Attachment_1_-_PWS.pdf

Referral Operations Center Performance Work Statement for the 48th Medical Group

PREPARED BY: 48th Contracting Squadron and 48th Medical Group

RAF Lakenheath, England DATE: 5 March 2018

Table of Contents

Section Number and Title

Page Number

1.0 Description of Services 3

2.0 Government Furnished Property and Services

3.0 Contractor-Furnished Property and Services 3

4.0 General Information 3

5.0 Specific Tasks 12

6.0 Service Delivery Summary 14

7.0 Definitions 14

8.0 Appendices 15

Appendix A, Medical Appointment Workflow Manager 14

Appendix B, Medical Referral Appointment Clerks 17

Appendix C, Applicable Publications and Forms

Appendix D, Health Insurance Portability and Accountability Act of

Appendix E, National Agency Check/Host Nation Check

1. Description of Services: The Government requires Medical Referral and Appointing Services to include Medical Appointment Workflow Manager at RAF Lakenheath, England, also referred to as the “Medical Treatment Facility” (MTF) herein. Performance shall be in accordance with the requirements contained in this Performance Work Statement (PWS), and standards of the Joint Commission and Health Services Inspection (HSI).

1.1. If the Contractor’s employee is a US military dependent, please disclose DEROS information to the

Contracting Officer’s Representative (COR).

2. Government Furnished Property

2.1. None furnished

3. Contractor-Furnished Property

3.1. None furnished

4. General Information

4.1. Hours of Operation

4.1.1. Normal base hours of operation are 07:00 – 16:00. However, the Contractor may find it necessary to deviate from the normal base hours of operation, to ensure timely completion of work under this PWS at no additional cost to the Government.

4.1.1.1. The Contractor's work schedule will be dependent upon MTF workload and the needs of the clinic or section in which the Contractor is to provide the service. The Contractor may be required to work more or less than eight (8) hours in a single day and/or 40 hours in a week.

4.1.2. Federal Holidays. The Contractor will not be required to work the following United States federal holidays, New Years’ Day, Martin Luther King Day, President’s Day, Memorial Day, Independence Day, Labor Day, Columbus Day, Veteran’s Day, Thanksgiving Day and Christmas Day.

4.1.3. On occasion, services may be required to support an activation or exercise of contingency plans outside the normal duty hours for a crisis declared by the command authority or overseas combatant commander. Emergency situations (i.e., accident and rescue operations, civil disturbances, natural disasters, military contingency operations, and exercises) may necessitate the Contractor to provide increased or reduced support as determined by the Contracting Officer (CO).

4.1.4. The Contractor will not be entitled to any adjustment to the contract unless coordination has been made in advance.

4.2. Contractor Personnel

4.2.1. Certifications

4.2.1.1. Public Health clearance is required and the Contractor shall submit immunization records and physical health certification with the proposal. The records must show proof of immunization against Hepatitis A and B, Measles, Mumps, Rubella, Varicella, and Influenza, current as of the Contractor’s start date. The Offeror shall also provide proof of negative TB skin test taken within the past 12 months. If the TB test was positive, submit proof of negative chest x-ray within the past 12 months. After start of work, the Government will provide post blood borne exposure protocols according to applicable AFIs. The health certification shall state the date on which the physical examination was completed, the name of the doctor who performed the examination, and a statement concerning the physical health of the individual. The certification shall also contain the following statement: “(Name of Contractor personnel) is suffering from no contagious diseases to include, but not limited to, Tuberculosis, Hepatitis A and B and human immunodeficiency virus (HIV).”

4.3. Security Clearances

4.3.1. The Contractor must have a valid Security Clearance granted by the Defense Security Service.

See Appendix E.

4.3.2. Contractor personnel working in 48 MDG will have a National Agency Check or host nation equivalent. The results of the check shall be provided to the Contracting Officer. The Government will not accept any employee with a federal conviction (or host nation equivalent) in their background check. See Appendix D for details.

4.4. Contractor Management

4.4.1. Non-Availability

4.4.1.1. The MTF will notify contract personnel in advance of upcoming down days to the greatest extent possible for scheduling purposes. In the event of unplanned closure of the facility due to natural disasters, military emergency, or severe weather, contract employees will not perform duties. In no event will unplanned or planned closure of the facilities or base entitle the contractor to an equitable adjustment.

4.4.1.2. The Contractor is required to provide enough staff to meet Performance Objectives at all times.

4.4.2. Dress and Appearance

4.4.2.1. Contractor shall present a professional, conservative, and neat appearance. Contractor shall report for duty in a professional manner, in appropriate attire befitting a healthcare setting, and having complied with acceptable standards of personal hygiene expected of health care workers.

4.4.2.2. While on duty, Contractor shall be neat and clean (free from visible dirt and stains), well-groomed and appropriately dressed. The personnel’s clothing shall fit correctly to provide a professional, modest appearance. If wearing scrubs they shall match the shade of blue as the rest of the hospital.

4.4.2.3. Contractor shall display legible MTF-provided identification card on his/her outer clothing.

4.4.2.4. Facial hair (including beards, mustaches, and sideburns) shall be controlled (restrained) or trimmed and kept clean at all times.

4.4.2.5. When required and supplied by the Government, wear special protective clothing and shoe covers. When duties are performed in specified areas, a disposable protective hood shall be worn to ensure infection control standards are met. These items shall remain the property of the Government and shall not be removed from the MTF. After use, protective clothing shall be turned in or destroyed as directed by the Chief of Service.

4.4.3. Conduct

4.4.3.1. The Contractor personnel shall record the time worked according to procedures determined by the MTF.

4.4.3.2. Contractor personnel shall comply with MTF policies regarding conduct. Conduct that may be deemed inappropriate and unacceptable includes, but is not limited to, use of profanity, threats of violence, or other unprofessional conduct in the work place.

4.4.3.3. Contractor personnel shall abide by Federal and local MTF regulations and requirements concerning the nature of limited privileged communication between patients and the contract employee as may be necessary for security and personnel reliability programs. They shall also abide by federal and local MTF regulations concerning the confidentiality of patient records, as embodied in federal statutes including the Privacy Act of 1974 and the Health Insurance Portability & Accountability Act of 1996. All regulations referenced are available for review from the Contracting Officer’s Representative (COR), MTF, or the CO. All medical records and reports will remain the property of the U.S. Government.

4.4.3.4. Contractor personnel shall abide by MTF bylaws, Joint Commission (JC), Department of Defense (DoD), Health & Safety Institute (HIS) and Medical Department regulations with regard to Utilization Review and Quality Assurance directives, including, but not limited to, in-service training, maintenance of records, performance evaluation, release of medical information.

4.4.3.5. Disruptive Contractor Personnel

4.4.3.5.1. The Contracting Officer may remove any Contractor employee that is found to be disrupting the normal operations of the clinic and/or department to which they have been assigned. Disruptions may include, but are not limited to, the inability to work with other personnel (military, civilian Government employees, and other contract employees), threats of violence, use of profanity while performing under this contract, and repeated non-compliance.

4.4.3.5.2. At any time during the performance of this contract, the Contracting Officer may immediately remove the health care professional whose actions or impaired state raises reasonable suspicion that clear and present danger of physical harm exists to a patient, healthcare professionals, Government personnel or to the impaired individual. This will be used in emergency situations only and not for the purpose of bringing performance issues or other non-urgent concerns to the attention of the Contractor.

4.5. Healthcare Requirements

4.5.1. In accordance with Federal Acquisition Regulation (FAR) 37.401 with regard to Non-Personal Services for health care services, the following information is provided:

4.5.1.1. This is a non-personal health care services contract, as defined in FAR 37.101, under which the contract is an independent Contractor.

4.5.1.2. The Government may evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of services rendered (e.g., professional judgments, diagnosis, for specific medical treatment).

4.5.1.3. The Contractor hereby indemnifies the Government for any liability producing act or omission by the Contractor, its employees and agents occurring during contract performance.

4.5.2. Any clinical or administrative adverse actions will be handled and processed in accordance with (IAW) applicable Air Force instruction(s).

4.5.3. An annual physical examination is required. The Contractor must provide proof of the medical examination (prior to starting work and before each option period) by a qualified medical practitioner and required immunizations prescribed by the MTF for continued practice within the facility. Report all information necessary to assure hospital records can be maintained correctly, and therefore comply with the Joint Commission (https://www.jointcommission.org/), Operational Safety and Health Administration (https://www.osha.gov/), and Center for Disease Control (https://www.cdc.gov/) health record requirements.

4.5.4. Contractor staff must comply with 48th Medical Group and unit standards of care as well as the healthcare practices of their specific profession. See Appendix C for a list of applicable publications and forms; this list is not exhaustive.

4.5.5. Provide patients with the utmost care and undivided attention.

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

4.5.7. Participate in Quality Inspection and Risk Management activities to the extent that these events fall within the scope of this PWS.

4.5.8. Health Insurance Portability and Accountability Act (HIPAA). All patients shall be assured of their privacy and personal dignity. Follow guidelines for confidentiality and privacy based on HIPAA. See Appendix D for further information.

https://www.jointcommission.org/ https://www.osha.gov/ https://www.cdc.gov/

4.6. Release of Information and Records Management

4.6.1. Only release medical information obtained during the course of this contract to MTF staff involved in the care and treatment of that individual patient.

4.6.2. Lists and/or names of patients shall not be disclosed or revealed in any way for any use outside the MTF without prior written permission by the Chief of the Medical Staff.

4.6.3. Prepare all documentation/records to meet or exceed established standards of the MTF, to include, but not limited to, timeliness, accuracy, content and signature.

4.6.4. Generate and manage IAW DoD 5400.07, DoD Freedom of Information Act Program, Chapter 4; AFI 33-129, Web Management and Internet Use, and AFI 33-201, Communications Security

(COMSEC).

4.6.5. Mark IAW instructions identified in DoD 5400.07, Safeguard all sensitive data IAW DoD Regulation 5400.07-3.10

4.6.6. When authorized for destruction, shred the records so that the pieces cannot be reconstructed.

Degauss or overwrite magnetic tapes or other magnetic media.

4.6.7. Patient lists, no matter how developed are For Official Use Only (FOUO) and shall be marked:

“FOR OFFICIAL USE ONLY”. This document contains information exempt from mandatory disclosure under the Freedom of Information Act (FOIA).

4.7. Government Quality Assurance

4.7.1. The Government will rely on the Contractor’s quality control program to assess performance whenever possible. However, the Government reserves the right to perform additional inspections as necessary, utilizing the Government’s Quality Assurance Surveillance Plan (QASP) and the inspection/acceptance provisions in the clause FAR 52.212-4 Contract Terms and Conditions -- Commercial Items.

4.8. Government-Furnished Training

4.8.1. The Contractor may be required to attend additional site-specific training in patient care aspects and procedures. This training will be provided by the Government during normal work hours.

4.9. Bioenvironmental Engineering/Hazmat Requirements

4.9.1. Environmental, Health, And Safety. The Contractor shall ensure all employees receive the necessary environmental, health, and safety training to ensure compliance with all OSHA, federal and local laws. The Contractor shall protect the health and safety of employees and the community, minimizing the risk of environmental pollution.

4.9.2. Pollution Prevention. "Pollution Prevention" and "Source Reduction" are defined in the Pollution Prevention Act of 1990, 42 U.S.C. §§ 13101-13109. Contractor's obligation under this section is limited to identifying pollution prevention opportunities and shall not be construed to require the Contractor to conduct activities not otherwise required by the program.

4.9.3. The Contractor shall comply with energy saving conservation practices as deemed necessary by the facility manager.

4.9.4. Contractors must coordinate with facility managers and receive a safety brief of hazards present within work areas.

4.10. Security

4.10.1. See Appendix E for information regarding Host Agency Checks (HAC) and National Agency Checks (NAC).

4.10.2. The Government will conduct criminal background checks on all providers during the AIS/security. The Contractor is responsible for ensuring the required security forms are complete to the best of their knowledge. See Appendix D

4.10.3. During performance, report any information or circumstances observed that may pose a threat to the security of DoD personnel, contractors, resources, and defense information to the Security Forces. The Flight Commander will brief the Contractor upon initial on-base assignment and as required thereafter. Comply with the requirements of Volume 1, AFI 71- 101, Criminal Investigations, and paragraph 1.1 of Volume 2, Protective Service Matters.

4.10.4. Adhere to local base procedures for entry to Air Force controlled and restricted areas, briefed upon in-processing.

4.10.5. Key Control

4.10.5.1. Ensure keys issued by the Government are properly safeguarded and not used by unauthorized personnel. Contractor shall not duplicate keys issued by the Government.

4.10.5.2. Lost keys shall be reported immediately to the facility manager. The Government replaces lost keys or performs re-keying. However, the Contractor shall be held liable for any cost incurred from re-keying the affected facilities.

4.11. Logistical Support

4.11.1. Individual logistical support is provided under this contract in accordance with FAR 25.301-2, 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: DD Form 1173 – Uniformed Services Identification and Privilege Card; Commissary (including rationed items); AAFES Facilities (Post/Base Exchange) (including rationed items); Armed Forces Recreation Facilities; Local Morale/Welfare Recreation Services; Military Banking Facilities; Military Postal Service (APO/FPO); Officer or NCO/EM Clubs; POV (Privately-Owned Vehicle permit); 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; Billeting in deployed areas is on a space-required basis (non-reimbursable); Messing Facilities at deployed sites only; Department of Defense Dependent Schools on a space available and tuition paying basis; Medical services on a reimbursable basis;

and Dental care only for emergency conditions on a reimbursable basis.

4.11.2. Logistical support does not extend to driving privileges. However, personnel are entitled by

United Kingdom (UK) Law to operate a vehicle on a valid United States driver’s license for up to one year from the date of residency or entry into the UK. For information on obtaining a UK driver’s license after the one year driving period, please refer to www.gov.uk.

4.11.3. 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.

5. Specific Tasks: See Appendix A & B for full Position Descriptions http://www.gov.uk/

6. Performance Requirement Summary (PRS)/ Service Summary

Performance Objectives/Statements PWS Paragraph Reference

Performance Thresholds/AQLs

The Contractor shall provide professional Patient Care

5 Delivers professional patient care.

AQL: No more than one customer or substantiated patient advocate complaint per quarter.

The Contractor shall protect patient confidentiality and privacy

4.6 No infractions

AQL: 100% Compliant

Accurate and Proper Records Management 4.6 Records are accurately maintained AQL: No more than two errors per quarter

Contractor shall meet or exceed the required metrics in accordance with AFI 44-176:

a. Average handle/transaction time per month of less than or equal to 180 seconds 3 minutes per call

b. shall answer 90% of all inbound with each clerk’s average answer time per month at 90 seconds [1.5 minutes].

c. each clerk’s average speed of answer per month of less than or equal to 45 seconds per call.

d. Dropped calls shall not exceed, 8 percent (8%) of all answered calls.

e. shall make outbound calls with each clerk’s average handle/transaction time per month, of less than or equal to one hundred and eighty

(180) seconds [3 minutes] per call.

Appendix A Maintain Service level Metric

AQL:

a. No individual day or hour average shall exceed 270 seconds [4.5 minutes].

b. This metric is known as Service Level. No individual day or hour average shall go below 75%.

c. No individual day or hour average shall exceed ninety

(90) seconds [1.5 minutes]

d. No individual day or hour average shall exceed 15 percent (15%) seconds.

e. No individual day or hour average shall exceed 270 seconds [4.5 minutes]

The Contractor shall record 100 percent (100%) of all inbound ACD routed calls

Appendix A ACD routed calls.

AQL: 100 % of all calls recorded

Contractor will be on time and ready for work as scheduled

4.1.1 Arrive for duty on time.

AQL: No more than 5 validated late arrivals per quarter without prior notice and approval to the COR

7. Definitions

Acronym/Abbreviation Definition AFFARS Air Force Federal Acquisition Regulation AFI Air Force Instruction AQL Acceptable Quality level CO Contracting Officer COR Contracting Officer Representative FAR Federal Acquisition Regulation FOIA Freedom of Information Act FOUO For Official Use Only HAC Host Agency Check IAW In Accordance With IP Installation Pass LFC Local File Check MOD Ministry of Defense NAC National Agency Check POC Point of Contact POV Personally Owned Vehicle PRS Performance Requirement Summary/SS PWS Performance Work Statement QCP Quality Control Plan SS Service Summary/PRS TJC The Joint Commission UK United Kingdom US United States

8.0 Appendices

Appendix A, Medical Appointment Workflow Manager Appendix B, Medical Referral & Appointment Service Clerks Appendix C, Applicable Publications and Forms Appendix D, Health Insurance Portability and Accountability Act of 1996 Appendix E, National Agency Check/Host Nation Check

APPENDIX A

APPOINTMENT WORKFLOW MANAGER:

Mandatory Knowledge and Skills

A fully qualified typist (computer keyboard) with a minimum of 50 Words per Minute is required.

General office administrative and clerical skills to perform receptionist duties and answer telephones.

Standard office equipment, such as personal computers, copiers, fax MRASChines, and telephone systems.

An understanding of general medical ethics, telephone etiquette, and excellent communication, to be able to actively convey information through the exchange of thoughts, messages, or information, by speech or writing, with excellent customer service skills, a professional demeanor, appropriate interaction with clients and able to promote the best image of the government.

Able to read, write, and speak English well and should not suffer from any reading, writing, speaking or hearing limitations, so as to ensure effective communication with customers on the phone.

Education

Must hold an Associate’s degree in a healthcare or business related field or UK equivalent education level or have at least 3 years of office management experience within the last 5 years.

Experience

Minimum of one year of clinical experience within the past 5 years and at least 6 months experience in medical office scheduling.

The Contractor shall have knowledge of professional care theories, principles, practices, and procedures to perform medical documentation of moderate difficulty and experience in assessing histories of patients, as appropriate.

The Contractor shall have knowledge of a variety of medical standards used in patient treatment.

Certifications

Possess and maintain current certification in Basic Life Support.

Specific Tasks

The Appointment Workflow Manager will be able to perform all of the tasks required of a Medical Referral and Appointing Service Clerks (MRASC).

The Appointment Workflow Manager will track the MTFs appointment scheduling performance against established performance standards directed by AFI 44-176, dated 8 September 2017, and any applicable DoD or MTF instruction. In the event AFI 44-176 is updated, the Contractor shall comply with the new standards within 60 days of the notification of the update.

Performance standards include, but are not limited to: average transaction time per MRASC, per call;

average speed of answer time per MRASC, per call; average phone “ready” time per MRASC; overall answer rate for inbound calls; overall abandoned call rate; specialty referral disposition time, per specialty;

average time from when a specialty referral is placed to when it is booked, per specialty; timeliness of scanning received initial results into the Health Artifact Image Management System (HAIMS).

The Appointment Workflow Manager will require access to all CISCO supervisory and Report servers and will be required to monitor/listen to recorded phone calls, as necessary, in order to monitor compliance with established protocols or to investigate patient/staff complaints.

When MRASC performance is below established standards, the Appointment Workflow Manager will take corrective action to improve performance.

The Appointment Workflow Manager will actively manage phone queues and MRASC assignments on the phone system to meet volume demands and sustain MTF performance standards.

The Appointment Workflow Manager will centrally manage referral queues, or “book boxes” in the MTF whether the specialty referrals are booked by the central appointment office or a locally approved clinic.

The Appointment Workflow Manager will notify specialty clinics of pending specialty referrals that are requiring action (e.g. review, Appoint to MTF, Info Needed, Refer to Subspecialty, and/or Space Available).

Ensure a hard copy or scanned referral results from other MTFs and from Network/non-network providers are promptly returned to the referring provider or PCM within three (3) business days of receipt.

Prepares monthly primary and specialty care management data reports as determined by the MTF/Government

Provides timely and descriptive feedback regarding utilization review issues.

Performs data collection and analysis to identify areas requiring management and improvement.

Acts as a catalyst when appropriate and manages implementation effectively.

Takes immediate action to correct behavior/attitudes of personnel not meeting professional standards.

Manage the training of all MRASC s and those required.

Use appropriate measures to ensure phone line is open or closed when appropriate.

APPENDIX B

MEDICAL REFERRAL & APPOINTMENT SERVICE CLERKS (MRASC)

Mandatory Knowledge and Skills

A fully qualified typist (computer keyboard) with a minimum of 50 Words per Minute is required.

General office administrative and clerical skills to perform receptionist duties and answer telephones.

Standard office equipment, such as personal computers, copiers, fax MRASChines, and telephone systems.

An understanding of general medical ethics, telephone etiquette, and excellent communication, to be able to actively convey information through the exchange of thoughts, messages, or information, by speech or writing, with excellent customer service skills, a professional demeanor, appropriate interaction with clients and able to promote the best image of the Government.

Able to read, write, and speak English well and should not suffer from any reading, writing, speaking or hearing limitations, so as to ensure effective communication with customers on the phone.

Education

Administrative personnel shall possess a high school diploma or General Educational Development equivalency. Completion of administrative assistant program is desirable.

Experience

At least 6 months of experience in medical office doing scheduling or referral management. Customer Service Training/experience.

Contract personnel basic knowledge and skill level includes: principles of excellent customer service;

TRICARE benefits; quality control and risk management; medical terminology, medical forms and records management; HIPAA guidelines for release of medical information; general medical and legal ethics;

excellent communications skills; strong organizational skills; and computer operations, including operational skills with Microsoft applications (Windows Operating system, Microsoft Word, Microsoft Access, and Excel,); personnel shall understand the importance of meeting deadlines. Knowledge of current ICD-10 (International Classification of Diseases, tenth revision) coding desirable, but not required.

The Contractor personnel shall have functioning knowledge of Government appointing MHS Guide to Access Success and referral management business rules (AFMS RMC Guide), Government appointing information systems, JC or AAAHC, UEI, HIPAA, DoD Health Information Privacy Regulation (DoD 6025.18-R), the Privacy Act, and DoD Privacy Program (DoD 5400.11-R). The Contractor shall ensure that their staff has read the current AFMS RMC User Guide prior to start of work.

Certifications

The Contractor is required to obtain a certification in Basic Life Support (BLS).

Performance Outcomes

The Contractor shall provide MRASC who engage with patients through phones and electronic means to answer/place calls and answer/place electronic messages for the 48th Medical Group, RAF Lakenheath in both specialty referral and/or primary care appointments.

The MRASC will perform within one or more of the following business lanes: Appointing Management or Consult Management with regard to primary and specialty care.

MRASC s shall utilize the Automated Call Distribution (ACD) system and TRICARE Online Patient Portal Secure Messaging In Accordance With (IAW) established protocols and where applicable, use Standard Operating Procedures (SOPs), Booking Protocols, and Business Rules in combination with developed skill sets in the execution of the MTF mission. The MRASCs shall meet or exceed the required metrics in accordance with Air Force Instruction (AFI) 44-176, dated 8 September 2017. In the event AFI 44-176 is updated, the Contractor shall comply with the new standards within 60 days of the notification of the update.

MRASCs shall handle inbound ACD routed calls with each clerk’s average handle/transaction time per month of less than or equal to one hundred and eighty (180) seconds [3 minutes] per call. No individual day or hour average shall exceed two hundred and seventy (270) seconds [4.5 minutes].

MRASCs shall answer 90 percent (90%) of all inbound ACD routed calls with each clerk’s average answer time per month at ninety (90) seconds [1.5 minutes]. This metric is known as Service Level. No individual day or hour average shall go below 75 percent (75%).

MRASCs shall handle inbound ACD routed calls with each clerk’s average speed of answer per month of less than or equal to 45 seconds per call. No individual day or hour average shall exceed ninety (90) seconds [1.5 minutes].

MRASCs shall manage inbound ACD routed calls to prevent calls from being dropped. Dropped calls shall not exceed, 8 percent (8%) of all answered calls. No individual day or hour average shall exceed 15 percent (15%) seconds.

MRASCs shall record 100 percent (100%) of all inbound ACD routed calls.

MRASCs shall make outbound calls with each clerk’s average handle/transaction time per month, of less than or equal to one hundred and eighty (180) seconds [3 minutes] per call. No individual day or hour average shall exceed two hundred and seventy (270) seconds [4.5 minutes].

MRASCs shall utilize the Composite Health Care System (CHCS) Managed Care Program Module, Assignment Order Processing Module, or any Air Force mandated system(s), to identify appointment availability, schedule, cancel, and reschedule appointments following local directives, established protocols, Booking Protocols, and the MTF Business Rules using the appropriate Access to Care (ATC) category, matched to the appropriate standard appointment types, and detail codes within the appropriate ATC standards.

MRASCs will generate or receive, and electronically deliver, telephone messages (t-cons) to medical providers and clinic support staff by using CHCS or AHLTA, or any Air Force mandated system(s), per individual clinic guidelines; AFI 44-176, dated 8 September 2017; and any other applicable DoD or MTF instruction. In the event AFI 44-176 is updated, the Contractor shall comply with the new standards within 60 days of the notification of the update.

MRASCs shall take the following actions concerning specialty care consults/referrals:

MRASCs shall disposition referrals as “Appoint to MTF” or “Defer to Network” within one (1) business day of receipt in accordance with Air Force Instruction (AFI) 44-176, dated 8 September 2017, and the DHA Interim Procedures Memorandum 17-002 dated 19 Jan 17. In the event AFI 44-176 or any new DHA Interim Procedure is updated, the Contractor shall comply with the new standards within 60 days of the notification of the update.

MRASCs will review referrals for administrative completeness, covered TRICARE benefit and required tests and pre-work. Coordinates with referring providers in cases where additional referral information is required.

MRASCs will book specialty care consults/referrals when contacted by the patient and the referral is dispositioned as “Appoint to MTF.” If the referral lacks a review disposition when the patient calls, then the MRASC will provide a “warm hand-off” to the specialty clinic to immediately review the referral and appoint or defer it.

MRASCs will proactively contact patients with active specialty referrals until the specialty or behavioral health care appointment can be booked, the patient cancels the referral, or the message has been delivered three (3) times (first message NLT day 3 and final message NET day 14). Each contact attempt will be documented in CHCS or any Air Force mandated system(s).

When the MTF cannot offer thee (3) different appointments within the access to care standard, the MRASC will inform the patient that the specialty referral can be deferred to the network and will offer the patient an MTF appointment outside the standard. The MRASC will process the specialty referral according to the patient’s preference.

MRASCs shall assist with ROFR determinations for specialty care that can be provided within the MTF using Service Availability (Capability) Listings and information systems that link the referral to the appointment to the ATC category and standard. ROFR shall be processed within the time limits outlined in the TRICARE Operations Manual, Chapter 8, Section 5.

MRASCs shall perform/assist with appointing network specialty care referrals as allowed by the TRICARE Overseas Program (TOP) Contractor

MRASCs will administratively close all un-appointed referrals accepted by the MTF NLT 180 days beyond the order date.

MRASCs shall manage the “cancellation line” feature, ensuring that when patients call in to cancel appointments by leaving voice mail, the MRASC shall retrieve message and go into AHLTA/CHCS, or any Air Force mandated system(s), to cancel the applicable appointment within same day or coordinate with the appropriate clinic to get the appointment cancelled within the same day.

When patients request to cancel a specialty referral appointment or consult, MRASCs will document the cancellation reason in CHCS, or any Air Force mandated system(s), and send a t-con to the referring provider within one (1) business day of the cancellation. No individual weekly timeliness average of cancellation notifications will exceed two (2) business days.

MRASCs shall verify beneficiary eligibility, using patient’s DOD ID number and two patient identifiers, update legacy Defense Enrollment Eligibility Reporting System (DEERS) information as necessary or refer patient to DEERS and update patient demographics in CHCS per DoD Healthcare policy, and local MTF policies.

MRASCs will attend all training activities, per local MTF policies. Training may include but is not limited to topics designed to increase skills, enhance work flow or communication, update on standard operating procedures, adjust to changing mission requirements, address facility or installation issues or increase overall effectiveness and efficiency of operations.

Contract personnel will provide Phase I (didactic/classroom), Phase II (over-the-shoulder/on the floor), and Phase III (specialty consult) training to all contract personnel at a level of excellence commensurate with training provided to civil service personnel.

Contract personnel will also provide training to Active Duty/Civilian/Red Cross volunteers who have been identified to support the MRASCs, when deemed necessary for times when the contract company does not/cannot provider the required personnel to meet contract requirements.

Contract personnel shall complete all required training within the first month of assignment and be able to perform all functions required for the MRASC.

MRASCs will provide patients with specific instructions for their appointment/referral following local directives, established protocols, SOPs, Booking Protocols, and the MTF Business Rules.

MRASCs will perform other administrative and clerical duties in support of the medical care and operational support as required.

MRASCs will advise patients of the provider, location, time and day of their booked appointments.

MRASCs will coordinate with specialty referral clinics (e.g., internal MTF, Veteran’s Affairs clinic, etc.)

on special patient instructions and tests required prior to appointment.

MRASCs will track initial specialty care and deferred to network primary care referrals to include obtaining reports from MTF, network, and non-network providers. The primary responsibility to obtain Network and purchased care results will be with the MTF.

MRASCs will process initial specialty care and deferred to network primary care reports in the HAIMS following the business rules outlined in AFI 44-176, dated 8 September 2017, close the specialty referral in

CHCS, and send a t-con to the referring provider or PCM within three (3) days of receipt of the report. In the event AFI 44-176 is updated, the Contractor shall comply with the new standards within 60 days of the notification of the update. No individual weekly timeliness average of network report notifications will exceed five (5) business days.

MRASCs will initiate efforts to capture network reports upon request of the referring provider or no later than 60 days from the date the specialty referral was ordered or as soon as a claim is discovered, whichever occurs first.

MRASCs will administratively close all open specialty referrals deferred to the network NLT 180 days beyond the order date.

MRASCs will pull NAL reports and enter them into AHLTA under the appropriate clinic.

MRASCs will use TOL Patient Portal Secure messaging to:

Register beneficiaries for TOL Patient Portal Secure Messaging Accounts IAW established protocols.

Out-process beneficiaries from TOL Patient Portal Secure Messaging when the member PCSs, separates, retires, or any other reason where the member no longer needs access to the system.

Communicate with beneficiaries for scheduling appointments or concerning the use/activation of referrals.

Answers main office phone line(s). Directs telephone calls to appropriate section for assistance, handles independently or takes messages as required.

Reviews referrals for administrative completeness and researches covered benefits prior to processing.

Determines patient eligibility for services and arranges and schedules medical appointments for referred care.

Provides general instructions to patients and ensures patients have necessary documentation for referred health care services.

Obtains updates and files medical records as needed.

Organizes and researches patient records, extract needed information, and review records for referral results within established guidelines.

Request medical records and ensures arrival of medical records prior to appointment(s).

Initiates and locates patient medical records as needed.

Obtains documentation as requested by healthcare providers (test results, or documentation not yet filed in records).

Ensures referral results are returned to the referring provide and to the medical record within required timelines. Assists with follow up, written or verbal, as necessary.

Utilizes the referral tracking data collection tool. Calculates metrics, and compiles monthly reports, as directed by the MTF.

Orients and trains MTF personnel about the referral process and timelines.

APPENDIX C

APPLICABLE PUBLICATIONS AND FORMS

Publications and forms applicable to this Performance Work Statement (PWS) are listed below. The Contractor shall follow those publications to the extent (that is, the specific procedure in a paragraph, section, chapter or volume) specified in the PWS. The government provides all publications and forms listed, they are provided electronically at http://www.e-publishing.af.mil/. The Government may issue supplements or amendments to listed publications from any organizational level during the life of the contract. It is the Contractor’s responsibility to check the website for updated supplements. The Contractor shall immediately implement those changes in publications that result in a decrease or no change in the contract price. Before implementing any such revision, supplement, or amendment that will result in an increase in contract price, the Contractor shall submit to the Contracting Officer (CO) a quote for approval. Price proposals shall be submitted within 30 calendar days from the revision, supplement, or amendment giving rise to the increase in cost of performance. The Government will consider changes in the contract price due to supplements and amendments shall be considered under the "Contract Terms and Conditions - Commercial Items" clause. The Government will continue to supply the Government forms needed for daily operations.

Publications Code:

AFI - Air Force Instruction AFMAN - Air Force Manual AFP - Air Force Pamphlet AF Form - Air Force Form DD Form - Department of Defense Form.

MDGI - Medical Group Instruction DoDD - Department of Defense Directive DoDI - Department of Defense Instruction

DEPARTMENT OF DEFENSE (DOD)

REGULATIONS/MANUALS/INSTRUCTIONS/DIRECTIVES

Number Title of Directive Date DHA IPM 18-001 Standard Processes Procedures and Appointments DHA PI 6025.03 Standard Processes Criteria for US Services DoDD 5400.11 Privacy Program DoDD 5500.7 Standards of Conduct DoD 6025.18-R Health Information Privacy DoDI 1402.5 Criminal History Background Checks DoDI 3020.37 Continuation of Essential DoD

AIR FORCE REGULATIONS/MANUALS/INSTRUCTIONS

Number Title of Directive Date AFI 33-119 AF Messaging AFI 33-129 Web Management and Internet Use AFI 33-201 Communications Security (COMSEC) AFI 33-322 Records Management Program http://www.e-publishing.af.mil/

AFI 41-115 Authorized Health Care and Benefits AFI 41-210 Patient Administration Functions AFI 44-171 Patient Centered Medical Home Operations AFI 44-176 Access to Care Continuum AFI 46-101 Nursing Services and Operations AFI 48-123 Medical Examinations and Standards AFI 71-101V1 Criminal Investigations Program AFI 71-101V2 Protective Service Matters AFI 44-119 Medical Quality Operations

Publications

Publications are available electronically, please note updates to policies which could potentially require position requirements to change are based upon these publications.

DoD publications are available at:

http://west.dtic.mil/whs/directives/

AF publications are available at:

http://www.e-publishing.af.mil/

Master Privilege List for physician credentialing is available at:

http://www.airforcemedicine.af.mil/Organizations/AFCCVO/Forms/Physicians http://west.dtic.mil/whs/directives/ http://www.e-publishing.af.mil/ http://www.airforcemedicine.af.mil/Organizations/AFCCVO/Forms/Physicians

APPENDIX D

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

1. 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.

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 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.

2. 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.

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

4. 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.

5. 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.

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

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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.

Specific Use and Disclosure Provisions

1. 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.

2. 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.

3. 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).

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