Attachment_1_-_Performance_Work_Statement.pdf

Nurse Utilization Manager Performance-based Work Statement

Attachment 1

Performance-based Work Statement (PWS)

FOR

Nurse Utilization Manager For 35th Medical Group, Misawa AB, Japan.

35TH CONTRACTING SQUADRON

MISAWA AIR BASE, JAPAN

Date: Jul 2019

TABLE OF CONTENTS

Section Description

1. DESCRIPTION OF SERVICES/GENERAL INFORMATION

1.2. SCOPE OF WORK

1.3. SPECIFIC DUTIES

1.4. REQUIRED QUALIFICATIONS

1.5. SUPERVISION RECEIVED

1.6. HOURS OF OPERATION

1.7. WORK SCHEDULE

1.8. INSTALLATION SECURITY NOTICE TO EMPLOYEES

1.9. SPECIAL SECURITY REQUIREMENTS

1.10. PERFORMANCE EVALUATION MEETINGS

1.11. SPECIAL REQUIREMENTS

1.12. HEALTH REQUIREMENTS

1.13. PROFESSIONAL LIABILITY RESPONSIBILITY/MEDICAL MALPRACTICE

1.14. CONTRACTOR PERSONNEL

1.15. TRAINING

2. SERVICES SUMMARY (SS)

3. GOVERNMENT FURNISHED PROPERTY (GFP) AND SERVICES

4 APPENDIX

4.1. APPLICABLE PUBLICATIONS AND FORMS

4.2. DEPARTMENT OF DEFENSE (DOD) REGULATIONS/MANUALS

INSTRUCTIONS/DIRECTIVES

4.3. AIR FORCE INSTRUCTIONS

4.4. OTHER REFERENCES

1. DESCRIPTION OF SERVICES/GENERAL INFORMATION. This is Non-Personal Service contract. The Government requires one (1) Full Time Equivalent Nurse Utilization Manager 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.

1.2. SCOPE OF WORK. Contractor personnel shall competently perform all tasks IAW AFI 44-173, Population Health and Medical Management, AFI 44-176, Access to Care Continuum, and AFI 44-170, Patient-Centered Medical Home (PCMH) Operations, ensuring all suspenses are met; documentation produced is legible, accurate, and professionally written, and all patient identifying information is protected. The general scope of work under this contract includes:

Providing Utilization Management activities and functions by using Medical Treatment Facility (MTF)-specific Quality Improvement processes to identify areas for review from data, suspected problem areas, and input from departments/services within the facility. Prioritizing projects based on high dollar, high volume or problem prone diagnoses. Identifying gaps between desired and actual program outcomes and developing an action plan to fix gaps. Determining effectiveness of the plan and continually evaluating the impact of implementation. Incorporating applicable utilization review tasks to ensure patients receive the right care, at the right time, in the right place, with the right provider, at the right cost. Collaborating with staff, facility departments, and outside agencies to determine the best, most cost-efficient care. Providing clinical and administrative oversight over Referral Management Center (RMC) staff, programs and processes.

1.2.1. The UM shall work in collaboration with PCMH teams, case managers (CM), disease management (DM) nurses, special needs coordinator (SNC), health care integrator (HCI) and group practice manager (GPM) to determine measures to target and manage enrollees and/or processes that relate to high-cost, high-volume or problem-prone diagnoses, procedures, services and beneficiaries who have demonstrated high utilization rates. Uses the TRICARE Management Activity Medical Management Guide in performance of these duties. Makes appropriate recommendations to DMs and CMs for high-utilization or high-risk enrollees to be entered into their processes.

1.2.2. Conduct special analyses on patient utilization of health services and health care provider orders and referrals for specialty care, therapies, pharmaceuticals and diagnostic testing to identify both excessive and insufficient use of services Identifies ways to reduce overutilization and suboptimal underutilization of services.

1.2.3. Facilitate utilization management activities by participation in multidisciplinary patient care activities. Initiate/coordinate communication between beneficiaries, PCMH team, DoD/civilian providers and ancillary health care workers. Provide feedback regarding utilization review issues within one (1) business day.

1.2.3.1. Educate PCMH staff on UM role, clinical referral process and tools available to determine appropriate level of care to achieve optimal patient outcomes.

1.2.3.2. In conjunction with the TRICARE Operations and Patient Administration (TOPA) staff, provides PCMH team with a weekly list of patients admitted to civilian hospitals.

1.2.3.3. Report any identified quality of care issues to SGH and/or Quality Management officer IAW MTF policy.

1.2.4. Perform medical in-processing utilization reviews for newly in-processed beneficiaries for covered benefits and specific needs and document the review on the patient’s electronic health record.

1.2.4.1. Refer complex care findings to CM, DM or SNC.

1.2.4.2. Track and report medical waiver discrepancies and patient safety issues to the

HCI.

1.2.4.3. Conduct MTF briefing at the installation’s Right Start program to orient and encourage newly arrived members and dependents on how to utilize MTF services.

1.2.4.3.1. Work with the GPM, TOPA and Public Health in providing timely and accurate access to care instructions.

1.2.5. Participate in Medical Management, Population Health Working Group (PHWG) and care coordination meetings with PCMH teams.

1.2.5.1. Track, trend and analyze Urgent Care Clinic (UCC) utilization and provide weekly report to PCMH team huddles to ensure follow-up care.

1.2.5.2. Track, trend and analyze Nurse Advice Line (NAL) utilization patterns; provide recommendations related to conditions, demographic factors, outcomes and formulate process improvements accordingly.

1.2.5.3. Report trends and metrics to the Executive Committee, Access to Care Working Group and PHWG.

1.2.6. Develop annual Utilization Management plan for inclusion in Population Health/Medical Management Strategic Plan in collaboration with stakeholders.

1.2.7. Provide Referral Management Center (RMC) supervision by:

1.2.7.1 Reviewing referrals for administrative, clinical completeness and appropriateness in coordination with the Chief, Medical Staff (SGH) or deputy SGH.

1.2.7.1.1. Completing medical necessity and benefit reviews on referrals and makes recommendations to the MTF approval authority for approval/disapproval of the specialty care requested. Coordinates with the TRICARE Overseas Program contractor as needed to determine availability of local care.

1.2.7.1.2. Submitting referrals from civilian providers to the TRICARE Service Center or TSC for medical necessity and appropriateness review.

1.2.7.1.3. Verifying eligibility of beneficiaries using Defense Eligibility Enrollment Reporting System (DEERS).

1.2.7.1.4. Reviewing and entering first right of refusal referrals into Composite Health Care System (CHCS) and database within one (1) business day of the date of the referral.

1.2.7.2. Providing clinical and administrative oversight over RMC personnel by:

1.2.7.2.1. Ensuring that RMC staff will coordinate with patient movement office to advise patients of their referral/health treatment options as related to their eligibility per beneficiary status and covered benefits.

1.2.7.2.2. Ensuring that RMC staff schedule referral appointments in accordance with Air Force Access to Care (ATC) standards with DoD and civilian health care providers. The UM shall notify the MTF group practice manager, TRICARE Operations and Patient Administration (TOPA) or SGH if ATC standards are not met for referrals.

1.2.7.2.3. Ensuring that RMC staff will provide patients with pre-appointment instructions and receive necessary documentation (i.e, diagnostic reports and/or treatment profiles) prior to their referral appointments.

1.2.7.2.3.1. At the population health management level, the UM shall coordinate with specialty referral clinics in obtaining pre-appointment instructions and/or tests for certain patient diagnostic groups. The UM shall periodically update these hand-outs and ensure that primary care clinics have the correct information.

1.2.7.2.4. Monitoring referral management CHCS queue to ensure patients who do not utilize the RMC walk-in service are called by RMC staff regarding the status of their referrals. The UM shall provide primary care clinics with patient hand-outs with instructions on RMC services and contact information.

1.2.7.2.4.1. Ensure that RMC staff will contact patients in the event referral requests are invalid, disapproved by second level review or TRICARE Overseas Program contractor and reschedule patients as soon as possible or instruct patients of other health care options.

1.2.7.2.5. Tracking specialty provider reports and ensuring that RMC personnel forward these to the primary care providers for review. The UM shall provide PCMs with a list of referrals that need close-outs or further review.

1.2.7.3. Providing training and orientation to new RMC personnel when senior RMC staff are unavailable. See 2.8 below for specific guidance.

1.2.7.4. Manning assistance by the UM to the RMC taking more than 7 days or more than 50% of the UM’s time shall be requested by the RMC supervisor or TOPA Flight Commander and approved by the SGH. The request shall be coordinated with the HCI and shall specify the scope of the manning assist and the end date. RMC tasks should not exceed 50% of the UM’s duties, and time spent shall be logged under the appropriate codes on the Defense Medical Human Resource System-internet (DMHRSi).

1.2.7.5. Representing Medical Management in TOPA meetings and conveying its programs and goals.

1.3. SPECIFIC DUTIES.

1.3.1. Documentation. The UM shall prepare all medical documentation to meet or exceed the standards required under applicable Air Force Instructions and the Joint Commission (TJC) guidelines. The Department of Defense’s electronic medical record system, Armed Forces Health Longitudinal Technology Application (AHLTA), shall be used for all patient encounters.

The provider shall utilize applicable adjunct local electronic systems to document non-encounter patient information, as required by applicable guidelines/processes.

1.3.1.1. The UM will use the following in documentation as appropriate: Ambulatory Procedure Grouping (APGs), Diagnostic Related Grouping (DRGs), International Classification of Diseases-Version 10 (ICD-10), Current Procedural Terminology-Version 4 (CPT-4) coding and InterQual or Milliman Ambulatory Care Guidelines.

1.3.2. Work Environment/Physical Requirements. The work is primarily sedentary.

However, there may be some physical demands. Requirements include standing, sitting or bending. Individual is required to walk throughout facility to interact with staff and providers including transport of relevant documents.

1.3.3. Information Technology Systems (ITS). CHCS, AHLTA, CarePoint and the Integrated Clinical Database (ICDB) programs must be used for case management services. The MTF will provide system accounts/access to contractor personnel after required training and security procedures have been completed by the contractor. The contractor shall comply with DoD communication and information technology security standards and policies. Initial and ongoing ITS training is necessary and provided by the Government.

1.3.4. Utilize MTF performance improvement tools in data collection and identifies barriers to the achievement of improvement in multidisciplinary treatment teams and/or clinical programs.

Seeks assistance from the MTF’s Quality/Performance Improvement Manager and other case managers as needed.

1.3.5. Comply with requirements, and assists clinical programs and treatment teams in preparation for The Joint Commission (TJC), National Committee for Quality Assurance accreditations; the Air Force Inspection Agency Health Service Inspection; Air Force Audit Agency audits and other internal or external reviews, as applicable. Implements and monitors follow-up recommendations for corrective actions.

1.3.6. Must comply with Air Force Equal Opportunity and safety policies and procedures.

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

1.4.1. Education. Minimum education required is a Bachelor of Science in Nursing from a college or university accredited by the National League for Nursing Accrediting Commission (NLNAC), or the Commission on Collegiate Nursing Education (CCNE) and recognized by the United States Department of Education.

1.4.2. Licensure. Contractor must possess a current, valid and unrestricted license as a Registered Nurse in 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 meet all state requirements, be unencumbered and remain in effect during contract employment. The contractor must be in good standing, and under no restrictions, with the state or national licensure board in any state in which a license is held or has been held within the last 10 years.

1.4.3. Experience. Minimum one year of nursing experience. Experience as a UM or outpatient or ambulatory care nurse is valued.

1.4.4. 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.

1.5. SUPERVISION RECEIVED:

1.5.1. Direct: Health Care Integrator

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

1.6. HOURS OF OPERATION. The contractor’s normal duty days and hours are Monday- Friday, 0730-1630, with an hour for lunch. The following is a list of legal federal holidays and 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.

1.7. 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. No shows or sudden disappearances may be cause for termination. 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 Functional Requirements Evaluator Designees (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. 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.

1.7.1. Non-Duty Days. The contractor personnel will 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 or down days.

1.7.2. 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.

1.7.2.1. 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 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.

1.7.3. Absences. The contractor shall advise the CO, Contracting Officer’s Representative (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.

1.7.3.1. 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 as much as possible at least 15 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.

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

1.7.5. 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 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.

1.7.6. Replacement of contractor personnel. Unless in an emergency, the contractor is required to give at least a 30-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 members 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.

1.7.7. 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 contractor personnel to arrive, etc.). The 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.

1.8. 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.

1.9. SPECIAL 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.

1.9.1. 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, Criminal History Background Checks on Individuals in Child Care Services, Enclosure 5. Contractor personnel receiving an unfavorable criminal background check status shall not be allowed to perform under this contract. The contractor is responsible for completing and submitting the government-provided SF 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.

1.9.2. National Agency Check (NAC). The government shall perform security investigations on contractor employees in accordance with DoD 5200.02, Personnel Security Program, and AFI 33-129, Web Management and Internet Use. The contractor shall submit a request for a NAC to the Unit Security Manager within five working days after the first duty day. Contractor personnel receiving unfavorable NAC status shall not be allowed to perform under this contract.

1.9.3. 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. 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.

1.9.4. 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.

1.9.4.1. 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 submit a DD1172-2 for MTF COR in Medical Logistics before their finger printing completion at Fighter Wing. Contractor is not able to schedule CAC appointment through Military PF (MPF) 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.

1.9.5. 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.

1.9.6. 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.

1.9.7. 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 government supervisor 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 Program, and paragraph 1.1 of Volume 2, Protective Security Matters.

1.9.8. 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).

1.9.9 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.

1.10. PERFORMANCE EVALUATION MEETINGS. The contractor may be required to meet periodically with Multi-functional Team Members at the beginning of contract performance. 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.

1.11. SPECIAL REQUIREMENTS.

1.11.1. 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 entitled Business Associate Agreement attached to the contract.

1.12. HEALTH REQUIREMENTS.

1.12.1. 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.

1.12.2. 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.

1.12.2.1. 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.

1.12.3. 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 TJC, OSHA, and Centers for Disease Control (CDC) health records requirement.

1.12.4. After start of work, in the event of blood borne exposure, the Government will provide follow up and care protocols according to applicable AFIs.

1.13. PROFESSIONAL LIABILITY RESPONSIBILITY/MEDICAL MALPRACTICE.

This non-personal service contract doesn’t establishes a 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 required to maintain medical malpractice liability insurance. The Government does not own any responsibility for the health care workers medical malpractice under this contract.

1.14. CONTRACTOR PERSONNEL.

1.14.1. 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.

1.14.2. 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.

1.14.3. 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.

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

1.14.5. 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):

1.14.5.1. SOFA status for Contractor employee and their lawful dependents

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

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

1.14.5.4. Full Base Exchange (BX) privileges

1.14.5.5. Full Commissary Privileges

1.14.5.6. Full Class VI Store Privileges

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

1.14.5.8. Military postal service privileges

1.14.5.9. Military banking and credit union privileges

1.14.5.10. Motor vehicle operator’s permit

1.14.5.11. Registration of one privately owned vehicle per family

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

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

1.14.5.14. Mortuary services on a reimbursable basis

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

1.14.5.16. Continuing education programs on a space-available basis

1.14.5.17. Morale, welfare, and recreation facilities

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

1.14.5.19. Legal assistance on a space-available basis

1.14.5.20. Billeting on a space-available basis

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

1.15. TRAINING. The contractor shall comply with and attend local 35 MDG Government-provided training which will include, but is not limited to, topics such as Basic Life Support (BLS), Compliance, Patient Safety, Newcomers Orientation, Performance Improvement, Risk Management, Infection Control, Fire Protection, Security, Patient Sensitivity, Automation Processing, and local in-service briefings. The classes may be scheduled individually throughout the year or scheduled at one time. These classes may take approximately 30 hours total during one year. This local training 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, such as professional conferences, license recertification and/or continuing education, with the exception of BLS.

2. SERVICES SUMMARY (SS).

2.1. 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.

2.2. 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 as identified in the Federal Acquisition Regulation (FAR) and all applicable supplements.

Termination for cause procedures may also be pursued by the Contracting Officer if after 90 days the contractor fails to meet the standards identified in this PWS. 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.

Performance Element

Performance Objective

PWS

Reference

Acceptable Quality Level

Surveillance Method

Quality Delivers service in a culturally competent, empathic, and sensitive nature consistent with the needs and conditions of the patients.

1.2. – 1.2.7.5.

The contractor will not receive any more than two valid customer or staff complaints per year.

Complaints.

Quality Demonstrates competence in the delivery of Utilization Manager services

1.2. – 1.2.7.5.

The contractor will not receive any more than two valid customer or staff complaints per year.

Complaints.

Quality Data and available metrics demonstrate progress towards annual UM plan goals.

1.2. – 1.2.5.

Meets performance requirements as determined by the direct or indirect supervisor.

Supervisor Inspection

Quality Effectively liaises between referral sources and other care settings as necessary.

1.2.7. – 1.2.7.5.

The contractor will not receive any more than two valid customer or staff complaints per year.

Complaints.

3. GOVERNMENT FURNISHED PROPERTY AND SERVICES.

3.1. 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.

3.2. 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.

3.3. 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.

3.4. 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): CHCS, TRICARE Online, Referral Management software/applications, Medical Readiness Decision Support System (MRDSS), AHLTA, MiCARE, Essentris, CHAS-ICDB, MHSPHP (Carepoint 4G) 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.

3.5. 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.

3.6. SECURITY FORCES AND FIRE PROTECTION.

- Security Forces phone number: 911

- Fire Department phone number: 911

3.6.1 Misawa Air Base Fire Prevention: The contractor shall be responsible for fire prevention in all contracted area, and be free from any potential fire hazards. The contractor shall comply with the following fire prevention guidance.

3.6.2 Fire Reporting: 1) The primary emergency reporting number on Misawa Air Base is 911 or 0176-53-1911 from off base. 2) On-base telephones if any, in the on-base warehouse(s) shall have “911” stickers. 3) All contractor-employed personnel shall be familiar with fire reporting numbers and procedures, and shall to put the number “0176-53-1911” into his/or her mobile- phone.

3.6.3 Vehicles: 1) Access for fire fighting vehicles must be maintained at all working sites. 2) Contractor’s vehicles shall not be parked within 15 feet of any fire hydrant of Fire Department connection. 3) Contractor’s vehicles shall give the right-of-way to responding fire/emergency vehicles.

3.6.4 Electrical Hazards: 1) All the contractor’s electrical tools and equipment shall be in good (original) working condition and its maintenance shall be done properly in compliance with manufacturer’s maintenance instructions. 2) All extension cords used shall be equipped with circuit breakers and plugged directly in the outlets (not other extension cords). 3) Building utility panels shall not be blocked by contractor tools/supplies.

3.6.5 Storage: 1) Flammable liquids shall not to be stored inside the warehouses, next to the buildings, or near exit ways. 2) Fire protection system shall not be obstructed at any time.

3.7. TRAINING. Reference sec. 16. The Government shall provide training on Government provided forms and equipment, and initial and continuing orientation. Training will be provided on the CHCS, AHLTA, Medical Expense and Performance Reporting System (MEPRS), and ICD-10/CPT/ADM coding, as required.

3.8. 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.

3.8.1. 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.

3.8.2. 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.

4. APPENDIX.

4.1. APPLICABLE PUBLICATIONS AND FORMS.

4.1.1. 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.

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

4.2. DEPARTMENT OF DEFENSE (DOD) REGULATIONS/MANUALS

INSTRUCTIONS/DIRECTIVES:

PUB NO. TITLE DATE CHANGE

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 DODI 6490.15 Integration of Behavioral Health Personnel (BHP)

Services Into Patient-Centered Medical Home (PCMH) Primary Care And Other Primary Care Service Settings

Aug 13

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

4.3. 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 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 44-171 Patient-Centered Medical Home Operations Jan 11 Nov 14 AFI 44-173 Population Health and Medical Management Jul 11 Jan 19 AFI 44-176 Access to Care Continuum Oct 14 Sep 17 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

4.4. 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

American Joint Committee on Cancer (AJCC) https://cancerstaging.org/Pages/default.aspx

Air Force Medical Service FY 14 Mental Health Business Practice and Coding Guide https://kx2.afms.mil/kj/kx1/bhop/Pages/home.aspx http://www.tricare.mil/tma/tai/downloads/ref.doc http://www.tricare.mil/tma/tai/downloads/ref.doc http://www.tricare.mil/ocmo/ http://www.tricare.mil/tma/Policy.aspx http://manuals.tricare.osd.mil/Default.aspx http://www.tricare.mil/ocfo/mcfs/ubo/index.cfm http://www.tricare.mil/ocfo/mcfs/ubo/index.cfm http://www.tricare.mil/tma/tai/ http://www.tricare.mil/DEERS http://www.tricare.mil/tma/ocmo/medicalmanagement.aspx