Attachment_1_-_Performance_Work_Statement.pdf

Performance-based Work Statement

Performance-based Work Statement (PWS)

FOR

Hospital Administration Services

For 35th Medical Group, Misawa AB, Japan.

35TH CONTRACTING SQUADRON

MISAWA AIR BASE, JAPAN

Date: Aug 2019

TABLE OF CONTENTS

Hospital Administration Services

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 a Non-Personal Service contract. The Government requires two (2) Full Time Equivalent (FTE) for this contract within the 35th Medical Group (MDG), Misawa Air Base, Japan. The contractor shall provide administrative services to ensure performance of daily functions associated with patient appointing, patient records management, consult tracking and any other administrative task assigned by the Medical Treatment Facility (MTF) officer/designee. The contractor shall not introduce services other than those included herein without prior recommendation to, and approval of, the Contracting Officer (CO). The number of contract position FTEs may be increased or decreased by 1 position during the life of the contract in accordance with Air Force Medical Readiness Agency (AFMRA) direction. If the quantity of position changes, the increase or decrease will be completes on a bilateral SF 30 through the contracting office.

1.1. U.S.Federal Holidays. 35 MDG observes the following holidays. If a holiday falls on a Saturday, it is observed on the preceding Friday. If a holiday falls on a Sunday, it is observed on the following Monday.

Holiday Day Observed

i. New Year’s Day January 1

ii. Martin Luther King Jr. Birthday Third Monday in January

iii. President’s Day Third Monday in February

iv. Memorial Day Last Monday in May

v. Independence Day July 4

vi. Labor Day First Monday in September

vii. Columbus Day Second Monday in October

viii. Veterans Day November 11

ix. Thanksgiving Day Fourth Thursday in November

x. Christmas day December 25

1.2. SCOPE OF WORK. The contractor will be knowledgeable in general medical ethics, health records administration, telephone etiquette, office management methods, excellent communications and customer service skills, strong organizational background and computer operations to include Windows Operating Systems, spreadsheet, database, and word processing applications. The contractor must understand the importance of deadlines. Prior to work or visiting in the MTF, the contractor shall create a Joint Knowledge Online (JKO) account via (https: http://jko.jfcom.mil/) and complete the HIPAA Training (course number: -US001). Upon the completion, provide a certificate of completion of the course to the HIPAA officer in TRICARE Operation & Patient Administration (TOPA). Any contractor that does not speak/understand English and does not work in MTF but will visit MTF to observe their employee’s, you will need to take a Government provided Japanese Slide Show to complete HIPAA training in advance of any planned visits. The completed training sign-in sheet with the completion date annotated shall be sent to the Contracting Officer’s Representative (COR) prior to stated visit.

1.2.1. Administrative tasks. The contractor shall perform tasks listed in sections 1.2.1.-1.2.9.

Performance shall meet or exceed established standards that include, but are not limited to:

timeliness, legibility, content, format, security and protection of patient identifying information.

The contractor shall provide administrative services to any department or section to include: 1) Urgent Care Clinic and 2) Surgical Services. The COR will coordinate with the contractor on the location of contractor services.

1.2.1. General Information Management. The contractor is required to schedule and reschedule appointments within the Access to Care (ATC) categories per Air Force Instruction (AFI) 44-176, Access To Care Continuum and Defense Health Agency - Interim Procedures Memorandum (DHA-IPM) 18-001. This and all other AFIs listed in this PWS can be found at www.e-publishing.af.mil. Administrative duties also include greeting patients and appropriately routing and screening phone calls. Verifies patients are registered in Composite Health Care Systems (CHCS) and Defense Eligibility and Enrollment Registration (DEERS). Assists with patient check in/out duties, performs end-of-day CHCS processing, completes clinic Ambulatory Data Management (ADM) functions, and coordinates patient related correspondence. Contractor is responsible to update demographic information. Orders, tracks, picks up, and delivers forms to customers.

1.2.2. Appointment Facilitation. The contractor is required to schedule appointments, locate medical records and ensure appropriate documents are available prior to all patient visits. Prints diagnostic reports and/or treatment profiles as necessary; participates with Primary Care Manager (PCM) teams to complete Preventive Health Assessment (PHA) tasking, i.e. routing charts for record reviews, initiating Department of Defense (DD) Forms 2766, Standard Form (SF) 507, AF1042, DD2766C, DD2766, DD2795, DD2796, DD2900, Pre Deployment Checklist, Post Deployment Checklist, Travel Med Checklist, AF 250, Exercise & C+20 Checklist. All forms listed in this PWS can be found at www.e-publishing.af.mil.

1.2.3. Referral Management. The contractor will receive medical provider referrals and ensure demographic information is accurate and complete; track referrals to include obtaining reports from network providers as needed. Attaches supplementary documentation (i.e. lab results) to referrals as requested. Coordinates all referral appointments. Manage clinical phone consult requests from patients. Disseminates referral instruction/handouts to beneficiaries with assistance of Government team members. Receives and routes evaluation/consultation reports to providers.

1.2.4. Medical Record Management. Medical record management and functions will be in strict accordance to higher headquarter guidance and or AFI 41-210, TRICARE Operations and Patient Administration. In the case of inconsistency Higher Headquarter guidance takes precedence. The contractor is must keep up general medical record by ensuring all forms are appropriately completed and filed, third party insurance information (DD Form 2569) and documentation is current and in the chart. This may include sensitive duty paperwork. Updates and validates CHCS/DEERS and other electronic healthcare databases. Retrieves, receives, and stores medical records. Processes requests for records and paperwork. Performs in and out-processing, audits, retirement actions, and copies medical records as required. Conducts research on loose documents, annotates and files accordingly. Researches records for appropriate MTF ownership and mails accordingly. All records, files, and documents provided by the government http://www.e-publishing.af.mil/ http://www.e-publishing.af.mil/ remain government property. The government section supervisor will provide guidance to the contractor employee who shall maintain and dispose of these records, files, and documents.

1.2.5. General Clinic Processing. The contractor will modify provider schedules and communicate schedule changes. Use current and department specific appointment booking protocols to schedule patient appointments. Coordinate with sensitive duty program monitor(s) as applicable. Perform Medical Expense and Performance Reporting System (MEPRS) monitor and Defense Medical Human Resource System-internet (DMHRSi) duties in accordance with AFI 41-102, Medical Expense and Performance Reporting System (MEPRS) for Fixed Military Medical and Dental Treatment Facilities. Retrieve, compile, and analyze data from a variety of sources. Assist in notification of patient duty absences (quarters/convalescent leave, etc.).

Coordinates with the Medical Evaluation Board (MEB) clerk on MEB patients. Coordinates Aeromedical Evacuation as assigned. Assists with patient check in/out duties. Performs CHCS end-of-day processing and coordinates with PCMs until completion. Completes clinic Ambulatory Data Module (ADM) functions. Coordinates patient related correspondence.

Validates coding of ADM encounters.

1.2.6. Documentation. Performs necessary paperwork such as general correspondence and committee minutes, and schedules and de-conflicts appointments. Schedules annual dental and physical exams for MDG active duty personnel. Tracks suspense. Proofreads/edits correspondence and documents for correct grammar, spelling, capitalization, punctuation, and format in accordance with Air Force Handbook 33-337, The Tongue and Quill. Returns incorrect material prepared by others with revisions marked.

1.2.7. Screen phone calls and visitors. Receives telephone calls, takes messages, greets visitors, and ascertains the nature of the call and visit.

1.2.8. Record Management. Monitors the 35 MDG records management program, AFI 33-332, Record Management Program, pg. 11-14 # 7, 8, 9 ensuring compliance with Air Force directives.

Serves as Records Custodian as assigned.

1.2.9. Customer Service. Performs routine customer service activities in a polite, professional and courteous manner. Greets patients and verifies patient identity and eligibility. Checks in patients for scheduled visits. Obtains/verifies third party insurance information. Identifies patients assigned to sensitive duty program. Verifies and updates patient demographics.

Determines if visit is accident or injury-related and documents accordingly. Provides patient with required paperwork and clinic instructions and manages patient flow. Schedules follow-up appointments as required. Tracks, or assists with tracking, diagnostic results and route to appropriate health care provider. Requests and check in/out patient records. Generates provider rosters. Adds patients to wait list and modifies wait list requests.

1.3. SPECIFIC DUTIES.

1.3.1. On-site Management. The contractor shall provide an on-site manager during 35 MDG duty days (excluding observed Federal Holidays and MTF closure days). The on-site manager shall be responsible for the daily attendance of contractor’s employee. An alternate may be designated, but the contractor shall identify those times when the alternate shall be the primary point of contact. The contractor shall designate this individual in writing to the CO and COR before the contract start date.

1.3.1.1. The on-site manager(s) will provide direct managerial oversight of Hospital administration services. The on-site manager(s) will be responsible for tracking the status of all the contractor’s employee’s schedule. Contractor will ensure staff performing the on-site manager(s) position meet the requirement in the paragraph 1.4.

On-site manager is also responsible for ensuring the quality of the services provided under this contract.

1.3.2. Submit Work Hours. To support providing a manning document in Resource Management Office (RMO), the on-site manager is required to provide all employees’ total work hours to MEPRS Program Manager and the COR on the first business day of the following month.

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 High school diploma or general educational development (GED) equivalency. Provide diploma or equivalency document for the Government’s review.

1.4.2. English Language Requirement. Contractor employee shall read, understand, speak, and write English. If contractor employee’s primary language is English, no certification is required.

If English language is not the primarily language, one of the following certifications will need to be submitted:

On-site manager – TOEIC 730, TOEFL (PBT) 550, TOEFL (CBT) 210, TOEFL (iBT) 80, CASEC 870(*), EIKEN Pre-1st.

Regular contractor employee - TOEIC 550, TOEFL (PBT) 460, TOEFL (CBT) 140, TOEFL (iBT) 50, CASEC 560(*), EIKEN 2nd.

(*) If the CASEC score is provided, the contract employee is required to complete one of other tests within 6 months. CASEC is considered as only reference score.

1.4.3. 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: The contractor is responsible for the supervision of its own employee(s).

1.5.2. Indirect: COR and FRED

1.6. HOURS OF OPERATION. The contractor workdays will generally consist of eight (8) hour days per day (Monday through Friday), excluding U.S. Federal Holidays. The contractor may be scheduled between the hours of 0630 – 1830, Monday through Friday with an hour for lunch. The contractor must coordinate with the CO, COR, and FRED for any schedule conflicts or concerns. Unscheduled MTF closures may be declared by the 35 MDG Commander. In the event, COR will notify to the contractor, on-site manager and/or contractor employees.

1.7. WORK SCHEDULE. The contractor may be required to perform at least 40 hours per week. If the contractor cannot perform in accordance with the schedule approved by the direct or indirect supervisor, the contractor shall promptly report to the CO for resolution. No shows or sudden disappearances may be cause for implementation of the termination process under 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 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.

1.7.1. Non-Duty Days. The contractor employee will not be required to perform on MTF closure days. It will be determined whether the PACAF family days would be MTF closure or half manning case by case basis. Therefore, the PACAF family days schedule would be notified by COR to the contractor, on-site manager and FREDs 3 business days prior of the family day.

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 employee to discontinue the service due to base closure. Until such a notification, the contractor employee are required to continue the performance.

1.7.3. 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.

1.7.3.1. Scheduled and Unscheduled Absences. The contractor employee need to coordinate their absences with the company. In the event that an employee will be taking time off, the contractor shall provide a substitute for that person in the event of planned absences. In cases of absences, regardless of vacation or sickness, the contractor shall provide temporary replacement staff. The contractor shall only provide replacement staff 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 of the replacement. The contractor employee must notify the working section if they are unable to report to work at least 2 hours prior to beginning of each duty day. The replacement must have current security clearance in accordance with PWS Paragraph 1.9.1.

1.7.4. Replacement of contractor employee. 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 FREDs to ensure all team members are aware. The contractor management staff shall replace permanent contractor employee 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.

1.7.4.1. 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.

1.7.5. 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 employee to arrive, etc.). The Rate for Non-paid days will be calculated as follows:

Monthly amount times 12 months divided by 4160 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 employee 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) and OF 306 (Declaration for Federal Employment) 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. Until the background check was clarified by 35 MDG Unit Security Manager, the contractor employee is not able to perform the services in MTF.

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. Contractor employee 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 employees are required to have access to the government local area network (LAN). Contractor shall obtain Common Access Card (CAC) for contractor employee.

1.9.4.1. Obtain CAC procedure. CACs are not authorized until the Background check is initiated. Contractor employee receiving a status other than favorable status on their background check will have their CAC privileges removed. Before completion of their background submission and finger print done, contractor employee, who has their own Social Security Numbers (SSN) and/or DoD ID number, shall obtain a Letter of Authorization (LOA) signed by CO and submit to COR. The contractor employee, who doesn’t own SSN nor DoD ID, shall submit 1172-2 to COR upon their background submission and finger print done. Contractor is not able to schedule CAC appointment through Military PF (MPF) until their Security Program completes (See para. 1.9.1.). Their process to obtain CAC shall take roughly two through three weeks, therefore contractor has responsible to contact to MTF COR in timely manner.

1.9.5. Physical Security. Contractor employee 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 employee, 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 (MFT) 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. Contractor employee 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.

1.12.5. If the abnormal lab results come back during their in-process, it is contractor’s responsibility to receive necessary treatment at contractor’s cost. The member who receives abnormal result may be required to have follow up exam or conference with MTF, but it will be at the Government cost.

1.14. CONTRACTOR EMPLOYEE.

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. Appearance. While on duty, contractor employee 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. The COR retains the authority to ask the contractor to change if attire is distracting or offensive to staff or patients. The contractor employee must be easily recognizable as a contractor employee and not a government employee.

1.14.3. Protective Clothing. When required and supplied by the MTF, contract employee 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. All contractor employees and/or contractor who is coming into the clinic to see their employee will be required to wear a MTF ID badge provided by Facility Management during in-processing. The ID badge must be visibly displayed between the shirt collar and the waist. The ID badge must be carried by the individual at all times while working at the MTF. The contractor will surrender all identification to the MTF upon termination. If the contractor employee can’t complete required training due to CAC related issue, they need to obtain a guest badge from Facility Management. The contractor employee has to bring the Flight Commander or Flight chief with them to obtain any badges otherwise, those member has to send an email to the Facility Management by stating the contractor employee is authorized to have access to the section.

1.14.4.1. Process of obtaining an identification badge from Facility Management.

1) Obtain most current Contractor IN-PROCESSING CHECKLIST from either CSS or COR. Complete by following the IN-PROCESSING CHECKLIST.

2) Visit to Education Training and schedule MDG New Comers Orientation date. (MDG New Comers Orientation is normally scheduled on 3rd Tuesday every month but can be changed due to Holiday/Family Day schedule.)

3) Complete Environmental Management System (EMS) after obtained a CAC.

4) Bring the IN-PROCESSING CHECKLIST and EMS certificate to Facility Management with Flight Commander or Flight chief to obtain ID badge. Or they need to send an email which states the new contractor employee is authorized to obtain an access to the section.

5) When contractor employee resigns without advance notice, on-site manager has to inform to COR immediately and return their ID badge to Facility or COR as soon as possible but no later than 3 business days after their resign.

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 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

Reference

Acceptable Quality Level

Surveillance Method

1 Quality Contractor performance meets or exceeds established standards with administrative services.

1.2.-1.3. No more than 2 deficiencies or COR- validated customer complaints per month in any one

Random Inspection and Customer Complaints.

of Administrative Tasks category (para. 1.1.1. thru 1.1.12).

2 Management Contractor appearance shall be neat and clean and professional behavior must be used at all times.

1.14.2. No more than 2

deficiencies or COR validated customer complaints per month.

Random Inspection and Customer Complaints

3 Schedule and Quality

Contractor provides continuous and reliable work as scheduled.

1.6., 1.7. No more than two

(2) one (1)-hour work coverage deficiencies per month.

Random Inspection and Customer Complaints

4 Regulatory Compliance

Contractor performance meets all Joint Commission and HIPAA Security Compliance.

1.11.1 100% Compliant Random Inspection and Customer 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). Contractor employee shall keep government furnished supplies, equipment, and work areas in safe, orderly and clean condition. Contractor employee shall notify the Government whenever maintenance of equipment is required.

3.2. WORK AREA/SPACE. Any space used by contractor employee 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 contractor employee 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 1.9 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

3.7. 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 CO 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

DODI 1402.5 Criminal History Background Checks on Individuals in Child Care Services DODI 4525.08 DoD Official Mail Management DOD 5200.02 Personnel Security Program DODM 5200.01 DoD Information Security Program: Overview, Classification, and

Declassification, Vol 1 & 2 DOD 5210.42R Nuclear Weapons Personnel Reliability Program (PRP) Regulation DOD 5400.7-R DOD Freedom of Information Act DOD 5400.11R DOD Privacy Program DODD 5500.07 Standards of Conduct DODI 6000.11 Patient Movement DOD 6010.13- Medical Expense and Performance Reporting System for Fixed Military

Medical and Dental Treatment Facilities DODI 6015.23 Delivery of Healthcare at Military Treatment Facilities: Foreign Service

Care; Third Party Collection; Beneficiary Counseling and Assistance Coordinators (BCACs)

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

DOD 6025.18R DoD Health Information Privacy Regulation DODI 6025.40 Military Health System Data Quality Management Control Procedures DODD 6040.41 Medical Records Retention and Coding at Military Treatment Facilities DODI 6040.42 Medical Encounter and Coding at Military Treatment Facilities DODI 6040.43 Custody and Control of Outpatient Medical Records DODI 6490.15 Integration of Behavioral Health Personnel (BHP) Services Into Patient-

Centered Medical Home (PCMH) Primary Care And Other Primary Care Service Settings

DODD 8520.02 Public Key Infrastructure (PKI) and Public Key (PK) Enabling DODD 8570.01 Information Assurance (IA) Training, Certification, And Workforce

Management DOD 8580.02R DoD Health Information Security Regulation

4.3. AIR FORCE INSTRUCTIONS:

PUB NO. TITLE

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

Diseases AFPD 33-3 Information Management

AFMAN 10-3902 /

DoD5210.42

Nuclear Weapons Personnel Reliability Program (PRP)

AFMAN 33-363 Management of Records AFM 31-116 Air Force Motor Vehicle Traffic Supervision AFI 31-401 Information Security Program Management AFI 31-501 Personal Security Program Management

AFI 33-152 User Responsibilities And Guidance For Information Systems AFI 33-129 Web Management and Internet Use

AFI 33-200 Information Assurance Management AFI 33-332 AF Privacy Program AFI 33-364 Records Disposition-Procedures and Responsibilities AFI 34-242 Mortuary Affairs Program AFI 36-2201 Air Force Training Program AFI 36-2910 Line of Duty (Misconduct) Determinations AFI 36-3002 Casualty Services AFI 36-3003 Military Leave Program AFI 40-102 Tobacco Use in the USAF AFI 40-701 Medical Support to Family Member Relocation and Exceptional Family

Member Program AFI 41-102 Medical Expense and Performance Reporting System For Fixed Military

Medical and Dental Treatment Facilities (RCS: DD-HA(AR)1453)) AFI 41-210 Patient Administrative Functions AFI 44-102 Medical Care Management AFI 44-119 Medical Quality Operations AFI 44-171 Patient-Centered Medical Home Operations AFI 44-173 Population Health and Medical Management AFI 44-176 Access to Care Continuum AFI 46-101 Nursing Services and Operations AFI 48-105 Surveillance, Prevention, and Control of Disease and Conditions of Public

Health or Military Significance AFI 48-123 Medical Examinations and Standards

AFI 41-200 Health Insurance Portability and Accountability Act (HIPAA)

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 http://www.tricare.mil/ocmo/ http://www.tricare.mil/tma/Policy.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

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