Attachment_1_PWS.docx

PERFORMANCE WORK STATEMENT

for

Credentials Management Services

For the 1st Special Operations Medical Group at Hurlburt Field, FL

Dated

6 April 2017

TABLE OF CONTENTS

1.0 Description of Services

SPECIFIC TASKS

4-5

APPENDIX B Sample Letter of Identification (LOI) – Official Travel of Government Contractors

18-22

PERFORMANCE WORK STATEMENT (PWS)

FOR CREDENTIAL MANAGMENT SERVICES

1. General Information. The contractor shall provide all personnel, equipment, supervision to support the 1st Special Operations Medical Group (1 SOMDG) Professional Staff Services Credentials and Quality Office. The purpose of this contract is to provide Credential Management services to maintain, coordinate, implement and manage the Department of Defense (DoD) Centralized Credentials Quality Assurance System (CCQAS) as the database Administrator.

1.1. Place of Performance. The Contractor shall perform the required services at 1 SOMDG located on Hurlburt Field, Florida. Contractor personnel shall comply with all installation and facility safety and security regulations, as well as, the health, safety, and security provisions of the contract. Contractor personnel shall report security or safety problems to the Contracting Officer and Security Police as appropriate.

1.2. The contractor shall analyze, design, implement and direct the credentials program for the 1 SOMDG and to ensure that the medical, dental, and allied health professional staff have qualified and competent healthcare professionals to meet the complex, diverse medical and dental needs of the beneficiary population served and to provide the highest quality medical, dental, and allied health professional care possible to achieve and maintain accreditation by The Joint Commission (TJC), and to integrate Assistant Secretary of Defense for Health Affairs (ASD/HA), Department of Defense (DoD), Air Force (AF), Major Command (MAJCOM), external accrediting agency policies and standards to maximize quality and delivery of healthcare by medical, dental, and allied health professional assigned staff. Provide expert knowledge to 1 SOMDG Commander, Chief of Medical Staff, Chief Nurse, Quality Services Manager, executive staff and all medical, dental and allied health professionals on credentialing and privileging and its crucial role in the success of the mission.

1.2.0. Credential Management Services:

1.2.1. Develops, coordinates, implements and manages an effective healthcare provider credentials program to meet TJC and Air Force Instruction (AFI) 44-119, Medical Quality Operations, Chapters five (5) through eight (8). Analyzes and evaluates the effectiveness of the credentials program to improve mission efficiency, effectiveness and productivity in meeting established goals and objectives. Contractor is the primary interface and point of contact to the 1 SOMDG Commander, Chief of Medical Staff, executive members, squadron commanders, department/service heads, other professional staff members assigned and professional affairs coordinators at other bases/commands, AF and Army reserves and national guard contingents, higher echelons and a myriad of professionals such as medical residency program directors at civilian hospitals and State and Federal agencies.

1.2.2. Analyzes, validates, and primary source verifies professional medical education and training of providers, requesting delineated medical privileges for appropriateness, continuity, and authenticity to ensure complete compliance with all credentialing policies established by higher authorities such as ASD/HA, TJC, DoD, AF and MAJCOM. Reviews all recommendations of inspecting bodies regarding credentialing, which include TJC, AF Inspector General, Air Force Medical Operations Agency, etc., and initiates appropriate changes that may be required. Assesses credentials program for effectiveness and implements changes and improvements in methods and procedures in accordance with established guidelines. Advises guard/reserve units’ credentials managers on credentialing/privileging requirements during annuals tours of duty.

1.2.3. Functions as special advisor to the MAJCOM Command Surgeon and assists other medical treatment facilities outside of parent MAJCOM with the credentialing process through consultative services related to the privileging and credentialing program. Provides expert advice and guidance on all aspects of the credentialing process, relying on comprehensive and extensive knowledge of all pertinent and current requirements and concerns.

1.2.4. Functions as the alternate liaison to 1 SOMDG Chief of the Medical Staff, Base Judge Advocate General’s Office and HQ AFSOC regarding adverse actions process for credentialed and privileged healthcare professionals and serves as the specialty advisor to the Chair of the Executive Committee of the Medical Staff for credentialing problems or untoward issues related to the privileging and credentialing program.

1.2.5. Establishes mechanisms and interprets ASD/HA guidelines, TJC standards, Air Force Instructions (AFI’s), Department of Defense (DoD) Directives and Medical Service Clinical Quality Assurance guidelines for the credentialing process. Establishes, manages and maintains, administers and maintains Providers’ Credentials File (PCF) and Provider Activity Files (PAF) on all credentialed and privileged healthcare practitioners.

1.2.6. Establishes, manages, administers and maintains the database for the Centralized Credentials Quality Assurance System (CCQAS), the DoD mandated website program for credentialing and privileging. The CCQAS supports the total electronic record and process. Manages and functions as the database Administrator for CCQAS and serves as the 1 SOMDG expert, gatekeeper, and its sole trainer. Designated by the Systems Office as the point of contact for entering privileged provider information into Composite Healthcare System (CHCS). Administers the Federal Drug Enforcement Administration (DEA) fee-exempt, Controlled Substance Registration Certificate Program.

1.2.7. Organizes and prepares agenda, materials, and summary reports/minutes for 1 SOMDG committees and functions pertaining to the credentials program. Assists privileged healthcare practitioners with maintaining requirements for maintenance of privileges to include assistance with the peer review program and compilation of necessary medical performance data as part of the re-privileging process. Work requires travel away from the normal duty station to attend an annual AF-Wide Quality symposium, periodic CCQAS and TJC, and medical staff services conference.

2.1. SERVICES SUMMARY

2.2. Services Summary (SS): The service requirements are summarized into performance outcomes that relate directly to mission essential items. The performance thresholds describe the minimum acceptable levels of service required for each performance objective. The thresholds are critical to mission success and acceptable (satisfactory) performance.

2.3.

Table 1 – Service Summaries

SS

Performance Objective (Credential Program Manager)

PWS Para

Performance Threshold To receive Satisfactory Rating

1.2.2.

100% of the time

1.2.5.

All items current and complete 95% of the time

3. GOVERNMENT FURNISHED PROPERTY, SUPPLIES AND SERVICES. The Government will provide the facilities, equipment, supplies, and services listed below. The Government will maintain accountability of any Government-furnished property, supplies and services. Government-furnished property shall be used only in the performance of this contract.

3.1. Government Furnished Facilities. The Government will provide 30 square feet of office space in the 1 SOMDG. No alterations to the office space shall be made without the specific written permission from the CO as coordinated and approved via the Civil Engineer work order, AF Form 332. In case of alterations necessary for compliance with OSHA, such permission shall not be reasonably withheld. The Contractor shall return the office space to the Government in the same condition as received, fair wear and tear and approved modifications.

3.2. Government Furnished Equipment/Materials.

3.2.1. Contractor personnel shall have joint use of all Government equipment available and necessary to perform services required by this contract. This includes copy machines, computers, fax machines, and the medical library. Use is limited to official Government business only.

3.2.2. The 1 SOMDG will provide all required Government forms used in the performance of services.

3.2.3. The 1 SOMDG will provide all office supplies currently and normally used in providing the required services. Contractor personnel may request additional office supplies through the facility supply system contingent on available funds and with the approval of the Chief of the Medical Staff. Denials and delays in acquiring any additional supplies beyond those currently and normally used shall not be cause for nonperformance of required services, or claims against the Government.

3.2.4. The 1 SOMDG will not provide uniforms, laboratory coats, or other personal clothing.

3.2.5. The 1 SOMDG will provide appropriate Personal Protective Equipment (PPE). The Government will be responsible for any repair, cleaning and inventory required for the PPE.

3.2.6. The Government will provide a personnel identification badge for contractor personnel to be used in accordance with 1 SOMDG and base security policy.

3.3. GOVERNMENT PROVIDED SERVICES.

3.3.1. Government Furnished Utilities. The Government will furnish electricity, water and sewage service as necessary for accomplishment of work in accordance with this contract. The Contractor shall adhere to all base level utility conservation practices or requirements. The Contractor shall be responsible for operating under conditions that prevent waste of utilities.

3.3.2. Telephone Service. The Government will provide station, local, long distance and Defense Switching Network (DSN) telephone services for official use only. Official use does not include administrative communications by employees on-site and the contractor’s corporate headquarters. Out-of-area calls not directly related to medical care of eligible beneficiaries are not authorized without the approval of the Chief of the Medical Staff. The contractor shall be responsible for reimbursement to the 1 SOMDG for the costs of all unauthorized communications.

3.3.3. Mail Service. The Government will provide intra-hospital distribution of mail and will provide outgoing mail service for official Government correspondence.

3.3.4. The Government will provide routine custodial services including emptying of trash; sweeping; mopping; and vacuuming, patient laundry services, and disposal of infectious waste. Additionally, custodial personnel will provide services upon request for immediate problems. Housekeeping (custodial services) will not clean nor move equipment such as medical or dental surgical instruments, surgical equipment, patient physiological monitoring equipment, equipment used in the diagnosis, care, or treatment of patients.

3.3.5. Security, Fire, and Medical Services. The Government will provide police and fire protection. In the event of a medical emergency, base ambulance service for transporting an injured employee to a local hospital is available on a cost reimbursement basis.

4. GENERAL INFORMATION.

4.1. Contract Manager. The Contractor shall designate a Contract Manager and alternate in writing to the CO no later than the pre-performance conference and anytime changes are made. The Contractor shall establish and maintain an office through which the Contract Manager or alternate(s) can be contacted during work hours. The Contractor shall also provide to the CO the names and phone numbers of Contractor POCs for after business hours including nights, weekends, and holidays. This information will be kept updated by the Contractor whenever personnel changes occur. The Contract Manager or alternate shall have full authority to act for the Contractor on all contract matters relating to the daily operation of this contract.

4.1.1. Quality Assurance. The government will periodically evaluate the contractor’s performance by appointing a Contracting Officer Representative (COR) to monitor performance to ensure services are received. The COR will evaluate the contractor’s performance through intermittent on-site surveillance of the contractor's quality control program and receipt of complaints from base personnel. The COR may survey each task as completed or increase the number of quality control surveillance if deemed appropriate because of repeated failures discovered during quality control inspections or because of repeated customer complaints. Likewise, the COR may decrease the number of quality control surveillance if merited by performance. The COR will also investigate complaints received from various customers located on the installation.The COR shall be responsible for initially validating customer complaints.

4.1.2. The Contracting Officer Representative (COR) is the authorized government representative(s) who will perform assessments of the contractor’s performance. Subsequent to contract award, the identity of the COR(s), with a letter defining their duties and authority will be promptly furnished to the successful bidder/offeror.

4.1.3. The COR(s) will inform the contract manager in person when discrepancies occur and will request corrective action. The COR(s) will make a notation of the discrepancy on their surveillance checklist with the date and time the discrepancy was noted and will request the contract manager (or authorized representative) to initial the entry on the checklist

4.1.4. Any matter concerning a change to the scope, prices, terms or conditions of this contract shall be referred to the Contracting Officer and not to the COR(s).

4.1.5. The services to be performed by the contractor during the period of this contract shall at all times and places be subject to review by the Contracting Officer or authorized representative(s) approved by CO in writing.

4.2. Contractor Personnel. Contractor personnel shall present a neat appearance. Contractor personnel shall be easily recognizable while on the installation in conjunction with this contract. The Government may restrict the employment under the contract of any Contractor employee or prospective Contractor employee, who is identified as a potential threat to the health, safety, security, general wellbeing, or operational mission of the installation and its population.

4.2.1. Contractor personnel shall wear appropriate identification badges on the outer clothing on the front of the body between the neck and waist so that the badge is visible at all times.

4.2.2. Prior to commencement of work, contractor personnel shall attend a government orientation to familiarize contractor personnel with the policies and procedures of the 1 SOMDG. The orientation will be scheduled by the COR during normal duty hours and will be at no cost to the contractor.

4.2.3. Contractor personnel shall complete annual training required in accordance with HIPAA, Joint Commission, AF Computer Security Policy, and AF Safety Policy. Training will be provided at no cost to the contractor and will be conducted on-site during duty hours.

Notification of required training will come from the Chief of the Medical Staff.

4.3. SKILLS AND KNOWLEDGE. Contractor personnel performing on-site services must possess the following knowledge and skills:

4.3.1. Read, understand, speak, and write English fluently.

4.3.2. Knowledge in the use of personal computers and computer programs to include Microsoft Office applications.

4.3.3. The ability to acquire and use basic computer skills such as Composite Health Care System (CHCS), Integrated Clinical Database (ICDB), Centralized Credentials Quality Assurance System (CCQAS), Armed Forces Health Longitudinal Technology Application (AHLTA).

4.3.4. Teaching and public speaking skills in order to provide guidance, counseling, training and professional evaluation.

4.4. QUALIFICATIONS. In addition to the skills and knowledge listed above in paragraphs 4.3.1-4.3.4, on-site contractor personnel performing shall possess the below qualifications:.

4.4.1. Expert knowledge of and skills in general management, organizational principles, and practices of credentialing and privileging to analyze, evaluate, advise, and coordinate on all aspects of the credentialing process. Contractor personnel must have a minimum of 3 years working experience in credentialing and privileging. Certification as a Certified Professional Credentials Specialist (CPCS) is required.

4.4.2. Extensive knowledge of individual states’ medical boards, national medical certifying medical boards, and other agency requirements regarding licensing and certification.

4.4.3. Extensive ability to analyze, identify, and resolve complex problems or unusual situations regarding the credentials and privileging process.

4.4.4. In-depth knowledge of Air Force healthcare directives related to medical practices and their association to credentialing actions. Minimum of 3 years working experience in the Military Healthcare System in credentialing is required.

4.4.5. Knowledge of medical terminology and procedures sufficient to oversee appropriateness of privileges requested and facilitate interaction with all levels of medical professionals.

4.4.1.6. Extensive knowledge of and ability to effectively use automated data systems, spreadsheet, database, word processing, and other electronic computer applications in the collection and analysis of data pertaining to medical staff issues. Minimum of 3 years working experience with the military’s Composite Health Care System (CHCS) program is required. A minimum of 3 years working experience with the military’s Centralized Credentials Quality Assurance System (CCQAS) is required.

4.5. CRIMINAL BACKGROUND CHECK REQUIREMENT.

4.5.1. The Government will conduct criminal background checks on individuals providing services under this contract, using the procedures set forth in Department of Defense Instruction 1402.5 dated 19 January 1993. Background checks will be based on fingerprints of individuals obtained by a Government law enforcement officer and inquiries conducted through the Federal Bureaus of Investigation and state criminal history repositories.

4.5.2. Contractor personnel may provide contract services prior to completion of background checks with the consent of the CO and 1 SOMDG commander.

4.5.3. Contractor personnel may obtain a copy of any background check pertaining to them and to challenge the accuracy and completeness of the information contained in the report.

4.6. RECORDS.

4.6.1. All records, files, documentation, working papers, and software provided by the government or generated in the performance of this contract become and remain government property.

4.6.2. All such records, files, documentation, and working papers, which this contract requires the contractor to maintain, shall be maintained in accordance with AFI 33-322, Records Management Program; AFI 33-364, Records Disposition-Procedures and Responsibilities; AF Electronic Records Management (ERM) Solution, AFRIMS, Records Disposition Schedule located at https://www.my.af.mil/gcss-af61a/afrims/afrims/ and all other pertinent directives, as supplemented.

4.7. HOURS OF PERFORMANCE. The contractor shall provide Credentials Program services, Mondays through Fridays 0730-1630 hours.

The contractor shall not provide services on Federal Holidays and non-duty days as follows:

New Year’s Day -1 January Martin Luther King Day -3rd Monday in January President’s Day -3rd Monday in February Memorial Day -last Monday in May Independence Day -4 July Labor Day -1st Monday in September Columbus Day -2nd Monday in October Veteran’s Day -11 November Thanksgiving Day -4th Thursday in November Christmas Day -25 December

If these holidays fall on Saturday, the preceding Friday will be observed. If these holidays fall on Sunday, the following Monday will be observed. If a holiday falls on a scheduled service day, the Contractor will be responsible for rescheduling services for the first day post the holiday observance. The non-duty days will precede or follow the Federal Holidays. A list of associated non-duty days will be provided to the contractor annually.

4.8. Base Closures. In the event of a base closure due to weather, exercises, or actual alerts, the contracting officer will inform the contractor’s program manager and provide further instructions. Contractor personnel shall contact the contractor’s program manager for instructions.

4.9. Contractor/Employee Base Pass and Identification, Special Clearances and Vehicle Passes. The Contractor personnel shall comply with all requirements and procedures IAW AFFAR 5352.242-9000, Contractor Access to Air Force Installations. The contractor shall submit the employee listing at the pre-performance conference and to the CO monthly as changes occur. All documentation shall be submitted for identification badges and base access devices to the Visitor Control Center (VCC) after the employee listing has been submitted to the CO.

4.10. Traffic Laws. The Contractor personnel shall comply with base traffic regulations.

4.11. Weapons, Firearms, and Ammunition. The Contractor personnel are prohibited from possessing weapons, firearms, or ammunition, on themselves or within their Contractor-owned or privately owned vehicle while on Hurlburt Field, FL.

4.12. For Official Use Only (FOUO). The Contractor personnel shall comply with DoD 5400-7-R, Chapter 4, DoD Freedom of Information Act (FOIA) Program requirements. This regulation sets policy and procedures for the disclosure of records to the public and for marking, handling, transmitting, and safeguarding FOUO material.

4.13. Reporting Requirements. The Contractor personnel shall report to an appropriate authority any information or circumstances of which they are aware may pose a threat to the security of DoD personnel, Contractor personnel, resources, and classified or unclassified defense information.

4.14. Physical Security. The Contractor personnel shall be responsible for safeguarding all government property and controlled forms provided for Contractor use. At the end of each work period, all government facilities, equipment, and materials shall be secured.

4.15. Reporting Full-Time-Equivalent (FTE) Data. The Contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract via a secure data collection site. The Contractor is required to completely fill in all required data fields at the Contractor Manpower Reporting Application (CMRA) site http://www.ecmra.mil (select the US Air Force logo).

4.15.1. Reporting Period. Reporting inputs will be for the labor executed during the period of performance for each Government fiscal year (FY), which runs 1 October through 30 September. While inputs may be reported 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 CMRA help desk.

4.15.2. 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.

4.15.3. User Manuals User manuals are available on the front page of the CMRA link at http://www.ecmra.mil

4.16. Safety Requirements and Reports. The Contractor personnel shall perform work in a safe manner as required by OSHA Safety and Health Requirements. Provide a verbal report to the CO as soon as possible of each occurrence of damage to Government property or an accident resulting in death, injury, occupational disease, or adverse environmental impact. Provide a completed copy of required Accident Investigation Reports to the CO within 5 calendar days of each occurrence.

4.17. Computer Security. A National Agency Check with Inquiries must be completed at the government’s expense to conduct a security background check for appropriate security of privacy act information. IAW AFI 33-202V1_AFMCSUP1, dated 30 November 2005, par 4.1.1.1.2. All contractors must have a National Agency Check with Inquiries (NACI) or single scope background investigation (SSBI) prior to granting access to government e-mail, network or computer systems.

4.17.1. The Contractor personnel shall complete and e-mail an electronic copy of the SF85, Electronic Personnel Security Questionnaire (EPSQ) file in the ".zdb" format to the Security Manager two weeks prior to commencement of work in the 1 SOMDG.

4.18. HEALTH CARE REQUIREMENTS.

4.18.1. The Contractor personnel shall report to the 1 SOMDG Public Health office during in-processing for a briefing on Medical Group Employee Health Program requirements.

4.19. CONFIDENTIALITY OF INFORMATION. Unless otherwise specified, all financial, statistical, personnel, and/or technical data which is furnished, produced or otherwise available to the contractor or health care worker during the performance of this contract are considered Government confidential business information and shall not be used for purposes other than performance of work under this contract. The Contractor personnel shall not release any of the above information without prior written consent of the CO. All medical records and reports remain the property of the Government.

4.19.1. Patient lists, no matter how developed, shall be treated as confidential information in accordance with the Privacy Act and the Health Insurance Portability and Accountability Act (HIPAA). Lists and/or names of patients shall not be disclosed to or revealed in any way for any use outside the 1 SOMDG, except through 1 SOMDG-specified processes.

4.19.2. Release of Medical Information: The Contractor personnel shall only release medical information obtained during the course of this contract to other 1 SOMDG staff involved in the care and treatment of that individual patient.

4.20.1. PRIVACY OF PROTECTED HEALTH INFORMATION

4.20.1.1. (a) Definitions. As used in this clause:

Individual has the same meaning as the term ``individual'' in 45 CFR 164.501 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.

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

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

(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 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.

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

(f) 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.

(g) 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.

(h) 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.

(i) 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.

(j) 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.

(k) 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 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 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) 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 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 the Privacy Rule means the section as 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 the Privacy Rule.

FAR 52.217-8, “Option to Extend Services” applies to this contract. The Government may require continued performance of any services within the limits and at the rates specified in the contract. These rates may be adjusted only as a result of revisions to prevailing labor rates provided by the Secretary of Labor. The option provision may be exercised more than once, but the total extension of performance hereunder shall not exceed 6 months. The Contracting Officer may exercise the option by written notice to the Contractor within 30 days. Upon exercising the option, the Government will add CLIN price.

APPENDIX A: Workload Estimates

The following are estimated hours required in performance of this contract:

Credentials Program Manager 12 Months (1,920 hours)

APPENDIX B

LETTER OF IDENTIFICATION INSTRUCTIONS and SAMPLE LOI for

OFFICIAL TRAVEL OF GOVERNMENT CONTRACTORS

The Letter of Identification (LOI) is the authorized means of contractor travel. Entitlements designated on this form do not constitute an authorization for those services. The government is not obligated to make arrangements or provide service(s) authorized a contractor employee. The Official Travel of Government Contractors form is designated for use within CONUS/OCONUS for local travel. The contract authorizing the travel should define the entitlements the contractor shall receive while in travel status.

Block 1. Contractor. The name, address, telephone and fax number of the contractor performing the contract authorizing the travel.

Block 2. Vendor/Cage Code. The vendor Commercial and Government Entity (CAGE) code. The code is identified in the contract.

Block 3. Date. Date LOI completed.

Block 4. Travel Order. Designate whether an individual or group is traveling on the orders. If a group, include pertinent information on a separate page (blank 8.5" x 11") and attach. If an amendment, check the block and include the amendment number, i.e. 001, 002, etc. If a rescission/revocation, check the appropriate block.

Block 5. Travel Authorization Number. A locally developed number assigned by the organization issuing the LOI, i.e. 2002-001. Each additional trip on the same Task will follow in sequence, i.e. 2002-002, 2002-003, etc.

Block 6. Employee Name & Title. Contractor employee authorized to travel. For group travel, include name and title on a separate page.

Block 7. SSAN. The social security number of the contractor employee authorized to travel.

Block 8. Destination/Itinerary. Identify the contractor employees travel itinerary, to include any stopovers authorized in conjunction with this travel.

Block 9. Purpose of Travel. Identify the purpose of the contractor employee's travel, i.e. contractor employee providing software support on the CAAP/AMP system, etc.

Block 10. TDY Length/Dates. List the length of the TDY, i.e. 15 Jan 02- 19 Jan 02.

Block 11. Contracted Travel Office. The contractor is not authorized to use the City Pairs Program at the local base SATO.

Block 12. Transportation. The contractor is/is not authorized transportation.

Block 12a. Air. Travel by air is/is not authorized.

Block 12b. Rail. Travel by rail is/is not authorized.

Block 12c. Military Air. The contractor employee is/is not authorized to travel by military transportation.

Block 12d. Privately Owned Vehicle. The contractor employee is/is not authorized to travel by private vehicle.

Block 12e. Bus. The contractor employee is/is not authorized to travel by bus.

Block 13. Government Lodging. The contractor employee is/is not authorized government lodging.

Block 13a. GS Equivalent Rating. The rating is for lodging purposes only. This information allows lodging personnel to determine what type of quarters the contractor employee should receive. The GS salary rating is used to equate the contractor employee's wages to a specific GS grade. The grade is listed on the LOI. Use either GS-11, GS-12, or GS-13.

Block 14. Excess Baggage. The contractor employee is/is not authorized excess baggage.

Block 14a. Number of Pieces. If excess baggage is authorized, list the number of pieces of excess baggage authorized.

Block 14b. Total Weight (lbs). If excess baggage is authorized, list the total weight in pounds in excess being authorized.

Block 15. Installation Access. The contractor employee is/is not authorized access to a government installation.

Block 15a. Hours of Installation Access. The hours the contractor employee will be authorized access to the installation, i.e. 0800-1700. If the contractor is authorized access for a limited time, please indicate the date(s), i.e. the contractor is authorized to travel 4-6 Jun 02, but he will require access to the installation on 4 Jun only, during the hours of 0800-1730.

Block 16. Commissary. The contractor is/is not authorized to use the commissary while in travel status.

Block 17. Base Exchange. The contractor employee is/is not authorized access to the Base Exchange while in travel status.

Block 18. Medical Services. The contractor employee is/is not authorized to use the base hospital for emergencies while in travel status. NOTE: The contractor will be billed for the services provided at the base hospital.

Block 19. Per Diem. The contractor employee is/is not authorized per diem.

Block 20. Other. Identify other services the contractor may be authorized while in travel status.

Block 21. Remarks. Include information not otherwise included in the form, but is necessary for the contractor employee to travel.

Block 22. Contract Number. The contract number under which the contractor employee is traveling. If travel is authorized using a task order number, list contract number under which the task order was written, i.e. GS 35 - 0137F.

Block 23. Task Order Number. If the contractor employee travel is authorized or pertains to a task order number list the task order number here.

Block 24. Contract Line Item Number. List the Contract Line Item (CLIN) authorizing the travel. Normally, 0002 or 0003.

Block 25. Contracting Organization/Address. List the name and address of the contracting office authorizing the travel.

Block 26. Telephone Number. List the DSN, Commercial number, and fax number of the contracting office approving the travel.

Block 27. Contract/Task Order Period. List the dates of performance (period of performance) of the current contract or task order approving the contractor employee travel, i.e. 1 Jul 01 - 30 Jun 02 or the specific date of the Period of Performance.

Block 28. Contracting Officer. List the name of the contracting individual responsible for the oversight of the contract, i.e. the contract administrator.

Block 29. E-Mail Address. List the e-mail address, telephone and fax number of the contracting officer authorizing the travel.

Block 30. Accounting Appropriation. The accounting data that is being used to fund the contractor employees’ current travel.

Block 31. Estimated Cost. An estimate of the total dollar amount allotted for the contractor employees current travel.

Block 32. Distribution. List all offices that require a copy of the authorization. Distribution should include the Contracting Officer, the functional representative initiating the travel request, finance (NOTE: DFAS will not make payment from the LOI. Contractors authorized to be reimbursed for this travel will be required to submit an invoice.

Block 33. Inquiries. The name of the individual to contact if questions/clarifications are required to the LOI.

Block 34. Telephone Number. The telephone number, fax number, and e-mail address of the individual who should be contacted if questions arise in relation to this travel.

Block 35. Authorizing Authority. Signature of the technical/functional representative authorizing the travel (COR). This individual is certifying that funds are available for this travel.

Block 36. Approving Authority. Signature of the contracting officer approving the travel. The approving authorities signature warrant funds, and the authorized travel is within the scope of the contract authorizing the travel.

Block 37. Authorizing Authority Information. The name, title, telephone (commercial and DSN) and e-mail address of the technical/functional representative authorizing the travel.

Block 38. Approving Authority Information. The name, title, telephone number (commercial and DSN) and e-mail address of the contracting officer authorizing the travel.

S A M P L E Letter of Identification (LOI) - Official Travel of Government Contractors

This letter is the official means of contractor employee travel for travel throughout CONUS/OCONUS. Contractor employees are not authorized to use the City Pairs Program Fares.

Privileges: Entitlements on this LOI do not mean the contractor is entitled to an Identification card. ID card benefits and privileges are governed by DoD 1000.13 & AFI 36-3026(I),

1. Contractor (Name, Address, E-Mail Address, Telephone & Fax Number)

4. Travel Order

Individual [ ] Group [ ] Amendment [ ] Recission/Revocation [ ]

5. Travel Authorization Number

[ ] Yes [ ] No 12a. Air [ ] Yes [ ] No

14b. Total Weight (lbs.)

[ ] Yes No [ ]

20. Other _______________________ [ ] Yes No [ ]

21. Remarks: Crewmembers possess Secret clearances.

25. Contracting Organization/Address

26. Telephone Number

27. Contract/Task Order Period

30. Accounting Appropriation

33. Address any inquiries regarding this LOI (Name)

34. Telephone Number: (850) 884-1269

35. Authorizing Authority:

36. Approving Authority:

37. Name:

38. Name:

Title: Contracting Officer Telephone: Number: (850) 884-1258 e-mail:

Joint Travel Regulation (JTR), Vol 2 is available at http://www.dtic.mil/perdiem/.

Section 6311 of title 5, United States Code, authorizes collection of this information. The primary use of this information is for the AF and your employer to obtain information related to your government directed travel. Where the employee identification number is your Social Security Number, collection of this information is authorized by Executive Order 9397. Furnishing this information on this form, including your Social Security Number, is voluntary, but failure to do so may result in the disapproval of this request.