Attach 1 - PWS Cardiothoracic Perfusionist Services.pdf

PERFORMANCE WORK STATEMENT

CARDIOTHORACIC PERFUSIONIST SERVICES

David Grant Medical Center

Travis AFB, CA

1 Dec 2019

Table of Contents

Section Title

1 Description of Services 3

2 Contractor Responsibilities 3

3 Services Summary 6

4 Government Furnished Property 8

5 General Information 8

6 Health Requirements 9

7 MTF Requirements 10

8 Criminal History Background Checks 12

9 Training Requirements 12

10 Contractor Identification 13

11 Environmental Controls 13

12 Records, Files, Documents, Data and 14

Work papers

Appendix A Applicable Publications 15

Appendix B Standard Abbreviations and Terms 18

Appendix C Estimated Workload 20

Appendix D List of Government Furnished Property 21

PERFORMANCE WORK STATEMENT (PWS)

CARDIOTHORACIC PERFUSIONIST SERVICES

David Grant Medical Center

Travis AFB, CA

1. DESCRIPTION OF SERVICES

1.1. The objective of this service is to provide non-personal pre-operative through post-operative

Cardiothoracic Perfusionist services for cardiothoracic surgical patients at David Grant Medical Center, Travis Air Force Base, California also referred to as the Medical Treatment Facility (MTF). The contractor shall comply with all applicable civilian, Department of Defense (DoD), Air Force and

Medical Treatment Facility (MTF) directives and instructions to include The Joint Commission (TJC) and

Health Services Inspection (HSI). Perfusion Services shall be available 24 hours a day, 365 days a year.

The Contractor must be able to provide perfusionists that meet the requirements of this Performance

Work Statement with the capability to respond and meet the required schedules to provide an estimated minimum of 30-40 surgical cases per year not to exceed an estimated maximum 50-60 cases per year.

2. CONTRACTOR RESPONSIBLITIES

2.1. The Contractor shall provide personnel possessing the skills, knowledge, abilities, and training to satisfactorily perform the service requirements included in this PWS. Contractor personnel performing work in support of cardiothoracic activities shall be fully trained in all aspects of the work to be performed. Private sector personnel performing work under this PWS shall remain employees of the

Contractor and shall not be considered employees of the government.

2.1.1 Clinical Perfusionist shall meet the following qualifications:

a. Bachelor’s degree with emphasis on medical technology, respiratory therapy, biological sciences, or nursing.

b. Graduated from an accredited training program in cardiovascular perfusion.

c. Certified or eligible for certification as a Certified Clinical Perfusionist (CCP) by the

American Board of Cardiovascular Perfusion (ABCP)

d. Must hold current certifications in Basic Life Support (BLS) and Advanced Cardiovascular

Life Support (ACLS)

e. Must have a minimum of 2 years of clinical experience within the past 3 years.

2.1.2 Specific Tasks

a. As a licensed perfusionist, the contractor shall perform all clinical perfusion duties associated with cardiac surgery, and other surgery, including operation of the cardiopulmonary bypass machines and cell saver.

b. Provide perfusion expertise for adult cardiopulmonary bypass (CPB) procedures. The provider shall review the case, history, pertinent lab values, and the proposed surgical plan and formulate appropriate perfusion plan in conjunction with the cardiac surgeon, and other operating surgeons requiring perfusion support. Assembles and primes the CPB circuit, initiates, monitors, and terminates CPB, and operates and monitors ultra filtration equipment.

Accurately obtains and records vital signs, Activated Clotting Time (ACT), thromboelastographic, and Arterial Blood Gas (ABG) during bypass procedures. Identifies emergency procedures and corrects problems promptly and accurately.

c. Provide auto transfusion services for cardiothoracic and other surgical procedures.

Assembles, operates, and disassembles auto transfusion apparatus, processes auto transfusion bloods for preoperative blood salvage, and documents all cell salvage completely and accurately.

d. Provide intra-aortic balloon pump (IABP) support as required. Assembles, operates, and assists with the insertion and removal of the IABP apparatus and provides troubleshooting support, timing, and maintenance as needed.

e. Provide perfusion expertise and support for ventricular assist devices (VADs). Assembles and operates pumps, provides bedside monitoring, terminates VAD procedures and maintains records in accordance with local operating instructions.

f. Assists in placement of monitoring devices and the pre- and post-operative transfer

(transportation) of the patient.

g. Perform routine maintenance, schedule preventive maintenance and accurately maintain records of CPB equipment, auto transfusion apparatus, IABP units and VAD equipment.

Monitor expendable supplies and equipment and places orders as necessary to maintain adequate stock levels.

h. For Cardiopulmonary Bypass

a. Appropriately assess patient profile and manage CPB. Use appropriate equipment/supplies and monitor data based on patient profile (age, condition, procedure).

b. Appropriately communicate with clinical team during procedures and resolve variances and abnormal situations that may arise. Utilize all available safety devices during CPB as per departmental policy.

c. Demonstrate appropriate clinical vigilance and awareness before, during, and after

CPB. Facilitates discussion with health care team which includes medical record review, decisions needed for prime selection, drug and blood additives, techniques for CPB.

d. Duties also to include operation of cell saver for procedures to include but not limited to cardiac surgery as necessary.

i. For Ancillary Procedures

a. Demonstrate competence and comprehensive knowledge of all ancillary procedures.

Competence in cardiac assist devices to include VADs, Extracorporeal Membrane

Oxygenator (ECMO), IABP, left heart bypass, Venovenous (VV) bypass for liver transplant, hyperthermic isolated limb perfusion, and autotransfusion, to include platelet gel processing.

b. Assess patient profile and manage ancillary procedures by using appropriate equipment and monitoring data.

c. Recognize when situations are critical, notify appropriate personnel and assist as needed.

d. Troubleshoot all technical devices.

e. Create and maintain accurate, complete legible records. Utilize electronic health record in accordance with Medical Group policy.

f. Perfusionists may work up to 10 – 15 days of call from home a month and must be able to be on site within 30 minutes. Schedule can be up to 5/10 hour days a month to include holidays and weekends.

2.2. The prime contractor‘s staff, including all teaming partners, subcontractors and their staff at

Corporate level involved in the company’s or team’s administration of this contract will hereafter be termed as Contractor. The prime Contractor retains responsibility for any teaming partner or subcontractor and shall be accountable for their performance. The medical support services labor categories recruited and hired by the Contractor to perform the services as described in this PWS will be termed hereafter as Contracted Employee, Contracted Personnel or HCW.

2.3. The Contractor shall maintain a plan that demonstrates a process for finding, pre-screening and submitting qualifying documentation against preliminary government minimum requirements for health care workers. The plan will effectively place fully qualified health care workers to perform at the

MTF. Plan will ensure the verification and validation of candidate qualifications meet the minimum qualifications as identified in the PWS. Plan must also ensure that HCWs meet the security requirements.

2.4. The Contractor shall have in place a management plan to ensure qualified candidates are recruited, screened, qualified, trained, monitored, and retained to fulfill service requirements under this contract. These systems and controls for performing and monitoring this data shall address the areas covered by the Services Summary. The Contractor shall employ these commercial quality control program/procedures to identify, prevent and ensure non-recurrence of defective services. Through implementation of the contractor’s quality control program/procedures, the government shall receive quality services meeting the requirements of this contract.

2.5. The Contractor shall appoint a program manager within 5 business days upon the award of the contract with name and contact information, and shall be responsible for the performance of the work, ensuring scheduled staff is on site and available to provide services. The program manager and an alternate shall be designated in writing to the Contracting Officer and have the authority to act for the contractor on all contracting matters relating to daily operation of this contract, to include solving MTF complaints regarding contracted personnel performance issues. The program manager or alternate shall be available during normal duty hours (7:30 am – 4:30 pm) to meet with Medical Logistics Personnel and the Contracting Officer’s authorized Contracting Officer’s Representative (COR) to discuss and solve problems.

2.6. The contractor shall have staff credentialed and approved through the MTF and will be ready to work onsite by the contract effective date.

3. SERVICES SUMMARY

This section describes the Government’s performance objectives. 3.1 Services Summary. As a minimum, COR and or FRED will monitor, review, and report on the Contractor’s performance and compliance with all Service Summary (SS).if it not identified as a performance objectives then the COR will not be able to assess the contractor’s performance . The performance thresholds referenced in the table briefly describes the minimum acceptable levels of service required for each service requirement.

The performance thresholds established for each of the performance objectives are the number of allowable defects permitted before the COR notifies the contracting officer in accordance with FAR

52.212.4, Contract Terms and Conditions-Commercial Items, or FAR 52.246-4, Inspection of Services -

Fixed Price.

3.2 Quality Control. The Contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. As a minimum the Contractor shall develop quality control procedures addressing the areas identified herein.

3.3 Quality Control Plan. The Contractor shall formulate and submit a written Quality Control Plan to the

Contracting Officer for review and feedback include when the QCP is due to the Contracting Officer. The

Contractor’s Quality Control Plan (QCP) shall be provided to the Contracting Officer for review and approval prior to the contract start date since the award date and start date is one in the same do we want it with the contractor’s proposal, since the contractor will not be able to start until an acceptable plan is provided?. The Quality Control Plan shall specifically address the spell out strategy to provide Quality

Control. The only use acronym after it is initially splled out.shall employ their commercial quality control program/procedures to identify, prevent and ensure non recurrence of defective services. 3.4 Quality

Assurance Evaluations. The government representative will evaluate the Contractor’s performance through intermittent on-site inspections of services performed as well as evaluate complaints from military personnel. The government may inspect each task as completed or increase the number of quality control inspections if deemed appropriate because of repeated failures discovered during quality control inspections or because of repeated customer complaints. Likewise, the government may decrease the number of quality control inspections if performance dictates.

3.5 Method(s) of Surveillance. The COR/FRED may inspect services provided by observing actual service, after a service has been completed and interviews with the customers. The contractor will be monitored and assessed throughout the period of performance of the contract with a combination of the following methods:

3.6 Third Party Audits. Third party audits will be conducted by federal, state, or local agencies (i.e

DGMC Public Health, Food Service Accountant, OSHA, Environmental Management).

3.7 Random/Periodic Inspections. Random or periodic inspections consists of the bulk of evaluations accomplished by the COR/FRED. The COR/FRED must ensure the amount of inspections is accomplished as set by the monthly surveillance schedule. The Government reserves the right to increase or decrease inspections of the Contractor's performance. The decision will be based on whether the

Contractor's performance is in alignment with performance thresholds/standards in the PWS.

3.8 Customer Complaint. The COR/FRED will collect all customer complaints. Before submitting this form to the COR, the COR will first investigate the complaint to verify validity and if there were any contributory factors or Government delays attributable to the complaint. The COR will submit the complaint to the CO/CS for their review before submitting the customer complaint record to the

Contractors POC to resolve the complaint. If, after investigation, the CORs determines there were no contributory factors or Government delays, the CORs will validate the complaint and submit the customer complaint record to the Contractor’s POC to resolve the complaint. Validated customer complaints must be resolved within 24-hours of the Contractor’s POC's receipt of the complaint form. If additional time is needed, the Contractor shall request, in writing, additional time to resolve complaints and obtain approval from the COR. All the circumstances and actions taken must be documented (in writing) by the

Government and Contractor on the Customer Complaint Record. Validated customer complaint forms become a permanent part of the COR file/electronic file in SPM.

3.9 Performance Evaluation. Performance of a service will be evaluated to determine whether or not it meets the performance requirements of the contract. When the performance requirement is not met the

COR will draft a Corrective Action Report (CAR) to the CO. The Contractor shall respond to the CAR

IAW instructions provided and return it to the COR within 5 business days of receipt. Inspection of accomplished/re-accomplished work shall be performed by CORs.

3.10 Government Remedies. The contracting officer shall follow FAR 52.212-4, Contract Terms and

Conditions-Commercial Items, for Contractor’s failure to perform satisfactory services or failure to correct non-conforming services.

Performance

Objective

Ref Performance Threshold Surveillance

Method

Rating

1. Fills positions and vacancies within prescribed standards.

Para 2.6. 100% of personnel are present for duty within contract effective date.

Third Party

Audits, Periodic observation, customer complaint.

Exceptional, Very Good, Satisfactory, Marginal, Unsatisfactory.

2. Provide qualified staff that possesses the skills, knowledge and abilities to independently perform the services required by this contract.

Para 2.1. - 2.5. 100% of personnel will be qualified at the beginning of performance on this contract.

Third Party

Audits, Periodic observation, customer complaint.

Exceptional, Very Good, Satisfactory, Marginal, Unsatisfactory.

3. All schedules will always be met.

Para 1.1 and

2.1.2, f.

100% of all schedules, surgeries, and call schedules will be met.

Third Party

Audits, Periodic observation, customer complaint.

Exceptional, Very Good, Satisfactory, Marginal, Unsatisfactory.

4. Complies with Government

Security requirements

Contract

Security

Requirements dated 6 Mar

100% of personnel will comply with Unit

Security Manager deadlines and instructions as required.

Third Party

Audits, Periodic observation, customer complaint.

Exceptional, Very Good, Satisfactory, Marginal, Unsatisfactory.

3.11. Inspection/Acceptance. The Contractor shall only invoice for acceptance those items that conform to the requirements of this contract. The Government reserves the right to inspect any services that have been tendered for acceptance. The Government may require re-performance of nonconforming services at no increase in contract price. If the contractor is unable to provide required staffing for scheduled or unscheduled surgeries, the government will reduce the monthly invoice at a prorated rate.

4. GOVERNMENT FURNISHED PROPERTY

Refer to Appendix D for list of Government Furnished Property.

5. GENERAL INFORMATION

5.1. In the event of an adverse action, the Contracting Officer (CO) and the contractor shall be notified by the COR as soon as possible when the necessity to exercise such authority becomes apparent.

The COR will also provide the Contracting Officer and the contractor with a written statement advising the contractor of an adverse action involving a health care worker, a brief statement of the basis for the action to provide the contractor sufficient information in order to make employment substitution decision as necessary, and if required, the final outcome of the adverse action process. The written notice will be marked by government as covered by 10 USC 1102. No other information pertaining to the adverse action will be released without MTF/CC permission.

5.2. Life Support Certification. Healthcare providers within the MTF must be current in the completion of the American Heart Association Basic Life Support (BLS) for Health Healthcare Providers

Course and other certifications required by AFI 44-102, AFI 44-119 and MDGI 44-61, Emergency

Cardiovascular Care (ECC) Program. Refer to Appendix C for required certifications. Web based training courses do not meet the standards.

5.3. Indemnification and Medical Liability Insurance. The Contractor will provide and maintain adequate liability insurance coverage consistent with the risks associated with the performance of all services required by this PWS. Refer to Federal Acquisition Regulation (FAR) Clause 52.237-7, "INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE"

Non-Service Summary Items PWS Para No.

COR Responsibilities

1. Appoint a program manager within five (5) days

2.5

Ensure that contractor has provide name within the 5 day period after award.

2. EMS Awareness Training slide presentation

11.2 Ensure contractor has reviewed within 7

business days of contract start date

6. HEALTH REQUIREMENTS

In accordance with AFI 48-105 and AFJI 48-110, all HCWs shall follow the methods for controlling and preventing disease as described in the American Public Health Association publication, Control of

Communicable Diseases (CDC) Manual and the Centers for Disease Control and Prevention publications, Morbidity and Mortality Weekly Report (MMWR) and its supplements. The contractor shall maintain workforce health qualifications as published in the most recent guidelines from these publications throughout the life of the contract and therefore comply with TJC, OSHA, and Center for Disease Control

(CDC) health records requirement. In addition, prior to commencement or assignment to the MTF.

Contracted Health Care Workers will be current on all listed immunizations as listed below prior to assignment to the MTF and shall provide proof of all immunizations from the following diseases:

MEHP Immunization / Screening Requirement

Presumptive evidence of immunity to measles, mumps and rubella includes any of the following

Measles, Mumps, Rubella (German Measles)

NOTE:

1. If a HCW does not have up-to-date blood test evidence with documentation of the complete series of 2 Measles, Mumps, and Rubella vaccinations or a positive titer for all 3 components, the HCW will require a MMR panel vaccination.

2. If the HCW’s titer result is determined as either negative or equivocal the HCW will require two doses of the MMR vaccine.

1. Written documentation of vaccination with 2 doses of live measles, mumps, and rubella or MMR vaccine administered at least 28 days apart OR

2. Laboratory evidence of immunity

(Positive “Convalescent” Measles, Mumps and Rubella immunoglobulin G (IgG) in the blood; equivocal results should be considered negative) OR

3. Laboratory confirmation in the HCWs record that the HCW had measles, mumps and rubella disease (Positive “Acute”

Measles, Mumps, and Rubella immunoglobulin M (IgM) in the blood OR

4. Birth before 1957 (The majority of persons born before 1957 are likely to have been infected naturally and may be presumed immune)

Tuberculosis (TB) Screening

NOTE: HCWs with a baseline positive or newly positive test result for M. tuberculosis infection (i.e., TST or BAMT) or documentation of treatment for LTBI or TB disease should receive one chest radiograph result to exclude TB disease (or an interpretable copy within a reasonable time frame, such as 6 months).

1. Two-step tuberculin skin test (TST) for M.

tuberculosis (BAMT)) that was performed within the previous 12 months OR

2. An approved blood assays for M.

tuberculosis (BAMT)) that was performed within the previous 12 months

Varicella (Chicken Pox)

All HCWs require proof of varicella immunity. Evidence of immunity includes

1. Written documentation of vaccination with 2 doses of varicella vaccine OR

2. Laboratory evidence of immunity or laboratory confirmation of disease OR

3. Diagnosis or verification of a history of varicella disease by a health-care provider

OR

4. Diagnosis or verification of a history of

Herpes Zoster by a health-care provider

Tetanus, Diptheria and Pertussis (Tdap).

All HCWs, regardless of age, will receive a one-time dose of the Combined Tetanus, Diphtheria and Pertussis (Tdap) vaccine if not previously vaccinated. HCWs will receive Td boosters every 10 years thereafter.

Influenza

Immunization against seasonal influenza each year is required unless there is a documented medical contraindication.

Hepatitis B Virus (HBV) Vaccine and Immunity

NOTE: All high-risk(1) and exposure-prone(2) HCWs who do not have a protective concentration of anti-HBs (>10 mIU/mL) after completion of the second vaccination series

(i.e., after receiving a total of 6 doses) will be tested for

Hepatitis B surface antigen (HBsAg) and Hepatitis B core antibody (anti-HBc) to determine infection status.

Completion of three doses of hepatitis B vaccine and serologic testing for Hepatitis B surface antibody (anti-HBs) within 30-60 days after completion of the three dose vaccination series is required for all HCWs with direct patient care duties.

(1) High-risk personnel: Personnel who have direct contact with patients or blood/body fluids, and are at ongoing risk for injuries with sharp instruments/needle sticks.

(2) Exposure-prone personnel: Medical and dental providers, nurses, and technicians who perform invasive procedures with sharp instruments in a poorly visualized or highly confined anatomic site, as defined by the most current CDC guidelines. All exposure-prone personnel are also high-risk.

6.1. Preventative, Prophylactic, and Follow-Up Procedures. The HCW shall ensure that he/she is in compliance with preventive, prophylactic and follow-up procedures, as well as infection control and employee health program procedures, as established by the MTF.

7. MTF REQUIREMENTS:

7.1. Dress and Appearance: Contract Personnel will maintain good personal hygiene and well groomed, professional appearance. Business casual dress attire is appropriate for the majority of the positions. If a specific position requires the wearing of a uniform (i.e., scrubs, etc.), it will be detailed in the individual position description. Unless otherwise identified, required uniforms will be provided by the contractor.

7.2. Physical Capability: All HCWs shall be physically capable of performing for extended periods of time as established in the PWS. The nature of this work will, at times, demand the contracted HCW be capable of responding to urgent/emergent medical issues.

7.3. Conduct: The CO may request the removal of a HCW when his or her conduct interferes with proper order or professionalism at David Grant Medical Center. .

7.4. English Language Requirement: All HCWs on this contract shall read and speak English fluently.

8. CRIMINAL HISTORY BACKGROUND CHECKS

8.1. The MTF will conduct criminal history background checks (CHBC) on all HCWs involved in the delivery of healthcare to children, under the age of 18 on a frequent and regular basis, as stated in the

DoDI 1402.5, The Contractor is responsible for ensuring the HCW completes additional local forms when meeting with the Unit Security Manager. Checks will be process IAW MDGI 44-39, Background

Investigation of Persons Providing Care to Children and AFI 44-119, para 5.4.7

8.1.1. HCWs may be employed under the contract pending completion of the background checks, but will require “close clinical supervision” as outlined in AFI 44-119, paragraph 5.4.7. The MTF Commander will determine if a HCW will be able to work pending a CHBC and make the decision on quality assurance, risk management, licensure, employee orientation, and credentials verification. Close clinical supervision for HCWs who’s CHBCs are pending may include supervised privileges or line of site supervision (i.e., chaperoned by an individual whose background check has been successfully completed) to ensure the protection of patients under the age of 18.

9. TRAINING REQUIREMENTS

9.1 Continued Medical Education (CME). HCWs, licensed, registered or certified by national/medical associations shall continue to meet the minimum standards for CME to remain current as prescribed by their professional licensing agency. CME shall be obtained at no additional cost to the Government; not obtained during hours billable to the Government; and, shall be reported to the Government Supervisor and MTF Credentials Committee when requested. Contractor shall ensure all HCWs performing on this contract complete all required training to maintain licensure and certification. The Government may validate compliance and currency of HCW training periodically. The Government may conduct periodic

CME classes at the MTF and may allow HCWs to attend, at no cost, on a space available basis when authorized by the Functional Requirements Evaluator Designee (FRED). HCWs receiving raining within the MTF, or other location, for the purpose of obtaining CMEs will not account for the time away from the place of performance (i.e., duty section) as billable to the Government.

9.2. HCWs shall be in good standing, and under no clinical restrictions with the state licensure board in any state in which a license is held, or has been held, within the last 10 years.

9.3 HCWs shall be current with, and have completed, all continuing education requirements specific by their professional licensure or certification.

9.4. The contractor shall insure compliance with completion of all MTF specified orientation and onboarding program(s), initial and annual training requirements, and comply with all MTF policies, procedures, productivity standards and instructions as provided by the MTF.

9.5. All health care workers must complete annual training required in accordance with Health Insurance

Portability and Accountability Act (HIPAA), The Joint Commission (TJC), AF Computer Security Policy and AF Safety Policy.

9.5.1. The contractor shall ensure that all Medical Support Service Personnel receive initial

CHCS/AHLTA, (Composite Health Care System, Armed Forces Health Longitudinal Technology

Application) Privacy Act, Information Assurance and HIPAA training through MHS Learn.

https://mhslearn.csd.disa.mil/ilearn/en/learner/mhs/portal/home.jsp

10. CONTRACTOR IDENTIFICATION

All contractor management staff or contracted employee shall clearly be identified as such at all times, including conversations, mail, email, faxes, and/or other electronic communication whether with government personnel, other contractor personnel, or with public when supporting this contract. Likewise, the contractor shall abide by all applicable laws and regulations when using government equipment and services in performance of this contract. As a minimum, contractor management staff or contracted personnel shall clearly identify themselves as contractors by: wearing badges which clearly and legibly identify the employee as a contractor; using the label “contractor” in email addresses in accordance with

Federal Acquisition Regulation (FAR) 37.114. MTF issued identification badge shall be worn above the waistline during the individual’s duty hours.

11. ENVIRONMENTAL CONTROLS

11.1. Compliance with Laws and Regulations. The contractor shall be knowledgeable of and comply with all applicable Local, State, and Federal requirements regarding environmental protection. In the event environmental laws/regulations change during the term of this contract, the contractor is required to comply as such laws come into effect. If there is an increase or decrease in cost as a result of the change, the contractor shall inform the Contracting Officer pursuant to notice requirements and negotiate a modification to the contract.

11.2. Environmental Management System (EMS). Contractors shall perform work under this contract in a manner that is consistent with Travis AFB EMS and conforms to all applicable environmental laws, regulations and policies. Upon awarding of the contract, t the Contractor to review and post the Travis EMS Environmental Policy Letter in the workplace and review the EMS Awareness

Training slide presentation; both items are located at the Travis AFB Environmental website at http://www.travis.af.mil/envirnment/compliance. Within seven business days of the start date, the

Contractor shall provide the Contracting Officer Representative with a list of names of all employees who viewed the applicable training as well as the date training was completed. The Contractor shall provide information when necessary to demonstrate written conformance with these requirements upon request.

https://mhslearn.csd.disa.mil/ilearn/en/learner/mhs/portal/home.jsp

12. RECORDS, FILES, DOCUMENTS, DATA AND WORK PAPERS

All records, files, documents, data and work papers provided by the Government remain Government property. The FRED will provide guidance to the HCW who shall maintain and dispose of these records, files and documents in accordance with Air Fore Manual 33-363 and IAW applicable HIPAA requirements as stated in the HIPAA clause. HCWs will comply with all Air Force Medical Service

AFMS requirements for safe keeping, handling, release and disposal of any of the above information.

These AFMS requirements shall include, but are not limited to: limiting access to government data, tracking information for origin to disposal, removal of personal identifiers and thoroughly destroying information when work is completed in accordance with Federal Law and DoD Regulations.

Appendix A

Applicable Publications

Publications and forms are available electronically through the internet. For example: http://www.e-publishing.af.mil/ is the Air Force’s e-publishing site and one way to obtain Air Force Instructions. DoD

Directives can be found at http://west.dtic.mil/whs/directives/. Regulations are followed by a “-R” (e.g., DoD 5200.-R) and be located on a website by clicking on “publications” instead of “directives”. 60th

Medical Group Instructions (60 MDGIs) can be located on the MTF website and can be provided to the contractor upon request.

DEPARTMENT OF DEFENSE (DoD) REGULATIONS/MANUALS INSTRUCTIONS/DIRECTIVES

PUB NO. TITLE

DoD 5200.01 Information Security Program and Protection of Sensitive

Compartmented Information

DoD 5200.2-R Personnel Security Program

DoDD 5400.11 Privacy Program

DoDD 5500.7 Standards of Conduct

DoDI 5400.7-R Freedom of Information Act

DoD 6025.5 Personal Services Contracts (PSCs) for Healthcare Providers

DoDI 6025.13 Medical Quality Assurance (MQA) and Clinical Quality

Management in the Military Health System

DoD 6025.18-R Health Information Privacy Regulation Jan 03

DoD 6025.40 Military Health System Data Quality Management Controls

Procedures

DoD 6040.41 Medical Records Retention and Coding at Military treatment

Facilities

DoD 6040-42 Medical Encounter and Coding at Military Treatment Facilities

DoD 6040.42 Custody and Control of Outpatient Medical Records

DoDD 8500.1 Information Assurance

DoD 8580.02-R HIPAA Security Rule

DoDI 1402.5 Criminal History Background Checks on Individuals in Child

Care Services

DoDI 6040.43 Custody and Control of Outpatient Medical Records http://www.e-publishing.af.mil/ http://www.e-publishing.af.mil/ http://west.dtic.mil/whs/directives/

AIR FORCE INSTRUCTIONS/MANUALS

PUB NO. TITLE

AFI 31-401 Information Security Program Management

AFI 31-501 Personal Security Program Management

AFI 33-119 Air Force Messaging

AFI 33-129 Web Management and Internet Use

AFI 33-200 Information Assurance (IA) Management

AFI 33-202V1 Network and Computer Security

AFI 33-322 Records Management Program

AFI 33-332 The Air Force Privacy and Civil Liberties Program

AFI 33-364 Records Disposition – Procedures and Responsibilities

AFI 34-242 Mortuary Affairs Program

AFI 36-1004 The Air Force Civilian Recognition Program

AFI 36-2201 Air Force Training Program

AFI 36-2910 Line of Duty (Misconduct) Determinations

AFI 36-3002 Casualty Services

AFI 40-102 TRAVISAFBSUP_1 Tobacco Use in the USAF

AFI 40-701 Special Needs Identification and Assignment Coordination

AFI 41-102 Air Force Medical Expense and Performance Reporting Systems

(MEPRS) for Fixed Military Medical and Dental treatment

Facilities

AFI 41-104 Professional Board and Nation Certification Examinations

AFI 41-106 Medical Readiness Program Management

AFI 41-210 TRICARE Operations and Patient Administration Functions

AFI 44-102 Medical Care Management

AFI 41-117 Medical Service Officers Education

AFI 44-119 Medical Quality Operations

AFI 46-101 Nursing Services and Operations

AFI 48-105 Surveillance, Prevention, and Control of Diseases and

Conditions of Public Health or Military Significance

AFI 48-110 Immunizations and Chemoprophylaxis for the Prevention of

Infectious Diseases

AFI 48-123 Medical Examinations and Standards

AFI 33-360 Publications and Forms Management

AFMAN 33-152 User Responsibilities and Guidance for Information Systems

AFMAN 33-363 Management of Records

60 MDG/Unit-Specific Operating Instructions/Protocols/Guidelines

MDGI 44-39 Background Investigation of Persons Providing Care to Children

MDGI 44-61 Emergency Cardiovascular Care (ECC) Program

MDGI 31-02 Notification, Dissemination, Protection, Reproduction, Destruction and Removal of Messages and Classified

Information

MDGI 48-10 Hospital Employee Health Program

Publications Code:

AFI--Air Force Instruction

AFMAN--Air Force Manual

AFP--Air Force Pamphlet

AF Form--Air Force Form

DD Form--Department of Defense Form

MDGI – Medical Group Instruction

Appendix B

Standard Abbreviations and Terms

Abbreviation and acronyms

CO: Contracting Officer

COR: Contracting Officer Representative

FRED: Functional Requirements Evaluator Designee

HCW: Health Care Worker.

MTF: Medical Treatment Facility

PWS: Performance Work Statement

QQ: Quality Control

SS: Services Summary

Terms

Commander (CC) - MTF Commander, Flight Commander or other activity head, or a designated representative, e.g., Contracting Officer’s Representative (COR) or Department Head, of the activity designated in contract.

Contracting Officer (CO) - The CO is the only appointed government official with the contract authority. The COR initiates requests for the contractor’s corrective actions, and evaluates the actions for effectiveness. The CO is responsible for monitoring contract compliance and resolving disagreements regarding interpretation of contract terms and conditions. The two primary functions of the CO with regard to surveillance are to authorize changes to the contract and to approve payment. Payment is authorized based on documented objective evidence provided by the COR that contractor performance meets the performance standards specified.

Contracting Officer’s Representative (COR) - The COR provides functional surveillance for contract performance. The COR monitors and evaluates compliance with contract requirements, documents performance, and reports surveillance results to the FC and CO. The COR must be objective, fair, and consistent in evaluating the contractor’s performance. CORs shall be trained, nominated and appointed in accordance with AFFARS MP5301.602-2(d).

Contractor - The Company identified in block 15A of Standard Form 33. The Contractor is an independent contractor and is responsible for its own liability. Contractor refers to the prime Contractor.

The prime Contractor retains responsibility for any teaming partner or subcontractor and shall be accountable for their performance.

Credentialing - The process of obtaining, verifying, and assessing the qualifications of HCWs to provide quality, safe patient care.

Functional Requirements Evaluator Designee (FRED) - Individual/s who are appointed to provide technical surveillance over contracted healthcare workers and who will provide feedback on a regular basis to the COR.

Health Care Worker (HCW) - An individual employed by the Contractor to provide healthcare services in the MTF. HCWs are either credentialed or non-credentialed.

Medical 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) - The standard of work that describes the core requirements in clear, specific, and objective terms with measureable outcomes.

Qualify - Qualifying is the process by which the contractor screens potential applicants to ensure workers possess the qualifications required by this performance work statement and meet any additional qualification requirements specified in Appendix C.

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

Recruit - Recruiting is the process by which medical administrative support workers from outside of the Government are located, contacted and hired for specific positions.

Retain - The continuity of high quality workers is a vitally important component in maintaining quality of care to Air Force beneficiaries. The Contractor shall design and manage a retention program that ensures low turnover and customer satisfaction with performance of medical administrative support workers.

Services Summary (SS) - Prescribes how the Government plans to (1) assess contractor performance and, (2) manage the contract to obtain efficiencies, improved performance, and cost savings throughout its life cycle.

Substitution Personnel - Temporary employees providing backfill for a permanent contract staff member. The coverage will be for scheduled or unscheduled absences.

Appendix C

Estimated Workload

1. Sufficient Perfusionists must be credentialed and available to provide services 24 hours per day, seven days per week and 365 days per year as required to include Federal Holidays, Down Days and weekends.

2. Perfusionists may work up to 10 - 15 days of call from home a month and must be able to be on site within 30 minutes.

3. Schedule can be up to 5/10 hour days per week.

4. Estimated surgeries per year 30-40. Maximum 50-60 surgery cases per year.

Appendix D

List of Government Furnished Property

The government will provide the following equipment, supplies and services listed below:

1. Personal Protective Equipment (PPE) including scrubs. The Government will be responsible for any repair, cleaning and inventory required for the PPE. The service provider is responsible for determining whether the government supplied PPE is adequate for their employees. The service provider is also responsible to provide all required occupational health physicals, PPE training and fit-testing associated with that PPE. The service provider will respond to any concerns raised by employee regarding compatibility with government supplied PPE and if needed, provide an alternate source of PPE. The government does not provide uniforms, laboratory coats, or other personal clothing.

2. Personnel identification badge for the Health Care Worker (HCW) to be used in accordance with MTF and base security policy.

3. Equipment/Office Furniture: The contracted staff shall have joint use with government personnel of all available equipment for performing services required by this contract.

4. Supplies: Medical and non-medical supplies commonly used in the facility for the care and management of patients or services. Commonly used supplies are those routinely stocked by the MTF.

5. Computer Equipment: Computer equipment required to schedule, check in, document, order ancillary services, and maintain appropriate electronic medical information that support the hard copy medical record.

6. Administrative support available limited copy machines, computers, fax machines, and medical library.

The same restrictions to use these items for Government official business apply.

7. Utilities: For the purpose of this contract, the government will furnish all required utilities such as water, telephone, electricity, etc.). Long distance and Defense Switched Network (DSN) telephone services will be provided for official use only.

8. Housekeeping: 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 instruments, surgical equipment, patient physiological monitoring equipment, equipment used in the diagnosis, care or treatment of patients.

9. Security Forces and Fire Protection: Phone numbers: Non-Emergency Fire Department: 424-3683;

Non-Emergency Security Police: 424-3293. Emergencies (call) 911.

10. Dining Facilities: Contractor personnel are authorized to use the hospital dining facilities.

11. Emergency Healthcare. The MTF will provide emergency health care to save loss of life or limb and preserve undue suffering for contract personnel for injuries or illness occurring while on duty in the MTF.

These services will be billed to the contractor at the current full reimbursement rate.