Solicitation_-_FA560619QA008_issued.pdf

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

1. REQUISITION NUMBER PAGE 1 OF

2. CONTRACT NO. 3. AWARD/EFFECTIVE

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17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN

OFFER

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK

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RFQ IFB RFP

SEE ADDENDUM

19.

ITEM NO.

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SCHEDULE OF SUPPLIES/SERVICES

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QUANTITY

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UNIT

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AMOUNT

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DATED . . YOUR OFFER ON SOLICITATION

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AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

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27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

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8 (A)

EDWOSB

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SMALL BUSINESS

FA560619QA008

Solicitation/Contract Form

Supplies or Services and Prices/Cost

Additional Information/Notes

Item Supplies/Service Quantity Unit Unit Price Amount

Option Line Item

Referral Management Assistant Bi-lingual Manufacturer's Part Number: Null Product Service Code: Q801 Firm Fixed Price

CIN: 00000000000004040902

1,920.0 Hours

Option Line Item

Referral Management Assistant Bi-lingual Firm Fixed Price

1,920.0 Hours

Option Line Item

Referral Management Assistant Bi-lingual Firm Fixed Price

1,920.0 Hours

Option Line Item

Referral Management Assistant Bi-lingual Firm Fixed Price

1,920.0 Hours

Option Line Item

Referral Management Assistant Bi-lingual Firm Fixed Price

1,920.0 Hours

Description/Specifications/Statement of Work

Performance Work Statement for Referral Management Center Administrative Support Services

Spangdahlem Air Base

Non-personal Services

13 May 2019

Table of Contents Subject Para

1. General 1

2. Service Summary 2

3. Definitions and Acronyms 3

4. Government Furnished Items and Services 4

5. Contractor Furnished items responsibilities 5

6. Specifics Tasks 6

7. Applicable Publications (Current Editors) 7

8. Performance of Services during crisis 8

9. Attachment/Technical Exhibit List 9

1. GENERAL: This is a nonpersonal services contract to provide administrative support services to the Referral Management Center (RMC) as described in this Performance Work Statement (PWS) at the 52 Medical Group Unit 3865, APO, AE 09126, 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 nonpersonal 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 PWS and the professional standards of the Joint Commission (JC).

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. Maintains and tracks referral records.

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

1.3.6. 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.

1.3.7. Orients new personnel to the RMC team.

1.3.8. 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 PWS at the 52 Medical Group Unit 3865, APO, AE 09126, Medical Treatment Facility (MTF). The contractor shall review and follow the Air Force Medical Service (AFMS) AFMS Referral Management (RM) Business Rules (BRS) as a reference to understand the purpose and objectives of the AFMS. The guide can be found in Air Force Instruction 44-176, Attachment 2.

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 Aug 19 - 31 Jul 20 Option Year I 1 Aug 20 - 31 Jul 21 Option Year II 1 Aug 21 - 31 Jul 22 Option Year III 1 Aug 22 - 31 Jul 23 Option Year IV 1 Aug 23 - 31 Jul 24

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 Contracting officer (CO) for review within 30 days after contract award, three (3) copies of a comprehensive written QCP shall be submitted to the CO and Contracting Officer's Representative (COR) within five (5) working days when changes are made thereafter. After acceptance of the QPC the contractor shall receive the CO acceptance in writing of any proposed change to his Quality Control (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's 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 CO 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 (QASP). This plan is primarily focused on what the Government must do to ensure that the contractor has performed in accordance with the performance standards. The QASP defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

1.6.3. Holidays: There are ten (10) U.S. federal holidays each year. They are New Year's Day (observed 1 January), Martin Luther King, Jr's Birthday (observed the third Monday in January), President's Day (observed the third Monday in May), Memorial Day (observed the last Monday in May), Independence Day (observed 4 July), Labor Day (observed the first Monday in September), Columbus Day (observed the second Monday in October), Veterans Day (observed 11 November), Thanksgiving Day (observed the fourth Thursday in November), and Christmas Day (observed 25 December). If New Year's Day, Independence Day, Veterans Day or Christmas Day falls on a Saturday, it is observed on Friday; if it falls on Sunday it is observed on Monday.

1.6.3.1. All US Federal Holidays that the contractor is not present in the facility are non-chargeable to the U.S.Government and will not be reimbursed to the contractor.

1.6.4. Hours of Operation: The contractor is responsible for conducting business, between the hours of 0730-1700 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.

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 52 Medical Group.

1.6.6. Type of Contract: The Government will award a Firm-Fixed-Price Contract.

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 DD254, which shall be provided upon request. The Unit Security Monitor is responsible for initiating this form, and can be contacted at +49 6565-61-3479.

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.

1.6.8. Periodic Progress Meetings: The CO, COR, and other Government personnel, as appropriate, may meet periodically with the contractor to review the contractor's performance. At these meetings, the CO 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.

1.6.9. Initial Performance Review: The initial evaluation of contractor performance shall take place within 30 days after the contractor assumes full performance responsibilities (i.e. after completion of transition/mobilization) to ensure the contractor has successfully started performance, completed transition, is fully operational, and is within the schedule and performance parameters of the contract.

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, and specifications; monitor contractor's performance and notifies both the CO 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 following 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 CO. 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:

1.6.12 Identification of Contractor Employees: All contract personnel attending meetings, answering Government telephones, and working in other situations in which 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 CO. 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 CO 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 CO to avoid or mitigate any such OCI. The contractor's mitigation plan will be determined to be acceptable solely at the discretion of the CO and in the event the CO unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the CO 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 Contractor Manpower Reporting:

1.6.15.1 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.

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

1.6.15.3 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.

1.6.15.4 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.

1.6.16 Personnel Requirements: Contractor personnel shall meet the following minimum qualification:

1.6.16.1 Language Requirement: Contractor personnel shall be able to type with a minimum of 40 words per minute and have the ability to speak and write English and German. The contractor shall provide a significant service as a translator between the German health care providers, and American medical health care beneficiaries. All languages should be spoken with sufficient structural accuracy and vocabulary pronunciation effective in most formal and informal conversations on practical and professional topics. An understanding in medical vocabulary is desired. All translating in writing will be done verbatim based on writer documentation received and transcribing. Correct grammar, spelling, punctuation, capitalization, and format to prepare written correspondence, forms, or reports is required. The work is primarily sedentary. However, there may be some physical demands. Requirements include prolonged walking, standing, sitting, or bending.

1.6.16.2 Contractor shall provide personnel who meet the language proficiency level at the beginning of and throughout their employment. A certification of language proficiency is required. Failure to satisfy language proficiency requirements shall have the effect of the position being considered vacant and the contractor will be required to have a replacement within three (3) duty days of the repeat demonstration failure. The 52d MDG requires contractors to meet minimum English and German language proficiency levels of 3, as proficiency levels outline in Bureau for International language Coordination (BILC) STANAG 6001, Allied Training Publication ATrainP-5, Edition A, Version 2, LANGUAGE PROFICIENCY LEVELS, dated 19 May 2016.

English German Read Speak Write Read Speak Write 3 3 3 3 3 3

1.6.16.2.1 Reading Ability

Ability level 3: Able to read routine correspondence, reports and technical material in his/her special field. Can grasp the essentials of articles of the above types without using a dictionary. For accurate understanding, frequent use of a dictionary required. Has occasional difficulty with unusually complex sentence structures.

1.6.16.2.2 Speaking Ability

Ability level 3: Able to speak the language with sufficient structural accuracy and vocabulary to participate effectively in most formal and informal conversations on practical and professional topics. Can discuss particular interests and special fields of competence with reasonable ease and comprehension. Vocabulary is broad enough that he/she rarely has to struggle for a word. The accent may be obviously foreign but control of grammar is good. Errors never interfere with understanding and rarely disturb the native speaker.

1.6.16.2.3 Writing Ability

Ability level 3: Can draft official correspondence and reports in a special field. Control of structure, spelling and vocabulary is adequate to convey the message accurately, but style may be quite foreign. All formal writing needs to be edited by an educated native.

1.6.16.3 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.

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

1.6.16.4.1 High School diploma or General Educational Development (GED) equivalency.

1.6.16.4.2 Completed training in Microsoft Windows and Excel is required.

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

1.6.16.5 Appearance:

1.6.16.5.1 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 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.

1.6.16.5.2 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.

1.6.16.5.3 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.

1.6.16.6 Health Requirements:

1.6.16.6.1 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.

1.6.16.6.2 Contract personnel providing services under this contract shall receive a pre-employment physical examination prior to commencement of work and annually thereafter. Per Occupational Safety and Health Act (OSHA) requirements, all contractor personnel who will have occupational exposure to blood or body fluids, or other potentially infectious materials, shall receive Hepatitis B vaccines, sign a voluntary declination, or have documented proof of immunity to Hepatitis B infection. Personnel who sign declinations may change their minds at any time and receive the Hepatitis B vaccines. It is the contractor's responsibility to report all information necessary to assure hospital records can be maintained correctly, and therefore comply with the OSHA and CDC health records requirement.

1.6.16.6.3 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, and CDC health records requirements.

1.6.16.7 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.

1.6.16.8 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.

2. SERVICE SUMMARY (SS)

The contractor service requirements are summarized into performance objectives that relate directly to mission essential items. The performance threshold briefly describes the minimum acceptable levels of service required for each requirement.

These thresholds are critical to mission success.

Performance Objectives PWS Paragraph Performance Threshold Surveillance Method 1: The contractor shall follow-up with MTF/Other MTF providers that did not complete referral results within 72 hours at 4 working days after the referral episode. 6.3.4.

6.3.5.

98%

Periodic Inspection 2: The contractor shall follow-up with Network/Non-Network providers on referral results, which are not returned within 10 business days after the referral episode. 6.3.4.

6.3.5.

90%

Periodic Inspection 3: The contractor shall provide RMC monthly statistical reports. 1.2.; 1.3.8.; 6.3. 98% 100% Inspection 4: The contractor shall attend meetings and training as required by the FRED 1.6.8.; 1.6.11.;

1.6.16.3.; 4.4.3.

5.4.

100% 100% Inspection 5: The contractor shall demonstrate respect and appropriate customer service to patients and MTF staff. 6.4. 98% Periodic Inspection

3. DEFINITIONS AND ACRONYMS:

3.1 DEFINITIONS:

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

3.1.2 ARMED FORCES HEALTH LONGITUDINAL TECHNOLOGY APPLICATION (AHLTA). AHLTA, the military's electronic health record (EHR) (formerly CHCS II; US DoD military health system)

3.1.3 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.

3.1.4 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.

3.1.5 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.

3.1.6 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.

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

3.1.8 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.

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

3.1.10 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.

3.1.11 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.

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

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

3.1.14 QUALITY ASSURANCE. The Government procedures to verify that services being performed by the contractor are performed according to acceptable standards.

3.1.15 QUALITY ASSURANCE SURVEILLANCE PLAN (QASP). An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

3.1.16 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.

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

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

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

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

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

3.2 ACRONYMS:

AHLTA Armed Forces Health Longitudinal Technology Application ACOR Alternate Contracting Officer's Representative AFFARS Air Force Federal Acquisition Regulation Supplement BAA Business Associate Agreement CCE Contracting Center of Excellence CFR Code of Federal Regulations CONUS Continental United States (excludes Alaska and Hawaii) COR Contracting Officer's 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 FRED Functional Requirements Evaluator Designee HIPAA Health Insurance Portability and Accountability Act of 1996 CO 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 SS Service Summary TE Technical Exhibit

4. GOVERNMENT FURNISHED ITEMS AND SERVICES:

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

4.2. 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.

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

4.4 Services:

4.4.1. 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.

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

4.4.3. 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.

4.4.3.1. The Government will provide training to the contractor's trainers. The contractor shall then train its 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.

4.4.3.2. The contractor's staff shall have functioning knowledge of Government appointing and referral management business rules, Government appointing information systems, the Joint Commission (JC), 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.

4.5. 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.

5. CONTRACTOR FURNISHED ITEMS AND RESPONSIBILITIES:

5.1. 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.

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

5.3. 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.

5.4. 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.

5.5. 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 AFI 41-210 when handling and providing patient information. Patient information shall not be disclosed or revealed to unauthorized personnel.

5.6. 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.

6. SPECIFIC TASKS:

6.1. 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.

6.2. Referral Appointing:

6.2.1. 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.

6.2.2. 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.

6.2.3. 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.

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

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

6.2.6. Prints diagnostic reports and treatment profiles as necessary.

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

6.2.8. The contractor shall submit network/non-network referral results through the Translations Automated Database Input and Verification System (TADIVS) for translations.

6.3 Referral Tracking:

6.3.1. Tracks referrals to include obtaining reports from MTF, Direct Care System, and network and non- network providers within established standards.

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

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

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

6.3.5. 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.

6.3.6. Documents that paper referral results are properly filed in patient's health record.

6.3.7. Assists in preparation of monthly reports as indicated.

6.4. Customer Service:

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

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

6.4.3. Serves as the "central clearing house" for providers and patients needing help with referrals.

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

6.6. 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.

6.6.1. The contractor shall obtain complete patient data, which may involve researching the information (e.g. telephoning the Quality Assurance Evaluator).

6.7. 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 Part 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 (5) working days of receipt of the request.

6.8. 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 any way for any use outside the MTF without prior written permission by the Government.

6.9. 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.

6.9.1. 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.

6.9.2. 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).

6.9.3. 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 in accordance with privacy act and HIPPA regulations.

6.10. 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.

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

6.12. 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.

7. APPLICABLE PUBLICATIONS (CURRENT EDITIONS):

7.1. The contractor must abide by all applicable regulations, publications, manuals, and local policies and procedures. These publications are available in the MTF and maintained by the Government either in hard copy or electronic copy available on-line at www.e-publishing.af.mil Supplements or amendments to listed publications from any organizational level may be issued during the life of the contract. The contractor shall immediately implement those changes in publications, which result in a decrease or no change in the price and notify the Contracting Officer (CO) in writing of such change. Should a decrease in contract price result, the contractor shall provide a proposal for reduction in the price to the CO. Prior to implementing any change that will result in an increase; the contractor shall submit to the CO a price proposal within 30 days of receipt of the change by the Contractor. The CO and the contractor shall negotiate the change into the contract under the provisions of the contract clause FAR 52. 212-4. Failure of the contractor to submit a price proposal within 30 days from receipt of the change shall entitle the Government to performance in accordance with such change at no increase in price. Applicable Technical, Regulations, References, Manuals, Specifications, and Documentation.

This list includes, but is not limited to the following:

Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act of 1992 United States Code, Title 5, "The Privacy Act of 1974," December 31, 1974 Title VI of the Civil Rights Act of 1964 Americans with Disabilities Act of 1990 Freedom of Information Act of 2016 Health Insurance Portability and Accountability Act of 1996 (HIPPA) Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 36 CFR 1194, "Electronic and Information Technology Accessibility Standards" DoD Regulation 5200. 2-R, "DoD Personnel Security Program," January 1987 45 CFR Parts 160 and 164, "Standards for Privacy of Individually Identifiable Health Information" 5 U.S.C.(S) 552a, "Records Maintained on Individuals" 32 CFR 199, "Civilian Health and Medical Program of the Uniformed Services" Rehabilitative Act of 1973, Section 508 TRICARE Operations Manual, 6010. 59-M, April 2015, Chapter 24 TRICARE Policy Manual 6010. 57-M, February 2008, Chapter 12 TRICARE Systems Manual, 7950.3-M, April 2015 DoD Directive 6025. 18-R, "DoD Health Information Privacy Regulation" DoD Directive 5400. 11, "DoD Privacy Program" Title 10, U. S. C. , Chapter 55 DoD Directive 5500. 7, "Standards of Conduct"

United States Air Force Regulations/Manuals/Instructions

AFI 44-176, Access to Care Continuum AFI 41-210, TRICARE Operations and Patient Administration Functions AFI 44-119, Medical Quality Operations AFI 41-200, Health Insurance Portability and Accountability Act (HIPAA) AFI 44-102, Medical Care Management Other References

The Joint Commission (JC) Accreditation Manuals, current edition: http://www.jcrinc.com/Accreditation-Manuals/

AFMS Referral Management Center User's Guide: https://kx2.afms.mil/kj/kx2/AFMOAHealthBenefits/Pages/home. aspx

8. PERFORMANCE OF SERVICES DURING CRISIS:

8.1. IAW DFARS 237. 76 and unless otherwise directed by an authorized government representative, it is determined that services as identified in this PWS are NOT essential for performance during a crisis.

9. ATTACHMENT/TECHNICAL EXHIBIT LISTING

9.1. Attachment 1/Technical Exhibit 1 - Services Summary

9.1. Attachment 3/Technical Exhibit 2 - Estimated Workload Data

9.1. Attachment 4 - HIPAA Business Associate Agreement

Attachment 3

ESTIMATED WORKLOAD DATA

ITEM

NAME ESTIMATED QUANTITY

1 Referral…