Attachment_1-_Performance_Work_Statement.pdf

Attachment 1 Performance Work Statement

Special Needs Coordinator

Performance Work Statement (PWS)

FOR

For 35th Medical Group, Misawa AB, Japan.

Non-Personal Service

35TH CONTRACTING SQUADRON

MISAWA AIR BASE, JAPAN

Date: 4 Dec 17

Coordination and Review

Contracting Officer Date

TABLE OF CONTENTS

Section Description

1. DESCRIPTION OF SERVICES/GENERAL INFORMATION

2. SCOPE OF WORK

3. SPECIFIC DUTIES

4. REQUIRED QUALIFICATIONS

5. SUPERVISION RECEIVED

6. HOURS OF OPERATION

7. WORK SCHEDULE

8. INSTALLATION SECURITY NOTICE TO EMPLOYEES

9. SECURITY REQUIREMENTS

10. PERFORMANCE EVALUATION MEETINGS

11. SPECIAL REQUIREMENTS

12. HEALTH REQUIREMENTS

13. PROFESSIONAL LIABILITY RESPONSIBILITY/MEDICAL MALPRACTICE

14. CONTRACTOR PERSONNEL

15. TRAINING

16. SERVICES SUMMARY

17. GOVERNMENT FURNISHED PROPERTY AND SERVICES

18. APPLICABLE PUBLICATIONS AND FORMS

19. DEPARTMENT OF DEFENSE (DOD) REGULATIONS/MANUALS

INSTRUCTIONS/DIRECTIVES

20. AIR FORCE INSTRUCTIONS

21. OTHER REFERENCES

1. DESCRIPTION OF SERVICES/GENERAL INFORMATION. This is a non-personal service contract. The Government requires one (1) Full Time Equivalent (FTE) Special Needs Coordinator for this contract within the 35th Medical Group (MDG), Misawa Air Base, Japan.

Contractor shall furnish all management and labor necessary to provide services in accordance with the requirements contained in this Performance Work Statement (PWS) and the professional standards, policies and guidelines of the 35 MDG, the Joint Commission (TJC), and all Air Force Instructions (AFIs) and regulations.

2. SCOPE OF WORK. Contractor personnel shall competently perform all tasks ensuring all suspenses are met; documentation produced is legible, timely, accurate, medically consistent, professionally written, and all patient identifying information is protected.

2.1. Must have knowledge and skills to effectively apply Special Needs Coordinator (SNC) functions:

2.1.a. Assessment: Identification of patients that need special medical and education needs/management; comprehensive collection of patient information and medical status;

and continued evaluation of an established plan of care.

2.1.b. Planning: Collaboration with the patient, family/caregiver, primary provider and other members of the health care team for developing an effective plan of care.

2.1.c. Facilitation: Care coordination and communication among all involved parties.

2.1.d. Advocacy: Support for the patient and family/caregivers to ensure identified education and appropriate, timely care coordination is received.

2.2. Must demonstrate mastery of theories, principles, and methodologies underlying psychosocial practice.

2.3. Must have knowledge and understanding of developmental growth; dynamics of human behavior, family, and other social systems; and impact of illness and disability on social functioning.

2.4. Must demonstrate ability in program planning, implementation, and evaluation, and in conducting individual, family, group, and community assessments.

2.5. Must demonstrate ability to work with service members and/or veterans and their families who are experiencing a wide range of complicated mental, emotional, behavioral, physical, psychosocial, and environmental problems.

2.6. Must have knowledge of medical privacy and confidentiality Health Insurance Portability and Accountability Act (HIPAA), and accreditation standards of the Joint Commission (TJC).

2.7. Must demonstrate ability to communicate effectively both orally and written.

2.8. Must be skillful and tactful in communicating skills with people who may be physically or mentally ill, uncooperative, fearful, emotionally distraught, and potentially agitated.

2.9. Must demonstrate ability to apply critical thinking skills and expertise in resolving complicated healthcare, social, interpersonal and financial patient situations.

2.10. Must possess organization, problem-solving and communication skills to articulate medical requirements to patients, families/care givers, medical and non-medical staff in a professional and courteous way.

3. SPECIFIC DUTIES.

3.1. The SNC oversees and manages the installation Exceptional Family Member Program- Medical (EFMP-M) IAW DoDI 1315.19 Exceptional Family Member Program, AFI 40-701, Medical Support to Family Member Relocation and Exceptional Family Member Program, AFI 44-173 Population Health and Medical Management, the 35th FW supplement to EFMP-M program, and subsequently implemented guidance memoranda.

3.1.1. Uses clinical assessment skills and maintains procedures to identify sponsors whose family members have special medical and educational needs in a timely manner. The SNC uses a multi-disciplinary and collaborative approach with other key service providers, such as installation youth and childcare facilities, and officer and enlisted spouses groups, to ensure effective outreach and identification of special needs. Ensures family members of the Air Force (AF) personnel or family of the AF member are appropriately "Q coded" (EFMP-enrolled).

3.1.2. Ensures all active duty sponsors known to the Air Force Personnel Center (AFPC), and local Military Personnel Section (MPS) and/or Commander Support Staff (CSS) where applicable, having family members with special needs are identified in AF medical special needs data management systems. Provides oversight for base-level data entry in AF-provided data management systems used in the management of EFMP-M.

3.1.3. Provides training to installation personnel and medical staff; and consultation as needed to support the implementation of EFMP-M base-wide.

3.1.4. Integrally involved in the Family Member Relocation Clearance (FMRC) process.

Ensures all FMRC requirements are implemented by all EFMP-M staff. Coordinates the enrollment process and travel screening for all active duty family members’ and travel screening upon request to the families of DoD civilian sponsored assignments going to an overseas base.

3.1.5. Provides oversight to ensure every AF sponsor with one or more family members with special needs assigned to the installation has a special needs file maintained at the Military Treatment Facility (MTF). Ensures Q-coded sponsors assigned to the installation are contacted annually to determine if there are unmet needs and to request updates of information as needed.

3.1.6. Collaborates with the Integrated Delivery System (IDS) and other interagency forums that provide family medical information and referrals to base and civilian agencies. Ensures EFMP families are referred to the Airman and Family Readiness Center for additional community assistance as needed. Maintains a cooperative working relationship with the MPS, CSS, and with AFPC. Actively supports the integration of EFMP-M, Exceptional Family Member Program-Family Support (EFMP-FS) and Exceptional Family Member Program-Assignments (EFMP-A) services at the installation. Provides information, appropriate contact information, and coordinates referrals as appropriate.

3.1.7. Accomplishes EFMP quarterly case reviews to discuss/assess newly identified families', complex, or unmet medical needs. Determine the appropriate resources necessary for the families.

3.1.8. Records patient specific assessments and clinical plans of action in Armed Forces Health Longitudinal Assessment (AHLTA) and the Special Needs record. Meeting minutes will not contain patient identifying information.

3.1.9. Coordinates and participates in Medical Management and care coordination meetings as assigned.

3.1.10. Participates in the clinic orientation and training of other staff of the Special Needs Program. Participates in committees, work groups, and task forces at the facility. Participates in Wing Right Start as the EFMP Screener.

3.1.11. Must maintain a level of productivity and quality consistent with: complexity of the assignment; facility policies and guidelines; established principles, ethics and standards of practice of professional social work and nursing, Health Services Inspection (HSI); and other applicable DoD and service specific guidance's and policies. Must comply with the Equal Employment Opportunity (EEO) Program, infection control and safety policies and procedures.

3.1.12. Follows applicable Wing/AF/DoD instructions, policies and guidelines.

3.1.13. Completes medical record documentation and coding and designated tracking logs and data reporting as required by local MTF/AF/DoD instructions, policies and guidance.

3.1.14. Completes all required electronic medical record training, MTF-specific orientation and SNC training programs.

3.1.15 Develop annual EFMP plan for inclusion in Medical Management Strategic Plan in collaboration with stakeholders.

3.2. Documentation. The contractor shall prepare all medical documentation to meet or exceed the standards required by the MTF, applicable Air Force Instructions and the Joint Commission guidelines. Only approved abbreviations shall be used for documentation of care in the health care record. The Department of Defense’s electronic medical record system, AHLTA, shall be used for all patient encounters.

4. REQUIRED QUALIFICATIONS:

4.1. Experience. Minimum of one (1) year full time experience in clinical nursing or social work; or six months of special needs care coordination, discharge planning or case management in a medical setting.

4.2. Education. Nurse applicants must at least possess an associate degree (ADN) or a Bachelor’s degree in nursing (BSN) accredited by a national nursing accrediting agency recognized by the US Department of Education. Social Worker applicants must at least possess an associate (ASW) or Bachelor’s degree in Social Work (BSW) from a school of social work fully accredited by the US Council on Social Work Education (CSWE).

4.3. Licensure. Nurse applicants must possess a valid, unrestricted license to practice as a Registered Nurse (RN) from one of the 50 states, and/or the District of Columbia, the Commonwealth of Puerto Rico, or territories of the United States. All licenses must be unencumbered and remain in effect during contract employment. The contractor must be in good standing, and under no restrictions, with the state in which a license is held or has been held, or the national licensure board, within the last 10 years. Social Worker applicants are not required to possess a license to apply.

4.4. Additional Knowledge. Be capable of performing the full range of medical services commensurate with the degree and/or professional license held. Fluently and proficiently read, write, speak and understand the English language. Possess working knowledge of computer applications and software to include Windows and Microsoft Office programs.

5. SUPERVISION RECEIVED:

5.1. Direct: Health Care Integrator

5.2. Indirect: Chief of the Medical Staff (SGH)

6. HOURS OF OPERATION. EFMP-Medical general duty days and office hours are Monday-Friday, 0730-1630, with an hour for lunch. The following is a list of legal federal holidays when services are not provided:

- New Year's Day 1st of January

- Martin Luther King's Birthday 3rd Monday of January

- President's Day 3rd Monday of February

- Memorial Day Last Monday of May

- Independence Day 4th of July

- Labor Day 1st Monday of September

- Columbus Day 2nd Monday of October

- Veteran's Day 11th of November

- Thanksgiving Day 4th Thursday of November

- Christmas Day 25th of December

NOTE: Any of the above holidays falling on a Saturday will be observed on the preceding Friday; holidays falling on a Sunday will be observed on the following Monday. The Government may add additional family days in conjunction with these holidays which may result in MTF closures.

7. WORK SCHEDULE. The contractor may be required to perform at least 40 hours per week during normal clinic business hours. If the contractor cannot perform in accordance with the schedule approved by the direct or indirect supervisor, the contractor shall promptly report to the Contracting Officer (CO) for resolution. The MTF will coordinate the appointment templates with the Contractor. The contractor may be required to work more than 8 hours in a single day or 40 hours in a week, as determined by the supervisor or designee based on the needs of the MTF. If additional hours are worked, the Government may reduce future scheduled hours to maintain a 40 hour work week average. All hours worked will be recorded accurately on the work schedules. Under no circumstances are the work schedules to reflect hours worked when the contractor was absent or vice versa. 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 CO will direct the contractor to discontinue the service due to base closure.

7.1. Non-Duty Days. The contractor personnel may not be required to perform on government non-duty days or other times when the MTF may be closed such as Pacific Air Forces (PACAF) family days.

7.2. Closures. The contractor employee shall not come in to work if the commander determines the base is closed due to snow, hurricane, or acts of God.

7.3 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 CO or the COR will direct the contractor personnel to discontinue the service due to base closure. Until such a notification, the contractor personnel are required to continue the performance.

7.4. Absences. The contractor shall advise the CO, Contracting Officer’s Representative (COR), and supervisor or designee about absences due to illness or incapacitation. If the contractor is absent for more than five (5) consecutive days due to illness, the Contractor shall provide the Government with a statement that the employee is free from communicable illness before or as the employee returns to work. The government has no interest in tracking the status of individual employees by name when they are absent, only to ensure that they will not pass illnesses onto others. The Government reserves the right to examine and/or re-examine any worker who meets this criterion.

7.4.1. Scheduled and Unscheduled Absences. The contractor personnel are allowed to take up to twenty (20) work days of leave annually. Leave is classified as both annual, vacation or sick leave. Leave shall be taken in one (1) day increments and shall not exceed ten (10) consecutive work days excluding weekends. All leave after taking 20 work days is considered non-paid days and shall be deducted from the contractor’s monthly invoice. In order to ensure that customer’s access to care is not limited due to manning, timing of leave shall be coordinated with supervisor as much as possible at least 15 days in advance. Unscheduled absences shall be called into supervisor by the contract provider within the first two (2) hours of each duty day that he/she is unable to report to work.

7.5. On-Call. There are no on-call requirements for this position.

7.6. Telework. Telework will only be used under certain circumstances, subject to the approval of the SGH and the MDG Commander. Clearance from Information Systems and the Privacy Officer will be required. The supervisor, together with the medical logistics POC, will determine how the hours worked will be monitored and documented. Telework should not exceed 40 hours per week and should not be used to substitute for regular duty hours at the clinic. The contractor will not use personal phones to communicate with patients while doing telework. The contractor will ensure HIPAA is not breached at all times.

7.7. Replacement of contractor personnel. Unless in an emergency, contractor personnel are required to give at least a 30-day official notice of the intention to vacate the job to contractor management staff, CO, CA, COR, and supervisor to ensure all team are aware. The contractor management staff shall replace permanent contractor personnel at the earliest possible date, ensuring vacancies do not exceed thirty (30) calendar days. The consecutive calendar days begin on the departing contract employee’s last duty day at the requesting location. The contractor management staff shall ensure that all temporary or permanent replacement staff are fully qualified, meet all pre-placement requirements and are ready to perform within the required timeframe.

7.7.1. Replacement of contractor personnel (Military dependents contractor). Contractor shall inform the CO, COR and supervisor or designee of their sponsor’s Date Estimated Return from Overseas (DEROS). The contractor will also notify all parties above as soon as possible, of any permanent changes to their sponsor’s assignment that may affect their services.

7.8. Non-paid days. The government will not be required to pay for unscheduled absences (if it is out of their authorized leave) or days where the contractor does not perform services (i.e.

waiting for replacement contractor personnel to arrive). Hourly Rate for Non-paid days will be calculated as follows:

CLIN Amount divided by 2080 = Hourly Rate

8. INSTALLATION SECURITY NOTICE TO EMPLOYEES. The government reserves the right to restrict the contractor 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 know that they may be subject to search, at the discretion of the installation commander, when entering or leaving the installation.

9. SECURITY REQUIREMENTS.

9.1. 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 completing and submitting the government-provided AF 2583 (REQUEST FOR PERSONNEL SECURITY ACTION) as part of the credentialing package prior to providing service at the MTF. Contractor may need to visit MTF to fill in the form in case they are not able to open attachment outside of Government computer. Contractor shall comply with all security and background check requirements as outlined in DODI 1402.5 and other applicable regulations and guidelines.

9.2. National Agency Check (NAC). The government shall perform security investigations on contractor employees in accordance with DoD 5200.2-R, Personal Security Program and AFI 33- 119, Electronic Mail Management and Use. The NAC will not incur additional cost to the contractor. The contractor shall submit a required form; AF 2583 and OF 306for MTF COR in Medical Logistics within three (3) working days of notification of contract award. Contractor personnel receiving unfavorable NAC status shall not be allowed to perform under this contract.

The completion of Security Program, contractor completes their finger prints in FW/IP. Until then, contractor are not allowed to start to work in MTF. To complete Security Program, it shall take roughly two through three weeks after submitting to MTF COR.

9.3. Base Access. Prior to start of work, the contractor shall submit a 5 AF Form 99, “Applications for Base Passes” to the 35th Contracting Squadron, Bldg. 656, for all employees requiring base access to perform the work within three (3) working days of notification of contract award. The contractor shall submit a 35 FW Form 54, “Application for Vehicle” and copies of the vehicle inspection certificate, for all the vehicles requiring base access under this contract. The contractor shall turn in all base passes to the Visitor Control Section, 35 SFS/SFAP, Bldg. 301, and obtain a return receipt after a pass is no longer needed or the contract expires, whichever comes first. Final payment may be withheld until the required clearances have been accomplished.

9.4. Base Computer Network Access. Contractor personnel are required to have access to the government local area network (LAN). Contractor shall obtain Common Access Card (CAC) for contractor personnel.

9.4.1. Obtain CAC procedure. Contractor shall submit a DD1172-2 for MTF COR in Medical Logistics within three (3) working days of notification of contract award. Contractor is not able to start process until their Security Program completes. (See para. 9.2.) Their process to obtain CAC shall take roughly two through three weeks, therefore contractor has responsible to contact to MTF COR within three (3) business days after contract is awarded.

9.5. Physical Security. Contractor personnel shall be responsible for safeguarding any and all medical information provided for contractor use. At the close of each work period, information shall be secured.

9.6. Credentialing and Privileging. The contractor shall comply with all applicable DoD, AFMS and 35 MDG credentialing requirements and be appropriately credentialed by the 35 MDG Credentials Officer prior to beginning patient care at the MTF. AFI 44-119 governs this credentialing process. Verification of credentials does not incur additional cost to the contractor.

Contractor shall visit MTF to start their credential paper work within three (3) business days after contract is awarded.

9.7. Reporting. During performance, report any information or circumstances observed that may pose a threat to the security of DoD personnel, contractor personnel, resources, and defense information to the Security Forces. The Contracting Officer Representative (COR) will brief the contractor upon initial on-base assignment of requirements. The contractor shall comply with the requirements of Volume 1, AFI 71-101, Criminal Investigations, and paragraph 1.1 of Volume 2, Protective Security Matters.

9.8. Anti-Terrorism. Random Antiterrorism Measures (RAMs). RAMS are conducted on Misawa Air Base at varying times during a 24-hour period and may consist of measures such as spot checks of identification credentials, random vehicle searches, and site security sweeps. The contractor is subject to participating and cooperating with RAMS as directed by competent authority. Anticipate increased RAMS during implementation of elevated Force Protection Conditions (FPCONs).

9.8.1. Reporting Suspicious Activity. It is the responsibility of all personnel working and residing on Misawa Air Base to be alert for detecting and reporting suspicious criminal or terrorist activity. The contractor shall immediately report any on-base observed suspicious activity to the 35 SFS/BDOC, Bldg. 646. All contractor-employed personnel shall be familiar with suspicious activity reporting numbers and procedures. The primary number for reporting suspicious activity on Misawa Air Base is 911from a base phone or 0176-53-1911 from a mobile phone or off-base.

10. PERFORMANCE EVALUATION MEETINGS. The contractor may be required to meet periodically with Multi-functional Team Members throughout the life of the contract. Meetings will be scheduled as needed by the Contracting Officer. The Contractor may request meetings at any time. The written minutes of these meetings shall be signed by the contract administrator and emailed out for all attendees to review. Attendees have five (5) days after minutes are emailed to dispute any items therein.

11. SPECIAL REQUIREMENTS.

11.1. HIPAA Business Associate Agreement

Refer the full text attachment entitled Health Insurance Portability and Accountability Act (HIPAA) Business Associate Agreement in accordance with AFI 41-200, HIPAA, 25 July 2017.

12. HEALTH REQUIREMENTS.

12.1. 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. This is at no additional cost to the contractor.

12.2. 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.”

12.3. As a condition of this contract, Occupational Safety and Health Administration (OSHA) requires that all contractors who will have occupational exposure to blood or body fluids, or other potentially infectious materials, shall receive Hepatitis B Vaccination series, sign a voluntary declination, or have documented proof of immunity to Hepatitis B infection by titer screening. 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 (TST) along with initial and bi-annual Human Immunodeficiency Virus (HIV) Test. Contractors must show proof of previous Measles, Mumps, Rubella/Rubeola (MMR), Tetanus/Diphtheria/Pertussis (Tdap), and Varicella vaccinations or consent to proof of immunity by titer screening. In addition, contractors must receive an Influenza vaccination annually.

12.3.1. The following vaccinations are mandatory IAW AFI 44-108, Infection Prevention and control Program. The contractor shall be responsible for assuring that all personnel report to the appropriate government medical office to receive the pre-employment examinations. The government will offer them at no cost to the contractor upon contract award:

- Hep B Vaccination Series (Serological test for those with direct patient care duties are required, may sign declination form if in low risk work environment)

- Tuberculosis Skin Test (TST) or an approved blood assay performed w/in the last 12 months.

For Japanese contractor: Chest X-Ray from a Japanese Occupational Health Doctor will be accepted. If they don’t have it an approved blood assay is required.

- Human Immunodeficiency Virus (HIV) Test, every 2 year (must sign consent form)

- Measles, Mumps, Rubella/Rubeola (MMR) vaccination or proof of immunity (if employee cannot show proof of vaccination, titer must be drawn before administering series)

- Varicella Vaccination or proof of immunity by titer screening (if employee cannot show proof of vaccination, titer must be drawn before administering vaccination)

- Tetanus/Diphtheria/Pertussis (Tdap) (booster every 10 years)

- Influenza, annual IAW DoD policy and annual AF/SG seasonal influenza memorandum

NOTE: Health requirements may change at any time during the contractors employment (IAW CDC and DoD policy). Contractors must comply with any additional health requirements during their employment at the cost of the government.

12.4. 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 TJC, OSHA, and CDC health records requirement.

12.5. Prior to start of work, no medical tests or procedures required by the contract shall be performed by the Government unless the provider is an eligible beneficiary. Expenses for all required tests and/or procedures shall be borne by the Contractor or provider, not the Government. After start of work, in the event of blood borne exposure, the Government will provide follow up and care protocols according to applicable AFIs.

13. PROFESSIONAL LIABILITY RESPONSIBILITY/MEDICAL MALPRACTICE.

This contract establishes a non-personal service relationship between the health care worker and the Government while the health care worker is performing services under this contract. The health care worker is not required to maintain medical malpractice liability insurance. The Government provides program direction and control IAW DoD and AF instructions concerning EFMP-M. Direction and control is the process by which the individual health care worker receives technical guidance, direction, and approval with regards to a task(s) with the requirements of this contract. All other employer/employee responsibilities (payroll, etc.) remain with the contractor.

14. CONTRACTOR PERSONNEL.

14.1. Conflict of Interest. Contractor shall not employ anyone who is an employee of the Department of the Air Force, either military or civilian, unless such person seeks and receives prior 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.

14.2. Personnel Appearance. While on duty, contractor personnel shall present a neat, well groomed, clean image and be dressed in appropriate workplace attire. Clothing shall fit correctly, present a professional, modest appearance and be kept neat and clean, free from visible dirt and stains. Facial hair (including beards, mustaches, and sideburns) shall be controlled (restrained) or trimmed and shall not interfere with safe work practices nor look unkempt or unclean. Contractor personnel shall comply with socially acceptable standards of personal hygiene expected of health care workers.

14.3. 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.

14.4. MTF Identification. The Government will supply MTF ID badges, vehicle passes and keys if applicable. The contractor will surrender all identification to the MTF upon termination.

14.5. Installation Services. The Government shall provide Contractor the following logistics support unless specifically excluded by the terms of the US-Japan SOFA:

14.5.1. SOFA status for Contractor employee and their lawful dependents

14.5.2. Duty-free importation privileges IAW SOFA and USFJ regulations

14.5.3. DD From 1173 (Uniformed Services Identification and Privilege Card)

14.5.4. Full Base Exchange (BX) privileges

14.5.5. Full Commissary Privileges

14.5.6. Full Class VI Store Privileges

14.5.7. Purchase of gasoline and petroleum, Oil, and Lubricant (POL) products at BX facilities

14.5.8. Military postal service privileges

14.5.9. Military banking and credit union privileges

14.5.10. Motor vehicle operator’s permit

14.5.11. Registration of one privately owned vehicle per family

14.5.12. Medical services for emergency care only on a reimbursable basis

14.5.13. Dental services for emergency care only on a reimbursable basis

14.5.14. Mortuary services on a reimbursable basis

14.5.15. DoD Dependent School on a space-available, tuition-paying basis

14.5.16. Continuing education programs on a space-available basis

14.5.17. Morale, welfare, and recreation facilities

14.5.18. Armed Forces recreation center facilities on a space-available basis

14.5.19. Legal assistance on a space-available basis

14.5.20. Billeting on a space-available basis

14.5.21. Housing referral services (limited to translation assistance and explanation of host country rental laws)

14.5.22. Security Clearance and Credentialing verification.

15. TRAINING. The contractor shall comply with all training requirements provided by the Government, the Air Force Medical Service (AFMS) and the 35th MDG including but not limited to: Basic Life Support (BLS), HIPAA Compliance, Sexual Assault Prevention and Response (SAPR), Patient Safety, Newcomers Orientation, Performance Improvement, Risk Management, Infection Control, Fire Protection, Information Security, , and local in-service briefings. The Government will also provide training on the Military Health System (MHS) applications used for electronic health record documentation. The trainings may be scheduled individually throughout the year or scheduled at one time. These training may take approximately 30 hours total during one year and will count toward the 40 hour per week requirement. Any voluntary or mandatory training outside of those provided by the 35 MDG and the Air Force Medical Operations Agency (AFMOA) (such as professional conferences, license recertification and/or continuing education) will be paid for by the contractor and may not be invoiced for hours.

16. SERVICES SUMMARY.

16.1. Quality Assurance. The government will receive, investigate, and validate complaints from various customers located on the installation. The government shall appoint a representative to monitor contract performance using a variety of means including following-up on customer complaints, conducting random site visits, reviewing documents prepared, etc.

16.2. Continuity of Services. If services are disrupted for more than five (5) consecutive days due to the contractor’s failure or refusal to perform, this contract may be terminated for cause IAW procedures listed in FAR 12.403. 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.

Contractors removed for alcohol or drug abuse problems, or impaired judgment may only be allowed to return to work with express Government approval.

16.3 Performance Evaluation. The contractor personnel’s performance shall be evaluated according to the following core competencies:

Performance Objective PWS Paragraph Performance Threshold Monitoring Method Addresses patients and their care professionally

2.5 No more than 3 validated

deficiencies or customer complaints per month.

100% inspection of submitted complaints as soon as received

Protects patient confidentiality and privacy

11.1 Zero breaches of

confidentiality or privacy

Quarterly inspection

Accurate and Proper Records Management

2.0., 3.2. No more than 2 validated deficiencies or customer complaint per quarter

Quarterly inspection

Ensures understanding and compliance with EFMP policies and procedures

3.1.3. Conducts at least one

(1)MDG-wide staff training per year on EFMP-M, including a review of DoD criteria for mandatory referral for enrollment in EFMP-M

Quarterly inspection

Ensures patient care and adherence to EFMP-M policies

3.1.5. Documented evidence of

annual contact with EFMP families’ AD sponsors exists

Quarterly inspection

17. GOVERNMENT FURNISHED PROPERTY AND SERVICES.

17.1. FACILITIES. The Government will provide use of all available MTF facilities and support services, materials, publications and forms and equipment required for contract performance (except as designated in the contract). Contract personnel shall keep government furnished supplies, equipment, and work areas in safe, orderly and clean condition. Contract personnel shall notify the Government whenever maintenance of equipment is required.

17.2. WORK AREA/SPACE. Any space used by contract personnel in performance of this contract may be used for other purposes during their absence. Items of clothing, personal effects, or equipment may not be able to be secured. The government will not incur any liability for theft, damage, or loss of such personal items.

17.3. TELEPHONE. The Government will provide defense switching network (DSN) lines limited to matters related to performance of this contract. Personal long distance calls are not authorized and the cost of all personal calls made will be deducted from the Contractor’s invoice.

17.4. COMPUTER SYSTEMS. Contractor shall be granted access to the following computer programs required to perform services under contract, including the issuance of a Common Access Card (CAC): Composite Health Care System (CHCS), TRICARE Online, Referral Management software/applications, Medical Readiness Decision Support System (MRDSS), Armed Forces Health Longitudinal Technology Application (AHLTA), MiCARE, Essentris, and general desktop settings. The government will provide training to the contract personnel on pertinent healthcare computer systems. Access to such patient data systems is considered a position of trust. Prior to being given access to such systems, contractor must have a background check as described in paragraph 1.8 and subparagraphs.

17.5. UTILITIES. Electricity, water, sewage, and heat shall be furnished by the Government, at no cost to the contractor for use in the performance of this contract.

17.6. LOGISTICAL SUPPORT. Individual logistical support is provided under this contract in accordance with FAR 25.802, DFARS 225.802, and the policies and procedures of DoD

4525.6-M and AFI 36-3026. Policies and procedures are subject to change. Examples of support are: DoD Common Access Card; Commissary (including rationed items); Base Exchange (including rationed items); Morale Welfare and Recreation facilities (e.g. chapels, clubs, cinema, fitness center); Military Banking Facilities; Military Postal Service (APO/FPO);

Mortuary Services (on reimbursable basis); POV (Privately Owned Vehicle license); Purchase of POL (Petroleum and Oil products); Transient Billets or Visiting Officers Quarters (VOQ) on space-available and reimbursable basis when travel is performed on Official Government Orders;

Department of Defense Dependent Schools on a space guaranteed and tuition paying basis;

Medical services on a reimbursable basis; Dental care only for emergency conditions on a reimbursable basis; Pet Registration and Control and Housing Referral. Logistical support is not authorized for Local National hires as it is forbidden by the Status of Forces Agreement (SOFA).

Local National hires may be authorized a CAC if their duties require access to Government computer programs. These privileges will have to go through an approval process through the 35th Fighter Wing once a contractor is selected, they are not guaranteed at the time of solicitation for this contract.

17.7. SECURITY FORCES AND FIRE PROTECTION.

- Security Forces phone number: From DSN: 911, From Commercial: 0176-53-1911

- Fire Department phone number: From DSN: 911, From Commercial: 0176-53-1911

17.8. TRAINING. Reference sec. 15. The Government shall provide training on Government provided forms and equipment, and initial and continuing orientation. Training will be provided on the CHCS, Template Management, Automated Data Processing Equipment Custodian responsibilities, Medical Expense and Performance Reporting System (MEPRS), and ICD- 9/ICD-10/CPT/ADM coding, AHLTA, MRDSS as required.

18. APPLICABLE PUBLICATIONS AND FORMS.

18.1. Publications and forms applicable to the performance work statement (PWS) are listed below. The contractor is obligated to follow those publications. Supplements or amendments to the below listed publications may be issued during the life of the contract.

18.1.3. For any changes in policy or program that the Government or the contractor determine should result in a change in price of the contract, the Government or the contractor shall notify the CO accordingly and submit a price proposal justifying the change. The contractor will receive notification via contract modification.

19. DEPARTMENT OF DEFENSE (DOD) REGULATIONS/MANUALS

INSTRUCTIONS/DIRECTIVES:

PUB NO. TITLE DATE CHANGE

DODI 1315.19 The Exceptional Family Member Program Dec 05 Apr 17

DODI 1402.5 Criminal History Background Checks on Individuals in Child Care Services

Jan 93

DODI 4525.08 DoD Official Mail Management Aug 06 DOD 5200.02 Personnel Security Program Mar 14 DODM 5200.01 DoD Information Security Program: Overview, Classification, and Declassification, Vol 1 & 2 Feb 12

DOD 5210.42R Nuclear Weapons Personnel Reliability Program (PRP) Regulation

Jun 06 Nov 09

DOD 5400.7-R DOD Freedom of Information Act Sep 98 Apr 06 DOD 5400.11R DOD Privacy Program May 07 DODD 5500.07 Standards of Conduct Nov 07 DODI 6000.11 Patient Movement May 12 DOD 6010.13- Medical Expense and Performance Reporting

System for Fixed Military Medical and Dental Treatment Facilities

Apr 08 Apr 14

DODI 6015.23 Delivery of Healthcare at Military Treatment Facilities: Foreign Service Care; Third Party Collection; Beneficiary Counseling and Assistance Coordinators (BCACs)

Oct 02

DODM 6025.13 Medical Quality Assurance (MQA) and Clinical Quality Management in the Military Health System

(MHS)

Oct 13

DOD 6025.18R DoD Health Information Privacy Regulation Jan 03 DODI 6025.40 Military Health System Data Quality Management

Control Procedures Nov 02

DODD 6040.41 Medical Records Retention and Coding at Military Treatment Facilities

Apr 04

DODI 6040.42 Medical Encounter and Coding at Military Treatment Facilities

Jun 04

DODI 6040.43 Custody and Control of Outpatient Medical Records Jun 04 DODD 8520.02 Public Key Infrastructure (PKI) and Public Key (PK)

Enabling May 11

DODD 8570.01 Information Assurance (IA) Training, Certification, And Workforce Management

Aug 04

DOD 8580.02R DoD Health Information Security Regulation Jul 07

20. AIR FORCE INSTRUCTIONS:

PUB NO. TITLE DATE CHANGE

AFI 48-110 Immunizations and Chemoprophylaxis for the

Prevention of Infectious Diseases Oct 13

AFPD 33-3 Information Management Sep 11

AFMAN 10-3902 /

DoD5210.42

Nuclear Weapons Personnel Reliability Program (PRP) Nov 06 Dec 12

AFMAN 33-363 Management of Records Mar 08 May 14 AFM 31-116 Air Force Motor Vehicle Traffic Supervision May 12

AFI 31-401 Information Security Program Management Nov 05 AFI 31-501 Personal Security Program Management Jan 05 AFI 33-152 User Responsibilities And Guidance For

Information Systems

Jun 12

AFI 33-129 Web Management and Internet Use Feb 05 AFI 33-200 Information Assurance Management Dec 08 AFI 33-332 AF Privacy Program Jun 13 AFI 33-364 Records Disposition-Procedures and Responsibilities Dec 06 May 14 AFI 34-242 Mortuary Affairs Program Apr 08 Jun 13 AFI 36-2201 Air Force Training Program Sep 10 Aug 13 AFI 36-2910 Line of Duty (Misconduct) Determinations Oct 02 Apr 10 AFI 36-3002 Casualty Services Feb 10 Feb 12 AFI 36-3003 Military Leave Program Oct 09 Feb 14 AFI 40-102 Tobacco Use in the USAF Mar 12 AFI 40-701 Medical Support to Family Member Relocation and

Exceptional Family Member Program Feb 12

AFI 40-701 35 FW

Supplement

35 FW Supplement for AFI 40-701: Medical Support to Family Member Relocation and Exceptional Family Member Program

May 16

AFI 41-102 Medical Expense and Performance Reporting System For Fixed Military Medical and Dental Treatment

May 14

AFI 41-210 Patient Administrative Functions Jun 12 AFI 44-102 Medical Care Management Jan 12

AFI 44-119 Medical Quality Operations Aug 11 AFI 44-173 Population Health and Medical Management Nov 14 Apr 16 AFI 46-101 Nursing Services and Operations Oct 11 AFI 48-105 Surveillance, Prevention, and Control of Disease and

Conditions of Public Health or Military Significance Mar 05 Oct 11

AFI 48-123 Medical Examinations and Standards Nov 13 AFI 41-200 Health Insurance Portability And Accountability Act

(HIPAA)

Jul 17

21. OTHER REFERENCES:

Information Source Location AFMS Referral Management Center User’s Guide https://www.tricare.mil/tma/tai/downloads/ref.doc

DOD TRICARE Management Agency Medical Management Guide http://www.tricare.mil/ocmo/ https://www.tricare.mil/tma/tai/downloads/ref.doc http://www.tricare.mil/ocmo/

TRICARE Policy and Operations Manuals http://www.tricare.mil/tma/Policy.aspx http://manuals.tricare.osd.mil/Default.aspx

The Unified Biostatistical Utility (UBO) programs: Third Party Collections (TPC), Medical Services Account (MSA), and Medical http://www.tricare.mil/ocfo/mcfs/ubo/index.cfm

Appointment Standardization Commander's Guide to Access http://www.tricare.mil/tma/tai/

Defense Enrollment Eligibility Report System (DEERS) http://www.tricare.mil/DEERS

DOD TRICARE Management Agency Medical Management Guide http://www.tricare.mil/tma/ocmo/medicalmanagement.aspx

American Joint Committee on Cancer (AJCC) https://cancerstaging.org/Pages/default.aspx http://www.tricare.mil/tma/Policy.aspx http://www.tricare.mil/ocfo/mcfs/ubo/index.cfm http://www.tricare.mil/ocfo/mcfs/ubo/index.cfm