Attachment 1a PWS_Rvd_11-3-23_Redacted.pdf

Evaluation (CE) is the periodic reviewing of the individual's background to determine whether they continue to meet the requirements for national security eligibility.

DoDINST 5200.02, Procedures for the DOD Personnel Security Program (PSP), requires all personnel in national security positions will be subject to CE. Adjudicative Guidelines are used to determine an individual’s national security eligibility. Certain emotional, mental, and personality conditions can impair judgment, reliability, or trustworthiness. A formal diagnosis of a disorder is not required for there to be a concern under this guideline. A duly qualified mental health professional (e.g., clinical psychologist or psychiatrist) employed by, or acceptable to and approved by the U.S. Government, should be consulted when evaluating potentially disqualifying and mitigating information. No negative inference concerning the standards in this Guideline may be raised solely on the basis of seeking mental health counseling.

3. SCOPE

The Contractor shall provide Licensed/Certified, (please fill out Personal Qualifications Statement – Psychologist/Psychiatrist ) (Attachment 0002), Clinical Psychologist services at their local facility in support of the PSNS & IMF, Bremerton. The services shall be performed in accordance with established principles and ethics of the medical profession. The quality of health care provided shall meet or exceed the current recognized standards established by applicable Federal and State laws, by the American Medical Association (AMA), American Osteopathic Association (AOA), the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission), the American Hospital Association (AHA), American Academy of Pediatrics, Bureau of Medicine and Surgery, Department of the Navy, the Naval MTF, Department of Defense Health Affairs, and those other professional associations which specify standards of performance for the medical professions. In all cases, the dignity of the patient will be given the highest regard, and the precepts of the American Hospital Association's "Bill of Rights for Patients" (See Attachment 0010), shall be observed.

The Contractor shall review submitted investigative and/or employment documents which may contain potentially disqualifying information regarding possible behavior, mental or emotional disorders or substance abuse. Based upon review of investigative information and personal interview of employee, the contractor shall determine whether any medical, psychological, psychiatric or emotional condition exists which could affect a person’s judgment or reliability. The Contractor shall return all investigative and/or employment documents with the written evaluation.

The Contractor conducted evaluations may include the following in the evaluation. (Note that considerations may not be all inclusive and evaluation or examination need not be limited to these issues in order to properly evaluate the individual.) Adjudication criteria, Attachment 0005 – 0008, is an excerpt from SECNAV 5510.30.

a. Mental/Emotional Conditions per Attachment 0008;

(1) Does the individual currently, or by history have any illness, mental condition, or dysfunctional behavior which, may cause a material defect in his/her ability and/or willingness to properly safeguard classified information or perform sensitive duties?

(2) Does the individual exhibit any illness, mental condition or dysfunctional behavior even though there is no confirming medical history?

(3) If there was a prior diagnosed mental condition, is it of a nature which has a high risk or recurrence even though there is no confirming medical history?

(4) If any of the above conditions exists, please provide the following information in layman terms:

(a) DSM-III-R multiaxial evaluation to include diagnosis, prognosis and a Global Assessment of Functioning.

(b) Date of onset of the condition. Is the behavior likely to continue? Is it controlled by medication? What type of medication and dosage? Is the medication being taken as prescribed? Is the individual experiencing any side effects from the prescribed medication?

If yes, what are the side effects?

(c) Has appropriate medical advice relating to treatment of a diagnosed illness, mental condition or dysfunctional behavior been followed? Is treatment or counseling on-going at this time, or is it recommended?

(d) Has the cause of the material defect been cured? Is the condition in remission? What is the probability of recurrence?

b. Sexual Conduct per Attachment 0005;

(1) History or extent of the conduct; is it likely to recur? If so, under what circumstances? Is the individual aware of the seriousness of the conduct?

(2) Is there clear demonstration that the individual has no intention of participating in such conduct in the future? Can the individual’s conduct be a basis for vulnerability to blackmail, pressure or coercion?

c. Substance Abuse per Attachment 0006 and Attachment 0007;

(1) History or extent or involvement with substance abuse; it is likely to recur? If so under what circumstance? Is the individual now or has he/she been addicted or dependent upon the substance?

(2) Do you feel the individual is likely to participate in such conduct in the future? Can the individual’s substance abuse be a basis for vulnerability to blackmail, pressure or coercion?

(3) Has the individual’s physical or mental health deteriorated as a result of substance abuse?

(4) What are the long and short term effects on the individual’s behavior, if any, of substance(s)?

d. Formal DSM-III-R Multiaxial Evaluation

(1) Provide a formal DSM-III-R multiaxial evaluation to include diagnosis, prognosis and a Global Assessment of Functioning. Include a statement as to whether any diagnosed mental condition or dysfunctional behavior identified may cause a material defect in the individual’s ability and/or willingness to properly follow orders, safeguard classified information or perform sensitive duties. (May not be required in all cases.)

(2) The Contractor evaluations shall, at a minimum, respond to the criteria listed above.

(3) The Contractor shall perform the initial examination evaluation of the individual within 45 days of the request for service. The government shall contact the contractor via telephone requesting evaluation. Written confirmation (request for evaluation) including investigative and/or employment documentation will be forwarded to the contractor by the requiring activity.

(4) The contractor will contact the Contracting Officer Representative for authorization to conduct any special testing above the basic evaluation.

4. SUBMITTALS

Fourteen days after the evaluation, the Contractor shall provide a written analysis, for minimum required analysis elements (see Attachment 0010), from a professional psychological perspective regarding a person’s ability and/or willingness to properly follow orders, judgment or reliability, ability to safeguard classified information or ability to perform sensitive duties.

The Contractor shall prominently display on the cover of each report the following information:

Name and business address Contract number.

Date of Report

The Contractor shall enclose the evaluation and any investigative and/or employment documentation in an opaque envelope with the words

“TO BE OPENED BY ADDRESSEE ONLY, CODE 1125 PERSONNEL SECURITY

EVALUATION ENCLOSED”

This envelope shall be enclosed in a second opaque envelope addressed to:

PSNS- DEPARTMENT OF THE NAVY COMMANDER

OFFICIAL BUSINESS

Or TRF- TRIDENT REFIT FACILITY

COMMANDING OFFICER

ATTN SECURITY DIRECTOR

Code 1125 shall review the evaluation to ensure that the evaluation responds to the minimum criteria listed above.

THE CONTRACTOR MAY NOT COPY OR RETAIN ANY DOCUMENTS APPENDED WITH THE

REQUEST FOR PSYCHIATRIC/MEDICAL EVALUATION.

Requests for evaluation results and/or information contained in the investigative files SHALL NOT BE

RELEASED TO ANY INDIVIDUAL (INCLUDING THE SUBJECT) OTHER THAN THE

CONTRACTING OFFICER REPRESENTATIVE (COR) AND THE PERSONNEL SECURITY

PROGRAM MANAGER (PSPM) SPECIFIED BELOW:

Primary PSPM:

Alternate PSPM:

Phone No.:

If a Contractor chooses to utilize United Parcel Service (UPS) or Federal Express, the Government will not consider the manifest as proof of delivery unless each package has a unique package identification number. Acceptance will occur only after the Government can verify actual receipt of the contract items—packaged, marked and labeled as required in this contract.

5. DEFINITIONS

CERTIFICATION/LICENSURE. The process by which an agency of Government grants permission to an individual to engage in a given occupation, upon finding that the applicant has attained the minimal degree of competency necessary to ensure that the public health, safety and welfare will be reasonably well protected.

CONTRACTING OFFICER. The Government employee with the authority to enter into; administer;

negotiate terms, conditions and/or amounts; and/or terminate contracts and make related determinations and findings. The term includes certain authorized representatives of the Contracting Officer acting within the limits of their authority as delegated by the Contracting Officer.

CONTRACTING OFFICER'S REPRESENTATIVE (COR). The Government employee responsible for assuring Contractor performance through audit, documentation, and liaison with the Contracting Officer.

The COR is appointed in writing by the Contracting Officer. The COR has no authority to resolve disputes or obligate funds.

6. INSURANCE

6.1. The Contractor shall comply with applicable provisions of the Federal Acquisition Regulations (FAR) 52.237-7 included in Section I.

6.2. The Offeror/ Contractor shall complete the Malpractice Insurance Certification Form at, (see Attachment 0003), as part of the Price Proposal and shall once a year thereafter at the commencement of each option year during the term of this contract provide an updated form to the Contracting Officer.

6.3. Before commencing work under a contract, the contractor shall certify to the Contracting Officer in writing that the required insurance has been obtained. The following insurance as referenced in FAR

28.306 & 28.307-2(b), is the minimum insurance required:

General liability - Bodily injury liability insurance coverage written on the comprehensive form of policy of at least $500,000 per occurrence.

6.2. Workers' compensation and employer's liability - Contractors are required to comply with applicable Federal and State workers' compensation and occupational disease statutes. If occupational diseases are not compensable under those statutes, they shall be covered under the employer's liability section of the insurance policy, except when contract operations are so commingled with a contractor's commercial operations that it would not be practical to require this coverage.

Employer's liability coverage of at least $100,000 shall be required, except in States with exclusive or monopolistic funds that do not permit workers' compensation to be written by private carriers.

7. OTHER REQUIREMENTS

7.1. HOURS OF OPERATION. Workload occurs as a result of scheduled requirements for evaluation.

7.2. The specific quantity of services required for physiologic evaluation is a function of the demand for these services.

7.3. Confidentiality of Information. Unless otherwise specified, all financial, statistical, personnel and/or technical data which is furnished, produced or otherwise available to the Contractor during the performance of this contract are considered confidential business information and shall not be used for purposes other than performance of work under this contract nor be released by the Contractor without prior written consent of the Commander, via the COR. Any presentation of any statistical or analytical materials, or any reports based on information obtained from the studies covered by this contract, will be subject to review and approval by the Commander, via the COR, before publication or dissemination.

7.4. The Contractor shall NOT make any disclosure regarding the contract or its patients without prior approval of the Contracting Officer. All inquiries from the media shall be forwarded to the COR.

7.5. CONFLICT OF INTEREST

7.5.1. The Contractor shall not, while performing services under this contract, advise, recommend, or suggest to persons eligible to receive services at Government expense that such persons should receive care from the Contractor at any place other than at a MTF.

7.6. QUALIFICATIONS

7.6.1. To be qualified for this contract, the contractor shall:

7.6.1.1. Possess a Doctor of Philosophy of Doctor of Psychology degree in clinical psychology from an accredited college approved by the American Psychological Association, or be Board Certified in Psychiatry.

7.6.1.2. Possess a current, valid, unrestricted license to practice as a Clinical Psychology or Psychiatrist in Washington State.

7.6.1.3. Have a minimum of five years’ experience in the last 10 years in a clinical setting providing similar services. Experience may be documented through letters of recommendation, your resume, curriculum vitae, etc.

7.6.1.4. Provide detailed information, in a resume format, regarding the psychologist’s/psychiatrist’s background as it relates to this requirement. Information provided shall include scholastic records, post graduate experience, and work experience. (See Attachment 2)

7.6.1.5. Be familiar with the DSM-IV and psychological testing (such as WAIS-R, WISC-C, Rorschach, TAT, CAT, MMPI, MCMI, MAPI, Bender and DAP), etc.

7.6.1.6. Represent an acceptable malpractice risk to the Navy. (See Attachment 0003)

7.6.1.7. Possess U.S. employment eligibility per (Attachment 0004). No alien shall be allowed to perform under this contract in violation of the Immigration Laws of the United States. Provide copies of supporting documentation.

7.6.2. The contractor (if group practice) shall review submitted investigative and/or employment documents which may contain potentially disqualifying information regarding possible behavior, mental or emotional disorders or substance abuses. Based upon review of investigative information and personal interview of employee, the contractor shall deter mine whether any medical, psychological, psychiatric or emotional condition exists which could affect a person’s judgment or reliability.

8. PRIOR WRITTEN PERMISSION REQUIRED FOR SUBCONTRACTS

None of the services required by this contract shall be subcontracted to or performed by persons other than the contractor without the prior written consent of the Contracting Officer. The subcontractor must have equal or superior qualifications to the Prime.

52.237-7 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE (JAN 1997)

(a) It is expressly agreed and understood that this is a non-personal services contract, as defined in Federal Acquisition Regulation (FAR) 37.101, under which the professional services rendered by the Contractor are rendered in its capacity as an independent contractor. The Government may evaluate the quality of professional and administrative services provided, but retains no control over professional aspects of the services rendered, including by example, the Contractor's professional medical judgment, diagnosis, or specific medical treatments. The Contractor shall be solely liable for and expressly agrees to indemnify the Government with respect to any liability producing acts or omissions by it or by its employees or agents. The Contractor shall maintain during the term of this contract liability insurance issued by a responsible insurance carrier of not less than the following amount(s) per specialty per occurrence:

$1,000,000.00.

(b) An apparently successful offeror, upon request by the Contracting Officer, shall furnish prior to contract award evidence of its insurability concerning the medical liability insurance required by paragraph (a) of this clause.

(c) Liability insurance may be on either an occurrences basis or on a claims-made basis. If the policy is on a claims-made basis, an extended reporting endorsement (tail) for a period of not less than 3 years after the end of the contract term must also be provided.

(d) Evidence of insurance documenting the required coverage for each health care provider who will perform under this contract shall be provided to the Contracting Officer prior to the commencement of services under this contract. If the insurance is on a claims-made basis and evidence of an extended reporting endorsement is not provided prior to the commencement of services, evidence of such endorsement shall be provided to the Contracting Officer prior to the expiration of this contract. Final payment under this contract shall be withheld until evidence of the extended reporting endorsement is provided to the Contracting Officer.

(e) The policies evidencing required insurance shall also contain an endorsement to the effect that any cancellation or material change adversely affecting the Government's interest shall not be effective until 30 days after the insurer or the Contractor gives written notice to the Contracting Officer. If, during the performance period of the contract the Contractor changes insurance providers, the Contractor must provide evidence that the Government will be indemnified to the limits specified in paragraph (a) of this clause, for the entire period of the contract, either under the new policy, or a combination of old and new policies.

(f) The Contractor shall insert the substance of this clause, including this paragraph (f), in all subcontracts under this contract for health care services and shall require such subcontractors to provide evidence of and maintain insurance in accordance with paragraph (a) of this clause. At least 5 days before the commencement of work by any subcontractor, the Contractor shall furnish to the Contracting Officer evidence of such insurance.

Contracting Officer insert the dollar value(s) of standard coverage(s) prevailing within the local community as to the specific medical specialty, or specialties, concerned, or such higher amount as the Contracting Officer deems necessary to protect the Government's interests.

LIST OF ATTACHMENTS

Attachment Description

0001 Privacy and Security of Protected Health Information

0002 Personal Qualifications Statement – Psychologist/Psychiatrist

0003 Malpractice Insurance Certification Form

0004 U. S. Employment Eligibility

0005 Guideline D Sexual Behavior

0006 Guideline G Alcohol Consumption

0007 Guideline H Drug Involvement

0008 Guideline I Psychological Conditions

0009 Written Analysis Minimum Required Elements

0010 American Hospital Association's "Bill of Rights for Patients"