Atch_1-_PWS_Admin_5_-_4May16.pdf

Attachment 1 - PWS

PERFORMANCE WORK STATEMENT FOR

MEDICAL ADMIN “5” CONTRACT

(NON-PERSONAL SERVICE)

SECTION TITLE

1. DESCRIPTION OF SERVICES

2. SERVICES SUMMARY

3. GOVERNMENT FACILITIES, EQUIPMENT, AND SERVICES

4. GENERAL INFORMATION

5. APPENDICES

Appendix A. Publications

Appendix B. Workload Data

Appendix C. HIPAA Privacy and Security Business Associate Agreement

Fairchild AFB, WA

4 May 2016

1. DESCRIPTION OF SERVICES The Contractor shall provide medical administrative services at the 92d Medical Group, Fairchild AFB, WA, also referred to as the "Medical Treatment Facility" (MTF) in accordance with all federal, state, local laws and regulations, commercial professional standards of the Accreditation Association for Ambulatory Healthcare (AAAHC) and this Performance Work Statement (PWS).

1.1. SCOPE OF WORK The Contractor shall provide five full-time medical admin personnel, and backfill employee(s) for scheduled absences, to perform services in accordance with this PWS. Contract personnel shall comply with all MTF infection control and safety procedures, practices, and standards.

1.1.1. Medical Administration personnel shall provide administrative support for screening patients, scheduling appointments, medical records maintenance, documenting insurance information and providing overall support to Family Health, Physical Therapy, Records and Appointment Desks. See Appendix B outlining specific position requirements.

1.2. PERSONNEL

1.2.1. POINT OF CONTACT The Contractor shall provide a point of contact and alternate that shall have full authority to act on all matters relating to the daily operation of this contract.

The Contractor shall designate these individuals, in writing, to the Contracting Officer prior to the contract performance start date.

1.2.2. REPLACEMENT STAFF The Contractor shall have adequate replacement personnel available to meet contract replacement requirements, ensuring a lapse in coverage does not occur. All replacement personnel shall meet or exceed position qualifications.

1.2.3. WORK ROSTER The Contractor shall provide a monthly work roster listing the name, dates and scheduled work hours for all contract employees. This list shall be provided to the assigned Contracting Officer’s Representative (COR) by the 15th of each month proceeding the month of service.

1.2.3.1. OVERTIME All overtime hours must be pre-approved. Overtime is not anticipated, but has been included as a separate item on the Pricing Schedule in the event that an overtime situation occurs.

1.2.3.2. PACING DAYS The Wing Commander has the authority to grant military personnel, ten minimum-staffing days per year at his or her discretion. Contractor personnel will either be given the choice of working those days, depending on the workload or to take the day off. Time off shall be coordinated with both the contractor and immediate supervisors at the MTF.

1.2.3.3. SCHEDULED ABSENCES All scheduled absences shall be coordinated no later than six (6) weeks in advance with the assigned COR for each position. Upon receiving notification of scheduled absences, the COR will notify the Contractor at least 5 weeks in advance whether replacement staff will be required during that absence. When replacement staff are required, the Contractor shall provide replacement information in accordance with paragraph 1.2.3 and notify the MTF COR no later than (4) weeks in advance.

1.2.3.4. UNSCHEDULED ABSENCES Unscheduled absences are those absences not coordinated at least four weeks in advance. Contract personnel shall not exceed the threshold established for unscheduled absences outlined in the Services Summary in Section 2 of this PWS. These do not include unscheduled absences as a result of extenuating circumstances approved by the COR. If an unscheduled absence exceeds two (2) consecutive days, the Contractor shall provide replacement staff on the third working day if required by the specific position.

1.2.4. CONTINUITY OF SERVICES If routine services are disrupted for more than three (3) consecutive scheduled shifts, the Government reserves the right to procure such services from another source until administrative services are restored by the Contractor, or adequate consideration for acceptance of nonconforming services shall be negotiated in accordance with the inspection and acceptance clause in this contract.

1.3. EDUCATION AND TRAINING REQUIREMENTS

1.3.1. QUALIFICATIONS The personnel performing this duty shall be knowledgeable in general medical ethics, health records administration, telephone etiquette, office management methods, have professional communication and customer service skills, strong organizational background and understand the importance of deadlines.

1.3.1.2. High School diploma or General Educational Development (GED) equivalency.

1.3.1.2.1. Completed training in Windows and have a working knowledge of Excel or able to build and maintain spreadsheets.

1.3.1.2.2. Completed and maintain currency in Basic Life Support Training as required by the

MTF.

1.3.1.2.3. Have at least one year experience in medical office scheduling, obtained in an office setting, or specialized Registered Health Information Technician (RHIT) experience and have a Registered Health Information Administrator certification.

1.3.2. ORIENTATION AND TRAINING The Government will provide mandatory orientation and initial training to contract personnel prior to their providing services. The Government will notify the contractor of the suspense for any ongoing training requirements required of contract personnel. Orientation takes approximately four hours to complete and consists of a walk-thru of the MTF, fire and safety training, infection control policies, criminal background checks, and providing proof of immunizations. Orientation dates may be scheduled directly between the COR and the individual contract personnel.

1.3.3. Contract personnel shall have knowledge and adhere to medical privacy and confidentiality including the Health Information Protection Privacy Act (HIPPA), and accreditation standards of Accreditation Association for Ambulatory Health Care; and Clinical Practice Guidelines and procedures.

1.4. ENGLISH LANGUAGE REQUIREMENT Contract personnel shall read, understand, speak, and write English well enough to effectively communicate with patients and MTF staff, both in person and via telephone.

2. SERVICES SUMMARY The Services Summary summarizes the performance objectives that relate directly to standards of performance required to meet mission needs. The performance threshold briefly describes the minimum acceptable overall levels of service required for each level of service. These thresholds are critical to mission success.

PERFORMANCE OBJECTIVE

PWS

PARAGRAPH

PERFORMANCE

THRESHOLD

Compliance with Scheduling requirements 1.2.3 1 complaint per FTE per month

Compliance with Duty Hours 1.2.3 1 complaint per FTE per month

Compliance with Annual Healthcare Training Requirements 4.7, Appendices 0 complaints

Appearance 4.8 1 complaint per FTE per month

Compliance with Documentation 4.2 1 complaint per FTE per month

Compliance with HIPAA Appendix C 0 complaints

Compliance with replacement Staffing 1.2.2 & 1.2.4 Not to exceed three in a year

3. GOVERNMENT FACILITIES AND SERVICES The Government will provide the equipment, supplies, and services listed below.

3.1. FACILITIES All contract personnel shall have joint use of the facilities and equipment in performance of this contract.

3.2. OFFICE/WORK/LOCKER AREA Those areas (office, exam room, etc.,) provided for the use by contract personnel shall present a clean and orderly appearance. Personnel shall ensure any decorative items present a professional, modest appearance in keeping with accepted community standards as office space will be shared with other members of the MTF. The government will not be responsible for loss or damage of personal items brought into the MTF.

3.3. PERSONAL PROTECTIVE EQUIPMENT (PPE) The Government will provide all appropriate PPE, i.e Cough masks, N95 masks, and gloves if necessary during flu season. The Government will be responsible for any repair, cleaning and inventory required for the PPE.

3.4. SUPPLIES The MTF will provide both medical and non-medical supplies (office supplies, forms) commonly used in the facility for the care and management of patients. Those supplies will remain the property of the Government and be used exclusively for services rendered in the

MTF.

3.5. ADMINISTRATIVE SUPPORT Contract personnel are authorized to use all administrative support services and equipment available to Government employees, to be used only in the performance of their respective duties. This includes the use of copy machines, fax machines, telephones, to include Defense Switching Network (DSN) lines and long distance if required for work related purposes. The same restrictions to limit use of these items for Official Government business apply.

4. GENERAL INFORMATION

4.1. RECORDS The contractor shall maintain records in accordance with AFI 33-322, Records Management Program, dated 4 Jun 12, paragraphs 10 through 10.5. The contractor shall coordinate record keeping actions with the local Records Custodian and Base Records Manager.

The contractor shall manage all records created for Government use in accordance with records management procedures outlined in AFI 33-364, Records Disposition-Procedures and Responsibilities, dated 22 Dec 06. All records containing Privacy Act material when collecting, safeguarding, maintaining, using, accessing, amending, and disseminating personal information in a system of records, shall be protected as such in accordance with AFI 33-332, Privacy Act Program, dated 12 Jan 15.

4.2. DOCUMENTATION All contract personnel shall prepare documentation to meet or exceed established standards of the MTF. Only MTF and Air Force approved abbreviations may be used in documentation of care in the health care record. Contract personnel shall ensure complete patient identifying information is on all documentation that is to become part of a health care record. All documentation shall comply with the Health Insurance Portability and Accountability Act (HIPAA) and all required protected health information policies as required in this PWS. (See Appendix C of the Performance of Work Statement for HIPAA in full text).

4.3. COMMUNICATION The Contractor shall ensure all personnel maintain open, professional communication with members of the MTF. Complaints validated by the COR and Chief of the Medical Staff shall be reported in writing to the contracting officer and the Contractor for action. Failure of the Contractor to correct validated complaints will be considered a failure to perform therefore allowing the government to impose its rights under the inspection and acceptance clause.

4.4. PREVENTATIVE, PROPHYLACTIC, AND FOLLOW-UP PROCEDURES The Contractor shall ensure all personnel are in compliance with preventive, prophylactic and follow-up procedures, as well as infection control and employee health program procedures, as established by the MTF.

4.5. PREGNANT EMPLOYEES Contract personnel shall report pregnancy to the Contractor and the COR. The MTF Employee Health Office will provide information concerning any work hazards in that area. The Contractor is to notify their pregnant employees of any work hazards.

It will be the employee and Contractor’s joint decision whether the individual will continue working in the environment.

4.6. ANNUAL TRAINING REQUIREMENTS All contract employees shall complete annual training as required to comply with HIPAA, AAAHC, AF Computer Security Policy, and AF Safety.

4.7. APPEARANCE Contracted Staff shall present a neat appearance and be easily recognized as a contract employee. Clothing shall be appropriate for patient care. Admin personnel shall wear 92 MDG issued identification at all times when on duty and have it readily visible.

4.8. ACCESS TO BASE NETWORK Contract personnel requiring access to the Air Force network shall have completed a National Agency Check (NAC) verified through the Joint Personnel Adjudication System (JPAS). This is accomplished by completing the Electronic Personnel Security Questionnaire (EPSQ) or if applicable, completing a SF 85P, Questionnaire for Public Trust Positions. Personnel shall submit all required forms through the base’s Security Forces Squadron for submission to the Office of Personnel Management (OPM) in accordance with AFI 31-501, paragraph 3.24. Upon receipt of proof that contract personnel forms have been submitted to OPM, the commander responsible for the contract can grant interim Local Area Network (LAN) and e-mail access in accordance with AFI 31-501, paragraph 3.27. All personnel requiring access shall comply with the following requirements of AFI 33-200, AF Cybersecurity Program Management, chapter 4, AFMAN 33-152, User Responsibilities and Guidance for Information Systems, and AFI 33-332, AF Privacy and Civil Liberties Program. All contract personnel shall complete initial Information Assurance (IA) training and perform all refresher training as required.

4.9. PRIVACY AND CONFIDENTIALITY

4.9.1. PATIENT LISTS All patient lists shall be treated as privileged information. Lists and/or names of patients shall not be disclosed to or revealed in any way for any use outside the MTF without prior written permission by the Medical Chief of Staff (SGH).

4.9.2. PATIENT SENSITIVITY Contract personnel shall respect and maintain the basic rights of patients, demonstrating concern for personal dignity and human relationships.

4.10. HOURS OF OPERATION

4.10.1. Normal hours of operation are 7:30 a.m. to 4:30 p.m., Monday through Friday, excluding federal holidays. The following federal holidays are observed:

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

4.11. CONTINUATION OF MISSION ESSENTIAL FUNCTIONS IAW DoDI 1100.22 Policy and Procedures for Determining Workforce Mix (12 Apr 10) and any applicable Air Force implementation, unless otherwise directed by an authorized Government representative, it is determined that the services under this Performance Work Statement (PWS) are not considered mission essential during a crisis.

4.12 NON-PERSONAL SERVICES AND/OR INHERENTLY GOVERNMENTAL

SERVICES The Government will neither supervise contractor employees nor control the method by which the contractor performs the required tasks. It shall be the responsibility of the contractor to manage its employees and to guard against any actions that are of the nature of personal services, or give the perception of personal services. If the contractor feels that any actions constitute, or are perceived to constitute personal services, it shall be the contractor’s responsibility to notify the CO immediately. These services shall not be used to perform work of a policy/decision making or management nature, (e.g., inherently governmental functions). All decisions relative to programs supported by the contractor shall be the sole responsibility of the Government.

4.13 CONTRACTOR MANPOWER REPORTING (CMR). DoD mandates that the contractor shall report all contractor labor hours required for performance of PEBLO services provided under this contract, via a secure data collection site (http://www.ecmra.mil). The contractor is required to complete all required data fields. Reporting inputs shall be for all labor executed during the period of performance for each 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 31October of each calendar year. Contractors may direct questions to the CMRA website under help desk.

4.13.1 MR User Manuals. Data for Air Force service requirements shall be input at the Air Force CMRA link. User manuals are available at the CMRA link at http://www.ecmra.mil.

5. APPENDICES

Appendix A – Publications Appendix B – Workload Data Appendix C – HIPAA

APPENDIX A

Publications

Publications applicable to this PWS are listed below and are required to be followed by the contractor. These publications are available in the MTF and maintained by the Government.

These publications can be accessed at http://www.e-publishing.af.mil/pubfiles. Supplements or amendments to these directives may be issued during the life of the contract.

PUBLICATION DATE

AFI 33-200, Information Assurance Management 15 Oct 10 AFI 31-401, Information Security Program Mgmt, paragraphs 3.27 1 Nov 05 AFI 33-115V2, Licensing Network Users Certifying Network Professionals, paragraph 5, 5.3, IC 2004-1

14 Apr 04

Health Insurance Portability and Accountability Act (HIPAA) http://www.tricare.mil/tma/hipaa/default.aspx

Aug 96

APPENDIX B

Workload Data

The following represents a sampling of job requirements for medical administrator positions at the MTF:

- Assists with patient check in/out duties, verifies they are registered Composite Healthcare System / Defense Enrollment Eligibility Reporting System (CHCS/DEERS), makes referrals to other sections as required

- Answers, screens, and routes phone calls to appropriate section for assistance

- Schedules appointments, maintains appointment protocols, and communicates schedule and appointment changes to both providers and patients

- Receives, locates, and stores medical records and ensures appropriate documents are available prior to patient visits

- Prints diagnostic reports, treatment profiles, and copies records as needed

- Participates with Primary Care Optimization (PCO) teams to complete Preventive Health Assessment tasks, routing, evaluation, and consultation of reports

- Assists in routing patient charts for review and completing required forms

- Attaches required supplementary documentation (i.e. lab results) and any other applicable documents to patient file prior to appointment

- Assists team members in dissemination of referral instructions and handouts to beneficiaries

- Ensures third party insurance information is current and filed in patient chart; coordinates affirmative claims

- Trains team members on proper medical records management and provides templates for easy processing

- Coordinates with MTF sensitive duty program monitor as applicable

- Ensures supplies are available for assigned work center

- Assists in the notification and processing paperwork of patient duty absences (quarters/convalescent leave, etc.)

- Coordinates with the Medical Evaluation Board (MEB) clerk on MEB patients

- Coordinates requests for Aero Medical evacuation

- Performs end-of-day CHCS processing

- Validates International Classification of Diseases 9/Current Procedural Terminology (ICD- 9/CPT) coding

- Supports Primary Care Manager (PCM) processing for appointment and appropriate access to care timeframes.

- Maintains accurate and up-to-date patient schedules, logs, records, and files. Updates demographics, extracts information, organizes and researches patient information as required.

- Participates in records review and performs audits as part of the facility’s quality assurance program.

- Performs retirement actions and retires medical records in accordance with Air Force guidelines.

APPENDIX C

HIPAA Privacy and Security Business Associate Agreement

Department of Defense Business Associate Agreement

Introduction

In accordance with DoD 6025.18-R “Department of Defense Health Information Privacy Regulation,” January 24, 2003, the Contractor meets the definition of Business Associate.

Therefore, a Business Associate Agreement is required to comply with both the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security regulations. This clause serves as that agreement whereby the Contractor agrees to abide by all applicable HIPAA Privacy and Security requirements regarding health information as defined in this clause, and in DoD 6025.18-R and DoD 8580.02-R, as amended. Additional requirements will be addressed when implemented.

(a) Definitions. As used in this clause generally refer to the Code of Federal Regulations (CFR) definition unless a more specific provision exists in DoD 6025.18-R or DoD 8580.02-R.

Individual has the same meaning as the term “individual” in 45 CFR

160.103 and shall include a person who qualifies as a personal representative in accordance with 45 CFR 164.502(g).

Privacy Rule means the Standards for Privacy of Individually Identifiable Health Information at 45 CFR part 160 and part 164, subparts A and E.

Protected Health Information has the same meaning as the term “protected health information” in 45 CFR 160.103, limited to the information created or received by the Contractor from or on behalf of the Government pursuant to the Contract.

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

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

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

Security Rule means the Health Insurance Reform: Security Standards at

45 CFR part 160, 162 and part 164, subpart C.

Terms used, but not otherwise defined, in this Clause shall have the same meaning as those terms in 45 CFR 160.103, 164.501 and 164.304.

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

(c) The Contractor shall use appropriate safeguards to prevent use or disclosure of the Protected Health Information other than as provided for by this Contract.

(d) The Contractor agrees to use administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic protected health information that it creates, receives, maintains, or transmits in the execution of this Contract.

(e) The Contractor agrees to mitigate, to the extent practicable, any harmful effect that is known to the Contractor of a use or disclosure of Protected Health Information by the Contractor in violation of the requirements of this Clause.

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

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

(h) The Contractor shall ensure that any agent, including a subcontractor, to whom it provides Protected Health Information received from, or created or received by the Contractor, on behalf of the Government, agrees to the same restrictions and conditions that apply through this Contract to the Contractor with respect to such information.

(i) The Contractor shall ensure that any agent, including a subcontractor, to whom it provides electronic Protected Health Information, agrees to implement reasonable and appropriate safeguards to protect it.

(j) The Contractor shall provide access, at the request of the Government, and in the time and manner reasonably designated by the Government to Protected Health Information in a Designated Record Set, to the Government or, as directed by the Government, to an Individual in order to meet the requirements under 45 CFR 164.524.

(k) The Contractor shall make any amendment(s) to Protected Health Information in a Designated Record Set that the Government directs or agrees to pursuant to 45 CFR 164.526 at the request of the Government, and in the time and manner reasonably designated by the Government.

(l) The Contractor shall make internal practices, books, and records relating to the use and disclosure of Protected Health Information received from, or created or received by the Contractor, on behalf of the Government, available to the Government, or at the request of the Government to the Secretary, in a time and manner reasonably designated by the Government or the Secretary, for purposes of the Secretary determining the Government’s compliance with the Privacy Rule.

(m) The Contractor shall document such disclosures of Protected Health Information and information related to such disclosures as would be required for the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

(n) The Contractor shall provide to the Government or an Individual, in time and manner reasonably designated by the Government, information collected in accordance with this Clause of the Contract, to permit the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

General Use and Disclosure Provisions

Except as otherwise limited in this Clause, the Contractor may use or disclose Protected Health Information on behalf of, or to provide services to, the Government for treatment, payment, or healthcare operations purposes, in accordance with the specific use and disclosure provisions below, if such use or disclosure of Protected Health Information would not violate the HIPAA Privacy Rule, the HIPAA Security Rule, DoD 6025.18-R or DoD 8580.02-R if done by the Government.

Specific Use and Disclosure Provisions

(a) Except as otherwise limited in this Clause, the Contractor may use Protected Health Information for the proper management and administration of the Contractor or to carry out the legal responsibilities of the Contractor.

(b) Except as otherwise limited in this Clause, the Contractor may disclose Protected Health Information for the proper management and administration of the Contractor, provided that disclosures are required by law, or the Contractor obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and used or further disclosed only as required by law or for the purpose for which it was disclosed to the person, and the person notifies the Contractor of any instances of which it is aware in which the confidentiality of the information has been breached.

(c) Except as otherwise limited in this Clause, the Contractor may use Protected Health Information to provide Data Aggregation services to the Government as permitted by 45 CFR 164.504(e)(2)(i)(B).

(d) Contractor may use Protected Health Information to report violations of law to appropriate Federal and State authorities, consistent with 45 CFR 164.502(j)(1).

Obligations of the Government

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

(a) The Government shall provide the Contractor with the notice of privacy practices that the Government produces in accordance with 45 CFR 164.520.

(b) The Government shall provide the Contractor with any changes in, or revocation of, permission by Individual to use or disclose Protected Health Information, if such changes affect the Contractor’s permitted or required uses and disclosures.

(c) The Government shall notify the Contractor of any restriction to the use or disclosure of Protected Health Information that the Government has agreed to in accordance with 45 CFR 164.522.

Permissible Requests by the Government

The Government shall not request the Contractor to use or disclose Protected Health Information in any manner that would not be permissible under the HIPAA Privacy Rule, the HIPAA Security Rule, or any applicable Government regulations (including without limitation, DoD 6025.18-R and DoD 8580.02-R) if done by the Government, except for providing Data Aggregation services to the Government and for management and administrative activities of the Contractor as otherwise permitted by this clause.

Termination

(a) Termination. A breach by the Contractor of this clause, may subject the Contractor to termination under any applicable default or termination provision of this Contract.

(b) Effect of Termination.

(1) If this contract has records management requirements, the records subject to the Clause should be handled in accordance with the records management requirements. If this contract does not have records management requirements, the records should be handled in accordance with paragraphs (2) and (3) below

(2) If this contract does not have records management requirements, except as provided in paragraph (3) of this section, upon termination of this Contract, for any reason, the Contractor shall return or destroy all Protected Health Information received from the Government, or created or received by the Contractor on behalf of the Government. This provision shall apply to Protected Health Information that is in the possession of subcontractors or agents of the Contractor. The Contractor shall retain no copies of the Protected Health Information.

(3) If this contract does not have records management provisions and the Contractor determines that returning or destroying the Protected Health Information is infeasible, the Contractor shall provide to the Government notification of the conditions that make return or destruction infeasible. Upon mutual agreement of the Government and the Contractor that return or destruction of Protected Health Information is infeasible, the Contractor shall extend the protections of this Contract to such Protected Health Information and limit further uses and disclosures of such Protected Health Information to those purposes that make the return or destruction infeasible, for so long as the Contractor maintains such Protected Health Information.

Miscellaneous

(a) Regulatory References. A reference in this Clause to a section in DoD 6025.18-R, DoD 8580.02-R, Privacy Rule or Security Rule means the section currently in effect or as amended, and for which compliance is required.

(b) Survival. The respective rights and obligations of Business Associate under the “Effect of Termination” provision of this Clause shall survive the termination of this Contract.

(c) Interpretation. Any ambiguity in this Clause shall be resolved in favor of a meaning that permits the Government to comply with DoD 6025.18-R, DoD 8580.02-R, the HIPAA Privacy Rule or the HIPAA Security Rule.