Attachment 1 - Ambulance Services PWS dated 2 Sep 2025.pdf

PERFORMANCE WORK STATEMENT

FOR

21st MEDICAL GROUP

AMBULANCE SERVICES

PETERSON SFB & SCHRIEVER SFB, COLORADO

2 September 2025

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1. DESCRIPTION OF SERVICES. The contractor shall provide full emergency medical transport services at Peterson Space Force Base (PSFB) and Schriever Space Force Base (SSFB), Colorado. This emergency patient transport service will consist of one (1) dedicated ambulance vehicle on each installation, with the backfill the vehicle in the event of mechanical or other issue in which the dedicated vehicle is unavailable. The contractor shall participate in PSFB and SSFB exercises, special events, sports/athletic events, and specialized training, and in-flight emergencies. The contractor shall furnish all labor, management, supervision, vehicle, supplies, equipment, transportation, and reports, except as provided in paragraph 1.9, Government- Furnished Property. The contractor shall, at a minimum, be responsible for providing the full range of Emergency Medical Technician (EMT), Paramedic, and ambulance services provided in the local community to include local protocols or standing orders and staffing minimums in accordance with current and future State of Colorado regulations and protocols. Performance shall be according to the requirements contained in this Performance Work Statement (PWS), professional standards of the Accreditation Association of Ambulatory Health Care (AAAHC) and the Colorado State Department of Public Health and Environment (CDPHE), Health Facilities and Emergency Medical Services Division, El Paso County, State of Colorado Rules and Regulations Concerning Ambulance Service.

1.1. EMERGENCY MEDICAL RESPONSE AND PATIENT TRANSPORT. The contractor shall provide ambulance and EMT/Paramedic resources in order to respond to emergencies as requested by the PSFB and SSFB Fire Department. Patients shall typically be transferred to the nearest appropriate civilian medical facility. Active-Duty Military members with minor acute injuries and illnesses shall be transported to Evans Army Community Hospital (EACH) on Fort Carson in accordance with established protocols and in consultation with an attending provider at the hospital.

1.1.1. Provide ambulance services 24 hours per day, every day of the year, including all holidays. This contract is the sole avenue for PSFB and SSFB emergency patient transport. The contractor shall establish and maintain a system to ensure that backup support is provided in the event of simultaneous responses, equipment failures, or other unforeseen circumstances.

Services must always be available.

1.1.2. The contractor shall travel to response sites in an appropriate medical response vehicle per information received primarily from PSFB or SSFB Fire Department. The contractor shall respond to requests from dispatch and shall provide the full range of EMT, Paramedic, and ambulance services provided in the local community to include local protocols or standing orders and staffing minimums in accordance with the most current State of Colorado and local regulations and protocols. Medical response vehicles shall contain, in fully functional working order, all applicable equipment required by the county, CDPHE, and all other state regulations.

All equipment shall be properly secured, all medications and supplies shall be maintained, in good working order, unexpired, and stored according to the manufacturer’s recommendations and follow any federal, state and/or local requirements.

1.1.3. The contractor is authorized to and shall bill/invoice separately for patient transport and emergency response services by seeking reimbursement in accordance with paragraph 1.7. The contractor may seek reimbursement for Advanced Life Support (ALS) level of services only if

Page | 3 the services were provided to the patient, are not unnecessary, and are medically indicated and required. If the contractor responds to an emergency and does not treat any patients, then the contractor must not bill. If the contractor fails to adhere to proper “ALS levels of care”, or if the contractor provides care or services which are not medically indicated (such as unneeded ALS services, wheelchair accessible ambulance services, etc.), then the contractor shall recognize this claim for reimbursement may be denied by the insurance carrier. In such cases where the denied billings are deemed as unnecessary expenses by the insurance carrier, the contractor agrees not to seek further direct reimbursement from the patient or the government. The government will not be liable for expenses incurred by local civilians or non-Department of Defense (DoD) patient emergencies.

1.1.4. The contractor shall hold a valid license and permit issued by the Board of County Commissioners (BoCC) for ambulances operating on and supporting PSFB and SSFB before starting performance of the contract and throughout the duration of the contract. A copy of the valid license and permit shall be provided to the COR before starting performance of the contract and within twenty-four (24) hours of any renewals. The contractor shall notify the COR of all scheduled or unscheduled inspections conducted by the state or county and provide a copy the inspection results/reports to the Government. The contractor shall notify the COR NLT than seven (7) calendar days before scheduled inspection, within forty-eight (48) of an unscheduled inspection, and provide the COR a copy of all inspection results/reports within twenty-four (24) hours of a completed inspection.

1.1.5. Response time is defined as from the time of receipt of call from base Fire Department Dispatcher to the time of arrival at the emergency location identified. Response time for all emergent requests for service on PSFB and SSFB, to include Basic Life Support (BLS) and Advanced Life Support (ALS) shall be within eight (8) minutes.

1.1.6. Contractor shall respond to calls with, at a minimum, one State of Colorado certified Emergency Medical Technician (EMT) and one State of Colorado certified Emergency Medical Technician-Paramedic/Advanced Cardiac Life Support (EMT-P/ACLS).

1.1.7. Contractor shall provide medical care and treatment appropriate to patient’s condition.

The contractor shall respect and maintain the basic rights of patients, demonstrating concern for personal dignity and human relationships. The contractor will be notified if an EMT or EMT-P receives complaints validated by the Contracting Officers Representative (COR) and Chief of the Medical Staff.

1.1.8. The contractor shall provide in-field and emergency medical flight line care, with capability to address decompression sickness and injuries related to in-flight emergencies, to include EMT-P/ACLS, in accordance with protocols developed by the contractor’s physician advisor in cooperation with representatives from local Fire Departments and the closest hospital with capability.

1.1.8.1. The contractor shall coordinate patient transport with local civilian and military hospitals when transporting patients from PSFB or SSFB to local hospitals.

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1.1.8.2. The contractor shall ensure an EMT or Paramedic remains with patients until a qualified member of the receiving hospital properly accepts the patients.

1.1.8.3. The contractor shall notify the specific base Fire Department after the receiving hospital properly accepts patient by identifying the name of patient, status (military, civilian, contractor, dependent, etc.), and name of hospital. This notification must be provided no later than one (1) hour after receiving hospital properly accepts patient. If notification is delayed due to response to another emergency call, then notification must be made as soon as possible

(ASAP).

1.1.9. MISSION ESSENTIAL SERVICES. The performance of these services are considered to be mission essential. All services identified in the PWS shall continue unless otherwise directed by the CO. The contractor is required to submit an Essential Services Plan to the CO within thirty (30) calendar days after contract performance start date.

1.2. BASE AND MTF EXERCISES/SPECIAL EVENTS/SPORTS EVENTS/SPECIALIZED

TRAINING. The contractor shall be responsible for participating in PSFB, SSFB, Medical Treatment Facility (MTF) training, exercises, and special events to include but not limited to sporting/athletic events, and other related events as required/requested (estimated at six (6) requests per month, per installation). The contractor will be notified one (1) day prior for all stand-by requests. The contractor may use the dedicated ambulance and crew on shift to support requests. Specific contractor responsibilities include:

1.2.1. Participate in advance and post exercise meetings.

1.2.2. Respond with EMTs to exercise sites and perform simulated duties.

1.2.3. Coordinate all activities during exercises with the Incident Commander. Coordination can be through the On-Scene Medical Director when the Field Response Team (FRT) is activated and on-scene.

1.2.4. Provide ambulance support during live-structural and aircraft live fire training, aerial flight operations and confined space hazardous materials exercises.

1.2.5. Provide ambulance support during sporting/athletic and special events (i.e., Change of Command and other official ceremonies) as requested.

1.3. DELIVERABLES.

1.3.1. Patient Care Documentation, Run reports, TRICARE billing submissions. The contractor shall prepare and submit to the COR documentation of each ambulance response at end of every month. This documentation shall detail any responses that failed to meet the eight (8) minute threshold, as well as why any response failed to meet the eight (8) minute threshold. The report shall be legible, accurate, thorough, and must contain a signature of an ambulance crewmember.

The contractor shall provide copies of all TRICARE submitted insurance billing for reimbursement.

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1.3.1.1. The contractor shall provide reasonable access to information related to transports to the MTF within 24 hours. The report shall be accomplished according to relevant Health Insurance Portability and Accountability Act (HIPAA) guidelines. This information will include date, response time, type of run (BLS or ALS), whatever available patient information (full name, military last 4 of SSN or civilian, patient condition, address responded to, the name of the hospital transported to) and an explanation of any exceptions to response time contained in Section 2, Service Summary. All refusals should also be documented to the same level, notwithstanding hospital transport.

1.3.1.2. Patient information shall be treated as privileged information in accordance with HIPAA. Lists and/or names of patients shall not be disclosed to or revealed in any manner for any use outside the MTF without prior written permission by the MTF Commander. All patient information shall be handled in accordance with all applicable HIPAA regulations and guidelines.

1.4. QUALITY CONTROL.

1.4.1. The contractor shall establish and maintain a complete Quality Control Plan (QCP) to ensure the requirements of the contract are provided as specified. The contractor’s QCP shall address risk management issues to include the contractor’s established processes, which are in place to evaluate the standard of care. The contractor shall ensure risk management issues are addressed in its written audit procedures. The contractor’s QCP shall be delivered to the CO no later than thirty (30) calendar days after contract award. Changes/updates to QCP shall be submitted to CO within fourteen (14) calendar days after changes/updates.

1.4.2. The Contracting Officer’s Representative (COR) will inspect the services provided. The contractor will not be held responsible for being unable to meet the response time due to factors beyond their control. This will include, but is not limited to, road construction or unplanned road closures, vehicle failures, inclement weather, communications inaccuracies or communications failures on the part of the Government, or employee incapacitation not related to misconduct or negligence.

1.4.3. Performance Evaluation Meetings. The CO may require the contractor or representative to meet with the CO, Contract Specialist, COR and other Government personnel as often as deemed necessary. The contractor may request a meeting with the CO when necessary. Written minutes of these meetings, signed by the contractor POC and CO or Contract Specialist, will be provided by the COR for file documentation. Should the contractor not concur with the minutes, such non-concurrence shall be provided in writing to the CO within ten (10) calendar days of receipt of the minutes.

1.5. GENERAL INFORMATION.

1.5.1. Contract Point of Contact (POC). The contractor shall provide a POC who shall be responsible for the performance of the work as specified in the PWS. The name of this person

Page | 6 and an alternate(s) who shall act for the contractor when the POC is absent shall be designated in writing to the CO and COR prior to contract start date and prior to each contract renewal period.

1.5.2. The contract POC or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract and be available during normal business hours (0730 -1630 hours). The contractor shall be responsible for ensuring contractor employees have appropriate communication equipment to include pagers or cellular telephones.

The contractor shall inform the COR and CO in writing of the phone numbers for this equipment and notify the Government immediately upon any subsequent changes. The POC and alternate(s) must be able to read, write, speak, and understand English.

1.5.3. The contractor shall ensure that all employees involved in activities that require certification or licensing shall meet all such requirements for:

1.5.3.1. Operation of an emergency ambulance in the State of Colorado and possessing a valid Class “C” driver’s license. Drivers must not have any reckless or dangerous driving citations within the previous 24-month period and have no Driving While Ability Impaired (DWAI) or Driving under the Influence (DUI) convictions in the previous three years. Drivers can have a maximum of six points per year assessed under the State of Colorado driving infractions system.

1.5.3.2. Possess and maintain current license to perform EMT and Paramedic services in the State of Colorado. Maintain current CPR certification from a Colorado Department of Public Health and Environment CPR approved provider.

1.5.3.3. Special Flight Line Driving Certification for all drivers performing services under this contract within fifteen (15) calendar days of the start of contract performance or within fifteen

(15) calendar days of new employee performance.

1.5.4. Contractor shall maintain files to assure that all EMTs performing work under this contract shall have current certifications and/or documents listed above. Upon request, the contractor shall allow the Government access to review these documents for any EMT/Paramedic performing under this contract. The contractor shall provide copies of certifications upon request.

1.5.5. All EMTs and Paramedics stationed on PSFB and SSFB will have a State of Colorado background check, which includes a Criminal Record Check. No contractor employees will be assigned to the PSFB and SSFB site until their background check is verified as not having felony convictions.

1.5.6. The contractor shall be solely responsible for compliance with Occupational Safety and Health Act (OSHA) (Public Law 91-596) and the resulting standards, OSHA standard 29 CFR 1910, 1926, and the protection of their employees. The contractor shall be responsible for all federal, state, and local regulations ensuring that all safety requirements are met. Additionally, the contractor is responsible for the safety and health of all subcontractor employees.

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1.5.7. The contractor shall not employ any person who is an employee of the US Government if employing that person would create a conflict of interest or interfere with the performance of their Government position. Additionally, the contractor shall not employ any person who is an employee of the Department of the Air Force, either military or civilian, unless such person has received approval according to DoD Directive 5500.07 Standards of Conduct.

1.5.8. Privacy. The contractor shall comply with the provisions of the Privacy Act of 1974 and the Health Insurance Portability and Accountability Act of 1996 to protect personal health information that the contractor may encounter while completing the tasks associated with this contract.

1.5.9. The contractor shall comply with existing Colorado Department of Public Health and Environment, Health Facilities and Emergency Medical Services Division, 6 CCR 1015-3, State Board of Health, Rules Pertaining to Emergency Medical Services and future amendments thereto, and current and future emergency medical service rules, regulations, and directives published for El Paso County, Colorado.

1.5.10. HISTORICAL WORKLOAD DATA

1.5.10.1. For PSFB, the average number of medical calls received annually is 245 for the installation. The average transports is 125 for the installation. The average number of in-flight emergencies is 20 annually with an average of 5 ground emergencies for the installation.

1.5.10.2. For SSFB, the average medical calls of medical call received annually is 109 for the installation. The average transports is 50 for the installation.

1.6. HEALTH REQUIREMENTS.

1.6.1. Contractor personnel providing services under this contract must have a pre-employment physical examination; TB testing; Measles, Mumps, Rubella (MMR) immunization; Varicella immunization; Hepatitis B immunization; Diphtheria, Tetanus, Pertussis (TDap) immunization;

Influenza immunization; Polio immunization; and Tuberculin Skin Test prior to commencement of work with updates as required. Payment for required examinations, testing, and immunizations will not be provided by the Government.

1.6.2. All health care workers shall follow the methods for controlling and preventing disease as described in the American Public Health Association publication, Control of Communicable Diseases Manual, and the Centers for Disease Control and Prevention (CDC) publication, Morbidity and Mortality Weekly Report (MMWR), and its supplements. Where applicable, the most recent guidelines from these publications are utilized as the standard. The contractor shall adhere to the Medical Group MDGI 44-50, Infection Control, Chapter 8, Clinic Employee Health Program.

1.7. REIMBURSEMENT

1.7.1. For TRICARE eligible beneficiaries, the contractor will seek reimbursement up to the

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Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) Maximum

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Allowable by Wisconsin Physician Services (WPS). If the contractor does not obtain full reimbursement or collects less than the billed amount from WPS, the contractor shall not balance bill any TRICARE eligible member for the balance or seek additional reimbursement through a third party, no exceptions. The contractor shall not seek double reimbursement through the Government for any services reimbursed through a third party. In these circumstances, the contractor will contact WPS billing for resolution. If WPS cannot resolve the issue, the contractor will contact the 21st Medical Group Tricare Operations and Patient Administration (TOPA) Flight and coordinate with the COR.

1.7.2. For non-TRICARE eligible beneficiaries, the contractor will seek reimbursement through its normal billing procedures such as billing private insurance, Medicare, or the individual patient.

1.7.3. The contractor’s failure to obtain reimbursement, or collection of less than the billed amount, will not financially obligate the 21st Medical Group, the United States Air Force, or the United States Government.

1.7.4. The contractor is to seek the appropriate reimbursement for the type of ambulance services provided. If only BLS services are provided, then the contractor will bill for a BLS, not ALS response. If the contractor responds to an emergency and does not treat any patients, then the contractor must not bill. The contractor must not send and bill for wheelchair accessible ambulances unless medically indicated.

1.8. CERTIFICATION REQUIREMENTS.

1.8.1. The contractor shall provide current BLS and ACLS certification and National Registry for Emergency Medical Technicians (NREMT) Paramedic certification to the contracting officer seven (7) calendar days before the start of contract performance. Certification of new employees are required no later than five (5) calendar days before employee starts 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 certification shall also contain the following statement: “(name of contract employee) is suffering from no contagious diseases to include but not limited to Tuberculosis, Hepatitis, and Sexually- Transmitted Diseases.”

1.9. CONTRACTOR MANPOWER REPORTING.

1.9.1 Entities that are awarded a federal contract, grant, or loan may be required to submit one or more post-award reports periodically, depending on award requirements. BioPreferred Reports and Service Contract Reports are submitted at SAM.gov available at https://sam.gov/content/entity-reporting.

1.9.2 The BioPreferred program promotes sustainable acquisition of bio-based products to promote rural economic development, create new jobs, and provide new markets for farm commodities. Vendors who have been awarded services or construction contracts issued after May 18, 2012 are required to report on their purchase of BioPreferred products in accordance with FAR 52.223-2.

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1.9.3 The Office of Management and Budget (OMB) requires federal agencies to report on activities performed by service contractors annually. Entities with service contracts are required to submit a report on all cost-reimbursement, time-and-materials, and labor-hour service contracts and orders.

1.9.4 Uses and Safeguarding of Information. Information from the secure website is considered to be proprietary in nature when the contract number and contractor identity are associated with the direct labor hours and direct labor dollars. At no time will any data be released to the public with the contractor’s name and contract number associated with the data.

1.10. GOVERNMENT-FURNISHED PROPERTY AND SERVICES.

1.10.1. The contractor will be provided a copy of PSFB and SSFB’s grid-map prior to start of performance.

1.10.2. The Government will provide a train-the-trainer course for Special Flight Line Driving in accordance with Paragraph 1.5.3.3 to a contract representative within fifteen (15) calendar days of the start of performance. This course will allow the contractor to train their employees.

1.10.3. The Government will provide Land Mobile Radios (LMRs) in order to assist the contractor in performing the requirements in this PWS.

1.10.4. The Government will provide a location on PSFB and SSFB to house the ambulance and for the ambulance crews. Space used by the contractor in performance of services may be used for other purposes during their absence. Items of clothing, personal effects, or equipment cannot be secured during their absence. The Government will not incur any liability for theft, damage to, or loss of personal items.

1.10.5. The ambulance crew will share common use areas within the Government facility.

Ambulance crew on shift will participate in area clean up duties of the shared common use areas, grooming, and sleeping areas.

1.11. SECURITY.

1.11.1. Security Investigative Requirements. Contractor employees shall be subject to security investigative processes to facilitate criminal background investigations IAW the Department of Defense Manual (DoDM) 5200.02 Air Force Manual (AFMAN) 16-1405, Air Force Personnel Security Program. The contractor shall advise their contracted employees that a favorable investigation, verified through the Joint Personnel Adjudication System (JPAS), is needed as a condition of employment under this contract.

1.11.2. National Agency Check with Written Inquires (NACI/T1). A personnel security investigation that is conducted by the Government for contractor employees performing under this contract. Contractor employees are considered to be in a public trust position and requires a favorable suitability determination on the NACI/T1 in order to perform on this contract. The NACI/T1 is required to be verified and documented in JPAS.

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1.11.2.1. The contractor POC will submit the contractor employee name, Social Security Number (SSN), email account and telephone contact number to the 21 MDG Security Manager.

If contractor personnel do not have a NACI/T1 documented in JAPS, a NACI/T1 will be initiated by the 21 MDG Security Manager through the Electronic Questionnaires for Investigations Processing (e-QIP) application.

1.11.2.2. The NACI/T1 consists of completing a Standard Form 85, Questionnaire for Public Trust Positions in the e-QIP application, a Federal Bureau of Investigation (FBI) fingerprint check, and a signed U.S. Office of Personnel Management Optional Form 306. The contractor POC will assist the 21 MDG Security Manager in providing all pertinent information of the contractor employee to initiate the e-QIP and ensure member completes the e-QIP application and fingerprint appointment in a timely manner. The 21 MDG Security Manger will arrange the fingerprint appointment with the base-level Security Information Protection Office.

1.11.3. The contractor shall comply with all PSFB and SSFB security requirements. PSFB and SSFB have controlled/restricted areas and special security procedures are utilized to deter espionage, sabotage, and theft of Air Force resources. The COR will assist the contractor POC to coordinate security matters with the 21 MDG and other base agencies, as needed.

1.11.3.1. Restricted Area Badges (RAB). The contractor employee will require a RAB to access restricted or controlled areas on PSFB/SSFB in performance of this contract. In order for a contractor to have unescorted access in a Restricted Area, the 21 MDG Security Manager must complete a RAB request and the member will have to complete escort training. A RAB cannot be processed unless the contractor employee has a completed NACI/T1 documented in JPAS.

The contractor POC will maintain a list of all employees SSN, height, weight, eye and hair color, as well as ensure the employee completes the required escort training.

1.11.3.2. Contractor Badges/Common Access Card (CACs). Either a contractor Badge or CAC will be issued to the contractor employee in performance of this contract. The contractor badge or CAC enables the member to access the installation.

1.11.3.3. Contractor Defense Biometrics Identification System (DBIDS) Badge. 21 MDG Security Manger will process all contractor DBIDS badge requests.

1.11.3.4. Common Access Card (CAC). An FBI fingerprint check with favorable results must be completed and a NACI/T1 completed or submitted to the Office of Personnel Management prior to a CAC being issued to the contractor employee. The 21 MDG Security Manager will process all CAC applications.

1.11.3.5. Visitor Pass. If a contractor employee is not able to access the installation, the 21 MDG Security Manger will process a visitor pass.

1.11.3.6. The contractor shall request, obtain, and properly use vehicle passes for all vehicles used in the performance of this contract, in accordance with AFI 31-218, Motor Vehicle Traffic Supervision. A restricted area vehicle pass will be issued for the primary response vehicle assigned to each installation. A temporary vehicle pass will be issued for temporary vehicles assigned during maintenance of the primary vehicle.

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1.11.4. The contractor POC is responsible for ensuring badges/CACs/RABs are renewed before expiration to prevent installation access problems. Absences caused by expired badges/CACs/RABs shall not relieve the contractor of its obligation to perform the services. The contractor POC shall ensure the following:

1.11.4.1. Immediately report any lost or stolen badges/CACs/RABs to the COR.

1.11.4.2. When a contractor employee’s performance under this contract ceases, the member shall return any Government issued badges/CACs/RABs to the COR.

1.11.5 In accordance with FAR Clause 52.222-50, Combating Trafficking in Person, the contractor must maintain 100% compliance and report non-compliance immediately to the contracting officer.

2. SERVICES SUMMARY

2.1. The following list of Services Summary (SS) items have specific Performance Thresholds assigned. Performance Thresholds below establish the minimum acceptable levels of service required for each SS item. These minimums do not relieve the contractor from performing 100% of work performance outlined in the contract and PWS.

Performance Objective

PWS

Paragraph Performance Threshold

1. Response time for all emergency requests for service on PSFB and SSFB, to include Basic Life Support (BLS) and Advanced Cardiac Life Support (ALS) shall be within eight (8) minutes.

1.1.5

90% of emergent responses within eight (8) minutes and 10% of emergent responses within twelve (12) minutes per month.

2. Provide medical care and treatment appropriate to the patient’s condition. The Contractor shall respect and maintain the basic rights of patients, demonstrating concern for personal dignity and human relationships.

1.1.7 No more than 1 validated customer complaint per quarter.

3. The contractor shall prepare and submit Patient Care Documentation, Run Reports and TRICARE submitted billing.

1.3.1

Provide patient care documentation, run reports and TRICARE submitted insurance billing by end of month 100% of the time.

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4. For TRICARE eligible members, if the contractor does not obtain full reimbursement or collects less than the billed amount from WPS, the contractor shall not balance bill any TRICARE eligible member for the balance or seek additional reimbursement through a third party, no exceptions. The contractor shall not seek double reimbursement through the Government for any services reimbursed through a third party.

1.7.1

100% compliance, no validated patient/customer complaints related to improper billing.

Information validated via monthly insurance billing submissions by the contractor.

5. Combating Trafficking in Persons IAW 52.222-50

1.11.5 Ensure 100% compliance with FAR

clause 52.222-50, Combating Trafficking in Person