Statement of Work EMG Studies Contract 1. The Contractor shall provide services of a local Diagnostic Center, Laboratory or Physician's Office to perform EMG/NCV Studies (Electromyography/Nerve Conduction Velocity) off-site, at their facility for eligible veterans as referred by the VA Puget Sound Health Care System (VAPSHCS), Seattle, WA. All beneficiaries referred during this period will be seen at the Contractor's place of business. It is the VA's intention to negotiate and award on a competitive basis under the authority of Title 38 USC Section 8153. 2. TYPE OF CONTRACT: The VA anticipates the award of a fixed price contract for this solicitation for commercial service. VA shall determine (based on an integrated assessment of each offeror's technical and price proposals) the individual proposals judged to be most advantageous to the Government. 3. The contractor's place of business must be located within Pierce County, Washington. The Contractor must possess all licenses, permits, accreditations and certificates as required by law. 4. The Government estimated that approximately two-hundred eighty-eight (288) studies will be referred under this contract. Approximately twenty-two (22) studies are to be performed per week. The quantities listed herein are estimates only and are not to be considered a minimum or maximum. 5. Please provide an all-inclusive rate to include professional and technical component for the CPT code listed. The VA uses the Medicare allowable reimbursement rate as a benchmark. The rates in effect at the time of award will be in effect throughout the contract period. Reimbursement for medically necessary services (CPT codes) not included in the pricing schedule will be paid in accordance with 38CFR17.56. 6. EMG/NCV Studies are to be scheduled and performed within ten (10) business-days of receiving the patient's name. The original test report must be received by the VAPSHCS no later than five (5) business-days after the study is performed. 7. VA Contact: Designated VA employees in Rehabilitation Care Services, VA Puget Sound Health Care System, will coordinate the scheduling of patients with the Contractor during normal working hours. Patients will be identified as an eligible veteran beneficiary through presentation of a Veterans Universal Access ID Card. If additional information is needed or if the patient does not show up for an appointment, the point-of-contact for patient referrals from VAPSHCS, American Lake Division is Epi Frazier, Program Support Assistant, Rehabilitation Care Services, (253)-583-1897. Point-of-contact for patient referrals from VAPSHCS, Seattle Division is Melanie Kriezis, Health Technician, Rehabilitation Care Services, (206) 277-1572. A record keeping system will be established by the Gail Wise, Supervisory Program Support Assistant, Seattle Division, (206) 277-1812, to monitor reporting and ensure compliance with established guidelines. 8. Reports: The Contractor shall provide a transcribed report, by FAX, to (206) 764-2263 at the VAPSHCS within 48 hours of the studies. If an emergent condition exists, Contractor must immediately FAX the report to the VA provider requesting the study. Reports shall be faxed to (206) 764-2263. 9. Report Format Requirements: All reports shall be typed and should include the following: 1) Reason for Consult 2) History & Physical 3) Nerve Conduction Study Data (if performed): include temperature, latencies, amplitudes and conduction velocities as applicable in table format. 4) Electromyography Data (if performed): information should be provided on spontaneous activity and MUAP abnormalities for each muscle tested. 5) Impression 6) Waveform Printouts

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