Atch 1 - Performance Work Statement.pdf

PERFORMANCE WORK STATEMENT

FOR

SPECIAL NEEDS IDENTIFICATION AND ASSIGNMENT COORDINATOR (SNIAC)

52 Medical Group Spangdahlem Air Base, Germany

PERFORMANCE WORK STATEMENT (PWS)

Special Needs Identification and Assignment Coordinator (SNIAC)

PART 1

GENERAL INFORMATION

1. GENERAL: This is a personal services contract to provide a Special Needs Identification and Assignment Coordinator (SNIAC).

1.1 Description of Services/Introduction: The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and personal services necessary to perform duties as a SNIAC 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.

1.2 Objectives: The primary purpose of this position is to serve as the SNIAC, overseeing the Family Member Relocation Clearance (FMRC) program.

1.3 Scope: In addition to the above main objective, the extended scope is to perform administrative duties concerning the coordination, processing, review and maintenance of medical records and information pertaining to individuals and families assigned to this installation or preparing to serve in overseas assignments and some CONUS assignments; to maintain SNIAC records; to ensure service availability for families relocating in conjunction with a Permanent Change of Station (PCS); to process Command Sponsorship requests and documents; to use a multi-disciplinary and collaborative approach with other key service providers, such as installation youth and childcare facilities, and officer and enlisted spouses groups, to ensure effective outreach and identification of special needs; to identify and enroll Active Duty (AD) Air Force families who meet eligibility criteria for SNIAC; to ensure Air Force (AF) sponsors assigned to the installation, or whose personnel functions are handled at the installation, are “Q-coded” (Exceptional Family Member Program - EFMP-enrolled) regardless of location of family members and to ensure compliance with Department of Defense (DoD) directives, AF policy and local Military Treatment Facility (MTF) instructions.

1.4. Period of Performance: The period of performance shall be for one (1) Base Year of 12 months and four (4) 12-month option years. The period of performance reads as follows:

Base Year - February 1, 2022 - January 31, 2023 Option Year 1 - February 1, 2023 - January 31, 2024 Option Year 2 - February 1, 2024 - January 31, 2025 Option Year 3 - February 1, 2025 - January 31, 2026 Option Year 4 - February 1, 2026 - January 31, 2027

1.5 General Information

1.5.1 Management Plan: The contractor shall provide a complete Commercial Management Plan to ensure the requirements of the contract are provided as specified. The contractor shall provide a plan describing the inspection system for the requested services listed in the PWS. The contractor shall develop and implement procedures to identify, prevent and ensure non-recurrence of unacceptable services. The contractor’s plan must be submitted with their initial proposal to the Contracting Officer (CO) for review and acceptance. The contractor shall update the plan as changes occur and changes shall be submitted for review by the CO.

1.5.2 Quality Assurance: The Government shall evaluate the contractor’s performance under this contract in accordance with 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).

1.5.3 Recognized Holidays:

New Year’s Day Labor Day Martin Luther King Jr.’s Birthday Columbus Day President’s Day Veteran’s Day Memorial Day Juneteenth Day Thanksgiving Day Independence Day Christmas Day

1.5.4 Family/Down Days: “Family Day/Down Day” are considered regular working days.

1.5.5 Hours of Operation: The contractor is responsible for conducting business, between the hours of 0730-1630 Monday thru Friday except Federal holidays or when the Government facility is closed due to local or national emergencies, administrative closings, or similar Government directed facility closings.

1.5.6 Place of Performance: The work to be performed under this contract will be performed at the 52d Medical Group (52 MDG) main clinic (Building 550), Spangdahlem Air Base, Germany.

1.5.7 Type of Contract: The Government will award a Firm-Fixed-Price Contract.t.

1.5.8 Security Requirements: Contractor personnel performing work under this contract must have a security clearance of “favorable” at time of the proposal submission and must maintain the level of security required for the life of the contract. Security and base access requirements are contained in Air Force Federal Acquisition Regulations (AFFARS) clause 5352.242-9000, Contractor Access to AF Installations.

The Medical Treatment Facility security manager is responsible for initiating and completing the Criminal History Background Check and approve of the individual.

1.5.8.1 Physical Security: The contractor shall be responsible for safeguarding all Government equipment, information and property provided for contractor use. At the close of each work period, Government facilities, equipment, and materials shall be secured.

1.5.8.2 Key Control: The contractor shall establish and implement methods of making sure all keys/key cards issued to the contractor by the Government are not lost or misplaced and are not used by unauthorized persons. NOTE: All references to keys include key cards. No keys issued to the contractor by the Government shall be duplicated. The contractor shall develop procedures covering key control that shall be included in the QCP. Such procedures shall include turn-in of any issued keys by personnel who no longer require access to locked areas. The contractor shall immediately report any occurrences of lost or duplicate keys/key cards to the Facility Manager.

1.5.9 Special Qualifications: The contractor shall possess one of the following qualifications for either Medical Social Worker – Special Needs Coordinator (SNC) or Clinical Nurse – Special Needs Coordinator (SNC) IAW Air Force Medical Service (AFMS) Commodity Council Clinical Acquisition Support Services (CLASS) Direct Patient Care Approved Position Descriptions Version 2.8, dated 28 August 2015:

1.5.9.1 Medical Social Worker – Special Needs Coordinator (SNC).

1.5.9.1.1 Education: Master of Social Work (MSW) degree from an accredited graduate school of social work.

1.5.9.1.2 License: Not applicable for Medical Social Worker.

1.5.9.1.3 Experience: Demonstrates a minimum of two (2) years full-time experience in care coordination, discharge planning or case management in a medical setting within the last four (4) years.

1.5.9.2 Clinical Nurse – Special Needs Coordinator (SNC).

1.5.9.2.1 Education: Shall be a graduate of associates (ADN) or baccalaureate degree (BSN) program in nursing accredited by a national nursing accrediting agency recognized by the US Department of Education.

1.5.9.2.2 License: Maintain an active, valid, current, and unrestricted license (with no limitations, stipulations or pending adverse actions) to practice nursing as a registered nurse in any US state/jurisdiction.

1.5.9.2.3 Experience: Minimum of three (3) years for ADN/2 years for BSN full-time experience in nursing and care coordination.

1.5.9.3 Shall maintain competency and currency in Basic Life Support (BLS) certification and other required training as identified and provided by 52 Medical Group.

1.5.9.4 Computer skills required: Shall have basic computer skills and working knowledge of Microsoft Office products such as Word, Excel, and Access. Shall be able to type an electronic health record entry and be proficient with use of the military out-patient electronic health record systems, such as the Armed Forces Federal Acquisition Longitudinal Technology Application (AHLTA) and (CHCS) or MHS Genesis, within sixty (60) days of obtaining Common Access Card (CAC) capability.

1.5.10 Post Award Conference/Periodic Progress Meetings: The contractor agrees to attend any post award conference convened by the contracting activity or contract administration office in accordance with Federal Acquisition Regulation Subpart 42.5. The CO, Contracting Officer’s Representative (COR), and other Government personnel, as appropriate, may meet periodically with the contractor to review the contractor's performance. At these meetings the CO will apprise the contractor of how the Government views the contractor's performance and the contractor will apprise the Government of problems, if any, being experienced. Appropriate action shall be taken to resolve outstanding issues. These meetings shall be at no additional cost to the Government.

1.5.11 Contracting Officer Representative (COR): The COR will be identified by separate letter. The COR monitors all technical aspects of the contract and assists in contract administration. 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, monitor contractor's performance and notifies the CO; coordinate availability of Government furnished property, and provide site entry of 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.

1.5.12 Key Personnel: The contractor shall provide a contract manager who shall be responsible for the performance of the work. The name of this person and an alternate who shall act for the contractor when the manager is absent shall be designated in writing to the CO. The contract manager or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract. The contract manager or alternate shall be available between 0800-1600, Monday thru Friday except Federal holidays or when the Government facility is closed for administrative reasons.

1.5.13 Identification of Contractor Employees: All contract personnel attending meetings, answering Government telephones, and working in other situations where their contractor status is not obvious to third parties are required to identify themselves as such to avoid creating an impression in the minds of members of the public that they are Government officials. They must also ensure that all documents or reports produced by contractors are suitably marked as contractor products or that contractor participation is appropriately disclosed. Contract personnel will be required to obtain and wear a 52 MDG badge in the performance of this service.

1.5.14 Contractor Travel: Not applicable.

1.5.15 Other Direct Costs: Not applicable.

1.5.16 Telework: Considering the COVID-19 pandemic, telework may be an option for specific Contractor personnel. Telework must be coordinated with the Government POC and COR prior to teleworking.

Telework is when Contractor personnel perform duties at an alternative worksite. If telework is approved, there shall be no access to and or no work performed on any classified information via telework. If access to sensitive information is needed, the Contractor shall have the proper certifications and clearance to access these systems or information. All work requiring access to these materials shall be performed at Government facilities and with Government supervision. The Contractor shall ensure the Government's interests under the terms of the contract are maintained and the required hours of performance are accounted for during any period of telework. Any additional costs required for the Contractor working off-site shall be the responsibility of the Contractor. Telework duties shall be performed at the same rate and quality as performing the same duties locally.

1.5.17 Data Rights: The Government has unlimited rights to all documents/material produced under this contract. All documents and materials, to include the source codes of any software, produced under this contract shall be Government owned and are the property of the Government with all rights and privileges of ownership/copyright belonging exclusively to the Government. These documents and materials may not be used or sold by the contractor without written permission from the CO. All materials supplied to the Government shall be the sole property of the Government and may not be used for any other purpose. This right does not abrogate any other Government rights.

1.5.18 Organizational Conflict of Interest: Contractor and subcontractor personnel performing work under this contract may receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statements, etc.) or perform evaluation services which may create a current or subsequent Organizational Conflict of Interests (OCI) as defined in FAR Subpart 9.5. The contractor shall notify the CO immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and shall promptly submit a plan to the CO to avoid or mitigate any such OCI. The contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the CO and in the event the CO unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the CO may affect other remedies as he or she deems necessary, including prohibiting the contractor from participation in subsequent contracted requirements which may be affected by the OCI.

1.5.19 Phase In /Phase Out Period: Not applicable.

PART 2

DEFINITIONS & ACRONYMS

2. DEFINITIONS AND ACRONYMS:

2.1 DEFINITIONS:

2.1.1 CONTRACTOR. A supplier or vendor awarded a contract to provide specific supplies or service to the Government. The term used in this contract refers to the prime.

2.1.2 CONTRACTING OFFICER (CO). A person with authority to enter into, administer, and or terminate contracts, and make related determinations and findings on behalf of the Government. Note: The only individual who can legally bind the Government.

2.1.3 CONTRACTING OFFICER'S REPRESENTATIVE (COR). An employee of the U.S. Government appointed by the contracting officer to administer the contract. Such appointment shall be in writing and shall state the scope of authority and limitations. This individual has authority to provide technical direction to the contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the contract.

2.1.4 DEFECTIVE SERVICE. A service output that does not meet the standard of performance associated with the Performance Work Statement (PWS).

2.1.5 DELIVERABLE. Anything that can be physically delivered but may include non-manufactured things such as meeting minutes or reports.

2.1.6 KEY PERSONNEL. Contractor personnel that are evaluated in a source selection process and that may be required to be used in the performance of a contract by the Key Personnel listed in the PWS. When key personnel are used as an evaluation factor in best value procurement, an offer can be rejected if it does not have a firm commitment from the persons that are listed in the proposal.

2.1.7 PHYSICAL SECURITY. Actions that prevent the loss or damage of Government property.

2.1.8 QUALITY ASSURANCE. The Government procedures to verify that services being performed by the contractor are performed according to acceptable standards.

2.1.9 QUALITY ASSURANCE Surveillance Plan (QASP). An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

2.1.10 QUALITY CONTROL. All necessary measures taken by the contractor to assure that the quality of an end product or service shall meet contract requirements.

2.1.11 SUBCONTRACTOR. One that enters into a contract with a prime contractor. The Government does not have privity of contract with the subcontractor.

2.1.12 WORKDAY. The number of hours per day the contractor provides services in accordance with the contract.

2.1.13 WORK WEEK. Monday through Friday, unless specified otherwise.

2.2 ACRONYMS:

AAAHC Accreditation Association for Ambulatory Health Care ACOR Alternate Contracting Officer's Representative AFFARS Air Force Federal Acquisition Regulation Supplement AHLTA Armed Forces Health Longitudinal Technology Application BLS Basic Life Support CAC Common Access Card CCE Contracting Center of Excellence CFR Code of Federal Regulations CHCS Composite Unites States (excludes Alaska and Hawaii) CONUS Continental United States (excludes Alaska and Hawaii) CO Contracting Officer COR Contracting Officer’s Representative COTS Commercial-Off-the-Shelf

DAF Department of the Air Force DD250 Department of Defense Form 250 (Receiving Report) DD254 Department of Defense Contract Security Requirement List DFARS Defense Federal Acquisition Regulation Supplement DMDC Defense Manpower Data Center ECHO Extended Care Health Option DoD Department of Defense EEO Equal Employment Opportunity EFMP Exceptional Family Member Program EFMP-M Exceptional Family Member Program-Medical FAR Federal Acquisition Regulation FDI Facility Determination Inquire FMRC Family Member Relocation Clearance GSU Geographically Separated Unit HSI Health Services Inspections HIPAA Health Insurance Portability and Accountability Act of 1996 ICDB Integrated Clinical Database KO Contracting Officer MPF Military Personnel Flight MSW Master of Social Work MPF Military Personnel Flight MTF Military Treatment Facility OCI Organizational Conflict of Interest OCONUS Outside Continental United States (includes Alaska and Hawaii) ODC Other Direct Costs PCS Permanent Change of Station PIPO Phase In/Phase Out POC Point of Contact PRS Performance Requirements Summary PWS Performance Work Statement QA Quality Assurance QAP Quality Assurance Program QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Program SN Special Needs SNIAC Special Needs Identification and Assignment Coordinator TE Technical Exhibit

PART 3

GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND SERVICES

3. GOVERNMENT FURNISHED ITEMS AND SERVICES:

3.1 Services: The Government will provide required training for the equipment listed in 3.4 below during the initial facility orientation. The contractor will be required to use the computer systems that are standard for the support of health care delivery at the MTF (i.e. AHLTA, CHCS, etc.).

3.2 Facilities: The Government will provide the necessary workspace for the contractor to provide the support outlined in the PWS to include desk space, telephones, computers, and other items necessary to maintain an office environment.

3.3 Utilities: The contractor shall instruct employees in utilities conservation practices. The contractor shall be responsible for operating under conditions that preclude the waste of utilities, which include turning off the water faucets or valves after using the required amount to accomplish cleaning vehicles and equipment. Lights shall be used only in areas where and when work is actually being performed. The clinic is a climate-controlled building, therefore mechanical equipment controls for heating, ventilation, and air conditioning systems shall not be adjusted by the contractor or by contractor employees.

3.4 Equipment: The Government will provide computer equipment required to schedule, check in, document, order ancillary services, and maintain appropriate electronic medical information that support the hard copy medical record.

3.5 Materials: Not applicable.

PART 4

CONTRACTOR FURNISHED ITEMS AND SERVICES

4. CONTRACTOR FURNISHED ITEMS AND RESPONSIBILITIES:

4.1 General: The contractor shall furnish all supplies, equipment, facilities and services required to perform work under this contract that are not listed under Section 3 of this PWS. At a minimum, all health care workers must maintain, at the contractor’s expense, current certification in either the American Heart Association Basic Life Support (BLS) (Course C) or the American Red Cross CPR/BLS Course.

4.2 Secret Facility Clearance: Not applicable. This position only requires a “favorable” clearance.

4.3. Materials: Not applicable.

4.4. Equipment: Not applicable.

PART 5

SPECIFIC TASKS

5. SPECIFIC TASKS:

5.1 Basic Services: The primary purpose of this position is to serve as the SNIAC, overseeing the Family Member Relocation Clearance (FMRC); to perform administrative duties concerning the coordination, processing, review and maintenance of medical records and information pertaining to individuals and families assigned to this installation or preparing to serve in overseas assignments and some CONUS assignments; to maintain SNIAC records; to ensure service availability for families relocating in conjunction with a PCS; to process command sponsorship requests and documents; to use a multi-disciplinary and collaborative approach with other key service providers, such as installation youth and childcare facilities, and officer and enlisted spouses groups, to ensure effective outreach and identification of special needs; to identify and enroll AD AF families who meet eligibility criteria for SNIAC; to ensure AF sponsors assigned to the installation, or whose personnel functions are handled at the installation, are “Q-coded” (EFMP-enrolled) regardless of location of family members and to ensure compliance with DoD directives, AF policy and local MTF instructions.

5.2 The duties include but are not limited to the following:

5.2.1 Task 1: Coordinates, processes, reviews, maintains and manages information pertaining to the SNIAC process and coordinates with the Military Personnel Flight (MPF) to provide FMRC information. Interviews sponsors and family members with an OCONUS or applicable CONUS assignment; reviews FMRC checklist with sponsor/spouse. Ensures completion of appropriate documents to include AF Form 1466, Request for Family Member’s Medical/Educational Clearance for Travel; AF Form 1466DO, Dental health Summary; DD Forms 2792 and 2792-1 Exceptional Family Member Medical and Education Summaries as applicable, and any other pertinent documentation. Coordinates with the gaining Military Treatment Facility (MTF); Initiates, reviews, completes, forwards and tracks Facility Determination Inquiries for all family members keeping within timelines as per established guidance and instructions. Consolidates all required documentation for transmittal to the gaining base including Individualized Education Plans and Individualized Family Service Plans. Coordinates paperwork for sponsor rebuttal or disapproval clearances.

Reviews all records and clearance packages to ensure documentation is complete. Coordinates and corresponds with FMRC world-wide and provides administrative support to geographically separated units.

Standards for Duty 1 are as follows:

5.2.1.1 The Medical Social Worker should demonstrate a minimum of two (2) years full-time experience in care coordination, discharge planning or case management in a medical setting within the last four (4) years.

The Clinical Nurse should demonstrate three (3) years (two years for BSN) full-time experience in nursing and care coordination.

5.2.1.2 Ensures all forms are completed properly and accurately.

5.2.1.3 Coordinates with the MPF providing FMRC information and documentation to active duty members.

5.2.1.4 Conducts all personal interviews and fact-gathering inquires in a timely and HIPPA compliant manner.

5.2.1.5 Completes all required documentation in accordance with DoD, AF, and SNIAC guidelines.

5.2.1.6 Provides oversight to ensure every AF sponsor with one or more family members with special needs assigned to the installation has a SN file maintained at the Military Treatment Facility (MTF). Ensures Q-coded sponsors assigned to the installation are contacted annually to determine if there are unmet needs and to request updates of information as needed.

5.2.2 Task 2: Initiates, develops and maintains effective working relationships with healthcare providers, departments within the medical center, the MPF, First Sergeant, commanders, military and civilian agencies, AFPC, and SNIAC and command personnel worldwide to ensure proper identification of special needs families and delivery of EFMP/SNIAC services. Ensures appropriate review and annotates documented services in SNIAC and medical records. Ensures documentation is reviewed and co-signed by the SNC/credentialed provider. Standards for Duty 2 are as follows:

5.2.2.1 Proficiently completes all required documentation in accordance with DoD, AF and SNIAC guidelines.

5.2.2.2 Thoroughly prepares clear and concise goals, plans, and agreements for services.

5.2.2.3 Ensures professional interfacing with SNIAC/EFMP delivery agencies and resources.

5.2.2.4 Advocates for the patient and family/caregivers to ensure identified education and appropriate, timely care coordination is received.

5.2.2.5 Provides training to installation personnel and medical staff, and consultation as needed to support the implementation of EFMP-M base-wide.

5.2.2.6 Participates in EFMP and case reviews, at least quarterly, to discuss/assess newly identified families’ complex, or unmet medical needs. Determine the appropriate resources necessary for the families.

5.2.2.7 Exercises skill, objectivity, and insight to properly manage special needs family members to avoid unnecessary expenditure of Permanent Change of Station (PCS) funds and family hardship. The employee recognizes the advantages and differences among alternatives and recommends the appropriate action to optimize the PCS process.

5.2.3 Task 3: Conducts screening interviews with SNIAC clients to determine need for enrollment, resources and services. Explains SNIAC services, requirements, policies and procedures, and obtains pertinent information to be incorporated into file/package. Documents interviews and evaluates the information collected. Develops initial tentative conclusions for enrollment needs, resources, FMRCs, etc., and provides information on the processes and available resources both on and off base such as those provided by Transitional Assistance Management Program, Extended Care Health Option, AF One Source and community agencies. Standards for Duty 3 are as follows:

5.2.3.1 Poses tactful questions in client interviews.

5.2.3.2 Develops appropriate conclusions and recommendations from interviews.

5.2.3.3 Provides clients with effective and accurate information.

5.2.4 Task 4: Schedules appointments for FMRCs and command sponsorship and ensures availability of all pertinent documentation for the appointments. Retrieves medical records and information from various records rooms, AHLTA, Integrated Clinical Database (ICDB) and other pertinent medical documentation resources and prepares for review. Schedules space for the FMRCs. Standards for Duty 4 are as follows:

5.2.4.1 Safeguards protected health information contained in medical records and only releases it for authorized purposes.

5.2.4.2 Provides accurate and understandable instructions/information to patients, visitors, medical staff, and outside sources using tact and diplomacy when dealing with sensitive issues.

5.2.4.3 Prepares requests as appropriate when retrieving documentation from the various records rooms in the various clinics.

5.2.5 Task 5: Uses varied and advanced functions of word processing software to create, format, modify, edit and print a variety of letters reports, memos, and other textual documents. Uses advanced functions to generate reports and documents, including tables of contents, import graphs or databases, create glossaries, and align multiple columns. Independently carries out familiar assignments in accordance with previous instructions, standard procedures for creating documents, or entering or retrieving data, and established use of software packages. Recognizes differences in existing procedures and applications and makes choices from among established alternatives. Receives and transmits electronic mail. Standards for Duty 5 are as follows:

5.2.5.1 Uses computer software effectively to prepare/develop accurate and useful documents.

5.2.5.2 Uses proper guidance for accurate formatting of documents and effectively reviews outgoing correspondences.

5.2.5.3 Routinely receives and transmits electronic messages and documents promptly and appropriately.

5.2.6 Task 6: Develops and maintains up to date databases on SNIAC/EFMP enrollees and maintains SNIAC records. Annotates essential information such as demographics, special needs, family information, etc. in records and databases; transfers and closes necessary cases as families PCS, separate or retire from the AF, or the special need no longer exists. Ensures tracking system is developed for incoming and out-going families. Requests and maintains necessary desire lists for families with identified Q-Codes from the MPF. Ensures those identified as “new enrollees” are identified to MPF so respective personnel records can be Q-Coded. Standards for Duty 6 are as follows:

5.2.6.1 Effectively develops and maintains up-to-date information on SNIAC/EFMP records and databases.

5.2.6.2 Continually tracks new enrollees with Q-Codes with MPF Q-Code Roster.

5.2.6.3 Transfers and/or closes cases in a timely manner.

5.2.6.4 Effectively uses various software programs to develop and maintain databases.

5.2.7 Task 7: Maintains and reports FMRC statistics and performs a variety of miscellaneous duties in support of the SNIAC process. Statistics include but are not limited to number of clearances processed/approved/denied, facility determination inquire (FDI), enrollees, etc. Receives and screens telephone calls; responds to various general and routine medical personnel and administrative inquiries;

orders and maintains supplies, and calls the SNC’s attention to matters requiring prompt action. Maintains Copies of completed program packages to include but not limited to FDIs and FMRCs. Participates fully with all inspection and regulatory actions. Standards for Duty 7 are as follows:

5.2.7.1 Maintains program data and statistics.

5.2.7.2 Promptly and courteously receives, greets, and responds to inquiries from patients/visitors and telephone callers.

5.2.7.3 Routinely provides office support functions in accordance with rules, regulations, and policies to ensure consistency and regulatory compliance.

5.2.7.4 Displays working knowledge of medical privacy and confidentiality (Health Insurance Portability and Accountability Act [HIPAA]), and accreditation standards of Accreditation Association for Ambulatory Health Care (AAAHC) and Health Services Inspections (HSI).

5.2.7.5 Accepts Work Environment/Physical Requirements that may include prolonged walking, standing, sitting, or bending, and computer use. Position may require patient visitation at another medical treatment facility. The employee may be required to work other than normal duty hours, which may include evenings, weekends, and/or holidays. May have exposure to communicable illnesses. The work does not require any special physical effort or ability.

5.2.7.6 Must maintain a level of productivity and quality consistent with complexity of the assignment;

facility policies and guidelines; established principles, ethics and standards of practice of professional social work, Health Services Inspection (HSI); and other applicable DoD and service specific guidance’s and policies. Must also comply with the Equal Employment Opportunity (EEO) Program, infection control and safety policies and procedures.

PART 6

APPLICABLE PUBLICATIONS

6. APPLICABLE PUBLICATIONS (CURRENT EDITIONS):

6.1 The contractor must abide by all applicable regulations, publications, manuals, and local policies and procedures. (AFI 40-701; AFI 36-2110; AFI 33-360)

6.2 Compliance with all publications, regulations and operating instructions provided by the Government is required when:

6.2.1 They pertain to the procedures for materials expediting herein and where the contractor is authorized by the performance work statement to accomplish the work specified in the publication, regulation or operating instructions.

6.2.2 The publications prescribe USAF policies, use of materials, procedures and processes applicable to the work requirements.

6.2.3 The contractor is required to acquire and work on the latest version of the publication.

PART 7

PERFORMANCE OF SERVICES DURING A CRISIS

7. PERFORMANCE OF SERVICES DURING CRISIS:

7.1 In accordance with DFARS 237.76 and unless otherwise directed by an authorized Government representative, it is determined that services as identified in this PWS are NOT essential for performance during emergency incidents or heightened levels of Force Protection Conditions.

PART 8

RECORDS MANAGEMENT STATEMENT

8. RECORDS MANAGEMENT STATEMENT:

8.1 The contractor who creates/manages data for use by the US Air Force will manage all data created or legally controlled by the Government, required by AF functional publication(s) or in support of the functional activity, IAW the AF Records Management procedures in AFI 33-322 Records Management, AFMAN 33-363 Management of Records, AFI 33-364 AF Records Disposition Procedures and Responsibilities, and any supplements to these documents. Any Privacy Act information will be protected and maintained IAW DoD 5400.11-R DoD Privacy Program and AFI 33-332 Privacy Act Program.

PART 9

ATTACHMENT/TECHNICAL EXHIBIT LISTING

9. ATTACHMENT/TECHNICAL EXHIBIT LIST:

9.1 Technical Exhibit 1 – Services Summary.

9.2 Technical Exhibit 2 – Deliverables Schedule.

9.3 Technical Exhibit 3 – Medical Employee Health Program (MEHP) for contractors

9.4 Technical Exhibit 4 – HIPAA Business Associate Agreement.

9.1 TECHNICAL EXHIBIT 1

Service Delivery Summary 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.

Performance Objective PWS Paragraph Performance Threshold

Remain current with all DoD, US Air Force, and Spangdahlem AB policies and procedures related to the EFMP process.

5.1 5.2.1 5.2.2.7 5.2.3 5.2.4.1 5.2.7

Complies with all regulatory and inspection criteria. 98% error free completion of all EFMP related communications and documentation. All defects are to be corrected within one duty day.

Meets all DoD, US Air Force, and Spangdahlem AB suspense timelines for all EFMP associated processes and submissions

5.2.6.3 95% Completion of all

EFMP- related tasks, submission and actions within established timelines. Written documentation and explanation of all suspense violations and a corrective action plan for all sustained deficiency trends.

Maintains all EFMP related records and files IAW AFI 41-701; completes quarterly reviews and annual update within required time frames.

5.2.2 5.2.4 5.2.6 5.2.7

98% error free completion of all EFMP related communications and documentation. All defects are to be corrected within one duty day.

Maintains good interpersonal relationship with co-workers, families, peers and other health team members.

5.2.1.4 5.2.2 5.2.3.1 5.2.4.2 5.2.7.2

No more than 1 valid customer or ICE (Interactive Customer Evaluation) complaint per year.

All medical notes must be closed within 3 working days.

5.2.1.5

5.2.2 No valid defects allowed.

9.2 TECHNICAL EXHIBIT 2

DELIVERABLES SCHEDULE

Deliverable Frequency # of Copies Medium/Format Submit To

Command Sponsorship applications

Receive and process packages Daily;

Interviews at least weekly

1 for file, 1 for MPS, 1 for member Paper/PDF MPS, Member

1466 application Daily 1 for MPS PDF MPS 1466 denial reapplication submissions

Daily as needed 1 for EFMP Paper EFMP-M

FDI internal routing Daily 1 Paper PCM/MH/School/ EDIS

Q-Base enrollment Daily 1 Database Database

SNIAC quarterly reviews Monthly 1 Paper Chart

EFMP annual contacts

Once a year minimum and as needed otherwise

1 Paper Chart

Q-Base Case Summary Monthly 1 Database SGH/EFMP-M

Q code letter Daily 1 Word MPS AF 2523 Daily 1 Paper Chart DD 2005 Daily 1 Paper Chart SF 600 Weekly 1 Paper Chart/AHLTA

DD 2792 Daily 1 Paper PCM/ Database/ Chart DD 2792-I Daily 1 Paper PCM/ Database/ Chart AF 1466 D Daily 1 Paper PCM/ Database/ Chart IEP/IFSP Daily 1 Paper PCM/ Database/ Chart

E-mail communications

As needed throughout the duty day As needed Outlook SGH/Chart

Hard copy correspondences Daily As needed Word, etc. Multiple POC

4380 Weekly As needed Word SNC/FMRC Telephone communications Daily As needed Orally Multiple POC

Direct customer service communication Daily As needed Phone / in-person / e-mail Multiple POC

EFMP

reassignment packages As needed 1 Paper/PDF AFPC

EFMP

reassignment

SGH/SNC cover letter

As needed 1 Paper/PDF AFPC

Deliverable Frequency # of Copies Medium/Format Submit To Reassignment education As needed Phone / in person AD Member / Dependent

Transfer of EFMP files Daily 1 Database Database

Redirect SHAPE packages As needed 1 Database Correct AOR

Archive records Weekly 1 Electronic / Chart Database/ File Drawer

SNIAC logs As needed 3 Excel Excel

EFMP/SNIAC

SGH data base Daily 1 Electronic Database

MFR for MPS communication Daily As needed Word MPS

Notify commander of

EFMP

circumvention

As needed As needed Phone / in-person Commander

Newcomers brief As needed 1 In person EFMP-M/EFMP-FS OPR for

Installation Directive

As directed by AFI 1 Word SGH/SNC

EFMP interviews Weekly 1 In-person SGH/SNC Command

Sponsorship interviews

Weekly 1 Paper SGH/SNC/MPS

9.3 Technical Exhibit 3

Medical Employee Health Program (MEHP) for contractors

1. MEHP enrollment

Public Health will in-process all Health Care Workers (HCWs) including contractors into the Aeromedical Services Information Management System (ASIMS) MEHP module and will ensure HCWs receive or have received all general requirements based on their risk categories with ten (10) days of starting work.

Contract personnel providing services under this contract shall receive a pre-employment physical examination prior to commencement of work. 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. The health certificate shall state that the contract employee is cleared to work without restrictions. The certification shall contain a signed statement by the examining physician stating that the employee is free of any contagious diseases.

2. General Requirements based on risk category:

HCWs to include contractors are required to have the following as a condition of employment:

2.1. Risk categories: All HCWs are assigned a CDC Exposure Risk Category in ASIMS (low-risk, high-risk or exposure-prone) upon in-processing, based on job duties. The assigned risk category dictates initial and ongoing MEHP requirements.

2.1.1. Low-risk personnel are those with minimal risk of exposure to patient blood/bodily fluids

2.1.2. High-risk personnel are those working in or under the jurisdiction of AF MTFs and Guard and Reserve medical units, who have direct contact with patients or blood/bodily fluids, and are at ongoing risk for injures with sharp instruments/needle sticks.

2.1.3. Exposure-prone personnel are those medical and dental providers, nurses, and technicians who perform invasive procedures, defined by the CDC as “surgical entry into tissues, cavities or organs or repair of major traumatic injuries associated with operating or delivery room, emergency department, or outpatient setting (dental and physician), cardiac catheterization and angiographic procedures; vaginal/cesarean delivery or other invasive obstetric procedure where bleeding occurs; or manipulation, cutting or removal MDGI 48-113, 29 January 2009 Certified Current and Essential as of 8 Nov 2017 5 of any oral or perioral tissues, including tooth structure, during which bleeding occurs or the potential for bleeding exists. All exposure prone personnel are also high risk.

Requirement Low Risk HBV Hep B vaccine series Influenza Vaccinate annually (HN HCWs and contractors: highly encouraged but not mandatory) MMR MMR vaccine series or (+) Ab titer Tdap/Td Booster every 10 yrs. (Tdap requires only a one-time dose) Varicella Varicella vaccine or (+) Ab titer TST/QFT Baseline (2-step TST or one time QFT) HIV screening : Active Duty (AD) every 2 yrs., Civilian/Contractor: n/a

Requirement High Risk HBV Hep B vaccine series and (+) HBsAb titer Influenza Vaccinate annually (HN HCWs and contractors: highly encouraged but not mandatory) MMR MMR vaccine series or (+) Ab titer Tdap/Td Booster every 10 yrs. (Tdap requires only a one-time dose) Varicella Varicella vaccine or (+) Ab titer TST/QFT Baseline (2-step TST or one time QFT)

HIV screening AD every 2 yrs., Civilian/Contractor: optional

Requirement Exposure Prone HBV Hep B vaccine series and (+) HBsAb titer, HBsAg titer if (-) HBsAb Influenza Vaccinate annually (HN HCWs and contractors: highly encouraged but not mandatory) MMR MMR vaccine series or (+) Ab titer Tdap/Td Booster every 10 yrs. (Tdap requires only a one-time dose) Varicella Varicella vaccine or (+) Ab titer TST/QFT Baseline (2-step TST or one time QFT) HIV screening AD every 2 yrs., Civilian/Contractor: optional

2.2. Requirements

2.2.1. Tuberculosis screening is required prior to employment and at periodic frequencies based on the local TB risk assessment and exposure to active TB cases. All HCWs must accomplish or present documentation of a two-step tuberculin skin test (TST) or an approved blood assay for TB screening (QFT), or documentation of the BCG vaccination.

2.2.3. Measles, Mumps and Rubella (MMR) immunity or documentation of two MMR vaccinations is required for all HCWs.

2.2.4. Varicella immunity or documentation of two varicella vaccinations is required for all AD, contractor, and civilian HCWs. Vaccine non-responders will be documented in ASIMS after the vaccination series has been accomplished twice.

2.2.5. Influenza vaccination is required for all AD members, contractors and civilian HCWs who provide direct patient care. HCWs who provide direct patient care can reasonably be interpreted to include any worker whose daily activities include contact with patients or involve work in common areas or clinic/hospital rooms where patients are likely to be present (e.g., clerical staff who interact with patients, food service personnel, and cleaning or janitorial staff). Influenza vaccination is highly encouraged but not mandatory for HN employees.

2.2.6. Hepatitis B vaccination is required for all AD HCWs, but can be declined by civilians/contractors categorized as low risk personnel Hepatitis B Vaccine Consent/Declination. High risk and exposure prone HCWs will be tested for anti-HBs within 30-60 days after completion of the three dose vaccine series. All personnel who do not develop protective immunity will complete a second three dose vaccine series and be tested for anti-HBs. It is not recommended for non-responders to receive more than two vaccination series.

2.2.7. HIV screening for all AD members is required every 2 years IAW AFI 44-178. HIV screening is offered to high risk and exposure prone civilian and contracted HCWs, and consent for testing should be documented using the HIV Antibody Testing Consent Form for Non-AD (Attachment 4).

2.2.8. HCWs infected with a bloodborne pathogen will be evaluated for duty restrictions. In general, they will not perform invasive procedures until disease resolution and non-infectivity status can be verified.

2.3. Expenses/responsibilities. No medical tests, immunizations or procedures required by the contract shall be performed by the Government unless the provider is an eligible beneficiary. Vaccinations may differ depending upon performance location. Expenses for all required tests, immunizations and/or procedures shall be borne by the contractor or contracting employee, not the Government. It is the contractor’s responsibility to ensure the contracting employee has all required immunizations and has knowledge of health precautions for the respective country.

2.4. Protocols for handling occupationally related illnesses and injuries:

All contract personnel providing services under this contract, who experience a parenteral (e.g., needle stick or cut) or mucous membrane exposure (e.g., splash to the mouth or eye) to blood or bloody body fluids, shall receive prompt treatment. The employee may choose to either seek care through the medical treatment facility (MTF) or the civilian sector IAW AFI 41-210 TRICARE Operations and Patient Administration Functions.

The MTF will evaluate the source of exposure for risk of Hepatitis B, Hepatitis-C, and Human Immunodeficiency Virus (HIV) and will provide a report of the findings to the contractor and the contracting employee.

It shall be the contractor’s responsibility to provide appropriate treatment as needed to possibly include Tetanus-Diphtheria booster, or Hepatitis-B Immune Globulin. The contractor shall be responsible for providing the employee with initial testing and if the source of exposure was unknown, positive, or considered at high risk for HIV infection, follow-up testing 3, 6, and 12 months after exposure. In the event of a confirmed or highly suspected parenteral exposure to HIV, the contractor shall ensure that the employee receives appropriate counseling and is referred immediately to a private infectious disease specialist for consideration of any post-exposure or experimental therapy. The Government may require the contractor to provide evidence of the status of treatment and testing of the employee.

MDGI 48-113 MEDICAL EMPLOYEE HEALTH PROGRAM

9.4 Technical Exhibit 4

HIPAA Business Associate Agreement.

This BAA can serve as a separate standalone agreement or may be used for new or existing contracts between the MTF and the business associate. If this BAA is used as a separate standalone agreement and as part of an underlying Contract, there are several identified references to Contracting Officers (COs) throughout the BAA that need to be removed. This BAA is NOT to be used in contracts for access to MHS-wide data or components of DHA. Contact the DHA Procurement Directorate at ContractPolicyDivision@dha.mil. for applicable contract language and guidance.

Business Associate Agreement

[USE FOR STANDALONE BAA ONLY] This Business Associate Agreement (this "Agreement") is entered into this ___ day of ________, _____ (the “Effective Date”) between [NAME OF MHS COVERED ENTITY] ("Covered Entity") and [NAME OF BUSINESS ASSOCIATE], a [type of business entity] ("Business Associate").

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.

(a) 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.

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.

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 [INSERT NAME OF BUSINESS

ASSOCIATE].

Agreement means this BAA together with the documents and/or other arrangements under which the Business Associate signatory performs services involving access to PHI on behalf of the MHS component signatory to this BAA.

Covered Entity shall generally have the same meaning as the term “covered entity” in the DoD HIPAA Issuances, and in reference to this BAA, shall mean [INSERT NAME OF MTF COMPONENT].

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…