Attch1_PWS_Referral_Manager.pdf

Performance Work Statement Referral Manager/LVN

NON-PERSONAL SERVICES

1. DESCRIPTION OF SERVICES:

1.1. The Government requires one Full Time Equivalent for this Performance Work Statement (PWS). The Contractor shall provide Referral Manager type of care to treat and/or support the treatment of the patients of the 31st Medical Group (31 MDG), Aviano Air Base Medical Treatment Facility (MTF). The MTF intends on the services, as identified in this PWS, to be performed by a qualified Technical Representative (TR) and the Contractor will conduct the TR work. Performance shall be in accordance with the requirements contained in this PWS in addition to the professional standards of the Joint Commission (TJC), USAF Medical Services standards, and any local standards maintained by the unit. The Contractor may be a member of a primary care management team.

1.2. SPECIFIC DUTIES/RESPONSIBILITIES:

1.2.1. The Referral Manager (RM) shall perform a full range of duties consistent with their labor category, education, training, experience, clinical privileges (as applicable) and assigned position.

1.2.2. The RM is required to have complete follow-through with each referral from beginning to end. End includes the Clear and Legible Report (CLR) being uploaded within the current medical database and the referral closed with the t-con sent to the patient’s PCM.

1.2.3. The RM is required to assist patients via phone, in person with their referrals and ensure patients have a thorough understanding of the referral process to ensure expectation management of all patients.

1.2.4. The RM maintains a professional relationship and consistent communication with the provider staff and with colleagues in the TRICARE Operations and Patient Administration (TOPA) work environment to ensure processes are managed and streamlined for optimal referral management.

1.2.5. The RM must maintain current access to all databases required for daily operations and be proactive to ensure there is no lapse in database access.

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

1.2.7. Coordinates specialty care referrals. Specialty Care routine referrals must be processed within the Access to Care Standard of 28 days per Air Force Manual 41-210. Urgent/ASAP referrals must be processed immediately, but not longer than 24 hours within a business day. All patients shall be assured of their privacy and personal dignity (per section 4.13).

1.2.8. Reviews specialty care referrals for appropriateness, covered benefit, and administrative and medical completeness.

1.2.9. Makes specialty care appointments and provides pre-appointment instructions to patient.

1.2.10. Provides health benefits advice to patients.

1.2.11. Maintains and tracks referral records.

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

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

1.2.14. Prepares and submits administrative reports and uploads a patient Clear and Legible Report into the patients’ medical record with a t-con sent to the patient’s provider.

1.2.15. The RM shall attend meetings and training as directed by the TOPA Flight Commander or his/her designee. The RM shall attend any additional special meeting called by the 31 MDG Commander or his/her designee as required.

1.2.16. Be productive and perform with minimal supervisory direction.

1.2.17. The RM shall display professionalism and positive/cooperative attitude.

1.3. EDUCATION AND TRAINING REQUIREMENTS:

1.3.1. Language Requirement. The Contractor shall read, understand, speak, and write English fluently.

1.3.2. Formal Education:

1.3.2.1. The RM will be subject to the credentialing and privileging requirements of AFI 44-119, Clinical Performance Improvement, to include adverse actions as applicable. The chief HCW executive, or his/her representative, will define the scope of practice for the RM.

1.3.2.2. Have an Associate Degree in Licensed Vocational Nurse, Business Administration, Management or Health Care Organizations from an accredited college or university.

1.3.2.3. Have, as a minimum, a current LVN certificate from an accredited national, state or military trained equivalent school. The licensed vocational nurse shall have and maintain an active, valid, current, unrestricted license (with no limitations, stipulations or pending adverse actions) to practice nursing as a LVN in a US jurisdiction. Maintenance of required certification is mandatory.

1.3.2.4. Experience working within the Air Force Medical Service or DoD is preferred (3-5 years in a specialty area).

Consideration will be given to those who have completed medical-related college-level coursework.

1.3.2.5. The RM will maintain standards for licensure and certification.

1.3.2.6. The RM shall be in good standing, and under no clinical restrictions, with the state licensure board in any state in which a license is held or has been held within the last 10 years.

1.3.3. PATIENT SENSITIVITY. The RM shall provide patients with the utmost care and attention. All patients shall be assured of their privacy and personal dignity.

1.3.4. COMMUNICATION/CONDUCT. Contracted personnel shall maintain an open and professional communication and conduct with members of the MTF staff. Complaints validated by the Chief of Medical Staff or TOPA Flight Commander shall be reported in writing to the contract administrator and the immediate supervisor for action. Failure of the contracted Referral Manager to correct validated complaints raised by the MTF staff and the contract administrator will be considered a failure to perform.

1.3.5. DOCUMENTATION. Contracted personnel shall prepare all documentation to meet or exceed established standards of the MTF, to include, but not limited to, timeliness, accuracy, content and signature. Only MTF and Air Force-approved abbreviations shall be used for documentation of the patient health record.

1.4. GENERAL INFORMATION & PERSONNEL REQUIREMENTS:

1.4.1. POINT OF CONTACT: The 31 MDG Commander shall provide a POC who shall be responsible for the oversight of the performance of the work. The POC shall have full authority to act for the 31 MDG Commander on all matters relating to the daily operation of this contract. The 31 MDG Commander shall designate this individual, in writing, to the Contracting Officer (CO) before the contract start date. An alternate may be designated, but the 31 MDG Commander shall identify those times when the alternate shall be the primary POC.

1.4.2. AVAILABILITY: The RM must be available to respond to patient’s needs at any time during their shift. The contracted Referral Manager shall notify the TOPA Flight Commander or Referral Management Lead, as early as possible of programmed absences to allow for planning of service coverage and workload distribution.

1.4.2.1. HOURS OF OPERATION: The nature of this position requires availability during the hours of the MTF open and closure. Currently, the MTF is open from 0730-1600; however, if the clinic timeframe changes in the future, then the hours must be adjusted to adhere to the MTF hours.

1.4.2.2. HOLIDAYS: The contracted Referral Manager is not required to provide services on the following days:

New Year's Day Martin Luther King Jr's Birthday Presidents Day Memorial Day Independence Day Labor Day

Columbus Day Veterans Day Thanksgiving Day Christmas Day USAFE Family Days Any 31st Fighter Wing down days

1.4.2.3. VACATIONS/ABSENCES. The RM shall be allowed up to 28 days of absences per year for vacation, sick leave, and miscellaneous reasons. The absences are to be coordinated with, and at the discretion of the TOPA Flight Commander and the Referral Management Lead. Absences will not excuse the performance of any duty under this contract.

1.4.2.4. ON CALL DUTY: The contracted Referral Manager will only be required to come to the base outside of normal duty hours on an emergency basis only. If personnel is called on base outside of normal duty hours, then the TOPA Flight Commander or Referral Management Lead will adjust the following week shift to adjust the 40-hour work week (Example: called in 2 hours on Saturday; therefore, may report late on Monday).

1.4.2.5. CONTINUITY OF SERVICES/REPLACEMENT STAFF: The 31 MDG POC shall ensure qualified personnel are available to provide coverage during scheduled absences of the contracted Referral Manager or when they will be unable to provide services for greater than one day.

1.4.2.6. PERFORMANCE OF SERVICES DURING CRISIS DECLARED BY THE NATIONAL COMMAND

AUTHORITY OR OVERSEAS COMBATANT COMMANDER: On occasion, services may be required to support an activation or exercise of contingency plans outside the normal duty hours.

1.4.2.6.1. Emergency situations (i.e. accident and rescue operations, civil disturbances, natural disasters, military contingency operations, and exercises) may necessitate the contracted Referral Manager provide increased or reduced support as determined by the contracting officer. The Government will negotiate an equitable adjustment with the contracted Referral Manager for the cost of these emergency requirements or adjust the hours as similarly stated in paragraph 1.4.2.4.

1.4.3. PERSONNEL REQUIREMENTS:

1.4.3.1. CRIMINAL BACKGROUND CHECK REQUIREMENT: The Government will conduct criminal background checks on individuals providing direct, unsupervised child care services under this contract, using the procedures set forth in Department of Defense Regulation 5200.1. The DoD Information Security Program and DoD Instruction 1402.5, Criminal History Background Checks on Individuals in Child Care Services, 19 Jan 1993.

1.4.3.1.2. The contractor shall provide the required certificates for background checks issued by the host nation. It will be 31 MDG's responsibility to conduct the necessary criminal background checks through the Federal Bureau of Investigation (FBI) in accordance with the Law (agreements between the Host Nation and United States).

1.4.3.1.3. Additional favorable security checks will be performed by the 31 MDG Security Manager, as required prior to the individual beginning to provide the required service.

1.4.3.1.4. Background checks will be based on fingerprints of individuals obtained by a Government law enforcement officer and inquiries conducted through the FBI and state criminal history repositories.

1.4.3.1.5. With the consent of the contracting officer, contractor personnel may provide contract services prior to completion of background checks. However, at all times while children are in the care of that individual, the contract provider shall be within sight and continuous supervision of a staff person whose background check has been completed.

1.4.3.1.6. Individuals shall have the right to obtain a copy of any background check pertaining to them and to challenge the accuracy and completeness of the information contained in the report.

1.4.3.1.7. Individuals who have previously received a background check shall provide proof of the check to the SGH, or obtain a new one.

1.4.3.1.8. NATIONAL AGENCY CHECK (NAC): As a minimum, the contract Referral Manager shall successfully complete a NAC operating government-furnished workstations that have access to Air Force automated information systems: Requests for personnel hired at the beginning of the contract, shall be submitted to the Government not later than 45 working days from the contract start date. Requests for personnel hired subsequent to the contract start date shall be submitted to the Government not later than five (5) business days.

1.4.3.1.8.1. Workdays Before Employee's First Duty Day. Contract Referral Manager personnel whom receive unfavorable NACs shall not be employed. The government will submit requests for investigations on the AF Form 2583, "Request for Personnel Security Action", at no additional cost to the contract Referral Manager. The contract Referral Manager shall comply with the requirements of DoD 5200.2-R, Personnel Security Program, and AFI 33- 119, Electronic l.1ail (E-mail) Management and Use.

1.4.3.1.8.2. The contract Referral Manager shall comply with the requirements of Volume 1, AFI 71-101, Criminal Investigations, and paragraph 1.1. Volume 2, Protective Service Matters. The contract Referral Manager shall report any information or circumstances of which they are aware that may pose a threat to the security of DoD personnel, resources, and classified or unclassified Defense information to the Chief of Medical Staff. The contract Referral Manager employee's immediate supervisor shall brief him/her upon initial on-base assignment and as required thereafter.

1.4.3.2. CONFLICT OF INTEREST: The Contractor shall not employ any person who is an employee of the United States Government if the employment of that person would create a conflict of interest. The Contractor shall not employ any person who is an employee of the Department of the Air Force, either military or civilian, unless such person seeks and receives approval in accordance with DoD Directive 5500.7 and Air Force policy.

1.4.3.3. APPEARANCE: The contract Referral Manager shall present a professional, conservative, and neat appearance. The contract Referral Manager shall report for duty in a professional manner, in appropriate attire befitting a health care setting, and having complied with socially acceptable standards of personal hygiene expected of health care workers.

1.4.3.3.1. While on duty, the contract Referral Manager shall be neat and clean (free from visible dirt and stains) well-groomed and appropriately dressed. The RM's clothing shall fit correctly to provide a professional, modest appearance, in keeping with normally accepted community standards of dress for the work being performed.

1.4.3.3.2. The contract Referral Manager shall display legible MTF-provided identification media on their outer clothing.

1.4.3.3.3. Facial hair (including beards, mustaches, and sideburns) shall be controlled (restrained) or trimmed. It shall not interfere with safe work practices, look unkempt, or be unclean.

1.4.3.3.4. PROTECTIVE CLOTHING: When required and supplied by the Government, the RM shall wear special protective clothing and shoe covers. When duties will be performed in specified areas, a disposable protective hood shall be worn to ensure infection control standards are met. The Government will provide this hood. These items shall remain the property of the Government and shall not be removed from the MTF. After use, protective clothing shall be turned in or destroyed as directed by the Chief of Medical Staff.

1.4.4. HEALTH REQUIREMENTS:

1.4.4.1. The contracted Referral Manager providing services under this contract shall receive a pre-employment physical examination prior to commencement of work, and annually thereafter. The physical shall report to a Government Referral Manager to receive a pre-employment examination and immunization prescribed by the MTF.

1.4.4.2. Not later than five (5) working days prior to commencement of work, certification shall be provided to the FAC ensuring the RM has completed the medical examination required above. This certification shall state the date on which the examination was completed, the name of the doctor who performed the examination, and a statement concerning the physical health of the individual. The certification shall also contain the following statement: "(Name of the contracted Referral Manager) is suffering from no contagious diseases to include, but not limited to, Tuberculosis, Hepatitis, and Venereal Disease)."

1.4.4.3. OSHA requires that all contract 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.

1.4.4.4. The contract Referral Manager is responsible for reporting to the Chief of Medical Staff, all information necessary to assure hospital records can be maintained correctly, and therefore comply with the TJC, OSHA, and CDC health record requirements.

1.4.4.5. Emergency Health Care: The MTF will provide emergency health care for the contract Referral Manager for injuries incurred while on duty in the MTF. These services will be billed to the contract Referral Manager's medical insurance carrier at the current full reimbursement rate.

1.4.5. MEDICAL QUALITY IMPROVEMENT/RISK MANAGEMENT (QI/RM):

1.4.5.1. The contract Referral Manager shall participate in QI/RM activities to the extent required by Section 2C, AFI 44-119 and the individual MTF QI/RM plan or regulation.

1.4.5.2. The Government will evaluate the providers' professional, as differentiated from administrative, performance under this contract using Quality Improvement standards specified in paragraph 2-12 and 2- 13, AFI 44-119.

Nothing in this paragraph precludes the Government from also conducting inspections under the Inspection/Acceptance requirement of FAR clause 52.212-4.

1.4.6. PERFORMANCE EVALUATION MEETINGS: The contracting officer (CO) will require the contract Referral Manager to meet with the CO, contract administrator, Functional Commander, and other government personnel as often as deemed necessary. Meeting will be documented in the contract file with written minutes signed by the contract RM and the CO, or contract administrator. Should the RM not concur with the minutes, such non-concurrence shall be provided in writing to the CO within ten (10) calendar days of receipt of the minutes.

1.4.7. ORIENTATION: The 31 MDG/CC shall ensure that all contract providers participate in the MTF orientation procedures for newly assigned providers to include regulation specific to their professional specialty, hospital and Air Force policy and procedures and completion of all mandated training.

1.4.8. RECORDS: The 31 MDG/CC shall create and maintain Government-owned /contractor-held records, regardless of media, in accordance with AFI 33-119, Electronic Mail (E-mail) Management and Use, paragraph 8;

AFI 33-202, Computer Security, paragraphs 3.5.1 and 3.6.1; AFI 33-322, Records Management Program, paragraphs 7,8,9, and 10 and supplements; AF.MAN 37-123, Management of Records, Chapters 2-6, paragraph 7.10 -7.29, and AFI 37-138, Records Disposition - Procedures and Responsibilities, Chapters 2,, 3 and 6 and supplements.

Identify all records required to be created by the PWS on the RIMS file plans. Upon completion of this contract, all government-owned/contract Referral Manager-held records (regardless of media) received, created, maintained, or provided in the performance of the PWS shall be turned over to the Government. Background electronic data and records specified for delivery to the contracting agency must be accompanied by sufficient technical document to permit the Air Force to use the data. In the event of default or non-performance, the Government will have access to all records in order to ensure mission support is not interrupted.

1.4.9. DOD FREEDOM OF INFORMATION ACT (FOIA) PROGRAM. The contract Referral Manager shall comply with the requirements of DoD Regulation 5400.7/Air Force Supplement, DoD Freedom of Information Act Program. The regulation sets policy and procedures for the disclosure of records to the public and for marking, handling, transmitting, and safeguarding For Official Use Only (FOUO) material. If the Contract Referral Manager receives a FOIA request; the Contract Referral Manager shall ensure it is delivered immediately to the base FOIA manager for processing. The FOIA manager will task a Government official who, as the authorized official, will make the decision on releasing Government records.

1.4.9.1. FOR OFFICIAL USE ONLY (FOUO): The contract Referral Manager shall create and maintain FOUO material IAW DoD 5400.7R, DoD Freedom Of Information Act Program, Chapter 4; AFI 33-129, Transmission of Information via the Internet, paragraphs 7.4, 8.2.3, 16 and 17; and AFI 33-201, Communications Security (COMSEC), Table 1. Mark all documents meeting the requirements identified in DoD Regulation 5400-7/Air Supplement, paragraphs C3.2.l.2 thru 3.2.19. as "For Official Use Only" IAW instructions identified in paragraph C4.2.l. Safeguard all sensitive data IAW DoD Regulation 5400.7/ Air Force Supplement, paragraph C4.4. When documents containing FOUO material are authorized for destruction, shred the records so that the pieces cannot be reconstructed. Degauss or overwrite magnetic tapes or other magnetic media.

1.4.9.2. PATIENTS LISTS: Patients lists, no matter how developed, shall be treated as privileged information. Add the following to the bottom of all patient lists: FOR OFFICIAL USE ONLY. This document contains information exempt. From mandatory disclosure under the Freedom Of Information Act (FOIA), Title 5 U S.C. 552 (b)(2) High and (b)(6) apply." Lists and /or names of patients shall not be disclosed or revealed in any way for any use outside the MTF without prior written permission by the Chief of Hospital Services.

1.4.9.3. RELEASE OF MEDICAL INFORMATION. The contract Referral Manager shall release medical information obtained during the course of this contract to MTF staff involved in the care and treatment of that individual patient only.

1.4.9.4. PRIVACY ACT PROGRAM: The contract Referral Manager shall create and maintain Privacy Act data IAW AFI 33-129, Transmission of Information via the Internet, paragraphs 7.4, 8.2.3, 16 and 17, and supplements;

AFI 33.201, Communications Security (COMSEC), table 1; AFI 33-322, Air Force Privacy Act Program, paragraphs 1.4.7, 1.4.8, 3.3.3, Chapters 7, 9 and 10 and supplements: and, Privacy Act systems of records notice (https://www.defenselink.mil/privacy/notices/usaf). The contract Referral Manager shall not create or maintain a Privacy Act system of records prior to public notice. If the contract Referral Manager receives a Privacy Act request, the contract Referral Manager shall be responsible for searching for the records and providing those records to a Government official who, as the authorized official, will make the decision on releasing the Government records.

1.4.9.5. FUNCTIONAL REQUESTS: A functional request is written for DoD records that does not cite either the FOIA or Privacy Act received from any person (including a member of the public), an organization, or a business.

The contract Referral Manager shall be responsible for searching for the records and providing those records to a Government official who, as the authorized official, will make the decision on releasing the Government records.

1.4.10. GENERAL INFORMATION

1.4.10.1. SECURITY. The Contractor shall notify the 31st Security Forces Squadron at Aviano AB, Italy, 30 days before on-base performance of the contract begins. The notification shall include:

1.4.10.1.1. Name, Address and Telephone Number of Contract Referral Manager

1.4.10.1.2. The contract number and contracting agency

1.4.10.1.3. The reason for the contract (i.e. the work to be performed)

1.4.10.1.4. The location (s) of contract performance and future performance, if known

1.4.10.1.5. The date contract performance begins

1.4.10.1.6. Any change to information previously provided under the paragraph

1.4.10.2. The Contractor shall ensure the following pass and identification items required for contract performance are obtained for the RM and non-government owned vehicles:

1.4.10.2.1. DD Form 1172, Application for Uniformed Services Identification Card, if applicable

1.4.10.2.2. AETC Form 58, Civilian Identification Card, if applicable

1.4.10.2.3. AF Form 2219 (series), Registered Vehicle Expiration Tab

1.4.10.2.4. DD Form 2220, DoD Registered Vehicle and Installation Tab

1.4.10.2.5. AF Form 75, Visitor/Vehicle Pass

1.4.10.2.6. AF Form 1199, USAF Restricted Area Badge, or locally developed badge

1.4.10.3. The RM shall return all identification media, including vehicle decals, to the Pass & ID Office upon completion /termination of the contract, as appropriate.

1.4.10.4. Physical Security. The RM shall safeguard all government property, including controlled forms provided for contract Referral Manager use. At the close of each work period, government equipment, facilities, and other valuable materials shall be secured.

1.4.10.4.1. Entry Procedures to Controlled/Restricted Areas. The RM shall implement local base procedures for entry to Air Force controlled/restricted areas where contract RM will work.

1.4.10.4.2. Key Control. The contract Referral Manager shall establish and implement key control procedures in the Quality Control Plan to ensure keys issued to the contract Referral Manager by the government are properly safeguarded and not used by unauthorized personnel. The contract Referral Manager shall not duplicate keys issued by the government.

1.4.10.4.2.1. Lost Keys. Lost keys shall be reported immediately to the 31 MDG Facilities Manager. The government replaces lost keys or performs re-keying. The total cost of lost keys, re-keying or lock replacement shall be deducted from the monthly payment due the Contractor.

1.4.10.4.2.2. The RM will not allow government-issued keys to be used by personnel other than self-Contract Referral Manager employees, and they shall not use keys to open work areas for personnel other than 31 MDG employees engaged in performance of their duties, unless authorized by the government functional area chief.

1.4.10.5. Traffic Laws. The contract Referral Manager shall comply with the installation traffic code as specified in AFI 91-207, USAF Traffic Safety Program, USAFE Supplement to AFI 91-207, and local traffic instructions.

1.4.10.6. SMOKING IN USAFE FACILITIES. The Contractor is advised that the Commander has placed restrictions on the smoking of tobacco products in USAFE facilities. AFI 40-102, Tobacco Use in the Air Force, and its AETC Supplement 1, outline the procedures used by the commander to control smoking in our facilities. Contract Referral Manager employees and visitors are subject to the same restrictions as government personnel. Smoking is permitted only in designated smoking areas.

1.4.10.7. GENERAL USE AND DISCLOSURE PROVISIONS. Except as otherwise limited in this Contract, the Contract Referral Manager may use or disclose Protected Health Information on behalf of, or to provide services to, the Government for the following purposes, if such use or disclosure of Protected Health Information would not violate the Privacy Rule or the Department of Defense Health Information Privacy Regulation if done by the Government:

1.4.10.7.1. To carry out treatment, payment and health care operations as provided in Sec. 164.502;

1.4.10.7.2. To individually of protected health information about them as provided in Sec. 164.502;

1.4.10.7.3. For the facility's directory or to persons involved in the individual's care or other notification purposes as provided in Sec. 164.510;

1.4.10.7.4. For national security or intelligence purposes as provided in Sec. 164.512(k)(2);

1.4.10.7.5. To correctional institutions or law enforcement officials as provided in Sec. 164.512(k)(5).

1.4.10.8. SPECIFIC USE AND DISCLOSURE PROVISIONS:

1.4.10.8.1. Except as otherwise limited in this contract, the contract Referral Manager may use Protected Health Information for the proper management and administration of the Contract Referral Manager or to carry out the legal responsibilities of the contract Referral Manager.

1.4.10.8.2. Except as otherwise limited in this contract, the Contract Referral Manager may disclose Protected Health Information for the proper management and administration of the Contract provided that disclosures are required by law, or the Contract Referral Manager obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and used or further disclosed only as required by law or for the purpose for which it was disclosed to the person, and the person notifies the Contract Referral Manager of any instances of which it is aware in which the confidentiality of the information has been breached.

1.4.10.8.3. Except as otherwise limited in this contract, the Contract Referral Manager may use Protected Health Information to provide Data Aggregation services to the Government as permitted by 45 CPR 164.504(e)(2)(i)(B).

1.4.10.8.4. Contract Referral Manager may use Protected Health Information to report violations of la\V to appropriate Federal and State authorities, consistent with 45 CFR 164.502G)(l).

1.4.10.8.5. Terms used, but not otherwise defined, in this performance work statement shall have the same meaning as those terms in 45 CFR 160.103 and 164.501, attachment 1.

1.4.10.8.5.1. The Contract Referral Manager agrees to not use or further disclose Protected Health Information other than as permitted or required by the Contract or as Required by Law.

1.4.10.8.5.2. The Contract Referral Manager agrees to use appropriate safeguards to prevent use or disclosure of the Protected Health Information other than as provided for by this contract.

1.4.10.8.5.3. The Contract Referral Manager agrees to mitigate, to the extent practicable, any harmful effect that is known to the Contract Referral Manager of a use or disclosure of Protected Health information by the Contract Referral Manager in violation of the requirements of this Contract.

1.4.10.8.5.4. The Contract Referral Manager agrees to report to the Government any use or disclosure of the Protected Health Information not provided for this Contract.

1.4.10.8.5.5. The Contract Referral Manager agrees to ensure that any agent, including a subcontract Referral Manager, to whom it provides Protected Health Information received from, or created or received by the Contract Referral Manager on behalf of the Government, agrees to the same restrictions and conditions that apply through this Contract to the Contract Referral Manager with respect to such information.

1.4.10.8.5.6. The Contract Referral Manager agrees to provide access, at the request of the Government, and in the time and manner designated by the Government, to Protected Health Information in a Designated Record Set, to the Government or as directed by the Government, to an individual in order to meet the requirements under 45 CFR 164.524.

1.4.10.8.5.7. The Contract Referral Manager agrees to make agreement(s) to Protected Health Information in Designated Record Set that the Government directs or agrees to pursuant to 45 CFR 164.526 at the request of the Government or an Individual, and in the time and manner designated by the Government.

1.4.10.8.5.8. The Contract Referral Manager agrees to make internal practices, books, and records relating to the use and disclosure of Protected Health Information received from, or created or received by the Contract Referral Manager on behalf of the Government, available to the Government, to at the request of the Government to the Secretary, in a time and manner designated by the Government or the Secretary, for purposes of the Secretary determining the Government's compliance with the Privacy Rule.

1.4.10.8.5.9. The Contract Referral Manager agrees to document such disclosures of Protected Health Information and information related to such disclosures as would be required for the Government to respond to a request by an individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

1.4.10.8.5.10. The Contract Referral Manager agrees to provide to the Government or an Individual, in time and manner designated by the Government, information collected in accordance with this Clause of the Contract, to permit the Government to respond to a request by an individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

1.4.10.9. OBLIGATIONS OF THE GOVERNMENT: Provisions for the Government to Inform the Contract Referral Manager of Privacy Practices and Restrictions.

1.4.10.9.1. Upon request, the Government shall provide the Contract Referral Manager with the notice of privacy practices that the Government produces in accordance with 45 CFR 164.520, as well as any changes to such notice.

1.4.10.9.2. The Government shall provide the Contract Referral Manager with any changes in, or revocation of, permission by Individual to use or disclose Protected Health Information, if such changes affect the Contract Referral Manager's permitted or required uses and disclosures.

1.4.10.9.3. The Government shall notify the Contract Referral Manager of any restriction to the use or disclosure of Protected Health Information that the Government has agreed to in accordance with 45 CFR 164.522.

1.4.10.10. PERMISSIBLE REQUESTS BY THE GOVERNMENT: The Government shall not request the Contract Referral Manager to use or disclose Protected Health Information in any manner that would not be permissible under the Privacy Rule if done by the Government, except for providing Data Aggregation services to the Government and for management and administrative activities of the Contract Referral Manager as otherwise permitted by this clause.

1.4.10.11. TERMINATION:

1.4.10.11.1. A breach of contract by the Contract Referral Manager of this clause, may subject the Contract Referral Manager to termination under any applicable default or termination provision of this Contract.

1.4.10.11.2. Effect of Termination

1.4.10.11.2.1. If this contract has records management requirements, the records subject to the Clause should be handled in accordance with the records management requirements. If this contract does not have records management requirements, the records should be handled in accordance with paragraphs below:

1.4.10.11.2.1.2. If this contract does not have records management requirements, except as provided in the paragraph above, upon termination of this Contract, for any reason, the contract Referral Manager shall return or destroy all Protected Health Information received from the Government, or created or received by the contract Referral Manager on behalf of the Government. This provision shall apply to Protected Health Information that is in the possession of subcontract Referral Managers or agents of the Contract Referral Manager. The Contract Referral Manager shall retain no copies of the Protected Health Information.

1.4.10.11.2.1.3. If this contract does not have records management provisions and the Contract Referral Manager determines that returning or destroying the Protected Health Information infeasible, the Contract Referral Manager shall provide to the Government notification of the conditions that make return or destruction infeasible. Upon mutual agreement of the Government and the Contract Referral Manager that return or destruction of Protected Health Information is infeasible, the Contract Referral Manager shall extend the protections of this Contract to such Protected Health Information and limit further uses and disclosures of such Protected Health Information to those purposes that make the return or destruction infeasible, for so long as the Contract Referral Manager maintain such Protected Health Information.

2. SERVICES SUMMARY:

PERFORMANCE

OBJECTIVES

PWS Paragraph Performance Threshold

Remedies

Duties performed with the CLR process

1.2.2 No more than 2

instances of supervisor intervention to initiate work per month

If more than 2 instances of supervisor intervention are required, then it will be reported in the monthly evaluation

Complies with professional conduct

1.2.4 & 1.4.3.3 Zero violations are standard

If professional conduct standards are not met, the 31 MDG will coordinate a formal meeting with the Contracting Office and the RM, and violations will be reported in the monthly evaluation

Complies with data access requirements

1.2.5 No more than 2

instances of supervisor intervention to initiate work per month

If more than 2 instances of supervisor intervention are required, then it will be reported in the monthly evaluation

Maintains patient 1.2.6 – 1.2.11 & Standard is zero If Referral Manager breaches patient privacy/confidentiality and processes patient specialty care referrals in a timely manner

1.4.10.7 – 1.4.10.8 breaches of privacy (May exceed by actively preventing violations).

privacy/ confidentiality the CO long with the 31 MDG HIPAA Privacy Officer will have to determine what actions to be taken on a case to case determination. Violations will be reported in the monthly evaluation

Adheres to specialty referral guidelines

1.2.7 No more than 3

instances of violating established referral guidelines

If more than 3 instances of violating established referrals are reported, then it will be reported in the monthly evaluation

Available for work at the appointed times.

1.4.2 No more than 3

instances of tardiness or leaving early in a quarter

If more than 3 instances of tardiness or leaving early in a quarter are reported, then the Contracting Officer will have to calculate the percentage to be deducted on the monthly fee and it will be addressed in the monthly evaluation

Hygiene and grooming meet hospital standards.

1.4.3.3

No more than 3 valid customer complaints.

If more than 3 valid customer complaints are received, then 31 MDG must meet with contractor to explain what is expected when referring to hygiene and grooming in an hospital environment. It will be reported in the monthly evaluation

Maintains professional manner and displays

1.4.3.3 No more than 3 valid

customer complaints.

If more than 3 valid customer complaints are received, then 31 MDG will coordinate a meeting with the Contracting Office and the contractor to explain what professional manner and displays are expected when dealing with patients. It will be reported in the monthly evaluation

Adheres to on-call availability and provision of

1.4.2.4 No more than 2

unplanned absences per quarter

If more than 3 valid customer complaints are reported, then it will be addressed in the monthly evaluation

Maintains appropriate DoD, AF and/or State licensure and registration

1.3.2 Mandatory prior to

performance of duties

If not provided by award date then the individual must present the licensure and registration within 30 days from date of award. If individual exceeds the indicated 30 days, then the individual will not be allowed to perform the required service until the documentation is presented

Completes all in-processing and out-processing, as well as job-specific data training as required by 31 MDG

1.4.7 Mandatory for initial &

maintaining job performance. RM will complete all applicable parts of the most recent 31 MDG in- and out-processing checklist

The RM must complete in-/out-processing, and attend the training within 30 days from start date. 31 MDG will not allow individual to perform the required duties until training is completed

2.1. METHODS OF SURVEILLANCE: A strategy, methods and tools the multi-functional team will use to assess the contractor's performance against the performance thresholds identified in the contract, specifically the service summary

2.1.1. CUSTOMER COMPLAINTS:

2.1.1.1. Written instructions and customer training to each organization receiving the contractor’s service.

Instructions and training should cover the format and content of the program and service to be surveyed: the action that may be expected from the COR, contract administrator, and contracting officer as a result of the complaints; and the limitation on the customers dealing with contractor personnel.

2.1.1.2. A point of contact (POC) must be designated to collect and determine the validity of all customer complaints, Customer Complaint Record, or a locally devised form may be used. All complaints and any resulting resolution of such complaints must be documented with the information required on the Customer Complaint Record. Customer complaint forms become permanent part of surveillance records. When a customer complaints are recorded, the POC must validate it within 2 hours and inform the Contractor within 4 hours. The Contractor must take corrective action within 1 day or if the Contractor disagrees with the customer complaint, he/she must inform the contracting officer for resolution of the complaint.

2.1.1.3. Tasks shown in the Services Summary as being surveyed by the customer complaint have no maximum payment percentage calculations. The customer complaints may be used as the basis for actions (other than payment deduction) against the contractor. In such cases, FAR clause 52.246-4, Inspection of Services, becomes the basis for the contracting officer’s actions.

2.1.2. RANDOM SAMPLING:

2.1.2.1. This is an appropriate method for frequently recurring tasks. The typical use of this surveillance method is lot size sampling. Initially, the 31 MDG POC will evaluate randomly selected samples of the activity to determine the acceptability of the entire requirement. This method of surveillance reduces the time spent on surveillance duties, and yet it still gives a reasonably accurate picture of a service’s overall acceptability. The Government will periodically evaluate the contractor Referral Manager performance by appointing a representative(s) to monitor performance to ensure services are received. The Government representative will evaluate the contracted Referral Manager performance through inspections of medical care documentation coding and requested reports and receive and investigate all complaints from base personnel. The Government may respect each task as completed or increase the number of quality assurance inspections if deemed appropriate because of repeated failures or because of repeated customer complaints. Likewise, the Government may decrease the number of quality assurance inspections of performance dictates. The Government contracting officer shall make a final determination of the validity of customer complaints.

2.1.2.2. If any of the services do not conform to contract requirements, the Government may require the contracted Referral Manager to perform the services again in conformity with contract requirements, at no cost to the Government. When the defects in services cannot be corrected by re-performance, the Government may -

2.1.2.2.1. Require the contracted Referral Manager to take necessary actions to ensure that future performance conforms to contract requirements; or

2.1.2.2.2. Reduce the contract price to reflect the reduced value of the services performed.

3. GOVERNMENT-FURNISHED PROPERTY AND SERVICES:

3.1. Equipment. Contracted Referral Manager shall have joint use of all available equipment for performing services on this contract, and ensure all equipment is properly cleaned and stored at the end of each work shift. In addition, they will ensure preventive maintenance on equipment is scheduled.

3.1.1. Personal Protective Equipment (PPE). The Government will furnish the contractor provider with appropriate PPE. The Government will be responsible for any repair, cleaning and inventory required for the PPE. This does not include any type of uniform or laboratory coat.

3.1.2. Identification Credentials. The MTF will provide each contractor provider with all required identification media.

3.1.3. Forms. The MTF will provide required Government forms used in the performance of services.

3.1.4. Supplies. The MTF will provide medical and non-medical supplies commonly used in the facility for the care and management of patients and the performance of the requirements of this contract.

3.1.5. Utilities. For the purpose of this contract, the Government will furnish all required utilities (such as water, telephone, electricity etc.) at no cost to the contracted Referral Manager. Long distance and Defense Switched Network (DSN) telephone services will be provided for use only in the lines of duties. The contractor shall participate in government energy conservation program.

3.2. SERVICES.

3.2.1. Administrative Support. The MTF will provide normal office administrative support services, to include telephone and utilities.

3.2.2. Patient Scheduling. Clinic personnel will assist in patient scheduling. Complete administrative control of the patient shall remain with the Government.

3.2.3. The MTF will provide Life Saving training through the Military Training Network.

3.3. CONTRACTOR FURNISHED ITEMS AND SERVICES. Except for these items or services specifically stated above to be Government furnished, the contracted Referral Manager shall furnish everything required to perform this contract in accordance with all its terms and conditions.

4. GENERAL DEFINITIONS:

4.1. Chief of Medical Staff (SGH): the Chief/Director of the MTF medical service for whom contracted providers are acquired, or his designated representative. Also referred to as the FAC.

4.2. Composite Health Care System (CHCS) Computer: system, which stores clinical and administration data. This system provides on-line communication for users in any supported location.

4.3. Contracting officer (CO): a duly appointed person with the authority to enter into, administer, and/or terminate contracts and make related determination and findings on behalf of the Government.

4.4. Credentials: certified documents providing evidence of education, training, licensure, board certification, experience and expertise of a health care provider.

4.5. Defective service: A service output that does not meet the standard of performance specified in the contract for that service. The method of surveillance for each performance objective is listed in the Services Summary.

Defective services will be determined by either customer complaint or periodic inspection. A defect may be either an unsatisfactory inspection report or a customer complaint, which addresses unacceptable tum-about times or errors in reports.

4.6. Exposure-prone procedure: A certain invasive surgical or dental procedure that has been implicated in the transmission of the hepatitis-B virus from an infected health care worker to a patient. Characteristics of exposure-prone procedures include digital palpation of a needle tip in a body cavity or the simultaneous presence of the health care worker's fingers and a needle or other sharp instrument or object in a poorly visualized or highly confined anatomic site.

4.7. Freedom of Information Act (FOIA) request: A written request for DoD records made by any person, including a member of the public, an organization, or a business that either explicitly or implicitly involves the FOIA, DoD Directive 5400.7.

4.8. Functional Area Chief (FAC): A generic term used interchangeably to refer to the Functional Commander, the Chief of Service, designated Quality Assurance personnel or Technical Representative of the Contracting Officer.

4.9. Full Reimbursement Rate: A rate, which is set annually by Congress, for reimbursement by non-eligible personnel who receive medical services at the MTF. This is a flat rate set for outpatient and inpatient care.

4.10. Functional Request: A written request for DoD records made by any person, including a member of the public, an organization, or a business that either does not cite the FOIA or Privacy Act. This does not include requests from Government employees with a need-to-know to perform official Government business.

4.11. Health care provider: Any contract health care professional who, under regulations of a Military Department, is granted clinical practice privileges in a military MTF, Dental Treatment Facility, or who is licensed or certified to perform health care services by a Governmental board or Agency, or professional health care society or organization.

4.12. Individual: has the same meaning as the term "individual" in 45 CFR 164.501, and shall include a person who qualifies as a personal representative in accordance with 45 CFR 164.502(g).

4.13 Invasive medical procedure: Any procedure that involves a puncture of the skin, the insertion of an instrument or foreign material into the body, or breaking of the mucosal lining of the body.

4.14. Privacy Act Request: A written request from the subject of the records or a request with the subject's written consent.

4.15. Privacy Rule: means the Standards for Privacy of Individually Identifiable Health Information at 45 CFR part 160 and part 164 subpart A.

4.16. Protected Health Information: has the same meaning as the term "protected health information" in 45 CFR 164.501, limited to the information created or received by the Contract Referral Manager from or on behalf of the Government.

4.17. Quality assurance: A planned and systematic pattern of all actions necessary to provide confidence that adequate technical requirements are established, products and services conform to established technical requirements, and satisfactory performance is achieved. For purposes of this contract, quality assurance refers to actions by the government.

4.18. Required by Law: has the same meaning as the term "required by law" in 45 CFR 164.501.

4.19. Secretary: means the Secretary of the Department of Health and Human Services or his/her designee.

4.20. Valid license: A grant of permission by an official agency of the District of Columbia, a state, or territory of the United States, to provide earn independently as a health care professional. Licenses must be current to be valid.

Some jurisdictions issue no-fee licenses to federal employees or military personnel. These are acceptable if the issuing authority will exercise professional regulating control over individuals with these licenses.