36C26018Q0176-001.docx

Alaska Air Ambulance Transportation Services

CONTRACT PURPOSE: This Performance Work Statement (PWS) defines services to provide Air Ambulance (emergent fixed and rotary wing) transportation services under a fixed price, Indefinite Quantity, Indefinite Delivery (IDIQ) contract for the Alaska VA Healthcare System (AVAHS).

Transportation originates at a hospital in the local area and ends at a medical facility outside the local area. The price should include all legs of transportation including ground ambulance to and from respective airports. The VA estimates that 95% of the trips would be to the Seattle VA Medical Center or Portland VA Medical Center; the rest of the trips will occur to other facilities in those areas.

A.DEFINITIONS:

AIR AMBULANCE: Fixed or rotary wing aircraft with a compartment that is designed and constructed to afford relative safety and comfort and to avoid aggravation of the patient’s condition. The aircraft, compartment, and personnel must meet all applicable federal and state standards for medical air transport.

ALS: Advance Life Support.

AVAHS – Alaska VA Healthcare System: 1201 North Muldoon Road, Anchorage AK 99504.

GROUND AMBULANCE: Vehicles for emergency medical care which provide a driver compartment and a patient compartment that will accommodate an Emergency Medical Technician (EMT), Paramedic (or RN as needed) and two litter patients, so positioned that at least one patient can be given intensive line support during transit; equipment and supplies for emergency care at the scene as well as during transport, and two-way radio communication and equipment for light rescue procedures. The ambulance must be designed and constructed to afford relative safety and comfort and to avoid aggravation of the patient’s condition.

AOD: Administrative Officer of the Day. This government employee is the administrative officer in charge during other than normal business hours.

BLS: Basic Life Support

BLS/With Lift for Power Wheel Chair: Basic Life Support with wheelchair lift and lock downs to transport power wheel chair and stretcher patient.

CCT: Critical Care Transport

CO / Contracting Officer: The person executing this contract on behalf of the Government and the only person authorized to make changes to the contract.

COR / Contracting Officer’s Representative: Person or persons authorized to act for the Contracting Officer within the limits of his / her authority.

FACILITIES OUTSIDE LOCAL AREA: Puget Sound Veterans Affairs Healthcare System (PSVAHCS), Veterans Affairs Portland Healthcare System (VAPORHCS) FEDERAL HOLIDAYS: New Year’s Day, Martin Luther King Jr. Birthday, Presidents Day, Memorial Day, Independence Day, Labor Day, Columbus Day, Veteran’s Day, Thanksgiving Day, Christmas Day, also any day determined by the President of the United States to be a Federal Holiday.

LOCAL FACILITIES: Facilities are defined as AVAHS, Humana Hospital, Joint Base Elmendorf Richardson (JBER) Hospital, Providence Medical Center.

NORMAL BUSINESS HOURS: Normal business hours are defined as Monday thru Friday, 8:00 a.m. to 4:30 p.m. local time.

PSA/HSA: Patient Service Assistant. This term may include Health Service Assistants.

TED STEVENS INTERNATIONAL AIRPORT: 5000 West International Airport Road, Anchorage AK 99502.

TRIP: A trip is defined as the distance, “ONE WAY ONLY,” over which a beneficiary will be transported. For all one-way trips ordered under this contract, the Contractor shall receive the base rate quoted under the “BASE RATE.” The Contractor shall also receive the mileage charge quoted under the “Mileage RATE.”

B. SCHEDULE:

1. The estimated demand for the Air Ambulance is a. Base Year 25 trips (8,000 Miles)

b. Option Year One (1) 30 trips (9,600 Miles)

c. Option Year Two (2) 35 trips (11,200 Miles)

C. COMPLIANCE:

1. All work related to this contract must be performed by the Contractor in accordance with all applicable Federal Aviation Administration (FAA), U.S. Department of Transportation, or Occupational Safety and Health Administration (OSHA) regulations, as well as applicable State health and safety regulations, health care accreditation standards (Joint Commission or equivalent accreditation organization) and standard industry practices as defined by the Association of Air Medical Services for air ambulance transportation.

D. PERSONNEL:

1. The Contractor shall provide the necessary licenses/certificates, competencies, privilege and credentialing in accordance with applicable State(s) and Federal regulation for each employee that will perform services under this contract.

E. RATE:

1. For all one-way trips ordered under this contract, the Contractor shall receive the base rate quoted under the “BASE RATE.” The “BASE RATE” shall constitute full compensation for ONE-WAY trips. The Contractor shall also receive the mileage charge quoted under the “Mileage RATE” for any one-way trip.

F. ORDERS:

1. Authorized AVAHS personnel will place telephone requests (orders) for contract services only with the Contractor’s dispatch office. The request for services shall specify the originating point and final destination. Only such travel is authorized and any costs incurred for unauthorized travel, stops, waiting time, etc. shall be the responsibility of the Contractor. Authorized AVAHS personnel are:

· Travel Clerks – (907) 257-4738

· Infirmary Staff

· Medical Administrative Assistants (MAAs) – (907) 257-5989

· VIRS Coordinators/UR Nurses Administrative Officer of the Day (AOD)

· Purchased Care Manager or designee - (907) 257-3740

· JBER Coordinator – (907) 580-5698

2. For prescheduled pickups, the Contractor shall be required to furnish the ground ambulance within ten (10) minutes of the prearranged time.

3. For unscheduled pickups, the Contractor agrees to have patient(s) transported to the departing airport, prepared, and airborne within 3 hours after the receipt of order or as agreed between the contractor and the authorized AVAHS requestor. If the Contractor identifies they cannot furnish the services within the time required, the Government reserves the right to obtain the necessary services from another source. The Government will be the sole judge in determining when to order services from a different source.

4. In the event of a “NO-SHOW” the Government reserves the right to obtain the necessary services from another source.

G. INSPECTION, QUALITY, AND PERFORMANCE STANDARDS:

1. The Government has the right to inspect the contractor premises, maintenance records of medical equipment and aircraft(s), flight logs, and dispatch records being used, for the contractual services. Furthermore, the contractor shall provide proof of insurance (see paragraph J.4) and copies of any licenses for all staff providing services upon request of the COR (see also paragraph D).

2. The last month of each contract year the Contracting Officer will review contract compliance reports submitted by the COR. The review will employ various monitoring methods, but will specifically include complaints and timeliness.

H. REPORTING RESPONSIBILITIES:

1. The Contractor shall furnish an in-flight medical attendant report of the patient’s status to the receiving facility. The report should include:

• Patient’s full name and social security number (whenever possible) – if not possible, explain the reasons.

• Time picked up.

• Originating and terminating points.

• Who called (initiator).

• Presenting problem.

• Immediate First Aid Measures (bandages, oxygen, restraints, etc)

• State of consciousness.

• Blood pressure.

• Pulse.

• Respiration.

• Any other noted symptoms or pertinent information, including vital signs not already described, level of consciousness, drugs administered, and details of therapeutic intervention.

• Any unusual circumstances encountered during the flight, including but not limited to inordinate altitudes flown, turbulence, and times associated with these conditions.

I. INVOICE PROCEDURES:

1. Invoices shall be submitted (monthly in arrears) no later than fifteen (15) calendar days following the end of the month in which services are rendered. Invoices are to include all contract services furnished for the preceding month. Invoices shall specify the patient name, 4-digit patient identifier, date of service, time of pick-up, whether the trip was “pre-scheduled” or “unscheduled”, pick-up and delivery point, trip number and separate charges (i.e. toll fee, medications, etc.) per trip for which payment is requested. Separate charges must be itemized.

2. All invoices will include a fixed base-rate line item & a mileage rate line item. Each line item shall include rate, quantity, description, and line total.

3. Invoices will be reviewed and reconciled with trip tickets and travel logs. Unauthorized charges will be suspended pending investigation. Unauthorized charges are those that are being disputed or have not been pre-approved by authorized VA personnel. A final determination will be made within 30 days after notifying the Contractor of charges being suspended.

4. All invoices rendered by the Contractor to AVAHS for contract services furnished in accordance with this contract shall be in full. Neither the beneficiary nor any other party shall be required to bear the burden of additional payments, surcharges, tip or other gratuity.

5. Authorized invoices shall be submitted through Tungsten Network (formally OB10) for payments. Invoicing information can be found at http://www.tungsten-network.com/us/en/veterans-affairs-us/.

J. LICENSES, CERTIFICATIONS AND INSURANCE:

1. Air Ambulance Pilot - Shall have a valid operator's license in accordance with Federal, State and local government requirements for their place of operation and for the services they perform.

2. EMTs - Shall be certified, licensed or otherwise officially recognized by the local, state or regional government or public entity where the emergency ambulance service is operated or by which it is governed.

3. Ambulance Driver - Shall have a valid operator's or chauffeur's license in accordance with Federal, State and local government requirements for their place of operation, for the services they perform.

4. Contractor - Shall maintain personal liability, automobile liability, and property damage insurance, as prescribed by the laws of the states of Oregon and Washington.

K. PATIENT PRIVACY AND CONFIDENTIALITY:

All "patient papers" transported with the patient are confidential in accordance with HIPAA. Contractor's personnel may review these records for assessment and treatment purposes only. Appropriate administrative and medical information will be provided to the Contractor for patient transport. If the medical record is transported with the patient, it may be used as a source of information if the situation warrants (i.e. emergent care while in-route). In all other instances, all documents will remain intact and sealed.

(End of Performance Work Statement)