Attachment 1 - Performance Work Statement 2022 v3.pdf

Exceptional Family Member Program (EFMP) Coordinator Performance Work Statement for the 48th Medical Group

PREPARED BY: 48th Contracting Squadron and 48th Medical Group RAF Lakenheath, England DATE: 16 Mar 2022

Table of Contents

Section Number and Title Page Number

1.0 Description of Services 3

2.0 Government Furnished Property and Services 3

3.0 Contractor-Furnished Property and Services 3

4.0 General Information 3

5.0 Specific Tasks 12

6.0 Service Delivery Summary 14

7.0 Definitions 14

8.0 Appendices 15

Appendix A, Applicable Publications and Forms 16

Appendix B, Health Insurance Portability and Accountability Act of 18

Appendix C, National Agency Check/Host Nation Check 23

Appendix D, Notice to Potential Contractors 26

1. Description of Services

1.1 The Government requires a non-personal services contract in accordance with FAR Subpart 37.4 for one (1) Full Time Equivalent (FTE) Exceptional Family Member Program Coordinator (EFMP) Social Worker for this contract at the established facilities at the 48th Medical Group, RAF Lakenheath, England, also referred to as the “Medical Treatment Facility” (MTF) herein.

Performance shall be in accordance with the requirements contained in this Performance Work Statement (PWS), and standards of the Joint Commission.

2. Government Furnished Property

2.1. None furnished

3. Contractor-Furnished Property

3.1. None furnished

4. General Information

4.1. Hours of Operation

4.1.1. Normal base hours of operation are 07:30 – 16:30. However, the contractor may find it necessary to deviate from the normal base hours of operation, to ensure timely completion of work under this PWS at no additional cost to the government.

4.1.1.1. The contractor's work schedule will be dependent upon MTF workload and the needs of the clinic or section in which the contractor is to provide the service. The contractor may be required to work more or less than 8 hours in a single day and/or 40 hours in a week. If additional hours are worked, the government may reduce future scheduled hours to maintain a 40 hour work week average.

4.1.1.2. The estimated hours to be worked during each period of performance is 1,920 hours.

4.1.2. Federal Holidays. The contractor will not be required to work the following United States federal holidays, New Years’ Day, Martin Luther King’s Birthday, President’s Day, Memorial Day, Juneteenth, Independence Day, Labor Day, Columbus Day, Veteran’s Day, Thanksgiving Day and Christmas Day.

4.1.3. On occasion, services may be required to support an activation or exercise of contingency plans outside the normal duty hours for a crisis declared by the command authority or overseas combatant commander. Emergency situations (i.e., accident and rescue operations, civil disturbances, natural disasters, military contingency operations, and exercises) may necessitate the contractor to provide increased or reduced support as determined by the contracting officer.

4.1.4. Only the Contracting Officer may authorize hours over 1,920 per year. The Contractor will not be entitled to any adjustment to the contract unless coordination has been made in advance.

4.2. Contractor Personnel

4.2.1. Education

4.2.1.1. The EFMP must hold a Master of Social Work (M.S.W.) degree from a school of social work fully accredited by the Council on Social Work Education (CSWE).

4.2.2. Experience

4.2.2.1. A minimum of two years full-time experience in care coordination, discharge planning or case management in a medical setting within the last four years.

4.2.3. Certifications

4.2.3.1. Maintain a current, unrestricted clinical license to practice social work in any one of the 50 states, the District of Columbia, Puerto Rico, or the U.S. Virgin Islands. A clinical social work license is defined as a license that allows the Social Worker to practice independently without clinical supervision.

4.2.3.2. The contractor is required to obtain a certification in Basic Life Support (BLS), Advance

Cardiac Life Support (ACLS), and Neonatal Resuscitation Program (NRP) by the American Heart Association and/or the Red Cross approved training program prior to contract start date.

4.2.3.3. An annual physical examination is required. The contractor must provide proof of the medical examination by a qualified medical practitioner and required immunizations prescribed by the MTF for continued practice within the facility. Report all information necessary to assure hospital records can be maintained correctly, and therefore comply with the Joint Commission, Operational Safety and Health Administration (OSHA), and Center for Disease Control (CDC) health record requirements.

4.2.3.4. Public Health clearance is required and the contractor shall submit immunization records and physical health certification. The records must show proof of immunization against Hepatitis A and B, Measles, Mumps, Rubella, Varicella, and Influenza, as well as provide proof of negative TB skin test taken within the past 12 months. If the TB test was positive, submit proof of negative chest x-ray within the past 12 months. After start of work, the government will provide post blood borne exposure protocols according to applicable AFIs. The health certification shall state the date on which the physical examination was completed, the name of the doctor who performed the examination, and a statement concerning the physical health of the individual. The certification shall also contain the following statement: “(Name of contractor personnel) is suffering from no contagious diseases to include, but not limited to, Tuberculosis, Hepatitis A and B and HIV.”

4.3. Security Clearances

4.3.1. The contractor must have a valid Facility Security Clearance granted by the Defense Security

Service (http://www.dss.mil). The contractor must comply with DoDD 5220.22, DoD Industrial Security Program, to determine eligibility for access of classified information for work performed under this PWS.

4.3.2. Contractor personnel working in 48 MDG will have a National Agency Check or host nation equivalent. The results of the check shall be provided to the Contracting Officer. The Government will not accept any employee with a federal conviction (or host nation equivalent) in their background check.

4.4. Contractor Management

4.4.1. Non-Availability

4.4.1.1. Scheduled non-availability is to be coordinated a minimum of 2 weeks in advance. Notify the Flight Commander or designee immediately of unscheduled absences to allow for planning of service coverage and workload distribution.

4.4.1.2. The MTF will notify contract personnel in advance of upcoming down days to the greatest extent possible for scheduling purposes. In the event of unplanned closure of the facility due to natural disasters, military emergency, or severe weather, contract employees will not perform duties.

4.4.1.3. The contractor is required to provide temporary replacement staff for contractor absences and scheduled or unscheduled absences of 30 or more calendar days.

4.4.2. Dress and Appearance

4.4.2.1. Contractor shall present a professional, conservative, and neat appearance. Contractor shall report for duty in a professional manner, in appropriate attire befitting a healthcare setting, and having complied with acceptable standards of personal hygiene expected of health care workers.

4.4.2.2. While on duty, contractor shall be neat and clean (free from visible dirt and stains), well-groomed and appropriately dressed. The personnel’s clothing shall fit correctly to provide a professional, modest appearance. If wearing scrubs they shall match the shade of blue as the rest of the hospital.

4.4.2.3. Contractor shall display legible MTF-provided identification card on their outer clothing.

4.4.2.4. Facial hair (including beards, mustaches, and sideburns) shall be controlled (restrained) or trimmed and kept clean at all times.

4.4.2.5. When required and supplied by the government, wear special protective clothing and shoe covers. When duties are performed in specified areas, a disposable protective hood shall be worn to ensure infection control standards are met. These items shall remain the property of the government and shall not be removed from the MTF. After use, protective clothing shall be turned in or destroyed as directed by the Chief of Service.

4.4.3. Conduct

4.4.3.1. The Contractor personnel shall record the time worked according to procedures determined by the MTF.

4.4.3.2. Contractor personnel shall comply with MTF policies regarding personal appearance and conduct. Conduct that may be deemed inappropriate and unacceptable includes, but is not limited to, use of profanity, threats of violence, or other unprofessional conduct in the work place.

4.4.3.3. Contractor personnel shall abide by Federal and local MTF regulations and requirements concerning the nature of limited privileged communication between patients and the contract employee as may be necessary for security and personnel reliability programs. They shall also abide by federal and local MTF regulations concerning the confidentiality of patient records, as embodied in federal statutes including the Privacy Act of 1974 and the Health Insurance Portability & Accountability Act of 1996. All regulations referenced are available for review from the Contracting Officer’s Representative (COR), MTF, or the Contracting Officer. All medical records and reports will remain the property of the U.S. Government.

4.4.3.4. Contractor personnel shall abide by MTF bylaws, Joint Commission (JC), Department of

Defense (DoD), Health & Safety Institute (HIS) and Medical Department regulations with regard to Utilization Review and Quality Assurance directives, including, but not limited to, in-service training, maintenance of records, performance evaluation, release of medical information.

4.4.3.5. Disruptive Contractor Personnel

4.4.3.5.1. The Contracting Officer may remove any contractor employee that is found to be disrupting the normal operations of the clinic and/or department to which they have been assigned. Disruptions may include, but are not limited to, the inability to work with other personnel (military, civilian Government employees, and other contract employees), threats of violence, use of profanity while performing under this contract, and repeated non-compliance.

4.4.3.5.2. At any time during the performance of this contract, the Contracting Officer may immediately remove the health care professional whose actions or impaired state raises reasonable suspicion that clear and present danger of physical harm exists to a patient, healthcare professionals, Government personnel or to the impaired individual. This will be used in emergency situations only and not for the purpose of bringing performance issues or other non-urgent concerns to the attention of the contractor.

4.4.3.5.3. If the need for a removal due to performance or other issues does occur, the Contracting

Officer will contact the contractor's point of contact and direct the contractor to remove that individual from the military facility and to not use that individual to perform any healthcare services required under this contract until the issue has been resolved.

4.4.3.5.4. If, after any investigation deemed necessary by the Contracting Officer and discussions with the contractor's representative, the Contracting Officer concludes that the contract healthcare professional’s requires permanent removal from performance under the contract, the Contracting Officer will notify the contractor that permanent removal is required. In the event of disagreements between the Government and the contractor's representative concerning matters of the contract healthcare professional, the decision of the Contracting Officer will be final. During the period of time between the removal and the final decision of the Contracting Officer, the contractor shall provide a backup/replacement healthcare professional in accordance with the terms of the contract.

4.5. Healthcare Requirements

4.5.1. In accordance with Federal Acquisition Regulation (FAR) 37.401 with regard to Non-Personal

Services for health care services, the following information is provided:

4.5.1.1. This is a non-personal health care services contract, as defined in FAR 37.101, under which the contract is an independent contractor.

4.5.1.2. The Government may evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of services rendered (e.g., professional judgments, diagnosis, for specific medical treatment).

4.5.1.3. The contractor hereby indemnifies the Government for any liability producing act or omission by the contractor, its employees and agents occurring during contract performance.

4.5.1.4. The contractor shall maintain medical liability insurance.

4.5.1.5. The contractor shall ensure that its subcontracts for provisions of health care services, contain the requirements of FAR clause 52.237-7, Indemnification and Medical Liability Insurance.

4.5.2. Any clinical or administrative adverse actions will be handled and processed IAW applicable

Air Force instruction(s).

4.5.3. An annual physical examination is required. The contractor must provide proof of the medical examination by a qualified medical practitioner and required immunizations prescribed by the MTF for continued practice within the facility. Report all information necessary to assure hospital records can be maintained correctly, and therefore comply with the Joint Commission (https://www.jointcommission.org/), Operational Safety and Health Administration (https://www.osha.gov/), and Center for Disease Control (https://www.cdc.gov/) health record requirements.

4.5.4. The Contractor shall make known to the MH flight commander, and/or Chief of the Medical

Staff the presence of any medical or mental health concern that would serve to significantly impair their ability to provide healthcare as a provider in the MTF.

4.5.5. Contractor staff must comply with 48th Medical Group and unit standards of care as well as the healthcare practices of their specific profession. See Appendix A for a list of applicable publications and forms; this list is not exhaustive.

4.5.6. Recognize adverse signs and symptoms and react quickly in emergency situations.

4.5.7. Provide patients with the utmost care and undivided attention.

4.5.8. Ensure a safe work environment and employee safe work habits.

4.5.9. Participate in Quality Inspection and Risk Management activities to the extent that these events fall within the scope of this PWS.

4.5.10. Health Insurance Portability and Accountability Act (HIPAA). All patients shall be assured of their privacy and personal dignity. Follow guidelines for confidentiality and privacy based on HIPAA. See Appendix B for further information.

4.6. Release of Information and Records Management

4.6.1. Only release medical information obtained during the course of this contract to MTF staff involved in the care and treatment of that individual patient.

4.6.2. 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 Chief of the Medical Staff.

4.6.3. Refer all requests for records to the Outpatient Records section.

4.6.4. Prepare all documentation/records to meet or exceed established standards of the MTF, to include, but not limited to, timeliness, accuracy, content and signature.

4.6.5. Generate and manage IAW DoD 5400-7R, DoD Freedom of Information Act Program, Chapter 4.

4.6.6. Mark IAW instructions identified in DoD 5400-7R paragraph C4.2.1. Safeguard all sensitive data IAW DoD Regulation 5400.7/Air Force Supplement, paragraph C4.4.

4.6.7. When authorized for destruction, shred the records so that the pieces cannot be reconstructed.

Degauss or overwrite magnetic tapes or other magnetic media.

4.6.8. Patient lists, no matter how developed are FOUO and shall be marked: “FOR OFFICIAL USE

ONLY”. This document contains information exempt from mandatory disclosure under the Freedom of Information Act (FOIA), Title 5 U.S.C. 552(b)(2) and (b)(6) apply.”

4.7. Credentialing

4.7.1. Contractor personnel shall provide certified copies of their successful completion of all medical training; applicable medical school diplomas; internship, master privilege list if applicable, residency and fellowship diplomas if applicable and a curriculum vitae. The contractor shall provide all documentation to ensure the candidate meets all the requirements for the position they are to fill. All required qualifications documents shall be submitted to the COR within 30 calendar days after notification of contract award. In the event the contractor personnel provided to the MTF has been removed or resigned from their position, the contractor will provide a new candidate within 30 calendar days to the COR. The contractor will meet all clinical privileging standards set by the Medical Treatment Facility Credentials Committee. Failure to maintain adequate credentials for the performance of responsibilities listed herein will subject the contractor to termination of the contract.

4.7.2. Providers will be subject to the credentials and privileging requirements of AFI 44-119, Clinical Performance Improvement, as well as adverse actions. New providers will have initial review by MTF Chief of the Medical Staff (SGH), one year after initial, and bi-annually after that. If the Privileged Provider has been in the system then they will be bi-annually thereafter.

4.7.3. The SGH, or his/her representative, will define the equipment and facility capabilities and verify contracted employees credentialing package meets the MTFs requirements.

4.7.4. Providers shall be able to obtain privileges through the applicable MTF Credentials Committee. The Contractor shall provide a complete, current and accurate credentialing package for each individual as required in AFI 44-119, Chapter 4.

4.7.5. The Credentials Committee or designated representative may have questions which they will wish to present to the contractor verbally or in writing. The Contractor shall answer questions presented by the Credentials Committee or designated representative either verbally or in writing. However, Government officials will not use these communications to conduct interviews.

4.7.6. If the contractor adds additional or replacement HCPs during the contract period, the same qualification standards, credentialing/privileging and health requirements shall apply.

4.7.7. The contractor shall not use any individual to provide direct health care services under this contract if that individual, within the past 5 years:

4.7.7.1. Has had his/her clinical privileges limited, suspended, or revoked by any health care facility, public or private, anywhere in the world.

4.7.7.2. Is the subject of a current or pending hearing or appeal brought by any health care facility, public or private, anywhere in the world, which may result in the limitation, suspension, or revocation of the individual’s clinical privileges.

4.7.8. This prohibition does not apply to any individual whose clinical privileges, although originally limited, suspended or revoked by a health care facility, were subsequently fully reinstated by the health care facility.

4.7.9. Limitation of clinical privileges, as used in this paragraph, refers to a partial withdrawal/reduction of clinical privileges as a result of a determination that, or pending investigation to determine whether, an individual has engaged in unprofessional conduct or substandard medical practice or is incompetent to perform certain medical practices.

4.8. Government Quality Assurance

4.8.1. The Government will rely on the contractor’s quality control program to assess performance whenever possible. However, the Government reserves the right to perform additional inspections as necessary, utilizing the Government’s Quality Assurance Surveillance Plan (QASP) and the inspection/acceptance provisions in the clause FAR 52.212-4 Contract Terms and Conditions -- Commercial Items.

4.9. Government-Furnished Training

4.9.1. The contractor may be required to attend additional site-specific training in patient care aspects and procedures. This training will be provided by the government during normal work hours.

4.10. Bioenvironmental Engineering/Hazmat Requirements

4.10.1. Environmental, Health, And Safety. The contractor shall ensure all employees receive the necessary environmental, health, and safety training to ensure compliance with all OSHA, federal and local laws. The contractor shall protect the health and safety of employees and the community, minimizing the risk of environmental pollution.

4.10.2. Pollution Prevention. "Pollution Prevention" and "Source Reduction" are defined in the Pollution

Prevention Act of 1990, 42 U.S.C. §§ 13101-13109. Contractor's obligation under this section is limited to identifying pollution prevention opportunities and shall not be construed to require the contractor to conduct activities not otherwise required by the program.

4.10.3. The contractor shall comply with energy saving conservation practices as deemed necessary by the facility manager.

4.10.4. Ionizing and Non-Ionizing Radiation: Contractors must obtain authorization from BE prior to bringing on site ionizing or non-ionizing sources/equipment onto the installation. Contractors must provide list of items and description of how they will be used to Bioenvironmental Engineering (BE) at 01638528047 or 48amds.sgpb@us.af.mil at least 10 days prior to the date required to bring them on base.

4.10.4.1. Non-Ionizing Radiation: Electromagnetic Frequency (EMF) Radiation and LASERS:

Contact BE/Installation Laser Safety Officer (48amds.sgpb@us.af.mil) at least 10 days prior to bringing on site (Example: LASER Classes: 1M, 2M, 3R, 3B, or 4; Transmitting antennas, radars etc.). Reference: AFI 48-139, LASER and Optical Radiation Protection Program, Paragraph 2.21)

4.10.4.2. Ionizing sources: Contact BE (48amds.sgpb@us.af.mil) at least 10 days prior to bringing on site ionizing sources/equipment. For regulated sources, provide copies of permits or sealed source certifications (Example: Troxler density gauges, sealed sources in various gauges/devices). Reference: AFI 48 -148, Ionizing Radiation Protection.

4.10.5. Hazardous Materials/Chemical Management: All hazardous material use requires prior authorization before bringing the hazardous material on base. "Hazardous material" includes many materials for which there is a manufacturer SDS, such as cleaning supplies, paints, solvents, sealants, lead acid batteries, fuels, herbicides, etc.

4.10.5.1. Inventory. The Contractor shall submit an inventory list of ALL chemical products to be used, along with copies of the SDS and COSHH Risk Assessment for each chemical product before bringing any potentially hazardous material onto RAF Lakenheath, RAF Feltwell or RAF Mildenhall. The Contractor shall submit completed inventories, SDS’s, and COSHH Risk Assessment’s to:

The Contracting Officer;

CE Environmental [for RAF Lakenheath --athena.kahler.ctr@us.af.mil (01638 523990); for

RAF Mildenhall -- jamie.griffin.6@us.af.mil (01638 545831)]; and

4.10.5.1. Bioenvironmental Engineering -- usaf.lakenheath.48-mdg.mbx.sgpb@mail.mil (01638

528047), at least 10 days prior to the date required to bring them on base.

4.10.5.2. Once approved, the Contractor shall maintain an inventory of all hazardous materials along with corresponding Safety Data Sheets (SDSs). The Contractor shall track and report actual hazardous material usage during the performance of the contract. Hazardous material usage for any contract that is less than one month in duration shall be reported at the end of the contract period. Hazardous material usage for any contract over a month in duration shall be reported no less than monthly. Hazardous material usage shall be reported using the attached “HazMat Monthly Usage Log Template”.

4.10.5.3. The Contractor shall not leave any excess hazardous materials or empty containers on site following completion of the project. The Contractor is responsible for the removal of all unused hazardous materials and proper disposal of all hazardous waste generated IAW AFI- 32-7086, Hazardous Materials Management

4.10.6. Controls of other hazards: Contractors must coordinate with Bioenvironmental Engineering

(BE) at 01638528047 or 48amds.sgpb@us.af.mil at least 10 days prior to start of project, regarding all potential health impacts to personnel (Example: Noise above 85 dBA, activities with potential airborne contaminants or particulates). Hazardous work areas/perimeters shall be established to control exposures and limit access to nearby facilities and personnel. Work shall be performed IAW all applicable occupational health and safety regulations.

4.10.7. Contractors must coordinate with facility managers and receive a safety brief of hazards present within work areas.

4.11. Security

4.11.1. See Appendix C for information regarding Host Agency Checks (HAC) and National Agency Checks (NAC).

4.11.2. The Government will conduct criminal background checks on all providers during the

AIS/security. The Contractor is responsible for ensuring the required security forms are complete to the best of their knowledge. See Appendix D

4.11.3. During performance, report any information or circumstances observed that may pose a threat to the security of DoD personnel, contractors, resources, and defense information to the Security Forces. The Flight Commander will brief the contractor upon initial on-base assignment and as required thereafter. Comply with the requirements of Volume 1, AFI 71- 101, Criminal Investigations, and paragraph 1.1 of Volume 2, Protective Service Matters.

4.11.4. Adhere to local base procedures for entry to Air Force controlled and restricted areas, briefed upon in-processing.

4.11.5. Key Control

4.11.5.1. Ensure keys issued by the Government are properly safeguarded and not used by unauthorized personnel. Contractor shall not duplicate keys issued by the Government.

4.11.5.2. Lost keys shall be reported immediately to the facility manager. The Government replaces lost keys or performs re-keying. However, the contractor may be held liable for any cost incurred from re-keying the affected facilities.

4.12. Logistical Support

4.12.1. Individual logistical support is provided under this contract in accordance with FAR 25.301-2, DFARS 225.802, and the policies and procedures of DoD 4525.6-M and AFI 36-3026. Policies and procedures are subject to change. Examples of support are: DD Form 1173 – Uniformed Services Identification and Privilege Card; Commissary (including rationed items); AAFES Facilities (Post/Base Exchange) (including rationed items); Armed Forces Recreation Facilities; Local Morale/Welfare Recreation Services; Military Banking Facilities; Military Postal Service (APO/FPO); Officer or NCO/EM Clubs; POV (Privately-Owned Vehicle license); Purchase of POL (Petroleum and Oil products); Transient Billets or Visiting Officers Quarters (VOQ) on space-available and reimbursable basis when travel is performed on Official Government Orders; Billeting in deployed areas is on a space-required basis (non-reimbursable); Messing Facilities at deployed sites only; Department of Defense Dependent Schools on a space available and tuition paying basis; Medical services on a reimbursable basis;

and Dental care only for emergency conditions on a reimbursablebasis.

4.12.2. Logistical support does not extend to driving privileges. However, personnel are entitled by UK

Law to operate a vehicle on a valid United States driver’s license for up to one year from the date of residency or entry into the United Kingdom. For information on obtaining a UK driver’s license after the one year driving period, please refer towww.gov.uk.

4.12.3. Logistical support is not authorized for Local National hires as it is forbidden by the Status of

Forces Agreement (SOFA). Local National hires may be authorized a CAC if their duties require access to Government computer programs.

5. Specific Tasks

5.1. The EFMP Coordinator oversees and manages the installation EFMP-M IAW DoD and AF policy and any subsequent implementing guidance.

5.1.1. Uses clinical assessment skills and maintains procedures to identify sponsors whose family members have special medical and educational needs in a timely manner. The EFMP uses a multi-disciplinary and collaborative approach with other key service providers, such as installation youth and childcare facilities, and officer and enlisted spouses groups, to ensure effective outreach and identification of special needs. Ensures family members of the AF personnel or family of the AF member are appropriately “Q coded” (EFMP-enrolled).

5.1.2. Ensures all active duty sponsors known to the Air Force Personnel Center, and local Military

Personnel Section (MPS) and/or Commander Support Staff (CSS) where applicable, having family members with special needs are identified in AF medical special needs data management systems.

Provides oversight for base-level data entry in AF-provided data management systems used in the management of EFMP-M.

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

5.1.4. Integrally involved in the Family Member Relocation Clearance (FMRC) process. Ensures all FMRC requirements are implemented by all EFMP-M staff. Coordinates the enrollment process and travel screening for all active duty family members’ and travel screening upon request to the families of DoD civilian sponsored assignments going to an overseasbase.

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

5.1.6. Collaborates with the Integrated Delivery System (IDS) and other interagency forums that provide family medical information and referrals to base and civilian agencies. Ensures EFMP families are referred to the Airman and Family Readiness Center for additional community assistance as needed. Maintains a cooperative working relationship with the base MPS, CSS, and with Air Force Personnel Center (AFPC). Actively supports the integration of EFMP-M, Exceptional Family Member Program – Family Support (EFMP-FS) and Exceptional Family Member Program – Assignments (EFMP-A) services at the installation. Provides information, appropriate contact information, and coordinates referrals as appropriate.

5.1.7. Ensures EFMP quarterly case reviews to discuss/assess newly identified families’, complex, or unmet medical needs. Determine the appropriate resources necessary for the families.

5.1.8. Patient specific assessments and clinical plans of action will be located in AHLTA and the Special

Needs record. Meeting minutes will not contain patient identifying information.

5.1.9. Coordinates and participates in designated facility meetings.

5.1.10. Participates in the clinic orientation and training of other staff of the Special Needs Program. May serve on committees, work groups, and task forces at the facility.

5.1.11. Must maintain a level of productivity and quality consistent with: complexity of the assignment;

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

5.1.12. Follows applicable local MTF/AF/DoD instructions, policies and guidelines.

5.1.13. Completes medical record documentation and coding and designated tracking logs and data reporting as required by local MTF/AF/DoD instructions, policies and guidance.

5.1.14. Completes all required electronic medical record training, MTF-specific orientation and EFMP training programs.

5.2.1 Must have knowledge and skills to effectively apply EFMP functions: a) Assessment:

Identification of patients that need special medical and education needs/management;

comprehensive collection of patient information and medical status; and continued evaluation of an established plan of care; b) Planning: Collaboration with the patient, family/caregiver, primary provider and other members of the health care team for developing an effective plan of care; c) Facilitation: Care coordination and communication among all involved parties; d) Advocacy:

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

5.2.2 Mastery of theories, principles, and methodologies underlying psychosocial practice.

5.2.3 Knowledge and understanding of developmental growth; dynamics of human behavior, family, and other social systems; and impact of illness and disability on social functioning.

5.2.4 Demonstrated abilities in program planning, implementation, and evaluation, and in conducting individual, family, group, and community assessments.

5.2.5 Strong capability to work with service members and/or veterans and their families who are experiencing a wide range of complicated mental, emotional, behavioral, physical, psychosocial, and environmental problems.

5.2.6 Working knowledge of medical privacy and confidentiality (Health Insurance Portability and

Accountability Act [HIPAA]), and accreditation standards of Accreditation Association for Ambulatory Health Care (AAAHC) and The Joint Commission (TJC).

5.2.7 Working knowledge of computer applications/software to include Microsoft Office programs, MS Outlook (e-mail), and internet familiarity is required. The ability to input, extract and format data from established databases is required.

5.2.8 Must demonstrate ability to communicate effectively both orally and written.

5.2.9 Must be skillful and tactful in communicating with people who may be physically or mentally ill, uncooperative, fearful, emotionally distraught, and potentially agitated.

5.2.10 Must demonstrate ability to apply critical thinking skills and expertise in resolving complicated healthcare, social, interpersonal and financial patient situations.

5.2.11 Must possess organization, problem-solving and communication skills to articulate medical requirements to patients, families/care givers, medical and non-medical staff in a professional and courteous way

6. Service Delivery Summary (SDS)/ Service Summary

Performance Objectives/Statements

PWS Paragraph Reference

Performance Thresholds/AQLs

a. The contractor shall a. 5.1 thru 5.5, 5.8, 5.9, a. Delivers professional provide professional 5.10 patient care.

Patient Care. AQL: No more than one customer complaint per quarter.

b. The contractor shall b. 5.6 b. No infractions Protects patient AQL: 100% Compliant confidentiality and privacy

c. Accurate and Proper c. 5.6, 5.7 c. Records are accurately Records Management maintained

AQL: No more than two errors per quarter

7. Definitions

Acronym/Abbreviation Definition AAAHC Accreditation Association for Ambulatory Health Care ADR Adverse Drug Reaction AF COLS Air Force Common Levels of Service AFFARS Air Force Federal Acquisition Regulation AFI Air Force Instruction AQL Acceptable Quality level CO Contracting Officer COR Contracting Officer Representative DUR Drug Utilization Review DV Distinguished Visitor EHS Extremely Hazardous Substances FAR Federal Acquisition Regulation FOIA Freedom of Information Act FOUO For Official Use Only HAC Host Agency Check HM Hazardous Material IAW In Accordance With IP Installation Pass IRB Investigational Review Board LFC Local File Check MOD Ministry of Defense NAC National Agency Check POC Point of Contact POV Personally Owned Vehicle PWS Performance Work Statement QCP Quality Control Plan SS Service Summary/PRS TJC The Joint Commission

UK United Kingdom US United States

8.0 Appendices

Appendix A, Applicable Publications and Forms Appendix B, Health Insurance Portability and Accountability Act of 1996 Appendix C, National Agency Check/Host Nation Check Appendix D, Notice to Potential Contractors

APPENDIX A

APPLICABLE PUBLICATIONS AND FORMS

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

The contractor shall follow those publications to the extent (that is, the specific procedure in a paragraph, section, chapter or volume) specified in the PWS. The government provides all publications and forms listed, they are provided electronically at http://www.e-publishing.af.mil/.

The government may issue supplements or amendments to listed publications from any organizational level during the life of the contract. It is the contractor’s responsibilities to check the website for updated supplements. The contractor shall immediately implement those changes in publications that result in a decrease or no change in the contract price. Before implementing any such revision, supplement, or amendment that will result in an increase in contract price, the contractor shall submit to the contracting officer (CO) a quote for approval. Price proposals shall be submitted within 30 calendar days from the revision, supplement, or amendment giving rise to the increase in cost of performance. The government will consider changes in the contract price due to supplements and amendments shall be considered under the "Contract Terms and Conditions - Commercial Items" clause. The government will continue to supply the government forms needed for daily operations.

Publications Code:

AFI - Air Force Instruction AFMAN - Air Force Manual AFP - Air Force Pamphlet AF Form - Air Force Form DD Form - Department of Defense Form.

MDGI - Medical Group Instruction

DEPARTMENT OF DEFENSE (DOD)

REGULATIONS/MANUALS/INSTRUCTIONS/DIRECTIVES

Number Title of Directive Date DoDD 5400.11 Privacy Program Nov 04 DoDD 5500.7 Standards of Conduct Aug 93 DoD 6025.18-R Health Information Privacy Jan 03 DoDI 1402.5 Criminal History Background Checks Jan 93 DoDI 3020.37 Continuation of Essential DoD Nov 90

AIR FORCE REGULATIONS/MANUALS/INSTRUCTIONS

Number Title of Directive Date AFI 33-119 AF Messaging Jan 05 AFI 33-129 Web Management and Internet Use Feb 05 AFI 33-201 Communications Security (COMSEC) May 05 AFI 33-322 Records Management Program Oct 03

AFI 41-115

AFI 41-210

AFI 48-123

Authorized Health Care and Benefits Patient Administration Functions Medical Examinations and Standards

Dec 01 Mar 06 Jun 06

AFI 71-101V1 Criminal Investigations Dec 99 AFI 71-101V2 Protective Service Matters Nov 02 AFI 44-119 Clinical Performance Improvement Jun 01

Publications

Publications are available electronically, please note updates to policies which could potentially require position requirements to change are based upon these publications.

DoD publications are available at:

http://west.dtic.mil/whs/directives/

AF publications are available at:

http://www.e-publishing.af.mil/

Master Privilege List for physician credentialing is available at:

http://www.airforcemedicine.af.mil/Organizations/AFCCVO/Forms/Physicians

APPENDIX B

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) OF

HIPAA is comprised of several different sections, each to be implemented by the Dept. of Health and Human Services. The medical facilities of the military services and the DOD health plans are specifically listed as covered by HIPAA. Currently, HIPAA Privacy and Security Rules, as set forth in the Code of Federal Regulations, are in effect for all MTFs. The specific implementation of HIPAA Privacy for DOD medical facilities is set forth in DOD 6025.18- R, and for HIPAA Security, the requirements for AF MTFs are contained in DOD 8580.02-R and AFI 41-217, which also contains additional Information Assurance requirements for all AF MTFs. DOD 6025.18-R, DOD 8580.02-R and AFI 41-217 are incorporated herein by reference. MTFs are responsible to insure overall compliance with HIPAA requirements, which includes incorporation of certain requirements in contracts entered or amended after the respective implementation dates.

IAW these regulations, the contractor and its employees meet the definition of Business Associates. Therefore, a Business Associate Agreement is required by law to comply with both the HIPAA Privacy and Security regulations. This clause serves as that agreement for each MTF, whereby the Contractor and its employees agree to abide by all HIPAA Privacy and Security requirements regarding health information as defined in this clause, DoD 6025-18-R, DOD 8520.02-R and AFI 41-217. Additional HIPAA requirements will be addressed when implemented.

Introduction

1. DEFINITIONS. As used in this clause generally refer to the Code of Federal Regulations (CFR) definition unless a more specific provision exists in DOD 6025.18-R, DOD 8520.02-R or

AFI 41-217.

Individual has the same meaning as the term “individual” in 45 CFR 164.50 1 and 164.103 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.

Electronic Protected Health Information has the same meaning as the term “electronic protected health information” in 45 CFR 160.103.

Required by Law has the same meaning as the term “required by law” in 45 CFR 164.501 and

164.103.

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

Security Rule means the Health Insurance Reform: Security Standards at 45 CFR part 160,162 and part 164, subpart C.

Terms used, but not otherwise defined, in this agreement shall have the same meaning as those terms in 45 CFR 160.103, 160.502, 164.103, 164.304 and 164.501.

2. 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.

3. 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.

4. The contractor agrees to use administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic protected health information that it creates, receives, maintains, or transmits in the execution of this contract.

5. 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.

6. The Contractor agrees to report to the government any security incident involving protected health information of which it becomes aware.

7. The contractor agrees to report to the government any use or disclosure of the Protected Health Information not provided for by this contract of which the contractor becomes aware of.

8. 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.

9. The contractor agrees to ensure that any agent, including a subcontractor, to whom it provides electronic Protected Health Information, agrees to implement reasonable and appropriate safeguards to protect it.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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 treatment, payment, or healthcare operations purposes, in accordance with the specific use and disclosure provisions below, if such use or disclosure of Protected Health Information would not violate the HIPAA Privacy Rule, DOD 6025.18-R, the HIPAA Security Rule, or DOD 8580.02-R if done by the government.

Specific Use and Disclosure Provisions

1. 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.

2. 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.

3. 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).

4. 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

1. 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.

2. 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.

3. 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 HIPAA Privacy Rule, DOD 6025.18R, the HIPAA Security Rule, or DOD 8580.02-R, 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.

Return of Government Records in the Event of a Termination

a. 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.

b. 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

1. Regulatory References. A reference in this Clause to a section in DOD 6025.18-R, HIPAA Privacy Regulation or DOD 8580.02-R, HIPAA Security Regulation, or any CFR or AFI provision means the section as currently in effect or as amended, and for…