Attachment_1_Performance_Work_Statement.pdf

PERFORMANCE-BASED

WORK STATEMENT FOR

SPECIAL NEEDS COORDINATOR

And

FAMILY MEMBER RELOCATIONS

CLEARANCE COORDINATOR

FOR

18TH MEDICAL GROUP

KADENA AB, JAPAN

7 December 2016

Attachment 1 FA5270-17-T-0005 Special Needs Coordinator

PERFORMANCE WORK STATEMENT

The Contractor shall ensure that all contract correspondence that is addressed to the United States Government is submitted in English or with an English translation.

1. SCOPE OF WORK

The SNC Tasks and Responsibilities

1.1. The SNC oversees and manages the installation EFMP-M IAW DoD and Air Force policy, and any subsequent implementing guidance.

1.2. Establishes and maintains procedures to identify sponsors whose family members have special medical and/or educational needs in a timely manner.

1.3. Conducts assessments of family members of RegAF sponsors to determine if special medical and/or education conditions exist that require EFMP enrollment.

1.4. Ensures all RegAF sponsors known to the MTF as having family members with special needs according to DoD criteria are identified to the AFPC (via the local MPS and/or CSS, where applicable) for issuance of an ALC “Q”, regardless of the location of family members or the source of family health care.

1.5. Ensures all Army, Navy, and Marine Corps sponsors of family members with special needs are referred to their Services’ EFMP POCs for enrollment and relocation support IAW Service-specific guidance.

1.6. Ensures all RegAF sponsors known to the AFPC, and local MPS and/or CSS where applicable, as having family members with special needs are identified in AF medical special needs data management systems.

1.7. Ensures every RegAF sponsor with one or more family members with special needs that is assigned to the installation has an SN file maintained at the MTF and a case established in the AF-provided special needs data system (Q-base).

1.8. Coordinates, with AFPC (and the local MPS and/or CSS, where applicable) all assignment actions for all Q-coded AF sponsors assigned to the installation, or whose personnel functions are handled at the installation, regardless of location of family members.

1.9. The SNC is involved in the FMRC process as outlined in AFI 40-701, Medical Support to Family Member Relocation and Exceptional Family Member Program.

1.10. Complies with requirements for data security, maintenance, collection, and reporting IAW AFPD 40-7 and any subsequent AFMOA, MAJCOM, or MTF implementing guidance.

1.11. Provides AFMOA/SGHW the MTF/CC-signed appointment letters for the SGH, SNC, FMRCC, and alternates for access to password-protected data systems.

1.12. Ensures an organizational email account is established and maintained permitting direct communication with the EFMP-M offices for AFPC and representatives of DoD components.

The format of this email account will be basename.EFMPM@us.af.mil and will appear in the global address listing as “Base name <space> EFMPM <space>”.

1.13. To comply with AF and DoD provisions for safeguarding PII/PHI, emails containing such material are to be sent encrypted or otherwise sent securely.

1.14. Ensures currency of EFMP-M office(s) contact information (e.g., phone numbers, fax numbers, email addresses) hosted within AF-provided web-based communications and data management systems. Updates the EFMP-M office’s contact information in the AF electronic data management system, and ensures currency of access to organizational e-mail accounts.

1.15. Establishes procedures for the creation, maintenance, secure storage, transfer and retirement of SN files and FDI files IAW AF policy, EFMP-M guidance, and MTF guidance for the protection of PII and PHI.

1.16. Ensures that sponsors are provided all necessary documents for enrollment in TRICARE, Extended Health Care Options (ECHO). Where the SNC may not release protected health information to the sponsor, the SNC provides the needed documentation to the identified patient of majority age, or forwards the information directly to the TRICARE Managed Care Support Contractor or other authorized Health Affairs agent upon request.

1.17. Coordinates with MTF TRICARE representatives to provide information to beneficiaries about community, state and national resources specific to the special needs population.

1.18. Ensures Q-coded sponsors assigned to the installation are contacted annually to update their EFMP status, and provide any updates needed in contact information, family composition, or family member conditions; verification of need for continued enrollment as well as pending PCS should also be discussed.

1.19. Maintains a cooperative working relationship with AFPC, installation MPS, CSS, and all other associated offices for the following duties:

1.19.1. Completion of the AF Form 4380 for outbound personnel, authorization letters for initiation and deletion of Q-codes, prompt initiation of the FMRC process at notification of pending OCONUS assignment (if Q-coded, include CONUS), or 6 months prior to follow-on after an unaccompanied assignment, support to EFMP reassignment/deferments, and regular delivery of the base Q-code roster from AFPC or local MPS/CSS to the SNC.

1.19.2. Develops a Wing Supplement to AFI 40-701, for Installation Commander approval, to coordinate installation functions. At joint base locations in which the Air Force is the supported component and in lieu of the installation directive, a signed Memoranda of Agreement (MOA) or Memoranda of Understanding (MOU) will specify roles, responsibilities, and coordination between the Air Force and sister Service agencies. In such circumstances, the MOA and/or MOU will be reviewed by base legal office prior to final signature.

1.20. Ensures the timely identification of family members with special needs through collaborative outreach with installation youth and childcare facilities, officer and enlisted spouses groups, public education forums and interaction with community key personnel.

1.21. Ensures the appropriate documentation of EFMP-M workload as a military-specific mission in consultation with the MTF Medical Expense and Performance Reporting System (MEPRS) monitor using MEPRS code FAZN for all EFMP-M associated workload.

1.22. Will actively support the integration of EFMP-M, EFMP-FS, and EFMP-A services at the installation.

1.23. Participates with EFMP-FS in Newcomer’s Orientation and relocation briefings to ensure coordinated transitions for EFMP families.

1.24. May participate in the Integrated Delivery System to address EFMP needs at the installation.

1.25. Meets with the SGH or designee at least weekly or more frequently as needed to review all current/pending FDIs and Command Sponsorship requests.

1.26. Leads the Exceptional Family Member quarterly case reviews to discuss newly identified families, complex or unmet needs and determine appropriate resources necessary for families.

1.27. The SNC will document in AHLTA/Q-base/SN file the outcomes and any necessary course of action for each case/family member with special needs reviewed.

1.28. Ensures healthcare coordination is provided to family members who have multiple/severe medical needs to include, but not limited to, completion of the “warm hand-off” IAW current AF policy, AFMOA EFMP-M guidance, and MTF guidance.

1.29. Professional Qualities. Coordinator must display integrity, ethical decision making, and collaborative skills as applied to both co-workers and patients/families. The 18th Medical Group has a zero tolerance policy to all forms of discrimination and harassment.

1.30. Organizational Skills. Coordinator must be able to manage a complex variety of tasks at various stages of completion.

1.31. Judgment and Decisions. Coordinator is expected to behave as a professional at all times and to always balance the needs of the Air Force, the needs of the patient/family, and the existing relevant regulations.

1.32. Communication Skills. The coordinator must be able to write and verbally communicate clearly in English. Knowledge of a second language is desirable but not required. The coordinator is responsible for educating appropriate medical staff on aspects of the EFMP program annually, and may be asked to present this verbally.

1.33. Provide excellent customer service for all patients, families, and staff.

1.34. Communicate and collaborate with PCMs and appropriate members of the health care team to ensure that needs of assigned patients are met without duplication of effort.

1.35. Network with social services, Integrated Delivery System (IDS), utilization management, and the Health Care Integrator (HCI) to coordinate actions providing the right care at the right time and the right place. Recognize and remain up to date on limitations imposed by MTF capabilities, and local national and other DoD community resources.

1.36. Operating Procedures and Standards

1.36.1. Identification

1.36.1.1. In the course of routine medical care: All medical staff will refer family members to the EFMP-M office when conditions are identified that meet EFMP eligibility criteria as specified in DoDI 1315.19, Enclosure 4. Enrollment of the family member in EFMP is mandatory once eligibility is established, and does not require consent of family members or sponsors. Medical providers work collaboratively with the SNC to explain the EFMP to families and to elicit their cooperation.

1.36.1.2. Upon sponsor in-processing: The EFMP-M staff members within the MTFs (SNC and FMRCCs) collaborate with Medical In/Out-Processing POCs to establish procedures to ensure prompt identification of families with special needs during base in-processing. Existing base or medical in-processing forums (such as “Right Start”) may be used.

1.36.2. Enrollment

1.36.2.1. Conducts assessments of family members of RegAF sponsors to determine if special medical and/or education conditions exist that require enrollment. These assessments include interviews with family members and review of medical records or other medical documentation.

1.36.2.2. Where special medical needs are identified that meet DoD criteria for EFMP enrollment, the SNC will ensure the completion of the DD Form 2792 for each eligible family member.

1.36.2.3. Copies of the DD Form 2792 pertaining to minor dependents may be provided to the sponsor, parent, or legal guardian for use as needed as long as state and federal laws and AF policies for the protection of health information are followed. Ages of majority for consent to release protected health information may vary according to the types of treatment sought. The SNC consults with the SJA as needed to determine when written consent of the minor must be obtained prior to release of the DD Form 2792 to the sponsor, parent, or legal guardian.

1.36.2.4. Copies of the DD Form 2792 pertaining to adult dependents are only provided to the patient described on the DD Form 2792, unless the identified patient provides HIPAA compliant authorization to release it to others outside the DoD healthcare network, including to the sponsor.

1.36.2.5. Where special educational needs and/or developmental delays are identified in a child age birth to high school graduate (or General Equivalency Diploma), the SNC ensures the completion of the DD Form 2792-1 by qualified early intervention or school personnel. Any child that requires special education services beyond secondary education are also required to submit a DD Form 2792-1.

1.36.2.6. Ensures a case entry is established in Q-base indicating the sponsor’s current duty location. The SNC ensures the location and identifying information (such as Social Security Numbers and special medical/educational conditions) of all family members is accurate in both SN file and Q-base.

1.36.2.7. Ensures that initiation or deletion requests for the ALC “Q” for RegAF members are written and submitted in a timely manner to the installation MPS or CSS, as appropriate. Copies are maintained in the SN file and provided to the sponsor to document enrollment in the AF EFMP (personnel system) as well as the AF EFMP-M (medical system). The SNC sends a copy of the Q-code initiation letter to the gaining review authority with any FDI via Q-base.

1.36.2.7.1. Special Needs Coordinator’s memorandum to the MPS where sponsor’s personnel functions are managed (referred to as the servicing MPS), requesting initiation of an ALC “Q”, also known as Q-code.

1.36.2.7.2. All EFMP enrollment or disenrollment actions addressed to AFPC or the servicing MPS must be signed by the appointed SNC at the base where the sponsor’s personnel functions are managed.

1.36.2.8. The SNC notes the EFMP enrollment with effective date in Electronic Health Record of the eligible family member(s).

1.36.2.9. Where there is a disagreement between the SNC and other medical provider(s) on whether enrollment criteria are met, the case is forwarded to the SGH, and if necessary AFMOA EFMP-M, for final decision making. Documentation of the reason for the decision is entered in the medical record of the identified family member.

1.36.3. Disenrollment

1.36.3.1. Removal from EFMP is accomplished through retirement of the RegAF member, majority age of the identified child in which they no longer qualify as a dependent, divorce of the identified spouse, death of the family member with special needs, or change in circumstance in which the identified special need no longer exists.

1.36.3.2. To initiate disenrollment from EFMP, the RegAF sponsor or adult family member submits documentation of the change in status or condition to the SNC at the base of sponsor’s personnel management function, who validates the change and that there are no other family members who have special needs. This documentation may be in the form of court documents, DD Form 2792, DD Form 2792-1, updated medical summary from the treating specialist/provider or other official/validated forms.

1.36.3.3. The SNC requests the MPS remove the ALC “Q” from the sponsor’s personnel record.

1.36.3.4. The SNC ensures the electronic case is archived in Q-base, and the SN file is closed following HIPAA, Privacy Act, and MTF requirements.

1.36.4. The Family Member Relocation Clearance (FMRC)

1.36.4.1. Where special needs are known via Q-code, or prior to any relocation, an FMRC review must be initiated within 6-months of government sponsored family member travel with the exception of training courses over 90 days that are performed en route and required by gaining assignment, as well as Embassy/Attaché assignments. These reviews must be initiated in accordance with the training requirements/reporting. This is to ensure the most recent medical and educational information is available to the review authorities. Follow up Embassy/Attaché FDIs are permitted up to 8-months in advance of sponsor’s RNLTD to the OCONUS location.

The sponsor must notify the SNC at the base of current assignment of any changes in family member conditions or in needed services that are identified after the initiation of the clearance process and before initiation of family travel.

1.36.4.2. Family members of RegAF sponsors requesting family member travel at government expense to an OCONUS location, and CONUS location when there are family members with special needs, must participate in the FMRC. Required documentation and attendance at the FMRC will vary depending on location of the gaining assignment and family composition.

1.36.4.3. When family members are geographically separated from their sponsors (unaccompanied tours or other reasons for family separation), the EFMP-M office at the sponsor’s servicing base is responsible for coordinating all EFMP-M functions.

1.36.4.4. When it is necessary to accomplish EFMP-M functions involving the family members the sponsor’s servicing EFMP-M office may request assistance from the EFMP-M office nearest to the family (referred to as the supporting base).

1.36.4.5. The supporting base completes the FMRC including completion of the AF Form 1466.

1.36.4.6. The AF Form 1466 used in the FMRC/FDI must be signed by the servicing base SGH on page 5.

1.36.4.7. If the family members are geographically separated from the MTF conducting the FMRC, they may be seen by a civilian provider or a provider at a sister Service MTF. The provider or the MTF with the most recent information available about family care needs provides the needed information to support the review. In these cases the SNC and the MRO may communicate with the provider interviewing family members to ensure understanding of the purpose of such screening, the limitations of service availability in many locations, and the documentation needed to support the gaining installation in making travel recommendations.

1.36.5. Prior to the FMRC

1.36.5.1. Reviews all required family members’ medical records for previous entries indicating special needs or specialty care service entries; reviews established SN files and Q-base; reviews the AF Form 1466, AF Form 1466D (only when indicated), DD2792-1 (only when indicated), DD Form 2792 (only when indicated) including Addendum 1, 2, and 3 as appropriate.

1.36.5.2. When indicated, reviews all Mental Health, Alcohol and Drug Abuse Prevention and Treatment, and FAP documentation for all family members and ensures completion of the DD Form 2792, Addendum 2 by a qualified mental health provider.

1.36.6. Conducting the FMRC

1.36.6.1. Participates with the MRO in jointly-scheduled interviews with all family members required to participate in the FMRC. Confidentiality of all family members will be maintained during the interview, offering individual interviews for every adult family member.

1.36.6.2. For families of RegAF members, the SNC first ensures all family members are listed on either page 2 or page 3 of the AF Form 1466.

1.36.6.3. The SNC completes the AF Form 1466, Section VII – Special Needs Coordinator Endorsement. Ensures an FDI is required when special medical needs (or special educational needs when the gaining location is OCONUS) are identified.

1.36.6.4. Ensures all required documents are completed, signed, and attached.

1.36.6.5. For DoD civilian families who volunteer for an FDI prior to relocation, the SNC with the MRO, interviews family members with special needs upon request, and forwards information via DD Form 2792 and DD Form 2792-1 with any cover summaries as appropriate. May use, but does not require, AF Form 1466 for FDIs of DoD civilian families with special needs.

1.36.7. FMRC Disposition and Responsibilities

1.36.7.1. For outbound FDIs, ensures documentation that supports the FMRC is processed in an expeditious manner toward timely assignment recommendations. (T-1). The SNC intervenes/elevates through the medical chain of command as needed where delays potentially impact timely assignments or employments of sponsors.

1.36.7.2. For inbound FDIs (RegAF and civilian sponsors), the SNC works with the FMRCC and the SGH to ensure all medical and educational authorities that might be involved in the care of identified needs are consulted for service availability. Supports the SGH in providing written responses that either recommend or do not recommend travel for family members. Where necessary housing modifications are identified in the FDI package, ensures the base housing office is advised of the anticipated needs during the relocation review period. This includes accessibility information provided by the housing office, where applicable, in the response to the losing EFMP-M office.

1.36.7.3. With the FMRCC, the SNC ensures all FDIs are appropriately logged and tracked during the review process. (T-1). Ensures the inbound FDI process is completed within allocated timeframe depending on clearance type upon receipt of a complete FDI. (T-1). If a response is not possible within this timeframe, ensures the losing EFMP-M office is notified of the reasons for the delay and intervenes as needed to expedite response.

1.36.7.4. With the FMRCC, the losing installation’s SNC ensures all considerations about potential limitations, types of housing modifications possible, etc., that are submitted by the gaining installation via FDI response are provided to the sponsor and/or adult family members upon receipt.

1.36.8. Standards of Care. EFMP-M will comply with MICT, Self-Assessment Checklist, The Joint Commission on Accreditation of Healthcare Organization (TJC) standards, or Accreditation Association for Ambulatory Health Care standards (AAAHC), AF policy, and MTF guidance, and other AF-sanctioned quality assurance mechanisms.

1.37. The Family Member Relocation Clearance Coordinator (FMRCC) will:

1.37.1. Participate in training and supervision from the SNC on EFMP-M duties.

1.37.2. Carry out the administrative aspects of the EFMP-M, including but not limited to scheduling appointments, assisting in records review, establishing and maintaining logs and SN files, and explaining forms or processes to families.

1.37.3. Use Q-base to document special needs family members and their sponsors assigned to the installation, to administratively manage cases, to process FDIs IAW the processes outlined in Chapter 3 of this publication, and to transfer cases to gaining facilities upon PCS.

1.37.4. Assist other installations or DoD agencies in the timely processing of relocation actions.

1.37.5. Coordinate with MPS, CSS, and/or AFPC on assignment-related administrative processes in support of special needs families, such as checking ALC “Q” rosters and distributing/collecting AF Forms 4380.

1.37.6. Notify sponsors and orders issuing agents of travel recommendations upon completion of FDI process.

1.37.7. Assist sponsors with appeal of “not recommended for travel” determinations.

1.37.8. Maintain files, logs and records that implement the FMRC process and all EFMP-M functions IAW established policy and with the support of the SNC.

1.37.9. Assist the SNC in the tracking and reporting of DoD and AF-required data, such as numbers of family members with special needs located at the installation.

1.37.10. Assist the SNC and MRO in capturing workload data and process efficiency measurements for EFMP-M IAW AF and MTF guidelines using MEPRS code FAZN for all EFMP-M associated workload.

1.38. Upon Sponsor in-processing:

1.38.1. If necessary, the FMRCC contacts the losing base to obtain an existing SN file.

1.38.2. The FMRCC ensures updated contact information is entered into Q-base.

1.39. Prior to the Family Member Relocation Clearance (FMRC) process initiation, the FMRCC:

1.39.1. Explains the process to the sponsor and to any adult family members.

1.39.2. Advises the sponsor that all family members enrolled in EFMP and those requesting government funded travel to OCONUS locations must attend the FMRC. Medical records and documentation from TRICARE network providers and/or medical providers receiving private insurance reimbursement must be made available prior to the screening appointment.

1.39.3. Advises sponsor of the required attendance of family members, based on geographical location and type of assignment. Family members who are not currently living with the sponsor, but plan to accompany the sponsor to the new duty location can complete the family member screening at the nearest MTF.

1.39.4. Ensures sponsors have all of the correct forms as appropriate (see specific information in AFI 40-701, Chapter 3); advises sponsors that the FMRC screening appointment will not be held without the completed forms; advises sponsors/family members on how to correctly prepare their part of the required forms.

1.39.5. Once all required paperwork has been completed and submitted to the EFMP-M office the following steps are conducted, the FMRCC:

1.39.5.1. Schedules the FMRC screening appointment. All required family members will be scheduled for the appointment (see AFI 40-701, para 3.7 for specific information).

1.39.5.2. Ensures both the SNC and the MRO, or their alternates, have reviewed all required family members’ medical records, when indicated the DD Form 2792, DD Form 2792-1, and/or AF Form 1466, pharmacy dispenses, and documentation from TRICARE network providers and/or privately insured medical providers prior to the face-to-face FMRC appointment.

1.40. Additionally, the FMRCC will:

1.40.1. Track each clearance from initiation to completion, ensuring documentation of recommendations are maintained at both the losing and gaining installations. Use Q-base to process FDIs. (T-1). Advise the SNC of each FDI or clearance package that exceeds the allocated window of time requirement for response and documents extenuating circumstances.

1.41. If the losing installation, the FMRCC will:

1.41.1. Where the decision to recommend travel is made at the losing installation, the losing FMRCC will forward to the orders issuing agent all pages of the AF Form 1466. Page 5 of the AF Form 1466 will note all family members listed on page 3 as being locally cleared by the losing installation SGH.

1.41.2. Notify sponsors and orders-issuing agents of travel recommendations upon the completion of the FDI process.

1.41.3. When travel has been recommended for all family members by the gaining review authority, the losing FMRCC will ensure sponsors or adult family members are aware of any travel considerations via the CfP Forum item 12.24 letter provided by the gaining EFMP-M office.

1.41.4. When the gaining review authority has recommended against family member travel for one or more family members, the losing FMRCC will ensure sponsors receive the AFMOA-developed Medical Information Sheet appropriate to the gaining location. The losing FMRCC will not share PHI of adult family members with sponsors, unless a written Release of Information has been obtained authorizing the release.

1.41.5. Assist sponsors with appeal of “not recommended for travel”. The appeal process must be initiated within 21 days of travel recommendation. Appeals will be processed based on new or omitted information that may result in a different travel recommendation. Process appeal packages in Q-base as appropriate.

1. 42. The SNC and FMRCC will ensure all other tasks and responsibilities not specifically addressed within this document are followed. The primary regulation that directs the Air Force EFMP-M process are found within AFI 40-701.

2. NON-PERSONAL SERVICES

2.1. This is a non-personal health care services contract. The Contractor shall provide one (1) Special Needs Coordinator and one (1) Family Member Relocation Clearance Coordinator.

2.2. 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.

2.3. Mission Essential Status. Contractor personnel are not designated as mission essential personnel.

2.4. The Contractor shall ensure the SNC and FMRCC are knowledgeable of the policies and procedures of their specific place of duty and of the medical activity.

2.5. MTF Requirements. Contractor personnel shall complete all MTF-specified orientation program(s), initial and annual training requirements, and comply with all MTF policies, procedures, productivity standards and instructions as provided by the MTF. The Government will provide initial MTF orientation and annual refresher training for contractor personnel.

This requirement will be conducted during normal duty hours.

3. PROFESSIONAL QUALIFICATIONS/REQUIREMENTS, SPECIAL NEEDS

COORDINATOR (SNC) AND FAMILY MEMBER RELOCATION CLEARANCE

COORDINATOR (FMRCC)

3.1. Education.

3.1.1. The SNC shall be a graduate of a baccalaureate or higher degree program, and if applicable, accredited by a national accrediting agency recognized by the US Department of Education. A degree in a medical field is preferred. Additionally, a Master’s degree and experience in program administration are preferred.

3.1.2. The FMRCC shall be at least a high school/GED graduate. At least an Associate’s degree and/or experience in program administration are preferred.

3.2. Licensure/Certification. Must have an active, valid, current and unrestricted license (with no limitations, stipulations or pending adverse actions) to practice his or her specialized area of medical care (e.g. Dental, Nursing, or Social Worker) in any US state/jurisdiction.

3.3. Employee is responsible for maintaining/renewing licensure from a state and if required, a certification or registration when caring for patients within the MTF. The SNC shall not perform any service if license is inactive or revoked.

3.4. Copies of required licensure shall be furnished to the Contracting Officer prior to performance on this contract and then turned in to the COR or designated FRED. Copies of renewals must be submitted ten (10) days before date of expiration.

3.5. Experience.

3.5.1. SNC: Must have a minimum of two (2) years for BS full-time experience in specialized field of study and care coordination, with clinical services being performed for at least 12 of the last 36 months.

3.5.2. FMRCC: must have a minimum of 4 years in the full time work force. At least two years of experience in an office, medically related clinic setting or administrative position is required. Prior military experience working and or experience within any military Medical Specialty Code or civilian equivalent is preferred. This position should be filled from within the local military or civilian dependent population who are already command sponsored on Okinawa, Japan and have legal authority to reside in Okinawa, Japan through the SOFA agreement. Non-command sponsored dependents do meet this requirement. A minimum of two years remaining on station after work start date is required of anyone filling this position due to the very high level of training required to be successful in this position.

3.6. SNC and FMRCC should have experience with Electronic Medical Records and preferably have experience with Armed Forces Health Longitudinal Technology Application (AHLTA).

3.7. SNC and FMRCC must have a military-specific background; prior active duty, military retiree, or military family member preferred; experience with Air Force medical services is preferred.

3.8. SNC and FMRCC should have experience with living in overseas locations. Prior experience with the Exceptional Family Member Program is preferred but not mandatory.

3.9. Knowledge. Must have the knowledge and skills to effectively apply SNC or FMRCC functions.

3.10. Assessment: The SNC must have the ability to identify patients and families with special medical and educational needs.

3.11. Planning: Collaboration with the patient, family/caregiver, primary provider and other members of the health care team for developing an effective plan of care is expected.

3.12. Facilitation: Care coordination and communication among all involved parties is key to provision of care for individuals with special medical needs.

3.13. Advocacy: Support for the patient and family/caregivers to ensure proper education of the patient and family and appropriate, timely care coordination is received.

3.14. The SNC should have several years’ experience, should be familiar with military medicine either as a Department of Defense Medic or family member, and should have had overseas military experience, wherever possible.

3.15. The SNC must have familiarity with clinical conditions that require specialized care, and demonstrated skills in interviewing families for the purposes of identifying special needs and for coordinating needed care.

3.16. The SNC must be a clinical level civilian equivalent officer from Biomedical Science Corps, Dental Corps, Nurse Corps or Medical Services Corps which will be referred to as SNC throughout the remainder of the Performance Work Statement (PWS), to support the Air Force Exceptional Family Member Program – Medical (EFMP-M) component, 18th Medical Group, Kadena AB, Japan, also referred to as the Medical Treatment Facility (MTF) herein.

4. PRIVILEGING & CREDENTIALS

4.1. SNCs will not be credentialed for the purposes of this contract. Direct patient care as a medical provider will not be required or supported under this contract.

5. DOCUMENTATION

5.1. SNC and/or FMRCC shall prepare all documentation to meet or exceed established standards of the MTF as outlined in the Operating Instructions of the MTF to include but not limited to: timeliness, legibility, accuracy, content and signature. Only MTF and Air Force approved abbreviations may be used to document care in the health care record. SNC and/or FMRCC shall ensure complete patient identifying information is on all documentation that is to become part of a health care record.

5.2. Performance of Services during a Crisis Declared by the National Command Authority of Oversees Combatant Commander. The Contractor is required to perform essential services in accordance with this PWS in emergency or limited force protection conditions such as natural disaster; however DODI 1100.22 does not apply to this contract for crisis situations where continuation of essential services by the Contractor is unfeasible.

5.3. The Government may evaluate the quality of professional and administrative services provided.

6. HEALTH REQUIREMENTS

6.1. 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:

a. 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.

b. 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.

c. 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.

6.2. 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: http://www.cdc.gov/vaccines/acip/index.html and http://www.cdc.gov/niosh/topics/healthcare/. For further information on current requirements, please contact PH at DSN 315-225-5311

6.3. At least fourteen (14) business days prior to start of work, the contractor is required to submit to the Contracting Officer, a complete employee qualification record for the

Attachment 1 FA5270-17-T-0005 Special Needs Coordinator http://www.cdc.gov/vaccines/acip/index.html http://www.cdc.gov/niosh/topics/healthcare/

SNC/FMRCC 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.

6.4. SNC/FMRCC must in-process through Public Health (PH) within 10 duty days of arrival at the 18th Medical Group.

6.5. SNC/FMRCC 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.

6.6. 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 after possible exposure). Expenses for all required pre-employment tests and/or procedures shall be borne by the contractor or contractor personnel, not the Government.

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

6.8. SNC/FMRCC 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 the contractor. If the vaccine is obtained at other facilities, the cost will be borne by the Contractor or contractor personnel, not the Government.

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

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

6.11. 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 Kadena AB, the Contractor shall provide written verification of treatment.

6.12. Pregnant Employees. It is the responsibility of the Contractor to notify the COR or designated FRED of a pregnant employee. MTF Employee Health office will provide information concerning any work hazards in that area. The contractor is to notify any pregnant employee of any work hazards. It will be the employee’s and the contractor’s joint decision whether the contracted employee works in the environment.

6.13. 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 maintain during the terms of this contract liability insurance 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.

Non-personal services contract employees must have an active, valid, current and unrestricted license (with no limitations, stipulations or pending adverse actions) to practice nursing as a registered nurse in any US state/jurisdiction. Employee is responsible for maintaining/renewing licensure from a state and if required, a certification or registration when caring for patients within the MTF. The SNC shall not perform any service if license is inactive or revoked.

7. CLAIMS PROCEDURES

7.1. 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.

8. OVERSEAS MEDICAL CARE

8.1. Contractor personnel should be prepared to use the medical and dental services of the host country unless otherwise authorized by virtue of being a DEERS enrolled military beneficiary authorized medical/dental services under Tricare. Medical care at overseas military treatment facilities is limited. Emergency 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.

8.2. 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 contract personnel.

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

8.4. 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.

8.5. 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).

9. GENERAL INFORMATION

9.1. English Requirement. The SNC shall read, understand, speak, and write English well enough to effectively communicate with patients and other HCWs. If not a native speaker, proof of a minimum score or higher of the following English test shall be submitted to the Contracting Officer prior to start of contract performance:

a. TOEIC score: 730 or higher

b. Other English Test if no TOEIC score is available: Equivalent level as the above

TOEIC score.

9.2. Identification. All contract personnel shall be clearly identifiable while on duty. All contract personnel shall wear a Contractor nametag with the company name, individual’s name, and specialty displayed: The nametag shall be worn on the outermost garment. Facility badges, provided by the government, must be worn at all times.

9.3. Appearance. While on duty, contract personnel shall be neat and clean, well-groomed, and dressed appropriately. Contract personnel’s clothing shall fit correctly to provide a professional, modest appearance in keeping with the normally accepted community standards of dress for the work being performed. In all cases, clothing shall be neat and clean. This includes being free from visible dirt and stains.

9.4. Point of Contact. The Contractor shall provide a point of contact that shall be responsible for the performance of the work. The point of contact shall have full authority to act for the Contractor on all matters relating to the daily operation of this contract. The point of contact may be a healthcare worker providing care in accordance with this PWS. The Contractor shall designate this individual, in writing, to the Contracting Officer upon award.

9.5. Work Roster. The Contractor shall provide a list by name, start date and social security number of alternate individual personnel to provide services in case the contractor employee is not available. This list shall be provided to the COR or designated FRED thirty (30) calendar days after award. The Contractor shall submit changes in writing to the Contracting Officer (CO) at least fifteen (15) calendar days in advance of the proposed change.

10. SERVICE SUMMARY (SS)

Performance Objective PWS Paragraph Performance Threshold

1. Ensures active duty sponsors with special needs family members are identified and “Q” coded within 30 days of identification.

1.1. 1.35.2.1.

1.2. 1.35.2.7.

1.3. 1.35.2.7.1.

1.20. 1.35.2.7.2.

1.35.2.

No more than one failure to appropriately meet timeline per month.

2. Ensures the inbound FDI process is completed within 14-calendar days from submission of a completed package from the gaining installation. If a response is not possible within this timeframe, ensures the losing FRMC Coordinator is notified of the reasons for delay and intervenes as needed to expedite response.

1.1.

1.9.

1.35.5.

1.35.7.2 1.35.7.3

No more than one avoidable failure to appropriately meet timeline per month; in other words, no more than one instance of missing a timeline without reasonable excuse as determined by the COR/FRED and/or SGH.

3. Ensures every AF sponsor with one or more family members with special needs that is assigned to the installation has an electronic record (Q-base case, AHLTA documentation & back-up e-file on the EFPM drive) maintained at the

MTF.

1.1.

1.6.

1.7.

1.35.2.6.

1.36.2.6.

100% compliance.

4. Ensures Q-coded sponsors assigned to the installation are contacted annually via phone call or in-person to determine if there are unmet needs/updates and documents encounter in Q-base.

1.1.

1.18.

1.26.

5.1.

No more than one failure to meet timeline per month.

5. Maintains patient confidentiality in accordance with the Privacy Act and all HIPAA regulations/guidance.

1.1. 1.35.3.4.

1.10. 1.35.6.2.

1.13. 13.7.

1.15. 13.10

1.16. 14.2.5.

1.35.2.4.

Standard is zero breaches of privacy/confidentiality (may exceed by actively protecting patient information).

6. SNC personnel will be in the work area and available for work at the appointed times.

1.1. 10.6.

10.1. 10.7.

10.2.

10.3.

10.4.

10.5.

No more than 3 instances of unapproved tardiness annually.

7. Maintains professional manner and displays positive/cooperative attitude.

Will respond to org box messages within 24-hours of message receipt.

Will answer phone calls immediately or return call within the duty day the call is received.

1.1.

1.14.

1.19.

1.28.

1.30.

1.32.

13.8.

No more than 2 validated complaints from patients, MDG staff, or base leadership annually.

8. Special Needs Coordinator will conduct reviews of all current/pending FDIs with the SGH at least weekly or more frequently as needed.

1.1.

1.25.

Standard is 100% review of all current FDIs identified for that particular week.

9. Ensures Q-base roster of Q-coded sponsors assigned to the installation reflects AFPC roster. There should be no inconsistencies.

1.1.

1.36.2.7.1.

1.36.2.7.2.

1.36.3.3.

100% compliance.

10. Conducts Quarterly Case Reviews and documents the meeting minutes within 72-hours of meeting conclusion.

1.1.

1.26.

1.27.

11. Documents at minimal in AHLTA and Q-base all EFMP enrollments, disenrollment’s, warm hand-offs, and clearance/command sponsorship appointments. Utilizes authorized templates/forms via Q-base resources.

1.1.

1.27.

1.28.

1.36.2.8.

100% compliance.

12. The SNC is responsible for educating appropriate medical staff on aspects of the EFMP program annually via in-person training and maintain a log of trainings conducted.

1.1.

1.32.

13. Ensure MICT checklist is completed and reflect true findings.

The SNC will update the MICT checklist monthly at minimal and brief findings/status to the Executive Staff as requested.

1.1.

1.36.8.

11. GOVERNMENT FURNISHED PROPERTY AND SERVICES

11.1. The Government will provide the following equipment, supplies, and services listed below for services performed inside government facilities unless otherwise stated in the contract.

11.1.1. Office/Work/Locker Area. Those areas (office, exam room, etc.) provided for the use of the contract personnel will present an orderly appearance. Contract personnel shall ensure these areas are tidy and any decorative items present a professional, modest appearance, and in keeping with accepted community standards. Office space will be shared with other members of the medical team. The government will not be responsible for loss or damage of personal items brought into the MTF. Ensure safe work environment and employee safe work habits, reference MTF and base safety programs.

11.1.2. Equipment. The healthcare worker shall have joint use of all available equipment for performing services required by this contract.

11.1.3. Personal Protective Equipment (PPE). The Government will furnish the contract personnel with appropriate PPE. The Government will be responsible for any repair, cleaning and inventory required for the PPE. This does not include any type of uniform or laboratory coat.

11.1.4. Forms. The MTF will provide required Government forms used in the performance of services.

11.1.5. Supplies. The MTF will provide supplies commonly used in the facility to perform in accordance with this PWS.

11.1.6. Identification Cards. The Government will issue a hospital identification (ID) badge which must be worn at all times within the MTF, when Infection Control issues are not compromised. The ID badge must be visibly displayed between the shirt collar and the waist.

A Common Access Card will also be issued to allow the contractor access to necessary computer systems and to the base and the MTF during heightened security. Both cards must be carried by the individual at all times while working at the MTF.

11.1.7. Computer Equipment. The MTF will provide computer equipment required to schedule, check-in, document, order ancillary services, and maintain appropriate electronic medical information that supports the hard copy medical record. The MTF will provide required training for these systems. The contractor will be required to use the computer systems that are standard for the support of health care delivery at the MTF.

11.1.8. Administrative Support. The contractor personnel will be authorized to use all administrative equipment/systems available to the government employees.