Attachment_1_-_Performance_Work_Statement_(PWS)_6_July_2018.pdf

FA5270-18-Q-B081

Attachment 1 - PWS

PERFORMANCE WORK STATEMENT (PWS)

FOR

LICENSED PRACTICAL NURSE (LPN) /LICENSED VOCATIONAL NURSE (LVN)

18th MEDICAL GROUP

6 July 2018

TABLE OF CONTENTS

Subject Page

1.0 DESCRIPTION OF SERVICES 3

2.0. SPECIFIC REQUIREMENTS 3

3.0. SERVICE SUMMARY (SS) 5

4.0. GENERAL INFORMATION 5

5.0. APPENDIX 13

5.1. APPLICABLE PUBLICATIONS AND FORMS 13

5.2. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT

(HIPAA) OF 1996 14

5.3. JAPANESE ROAD LAWS 19

5.4. REQUIRED INSURANCE by JAPANESE LAW 20

5.5. WORKLOAD ESTIMATE 20

5.6. SPECIAL CONTRACT CLAUSES 20

1.0 DESCRIPTION OF SERVICES: The contractor shall provide all management, tools, supplies equipment, and labor necessary to operate and maintain two full time equivalent Licensed Practical Nurse (LPN)/Licensed Vocational Nurse (LVN) at Kadena Flight and Operational Medicine Clinic.

1.1 OVERVIEW OF SERVICES. This contract is a non-personal services contract. The contractor shall furnish all labor, management, and supervision, in support of the 18th Medical Group, Aerospace Medicine Squadron, Flight and Operational Medicine Clinic.

1.2. These services are considered to be non-mission essential.

2.0 SPECIFIC REQUIREMENTS.

2.1 TASK 1 – Serves as a LPN/LVN performing patient care and nursing administrative duties for outpatients in accordance with established policies, procedures, protocols, and guidelines.

2.1.1. Monitors and records age appropriate physiological measurements.

2.1.2. Orients new patients to the clinic/hospital environment.

2.1.3. Assists with patient check-ins, admissions, discharges, and transfers as directed.

2.1.5. Provides individualized patient teaching on appropriate topics to include preventative healthcare and health maintenance.

2.1.6. Utilize military clinical software and Web based applications to perform duties on a daily basis.

2.1.7. Prepares and positions patients for diagnostic testing, examinations, treatments, and clinical procedures.

2.1.8. Prepares and administers medications in accordance with scope of practice and training.

2.1.9. Perform appropriate portions of medical examinations, treatment, diagnostic, and clinical procedures.

2.1.10. Record treatment, procedure rendered, and observed effects.

2.1.11. Identify patient problems and accurately notifies patient care team of observations.

2.1.12. Recognize and respond to emergencies and performs basic life support measures.

2.1.13. Perfoms medical records review and applies appropriate protocols and guidelines to determine medical needs.

2.1.14. Adhere to infection control procedures including use of personal protective equipment, disposal of waste, and aseptic technique.

2.1.15. Performs central sterile supply duties.

2.1.16. Ensures all equipment is properly assembled, operates, cleaned and stored at the end of each work shift. Ensures preventive maintenance and routine cleaning are performed as directed.

2.1.17. Maintain patient medical records in electronic format as well as hard copy as required.

2.1.18. Prepare and submit administrative reports.

2.1.19. Participate in training and continuing education programs for new procedures, techniques, and equipment.

2.1.20. Ensure a safe work environment and employee safe work habits.

2.1.21. Establish and maintain appropriate, professional, interpersonal relationships with co-workers, families, peers, and other team members.

2.1.22. Plan, organize, and implement medical standards activities for the Chief of Aerospace Medicine (SGP).

2.1.23. Attend and participate in meetings such as: professional staff conferences, quality improvement meetings, staff meetings, commander’s staff meetings, flight meetings, and other meeting required by applicable regulations, Military Treatment Facility (MTF) guidance, or by the flight Commander or his/her designated representative.

2.1.24. Provide medical standards guidance policy interpretation and application to health care professionals and medical support staffs within the medical treatment facilities and to personnel throughout the installation.

2.2 EDUCATION AND TRAINING REQUIREMENTS: Contractor employee shall meet the following minimum qualifications:

2.2.1. Must complete all MTF-specified orientation programs, initial and annual training requirements, and comply with all MTF policies, procedures, productivity standards and instructions as provided by the MTF.

2.2.2. Must have successfully completed all education and training requirements leading to and graduated from an accredited national, state or military equivalent school for Vocational Nursing or equivalent.

2.2.3. Must have and maintain throughout the course of contract, a current, active, valid, unrestricted license (with no limitations, stipulations or pending adverse actions) to practice as a LPN or equivalent from a US jurisdiction. License must be recognized and accepted by the State of practice in accordance with governing regulations.

2.2.4. Have knowledge of professional care theories, principles, practices, and procedures to perform nursing assignments of moderate difficulty and experience in assessing pediatric, adolescent, adults, obstetrics, and geriatric patients, as appropriate. Utilizes the nursing process as a basis for professional practice.

2.2.5. Have knowledge of a wide range of medical disorders/conditions and disease processes across the lifespan, as appropriate.

2.2.6. Have knowledge of preventive health schedules, procedures, processes and education methods.

2.2.7. Have knowledge of disease management and population health principles.

2.2.8. Have knowledge of a variety of pharmacological agents used in patient treatment, the desired effects, side effects, and complications of their use as well as the accurate administration of the pharmacologic agent, including dosage calculations as required. Knowledge of the administrative requirements for proper documentation of patient conditions including disease progress, acknowledgement of teaching, and follow up care.

2.2.9. Have knowledge of computer operations and proficiency in use of basic word processing, data entry and automated medical records.

2.2.10. Have experience within the last 48 months in a primary care clinic setting.

3.0 SERVICE SUMMARY (SS).

ITEM

PERFORMANCE

OBJECTIVE

PWS

SUBTASK(S)

PARA.

REFERENCE

PERFORMANCE

THRESHOLD

SS#

Provides outpatient care and administrative support.

2.1.

No more than two (2) substantiated discrepancies per month.

SS#

Maintain current, active, valid, unrestricted LPN license or equivalent and BLS certification. 2.2. Zero discrepancies.

4.0. GENERAL INFORMATION.

4.1 CONTRACTOR REPRESENTATIVE. The Contractor shall designate to the Contracting Officer (CO), in writing, a primary point-of-contact for contract implementation, coordination and administration not later than ten (10) business days after receiving notice of contract award.

The Contractor shall notify the CO of changes in the primary point-of-contact at least ten (20) work days prior to any change. All notifications shall be in writing and shall state the name and contact information for the point-of-contact. The Contractor representative may reside/be located outside of Japan (i.e in the United States), but shall be available by telephone or email from 0700 to 1600 Japan Standard Time.

4.2 DOCUMENTATION. The Contractor shall provide the contracting office the required documentation for all support services personnel within ten (10) business days of contract award notification to comply with required performance periods of the contract by taking into consideration that the DoD Contractor Personnel Office (DOCPER) process requires an average of eight(8) to ten (10) weeks for completion.

4.3 CONFLICT OF INTERESTS. Contractor personnel shall not bill patients for services rendered under this contract. Contractor personnel shall not request or accept compensation of any kind for patients treated, procedures performed, or any other actions performed. Contractor personnel shall not, while performing services under this contract, advise, recommend, or suggest to persons eligible to receive medical care at U.S. Government expense that such persons should receive care from the Contractor at any place other than as designated under this contract.

4.4 CONFIDENTIALITY OF INFORMATION. Unless otherwise specified under this contract, all financial, statistical, personnel, and/or technical data which is furnished, produced or otherwise available to the Contractor during the performance of this contract are considered confidential business information and shall not be used for purposes other than performance of work under this contract. The Contractor shall not release any of the above information without prior written consent of the CO. The Contractor shall not use patient care rendered pursuant to this contract as part of a study, research project, or publication.

4.5 MEDIA AND OTHER INQUIRIES. The Contractor or Contractor personnel shall not respond to any media inquiries. Any inquiries from the media, third parties, or public agencies shall be immediately relayed to the Contracting Officer Represantitive (COR), who will relay them to the Medical Treatment Facility (MTF) Public Affairs Officer or, after duty hours, to the Administrative Officer of the Day. There shall be no interviews, comments, or any other response without the prior knowledge and approval of the MTF Commander. Other than routine inquiries from external agencies, all other inquiries and complaints shall be brought to the attention of the

COR.

4.6 INDIVIDUAL LOGISTICAL SUPPORT

4.6.1. INDIVIDUAL LOGISTICAL SUPPORT: Individual logistical support may be provided under this contract in accordance with FAR 25.802, DFARS 225.802, and the policies and procedures of DoD 4525.6-M and AFI 36-3026. Policies and procedures are subject to change. Examples of support are: DOD Common Access Card (CAC); Commissary (including rationed items); Base Exchange (including rationed items); MWR Facilities (e.g. chapels clubs, cinema,fitness center); Military Banking Facilities; Military Postal Service (APO/FPO);

Mortuary Services (on reimbursable basis); POV (Privately-Owned Vehicle license); Purchase of POL (Petroleum and Oil products); Transient Billets or Visiting Officers Quarters (VOQ) on space-available and reimbursable basis when travel is performed on Official Government Orders; Department of Defense Public Schools (DODDS) on a space guaranteed and tuition paying basis; Medical Services on a reimbursable basis; Dental care only for emergency conditions on a reimbursable basis; Pet Registration and Control and Housing Referral.

Logistical support is not authorized for Local National hires as it is forbidden by the Status of Forces Agreement (SOFA).

Local National hires may be authorized a CAC if their duties require access to Government computer programs (refer to APPENDIX C, Special Contract Clauses).

4.7 EMERGENCY HEALTHCARE FOR CONTRACTOR PERSONNEL. The MTF will provide emergency health care for injuries or life threatening medical emergencies occurring while on duty under the provisions of Air Force Instruction (AFI) 41-210. (See 5.1 – Applicable Forms and Publications). In emergencies, transportation in U.S. Government ambulances may be furnished by the U.S. Government on a reimbursable basis. The Contractor shall reimburse the U.S. Government for such services as billed by the MTF.

4.8 CONTRACTOR PERSONNEL PRIVATE PRACTICE. Contractor personnel are prohibited by reason of their employment under this contract from conducting private practice.

The CO will unilaterally resolve any issues concerning potential conflicts.

4.9 OVERSEAS REQUIREMENTS. The Contractor is responsible for ensuring all country clearances, passports, visas, and accreditations required by the Host Nation are obtained prior to employment of individuals under this contract. Documentation requirements are subject to change as SOFAs change. In the event a proposed Contractor employee is denied Host Nation approval, accreditation, and/or permission, the prospective awardee shall submit like documentation for another nominee. The Contractor will be responsible for obtaining the appropriate country specific requirements, and will coordinate this with the CO or COR. The Contractor shall provide written notification to the CO and the COR within 24 hours of becoming aware of accredited Contract personnel no longer performing duties requiring accreditation/clearances/permissions. The Contractor shall recognize that Host Nation authorities may conduct on-site inspections at any time in the Contractor personnel’s work area for the purpose of verifying the status of positions and Contractor personnel and appropriate visas or permissions. The Contractor shall assume all costs related to submission of required documentation. At the time of preparation of this contract, applicable information and forms for placement of Contractor personnel in Japan may be accessed at the DOCPER and U.S. Department of State websites. (See 5.1 – Applicable Forms and Publications)

4.10 CONTRACTOR PERSONNEL HEALTH REQUIREMENTS. Contractor personnel and dependents shall be up to date on immunizations required or recommended by the U.S.

Department of Health and Human Services for travel to the Host Nation. (See 5.1 – Applicable Forms and Publications) The U.S. Government will not reimburse the Contractor for this expense.

Contractor personnel providing services under this contract shall receive a pre-employment physical examination prior to commencement of work and annually thereafter. Certification shall be provided to the COR that Contractor personnel have completed medical evaluation required no later than seven (7) business days prior to commencement of work . This certification shall state the date on which the examination was completed, the doctor’s name that performed the examination, and a statement concerning the physical health of the individual. The certification shall also contain the following statement: “(name of contractor employee) is suffering from no contagious diseases to include but not limited to Tuberculosis and Hepatitis.” Per Occupational Safety Health Administration (OSHA) requirements, all Contractor 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. (See 5.1 – Applicable Forms and Publications) Personnel who sign declinations may change their minds at anytime 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. (See 5.1 – Applicable Forms and Publications)

4.11. CONTRACTOR MANAGEMENT. Contractor Management staff shall advise contractor personnel that a favorable Joint Personnel Adjudication System report is needed as a condition of employment under this contract. The contractor management staff understands the MTF commander may allow contractor personnel temporary or interim access to government systems in non-sensitive positions pending final adjudication of the National Agency Check with Inquiries (NACI). Any contractor personnel receiving an “Unfavorable” determination will be immediately removed from the position

4.12. CRIMINAL HISTORY BACKGROUND CHECK (CHBC). CHBC are required for Contractor personnel involved in the delivery of healthcare to children under the age of 18 on a frequent and regular basis, as stated in Department of Defense Instruction (DoDI) 1402.5, Enclosure 5. (See 5.1 – Applicable Forms and Publications) The Contractor shall ensure that the personnel follows local MTF policy to provide fingerprints on a properly completed Standard Form 87, Fingerprint Card for Federal Employees. (See 5.1 – Applicable Forms and Publicaitons) The procedures for completing the required CHBC are outlined in the DoDI

1402.5. (See 5.1 – Applicable Forms and Publications)

4.12.1 PENDING COMPLETION OF NACI AND CHCB. The Contractor personnel may provide contract services prior to completion of background investigation. The Contractor understands that the MTF Commander may allow the Contractor personnel to temporarily occupy sensitive positions pending NACI. The Contractor personnel 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. Pending completion of CHBC the Air Force Surgeon General requires close clinical supervision and full compliance with existing DoD Directives, Instructions, and other guidance on quality assurance, risk management, licensure, personnel orientation and certification verification. The MTF Commander will determine what constitutes “close clinical supervision” for individuals whose NACIs/CHCB are pending, either supervised practice ensuring protection of patients under the age of 18 or line-of-sight supervision (i.e., chaperoned by an individual whose background investigation has been successfully completed) at all times when caring for these patients.

4.13 COMMON ACCESS CARD. Common Access Card (CAC) is a DOD-mandated program affecting military, DOD civilians and eligible Contractors. The Contractor shall comply with the requirements of this program. Visit the website for more information:

http://www.cac.mil/.

http://www.cac.mil/

4.14 WORK SCHEDULE Workdays will generally consist of eight (8) hour days. Services are generally required five (5) days each week (Monday through Friday), excluding U.S. Federal holidays. Required services may be scheduled between the hours of 7:00 a.m. to 4:00 p.m., Monday through Friday. Hours are subject to change based on need and as mutually agreed between the Functional Resource Evaluator Designee (FRED) and the Contractor however; the total number of hours will not exceed eighty (80) hours per two (2) week period. A lunch period is not a payable period, but will be coordinated with the FRED. Commuting time to and from required place of performance is not compensable by the Government. In no case will overtime be authorized or paid.

4.14.1. Non-Duty Days Contractor personnel are not required to perform on government non-duty days or other times when the MTF may be closed such as Pacific Air Forces (PACAF) family days (approximately 7 – 8 days per year). The FRED at each location shall notify the contractor five (5) work days prior the family day if performance will be required. Non-duty days shall be considered non-paid days and shall be deducted from the contractor’s monthly invoice.

4.14.2. HOLIDAYS. The following is a list of legal federal holidays. Any federal holiday falling on a Saturday will be observed on the preceding Friday, holidays falling on a Sunday will be observed the following Monday.

U.S. Holidays:

January 1 New Year’s Day 3rd Monday in January Martin Luther King, Jr. Day 3rd Monday in February Washington’s Birthday Last Monday in May Memorial Day July 4 Independence Day 1st Monday in September Labor Day 2nd Monday in October Columbus Day November 11 Veterans Day 4th Thursday in November Thanksgiving Day December 25 Christmas Day

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

4.14.4. Scheduled and Unscheduled Absences. Contractor personnel are allowed to take up to twenty (20) work days of leave annually. Leave is classified as both annual, vacation or sick leave. Leave shall be taken in one (1) day increments and shall not exceed ten (10) consecutive work days. All leave is considered non-paid days and shall be deducted from the contractor’s monthly invoice. Timing and details shall be coordinated with the FERD. Scheduled absences shall be scheduled at least thirty (30) calendar days in advance and mutually agreed upon by the COR and individual. Unscheduled absences shall be called into the FRED by the contract provider within the first two (2) hours of each duty day that he/she is unable to report to work.

4.15 CONTRACTOR ORIENTATION AND NEW PERSONNEL REQUIREMENTS.

4.15.1 GENERAL TRAINING. The Contractor shall be responsible for ensuring personnel comply with health information privacy and security policies and procedures. The Government shall provide training on Government provided forms and equipment, Air Force directives, MTF policies and procedures. Contractor personnel shall participate in continuing education programs to update and/or maintain skills and knowledge to meet annual requirements.

4.15.2 ORIENTATION TRAINING. The Contractor shall ensure that all Contractor personnel participate in the Government provided MTF orientation program for newly assigned personnel within 30 days of performance start. Orientation training will be conducted during normal hours of operation, and will be scheduled by the FRED. Orientation shall include training on regulations specific to the professional specialty, and hospital and Air Force policy and procedures, instructions on automation processing, quality assurance policies, and other information systems as they apply to the position.

4.15.3 GOVERNMENT PROVIDED TRAINING.

Alcohol and Drug Abuse Prevention and Treatment Program Annual Block Training Armed Forces Health Longitudinal Technology Application (AHLTA)

Basic Life Support (BLS) IAW AFI 41-101 – current/continual certification (See 5.1 – Applicable Forms and Publications)

Composite Healthcare Computer System (CHCS) Infection Control Health Insurance Portability and Accountability Act (HIPAA) – initial and annual certification training. (See 5.1 – Applicable Forms and Publications) Military Health Care Computer Systems/Procedures New Personnel Orientation On-the-job-training (work center/patient safety, waste disposal, fire prevention etc.)

Personnel Reliability Program Total Force Awareness Training – DoD Information Assurance Awareness Total Force Awareness Training – Information Protection Training

4.15.4. COMPUTER TRAINING. Contractor personnel who have any interaction with the MTF computer systems must receive training for the applicable system(s). The FRED will coordinate the necessary computer training. The training will be on-site and during normal hours of operation.

This training will be at no cost to the Contractor. Access to patient data systems is an "Automated Data Processing Sensitive" position requiring compliance with AFI 31-501 (See 5.1 – Applicable Forms and Publications). The Contractor shall comply with agency personal identity verification procedures that implement Homeland Security Presidential Directive-12 (HSPD-12), Office of Management and Budget (OMB) guidance M-05-24, and Federal Information Processing Standards Publication (FIPS PUB) Number 201. (See 5.1 – Applicable Forms and Publications)

4.16 COMMANDER’S TOBACCO USE GUIDANCE. The Air Force recognizes equal work breaks (when these breaks are permitted) for tobacco users and non-tobacco users. The MTF will have a smoke free medical campus.

Tobacco use is prohibited in government vehicles, inside buildings and within 50 feet of building‘s direct service entryway. The spitting of such non-smoking tobacco products into cups, cans, or any type of container within the above-restricted areas is prohibited.

4.17. U.S. GOVERNMENT-PROVIDED FACILITY/EQUIPMENT SUPPLIES,

INFORMATION AND SERVICES:

4.17.1. Government provide facility and equipment under this contract will be furnished to Contractor employees at no cost and shall be used only in performance of services under this contract.

4.17.2. The Government will provide the Contractor access to Air Force directives, MTF policies and procedures prior to start of contract performance date.

4.17.3. Facilities: During the hours of performance under this contract, the Contractor employees shall have the use of office space available.

4.17.4. Equipment and Supplies: Available equipment and office supplies for the performance of services under this contract, such as desk, chair, lighting, computer, printer, phone, copier, paper, folders, file cabinets, etc.

4.17.5. Electronic Documentation: As available at the local MTF, a standardized electronic documentation system or electronic medical record will be provided, such as, but not limited to CHCS and AHLTA.

4.17.6. Directives/Forms/Work Files: Unless noted otherwise, all required Air Force and Department of Defense directives, forms and other work files applicable to the MTF Medical Materiel Program (MM)/Services will be furnished by the Government and will be retained by the Government.

4.18. CONFORMANCE WITH ENVIRONMENTAL MANAGEMENT SYSTEMS. The

Contractor shall perform work under this contract consistent with the relevant environmental policy and objectives identified in the installation Environmental Management System (EMS) applicable for your contract. The Contractor shall perform work in a manner that conserves water, energy and other resources to the maximum extent feasible and ensure minimum production of waste as possible, giving preference to recycling and reutilization opportunities.

Furthermore, the Contractor shall give preference to less toxic materials whenever available and still reliable for their work. In the event an environmental nonconformance or noncompliance of host nation and USAF environmental laws and regulations associated with the contracted services is identified, the contractor shall take corrective and/or preventative actions. In the case of a noncompliance, the Contractor shall respond and take corrective action immediately. In the case of a nonconformance, the Contractor shall respond and take corrective action based on the time schedule established by the EMS Coordinator. In addition, the Contractor shall ensure that their employees are aware of the environmental management system on base and how these requirements affect their work performed under this contract. All on-site contractor personnel shall receive the installation EMS awareness level information.

4.19. CONFORMANCE WITH ENVIRONMENTAL REQUIREMENTS. The contractor shall perform all work in accordance with applicable Japanese and US Air Force environmental laws, regulations and operating standards, including but not limited to the Final Governing Standards (FGS) for Japan. The contractor shall be immediately capable of understanding and addressing environmental laws and regulations as they pertain to work performed under this contract.

The FGS for Japan and other important environmental laws & requirements applicable for all contractors working on base.

4.20. CONTRACTOR MANPOWER REPORTING LANGUAGE FOR CONTRACT

PERFORMANCE WORK STATEMENTS.

The contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract. The contractor is required to completely fill in all required data fields at http://www.ecmra.mil . Reporting inputs will be for the labor executed during the period of performance for each Government fiscal year (FY), which runs 1 October through 30 September. While inputs may be reported any time during the FY, all data shall be reported no later than 31 October* of each calendar year. Contractors may direct questions to Contractor Manpower Reporting Application (CMRA) help desk.

Reporting Period: Contractors are required to input data by 31 October of each year.

Uses and Safeguarding of Information: Information from the secure web site is considered to be proprietary in nature when the contract number and contractor identity are associated with the direct labor hours and direct labor dollars. At no time will any data be released to the public with the contractor name and contract number associated with the data.

User Manuals: Data for Air Force service requirements must be input at the DoD eCMRA link. However, user manuals for government personnel and contractors are available at the DoD eCMRA link at http://www.ecmra.mil.

4.21. MEDICAL LIABILITY INSURANCE.

The Government may evaluate the quality of professional and administrative services provided, but retains no control over professional aspects of the services rendered, including by example, the Contractor's professional medical judgment, diagnosis, or specific medical treatments. The Contractor shall be solely liable for and expressly agrees to indemnify the Government with respect to any liability producing acts or omissions by it or by its issued employees. The Contractor shall provide a copy of the medical liability insurance document to the Contracting Officer prior to contract performance and maintain such insurance during the terms of this contract. The liability insurance shall be issued by a responsible insurance carrier of not less than the following amount(s) per specialty per occurrence $1,000,000.00, $3,000,000.00 http://www.ecmra.mil/ aggregate. If at any time the Contractor changes insurance providers, the Contractor shall provide evidence to the Contracting Officer that the Government will be indemnified to the limits specified above per specialty per occurrence. Reference AFI 44-119, Medical Quality Operations, 4.2.5.2. Non-personal services contract personnel are independent contractors and are required to carry professional liability insurance. The Federal Tort Claims Act does NOT cover this individual. The contractor is responsible to ensure that the individual has malpractice liability coverage and often indemnifies its employee. Non-personal services contract employees must maintain a current, unrestricted, active license from the state in which they are practicing and, if required, a certification or registration when caring for patients within the MTF.

5.0. APPENDIX.

5.1 APPLICABLE PUBLICATIONS AND FORMS. Supplements or amendments to listed publications and/or forms from any organizational level may be issued during the life of this contract. Should any publication or form revision cause a change in the contractor’s processes, procedures and/or standards of operation, the contractor shall advise the CO of such changes in writing within 30 days of receipt of the publication or form revisions.

REFERENCE LONG TITLE

AFI 48-123

Medical Examinations and Standards AFI 48-149 Flight and Operational Medicine

AFI 10-203 Duty Limiting Conditions

AFI 48-101 Aerospace Medicine Enterprise

AFI 41-101 Obtaining Alternative Medical and Dental Care

AFI 41-217 Health Information Assurance for Military Treatment Facilities

AFI 31-501 Personnel Security Program Management AFI 41-114 Military Health Services System Matrix AFI 33-202 Network and Computer Security AFI 41-117 Medical Service Officer Education AFI 44-119 Clinical Performance Improvement AFI 48-105 Surveillance, Prevention, and Control of

Diseases and Conditions of Public Health or Military Significance

DOCPER DoD Contractor Personnel Office DoDD 5500.7 Standards of Conduct DoDD 5200.2 DoD Personnel Security Program DoDD 6025.18-R Health Information Privacy DoDD 8580.02-R DoD Health Information Security Regulation

DoDI 1402.5 Criminal History Background Checks on Individuals In Child Care Services

DoDI 3020.37 Continuation of Essential DoD Contractor Services During a Crisis

FIPS PUB 201 Federal Information Processing Standards Publication 201

Health Records Occupational Safety Heatlh Administration

Hepatitis B – OSHA

Occupational Safety Health Administration

HIPAA Health Insurance Portability and Accountability Act

HSPD 12 Homeland Security Presidential Directive 12 OF 306 Declaration for Federal Employment

OMB M-05-24 Office of Management and Budget M-05-24

Privacy Act of 1974 Privacy Act of 1974

Standard Form 85P Questionnaire for Public Trust Positions

Standard Form 87 Fingerprint Card for Federal Employees state.gov U.S. Department of State

Vaccination/immunization U.S. Department of Health and Human Services

USFJI 64-100 Headquarters, United States Forces, Japan Instruction 64-100

AFI41-210 Tricare Operations and Patient Administration Function

5.2 HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

OF 1996

HIPAA is comprised of several different sections, each to be implemented by the Dept. of Health and Human Services. The medical facilities of the military services and the DOD health plans are specifically listed as covered by HIPAA. Currently, HIPAA Privacy and Security Rules, as set forth in the Code of Federal Regulations, are in effect for all MTFs. The specific implementation of HIPAA Privacy for DOD medical facilities is set forth in DOD 6025.18- R, and for HIPAA Security, the requirements for AF MTFs are contained in DOD 8580.02-R and AFI 41-217, which also contains additional Information Assurance requirements for all AF MTFs. DOD 6025.18-R, DOD 8580.02-R and AFI 41-217 are incorporated herein by reference. MTFs are responsible to insure overall compliance with HIPAA requirements, which includes incorporation of certain requirements in contracts entered or amended after the respective implementation dates.

IAW these regulations, the Contractor and its employees meet the definition of Business Associates. Therefore, a Business Associate Agreement is required by law to comply with both the HIPAA Privacy and Security regulations. This clause serves as that agreement for each MTF, whereby the Contractor and its employees agree to abide by all HIPAA Privacy and Security requirements regarding health information as defined in this clause, DoD 6025-18-R, DOD 8520.02-R and AFI 41-217. Additional HIPAA requirements will be addressed when implemented.

Introduction

(a) Definitions. As used in this clause generally refer to the Code of Federal Regulations (CFR) definition unless a more specific provision exists in DOD 6025.18-R, DOD 8520.02-R or AFI 41-217.

HITECH Act shall mean the Health Information Technology for Economic and Clinical Health Act included in the American Recovery and Reinvestment Act of 2009.

Individual has the same meaning as the term “individual” in 45 CFR 164.50 1 and 164.103 and shall include a person who qualifies as a personal representative in accordance with 45 CFR 164.502(g).

Privacy Rule means the Standards for Privacy of Individually Identifiable Health Information at 45 CFR part 160 and part 164, subparts A and E.

Protected Health Information has the same meaning as the term “protected health information” in 45 CFR 164.501, limited to the information created or received by The Contractor from or on behalf of the Government.

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

Required by Law has the same meaning as the term “required by law” in 45 CFR 164.501 and 164.103.

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

Security Incident shall have the same meaning as the term “security incident” in 45 CFR 164.304, limited to the information created or received by Contractor from or on behalf of the Covered Entity.

Security Rule means the Health Insurance Reform: Security Standards at 45 CFR part 160,162 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, 160.502, 164.103, 164.304 and 164.501.

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

(c) The Contractor agrees to use appropriate safeguards to maintain the privacy of the Protested Health Information and to prevent use or disclosure of the Protected Health Information other than as provided for by this Contract.

(d) The HIPAA Security administrative, physical, and technical safeguards in 45 CFR 164.308,

164. 310, and 164.312, and the requirements for policies, procedures and documentation in 45 CFR 164.316 shall apply to the Contractor. The additional requirements of Title XIII of the HITECH Act that relate to security and that are made applicable with respect to covered entities shall also be applicable to the contractor. The Contractor agrees to use 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 in the execution of this Contract.

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

(f) The Contractor agrees to report to the Government any security incident involving protected health information of which it becomes aware.

(g) The Contractor agrees to report to the Government any use or disclosure of the Protected Health Information not provided for by this Contract of which the Contractor becomes aware of.

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

(i) The Contractor agrees to ensure that any agent, including a subcontractor, to whom it provides electronic Protected Health Information, agrees to implement reasonable and appropriate safeguards to protect it.

(j) The Contractor agrees to provide access, at the request of the Government, and in the time and manner designated by the Government to Protected Health Information in a Designated Record Set, to the Government or, as directed by the Government, to an Individual in order to meet the requirements under 45 CFR 164.524.

(k) The Contractor agrees to make any amendment(s) to Protected Health Information in a Designated Record Set that the Government directs or agrees to pursuant to 45 CFR 164.526 at the request of the Government or an Individual, and in the time and manner designated by the Government.

(1) The Contractor agrees to make internal practices, books, and records relating to the use and disclosure of Protected Health Information received from, or created or received by the Contractor on behalf of, the Government, available to the Government, or at the request of the Government to the Secretary, in a time and manner designated by the 'Government or the Secretary, for purposes of the Secretary determining the Government's compliance with the Privacy Rule.

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

(n) The Contractor agrees to provide to the Government or an Individual, in time and manner designated by the Government, information collected in accordance with this Clause of the Contract, to permit the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

General Use and Disclosure Provisions

Except as otherwise limited in this Agreement, the Contractor may use or disclose Protected Health Information on behalf of, or to provide services to, the Government for treatment, payment, or healthcare operations purposes, in accordance with the specific use and disclosure provisions below, if such use or disclosure of Protected Health Information would not violate the HIPAA Privacy Rule, DOD 6025.18-R, the HIPAA Security Rule, or DOD 8580.02-R if done by the Government. The additional requirements of Title XIII of the HITECH Act that relate to privacy and that are made applicable with respect to covered entities shall also be applicable to the Contractor.

Specific Use and Disclosure Provisions

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

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

(c) Except as otherwise limited in this Agreement, the Contractor may use Protected Health Information to provide Data Aggregation services to the Government as permitted by 45 CFR 164.504(e)(2)(i)(B).

(d) Contractor may use Protected Health Information to report violations of law to appropriate Federal and State authorities, consistent with 45 CFR 164.502(j)(1).

Obligations of the Government

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

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

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

(c) The Government shall notify the Contractor of any restriction to the use or disclosure of Protected Health Information that the Government has agreed to in accordance with 45 CFR 164.522.

Permissible Requests by the Government

The Government shall not request the Contractor to use or disclose Protected Health Information in any manner that would not be permissible under the HIPAA Privacy Rule, DOD 6025.18R, the HIPAA Security Rule, or DOD 8580.02-R, if done by the Government, except for providing Data Aggregation services to the Government and for management and administrative activities of the Contractor as otherwise permitted by this clause.

Termination

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

(3) If this contract does not have records management provisions and the Contractor determines that returning or destroying the Protected Health Information is infeasible, the Contractor shall provide to the Government notification of the conditions that make return or destruction infeasible. Upon mutual agreement of the Government and the Contractor that return or destruction of Protected Health Information is infeasible, the Contractor shall extend the protections of this Contract to such Protected Health Information and limit further uses and disclosures of such Protected Health Information to those purposes that make the return or destruction infeasible, for so long as the Contractor maintains such Protected Health Information.

Miscellaneous

(a) Regulatory References. A reference in this Clause to a section in DOD 6025.18-R, HIPAA Privacy Regulation or DOD 8580.02-R, HIPAA Security Regulation, or any CFR or AFI provision means the section as currently 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, the CFR HIPAA Privacy Rule, DOD 8520.02-R, the CFR HIPAA Security Rule and AFI 41-217.

5.3. JAPANESE ROAD LAWS

5.3.1. The contractor shall comply with Japanese Road Laws while on US Military installations to specifically include: Article 43 The Road Law (Japan) (prohibited acts relative to roads). No person shall commit the following described acts:

5.3.2. Damaging the road, causing roads to be littered with debris, polluting the roads with debris or fallout from motor vehicles or otherwise defacing roads unreasonably or without due cause.

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

5.3.4. The agency managing a road may when there is reasonable cause for him to feel that items or cargo being carried in or on a motor vehicle may fall out and damage, pollute, or otherwise deface the road in such manner as to hinder or obstruct the traffic, order the operator of the vehicle in question to take steps or measures necessary to prevent occurrence of such hindrance by stopping operation of the vehicle, or correcting the method of loading or traveling or operation of the vehicle.

5.4. REQUIRED INSURANCE by JAPANESE LAW

5.4.1. The Contractor shall procure and maintain during the entire period of his performance under this contract the following minimum insurance on each vehicle used by the Contractor at the work site.

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

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

5.4.4. Prior to the commencement of work hereunder, the Contractor shall furnish to the Contracting Officer a certificate or written statement of the above required insurance. The policies evidencing required insurance shall contain an endorsement to the effect that cancellation or any material change in the policies adversely affecting the interests of the U.S.

Government in such insurance shall not be effective for such period as may be prescribed by the laws of the state in which this contract is to be performed and in no event less than thirty (30) days after written notice thereof to the Contracting Officer.

5.5. ESTIMATED WORKLOAD DATA

The following is the workload estimate for LPN/LVN:

Workload Estimate Monthly Average Hours per month

Patient contacts/care coordination

420 Contacts

Medical Record Reviews

Approximately 450/month

Written Reports Data Reports 6

Meetings/Briefings Staff meetings/Trainings 13

Miscellaneous

Miscellaneous Medical Service Specialist and Administrative duties

Total

**The estimated LPN/LVN Patient Contact/Care Coordination and Medical Record Reviews Workload will include Scheduled Patient Appointments, Telephone Consults, MiCare Secure Messaging, and any patients that may have to be walked in to the provider.

5.6. SPECIAL CONTRACT CLAUSES

(1) Contract to be performed in Japan. The Status of Forces Agreement between the United States and Japan (SOFA) governs the rights and obligations of the United States armed forces in Japan. Unless a contractor is present in Japan solely to perform under a contract with the

United States for the sole benefit of the United States armed forces in Japan and is accorded privileges under SOFA Article XIV, it and its employees shall be subject to all the laws and regulations of Japan. Certain contractor employees and their dependents not accorded privileges under SOFA Article XIV may be accorded privileges under SOFA Article l(b)

(2) The Contractor shall comply with the instruction of the Contracting Officer concerning the entry of its employees, equipment, and supplies into Japan, and shall comply with all applicable Japanese laws and regulations as well as United States Forces Japan (USFJ) and USFJ component policies and regulations during the performance of this contract.

(3) SOFA Article l(b) Status

(A) SOFA Article l(b) status. Contractor employees performing under contracts with the United States for the provision of services in support of U.S. armed forces in Japan, and whose presence is required in Japan to provide such services, may be determined eligible to acquire l(b) does not create a lawful status in Japan for any entity other than individuals (e.g., the company employing the individual does not acquire SOFA status under Article l(b)). To qualify for SOFA status under SOFA Article l(b), such individuals must be:

(i)United States nationals,

(ii) not ordinarily resident in Japan,

(iii) present in Japan at the invitation of, and solely for the purpose of executing contracts with, the United States for the benefit of the United States armed forces, and (iv) not contractors or employees of a contractor whose presence in Japan is solely for the purpose of executing contracts within the definition of SOFA Article XIV.

(B) The contracting officer may determine a proposed contractor employee's eligibility for recognition as a Member of the Civilian Component under Article l(b) of the SOFA by documenting on a Letter of Authorization (LOA) that the contractor…