Ambulance Services PWS - DRAFT.pdf

PERFORMANCE WORK STATEMENT

FOR

PARAMEDIC / EMERGENCY MEDICAL TECHNICIAN & AMBULANCE SERVICES

KIRTLAND AIR FORCE BASE

3 January 2025

1. GENERAL: This is a non-personal services contract to provide paramedic, emergency medical technician, and ambulance services. The Government will not exercise any supervision or control over contract personnel performing the services herein. Such contract personnel shall be accountable solely to the Contractor who, in turn is responsible to the Government as it applies to this Performance Work Statement and any terms and conditions of any resultant contract.

1.1 DESCRIPTION OF SERVICES: The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, management, supervision, reports, and other items and non-personal services necessary to perform paramedic, emergency medical technician, and ambulance services as defined in this Performance Work Statement (PWS) except for those items specified as government furnished property and services. The contractor shall perform to the standards in this contract. The Contractor shall provide a New Mexico State licensed paramedic, licensed emergency medical technician (EMT), and fully supplied and equipped ambulance for emergency medical response and patient transport for all personnel on Kirtland Air Force Base (KAFB) and 377 MDG Campus 24 hours a day, 7 days a week, 365 days a year.

The Contractor shall be located on KAFB to provide emergency medical response to KAFB and the 377 MDG Campus, as well as subsequent necessary transport.

1.2 SCOPE: Services include the range of paramedic, EMT, and ambulance services provided in the local community, including connectivity to area-wide 911 dispatch. Emergent patients will only be transported to the NMVAHCS Emergency Department (ED) except those excluded, (trauma, Pediatrics, Obstetrics, or civilian patient’s choice), or diverted. Contractor is responsible for billing patients who choose to go to a hospital other than the VA Emergency Department.

Transport of these patients would follow current Contractor procedures and guidance. The contractor shall participate in KAFB air shows, as requested.

1.2.1 Performance shall be according to the requirements contained in this PWS, and professional standards of The Joint Commission, AFI 44-119 Medical Quality Operations, the Department of Transportation (DOT), the National Incident Management System (NIMT), and the New Mexico Emergency Medical System Bureau, PRC and CAAS.

1.3 GENERAL INFORMATION

1.3.1 HOURS OF OPERATION. The Contractor shall provide complete emergency medical response service and transport to KAFB 24 hours a day, 7 days a week, 365 days a year, to include Federal holidays and weekends.

1.3.2 ESSENTIAL CONTRACTOR SERVICES. In accordance with DoDI 3020.37, Continuation of Essential DoD Contractor Services During Crisis, the following services are identified as mission-essential that must not be interrupted during a crisis:

1.3.2.1. During crisis, operations shall continue as outlined in the PWS, and as supplemented in the Contractor’s Mission Essential Contractor Services Plan.

1.3.2.2 EMERGENCY PROCEDURES. Contractor employees shall follow the direction of Government employees in regards to emergency procedures, i.e., fire, tornado, active shooter, bomb threats, etc. It is the responsibility of the Contractor to provide guidance and establish procedures for responding to emergencies for their employees. 377th Medical Group will explain on the job emergency procedures. It is the Contractor's responsibility to account for their employees following an emergency evacuation. Contractor personnel shall participate with Government personnel in all fire, tornado, active shooter, and bomb threats at no additional cost to the Government.

1.3.3. The Contractor shall begin full performance of the contract requirements by the period of performance specified in the contract. It is absolutely critical that a sufficient number of contract paramedics and EMTs to performed required services be licensed according to New Mexico state laws and regulations, as well as any other Contractor standards.

1.4. CONTRACTOR PERSONNEL.

1.4.1. Contract Manager: The Contractor shall designate in writing a Contract Manager (CM), and any alternate(s) who shall act as CM in the manager’s absence. The designation shall be submitted to the Contracting Officer (CO) and the Contracting Officer’s Representative (COR) within two (2) business days after contract award, and include telephone numbers and e-mail addresses where these persons may be contacted at any time. The CM and alternate(s) shall have full authority to act for the Contractor on all matters relating to the operation of this contract.

The CM or alternate(s) shall be available to meet with Government personnel designated by the CO to discuss problem areas. The CM and alternate(s) shall be able to read, write, speak, and understand English fluently. The CM or alternate(s) shall be available 24 hours a day, 7 days a week, and 365 days a year.

1.4.2. Contract Employees. The Contractor shall not employ persons on this contract if such employee is identified to the Contractor as a potential risk to the health, safety, security and/or general well-being or operational mission of the AF and their population. The Contractor shall not employ any person who is an employee of the United States Government, including the Department of the Air Force (AF), either military or civilian, if the employment of that person would create a conflict of interest, unless such person seeks and receives approval according to the DoD 5500.7-R Joint Ethics Regulations (JER). In addition, the Contractor shall not employ any person who is an employee of the AF if such employment would be contrary to the policies contained in AFI 64-106, Air Force Industrial Labor Relations Activities. This shall include all Active Duty and Reservists stationed at Kirtland AFB, NM. The Contractor shall be prohibited from employing off-duty CORs who are surveilling any contracts/subcontracts awarded to the Contractor.

1.4.2.1 All Contractor employees, depending on particular condition, occasion or place, or job assignment shall require professional, suitable attire. All Contractor employees shall conduct themselves in a professional and courteous manner. Contractor employees shall identify themselves as Contractor personnel by displaying distinguishing badges or other visible identification for meetings with Government personnel. In addition, Contractor shall require Contractor personnel to appropriately identify themselves as a Contractor employee in telephone conversations and in formal and informal written correspondence.

1.4.2.2 The selection, assignment, reassignment, transfer, supervision, management, and control of Contractor employees in the performance of the PWS shall be the responsibility and prerogative of the Contractor. However, the Contractor shall comply with the requirements set forth in this PWS, and KAFB regulations concerning conduct of employees as referenced herein.

The Contractor shall employ and maintain a technically trained, experienced, and licensed workforce.

1.4.2.3 The Contractor’s Management will ensure that all employees, to include any sub-contractor employees, performing work in support of this contract receive Operations Security (OPSEC) Awareness training. The training must be accomplished prior to entering the work site on day one of the work effort. The government (i.e., Contracting Officer, Unit Security Assistant, Unit OPSEC Coordinator, or 377 Air Base Wing OPSEC/Signature Manager (377 ABW/SMO)), can provide a tailored lesson plan for use by the Contractor’s Management to ensure training requirements are met. It is critical that contractor employees fully understand the importance of not discussing work details associated with this work effort, such as: actions or activities observed, the statement of work, as-built or other drawings, etc., in public or outside of the worksite. The Contractor’s Management will track all training by employee name and date the training was provided using a spreadsheet or similar document, such as a sign-in roster, and provide a copy to the assigned Contracting Officer.

1.4.3 CONTINUITY OF SERVICES. The Contractor shall ensure that qualified backup paramedics and EMTs are available to provide coverage during scheduled and unscheduled absences of primary scheduled paramedics and EMTs.

1.4.4. WORK ROSTER. The CM shall provide a list with individual names of paramedics and EMTs. This list will be provided to the Contracting Officer's Representative (COR) on a monthly basis or more frequently, if needed. (Deliverable Work Roster)

1.4.4.1. The contractor will provide the COR a cover letter with an employee work roster confirming employee training, DOT licenses, and medical certifications are up to date on a monthly basis or as needed. (Deliverable Confirmation Letter)

1.4.4.2. Listing of Contractor Employees: The Contractor shall provide an initial listing of Contractor's employees' names and position titles to the CO and COR. The Contractor shall also provide an updated listing of personnel to the CO and COR when employees affecting the work of this contract have a status or position change.

1.4.5. Quarterly meetings with CM, COR, and 377 MDG personnel are required to address any concerns.

1.4.5 HEALTH REQUIREMENTS.

1.4.5.1. Contract personnel providing services under this contract shall receive a pre-employment physical examination and immunizations prior to commencement of work and annually thereafter. Examinations, testing, and immunizations are the responsibility of the Contractor.

1.4.5.1.1. No later than five (5) business days before the period of performance begins, and upon request, certification shall be provided to the COR that paramedics and EMT have completed medical evaluations required above. This certification shall state the date on which the examination was completed, the doctor's name that performed the examination, and a statement concerning the physical health of the individual. (Deliverable Statement)

1.4.5.3. Also, as a condition of employment, OSHA requires that all contract personnel who will have occupational exposure to blood or body fluids, or other potentially infectious materials, shall receive Hepatitis B vaccine, sign a voluntary declination, or have documented proof of immunity to Hepatitis B infection. Personnel who sign declinations may change their minds at any time and receive the Hepatitis B vaccine without penalty. Immunizations are the responsibility of the Contractor.

1.4.5.4. The Contractor shall report to the COR all information necessary to assure medical records can be maintained correctly, and therefore comply with The Joint Commission, OSHA, and Center for Disease Control (CDC) health records requirements within 5 business days of any Government request.

1.5. QUALITY CONTROL (QC). The Contractor shall develop an effective QC program to ensure services are performed in accordance with the PWS. The Contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The Contractor’s QC program is the means by which the company assures itself that work complies with the requirement of the contract. The Contractor’s QC plan (QCP) shall be provided to the CO and COR within 30 calendar days after contract award, and within 14 calendar days after changes to the plan occur. The CO and COR will review the QCP, and the CO will communicate in writing the acceptance of the plan. At minimum, the QCP shall address the areas identified in the service summary. (Deliverable Quality Control Program)

1.6. QUALITY ASSURANCE.

1.6.1. Quality Assurance Surveillance Plan. The Government will evaluate the Contractor’s performance under this contract using the methods of surveillance specified in the Quality

Assurance Surveillance Plan (QASP). This plan is primarily focused on what the Government must do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

1.6.2 Contracting Officer’s Representative (COR). The COR is a representative of the CO and monitors all technical aspects of the contract and will participate in the administration of this contract. The COR is authorized to perform the following functions: assure that the Contractor performs the technical requirements of the contract, perform inspections necessary in connection with contract performance, maintain written and oral communications with the Contractor concerning technical aspects of the contract, issue written interpretations of technical requirements, including Government specifications, monitor Contractor's performance and notifies both the Contracting Officer and Contractor of any deficiencies, coordinate availability of Government furnished property, and provide base access to Contractor personnel. A letter of designation issued to the COR, a copy of which is sent to the Contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the resulting order. Any matter concerning a change to the scope, prices, terms, or conditions of this contract shall be referred to the CO.

1.6.3. Performance Remedies. When performance issues are identified, the COR will document the non-conforming performance as outlined in the QASP. Remedies may require the Contractor’s submission of a corrective action plan or performance improvement plan to resolve a performance issue.

1.7. ENVIRONMENTAL PROTECTION AND SAFETY.

1.7.1. Environmental Protection and Safety: The Contractor and its employees shall be knowledgeable of and comply with all applicable federal, state, and local laws, regulations, instructions, and requirements regarding environmental protection and occupational safety and health. The Contractor shall comply with any laws, instructions, or regulation changes during the term of this contract, at no additional cost to the Government. The Contractor shall follow manufacturer's guidelines and professional recommendations for control of humidity, temperature, cleanliness, and materials handling (including hazardous materials, hazardous waste, and medical waste).

1.7.2. Hazardous Material: Hazardous materials, hazardous waste, and medical waste generated by the contractor shall not be disposed of on KAFB or the NMVAHCS campus. In the event of a spill which could cause any harmful environmental effects, the Contractor shall immediately report the incident to the COR and shall submit a report about the incident within four (4) hours.

The format of the report shall be left up to the Contractor, but the report shall contain the following information:

• Name and contact number of person reporting the incident

• Date and time of incident

• Location and source of incident

• Substance or pollutant spilled

• Amount spilled and rate of discharge

• Any damages or injuries involved

• Extent of area impacted

• Potential hazards

• Actions taken

• Organizations contacted

• Remarks Section - That addresses the cause of the spill (e.g., human error, equipment, etc.) and whether 911 was called and which agencies responded.

1.7.3. Environmental and Safety Training: The Contractor's personnel shall have Resource Conservation Recovery Act (RCRA) environmental and safety training required by state and federal government. The training shall be provided by the Government and in accordance with the following regulations:

a) Occupational Safety and Health Administration (OSHA) Hazardous Waste Operations and Emergency Response Standard Title 29, CFR Part 1910.120 "Hazardous Waste Operations and Emergency Responses" 40 CFR Part 63.741-40 and CFR 63.753, Subpart GG-National Emission Standards of Aerospace Manufacturing and Rework Facilities.

b) AFI 32-7042, "Solid and Hazardous Waste Compliance" - The Contractor shall provide the environmental and safety training certificate for all employees to the CO and COR within thirty (30) calendar days after contract award date. (Deliverable Cover Sheet)

1.8. HEALTH AND SAFETY ON GOVERNMENT INSTALLATIONS. In performing work under this contract on a Government installation, the Contractor shall comply with the specific health and safety requirements established by this contract.

1.9. INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE. The Contractor shall provide and maintain adequate liability insurance coverage consistent with the risks associated with the performance of all services required by this PWS. Refer to Federal Acquisition Regulation (FAR) Clause 52.237-7, "INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE". The Contractor may fulfill the obligations of this Section via a program of self-insurance.

1.10. VEHICLE EQUIPMENT.

1.10.1. The Contractor shall be required to provide all emergency vehicles equipped with the required medical equipment to provide emergency medical response services IAW this PWS.

1.10.2. Privately Owned Motor Vehicles (POVs): Contractor personnel shall comply with the directives pertaining to operation and parking of POVs at any location at the 377 MDG or

KAFB.

1.11. PHASE-IN/PHASE-OUT.

1.11.1. Contractor Phase-In: The phase-in period occurs during the thirty (30) calendar day prior to the start of the period of performance. The Contractor shall hire a workforce to assure satisfactory performance beginning on the contract start date.

1.11.2. Contractor Phase-Out Requirements: In the event the follow-on contract is not awarded to the incumbent, the incumbent Contractor shall be fully responsible for all work performed under this PWS. The incumbent Contractor shall cooperate fully to permit an orderly changeover of workload. The incumbent Contractor shall allow the new contractor and Government personnel access on a non-interference basis, to observe the day-to-day operations and to become familiar with the work requirements and procedures.

1.11.3. The Contractor shall begin the orientation as required by the COR. During the orientation period, the Contractor shall complete the following:

1.11.3.1. The Contractor must have a license to provide ambulance services on and around KAFB from the New Mexico State Department of Health, EMS Division.

1.11.3.2. Access KAFB facilities in order to familiarize supervisors, key personnel, and staff with equipment, reporting, work schedules, and procedures. However, such access will not interfere with the production efforts of current work force. To preclude such interference, arrangements for access to government facilities will be made with the COR.

1.11.3.4. Provide paramedic and EMT licenses from the State of New Mexico no later than five

(5) business days before period of performance begins. (Deliverable Licenses)

2. PARAMEDIC/EMERGENCY MEDICAL TECHNICIAN & AMBULANCE

SERVICES

2.1. CERTIFICATION REQUIREMENTS. The Contractor shall provide a copy of the following certification requirements upon request. (Deliverable Certifications):

2.1.1. Current Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS) certification, and NM EMS certification.

2.1.2. Certification of current physical examination for each employee signed by the examining physician. Physical examination must be current as of 24 months prior to contract’s start date.

2.2. LICENSE/REGISTRATION. All contractor paramedics and EMTs shall possess a valid, unrestricted paramedic or EMT license from the State of New Mexico.

2.3. EDUCATION & TRAINING REQUIREMENTS AND FORMAL EDUCATON.

Contractor paramedics and EMTs shall have completed all courses required to obtain and maintain licensure as a paramedic or EMT. Additionally, continuing medical education (CME), which shall be Contractor provided, shall be accomplished as required. Provide certifications as requested by COR. (Deliverable Certifications)

2.4. COMMUNICATION.

2.4.1. The Contractor shall ensure contract paramedics and EMTs maintain open and professional communication with members of KAFB or serviced population. Complaints received by 377 MDG will be passed along to the OCR for review and validation. Valid complaints will be addressed according to a remedy outlined in the QASP.

2.4. Contractor will use their current EMS dispatch for all 911 calls for KAFB.

2.5. PROTOCOL. [The Contractor shall submit their pre-hospital protocols as part of the proposal. This portion of the PWS will be updated at contract award to include protocols.]

2.7. AMBULANCE RESPONSE. The Contractor shall provide an emergency medical response to emergencies as requested within DODI 6055.06, Fire and Emergency Services Guides response times of 12 minutes, 90 percent of the time, calculated from the time of initial dispatch. This calculation shall be done monthly and averaged for the previous three months for a rolling quarterly report submitted monthly. The response shall include the transfer of emergent patients from KAFB to the NMVAHCS ED. (Deliverable Response Times)

2.8. DOCUMENTATION.

2.8.1. Paramedics and EMTs shall prepare all documentation to meet or exceed established standards of the Contractor, to include, but not limited to, timeliness, legibility, accuracy, completeness, and signatures. Contractor may choose to use an electronic health record. The paramedic shall ensure complete patient identifying information is on all documentation to be provided to the COR relating to the transport. The Contractor shall be required to complete run sheets on each response and forward same to the COR. All original documentation shall remain the property of the Government and contractor may retain copies for QI purposes.

2.8.2. Patient information shall be collected and reported to include the following information:

Date of Transport

Patient's Name Call Location Destination Nature of Call Response Time Run Report/Dispatch # Notes Beneficiary Status (Active Duty, TRICARE, VA, Other Health Insurance)

2.9. RECORDS. The Contractor shall be responsible for creating, maintaining, and disposing of only those government required records which are specifically cited in this PWS or as may be required by the provisions of a mandatory directive listed in Appendix B of this PWS. If requested by the Government, the Contractor shall provide the original record or a reproducible copy of any such records within five (5) working days of receipt of the request. A daily call volume report must be provided to the Administrative Officer of the Day (AOD) at the end of each shift. The AOD will forward the report/dispatch numbers to the COR at the beginning of the next duty day. (Deliverable Report)

2.10. PATIENT INFORMATION. Patient information, no matter how developed, shall be treated as privileged information under the Privacy Act, Health Insurance Portability and Accountability Act (HIPAA), and applicable release of information guidelines. Lists and/or names of patients shall not be disclosed to or revealed in any way for any use outside the 377 MDG or KAFB without prior written permission of the 377 MDG Chief of Staff.

2.11. RELEASE OF MEDICAL INFORMATION. The paramedics and EMTs shall only release medical information obtained during the course of this contract to the patient, staff of the 377 MDG, or community hospital involved in the care and treatment of that individual patient.

2.12.. PATIENT SENSITIVITY. Contract paramedics and EMTs shall respect and maintain the basic rights of patients demonstrating concern for personal dignity and human relationships.

Patient complaints of paramedics and EMTs shall be submitted to the COR for review and validation. Valid complaints will be addressed according to a remedy outlined in the QASP. A copy of all complaints will be provided to the Contractor.

2.13. Must have and maintain current Government-provided maps of KAFB in the ambulance.

2.13 BILLING

2.14 KAFB AIR SHOWS/SPECIAL EVENTS.

2.14.1 The contractor shall be responsible for participating in any KAFB, 377 ABW, 377 MDG and Fire Department training, exercises and special events upon request from the COR. The contractor shall provide up to 100 hours per period of performance for ambulance stand-by coverage in addition to normal coverage hours specified in paragraph 1.3.1. The CO or COR will notify the contractor at least seven business days prior to the start of the special event and the number of dedicated ambulances required. Specific contractor responsibilities in support of these special events may include:

2.14.1.1. Participating in pre & post exercise/event meetings.

2.14.1.2. Responding to exercise/event sites and performing simulated duties.

2.14.1.3. Coordinating all activities during exercises/events with the On-Scene Medical Director, IC or event point of contact.

2.14.1.4. Providing sufficient ambulance coverage for special events while simultaneously supporting non-event response.

2.15. BUSINESS ASSOCIATE AGREEMENT (BAA)

2.15.1. Introduction. In accordance with 45 CFR 164.502(e)(2) and 164.504(e) and paragraph C.3.4.1.3 of DoD 6025.18-R, “DoD Health Information Privacy Regulation,”

January 24, 2003, this document serves as a business associate agreement (BAA) between the signatory parties for purposes of the Health Insurance Portability and Accountability Act (HIPAA) and the “HITECH Act” amendments thereof, as implemented by the HIPAA Rules and DoD HIPAA Issuances (both defined below). The parties are a DoD Military Health System (MHS) component, acting as a HIPAA covered entity, and a DoD contractor, acting as a HIPAA business associate. The HIPAA Rules require BAAs between covered entities and business associates. Implementing this BAA requirement, the applicable DoD HIPAA Issuance (DoD 6025.18-R, paragraph C3.4.1.3) provides that requirements applicable to business associates must be incorporated (or incorporated by reference) into the contract or agreement between the parties.

2.15.2. Catchall Definition. Except as provided otherwise in this BAA, the following terms used in this BAA shall have the same meaning as those terms in the DoD HIPAA Rules:

Data Aggregation, Designated Record Set, Disclosure, Health Care Operations, Individual, Minimum Necessary, Notice of Privacy Practices (NoPP), Protected Health Information (PHI), Required By Law, Secretary, Security Incident, Subcontractor, Unsecured Protected Health Information, and Use.

2.15.2.1. Breach means actual or possible loss of control, unauthorized disclosure of or unauthorized access to PHI or other PII (which may include, but is not limited to PHI), where persons other than authorized users gain access or potential access to such information for any purpose other than authorized purposes, where one or more individuals will be adversely affected. The foregoing definition is based on the definition of breach in DoD Privacy Act Issuances as defined herein.

2.15.2.2. Business Associate shall generally have the same meaning as the term “business associate” in the DoD HIPAA Issuances, and in reference to this BAA, shall mean Contractor.

2.15.2.3. Agreement means this BAA together with the documents and/or other arrangements under which the Contractor performs services involving access to PHI on behalf of the Government.

2.15.2.4. Covered Entity shall generally have the same meaning as the term “covered entity” in the DoD HIPAA Issuances.

2.15.2.5. DHA Privacy Office means the DHA Privacy and Civil Liberties Office. The DHA Privacy Office Director is the HIPAA Privacy and Security Officer for DHA, including the National Capital Region Medical Directorate (NCRMD).

2.15.2.6. DoD HIPAA Issuances means the DoD issuances implementing the HIPAA Rules in the DoD Military Health System (MHS). These issuances are DoD 6025.18-R (2003), DoDI

6025.18 (2009), and DoD 8580.02-R (2007).

2.15.2.7. DoD Privacy Act Issuances means the DoD issuances implementing the Privacy Act, which are DoDD 5400.11 (2007) and DoD 5400.11-R (2007).

2.15.2.8. Health and Human Services (HHS) Breach means a breach that satisfies the HIPAA Breach Rule definition of breach in 45 CFR 164.402.

2.15.2.9. HIPAA Rules means, collectively, the HIPAA Privacy, Security, Breach and Enforcement Rules, issued by the U.S. Department of HHS and codified at 45 CFR Part 160 and Part 164, Subpart E (Privacy), Subpart C (Security), Subpart D (Breach) and Part 160, Subparts C-D (Enforcement), as amended by the 2013 modifications to those Rules, implementing the “HITECH Act” provisions of Pub. L. 111-5. See 78 FR 5566-5702 (Jan.

25, 2013) (with corrections at 78 FR 32464 (June 7, 2013)). Additional HIPAA rules regarding electronic transactions and code sets (45 CFR Part 162) are not addressed in this BAA and are not included in the term HIPAA Rules.

2.15.2.10. Service-Level Privacy Office means one or more offices within the military services (Army, Navy, Air Force, or Space Force) with oversight authority over Privacy Act and HIPAA privacy compliance.

2.15.3. Obligations and Activities of Contractor

2.15.3.1. The Contractor shall not use or disclose PHI other than as permitted or required by the contract or as required by law.

The Contractor shall use appropriate safeguards, and comply with the DoD HIPAA Rules with respect to electronic PHI, to prevent use or disclosure of PHI other than as provided for by the contract.

2.15.3.2. The Contractor shall report to the CO or COR any Breach of which it becomes aware, and shall proceed with breach response steps as required below. With respect to electronic PHI, the Contractor shall also respond to any security incident of which it becomes aware in accordance with any Information Assurance provisions of the contract. If at any point, the Contractor becomes aware that a security incident involves a Breach, the Contractor shall promptly initiate breach response as required below.

2.15.3.3. In accordance with 45 CFR 164.502(e)(1)(ii)) and 164.308(b)(2), ( respectively), as applicable, the Contractor shall ensure that any subcontractors that create, receive, maintain, or transmit PHI on behalf of the Contractor agree to the same restrictions, conditions, and requirements that apply to the Contractor with respect to such PHI.

2.15.3.4. The Contractor shall make available PHI in a Designated Record Set, to the CO or COR or, as directed by the Government, to an Individual, as necessary to satisfy the Government's obligations under 45 CFR 164.524.

2.15.3.5. The Contractor shall make any amendment(s) to PHI in a Designated Record Set as directed or agreed to by the Government pursuant to 45 CFR 164.526, or take other measures as necessary to satisfy Government's obligations under 45 CFR 164.526.

2.15.3.6. The Contractor shall maintain and make available the information required to provide an accounting of disclosures to the Government or an Individual as necessary to satisfy the Government's obligations under 45 CFR 164.528.

2.15.3.7. To the extent the Contractor is to carry out one or more of the Government's obligation(s) under the HIPAA Privacy Rule, the Contractor shall comply with the requirements of HIPAA Privacy Rule that apply to the Government in the performance of such obligation(s).

2.15.3.8. The Contractor shall make its internal practices, books, and records that pertain to this contract available to the Secretary of the Department of HHS and/or the CO or COR for purposes of determining compliance with the HIPAA Rules.

2.15.4 Permitted Uses and Disclosures by the Contractor

2.15.4.1. The Contractor may only use or disclose PHI as necessary to perform the services set forth in the contract or as required by law. The Contractor is not permitted to de-identify PHI under DoD HIPAA issuances or the corresponding 45 CFR 164.514(a)-(c), nor is it permitted to use or disclose de-identified PHI, except as provided by the Contract or directed by the Government.

2.15.4.2. The Contractor agrees to use, disclose, and request PHI only in accordance with the HIPAA Privacy Rule “minimum necessary” standard and corresponding DHA policies and procedures as stated in the DoD HIPAA Issuances.

2.15.4.3. The Contractor shall not use or disclose PHI in a manner that would violate the DoD HIPAA Issuances or HIPAA Privacy Rules if done by the Government, except uses and disclosures for the Contractor's own management and administration and legal responsibilities or for data aggregation services as set forth in the following three paragraphs.

2.15.4.4. Except as otherwise limited in the contract, the Contractor may use PHI for the proper management and administration of the Contractor or to carry out the legal responsibilities of the Contractor. The foregoing authority to use PHI does not apply to disclosure of PHI, which is covered in the next paragraph.

2.15.4.5. Except as otherwise limited in the contract, the Contractor may disclose PHI for the proper management and administration of the Contractor or to carry out the legal responsibilities of the Contractor, provided that disclosures are required by law, or the Contractor obtains reasonable assurances from the person to whom the PHI is disclosed that it will remain confidential and used or further disclosed only as required by law or for the purposes for which it was disclosed to the person, and the person notifies the Contractor of any instances of which it is aware in which the confidentiality of the information has been breached.

2.15.4.6. Except as otherwise limited in the contract, the Contractor may use PHI to provide Data Aggregation services relating to the Government's health care operations.

2.15.5. Provisions for Government to Inform Contractor of Privacy Practices and Restrictions

2.15.5.1. The Government shall provide the Contractor with the Notice of Privacy Practices that the Government produces in accordance with 45 CFR 164.520 and the corresponding provision of the DoD HIPAA Issuances.

2.15.5.2. The Government shall notify the Contractor of any changes in, or revocation of, the permission by an Individual to use or disclose his or her PHI, to the extent that such changes affect the Contractor's use or disclosure of PHI.

2.15.5.3. The Government shall notify the Contractor of any restriction on the use or disclosure of PHI that the Government has agreed to or is required to abide by under 45 CFR 164.522, to the extent that such changes may affect the Contractor's use or disclosure of PHI.

2.15.6. Permissible Requests by Government. The Government shall not request the Contractor to use or disclose PHI in any manner that would not be permissible under the HIPAA Privacy Rule or any applicable Government regulations (including without limitation, DoD HIPAA Issuances) if done by the Government, except for providing Data Aggregation services to the Government and for management and administrative activities of the Contractor as otherwise permitted by this BAA.

2.15.7. Breach Response

2.15.7.1. In general.

In the event of a breach of PII/PHI held by the Contractor, the Contractor shall follow the breach response requirements set forth below, which is designed to satisfy both the Privacy Act and HIPAA, as applicable. If a breach involves PII without PHI, then the Contractor shall comply with DoD Privacy Act Issuance breach response requirements only; if a breach involves PHI (a subset of PII), then the Contractor shall comply with both Privacy Act and HIPAA breach response requirements. A breach involving PHI may or may not constitute an HHS Breach. If a breach is not an HHS Breach, then the Contractor has no HIPAA breach response obligations. In such cases, the Contractor must still comply with breach response requirements under the DoD Privacy Act Issuances.

If the DHA Privacy Office determines that a breach is an HHS Breach, then the Contractor shall comply with both the HIPAA Breach Rule and DoD Privacy Act Issuances, as directed by the DHA Privacy Office, regardless of whether the breach occurs at DHA or at one of the Service components. If the DHA Privacy Office determines that the breach does not constitute an HHS Breach, then the Contractor shall comply with DoD Privacy Act Issuances, as directed by the CO or COR. The following provisions set forth the Contractor's Privacy Act and HIPAA breach response requirements for all breaches, including but not limited to HHS breaches.

This following section is designed to satisfy the DoD Privacy Act Issuances and the HIPAA Breach Rule as implemented by the DoD HIPAA Issuances. In general, for breach response, the Contractor shall report the breach to the Government (CO or COR), assess the breach incident, notify affected individuals, and take mitigation actions as applicable.

Because DoD defines “breach” to include possible (suspected) as well as actual (confirmed) breaches, the Contractor shall implement these breach response requirements immediately upon the Contractor's discovery of a possible breach.

2.15.7.2. Government Reporting Provisions

The Contractor shall report the breach within one (1) hour of discovery to the US Computer Emergency Readiness Team (US CERT), and, within 24 hours of discovery to the DHA Privacy Office and the other parties set forth below. The Contractor is deemed to have discovered a breach as of the time a breach (suspected or confirmed) is known to any person (other than the person committing it) who is an employee, officer, or other agent of the Contractor.

The Contractor shall submit the US CERT report using the online form at https://forms.us-cert.gov/report/. Before submission to US CERT, the Contractor shall save a copy of the report. After submission, the Contractor shall record the US CERT Reporting Number.

Although only limited information about the breach may be available as of the one hour deadline for submission, the Contractor shall submit the US CERT report by the deadline. The Contractor shall e-mail updated information as it is obtained, following the instructions at:

http://www.us-cert.gov/pgp/email.html. The Contractor shall provide a copy of the initial or updated US CERT report to the DHA Privacy Office and the CO or COR, if requested by either. Contractor questions about US CERT reporting shall be directed to the DHA, CO or COR, not the US CERT office.

The Contractor report, due within 24 hours, shall be submitted by completing the New Breach Reporting Form DD 2959 at the Breach Response page on the DHA Privacy Office web site and email that form to, as applicable, the DHA Privacy Office, the CO and COR, the Contractor's DoD point of contact (POC), unless the POC specifies another addressee for breach reporting. Encryption is not required, because Breach Report Forms should not contain individually identifiable PII/PHI. The email address for notices to the DHA Privacy Office is provided at the Privacy Office website breach response page. If electronic mail is not https://forms.us-cert.gov/report/ https://forms.us-cert.gov/report/ http://www.us-cert.gov/pgp/email.html available, telephone notification is also acceptable, but all notifications and reports delivered telephonically must be confirmed by email as soon as technically feasible.

If multiple beneficiaries (for example: patients treated and/or transported) are affected by a single event or related set of events, then a single reportable breach may be deemed to have occurred, depending on the circumstances. The Contractor shall inform the DHA Privacy Office as soon as possible if it believes that “single event” breach response is appropriate; the DHA Privacy Office will determine how the Contractor shall proceed and, if appropriate, consolidate separately reported breaches for purposes of Contractor report updates, beneficiary (for example: patients treated and/or transported) notification, and mitigation.

When a Breach Report Form initially submitted is incomplete or incorrect due to unavailable information, or when significant developments require an update, the Contractor shall submit a revised form or forms, stating the updated status and previous report date(s) and showing any revisions or additions in red text. Examples of updated information the Contractor shall report include, but are not limited to: confirmation on the exact data elements involved, the root cause of the incident, and any mitigation actions to include, sanctions, training, incident containment, follow-up, etc. The Contractor shall submit these report updates promptly after the new information becomes available. Prompt reporting of updates is required to allow the DHA Privacy Office to make timely final determinations on any subsequent notifications or reports. The Contractor shall provide updates to the same parties as required for the initial Breach Reporting Form. The Contractor is responsible for reporting all information needed by the DHA Privacy Office to make timely and accurate determinations on reports to t h e D e p a r t m e n t o f HHS as required by the HHS Breach Rule and reports to the Defense Privacy and Civil Liberties Office as required by DoD Privacy Act Issuances.

In the event the Contractor is uncertain on how to apply the above requirements, the Contractor shall consult with the DHA Privacy Office (or the CO or COR, which will consult with the Privacy Office as appropriate) when determinations on applying the above requirements are needed.

2.15.7.3. Individual Notification Provisions

If the DHA Privacy Office determines that individual notification is required, the Contractor shall provide written notification to individuals affected by the breach as soon as possible, but no later than ten (10) working days after the breach is discovered and the identities of the individuals are ascertained. The 10-day period begins when the Contractor is able to determine the identities (including addresses) of the individuals whose records were impacted.

The Contractor's proposed notification to be issued to the affected individuals shall be submitted to the parties to which reports are submitted under the above paragraphs for their review, and for approval by the DHA Privacy Office. Upon request, the Contractor shall provide the DHA Privacy Office with the final text of the notification letter sent to the affected individuals. If different groups of affected individuals receive different notification letters, then the Contractor shall provide the text of the letter for each group. (PII shall not be included with the text of the letter(s) provided.) Copies of further correspondence with affected individuals need not be provided unless requested by the Privacy Office. The Contractor's notification to the individuals, at a minimum, shall include the following:

• The individual(s) must be advised of what specific data was involved. It is insufficient to simply state that PII has been lost. Where names, Social Security Numbers (SSNs) or truncated SSNs, and Dates of Birth (DOBs) are involved, it is critical to advise the individual that these data elements potentially have been breached.

• The individual(s) must be informed of the facts and circumstances surrounding the breach. The description should be sufficiently detailed so that the individual clearly understands how the breach occurred.

• The individual(s) must be informed of what protective actions the Contractor is taking or the individual can take to mitigate against potential future harm. The notice must refer the individual to the current Federal Trade Commission (FTC) web site pages on identity theft and the FTC’s Identity Theft Hotline, toll-free: 1-877-ID-THEFT (438- 4338); o r a t TTY line: 1-866-653-4261.

• The individual(s) must also be informed of any mitigation support services (e.g., one year of free credit monitoring, identification of fraud expense coverage for affected individuals, provision of credit freezes, etc.) that the Contractor may offer affected individuals, the process to follow to obtain those services and the period of time the services will be made available, and contact information (including a phone number, either direct or toll-free, email address, and postal address) for obtaining more information.

The Contractor shall ensure any envelope containing written notifications to affected individuals are clearly labeled to alert the recipient to the importance of its contents, e.g., “Data Breach Information Enclosed,” and that the envelope is marked with the identity of the Contractor and/or subcontractor organization that suffered the breach. The letter must also include contact information for a designated POC to include, phone number, email address, and postal address.

If the Contractor determines that it cannot readily identify, or will be unable to reach, some affected individuals within the 10-day period after discovering the breach, the Contractor shall so indicate in the initial or updated Breach Report Form. Within the 10- day period, the Contractor shall provide the approved notification to those individuals who can be reached.

Other individuals must be notified within 10 days after their identities and addresses are ascertained. The Contractor shall consult with the DHA Privacy Office, which will determine which media notice is most likely to reach the population not otherwise identified or reached. The Contractor shall issue a generalized media notice(s) to that population in accordance with Privacy Office approval.

The Contractor shall, at no cost to the government, bear any costs associated with a breach of PII/PHI that the Contractor has caused or is otherwise responsible for addressing.

Breaches are not to be confused with security incidents (often referred to as cyber- security incidents when electronic information is involved), which may or may not involve a breach of PII/PHI. In the event of a security incident not involving a PII/PHI breach, the Contractor shall follow applicable DoD Information Assurance requirements under its contract. If at any point the Contractor finds that a cyber-security incident involves a PII/PHI breach (suspected or confirmed), the Contractor shall immediately initiate the breach response procedures set forth here. The Contractor shall also continue to follow any required cyber security incident response procedures to the extent needed to address security issues, as determined by DoD/DHA.

2.15.7.4. Termination

Non-compliance by the Contractor (or any of its staff, agents, or subcontractors) with any requirement in this BAA may subject the Contractor to termination under any applicable default or other termination provision of the contract.

2.15.7.5. Effect of Termination.

If the contract has records management requirements, the Contractor shall handle such records in accordance with the records management requirements. If the contract does not have records management requirements, the records should be handled in accordance with paragraphs below. If the contract has provisions for transfer of records and PII/PHI to a successor Contractor, or if DHA gives directions for such transfer, the Contractor shall handle such records and information in accordance with such contract provisions or DHA direction.

If the contract does not have records management requirements, except as provided in the following paragraph, upon termination of the contract, for any reason, the Contractor shall return or destroy all PHI received from the Government, or created or received by the Contractor on behalf of the Government that the Contractor still maintains in any form. This provision shall apply to PHI that is in the possession of subcontractors or agents of the Contractor. The Contractor shall retain no copies of the PHI. Notwithstanding the foregoing, the Contractor may retain an archival copy or PHI for its own management and administration or to carry out its legal responsibilities after the termination of the Agreement provided that the Contractor continues to use appropriate safeguards and comply with Subpart C or 45 CFR Part 164 for so long as the Contractor retains the PHI.

If the contract does not have records management provisions and the Contractor determines that returning or destroying the PHI is infeasible, the Contractor shall provide to the Government notification of the conditions that make return or destruction infeasible. Upon mutual agreement of the Government and the Contractor that return or destruction of PHI is infeasible, the Contractor shall extend the protections of the contract to such PHI and limit further uses and disclosures of such PHI to those purposes that make the return or destruction infeasible, for so long as the Contractor maintains such PHI.

2.15.7.6. Miscellaneous

Survival. The obligations of Contractor under the “Effect of Termination” provision of this BAA shall survive the termination of the contract.

Interpretation. Any ambiguity in the contract shall be resolved in favor of a meaning that permits the Government and the Contractor to comply with the HIPAA Rules and the DoD HIPAA Rule.

3. SERVICE SUMMARY (SS)

SS

Item

Performance Objective PWS Para

Performance Threshold

SS-1 Service: Provide 24-hour, NM state licensed paramedics for emergency medical response (EMR) and transport, and for medical services within the scope of their license to the NMVAHCS

ED

1.1 100%

SS-2 Service: Provide 24-hour, NM state licensed EMTs for EMR and transport, and for medical services within the scope of their license to the NMVAHCS ED

1.1 100%

SS-3 Service: Provide fully equipped and supplied ambulance for EMR and transport on KAFB and the 377 MDG campus

1.1 100%

SS-4 EMR: Response time to emergencies in 12 minutes or less. 1.8 90%

SS-5 Documentation: Preparation of all required run sheets to meet current Contractor EMR standards, including but not limited to, timeliness, legibility, accuracy, content, and signature.

1.9 100%

SS-6 Arrangement of Replacement Staff: Provide fully licensed paramedics and EMTs for 24-hour coverage

1.2.1 100%

SS-7 Health Requirements: Physical examinations and required immunizations…