ATTACHMENT_4_-_REFERRAL_MANAGEMENT_PWS.pdf

PERFORMANCE WORK STATEMENT

AIR FORCE MEDICAL SUPPORT AGENCY

HEADQUARTERS UNITED STATES AIR FORCE

FOR

REFERRAL MANAGEMENT SERVICES

19 December 2014

Table of Contents

1. DESCRIPTION OF SERVICES

2. SUMMARY OF REQUIREMENTS

3. STAFFING AND PERSONNEL REQUIREMENTS

4. PLACE OF PERFORMANCE………………………………………………………………..18

5. AUTOMATED INFORMATION SYSTEMS (AIS) III AND BASE SECURITY

REQUIREMENT……………………………………………………………………………. 19

6. SERVICE SUMMARY…………………………………………………………………… 21

7. DELIVERABLES

8. GOVERNMENT FURNISHED PROPERTY AND SERVICES…………………………….24

9. ADDITIONAL CONTRACT REQUIREMENTS……………………………………………25

10. CONTINUITY OF SERVICES……………………………………………………………...26

APPENDIX A Medical Treatment Facilities APPENDIX B Publications and Regulations APPENDIX C Three (3) Year Workload Summary APPENDIX D Personally Identifiable Information (PII), Protected Health Information (PHI), and Federal Information Requirements APPENDIX E Organizational Conflict of Interest…………………………………………….43 APPENDIX F Non-Disclosure Agreement……………………………………………………46

ATTACHMENT 1 – Referral Management Center Guide - version 9.0

1. DESCRIPTION OF SERVICES.

1.1. Background. The Air Force Medical Service (AFMS) operates and manages a worldwide healthcare system to deliver medical service for more than 2.63 million eligible beneficiaries.

Beneficiaries include active duty, family members and retirees, during both peacetime and wartime. The AFMS responds to a full spectrum of anticipated health requirements and provides an integrated healthcare system from forward deployed locations through definitive care with an emphasis on prevention of illness and injury. Each referral is coordinated through a process called Referral Management (RM). When specialty care is referred, the Referral Management Center (RMC) is responsible for advising the patient of their benefit and working with the referring provider and the Managed Care Support Contractor (MCSC) to ensure that the referral is accurate. The RMC is also responsible for coordinating the referral with the specialty office, facilitating the recapture of Medical Treatment Facility (MTF) direct care capabilities, tracking the referral to closure, and returning all results of treatment to the patient’s medical record. The number of referrals in a MTF varies depending on the patient population, illness severity, local networks and referral patterns.

1.2. Scope. The Contractor shall support the AFMS’ mission of staffing and managing RMCs at the MTFs, serving as the one-stop shop for all referrals from the initiation of a referral to receipt of a clear, legible, Health Insurance Portability and Accountability Act (HIPAA) (Appendix D) compliant report is returned to the MTF. The RMC serves as the central clearing house for providers and patients needing information or help with referrals. RM is a critical program within DoD and the AFMS, supporting the patient-centered medical home model and optimizing the MTF’s clinical specialty capabilities and expeditionary medicine currency platforms. The contractor shall:

1.2.1. Provide RM services for the MTFs identified in Appendix A – Medical Treatment Facilities (MTFs).

1.2.2. Adhere to all applicable publications and regulations regarding the RM process

(those in effect at the time of contract award and any changes made throughout the contract period of performance) – reference Appendix B.

1.3. Acronyms.

ACRONYM DEFINITION

AAAHC Accreditation Association for Ambulatory Health Care AF Air Force AFI Air Force Instruction AFMC Air Force Materiel Command AFMS Air Force Medical Service AFMSA Air Force Medical Support Agency AHLTA Armed Forces Health Longitudinal Technology Application AIS Automated Information Systems ATC Access to Care CAC Common Access Card

CC Commander CDC Centers for Disease Control and Prevention CFR Code of Federal Regulations CHCS Composite Health Care Suite CLR Clear and Legible Report CMRA Contractor Manpower Reporting Application CO Contracting Officer COR Contracting Officer’s Representative DEERS Defense Enrollment Eligibility Reporting System DoD Department of Defense FAR Federal Acquisition Regulation FRED Functional Requirements Evaluator Designee (MTF level) FY Fiscal Year HAIMS Health Artifact Imaging & Management System HIPAA Health Insurance Portability and Accountability Act HQ Headquarters IAW In Accordance With IT Information Technology ICD-B Integrated Clinical Database-B MCSC Managed Care Support Contractor MMWR Morbidity and Mortality Weekly Report MTF Medical Treatment Facility NACI National Agency Check with Inquiries NCQA National Committee for Quality Assurance NDA Non-Disclosure Agreement NLT No Later Than OCI Organizational Conflict of Interest ODCS Other Direct Care System OPM Office of Personnel Management PA Privacy Act PCM Primary Care Manager PHI Protected Health Information PII Personally Identifiable Information PM Program Manager PMP Project Management Plan ProStaff Professional Staff PRP Personal Reliability Program POC Point of Contact PWS Performance Work Statement QCP Quality Control Plan RCR Regional Contractor Representative RM Referral Management RMC Referral Management Center RMS Referral Management System

RMSTR Referral Management Tracking Reports RMPMT Referral Management Program Management Tool ROFR Right Of First Refusal SG Surgeon General SS Service Summary UM Utilization Management T-Con Telephone Consult TJC The Joint Commission USAF United States Air Force

1.4. Definitions.

As used throughout this Performance Work Statement (PWS), the following terms shall have the meanings set forth below:

Armed Forces Health Longitudinal Technology Application (AHLTA), Composite

Health Care System (CHCS) or other future approved electronic healthcare record:

The military’s electronic health record and computer system that stores clinical and administrative data. These systems provide on-line communication for users in any supported location.

Chasing: RMC personnel track and retrieve results, Clear and Legible Reports (CLRs), for referrals written by MTF; as per latest AFMS RMC business rules.

Clear and Legible Reports (CLRs): Specialty care consultation/referral reports, operative reports, and notes on episode of care and discharge summaries for beneficiaries referred by an MTF. CLRs may appear on a wide variety of media including paper, digital, facsimile, X-ray film and other media. CLRs are typically 3-5 pages long but may be longer or shorter depending on the episode of care.

Full Reimbursement Rates: Rates annually set by Congress for payment by non-eligible personnel for services received at a MTF. These are flat rates set for outpatient and inpatient care.

Health Care Provider: Any Contractor or Government health care professional who, under regulations of a Military Department, is granted clinical practice privileges in a Military MTF or Dental Treatment Facility or who is licensed or certified to perform health care services by a Governmental board or agency or professional health care society or organization.

Licensure: Documents providing evidence of education, training, license, experience, certification and expertise of a health care provider.

Managed Care Support Contractor (MCSC): The organization(s) contracted by TRICARE Management Activity to provide health care outside the Direct Care System.

Right of First Refusal (ROFR) Referrals: Referrals from network/non-network/Veteran Affairs providers that are sent to MTFs with specialty care capability/capacity.

Valid License: A grant of permission by an official agency of the District of Columbia, a state, commonwealth, or territory of the United States to provide care independently as a health care professional. Licenses must be current. Some jurisdictions issue no-fee licenses to federal employees or military personnel. These licenses are acceptable if the issuing authority will exercise professional regulatory control over individuals with these licenses.

2. SUMMARY OF REQUIREMENTS

2.1. Task Description. The Contractor shall provide personnel, supervision, training, and services necessary to perform all duties described in this PWS. A three (3) year workload history is provided at Appendix C.

2.1.1. Referral Management Center (RMC) Operations.

2.1.1.1. Operate the RMC at the MTFs listed within Appendix A. Support RMC operations and provide referral management services to patients during normal MTF business hours (as specified in paragraph 4) for telephonic, electronic, and in person access.

2.1.1.2. Process and review referrals in Government information systems including, but not limited to: the Composite Health Care Suite (CHCS), MCSC referral systems, Armed Forces Health Longitudinal Technology Application (AHLTA), Health Artifact Imaging & Management System (HAIMS), and Referral Management System (RMS) Integrated Clinical Database-B (ICD-B) programs.

2.1.1.3. Accurately refer patients to subsequent care using the most current MTF Capabilities Report, and the Access to Care (ATC) standards and RMC Business Rules as outlined in Air Force Instruction AFI44-176 and in the AFMS Referral Management Center Guide – version 9.0, Attachment 1 of the PWS.

2.1.1.4. Initiate, follow, manage, and close all referrals within timeliness standards identified in the TRICARE Operations Manual, the RMC business rules, and other current Government policies, regulations, and memorandums.

2.1.1.5. Provide patient education including, but not limited to, specialty care referral, procedures, and labs to prepare the patient for their specialty care appointment and/or procedure.

2.1.1.6. Provide MTF clinical personnel education concerning referral process and timelines, no less than semi-annually. The Contractor will utilize education opportunities during training venues to include, but not limited to, provider/nurse orientation briefings and Professional Staff (ProStaff) meetings.

2.1.1.7. Identify and notify the Government MTF case manager, Utilization Management (UM) nurse or Primary Care Management (PCM) team, as appropriate, of any patient that may benefit from or may require care management/coordination.

2.1.1.8. Sustain and follow the most current MTF Specialty Clinic Booking Guidance, MTF Capabilities Report and MTF/MCSC Memorandums of Understanding. Utilize these to maximize recapture initiatives and enhancements.

2.1.1.9. Participate in inspections, by providing any requested referral management information by inspectors.

2.1.2. Referral Review/Appointing Function.

2.1.2.1. Review initial specialty care and deferred-to network primary care referrals for administrative completeness (e.g., TRICARE Operations Manual, Chapter 8, Section 5), covered TRICARE benefit and required tests and pre-work. Coordinate with referring providers in cases where additional referral information is required.

2.1.2.2. Verify patients are registered in CHCS and Defense Enrollment Eligibility Reporting System (DEERS); update demographic and other pertinent information through the appropriate medical systems and software programs. Obtain current and accurate contact information (i.e., cell/home phone numbers, and address).

2.1.2.3. Determine patient eligibility for services and schedule specialty referral appointments to MTF or Other Direct Care System (ODCS) (ex: other nearby MTF) using CHCS booking procedures, ATC standards, and established clinic capability/booking protocols as outlined in AFI 44-176 and in the AFMS Referral Management Guide. If there are no MTF or ODCS referral appointments within ATC standards, the RMC shall defer the referral to the network through the MCSC. The RMC shall transmit the referral though the RMS to the MCSC.

2.1.2.4. Assist with ROFR determinations for specialty care that can be provided within the MTF using service availability (capability) listings and information systems that link the referral to the appointment with the ATC category and standard.

2.1.2.5. Document patient appointments in the approved AFMS system(s), such as but not limited to CHCS, the RMS, and ALTHA. Enter ROFR-type referrals into CHCS for review and appointments.

2.1.2.6. Process ROFRs within the time limits outlined in the TRICARE Operations Manual, Chapter 8, Section 5 (or as amended).

2.1.2.6.1. Accept/decline urgent priority ROFRs received within thirty (30) minutes of receipt.

2.1.2.6.2. Accept/decline routine priority ROFRs received within one (1) business day of receipt.

2.1.2.6.3. Return completed ROFR specialty care referral results to the referring purchased care provider within ten (10) business days of the kept specialty encounter.

2.1.2.7. Verify that referrals are activated within the referral priority standards (Routine, Emergent, and Urgent). RMC staff shall assist with appointing/activating referrals and providing customer support to patients as outlined in the latest AFMS RMC Business Rules.

2.1.2.8. Correct inaccurate authorizations in the RMS.

2.1.2.9. Coordinate with specialty referral clinics (e.g., internal MTF, ODCS, Veteran’s Affairs clinic, etc.) on special patient instructions and tests required prior to appointment.

2.1.2.10. Provide pre-appointment instructions to patients, if possible, prior to leaving the MTF. Advise patients of the provider, location, time, and day of referral appointments or request the patient to call back for appointment information if patient not provided appointment prior to leaving the MTF. Include care episode information for the referral provider as to where to return referral results.

2.1.2.11. Print diagnostic reports and treatment profiles as required for patients to hand carry to a network/non-network initial specialty care appointment.

2.1.2.12. Contact and inform patients in the event referral requests are invalid (e.g., non-covered benefits) or disapproved by MTFs second level reviewer or MCSC. Reschedule or instruct patient of other health care options within two (2) business days.

2.1.2.13. Submit referrals to the appropriate reviewer when required for medical necessity and appropriateness review.

2.1.2.14. Utilize the referral naming convention in Telephone Consults (T-Cons), AHLTA clinical notes and HAIMs, or additional systems, as outlined in the latest AFMS RMC business rules.

2.1.2.15. Return all calls within two (2) business days.

2.1.2.16. Monitor the secure messaging box three (3) times a day for messages. Follow-up with patients and/or direct messages to the PCM team accordingly.

2.1.2.17. Generate and forward referral-related patient telephone consults requiring clinical decision-making to the appropriate provider/team.

2.1.2.18. Review TRICARE Regional Office reconciliation/summary report daily;

identify all open referrals and ensure resubmission.

2.1.3. Referral Tracking Function.

2.1.3.1. Track and obtain initial specialty care and deferred to Network primary care referrals to include obtaining CLRs from MTF, ODCS, network, and non-network providers. When follow-up results are received from specialists, ensure they are sent to the referring provider or PCM.

2.1.3.2. Retrieve CLRs no later than (NLT) (120) calendar days after the order entry date.

If the RMC does not receive the CLRs within (120) calendar days, the Contractor is responsible for researching (chasing) and expeditiously retrieving CLRs as outlined in the latest AFMS RMC business rules.

2.1.3.3. Import/scan CLRs into the correct patients’ medical record within three (3) business days from receipt of results, as outlined in the TRICARE Operations Manual and the latest AFMS RMC business rules.

2.1.3.4. Follow-up with MTF specialty care providers who did not complete CLR referral results in accordance with AFMS RMC business rules.

2.1.3.5. Return CLR results to the referring provider or PCM within three (3) business days of receipt from the consulted provider/specialist.

2.1.3.6. Provide the referring providers a monthly list of their referred patients who have not scheduled their initial specialty care appointment for the referring provider/team’s action.

2.1.3.7. Provide initial results of all referrals written by the MTF. Send all referrals to the referring provider/PCM for review to be tracked and closed.

2.1.3.8. Prepare referral management data reports/metrics, using referral tracking data tools. Reports and metrics will be as determined by the latest AFMS RM Business rules, local MTF policies and procedures, as well as any regulatory guidance (ex: AAAHC, TJC, NCQA, etc.) currently in effect. Accuracies shall be completed within three (3) business days. Utilize information to maximize recapture initiatives/enhancements.

2.1.4. Heath Benefits Function.

2.1.4.1. Accurately advise all patients of their referral eligibility, beneficiary status, and health treatment options as outlined by their TRICARE enrollment and/or DEERS status.

2.1.4.2. Coordinate with MTF Chief of Medical Staff (SGH) for all active, reserve, and guard referrals not covered under the TRICARE benefit for approval.

2.1.4.3. Direct patient to patient travel coordinator and provide information on travel related benefits.

2.1.4.4. Assist MTF, as necessary, on advising patients regarding Line-of-Duty, Personal Reliability Program (PRP), and Medical Evaluation Board issues as outlined in AFI 41-210, Tricare Operations and Patient Administration Functions, and AFI 36-3212, Physical Evaluation for Retention, Retirement, Separation (in conjunction with MTF Physical Evaluation Board Liaison Officer and MTF PRP monitor). Verify appropriate paperwork is on file prior to authorization.

2.1.5. Customer Service Function.

2.1.5.1. Provide medical ethics, telephone etiquette, office, administrative, and clerical skills to perform receptionist duties. Provide positive, courteous and professional customer service support to patients and MTF staff.

2.1.5.2. Initiate, receive, and coordinate (telephone/computer/written) communication between beneficiaries, team members, internal staff and providers, network/outside providers and ancillary health care workers regarding specialty clinic appointments and referrals.

2.1.5.3. The contractor will resolve substantiated complaints within five (5) business days of receipt of complaint.

2.2. REFERRAL MANAGEMENT CENTER REQUIRED PLANS & REPORTING

REQUIREMENTS.

2.2.1 Transition Plan.

2.2.1.1. Transition Phase-in. The Contractor shall include a Phase-in Plan as part of their proposal that describes in detail, what actions the Contractor will take to ensure their employees are prepared to begin performance for all services required under this PWS along with the process to minimize disruption in services throughout the transition. The Contractor shall attend a post-award orientation meeting, at no cost to the Government, within five (5) business days after task order award to review requirements and implementation of the Contractor’s transition plan. In addition, the Contractor shall provide a weekly update to the COR on meeting milestones; identifying critical issues and plans for addressing/resolving issues. The requirement for weekly update meetings may be terminated, at government discretion, at the end of the contract transition-in period.

2.2.1.2. Transition Phase-out. The Contractor shall include a Phase-out Plan as part of their proposal that describes in detail, what actions the Contractor will take to ensure a smooth and successful transition of operations between this contract and the next contract provider. Assistance shall include, but is not limited to, detailing current requirements, suggesting milestones and suggesting necessary actions for the last (20) business days of the contract; this may include formal coordination with Government staff or contractor successor staff as needed. The plan should illustrate a process that would allow the

Contractor to turn over ongoing/outstanding referral actions (in a mutually agreed upon format) whereby the Government could continue uninterrupted referral management services. It shall also include providing any information pertinent to the daily activities as outlined in the PWS such as duties, responsibilities, data, metrics, or requirements that are critical for ensuring continued operations.

2.2.2. Operations Plan. The Contractor shall include as part of their proposal an Operations Plan that outlines the Contractor’s organizational structure, their approach to referral management services, quality assurance measures, and clearly defines role and responsibilities, and issue mitigation amongst employees, to ensure an effective and efficient RMC that minimizes staff turnover.

2.2.2.1. The Contractor shall maintain the Operations Plan and notify the CO and COR of any significant changes to the plan during the course of the contract.

2.2.3. Contingency Plan. The Contractor shall include a Contingency Plan as part of their proposal that describes how the Contractor shall ensure continuity of operations for all services required under this PWS. In the event of staffing shortages, equipment or communication failures, or other delays associated with the performance of Referral Management Services under this contract, the Contractor shall implement the contingency plan to provide uninterrupted referral management services.

2.2.3.1. The contingency plan shall address risks associated with staffing shortages and equipment or communication failures, and ensure the plan eliminates causes of schedule disruptions, increased costs, or degradation of performance. The contingency plan shall not rely on the Government to ensure continuity of operations. For those MTFs with one

(1) individual, the plan must include a specific, measurable strategy for accomplishing all requirements listed in the PWS during staffing shortages, without placing additional burden or workload on the Government. The Contracting Officer (CO) and Program Manager (PM) may review the contingency plan at any time to ensure it is practical and executable with regard to the ability to interface with Government systems or infrastructure. If the contingency plan fails during an actual contingency, the Government will require the Contractor to correct the plan within five (5) business days in addition to any other re-performance associated with the failure of the plan.

2.2.3.2. The Contractor shall continue to conduct services during uncontrollable events such as interruptions of electrical power or Information Technology (IT) connectivity for those functions which may be completed manually during this time, with the understanding that full service shall resume upon restoration of electrical power and/or computer availability.

2.2.4. Quality Control Plan. The Contractor shall prepare and adhere to a Quality Control Plan (QCP). The Offeror shall submit the QCP with its proposal and submit updates as needed after task order award. The QCP shall document how the Contractor shall meet and comply with the quality standards established in this PWS. At a minimum, the QCP must include a self-inspection plan, an internal staffing plan, and an outline of the procedures that the Contractor shall use to maintain quality, timeliness, responsiveness, customer satisfaction, and any other requirements set forth in this PWS. The Contractor QC plan/program shall include:

2.2.4.1. Continuing review of the contract performance including compliance with regulations referenced in the PWS. Contractor shall accomplish reviews and record on a schedule as dictated by the QCP. Records shall be made available to the Government Upon request by the COR, make records available to the Government throughout the contract performance period and for the period after contract completion until final settlement of any claims under this contract.

2.2.4.2. A method of identifying and preventing deficiencies in the quality of service before the level of performance deteriorates to an unacceptable level. Provide audit results to the COR upon request.

2.2.4.3. The policy and procedures to ensure all contractor personnel have the required skills and training initially and annually. The plan should also identify the individual(s) performing the assessment.

2.2.4.4. Provide subsequent changes to the CO for review and acceptance before implementation.

2.2.5. Staffing Plan. The Contractor shall include a Staffing Plan as part of their proposal that details how the Contractor will find, qualify, and retain personnel to perform referral management services for all geographic locations identified in Appendix A. The staffing plan shall also describe how turnover of staff will be minimized.

2.2.6. Contractor Manpower Reporting Requirements. The Medical Expense and Performance Reporting System (MEPRS) is the DoD accounting system for financial, personnel, and workload data within MTFs. The Defense Medical Human Resources System-internet (DMHRSi) is the interface used to report hours worked in the MTF. Per DoD Manual 6010.13-M, Medical Expense and Performance Reporting System for Fixed Military Medical and Dental Treatment Facilities, when working within an MTF, the Contractor is required to submit hours worked bi-weekly through DMHRSi to their assigned MTF for entry into the system by the Government, or as required by policy updates.

2.2.6.1. The Contractor shall also report and update the Contractor Manpower Reporting Application (CMRA). Reporting inputs will be for the labor executed during the period of performance for each Government Fiscal Year (FY), which runs 1 October through 30 September. While inputs may be reported any time during the FY, all data shall be reported no later than 31 October of each calendar year. Contractors may direct questions to the Contractor Manpower Reporting Application (CMRA) help desk.

2.2.6.2. Information from the secure web site is considered to be proprietary in nature when the contract number and Contractor identity are associated with the direct labor hours and direct labor dollars. At no time shall any data be released to the public with the Contractor name and contract number associated with the data.

2.2.6.3. Data for Air Force service requirements must be input at the Air Force CMRA link. However, user manuals for Contractors are available at the Army CMRA link at:

http://www.ecmra.mil.

3. STAFFING AND PERSONNEL REQUIREMENTS.

3.1. Regional Contractor Representative (RCR). Within five (5) calendar days after task order award, the Contractor shall provide, in writing to the CO and the COR, the name of the RCR responsible for coordination and implementation of referral management services.

Additionally, the RCR shall be available telephonically to the CO, the COR, the MTF Functional Requirements Evaluator Designee (FRED), and MTF contractor personnel during normal duty hours to discuss any problem that may arise concerning contractual matters relating to daily operation of the contract.

3.1.1. The Contractor shall notify the CO/COR at least five (5) calendar days in advance of any change or replacement actions concerning the individual selected to be the RCR after the contract period of performance begins. Such notification shall be in writing and shall state the name and telephone number of the new RCR.

3.1.2. The RCR shall advise CO/COR immediately of unforeseen events that could affect performance of these contract requirements. Personnel changes, to include scheduled and unscheduled absences of contractor personnel shall be reported to the COR as soon as possible. The RCR shall provide a plan for continued support until the departing Contractor personnel is replaced.

3.1.3. The RCR shall provide a point of contact (POC) within each MTF.

3.1.4. The RCR shall provide a monthly staffing report (per MTF) to the COR no later than fifteen (15) business days after the end of the previous month. Staffing level decisions will remain the responsibility of the contractor to ensure performance of all requirements within this PWS; however, a monthly staffing report is required for accountability and security purposes within the MTF.

3.2. Minimum Education and Experience Requirements: All contractor personnel shall meet the minimum qualifications below:

3.2.1. Admin Clerks.

3.2.1.1. Shall read, understand, speak, and write English fluently.

3.2.1.2. High school diploma or General Educational Development (GED) equivalency.

3.2.1.3. General office administrative and clerical skills to perform receptionist duties and answer telephones.

3.2.1.4. Operational computer skills with general working knowledge of word processing, and Microsoft applications (including Windows, Word, Excel, Outlook).

3.2.1.5. Preferred two (2) years of healthcare administrative experience in either an inpatient or outpatient care setting within the last three (3) years.

3.2.1.6. General medical ethics, telephone etiquette, written/verbal/electronic communication, and customer service skills.

3.2.2. Licensed Professionals.

3.2.2.1. Shall read, understand, speak, and write English fluently.

3.2.2.2. Shall have knowledge, skills and computer literacy to interpret and apply medical care criteria, such as, but not limited to, InterQual or Milliman Ambulatory Care Guidelines.

3.2.2.3. Shall have a minimum of two (2) years broad-based clinical nursing experience in either an inpatient or outpatient care setting within the last three (3) years.

3.2.2.4. License must be valid and unrestricted. Contract personnel shall be in good standing, and under no clinical restrictions, with the licensure boards in all jurisdictions in which a license is held or has been held within the last ten (10) years.

3.2.2.5. Operational computer skills with general working knowledge of word processing, and Microsoft applications (including Windows, Word, Excel, Outlook).

3.2.2.6. General medical ethics, telephone etiquette, written/verbal/electronic communication, and customer service skills.

3.3. Verification of Personnel Qualifications.

3.3.1. The Contractor shall take specific action, including Primary Source Verification, to ensure that all contractor personnel applications have the required prerequisites for application and do not have disqualifying impediments for employment at the MTF. This is a non-delegable responsibility of the Contractor.

3.3.2. The Contractor shall provide and maintain supporting documentation/qualifying factors (e.g. health, security, training certificates, licensures, BLS, initial/annual training requirements, CEUs, immunizations) to the FRED and COR, for only personnel who can meet the requirements of the PWS. The submission of incomplete documentation or personnel lacking the proper pre-requisites qualifications is unacceptable.

3.3.2.1. The Contractor shall ensure supporting documentation/qualifying factors for contractor personnel are renewed at least five (5) business days prior to expiration.

3.3.2.2. In cases where the Contractor is having difficulty finding qualified applicants, an equivalency determination (waiver) request can be sent to the MTF FRED, COR and CO for consideration.

3.3.3. The Contractor shall provide supporting documentation/qualifying factors no later than 14 calendar days from receipt of notice of Government acceptance of proposed Contractor personnel.

3.3.4. The Contractor shall provide a complete personnel package (supporting documentation/qualifying factors) to the FRED and COR that contains the following:

3.3.4.1. A copy of the proposed contractor personnel’s professional resume, accompanied by that individual’s sworn affidavit of the truthfulness of same, indicating experience, education, training, and technical expertise in the type of care to be rendered.

3.3.4.2. A copy of a valid, current, unrestricted state nursing license for RNs and LPNs. Licensure rules of the State Board of Nursing of the state in which the MTF resides shall apply.

3.3.4.3. Security training, investigation appointment schedule and any other pertinent information regarding the individual, schedule and performance start date.

3.3.4.4. A signed consent form for release of information/non-disclosure agreement.

3.3.4.5. health, security, training certificates, licensures, BLS, initial/annual training requirements, CEUs, immunizations

3.3.4.6. The electronic qualifying documentation package must be a single scanned file that the Government can easily view, recognize, and store.

3.3.5. All personnel shall have read and understand information within AFI 44-176, the MHS Guide to Access Success, AFMS MTF Referral Management Guide, TJC, AAAHC and referral management criteria, HIPAA, DoD Health Privacy Regulation (DoD 6025.18-R), the Privacy Act, and DoD Privacy Program (DoD 5400.11-R) prior to the start of work.

3.4. Health Requirements. In accordance with Air Force Joint Instruction 48-110 and Air Force Instruction (AFI) 48-105, all RMC personnel shall follow the methods for controlling and preventing disease as described in the American Public Health Association publication, Control of Communicable Diseases Manual, and the Centers for Disease Control and Prevention (CDC) publication, Morbidity and Mortality Weekly Report (MMWR), and its supplements. For the purposes of this contract, the AFMS considers RMC personnel ―healthcare personnelǁ to whom these requirements apply. Therefore, RMC personnel must comply with all MMWR guidelines.

For purposes of this contract, CDC recommendations are considered requirements.

3.4.1. Prior to start of work, the Contractor is required to supply proof of immunization of RMC personnel working within MTFs for the following diseases: hepatitis B, influenza, measles, mumps, rubella, varicella, Tdap, influenza. In addition, proof of a negative TB skin test completed within the past twelve (12) months (if positive, proof of negative chest X-ray within the past twelve (12) months) is required. The MTF will not provide immunizations or tests for individuals not entitled to medical care.

3.4.1.1. Proof of subsequent immunizations, required for continued employment at the MTF, must be provided on the anniversary of the employee’s hire date or when the option year is executed, whichever comes first.

3.4.2. The MTF will not perform any medical tests or procedures required by the contract for non-beneficiaries except in the rare case of post-exposure in accordance with Air Force, DoD, and CDC guidelines or recommendations.

3.5. Basic Life Support Certification. At a minimum, any Contractor personnel working within an MTF must maintain either current certification in the American Heart Association Basic Life Support (BLS) (Course C) or the American Red Cross CPR/BLS (Heart Saver) Course. Any exceptions are in accordance with the local MTF/CC.

3.5.1. The Contractor shall ensure that RMC personnel obtain initial training at no cost to the Government prior to duty start date so that RMC personnel arrive in their positions fully qualified; however, the Government may offer refresher training for RMC personnel on a space-available basis. If RMC personnel receive training within the facility, the time spent in the training course will not be billable to the Government. The Government will not pay for recertification training obtained outside the MTF.

3.6. Absences and Leave. Contractor personnel shall advise the FRED or other designee in FRED’s absence, about absences due to illness or incapacitation. If the Contractor personnel is absent for three (3) or more consecutive days due to illness, the FRED may require written documentation from a qualified health care provider that he or she is free from communicable disease and the cause of the worker’s current illness, if the MTF’s FRED determines it is necessary.

3.7. Training.

3.7.1. Government Furnished Training: The Government will provide initial on-the-job (OJT) training on Government provided forms and equipment, initial orientation, and annual training requirements specific to the MTF. The Government will also provide initial training, within five (5) business days of task order award, to the Contractors’ education and training department for subsequent Contractor training (“train the trainer”) to their employees on all Government provided forms, equipment, and software application systems to include, but not limited to: HIPAA, Referral Management Business Rules, CHCS, AHLTA, RMS, MCSC referral system, and MiCare. The Contractor’s trainers shall be responsible for all future training necessary to perform the work as defined in this PWS. Training shall not hamper the quantity, quality, or timeliness of daily work requirements.

3.7.1.1. The AMFS designated online learning environment may be used to support pre-placement training requirements, as available. A list of available computer based trainings will be provided to the contractor within five (5) business days after contract award.

3.7.2. Continuous Training. Continued certification and training required to maintain referral management proficiency of contractor employees throughout the period of performance is the responsibility of the Contractor. Training shall not hamper the quantity, quality or timeliness of daily work requirements.

3.8. Conduct. The CO may request that any Contractor personnel whose conduct, in the opinion of the CO, interferes with proper order or whose actions fail to meet the level of professionalism expected of a representative of the AFMS, be removed from any responsibility or service under this contract.

3.8.1. The Contractor shall not employ individuals on this contract who are potential threats to health, safety, security, general well-being, or the operational mission of the DoD and its population. This shall include individuals who are a potential threat because of prior criminal convictions (reference AUTOMATED INFORMATION SYSTEMS (AIS) III SECURITY REQUIREMENTS, Section 5). The Government reserves the right to refuse access to Government facilities and/or operations under this contract to any Contractor personnel, or prospective employee, identified as a potential threat to the health, safety, security, general well-being, or operational mission of the AF and its population.

3.8.2. Contractor personnel working in a Government facility shall maintain good personal hygiene and a well-groomed, professional appearance; at a minimum, business casual dress attire is required. Nametag shall be displayed and visible at all times. A picture identification badge shall depict Contractor name, employee’s name, and employee’s title.

3.8.3. The Contractor shall ensure all government-issued identification badges, keys, and equipment (as appropriate) are returned to the COR or MTF Security Manager when an individual leaves employment under this contract and/or upon expiration of this contract.

3.8.4. No cell phone use is permitted in the duty section. Cell phones may be used outside the duty section.

3.9. Traffic, Safety and Fire Regulations.

3.9.1. The Contractor shall ensure that all Contractor personnel comply with installation and MTF requirements, regulations, and procedures. The Contractor Management Staff shall ensure that Contractor personnel park vehicles only in the designated parking locations.

3.9.2. While working in the MTF, Contractor personnel shall comply with all safety and fire procedures/practices associated with the medical facility and participate in all routine drills if Contractor personnel are present for such drills.

3.9.3. The Government shall not be liable for any injury to the Contractor’s personnel or damage to the Contractor's property unless such injury or damage is due to negligence on the part of the Government and is recoverable under the Federal Torts Claims Act, or pursuant to other Federal statutory authority.

3.10. Travel. The Contractor is solely responsible for their own travel for day to day management and operations, to include any trips to address site or personnel issues and education and training (paragraph 3.7.1.) Travel for Nurse and Administrative staff at MTFs is not authorized and will not be reimbursed.

3.11. Indemnification and Medical Liability Insurance. The Contractor shall provide and maintain liability insurance coverage (minimum of $1,000,000 per occurrence and $3,000,000 general aggregate) consistent with the risks associated with the performance of all services required by this PWS. The Contractor shall provide documentation verifying insurance to the CO no later than thirty (30) calendar days after contract award. Refer to Federal Acquisition Regulation (FAR) Clause 52.237-7, “INDEMNIFICATION AND MEDICAL LIABILITY

INSURANCE.”

3.12. Non-Personal Services. The Government will neither supervise Contractor personnel nor control the method by which the Contractor performs the required tasks. It shall be the responsibility of the Contractor to manage its personnel and to guard against any actions that are of the nature of personal services, or give the perception of personal services. If the Contractor feels that any actions constitute, or are perceived to constitute personal services, it shall be the Contractor’s responsibility to notify the CO immediately. These services shall not be used to perform work of a policy/decision making or management nature, i.e., inherently Governmental functions. All decisions relative to programs supported by the Contractor shall be the sole responsibility of the Government.

4. PLACE OF PERFORMANCE.

4.1. Place of Performance: The Contractor shall determine the appropriate staffing and placement of contractor staff necessary to carry out the services under this contract at the MTFs identified in Appendix A.

4.2. Available Hours of Operation. The Contractor shall provide Referral Management Services during normal “MTF operating hours,” from 7:30 AM through 4:30 PM, Monday through Friday, excluding federal holidays.

4.3. Scheduled Holidays. New Year’s Day; Dr. Martin Luther King, Jr. Birthday; President’s Day; Memorial Day; Independence Day; Labor Day; Columbus Day; Veteran’s Day;

Thanksgiving Day; Christmas Day.

4.4. Planned Closures: Days that Air Force leadership designates as a minimal manning/liberal leave day(s) (i.e. Family day, down day) for Government employees can result in a planned facility closure.

4.4.1. The Referral Management Contractor personnel in the MTFs may perform duties during minimal manning/liberal leave day(s) (i.e. Family day, down day) when Government staff is in the facility for oversight in accordance with MTF policy. At no time shall the Contractor personnel work without Government oversight.

4.5. Unplanned Closures: An unplanned closure is a closure of a federal facility due to a natural disaster, military emergency, severe weather, or any other reason that is not planned.

Unplanned closures exceeding five (5) business days will be evaluated for potential partial termination for convenience.

5. AUTOMATED INFORMATION SYSTEMS (AIS) III AND BASE SECURITY

REQUIREMENTS.

5.1. Personnel Security Requirements: The Contractor shall implement and administer a security program in accordance with DoD 5220.22-M National Industrial Security Program Operating Manual, February 28, 2006 change 1 March 28, 2013 (or current version) to ensure that sensitive information and Government documentation are protected.

5.1.1. Personnel under this contract shall have access to and/or process information requiring protection under the Privacy Act of 1974 on unclassified AIS. Because of this access, personnel working for the Government under this contract are in non-sensitive public trust positions designated as Automated Information Systems III (formally ADP III) positions in accordance with DOD Directive 5200.2-R. In compliance with DOD Directive 5200.2-R and AFI 31-501, Personnel Security Program Management, a National Agency Check with written Inquiries (NACI) is required for all AIS III positions.

5.1.2. The Contractor management staff shall fully adhere to the provisions in referenced publications by having all personnel who are performing under this contract submit the appropriate forms to obtain and maintain a positive suitability determination (favorable outcome from the NACI investigation) for continued performance under this contract.

5.1.3. The Contractor management staff shall appoint a Security Officer to be the point of contact for clearance processing with the Government Unit Security Manager. The Contractor’s Security Officer shall be responsible for coordinating the initiation of the background investigation for all contract personnel prior to contract performance.

5.1.4. The Contractor shall schedule an appointment for new personnel with the Government Unit Security Manager prior to the start date.

5.1.4.1. Following contract award, the Contractor Security Officer is required to provide two (2) printed and signed (original signatures) hardcopies of the SF-85, Questionnaire for Public Trust Positions, as directed by the Government Unit Security Manager.

Access and submit an electronic SF-85, through the Office of Personnel Management web site at https://www.e-quip.opm.gov/equip-applicant/showLogin.login or other website as designated by the Government Unit Security Manager.

5.1.4.2. The Contractor shall ensure that personnel bring the necessary documentation requested on the SF-85 (i.e., full name, date and place of birth (city and state), citizenship, social security number, e-mail address, etc.) to prevent processing delays.

The FRED and the COR shall be notified of any discrepancy or delay.

5.1.5. The Contractor shall advise personnel that a favorable report is required as a condition of employment under this contract. While the MTF Commander may allow contract personnel temporary or interim access to Government computer systems in non-sensitive positions pending the outcome of the NACI, this contract requires the immediate removal of personnel from this contract if the NACI investigation results in an unfavorable or denied adjudication. In addition, the Government will immediately suspend contractor personnel computer access if the NACI is returned with an adjudication of “no determination made.”

5.1.6. The MTF Commander will determine whether to allow the contractor personnel to continue in the public trust position or deny computer access, which requires removal of the personnel from the position.

5.2. Potential Threat. The Contractor management staff shall not employ individuals who are potential threats to health, safety, security, general well-being or operational mission of the Department of Defense (DoD) and its population. This shall include individuals who are a potential threat due to prior criminal convictions. This is in addition to employment eligibility verification (e-verify) requirements cited in FAR 52.222-54.

5.3. Security Education. The Government will be responsible for administering security education training per DoD 5200.1-R Information Security Program Regulation, AFI 31-401 Information Security Program Management, and AFI 31-601 Industrial Security Program Management. All training is mandatory, to include initial, refresher, quarterly, annual security awareness training. Mandatory training also includes Anti-terrorism Awareness training and Operational Security (OPSEC) training. OPSEC training will also address specific security criteria for protecting critical information and OPSEC indicators within the Contractors’ duties.

The Contractor is responsible for ensuring Contractor personnel attend or accomplish this training.

5.4. Pass and Identification Items. The Contractor shall ensure contractor personnel obtain the pass and identification items required for contract performance and accomplish the processes outlined below as required.

5.4.1. Common Access Card (CAC). Each contractor personnel shall have the CAC in his/her possession at all times while working on any Government installation and shall surrender the CAC to the Government Unit Security Manager at the end of his/her employment under this contract or when the CAC expires, whichever occurs first. The Contractor’s Security Officer will ensure a completed security package in accordance with Base or MTF security program policy.

5.4.1.1. Report the loss of any pass and identification items to the issuing activity and the FRED as soon as possible.

5.4.1.2. Retrieving Identification Media. The Contractor shall retrieve all identification media from employees who depart for any reason before the contract expires (e.g., terminated for cause, retirement) and return, within five (5) business days, such media to the issuing office or the location specified by local policy/directives.

5.4.1.3. Reporting Requirements. Contractor personnel shall report to an appropriate authority, any information or circumstances of which they are aware may pose a threat to the security of DOD personnel, Contractor personnel, and resources.

5.4.2. Identification. All Contractor/Subcontractor personnel shall identify themselves as Contractor Personnel during all forms of communications such as business meetings, telephone conversations, electronic mail, attendance sheets, coordination documentations, reports, and the signature blocks utilized in all correspondence. The Contractor/Subcontractor personnel shall wear a picture identification badge and identify their workspace area with their name and company affiliation. The Contractor shall provide an identification badge to Contactor personnel NLT the 1st duty day.

6. SERVICE SUMMARY.

6.1. Service Summary (SS).

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.

6.1.1. Service Summary Table.

Performance Objectives

PWS

Paragraph Performance

Threshold/Standard Surveillance

Method

Schedule specialty referral appointments to MTF or ODCS (ex: other nearby MTF) using CHCS booking procedures, ATC standards, and established clinic capability/ booking protocols as outlined in AFI 44-176, Access to Care Continuum, and in the AFMS Referral Management Guide.

2.1.2.3. 95% scheduling accuracy per MTF per month

Periodic inspection on the last business day of each month via the FREDs

Review the…