Attachment 2 - Statement of Work.pdf

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Attachment 2

NASA Employee International Medical Support Statement of Work (SOW)

I. Overview of Requirement

The Contractor shall provide resources necessary to accomplish medical assistance services for all NASA civil servants traveling internationally on official business. This support shall primarily consist of telephonic and electronic assistance to travelers with issues they are experiencing, such as locating nearby pharmacies or medical facilities that offer non-urgent medical care, identifying entities that can assist with replacement or repair of medical devices (e.g., eyeglasses, mobility equipment), and providing resources for assistance with lost travel documents. Other infrequent support includes arranging for support for the traveler who is experiencing a medical condition that requires (1) medical escort during ground/air transport, (2) English (or other language native to the patient) speaking medical translation during either in-patient hospitalization or out-patient definitive medical care; and (3) locating the nearest appropriate medical facility equivalent to U.S. standards of medical care to address a critical medical condition/injury. Services may also include providing ground transportation and/or “Air Ambulance Evacuation” in response to an international medical emergency for NASA civil servant international travelers. “Air ambulance evacuation” includes providing fully trained, licensed, and certified medical personnel and equipment to ensure a sick or injured traveler is provided the proper services to be stabilized prior to and during air transportation.

II. Eligibility

1. Only NASA civil service employees hereinafter “NASA employees” traveling on official

Government business outside the continental United States (OCONUS) are eligible for support under the agreement with Contractor. Although Hawaii and U.S. territories are not considered international, they are included as OCONUS for support under this agreement.

2. NASA employee official business travel categories include, but are not limited to, employees who are on temporary duty travel, permanent change of station transition travel, and/or extended duty assignments in any part of the world other than the Continental United States.

3. Injuries or illnesses sustained by NASA employees who are (1) on personal leave/vacation while OCONUS or (2) become ill or injured during non-business hours are not covered for services under this agreement. At NASA’s discretion, this restriction may be waived.

4. NASA employee family members and NASA contractor employees are not covered for services under the agreement.

5. NASA employees shall not be required to complete paperwork, become enrolled, or obtain membership with the Contractor as part of this agreement in order to receive services and support.

III. NASA Employee Information Access (Contract Line Item Number (CLIN) 001)

1. Contractor shall provide, at the time of award, a dedicated phone number(s) to be used by all

NASA employees (travelers and NASA primary points of contact), regardless of their physical location.

2. Contractor shall have a method/procedure in place, within seven (7) calendar days of contract award, which enables 24/7/365 confidential and secure transmission of a NASA employee’s medical condition to the NASA-designated physicians in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards. Unless waived by NASA under extraordinary circumstances, non-encrypted electronic mail and facsimile methods shall not be used by Contractor to communicate an employee’s personally identifiable information, medical information, medical treatment, and similar details to NASA.

3. Thirty days after the date of contract award, a minimum of 2,000 laminated (or equivalent re-usable) cards (standard business-card-size) shall be delivered to the NASA Contracting Officer Representative (COR) for distribution to Agency stakeholders and NASA employee travelers. The cards shall include the Contractor’s telephone number and any necessary dialing instructions to be used by travelers while in international locations, Contractor’s e-mail, and (if applicable) Contractor’s website URL to be used while abroad. Each year thereafter, Contractor shall provide 200 cards.

4. Every six months on a day and time coordinated with NASA, Contractor shall conduct an informational webinar (approximately 15 to 30 minutes in duration) for NASA employees.

The initial webinar shall be live and conducted within 21 calendar days of contract award.

Content shall include information such as how NASA travelers may access the Contractor by phone or electronic methods; a description of services and support provided to NASA employees before and during travel; and any other information the Contractor believes would be of value. The Contractor may provide a similar on-demand pre-recorded informational webinar for employee access for subsequent sessions if it contains the same information as a live webinar.

IV. Non-Emergency Medical Assistance Services (CLIN 001)

1. Based on time zone differences world-wide, the Contractor shall be able to provide 24/7/365 non-emergency medical assistance to NASA employees. Non-emergency NASA employee requests for assistance do not require NASA permission to proceed and may be handled by Contractor telephonically or electronically. Examples include:

a. Some countries require NASA to provide confirmation/evidence that travelers have medical evacuation insurance/coverage/benefits. The Contractor should be able to assist NASA employees with providing this documentation and any other medically related information required on applications to enter foreign countries.

b. Providing NASA employees with information about non-emergency delivery of medicines, drugs, and medical supplies and non-emergency advice/physician referral (e.g., locations of nearby English-speaking physicians or dentists, how to obtain replacement prescription medication) convenient to the employee’s location.

c. Providing NASA employees advice on corrective lens replacement and medical device replacement if lost, stolen, or broken during travel.

d. Provide medical translation and interpretation to include telephonic language assistance with medical incidents and medical translations of medical records to the extent required to resolve the inquiry.

e. Upon request, Contractor shall assist NASA employees in obtaining documentation for medical insurance claims (including Department of Labor Federal Workers’ Compensation) for care arranged by, or coordinated with, the Contractor, especially ensuring documentation is in English or translated into English.

V. Patient Records

Typically, NASA employee medical records will only be generated if hospitalization or medical evacuation/transportation is conducted.

1. Maintenance, storage, and retention of all NASA employee patient care records in

Contractor’s possession, including those generated prior to and during transport, shall comply with applicable HIPAA and privacy regulations.

2. Patient care records must be stored in a secure location inaccessible to the public and include, but not be limited to:

• Time zone(s) used in recording information

• Patient vital signs

• Reason for medical transport

• If known, patient allergies and current medications

• Treatments and medications used on patient and the patient’s response to them

• Description of consent provided by patient relative to risks, benefits, and limitations

• Signatures and initials of all medical personnel who performed treatments/procedures

3. Contractor shall provide to NASA a description of Contractor’s patient record transfer/retention methods, including destruction methods used when a case has been completed.

4. Upon request, Contractor shall ensure that the employee’s medical records are transferred to employee’s personal United States-based physician and/or provided to the employee to take with him/her.

VI. Additional Requirements (CLIN 002)

1. Emergency Medical Travel Assistance – Logistics

a. For emergency medical events that will require CLIN 002 support, Contractor shall pre-coordinate activities and services with designated NASA physicians to discuss treatment options for NASA employees, based on the details of their health status.

b. When Contractor is contacted by a NASA employee, a NASA employee’s colleague, a NASA employee’s supervisor, or a NASA employee’s family member about an employee’s illness or injury, Contractor shall contact the designated NASA physician (identified in Appendix A) as follows:

• Immediately by phone when a NASA employee’s medical transportation (by ground or air) and/or critical hospitalization is required.

• During waking hours (0800-2000 Eastern, 7 days per week) by phone or by confidential/encrypted electronic mail (7 days per week) for non-critical or routine events. This includes outpatient care, unless the employee’s local OCONUS physician expresses concern and requests immediate telephone contact with NASA’s designated physician.

c. Contractor pre-coordination with NASA points of contact (identified in Appendix A) shall include discussing plans to transport, hospitalize, and the means and methods of NASA employee evacuation (e.g., employee’s medical condition, employee’s physical location, degree of urgency, fitness to travel, distance to hospital, airport location, and current weather conditions). As circumstances permit, Contractor’s discussion of service choices and alternatives with NASA points of contact shall include estimates of cost.

The Contractor is to obtain NASA approval for transportation services that exceed $100,000.

d. Contractor shall ensure medical monitoring staff is available to talk/confer with the NASA-designated physician(s) as necessary to keep NASA apprised of the NASA employee’s status and that the NASA-designated physician(s) is/are provided with the name and phone number of a Contractor medical point of contact.

2. Emergency Medical Ground Transportation Services

a. Contractor shall provide medical services for NASA employees who are experiencing a medical condition that requires ground transportation to a healthcare facility, which may result in in-patient hospitalization or out-patient definitive medical care.

b. Contractor shall arrange for transportation under medical supervision to the closest medical facility in their duty station country (or other country if it is closer) having Western equivalence in medical treatment, capabilities, and expertise.

c. All decisions for ground transport shall be pre-coordinated with NASA.

d. If a medical emergency cannot be supported by ground transportation (e.g., criticality of incident or environmental conditions) and air transportation is required, the Contractor shall refer to section VI.3 requirements below.

e. There shall be no transport of NASA employees for short-term, interim, or long-term medical assistance/support or stabilization to any areas listed on the real-time version of the Department of State alert’s website https://travel.state.gov/content/travel/en/traveladvisories/traveladvisories.html/

f. NASA employees under treatment at a location which subsequently becomes listed on the Department of State alert site shall be relocated to a safe facility if transport back to the United States is not possible.

g. Medical Staffing, Equipment, Supplies, and Support

i. In Contractor’s selection of appropriate medical treatment centers (i.e., local hospitals) for NASA employees via ground transport, the Contractor shall ensure that medical transport services (i.e., ambulances) employ appropriate safety procedures and contingencies for temporary situations in areas traveled that may increase risk (e.g., extreme weather, recent/impending political situations, natural disasters).

ii. Contractor shall ensure there is supervision of patient care. A representative knowledgeable and legally enabled to perform clinical supervision must be employed by Contractor to work collaboratively in coordinating patient care delivery by the medical professionals assigned to a NASA employee’s transport.

iii. At NASA’s request, Contractor shall provide substantive and detailed evidence of capabilities and methods to safely and expeditiously extract injured/ill employees from remote locations.

3. Emergency Medical Air Ambulance Services

a. The use of air ambulance transport is usually associated with critical and urgent medical emergency care; time is of the essence. Therefore, the Contractor shall ensure that the air ambulance transportation fleet is capable of meeting a response time of no more than 5 hours from Contractor notification to reaching the NASA employee. It is understood that this timeframe may be impacted by other variables and circumstances (e.g., remote location pick-up, weather conditions, medical transport personnel muster, and pre-coordination with NASA).

b. Air ambulance extractions from remote locations where ground transportation is not possible may be required. At NASA’s request, Contractor shall provide substantive and detailed evidence of capabilities and methods to safely and expeditiously extract injured/ill employees from remote locations.

c. All decisions for air transport shall be pre-coordinated with NASA and Contractor must adhere to the requirements listed in section VI.1., as well as the requirements in this section.

d. At NASA’s discretion and depending on the circumstances, transportation and selection of a suitable medical facility may involve direct transport of the NASA employee back to the United States. This may depend on an employee’s medical status and fitness to travel.

e. At NASA’s request, Contractor shall assist with arrangements for an air transportation ticket for the NASA employee’s relative (one relative) to join the employee who has been, or will be, hospitalized/treated. This includes arrangements for the NASA employee’s relative to travel back to the United States with the NASA employee.

f. Transportation of NASA employees by air shall be to the closest medical facility in their duty station country (or other country if it is closer) having Western equivalent in medical treatment, capabilities, and expertise.

g. During the term of the contract for air ambulance transport situations, Contractor’s use of any their own, leased or chartered aircraft shall comply with local and long-distance aircraft and pilot requirements (applicable to prime and subcontractors). Aircraft used for

NASA employee transport shall be certificated, operated, and maintained in accordance with 14 CFR:

• Part 21—Certification Procedures for Products and Parts

• Part 25—Airworthiness Standards: Transport Category Airplanes

• Part 29—Airworthiness Standards: Transport Category Rotorcraft

• Part 39—Airworthiness Directives

• Part 43—Maintenance, Preventative Maintenance, Rebuilding, and Alteration

• Part 61—Certification: Pilots, Flight Instructors, and Ground Instructors

• Part 65—Certification: Airmen Other Than Flight Crewmembers

• Part 91—General Operating and Flight Rules

• Part 135—Operating Requirements: Commuter and On-Demand Operations

h. Contractor shall have a documented Safety Management System (SMS) in accordance with International Civil Aviation Organization (ICAO), Federal, and industry standards.

Requirements include the following:

i. A structured means of safety risk management decision making.

ii. A means of demonstrating safety management capability before system failures occur.

iii. Increased confidence in risk controls through structured safety assurance processes.

iv. An effective interface for knowledge sharing.

v. A safety promotion framework to support a sound safety culture.

i. Medical Staffing, Equipment, Supplies, and Support

i. Contractor shall employ personnel for international air ambulance medical transportation who possess expertise, qualifications, certifications, and experience commensurate with the level of care required for the patient.

1) Basic Care is considered to be the transport of a patient whose condition warrants an attendant commensurate with the scope of practice for an Emergency Medical Technician (EMT) or equivalent. The patient is considered stable and requires minimal supervision or care. The EMT provider must be registered, certified, or permitted according to the appropriate regulations in their nation of residence and/or the authority having jurisdiction. The EMT provider must be current in licensure in their nation of residence and have a minimum of five years of experience in a pre-hospital setting and critical care.

2) Advanced Care is considered to be the transport of a patient whose condition warrants an attendant commensurate with the scope of practice of a registered nurse (RN), paramedic and/or respiratory therapist. RNs must be current in licensure in their nation of residence and have a minimum of five years of experience in a hospital or pre-hospital setting. Paramedics must be registered, licensed, certified, or permitted according to appropriate regulations in their nation of residence and/or the authority having jurisdiction. Paramedics must have a minimum of five years advanced life support experience and critical care.

Respiratory technicians must have current and appropriate licensure in their nation of residence and a minimum of five years’ experience. Advanced care patients are stable enough to travel but require certain support, including but not limited to: oxygen, mobilization devices, emptying drainage bags, dressing changes, medication administration, cardiac or diabetic complications support, and respiratory complications (e.g., hypoxia, suctioning, humidity needs) support.

ii. Utilizing the Commission on Accreditation of Medical Transport Systems (CAMTS) patient care medical escort standards as the foundation for acceptable staffing, the following criteria, or equivalent, shall be met by activities conducted and medical personnel involved with air ambulance transportation/evacuation of NASA employees:

1) Basic Care medical escort personnel must have completed training or show proof of recent experience/training in the following (or equivalent) areas:

− Altitude physiology/stressors of flight − Aircraft orientation and in-flight procedures/general aircraft safety (e.g., depressurization) − Contact and communication procedures − Identification of, and handling, hazardous materials (including response) − Infection control − Sleep deprivation, sleep inertia, circadian rhythms and recognizing signs of fatigue − Proper personal protective equipment and clothing − Emergency/hospital care − Pre-hospital care − Basic life support (BLS) based on American Heart Association standards or equivalent − Advanced cardiac life support (ACLS) based on American Heart Association standards or equivalent − Education/training specific to various types of transport that might be used for medical transportation/evacuations − Procedures for handling patients with a known communicable disease at the time of the request or discovered during/after transport.

− Procedures to be used should the patient’s condition worsen (e.g., additional emergency measures needed, additional professional staff required).

− Patient loading and unloading procedures if patient is on a stretcher − Familiarization with ground and air transport and equipment if utilizing a third-party vehicle/aircraft

2) Advanced Care medical escort personnel must have completed training or show proof of recent experience/training in the following (or equivalent) areas:

− Altitude physiology/stressors of flight − Anatomy, physiology and assessment for adult and pediatric patients − Aircraft orientation and in-flight procedures/general aircraft safety (e.g., depressurization) − Contact and communication procedures

− Identification of, and handling, hazardous materials (including response) − Infection control − Sleep deprivation, sleep inertia, circadian rhythms and recognizing signs of fatigue − Proper personal protective equipment and clothing − Emergency/hospital care − Pre-hospital care − Basic life support (BLS) based on American Heart Association standards or equivalent − Advanced cardiac life support (ACLS) based on American Heart Association standards or equivalent − Education/training specific to various types of transport that might be used for medical transportation/evacuations − Procedures for handling patients transported with a known communicable disease at the time of the request or discovered during/after transport.

− Procedures to be used should the patient’s condition worsen (e.g., additional emergency measures needed, additional professional staff required).

− Patient loading and unloading procedures if patient is on a stretcher − Familiarization with ground and air transport safety and equipment if utilizing a third-party vehicle/aircraft − Disaster and triage − Environmental emergencies − Mechanical ventilation and respiratory physiology for adults − Metabolic/endocrine emergencies − Post-traumatic injury complications − Pharmacology and toxicology − Didactic education supporting medical transport service and patient scope of care − Respiratory emergencies − Thermal, chemical and electric burns

4. Repatriation of Mortal Remains

a. In the event of a NASA employee’s death, Contractor shall render assistance and provide for the return of mortal remains via coordination with NASA and employee’s next of kin.

b. Assistance shall include locating a funeral home or equivalent entity to prepare the body for transport, transporting the body from the site of death to the sending funeral home or equivalent entity and then to the airport, ensuring the provision of a minimally necessary casket or air tray for transport, coordinating with consular services, procuring death certificates, and transporting the remains from the airport to the receiving funeral home in the United States.

c. Other services that may be necessary include notifying the next of kin, arranging for identification of the body, and assisting in making travel arrangements for next of kin.

VII. Invoices, Payment, and Quarterly Reports

1. For CLIN 002, Contractor shall guarantee payment to all providers, as NASA’s Agent, for all costs associated with in-patient or out-patient medical care provided in the NASA employee’s location, until invoices are prepared by Contractor and submitted to NASA for payment. Costs may include medical facility/hospital room, medical supplies/equipment, medication, surgical procedures, monitoring, and utilization of physicians with specialized expertise.

2. For CLIN 002, to ensure timely reimbursement, Contractor shall ensure (within 21 calendar days of the last day of service provided to the employee) submission to NASA of the final invoice associated with Contractor-provided services, including medical facility/hospital services where a NASA employee was stabilized. Invoices and other associated documentation sent to NASA shall not include any NASA employee patient’s medical information protected by the Privacy Act or HIPAA. Copies of subcontractor invoices or other “pass-through” service costs shall accompany invoices. Invoices for ground and/or air transportation shall identify (as applicable) the call number, aircraft tail number used, date and time of each mission, quantity of Great Circle Statute Miles (GCSMs) flown, originating and final destinations, and the number of hours and level for each medical personnel used.

Reimbursable expenses must be identified separately, and receipts must be provided for all expenses claimed.

3. For CLIN 001 and CLIN 002, the Contractor shall electronically submit to the NASA COR and NASA Contracting Officer a quarterly report summarizing services (including no-cost support) provided to NASA. Indicating “no services provided during this time period” entry is acceptable. For services provided, the report shall include, at a minimum, the date each service was provided, the initials of the NASA employee for which support was provided, and the general type of service provided (e.g., ground transport, telephone referral, air ambulance). Costs associated with services provided shall be included in the report.

Appendix A

Authorization to Proceed POCs and Protocol

NASA points of contact (available 24/7/365) for Contractor’s obtaining authorization to proceed with services for NASA employees are as follows:

Primary: Designated civil service physicians from Kennedy Space Center Secondary: NASA Deputy Chief Health and Medical Officer or Chief Health and

Medical Officer Tertiary: Contracting Officer’s Representative located in the Office of the Chief

Health and Medical Officer

Information will be provided upon award.