Teleradiology_PWS_(Final _3_Mar_16).pdf

Attachment 1

FA3010-16-R-0013

3 Mar 16

PERFORMANCE WORK STATEMENT

FOR DIAGNOSTIC RADIOLOGY

TO PROVIDE TELERADIOLOGY SERVICES

FOR KEESLER AFB, MS

Dated 3 March 2016

TABLE OF CONTENTS

SECTION TITLE PAGE

1. DESCRIPTION OF SERVICES 3

2. SERVICE SUMMARY 7

3. GOVERNMENT FURNISHED PROPERTY & SERVICES 8

4. GENERAL INFORMATION 8

5. APPENDICES

A. DEFINITIONS 16

B. CONTRACT EMPLOYEE CREDENTIALING REQUIREMENTS 19

C. HIPAA REQUIREMENTS 25

D. APPLICABLE PUBLICATIONS AND FORMS 30

E. ESTIMATED WORKLOAD DATA 32

F. DIACAP PROCESS 32

1. DESCRIPTION OF SERVICES. The Contractor shall provide (Non-personal) professional diagnostic radiological services via Teleradiology connecting to Air Force Information Networks (referred to hereafter as AFIN) to provide image interpretation and reports by board certified radiologists for the 81st Medical Group (81 MDG), Keesler AFB, Mississippi (MS), also referred to herein as the "Military Treatment Facility" (MTF). Contractor must currently be authorized to connect to U.S. Air Force network and have computer hardware that is capable of receiving Digital Imaging and Communications in Medicine (DICOM) compliant diagnostic imaging studies from the MTF and to return a final interpretation report that will automatically upload into the Department of Defense Composite Healthcare System (CHCS) and patient’s Electronic Medical Record (EMR).

1.1. SCOPE OF WORK. Teleradiology services shall include professional preliminary and final interpretation, as well as specific consultation as needed. The services provided in this contract will be utilized to supplement Air Force radiologists. Examinations include basic film (computed radiography), computed tomography, magnetic resonance imaging, ultrasound, and nuclear medicine.

1.2. SPECIFIC TASKS FOR WHICH THE CONTRACTOR SHALL BE RESPONSIBLE. The contract radiologist shall provide diagnostic interpretations of radiological examinations performed by Government personnel and provide further diagnostic consultation that relates to diagnostic imaging, upon request, to the other members of the medical staff. “Examinations", as referred to herein consists of individual patient examinations, which may include preliminary and final interpretation of one or more images. Further diagnostic telephone consultation may be required upon request of the user.

1.2.1. HOURS OF OPERATION. The contract employee(s) shall provide services seven days per week, twenty-four (24) hours per day, Monday through Sunday, including federal holidays on an "as-required" basis during the period of the contract. Diagnostic imaging studies shall be given to the contractor’s teleradiology service and coordinated with the MTF to ensure that the complete study is received by the service.

1.2.2. DIAGNOSTIC IMAGING STUDIES. The contract radiologist shall interpret diagnostic imaging studies to include: basic film (computed radiography), computed tomography, magnetic resonance imaging, ultrasound studies, and nuclear medicine.

1.2.2.1. The contract radiologist shall provide technical assistance in all diagnostic imaging studies and participate in protocoling an exam if a radiologist’s input is necessary for administration of contrast agent or other issues.

1.2.2.2. Interpretation shall consist of medical evaluation of diagnostic imaging studies consistent with the American College of Radiology’s “Practice Parameter for Communication of Diagnostic Imaging Findings”. The radiologist shall provide interpretation and dictation on a daily basis for all services performed.

1.2.2.3. For STAT/emergent studies, the contractor must provide a preliminary diagnostic report within one hour (60 minutes) and a final report within four hours (240 minutes) of receipt of the transmitted images.

1.2.2.4. For routine/non-emergent studies, the contractor must provide a final diagnostic report within 24 hours (1450 minutes) of receipt of the transmitted images.

1.2.2.5. The name of the interpreting radiologist shall be clearly noted on all interpretive reports.

1.2.3. TRANSCRIPTIONS. The teleradiology service shall provide a final interpretation report into the CHCS, within 24 hours (1450 minutes). In case failed network connection prevents report transfer into CHCS, a final report can be sent by facsimile, secure e-mail or other communication acceptable by the MTF within 24 hours and a final report placed into CHCS by the contractor within 12 hours after the network connection is reestablished.

1.2.4. CONSULTATION. The contractor’s diagnostic radiologists shall provide written or telephonic advice and professional opinions within one hour upon request by the MTF medical staff if an MTF radiologist is unavailable.

1.2.5. MEETINGS. Although participation in MTF committees (Professional Staff Meeting, Executive Committee of the Medical Staff, Credentials Function, etc.) by the contractor’s radiologists is not routinely required, the contractor agrees to make the credentialed radiologists available in support of the various boards and committees within the MTF if a particular event should require. Such a request will be provided through the contract administrator to the contractor at least seven days in advance if a contractor’s radiologist participation is required.

Attendance can be in-person, via teleconference, or video conference based on the type of meeting and prior coordination and acceptance by the MTF personnel, at no additional cost to the government.

1.2.6. The contractor must have and maintain all applicable information security clearances and authorizations required to establish connection and maintain connection to the Air Force network:

1.2.6.1. The contractor must integrate the Risk Management Framework (RMF) into the Information Technology (IT) system development life cycle as required by DoDI 8500.01, Cybersecurity and DoDI 8510.01, Risk Management Framework for DoD Information Technology. RMF replaces the DoD Information Assurance Certification and Accreditation Process (DIACAP) and manages the life-cycle cybersecurity risk to DoD IT. Contractor must submit evidence of RMF compliance at the time of submission of proposal and maintain such accreditation throughout the course of contract execution. The RMF process is described in Appendix F.

1.2.6.2. Prior to beginning to provide any services under this agreement, Contractor shall obtain all applicable government required authorizations to have a Virtual Private Network (VPN)/Business-to-Business connection (B2B) to the Air Force Computer Network System. This shall include an Authorization to Operate (ATO) and an Authorization to Connect (ATC). The contractor shall provide a valid ATC within three days of contract award.

1.2.6.3. Contractor must employ electronic systems which have the ability to interface directly with the Department of Defense Composite Healthcare System (CHCS) by HL7 interface/BHIE adapter from their work site to directly transcribe interpretations into the patient record. The contractor must have computer hardware that is capable of receiving Digital Imaging and Communications in Medicine (DICOM) compliant images from the MTF.

1.2.7. PRIVILEGING/CREDENTIALING REQUIREMENTS.

1.2.7.1. All physicians providing service under the provision of this contract shall have current ACR Board Certification and be activity participating in and remain in good standing in the Maintenance of Certification (MOC) process.

1.2.7.2. Placement of Contractor Personnel. The Contractor shall provide sufficient number of employees to meet all contract requirements by the commencement date. The Contractor shall recruit and place credentialed contractor personnel in a timely manner. The contractor shall submit complete and accurate credentialing documentation to the Credential Office within 14 calendar days after award of contract for initial contractor personnel for all personnel providing services under this contract.

1.2.7.3. Replacement of Contractor Personnel. The contractor will maintain sufficient numbers of MTF credentialed radiologists and arrange the radiologists’ schedule of anticipated absences to maintain adequate coverage to read exams without interruption to providing the service. The contractor shall submit all credentialing documentation to the Credential Office within 30 working days prior to performance of services by any replacement contract personnel providing services under this contract.

1.2.7.4. The credentials of all providers shall be reviewed and privileges granted as outlined in the most current version of Air Force Instruction (AFI) 44-119, Medical Quality Operations, 16 Aug

11. The Contractor employees shall possess the requisite credentials enabling the granting of privileges by the MTF for performance of all tasks.

1.2.7.5. See Appendix B, CONTRACT EMPLOYEE CREDENTIALING REQUIREMENTS.

1.2.7.6. Applications for privileges shall be screened through the National Practitioners Data Bank.

The contractor shall notify the Contracting Officer (CO) and 81 MDG Credentials Office of any changes to maintain the Centralized Credentials Quality Assurance System data current.

1.2.7.7. Professional staff appointments and clinical privilege actions will be based on review of documents listed, in accordance with AFI 44-119. Reappointment shall occur not less than every two (2) years, in accordance with AFI 44-119. The contractor shall report any incident that may impact the continued privileging of a physician to the CO and 81 MDG credentials Office.

1.2.7.8. Applications for clinical privileges for replacement contract providers shall be submitted to the MTF Credentials Office no later than thirty (30) calendar days prior to the provider assuming duty. The credentials requirements are the same as those identified in para 1.2.6.5.

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

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

1.2.8. DENIAL/TERMINATION OF PRIVILEGES.

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

1.2.8.2. The CO and the Contractor shall be notified by the Government Supervisor of denial/termination of privileges. The CO and Contractor shall have copies of documentation initiating the revocation process.

2. SERVICE SUMMARY.

Performance Objective PWS Para Performance Threshold

SS-1. Hours of contract operation 1.2.1. 100% Compliance per month

SS-2. Provide technical assistance 1.2.2.1 98% Compliance per month

SS-3. Preliminary interpretation report for STAT studies 1.2.2.3. 98% Compliance per month SS-4. Final interpretation report for STAT studies 1.2.2.3. 100% Compliance per month SS-5. Final interpretation report for Routine studies 1.2.2.4. 100% Compliance per month

SS-6. Final interpretation reports in CHCS 1.2.3. 98% Compliance per month

SS-7. Professional Consultation services 1.2.4. 98% Compliance per month

SS-8. Contractor POC attends meetings as requested 1.2.5. 100% Compliance

SS-9. Maintain authorizations to connect to Air Force network 1.2.6. 100% Compliance

SS-10. Providers maintain appropriate board certification 1.2.7.1. 100% Compliance

SS-11. Timely privileging submission for initial contract physicians 1.2.7.2. 100% Compliance

SS-12. Timely privileging submission for replacement contract physicians 1.2.7.3. 100% Compliance

SS-13. Providers maintain all requirements for continued privileging 1.2.7.5. 100% Compliance

SS-14. Contractor POC availability 4.2.5. 100% Compliance

SS-15. Maintaining Government Computer Access 4.2.9. 100% Compliance

SS-16. Security of patient information 4.12. 100% Compliance

2.1. The Government will periodically evaluate the Contractor’s performance by appointing Government representatives known as Contracting Officer Representatives (COR)s to monitor performance to ensure services are received. The CORs 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 assurance inspections if deemed appropriate because of repeated failures or because of repeated customer complaints. Likewise, the Government may decrease the number of quality assurance inspections if performance dictates. The CO shall make final determination of the validity of customer complaint(s).

2.2. 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.

3. GOVERNMENT–FURNISHED PROPERTY AND SERVICES.

3.1. The Government will perform and transmit all study images electronically to the contactor for diagnostic radiological interpretations along with any clinical information available to the radiologic technologist.

3.2. All digital images and accompanied data shall remain the property of, and subject to the exclusive control of the U.S. Government. All related reports, images, and documents prepared by the contractor for diagnostic imaging interpretation and support in fulfillment of this contract will become the property of the U.S. Government.

3.3. A fax number(s) will be provided to the contractor within three calendar days after award.

3.4. The Government Hospital Info System (HIS) is using CHCS (Composite Health Care System) and AGFA Picture Archiving and Communication System (PACS) that has the ability to transmit DICOM images directly from the PACS system and the modalities.

3.5. The Government is currently using the HL-7 interface system which the contractor may utilize for directing final reports directly into the HIS at no cost to the Government.

3.6. The Government permits the contractor to place an approved DICOM send station behind the Government’s firewall in order to facilitate a central point of DICOM transfer once an ATC is issued.

4. GENERAL INFORMATION.

4.1. CONTRACTOR FURNISHED PROPERTY: This is not intended to be a comprehensive list of all contractor furnished property, it covers the core components that are possibly involved in a complete personnel equipment, and service solution. The contractor is required to assess the full extent of support necessary to provide the required services, equipment, and/or personnel for this contract. Compliance with the elements of this section are only relevant to the extent it is applicable to this contract.

4.1.1. The contractor shall be required to obtain Virtual Private Network (VPN) access to connect to the Government Local Access Network (LAN) and must communicate with the network, DICOM, and HL7.

4.1.2. The contractor shall be responsible for network connectivity to access from their database location to the Government computer systems for the transference of interpretation reports.

4.1.3. Computer hardware utilized for viewing images shall be capable of resolution display quality in accordance with the current edition of the ACR–AAPM–SIIM Technical Standard For Electronic Practice of Medical Imaging, which can be obtained on the American College of Radiology (ACR) website. The contractor will maintain all other applicable standards described in this document.

4.1.4. Maintenance of computer hardware to ensure capability and submission of those maintenance records if requested by the Government.

4.2. CONTRACTOR PERSONNEL. Radiologists assigned by the contractor to provide the official interpretation of images transmitted by teleradiology must maintain licensure appropriate necessary to deliver radiologic service. Physicians providing services under this contract must be privileged by the guidelines set by The Joint Commission (TJC) and Air Force Instructions prior to execution of service and maintain their credentials while providing service. The contractor shall ensure professional liability coverage is in place in accordance with jurisdictional requirement of the state in which services are being performed.

4.2.1. No work shall be performed outside of the United States.

4.2.2. After receipt of contract award, the contractor shall furnish a list of qualified radiologists, including name and telephone number, scheduled to perform services during the performance of this contract.

4.2.3. ENGLISH LANGUAGE REQUIREMENT. The contractor shall ensure that all contractor personnel providing services under this contract are able to read, write and speak English fluently.

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

4.2.5. AVAILABILITY. The Contractor shall provide a point of contact that is available via telephone for seven (7) days a week, 24-hours per day, Monday through Sunday, including Federal Holidays.

4.2.6. CONFLICT OF INTEREST. The Contractor shall not employ any person who is an employee of the United States Government if the employment of that person would create a conflict of interest. The Contractor shall not employ any person who is an employee of the Department of the Air Force, either military or civilian, unless such person seeks and receives approval in accordance with (IAW) DoD Directive (DoDD) 5500.7, Standards of Conduct, 29 Nov 07, and AF policy.

4.2.7. CONTINUING HEALTH EDUCATION (CHE)/ CERTIFIED EDUCATION UNITS

(CEU) REQUIREMENTS. Contractor personnel registered or certified by national/medical associations shall continue to meet the minimum standards for CHE to remain current as prescribed in Chapter 4, AFI 41-117, Medical Service Officer Education, 25 Mar 15. CHE hours will be reported to the Medical Director, annually on the first normal duty day in January for the previous calendar year. Periodic CHE may be conducted at the MTF and will be available, at no cost, should the Contractor personnel desire to attend. Attendance will be at the discretion of the Flight Commander/Medical Director and will not be billable.

4.2.8. INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE. The Contractor shall provide and maintain adequate liability coverage for their employees, consistent with the risks associated with the performance of all services required by this performance work statement (PWS)/contract. Refer to Federal Acquisition Regulation (FAR) clause 52.237-7, "Indemnification and Medical Liability Insurance".

4.2.9. GOVERNMENT COMPUTER ACCESS/SECURITY. Contractor shall provide personnel who qualify for all applicable security clearance requirements to maintain access to the Air Force network. The contractor employees shall comply with the requirement to obtain the minimum personnel security investigations as prescribed by DODI 5200.02, DOD Personnel Security Program (PSP), 9 Sep 14 and AFI 31-501, Personnel Security Program Management, 27 Jan 05, paragraphs 3.27.3.7 to 3.27.3.7.2. Submission of required security clearance documents shall be performed within 7 days of contract award.

4.2.10. PATIENT LISTS. All 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 to any unauthorized person or for any use outside the MTF without prior written permission by the Chief of Hospital Services, in accordance with federal law, and Air Force and Medical Group Instructions, to include the Privacy Act, the Health Insurance Portability and Accountability Act (HIPAA) (see Appendix C), and AFI 41-210, TRICARE Operations and Patient Administration Functions, 6 Jun 12.

4.2.11. PERFORMANCE EVALUATION MEETINGS. The CO will require the Contractor to meet with the CO, CA, Functional Commander/Functional Director (FC/FD), and other Government personnel as often as deemed necessary to discuss any performance discrepancies, at no additional cost to the government. The contractor may request a meeting with the CO when deemed necessary.

4.3. CONTINUITY OF SERVICES/REPLACEMENT STAFF. The contractor shall ensure sufficient staffing and resources to provide all required services and support throughout the term of the contract.

4.4. CONTINUATION OF CONTRACTOR SERVICES DURING BASE EXCERCISES,

LOCAL EMERGENCIES OR CONTINGENCIES, AND IMPLEMENTATION OF

LOCAL CONTINGENCY PLANS.

4.4.1. It has been determined that all services specified in the PWS/contract shall be performed during (and/or in support of, whichever is appropriate) base exercises, local emergencies or contingencies, and implementation of local contingency plans as long as network connectivity remains intact. However, the Contracting Officer will notify the contractor in the event that the contractor is relieved from performing any of the services during base exercises, local emergencies or contingencies, or implementation of local contingency plans.

4.4.2. The Government establishes contingency plans and training missions to support mobilization and national emergencies, and to augment local Governments in the event of natural disasters. The Government must be able to react to such events without undue delay. These sudden or unusual events may impact the Contractor’s operations. The Contractor shall provide the tasks as required by this PWS to support a contingency operation or exercise of contingency plans 7 days a week, 24 hours a day, for the duration of the contingency or exercise (4-5 times per year).

Examples of such events include natural disasters (e.g., tornados, major storms, flash floods);

exercises, mobilizations, deployments, or sudden buildup of forces (e.g., war, police action, international crisis, and civil disturbance), including backfill of Contractor personnel in the event of activation, draft or recall to active duty; terrorism or other threats to personnel or property;

utility outages; and local Government emergencies (e.g., accidents and fires).

4.5. RELATIONSHIP OF THE PARTIES. This is a non-personal services agreement.

Contractor personnel are not subject to the supervision and control of a Government officer or employee. (FAR 37-104(a)(1)(ii)). The contractor personnel shall perform their duties IAW specific tasks outlined in this PWS/resultant contract. Supervisory functions and managing contractor employees, such as hiring, directing, counseling, and firing of contractor personnel are the responsibility of the contractor and performed by the contractor, not the Government.

4.6. EDUCATION. The contract provider shall provide a Doctor of Medicine or Doctor of Osteopathic Medicine degree for all contractor personnel responsible for providing specified services to Keesler AFB under contract. Additionally, physicians providing specified services under this contract shall have completed a radiology residency at an institute recognized to provide such credentials in the United States.

4.7. LICENSURE/REGISTRATION. The contract provider must maintain a valid unrestricted medical license or authorizing document from any U.S. state to practice Diagnostic Radiology.

4.8. BOARD CERTIFICATION. The provider shall successfully completed a certification examination and be certified by the American Board of Radiology (ABR) or the American Osteopathic Board of Radiology (AOBR) in Diagnostic Radiology.

4.9. EXPERIENCE. The contractor radiologists shall have been continuously employed in the practice of diagnostic radiology or in training for 24 months within the last 36 months.

4.10. RECORDS. RECORDS. The Contractor shall create, maintain, and provide Government-owned/Contractor-held records, regardless of media, in performance of this contract IAW the following directives:

AFI 33-322, Records Management Program, 4 Jun 12, Incorporating Change 1, 18 Dec 14 http://www.e-publishing.af.mil/shared/media/epubs/AFI33-322.pdf

AFMAN 33-363, Management of Records, 1 Mar 08; Incorporating Change 1, 28 Jan 15, and Keesler Supplement, 23 Apr 14 AFI 33-364, Records Disposition—Procedures and Responsibilities, 22 Dec 06 and AFGM2014-01, 28 May 14 Air Force Information Management System database (AFRIMS) (access through the Air Force Portal at https://www.my.af.mil/afrims/afrims/afrims/rims.cfm

Air Force Electronic Records Management Solution

4.10.1. The Contractor shall segregate the Government-owned records from the Contractor-owned records and identify all records required to be created by the PWS on the AFRIMS file plans. The Contractor shall create and maintain paper and electronic records (\\52mahg-fs-106) as appropriate.

The Contractor shall maintain the software and background data to retrieve official electronic Government records throughout the lifecycle of the records.

4.10.2. The Contractor maintains and disposes of records IAW the AF records disposition schedules.

4.10.3. Electronically Stored Information (ESI). The Contractor shall maintain Government owned electronic non-official records on the organizational shared network drive according the subjective categories (example: template, common, reference material, and working files). Grant the base records manager access to all files located on the organizational shared network drive.

The Contractor shall maintain the official electronic records on the base designated shared network drive (\\52mahg-fs-106) IAW the Air Force Electronic Records Management System and AFMAN 33-363, Chapter 6.

4.10.4. Upon completion of this contract, all Government-owned/Contractor-held records (regardless of media) received, created, maintained, or provided in the performance of the PWS 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 documentation and software to permit the Air Force 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.

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

4.10.6. Freedom of Information Act (FOIA) Program. The Contractor shall comply with the requirements of DOD 5400.7-R/AFMAN 33-302, Freedom of Information Act Program, 21 Oct 10, and incorporating through Change 2, 22 January 2015. If the Contractor receives a FOIA request, the Contractor shall ensure it is delivered immediately to the base FOIA manager (81 CS/SCOK) for processing. The FOIA manager will task a Government official who, as the authorized official, will make the decision on releasing Government records.

4.10.7. Privacy Act Program. The Contractor shall create, maintain, and destroy Privacy Act data IAW AFI 33-332, The Air Force Privacy and Civil Liberties Program, 12 Jan 15; and Privacy Act systems of records notice(s) (http://dpcld.defense.gov/Privacy/SORNs.aspx). The Contractor shall not create or maintain a Privacy Act system of records prior to public notice. If the http://www.e-publishing.af.mil/shared/media/epubs/AFMAN33-363.pdf http://www.e-publishing.af.mil/shared/media/epubs/AFMAN33-363.pdf https://www.my.af.mil/afrims/afrims/afrims/rims.cfm http://dpcld.defense.gov/Privacy/SORNs.aspx

Contractor receives a Privacy Act request, the Contractor shall be responsible for searching for the records and providing those records to a Government official who, as the authorized official, will make the decision on releasing the Government records.

4.10.8. Functional Requests. A functional request is a written request for DOD records received from any person (including a member of the public), or a business that does not cite either the FOIA or Privacy Act. The Contractor shall be responsible for searching for the records and providing those records to a Government official who, as the authorized official, will make the decision on releasing the Government records.

4.11. RELEASE OF MEDICAL INFORMATION. The Contractor shall release medical information obtained during the course of this contract to Military Treatment Facility (MTF) staff involved in the care and treatment of that individual patient only in accordance with Appendix C.

4.12. SECURITY. The Contractor is responsible for maintaining the security of patient information in accordance with HIPAA guidelines. Unauthorized access to Contractor controlled data will be reported to the CO and 81 MDG Quality Assurance Officer immediately. See Appendix C.

4.13. RELEASE OF MEDICAL INFORMATION. The provider shall only release medical information obtained during the course of this contract to other MTF staff involved in the care and treatment of that individual patient. All patient information will comply with HIPAA standards.

4.14. COMMUNICATION. The Contractor shall ensure contract providers maintain open and professional communication with providers in the MTF. Complaints validated by the COR and Chief of the Medical Staff shall be reported in writing to the Contract Administrator (CA) and the Contractor for action. Failure of the Contractor to correct validated complaints raised by the MTF staff and the CO will be considered a failure to perform.

4.15. DOCUMENTATION. All contract personnel shall prepare all documentation to meet or exceed established standards of the MTF to include but not limited to: timeliness, legibility, accuracy, content and signature. Only MTF and Air Force approved abbreviations shall be used to document care in the health care record. Contractor personnel shall ensure patient identifying information is on all documentation that is part of the health care record. Contract providers shall review other providers' medical records as required by the Diagnostic Imaging Flight Commander or Director of Medicine for quality assurance, accuracy and compliance with the standard of care.

Corrections to documentation will be made by the Government.

4.16. QUALITY ASSURANCE/CONTROL

4.16.1. The Government shall monitor the contractor’s performance of this contract using quality assurance procedures established by the 81st MDG. Additionally, the contractor’s performance is subject to scheduled and unscheduled review.

4.16.2. The contractor shall have an internal quality control procedure, which shall ensure the contractor’s performance/medical care evaluation will be at a level commensurate with standards of the medical profession and the American College of Radiology. Accuracy for preliminary interpretation shall be 98% and 100% for final interpretations in evaluating for major discrepancies that would result in a change to a patients care plan.

4.16.3. The 81st MDG shall maintain a record-keeping system that monitors the contractor’s performance by exams interpreted for the purpose of payment verification.

4.16.4. Teleradiology Quality Control: a test image, such as the Society of Motion Picture and Television Engineers (SMPTE) test pattern shall be transmitted, archived, retrieved and displayed at least weekly, to test the overall operation of the system under conditions that simulate the normal operation of the system. The contractor shall maintain written documentation of the test performance and results. Failures of this QC test shall result in cessation of teleradiology services until technical problems have been successfully resolved.

4.17. CONTRACTOR MANPOWER REPORTING.

The Contractor shall report ALL Contractor labor hours (including subcontractor labor hours) for performance of services under this contract via a secure data collection site. The Contractor is required to completely fill in all required data fields at http://www.ecmra.mil. Reporting inputs will be for all labor executed during the performance for each Government fiscal year (FY), which runs 1 October through 30 September. While inputs may be reported at any time during the FY, all data shall be reported no later than 31 October of each calendar year. Contractors may direct questions to the Contractor Manpower Reporting Application (CMRA) help desk.

*REPORTING PERIOD: Contractors are required to input data by 31 October of each year.

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.

5. APPENDICES

A. GENERAL DEFINITIONS

B. CONTRACT EMPLOYEE CREDENTIALING REQUIREMENTS

C. HIPAA REQUIREMENTS

D. APPLICABLE PUBLICATIONS AND FORMS

E. ESTIMATED WORKLOAD DATA

F. DIACAP PROCESS

http://www.ecmra.mil/

APPENDIX A

GENERAL DEFINITIONS

As used throughout this Performance Work Statement (PWS), the following terms shall have the meaning set forth below:

Clinical Privileges. Those inpatient and ambulatory clinical activities permitted the provider in the granting medical treatment facility (MTF) after evaluation by the credentials function and approved by the medical center commander.

Composite Health Care System (CHCS). Computer system, which stores clinical and administrative data. This system provides on-line communication for users in any supported location.

Contract Provider. Any healthcare personnel providing medical services for this MTF who are either directly employed by, or who provide services pursuant to a contract with the Contractor.

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.

Contracting Officer Representative (COR). A duly appointed person with the authority to represent the Contracting Officer on matters regarding the evaluation of a contract provider’s fulfillment of contract obligations for specified Government contracts.

Contractor Management Staff. The Contractor’s internal staff, including all teaming partners, subcontractors, and their staff at corporate level involved in the company’s or team’s administration of this contract.

Contractor personnel. Any contract health care professional who, under regulations of a Military Department, is granted clinical practice privileges in a military MTF of Dental Treatment Facility, or who is licensed or certified to perform health care services by a Governmental board or Agency, or professional health care society or organization.

Credentialed Position. The labor category in which the contractor personnel is granted clinical practice privileges in an MTF through a defined credentials process, to treat military beneficiaries.

Credentials. Certified documents providing evidence of education, training, licensure, board certification, experience, and expertise of a health care provider.

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 Services Summary (SS). Defective services will be determined by either customer complaint or periodic inspection. A defect may be either an unsatisfactory inspection report or a customer complaint, which addresses unacceptable turn-around times or errors in reports.

Exposure-prone procedure. A certain invasive surgical or dental procedure that has been implicated in the transmission of the hepatitis-B virus from an infected health care worker to a patient. Characteristics of exposure-prone procedures include digital palpation of a needle tip in a body cavity or the simultaneous presence of the health care worker’s fingers and a needle or other sharp instrument or object in a poorly visualized or highly confined anatomic site.

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.

FAC or Functional Area Chief. A generic term used interchangeably to refer to the Functional Commander/Functional Director (FC/FD), the Chief of Service, designated Quality Assurance personnel or technical representatives of the CO.

Full reimbursement rate. A rate, which is set annually by Congress, for reimbursement by non-eligible personnel who receive medical services at the MTF. This is a flat rate set for outpatient and inpatient care.

Functional Commander/Functional Director (FC/FD). The Chief/Director of the MTF medical service for whom the Contractor personnel are acquired, or his designated representative. Also referred to as the FAC.

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.

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

Performance Work Statement (PWS). A document that describes a service in terms of the output requirements.

Primary Source Verification. The verification in writing or by documented telephone conversation from the original medical or nursing school, training or residency program, licensing or certifying boards, etc. The training and credentials claimed by a health care provider and used in the privileging process.

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

Privileging. Frequently referred to as credentialing. The process whereby the medical center commander, or the major command surgeon general, upon recommendations from the MTF credentials function, grants to individual health care providers the privileges and responsibility of providing specified medical and dental care within the MTF.

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 Improvement/Risk Management (QI/RM) Plan. An organized document that describes the methods of doing QI reviews within the MTF. The plan designates the areas of responsibility and accountability for the QI program and the mechanisms for monitoring and evaluating patient care. It is consistent with the JCAHO monitoring and evaluation (M&E) approach and the Air Force Risk Management (RM) efforts.

Substitution. The temporary placement of a qualified contractor personnel for a defined period of time until the permanent contractor personnel returns to work.

Valid license. A grant of permission by an official agency of the District of Columbia, a state, or territory of the United States, to provide care independently as a health care professional. Licenses must be current to be valid. Some jurisdictions issue no-fee licenses to Federal employees or military personnel. These are acceptable if the issuing authority will exercise professional regulating control over individuals with these licenses.

APPENDIX B

81st MEDICAL GROUP (KMC) CREDENTIALING

PROCEDURES

All required credentialing forms can be obtained from: 81 MDG/SGH (CREDENTIALS)

301 FISHER ST., STE. 5A 206

Keesler AFB, MS 39534

READ INSTRUCTION ON ALL FORMS AND FOLLOW THEM. IF ANY PART OF THE

APPLICATION PACKAGE IS INCOMPLETE OR MISSING THE ENTIRE PACKAGE WILL

BE RETURNED FOR PROPER COMPLETION.

a. Read, complete, and return the following:

----AF Form 1540, Application for Clinical Privileges ----AF Form 1562, Credentials Evaluation of Health Care Practitioners ----Privilege List (Specialty Specific) ----Release of Liability ----Bylaws ----Copy of Photo ID ----Copies of all professional practice licenses held

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

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

d. AF Form 1562. Two AF 1562s are required, one from a clinical supervisor and one from a peer.

The clinical supervisor should also approve/recommend your requested privileges on the AF privilege list provided to you, as discussed above.

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

- Qualifying degree and any other professional education/training diplomas.

- Internship, residency, fellowship and all other specialty training certificates.

- Copy of Board Certification

- ALL current state licenses.

- DEA Registration

- CME certificates for the past two years

- Affiliation verification and copy of privileges held from all hospitals within the last 10 years.

f. Return/Deliver the application for privileges to RM 5A 206, Keesler medical Center or mail to the address above.

Contract radiologists may not interpret images until clinical privileges have been approved.

APPENDIX C

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) OF

1996 REQUIREMENTS

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) OF

1996. All individuals performing services at the 88th Medical Group are required to complete HIPAA Act of 1996 Privacy Rule training and will be held accountable for complying with the 88th Medical Group's specific health information privacy policies and procedures:

PRIVACY AND SECURITY OF PROTECTED HEALTH INFORMATION

(a) Definitions. As used in this clause:

Individual has the same meaning as the term "individual" in 45 CFR 164.501 and

164.103 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 164.501, limited to the information created or received by The Contractor from or on behalf of The Government.

Required by Law has the same meaning as the term "required by law" in

45 CFR 164.501 and 164.101

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 Agreement shall have the same meaning as those terms in 45 CFR 160.103, 164.501 and 164.304.

(b) 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.

(c) 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) 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 Contract.

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

(g) The Contractor agrees to report to the Government any use or disclosure of the Protected Health Information not provided for by this Contract.

(h) 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.

(i) 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

(j) 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.

(k) 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.

(l) 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.

(m) 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.

(n) 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.

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 the following purposes, if such use or disclosure of Protected Health Information would not violate the Privacy Rule, the Security Rule or the Department of Defense Health Information Privacy Regulation if done by the Government: [List Purposes].

Specific Use and Disclosure Provisions

(a) 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.

(b) 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.

(c) 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 1 64.504(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) 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.

(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 Privacy Rule if done by the Government, except for providing Data Aggregation services to the Government and for management and administrative activities of the…