Attachment 1 - FMRCC PWS 6 May 20.pdf

Performance Work Statement (PWS)

Family Member Relocation Clearance Coordinator (FMRCC)

For

The 18th Medical Group

Kadena Air Base, Okinawa Japan

6 May 2020

CONTENTS:

Description of Services

1 Scope

1.2 Place of Performance

1.3 Mission Essential Status

1.4 Education and Experience Requirements

1.5 FMRCC Services Task

1.6 Mandatory Knowledge and Skills:

1.7 Orientation and Training:

1.8 Hours of Operation:

2 Facility and Equipment

2.1 Government Provided

3 General Information

3.1 Quality Assurance/Control

3.2 Security Requirements:

3.3 Privacy and Confidentiality:

3.4 Status of Force Agreement (SOFA)

4 Service Summary

5 Appendices

5.1 Appendix 1 – Definitions/Acronyms

5.2 Appendix 2 – Applicable Publications

Description of Services

1. Scope:

1.1. This position serves as the Family Member Relocation Clearance Coordinator (FMRCC) for the Medical Treatment Facility (MTF) and its geographic area of responsibility. The 18th

Medical Group (MDG) requires the FMRCC contract to provide all management, tools, supplies equipment, any required Personal Protective Equipment (PPE), and labor necessary to support the 18th MDG mission by providing health care support services to eligible beneficiaries.

1.2 Place of Performance:

1.2.1 The Contractor shall provide services at the 18th MDG, Kadena AB, Japan.

1.3 Mission Essential Status:

1.3.1 This service is determined to be Non-essential for performance during crisis according to

Department of Defense Instruction (DODI) 3020.41, Operational Contract Support, paragraph

2.c. in the event of crisis, the contractor will be notified by the Contracting Officer (CO) of the need to discontinue services due to contingency, base closure or other causes. If notification to discontinue services is not received, the contractor will be expected to continue performance In

Accordance With (IAW) the Performance Work Statement (PWS).

1.4 Education and Experience Requirements:

1.4.1 Education: Associate of Art (AA) Degree in business administration, management, or health care organizations from an accredited college or university.

1.4.3 Experience. Two years’ experience in a medically related clinic setting or administrative position is required.

1.5 FMRCC Services Task

1.5.1 Participate in training and supervision from the Special Needs Coordinator (SNC) on

Exceptional Family Member Program-Medical (EFMP-M) duties.

1.5.2 Carry out the administrative aspects of the EFMP-M, including but not limited to scheduling appointments, assisting in records review, establishing and maintaining logs and

Special Needs (SN) files, and explaining forms or processes to families.

1.5.3 Use Q-base data system, AHLTA documentation & back-up e-file on the Exceptional

Family Member Program (EFMP) drive maintained at the MTF to document special needs family members and their sponsors assigned to the installation, to administratively manage cases, to process Federal Determination Inquiries (FDIs) IAW the processes outlined in Chapter 3 of this publication, and to transfer cases to gaining facilities upon Permanent Change of Station

(PCS).

1.5.4 Assist other installations or Department of Defense (DoD) agencies in the timely processing of relocation actions.

1.5.5 Coordinate with Military Personnel Facility (MPF), Command Support Section (CSS), and/or Air Force Personnel Center (AFPC) on assignment-related administrative processes in support of special needs families, such as checking Assignment Limiting Code (ALC)“Q” rosters and MPF for collecting Air Force (AF) Forms 4380.

1.5.6 Notify sponsors and orders issuing agents of travel recommendations upon completion of

FDI process.

1.5.7 Assist sponsors with appeal of “not recommended for travel” determinations.

1.5.8 Maintain files, logs and records that implement the FMRCC process and all EFMP-M functions IAW established policy and with the support of the SNC.

1.5.9 Assist the SNC in the tracking and reporting of DoD and AF-required data, such as numbers of family members with special needs located at the installation.

1.5.10 Assist the SNC and Medical Review Officer (MRO) in capturing workload data and process efficiency measurements for EFMP-M IAW AF and MTF guidelines using Medical

Expense and Performance Reporting System (MEPRS) code “FAZN” for all EFMP-M associated workload.

1.5.11 Upon Sponsor in-processing:

1.5.11.1 If necessary, the FMRCC contacts the losing base to obtain an existing SN file.

1.5.11.2 The FMRCC ensures updated contact information is entered into Q-base.

1.5.12 Prior to the Family Member Relocation Clearance (FMRC) process initiation, the

FMRCC:

1.5.12.1 Explains the process to the sponsor and to any adult family members.

1.5.12.2 Advises the sponsor that all family members enrolled in EFMP and those requesting government funded travel to Outside Continental United States (OCONUS) locations must attend the FMRC. Medical records and documentation from TRICARE networks providers and/or medical providers receiving private insurance reimbursement must be made available prior to the screening appointment.

1.5.12.3 Advises sponsor of the required attendance of family members, based on geographical location and type of assignment. Family members who are not currently living with the sponsor, but plan to accompany the sponsor to the new duty location can complete the family member screening at the nearest MTF.

1.5.12.4 Ensures sponsor have all of the correct forms as appropriate (see specific information in

AFI 40-701, Chapter 3); advises sponsors that the FMRC screening appointment will not be held without the completed forms, advises sponsors/family members on how to correctly prepare their part of the required forms.

1.5.12.5 Once all required paperwork has been completed and submitted to the EFMP-M office the following steps are conducted, the FMRCC:

1.5.12.5.1 Schedules the Family Member Clearance (FMC) screening appointment. All required family members will be scheduled for the appointment (see AFI 40-701, para 3.7 for para 3.7 for specific information.)

1.5.12.5.2 Ensures both the SNC and the MRO, or their alternates, have reviewed all required family members’ medical records, when indicated the DD Form 2792-1, and/or AF Form 1466, pharmacy dispenses, and documentation from TRICARE network providers and/or privately insured medical providers prior to the face-to-face FMRC appointment.

1.5.13 Additionally, the FMRCC will:

1.5.13.1 Track each clearance from initiation to completion, ensuring documentation of recommendations are maintained at both the losing and gaining installations. Use Q-base to process FDIs. Ensure the inbound FDI process is completed within 14-calendar days from submission of a completed package from the gaining installation. If a response is not possible within this timeframe, ensures the losing FRMC Coordinator is notified of the reasons for delay and intervenes as needed to expedite response. Advise the SNC of each FDI or clearance package that exceeds the allocated window of time requirement for response and documents extenuating circumstances.

1.5.14 At the losing installation, the FMRCC will:

1.5.14.1 Where the decision to recommend travel is made at the losing installation, the losing

FMRCC will forward to the orders issuing agent all pages of the AF Form 1466. Page 5 of the

AF Form 1466 will note all family members listed on page 3 as being locally cleared by the losing installation Chief of Medical Staff (SGH)

1.5.14.2 Notify sponsors and orders-issuing agents of travel recommendations upon the completion of the FDI process.

1.5.14.3 When travel has been recommended for all family members by the gaining review authority, the losing FMRCC will ensure sponsors or adult family members are aware of any travel considerations via letter provided by the gaining EFMP-M office.

1.5.14.4 When the gaining review authority has recommended against family member travel for one or more family members, the losing FMRCC will ensure sponsors receive the Air Force

Medical Readiness Agency (AFMRA)-developed Medical Information Sheet appropriate to the gaining location. The losing FMRCC will not share Patient Health Information (PHI) of adult family members with sponsors, unless a written Release of Information has been obtained authorizing the release.

1.5.14.5 Assist sponsor with appeal of “not recommended for travel.” The appeal process must be initiated within 21 days of travel recommendation. Appeals will be processed based on new or omitted information that may result in a different travel recommendation. Process appeal packages in Q-base as appropriate.

1.5.15 The SNC and FMRCC will ensure all other task and responsibilities will not specifically addressed within this documents are followed. The primary regulation that directs the Air Force

EFMP-M process are found within AFI 40-701.

1.5.16 FMRCC and/or SNC shall prepare all documentation to meet or exceed established standards of the MTF as outline in the Operating Instruction of the MTF to include but not limited to: timeliness, legibility, accuracy, content, and signature. Only MTF and Air Force approved abbreviations may be used to document care in the health care record.

1.5.17 FMRCC and/or SNC shall ensure complete patient identifying information is on all documentation that is to become part of a health care record.

1.5.18 Performance of Services during a Crisis Declared by the National Command Authority of

Overseas Combatant Commander. The FMRCC is required to perform essential services in accordance with this PWS in emergency or limited force protection conditions such as natural disaster; however DODI 1100.22 does not apply to this contract for crisis situations where continuation of essential services by the Contractor is unfeasible.

1.6 Mandatory Knowledge and Skills:

1.6.1 Knowledge. Must have the knowledge in accreditation standards, privacy, and confidentiality requirements. Must have knowledge in Microsoft Office programs, Outlook, internet familiarity and other computer system necessary to effectively apply FMRCC functions.

1.6.2 Planning. Collaboration with the patient, family/caregiver, primary provider and other members of the health care team for developing an effective plan for care is expected.

1.6.3 Facilitation. Care coordination and communication among all involved parties is key to provision of care for individuals with special medical needs.

1.6.4 Advocacy. Support for the patient and family/caregivers to ensure proper education of the patient and family and appropriate, timely care coordination is received.

1.6.5 Ability to communicate effectively both orally and in writing to motivate, train, and work effectively with a diverse workforce.

1.7 Orientation and Training:

1.7.1 The Government will provide the following 18th MDG initial and ongoing training:

1. Newcomers Orientation (Initial)

2. Medical Facility/Air Force Unique Training (Ongoing)

3. Security Training (Ongoing)

4. Military Health System (MHS) Access to Care standards (Ongoing)

5. Section Specific Safety Briefings (Ongoing)

6. Clinic Specific Training (Ongoing)

1.7.2 The Government will provide initial and ongoing training on 18th MDG appointing protocols/protocol changes to the Contract personnel. These trainings will be given on an as needed basis.

1.7.2.1 When in-processing the MTF, contractors are required to provide proof of immunizations including, but not limited to: Hepatitis B; Measles, Mumps, and Rubella (MMR);

Tetanus, Diphtheria, Pertussis (Tdap); Tuberculosis; Varicella; and Influenza (annual requirement). Any missing immunizations will be required in order to finalize in-processing and will be obtained at the Contractor’s expense.

1.7.2.2 FMRCC must in-process through Public Health (PH) within 10 duty days of arrival at the 18th MDG. FMRCC will not begin duties until and unless determined to be in compliance with infection/immune status as defined by Center For Disease Control (CDC), Advisory

Committee of Immunizations Practices (ACIP) and PH.

1.7.2.3 No pre-employment medical tests or procedures required by the contract will be performed by the MTF (with the exception of Tuberculosis testing after start of work and after possible exposure). Expenses for all required pre-employment and annual tests and/or procedures shall be borne by the contractor or contractor personnel, not the Government.

1.7.3 The Government will provide training on the following electronic systems:

1. CHCS (Composite Health Care System)

2. AHLTA (Armed Forces Health Longitudinal Technology Application)

3. Q-Base (Limiting Code Q Database)

1.8 Hours Of Operation:

1.8.1 The contractor shall maintain the following service hours to conduct normal day-to-day business: 7:30 a.m. to 4:30 p.m., Monday-Friday with a maximum of 40 hours per week. When necessary for contractor personnel to work hours other than 7:30 a.m. to 4:30 p.m., Monday through Friday, contractor must coordinate with the section chief or Contract Officer

Representative (COR). A lunch period is not a payable period, and will be coordinated with the

Functional Representative Evaluator Designee (FRED). Commuting time to and from required place of performance is not compensable by the Government. There will be no overtime paid on this contract.

1.8.2 The Contractor is required to work during days that have been designated by the

Installation Commander or 18th MDG leadership as days of reduced operations (i.e., PACAF/5th

Air Force Training Days, Family Days, Exercises, minimally manned or reduced hours of operation). The Contractor is encouraged to conduct in-house training when clinic services are limited. The FRED will notify the Contractor personnel of any changes to the provider staffing schedules due to inclement weather, clinic closures, etc.

1.8.3 Contract personnel are not required to provide services on the observance day for the following Federal Holidays:

New Year’s Day

Martin Luther King Day

President’s Day

Memorial Day

Independence Day

Labor Day

Columbus Day

Veteran’s Day

Thanksgiving Day

Christmas Day

1.8.4 Scheduled and Unscheduled Absences. Contractor personnel are allowed to take up to twenty (20) work days of leave annually. Leave is classified as both annual, vacation or sick leave. Leave shall be taken in one (1) day increments and shall not exceed ten (10) consecutive work days. All leave is considered non-paid days and shall be deducted from the contractor’s monthly invoice. Timing and details shall be coordinated with the FRED. To the maximum extent practicable, scheduled absences shall be scheduled at least thirty (30) calendar days in advance and mutually agreed upon by the COR and individual. Unscheduled absences shall be called into the FRED by the contract provider within the first two (2) hours of each duty day that he/she is unable to report to work

1.8.4.1 In case of absences or illness exceeding two weeks, the Contractor shall replace the absent employee with another of equal or exceeding qualifications. The Contractor/Contractor’s personnel shall advise the FRED, supervisor or designee of absences due to illness or incapacitation.

1.8.4.2 If the Contractor is absent for more than two consecutive days due to illness, the

Contractor shall provide the Government with a statement that the employee is free from communicable illness before/as the employee returns to work. The Government’s intent is to ensure that illnesses will not be passed to others in the workplace. The Government reserves the right to examine and or re-examine any worker who meets this criterion.

1.8.5 Replacement of contractor personnel. The contractor management staff shall replace permanent contractor personnel within 21-30 days of position vacancy. Contractor personnel must notify to the Contractor and the Government staff (FRED, COR, Contract Administer (CA), and CO) of the intention to vacate the job at least thirty (30) calendar days prior to the last duty day. (e.g. send resignation form/document to the Contractor). The Contractor must provide candidate package to the Government staff no later than thirty (30) calendar days prior to the date of resignation. The contractor management staff shall ensure that all temporary or permanent replacement staff are fully qualified, meet all pre-placement requirements and are ready to perform within the required timeframe.

1.8.6 The Defense Medical Human Resources System Internet (DMHRSi) is the DoD accounting system for financial, personnel, education and training, and workload within the 18th

MDG. The Contractor staff is responsible to provide all required information monthly (for example: personal data, work schedule, worked hours, work center, etc.) for all contractor personnel to the MEPRS manager or clinic MEPRS monitor for entry into the system by the Air

Force.

1.8.7 The contract company will submit invoice for hours work by employee in Wide Area

Work Flow (WAWF) monthly to the COR. The COR will then validate works hours invoiced against by verifying against the FREDs method of timekeeping. Once validated, COR will accept invoice and submit invoice in WAWF to Defense Finance and Accounting Services (DFAS) for payment. Contractor will only be allowed to invoice for hours rendered.

2. Facility and Equipment

2.1 Government Provided:

2.1.1 The Government will provide a room within building 626 for the FMRCC. No alterations to the facilities shall be made without specific written permission and approval. In case of alterations necessary for compliance with Occupational Safety and Health Administration

(OSHA), such permission shall not be unreasonably withheld. The Contractor shall return the facilities to the Government in the same condition as received, except for fair wear and tear and approved modifications. These facilities shall only be used in performance of this contract.

2.1.2 The Government will furnish utilities to include heating, electricity, water, and sewer.

2.1.3 The Government will provide all equipment necessary to accomplish the appointing procedures including telephony equipment, computers, and general office supplies.

2.1.4 The Contractor shall notify COR, in writing, of any equipment that is broken, damaged, or in any way inoperable.

2.1.5 The Contractor is authorized to telework from home as required by COR for emergency situations that impact the mission. The contractor will use their own computer and CAC reader to

Telework.

3. General Information

3.1 Quality Assurance/Control

3.1.1 The Government will periodically evaluate the contractor’s performance by appointing a

COR and FRED to monitor performance to ensure services are received. The COR will complete a monthly surveillance report and submit it to the Contracting Officer. The COR may evaluate the Contractor’s performance through intermittent on-site inspections of the

Contractor’s performance and receipt of validated complaints. The Government may increase or decrease the number of inspection based on performance. The COR shall make determination of the validity of customer complaint(s). In the event there is a dispute, the Contracting Officer will make the final determination. Government personnel will record all surveillance observations.

The preferred method, when possible, of correcting contract defects is re-performance at no additional contract cost. At a minimum, contractor shall provide documentation of their efforts to preclude repeat deficiencies.

3.1.2 The Contractor shall develop, submit for CO acceptance, and maintain a quality control plan to ensure appointing services are performed in accordance with this statement of work and specifically address the Service Summary (SS) items within 15 days after contract award. The

Contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services.

3.1.3 The Contractor’s Quality Control Plan shall include, as a minimum:

3.1.3.1 Inspection System. A description of the inspection methodology used to cover all tasks and services. The description shall include specifics as to the areas to be inspected on a scheduled and unscheduled basis, frequency of inspections, submission of quality control inspection schedule, and dthe title and organizational placement of the inspectors.

3.1.3.2 Identification/Prevention Methods. A description of the methods to be used for identifying and preventing defects in the quality of service performed.

3.1.3.3 Documentation. The Contractor shall document inspections and corrective or preventive actions taken. The record of inspections shall be kept and made available to the Government throughout the contract performance period and for the period after contract completion until final settlement of any claims under this contract.

3.1.4 The Contractor shall establish and implement methods of making sure all keys/combinations issued to the Contractor by the Government are not lost or misplaced and are not used by unauthorized persons. The Contractor shall not duplicate any keys issued by the

Government. The Contractor shall immediately report to the COR any occurrences of lost or duplicated keys. In the event keys, other than master keys, are lost or duplicated, the Contractor may be required, upon written direction of the COR, to re-key or replace the affected lock or locks without cost to the Government. The Government may, however, at its option, replace the affected lock or locks or perform re-keying and deduct the cost of such from the monthly payment due the Contractor. In the event a master key is lost or duplicated, the Government shall replace all locks and keys for that system, and deduct total cost from the monthly payment due the Contractor.

3.2 Security Requirements:

3.2.1 All personnel employed by the Contractor in the performance of this contract, or any representative of the Contractor entering the Government installation, shall abide by all security regulations of the installation. All employees shall possess base provided identification cards and

Vehicle Registration Certificates for personal vehicles requiring access to Kadena AB. When any employee no longer works for the Contractor at the installation, the Contract Manager shall return any Government-furnished identification to the Government. These passes are at no cost to the contractor. The 18th MDG Trusted Agents shall coordinate assistance in attaining the proper installation identification.

3.2.2 Contractor employees shall wear visible identification badges on the front of outer clothing, between the neck and waist.

3.2.3 The Contractor’s employees shall have background check completed in order to have access to Government systems. Contractor is responsible for completing a SF85P Worksheet and providing fingerprint cards for each employee prior to access to the installation. The Contractor shall comply with regulations, DoD 5200.2-R Personnel Security Program.

Note: the Contractor may request an interim clearance for access to government systems when the clearance has not been finalized at the time of employment. However, the 18 MDG

Commander must approve this interim access, and evidence must be presented that shows the clearance has been initiated, pending favorable final approval. The Point of Contact (POC) for this will be the 18 MDG Security Officer.

3.2.4 The Contractor shall be responsible for safeguarding all government property provided for contractor use. At the end of each work shift, all government facilities, equipment, and materials shall be secured.

3.3 Privacy and Confidentiality:

3.3.1 PHI. The Contractor shall comply with all Health Insurance Portability and Accountability

Act (HIPAA) guidelines. Patient information, lists and/or names of patients shall not be disclosed or revealed in any way for any use outside the MTF without prior written permission by the 18 MDG Commander. Any unauthorized disclosures shall be immediately documented and forwarded to the COR. The Contractor shall maintain, transmit, retain in strictest confidence, and prevent the unauthorized duplication, use, and disclosure of PHI in accordance with

Standards for Privacy of Individually Identifiable Health Information, final rule, December 18, 2000 DoD Health Information Privacy Regulation (DoD 6025.18-R), the Privacy Act, and DoD

Privacy Program (DoD 5400.11-R). The Contractor shall provide patient information only to employees, contractors, subcontractors, and government personnel having a need to know requirement for such information in the performance of their duties for this tasking. The 18

MDG shall approve the release of any patient information prior to the release.

3.4 Status of Force Agreement (SOFA):

3.4.1 The SOFA between the United and Japan governs the rights and obligations of the United

States armed forces in Japan. Unless a contract is present in Japan solely to perform under a contract with the United States for the sole benefits of the United States armed forces in Japan and accorded privileges under SOFA Article XIV, it and its employees shall be subject to all the laws and regulations of Japan. Certain contractor employees and their dependents not accorded privileges under SOFA Article XIV may be accorded privileges under SOFA Article 1 (b)

3.4.2 The FMRCC shall comply with the instruction of the Contracting Officer concerning the entry of its employees, equipment, and supplies into Japan, and shall comply with all applicable

Japanese Laws and regulations as well as United States Forces Japan (USFJ) and USFJ component policies and regulations during the performance of this contract.

3.4.3 SOFA Article l(b) Status:

(A) SOFA Article l(b) status. Contractor employees performing under contracts with the

United States for the provision of services in support of U.S. armed forces in Japan, and whose presence is required in Japan to provide such services, may be determined eligible to acquire

1(b) does not create a lawful status in Japan for any entity other than individuals (e.g.,the company employing the individual does not acquire SOFA status under Article 1(b)). To qualify for SOFA status under SOFA Article 1(b), such individuals must be:

(i) United States nationals

(ii) Not ordinarily resident in Japan

(iii) Present in Japan at the invitation of, and solely for the purpose of executing contracts, with, the United States for the benefit of the United States armed forces, and

(iv) Not contractors or employees of a contract whose presence in Japan is solely for the purpose of executing contracts within the definition of SOFA Article XIV.

(B) The contracting officer may determine a proposed contract employee’s eligibility for recognition as a Member of the Civilian Component under Article 1(b) of SOFA by documenting on a Letter of Authorization (LOA) that the contractor employee is essential to the mission of the United States armed forces and has a high degree of skill knowledge for the accomplishment of mission requirements by fulfilling one of the following:

(i) Acquiring the skill and knowledge through a process of higher education or specialized training and experience; or

(ii) Possessing a security clearance recognized by the United States to perform his or her duties; or

(iii) Possessing a license or certification issued by a U.S. Federal Department of Agency, U.S.

State, U.S. Territory, or the District of Columbia to perform his or her duties; or

(iv) Identified by the United States armed forces a necessary in an emergent situation and will remain in Japan for less than 91 days to fulfill specialized duties; or

(v) Specifically authorized by the Joint Committee

(C) FMRCC shall present a valid LOA, signed by the Contracting Officer, to Japanese immigration officials upon entry into Japan to received Government of Japan (GOJ) recognition as a Member of the Civilian Component under Article 1(b) of SOFA

(D) SOFA Article l(b) privilege and benefits. Persons granted authority to enter Japan under

SOFA Article 1(b) and their dependents (defined as spouse, children under 21, and, if dependent for over half their support upon an individual having SOFA Article 1(b) status, parents and children over 21) may be accorded the following benefits of the SOFA. These privileges are personal to the employee/dependent and do not inure to the employer:

(i) Access to and movement between facilities and areas in use by the United States armed forces and between such facilities and areas and the port or airports of Japan as provided for in

SOFA Article V, paragraph 2;

(ii) Entry into Japan and exemption for Japanese laws and regulations on the registration and control of aliens as provided for in SOFA Article IX;

(iii) Acceptance as valid by Japan, without a driving test or fee, a U.S. Forces, Japan

Operator’s Permit for Civilian Vehicle as provided for in SOFA Article X, Issuance of such permit shall be subject to applicable military regulation;

(iv) Exemption form customs duties and other such charges on materials, supplies, and equipment which are to be incorporated into articles or facilities used by the United States armed forces furniture, household goods for private use imported by person when they first arrive to work in Japan, vehicles and parts imported for private use, and reasonable quantities of clothing and household good for everyday private use which are mailed into Japan through

United States military post offices as provided for in SOFA Article Xi, paragraphs 2 and 3;

(v) Exemption from the laws and regulations of Japan with respect to terms and conditions of employment as provided for in SOFA Article XII, paragraph 7, except that such exemption shall not apply to the employment of local national in Japan;

(vi) Exemption from Japanese taxes to the Government of Japan or to any other taxing agency in Japan on income received as a result of their service with the United States armed forces as provided for in SOFA Article XIII. The provisions of Article XIII do not exempt such persons from payment of Japanese taxes on income derived from Japanese sources;

(vii) If authorized by the installation commander or designee, the right to use exchanges, commissaries, messes, social clubs, theaters, newspapers and other non-appropriated fund organizations regulated by United States military authorities as provided for in SOFA Article

XV;

(viii) The transmission into or outside of Japan of United States dollar or dollar instruments realized as a result of contract performance as provided for in SOFA article XIX, paragraph 2;

(ix) The use of postal facilities as provided for in SOFA Article XXI;

(x) Exemption from taxation in Japan on the holding, use transfer by death, or transfer to person or agencies entitled to tax exemption under the SOFA, of movable property, tangible or intangible, the presence of which in Japan is due solely to the temporary presence of these persons in Japan, provided such exemption shall not apply to property held for the purpose of investment or the conduct of other business in Japan or to any intangible property registered in

(xii) Logistics Support. Contractor, contractor personnel, and in case of personnel granted

SOFA article 1(b) status dependents, shall, subject to availability as determined by the installation commander or designee, by provided logistics support including, but not limited to, the items below:

1. Base Exchange, including exchange service stations, theaters, and commissary (Article 1.b personnel/dependents and Article XIV personnel only);

2. Laundry and dry cleaning

3. Military banking facilities (Article 1(b) personnel/dependents and Article XIV personnel only;

4. Transient billeting facilities;

5. Open mess (club) membership, as determined by each respective club;

6. Casualty assistance (mortuary Services) on reimbursable basis;

7. Routine medical care on a reimbursable basis for U.S. citizen and emergency medical care on a reimbursable basis for non-U.S citizens;

8. Dental care, limited to relief of emergencies on a reimbursable basis;

9. Department of Defense Dependent Schools on a space-available and tuition-paying basis;

10. Postal support; as authorized by military postal regulations

11. Local recreation services on a space-available basis;

12. Issuance of U.S. Forces, Japan Operator’s Permit;

13. Issuance Of vehicle license plates

14. Conduct. Civilian personnel supporting the U.S. armed forces in Japan are guests in a foreign country and must at all times conduct themselves in an honorable and credible manner.

Criminal conduct and dishonorable personal behavior committed either on or off duty adversely impacts U.S. and Japanese relations, tarnishes the image of the DoD and USFJ, and hampers the Force’s military readiness.

3.4.3.1. Compliance with laws and regulations. The Contractor shall comply with, and shall ensure that its personnel are familiar with, and comply with, all applicable-

(i) United States, host country, and third country national laws;

(ii) Treaties and international agreements;

(iii) United States regulations, United States Armed Forces directives, instructions, policies, and procedures; and

(iv) Removal and replacement of Contractor personnel. The Contracting Officer may direct the contractor, at its own expense, to remove and replace any Contractor personnel who fail to comply with or violate applicable requirements of this contract, including those stipulated in this section. Such action may be taken at the Government’s discretion without prejudice to its rights under any other provision of this contract, including the termination for default or cause.

4 Service Summary (SS)

SS# Performance Objective PWS

Paragraph

Performance

Threshold

Method of

Assessment

1 Ensures the inbound FDI process is completed within

14-calendar days from submission of a completed package from the gaining installation.

1.5.13.1 No more than one

avoidable failure to meet timeline per month

Monthly

Surveillance

2 Ensures every AF sponsor with special needs that is assigned to the installation has an electronic record.

1.5.3

1.5.12.2-

1.5.12.4

1.5.13.1

100% Compliance

3 Maintains professional manner and displays positive/cooperative attitude.

Will respond to org box messages within 24-hours of message receipt.

1.6.1-1.6.5 No more than 2 validated complaints from patients; MDG staff, or base leadership quarterly

Monthly

Surveillance

4 Ensures Q-base roster of Q-coded sponsors assigned to the installation reflects AFPC roster. There should be no inconsistencies.

1.5.11.2

1.5.12

1.5.5

No more than one avoidable failure to meet timeline per month

Monthly

Surveillance

5 Documents at minimal in

AHLTA and Q-base all

EFMP enrollments, disenrollment’s, warm hand-offs, and clearance/command sponsorship appointments.

Utilizes authorized templates/forms via Q-base resources

1.13.1

1.5.5

No more than one avoidable failure to meet timeline per month

5 APPENDICES

5.1 Appendix 1 - Definitions/Acronyms

1. General Definitions

Contracting Officer. A person duly appointed with the authority to enter into, administer, and terminate contracts on behalf of the Government

Contracting Officer Representative. Government personnel who survey contractor compliance. They are the contractor’s first point of contact for contract issues.

Government. The Federal government of the United States of America.

Government Quality Assurance. Those actions taken by the Government to assure contractor services meet the requirements of the contract.

Medical Group/Medical Treatment Facility. Air Force hospitals or clinics, including all activities providing outpatient and/or in-patient healthcare services for authorized personnel.

Performance Work Statement. A document accurately describes a service in terms of the output requirements.

Quality Control. Those actions taken by a Contractor to control the quality of output and to ensure that they conform to contract requirements and reasonable standards of medical care.

2. Acronyms

AA - Associate of Art

ACIP- Advisory Committee of Immunization Practices

AF - Air Force

AFMRA - Air Force Medical Readiness Agency

AFPC - Air Force Personnel Center

AHLTA – Armed Forces Health Longitudinal Technology Application

ALC – Assignment Limiting Code

CA - Contract Administer

CDC - Center for Disease Control

CHCS – Composite Health Care System

CO - Contracting Officer

COR - Contract Officer Representative

CSS - Command Support Section

DFAS- Defense Finance and Accounting Services

DOD - Department of Defense

DODI - Department of Defense Instruction

EFMP - Exceptional Family Member Program

EFMP-M - Exceptional Family Member Program-Medical

FDI - Federal Determination Inquiry

FMC- Family Member Clearance

FMRC - Family Member Relocation Clearance

FMRCC - Family Member Relocation Clearance Coordinator

FRED - Functional Representative Evaluator Designee

GOJ - Government of Japan

HIPAA - Health Insurance Portability and Accountability Act

IAW - In Accordance With

LOA - Letter of Authorization

MDG - Medical Group

MEPRS - Medical Expense and Performance Reporting System

MPF - Military Personnel Facility

MRO - Medical Review Officer

MTF – Military Treatment Facility

OCONUS - Outside Continental United States

OSHA - Occupational Safety and Health Administration

PCS - Permanent Change of Station

PHI - Patient Health Information

POC - Point of Contact

PPE- Personal Protective Equipment

PWS - Performance Work Statement

SNC - Special Needs Coordinator

SOFA - Status of Force Agreement

SS - Service Summary

WAWF- Wide Area Work Flow

5.2 Appendix 2 – Applicable Publications

Publications and forms applicable to the Performance Work Statement (PWS) are listed below. The

Contractor is obligated to follow those publications. These publications are available in the MTF and maintained by the Government. Supplements or amendments to listed publications from any organizational level may be issued during the life of the contract. The Contractor shall immediately implement those changes in publications, which result in a decrease or no change in the price and notify the CO thru COR in writing of such change. Should a decrease in contract price result; the Contractor shall provide a proposal for reduction in the price to the CO thru COR. Prior to implementing any change that will result in an increase, the Contractor shall submit to the CO thru COR a price proposal within 30 days of receipt of the change by the Contractor. The CO and the Contractor shall negotiate the change into the contract under the provisions of the contract clause entitled “Changes”. Failure of the Contractor to submit a price proposal within 30 days from receipt of the change shall entitle the Government to performance in accordance with such change at no increase in price

Applicable Technical, Regulations, References Manuals, Specifications, and Documentation. This list includes, but is not limited to the following:

Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act of 1992

Privacy Act of 1974

Title VI of the Civil Rights Act of 1964

Section 504 of the Rehabilitation Act of 1973

DoD Directive 5400.11-R, “The Freedom of Information Act of 1967”

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Electronic and Information Technology Accessibility Standards (36 CFR 1194)

DOD Regulation 5200.2-R, “DoD Personnel Security Program,” January 1987

Standards for Privacy of Individually Identifiable Health Information, Final Rule, December 28, 2000 5

U.S.C. § 552a, as amended

32 CFR 199

Rehabilitative Act of 1973, Section 508

Appointment Standardization Commander’s Guide to Access Success

TRICARE Operations Manual, 6010.51-M, August 1, 2002, Chapter 21, Section 3

TRICARE Systems Manual, 7950.1-M, August 1, 2002, Chapter 1

Accreditation Process (DITSCAP)

DoD Health Information Privacy Regulation (DoD 6025.18-R)

DOD Privacy Program (DoD 5400.1l-R) Title 10, U.S.C., Chapter 55

DOD Directive 5500.7, Standards of Conduct, Mar 87

AIR FORCE REGULATIONS/MANUALS/INSTRUCTIONS

AFI 40-701, Medical Support to Family Member Relocation and Exceptional Family Member Program

AFI 41-115, Authorized Health Care and Health Care Benefits in the Military Health System

AFI 41-210, Patient Administration Functions

AFI 44-119, Medical Service Quality Improvement and Risk Management

OTHER REFERENCES

Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Accreditation Manual for

Hospitals, current edition

The Commander’s Guide to Access Success, http://www.tricare.osd.mil/tai/cguide.htm

Access to Care in Preparation for the T-Nex Environment, First Consulting Group Study, Prepared for

AF/SG, March 2003 http://www.tricare.osd.mil/tai/cguide.htm