(Atch_2)_(Final)_PWS_ _11_Mar_16.pdf

Attachment 2 To Solicitation No. FA5209-16-T-0043

PERFORMANCE WORK STATEMENT (PWS)

FOR

SEPARATION HISTORY AND PHYSICAL EXAMINATIONS (SHPE)

PROGRAM/LICENSED VOCATIONAL NURSE (LVN)

FOR

374TH MEDICAL GROUP,

YOKOTA AIR BASE, JAPAN

374 AMDS/SGPF

11 March 2016

TABLE OF CONTENTS

Section Number and Title Page Number

1. BACKGROUND 3

2. OBJECTIVE 3

3. SCOPE 3

4. POSITION REQUIREMENTS 4

5. SERVICE SUMMARY (SS) 8

6. GENERAL INFORMATION INFORMATION 10

7. APPENDIX 15

SEPARATION HISTORY AND PHYSICAL EXAMINATIONS (SHPE) PROGRAM/LICENSED

VOCATIONAL NURSE (LVN)

AT 374TH MEDICAL GROUP YOKTOA AIR BASE, JAPAN

1. BACKGROUND: The Air Force Medical Service (AFMS) has a requirement for one (1) Licensed Vocational Nurse (LVN) at the 374th Medical Group, Yokota AB, Japan, also referred to as the “medical treatment facility” (MTF) herein. Due to current manpower constraints, the required contractor will supplement the efforts of 374th Medical Group in support of the Separation History and Physical Examinations (SHPE) program.

This is a new DOD requirement for all service members, including reserve personnel, to have a complete physical if they have been on active duty for 180 days or more. The information captured during the SHPE is to help screenshot the members medical occurrences that occurred while on active duty for documentation purposes and to assess the members medical standing upon separation and to assist the Veterans Affairs (VA) in the claims process or if future medical issues happen once the member has separated if any. It also annotates if the member is fit for future service in a different branch or the reserve components. Historically in 2015, 178 patients were seen for SHPE exams. These SHPE exams are a requirement for all Active Duty Service members from all service branches.

2. OBJECTIVE: The objective of this requirement is to obtain contractor support in providing the full range of services required to implement the SHPE program.

3. SCOPE:

3.1. Performance shall be according to the requirements contained in this Performance Work Statement (PWS). The services to be performed shall be non-personal services and not inherently governmental.

The Contractor is solely liable for the actions of their employees. The prime contractor‘s staff, including all teaming partners, subcontractors and their staff at corporate level involved in the company’s administration of this contract will hereafter be termed as Contractor. The prime contractor retains responsibility for any teaming partner(s) or subcontractor(s) and shall be accountable for their performance.

Contractor personnel are not designated as mission essential personnel due to these services being considered to be non-mission essential. The Contractor shall furnish all labor and program management, in support of the 374th Medical Group’s Separation History and Physical Examinations (SHPE) program.

Contractor personnel shall serve as a Base Operational Medicine Cell (BOMC) technician to provide comprehensive SHPEs to all separating Active Duty service members to include Air Force, Navy, Army, Marines, and Coast Guard service members, who are scheduled to be separated from active duty after serving for 180 days or more. The general tasks include SHPE Program Management, Notification of Seperation, Service Member Record Review, Coordination of Appointments, and Data Management.

The historical data is as follows regarding the BOMC

Workload Estimate Monthly Average Hours per month

Patient contacts/care coordination/scheduling

Approximately 40 Contacts

Medical record/history reviews Approximately 45/month 90

Written Reports Data Reports/Metrics 8

Meetings/Briefings Staff meeting/High Interest Meeting 8

Miscellaneous Miscellaneous Medical Service Specialist and Administrative duties

Total

4. POSITION REQUIREMENTS:

4.1. SHPE PROGRAM MANAGEMENT: SHPE Personnel will stay up to date with current guidelines and policy regarding the SHPE via the knowledge exchange, AFMOA SHPE User Guide, SHPE teleconferences, DTM 14-006 and AFI 48-123 to ensure 374th Medical Group Compliance. SHPE Personnel will review and assist with updates as needed at a minimum of every 1 year for the following:

SHPE OIs, SOPs and future MOUs as needed. SHPE personnel will also communicate and train, as needed all MTF stakeholders as needed to maintain the SHPE program. SHPE personnel will train new provider Primary Care Managers (PCMs) to ensure they understand their role in the SHPE process. SHPE Personnel will prepare and submit administrative reports as requested to track compliance of the SHPE program in the MTF. The following section is broken down to reflect the SHPE process: SHPE personnel are notified of service member separation and forms are provided to service member, SHPE conducts a record review of the service member, SHPE schedules all necessary appointments including readiness items, finalizes SHPE the package, briefs member on the VA Process from overseas and signs off on all forms. This section is further broken down into data management, education and training requirements and other specified duties.

4.2. SHPE NOTIFICATION OF SEPERATION: SHPE Personnel will coordinate with the MTF to ensure the virtual out-processing checklist is updated with most current SHPE instructions for service members. The SHPE Personnel will provide briefings during TAPS for service members who are separating and ensure information presented at TAPS synchronize with information given throughout the SHPE process. A brochure will be updated and maintained that will be provided to separating service members on the SHPE process. The process starts at 180 days with processing for separation/ retirement.

Once the forms are completed with the PCM, the member can start the VA claims process via E- Benefits.

4.3. SERVICE MEMBER RECORD REVIEW BY SHPE PESONNEL: SHPE personnel will identify if the member has 180 days of military service, thus requiring a SHPE exam. SHPE Personnel will identify intent to file a VA claim or not. SHPE Personnel will identify previous SS Form 2807-1, DD Form 2808 exams within the past 12 months to provide waiver options if applicable. SHPE Personnel will assist with routing applicable waivers to completion. SHPE will screen for any outstanding occupational health exams (OHME), Individual Medical Readiness requirements, Deployment Health Assessments and other periodic medical surveillance requirements. All periodic OHME (such as hearing conservation and ionizing radiation medical surveillances) are completed before the SHPE is conducted. A referral to Audiology may be needed is the member does not meet criteria for OHME. Any periodic testing required by other issuances must be completed before the SHPE coordination (ex. HIV testing in accordance with DoD instruction 6485.01).

4.4. SHPE COORDINATION FOR APPOINTEMNTS:

4.4.1. Review DD Form 2807-1 and ensure it is completed prior to booking face-to-face SHPE appointment with PCM. The DD Form 2808 will be reviewed as well to ensure all patients pertinent information is updated and accurate prior to booking appointment.

4.4.2. Medical Record review: The SHPE Personnel will complete the medical record review based on completed DD form 2807-1 to identify additional testing and examination required based on DoD policy and MTF protocols. Record reviews will also identify conditions that are disqualifying for continued military service per AFI 48-123, Chapter 5 and the Medical Standards Directory. The medical record review will summarize the service member’s pertinent medical history for the provider completing the

SHPE.

4.4.3. Audiogram: SHPE personnel will assist Service Members with booking Threshold Audiograms. If member is on a Hearing Conservation Program, ensure audiogram is a termination test type and that this is communicated to the technician performing the audiogram. Ensure technicians who perform audiograms are utilizing SHPE TSWF in AHLTA and that SF600 and DD form 1753/2215/2216 (as appropriate) are filled out correctly and loaded into AHLTA. SHPE personnel will ensure required examinations and testing prior to the SHPE is conducted (for example, Audiology referral due to abnormal audiogram).

4.4.4. SHPE personnel will schedule a SHPE exam with the Service members PCM team to ensure appropriate timing of the exam within 180 days and within 90 days for DoD exam. This can be accomplished earlier if member has 45 days of terminal leave. SHPE personnel will ensure an AHLTA encounter can be initiated immediately to document all pre-SHPE actions and results as they occur. Other clinical preventative services indicated by the Service member’s age, gender or medical conditions as determined by a medical record review (including the DD Form 2807-1). These tests are ordered under the name of the privileged provider scheduled to complete the SHPE.

4.4.5. SHPE Documentation: Once an appointment is scheduled, SHPE personnel will open an AHLTA encounter using the SHPE Tri-Service Workflow and document as needed. After the PCM encounter is complete, upload the signed 2807-1 into HAIMS and associate with encounter. Ensure the S/O module of the AHLTA encounter has the SHPE TSWF. Document required Labs, consults etc. Based on the record review and input from the PCM into the AHLTA encounter. Enter orders into the A/P as needed for the provider to sign. Ensure Providers sign off orders in a timely manner.

4.4.6. The SHPE Personnel will ensure there is enough access to care via appointment times to facilitate the specified time frame within the SHPE program, and if not, that this is communicated to the Medical Standards Management Element (MSME) and Flight Commander of Flight Medicine. If other departments are unable to provide appointment access to facilitate the completion of the SHPE exam, this will be communicated to the MSME and Flight Commander of Flight Medicine.

4.5. DISPOSITION FOLLOWING SHPE EXAM: The service member will be either medically cleared for separation, referred to Deployment Availability Working Group (DAWG) or require additional evaluation to determine status. SHPE personnel will assist with referral to the DAWG if the member is deemed not medically cleared for retirement/separation due to disqualifying condition IAW AFI-10-203.

4.6. EXAM COMPLETION VALIDATION: No earlier than 30 days prior to final out-processing, the SHPE personnel will verify completion, currency and proper documentation of the SHPE (to include VA or DOD indication on the TSWF or equivalent for DoD tracking purposes). Once verified, SHPE staff will sign off the virtual Out-Processing Checklist or equivalent.

4.7. DATA MANAGEMENT:

4.7.1. Utilize military clinical software and Web based applications to perform duties on a daily basis to include CHCS, AHLTA, ASIMS, HAIMS, Virtual MPF, Microsoft Word, Excel and PowerPoint.

4.7.2. Forms: SHPE personnel will update the SHPE brochure as needed to provide to Service Members.

Will utilize and correctly fill out the DD Form 2807-1 and DD Form 2808.

4.8. OTHER DUTIES ASSIGNED:

4.8.1. Prepare and position patients for diagnostic testing, examinations, treatments, and clinical procedures.

4.8.2. Adhere to infection control procedures including use of personal protective equipment, disposal of waste, and aseptic technique.

4.8.3. Ensures all equipment is properly assembled, operates, cleaned and stored at the end of each work shift. Ensures preventive maintenance and routine cleaning are performed as directed.

4.8.4. Establish and maintain appropriate, professional, interpersonal relationships with co-workers, families, peers, and other team members.

4.8.5. Ensure a safe work environment and employee safe work habits in accordance with the MDG Safety Program under MDGI 44-138.

4.8.6. Attend and participate in meetings such as: professional staff conferences, quality improvement meetings, staff meetings, commander’s staff meetings, flight meetings, and other meeting required by Military Treatment Facility (MTF) guidance, or by the flight Commander or his/her designated representative.

4.8.7. Provide medical standards guidance policy interpretation and application to health care professionals and medical support staffs within the medical treatment facilities and to personnel throughout the installation.

4.9. EDUCATION/LICENSE AND TRAINING REQUIREMENTS:

4.9.1. Pre-Award Training Qualifications. Contractor employee shall meet the following minimum qualifications:

Education: Must have successfully completed all education and training requirements leading to and graduated from an accredited national, state or military equivalent school for Vocational Nursing or equivalent.

License/Certification: Must have and maintain throughout the course of contract, a current, active, valid, unrestricted license (with no limitations, stipulations or pending adverse actions) to practice as a LVN or equivalent from a US jurisdiction. License must be recognized and accepted by the State of practice in accordance with governing regulations. TOEIC score of at least 730 or equivalent certificate is required for non-native English speakers.

Experience: Have at least 12 months experience in an LVN role.

4.9.2. Post Award/Orientation Training: The Contractor shall participate in the 374th Newcomer’s Hospital Orientation within 30 days of start. This Orientation is schedule d through the Education and Training Department. Orientation training will be conducted during normal hours of operation, and will be scheduled by the COR. Contractor personnel who have any interaction with the MTF computer systems must receive training for the applicable system(s). The COR will coordinate the necessary computer training. The training will be on-site and during normal hours of operation. This training will be at no cost to the Contractor. Access to patient data systems is an "Automated Data Processing Sensitive" position requiring compliance with AFI 31-501 (See Appendix A). The Contractor shall comply with agency personal identity verification procedures that implement Homeland Security Presidential Directive-12 (HSPD-12), Office of Management and Budget (OMB) guidance M-05-24, and Federal Information Processing Standards Publication (FIPS PUB) Number 201. (See Appendix A)

4.9.3. Recurring Training: Participate in training and continuing education programs for new procedures, techniques, and equipment as needed to perform duties. Must complete all MTF-specified annual training requirements, and comply with all MTF policies, procedures, productivity standards and instructions as provided by the MTF. The Education and Training Department will assign computer based and in-person trainings to maintain MTF requirements. Training includes but is not limited to the following:

Alcohol and Drug Abuse Prevention and Treatment Program Annual Block Training Armed Forces Health Longitudinal Technology Application (AHLTA) Basic Life Support (BLS) IAW AFI 41-101 – current/continual certification (See Appendix A) Composite Healthcare Computer System (CHCS) Cultural Diversity Infection Control Health Insurance Portability and Accountability Act (HIPAA) – initial and annual certification training.

(See Appendix A) Military Health Care Computer Systems/Procedures New Personnel Orientation On-the-job-training (work center/patient safety, waste disposal, fire prevention etc.)

Personnel Reliability Program Total Force Awareness Training – DoD Information Assurance Awareness Total Force Awareness Training – Information Protection Training

5. SERVICES SUMMARY (SS):

SS Number and Performance Objective

Describe Task Performance Threshold

Method of Assessment

SS #1. SHPE personnel shall maintain the currency and relevance of the following:

SHPE OIs, SOPs and MOUs.

4.1 Program

Management

Minimum of one annual review.

Additional reviews, if required will be submitted in the time frame established by the COR

Periodic Inspection by

SS #2. SHPE personnel shall coordinate with MTF, update out processing checklist, and provide TAPS brief

4.2 Notification of

Separation

Process starts no later than 180 days with processing for separation/ retirement.

No more than 3 missed/unrepresented briefings per year.

Periodic Inspection by

SS #3. SHPE Personnel will identify previous SS Form 2807-1, DD Form 2808 exams within the past 12 months to provide waiver options if applicable.

Review of outstanding occupational health exams

4.3 Service

Member Record Review by SHPE Personnel

No more than 3 missed SS Form 2807-1, DD Form 2808 that could have resulted in a waiver per year.

No more than 5 missed screenings prior to SHPE exam annually

Periodic Surveillance (Quarterly)

SS #4. Ensure preliminary actions are complete prior to PCM appointment

Ensure post scheduling actions are complete such as opening an AHLTA encounter, uploading the signed 2807-1 into HAIMS, reviewing provider signatures, and documenting as required.

4.4 Coordination

for Appointments

No more than 4 missed/incomplete or incorrectly completed 2807-1 prior to booking face-to-face SHPE apt with the PCM Annually.

No more than 5 SHPE AHLTvA encounters with incomplete information prior to closure annually.

SS #5. Once verified, SHPE staff will sign off the virtual Out-Processing Checklist or equivalent.

4.6 Exam

Completion Validation

Outprocessing checklist will be verified and signed within 3 duties days of the completion of the SHPE exam.

SS #6. Must have and maintain throughout the course of contract, a current, active, valid, unrestricted license (with no limitations, stipulations or pending adverse actions) to practice as a LVN or equivalent from a US jurisdiction. License must be recognized and accepted by the State of practice in accordance with governing regulations.

4.9 Education/License and Training Requirements

Must maintain license for entirety of employment with no lapse.

SS #7 Recurring Training:

Participate in training and continuing education programs for new procedures, techniques, and equipment as needed to perform duties.

Must complete all MTF-specified annual training requirements, and comply with all MTF policies, procedures, productivity standards and instructions as provided by the MTF. The Education and Training Department will assign computer based and in-person trainings to maintain MTF requirements.

4.9 Education/License and Training Requirements

Must maintain MTF specific training.

Member will complete requested deficiency within 30 days of noted deficiency.

6. GENERAL INFORMATION:

6.1 CONTRACTOR REPRESENTATIVE: The Contractor shall designate to the Contracting Officer (KO), in writing, a primary point-of-contact for contract implementation, coordination and administration not later than ten (10) business days after receiving notice of contract award. The Contractor shall notify the KO of changes in the primary point-of-contact at least ten (10) workdays prior to any change. All notifications shall be in writing and shall state the name and contact information for the point-of-contact.

The Contractor representative may reside/be located outside of Japan (i.e. in the United States), but shall be available by telephone or email from 0700 to 1600 Japan Standard Time.

6.2 POINT OF CONTACT: The Contractor shall provide a point of contact that shall be responsible for the performance of the work. The point of contact shall have full authority to act for the Contractor on all matters relating to the daily operation of this contract. The point of contact may be a LVN worker providing SHPE personnel in accordance with this PWS. The Contractor shall designate this individual, in writing, to the Contracting Officer upon award.

6.3 INDENTIFICATION/ATTIRE: All contractor personnel shall be clearly identifiable while on duty.

All contractor personnel shall wear a Contractor nametag with the company name, individual’s name, and specialty displayed. The nametag shall be worn on the outermost garment. Facility badges must be worn at all times. While on duty, dressed professionally in business casual attire.

6.4 WORK SCHEDULES: Workdays will generally consist of eight (8) hour days. Services are generally required five (5) days each week (Monday through Friday), excluding U.S. Federal holidays. Required services may be scheduled between the hours of 0730 to 1630, Monday through Friday. Hours are subject to change based on need and as mutually agreed between the COR and the Contractor however; the total number of hours will not exceed eighty (80) hours per two (2) week period. A lunch period is not a payable period, but will be coordinated with the COR. Commuting time to and from required place of performance is not compensable by the Government. In no case will overtime be authorized or paid. (See Paragraph 3.1 Scope.) Workload Estimate table to view the workload layout and duties to be expected.

Non-Duty Days: Contractor personnel may 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 (approximately 5 - 6 days per year). The COR at each location shall notify the Contractor five (5) work days prior the family day if performance will be required. Non-duty days shall be considered non-paid days and shall be deducted from the Contractor’s monthly invoice.

Scheduled and Unscheduled Absences: Contractor personnel are allowed to take up to 10 workdays 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 workdays. All leave is considered non-paid days and shall be deducted from the Contractor’s monthly invoice. Timing and details shall be coordinated with the COR. Scheduled absences shall be scheduled at least thirty (30) calendar days in advance and mutually agreed upon by the COR and individual. Unscheduled absences shall be called into the COR by the contract provider within the first two (2) hours of each duty day that he/she is unable to report to work.

Holidays: The following is a list of legal federal holidays. Any federal holiday falling on a Saturday will be observed on the preceding Friday, holidays falling on a Sunday will be observed the following Monday.

U.S. Holidays:

January 1 New Year’s Day 3rd Monday in January Martin Luther King, Jr. Day

3rd Monday in February Washington’s Birthday Last Monday in May Memorial Day July 4 Independence Day 1st Monday in September Labor Day 2nd Monday in October Columbus Day November 11 Veterans Day 4th Thursday in November Thanksgiving Day December 25 Christmas Day

In the event of unplanned closure of the MTF due to natural disaster, military emergency, severe weather, security threat, or a facility-related problem that prevents the contractor personnel from performing services under this contract, these Contractor employees shall follow the same departure and reporting directions given to Government personnel and the Contractor shall treat its employees as they determine appropriate.

6.4.1 Non-paid days: The government will not be required to pay for non-duty days, scheduled/unscheduled absences or days where the Contractor does not perform services (i.e. waiting for replacement contractor personnel to arrive). Non-paid days shall be deducted from the monthly invoice amount and shall be calculated as follows:

Contract Line Item Number (CLIN) Monthly Amount divided by total monthly hours = Hourly Rate

6.5 REPLACEMENT OF CONTRACTOR PERSONNEL: The Contractor management staff shall replace permanent the contractor personnel at the earliest possible date ensuring vacancies do not exceed sixty (60) calendar days. The consecutive 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 60 days.

6.6 CONFLICT OF INTERESTS: Contractor personnel shall not bill patients for services rendered under this contract. Contractor personnel shall not request or accept compensation of any kind for patients treated, procedures performed, or any other actions performed. Contractor personnel shall not, while performing services under this contract, advice, recommend, or suggest to persons eligible to receive medical care at U.S. Government expense that such persons should receive care from the Contractor at any place other than as designated under this contract.

6.7 CONFIDENTIALITY OF INFORMATION: Unless otherwise specified under this contract, all financial, statistical, personnel, and/or technical data which is furnished, produced or otherwise available to the Contractor during the performance of this contract are considered confidential business information and shall not be used for purposes other than performance of work under this contract. The Contractor shall not release any of the above information without prior written consent of the KO. The Contractor shall not use patient care rendered pursuant to this contract as part of a study, research project, or publication.

6.8 MEDIA AND OTHER INQUIRIES: The Contractor or Contractor personnel shall not respond to any media inquiries. Any inquiries from the media, third parties, or public agencies shall be immediately relayed to the COR, who will relay them to the Medical Treatment Facility (MTF) Public Affairs Officer or, after duty hours, to the Administrative Officer of the Day. There shall be no interviews, comments, or any other response without the prior knowledge and approval of the MTF Commander. Other than routine inquiries from external agencies, all other inquiries and complaints shall be brought to the attention of the

COR.

6.9 EMERGENCY HEALTHCARE FOR CONTRACTOR PERSONNEL: The MTF will provide emergency health care for injuries or life threatening medical emergencies occurring while on duty under the provisions of Air Force Instruction (AFI) 41-210. In emergencies, transportation in U.S. Government ambulances may be furnished by the U.S. Government on a reimbursable basis. The Contractor shall reimburse the U.S. Government for such services as billed by the MTF.

6.10 CONTRACTOR PERSONNEL PRIVATE PRACTICE: Contractor personnel are prohibited by reason of their employment under this contract from conducting private practice. The CO will unilaterally resolve any issues concerning potential conflicts.

6.11 OVERSEAS REQUIREMENTS: The Contractor is responsible for ensuring all country clearances, passports, visas, and accreditations required by the Host Nation are obtained prior to employment of individuals under this contract. Documentation requirements are subject to change as Status of Forces Agreement (SOFA) change. In the event a proposed Contractor employee is denied Host Nation approval, accreditation, and/or permission, the prospective awardee shall submit like documentation for another nominee. The Contractor will be responsible for obtaining the appropriate country specific requirements, and will coordinate this with the CO and COR. The Contractor shall provide written notification to the CO and the COR within 24 hours of becoming aware of accredited Contract personnel no longer performing duties requiring accreditation/clearances/permissions. The Contractor shall recognize that Host Nation authorities may conduct on-site inspections at any time in the Contractor personnel’s work area for verifying the status of positions and Contractor personnel and appropriate visas or permissions. The Contractor shall assume all costs related to submission of required documentation. At the time of preparation of this contract, applicable information and forms for placement of Contractor personnel in Japan may be accessed at the DOCPER and U.S. Department of State websites. (See Appendix A)

6.12 CONTRACTOR PERSONNEL HEALTH REQUIREMENTS: Contractor personnel and dependents shall be up to date on immunizations required or recommended by the U.S. Department of Health and Human Services for travel to the Host Nation. (See Appendix A) The U.S. Government will not reimburse the Contractor for this expense. Contractor personnel providing services under this contract shall receive a pre-employment physical examination prior to commencement of work and annually thereafter.

Certification shall be provided to the COR that Contractor personnel have completed medical evaluation required no later than seven (7) business days prior to commencement of work. This certification shall state the date on which the examination was completed, the doctor’s name that performed the examination, and a statement concerning the physical health of the individual. The certification shall also contain the following statement: “(name of contractor employee) is suffering from no contagious diseases to include but not limited to Tuberculosis and Hepatitis.” Per Occupational Safety Health Administration (OSHA) requirements, all Contractor personnel who will have occupational exposure to blood or body fluids, or other potentially infectious materials, shall receive Hepatitis B vaccine, sign a voluntary declination, or have documented proof of immunity to Hepatitis B infection. (See Appendix A) Personnel who sign declinations may change their minds at anytime and receive the Hepatitis B vaccine without penalty. It is the Contractor’s responsibility to report all information necessary to assure hospital records can be maintained correctly, and therefore comply with the OSHA and Center for Disease Control (CDC) health records requirement. (See Appendix A)

6.12.1 PREGNANT EMPLOYEES: It is responsibility of the Contractor to notify the COR of a pregnant employee. MTF Employee Health Office will provide information concerning any work hazards in that area. The Contractor is to notify their pregnant employee of any work hazards. It will be the employee and the Contractor’s joint decision whether the contracted employee works in the environment.

6.13 ADMINISTRATIVE CHECKS AND REQUIREMENTS:

6.13.1 NATIONAL AGENCY CHECK WITH INQUIRIES (NACI): Since personnel under this contract will have access to critical government information and/or process information requiring protection under the Privacy Act of 1974, these positions are considered Public Trust Positions. Compliance with DoD Directive 5200.2-R, AFI 31-501and Homeland Security Presidential Directive 12 (HSPD-12) is mandatory for these positions. (See Appendix A) A background investigation consisting of a National Agency Check with Inquiries (NACI) is required for all personnel under this contract. The Contractor shall fully adhere with the provisions of referenced publications by having each of their employees who are performing under this contract initiate and complete a NACI. Background investigation requests for employee will be submitted through the Personnel Security Office, Yokota AB, Japan. Member will be fingerprinted and required to complete the appropriate forms (Standard Form 85P, Questionnaire for Public Trust Positions and OF 306, Declaration for Federal Employment). (See Appendix A) The Contractor shall advise employee that a favorable suitability determination is required as a condition of employment under this specific contract. The employee shall apply for the NACI prior to start of performance. The government is solely responsible for the cost associated with the initiation, application and completion of the background investigation with exceptions for expenses incurred for Police Checks for “local hire” personnel.

6.13.2 CRIMINAL HISTORY BACKGROUND CHECK (CHBC): CHBC are required for Contractor personnel involved in the delivery of healthcare to children under the age of 18 on a frequent and regular basis, as stated in Department of Defense Instruction (DoDI) 1402.5, Enclosure 5. (See Appendix A) The Contractor shall ensure that the personnel follow local MTF policy to provide fingerprints on a properly completed Standard Form 87, Fingerprint Card for Federal Employees. (See Appendix A) The procedures for completing the required CHBC are outlined in the DoDI 1402.5. (See Appendix A)

6.13.3 PENDING COMPLETION OF NACI AND CHCB: The Contractor personnel may provide contract services prior to completion of background investigation. The Contractor understands that the MTF Commander may allow the Contractor personnel to temporarily occupy sensitive positions pending NACI. The Contractor personnel will be immediately removed from the position if at any time the NACI receives unfavorable adjudication, or if other unfavorable information that would affect the NACI becomes known. Pending completion of CHBC the Air Force Surgeon General requires close clinical supervision and full compliance with existing DoD Directives, Instructions, and other guidance on quality assurance, risk management, licensure, personnel orientation and certification verification. The MTF Commander will determine what constitutes “close clinical supervision” for individuals whose NACIs/CHCB are pending, either supervised practice ensuring protection of patients under the age of 18 or line-of-sight supervision (i.e., chaperoned by an individual whose background investigation has been successfully completed) at all times when caring for these patients.

6.14 EFFECT OF TERMINATION

6.14.1 If this contract has records management requirements, the records subject to the Clause should be handled in accordance with the records management requirements. If this contract does not have records management requirements, the records should be handled in accordance with paragraphs 6.14.2 and

6.14.3 below.

6.14.2 If this contract does not have records management requirements, except as provided in paragraph

(3) of this section, upon termination of this Contract, for any reason, the Contractor shall return or destroy all Protected Health Information received from the Government, or created or received by the Contractor on behalf of the Government. This provision shall apply to Protected Health Information that is in the possession of subcontractors or agents of the Contractor. The Contractor shall retain no copies of the Protected Health Information.

6.14.3 If this contract does not have records management provisions and the Contractor determines that returning or destroying the Protected Health Information is infeasible, the Contractor shall provide to the Government notification of the conditions that make return or destruction infeasible. Upon mutual agreement of the Government and the Contractor that return or destruction of Protected Health Information is infeasible, the Contractor shall extend the protections of this Contract to such Protected Health Information and limit further uses and disclosures of such Protected Health Information to those purposes that make the return or destruction infeasible, for so long as the Contractor maintains such Protected Health Information.

6.15 COMMANDER’S TOBACCO USE GUIDANCE: The Air Force recognizes equal work breaks (when these breaks are permitted) for tobacco users and non-tobacco users. The MTF will have a smoke free medical campus. Tobacco use is prohibited in government vehicles, inside buildings and within 50 feet of building‘s direct service entryway. The spitting of such non-smoking tobacco products into cups, cans, or any type of container within the above-restricted areas is prohibited.

6.16 HIPAA Compliance: The Contractor agrees to abide by all the requirements of the Health Insurance Portability and Accountability Act (HIPAA) as codified at 45 CFR Part 160 and Part 164, subparts A and E, and implemented by DoD 6025.18-R regarding the privacy and confidentiality of health records and information being provided and shared under the resulting contract. The Contractor shall also comply with the Business Associate Agreement under Privacy of Protected Health Information.

HIPAA is comprised of several different sections, each to be implemented by the Dept. of Health and Human Services. The medical facilities of the military services and the DOD health plans are specifically listed as covered by HIPPA. Currently, HIPAA Privacy and Security Rules, as set forth in the Code of Federal Regulations, are in effect for all MTFs. The specific implementation of HIPPA Privacy for DOD medical facility is set forth in DOD 6025.18-R, and for HIPAA Security, the requirements for AF MTF’s are contained in DOD 8580.02-R and AFI 41-217, which also contains additional Information Assurance requirements for all AF MTF’s . DOD 6025.18-R, DOD 8580.02-R and AFI 41-217 are incorporated herein by reference. MTRs are responsible to insure overall compliance with HIPAA requirements, which includes incorporation of certain requirements in contracts entered or amended after the respective implementation dates.

IAW these regulations the Contractor and its employees meet the definition of Business Associates.

Therefore, a Business Associate Agreement is required by law to comply with both the HIPAA Privacy and Security regulations. This clause serves as that agreement for each MTF, whereby the Contractor and its employees agree to abide by all HIPAA Privacy and Security requirements regarding health information as defined in this clause, DOD 6025-18-R, DOD 8520.02-R and AFI 41-217. Additional HIPAA requirements will be addressed when implemented.

6.17 CONTRACTOR MANPOWER REPORTING LANGUAGE FOR CONTRACT PERFORMANCE

WORK STATEMENTS: The Contractor shall report all contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract. The Contractor is required to completely fill in all required data fields at http://www.ecmra.mil. Reporting inputs will be for the labor executed during the period of performance for each Government fiscal year (FY), which runs 1 October through 30 September. While inputs may be reported any time during the FY, all data shall be reported no later than 31 October* of each calendar year. Contractors may direct questions to the CMRA help desk.

Reporting Period: Contractors are required to input data by 31 October of each year.

Uses and Safeguarding of Information: Information from the secure web site is considered proprietary in nature when the contract number and contractor identity are associated with the direct labor hours and direct labor dollars. At no time will any data be released to the public with the contractor name and contract number associated with the data.

User Manuals: Data for Air Force service requirements must be input at the Air Force CMRA link. However, user manuals for government personnel and contractors are available at the Army CMRA link at http://www.ecmra.mil.

MISCELLANEOUS:

Regulatory References. A reference in this Clause to a section in DOD 6025.18-R, HIPAA Privacy Regulation or DOD 8580.02-R, HIPAA Security Regulation, or any CFR or AFI provision means the section as currently in effect or as amended, and for which compliance is required.

Survival. The respective rights and obligations of Business Associate under the "Effect of Termination" provision of this Clause shall survive the termination of this Contract.

Interpretation. Any ambiguity in this Clause shall be resolved in favor of a meaning that permits the Government to comply with DOD 6025.18-R, the CFR HIPAA Privacy Rule, DOD 8520.02-R, the CFR HIPAA Security Rule and AFI 41-217.

7. APPENDIX:

APPENDIX A: LIST OF REFERENCE AND TITLE

APPENDIX B: JAPANESE ROAD LAWS AND REQUIRED INSURANCE

APPENDIX C: ABBREVIATION

APPENDIX A

LIST OF REFERENCE AND TITLE

Below is Reference and Title specified in the PWS. Supplements or amendments to the listed references, publication and forms from any organizational level may be issued during the life of this contract. Should any publication or form revision cause a change in the Contractor’s processes, procedures and/or standards of operation, the Contractor shall advise the CO of such changes in writing within 30 days of receipt of the publication or form revisions.

REFERENCE LONG TITLE

AFI 48-123 Medical Examinations and Standards

AFI 48-149 Flight and Operational Medicine

AFI 10-203 Duty Limiting Conditions

AFI 48-101 Aerospace Medicine Enterprise

AFI 41-101 Obtaining Alternative Medical and Dental Care

AFI 41-217 Health Information Assurance for Military Treatment Facilities

AFI 31-501 Personnel Security Program Management

AFI 41-114 Military Health Services System Matrix

AFI 33-202 Network and Computer Security

AFI 41-117 Medical Service Officer Education

AFI 44-119 Clinical Performance Improvement

AFI 48-105 Surveillance, Prevention, and Control of Diseases and Conditions of Public Health or Military Significance

DOCPER DoD Contractor Personnel Office

DoDD 5500.7 Standards of Conduct

DoDD 5200.2 DoD Personnel Security Program

DoDD 6025.18-R Health Information Privacy

DoDD 8500.1 Information Assurance

DoDI 1402.5 Criminal History Background Checks on Individuals In Child Care Services

DoDI 3020.37 Continuation of Essential DoD Contractor Services During a Crisis

FIPS PUB 201 Federal Information Processing Standards Publication

Health Records Occupational Safety Health Administration

Hepatitis B – OSHA

Occupational Safety Health Administration

HIPAA Health Insurance Portability and Accountability Act

HSPD 12 Homeland Security Presidential Directive 12

OF 306 Declaration for Federal Employment

OMB M-05-24 Office of Management and Budget M-05-24

Privacy Act of 1974 Privacy Act of 1974

Standard Form 85P Questionnaire for Public Trust Positions

Standard Form 87 Fingerprint Card for Federal Employees state.gov U.S. Department of State

Vaccination/immunization U.S. Department of Health and Human Services

DD Form 2807-1 Report of Medical History

DD Form 2808 Record of Examination

DD Form 1753 / 2215 / 2216 Master Station Log/Reference Audiogram/Hearing Conservation Data

APPENDIX B

JAPANESE ROAD LAWS AND REQUIRED INSURANCE

1. JAPANESE ROAD LAWS:

1.1. The Contractor shall comply with Japanese Road Laws while on US Military installations to specifically include: Article 43 the Road Law (Japan) (prohibited acts relative to roads). No person shall commit the following described acts:

1.2. Damaging the road, causing roads to be littered with debris, polluting the roads with debris or fallout from motor vehicles or otherwise defacing roads unreasonably or without due cause.

1.3. Article 43-2 (Measures to be taken to prevent cargo or things loaded on motor vehicles from falling out)

1.4. The agency managing a road may when there is reasonable cause for him to feel that items or cargo being carried in or on a motor vehicle may fall out and damage, pollute, or otherwise deface the road in such manner as to hinder or obstruct the traffic, order the operator of the vehicle in question to take steps or measures necessary to prevent occurrence of such hindrance by stopping operation of the vehicle, or correcting the method of loading or traveling or operation of the vehicle.

2. REQUIRED INSURANCE BY JAPANESE LAW:

2.1. The Contractor shall procure and maintain during the entire period of his performance under this contract the following minimum insurance on each vehicle used by the Contractor at the work site.

2.2. Type: Automobile Property Damage Insurance Amount: ¥3,000,000 or Dollar equivalent Bodily Injury Insurance Amount: ¥30,000,000 or Dollar equivalent

2.3. All vehicles must be properly inspected/insured in accordance with Japanese Compulsory Insurance (JCI) requirements.

2.4. Prior to the commencement of work hereunder, the Contractor shall furnish to the Contracting Officer (KO) a certificate or written statement of the above required insurance. The policies evidencing required insurance shall contain an endorsement to the effect that cancellation or any material change in the policies adversely affecting the interests of the U.S. Government in such insurance shall not be effective for such period as may be prescribed by the laws of the state in which this contract is to be performed and in no event less than thirty (30) days after written notice thereof to the KO.

APPENDIX C

LIST OF ABBREVIATIONS

AFMOA Air Force Medical Operation Agency AFMS Air Force Medical Service AHLTA Armed Forces Health Longitudinal Technology Application A/P Anatomy & Physiology ASIMS Aerospace Information Management System BLS Basic Life Support BOMC Base Operational Medicine Cell CDC Center for Disease Control CHCS Composite Healthcare Computer System CHBC Criminal History Background Check CO Contracting Officer COR Contracting Officers Representative DAWG Deployment Availability Working Group DOCPER DoD Contractor Personnel Office DOD Department of Defense DoDI Department of Defense Instruction EMS Environmental Management System FGS Final Governing Standards FIPS PUB Federal Information Processing Standards Publication FY Fiscal Year HAIMS Healthcare Artifacts and Image Management Solution HIPAA Health Insurance Portability and Accountability Act HSPD Homeland Security Presidential Directive JCI Japanese Compulsory Insurance JST Japan Standard Time LVN Licensed Vocational Nurse MDG Medical Group MDGI Medical Group Instruction MTF Medical Treatment Facility MOU Memorandum of Understanding MPF Military Personnel Flight MSME Medical Standards Management Element NACI National Agency Check With Inquiries OHME Outstanding Occupational Health Exams OMB Office of Management and Budget OSHA Occupational Safety Health Administration PCM Primary Care Managers PWS Performance Work Services SHPE Separation History and Physical Examination SOFA Status of Forces Agreement SOP Standard Operationing Procedures SS Services Summary TAPS Transition Assistance Program Service TSWF Tri Service Work Flow VA Veteran’s Assistance