Attachment 1 - Performance Work Statement 10 June 2021.pdf

PERFORMANCE WORK STATEMENT

For

Resilience Center and Health and Wellness Center Administration Services

At

Hurlburt Field, FL

Dated

10 June 2021

Resilience Center and Health and Wellness Center Administration Services

TABLE OF CONTENTS

SECTION NUMBER AND TITLE Page

1.0 DESCRIPTION OF SERVICES 3 - 5

2.0 SERVICE SUMMARY

5 - 5

3.0 GOVERNMENT PROVIDED PROPERTY AND SERVICES

6 - 7

4.0 GENERAL INFORMATION

7 - 18

APPENDIX A - WORKLOAD ESTIMATES

1.0. DESCRIPTION OF SERVICES

1.1. The contractor shall provide all non-personal services, to include: personnel to support of 1 SOW, Resilience Center and 1 SOAMDS/SGPZ, Health and Wellness Center (HAWC).

1.2. The contractor shall create, manage, implement, brief and maintain the all aspects of the Resilience Center Commando Ready Program and HAWC programs. The Commando Ready program improves base and unit cohesion, provides Airmen with a personalized process that properly welcomes and connects airmen and their families to Hurlburt Field while increasing readiness and resilience.

1.3. Health and Wellness Center Administrator

1.3.1. Manage the Health and Wellness Center (HAWC) Services

1.3.2. Assist in the preparation of management plans and reports. Coordinate schedules to facilitate contract deliverables, Technical Order (TO) review, briefings, presentations, perform analysis, development and review of program or functional areas as required. Utilize the Armed Forces Health Longitudinal Technology Application (AHLTA), Composite Health Care System, and Preventive Health Assessment and Individual Medical Readiness. Update education and intervention dates, delete and modify Unit Fitness Program Managers in the Air Force Fitness related systems to include the Air Force Fitness Management System. Manage the usage of HAWC services to include scheduling classes, classrooms, meetings and appointments.

1.3.3. Gather and maintain all data associated with HAWC and Commando Ready program and prepare reports and presentations that accurately convey data trends and associated analysis.

1.3.4. Maintain Air Force Comprehensive Airman Fitness and United States Special Operations Command (USSOCOM) Preservation of the Force and Family programs.

1.4. Resilience Center Operations Administrator

1.4.1. Manage the operation of the Commando Ready Resilience Center Services

1.4.2. Manage the operation of the Commando Ready Resilience Center to include scheduling classes, classrooms, meetings and appointments for the Commando Ready Program and resilience training participants. Facilitates the Hurlburt Field Integrated Delivery System (IDS) agencies that provide programs supporting mental, physical, and social resilience domain to facilitate appropriate referral. Utilize the Armed Forces Health Longitudinal Technology Application (AHLTA), Composite Health Care System, and Preventive Health Assessment and Individual Medical Readiness. Update education and intervention dates, and modify Unit Fitness Program Managers and members in the Air Force Comprehensive Airman Fitness and United States Special Operations Command (USSOCOM) Preservation of the Force and Family programs.

1.4.3. Maintain Air Force Fitness and monitor Air Force Fitness Management System and MyLearning at https://lms-jets.cce.af.mil.

1.4.4. Provide briefings in support of the Commando Ready and Resilience Center Programs

1.4.5. Gather and maintain all data associated with Commando Ready and prepare reports and presentations that accurately convey data trends and associated analysis.

1.5. Deliverable. All deliverables must meet professional standards and the requirements set forth in contractual documentation. The contractor shall be responsible for delivering all end items specified. The following items are outputs, which fall within the scope of this effort and which are illustrative of the type of work the Government expects to require.

Deliverable Paragraph

Reference Date of Submission Date of Subsequent

Submission Distribution

Monthly Status Report

1.5.1 45 days after award 15th of each Month CO & COR

Employee’s List

4.9 Within fifteen

(15) business days of contract award

When any staffing change occurs.

CO & COR

Full-Time Equivalent Reports

4.16.

to

4.16.3

Annually No Later Than (NLT) 31 October https://www.sam.gov

1.5.1. Monthly Status Report - will be on contractor letterhead, and will list previous month’s accomplishments, identified problems/solutions, planned vacation, vacancies, etc. Reports must be submitted via the COR no later than the 15th workday of every month. The Monthly Progress Report will be approved by the COR prior to submittal to the CO. Failure to provide reports correctly shall require the contractor to resubmit.

The Monthly Progress Report shall include, all of the following.

1. Contract number and Project Name.

2. Brief task description.

3. A narrative review of work accomplished during the reporting period and/or significant events.

4. Deliverable progress.

5. Problems areas anticipated activity for the next reporting period.

6. Description of any, other direct costs, training or unique services provided or planned. What kind of unique services could the Contractor provide? Everything to be provided should be mentioned in the PWS. Any innovative processes worked/developed, which are encouraged to alleviate workload, yet still, meet the objectives required.

https://lms-jets.cce.af.mil/ https://www.sam.gov/

2.0 SERVICES SUMMARY

Services Summary (SS): The service requirements are summarized into performance outcomes that relate directly to mission essential items. The performance thresholds describe the minimum acceptable levels of service required for each performance objective. The thresholds are critical to mission success and acceptable (satisfactory) performance.

SS

# Performance Objective PWS

Para # Performance Threshold

(to receive Satisfactory Rating)

Contractor Manage the Health and Wellness Center (HAWC) Services operations

1.3.2 1.3.3 1.3.4

Contractor received no more than two (2) written customer complaints annually.

Customer complaints were successfully resolved within five (5) workdays of notification, 90% of the time.

Contractor Resilience Center Operations

1.4.2 1.4.3 1.4.4 1.4.5

Contractor received no more than two (2) written validated customer complaints annually. Customer complaints were successfully resolved within five (5) workdays of notification, 90% of the time.

3 Provide Confidentiality of Information 4.20

The Contractor personnel shall not release any confidential without prior written consent. All confidential information must be protected and maintained 100% of the time.

4 Contractor met required delivery schedule. 1.5

No more than one late deliverable semi-annually. All corrections must be accomplished within two working days, 90% of the time.

Contract employee(s) were clearly identified during performance of duties.

4.3.9. 90% compliance.

Contractor personnel shall complete annual training required in accordance with HIPAA, Joint Commission, AF Computer Security Policy, and AF Safety Policy.

4.3.17

Contractor shall complete training within 60 days of contract start/change of personnel. Annual refresher training must be completed prior to expiration of annual requirement.

3.0. GOVERNMENT FURNISHED RESOURCES.

3.1. The government will provide the limited facilities, equipment, materials, and services listed here. Specific responsibilities are detailed in this section.

3.2. Facilities. The Government will provide office space at 1 SOAMDS/SGPZ, Health and Wellness Center, 452 Cody AVE, STE 127A, Bldg 90232 and 1 SOW Resiliency Center, 424 Cody AVE, Bldg 90229, Hurlburt Field, Florida. The Government retains the authority to modify or realign facilities and space provided to the contractor based on current or future Air Force guidelines for space utilization, mission requirements, and personnel requirements of the contractor as necessary. Government facilities have been inspected for compliance with OSHA.

No hazards have been identified for which work-arounds have been established. Should a hazard be subsequently identified, the government will correct the hazard according to base-wide government developed and approved plans of abatement taking into account safety and health priorities. A higher priority for correction will not be assigned to the facilities provided to the contractor merely because of this contracting initiative. The fact that no such conditions have been identified does not warrant or guarantee that no possible hazard exists, or that work-around procedures will not be necessary or that the facilities as furnished will be adequate to meet the responsibilities of the contractor. Compliance with OSHA and other applicable laws and regulations for the protection of employees shall be exclusively the obligation of the contractor.

3.3. Automatic Data Processing Equipment (ADPE). The government host unit will grant access to ADPE and training to the minimum extent necessary for mission accomplishment. The contractor shall use ADPE for controlling and tracking data and information as well as any other duties related to contract performance. The contractor shall not use government furnished ADPE or services for non-contractual related purposes. The contractor shall comply with all computer system security procedures required by the Government.

3.3.1. Local Area Network Access (LAN). In accordance with AFI 33-119, Electronic Mail Management and Use, paragraph 9.2.5, contractor personnel using unclassified automated information systems that have access to sensitive information must possess, at a minimum, a National Agency Check or Entrance National Agency Check in accordance with DoD 5200.2-R, Personnel Security Program or screening in accordance with AFI 31-501, paragraph 3.27, Personnel Security Program Management.

3.3.2. Computer Security. The contractor shall maintain computer systems security integrity in accordance with the Air Force Computer Security (COMPUSEC) program (AFSSI 5102). The contractor personnel will be required to complete testing IAW AFI 33-204, Information Assurance Awareness Program and satisfy any other local requirements set forth by the 1st Special Operations Communications Squadron or other government agency prior to being allowed access to government computers.

3.4. Administrative Supplies. The Government will provide reasonable amounts of administrative supplies (e.g., office supplies.

3.5. Government - Furnished Services

3.5.1. Security Forces. The Government will provide general security service. Security Forces phone extensions are 911 for emergencies, and 884-7114 for routine calls.

3.5.2. Postal or Installation Distribution. Official government or contractor mail that is generated as a result of performance of this contract will be handled, at government expense, via the Base Information Transfer System (BITS) at Hurlburt Field, Florida. The contractor shall not use BITS to handle non-government or non-contract-related mail.

3.5.3. Telephone Service. The Government will provide access to telephone for use in making local and long distance calls in performance of official contract related requirements.

3.5.4. Emergency Medical Services. In the event of a severe emergency, 911 should be contacted.

Ambulance transport responds from the Hurlburt Field Clinic for Monday through Friday. On weekends and holidays, Okaloosa County ambulance transport will respond. One of the units will respond to the 911 call, and if necessary, transport a service provider employee to one of the local hospitals. The service provider shall reimburse the respective agency for these services.

4.0. GENERAL INFORMATION

4.1. Quality Assurance. According to Federal Acquisition Regulation (FAR) sections 52.246-4 Inspection of Services - Fixed-Price and 52.246-5, the government will evaluate the contractor’s performance under this contract. For all requirements of the contract, including those tasks listed in the Service Summary (SS), Section 2, the COR will follow standard surveillance and inspection procedures. Any action taken by the contracting officer as a result of surveillance will be according to the terms of this contract.

4.2. Quality Control. The contractor shall provide a Quality Control Plan in compliance with FAR sections 52.246-4 Inspection of Services - Fixed-Price.

4.2.1. Contents. The plan shall include a detailed description of the processes to be used during performance to ensure the services meet or exceed the requirements of the SS, the PWS and contract. The plan shall systematically provide for early identification of nonconforming service;

develop metrics to track performance trends; detail corrective actions required to insure timely and acceptable performance in accordance with the PWS; identify organizational placement of the inspectors and describe the contractor’s partnering approach with the Government to ensure mission objectives are met. Additionally, plans that require employees to comply with the government control procedures for materials, equipment, facilities, and keys or lock combinations shall be included. To include all required security and accountability forms documentation.

4.2.2. Copy of Metrics. The contractor shall provide a copy of the metrics data along with analysis in their weekly report to the government COR not later than 1000 hours each Friday. Metrics shall address each SS item and any other contractor or Government identified metric that will facilitate successful performance of contract requirements.

4.2.3. Revisions. Revisions to the Quality Control plan may be required at any time during performance of the contract to assure contractor compliance with requirements of the PWS and contract. The contractor shall make appropriate revisions and obtain acceptance of the revised plan from the contracting officer. Revised copies of the Quality Control Plan shall be provided to the contracting officer.

4.2.4. Performance Evaluation Meetings. The Contracting Officer may require to meet with the contractor administrator, COR, other government personnel as deemed necessary. The contractor may request a meeting with the contracting officer when he/she believes such a meeting is necessary. Written minutes of any such meetings will be recorded in the contract and signed by the site leader and the contracting officer or contract administrator. If the contractor does not concur with any portion of the minutes, such non-concurrence shall be provided in writing to the Contracting Officer by the contractor within ten (10) calendar days following receipt of the minutes.

4.3. Contractor Personnel. The Contractor shall provide a Program Manager who shall be overall responsible for contract performance. The Program Manager shall be available via telephone within 30 minutes to address government concerns. The Program Manager does not need to be assigned to the worksite and shall not be directly billable to the contract.

4.3.1. Employees. The contractor shall ensure personnel are commensurate with manning and experience levels for each designated position and job description. Personnel should be familiar with the daily business of the unit they support. Ensure all employees possess the following professional qualifications before starting work under this contract. Have the capability to read, write, speak, and understand English. Be familiar with military command and control structures.

Possess a valid civilian driver’s license

4.3.2. The contractor shall maintain a current listing of employees. The list shall include each employee’s full name, aliases and social security number and shall be marked For Official Use Only. The original and one copy of this list shall be furnished to the Contracting Officer at the pre-performance conference. Personnel changes at Hurlburt Field, Florida that are made during the performance of this contract shall be sent to the Contracting Officer and 1 SOW/CVB, within two (2) working days of the change.

4.3.3. The contractor shall not employ persons for work on this contract if such employee is identified to the contractor by the Contracting Officer as a potential threat to the health, safety, security, general well-being, or operational mission of the installation and its population. Where reading, understanding, and discussing safety, security, mission, and environmental issues are an integral part of a contract employee’s duties, that employee must be able to understand, read, write, and speak English.

4.3.4. 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. 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 seeks and receives approval according to DoD Regulation 5500.7-R, Joint Ethics Regulations (JER). The contractor shall not employ any person who is an employee of the Department of the Air Force if such employment would be contrary to the policies in AFI 64-106, Air Force Industrial Labor Relations Activities.

4.3.5. Prior to commencement of work, contractor personnel shall attend a government orientation to familiarize contractor personnel with the policies and procedures of the 1 SOMDG. The orientation will be scheduled by the COR during normal duty hours and will be at no cost to the contractor.

4.3.6. Dress/Appearance. Contractor personnel shall present a clean and neat appearance.

Contractor shall not permit cut off shorts and clothing with tears, or revealing clothing or clothing with obscene or inflammatory designs, slogans, or remarks, and clothing representing military attire such as BDUs or DCUs.

4.3.7. Smoking, Eating and Drinking. The contractor shall permit smoking, eating and drinking only in designated areas.

4.3.8. Driving License/On-base Requirements. The contractor and employees shall comply with base traffic regulations at all sites. The contractor shall ensure employees have a current and valid state/country driver’s license before allowing the employee to operate a personal vehicle on Hurlburt Field, Florida.

4.3.9. Contractor Identification. Contractor personnel shall wear badges identifying them as contractors at all times. The Government will issue badges through the wing administration section.

4.3.10. Place of Performance. The Contractor shall perform the required support at 1 SOW, Resilience Center and 1 SOAMDS/SGPZ, Health and Wellness Center located on Hurlburt Field, Florida. Contractor personnel shall comply with all installation and facility safety and security regulations, as well as, the health, safety, and security provisions of the contract. Contractor personnel shall report security or safety problems to the Contracting Officer and/or Security Police as appropriate.

4.3.11. Hours of Work. Normal duty hours are Monday through Friday, 0730 to 1630 hours, based on the projected instruction schedule, except for federal holidays. Contractors are not expected to work more than 80 hours per two-week pay period.

4.3.12. Holidays and Vacation. The contractor will not normally be required to work during the following holidays. If performance is required for these holidays, it will be approved and scheduled in advance with the COR.

New Year's Day January 1 Martin Luther King Day Third Monday of January President's Day Third Monday of February

Memorial Day Last Monday in May Juneteenth June 19 Independence Day July 4 Labor Day First Monday of September Columbus Day Second Monday in October Veterans Day November 11 Thanksgiving Fourth Thursday in November Christmas December 25

If the holiday falls on a Saturday, it is observed on the preceding Friday. If the holiday falls on a Sunday, it is observed on the following Monday.

4.3.13. Vacation and Compensatory Time. All earned compensatory time off must be used within 90 days of it being accrued. The contractor shall submit in the monthly status report a vacation and compensatory time off schedule.

4.3.14. Government Provided Training. If the contractor attends any government provided training, the contractor is responsible to provide the trained capability for the duration of the contract.

4.3.15. Conservation of Utilities. The contractor and their employees shall operate under conditions that prevent the waste of utilities.

4.3.16. Prior to commencement of work, contractor personnel shall attend a government orientation to familiarize contractor personnel with the policies and procedures of the 1 SOMDG.

The orientation will be scheduled by the COR during normal duty hours and will be at no cost to the contractor.

4.3.17. Contractor personnel shall complete annual training required in accordance with HIPAA, Joint Commission, AF Computer Security Policy, and AF Safety Policy. Training will be provided at no cost to the contractor and will be conducted on-site during duty hours.

4.4. Skill and Knowledge. Contractor personnel performing on-site services must possess the following knowledge and skills:

4.4.1. Read, understand, speak, and write English fluently. Teaching and public speaking skills in order to provide guidance, counseling, training, professional and cooperative attitude.

4.4.2. Knowledge and ability to communicate effectively, both oral and in writing with tact and courtesy.

4.4.3. Knowledge in the use of personal computers and computer programs to include Microsoft Office applications. Knowledge of Microsoft and other various office automation software processing procedures and function keys and the similarities and differences among software types to produce a wide range of documents, web pages, portal development, graphics and tables within text, to edit and reformat electronic drafts, and to update and revise existing databases or spreadsheets. knowledge of Microsoft and other various office automation software processing procedures and function keys and the similarities and differences among software types to produce a wide range of documents, web pages, portal development, graphics and tables within text, to edit and reformat electronic drafts, and to update and revise existing databases or spreadsheets.

4.4.4. Knowledge of Composite Health Care System (CHCS) Armed Forces Health Longitudinal Technology Application (AHLTA) and Preventive Health Assessment and Individual Medical Readiness.

4.4.5. Knowledge of information management procedures and rules.

4.5. Qualifications. In addition to the skills and knowledge listed above in paragraphs

4.0 - 4.4.5, on-site contractor personnel performing shall possess the below qualifications.

4.5.1. Expert knowledge of technical writing, proofreading, technical editing of word processing and other computer-based documents, integration of various sources into a cohesive product which may be delivered as computer-based magnetic media, preparation of graphical and narrative presentation material, skills in general management, organizational principles, to analyze, evaluate, advise, and coordinate.

4.6. Criminal Background check Requirement. The Government will conduct criminal background checks on individuals providing services under this contract, using the procedures set forth in Department of Defense Instruction 1402.5 dated 19 January 1993. Background checks will be based on fingerprints of individuals obtained by a Government law enforcement officer and inquiries conducted through the Federal Bureaus of Investigation and state criminal history repositories.

4.6.1. Contractor personnel may provide contract services prior to completion of background checks with the consent of the CO, 1 SOW and 1 SOMDG commander.

4.6.2. Contractor personnel may obtain a copy of any background check pertaining to them and to challenge the accuracy and completeness of the information contained in the report.

4.7. Records. All records, files, documentation, working papers, and software provided by the government or generated in the performance of this contract become and remain government property.

4.7.1. All such records, files, documentation, and working papers, which this contract requires the contractor to maintain, shall be maintained in accordance with AFI 33-322, Records Management Program; AFI 33-364, Records Disposition-Procedures and Responsibilities; AF Electronic Records Management (ERM) Solution, AFRIMS, Records Disposition Schedule located at https://www.my.af.mil/gcss-af61a/afrims/afrims/ and all other pertinent directives, as supplemented.

4.8. Hour of Performance. The contractor shall provide Administrative services, Mondays through Fridays 0700-1600 hours.

https://www.my.af.mil/gcss-af61a/afrims/afrims/

The contractor shall not provide services on Federal Holidays and non-duty days as follows:

New Year’s Day - 1 January Martin Luther King Day - 3rd Monday in January President’s Day - 3rd Monday in February Memorial Day - last Monday in May Juneteenth - 19 June Independence Day - 4 July Labor Day - 1st Monday in September Columbus Day - 2nd Monday in October Veteran’s Day - 11 November Thanksgiving Day - 4th Thursday in November Christmas Day - 25 December

If these holidays fall on Saturday, the preceding Friday will be observed. If these holidays fall on Sunday, the following Monday will be observed. If a holiday falls on a scheduled service day, the Contractor will be responsible for rescheduling services for the first day post the holiday observance. The non-duty days will precede or follow the Federal Holidays. A list of associated non-duty days will be provided to the contractor annually.

4.9. Base Closure. In the event of a base closure due to weather, exercises, or actual alerts, the contracting officer will inform the contractor’s program manager and provide further instructions.

Contractor personnel shall contact the contractor’s program manager for instructions.

4.10. Contractor/Employee Base Pass and Identification, Special Clearances and Vehicle Passes.

The Contractor personnel shall comply with all requirements and procedures IAW AFFAR 5352.242-9000, Contractor Access to Air Force Installations. The contractor shall submit the employee listing at the pre-performance conference and to the CO monthly as changes occur. All documentation shall be submitted for identification badges and base access devices to the Visitor Control Center (VCC) after the employee listing has been submitted to the CO.

4.11. Traffic Laws. The Contractor personnel shall comply with base traffic regulations.

4.12. Weapons, Firearms, and Ammunition. The Contractor personnel are prohibited from possessing weapons, firearms, or ammunition, on themselves or within their Contractor-owned or privately owned vehicle while on Hurlburt Field, FL.

4.13. For Official Use Only (FOUO). The Contractor personnel shall comply with DoD 5400-7-R, Chapter 4, DoD Freedom of Information Act (FOIA) Program requirements. This regulation sets policy and procedures for the disclosure of records to the public and for marking, handling, transmitting, and safeguarding FOUO material.

4.14. Reporting Requirements. The Contractor personnel shall report to an appropriate authority any information or circumstances of which they are aware may pose a threat to the security of DoD personnel, Contractor personnel, resources, and classified or unclassified defense information.

4.15. Physical Security. The Contractor personnel shall be responsible for safeguarding all government property and controlled forms provided for contractor use. At the end of each work period, all government facilities, equipment, and materials shall be secured.

4.16. Reporting Full-Time-Equivalent (FTE) Data. The Contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract via a secure data collection site. The Contractor is required to completely fill in all required data fields at the System for Award Management (https://www.sam.gov).

4.16.1. Reporting Period. Reporting inputs will be for the labor executed during the period of performance for each Government fiscal year (FY), which runs 1 October through 30 September.

While inputs may be reported any time during the FY, all data shall be reported no later than 31 October of each calendar year. Contractors may direct questions to the System for Award Management (https://www.sam.gov) help desk.

4.17. Safety Requirement and reports. The Contractor personnel shall perform work in a safe manner as required by OSHA Safety and Health Requirements. Provide a verbal report to the CO as soon as possible of each occurrence of damage to Government property or an accident resulting in death, injury, occupational disease, or adverse environmental impact. Provide a completed copy of required Accident Investigation Reports to the CO within 5 calendar days of each occurrence.

4.18. Computer Security. A National Agency Check with Inquiries must be completed at the government’s expense to conduct a security background check for appropriate security of privacy act information. IAW AFI 33-202V1_AFMCSUP1, dated 30 November 2005. All contractors must have a National Agency Check with Inquiries (NACI) or single scope background investigation (SSBI) prior to granting access to government e-mail, network or computer systems.

4.18.1. The Contractor personnel shall complete and e-mail an electronic copy of the SF85, Electronic Personnel Security Questionnaire (EPSQ) file in the ".zdb" format to the Security Manager two weeks prior to commencement of work in the 1 SOMDG.

4.19. Health Care Requirements. The Contractor personnel shall report to the 1 SOMDG Public Health office during in-processing for a briefing on Medical Group Employee Health Program requirements.

4.20. Confidentiality of information. Unless otherwise specified, all financial, statistical, personnel, and/or technical data which is furnished, produced or otherwise available to the contractor or health care worker during the performance of this contract are considered Government confidential business information and shall not be used for purposes other than performance of work under this contract. The Contractor personnel shall not release any of the above information without prior written consent. All medical records and reports remain the property of the Government.

4.20.1. Patient lists, no matter how developed, shall be treated as confidential information in accordance with the Privacy Act and the Health Insurance Portability and Accountability Act (HIPAA). Lists and/or names of patients shall not be disclosed to or revealed in any way for any use outside the 1 SOMDG, except through 1 SOMDG-specified processes.

4.20.2. Release of Medical Information: The Contractor personnel shall only release medical information obtained during the course of this contract to other 1 SOMDG staff involved in the care and treatment of that individual patient.

4.21. PRIVACY OF PROTECTED HEALTH INFORMATION

4.21.1. (a) Definitions. As used in this clause:

Individual has the same meaning as the term ``individual'' in 45 CFR 164.501 and shall include a person who qualifies as a personal representative in accordance with 45 CFR 164.502(g).

Privacy Rule means the Standards for Privacy of Individually Identifiable Health Information at 45 CFR part 160 and part 164, subparts A and E.

Protected Health Information has the same meaning as the term ``protected health information'' in 45 CFR 164.501, limited to the information created or received by The Contractor from or on behalf of The Government.

Required by Law has the same meaning as the term ``required by law'' in 45 CFR 164.501.

Secretary means the Secretary of the Department of Health and Human Services or his/her designee.

Terms used, but not otherwise defined, in this Agreement shall have the same meaning as those terms in 45 CFR 160.103 and 164.501.

(b) The Contractor agrees to not use or further disclose Protected Health Information other than as permitted or required by the Contract or as Required by Law.

(c) The Contractor agrees to use appropriate safeguards to prevent use or disclosure of the Protected Health Information other than as provided for by this Contract.

(d) The Contractor agrees to mitigate, to the extent practicable, any harmful effect that is known to the Contractor of a use or disclosure of Protected Health Information by the Contractor in violation of the requirements of this Contract.

(e) The Contractor agrees to report to the Government any use or disclosure of the Protected Health Information not provided for by this Contract.

(f) The Contractor agrees to ensure that any agent, including a subcontractor, to whom it provides Protected Health Information received from, or created or received by the Contractor on behalf of the Government, agrees to the same restrictions and conditions that apply through this Contract to the Contractor with respect to such information.

(g) The Contractor agrees to provide access, at the request of the Government, and in the time and manner designated by the Government to Protected Health Information in a Designated Record Set, to the Government or, as directed by the Government, to an Individual in order to meet the requirements under 45 CFR 164.524.

(h) The Contractor agrees to make any amendment(s) to Protected Health Information in a Designated Record Set that the Government directs or agrees to pursuant to 45 CFR

164.526 at the request of the Government or an Individual, and in the time and manner designated by the Government.

(i) The Contractor agrees to make internal practices, books, and records relating to the use and disclosure of Protected Health Information received from, or created or received by the Contractor on behalf of, the Government, available to the Government, or at the request of the Government to the Secretary, in a time and manner designated by the Government or the Secretary, for purposes of the Secretary determining the Government’s compliance with the Privacy Rule.

(j) The Contractor agrees to document such disclosures of Protected Health Information and information related to such disclosures as would be required for the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

(k) The Contractor agrees to provide to the Government or an Individual, in time and manner designated by the Government, information collected in accordance with this Clause of the Contract, to permit the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45

CFR 164.528.

General Use and Disclosure Provisions: Except as otherwise limited in this Agreement, the Contractor may use or disclose Protected Health Information on behalf of, or to provide services to, the Government for the following purposes, if such use or disclosure of Protected Health Information would not violate the Privacy Rule or the Department of Defense Health Information Privacy Regulation if done by the Government: [List Purposes].

Specific Use and Disclosure Provisions:

(a) Except as otherwise limited in this Agreement, the Contractor may use Protected Health Information for the proper management and administration of the Contractor or to carry out the legal responsibilities of the Contractor.

(b) Except as otherwise limited in this Agreement, the Contractor may disclose Protected Health Information for the proper management and administration of the Contractor, provided that disclosures are required by law, or the Contractor obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and used or further disclosed only as required by law or for the purpose for which it was disclosed to the person, and the person notifies the Contractor of any instances of which it is aware in which the confidentiality of the information has been breached.

(c) Except as otherwise limited in this Agreement, the Contractor may use Protected Health Information to provide Data Aggregation services to the Government as permitted by 45 CFR 164.504(e)(2)(i)(B).

(d) Contractor may use Protected Health Information to report violations of law to appropriate Federal and State authorities, consistent with 45 CFR 164.502(j)(1).

Obligations of the Government. Provisions for the Government to Inform the Contractor of Privacy Practices and Restrictions:

(a) Upon request the Government shall provide the Contractor with the notice of privacy practices that the Government produces in accordance with 45 CFR 164.520, as well as any changes to such notice.

(b) The Government shall provide the Contractor with any changes in, or revocation of, permission by Individual to use or disclose Protected Health Information, if such changes affect the Contractor's permitted or required uses and disclosures.

(c) The Government shall notify the Contractor of any restriction to the use or disclosure of Protected Health Information that the Government has agreed to in accordance with 45

CFR 164.522.

Permissible Requests by the Government: The Government shall not request the Contractor to use or disclose Protected Health Information in any manner that would not be permissible under the Privacy Rule if done by the Government, except for providing Data Aggregation services to the Government and for management and administrative activities of the Contractor as otherwise permitted by this clause.

Termination:

(a) Termination. A breach by the Contractor of this clause, may subject the Contractor to termination under any applicable default or termination provision of this Contract.

(b) Effect of Termination.

(1) If this contract has records management requirements, the records subject to the Clause should be handled in accordance with the records management requirements. If this contract does not have records management requirements, the records should be handled in accordance with paragraphs (2) and (3) below

(2) If this contract does not have records management requirements, except as provided in paragraph (3) of this section, upon termination of this Contract, for any reason, the Contractor shall return or destroy all Protected Health Information received from the Government, or created or received by the Contractor on behalf of the Government. This provision shall apply to Protected Health Information that is in the possession of subcontractors or agents of the Contractor. The Contractor shall retain no copies of the Protected Health Information.

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

Miscellaneous:

(a) Regulatory References. A reference in this Clause to a section in the Privacy Rule means the section as in effect or as amended, and for which compliance is required.

(b) Survival. The respective rights and obligations of Business Associate under the ``Effect of Termination'' provision of this Clause shall survive the termination of this Contract.

(c) Interpretation. Any ambiguity in this Clause shall be resolved in favor of a meaning that permits the Government to comply with the Privacy Rule.

APPENDIX A: Workload Estimates

The following are estimated hours required in performance of this contract:

Administrative Specialist 1,920 Hours Administrative Specialist 1,920 Hours