Attachment_1_-_Performance-based_Work_Statement_(PWS).pdf

Attachment 1 of RFQ #FA520519QMG03

Performance Work Statement (PWS)

FOR

Social Worker For 35th Medical Group, Misawa AB, Japan.

Personal Service

35TH CONTRACTING SQUADRON

MISAWA AIR BASE, JAPAN

July 2019

4TABLE OF CONTENTS

Social Worker

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

22. APPENDIX A

1. DESCRIPTION OF SERVICES/GENERAL INFORMATION. This is a personal service contract. The Government requires one (1) Full Time Equivalent (FTE) Social Worker (SW) 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 Social Worker (SW) functions:

2.1.a. Assessment: Identification and diagnosis of patients that present with mental health needs/management; comprehensive collection of patient information and mental health status; and continued evaluation and treatment 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. Intervention: Evidence-based treatment interventions to address patient/family needs.

2.1.d. Advocacy/Outreach: Support for the patient and family/caregivers to ensure identified education and appropriate, timely care coordination is received. Support within the community to raise awareness of mental health treatment and prevention.

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

2.3. Must have knowledge and understanding of 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. Assessment and evaluation of psychological and behavioral functioning, as well as diagnosis and treatment of mental and behavioral disorders in outpatient mental health. Provides evidence-based interventions at the individual, family, group, and community level to prevent and treat psychological dysfunction and to enhance the overall health of members of the Department of Defense community.

3.1.1. Evaluation. Evaluate children from infancy through adolescence, to include conducting child and family interviews. Evaluate adults with a wide array of socio-emotional and mental health concerns. Perform psychosocial evaluations to assess and/or treat emotional/behavior problems, educational/academic problems, attention problems, organic disorders, eating disorders, psychotic disorders, social and interpersonal dysfunction, physical/sexual/emotional abuse and neglect, personality dysfunction and drug/alcohol abuse.

3.1.2. Treatment. Provide treatment across a range of modalities to include psychotherapy, play, group and family therapy with all aged children, adolescents, and adults. Treat adjustment disorders, oppositional and non-compliant behavior, attention deficit disorders, anxiety disorders and phobias, eating disorders, elimination disorders, school and work-related problems, psychosis and affective disorders, abuse and other trauma (either psychological or physical), addictions and alcohol/substance abuse issues, and support the psychological management of medical problems. Provide varied levels of intervention, including individual, parent, marital, group, and family therapy.

3.1.3. Plans, manages, and provides social service in mental health, medical, correctional, Children Have a Potential, and Child Advocacy, and any other professional military setting. Uses social case work, therapy techniques, administration, community organization, consultation, teaching, research, planning, and coor-dinated military and civilian health, education, and welfare services to assist eligible personnel. Assesses and plans for the social needs of individuals, families, groups, and organizations in military community.

3.1.4. Coordinates social service activities and maintains liaison with military and civilian resources. Provides consultation on social aspects of policies, procedures, and services to medical staff, commanders, base agencies, volunteers, major commands, and other installations of assignment. May administers and oversee social service programs. Assists in, or develops resources and social service programs. May require coordination with other clinics and hospitals in cases of high risk for violence to self and/or others or in cases which require a higher level of care (e.g., individual outpatient unit). May require coordination with TriCare and other insurance companies as well as aeromedical evacuation operations.

3.1.5. Explores basic personality structure in relationship to developing behavioral patterns, mechanisms, and symptoms. Applies principles, knowledge, and practice of professional social work to provide social diagnosis, treatment, research, consultation, and preventive social service programs for individuals, families, groups, and organizations in military community.

3.1.6. May be involved in the Family Member Relocation Clearance (FMRC) process and enrollment process for all active duty family members’ upon request to the families of DoD civilian sponsored assignments going to an overseas base.

3.1.7. Provides expert consultation to squadron/group/wing leadership regarding psychological well-being of Misawa community.

3.1.8. May collaborate with the Integrated Delivery System (IDS) and other interagency forums that provide family medical information and referrals to base and civilian agencies.

3.1.9. May be required to have rotational on-call hours providing recommendations for crisis response, safety, and evaluation of patients who may be in need of a higher echelon of care.

3.1.10. Attends and participates in ProStaff, High Interest, Multicase consultation, and other care coordination meetings and trainings as assigned.

3.1.11. Participates in the clinic orientation and training of other staff of the Mental Health Flight. Participates in committees, work groups, and task forces at the facility. Contractor has option to participate in unit morale events if desired and approved by the Functional Requirements Evaluator Designee(s) (FRED).

3.1.12. 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.

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

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

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 patient encounters. Contractor may be required to document in other military electronic medical systems.

4. REQUIRED QUALIFICATIONS: All the requirements in this section will be reviewed and approved by 35 MDG personnel during the solicitation and/or replacement process.

4.1. Experience. Minimum of one (1) year full time experience in clinical social work within the last five (5) years. Must have completed a clinical practicum in the area of mental health.

4.2. Education. Applicants must at least possess a Master’s degree accredited by a national social work accrediting agency. Social Worker applicants must also have completed a clinical practicum in the area of mental health.

4.3. Licensure. Applicants are highly recommended to possess a valid, unrestricted license to practice as a Licensed Social Worker from one of the 50 states, and/or the District of Columbia, the Commonwealth of Puerto Rico, or territories of the United States. If the individual does not have a valid, unrestricted license to practice as a Licensed Social Worker, then the individual must have completed a Master’s Level degree in Social Work or Psychology and in the process of acquiring a valid, unrestricted license to practice as a Licensed Social Worker 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.

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. Contractor must be able to provide contract company with proof of being able to fluently and proficiently read, write, speak and understand the English language if English is not the contractor’s first language. Possess working knowledge of computer applications and software to include Windows and Microsoft Office programs.

4.5. Additional Requirement for applicants who are not a U.S. national. Non-US citizen applicants and their non-US citizen employees are required to have a valid Japanese working VISA prior to the first day of this contract. The applicant is responsible for obtaining any required Japanese working VISAs.

5. SUPERVISION RECEIVED:

5.1. Direct: Element Chief and Flight Commander

5.2. Indirect: Chief of the Medical Staff (SGH) and Medical Operations Squadron (MDOS) Commander

6. HOURS OF OPERATION. Mental Health-medical general duty days and office hours are Monday-Friday, 0730-1630, with an hour for lunch. However, a rotational emergency call shift may apply requiring some weekend and night hours via phone and possibly face-to-face response to evaluate a patient in the urgent care center (UCC). 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 8 hours per day during normal clinic business hours and approximately 112 hours of on-call services per fiscal year. 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. No shows or sudden disappearances may be cause for implementation of the termination process as described in FAR 12.403. 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, FREDs 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.

7.1. Down Day/Family Days . The contractor personnel will 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 when on-call services is required.

7.2. Closures. If the commander determines the base is closed due to snow, hurricane, or acts of God, the contractor shall annotate their time sheet as such. In such cases where the Wing Commander determines the base closed to all “non-essential personnel”, the contracted employees under this contract will be released from work. These incidents will not change the invoicing amount, as these cases are outside of the Contractor’s control.

7.2.1. 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 Contracting Officer’s Representative (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.

7.3. Absences. The contractor shall advise the CO, COR, and FRED 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.

7.3.1. 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. In cases of absences in excess of 10 days, the contractor shall provide temporary replacement staff. The contractor shall only provide personnel with equal or greater qualifications and replacement staff must submit their package and get approved in writing by the 35 MDG evaluator prior to the start of work. All leave 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 flight commander at least 15 calendar days in advance. The contractor personnel must notify the working section if they are unable to report to work at least 2 hours prior to beginning of each duty day.

7.4. On-Call. There are on-call requirements for this position. See above.

7.5. 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 Flight Commander, 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.

7.6. Replacement of contractor personnel. Unless in an emergency, the contractor is required to give at least a 30-Calendar day official notice of the intention to vacate the job to contractor management staff, CO, Contracting Administrator (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 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. The Government reserves the right to follow termination procedures as outlined in FAR 12.403 after the thirty (30) calendar days vacancy period unless the CO determines the termination is not in the best interest of the Government.

7.6.1. Additional Requirement for applicants who are not a U.S. national. If non-US citizen employees will be working as a replacement, they are required to have a valid Japanese working VISA prior to their first day of work.

7.7. Non-paid days. The government will not be required to pay for scheduled/unscheduled absences or days where the contractor does not perform services (i.e. waiting for replacement if it is out of 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:

Monthly amount times 12 months divided by 2080 hours = Hourly Rate

This calculation will be utilized only for invoicing purposes if there is Non-paid days during the month.

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. The contractor shall comply with all Misawa AB security requirements. The government will provide escorts for the contractor, as required. Failure to comply with the security requirements is cause for termination.

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 a status other than favorable status shall not be allowed to perform under this contract. The contractor is responsible for completing and submitting the government-provided AF2583 and OF 306 (Security Clearance Application) to the COR or Supervisor within three (3) working days of notification of contract award as part of the credentialing package. Contractor may need to visit MTF to fill in the form in case they are not able to open attachment outside of Government computer. 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 to three weeks after submitting to MTF COR. 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 contractor shall submit a request for a NAC to the Unit Security Manager 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.

9.3. Base Access. Prior to start of work, the contractor shall submit a 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. CACs are not authorized until the Background check is initiated.

Contractor personnel receiving a status other than favorable status on their background check will have their CAC privileges removed.

9.4.1. Obtain CAC procedure. CACs are not authorized until the Background check is initiated. Contractor personnel receiving a status other than favorable status on their background check will have their CAC privileges removed. Upon completion of their background submission, contractor shall bring a Letter of Authorization (LOA) signed by CO to in Medical Logistics after their finger printing completion at Fighter Wing. After Trust Agent (TA) in Medical Logistics approve their TASS, contractor is not able to schedule CAC appointment through Military PF (MPF). After receive a CAC, the contractor section Supervisor is responsible to route further required document to obtain full computer access what the contractor is required to provide the service under this contract position. The whole process to obtain CAC and full computer access shall take roughly one month or so, therefore contractor has to submit the required documents to MTF COR in timely manner.

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 and privileging requirements and be appropriately credentialed and privileged by the 35 MDG Credentials Committee prior to beginning patient care at the MTF and no later than 15 days prior to contract start date. AFI 44-119, Medical Quality Operations, governs this credentialing process. Verification of credentials does not incur additional cost to the contractor. Contractor shall contact 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 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. 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).

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

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 to receive a pre-employment examination and immunizations/shots prescribed by the MTF. This is at no additional cost to the contractor.

12.2. 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.

12.2.1. MEDICAL SERVICES. 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.

12.3. 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.

12.4. 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 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. The health care worker is not required to maintain medical malpractice liability insurance. Health care workers providing services under this contract shall be rendering personal services to the Government and shall be subject to day-to-day supervision and control by Government personnel. Supervision 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. LOGISTICAL SUPPORT. Individual logistical support will be requested 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. The Government shall provide Contractor the following logistics support unless specifically excluded by the terms of the US-Japan Status of Forces Agreement (SOFA) and as deemed appropriate by the CO:

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. The contractor will assume all costs associated with travel and training attendance, and may not invoice for hours, for any mandatory or voluntary training outside of that provided by the 35 MDG and the Air Force Medical Readiness Agency (AFMRA), such as professional conferences, license recertification and/or continuing education.

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:

Item No.

Performance Element

Performance Objective

PWS

Paragraph

Performance Threshold

Monitoring Method

1 Quality Addresses patients and their care professionally

2, 3 No more than 3 validated deficiencies or customer complaints per month.

100% inspection of submitted complaints as soon as received

2 Regulatory Compliance

Protects patient confidentiality and privacy

11.1 Zero breaches of

confidentiality or privacy

Quarterly inspection

3 Quality Accurate and Proper Records Management

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

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 9 and subparagraphs.

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

17.6. 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

17.7. 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 International Classification of Diseases (ICD)-9/ICD-10/ Current Procedures Technology (CPT)/ Administrative (ADM) coding, AHLTA, MRDSS as required.

17.8. CONTRACTOR-OWNED/CONTRACTOR OPERATED EQUIPMENT.

Except for items or services specifically stated here to be Government furnished, the contractor shall furnish everything else required to perform this contract in accordance with this PWS.

17.8.1. Initial Inspection. All contractor-owned equipment shall be inspected and approved by the biomedical equipment maintenance section prior to use in the facility to ensure the equipment is safe for use and that it meets facility electrical standards. This includes but is not limited to personal items such as coffee makers and radios.

17.8.2. Replacement of Contractor-Owned/Operated Equipment. If, based on diagnostic testing and established industry standards, any contractor-owned/operated equipment is deemed unsafe by biomedical equipment maintenance section personnel, it shall be tagged as unserviceable and removed from use. Replacement of any equipment such removed shall be at contractor expense.

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. Publications are available in the MTF and are maintained by the 35 MDG. Supplements or amendments to the below listed publications may be issued during the life of the contract.

18.1.1. If such changes to publications will incur a change to the contract, a modification will be completed by the CO following the procedures of FAR 52.212-4(c) Changes pursuant to the contract terms and conditions.

19. DEPARTMENT OF DEFENSE (DOD) REGULATIONS/MANUALS

INSTRUCTIONS/DIRECTIVES:

PUB NO. TITLE DATE

DoDI 6490.04 Mental Health Evaluations of Members of the Military

Services Mar 13

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

Jul 16

DODI 4525.08 DoD Official Mail Management Aug 06 DOD 5200.02 Personnel Security Program Apr 17 DODM 5200.01 DoD Information Security Program: Overview, Classification, and Declassification, Vol 1 & 2 Mar 13

DOD 5210.42 Nuclear Weapons Personnel Reliability Program (PRP) Regulation

Jun 16

DOD 5400.7-R DOD Freedom of Information Act Jan 17 DOD 5400.11R DOD Privacy Program May 07 DODD 5500.07 Standards of Conduct Nov 07 DODI 6000.11 Patient Movement Jun 18 DOD 6010.13-M Medical Expense and Performance Reporting System for

Fixed Military Medical and Dental Treatment Facilities 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

AFI 48-110 Immunizations and Chemoprophylaxis for the Prevention of Infectious Diseases Oct 13

AFI 44-172 Mental Health Nov 13 AFI 40-301 Family Advocacy Program Oct 17

AFI 90-501 Community Action Information Board and Integrated

Oct 15 AFM 31-116 Air Force Motor Vehicle Traffic Supervision May 12

AFI 44-176 Access to Care Continuum Sep17

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 May 14 AFI 34-242 Mortuary Affairs Program Jun 13 AFI 36-2201 Air Force Training Program Aug 13 AFI 36-2910 Line of Duty (Misconduct) Determinations Apr 10 AFI 36-3002 Casualty Services Feb 12 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 Facilities

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 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 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/

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 https://www.tricare.mil/tma/tai/downloads/ref.doc http://www.tricare.mil/ocmo/ 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