Attachment_1_-_PWS_DRHA_MHA_Providers_dated_7_June_2019.pdf

Attachment 1 – Performance Work Statement (PWS) RFQ No. FA527019QB005

PERFORMANCE WORK STATEMENT

DEPLOYMENT-RELATED HEALTH ASSESSMENT

(DRHA)/ANNUAL MENTAL HEALTH ASSESSMENT

(MHA) PROVIDER SERVICES

Kadena Air Base, Japan

18 MDG/SGPM

7 June 2019

TABLE OF CONTENTS

SECTION PAGE

1 DESCRIPTION OF SERVICES 3

2 SUMMARY OF SERVICES 12

3 GENERAL INFORMATION 13

4 SPECIAL QUALIFICATIONS 19

5 APPENDICES 23

1. DESCRIPTION OF SERVICES.

1.1. The contractor shall supply two licensed and/or certified medical contractors (see paragraph 4.12 “Special Qualifications” for acceptable contractors) to manage and monitor the Deployment-Related Health Assessment (DRHA)/Annual Mental Health Assessment (DRHA/MHA) Deployment Medicine and annual Mental Health Assessment (MHA) Services.

1.1.1. DEPLOYMENT MEDICINE: In accordance with (IAW) DoDI 6490.12, Mental Health Assessments for Service Members Deployed in Connection with a Contingency Operation and AFI 48-122, Deployment Health requires person-to-person deployment mental health assessments be conducted for each Service member deployed resulting from a Joint Chiefs of Staff (JCS) combatant command deployment order for 30 continuous days or greater to a land-based location outside the United States, according to reporting instructions, or individuals deploying on contingency, exercise, deployment (CED) orders for greater than 30 days to OCONUS locations with medical support from only non-fixed (temporary) medical facilities. DoDI 6490.03, requires deploying personnel to complete three (3) DRHAs: DD Forms 2795, Pre-Deployment Health Assessment, 2796, Post-Deployment Health Assessment (PDHA), and 2900, Post-Deployment Health Reassessment (PDHRA). Additionally, DoDI 6490.12, mandates personnel complete two additional deployment mental health assessments (MHAs) as part of DoD DRHA requirements and for them to be documented on DD Form 2978, Deployment Mental Health Assessment. As a result, DoD requires a total of five DRHAs. All DRHAs will be completed using Aeromedical Services Information Management System (ASIMS) and documented in Armed Forces Health Longitudinal Technology Application (AHLTA)/Electronic Health Record. DRHAs will be performed according to AFI 48-122 Deployment Health. Patient care and documentation will be clear and concise, and comply with MDG and The Joint Commission (TJC) standards.

1.1.2. NON-PERSONAL SERVICES. The contractor under this contract will be non-personal services as described in FAR part 37.4. The position shall provide direct patient care activities in primary care clinics and/or mental health clinics in support of Air Force mental health services.

1.1.3. ADDITIONAL SERVICES: Although the DRHA/MHA mission will remain priority, upon approval by the Functional Requirement Evaluator Designees (FRED), the contractor may support clinical or administrative support for Flight Operational Medicine Clinic (FOMC)/Base Operational Medicine Clinic (BOMC)/PA Clinic services (e.g. PHAs, fast track return to duty clinic, or other initiatives to return Airman back to mobility ready) within their respective credential and privileging to fulfill a 40-hour work week.

1.1.4. .MISSION ESSENTIAL STATUS. The contractor is not designated as a mission essential person.

1.2. SPECIFIC TASKS (DRHA/MHA Providers).

1.2.1. The contractor shall supply two licensed and/or certified medical contractors (see paragraph 4.12 “Special Qualifications” for acceptable contractors) to manage and monitor the DRHA/MHA program and coordinate appropriate aspects of the program with the base Installation Deployment Officer (IDO), Unit Deployment Managers (UDMs), Unit Health Monitors (UHMs), Public Health, FOMC/BOMC, commanders, Chief of Medical Staff (SGH), Chief of Aerospace Medicine (SGP) and medical clinic personnel.

1.2.2. Monitor and facilitate processing of DRHA/MHA and ensure members are assessed within the prescribed timeframe.

1.2.2.1. DRHA 1: DRHA #1 - Within 120 days before the estimated date of deployment (i.e., date departing home station for deployment or first movement). Face-to-face visit.

1.2.2.2. DRHA 2: within 30 days prior to departure from theater or within 30 days upon return to home station or IAW with current policy. Face-to-face visit.

1.2.2.3. DRHA 3: between 90-180 days after return from deployment or IAW with current policy. Person-to-person visit.

1.2.2.4. DRHA 4: between 181-545 days after return from deployment or IAW with current policy. Whenever possible, DRHA 4 and 5 will be completed with the annual Preventative Health Assessment (PHA). Person-to-person visit.

1.2.2.5. DRHA 5: between 546-910 days after return from deployment or IAW with current policy. Whenever possible, DRHA 5 will be completed with the annual PHA.

Person-to-person visit.

1.2.3. Ensure deployer’s Individual Medical Readiness (IMR) is current.

1.2.4. DRHAs rely heavily on the delivery of multiple levels of education to multiple audiences in the process, including deployers, leaders, and clinicians and the contractor may be needed to brief in these particular forums. Educating patients about their individual deployment-related health concerns is critical. The contractor must attend meetings and be able to brief statistics monthly to public health flight leadership.

1.2.5. The contractor will review the medical records and/or deployment questionnaires of each deployer pre- and post-deployment to ensure they are worldwide qualified and meet all medical requirements.

1.2.6. The contractor must have a working knowledge of Microsoft Office applications and become proficient in the use of the following computer systems: Composite Health Care Systems (CHCS) – Armed Forces Health Longitudinal Technology Application (AHLTA), ASIMS.

1.2.7. ANNUAL MENTAL HEALTH ASSESSMENT: DoDI 6490.03 and AFI 48-122 mandates that all active duty members and selected reserve service members receive an annual telephone consult or person-to-person MHA appointment, if warranted with a provider. The MHA will be aligned with non-flyer service members’ PHA DD Form 3024, Annual Periodic Health Assessment. The annual mental health assessments will be conducted IAW with the tri-service PHA guide, policies, and DoDI. All annual mental health assessments will be completed using ASIMS and documented in AHLTA/Electronic Health Record.

1.2.7.1. All patients selected for a person-to-person MHA appointment must be seen within 15 minutes of scheduled arrival time either by face-to-face or telephone consult.

1.2.7.2. Contact patients for clinic appointments. Relay general appointment instructions to patients.

1.2.7.3 Maintain knowledge of content and intent of DoD and USAF policies listed in https://kx2.afms.mil/kj/kx3/DeploymentHealth/Pages/ProviderEducationTraining.aspx and http://www.pdhealth.mil regarding deployment health and MHAs. If the offeror is not able to access the URL listed above, copies of documents can be provided upon request.

1.2.7.3.1. Ensure the Kadena Air Base DRHA/MHA program is administered in accordance with current DoD, DHA, and USAF policy regarding deployment health and PHA as described in paragraph 1.2.7.3 URL. If the contractor is not able to access the website, copies of documents can be provided upon request.

1.2.7.3.2. Ensure accurate knowledge of referral system and limitations on island.

1.2.7.4. Remain knowledgeable in DoD/Veterans Affairs (VA) The Management of Chronic Multisymptom Illness (CMI) found at https://healthquality.va.gov/guidelines/MR/cmi

1.2.7.5. Remain updated on DRHA/MHA guidance provided by DoD and USAF listed on https://kx2.afms.mil/kj/kx3/DeploymentHealth/Pages/home.aspx.

1.2.7.6. Remain knowledgeable and updated on the specific reporting instructions for the 99 different regions within INDOPACOM in order to review and medically clear military members for deployments and TDY taskings.

1.2.7.7. Ensure healthcare contractors conducting DRHA/MHA receive, DoD/VA PDH-CPG training IAW with AFI 48-122, Deployment Health and any other appropriate mental health education, and are sufficiently trained and certified to perform mental health assessments.

Additionally, the contractor shall preform peer reviews IAW MDGI 44-119, Peer Review.

https://kx2.afms.mil/kj/kx3/DeploymentHealth/Pages/ProviderEducationTraining.aspx.

1.2.7.8. Ensure all personnel deploying to a location that requires a DRHA, complete the DRHA questionnaire and receive a person-to-person interview or is arranged with a privileged contractor in the required timelines. *NOTE: Kadena is a very high ops tempo location and therefore last minute deployments and TDYs often occur. In the instance of a short notice tasking that occurs during the duty day (0600 – 1800) it is expected that the DRHA/MHA team will complete all requirements within the duty day and future schedule is adjusted to ensure contractor fulfills 40-hour work week. All personnel redeploying from these locations must receive a person-to-person interview in accordance with the timeframes listed in paragraphs and the following:

https://kx2.afms.mil/kj/kx3/DeploymentHealth/Pages/ProviderEducationTraining.aspx http://www.pdhealth.mil/ https://healthquality.va.gov/guidelines/MR/cmi https://kx2.afms.mil/kj/kx3/DeploymentHealth/Pages/home.aspx

1.2.7.8.1. For CRITICAL findings, contact the patient to determine if urgent care or immediate intervention is required, within 1 duty day. Ensure a person-to-person provider interview occurs within 3 duty days.

1.2.7.8.2. For PRIORITY findings, ensure a person-to-person provider interview occurs within 7 calendar days.

1.2.7.8.3. For ROUTINE findings, ensure a person-to-person provider interview occurs within 30 calendar days.

1.2.7.9. Ensure all personnel deploying receive appropriate Force Health Protection Prescriptive Products (FHPPP) per AFI 44-102, Medical Care Management, to include:

1.2.7.9.1 Prescribing anti-malarial prophylaxis IAW Centers for Disease Control and Prevention (CDC), National Center for Medical Intelligence (NCMI), TRAVAX and location specific reporting instructions.

1.2.7.9.2. Prescribing chemical warfare antidotes including but not limited to ATNAA (atropine and pralidoxime chloride) and Diazepam auto injectors, pyridostigmine bromide.

1.2.7.9.3. Prescribing biological warfare antibiotics IAW Air Force Reporting Instructions Tool (AFRIT) and NCMI and the most current location specific Reporting Instructions (RIs).

1.2.7.9.4. Providing clinical guidance for members with potential contraindications to Force Health Protection Prescription Products vaccinations including but not limited to smallpox and anthrax.

1.2.7.10. Consult with the Public Health Flight Commander, SGH, and SGP regarding members requiring medical waivers.

1.2.7.11. The contractor will identify the need for a Medical Alert Identification Tag for deployers identified with specific medical conditions.

1.2.7.12. The contractor may assist in any deployment-related task to include, but not limited to managing waivers or IMR requirements for the deployer.

1.2.7.13. Coordinates with the designated Mental Health Provider Consultant/SGH on mental health or adverse health trends identified by DRHA/annual MHA data analysis to the Population Health Working Group and the Community Action Information Board/Integrated Delivery System.

1.2.7.14. Provide Advanced Cardiac Life Support certification and Basic Life Support certification. Also attend any other training that is inherent to the 18 MDG at the 18 MDG’s expense.

1.2.7.15. Interview and assess patients regarding pre/post deployment health concerns and appropriately document all interviews and assessments.

1.2.7.16. The MDG will familiarize the contractor with the AFMS guidelines https://kx2.afms.mil/kj/kx3/DeploymentHealth/Pages/home.aspx and remain knowledgeable in the stressors and health threats common to deploying personnel. Maintain proficiency in implementation of interventions or programs or knowledge of such programs to make appointment referrals that may mitigate such threats or adequately treat deployment-related health conditions.

1.2.7.17. Consult with Kadena Air Base UDMs to ensure deploying and redeployed Service members are notified of eligibility for DRHA/MHA completion in a timely manner and to assist with maintaining satisfactory completion rates.

1.2.7.18. Conduct DRHAs IAW the Deployment Health Assessments Program Guide, per most current guidance.

1.2.7.19. Document clinical encounters in patients’ electronic medical records using appropriate codes for DRHA/MHAs, and other deployment-related-condition encounters.

The contractor shall prepare all documentation to meet or exceed established standards of the MDG to include but not limited to: timeliness, legibility, accuracy, content, and signature.

1.2.7.20. Provide patient referrals for specialty care and ensure follow-up. Document referrals on DRHA/MHA questionnaire and in patients’ electronic medical records. The contractor shall follow Federal, DoD, Air Force, Military Treatment Facility (MTF), and clinic regulations and policies when arranging for a referral or consult. The contractor shall inform patient of the required referral or consult by indicating the specialty involved. The contractor shall not recommend to the patient that he/she consult a specific practitioner or use a specific practice.

1.2.7.21. Report DRHA/MHA and applicable IMR compliance metrics and any program shortfallsto installation leadership, such as Population Health Working Group, Aerospace Medicine Council, Kadena Team Staff Meeting, Community Action Leadership Board, Public Health Flight Meeting, etc.

1.2.7.22. The MDG will familiarize the contractor with all applicable IMR elements in ASIMS.

1.2.7.23. Monitor the DRHA/MHA open list at least daily.

1.2.8. QUALITY IMPROVEMENT: The contractor shall assess answers to mental health questions on the DRHA/MHA forms and refer to MH clinic, if needed.. The contractor shall participate in a continual process of self-evaluation and strive for excellence in their clinical practice. A sampling of the contractor’s work will be peer reviewed monthly IAW MDGI 44- 119, Provider Peer Review (available upon request), to ensure quality. The contractor will also attend the monthly Pro-Staff meeting unless prevented by leave or patient care.

1.2.9. TRAINING: The contractor shall serve in an advisory and teaching capacity to other staff members during their work hours, will conduct peer review of other staff members as assigned monthly, as well as one hour of in-service training as needed.

1.2.10. PATIENT SENSITIVITY: The contractor shall respect and maintain the basic rights of patients, demonstrating concern for personal dignity and human relationships.

Contractors receiving complaints validated by the Quality Office or Chief of Medical Staff, will be submitted to the Contracting Officer’s Representative (COR) and shall be subject to counseling and, depending on the nature and severity of the complaint, separation from performing services under this contract.

1.2.11. RELEASE OF MEDICAL INFORMATION: The contractor shall only release medical information obtained during the course of this contract as is appropriate to other MTF staff involved in the care and treatment of that individual patient in accordance with Health Insurance Portability and Accountability Act (HIPAA) regulations, Privacy Act, FOIA requests, AFI 41-210, AFI 44-109 and 18 MDGI 37-1.

1.2.12. COMMUNICATIONS: The contractor shall maintain open and professional communication with members of the 18 MDG and with Unit Commanders IAW DOD, AF, MDG, and clinic instructions. See Appendix A for a listing of relevant publications/instructions. Complaints validated by the Quality Office and Chief of Medical Staff shall be reported in writing to the contract administrator and the Contractor for action by the 18 CONS office. Failure of the Contractor to correct validated complaints raised by the MTF staff will be considered a failure to perform.

1.2.13. PROFESSIONAL MANNER AND POSITIVE/ COOPERATIVE ATTITUDE:

Contractor shall refrain from the use of profanity, sexual or racial jokes, or other behavior that would normally be considered unprofessional in a medical setting. Complaints validated by the FRED shall be reported in writing to the contract administrator and the contractor for action by the 18 CONS office. Failure of the contractor to correct validated complaints by the MDG staff or patients will be considered a failure to perform.

1.3. SPECIAL REQUIREMENTS.

1.3.1. English Language Requirement. The contractor shall read, understand, speak, and write English clearly and fluently.

1.3.2. Prior work experience with PTSD, TBI, combat-related stressors, etc. The contractor shall have knowledge and understanding of the military environment including but not limited to rank structure and customs/courtesies.

1.3.3. Licensure/Certification. In accordance with paragraph 4.1, AFI 44-119, Medical Quality Operation, contract personnel shall maintain a current, valid, and unrestricted state license and/or national certification to practice.

1.3.4. Copies of required certification for each Contractor shall be furnished to the Contracting Officer (CO) or designated representative prior to performance on this contract.

1.3.5. Appearance. Contract personnel shall present a neat appearance and be easily recognized. This may be accomplished by wearing clothing bearing the name of the company or by wearing the MTF Badge or other appropriate badges, which contain the company name and employee’s name. Such badges shall be worn on the outermost garment.

The Contractor is responsible for acquiring an appropriate number of badges to meet their needs at their own expense.

1.3.6. No pending ethical complaints.

1.3.7. Health Requirements.

1.3.7.1. Contractor shall receive a pre-employment physical examination prior to commencement of work. Contractor shall report the pre-employment examination and immunizations/shots as prescribed by the MDG and AFI standards MDGI 48-10, Employee Health Program and AFI 44-108, Infection Prevention and Control Program.

1.3.7.2. Prior to commencement of work, medical certification shall be provided to the COR that health care contractors have completed the medical evaluation no later than five (5) business days after the contract is awarded. 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 and mental health of the individual. The certification shall also contain the following statement: “(name of contract employee) is not suffering from any contagious diseases to include but not limited to Tuberculosis and Hepatitis or from any medical or mental condition which would compromise safe patient care.”

1.3.7.3. Occupational Safety and Health Standards (OSHA) requires that all contract personnel who will have occupational exposure to blood or body fluids, or other potentially infectious materials, shall receive a Hepatitis B vaccine (at their own expense)or have documented proof of immunity to Hepatitis B infection.

1.3.7.4. It is the contractor’s responsibility to submit their medical record information necessary to assure accurate hospital recordkeeping and therefore comply with AAAHC, OSHA, and CDC health records requirements.

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

1.3.7.6. All contract employees performing health care services under this contract shall complete annual medical evaluations, laboratory testing, and immunizations, as required, IAW MDGI 48-10, Medical Employee Health Program. The contractor shall provide a medical certificate to the COR, documenting the results of the evaluation.

1.3.8. Orientation. The contractor shall ensure that all contractors participate in the MTF orientation procedures for newly assigned contractors to include regulations specific to their professional specialty and hospital and Air Force policies and procedures.

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

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

1.3.9.2. The Contractor agrees to use appropriate safeguards to prevent use or disclosure of the PHI other than provided by this Contract.

1.3.9.3. The Contractor agrees to assist in mitigation, when disclosure of PHI is known to the Contractor, as it is in violation of the requirements of this Contract.

1.3.9.4. The Contractor agrees to report to the Government any use or disclosure of the PHI not provided for by this Contract.

1.3.9.5. The Contractor agrees to ensure that any agent, including whom it provides or receives PHI, agrees to the same restrictions and conditions that apply through this Contract.

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

1.3.9.7. The Contractor agrees to document disclosures of PHI 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 PHI in accordance with 45 CFR 164.528, Right to an Accounting of Disclosures of Protected Health Information.

1.3.9.8. 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 PHI in accordance with 45 CFR 164.528, Right to an Accounting of Disclosures of Protected Health Information.

1.3.9.9. The contractor shall complete required initial HIPAA training within 30 days of the start of contract performance, and annually thereafter. The contractor may submit proof of prior comprehensive training to the Privacy Office. It will be evaluated and accepted if it meetsthe national HIPAA standard of training requirement.

1.4. PRIVILEGING REQUIREMENTS:

1.4.1. Privileging. Contractor personnel performing the DRHA and MHA functions must have credentials sufficient to authorize the granting of privileges by the MDG to perform all tasks in this performance work statement as outlined in AFI 44-119, Medical Quality Operations.

The type of professionals that may perform this work include: Physician Assistant or Nurse

Practitioner.

1.4.2. Initial application for clinical privileges, to include credentials action history, malpractice history, and completed copies of the below listed documents, shall be submitted to the MDG Credentials Office within 14 calendar days from receipt of notice of contract award, to the Contracting Office. If credentialing is not awarded for the contractor, the contractor shall provide another qualified candidate within 10 business days after receiving notification from the Contracting Office.

1.4.2.1. Copy of valid, current, unrestricted state license to practice and/or, if applicable, Board Certification

1.4.2.2. Contractor’s Education and Training Information

1.4.2.3. Current Basic and Advanced Life Support (BLS/ACLS) card

1.4.2.4. Signed consent for Release of information

1.4.2.5. Copy of proposed contractor’s professional resume, accompanied by that individual’s sworn affidavit of the truthfulness of same.

1.4.2.6. List of states in which contractor currently holds or has held a license to practice related services.

1.4.2.7. Certification of current physical examination. The certification shall contain a signed statement by the examining physician stating that employee is free of any contagious diseases or any medical condition that would prevent safe patient care. Physical examination certification shall be within the 12 month period prior to application for privileges.

1.4.2.8. Reference letters- need evaluation forms (AF Form 1562) completed by most current supervisor, peer, and department head.

1.4.2.9. Verified Privilege list (Contractor’s Specialty) by Supervisor- AF Form 2824 (Clinical Privileges, Mental Health Provider), AF Form 4305 ( Clinical Privileges-Preventive Medicine Specialists), AF Form 2816 (Clinical Privileges – Family Practice and Primary Care Physicians)

1.4.2.10. National Provider Identifier (NPI)

1.4.2.11. Criminal History Background Check – required for contractors who will see patients less than 18 years old

1.4.3. Review of Credentials Packages. The Government reserves the right to limit the number of credentialing packages it will evaluate.

1.4.4. Adverse Privileges Actions. Action to suspend, limit or revoke a contractor’s privileges will be in accordance with AFI 44-119.

1.4.4.1. The Medical Group and the contractor shall be notified via MDG Service Contract Manager (630-4052) and Credentials Manager (630-4780) by Contracting Office as soon as possible when the necessity to exercise such authority becomes apparent. The MDG will also provide the CO and contractor with copies of documentation initiating the revocation process if such actions become apparent.

1.4.5. If individual clinical privileges have been summarily suspended pending an investigation into questions of professional ethics or conduct, the contractor’s performance under this contract may be suspended until clinical privileges are reinstated. No reimbursement shall be made and no other compensation shall accrue to the contractor so long as performance is suspended. The denial, suspension, limitation, or revocation of clinical privileges based upon practitioner impairment or misconduct shall be reported to the appropriate authorities.

1.4.6. Change in Personnel/Locum Tenens. When a change in contractor/locum tenens is anticipated, the contractor shall provide to CO the same credentials as required for the initial contractor four (4) weeks prior to when the proposed change in personnel is to take place. The same review process applies to all replacement contract personnel as for the original contractor.

2. SUMMARY OF SERVICES.

This PWS identifies contract requirements for 2 full-time positions (physician assistant or nurse practitioner) to manage operations for the Active Duty Annual Mental Health Assessment and DRHA programs at Kadena Air Base, Japan.

Performance Objective PWS Ref Performance Threshold Provide quality patient care to our deployers,

1.2.8. No more than 3 discrepancies on

assessment and treatment peer review items per month.

Complete person-to-person evaluations for all members with a completed DRHA/annual MHA questionnaire within the required timeframes

1.1.1. Completion metric will remain at

or above 90%.

Patient care and documentation will be clear and concise, and comply with MDG, The Joint Commission (TJC), and clinic standards.

1.1.1. No more than 2 discrepancies on

documentation peer review items per month.

Maintains patient privacy/confidentiality.

1.3.9.11. Standard is zero breeches of

privacy (may exceed by actively protecting patient information)

Personnel in the work area are available for work at the appointed times.

1.2.7.1. No more than 3 instances of

unapproved tardiness or leaving early per quarter.

Absences scheduled at least 30 days in advance

4.6.2.2. No more than 2 unplanned

3. GOVERNMENT PROVIDED PROPERTY AND SERVICES.

3.1. The contractor will be provided an office with a door, office furniture and supplies, a telephone and a computer equipped with necessary programs to fulfill their duties and responsibilities.

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 submit to the Contracting Officer for review no later than five business days. 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 specifics as to the areas to be inspected on a scheduled and unscheduled basis, frequency 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.

4.2.1. 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).

4.2.2. The Contracting Officer’sRepresentative (COR) is the authorized government representative who will perform assessments of the contractor’s performance compliance with the terms and conditions of the contract. Subsequent to contract award, the identity of the COR(s), with a letter defining their duties and authority will be promptly furnished to the successful bidder/offerer.

4.2.3. The FRED (Functional Requirement Evaluator Designee) is responsible for monitoring, assessing, recording, and reporting on contractor’s performance. COR will sign off quality assurance monitoring form which is completed by FRED and maintain surveillance documentation, notify the Contracting Officer (CO) of any significant performance deficiencies and recommend improvements to the QASP and Performance Work Statement (PWS) throughout the life of the acquisition. The COR will maintain surveillance documentation, notify the Contracting Officer (CO) of any significant performance deficiencies and recommend improvements to the QASP and Performance Work Statement (PWS) throughout the life of the acquisition.

4.2.4. The COR will inform the contract manager in person when discrepancies occur and will request corrective action. The COR(s) or FRED will make a notation of the discrepancy on their surveillance checklist with the date and time (if known) the discrepancy was noted.

4.2.5. Any matter concerning a change to the scope, prices, terms or conditions of this contract shall be referred to the CO.

4.2.6. The services to be performed by the contractor during the period of this contract shall at all times and places be subjected to review by the CO or authorized representative(s).

4.3. SECURITY REQUIREMENTS.

4.3.1. Security and base access requirements are contained in clause AFFARS 5352.242-9000 “Contractor Access to Air Force Installations (Nov 2012).” 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.

4.3.2. 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.

4.3.3. OPERATIONS SECURITY (OPSEC) Contractor personnel will participate in the OPSEC program locally administered by the AF activity if applicable.

4.4. PHYSICAL SECURITY.

4.4.1. The Contractor shall be responsible for safeguarding all government property provided for contractor use. At the close of each work period, government facilities, equipment, and materials shall be secured, and utilities turned off or set for conservation.

4.4.2. Identification and Base Passes: The contractor shall obtain identification card and base pass for the contract contractor and vehicle. Application shall be coordinated through the CO. At time of application, Security Forces may conduct a background check on employee.

Upon termination of employment, the contractor shall return identification card and base pass to Contracting Office within 24 hours.

4.4.3. 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. The contractor shall report lost keys to QA personnel. In the event keys, other than master keys, are lost or duplicated, the contractor shall, upon written direction of the contracting officer, rekey or replace the affected lock or locks;

however, the government, at its option, may replace the affected lock or locks or perform rekeying. When the replacement of locks or rekeying is performed by the government, the total cost of rekeying or the replacement of the lock or locks shall be deducted from the monthly payment due the contractor.

4.4.4. 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. The contractor shall not duplicate any keys issued by the government.

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

4.5. Contract personnel will adhere to all local traffic laws while on Kadena AB.

4.5.1. Reporting Requirements. Contractor personnel shall report to an appropriate authority any information or circumstances of which they are aware may pose a threat to the security of DOD personnel, contractor personnel, resources, and classified or unclassified defense information. Contractor employees shall be briefed by their immediate supervisor upon initial on-base assignment.

4.5.2. Weapons, Firearms, and Ammunition. Contractor employees are prohibited from possessing weapons, firearms, or ammunition, on themselves or within their contractor-owned vehicle or privately-owned vehicle while on Kadena Air Base.

4.5.3. The contractor shall achieve the same level of trustworthiness for contractor or subcontractor personnel as required for Government personnel with similar access to automated information systems (AISs) and networks containing DoD Sensitive Information (SI). The contractor shall meet the personnel security requirements for Automated Data Processing (ADP) access in DoD 5200.2-R, Personnel Security, for employees and subcontractor employees that require access to Government (IT) systems or DoD SI, or are involved in developing, delivering, or supporting IT systems and services, or safeguarding DoD sensitive information within Government or contractor systems. The contractor shall classify ADP/IT or related positions, submit appropriate paperwork for background investigations or proof of a favorable adjudication, ensure individuals receive requisite training and document compliance. Personnel background investigations and training must be initiated before access to DoD AIS/networks or DoD SI is allowed. Following contract award, details for completing and forwarding forms for requesting an investigation will be paid for by the contractor but coordinated with the Government IT Security Officer designated for the networks and systems being accessed.

4.5.4. National Agency Checks (NAC). The contractor shall comply with DoD 5200.2-R, Department of Defense Personnel Security Program and AFI 33-119, electronic Mail Management and Use requirements for contractor personnel operating Government workstations that have unclassified automated information systems (e-mail, MIS, Internet, CAMS, etc.) Request for NAC on contractor personnel hired at the beginning of the contract, shall be submitted to the Government not later than 14 business days from the contract start date. Request for NACs on contractor personnel hired subsequent to the contract start date shall be submitted to the Government not later that five (5) workdays from the employee’s first duty day. Contractor personnel receiving unfavorable NACs shall not be hired. The contractor at no additional cost to the Government shall submit these investigations.

4.6. HOURS OF OPERATION.

4.6.1. Normal Hours of Operation. The contractor shall perform the services required under this contract during the following hours: 0600 to 1800, Monday through Friday, but will not exceed a 40-hour work week. When necessary for contractor personnel to work hours other than 0730 to 1630, Monday through Friday, contractor must coordinate with FRED. The Government will not pay overtime on this contract. The contractor may work, with prior approval of the FRED, extended hours to ensure timely completion of work at no additional cost to the government).

4.6.1.1. Upon notification, the contractor shall be available within 1 hour during normal duty hours, Monday through Friday, to meet with government personnel designated by the FRED to discuss problem areas.

4.6.2. 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. If the holiday falls on Saturday, it is observed on Friday. If the holiday falls on a Sunday, it is observed on Monday.

4.6.2.1. Down/Family Days. On work days that have been declared “down/family days,” the contractor may be asked to perform the services required under this contract. If performance is required for partial down/family days, payment will be authorized for services provided only for hours worked. The FRED will determine if services are required and notify the COR to notify the contractor five work days prior to the down/family day.

4.6.2.2. Absences and leave. All absences should be scheduled at least 30 days prior to the requested days off and communicated to the FRED. A maximum of 10 days off can be taken over a 3 month period unless there has been an emergency. The contractor shall not be compensated during periods of absences and leave to include both annual and sick leave. If the contractor is absent for three or more consecutive days due to illness, the contractor shall be required to provide written documentation from a qualified health care provider that he or she is free from communicable disease and the cause of the worker’s current illness. The Government reserves the right to examine and or re-examine any worker who meets this criterion.

4.6.2.3. The contractor shall maintain a timesheet to document hours worked daily, weekly, monthly. This shall be provided with contractor’s monthly invoice.

4.7. 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:

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

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

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

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

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 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 listed in the Japanese Environmental Governing Standards (JEGS) or the Kadena AB Spill Plan 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.

4.9.1 Government personnel, other than contracting officers (COs) and Contracting Officer Representative (COR), 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. 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.

4.10.4. 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.

4.10.5. 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.

4.10.6. Ensure personnel have the following on-base emergency services phone numbers programmed into their cell phones: Kadena Dispatch at 098-934-5911 or 098-962-9445.

4.11. TRAINING.

4.11.1. Training Participation. Once hired, the contractor shall complete and maintain all training requirements for MDG credentialed providers IAW DoD, Air Force, MDG and clinic instructions at no additional cost to the contractor.

4.11.2. Continuing Education (CE) Requirements. Health care contractors shall meet the minimum standards for CE to remain current as prescribed in AFI 44-119. CE shall be obtained at no additional cost to the Government and shall be reported to the Credentials officer in conjunction with requirements of individual provider state licensure and forwarded to the COR. Periodic CE may be conducted at the MDG and will be available, at no cost, to any health care contractor desiring to attend. If the contractor attends CE conducted at the MDG, these hours will not be charged to the government.

4.11.3. Medical Quality Assurance/Risk Management (QA/RM).

4.11.3.1. Health care contractors shall participate in QA/RM activities to the extent required by AFI 44-119 Chapter 8 and the 18 MDG QA/RM plan or regulation.

4.11.3.2. The Government will evaluate the contractor’s professional, as differentiated from administrative, performance under this contract using quality assurance standards specified in AFI 44-119. Nothing in this paragraph precludes the Government from also conducting inspections under the Inspection/Acceptance clause of FAR 52.212-4.

4.12. SPECIAL QUALIFICATIONS.

4.12.1. Advanced degree in accepted field of study from an accredited institution, along with current, valid license and/or certification (as applicable) to practice in field of expertise. The contractor must be trained and licensed/certified provider in one of the following fields:

Physician Assistant (PA). PA must have a Master of Physician Assistant Studies degree from a PA educational program accredited by U.S. Accreditation Review Commission for the Physician Assistant. Candidate also must hold current certification from the U.S.

National Commission on Certification of Physician Assistants (NCCPA). Maintenance of required Certification is mandatory. Candidates shall have experience with evaluation and treatment of mental health disorders to include Post Traumatic Stress Disorder, have at least 24 months of experience as a Physician Assistant within the last 36 months and have previous experience working as a PA with patients with history of combat-related stressors patients.

Nurse Practitioner (NP). Nurse Practitioner must hold a Master’s Degree in Nursing from an accredited institution, as well as a current unrestricted license to practice nursing in one of the fifty states, the District of Columbia, Puerto Rico, Guam, or the U.S. Virgin Islands. Candidate also must be certified as a nurse practitioner by a professional organization such as the American Nurses Credentialing Center (ANCC) or the American Academy of Nurse Practitioners (AANP). Maintenance of required unrestricted licensure along with certification is mandatory. Candidates shall have experience with evaluation and treatment of mental health disorders to include Post Traumatic Stress Disorder, have practiced as a Nurse Practitioner providing direct patient treatment in the outpatient clinical setting for at least 12 months within the past 24 months and have previous experience working as an NP with patients with history of combat-related stressors patients.

4.12.1.1. Eligibility for privileges and credentialing with Air Force Medical Service, as applicable to field of practice.

4.12.2. Ability to communicate professionally and effectively, both orally and in writing.

4.12.3. Ability to use effectively all computerized military medical databases and electronic medical charts.

4.13. CONTINUATION OF ESSENTIAL DOD CONTRACTOR SERVICES

DURING CRISIS IAW DoDI 3020.37.

4.13.1. IAW DODI 3020.37 this requirement is not considered mission essential.

4.14. PHASE OUT.

4.14.1. If there is a change in contractor or if the operation reverts to in-house, the incumbent contractor will provide familiarization, to the government or the follow-on contractor, whichever the case may be. During the phase-out familiarization period, which will be no less than two weeks and no more than one month, the incumbent will be fully responsible for the operation and management of the DRHA program.

4.14.2. The government reserves the right to conduct site visits in all contractor operated facilities in conjunction with the solicitation of offers for the follow-on contract. In the event the follow-on contract is awarded to other than the incumbent, the incumbent contractor will cooperate to the extent required to permit an orderly change over to the successful contractor.

With regard to the successor contractor’s access to incumbent employees, a recruitment notice may be placed in each facility.

4.15.