Draft Performance Work Statement Medical Physicist Survey Services.docx

PERFORMANCE WORK STATEMENT

Medical Health Physicist Survey Services

SECTION 1 GENERAL

1.1. Description of Work. The Contractor shall furnish all necessary travel, labor, materials, tools, parts required for inspection, annual radiation safety evaluation (survey) support and certified health physicist for radiology, dental and nuclear medicine physics testing. Services shall be performed at Martin Army Community Hospital, (MACH), Fort Benning, Georgia 31905.

1.2 Performance Measures. The proposed purchase order shall cover the base period of date of award through one year plus four (4) option years, in accordance with all terms, conditions, provisions, schedules, and specifications of this performance work statement.

1.2.1. Outcome. The Contractor shall perform inspections, testing and annual radiological physics surveys as required by Joint Commission (JC), the American College of Radiology (ACR), Food & Drug Administration (FDA) Occupational Safety & Health Administration (OSHA), Army Regulations (MEDCOM 40-42, TB MED 521) and Code of Federal Regulations Title 21 Subpart J that meet or exceed current standards established by JC, ACR, FDA, OSHA.

1.2.2. Standards. Services shall be performed by Contractor who is board certified in Diagnostic Radiology by the American Board of Radiology or equivalent in the appropriate disciplines of radiologic physics, including diagnostic, therapeutic, and/or medical nuclear physics or equal, who demonstrates competency in these disciplines. Certification is to be submitted with proposal.

1.2.3. How Measured. The Contractor shall furnish annual radiographic surveys as indicated noting a separate “Pass-Fail” entry in the report, or for specific instances where the item is not applicable to the make and model of the system being evaluated, a notation of “N/A” (not applicable). Each failed item shall have a concise explanation of why it failed. For mammography systems, contractor shall include necessary information to fulfill ACR accreditation requirements. The Military Treatment Facility DENTAC and Veterinarian Treatment Facility all use digital image systems to acquire images. Performance requirements shall be in accordance with the ACR standards.

1.2.4. Qualifications. Matrix of Inspection and Reporting for Diagnostic X-Ray Systems and Measurement of Assessment Criterion are identified at Technical Exhibit A.

1.2.5. For all routine scheduled inspections, the Contractor shall have at least thirty calendar days’ notice to schedule site-visit. Scheduling shall be coordinated with the Government Representative, Radiology Administrator or Radiology NCOIC at all times prior to notification of site visit to the requiring facility.

1.3 PERSONNEL QUALIFICATIONS.

1.3.1. Degree/Education: master’s degree Graduate from a college in medical physics, radiological physics, health physics, or physics accredited by the Commission on Accreditation of Medical Physics Education Programs, Inc (CAMPEP)

1.3.2. Certifications: Board eligible or board certified in diagnostic medical physics or nuclear medical physics, or therapeutic medical physics form the American Board of Radiology of medical health physics from the American Board of Medical Physics (ABMP). Experience: Three (3) years of experience as a Medical Physicist after graduation. Please provide proof of Certifications.

1.3.5.1. Personnel responsible for the inspection of x-ray emitting equipment shall provide documentation of their education, training, and experience to include a full or partial list of current facilities where they conduct tests to be determined qualified to conduct specified tests. The Health Physics Office will evaluate the prospective inspector qualifications and based on the information provided and at our discretion, the prospective inspector (s) will either be authorized to conduct the tests or denied permission to conduct the tests. This will be an on-going assessment and will be a basis for continued use. The successful contractor shall at any time submit other individuals for evaluation.

1.3.5.2. The contractor may at their discretion request that personnel in training status be authorized to conduct inspections, but these inspections shall be under the direction and supervision of an individual authorized to conduct the tests. The contractor shall also notify the Health Physics Officer/Government Representative Military Treatment Facility. Radiology Administrator of their intent to use individuals in training status prior using such individual. At the Government’s discretion we may or may not grant authorization.

1.3.5.3. For testing any modality that requires specific education, training and experience requirements shall be current, i.e., mammography and stereotactic breast biopsy. The contractor shall submit all required documentation to prove the necessary qualifications and resubmit documentation periodically as required. Please provide proof of Certifications.

1.4 PHYSICAL SECURITY.

1.4.2. The contractor representative(s) dispatched to the MTF shall report upon arrival to MACH to the Security Office to receive a Visitor badge which shall be worn for the duration of their stay on campus. The Visitor badge shall be turned in to the MACH Security office upon leaving the facility when the inspection is completed.

1.4.3. Access to Installation and Facilities: Contractor personnel are required to meet military installation access requirements. This includes personal identification (i.e., a valid current driver’s license or other U.S. state government issued identification), and for vehicle operators, having proof of current insurance and vehicle registration or a current and valid vehicle lease/rental contract. Vehicle or personal searches may be required at any time for entry, and during emergency exercises or actual emergencies, access to an installation may be restricted indefinitely with little or no notice. Access to the individual facilities will require personal identification, as well as possible additional access requirements, including issuance of a facility identification card.

1.5 QUALITY CONTROL

1.5.1 The contractor shall establish and maintain a complete Quality Control Plan to ensure that the requirements of the contract are provided as specified at Technical Exhibit A.

1.6 QUALITY ASSURANCE. The government will evaluate the contractor’s performance under this contract using the method of surveillance specified in the Quality Assurance Surveillance Plan (QASP) at Technical Exhibit B. All surveillance observations will be recorded by the government. When an observation indicated defective performance, the Government Representative will obtain the contractor’s initials on the record of observation.

1.7 HOURS OF OPERATION.

1.7.1 Normal Hours. Although MACH Department of Radiology is a facility that operates 24 hours, the Department will only be available for survey inspections during the hours of 0730 to 1700 Monday through Friday.

The facility also observes various Minimal Manning Days, when there will be reduced staff, in conjunction with Federal Holidays.

MACH observed Minimal Manning Days are updated annually. Contact the Government Representative for the current list of observed Minimal Manning Days.

1.7.2. For all routine scheduled inspections, the Contractor shall have at least thirty calendar days’ notice to schedule site-visit. Scheduling shall be always coordinated with the MTF Radiology Administrator prior to notification of site visit to the requiring facility.

1.7.2.1. Scheduling of compliance testing shall be conducted at times to be mutually agreed upon by MTF Radiology Administrator. A written report of this survey and evaluation shall be submitted to the MTF Radiology Administrator, no later than 30 days after survey completion. For all equipment requiring corrective action, or special call-back inspection, the MTF Radiology Administrator will coordinate with the contractor for necessary repairs, inspections and/or adjustments as needed. In such cases, the contractor shall provide the inspection within ten calendar days of notification by MTF Radiology Administrator.

1.7.2.2. Special Call -Back Inspections. Due to sudden failure of x-ray equipment and subsequent repairs, it may be necessary to schedule, on short notice, a “special call-back inspection” to place the equipment back in service at the earliest possible time. In such cases, the contractor shall provide the inspection within ten calendar days of notification by the Health Physics Officer/ Government Representative/MTF Radiology Administrator.

1.7.3. Emergency Services. The contractor shall be able to provide and comply with a 24-hour emergency, urgent on-site response when required.

1.8. CONSERVATION OF UTILITIES. The contractor will be required to participate in government energy conservation programs.

SECTION 2 DEFINITIONS

2.1STANDARD DEFINITIONS

Health

2.1.1. Contracting Officer (KO): A person duly appointed with the authority to enter into and administer contracts on behalf of the U.S. Government.

2.1.2. Government Representative: An individual designated by the contracting officer to act as his representative to assist in the administering a contract. The source and authority for a Government Representative are contained in the written letter of designation.

2.1.3. Customer Complaint: A means of documenting certain kinds of contract service problems. A government program that is explained to every organization that receives service under this contract which is used to evaluate contractor’s performance.

2.1.4. Defective Performance: A service output that does not meet the standard of performance associated with it in the Performance Requirements Summary (PRS).

2.1.5. Government Property: All property owned or leased to the government or acquired by the government under the terms of the contract. Government property includes both government furnished property and contractor acquired property as defined in the Federal Acquisition Regulation (FAR) 45.101.

2.1.6. Performance Requirements Summary (PRS): Identifies the key service outputs of the contract that will be evaluated by the government to assure contract performance standards are met by the contractor.

2.1.7. Quality Assurance (QA): Those actions taken by the government to assure services meet the requirements of the Performance Work Statement (PWS) and all other service outputs.

2.1.8. Quality Assurance Surveillance Plan (QASP): An organization written document used for the quality assurance surveillance. The document contains specific methods to perform surveillance of the contractor.

2.1.9. Quality Control (QC): Those actions taken by a contractor to control the performance of services so that they meet the requirement of the PWS.

SECTION 3. GOVERNMENT FURNISHED PROPERTY AND SERVICES

3.1 The government property made available under this contract shall be for use only in the performance of the resulting contract.

SECTION 4. CONTRACTOR FURNISHED ITEMS AND SERVICES

4.1 The contractor shall provide all labor and equipment necessary to perform the required services.

4.2. Additional Requirements: Non-Technical Information.

Any information observes, overhead, recorded in data obtained, or provided in reports is “FOR OFFICIAL USE ONLY” and shall not be disclosed to a third party except on the written authorization of the Government, i.e. Government Representative or the Contracting Officer or their assignee.

All contractors and or employees are expected to maintain a reasonable security posture for all information maintained in electronic format. If there is a breach in such information the contractor is responsible for notifying the Health Physics Officer/ Government Representative and Contracting Officer of such discovery.

All patient information is subject to the requirements of the Privacy Act of 1974, as well as the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Updated versions. If a patient information is observed at a medical treatment facility, the contractor personnel are obligated to comply with the requirements of these laws and not disclose this information in accordance with the HIPAA Act (June 2020).

SECTION 5. SPECIFIC TASKS

5.1 Contractor Representative Duties: The duties for the Contractor Representative are as follows:

Duties: Maintain calibration of all contracted machines and radiation sources according to accepted industry protocols and practices. Provide clinical expertise for acceptance testing, commissioning, calibration, and periodic quality assurance of contracted equipment. Measure and analyze bean data for contracted machines and assure that beam and source data are correctly entered into system and beam data is tabulated in a form that usable by technologists. Perform and direct the determination of radiation dose distributions for patients.

Meet radiation monitoring requirements, quality assurance, and safety requirements to ensure compliance with federal and Army requirements, hospital radiation safety regulations, and national standards of performance. Inspect contracted machines to include computerized tomographic (CT) units, magnetic resonance (MRI) units, mammography units, stereotactic biopsy units, gamma cameras, SPECT CT cameras, cone bean CT units, bone densitometer(s), multiple fluoroscopy units, multiple C-Arm units, multiple mini-C-Arm units, and any other additional units at the contract site according to acceptable standards and guidelines.

5.2. The contractor representatives dispatched to the MTF shall complete equipment inspections according to accepted standards for imaging equipment to include tasks listed in the matrix of inspection and reporting requirements as listed in EXHIBIT A and as included in typical Performance Testing Reports from professional Medical Physicist Services.

5.3. The contractor shall send the final Medical Physicist Services report AND the most current, updated Curriculum Vitae of the Certified Medical Physicist who performed the inspection of the equipment inspection to the Radiology Administrator within 30 days of the completed inspection. The final report shall include the following sections:

5.4. The contractor’s reporting of defects, and written report generation and submission shall include all Mammography Quality Standards Act (MQSA) inspections, reports shall be made within the specified times, and specific actions required for defects found as specified by MQSA requirements. Contractor shall provide notification to the MTF Radiology Administrator one business day of detecting deficiencies in equipment and provide immediate verbal and written notification to the onsite facility clinic personnel of such deficiencies.

5.5. All final written reports shall be submitted to the MTF Radiology Administrator, and for mammography, a copy of the final written report shall be sent directly to facility, within thirty calendar days of the completion of the test. Reports submitted to the MTF Radiology Administrator shall include summary of deficiencies, a list of all equipment tested including description/model, location, serial number, and equipment control number. Reports shall be submitted electronically in Adobe.pdf format AND in hard copy. When requested, the contractor shall provide clarification of reports within thirty calendar days of the request.

SECTION 6 APPLICABLE PUBLICATION AND FORMS

6.1. Army Regulation MEDCOM 40-42

6.2. TB MED 521

6.3. Code of Federal Regulations Title 21 Subpart J, Mammography Quality Standards Act (MQSA)

6.4. The Joint Commission

6.5. American College of Radiology (ACR)

6.6. Occupational Safety & Health Administration (OSHA)

ANTI-TERRORISM OPERATIONS SECURITY

Access and general protection/security policy and procedures. This standard language is for contractor employees with an area of performance within a DHA controlled installation, facility, or area. Contractor and all associated sub-contractors’ employees shall provide all information required for background checks to meet installation access requirements to be accomplished by installation Provost Marshal Office, Director of Emergency Services or Security Office. Contractor workforce must comply with all personal identity verification requirements (FAR clause 52.204-9, Personal Identity Verification of Contractor Personnel) as directed by DOD, DHHQ and/or local policy. In addition to the changes otherwise authorized by the changes clause of this contract, should the Force Protection Condition (FPCON) at any individual facility or installation change, the Government may require changes in contractor security matters or processes.

For contractor not eligible for CAC but requires access to DoD facility or installation.

Contractor and all associated sub-contractors’ employees shall comply with adjudication standards and procedures using the National Crime Information Center Interstate Identification Index (NCIC-III) and Terrorist Screening Database (TSDB), applicable installation, facility and area commander installation/facility access and local security policies and procedures (provided by government representative), or, at OCONUS locations, in accordance with status of forces agreements and other theater regulations.

iWATCH/Suspicious Activity Reporting Training. This standard language is for contractor employees with an area of performance within a DHA-controlled installation, facility, or area. The contractor and all associated subcontractors shall brief all employees on the local Suspicious Activity Training program (training standards provided by the requiring activity ATO). This locally developed training will be used to inform employees of the types of behavior to watch for and instruct employees to report suspicious activity to the Government Representative. This training shall be completed within 30 calendar days of contract award and within 05 calendar days of new employees commencing performance, with the results reported to the Government Representative NLT 30 calendar days after contract award.

For contracts that require OPSEC Training. Per DHA-AI 5200.03, Operations Security, the contractor employees must complete Level I OPSEC Awareness training. New employees must be trained within 30 calendar days of their reporting for duty and annually thereafter.

For Cyber Awareness (Information Assurance (IA)/information Technology (IT) training. All contractor employees and associated subcontractor employees must complete the DoD Cyber Awareness training before issuance of network access and annually thereafter. All contractor employees working IA/IT functions must comply with DoD requirements DoD 8570.01 and DoD 8570.01-M within six months of appointment to IA/IT functions. DoD Cyber Awareness Challenge Training is available at the following website:

https://jkodirect.jten.mil/Atlas2/page/login/Login.jsf?ORG=NAVSEA , DOD Course US1364-22 DOD Cyber Awareness Challenge 2022.

SECTION 7 REPORTS AND CLAUSES

DELIVERABLES

Copies

Key Personnel List

NLT 30 business days of TO award

Electronic copy via email Radiology Administrator & MACH Health Physics Officer

Initial Placement of Physicists: Qualifying Documentation (i.e., qualifying package; credentialing package)

NLT 30 days before the required start date

Electronic copy via email Radiology Administrator & MACH Health Physics Officer

Replacement of Physicists:

Qualifying documentation (i.e., qualifying package; credentialing package) NLT 15 days after vacancy occurs for non-credentialed.

Electronic copy via email Radiology Administrator & MACH Health Physics Officer

Quality Control Plan

Within 30 days of TO award

via email

Radiology Administrator & MACH Health Physics Officer

Electronic copy

Radiology Administrator & MACH Health Physics Officer

Electronic copy

Radiology Administrator & MACH Health Physics Officer

Electronic copy

Radiology Administrator & MACH Health Physics Officer

Electronic copy

Radiology Administrator & MACH Health Physics Officer

Electronic copy

Radiology Administrator & MACH Health Physics Officer

Electronic copy

Radiology Administrator & MACH Health Physics Officer

Electronic copy

Radiology Administrator & MACH Health Physics Officer

Complete Mammography (2 FFD Units, 1 Stereotactic Unit) Annual Medical Physics Surveys Annual NLT 30 days past prior inspection

Electronic copy

Radiology Administrator & MACH Health Physics Officer

Electronic copy

Radiology Administrator & MACH Health Physics Officer

Complete Fluoroscopy Unit in MACH Core Annual Medical Physics Survey Annual NLT 30 days past prior inspection

Electronic copy

Radiology Administrator & MACH Health Physics Officer

Complete Fluoroscopy Unit in Urology Clinic Annual Medical Physics Survey

Complete various C-Arm Units Annual Medical Physics Survey

Complete various Mini-C-Arm Units Annual Medical Physics Survey

EXHIBIT A MATRIX OF INSPECTION REQUIREMENTS

The following performance Matrix of Inspection and Reporting Requirements for Diagnostic X-ray System are required on this Purchase Order:

Measurement or Assessment Criterion System Applicability

Expected Reporting Documentation

Each item listed will have a separate “Pass-Fail” (or the like) entry in the report, or for specific instances where the item is not applicable to the make and model of the system being evaluate, a notation of “not applicable.” Each “failed” item will have a concise explanation of why it failed; this may be listed in the report at immediate area of the item or may be referenced and reported in a summary area of the report. As applicable, other items should be notated with concise descriptive information pertinent to the item.

For mammographic systems, include necessary information to fulfill ACR accreditation requirements.

Selected tube indication (if more than one tube in the device)

X

X

Tube centering over image receptor

Means to indicate when beam axis is perpendicular to image receptor

Exposure termination after preset time interval, mAs, or pulses

Source-to-Image Distance indication and accuracy

Means to terminate exposure at any time

X

X

X

X

X

X

X

X

X

Cumulative timer not greater than 5 minutes

Audible indicator at tube

Collimator tracks vertical lR movement

Primary barrier transmission

Matrix of Inspection and Reporting Requirements for Diagnostic X-ray Systems

System Applicability

Continuous audible sound when using high- level control

Minimum SSD appropriate for device

X

X

X

Battery charge indication

X

Six-foot exposure cord

X

Report as stated in TB MED 521, including measurement values, acceptance criteria, and whether this passed or failed the acceptance criteria. Add appropriate concise notation for items when necessary. Note whether the specific item was “not applicable” due to the specific make and model of the system being evaluated.

For mammographic systems, include necessary information to fulfill ACR accreditation requirements.

Collimation Assessment

Fulcrum height

X

Slice thickness

X

Uniformity of motion

X

Beam Alignment

High/Low Contrast values

Entrance Exposure Rates

Primary Barrier Transmission Rate

Focal Spot Performance

Automatic Exposure Control (AEC) System Performance

Uniformity of Screen Speed

System Applicability

Phantom Image Quality Evaluation

Breast Entrance Exposure, Average Glandular Dose and Output Rate

Viewbox Luminance and Room Illuminance

Digital Receptor Uniformity

X

Localization Accuracy Test

X

For mammographic systems, include necessary information to fulfill ACR accreditation requirements.

For mammographic systems, include necessary information to fulfill ACR accreditation requirements.

Include necessary information to fulfill ACR accreditation requirements for the specific modality.

X

X

Scatter radiation at Control Booth entry

Scatter radiation at boundary walls to uncontrolled areas, floor, and ceiling

Mammography- Stereotactic Breast Biopsy Unit Assembly Evaluation

Artifact Evaluation

If images are obtained during testing of a system (preferably, this should be done), a concise descriptive assessment of any identified artifacts observed should be given. Any deficiencies should be noted, along with specific corrective action recommendations that will return the program to compliance when followed.

Include necessary information to fulfill ACR accreditation requirements.

System Applicability

Site technologist’s QC Program assessment

A concise descriptive assessment of the program should be given. Any deficiencies should be noted, along with specific corrective action recommendations that will return the program to compliance when followed.

Include necessary information to fulfill ACR accreditation requirements.

Mechanical indexing Table indexing

X

Radiation Field Profile: Collimation Accuracy

Gantry Tilt Accuracy

X

Report as stated in TB MED 521, including measurement values, acceptance criteria, and whether this passed or failed the acceptance criteria. Add appropriate concise notation for items when necessary. Note whether the specific item was “not applicable” due to the specific make and model of the system being evaluated.

Table Isocenter/Sagittal Alignment Light Congruence

Isocenter Alignment

X

Accuracy of Scan Prescription from Scout Localization image

Image Scan Width Accuracy

X

CT Number Uniformity with typical measured values

Noise

X

Spatial Resolution (high and low contrast resolution)

CTDI, DLP, and Effective Dose

X

PERFORMANCE REQUIREMENTS SUMMARY (PRS)

Performance Objective Performance Standard

1. Completed Nuclear Medicine SPECT CT Medical Physics Annual Surveys Equipment surveys performed in accordance with FDA, ACR and Army regulations (MEDCOM

40-42,TB MED 521)

Completed the inspection survey

ON THE

EXPIRATION

date of inspection.

Scheduled & completed survey WELL BEFORE expiration date of previous survey.

Completed inspection AFTER previous inspection expiration date.There was a gap between surveys.

100% MACH Rep sees survey being completed; receives completed inspection report each time task is performed

inspection survey

ON THE

EXPIRATION

date of inspection.

Scheduled & completed survey WELL BEFORE expiration date of previous survey.

Completed inspection AFTER previous inspection expiration date. There was a gap between surveys.

100% MACH Rep sees survey being completed; receives completed inspection report each time task is performed

inspection survey

ON THE

EXPIRATION

date of inspection.

Scheduled & completed survey WELL BEFORE expiration date of previous survey.

Completed inspection AFTER previous inspection expiration date. There was a gap between surveys.

100% MACH Rep sees survey being completed; receives completed inspection report each time task is performed

inspection survey

ON THE

EXPIRATION

date of inspection.

Scheduled & completed survey WELL BEFORE expiration date of previous survey.

Completed inspection AFTER previous inspection expiration date. There was a gap between surveys.

100% MACH Rep sees survey being completed; receives completed inspection report each time task is performed

inspection survey

ON THE EXPIRATION

date of inspection.

Scheduled & completed survey WELL BEFORE expiration date of previous survey.

Completed inspection AFTER previous inspection expiration date. There was a gap between surveys.

100% MACH Rep sees survey being completed; receives completed inspection report each time task is performed

6. Completed Bone Densitometer Annual Medical Physics Survey.

First year = 2019

inspection survey

ON THE EXPIRATION

date of inspection.

Scheduled & completed survey WELL BEFORE expiration date of previous survey.

Completed inspection AFTER previous inspection expiration date. There was a gap between surveys.

100% MACH Rep sees survey being completed; receives completed inspection report each time task is performed

7. Completed CT Annual Medical Physics Survey.

inspection survey

ON THE

EXPIRATION

date of inspection.

Scheduled & completed survey WELL BEFORE expiration date of previous survey.

Completed inspection AFTER previous inspection expiration date. There was a gap between surveys.

100% MACH Rep sees survey being completed; receives completed inspection report each time task is performed

8. Completed Mammography (2 FFD Units, 1 Stereotactic Unit) Annual Medical Physics Survey.

inspection survey

ON THE

EXPIRATION

date of inspection.

Scheduled & completed survey WELL BEFORE expiration date of previous survey.

Completed inspection AFTER previous inspection expiration date. There was a gap between surveys.

100% MACH Rep sees survey being completed; receives completed inspection report each time task is performed

9. Completed MRI

3.0 T Annual Medical Physics Survey.

Equipment surveys performed in accordance with ACR, AAPM and Army regulations (MEDCOM 40-42,TB MED 521)

Completed the inspection survey

ON THE

EXPIRATION

date of inspection.

Scheduled & completed survey WELL BEFORE expiration date of previous survey.

Completed inspection AFTER previous inspection expiration date. There was a gap between surveys.

100% MACH Rep sees survey being completed; receives completed inspection report each time task is performed

inspection survey

ON THE

EXPIRATION

date of inspection.

Scheduled & completed survey WELL BEFORE expiration date of previous survey.

Completed inspection AFTER previous inspection expiration date. There was a gap between surveys.

100% MACH Rep sees survey being completed; receives completed inspection report each time task is performed

inspection survey

ON THE

EXPIRATION

date of inspection.

Scheduled & completed survey WELL BEFORE expiration date of previous survey.

Completed inspection AFTER previous inspection expiration date. There was a gap between surveys.

100% MACH Rep sees survey being completed; receives completed inspection report each time task is performed

inspection survey

ON THE

EXPIRATION

date of inspection.

Scheduled & completed survey WELL BEFORE expiration date of previous survey.

Completed inspection AFTER previous inspection expiration date. There was a gap between surveys.

100% MACH Rep sees survey being completed; receives completed inspection report each time task is performed

inspection survey

ON THE

EXPIRATION

date of inspection.

Scheduled & completed survey WELL BEFORE expiration date of previous survey.

Completed inspection AFTER previous inspection expiration date. There was a gap between surveys.

100% MACH Rep sees survey being completed; receives completed inspection report each time task is performed

inspection survey

ON THE

EXPIRATION

date of inspection.

Scheduled & completed survey WELL BEFORE expiration date of previous survey.

Completed inspection AFTER previous inspection expiration date. There was a gap between surveys.

100% MACH Rep sees survey being completed; receives completed inspection report each time task is performed

inspection survey within 1 week of call for inspection as an emergent case.

AFTER 1 week of initial call for inspection as an emergent case.

100% MACH Rep sees survey being completed; receives completed inspection report each time task is performed

END OF THE PERFORMANCE WORK STATEMENT

SUPPLEMENT TO THE PERFORMANCE WORK STATEMENT

1. GOVERNMENT HOLIDAYS

The following Government Holidays are observed:

New Year’s Day Martin Luther King Jr.’s Birthday President’s Day Memorial Day Juneteenth Day Independence Day Labor Day Columbus Day Veteran’s Day Thanksgiving Day Christmas Day

Any of the above holidays falling on a Saturday will be observed on the preceding Friday; holidays falling on a Sunday will be observed on the following Monday. Any holidays that are declared by Presidential Executive Order shall be observed in the same manner as the holidays listed above. If the area in which a contractor is scheduled to perform maintenance is closed due to a holiday declared by an Executive Order and the contractor is not required to report in, contractor shall service equipment on the available day staff will be present. Closures of the installation due to inclement weather or other such acts of God shall be handled in the same manner.

2. Invoicing and Payment The contractor shall submit monthly, in arrears, itemized invoices in accordance with DFARS 252.232-7003 & 252.232-7006, for services rendered under this contract. Information regarding Wide Area Workflow is available on the Internet at https://piee.eb.mil

3. TOBACCO FREE MEDICAL CAMPUS (TFMC)

The Contractor shall ensure that all contract personnel comply with the U.S. Army Medical Command and MTF smoking policies while performing services under this contract. Smoking restrictions will apply at any location or building where health care activities are performed under this contract.

In accordance with Army Regulation 600-63, paragraph 7-3, 14 April 2015; Operations Order 15-48 (Army Medical Command (MEDCOM) Tobacco Free Living – USAMEDCOM), 8 May 2015; and any Operations Order, regulation or other instruction implementing, defining or otherwise addressing the Tobacco Free Medical Campus (TFMC) on any military installation or DoD-controlled location, Contractor personnel are prohibited from using any tobacco product on or within any TFMC while performing under this contract. TFMCs are established at each installation or DoD-controlled location and include: (1) any property or non-residential building that is operated, maintained or assigned to support medical activities, including but not limited to, hospitals, medical laboratories, outpatient clinics (including medical, dental, and veterinary facilities), or aid stations operating for the primary purpose of delivering medical care and services for DOD eligible beneficiaries and /or meeting the mission of the Army Medical Command; (2) all other facilities in which medical activities or administration take place, to include HQ MEDCOM and Defense Health Headquarters; (3) all internal roadways, sidewalks and parking lots; and (4) all sidewalks, parking lots and grounds external but adjacent to the building or related to the migratory corridors surrounding the medical facility. The contractor shall obtain from the Government Representative any orders, regulations, instructions or other documents implementing, defining or otherwise addressing the TFMC for any given installation or DoD-controlled location where contractor personnel may perform under this contract and shall instruct contractor personnel on the TFMC limitations for installations or DoD-controlled locations where they may perform under this contract.

4. EXCLUSION FROM PARTICIPATION IN FEDERAL HEALTH CARE PROGRAM Exclusion from Participation in Federal Health Care Programs (October 2015)

a. The Contractor shall not employ or contract with any individual or entity (hereinafter collectively referred to as “person”) to provide items or services that will be included in invoices submitted to the Government under this contract if such person is listed on the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) List of Excluded Individuals and Entities (LEIE) or the TRICARE Sanctioned Provider List. The Government is legally prohibited from paying for provision of items or services by such persons. The prohibition extends to services beyond direct patient care, such as services of persons in executive or leadership roles and administrative and management services, whether or not such services are billed separately. The LEIE may be found at h ttp://oig.hhs.gov/fraud/exclusions.asp, and the TRICARE Sanctioned Provider list at h ttp://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/Quality-And-Safety-of- H ealthcare/Program-Integrity/Sanctioned-Providers. The LEIE and TRICARE Sanctioned Provider List are hereinafter collectively referred to as “the Lists.”

b. Prior to start of contract performance, the Contractor shall (a) query the Lists to determine whether the name of any person the Contractor employs or contracts with to provide services or items for which payment may be made under this contract appears on the Lists, and (b) certify to the Contracting Officer that the Contractor has queried the Lists and no such names appear on either of the Lists.

c. During performance of the contract, and prior to persons other than those whose names were queried in accordance with paragraph 2, above, (hereinafter “new persons”) providing services or items under the contract, the Contractor shall (a) query the Lists as in paragraph 2, and (b) certify to the Contracting Officer that the names of such new persons do not appear on either of the Lists.

d. The Contractor is advised that during performance of the contract, MTF personnel will perform a recurrent recheck of the names of contractor personnel working in the MTF against the Lists, as specified in OTSG/MEDCOM Policy Memo 15-037. The Government will notify the Contractor in the event any contractor personnel working in the MTF appear on either of the Lists.

e. Should any person providing items or services under the contract appear on either of the Lists at any time during contract performance, the Contractor shall (a) in cases where the Contractor identified the person, notify the Contracting Officer, and (b) promptly remove that person from the contract.

f. Violation of any aspect of the above paragraphs shall be considered a material breach of the contract and may result in termination of the contract.

g. The Contractor is further advised that, in accordance with Civil Monetary Penalties Law [CMP] (codified at 42 USC § 1320a- 7a): There are steep civil monetary penalties associated with billing the Government for providing items or services by a person on either of the Lists, and with failing to return to the Government any overpayments received for provision of such items or services.

Billing under the contract for provision of items or services by a person on either List may also result in exclusion of the person that employs or contracts with such person. HHS OIG has issued a Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs with additional information on the CMP. The Special Advisory Bulletin may be found at h ttp://oig.hhs.gov/exclusions/files/sab-05092013.pdf.

5. Personally Identifiable Information, Protected Health Information, and Federal Information Requirements (Revised 10/27/2020)

General Requirements Overview - Personally Identifiable Information (PII), Protected Health Information (PHI) and Federal Information Laws

This Section addresses the Contractor’s requirements under The Privacy Act of 1974 (Privacy Act), The Freedom of Information Act (FOIA), and The Health Insurance Portability and Accountability Act (HIPAA) as set forth in applicable statutes, implementing regulations and Department of Defense (DoD) issuances. In general, the Contractor shall comply with the specific requirements set forth in this Section and elsewhere in this Contract. The Contractor shall also comply with requirements relating to records management as described herein.

This Contract incorporates by reference the federal regulations and DoD issuances referred to in this Section. If any authority is amended or replaced, the changed requirement is effective when it is incorporated under contract change procedures. Where a federal regulation and any DoD issuance govern the same subject matter, the Contractor shall first follow the more specific DoD implementation unless the DoD issuance does not address or is unclear on that matter. DoD issuances are available at http://www.dtic.mil/whs/directives.

For purposes of this Section, the following definitions apply.

1. DoD Privacy Act Issuances means the DoD issuances implementing the Privacy Act, which are DoDI 5400.11, DoD Privacy and Civil Liberties Programs, January 29, 2019 and DoDI 5400.11- R, Department of Defense Privacy Program, May 14, 2007.

HIPAA Rules means, collectively, the HIPAA Privacy, Security, Breach and Enforcement Rules, issued by the U.S. Department of Health and Human Services (HHS) and codified at 45 Code of Federal Regulations (CFR) Part 160 and Part 164, Subpart E (Privacy), Subpart C (Security), Subpart D (Breach) and Part 160, Subparts C-E (Enforcement), as amended.

Additional HIPAA rules regarding electronic transactions and code sets (45 CFR Part 162) are not addressed in this Section and are not included in the term HIPAA Rules.

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

Defense Health Agency (DHA) Privacy Office is the DHA Privacy and Civil Liberties Office. The DHA Privacy Office Chief is the HIPAA Privacy and Security Officer for DHA.

2. Records Management When creating and maintaining official government records, the Contractor shall comply with all federal requirements established by 44 United States Code (U.S.C.) Chapters 21, 29, 31, 33 and 35, and by 36 CFR, Chapter XII, Subchapter B – Records Management. The Contractor shall also comply with DoD Administrative Instruction No. 15 (DoD AI-15), “OSD Records and Information Management Program” (May 3, 2013) and Records Management requirements outlined in the current TRICARE Operations Manual (TOM).

3. Freedom of Information Act (FOIA) The Contractor shall comply with the following procedures if it receives a FOIA request and immediately contact the DHA FOIA Officer for evaluation/action:

The Contractor shall inform beneficiaries that DHA FOIA procedures require a written request preferably sent via the National FOIA Portal at: www.FOIA.gov. However, requesters may also submit requests via email at DHA.FOIA@mail.mil; or via postal delivery addressed to the DHA Freedom of Information Service Center, 7700 Arlington Boulevard, Suite 5101, Falls Church, Virginia 22042-5101. All FOIA requests shall describe the desired record as completely as possible to facilitate its retrieval from files and to reduce search fees which may be borne by the requestor. Contract and/or Modification numbers must be included in all FOIA requests seeking DHA procurement records. Although the administrative time limit to grant or deny a request (ten working days after receipt) does not begin until the request is received by DHA, the Contractor shall act as quickly as possible and respond to DHA within ten working days.

In response to requests received by the Contractor for the release of information, unclassified information, documents and forms which were previously provided to the public as part of routine services shall continue to be made available in accordance with previously established criteria. All other requests from the public for release of DHA records and, specifically, all requests that reference FOIA shall be immediately forwarded to DHA, ATTENTION: Freedom of Information Officer, for appropriate action. Direct contact, including interim replies, between TRICARE contractors and such requestors is not authorized. The Contractor shall process requests by individuals for access to records about themselves in accordance with directions from the DHA Freedom of Information Service Center. If such a requestor specifically makes the request under the Privacy Act or does not make clear whether the request is made under FOIA or the Privacy Act, the Contractor shall process the request in accordance with directions from the DHA Privacy Office.