Attachment_1_-_Performance_Work_Statement.pdf

Clinical Nurse-Labor & Delivery Performance Work Statement

Performance-based Work Statement (PWS)

FOR

Clinical Nurse-Labor and Delivery For 35th Medical Group, Misawa AB, Japan.

Personal Service

35TH CONTRACTING SQUADRON

MISAWA AIR BASE, JAPAN

Date: 5 Apr 19

SOLICITATION #: FA520519QMG08

TABLE OF CONTENTS

Section Description

1. DESCRIPTION OF SERVICES/GENERAL INFORMATION

2. SCOPE OF WORK

3. SPECIFIC DUTIES

4. REQUIRED QUALIFICATIONS

5. SUPERVISION RECEIVED

6. HOURS OF OPERATION

7. WORK SCHEDULE

8. INSTALLATION SECURITY NOTICE TO EMPLOYEES

9. SECURITY REQUIREMENTS

10. PERFORMANCE EVALUATION MEETINGS

11. SPECIAL REQUIREMENTS

12. HEALTH REQUIREMENTS

13. PROFESSIONAL LIABILITY RESPONSIBILITY/MEDICAL MALPRACTICE

14. CONTRACTOR PERSONNEL

15. TRAINING

16. SERVICES SUMMARY

17. GOVERNMENT FURNISHED PROPERTY AND SERVICES

18. APPLICABLE PUBLICATIONS AND FORMS

19. DEPARTMENT OF DEFENSE (DOD) REGULATIONS/MANUALS

INSTRUCTIONS/DIRECTIVES

20. AIR FORCE INSTRUCTIONS

21. OTHER REFERENCES

1. DESCRIPTION OF SERVICES. This is a mission essential personal service contract. The Government requires one (1) Full Time Equivalent Clinical Nurse for this contract within the Labor and Delivery Unit, 35th Medical Group (MDG), Misawa Air Base, Japan. Contractor shall furnish all management and labor necessary to provide in accordance with the requirements contained in this Performance Work Statement (PWS) and the professional standards, policies, the American Nurses Association, 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. The completion of Advanced Cardiac Life Support (ACLS) certification, Neonatal Resuscitation Program (NRP) certification, Emergency Clinical Obstetrics (ECO), Sugar, Temperature, Airway, Blood pressure, Lab work, and Emotional support (STABLE); and Intermediate Fetal Heart Monitoring from Association of Women’s Health, Obstetrics, and Neonatal Nurse (AWHONN) is mandatory within 30-90 duty days of arrival. Recertification will be provided by the Medical Treatment Facility (MTF) at no cost to the contractor.

2.1. Coordinates patient care through a continuum and facilitates the achievement of high quality, safe and cost effective care.

2.2. Participates in the orientation and training of newly assigned personnel, as appropriate.

2.3. Ensures compliance with standards of care and practice in accordance with all established Unit Operating Instructions (which following national guidance from AWHONN, American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP), Medical Group Instructions and Air Force Instructions used in the medical treatment facility. Provides care within ethical and legal boundaries.

2.4. Provides appropriate patient assessment skills.

2.5. Accountable for making patient care assignments based on the scope of practice and skill level utilizing the nursing process as a basis for professional practice.

2.6. Sets up, operates, and monitors specialized medical equipment such as IV infusion pumps, PCA pumps, vital sign machines, electronic fetal monitoring, cardiac monitoring devices, EKG units, oxygen analyzers, nebulizers, ultrasound, emergency transport and other unit-specific equipment.

2.7. Recognizes adverse signs and symptoms and reacts quickly in emergency situations.

2.8. Makes referral appointments and arranges specialty care, as applicable.

2.9. Completes orientation and competency verification programs in accordance with unit guidelines.

2.10. Serves and participates in committees, functions and other meetings as directed. Provides relevant and timely information to these groups, and assists with decision making and process improvement. Participates in customer service initiatives and medical readiness activities designed to enhance health services.

2.11. Performs sterile vaginal examinations, speculum examinations, and diagnostic procedures via electronic fetal monitoring and tocometer.

2.12. Prepares patients for surgery, ultrasound, amniocentesis, or other prescribed medical procedures.

2.13. Provides critical care and evaluation of patients.

2.14. Develops nursing care plans, performs care as outlined in clinical pathways, and standing order sets.

2.15. Provides and documents individual and family education.

2.16. Prepares sterile supplies, non-sterile supplies, and ensures required equipment is present and ready for use.

2.17. Adjusts equipment as required. Reports all problems to the Non-Commissioned Officer In Charge (NCOIC) and works with maintenance service technicians to address problems.

2.18. Checks the operating parameters of the equipment each time before the equipment is used.

2.19. Develops and monitors quality improvement programs with peer reviews, staff education, chart reviews, and statistics.

2.20. Performs telephone consults, triage, and other necessary administrative tasks as required,

2.21. Maintain knowledge of how to provide nursing care from a multi-disciplinary continuum, from normal physiological changes to a wide variety of disease processes that may complicate the ante-partum, intra-partum or postpartum stages of pregnancy, the immediate care of the newborn and have a varied knowledge in women’s health issues and the physiological changes in the normal life cycle.

2.22. Maintain knowledge of the variety of pharmacological agents used in patient treatment, the desired effects, side effects, and complications of their use as well as the accurate administration of the pharmacologic agent, including dosage calculations as required.

2.23. Maintain knowledge of the administrative requirements for proper documentation of patient’s condition including disease progress, acknowledgement of teaching, and follow up care.

2.24. Maintain knowledge of computer operations and proficiency in the use of basic word processing, data entry and automated medical records.

2.25. Maintain knowledge of effective communication and collaboration with the health care team, both in oral and written form.

2.26. Maintain knowledge of synthesizing data from a variety of sources to make appropriate clinical decisions.

3. SPECIFIC DUTIES.

3.1. Patient Care. The general scope of work under this contract includes performing services in the following patient care areas:

Antepartum Labor & Delivery Postpartum Neonatal via Rooming-In or Nursery

3.2. Documentation. The provider shall prepare all medical documentation to meet or exceed the standards required under AFI 46-101 Nursing Services and Operations, Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), 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 systems, AHLTA (outpatient) and Essentris (inpatient), shall be used for all patient encounters.

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.

4.1. Experience. Minimum of one (1) year experience as an inpatient labor and delivery nurse is required. Experience with postpartum and newborn nursery is highly recommended. All experiences should be within the last 5 years.

4.2. Education. Graduate of a baccalaureate degree program in nursing (BSN) accredited by a national nursing accrediting agency recognized by the U.S. Department of Education.

Maintenance of Basic Life Support (BLS) is mandatory. Recertification will be provided by the Medical Treatment Facility (MTF) at no cost to the contractor.

4.3. Additional Knowledge. Be capable of performing a full range of medical services commensurate with the 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.

4.4. Licensure. Possess and maintain an active (characterized by present activity, participation, practice, or use); current (not revoked, suspended, or lapsed); valid (the issuing authority accepts and considers professional performance and conduct in determining continued licensure); and unrestricted (not subject to state imposed stipulations or restriction pertaining to the scope, location, or type of practice ordinarily granted to all other applicants for similar licensure in the granting jurisdiction) license from a U.S. jurisdiction as a Registered Nurse (RN). 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 licensure board in any state in which a license is held or has been held within the last 10 years.

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 as listed in the solicitation. The contractor/applicant is responsible for obtaining any required Japanese working VISAs.

5. SUPERVISION RECEIVED:

5.1. Direct: Multi Service Unit Flight Commander

5.2. Indirect: Shift Charge Nurse

5.3. This contract is a personal services contract and is intended to create an employer-employee relationship between the Government and the individual Health Care Providers. The performance of the individual Health Care Providers (HCP) under this Personal Service Contract (PSC) is subject to the day-to-day supervision and control by healthcare facility personnel comparable to that exercised over military and civil service HCPs engaged in comparable work.

Any personal injury claims alleging negligence by the individual HCP’s within the scope of the HCPs performance of the PSC shall be processed by DoD as claims alleging negligence by DoD military or civil service HCPs. The PSC does not create an employer-employee relationship between the Government and any corporation, partnership, business association or other party or legal entity with which the individual HCP(s) may be associated.

6. HOURS OF OPERATION. The contractor will be required to work various U.S. federal holiday and Pacific Air Force (PACAF) family days as required to meet mission requirements, to include:

- 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

7. WORK SCHEDULE. The contractor is required to perform fourteen –sixteen (14-16) shifts of twelve - fourteen (12-14) hours each per monthly schedule. The daytime shifts (starts at 0545) will alternate quarterly with night shift (starts at 1745). If the contractor cannot report to work as scheduled due to an emergency or illness, the contractor shall promptly notify the supervisor and Charge Nurse for resolution. No shows or sudden disappearances are reported to the contracting office and may resolve in negative reports against the company and could result in the termination process being enacted in accordance with FAR 12.403. The contractor may be required to work various shifts or augment clinical nursing support during the absence of other team nurses due to illness, leave, or deployment. The contractor may be required to work more than 12 hours in a single shift or 84 hours in a two-week period, as determined by the supervisor or designee based on the needs of the MTF. All hours in excess of the scheduled fourteen-sixteen (14-16) twelve - fourteen (12-14) hours shifts in a month will be paid at the amount listed in the Overtime CLIN. 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. Closures. Due to the 24-hour operation of the Labor and Delivery Unit, if the commander determines the base is closed due to snow, hurricane, or acts of God for non-essential personnel, the unit remains open and the contractor is still expected to show for work unless physically unable to travel to the assigned duty location.. If unable to make it to work, the contractor shall annotate their time sheet as such and notify the supervisor and charge nurse that they are unable to report to work. Such occurrences are not billable to the Government. The contractor shall only invoice for actual hours worked.

7.1.1. Performance of Services During Crisis Declared By The National Command Authority or Overseas Combatant Commander. This service is determined to be mission essential for performance during crisis according to DoDI 3020.37.

7.2. Absences. The contractor shall advise the Contracting Office (CO), Service Contract Manager (SCM), Contracting Officer Representative (COR) and supervisor or designee about absences due to illness or incapacitation. If the contractor is absent for more than five (5) consecutive days due to illness, the Contractor shall provide the Government with a statement that the employee is free from communicable illness before or as the employee returns to work.

The government has no interest in tracking the status of individual employees by name when they are absent, only to ensure that they will not pass illnesses onto others. The Government reserves the right to examine and/or re-examine any worker who meets this criterion.

7.2.1. Scheduled and Unscheduled Absences. The contract personnel will have twenty (20) days of leave annually. Leave is classified as both annual and sick leave and must be taken in one (1) day increments. All leave taken is considered non-paid days and shall be deducted from the contractor’s monthly invoice. Leave will be approved on a case by case basis and will be granted at the discretion of the supervisor and must be in accordance with manning and mission requirements. In order to ensure that customer’s access to care is not limited due to manning, timing of leave shall be coordinated with supervisor as much as possible, at least 30 days in advance. Unscheduled absences shall be called into the FRED and charge nurse by the contract employee at least two (2) hours prior to each duty day that he/she is unable to report to work.

7.3. On-Call. The contractor will not be expected to perform on-call duties.

7.4. Payment. The contractor will submit their invoice monthly in accordance with the contract terms and conditions.

7.5. 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.

7.6. Non-paid days. The government will not be required to pay for 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 ÷ Date of the month = Daily Rate Daily Rate ÷ Hours the contractor supposed to work = Hourly Rate *Hourly Rate is only utilized only when/if the contractor has to leave during the middle of shift.

This calculation will only be used for invoicing purposes if there are 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.

8.1. REQUIRED INSURANCE.

(a) The contractor shall procure and maintain during the entire period of his/her performance under this contract, the following minimum vehicle insurance:

Property Damage – Y2,000,000

(b) Prior to the commencement of work hereunder, the contractor shall furnish to the Contracting officer a certificate or written statement of the above required insurance. The contractor is required to notify the Contracting Officer immediately upon cancellation or of any material change in the policies adversely affecting the interests of the Government.

(c) The contractor agrees to insert the substance of this clause including this paragraph c, in all subcontracts hereunder

9. SECURITY REQUIREMENTS.

9.1. Criminal Background Check. Background checks are required on all healthcare workers involved in the delivery of healthcare to children under the age of 18 on a frequent and regular basis as stated in DODI 1402.5, Enclosure 5. Contractor personnel receiving an unfavorable criminal background check shall not be allowed to perform under this contract. The contractor is responsible completing and submitting the government-provided AF 2583 (REQUEST FOR PERSONNEL SECURITY ACTION) as part of the credentialing package prior to providing service at the MTF. Contractor may need to visit MTF to fill in the form in case they are not able to open attachment outside of government computer. Contractor shall comply with all security and background check requirements as outlined in DODI 1402.5 and other applicable regulations and guidelines.

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

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

9.3. Base Access. Prior to start of work, the contractor shall submit a 5 AF Form 99, “Applications for Base Passes” to the 35th Contracting Squadron, Bldg 656, for all employees requiring base access to perform the work. 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.

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. CAC will be issued by the Government at no additional cost to the contractor.

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.

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. The nurse is required to submit current nursing license to the Education and Training Office for nursing license validation.

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

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

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

Meetings will be scheduled as needed by the Contracting Officer. The Contractor may request meetings at any time. The written minutes of these meetings shall be signed by the CA 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

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 attachment 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. The contractor personnel 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. 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:

- Hepatitis 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. 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. Installation Services. The Government shall request the following logistics support for the Contractor:

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 Form 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)

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 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 20 hours total during one year. This local training will count toward the 84 hour within 2 weeks 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.

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. No more than 2 valid (verified by Government personnel) deficiencies or customer complaints per month.

16.2. Continuity of Services. Failure to perform the services for more than five (5) consecutive days without legitimate reason will result in the procedures of termination in accordance with Federal Acquisition Regulation (FAR) 12.403 – Termination. 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 Objective PWS Paragraph Performance Threshold

Contractor ably performs full range of medical services as a nurse commensurate with their specialty and background.

2.-2.18;

3.-3.2;

16.1

No more than 2 valid deficiencies (e.g.:

Reporting late to duty, medication administration errors, documentation errors, etc.) or customer complaints per month.

Keep work area in an orderly appearance. And behave in a professional manner at all times.

17.1., 17.2.

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

Keep personal appearance, including facial hair, neat and clean, and always wear name tag.

14.2.- 14.4.

No more than 2 validated customer complaints per month.

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

7.-7.3. The contractor performs seven (7) shifts of 12 hours each to include weekends, nights and holidays.

HIPPA Compliance 11.1. 100% Compliant

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. 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 subparagraph below.

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

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

17.6. SECURITY FORCES AND FIRE PROTECTION.

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

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

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.

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 ICD- 9/ICD-10/CPT/ADM coding, AHLTA, MRDSS as required.

18. APPLICABLE PUBLICATIONS AND FORMS.

18.1. Publications and forms applicable to the performance work statement (PWS) are listed below. The contractor is obligated to follow those publications. 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 Contracting Officer 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 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 DODD 8520.02 Public Key Infrastructure (PKI) and Public Key (PK)

Enabling May 11

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

Aug 04

DOD 8580.02R DoD Health Information Security Regulation Jul 07

20. AIR FORCE INSTRUCTIONS:

PUB NO. TITLE DATE CHANGE

AFI 48-110 Immunizations and Chemoprophylaxis for the

Prevention of Infectious Diseases Oct 13

AFPD 33-3 Information Management Sep 11

AFMAN 10-3902 /

DoD5210.42

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

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

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

Information Systems

Jun 12

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

Exceptional Family Member Program Feb 12

AFI 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 46-101 Nursing Services and Operations Oct 11 AFI 48-105 Surveillance, Prevention, and Control of Disease and

Conditions of Public Health or Military Significance Mar 05 Oct 11

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

(HIPAA)

Jul 17

21. OTHER REFERENCES:

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

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

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

The Joint Commission (TJC) Manuals and Publications Current Edition 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 https://cancerstaging.org/Pages/default.aspx