A06__0040567766_PWS_Updated_May_17_2022_-_Final_0001.pdf

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Attachment 1 - Performance Work Statement

Medical Clinic Operations

Part 1 - GENERAL

a. Purpose

This performance-based work statement sets forth the services to be performed with performance standards and performance measures through the quantities, limits or areas applying to the operation of the Medical Clinics located in Mammoth Hot Springs, Lake and Old Faithful areas of Yellowstone

National Park. The distance from Mammoth Hot Springs to the nearest medical facilities outside the park would be 61 miles to Livingston, MT; from Lake Yellowstone area, 69 miles to Cody, WY; and from Old

Faithful, 82 miles to Big Sky, MT. Primary goals of the Yellowstone Medical Clinics operation include providing local residents, employees, and visitors with year-round access to primary, urgent, preventative and employment related health care and supporting the operation of the National Park Service's

Yellowstone National Park Office of Emergency Services.

Nonpersonal Healthcare Services – This contract is a nonpersonal services contract, as defined in 37.101, under which the contractor is an independent contractor;

The Government may evaluate the quality of professional and administrative services provided, but retains no control over the medical professional aspects of services rendered (e.g., professional judgments, diagnosis for specific medical treatment);

The contractor is required to indemnify the Government for any liability producing act or omission by the contractor, its employees and agents occurring during contract performance;

The contractor is required to maintain medical liability insurance, in a coverage amount acceptable to the contracting officer, which is not less than the amount normally prevailing within the local community for the medical specialty concerned; and

The contractor is required to ensure that its subcontracts for provisions of health care services contain the requirements of the clause at 52.237-7, including the maintenance of medical liability insurance.

b. Objectives

Provide high quality primary, urgent and preventative care, including telehealth mental health services, to

Yellowstone National Park's visitors and the local community.

Support the National Park Service's Yellowstone National Park Office of Emergency Services.

Support Yellowstone National Park's overall operations by providing high quality employment-related health care to employees of the National Park Service and other local employers.

Ensure the operation meets all state federal and local regulations and licensing requirements and that the clinic operates in accordance with general industry standards and best practices.

Provide all services at reasonable and affordable rates.

Accept a broad range of insurance and provide reasonable methods for patients without insurance to pay for services, including Yellowstone National Park's foreign visitors.

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Collect healthcare-related debts from all patients who are able to pay in accordance with general industry standards and best practices.

Provide efficient and complete pharmacy services year-round in Mammoth Hot Springs.

c. Background

The National Park Service preserves unimpaired the natural and cultural resources and values of the

National Park System for the enjoyment, education and inspiration of this and future generations. The

National Park Service cooperates with partners to extend the benefits of natural and cultural resource conservation and outdoor recreation throughout this country and the world. For more information on

Yellowstone National Park, please visit the park’s website at: https://www.nps.gov/yell/index.htm.

National Park Service policy requires Yellowstone National Park to make reasonable efforts to provide appropriate emergency medical services to persons who become ill or are injured while visiting the park.

Yellowstone is one of the most remote locations in the 48 contiguous states. Distances from park interior locations to medical facilities outside of the park can exceed 100 miles. The park experiences more than

4 million annual visits, most of which are concentrated in the summer season. High elevation, combined with the potential for severe weather, creates a challenging environment for transporting people in need of medical attention. The strategic locations of the park’s medical clinics shorten transport time to critical care and contribute to more positive outcomes. In addition, growing numbers of cars, vans and buses in the park have increased the potential for mass casualty events. In recent years, directly because of proximity, the clinics and their highly trained staff have played key roles in ensuring positive outcomes for visitors involved in such incidents.

The clinics also play a key role in providing essential medical services to hundreds of NPS and thousands of concessions and contractor employees. In addition, the dispersed geographic locations of the clinics enable the park to more effectively monitor and manage disease outbreaks, providing park management with real time disease trend data.

d. Park Visitation and Community Population

Visitation

Total visitation at Yellowstone National Park over the past ten years has fluctuated, with strong increases to record high visitation levels in 2015 and 2016. Overall, Park visitation grew at an average annual rate of 2.8 percent from 2010 to 2019.

The graph below displays the total number of visitors to Yellowstone National Park from 2010 through

2020. While the COVID-19 pandemic drove a decrease from 2019 to 2020, visitation has rebounded to record levels in 2021.

https://www.nps.gov/yell/index.htm

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3,640,185

3,394,326 3,447,729

3,188,030

3,513,484

4,097,710

4,257,177

4,116,524 4,115,000 4,020,288

3,806,305

2,500,000

2,700,000

2,900,000

3,100,000

3,300,000

3,500,000

3,700,000

3,900,000

4,100,000

4,300,000

4,500,000

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Yellowstone Recreational Visits

Community Population

Yellowstone National Park is in the northwest corner of Wyoming with portions extending into southwestern Montana and southeastern Idaho. Communities around the park include:

Community Location Population

Cooke City, Montana 4 Miles From the park’s Northeast Entrance 63

Gardiner, Montana At the park’s North Entrance 879

West Yellowstone, Montana At the park’s West Entrance 1,376

Cody, Wyoming 53 Miles From the park’s East Entrance 9,744

Jackson, Wyoming 64 Miles From the park’s South Entrance 10,659

Livingston, Montana 56 Miles From the park’s North Entrance 7,893

Bozeman, Montana 82 Miles From the park’s North Entrance 53,323

e. Partnership

The Contractor and the National Park Service will work as partners to be flexible and to provide the best and most efficient services possible while working within the framework of this contract. The National

Park Service encourages the Contractor to make suggestions for operational improvements and will respond to requests for modification. The Clinic Manager is a key member of the Yellowstone National

Park community and is required to attend and participate in meetings pertaining to park operations when directed by the National Park Service.

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f. Current Operational Conditions

Medical Clinic Statistics

2017 2018 2019* 2020* 2021

Breakout by visits - visitors 53% 53% 34% 25% 33%

Breakout by visits - employees 47% 47% 66% 75% 67%

By Employers

Delaware North 5% 4% 6% 6% 6%

Medcor/YPSS/Contractors 1% 3% 5% 5%

National Park Service 12% 11% 21% 30% 30%

Xanterra 27% 31% 67% 54% 55%

Community of Gardiner, MT 2% 1% 3% 5% 4%

Total Clinic visits 6,729 7,920 7,800 4,400* 7,012

*In 2019, operator notes a different reporting system was initiated. Prior to 2019, when a patient had a follow up visit for something they were being treated for it was not counted as another clinic visit. In 2019, it was determined that, clinically, the follow up visits should be captured as a new visit.

*2020 – Due to Covid park was closed for a period of time. Covid operations throughout the year impacted employee numbers, total visitation, etc. - reflected in total clinic visits.

PART 2 - DEFINITIONS AND ACRONYMS

The following terms, when used in this contract, will be construed and/or interpreted as follows, unless the context expressly requires a different construction and/or interpretation. In the event of a conflict in language between the Definitions and other sections of this contract, the language in specifications will govern.

AQL - Acceptable Quality Level - The maximum percent of defective work that can be considered satisfactory on the average. Considered the allowable leeway or variance from a standard before the

Government will reject the specific service.

CO - Contracting Officer - means a person with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings.

COR - Contracting Officer's Representative - an individual, including a contracting officer’s representative (COR), designated, and authorized in writing by the contracting officer to perform specific technical or administrative functions.

DOI - Department of the Interior

FAR - Federal Acquisition Regulation

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HIPAA - Health Insurance Portability and Accountability Act of 1996

Marketing - Any activity conducted by, or on behalf of, the contractor where information regarding the services offered by the contractor is disseminated in order to persuade eligible persons to enroll or accept any application for enrollment in the contractor's plan operated pursuant to this contract.

Medical Record or Electronic Medical Record - A single, complete electronic record (CPRS) maintained by the contractor's staff on site, which documents all of the treatment plans developed, identifies problem list, and medical services ordered and received by the patient.

Primary Care - Health care provided by a medical professional (as a general practitioner or a pediatrician) with whom a patient has initial contact and by whom the patient may be referred to a specialist for further treatment

Primary Care Provider - A primary care physician or registered Advanced Practice Nurse, Nurse

Practitioner or Physician Assistant practicing in accordance with Wyoming State law, who is responsible for supervising, coordinating, and providing initial and primary care to patients, initiating referrals for specialist care, and maintaining the continuity of patient care.

Prior Authorization - The act of authorizing specific services or activities before they are either rendered or occur.

PI - Performance Improvement - The ongoing process of responding to data gathered through quality monitoring efforts, in such a way as to improve the quality of healthcare delivered to individuals. This process necessarily involves follow-up studies of the measures taken to improve clinical activities in order to demonstrate that the desired change has occurred.

PRS - Performance Requirements Summary - The PRS shows the contract requirements, the component requirements related to each contract requirement, may show the price of each work requirement as a percentage of the associated contract requirement (fixed price contract), the standard of performance, and the acceptable quality level (AQL).

Performance Standard - An acknowledged measure of comparison.

QASP - Quality Assurance Surveillance Plan - An organized written document used by Government for quality assurance surveillance. Document contains sampling/evaluation guides, checklists, and the performance requirement summary (PRS).

QA - Quality Assurance - The management of the service quality and responsiveness by the Contractor and starts with the early stages of quality development and runs through every phase to contract close-out.

This generally refers to post-award surveillance of the Contractor's work.

QM - Quality Monitoring - The ongoing process of assuring that the delivery of healthcare is appropriate, timely, accessible, available, medically necessary, and in keeping with established guidelines and standards and reflective of the current state of medical knowledge.

Subcontractor - Any organization or person who provides any function or service for the contractor specifically related to securing or fulfilling the contractor's obligations.

Surveillance - The process of monitoring, either by direct evaluation, observation, or other information sources, of Contractor performance.

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Urgent Care - Health care provided by a medical professional (as a general practitioner or a pediatrician) with whom a patient has initial contact and by whom the patient may be referred to a specialist for further treatment

USPHS - United States Public Health Service

PART 3 – GOVERNMENT- FURNISHED PROPERTY & SERVICES

a. General Information

The National Park Service will furnish clinic facilities and limited equipment to be used by the Contractor to provide work under this contract. The National Park Service may also permit the contractor to use a limited number of housing units. See Section 3.d below.

b. Equipment

See attached property list. The Contractor shall cooperate to accomplish an inventory of government furnished equipment as determined necessary by the National Park Service.

The Contractor must provide all other equipment necessary to provide the required services under this contract.

c. Facilities

At no cost to the Contractor, the National Park Service will:

Provide the use of the existing clinic facilities, which consist of:

1. Mammoth Clinic, building #557, FMSS #14444, 3,299 square feet;

2. Lake Clinic, building # LA00712, FMSS #14259, 9,834 square feet; and

3. Old Faithful Clinic, FMSS #03YPMS920, 2,484 square feet.

Provide water, sewer, and general trash pick-up (not to include medical waste or hazardous material) at all

Clinic facilities. The Contractor is responsible for managing its medical and/or hazardous waste and its disposal. The Contractor is also responsible for working directly with the provider for all other utility services, including, but not limited to electricity, phones, and internet. The Contractor or its employees are responsible for applicable rent and the cost of utilities associated with park housing. For reference and planning purposes see attachment #5 for the current housing units and associated rental costs assigned to the current medical services provider:

Provide snow removal in the parking areas, drop off lanes and roads leading up to the clinics. The

Contractor is responsible for removing snow from the roofs, entrances, porches, and walkways of its assigned facilities. The Contractor will manage ice on walkways for safety. The NPS must approve any chemical used for removing ice in advance of its use.

Provide lawn and landscaping maintenance for the Mammoth clinic.

If clinic facility rehabilitations are deemed necessary by the NPS, the clinic operator will cooperate to facilitate the work. The Service anticipates minimal / limited impact to operations during any renovation or rehabilitation activity.

Provide component renewal, recurring maintenance, and major repairs to the assigned facilities.

Component renewal, recurring maintenance and major repair include the planned replacement of a component at the end of its useful life. Component renewal examples include the following:

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• replacement of foundations, building frames, window frames, windows, doors, sheathing, subfloors, drainage and roofs;

• replacement of building systems such as electrical distribution systems, built-in heating and cooling systems, and plumbing systems; and

• the rehabilitation of components of facilities.

Recurring maintenance includes planned work activities to sustain the useful life of an asset or component that reoccur on a periodic cycle of greater than one year. Typical recurring maintenance projects include, but are not limited to, painting, replacement of carpeting and refinishing hardwood floors.

If the repair is the responsibility of the National Park Service, the clinic manager will submit a work order through the COR.

The Contractor shall provide janitorial services and be responsible for maintaining the clinic facility in a neat and orderly condition, so that the clinic is clean, safe, free of fire hazards, and meets all applicable standards for a health clinic operating in the state of Wyoming.

The Contractor is responsible for all facility operations of the assigned clinics. Facility operations include, but are not limited to the following:

• Normal or routine cyclic or preventive maintenance.

• Cleaning of sink traps.

• Replacement and repair of light fixtures and replacement of light bulbs.

• Replacement of rubber gaskets and other small parts of valves and replacement and repair of plumbing fixtures.

• Normal roof upkeep, such as repair of minor leaks, cleaning of rain gutters, and removal of accumulated debris that might trap water.

• Spot painting of areas chipped through daily use.

• Cleaning or servicing of equipment.

• Daily janitorial activities.

• Litter removal.

• Snow removal from all sidewalks associated with the clinic facilities.

• Maintenance of furnishings.

d. Housing

In its sole discretion, the National Park Service may permit the Contractor to use available housing for use by Contractor employees at various locations within the Mammoth Hot Springs, Lake, and Old Faithful areas. Housing provided by the National Park Service may include single family homes, apartment style units, or trailer sites appropriate for travel trailers or fifth-wheel trailers. See attached list of employee housing and rents assigned to the current clinic provider. The park intends to provide equivalent housing units for use by Clinic employees but may substitute substantially similar units within the same developed area as conditions require. The following table indicates the current assigned units and applicable monthly rent rates. Annual government housing rate assessments and subsequent increases or decreases will be applied to all units occupied by the Contractor in the same manor applied to government employees in park housing.

If the National Park Service permits trailer sites appropriate for travel trailers or fifth wheel trailers, the

Contractor or its employees are responsible for providing all travel trailers or fifth wheel trailers. The

Attachment 1 8 of 25 contractor is also responsible to provide and maintain backflow prevention devices to prevent cross connection contamination.

The Contractor and its employees must comply with any rules for management and operation of trailer sites and housing in Yellowstone National Park. The Yellowstone National Park Housing Initiative may require tenants to move to different quarters to complete upgrades and repairs as necessary. All terms and conditions of the Employee Housing Manual (see attached) apply. Tenants are given 30 days’ notice of relocation requirements.

The Contractor may use housing provided by the National Park Service only as residences for its employees and their immediate families or other personnel who are performing work under this contract.

To provide the adequate staffing necessary to conduct the required operations, the Contractor may need to hire more staff than the housing provided by the National Park Service can accommodate. The Contractor is responsible for providing adequate staffing to deliver the required operations regardless of whether the housing provided by the National Park Service is sufficient. The Contractor or its employees are responsible for the payment of the cost of additional housing to the provider. Additional housing and trailer sites may be available within the park for rent from the park Concessioners or outside the park between the gateway community of Gardiner, MT (approximately 5 miles from Mammoth Hot Springs) and Livingston, MT (approximately 50 miles from the North Entrance).

PART 4 - CONTRACTOR FURNISHED ITEMS & SERVICES

a. General Information & Service

Contractor Services

(a) Medical Services – General

i. The Contractor is responsible for fully operating the three Yellowstone Medical Clinics by providing high-quality, affordable primary healthcare, urgent healthcare, preventative healthcare and employment-related healthcare to the local community, employers, concessioner and other employees, and visitors to Yellowstone National

Park. The Contractor is responsible for working with the National Park Service to support the operations of the National Park Service Office of Emergency Services. The

Contractor is responsible for providing a basic diagnostic lab, Point of Care Testing and Ultrasound, and for providing basic pharmacy services. The Contractor must ensure that all aspects of the Yellowstone Medical Clinics operate in accordance with all applicable federal, state, and local regulations and licensing requirements and in accordance with general industry standards and best practices.

(b) Support of National Park Service Branch of Emergency Services

i. The Contractor will work with the Office of Emergency Services to establish general guidelines for appropriate times of day and/or communication consults with the

Contractor for situations in which Yellowstone EMS Providers are considering ambulance transport of patients to the clinic after the clinic’s scheduled closing time.

ii. While rare, an unusually high number of near simultaneous field incidents or severe weather events can exhaust or limit the transport capability of local EMS agencies. A willingness of the Contractor to accept ambulance transported patients right up to the scheduled clinic closing time in these rare instances will be required.

iii. The Contractor must cooperate with the National Park Service Office of Emergency

Services to plan for mass casualty incidents and/or other disasters that may limit or overwhelm the ambulance transport capability of the area. The Contractor will be

Attachment 1 9 of 25 required to perform additional duties in the event of a mass casualty incident or disaster.

(c) Collaboration with United States Public Health Services

i. The Contractor must cooperate with representatives from United States Public Health

Service working at Yellowstone National Park. At the discretion of the National Park

Service, the Contractor will be required to participate in a United States Public Health

Service illness reporting program.

(d) Employment-Related Health Care

i. During all hours of operation, the Contractor must provide the staff, equipment and supplies required to perform employment-related health care, including, but not limited to, pre-employment physicals and screening, scheduled and random toxicology screening, Department of Transportation physicals, post-accident screening, respirator protection fit-test physicals, and worker compensation related healthcare.

ii. The Contractor must collaborate with local employers to provide employment-related healthcare and must provide employment-related healthcare during all hours of operation on both a walk-in and appointment basis.

iii. Fire Department Physician (from NFPA 1500)

The Mammoth Clinic physician will serve as the official designated physician who shall be responsible for guiding, directing, and advising the members with their health and fitness for various duties.

The fire department physician shall provide medical guidance in the management of the occupational safety, health, and wellness program.

The fire department physician shall be a licensed medical doctor or osteopathic physician qualified to provide professional expertise in the areas of occupational safety and health as they relate to emergency services.

The fire department physician shall be readily available for consultation and to provide professional services on an urgent basis.

(e) Pharmacy Services

i. The Contractor must maintain, on-site at all clinics, all supplies and pharmaceuticals commonly used and necessary to provide primary healthcare, urgent healthcare, preventative healthcare, and employment related healthcare.

ii. All supplies and pharmaceuticals must be stored and maintained in a manner that meets federal, state, and local law and regulations.

(f) Laboratory Services

i. During all hours of operation, the Contractor must maintain a basic laboratory and staff capable of diagnosing common conditions associated with primary healthcare, urgent healthcare, preventative healthcare, and employment-related healthcare.

ii. The Contractor must provide Point of Care testing and Point of Care ultrasound at all clinics during hours of operation.

Minimum Required Testing:

eFast Exam, basic metabolic panel, POC Hemoglobin or POC Hematocrit test, glucose, hemoccult, urine HCG, UA Dip (waived), Rapid Strep A, Rapid Flu

A/B, Rapid Covid-19, and Mono Spot

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iii. The Contractor must provide all laboratory equipment and ensure that the operation and equipment are maintained in a manner that meets federal, state, and local law and regulations.

iv. All Contractor supplied equipment should be up to date and meet general industry standards and best practices.

(g) Ultrasound Services

i. During hours of operation, the Contractor must provide ultrasound services at all clinics, including, but not limited to, provision of on-site staff qualified to operate the ultrasound equipment and on-site or off-site staff qualified to interpret images and provide a diagnosis.

ii. The National Park Serivce will not provide the required equipment.

iii. At its cost, the Contractor must maintain all ultrasound equipment to the standards required by federal, state, and local law and regulations as well as general industry standards and best practices.

iv. The Contractor must operate the ultrasound equipment in accordance with federal, state, and local law and regulations as well as general industry standards and best practices and must maintain all required licenses for the associated equipment and personnel.

(h)X-Ray Services

i. During hours of operation, the Contractor must provide X-Ray services at all clinics, including, but not limited to, provision of on-site staff qualified to operate the X-Ray equipment and on-site or off-site staff qualified to interpret images and provide a diagnosis.

ii. The National Park Service will provide digital X-Ray equipment. See attached property list.

iii. At its cost, the Contractor must maintain all X-Ray equipment to the standards required by federal, state, and local law and regulations as well as general industry standards and best practices.

iv. The Contractor must operate the X-Ray equipment in accordance with federal, state, and local law and regulations as well as general industry standards and best practices and must maintain all required licenses for the associated equipment and personnel.

(i)Telehealth Mental Health Services and Crisis Intervention

i. The Contractor must provide scheduled telehealth mental health services. To promote this service to the Yellowstone community, the Contractor must have a mental health care provider at Yellowstone National Park (in person) at least quarterly and provide telehealth mental health as scheduled during clinic hours. At a minimum, Contractor dedicated staff will travel to the clinic once a month and do the following when at each clinic to promote mental health services:

meet with local businesses, agencies, and organizations through various means, including, but not limited to, human resources departments and staff meetings;

meet with local groups and committees, including, but not limited to, the

Yellowstone Chamber of Commerce and the Yellowstone Health and Wellness

Committee;

look for additional opportunities to provide outreach and advertise available services to the local community, including mental health telehealth and in person consults; and

Attachment 1 11 of 25 create, promote, and implement a quarterly community health education event that covers mental health and health behavior topics by a licensed mental health or primary care provider, as well as promote Contractor programs and services.

ii. The Contractor must also proactively market health services including mental health services through a variety of electronic and print methods, including, but not limited to, newsletters, flyers, and advertisements in the local Yellowstone paper in accordance with Part 5, C.2 of this Performance Work Statement. Promotion of telehealth mental health services must be incorporated into the Contractor’s marketing plan and annual community meeting.

iii. The Contractor will bill for all costs associated with the above services as part of the

Telehealth Mental Health Services. Costs include, but are not limited to, labor, all supplies necessary to perform the tasks, and travel. The contractor shall ensure that no duplicate payments are received for the same service provided.

The Contractor is recognized to not be a crisis mental health agency; however, the Contractor can facilitate linking Yellowstone employers with community and other resources that provide crisis intervention.. This performance work statement (PWS) only covers the cost of facilitating/arranging for this service.

(j)Seasonal Health Care Program (SEHCP) – minimum requirements

The Contractor must provide and administer the Area’s SEHCP program.

i. The program is designed to help seasonal employees pay for their health care while working in Yellowstone National Park. This SEHCP is a preferred program intended to supplement, not replace, other primary insurance that seasonal employees may have. The program is to provide reduced rates for care provided to seasonal employees at park clinics located at Mammoth Hot Springs, Old Faithful and Lake.

ii. Participation is mandatory for all seasonal employees of the concessioners with facilities in the park. It is an optional plan for seasonal Service employees and concession employees who work for concessioners who operate in the park but do not have assigned facilities in the park. Family members are not covered under this plan unless they are employed as a seasonal worker and eligible for this plan under their employment.

iii. The intent of the program is secondary to any other valid insurance that a covered employee is eligible for. The Contractor can file claims for any service provided to covered employees with any applicable health insurance including Medicare, auto medical liability, no-fault auto insurance, Veteran’s Administration disability, or any other third-party insurance carried by the employee.

iv. Employees should expect at a minimum the following services at no expense:

• Follow up treatment by a physician or physician’s assistant at the clinic, as long at the initial treatment occurred at a clinic in the park.

• Blood pressure checks.

• Ground ambulance charges for Yellowstone National Park Ambulances – this does not include any drugs, supplies or procedures that are used or performed during transport.

v. Participants’ expenses are limited for some services such as the following services:

• Outpatient lab, x-ray, pharmacy, supplies, and procedures are provided at a lower rate.

• Initial visit services from a physician or physician’s assistant are provided at a set reduced rate.

NOTE: Reference Attachment 12 – SEHCP and Gap Program Overview for additional information on these revenue sources.

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(k) Authorized Services

• The Contractor may provide additional health related services in support of

Yellowstone National Park's visitors and local community. Additional services could include, but are not limited to, in-person mental health services, physical therapy, dental services, support groups, an after-hours nurse advice line, and specialized services such as women's health or pediatrics. All additional services must be approved by the CO.

Clinic-specific requirements

Old Faithful Medical Facility

• This facility will provide emergency medical services to park visitors, National Park

Service, Concessioner and other employees and residents working and living in the park on a seasonal basis operating from April 15 through October 31.

• The facility will be equipped and have staff trained to appropriately manage cardiac patients including, at a minimum, 12-lead EKG capabilities, and the ability to diagnose, initiate and maintain thrombolytic therapy. Services will include a small laboratory for CLIA waived diagnostic tests, x-rays, ultrasound, and the ability to dispense pharmaceuticals. The staff will be trained to provide routine C-spine evaluations and clearance of C-spine injuries.

• Telehealth Mental Health Services and facilitate Crisis Intervention

Lake Medical Services Facility

• This facility will provide emergency services to park visitors, National Park Service, Concessioner and other employees and residents, as well as routine clinical treatment to patients on a seasonal basis operating from May 15th through October 15.

• The facility will be equipped and have staff trained to appropriately manage cardiac patients including, at a minimum, 12-lead EKG capabilities, and the ability to diagnose, initiate and maintain thrombolytic therapy. Services will include a small laboratory for minimal diagnostic tests, x-rays, ultrasound and the ability to dispense pharmaceuticals.

Mammoth Medical Facility

• This facility will provide emergency services to park visitors, National Park Service, Concessioner and other employees and residents living in the area, as well as routine clinical treatment to patients on a year-round basis.

• Staffing will be adequate to provide for routine clinic appointments, emergencies, x-ray services, ultrasound, pre-employment physicals, Department of Transportation physicals, drug screens, pulmonary function testing, vision and hearing screening and tonometry, diagnostic laboratory services (either through waived testing or reference labs in Montana and Wyoming), and the ability to dispense basic pharmaceutical services for urgent care needs. The facility will be equipped and have staff trained to appropriately manage cardiac patients including, at a minimum, 12-lead EKG capabilities, and the ability to diagnose, initiate and maintain thrombolytic therapy.

Services will include a small laboratory for minimal diagnostic tests, x-rays, ultrasound and the ability to dispense pharmaceuticals. The staff will be trained to provide routine

C-spine evaluations and clearance of C-spine injuries.

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(a) Schedule of Operation

Though generally stated in this section, an annual schedule shall be submitted to the COR by

March 1 from the Contractor for the following spring, summer, and winter operations for each facility. Generally speaking, at Old Faithful and Lake, if lodging facilities are open and operating, location clinics will be open. Mammoth Clinic operates year-round.

Old Faithful Medical Facility

• April 15 through September 15

--Seven days a week, twelve hours a day

--Staffing, at a minimum:

o Physician’s assistant or Nurse Practitioner o Registered nurse

After hours on call for emergencies o Physician’s assistant or Nurse Practitioner o Paramedic or nurse

• September 16 through October 31st

--Seven days a week, eight hours a day

--Staffing, at a minimum:

o Physician’s assistant or Nurse Practitioner o Registered nurse

-- After hours on call for emergencies o Physician’s assistant or Nurse Practitioner o Paramedic or nurse

• December 15 through March 15

One 2-day clinic between Dec 15 to Jan 1

One 2-day clinic between Jan 15 and Feb 1

One 2-day clinic between Feb 15 and March 1

--Staffing, at a minimum:

o Physician’s assistant or Nurse Practitioner o Registered nurse

Lake Medical Facility

• May 15 through September 15

--Seven days a week, twelve hours a day

--Staffing, at a minimum:

o Physician’s assistant or Nurse Practitioner o Registered nurse

-- After hours on call for emergencies

Attachment 1 14 of 25 o Paramedic or nurse

Sept 16 through October 15

-Seven days a week, eight hours a day

--Staffing, at a minimum:

o Physician’s assistant or Nurse Practitioner o Registered nurse

-- After hours on call for emergencies o Paramedic or nurse

Mammoth Medical Facility

• June 1 through September 30

--Open seven days a week, eight hours a day

--Staff, at a minimum:

o Full-time physician o Registered nurse o Billing/Receptionist o Physician’s assistant or Nurse Practitioner and registered nurse for weekend coverage

• October 1 through May 31

--Five days a week, eight hours a day (except Friday: minimum 4 hour day), --Closed Thanksgiving Day, Christmas Day, New Year’s Day.

-- Staff, at a minimum:

o Full time physician o Registered nurse

After Hours Call Out:

INCLUSION CRITERIA

• Chest Pain (suspected cardiac)

• Respiratory distress

• Altered level of consciousness

• Severe allergic reaction

• Uncontrolled, severe pain

• Uncontrolled, significant bleeding

• Shock

• Major trauma

• Mass casualty

• Complications and high-risk subject TASER cases

EXCLUSION CRITERIA

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• Simple alcohol intoxication

• Patient refusing ambulance transport

• N/V dehydration (considering time of day)

• Anything that can wait until clinic opens

• Direct transport to hospital

• Anything non on the inclusion list

• Respiratory distress

• Altered level of consciousness

• Severe allergic reaction

• Uncontrolled, severe pain

• Uncontrolled, significant bleeding

• Shock

• Major trauma

• Mass casualty

• Complications and high-risk subject TASER cases

(b) Operating Dates

• Dates may fluctuate with weather and road conditions. Specific dates of operation will be approved annually by the Superintendent.

• If required when multiple Clinics are open, Clinic closures will stagger to ensure that at least one medical facility is open to provide medical coverage in the park per the schedule of operation listed above..

• After hours, medical calls will be routed through the National Park Service

Communication Center.

(c) Obligation

• The National Park Service approves operating seasons for all facilities and services annually. The Contractor will annually submit, to the COR, a written schedule of proposed opening and closing dates and operating hours for all clinic operations no later than March 1 prior to the operating season for the Superintendent’s approval.

Changes to operating hours and opening and closing dates will be agreed upon and approved by the Superintendent prior to implementation. All services will be open with regular hours of operation during any holidays within the summer operating season; and will be adequate to ensure that visitors are able to obtain medical services.

Personnel must be available for after-hours callout for emergency calls during the summer operating season, in accordance with the after hours callout criteria.

(d) Emergency Medical Services Program Support

• The Contractor will designate an EMS Liaison to serve as the contact with the

Service’s Emergency Medical Services Coordinator.

• The Contractor will work with Emergency Medical Services Program if the established afterhours callout criteria needs to be modified or if there are instances of it being used incorrectly or inappropriately.

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• The Contractor will work in conjunction with the Emergency Services Program in training for mass causality incidents. This training should occur minimally once during the summer operations.

(e) Quality Assurance Program

• The Contractor will provide support to the National Park Service’s emergency personnel establishing continuity of medical services between park staff and the medical clinics. This support would be in the form participation in a Quality

Assurance Program. This will include participation by the Medical Director of the clinics, and appropriate staff having expertise in this area. The Quality Assurance

Program, at a minimum, includes, performance proficiency, authorization standards, transport reviews and documentation, equipment, and vehicle standards.

(f) Emergency Medical Service Ambulances

The National Park Service will provide and staff all park ambulances.

(g) Medical Communication Equipment

• Communication equipment: Contractor shall provide their own equipment (P25

(narrow band) Motorola radio equipment compatible with the park’s radio system. Yellowstone Telecommunications will provide Radio Frequency

Authorizations (RFA) for the use of NPS frequencies and also provide contractor with assistance as needed to communicate on the NPS system (e.g. maps, training modules, and programming assistance).

(h) Emergency Air Transportation

• Air transportation requests must be coordinated through the park.

(i) Employee Assistance Program

• The Contractor will provide initial consultation and assistance to government and

Concessions employees and their families who need counseling; and will provide appropriate referrals as needed.

Personnel

(a) Key Personnel

• Prior to commencement of services under this contract, the Contractor must provide to the National Park Service for its approval the name or names and résumé or résumés of the employee or employees who will perform two primary functions for the performance of the on-site work required under this contract, the

Contractor's Representative, and the Clinic Manager. The tasks may either be performed separately by two individuals or both tasks may be performed by the same individual. The Clinic Manager or Contractor’s Representative must be physically present a minimum of one (1) day per week and must be available by email and phone to provide support of the clinic operations during all other hours.

• Prior to installing a replacement Contractor's Representative or Clinic Manager, the Contractor must submit the employee's résumé to the National Park Service for approval.

i. The Contractor's Representative - The Contractor must provide a Contractor's

Representative who will be the Contractor's primary representative having the Contractor's full authority to act on matters pertaining to the performance of services required under this contract.

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ii. The Contractor's Representative will follow National Park Service procedures for the reporting of accidents and incidents and will ensure that all required reports, deliverables, and bills are submitted to the CO or COR in the timeframe required by the contract.

iii. The Clinic Manager - The Clinic Manager is responsible for the day-to-day operation of the Yellowstone Medical Clinics including the supervision of clinic staff. The Clinic Manager must be assigned to Yellowstone National

Park throughout the year and be on-site at least one (1) day per week. If the

Clinic Manager is not on site, then they must be on-call whenever work is being performed by the Contractor's employees. When the Clinic Manager is or will be unavailable for any reason, the Contractor must promptly notify the COR of the manager’s temporary replacement.

(b) Clinic Staff

i. During all hours of operation, the Contractor will provide sufficient staffing to meet the requirements of this contract and to support the operations of the

National Park Service’s Office of Emergency Services and meet the medical needs of the local community and visiting public. Minimum staffing levels are described above in Part 4: CONTRACTOR FURNISHED ITEMS AND

SERVICES.

ii. Staffing must include a sufficient number of medical practitioners, administration and support staff, janitorial staff+ and laboratory and technical staff for each location.

iii. Qualifications and Training - The Contractor must ensure that all clinic staff have received sufficient training and that their qualifications comply with all federal, state, and local regulations and licensing requirements as well as general industry standards and best practices for all tasks that the employees are required to perform.

iv. Human Health and Safety - The National Park Service retains the right to request documentation from the Contractor that demonstrates it is meeting or exceeding industry standards for occupational health and safety. This could, for example, include a request for employee training records on the safe handling of chemicals in the workplace.

v. Employee Identification and Appearance. At a minimum, the Contractor will issue all employees a photo identification card that includes their name and an expiration date. These identification cards will be collected by the

Contractor upon termination of employment or at the end of the season for seasonal employees. The Contractor will ensure that all employees in direct contact with the public wear uniforms or standardized clothing with a nametag. Employees will be neat and clean in appearance and will project a positive, friendly, helpful attitude and be capable of and willing to answer visitors’ questions and provide visitor assistance.

vi. Park Entrance Passes

a. The Contractor will instruct its permanent and seasonal employees to obtain employee entrance passes from the National Park Service per appropriate channels.

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b. All Park passes remain the property of the U.S. Government and will be surrendered upon termination of employment.

vii. Employee Hiring Procedures

a. Staffing Requirements. All applicable requirements of the U.S.

Department of Labor will be met. Full-time work will be offered whenever possible. Prior to employment, employees will be informed if less than full-time employment may occur during slow periods.

b. Drug-free Environment. The Contractor will maintain a drug-free workplace environment. The Contractor will conduct educational program(s) for its employees to deter substance and alcohol abuse. All employees who either are in safety sensitive positions (e.g., commercial driver’s license holders, certified or licensed medical staff) or in positions where a federal or state law so requires, must participate in a drug-testing program. Should illegal drug use occur, the use and subsequent action taken must be promptly reported by the

Contractor to the Chief Ranger’s Office or to a National Park Service

Law Enforcement Investigator.

c. Background Checks. The Contractor will ensure that comprehensive background checks are performed on all employee hires, to include:

wants/warrants check; criminal history check; federal criminal records check; national multi-jurisdictional database and sexual offender search; social security number trace; and driving history check. No employee will be hired if they show any active wants or warrants

(current fugitive from justice). When the Contractor learns that an employee is the subject of an active warrant, the Contractor will immediately notify the National Park Service Chief Ranger’s Office.

viii. Driver Requirements. Drivers of passenger carrying vehicles will have a valid state operator’s license for the size and class of vehicle being driven. They also must comply with any additional Wyoming requirements for the type of vehicle driven or number of passengers carried.

ix. Training

a. Safety. The Contractor will train its employees annually according to the training requirements in its Risk Management Plan. The

Contractor shall provide a copy of its Risk Management Plan to the

COR annually.

b. Job Training and Orientation. The Contractor will provide appropriate job training to each employee prior to duty assignments and working with the public. The Contractor will provide mandatory employee orientation for all new employees and inform employees of park regulations and requirements that affect their employment and activities while working and residing in the park.

c. Environmental Training. The Contractor will provide environmental training to all employees according to requirements in its

Environmental Management Program. The Contractor shall provide a copy of its Environmental Management Plan to the COR annually.

d. Visitor Information Training. The Contractor will provide visitor information training for all employees who interact with visitors. The

Contractor will cooperate with the National Park Service in providing

Attachment 1 19 of 25 park orientation sessions for its seasonal employees. Programs will include information on National Park Service regulations, policies, and park resources, as well as the Contractor’s expectations, park standards and safety.

x. Licensing

a. The Contractor is required to comply with all federal, state, and local laws and regulations and must maintain all required licenses for all clinic operations, equipment and personnel including, but not limited to those associated with, X-Ray services, laboratory services, pharmacy services and general medical services. The Contractor must provide a copy of all licenses to the CO or COR upon request.

b. The Contractor must inform the CO or COR of any inspection by any regulatory entity within 24 hours after the inspections and must provide the results or any reports generated from the inspection within

24 hours after the results or report are received.

PART 5 - CONTRACTOR ADMINISTRATIVE RESPONSIBILITIES

A) Fire Protection

(1) The National Park Service structural fire department responds to various emergencies and/or disasters. "Emergency or Disaster" means the occurrence or imminent threat of widespread or severe damage, injury, or loss of life or property resulting from any natural or artificial cause, including tornadoes, windstorms, snowstorms, wind-driven water, high water, floods, wave action, earthquakes, landslides, mudslides, volcanic action, fires, explosions, air or water contamination requiring emergency action to avert danger or damage, blight, droughts, infestations, riots, sabotage, hostile military or paramilitary action, disruption of state services, accidents involving radiation byproducts or other hazardous materials, bioterrorism, or incidents involving weapons of mass destruction.

(2) Contractor

• Contractor will designate an individual as the primary contact as liaison between the

Contractor and the National Park Service structural fire department.

• The Contractor will be required to submit a Fire Protection Plan to the CO and or COR for review and approval.

• The Contractor will employ a “no tolerance” policy toward employees found to have tampered with smoke or fire detectors. Such employees will be immediately terminated.

• Fire prevention, protection and suppression will be primary…