Attch 2_RMC PWS 7 March 22.pdf

FA561322R0005

PERFORMANCE WORK STATEMENT

FOR

REFERRAL MANAGEMENT CENTER (RMC) SUPPORT SERVICES

At the 86th Medical Group

7 Mar 22

1.0. DESCRIPTION OF SERVICES:

1.1. The contractor shall provide non-personal services in support of the 86th Medical Group’s (86 MDG) TRICARE Operations and Patient Administration Flight. . The contractor shall provide all management, supervision, and personnel to obtain medical consultation and administrative support for the Medical Treatment Facility (MTF) staff and beneficiaries. The contractor shall ensure optimized patient flow by assisting patients at the Referral Management Center (RMC) to process their referrals to specialty care and making their appointments to include computerized appointment booking and appointment validation. The contractor shall maintain and assist with a variety of health record storage and retrieval systems. The contractor shall participate with RMC staff in providing, assessing, and improving a wide variety of customer services/relations. The contractor shall prepare and submit administrative and statistical reports.

The contractor shall assist in the management of all forms of communication between beneficiaries, team members, network/outside providers and ancillary health care workers. Performance shall be according to the requirements contained in this Performance Work Statement (PWS), and professional standards of the Joint Commission on Accreditation of Healthcare Organization (JCAHO). Requested services are considered to be non-mission essential.

1.1.1 BACKGROUND. The RMC staff are the functional experts in the area of health benefits and advises both patients and clinic staff on specialty care referrals. The technicians track all referrals in the MTF and coordinates specialty care for our beneficiaries seeking care at the MTF and all network medical facilities.

1.1.2. The contractor shall review and follow the Air Force Medical Service (AFMS) Referral Management Center User’s Guide as a reference to understand the purpose and objectives of the AFMS.

The guide can be found at referral_management (health.mil)

1.1.3. The contractor shall provide services in conjunction with other contractors and government personnel.

1.2. The contractor shall provide medical consultation and administrative support for the MTF staff and beneficiaries. Tasks include, but are not limited to, the following:

1.2.1. Coordinating referral management functions and ensures team members receive information in a timely and efficient manner to facilitate continuity of patient care.

1.2.2. Coordinating specialty care referrals in MTF/HN (Host Nation).

1.2.3. Reviewing specialty care referrals for appropriateness, covered benefit, and administrative completeness.

1.2.4. Making specialty care appointments in MTF.

1.2.5. Serving as functional expert in the area of health benefits.

1.2.6. Maintaining and tracking referral records.

1.2.7. Participating with team members in providing, assessing, and improving a wide variety of customer services/relations.

1.2.8. Assisting in the management of all forms of communication between beneficiaries, team members, internal staff and providers, network/outside providers and ancillary health care workers.

1.2.9. Orienting new personnel to the RMC team.

1.2.10. Preparing and submitting administrative reports.

1.2.11. Making specialty care appointments and providing pre-appointment instructions to patients.

1.2.12. Providing health benefits advice to patients.

1.3. SPECIFIC RMC TASKS:

1.3.1. REFERRAL APPOINTING. The contractor shall:

1.3.1.1. Review new consults (those picked up from the clinics, printed at the RMC, emailed, in EWRAS (Enterprise Wide Referral and Authorization System), Composite Health Care Systems CHCS, Consult Tracking Tool or faxed to the RMC) to ensure that each includes the following minimum information:

Patient’s name FMP/Sponsor’s social security number Patient’s date of birth Home phone/work phone Originating clinic Specialty clinic being referred to Specific provider if so requested and contact for that provider Originating provider’s name, phone number, and clinic Point of contact at the clinic if the provider is not available Provider’s facsimile number Status of patient (Prime, Plus, Standard CHAMPUS, Medicare) Number of visits authorized Time frame for consults Brief summary of reason for consult ICDB and CPT code(s), if required

1.3.1.2. If the consult does not include the items listed in 1.3.1.1, the RMC staff shall fill in as much data as possible before returning the consult to the originating provider.

1.3.1.3. Appoint patients on referrals they receive the same day the referrals are requested and within 30 minutes of arrival in the RMC .

1.3.1.4. Book appointments within Access To Care (ATC) standards to the MTF, or another MTF.

1.3.1.5. Use information systems that link the referral to the appointment to the ATC category and standard.

1.3.1.6. Advise the patient of the provider, location, time and day of the referral appointment prior to the patient leaving the facility.

1.3.1.7. For MTF referrals, direct the patient to call back on the next work day for appointment information if the patient is not provided appointment prior to leaving MTF. If the patient does not call back within one work day, the RMC staff shall attempt to contact patient within three work days to book the appointment.

1.3.1.8. Book specialty care appointments to other MTFs as needed.

1.3.1.9. Book specialty appointments to Network providers as described above (Process to book to Network/non-network providers will be outlined in the local RMC MDGI 41-103, and will be provided to the contractor by the Functional Requirement Evaluator Designee (FRED) upon contract award. The primary responsibility to notify patients of their specialty care referrals to the Network/Non-network resides with the MCSC.

1.3.1.10. Provide monthly reports that show patients requiring referral care were treated within ATC standards.

1.3.2. HEALTH BENEFITS FUNCTIONS. The contractor shall:

1.3.2.1. Advise all categories of patients of what their referral/health treatment options are as related to their eligibility and beneficiary status (Active Duty, Prime, Standard, Plus, civilian).

1.3.3. REFERRAL TRACKING. The contractor shall:

1.3.3.1. Track all referral requests and results going out of and into the MTF.

1.3.3.2. Document the patient’s appointment, with whom; either the MTF, another MTF, the Network or with a non-network provider.

1.3.3.3. Document the name of the referring provider/Primary Care Manager (PCM) and MTF for purposes of returning specialty results to the referring provider/PCM.

1.3.3.4. Follow-up with MTF providers who did not complete referral results within 72 hours of the referral episode by four work days after the referral episode. 90 percent of the results shall be completed by four work days and 100 percent by 30 calendar days.

1.3.3.5. Ensure that results from other MTFs are returned to the referring provider and to the medical record within 72 hours of the referral episode.

1.3.3.6. Ensure that results from Network/non-network providers are returned to requesting provider as outlined in MDGI 41-103. The primary responsibility to obtain Network/Non-Network specialty care reports and return them to the referring provider resides with the contractor.

1.3.3.7. Follow-up with all Direct Care Providers who did not complete referral results by four work days after the completion of the referral encounter.

1.3.3.8. Refer to the follow up process outlined in MDGI 41-103 to follow up with network/non- network providers who did not complete referral results within their specific timeline after the completion of the referral encounter. The primary responsibility to obtain network/non-network results resides with the contractor.

1.3.3.9. Document in the Consult Tracking Tool that electronic referral results are properly routed to providers via Armed Forces Health Longitudinal Technology Application (AHLTA) or that hard copy paper results are filed in patient’s medical record after provider review.

1.3.3.10. Provide monthly reports showing compliance percentage for MTF, other MTF, and Network/non-network provider’s referral return rate.

1.3.4. REFERRAL REVIEW. The contractor shall:

1.3.4.1. Review the referral for the following areas:

Suitability Administrative and clinical completeness Covered CHAMPUS benefit for the specific patient Required tests and pre-work

1.3.4.2. Submit referrals to non-network provider to MCSC via the fiscal responsible entity for medical necessity/appropriateness review.

1.3.4.3. Contact patient in event referral request is invalid, disapproved by second level review/MCSC and reschedule patient as soon as possible or instruct patient of other health care options.

1.3.5. COORDINATION FUNCTIONS. The contractor shall:

1.3.5.1. Determine where referral will be treated based on rule sets/MOUs/local market conditions, and on MTF capabilities.

1.3.5.2. Coordinate with appropriate work center for travel orders, and non-medical attendants as required.

1.3.5.3. Ensure patient leaves MTF with all necessary documentation, including tests and other paperwork the referral provider is provided information on where to return his/her results.

1.3.6. CUSTOMER SERVICE. The contractor shall:

1.3.6.1. Provide requesting provider with administrative assistance.

1.3.6.2. Provide the MTF referring provider with referral results.

1.3.6.3. Get the right patient to the right service/provider within Access To Care (ATC) standards.

1.3.6.4. Serve as the focal point for providers and patients requesting assistance with referrals.

1.3.7. The contractor shall maintain and provide monthly statistical reports, due by the 10th calendar day of the following month, for the following:

1.3.7.1. Total consults received per specialty broken down into beneficiary category.

1.3.7.2. Total consults per provider and specialty.

1.3.7.3. Disposition of consults and reasons for deferral and denial.

1.3.7.4. Breakdown of time periods to access each specialty, internally and externally.

1.3.7.5. Total consults denied access to the MTF.

1.3.7.6. Total recaptured care directed to the MTF.

2. SPECIFIC TASKS FOR LICENSED PRACTICAL NURSE (LPN) AND ADMINISTRATIVE

SUPPORT PERSONNEL:

2.1.1. PERFORMANCE QUALIFICATION FOR LPN:

2.1.1.1. ADMINISTRATIVE. The contractor shall have a basic knowledge level including: principles of customer service, TRICARE, quality control and risk management, medical terminology, medical forms and records management, anatomy and physiology, guidelines for release of medical information, medical and legal ethics, infection control concepts, applicable systems technology, supply procedures, and information systems.

2.1.1.2. The contractor shall ensure contractor employees have received Occupational Safety and Health Administration (OSHA) required training for the position in which they will perform, and that training currency is maintained. Documentation of such training shall be provided to the COR.

2.1.1.3. NURSING. The contractor shall:

2.1.1.3.1. Follow and comply with Air Force, MTF, and section policies and regulations when providing nursing care and treatment to beneficiaries.

2.1.1.3.2. Attend section’s meetings in-services and training (excluding military training) on a regularly scheduled session.

2.1.1.3.3. Facilitate professional and patient care activities.

2.1.1.3.4. Interface with the multidisciplinary personnel as needed to ensure appropriateness of referrals.

2.1.1.3.5. Participate in multidisciplinary team activities.

2.1.1.3.6. Maintain current nursing license, current knowledge of referral management, and documentation of continuing education credits.

2.1.1.3.7. Demonstrates an ability to express self in all areas of communication, effective listening, and questioning techniques.

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

2.1.1.3.9. Performs data collection and review to identify areas requiring intensive management.

2.1.1.4. REFERRAL APPOINTING. The contractor shall:

2.1.1.4.1. Clarify with the Beneficiary Counseling and Assistance Coordinator (BCAC) for instances if a referral is not a TRICARE Covered Benefit. The BCAC will perform a Covered Benefit Review (CBR) and maintain a multi-level appeal process for all defer to network referrals.

2.1.1.4.2. Verify patients are registered in Composite Healthcare Computer System/Defense Eligibility Enrollment Reporting System (CHCS/DEERS); updates demographic information as needed.

2.11.4.3. Provides Right of First Refusal (RFR) determinations for specialty care that can be provided within the MTF using Service Availability Listings (SAL) and information systems that link the referral to the appointment to the ATC category and standard.

2.1.1.4.4. Schedule specialty referral appointments to MTF, Direct Care System, or Network/non-network providers within ATC standards.

2.1.1.4.5. Coordinate with specialty referral clinics (internal or external) on special patient instructions and tests required prior to appointment.

2.1.1.4.6. Advise patients of the provider, location, time and day of referral appointments or requests the patient to call back for appointment information if an appointment was not provided prior to leaving

MTF.

2.1.1.4.7. Provide pre-appointment instructions to patients as indicated.

2.1.1.4.8. Locate referral requests and ensures appropriate documents are available prior to all specialty appointments.

2.1.1.4.9. Print diagnostic reports and treatment profiles as necessary.

2.1.1.4.10. Ensure patients leave MTF with all necessary documentation appropriate for the referred care episode and the referral provider knows where to return his/her results.

2.1.1.4.11. Contact patients in event referral requests are invalid, disapproved by second level review/MCSC and reschedules patients as soon as possible or instructs patients of other health care options.

2.1.1.4.12. Submit referrals to non-network providers to TSC for medical necessity/ appropriateness review.

2.1.1.4.13. Receive and appropriately forwards clinical phone consult requests from patients.

2.1.1.5. HEALTH BENEFITS ADVICE. The contractor shall:

2.1.1.5.1. Advise all categories of patients of what their referral/health treatment options are as related to their eligibility and beneficiary status.

2.1.1.5.2. Coordinate with appropriate work center for travel orders, and non-medical attendants as required.

2.1.1.6. REFERRAL TRACKING. The contractor shall:

2.1.1.6.1. Track referrals to include obtaining reports from MTF, Direct Care System, and network/non-network providers within established standards.

2.1.1.6.2. Document the patient’s appointment, with whom; either the MTF, another MTF, the Network or with a non-network provider.

2.1.1.6.3. Document the name of the referring provider/PCM and MTF for purposes of returning specialty results.

2.1.1.6.4. Follow-up with MTF providers who did not complete referral results within required timelines.

2.1.1.6.5. Ensure that results from other MTFs and from Network/non-network providers are returned to the referring provider and to the medical record within required timelines and follow up as necessary.

2.1.1.6.6. Document that paper referral results are properly filed in patient’s health record.

2.1.1.6.7. Assist in preparation of monthly reports as indicated.

2.1.1.7. CUSTOMER SERVICE. The contractor shall:

2.1.1.7.1. Greet patients, screen, and appropriately route phone calls.

2.1.1.7.2. Provide requesting provider with administrative assistance.

2.1.1.7.3. Serve as the “central clearing house” for providers and patients needing help with referrals.

2.1.1.8. PROCEDURE GUIDANCE. The Contractor shall perform referral education services compatible with the medical facility's operating capacity and equipment. New services shall not be introduced without prior recommendation and approval of the MTF-Commander or authorized representative.

2.1.1.9. DUTY ASSIGNMENT. The Contractor shall be primarily required to perform nursing services in the RMC. When primary services are not required, the contractor shall be assigned by the MTF Supervisor to provide Utilization Management (UM)-related activities.

2.1.1.10. OTHER SUPPORT. The Contractor shall provide immediate evaluation of emergency problems as they occur and follow established guidelines for seeking assistance.

2.1.1.11. DOCUMENTATION. The Contractor shall prepare all documentation to meet or exceed established standards of the MTF to include but not limited to timeliness, legibility, accuracy, content and signature. Unless approved for delay, contractor shall meet all suspense dates. Only MTF and Air Force approved abbreviations shall be used for documentation of care in the health care record.

2.1.1.12. SELF-EVALUATION. The medical service specialist shall participate in a continual process of self-evaluation and strive for excellence in nursing practice.

2.1.1.13. ATTENDANCE AT MEETINGS. The medical service specialist shall attend and participate in meetings, professional staff conferences, and other appropriate professional activities as needed.

2.1.2. PERFORMANCE QUALIFICATION FOR ADMINISTRATIVE SUPPORT PERSONNEL

2.1.2.1. ADMINISTRATIVE. The contractor shall have a basic knowledge level to include: principles of customer service, TRICARE, quality control and risk management, medical terminology, medical forms and records management, guidelines for release of medical information, medical and legal ethics, applicable systems technology, supply procedures and, information systems.

2.1.2.2. REFERRAL APPOINTING. The contractor shall:

2.1.2.2.1. Review referrals for suitability, administrative, and clinical completeness, covered TRICARE benefit, and required tests and pre-work. Coordinate with referring provider in cases where additional referral information is required.

2.1.2.2.2. Verify patients are registered in CHCS, EWRAS, and DEERS; updates demographic information as needed.

2.1.2.2.3. Assist with RFR determinations for specialty care that can be provided within the MTF using Service Availability (Capability) Listing (SAL) and information systems that link the referral to the appointment to the ATC category and standard.

2.1.2.2.4. Schedule specialty referral appointments to MTF or Direct Care System, and to Network/non-network provider, within ATC standards 90 percent of the time.

2.1.2.2.5. Coordinate with specialty referral clinics (internal or external) on special patient instructions and tests required prior to appointment.

2.1.2.2.6. Advise patients of the provider, location, time and day of referral appointments or requests the patient to call back for appointment information if an appointment was not provided prior to leaving

MTF.

2.1.2.2.7. Assist team members in providing pre-appointment instructions to patients as indicated.

2.1.2.2.8. Locate referral requests and ensure appropriate documents are available prior to all specialty appointments.

2.1.2.2.9. Print diagnostic reports and treatment profiles as necessary.

2.1.2.2.10. Ensure patients leave MTF with all necessary documentation appropriate for the referred care episode and the referral provider knows where to return his/her results.

2.1.2.2.11. Contact patients in event referral requests are invalid, disapproved by second level review and reschedule patients as soon as possible or instruct patients of other health care options.

2.1.2.2.12. Submit referrals when required for medical necessity and appropriateness review.

2.1.2.2.13. Receive and appropriately forward clinical phone consult requests from patients.

2.1.2.3. HEALTH BENEFITS ADVICE. The contractor shall advise all categories of patients of what their referral and health treatment options are as related to their eligibility and beneficiary status.

2.1.2.4. REFERRAL TRACKING. The contractor shall:

2.1.2.4.1. Track referrals to include obtaining reports from MTF, Direct Care System, and network and non-network providers within established standards. The primary responsibility to obtain Network/Non- Network results and return them to the referring provider resides with the MCSC/MTF.

2.1.2.4.2. Document patient appointments, either in the MTF, another MTF, in the Network or with a non-network provider in the Consult Tracking Tool.

2.1.2.4.3. Document in the Consult Tracking Tool the name of the referring provider/PCM and MTF for purposes of return of completed specialty results.

2.1.2.4.4. Follow-up with MTF providers who did not complete referral results within required timelines.

2.1.2.4.5. Ensure that results from other MTFs and from Network/non-network providers are returned to the referring provider and to the medical record within required timelines and follow up as necessary.

(Process to obtain Network/non-network reports and return them to the referring providers will be outlined in the Memorandum of Understanding (MOU) between the MCSC and the MTF. The primary responsibility to obtain Network/Non-Network results resides with the MCSC).

2.1.2.4.6. Document in Consult Tracking Tool that electronic referral results are properly routed in AHLTA to the Primary Care Manager and paper referral results are properly routed to Primary Care Manager and filed in patient’s health record.

2.1.2.4.7. Assist in preparation of monthly reports.

2.1.2.5. CUSTOMER SERVICE. The contractor shall:

2.1.2.5.1. Greet patients, screen, and appropriately route phone calls.

2.1.2.5.2. Provide requesting provider with administrative assistance.

2.1.2.5.3. Serves as the “central clearing house” for providers and patients needing help with referrals.

2.1.2.5.4. Provide administrative support to the Medical Evaluation Board (MEB) program.

2.1.2.5.5. Provide administrative support to the Service Treatment Record (STR) program.

2.2. QUALIFICATIONS.

2.2.1. Contractor personnel shall be able to type with a minimum of 40 words per minute and have the ability to speak and write English language. Correct grammar, spelling, punctuation, capitalization, and format to prepare written correspondence, forms or reports is required. The work is primarily sedentary.

However, there may be some physical demands. Requirements include prolonged walking, standing, sitting or bending.

2.2.2. UNIQUE MILITARY HEALTH CARE SYSTEMS/PROCEDURES:

- Armed Forces Health Longitudinal Technology Application (AHLTA).

- Composite Health Care Systems (CHCS).

- Defense Enrollment Eligibility Reporting System (DEERS).

2.2.3. Contractor employees shall meet the following minimum qualifications by specialty:

2.2.3.1. EDUCATION AND TRAINING MEDICAL SERVICES COORDINATOR (LICENSED

PRACTICAL NURSE (LPN). Qualification of LPN. Proof of graduation from an approved National League of Nursing LPN program.

2.2.3.1.1. LICENSE. The medical service specialist shall possess a valid unrestricted license LPN to practice Nursing from the state at which services are rendered.

2.2.3.1.2. Copies of documents listed below shall be submitted 30 days from receipt of notice of contract award to the Government.

2.2.3.1.3. Contractor employee shall provide required qualification documents to the QAP within 30 calendar days after contract award. The applicable Medical Treatment Facility Commander will ensure that each Contractor is eligible for the granting of all necessary privileges 30 days after contract award. The Contractor will meet all clinical privileging standards set by the Medical Treatment Facility Credentials Committee. Failure to maintain adequate credentials for the performance of responsibilities listed herein will subject the Contractor to termination of this contract.

2.2.3.1.4. Continuing Education: All contractor employees shall maintain Continuing Education credit sufficient to maintain both their clinical license and to meet MTF specific Quality Assurance standards for credentialing.

The U.S. Government will not pay for the continuing education.

2.2.3.1.5. Copy of valid, current, unrestricted state nursing license.

2.2.3.1.6. Copy of nursing education and training.

2.2.3.1.7. Copy of current Basic Life Support (BLS) mandatory. Advanced Cardiac Life Support (ACLS) certification desirable.

2.2.3.1.8. A signed consent form for release of information.

2.2.3.1.9. A copy of the proposed medical service specialist’s professional resume, accompanied by that individual’s sworn affidavit of the truthfulness of same, indicating experience, training, and technical expertise in the type of care to be rendered.

2.2.3.1.10. A list of all states in which the medical service specialist as LPN currently holds or has held a license to practice related services.

2.2.3.1.11. EXPERIENCE. Contractor employee shall possess excellent oral and written communication skills, interpersonal skills, and have working knowledge of computers, specifically the Internet, Microsoft Word, Microsoft Access, Microsoft Excel and Microsoft Windows.

2.2.3.1.12. Contractor shall be able to read, write, speak, and understand English.

2.2.3.1.13. EXPERTISE. Contractor performing this duty shall be knowledgeable in general medical ethics, health records administration, telephone etiquette, office management methods, excellent communications and customer service skills, strong organizational background, and computer operations to include Microsoft Windows and spread sheet type applications.

2.2.3.2. EDUCATION AND TRAINING; MEDICAL SERVICES COORDINATOR (ADMIN

SUPPORT SERVICES). The contractor employee performing this duty shall meet the following requirements:

2.2.3.2.1. High School diploma or General Educational Development (GED) equivalency. Completion of Administrative Assistant program is desirable.

2.2.3.2.2. Completed training in Microsoft Windows and Microsoft Excel is desirable.

2.2.3.2.3. Completed and maintained Basic Life Support Training as required by the MTF.

2.2.3.2.4. Contractor shall be able to read, write, speak, and understand English.

2.2.3.2.5. EXPERTISE. Contractor performing this duty shall be knowledgeable in general medical ethics, health records administration, telephone etiquette, office management methods, excellent communications and customer service skills, strong organizational background, and computer operations to include Microsoft Windows and spread sheet type applications. Personnel must understand the importance of deadlines. Knowledge of coding desirable, but not required.

3. Services Summary:

Performance Objective

PWS

Para

Performance Threshold

SS 1: Appointing patients on referrals (unless patient refuses).

1.3.1.1

No more than 3 defects per month

SS 2: Appointing patients within Access to Care Standards

1.3.1.4.

SS 3: For MTF referrals, direct the patient to call back on the next duty day for appointment information if the patient is not provided appointment prior to leaving MTF. If the patient does not call back within one work day, the RMC staff shall attempt to contact patient within 72 hours to book the appointment.

1.3.1.7.

SS 4: Follow-up with MTF/Other MTF providers that did not complete referral results within 72 hours at 4 working days after the referral episode.

1.3.3.1

1.3.3.10

SS 5: Follow-up with Network/non-network providers or Managed Care Support Contractor (MCSC) on referral results which are not returned within 10 work days after the referral episode.

1.3.3.1

1.3.3.10

SS 6: Provide RMC monthly statistical reports.

1.3.7. No more than 3 defects

per calendar quarter

SS 7: Attend meetings and training as required by the COR and

CO.

2.1.1.3.2., 2.1.1.13 per calendar quarter

3.1. Quality Control:

3.2. The contractor shall have a planned and systematic quality control process for monitoring, analyzing and improving their contract performance.

3.3. The contractor shall ensure that all contractor employees comply with the contractor’s as well as the MTF quality management/process improvement activities.

3.4. The contractor shall provide a copy of their proposed Quality Control Plan (QCP) at the pre-performance conference for acceptance by the Contracting Officer (CO). The accepted QCP will become a compliance document. The QCP shall assure the requirements of the contract are provided consistently with reasonable standards of administrative support. The CO will notify the contractor of the acceptance or rejection of the plan prior to contract start date. The contractor shall obtain acceptance of the revised plan by the CO prior to contract start date. The Contractor QC program shall include:

3.4.1. Continuing review of the contract performance including compliance with regulations referenced in the contract. Review shall be accomplished and recorded on a schedule as dictated by the contractor's written QCP. Records shall be made available to the Government COR upon Government request throughout the contract performance period and for the period after contract completion until final settlement of any claims under this contract.

3.4.2. A method of identifying deficiencies in the quality of service before the level of performance deteriorates to an unacceptable level. Audit results shall be made available to the COR upon Government request.

3.4.3. Subsequent changes to the QCP shall be provided to the CO for review and acceptance before implementation.

3.5. Inspection: The inspection and acceptance point for all services rendered under this contract will be the COR. The performance by the contractor personnel, the quality of services rendered, and any documentation or written material in support of same, will be subject to continuous inspection, surveillance and review for acceptance by the CO or COR. Quality Assurance procedures established by the MTF will be used for continuous monitoring.

4. GENERAL INFORMATION:

4.1. PERSONNEL:

4.1.1. The Contractor shall designate to the CO, in writing, a primary point-of-contact for contract implementation, coordination and administration as soon as possible but not later than ten calendar days after receiving notice of contract award. The Contractor shall notify the CO of changes in the primary point-of-contact at least five calendar days prior to any change. All notifications shall be in writing and shall state the name and contact information for the point-of-contact. The contractor’s representative shall communicate with the local Government point of contact on a quarterly basis, or when requested by the COR or CO, to discuss and resolve any problems that the contractor or the Government may be experiencing. Unresolved problems shall be referred to the CO. The Contractor Representative may reside/be located outside of Germany (i.e. in the United States), but shall be available by telephone or email from 0700 to 1600 Monday through Friday excluding holidays Central European Time.

4.1.2 Prior to official hiring of personnel, it must be approved by MDG personnel to ensure proper qualification standards are met as stated within this Performance Work Statement.

4.1.3. Contract personnel shall present a neat appearance commensurate with that required of a professional.

4.1.4. Neither uniformed personnel nor U.S. Government civilian employees shall be employed to perform services under this contract.

4.2. REGULATIONS. The Contractor shall abide by all MTF standards, rules, and procedures including requirements for any licensure, credentialing, and quality assurance requirements. Such regulations include, but are not limited to, general safety, fire prevention, waste disposal, infection control, TJC, UEI, HIPAA, and patient safety initiatives.

4.3. REMOVAL OF CONTRACTOR PERSONNEL. At any time during the performance of this contract, the CO may direct the Contractor to immediately remove any Contractor personnel whose actions or impaired state raises reasonable suspicion that clear and present danger of physical harm exists to a patient, other Contractor personnel, and government personnel or to the impaired individual. This provision will be used in emergency situations only and not for the purpose of bringing performance issues or other non-urgent concerns to the attention of the Contractor. If the need for a removal occurs, the COR will contact the Contractor's point-of-contact and direct the Contractor to remove that individual from the MTF and to not use that individual to perform any services required under this contract until the issue has been resolved by the CO. A review of the basis for removal will be made by the CO within three business days after removal. If, after any investigation deemed necessary by the CO and discussions with the Contractor's representative, the CO concludes that the Contractor personnel’s impairment requires permanent removal from performance under the contract, the CO will notify the Contractor that permanent removal is required. In the event of disagreements between the Government and the Contractor's representative concerning matters of the impaired Contractor personnel, 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 shall provide back-up/replacement Contractor personnel IAW the terms and conditions of this contract.

4.4. CONFIDENTIALITY OF INFORMATION. Unless otherwise specified under this contract, all financial, statistical, personnel, and/or technical data which is furnished, produced or otherwise available to the Contractor during the performance of this contract are considered confidential business information and shall not be used for purposes other than performance of work under this contract. The Contractor shall not release any of the above information without prior written consent of the CO.

4.5. MEDIA AND OTHER INQUIRIES. The Contractor or Contractor personnel shall not respond to any media inquiries. Any inquiries from the media, third parties, or public agencies shall be immediately relayed to the COR who will relay them to the MTF Public Affairs Officer or, after duty hours, to the Administrative Officer of the Day. There shall be no interviews, comments, or any other response without the prior knowledge and approval of the MTF Commander. Other than routine inquiries from external agencies, all other inquiries and complaints shall be brought to the attention of the COR.

4.6. All contractor employees shall give the highest regard to patient dignity and observe the precepts of the American Hospital Association’s “Bill of Rights for Contractor patients.” Performance shall be in accordance with the standards contained in this PWS and the terms and conditions of the contract. The contractor employees shall abide by MTF rules, regulations, and bylaws, including Medical Staff Bylaws and applicable Air Force regulations and HIPAA governing such things as medical records, etc. (See para 5.0).

4.7. OVERSEAS REQUIREMENTS. The Contractor is responsible for ensuring all country clearances, passports, visas, and accreditations required by the Host Nation are obtained prior to employment of individuals under this contract. The Contractor shall be responsible for obtaining the appropriate country specific requirements, and shall coordinate this with the CO and/or COR. All Contractor personnel shall have been cleared, granted visas, work permits etc. The Contractor shall provide written notification to the CO and the COR within 24 hours of becoming aware of Contractor personnel no longer performing duties requiring clearances/permissions. The Contractor shall recognize that Host Nation authorities may conduct on-site inspections at any time in the Contractor personnel’s work area for the purpose of verifying the status of positions and Contractor personnel and appropriate visas or permissions. The Contractor shall assume all costs related to submission of required documentation.

The contractor shall comply with all business registration requirements in Germany.

4.8. Services are approvable under NORTH ATLANTIC TREATY ORGANIZATION (NATO) STATUS OF FORCES AGREEMENT (SOFA) Status accreditation under Article 72 or 73.

4.8.1. AUTHORIZATION OF CONTRACT PERSONNEL. An individual who has: (1) been hired as a consequence of this contract, (2) is a full-time (40 hours per week or more) contract employee, (3) is employed in a Host Nation country (4) is a national (citizen) of or an ordinary resident of the United States provided that the contract employee is not also a Host Nation country (local) resident (i.e., a dual citizen), or (5) a U.S. citizen or a citizen of a North Atlantic Treaty Organization (NATO) country other than the Host Nation and provided that the contract employee is not an ordinary resident of the Host Nation. The representative host country U.S. Government shall make the determination of a contract employee’s status with respect to being an ordinary resident.

Authorized Contractor personnel and their authorized dependents will be granted privileges consistent with those granted members of the civilian component of the U.S. Forces.

4.8.2. AUTHORIZATION OF CONTRACT PERSONNEL DEPENDENTS. Authorized dependents include the Contractor personnel’s: lawful spouse, unmarried child, stepchild, or a lawfully adopted child who will reside in the host country with the Contractor personnel. (Child is defined as: has not passed his/her 21st birthday or, if past, is incapable of self-support because of mental or physical incapability that existed before that birthday and is dependent on the Contractor for over one-half of his/her support.) The benefits listed below, if available, are generally extended as noted without special financial consideration due to the U.S. Government. In such cases the U.S.

Government does not charge for use of these benefits, and the contract price should not be inflated by the value of these benefits. Should any of the below needed benefits not be available, negotiations will be conducted with the Contractor and consideration determined.

4.8.3. LOGISTICAL SUPPORT. The U.S. Government will provide individual logistical support for Contractor personnel and authorized dependents to the extent available and as authorized by NATO Status of Forces Agreement (SOFA) Supplementary Agreement Article 72, and foreign regulations; by current applicable international agreements, arrangements, policies; and the local Installation Commander. The duration of the initial individual logistic support authorization may be subject to a time limitation. Prior to expiration of the initial logistical support authorization (if and as applicable), the COR and Contractor shall expedite/process the individual Renewal/Authorization in sufficient advance to ensure continuation of logistical support. Logistical support is provided only for those Contractor personnel that are providing services solely for U.S. Forces. Logistical support, if granted, will only be provided to authorized, full-time (40 hours per week) Contractor and authorized dependents as defined in paragraphs 4.8.1 and 4.8.2. The following logistical support will be provided to applicable Contractor personnel:

1) Commissary

2) Army Air Force Exchange Service

3) Armed Forces Recreation Facilities

4) Class VI (alcoholic beverages, including rationed items)

5) Legal assistance (on a space available basis)

6) Local government transportation for official government business (non-tactical vehicle)

7) Local Moral/Welfare Recreation Services

8) Military Banking facilities

9) Military postal services

10) Officer and NCO Club memberships

11) Mortuary services

12) Privately Owned Vehicle (POV) authorization

13) Housing office (Note: Limited. These services are limited to translation assistance and an explanation of host-country rental laws and utility and telephone services)

14) Petroleum, Oils, and Lubricants (POL) purchases

15) Transient billets on space available basis

16) Messing Facilities at remote sites only (reimbursable)

17) Army Continuing Education Services

18) Credit union facilities

19) * Dependent Schools, on space available, tuition paying basis

20) Medical/Dental on a reimbursable basis. Dental on emergency basis only

21) Pet and firearm registration and control

22) NATO status of Forces Agreement stamp (subject to approval of Host nation Customs Authority)

23) Customs exemptions *Note: The Government will not pay for tuition

4.9. CONTRACTOR PERSONNEL HEALTH REQUIREMENTS. Contractor personnel shall be up to date on immunizations required or recommended by the U.S. Department of Health and Human Services for travel to the Host Nation. The U.S. Government will not reimburse the Contractor for this expense. Contractor personnel providing services under this contract shall receive a pre-employment physical examination prior to commencement of work and annually thereafter. No later than seven (7) working days prior to commencement of work, certification shall be provided to the COR that Contractor personnel have completed medical evaluation required above. This certification shall state the date on which the examination was completed, the doctor’s name that performed the examination, and a statement concerning the physical health of the individual. The certification shall also contain the following statement: “(name of contractor employee) is suffering from no contagious diseases to include but not limited to Tuberculosis and Hepatitis.” Per Occupational Safety and Health Administration (OSHA) requirements, all Contractor personnel who will have occupational exposure to blood or body fluids, or other potentially infectious materials, shall receive Hepatitis B vaccine, sign a voluntary declination, or have documented proof of immunity to Hepatitis B infection. Personnel who sign declinations may change their minds at any time and receive the Hepatitis B vaccine without penalty. It is the Contractor’s responsibility to report all information necessary to assure hospital records can be maintained correctly, and therefore comply with the OSHA and CDC health records requirement.

4.10. ADMINISTRATIVE CHECKS AND REQUIREMENTS:

4.10.1. Tier 1 (T1) Background Investigation. Since personnel under this contract will have access to Non- Sensitive government information and/or process information requiring protection under the Privacy Act of 1974, these positions are considered Low Risk Positions. Compliance with DoD Manual 5200.2, AFMAN 16-1405 and Homeland Security Presidential Directive 12 (HSPD-12) is mandatory for these positions (See 5.1.–Applicable Forms and Publications). A Tier 1 (T1) background investigation is required for all personnel under this contract. The Contractor shall fully adhere with the provisions of referenced publications by having each of their employees, who are performing under this contract, initiate and complete a T1. T1 investigation requests for employee will be submitted through the Suitability/Fitness Security Office, Ramstein AB, Germany. Member will be fingerprinted and required to complete the appropriate forms (Standard Form 85, Questionnaire for Non-sensitive Positions, any state release forms, and OF 306 Declaration for Federal Employment. For local hire personnel, a Security Questionnaire for a Simple Security Check (AE Reg 604-1) shall be completed. (See 5.1.–Applicable Forms and Publications)). The contractor shall advise employee that a favorable suitability/fitness determination is required as a condition of employment under this specific contract. The employee shall apply for the T1 prior to start of performance. The government is solely responsible for the cost associated with the initiation, application and completion of the T1 investigation with exceptions for expenses incurred for Police Checks for “local hire” personnel.

4.10.2. PENDING COMPLETION OF T1. The Contractor personnel may provide contract services prior to completion of background investigation. The Contractor understands that the MTF Commander may allow the Contractor personnel to temporarily occupy non-sensitive positions pending T1. The Contractor personnel will be immediately removed from the position if at any time the T1 receives unfavorable adjudication, or if other unfavorable information that would affect the T1 becomes known.

Pending completion of State Criminal History Records Check (SCHRC) the Air Force Surgeon General requires close clinical supervision and full compliance with existing DoD Directives, Instructions, and other guidance on quality assurance, risk management, licensure, personnel orientation and certification verification. The MTF Commander will determine what constitutes “close clinical supervision” for individuals whose T1/SCHRC are pending, either supervised practice ensuring protection of patients under the age of 18 or line-of-sight supervision (i.e., chaperoned by an individual whose background investigation has been successfully completed) at all times when caring for these patients.

4.11 PLACE AND HOURS OF OPERATION. Services are to be performed at the 86th Medical Group, Ramstein Air Base, Germany during the following hours: 0700-1630 hours (to include a 1 hour lunch break daily): Monday through Friday, including German holidays, but excluding U.S. Federal holidays. Workdays will generally consist of eight hour days. Hours are subject to change as mutually agreed between the FRED and the Contractor, however, the total number of hours will not exceed 80 hours every two weeks.

4.11.1. Alternate Work Schedule (AWS). AWS may be allowed at the MTF’s discretion, however, the total number of hours shall not exceed 80 hours per pay period. An AWS must be presented and reviewed by the MTF before implementation. The Government may change the scheduled AWS at any time based on mission requirements.

4.12. HOLIDAYS. The following is a list of legal federal holidays. Any federal holiday falling on a Saturday will be observed on the preceding Friday, holidays falling on a Sunday will be observed the following Monday.

U.S. Holidays:

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

4.13. ABSENCES. The contractor may request, and the FRED may approve, based upon the recommendation of the section chief or from personal knowledge, a reduction in contract performance requirements up to a maximum of 20 working days 8 hours per day, scheduled or unscheduled, due to illness, leave, and other justified reasons per 12-month contract performance period. The contractor shall notify the FRED of any absences that are justified and the FRED will track the number of days the contractor is absent. The number of consecutive days for scheduled or unscheduled absences will be at the discretion of either the MTF commander, section chief, or FRED based on workload with coordination through the FRED. It is the contractor‘s responsibility to approve any absences of the contractor personnel and to coordinate absences with the section chief and/or FRED. The contractor shall provide back-up coverage for all scheduled or unscheduled absences in excess of twenty (20) workdays per 12-month contract performance period at no additional cost to the government. To prevent any delays in staffing coverage and recruiting, the contractor shall provide (1) part-time employee to immediately back-fill any unexpected terminations.

4.14. CLOSURES. There are USAFE-AFAFRICA Family Days, Presidential Executive Orders, Goal Days, or other command-declared closures, for which the MTF will be closed and the Contractor will not be required to provide services. Therefore, the Contractor shall advise its personnel accordingly and treat these situations as determined appropriate. The USAFE-AFAFRICA Family Days are scheduled by the USAFE-AFAFRICA Commander. Goal Days are scheduled on the discretion of the 86AW Commander.

4.15. UNPLANNED CLOSURES. In the event of unplanned closure of the MTF due to natural disaster, military emergency, pandemic conditions, severe weather, security threat, or a facility-related problem that prevents contractor personnel from performing services under this contract, the contractor personnel shall follow the same departure and reporting directions given to Government personnel and the Contractor shall treat its personnel as they determine appropriate.

4.16. COMMANDER’S TOBACCO USE GUIDANCE. The MTF will have a smoke free medical campus with only one authorized smoking area for buildings 2114, 2121 and 2182. Details to the MDG smoking policy will be defined to contractor employee during initial orientation.

4.17. CONTRACTOR ORIENTATION AND NEW PERSONNEL REQUIREMENTS:

4.17.1. GENERAL TRAINING. Contractor personnel shall abide by all MTF standards, rules, and procedures including requirements for any licensure, credentialing, and quality assurance requirements.

Such regulations include, but are not limited to, general safety, fire prevention, waste disposal, infection control, AAAHC, JCAHO, and patient safety initiatives. All contractor personnel performing services at the MTF are required to complete initial and annual refresher HIPAA, Anti-terrorism/Force Protection (AT/FP), and safety training as provided by the MTF for its personnel. The contractor will be held accountable for ensuring that the personnel comply with health information privacy and security policies and procedures. The government will also provide training on government provided forms and equipment, universal precautions, initial orientation, and continuing orientation. Contractor personnel shall participate in continuing education programs to update and/or maintain skills and knowledge to meet annual requirements. Contractor personnel shall participate in evaluation of the quality and effectiveness of activities and services of the unit.

4.17.2. ORIENTATION TRAINING. The Contractor shall ensure that all Contractor personnel participate in the government provided MTF orientation program for newly assigned personnel within the first two weeks of performance start.