Page 1 of 106 Page 1 of 106 CONTRACT DESCRIPTION Title of Project: Medical Disability Examinations (MDEs) under Section 504 of the Veterans Benefits Improvements Act of 1996 (Public Law 104 275; 38 U.S.C. 5101) | Region 4 (Pacific) Background: The Department of Veterans Affairs (VA) through the Veterans Benefits Administration (VBA) administers the Compensation & Pension (C&P) Program for benefits to Veterans, their dependents, and their survivors. Entitlement determinations for disability compensation and pension claims are made by VBA Rating Veterans Service Representatives (RVSRs) and Decision Review Officers (DROs) working in VA Regional Offices (VAROs) across the country. VA Central Office (VACO) assists the VAROs. An MDE is a critical piece of evidence for determining the extent of permanent impairment, and thus the percent of disability that defines the dollar benefit a Veteran is awarded. Because it is so critical, the examination report must be of high quality, providing essential information to support each diagnosed disability. It is not enough to simply state a diagnosis. The examination report must provide detailed findings sufficient for RVSRs and DROs to arrive at a determination that is able to withstand the scrutiny of appellate review. Veterans may appeal disability ratings. MDE's must be sufficiently accurate, thorough, and detailed to answer these challenges. The Contractor therefore shall follow the requirements of the worksheets to ensure that sufficient criteria are met. For the purpose of this PWS, the term worksheet represents a Disability Benefit Questionnaire (DBQ) or Compensation and Pension (i.e., Aid & Attendance; Bones) worksheet in situations where specific DBQs do not exist. VA reserves the right to substitute worksheets or any other system VA may deploy in the future. On October 9, 1996, Congress enacted Public Law 104-275, which authorized VA to contract for medical examinations from non-VA medical sources. The report stated a desire to see the contract medical examination authority expanded and made permanent. A subsequent contract was awarded under the same public law authority. The current contracts provided over 724,000 examination referrals during fiscal year 2017, and each referral, on average, results in 2-3 unique examination types, plus additional ancillary diagnostic services and Veteran travel benefits. This contract is anticipated to execute approximately of 7.7 million examination requests over the life of the 10-year contract. VA has a critical requirement for one or more prime contractors with deep and relevant institutional/corporate experience and knowledge to provide the above referenced disability examination services for Veterans through hiring and/or subcontracting with, training, and overseeing a skilled network of licensed examiners. Additionally, the prime contractor(s) shall possess deep and relevant institutional/corporate experience and knowledge in the development and maintenance of an IT network capable of interfacing with various VA systems in order to process incoming examination requests and to transmit examination results and other data back into the VA s systems. Contract Type: This contract is a Firm Fixed-Price, Indefinite Delivery, Indefinite Quantity (IDIQ) contract, under FAR 16.202. Contract Minimum and Maximum Value: In accordance with FAR 16.504(a)(4)(ii), the guaranteed minimum dollar value for each contract awarded under this solicitation is $3,500,000. The Government anticipates it will order the following maximum quantities of examination requests over the 10-year life of the contract: Region 4 (Pacific): 2.0 Million Exam Requests The actual exam request volume may vary from year to year and depends on many factors, including, but not limited to the following examples: Number of Veterans that file for Disability benefits; Any unexpected increase or decrease in the number of active Servicemembers; New armed conflicts; New conditions being added to those that are eligible for award of benefits; and/or Any significant change in the volume of exams that can be handled internally by VA through VHA exam providers versus contracted exam providers . Period of Performance: The period of performance is a base period of 12 months from the date of award, with nine subsequent 12-month option periods, subject to the availability of funds. Exercise of options will be made at the sole discretion of the Government. If VA chooses not to exercise an option, that shall not be deemed a termination of the contract. Following are the periods of performance: Base Year: November 28, 2018 November 27, 2019 Option Year 1: November 28, 2019 November 27, 2020 Option Year 2: November 28, 2020 November 27, 2021 Option Year 3: November 28, 2021 November 27, 2022 Option Year 4: November 28, 2022 November 27, 2023 Option Year 5: November 28, 2023 November 27, 2024 Option Year 6: November 28, 2024 November 27, 2025 Option Year 7: November 28, 2025 November 27, 2026 Option Year 8: November 28, 2026 November 27, 2027 Option Year 9: November 28, 2027 November 27, 2028 Place of Performance: Performance shall take place at the Contractor s place of business and at the examination provider s place of business. Scope of Work: This contract requires private-sector MDEs on behalf of VA. The Contractor shall provide all resources necessary to accomplish the deliverables described in the PWS, except as may otherwise be specified. The Contractor is to locate, subcontract, and train medical professionals in performing MDEs for Veterans in one or more of four geographic Regions. The Contractor shall document examination findings as provided in this PWS. The geographic area (or VBA Region) to be serviced by this contract includes Region 3 (MidWest). Following are details for each of the various VBA Regions: Page 1 of 106 Page 1 of 106 MDE REGIONS 1-4 Region 1 (Northeast): To include Veterans that reside anywhere within the states of Connecticut, Delaware, Illinois, Indiana, Maine, Massachusetts, Michigan, Missouri, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, and Vermont. The total anticipated volume of examination requests for this region is 1.1 million over the 10-year life of the contract. Disability claims for this region are, primarily, serviced out of the following VA Region Offices, although other VA Region Offices may administer the claim according to VA s National Work Queue program: Page 1 of 106 Page 9 of 106 Page 1 of 106 Hartford, CT Chicago, IL Wilmington, DE Boston, MA Indianapolis, IN Togus, ME Detroit, MI Manchester, NH Newark, NJ Buffalo, NY New York, NY Philadelphia, PA Pittsburgh, PA Providence, RI Cleveland, OH White River Junction, VT St. Louis, MO Page 1 of 106 Page 10 of 106 Page 1 of 106 Region 2 (Southeast): To include Veterans that reside anywhere within the states of Alabama, Arkansas, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia. The total anticipated volume of examination requests for this region is 2.7 million over the 10-year life of the contract. Page 1 of 106 Page 9 of 106 Page 1 of 106 Disability claims for this region are, primarily, serviced out of the following VA Region Offices, although other VA Region Offices may administer the claim according to VA s National Work Queue program: Page 1 of 106 Page 4 of 6 Page 1 of 106 Washington, DC Montgomery, AL Little Rock, AR St. Petersburg, FL Atlanta, GA Louisville, KY New Orleans, LA Baltimore, MD Jackson, MS Winston-Salem, NC Columbia, SC Nashville, TN Roanoke, VA Huntington, WV Page 1 of 106 Page 11 of 106 Page 1 of 106 Region 3 (Midwest): To include Veterans that reside anywhere within the states of Colorado, Iowa, Kansas, Minnesota, Nebraska, North Dakota, Oklahoma, South Dakota, Texas, Wisconsin, and Wyoming. The total anticipated volume of examination requests for this region is 1.9 million over the 10-year life of the contract. Page 1 of 106 Page 4 of 9 Page 1 of 106 Disability claims for this region are, primarily, serviced out of the following VA Region Offices, although other VA Region Offices may administer the claim according to VA s National Work Queue program: Page 1 of 106 Page 1 of 106 Denver, CO Wichita, KS Des Moines, IA St. Paul, MN Lincoln, NE Muskogee, OK Fargo, ND Sioux Falls, SD Waco, TX Houston, TX Milwaukee, WI Cheyenne, WY Page 1 of 106 Page 10 of 106 Page 1 of 106 Region 4 (Pacific): To include Veterans that reside anywhere within the states of Arizona, California, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Alaska, and Hawaii. The total anticipated volume of examination requests for this region is 2.0 million over the 10-year life of the contract. Page 1 of 106 Page 10 of 106 Page 1 of 106 Disability claims for this region are, primarily, serviced out of the following VA Region Offices, although other VA Region Offices may administer the claim according to VA s National Work Queue program: Page 1 of 106 Page 49 of 106 Page 1 of 106 Oakland, CA Los Angeles, CA Phoenix, AZ Seattle, WA Boise, ID Reno, NV Portland, OR San Diego, CA Honolulu, HI Anchorage, AK Salt Lake City, UT Albuquerque, NM Ft. Harrison, MT Page 1 of 106 Page 1 of 106 List of Contract Line Items: LINE ITEM DESCRIPTION UNIT OF ISSUE 0001 General Medical Examination 0001A General Medical - Compensation: Comprehensive General Medical Examination to include a complete base-line exam covering all body parts EA 0001AA Requiring 1-5 DBQs EA 0001AB Requiring 6-10 DBQs EA 0001AC Requiring 11-15 DBQs EA 0001AD Requiring 16 or more DBQs EA 0001B General Medical - Pension EA 0001BA Requiring 1-5 DBQs EA 0001BB Requiring 6-10 DBQs EA 0001BC Requiring 11-15 DBQs EA 0001BD Requiring 16 or more DBQs EA 0001C General Medical - Separation Health Assessment for Shared Examinations for VA/DOD (including BDD, IDES, and Examinations) EA 0001CA Requiring 1-5 DBQs EA 0001CB Requiring 6-10 DBQs EA 0001CC Requiring 11-15 DBQs EA 0001CD Requiring 16 or more DBQs EA 0001D Aid and Attendance or Housebound EA 0001DA Requiring 1-5 DBQs EA 0001DB Requiring 6-10 DBQs EA 0001DC Requiring 11-15 DBQs EA 0001DD Requiring 16 or more DBQs EA 0001E Cold Injury Residuals EA 0001F General Medical - Comprehensive Medical Examination to include a Gulf War DBQ EA 0001FA Requiring 1-5 DBQs EA 0001FB Requiring 6-10 DBQs EA 0001FC Requiring 11-15 DBQs EA 0001FD Requiring 16 or more DBQs EA 0001G General Medical - Comprehensive Medical Examination to include a Prisoner of War DBQ EA 0001GA Requiring 1-5 DBQs EA 0001GB Requiring 6-10 DBQs EA 0001GC Requiring 11-15 DBQs EA 0001GD Requiring 16 or more DBQs EA 0002 Musculoskeletal System 0002A Osteomyelitis EA 0002B Arthritis EA 0002C Amputations EA 0002D Shoulder and Arm Conditions EA 0002E Elbow and Forearm Conditions EA 0002F Wrist Conditions EA 0002G Hand and Finger Conditions EA 0002H Back (Thoracolumbar Spine ) Conditions EA 0002I Neck (Cervical Spine) Conditions EA 0002J Hip and Thigh Conditions EA 0002K Knee and Lower Leg Conditions EA 0002L Ankle Conditions EA 0002M Foot Conditions, Including Flatfoot (Pes Planus) EA 0002N Bones EA 0002O Muscle Injuries EA 0003 Organs of Special Sense / Eye 0003A Eye Conditions EA 0004 Impairment of Auditory Acuity/Ear and Other Sense Organs 0004A Hearing Loss and Tinnitus EA 0004B Ear (including vestibular & infectious ) EA 0004C Loss of Sense of Smell and/or Taste (ENT) EA 0005 Infectious Diseases, Immune Disorders and Nutritional Deficiencies 0005A Persian Gulf/Afghanistan Infectious Diseases EA 0005B HIV-Related Illnesses EA 0005C Infectious Diseases (other than HIV-Related Illnesses, Chronic Fatigue Syndrome, or Tuberculosis) EA 0005D Systemic Lupus Erythematosus (SLE) and Other Autoimmune Diseases EA 0005E Nutritional Deficiencies EA 0005F Chronic Fatigue Syndrome (rheumatological) EA 0006 Respiratory System 0006A Sinusitis, Rhinitis, and Other Conditions of the Nose, Throat, Larynx, and Pharynx (ENT) EA 0006B Respiratory Conditions (other than Tuberculosis and Sleep Apnea) EA 0006C Tuberculosis EA 0006D Sleep Apnea EA 0006E Sleep Studies (HSAT) EA 0006F Sleep Studies (PSG & ECG) EA 0007 Cardiovascular System 0007A Heart Conditions (including IHD, Non-IHD, Arrhythmias, Vascular Disease and Cardiac Surgery) EA 0007B Artery and Vein Conditions (Vascular Diseases including Varicose Veins) EA 0007C Hypertension EA 0008 Digestive System 0008A Esophageal Disorders (including GERD, Hiatal Hernia and Other Esophageal Disorders) EA 0008B Gallbladder and Pancreas Conditions EA 0008C Intestinal Conditions (other than Surgical or Infectious), including Irritable Bowel Syndrome, Crohn's Disease, Ulcerative Colitis and Diverticulitis EA 0008D Intestinal Surgery (Bowel Resection, Colostomy, Illiostomy) EA 0008E (Hepatitis, Cirrhosis, and other) Liver Conditions EA 0008F Peritoneal Adhesions EA 0008G Stomach and Duodenum Conditions (not including GERD or Esophageal Disorders) EA 0008H Infectious Intestinal Disorders (including Bacterial and Parasitic Infections) EA 0008I Hernias (including Abdominal, Inguinal and Femoral Hernias) surgical EA 0008J Rectum and Anus Conditions (including Hemorrhoids) EA 0009 Genitourinary System 0009A Kidney Conditions EA 0009B Urinary Tract (including Bladder and Urethra ) Conditions (excluding Male reproductive System) EA 0009C Prostate Cancer EA 0009D Male Reproductive Organ Conditions EA 0010 Gynecological Conditions and Disorders of the Breast 0010A Gynecological Conditions EA 0010B Breast Conditions and Disorders EA 0011 Hemic and Lymphatic Systems 0011A (Hairy Cell and Other B-Cell) Leukemia EA 0011B Hematologic and Lymphatic Conditions, including Leukemia EA 0012 Skin (Derm) 0012A Skin Diseases EA 0012B Scars/Disfigurement EA 0013 Endocrine System 0013A Diabetes Mellitus EA 0013B Endocrine Diseases (other than Thyroid and Parathyroid, or Diabetes Mellitus) EA 0013C Thyroid and Parathyroid Conditions EA 0014 Neurological Conditions and Convulsive Disorders 0014A Central Nervous System and Neuromuscular Diseases (except TBI, ALS, PD, MS, Headaches, TMJ, Epilepsy, Narcolepsy, Peripheral Nerves, Sleep Apnea, Cranial Nerves, Fibromyalgia, and CFS) EA 0014B Parkinson's Disease EA 0014C Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease) EA 0014D Diabetic Sensory-Motor Peripheral Neuropathy EA 0014E Narcolepsy EA 0014F Fibromyalgia EA 0014G Headaches (including Migraine Headaches) EA 0014H Multiple Sclerosis (MS) EA 0014I Initial Evaluation of Residuals of Traumatic Brain Injury (I-TBI) EA 0014J Review Evaluation of Residuals of Traumatic Brain Injury (R-TBI) EA 0014K Cranial Nerve Conditions EA 0014L Peripheral Nerve Conditions (not including Diabetic Sensory-Motor Peripheral Neuropathy) EA 0014M Seizure Disorders (epilepsy) EA 0015 Mental Disorders 0015A Mental Disorders (other than PTSD) EA 0015B Mental Disorders (other than PTSD) - Telehealth examination EA 0015C Initial Post Traumatic Stress Disorders (PTSD) EA 0015D Initial Post Traumatic Stress Disorders (PTSD) - Telehealth examination EA 0015E Review Post Traumatic Stress Disorders (PTSD) EA 0015F Review Post Traumatic Stress Disorders (PTSD) - Telehealth examination EA 0015G Eating Disorders EA 0015H Eating Disorders - Telehealth examination EA 0016 Dental and Oral Conditions 0016A Oral and Dental Conditions, including Mouth, Lips, and Tongue (other than Temporomandibular Joint Conditions) EA 0016B Temporomandibular Joint (TMJ) Conditions EA 0017 Ancillary Diagnostic Tests (The percentage proposed listed shall be applied to the current National Medicare baseline using the applicable Current Procedural Terminology (CPT) code to determine the unit price at the time of invoice.) 0017A Procedures EA 0017B Tests EA 0017C Laboratory Work EA 0017D X-rays EA 0018 Camp Lejeune Contaminated Water (CLCW) Subject Matter Expert (SME) Opinions 0018A CLCW SME Opinions EA 0019 Record Review Medical File & Medical Opinions 0019A Record Review Medical File ( 3" or >749 pgs) EA 0019CC Record Review Medical File w/ Medical Opinion (> 3" or >749 pgs) EA 0020 No Shows (If Veteran or Servicemember does not appear for appointment or does not contact vendor within the acceptable timeframe to reschedule but does request a rescheduled appointment, No show is charged on initial appointment but at a lower price since administrative prep work is eventually used by examiner) 0020A Complete No Show (Veteran or Servicemember does not appear) EA 0020B Partial No Show (Veteran or Servicemember requests to reschedule appointment within less than 24 hours notice) EA 0021 Deliverables 0021A Detailed PMP (with QAP) and Briefing in accordance with Section 8.6 of the Performance Work Statement (PWS) Not Separately Priced (NSP) 0021B Training Plan in accordance with Section 8.6 of the PWS NSP 0021C Monthly Status Reports in accordance with Section 8.6 of the PWS NSP 0021D Annual Statement of ADA & OSHA Compliance in accordance with Section 8.6 of the PWS NSP 0021E Quarterly Reports of ADA & OSHA Compliance in accordance with Section 8.6 of the PWS NSP 0022 Other 0022A Travel Mileage for examination of Incarcerated or Housebound Veteran Not to Exceed (NTE) 0022B Travel Time for Performing examination of Incarcerated or Housebound Veteran NTE 0022C Monetary Incentive may be awarded quarterly in accordance with Section 12.0 of the PWS Per Quarter 0022D Veteran Mileage Reimbursement 0023 Acceptable Clinical Evidence (ACE) exam Exam Discount Percentage: The listed percentage is the discount to be applied in accordance with PWS Section 10.23 and the performance of ACE qualified examinations. EA