Attachment_-_1_PWS_dated_20_Aug_2015.pdf

RFQ No.: FA5270-15-R-0018 Attachment 1, PWS dated 20 Aug 15

ACCESS TO CARE (ATC) ADMINISTRATIVE SERVICES, Okinawa, Japan

PERFORMANCE-BASED WORK STATEMENT (PWS)

FOR

“ACCESS TO CARE”

PATIENT APPOINTING AND ADMINISTRATIVE SUPPORT FOR THE

18th MEDICAL GROUP

KADENA AIR BASE, JAPAN

20 Aug 2015

TABLE OF CONTENTS

SECTION TITLE PAGE

I FAMILY HEALTH FRONT DESK CLERK 2

FLIGHT MEDICINE 4

PEDIATRICS FRONT DESK CLERK 6

PATIENT ADMIN RECS FUNCTION 8

APPOINTMENT CLERKS 10

II SERVICES SUMMARY / PERFORMANCE OBJECTIVES 11

III GENERAL INFORMATION 14

APPENDIX 1 APPLICABLE PUBLICATIONS AND INSTRUCTIONS 24

FAMILY HEALTH FRONT DESK CLERK

1. DESCRIPTION OF SERVICES. The Contractor shall provide administrative support services to Primary Care Manager (PCM) teams and beneficiaries to ensure daily functions associated with patient appointing and consult tracking for the Primary Care Clinics. The Contractor shall provide services for the 18th Medical Group, also referred to as the "medical treatment facility"

(MTF) herein.

1.2. The contractor shall:

Coordinate health services management functions and ensure team members receive information in a timely and efficient manner to facilitate continuity of patient care. Participates with PCM team members in providing, assessing and improving a wide variety of customer services and customer relations. Provide assistance in the management of all forms of communication between beneficiaries and PCM team members.

1.2.1. The contractor shall provide services in the Family Health Clinic.

1.3. GENERAL INFORMATION MANAGEMENT. Contractor shall:

1.3.1. Schedule appointments for follow-up within the Access to Care (ATC) categories, greet patients, screen and appropriately route phone calls at the front desk. Create telephone consultations and assist patients with Micare registration and invites. Average number of customer service phone calls per week at the front desk is 250. Average Micare invites per day is 20.

1.3.2. Verify patients are registered in Composite Health Care Systems (CHCS) and Defense

Eligibility and Enrollment Registration (DEERS). If not enrolled in (DEERS) or (CHCS) explain to the patient they will need to enroll through TRICARE.

1.3.3. Ensure all dependents and retirees have a DD2569 (Third Party Collections Form) on file, or provide form to be filled out and annotated in their records prior to checking in each patient.

The average number of dependents checking in per day is 50.

1.3.4. Assist with patient check in/out duties and performs end-of-day CHCS processing.

Provides patients with the appropriate paper work for their appointment upon check in and assists patients if needed. The average number of patients that check in per day ranges from 130-150.

End of day processing takes approximately 30 minutes to accomplish. At the end of the day every day the schedules need to be printed for the following day in case the system is down in the morning.

1.3.5. Complete clinic Ambulatory Data Management (ADM) functions, and coordinates patient related correspondence. Contractor shall update demographic/patient identification information.

1.4. APPOINTMENT FACILITATION. Contractor shall:

1. Schedule appointments for follow-ups and walk-in patients at the clinics discretion. Create telephone consultations for patients who want to speak with their provider team, get medication refills, results, or etc. Follow-ups and Walk-ins at the front desk averages between 30-50 patients per day.

2. Print diagnostic reports such as radiology findings and laboratory results. Route the results through clinical staff before providing them to the patient.

3. Perform all other administrative tasks assigned.

1.5. PROCEDURAL GUIDANCE. The Contractor shall not introduce services other than those included herein without prior recommendation to, and approval of, the Contracting Officer (CO).

If the scope of the contract is changed by additional services, the Contracting Officer (CO) prior to implementation will incorporate the change into the contract.

1.6. DOCUMENTATION. The Contractor shall prepare all documentation to meet or exceed established standards of the MTF to include but not limited to: timeliness, legibility, accuracy, content, format, complete patient identifying information, medically consistent, and error free.

The contractor shall obtain complete patient data, which may involve researching the information (e.g. telephoning the Contracting Officer’s Representative (COR)).

1.7. PATIENT LISTS. Patient lists, no matter how developed, shall be treated as privileged information. Lists and/or names of patients shall not be disclosed to or revealed in any way for any use outside the MTF without prior written permission by the Chief of Medical Staff.

1.8. RELEASE OF MEDICAL INFORMATION. Contract employees shall only release medical information obtained during the course of this contract to other MTF staff involved in the care and treatment of that individual.

1.9. COMMUNICATION. The Contractor shall ensure contract employees maintain open and professional communication with members of the MTF.

1.10. COMPLAINT MANAGEMENT. Complaints validated by the COR and Chief of the

Medical Staff shall be reported in writing to the Contracting Officer and the Contractor for action. Failure of the Contractor to correct validated complaints cited by the MTF staff and the

CO will be considered a failure to perform.

1.11 EDUCATION AND TRAINING. The MTF (Government) shall provide training on

Government provided forms and equipment, initial and continuing orientation. Training will be provided on the Composite Healthcare System, basic life support training, and Health Insurance

Portability and Accountability Act (HIPAA). Access to all privacy regulations will be provided.

The personnel performing this duty must complete and maintain the Basic Life Support Training every two years.

FLIGHT MEDICINE FRONT DESK CLERK

1. DESCRIPTION OF SERVICES. The Contractor shall provide administrative support services to Primary Care Manager (PCM) teams and beneficiaries to ensure daily functions associated with patient appointing, patient records management, and consult tracking for the

Primary Care Clinics. The Contractor shall provide services for the 18th Medical Group, also referred to as the "medical treatment facility" (MTF) herein.

in a timely and efficient manner to facilitate continuity of patient care. Maintain health records and storage and retrieval system. Participates with PCM team members in providing, assessing and improving a wide variety of customer services and customer relations. Provide assistance in the management of all forms of communication between beneficiaries and PCM team members.

1.2.1. The contractor shall provide services in the Flight Medicine Clinic.

1.3.1. Schedule appointments within the Access to Care (ATC) categories, greet patients; screen and appropriately route phone calls. The average number of phone calls per week for customer service questions and appointments is 200.

Eligibility and Enrollment Registration (DEERS). If not enrolled in (DEERS) or (CHCS) ensure they have a DD2569 available, or provide form to be filled out and annotated in their records.

1.3.3. Assist with patient check in/out duties and performs end-of-day CHCS processing.

Responsible for patient walk-ins, which on average are 150 patients per week. The average number of patients that check in per day is 40. End of day processing takes 30 minutes to accomplish. At the end of the day every day the schedules need to be printed for the following day in case the system is down in the morning

1.3.4. Complete clinic Ambulatory Data Management (ADM) functions, and coordinates patient

1.4.1 Schedule appointments, locate medical records and ensure appropriate documents are available prior to all patient visits.

1.4.2 Print diagnostic reports and/or treatment profiles as necessary; participates with PCM teams to complete Preventive Health Assessment (PHA) tasking, such as routing charts for record reviews and initiating Department of Defense (DD) Form 2766, Adult Preventative and

Chronic Care Flow sheet.

1.4.3. Coordinate Occupational Health Assessments (OHA) patient’s appointments with Public

Health Clinic. There are 20 OHAs that need to be performed weekly.

1.4.4. Coordinate Isoniazid (INH) patient’s initial and continuing treatment appointments with the Public Health Clinic.

1.5. MEDICAL RECORD MANAGEMENT. Contractor shall:

1.5.1. Upkeep general medical record by ensuring all forms are appropriately completed and filed, third party insurance information (DD Form 2569 Third Party Collection Program-Record of Other Health Insurance) and documentation is current and in the chart. Maintains approximately 1400 medical records.

1.5.2. Update CHCS/DEERS and retrieve, receive, and store medical records.

1.5.3. Perform in and out processing, audits, retirement actions, and copy medical records as required.

1.5.4. Conduct research on loose documents, annotate and file accordingly.

1.5.5. Research records for appropriate MTF ownership and mails accordingly. All records, files, and documents provided by the government remain Government property. Experienced contractor team members will help train new contractor team members regarding proper medical records management. The government section supervisor will provide guidance to contractor personnel who shall maintain and dispose of these records, files, and documents.

1.6. PROCEDURAL GUIDANCE. The Contractor shall not introduce services other than those included herein without prior recommendation to, and approval of, the Contracting Officer

(CO). If the scope of the contract is changed by additional services, the Contracting Officer

(CO) prior to implementation will incorporate the change into the contract.

1.7. DOCUMENTATION. The Contractor shall prepare all documentation to meet or exceed content, format, complete patient identifying information, medically consistent, and error free.

information (e.g. telephoning the Contracting Officer’s Representative (COR)).

1.8. PATIENT LISTS. Patient lists, no matter how developed shall be treated as privileged

1.9. RELEASE OF MEDICAL INFORMATION. Contract employees shall only release medical information obtained during the course of this contract to other MTF staff involved in the care and treatment of that individual.

1.10. COMMUNICATION. The Contractor shall ensure contract employees maintain open and professional communication with members of the MTF.

1.11. COMPLAINT MANAGEMENT. Complaints validated by the COR and Chief of the

Medical Staff shall be reported in writing to the contract administrator and the Contractor for

1.12 EDUCATION AND TRAINING. The MTF (Government) shall provide training on provided on the Information Assurance (IA), Composite Health Care System (CHCS), Armed

Forces Health Longitudinal Technology Application (AHLTA), basic life support training

(BLS), and Health Insurance Portability and Accountability Act (HIPAA). Access to all privacy regulations will be provided. The personnel performing this duty must complete and maintain

Basic Life Support Training every two years.

PEDIATRICS FRONT DESK CLERK

1. DESCRIPTION OF SERVICES. The Contractor shall provide administrative support services to Primary Care Manager (PCM) teams and beneficiaries to ensure daily functions associated with patient appointing, patient records management, and consult tracking for the Primary Care

Clinics. The Contractor shall provide services for the 18th Medical Group, also referred to as the

"medical treatment facility" (MTF) herein.

in a timely and efficient manner to facilitate continuity of patient care. Participates with PCM team members in providing, assessing and improving a wide variety of customer services and

1.2.1. The contractor shall provide services in Pediatrics.

1.3.1. Schedule appointments for follow-up within the Access to Care (ATC) categories, greet patients, screen and appropriately route phone calls at the front desk. Create telephone consultations and assist patients with Micare registration and invites. Average number of phone calls per week at the front desk is 200. Average Micare invites per day is 15.

they have a DD2569 available, or provide form to be filled out and annotated in their records.

1.3.3. Ensure all dependents and retirees have a DD2569 (Third Party Collections Form) on file, or provide form to be filled out and annotated in their records prior to checking in each patient.

The average number of dependents checking in per day is 50.

1.3.4. Assist with patient check in/out duties and performs end-of-day CHCS processing.

Provides patients with the appropriate paper work for their appointment upon check in and assists patients if needed. The average number of patients that check in per day ranges from 25-

55. End of day processing takes approximately 20 minutes to accomplish. At the end of the day every day the schedules need to be printed for the following day in case the system is down in the morning.

1.3.5. Complete clinic Ambulatory Data Management (ADM) functions, and coordinates patient

1.4.1 Schedule appointments for follow-ups and walk-in patients at the clinics discretion. Create telephone consultations for patients who want to speak with their provider team, get medication refills, results, etc. Follow-ups and Walk-ins at the front desk range from approximately 20-30 patients per day.

1.4.2. Print diagnostic reports such as radiology findings and laboratory results. Route the results through clinical staff before providing them to the patient.

1.4.3. Perform all other administrative tasks assigned.

content, format, complete patient identifying information, medically consistent, and error free.

information.

1.7. PATIENT LISTS. Patient lists, no matter how developed shall be treated as privileged

1.11. EDUCATION AND TRAINING. The MTF (Government) shall provide training on provided on the Composite Healthcare System, basic life support training, and Health Insurance

Portability and Accountability Act (HIPAA). Access to all privacy regulations will be provided.

The personnel performing this duty must complete and maintain Basic Life Support Training

PATIENT ADMINISTRATION RECORDS FUNCTION

services to Outpatient Medical Records and beneficiaries to ensure daily functions associated with patient records management. The Contractor shall provide services for the 18th Medical

Group, also referred to as the "medical treatment facility" (MTF) herein.

Coordinate health services management functions and ensure team members receive information in a timely and efficient manner to facilitate continuity of patient care. Maintain health records and storage and retrieval system. Participates with Outpatient Records team members in providing, assessing and improving a wide variety of customer services and between beneficiaries.

1.2.1. The contractor shall provide services to the Patient Administration Records room.

1.3.1. Greet patients and assist all beneficiaries with access to their medical records.

1.3.2. Verify all patients are registered in Composite Health Care Systems (CHCS) and Defense the individual proceeds to the TRICARE Service Center and/or reports to their respective

Military Personnel Section.

1.4. MEDICAL RECORD MANAGEMENT. Contractor shall:

1.4.1 Upkeep general medical records by ensuring all forms are appropriately completed and filed, third party insurance information (DD Form 2569 Third Party Collection Program-Record of Other Health Insurance) and documentation is current and in the chart. Accurately maintain

18,000 medical records.

1.4.2 Update CHCS/DEERS and retrieve, receive, and store medical records. The average daily pull is 10 and the approximate daily file is 90 records. Assist the customer service window with an average of 250 patients per months.

1.4.3 Perform in and out processing, audits, retirement actions, and copy medical records as required. The record retirements are accomplished annually and must be completed within 30 days. It takes approximately 160 man hours to accomplish a records retirement. The 6,600

Active Duty record audits must be completed annually and within 30 days. Personnel will in-process on average 65 records weekly and out-process approximately 125 members weekly.

Personnel will conduct on average 95 record copy requests per month, requiring approximately

2 hours per record with each request consisting of 2 records on average.

1.4.4 Upload loose documentation in HAIMS. Average amount of documentation to be uploaded is 6 inches daily, in which 1 inch of paperwork takes on average 90 minutes to upload.

1.4.5 Research records for appropriate MTF ownership and mails accordingly. All records, files, and documents provided by the government remain Government property. Experienced contractor team members will help train new contractor team members regarding proper medical records management. The government section supervisor will provide guidance to contractor personnel who shall maintain and dispose of these records, files, and documents.

1.4.6. Conduct Service Treatment Records (STRs) Retirement monthly. Average amount of records pulled and processed per month is 50 STRs. All AHLTA notes, Labs and Radiology reports must be printed and filed within record. Each STR takes on average 90 minutes to complete.

content, format, complete patient identifying information, medically consistent, and error free.

1.12 EDUCATION AND TRAINING. The MTF (Government) shall provide training on provided on the Composite Healthcare System, basic life support training, and Health Insurance

Portability and Accountability Act (HIPAA). Access to all privacy regulations will be provided.

APPOINTMENT CLERKS

services to Primary Care Manager (PCM) teams and beneficiaries to ensure daily functions associated with patient appointing and consult tracking for the Primary Care Clinics. The

Contractor shall provide services for the 18th Medical Group, also referred to as the "medical treatment facility" (MTF) herein.

1.2 The contractor shall:

in a timely and efficient manner to facilitate continuity of patient care. Participates with PCM team members in providing, assessing and improving a wide variety of customer services and

1.2.1 The contractor shall provide services for the appointment desk.

1.3 GENERAL INFORMATION MANAGEMENT. Contractor shall:

1.3.1 Schedule appointments within the Access to Care (ATC) categories, screen and appropriately route phone calls, and create telephone consultations.

1.3.2 Verify patients are registered in Composite Health Care Systems (CHCS) and Defense

Eligibility and Enrollment Registration (DEERS) prior to booking appointments. If not enrolled in (DEERS) or (CHCS) inform the patient to report to TRICARE to get registered.

1.3.3 Complete clinic Ambulatory Data Management (ADM) functions, and coordinates patient

1.4 APPOINTMENT FACILITATION. Contractor shall:

1.4.1 Schedule all medical appointments. Create telephone consultations for patients who want to speak with their provider team, get medication refills, results, etc. The average number of calls per month ranges from 6,300 to 7,400. This breaks down to an average of 370 calls per day. Each phone call must be answered within 90 seconds.

1.4.2 Be familiar with all front desk procedures in Family Health, Pediatrics, Flight Medicine, Internal Medicine, Women’s Health, and Optometry.

content, format, complete patient identifying information, medically consistent, and error free.

information.

1.10 COMPLAINT MANAGEMENT. Complaints validated by the COR and Chief of the

1.11. EDUCATION AND TRAINING. The MTF (Government) shall provide training on provided on the Composite Healthcare System, basic life support training, and Health Insurance

Portability and Accountability Act (HIPAA). Access to all privacy regulations will be provided.

SECTION II

SERVICES SUMMARY / PERFORMANCE OBJECTIVES

The Contractor service delivery requirements are summarized into performance objectives that relate directly to standards of performance required to meet mission essential needs. For the

Performance Objective to be met, service delivery must be in substantial compliance with applicable performance standards. The Performance Threshold describes the minimum overall levels of service delivery required for acceptable quality control. Failure to meet these

Performance Thresholds means that contractor Quality Control is unacceptable and the contractor will be required to re-perform the task. If the task is still unacceptable then a meeting with the contractor will be conducted to improve the situation. The following is a list of the key performance objectives that will be verified as contractually compliant by government personnel; however, inspection of any contract requirement is authorized.

FAMILY HEALTH FRONT DESK CLERK

PERFORMANCE

OBJECTIVE

PWS REFERENCE

THRESHOLD

General Information

Management

Para 1.3

95% of tasks completed with no error

Appointment Facilitation

Para 1.4

95% of all appointments booked correctly including correct ATC search with booked appt type

Telephone consults

No more than 3 errors per

120 days

Communication

Para 1.9

No more than 2 written customer complaints per

FLIGHT MEDICINE FRONT DESK CLERK

booked correctly including

Medical Records

Para 1.5

95% of all loose paperwork researched and filed within

48 hours of receipt

Para 1.10

PEDIATRICS FRONT DESK CLERK

booked correctly including

PATIENT ADMINISTRATION RECORDS FUNCTION

Medical Records

95% of all loose paperwork researched and filed within

48 hours of receipt

Para 1.11

APPOINTMENT CLERKS

booked correctly including

Telephone consultations

SECTION III

GENERAL INFORMATION

4. QUALITY CONTROL

4.1. PERFORMANCE EVALUATION MEETINGS. The CO shall periodically require the

Contractor or representative to meet with the CO, contract administrator, COR, and other government personnel. The Contractor may request a meeting with the CO. Meetings will be documented in the contract file with written minutes signed by the contract manager and the CO.

Should the Contractor not concur with the minutes, such non-concurrence shall be provided in writing to the CO within ten (10) calendar days of receipt of the minutes.

4.1.1. The government shall rely on the contractor's existing quality assurance systems as a substitute for government inspection and testing.

4.2. SECURITY REQUIREMENTS.

4.2.1. Physical Security. The Contractor shall be responsible for safeguarding all medical information provided for Contractor use. At the close of each workday, information shall be secured.

4.2.2. Identification and Base Passes. The contractor shall obtain identification cards and base passes for employees and vehicles. Application shall be coordinated through the CO or designated representative. At time of application, Security Forces will conduct a background check on employees. Upon termination of employment, the contractor shall return identification cards and base passes to security Forces within 24 hours.

4.2.3. Key Control. The contractor shall establish and implement methods of ensuring that all keys issued to the contractor by the government are not lost or misplaced and are not used by unauthorized persons. The contractor shall report lost keys to the QAP. The contractor shall not duplicate any keys.

4.2.3.1. The government may, at its option, require the contractor to replace keys, reimburse the government for replacement of locks, or re-key as a result of contractor losing keys. In the event a master key is lost, the contractor shall replace all locks and keys for that system and the total cost shall be deducted from the monthly payment.

4.3.4. The contractor shall achieve the same level of trustworthiness for contractor or subcontractor personnel as required for Government personnel with similar access to automated information systems (AISs) and networks containing DoD Sensitive Information (SI). The contractor shall meet the personnel security requirements for Automated Data Processing (ADP) access in DoD 5200.2-R, Personnel Security, for employees and subcontractor employees that require access to Government (IT) systems or DoD SI, or are involved in developing, delivering, or supporting IT systems and services, or safeguarding DoD sensitive information within

Government or contractor systems. The contractor shall classify ADP/IT or related positions, submit appropriate paperwork for background investigations or proof of a favorable adjudication, ensure individuals receive requisite training and document compliance. Personnel background investigations and training must be initiated before access to DoD AIS/networks or DoD SI is allowed. Following contract award, details for completing and forwarding forms for requesting an investigation will be coordinate with the Government IT Security Officer designated for the networks and systems being accessed.

4.3.5. National Agency Checks. The contractor shall comply with DoD 5200.2-R, Department of Defense Personnel Security Program and AFI 33-119, electronic Mail Management and Use requirements for contractor personnel operating Government workstations that have unclassified automated information systems (e-mail, MIS, Internet, CAMS, etc.) Requests for National

Agency Checks (NAC) on contractor personnel hired at the beginning of the contract shall be submitted to the Government no later than 14 working days from the contract start date.

Requests for NACs on contractor personnel hired subsequent to the contract start date shall be submitted to the Government not later than five (5) workdays prior to the employee’s first duty day.

4.3.5.1 Proof of background check. The contractor shall provide, at no cost to the government, a certificate of criminal record from the National Police Agency of Japan to the security manager no later than 14 working days from the employee’s start date. This document will allow the security manager to grant access to the employee for automated information systems

(AISs) and networks containing DoD Sensitive Information (SI). Contractor personnel receiving unfavorable NACs shall not be granted access to these systems and will be terminated.

4.4. PERSONNEL.

4.4.1. INITIAL EMPLOYMENT. During the first 30 days of each new employee starting work under this contract, the government will closely monitor individual performance. At the end of the 30 days, the MTF will notify the contractor of any employee who demonstrates unsatisfactory performance in relation to the performance objectives outlined in this document.

4.4.2. HEALTH REQUIREMENTS. Initial immunization documentation shall be provided by the contractor to the MTF prior to a contract employee commencing work. Documentation is required for: MMR (immunization or titer levels for Rubella and Rubeola), history of chicken pox disease or positive titer (varicella vaccination must be accomplished if lack of immunity), Tetanus Diphtheria (Td), TB Mantoux skin test (IPPD) if positive, minimum requirement will be follow- up with the contractor's physician and a chest x-ray. Additionally, a physician must provide documentation of "no active respiratory disease." It is the contractor’s responsibility to pay for any medical exam necessary to ensure this public health compliance requirement is met.

4.5. HOURS OF OPERATION.

4.5.1. Provide services during the normal day-to-day business hours for the MTF.

BLDG # DAYS OF THE WEEK HOURS OF OPERATION

626 Monday through Friday 06:30 A.M. - 5:00 P.M.

4.5.2. Recognized Holidays. The contractor is not required to provide service on the following days:

New Year's Day 1 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 4 July

Labor Day First Monday in September

Columbus Day Second Monday in October

Veterans' Day 11 November

Thanksgiving Day Fourth Thursday in November

Christmas Day 25 December

4.6. CONTRACTOR PERSONNEL.

4.6.1. CONFLICT OF INTEREST. The contract shall not be any person who is an employee of the Department of the Air Force, either military or civilian, unless such person seeks and receives approval in accordance with DOD Directive 5500.7-R, Joint Ethics Regulation. The contractor personnel shall not employ persons for the work of this contract if such employment would create a conflict of interest per AFI 64-106, AIR FORCE INDUSTRIAL LABOR

RELATIONS ACTIVITIES.

4.6.2. CONTRACT MANAGER (CM). The Contractor shall provide a CM who shall be responsible for the performance of the work. The CM shall be available in person or via telephone Monday through Friday, 6:30 A.M. until 5:00 P.M. excluding federal holidays. 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 Contractor shall designate this individual, in writing, to the

Contracting Officer (CO) before the contract start date. An alternate may be designated, but the

Contractor shall identify those times when the alternate shall be the primary point of contact.

4.6.3. EMPLOYEE REQUIREMENTS. All personnel, regardless of functional area (i.e. Family

Health Front Desk Clerk, Appointment Clerk etc.), must meet the below requirements.

4.6.3.1. ENGLISH LANGUAGE REQUIREMENT. Personnel shall read, understand, speak, and write English to at least a STEP (Eiken) 2 nd grade, TOEIC score 519 or TOEFL score 456 level or higher. If personnel’s primary language is English, no certification is required.

4.6.3.2. High School diploma or General Educational Development (GED) equivalency.

4.6.3.3. EXPERTISE. The personnel performing this duty are knowledgeable in general medical terminology/language, medical ethics, health records administration, telephone etiquette, office management methods, excellent communications and customer service skills, strong organizational background and computer operations to include Windows Operating

Systems, spreadsheet, database, and word processing applications.

4.6.4. ABSENCES AND LEAVE. In case of absences or illness, exceeding one (1) day the

Contractor shall replace the absent employee with another person, of equal or exceeding qualifications, within 24 hours of COR’s notification. The identified substitute must have already completed, or be in the process of completing, NAC requirements in order to access government computers. The Contractor shall advise the CO, supervisor or designee about absences due to illness or incapacitation. If the contractor is absent for more than two consecutive days due to illness, the Contractor shall provide the government with a statement that the employee is free from communicable illness and the cause of the illness before or as the employee returns to work. The government has no interest in tracking the status of individual employees by name when they are absent, only to ensure that they will not pass illnesses on to others. The Government reserves the right to examine and or re-examine any worker who meets this criterion. The Contractor shall notify the MTF within fourteen (14) days in advance of scheduled leave for all employees.

4.6.5. FAILURE OR INABILITY TO PERFORM. Any worker demonstrating impaired judgment shall not be permitted to work in the MTF. The Government reserves the right to remove from the facility any worker who in the judgment of a licensed provider is impaired by drugs or alcohol. Workers removed for alcohol/drug abuse or behavioral misconduct may be allowed to return to work under the terms of this agreement only with prior Government approval. Evidence of continued problems will be cause for the Government to require that the contractor furnish another worker to perform the required duties.

4.7. CONTINUATION OF ESSENTIAL DOD CONTRACTOR SERVICES DURING CRISIS

IAW DoDI 3020.37. Contractor Personnel Authorized to Accompany the U.S. Armed Forces; it is the responsibility of the FD/FC to make the determination of the Access to Care services to be non-essential. This service is not determined to be essential for performance during crisis. In the event of crisis, the contractor will be notified by the Contracting Officer of the need to discontinue services due to base closure or other causes. If notification to discontinue services is not received, the contractor will be expected to continue performance in accordance with this

PWS.

4.8. PHASE OUT

4.8. 1. If there is a change in contractor or if the operation reverts to in-house, the incumbent contractor will provide familiarization, to the government or the follow-on contractor, whichever the case may be. During the phase-out familiarization period, the incumbent will be fully responsible for the operation of this contract.

4.8.2. The government reserves the right to conduct site visits in all contractor operated facilities in conjunction with the solicitation of offers for the follow-on contract. In the event the follow-on contract is awarded to other than the incumbent, the incumbent contractor will cooperate to the extent required to permit an orderly change over to the successful contractor. With regard to the successor contractor’s access to incumbent employees, a recruitment notice may be placed in each facility.

4.9 CONTRACTOR MANPOWER REPORTING. The Contractor shall report ALL Contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract for the Air Force via a secure data collection site. 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 shall direct questions to the CMRA help desk.

5. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

OF 1996

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 HIPAA. 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 HIPAA Privacy for DOD medical facilities is set forth in DOD 6025.18-

R, and for HIPAA Security, the requirements for AF MTFs are contained in the Health

Information Technology (HIT) Guide. The HIT Guide also contains additional information

Assurance requirements for all AF MTFs. MTFs 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 DoD 6025-18R, the Contractor and Health Care Workers 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 Health Care Workers agree to abide by all HIPAA Privacy and

Security requirements regarding health information as defined in this clause, DoD 6025-18-R, as amended and draft/final AFI 41-217, incorporated by reference. Additional HIPAA requirements will be addressed when implemented.

5.1. PRIVACY OF PROTECTED HEALTH INFORMATION

(a) Definitions. As used in this clause generally refer to the CFR definition, unless a more specific provision exists in DOD 6025.18-R:

Individual has the same meaning as the term “individual” in 45 CFR 164.501 and shall include a person who qualifies as a personal representative in accordance with 45 CFR 164.502(g).

Privacy Rule means the Standards for Privacy of Individually Identifiable Health Information at

45 CFR part 160 and part 164, subparts A and E.

Protected Health Information has the same meaning as the term “protected health information” in

45 CFR 164.501, limited to the information created or received by The Contractor from or on behalf of The Government.

Required by Law has the same meaning as the term “required by law” in 45 CFR 164.501.

Secretary means the Secretary of the Department of Health and Human Services or his/her designee.

Terms used, but not otherwise defined, in this Agreement shall have the same meaning as those terms in 45 CFR 160.103 and 164.501.

(b) Contractor agrees to not use or further disclose Protected Health Information other than as permitted or required by the Contract or as Required by Law.

(c) Contractor agrees to use appropriate safeguards to prevent use or disclosure of the Protected

Health Information other than as provided for by this Contract.

(d) Contractor agrees to mitigate, to the extent practicable, any harmful effect that is known to the Contractor of a use or disclosure of Protected Health Information by the Contractor in violation of the requirements of this Contract.

(e) Contractor agrees to report to the Government any use or disclosure of the Protected Health

Information not provided for by this Contract.

(f) Contractor agrees to ensure that any agent, including a subcontractor, to whom it provides

Protected Health Information received from, or created or received by the Contractor on behalf of the Government, agrees to the same restrictions and conditions that apply through this

Contract to the Contractor with respect to such information.

(g) Contractor agrees to provide access, at the request of the Government, and in the time and manner designated by the Government to Protected Health Information in a Designated Record

Set, to the Government or, as directed by the Government, to an Individual in order to meet the requirements under 45 CFR 164.524.

(h) Contractor agrees to make any amendment(s) to Protected Health Information in a

Designated Record Set that the Government directs or agrees to pursuant to 45 CFR 164.526 at the request of the Government or an Individual, and in the time and manner designated by the

Government.

(i) Contractor agrees to make internal practices, books, and records relating to the use and disclosure of Protected Health Information received from, or created or received by the

Contractor on behalf of, the Government, available to the Government, or at the request of the

Government to the Secretary, in a time and manner designated by the Government or the

Secretary, for purposes of the Secretary determining the Government’s compliance with the

Privacy Rule.

(j) Contractor agrees to document such disclosures of Protected Health Information and information related to such disclosures as would be required for the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

(k) Contractor agrees to provide to the Government or an Individual, in time and manner designated by the Government, information collected in accordance with this Clause of the

Contract, to permit the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

5.2. GENERAL USE AND DISCLOSURE PROVISIONS

Except as otherwise limited in this Agreement, the Contractor may use or disclose Protected

Health Information on behalf of, or to provide services to, the Government for the other purposes, if such use or disclosure of Protected Health Information would not violate the

Privacy Rule or the Department of Defense Health Information Privacy Regulation if done by the Government: Treatment, Payment or Healthcare Operations.

5.3. SPECIFIC USE AND DISCLOSURE PROVISIONS

(a) Except as otherwise limited in this Agreement, the Contractor may use Protected Health

Information for the proper management and administration of the Contractor or to carry out the legal responsibilities of the Contractor.

(b) Except as otherwise limited in this Agreement, the Contractor may disclose Protected Health

Information for the proper management and administration of the Contractor, provided that disclosures are required by law, or the Contractor obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and used or further disclosed only as required by law or for the purpose for which it was disclosed to the person, and the person notifies the Contractor of any instances of which it is aware in which the confidentiality of the information has been breached.

(c) Except as otherwise limited in this Agreement, the Contractor may use Protected Health

Information to provide Data Aggregation services to the Government as permitted by 45

CFR 164.504(e)(2)(i)(B).

(d) Contractor may use Protected Health Information to report violations of law to appropriate

Federal and State authorities, consistent with 45 CFR 164.502(j) (1).

5.4. OBLIGATIONS OF THE GOVERNMENT

Provisions for the Government to Inform the Contractor of Privacy Practices and Restrictions

(a) Upon request the Government shall provide the Contractor with the notice of privacy practices that the Government produces in accordance with 45 CFR 164.520, as well as any changes to such notice.

(b) The Government shall provide the Contractor with any changes in, or revocation of, permission by Individual to use or disclose Protected Health Information, if such changes affect the Contractor’s permitted or required uses and disclosures.

(c) The Government shall notify the Contractor of any restriction to the use or disclosure of

Protected Health Information that the Government has agreed to in accordance with 45 CFR

164.522.

5.5. PERMISSIBLE REQUESTS BY THE GOVERNMENT

The Government shall not request the Contractor to use or disclose Protected Health Information in any manner that would not be permissible under the Privacy Rule if done by the Government, except for providing Data Aggregation services to the Government and for management and administrative activities of the Contractor as otherwise permitted by this clause.

5.5.1. TERMINATION

(a) Termination. A breach by the Contractor of this clause, may subject the Contractor to termination provision of this Contract.

(b) Effect of Termination.

(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 (2) and (3) below

(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.

(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.

5.5.2. MISCELLANEOUS

(a) ) Regulatory References. A reference in this Clause to a section in the Privacy Rule or

DOD 6025.18-R means the section in effect or as amended, and for which compliance is required.

(b) 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.

5.6. SECURITY OF PROTECTED HEALTH INFORAMATION

(a) Definitions. As used in this clause:

Electronic Protected Health Information has the same meaning as the term “electronic protected health information” in 45 CFR 160.103.

Secretary means the Secretary of the Department of Health and Human Services or his/her designee.

Security Rule means the Security Standards for the Protection of Electronic Protected health

Information at 45 CFR part 160 and part 164, subpart C.

Terms used, but not otherwise defined, in this Agreement shall have the same meaning as those terms in 45 CFR 160.103, 164.103, and 164.304.

(b) The Contractor agrees to implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity and availability of the

Electronic Protected Health Information that it creates, receives, maintains, or transmits on behalf of the Government.

(c) The Contractor agrees to report to the Government any security incident of which it becomes aware.

(d) The Contractor agrees to ensure that any agent, including a subcontractor, to whom it provides Electronic Protected Health Information that it creates, receives, maintains, or transmits on behalf of the Government, agrees to the same restrictions and conditions that apply through this Contract to the Contractor with respect to such information.

5.6.1. MISCELLANEOUS

(a) ) Regulatory References. A reference in this Clause to a section in the Security Rule means the section as in effect or as amended, and for which compliance is required.

(b) Interpretation. Any ambiguity in this Clause shall be resolved in favor of a meaning that permits the Government to comply with the Security Rule per the CFR, then AFI 41-217 and any subsequent MTF Health Information Assurance Policies.

5.6.2. EQUIPMENT. During the hours of performance under this contract, the government will furnish desk, chair, workspace, computer and computer equipment, necessary software, required network access and connectivity, telephone, fax, reproduction services, office supplies, and parking on a shared basis.

5.6.3. COMPUTER SYSTEMS. The government will provide the contractor personnel access to the computer programs required to perform the tasks to include CHCS, TRICARE Online, ADS, Referral Management software/applications, and general desktop settings. In accordance with any applicable contract clauses, Common Access Cards (CAC) will be issued to the contractor personnel.

5.6.4. PROVIDED PUBLICATIONS. The Government shall provide the Contractor access to

Air Force directives, MTF policies and procedures prior to start of contract performance date.

5.7. JAPANESE ROAD LAWS.

5.7.1. 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:

5.7.2. 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.

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

5.7.4. 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.

5.8 REQUIRED INSURANCE by JAPANESE LAW.

5.8.1. 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.

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

5.8.3. All vehicles must be properly inspected/insured in accordance with Japanese Compulsory

Insurance (JCI) requirements.

5.8.4. Prior to the commencement of work hereunder, the Contractor shall furnish to the CO 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 CO.

APPENDIX 1

APPLICABLE PUBLICATIONS AND

FORMS

The contractor shall follow the publications below. The publications are available in the MTF and maintained by the Government. Supplements or amendments to listed publications from any organizational level may be issued during the life of the contract. The Contractor shall immediately implement those changes in publications that result in a decrease or no change in the price and notify the Contracting Officer (CO) in writing of such change. Should a decrease in contract price result; the Contractor shall provide a proposal for reduction in the price to the CO.

Prior to implementing any change that will result in an increase, the Contractor shall notify the

CO in writing, a breakdown of the proposed changes and the price associated within 30 days of receipt of the change by the Contractor. The CO and the Contractor shall negotiate the change into the contract. Failure of the Contractor to submit a price proposal within 30 days from receipt of the change shall entitle the Government to performance in accordance with such change at no increase in price.

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