DRHA_PWS_New_21_Oct_15.docx

PERFORMANCE WORK STATEMENT (PWS)

FOR

DEPLOYMENT-RELATED HEALTH ASSESSMENT (DRHA) PROGRAM SERVICES

AT THE 86th MEDICAL GROUP AEROSPACE MEDICINE SQUADRON

21 Oct 15

TABLE OF CONTENTS

Subject Page

1.0 DESCRIPTION OF SERVICES 3

2.0 SPECIFIC REQUIREMENTS 4

3.0 SERVICES SUMMARY 6

4.0 GENERAL INFORMATION 7

5.0 APPLICABLE PUBLICATIONS AND FORMS 16

6.0 APPENDICES 26

APPENDIX A – Workload Estimates

1.0 DESCRIPTION OF SERVICES

1.1 OVERVIEW OF SERVICES. This contract is a personal services contract (PSC) and intends to create an employer-employee relationship between the Government and the individual health care providers (HCPs) only to the extent necessary for providing the healthcare services required under this contract. The performance of healthcare services by the individual HCPs under a personal services contract is subject to day-to-day supervision and control comparable to that exercised over military and civil service HCPs engaged in comparable healthcare services. Pursuant to 10 USC 1089(a), any personal injury claims alleging negligence by the individual HCPs within the scope of the HCPs performance of the personal services contract shall be processed by DoD in the same manner as claims alleging negligence by Department of Defense (DoD) military or civil service HCPs. The contract does not create an employer-employee relationship between the Government and any corporation, partnership, business association or other party or legal entity with which the HCP may be associated. The authority for this contract is 10 United States Code 1091. These services are considered to be non-mission essential.

1.2 BACKGROUND INFORMATION. DRHA is a Department of Defense (DoD)-mandated program that was developed to comply with DoD Instruction (DoDI) 6490.03, Deployment Health, dated 30 September 2011 (See 5.1-Applicable Publications and Forms). The National Defense Authorization Act for Fiscal Year 2010, Section 708, required the DoD to implement person-to-person mental health assessments for each member of the Armed Forces who is deployed in connection with a contingency operation. Pre- and post-deployment health assessments must be administered at the following intervals:

1) Within 4 months before the estimated date of deployment; 2) Within 30 days after return from deployment; 3) Between 3 and 5 months after return from deployment; 4) Between 6 and 17 months after return from deployment; and 5) Between 18 and 30 months after return from deployment. Ramstein Air Base deploys 4,500 military personnel per year that equates to a need for over 9-12,000 appointments to meet the 3-4 appointments each deployer will require annually.

1.3 PERSONNEL REQUIREMENTS. The Contractor shall provide qualified/fully certified Family Nurse Practitioner(s) or Physician Assistant(s) and Licensed Practical Nurse(s) to perform pre- and post-deployment assessment services at the Ramstein Air Base, 86th Medical Group. Contracted services shall include comprehensive health evaluations/assessments conducted pre- and post-deployment for active duty members assigned to Ramstein Air Base and Geographically Separated Units (GSUs). For GSU’s DRHA’s are completed through phone appointments and patient referred to their local provider if applicable. (Contractor personnel travel is not required) The Contractor shall provide all management, supervision, relocation, training, and qualified personnel. The Contractor shall perform in accordance with (IAW) this PWS. Relocation costs, if any, shall not be reimbursed separately.

2.0 SPECIFIC REQUIREMENTS.

2.1 SUBTASK 1 - FAMILY NURSE PRACTITIONER or PHYSICIAN ASSISTANT SERVICES. Contractor personnel shall provide a full range of Family Nurse Practitioner or Physician Assistant services IAW privileges granted by the 86th MDG Commander (e.g., clinical practice oversight; provide general screening, medical care, and examinations of patients for routine, acute, and chronic conditions; provide immunizations; diagnose, treat, and counsel patients as necessary). In addition, the Contractor personnel:

2.1.1 Shall perform primary health care for pre-and post-deployed active duty members.

2.1.2 Shall collaborate with the primary care physician in the health care of patients with chronic illnesses.

2.1.3 Shall conduct patient examinations, prescribe therapeutic measures, provide treatment, and perform procedures IAW their credentialing.

2.1.3.1 Shall only prescribe drugs within the scope of practice for a Family Nurse Practitioner or Physician Assistant. Drugs outside the scope of practice shall be ordered by the consulting physician.

2.1.4 Shall request consultation or referral with appropriate physicians, clinics, or other health resources as necessary (e.g. radiology, laboratory etc.).

2.1.5 Shall order diagnostic tests as necessary.

2.1.6 Shall schedule follow-up appointments, as necessary.

2.1.7 Shall promote preventive health maintenance care including the identification of potential health risks, annual physicals, positive health behaviors, and self-care skills through education and counseling.

2.1.8 Shall ensure compliance with standards of care and practice IAW all established policies, procedures, and guidelines used in the medical treatment facility (MTF) and provide care within ethical and legal boundaries.

2.1.9 Shall ensure a safe work environment, employee safe work habits, and patient safety IAW DoD, Air Force, 86 MDG and industry standard regulatory agencies, 86 MDG infection control and process improvement standards/initiatives.

2.1.10 Shall perform infection control procedures, as necessary.

2.1.11 Shall report communicable diseases to the Medical Treatment Facility (MTF) Public Health Office immediately.

2.1.12 Shall review all available consultation paperwork prior to patient visit, may include requesting reports of evaluations / treatment from network providers.

2.1.13 Shall prepare all documentation IAW established standards of the MTF, to include: the timeliness, accuracy, content, and appropriate signatures (e.g. prevention / chronic care flow sheets). Only MTF and Air Force-approved abbreviations shall be used for documentation of the patient health record.

2.1.14 Shall maintain current knowledge of content and intent of DoD and USAF policy regarding deployment health assessments and process guidance provided by DoD and USAF. Policies are located within the MTF, and will be provided during initial orientation and annual training requirements. (See 4.16.2.1.-Government Provided Training/Annual Training.)

2.1.15 Shall demonstrate current knowledge of DoD/Veterans Affairs (VA) Post-Deployment Health Clinic Practice Guidelines (PDH-CPG). Will be responsible for providing Public Health Flight and other key medical personnel with annual DRHA training as well as pertinent program updates. . (See 5.1-Applicable Publications and Forms)

2.1.16 Shall complete all deployment health clinician training required by DoD and USAF. Training will be conducted by the MTF, and will be provided during initial orientation and annual training requirements.

2.1.17 Shall comply with the Post Deployment Health Application User’s Guide. (See 5.1-Applicable Publications and Forms)

2.2. SUBTASK II - LICENSED PRACTICAL NURSE (LPN) HEALTHCARE SERVICES Contractor personnel shall provide a full range of LPN services IAW privileges granted by the 86th MDG Commander. In addition, the Contractor personnel:

2.2.1 Shall serve as an LPN performing patient care and nursing administrative duties for outpatients IAW established policies, procedures, protocols, and guidelines.

2.2.1.1 Shall perform a variety of diagnostic procedures; set-up procedure room and equipment; provide individualized patient education for preventative healthcare and health maintenance.

2.2.1.2 Shall prepare and position patient for examinations and treatments.

2.2.2 Shall provide individualized patient teaching regarding their individual deployment-health concerns and ensures deployers know the avenue for accessing referral or follow-up care.

2.2.3 Shall provide patients with the utmost care and attention. All patients shall be assured of their privacy and personal dignity.

2.2.4 Shall perform infection control procedures, as necessary.

2.2.5 Shall report communicable diseases to Public Health.

2.2.6 Shall prepare all documentation IAW established standards of the MTF, to include: timeliness, accuracy, content, and signature (e.g. prevention / chronic care flow sheets). Only MTF and Air Force-approved abbreviations shall be used for documentation of the patient health record.

2.2.7 Shall maintain current knowledge of content and intent of DoD and USAF policy regarding deployment health assessments and process guidance provided by DoD and USAF. Policies are located within the MTF, and will be provided during initial orientation and annual training requirements.

2.2.8 Shall demonstrate current knowledge of DoD/Veterans Affairs (VA) Post-Deployment Health Clinic Practice Guidelines (PDH-CPG). (See 5.1-Applicable Publications and Forms))

2.2.9 Shall complete all deployment health clinician training required by DoD and USAF. Training will be conducted by the MTF, and will be provided during initial orientation and annual training requirements.

2.2.10 Shall comply with the Post Deployment Health Application User’s Guide. (See 5.1-Applicable Publications and Forms)

2.3. EDUCATION AND TRAINING–FAMILY NURSE PRACTITIONER or PHYSICIAN ASSISTANT. Contractor personnel shall meet the following minimum qualifications:

2.3.1 Master’s Degree in Health Care Science

2.3.2 Have and maintain a current license (not revoked, suspended, or lapsed in registration) to practice medicine in any one of the 50 states, the District of Columbia, Puerto Rico, Guam, or the United States (U.S.)Virgin Islands that allows for the independent practice of clinical services. This license shall be valid and unrestricted (not subject to restriction pertaining to the scope, location, or type of practice ordinarily granted to other applicants for similar licenses in granting jurisdiction).

2.3.3 Certified as a Family Nurse Practitioner by the American Nursing Credentialing Center (ANCC) or certified as a Physician Assistant by the National Commission on Certification of Physician Assistants (NCCPA).

2.3.4 Minimum of two (2) years of clinical experience as a Family Nurse Practitioner or Physician Assistant during the last 3 years.

2.3.5 The Contractor personnel shall possess proof of the following knowledge within their license:

2.3.6 The Contractor personnel shall maintain requirements related to professional licensure including continuing medical education and Advanced Life Support (ALS)/Basic Life Support (BLS) as required by the military treatment facility Credentials Manager and Education (CME) and Training department and maintain any requirements for the Deployment Health Clinic as specified by the Medical Group.

2.4 EDUCATION AND TRAINING–FAMILY NURSE PRACTITIONER or PHYSICIAN ASSISTANT. Contractor personnel shall meet the following minimum qualifications:

2.4.1 Master’s Degree in Health Care Science

2.4.2 Have and maintain a current license (not revoked, suspended, or lapsed in registration) to practice medicine in any one of the 50 states, the District of Columbia, Puerto Rico, Guam, or the U.S. Virgin Islands that allows for the independent practice of clinical services. This license shall be valid and unrestricted (not subject to restriction pertaining to the scope, location, or type of practice ordinarily granted to other applicants for similar licenses in granting jurisdiction).

2.4.3 Certified as a Family Nurse Practitioner by the American Nursing Credentialing Center (ANCC) or certified as a Physician Assistant by the National Commission on Certification of Physician Assistants.

2.4.4 Minimum of two (2) years of clinical experience as a Family Nurse Practitioner or Physician Assistant.

2.4.5 Shall attend Medical Treatment Facility (MTF) provided annual training which will include. but is not limited to, topics such as safety, QA/RM/Process Improvement, infection control, fire protection, security, patient sensitivity and HIPAA training. The classes may be scheduled individually throughout the year or scheduled at one time.

2.4.6 The Contractor personnel must possess the following knowledge:

2.4.6.1 Knowledge of professional care theories, principles, practices, disease process, and procedures.

2.4.5.2 Knowledge and skill in cardiopulmonary resuscitation used to initiate resuscitation measures when necessary, and assist medical team in providing support measure.

2.4.6.3 Knowledge of pharmaceuticals, their expected beneficial effects, and potential side effects.

2.4.6.4 Knowledge of emergency medical procedures.

2.5 EDUCATION AND TRAINING –LICENSED PRACTICAL NURSE (LPN).

2.5.1 The LPN shall have, as a minimum, a current LPN certificate from an accredited national, state or military trained equivalent school.

2.5.2 The LPN shall have and maintain an active, valid, current, unrestricted license (with no limitations, stipulations or pending adverse actions) to practice nursing as a licensed practical nurse (LPN) in a US jurisdiction. Maintenance of required certification is mandatory.

2.5.3 Minimum of one (1) year of clinical experience.

2.5.4 The Contractor personnel must possess the following knowledge:

2.5.4.1 Knowledge of standard nursing care principles, procedures, and practices.

2.5.4.2 Knowledge and skill in cardiopulmonary resuscitation used to initiate resuscitation measures when necessary and assist medical team in providing support measure.

2.5.4.3 Knowledge of pharmaceuticals, their expected beneficial effects, and potential side effects.

2.5.4.4 Knowledge of emergency medical procedures.

3.0 SERVICES SUMMARY.

3.1 SERVICES SUMMARY–NP/PA

or Physician Assistant.

SS# 04

established standards of the Medical Treatment Facility (MTF), to include: timeliness, accuracy, content, and signature (e.g. prevention / chronic care flow sheets).

3.2 SERVICES SUMMARY–LPN

4.0 GENERAL INFORMATION

4.1 CONTRACTOR REPRESENTATIVE. The Contractor shall designate to the Contracting Officer (CO), in writing, a primary point-of-contact for contract implementation, coordination and administration not later than ten (10) workdays after receiving notice of contract award. The Contractor shall notify the CO of changes in the primary point-of-contact at least five work days prior to any change. All notifications shall be in writing and shall state the name and contact information for the point-of-contact. The Contractor Representative may reside/be located outside of Germany (i.e. in the United States), but shall be available by telephone or email from 0700 to 1600 Central European Time.

4.2 REGULATIONS. The Contractor shall abide by all MTF standards, rules, and procedures including requirements for any licensure, credentialing, and quality assurance requirements. Such regulations include, but are not limited to, general safety, fire prevention, waste disposal, infection control, Accreditation Association for Ambulatory Health Care (AAAHC), Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and patient safety initiatives.

4.3. REMOVAL OF CONTRACTOR PERSONNEL. At any time during the performance of this contract, the CO or Contracting Officer Representative (COR) may direct the contractor to immediately remove any contractor personnel whose actions or impaired state raises reasonable suspicion that clear and present danger of physical harm exists to a patient, other contractor personnel, and Government personnel or to the impaired individual. This provision will be used in emergency situations only and not for the purpose of bringing performance issues or other non-urgent concerns to the attention of the contractor. If the need for a removal occurs, the COR will contact the contractor's point-of-contact and direct the contractor to remove that individual from the MTF and to not use that individual to perform any services required under this contract until the issue has been resolved by the CO. A review of the basis for removal will be made by the CO within three working days after the COR directed the removal. If, after any investigation deemed necessary by the CO and discussions with the contractor's representative, the CO concludes that the contractor personnel’s impairment requires permanent removal from performance under the contract, the CO will notify the contractor that permanent removal is required. In the event of disagreements between the Government and the contractor's representative concerning matters of the impaired contractor personnel, the decision of the CO will be final. During the period of time between the removal and the final decision of the CO, the contractor shall provide back-up/replacement Contractor personnel IAW the terms and conditions of this contract.

4.4 RESPONSIBILITY AND PROCEDURES FOR SUITS FILED. If any suit or action is filed or any claim is made against the contractor personnel, which occurred as a result of work performed by the contractor personnel under this contract, the contractor shall immediately notify the COR and the CO and the chief of the appropriate services and promptly furnish them copies of all pertinent papers received. The contractor shall cooperate with the U.S. Government, without further compensation, in the processing, review, settlement, or defense of the suit, action, or claim; and authorize U.S. Government representatives to settle or defend the claim and to represent the contractor personnel in, or take charge of, any litigation involved in such an action. The contractor personnel may, at his/her own expense, participate in defense of such claim or litigation.

4.5 CONFLICT OF INTERESTS. Contractor personnel shall not bill patients for services rendered under this contract. Contractor personnel shall not request or accept compensation of any kind for patients treated, procedures performed, or any other actions performed. Contractor personnel shall not, while performing services under this contract, advise, recommend, or suggest to persons eligible to receive medical care at U.S. Government expense that such persons should receive care from the contractor at any place other than as designated under this contract.

4.6 CONFIDENTIALITY OF INFORMATION. Unless otherwise specified under this contract, all financial, statistical, personnel, and/or technical data which is furnished, produced or otherwise available to the contractor during the performance of this contract are considered confidential business information and shall not be used for purposes other than performance of work under this contract. The contractor shall not release any of the above information without prior written consent of the CO. The contractor shall not use patient care rendered pursuant to this contract as part of a study, research project, or publication.

4.7 MEDIA AND OTHER INQUIRIES. The contractor or contractor personnel shall not respond to any media inquiries. Any inquiries from the media, third parties, or public agencies shall be immediately relayed to the COR, who will relay them to the MTF Public Affairs Officer or, after duty hours, to the Administrative Officer of the Day. There shall be no interviews, comments, or any other response without the prior knowledge and approval of the MTF Commander. Other than routine inquiries from external agencies, all other inquiries and complaints shall be brought to the attention of the COR.

4.8 AUTHORIZATION OF CONTRACTOR PERSONNEL. An individual who has: (1) been hired as a consequence of this contract, (2) is a full-time (40 hours per week or more) contract employee, (3) is employed in a Host Nation country, (4) is a national (citizen) of or an ordinary resident of the United States provided that the contract employee is not also a Host Nation country (local) resident (i.e., a dual citizen), or (5) a U.S. citizen or a citizen of a NATO country other than the Host Nation and provided that the contract employee is not an ordinary resident of the Host Nation. The representative host country U.S. Government shall make the determination of a contract employee’s status with respect to being an ordinary resident. Authorized Contractor personnel and their authorized dependents will be granted privileges consistent with those granted members of the civilian component of the U.S. Forces.

4.8.1 AUTHORIZATION OF CONTRACTOR PERSONNEL DEPENDENTS. The contractor personnel’s lawful spouse who will reside in the host country with the Contractor personnel or an unmarried child, including a stepchild, or a lawfully adopted child of the Contractor personnel, who will reside in the host country with the contractor personnel. (The child either has not passed his/her twenty-first (21st) birthday or, if passed, is incapable of self-support because of mental or physical incapability that existed before that birthday and is dependent on the contractor for over one-half of his/her support.) The benefits listed below, if available, are generally extended as noted without special financial consideration due to the U.S. Government. In such cases, the U.S. Government does not charge for use of these benefits, and the contract price should not be inflated by the value of these benefits. Should any of the below needed benefits not be available, negotiations will be conducted with the Contractor and consideration determined.

4.8.2 LOGISTICAL SUPPORT. The U.S. Government will provide individual logistical support for Contractor personnel to the extent available and as authorized by NATO Status of Forces Agreement Supplementary Agreement (SOFA SA) Article 72, and foreign regulations; by current applicable international agreements, arrangements, policies; and the local Installation Commander. The duration of the initial individual logistic support authorization may be subject to a time limitation. Prior to expiration of the initial logistical support authorization (if and as applicable), the COR and Contractor shall expedite/process the individual Renewal/Authorization in sufficient advance to ensure continuation of logistical support. Logistical support is provided only for those contractor personnel that are providing services solely for U.S. Forces. Logistical support, if granted, will only be provided to authorized, full-time (40 hours per week) contractor and authorized dependents as defined in paragraphs 4.8 and 4.8.1. The following logistical support will be provided to applicable contractor personnel:

1) Commissary

2) Army Air Force Exchange Service

3) Armed Forces Recreation Facilities

4) Class VI (alcoholic beverages, including rationed items)

5) Legal assistance (on a space available basis)

6) Local government transportation for official government business (non-tactical vehicle)

7) Local Moral/Welfare Recreation Services

8) Military Banking facilities

9) Military postal services

10) Officer and NCO Club memberships

11) Mortuary services

12) Privately Owned Vehicle (POV) authorization

13) Housing office (Note: Limited. These services are limited to translation assistance and an explanation of host-country rental laws and utility and telephone services)

14) Petroleum, Oils, and Lubricants (POL) purchases

15) Transient billets on space available basis

16) Messing Facilities at remote sites only (reimbursable)

17) Army Continuing Education Services

18) Credit union facilities 19)* Dependent Schools, on space available, tuition paying basis

20) Medical/Dental on a reimbursable basis. Dental on emergency basis only

21) Pet and firearm registration and control

22) NATO status of Forces Agreement stamp (subject to approval of Host nation Customs Authority)

23) Customs exemptions *Note: The Government will not pay for tuition

4.9 EMERGENCY HEALTHCARE FOR CONTRACTOR PERSONNEL. The MTF will provide emergency health care for injuries or life threatening medical emergencies occurring while on duty. The Contractor shall reimburse the U.S. Government for such services as billed by the MTF.

4.9.1 OVERSEAS EMERGENCY MEDICAL SERVICES. In emergencies, transportation in U.S. Government ambulances may be furnished by the U.S. Government on a reimbursable basis. Contractor personnel may not be authorized occupational health services in all locations. Locations where occupational health services are available will be identified in the contract. Contractor employees may receive emergency first aid and medical treatment subsequent to on the job injuries under the provisions of AFH 41-114 (See 5.0–Appendix). These services will be chargeable to the contractor.

4.10 CONTRACTOR PERSONNEL PRIVATE PRACTICE. Contractor personnel are prohibited by reason of their employment under this contract from conducting private practice. The CO will unilaterally resolve any issues concerning potential conflicts.

4.11 DOCUMENTATION.

4.11.1 OVERSEAS REQUIREMENTS. The Contractor is responsible for ensuring all country clearances, passports, visas, and accreditations required by the Host Nation are obtained prior to employment of individuals under this contract. Documentation requirements are subject to change as Status of Forces Agreement(s) (SOFA) change. In the event a proposed Contractor employee is denied Host Nation approval, accreditation, and/or permission, the prospective awardee shall submit like documentation for another nominee. The Contractor will be responsible for obtaining the appropriate country specific requirements, and will coordinate this with the CO or COR. All Contractor personnel shall have been accredited, cleared, granted visas, etc., to specific positions at specific overseas locations. The Contractor shall provide written notification to the CO and the COR within 24 hours of becoming aware of accredited Contract personnel no longer performing duties requiring accreditation/clearances/permissions. The Contractor shall recognize that Host Nation authorities may conduct on-site inspections at any time in the Contractor personnel’s work area for the purpose of verifying the status of positions and Contractor personnel and appropriate visas or permissions. The Contractor shall assume all costs related to submission of required documentation. At the time of preparation of this contract, applicable information and forms for placement of Contractor personnel in Germany may be accessed at the DOCPER and U.S. Department of State websites. (See 5.1-Applicable Publications and Forms). The Contractor shall provide the CO the required documentation for all support services personnel in due time to comply with required performance periods of the contract by taking into consideration that the DoD Contractor Personnel Office (DOCPER) process requires an average of 8 to 10 weeks for completion. (

4.11.2 CONTRACTOR PERSONNEL HEALTH REQUIREMENTS. Contractor personnel and dependents shall be up to date on immunizations required or recommended by the U.S. Department of Health and Human Services for travel to the Host Nation (See 5.1-Applicable Publications and Forms). The U.S. Government will not reimburse the Contractor for this expense. Contractor personnel providing services under this contract shall receive a pre-employment physical examination prior to commencement of work and annually thereafter. Contractor personnel shall report to the contractor’s physician to receive a pre-employment examination and immunizations/shots prescribed by the MTF. No later than seven (7) working days prior to commencement of work, certification shall be provided to the Functional Requirements Evaluator Designee (FRED) that Contractor personnel have completed medical evaluation required above. This certification shall state the date on which the examination was completed, the doctor’s name that performed the examination, and a statement concerning the physical health of the individual. The certification shall also contain the following statement: “(name of contractor employee) is suffering from no contagious diseases to include but not limited to Tuberculosis and Hepatitis.” Per OSHA requirements, all contractor personnel who will have occupational exposure to blood or body fluids, or other potentially infectious materials, shall receive Hepatitis B vaccine, sign a voluntary declination, or have documented proof of immunity to Hepatitis B infection. (See 5.1-Applicable Publications and Forms)) Personnel who sign declinations may change their minds at any time and receive the Hepatitis B vaccine without penalty. 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. (See 5.1-Applicable Publications and Forms)

4.11.3 LICENSE VERIFICATION AND CREDENTIALS REVIEW OR PRIVILEGING. Contractor personnel shall follow Air Force Instruction (AFI) 44-102, Medical Care Management, for all health care services provided in the MTF. (See 5.1-Applicable Publications and Forms) The Contractor shall meet all privileging standards set by the MTF Credentials Committee. The contractor shall submit only complete packets for candidates with realistic employment opportunities. The contractor shall submit applications for the credentialing process for those Contractor personnel who will render full-time performance under this contract. The Contractor is not exempted from submitting complete packets on any contractor personnel who were or are privileged under another contract. The contractor shall ensure the contractor personnel meet the requirements of the PWS before submitting the credentialing/ privileging package to the COR. The contractor shall perform all primary source verifications and include all verifications with the credentials package or competency assessment folder information for non-privileged staff IAW AFI 44-102. The contractor shall obtain all paperwork, letters of reference, approvals, work history, etc. required by the MTF credentialing or licensure verification processes. The MTF staff will not assist the contractor in obtaining any needed information for initial credentialing. The contractor is responsible for the current competence of contractor personnel used to provide health care services under this contract. Privileges are facility specific and the department chair or service chief develops the criteria to award privileges. The contractor shall request from the COR, documentation requirements for privileges or for license verification, as required by the position, for each contractor personnel performing under this contract. Contractor personnel who require privileging shall not provide health care services until they have been granted privileges at the MTF. The Credentials Committee may have questions, which they will present to the contractor’s personnel verbally or in writing. The contractor’s personnel shall answer questions presented by the Credentials Committee either verbally or in writing. However, the Government officials will not use this communication to conduct interviews. The COR will provide immediate fax, telephonic notification, or e-mail notice to the contractor of the results of the credentials evaluation for the award of privileges. The COR will annotate/document the date/time the contractor was advised of denial or award of privilege for personnel. Time and expenses incurred relative to presentation of the required credentials packet and the application for clinical privileges will be the Contractor’s. All credentialing packets submitted by the contractor in the fulfillment of duties under this contract shall become and remain the property of the U.S. Government. If the contractor adds additional/or replacement personnel during the contract period, the same qualification standards, credentialing/privileging and health requirements shall apply. The contractor shall not use any individual to provide direct health care services under this contract if that individual, within the past five years: has had his/her clinical privileges limited, suspended, or revoked by any healthcare facility, public or private, anywhere in the world; is the subject of a current or pending hearing or appeal brought by any health care facility, public or private, anywhere in the world, which may result in the limitation, suspension, or revocation of the individual’s clinical privileges. This prohibition does not apply to any individual whose clinical privileges, although originally limited, suspended or revoked by a health care facility, were subsequently fully reinstated by the health care facility. Limitation of clinical privileges, as used in this paragraph, refers to a partial withdrawal/reduction of clinical privileges as a result of a determination that, or pending investigation to determine whether an individual has engaged in unprofessional conduct or substandard medical practice or is incompetent to perform certain medical practices.

4.11.4 ABUSE OF PRIVILEGES. The U.S. Government retains the right to withdraw privileges as a result of contractor or contractor personnel’s abuse of privileges at no additional cost to the U.S. Government. The contractor shall ensure that, upon termination or transfer of any contractor personnel who is granted privileges identified above, action is taken simultaneously with termination of employment to ensure that said contractor personnel ceases to have access to the above privileges. The contractor shall ensure that identification passes or other documents pertinent to and/or peculiar to the contract or privileges hereunder are turned over to the issuing office upon termination or transfer of any contractor personnel. The contractor shall require a written receipt of such return and shall immediately forward a copy to the CO.

4.12 RELATIONSHIP OF THE PARTIES, RESPONSIBILITY AND PROCEDURES

4.12.1 Professional Liability:

4.12.1.1 Pursuant to 10 USC 1089(a), the Department of Defense shall process any personal injury claim alleging negligence by the contractor within the scope of the contractor’s performance of this contract as claims alleging negligence by DOD military or civil service employees. The contractor is not required to maintain medical malpractice liability insurance, and the U.S. Government will not reimburse or otherwise pay for such insurance should any be purchased.

4.12.2 Responsibility and Procedures:

4.12.2.1 If any suit or action is filed or any claim is made against the contractor personnel, which occurred as a result of work performed by the contractor under this contract, the contractor shall immediately notify the COR and the Contracting Officer and the chief of the appropriate services and promptly furnish them copies of all pertinent papers received.

4.12.2.2. The contractor shall cooperate with the U.S. Government, without further compensation, in the processing, review, settlement, or defense of the suit, action, or claim; and, authorize U.S. Government representatives to settle or defend the claim and to represent the contract employee in, or take charge of, any litigation involved in such an action. The contract personnel may participate in defense of such claim or litigation at the contractor personnel's own expense.

4.13 ADMINISTRATIVE CHECKS AND REQUIREMENTS.

4.13.1 NATIONAL AGENCY CHECK WITH INQUIRIES (NACI). Since personnel under this contract will have access to critical government information and/or process information requiring protection under the Privacy Act of 1974, these positions are considered Public Trust Positions. Compliance with DoD Directive 5200.2-R, AFI 31-501and Homeland Security Presidential Directive 12 (HSPD-12) is mandatory for these positions. (See 5.1–Applicable Publications and Forms). A background investigation consisting of a National Agency Check with Inquiries (NACI) is required for all personnel under this contract. The Contractor shall fully adhere with the provisions of referenced publications by having each of their employees who are performing under this contract initiate and complete a NACI. Background investigation requests for employee will be submitted through the Personnel Security Office, Ramstein AB, Germany. Member will be fingerprinted and required to complete the appropriate forms (Standard Form 85P, Questionnaire for Public Trust Positions and OF 306, Declaration for Federal Employment; See 5.1–Applicable Publications and Forms). The contractor shall advise employee that a favorable suitability determination is required as a condition of employment under this specific contract. The employee shall apply for the NACI prior to start of performance. The government is solely responsible for the cost associated with the initiation, application and completion of the background investigation with exceptions for expenses incurred for Police Checks for “local hire” personnel.

4.13.2 CRIMINAL HISTORY BACKGROUND CHECK (CHBC). CHBC are required for Contractor personnel involved in the delivery of healthcare to children under the age of 18 on a frequent and regular basis, as stated in Department of Defense Instruction (DoDI) 1402.5, Enclosure 5. (See 5.1–Applicable Publications and Forms). The Contractor shall ensure that the personnel follows local MTF policy to provide fingerprints on a properly completed Standard Form 87, Federal Bureau of Investigation United States Department of Justice Fingerprint Card. (See 5.1–Applicable Publications and Forms) The procedures for completing the required CHBC are outlined in the DoDI 1402.5.

4.13.3 PENDING COMPLETION OF NACI AND CHCB. The contractor personnel may provide contract services prior to completion of background investigation. The contractor understands that the MTF Commander may allow the contractor personnel to occupy sensitive positions pending NACI temporarily. The contractor personnel will be immediately removed from the position if at any time the NACI receives unfavorable adjudication, or if other unfavorable information that would affect the NACI becomes known. Pending completion of CHBC the Air Force Surgeon General requires close clinical supervision and full compliance with existing DoD Directives, Instructions, and other guidance on quality assurance, risk management, licensure, personnel orientation and certification verification. The MTF Commander will determine what constitutes “close clinical supervision” for individuals whose NACIs/CHCB are pending, either supervised practice ensuring protection of patients under the age of 18 or line-of-sight supervision (i.e., chaperoned by an individual whose background investigation has been successfully completed) at all times when caring for these patients.

4.15 HOURS OF OPERATION. The healthcare services are to be performed at the 86th Medical Group, Ramstein Air Force Base, Germany. The 86 MDG’s normal business hours are 0700-1630 hours Monday through Friday, excluding U.S. Federal holidays. Except for USAFE Family Days (see paragraph 4.15.2. below), contract employee actual working times, not including one uncompensated hour off for lunch daily, holidays and Family days, shall not exeed 10 hours a day, 80 hours within a two-week time period, and overall 1960 hours annually. The contractor’s employee(s) shall not work overtime nor will any such overtime be paid.

4.15.1 HOLIDAYS. The following is a list of legal federal holidays. Any federal holiday falling on a Saturday will be observed on the preceding Friday, holidays falling on a Sunday will be observed the following Monday.

U.S. Holidays:

4.15.2 USAFE FAMILY DAYS. For the base period and each option period of this contract there are an estimated five USAFE Family Days scheduled that the MTF will be closed and the Contractor will not be able to provide services. The contractor will not be compensated for services for these days. Therefore, the Contractor shall advise their personnel accordingly and treat these situations as they deem appropriate. The USAFE Commander schedules the USAFE Family days.

4.15.3. UNPLANNED CLOSURES. In the event of unplanned closure of the MTF due to natural disaster, military emergency, severe weather, security threat, or a facility-related problem that prevents contractor personnel from performing services under this contract, these contractor personnel shall follow the same departure and reporting directions given to Government personnel and the contractor shall treat its personnel as they determine appropriate. The contractor shall not submit an invoice or otherwise seek additional payment from the Government for any expenses incurred by the contractor as a result of any such unplanned closure.

4.15.4 ABSENCES. The contractor may request, and the CO may approve, based upon the recommendation of the section chief or COR, a unpaid reduction in contract performance requirements up to a maximum of 20 working days 8 hours per day, scheduled or unscheduled) due to illness, and other justified reasons per 12-month contract performance period. The contractor will notify the COR of any absences that are justified. The number of consecutive days for scheduled or unscheduled absences will be at the discretion of either the MTF commander, section chief, or COR based on workload with coordination through the COR. It is the contractor‘s responsibility to approve any absences of the contractor personnel and to coordinate absences with the section chief and/or COR. The contractor shall provide back-up coverage for all scheduled absences in excess of twenty (20) consecutive workdays at no additional cost to the government. Replacement contractor employee may work in a temporary duty status (TDY) and be exempt from obtaining a work permit. This process is called fax-back process and must be completed before the employee arrives or begins work in Germany. Application under the fax-back process is mandatory for contractor employees performing work in Germany in a TDY status. Contractor employees who arrive in Germany using this process will not be issued a CAC with privileges and will not receive individual logistics support, but may be eligible for an installation pass.

4.16 CONTRACTOR ORIENTATION AND NEW PERSONNEL REQUIREMENTS.

4.16.1 GENERAL TRAINING. Contractor personnel shall abide by all MTF standards, rules, and procedures including requirements for any licensure, credentialing, and quality assurance requirements. Such regulations include, but are not limited to, general safety, fire prevention, waste disposal, infection control, AAAHC, JCAHO, and patient safety initiatives. All contractor personnel performing services at the MTF are required to complete initial and annual refresher Health Insurance Portability and Accountability Act of 1996 (HIPAA), Anti-terrorism/Force Protection (AT/FP), and safety training as provided by the MTF for its personnel. The contractor will be held accountable for ensuring personnel comply with health information privacy and security policies and procedures. The Government will also provide training on Government provided forms and equipment, universal precautions, initial orientation, and continuing orientation. Contractor personnel shall participate in continuing education programs to update and/or maintain skills and knowledge to meet annual requirements. Contractor personnel shall participate in evaluation of the quality and effectiveness of activities and services of the unit. The Government will also train and provide access to Air Force directives, MTF policies and procedures prior to start of contract performance.

4.16.2 ORIENTATION TRAINING. The Contractor shall ensure that all contractor personnel participate in the government provided MTF orientation program for newly assigned personnel within the first two weeks of performance start. Orientation training will be conducted during normal hours of operation, and will be scheduled by the FRED. Orientation shall include training on the following:

(a) regulations specific to the professional specialty, the hospital and Air Force policy and procedures

(b) instructions on automation processing, quality assurance policies, Composite Healthcare Computer System (CHCS) (obtain password), and other information systems

(c) local in-service, and safety briefings as they apply to the position.

4.16.2.1 GOVERNMENT PROVIDED TRAINING/ ANNUAL TRAINING:

Basic Life Support (BLS) IAW AFI 41-101 – current/continual certification (See 5.1 – Applicable Forms and Publications)

Renewals (initial training is the Contractor’s responsibility prior to contract start) of Basic Life Support (BLS) Pediatric Advanced Life Support (ACLS), Pediatric Advance Life Support (PLAS), IAW AFI 41-101 – current/continual certification (See 5.1 – Applicable Forms and Publications) as required by the 86 MDG Credentials Office.

4.16.2.2 COMPUTER TRAINING. Contractor personnel who interact with the MTF computer systems must receive training for the applicable system(s). The FRED will coordinate the necessary computer training. The training will be on-site and during normal hours of operation. This training will be at no cost to the contractor. Access to patient data systems is an “Automated Data Processing Sensitive” position requiring compliance with AFI 31-501. The contractor shall comply with agency personal identity verification procedures that implement Homeland Security Presidential Directive-12 (HSPD-12), Office of Management and Budget (OMB) guidance M-05-24, and Federal Information Processing Standards Publication (FIPS PUB) Number 201. (See 5.1–Applicable Publications and Forms) The Government will train and give access to contractor personnel on the following systems: CHCS, which is the DoD’s worldwide automated medical information system that interfaces with 40+ external clinical and administrative systems, AHLTA system, which contains the MTF’s appointment scheduling program, pharmacy, lab, and radiology ordering system and is interlinked with other departments in the MTF.