Attachment 1 - Performance Work Statement.pdf

Consult and Appointment Management Office

(CAMO)

Performance Work Statement for the 48th Medical Group

(MDG) and 501st Combat

Support Wing (CSW)

PREPARED BY: 48th Contracting Squadron and 48th Medical Group

RAF Lakenheath, England

Updated 17 Nov 2022

Table of Contents

Section Number and Title

Page Number

1.0 Description of Services

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, Medical Appointment Workflow Lead 14

Appendix B, Medical Referral and Appointment Service Clerks 17

Appendix C, Applicable Publications and Forms

Appendix D, National Agency Check/Host Nation Check

Appendix E, Notice to Potential Contractors 25

1. Description of Services

1.2. The Government requires Medical Referral and Appointing Services to include Medical Appointment

Workflow Lead at RAF Lakenheath, England, also referred to as the “Medical Treatment Facility” (MTF) herein. The appointing services will be centralized at the 48th Medical Group (MDG) at RAF Lakenheath but will include appointments for and the 501st Combat Support Wing (CSW) Medical squadrons located at

RAF Alconbury and RAF Croughton. Performance shall be in accordance with the requirements contained in this Performance Work Statement (PWS), and standards of the Unit Effectiveness Inspection (UEI).

2. Government Furnished Property: None furnished

3. Contractor-Furnished Property: None furnished

4. General Information

4.1. Hours of Operation

4.1.1. Normal base hours of operation are 07:00 – 16:00. However, the contractor personnel 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.

4.1.2. 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 personnel may be required to work more or less than 8 hours in a single day and/or 40 hours in a week.

4.1.3. Federal Holidays. The performance will not be required on 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.

4.1.4. Closures. The Contractor shall be compensated only for actual hours worked by the Contractor’s employees. During anticipated closure of the facilities due to Presidential Executive Orders, Command-declared training holidays, administrative leave granted the entire staff, or other closure, the contractor personnel shall not perform work and no hours will be billed to the Government for those days unless otherwise stated on the task order. Depending on mission requirements, the

Contracting Officer (CO) may require that the Contractor employees work on Command-declared training holidays. There are nine (9) Europe Regional Medical Command (ERMC) training holidays where Health Care providers (HCPs) will work unless they decide to take leave. The Government will provide the required oversight for HCPs to be onsite during times services are being provided.

The Contractor shall not submit an invoice or otherwise seek additional payment from the

Government for the specified periods that its employees do not perform services under this contract.

In the event of unplanned closure of the facility due to natural disaster, military emergency, severe weather, security threat, or a facility-related problem that prevents the Contractor’s personnel from performing services under this contract, the Contractor’s employees shall follow the same departure and reporting directions given to Government personnel and the contractor shall treat its employees as they determine appropriate. The Contractor shall not submit an invoice or otherwise seek additional payment from the Government for any expenses incurred by the contractor as a result of any such unplanned closure.

4.2. Contractor Personnel

4.2.1. Certifications: Possess and maintain current certification in Basic Life Support (BLS).

4.2.2. Public Health clearance is required, and the Contractor shall submit immunization records and physical health certification with their proposal. The records must show proof of immunization against Hepatitis A and B, Measles, Mumps, Rubella, Varicella, and Influenza. The contractor personnel shall also 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

DoD, DHA, AF, and MTF policies & instructions. 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. Contractor personnel working in 48 MDG shall have a National Agency Check (NAC) or host nation equivalent. Cost of clearance requests is part of the contractor's recruitment costs. The name and address of the COR shall be included in each request as the recipient of the results. Unfavorable results that indicate risk to safe and/or effective delivery of services will constitute grounds for contract termination for cause. Decisions regarding dismissal of the contractor for unfavorable results of the background check are the sole responsibility of the COR. The Government will not accept any employee with a Federal conviction (or host nation equivalent) in their background check.

4.3.2. If the contractor has previously received a background check, s/he shall provide proof of the check or obtain a new one. A new investigation is required if a break in service to the Department of

Defense results in a time-lapse of more than 3 years.

4.4. Contractor Management

4.4.1. Non-Availability. The MTF will notify contractor 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.

4.4.2. The contractor is required to provide enough staff to meet Performance Objectives at all times.

4.4.3. Dress and Appearance

4.4.3.1. Contractor personnel 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.

4.4.3.2. While on duty, contractor personnel shall be neat and clean (free from visible dirt and stains), well- groomed and appropriately dressed. The contractor personnel’s clothing shall fit correctly to provide a professional, modest appearance.

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

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

4.4.3.5. 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.

4.4.4. Conduct

4.4.4.1. Contractor personnel shall comply with MTF policies regarding 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 workplace.

4.4.4.2. 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 (HIPAA) of 1996. Personnel should complete HIPAA training prior to hire or within the first 30 days of employment, and complete refresher training. 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.

Contractor personnel shall abide by MTF bylaws, the Defense Health Agency (DHA), The Joint

Commission (TJC), 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.

4.4.4.3. Disruptive Contractor Personnel

4.4.4.3.1. 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 with direction of the contracting officer or contracting officer's representative, participating in discriminatory practices against anyone in the performance of this contract, failure to abide by MTF rules, regulations, and policies, and any other conduct that may prevent or hinder the successful performance of this contract.

4.4.4.3.2. At any time during the performance of this contract, the Contracting Officer may immediately remove contractor personnel 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.

4.4.4.3.3. 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.

4.4.4.3.4. If, after any investigation deemed necessary by the Contracting Officer and discussions with the contractor’s representative, the Contracting Officer concludes that the contractor personnel 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 contractor personnel, 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 medical administration, the following information is provided:

4.5.1.1. This is a non-personal medical administration contract, as defined in FAR 37.101, under which the contractor 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, etc.).

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.

4.5.2. 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 TJC (https://www.jointcommission.org/), Operational Safety and Health Administration (https://www.osha.gov/), and Center for Disease

Control (https://www.cdc.gov/) and DHA health record requirements.

4.5.4. Contractor staff must comply with DHA, 48 MDG, and 501 CSW unit standards of care as well as the healthcare practices of their specific profession. See Appendix C for a list of applicable publications and forms; this list is not exhaustive.

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

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

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

4.5.8. Health Insurance Portability and Accountability Act (HIPAA). All patients shall be assured of their http://www.jointcommission.org/) http://www.jointcommission.org/) http://www.osha.gov/) http://www.cdc.gov/) 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. Prepare all documentation/records to meet or exceed established standards of the MTF, to include, but not limited to, timeliness, accuracy, content, and signature.

4.6.4. Generate and manage IAW DoD 5400.07, DoD Freedom of Information Act Program, Chapter 4; AFI

33-129, Web Management and Internet Use, and AFI 33-201, Communications Security (COMSEC).

4.6.5. Mark IAW instructions identified in DoD 5400.07, Safeguard all sensitive data IAW DoD

Regulation 5400.07-3.10

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

Degauss or overwrite magnetic tapes or other magnetic media.

4.6.7. 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).

4.7. Government Quality Assurance: 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.

4.8. Government-Furnished Training: The Contractor personnel 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.

4.9. Security

4.9.1. See Appendix D for information regarding Host Agency Checks (HAC) and National Agency

Checks (NAC).

4.9.2. 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

4.9.3. 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.

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

4.9.5. Key Control

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

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

4.10. Logistical Support

4.10.1. 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 reimbursable basis.

4.10.2. 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 to www.gov.uk.

4.10.3. 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: See Appendix A & B for full Position Descriptions http://www.gov.uk/

6. Performance Requirement Summary (PRS)/ Service Summary

Performance Objectives/Statements PWS Paragraph

Reference

Performance

Thresholds/AQLs

The contractor personnel shall provide professional Customer Service

4.5.5 Delivers professional patient

care.

AQL: No more than one customer or substantiated patient advocate complaint per quarter.

The contractor personnel shall Protect patient confidentiality and privacy

4.6 No infractions

AQL: 100% Compliant

Accurate and Proper Records Management 4.6.3 Records are accurately maintained AQL: No more than two errors per quarter

Contractor shall meet or exceed the required metrics in accordance with AFI 44-176 DoD, DHA, AF and MTF policies & instructions (this block only applies to Central Appointing):

a. Average call handle/transaction time per month of less than or equal to 180 seconds

b. Contractor shall answer 90% of all inbound within 90 seconds

c. Each average speed of answer per month of less than or equal to 45 seconds per call

d. Dropped calls shall not exceed eight (8) percent of all calls

App B, 5.3-5.7 Maintain Service level Metric

AQL:

a. No individual day average shall exceed 270 seconds

b. This metric is known as

Service Level. No individual day shall go below 75%.

c. No individual day average shall exceed ninety

(90) seconds

d. No individual day average shall exceed 15%.

The contractor personnel shall record 100 percent (100%) of all inbound ACD routed calls.

This requirement only applies when mechanism for recording calls is available

App B, 5.8 ACD routed calls. AQL: 100 % of all calls recorded

The contractor personnel shall adhere to Booking protocols with less than eight (8) inaccurately scheduled appointments per month

App B, 5.3 Accuracy of Booking Protocol

Procedures AQL: No more than

8 inaccurately scheduled appointments per month after training period.

Contractor personnel will be on time and ready for work as scheduled

4.1.1 Arrive for duty on time. AQL:

No more than five (5) validated late arrivals per quarter without prior notice

Contractor shall disposition all referrals sent to them as “Appoint to MTF” or “Defer to

Network” within one business day.

App B, 5.13 AQL: No individual weekly average disposition time shall exceed two (2) business days (48 Hours)

Each contractor employee shall document every contact attempt in the notes section of a referral when attempting to call a patient to schedule an appointment or when attempting to call a network provider to obtain network referral results

App B, 5.16 AQL: No more than 5% of contact attempts shall go undocumented in the referral notes

Contractor personnel shall close all open referrals no later than 180 days after the referral was opened.

App B, 5.35 100% compliant

Contractor personnel shall upload all network referral results into the HAIMS and send a

“results received” t-con to the referring provider within three (3) business days

App B, 5.9 No individual weekly average processing time of network referral results shall exceed five

(5) business days

Contractor personnel shall make at least two (2) attempts to retrieve network referral results from the network provider NLT 60 days from when the referral was ordered, 10 days from when the initial network appointment occurred, or when a claim is discovered, whichever happens first.

App B, 5.21, 5.34 100% compliant

Management Plan App G To be completed at time of award

7. INFORMATIONAL PRICING NOTE. TUPE - Transfer of Undertakings (Protection of

Employment) Regulations 2006.

Definition. The United Kingdom's Transfer of Undertakings (Protection of Employment) Regulations

2006 (TUPE) is the main piece of legislation governing the transfer of an undertaking, or part of one, to another. The regulations are designed to protect the rights of employees in a transfer situation.

During the solicitation phase and award of the resultant contract the Government does not have access to specific TUPE information nor becomes involved with related TUPE processes and associated liabilities

(to include indemnification) that may transpire during pre-award or post-award phases between transferor and transferee. While the Government understands the relevance of TUPE-information in proposing fixed prices, the responsibility to provide TUPE-information rests solely with the transferor; governed by

Regulation 11 of the Transfer of Undertakings (Protection of Employees) Regulations 2006 (TUPE). As the transferor need only provide TUPE information to the transferee prior to the transfer, the Government will only make available the listing of the current, incumbent contractor(s) with associated points of contact if requested. The Government is not responsible for determination of TUPE applicability; the responsibility lies solely with the transferor.

As this is a firm-fixed price contract, it is incumbent upon the Offeror to calculate any anticipated TUPE pricing at time of proposal submittal. TUPE costs cannot be submitted as a conditional proposal, if submitted as such the Offerors proposal will be considered unacceptable and the Offeror may be excluded from competition.

8. Definitions

Acronym/Abbreviation Definition

AFFARS Air Force Federal Acquisition Regulation

AFI Air Force Instruction

AQL Acceptable Quality level

CO Contracting Officer

COR Contracting Officer Representative

DHA Defense Health Agency

FAR Federal Acquisition Regulation

FOIA Freedom of Information Act

FOUO For Official Use Only

HAC Host Agency Check

IAW In Accordance With

IP Installation Pass

LFC Local File Check

MOD Ministry of Defense

NAC National Agency Check

POC Point of Contact

POV Personally Owned Vehicle

PRS Performance Requirement Summary/SS

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, Medical Appointment Workflow Lead

Appendix B, Medical Referral & Appointment Service Clerks

Appendix C, Applicable Publications and Forms

Appendix D, Health Insurance Portability and Accountability Act of 1996

Appendix E, National Agency Check/Host Nation Check

Appendix F, Notice to Potential Contractors

Appendix G, Contractors In-Processing & Welcome Packet

APPENDIX A

APPOINTMENT / REFERRAL MANAGEMENT WORKFLOW LEAD:

1. Mandatory Knowledge and Skills

1.1. A fully qualified typist (computer keyboard) with a minimum of 50 Words per Minute is required.

1.2. General office administrative and clerical skills to perform receptionist duties and answer telephones.

1.3. Standard office equipment, such as personal computers, copiers, fax machines, and telephone systems.

1.4. An understanding of general medical ethics, telephone etiquette, and excellent communication, to be able to actively convey information through the exchange of thoughts, messages, or information, by speech or writing, with excellent customer service skills, a professional demeanor, appropriate interaction with clients and able to promote the best image of the

Government.

1.5. Able to read, write, and speak English well and should not suffer from any reading, writing, speaking or hearing limitations, so as to ensure effective communication with customers on the phone.

2. Education: Must hold an Associate degree in a healthcare or business-related field or UK equivalent education level or have at least three (3) years of office management experience within the last five (5) years.

3. Experience

3.1. Minimum of one year of healthcare experience within the past five (50 years and at least six

(6) months experience in medical office scheduling.

3.2. The Contractor shall have knowledge of professional care theories, principles, practices, and procedures to perform medical documentation of moderate difficulty and experience in assessing histories of patients, as appropriate.

3.3. The Contractor shall have knowledge of a variety of medical standards used in patient treatment.

4. Certifications: Possess and maintain current certification in Basic Life Support

5. Specific Tasks

5.1. The Appointment Workflow Manager shall perform all of the tasks required of a Medical

Referral and Appointing Service Clerks (MRASC).

5.2. The Appointment Workflow Manager shall track the MTFs appointment scheduling performance against established performance standards directed by AFI 44-176, dated 8 September 2017, and any applicable DoD, DHA, AF, and MTF policies & instructions.

5.3. Performance standards include, but are not limited to: average transaction time per MRASC, per call; average speed of answer time, per call; average phone “ready” time per MRASC; overall answer rate for inbound calls; overall abandoned call rate; specialty referral disposition time, per specialty; average time from when a specialty referral is placed to when it is booked, per specialty; timeliness of scanning received initial results into the Health Artifact Image

Management System (HAIMS).

5.4. The Appointment Workflow Manager will require access to all CISCO supervisory and Report servers and will be required to monitor/listen to recorded phone calls, as necessary, in order to monitor compliance with established protocols or to investigate patient/staff complaints. Compiles monthly reports, as directed by the MTF. This applies only if mechanism for recording calls is available.

5.5. When MRASC performance is below established standards, the Appointment Workflow Manager will take corrective action to improve performance.

5.6. The Appointment Workflow Manager will actively manage phone queues and MRASC assignments on the phone system to meet volume demands and sustain MTF performance standards.

5.7. The Appointment Workflow Manager will centrally manage referral queues, or “book boxes” in the MTF whether the specialty referrals are booked by the central appointment office or a locally approved clinic.

5.8. The Referral Management Clerk will notify the referring provider of all routine priority referrals not used or cancelled by their patients IAW local MTF policy, but no less than monthly. (Note: the

RMC should utilize RMS to generate a report by referring provider for the desired date range and provide it to leadership IAW local MTF policy.) ADD IAW AFI 44-176, Business Rule #24.

5.9. Ensure a hard copy or scanned referral results from other MTFs and from Network/non-network providers are promptly returned to the referring provider or PCM within three (3) business days of receipt.

5.10. Prepares monthly primary and specialty care management data reports provides briefings, attends meetings and teleconferences as determined by the MTF/Government

5.11. Provides timely and descriptive feedback regarding utilization review issues.

5.12. Performs data collection and analysis to identify areas requiring management and improvement.

5.13. Acts as a catalyst when appropriate and manages implementation effectively.

5.14. Takes immediate action to correct behavior/attitudes of personnel not meeting professional standards.

5.15. Manage the training of all MRASC s and those required.

5.16. Use appropriate measures to ensure phone line is open or closed when appropriate.

APPENDIX B

MEDICAL REFERRAL & APPOINTMENT SERVICE CLERKS (MRASC)

1. Mandatory Knowledge and Skills

1.1. A fully qualified typist (computer keyboard) with a minimum of 50 Words per Minute is required.

1.2. General office administrative and clerical skills to perform receptionist duties and answer telephones.

1.3. Standard office equipment, such as personal computers, copiers, fax machines, and telephone systems.

1.4. An understanding of general medical ethics, telephone etiquette, and excellent communication, to be able to actively convey information through the exchange of thoughts, messages, or information, by speech or writing, with excellent customer service skills, a professional demeanor, appropriate interaction with clients and able to promote the best image of the government.

1.5. Able to read, write, and speak English well and should not suffer from any reading, writing, speaking or hearing limitations, so as to ensure effective communication with customers on the phone.

2. Education: Administrative personnel shall possess a high school diploma or General Educational

Development equivalency. Completion of administrative assistant program is desirable.

3. Experience

3.1. At least six (6) months of experience in medical office doing scheduling or referral management.

Customer Service Training/experience.

3.2. Contract personnel basic knowledge and skill level includes: principles of excellent customer service; TRICARE benefits; quality control and risk management; medical terminology, medical forms and records management; HIPAA guidelines for release of medical information; general medical and legal ethics; excellent communications skills; strong organizational skills; and computer operations, including operational skills with Microsoft applications (Windows Operating system, Microsoft Word, Microsoft Access, and Excel,); personnel shall understand the importance of meeting deadlines. Knowledge of current ICD- 10 (International Classification of Diseases, tenth revision) coding desirable, but not required.

3.3. The Contractor personnel shall have functioning knowledge of Government appointing MHS Guide to Access Success and referral management business rules (AFMS RMC Guide), Government appointing information systems, DHA, TJC or AAAHC, UEI, HIPAA, DoD Health Information

Privacy Regulation (DoD 6025.18-R), the Privacy Act, and DoD Privacy Program (DoD 5400.11-

R). The Contractor shall ensure that their staff has read the current AFMS RMC User Guide prior to start of work.

4. Certifications: The contractor is required to obtain a certification in Basic Life Support (BLS).

5. Performance Outcomes

5.1. The Contractor shall provide MRASC who engage with patients through phones and electronic means to answer/place calls and answer/place electronic messages for the 48 MDG, RAF

Lakenheath, in both specialty appointing, primary care appointments and/or referral management.

Referral management will be required assist walk in customers with referrals. The MRASC will assume centralized specialty appointing (approximately 6,200 calls per month), primary care appointing (approximately 7,200 calls per month) and referral management (1,100 referrals per month).

5.2. The MRASC will perform within one or more of the following business lanes: Appointing

Management or Consult Management with regard to primary and specialty care.

5.3. MRASC s shall utilize the Automated Call Distribution (ACD) system and TRICARE Online

Patient Portal Secure Messaging In Accordance With (IAW) established protocols and where applicable, use Standard Operating Procedures (SOPs), Booking Protocols, and Business Rules in combination with developed skill sets in the execution of the MTF mission. The MRASCs shall meet or exceed the required metrics in accordance with Air Force Instruction (AFI) 44-176, dated 8

September 2017. DoD, DHA, AF and MTF policies & instructions.

5.4. MRASCs shall handle inbound ACD routed calls with each average handle/transaction time per month of less than or equal to one hundred and eighty (180) seconds per call. No individual day or hour average shall exceed two hundred and seventy (270) seconds.

5.5. MRASCs shall answer 90 percent (90%) of all inbound ACD routed calls with each average answer time per month at ninety (90) seconds This metric is known as Service Level. No individual day or hour average shall go below 75 percent (75%).

5.6. MRASCs shall handle inbound ACD routed calls with each average speed of answer per month of less than or equal to 45 seconds per call. No individual day or hour average shall exceed ninety (90) seconds.

5.7. MRASCs shall manage inbound ACD routed calls to prevent calls from being dropped. Dropped calls shall not exceed, 8 percent (8%) of all answered calls. No individual day or hour average shall exceed 15 percent (15%) seconds.

5.8. MRASCs shall record 100 percent (100%) of all inbound ACD routed calls.

5.9. MRASCs shall make outbound calls with each clerk’s average handle/transaction time per month, of less than or equal to one hundred and eighty (180) seconds per call. No individual day or hour average shall exceed two hundred and seventy (270) seconds.

5.10. MRASCs shall utilize the Composite Health Care System (CHCS) Managed Care Program Module, Assignment Order Processing Module, or any Air Force mandated system(s), to identify appointment availability, schedule, cancel, and reschedule appointments for 48 MDG and 501 CSW, following local directives, established protocols, Booking Protocols, and the MTF Business Rules using the appropriate Access to Care (ATC) category, matched to the appropriate standard appointment types, and detail codes within the appropriate ATC standards.

5.11. MRASCs will generate or receive, and electronically deliver, telephone messages (t-cons) to medical providers and clinic support staff by using CHCS or AHLTA, or any Air Force mandated system(s), per individual clinic guidelines; AFI 44-176, dated 8 September 2017; and any other applicable DoD, DHA, AF, and MTF policies & instructions.

5.12. MRASCs shall take the following actions concerning specialty care consults/referrals:

5.13. MRASCs shall disposition referrals as “Appoint to applicable MTF, RAF Lakenheath, RAF

Alconbury, and RAF Croughton” or “Defer to Network” within one (1) business day of receipt in accordance with Air Force Instruction (AFI) 44-176, dated 8 September 2017, and the DHA

Interim Procedures Memorandum 17-002 dated 19 Jan 17. DoD, DHA, AF and MTF policies & instructions.

5.14. MRASCs shall review referrals for administrative completeness, covered TRICARE benefit and required tests and pre-work. Coordinates with referring providers in cases where additional referral information is required.

5.15. MRASCs will book specialty care consults/referrals when contacted by the patient and the referral is dispositioned as “Appoint to RAF Lakenheath MTF. If the referral is dispositioned as

RAF Alconbury or RAF Croughton, the MRASCs will transfer the call to the appropriate referral line.” If the referral lacks a review disposition when the patient calls, then the MRASC will provide a “warm hand-off” to the specialty clinic to immediately review the referral and appoint or defer it.

5.16. MRASCs will proactively contact patients with active specialty referrals until the specialty or behavioral health care appointment can be booked, the patient cancels the referral, or the message has been delivered three (3) times (first message NLT day 3 and final message NET day

14). Each contact attempt will be documented in CHCS or any Air Force mandated system(s).

5.17. When the MTF cannot offer three (3) different appointments within the access to care standard, the

MRASC will inform the patient that the specialty referral can be deferred to the network and will offer the patient an MTF appointment outside the standard. The MRASC will process the specialty referral according to the patient’s preference.

5.18. MRASCs shall assist with ROFR determinations for specialty care that can be provided within the

MTF using Service Availability (Capability) Listings and information systems that link the referral to the appointment to the ATC category and standard. ROFR shall be processed within the time limits outlined in the TRICARE Operations Manual, Chapter 8, Section 5.

5.19. MRASCs shall perform/assist with appointing network specialty care referrals as allowed by the

TRICARE Overseas Program (TOP) Contractor

5.20. MRASCs will administratively close all un-appointed referrals accepted by the MTF NLT 180 days beyond the order date.

5.21. MRASCs shall manage the “cancellation line” feature, ensuring that when patients call in to cancel appointments by leaving voice mail, the MRASC shall 60 message and go into AHLTA/CHCS, or any Air Force mandated system(s), to cancel the applicable appointment within same day or coordinate with the appropriate clinic to get the appointment cancelled within the same day.

5.22. When patients request to cancel a specialty referral appointment or consult, MRASCs will document the cancellation reason in CHCS, or any Air Force mandated system(s), and send a t-con to the referring provider within one (1) business day of the cancellation. No individual weekly timeliness average of cancellation notifications will exceed two (2) business days.

5.23. MRASCs shall verify beneficiary eligibility, using patient’s DOD ID number and two (2) patient identifiers, refer patient to DEERS and update patient demographics in CHCS per DoD

Healthcare policy, and local MTF policies.

5.24. MRASCs will attend all training activities, per local MTF policies. Training may include but is not limited to topics designed to increase skills, enhance workflow or communication, update on standard operating procedures, adjust to changing mission requirements, address facility or installation issues or increase overall effectiveness and efficiency of operations.

5.25. Contract personnel will provide Phase I (didactic/classroom), Phase II (over-the- shoulder/on the floor), and Phase III (specialty consult) training to all contract personnel at a level of excellence commensurate with training provided to civil service personnel.

5.26. Contract personnel will also provide training to Active Duty/Civilian/Red Cross volunteers who have been identified to support the MRASCs, when deemed necessary for times when the contract company does not/cannot provider the required personnel to meet contract requirements.

5.27. Contract personnel shall complete all required training within the first month of assignment and be able to perform all functions required for the MRASC.

5.28. MRASCs will provide patients with specific instructions for their appointment/referral following local directives, established protocols, SOPs, Booking Protocols, and the MTF Business Rules.

5.29. MRASCs will perform other administrative and clerical duties in support of the medical care and operational support as required.

5.30. MRASCs will advise patients of the provider, location, time and day of their booked appointments.

5.31. MRASCs will coordinate with specialty referral clinics (e.g., internal MTF, Veteran’s Affairs clinic, etc.) on special patient instructions and tests required prior to appointment.

5.32. MRASCs will track initial specialty care and deferred to network primary care referrals to include obtaining reports from MTF, network, and non-network providers. The primary responsibility to obtain Network and purchased care results will be with the MTF.

5.33. MRASCs will process initial specialty care and deferred to network primary care reports in the

HAIMS following the business rules outlined in AFI 44-176, dated 8 September 2017, DoD, DHA, AF and MTF policies & instructions, close the specialty referral in CHCS, and send a t-con to the referring provider or PCM within three (3) days of receipt of the report. No individual weekly timeliness average of network report notifications will exceed five (5) business days.

5.34. MRASCs will initiate efforts to capture network reports upon request of the referring provider or no later than 60 days from the date the specialty referral was ordered or as soon as a claim is discovered, whichever occurs first.

5.35. When a CLR has not been received or documented in the EHR, the RMC will check the applicable claims database for a claim.

5.36. If a claim is found, the RMC will request the CLR from the rendering purchased care provider. If there is no response from the provider within 10 calendar days, repeat. If the provider still does not provide the CLR, the RMC will close the referral in CHCS using the status of “Deferred results received” and annotate {CRNRR} in soft brackets in the CHCS

Review Comment Field indicating a claim was reported but no results were received. Notify the referring provider. Initiate TRICARE contractor procedures as per the TOM and/or the

Memorandum of Understanding (MOU) with the TRICARE regional contractor. Additionally, forward a report to the TRICARE Regional Office each month that lists all provider names, specialty care rendered, and referral Unique Identifier Numbers for which no CLR has been received after two attempts or per MOU. Per AFI 44-176, Business Rule #21.1 and 21.2

5.37. MRASCs will administratively close all open specialty referrals deferred to the network NLT 180 days beyond the order date.

5.38. MRASCs will pull NAL reports and enter them into AHLTA under the appropriate clinic.

5.39. MRASCs will use TOL Patient Portal Secure messaging to:

5.40. Register beneficiaries for TOL Patient Portal Secure Messaging Accounts IAW established protocols.

5.41. Out-process beneficiaries from TOL Patient Portal Secure Messaging when the member PCSs, separates, retires, or any other reason where the member no longer needs access to the system.

5.42. Communicate with beneficiaries for scheduling appointments or concerning the use/activation of referrals.

5.43. Answers main office phone line(s). Directs telephone calls to appropriate section for assistance, handles independently or takes messages as required.

5.44. Reviews referrals for administrative completeness and researches covered benefits prior to processing.

5.45. Determines patient eligibility for services and arranges and schedules medical appointments for referred care.

5.46. Provides general instructions to patients and ensures patients have necessary documentation for referred health care services.

5.47. Obtains updates and files medical records as needed.

5.48. Organizes and researches patient records, extract needed information, and review records for referral within established guidelines.

5.49. Request medical records and ensures arrival of medical records prior to appointment(s).

5.50. Initiates and locates patient medical records as needed.

5.51. Obtains documentation as requested by healthcare providers (test results, or documentation not yet filed in records).

5.52. Ensures referral results are returned to the referring provide and to the medical record within required timelines. Assists with follow up, written or verbal, as necessary.

5.53. Utilizes the referral tracking data collection tool. Calculates metrics, and compiles monthly reports, as directed by the MTF.

5.54. Orients and trains MTF personnel about the referral process and timelines.

APPENDIX C

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 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

IPM - Interim Processing Memorandum

DHA PI - Defense Health Agency Procedural Instruction

DEPARTMENT OF DEFENSE (DOD)

REGULATIONS/MANUALS/INSTRUCTIONS/DIRECTIVES

Number Title of Directive Date

DHA IPM 18-001 Standard Processes Procedures and Appointments Feb 20 DHA PI 6025.03 Standard Processes Criteria for UC Services Jan 18

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 Authorized Health Care and Benefits Dec 01

AFI 41-210 Patient Administration Functions Mar 06

AFI 44-171 Patient Centered Medical Home Operations Nov 14 AFI 44-176 Access to Care Continuum Sep 17 http://www.e-publishing.af.mil/

AFI 46-101 Nursing Services and Operations Jan 15

AFI 48-123 Medical Examinations and Standards 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.

DHA Publications are available at:

https://info.health.mil

DoD publications are available at:

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

AF publications are available at:

Master Privilege List for physician credentialing is available at:

http://www.airforcemedicine.af.mil/Organizations/AFCCVO/Forms/Physicians http://west.dtic.mil/whs/directives/ http://www.airforcemedicine.af.mil/Organizations/AFCCVO/Forms/Physicians

APPENDIX D

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) OF 1996

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 ensure 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…