Attachment_1_-_PWS_WH_RN_Contracts_(FY17).pdf

PERFORMANCE BASED WORK STATEMENT

FOR

WOMEN’S HEALTH REGISTERED NURSE

Kadena Air Base, Japan 14 May 2016

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Attachment 1

PERFORMANCE WORK STATEMENT

TABLE OF CONTENTS

SECTION PAGE

1 DESCRIPTION OF SERVICES 3-11

2 SERVICES SUMMARY 11-12

3 GOVERNMENT FURNISHED PROPERTY AND SERVICES 13

4 GENERAL INFORMATION 13-23

5 APPENDICES 23-25

1. DESCRIPTION OF SERVICES.

The contractor shall provide all management, tools, supplies, equipment, and labor necessary to operate and maintain one full time equivalent Health Care Registered Nurse.

1.1. BASIC SERVICES.

1.1.1. OBJECTIVE: To provide one full Registered Nurses (RN) who is eligible to work in Women’s Health Clinic and within the medical treatment facility to provide comprehensive primary, preventive, and therapeutic healthcare services required for government beneficiaries on the telephone and/or in-person consultations. Comply with all applicable laws regulations, Association for Accreditation of Ambulatory Healthcare Facilities, Health Services Inspection standards, and all other applicable standards.

1.1.2. GENERAL SCOPE: The RN shall fulfill the duties, qualifications and requirements of the position description. These duties, qualifications and requirements include the following:

Collaborates with the Primary Care Manager (PCM), Health Care Integrator, and other members of the multidisciplinary team to determine enrolled population’s healthcare needs, required preventive services, and disease case management. Teaches patients and families ways to maintain or improve their health status. Participates in and conducts studies relevant to health care and nursing needs of patients. RN shall respond to patients in distress with emergency interventions including life sustaining measures such as Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS), the Heimlich maneuver, bleeding control, treatment of injuries, etc. If appropriate, administer ACLS/PALS medications and perform defibrillation in accordance with ACLS/PALS guidelines. If required, RN shall provide ACLS/PALS care and accompany patient on ground transports. The RN shall attend flight meetings and participate in training relevant to clinical practice and procedures, as directed by flight commander and/or nurse manager.

1.1.3. DOCUMENTATION: The RN shall prepare all medical documentation to meet or exceed the standards required under Air Force Instruction (AFI) 41-210, paragraph 4.2, Documenting Health Records and the Accreditation Association for Ambulatory Health Care (AAAHC), Accreditation Handbook for Ambulatory Health Care chapter entitled Clinical Records and Health Information. The DoD’s electronic medical record, AHLTA, will be used for all patient encounters when it is available (or as directed otherwise by flight commander).

1.1.4. ORIENTATION: The RN shall participate in the MTF orientation procedures for newly assigned personnel to include regulations specific to their professional specialty and hospital and Air Force policy and procedures. See additional training requirements listed in Section 4.11.

1.1.5 WOMEN’S HEALTH NURSE REQUIREMENTS: The RN is an educated and experienced nurse who focuses on offering primary care services to women of all ages. The RN shall provide care for acute and chronic health problems, but they are also skilled in offering health counseling services as well as preventative services, and referrals to relevant specialists when necessary. The RN shall generally work with patients beginning at puberty through their advanced years, providing health care, disease prevention, and health promotion services. The RN shall provide a full range of Gynecological and Obstetrical services in accordance with

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privileges granted by the Commanding Officer (e.g. provide general screening and medical care and examinations of patients for routine, acute and chronic conditions involving any and all organ systems; order immunizations; diagnose, treat, and counsel patients as indicated). This does not include the scheduled delivery of infants as all deliveries are scheduled at Foster Medical Facility.

1.1.6. FAMILY HEALTH NURSE REQUIREMENTS: The RN shall treat/evaluate all scheduled patients; treat patients with common acute and chronic conditions, illnesses, or minor trauma within accepted protocols, national, and clinical guidelines, Nurse Practice Acts, and/or in collaboration with a physician, as well as, request consultation or referral as appropriate.

Duties include, but not limited to nursing care, monitoring of plans and equipment, facilitate the transition to the appropriate level of care through coordination with the patient, the patient’s family/caregiver and the multi-disciplinary healthcare team. This includes consideration for, but is not limited to, acute, chronic, multiple, complex, catastrophic, or life-threatening illnesses;

combat stress, residuals of traumatic brain injury; community adjustment; addictions and other health problems.

1.1.7. PEDIATRIC NURSE REQUIREMENTS: The RN shall provide compassionate and high quality care to children of all ages, ranging from birth up to the age of 18. Duties include, but not limited to nursing care, childhood immunizations, developmental screenings medication prescriptions, school physicals, treatment of common illnesses and well-child exams. They work hand-in-hand with pediatricians and other healthcare providers.

1.1.8 While the Registered Nurse will mainly be assigned to work in Women’s Health Clinic.

The RN may work in designated areas, in the event there is a need for coverage in each of the other clinics, the nurse will be able, based on their general nursing credentials, to rotate and cover other clinics in the MTF as needed.

1.2. SPECIAL REQUIREMENTS.

1.2.1. EDUCATION: The contract registered nurses must have graduated from an associate degree (AD) or a baccalaureate degree program in nursing (BSN) accredited by a national nursing accrediting agency recognized by the US Department of Education.

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

1.2.3. EXPERIENCE. Twelve months of clinical experience within the last 48 months is desired.

1.2.4. In accordance with AFI 48-105, all health care workers shall follow the methods for controlling and preventing disease as described in the American Public Health Association publication, Control of Communicable Diseases Manual, and the Centers for Disease Control and Prevention (CDC) publication, Morbidity and Mortality Weekly Report (MMWR), and its

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supplements. Where applicable, the most recent guidelines from these publications are utilized as the standard.

1.2.5. Before start of work, health care workers shall provide proof of immunization from the following diseases according to CDC guidelines: Hepatitis B, measles, mumps, rubella, varicella, and influenza. The RN shall also provide proof of a negative TB skin test within 12 months (if positive, proof of negative chest X-ray within 12 months) prior to start of work. After start of work, the Government will provide post blood borne exposure protocols according to applicable AFIs.

1.2.6. In those areas where there is a higher risk of transmission of tuberculosis, healthcare workers will be tested as frequently as directed by the MTF policy. This test will be provided by the MTF.

1.2.7. Immunization information will be tracked in DoD computer systems for all healthcare workers.

1.2.8. Medical Tests. No medical tests or procedures required by the contract may be performed at the MTF (with the exception of Tuberculosis testing after start of work). The other exception to this policy will be if the provider is otherwise a military healthcare beneficiary or if the provider resides on Okinawa. There may be undue hardship incurred to perform testing at another facility. Expenses for all required tests and/or procedures (e.g., respirator fit testing where required) shall be borne by the health care workers at no additional expense to the Government.

1.2.9. TRAINING. CONTINUING NURSING EDUCATION (CNE) REQUIREMENTS.

The RN must maintain CNE credits consistent with the requirements of their state licensure at no additional cost to the government. The Red Cross offers certain CNE/certifications at cost to the contractor at Outside the Continental United States (OCONUS) locations.

1.2.10. MTF ORIENTATION: The local MTF will provide initial Medical Group orientation training as required, to include Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), and Pediatric Advanced Life Support (PALS). The contractor is responsible for ensuring no lapse in BLS, ACLS, or PALS certifications for the duration of the contract.

1.2.11. CREDENTIALING/PRIVILEGING. The RN will be subject to the licensure requirements of AFI 44-119, Medical Quality Operations. The contract registered nurses must have graduated from an associate degree (AD) or a baccalaureate degree program in nursing (BSN) accredited by a national nursing accrediting agency recognized by the US Department of Education. The RN shall meet and provide evidence of all state licensing/certification requirements prior to performing as a Registered Nurse.

1.2.12. Licensure/Registration. In accordance with paragraph 4.2, AFI 44-119, Medical Quality Operations, 24 September 2007, personal services contract personnel providing care in the MTF must maintain a current, active, unrestricted license from any U.S. jurisdiction.

1.2.13 Copies of required certification for each RN shall be furnished to the Contracting Officer or MDG designated representative prior to performance on this contract.

1.2.14. Health care workers must be immunized annually with the influenza vaccine.

This vaccine will be provided by the Government, if available as determined by the MTF.

Although this vaccine may be provided by the Government, it may be obtained at other facilities with the cost being borne by the RN. Unless vaccinated by the Government, the RN shall be required to show proof of the vaccination.

1.3. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT

(HIPAA) OF 1996: All individuals performing services at an Air Force MTF are required to complete initial and annual refresher HIPAA and Security Rule training as provided by the MTF for its personnel and will be held accountable for complying with health information privacy and security policies and procedures.

1.3.1. 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 draft/final AFI 41- 217, which also contains additional Information Assurance requirements for all AF MTFs. Both DOD 6025.18-R and the final AFI 41-217, when published, are incorporated herein by reference. The draft AFI 41-217 will be an attachment to this contract in the interim. MTFs are responsible to ensure overall compliance with HIPAA requirements, which includes incorporation of certain requirements in contracts entered or amended after the respective implementation dates.

1.3.2. IAW DoD 6025-18R, the RN 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 RN 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.

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.

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

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

(e) The RN agrees to report to the Government any use or disclosure of the Protected Health Information not provided for by this Contract.

(f) The RN agrees to ensure that any agent, to whom it provides Protected Health Information received from, or created or received by the RN on behalf of the Government, agrees to the same restrictions and conditions that apply through this Contract to the RN with respect to such information.

(g) The RN 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) The RN 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) The RN 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 RN 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.

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(j) The RN 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) The RN 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.

General Use and Disclosure Provisions

Except as otherwise limited in this Agreement, the RN 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.

Specific Use and Disclosure Provisions

(a) Except as otherwise limited in this Agreement, the RN may use Protected Health Information for the proper management and administration of the RN or to carry out the legal responsibilities of the RN.

(b) Except as otherwise limited in this Agreement, the RN may disclose Protected Health Information for the proper management and administration, provided that disclosures are required by law, or the RN 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 RN 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 RN 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) RN may use Protected Health Information to report violations of law to appropriate Federal and State authorities, consistent with 45 CFR 164.502(j)(1).

Obligations of the Government

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

(a) Upon request the Government shall provide the RN 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 RN with any changes in, or revocation of, permission by Individual to use or disclose Protected Health Information, if such changes affect the RN permitted or required uses and disclosures.

(c) The Government shall notify the RN 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.

Permissible Requests by the Government

The Government shall not request the RN 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 RN as otherwise permitted by this clause.

Termination

(a) Termination. A breach by the RN of this clause, may subject the RN to termination under any applicable default or 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 RN shall return or destroy all Protected Health Information received from the Government, or created or received by the RN on behalf of the Government. This provision shall apply to Protected Health Information that is in the possession of the RN. The RN shall retain no copies of the Protected Health Information.

(3) If this contract does not have records management provisions and the RN determines that returning or destroying the Protected Health Information is infeasible, the RN shall provide to the Government notification of the conditions that make return or destruction infeasible. Upon mutual agreement of the Government and the RN that return or destruction of Protected Health Information is infeasible, the RN 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 RN maintains such Protected Health Information.

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.

(c) Interpretation. Any ambiguity in this Clause shall be resolved in favor of a meaning that permits the Government to comply with DOD 6025.18-R first and then the Privacy Rule as contained in the CFR.

Security of Protected Health Information

(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 RN 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 RN agrees to report to the Government any security incident of which it becomes aware.

(d) The RN agrees to ensure that any agent, 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 RN with respect to such information.

1.4. PREGNANT EMPLOYEES. The RN should report their pregnancy to the Government supervisor. The MTF Employee Health Office will provide information concerning any work hazards in her work area inherent to gestational females. The Government is to notify the pregnant health care worker of any work hazards. It will be the Government and health care worker joint decision whether she continues work in the environment.

1.5. ENGLISH LANGUAGE REQUIREMENT. The RN shall read, understand, speak, and write English fluently to be able to communicate clearly with patients. The RN shall have typing skills and be computer literate with Microsoft Windows/Office.

1.6. ADP III SECURITY REQUIREMENTS

1.6.1 Since the RN under this contract has access to and/or processes information requiring protection under the Privacy Act of 1974, these positions are considered “ADP III” positions.

Compliance with DoD Directive 8500.1, DoD Directive 5200.2, AFI 31-501 and AFI 33-202 is mandatory for ADP III positions. Therefore, a National Agency Check with Inquiries (NACI) is required for United States Citizen health care workers under this contract. The contractor shall fully adhere with the provisions of referenced publications by having each of their employees who are performing under this contract make an appointment (through the FRED/COR) with the appropriate security organization at the installation where service is provided. Each individual will be fingerprinted and required to complete the appropriate forms, usually a Standard Form 86, Standardized Investigative Request Form. The RN shall advise their employees that a positive report is needed as a condition of employment under this contract. The RN shall apply for the NACI prior to the start of performance.

1.6.2. The RN understands that, while the MTF commander may allow health care workers to temporarily occupy non-critical sensitive positions pending NACI, the RN will be immediately removed from the position if at any time the NACI receives unfavorable adjudication, or if other unfavorable information that would affect the NACI becomes known.

1.7. COMMUNICATION. The RN ensures to maintain open and professional communication with the appointed contract FRED/COR members of the MTF, and 18th Contracting Squadron.

1.8. MEDICAL MALPRACTICE. This contract establishes a personal services relationship between the RN and the Government while performing services under this contract. This personal services relationship is entered into under the authority of section 1091 of Title 10, United States Code. Accordingly, section 1089 of Title 10, United States Code shall apply to personal injury lawsuits filed against the health care worker(s) based on negligent or wrongful acts or omissions incident to performance within the scope of this contract. This personal services relationship is solely between the RN and the Government.

1.8.1. The RN is not required to maintain medical malpractice liability insurance. The RN providing services under this contract shall be rendering personal services to the Government and shall be subject to day-to-day supervision and control by Government personnel.

Supervision and control is the process by which the individual, RN, receives technical guidance, direction, and approval with regard to a task(s) within the requirements of this contract. All other employer/employee duties and responsibilities (payroll, etc.) remain the responsibility of the prime RN.

2. SERVICES SUMMARY.

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

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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. 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.

Performance Objective PWS Para

Performance Threshold Surveillance Method

Provides primary, preventative, and therapeutic healthcare services on telephone and/or in-person consultations.

1.1.1

No more than 2 discrepancies on services provided during peer/preceptor review per month

Monthly Surveillance

License/certification: Nurse applicants must be a current U.S. LICENSED Registered Nurse. Active, current, valid and unrestricted license to practice nursing in accordance with State Board requirements.

1.2.2 and

1.2.12

Zero Discrepancies

100% Compliance

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

1.1.2

No more than 2 valid customer/patient complaints

Specific Tasks Women’s Health: provides for acute and chronic health problems, but offer health counseling services and referrals to relevant services

1.1.5

Specific Tasks Family Health Nurse: provides treatment of patients with common acute and chronic conditions, illnesses, or minor trauma.

1.1.6

Specific Tasks Pediatric Nurse: provides care to childhood immunizations, developmental screenings, medication prescription, school physicals, treatment of common illnesses and well-child exams.

1.1.7

3. GOVERNMENT FURNISHED PROPERTY AND SERVICES.

3.1. GENERAL. The Government will provide the following equipment, supplies, and services listed below for services performed inside government facilities unless otherwise stated in the contract. The property remains accountable to the Government.

3.2. 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.

3.3. 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, and office supplies, and forms required to perform assigned duties.

3.3.1. Contact 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.

3.4. SUPPLIES. The Government will provide non-medical supplies commonly used in the facility for administrative, non-clinical services supporting the care and management of patients.

Commonly used supplies are those routinely stocked by the MTF.

3.5. HOUSEKEEPING. The Government will provide housekeeping services.

4. GENERAL INFORMATION.

4.1 QUALITY CONTROL.

The Contractor is required to control the quality of service delivery and offer to the Government for acceptance only services which conform to contract requirements. The overall control of quality must meet the specified performance thresholds for each requirement in the Services Summary.

4.1.1. The government shall rely on the contractor's existing quality assurance systems as a substitute for government inspection and testing, when contracting for commercial services, unless market research indicates otherwise.

4.1.2. Quality Control Plan. For non-commercial services, or if market research indicates it's a customary commercial practice, the contractor shall provide a complete Quality Control Plan (QCP) to ensure the requirements of the contract are provided as specified. The contractor shall provide a QCP describing the inspection system for the requested services listed in the PWS.

The contractor shall develop and implement procedures to identify, prevent and ensure non-recurrence of unacceptable services. The contractor shall update the plan as changes occur and changes shall be submitted for review by the Contracting Officer.

4.1.3. The contractor’s QCP shall contain, as a minimum, the following items:

(a) A description of the inspection system to cover all services. Description shall include specifies as to the areas to be inspected on a scheduled and unscheduled basis, frequently of inspections, and the title and organizational placement of the inspector(s).

(b) A description of the methods to be used for identifying and preventing defects in the quality of service performed.

(c) A description of how the records will be kept. Records must document all inspections and corrective or preventive actions taken.

4.1.4. Records of inspections shall be kept and made available to the Government throughout the contract performance period and for the period after contract completion until final settlement of any claims under this contract.

4.2 QUALITY ASSURANCE.

The government will periodically evaluate the contractor’s performance by appointing a representative(s) to monitor performance to ensure services are received. The government representative will evaluate the contractor’s performance through intermittent on-site inspections of the contractor's quality control program and receipt of complaints from base personnel. The government may inspect each task as completed or increase the number of quality control inspections if deemed appropriate because of repeated failures discovered during quality control inspections or because of repeated customer complaints. Likewise, the government may decrease the number of quality control inspections if merited by performance. The government will also investigate complaints received from various customers located on the installation. The contractor shall be responsible for initially validating customer complaints. However, the government representative shall make final determination of the validity of customer complaint(s) in cases of disagreement with customer(s).

4.2.1. The Functional Resource Evaluator Designee (FRED/COR) is the authorized government representative(s) who will perform assessments of the contractor’s performance. Subsequent to contract award, the identity of the FRED/COR, with a letter defining their duties and authority will be promptly furnished to the successful bidder/offeror.

4.2.2. The FRED will inform the COR(s) in person when discrepancies occur and will request corrective action. The FRED will make a notation of the discrepancy on their surveillance checklist with the date and time the discrepancy was noted and will request the COR(s) to initial the entry on the checklist.

4.2.3. Any matter concerning a change to the scope, prices, terms or conditions of this contract shall be referred to the COR(s).

4.2.4. The services to be performed by the contractor during the period of this contract shall at all times and places be subject to review by the Contracting Officer or authorized representative(s).

4.3. SECURITY REQUIREMENTS.

Security and base access requirements are contained in clause 5352.242-9000 “Contractor Access to Air Force Installations.” Contractor employees will be required to obtain and display identification badges. Anticipate delays in getting commercial vehicles on base and allow time for commercial vehicles to reach their destination by driving designated routes at posted speed limits throughout the base. Procedures for commercial vehicle access to the base are subject to change without prior notice.

4.3.1. ID Passes, Badges and Vehicle Stickers: The contractor is responsible to obtain such clearances and/or passes as required for his/her employees to enter military installations on Okinawa prior to start to work. The contractor shall be responsible for all passes issued to his/her employees under this contract. Applications shall be coordinated through the Contracting Officer or designated representative. At the time of application, Security Forces may conduct a background check on employees. Upon termination of employment, the contractor shall be responsible for returning identification cards and base passes to Security Forces within 24 hours.

4.3.2. The MTF will conduct criminal background checks on all health care workers involved in the delivery of healthcare to children, under the age of 18 on a frequent and regular basis, as stated in DODI 1402.5, Enclosure 5. The RN is responsible for ensuring the completed SF 85P (Public Trust Positions) is contained in credentialing packages prior to providing services at the MTF (Security Manager). The RN shall follow local MTF policy to provide fingerprints on a properly completed SF87 (FBI US Department of Justice Fingerprint Card). The procedures for completing the required background check are outlined in the Department of Defense Instruction

(DODI) 1402.5.

4.3.3. Health care workers may be employed under the contract pending completion of the background checks provided they meet the following criteria pending completion of background checks: The MTF Commander shall require close clinical supervision and full compliance with existing DoD Directives, Instructions, and other guidance…on quality assurance, risk management, licensure, employee orientation, and credentials verification. These policies rely on process and judgment, and meet the intent of the ‘direct sight supervision’ provision, affording local commanders a flexible and reasonable alternative. Therefore, the Commander will determine what constitutes “close clinical supervision” for individuals whose CHBCs are pending--either supervised privileges ensuring protection of patients under the age of 18 or line-of-sight supervision (i.e., chaperoned by an individual whose background check has been successfully completed) at all times when caring for these patients.

4.3.4. If the RN has previously received a security clearance, complete investigation (JPAS copy), background check, proof of the check shall be provided or a new one obtained. A new investigation is required if a break in service to the Department of Defense results in a time lapse of more than 2 years. Re-verification shall be accomplished every 5 years.

4.3.5. Payment of fees incurred in the conduct of any criminal history background check is the responsibility of the Government, with the exception of foreign local Police Department.

4.3.6. National Agency Checks. The RN shall comply with DoD 5200.2-R, Department of Defense Personnel Security Program and AFI 33-119, electronic Mail Management and Use

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requirements for contracted personnel operating Government workstations that have unclassified automated information systems (e-mail, MIS, Internet, CAMS, etc.) Request for National Agency Checks (NAC) via completion of SF-86 on RN 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. Request for NACs on RN personnel hired subsequent to the contract start date shall be submitted to the Government no later than five (5) workdays from the employee’s first duty day.

RN personnel receiving unfavorable NACs shall not be hired and or may be removed from contract. The RN, at no additional cost to the Government, shall be responsible for the charges incurred from these investigations by providing a charge account.

4.3.7. Restricted Area Access: The Chief Nurse shall arrange for any necessary access to restricted areas if necessary.

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

4.3.9. Smoking is not permitted in any government building or work area.

4.4. PHYSICAL SECURITY.

The contractor shall be responsible for safeguarding all government property provided for contractor use. At the close of each work period, government facilities, property, and materials shall be secured.

4.4.1. Key Control. The contractor shall establish and implement methods of ensuring that all keys/key cards issued to the contractor by the government are not lost or misplaced and are not used by unauthorized persons. (NOTE: All references to keys also include key cards. No keys issued to the contractor by the government shall be duplicated. The contractor shall develop procedures covering key control that shall be included in the quality control plan. Such procedures shall include turn-in of any issued keys by personnel who no longer require access to locked areas.)

4.4.1.1. The contractor shall immediately report the occurrences of a loss of duplicate key to the contracting officer.

4.4.1.2. In the event keys, other than master keys, are lost or duplicated, the contractor shall, upon written direction of the contracting officer, re-key or replace the affected lock or locks;

however, the government, at its option, may replace the affected lock or locks or perform re-keying. When the replacement of locks or re-keying is performed by the government, the total cost of re-keying or the replacement of the lock or locks shall be deducted from the monthly payment due the contractor. In the event a master key is lost or duplicated, all locks and keys for that system shall be replaced by the government and the total cost deducted from the monthly payment due the contractor.

4.4.1.3. The contractor shall prohibit the use of keys issued by the government by any persons other than the contractor’s employees. The contractor shall prohibit the opening of locked areas by contractor employees to permit entrance of persons other than contractor’s employees

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engaged in the performance of assigned work in those areas, or personnel authorized entrance by the Contracting Officer.

4.4.2. Lock Combinations. The contractor shall establish and implement methods of ensuring that all lock combinations are not revealed to unauthorized persons. The contractor shall ensure that lock combinations are changed when personnel having access to the combinations no longer have a need to know such combinations. These procedures shall be included in the contractor’s Quality Control Plan.

4.5. HOURS OF OPERATION.

4.5.1. Normal Hours of Operation. The contractor shall perform the services required under this contract during the following hours: Monday - Friday 0730-1630, except U.S. Federal Holidays, and during Early Nurse rotation 0630 – 1530 on selected days. (The contractor may work, with prior approval of the Contracting Officer, extended hours to ensure timely completion of work at no additional cost to the government.)

4.5.1.1. Recognized Holidays. The contractor is not required to provide service on the following days: New Year’s Day, Martin Luther King Day, Presidents Day, Memorial Day, Independence Day, Labor Day, Columbus Day, Veterans Days, Thanksgiving Day and Christmas Day. If the holiday falls on Saturday, it is observed on Friday. If the holiday falls on a Sunday, it is observed on Monday.

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

4.5.1.2. Down Days/Clinic Closures: The contractor is not required to provide service on PACAF Family Days or clinic down days. Any holidays that are declared by Presidential Executive Order shall be observed in the same manner as the holidays listed above. If the area in which contract personnel is scheduled to work is closed due to the holiday declared by an Executive Order and the employee is not required to report in, payment will not be made for those hours. Closures of the installation due to inclement weather or other such acts of God shall be handled in the same manner.

4.5.2 HEALTH REQUIREMENTS

4.5.2.1 A pre-employment physical is not required unless recommended by 18 AMDS Public Health. Per Occupational Safety Health Administration (OSHA) requirements, all Contractor

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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. Validation of Hepatitis B immunity is required for all Contractors identified in an exposure prone positon. Personnel who sign declinations may change their minds at any time and receive the Hepatitis B vaccine without penalty. It is the Contractor's responsibility to report all information necessary to assure hospital records can be maintained correctly, and therefore comply with the OSHA and Center for Disease Control (CDC) health records requirement. Additionally, contractors will comply with all medical requirements outlined in MDGI 48-10, Medical Employee Health Program.

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.

4.5.3 ABSENCES AND LEAVE.

4.5.3.1 All absences should be scheduled at least two weeks prior to the days off, and approved by the Flight Commander. Appointments should be approved by the COR/FRED two days prior to scheduling. Sickness/un-expected leave notification should be given no later than 1 business day.

4.6. CONSERVATION OF UTILITIES.

The contractor shall instruct employees in utilities conservation practices. The contractor shall be responsible for operating under conditions which prevent the waste of utilities which include the following:

4.6.1. Lights shall be used only in areas where and when work is actually being performed.

4.6.2. Mechanical equipment controls for heating, ventilation, and air conditioning systems shall not be adjusted by the contractor or by contractor employees unless authorized.

4.6.3. Water faucets or valves shall be turned off after the required use has been accomplished.

4.6.4. Government telephones shall be used only for official government business.

4.7. RECORDS.

The contractor shall be responsible for creating, maintaining, and disposing of only those government required records that are specifically cited in this PWS or required by the provisions of a mandatory directive listed in Applicable Publications and Forms. If requested by the Government, the contractor shall provide the original record or a reproducible copy of any such record within five working days of receipt of the request.

4.8 ENVIRONMENTAL CONTROLS.

4.8.1. Compliance with Laws and Regulations. The contractor shall be knowledgeable of and comply with all applicable Japan Environmental Governing Standards (JEGS), 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

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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.

4.8.2. 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.

4.8.3. 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.

4.9. GOVERNMENT OBSERVATIONS.

Government personnel or FRED/COR(s), may from time to time, with CO coordination, observe contractor operations. However, these personnel may not interfere with contractor performance or make any changes to the contract.

4.10. SAFETY REQUIREMENTS.

In performing work under this contract, the contractor shall:

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

4.10.2. 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.

4.10.3. 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.

4.10.4. 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.

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

4.10.6. 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.

4.10.7. 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.

4.10.8. 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.

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

4.10.10. Ensure personnel have the following on-base emergency services phone numbers programmed into their cell phones:

While working on Kadena, Okuma, Camp Shields, or Torii Station, call Kadena Dispatch at 098-934-5911 or 098-962-9445.

While working on Camp Foster, Camp Courtney, Camp Hansen, Camp Schwab, or Camp Kinser, call Foster Dispatch at 098-911-1911.

4.13. PARTNERING AGREEMENT.

The contracting officer may require a partnering agreement between the government and the contractor to ensure joint cooperation and a sound partnership of all parties involved in the execution of this contract. Partnering is the creation of a government-contractor relationship that promotes achievement of mutually beneficial goals. It involves an agreement in principle to share the risks involved in completing the project and to establish and promote a nurturing partnership environment. Representatives from each organization are encouraged to participate in developing the partnering agreement. Suggested representation is the civil engineer manager, the government inspector, the government contract administrator, the contractor’s manager and the contractor’s quality control person. All costs for the partnership agreement should be shared equally between the government and contractor. This group is responsible for developing a formal partnering agreement that should be signed by all parties involved.