Final_PWS_13_Oct_15.pdf

Ambulance Service Hanscom Air Force Base. MA

PERFORMANCE WORK STATEMENT

FOR

AMBULANCE SERVICES

AT

HANSCOM AIR FORCE BASE

MASSACHUSETTS

October 13, 2015

Ambulance Service Hanscom Air Force Base. MA

TABLE OF CONTENTS

SECTION 1. – DESCRIPTION OF SERVICES

PARAGRAPH 1.1. – EMERGENCY MEDICAL RESPONSE

AND PATIENT TRANSPORT

PARAGRAPH 1.2. – 66th AIR BASE GROUP AND MTF EXERCISE/

SPECIAL EVENTS/SPECIALIZED TRAINING

PARAGRAPH 1.3. – DOCUMENTATION

PARAGRAPH 1.4. – RECORDS

PARAGRAPH 1.5. – PATIENT LISTS

PARAGRAPH 1.6. – PATIENT SENSITIVITY

PARAGRAPH 1.7. – RELEASE OF MEDICAL INFORMATION

PARAGRAPH 1.8. – COMMUNICATION

PARAGRAPH 1.9 – MISSION ESSENTIAL SERVICES.

SECTION 2 - SERVICE DELIVERY SUMMARY

SECTION 3 - GOVERNMENT-FURNISHED PROPERTY AND SERVICES

SECTION 4 - GENERAL INFORMATION

PARAGRAPH 4.1. – CONTRACT MANAGER

PARAGRAPH 4.2. – CERTIFICATION AND LICENSING REQUIREMENTS

PARAGRAPH 4.3. – HEALTH REQUIREMENTS

PARAGRAPH 4.4. – APPEARANCE

PARAGRAPH 4.5. – HANSCOM AIR FORCE BASE GATE

SECTION 5 - APPENDICES

Ambulance Service Hanscom Air Force Base. MA

1. DESCRIPTION OF SERVICES

The Contractor shall provide full emergency patient transport services at Hanscom AFB, all associated housing areas, and the Hanscom AFB Family Campground Area, South Street, Bedford MA. This contract does not include MassPort Hanscom Field. Emergency response and transport services will be coordinated via the 66th Security Forces 911 operator or Hanscom AFB Fire Department in the event of an in-flight emergency that requires medical response. Contractor will participate in 66th Air Base Group and 66th

Medical Squadron (referred to as MTF hereafter) exercises, specials events, and specialized training.

Contractor shall furnish all labor, management, supervision, vehicles, supplies, equipment, transportation, and reports, except as provided in Section 3, Government-Furnished Property and Services. Contractor care shall, at a minimum, cover the full range of Emergency Medical Technician-Paramedic (EMT-P) and ambulance services provided in the local community to include Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), local protocols or standing orders and staffing minimums in accordance with the most current Massachusetts “Emergency Medical Services Pre-Hospital Treatment

Protocols” and MA 105 CMR 170.000: “Emergency Medical Services System” regulations. 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/Accreditation

Association for Ambulatory Health Care and Massachusetts State Department of Health's Division of

Emergency Medical Services.

1.1 EMERGENCY MEDICAL RESPONSE AND PATIENT TRANSPORT

The Contractor shall provide ambulance response to emergencies as requested by the Hanscom AFB Fire

Department. Patients will be transferred to nearest appropriate medical facility of patient choice, as warranted by condition. These hospitals will be referred to as "local hospitals" hereafter. Actual work involved in performance of this contract shall include:

1.1.1 Providing ambulance services 24 hours per day every day of the year to include all holidays. This contract is the sole avenue for Hanscom AFB emergency patient transport. The contractor must establish and maintain a system to ensure that backup support is provided in the event of simultaneous responses, equipment failures, or other unforeseen circumstances. Services must always be available.

1.1.2 Traveling to response sites in an appropriate medical response vehicle per information received primarily from the Hanscom AFB Fire Department.

1.1.2.1 Response time is defined as the time of receipt of call from Hanscom Fire Department to the time of arrival at the emergency location identified.

1.1.2.2 Response time for BLS will be within 7 minutes 90% of the time and 15 minutes 100% of the time in accordance with (IAW) Section 2, Service Delivery Summary. IAW Massachusetts General Laws (MGL) c.89, the contractor will exercise caution and due regard under the circumstances for the safety of the persons and property. Considering this, the contractor will be required to annotate justification for inclement weather or other acts of God for the response times that do not meet threshold.

1.1.2.3 Response time for ALS will be within twelve (12) minutes 90% of the time and 15 minutes 100% of the time IAW Section 2, Service Delivery Summary. IAW Massachusetts General Laws (MGL) c.89, the contractor will exercise caution and due regard under the circumstances for the safety of persons and

Ambulance Service Hanscom Air Force Base. MA property. Considering this, the contractor will be required to annotate justification for inclement weather or other acts of God for the response times that do not meet threshold.

1.1.3 Responding to calls with, at a minimum, two State of Massachusetts certified Emergency Medical

Technician (EMT) personnel, with one designated as an EMT-Paramedic with Advanced Cardiac Life

Support (ACLS). Pediatric Advanced Life Support (PALS) certified personnel may also be required as warranted by the age and/or circumstances of the emergency. If any conflict arises with MA state law/regulations, MA law/regulations will take precedent.

1.1.4 Providing medical care and treatment appropriate to patient’s condition. The contractor will respect and maintain the basic rights of patients, demonstrating concern for personal dignity and human relationships.

1.1.5 Coordinating in-field care, to include EMT-P with ACLS and PALS certification, in accordance with

Local County Fire Rescue protocols with local hospitals.

1.1.6 Coordinating patient transport with local hospitals.

1.1.7 Transporting patients to local hospitals from Hanscom AFB and all associated housing areas including the Hanscom AFB Family Campground Area, South Street, Bedford MA.

1.1.8 Ensuring the EMT-P remains with patients until a member with equal certifications or higher receives patient at the destination facility.

1.2. 66th AIR BASE GROUP AND MTF EXERCISE/SPECIAL EVENTS/SPECIALIZED TRAINING.

Contractor shall be responsible for participating in 66th Air Base Group and MTF exercises, events, and training not more than fifty (50) times per year, each lasting approximately two to three (2-3) hours in length.

The Contracting Officer or Contracting Officer’s Representative will provide the contractor at least 7 days advance notice prior to the exercise/event/training date via email or phone. Specific responsibilities include:

1.2.1 Participating in advance and post exercise meetings including meetings and discussions with the Wing

Inspection Team (WIT).

1.2.2. Following the directions of the Fire Chief or On-Scene Commander regarding the positioning of ambulance.

1.2.3. Triage and stabilize patients until transport.

1.2.4. Communicate frequent updates of casualty information to medical representative at that scene or to the Emergency Operations Center (EOC).

1.2.4.1. Number of casualties

1.2.4.2. Number of patients transported, status (delayed, immediate, minimal, expectant), delivery facility

1.2.3 Responding with EMTs to exercise sites and performing mock duties.

1.2.4 Providing ambulance stand-by during live-structural fire training.

Ambulance Service Hanscom Air Force Base. MA

1.2.5 Providing ambulance stand-by during special events (i.e. Change of Command and other official functions).

1.3 DOCUMENTATION. The contractor will prepare and submit all documentation in accordance with the

Contract Data Requirements List, DD Form 1423, and include the following, which shall be timely, legible, accurate, and thorough and must contain a signature. The contractor ensures accurate and complete patient identifying information is on all documentation to be provided to the MTF relating to the transport. Run sheets and patient information will be submitted to the MTF the following duty day.

1.3.1 The contractor will notify the MTF by MiCare message

(http://app.relayhealth.com/security/login/default.aspx) or Fax (781-225-2583) of run sheets the next duty day of patient acceptance to emergency room.

1.3.1.1 Provide the following for each patient transported in the run sheet:

1.3.1.1.1. Name, address and home phone/cell phone number

1.3.1.1.2. Name of the accepting hospital

1.3.2 The contractor shall establish and maintain a complete Quality Control Plan (QCP) to ensure the requirements of the contract are provided as specified. The contractor shall submit a Quality Control

Plan not later than 15 days after contract award. The contractor shall not incorporate any changes to the QCP unless they have been accepted by the Contracting Officer once the initial QCP has been accepted.

1.3.2.1 The Contractor’s QCP should address risk management to include processes in place to evaluate and ensure the standard of care is met in all cases.

1.3.3 The contractor will provide monthly documentation to the MTF relating to all transports NLT the 5th of each month for the previous month; (example: September’s info will be submitted NLT 5 October). This information will include: date, time dispatched/enroute/on scene/first pt contact/depart pickup location/hand off to hospital personnel, run number, type of run (BLS or ALS), available patient information [full name, military (last 4 of SSN) or civilian, DOB], patient condition, all patient care rendered, complete incident and destination location addresses, and an explanation of any exceptions to response time or reasonable patient care by local and national standards contained in Section 2, Service Delivery Summary. All refusals shall also be documented to the same level, notwithstanding hospital transport.

1.4. RECORDS. Be responsible for creating, maintaining, and disposing of only those Government required records which are specifically cited in this PWS or as may be required by the provisions of the directive listed in Appendix 2 of this PWS. If requested by the Government, provide the original record or a reproducible copy of any such records within five working days of receipt of the request.

1.5. 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 the Medical Staff.

1.6. PATIENT SENSITIVITY. Contract personnel shall respect and maintain the basic rights of patients, demonstrating concern for personal dignity and human relationships. Personnel receiving complaints validated by the COR 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.

Ambulance Service Hanscom Air Force Base. MA

1.7. RELEASE OF MEDICAL INFORMATION. Only release medical information obtained during the course of this contract to the patient, legal guardian, or other MTF staff involved in the care and treatment of that individual patient.

1.8. COMMUNICATION. Ensure open and professional communication with members of the MTF.

Complaints validated by the COR and Chief of the Medical Staff shall be reported in writing to the

Contracting Officer (CO) and the Contractor for action. Failure by the Contractor to correct validated complaints raised by the MTF staff and the CO will be considered a failure to perform.

1.9 MISSION ESSENTIAL SERVICES. These services have been determined to be mission essential by the functional Commander for Medical Contracting at the 66 th

Medical Squadron.

1.9.1 The contractor shall perform the following services which are mission essential to Hanscom AFB during times of crisis and emergency:

1.9.1.1 Respond within adequate time based on type of call (ALS/BLS).

1.9.1.2 Responding to calls with, at a minimum, two State of Massachusetts certified

Emergency Medical Technician (EMT) personnel, with one designated as an EMT-Paramedic with

Advanced Cardiac Life Support (ACLS). Pediatric Advanced Life Support (PALS) certified personnel may also be required as warranted by the age and/or circumstances of the emergency.

1.9.1.3 Provide ambulance response/back-up support to all emergencies 24 hours a day/365.

1.9.1.4 Provide adequate flow of information, documentation and communication to medical

Representatives related to all transports.

2. SERVICE DELIVERY SUMMARY (SDS)

Table 2.1

Performance Objectives SOW

Para.

Performance

Threshold

Seven (7) Minutes Response Time for

BLS

1.1.2.2 90 % of

BLS calls per month

Fifteen (15) Minutes Response Time for BLS

1.1.2.2 100 % of

BLS calls per month

Twelve (12) Minutes Response Time for ALS

1.1.2.3 90 % of

ALS calls per month

Fifteen (15) Minutes Response Time for ALS

1.1.2.3 100 % of

ALS calls per month

Patient Care 1.1.4 100% of

Medical

Standard of

Ambulance Service Hanscom Air Force Base. MA

Care met

Documentation 1.3 100%

Exercises, Inspections and Exercise

Analysis

1.2 100%

Availability/Coverage/ Preparedness 1.1 100%

2.2 The Government will periodically evaluate the Contractor’s performance by appointing a representative(s) from the 66th Medical Squadron (MDS) to monitor performance to ensure services are received IAW contract requirements. 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).

2.3 If any of the services do not conform to contract requirements, the Government may require the

Contractor to perform the services again in conformity with contract requirements, at no increase in contract amount. When the defects in services cannot be corrected by re-performance, the Government may:

2.3.1. Require the Contractor to take necessary action to ensure that future performance conforms to contract requirements; and

2.3.2. Reduce the contract price to reflect the reduced value of the services performed.

3. GOVERNMENT-FURNISHED PROPERTY AND SERVICES

3.1 The Contractor will be provided a copy of Hanscom AFB’s grid-map prior to start of performance.

3.2 Except for those items or services specifically stated above, the Contractor shall furnish everything required to perform this performance work statement.

4. GENERAL INFORMATION

4.1 CONTRACT MANAGER: The contractor shall provide a contract manager who shall be responsible for the performance of the work. The name of this person and an alternate(s) who shall act for the contractor when the manager is absent shall be designated in writing to the contracting officer prior to contract start date.

4.1.1 The contract manager or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract and available during normal business hours

(0730-1630) Monday through Friday.

4.1.2 All contractor personnel required to deliver services must be able to read, write, speak, and understand English.

4.2. CERTIFICATION AND LICENSING REQUIREMENTS. The contractor shall ensure that all employees involved in activities that require certification or licensing shall meet all such requirements for:

Ambulance Service Hanscom Air Force Base. MA

4.2.1 Contractor personnel operating an emergency ambulance in the State of Massachusetts must possess the appropriate valid class Massachusetts driver's license in accordance with Massachusetts state laws. 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 can have a maximum of six points per year assessed under the state of Massachusetts driving infraction system.

4.2.2 Possessing a current, unrestricted license to perform EMT (Basic or Paramedic) services in the

State of Massachusetts.

4.2.3. Possessing a current Basic Life Support (BLS) and ACLS certification. Pediatric Advanced Life

Support (PALS) certified personnel may also be required as warranted by the age and/or circumstances of the emergency.

4.2.4. Contractor shall maintain files to assure that all EMTs performing work under this contract shall have current certifications and/or documents listed in 4.2 above. Annually and upon request, the contractor must provide the Government a consolidated report of the status of these documents and/or copies of certifications for any EMT/Paramedic performing under this contract.

4.2.5. All ambulance drivers needing access to the flight line for an ambulance run will contact and report to the fire station for a flight line escort by the fire department.

4.2.6. All contract personnel responding to Hanscom AFB will have a Criminal-Offender-Record-Check or

C.O.R.I. NO individuals will be assigned to the Hanscom AFB site until their C.O.R.I. comes back with No felony convictions pursuant to MGL 115 CMR 11.00.

4.3. HEALTH REQUIREMENTS. The Contractor is solely responsible for compliance with the

Occupational Safety and Health Act (OSHA) (Public Law 91-596) and the resulting standards, OSHA

Standard 29 CFR 1910, 1926, and the protection of their employees. It is the contractor’s sole responsibility to make certain that all safety requirements are met. Additionally, the contractor is responsible for the safety and health of all sub-contractor employees.

4.4. APPEARANCE. Present a professional appearance and be easily recognized as Contractor paramedic employees. Contract employees will not wear clothing items deemed offensive and inappropriate tattoos will not be visible.

4.5 HANSCOM AIR FORCE BASE GATE access hours are as follows:

4.5.1 Gate 1, Vandenberg Gate, Route 2A, Lexington MA, is open from 0530 hours through 2200 hours

Monday through Friday, and 0600 hours through 1800 hours Saturday and Sunday.

4.5.2 Gate 2, Marrett Road Extension Gate, is permanently closed.

4.5.3 Gate 3, MIT/Lincoln Lab Gate, Wood Street, Lexington MA, is open from 0600 hours through 1800 hours Monday through Friday.

4.5.4. Gate 4, Hartwell Gate, Hartwell Avenue, Lexington MA, is open 24 hours a day/7 days per week.

Ambulance Service Hanscom Air Force Base. MA

5.0. APPENDICES

APPENDIX I: PUBLICATIONS

APPENDIX II: GENERAL DEFINITIONS

APPENDIX III: HIPAA Privacy and Security Business Associate Contract Language (March 11, 2008)

Ambulance Service Hanscom Air Force Base. MA

APPENDIX I

PUBLICATIONS

M = Mandatory Guidance, A = Advisory or Supplemental Information

The following documentation will provide all needed background to offer insight and direction.

Reference

Number

Title (and Website, if applicable) Date M/A Applicable

Paragraph

AFI 32-2001 Fire Emergency Services (FES)

Program

27 Feb 2014 M All

AFI 44-102 Medical Care Management 17 Mar 2015 M All; 2.20.12

DoDI 6055.06 DoD Fire and Emergency Services

(F&ES) Program

21 Dec 2006 M All, TABLE

E3.T1.

AETCI 36-3001 Issue and Control of AETC Civilian

ID Cards

30 Sep 1999 M All

AFI 10-1101 Operations Security (OPSEC)

Instructions

8 Jun 2011 M All

AFI 31-204

Air Force Motor Vehicle Traffic

Supervision

14 Jul 2000 M All

AFI 31-401 Information Security Program

Management

1 Nov 2005 M All

AFI 31-601 Industrial Security Program

Management

29 Jun 2005 M All

AFI 33-111 Voice Systems 24 Mar 2005

M

All

AFI 36-3026 Identification Cards for Members of the Uniformed Service, Their

Family Members, and Other

Eligible Personnel

29 Jul 1999 M All

AFI 44-119 Medical Quality Operations 16 Aug 2011 M 3.1-5.

DoD 5220.22

Industrial Security Regulation 27 Sep 2004 M All

DoD 5200.1

Information Security Program 9 Oct 2008 M All

DOD Instruction

1402-5

Criminal History Background

Checks on Individuals in Child

Care Services

January 1993

M

All

DOD Directive

5500.7

Standards of Conduct

29 Nov 2007

All

AFPD 31-6

Industrial Security 1 Apr 2000 M All

Ambulance Service Hanscom Air Force Base. MA

MGI 48-11 Management of Decompression

Sickness

30 Nov 2005 M 3.1.1. - 4.2.

MGI 48-12

Aircraft Emergencies

20 Jun 2007

1.3.2. –1.4.5.

MGI 48-13

Physiological Incidents

17 Oct 2005

1.3.1.1.

1.4. – 1.4.4.

Ambulance Service Hanscom Air Force Base. MA

APPENDIX II

GENERAL DEFINITIONS

GENERAL DEFINITIONS. As used throughout this Performance Work Statement, the following terms shall have the meaning set forth below:

Administrator. The generic term for the person assigned the overall responsibility of business and administration operations within the MTF.

Contracting Officer (CO). A duly appointed person with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings on behalf of the Government.

Contractor-owned records. Records that relate exclusively to the contractor’s internal business or are of a general nature not specifically related to the performance of work under the contract.

Defective Service. A service output that does not meet the standard of performance specified in the contract for that service. The method of surveillance for each performance objective is listed in the Service Summary.

A defect may be either an unsatisfactory inspection report or a customer complaint, which addresses unacceptable turn-around times or errors in reports.

Federal Acquisition Regulation (FAR). The FAR provides contracting policy for the Federal Government.

Freedom of Information Act (FOIA) Request. A written request for DoD records made by any person, including a member of the public, an organization, or a business that either explicitly or implicitly involves the FOIA, DoD Directive 5400.7-R.

Functional Commander (FC). The person responsible for Medical Services performance-based work statements.

Functional Request. A written request for DoD records made by any person, including a member of the public, an organization, or a business that either does not cite the FOIA or Privacy Act. This does not include requests from Government employees with a need to know to perform official Government business.

Government. The federal government of the United States of America.

Government-Owned Contractor-Held Records. Records regardless of media that document the contractor’s activities and functions necessary for the performance of the contract. This shall include documentation of those day-to-day operating procedures that are essential to carrying out the performance work statement and those actions, organizational structure, policies, decisions, operations, and activities necessary to perform or continue the work performed under the contact

Medical Treatment Facility (MTF). Air Force hospitals or clinics, including all activities providing outpatient and/or in-patient healthcare services for authorized personnel.

Official record. Documents, regardless of form, that a government agency, including the contractor, creates or receives during the processing of government business as evidence of its organization, functions, policies, decisions, procedures, operations, or other activities or because of the material’s informational value.

Ambulance Service Hanscom Air Force Base. MA

Performance Work Statement (PWS). A document that accurately describes the essential and technical requirements for items, materials, or services, including the standards used to determine whether the requirements are met. The PWS is written in compliance with the FAR, as supplemented, and serves as the scope of work and the basis for all costs. Also called the Performance Work Statement.

Privacy Act Request. A written request from the subject of the records or a request with the subject’s written consent.

Quality Assurance. A planned and systematic pattern of all actions necessary to provide confidence that adequate technical requirements are established, products and services conform to established technical requirements, and satisfactory performance is achieved. For purposes of this contract, quality assurance refers to actions by the government.

Quality Control (QC). Those actions taken by a Contractor to control the quality of output and to ensure that they conform to contract requirements and reasonable standards of medical care.

Contracting Officer’s Representative (COR). Government representative that assesses and documents the contractor’s performance to ensure contract standards are achieved.

Sponsor’s Social Security Number. The “sponsor” is the military member, whether active duty or retired.

All military medical documentation and records are filed by the sponsor’s social security number (SSN) to include spouses and family members. The sponsor’s SSN has a prefix of 20 to distinguish between family charts. The spouse has a family member prefix of “30” and the children are sequentially numbered by birth order, i.e. “01 for the first, 02 for the second, and so forth. For example, a spouse’s chart will be identified as

“30/000-00-000.”

Ambulance Service Hanscom Air Force Base. MA

Appendix III

HIPAA Privacy and Security Business Associate Contract Language (March 11, 2008)

Department of Defense

Standard Contract Clause for Business Associates

Introduction

In accordance with DoD 6025.18-R “Department of Defense Health Information Privacy Regulation,”

January 24, 2003, the Contractor meets the definition of Business Associate. Therefore, a Business Associate

Agreement is required to comply with both the Health Insurance Portability and Accountability Act (HIPAA)

Privacy and Security regulations. This clause serves as that agreement whereby the Contractor agrees to abide by all applicable HIPAA Privacy and Security requirements regarding health information as defined in this clause, and in DoD 6025.18-R and DoD 8580.02-R, as amended. Additional requirements will be addressed when implemented.

(a) 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 or DoD

8580.02-R.

Individual has the same meaning as the term “individual” in 45 CFR 160.103 and shall include a person who qualifies as a personal representative in accordance with 45 CFR 164.502(g).

Privacy Rule means the Standards for Privacy of Individually Identifiable Health Information at 45

CFR part 160 and part 164, subparts A and E.

Protected Health Information has the same meaning as the term “protected health information” in 45

CFR 160.103, limited to the information created or received by the Contractor from or on behalf of the

Government pursuant to the Contract.

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

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

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

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

Terms used, but not otherwise defined, in this Clause shall have the same meaning as those terms in 45

CFR 160.103, 160.502, 164.103, 164.304, and 164.501.

(b) The Contractor shall not use or further disclose Protected Health Information other than as permitted or required by the Contract or as Required by Law.

(c) The Contractor shall use appropriate safeguards to prevent use or disclosure of the Protected

Health Information other than as provided for by this Contract.

Ambulance Service Hanscom Air Force Base. MA

(d) 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.

(e) 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 Clause.

(f) The Contractor shall report to the Government any security incident involving protected health information of which it becomes aware.

(g) The Contractor shall 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.

(h) The Contractor shall 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.

(i) The Contractor shall 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.

(j) The Contractor shall provide access, at the request of the Government, and in the time and manner reasonably 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.

(k) The Contractor shall 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, and in the time and manner reasonably designated by the Government.

(l) The Contractor shall 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 reasonably designated by the Government or the Secretary, for purposes of the Secretary determining the Government’s compliance with the Privacy Rule.

(m) The Contractor shall 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.

(n) The Contractor shall provide to the Government or an Individual, in time and manner reasonably 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.

Ambulance Service Hanscom Air Force Base. MA

General Use and Disclosure Provisions

Except as otherwise limited in this Clause, 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, the HIPAA Security

Rule, DoD 6025.18-R or DoD 8580.02-R if done by the Government.

Specific Use and Disclosure Provisions

(a) Except as otherwise limited in this Clause, 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.

(b) Except as otherwise limited in this Clause, 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.

(c) Except as otherwise limited in this Clause, 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) 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).

Obligations of the Government

Provisions for the Government to Inform the Contractor of Privacy Practices and Restrictions

(a) The Government shall provide the Contractor with the notice of privacy practices that the

Government produces in accordance with 45 CFR 164.520.

(b) 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.

(c) 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.

Permissible Requests 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, the HIPAA Security Rule, or any applicable Government regulations (including without limitation, DoD

Ambulance Service Hanscom Air Force Base. MA

6025.18-R and 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.

Termination

(a) 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.

(b) Effect of Termination.

(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

(2) If this contract does not have records management requirements, except as provided in paragraph (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.

(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.

Miscellaneous

(a) Regulatory References. A reference in this Clause to a section in DoD 6025.18-R, DoD 8580.02-

R, Privacy Rule or Security Rule means the section currently in effect or as amended, and for which compliance is required.

(b) 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.

(c) 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, DoD 8580.02-R, the HIPAA Privacy Rule or the HIPAA

Security Rule.