Attachment_1_-_Performance-based_Work_Statement_(PWS).pdf

Attachment 1 of RFQ #FA520519QMG09

Performance-based Work Statement (PWS)

For

Deployment-related Health Assessment (DRHA)

/Mental Health Assessment (MHA) Provider For 35th Medical Group, Misawa AB, Japan.

Personal Service

35TH CONTRACTING SQUADRON

MISAWA AIR BASE, JAPAN

June 2019

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. SPECIAL SECURITY REQUIREMENTS

10. PERFORMANCE EVALUATION MEETINGS

11. SPECIAL REQUIREMENTS

12. HEALTH REQUIREMENTS

13. PROFESSIONAL LIABILITY RESPONSIBILITY/MEDICAL MALPRACTICE

14. CONTRACTOR PERSONNEL

15. TRAINING

16. SERVICES SUMMARY

17. GOVERNMENT FURNISHED PROPERTY AND SERVICES

18. APPLICABLE PUBLICATIONS AND FORMS

19. DEPARTMENT OF DEFENSE (DOD) REGULATIONS/MANUALS

INSTRUCTIONS/DIRECTIVES

20. AIR FORCE INSTRUCTIONS

21. OTHER REFERENCES

1. DESCRIPTION OF SERVICES/GENERAL INFORMATION. This is personal service contract. The Governments intends to contract for one – Full Time Equivalent (FTE) credentialed provider from one of the following categories: (1) Physician (both Medical Doctor (MD) or Doctor of Osteopathy (DO) are acceptable), (2) Nurse Practitioner (NP), or (3) Physician Assistant (PA), within the Aerospace Medicine Squadron, 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 and guidelines of the 35 MDG, the Joint Commission (TJC), and all Air Force Instructions (AFIs) and regulations.

2. SCOPE OF WORK. Contractor personnel shall competently perform all tasks ensuring all suspense’s are met; documentation produced is legible, timely, accurate, medically consistent, professionally written, and all patient identifying information is protected. Duties include but are not limited to the following:

2.1. Provide a full range of Physician, Nurse Practitioner (NP), or Physician Assistant (PA), services in accordance with privileges granted by the Commanding Officer (e.g., supervise and provide general screening and medical care and examinations of patients for routine, acute and chronic conditions involving any and all organ systems; provide immunizations; diagnose, treat, and counsel patients as indicated).

2.2. Perform Deployment Related Health Assessments (DRHA), annual Periodic Health Assessments (PHA), and annual Mental Health Assessments (MHA) services that comply with applicable Department of Defense and Air Force policy and guidance, to include required standards of care and clinical practice guidelines.

2.3. Treat patients with common acute conditions, illnesses, or minor trauma within accepted protocols, Nurse Practice Acts, and/or in collaboration with a physician.

2.4. Collaborate with the physician in the health care of patients with chronic illnesses.

2.5. Order diagnostic tests as applicable.

2.6. Prescribe and dispense medications as delineated by the Pharmacy and Therapeutics Committee.

2.7. Promote preventive and health maintenance care, including annual physicals, positive health behaviors, and self-care skills through education and counseling.

2.8. Coordinates patient care through a continuum and facilitates the achievement of optimal outcomes in relation to care, quality and cost effectiveness.

2.9. Ensures compliance with standards of care and practice in accordance with all established policies, procedures, and guidelines used in the medical treatment facility. Provides care within ethical and legal boundaries.

2.10. Assesses patients.

2.11. Ability to effectively communicate and collaborate with a diverse group of people for the purpose of informing the healthcare team of plans/actions, for teaching/education to benefit the patient/family and organization. Effectively uses appropriate communication format in addressing professional issues.

2.12. Excellent written communication skills to perform accurate documentation, both written and electronic, of all activity in accordance with requirements.

2.13. Ability to recognize adverse signs and symptoms and react quickly in emergency situations.

2.14. Completes orientation and competency verification programs in accordance with (IAW) unit guidelines.

2.15. Participates in the orientation of newly assigned personnel, as appropriate.

2.16. 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.

2.17. Ensures a safe work environment, employee safe work habits and patient safety IAW regulatory agencies, infection control policies, and process improvement initiatives.

2.18. Request consultation or referral with appropriate physicians, clinics, or other health resources as indicated.

2.19. Must a have working knowledge of Microsoft Office applications and ability to become proficient in the use of the following computer systems: Composite Health Care Systems (CHCS) – Armed Forces Health Longitudinal Technology Application (AHLTA), Aeromedical Services Information Management System (ASIMS), Individual Medical Readiness (PIMR), and the new military electronic health care system when it becomes available.

3. SPECIFIC DUTIES.

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

Flight and Operational Medicine Clinic (FOMC) Base Operational Medicine Clinic (BOMC)

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, standards of the MTF, applicable Air Force Instructions and the Joint Commission guidelines. Only approved abbreviations shall be used for documentation of care in the health care record. The Department of Defense’s electronic medical record systems, to include AHLTA, 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 in an outpatient clinical setting within the last five (5) years.

4.2. Education. Graduate of a Master’s level degree program recognized by the U.S.

Department of Education. Maintenance of Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) certification is mandatory. Recertification will be provided by the MTF at no cost to the contractor. Completion of accredited program leading to the award of Physician, Nurse Practitioner (NP), or Physician Assistant (PA).

4.3. 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 licensed Physician, Nurse Practitioner (NP), or Physician Assistant (PA). 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.

4.4. 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.

5. SUPERVISION RECEIVED:

5.1. Direct: Flight Medicine Flight Commander

5.2. Indirect: Flight Medicine Clinic Nurse Manager

6. HOURS OF OPERATION. The available duty days and hours for this position to complete 40 hours per week of work will be Monday-Friday, 0730-1630, with 60 minutes 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.

7. WORK SCHEDULE. The contractor may be required to perform at least 8 hours per day 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 implementation of the termination process as described in FAR 12.403. The MTF will coordinate the appointment templates with the Contractor. The contractor may be required to work more than 8 hours in a single day or 40 hours in a week, as determined by the supervisor, 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.

7.1. Down Day/Family 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.

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

7.2.1. Performance of Services during Crisis Declared by the National Command Authority or Overseas Combatant Commander. This service contract is not classified as “mission-essential” during a crisis as declared by the National Command Authority or Overseas Combatant Commander. In the event of such a crisis, the CO or the COR will direct the contractor personnel to discontinue the service due to base closure. Until such a notification, the contractor personnel are required to continue the performance.

7.3. Absences. The contractor shall advise the CO, COR, and FRED or designee about absences due to illness or incapacitation. If the contractor is absent for more than five (5) consecutive days due to illness, the Contractor shall provide the Government with a statement that the employee is free from communicable illness before or as the employee returns to work.

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

7.3.1. Scheduled and Unscheduled Absences. The contractor personnel is 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.

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

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.

7.5.1. Additional Requirement for applicants who are not a U.S. national. If non-US citizen employees will be working as a replacement, they are required to have a valid Japanese working

VISA prior to their first day of work.

7.6. 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.

8. INSTALLATION SECURITY NOTICE TO EMPLOYEES. The government reserves the right to restrict the contractor who is identified as a potential threat to the health, safety, security, general well-being, or operational mission of the installation and its population. The contractor shall know that they may be subject to search, at the discretion of the installation commander, when entering or leaving the installation.

9. 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.

9.1. Criminal Background Check. Background checks are required on all healthcare workers involved in the delivery of healthcare to children under the age of 18 on a frequent and regular basis as stated in DODI 1402.5 Enclosure 5. Contractor personnel receiving a status other than favorable status shall not be allowed to perform under this contract. The contractor is responsible for completing and submitting the government-provided AF2583 and OF 306 (Security Clearance Application) to the COR or Supervisor within three (3) working days of notification of contract award as part of the credentialing package. Contractor may need to visit MTF to fill in the form in case they are not able to open attachment outside of Government computer. The completion of Security Program, contractor completes their finger prints in FW/IP. Until then, contractor are not allowed to start to work in MTF. To complete Security Program, it shall take roughly two to three weeks after submitting to MTF COR. Contractor shall comply with all security and background check requirements as outlined in DODI 1402.5 and other applicable regulations and guidelines.

9.2. National Agency Check (NAC). The government shall perform security investigations on contractor employees in accordance with DoD 5200.2-R, Personal Security Program and AFI 33-119, Electronic Mail Management and Use. The contractor shall submit a request for a NAC to the Unit Security Manager within three (3) working days of notification of contract award.

Contractor personnel receiving unfavorable NAC status shall not be allowed to perform under this contract.

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

9.4. Base Computer Network Access. Contractor personnel are required to have access to the government local area network (LAN). Contractor shall obtain Common Access Card (CAC) for contractor personnel. CACs are not authorized until the Background check is initiated.

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

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

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

9.6. Credentialing and Privileging. The contractor shall comply with all applicable DoD, AFMS and 35 MDG credentialing and privileging requirements and be appropriately credentialed and privileged by the 35 MDG Credentials Committee prior to beginning patient care at the MTF and no later than 15 days prior to contract start date. AFI 44-119, Medical Quality Operations, governs this credentialing process. Verification of credentials does not incur additional cost to the contractor. The Physician, Nurse Practitioner (NP), and Physician Assistant (PA) is required to submit their current license to the Education and Training Office for 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 Contracting Officer Representative (COR) will brief the contractor upon initial on-base assignment of requirements. The contractor shall comply with the requirements of Volume 1, AFI 71-101, Criminal Investigations, and paragraph 1.1 of

Volume 2, Protective Security Matters.

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

Anticipate increased RAMS during implementation of elevated Force Protection Conditions (FPCONs).

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

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

11. SPECIAL REQUIREMENTS.

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

12. HEALTH REQUIREMENTS.

12.1. Contract personnel providing services under this contract shall receive a pre-employment physical examination prior to commencement of work and annually thereafter. Health care providers shall report to the Government to receive a pre-employment examination and immunizations/shots prescribed by the MTF. This is at no additional cost to the contractor.

12.2. As a condition of this contract, Occupational Safety and Health Administration (OSHA) requires that all contractors who will have occupational exposure to blood or body fluids, or other potentially infectious materials, shall receive Hepatitis B Vaccination series, sign a voluntary declination, or have documented proof of immunity to Hepatitis B infection by titer screening. Personnel who sign declinations may change their minds at any time and receive the Hepatitis B vaccine without penalty. Other tests required upon employment include Tuberculosis Skin Test (TST) along with initial and bi-annual Human Immunodeficiency Virus

(HIV) Test. Contractors must show proof of previous Measles, Mumps, Rubella/Rubeola (MMR), Tetanus/Diphtheria/Pertussis (Tdap), and Varicella vaccinations or consent to proof of immunity by titer screening. In addition, contractors must receive an Influenza vaccination annually.

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

- 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

- Human Immunodeficiency Virus (HIV) Test, every 2 years (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 series)

- 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 or expiration of the contract.

14.5. LOGISTICAL SUPPORT. Individual logistical support will be requested under this contract in accordance with FAR 25.802, DFARS 225.802, and the policies and procedures of DoD 4525.6-M and AFI 36-3026. The Government shall provide Contractor the following logistics support unless specifically excluded by the terms of the US-Japan Status of Forces Agreement (SOFA) and as deemed appropriate by the CO:

14.5.1. SOFA status for Contractor employee and their lawful dependents

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

14.5.3. DD 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)

14.5.22. Security Clearance and Credentialing verification.

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

16. SERVICES SUMMARY.

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

16.2. Continuity of Services. If services are disrupted for more than five (5) consecutive days due to the contractor’s failure or refusal to perform, this contract may be terminated for default at the discretion of the CO. This contract may be also be terminated by the CO 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.

Item No.

Performance Element

Performance Objective PWS Paragraph

Performance Threshold

Quality Contractor ably performs full range of medical services as a Physician, Nurse Practitioner (NP) and Physician Assistant (PA) commensurate with their specialty and background

2.-2.19;

3.-3.2; 4.- 4.4

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

Management Keep work area in an orderly appearance.

And behave in a professional manner at all times.

14.2. No more than

2 valid deficiencies or customer complaints per month.

Management Keep appearance, including facial hair, neat and clean, and always wear name tag 14.2.- 14.4.

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

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

7.-7.3. The contractor performs eight (8) shifts of 8 hours each in a two-week period.

5 Regulatory Compliance

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 (except as designated in the contract). Contract personnel shall keep government furnished supplies, equipment, and work areas in safe, orderly and clean condition. Contract personnel shall notify the Government whenever maintenance of equipment is required.

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

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

17.4. COMPUTER SYSTEMS. Contractor shall be granted access to the following computer programs required to perform services under contract, including the issuance of a Common Access Card (CAC): Composite Health Care System (CHCS), TRICARE Online, Referral Management software/applications, Medical Readiness Decision Support System (MRDSS), Armed Forces Health Longitudinal Technology Application (AHLTA), MiCARE, Essentris, and general desktop settings. The government will provide training to the contract personnel on pertinent healthcare computer systems. Access to such patient data systems is considered a position of trust. Prior to being given access to such systems, contractor must have a background check as described in paragraph 9 and subparagraphs.

17.5. UTILITIES. Electricity, water, sewage, and heat in the MTF 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: 911, From Commercial: 0176-53-1911

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

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

17.8. CONTRACTOR-OWNED/CONTRACTOR OPERATED EQUIPMENT.

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

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

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

18. APPLICABLE PUBLICATIONS AND FORMS.

18.1. Publications and forms applicable to the performance work statement (PWS) are listed below. The contractor is obligated to follow those publications. Publications are available in the MTF and are maintained by the 35 MDG. Supplements or amendments to the below listed publications may be issued during the life of the contract.

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

19. DEPARTMENT OF DEFENSE (DOD) REGULATIONS/MANUALS

INSTRUCTIONS/DIRECTIVES:

PUB NO. TITLE DATE 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 MDGI 46-104, Nursing Services and Operations Current Edition MDGI 46-106, Patient/Family Education Planning Current Edition MDGI 44-140, Improving Organization Performance Current Edition Maternal Newborn Unit Operating Instructions Current Edition Maternal Newborn Unit Reference Library 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