Attachment_1_(Amend_0002)_-_Performance_Work_Statement.pdf

Solicitation Number: FA520918R0005 Attachment 1– Performance Work Statement

(Amendment 0002 - Changed para: 1.6.1)

PERFORMANCE WORK STATEMENT

FOR

JAPAN-WIDE NURSING SERVICES (JWN)

FOR

KADENA, MISAWA, AND YOKOTA AIR FORCE BASE

374 MDG

16 FEB 2018

JAPAN WIDE NURSE CONTRACT

AT 374TH MEDICAL GROUP, YOKOTA AIR BASE, JAPAN

1. DESCTIPTION OF SERVICES: The Air Force Medical Service (AFMS) has a requirement for five (5) Registered Nurse (RN) Case Managers, two (2) Licensed Practical Nurse or Licensed Vocational Nurse (LPN/LVN) Utilization Managers, one (1) Nurse Practitioner (NP) DRHA provider and one (1) RN, Family Practice Clinical Nurse at Air Force medical treatment facilities in Japan. The contractor shall provide all labor, materials, tools, equipment, transportation, and supervision necessary to recruit, qualify, place, manage and retain the following case manager, utilization management, and nurse professionals:

Kadena AB* Two (2) Registered Nurse Case Managers One

(1) LPN/LVN Utilization Manager

* Personnel are also required to work at United States Naval Hospital Okinawa

Misawa AB

One (1) Registered Nurse Case Manager

Yokota AB Two (2) Registered Nurse Case Managers One

(1) LPN/LVN Utilization Manager One (1) Nurse Practitioner (NP) DRHA Provider One (1) Family Practice Clinical Nurse (RN)

1.1. NON-PERSONAL SERVICES. The services to be performed shall be non-personal services and are not inherently governmental. The contractor is solely liable for the actions of their employees.

1.2. CONTRACTOR MANAGEMENT STAFF RESPONSIBILITIES.

1.2.1. The prime contractor’s staff, including all teaming partners, subcontractors and their staff at corporate level involved in the company’s or team’s administration of this contract will hereafter be termed as contractor management staff. The contractor retains responsibility for any teaming partner or subcontractor and shall be accountable for their performance.

1.2.2. The four (4) labor categories recruited and hired by the contractor management staff to perform the services as described in this contract will be termed hereafter as contractor personnel.

1.2.3. At least fourteen (14) business days prior to the required start date at the Military Treatment Facility (MTF), the contractor management staff shall provide to the MTF an employee package for that employee as proof the employee meets all experience and training requirements of the contract.

The package shall consist of a resume or curriculum vitae, minimum of two (2) letters of recommendation, a copy of nursing license, a copy of any applicable certification certificate or cards and any other qualifying documentation (i.e., immunization record).

1.2.4. The Defense Medical Human Resources System Internet (DMHRSi) is the DoD accounting system for financial, personnel, education and training, and workload within MTFs. The Contractor Management Staff is responsible to provide all required information monthly (for example: personal data, work schedule, worked hours, work center, etc.) for all contractor personnel to the Medical Expense and Performance Reporting System (MEPRS) manager or clinic MEPRS monitor for entry into the system by the Air Force.

1.2.5. The contractor shall submit an employment agreement to the Government covering the base period at proposal submissions. The employment agreement is any form of the document that proves the performer’s engagement between the contractor and the individual (contractor’s employee) who will be dispatched to the designated location.

1.3. POSITION REQUIREMENTS.

1.3.1. General Requirements Applicable to Each Position

1.3.2. Work Environment/Physical Requirements. The work is primarily sedentary. However, there may be some physical demands. Requirements include standing, sitting or bending. Individual is required to walk throughout facility to interact with staff and providers including transport of relevant documents.

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

1.3.4. Utilizes MTF performance improvement tools in data collection and identifies barriers to the achievement of improvement in multidisciplinary treatment teams and/or clinical programs. Seeks assistance from the MTF’s Quality/Performance Improvement Manager and other case managers as needed.

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

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

1.3.7. Contractor employees performing under contracts with the United States for the provision of services in support of U.S. armed forces in Japan, and whose presence is required in Japan to provide such services, may be determined eligible to acquire the Status of Forces Agreement between the United States and Japan (SOFA) status in Japan as part of the civilian component under Article I(b) of the SOFA.

1.3.8. Knowledge and understanding of developmental growth; dynamics of human behavior, family, and other social systems; and the impact of illness and disability on social functioning. Demonstrate knowledge of and respect for military chain of command, structure of medical management department, concepts of care coordination, and patient education. HCI is the supervisor for medical management and the rater for all medical management nurses, i.e. case management RN (CM), special needs coordinator RN (SNC), utilization management RN (UM), and disease management RN (DM).

1.4. The Contractors may be required to complete theater specific training and are considered key personnel. In addition, contractors may be utilized to the fullest scope of practice in the event of increased population and/or enrollment.

1.5. Licensed Practical Nurse/Licensed Vocational Nurse (LPN/LVN), Utilization Manager

1.5.1. Education. Graduation from a State Board of Nursing approved LPN/LVN training program or completion of equivalent United States military training that permits sitting for a state licensure examination.

1.5.2. License/certification. Nurse applicants must be a current U.S. LPN/LVN. Active, current, valid and unrestricted license to practice nursing in accordance with State Board requirements. License cannot be under investigation nor have any adverse action pending from a Nursing State Board or national licensing/certification agency.

1.5.3. Experience. Four (4) years of clinical nursing experience is required. LPN/LVN shall have held full time employment in a nursing field for twelve (12) out of the last twenty-four (24) months (mandatory). Equivalent combinations of education and experience may be qualifying if the experience is directly related to utilization management. Equivalency combinations must be acceptable to the MTF and approved by the Contracting Officer.

1.5.4. Knowledge. The contractor must have a working knowledge of Ambulatory Procedure Grouping (APGs), Diagnostic Related Grouping (DRGs), International Classification of Diseases- Version 9 (ICD-9), Current Procedural Terminology-Version 4 (CPT-4) coding and InterQual or Milliman Ambulatory Care Guidelines. Working knowledge is defined as having at least one (1) year of experience working these items or training certifications.

1.5.5. Specific Tasks

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

1.5.5.2. Conducts special analyses on patient utilization of health services and health care provider orders and referrals for specialty care, therapies, pharmaceuticals and diagnostic testing to identify both excessive and insufficient use of services (e.g., patients with 100% or more emergency room visits compared to the average of all patients; physicians who order 50% more special tests than their peers). Identifies ways to reduce overutilization and suboptimal underutilization of services.

1.5.5.3. Reviews referrals for administrative, clinical completeness and appropriateness in coordination with the Chief, Medical Staff (SGH) or deputy SGH. Completes medical necessity and benefit reviews on referrals and makes recommendations to the MTF approval authority for approval/disapproval of the specialty care requested. Coordinates with the TRICARE Overseas Program contractor as needed to determine availability of local care.

1.5.5.4. Schedules referral appointments in accordance with Air Force Access to Care (ATC) standards with DoD and civilian health care providers. Ensures appointing is done within the Access to Care standards. Notifies the MTF group practice manager, TRICARE Operations and Patient Administration Flight or SGH if ATC standards are not met for referrals.

1.5.5.5. Coordinates with specialty referral clinics to obtain special patient instructions and/or tests required prior to appointment. Provides pre-appointment instructions to patients as well as the details regarding their referral appointment (i.e., date/time, provider, and location). Ensures patients receive necessary documentation appropriate for the referred medical care visit.

1.5.5.6. Locates referral requests and ensures appropriate documents are available prior to all specialty appointments. Prints diagnostic reports and/or treatment profiles as necessary.

1.5.5.7. Verifies eligibility of beneficiaries using Defense Eligibility Enrollment Reporting System (DEERS).

1.5.5.8. Facilitates utilization management activities by participation in multidisciplinary patient care activities. Initiates/coordinates communication between beneficiaries, team members, internal staff and providers, DoD/civilian providers and ancillary health care workers. Provides feedback regarding utilization review issues within one (1) business day.

1.5.5.9. Reviews and enters first right of refusal referrals into CHCS and database within one (1) business day of the date of the referral.

1.5.5.10. Interfaces with the TRICARE Overseas Program contractor, SGH and multidisciplinary personnel as needed to ensure appropriateness of referrals. Submits referrals from civilian providers to the TRICARE Service Center or TSC for medical necessity and appropriateness review.

1.5.5.11. Performs data collection, trending and analysis to identify patient care requiring intensive management. Refers to case management officials as needed.

1.5.5.12. Provides and educates Adjusted Clinic Grouping (ACG) or Resource Utilization Band (RUB) data to Primary Care Manager (PCM) teams to help identify high utilizer patients for medical management referrals.

1.5.5.13. Process medical in-process forms for Hospital Newcomers, First Term Airmen Class (FTAC), and Right Start programs. Identifies and reports patients with outstanding profile or Review in Lieu of MEB (RILO/MEB) to flight medicine providers.

1.5.5.14. Receives and makes patient telephone calls and computer/written correspondence regarding specialty clinic appointments and referrals. Routinely monitors referral management CHCS queue to ensure patients are being called that do not utilize the Referral Management Center (RMC) walk-in service.

1.5.5.15. Contacts patients in event referral requests are invalid, disapproved by second level review or TRICARE Overseas Program contractor and reschedules patients as soon as possible or instructs patients of other health care options.

1.5.5.16. Answers, completes and/or appropriately forwards patient or provider telephone calls.

1.5.5.17. Coordinates with patient movement office to advise patients of their referral/health treatment options as related to their eligibility per beneficiary status and covered benefits.

1.6. Registered Nurse Case Manager

1.6.1. Education. Must have graduated from a baccalaureate degree program in nursing (BSN) accredited by a national nursing accrediting agency recognized by the US Department of Education.

1.6.2. Nurse applicants must be a current U.S. licensed Registered Nurse. Active, current, valid and unrestricted license to practice nursing in accordance with State Board requirements. License cannot be under investigation nor have any adverse action pending from a Nursing State Board or national licensing/certification agency. Fully licensed (without restriction) as a registered nurse to practice nursing autonomously within the scope of nursing credentials/educational levels.

1.6.3. Experience. RN must have at least three (3) years of licensed nursing practice. Two (2) years’ experience in Discharge Planning or Case Management is highly desired. Certification in case management from the American Case Management Association, the American Academy of Case Management or the American Nurses Credentialing Center issued within the last (2) two years may be substituted for direct case management experience.

1.6.3.1. Equivalent combinations of education and experience may be qualifying if the education or experience is directly related to case management. Equivalency combinations must be acceptable to the MTF and approved by the Contracting Officer.

1.6.3.2. One registered nurse case manager position at Yokota AB must speak fluent Japanese. Japanese- Language Proficiency Test Certificate of Results and Score of at least N2 or equivalent certificate are required for non-native Japanese speakers. The Government will accept a Japanese STAMP Score with a Benchmark Level of 8 (Advance-Mid) as an equivalent to the Language Proficiency Test Certificate of Results and Score of N2. Any other possible equivalent certification of language certification, not listed above, will be submitted to and approved by the Contracting Officer. When visiting patients at the host nation facility (i.e. Japanese Hospitals), the intent is to provide healthcare services and build relationships with the host national providers. Non-healthcare services are not authorized.

1.6.4. Specific Tasks

1.6.4.1. Provides patient-centered case management and discharge/disposition planning (e.g., patient advocacy, assessment, planning, implementation, coordination, monitoring, and evaluation) in inpatient and ambulatory care settings, with early identification and interventions focused on outcomes.

1.6.4.2. Completes general and special needs program planning, implementation, and evaluation, and in conducting individual, family, group, and community interviews and assessments as well as individualized identification of special needs.

1.6.4.3. Ensures initial and ongoing assessments identify patient needs, issues, resources and care plans in a timely manner including patient health education needs.

1.6.4.4. Ensures care goals are set and agreed upon by the primary provider and patient.

1.6.4.5. Ensures coordination of care delivery processes to enhance patient’s health and wellness, safety, productivity, and quality of life, to include alternate care settings and the home environment.

1.6.4.6. Teleconference and Webinar: Attend routinely scheduled teleconference and webinar, i.e.

CarePoint Training, AFMOA Medical Management, MiCare training, etc.

1.6.4.7. Database access and nursing informatics: Utilize CarePoint daily to identify patients for medical management referrals, i.e. UM, DM, CM, or SNC. Document CarePoint usage and MiCare usage in AHLTA daily. Demonstrate ability to build query in Care Point and Group List in MiCare in order to manage your group of case management patients.

1.6.4.8. Briefings: Submit all briefing documents to HCI by the specified due dates, i.e. monthly Population Health Support Function (PHSF) PowerPoint slides and monthly peer review excel documents if applicable.

1.6.4.9. PCM Huddle: Attend weekly PCM huddle to collaborate with PCM team for patient referral to medical management services. Coordinate with PCM nurse to determine a designated weekly time for PCM huddle.

1.6.4.10. Case management nurse coverage (YOKOTA AB): There are two case management RNs. One case management RN to communicate with the host nation facilities (HNF) and another case management RN to communicate with St. Luke’s hospital, CONUS facilities, and aeromedical evacuation (AE) team, and Theatre Patient Movement Requirements Center (TMPRC). Unless authorized by HCI/FREDS/COR, The HNF RN and the AE RN cannot be out of the office at the same time since they provide coverage for each other when one is out of the office.

1.6.4.11. Space “A” patients (“Civilian” non-Tricare beneficiaries): Although patients who are seen on space available (space “A”) basis are not in the same priority category as active duty patients, they will receive the same high quality of care from medical management nurses, regardless of status. Timely of care services is determined by acuity level, not by status. Medical Management nurses will continue to provide services to Space “A” patients in order to alleviate workload on the Primary Care Manager (PCM). The intent of Medical Management is to support the PCM and the concept of Patient-Centered Medical Home (PCMH). As vital members of the medical Management team, all medical management nurses will provide the same quality of care for space “A” patients as patients in other priority categories. This is needed to facilitate a smoother workflow based on PCMH concept.

1.6.4.12. Medical CMs provide CM services for Mental Health (MH) treatment to MTF MH Clinic patients only as outlined in AFI 44-172, Mental Health. MH CM for MH patients is provided by MH staff except in special and very limited circumstances. In cases where MH patients have medical issues that require specialty care and/or medical CM, the medical CM will co-manage the patient with the MH

CM.

1.7. Nurse Practitioner (NP) DRHA Provider

1.7.1. Education/License/Experience. The contract supplied Provider must have an advanced degree in an accepted field of study from an accredited institution, along with current, valid license and/or certification (as applicable) to practice in field of expertise. The contract provider must be trained and licensed/certified provider as follows:

1.7.2. Nurse Practitioner. Nurse Practitioner must hold at a minimum a Master’s Degree in Nursing from an accredited institution, as well as a current unrestricted license to practice nursing in one of the fifty states, the District of Columbia, Puerto Rico, Guam, or the U.S. Virgin Islands. Candidate also must be certified as a nurse practitioner by a professional organization such as the American Nurses Credentialing Center (ANCC) or the American Academy of Nurse Practitioners (AANP). Maintenance of required licensure/certification is mandatory. Candidate should also have experience with evaluation and treatment of mental health disorders to include Post Traumatic Stress Disorder.

1.7.3. SPECIFIC TASKS (DRHA PROVIDER)

1.7.3.1. Coordinate appropriate aspects of the program with the base Installation Deployment Officer (IDO), Unit Deployment Managers (UDMs), Unit Health Monitors (UHMs), Occupational Shop Supervisors, Public Health, commanders, Chief of Medical Staff (SGH), Chief of Aerospace Medicine (SGP) and medical clinic personnel.

1.7.3.2. Perform deployment related health assessment and annual mental health assessment services that comply with applicable Department of Defense and Air Force policy and guidance, to include required standards of care and clinical practice guidelines.

1.7.3.3. Ensure all personnel deploying to a location which requires a DRHA complete the DRHA questionnaire, and receive a person-to-person interview, or arrange with a privileged provider within 30 days of submission by member. All personnel redeploying from these locations must receive a person-to-person interview in accordance with the following timeframes:

1.7.3.4. For CRITICAL findings, contact the patient to determine if urgent care or immediate intervention is required, within 1 duty day. Ensure a face-to-face provider interview occurs within 3 duty days.

1.7.3.5. For PRIORITY findings, ensure a face-to-face provider interview occurs within 7 calendar days

1.7.3.6. For ROUTINE findings, ensure a face-to-face provider interview occurs within 30 calendar days.

1.7.3.7. Ensure accurate knowledge of referral system and limitations on island.

1.7.3.8. Ensure all personnel deploying receive appropriate Force Health Protection Prescriptive Products (FHPPP) per AFI 44-102, Medical Care Management to include:

1.7.3.8.1. Prescribing anti-malarial prophylaxis IAW Centers for Disease Control and Prevention (CDC), National Center for Medical Intelligence (NCMI) and location specific reporting instructions (RIs).

1.7.3.8.2. Prescribing chemical warfare antidotes including but not limited to ATNAA (atropine and pralidoxime chloride) and Diazepam autoinjectors, pyridostigmine bromide.

1.7.3.8.3. Prescribing biological warfare antibiotics IAW CDC, NCMI and location specific RIs.

1.7.3.8.4. Providing clinical guidance for members with potential counter-indications to FHPPP vaccinations including but not limited to smallpox and anthrax.

1.7.3.9. Consulting with the SGH and SGP regarding members requiring medical waivers.

1.7.3.10. Consult with Yokota Air Base UDMs to ensure deploying and redeployed Service members are notified of eligibility for DRHA completion in a timely manner and to assist with maintaining satisfactory completion rates.

1.7.3.11. Conduct DHAs IAW the Deployment Health Assessments Program Guide, 15 November 2014 or most current guidance.

1.7.3.12. Document clinical encounters in patients’ electronic medical records using appropriate codes for DRHAs, and other deployment-related-condition encounters. The contract provider shall prepare all documentation to meet or exceed established standards of the MTF to include but not limited to:

timeliness, legibility, accuracy, content, and signature.

1.7.3.13. Provide patient referrals for specialty care and ensure follow-up. Document referrals on DRHA questionnaire and in patients’ electronic medical records. The contract provider shall follow Federal, DoD, Air Force, Medical Treatment Facility (MTF), and clinic regulations and policies when arranging for a referral or consult. The contract provider shall inform patient of the required referral or consult by indicating the specialty involved. The contract provider shall not recommend to the patient that he/she consult a specific practitioner or use a specific practice.

1.7.3.14. As appropriate, report DRHA compliance metrics and program initiatives to installation leadership, such as Population Health Working Group, Aerospace Medicine Council, Yokota Team Staff Meeting, etc.

1.7.3.15. Ensure the Yokota Air Base DRHA program is administered in accordance with current DoD and USAF policy regarding deployment health.

1.7.3.16. Remain knowledgeable in DoD/Veterans Affairs (VA) Post-Deployment Health Clinical Practice Guideline (PDH-CPG) found at http://www.pdhealth.mil/education/presentations.asp#ett

1.7.3.17. Ensure health care providers conducting DRHAs receive DoD/VA PDH-CPG training, and other appropriate deployment-healthcare education, and are sufficiently trained and certified to perform mental health assessments.

1.7.4. Provide a full range of nurse practitioner services in accordance with privileges granted by the Commanding Officer (e.g., supervise and provide general screening and medical care and examinations of patients for routine, acute and chronic conditions involving any and all organ systems; provide immunizations; diagnose, treat, and counsel patients as indicated). “Full range of nurse practitioner service” includes providing quality patient care to deployers, services members, family members, and other beneficiaries as needed.

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

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

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

1.7.8. Order diagnostic tests as applicable.

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

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

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

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

1.8. Assesses patients

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

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

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

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

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

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

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

1.9. Family Practice Clinical Nurse (RN)

1.9.1. Education. Must have graduated from a baccalaureate degree program in nursing (BSN) accredited by a national nursing accrediting agency recognized by the US Department of Education.

1.9.2. License/certification. Nurse applicants must be a current U.S. licensed Registered Nurse.

Active, current, valid and unrestricted license to practice nursing in accordance with State Board requirements. License cannot be under investigation nor have any adverse action pending from a Nursing State Board or national licensing/certification agency.

1.9.3. Experience. RN must have at least three (3) years of clinical experience in a primary care setting to include; outpatient clinic, inpatient hospital, emergency room or urgent care.

1.9.4. Knowledge of professional care theories, principles, practices, and procedures. Experience in assessing pediatric, adolescent, adults, obstetrics, and geriatric patients, as appropriate.

1.9.5. Knowledge of a wide range of medical disorders/conditions and disease processes across the lifespan, as appropriate. Knowledge of preventive health schedules, procedures, processes and education methods as well as knowledge of disease management and population health principles.

1.9.6. Knowledge of a variety of pharmacologic agents used in patient treatment, the desired effects, and complications of their use as well as the accurate administration of the pharmacologic agent, including dosage calculation as required. Knowledge of the administrative requirements for proper documentation of patient conditions including disease progress, acknowledgment of teaching, and follow up care.

1.10. Specific Tasks

1.10.1. Provide consultation from a nursing standpoint in complex cases and act as a point of contact for professional colleagues involved with patient and patient’s family. The CN will assist in preparation of histories and clinical records, ensure continuity of care of referrals under provider’s guidance, and ensure follow up appointments are made in a timely manner for patients after referrals are completed.

1.10.2. Assist in preparation and review of case histories and clinical records as needed. Under the provider’s guidance, the CN will order diagnostic procedures and imaging studies including radiographs, MRI, CT scans, clinical laboratory tests and other diagnostic imaging studies as appropriate. The CN will ensure providers are updated of all imaging and lab results.

1.10.3. Actively participate in ongoing improvement projects, depending on clinical needs, associated with disease management, prevention, and population-based health management.

Ensures initial and ongoing assessments identify patient needs, issues, resources and care plans in a timely manner including patient health education needs.

1.10.4. Assist the Health Care Integrator (HCI) and providers to re-assess and refine clinic level prevention programs. Assist with implementation of new or changing prevention recommendations for the clinic team. Provide disease management/population health focused inservices to team.

1.10.5. Educate and counsel at appropriate age levels patient and patients’ family about their potential risk for diseases or injuries, using clinic approved literature or websites. The CN will ensure the patient/family’s understanding and compliance and make appropriate recommendations and referrals.

1.10.6. Triage questions regarding medical necessity, appropriateness of care, and quality concerns for patients using established guidelines from telephone triage protocols . Use appropriate resources and provider for consult management. These telephone consults (t-cons) will be generated through AHLTA.

Each t-con will evaluate patient needs and respond to identified needs and/or redirect concerns to appropriate level of care. The CN will ensure symptom based t-cons are addressed within 24hours and non-symptom based t-cons will be addressed within 72 business hours. If there are problems with computer access, these issues must be clearly documented.

1.10.7. Ensures coordination of care delivery processes to enhance patient’s health and wellness, safety, productivity, and quality of life, to include alternate care settings and the home environment.

1.10.8. Demonstrate strong customer service skills and foster development of those skills throughout entire PCM team.

1.10.9. Furnish procedures compatible with the medical facility's operating capacity and equipment. New medical procedures/services shall not be introduced without prior recommendation to, and approval of, the MTF Commander or authorized representative. The CN should be proficient in or willing to train on the following procedures: IV placement and medication administration, IM medication administration, oral mediation administration, physical assessments, vision assessments, otoacoustic emissions test, nebulizer treatments, vaccination administration, ear irrigation, venipuncture, bladder catheterizations, Pulmonary Function Tests

1.10.10. Histories and exams performed by the CN will be pertinent and clearly documented in a timely fashion in AHLTA. Documentation must be clear, concise and complete for all patients. Nursing diagnosis will be accurate with appropriate action and follow-up. Referrals will be appropriate for diagnosis and assessment and age appropriate preventive screenings will be demonstrated.

1.10.11. Document evaluation of pain, medication administration and re-assessment of pain. Medication reconciliation will be documented for all encounters. Correctly use and document Clinical Practice Guidelines (CPGs) and Staff Support Protocols (SSP) per facility standards. Follow up abnormal vital signs and document actions. All clinic procedures will be documented accurately and in a timely manner.

1.10.12. Assist the Health Care Integrator (HCI) and providers to re-assess and refine clinic level prevention programs. Assist with implementation of new or changing prevention recommendations for the clinic team. Provide disease management/population health focused inservices to team.

1.10.13. Support providers on transport of patients on an as needed basis during regularly scheduled hours. Patient will be monitored during transport per MTF protocol, documentation will be clear and concise and with warm hand-off to accepting nurse.

1.11. GENERAL INFORMATION.

1.12. MEDICAL LIABILITY INSURANCE. The Government may evaluate the quality of professional and administrative services provided, but retains no control over professional aspects of the services rendered, including by example, the Contractor’s professional medical judgment, diagnosis, or specific medical treatments. The Contractor shall be solely liable for and expressly agrees to indemnify the Government with respect to any liability producing acts or omissions by it or by its issued employees. The Contractor shall provide a copy of the medical liability insurance document to the Contracting Officer prior to contract performance and maintain such insurance during the terms of this contract. The liability insurance shall be issued by a responsible insurance carrier of not less than the following amount(s) per specialty per occurrence $1,000,000.00, $3,000,000.00 aggregate. If at any time the Contractor changes insurance providers, the Contractor shall provide evidence to the

Contracting Officer that the Government will be indemnified to the limits specified above per specialty per occurrence. Reference AFI 44-119, Medical Quality Operations, 4.2.5.2. Non-personal services contract personnel are independent contractors and are required to carry professional liability insurance.

The Federal Tort Claims Act does NOT cover this individual. The contractor is responsible to ensure that the individual has malpractice liability coverage and often indemnifies its employee. Non-personal services contract employees must maintain a current, unrestricted, active license from the state in which they are practicing and, if required, a certification or registration when caring for patients within the

MTF.

1.13. PRE-PERFORMANCE HEALTH REQUIREMENTS

1.13.1. All healthcare workers (HCW) must in-process through Public Health (PH) within 10 duty days of arrival at the 374 Medical Group.

1.13.2. The Centers for Disease Control and Prevention (CDC) Healthcare Infection Control Practices Advisory Committee (HICPAC) and Advisory Committee on Immunization Practices (ACIP) definition for HCW is used here and includes:

1.13.2.1. All paid and unpaid persons working in health-care settings who have the potential for exposure to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or contaminated air.

1.13.2.2. HCW might include (but are not limited to) physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, volunteers, contractual staff.

1.13.2.3. HCW might also include persons (e.g., clerical, dietary, housekeeping, maintenance, and volunteers) not directly involved in patient care but potentially exposed to infectious agents that can be transmitted to and from HCW.

1.13.2.4. Department of Defense Joint Instruction AFJI 48-110 “Immunizations and Chemoprophylaxis” directs immunizations and chemoprophylactic practices follow current national standards as per CDC ACIP. Specific guidance for healthcare workers is posted on the internet.

i. http://www.cdc.gov/vaccines/acip/index.html and http://www.cdc.gov/niosh/topics/healthcare/

ii. For further information on current requirements, please contact PH at DSN 315-225-5311

1.13.2.5. HCW will not begin duties until and unless determined to be in compliance with infection/immune status as defined by CDC ACIP and determined by PH.

1.13.3. Preventive, Prophylactic and Follow-up Procedures. The contractor shall ensure that his/her employees are in compliance with preventive, prophylactic and follow-up procedures, as well as infection control and employee health program procedures, as established by the MTF. Required preventive, prophylactic and follow-up procedures will be paid by the Contractor. If care is received somewhere other than Yokota AB, the Contractor shall provide written verification of treatment.

1.13.4. Pregnant Employees. It is the 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.

1.13.5. 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.

1.13.6. At least fourteen (14) business days prior to start of work, the contractor management staff is required to supply a complete employee qualification record (reference Paragraph 2.3.) as proof of immunization of contractor personnel working within MTFs for the following diseases: hepatitis B, influenza, measles, mumps, rubella, varicella, TDap, and proof of a negative TB skin test completed within the past twelve (12) months (if positive, proof of negative chest X-ray within the past twelve (12) months), hepatitis A and poliovirus.

1.13.7. Contractor personnel working at Kadena Air Base (registered nurse case managers) who must travel to the United States Naval Hospital Okinawa daily must have HIV titer as required by the MTF prior to the start of work.

1.13.8. No pre-employment medical tests or procedures required by the contract will be performed by the MTF (with the exception of Tuberculosis testing after start of work and exposure). Expenses for all required tests and/or procedures shall be borne by the contractor management staff or contractor personnel, not the Government.

1.13.9. In those areas where there is a higher risk of transmission of tuberculosis, contractor personnel may be tested as frequently as directed by the MTF policy at the Government’s expense.

1.13.10. Contractor personnel working in an MTF are required to be immunized annually with the influenza vaccine as recommended by the CDC. This vaccine will be provided by the Government at no cost to contractor personnel. If the vaccine is obtained at other facilities, the cost will be borne by the Contractor Management Staff or contractor personnel, not the Government.

1.13.11. Immunization information for contractor personnel shall be provided to the respective MTF for government personnel to record and track in DoD computer systems.

1.13.12. The Government will provide post blood borne exposure protocols according to applicable Air Force Instructions.

1.14. MEDICAL HEALTH INSURANCE COVERAGE Contractor personnel and their dependents residing with them in Japan, if applicable, must have adequate health insurance coverage for overseas medical services. This includes coverage to pay for the cost of medical evacuation from the host country to receive emergency medical treatment when adequate treatment is not available in the host country.

1.15. OVERSEAS MEDICAL/EDUCATION SERVICES

Contractor personnel should be prepared to use the medical and dental services of the host country.

Medical care at overseas military treatment facilities is limited. Care, when available will be provided on a reimbursable basis, through MTF billing of the patients’ medical insurance. Patients are responsible for paying any copays, deductibles or non-covered services, if applicable, to the MTF. Mental health care professionals are generally not available in the military medical units and host nation mental health professionals usually do not meet the needs of Americans. Individuals or family members with behavior disorders or requiring psychiatric or mental health care should not travel to overseas areas. Internal medicine practitioners and cardiologists are generally not available in military health care units. Military and foreign country pharmacies may not stock medicines or prescription drugs that are available in the U.S. Contractor personnel must pay for all prescriptions filled at the MTF. The MTFs pharmacy rates are comparable to rates in the United States. The contractor must determine whether adequate medical care is available in the host country prior to sending personnel or their family members that have medical problems or require medication. Military dental clinics are usually only available to provide emergency services.

1.16. Emergency healthcare services, if available, resulting from employment related accidents or injuries will be provided by the Government on a reimbursable basis.

1.16.1. It is the responsibility of the contractor to ensure the Government and host nation health care providers are paid for medical services rendered to contractor personnel and their dependents.

1.16.2. Under extreme emergency conditions where special circumstances require government transportation, the contractor shall be charged at the DoD established movement rate or Full Reimbursement Rate (FRR).

1.17. DEPARTMENT OF DEFENSE SCHOOLS (DoDDS). Education, including special education, to the children of contractor personnel who are eligible for services from DoDDS may attend school on a tuition and space available basis. Students must meet DoDDS criteria for special education. Services are provided based on an Individualized Educational Program. Most schools are not staffed for all disabilities although DoDDS staffs schools in specific locations for a full range of disabilities. Prior to sending a contractor employee and their child(ren) with significant disabilities (i.e., blindness, deafness, severe mental retardation, serious emotional impairments) to the job location, the contractor employee shall ensure the child's educational needs can be met.

1.18 PROCEDURE GUIDANCE. Contractor personnel shall perform medical duties in accordance with the MTF’s operating instructions and DoD or Air Force guidance. Changes or deviations from established objectives for services shall not be made without prior recommendation to, and approval of Contracting Officer or authorized representative (COR).

1.19. WORK SCHEDULES.

1.19.1. 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 6:00 a.m. to 7:00 p.m., 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.

1.19.2. 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 7 – 8 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.

1.19.3. Scheduled and Unscheduled Absences. Contractor personnel are allowed to take up to twenty

(20) work days of leave annually. Leave is classified as both annual, vacation or sick leave. Leave shall be taken in one (1) day increments and shall not exceed ten (10) consecutive work days. 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.

1.19.4. Replacement of contractor personnel. The contractor management staff shall replace permanent contractor personnel at the earliest possible. Contractor personnel must notify to the Contractor and the Government staff (FRED, COR, CA or KO) of the intention to vacate the job at least thirty (30) calendar days prior to the last duty day at the requesting location. (e.g. send resignation form/document to the Contractor). The Contractor must provide candidate package to the Government staff no later than thirty (30) calendar days prior to the date of resignation. 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.

1.19.5. 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:

CLIN Monthly Amount divided by thirty (30) calendar days = Daily Rate Daily rate divided by 8 hours = hourly rate Deduction amount = hourly rate multiplied by hours in absence

*** Thirty (30) calendar days shall be used for calculation purposes regardless of the total number of days within the month.***

The base closure due to the incremental weather may not be non-duty days. The rare cases will be determined whether duty or non-duty days by the FRED/COR.

1.19.6. Federal Holidays. Federal Holidays are paid days. Any Federal Holidays falling on Saturday will be observed on the preceding Friday, holidays falling on a Sunday will be observed the following Monday.

New Year’s Day 01 January Martin Luther King’s Birthday Third Monday in January President’s Day Third Monday in February Memorial Day Last Monday in May Independence Day 04 July Labor Day First Monday in September Columbus Day Second Monday in October Veteran’s Day 11 November Thanksgiving Day Fourth Thursday in November Christmas Day 25 December

1.20. CONDUCT.

1.20.1. The contracting officer may request that any contractor management staff or contractor personnel whose conduct, in the opinion of the Contracting Officer, interferes with proper order or professionalism at the installation where services are performed, be removed from such installation and the contractor will comply with such request.

1.20.2. The contractor management staff shall not employ individuals who are potential threats to health, safety, security, general well-being, or operational mission of the DoD and its population.

1.20.3. The contractor management staff is responsible to ensure…