DRAFT PWS MED REFERRAL.docx

PERFORMANCE WORK STATEMENT (PWS)

MEDICAL REFERRAL SERVICES – Satellite Cities United States Military Entrance Processing Command (USMEPCOM)

1 GENERAL

This is a non-personal services contract to provide medical referral services to support USMEPCOM Military Entrance Processing Stations (MEPS), to include supporting satellite cities, and remote processing stations (RPS) herein referred to collectively as MEPS. Refer to Exhibit A for MEPS locations throughout the continental United States, Alaska, Hawaii, and Puerto Rico. Medical referral services will support medical examinations provided to applicants processing into the Active, Reserve and National Guard components of the Armed Forces for Departments of Army, Navy, Air Force, Marine Corps, Space Force and United States Coast Guard, and other government agencies such as the National Oceanic and Atmospheric Administration (NOAA).

1.1 Background: USMEPCOM is the joint military and civilian organization providing a gateway through which qualified applicants enter the U.S. Armed Forces (https://www.mepcom.army.mil). This mission requires that the physical, mental, and moral qualifications of every new applicant is determined prior to taking the oath to serve the United States. USMEPCOM does not employ specialty medical providers. When specialty consultant expertise is needed to determine applicant medical qualification, that expertise is obtained through medical referral services.

1.2 Scope of Work: The contractor shall provide qualified personnel, services, materials, equipment, supplies, facilities, and supervision necessary to conduct medical referral services that include, but are not limited to, medical/dental consultations and ancillary/laboratory services listed in Exhibit G. The contractor shall provide results from the medical referral services for use by government providers who ultimately make determinations to medically qualify, or disqualify, applicants for military service. The contractor shall provide specialty consultants who will interview and examine applicants and confirm diagnoses and provide prognosis of applicants’ pre-existing medical conditions. The contractor shall provide laboratory and ancillary services to support the government providers in their medical qualification determinations by handling, processing, testing and reporting results from lab tests, radiologic studies and/or medical procedures.

1.2.1 The contractor shall provide in-person face-to-face medical services that are performed within the required mile radius of the locations as identified in Exhibit A. Performance of services shall be in accordance with this PWS and the established principles and ethics of the medical professions.

1.2.2 The contractor shall provide virtual medical services. Performance of services shall be in accordance with this PWS and the established principles and ethics of the medical professions.

1.2.3 During the contract's lifespan, applicant medical documentation may be provided in both paper and digital formats. Specialists will be required to review and respond to requests in the specified format.

1.2.4 Hours of Performance. Operating hours are specific to the MEPS local time zone. MEPS duty hours vary, typically covering between 0600 and 1600, Monday through Friday (excluding Federal Holidays). MEPS may be open on Saturdays as necessary (see Exhibit F, Fiscal Year 2023 Operating Schedule). The government will notify the contractor of any changes to the operating schedule.

1.3 Non-personal services. Services performed under this contract are non-personal.

1.3.1 Professional Liability Responsibility and Procedures. Personnel rendering services under this contract are not subject; either by the contract's terms or by the manner of its administration, to the supervision and control usually prevailing in relationships between the government and its employees. The government will not be liable for malpractice allegations against the contractor or its specialty consultants based upon performance of this contract. Therefore, the contractor and/or the specialty consultant shall be required to carry malpractice.

1.3.2 The contractor shall immediately notify the government (the Contracting Officer (KO) and the Contracting Officer's Representative (COR)) of any suit, action filed, or claim made against the specialty consultant (whether performing under a personal or non-personal services contract), which occurred as a result of work performed by the specialty consultant. When requested, the contractor is responsible for ensuring that the specialty consultant promptly furnishes copies of all pertinent documents to the above referenced individuals.

1.4 CONTRACTOR REPRESENTATIVE AND OTHER PERSONNEL.

1.8.1. Notification. The contractor shall ensure that the COR is promptly notified of performance issues or problems within three business days.

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

September 2, 2023 = 20230902 September 10, 2023 = 20230910

2.1.17 MILITARY TIME. Military time is on a 24-hour clock, i.e.:

2.1.23 FACE-TO-FACE. Face-to-face or “in-person face-to-face” encounters occur when both the applicant and medical service provider are in the same room with each other while medical services are being rendered.

2.1.23 VIRTUAL HEALTH or Telehealth, these terms are used inter-changeably throughout this document. Virtual health occurs when the patient and medical service providers are in two distinct geographic locations.

2.1.24 ASYCHRONOUS or “store and forward” telehealth encounters involve the transmission of medical images or information in one direction at a time via electronic communication.

2.1.25 SYNCHRONOUS or “real time” telehealth encounters are characterized by the use of interactive, electronic communication exchange in at least two directions during the same time period. For example, live video conferencing provides face-to-face communication between a provider and a patient.

2.1.26 Satellite City - a city where medical or dental service is required to be provided by the contractor. Each Satellite City is typically associated with one or more MEPS extending the geographic area for medical services provided. Exhibit A MEPS provides a listing of Satellite Cities with associated MEPS.

2.1.27 Remote Processing Station – facility or site performing certain functions of a separately-located MEPS command on its behalf

HMO Head Medical Officer

3. GOVERNMENT FURNISHED ITEMS AND SERVICES.

3.1 Materials.

3.1.1 Standard Form (SF) 513. The Government will provide a SF 513, Consultation Sheet (Exhibit E and Governments Deliverables Table in Section 6) for each applicant that requires a referral service from any of the MEPS.

3.1.2 DD Form 1966. The Government will provide a DD Form 1966 (Record of Military Processing - Armed Forces of the United States), Page 5, Section VIII - Parental/Guardian Consent for Enlistment (Exhibit D), which grants parental consent, for those applicants that are identified as minors (less than 18 years of age, and non-emancipated). Further processing is not authorized if this form is not provided.

3.1.3 Operational Schedule. The COR will provide the contractor an USMEPCOM operational schedule during phase-in period, and prior to each option year thereafter (See Governments Deliverables Table in Section 6).

3.2 Government Services.

3.2.1 Transportation. The Government may provide transportation for the applicant(s) to and from the contracted facility for in-person consultations or services. The contactor is not responsible for applicant transportation.

3.3 MEDICAL REFERRALS.

3.3.1 The Government will notify the contractor of medical referrals on a daily basis.

3.3.2 Government Initiated Cancellations. If unforeseen events require the cancellation of any type of appointment by the MEPS, the MEPS GPOC will notify the specialty consultant or ancillary/laboratory facility at least 24 hours prior to the scheduled appointment. Appointments cancelled by the MEPS at least 24 hours prior to the scheduled appointment time shall not be billed by the specialty consultant or facility for services not rendered. Appointments cancelled within 24 hours of a scheduled appointment time shall be billed against the "No Show" CLIN.

4. CONTRACTOR FURNISHED MATERIAL, EQUIPMENT, AND QUALIFICATIONS. The contractor shall furnish all supplies, equipment, facilities, and services required to perform work under this contract that are not listed under Section 3 of this PWS.

4.1 PERSONNEL QUALIFICATIONS. An outline of qualifications for the contractor staff is given below:

4.1.1 Specialty Consultant Qualifications:

4.1.1.1 Physician specialty consultants shall be graduates from an accredited medical school either by the American Association of Colleges of Osteopathic Medicine or the Liaison Committee on Medical Education and be a qualified Medical Doctor (MD) or Doctor of Osteopathy (DO). Specialists shall be board certified or board eligible in their medical specialties. The contractor shall only use qualified and licensed Optometrists and/or Ophthalmologists to perform vision tests. Dentists shall be graduates from a dental school accredited by the American Dental Association's (ADA's) Commission on Dental Accreditation.

4.1.1.2 Dental and specialty consultants shall possess and maintain a professional license, certification, or registration, as required by the profession and appropriate regulatory bodies through the term of the contract.

4.1.1.3 Specialty Referral qualifications require the specialty consultants be certified by The American Board of Medical Specialties (ABMS) such as those specialties listed in Exhibit G or by their own specialty board. The specialty consultant shall be competent to render expert medical opinion regarding the specific medical consultation requested by the MEPS. Associate, provisional, or student membership is not acceptable. Membership or certification must be at the full clinical level. Specialty consultants that are not board certified must have completed an approved residency within the prior 3 years from the performance start of this contract and must be in the process of obtaining their board certification. Dental specialists do not require board certification.

4.1.2 Resident physicians undergoing specialty training and seeking employment outside their residency will not be used as consultants.

4.1.3 HQ USMEPCOM may exclude the following individuals or entities from participation as a specialty consultant:

4.1.3.1 Misdemeanor conviction related to health care fraud. Minimum period: 3 years.

4.1.3.2 Conviction related to fraud in non-health care programs. Minimum period: 3 years.

4.1.3.3 Misdemeanor conviction related to obstruction of an investigation. Minimum period: 3 years.

4.1.3.4 Misdemeanor conviction relating to a controlled substance. Minimum period: 3 years.

4.1.3.5 License revocation or suspension. Minimum period: No less than the period imposed by the state licensing authority.

4.1.3.6 Exclusion or suspension under a Federal or State health care program. Minimum period: No less than the period imposed by Federal or state health care program.

4.1.4 Medical and Dental Specialist delivering services virtually shall comply with the requirements published by the department of Health and Human Services, https://telehealth.hhs.gov.

5. DESCRIPTION OF WORK.

5.1 The contractor shall provide a network of medical and dental specialty consultants, and ancillary and laboratory services, collectively called referral services, capable of supporting accession services as required by the MEPS providers. The contractor shall ensure that all referral services provided are IAW established standards, principles, and ethics of the profession and applicable professional specialty organizations, The Joint Commission (TJC) standards, applicable DoD and agency specific regulations, directives, and policies. The contractor shall provide technically competent specialty consultants who shall give the highest regard to applicant dignity. The contractor shall provide quality referral services; conduct thorough consultations and services; complete timely credential review and privileges, conduct background investigations; and manage recruitment and retention of healthcare professionals. Referral services, consultations, and services may be accomplished using face-to-face meetings or conducted virtually between the specialty consultant and applicant.

5.1.1 Specialty consultants choosing to use virtual or telehealth shall use a platform that is authorized (e.g. has reasonable and appropriate safeguards to prevent disclosure to unauthorized parties and secure channels of communications) for the conduct of virtual or telehealth.

5.1.2 The MEPS provider is responsible for considering the specialty consultant's medical opinion. The specialty consultant does not make a final qualification or disqualification determination on the applicant's acceptance/suitability for the military services and other federal agencies. Since this is a critical step in the process of qualifying applicants for military service, the contractor shall ensure the consultant is available for telephonic consultation with the MEPS provider, should the need arise.

5.1.3 Specialty consultants choosing to use virtual or telehealth shall conduct the entire session using audio and visual telecommunication capabilities. If audio and visual are not available for the entire session or, when audio or visual are disrupted or terminated before the completion of the session, the session shall be rescheduled at a time when audio and visual telecommunications are available. Disrupted sessions shall restart at a point deemed appropriate by the specialty consultant to ensure they are able to gather sufficient information to render a professional opinion. Virtual or telehealth is only authorized when the specialty consultant can satisfy all requirements of the referral order via that method of appointment.

5.2 MEDICAL REFERRAL SERVICES TYPES. The contractor shall provide Medical Referral Services via one of the four processes:

5.2.1 Consultation Only. The MEPS contacts the contractor with a referral. The contractor schedules the referral for a consultation. Consultations may be accomplished using face-to-face meetings or conducted virtually between the medical/dental Specialist and applicant. A final report is generated by the contractor and sent, via the contractor's secure web-based portal, to the MEPS The reports shall be accessible to the MEPS GPOC within three business days after the appointment date.

5.2.2 Consultation followed by ancillary and/or laboratory services. The MEPS contacts the contractor with a referral. The contractor schedules the referral for a consultation, which includes any necessary ancillary and/or laboratory services, as authorized by the MEPS. A consultation followed by ancillary and/or laboratory services may be accomplished using face-to-face meetings or conducted virtually between the medical/dental Specialist and applicant. A final report is generated and sent, via the contractor's secure web-based portal, to the MEPS. The reports shall be accessible the MEPS GPOC within three business days after the lab results are available.

5.2.3 Ancillary and/or laboratory service followed by consultation. The MEPS contacts the contractor with a referral. The contractor schedules the referral with ancillary and/or laboratory services and then a follow-up appointment with a consultation appointment. Ancillary and/or laboratory service followed by consultation may be accomplished using face-to-face meetings or conducted virtually between the medical/dental Specialist and applicant. A final report with results is generated and sent via the contractor's secure web-based portal, to the MEPS. The reports shall be accessible to the MEPS GPOC within three business days after the appointment date.

5.2.4 Ancillary and/or laboratory service only. The MEPS contacts the contractor with a referral. The contractor schedules the referral with ancillary and/or laboratory services. A final report with results is generated and sent via the contractor's secure web-based portal, to the MEPS. The reports shall be accessible to the MEPS GPOC within three business days after the appointment date.

5.3 MEDICAL REFERRALS SERVICES. The contractor shall provide and maintain a medical network specific to specialty consultant and ancillary/laboratory services to support medical referral requests for MEPS locations (see in Exhibit A).

5.3.1 Specialty Consultant Services. The contractor shall provide specialty consultant services listed in Exhibit G. Additional specialties may be incorporated, or removed, during the term of the contract by negotiation of a contract modification. All specialty consultant services shall be executed in accordance with standard healthcare industry practices. All medical and dental consultation services shall be accomplished in accordance with section 5.1

5.3.2 Ancillary Services. The contractor shall provide and maintain a medical network specific to ancillary services to include radiologic services with interpretation for each MEPS address location (see in Exhibit A). Upon completion of ancillary services, the contractor shall provide a diagnostic evaluation of tests as appropriate.

5.3.3 Laboratory Services. The contractor shall provide and maintain a medical network specific to laboratory services for each MEPS address location, as identified in Exhibit A. The contractor shall provide, at a minimum, the full range of clinical and anatomic pathology diagnostic testing capabilities to execute required tests annotated in Exhibit G. All clinical reference laboratory testing shall be executed in accordance with standard industry practices. Upon completion of laboratory services, the contractor shall provide a diagnostic evaluation of tests as appropriate.

5.3.3.1 All Medical referral services shall be executed at the contractor's premises (professional office location), or within the contractor's network of laboratories [affiliate(s) or qualified subcontractor(s)].. Medical referral services may be accomplished using face-to-face meetings or conducted virtually between the medical/dental Specialist and applicant.

5.3.3.2 Laboratory Regulatory Standards. The contractor shall ensure all laboratories in the specialty consultant network meet the federal regulatory standards outlined in the Clinical Laboratory Improvement Amendments (CLIA) of 1988 and maintain a CLIA- and College of American Pathologists (CAP)-accredited quality control program. Current CLIA requirements are located at https://www.cms.gov/regulations-and-guidance/legislation/clia. Upon request from the COR or KO, the contractor shall provide documentation of quality control policies.

5.3.3.2.1 All laboratory test methods shall be FDA approved.

5.3.4 Lost or Damaged Specimens. The contractor shall immediately report specimens lost due to breakage, spillage/leakage, misplacement, mishandling or any other contractor-related problem(s) to the submitting MEPS.

5.4 SCHEDULING AND REFERRAL PROCESSING TIMES. MEPS will submit referrals for scheduling between 0800-1600 local time, Monday through Friday. Some locations may submit referrals during these hours on Saturdays. The contractor shall ensure that all referral requests are completed within the timeframes stated below:

5.4.1 For orders placed prior to 10 AM local time, the contractor shall complete tests and/or services in Group A of Exhibit G, to include appointment on the same day of the request with results due within 3 business days of appointment. For orders placed after 10 AM local time, the contractor shall complete tests and/or services in Group A of Exhibit G, to include appointment within the next business day of the request with results due within 3 business days of appointment.

5.4.2 The contractor shall complete tests and/or services in Group B of Exhibit G to include appointment within five business days of the request with results due within 3 business days of the appointment.

5.4.3 The contractor shall complete tests and/or services in Group C of Exhibit G within 15 business days of the request with results due within 3 business days of appointment. The appointment scheduling shall be completed within the first 5 business days of the 15 business days allotted for execution of services. For example, for an order placed on Business Day 0, the date of the appointment must be confirmed by Business Day 0+5, and that appointment date must occur prior to Business Day 0+15.

5.4.4 Cancellations. If unforeseen events require the cancellation of appointments by a specialty consultant, the contractor shall notify the MEPS GPOC and the contractor's representative NLT 48 hours prior to the scheduled appointment. The contractor shall re-schedule the appointment within 3 business days to meet the provisions of this PWS. Rescheduled appointments due to provider cancellation will not be exempt from the scheduling timelines detailed in 5.4.1-5.4.3.

5.5 Authentication/Verification of Applicants. The contractor shall authenticate and verify the identity of the applicant prior to performing any referral services. The applicant shall provide a state issued photo ID, U.S. passport or school identification,

5.6 The contractor shall provide services for minors (less than 18 years of age, and non-emancipated), only when the applicant provides a signed consent form for performing medical procedures, which is a DD Form 1966 (Record of Military Processing – Armed Forces of the United States), Page 5, Section VIII – Parental/Guardian Consent for Enlistment (Exhibit D). The contractor shall not provide medical services to the minor applicant, and the government will not pay for services when the DD Form 1966 is not provided or has not been signed by the parent/guardian

5.7. The contracted specialty consultant shall initiate and receive approval from the COR, prior to performing the consultations or medical services when services are expected to exceed $2,000.

5.8 The contractor shall ensure that specialty consultants do not treat medical conditions under this contract. Any treatment or preventative services rendered - for example immunizations, prescribing medications or castings - that were not authorized by MEPS staff will not be reimbursed to the contractor or its subcontractors.

5.6 BILLING PROCESS.

5.6.1 The Government is not liable for medical services performed outside the scope of this contract

5.6.2 The contractor shall ensure that its specialty consultants and laboratory services facilities do not bill the government and/or applicants directly.

5.6.3 The contractor shall submit itemized invoices and validate all contract medical network provided services for accuracy. The contractor shall ensure that specialty consultants only charge fees for diagnostic services provided to applicants.

5.6.4 The contractor shall provide complete, accurate, and error-free invoices to the KO and COR using the government provided format no later than the 5th business day of each month.

5.6.5 A monthly summary invoice shall contain:

Invoice Number Invoice Date Contract Line Item Number (CLIN) Type of Specialty Consultation Performed and Associated Ancillary/Laboratory Service Identification of type of interface between medical or dental specialist and the applicant (Virtual or In-Person) Type of Standalone Ancillary/Laboratory Service Performed Quantity Unit Price Invoice Total Amount

A signed statement from the contractor attesting that each medical or dental professional providing service is in compliance with the standards stated in paragraph 4.1.1 Specialty Consultant Qualifications, at the location where the applicant is physically present during the medical or dental encounter.

5.6.6 The contactor shall validate medical/dental consultations and ancillary/laboratory invoices for accuracy.

5.6.7 The medical/dental consultation and ancillary/laboratory services monthly billing detail shall be sorted by, Service/Branch, Battalion (Exhibit A-Western and Eastern Sector Battalions and MEPS Stations), then by either MEPS, RPS, or Satellite City and contain:

Battalion Number Name of the MEPS, RPS, or Satellite City Invoice Number Order Number Invoice Date CLIN(s) Type of Specialty Consultation Performed (if applicable) Medical Testing and or Laboratory Service(s) Performed (if applicable) Quantity Identification of type of interface between medical or dental specialist and the applicant (Virtual or In-Person) Unit Price Invoice Total Amount Date Service Requested From MEPS Date Service Appointment Scheduled Date Service Received ICD-10 Code CPT(s) Applicant Name (Last Name, First, Ml) Full Social Security Number (SSN) Gender Age Applicant Component/Service Specialist Name Visited Specialist National Specialist Identifier (NPI#) Location of Consult No-Show/Cancel<24hrs Yes/No Service Facility Name Visited (standalone ancillary/laboratory service) Military Branch MEPS Exceptions

5.6.8 Billing. The contractor shall ensure that it performs periodic checks for billing codes errors.

5.7 REPORTS

5.7.1 The contractor shall provide to the COR a monthly report summary titled "MEPS Consultations" outlining the following:

MEPS, RPS, or Satellite City, Sorted by Name Number of Applicants Evaluated Specific Consultation Specialty (Orthopedic, Cardiology, etc) and Total Cost Specific Ancillary/Laboratory Services and Total Cost

5.7.2 The contractor shall provide to the COR a monthly report summary titled "MEPS Consultant and Ancillary/Laboratory Facility Roster" which will include the following information, sorted by Battalion. The report shall list the specialists and facilities that MEPS will utilize in their immediate location.

Battalion Number MEPS, RPS, or Satellite City, Sorted by Name Name of Specialist Address of Specialist or Facility Phone number and Fax number of Specialist Specialist's or Facilities Specialty Specialist's or Facilities Contract Start Date Licensure Date Board Certification Date Approximate Distance from MEPS, RPU, or Satellite City medical facility Identification of type of interface between medical or dental specialist and the applicant (Virtual or In-Person) Average Scheduling Projected Availability (e.g. scheduling 10 days out, 20 days out, etc)

5.7.3 The contractor's SCNs shall provide typed reports rendering medical diagnosis and prognosis based on face-to-face interview and comprehensive examination of the applicant on the area of concern as specified on digital Standard Form 513 that is made available by the government.

5.7.3.1 The contractor's SCNs shall provide accurate diagnostic results of ancillary or laboratory services provided.

5.8 WEB BASED SOLUTION. The contractor shall provide a commercial-based solution as a means to manage the medical referral process. The web-solution shall be HIPAA compliant and shall allow secure access for authorized government personnel. The contractor's web-solution shall include the ability for USG personnel to schedule referrals, view referral status, access consult and ancillary/laboratory results, review applicant appointment scheduling, monthly reports, statistical data (what was ordered by MEPS, type of consult and ancillary or laboratory service), developed training plan, historical data. The web-based solution shall also include a report that displays funds used and funds remaining on each contract line number (CLIN) as well as orders requested for future appointments which have not yet occurred. The contractor shall have a process to send appointment notifications (initial, reminders, reschedule, and cancellations) to applicants via text, voicemail, and email. The contractor shall ensure that an email notification, by order number, is sent to the appropriate government personnel who submitted the referral, and/or appropriate service liaisons and recruiters, with updated appointment information.

5.8.1 Backup plan. The contractor shall have a plan to ensure continued scheduling so the MEPS can continue to schedule appointments and receive referral reports during periods in which the contractor’s electronic system is unavailable. This plan should include as a minimum, the following:

A government-approved method of transmitting secure information to MEPS for completed services in the format specified in 5.7.3

For outages greater than 2 calendar days, a government-approved secure method of receiving orders from MEPS.

6. DELIVERABLES SCHEDULE.