PWS_Dental_Support.pdf

FOR OFFICIAL USE ONLY

Performance Work Statement (PWS)

For

Dental Treatment Services

In Support of

Individual Medical Readiness (IMR) And

Fully Medically Ready (FMR), Periodic Health Assessment (PHA), Soldier Readiness Check (SRC), Soldier Readiness Processing (SRP), and

Mobilization Support

PART 1

GENERAL INFORMATION

1. General Information:

1. General: This is a non-personal services contract to provide dental treatment services. The Government shall not exercise any supervision or control over the contract service providers performing the services herein. Such contract service providers shall be accountable solely to the Contractor who, in turn is responsible to the Government.

1.1. Description of Services/Introduction: The Contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and services necessary to perform dental treatment services as defined in this Performance Work Statement except for those items specified as Government furnished property and services. The Contractor shall perform to the standards in this contract.

1.2. Background: Individual Medical Readiness (IMR) and Fully Medically Ready (FMR) are the basic principles of force-sustainment for Army National Guard (ARNG) forces. Dental health is vital for force health protection, and failure to achieve a standard of level of dental health could preclude a Soldier from deploying. Dental Readiness is a command responsibility. The purpose of this Performance Work Statement (PWS) is to cover the various components of IMR/FMR, to include, but not be limited to: annual dental exams, digital bitewings radiographs, digital panoramic radiographs, DENCLASS data entry of all radiographs and dental records, identification and treatment of all Class 3 Soldiers who are able to be treated in a remote treatment setting and are not projected to require follow up dental treatment procedures. The DoD established a uniform dental classification in HA Policy

02-l l, Policy on Standardization of Oral Health and Readiness Classification. The DoD policy requires dental screening examinations and remediation to be accomplished and documented on 90%+ of service members.

Members of the ORARNG shall receive an annual dental screening examination to determine their dental classification. The result of that screening examination shall be entered into the DENCLASS database on the date of examination. The DENCLASS database updates the Army Medical Protection System, MEDPROS. It is essential to provide required dental treatment to ensure the highest Dental Deployable Rate for soldiers.

1.3. Objectives: The purpose is to convert all Soldiers due or identified as needing annual medical, hearing, immunization, and dental readiness services at an event to a medical readiness class of 1 or 2.

1.4. Scope: The objective of this contract is to conduct and complete the requirements of ARNG IMR/FMR dental readiness requirements on all eligible (mobilizing or not) Service Members (SMs) in the ARNG utilizing HIPAA, ADA and OSHA-Compliant Contractor set up in Oregon National Guard Facilities or mobile health facilities.

Dental services shall be performed by Oregon licensed professionals. The Contractor shall be held liable and are responsible for ensuring and verifying the appropriate level of Credentialing /Privileging (Licensure, Diploma, background checks, etc.) for all contract providers in support of any ARNG.

1.5. General Information

1.5.1. Quality Control: The Contractor shall provide a preliminary Quality Control Plan (QCP) with their proposal.

The level of detail, management controls, and processes to ensure responsiveness to corrective actions will be used in evaluating potential Contractors. The QCP shall include a detailed discussion of the steps proposed to ensure quality, adherence to schedule, proactive communication and adherence to budget. The QCP shall include a description of corrective action steps to take should the Contractor performance be substandard. An organizational depiction of the project team and chain(s)-of-command shall also be included in the QCP. The QCP shall be submitted as part of the proposal.

1.5.2. Quality Assurance: The Government shall evaluate the Contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan. This plan is primarily focused on what the Government must do to ensure that the Contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

1.5.3. Hours of Operation: The Contractor is responsible for providing services at the time and location as specified in the exhibits. The exhibits indicate the number of soldiers, services to be provided, location, dates and times. The

Contractor must at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS.

1.5.4. Place of Performance: The work to be performed under this contract will be performed at government facility or site. Conditions may occasionally be austere and the Contractor must be able to perform all the tasks defined in the PWS in a stand-alone environment. Contractor travel will be the sole responsibility of the Contractor and should be included in the price schedule for services.

1.5.5. Security Requirements: Contractors performing work under this contract must maintain a list of all personnel performing services at event for access on government and military facilities.

1.5.6. AT/OPSEC: Contractors require level I OPSEC training and know the MONG Critical Information List (CIL)

IAW AR 530-1. Applicability statement: Contractors must comply with contractually imposed operations security requirements. Also, if Contractors have access to government information they are required to follow the same requirements for protection of sensitive, unclassified government information per Joint Ethics Regulation and Public

Law. Contracts that Require OPSEC Training. Per AR 530-1, Operations Security, new Contractor employees must complete Level I OPSEC training within 30 calendar days of their reporting for duty. All Contractor employees must complete annual OPSEC awareness training.

1.5.7. AT Level 1 Awareness Training (AT): Security Requirements. The Contractor shall comply with all applicable installation/facility access and local security policies and procedures, which may be obtained from the

Contracting Officer’s Representative (COR). The Contractor shall also provide all information required for background checks to meet installation access requirements to be accomplished by installation Provost Marshal

Office, Director of Emergency Services or Security Office. The Contractor shall ensure compliance with all personal identity verification requirements as directed by DOD, HQDA and/or local policy. Should the Force Protection

Condition (FPCON) change, the Government may require changes in Contractor security matters or processes.

1.5.8. AT Level I Training. All Contractor employees, to include subcontractor employees, requiring access Army installations, facilities and controlled access areas shall complete AT Level I awareness training within 30 calendar days after contract start date or effective date of incorporation of this requirement into the contract, whichever is applicable. The Contractor shall submit certificates of completion for each affected Contractor employee and subcontractor employee, to the COR or to the Contracting Officer, if a COR is not assigned, within 30 calendar days after completion of training by all employees and subcontractor personnel. AT level I awareness training is available at the following website: https://atlevel1.dtic.mil/at.

1.5.9. iWATCH Training. The Contractor and all associated sub-contractors shall brief all employees on the local iWATCH program (training standards provided by the requiring activity ATO). This local developed training will be used to inform employees of the types of behavior to watch for and instruct employees to report suspicious activity to the COR. This training shall be completed within 30 calendar days of contract award and within 30 calendar days of new employees commencing performance with the results reported to the COR NLT 5 calendar days after contract award.

1.5.10. Pre‐screen candidates using E‐Verify Program. The Contractor must pre‐screen Candidates using the E‐

Verify Program (http://www.dhs.gov/E‐Verify) website to meet the established employment eligibility requirements.

The vendor must ensure that the candidate has two valid forms of Government issued identification prior to entering the correct information into the E‐Verify system. An initial list of verified/eligible candidates must be provided to the COR no later than 3 business days after the initial contract award. When contracts are with individuals, the individuals will be required to complete a Form I‐9, Employment Eligibility Verification, with the designated

Government representative. This Form will be provided to the Contracting Officer and shall become part of the official contract file.

1.5.11. Protection of Personally Identifiable Information (PII). The Contractor shall protect all PII encountered in the performance of services in accordance with DFARS 224.103 and DoDD 5400.11, Department of Defense

Privacy Program, and DoD 5400.11-R. If a PII breach results from the Contractor’s violation of the aforementioned policies, the Contractor shall bear all notification costs, call-center support costs, and credit monitoring service costs for all individuals who’s PII has been compromised.

1.5.12. Common Access Card (CAC) Requirements: The CAC is the DoD Federal Personal Identity Verification credential. In accordance with Directive Type Memorandum (DTM) 08-003, December 1, 2008, incorporating

Change 5, October 8, 2013, Initial issuance of a CAC requires at a minimum, the completion of FBI fingerprint check with favorable results reflecting "No Record" and submission of a National Agency Check with Inquiries

(NACI) to the Office of Personnel Management (OPM), or a DoD-determined equivalent investigation. The issuance of a CAC will be based on four criteria; (a) eligibility for a CAC; (b) verification of DoD affiliation from an authoritative data source; (c) completion of background vetting requirements according to the Federal

Information Processing Standards Publication 201-1, Personal Identity Verification of Federal Employees and

Contractors, March 2006, and DoD Regulation 5200.2-R, Department of Defense Personnel Security Program, January 1987, and (d) verification of a claimed identity. CAC eligible personnel must be registered in the Defense

Enrollment Eligibility Reporting System (DEERS) through either an authoritative personnel data feed from the appropriate Service or Agency or Trusted Associate Sponsorship System (TASS).

1.5.12.1. HSPD-12 Background Investigation Requirements: The Contractor will ensure CACs are obtained by all contract or subcontract personnel assigned to work on the Government site and by personnel requiring access to a

DoD network (and other eligible populations as specified in DTM-08-003 Attachment 3, paragraph 3a.) are required to, at a minimum, have received a favorable FBI fingerprint check and must have submitted to the OPM a NACI or equivalent/higher investigation. It is the responsibility of the Contractor to ensure all employees requiring an initial background investigation complete a Personnel Security Investigation Portal (PSIP) form at the earliest possible date and that this form is forwarded to the COR immediately. The COR will review the form for completeness and accuracy and forward to the National Guard Bureau Personnel Security manager who will initiate the investigation process via the PSIP. Contractor personnel will then receive two e-mail messages; the first will confirm the request has been received by the Office of Personnel Management, and the second will provide instructions for the completion of the appropriate form via the Electronic Questionnaires for Investigations Processing (e-QIP) system.

Upon completion of the e-QIP questionnaire and submittal of all required documents, including fingerprint card to the security manager, the BI will be initiated. The Contractor shall ensure all instructions regarding background investigation processing, including those provided verbally, by e-mail or via a Government system are complied with immediately. The Contractor is cautioned the entire process from submittal of the PSIP form to return of the

FBI fingerprint check may routinely take from 2-6 weeks and shall factor this lead time into its hiring/placement process. The Contractor shall make all reasonable efforts to ensure Contractor employees meet CAC eligibility standards upon assignment to the contract and shall be held responsible for delays, failure to meet performance requirements or decreases in efficiency in accordance with the applicable inspection clause.

1.5.12.2. Trusted Associate Sponsorship System (TASS): The Contractor is responsible for processing applications for CACs for every Contractor employee who deploys with the military force OR who has need to access any government computer network in accordance with FAR 52.204-9, "Personal Identity Verification of Contractor

Personnel." The Contractor is responsible for managing requests for new or renewal CAC cards in sufficient time to ensure all Contractor employees have them when needed to perform work under this contract. The norm is at least ten calendar days advance notice to the Trusted Agent (TA), unless there are extenuating circumstances approved by the COR or KO. It is recommend a "Corporate Facility Security Officer" (FSO) be designated to serve as your firm's single point of contact for Background Investigation (BI), the TASS application process and other CAC and security related matters. If a FSO is not established, each Contractor employee requiring a CAC will be required to process their own applications. CAC applications shall be processed through the TASS. The Contractor's FSO Or

Contractor employee shall submit requests for a CAC via email to the designated TASS TA before accessing the

TASS website. The TASS TA for this requirement will be:The government will establish a TASS application account for each CAC Request and will provide each Contractor employee a USER ID and Password, via email, to the FSO. The FSO or Contractor employee shall access the TASS account and complete the CAC application

(entering/editing Contractor information as applicable) https://www.dmdc.osd.mil/tass/.

The FSO or Contractor employee will submit completed applications in TASS and will follow up to ensure the TA is processing the request. A CAC cannot be issued without evidence the FSO has initiated a NACI. The government will inform the Contractor's applicant, via email, of one of the following: Approved.* Upon approval, the information is transferred to the Defense Enrollment Eligibility Reporting System (DEERS) database and an email notification is sent to the Contractor with instructions on obtaining their CAC. The Contractor proceeds to a Real-

Time Automated Personnel Identification System (RAPIDS) station (RAPIDS Site Locator:

http://www.dmdc.osd.mil/rsl/). Rejected.* The Government, in separate correspondence, will provide reason(s) for rejection. Returned. Additional information or correction to the application required by the Contractor employee.*The Contractor shall maintain records of all approved and rejected applications. At the RAPIDS station, the RAPIDS Verification Officer will verify the Contractor by SSN and two forms of identification. Identity source

Documents must come from the list of acceptable documents included in Form I-9, OMB No. 115-0136, "Employment Eligibility Verification." Consistent with applicable law, at least one document from the Form I-9 list shall be a valid (unexpired) State or Federal Government-issued picture identification (ID). The Identity documents will be inspected for authenticity and scanned and stored in the DEERS upon issuance of an ID. The photo ID requirement cannot be waived, consistent with applicable statutory requirements. The Verification Officer will capture primary and alternate fingerprints, picture, and updates to DEERS and will then issue a CAC. Issued CACs shall be for a period of performance not longer than three (3) years or the individual's contract end date (inclusive of any options), whichever is earlier. The Contractor shall return issued CAC's to the COR/KO office upon departure or dismissal of each Contractor employee. Obtain a receipt for each card.

1.5.12.3. The Contractor shall register with Army Knowledge Online (AKO) each Contractor employee, including subcontractors, who may be require logical access to a government website, application or network. This can be done by going to: http://www.us.army.mil and register as an "Army Guest," with the sponsor being the COR or a

COR designated individual if the COR is ineligible to Serve as an AKO Sponsor. Note: If an employee of a

Contractor loses the Privilege to access AKO, they lose the ability to renew their CAC. Therefore it is critical

Contractor employees maintain their AKO accounts.

1.5.13. Credentialing and Insurance: The Contractor is responsible for providing the credentialing service to document that medical personnel meet the standards directed by Army Regulation (AR) 40-68. Further, Contractors are required to provide proof of Professional Liability Insurance for all Medical Personnel supporting clinical requirements. Non-clinical personnel may be covered by the Contractor’s General Liability Insurance Policy.

1.5.14. Physical Security: The Contractor shall be responsible for safeguarding all Government information for

Contractor use. At the close of each work period, Government facilities, equipment, and materials shall be secured.

Contractor will be responsible for security of equipment and material uses to complete the PWS.

1.5.15. Special Qualifications: HIPAA Training, MILVAX certified, access and familiarization to MODS, MEDCHART and DOEHRS databases.

1.5.16. Post Award Conference/Periodic Progress Meetings: The Contractor shall attend any post award conference convened by the contracting activity or contract administration office in accordance with Federal Acquisition

Regulation Subpart 42.5. The Contracting Officer, Contracting Officers Representative (COR), and other

Government personnel, as appropriate, may meet periodically with the Contractor to review the Contractor's performance. At these meetings the Contracting Officer or COR will apprise the Contractor of how the Government views the Contractor's performance and the Contractor will apprise the Government of problems, if any, being experienced. Appropriate action shall be taken to resolve outstanding issues. These meetings shall be at no additional cost to the Government.

1.5.17. Key Personnel: The Contractor shall provide personnel qualified, certified and/or licensed in the State services are to be provided in depending on the task order. The follow personnel are considered key personnel by the Government:

1.5.17.1. Contract Manager: The Contractor shall provide a contract manager who shall be responsible for the performance of the work. The name of this person and an alternate who shall act for the Contractor when the manager is absent shall be designated in writing to the Contracting Officer. The contract manager or alternate shall have full authority to act for the Contractor on all contract matters relating to daily operation of this contract. The contract manager or alternate shall be available between the dates/times specified in the task order.

1.5.17.2. Dentist - General

Years of experience in specialty: minimum 1 year experience

Minimum education: Doctor of Dental Surgery (DDS) Degree

Certification/License: active unrestricted state medical license

ACLS: preferred

BCLS: required for state employment

1.5.17.3. Registered Dental Assistant

Years of experience in specialty: minimum 3 year experience

Minimum education: high school diploma, X-ray license

Certification/License: certification preferred, licensed required for state employment

ACLS: preferred

BCLS: required for state employment.

1.5.18. Identification of Contractor Employees: All contract personnel attending meetings, answering Government telephones, and working in other situations where their Contractor status is not obvious to third parties are required to identify themselves as such to avoid creating an impression in the minds of members of the public that they are

Government officials. They must also ensure that all documents or reports produced by Contractors are suitably marked as Contractor products or that Contractor participation is appropriately disclosed

PART 2

DEFINITIONS & ACRONYMS

2. Definitions & Acronyms:

2.1. DEFINITIONS:

2.1.1. CONTRACTOR. A supplier or vendor awarded a contract to provide specific supplies or service to the

Government. The term used in this contract refers to the prime.

2.1.2. CONTRACTING OFFICER. A person with authority to enter into, administer, and or terminate contracts, and make related determinations and findings on behalf of the Government. Note: The only individual who can legally bind the Government.

2.1.3. CONTRACTING OFFICER'S REPRESENTATIVE (COR). An employee of the U.S. Government appointed by the Contracting Officer to administer the contract. Such appointment shall be in writing and shall state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the contract.

2.1.4. DEFECTIVE SERVICE. A service output that does not meet the standard of performance associated with the Performance Work Statement.

2.1.5. DELIVERABLE. Anything that can be physically delivered, but may include non-manufactured things such as meeting minutes or reports.

2.1.6. KEY PERSONNEL. Contractor personnel that are evaluated in a source selection process and that may be required to be used in the performance of a contract by the Key Personnel listed in the PWS. When key personnel are used as an evaluation factor in best value procurement, an offer can be rejected if it does not have a firm commitment from the persons that are listed in the proposal.

2.1.7. PHYSICAL SECURITY. Actions that prevent the loss or damage of Government property.

2.1.8. QUALITY ASSURANCE. The Government procedures to verify that services being performed by the

Contractor are performed according to acceptable standards.

2.1.9. QUALITY ASSURANCE Surveillance Plan (QASP). An organized written document specifying the surveillance methodology to be used for surveillance of Contractor performance.

2.1.10. QUALITY CONTROL. All necessary measures taken by the Contractor to assure that the quality of an end product or service shall meet contract requirements.

2.1.11. SUBCONTRACTOR. One that enters into a contract with a prime Contractor. The Government does not have privities of contract with the subcontractor.

2.1.12. WORK DAY. The number of hours per day the Contractor provides services in accordance with the contract.

2.2. ACRONYMS:

ADCS Army Dental Care System

ADA American Dental Association

ADDR Active Duty Dental Repository

ALARACTS All Army Activities

ACOR Alternate Contracting Officer's Representative

AFARS Army Federal Acquisition Regulation Supplement

AR Army Regulation

ARNG Army National Guard

CAC Common Access Card

CLIA Clinical Laboratory Improvement Amendments

CCE Contracting Center of Excellence

CFR Code of Federal Regulations

CONUS Continental United States (excludes Alaska and Hawaii)

COR Contracting Officer Representative

COTR Contracting Officer's Technical Representative

COTS Commercial-Off-the-Shelf

DA Department of the Army

DD250 Department of Defense Form 250 (Receiving Report)

DD254 Department of Defense Contract Security Requirement List

DENCLASS Dental Classification Application

DENCOM Dental Command

DFARS Defense Federal Acquisition Regulation Supplement

DMDC Defense Manpower Data Center

DOD Department of Defense

DNA Deoxyribonucleic Acid

DOEHRS Defense Occupations and Environmental Health Readiness System

DRC Dental Readiness Classification

DRE Digital Rectal Exam

DTR Dental Treatment Record

FAR Federal Acquisition Regulation

FMR Fully Medically Ready

G6PD Glucose - 6 - Phosphate Dehydrogenate

HCG Human Chorionic Gonadotropin

HIPAA Health Insurance Portability and Accountability Act of 1996

HIV Human Immunodeficiency Virus

HRR Health Readiness Record

IAW In Accordance With

IMR Individual Medical Readiness

ISO Isolation

KO Contracting Officer

MEB Medical Evaluation Board

MEDCOM U.S. Army Medical Command

MEDCHART Medical Electronic Data (for) Care History and Readiness Tracking

MEDPROS Medical Protection System

MMRB Medical MOS Retention Board

MND Medical Non-deployment Module

MWDE MEDPROS Wed Data Entry

MODS Medical Operational Data System

MOS Military Occupational Specialty

MRC Medical Readiness Classification

NGB National Guard Bureau

OCI Organizational Conflict of Interest

OCONUS Outside Continental United States (includes Alaska and Hawaii)

ODC Other Direct Costs

ORARNG Oregon Army National Guard

OSS Office of the State Surgeon

OSHA Occupational Safety and Health Administration

PDHRA Post Deployment Health Reassessment

PEB Physical Evaluation Board

PHA Periodic Health Assessment

PIPO Phase In/Phase Out

POC Point of Contact

PPD Tuberculosis/Tuberculin Skin Test

PPE Personal Protective Equipment

PRS Performance Requirements Summary

PWS Performance Work Statement

QA Quality Assurance

QAP Quality Assurance Program

QASP Quality Assurance Surveillance Plan

QC Quality Control

QCP Quality Control Program

RDA Registered Dental Assistant

RPR Rapid Plasma Reagin

SPRINT Speech in Noise Recognition Test

SRC Soldier Readiness Check

SRP Soldier Readiness Processing

STR Soldier Treatment Record

SOW Statement of Work

TE Technical Exhibit

TITMUS Vision Testing Equipment Manufacturer’s Name

TMC Troop Medical Clinic

PART 3

GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, MATERIALS AND SERVICES

3. Government Furnished:

3.1. Facilities: The Government will coordinate the availability of work space as necessary for the contactor. A government representative will be designated to provide the Contractor access and to secure the facility at the conclusion of each day. Parking will be provided for mobile facilities. No armory, troop medical clinic, or office space will be provided or utilized unless prior approval is received from the Office of the State Surgeon.

3.2. Equipment: The Government will not provide equipment.

3.3. Materials: The Government will not provide materials.

3.4. Services: The Government will provide a pre-event point of contact to coordinate services, an on-site POC to coordinate entry to the facility and assist with providing access to government provided tables, chairs, and spaces to be used when applicable. The Government will also be responsible for packaging and shipping of lab work and/or specimens.

3.5. Utilities: If utilities are furnished the Contractor shall instruct employees in utilities conservation and environmental practices. Trash and hazmat disposal are not provided. Utilities to include water and electricity are not provided for mobile facilities. The Contractor shall be responsible for operating under conditions that preclude the waste of utilities which include turning off the water faucets or valves after using the required amount to accomplish cleaning vehicles and equipment.

PART 4

CONTRACTOR FURNISHED PROPERTY, EQUIPMENT, AND MATERIALS

4. Contractor Furnished:

4.1. General: The Contractor shall furnish all supplies, equipment, facilities and services required to perform work under this contract that are not listed under Section 3 of this PWS. Service operations shall meet all OSHA, HIPPA and Privacy Act standards.

4.2. Property: Generally when mobile facilities are required only parking for those facilities will be available.

4.3. Equipment:

4.3.1. The Contractor shall furnish medical and dental equipment to provide the services to meet the requirements under this PWS.

4.3.2. The Contractor shall have the capability to meet the requirements either with or without government facility space.

4.3.3. Setup of Contractor's equipment is to be completed by 17:00 hours the day prior to event commencement.

Setup of Contractor's equipment is the sole responsibility of the Contractor. Breakdown of the Contractor's equipment is the sole responsibility of the Contractor.

4.3.4. The Contractor must have capability for real-time, point of service DENCLAS. This requires Contractor to have high-speed broadband, bar-code scanning capability and CAC enabled staff.

4.4. Materials: The Contractor shall furnish dental service materials and supplies necessary to meet the requirements under this PWS and which are not listed under Section 3 of this PWS.

PART 5

CONTRACTOR SPECIFIC TASKS & REQUIREMENTS

5. Specific Tasks and Requirements:

5.1. General Requirements:

5.1.1. The Contractor shall provide services for Individual Medical Readiness IAW with AR 40-501 and DoDI

6025.19.

5.1.2. The Office of the State Surgeon will provide rosters prior to each event.

5.1.3. As required, provide timely feedback and work progress/ status of number of examinations completed to the

Office of the State Surgeon's POC (or designated representative) as to timelines or factors that may negatively impact processing the required number of Soldier exams in the number of days allowed for the event.

5.1.4. Provide completion status to Office of the State Surgeon's POC (or designated representative) as to time requirements to complete jobs to insure timely processing.

5.1.5. Contractor must notify the Office of the State Surgeon's POC (or designated representative) at the end of the event.

5.1.6. Contractor shall be licensed on any services rendered and equipment operated during mission.

5.1.7. The Contractor shall be prepared to provide services as indicated in the exhibits.

5.2. Dental Services:

5.2.1. Digital Bitewings, Digital Panoramic Radiographs & Dental Exams: The Contractor shall perform required dental examinations to include digital bitewings and digital panoramic radiographs if clinically indicated in support of the annual dental screenings IAW AR 40-501. The Contractor must use HIPAA, OSHA & ADA Compliant

Mobile Dental Practice or Portable Dental equipment. The Contractor shall have experience in and capability to upload all exam and digital radiographs into the DENCLASS system on-site. The Contractor shall ensure all

Soldiers have a current digital Panoramic Radiograph on file and if missing, the Contractor shall perform new radiographs. Adherence to all OSHA requirements, State and Federal Regulations are mandatory. Film or radiographs will not be accepted.

5.2.2. Diagnostic Services:

D0l20 - Periodic Oral Evaluation

D0l50 - Comprehensive Oral Evaluation

D0330 - Panoramic Film

D0272 - Bitewings-Two Films

D0274 - Bitewings-Four Films

D02201/D0230 - Periapical (limited)

5.2.3. Exam. A periodic oral evaluation shall assess the current state of oral health and risk for future dental disease, as well as assessing general health factors that relate to the treatment of the patient. Personnel performing the dental screening examination have a moral and ethical obligation to inform the Soldier if they observe any sign or symptom for which the Soldier should obtain further evaluation or care. The following measures are required for each periodic oral evaluation:

5.2.3.1. Caries risk assessment - Classify Soldiers as low, moderate or high risk for caries as outlined by the

American Dental Association's 1995 Special Supplement. This assessment will allow the ADCS to identify those at high risk for future disease and appropriately manage their care.

5.2.3.2. Periodontal assessment - Periodontal Screening and Recording (PSR), a screening procedure endorsed by the American Dental Association and the American Academy of Periodontology, should be utilized to determine the need for periodontal treatment.

5.2.3.3. Tobacco risk assessment - Classify Soldiers as a smoker, user of smokeless tobacco or as both.

5.2.3.4. Oral cancer screening - Perform a thorough oral cancer screening on all beneficiaries as part of all annual examinations.

5.2.3.5. Digital radiographs should be taken only for clinical reasons according to FDA guidelines as determined by an ORARNG dentist. Radiographs should be of diagnostic quality, properly identified and dated. A digital panograph is required to be present in dental record and it must be of adequate quality for diagnostic / identification purposes. There is no time requirement on updating panographic radiographs. However, the digital panographic radiograph must adequately represent the current oral condition of the Soldier. Digital radiographs shall be performed on all service members who do not have a digital panograph on file in the DENCLASS system, regardless of when the hardcopy pantograph is dated, or at the discretion of the State Dental Officer.

5.2.4. Each exam shall be entered into the DENCLASS reporting system and annotated on the SF 603 (Health

Record - Dental) and the DA 5570 (Health Questionnaire for Dental Treatment) of the Soldier's dental records.

5.2.5. Electronic entry of data into the DENCLASS database is required on site at the completion of the Dental

Screening mission to include the upload of any radiographs taken during the event to the Active Duty Dental

Repository (ADDR) system.

5.3. Dental Treatment:

5.3.1. Based on National Guard Bureau's national statistics, it is estimated that as a result of dental exams, which will be conducted by ORARNG personnel, 30% of the alerted & eligible Soldiers will be classified as Classification

3, Non-Deployable without Dental Treatment. This means that an estimated 30% of the population of Soldiers will require dental treatment to be raised to a Class 2 Status, or deployable, before their mobilization. The Contractor shall provide dental treatment approved by ORARNG personnel within an OSHA & ADA-Compliant Mobile Dental

Practice at armories and training sites. After each dental examination is complete, the Contractor will make a recommendation based on the authorized dental treatment procedures listed below to convert 30% or more of the contracted population that are eligible per 5.4.2 below with a Dental Readiness Classification (DRC) 3 to DRC 2 or

1 in the event times outlined in the task order. Contractor will attempt to convert as many DRC 3 during the event to provide a greatest number of medical ready Soldiers. Treatment will be provided only when the treatment plan is uploaded and approved in DENCLASS by authorized ORARNG personnel.

5.3.2. Authorized dental procedures:

(a) Restorative Services (provided only to soldiers alerted to an OCONUS mission):

D2140 - Amalgam-One Surface

D2150 - Amalgam-Two Surfaces

D2160 - Amalgam-Three Surfaces

D2161 - Amalgam-Four or More Surfaces

D2330 - Composite-One Surface

D2331 - Composite-Two Surfaces

D2332 - Composite-Three Surfaces

(b) Posterior composites (will be authorized only when a posterior composite is necessary to provide a quality restoration and no other alternative is available):

D2335 - Composite-Four or More Surfaces

D2391 - Composite-One Surface

D2392 - Composite-Two Surfaces

D2393 - Composite-Three Surfaces

D2394 - Composite-Four or More Surfaces

D2931 - Prefabricated Stainless Steel Crown

D2950 - Core Buildup, including any pins

D2954 - Prefabricated Post and Core

(c) Endodontic Services (provided only to soldiers alerted to an OCONUS mission):

D3310 - Anterior Root Canal Therapy

D3320 - Bicuspid Root Canal Therapy

(d) Periodontal Services:

D4355 - Full Mouth Debridement

D4342 - Periodontal Scaling and Root Planning, 1 to 3 teeth per quadrant

Periodontal scaling and root planning is authorized only when a periodontal abscess is present

(e) Prosthodontic Services (provided only to Soldiers alerted to an OCONUS Mission):

D5110 - Complete Denture-Maxillary

D5120 - Complete D e n t u r e -Mandibular

D5211 - Maxillary Partial Denture-Resin Base

D5212 - Mandibular Partial Denture-Resin Base

(f) Oral Surgery Services (provided only to Soldiers alerted to an OCONUS Mission):

D7140 - Extraction, Erupted Tooth or Exposed Root

D7210 - Surgical Removal of Erupted Tooth

D7220 - Removal of Impacted Tooth, Soft Tissue

D7230 - Removal of Impacted Tooth, Partial Bony

D7240 - Removal of Impacted Tooth, Completely Bony

(g) Orthodontic Services (provided only to Soldiers alerted to an OCONUS Mission):

D8680-0rthodontic Retention

(h) The following dental procedures are not authorized:

Bridges and/or implants

Removal of Asymptomatic third molars

Routine Prophylaxis (cleanings)

Restorations for aesthetics only

Restorations for small (non-class 3) caries

Extensive Root plane/scaling

Osseous Surgery

Other diagnostic services

5.3.3. The above listings are guides to assist the State Dental Officer or his/her designee in determining treatment to be authorized. The treatment provided by the ARNG is to get the Soldier from a dental class 3 to a dental class 2 only, Comprehensive Treatment (to DENCLASS I) is not authorized.

5.3.4. The State Dental Officer (or designated representative) will review all dental treatment plan for dental care to insure that the above clinical guidelines are met. Exceptions can be made, but they must be coordinated with the

State Surgeon.

5.3.5. Follow-On Dental and Prescription Services: Contractor shall provide for any appropriate prescription medication or local follow-on services at no cost to the state for any Soldier issues directly related to procedures or treatments performed at an event by the Contractor’s personnel.

5.4. Place of Performance: The place of performance is indicated in each Exhibit.

5.5. Administrative: The Contractor shall ensure that all appropriate DA, DD or SF forms (in accordance with references) are utilized for each service supplied. The forms will be made available through the State Medical or

Detachment office. The Contractor shall provide all documentation concerning medical or dental treatment to the ORARNG.

5.67. Reporting of Services

5.6.1. Contractor will provide a final report at the completion of medical and dental services that contains a detailed account of all service provide to the individual Service Member and totals of each service provided at the event.

Report Summaries can be formatted per the Contractors needs but will contain at a minimum all the following information:

5.6.2. Event Summary Report will include at a minimum the total number of Soldiers that:

• Checked in/out for Dental Exams

• DRC 1

• DRC 2

• DRC 3 (3A/3B)

• 95%+ conversion rates on soldiers identified as needing dental treatment

• Soldiers that received Dental Bitewing X-Rays

• Dental Panograph X-Rays

• DD Form 2813 submitted SM

• Dental Treatments

• Remaining DRC 3A’s/3B’s

5.6.3. Individual Service Member Report will be a by name roster of each service that individual Service Member received , classification of Medical Readiness Classification (MRC) and Dental Readiness Classification. The report will include at a minimum the following information on each Service Member:

• Name (Last, First, MI)

• Full SSN

• Rank

• Dental Exam

• Dental Treatment

• Ending Dental Class after Treatment

• Dental Readiness Classification (DRC)

• Dental X-ray (Panograph)

• Dental X-ray (Bitewing)

• Dental Notes

• Dental Prescriptions

5.7. Contractor Manpower Reporting (CMR)

5.7.1. The Contractor shall report ALL Contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract for the National Guard Bureau via a secure data collection site.

5.7.2. The Contractor shall completely fill in all required data fields using the following web address:

http://www.ecmra.mil/. Reporting inputs shall be for the labor executed during the period of performance during each Government fiscal year (FY), which runs October 1 through September 30. While inputs may be reported any time during the FY, all data shall be reported no later than October 31 of each calendar year, beginning with 2013.

Contractors may direct questions to the help desk at http://www.ecmra.mil

PART 6

APPLICABLE PUBLICATIONS

6. Applicable Publications (Current Editions)

6.1. The Contractor must abide by all applicable regulations, publications, manuals, and local policies and procedures.

AR 40-501 (Standards of Medical Fitness) http://www.usapa.army.mil

AR 40-35 (Dental Readiness & Community Oral Health Prevention) http://www.usapa.army.mil

AR 40-66 (Medical Record Administration and Health Care Documentation) http://www.usapa.army.mil

DoDI 6025.19 (Individual Medical Readiness) http://www.dtic.mil/whs/directives/corres/

Applicable DOD Directives, Instructions, and Publications http://www.dtic.mil/whs/directives/corres/

Applicable Medical & Dental ALARACTS https://www.us.army.mil/suite/page/550282

Applicable MILPER Messages https://perscomnd04.army.mil/milpermsgs.nsf

PART 7

APPENDICES

A. Performance Requirements Summary

B. Deliverables Schedule

APPENDIX A

Performance Requirements Summary

The Contractor service requirements are summarized into performance objectives that relate directly to mission essential items. The performance threshold briefly describes the minimum acceptable levels of service required for each requirement. These thresholds are critical to mission success.

The Contractor service requirements are summarized into performance objectives that relate directly to mission essential items. The performance threshold briefly describes the minimum acceptable levels of service required for each requirement. These thresholds are critical to mission success.

Performance

Objective:

Standard Performance Threshold Method of Surveillance

PRS# 1: Contract shall update DENCLASS for each Service Member

All Bitewing &

Panograph X-rays, DD

Form 603, will be upload into DENCLASS during the event.

Zero deviation from standard.

Case Management/Care

Coordinators will review

DENCLASS for errors or missing documents.

PRS#2: Contractor will convert all DRC 3 to

DRC 2 or 1 within the authorized dental treatment procedures.

All Treatment Plans and

DRC 3 Conversions will be uploaded into

DENCLASS during the event.

Zero deviation from standard. Case Management/Care

Coordinators will review

HRR for errors or missing documents.

APPENDIX B

DELIVERABLES SCHEDULE

Deliverable Frequency # of Copies Medium/Format Submit To

Contractor will provide at the conclusion of onsite services a report summary of all services provided (see paragraph 5.6.2.)

One report will be generated at the conclusion of the event after all services are complete.

1 Copy for the

State Surgeon's

Representative

Digital or Paper

Copies

Contracting

Officer

Representatives or

Case Management

Staff from the

State Surgeon's

Office

Contractor will provide, at the conclusion of onsite services a report summary of all services provided on each individual Service

Member (see paragraph 5.6.3.)

One report will be generated at the conclusion of the event after all services are complete.

1 Copy for the

State Surgeon's

Representative

Digital or Paper

Copies

Contracting

Officer

Representative or

Case Management

Staff from the

State Surgeon's

Office