Peblo_PWS.pdf

RFQ NO. FA5270-15-T-0067

Attachment 1, PWS

PERFORMANCE WORK STATEMENT

FOR

NONPERSONAL SERVICE CONTRACT

AIR FORCE MEDICAL SERVICES PEBLO

STAFFING

AT

KADENA AB, OKINAWA, JAPAN

18 MDSS/SGSM

Kadena AB, Okinawa, Japan

April 2015

1.0. OBJECTIVE: Non-personal service of Physical Evaluation Board Liaison Officer (PEBLO) will serve a clinical administrator in the Medical Evaluation Board (MEB) program.

1.1. GENERAL SCOPE: Representative will be responsible for counseling active duty and Reserve Component members (Reserve and Guard) and commanders on program requirements, military benefits, legal rights, and the appeals process. Coordinates Aeromedical evacuation or other patient travel requirements, Temporary Disability Retirement Listings (TDRL), fitness for duty determinations, lines of duty and other program requirements related to the Disability Evaluation System (DES). Advises service member and medical staff on Physical Evaluation Board (PEB) findings. The PEBLO shall furnish all labor, management, supervision, consultations and reports. Performance shall meet the professional standards of the Joint Commission on Accreditation of Healthcare Organization (JCAHO), Accreditation Association for Ambulatory Health Care (AAAHC), Unit Effectiveness Inspection (UEI), and Department of Defense (DoD)/Veterans Administration (VA)/United States Air Force (USAF) Instructions/Regulations. Representative will need to have a working knowledge of the above mentioned.

1.1.2. The PEBLO shall maintain health record storage. Contract personnel shall maintain and dispose of records, files, documents, and work papers in accordance with instructions provided by the Quality Inspector (QI) and in accordance with MTF (Medical Treatment Facility) policy and procedures.

1.2. SPECIFIC ADMINISTRATIVE TASKS: Provides administrative support for day to day operations; independently identifies the need for analyses, reports, and statistical workload data from various disability evaluation program sources.

1.2.1. Plans and completes necessary MEB process activities from the time of notification of the need to evaluate an active duty member’s fitness for duty until a disposition is made by the Secretary of the Air Force Personnel Council.

1.2.2. Responsible for obtaining, assembling, and forwarding all documents and records required by the PEB.

1.2.3. Receives and responds to inquiries from beneficiaries, DoD Components, other agencies, and various interested parties.

1.2.4. Coordinates with appropriate points of contact throughout the MHS, the line of the Air Force agencies, (i.e. Military Personnel Flights, Comptroller, Transportation, Aeromedical Evacuation) and the Department of Veterans Affairs (i.e. Veterans Benefits Administration [VBA] and Veterans Health Administration [VHA]) to best meet the member’s needs for information or assistance.

1.2.5. Assists the medical professional staff and other staff members on the regulatory and procedural aspects of profiling and disability processing.

1.2.6. Must have the ability to work cooperatively and interact in a positive and professional manner with patients, care giver(s)/support system, case managers, providers, and co-workers; work productively with minimal supervision.

1.2.7. Does not supervise or evaluate any other staff members.

1.2.8. Assures necessary arrangements are made for members to travel on temporary duty status to and from other locations as required.

1.2.9. Updates local program documentation, i.e., patient handouts, training documents, checklists, operating procedures, etc.

1.2.10. Advises service member and medical staff on PEB findings.

1.3. REPORTS: The PEBLO shall prepare and submit reports requested by the Quality Inspector (QI).

1.3.1. Maintain and provide monthly statistical reports to oversight committees and functions within the timelines designated by the QI.

1.4. STAFF TRAINING: The PEBLO is responsible for conducting initial training of all new providers and conduct refresher provider training once a year. Provides MEB orientation program and on the job training for assigned staff personnel as required.

1.5. MEETINGS: PEBLO shall attend and participate in meetings, staff conferences, and other appropriate activities as directed by QI.

1.6. COMMUNICATION: The PEBLO shall ensure that contract personnel maintain open and professional communication with other personnel. Complaints validated by QI and TRICARE Operations and Patient Administration (TOPA) Flight Commander shall be reported in writing to the contract administrator and the PEBLO for action. Failure of the PEBLO to correct validated complaints raise by the MTF staff and the Commander will be considered a failure to perform.

1.7. MONITOR EFFECTIVENESS: Monitors the effectiveness and efficiency of the local MEB, Line of Duty, and TDRL programs using the TRICARE Operations Self-inspection Checklist and other related AF instructions.

2.SERVICE SUMMARY (SS)

Performance Objectives Sow Paragraph

Performance Threshold

Did the service provider complete the administrative portion of the MEB case and send to AFPC (Air Force Personnel Center) within 30 days of completion of narrative summary by PCM (Primary Care Manager)?

1.2.1.

1.2.2. 100%

3. GOVERNMENT-FURNISHED PROPERTY AND SERVICES

3.0. GENERAL. The Government will provide the following equipment, supplies, and services listed below:

3.1. FACILITIES. The contractor shall be co-located with government personnel. Office space shall be provided in Bldg 626. The contractor shall be responsible for keeping the surrounding areas in a clean and orderly condition.

3.2. EQUIPMENT. Contract personnel shall have availability and access to government furnished equipment for performing services required by this contract. This includes computers, office equipment and furnishings, telephones, space, office supplies, and forms required to perform assigned duties.

3.2.1. Contract personnel will be authorized use of an administrative support available to Government employees. This will include but not be limited to copy machines, telefax machines, medical library, installation distribution, Class-A telephone lines and Defense Switching Network (DSN) lines for Government official business only.

3. 3. HOUSEKEEPING. The Government shall provide routine housekeeping services.

3.4. GOVERNMENT ORIENTATION/TRAINING. The Government will provide training on Government provided forms and equipment, universal precautions, initial orientation and continuing orientation. Contractor will participate in continuing education programs to update and/or maintain skills and knowledge to meet annual requirements.

Contractor will participate in evaluation of the quality and effectiveness of activities and services of the unit.

3.41. The Government will provide training to include appointing, referral management business rules, and Government IT systems requirements. The contractor’s staff shall have functioning knowledge of Government appointing and referral management business rules, Government appointing information systems, Joint Commission for the Accreditation of Healthcare Organizations (JCAHO), Accreditation Association for Ambulatory Health Care (AAAHC), HIPAA, DoD Health Information Privacy Regulation (DoD 602118-R) the Privacy Act, and DoD Privacy Program (DoD 5400. 1 l-R) to appoint beneficiaries correctly. All contractor staff that access Government IT systems shall be trained in security awareness, protection of Government sensitive and privacy information, and their responsibility and consequences before access is authorized.

3.6. RECORDS, FILES, DOCUMENTS, AND WORK PAPERS. All records, files, documents, and work papers provided by the government remain Government property.

The QI will, provide guidance to the contract personnel who shall maintain and dispose of these records, files, documents, and work papers in accordance with MTF policy and procedures.

3.7. SPACE, UTILITY, TELEPHONE SERVICES. The Government will provide all utilities and telephone services.

4. GENERAL INFORMATION

4.0 QUALITY ASSURANCE. The government will monitor the contractor’s performance. The government may increase or decrease the number of quality assurance inspections as performance indicates. The government reserves the right to inspect all of the contractor’s performance to ensure services are received. The contracting officer (CO), Quality Inspector (QI), or contractor may hold performance meetings regularly or as requested.

4.1. HOURS OF OPERATION.

4.1.1. The contractor shall maintain the following service hours to conduct normal day-to-day business: 7:00 a.m. to 4:00 p.m., Monday through Friday with a maximum of 40 hrs per week. When necessary for contractor personnel to work hours other than 7:00 a.m. to 4:00 p.m., Monday through Friday, contractor must coordinate with QI. There will be no overtime paid on this contract.

4.1.2. Recognized Holidays: The contractor is not required to provide service, other than emergency calls, 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

4.1.3. PERFORMANCE PERIOD:

FY15 Basic Year: 1 Jul 15 – 30 Jun 16 FY16 Option Year 1: 1 Jul 16 – 30 Jun 17

FY17 Option Year 2 : 1 Jul 17 – 30 Jun 18 FY18 Option Year 3: 1 Jul 18 – 30 Jun 19 FY19 Option Year 4: 1 Jul 19 – 30 Jun 20

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 work period, 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 may 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 QI. 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 or duplicated, the contractor shall replace all locks and keys for that system and the total cost shall be deducted from the monthly payment.

4.2.4. 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 coordinated with the Government IT Security Officer designated for the networks and systems being accessed.

4.2.4.1. The contractor shall use Protected Health Information (PHI) for their designated project only. This information shall not be used to create databases or any other product not intended for use specifically for this project. All PHI related to the project, but not delivered to the Government, shall be destroyed at the conclusion of the tasking.

Destruction of the information shall comply with The Deputy Secretary of Defense Memorandum, subject: “Destruction of DoD Computer Hard Drives Prior to Disposal,” dated January 8, 2001. The Memorandum requires that all hard drives containing unclassified data being disposed of outside DoD be removed and destroyed through sanitation of SI from storage media in a manner that gives assurance that the information is unrecoverable by technical means.

4.2.4.1.1. AU PHI processed and hard copy output by government and contractor Information Systems, ISs, and networks is considered SI and will be treated as “For Official Use Only”, FOUO, information, as directed by DoD 5400.7, “Freedom of Information Act,” September 1997. Any SI (e.g., PHI and privacy data, processed, printed, stored, or manipulated on government and contractor ISs and networks will be protected, marked, and labeled in accordance with DoD 5200. 1-R.

4.2.4.1.2. The contractor shall maintain, transmit, retain in strictest confidence, and prevent the unauthorized duplication, use, and disclosure of PHI in accordance with Standards for Privacy of Individually Identifiable Health Information, Final Rule, December 28, 2000, DoD Health Information Privacy Regulation (DoD 6025.1 8-R), the Privacy Act, and DoD Privacy Program (DoD 54.00.11-R). The Contractor shall provide patient information only to employees, Contractors, subcontractors, and Government personnel having a need to know such information in the performance of their duties for this project. The CO’s representative or QI shall approve the release of any patient information prior to the release.

4.2.5. Classified Information: The contractor shall safeguard all sensitive and For Official Use Only (FOUO) information that the contractor may be subjected to during the course of fulfilling this contract. Contractor personnel shall not disclose sensitive and FOUO information to any personnel or agencies, Government or civilian who do not have a verifiable need to know of that information.

4.2.5.1. Should contractor personnel receive or suspect they have learned of classified information; the contractor shall identify theft suspicion to the CO thru QI. The CO & QI shall then arrange for a security debriefing between the contractor and the appropriate security personnel.

4.2.6. Restricted Area Access: The QI shall arrange for any necessary access to restricted areas.

4.3. CONTRACTOR PERSONNEL. The personnel performing this duty shall be responsible for the performance of the work and shall have full authority to act for the contractor on all matters relating to daily contract operations. Personnel must be knowledgeable in general medical ethics, health records administration, telephone etiquette, office management methods, excellent communications and customer service skills, and strong organizational background and computer operations to include AHLTA, Microsoft Windows and spread sheet type applications. Personnel shall understand the importance of deadlines.

4.3.1. The contractor shall be available within 1 hour during normal duty hours, Monday through Friday, to meet with government personnel designated by the CO to discuss problem areas.

4.3.1.1. Absences and Leave. The contractor shall not be compensated during periods of absences and leave to include both annual and sick leave. If the contractor is absent for three or more consecutive days due to illness, the contractor shall be required to provide written documentation from a qualified health care provider that he or she is free from communicable disease and the cause of the worker’s current illness, The Government reserves the right to examine and or re-examine any worker who meets this criterion.

4.3.1.2. The contractor shall notify the QI in advance of scheduled leave and accommodate the MTF schedule for leave periods of a week or more. In cases of scheduled leave and temporary absences (scheduled or unscheduled) greater than 80 consecutive hours, the Contractor shall provide temporary replacement staff or salary will be deducted for approximate hours missed. The Contractor agrees to provide temporary replacement staff of equal or greater qualifications per the PWS requirements (Section 1 and 4). If the Contractor does not provide a temporary replacement, the Government reserves the right to procure such services from another source, until the Contractor restores routine services.

When the Government exercises its right to procure these services from another source, the Government will reduce the Contractor’s invoice at an equivalent amount to that incurred for the other source’s services. A copy of the other source’s service ticket will be used as the basis for this reduction. The Government will furnish the Contractor a copy of this ticket upon the Contractor’s request.

4.3. The contractor shall not employ persons for work on this contract if such employee is identified to the contractor by the CO as a potential threat to the health, safety, security, general wellbeing, or operational mission of the installation and its population.

4.3.1. Contractor personnel shall present a clean, neat appearance and be easily recognized.

The Medical Treatment Facility Badge shall be worn on the outermost garment.

4.3.2. Smoking is not permitted in any government building or work area. Smoking is authorized only in designated areas. The 18th Medical Group is a smoke-free campus.

4.3.3. The contractor shall not employ any person who is an employee of the US Government if employing that person would create a conflict of interest. Additionally, the contractor shall not employ any person who is an employee of the US Government either military or civilian, unless such person seeks and receives approval in accordance with Joint Ethics Regulation. The contractor shall not employ any person who is an employee of the Department of the Air Force if such employment would be contrary to Air Force policies.

4.3.4. Emergency Health Care. The MTF will provide emergency health care for contract personnel for injuries occurring while on duty in the MTF. These services will be billed to the Contractor at the current full reimbursement rate.

4.4. EDUCATION, TRAINING, LICENSURE, AND EXPERIENCE: The PEBLO shall ensure that personnel meet the following requirements below. Copies of the documents listed below shall be submitted with the quote.

4.4.1. Education: Proof of graduation from any accredited college with at least an associate’s degree in any medical field. Requirement can be waived with adequate work related experience.

4.4.2. Certifications: Provide any copies of medical certifications for example coding or transcription certificates.

4.4.5. Must have knowledge and one year experience in AHLTA, Composite Health Care System (CHCS), and Preventive Health Assessment and ASIMS.

4.4.6. NATIONAL AGENCY CHECKS. The contractor shall comply with the DoD 5200.2-R, Personal Security Program, and API 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.) Request for National Agency Checks (NAC)/favorable background investigation per AFSSI 8522 Chap 3.1.2, on contractor personnel hired at the beginning of the contract, shall be submitted to the Government not later than 14 working days from the contract start date.

Request for NACs on contractor personnel hired subsequent to the contract start date shall be submitted to the Government not later than five (5) workdays from the employee’s first duty day. Contractor personnel receiving unfavorable NACs shall not be hired. The Government at no additional cost to the contractor shall submit these investigations.

4.5. HEALTH REQUIREMENTS: Certification of current physical examination is required. The certification shall contain a signed statement by the examining physician stating that the employee is free of any contagious diseases.

4.5.1. A pre-employment physical examination is required prior to commencement of work and annually thereafter.

4.5.1.1. Not later than five (5) working days prior to commencement of work, certification shall be provided to the QAP that contract LPN/RN have completed medical evaluation required above. This certification shall state the date on which the examination was completed, the doctor’s name that performed the examination, and a statement concerning the physical health of the individual. The certification shall also contain the following statement: “(name of contract employee) is free from contagious diseases.”

4.5.2. INFECTION CONTROL AND SAFETY. The contractor shall comply with all MTF infection control and safety procedures, practices, and standards.

4.5.2.1. As a condition of employment, OSHA requires that all personnel who will have Occupational exposure to blood or body fluids, or other potentially infectious materials, shall receive Hepatitis B vaccine, sign a voluntary declination, or have documented proof of immunity to Hepatitis B infection. Personnel who sign declinations may change their minds at anytime and receive the Hepatitis B vaccine without penalty.

4.5.3. HIPAA COMPLIANCE. The contractor agrees to abide by all the requirements of the Health Insurance Portability and Accountability Act (HIPAA) regarding the privacy and confidentiality of health records and information being provided and shared tinder the resulting contract. The contractor shall also enter a Business Associate Agreement with the Medical Group.

4.5.3.1. The 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.

4.5.3.2. The Contractor agrees to use appropriate safeguards to prevent use of disclosure of the Protected Health Information other than as provided for by this Contract.

4.5.3.3. The contractor agrees to assist in mitigation, 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.

4.5.3.4. The Contractor agrees to report to the Government any use or disclosure of the Protected Health Information not provided for by this Contract.

4.5.3.5. The 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.

4.5.3.6. The 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 meeting the requirements under 45 CFR, Right to Access of Protected Health Information.

4.5.3.7. The 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, Right to Amend Protected Health Information, at the request of the Government or an Individual, and in the time and manner designated by the Government.

4.5.3.8. The 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.

4.5.3.9. The 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, Right to an Accounting of Disclosures of Protected Health Information.

4.5.3.10. The Contractor agrees to provide to the Government or an Individual, in time and manner designated by the Government, information collected in accordance with the 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 Right to an Accounting of Disclosures of Protected Health Information.

4.5.3.11. The contractor shall complete required initial Health Insurance Portability and Accountability Act training within 30 days of assignment to the Medical Group, and annually thereafter. In lieu of initial training, the contractor may submit proof of prior comprehensive training to the privacy office. Such training will be evaluated, and will be accepted providing it meets the training standards of the Department of Defense and the Medical Group.

4.6. ENVIRONMENTAL CONTROLS

4.6.1. Compliance with Laws and Regulations. The contractor shall be knowledgeable of and comply with all applicable Interstate, Federal, State, and Local laws, regulations, and requirements regarding environmental protection. In the event environmental laws/regulations change during the term of this contract, the contractor is required to comply as such laws come into effect. If there is an increase or decrease in cost as a result of the change, the contractor shall inform the Contracting Officer pursuant to notice requirements and negotiate a modification to the contract.

4.6.2. Notification of Environmental Spills. If the contractor spills or releases any substance contained in 40 CFR 302 into the environment, the contractor or its agent shall immediately report the incident to Kadena AB Fire Dept at 911. The liability for the spill or release of such substances rests solely with the contractor and its agent.

4.6.3. Material Storage and Use. The contractor shall follow manufacturer’s guidelines and professional recommendations for control of humidity, temperature, cleanliness, and materials handling. This includes hazardous materials.

4.7. SAFETY REQUIREMENTS

In performing work under this contract, the contractor shall:

4.7.1. Conform to the safety requirements contained in the contract for all activities related to the accomplishment of the work.

4.7.1.2. Perform work in a safe manner as required by OSHA 2206, General Industry, Occupational Safety and Health Standards (29 CFR 1910) and Japan Environmental Governing Standards (JEGS) by US Force Japan.

4.7.1.3. Develop and provide at the start of the orientation period or the start of the first operational performance period (if there is no orientation period) a safety plan for the protection of government facilities and property and to provide a safe work environment for contractor personnel

4.7.1.4. Provide protection to government property to prevent damage during the period of time the property is under the control or in possession of the contractor.

4.7.1.5. Include a clause in all subcontracts to require subcontractors to comply with the safety provisions of this contract as applicable.

4.7.1.6. Record and report promptly (within one hour) to the contracting officer or designated government representative (GR), all available facts relating to each instance of damage to government property or injury to either contractor or government personnel.

4.7.1.7. In the event of an accident/mishap, take reasonable and prudent action to establish control of the accident/mishap scene, prevent further damage to persons or property, and preserve evidence until released by the accident/mishap investigative authority through the contracting officer.

4.7.1.8. If the government elects to conduct an investigation of the accident/mishap, the contractor shall cooperate fully and assist government personnel in the conduct of investigation until the investigation is completed.

4.7.1.9. Include a clause in each applicable subcontract requiring the subcontractor's cooperation and assistance in accident reporting and investigation

4.8. INSURANCE:

4.8.1. REQUIRED INSURANCE (In addition to that required by Japanese Law).

(a) 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.

Type: Automobile Property Damage Insurance, Amount: Y3,000,000 or Dollar equivalent Bodily Injury Insurance Amount: Y30,000,000 or Dollar equivalent.

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

(b) Prior to the commencement of work, the Contractor shall certify in writing that your company has obtained and will maintain the required insurance for the life of the contract.

4.9. Termination

4.9.1. The CO may require that the contractor be removed from the Government job if they endanger persons or property, or whose continued employment under this contract is inconsistent with the interests of military security.

4.9.1.2. The CO, in writing, may require that the contractor be removed from the work site, area or base due to objectionable behavior. Objectionable behavior includes, but is not limited to, being improperly attired, using profane language or abusing or disobeying base/host country rules of conduct or regulations.

4.9.1.3. The contractor may terminate his/her contract with a 60 day notice given. This notice must be communicated with the QAP/Flight Commander and Medical Group Commander.

4.10. SUBMISSION OF INVOICES: The contractor shall submit an original, plus three

(3) copies of the invoice, no later than the 2nd workday of each month to the following:

18 MDSS/SGSL

Unit 5268 FM5270 Davis Ave Bldg 626 APO AP Kadena AB, Okinawa, Japan 96368

An invoice is a written request for payment under the contract for supplies delivered and services rendered. Each summary invoice shall be annotated and signed by the contractor or his/her designated representative that the charges are true and accurate.

In order to be proper, an invoice should include (and in order to support the payment of interest penalties must include) the information required:

(i) Invoice date;

(ii) Name of Contractor;

(iii) Contract number;

(iv) Date of sale and original receipts for items to be reimbursed;

(v) Name and address to which payment is to be sent (which must be the same as that in the contract or on &proper notice of assignment;

(vi) Name (where practicable), title, telephone number and mailing address of person to be notified in the event of a defective in-voice; and

(vii) Any other information or documentation required by the contract

(viii) While not required, the Contractor is strongly encouraged to assign an identification number to each invoice.

The Quality Assurance Personnel will verify that all services have been performed in a satisfactory manner and accept services performed by generating, signing, and forwarding an original, plus three (3) copies of the DD Form 250, Material Inspection and Receiving Report, with the original plus three (3) copies of the contractor’s invoice to DFAS Japan at the address below and one (1) copy of each to 18th Contracting Squadron within three working days from processing.

DFAS—FVF/JA-JAPAN

AIR FORCE VENDOR PAY

BRANCH/BVNF

UNIT 5220

APO AP 96328-5220

Attachment I

APPLICABLE PUBLICATIONS AND FORMS

Publications and forms applicable to the Performance Work Statement (PWS) are listed below. The Contractor is obligated to follow those publications. These 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, which result in a decrease or no change in the price and notify the CO thru QI 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 thru QI. Prior to implementing any change that will result in an increase, the Contractor shall submit to the CO thru QI a price proposal within 30 days of receipt of the change by the Contractor. The CO and the Contractor shall negotiate the change into the contract under the provisions of the contract clause entitled “Changes”. 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.

Applicable Technical, Regulations, References Manuals, Specifications, and Documentation. This list includes, but is not limited to the following:

Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act of 1992

Privacy Act of 1974

Title VI of the Civil Rights Act of 1964

Section 504 of the Rehabilitation Act of 1973

DoD Directive 5400.11-R, “The Freedom of Information Act of 1967”

Health Insurance Portability and Accountability Act of 1996 (HIPPA)

Electronic and Information Technology Accessibility Standards (36 CFR 1194)

DOD Regulation 5200.2-R, “DoD Personnel Security Program,” January 1987

Standards for Privacy of Individually Identifiable Health Information, Final Rule, December 28, 5 U.S.C. § 552a, as amended

32 CFR 199

Rehabilitative Act of 1973, Section 508 Appointment Standardization Commander’s Guide to Access Success

TRICARE Operations Manual, 6010.51-M, August 1, 2002, Chapter 21, Section 3

TRICARE Systems Manual, 7950.1-M, August 1, 2002, Chapter 1

Accreditation Process (DITSCAP)

DoD Health Information Privacy Regulation (DoD 6025.18-R)

DOD Privacy Program (DoD 5400.1l-R) Title 10, U.S.C., Chapter 55

DOD Directive 5500.7, Standards of Conduct, Mar 87

AIR FORCE REGULATIONS/MANUALS/INSTRUCTIONS

AFI 33-119, Electronic Mail (E-Mail) Management and Use, Mar 99

AFI 41-115, Authorized Health Care and Health Care Benefits in the Military Health System

AFI 41-210, Patient Administration Functions

AFI 44-119, Medical Service Quality Improvement and Risk Management, Oct 95

OTHER REFERENCES

Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Accreditation Manual for Hospitals, current edition

JCAHO Ambulatory Health Care Standards Manual, current edition http://www.jcaho.org/accredited+organizations/hospitals/standards/new+standards/pc_xwa lk_hap.pdf http://www.jcaho.org/accredited+oranizations/hospitals/standards/new+standards/im xwalk hap.pdf http://www.jcaho.org/accredited+organizations/hospitals/standards/new+standards/pc_xwalk_hap.pdf http://www.jcaho.org/accredited+organizations/hospitals/standards/new+standards/pc_xwalk_hap.pdf http://www.jcaho.org/accredited+oranizations/hospitals/standards/new+standards/im%20xwalk%20hap.pdf http://www.jcaho.org/accredited+oranizations/hospitals/standards/new+standards/im%20xwalk%20hap.pdf

AFMS Referral Management Center User’s Guide: https://kx.afms.mil/healthbenefits/

15. HQ USAF/SGO Memorandum, TRICARE Operations and Patient Administration Flight, date 27 August 2004.

16. 2005 Active Duty Health Services Inspection Guide

17. Joint Commission on Accreditation of Health Care Organizations (JCAHO) 2005 Standards (Pre-Publication Edition), http://www. jcaho.org/accredlited+oraanizations/hospitals/standards/new+standards/pc xwalk_hap.pdf

18. The Commander’s Guide to Access Success, http://www.tricare.osd.mil/tai/cguide.htm

19. Access to Care in Preparation for the T-Nex Environment, First Consulting Group Study, Prepared for AF/SG, March 2003 http://www.tricare.osd.mil/tai/cguide.htm