SOW Rev. 11-27-2023.docx

STATEMENT OF WORK

Veterans Affairs Pacific Island Health Care System Air Ambulance Services Rev. November 27, 2023

1.0 General Information: This statement of work defines services to provide Air Ambulance (emergent fixed or rotary wing) transportation services under a requirement, firm fixed price contract for the VA Pacific Islands Health Care System (VAPIHCS) beneficiaries. Transportation originates from Maui, Kauai, Molokai, the Big Island of Hawaii (Hilo and Kona), Lanai, or Niihau and the final destination will be to the VA Pacific Islands Health Care System, Tripler Army Medical Center or to a local hospital within the city of Honolulu, HI. The price should include all legs of transportation including ground ambulance to and from respective airports.

2.0 Definitions:

2.1 14 CFR Part 119: Title 14 of the Code of Federal Regulations Part 119, issued by the Federal Aviation Administration (FAA), prescribes the certification requirements an operator must meet in order to obtain and hold a certificate authorizing operations under Parts 121 or 135 and operation specifications for each kind of operation to be conducted in each class and size of aircraft.

2.2 14 CFR Part 121: Title 14 of the Code of Federal Regulations Part 121, issued by the Federal Aviation Administration (FAA), prescribes operating requirements governing the domestic, flag, and supplemental operations of each person who holds or is required to hold an Air Carrier certificate or operating certificate under Federal Aviation Regulations Part 119.

2.3 14 CFR Part 135: Title 14 of the Code of Federal Regulations Part 135, issued by the Federal Aviation Administration (FAA), prescribes rules governing commuter and on-demand operations of each person who holds or is required to hold an Air Carrier Certificate or Operating Certificate under FAA Part 119.

2.4 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 meet all applicable federal and state standards for medical air transport.

2.5 ALS: Advance Life Support.

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

2.7 BLS: Basic Life Support. Basic Life Support should include wheelchair lift and lock downs to transport power wheel chair and stretcher patients when necessary.

2.8 CCT: Critical Care Transport

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

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

2.11 Federal Acquisition Regulations (FAR): Is established for the codification and publication of uniform policies and procedures for acquisition by all executive agencies. The Federal Acquisition Regulations System consists of the Federal Acquisition Regulation (FAR), which is the primary document, and agency acquisition regulations that implement or supplement the FAR.

2.12 Federal Aviation Regulations (FARs): are rules prescribed by the Federal Aviation Administration (FAA) governing all aviation activities in the United States. The FARs is part of Title 14 of the Code of Federal Regulations (CFR). A wide variety of activities are regulated, such as airplane design, typical airline flights, pilot training activities, hot-air ballooning and even model rocket launches. The rules are designed to promote safe aviation, protecting pilots, passengers and the general public from unnecessary risk. They are also intended to protect the national security of the United States, especially in light of the September 11, 2001 attacks.

2.13 Federal Holidays: New Year’s Day, Martin Luther King Jr. Birthday, Presidents Day, Memorial Day, Independence Day, Labor Day, Juneteenth, 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.

2.14 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 is designed and constructed to afford relative safety and comfort and to avoid aggravation of the patient’s condition.

2.15 Neighbor Island(s): A Neighbor Island is Maui, Kauai, Molokai, the Big Island of Hawaii (Hilo and Kona), Lanai, or Niihau.

2.16 Normal Business Hours: Normal business hours are defined as Monday thru Friday, 8:00 a.m. to 4:30 p.m. local time.

2.17 Requesting Official: The requesting official is a medical care provider on the Neighbor Islands that has received authorization from the VAPIHCS to request air ambulance services on behalf of the veteran/patient.

2.18 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.”

2.19 Drop Off Locations:

(1) VAPIHCS / VA Spark M. Matsunaga Medical Center: 459 Patterson Road, Honolulu, HI 96819.

(2) Tripler Army Medical Center (TAMC): located at 1 Jarrett White Road, Honolulu, HI 96859.

3.0 Demand:

3.1 The demand for the Air Ambulance services is estimated at eight to ten (8 -10) Trips per month.

4.0 Performance Period:

4.1 The period of performance is five (5) years.

4.2 The contractor shall be fully mobilized to begin performance within thirty (30) days of contract award.

5.0 Description of Work:

5.1 The Contractor shall provide ALS/BLS/CCT air ambulance service twenty-four (24) hours per day, seven (7) days per week, including all holidays for beneficiaries of the VA.

5.2 The Contractor shall provide passenger air charter service and related passenger services to assist the Government in meeting its travel needs from the Neighbor Island to Oahu, HI.

5.3 Contractor shall use contractor-owned stretchers, wheelchairs, linens or any other items required in transporting patient(s) from one place to another.

5.4 This contract shall include BLS, ALS and CCT services as required.

5.5 The contractor shall provide all legs of transportation including ground ambulance to and from respective airports.

5.6 All travel is one-way from a Neighbor Island to Oahu, HI.

6.0 Locations:

6.1 Pick-up location shall be from Maui, Kauai, Molokai, the Big Island of Hawaii (Hilo and Kona), Lanai, or Niihau. In most instances the pick-up location will be at a medical facility.

6.2 Drop-off location will be on the island of Oahu, Hawaii. The contractor shall provide ground transportation to the appropriate receiving medical facility on Oahu.

7. Orders for Service:

7.1 The Requesting Official will place telephone requests (orders) for contract services with the Contractor’s dispatch office. The request for services shall specify the originating point and final destination. The Contractor shall verify that the telephone request has been authorized by the VAPIHCS either by confirming VAPIHCS approval with the Requesting Official at the time of the telephone request or by verifying with any VAPIHCS authorized personnel. The list of Authorized Personnel will be provided by the Contracting Officer's Representative (COR) and will be updated and maintained by the COR

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

7.2 For unscheduled pickups, the Contractor dispatch will respond within a reasonable amount of time not to exceed thirty (30) minutes and coordinate the transportation of the beneficiary. The Contractor agrees to have patient prepared and airborne within three (3) hours after the receipt of telephone order or as agreed between the contractor and the authorized Requesting Physician. 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.

7.3 Unscheduled pickups are conducted under 14 CFR Part 121 (supplemental operations) and 14 CFR Part 135 (commuter and on-demand operations).

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

8.0 Rate:

8.1 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.

9.0 Cancellation:

9.1 If the delivery order is cancelled by the Requesting Physician, the Contractor will be paid for actual statute miles traveled at the time of the cancellation, plus the necessary statute miles the Contractor’s aircraft must travel to return to its starting location. The return mileage is only reimbursable if the contractor does not have another destination on its flight plan.

10.0 Personnel:

10.1 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.

11.0 Licenses, Certifications and Insurance:

11.1 All work related to this contract will be performed by the Contractor in accordance with any applicable FAA, U.S. Department of Transportation, or OSHA regulations, as well as applicable State health and safety regulations, health care accreditation standards (JCAHO or equivalent accreditation organization) and standard industry practices as defined by the Association of Air Medical Services for air ambulance transportation.

11.2 This solicitation applies to non-scheduled operations of air transportation conducted under:

14 CFR Part 121 (“Supplemental Operations”) 14 CFR Part 135 (“Commuter and On-Demand Operations”)

11.3 FARs Part 135 Operators must be in compliance with applicable regulations as outlined in Federal Aviation Regulations Part 135: Operating Requirements: Commuter & On-Demand Operations & Rules Governing Persons on Board Such Aircraft.

11.4 FARs Part 121 Operators must be in compliance with applicable regulations as outlined in Federal Aviation Regulations Part 121: Operating Requirements: Domestic, Flag, and Supplemental Operations.

11.5 Medical Standards – refer to Federal Aviation Regulations (FARs) Part 61.23, Subpart A: “Medical Certificates: Requirement and Duration”

· Medical Class (1st, 2nd, or 3rd)

· Medical Date (FAA certified physician check)

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

11.7 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.

11.8 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.

11.9 Maintenance Personnel – Contractor shall insure that contracted maintenance, including repair and overhaul facilities, is performed by maintenance organizations acceptable to the Civil Aviation Regulations (CAR).

11.9.1 Operators, (at their discretion) are expected to hire and train the number of employees that would be reasonably required to safely maintain the company aircraft and support the scope of the maintenance operation both at home station and at en route locations.

11.9.2 Ensure that all maintenance tasks, including required inspections and airworthiness directives, are performed.

11.9.3 Maintenance actions are properly documented, and discrepancies identified between inspections are corrected.

11.9.4 Mechanics must be fit for duty, properly certified with the company’s certification and knowledgeable of the necessary aircraft-specific requirements to accomplish the maintenance tasks.

11.9.5 Non-certified and inexperienced personnel must receive supervision from individuals compliant with FARs Part 43.3.

11.9.6 Freedom from alcohol and drug abuse is required as outlined in Federal Aviation Regulations FARs Part 135: Subpart E “Flight Crewmember Requirements.”

11.10 Contractor: Shall maintain personal liability, personal aircraft and automobile liability, and property damage insurance, as prescribed by the laws of the state of Hawaii, and in accordance with VAAR clauses 852.228-71 and 852.237-70.

11.10.1 Liability Insurance. The Operator shall maintain, or cause to be maintained at its sole expense, bodily injury and property damage liability insurance.

11.10.2 Hull Insurance. The Operator shall maintain, or cause to be maintained at its sole expense, all risks aircraft hull insurance in an amount equal to the value of the aircraft. Such policy shall designate the Operator and any first lien mortgage holder as loss payees as their interests may appear.

11.10.3 Insurance Certificates. The Operator shall provide the VA with a Certificate of Insurance evidencing the insurance coverage required upon execution hereof and immediately upon the VA’s or ordering agency’s request at any time thereafter.

11.10.4 Workers Compensation. The Operator shall maintain worker’s compensation insurance providing applicable statutory benefits for all employees performing services. The cost of such worker’s compensation insurance premiums is the Operator’s responsibility.

12.0 Training

12.1 Crew Resource Management (CRM) is a best practices measure that is taught, practiced and evaluated during all phases of operations training. There are no general mandates imposed on an operator regarding the frequency of CRM training. However, the expectation is that the frequency of CRM training is sufficient to ensure that the operator meets all Federal Aviation Regulations (all parts) from Title 14 and Code 49 of Federal Regulations. In order to ensure CRM competency, the following minimum areas must be covered:

12.1.1 Role playing scenarios between crew members to ensure clear channels of communication exist.

12.1. Role playing scenarios that demonstrate how to over-ride a senior crew member’s decision if that senior crew member has made an error.

12.1.3 Delegation of duties under normal circumstances and situations where a senior crew member in a decision-making chain-of-command is incapacitated.

12.2 Flight and cabin crews have jet recurrent training as mandated in Federal Aviation Regulations 135.295 and 135.297 respectively.

12.3 Maintenance Personnel Training - Orientation, familiarization, on-the-job, and appropriate initial and recurrent training for all full and part-time personnel is expected. This training should include aircraft familiarization systems, and job specific duties related to avionics and power plant. The use of such training aids as mockups, simulators and computer based training enhances maintenance training efforts, and is desired. Initial and recurrent training requirements and frequency are established for each operator as outlined by Federal Aviation Administration (FAA) Advisory Circular (AC) 120-42. All maintenance employees must be in compliance with Federal Aviation Regulations (FARs) Part 43.

12.4 Information Security Training – See VA Handbook 6500.6, Appendix C, paragraph 9.9

12.4.1 All contractor employees and subcontractor employees requiring access to VA information and VA information systems shall complete the following before being granted access to VA information and its systems:

12.4.1.1 Sign and acknowledge (either manually or electronically) understanding of and responsibilities for compliance with the Contractor Rules of Behavior, Appendix E relating to access to VA information and information systems;

12.4.1.2 Successfully complete the VA Cyber Security Awareness and Rules of Behavior training and annually complete required security training;

12.4.1.3 Successfully complete the appropriate VA privacy training and annually complete required privacy training; and

12.4.1.4 Successfully complete any additional cyber security or privacy training, as required for VA personnel with equivalent information system access [to be defined by the VA program official and provided to the contracting officer for inclusion in the solicitation document – e.g., any role-based information security training required in accordance with NIST Special Publication 800-16, Information Technology Security Training Requirements.]

12.4.2 The contractor shall provide to the contracting officer and/or the COTR a copy of the training certificates and certification of signing the Contractor Rules of Behavior for each applicable employee within 1 week of the initiation of the contract and annually thereafter, as required.

12.4.3 Failure to complete the mandatory annual training and sign the Rules of Behavior annually, within the timeframe required, is grounds for suspension or termination of all physical or electronic access privileges and removal from work on the contract until such time as the training and documents are complete.

13.0 Designation of Contracting Officer’s Representative (COR)

13.1 The Contracting Officer (CO) will appoint a Contracting Officer Representative (COR) to perform tasks related to the execution and surveillance of this contract. The COR will be designated to represent the Contracting Officer (CO) in furnishing technical guidance and advice under this contract. The foregoing is not to be construed as authorization to interpret or furnish advice and information to Contractor relative to the financial or legal aspect of the contract. Those matters are the responsibility of the CO and shall not be delegated.

13.2 The CO is responsible for the administration of this contract. The CO is the only individual authorized, to extent indicated in this contract, to take actions on behalf of the Government, which may result in changes in the contract terms, to include deviation from the statement of work, details, and performance schedules. Communications pertaining to contractual matters shall be addressed to the CO. No changes in or deviation from the scope of work shall be affected without a written modification to the contract executed by the CO. No oral statements of any person whosoever will in any matter or degree, modify or otherwise affect the terms of this contract.

13.3 The Contractor will receive a copy of Delegation Letter which will identify the COR appointed by the CO.

14.0 Inspection, Quality, and Performance Standards:

14.1 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 contracted services. Furthermore, annually the contractor must provide proof of insurance and copies of any licenses for all staff providing services under this contract upon request of the COR. See VAAR Clauses 852.228-71 and 852.237-70 for further details on insurance requirements.

14.2 Contractor will ensure that each beneficiary is treated in a professional manner, keeping in mind diversity of our beneficiaries. Each beneficiary will be treated with the highest quality of care and standards established in the industry. Some of the areas to be assessed are:

a. Patient safety

b. Medical services

c. Equipment and aircraft maintenance program

14.3 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.

14.4. The COR or CO has the right to copies of data or records retrieved from the aircraft’s flight data recorder (a.k.a. “black box”).

14.5 In aircraft containing video devices, the COR or CO has the right to possession and to create copies of such footage.

15.0 Reporting Responsibilities:

15.1 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.

15.2 The Contractor shall furnish reports, electronically, on a quarterly basis, based on the government’s fiscal year (October 1 through September 30), the following reports:

The report is due by the 30th calendar day after the end of each three-month reporting period based on the effective date of the contract.

Reports shall be submitted, in electronic format, to Francisco.Valdez@va.gov Jonathan.Lum@va.gov

15.3 Maintenance Records – maintenance actions shall be well documented and provide a complete record of maintenance accomplished and, for repetitive actions, maintenance required. Inspection compliance, airworthiness release, and maintenance release records shall be complete and signed by approved personnel. The COR may request these records at any time during the contract period.

16.0 Invoice Procedures:

16.1 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 to the Patient Travel Coordinator who placed the service order.

16.2 Invoices are to include all contract services furnished for the preceding month. Invoices shall specify the patient’s 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.

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

16.4 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.

16.5 In accordance with VA accounting procedures and in order to provide an audit trail for questions and concerns pertaining to payment, the Contractor shall be furnished, in advance a series of numbers corresponding to the month in which the service is rendered. This number is to be referenced on all invoices as applicable.

16.6 All invoices rendered by the Contractor to VAPIHCS 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.

17.0 Patient Privacy and Confidentiality:

17.1 Health Insurance Portability and Accountability Act (HIPAA), Privacy Rule, and Security Rule:

17.1.1 Whereas the Contractor will have access to Business Associate Protected Health Information (PHI) and Electronic Protected Health Information (EPHI) that is subject to protection under regulations issued by the Department of Health and Human Services, as mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 CFR Parts 160 and 164, Subparts A and E, the Standards for Privacy of Individually Identifiable Health Information (“Privacy Rule”), and 45 CFR Parts 160 and 164, Subparts A and C, the Security Standard (“Security Rule”); and whereas, Department of Veterans Affairs Veterans Health Administration is a “Covered Entity” as that term is defined in the HIPAA implementing regulations, 45 CFR 160.103.

17.2 All patient documents 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.

18.0 Information Security:

18.1 The contractor, their personnel, and their subcontractors shall be subject to the Federal laws, regulations, standards, and VA Directives and Handbooks regarding information and information system security as delineated in this contract.

19.0 Liquidated Damages for Breach of Data:

19.1 See VAAR clause 852.211-76 Liquidated Damages – Reimbursement for Data Breach Costs

20.0 Quality Assurance Surveillance Plan (QASP):

20.1 QASP is a systematic method used by the Government to evaluate Contractor’s actions and performance based on Statement of Work requirements. The QASP is designed to provide an effective method of monitoring contractor performance for each listed objective on the SOW. A QASP is based on the premise the Government desires to maintain a quality standard in providing air ambulance services.

20.2 For the tasks listed in the Performance Requirement Table (PRT) below, the COR will follow the methods of surveillance specified in this contract.

20.3 When a required service in the PRT indicates defective performance, the COR will require the contract manager or representative at the site to document the observation and forward to the Contracting Officer to maintain in the file. The documentation of the observation does not necessarily constitute concurrence with the observation, only acknowledgment that he or she has been made aware of the defective performance. Government surveillance of tasks not listed in the PRT or by methods other than those listed in the PRT (such as provided for by the Inspection of Services clause) may occur during the performance period of this contract. Such surveillance will be done according to standard inspection procedures or other contract provisions. Any action taken by the contracting officer as a result of surveillance will be in accordance with the terms of this contract.

Performance Requirements Table:

Surveillance Reduction when AQL Exceeded

Standards and Safety Guidelines

Aircraft Maintenance Program

Aircraft maintenance logs reviewed semi-annually

minutes

Data

travel coordinator

travel coordinator

Satisfaction

travel coordinator

Coordination