PWS_-_Referral_Management_GK.pdf

PERFORMANCE WORK STATEMENT

FOR

REFERRAL MANAGEMENT CENTER ADMINISTRATIVE SUPPORT SERVICES

GEILENKIRCHEN AIR BASE, GERMANY

17 March 2017

PERFORMANCE WORK STATEMENT (PWS)

REFERRAL MANAGEMENT CENTER ADMINISTRATIVE SUPPORT SERVICES

PART 1

GENERAL INFORMATION

1. GENERAL: This is a non-personal services contract to provide administrative support services to the

Referral Management Center (RMC) as described in this Performance Work Statement at the 470th Air

Base Squadron U.S. Clinic, Unit 8030, APO, AE 09104, Medical Treatment Facility (MTF). The

Government shall not exercise any supervision or control over the contract service providers performing the services herein. Such contract service providers shall be accountable solely to the Contractor who, in turn is responsible to the Government.

1.1 Description of Services/Introduction: The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform administrative support services to the Referral Management Center (RMC) as defined in this

Performance Work Statement except for those items specified as government furnished property and services. The contractor shall perform to the standards in this contract.

1.2 Background: The contractor shall provide administrative support for the MTF staff and beneficiaries.

The contractor shall ensure patient flow is optimized by assisting patients at the Referral Management

Center (RMC) to process their referrals to specialty care and making their appointments to include computerized appointment booking and appointment validation. The contractor shall maintain or assist with a variety of health record storage and retrieval systems. The contractor shall participate with RMC staff in providing, assessing and improving a wide variety of customer services/relations. The contractor shall prepare and submit administrative and statistical reports. The contractor shall orient new personnel to

RMC. The contractor shall assist in the management of all forms of communication between beneficiaries, team members, network/outside providers and ancillary health care workers. Contractor service and care shall cover the range of services provided in a civilian medical treatment facility. Performance shall be according to the requirements contained in this Performance Work Statement (PWS), professional standards of the Joint Commission (JC) and the Accreditation Association of Ambulatory Health Care

(AAAHC).

1.3 Objectives:

1.3.1. Coordinates referral management functions and ensures team members receive information in a timely and efficient manner to facilitate continuity of patient care.

1.3.2. Coordinates specialty care referrals in MTF or Host Nation (HN).

1.3.3. Reviews specialty care referrals for appropriateness of medical facility, covered benefit and administrative completeness.

1.3.4. Makes specialty care appointments in MTF or HN.

1.3.5. Assists in providing patients specialty care referral information/instructions.

1.3.6. Serves as functional expert in the area of health benefits.

1.3.7. Maintains and tracks referral records.

1.3.8. Participates with team members in providing, assessing and improving a wide variety of customer services/relations.

1.3.9. Assists in the management of all forms of communication between beneficiaries, team members, internal staff and providers, network and outside providers and ancillary health care workers.

1.3.10. Orients new personnel to the RMC team.

1.3.11. Prepares and submits administrative reports.

1.4 Scope: The Contractor shall provide administrative support services to the Referral Management

Center (RMC) as described in this Performance Work Statement at the 470th Air Base Squadron U.S.

Clinic, Unit 8030, APO, AE 09104, Medical Treatment Facility (MTF). The contractor shall review and follow the Air Force Medical Service (AFMS) Referral Management Center User’s Guide as a reference to understand the purpose and objectives of the AFMS. The guide can be found at https://kx2.afms.mil/kj/kx2/AFMOAHealthBenefits/Pages/home.aspx or made available by TRICARE service center.

1.5 Period of Performance: The period of performance shall be for one (1) Base Year of 12 months and four (4) 12-month option years. The Period of Performance reads as follows:

Base Year 1 Sep 2017 - 31 Aug 2018

Option Year I 1 Sep 2018 - 31 Aug 2019

Option Year II 1 Sep 2019 - 31 Aug 2020

Option Year III 1 Sep 2020 - 31 Aug 2021

Option Year IV 1 Sep 2021 - 31 Aug 2022

1.6 General Information

1.6.1 Quality Control: The contractor shall develop and maintain an effective quality control program to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The contractor’s quality control program is the means by which he assures himself that his work complies with the requirement of the contract. The Contractor shall provide a Quality Control Plan (QCP) to the KO for review within 30 days after contract award, three copies of a comprehensive written QCP shall be submitted to the KO and

COR within 5 working days when changes are made thereafter. After acceptance of the quality control plan the contractor shall receive the contracting officer’s acceptance in writing of any proposed change to his QC system.

1.6.1.1. The Contractor QC program shall include:

1.6.1.2. Continuing review of the contract performance including compliance with regulations referenced in the contract. Review shall be accomplished and recorded on a schedule as dictated by the Contractor's written QC Plan. Records shall be made available to the Government Contracting Officer Representative

(COR) upon Government request throughout the contract performance period and for the period after contract completion until final settlement of any claims under this contract.

1.6.1.3. A method of identifying deficiencies in the quality of service before the level of performance deteriorates to an unacceptable level. Audit results shall be made available to the COR upon Government request.

1.6.1.4. Subsequent changes thereto shall be provided to the KO for review and acceptance before implementation.

1.6.2 Quality Assurance: The government shall evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan. This plan is primarily focused on what the

Government must do to ensure that the contractor has performed in accordance with the performance https://kx2.afms.mil/kj/kx2/AFMOAHealthBenefits/Pages/home.aspx standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

1.6.3 Recognized Holidays: The following are NATO holidays. A list with the dates will be provided prior to the start of each year and option year as soon as they are available. The holiday schedule is as follows: New Year’s Day, Good Friday, Easter Sunday, Easter Monday, Labor Day, Ascension Day, Whit

Sunday, Whit Monday, Corpus Christi, German Unity Day, All Saints Day, Christmas Day and Boxing

Day.

1.6.4 Hours of Operation: The contractor is responsible for conducting business, between the hours of

0800-1700 Monday through Friday, or as negotiated with the MTF, equal to 40 hours per week except

Federal holidays or when the Government facility is closed due to local or national emergencies, administrative closings, or similar Government directed facility closings. For other than firm fixed price contracts, the contractor will not be reimbursed when the government facility is closed for the above reasons. The Contractor must at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS when the Government facility is not closed for the above reasons. When hiring personnel, the Contractor shall keep in mind that the stability and continuity of the workforce are essential.

1.6.5 Place of Performance: The work to be performed under this contract will be performed at 470th

Medical Flight US Clinic, Geilenkirchen NATO AB, Germany.

1.6.6 Type of Contract: The government will award a (non-personal services -- Type of contract to be determined by KO and the in consultation with the customer).

1.6.7 Security Requirements: Contractor personnel performing work under this contract must have a

National Agency Check at time of the proposal submission, and must maintain the level of security required for the life of the contract. The security requirements are in accordance with the attached DD254.

The unit security monitor is responsible for initiating this form, and can be contacted at +49 (0)2451-63-

2228.

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

1.6.7.2 Key Control. The Contractor shall establish and implement methods of making sure all keys/key cards issued to the Contractor by the Government are not lost or misplaced and are not used by unauthorized persons. NOTE: All references to keys include key cards. No keys issued to the Contractor by the Government shall be duplicated. The Contractor shall develop procedures covering key control that shall be included in the Quality Control Plan. Such procedures shall include turn-in of any issued keys by personnel who no longer require access to locked areas. The Contractor shall immediately report any occurrences of lost or duplicate keys/key cards to the Contracting Officer.

1.6.7.2.1 In the event keys, other than master keys, are lost or duplicated, the Contractor shall, upon direction of the Contracting Officer, re-key or replace the affected lock or locks; however, the Government, at its option, may replace the affected lock or locks or perform re-keying. When the replacement of locks or re-keying is performed by the Government, the total cost of re-keying or the replacement of the lock or locks shall be deducted from the monthly payment due the Contractor. In the event a master key is lost or duplicated, all locks and keys for that system shall be replaced by the Government and the total cost deducted from the monthly payment due the Contractor.

1.6.7.2.2 The Contractor shall prohibit the use of Government issued keys/key cards 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 employees engaged in the performance of assigned work in those areas, or personnel authorized entrance by the Contracting Officer.

1.6.8 Special Qualifications: Certification as a Licensed Practical Nurse is not required but desirable.

1.6.9 Post Award Conference/Periodic Progress Meetings: The Contractor agrees to attend any post award conference convened by the contracting activity or contract administration office in accordance with

Federal Acquisition Regulation Subpart 42.5. The contracting officer, Contracting Officers Representative

(COR), and other Government personnel, as appropriate, may meet periodically with the contractor to review the contractor's performance. At these meetings the contracting officer will apprise the contractor of how the government views the contractor's performance and the contractor will apprise the Government of problems, if any, being experienced. Appropriate action shall be taken to resolve outstanding issues.

These meetings shall be at no additional cost to the government.

1.6.10 Contracting Officer Representative (COR): The COR will be identified by separate letter. The

COR monitors all technical aspects of the contract and assists in contract administration. The COR is authorized to perform the following functions: assure that the Contractor performs the technical requirements of the contract: perform inspections necessary in connection with contract performance:

maintain written and oral communications with the Contractor concerning technical aspects of the contract:

issue written interpretations of technical requirements, including Government drawings, designs, specifications: monitor Contractor's performance and notifies both the Contracting Officer and Contractor of any deficiencies; coordinate availability of government furnished property, and provide site entry of

Contractor personnel. A letter of designation issued to the COR, a copy of which is sent to the Contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the resulting order.

1.6.11 Key Personnel: The follow personnel are considered key personnel by the government: contract manager/Alternate contract manager. The contractor shall provide a contract manager who shall be responsible for the performance of the work. The name of this person and an alternate who shall act for the contractor when the manager is absent shall be designated in writing to the contracting officer. The contract manager or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract. Due to the overseas location of the contract, contract manager or alternate shall respond within 24 hours of request, except Federal holidays or when the government facility is closed for administrative reasons. Qualifications for all key personnel are listed below:

1.6.11.1 Contract Manager and Alternate must have managerial experience and knowledge of contract requirements.

1.6.12 Identification of Contractor Employees: All contract personnel attending meetings, answering

Government telephones, and working in other situations where their contractor status is not obvious to third parties are required to identify themselves as such to avoid creating an impression in the minds of members of the public that they are Government officials. They must also ensure that all documents or reports produced by contractors are suitably marked as contractor products or that contractor participation is appropriately disclosed. The contractor personnel will be required to obtain and wear badges in the performance of this service.

1.6.13 Data Rights: The Government has unlimited rights to all documents/material produced under this contract. All documents and materials, to include the source codes of any software, produced under this contract shall be Government owned and are the property of the Government with all rights and privileges of ownership/copyright belonging exclusively to the Government. These documents and materials may not be used or sold by the contractor without written permission from the Contracting Officer. All materials supplied to the Government shall be the sole property of the Government and may not be used for any other purpose. This right does not abrogate any other Government rights.

1.6.14 Organizational Conflict of Interest: Contractor and subcontractor personnel performing work under this contract may receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statements, etc.) or perform evaluation services which may create a current or subsequent

Organizational Conflict of Interests (OCI) as defined in FAR Subpart 9.5. The Contractor shall notify the

Contracting Officer immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and shall promptly submit a plan to the Contracting Officer to avoid or mitigate any such OCI. The Contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the Contracting Officer and in the event the Contracting Officer unilaterally determines that any such

OCI cannot be satisfactorily avoided or mitigated, the Contracting Officer may effect other remedies as he or she deems necessary, including prohibiting the Contractor from participation in subsequent contracted requirements which may be affected by the OCI.

1.6.15 Phase In /Phase Out Period: To minimize any decreases in productivity and to prevent possible negative impacts on additional services, the Contractor shall have personnel on board, during the thirty

(30) day phase in/ phase out periods. During the phase in period, the Contractor shall become familiar with performance requirements in order to commence full performance of services on the contract start date.

1.6.16 Contractor Manpower Reporting: The contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract for the US Air

Force via a secure data collection site. The contractor is required to completely fill in all required data fields at http://www.ecmra.mil. Reporting inputs will be for the labor executed during the period of performance for each Government fiscal year (FY), which runs 1 October through 30 September. While inputs may be reported any time during the FY, all data shall be reported no later than 31 October* of each calendar year. Contractors may direct questions to the CMRA help desk.

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

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

1.6.17. Personnel Requirements:

1.6.17.1. English Language Requirement. Personnel shall read, understand, speak and write English.

Reading, understanding, speaking, writing German and/or Dutch is desirable, but not required.

1.6.17.2. Expertise: The personnel performing this duty shall be knowledgeable in general medical ethics, health records administration, telephone etiquette, office management methods, excellent communications and customer service skills, strong organizational background and computer operations to include

Microsoft Windows and Microsoft Office applications. Personnel must understand the importance of deadlines. Knowledge of coding is desirable, but not required.

1.6.17.3. Education and Training: The personnel performing this duty shall meet the following requirements:

1.6.17.3.1. High School diploma or General Educational Development (GED) equivalency. Completion of

Administrative Assistant program is desirable.

1.6.17.3.2. Completed training in Microsoft Windows and Excel is desirable.

1.6.17.3.3. Completed and maintains Basic Life Support Training as required by the MTF.

1.6.17.3.4. Current certification as a licensed practical nurse is desired, but not required.

1.6.17.4. Appearance.

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

1.6.17.4.2. Facial Hair (including beards, mustaches and sideburns). Facial hair shall be controlled

(restrained) or trimmed. It shall not interfere with safe work practices, look unkempt or unclean.

1.6.17.4.3. Office/Work Area Appearance. Office areas provided for contract personnel use shall present an orderly appearance. The contract personnel shall ensure these areas are tidy and any decorations present a professional, modest appearance in keeping with accepted community standards.

1.6.17.5. Health Requirements:

1.6.17.5.1. Certification of current physical examination for each employee. The certification shall contain a signed statement by the examining physician stating that the employee is free of any contagious diseases.

Physical examination must be current within 12 months prior to application for privileges.

1.6.17.5.2. Contract personnel providing services under this contract shall receive a pre-employment physical examination prior to commencement of work and annually thereafter. Contract personnel report to the contractor’s physician to receive a pre-employment examination and immunizations/shots prescribed by the MTF.

1.6.17.5.3. Not later than five (5) working days prior to commencement of work, certification shall be provided to the Contracting Officer’s representative that contract personnel have completed medical evaluation required above. This certification shall state the date on which the examination was completed, the doctor’s name that performed the examination, and a statement concerning the physical health of the individual. The certification shall also contain the following statement: “(name of contract employee) is free from contagious diseases.”

1.6.17.5.4. Also, as a condition of employment, Occupational Safety Health Administration requires that all contract personnel who will have occupational exposure to blood or body fluids, or other potentially infectious materials, shall receive Hepatitis B vaccine, sign a voluntary declination, or have documented proof of immunity to Hepatitis B infection. Personnel who sign declinations may change their minds at anytime and receive the Hepatitis B vaccine without penalty.

1.6.17.5.5. It is the contractor’s responsibility to report (to the appropriate MTF staff member) all information necessary to assure MTF records can be maintained correctly and therefore comply with the

JC, OSHA, AAAHC, and CDC health records requirements.

1.6.17.6. 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.

1.6.17.7. Indemnification and Medical Liability Insurance. The Contractor shall provide and maintain adequate liability insurance coverage consistent with the risks associated with the performance of all services required by this PWS. The contractor shall provide the documentation to the CO NLT 30 days after award date. Refer to Federal Acquisition Regulation (FAR) Clause 52.237-7, "INDEMNIFICATION

AND MEDICAL LIABILITY INSURANCE,” in Section I of this contract.

PART 2

DEFINITIONS & ACRONYMS

2. DEFINITIONS AND ACRONYMS:

2.1 DEFINITIONS:

2.1.1. AMBULATORY DATA SYSTEM. Automatic system for the collection of ambulatory care data such as diagnosis and procedure codes, evaluation and management codes, and disposition.

2.1.2 ARMED FORCES HEALTH LONGITUDINAL TECHNOLOGY APPLICATION (AHLTA).

AHLTA, the military's electronic health record (EHR) (formerly CHCS II ; US DoD military health system)

2.1.3. COMPOSITE HEALTH CARE SYSTEM (CHCS). CHCS is a computer system that stores clinical and administrative data. This system provides on-line communication for users in any supported location.

2.1.4 CONTRACTOR. A supplier or vendor awarded a contract to provide specific supplies or service to the government. The term used in this contract refers to the prime.

2.1.5 CONTRACTING OFFICER. A person with authority to enter into, administer, and or terminate contracts, and make related determinations and findings on behalf of the government. Note: The only individual who can legally bind the government.

2.1.6 CONTRACTING OFFICER'S REPRESENTATIVE (COR). An employee of the U.S. Government appointed by the contracting officer to administer the contract. Such appointment shall be in writing and shall state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the contract.

2.1.7 DEFECTIVE SERVICE. A service output that does not meet the standard of performance associated with the Performance Work Statement.

2.1.8. DEFENSE ENROLLMENT ELIGIBILITY REPORTING SYSTEM (DEERS). The automated information system designed to maintain timely and accurate information on service members and dependents that are eligible for military benefits and entitlements, and to detect and prevent fraud and abuse in the distribution of these benefits and entitlements.

2.1.9 DELIVERABLE. Anything that can be physically delivered, but may include non-manufactured things such as meeting minutes or reports.

2.1.10. ELECTRONIC WORLDWIDE REFERRAL AND AUTHORIZATION SYSTEM (EWRAS). The

HIPAA-compliant, MHS information technology solution for standardizing the business rules and for managing referrals and authorization in the TRICARE environment.

2.1.11. KEY PERSONNEL. Contractor personnel that are evaluated in a source selection process and that may be required to be used in the performance of a contract by the Key Personnel listed in the PWS. When key personnel are used as an evaluation factor in best value procurement, an offer can be rejected if it does not have a firm commitment from the persons that are listed in the proposal.

2.1.12. MEDICAL TREATMENT FACILITY (MTF). Air Force hospitals or clinics, including all activities providing outpatient and/or in-patient health care services for authorized personnel.

2.1.13 PHYSICAL SECURITY. Actions that prevent the loss or damage of Government property.

2.1.14 QUALITY ASSURANCE. The government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

2.1.15 QUALITY ASSURANCE Surveillance Plan (QASP). An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

2.1.16. QUALITY ASSURANCE/RISK MANAGEMENT (QA/RM) COMMITTEE. Responsible for the execution of the MTF QA/RM plan to include the duties outlined in AFI 44-119. The committee ensures an ongoing assessment of the quality and appropriateness of all medical care and will put in priority sequence suspected problems for evaluation, resolution, and follow-up.

2.1.17 QUALITY CONTROL. All necessary measures taken by the Contractor to assure that the quality of an end product or service shall meet contract requirements.

2.1.18 SUBCONTRACTOR. One that enters into a contract with a prime contractor. The Government does not have privity of contract with the subcontractor.

2.1.19. TRICARE ONLINE. A Department of Defense (DoD) computer system and the primary platform for EWRAS

2.1.20 WORK DAY. The number of hours per day the Contractor provides services in accordance with the contract.

2.1.2 WORK WEEK. Monday through Friday, unless specified otherwise.

2.2 ACRONYMS:

AAAHC Accreditation Association of Ambulatory Health Care

AHLTA Armed Forces Health Longitudinal Technology Application

ACOR Alternate Contracting Officer's Representative

AFFARS Air Force Federal Acquisition Regulation Supplement

CCE Contracting Center of Excellence

CFR Code of Federal Regulations

CONUS Continental United States (excludes Alaska and Hawaii)

COR Contracting Officer Representative

DD250 Department of Defense Form 250 (Receiving Report)

DD254 Department of Defense Contract Security Requirement List

DFARS Defense Federal Acquisition Regulation Supplement

DMDC Defense Manpower Data Center

DOD Department of Defense

FAR Federal Acquisition Regulation

HIPAA Health Insurance Portability and Accountability Act of 1996

KO Contracting Officer

OCI Organizational Conflict of Interest

OCONUS Outside Continental United States (includes Alaska and Hawaii)

ODC Other Direct Costs

PIPO Phase In/Phase Out

POC Point of Contact

PRS Performance Requirements Summary

PWS Performance Work Statement

QA Quality Assurance

QAP Quality Assurance Program

QASP Quality Assurance Surveillance Plan

QC Quality Control

QCP Quality Control Program

TE Technical Exhibit

PART 3

GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND SERVICES

3. GOVERNMENT FURNISHED ITEMS AND SERVICES:

3.0. General: The Government shall provide the following equipment and supplies listed.

3.1. Equipment: The Government shall furnish desk, workspace, computer equipment, necessary software, required network access and connectivity, telephone, utilities, fax, reproduction services, office supplies and parking.

3.2. Forms: The MTF shall provide required Government forms used in the performance of services.

3.3 Services:

3.3.1. Administrative Support: Contract personnel will be authorized to use all administrative support available to Government employees. This will include but not be limited to copy machines, telefax machines, medical library, installation distribution, Class-A telephone lines and Defense Switching

Network (DSN) lines. Contract personnel shall be authorized CHCS, AHLTA, TRICARE Online, EWRAS, ADS and computer access only to complete assigned tasks. Contractor’s use of CHCS, other electronic systems, and a computer system is limited to official government business.

3.3.2. Housekeeping: The Government as part of the MTF housekeeping contract will provide routine housekeeping.

3.3.3. Government Orientation/Training: The Government will provide training on Government provided forms and equipment, universal precautions, initial orientation and continuing orientation. Participates in continuing education programs to update and/or maintain skills and knowledge to meet annual requirements. Participates in evaluation of the quality and effectiveness of activities and services of the unit.

3.3.3.1. The Government will provide training to the contractor’s trainers. The contractor shall then train their staff in order to meet the requirements as specified in this contract. The contractor shall train all staff in accordance with the requirements of the MTF Commander's training plan that includes appointing, referral management business rules, and Government IT systems requirements.

3.3.3.2. The contractor’s staff shall have functioning knowledge of Government appointing and referral management business rules, Government appointing information systems, The Joint Commission (JC), Accreditation Association of Ambulatory Health Care (AAAHC), Health Insurance Portability and

Accountability Act (HIPAA), DoD Health Information Privacy Regulation (DoD 6025.18-R) the Privacy

Act, and DoD Privacy Program (DoD 5400.11-R) to appoint beneficiaries correctly. All contractor staff that access Government IT systems shall be trained in security awareness, protection of Government sensitive and privacy information and their responsibility and consequences before access is authorized.

3.4. Records, Files, Documents, and Work Papers: All records, files and documents provided by the government remain Government property. The Quality Assurance Personnel (QAP) will provide guidance to the contract personnel who shall maintain and dispose of these records, files, and documents in accordance with the Privacy Act of 1974, the Health Insurance Portability and Accountability Act (HIPAA) of 1996, and AFI 41-210 when handling patient information. Patient information shall not be disclosed or revealed to unauthorized personnel.

PART 4

CONTRACTOR FURNISHED ITEMS AND SERVICES

4. CONTRACTOR FURNISHED ITEMS AND RESPONSIBILITIES:

4.1. General: Except for those items or services specifically stated in Part 3 to be Government furnished, the contractor shall furnish everything required to perform this contract in accordance with all of its terms.

4.2. Contractor Owned/Contractor Operated Equipment: The Government does not anticipate a need for contractor furnished equipment.

4.3. Initial Inspection: All contractors owned equipment will be inspected and approved by the biomedical equipment maintenance section prior to use in the facility. This includes personal items such as coffee makers and radios.

4.4. Replacement Of Contractor Owned/Contractor Operated Equipment: If, in the judgment of the biomedical equipment maintenance section personnel, a piece of contractor owned and operated equipment is unsafe, based on diagnostic testing and established industry standards, it shall be tagged as unserviceable and removed from use. Replacement of said equipment will be at the contractor’s expense.

4.5. Unit Specific Orientation: The contractor shall ensure that all contract employees participate in the

MTF unit specific orientation to include: regulations specific to their professional specialty, hospital and

Air Force policy and procedures at the Government expense. The contract employees shall have their skills accessed on an initial and annual basis by the Government. The Contractor shall ensure that contract employee is trained and maintains training in Basic Life Support as required by the MTF.

4.6. Records, Files And Work Papers: Contract personnel shall maintain and dispose of Government provided as well as contractor generated records, files, and documents in accordance with instructions provided by the QAP, the Privacy Act of 1974, and the Health Insurance Portability and Accountability Act

(HIPAA) of 1996, and in accordance with Air Force Instruction 41-210 when handling and providing patient information. Patient information shall not be disclosed or revealed to unauthorized personnel.

4.7. National Agency Checks: The contractor shall comply with the DoD 5200.2-R, Personal Security

Program, and AFI 33-119, Air Force Messaging, requirements for contractor personnel operating

Government workstations that have unclassified automated information systems (e-mail, MIS, Internet, CAMS, etc.) Request for National Agency Checks (NAC), on contractor personnel hired at the beginning of the contract, shall be submitted to the Government not later than fourteen (14) working 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 than five (5) workdays from the employee’s first duty day.

Contractor personnel receiving unfavorable NACs shall not be hired. These investigations shall be submitted by the Government at no additional cost to the contractor.

PART 5

SPECIFIC TASKS

5. SPECIFIC TASKS:

5.1 Basic Services: The contractor shall provide services with basic knowledge for customer service, TRICARE, quality control and risk management, medical terminology, medical forms and records management, guidelines for release of medical information, medical and legal ethics, and information systems. Knowledge of coding desirable, but not required.

5.2 Referral Appointing:

5.2.1. Reviews referrals for suitability, administrative, and clinical completeness, covered TRICARE benefit, required tests and pre-work. Coordinates with referring provider in cases where additional referral information is required.

5.2.2. Verifies patients are registered in Composite Health Care System (CHCS), Armed Forces Health

Longitudinal Technology Application (AHLTA), EWRAS, and Defense Enrollment Eligibility Reporting

System; updates demographic information as needed.

5.2.3. Assists with Right of First Refusal (RFR) determinations for specialty care that can be provided within the MTF using Service Availability (Capability) Listing (SAL) and information systems that link the referral to the appointment to the Access to Care (ATC) category and standard.

5.2.4. Schedules specialty referral appointments to MTF or Direct Care System, and if allowed to

Network/non-network provider, within Access to Care standards 90 percent of the time

5.2.5.Coordinates with specialty referral clinics (internal or external) on special patient instructions and tests required prior to appointment.

5.2.6.Advises patients of the provider, location, time and day of referral appointments or requests the patient call back for appointment information if not provided appointment prior to leaving MTF.

5.2.7.Assists team members in providing pre-appointment instructions to patients as indicated.

5.2.8. Locates referral requests and ensures appropriate documents are available prior to all specialty appointments.

5.2.9.Prints diagnostic reports and treatment profiles as necessary.

5.2.10. Ensures patients leave MTF with all necessary documentation appropriate for the referred care episode and the referral provider knows where to return his/her results.

5.2.11. Contacts patients in event referral requests are invalid, disapproved by second level review and reschedules patients as soon as possible or instructs patients of other health care options. Submits referrals when required for medical necessity and appropriateness review.

5.2.12. Receives and appropriately forwards clinical phone consult requests from patients.

5.2.13. The contractor shall submit network/non-network referral results through the Translations

Automated Database Input and Verification System (TADIVS) for translations.

5.3 Health Benefits Advice:

5.3.1. Advises all categories of patients of what their referral and health treatment options are as related to their eligibility and beneficiary status.

5.4 Referral Tracking:

5.4.1. Tracks referrals to include obtaining reports from MTF, Direct Care System and network and non-network providers within established standards. The primary responsibility to obtain network/non-network results and return them to the referring provider resides with the managed care support contractor.

5.4.2. Documents patient appointments, with whom, either in the MTF, another MTF, in the network or with a non-network provider.

5.4.3. Documents the name of the referring provider/PCM and MTF for purposes of return of completed specialty results.

5.4.4. Follows-up with MTF providers who did not complete referral results within required timelines.

5.4.5. Ensures that results from other MTFs and from Network/non-network providers are returned to the referring provider and to the medical record within required timelines and follows up as necessary.

(Process to obtain Network/non-network reports and return them to the referring providers will be outlined in the Memorandum of Understanding (MOU) between the T-Nex MCSC and the MTF. The primary responsibility to obtain Network/Non-Network results is the T-Nex MCSC).

5.4.6 Documents that paper referral results are properly filed in patient’s health record.

5.4.7 Assists in preparation of monthly reports as indicated.

5.5. Customer Service:

5.5.1. Greets patients, screens and appropriately routes phone calls.

5.5.2. Relieves requesting provider from as many administrative burdens as possible.

5.5.3. Serves as the “central clearing house” for providers and patients needing help with referrals.

5.6. Procedure Guidance: The contractor shall not introduce services other than those included herein without prior recommendation to, and approval of, the Contracting Officer (CO). If the scope of the contract is changed by new services, the CO prior to implementation will incorporate the change into the contract.

5.7. Documentation: The contractor shall prepare all documentation to meet or exceed established standards of the MTF to include but not limited to: timeliness, legibility, accuracy, content, format, complete patient identifying information, medically consistent and error free.

5.7.1. The contractor shall obtain complete patient data, which may involve researching the information

(e.g. telephoning the Quality Assurance Evaluator).

5.8. Records: The contractor shall be responsible for creating, maintaining, and disposing of only those

Government required records which are specifically cited in this PWS or as may be required by the provisions of mandatory directives listed in Section C-7 of this PWS. If requested by the Government, the contractor shall provide the original record or a reproducible copy of any such records within five working days of receipt of the request.

5.9. Patient Lists: Patient lists, no matter how developed shall be treated as privileged information. Lists and/or names of patients shall not be disclosed to or revealed in anyway for any use outside the MTF without prior written permission by the Government.

5.10. Security Requirements: 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

(Information Technology - 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 coordinated with the Government

IT Security Officer designated for the networks and systems being accessed.

5.10.1. The contractor shall use Protected Health Information (PHI) or Personally Identifiable Information

(PII) for their designated project only. This information shall not be used to create databases or any other product not intended for use specifically for this project. All PHI/PII related to the project, but not delivered to the Government, shall be destroyed at the conclusion of the tasking. Destruction of the information shall comply with The Deputy Secretary of Defense Memorandum, subject: “Destruction of

DOD Computer Hard Drives Prior to Disposal,” dated January 8, 2001. The Memorandum requires that all hard drives containing unclassified data being disposed of outside DoD be removed and destroyed through sanitation of SI from storage media in a manner that gives assurance that the information is unrecoverable by technical means.

5.10.2. All PHI/PII processed and hard copy output by government and contractor Information Systems

(IS), and networks is considered SI and will be treated as “For Official Use Only,” FOUO, information, as directed by DoD 5400.7, “DoD Freedom of Information Act Program,” September 1997. Any SI (e.g., PHI/PII and privacy data, processed, printed, stored or manipulated on government and contractor ISs and networks will be protected, marked and labeled in accordance with DoD Information Security Program, (DoD 5200.1-R).

5.10.3. The contractor shall maintain, transmit, retain in strictest confidence, and prevent the unauthorized duplication, use, and disclosure of PHI in accordance with Standards for Privacy of Individually

Identifiable Health Information, Final Rule, December 28, 2000, DoD Health Information Privacy

Regulation (DoD 6025.18-R), the Privacy Act, and DoD Privacy Program (DoD 5400.11-R). The contractor shall provide patient information only to employees, contractors, subcontractors and

Government personnel having a need to know such information in the performance of their duties for this project. The Contracting Officer’s representative or QAP shall approve the release of any patient information prior to the release.

5.11. Communication: The contractor shall ensure contract employees maintain open and professional communication with members of the MTF. Complaints validated by the QAP and Government shall be reported in writing to the contract administrator and the contractor for action. Failure of the contractor to correct validated complaints cited by the MTF staff and the CO will be considered a failure to perform.

5.12. Infection Control And Safety: The contract employee shall comply with all MTF infection control and safety procedures, practices and standards.

5.13. Accreditation Association Of Ambulatory Health Care (AAAHC), Health Services Inspection (HSI) and The Joint Commission (JC): The contract employee shall meet all applicable AAAHC, HSI and

JCAHO standards during the performance of this contract.

5.14. Patient Privacy: The contractor shall abide by the Privacy Act of 1974 as well as the Health

Insurance Portability and Accountability Act (HIPAA) of 1996.

PART 6

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) OF 1996

6. HIPAA:

6.1 HIPAA is comprised of several different sections, each to be implemented by the Dept. of Health and

Human Services. The medical facilities of the military services and the DOD health plans are specifically listed as covered by HIPAA. Currently, HIPAA Privacy and Security Rules, as set forth in the Code of

Federal Regulations, are in effect for all MTFs. The specific implementation of HIPAA Privacy for DOD medical facilities is set forth in DOD 6025.18-R, and for HIPAA Security, the requirements for AF MTFs are contained in 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.

6.2 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.

6.3 Introduction:

6.3.1 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.

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

6.3.1.2 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).

6.3.1.3 Privacy Rule means the Standards for Privacy of Individually Identifiable Health Information at 45

CFR part 160 and part 164, subparts A and E.

6.3.1.4 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.

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

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

164.103.

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

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

6.3.1.9 Security Rule means the Health Insurance Reform: Security Standards at 45 CFR part 160,162 and part 164, subpart C.

6.3.1.10 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.

6.3.2 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.

6.3.3 The Contractor agrees to use appropriate safeguards to maintain the privacy of the Protested Health

Information and to prevent use or disclosure of the Protected Health Information other than as provided for by this Contract.

6.3.4 The HIPAA Security administrative, physical, and technical safeguards in 45 CFR 164.308, 164. 310, and 164.312, and the requirements for policies, procedures and documentation in 45 CFR 164.316 shall apply to the Contractor. The additional requirements of Title XIII of the HITECH Act that relate to security and that are made applicable with respect to covered entities shall also be applicable to the contractor. The Contractor agrees to use administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic protected health information that it creates, receives, maintains, or transmits in the execution of this Contract.

6.3.5 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.

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

6.3.7 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.

6.3.8 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…