Attch 1 - PWS CPE Educator 26 Jan 22.pdf

PERFORMANCE WORK STATEMENT (PWS)

FOR

Clinical Pastoral Education (CPE) Educator Services 26 January 2022

Attachment 1

1. INTRODUCTION. The 59th Medical Group (MDG) delivers primary and operational health care services at seven geographically separated facilities to a diverse population of 150,000 people from the 130 plus units at Joint Base San Antonio (JBSA) - Lackland, Texas. Operating at seven facilities across JBSA, the group provides care to active-duty military members, dependents and civilians, as well as basic military trainees, technical training students, and students from around the world studying at the Defense Language Institute English Language Center and Inter-American Air Forces Academy.

The 59th MDG is home to the largest optometry and public health flight in the Department of Defense (DOD); the DOD's first military training consultation service; the first athletic trainer embedded clinic -known as the Versatile Injury Prevention and Embedded Reconditioning clinic in the Air Force; and one of only three en-route patient staging systems in the continental U.S. Recording approximately 185,000 patient encounters each year, the group provides a variety of services including primary health care, optometry, preventive health, public health, bioenvironmental engineering, acute rehabilitation, and aeromedical services.

Hours of Operation. Monday - Friday 7 am to 4:30 pm, except holidays.

1.1. OBJECTIVE. To procure Clinical Pastoral Education Educator support services.

1.2. SCOPE. The contractor monitors, manages and reports on Clinical Pastoral Education Educator support services for higher management and develops plans to improve timeliness and accuracy rates, service availability, and overall MTF performance and compliance.

1.3. DESCRIPTION OF SERVICES. The contractor shall supply all necessary equipment and labor required to perform non-personal professional services at a Military Treatment Facility(s) (MTF).

(Reference PWS, para 1.8.2.)”. Additionally, the contractor monitors, manages and reports on services for higher management and develops plans to improve timeliness and accuracy rates, service availability, and overall MTF performance and compliance.

1.4. REQUIREMENT WITH BACKGROUND. This is a follow-on requirement currently being performed.

The Contractor shall provide one (1) Clinical Pastoral Education (CPE) Educator to provide non-personal services at San Antonio Texas Department of Defense Military Treatment Facilities. The contracted CPE Educator will enable the chaplain residents to provide services to include pastoral care to patients, families, and staff while developing pastoral competency and battlefield readiness in chaplain residents through supervised reflection. The CPE shall work within the Government provided facility and use Government provided equipment and perform services and support compatible with the medical facility’s operating capacity and equipment.

1.5. SPECIFIC TASKS. All services rendered shall be in accordance with "The Standards of The Association for Clinical Pastoral Education" (ACPE), in its entirety. The CPE shall perform the following tasks:

1.5.1. Coordinate, attend, and monitor residents designated weekday morning devotionals.

1.5.2. Conduct and coordinate all Clinical Pastoral training programs through the Wing Chaplain’s Office.

The Wing Chaplain will inform the Contracting Officer Representative (COR), the CPE Educator provided

Clinical Pastoral Education (CPE) Educator Services the training program to the Wing Chaplain 15 business days prior to the start of the CPE Program Level I (Units 1 & 2) or Level II (Units 3 & 4) or at the beginning of each respective unit.

1.5.3. Provide to the residents CPE training accredited by the ACPE.

1.5.4. Facilitate structural group and individual education, accompanied by the supervised clinical practice in ministry. The Standards of the ACPE, Section 308.1. Conducts make-up refresher training for residents who fall outside this limit to meet the ACPE standards. See ACPE website link below http://www.manula.com/manuals/acpe/acpe-manuals/.

1.5.5. Conduct weekly individual oversight as described in the Standards of the ACPE Manual Section

301.2 and 303.4.

1.5.6. Conduct weekly versatile presentations (in class) in which students present a pastoral encounter to other students and the CPE for discussion and feedback.

1.5.7. Conduct weekly group meetings to utilize individual and group oversight for personal and professional growth and for developing the capacity to evaluate the student's ministry.

1.5.8. Administer weekly didactic courses that address specific topics related to personality theory and pastoral care and "open agenda" group sessions where students process issues that have risen during the training.

1.5.9. Provide consultations as requested by students, in accordance with the ACPE standards.

1.5.10. Provide CPE Level I and II curriculum for the residents as defined in the Standards of the ACPE Manual, Section 308.6 – 308.6.4. This consists of a total of four units (two units per Level) in the academic year with a minimum of six residents to a maximum of ten residents.

1.5.11 Provide additional hours (16 per month as reflected in the contract) to meet the workload surge during the months of April – June. The workload will increase due to end of year project grading, graduation preparations, while sponsoring incoming CPE residents.

1.6. QUALIFICATIONS. The CPE Educator shall meet the following qualification requirements:

1.6.1. EDUCATION. The CPE Educator shall:

1.6.1.1. At minimum, have master’s level of education from an Accredited Theological University (Seminary).

1.6.2. CERTIFICATIONS. The CPE Educator shall:

1.6.2.1. Be a certified CPE Educator through the ACPE Inc.

1.6.2.2. Have and maintain a current Basic Life Support (BLS) certification.

1.6.2.3. Complete the Contract Specific Requirements Prior to Performance Wilford Hall Ambulatory Surgical Center/59 MDW (Appendix B).

Clinical Pastoral Education (CPE) Educator Services

1.7. EXPERIENCE. The CPE shall meet the following requirements:

1.7.1. The CPE shall have at least 1 year experience as a Certified Educator for the ACPE and possess an active membership with the ACPE national accrediting agency.

1.7.2. The CPE shall be knowledgeable with spelling, grammar, syntax, format, forms, procedures, and basic medical terminology sufficient to process and type correspondence and statistical reports.

1.8. GENERAL INFORMATION.

1.8.1. PERIOD OF PERFORMANCE/REQUIRED START DATE. The period of performance for this contract is for 1-year base, plus four (4) 1-year option periods thereafter.

The contractor has 30 calendar days from contract award to initially fill the position and 30 calendar days from the departing worker’s assignment end date for a replacement worker.

1.8.2. PLACE OF PERFORMANCE. The work to be performed under this contract will be at JBSA – Fort Sam Houston, Brooks Army Medical Center (BAMC). Contractor shall receive (2) two weeks’ notice prior to the reassignment, if necessary, to another MTC Clinic within the JBSA area.

1.8.3. ROUTINE OR SITUATIONAL TELEWORK. The government reserves the right to authorize routine or situational telework on a case-by-case basis. Examples include but are not limited to the following:

a) Employee has a short-term need for uninterrupted time to complete work on a complex project or report.

b) Employee is recovering from illness or an injury and is temporarily unable to report to the traditional office physically.

c) Employee receives word of inclement weather and notifies her/his Educator that s/he would like to opt for unscheduled telework that day.

d) Employee is directed to work from an alternate location as a result of a local, state or national event/crisis.

1.8.3.1. The contractor shall be responsible for safeguarding all issued equipment, information and property provided by the government. Prior to commencing telework, the employee must complete government provided fundamental telework employee training and have a suitable workspace, adequate utilities for installing equipment and a general work environment that is free from interruptions and provides reasonable security and protection of government property and governmental and personal information.

1.8.4. OPERATIONAL HOURS. Contract performance requirements are governed by the contract. The contractor shall provide qualified and trained personnel to cover the required hours of performance.

Normal hours of operation are 7:30 am to 4:30 pm, Monday through Friday, with a 1-hour non-paid lunch each day, not to exceed 40 hours per week. Deviations to these days and times will be only as authorized by the contracting officer representative (COR) and Contracting Officer (CO).

Clinical Pastoral Education (CPE) Educator Services

1.8.4.1. UNPLANNED ABSENCES. Unplanned absences shall be reported to the COR by the contractor no later than 2 hours prior to the start of the shift by the contractor.

1.8.4.2. PLANNED ABSENCES. The contractor shall ensure that scheduled absences do not interrupt service performance. Scheduled absences shall be scheduled at least 30 calendar days in advance and mutually agreed upon by the Contracting Office Representative (COR).

1.8.4.3. OVERTIME HOURS. Overtime is NOT authorized on this requirement.

1.8.4.4. ON CALL HOURS. On-call hours is NOT authorized on this requirement.

1.8.4.5. MISSION ESSENTIAL. Services performed under this contract have been determined not to be essential for performance during crisis declared by the National Command Authority.

1.8.4.6. FEDERAL HOLIDAYS: The MTF will observe the following federal holidays.

Holiday* Projected Date New Year’s Day January 1 Martin Luther King Jr’s Birthday 3rd Monday in January President’s Day 3rd Monday in February Memorial Day Last Monday in May Juneteenth National Independence Day June 19 Independence Day July 4 Labor Day 1st Monday in September Columbus Day 2nd Monday in October Veterans’ Day November 11 Thanksgiving Day 4th Thursday in November Christmas Day December 25

* Should the official holiday fall on Saturday then the observed holiday is the previous Friday.

Should the official holiday fall on Sunday then the observed holiday is the following Monday.

1.8.4.7. PLANNED CLOSURES/OTHER NON-DUTY DAYS. Non-performance day(s) that the Government designates as a planned facility closure(s).

1.8.4.8. PLANNED CLOSURES. The MTF will be closed on Federal Holidays as indicated above.

1.8.4.9. OTHER NON-DUTY DAYS PLANNED CLOSURES. None at this time, but the COR will notify the company, via email, 30 days in advance of the closure.

1.8.4.10. UNPLANNED CLOSURES. None at this time, but the COR will notify the company of the unplanned closure as necessary.

1.8.4.11. TRAVEL. N/A

1.8.4.12. The Contractor is advised that special activities including but not limited to commander’s calls, sports days, employee quality of life meetings, late reporting, staggered reporting times, early release, Clinical Pastoral Education (CPE) Educator Services physical fitness time, office picnics, and holiday parties are for Government personnel only and do not apply to the contractor employees unless expressly stated otherwise in the contract. If any special activity occurs, the contractor will continue to perform contract requirements unless expressly excused by the CO. In the event that the CO excuses performance, the contractor understands that its employees’ participation in such event will not be at government expense. The contractor is further advised that any special time off granted by the President or other competent authority is for Government personnel only and does not apply to the contractor employees. The CPE shall take their direction concerning their duty status and hours of performance from their contractor management chain and not from Government personnel.

1.8.5. MTF ORIENTATION. All personnel assigned to the 59 MDW will complete base and facility orientation within 30 duty days of assignment. The MTF Orientation will familiarize the CPE with the policies and procedures of the MTF and will be scheduled by the COR, or the designated government representative. Orientation attendance shall be required of the HCW during government paid duty time.

The Government will restrict the performance on this contract by any individual who is identified as a potential threat to the health, safety, security, general well-being, or operational mission of the MTF and its population. Orientation attendance shall be required of the Contractor during Government paid working hours.

1.8.5.1. The Contractor shall not advise, recommend, or suggest to persons eligible to receive medical care at Government expense that such person should receive care at an outside agency or provider at any place other than as designated under this contract.

1.8.5.2. The Contractor shall not use Government facilities or other Government property for personal use or other business not related to this contract.

1.8.5.3. The Contractor shall not respond to any media inquiries nor provide interviews, comments, or any other responses to the media regarding any subject related to this contract. All inquiries or complaints from the media or other sources shall be immediately relayed to the COR and CO.

1.8.5.4. The contractor shall ensure that its employees conduct themselves in a professional manner while on the installation and refrain from disruptive, offensive, or otherwise improper behavior that undermines order and discipline. The CO may direct the contractor to remove from performance of this contract on this installation any contractor employee engaging in such misconduct.

1.8.5.5. The Contractor shall abide by federal and local MTF regulations concerning the confidentiality of patient records, as embodied in federal statutes including the Privacy Act of 1974 and the Health Insurance Portability & Accountability Act of 1996.

1.8.5.6. The Contractor shall not release any of the above information without prior written consent of the CO.

1.8.6. SMOKING IN AF FACILITIES. Contractors are advised that the AF has placed restrictions on the smoking of tobacco products in AF facilities. AFI 40-102, Tobacco Free Living, outlines the procedures used by the commander to control smoking in our facilities. Contractor employees and visitors are subject to the same restrictions as government personnel. Smoking is permitted only in designated smoking areas.

Clinical Pastoral Education (CPE) Educator Services

1.8.7. JOINT BASE SAN ANTONIO (JBSA) TRAFFIC CODE. All applicable Traffic Codes will be enforced and apply to all personnel operating vehicles on a JBSA installation. The governing instruction for all Traffic Codes is AFI 31-218(1) and Air Force Manual (AFMAN) 31-116.

1.8.8. CELL PHONE USAGE. Contractors are advised that DoD Instruction (DoDI) 6055.04 prohibits cellular telephone usage when approaching, entering or exiting any installation gate. Cell phone usage by drivers on installations is prohibited in moving vehicles unless used with a hands-free device. The installation Security Forces Squadron (SFS) is strictly enforcing this regulation. Those found in violation of this regulation are subject to be ticketed.

1.8.9. BASE FIRE PREVENTION PROGRAM. The contractor will be required to comply with the applicable Fire Prevention Program, for JBSA Lackland the applicable directive is AFI 91-203, Air Force Consolidated Occupational Safety Instruction. Contact the Contracting Office for a copy of AFI 91- 203.1.3.6.

1.9. IN PROCESSING. All personnel performing service under this contract shall be required to in process through the 59th Medical Wing Logistic Contract Personnel Office upon reporting for duty. During the in-processing, an MTF checklist will be provided to ensure a proper in-process is completed within 30 duty days to the necessary areas (Division of Education and Training, Systems, Keys/Badges, Security etc.). All mandatory training will be completed. Upon termination or expiration of the contract, contract personnel shall be required to out-process through the same office and return all government issued items (i.e., keys, badges, CAC, etc.).

1.9.1. FINGERPRINTS. CPE shall be subject to security processes for fingerprints according to agency regulations and instructions (Army, AF, Navy, and DHA and potentially the VA) as outlined in the contract. HCWs shall be subject to the following security processes for fingerprints:

1.9.1.1. The security manager will provide the information and forms for the CPE to have their fingerprints taken. An HCW shall not be issued a Common Access Card (CAC) without first satisfying the background vetting requirements, per DoDI 1000.13, Volume 1. Since the background vetting process can take up to 18 months, the HCW maybe issued a CAC after a Federal Bureau of Investigation (FBI) fingerprint check returns favorable results provided that the NACI investigation has been initiated.

An HCW approved by the Government will coordinate to have an FBI fingerprint check appointment completed after the Period of Performance for the position has begun, and NLT twenty (20) days prior to the HCW’s required start date. In the event that Government approval of the HCW does not occur in time to meet the above deadline, the FBI fingerprint check should be completed without undue delay, as no HCW can begin work without first receiving a favorable outcome on the FBI fingerprint check. If an unfavorable fingerprint check is returned, the HCW will not be issued a CAC. Since the CAC is required by the HCW for installation access and essential to the performance of duties, an HCW’s ineligibility to receive a CAC will result in the Contractor being required to provide a replacement candidate.

1.9.2. GOVERNMENT TRAINING. The following training will be completed during in-processing by MTF personnel:

__ HIPAA & Privacy Act __ Anti-Terrorism __ OPSEC __ Combating Trafficking in Person

Clinical Pastoral Education (CPE) Educator Services

__ SHARP __ DOD Cyber Awareness Training __ CHCS/AHLTA/GENESIS __ Sexual Harassment __ Active Shooter __ Suicide Prevention __ OTHER: _______________________________________________________________________

Additional Training Requirements. The Government will schedule and furnish initial and annual training which may include but shall not be limited to various applicable software, data base systems, quality assurance policies, radiation safety, local in-service, safety briefings, compliance, patient safety, performance improvement, risk management, infection control, fire protection, security, Operations Security (OPSEC) and patient sensitivity training. The classes may be scheduled as required throughout the life of the contract. The Government may provide voluntary specialty training to the HCW.

1.9.3. ANNUAL IMMUNIZATIONS. Contracted Personnel shall be immunized with seasonal influenza vaccine and any other vaccine recommended by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control (CDC) or service/MTF specific guidance as outlined in DoDD 6205.02, DOD Immunization Program for health care workers or as specified by the service/MTF as follows:

1.9.3.1. Prior to contract performance, the Contractor shall provide proof of immunization or immunity from or screening for the following diseases according to Air Force guidelines equivalent to that provided to active work Armed Forces: Hepatitis B, MMR (Measles, Mumps, and Rubella), Varicella, Tdap (Tetanus, Diphtheria, and Pertussis), Tuberculosis (TB), Human Immunodeficiency Virus (HIV) (Contractor who has direct patient care) and influenza for all personnel.

1.9.3.2. Contractor shall control and prevent disease in accordance with AFI 48-I05 Surveillance Prevention and Control of Diseases and Conditions of Public Health or Military Significance, and the American Public Health Association Publication, Control of Communicable Diseases Manual, and the Centers for Disease Control and Prevention (CDC) publication, Morbidity and Mortality Weekly Report, Air Force Policy (as applicable) and its supplements. For the TB screening, the Contractor shall provide proof of negative TB 2-step skin testing IA W CDC. If an individual has a past positive TB skin test, the Contractor shall provide proof of a negative chest X-ray within twelve (12) months prior to personnel performing.

1.9.3.3. The Government reserves the right to require more frequent TB testing of personnel based on the facility annual TB risk assessment. Additional vaccines as they are made mandatory for health care workers may also be required in unusual circumstances. In summary, contractors should have and maintain all requirements. See Appendix B.

1.9.3.4. The Contractor shall not obtain medical tests or procedures at the MTF unless identified in Section three (3) Government-Furnished Property and Services. The Contractor shall be responsible for the cost of any emergency medical services received. Influenza Immunization. Contractor shall receive the current influenza immunization, at contractor's expense, unless contraindicated by allergy; as an example, to eggs as evidenced by hives, difficulty breathing, itching, and other symptoms of anaphylactic hypersensitivity, this exemption requires a Physicians diagnosis. Proof of vaccination will be required.

1.9.4. TUBERCULOSIS SCREENING. The additional immunization/screening requirements for the risk of exposure to tuberculosis (TB) are as follows:

Clinical Pastoral Education (CPE) Educator Services

1.9.4.1. IAW Centers for Disease Control and Prevention Testing Guidelines (2-step testing protocol or an approved blood assay screening). Must be performed within the last 12 months for new employees to the Military Healthcare System. If the member has a history of previous latent TB or active TB, a chest radiograph may be required before being cleared to work based upon physician’s discretion. Periodic requirement based on annual TB Risk Assessment.

1.9.4.2. HAZARDOUS MATERIALS. This PWS does not call for any hazardous material to be provided by the Contractor.

1.10. QUALITY ASSURANCE. The government will periodically evaluate the Contractor's performance by appointing a COR to monitor performance to ensure services are received and are acceptable.

The COR will correspond with an assigned Functional Requirements Evaluator Designee (FRED) to assist in monitoring schedule compliance (days/hours worked) and inspecting work performance. The COR will evaluate the Contractors performance in accordance with the government's Quality Assurance Surveillance Plan (QASP). This Government-only plan is primarily focused on what the Government will do to ensure that the Contractor has performed IAW contract performance standards. The contract QASP provides a systematic method to evaluate performance to include how the performance standards will be applied, the frequency of surveillance, and the acceptable quality levels for each of the metrics identified in Section 5, Performance Management of the QASP.

1.10.1. The QASP is created with the premise that the Contractor is responsible for management and quality control actions to meet the terms of the contract while the Government is responsible for quality assurance actions.

1.11. QUALITY CONTROL. The Contractor shall be responsible for quality control for all work accomplished during the performance of the contract. The Contractor shall maintain a Quality Control Plan (QCP) which ensures the requirements in this PWS are met. As a minimum, the Contractor shall develop quality control procedures that address the areas identified in Section 2, Service Summary.

1.11.1. QUALITY CONTROL PLAN (QCP). A written QCP shall be submitted as part of the contractor’s proposal package. Any changes after initial QCP submission need to be accepted by the CO (in writing) prior to implementation.

1.11.2. CONTRACTOR REPRESENTATIVE. The contractor shall identify the name and telephone number of the contractor’s point of contact to the Contracting Officer (CO) in writing prior to beginning performance. The contractor shall identify in the designation letter any limitations on its representative's authority to act on behalf of the contractor. The contractor shall provide an updated designation letter whenever any changes occur.

1.11.3. The Contractor Representative shall respond to a request to meet with the CO no later than 24 hours of notification under routine circumstances.

1.11.4. Contractor employees performing under this contract shall abide by the provisions of MDWI 41- 101 Medical Expense and Performance Reporting System (MEPRS), (Paragraph 2.1.3.). The contractor shall provide documentation or records of units worked through Procurement Integrated Enterprise Environment (PIEE).

Clinical Pastoral Education (CPE) Educator Services

1.11.5 COMPLIANCE. The Contractor shall comply with all applicable Air Force Instructions (AFI), Department of Defense (DoD) Regulations, and Medical Wing Instructions (MDWI) as outlined in Appendix A.

1.11.6. REMOVAL OF CONTRACTOR. The Government, through the CO, reserves the right to require immediate removal from contract performance on the installation or any Government facility, any individual whose actions raise reasonable suspicion that patient care or services may be compromised in any way, or that pose a threat of harm to other contractor/Government personnel or self. Removal under other circumstances will be subsequent to, and at the direction of the CO only.

1.11.6.1. If a situation meriting removal occurs as outlined in the previous paragraph, the COR will contact the CO and the contractor’s representative no later than 24 hours. A meeting may be required with the CO, COR and contractor representative to discuss further action.

1.11.6.2. The CO will notify the Contractor if and when permanent removal is required. In the event of a disagreement between the Government and the Contractor, the decision of the CO will be final. During the period of time between the removal and the final decision of the CO, the Contractor agrees to provide backup/replacement Contractor in accordance with the terms of this contract.

1.11.6.3. The Contractor may be required to submit to drug/alcohol testing. The Government may require temporary or permanent removal from contract performance any individual who refuses or fails testing.

1.11.7. REPORTS. The Contractor shall submit initial, quarterly, and annual reports to the COR and/or credentials office (as applicable) for use in monitoring performance. Such reports may include:

1.11.7.1. REPORTS FREQUENCY.

Initial Effective date of award Quarterly 1st Qtr. (October 1) 2nd Qtr. (January 1) 3rd Qtr. (April 1), and 4th Qtr. (July 1) Annual September 5

Report Type Timeline

Health and Immunization requirements Personnel Changes Initially Basic Life Support (BLS), as accepted by American Heart Quarterly Association (AHA) (Heart Savers, Admin) (Providers course) or American Red Cross

Quarterly

*Continuing Education Units date Initially and upon expiration *Competency and currency of licensure/Registration date Initially and upon expiration

* Security requirements Initially Invoices submitted in WAWF Monthly

*Note: In accordance with Military Training Bulletin NO. 07-003 (7 Feb 07), this training will not be provided by the Government.

Clinical Pastoral Education (CPE) Educator Services

1.12. SECURITY.

1.12.1. GENERAL SECURITY REQUIREMENTS. The Contractor shall follow all guidelines found in Appendix C, Department of Defense (DoD) Business Associate Agreement (BAA).

1.12.2. INTERNAL OPERATING INSTRUCTIONS (OI). The Contractor shall abide by the MTF’s current OIs for internal circulation control, the protection of resources, and the regulated entry into Air Force controlled areas during normal, simulated, and actual emergency operations.

1.12.3. REPORTING REQUIREMENTS. The contractor shall comply with AFI 71-101, Volume 1, Criminal Investigations Program (Chapter 2, paragraph 2.7) and Volume-2, Protective Service Matters, (Paragraph 1.2). Contractor shall report to Security Forces any information or circumstances which may pose a threat to DoD or Contractor, resources, or DoD information.

1.12.4. GOVERNMENT COMPUTER ACCESS REQUIREMENTS. If this contract requires the CPE to have access to government computers, the CPE requiring access to government computers shall successfully complete, a National Agency Check with Inquiries (NACI) request, before obtaining access to the computer. These investigations shall be submitted by the government at no additional cost to the contractor. All contractor employees affected by this requirement must have completed an acceptable submission that complies with all directions for completion of the investigation request through the government security office no later than 30 calendar days of Contract Award or Notice of Award. To begin this process, all affected contractor employees must complete no later than 15 calendar days after Contract Award or Notice of Award Standard Form 85P worksheet that can be downloaded from http://www.opm.gov/forms/pdf_fill/SF85P.pdf.

The contractor shall notify the COR or Government Inspector when the worksheet is complete. The affected employee will then be scheduled by the government for two or more appointments to complete the security package. If at any point after submission of the security worksheet, disqualifying information is discovered or developed, the government reserves the right to deny computer access. In this instance the CO will notify the contractor of the denial. That individual will no longer be allowed to perform duties requiring computer access. After submission of the complete security package through the security office and completion of an adjudicated NACI, contractor employees may obtain their “Common Access Card” (CAC) for the duration of their contract, unless disqualifying information is subsequently discovered. In this instance access will be revoked. The NACI adjudication process normally takes 2 to 5 months after submission of the package. The contractor shall comply with DODD 5200.08R Physical Security Program, (Chapter 3, Section C.3) requirements.

1.12.5. INSTALLATION ACCESS. Criminal History Check will be conducted on all prime/subcontractor employees requiring base access. The contractor shall provide the CO and the Information Protection Office a current list of employees needing access no later than 3 working days after receiving award or Notice of Award. The list shall include employee’s name, date of birth, social security number, state driver’s license/state ID number and state of issue. Notifications of contractor employee additions and deletions shall be provided with the same information listed above no later than 3 working days. The Government will notify the Contractor that installation access passes are available for those employees clearing the criminal history check no later than 10 business days after receipt of the list.

The duration of any pass issued will not exceed 1 year or the duration of the contract, whichever is shorter. This process will be repeated at the exercise of any option period.

Clinical Pastoral Education (CPE) Educator Services

1.12.6. GOVERNMENT DATA. The Contractor shall manage all data created for Government use or legally controlled by the Government, in support of the functional activity or required by AF publication, IAW with the records management procedures in Air Force Instruction (AFI) 33-322, Records Management Program, Air Force Manual (AFMAN) 33-363, Management of Records, and the Air Force Records Disposition Schedule (AFRDS).

1.12.7. FREEDOM OF INFORMATION. The contractor shall not respond to any Freedom of Information Act request or release any information in response to a Freedom of Information request. Any request for information received by the contractor under the Freedom of Information Act will be referred to the CO.

1.12.7.1. USES AND SAFEGUARDING OF INFORMATION. Information from the secure web site is considered to be proprietary in nature when the contract number and Contractor identity are associated with the direct labor hours and direct labor dollars. At no time will any data be released to the public with the Contractor name and contract number associated with the data.

1.12.8. PHYSICAL SECURITY. The contractor shall comply with Force Protection Condition (FPCON) procedures, Random Antiterrorism Measures (RAMS) and local search/identification requirements.

The contractor shall safeguard all government property, including controlled forms, provided for contractor use. At the close of each work period, government training equipment, ground aerospace vehicles, facilities, support equipment, and other valuable materials shall be secured.

1.12.9. KEY CONTROL. The contractor shall safeguard all keys issued by the government and ensure they are used only by authorized CPE. The contractor shall not duplicate issued keys and shall report lost keys to the CO immediately. The contractor will be charged for lost keys, re-keying, and lock replacement as applicable.

1.12.10. ADDITIONAL SECURITY REQUIREMENTS. NACIs will be IAW Homeland Security Presidential Directive 12 (HSPD-12).

1.12.11. UNESCORTED ENTRY TO RESTRICTED/CONTROLLED AREAS. If this contract requires unescorted entry to controlled or restricted areas, the contractor shall comply with DOD 5200.2-R, Appendix 1, and AFI 31-501, Personnel Security Program Management (Paragraph 3.24).

If the performance of this contract requires unescorted entry to a restricted/controlled area, personnel must have a favorably adjudicated NACI investigation. All contractor employees affected by this requirement must have completed an acceptable submission that complies with all directions for completion, of the investigation request through the government security office no later than 30 calendar days of Contract Award or Notice of Award. To begin this process, all affected contractor employees must complete no later than 15 calendar days after Contract Award or Notice of Award Standard Form 85P worksheet that can be downloaded from http://www.opm.gov/forms/pdf_fill/SF85P.pdf.

The contractor shall notify the COR or Government Inspector when the worksheet is complete. The affected employee will then be scheduled by the government for two or more appointments to complete the security package. If at any point after submission of the security worksheet, disqualifying information is discovered or developed, the government reserves the right to deny entry to restricted/controlled areas. In this instance the CO will notify the contractor of the denial. That individual will not be allowed to perform duties requiring access to restricted/controlled areas. Upon receipt of a favorable investigation results and authorization by the appropriate commander, the contractor member will receive appropriate

Clinical Pastoral Education (CPE) Educator Services entry credentials for access to restricted/controlled areas, unless disqualifying information is subsequently discovered. In this instance access will be revoked. The NACI adjudication process normally takes 2 to 5 months after submission of the package.

1.12.12. WEAPONS, FIREARMS, AND AMMUNITION. Contractor employees are prohibited from possessing weapons, firearms, or ammunition, on themselves or within their contractor-owned vehicle or privately-owned vehicle while on JBSA.

2. Performance Assessment. The following Service Summary outlines the defined performance objectives for this acquisition with the corresponding goal performance thresholds.

2.1. The method(s) of performance assessment for each acquisition performance objective is as follows:

PO

# Performance Objective (PO) PWS paragraph Performance

Threshold (Per FTE)

1. Facilitates structural group and individual education, accompanied by the supervised clinical practice in ministry. The Standards of the ACPE, Section 308.1. Conducts make-up refresher training for residents who fall outside this limit to meet the ACPE standards. See ACPE website link below http://www.manula.com/manuals/acpe/acpe-manuals/

1.5.4 No more than

two (2) complaints /discrepancies per month

2. Shall provide CPE Level I and II curriculum for the residents as defined in the Standards of the ACPE Manual, Section 308.6 –

308.6.4. This consists of a total of four units in the academic year with a minimum of six residents to a maximum of ten residents.

1.5.10 No more than

two (2) complaints per month

3. The Contractor shall submit initial, quarterly, and annual reports to the COR and/or credentials office (as applicable) for use in monitoring performance.

1.8.7 100% compliance

2.2. Non-Service Summary Items. The Contractor is required to provide all services identified in the PWS. COR is required to inspect non-service summary items on a periodic basis.

3. Government-Furnished Property and Services.

3.1. The Government will provide use of all available MTF facility’s and support services, materials, publications and forms, use of equipment, and specialty clothing required for contract performance (except as designated in the contract). The Contractor shall keep Government furnished supplies, equipment, and work areas in a safe, orderly and clean condition.

3.2. The Government will schedule and furnish initial and annual training which may include but shall not be limited to various applicable software, data base systems, quality assurance policies, radiation safety, local in-service, safety briefings, compliance, patient safety, performance improvement, risk management, infection control, fire protection, security, Operations Security (OPSEC) and patient sensitivity training. The classes may be scheduled as required throughout the life of the contract.

Clinical Pastoral Education (CPE) Educator Services

3.3. SPECIALTY TRAINING. The Government may provide voluntary specialty training to the Contractor.

3.4. Any space used by Contractor in performance of this contract may be used for other purposes during their absence. Items of clothing, personal effects, or equipment may not be able to be secured at the MTF. The Government will not incur any liability for theft, damage to, or loss of such personal items.

3.5. The Government will provide local telephone service, Class-A telephone lines and Defense Switching Network lines limited to matters related to the performance of this contract. Personal long distance calls are not authorized.

3.6. The MTF will provide emergency healthcare for injuries occurring while working. The Contractor shall reimburse the Government for such services. This includes blood borne exposure protocols after start of work. The Government will provide initial testing at no cost, but the Contractor shall provide follow-up testing or reimburse the Government for such services performed within the MTF. The Contractor will provide the MTF with documentation for follow-ups performed outside the MTF as required by MTF policy. The Government will provide post-exposure tuberculosis testing at no charge to the Contractor when required (ex. following exposure to active TB case with in MTF) to avoid testing delays.

3.7. The Government will provide MTF ID badges which will be worn/displayed at all times when in the MTF while at work. Upon favorable clearance, Contractor will be issued a CAC in order to access patients’ records. Items will remain Government property and will be returned to MTF upon completion of use.

4. List of Appendices

Appendix A: Referenced Department of Defense, Air Force, and 59th Medical Wing Publications Appendix B: Contract Specific Requirements Prior to Performance Appendix C: HIPAA Business Associate Agreement (BAA) Appendix D: Insurance Requirements

Clinical Pastoral Education (CPE) Educator Services

APPENDIX A

REFERENCED DEPARTMENT OF DEFENSE, AIR FORCE, AND 59TH MEDICAL WING

PUBLICATIONS

In all instances, current version applies. Publications can be found electronically at http://www.e-publishing.af.mil and http://www.e-publishing.af.mil/otherpublishingsites.asp. Medical Wing Instructions and Operating Instructions will be furnished upon request.

AFI 31-218, Motor Vehicle Traffic Supervision (in its entirety) AFI 31-501, Personnel Security Program Management AFI 31-401, Information Security Program Management AFI 33-322, Records Management Program AFMAN 33-363, Management of Records AFI 40-102, Tobacco Free Living (in its entirety) AFI 48-105, Surveillance, Prevention and Control of Diseases and Conditions of Public Health or Military Significance. (Paragraph 1.8.9) AFI 71-101, Volume I, Criminal Investigations. (IAW 502 CONS & 502 SFS MOA) AFI 71-101, Volume 2, Protective Service Matters. (IAW 502 CONS & 502 SFS MOA) DoD Directive 5200.28, Security Requirements for Automatic Data Processing (ADP) Systems (Paragraph E6.4.1.2) AFI 91-203, Air Force Consolidated Occupational Safety Instruction DoD Directive 5200.2-R, DoD Personnel Security Program DoDI 1402.5 Criminal History Background Checks on Individuals in Child Care Services MDWI 36-2601, Human Resource Development (in its entirety) MDWI 41-101, Medical Expense and Performance Reporting Systems (MEPRS) (Paragraph 2.1.3.)

AFI 44-119, Medical Quality Operations AFMAN 31-116, Air Force Motor Vehicle Traffic Supervision. (in its entirety).

DODI 6055.04, DoD Traffic Safety Program. (Paragraph 1.3.4.9).

DOD Directive 5200.08, Security of DoD Installations and Resources and the DoD Physical Security Review Board (PSRB). (Paragraph 1.3.5.5).

HSPD 12, Homeland Security Presidential Directive 12. (Paragraph 1.3.5.11).

Clinical Pastoral Education (CPE) Educator Services

APPENDIX B

CONTRACT SPECIFIC REQUIREMENTS PRIOR TO PERFORMANCE

WILFORD HALL AMBULATORY SURGICAL CENTER/59 MDW

FAXED TO: __________________________FAX:__________________DATE:_____________

Contract Position: __________________________________________ Name: ____________________________________________________

All personnel performing service under this contract shall be required to in-process through the 59th Medical Wing Contract Services Section upon reporting for duty.

The following contract specific required items are to be provided to the Contract Services Section by the contractor prior to performance:

_______Pre-employment medical exam (no earlier than 45 days before start date) _______Immunization Record _______Varicella (Serologic evidence of immunity or documentation of 2-shot series) _______Tdap (Documentation of tetanus/diphtheria vaccination within two (2) years or current Tdap vaccine.)

_______TB- 2 Step Testing or Neg. Chest X-Ray for Past Positive Tests (see screening criteria below)

Screening Criteria Required Testing No Previous Documented TST result Two-step baseline TST Previous documented Neg TST >12 months before new employment Two-step baseline TST Previous documented Neg TST < 12 months before new employment Single TST > 2 previous documented Neg TST but most recent TST >12 months Single TST

Previous documented Positive TST Chest X-Ray (negative) _______MMR (Serologic evidence of immunity or documentation of 2-shot series) _______Hepatitis B (Serologic evidence of immunity or documentation of 3-shot series) _______HIV (direct contact with patients or body fluids) (Frequency shall be based on exposure risk per hospital employee program) _______Influenza (current series) _______Drug Testing _______Security Background Check ____SF 86 (If applicable) ____ State ____NAC ____LFC

Affidavit signed and dated by the Contractor. Copy of signed AF FM 2583 or Sentinel Key verification printout from a Security Manager.

_______Copy of non-disclosure statement _______Copy of license (if applicable) _______Copy of certifications (if applicable) _______Credentials package (if applicable)

Clinical Pastoral Education (CPE) Educator Services

APPENDIX C

Department of Defense (DoD) Business Associate Agreement (BAA)

Introduction. In accordance with 45 CFR §§164.502(e)(2), 164.504(e); the Health Information Technology for Economic and Clinical Health (HITECH) Act; and paragraph 3.3.c. of Department of Defense Manual (DoDM) 6025.18, “Implementation of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule in DoD Health Care Programs,” March 13, 2019, and Chapter 1, Section 5 of the TRICARE Operations Manual, this document serves as a Business Associate Agreement (BAA) between the executing parties for purposes of the Health Insurance Portability and Accountability Act (HIPAA) as implemented by the HIPAA Rules and Department of Defense (DoD) HIPAA Issuances (as defined below).

The parties are a DoD Component, acting as a HIPAA Covered Entity, and a Business Associate (i.e., a DoD Contractor creates, receives, maintains, and/or transmits protected health information (PHI) for the purpose of performing covered functions on behalf of the DoD Component). The HIPAA Rules (as defined below) require BAAs between covered entities and business associates. As such, this BAA implements and incorporates the applicable DoD HIPAA Issuances (including DoDI 6025.18 and the authorities incorporated therein) and provides the Business Associate requirements which apply to the relevant Business Associates contract or other agreement between the parties.

(a) Catchall Definition:: Except as otherwise provided in this BAA, the following terms used in this BAA shall have the same meaning as those terms in the DoD HIPAA Issuances: Data Aggregation, Designated Record Set, Disclosure, Health Care Operations, Individual, Minimum Necessary, Notice of Privacy Practices (NoPP), PHI,, Required by Law, Secretary of HHS, Security Incident, Subcontractor, Unsecured Protected Health Information, and Use.

(b) Specific definitions:

Agreement means this BAA together with the documents and/or other arrangements under which the Business Associate signatory performs services involving access to PHI on behalf of the DoD component signatory.

Breach means the loss of control, compromise, unauthorized disclosure, unauthorized acquisition, or any similar occurrence where: (1) a person other than an authorized user accesses or potentially accesses personally identifiable information; or (2) an authorized user accesses or potentially accesses Personally Identifiable Information (PII) for an other than authorized purpose. The foregoing definition is based on the definition of breach in Office of Management and Budget (OMB) Memorandum M-17-12.

Business Associate shall generally have the same meaning as the term “Business Associate” in the DoD HIPAA Issuances, and in reference to this BAA, shall mean [insert name of the non-federal Business Associate entity/signatory to this BAA].

Covered Entity shall generally have the same meaning as the term “covered entity” in the DoD HIPAA Issuances, and in reference to this BAA, shall mean [insert name of the DoD Component entity/DoD signatory to this BAA].

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Covered Functions are functions of a covered entity, the performance of which makes the entity a health plan or health care provider as outlined in DoDM 6025.18.

Defense Health Agency (DHA) Privacy Office means the DHA Privacy and Civil Liberties Office, with the responsibilities and authorities as outlined in DoDM 6025.18. The Chief of the DHA Privacy Office is the HIPAA Privacy and Security Officer for DHA.

DoD HIPAA Issuances means all DoD issuances implementing the HIPAA Rules in the DoD Military Health System (MHS). These issuances include DoDM 6025.18 (2019), Department of Defense Instruction (DoDI) 6025.18, “Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule Compliance in DoD Health Care Programs,” March 13, 2019; and DoDI 8580.02, “Security of Individually Identifiable Health Information in DoD Health Care Programs,” August 12, 2015.

DoD Privacy Program Issuances means the current DoD issuances implementing within DoD the Privacy Act and certain privacy-related authorities, as identified by DHA Privacy Office Guidance. These issuances are DoDI 5400.11, “DoD Privacy and Civil Liberties Programs,” January 29, 2019, DoDM 5400.11, Volume 2 “DoD Privacy and Civil Liberties Programs: Breach Preparedness and Response Plan,” May 6, 2021 and DoD 5400.11-R, “Department of Defense Privacy Program,” May 14, 2007. These issuances are available on the Washington Headquarters Services DoD Directives website (https://www.esd.whs.mil/DD/) or upon request.

Department of Health and Human Services (HHS) Breach means a breach that satisfies the HIPAA Breach Rule definition of breach found in 45 CFR §164.402.

HIPAA Rules means the regulations issued by HHS pursuant to its authority to issue regulations on health information privacy, as provided by Section 264(c) of HIPAA. The HIPAA Rules, as amended by the Omnibus Final Rule, include the HIPAA Privacy Rule, the HIPAA Breach Rule, the HIPAA Security Rule, and the HIPAA Enforcement Rule.

Obligations and Activities of the Business Associate

(a) The Business Associate shall not use or disclose PHI other than as permitted or required by the

Agreement or as required by law.

(b) The Business Associate shall use appropriate safeguards, and comply with the HIPAA Rules and DoD

HIPAA Issuances incorporated by reference in this document Issuances with respect to PHI, to prevent use or disclosure of PHI other than as provided for by the Agreement.

(c) The Business Associate shall report to the Covered Entity any breach of which it becomes aware, and shall proceed with breach response steps as required by Part V of this agreement. With respect to electronic PHI, the Business Associate shall also respond to any security incident of which it becomes aware in accordance with any cybersecurity provisions of the Agreement. If at any point the Business Associate becomes aware that a security incident involves a breach, the Business Associate shall immediately initiate breach response as required by Part V of this BAA.

(d) In accordance with DoDM 6025.18, paragraph 3.3.c.(3)(b)4, 45 CFR §164.502(e)(1)(ii)) and

§164.308(b)(2),the Business…