Attchment 1-PWS.pdf

PERFORMANCE WORK STATEMENT

USMTM COMMUNITY CLINIC (UCC)

15 February 2021

SECTION 1

1. GENERAL REQUIREMENTS:

1.1. SCOPE OF WORK: The Contractor shall provide trained full time equivalent (FTE) medical personnel to provide on-site outpatient medical assessment and treatment at the UCC, Riyadh KSA for the United States Military Training Mission and its Mission Partners.

1.2. OVERVIEW: This is a non-personal services contract and all personnel performing under this contract shall remain employees of the Contractor and are not employees of the US Government. All such persons shall be under the control and supervision of the Contractor at all times. The Contractor shall provide sufficient personnel who meet all requirements herein and who can be relied upon to perform in strict accordance with the contract. Performance shall be in accordance with the standards contained in this Performance Work Statement (PWS). The contract personnel shall perform all services in accordance with the ethical, professional and technical standards defined in the standards of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The contract personnel shall be required to comply with regulations governing provider credentialing, privileging and professional performance, and demonstrate competence and be USMTM Medical Director approved. The contractor shall provide these services to eligible beneficiaries of the military health care system who present themselves for treatment (the services provided shall be at no expense to the beneficiaries). The Contractor shall not hire any person whose employment would result in a conflict of interest under applicable US Government laws and regulations.

Contract performance shall not begin until after the pre-performance meeting and a Notice to Proceed (NTP) is received by the contractor. Contract performance shall being no later than 28 June 2021.

2. PERSONNEL:

2.1. PHYSICIAN: Available during normal working hours of 0800 – 1700 Sunday through Thursday with an hour lunch break. Shall be able to read, write, speak, and understand English fluently. Clinical duties include routine care, sick call, physical examinations, urgent and emergency care. Responsible for arranging appropriate specialty referrals when needed. Shall proactively monitor patients for preventative health risks and discuss healthy lifestyle changes as warranted. Shall proactively monitor patients with high-risk, chronic conditions including but not limited to diabetes, heart disease, and asthma. Shall perform minor surgical procedures such as mole/cyst removal, cryotherapy of warts, suturing of lacerations. Shall prescribe medications compatible with the UCC formulary. Shall possess sufficient initiative, interpersonal relationship skills and social sensitivity such that he/she can relate constructively to a variety of patients from diverse backgrounds. In the course of his/her duties, the physician shall relate to the soldier, other military health care workers, and often to the unit authorities of the soldier. In event of a mass casualty situation, the contract physician shall assistance the UCC medical team. Physicians shall have no more than 3 valid defects per month for any combination of the requirements stated above.

2.1.1. The Contractor shall provide FTE physicians who have successfully attained a

Doctor of Medicine (M.D.) degree, a Doctor of Osteopathy (D.O.) degree or a Bachelor of Medicine and Basic Surgery (M.B.B.S.) degree from a medical school appropriately accredited through a formal process that uses criteria comparable to those established for U.S. medical schools by the Liaison Committee on Medical Education (LCME) or that uses other globally accepted criteria, such as those put forth by the World Federation for Medical Education (WFME). The physician the Contractor provides shall have been classified and registered by the Saudi Commission for Health Specialties and actively practicing at the professional rank of General Practice for a minimum of two years, or who have been classified and registered by the Saudi Commission for Health Specialties at the professional rank of Resident, Registrar, Senior Registrar, or Consultant. The physician is required to have obtained the Saudi Specialty Certificate in General Practice, a Branch Specialization, or a Subspecialty as outlined in the Guideline of Professional Classification and Registration For Health Practitioners published by the Saudi Commission For Health Specialties.

2.1.2. Shall have a current Basic Life Support (BLS), Advance Cardiac Life Support

(ACLS), and Prehospital Trauma Life Support (PHTLS) certification. These certifications shall be maintained in a current status at all times while performing services under this contract.

2.1.3. The physician providing services under the terms and conditions of this contract shall have their credentials reviewed by the UCC Medical Director or designated alternate, and are granted clinical privileges by the UCC Medical Director in accordance with UCC regulations before commencement of services. Actions to limit, suspend, or revoke clinical privileges shall be recommended by the UCC Medical Director and approved by the CO. The Contractor and the Contractor physician do not have the right to appeal a limitation, suspension, or revocation decision. If there are adverse actions on the physician providing services under this contract, which in any way limits his/her privileges, the Government reserves the right to require performance by a physician who is fully privileged. Failure to meet the privileging requirements does not relieve the Contractor from the responsibility of insuring that required services are performed.

2.1.4. Applications for clinical privileges shall be submitted as soon as possible before performance start date. The Contractor shall submit the required documentation listed below through the CO to the UCC Medical Director. Copies of the required forms will be provided for the contractor's use and may be reproduced for obtaining privileges.

With the advice of the UCC Medical Director, or their designated Alternate, credentials will be approved or disapproved and delineation of privileges within 15 calendar days after receipt of complete documentation. The contractor shall ensure that a physician who has been granted privileges is available to begin performance within 14 calendar days after notification of approved privileges by the CO.

2.1.5. Should the Contractor be asked to add additional physicians during the contract period; the same credentialing process shall apply for any UCC additional physicians.

No contract physician shall provide services under this contract without prior approval of the Medical Director or designated alternate. The Contractor shall submit completed credentials packets for any additional providers 45 calendar days prior to projected start date. Incomplete credentials packets may be returned without action.

2.1.6. Presentation of a physician to the UCC by the Contractor shall, on a continuous basis, constitute evidence that the contractor has investigated and verified all information presented to the UCC for the purpose of physician credentialing. During the term of the contract, the Contractor shall notify the CO within 24 hours upon becoming aware of any information which may compromise a contract physician's credentials at the UCC. This shall include, but is not limited to, information linking a contract physician with chemical dependence, misdemeanor, felony, or medical malpractice. This information shall be reviewed by the COR and may result in the rescinding of credentials. The UCC Medical Director or designated alternate are the sole personnel authorized to recommend to the CO that a particular contract physician be granted privileges.

2.1.7. If the credentials of any physician are revoked, he/she shall not be permitted to continue practicing medicine at the UCC. Such action will not relieve the Contractor from responsibility to perform the services required by this contract.

2.1.8. If the physician is unable to perform required duties for any reason, the contractor shall provide a temporary replacement within 24 hours. This replacement shall provide limited support during UCC operations until such a time the normal physician is able to return to work, or a full time replacement can be properly credentialed and vetted by the UCC Medical Director or designated alternate.

2.1.9. The Contractor shall provide Physicians based on the following set of manning ratios, which may be adjusted up or down throughout the life of the contract based on mission needs.

2.1.9.1. Manning Ratios:

2.1.9.1.1. 1-400 Personnel – 1 FTE Physician

2.1.9.1.2. 401-800 – 1 FTE Physicians

2.1.9.1.3. 801-1200 – 1 FTE Physicians

2.2. NURSE: The Contractor shall provide FTE nurses who possesse excellent English speaking and writing skills. They must be licensed to clinically practice their health specialty within the Kingdom of Saudi Arabia as identified in the Guideline of Professional Classification and Registration for Health Practitioners published by the Saudi Commission for Health Specialties. They shall remain competent, qualified and adequately trained to perform assigned duties. The UCC Medical Director shall be subject to administrative oversight, but retains no control over professional aspects of the services rendered by the contract physician and nurse. The Contracting Officer (CO), USMTM Contracting, will maintain contract oversight and will be the final approval authority for all contract related matters. Nurses shall have no more than 3 valid defects per month for any combination of the requirements stated above.

2.2.1. Available during normal working hours of 0800 – 1700 Sunday through Thursday with an hour lunch break. Shall be able to read, write, speak, and understand English.

The Contractor shall provide a nurse who has successfully attained a Bachelor of Science or Arts in Nursing Degree (B.S.N. or B.A.N.) or Master of Science in Nursing from an appropriately accredited nursing school. The nurse the Contractor provides shall be BLS and ACLS trained and certified. The nurse the Contractor provides shall have been classified and registered by the Saudi Commission for Health Specialties.

The nurse the Contractor provides shall have had at least 1 year of licensed clinical experience. Activities are to provide direct patient care, such as obtaining vital signs, documenting a brief history in the medical chart, and informing physicians of any severely ill individuals who need quick attention. Gives SQ/IM medications and starts and monitors administration of IV fluids and IV medications. Assists the physician with surgical procedures. Provides patient education as needed. Serves as a chaperone as needed. In the event of a mass casualty situation, the nurse shall provide assistance to the UCC medical team.

2.2.2. If the nurse is unable to perform required duties for any reason, the contractor shall provide a temporary replacement within 24 hours. This replacement shall provide limited support during UCC operations until such a time the normal nurse is able to return to work, or a full time replacement can be properly credentialed and vetted by the UCC Medical Director or designated alternate.

2.2.3. The Contractor shall provide Nurses based on the following set of manning ratios, which may be adjusted up or down throughout the life of the contract based on mission needs.

2.2.3.1. Manning Ratios:

2.2.3.1.1. 1-400 Personnel – 1 FTE Nurse

2.2.3.1.2. 401-800 – 2 FTE Nurses

2.2.3.1.3. 801-1200 – 2 FTE Nurses

2.3. PHARMACIST: The Contractor shall provide FTE pharmacists who are available to work 0800 – 1700 Sunday through Thursday. Shall be able to read, write, speak, and understand English. The Contractor shall provide a pharmacist or pharmacists who have successfully attained a Bachelor of Pharmacy, Master of Pharmacy or Doctor of Pharmacy degree from an appropriately accredited pharmacy school. The pharmacist or pharmacists the Contractor provides shall be BLS trained and certified. The pharmacist or pharmacists the Contractor provides shall have been classified and registered by the Saudi Commission for Health Specialties at the professional rank of Pharmacist, Senior Pharmacist or Consultant Pharmacist. The pharmacist will dispense medication / supplies to a valid provider request.

The pharmacist will clarify prescriptions that appear inconsistent with recommended usage and amount as well as notify provider of interactions with other medications the patient is taking. The pharmacist will maintain the formulary, assuring sufficient in-dated stock, regularly inventory medication / supplies, report weekly on stock levels, notify staff of critical shortages, and assist and facilitate obtaining replacement medications / supplies locally. Contractor will manage destruction of expired medications, including controlled medications, per their facilities procedures. Pharmacists shall have no more than 3 valid defects per month for any combination of the requirements stated above.

2.3.1. Manning Ratios:

2.3.1.1. 1-400 Personnel – 1 FTE Pharmacist

2.3.1.2. 401-800 – 1 FTE Pharmacist

2.3.1.3. 801-1200 – 1 FTE Pharmacist

3. PERSONNEL HEALTH REQUIREMENTS: The expense for all physical examinations and immunizations required under the provisions of this paragraph shall be borne by the contractor.

3.1. All Contractor personnel performing direct health care services under this contract shall receive a general physical examination prior to commencement of services. The Contractor shall provide the COR, 10 calendar days before beginning services under this contract, a physical examination certificate for UCC individual direct health care provider who will provide services. The certification shall state the date on which the physical examination was completed, the name of the physician who performed the examination, and a statement concerning the physical health of the individual. The physician who performed the examination shall sign this certification. The physical examination shall have occurred within the prior year before beginning services and the certification shall state the Contractor personnel has had no significant changes in his/her health since his/her last physical examination. The physical examination shall include the following:

3.2. Test for the antibody to HIV (Human Immunodeficiency Virus) with documented results of the test.

3.3. A history to show that direct health care provider has completed a primary series of immunization with tetanus and diphtheria toxoids and that a booster dose is current (within the past 10 years).

3.4. A test for the hepatitis (Type B) virus with documentation of the results. A profile shall be established to show immune status to hepatitis. Non-immune health care workers (lacking anti-HB(c) or anti-HB(s)) shall be required to complete an immunization series with a Hepatitis-B vaccine (e.g., Recombivax, Engerix).

3.5. The physical examination shall also document serologic evidence of immunity to measles and rubella or provide documentation of immunization with measles, mumps and rubella (MMR) vaccine using the following guidelines:

3.6. Employees born before 1957 will be considered immune for MMR.

3.7. Employees born in or after 1957 who have received one dose of MMR previously shall receive one booster dose.

3.8. Employees born in or after 1957 without documentation of any previous vaccination with

MMR should receive two doses of vaccine, separated by no less than one month.

3.9. Any contractor personnel with signs or symptoms consistent with Tuberculosis (TB) infections such as chronic cough, unexplained weight loss, fatigue, night sweats and etc.

should undergo a chest x-ray and sputum test analysis. All contractor personnel should undergo an annual tuberculosis screening questionnaire. If indicated, those who have not received the Bacillus Calmette-Guerin (BCG) vaccination should undergo tuberculosis skin testing, and those who have received the BCG vaccination or had a prior positive response to tuberculosis skin testing should undergo a chest x-ray.

3.10. All contractor personnel performing direct health care services under this contract, who experience a parenteral (e.g., needle-stick or cut) or mucous membrane exposure (e.g., splash to the eye or mouth) to blood or bloody body fluids, shall receive prompt treatment. The medical treatment facility - UCC will evaluate the source of exposure for risk of Hepatitis-B, Hepatitis-C, and Human Immunodeficiency Virus (HIV) and will provide appropriate counseling to the potentially exposed medical provider. The UCC will offer post exposure chemoprophylaxis counseling to prevent HIV. The initial dose is currently recommended within 2 hours after exposure. If necessary, this can be considered an emergency and the initial dose provided with follow-up doses given by the provider’s medical support element. It shall be the contractor's responsibility to provide appropriate treatment as needed to possibly include Tetanus- Diphtheria booster, Immune Globulin, Hepatitis-B vaccine booster, or Hepatitis-B Immune Globulin. The contractor shall be responsible for providing the contract employee with initial testing and if the source of exposure was unknown, positive, or considered at high risk for HIV infection, follow-up testing 3, 6, and 12 months after exposure. In the event of a confirmed or highly suspected parenteral exposure to HIV, the contractor shall insure that the contract provider receives appropriate counseling and is referred immediately to an infectious disease specialist for consideration of any therapy. The Government may require the contractor to provide evidence of the status of treatment and testing of the individual provider under the contract.

3.11. All contract personnel shall receive the current influenza immunization by 1 January of each year unless contraindicated by allergy to eggs. The contractor shall provide the COR a certification 10 calendar days after immunization is completed. The certification shall state the date on which the influenza immunization was completed and the name of the physician who provided the immunization.

3.12. AUTHORIZED MEDICAL ABSENCE

3.13. Failure to meet the requirements stated herein, or when test results determine a contract provider has a contagious disease, the contracting officer may, upon the advice of the military clinical staff, determine that such provider is not an acceptable individual to perform services under this contract.

3.14. Backup personnel shall be required to provide equally current certification of health at the time of initial request for clinical privileges, and annually thereafter. The expense for all physical examinations required under the provisions of this paragraph shall be borne by the Contractor.

4. EMPLOYEE IDENTIFICATION: Contractor personnel shall display on duty and have on person at all other times both the Force Protection issued identification and contractor issued identification while on duty.

5. EMPLOYEE PERFORMANCE: The Contractor is responsible for providing personnel who are adequately rested and fully physically and mentally capable of performing the duties required under this contract. The Contractor shall not allow any employee to perform work under this contract who is under the influence of alcohol, drugs or any other incapacitating agents. The contract personnel must conduct themselves in a professional manner. Validated patient complaints may result in removal of the contract personnel. The contractor shall provide a suitable qualified replacement. The Contractor and his employee's shall observe the UCC Smoking/Tobacco Policy.

6. EMPLOYEE APPEARANCE: Contract personnel may wear dresses, shirts, pants or slacks, shirt or blouse with collar and sleeves, scrubs, shoes and socks. Contract physician may wear white laboratory/physician coats over civilian attire. The UCC Medical Director has the right to determine when attire does not provide a professional appearance and the right to remove contract personnel who do not maintain a professional appearance. The contractor shall provide a suitable qualified replacement.

7. SAFETY: The Contractor shall conduct activities in strict conformance with all applicable

Safety Regulations. Immediately after a job-connected injury, the Contractor shall prepare a report of the injury in accordance with the Contractor’s policy. If an injury is urgent/emergent, the contract physician may utilize UCC medical services for initial medical treatment. Any technical advice and assistance necessary for reporting and investigating accidents may be requested from the USMTM Law Enforcement Section through the COR.

8. POST SECURITY/CONTROL:

8.1. The UCC is located within a limited access compound with controlled gate openings and closures. Unscheduled gate closures by the Security personnel may occur at any time and all personnel entering or exiting the compound may experience a delay. All vehicles and personnel are subject to search and seizure upon both entering and leaving the compound and immediate UCC location.

8.2. The Contractor shall furnish a personnel list in writing to the Contracting Officer prior to commencement of work under this contract. This list will include information required by Force Protection measures of the UCC for all employees engaged in the performance of this contract. In the event of a change in employees, the Contractor shall advise the Contracting Officer of the change and shall furnish in writing, no later than five working days before the change, the same information as stated above. The contractor shall provide full coverage until all documents are approved and badges are issued.

8.3. Contract personnel operating any vehicle shall comply with all applicable regulations and policies relating to vehicle operation and registration.

8.4. Contractor-owned vehicles shall be subject to the registration and insurance requirements of Saudi Arabia.

8.5. The contractor shall not be compensated for delays due to gate closures; however, he/she will be allowed to make up the time. The personnel under this contract will be identified as mission-essential personnel.

9. SERVICES SUMMARY. The contract service requirements are summarized in performance objectives that relate directly to mission essential items. The performance threshold briefly describes the minimally acceptable levels of service required for each requirement. The Services Summary (SS) and the contractor’s Quality Control Plan provide information on contract requirements, the expected level of contractor performance and the expected method of government validation and confirmation of services provided. These thresholds are critical to mission success. Procedures as set forth in the FAR 52.212-4 (a), Contract Terms and Conditions - Commercial Items, Inspection/Acceptance, will be used to remedy all deficiencies.

During the initial 30 days of the contract, two additional errors on each work shall be allowed in an effort to identify normal phase-in problems.

Performance Objective PWS

Para Performance Threshold

Remedy Method of Assessment

SS-1

Physician

a. Available During Duty Hours

b. Read, Write, & Speak English

c. Clinical Routine Care of Patients

d. Emergency Care of Patients

e. Minor Surgery Prescribe Medications

2.1, inclusive

No more than 3 valid defects per month

5% monthly invoice deduction

Periodic Assessments

Valid Customer Complaint

SS-2

Nurse

a. Available During Duty Hours

b. Read, Write, & Speak English

c. Provide Direct Patient Care

d. Administer Medications & IVs

e. Assists Physician

2.2, inclusive

No more than 3 valid defects per month

5% Labor monthly invoice deduction

Periodic Assessments

Valid Customer Complaint

SS-3

Pharmacist

a. Available During Duty Hours

b. Read, Write, & Speak English

c. Provide Direct Patient Care

d. Administer Medications & IVs

e. Assists Physician

f. Provide Patient Education

2.3, inclusive

No more than 3 valid defects per month

5% Labor monthly invoice deduction

Periodic Assessments

Valid Customer Complaint

9.1. QUALITY CONTROL. The contractor shall provide a written description of the quality control system to include identification of commercial practices and procedures to be used. Include the inspection system requirements of FAR 52.246-4 in this document. The contractor shall develop and implement procedures to identify, prevent, and ensure non-performance and continual repeat of defective service does not occur. A written Quality Control Plan shall be submitted to the contracting officer for review and feedback. The plan shall be submitted no later than the pre-performance conference. The plan shall specifically address the contractor’s strategy to provide quality workmanship, continual process improvement and for correcting deficiencies as required.

9.2.QUALITY ASSURANCE. The government shall inspect and evaluate the contractor’s performance to ensure services are received in accordance with requirements set forth in this contract. The CO or COR shall inspect by validating actual work performance, physically checking an attribute of the completed task, checking a management information report, investigating customer complaints, conferring with facility managers, or otherwise inspecting the task or its results to determine whether or not performance meets the standards contained in this PWS. The CO or COR will use the contractor’s work schedule or modified version thereof, to record validation results. Results of the validation then become the official Air Force record of the Contractor’s performance. When a performance threshold has not been met or contractor performance has not been accomplished, the COR will initiate and provide the Contracting Officer a Performance Assessment Report (PAR) for issuance to the contractor. The contractor shall respond to the COR in accordance with the instructions provided and return it to the Contracting Officer within 10 calendar days of receipt.

9.2.1. Voluntary Protection Program. The contractor shall perform work in a safe manner as required by OSHA Safety and Health Requirements. Provide a verbal report to the CO as soon as possible of each occurrence of damage to Government property or an accident resulting in death, injury, occupational disease, or adverse environmental impact. Provide a completed copy of required Accident Investigation Reports to the CO within five calendar days of each occurrence. Detailed information on Voluntary Protection Plan (VPP) is available on the OSHA website at http://www.osha.gov/dcsp/vpp/index.html.

9.3.PERFORMANCE ASSESSMENT

9.3.1. Periodic Validations. This method requires the COR to employ a “spot check” style of evaluation based on the contractor’s schedule. Periodic validations will be conducted on a scheduled basis (daily, weekly, monthly, quarterly, semi-annual or annually) and may be adjusted, based on quality trends. Any unsatisfactory inspection (defect) result shall be recorded, and the Contractor shall re-perform the service, if possible, after notification by the CO or COR. Failing to meet the performance threshold as outlined in the SS for any of these performance objectives in any one month period shall result in: a warning or letter of concern from the CO, and applicable billing adjustment. Failing to meet the performance threshold as outlined in the SS of these performance objectives in any combination for any two, or more consecutive or non-consecutive months during a contract period shall constitute an immediate Progress Meeting with the Multi-functional Team. All remedies shall be in accordance with the FAR 52.212-4 (a), Contract Terms and Conditions - Commercial Items, Inspection/Acceptance.

9.4. PERIODIC PROGRESS MEETINGS. The CO, Functional Commander, COR, other government personnel as appropriate, and the Contractor shall periodically meet to discuss the Contractor’s performance.

http://www.osha.gov/dcsp/vpp/index.html

The following issues shall be discussed, opportunities to improve the contract, any modifications required of the contract, unsatisfactory inspections and trends against each performance objective observed, positive performance and steps taken by the Contractor to prevent unsatisfactory occurrences in the future. The Contractor shall provide a summation of unsatisfactory inspections and customer complaints and provide insight into any identified trends. A written record of these meetings shall be signed by the CO and any other signatures as deemed appropriate and distributed to the functional area and the contractor. Should the contractor not concur with the minutes, the contractor shall provide a written notification to the CO identifying areas of non-concurrence for resolution.

SECTION 2

10. DEFINITIONS: The following special terms and/or phrases are used in this Performance Work Statement:

10.1. ADVISORY DOCUMENT: Those directives, which the Contractor may use for information and guidance but are not binding for compliance.

10.2. BENEFICIARIES OF THE MILITARY HEALTHCARE SYSTEM: Those individuals entitled to care at the USMTM COMMUNITY CLINIC.

10.3. CONTRACT SPECIALIST: The official Government representative delegated authority by the

Contracting Officer to administer a contract. This individual, normally working in an appropriate Contracting/Procurement career field, advises on all technical contractual matters.

10.4. CONTRACTING OFFICER (CO/KO): A person who either by virtue of his/her position and appointment has authority to enter into and administer contracts and make determinations and findings with respect thereto. The Contracting Officer is the only person with authority to make changes to the contract and bind the Government.

10.5. CONTRACTING OFFICER'S REPRESENTATIVE (COR): An individual designated in writing by the

Contracting Officer to perform technical surveillance as specified in appointment letter.

10.6. FULL-TIME EQUIVALENT (FTE): The requirement for a single FTE on the contract can range from 1880 to 2000 total annual billable hours; therefore, total annual billable hours from 1880 to 2000 will be the standard range for an FTE of 1.0 on the contract. HCW positions with annual billable hours less than 1880 will be calculated by dividing the number of hours by 1880. For example, a physician position with 1504 billable hours would be considered a 0.80 FTE position (1504 hours /1880 hours rounded to the 1/100th decimal point). The number of FTEs for each labor category (nurse, physician, and pharmacist) will be established in the contract and calculated by dividing the annual billable hours by the contract standard range from 1880 to 2000 hours. Positions with annual billable hours within this range will be considered an FTE of 1.0.

10.7. MANDATORY DOCUMENTS: Those directives which the contractor is obliged to perform the effort strictly in accordance with. The method specified in the directives shall be performed by the Contractor to meet the stated results of the directives.

10.8. OUTCOMES MANAGEMENT: A multi-disciplinary health care delivery process, whose goals are to provide quality health care, decrease fragmentation, enhance patient care outcomes and constrain costs.

10.9. QUALITY ASSURANCE: A methodology used by the Government Contracting Officer to ensure that the quality of purchased goods and services received are acceptable and in accordance with established standards and requirements of this contract.

10.10. QUALITY CONTROL: A methodology used by the Contractor to control the quality of goods and/or services provided.

10.11. PERFORMANCE IMPROVEMENT: A systematic methodology used by the UCC to assess and improve healthcare processes and outcomes in an ongoing and continuous fashion. It includes elements of quality control and quality assurance, as well as specific management tools and techniques to achieve measurable improvement in key hospital functions and significant aspects of healthcare performance.

10.12. RISK MANAGEMENT: An element of quality assurance used by the UCC which assesses and strives to reduce the medical legal risk associated with individual cases, patterns of care, or hospital systems.

10.13. TECHNICAL LIBRARY: A library containing the technical specifications, regulations, manuals and forms identified in Section 6 of this Performance Work Statement. The Technical Library is set up and maintained by the functional area (Physical Exams Section) for use by contractors prior to award of the contract.

10.14. UTILIZATION MANAGEMENT: An element of performance improvement used by the UCC which assesses and strives to improve the effective use of hospital resources, including personnel, supplies, equipment and finances.

10.15. ACRONYMS: The following acronyms are used in this Performance Work Statement.

ACLS Advance Cardiac Life Support BCG Bacillus Calmette Guerin BLS Basic Life Support CME Continuing Medical Education CO/KO Contracting Officer COR Contracting Officer’s Representative COTR Contracting Officer’s Technical Representative CQI Continuing Quality Improvement DOD Department of Defense ESKAN COMMUNITY CLINIC Military Treatment Facility HIV Human Immunodeficiency Virus ID Identification ISCS Inspection of Services Clause Summary JCAHO Joint Commission on Accreditation of Healthcare Organizations MOA Memorandum of Agreement PCF Provider Credentials File PHTLS Prehospital Trauma Life Support PWS Performance Work Statement QA Quality Assessment QA&I Government Quality Assessment and Improvement TRICARE Military Health Insurance RN Registered Nurse

SECTION 3

GOVERNMENT FURNISHED PROPERTY, FACILITIES AND SERVICES:

11. GENERAL: The Government shall provide the following:

11.1. Office space including desk, chairs, electricity and telephones. The Contractor shall not make any structural changes without prior approval of the COR. Structural repairs required during the term of the contract shall be reported to the COR for appropriate action. The Contractor shall reimburse the Government for repairs not attributable to fair wear and tear.

11.2. All needed computer equipment and network capability for daily operations.

11.3. All equipment and supplies deemed necessary and approved by the COR for medical care in the

Physical Exam Section shall be furnished with the exception of personal physician items shown in Section 4.

11.4. The Government shall provide all structural building maintenance and UCC housekeeping services at no cost to the Contractor.

SECTION 4

12. CONTRACTOR FURNISHED ITEMS:

12.1. The Contractor shall provide existing contractor issued identification for all personnel.

12.2. The Contractor shall ensure the physician providing medical services under this contract have his/her rubber stamp containing their full name, degree, title and company name (if applicable) or the word "Contractor". The stamp shall be placed on all forms and documentation having the physician's signature.

12.3. The Contractor shall, as appropriate, furnish white laboratory coats to be worn over civilian attire, white uniforms, hospital scrubs or other professional attire.

12.4. The Contractor shall furnish personal/professional items including but not limited to stethoscopes, reflex hammers, and penlights.

12.5. The Contractor shall provide a current identification (ID)/passport photo of all personnel performing services under this contract. Photo shall be provided to the COR within five (5) working days of a physician beginning performance on this contract.

SECTION 5

PERFORMANCE WORK STATEMENT – SPECIFIC TASKS:

13. HOURS OF OPERATION: The Contractor’s normal operating hours shall be a 5-day work week, Sunday through Thursday, to exclude legal US and Saudi Arabian holidays delineated below. Duty positions designated “day shift” shall be present in the UCC for duty between the hours of 0800 and 1700.

13.1. The United States Government and its Embassy to the Kingdom of Saudi Arabia typically observes the holidays delineated below (actual dates subject to change). The Contractor will not be expected to provide medical personnel on these holidays.

New Year’s Day January 1 Martin Luther King’s Birthday Third Monday in January President’s Day Third Monday in February Memorial Day Last Monday in May Eid al Fitr – Ramadan 5 days - varies Eid al Adha – Hajj 5 days - varies Independence Day July 4 Labor Day First Monday in September Saudi National Day 1 day - varies Columbus Day Second Monday in October Veterans Day November 11 Thanksgiving Day Last Thursday in November Christmas Day December 25

The Contractor’s workday schedule may vary by function (i.e. emergency services) as directed by the Contracting Officer. Only the Contracting Officer shall have the authority to direct or change the Contractor’s hours of operation.

14. PROVIDING PATIENT CARE:

14.1. Patients discovered during examinations or routine appointments that require urgent treatment or stabilization of any possible life threatening conditions shall be promptly transported by ambulance to the most appropriate Emergency Room available for the patient based on their medical problem, the proximity and travel time to the Emergency Room, and access to care at the Emergency Room including consideration of insurance and memorandums of agreement. Unless otherwise stated in local policy, the contract physician will accompany the patient and provide any life sustaining care required in route. Routine clinic visits will be suspended during management of the emergency response. Examples include such things as, but not limited to the following suspected diagnoses; hemorrhage, myocardial infarction, arrhythmia and cardiac vascular accident. When possible to do without delaying emergency care, the decision where the patient will be referred should be provided to the UCC Medical Director, prior or during patient transport.

14.2. Stable patients requiring admission and/or same day specialty clinic consultation shall be coordinated with the UCC Medical Director and Health Benefits Advisor (TRICARE POC). Any patient sent for urgent/emergent care or admission will immediately be identified to the UCC Medical Director or the designated Alternate. Care not requiring referral shall utilize the services available at the UCC.

14.3. Treatment of patients shall be performed at the UCC except for instances when patients are referred by

TRICARE to other medical facilities for performance of special diagnostic procedures or definitive care not offered at the UCC.

14.4. All referrals to civilian institutions or physicians for specialized diagnostic studies or definitive care not offered at UCC shall be processed through the Health Benefits Advisor (TRICARE POC). Contractor personnel are responsible for acquiring all imaging, testing and specialty provider visit reports in a timely manner, not more than 3 days after the provided services. The ordering physician will review and sign all reports. Follow-up with the patient is expected after all imaging and specialty provider visits as continuity of care is essential to standards of care.

14.5. Physicians shall become familiar with the clinic formulary and TRICARE formulary. Contract physicians authorized to prescribe pharmaceuticals shall do so according to the availability of drugs listed therein. The pharmacy services will provide instructions to all prescribing practitioners on substitutability of generic drugs for prescribed drugs. UCC pharmacy will attempt to stock and provide all necessary/suitable medications and/or alternative and/or additions, which will be approved by the UCC Medical Director or designated Alternate.

14.6. Physicians shall perform routine and annual physical examinations and may place patients on bed rest or duty restrictions.

14.7. The Contractor shall advise the COR of any problems encountered in connection with meeting the needs of patients treated by the physicians, including problems with UCC personnel.

15. PROCEDURES AND TASKS: The Contractor shall perform the following procedures and tasks:

The physicians performing under this contract shall adequately perform the following medical procedures and tasks:

15.1. Surgical debridement of minor wounds in follow-up

15.2. Wound and burn care

15.3. Suture removal

15.4. Nail trephination

15.5. Immobilization techniques of extremities/crutches

15.6. Arthrocentesis/injection of joints

15.7. Dressing changes

15.8. Minor foreign body removal (superficial, splinters etc.)

15.9. Injections - I.M./SQ

15.10. Intravenous fluid administration

15.11. ECG

15.12. Venipuncture – peripheral

15.13. BLS/ACLS procedures

16. RESTRICTIONS AND CONSTRAINTS:

16.1. The Contractor shall not employ persons convicted of violations of criminal statutes, misdemeanors, or felonies involving moral turpitude. The CO may remove from the job site any contract employee who endangers persons or property, whose continued employment is inconsistent with the interest of military security or who is found to be incapacitated or under the influence of alcohol, drugs or other substances.

Removal of employees for any reason does not relieve the Contractor of the requirement to perform services specified herein.

16.2. The Contractor shall not employ any DOD employee, to provide healthcare under this contract.

16.3. The Contractor and their physicians shall not bill a patient, an insurer, or anyone else for services. The only compensation that the contractor is entitled to for performance of the contract is payment as the contract specifies.

16.4. With the exception of authorized referrals under this contract, the Contractor or Contractor physicians shall not, while performing services under this contract advise, recommend, or suggest to persons eligible to receive medical care at Army or Air Force expense, that such persons should receive care at any place other than at the UCC or from TRICARE approved providers.

16.5. The Contractor or contractor physicians are not prohibited because of their employment, under this contract, from conducting a separate practice, so long as there is no conflict with the performance of services under this contract.

16.6. The Contractor or contract physicians shall not make use of any Government facilities or other

Government property in connection with conducting a separate practice.

16.7. The Contractor or contract physicians shall not introduce new medical procedures or services without prior written approval of the UCC Medical Director, the designated Alternate, or TRICARE.

16.8. The Contractor, its subcontractors, and physicians are expected to exercise their independent discretion and expertise in performance of the duties and responsibilities set forth in this statement of work without direct or indirect supervision of Government personnel.

16.9. The Contractor or contract physician shall, without additional change in contract price, be responsible for obtaining any necessary licenses and permits.

17. ADMINISTRATIVE PROCEDURES:

17.1. The contract physicians are required to generate and maintain proper written and electronic medical records on beneficiaries to whom treatment is provided in accordance with established medical record administration. All records generated in the performance of the contract will remain the property of and subject to exclusive control of the U.S. Government.

17.2. The Contractor shall provide physician services only to eligible Military and Civilian personnel. It is the responsibility of the UCC to determine whether a patient is eligible to receive medical care.

18. CONTINUITY OF SERVICES:

18.1. The Contractor shall not use backup (temporary short-term) physicians on a continuous basis in the performance of this contract.

18.2. The Contractor shall assign a physician to be backup (temporary short-term) coverage who maintains

UCC privileges, appropriate compound identification, and UCC computer privileges, available at all times to cover absences of a primary physician, such as for illness or leave. All Contractor backup physicians proposed to cover during absences of the primary physicians will have to meet the same training, certification, licensure and privileged requirements as the primary physicians. Documentation on backup physicians shall be submitted, in writing, to the UCC Medical Director through the CO for approval and privileging. Credentials must be submitted no later than 30 calendar days before the backup physician(s) perform under this contract. The absence of the primary physician shall not exceed 30 days in one (1) year of the contract period.

18.3. The Contractor shall assign one nurse to be backup (temporary short-term) to the regular staff who maintain UCC privileges, appropriate compound identification, and UCC computer privileges, with one back-up nurse available at all times to cover absences of a primary nurse, such as for illness or leave. All Contractor backup nurses proposed to cover during absences of the primary nurses will have to meet the same training, certification and licensure requirements as the primary nurses. Documentation on backup nurses shall be submitted, in writing, to the UCC Medical Director through the CO for approval.

Credentials must be submitted no later than 30 calendar days before the backup nurse(s) perform under this contract. The absence of the primary nurse shall not exceed 30 days in one (1) year of the contract period.

18.4. The COR shall notify the Contractor immediately when changes develop which affect the patient scheduling.

19. ORIENTATION:

19.1. The USMTM Community Clinic Medical Director will familiarize the contract physician before such physician begins performance under this contract, with peculiarities of treating active duty soldiers and civilians to include:

19.1.1. Training on the military electronic medical record used to document encounters.

19.1.2. Profiles - Placing soldiers at bed rest or restrictions.

19.1.3. Sick Call - at specified times active duty soldiers receive priority in treatment.

19.1.4. Restrictions on treating aviation and other specialized personnel.

19.1.5. Formulary restrictions on prescriptions.

19.1.6. Other restrictions peculiar to the military environment as they arise.

SECTION 6

20. APPLICABLE TECHNICAL SPECIFICATIONS, REGULATIONS, MANUALS, AND FORMS:

Documents applicable to this Performance Work Statement are listed below. The Physical Exams Section has set up and will maintain the Technical Library for use by the contractor.

REGULATIONS

Title 10 USC, Chapter 55, Parts 1071 through 1088, 1090, 1093, 1095 and 1097 Title 5 USC, Part I, Chapter 5, Subchapter II, Section 552 Title 42 USC, Chapter 7, Subpart XI, Part C 45 CFR, Parts 160, 162 and 164, Department of Health and Human Services 29 CFR 1910, OSHA General Industry Standards DODI 6015.23, Delivery of Healthcare at Military Treatment Facilities: Foreign Service Care; Third-Party Collection; Beneficiary Counseling and Assistance Coordinators (BCACs) DODD 6025.18-R, Privacy of Individually Identifiable Health Information in DoD Health Care Programs TB MED 289, (AF, USA, Navy, DOT), Aeromedical Evacuation, A Guide for Healthcare Providers TB MED 287, Pseudofolliculitis of the Beard and Acne Keloidalis Nuchae AFI 41-115, Authorized Healthcare and Healthcare Benefits in the Military Health System (MHS) AR 40-3, Medical, Dental and Veterinary Care AFI 40-101, Health Promotion Program AR 40-501, Standards of Medical Fitness AFI 48-123, Medical Examinations and Standards AFI 48-133, Physical Examination Techniques AR 40-66, Medical Record Administration and Health Care Documentation AFI 41-210, Patient Administration Functions AFJI 48-110, Immunizations and Chemoprophylaxis AFI 48-101, Aerospace Medical Operations AFI 48-145, Occupational Health Program AFI 48-115, The Tuberculosis Detection and Control Program AFI 44-108, Infection Control Program AFI 44-157, Medical Evaluation Boards (MEB) and Continued Military Service USMTMI 30-4, Casualty Reporting MS SOP, Pharmacy Operations

TECHNICAL MANUALS

JCAHO Manual, Current Edition Lippincott Manual of Nursing Practice, Current Edition Immunization Toolkit, Current Edition

OTHER

Formulary, Current Edition

END OF SECTION