1. CONTRACT ID CODE P AGE OF PAGES AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT J 1 172. AMENDMENT/MODIFICATION NO. 3. EFFECTIVE DATE 4. REQUISITION/P URCHASE REQ. NO. 5. P ROJECT NO.(If applicable)0001 30-Apr-20106. ISSUED BY CODE N62645 7. ADMINISTERED BY (If other than item 6) CODE NAVAL MEDICAL LOGISTICS COMMAND 693 NEIMAN STREET See Item 6 FORT DETRICK MD 217028. NAME AND ADDRESS OF CONT RACT OR (No., Street, County, State and Zip Code) X 9A. AMENDMENT OF SOLICIT AT ION NO. N62645-10-R-0002 X 9B. DAT ED (SEE IT EM 11) 14-Apr-2010 10A. MOD. OF CONT RACT /ORDER NO. 10B. DAT ED (SEE IT EM 13)CODE FACILIT Y CODE 11. T HIS IT EM ONLY APPLIES T O AMENDMENT S OF SOLICIT AT IONS X The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offer is extended, X is not extended. Offer 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 Items 8 and 15, and returning 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 ACKNOWLEDGMENT TO BE RECEIVED AT THE P LACE DESIGNATED FOR THE RECEIP T OF OFFERS PRIOR TO THE HOUR AND DATE SP ECIFIED 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.12. ACCOUNT ING AND APPROPRIAT ION DAT A (If required) 13. T HIS IT EM APPLIES ONLY T O MODIFICAT IONS OF CONT RACT S/ORDERS. IT MODIFIES T HE CONT RACT /ORDER NO. AS DESCRIBED IN IT EM 14. A. T HIS CHANGE ORDER IS ISSUED PURSUANT T O: (Specify authority) T HE CHANGES SET FORT H IN IT EM 14 ARE MADE IN T HE CONT RACT ORDER NO. IN IT EM 10A. B. T HE ABOVE NUMBERED CONT RACT /ORDER IS MODIFIED T O REFLECT T HE ADMINIST RAT IVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORT H IN IT EM 14, PURSUANT T O T HE AUT HORIT Y OF FAR 43.103(B). C. T HIS SUPPLEMENT AL AGREEMENT IS ENT ERED INT O PURSUANT T O AUT HORIT Y OF: D. OT HER (Specify type of modification and authority)E. IMPORT ANT : Contractor is not, is required to sign this document and return copies to the issuing office.14. DESCRIPT ION OF AMENDMENT /MODIFICAT ION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.) The purpose of this amendment is to answ er questions submitted (See Continuation Page) and to add information about the current contract for these services in Amendment AE. The second note in Section A w ill be removed and Section C.2.2 w ill be modified. The dollar threshold for NAICS code 621111 is also corrected in Section K Clause 52.204-8.Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.15A. NAME AND T IT LE OF SIGNER (T ype or print) 16A. NAME AND T IT LE OF CONT RACT ING OFFICER (T ype or print) TEL: EMAIL:15B. CONT RACT OR/OFFEROR 15C. DAT E SIGNED 16B. UNIT ED ST AT ES OF AMERICA 16C. DAT E SIGNED BY 30-Apr-2010 (Signature of person authorized to sign) (Signature of Contracting Officer)EXCEPT ION T O SF 30 30-105-04 ST ANDARD FORM 30 (Rev. 10-83)APPROVED BY OIRM 11-84 Prescribed by GSA FAR (48 CFR) 53.243
N62645-10-R-0002 0001 Page 2 of 17SECTION SF 30 BLOCK 14 CONTINUATION PAGESUMMARY OF CHANGESSECTION SF 30 - BLOCK 14 CONTINUATION PAGEThe following have been added by full text: QUESTIONS AND ANSWERSQuestions and Answers for Pediatric Gastroenterologist Services1. Question: Can you please advise if this solicitation has a set-aside status or is it full and open?Response: This solicitation is not a set-aside. This requirement is solicited under full and open competition.2. Question: Is this a new or follow-on requirement?Response: This is a new contract; however the minimum quantities are currently being performed under contract.See Section J, Attachment AE of the solicitation for details.3. Question: If follow-on, who is the incumbent, and are they eligible to recomplete?Response: See response to Question 2 above. Current contractor pricing can be found in Section J, Attachment AEof the solicitation.4. Question: Can you please provide prior award/expiration dates and value?Response: Current contract expires 30 September 2010. See response to question 2 above for current unit prices.Award value will be determined based on factors in section L of the solicitation with regards to Best Value for theGovernment.5. Question: What is the expected award date?Response: The estimated award date is on or about 29 June 2010.6. Question: Is this requirement a 100% small business set-aside?Response: See response to question 1 above.7. Question: Will the Government consider a change to bi-weekly invoicing?Response: Invoicing is completed utilizing the Wide Area Work Flow (WAWF) system. Thecontractor shall submit invoices for payment every two weeks. The Government will process invoices for paymentevery two weeks. Please refer to Section G of the Request for Proposal (RFP).8. Question: Are there any Government of Contract incumbents? Please provide the billable rates. How manyFTEs are currently being filled by the incumbent?Response: See response to question 2 above. Fill rates are proprietary information.9. Question: Will a maximum total of 5 or 8 physicians be privileged?Response: A maximum total of 5 physicians may be privileged. Refer to Section C.9.1 of the solicitation.
N62645-10-R-0002 0001 Page 3 of 1710. Question: Referencing Section C.5.1.3 and C.5.1.4 “Participate in scheduled meetings” and “Attend annualrenewal of the following Annual Training Requirements”. Will these meetings and training hours be billable to thegovernment? If so will they be scheduled during the Physician’s 520 Regular In Clinic Duty hours or outside of thenormal scheduled work hours?Response: This is part of the normal administrative duties. Refer to billable CLINs in section B.11. Question: Will the government consider taking references for Pediatrician services instead of PediatricSpecialty references?Response: Refer to Section L.2.2.1 of the solicitation. In order to be considered relevant, the services must havebeen provided within the last 5 years. The offeror shall submit information regarding experience performingservices that are relevant to a Pediatric Specialty. The Government will examine the age of the previous/currentcontracts, labor category, the total number of personnel provided, and the clinical settings in which the pastperformance occurred. The offeror may include contracts that demonstrate the prior experience of key personnel orsubcontractors/teaming partners who will be performing in support of the contract resulting from this solicitation;such contracts shall be clearly identified to show the relationship of the past performance entry to the offeror. Theofferor shall describe thoroughly the role and authority the key personnel or subcontractors/teaming partnersexercised in the performance of their contract duties.12. Question: Since you changed the NAICS code from 622110 to 621111, does that also change the requirementyou input regarding Independent contracts? (page 3) In other words, as a Locum Tenens company, can we nowrespond to this bid proposing our Independent Contractors (medical providers) as candidates?Response: The NAICS code does not relate to usage of independent contractors. Refer to Section C.1.2 of thesolicitation.13. Question: In reference to Page 3 of 82 of the solicitation:All our physicians are “independent contractors” not our employees. We do not pay any of their taxes, etc. Am Icorrect in thinking, we will not qualify to submit a proposal for services because of this statement?Response: Section C.2.2 of the solicitation has been modified and this language shall govern determinations forcontract award. Section A has also been modified.14. Question: Further investigation of SOW is indicating that if we get permission from the Contracting Officer, wecould still submit a bid proposal for these services even though our providers would be “independent contractors”.Response: See response to question 13 above.15. Question: Is there an infrastructure already built for this position such as nurses, MA, office space, computers,social workers, triage and dieticians?Response: According to Section B services are provided at Naval Medical Center San Diego where an infrastructureexists. See section C.5 of the solicitation.16. Question: Will they have access to endoscopy needs and referrals?Response: Refer to Section C.5 of the solicitation.17. Question: What is the catchment area that they will be covering?Response: Refer to Section C.1 of the solicitation.18. Question: Is this a new requirement?
N62645-10-R-0002 0001 Page 4 of 17Response: See response to question 2 above.SECTION A - SOLICITATION/CONTRACT FORMThe following have been modified: SECTION AALL OFFERORS PLEASE NOTE:The solicitation and all amendments will be posted to the Naval Medical Logistics Command(NAVMEDLOGCOM) website-http://www.nmlc.med.navy.mil/DBU-RFP.asp It is the offeror’s sole responsibilityto periodically check the web site for amendments and to ensure that all amendments issued prior to the closing dateare acknowledged in accordance with instructions in Block 11 of the SF 30. All proposed prices and supplementalpricing information for all CLINs shall be submitted on the electronic pricing worksheet posted on theNAVMEDLOGCOM website. Please note that any reformatting of the pricing worksheet may cause serious delayin the evaluation process and may result in rejection of the offerors entire proposal. A complete past performanceand business proposal shall be submitted in accordance with Section L. Additionally, see Section K for informationregarding On-line Certification and Representations.Completed Volumes I and II (past performance and business) shall be submitted at the same time to the addressbelow by the closing time and date of 2:00 p.m. local time on 12 May 2010.If any one proposal volume is received past the stated closing date specified in this solicitation, the entire proposalwill be considered late. No further consideration will be given to any offeror who submits any of these volumes lateIAW FAR 15.208(b).Offerors who desire to hand deliver their proposals must submit a request no later than five working days prior tothe anticipated submission date to the email address: Acquisitions@med.navy.mil. Attn: Code 024R. Thecontractor shall provide: 1) Name(s) of point of contact; 2) Phone and Fax Number; 3) Email Address; and 4)Requested Date/Time of Delivery. The contractor can expect confirmation of their request within 3 work days ofreceipt with concurrence of the requested delivery date/time or an alternate delivery date/time. It is the Offeror’sresponsibility to follow-up with NAVMEDLOGCOM if no confirmation is received within 72 hours. Any laterequests for hand delivery will not be honored. The contractor shall be required to make all arrangements for accessto the Fort Detrick military installation. It is the Offerors responsibility to ensure that proposals are delivered by thedue date and time required.The address for proposal submission is:Naval Medical Logistics CommandATTN: Code 024R693 Neiman StreetFort Detrick, MD 21702Telephone: (301) 619-9335Offerors SHALL NOT contact any incumbent health care workers during their official duty hours.Offerors should direct all questions regarding this requirement to the Contract Specialist atAcquisitions@med.navy.mil. ATTN: CODE 024R.In accordance with the Naval Marine Corps Acquisition Regulation Supplement (NMCARS) 5232.903,Responsibilities: For Prompt Payment Act purposes, this contract is subject to the 7 calendar day constructiveacceptance period.
N62645-10-R-0002 0001 Page 5 of 17NAICS stands for North American Industry Classification System. For more information on this, see the U.S.Census Bureau NAICS website http://www.census.gov/epcd/www/naics.html.The NAICS code for this requirement is 621111.Offerors shall propose prices for all of the quantities.NOTE: The blank space contained in Block 12 of the SF 33 should read 120 calendar days.SECTION C - DESCRIPTIONS AND SPECIFICATIONSThe following have been modified: STATEMENT OF WORKNOTE 1: The use of “Commanding Officer” throughout this Section C means: Commander, Naval Medical Center,San Diego, CA, or a designated representative, e.g., Contracting Officer’s Representative (COR) or DepartmentHead.NOTE 2: The term “health care worker” (HCW) refers to the individual(s) providing services under this contract.NOTE 3: The term “contractor” shall mean the offeror identified in block 15A of Standard Form 33 or block 7 onthe Standard Form 26 and its HCWs who are providing services under the contract.NOTE 4: The term MTF refers to the Military Treatment Facility or other Federal Medical Treatment Facility atwhich services are performed.NOTE 5: The term COR refers to the Contracting Officer’s Representative, a government employee appointed inwriting by the Contracting Officer to serve as technical liaison between the government and the contractor.STATEMENT OF WORKC.1. The contractor shall provide, in accordance with this statement of work, comprehensive PediatricGastroenterology physician services within the Naval Medical Center, San Diego, CA.C.1.1. During the term of the contract, contractor services shall be provided for the treatment of active duty militarypersonnel, their dependents, eligible Navy civilian employees, and other eligible beneficiaries designated by theGovernment, in accordance with the terms and conditions of the contract.C.1.2. It is essential that continuity of services be maintained to the maximum degree possible; therefore,substitution of contract HCWs shall be kept to the absolute minimum necessary to perform the services required andto provide adequate back-up personnel. All Physicians, including back-up Physicians, are subject to credentialsreview and privileging prior to performance of services. See Section C.9, Credentialing Requirements, regardinglimitations on the number of physicians providing services under this contract.C.1.3. The services specified in this statement of work shall be performed in accordance with established principlesand ethics of the medical profession. The quality of health care provided will meet or exceed the current recognizedstandards established by the Joint Commission of Accreditation of Health Care Organizations (JCAHO), TheAmerican Hospital Association (AHA), American Medical Association (AMA), and those other professionalassociations that specify standards of performance for the medical profession. In all cases, the dignity of the patient
N62645-10-R-0002 0001 Page 6 of 17will be given the highest regard and the precepts of the American Hospital Association’s “Bill of Rights forPatients" shall be observed.C.1.4. Due to the nature of medical personal services which require Government supervision, the need for HCWaccess to Composite Health Care System (CHCS)/ Armed Force Health Longitudinal Technology Application(AHLTA), and patients that present only at the MTF, the contract does not lend itself to allow HCWs totelecommute.C.2. SUITS ARISING OUT OF MEDICAL MALPRACTICEC.2.1. The HCWs are serving at the MTF under a personal services contract entered into under the authority ofsection 1091 of Title 10, United States Code. Accordingly, section 1089 of Title 10, United States Code shall applyto personal injury lawsuits filed against the HCW(s) based on negligent or wrongful acts or omissions incident toperformance within the scope of this contract.C.2.2. In a similar, but unrelated, personal services acquisition, the Department of Justice determined that healthcare workers performing pursuant to a subcontract were not within the class of individuals protected by 10 USC1089. To insure a different result, the contractor is encouraged to carry all health care workers performing underthis contract as its own employees. However, if the contractor chooses to designate the health care workers as otherthan its employees (i.e., as independent contractors or employees of any tier subcontractor), then, as part of itsresponse to the Request for Proposal (RFP), the contractor must submit a detailed description of the medicalmalpractice insurance covering the acts and omissions of these health care workers. The description must specifythe policy purchaser (individual or subcontractor, for example), coverage limitations, and the designatedbeneficiaries. The contractor may not include the price of medical malpractice insurance as a separately priced lineitem; however, medical malpractice insurance costs may be included in the contractors loaded labor rate.C.2.3. The HCWs are not required to maintain medical malpractice liability insurance. In the event of a claim orlawsuit relating to the HCWs performance of duties under the contract, the parties shall follow the proceduresestablished in SECNAVINST 6300.3A, a copy of which can be viewed at http://doni.daps.dla.mil/.C.2.4. HCWs providing services under the contract shall be rendering personal services to the Government andshall be subject to day-to-day supervision and control by Government personnel. Supervision and control is theprocess by which the individual HCW receives technical guidance, direction, and approval with regard to a task(s)within the requirements of this contract.C.3. DUTY HOURS.C.3.1. The contractor shall provide sufficient personnel to cover the schedule. The contractor shall maintainsufficient back-up personnel to ensure coverage of the schedule during periods of both scheduled and unscheduledabsence.C.3.1.1. Regular In-Clinic Duty. The contractor shall provide a Pediatric Gastroenterologist to provide services inthe Pediatric Clinic 1 day a week for 8.5 hours, with an uncompensated .5-hour meal break. In addition, thecontractor shall provide a Pediatric Gastroenterologist to perform procedures for 4 hours every other week. Thecontractor shall bill separately for services in accordance with the CLIN assigned for Regular In-Clinic Duty inSection B.C.184.108.40.206. Schedules will be coordinated between the Contractor and the Government at least 60 days in advance.C.3.1.2. On-call. On-call services shall be conducted on a 24 hours a day/7 days per week basis. On-call coverageconsists of a pager watch that the MTF can contact to notify the physician to contact and/or report to the MTF. Thecontractor shall bill separately for services in accordance with the CLIN assigned for On-call in Section B.C.220.127.116.11. When the physicians are providing this “on-call” coverage, they shall be available via telephone and/orpager and within 1 hour travel time of the Medical Treatment Facility (MTF).
N62645-10-R-0002 0001 Page 7 of 17C.3.1.3. Call-back. The physician may be required to return to the MTF during “on-call” to attend patients.Historical data indicates that the Pediatric Gastroenterologist may be required to be present at the Naval MedicalCenter in response to a call back a maximum of 48 hours annually. The contractor shall bill in accordance with theCLIN assigned for Call Back Services in Section B.C.18.104.22.168. When determined by the referring/consulting physician that Pediatric Gastroenterology services areneeded on-site, the on-call physician shall arrive at the MTF within 1 hour of notification.C.22.214.171.124. The contractor shall bill the Government for the actual time providing treatment to assigned patients.The contractor shall not bill for time in transit to and from the MTF.C.126.96.36.199. When the physician is called back to the MTF to provide services during on-call service hours, thecontractor shall only bill for call back services The contractor shall not bill for on-call services during this time.C.3.2. The specific coverage schedule for each month will be coordinated with the supervisor 60 days in advance.No services, other than on-call and call-back (as required) services, will be scheduled for the day of observance ofFederal holidays.C.3.3. The active duty Navy Department Head, Pediatrics, or Senior Medical Officer will supervise all HCWs withinthe Pediatrics Department.C.3.4. In the instance where the Government directs the HCW to remain on duty in excess of their scheduled shiftdue to an unforeseen emergency or to complete patient treatment where lack of continuity of care would otherwisejeopardize patient health, the HCW shall remain on duty. The Government will coordinate with the Contractor on acase-by-case basis with the goal of granting an equal amount of compensatory time to the HCW. This provision isnot intended to apply to the time required to complete routine tasks (e.g., completion of paperwork or routineadministrative tasks at the end of a shift) which are to be completed as part of the shift.C.4. ABSENCES AND LEAVEC.4.1. The government is procuring coverage of HCW services; therefore, no personal leave (annual or sick) or paidholiday benefit will accrue to the contractor.C.4.2. Administrative Leave. For unusual and compelling circumstances (e.g., weather emergencies) in which theCommanding Officer either excuses all facility personnel from reporting to work or dismisses all personnel early,the Commanding Officer is authorized to grant administrative leave to the HCW. This administrative leave may becompensated leave.C.4.3 Furlough. Unless otherwise authorized by a defense appropriations bill, contractors shall not be reimbursedby the Government for services not rendered during a Government furlough. In the event of a GovernmentFurlough, the Commanding Officer will determine which contract employees are considered critical and thereforemust report to work. Contract employees deemed critical shall be compensated for services rendered during afurlough. All other contract employees shall be furloughed until the Government shutdown ends or they are notifiedby the Contracting Officer’s Representative that they have become critical employees.C.4.4. A HCW with a bona fide medical emergency occurring while on duty or with an on-the-job injury will beprovided medical care until the condition is stabilized. The contractor shall reimburse the Government for allmedical services provided unless the HCW is otherwise entitled to Government medical services.C.4.5. If a HCW becomes ill or is otherwise unable to fulfill his/her obligation to work, he/she shall notify thecontractor who in turn shall notify the COR. The contractor is responsible for replacing a HCW who, for anyreason, misses more than 2 hours of a shift. The HCW must meet the minimum contract qualifications and beapproved for work (i.e., has been credentialed and privileged as appropriate and has satisfactorily completedorientation).
N62645-10-R-0002 0001 Page 8 of 17C.5. GENERAL DUTIES/RESPONSIBILITIES. The HCW shall perform a full range of Pediatric Gastroenterologyservices using government furnished supplies, facilities and equipment within the assigned unit of the MTF. TheHCW’s productivity is expected to be comparable to that of other individuals performing similar services. TheHCWshall perform the following duties:C.5.1. ADMINISTRATIVE DUTIES/REQUIREMENTS.C.5.1.1. Provide training and/or direction as applicable to supporting Government employees (i.e. hospitalcorpsmen, technicians, students) assigned to the HCW during the performance of clinical procedures. Such directionand interaction will adhere to Government and professional clinical standards and accepted clinical protocol.C.5.1.2. Perform necessary administrative duties that include maintaining statistical records of HCW workload.Operate and manipulate automated systems such as CHCS, Ambulatory Data System (ADS), and AHLTA.C.5.1.3. Participate in scheduled meetings to review and evaluate the care provided to patients, identifyopportunities to improve the care delivered, and recommend corrective action when problems exist. Participate inclinical staff quality assurance and Risk Management (RM) functions and Process Action Teams, as prescribed bythe MTF Commander or designee. Participate in peer review and performance improvement activities.C.5.1.4. Attend annual renewal of the following Annual Training Requirements: family advocacy, disaster training,Sexual Harassment, and other courses as directed.C.5.1.5. Participate in the implementation of the Family Advocacy Program as directed.C.5.1.6. Comply with the HIPAA (Health Insurance Portability and Accountability Act) privacy and securitypolicies of the treatment facility. Providers shall obtain/maintain a National Provider Identifier (NPI) in accordancewith DOD and MTF policy/instruction as applicable.C.5.1.7. Perform technical duties including, but not limited to, providing input in the evaluation for the procurementof equipment and software.C.5.1.8. Complete continuing education to meet own professional growth and specialty standards. Maintain anawareness of responsibility and accountability for own professional practice.C.5.1.9. Demonstrate effective and professional communication methods, and skills, using lines of authorityappropriately. Demonstrate appropriate delegation of tasks and duties in the direction and coordination of healthcare team members, patient care, and clinic activities.C.5.2. CLINICAL DUTIES/RESPONSIBILITIES:C.5.2.1. Perform a full range of Pediatric Gastroenterology services in accordance with clinical privileges granted bythe commanding officer. Provide comprehensive care and treatment for all types of pediatric gastroenterologyproblems. Contribute to health care system and clinical environment to achieve quality services and positive patientoutcomes.C.5.2.2. Comply with the standards of the Joint Commission, applicable provisions of law and the rules andregulations of any and all governmental authorities pertaining to licensure and regulation of health care personneland medical treatment facilities, the regulations and standards of medical practice of the MTF and the bylaws of thehospitals medical staff. Adhere to and comply with all Department of the Navy, Bureau of Medicine and Surgery,Department of Defense and local Hospital/Clinic instructions and notices that may be in effect during the term of thecontract.C.5.2.3. Apply broad-based knowledge of acute and chronic diseases of the digestive system (esophagus, stomach,intestines, liver, and pancreas) and nutritional disorders that affect pediatric patients.
N62645-10-R-0002 0001 Page 9 of 17C.5.2.4. Competently perform the following procedures: diagnostic and therapeutic upper gastrointestinalendoscopy, percutaneous endoscopic gastrostomy tube placement, diagnostic and therapeutic flexiblesigmoidoscopy, diagnostic and therapeutic colonoscopy, percutaneous liver biopsy, rectal biopsy, anorectalmanometry, esophageal manometry, esophageal pH monitoring, breath hydrogen analysis, and establishment andmaintenance of parenteral and enteral nutrition.C.5.2.5. Prescribe and dispense medications as delineated by the Pharmacy and Therapeutics Committee.C.5.2.6. Review and co-sign charts of patients who have received consultative care from Nurse Practitioners.C.5.2.7. Comply with command infection control guidelines; practice universal precautions.C.5.2.8. Demonstrate awareness of legal issues in all aspects of patient care and unit function and strive to managesituations in a reduced risk manner. Demonstrate awareness and sensitivity to patient/significant others rights, asidentified within the institution. Serve as a patient advocate, maintain patients’ right to confidentiality, and provideeffective patient education. Promote preventive and health maintenance care and positive health behaviors througheducation and counseling.C.5.2.9. Support the development of academic and research activities within the department including mentoringresidents in research projects.C.5.2.10. Assist in directing the thorough instruction of residents and/or students in a specialty area in accordancewith the Accreditation Council for Graduate Medical Education (ACGME) and appropriate certifying board and/orsubspecialty board guidelines. This would include ensuring the up-to-date practice of that specialty within thedepartment, adherence to applicable professional practice standards and the development of appropriate protocols.C.5.2.11. Provide, and participate in, in-service training to hospital staff members at interdepartmental conferences,tumor boards, etc. Provide educational and CME lectures for residents and staff on a regular basis (frequency oflectures to be determined by the department chairman), and mentor and teach residents, fellows, colleagues, medicalstudents and interns.C.6. FAILURE AND/OR INABILITY TO PERFORMC.6.1. If clinical privileges of a HCW have been summarily suspended or are being held in abeyance (perBUMEDINST 6320.66E (or latest version)), pending an investigation into questions of professional ethics orconduct, performance under the contract may be suspended until clinical privileges are reinstated. Noreimbursement shall be made and no other compensation shall accrue to the contractor for the affected HCW so longas performance is suspended or clinical privileges are held in abeyance. The denial, suspension, limitation, orrevocation of clinical privileges based upon practitioner impairment or misconduct will be reported to theappropriate licensing authorities of the state in which the license is held IAW BUMEDINST 6320.66E (or latestversion) and BUMEDINST 6320.67A CH01.C.6.2. Any HCW demonstrating impaired judgment will be removed from providing health care services. TheGovernment reserves the right to remove any HCW who, in the judgment of a licensed physician, is impaired bydrugs or alcohol.C.6.3. Any HCW with alcohol or drug abuse problems may be allowed to return to work under the terms of thiscontract only with prior Government approval.C.6.4. This contract is voidable at the option of the Government if the contractor fails to provide the physicalcertifications as outlined in paragraph C.11.1.C.7. GENERAL REQUIREMENTS.
N62645-10-R-0002 0001 Page 10 of 17C.7.1. HCWs shall comply with Executive Order 12731, October 17, 1990 (55 Fed. Reg. 42547), Principles ofEthical Conduct for Government Officers and Employees, and shall also comply with Department of Defense (DoD)and Department of the Navy (DON) regulations implementing this Executive Order.C.7.2. HCWs shall become acquainted with and obey all station regulations, shall perform in a manner to precludethe waste of utilities, and shall not use Government resources (i.e. telephone, fax machine, computers, copiers, etc.)for personal business. All motor vehicles operated on these installations by HCWs shall be registered with the basesecurity service according to applicable directives. Eating by HCWs is prohibited in patient care areas/clinics and isrestricted to designated areas. Smoking is prohibited in all clinic facilities.C.7.3. Except as provided in this clause and in section H, HCWs are not prohibited from conducting a privatepractice of their professions or from engaging in other employment. However, the HCWs shall not, simultaneouslywith performance under the contract, engage in other employment that creates a conflict of interest, violates federallaw (see Section H), or potentially compromises the quality of their work under the contract. Further, such privatepractice or other employment shall not be conducted during those hours in which the HCW is required to renderservices under the contract. HCWs shall make no use of the Government facilities or property provided under thecontract in connection with other employment. [NAVMED P-117, Chapter 1, Article 1-22 and BUMED notice6000 apply http://www.med.navy.mil/directives/Pages/NAVMEDP-MANMED.aspxC.7.4. While on duty, HCWs shall not advise, recommend, or suggest to individuals authorized to receive servicesat Government expense that such individuals should receive services from the HCW when they are not on duty, orfrom a partner or group associated in practice with the contractor, except with the express written consent of theCommanding Officer. The contractor shall not bill individuals entitled to those services rendered pursuant to thiscontract.C.7.5. HCWs shall be neat, clean, well groomed, and in appropriate clothing when in patient care and public areas.All clothing shall be free of visible dirt and stains, and shall fit correctly. Fingernails shall be clean and free fromdirt and hair shall be neatly trimmed and combed. HCWs shall display an identification badge, which includes theHCW’s full name and professional status (furnished by the Government) on the right breast of the outer clothing.Security badges provided by the Government shall be worn when on duty.C.7.6. The Secretary of the Navy has determined that the illegal possession or use of drugs and paraphernalia in amilitary setting contributes directly to military drug abuse and undermines Command efforts to eliminate drug abuseamong military personnel. The policy of the Department of the Navy (including the Marine Corps) is to deter anddetect drug offenses on military installations. Measures to be taken to identify drug offenses on militaryinstallations, and to prevent introduction of illegal drugs and paraphernalia, include routine random inspection ofvehicles while entering or leaving, with drug detection dogs when available, and random inspection of personalpossessions on entry or exit. If there is probable cause to believe that a HCW has been engaged in use, possession,or trafficking of drugs, the HCW may be detained for a limited period of time until he/she can be removed from theinstallation or turned over to local law enforcement personnel having jurisdiction. When illegal drugs arediscovered in the course of an inspection or search of a vehicle operated by a HCW, the HCW and vehicle may bedetained for a reasonable period of time necessary to surrender the individual and vehicle to appropriate civil lawenforcement personnel. Action may be taken to suspend, revoke, or deny clinical privileges as well as installationdriving privileges. Implicit with the acceptance of this contract is the agreement by the HCW to comply with allFederal and State laws as well as regulations issued by the Commander of the military installation concerning illegaldrugs and paraphernalia.C.7.7. All financial, statistical, personnel, and technical data which are furnished, produced or otherwise availableto the contractor during the performance of this contract are considered confidential business information and shallnot be used for purposes other than performance of work under this contract. Such data shall not be released by thecontractor without prior written consent of the COR. Any presentation of any statistical or analytical materials, orany reports based on information obtained from studies covered by this contract, will be subject to review andapproval by the COR before publication or dissemination.
N62645-10-R-0002 0001 Page 11 of 17C.7.8. HCWs shall read, write, speak, and understand the English language fluently and maintain goodcommunication skills with patients and other health care personnel.C.7.9. HCWs shall be physically capable of standing and/or sitting for extended periods of time and capable ofnormal ambulation.C.7.10. HCWs providing services under the contract shall arrive for each scheduled shift in a well-rested conditionand shall have had at least 6 hours of rest from all other duties as a HCW immediately prior to reporting for the shift.C.7.11. In order to carry out the duties required by the contract, all HCWs will be required to access Navyinformation technology networks/systems containing sensitive information. Only HCWs who are U.S. citizens canbe granted access to Department of Navy (DON) Information Technology networks/systems and sensitiveinformation (see Section H, Information Technology/Sensitive Information Security Requirements and AttachmentAA Citizenship Requirements).C.7.12. HCWs shall be in good standing, and under no restrictions, with the state licensure board in any state inwhich a license is held or has been held within the last 10 years.C.7.13. HCWs shall represent an acceptable malpractice risk to the Government.C.7.14. The contractor and all HCWs shall comply with all MTF checkout processes. These processes includereturning government property, i.e., identification badges, pagers, cellular phones, etc., to the MTF upon a HCW’slast day of service. Failure to do so promptly may result in delay of payment to the contractor.C.7.15. The Contractor shall comply with all applicable Federal, State, and local laws and MTF instructions andpolicies.C.7.16. Contractor staff shall participate in executing the Emergency Preparedness Plan (drills and actualemergencies) as scheduled by the MTF (typically semiannually). An MTF personnel re-call list with personalcontact information for all military, civil service and contractor staff is required to prepare in advance for an actualemergency. Upon commencement of performance, the contractor shall provide the COR with a list of personalcontact information for a designated contractor representative as well as all contractor staff performing services.The contractor shall provide an updated list to the COR bimonthly. Should an emergency occur that will affect theHCWs’ shifts, the designated contractor representative and the HCWs will be contacted.C.8. SPECIFIC QUALIFICATIONS.C.8.1. Possess a Doctorate Degree in Medicine from an accredited college approved by the Liaison Committee onMedical Education and Hospitals of the American Medical Association, a Doctorate Degree in Osteopathy from acollege accredited by the American Osteopathic Association, or permanent certification by the EducationalCommission for Foreign Medical Graduates (ECFMG).C.8.2. Board certification in Pediatrics by the American Board of Pediatrics or the American OsteopathicAssociation.C.8.3. Board certification in Pediatric Gastroenterology by the American Board of Pediatrics.C.8.4. Current, unrestricted license to practice medicine in any one of the fifty States, the District of Columbia, theCommonwealth of Puerto Rico, Guam or the U.S. Virgin Islands.C.8.5. Current certification in Pediatric Advanced Life Support (PALS).C.8.6. Possess 1 year of subspecialty experience after receipt of subspecialty certification.C.8.7. Successfully have completed at least 50 hours of continuing medical education within the last 36 months.
N62645-10-R-0002 0001 Page 12 of 17C.9. CREDENTIALING REQUIREMENTSC.9.1. The Commanding Officer will privilege not more than three (3) physicians to provide regularly scheduledclinic and procedures services. The contractor will be allowed to obtain privileges for a maximum of five (5)physicians to provide on-call/call-back services.C.9.2. Upon award, the HCW shall complete an Individual Credentials File (ICF) prior to performance of services.The completed ICF must be forwarded 30 days prior to performance of duties to the MTFs Medical Staff ServicesProfessional (MSSP). The ICF, maintained at the MTF, contains specific information with regard to qualifyingdegrees and licenses, past professional experience and performance, education and training, health status, andcurrent competence as compared to specialty-specific criteria regarding eligibility for defined scopes of health careservices. BUMED Instruction 6320.66E, Section 4 and Appendices B and R detail the ICF requirements.BUMEDINST 6320.66E is available at http://www.med.navy.mil/directives/Pages/ExternalDirectives.aspx. ClickBUMED Directives, select page 2 of the directives, and scroll down to the instruction number. The instruction isnow contained in several separate files.C.9.3. If during the Governments evaluation of the ICF a negative current clinical competency assessment isdetermined, it will bring the MTF’s consideration of the HCW’s application for credentialing/privileging to animmediate close. Since granting credentialing/privileging is required as a condition of employment under theresulting contract, a negative current clinical assessment will result in the issuance of a contract termination noticeby the contracting officer under the clause at FAR 52.249-12.C.10. ORIENTATION. Each physician shall undergo a Government-provided orientation. Orientation shall takeplace at a mutually agreeable time during the first 30 days immediately following the commencement of service bythe physician. Orientation for the physicians who will provide clinic/on-call services shall be up to 12 hours induration. Orientation for physicians who will provide only on-call services shall be up to 2 hours. Orientation maybe waived for personnel who have previously provided services at NAVMEDCEN San Diego, CA.C.11. REGULATORY COMPLIANCE REQUIREMENTSC.11.1. Within 60 days prior to performance of services by a HCW, the HCW shall obtain, at contractor expense,documentation of required immunizations and physical testing, and a statement from the HCWs licensed medicalpractitioner or a report of a physical examination. The physical examination and immunization documentation shallindicate that the HCW is free from mental or physical impairments that would restrict the HCW from providing theservices described herein. The requirements are provided on the HEALTH EXAMINATION ANDIMMUNIZATION/SCREENING REQUIREMENT FORM, the current version of which is available at:http://www-nmlc.med.navy.mil/handbooks/Physical%20Exam%20and%20Immunization%20Form.pdf. Thecontractor shall always obtain the current version from the web page and shall have the form completed in itsentirety in accordance with its instructions. The facility shall identify any incumbent HCWs who are not required tocomplete this documentation after contract award. Declinations shall only be permitted based on either the HCW’sreligious convictions or medical contraindications (as documented by a qualified health care provider). TheHepatitis B vaccine declination can be found on the World Wide Web at http://www.osha.gov/SLTC/etools/hospital/hazards/bbp/declination.html.C.11.1.1. Except for those workers who decline Hepatitis B vaccine as given above, the Hepatitis B requirementsgiven in the HEALTH EXAMINATION AND IMMUNIZATION/SCREENING REQUIREMENT FORM providethat a HCW must either show a positive titer or demonstrate persistent non-response to the vaccine. A HCW may beapproved for service at the MTF prior to achieving a Hepatitis B positive titer or demonstrating a persistent non-response according to the following provisions:C.188.8.131.52. A HCW must receive the first vaccination of his/her initial vaccination series prior to commencingservice under the contract and must complete the series not later than 6 months after commencing service and, if anegative titer is obtained, must complete the second series within another 6 months; or
N62645-10-R-0002 0001 Page 13 of 17C.184.108.40.206. A HCW who has completed his/her initial series and obtained a negative titer must commence his/hersecond vaccine series prior to commencing service and must complete the second series not later than 6 months aftercommencing service.C.11.1.2. HCWs approved according to the provisions above will be considered persistent non-responders untilthere is evidence to the contrary and will be counseled by a licensed practitioner regarding the implications of non-response.C.11.1.3. If a HCW fails to comply with the applicable schedule above, the contractor shall replace the HCW if sodirected by the Contracting Officer.C.11.2. Except as provided in paragraph C.11.3, below, no medical tests or procedures required by the contract maybe performed in the MTF. Expenses for all required tests and/or procedures shall be borne by the contractor at noadditional expense to the Government.C.11.3. HCWs shall agree to undergo personal health examinations and such other medical and dental examinationsat any time during the term of the contract, as the Commanding Officer may deem necessary for preventivemedicine, medical surveillance, performance improvement, or privileging purposes. These examinations will beprovided by the Government. If the contractor chooses, these examinations may be provided by private physician ordentist, at no expense to the Government.C.11.4. It is essential that HCWs be vaccinated annually against influenza according to BUMED and CDCguidelines aimed at reducing the impact of influenza disease in health care settings. The Government will providethe influenza vaccine free of charge. If the HCW chooses to be immunized by the Government, the HCW shall signa waiver releasing the Government from legal liability in accordance with local procedures and policies.Alternately, the HCW may obtain the vaccine at another facility, with the HCW bearing the total cost, and provideproof of vaccination to the Government. If the HCW declines vaccination, a signed declination form shall beprovided to the Government in accordance with CDC recommendations and MTF policies.C.11.5. HCWs who do not show a positive antibody titer after immunization and appear to have a "non-immune"status must report varicella exposure to the COR. In accordance with CDC Recommendations, such HCWs may beremoved from patient care duties beginning on the tenth day following exposure and remain away from work for themaximum incubation period of varicella (21 days). In this instance all personnel must be replaced during this periodto ensure maintenance of contractually required coverage.C.11.6. On an annual basis, HCWs must provide a current Purified Protein Derivative (PPD) reading or anevaluation if they are a known PPD reactor. The Contractor is responsible for any expenses incurred for requiredtesting.C.11.7. BLOODBORNE PATHOGEN ORIENTATION PROGRAM. HCWs shall participate in the Command’sBloodborne Pathogen Orientation Program. The HCW shall also participate in all required annual training and inperiodic training for all procedures that have the potential for occupational exposure to bloodborne pathogens.C.11.8. MANAGEMENT OF HIV POSITIVE HCWs. HIV positive HCWs will be managed in accordance with thecurrent CDC guidelines and Section 503 of the Rehabilitation Act (29 U.S.C. 793) and its implementing regulations(41 CFR Part 60-741).C.11.9. PREVENTION OF THE TRANSMISSION OF THE HIV VIRUS. HCWs shall comply with the CDC’s“Universal Precautions” for the prevention of the transmission of the HIV virus.C.11.10. MANAGING THE CLINICAL RISK IN THE WORK ENVIRONMENT. The work environmentinherently involves risks typically associated with the performance of clinical procedures. The HCW may beexposed to contagious disease, infections and flying debris, requiring the wearing of personal protection equipmentsuch as scrub attire, gloves, masks, and eye protection.
N62645-10-R-0002 0001 Page 14 of 17SECTION J - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACHMENTSTable of Contents has been deletedThe following have been added by full text: A LIST OF ATTACHMENTSAttachment AA Lists of Acceptable Documents to establish U.S. CitizenshipAttachment AB Contract Administration Plan (CAP)Attachment AC Wage DeterminationAttachment AD Supplemental Pricing Sheet SampleAttachment AE Current Contract Information ATTACHMENT AECurrent Contract N62645-05-C-4163 for Pediatric Gastroenterologist services at Naval Medical Center, San Diego,CA being performed by Children’s Specialist of San Diego.Description POP Unit Price HoursIn-Clinic 1 Oct 09 - 30 Sep 10 $133.73 520On Call 1 Oct 09 - 30 Sep 10 $14.34 8,760Call Back 1 Oct 09 - 30 Sep 10 $14.34 48* The unit prices shown reflect the actual hourly rates in the current task order under which same or similar servicesare being performed at the indicated location. It should not be assumed however, that the task order Statements ofWork (SOWs) from which the hourly rates are taken are identical to the contract requirements identified in SectionC.The following have been deleted: TABLE OF CONTENTSSECTION K - REPRESENTATIONS, CERTIFICATIONS AND OTHER STATEMENTS OF OFFERORSThe following have been modified:52.204-8 ANNUAL REPRESENTATIONS AND CERTIFICATIONS (FEB 2009)(a)(1) The North American Industry Classification System (NAICS) code for this acquisition is 621111.(2) The small business size standard is $7.5 million.
N62645-10-R-0002 0001 Page 15 of 17(3) The small business size standard for a concern which submits an offer in its own name, other than on aconstruction or service contract, but which proposes to furnish a product which it did not itself manufacture, is 500employees.(b)(1) If the clause at 52.204-7, Central Contractor Registration, is included in this solicitation, paragraph (d) of thisprovision applies.(2) If the clause at 52.204-7 is not included in this solicitation, and the offeror is currently registered in CCR, andhas completed the ORCA electronically, the offeror may choose to use paragraph (d) of this provision instead ofcompleting the corresponding individual representations and certifications in the solicitation. The offeror shallindicate which option applies by checking one of the following boxes:(__) Paragraph (d) applies.(__) Paragraph (d) does not apply and the offeror has completed the individual representations and certifications inthe solicitation.(c)(1) The following representations or certifications in ORCA are applicable to this solicitation as indicated:(i) 52.203-2, Certificate of Independent Price Determination. This provision applies to solicitations when a firm-fixed-price contract or fixed-price contract with economic price adjustment is contemplated, unless--(A) The acquisition is to be made under the simplified acquisition procedures in Part 13;(B) The solicitation is a request for technical proposals under two-step sealed bidding procedures; or(C) The solicitation is for utility services for which rates are set by law or regulation.(ii) 52.203-11, Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions. Thisprovision applies to solicitations expected to exceed $100,000.(iii) 52.204-3, Taxpayer Identification. This provision applies to solicitations that do not include the clause at52.204-7, Central Contractor Registration.(iv) 52.204-5, Women-Owned Business (Other Than Small Business).This provision applies to solicitations that--(A) Are not set aside for small business concerns;(B) Exceed the simplified acquisition threshold; and(C) Are for contracts that will be performed in the United States or its outlying areas.(v) 52.209-5, Certification Regarding Responsibility Matters. This provision applies to solicitations where thecontract value is expected to exceed the simplified acquisition threshold.(vi) 52.214-14, Place of Performance--Sealed Bidding. This provision applies to invitations for bids except those inwhich the place of performance is specified by the Government.(vii) 52.215-6, Place of Performance. This provision applies to solicitations unless the place of performance isspecified by the Government.(viii) 52.219-1, Small Business Program Representations (Basic & Alternate I). This provision applies tosolicitations when the contract will be performed in the United States or its outlying areas.(A) The basic provision applies when the solicitations are issued by other than DoD, NASA, and the Coast Guard.
N62645-10-R-0002 0001 Page 16 of 17(B) The provision with its Alternate I applies to solicitations issued by DoD, NASA, or the Coast Guard.(ix) 52.219-2, Equal Low Bids. This provision applies to solicitations when contracting by sealed bidding and thecontract will be performed in the United States or its outlying areas.(x) 52.222-22, Previous Contracts and Compliance Reports. This provision applies to solicitations that include theclause at 52.222-26, Equal Opportunity.(xi) 52.222-25, Affirmative Action Compliance. This provision applies to solicitations, other than those forconstruction, when the solicitation includes the clause at 52.222-26, Equal Opportunity.(xii) 52.222-38, Compliance with Veterans Employment Reporting Requirements. This provision applies tosolicitations when it is anticipated the contract award will exceed the simplified acquisition threshold and thecontract is not for acquisition of commercial items.(xiii) 52.223-1, Biobased Product Certification. This provision applies to solicitations that require the delivery orspecify the use of USDA-designated items; or include the clause at 52.223-2, Affirmative Procurement of BiobasedProducts Under Service and Construction Contracts.(xiv) 52.223-4, Recovered Material Certification. This provision applies to solicitations that are for, or specify theuse of, EPA-designated items.(xv) 52.225-2, Buy American Act Certificate. This provision applies to solicitations containing the clause at52.225-1.(xvi) 52.225-4, Buy American Act--Free Trade Agreements—Israeli Trade Act Certificate. (Basic, Alternate I, andAlternate II) This provision applies to solicitations containing the clause at 52.225-3.(A) If the acquisition value is less than $25,000, the basic provision applies.(B) If the acquisition value is $25,000 or more but is less than $50,000, the provision with its Alternate I applies.(C) If the acquisition value is $50,000 or more but is less than $67,826, the provision with its Alternate II applies.(xvii) 52.225-6, Trade Agreements Certificate. This provision applies to solicitations containing the clause at52.225-5.(xviii) 52.225-20, Prohibition on Conducting Restricted Business Operations in Sudan--Certification.(xix) 52.226-2, Historically Black College or University and Minority Institution Representation. This provisionapplies to--(A) Solicitations for research, studies, supplies, or services of the type normally acquired from higher educationalinstitutions; and(B) For DoD, NASA, and Coast Guard acquisitions, solicitations that contain the clause at 52.219-23, Notice ofPrice Evaluation Adjustment for Small Disadvantaged Business Concerns.(2) The following certifications are applicable as indicated by the Contracting Officer:-------(i) 52.219-19, Small Business Concern Representation for the Small Business Competitiveness DemonstrationProgram.
N62645-10-R-0002 0001 Page 17 of 17------(ii) 52.219-21, Small Business Size Representation for Targeted Industry Categories Under the Small BusinessCompetitiveness Demonstration Program.------(iii) 52.219-22, Small Disadvantaged Business Status.------(A) Basic.------(B) Alternate I.------(iv) 52.222-18, Certification Regarding Knowledge of Child Labor for Listed End Products.------(v) 52.222-48, Exemption from Application of the Service Contract Act to Contracts for Maintenance,Calibration, or Repair of Certain Equipment Certification.------(vi) 52.222-52 Exemption from Application of the Service Contract Act to Contracts for Certain Services--Certification.------(vii) 52.223-9, with its Alternate I, Estimate of Percentage of Recovered Material Content for EPA-DesignatedProducts (Alternate I only).------(viii) 52.223-13, Certification of Toxic Chemical Release Reporting.------(ix) 52.227-6, Royalty Information.------ (A) Basic.------ (B) Alternate I.-------(x) 52.227-15, Representation of Limited Rights Data and Restricted Computer Software.(d) The offeror has completed the annual representations and certifications electronically via the OnlineRepresentations and Certifications Application (ORCA) website at http://orca.bpn.gov. After reviewing the ORCAdatabase information, the offeror verifies by submission of the offer that the representations and certificationscurrently posted electronically that apply to this solicitation as indicated in paragraph (c) of this provision have beenentered or updated within the last 12 months, are current, accurate, complete, and applicable to this solicitation(including the business size standard applicable to the NAICS code referenced for this solicitation), as of the date ofthis offer and are incorporated in this offer by reference (see FAR 4.1201); except for the changes identified below(offeror to insert changes, identifyingchange by clause number, title, date). These amended representation(s) and/orcertification(s) are also incorporated in this offer and are current, accurate, and complete as of the date of this offer.------------------------------------------------------------------------FAR Clause Title Date Change------------------------------------------------------------------------------ ---------- ------ ------------------------------------------------------------------------------Any changes provided by the offeror are applicable to this solicitation only, and do not result in an update to therepresentations and certifications posted on ORCA.(End of Provision)(End of Summary of Changes)