Attachment1_SOW_Medical_Services_DFWP_NPD_and_HC_FINAL_ Amendment 2.docx

U.S DEPARTMENT OF HOMELAND SECURITY

U.S Customs and Border Protection

Office of Human Resources Management

STATEMENT OF WORK

FOR

MEDICAL SERVICES

TO SUPPORT

THE OFFICE OF HUMAN RESOURCES MANAGEMENT

NATIONAL PROGRAMS DIVISION

Medical and Fitness Branch and

CBP HIRING CENTER

June 29, 2020

STATEMENT OF WORK

Medical Services Contract Table of Contents

1.0 BACKGROUND 4

1.0 BACKGROUND

As a Federal law enforcement agency, U.S. Customs and Border Protection (CBP) is responsible for ensuring that certain personnel are fully qualified to safely and effectively perform the essential job duties without undue risk or hazard to self or public. This involves, but is not limited to, developing and the implementation of the Office of Personnel Management approved job-related medical standards, facilitating medical examinations and consultations, and managing and implementing the Federal Drug-Free Workplace Program to deter illegal drug use.

1.1 This statement of work is for medical services to support two program offices within CBP’s Office of Human Resources Management (HRM), namely, National Programs Division’s (NPD) Medical and Fitness Branch (MFB) and CBP Hiring Center (CBP HC).

1.2 CBP Hiring Center (CBP HC) is located in Bloomington, MN, and for the purposes of this SOW, is responsible for the coordination of the pre-employment candidate medical examinations and fitness tests for positions with medical standards and physical requirements, and for the scheduling of specimen collection services for the drug testing of candidates selected to occupy safety sensitive positions.

1.3 NPD’s Medical and Fitness Branch is responsible for the following medical service programs:

1.3.1 Employee Examinations and Consultations

1.3.2 Fitness for Duty Evaluations (FFDE)

1.3.3 Return to Work (Non – Workers’ Compensation Cases)

1.3.4 Medical Documentation Review

1.3.5 Medical Consultation for Clinical Opinion

1.3.6 Medical and Physical Requirements

1.3.7 Federal Drug-Free Workplace Program

2.0 SCOPE

2.1 National Program Division’s Medical and Fitness Branch

Under Section A, of this statement of work (SOW) is for the comprehensive provision of a Medical Services Contractor (hereafter referred to as the “Contractor”) to provide professional services which support MFB within NPD. These services shall include: Contractor’s Reviewing Physician Consultants to review and form an opinion of the actual examination findings of the independent medical examinations (IME) performed by physicians and/or healthcare practitioners.

Additional performance activities include: medical, psychiatric, and functional capacity evaluations of employees; consultation services for the development, verification, and validation of job-related medical and physical requirements, medical consultations for clinical opinions, and medical documentation review, detailed written reports of the examination and diagnostic findings, and medical and physical requirements.

In addition, this SOW includes services to support CBP’s Drug-Free Workplace Program (DFWP) to include Health and Human Services (HHS)-certified clinics for specimen collection; HHS-certified collection staff, and the analysis of the collected specimens by an HHS-certified forensic laboratory. The Contractor’s HHS-certified forensic laboratory reports all drug test results only to the Contractor’s designated Medical Review Officer (MRO). The MRO conducts a final review of all drug testing results and reports only verified results to the Contract Officer Representative (COR).

In support of the DFWP, the Contractor shall provide specimen collection supplies and shipping of these supplies to approximately 600 duty stations and collection sites within the continental United States (U.S.) and U.S. Territories and overseas. Note that at this time, overseas locations are limited to Canada, and the Caribbean. During the life of this contract, overseas shall include but not limited to locations such as Abu Dhabi and Dublin.

The Site Coordinator, a separate contractor, coordinates specimen collection events at CBP duty stations in concert with CBP management and the Contractor. The Blind Sample supplier is a separate contractor to ensure quality measures.

For the purposes of this SOW, the title Medical Review Officer (MRO) refers to the physician who provides medical oversight of the Agency’s Drug-Free Workplace Program (DFWP).

For the purposes of this SOW, the title Medical Examiner refers to the physician(s) or practitioner(s) (e.g., Ph.D., Au. D. or D.O., etc.) performing the examinations and/or evaluations affiliated with the requested employee medical services. The aforementioned is in contrast to, the title Reviewing Physician Consultant, which refers to the Contractor’s physician(s) who reviews all the available documentation and provides the Agency with a medical determination.

The Contractor shall maintain a web-based data system, accessible remotely from any internet ready PC with a high speed connection, by CBP personnel per the Web Services and reporting requirements in this SOW.

The Agency recognizes the fiscal, environmental, and health issues inherent in travel. The Government will consider technology related methods for interaction, such as virtual attendance. When feasible, the Agency may implement such practices.

2.2 EMPLOYEE MEDICAL SERVICES – Examinations and Consultations

Employee medical services include the following: employee fitness for duty evaluations, return to work reviews after an injury or illness; medical documentation review, medical consultation for clinical opinion, and specialists to assist in the development of vision and hearing requirements portion of medical standards specific to certain positions.

2.2.1 Fitness for Duty Evaluations

A fitness for duty evaluation may be conducted when there is job performance or behavior issue. Federal employees undergo fitness for duty evaluations (FFDE) s in accordance with 5 CFR § 339.301 - Authority to Require an Examination. Under 5 CFR § 339.301(b)(3), an employee who is in a position with medical or physical requirements, may be required to undergo a FFDE whenever there is a direct question about an employee’s continued capacity to meet the physical or medical requirements of a position. For those positions without medical standards, management may offer a FFDE under 5 CFR § 339.302.

Psychiatric evaluations must begin with a general examination before proceeding with the psychiatric evaluation.

2.2.2 Return to Work for Non-Workers’ Compensation Cases

CBP may require an employee (covered or not covered by medical standards) who has applied for or is receiving continuation of pay or compensation as a result of an on-the-job injury and disease to report for an examination to determine medical limitations that may affect placement decisions, based on 5 CFR 339.301(c). In compliance, MFB facilities “Review of Information-Return to Work Consultations.”

2.2.3 Medical Documentation Review

Medical documentation submitted by the employee and/or management that is submitted requires a determination which meets the provisions set forth in the following:

2.2.3.1 The Family and Medical Leave Act of 1993 (FMLA), Title 29 CFR Part 825, is an entitlement law that allows employees to take up to twelve (12) weeks of unpaid leave per twelve (12) months;

2.2.3.2 Medical Hardship Reassignment (National Treasury Employee Union (NTEU) Article 39 Section 2.E. (October 2017)): a recommendation based on the analysis of the hardship-circumstance specifics to the health-related documentation submitted in support of reassignment at another duty station in an expedited manner. This is specific to NTEU members.

2.2.3.3 Compassionate Transfers: a recommendation based on the analysis of medical documentation submitted when medical care is not readily available to the employee and/or family member working and living in remote areas. This is specific to the National Border Patrol Council members.

2.2.3.4 Reasonable Accommodations: a consultative opinion of medical documentation evaluated against the accommodation sought by the employee or the agency.

2.2.3.5 Various medical documentation submitted by employees and CBP management officials.

2.2.4 The chart below summarizes the number of employee examinations and consultation reviews conducted during Fiscal Year (FY) 2015- 2019.

Table I - Employee Medical Examination Historical Trends

Employee Medical Examination Historical Trends

2.3 Medical Standards and Programs

2.3.1 In compliance with 5 C.F.R. Part 339 CBP develops job-related medical requirements based on the essential job functions and physical requirements identified by conducting job analyses.

2.3.1.1 Development of Vision and Hearing Medical Requirements

This effort is intended to develop job-related vision and hearing requirements, as well to provide medical consultation related to medical and physical requirements and medical policies. The request for contractual support to develop the vison and hearing requirements of the medical standards for certain positions within CBP is subject to the needs of the Government.

2.4 Federal Drug-Free Workplace Program

2.4.1 NPD administers and implements the Federal Drug-Free Workplace Program DFWP) in accordance with the Department of Health and Human Services (HHS), DHS Directive, and DHS CBP Drug-Free Workplace Plan (October 2017). CBP conducts drug testing under the following circumstances:

2.4.1.1 Random – employees who occupy safety sensitive positions considered as testing designated positions (TDPs).

2.4.1.2 Reasonable suspicion drug testing

2.4.1.3 Post-accident

2.4.1.4 Voluntary

2.4.1.5 Return to work

2.4.1.6 Follow-up drug testing

2.4.1.7 Pre-employment (coordinated by CBP Hiring Center).

2.4.2 CBP workforce is comprised of TDPs within the transportation industries. The Department of Transportation (DOT) regulations issued in 1988 and those issued under the authority of the Omnibus Transportation Employee Testing Act of 1991, require drug and alcohol testing of employees in “safety-sensitive” positions in aviation, trucking, mass-transit, pipeline, and other transportation industries. Therefore, in compliance with DOT regulations at Title 49 CFR Part 40, during the life of the contract, CBP may implement alcohol testing for covered employees under the following circumstances: random, reasonable suspicion, and post-accident.

2.4.3 The table below summarizes the number of employee drug tests conducted during Fiscal Years (FY) 2015 through FY 2019.

Table 2 – Employee Specimen Collected Historical Trends

HISTORICAL VOLUME OF SPECIMEN COLLECTED

Circumstances

Fiscal Year

2.4.4 In respects to the DFWP, to successfully perform the services required by this Contract, the Contractor must comply with HHS Mandatory Guidelines and HHS Collection Handbook for the Collection of Urine Specimen for Federal Agency Workplace Drug Testing Programs, hereafter referred to as “HHS Guidelines,” and the “HHS Collection Handbook,” respectively.

2.5 CBP Hiring Center

Section B of this Statement of Work (SOW) provides the specific tasks and requirements for pre-employment medical services, medical consultation services, pre-employment fitness testing services, and pre-employment drug testing services for CBP.

The services under this contract are subject to the needs of the Government and to the availability of funds; the volume of tests ordered is contingent upon the number of new hires approved by Congress and specific hiring requirements. CBP shall make a good faith effort to keep the Contractor informed of anticipated or impending needs for services. The volume of requests sent by CBP to the Contractor shall vary widely by day – CBP may send up to several thousand requests in one day which will need to be completed within the timelines specified in this SOW.

Candidates for the Customs and Border Protection Officer (CBPO), Border Patrol Agent (BPA), Air Interdiction Agent (AIA), Marine Interdiction Agent (MIA), and Aviation Enforcement Agent (AEA), Agriculture Specialist (AGS), Criminal Investigator (CI), and Detection Enforcement Officer (DEO) positions receiving a conditional offer of employment are required to undergo a Pre-Employment Medical Examination and/or Fitness Test-1 (PFT-1) to ensure that they are medically and physically prepared to meet the demands of the Academy, and capable of performing the required tasks of the position.

In addition, this SOW includes services to support CBP’s Drug-Free Workplace Program (DFWP) to include Health and Human Services (HHS)-certified clinics for specimen collection; HHS-certified collection staff, the analysis of the collected specimens by a HHS-certified laboratory, and the services of a Medical Review Officer to provide oversight of the DFWP.

The Contractor shall identify and establish facilities capable of performing candidate medical examination, fitness testing, and drug testing services within a sixty (60) mile radius of the candidate's home address. If a candidate is located in an area where facilities capable of performing these services are scarce and the Contractor has existing facilities in their network located outside of the sixty (60) mile radius, the Contractor may request that the Contracting Officer (CO) or Contracting Officer's Representative (COR) authorizes a candidate to be examined or tested at the existing facility in the Contractor's network.

The Contractor shall provide medical examination, fitness testing, and drug testing services to include specimen collection supplies and shipping of these supplies to collection sites within the continental United States (U.S), Alaska, Hawaii, Washington DC, U.S. Virgin Islands, Puerto Rico, Guam, and Saipan. The Contractor, upon request, shall also provide pre-employment medical examination, fitness testing, and drug testing services at overseas locations including, but not limited to, Canada and Germany. The need for additional overseas testing locations may arise throughout the life of this contract. The sixty (60) mile radius requirement does not apply to services being performed overseas.

Regardless of past performance or contract administration on the former medical services contract for CBP, this SOW shall be enforced for the contract awarded under this solicitation.

The Contractor shall have the ability to provide automated self-scheduling capabilities to allow candidates to elect date, time, and location for medical examination, fitness test, and drug test appointments.

The Agency recognizes the fiscal, environmental, and health issues inherent in travel. The Government will consider technology related methods for interaction, such as virtual attendance. When feasible, the Agency may implement such practices.

2.6 PRE-EMPLOYMENT SERVICES

Pre-employment services include the following: pre-employment medical examinations, medical consultations, pre-employment fitness tests, and pre-employment drug test collection, laboratory, and Medical Review Officer.

2.6.1 Pre-Employment Medical Examination Services

2.6.1.1 Services performed under this SOW are for the purpose of providing medical information and recommendations for CBP's programs; however, final medical determination and hiring decisions are the responsibility of CBP.

2.6.1.2 The Contractor shall provide all medical examination facilities and personnel, electronic communications of all medical examination data, and all equipment necessary for completion of the medical examinations nationwide, as well as overseas upon request.

2.6.1.3 The Contractor shall provide an IT platform accessible to CBP personnel, Contractor personnel, and candidates. The platform shall provide the ability to collect, share, and transmit candidate information, including but not limited to medical examinations and consultations, candidate responses to medical follow-up, and provide candidates with the ability to review and provide required follow-up information.

2.6.1.4 Schedule candidates to take the medical examination and psychiatric evaluation (if applicable) in coordination with the CBP Hiring Center as requested by the Contracting Officer’s Representative (COR).

2.6.1.5 Administer the medical examination to candidates receiving conditional offers of employment for the BPA, CBPO, AGS, AIA, MIA, CI, and DEO positions.

2.6.1.6 The chart below summarizes the number of pre-employment medical examinations requested and completed during Fiscal Year (FY) 2016- 2019.

2.6.1.7

Table 1 – Pre-Employment Medical Examination Historical Trends

Pre-Employment Medical Examination Historical Trends

2.6.2 Medical Consultation Services

2.6.2.1 The Contractor shall provide medical consultation services to the CBP, Office of Human Resources Management (HRM), located at the CBP Hiring Center. The Contractor shall be responsible for providing medical consultations and recommendations for all medical issues, including mental health and vision. The recommendations shall relate to the vendor’s opinion on the ability of the candidate to perform CBP job functions.

2.6.2.2 The chart below summarizes the number of pre-employment medical consultations requested and completed during Fiscal Year (FY) 2017- 2019.

Table 2 – Medical Consultation Historical Trends

Pre-Employment Medical Consultation Historical Trends

2.6.3 Pre-Employment Fitness Test (PFT-1) Services

2.6.3.1 The Contractor shall provide all fitness testing facilities, all fitness testing personnel, electronic communications of all fitness test data, and all equipment necessary for completion of the PFT-1 nationwide, as well as overseas upon request.

2.6.3.2 Schedule candidates to take the PFT-1 in coordination with the CBP Hiring Center as requested by the Contracting Officer’s Representative (COR).

2.6.3.3 Administer the PFT-1 to candidates receiving conditional offers of employment for the BPA, CBPO, AIA, MIA, and AEA positions.

2.6.3.4 The chart below summarizes the number of pre-employment fitness tests requested and completed during Fiscal Year (FY) 2016- 2019.

Table 3 – Pre-Employment Fitness Test Historical Trends

Historical Volume of Candidate Fitness Tests Requested - PFT-1

2.6.4 Pre-Employment Drug Test Services

2.6.4.1 Federal Drug-Free Workplace Program

2.6.4.1.1 Preemployment drug testing is coordinated by CBP Hiring Center, while NPD administers the Drug-Free Workplace Program. Reference SOW 2.4.1.

2.6.4.2 The chart below summarizes the number of pre-employment drug tests requested and completed during Fiscal Year (FY) 2016-2019.

Table 4 – Pre-employment Drug Test Historical Trends

Historical Volume of Candidate Drug Tests

3.0 APPLICABLE DOCUMENTS AND ATTACHMENTS FOR NPD AND HC

3.1 Title 5 CFR Part 339 (January 2017) – Medical Qualification Determination Below is the link to the Medical Qualification Determination that pertains to FFDE, Medical Standards and Physical Requirements (82 FR 5340, January 18, 2017):

https://www.gpo.gov/fdsys/pkg/FR-2017-01-18/pdf/2017-00804.pdf

3.2 Title 5 CFR § 297.205 – Access to Medical Records

Below is the link to the Access to Medical Records that defines the procedures for disclosure of mental health records:

https://www.gpo.gov/fdsys/pkg/CFR-2002-title5-vol1/pdf/CFR-2002-title5-vol1-part297.pdf

3.3 Title 29 CFR § 825.100 – The Family and Medical Leave Act of 1993, as amended, (FMLA) – Applicable to NPD only Below is the link to FMLA:

https://www.gpo.gov/fdsys/pkg/CFR-2011-title29-vol3/pdf/CFR-2011-title29-vol3-part825.pdf

3.4 The Department of Health and Human Services Mandatory Guidelines for Federal Workplace Drug Testing Programs, effective October, 1, 2017.

Below is the link to the Federal Register Notice of Revisions of the Mandatory Guidelines (82 FR 7920, January 23, 2017):

https://www.gpo.gov/fdsys/pkg/FR-2017-01-23/pdf/2017-00979.pdf

3.5 The Department of Health and Human Services Mandatory Guideline for Federal Workplace Drug Testing Programs-Oral/Fluid, effective January 1, 2020.

Below is the link to the Federal Register Notice of Revisions of the Mandatory Guidelines (84 FR 57554, October 25, 2019):

https://www.govinfo.gov/content/pkg/FR-2019-10-25/pdf/2019-22684.pdf

3.6 The Department of Health and Human Services Medical Review Officer Guidance Manual for Federal Workplace Drug Testing Programs, effective October 1, 2017.

Below is the link to the Medical Review Officer Guidance Manual https://www.samhsa.gov/sites/default/files/workplace/mro-guidance-manual-oct2017_2.pdf

3.7 The Department of Health and Human Services Urine Specimen Collection Handbook, effective October, 2017.

The Contractor shall comply with the HHS Collection Handbook for the Collection of Urine Specimen for Federal Agency Workplace Drug Testing Programs, found at the link below:

https://www.samhsa.gov/sites/default/files/workplace/urine-specimen-collection-handbook-oct2017_2.pdf

3.8 DHS Handbook for Safeguarding Sensitive Personally Identifiable Information, Privacy Policy Directive 047-01-007, Revision 3, December 4, 2017 The Contractor shall ensure that all employees assigned to work on the Contract shall comply with the DHS Handbook for Safeguarding Sensitive Personally Identifiable Information, found at the link below:

https://www.dhs.gov/sites/default/files/publications/dhs%20policy%20directive%20047-01-007%20handbook%20for%20safeguarding%20sensitive%20PII%2012-4-2017.pdf

3.9 DHS Sensitive Systems Policy Directive 4300A

The Contractor shall comply with DHS information on security policy, standards, and guidelines, found at the link below:

https://www.dhs.gov/sites/default/files/publications/4300A%20Sensitive-Systems-Handbook-v12_0-508Cs.pdf

3.10 Title 41 CFR §§ 300-304 - Federal Travel Regulations

The Contractor shall comply with the Federal Travel Regulations when travel is billable under this contract. Information found at the following link: https://www.gsa.gov/cdnstatic/FTR_Amendments_Through_2018-01.pdf

3.11 Public Law 104-191, Health Insurance Portability and Accountability Act of 1996

(HIPAA)

The Office for Civil Rights enforces the Health Insurance Portability and Accountability Act (August 21, 1996) Privacy Rule, which protects the privacy of individually identifiable health information; the HIPAA Security Rule, which sets national standards for the security of electronic protected health information; and the confidentiality provisions of the Patient Safety Rule, which protect identifiable information being used to analyze patient safety events and improve patient safety.

www.gpo.gov/fdsys/pkg/PLAW-104publ191/pdf/PLAW-104publ191.pdf

3.12 NON-Disclosure Agreement (NDA)

DHS Form 1100-6, Non-Disclosure Agreement can be found at the link below:

http://www.fas.org/sgp/othergov/dhs-nda.pdf

3.13 Standards of Conduct - Applicable to NPD only

DHS U.S. Customs and Border Protection Directive No. 51735-013A, dated March 13, 2012, Standards of Conduct found at the link below:

http://cbpnet.cbp.dhs.gov/HRM/Documents/conduct_standards.pdf#search=standards%20of%20conduct

3.14 The National Archives and Records Administration, General Records Scheduled 1: Rule 36 - Applicable to Post-Employment only.

Federal Workplace Drug Testing Program Files; and Rule 30 - Administrative Grievance, Disciplinary, and Adverse Action

3.15 National Institute of Standards and Technology guidance and requirements http://www.nist.gov/index.html

3.16 Selected Occupational Safety and Health Standards, 29 CFR 1910.38 and 1910.157 www.gpo.gov/fdsys/browse/collectionCfr.action?collectionCode=CFR

3.17 29 CFR Part 1910.1030, Occupational Safety and Health Standards: Blood borne Pathogens. Occupational Safety and Health Standards: Blood borne Pathogens addresses safety for all occupational l exposure to blood or other potentially infectious materials. This Part describes requirements for exposure control, methods of compliance, Hepatitis B vaccination and post-exposure evaluation and follow-up, labels and signs, recordkeeping, etc.

3.18 Attachment #1: NPD Nurse Consultant Medical Services Request

3.19 Attachment #2: NPD - Authorization for Release of Medical Records

3.20 Attachment #3: NPD – Labor Employee Relations (LER) Request for Medical Services

3.21 Attachment #4: Medical Requirements and Essential Job Tasks for various CBP Positions.

3.22 Attachment #5: NPD - Employee Medical Examination and History Report

3.23 Attachment #6: Specialized Test List

3.24 Attachment #8A: Border Patrol Agent Medical Requirements

3.25 Attachment #8B: Customs and Border Protection Officer Medical Requirements

3.26 Attachment #8C: Criminal Investigator Medical Requirements

3.27 Attachment #8D: Marine Interdiction Agent Medical Requirements

3.28 Attachment #8E: Agriculture Specialist Medical Requirements

3.29 Attachment #8F: Air Interdiction Agent Medical Requirements

3.30 Attachment #8G: Detection Enforcement Officer Medical Requirements

3.31 Attachment #9: Candidate Medical Examination and History Report

3.32 Attachment #10A: Border Patrol Agent Medical Requirements

3.33 Attachment #10B: Customs and Border Protection Officer Medical Requirements

3.34 Attachment #10C: Criminal Investigator Medical Requirements

3.35 Attachment #10D: Marine Interdiction Agent Medical Requirements

3.36 Attachment #10E: Agriculture Specialist Medical Requirements

3.37 Attachment #10F: Air Interdiction Agent Medical Requirements

3.38 Attachment #10G: Detection Enforcement Officer Medical Requirements

3.39 Attachment #11: Candidate Medical Examination Rating Sheet

3.40 Attachment #12: Non-Psych Medical Consultation Request Form

3.41 Attachment #13: Non-Psych Level I Consultation Medical Qualification Template

3.42 Attachment #14: Non-Psych Consultation Medical Qualification Template

3.43 Attachment #15: Non-Psych Specialist Consultation Medical Qualification Template

3.44 Attachment #16: Psychiatric Consultation Med Qual Template

3.45 Attachment #17A: Border Patrol Agent Fitness Test Administrator Manual

3.46 Attachment #17B: Border Patrol Agent Fitness Test Audio File

3.47 Attachment #17C: Customs and Border Protection Fitness Test Administrator Manual

3.48 Attachment #17D: Customs and Border Protection Fitness Test Audio File

3.49 Attachment #17E: Aviation Enforcement Agent / Air Interdiction Agent / Marine Interdiction Agent Fitness Test Administrator Manual

3.50 Attachment #17F: Aviation Enforcement Agent Fitness Test Audio File

3.51 Attachment #17G: Air Interdiction Agent Fitness Test Audio File

3.52 Attachment #17H: Marine Interdiction Agent Fitness Test Audio Files

3.53 Attachment #17I: CBP Fitness Test Standards and Scoring Tables

3.54 Attachment #18: Auditory Testing Requirement and Hearing Aids

3.55 Attachment #19: Non-Psychiatric Consult Cover Letter

3.56 Attachment #20: Psychiatric Consult Cover Letter

3.57 Attachment #21: Vision Consult Cover Letter

3.58 Appendix A – Deliverables / Milestones for NPD and CBP Hiring Center

Section A: Employee Services - NPD

All requirements outlined in SECTION A of this SOW apply to employee services for NPD

4.0 SPECIFIC TASKS FOR EMPLOYEE SERVICES

4.1 TASK 1: GENERAL MEDICAL EXAMINATION SCHEDULING

4.1.1 NPD/COR will submit the request for an appointment to the Contractor via electronic secured transmission. The documentation may include, but not limited to the following:

4.1.1.1 Nurse Consultant Request for Medical Services (See Attachment #1);

4.1.1.2 Authorization for Request of Medical Records (See Attachment #2);

4.1.1.3 CBP’s Management supporting documentation;

4.1.1.4 Medical supporting documentation provided by the employee, if available; and

4.1.1.5 Labor Employee Relations (LER) Request for Medical Services Form (See Attachment #3).

4.1.2 The COR will provide to the Contractor, at the time of the request for an appointment, a copy of the following documents that are specific to the employee’s essential job duties. All document transmittal will be conducted by electronic secured transmission.

4.1.2.1 Medical Standards and Essential Job Task Lists specific to the employee’s position, if available;

4.1.2.2 Medical supporting documentation provided by the employee, if available; and

4.1.2.3 The employee’s position description.

4.1.3 The Contractor shall utilize the documents listed in Section 4.1.1 and 4.1.2 of this SOW solely as Tools for objectively determining fitness for duty opinions.

4.1.4 The Contractor shall receive the request, by secured electronic transmission, for FFDE and coordinate an appointment for a medical examination to be performed by a healthcare provider selected by the Contractor based on the specifics of the COR’s request documented in Nurse Consultant Request for Medical Services.

4.1.5 The following timeframes and record transmittal conducted by secured electronic transmission will apply:

4.1.5.1 Review of the FFDE: The Contractor shall review the provided FFDE request package for completeness within one (1) business day of the initial request for FFDE.

4.1.5.2 The Contractor shall contact the COR by e-mail for a FFDE package that is incomplete to process, to request additional documentation, and for clarification of the request within one (1) business day of the initial receipt of the FFDE request.

4.1.5.3 The Contractor shall schedule appointments for the General Examination and/or non-mental health portion of the FFDE within two (2) business days of the receipt of the initial FFDE request package.

4.1.5.4 The Contractor shall schedule the requested appointment date within fifteen (15) business days of the receipt of the written request via by secured electronic transmission from the COR unless otherwise specified by the COR, e.g. in cases where a date further in the future would be preferable.

4.1.5.5 The Contractor shall ensure the receipt of the “Authorization for Request of Medical Records from the COR by the seventh (7th) calendar day by sending to the COR up to three (3) reminders via e-mail message prior to the 7th calendar day deadline.

4.1.5.6 The Contractor shall request approval from the COR, via e-mail messaging, to cancel the general examination on the seventh (7th) calendar day prior to the actual scheduled day of the examination as applicable to special circumstances.

4.1.5.7 The Contractor shall forward the completed FFDE request via secured electronic transmission e-mail messaging to the selected medical examiner seven (7) calendar days prior to the scheduled appointment for FFDE.

4.1.6 The employee’s consent is required prior to forwarding any employee information to a third party (contractor examining physician). The Contractor shall not forward the FFDE request to the selected Contractor medical examiner until the completed “Authorization for Request of Medical Records” is received from the COR. The completed FFDE request packet (with consent) shall be sent at least five (5) business days prior to the scheduled examination. It shall be sent via secured electronic transmission. (See Security Section 12.0 of the SOW or required method of transferring the medical information from the Contractor to the Contractor physician)

4.1.7 Appointment Details: The Contractor shall schedule appointments for medical examination at healthcare facilities that are located within a 6sixty (60) 0-mile radius of the employee duty station.

4.1.8 The appointment for FFDE shall include the following details:

4.1.8.1 Name of the medical facility

4.1.8.2 Address to include city and zip code

4.1.8.3 Telephone number

4.1.8.4 Appointment date and time

4.1.9 At the time the appointment is scheduled by the Contractor, the Contractor shall provide to the COR, all information pertinent to the examination including a valid and current address to the facility, and any special instructions that must be communicated to the employee prior to the appointment. The Contractor shall provide the appointment details via secured electronic transmission.

4.2 TASK 2: EMPLOYEE MEDICAL EXAMINATIONS PROCESS

4.2.1 Employee General Medical Evaluation Documentation and Appointment

4.2.1.1 The “Medical Examination and History Report” is a two part form. The employee will complete the first portion entitled, “Employees and Examining Facilities” prior to being seen by the general physician. (See Attachment #5).

4.2.1.2 The medical evaluation findings shall be measured against the Medical Guidelines for CBP Weapon Carrying Positions when applicable (See Attachment #4). The medical screening shall include a thorough assessment of the employee's medical history and shall determine the following:

4.2.1.2.1 Whether the employee has a history of a particular medical condition in which recurrence cannot medically be ruled out;

4.2.1.2.2 The etiology of any disease or condition;

4.2.1.2.3 The level/degree of stability of an existing or past disease/condition;

4.2.1.2.4 The level/degree of severity of conditions identified; and

4.2.1.2.5 The existence and extent of any new findings not identified in the history.

4.2.1.3 The Contractor examining physician shall complete all questions for each body system and based findings for each system reviewed on the provided Medical Guidelines.

4.2.1.4 Within seven (7) business days after the actual examination of the employee, the Contractor examining physician shall review all medical examination records, ensuring thoroughness and completeness of requirement before forwarding paperwork by secured electronic transmission to the Contractor Lead Reviewing Physician Consultant.

4.2.1.5 The Examining Physician (General and/or Specialist) shall not make any recommendation (s) verbally or in writing to the employee concerning the ability of the employee to perform the essential job duties, return to work letter, prescriptions, or work schedule. In the event that the Contractor is approached by an employee for a flow up note and or an appointment, the Contractor shall refer the employee to the COR.

4.2.2 Employee Medical Examination (Determination) Process

4.2.2.1 The Lead Reviewing Physician Consultant shall be responsible for:

4.2.2.1.1 Receiving and reviewing the medical report from the Contractor’s general and specialist examining physicians and providing an opinion regarding the employee's current medical qualification for the specific position (including a description of current health status, stability of condition, use of medication that may affect safe and effective job performance, and the rationale for the opinion).

This opinion shall be clearly written in narrative form based upon the findings as stated on the employee self-reporting history, the actual medical examination, employer work observations, and the review of all provided medical documentation provided by the employee, if any.

4.2.2.1.2 Determining in the opinion whether the employee is "Fit" or "Not Fit" to perform the essential functions of the specific position identified. This opinion shall be supported solely by the objective criteria within the employee’s Position Description and standards supplied by CBP regarding medical and physical requirements.

4.2.2.1.3 Indicating in the determination when the employee's continued medical qualification for the position may only be determined by providing additional information and/or a comprehensive assessment by a specialist prior to rendering an opinion.

4.2.2.2 The Lead Reviewing Physician Consultant shall review all examinations, diagnostic finding, and laboratory results and provide the determination to the COR within seven (7) business days of the Contractor’s receipt of the examination documentation by secured electronic transmission.

4.2.2.3 For abnormal laboratory test results, diagnostic study findings that a prudent healthcare provider deems urgent, or life threatening, it shall be the Lead Reviewing Physician Consultant professional duty to contact the employee via telephone within 24 hours of receipt of the findings and advise the employee of the results.

4.2.2.3.1 The Lead Reviewing Physician Consultant shall notify the COR or Agency Nurse Consultant assigned to the case via telephone follow it up with an email within twenty-four (24) hours of the notification to the employee.

4.2.2.4 All opinion or determination documents provided to the COR shall be placed on official letterhead and shall be legible print or legible hand-written print.

4.2.2.5 All reports submitted by the Contractor shall be complete and decisive in opinion prior to submission.

4.2.2.6 If the Lead Reviewing Physician Consultant recommends that a more detailed assessment by a medical examiner /physician specialist (e. g. Independent Medical Examination (IME)) is required, the Lead Reviewing Physician Consultant shall notify the COR via secured e-mail of the requirement for an IME by secured electronic transmission within seven (7) business days of the receipt of the examining physician report. Once the COR requests the Contractor to schedule an IME, the Contractor shall schedule the appropriate specialist examination.

The Contractor shall provide the COR with appointment details via secured e-mail (e.g. name/medical specialty, address, phone number, date/time, etc.) at least fifteen (15) business days in advance of the scheduled appointment.

4.3 TASK 3: OTHER EMPLOYEE MEDICAL SERVICES

4.3.1 Employee Specialized Medical Tests

4.3.1.1 The COR may add “Specialized Medical Tests” (additional laboratory test and/or diagnosis studies) to the employee’s examination. The COR may occasionally request that the Contractor complete the additional specialized test outside of an employee examination. For example, based on the initial clinical findings of the employee examination, the COR may then request additional tests to support a definitive diagnosis and opinion. (See Attachment #6).

At the time of the final scheduling of the examination and/or evaluation, the Contractor shall provide to the COR, via secured electronic transmission, the cost of both the medical examiner evaluation(s) and the specific cost(s) of any specialized tests as set under the terms of the contract.

4.3.1.2 The Contractor shall order specialized test based upon the presentation of the employee. For example, for diagnoses related to substance use disorder and based on the standard of care and professional judgement, the Contractor shall order FFD Drug Testing for drugs of abuse. The Contractor shall complete the scheduling of FFD Drug Testing within two (2) business days of the receipt of the request from a COR.

4.3.1.3 FFD Drug Testing must comply with Federal authorities for the Federal Drug Testing programs using with strict chain of custody. Note: the FFD Drug Test is independent of the Agency’s Drug-Free Workplace Program.

4.3.2 Independent Medical Examination (Non-psych)

4.3.2.1 The Contractor shall schedule an appointment for an Independent Medical Examination (IME) within the same time frames as the general appointment schedulings. See Section 4.1.5 of this SOW.

4.3.2.2 Cancellations: The cancelation fees for the IME is incorporated in the price of the IME.

4.3.2.3 Reschedule: The fee to reschedule an IME is incorporated in the price of the IME.

4.3.2.4 No shows: The Contractor shall notify the COR and designee by telephone and follow up with an email that same day when an employee does not attend his/her scheduled medical appointment and the Contractor shall be paid the IME "no show" fee.

4.3.2.5 The IME Specialist shall perform the evaluation and form an opinion, “Fit or Not Fit” based on the evaluation findings, employee’s position description, and all provided information and form an opinion whether the employee can safely, efficiently perform all of the duties of the specific position without restrictions.

4.3.2.6 The IME Healthcare providers shall submit the report findings and opinion to the Contractor as set forth in Section 4.2.1.4. of this SOW.

4.3.3 Psychiatric (Mental Health) Independent Medical Examination

4.3.3.1 The Contractor shall schedule an appointment for a Psychiatric IME within the same time frames and same requirements as stated in Section 4.3.2. of this SOW.

4.3.3.2 The Psych IME provider shall perform the psychiatric evaluation and form an opinion Fit or Not Fit. See Section 4.3.2.6 of this SOW.

4.3.3.2.1 Psychiatric IMEs will be billed under a separate CLIN. The Contractor shall process a psychiatric IME in the same manner as a medical IME.

4.3.4 Agency requested IME addendum:

4.3.4.1 In the event and upon notification that additional information is available and/or the Agency has additional questions to be addressed by the examining IME physician after the determination is rendered, the Contractor shall provide the addendum to the COR within 15 business days of the receipt of the request.

4.3.5 Lead Reviewing Physician Consultant requested IME addendum:

4.3.5.1 The Lead Reviewing Physician shall review all IME report findings. In the event that a Lead Reviewing Physician Consultant determines that an addendum is necessary in order to make a fitness for duty determination, then the Lead Reviewing Physician Consultant shall provide, via secured electronic transmission, the addendum questions to the Contractor’s examining IME physician within one (1) business day of the determination. The Contractor shall not charge the government for an addendum due to the Contractor’s examining IME physician’s inability to address the question(s) posed in the initial request for opinion. The Contractor shall provide the revised IME report via secured electronic transmission within seven (7) business days of notification of deficiency.

4.3.6 The Contractor’s Mental Health and Vision Reviewing Physicians

4.3.6.1 The Contractor shall manage all Psychiatric and Vision IME reviews by Specialists of the same discipline e.g. Board Certified Psychologist, Board Certified Psychiatrist, Board Certified Addiction Specialist, Board Certified Optometrist or Ophthalmologist. The Mental Health Reviewing Consultant shall review all psych IME reports. The Vision Reviewing Physician Consultant shall review vision IME reports. All Reviewing Consultants shall review examination finding reports as set forth in Section 4.2.2 of this SOW.

4.4 TASK 4: EMPLOYEE PSYCHIATRIC CONSULTATIONS

4.4.1 The Contractor shall provide all available records to the Contractor’s Mental Health Reviewing Consultant for review within seven (7) business days of the receipt of the report from the examining psych IME physician. The records shall be provided via secured electronic transmission. The Mental Health Reviewing Consultant shall ensure that the examining psychiatric physician addressed all questions posed in the “Nurse Consultant Medical Services Request “in the report to the Agency. (See Attachment #1.)

4.4.1.1 The Mental Health Reviewing Consultant shall review all documentation provided by the IME (s) for adequacy, consistency, and credibility. Any discrepancies or other aberrant issues shall be communicated between the IME provider and the Mental Health Reviewing Consultant to establish a unified opinion. The Mental Health Reviewing Consultant shall review and study all documents and provide a written recommendation to the COR via secured electronic transmission within seven (7) business days.

In the rare event that a unified opinion is not established, the Mental Health Reviewing Consultant’s written report will be the definitive recommendation and provided to the COR as required via secured electronic transmission.

4.4.1.2 The final recommendation shall address specific questions by the COR and shall include if the employee is "FIT or NOT FIT" to perform the essential duties of the assigned position safely and efficiently. The final recommendation shall address whether:

pose a reasonable probability of substantial harm.

4.4.1.3 For employees in weapon-carrying positions and/or public safety positions, the psychiatric physician's evaluation shall give emphasis as to the employee's judgment and ability to safely perform the essential work duties of the employee's position.

4.4.1.4 In those cases in which the position is not considered safety sensitive or weapon-carrying, the Contractor may receive requests for an evaluation of employees in occupations that do not require medical standards. NPD will provide a current job description and other resource materials, which the Contractor shall consider when making the recommendation. During Fiscal Year 2018, there were thirteen (13) cases in this category, see Table # 1 – Employee Medical Examination Historical Trends.

4.5 TASK 5: MEDICAL REVIEW CONSULTATION SERVICES – LEAD REVIEWING PHYSICIAN CONSULTANT

4.5.1 At the request of the COR by electronic secure transmission, the Lead Reviewing Physician Consultant shall review medical documentation provided by the employee. The scope of Lead Reviewing Physician Consultant shall include, but not limited to the following medical review services:

4.5.1.1 Review of documentation concerning general medical issues and questions concerning medical standards and physical requirements of CBP positions.

4.5.1.2 Review of medical cases to prepare for legal proceedings to advise CBP's Office of the Chief Counsel (OCC).

4.5.1.3 Return to Work: Occasional physician reviews of medical documentation and physician issuance of a written, comprehensive opinion as to whether an employee can safely and efficiently resume the full range of duties of his/her position.

4.5.1.4 Determining qualifications for the designation "qualified Individual with a disability" under the Americans with Disabilities Act as amended: Occasional physician reviews of medical documentation and physician issuance of a written, comprehensive opinion as to whether the employee meets criteria for this designation.

4.5.1.5 Reasonable Accommodation requests: Occasional physician reviews of medical documentation and physician issuance of a written, comprehensive opinion as to whether accommodation is appropriate and justified under current statutes.

4.5.1.6 Family and Medical Leave Act (FMLA) requests: Occasional physician reviews and physician issuance of a written, comprehensive opinion as to whether the provided information meets the medical criteria for leave under FMLA.

4.5.1.7 Employees with time and attendance issues: Occasional physician reviews and physician issuance of an opinion as to what course of action should be taken in cases of employee time/attendance problems.

4.5.1.8 Consultations with CBP’s Office of the Chief Counsel (OCC) on any medically related issue that affects Tort claims from private citizens

4.5.1.9 Consultations by telephone and email with attorneys from CBP’s OCC. The COR will authorize a block of time for services and the Contractor shall document services rendered in tenths of an hour.

4.5.1.10 The COR will provide to the Contractor by electronic secure transmission all available supporting documentation (e.g., medical records, administrative reports, etc.) to support a medical opinion of the employee’s status in cases below in Section (4.5.2).