Misawa_BHOP_PWS_2013_Revision_-_22_Jul_13_-_FINAL.pdf

Performance-based Work Statement (PWS)

FOR

Behavioral Health Optimization Program-Clinical Psychologist for the 35th Medical Group

Personal Service

TH

CONTRACTING SQUADRON

MISAWA AIR BASE, JAPAN

DATE: 22 July 2013

TABLE OF CONTENTS

FOR

BEHAVIORAL HEALTH OPTIMIZATION PROGRAM

- CLINICAL PSYCHOLOGIST/CLINICAL SOCIAL WORKER

Section Description Page

1. DESCRIPTION OF SERVICES/ GENERAL INFORMATION 2

2. SERVICE SUMMARY 16

3. GOVERNMENT FURNISHED PROPERTY AND SERVICES 17

4. APPENDICES/APPLICABLE PUBLICATIONS AND FORMS 19

1. DESCRIPTION OF SERVICES/ GENERAL INFORMATION. This is a personal services contract for a full time Clinical Psychologist to support the Air Force Behavioral Health

Optimization Program (BHOP). The contractor shall provide all management, labor, materials, tools, equipment, transportation, and materials necessary to provide direct patient care activities in primary care clinics and/or mental health clinics in support of Air Force mental health services. The Contractor shall provide care at the 35th Medical Group, Misawa AB Japan in accordance with the requirements contained in this Performance-based Work Statement (PWS), and the Joint Commission (TJC). The services provided by the contractor are considered personal services as described in the Defense Federal Acquisition Regulation Supplement

(DFARS) part 237.104. (See Attachment 1 to this section for complete position description)

1.1 SCOPE OF WORK. The Contractor shall perform the following tasks to meet or exceed established standards to include: timeliness, legibility, accuracy, content, format, patient identifying information, medically consistent, and error free.

1.1.2 Behavioral Health Consultant in the Patient Centered Medical Home (PCMH). The type of work may include, but not limited to, the following:

1.1.3 Participates in and successfully completes Air Force BHC training. Demonstrates core competency skills to an expert trainer within 90 days of starting to see patients in primary care.

The 90-day threshold for demonstration of core competency skills will be extended if the Air

Force is unable to provide training opportunities within 90 days.

1.1.4 Provides brief (typically no more than four appointments) cognitive/behavioral interventions in primary care under the Air Force consultation model (i.e., per the Air Force

Behavioral Health Optimization Program Practice Manual). Services will mimic the pace of primary care (i.e., patients seen for 15- to 30-minute appointments).

1.1.5 Use validated symptom inventories to assess current symptom severity.

1.1.6 Maintain accurate and current notes in the electronic medical records of all patients.

1.1.7 Assess barriers to treatment adherence and help patient problem-solve solutions to barriers.

1.1.8 Provide patients with education regarding their mental health condition and treatment regimen.

1.1.9 Routinely staffs difficult cases with the referring provider, behavioral health consultant and/or psychiatry consultant.

1.1.10 May provide classes and/or groups in format appropriate for primary care (e.g., drop-in stress management class, group medical visit for a chronic condition).

1.1.11 Successfully consults with PCMs on-demand about general issues or specific patients.

1.1.12 Ensures PCMs receive same-day verbal and/or written feedback on patients referred.

1.1.13 Delivers brief presentations/trainings to primary care team members regarding behavioral health issues and BHC services.

1.1.14 Participates in team efforts to develop, implement, evaluate, and revise clinical pathway programs needed in the clinic.

1.1.15 Duties may include supervision of providers who are in training or not fully licensed.

1.1.16 Consults with medical personnel, legal authorities, and military commanders as required.

1.1.17 Participates in military specific training (e.g., use of the Air Force Guide to Managing

Suicidal Behavior, pre-post deployment screening, PTSD, and combat stress, etc).

1.1.18 Attends and participates in meetings during normal duty hours and professional staff conferences and other appropriate professional activities such as, but not limited to the following: quality improvement meetings, professional staff meetings, commander's staff meetings, primary care staff meetings, appropriate meetings of the mental health flight, High

Interest Log case staffing, and others required by applicable regulations, MTF guidance, or as directed by supervisor.

1.1.19 All other qualification requirements as defined in PWS, attachment 1.

1.2 Procedure Guidance. The provider shall perform duties in accordance with the medical facility’s operating instructions, Air Force instruction and policies and higher-level DoD regulations See Paragraph 5.2. and 5.3.). Changes or deviations from established objectives for services shall not be made without prior recommendation to, and approval of, the MTF

Commander or authorized representative.

1.3 DOCUMENTATION. The contractor shall prepare all documentation to meet or exceed

AFI 46-101 Nursing Services and Operations and established standards of the MTF to include timeliness, legibility, accuracy, content and signature. Only MTF, Air Force, and/or TJC approved abbreviations shall be used for documentation of care in the health care record.

1.4 PERSONAL SERVICES. In accordance with the DODI 6025.5 the following information is mandatory.

1.4.1 That the contract is a personal services contract and that the contract is intended to create an employer-employee relationship between the Government and the individual health care worker(s).

1.4.2 That the performance of the individual health care worker(s) under the PSC is subject to day-to-day supervision and control by healthcare facility personnel comparable to that exercised over military and civil service health care worker(s) engaged in comparable work; and

1.4.3 That any personal injury claims alleging negligence by the individual HCPs within the scope of the HCP's performance of the PSC shall be processed by DoD as claims alleging negligence by DoD military or civil service HCPs; and

1.4.4 The PSC does not create an employer-employee relationship between the Government and any corporation, partnership, business association or other party or legal entity with which the individual HCP(s) may be associated.

1.5 QUALITY ASSURANCE. The government will receive and investigate complaints from various customers located on the installation. The contractor shall be responsible for initially validating customer complaints. However, the Contracting Officer (CO) shall make final determination of the validity of customer complaint(s) in cases of disagreement between contractor and customer(s).

1.6 GOVERNMENT REMEDIES. The contracting officer shall follow the requirements of

FAR 52.212-4, Contract Terms and Conditions for Commercial Items (Jun 2013) for contractor’s failure to correct nonconforming services.

1.10.1. Non-conforming services formula. The Government shall utilize the following method for determining monetary adjustments:

(a) The contractor will be paid on an hourly basis.

(b) All unacceptable or missed work will be deducted on a 10 minutes basis, meaning the hourly rate will be deducted in 10 minute increments up to 60 minutes. Contracting Officer will make deduction rate determination for work not performed or deemed unacceptable.

1.7 CONTINUITY OF SERVICES. If routine services are disrupted for more than 30 consecutive days, the Government reserves the right to terminate the contract for cause.

1.7.1 Any worker demonstrating impaired judgment shall not be permitted to work in the MTF.

The Government reserves the right to remove from the facility any contractor who, in the judgment of a licensed physician, is impaired by drugs or alcohol.

1.7.2 Contractors removed for alcohol or drug abuse problems may be allowed to return to work under the terms of this agreement only with prior Government approval. Evidence of continued problems will be cause for the Government to require that the contractor furnish another qualified contractor to perform the required duties.

1.8 HOURS OF OPERATION. The contractor’s normal work week is 40 hours (8 hours per day). Normal duty days and hours are Monday – Friday, 07:00 – 17:00, no weekends and no

Federal Holidays. The following U.S. federal holidays will be put into the schedule, but due to

24-hour operations the holiday time off may not fall on the date the actual holidays occur:

-New Year’s Day 1 st of January

-Martin Luther King’s Birthday 3 rd

Monday of January -President’s Day 3 rd Monday of February

-Memorial Day Last Monday of May -Independence Day 4 th of July

-Labor Day 1 st Monday of September

-Columbus Day 2 nd

Monday of October -Veteran’s Day 11 th of November

-Thanksgiving Day 4 th

Thursday of November -Christmas Day 25 th of December

1.9 WORK SCHEDULE. The Contractor will be compensated only for time actually devoted to delivery of services in this contract unless a base or MTF closure prevents the provider from performing a normal duty day. There may be occasions when mission and workload changes require contractor to adjust the work schedule to meet demand. The provider will not perform overtime or on-call duties under this contract. In the instance where the Government supervisor directs the provider to remain on duty in excess of their scheduled shift due to an unforeseen emergency or to complete patient treatment where lack of continuity of care would otherwise jeopardize patient health, the provider shall remain on duty. This provision is not intended to apply to the time required to complete routine tasks (e.g., completion of paperwork or routine administrative tasks at the end of a shift), which are to be completed as part of the normal shift. The provider’s schedule shall be adjusted for the additional hours such that the number of hours on the contract is not exceeded and no overtime is expended. The contractor shall submit monthly work schedule to the Flight Commander for approval no later than the 25th day of the previous month. If the contractor cannot perform as the approved schedule for emergency, the contractor shall promptly report to the government for resolution. No show or sudden disappearance without coordination may be the basis for termination. May be required to augment behavioral health support during the absence of other clinical pschologist due to illness, leave or deployment.

1.9.1 Absences. Unless otherwise agreed upon, the contractor shall provide the MTF officer/designee with advance notice (30 days) of pending absences. Any replacement staff is required to have proper security clearance prior to starting work.

1.9.2 Down Days/Family Days. Down Days and Family Days will be incorporated into the schedule.

1.9.3 Closures. If the commander determines the base is closed due to snow, hurricane, or acts of God for non-essential personnel, the unit remains open and the contractor is still expected to show for work unless physically unable to make it to the building. If unable to work, the contractor shall annotate their time sheet as such. Such occurrences are not billable to the Government. The contractor shall only invoice for actual hours worked.

1.10 INSTALLATION SECURITY NOTICE TO EMPLOYEES. The Government reserves the right to restrict employment under this contract of any Contractor employee, who is identified as a potential threat to the health, safety, security, general well-being, or operational mission of the installation and its population. The contractor shall inform all assigned workers that they may be subject to search, at the discretion of the installation commander, when entering or leaving the installation.

1.11 SECURITY REQUIREMENTS.

1.11.1 Criminal Background Check. Background checks are required on all healthcare workers involved in the delivery of healthcare to children under the age of 18 on a frequent and regular basis as stated in DODI 1402.5 Enclosure 5. Contractor personnel receiving an unfavorable criminal background check status shall not be allowed to perform under this contract. The contractor is responsible for completing and submitting the government-provided

SF 86 (Security Clearance Application) as part of the credentialing package prior to providing service at the MTF. Contractor shall comply with all security and background check requirements as outlined in DODI 1402.5 and other applicable regulations and guidelines.

1.11.2 National Agency Check with Inquiries and Fingerprint Check (NACI). The completion of a FBI fingerprint check with favorable results and submission of a National

Agency Check with Inquires to the Office of Personnel Management (OPM) or DoD determined equivalent investigation is required for all contractors requiring access to Government computer systems. The government shall perform the security investigations on the contractor employees in accordance with DoD 5200.2-R, Personal Security Program and AFI 33-119, Electronic Mail

Management and Use. The contractor personnel shall submit a request for NACI to the designated government official (the Unit Security Manager) within 5 working days from the contractor’s first duty day. The Unit Security Manager will initiate the E-Qip application. The contractor will complete the E-Qip application within 15 days. Contractor personnel receiving unfavorable NACI or fingerprint results shall not perform the work under this contract.

1.11.3 Base Access. Prior to start of work, the contractor shall submit 5 AF Form 99, Applications for Base Passes to 35th Contracting Squadron, Bldg 656, for employees requiring base access to perform the work. The contractor shall submit 35 FW Form 54, Application for

Vehicle and copies of vehicle inspection certificate, for all the vehicles requiring base access to perform work under this contract. Upon completion of this contract, the contractor shall return all passes to the Visitor Control Section, 35 SFS/SFAP, Bldg 301, and obtain a certification of receipt. Final payment will be withheld until the contractor has accomplished the required clearances.

1.12 PERFORMANCE OF SERVICES DURING CRISIS DECLARED BY THE

NATIONAL COMMAND AUTHORITY OR OVERSEAS COMBATANT

COMMANDER. This service contract is not classified as ―mission-essential‖ during a crisis as declared by the National Command Authority or Overseas Combatant Commander. In the event of such a crisis, the contracting officer or the RMC manager will direct the contractor to discontinue the service due to base closure. Until such a notification, the contractor is required to continue the performance.

1.13 SPECIAL REQUIREMENTS.

1.13.1 HIPAA Compliance.

Introduction

In accordance with DoD 6025.18-R ―Department of Defense Health Information Privacy

Regulation,‖ January 24, 2003, the Contractor meets the definition of Business Associate.

Therefore, a Business Associate Agreement is required to comply with both the Health Insurance

Portability and Accountability Act (HIPAA) Privacy and Security regulations. This clause serves as that agreement whereby the Contractor agrees to abide by all applicable HIPAA Privacy and

Security requirements regarding health information as defined in this clause, and in DoD

6025.18-R and DoD 8580.02-R, as amended. Additional requirements will be addressed when implemented.

(a) Definitions. As used in this clause generally refer to the Code of Federal Regulations

(CFR) definition unless a more specific provision exists in DoD 6025.18-R or DoD 8580.02-R.

Individual has the same meaning as the term ―individual‖ in 45 CFR 160.103 and shall include a person who qualifies as a personal representative in accordance with 45 CFR

164.502(g).

Privacy Rule means the Standards for Privacy of Individually Identifiable Health

Information at 45 CFR part 160 and part 164, subparts A and E.

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

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

Required by Law has the same meaning as the term ―required by law‖ in 45 CFR

164.103.

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

Security Rule means the Health Insurance Reform: Security Standards at 45 CFR part

160, 162 and part 164, subpart C.

Terms used, but not otherwise defined, in this Clause shall have the same meaning as those terms in 45 CFR 160.103, 160.502, 164.103, 164.304, and 164.501.

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

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

Protected Health Information other than as provided for by this Contract.

(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 shall, at their own expense, take action 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. These mitigation actions will include as a minimum those listed in the TMA Breach Notification

Standard Operating Procedure (SOP), which is available at:

http://www.tricare.mil/tmaprivacy/breach.cfm

(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.

1.13.2 Joint Commission (JC). The contractor personnel shall meet all the applicable JCAHO standards during the contract performance. JCAHO standards can be referenced at the following website: http://www.jointcommission.org/Standards/FAQs/

1.13.3 Physical Security. The Contractor shall be responsible for safeguarding all medical information provided for Contractor use. At the close of each work period, information shall be secured.

1.13.4 Base Computer Network Access. Contractor personnel are required to have access to the government LAN. The government and the contractor shall follow the requirements in

AFFARS 5352.242-9001 - Common Access Cards for Contractor Personnel, to obtain CAC(s) for contractor personnel.

1.14 Health Requirements.

1.14.1 Contract personnel providing services under this contract shall receive a pre-employment physical examination prior to commencement of work and annually thereafter. Health care providers shall report to the Government or contractor’s physician to receive a pre-employment examination and immunizations/shots prescribed by the MTF.

1.14.2 Prior to commencement of work, certification shall be provided to the contracting officer’s representative that health care providers have completed medical evaluation required above. This certification shall state the date on which the examination was completed, the doctor’s name that performed the examination, and a statement concerning the physical health of the individual. The certification shall also contain the following statement: ―(name of contract employee) is suffering from no contagious diseases to include, but not limited to Tuberculosis, Hepatitis, and Venereal Disease.‖ http://www.jointcommission.org/Standards/FAQs/

1.14.3 As a condition of this contract, OSHA requires that all contractors who will have occupational exposure to blood or body fluids, or other potentially infectious materials, shall receive Hepatitis B vaccine, sign a voluntary declination, or have documented proof of immunity to Hepatitis B infection. Personnel who sign declinations may change their minds at any time and receive the Hepatitis B vaccine without penalty. Other tests required upon employment include

Tuberculosis Skin Test along with initial and bi-annual HIV blood test. Contractors must show proof of previous vaccination for Rubella, Rubeola, and Varicella or they must consent to allowing a lab test be conducted for confirmation and vaccine receipt if deficient. Reference

Section 3, Government Furnished Property and Services.

1.14.4 It is the contractor’s responsibility to report (to the appropriate MTF staff member) all information necessary to assure hospital records can be maintained correctly, and therefore comply with the JCAHO, OSHA, and CDC health records requirement.

1.15 PROFESSIONAL LIABILITY RESPONSIBILITY/MEDICAL MALPRACTICE.

This contract establishes a personal service relationship between the health care worker and the

Government while the health care worker is performing services under this contract. This personal services relationship is entered into under the authority of section 1091 of Title 10, United States Code. Accordingly, section 1089 of Title 10, United States Code shall apply to personal injury lawsuits filed against the health care worker(s) based on negligent or wrongful acts or omissions incident to performance within the scope of this contract. This personal services relationship is solely between the health care worker and the Government. Therefore, if the prime contractor is not serving as the health care worker with the Government under this contract then responsibility for insurance and liability no longer rest with the Government for the prime contractor.

1.16 OTHER INSURANCE REQUIREMENTS

Before commencing work under a contract, the Contractor shall certify to the Contracting

Officer in writing that the required insurance has been obtained by the prime contractor and their teaming partners/subcontractors for the provider. The following insurance as referenced in FAR

28.306 (b) (1) and 28.307 is the minimum insurance required:

1.16.1 General liability - Bodily injury liability insurance coverage written on the comprehensive form of policy of at least $500,000 per occurrence.

1.16.2 Automobile liability - Automobile liability insurance written on the comprehensive form of policy. The policy shall provide for bodily injury and property damage liability covering the operation of all automobiles used in connection with performing the contract. Policies covering automobiles operated in the United States shall provide coverage of at least $200,000 per person and $500,000 per occurrence for bodily injury and $20,000 per occurrence for property damage.

The amount of liability coverage on other policies shall be commensurate with any legal requirements of the locality and sufficient to meet normal and customary claims.

1.16.3 Workers' compensation and employer's liability - Contractors are required to comply with applicable Federal and State workers' compensation and occupational disease statutes. If occupational diseases are not compensable under those statutes, they shall be covered under the employer's liability section of the insurance policy, except when contract operations are so commingled with a contractor's commercial operations that it would not be practical to require this coverage. Employer's liability coverage of at least $100,000 shall be required, except in

States with exclusive or monopolistic funds that do not permit workers' compensation to be written by private carriers.

1.16.4 Medical Health Insurance Coverage

1.16.4.1 The overseas location in this requirement may have extremely limited medical support;

therefore, it is in the best interest of all parties that the provider have a documented physical based on a thorough review of the candidate's medical history and physical examination, including an individual assessment of his/her specific medical needs. While a candidate may effectively manage a chronic health condition or limitation within the United States, overseas management may be difficult when considering the medical capabilities in a foreign country, the differing health care standards, insurance coverage and availability of care.

1.16.4.2 Routine health care and all dental services for the provider must be obtained/contracted with a local private hospital or the host country’s National Health System. The Government expects that the provider will have adequate health insurance coverage provided by the contractor for overseas medical services.

1.16.4.3 Emergency healthcare services, including all required transportation expenses, if available, may be provided by the Government on a cost reimbursable basis. It is the responsibility of the contractor to ensure the Government is reimbursed for services rendered to the provider, or the local agencies are paid. The provider must have adequate health insurance coverage provided by the contractor to pay for medical evacuation from the host country to receive emergency medical treatment when adequate treatment is not available in the host country.

1.17 CONTRACTOR PERSONNEL.

1.17.1 Conflict of Interest. The contractor personnel shall not be any person who is an employee of the Department of the Air Force, either military or civilian, unless such person seeks and receives approval in accordance with DOD Directive 5500.7-R, Joint Ethics

Regulation. The contractor shall not employ persons for the work of this contract if such employment would create a conflict of interest per AFI 64-106, AIR FORCE INDUSTRIAL

LABOR RELATIONS ACTIVITIES.

1.17.2 Office/Work area Appearance. The areas provided for the contractor use shall present an orderly appearance. The contractor shall ensure those areas are tidy and any decorations present a professional, modest appearance in keeping with accepted community standards and

MTF safety policies.

1.17.3 Professional Environment. The contractor will promote an environment that is in compliance with DOD and Air Force directives prohibiting unlawful discrimination and sexual harassment. This environment will be free from personal, social, or institutional barriers based on race, color, religion, sex, or national origin. The contractor will report any suspected problems to the Chief of Medical Staff or the Medical Operations Squadron's chain of command for review and investigation. The contractor will have access to a copy of AFI 36-2706 (Military Equal

Opportunity and Treatment Program) upon request for review.

1.17.3.1 Maintains Professional Manner and Displays Positive/Collaborative Attitude. The contractor shall actively participate as a member of the Primary Care Element as an integral member. The contractor shall refrain from the use of profanity, sexual or racial jokes, or other behavior that would normally be considered unprofessional in a medical setting. Complaints validated by the flight commander shall be reported in writing to the contract administrator and the contractor for action. Failure of the contractor to correct validated complaints raised by the

Military Treatment Facility (MTF) staff or patients will be considered a failure to perform.

1.17.4 Appearance. While on duty, the contractor shall be neat and clean, well groomed, and dressed appropriately. Clothing shall fit correctly to provide a professional, modest appearance in keeping with the normally accepted community standards of dress for the work being performed.

In all cases, clothing shall be neat and clean. This includes being free from visible dirt and stains.

The contractor must be easily recognizable as a contractor and not a government employee.

1.17.5 Facial Hair. (To include beards, mustaches, and sideburns). Facial hair shall be controlled (restrained) or trimmed. It shall not interfere with safe work practices, look unkempt or unclean.

1.17.6 Protective Clothing. When required and supplied by the MTF, contract personnel shall wear special protective clothing and shoe covers. These items shall remain the property of the

Government and shall not be removed from the MTF. Special protective clothing shall be used, then turned in or destroyed as directed by the MTF officer/designee.

1.17.7 Identification. The contractor personnel shall be recognized as a contractor and shall wear an appropriate name tag or distinctive clothing bearing the name of the company. The name tag shall be provided by the 35th Medical Group and shall contain the company name, employee name, and read ―Contractor‖. In addition, email addresses for contractor personnel will identify them as a ―Contractor‖.

1.18 TRAINING. Training will be completed as required by the MTF during the period of the contract. This training will be provided during the contractor’s normal duty hours. The contractor personnel will complete the following training requirements provided by the 35th

Medical Group:

Newcomers Orientation

Annual Sustainment Training

Information Awareness Training

Suicide Prevention Training

Health Insurance Portability and Accountability Training (HIPAA)

Basic Life Support and Advanced Cardiovascular Life Support (ACLS)

Neonatal Resuscitation Course

Self Aid and Buddy Care Training

1.18.1 Continuing Education Units (CEU) requirements. Contractors registered or certified by national/medical associations shall continue to meet the minimum standards for CEU to remain current. CEU shall be obtained at no additional cost to the Government and shall be reported to the MTF officer/designee annually on the first duty day in January for the previous calendar year. Periodic CEU may be conducted at the MTF and will be available at no cost.

1.19 English Language. The provider shall be proficient in reading, writing, understanding and speaking English at a level necessary to fully perform all required duties and tasks of their job. The COR may request demonstrations of ability to meet personnel language proficiency requirements by any reasonable method.

1.20 MTF PRIVILEGING REQUIREMENT

1.20.1 The provider will be subject to the credentials and privileging requirements of AFI 44- 119, Clinical Performance Improvement as well as adverse actions.

1.20.2 The MTF Chief of the Medical Staff, or his/her representative, will define the scope of practice for the provider.

1.20.3 The provider shall be able to obtain privileges through the applicable MTF Credentials Committee. The Contractor shall provide a complete, current and accurate credentialing package for the provider as required in AFI 44-119, Chapter 4.

1.20.4 The Contractor shall make the proposed provider available for interview (via telephone) by the MTF prior to beginning the MTF privileging process.

1.20.5 The Government shall review the credentials of the provider. The MTF must award privileges before the provider may start work at the MTF. The MTF needs a minimum of 30 days after receipt of a complete package to grant privileges.

1.20.6 Any clinical or administrative adverse actions will be handled and processed IAW AFI 44-119, Chapter 7. In the event of an adverse action, the Contracting Officer (CO) will provide a written statement advising the Contractor of an adverse action. The written statement will detail the basis for the action, provide the Contractor sufficient information in order to make employment/substitution decisions as necessary, and if required, the final outcome of the adverse action process. Per 10 USC 1102, the Government will mark the written notice(s) according to the adverse action. No other information pertaining to the adverse action will be released without MTF permission.

1.20.7 The Government will conduct criminal background checks on the provider during the AIS/security investigation per Paragraph 3.9 above as stated in DoDI 1402.5, Enclosure 5. The Contractor is responsible for ensuring the required security forms per Paragraph 3.9 above.

1.21 PRESCRIPTIONS. Qualification to prescribe pharmaceuticals is not directly sought under this contract. Any individual with prescribing credentials shall become familiar with the hospital formulary and prescribe pharmaceuticals according to the drugs listed in the formulary.

The formulary is provided during the MTF in-processing/orientation processes The Pharmacy

Service will provide instruction to all prescribing providers on substitutions of generic drugs upon in-processing the MTF.

1.20.1 A clinical psychologist position must have obtained the higher education and training than required in the position description to prescribe pharmaceuticals. If the individual placed meets those requirements, Paragraph 1.21 would be applicable.

1.20.2 A social worker position will not prescribe at the MTF.

1.21 REFERRALS AND CONSULTS. The provider shall follow DoD, Air Force and MTF regulations and policies when arranging for a referral or consult.

1.21.1 The provider must possess controlled substances registration certificate from the Drug Enforcement Agency (DEA) IAW the laws of the state in which he/she is licensed. Only the psychiatrist position will require a DEA.

1.22 MISSION ESSENTIAL STATUS. The provider is not designated as a mission essential person.

1.23 CONTRACTOR FURNISHED ITEMS.

1.23.1 Provider Stamps for paper medical care documentation must include Name, Title, Contractor Company Name, MTF. For example, Jane Doe, Clinical Social Worker, Contractor, XYZ Company, 35 MDG, Mental Health Flight.

1.23.2 Special Request Items. Specially requested supplies, furniture or equipment not typically available at the MTF for all providers and required by the provider will be the responsibility of the Contractor. This includes any upgraded or replacement supplies not routinely acquired by the MTF.

1.24 CONTRACTOR OWNED/CONTRACTOR OPERATED EQUIPMENT.

Except for those items or services specifically stated here to be Government furnished, the

Contractor shall furnish everything required to perform this contract in accordance with all of its terms.

1.24.1 Initial Inspection. All contractor owned equipment shall be inspected and approved by the biomedical equipment maintenance section prior to use in the facility. Some examples are items such as coffee makers and radios.

1.24.2 Replacement of Contractor Owned/Contractor Operated Equipment. If, in the judgment of the biomedical equipment maintenance section personnel, a piece of contractor owned and operated equipment is unsafe, based on diagnostic testing and established industry standards, it shall be tagged as unserviceable and removed from use. Replacement of equipment shall be at the contractor’s expense.

2 SERVICE SUMMARY

Performance Objective PWS

Paragraph

Acceptable Quality Level

Provide Clinical Psychologist tasks to meet or exceed the established standards.

1.1- 1.5, 1.7 -

1.9

No more than 2 valid deficiencies or customer complaints per month.

Maintains currency of continuing medical education, certification(s), health requirements, BLS/ACLS and initial/annual training completion records

1.18, Attch 1 para 2.1.6

95% of requirements are renewed before 1 week of expiration. 100% of requirements are renewed before expiration per requesting location per calendar year.

Provides satisfactory customer service (MTF)

1.17 The provider will not receive any more than

two valid customer complaints per year.

Concerns and complaints will be resolved within 30 calendar days from receipt.

Accurate Reports Hours

Worked on Invoice

1.9 Invoice hours submitted by contractor match

MEPRS/DFARS data to within 1 hour per month

Maintains accurate and current notes in the Mental Health records, inpatient medical records and electronic medical records of all patients seen, as appropriate, and produces reports of evaluation and/or treatment, as required.

Attch 1 para

2.1.5.

95% of the notes and records submitted on time and accurate

Maintain a current license to practice psychology in any one of the 50 states, the District of

Columbia, Puerto Rico, or the

U.S. Virgin Islands.

Attch 1 para

1.3

100% Compliant

HIPPA Compliance

1.13.1 100% Compliant

Work Schedule. The contractor provides continuous and reliable work as scheduled; the MTF can operate in full measure.

1.8-1.9 Contractor performs 40 hours (8 hours per day) excluding weekends and Federal

Holidays.

3 GOVERNMENT FURNISHED PROPERTY AND SERVICES.

3.1 Facilities. The government will furnish desk, chair, workspace, computer and computer equipment, necessary software, required network access and connectivity, telephone, fax, reproduction services, office supplies, and parking.

3.2 Computer systems. The government will provide the contractor access to the computer programs required to perform the tasks to include CHCS, Essentris, AHLTA and general desktop settings.

3.3 Utilities. Electricity, water, sewage, and heat shall be furnished by the Government, at no cost to the contractor for their use in the performance of services called for.

3.4 Security Forces and Fire Protection. The Government shall provide these services.

Security Forces’ phone number: 911

Fire Department’s phone number: 911

3.5 Medical Services. The following vaccinations are offered at no cost to the contractor:

Hepatitis B vaccine

Tuberculosis skin test

Lab test to screen for Rubella, Rubeolla, and Varicella and/or vaccination

3.6 Trainings. The Government shall provide training on Government provided forms and equipment, initial and continuing orientation. Training will be provided on the Composite Health

Care System (CHCS), Essentris, AHLTA, DMHRSi, and ICD-9/CPT/ADM coding if required.

3.7 Misawa Air Base Fire Prevention: The contractor shall be responsible for fire prevention in all contracted area, and be free from any potential fire hazards. The contractor shall comply with the following fire prevention guidance. Fire Reporting: 1) The primary emergency reporting number on Misawa Air Base is 911 or 0176-53-1911 from off base. Fire Department operations take place out of bldg 947 and 3003 for main base, and bldg 1940 for the north housing area. 2) On-base telephones if any, in the on-base warehouse(s) shall have ―911‖ stickers. 3) All contractor-employed personnel shall be familiar with fire reporting numbers and procedures, and shall to put the number ―0176-53-1911‖ into his/or her mobile-phone. Vehicles:

1) Access for fire fighting vehicles must be maintained at all working sites. 2) Contractor’s vehicles shall not be parked within 15 feet of any fire hydrant of Fire Department connection. 3)

Contractor’s vehicles shall give the right-of-way to responding fire/emergency vehicles.

Electrical Hazards: 1) All the contractor’s electrical tools and equipment shall be in good

(original) working condition and its maintenance shall be done properly in compliance with manufacturer’s maintenance instructions. 2) All extension cords used shall be equipped with circuit breakers and plugged directly in the outlets (not other extension cords). 3) Building utility panels shall not be blocked by contractor tools/supplies. Storage: 1) Flammable liquids shall not to be stored inside the warehouses, next to the buildings, or near exit ways. 2) Fire protection system shall not be obstructed at any time. Carpet storage shall be neat in a manner which does not present fire/safety hazards and not to block the access to where fire-extinguishers are mounted.‖

3.8 Housekeeping. Housekeeping services will be provided by the MTF.

3.9 Use of the Defense Switched Network (DSN) for official use only supporting the contracted services.

4 APPENDICES/APPLICABLE PUBLICATIONS AND FORMS

4.1 Publications applicable to this requirement include, but are not limited to, those listed below. The Contractor is obligated to follow all applicable publications and references thereto.

Supplements or amendments to listed publications from any organizational level may be issued during the life of the contract. The Contractor shall immediately implement those changes in publications, which result in a decrease or no change in the price and notify the CO in writing of such change. Should a decrease in contract price result; the Contractor shall provide a proposal for reduction in the price to the CO. Prior to implementing any change that will result in an increase; the Contractor shall submit to the CO a price proposal within 30 days of receipt of the change by the Contractor. The CO and the Contractor shall negotiate the change into the contract under the provisions of the contract clause entitled "Changes". Failure of the Contractor to submit a price proposal within 30 days from receipt of the change shall entitle the Government to performance in accordance with such change at no increase in price.

4.2 Publications and forms are available electronically through the internet and are maintained by the Government.

4.3 DoD Directives can be found at http://west.dtic.mil/whs/directives. Regulations are followed by a ―-R‖ (e.g., DoD 6025.18-R) and can be located on the website by clicking on ―Publications‖ instead of ―Directives.‖

DEPARTMENT OF DEFENSE (DoD) REGULATIONS/MANUALS

INSTRUCTIONS/DIRECTIVES

PUB NO. TITLE DATE

DoD 5400.11-R Department of Defense Privacy Program May 07

DoD 6025.18R DoD Health Information Privacy Regulation Jan 03 DoD 8580.02-R DoD Health Information Security Regulation Jul 07 DoDD 1300.22 Mortuary Affairs Policy Feb 00 DoDD 2310.2 Personnel Recovery Dec 00 DoDD 5200.2 Personnel Security Program Apr 99 DoDD 5400.11 DoD Privacy Program Nov 04

DoDD 5500.7 Standards of Conduct Aug 93 DoD 6010.13-M Medical Expense and Performance Reporting System for

Fixed Military Medical and Dental Treatment Facilities Nov 00

DoDD 6040.41 Medical Records Retention and Coding at Military Treatment Facilities

Apr 04

DoDD 8190.3 Smart Card Technology Aug 02 DoDD 8500.1 Information Assurance Oct 02 DoDI 1010.15 Smoke Free DoD Facilities Jan 01

DoDI 2000.16 DoD Antiterrorism (AT) Standards Oct 06 DoDI 1402.5 Criminal History Background Checks on Individuals in

Child Care Services Jan 93

DoDI 3020.37 Continuation of Essential DoD Contractor Services During a Crisis

Nov 90

DoDI 3020.41 Contractor Personnel Authorized to Accompany the U.S.

Armed Forces

Oct 05

DoDI 6000.11 Patient Movement Sep 98 DoDI 6015.23 Delivery of Healthcare at Military Treatment Facilities:

Foreign Service Care; Third Party Collection; Beneficiary Counseling and Assistance Coordinators (BCACs)

Oct 02

DoDI 6025.8 Ambulatory Procedure Visit (APV) Sep 96 DoDI 6040.42 Medical Encounter and Coding at Military Treatment

Facilities Jun 04

D…