PWS Special Needs Coordinator GK.pdf

PERFORMANCE WORK STATEMENT FOR

SPECIAL NEEDS COORDINATOR

GEILENKIRCHEN NATO AIR BASE

(NON-PERSONAL SERVICE)

03/04/2020

Table of Contents

Subject/Section Page Number

1. General 3

2. Special Needs Coordinator 7

3. Definitions and Acronyms 14

4. Government Furnished Property, Equipment and Services 16

5. Contractor Furnished Items and Services 16

6. Specific Tasks 17

7. Applicable Publications 20

8. Performance of Services during a Crisis 20

9. Records Management Statement 21

10. Attachment/Technical Exhibit Listing 21

11. Service Delivery Summary 22

12. HIPAA Business Associate Agreement 24

GENERAL INFORMATION

GENERAL: This is a non-personal services contract to provide a Special Needs Coordinator (SNC).

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 duties as a Special Needs Coordinator (SNC) 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. Please see Special Needs Coordinator roles and responsibilities from AFI 40-701:

1.2 Background: Traditionally, an ideal candidate for this position is a prior active duty social worker who has worked in the Exceptional Family Member Program (EFMP).

1.3 Objectives: The primary purpose of this position is to serve as the Special Needs Coordinator

1.4 Scope: In addition to the above main objective, the extended scope is to perform administrative duties concerning the coordination, processing, review and maintenance of medical records and information pertaining to individuals and families assigned to this installation or preparing to serve in overseas assignments and some CONUS to maintain EFMP records; to ensure service availability for families relocating in conjunction with a PCS; to process Command Sponsorship requests and documents; to use a multi-disciplinary and collaborative approach with other service providers, such as installation youth and childcare facilities, and officer and enlisted spouses groups, to ensure effective outreach and identification of special needs; to identify and enroll Active Duty (AD) Air Force families who meet eligibility criteria for EFMP; to ensure Air Force (AF) sponsors assigned to the installation, or whose personnel functions are handled at the installation, are "Q-coded" (Exceptional Family Member Program - EFMP-enrolled) regardless of location of family members and to ensure compliance with Department of Defense (DoD) directives, AF policy and local Military Treatment Facility (MTF) instructions.

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

Base Year

Option Year l

Option Year II

Option Year III

Option Year IV

1.6 General Information

1.7 Quality Control: The contractor shall provide a complete Quality Control Program (QCP) to ensure the requirements of the contract are provided as specified. The contractor shall provide a QCP describing the inspection system for the requested services listed in the PWS. The contractor shall develop and implement procedures to identify, prevent and ensure non-recurrence of unacceptable services. The Contractor's QC plan must be submitted with their initial proposal to the Contracting Officer for review and acceptance. The contractor shall update the plan as changes occur and changes shall be submitted for review by the Contracting Officer.

1.8 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. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

1.9 Recognized Holidays:

New Year's Day, Good Friday, Easter Monday, Corpus Christi, Christmas Day, Labor Day, Ascension Day, Whit Monday, German Unity Day, Boxing Day

1.10 Hours of Operation: The contractor is responsible for conducting business between the hours of 0800- 1700 Monday through Thursday and 14:30 on Fridays except German 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.

1.11 Place of Performance: The work to be performed under this contract will be performed at the 470th Medical Clinic (Building 208), Geilenkirchen Air Base, Germany.

1.12 Duty at other locations: This position may be required to go to TDY locations for specific training related to their job. The exact number of TDYs is currently unknown but is estimated not to exceed 14 days per fiscal year.

The U.S. Government will advise the contractor a minimum of 10 calendar days in advance of the

TDY.

Arrangements for and costs of all travel, transportation, meals, lodging, and incidentals are the responsibility of the contractor. Costs for these expenses will be reviewed and certified by the

Contracting Officer's Representative (COR) and approved by the Contracting Officer. All travel and transportation shall utilize commercial sources and carriers provided the method used for the appropriate geographical area results in reasonable charges to the U.S. Government.

The U.S. Government will not pay for business class or first-class travel. Lodging and meals shall be reimbursed in accordance with the standard per diem rates in the DOD Joint Travel Regulation (JTR).

Reimbursable costs will be reviewed by the COR and certified by the KO. All TDY costs will be submitted for reimbursement within 60 days of the end of the TDY.

The website for per diem rates is: http://perdiem.hqda.pentagon.mil/perdiem/perdiemrates.html

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

1.14 Security Requirements: Contractor personnel performing work under this contract must have a security clearance of "favorable" at time of the proposal submission, and must maintain the level or security required for the life of the contract. Security and base access requirements are contained in clause 5352.242-9000, Contractor Access to Air Force Installations.

1.15 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.

1.16 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.

1.17 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.

1.18 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 or 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.

1.19 Lock Combinations: not applicable.

1.20 Special Qualifications: The contractor shall possess the following qualifications:

1.21 Demonstrates a minimum of two (2) years full-time experience in care coordination, discharge planning or case management in a medical setting within the last four (4) years.

1.22 Shall maintain competency in Basic Life Support (BLS) certification.

1.23 Must possess a degree in Nursing or Medical Social Work. Medical Social Workers filling the SNC position must possess a Masters of Social Work (MSW) degree from an accredited graduate school of social work. Clinical nurses filling the SNC position shall be a graduate of associates (ADN), or hold a baccalaureate degree (BSN) program in nursing, accredited by a national nursing accrediting agency recognized by the US Department of Education.

1.24 License: Nurse candidates must maintain an active, valid, current, and unrestricted license (with no limitations, stipulations or pending adverse actions) to practice nursing as a registered nurse in any US state/jurisdiction.

1.25 Computer skills required: Shall have basic computer skills and working knowledge of Microsoft Office products such as Word, Excel, and Access. Shall be able to type an electronic health record entry and be proficient with use of the military out-patient electronic health record systems, Armed Forces Federal Acquisition Longitudinal Technology Application (AHLTA) and (CHCS), within 60 days of' obtaining Common Access Card (CAC) capability.

1.26 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.

1.27 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.

1.28 Key Personnel: 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 lo daily operation of this contract. The contract manager or alternate shall be available between 0800- 1600, Monday through Thursday (0800 – 1430 on Fridays) except Federal holidays or when the Government facility is closed for administrative reasons.

1.29 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. Contract personnel will be required to obtain and wear a 470th Medical Clinic badge in the performance of this service.

1.30 Contractor Travel: not applicable.

1.31 Other Direct Costs: not applicable.

1.32 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.

1.33 Organizational Conflict of Interest: Contractor and subcontractor personnel performing work under this contract may receive, have access lo 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 affect 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.

1.34 Phase ln /Phase out Period: Not applicable.

1.35 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://ww,v.ecmra.mil.

1.36 Reporting inputs will be for the labor executed during the period of performance for each Government fiscal year (FY), which runs l 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.

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

1.38 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.

1.39 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.ccmra.mil.

SPECIAL NEEDS COORDINATOR (SNC)

2.1 The SNC must have familiarity with clinical conditions that require specialized care, and demonstrated skills in interviewing families for the purposes of identifying special needs and for coordinating needed care. The SNC reports to the SGH (or the Health Care Integrator, where specified in local instructions) when fulfilling SNC duties.

2.2 The SNC oversees and manages the installation EFMP-M IA W DoD and Air Force policy, and any subsequent implementing guidance. The SNC:

2.3 Establishes and maintains procedures to identify sponsors whose family members have special medical and educational needs in a timely manner. The SNC uses a multi-disciplinary and collaborative approach with other key service providers, such as installation youth and childcare facilities, and officer and enlisted spouses groups, to ensure effective outreach and identification of special needs.

2.4 Ensures all active duty sponsors known to the MTF as having a special needs family member according to

DoD criteria are identified to the AFPC (via the local MPS and/or CSS, where applicable) for issuance of assignment limitation code -QII, regardless of the location of family members or the source of family health care.

2.5 Ensures all Army, Navy, and Marine Corps active duty sponsors of family members with special needs are referred to their Services' EFMP points-of- contact for enrollment and relocation support IAW Service-specific guidance. Consults with the MAJ COM EFMP-M Liaisons and/or AFMOA/SGHW as needed to support members of other DoD branches.

2.6 Ensures all active duty sponsors known to the AFPC, and local MPS and/or CSS where applicable, as having family members with special needs are identified in AF medical special needs data management systems.

2.7 Coordinates, with AFPC (and the local MPS and/or CSS, where applicable) all assignment actions for all -

Q-coded (EFMP-enrolled) AF sponsors assigned to the installation, or whose personnel functions are handled at the installation, regardless of location of family members.

2.8 Provides training to medical staff, and consultation as needed to support the implementation of EFMP-M base-wide.

2.9 The SNC, with the SGH, ensures training and reference material is provided to the personnel listed in the following paragraphs within 90 days of trainee’s assumption of responsibilities and on an ongoing basis as needed. Ensures annual refresher training or procedural reviews, at a minimum to:

2.10 The alternate SNC(s), Medical Review Officer (MRO) and alternate(s), FMRCC and alternate(s), and other

MTF staff with EFMP-M duties, regarding DoD and AF policy and their assigned responsibilities.

2.11 All MTF clinical personnel on the use of DoD criteria (DoDI 1315.19, Enclosure 4) for identifying family members with special medical and educational needs, and EFMP-M referral procedures. This training may be delivered as part of existing professional staff orientation, training forums and/or computer based training.

2.12 The SNC supports base-wide training on EFMP through the provision/review of training materials for unit commanders, their representatives, and training monitors. The SNC reviews training materials and references used by installation-level Civilian Personnel staff involved with screening family members of civilian employees for OCONUS travel upon request.

2.13 Is integrally involved in the FMRC process. Follows procedures outlined in this instruction and refers to subsequent AF implementing guidance as needed. Ensures all FMRC requirements are implemented by all

EFMP-M staff. Works with supervisors/raters of other EFMP- M staff as needed to correct noncompliance and to ensure appropriate interactions with family members.

2.14 For outbound FDIs, the SNC participates with the MRO in jointly-scheduled interviews with all family members requesting government-authorized travel to accompany a sponsor in PCS face-to-face interviews are required for families of active duty and recommended for families of DoD civilians). Exceptions may be made IAW para 2.19.2.3.1.4 and 3.4.3.4.1 of this instruction. Prior to the joint interview, the SNC reviews all medical records and MTF clinical data sources and summaries available, and plans the interview(s) with the MRO, ensuring options for private discussions with adult family members. Where face-to-face interviews are not possible due to extreme distances from any MTF, or due to the family member's inpatient/residential status or other serious medical condition, the SNC notes the exception in the

FDI package to the gaining review authority.

2.15 Conjoint interviews with families reduce the burden on customers by allowing -one- stop processing of their travel screenings. Where it is not feasible to offer conjoint interviews, the SNC ensures modifications to the conjoint interview procedure are detailed in local operating instructions that address how the needs of families are considered in the FMRC process.

2.16 For families of active duty members, the SNC first ensures all family members are listed on either page 1 or page 2 of the AF form 1466 for OCONUS travel requests; ensures all family members with special needs are listed on either page 1 or page 2 of AF form 1466 for CONUS travel. The SNC documents in the designated section on the AF Form 1466 the findings from record reviews and interviews with family members to support travel recommendations. Ensures any -yes items specifying needs for housing modifications, adaptive equipment, etc., are addressed in the designated sections of the DD Form 2792 for the specified family member.

2.17 For DoD civilian families who volunteer for an FDI prior to relocation, interviews special needs family members upon request, and forwards information via DD Form 2792 and DD Form 2792-1 with any cover summaries as appropriate. May use, but does not require, AF Form 1466 for FDIs of DoD civilian families with special needs.

2.18 If the family members are geographically separated from the MTF supporting the FMRC, they may be seen by a civilian provider or a provider at a sister service MTF. The provider(s) or MTF(s) with the most recent information available about family care needs provides the needed information to support the review. The family member(s) provide written consent to their medical provider(s) to release information to the EFMP-

M staff for the purpose of coordinating care through relocation. In these cases the SNC and MRO collaborate to communicate with the provider interviewing family members to ensure understanding of the purpose of such screening, the limitations of service availability in many locations, and the documentation needed to support the gaining installation in making travel recommendations. When it is necessary to involve a civilian provider in completing DD Forms 2792, the MRO and SGH at the sponsor's base retain responsibility for completion of the AF Form 1466 for families of active duty members. MTFs of any

Service branch that are located near geographically separated family members may provide input to the AF

Form 1466 as supporting bases. See para. 3.4.3. A cover memo may be sent in the FDI in lieu of AF Form

1466 for families of DoD civilians.

2.19 The SNC, with the SGI-l, ensures outbound documentation that supports the FMRC is processed in an expeditious manner toward timely assignment recommendations. The SNC intervenes/elevates through the medical chain of command as needed where delays potentially impact timely assignments or employments of sponsors.

2.20 For inbound FDIs (active duty and civilian sponsors), the SNC works with the FMRCC and the SGH to ensure all medical and educational authorities that might be involved in the care of identified needs are consulted for service availability. Supports the SGH in providing written responses that either recommend or do not recommend travel for families of active duty members, or that outline potential limitations of services for families of civilian sponsors. Where necessary housing modifications are identified in the FDI package, ensures the base housing office is advised of the anticipated modification(s) during the 14-day relocation review period. Incudes accessibility information provided by the housing office, where applicable, in the response to the losing installation.

2.21 With the FMRCC, the SNC ensures all FDIs are appropriately logged and tracked during the review process. Ensures the inbound FDI process is completed within 14 calendar days from submission of a completed package to response from the gaining installation. If a response is not possible within this time frame, ensures the losing FRMC Coordinator is notified of the reasons for delay and intervenes as needed to expedite response.

2.22 With the FMRCC, the losing installation's SNC ensures all considerations about potential limitations, types of housing modifications possible, etc., that are submitted by the gaining installation via FDI response are provided to the sponsor and/or adult family member(s) upon receipt.

2.23 With the FMRCC, ensures sponsors receiving an initial recommendation against OCONUS family member travel are advised of the pinpoint process and of further MAJCOM consideration of OCONUS travel options.

2.24 Complies with requirements for data security, maintenance, collection, and reporting IA W AFPD 40-7 and any subsequent AFMOA, MAJ COM, or MTF implementing guidance. The SNC:

2.25 Maintains responsibility for base-level data entry in AF-provided data management systems used in the management of EFMP-M. Ensures all family members of active duty personnel that have been identified as having special needs according to the DoD criteria are entered into the database, with the number of special needs family members identified reported upon request to AFMOA/SGI-IW. Tracks FDIs involving active duty personnel and DoD civilians using tracking mechanisms specified by the MTF and/or AFMOA, to include AF-sanctioned electronic data systems.

2.26 Provides on-going training, support and oversight for FMRCCs performing data collection and information processing to support reassignment coordination in AF-provided data management systems.

2.27 Provides AFMOA/SGJ-JW the MTF/CC-signed appointment letters for the SNC, FM RCC, and alternates for access to password-protected data systems. Ensures all primary and alternate SNCs and FMRCCs register on the Special Needs site to activate their database access upon appointment by the MTF/CC.

Consults with AFMOA/SGJ-IW as needed for access assistance. Immediately submits requests for termination of accounts to AFMOA/SGJ-IW when staff members no longer hold appointed EFMP-M roles.

2.28 Ensures currency of EFMP-M office(s) contact information (e.g., phone numbers, fax numbers, email addresses) hosted within the AF-provided web-based communications and data management systems.

Updates the EFMP-M office's contact information in all AF-sanctioned directories, and ensures currency of access to organizational e-mail accounts.

2.29 Ensures documentation is maintained IAW para. 3.5 of this instruction and works collaboratively with

MTF patient administrative functions to comply with these requirements. Establishes procedures for the creation, maintenance, secure storage, transfer and retirement of SN files and FDI files IAW Air Force policy, EFMP-M implementing guidance, and MTF guidance for the protection of sensitive medical information.

2.30 Ensures every AF sponsor with one or more family members with special needs that is assigned to the installation has a SN file maintained at the MTF.

2.31 Ensures a case entry is established/updated in the AF electronic data management system indicating the sponsor's current duty location. The SNC ensures the location and identifying information (such as Social

Security Numbers and special medical/educational conditions) of all family members is accurate in both

SN file and the electronic data management system.

2.32 Participates in the MTF quality assurance program for EFMP-M.

2.33 The SNC performs periodic self-assessments using MTF Operating Instructions, installation instructions, AFIA or other monitoring agency inspection criteria, AFMOA implementing guidance, and AF and DoD policy.

2.34 The SNC, under the direction of the MTF/CC and SGH, tracks indicators of process efficiency, and elevates trends as needed toward continuous process improvement. Reports data collected to the MAJCOM

EFMP-M Liaison for submission to AFMOA/SGHW upon request.

2.35 The SNC elevates areas of non-compliance or resource constraints through the MTF according to existent quality assurance mechanisms. Where quality of care may be compromised, the SNC immediately elevates the concern to the SGH.

2.36 Conducts assessments of family members of active duty personnel to determine if special medical or education conditions exist that require EFMP enrollment. These assessments include interviews with family members and review of medical records or other medical documentation.

2.37 Where special medical needs are identified that meet DoD criteria for EFMP enrollment, the SNC will ensure the completion or the DD Form 2792 for each eligible family member. These forms are maintained in the SN file. The SNC ensures the release or these documents according to the following:

2.38 Copies of DD Form 2792 pertaining to minor dependents may be provided to the sponsor, parent or legal guardian for use as needed, providing state and federal laws and AF policies are followed pertaining to the protection of health information. Ages of majority for consent to release protected health information may vary according to the types of treatment sought. The SNC consults with the SJA as needed to determine when written consent of the minor must be obtained prior to release of the DD Form 2792 to the sponsor, parent or legal guardian.

2.39 Copies of DD Form 2792 pertaining to adult dependents are only provided to the patient described on the

DD Form 2792, unless the identified patient provides express written permission to release it to others outside the DoD healthcare network, including to the sponsor.

2.40 Where special educational needs and/or developmental delays are identified in a child up to 21 years of age, or where a child aged birth to 6 years of age has or is at risk of developmental delays that might require early intervention or early childhood special education, the SNC ensures the completion of' the DD

Form 2792-1 by qualified early intervention or school personnel. Copies of this in formation are provided to the sponsor, parent, or guardian.

2.41 DD Form 2792s and DD Form 2792-I’s are not released to Personnel agents or to other non- medical entities without express written consent by the patient of majority age or parent/legal guardian. Exceptions are noted in this instruction for the processing of EFMP Reassignment Requests or necessary releases to process family member travel requests into remote areas not served by the AFMS. The information is protected as are other identifiable health information documents within the Health Affairs system.

2.42 Determines appropriateness of all EFMP enrollment or disenrollment actions based on review of medical or educational documentation. Signs all memoranda to initiate EFMP enrollment for active duty AF members.

Ensures that initiation or deletion of authorization letters for the assignment limitation code- Q for active duty AF members are written and submitted in a timely manner to the installation MPS or CSS, as appropriate. Copies are maintained in the SN file and provided to the sponsor to document enrollment in the AF EFMP (personnel system) as well as the AF EFMP-M (medical system). The SNC sends a copy of the Q-code initiation letter to the gaining base with an FDI when the need for enrollment was newly identified in the course of the FMRC process.

2.43 The SNC notes the EFMP enrollment with effective date in the progress notes pages of outpatient medical records of the eligible family member(s) and of the sponsor. May annotate on the left side (summary) of these medical records Q-coded.

2.44 Where there is disagreement between SNC and other medical provider(s) on whether enrollment criteria are met, the case is forwarded to the SGH for final decision making. Documentation of the reason for the decision made is entered in the medical record of the identified family member.

2.45 Ensures that sponsors are provided all necessary documents for enrollment in TRICARE, Extended Health

Care Options. Where the SNC may not release protected health information to the sponsor, the SNC provides the needed documentation to the identified patient of majority age, or forwards the information directly to the TRICARE Managed Care Support Contractor or other authorized Health Affairs agent upon request.

2.46 Coordinates with MTF TRICARE representatives to provide information to beneficiaries about community and national resources specific to the special needs population. Informs families of existing information and referral services such as Military One Source, Military Home front, and Airman and Family Readiness

Centers.

2.47 Coordinates with primary care providers to provide referrals for counseling related lo special medical and educational conditions.

2.48 Through collaboration with IDS and other interagency forums, assists in providing families’ information and referrals lo base and civilian agencies to enhance services to family members with special needs.

Refers all EFMP families lo the Airman and Family Readiness Center for additional community assistance as needed.

2.49 Ensures Q-coded sponsors assigned to the installation are contacted annually to determine if there are unmet needs and to request updates of information as needed. Ensures these contacts are documented and that data systems are updated where appropriate. These contacts do not require a face-to-face visit, but sponsors who report changes (in diagnoses, family composition, etc.) will be asked to update their information in person, with supporting documentation.

2.50 These annual contacts may be an e-mailed request to the sponsor to update demographic information, family composition, and the type(s) of special need, so long as the e-mailed contact does not result in any release by the MTF of confidential or protected information. Each sponsor contacted by email must not be able to view the names of other sponsors in the address list. Sponsors will be directed to contact the EFMP-

M office by phone or in person to discuss health information. Annual contact attempts will be printed and placed in the SN file. To comply with AF and DOD provisions for safeguarding PII/PHI, emails containing such material are lo be sent encrypted or otherwise sent securely.

2.51 Ensures the coordination of enrollment processes for all active duty members, and travel screening processes for families of civilian sponsors and active duty members representing all branches of the military. Uses information posted on the AF Special Needs website and Military Home front website for forms and processes unique to other branches of Service. Contacts the MAJ COM EFMP-M Liaison or nearest sister Service EFMP Coordinator for additional guidance as needed.

2.52 Maintains a cooperative working relationship with AFPC, installation MPS, CSS, and all other associated offices for the following duties:

2.53 Completion of the AF Form 4380 for outbound personnel, authorization letters for initiation and deletion of Q-Codes, prompt initiation of the FMRC process al notification of pending assignment or 6 months prior to follow-on after an unaccompanied assignment, support to EFMP reassignment/deferments, and regular delivery of the base Q-Code roster from AFPC or local MPS/CSS to the SNC.

2.54 Develops an installation directive, for Installation Commander Approval to coordinate these installation functions (see 2.8.3).

2.55 The OCONUS MAJCOM EFMP-M POC will work with losing and gaining SNCs and coordinate with

AFPC and TRI CARE to pinpoint location with appropriate resources.

2.56 Ensures the timely identification of family members with special needs through collaborative outreach with installation youth and childcare facilities, officer and enlisted spouses groups, public education forums and interaction with community key personnel.

2.57 Ensures the appropriate documentation of EFM P-M workload as a military-specific mission in consultation with the MTF Medical Expense and Performance Reporting System (MEPRS) monitor.

2.58 Ensures SNC interest documentation in Q-base system annotating the reason for interest to facilitate appropriate tracking of special needs family members.

2.59 Adheres to any AFMOA, MAJCOM, or MTF EFMP-M implementing publications for completion of SNC duties.

2.60 Actively supports the integration of EFMP-M, EFMP-FS and EFMP-A services at the installation.

2.61 Participates with EFMP-FS in Newcomer's Orientation and Relocation briefings to ensure coordinated transitions for EFMP families. Provide information, appropriate contact information, and coordinate referrals as appropriate.

2.62 Participates in IDS to address EFMP needs at the installation.

2.63 Participates in Exceptional family Member quarterly case reviews to discuss newly identified families, complex or unmet needs and determine appropriate resources necessary for families. Documents in

AHLTA/SN record the outcomes of these reviews and plan of action for special need family member.

Retains meeting minutes without specific patient information documented. Specific patient information will be documented in AHLTS/SN record.

DEFINITIONS & ACRONYMS

3.1 DEFINITIONS:

3.2 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.

3.3 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.

3.4 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.

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

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

3.7 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.

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

3.9 QUALITY ASSURANCE. The Government procedures to verify that services being performed by the

Contractor are performed according to acceptable standards.

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

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

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

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

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

3.15 ACRONYMS:

AAAHC Accreditation Association for Ambulatory Health Care

ACOR Alternate Contracting Officer's Representative

AFFARS Air Force Federal Acquisition Regulation Supplement

AHLTA Armed Forces Health Longitudinal Technology Application

BLS Basic Life Support

CAC Common Access Card

CCE Contracting Center of Excellence

CFR Code of Federal Regulations

CHCS Composite Health Care System

CONUS Continental United States (excludes Alaska and Hawaii)

COR Contracting Officer Representative

COTS Commercia1-Off-the-Shelf

DAF Department of the Air Force

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

ECHO Extended Care Health Option

DoD Department of Defense

EEO Equal Employment Opportunity

EFMP Exceptional Family Member Program

EFMP-M Exceptional Family Member Program-Medical

FAR Federal Acquisition Regulation

FDI Facility Determination Inquiry

FMRC Family Member Relocation Clearance

GSU Geographically Separated Unit

HSI Health Services Inspections

HIPAA Health Insurance Portability and Accountability Act of 1996

ICDB Integrated Clinical Database

KO Contracting Officer

MPF Military Personnel Flight

MSW Masters or Social Work

MTF Military Treatment Facility

OCI Organizational Conflict of Interest

OCONUS Outside Continental United States (includes Alaska and Hawaii)

ODC Other Direct Costs

PCS Permanent Change of Station

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

SN Special Needs

SNC Special Needs Coordination

TE Technical Exhibit

GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND SERVICES

4.1 GOVERNMENT FURNISHED ITEMS AND SERVICES:

4.2 Services: The Government will provide required training for the equipment listed in 3.4 below during the initial facility orientation. The contractor will be required to use the computer systems that are standard for the support of health care delivery at the MTF (i.e. AHLTA, CHCS, etc.).

4.3 Facilities: The Government will provide the necessary workspace for the contractor lo provide the support outlined in the PWS to include desk space, telephones, computers, and other items necessary to maintain an office environment.

4.4 Utilities: The Contractor shall instruct employees in utilities conservation practices. The contractor shall be responsible for operating under conditions that preclude the waste of utilities, which include turning off the water faucets or valves after using the required amount to accomplish cleaning vehicles and equipment.

Lights shall· be used only in areas where and when work is actually being performed. The clinic is a climate controlled building, therefore mechanical equipment controls for heating, ventilation, and air conditioning systems shall not be adjusted by the contractor or by contractor employees.

4.5 Equipment: The Government will provide computer equipment required lo schedule, check in, document, order ancillary services, and maintain appropriate electronic medical information that support the hard copy medical record.

4.6 Materials: not applicable.

CONTRACTOR FURNISHED ITEMS AND SERVICES

5.1 CONTRACTOR FURNISHED ITEMS AND RESPONSIBILITIES:

5.2 General: The Contractor shall furnish all supplies, equipment, facilities and services required to perform work under this contract that are not listed under Section 3 of this PWS. At a minimum, all health care workers must maintain at the contractor's expense current certification in either the American Heart

Association Basic Life Support (BLS) (Course C) or the American Reel Cross CPR/BLS Course.

5.3 Secret Facility Clearance: Not applicable. This position only requires a "favorable" clearance.

5.4 Materials: Not applicable.

5.5 Equipment: Not applicable.

SPECIFIC TASKS

6.1 Specific Tasks:

6.2 Basic Services: The primary purpose of this position is to serve as Specialist for the Special Needs

Identification and Assignment Coordination (SNC) Process; to review medical records and information pertaining to individuals and families assigned to this installation or preparing to serve in overseas assignments and some CONUS assignments; to ensure service availability for families relocating in conjunction with a PCS; to process Command Sponsorship requests and documents; to use a multi disciplinary and collaborative approach with other key service providers, such as installation youth and childcare facilities, and officer and enlisted spouses groups, to ensure effective outreach and identification of special needs; to identify and enroll AD Air Force families who meet eligibility criteria for EFMP; to ensure AF sponsors assigned to the installation, or whose personnel functions are handled at the installation, are "Q-coded" (EFMP-enrolled) regardless of location of family members and to ensure compliance with DoD directives, Air Force (AF) policy and local MTF instructions.

6.3 The duties include but are not limited to the following:

6.4 Task 1: Reviews and manages information pertaining to the SNC process and coordinates with the Military

Personnel Flight (MPF) to provide FMRC information. Interviews sponsors and family members with an

OCONUS or applicable CONUS assignment; reviews FMRC checklist with sponsor/spouse. Ensures completion of appropriate documents to include AF Form 1466, Request for Family Member's

Medical/Educational Clearance for Travel; AF Form 1466DO, Dental health Summary; DD Forms 2792 and 2792-1 Exceptional Family Member Medical and Education Summaries as applicable, and any other pertinent documentation. Coordinates with the gaining Military Treatment Facility (MTF); Initiates, reviews, completes, forwards and tracks Facility Determination Inquiries for all family members keeping within timelines as per established guidance and instructions. Consolidates all required documentation for transmittal to the gaining base including Individualized Education Plans and Individualized Family Service

Plans. Reviews paperwork for sponsor rebuttal or disapproval clearances. Reviews all records and clearance packages to ensure documentation is complete. Coordinates and corresponds with FMRC corresponds with FMRC coordinators world-wide and provides administrative support to geographically separated units. Standards for Duty 1 are as follows:

6.5 Ensures all forms are completed properly and accurately

6.6 Coordinates with the MPF providing FMRC information and documentation to active duty members.

6.7 Conducts all personal interviews and fact-gathering inquires in a timely and HIPPA compliant manner.

6.8 Completes all required documentation in accordance with DoD, AF, and EFMP guidelines.

6.9 Provides oversight to ensure every AF sponsor with one or more family members with special needs assigned to the installation has a SN file maintained at the Military Treatment Facility (MTF). Ensures Q-coded sponsors assigned to the installation are contacted annually to determine if there are unmet needs and to request updates of information as needed.

6.10 Task 2: Initiates, develops and maintains effective working relationships with healthcare providers, departments within the medical center, the MPF, 1st Sgts, Commanders, military and civilian agencies, AFPC, and EFMP and Command personnel worldwide to ensure proper identification of special needs families and delivery of EFMP services. Ensures appropriate review and annotates documented services in

EFMP and medical records. Ensures documentation is reviewed and co-signed by the SNC/credentialed provider. Standards for Duty 2 are as follows:

6.11 Proficiently completes all required documentation in accordance with DoD, AF and guidelines.

6.12 Thoroughly prepares clear and concise goals, plans, and agreements for services.

6.13 Ensures professional interfacing with EFMP delivery agencies and resources.

6.14 Advocates for the patient and family/caregivers to ensure identified education and appropriate, timely care coordination is received.

6.15 Provides training to installation personnel and medical staff, and consultation as needed to support the implementation of EFMP-M base-wide.

6.16 Participates in EFMP and case reviews, at least quarterly, to discuss/assess newly identified families', complex, or unmet medical needs. Determine the appropriate resources necessary for the families.

6.17 Exercises skill, objectivity, and…