Attachment 1 - FA4861-22-R-0010 Statement of Work.pdf

STATEMENT OF WORK

FOR

PATIENT TRANSPORT SERVICES

1.0 GENERAL.

Contractor shall provide patient transportation services requested by the Mike O'Callaghan Military Medical Center, Nellis AFB, NV (referred to as MOMMC hereafter). The contractor agrees to provide non-emergent transport services performed in accordance with local, state and federal laws. Contractor shall furnish all labor, management, supervision, vehicles, supplies, equipment, transportation, and reports. The Contractor agrees not to bill MOMMC for transport services that are not authorized in advance for payment by an authorized caller under this agreement, or bill for transport that is otherwise billable to a third party insurance company.

1.1 WORK TO BE PERFORMED.

1.1.1 SPECIFIC. The Contractor shall perform inter-facility transfers to and from MOMMC. Transfer to residences is strictly prohibited and will not be billed to the government. Contactor shall assume all liability for patients while in their care. The Contractor shall comply with all applicable Clark County Emergency Medical Services (EMS) Protocols and Centers for Medicare and Medicaid Guidelines. Non-emergent transportation, as defined by MOMMC and the Contractor, shall occur within two (2) hours of transportation request

1.1.2 LOCATION. Nellis Air Force Base and surrounding areas within Clark County including Las Vegas, North Las Vegas, and Henderson, Nevada

1.1.3 HOURS OF OPERATION. MOMMC operates under 24/7 capabilities 365 days a year.

1.2 MANAGEMENT REQUIREMENTS

1.2.1 CONTRACTING REPRESENTATIVE. The Contractor shall provide a point of contact (Contractor Representative) that shall be responsible for the performance of the work. The point of contact shall have full authority to act for the Contractor on all matters relating to the daily operation of this contract. The Contractor shall designate this individual, in writing, to the Contracting Officer (CO) before start of contract. An alternate shall be designated, but the Contractor shall identify those times when the alternate shall be the primary point of contact.

1.2.2 MOMMC AUTHORIZED CALLERS. MOMMC will limit the ordering of transportation payable under this agreement to MOMMC personnel listed on an authorized caller list that will be provided to the contractor and updated as authorized callers change. MOMMC nurses, providers, and other personnel will communicate with the contractor to facilitate safe transport; however, the contractor agrees not to bill MOMMC for any transport services that were not pre-authorized for payment by a member on the authorized caller list. The Contractor will annotate and log the rank and name of the authorized caller for each transfer request.

1.3 PERSONNEL REQUIREMENTS

1.3.1 EMPLOYEE CRIMINAL BACKGROUND CHECK. The Contractor assumes responsibility for conducting criminal background investigations on employees who will respond to medical emergencies on or around Nellis AFB, NV. The contractor shall produce the results of these checks upon request by the 99th Medical Support Squadron Commander, Nellis AFB, NV. Additionally, MOMMC may conduct its own formal background investigation of all Government Contractors and the Contractor agrees to cooperate.

1.3.2 EDUCATION AND TRAINING REQUIREMENTS.

1.3.2.1. FORMAL EDUCATION/CERTIFICATION. All drivers performing duties under this contract must possess a valid driver's license within the State of Nevada. Additionally, drivers must have completed Contractor specific proficiency training for all vehicles being operated and comply with all applicable Clark County Emergency Medical Services (EMS) requirements.

1.4 VEHICLE REQUIREMENTS.

All vehicles shall be specifically designed for transporting sick and injured patients and contain all needed equipment and supplies for their safe transport, including all safety and life-saving equipment as required by state and local law, and staffed by personnel trained to provide first aid and emergency response treatment (i.e. ambulance). Vehicle specifications are as follows, but not limited to:

a. Interior climate control.

b. Southern Nevada Area Communications Council (SNACC) compliant communication equipment enabling two way communication between MOMMC and the medical crew on board.

1.5 INVOICING, BILLING AND RECEIVING.

The Contractor agrees to comply with Medicare and Medicaid patient transportation requirements and bill Medicare, Medicaid, TRICARE and other third party insurers in lieu of MOMMC when allowable under insurance carrier rules. The Contractor therein agrees to follow Centers for Medicare and Medicaid guidelines for patient transportation.

MOMMC shall, at the time of requesting transportation from Contractor, furnish the necessary information to the Contractor to assist in proper billing and scheduling of transportation services. This includes a face sheet and a properly completed "Inter- facility Patient Transfer Form" to support the Contractor's claim for payment, which includes the log of the callers authorizing the patient transfers. The Contractor agrees not to bill MOMMC for any services, unless authorized for payment in advance by an authorized caller, and the patient transportation is not eligible for reimbursement by a third party insurance carrier. In some cases, the Contractor will be responsible to bill and collect payment from the patient.

Cases where the patient is billed will be limited to situations when MOMMC is prohibited under fiscal law to authorize payment, and when no third party insurer is required to pay. In all cases, MOMMC authorized callers will identify at the time of requesting the service whether or not MOMMC will pay for the services. MOMMC agrees to provide the Contractor, within five (5) business days of Contractors request, any information within its possession or control, including but not limited to the emergency room report, history and physical, and discharge summary to facilitate proper billing and collections for the transportation services.