F3G4BA5163AW01_EMS_Final_PWS.pdf

PERFORMANCE WORK STATEMENT

FOR THE

PARAMEDIC/AMBULANCE CONTRACT

AT

CREECH AFB

NEVADA

22 September 2014

TABLE OF CONTENTS

SECTION NO. AND TITLE PAGE No.

1.0 DESCRIPTION OF SERVICES 3

1.1 SCOPE OF WORK 3

1.2 GENERAL OPERATIONAL REQUIREMENTS 3

1.2.1. SERVICE COVERAGE FEES VS TRANSPORT COVERAGE FEES 3

1.2.2. MANAGEMENT REQUIREMENTS 3-4

1.3. PERSONNEL REQUIREMENTS 4

1.3.1. EMPLOYEE CRIMINAL BACKGROUD CHECK 4

1.3.2. EDUCATION AND TRAINING REQUIREMENT 5

1.4. HEALTH REQUIREMENTS 6

1.5. HOURS OF OPERATION 6

1.6. INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE 6

2.0 SERVICES SUMMARY 7-8

3.0 GOVERNMENT FURNISHED PROPERTY 8

4.0 CONTRACTOR FURNISHED ITEMS AND SERVICES 9

5.0 GENERAL INFORMATION 9

6.0 APPENDICES 9

APPENDIX A SPECIFIC TASKS 10-14

APPENDIX B ACRONYMS AND DEFINITONS 15-16

APPENDIX C APPLICABLE PUBLICATIONS AND FORMS 17

APPENDIX D MEDICAL DISCLOSURE 18-22

APPENDIX E CREECH AFB CONTRACTOR SECURITY 23-31

1.0 DESCRIPTION OF SERVICES

1.1. SCOPE OF WORK. The contractor shall provide State of Nevada certified or National Registered Emergency Medical Technicians (NREMT) medics and ambulances for emergency response and patient transport services required for Government beneficiaries and the general population on Creech AFB NV. The minimum team composition is one (1) paramedic and one (1) EMT/EMT-Advance. The Contractor shall provide full emergency patient transport services servicing Creech AFB NV. Response time for all emergencies in accordance with Air Force Instructions, state, and local requirements will not exceed twelve

(12) minutes for Advanced Cardiac Life Support (ACLS) personnel. Emergency response and transport services will be coordinated using the Nellis-Creech AFB Emergency Dispatch platform and Clark County Dispatch. Contractor shall serve as the Advanced Life Saving medical response unit for all emergencies at Creech AFB at all times to include down days and holidays. Contractor will participate in 99th Air Base Wing (99 ABW), authorized tenant units, and 99th Medical Group (referred to as the MTF hereafter) exercises as further specified in Appendix A. Contractor shall furnish all labor, management, supervision, vehicles, supplies, equipment, transportation, and reports, except as provided in Section 2.0.

Contractor care shall, at a minimum, cover the range of paramedic and ambulance services provided in the local community to include local protocols, or standing orders and staffing minimums. Performance shall be according to the requirements contained in this Performance Work Statement (PWS) and professional standards of the Joint Commission on Accreditation of Healthcare Organizations, and the Southern Nevada Health District’s Division of Emergency Medical Services.

1.2. GENERAL OPERATIONAL REQUIREMENTS

1.2.1. SERVICE COVERAGE FEES VS. TRANSPORT COVERAGE FEES. This contract is a mechanism for Creech AFB NV to ensure it has full Advanced Life Saving emergency response available for any medical emergency. The cost of care and/or transport will be covered in the cost of the contract. Services provided to anyone that is not an eligible Department of Defense beneficiary will be the individual’s own financial responsibility. The contractor will be responsible to bill the patient directly for cost incurred.

1.2.2. MANAGEMENT REQUIREMENTS

1.2.2.1. 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 daily operation of this contract. The point of contact may be a paramedic providing care in accordance with this PWS. The Contractor shall designate this individual, in writing, to the Contracting Officer (CO) before start of contract. An alternate shall be designated, but the Contractor shall identify those times when the alternate shall be the primary point of contact.

1.2.2.2. WORK ROSTER. The Government reserves the right to request a detailed work roster from the Contractor after the 15th of the month for the work schedule of the following month.

1.2.2.2.1. AVAILABILITY. The contractor shall provide a point of contact that shall be available via telephone 24 hours a day, every day of the year. This individual is designated by the Contractor. This individual (or individuals) will act as a liaison between the Contractor and MTF for communication purposes, and is a separate requirement from that listed in 1.2.2.1.

1.2.2.2.2. CONTINUITY OF SERVICES. This contract is the sole avenue for Creech AFB emergency patient transport/ambulance response. Therefore, the contractor must ensure 24 hour a day/every day of the year coverage with no interruptions in coverage. If emergency patient transport services are unavailable for any period or for any reason other than current patient transport, the Government reserves the right to procure such services from another source pending full restoration of full paramedic emergency patient transport services by the Contractor. When the Government exercises its right to procure these services from another source, the Contactor will be liable for the cost of the procured services. A copy of the other source’s service ticket or invoice shall be used as the basis for this liability. The Government will furnish the Contractor a copy of this ticket upon the Contractor’s request.

1.2.2.2.3. Contractor Full-Time Equivalent Reporting. “The contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract for the Paramedic/Ambulance Contract via a secure data collection site. The contractor is required to completely fill in all required data fields using the following web address http://www.ecmra.mil.

Reporting inputs will be for the labor executed during the period of performance during each Government fiscal year (FY), which runs October 1 through September 30. While inputs may be reported any time during the FY, all data shall be reported no later than October 31 of each calendar year. Contractors may direct questions to the ECMRA help desk.”

Uses and Safeguarding of Information: Information from the secure web site is considered to be proprietary in nature when the contract number and contractor identity are associated with the direct labor hours and direct labor dollars. At no time will any data be released to the public with the contractor name and contract number associated with the data.

User Manuals: Data for Air Force service requirements must be input at the Air Force CMRA link. However, user manuals for government personnel and contractors are available at the Army CMRA link at http://www.ecmra.mil.

1.3. PERSONNEL REQUIREMENTS.

1.3.1 EMPLOYEE CRIMINAL BACKGROUND CHECK. The Contractor assumes responsibility for conducing criminal background investigations on employees who will likely respond to medical emergencies on Creech AFB NV. The contractor shall produce the results of these checks upon request by the 99th Medical Group Commander at Nellis AFB NV.

http://www.ecmra.mil/ http://www.ecmra.mil/

Additionally, 99 MDG will conduct its own formal background investigation of all Government Contractors.

1.3.2. EDUCATION AND TRAINING REQUIREMENTS.

1.3.2.1. FORMAL EDUCATION/CERTIFICATION. All drivers performing duties under this contract must be high school graduates or have received a General Education equivalency certificate. Drivers must possess a valid driver’s license with a State of Nevada and/or be required to obtain a flight line license at Creech AFB. Additionally, drivers must have completed Contractor specific proficiency training for all specialized ambulances being operated and completed the Emergency Vehicle Operators course. Paramedics performing services under this contract must be high school graduates or have a General Education equivalency certificate and be certified by the State of Nevada as a paramedic. All crews must respond to calls with, at a minimum, one (1) paramedic and one (1) EMT.

1.3.2.2. DRIVING RECORD. Drivers must not have any reckless or dangerous driving citations within the previous 24 month period and have no Driving While Intoxicated (DWI) or Driving Under the Influence (DUI) convictions in the previous five years. Drivers may not have more than two infractions assessed in a three year period under the State of Nevada driving infraction system.

1.3.2.3. EXPERIENCE. At least one paramedic per ambulance shall have been employed as an emergency response paramedic six out of the past twelve months. NREMT Certification or State of Nevada Emergency Medical Technician Certification is required.

1.3.2.4. TRAINING and DOCUMENTATION. The Contractor shall maintain files to assure that all paramedics performing work under this contract shall have current certifications and/or documents listed below. Upon request the contractor shall provide copies of these documents for any paramedic to the 99th Medical Group Commander within forty-eight (48) hours.

1.3.2.4.1. Copy of valid, current, unrestricted State of Nevada Paramedic Certification.

1.3.2.4.2. Paramedic continuing medical education, driver education and training files.

1.3.2.4.3. Current Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), Pre-hospital Trauma Life courses.

1.3.2.4.4. Ambulance response teams must be trained in National Incident Management Systems (NIMS) response procedures, must meet BLS/ACLS/Paramedic requirements, be HIPAA trained, and meet EMS/ALS requirements for Clark County.

1.4. HEALTH REQUIREMENTS.

1.4.1. Contract personnel are required to have a medical examination within the 12 months prior to providing services under this contract. The examination will not be at the Government’s expense. Additionally, all personnel performing duties under this contract must be able to lift 100 pounds, unassisted.

1.4.2. Not later than five (5) working days prior to commencement of work, Contractor shall obtain proof of certification that health care providers have completed medical evaluation required above. This certification shall state the date on which the examination was completed, the doctor’s name that performed the examination, and the following statement: “(name of contract employee) is suffering from no contagious disease to include but not limited to Tuberculosis, Hepatitis, and HIV.” Contractor shall provide information to 99th Medical Group upon completion.

1.5. HOURS OF OPERATION. The Contractor is required to provide full paramedic emergency patient response and transport services 24 hours a day, every day of the year to include all down days and holidays. These services are considered life or death and considered mission essential. Members will also perform stand-by medical services for base events that have been approved by the 99 MDG Commander. (Example: Change of Commands, Wing Runs, base events, etc.)

1.6. INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE. The Contractor shall provide and maintain adequate liability insurance coverage consistent with the risks associated with the performance of all services required by this PWS in reference with Federal Acquisition Regulations (FAR) 52.237-7, Indemnification & Medical Liability Clause.

1.7. MEDICAL QUALITY ASSURANCE/RISK MANAGEMENT (QA/RM). Contractor shall meet the QA/RM documentation requirements of the State of Nevada for emergency medical care providers and those of Clark County if they exceed state requirements.

1.7.1. Healthcare workers shall participate in QA/RM activities to the extent required by Air Force Instruction (AFI) 44-119, Medical Quality Operations, and the individual MTF QA/RM plan or regulation.

1.7.2. The Government will evaluate the provider’s professional, as differentiated from administrative, performance under this contract using quality assurance standards specified in AFI 44-119. Nothing in this paragraph precludes the Government from also conducting inspections under the Inspection of Services clause. See Services Summary in Section 2.0.

1.8. CONTINUING MEDICAL EDUCATION (CME) REQUIREMENTS. Paramedics certified by the State of Nevada shall continue to meet the minimum standards for Continuing

Education Units (CEUs) to remain current as prescribed by certifying agency. CEUs shall be obtained at no additional cost to the Government. Contractor will provide continuing education status of paramedics to 99th Medical Group Commander annually.

2.0. SERVICES SUMMARY: The Services Summary identifies the performance objectives and performance thresholds for all critical tasks associated with providing the services outlined in this PWS. This section contains only those items considered most important for mission accomplishment. The performance objectives are those services/tasks required in the PWS. The performance threshold briefly describes the minimum acceptable levels of service required for each requirement. The thresholds are critical to mission success. The Government expects the Contractor to perform at the acceptable levels throughout the life of the contract.

SS

Performance Objective PWS Para

Performance Measure Performance Threshold

1 Response Time/ Transport 1.1.;

1.3.2.1;

A.1.1.

Response time for all emergencies will not exceed twelve (12) minutes.

90% Compliance

2 Contract Shall provide 24-hour uninterrupted response coverage

1.1; 1.2.1;

1.2.2.2.2.;

1.3.2.1.

A.2; A.3

Contractor care shall, at a minimum, cover the range of paramedic and ambulance services provided in the local community to include local protocols, or standing orders and staffing minimums.

100% Compliance

3 Contractor Participation 1.1; 1.2.1;

1.2.2.2.2.

A.2.; A.3.

Contractor shall provide medical response for all emergencies located at Creech AFB NV. Contractor will participate in 99 ABW, authorized tenant unit, and 99 MDG exercises.

100% Compliance

4 Availability 1.2.2.2.1 Contractor shall provide a POC that shall be available via telephone 24 hours a day, every day of the year.

100% Compliance

5 Continuity of Service 1.2.2.2.2. Contractor is sole avenue for emergency patient transport/ ambulance response; therefore, contractor must establish/maintain Mutual Aid Agreement with Clark County Fire Dept to assure backup support is provided in event the contractor cannot perform duties due to unforeseen circumstances.

100% Compliance

6 Experience/Certification

1.3.2.1.;

1.3.2.3;

1.3.2.4.3.

A.1.4.

All drivers must possess valid NV license. Certified by the State of NV/NREMT EMT. They must have completed county protocols and current BLS. Certified by the State of NV/NREMT as a paramedic. They

100% must also have completed county protocols, current BLS, ACLS, PALS

7 Communication A.2.1.;

A.8.

Contractor shall ensure contract providers maintain open and professional communication with members of the MTF.

100%

2.1. The Government will periodically evaluate the Contractor’s performance by appointing a representative(s) to monitor performance to ensure services are received. The Government representative will evaluate the Contractor’s performance through inspections of call logs/reports and receive and investigate all complaints from base personnel. The Government may inspect each task as completed or increase the number of quality control inspections if deemed appropriate because of repeated failures discovered during quality control inspections or because of repeated customer complaints. Likewise, the Government may decrease the number of quality control inspections if performance dictates. The Government representative shall make final determination of the validity of customer complaint(s).

3.0. GOVERNMENT-FURNISHED PROPERTY AND SERVICES

3.1 GENERAL. Unless specifically listed below as Government Furnished Property, Material, Equipment or Services, the contractor shall supply all necessary requirements to perform the services listed in the PWS. The Government shall provide the following equipment, supplies, and services listed below:

3.2 FACILITIES. The Government shall provide year-round interior vehicle stall parking for one ambulance unit, and shared work/living quarters (kitchen, private sleeping, recreation, office) as a base of operations at a fire station on Creech AFB NV.

3.3. FORMS: The paramedics must have a Nevada certified Medical Director. Contractor shall provide on-line and off-line Medical Direction using Nevada State and/or local county Pre-hospital protocol. Patients will be transported to local hospitals per Nevada State and/or Local Medical Director instructions and protocol. AF Form 552 is not required to be used by contractors; however, the MTF shall provide any required Government forms used in the performance of services. The Air Force Patient Care Form, AF Form 552, shall be used to document all responses and patient transports.

3.4. RADIOS. The Government shall provide two handheld radios with chargers for emergency notification.

3.5. MISCELLANEOUS. The Government shall provide a phone listing of all base agencies and detailed grid map of Creech AFB, the Nevada Test & Training Range, and a cell phone. An updated phone listing and map shall be provided on an annual basis or as needed.

4.0. CONTRACTOR FURNISHED ITEMS AND SERVICES. Except for those items or services specifically stated in Section 2 as Government furnished; the Contractor shall furnish everything required to perform this contract in accordance with terms and conditions. Items can include, but are not limited to: paramedics, emergency medical technicians, ambulances, supplies for ambulances, stretchers, medical gases for ambulances, and road maps.

5.0. GENERAL INFORMATION

5.1. Government Supervision of Contractor Employees: The Government will not directly supervise contractor employees. However, the ambulance crew will take direction from the Incident Commander (typically the base fire chief), under the principles of the Air Force Incident Management System. The Government will inspect contractor performance in accordance with the Performance Plan (PP) or Management Plan (MP) and any other clauses included in the contract.

5.2. Quality Control: The Contractor shall ensure that the government receives the level of quality that is consistent with the requirements specified in this statement of work. The contractor’s quality control plan shall be made available for Government review upon request.

The Contractor shall be responsible for overall responsiveness, cost control, adherence to schedules, technical quality of work, and commitment to customer satisfaction.

5.3 Phase-In Plan: The phase-in period shall not exceed 30 calendar days from the start of the period of performance established for the base year. At the end of the phase-in period, the contractor shall perform according to all the terms and conditions of this contract.

6.0. APPENDICES

Appendix A – Specific Tasks Appendix B – Acronyms and Definitions Appendix C – Applicable Publications and Forms Appendix D – Medical Disclosure Appendix E – Creech AFB Contractor Security

APPENDIX A - SPECIFIC TASKS

A.1. SPECIFIC PROCEDURES FOR WHICH THE CONTRACTOR SHALL BE

RESPONSIBLE

A.1.1. EMERGENCY PARAMEDIC RESPONSE AND PATIENT TRANSPORT. The

Contractor shall provide ambulance response to emergencies as directed by the Nellis-Creech AFB

Emergency Dispatch platform. Contractor shall provide on-line and off-line Medical Direction using Nevada State and/or local county Pre-hospital protocol. Paramedics need a state certified medical director. Patients will be transported to local hospitals per State/Local Medical Director instructions. Actual work involved in performance of this contract shall include but not be limited to:

A.1.2. Responding in conjunction with military medical responders when required for suspected incidents or disasters involving hazardous material, weapons of mass destruction, biological/chemical/radiological contamination. The Incident Commander will ensure the contract ambulance remains at a safe distance from any hazard in accordance with all response plans and Air

Force Incident Management System (AFIMS) guidelines. After gross decontamination, patients will be transported to local hospitals by the contractor.

A.1. 3. Traveling to response sites in an appropriate medical response vehicle per directions received primarily from the Nellis-Creech AFB Emergency Dispatch platform.

A.1.4. Providing full Advanced Life Support paramedic care and treatment to patients and providing supplies, services and equipment necessary to maintain the patient’s medical status, which could change despite proper medical care/treatment.

A.1.5. Coordinating in-field care IAW Clark County EMS System protocols and local hospitals.

A.1.6. Coordinating patient transport with local hospitals. This will include coordinating through the medical director for any potential air transport as requested on an as needed basis by the responding ambulance crew.

A.1.7. Transporting patients to local hospital from Creech AFB NV.

A.1.8. Ensuing a paramedic remains with patients until patients are properly accepted by a qualified member of the receiving hospital.

A.2. 99th AIR BASE WING, AUTHORIZED TENANT UNIT, AND MTF EXERCISE

PARTICIPATION. Contractor shall be responsible for participating in 99 ABW and MDG exercises and inspections. The 99 ABW or MDG will provide at least 7 days advance notification prior to exercise date and will not exceed 60 hours per year. Specific response times for exercise will not be provided until the day of the exercise. Specific responsibilities and procedures include, but are not limited to the following:

A.2.1. Participating in advance exercises preparatory meetings as required.

A.2.2. Assisting 99 ABW, authorized tenant unit, and MDG Wing Inspection Team (WIT) with developing exercise scenarios, goals, and objectives.

A.2.3. Responding with paramedics to exercise sites and performing mock duties as needed.

A.2.4. Falling under the authority of the Fire Chief or Incident Commander and obeying all directives they provide.

A.2.5. Providing mock field patient care and mock patient transport during exercises.

A.2.6. Participating in after-action exercise meetings and completing written critiques as requested.

A.2.7. Providing detailed exercise analysis, as required, by member of the 99 ABW, authorized tenant unit and MDG WIT.

A.3. DOCUMENTATION. All Contractor prepared documentation shall be timely, legible, accurate, and thorough and must contain a signature. The paramedic shall ensure complete patient identifying information is on all documentation to be provided to the MDG relating to the transport.

Three types of response reports need to be generated:

Immediate: Within 2 hours report via HIPPA compliant email to designated distribution list information about the patient treated (name, rank, social security number, unit, status, time seen, diagnosis, prognosis, transport requirement included).

Daily: Summary of daily responses with updated information on personnel seen/treated over previous 24 hours.

Monthly: Spreadsheet containing detailed information about each response.

All of the particular details for the reports will be at the discretion of the AF.

A.4. TOTAL QUALITY IMPROVEMENT. The Government Supervisor, or designee, shall assess response time to calls, on-scene time, documentation of care, and trauma call documentation to assure its quality.

A.5. RECORDS. The MDG shall be responsible for creating, maintaining, and disposing of only those Government required records which are specifically cited in the PWS or as may be required by the provisions of a mandatory directive listed in Appendix C of the PWS. If requested by the

Government, the Contractor shall provide the original record or a reproducible copy of any such records within five (5) working days of receipt of the request.

A.6. RELEASE OF MEDICAL INFORMATION. Under this PWS, the contractor will be considered a ‘Business Associate’ under the terms of the Health Insurance Portability &

Accountability Act of 1996 (HIPAA), Public Law 104-191, and its implementing regulations, including D0D 6025.18-R. In the performance of this contract, the contractor shall, when performing as a ‘Business Associate,’ comply with all rules and requirements applicable to a ‘Business Associate’ under HIPAA and its implementing regulations including DoD 6025.18-R, see Appendix D, HIPAA guidelines. Violation of HIPAA may involve the imposition of fines and/or imprisonment. The

Contractor shall include this notification and requirement in every subcontract for ‘Business

Associate’ service.

A.6.1. Any reporting in regards to information that may be received about a sexual assault will be in compliance of AFI 36-6001.

A.7. COMMUNICATION. The Contractor shall ensure contract providers maintain open and professional communication with members of the MDG. Complaints validated by the COR and Chief of Medical Staff, shall be reported in writing to the contract administrator and the Contractor for action. Failure of the Contractor to correct validated complaints raised by the MDG staff and the

COR will be considered a failure to perform.

A.8. PERFORMANCE EVALUATION MEETINGS. The CO shall require the Contractor or his representative to meet with the CO, contract administrator, COR, and the Government representatives at least monthly or as often as deemed necessary. The Contractor may request a meeting with the CO when he deems such necessary. Meetings will be documented in the contract file with written minutes signed by the contract manager and the CO, or contract administrator. Should the Contractor not concur with the minutes, such non-concurrence shall be provided in writing to the CO within ten (10) calendar days of receipt of the minutes.

APPENDIX B – ACRONYMS AND DEFINITIONS

99 ABW – 99th Air Base Wing

AD - Active Duty

ACLS - Advanced Cardiac Life Support

AFIMS – Air Force Incident Management System

BLS - Basic Life Support

CEU - Continuing Education Unit

CME - Continuing Medical Education

CO - Contracting Officer: The Contracting Officer responsible for administering the contract afterward. The CO is the only individual who can make changes in the contract, bind the government monetarily, and direct the contractor.

COR - Contracting Officer Representative: A government person responsible for assessment of contractor performance.

DWI - Driving While Intoxicated

DUI - Driving Under The Influence

GED – General Educational Development

HIPAA - Health Information Portability & Accountability Act

IAW - In Accordance With

IC – Incident Commander

JCAHO - Joint Commission On Accreditation Of Healthcare Organizations

MDG – Medical Group

MTF - Military Treatment Facility: Air Force hospitals or clinics, including all activities providing outpatient and/or in-patient health care services for authorized personnel.

NIMS – National Incident Management System

POC- Point of Contact

PWS - Performance Work Statement: A document that accurately describes a service in terms of the output requirements.

QA/RMC - Quality Assurance/Risk Management Committee. Committee responsible for the execution of the MTF QA/RM plan to include the duties outlined in AFI 44-119. The committee ensures an ongoing assessment of the quality and appropriateness of all medical care and will put in priority sequence suspected problems for evaluation, resolution, and follow-up.

QA/RMP - Quality Assurance/Risk Management Plan. An organized document which describes the methods of doing quality assurance (QA) reviews within the MTF. It designates the areas of responsibility and accountability for the QA program and the mechanisms for monitoring and evaluating patient care. It is consistent with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) monitoring and evaluation (M&E) approach and the Air Force risk management (RM) efforts.

SS- Services Summary: 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

WIT - Wing Inspection Team: Formerly known as Exercise Evaluation Team (EET)

APPENDIX C – APPLICABLE PUBLICATIONS AND FORMS

C. 1. Publications and forms applicable to the Performance Work Statement (PWS) are listed below. The Contractor is obligated to follow those publications. These publications are available in the MTF and maintained by the Government. Supplements or amendments to listed publications from any organizational level may be issued during the life of the contract. The Contractor shall immediately implement those changes in publications that result in a decrease or no change in the price and notify the Contracting Officer (CO) in writing of such change. Should a decrease in contract price result; the Contractor shall provide a proposal for reduction in the price to the CO. Prior to implementing any change that will result in an increase; the Contractor shall submit to the CO a price proposal within 30 days of receipt of the change by the Contractor. The CO and the Contractor shall negotiate the change into the contract under the provisions of the contract clause entitled "Changes." Failure of the Contractor to submit a price proposal within 30 days from receipt of the change shall entitle the Government to performance in accordance with such change at no increase in price.

PUB NO. TITLE DATE

DEPARTMENT OF DEFENSE (DOD)

REGULATIONS/MANUALS/INSTRUCTIONS/DIRECTIVES

DOD Instruction 1402.5, Criminal History and Background Checks on Individuals in Child Care

Jan 93

DoD Directive 5500.7, Standards of Conduct

Nov 07

DoD Instruction 6040.40, Military Health System Data Quality Management Control Procedure

Nov 02

DODI 6055.06 Fire and Emergency Services Programs Dec 06

AIR FORCE REGULATIONS/MANUALS/INSTRUCTIONS

AFI 41-217 Health Information Assurance for Military Treatment Facilities Dec 05

AFI 44-119 Medical Quality Operations Aug 11

AFI 36-6001 Sexual Assault Prevention and Response Oct 10

AFI 32-2001 Fire Emergency Services Program Feb 14

OTHER REFERENCES

Health Information Portability and Accountability Act (HIPAA) 1997 P.L. 101-647, Section 231, Subtitle E-Child Care Worker Employee Background Checks

C. 2 FORMS. The MTF will provide required Government forms used in the performance of services. Some of the forms used in the performance of duties are, but not limited to, those listed below:

AF Form 552, The Air Force Patient Care Form Nov 10

APPENDIX D - MEDICAL DISCLOSURE

D. 1. PRIVACY AND CONFIDENTIALITY

D.1. 1. PATIENT LISTS. Patient lists, no matter how developed shall be treated as privileged information. Lists and/or names of patients shall not be disclosed to or revealed in any way for any use outside the MTF without prior written permission by the Chief of Hospital Services.

D 1. 2. PATIENT SENSITIVITY. Contractors shall respect and maintain the basic rights of patients, HIPAA regulations, demonstrating concern for personal dignity and human relationships. Contractors receiving complaints validated by the QAP and Chief of the Medical Staff shall be subject to counseling and, depending on the nature and severity of the complaint, separation from performing services under this contract.

D 1. 3. RELEASE OF MEDICAL INFORMATION. The contract employee shall only release medical information obtained during the course of this contract to other MTF staff involved in the care and treatment of the individual patient.

D 1. 4. PRIVACY OF PROTECTED HEALTH INFORMATION. HEALTH

INFORMATION PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) OF 1996.

D 1.4.1. HIPAA is comprised of several different sections, each to be implemented by the Dept. of Health and Human Services. The medical facilities of the military services and the DOD health plans are specifically listed as covered by HIPAA. Currently, HIPAA Privacy and Security Rules, as set forth in the Code of Federal Regulations, are in effect for all MTFs. The specific implementation of HIPAA Privacy for DOD medical facilities is set forth in DOD 6025.18-R, and for HIPAA Security, the requirements for AF MTFs are contained in DOD 8580.02-R and AFI 41-217, which also contains additional Information Assurance requirements for all AF MTFs. DOD 6025.18-R, DOD 8580.02-R and AFI 41-217 are incorporated herein by reference. MTFs are responsible to ensure overall compliance with HIPAA requirements, which includes incorporation of certain requirements in contracts entered or amended after the respective implementation dates.

D 1.4.2. IAW these regulations, the Contractor and its employees meet the definition of Business Associates. Therefore, a Business Associate Agreement is required by law to comply with both the HIPAA Privacy and Security regulations. This clause serves as that agreement for each MTF, whereby the Contractor and its employees agree to abide by all HIPAA Privacy and Security requirements regarding health information as defined in this clause, DoD6025-18-R, DOD 8520.02-R and AFI 41-

217. Additional HIPAA requirements will be addressed when implemented.

D 1.5 INTRODUCTIONS.

D.1.5.1. DEFINITIONS. As used in this clause generally refer to the Code of Federal Regulations (CFR) definition unless a more specific provision exists in DOD 6025.18-R, DOD 8520.02-R or AFI 41-217.

D.1.5.2 Individual has the same meaning as the term “individual” in 45 CFR 164.50 1 and 164.103 and shall include a person who qualifies as a personal representative in accordance with 45 CFR 164.502(g).

D.1.5.3. Privacy Rule means the Standards for Privacy of Individually Identifiable Health Information at 45 CFR part 160 and part 164, subparts A and E.D.1.5.4. Protected Health Information has the same meaning as the term “protected health information” in 45 CFR 164.501, limited to the information created or received by The Contractor from or on behalf of the Government.

D.1.5.5. Electronic Protected Health Information has the same meaning as the term “electronic protected health information” in 45 CFR 160.103.

D.1.5.6 Required by Law has the same meaning as the term “required by law” in 45 CFR 164.501 and 164.103.

D.1.5.7. Secretary means the Secretary of the Department of Health and Human Services or his/her designee.

D.1.5.8. Security Rule means the Health Insurance Reform: Security Standards at 45 CFR part 160,162 and part 164 subpart C.

D.1.5.9. Terms used, but not otherwise defined, in this Agreement shall have the same meaning as those terms in 45 CFR 160.103, 160.502, 164.103, 164.304 and 164.501.

D.1.5.10. The Contractor agrees to not use or further disclose Protected Health Information other than as permitted or required by the Contract or as Required by Law.

D.1.5.11. The Contractor agrees to use appropriate safeguards to prevent use or disclosure of the Protected Health Information other than as provided for by this Contract.

D.1.5.12. The Contractor agrees to use administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic protected health information that it creates, receives, maintains, or transmits in the execution of this Contract.

D.1.5.13. The Contractor agrees to mitigate, to the extent practicable, any harmful effect that is known to the Contractor of a use or disclosure of Protected Health Information by the Contractor in violation of the requirements of this Contract.

D.1.5.14. The Contractor agrees to report to the Government any security incident involving protected health information of which it becomes aware.

D.1.5.15. The Contractor agrees to report to the Government any use or disclosure of the Protected Health Information not provided for by this Contract of which the Contractor becomes aware of.

D.1.5.16. The Contractor agrees to ensure that any agent, including a subcontractor, to whom it provides Protected Health Information received from, or created or received by the Contractor on behalf of the

Government agrees to the same restrictions and conditions that apply through this Contract to the Contractor with respect to such information.

D.1.5.17. The Contractor agrees to ensure that any agent, including a subcontractor, to whom it provides electronic Protected Health Information, agrees to implement reasonable and appropriate safeguards to protect it.

D.1.5.18. The Contractor agrees to provide access, at the request of the Government, and in the time and manner designated by the Government to Protected Health Information in a Designated Record Set, to the Government or, as directed by the Government, to an Individual in order to meet the requirements under 45 CFR 164.524.

D.1.5.19. The Contractor agrees to make any amendment(s) to Protected Health Information in a Designated Record Set that the Government directs or agrees to pursuant to 45 CFR 164.526 at the request of the Government or an Individual, and in the time and manner designated by the Government.

D.1.5.20. The Contractor agrees to make internal practices, books, and records relating to the use and disclosure of Protected Health Information received from, or created or received by the Contractor on behalf of, the Government, available to the Government, or at the request of the Government to the Secretary, in a time and manner designated by the Government or the Secretary, for purposes of the Secretary determining the Government's compliance with the Privacy Rule.

D.1.5.21. The Contractor agrees to document such disclosures of Protected Health Information and information related to such disclosures as would be required for the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

D.1.5.22. The Contractor agrees to provide to the Government or an Individual, in time and manner designated by the Government, information collected in accordance with this Clause of the Contract, to permit the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

D.1. 6. GENERAL USE AND DISCLOSURE PROVISIONS Except as otherwise limited in this Agreement, the Contractor may use or disclose Protected Health Information on behalf of, or to provide services to, the Government for treatment, payment, or healthcare operations purposes, in accordance with the specific use and disclosure provisions below, if such use or disclosure of Protected Health Information would not violate the HIPAA Privacy Rule, DOD 6025.18-R, the HIPAA Security Rule, or DOD 8580.02- R if done by the Government.

D.1.7. SPECIFIC USE AND DISCLOSURE PROVISIONS.

D.1.7.1. Except as otherwise limited in this Agreement, the Contractor may use Protected Health Information for the proper management and administration of the Contractor or to carry out the legal responsibilities of the Contractor.

D.1.7.2. Except as otherwise limited in this Agreement, the Contractor may disclose Protected Health Information for the proper management and administration of the Contractor, provided that disclosures are required by law, or the Contractor obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and used or further disclosed only as required by law or for the purpose for which it was disclosed to the person, and the person notifies the Contractor of any instances of which it is aware in which the confidentiality of the information has been breached.

D.1.7.3. Except as otherwise limited in this Agreement, the Contractor may use Protected Health Information to provide Data Aggregation services to the Government as permitted by 45 CFR 164.504(e)(2)(i)(B).

D.1.7.4. Contractor may use Protected Health Information to report violations of law to appropriate Federal and State authorities, consistent with 45 CFR 164.502(j)(1).

D. 2. OBLIGATIONS TO THE GOVERNMENT. Provisions for the Government to Inform the Contractor of Privacy Practices and Restrictions:

D.2.1. Upon request the Government shall provide the Contractor with the notice of privacy practices that the Government produces in accordance with 45 CFR 164.520, as well as any changes to such notice.

D.2.2. The Government shall provide the Contractor with any changes in, or revocation of, permission by Individual to use or disclose Protected Health Information, if such changes affect the Contractor's permitted or required uses and disclosures.

D.2.3. The Government shall notify the Contractor of any restriction to the use or disclosure of Protected Health Information that the Government has agreed to in accordance with 45 CFR 164.522.

D. 3. PERMISSIBLE REQUEST BY THE GOVERNMENT. The Government shall not request the Contractor to use or disclose Protected Health Information in any manner that would not be permissible under the HIPAA Privacy Rule, DOD 6025.18R, the HIPAA Security Rule, or DOD 8580.02-R, if done by the Government, except for providing Data Aggregation services to the Government and for management and administrative activities of the Contractor as otherwise permitted by this clause.

D. 4. TERMINATION. A breach by the Contractor of this clause, may subject the Contractor to termination under any applicable default or termination provision of this Contract.

D. 4.1. EFFECTS OF TERMINATION.

D.4.1.1. If this contract has records management requirements, the records subject to the Clause should be handled in accordance with the records management requirements. If this contract does not have records management requirements, the records should be handled in accordance with paragraphs (2) and (3) below.

D. 4.1.2. If this contract does not have records management requirements, except as provided in paragraph (E 4.1.3.) of this section, upon termination of this Contract, for any reason, the Contractor shall return or destroy all Protected Health Information received from the Government, or created or received by the Contractor on behalf of the Government. This provision shall apply to Protected Health Information that is in the possession of subcontractors or agents of the Contractor. The Contractor shall retain no copies of the Protected Health Information.

D. 4.1.3. If this contract does not have records management provisions and the Contractor determines that returning or destroying the Protected Health Information is infeasible, the Contractor shall provide to the Government notification of the conditions that make return or destruction infeasible. Upon mutual agreement of the Government and the Contractor that return or destruction of Protected Health Information is infeasible, the Contractor shall extend the protections of this Contract to such Protected Health Information and limit further uses and disclosures of such Protected Health Information to those purposes that make the return or destruction infeasible, for so long as the Contractor maintains such Protected Health Information

D. 5. MISCELLANEOUS.

D. 5.1. REGULATORY REFERENCES. A reference in this Clause to a section in DOD 6025.18- R, HIPAA Privacy Regulation or DOD 8580.02-R, HIPAA Security Regulation, or any CFR or AFI provision means the section as currently in effect or as amended, and for which compliance is required.

D. 5.2. SURVIVAL. The respective rights and obligations of Business Associate under the "Effect of Termination" provision of this Clause shall survive the termination of this Contract.

D. 5.3. INTERPRETATION. Any ambiguity in this Clause shall be resolved in favor of a meaning that permits the Government to comply with DOD 6025.18-R, the CFR HIPAA Privacy Rule, DOD 8520.02- R, the CFR HIPAA Security Rule and AFI 41-217.

APPENDIX E

Creech AFB CONTRACTOR SECURITY

INSTALLATION ENTRY CONTROL PROCEDURES FOR ALL CONTRACTORS

The following appendix provides information from Air Force Instruction 31-101, Air Force Instruction 31-113 and local supplements on requirements for entering and conducting business while on Creech Air Force Base (CAFB), Nevada.

1. Contract Award.

1.1. Upon award of a contract, all contractors (including Small Purchase contractors), will have background checks conducted on all employees (including subcontractors or temporary employees) requiring access to CAFB.

1.2. The base Point of Contact (POC) is the unit or the base contracting office administratively who services the contract. The authorized format used for submitting employee personal information for background checks is located at Attachment 1, Request for Background Check.

1.3. The contractor is responsible for providing their employees’ personal information to their base POC. Failure to provide all personal information required or providing fraudulent information will result in the employee’s base access being denied and possible disbarment actions to all military installations.

1.3.1. Full given name which appears on their government issued license or ID, to include middle names or any known aliases.

1.3.2. Date of Birth.

1.3.3. Social Security number.

1.3.4. Driver’s license number and state of issue.

1.3.5. Project name and contract number.

1.3.6. Requestor’s name.

1.4. Each base POC is appointed by their commander or management director on DD Form 577, Appointment/Termination Record – Authorized signature, and forwards a signed copy to the Visitor Control Center (VCC) annually.

1.5. The base POC sends a request, via email, to the 799 SFS/S5 EALs organizational email address, which can be located on the Global Listing (Creech). Personal employee information will be included on Attachment 1, Request for Background Check/Entry Access List (EAL).

1.6. The 799th Security Forces Squadron (799 SFS) will, upon receiving the EAL from the base POC, conduct a background check of the contractor personnel using approved authoritative government databases to include NCIC/FCIC and DAVID.

1.7. Any contractor employee found to have a criminal conviction listed below or have an outstanding warrant(s) will not be allowed entry to the base.

1.7.1. The individual is known to be or reasonably suspected of being a terrorist or belongs to an organization with known terrorism links/support.

1.7.2. The installation is unable to verify the individual's claimed identity.

1.7.3. There is a reasonable basis to believe the individual has submitted fraudulent information concerning his or her identity.

1.7.4. There is a reasonable basis to believe the individual will attempt to gain unauthorized access to classified documents, information protected by the Privacy Act, information that is proprietary in nature, or other sensitive or protected information.

1.7.5. There is a reasonable basis to believe the individual will unlawfully or inappropriately use an access credential outside the workplace.

1.7.6. There is a reasonable basis to believe based on an individual's criminal or dishonest history, that issuance of an access credential poses an unacceptable risk to the installation/mission.

1.7.7. The individual has/had been barred from entry/access to a Federal installation or facility.

1.7.8. The individual is wanted by Federal or civil law enforcement authorities, regardless of offense or violation.

1.7.9. The individual has been incarcerated within the past ten years, regardless of offense/violation, unless released on proof of innocence.

1.7.10. The individual has any conviction for espionage, sabotage, treason, terrorism, or murder.

1.7.11. The individual’s name appears on any Federal or State agency’s ―watch list or ―hit list for criminal behavior or terrorist activity.

1.7.12. The individual has been convicted of a firearms or explosive violation within the past ten years.

1.7.13. The individual has been convicted of sexual assault, armed robbery, rape, child molestation, child pornography, trafficking in humans, drug possession with intent to sell or drug distribution.

1.7.14. There is a reasonable basis to believe, based on the individual's material, intentional false statement, deception, or fraud in connection with Federal or contract employment, that issuance of an access credential poses an unacceptable risk to the installation/mission.

1.7.15. There is a reasonable basis to believe, based on the nature or duration of the individual's alcohol abuse without evidence of substantial rehabilitation, that issuance of an access credential poses an unacceptable risk to the installation/mission.

1.7.16. There is a reasonable basis to believe, based on the nature or duration of the individual's illegal use of narcotics, drugs, or other controlled substances without evidence of substantial rehabilitation, that issuance of an access credential poses an unacceptable risk to the installation/mission.

1.7.17. A statutory or regulatory bar prevents the individual's contract employment; or would prevent Federal employment under circumstances that furnish a reasonable basis to believe that issuance of a access credential poses an unacceptable risk to the installation/mission.

1.7.18. The individual has knowingly and willfully engaged in acts or activities designed to overthrow the U.S.

Government by force.

1.7.19. In addition to the above disqualifying factors, 99 ABW/CC has determined the following criminal violations will be grounds for denial on Creech Air Force Base IAW 99 ABW Integrated Defense Plan (IDP) 31- 101.

1.7.19.1. Any conviction of attempted/completed homicide or manslaughter.

1.7.19.2. Conviction of armed assault/robbery.

1.7.19.3. Ten or more habitual felony convictions within the past 10 years of the date of the background.

1.8. Upon completion of the background check, the results (approved/denied) will be electronically emailed to the requesting base POC. The email response will state whether the applicant is approved, denied, or pending further review by 799 SFS and base legal. Contract employee(s) approved for base access will report to the VCC to retrieve their Digital Biometrics Identification System (DBIDS) pass. Contract employees who have been denied, may rebut the 799 SFS denial and request 99 ABW/CC overturn their denied entry for employment. Employees wishing to rebut the denial will be referred to the VCC for further guidance.

1.9. The initial background check is valid for the duration of the pass,…