Combo_(Dentist)_10_Sept_13.docx

SOLICITATION AMENDMENT 2

F2X4A23151AG04 – Dentist

GENERAL INFORMATION

The 42nd Contracting Squadron, 50 LeMay Plaza, Bldg 804, Maxwell AFB, AL has a requirement to purchase items as described in this document. This is a streamlined combined synopsis/solicitation for commercial items prepared in accordance with the format in FAR Subpart 12.6 as supplemented with additional information included in this notice.

This announcement constitutes the only notice. A written solicitation will not be issued. This requirement is issued as a request for proposal (Reference-Number F2X4A23151AG04). The solicitation document and incorporated provisions and clauses are those in effect the Federal Acquisition Circular 2005-69 and Defense Acquisition Circular 20130808 effective date 08 August 2013.

A Firm Fixed Priced Award will be made in accordance with the following:

NAICS Code: 621210, size standard $7.0 Million

The Defense Priorities and Allocations System rating is S10.

“Notice to Offeror(s)/Supplier(s): Funds are not presently available for this effort. No award will be made under this solicitation until funds are available. The Government reserves the right to cancel this solicitation, either before or after the closing date. In the event the Government cancels this solicitation, the Government has no obligation to reimburse an offeror for any costs.”

NATURE OF ACQUISITION:

Maxwell AFB has a requirement to purchase the below listed services. This procurement will be awarded under Simplified Acquisition Procedures. All inquiries/responses to this notice must be received by 20 September 2013, 16:00 hrs CST. Period of Performance (PoP): 01 Oct 13 - 30 Sep 14 (base year) with four (4) one-year options.

SCHEDULE OF SUPPLIES/SERVICES:

The contractor shall provide the service listed below, which is to be performed on Maxwell, AFB. The Government estimates approximately 1920 hours per CLIN, per year. (Contractor is not bound to this estimate.)

CLIN 0001: Dentist at the Maxwell Ambulatory Healthcare Center in accordance with (IAW) all local, state and federal laws and the requirements of the Performance Work Statement (PWS) Qty: ______ Unit: Hrs Unit Price: $_____________ Total Cost: $_____________ Base Period PoP: 1 October 2013 - 30 September 2014 $__________

CLIN 0002: Dentist Week-day on-call at the Maxwell Ambulatory Healthcare Center in accordance with (IAW) all local, state and federal laws and the requirements of the Performance Work Statement (PWS) Qty: ______ Unit: Hrs Unit Price: $_____________ Total Cost: $_____________ Base Period PoP: 1 October 2013 - 30 September 2014

CLIN 1001: Qty: ______ Unit: Hrs Unit Price: $_____________ Total Cost: $_____________ Option Year 1 PoP: 1 October 2014 - 30 September 2015

CLIN 1002: Qty: ______ Unit: Hrs Unit Price: $_____________ Total Cost: $_____________ Option Year 1 PoP: 1 October 2014 - 30 September 2015

CLIN 2001: Qty: ______ Unit: Hrs Unit Price: $_____________ Total Cost: $_____________ Option Year 2 PoP: 1 October 2015 - 30 September 2016

CLIN 2002: Qty: ______ Unit: Hrs Unit Price: $_____________ Total Cost: $_____________ Option Year 2 PoP: 1 October 2015 - 30 September 2016

CLIN 3001: Qty: ______ Unit: Hrs Unit Price: $_____________ Total Cost: $_____________ Option Year 3 PoP: 1 October 2016 - 30 September 2017

CLIN 3002: Qty: ______ Unit: Hrs Unit Price: $_____________ Total Cost: $_____________ Option Year 3 PoP: 1 October 2016 - 30 September 2017

CLIN 4001: Qty: ______ Unit: Hrs Unit Price: $_____________ Total Cost: $_____________ Option Year 4 PoP: 1 October 2017 - 30 September 2018

CLIN 4002: Qty: ______ Unit: Hrs Unit Price: $_____________ Total Cost: $_____________ Option Year 4 PoP: 1 October 2017 - 30 September 2018

Total: $__________

*All work is to be performed in accordance with (IAW) the attached Performance Work Statement (PWS).

PROPOSAL PREPARATION INSTRUCTIONS

To assure timely and equitable evaluation of proposals, offerors must comply with the instructions contained herein. Noncompliance may raise doubt regarding an offeror’s performance capabilities and may be grounds to eliminate the proposal from consideration for contract award. Proposals must be complete, self-sufficient, and respond directly to the requirement of the RFP. The response shall consist of two sections: (1) Price and (2) Past Performance. The Government intends to evaluate proposals and award a contract without discussions with offerors. Therefore, initial price should contain the offeror’s best terms from a price standpoint. Submitted documents must be fully responsive to and consistent with the requirement of this RFP.. (A) Price Proposal: The offeror must provide a price for the each item listed above (0001, 0002, 1001, 1002, 2001, 2002, 3001,3002 and 4001, 4002); (B) Past Performance: Please submit at least two references that can provide relevant past performance information. Relevant information is the same or a similar type service as described in this combined synopsis/solicitation. Past performance information, must include contract number, points of contact with telephone numbers and other information the offeror deem relevant for same or similar service described in this combined synopsis/solicitation.

a. The offeror must submit dated proposal on company letterhead with unit prices and extended prices in response to this solicitation. In doing so and without taking any exception to the requirements of this synopsis/solicitation, including specification, “Schedule of Supplies/Services” and terms and conditions, the offeror accedes to all solicitation requirements. Offerors must clearly identify any exception to the solicitation terms and conditions and provide complete accompanying rationale.

b. Offerors must include a completed copy of the provisions at FAR 52.212-3, Alternate I, Offeror Representations and Certifications – Commercial Items

c. Interested parties capable of providing the requirement must submit a written proposal to include discount terms, tax identification number, cage code, and DUNS.

d. To be eligible to receive an award resulting from this RFP, contractors must be registered in the DoD Systems for Award Management database, no exceptions. To register, please visit http://www.sam.gov or by calling 1-866-606-8220.

IMPORTANT NOTE: This Dental requirement is a 100% small business set-aside. Neither multiple Offerors nor Multiple Awards will be considered. A single award will be made in the resultant contract.

BASIS FOR AWARD

This is a competitive best value acquisition utilizing simplified procedures authorized by FAR 13.5, “Test Program for Certain Commercial Items.” For proposals determined technically acceptable, a best value selection based on price and past performance will be made.

An offeror will be determined technically acceptable if no exception is taken to the Performance Work Statement (PWS) and requirements of the RFP. Award will be based on price and past performance. Each offeror’s proposed price will be evaluated for reasonableness. Price will always be an important factor; therefore, offerors should make diligent efforts to control costs and submit fairly priced proposals. Past performance will be evaluated based on relevancy (size/scope/complexity), quality of product/service, timeliness of delivery/performance and business relations (customer service). To be considered for award an offeror must have acceptable past performance based upon information available to the contracting officer and offer a reasonable price.

Award may be made to other than the low offeror when, after evaluating past performance, the contracting officer determines it to be in the government’s best interest.

CONTRACT TERMS AND CONDITIONS:

The following provisions and clauses apply:

By reference:

The following provisions are included:

52.204-7, System for Award Management 52.212-1, Instructions to Offerors- Commercial Items 52.212-2, Evaluation – Commercial Items 52.212-3 and Alt 1, Offeror Representations and Certifications – Commercial Items 52.217-5, Evaluation of Options 252.204-7004 Alt A, System for Award Management 252.209-7999 Representation by Corporations Regarding an Unpaid Delinquent Tax Liability or a Felony Conviction under any Federal Law

The following clauses are included:

52.203-3, Gratuities 52.204-9, Personal Identity Verification of Contractor Personnel 52.204-13, System for Award Management Maintenance.

52.212-4, Contract Terms and Conditions-Commercial Items.

52.212-5, Contract Terms and Conditions Required to Implement Statutes Or Executive Orders-Commercial Items The following FAR Clauses cited in this clause also applies:

52.203-6, Restrictions on Subcontractor Sales to the Government 52.204-10, Reporting Executive Compensation and First-Tier Subcontract Awards 52.209-6, Protecting the Government's Interest when Subcontracting with Contractor's Debarred, Suspended, or Proposed for Debarment.

52.219-6, Notice of Total Small Business Set-Aside 52.219-8, Utilization of Small Business Concerns 52.219-13, Notice of Set-Aside on Orders 52.219-14, Limitations on Subcontracting 52.219-28, Post Award Business Program Representation 52.222-3, Convict Labor 52.222-21, Prohibition of Segregated Facilities 52.222-26, Equal Opportunity 52.222-35, Equal Opportunity for Veterans 52.222-36, Affirmative Action for Workers with Disabilities 52.222-37, Employment Reports on Special Disabled Veterans, Veterans of the Vietnam Era, and Other Eligible Veterans 52.222-40, Notification of Employee Rights under the National Labor Relations Act 52.222-50, Combating Trafficking in Persons 52.222-53, Exemption from Application of the Service Contract Act to Contracts for Certain Services-- Requirements 52.223-18, Contractor Policy to Ban Text Messaging While Driving 52.225-13, Restriction on Certain Foreign Purchases 52.232-33, Payment by Electronic Funds Transfer 52.233-3, Protest After Award 52.233-4, Applicable Law for Breach of Contract Claim.

52.222-17, Non-Displacement of Qualified Workers 52.228-5, Insurance -- Work on a Government Installation 52.232-18, Availability of Funds 52.237-2, Protection of Government Buildings, Equipment, and Vegetation.

DFARS Clauses:

252.203-7000, Requirements Relating to Compensation of Former DOD Officials 252.203-7002, Requirement to Inform Employees of Whistleblower Rights 252.204-7000, Disclosure of Information 252.232-7003, Electronic Submission of Payment Requests 252.225-7012, Preference for Certain Domestic Commodities 252.226-7001, Utilization of Indian Organizations, Indian-Owned Economic Enterprises, and Native Hawaiian Small Business Concerns 252.237-7010, Prohibition on Interrogation of Detainees by Contractor Personnel 252.243-7002, Requests for Equitable Adjustment

By Full Text:

Clause 52.217-8 Option to Extend Services (Nov 1999)

The Government may require continued performance of any services within the limits and at the rates specified in the contract. These rates may be adjusted only because of revisions to prevailing labor rates provided by the Secretary of Labor. The option provision may be exercised more than once, but the total extension of performance hereunder shall not exceed 6 months. The Contracting Officer may exercise the option by written notice to the Contractor within 15 Days.

Clause 52.217-9 Option to Extend the Term of the Contract (Mar 2000)

(a) The Government may extend the term of this contract by written notice to the Contractor within 15 days provided that the Government gives the Contractor a preliminary written notice of its intent to extend at least 30 days before the contract expires. The preliminary notice does not commit the Government to an extension.

(b) If the Government exercises this option, the extended contract shall be considered to include this option clause.

(c) The total duration of this contract, including the exercise of any options under this clause, shall not exceed 66 months.

52.252-1, Solicitation Provisions Incorporated by Reference (Feb 1998)

This solicitation incorporates one or more solicitation provisions by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. The offeror is cautioned that the listed provisions may include blocks that must be completed by the offeror and submitted with its quotation or offer. In lieu of submitting the full text of those provisions, the offeror may identify the provision by paragraph identifier and provide the appropriate information with its quotation or offer. Also, the full text of a solicitation provision may be accessed electronically at this/these address(es):

http://farsite.hill.af.mil/

52.252-2, Clauses Incorporated by Reference (Feb 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es):

http://farsite.hill.af.mil/

(End of Clause)

AFFARS Clauses:

5352.201-9101 OMBUDSMAN (NOV 2012)

(a) An ombudsman has been appointed to hear and facilitate the resolution of concerns from offerors, potential offerors, and others for this acquisition. When requested, the ombudsman will maintain strict confidentiality as to the source of the concern. The existence of the ombudsman does not affect the authority of the program manager, contracting officer, or source selection official. Further, the ombudsman does not participate in the evaluation of proposals, the source selection process, or the adjudication of protests or formal contract disputes. The ombudsman may refer the party to another official who can resolve the concern.

(b) Before consulting with an ombudsman, interested parties must first address their concerns, issues, disagreements, and/or recommendations to the contracting officer for resolution. Consulting an ombudsman does not alter or postpone the timelines for any other processes (e.g., agency level bid protests, GAO bid protests, requests for debriefings, employee-employer actions, contests of OMB Circular A-76 competition performance decisions).

(c) If resolution cannot be made by the contracting officer, concerned parties may contact the Center/MAJCOM or AFISRA ombudsmen, Primary: Mr. David Jones, Deputy Chief, Contracting Division, HQ AETC/PK; Alternate: Mr. Stephen Smith, Chief, Acquisition Support Branch, HQ AETC/PKA; Address: 2035 First Street West, Ste 1, Randolph AFB TX 78150-4324; Telephone Numbers: (210) 652-7907 or (210) 652-7075; Facsimile Number: (210) 652-8344; and E-mail Addresses: david.jones.3@us.af.mil or stephen.smith@us.af.mil. Concerns, issues, disagreements, and recommendations that cannot be resolved at the MAJCOM/DRU or ARISRA level, may be brought by the concerned party for further consideration to the Air Force ombudsman, Associate Deputy Assistant Secretary (ADAS) (Contracting), SAF/AQC, 1060 Air Force Pentagon, Washington DC 20330-1060, phone number (703) 588-7004, facsimile number (703) 588-1067.

(d) The ombudsman has no authority to render a decision that binds the agency.

(e) Do not contact the ombudsman to request copies of the solicitation, verify offer due date, or clarify technical requirements. Such inquiries shall be directed to the Contracting Officer.

(End of clause)

AF 5352.223-9001 HEALTH AND SAFETY ON GOVERNMENT INSTALLATIONS (JUN 1997)

(a) In performing work under this contract on a Government installation, the contractor shall:

(1) Comply with the specific health and safety requirements established by this contract;

(2) Comply with the health and safety rules of the Government installation that concern related activities not directly addressed in this contract;

(3) Take all reasonable steps and precautions to prevent accidents and preserve the health and safety of contractor and Government personnel performing or in any way coming in contact with the performance of this contract; and

(4) Take such additional immediate precautions as the contracting officer may reasonably require for health and safety purposes.

(c) The contracting officer may, by written order, direct Air Force Occupational Safety and Health Standards (AFOSH) and/or health/safety standards as may be required in the performance of this contract and any adjustments resulting from such direction will be in accordance with the Changes clause of this contract.

(d) Any violation of these health and safety rules and requirements, unless promptly corrected as directed by the contracting officer, shall be grounds for termination of this contract in accordance with the Default clause of this contract.

5352.242-9000 CONTRACTOR ACCESS TO AIR FORCE INSTALLATIONS (AUG 2007)

(a) The contractor shall obtain base identification and vehicle passes, if required, for all contractor personnel who make frequent visits to or perform work on the Air Force installation(s) cited in the contract. Contractor personnel are required to wear or prominently display installation identification badges or contractor-furnished, contractor identification badges while visiting or performing work on the installation.

(b) The contractor shall submit a written request on company letterhead to the contracting officer listing the following: contract number, location of work site, start and stop dates, and names of employees and subcontractor employees needing access to the base. The letter will also specify the individual(s) authorized to sign for a request for base identification credentials or vehicle passes. The contracting officer will endorse the request and forward it to the issuing base pass and registration office or security police for processing. When reporting to the registration office, the authorized contractor individual(s) should provide a valid driver’s license, current vehicle registration, valid vehicle insurance certificate, and to obtain a vehicle pass.

(c) During performance of the contract, the contractor shall be responsible for obtaining required identification for newly assigned personnel and for prompt return of credentials and vehicle passes for any employee who no longer requires access to the work site.

(d) When work under this contract requires unescorted entry to controlled or restricted areas, the contractor shall comply with citing the appropriate paragraphs as applicable.

(e) Upon completion or termination of the contract or expiration of the identification passes, the prime contractor shall ensure that all base identification passes issued to employees and subcontractor employees are returned to the issuing office.

(f) Failure to comply with these requirements may result in withholding of final payment.

5352.242-9001 COMMON ACCESS CARDS (CACs) FOR CONTRACTOR PERSONNEL (NOV 2012)

(a) For installation(s)/location(s) cited in the contract, contractors shall ensure Common Access Cards (CACs) are obtained by all contract or subcontract personnel who meet one or both of the following criteria:

(1) Require logical access to Department of Defense computer networks and systems in either:

(2) Perform work, which requires the use of a CAC for installation entry control or physical access to facilities and buildings.

(b) Contractors and their personnel shall use the following procedures to obtain CACs:

(1) Contractors shall provide a listing of personnel who require a CAC to the contracting officer. The government will provide the contractor instruction on how to complete the Contractor Verification System (CVS) application and then notify the contractor when approved.

(2) Contractor personnel shall obtain a CAC from the nearest Real Time Automated Personnel Identification Documentation System (RAPIDS) Issuing Facility (typically the local Military Personnel Flight (MPF)).

(c) While visiting or performing work on installation(s)/location(s), contractor personnel shall wear or prominently display the CAC as required by the governing local policy.

(d) During the performance period of the contract, the contractor shall:

(1) Within 7 working days of any changes to the listing of the contract personnel authorized a CAC, provide an updated listing to the contracting officer who will provide the updated listing to the authorizing government official;

(2) Return CACs in accordance with local policy/directives within 7 working days of a change in status for contractor personnel who no longer require logical or physical access;

(3) Return CACs in accordance with local policy/directives within 7 working days following a CACs expiration date; and

(4) Report lost or stolen CACs in accordance with local policy/directives.

(e) Within 7 working days following completion/termination of the contract, the contractor shall return all CACs issued to their personnel to the issuing office or the location specified by local policy/directives.

(f) Failure to comply with these requirements may result in withholding of final payment.

(End of clause)

SPECIAL INSTRUCTION 45 REQUIRED INSURANCE

Reference FAR clause 52.228-5 entitled “Insurance...” the Contractor shall, at its own expense, procure and thereafter maintain the following kinds of insurance with respect to performance under the contract.

a. Workmen’s Compensation and Employers Liability Insurance as required by law except that if this contract is to be performed in a State which does not require or permit private insurance, then compliance with the statutory or administrative requirements in any such State will be satisfactory. The required Workmen’s Compensation insurance shall extend to cover employer’s liability for accidental bodily injury or death and for occupational disease with a minimum liability limit of $100,000.

b. General Liability Insurance. Bodily injury liability insurance, in the minimum limits of $500,000 per occurrence shall be required on the comprehensive form of the policy.

c. Automobile Liability Insurance. The insurance shall be required on the comprehensive form of policy and shall provide bodily and property damage liability covering the operation of all automobiles used in connection with the performance of the contract. At least the minimum limits of $200,000 per person and $500,000, per occurrence for bodily injury and $20,000 per occurrence for property damage shall be required. This insurance shall cover the operation of automobiles by Contractor employees and authorized Government employees and third parties.

SPECIAL INSTRUCTION 119 WAWF-ELECTRONIC SUBMISSION OF INVOICE

Reference DFARS Clause 252.232-7003 “ELECTRONIC SUBMISSION OF PAYMENT REQUESTS.”

Invoices shall be submitted and accepted using Wide Area Workflow (WAWF) web-based system at https://wawf.eb.mil. For information on WAWF including web-based training, visit the web-site and click on “About WAWF”. The web-site also contains detailed instructions for setting up your computer to achieve the best results with the system. If you have additional questions contact the WAWF-RA Customer Helpdesk at (866) 618-5988, Option 2 The following information codes will be required to submit your invoices correctly through WAWF:

SELECT TYPE OF INVOICE:

Contract Specialist/Administrator selects only one (1) of the following:

|X| Invoice and Receiving Report (Combo) (Creates two documents, an Invoice and a Receiving Report, within one data entry session (Combo). Creating both documents at the same time, rather than separately, is recommended.

Construction Invoice (Creates a Construction Payment Invoice from a contract for construction. Both an Inspector and a Contracting Officer must review and accept).

Contract Number: Block 2 of the SF1449 Form (If this is a GSA Delivery Order award, enter the GSA NUMBER)

Delivery Order: Block 4 of (Order Number) of SF1449 No Dashes – (if applicable)

Pay DoDAAC: Block 16a (Payment will be made by) of SF1449 – Pay DoDAAC code is used to route documents to the Defense Finance Accounting office responsible for payment.

The accounts payable mailing address can be located in Block 18a of SF1449. You can easily access payment information using the DFAS web site at http://www.dod.mil/dfas. Your contract/purchase order number or invoice will be required to inquire status of your payment.

Issue by DoDAAC: Block 9 (Issued by) of SF1449. Contracting office that issued your contract – WAWF uses the code to route the document to the base.

Admin DoDAAC: Block 16 (Administered by) of SF1449)

Ship-To Code: Block 15 (Deliver To) of SF1449 – This is a crucial piece of information. It will be different for almost every contract issued.

Ship-From Code: Not a required field for Air Force contracts.

Inspected by DoDAAC: Block 15 (Deliver to) of SF1449 - If an inspection is called for in the document, then you must provide the DoDAAC/Ext this code identifies the inspector.

Service Acceptor: Block 15 (Deliver to) of SF1449 – It is used to route documents to receiving service acceptor in WAWF.

LPO DoDAAC/Ext: Not a required field for Air Force contracts.

ADDITIONAL E-MAIL NOTIFICATIONS: The VENDOR and the DFAS Office will automatically receive a notice; after clicking SUBMIT WAWF will prompt for additional email submissions. The following E-Mail addresses MUST be input in order to prevent delays in processing:

Receiver/Acceptor: david.kimbrough@us.af.mil

Contract Specialist: eldrae.perdue@us.af.mil

Contracting Officer: kimberly.knott.1@us.af.mil

In addition to the requirement of this local clause, the Contractor shall meet the requirements of the appropriate payment clauses in this contract when submitting payment requests.

(End of Clause)

SPECIAL INSTRUCTION 114 REQUIRED POSTERS

Please utilize the following website to access and download as appropriate EEO posters, Service Contract posters, and disability posters required in accordance with 52.222-26, 52.222-41, and 52.222-36 respectively.

http://www.dol.gov/osbp/sbrefa/poster/main.htm

(End of Clause)

Points of Contact:

Eldrae Perdue Contracting Specialist Phone (334) 953-4745, Fax (334) 953-3527 eldrae.perdue@us.af.mil

Kimberly Knott Contracting Officer Phone (334) 953-8552, Fax (334) 953-3527 kimberly.knott.1@us.af.mil

PERFORMANCE WORK STATEMENT (Dentist):

Section 1

GENERAL

1. DESCRIPTION OF SERVICES The Contractor shall provide one (1) Full Time Equivalent (FTE) Dentist for the Maxwell Ambulatory Healthcare Center, also referred to as the “Medical Treatment Facility” (MTF) herein. Performance shall be according to the requirements contained in this Performance Work Statement (PWS), the professional standards of the Accreditation Association for Ambulatory Health Care (AAAHC), American Dental Association (ADA), the Air Force Health Services Inspection Agency Office of the Health Service Inspector, and applicable Air Force regulations. Contractor shall administer dental education program; conduct dental examinations and provides dental care for military members with special standards of dental qualification.

1.1. CONTRACTOR STAFFING PLAN: The Contractor shall establish and maintain a staffing plan for staffing vacant positions with fully qualified health care workers from outside of the Government. A copy of the plan shall be forward to the Contracting Officer (CO) prior to contract start date. The plan shall include a timeframe for hiring, credentialing, and if the employee is terminated or quits a re-hiring proposal as part of the proposal as part of the evaluation criteria prior to contract award.

1.2. PERSONNEL.

1.2.1. POINT OF CONTACT. The Contractor shall provide a point of contact that shall be responsible for the performance of the work. The point of contact shall have full authority to act for the Contractor on all matters relating to the operation of this contract. The Contractor shall designate this individual, in writing, to the Contracting Officer Representative (COR) before the contract start date.

1.2.2. AVAILABILITY. The Contractor shall provide a point of contact that shall be available via telephone five (5) days a week, Monday through Friday, 7:00 AM until 5:00 PM, (defined herein as a ”duty day”), excluding Federal Holidays.

1.2.3. ARRANGE FOR REPLACEMENT STAFF. The Contractor shall arrange for pre-credentialed locum tenens coverage when the Contractor will be unable to provide services for four (4) or more consecutive weeks. Locum tenens personnel will have all credentials accepted through the 42d Medical Group before any service is performed within the MTF.

1.2.4. PERSONNEL REQUIREMENTS.

1.2.4.1. ENGLISH LANGUAGE REQUIREMENT. Personnel shall read, understand, speak, and write English well enough to communicate effectively with patients and other healthcare workers.

1.2.4.2. Contractor personnel shall present a neat appearance and be easily recognized as contractor employees. A hospital issued nametag will be provided designating “contractor”.

1.2.4.3. United States citizenship

1.2.4.4. Board Certification in a dental specialty is not required.

1.2.5. CRIMINAL BACKGROUND CHECK REQUIREMENT.

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

1.2.5.2. Individuals must obtain a new a background check and shall provide proof of the background check to the MTF COR.

1.2.6. CONFLICT OF INTEREST. The Contractor shall not employ any person who is an employee of the United States Government if the employment of that person would create a conflict of interest. The Contractor shall not employ any person who is an employee of the Department of the Air Force, either military or civilian, unless such person seeks and receives approval in accordance with DoD Directive 5500.7, Standards of Conduct, dated 29 November 2007, and Air Force policy.

1.3. CREDENTIALS REQUIREMENTS

1.3.1. PRIVILEGING. The credentials of all providers shall be reviewed and privileges granted as outlined in AFI 44-119, Medical Quality Operations. The Contractor is responsible to ensure that proposed staff possesses the requisite credentials enabling the granting of privileges by the MTF sufficient to allow for performance of all tasks identified in Section 4 of this PWS. All requirements shall be available to the MTF day one of work in order for performance and payment of services to begin.

ATTACHMENT 1

42D MEDICAL GROUP CREDENTIALING PROCEDURES

For Contracting Agencies

THE PROVIDER MAY NOT REPORT TO THE MTF UNTIL ALL CLINICAL PRIVILEGES DOCUMENTS ARE RECEIVED PLEASE CAREFULLY READ ALL INSTRUCTIONS ON ALL FORMS. IF ANY PART OF THE APPLICATION PACKAGE IS INCOMPLETE OR MISSING, THE ENTIRE PACKAGE WILL BE RETURNED FOR PROPER COMPLETION.

PLEASE SAVE EACH DOCUMENT SEPARATELY AS A PDF FILE.

PROVIDER:

1. Read, complete and return the following:

2. AF Form 1540, Application for Clinical Privileges. Complete Section I through IX and sign.

Please use MM/DD/YYYY format for all dates.

In Section IV, please ensure that ALL facilities where you have EVER been granted privileges since qualifying degree are listed.

In Section V, please ensure ALL licenses EVER HELD are listed.

3. Privilege List. Review and complete the privileges list for your specialty by placing a # 1, 2, or 4 in the requested column, according to the instructions at the top of the form. DO NOT use “x’s” check marks or initials!!! Also DO NOT use a code 3. Place your signature in the “Provider Signature” space.

4. AF Form 1562. Sign and date the top section of each of the AF Forms 1562, (2 Forms are Required). These will be sent to the individuals you list as references on your application.

5. Provide copies of the following documents if needed for your credentials folder (any training certificates, licenses, etc. listed on your application must be presented before privileges will be awarded):

THE PACKET FROM THE CONTRACT COMPANY MUST INCLUDE THE FOLLOWING:

15 FEB 2013

1.3.1.1. Initial applications for clinical privileges, to include credentials action history, malpractice history, and completed copies of the below listed documents, shall be submitted to the applicable MTF Credentials Committee in accordance with the Contract Staffing Plan in 1.1. Additionally, the Contractor shall make all proposed health care providers available for interview by the applicable MTF during the credentialing process.

a. Copy of valid, current, unrestricted applicable state dental license, shall be submitted. Under a personal services contract, have and maintain an unrestricted license in one of the 50 States, the District of Columbia, the Commonwealth of Puerto Rico, Guam, or the U.S. Virgin Islands, and be able to obtain clinical privileges to practice at the MTF where services are provided and have current Drug Enforcement Agency (DEA) registration number (certification). Copies of required certification shall be furnished to the Contracting Officer prior to performance on this contract. Each required document must be sent in PDF form, one document per PDF, to ensure credentialing as soon as possible. Attached credentialing document is what is expected. (See Attachment 1 above)

b. Provider education and training.

c. Current Basic Life Support (BLS)/ Advanced Cardiac Life Support (ACLS) based on guidance in AFI 44-102, Medical Care Management.

d. A signed consent for release of information.

e. Copy of Drug Enforcement Agency (DEA) certificate, if applicable. Must have an Alabama License to meet the DEA requirements.

f. A copy of the proposed contract provider’s professional resume (curriculum vitae), accompanied by that individual’s sworn affidavit of the truthfulness of same, indicating experience, training, and technical expertise in the type of care to be rendered.

g. A list of all states in which contract provider currently holds or has held a license to practice related services.

h. Certification of current physical examination for each employee. The certification shall contain a signed statement by the examining physician stating that the employee is free of any contagious diseases. Physical examination must be current and within the 12 months prior to the application for privileges.

1.3.1.2. Applications for privileges will be screened through the National Practitioners Data Bank.

1.3.1.3. Professional staff appointments and clinical privilege actions will be based on review of documents listed in paragraph 1.3.1, in accordance with AFI 44-119, Medical Quality Operations.

1.3.1.4. Applications for clinical privileges, for replacement contract providers shall be submitted to the applicable MTF Credentials Committee through the COR where services are to be provided, not later than thirty (30) calendar days prior to the provider assuming duty.

1.3.1.5. The Contractor is required to submit a progress report within thirty (30) days of contract award. The progress report will include total numbers of applicants for each position, total number of interviews for each position, hiring limitations if any, and proposed start to work day.

1.3.1.6. The Contractor must submit only complete credentials applications for processing. Incomplete applications (those that do not fully comply with the requirements) will not be accepted by the Government and will be returned without action.

1.3.1.7. The Contractor must take specific action, including Primary Source Verification, to ensure that contract provider applications have the required prerequisites for privileging and do not have disqualifying impediments for privileges at the applicable MTF. This is a non-delegable responsibility of the Contractor.

1.3.1.8. The Contractor will submit applications for only those contract providers who can reasonably be anticipated to render the actual, substantial performance on the contract. The submission of primary contract providers for credentialing who lack the requisite qualifications, or who will not work at all, is unacceptable and will be considered a failure to perform.

1.4. RELATIONSHIP OF THE PARTIES, PROFESSIONAL LIABILITY RESPONSIBILITY, AND PROCEDURES.

1.4.1. RELATIONSHIP OF THE PARTIES. This is a personal services contract as defined in Federal Acquisition Regulation (FAR) 2.101. The health care provider who furnishes services under this contract is subject to the day-to-day supervision and control of employees of the United States. The COR and applicable Flight Commanders will provide the supervision and control where the services are performed.

1.4.2. PROFESSIONAL LIABILITY RESPONSIBILITY. The health care provider’s status as a personal servant of the United States entitles it to applicable coverage of the Federal Tort Claims Act as provided in the Medical Malpractice Immunity Act, 10 U.S.C. 1089. Therefore, the health care provider shall not be liable for claims of personal injury or death, allegedly caused by the negligence of the health care provider, which occur within the scope of work performed by the health care provider under this contract, and are not otherwise compensated for, or covered by, private insurance. Such claims will be processed in accordance with the procedures established by those statutes, implementing regulations, and as set out below. The Contractor is not required to maintain dental malpractice liability insurance, and the government will not reimburse or otherwise pay for such insurance should any be purchased.

1.4.3. CLAIMS PROCEDURES. If any suit or action is filed or any claim is made against the health care provider, which occurred as a result of work performed by the health care provider under this contract, the health care provider shall:

1.4.3.1. Immediately notify the COR and promptly furnish copies of all pertinent papers received;

1.4.3.2. Cooperate with the Government, without further compensation, in the processing, review, settlement or defense of the suit, action or claim; and;

1.4.3.3. Authorize Government representatives to settle or defend the claim and to represent the health care provider in, or take charge of, any litigation involved in such an action. The health care provider may participate, at his own expense, in defense of such claim or litigation.

1.5. DENIAL/TERMINATION OF PRIVILEGES.

1.5.1. Actions to limit, suspend, or revoke clinical privileges shall be in accordance with the procedures outlined in AFI 44-119, Medical Quality Operations.

1.5.2. The CO and the Contractor shall be notified by the COR as soon as possible when the necessity to exercise such authority becomes apparent. The COR will also provide the CO and the Contractor with copies of documentation initiating the revocation process if such actions become apparent.

1.6. EDUCATION AND TRAINING REQUIREMENTS. The Contractor must submit in writing to the MTF commander through the COR any request for waivers to the education and training requirements. The waiver request must explicitly state what requirement the Contractor is requesting be waived.

1.6.1. Provider must have graduated from an approved dental school, accredited by ADA and acceptable to the U.S. Air Force Surgeon General. Current Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) course completion are required dependent upon AFI 44-102.Medical Care Management. Contract general dentists shall have a minimum of 1 year of experience following graduation from dental school. Contract general dentists shall be capable of performing the full range of dental services commensurate with a degree in General Dentistry. In addition, each contract dentist shall have been performing clinical dentistry during 12 of the last 18 months immediately prior to performance on this contract.

1.7. HEALTH REQUIREMENTS:

1.7.1. PREASSIGNMENT MEDICAL EVALUATION: No contract employee shall perform health care services under this contract unless a pre-assignment medical evaluation has been performed not more than thirty (30) calendar days prior to submission of credentials. The purpose of this medical evaluation is to determine if the individual, from a healthcare standpoint, possesses the minimum physical abilities needed to perform the proposed job without significant risk to personal health or the health and safety of others. As a minimum, the individual shall be free of physical defects or medical conditions which might reasonably be expected to place other workers, patients, or the public at risk. Not later than five (5) days prior to the commencement of performance of health care services under this contract by any employee, the Contractor shall provide to the Public Health (Employee Health) Flight certification that such employees have completed the medical evaluation requirements identified below. This certification shall state the date on which the examination was completed, the doctor’s name that performed the examination and a statement concerning the physical health of the individual. Initial documentation is required for: MMR (immunization or titer levels for Rubella and Rubeola), history of chicken pox disease or positive titer (varicella vaccination must be accomplished if lack of immunity), TB Mantoux skin test (IPPD) if positive, minimum requirement will be follow-up with contractors physician and a chest x-ray. A physician must provide documentation of “no active respiratory disease”, Hepatitis B vaccination/series are required for all personnel with occupational risk of exposure (declination are not acceptable, this is a condition of employment) and if the employee will be involved in exposure-prone procedures (ex: dentist, dental hygienist) they will have their HbsAg status determined. This is to be done by providing documentation of the HbsAb (if positive they will be referred to the MTF Credentials committee to determine scope of practice). If, in the opinion of the evaluating dental practitioner, the individual is found to be qualified for duty, the medical statement shall include the following wording: “(NAME OF EMPLOYEE) possesses the minimum physical abilities to perform the proposed duties of a (insert job title). He/she has documented proof of immunization against/immunity to rubeola, rubella, and hepatitis B and does not have an active infectious condition which might place others at risk.” If, in the opinion of the evaluating medical practitioner, the individual does not possess the minimum capabilities needed to perform the proposed job or does not meet the conditions of employment or will pose a risk to others, the medical statement shall contain the following wording: “For medical reasons, (NAME OF EMPLOYEE) is not qualified for employment as a (insert job title).” Certification shall be provided to the CO, who will forward to the MTF Employee Health Office.

1.7.2. ANNUAL MEDICAL EVALUATION. All contract employees performing health care services under this contract shall complete annual medical evaluations as required by the MTF hospital employee health program. The contractor shall provide to the COR a certificate, as described above, documenting the results of this evaluation.

1.7.3. PREVENTIVE, PROPHYLACTIC, AND FOLLOW-UP PROCEDURES. The contractor shall ensure that his/her employees are in compliance with preventive, prophylactic and follow-up procedures, as well as infection control and employee health program procedures, as established by the MTF. The Government will provide required preventive, prophylactic and follow-up procedures to contract employees in the military MTF. The Contractor shall reimburse payment for these services. If care is received elsewhere, the Contractor shall provide written verification of treatment.

1.8. EMERGENCY HEALTH CARE. The MTF will provide emergency health care for contract personnel for injuries occurring while on duty in the MTF. These services will be billed to the Contractor at the current full reimbursement rate.

1.9. HOURS OF OPERATION. Core patient care hours are 7:00am – 4:00pm, Monday through Friday. Contract employees shall be present during core hours with additional time to complete documentation and manage the empanelled population as required. Expectations are a minimum of 40 hours up to 60 hours average per week. Contract personnel should follow command announcements for reporting to work as it relates to inclement weather or base closures.

1.10. FEDERAL HOLIDAYS/MTF CLOSURE. The Contractor will not provide routine services on federal holidays. The Contractor will not provide routine services during Department of Defense (DOD), AF or Wing-declared down-days, or events which result in dental facility closure. (Some exceptions may apply as directed by the MDG COR staff.) Note: for Squadron functions/emergency base closure, i.e. weather, contractors will not be reimbursed or paid for these events. Also, alternate duty location events will not be reimbursed.

1.11. ON CALL/AFTER DUTY RESPONSE TIME. The contract provider shall provide on call services.

1.12. SECTION FLEXIBILITY. Contract personnel may be required to work in other dental duty sections. Contract personnel shall be flexible in rotating temporarily, or permanently moving into, other duty sections upon notification of the COR. Contract personnel identified for rotation or temporary move into a new duty section will be required to undergo orientation to new section IAW Para. 1.13 of this PWS.

1.13. DENTAL QUALITY ASSURANCE/RISK MANAGEMENT (QA/RM).

1.13.1. Health care providers shall participate in QA/RM activities to the extent required by AFI 44-119, Medical Quality Operations and the individual MTF QA/RM plan or regulation. This includes, but is not limited to, peer review at a minimum of 10 encounters per month.

1.13.2. The Government will evaluate the provider's professional performance, as differentiated from administrative performance under this contract using quality assurance standards specified in AFI 44-119, Medical Quality Operations.

1.14. ORIENTATION. The Contractor shall ensure that all contract providers participate in the MTF orientation and service/clinic specific orientation prior to furnishing services under this contract. Clinic orientation must occur within five (5) duty days of employment start date. MTF orientation must occur within thirty (30) days of employment start date.

1.15. CONTINUING EDUCATION (CE) DENTAL REQUIREMENTS. Health care providers registered or certified by national/dental associations shall continue to meet the minimum standards for CE to remain current as prescribed in AFI 41-117, Medical Service Officer Education. CE shall be obtained at no additional cost to the Government and shall be reported to the COR and MTF Credentials Committee annually on the first normal duty day in January for the previous calendar year. Periodic CE may be conducted at the MTF and will be available, at no cost, to any healthcare provider desiring to attend.

1.16. ANNUAL TRAINING REQUIREMENTS: All contract employees must complete any mandatory and annual training required IAW DoD, Air Force Instructions, medical facility training requirements, and regulatory agencies (AAAHC, Health Insurance Portability and Accountability Act (HIPAA), Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Health Services Inspection (HSI), AF Computer Security Policy, and AF Safety Policy). They must complete any additional training as dictated by facility or work-center.

1.17. MTF PROVIDER DIRECTORY: Contract physicians will provide information necessary for paper and web-based MTF provider directory. Credentialed providers will include information such as name, degree, specialty, board status, office telephone and fax number, and licensing information. A picture of the provider is encouraged, but optional. Additional education and training information completed by the provider may also be included. Educational information and links to health information for the provider’s patient population is also encouraged.

1.18. GOVERNMENT COMPUTER ACCESS: The contractor will ensure that all Contract employees comply with the requirement to obtain the minimum…