 3 Price, Attachment 6 There is a typo in Attachment 6 in all years – Contractor Manpower Reporting and Excess Hours are transposed (See NSP listed for Excess Hours)

Will the Government be releasing a corrected Attachment 6 or shall we make the change?

See 13.

No specified education and experience level requirement identified, however, the proposed on-site representative must be able to meet the contract coordination and implementation requirements in PWS Paragraph 1.8.

No the representative will not have a work station, computer, or GFP.

· Can the government please clarify this statement as normally the PPQ’s come directly from the reference?

· Given that we may not have enough time to get an answer back from our references may we respectfully request an extension?

See 21.

Only Government agencies and private sector companies (end user) shall send PPQs to requesting past performance information to arlisa.t.harley.civ@mail.mil via email no later than 7 August 2018, 12:00 PM CST.

There are no time extensions for PPQ submittal.

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to verify receipt of proposal.”

In the previous paragraph it only states that we should send proposal via email to arlisa.t.harley.civ@mail.mil.

Are offerors to send the proposal to both contacts?

If yes, should we still send another email verifying the receipt of the proposal?

Email 1: Send proposal via email to arlisa.t.harley.civ@mail.mil.

Email 2: Send an e-mail to Ms. Barbara C. Nelson at barbara.c.nelson8.civ@mail.mil and Ms. Arlisa T. Harley at arlisa.t.harley.civ@mail.mil to verify receipt of proposal.

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up to 8 students per day with case calls averaging 1 hr/SRNA. Not all contractors are assigned to students. It could be only 2, 4, 6 students at any given time being staffed by a contract CRNA due to also having military CRNA's that staff these students and sharing responsibilities.

Does the Contracting Office still consider these adjusted rates to be acceptable minimums for retaining and attracting CRNA candidates under this procurement?

First Part: No response is required as no question has been asked.

Second Part: The Total Employee Compensation plan will be evaluated to determine whether the proposed compensation is sufficient to recruit and retain qualified candidates based on the Government's market research and Independent Government Estimate and whether the proposed compensation exceeds either $400,000 per year (to include bonuses and incentives) based on Title 10 U.S.C. Section 1091 or the FTER of $208.33 as established under DHA-PI 6025.05.

Does the Government agree it dictates the requested services contained in the PWS and it expects the Awardee to exert control over the healthcare professionals (HCPs) hired to perform the requested services to ensure the HCPs comply with the PWS?

First Part: No response is required as no question has been asked.

Second Part: See PWS for definition of personal services, paragraph 1.1.

Does the Government expect the awardee to exert control over the HCPs to ensure they arrive on time to work and perform the shift schedule as identified by the Government?

First Part: No response is required to the first sentence as no question has been asked.

Second Part: See PWS for definition of personal services, paragraph 1.1.

Per PWS 1.3.2., Administrative: Each day that services are performed the contract HCP provider may be required to sign-in his/her time of arrival and departure on a log sheet that will be maintained at a designated area. These attendance logs are for the sole use of government officials to ensure compliance with FTE hours and will not be provided to the contractor for any reason and/or purpose. In addition, under no circumstances will Government employees sign or verify the contractor’s time sheets for the contractor’s health care providers.

Does the Government expect the awardee to take corrective action if reports of an HCP’s poor performance are brought to their attention?

First Part: See PWS for definition of personal services, paragraph 1.1.

Second Part: See PWS for definition of personal services, paragraph 1.1.; Performance Measures, 1.1.3.; and Removal of Contract Employee, 1.3.7.4.

Given these steep penalties imposed by the US Department of Labor and the US Internal Revenue Service, does the Contracting Office consider misclassification of employees as independent contractors to be a significant risk and an unacceptable element of an offeror’s Compensation Plan?

First Part: No response is required as no question has been asked.

Second part: See FAR 52.222-46.

Does the Government consider fringe amounts significantly lower than those corresponding to CRNA employees outlined above to be Unacceptable when evaluating the Compensation Package?

First Part: No response is required as no question has been asked.

Second Part: See the Addendum to FAR 52.212-2 for how the total employee compensation plan will be evaluated and how "unacceptable" is defined.

FAR 52.219-14

FAR 52.219-14

Limitations on Subcontracting is incorporated into the Solicitation. As the Government knows, 1099 contractors are subcontractors and not employees.

Will the Government confirm 1099 subcontractors working for an 8(a) Offeror would not meet the 51% threshold unless each individual HCP is certified as an 8(a) concern?

First Part: No response is required as no question has been asked.

Second Part: Per FAR 52.219-14(c)(1) At least 50 percent of the cost of contract performance incurred for personnel shall be expended for employees of the concern.

Factor 3 - Price Offerors proposing CRNAs hired on a 1099 basis will undoubtedly have a lower total evaluated price, but this price advantage is derived by knowingly violating IRS and DOL rules not to mention possible violations of the FAR’s Limitations on Subcontracting on this 8(a) set aside procurement.

Will the Government deem price proposals incorporating CRNAs hired on a 1099 basis to be unfair and unreasonable?

First Part: No response is required as no question has been asked.

Second Part: Per Addendum to 52.212-2, Evaluation Criteria, Factor 3, Price: A price is reasonable if, in its nature and amount, it does not exceed that which would be incurred by a prudent person in the conduct of competitive business. The Offeror’s Price proposal will be evaluated, using one or more of the price analysis techniques defined in FAR 15.404-1(b)(2), in order to ensure a fair and reasonable price. Some of those techniques are, but not limited to, comparison of proposed prices received in response to the solicitation and/or comparison of proposed prices with the Independent Government Estimate. Price must be determined fair and reasonable.

1.1.3.2 Acceptable Measures CRNAs must have a fill-rate of at least 95% of requested shifts; turnover rate of not more than one (1) person per quarter (3-month period); no more than two substantiated patient complaints in any twelve-month period against any one provider; and no HCP initiated cancellations of treatments except as medically required by patient care.

This does not align with the Performance Requirements Summary in 1.10.

Is a Turnover Rate of 25% (6.25 FTE) acceptable per the PRS or is the acceptable level of performance not more than 1 person per quarter. The latter would require a Turnover Rate of 4% or less to be acceptable.

A Turnover Rate of no more than four (4) HCP’s per year and not more than one (1) person per quarter (3-month period) is acceptable.

The PRS of solicitation in Section 1.10, Performance Requirements Summary (PRS) will be corrected by Amendment 0001 and posted on www.fbo.gov.

1.1.3.2 Acceptable Measures CRNAs must have a fill-rate of at least 95% of requested shifts; turnover rate of not more than one (1) person per quarter (3-month period); no more than two substantiated patient complaints in any twelve-month period against any one provider; and no HCP initiated cancellations of treatments except as medically required by patient care.

This does not align with the Performance Requirements Summary in 1.10.

Is a Complaint Rate of 25% acceptable per the PRS or is the acceptable level of performance not more than 2 complaints per provider each year?

A Complaint Rate of no more than two (2) substantiated patient complaints in any twelve-month period against any one provider.

The PRS of solicitation in Section 1.10, Performance Requirements Summary (PRS) will be corrected by Amendment 0001 and posted on www.fbo.gov.

1.1.3.2

PERFORMANCE

Not medically directed. CRNA’s are expected to administer all induction agents and manage cases independently through the perioperative phase.

· Thoracic Anesthesia __________

· Cardiac Anesthesia __________

· Major Vascular Anesthesia ________

· Obstetric Anesthesia__________

· Pediatric Anesthesia__________

· Neuroanesthesia__________

· Trauma Anesthesia__________

· Critical Care Medicine__________

· Anesthesia for Outpatient Surgery__________

· Office-based Anesthesia__________

· Regional Anesthesia__________

· Preop Screening Clinic__________

· Orthopedic Anesthesia__________

· Acute Pain Service__________

· Other ------ Please describe__________

•Thoracic Anesthesia-Sometimes

•Cardiac Anesthesia-Rarely

•Major Vascular Anesthesia-Usually

•Obstetric Anesthesia-always/usually

•Pediatric Anesthesia-sometimes

•Neuroanesthesia-always

•Trauma Anesthesia-always

•Critical Care Medicine-never

•Anesthesia for Outpatient Surgery-always

•Office-based Anesthesia-never

•Regional Anesthesia-usually

•Preop Screening Clinic-always

•Orthopedic Anesthesia-always

•Acute Pain Service-sometimes

•Other -Please describe:

•Cardiac Cath Clinic-always, •Pulmonary clinic-always

•Radiology MRI-always

•GI clinic-always

•Rad oncology-always (but rare cases)

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