Performance_Work_Statement__10_Aug_15_Rev_10_Sep_15.doc

PERFORMANCE WORK STATEMENT

PERFORMANCE WORK STATEMENT (PWS)

FOR

21ST MEDICAL GROUP (MDG)

LICENSED VOCATIONAL NURSE (LVN)

Attachment 1 10 Aug 2015

TABLE OF CONTENTS

SECTION

TITLE

PAGE

DESCRIPTION OF SERVICES

3 – 4

SERVICE SUMMARY

GOVERNMENT AND CONTRACTOR FURNISHED

6 – 7

PROPERTY AND SERVICES

GENERAL INFORMATION

8 – 13

APPENDICES

Appendix A-Applicable Publications and Forms, and Standard Clinic Procedures

Appendix B -Licensed Vocational Nurse

Appendix C -Medical Evaluations and Other Medical Issues

Appendix D -Security Requirements and Information

Appendix E -Health Insurance Portability and Accountability Act (HIPAA) of 1996

Appendix F -Definitions

Appendix G –Vaccinations

Appendix H -General Credentialing Procedures

1.0 DESCRIPTION OF SERVICE

Licensed Vocational Nurse (LVN) will provide medical healthcare services to eligible beneficiaries. Contractor care shall cover the range of Family Health Clinic services on an outpatient/ambulatory basis, which would normally be provided in a civilian medical treatment facility (MTF). This may include mild trauma, and wellness and prevention. Contractor shall not perform obstetrics, inpatient or emergency room care services. The Contractor is responsible for ensuring the LVN coordinates health service management functions and information in a timely and efficient manner to facilitate continuity of patient care. The location is the 21st Medical Group at Peterson AFB, CO and Schriever AFB, CO.

1.1 PERSONAL SERVICES: Excluding the contract PM, personnel performing under this contract are subject to day-to-day supervision and control by his/her Government supervisor comparable to that exercised over military and civil service health care providers engaged in comparable work. Should contract employees encounter a performance problem that cannot be resolved with their supervisor, the problem should be referred to their employer. Contract personnel remain employees of the Contractor and responsibility for evaluation of an employee’s performance remain with the Contractor.

1.1.1 LICENSED VOCATIONAL NURSE: Assists in routine care and treatment of patients, to include flying and special operational duty personnel, when required. Organizes the medical environment, performs and participates in support activities for outpatient care situations, including contingency operations and disasters. See Appendix B for LVN Job Description.

1.1.1.1 Personnel Reliability Program (PRP): All staff will care for patients enrolled in the PRP program in accordance with MDGI 36-11.

1.2 DOCUMENTATION: Contractor shall complete clinical documentation within 72 hours of appointment, and the clinical documentation shall be coded appropriately.

1.3 NEW PROCEDURES/SERVICES: The Contractor shall obtain approval from the MTF Commander before introducing a new medical procedure or service.

1.4 MTF PROCEDURES: The Contractor shall adhere to all applicable Department of Defense (DoD), Air Force (AF), and MTF policies, procedures, and standards of operation for the MTF. (see Appendix A).

1.5 DEFINITIONS: See Appendix F Definitions applicable to the PWS.

2.0 SERVICE SUMMARY (SS)

2.1 PERFORMANCE EVALUATION: The Government will evaluate the Contractor’s performance by appointing a Functional Requirement Evaluator Designee (FRED) who will monitor performance and ensure services are received. This information is used to validate invoices from the Contractor.

2.2 FACILITY: LVN will work exclusively within the facilities of 21st Medical Group at either location of Peterson AFB, CO and Schriever AFB, CO.

21st MDOS/SGOF

21st MDOS/SGOF 559 Vincent St., Building 959

220 Falcon Parkway Peterson AFB, CO 80914

Schriever AFB, CO 80912

2.3 PERFORMANCE OBJECTIVES: Monitoring is based on the SS’s Performance Objectives in paragraph 2.0. The Government may evaluate each SS as frequently as it deems necessary. Although satisfactory performance of all the requirements of the PWS are expected, the Performance Objectives are considered critical areas of interest, and are specifically used to measure the health of the contract.

2.4 COMPLAINTS: In the case of a customer or patient complaint (whether a performance objective or not), the FRED and Contracting Officer (CO) shall investigate and make a determination of the validity of complaint. If a valid complaint, the Contractor will be provided a written notice and the opportunity to respond.

3.0 GOVERNMENT AND CONTRACTOR FURNISHED PROPERTY AND SERVICES

3.1 The Government will provide the following equipment, supplies, and services on a shared basis:

3.1.1 ORIENTATION TRAINING: The Government shall provide orientation training. The LVN shall participate in the MTF orientation process for newly assigned medical personnel. The healthcare professionals agree to complete training that will include, but is not limited to, MTF Check-In/Check-Out Processing, Orientation Program, Annual Training requirements; and any training necessary to perform all duties with-in scope of care. This includes Composite Health Care System (CHCS), Armed Forces Health Longitudinal Technology Application (AHLTA), Preventive Health Assessment and Individual Medical Readiness (IMR), Carepoint 4G Aeromedical Services Information Management Systems (ASIMS), MiCare and other job specific data training. Training records and supervision for all team members will be maintained by the FRED and the Contractor.

3.1.2 ANNUAL TRAINING REQUIREMENTS: All contract employees must complete annual training required IAW the Joint Healthcare Organization (JHO) Air Force Computer Security Policy, and Air Force Safety Policy.

3.1.3 EQUIPMENT/OFFICE FURNITURE: The LVN shall be provided available equipment for performing services.

3.1.4 SUPPLIES: The MTF will provide medical and non-medical supplies commonly used in the facility for the care and management of patients. The MTF will supply central sterile supply (CSS) services. Sterile equipment trays, instrumentation, instrument packs, and supplies will be provided by this service. After use, team members shall follow local procedures and policies to have the Government clean and re-sterilize supplies. These supplies will be available to team members on an equal basis with those of other clinic personnel/services.

3.1.5 GOVERNMENT FORMS: The MTF will provide all Government forms required for the performance of services.

3.1.6 ADMINISTRATIVE SUPPORT: All administrative support (template design, appointment booking, etc.) shall be commensurate with those administrative support services currently being provided to the LVN providers IAW MTF procedures and each clinic.

3.1.7 PERSONAL PROTECTIVE EQUIPMENT (PPE): Appropriate PPE will be provided, along with any repair, cleaning, and inventory required for it. This does not include any type of uniform. Any protective gear or items shall remain the property of the Government and shall not be removed from the MTF. After use, protective clothing shall be turned in or destroyed as directed by Infection Control.

3.1.8 IMMUNIZATIONS: The MTF will not provide immunizations.

3.1.9 IDENTIFICATION CREDENTIALS: The MTF will provide the LVN with all required identification media.

3.1.10 COMPUTER EQUIPMENT: The LVN shall use the computer systems that are standard for the support of healthcare delivery at the MTF (e.g., AHLTA, CHCS, IMR, ASIMS, MiCare and Carepoint 4G). The MTF will provide computer equipment required to schedule, check in, document, order ancillary services, and maintain appropriate electronic medical information that support the hard copy medical record. The MTF will provide required training for these systems.

3.1.11 UTILITIES: Water, telephone, electricity, etc. will be provided at no cost to the Contractor. Long distance and Defense Switched Network (DSN) telephone services will be provided for official business use only.

3.1.12 HOUSEKEEPING: Housekeeping services will be provided.

3.2 Except for those items or services specifically stated in Section 3, the Contractor shall furnish everything required to perform this contract in accordance with all of its terms.

4.0 GENERAL INFORMATION

4.1 HIRING CANDIDATES: This is a personal services contract. Therefore, the Contractor shall be responsible for interviewing and hiring qualified candidates. Contractor shall be given 60 days from time of award or time of vacancy of position to find and place qualified candidates.

4.2 REQUIRED TRAINING: At beginning of employment, the LVN shall successfully complete all required CHCS, AHLTA, IMR, Carepoint 4G, MiCare and other required trainings as directed by MTF.

4.3 IN-PROCESSING/OUT-PROCESSING PROCEDURES: At beginning of employment, the LVN completes all in-processing and out-processing 21st Medical Group requirements (e.g. badges, e-mail accounts, privacy act, etc.) within 2 weeks of start of work and within 24 hours of stop work.

4.4 CONTRACTOR PROVIDES: Contractor shall furnish all labor, management, non-medical supervision, teaching, consultations and reports. Performance shall be according to the requirements contained in this PWS, professional standards of TJC, and all required DoD and AF applicable policies and instructions.

4.5 SERVICES DURING A CRISIS OR EXERCISE: Services may be required outside of normal duty hours. These services may be required due to support the activation of personnel or for exercising contingency plans. Also, real world emergency situations (i.e., accident and rescue operations, civil disturbances, natural disasters, or military operations) may necessitate team members to provide increased or reduced support temporarily, as determined by the MTF Commander. Contractor shall obtain written permission from the CO prior to working overtime that is not otherwise covered by contract.

4.6 WORKPLACE FLEXABILITY: The LVN will be working primarily in the Family Health Clinic. However, if there are emergencies, shortages, or another pressing issue, the LVN may be temporarily reassigned to another Clinic setting (i.e., Women’s Health Clinic, Pediatrics, etc.). This reassignment shall last no longer than 8 months in a 12 month period.

4.7 WORK ROSTER: The FRED shall provide a work schedule for the LVN 30 days in advance. The LVN shall submit requested work schedule changes in writing to the FRED at least 72 hours in advance of the proposed change.

4.8 SECURITY REQUIREMENTS AND INFORMATION: See Appendix D.

4.9 PRIVACY AND CONFIDENTIALITY:

4.9.1 PATIENT SENSITIVITY: Contract providers shall respect and maintain the basic rights of patients, demonstrating concern for personal dignity and human relationships. Providers receiving complaints validated by the FRED, SGH, and the CO shall be subject to counseling and, depending on the nature and severity of the complaint, relieved of his/her position.

4.9.2 PATIENT LISTS: No matter how developed, patient lists shall be treated as privileged information.

4.9.3 The Contractor shall create and maintain Privacy Act data lAW:

· AFI 33-115, Air Force Information Technology (IT) Service Management

· AFMAN33-282, Computer Security (COMPUSEC)

· AFI 33- 332, AF Privacy and Civil Liberties Program

· Privacy Act systems of records notice(s).

· All records are the property of the Government. The Contractor shall not copy or maintain separate records on any or all patients subject to termination of this contract, all records are the property of the Government.

If the Contractor receives a Privacy Act request, the Contractor shall ensure medical record is not in their possession and if it is then will give record and request to government HIPPA official, or if records not in their possession will give request to HIPPA official who will obtain the record and make the decision on releasing the Government record.

4.10 HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) OF 1996: All individuals performing services at the respective MTF are required to complete HIPAA training and will be held accountable for complying with the MTF’s specific health information privacy policies and procedures. See Appendix E.

4.11 CONTRACTOR’S POINT OF CONTACT (POC): The Contractor shall provide a POC (administrator/manager) who shall be available via telephone five (5) days a week, Monday through Friday, 7:00 a.m. until 5:00 p.m. local time, excluding Federal Holidays. The POC shall have the authority to act for the Contractor on all matters relating to the successful execution of this contract. The Contractor shall designate this individual, in writing, to the CO for the contract before the contract start date. An alternate may be designated, but the Contractor shall identify those times when an alternate shall be the primary POC.

4.12 QUALITY ASSURANCE PERSONNEL (FRED): The Government shall identify in writing the FREDs, the CO, and the Contracting Specialist (CS) to the Contractor. The Contractor shall contact the CO or CS whenever there is a legal or contractual question/issue that needs to be discussed. If the Contractor works outside of the scope, or the terms and conditions of this contract without prior written permission from the CO, they are working at their own risk.

4.13 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 AF, either military or civilian, unless such person seeks and receives approval in accordance with DoD Directive 5500.7, Standard of Conduct, and AF policy.

4.14 NON-COMPETE PROVISION: The Contractor will not require that team members sign a non-compete agreement as a condition of employment that would restrict its employees from being employed or accepting offers of employment by the new Contractor of any follow-on contract. This would hinder the Government’s ability to accomplish the mission of providing continuity and quality medical care to beneficiaries. By submitting a quote and acceptance of a contract, the Contractor agrees to not enforce any non-compete provisions, if any exist, against any employee that accepts an offer of employment with the follow-on Contractor to provide the same services covered by the provisions of this TO and will not seek reimbursement from the Government.

4.15 CONTINUING MEDICAL EDUCATION (CME) REQUIREMENTS: The LVN shall continue to meet the minimum standards for CME to remain current as prescribed in AFI 41-117. CME shall be obtained at no additional cost to the Government. The team member shall report CME credits to the FRED annually on the first normal duty day in January for the previous calendar year. Periodic CME may be conducted at the MTF and will be available, at no cost, to any team members desiring to attend.

4.16 HEALTH AND MEDICAL ISSUES:

4.16.1 PRE-EMPLOYMENT MEDICAL EVALUATION: See Appendix C Medical Evaluation for requirements.

4.16.2 VACCINATIONS: See Appendix G for required Vaccinations.

4.16.3 PARENTERAL EXPOSURE: Team personnel who experience a parenteral (e.g., needle-stick or cut) or mucous membrane exposure (e.g., splash to the eye or mouth) to blood or bloody body fluids, shall receive prompt treatment. The MTF shall evaluate the source of exposure for risk of Hepatitis-B, Hepatitis-C, and Human Immunodeficiency Virus (HIV), and provide appropriate treatment. The Contractor shall provide a report of the incident and the treatment provided to the Infection Control Officer, located at the MTF. In the event of a confirmed or highly suspected parenteral exposure to HIV, the Contractor shall ensure that the team member receives appropriate follow-up care. The Government may require the Contractor to provide evidence of the status of treatment and testing of the team member.

4.16.4 PREGNANT EMPLOYEES: Contract employees should report their pregnancy to the Contractor. The Contractor shall notify the FRED and the CO of the pregnancy. The MTF Employee Health Office will provide information concerning any work hazards in that area. The Contractor is to notify their pregnant employee of any work hazards. It will be the employee and the Contractor’s joint decision whether the contracted employee works in the clinic environment.

4.16.5 EMERGENCY HEALTHCARE: The MTF will provide emergency healthcare for the Contractor providers for injuries incurred while on duty in the MTF. These services will be billed to the Contractor at the current reimbursement rate.

4.17 APPEARANCE AND HYGIENE: The LVN shall present a professional, conservative, and neat appearance. Contractor personnel shall report for duty in a professional manner, in appropriate attire befitting a healthcare setting, and having complied with socially acceptable standards of personal hygiene expected of healthcare workers. Additionally, team members shall display legible MTF-provided identification media on their outer clothing.

4.18 MULTI-FUNCTIONAL TEAM (MFT) MEETINGS: Quarterly or as often as necessary, an MFT meeting will be held to discuss any issue pertaining to this contract. Members of the MFT are: the CO, CS, FREDs, Contractor’s POC, and any other parties as deemed necessary. Meetings will be documented in the contract file with written minutes signed by the Contractor and the CO, or CS (if meeting requested by Contractor, minutes will be the responsibility of Contractor). 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. Whenever deemed necessary, the Contractor may request a meeting with the CO.

4.19 RECORDKEEPING:

4.19.1 Records shall be handled per applicable AFIs, MDG policy and MTF standards.

4.19.2 The Contractor shall segregate any Government-owned records from the company-owned records.

4.19.3 Upon completion of this contract, all Government-owned/Contractor-held records (regardless of media) received, created, maintained or provided in the performance of this contract shall be turned over to the Government. Background electronic data and records specified for delivery to the contracting agency must be accompanied by sufficient technical documents to permit the AF to use the data. In the event of default or non-performance, the Government will have access to all records in order to ensure mission support is not interrupted.

4.20 SMOKING IN FACILITIES: Smoking policies are covered by AFI 40-102, Tobacco Free Living. Contractor employees and visitors are subject to these same restrictions as Government personnel. Smoking is permitted only in designated smoking areas, or as defined by the AFI.

4.21 DUTY DAYS/HOURS:

4.21.1 A normal operating hours at the 21st MDG are from 0710 to 1630, Monday through Friday. 8 hours of duty shall be scheduled during these operating hours. Any changes to shift work outside of the normal duty hours will be coordinated through the Contracting Officer.

4.21.2 The following are paid Federal holidays: New Year’s Day, Martin Luther King Jr.’s Birthday, Presidents Day, Memorial Day, Independence Day, Labor Day, Columbus Day, Veterans Day, Thanksgiving Day, or Christmas Day.

4.21.3 The Government shall not pay for any instance of closure (i.e. Family Day, Down Day) where the employee is not required to work.

4.22 Ensure a safe work environment and employee safe work habits.

4.23 Maintain a professional manner and display a cooperative and positive attitude.

4.24 Provide patients with the utmost care and attention. All patients shall be assured of their privacy and personal dignity.

4.25 Ensure all equipment is properly cleaned and stored at the end of each work shift. Ensure routine cleaning is performed as directed by the Family Health Team or FC (or designated representative).

4.26 The LVN shall read, understand, speak, and write English fluently.

4.27 CONTRACTOR MANPOWER REPORTING

4.27.1 The contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract for the 21st Medical Group via a secure data collection site. The contractor must completely fill in all required data fields using the following web address http://www.ecmra.mil

4.27.2 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.

5. WAGE DETERMINATIONS UNDER SERVICE CONTRACT ACT

5.1 Services may be subject to labor rates based on wage determination 05-2079 (Rev.-17). See attachment 4.

5.0 APPENDICES

APPENDIX

TITLE

A

Applicable Publications and Forms, and Standard Clinic Procedures B

Licensed Vocational Nurse (LVN) - Outpatient C

Medical Evaluations and Other Medical Issues

D

Security Requirements and Information

E

Health Insurance Portability and Accountability Act (HIPAA) of 1996

F

Definitions G

Vaccinations

H

General Credentialing Procedures Attachment 1

10 Aug 15