PWS OHPRN Revised 11 Feb 21.pdf

PERFORMANCE WORK STATEMENT (PWS)

FOR

OCCUPATIONAL HEALTH PHYSICIAN AND REGISTERED NURSE (RN)

AT THE 86TH MEDICAL GROUP

11 February 2021

TABLE OF CONTENTS

Subject Page

1.0 DESCRIPTION OF SERVICES 3

2.0. SPECIFIC REQUIREMENTS 3

3.0. SERVICES SUMMARY (SS) 7

4.0. GENERAL INFORMATION 8

5.0. APPENDICES 15

5.1. APPLICABLE PUBLICATIONS AND FORMS 15

5.2. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT

(HIPAA) OF 1996 17

5.3. WORKLOAD ESTIMATE 24

1.0 DESCRIPTION OF SERVICES.

1.1 OVERVIEW OF SERVICES. This contract is a Personal Services Contract (PSC) and is intended to create an employer-employee relationship between the Government and the individual Health Care Providers (HCP) only to the extent necessary for providing the healthcare services required under this contract. The performance of healthcare services by the individual HCP under a personal services contract is subject to day-to-day supervision and control comparable to that exercised over military and civil service HCP engaged in comparable healthcare services.

Pursuant to 10 USC 1089(a), any personal injury claims alleging negligence by the individual HCP within the scope of the HCP 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 HCP. 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 as defined by DoDI 1100.22.

1.2. This requirement is in support of the 86th Medical Group’s (MDG) Occupational Medicine. The Contractor shall be qualified to perform services in accordance with (IAW) this Performance Work Statement (PWS), and The Joint Commission (TJC)). Relocation costs, if applicable, shall be included in the price of the service.

1.3 PERSONNEL REQUIREMENTS: The Contractor shall provide a qualified Occupational Health Provider and a qualified Occupational Registered Nurse to perform services at the 86th Medical Group, Ramstein Air Base, as identified in paragraphs 2.1. and 2.2.

2.0 SPECIFIC REQUIREMENTS.

2.1 SUBTASK I – OCCUPATIONAL HEALTH PHYSICIAN shall:

2.1.1. Provide occupational medicine and administrative support. Maintain a program dedicated to job related outpatient clinical services and workplace safety. Examine and evaluate a wide spectrum of occupational medicine patients; exams shall include, but are not limited to pre-placement, occupational surveillance hearing related, pre-deployment, fitness for duty, fitness and risk, tuberculosis prevention, preventive health examinations, military accessions, separation and retirement exams, and medical clearances. Coordinate patient referral to other medical providers and facilities. Manage return-to-work programs and surveillance examination requirements as determined by federal law. Assist in the establishment of procedures to identify occupational hazards, to notify appropriate agencies of occupational disease or injuries, and to investigate job related injuries and illnesses. Serve as a liaison with federal, state, and local agencies in the US, Germany, and other countries as needed for mission accomplishment on matters related to occupational medicine. Determine frequency of and space for occupational medicine exams required by federal regulations and work place exposures. Assist in the development and maintain professional standards for occupational illness and injury care using Agency for Healthcare Policy and Research (AHCPR), American College of Occupational and Environmental Medicine (ACOEM), or other professional society guidelines as appropriate.

2.1.2. Provide preventive medicine support. Provide health education and control measures for preventable disease and injuries. Identify occupational medicine research needs. Assist in the development and implementation of research projects to control communicable and preventable disease. Research projects can be independent or in conjunction with Public Health as dictated by mission needs. Provide guidance on nutrition, food service sanitation, water supply safety, sewage and waste disposal, immunizations and other community health issues.

2.1.3. Advise line supervision and medical staff on occupationally unique exposures, patient management and treatment. Provide medical advice and guidance to Bioenvironmental Engineering, Public Health, and other organizations. Review occupational injury and illness data obtained from other facility care providers. Advise line management on workers’ fitness for duty according to 5 CFR, Part 339. Provide recommendations to Department of Labor on workers’ compensation claims, and to the Social Security Administration regarding disability retirement applications.

2.1.4. Attend and participate in weekly and monthly meetings such as: professional staff conferences, quality improvement meetings, staff meetings, commander’s staff meetings, flight meetings, and other meetings required by applicable regulations, Military Treatment Facility (MTF) guidance, or by the flight Commander or his/her designated representative. Attend Federal Employee Compensation Act (FECA) working groups as required.

2.2 SUBTASK II – OCCUPATIONAL HEALTH REGISTERED NURSE (RN). The duties include but are not limited to the following:

2.2.1. Clinic based:

2.2.1.1. Ability to synthesize data from a variety of sources and make appropriate clinical decisions (i.e. use guidelines from the United States Public Health Service and data from our population health metrics to determine and track preventive medicine screening exams).

2.2.1.2. Coordinate patient care through a continuum and facilitate the achievement of optimal outcomes in relation to clinical care, quality and cost effectiveness.

2.2.1.3. Ensure compliance with standards of care and practice IAW all established policies, procedures, and guidelines used in the medical treatment facility. Provide care within ethical and legal boundaries.

2.2.1.4. Accountable for making patient care assignments based on the scope of practice and skill level of personnel assigned to the occupational medicine element.

2.2.1.5. Assess patient needs telephonically.

2.2.1.6. Ability to recognize adverse signs and symptoms and quickly react in emergency situations.

2.2.1.7. Excellent oral communication skills for patient/family education and telephone triage of patients.

Telephone and in-person assessment/evaluation includes the determination of optimal time and location for patient management (ER, clinic, homecare) and follow-up care as required. Administer and communicate treatment plans and patient teaching IAW established protocols. Collect and assess significant patient history information and perform all necessary patient teaching.

2.2.1.8. Excellent written communication skills to perform accurate documentation, both written and electronic, of all activity, including telephone contacts, IAW requirements.

2.2.1.9. Make referral appointments and arrange specialty care as appropriate.

2.2.1.10. Skill in setting up, operating and monitoring specialized medical equipment such as cardiac monitoring devices, Electrocardiogram (ECG) units, oxygen analyzers, nebulizers, and other clinic specific equipment.

2.2.1.11. Perform/assist with procedures such as bladder catheterizations, administration of oxygen, visual acuity tests, EKGs, irrigation of eyes and ears, tympanograms, splinting, phlebotomy and other clinic specific procedures, in accordance with established protocols.

2.2.2. Administrative based:

2.2.2.1. Ability to effectively communicate and collaborate with a diverse group of people for the purpose of informing the healthcare team of plans/actions, for teaching/education to benefit the patient/family and organization.

Effectively uses appropriate communication format in addressing professional issues.

2.2.2.2. Ensure for proper documentation of procedures and treatments.

2.2.2.3. Ensure all equipment and exam rooms used in the Occupational Health clinic are properly cleaned and that all equipment is stored at the end of each work shift. A work shift is considered the regular work shift for military personnel as determined by the MDG/CC or AMDS/CC, whichever hours are more inclusive, but will not exceed the work hours stated in paragraph 4.17. Ensure preventive maintenance and routine cleaning are performed as directed. Ensure medication/supplies are replenished.

2.2.2.4. Participate in the orientation and training of newly assigned personnel, as appropriate.

2.2.2.5. May be required to work various shifts or augment clinical nursing support during the absence of other team nurses due to illness, leave or deployment. These shifts will be based on mission needs, and may not be within the 0730-1630 hours timeframe. They will not exceed 10 hrs per day and will be within the 80 hrs/2 weeks that are required.

2.2.2.6. Ensure a safe work environment, employee safe work habits and patient safety IAW regulatory agencies, infection control policies, and process improvement initiatives as referenced in paragraph 5.1.

2.2.2.7. Make appointments for annual Occupational Health examinations, fitness for duty examinations, and occupational injuries.

2.2.2.8. Coordinate hearing evaluations with Public Health and subsequent specialty evaluations as needed.

2.2.2.9. Report statistics regarding examinations and occupational health injuries/concerns periodically to the Occupational Health Working Group.

2.3 EDUCATION AND TRAINING OF OCCUPATIONAL HEALTH PHYSICIAN. Contractor employee shall meet the following minimum qualifications:

2.3.1. Have a doctor of medicine degree from a Liaison Committee on Medical Education (LCME) approved school of medicine, or a doctor of osteopathy degree from an American Osteopathic Association (AOA) approved school of osteopathic medicine, or a medical or osteopathy school acceptable to the Surgeon General USAF.

2.3.2. Completed at least 1 year of graduate medical education in a clinical specialty at an Accreditation Council for Graduate Medical Education (ACGME) approved hospital acceptable to the Surgeon General, HQ USAF.

2.3.3. Physician who is board certified in any of these specialties: Aerospace Medicine, Occupational Medicine, Family Medicine, Internal Medicine or a residency trained Flight Surgeon.

2.3.4. Have a minimum of 12 months of experience in occupational medicine or flight and operational medicine within the past 36 months.

2.4 EDUCATION AND TRAINING OF OCCUPATIONAL HEALTH REGISTERED NURSE. Contractor employee shall meet the following minimum qualifications:

2.4.1. Have experience in professional care theories, principles, practices, and procedures to perform nursing assignments of moderate difficulty and experience in assessing pediatric, adolescent, adults, obstetrics, and geriatric patients, as appropriate. Utilizes the nursing process as a basis for professional practice.

2.4.2 Have experience in a wide range of medical disorders/conditions and disease processes across the lifespan, as appropriate.

2.4.3. Have experience in preventive health schedules, procedures, processes and education methods.

2.4.4. Have experience in disease management and population health principles.

2.4.5. Have experience in a variety of pharmacological agents used in patient treatment, the desired effects, side effects, and complications of their use as well as the accurate administration of the pharmacologic agent, including dosage calculations as required. Knowledge of the administrative requirements for proper documentation of patient conditions including disease progress, acknowledgement of teaching, and follow up care.

2.4.6. Have experience in computer operations (Microsoft Windows) and proficiency in use of Microsoft Office Suite and automated medical records (AHLTA, ASIMS, and other DOD databases as assigned).

2.4.7 Have a nursing degree from an Accreditation Commission for Education in Nursing (ACEN) or a Commission of Collegiate Nursing Education (CCNE) approved program, or a nursing degree acceptable to the Surgeon General USAF.

2.4.8. Have at least 24 months of experience within the last 48 months in a primary care clinic setting.

2.5. LICENSE VERIFICATION AND CREDENTIALS REVIEW OR PRIVILEGING:

2.5.1. The contractor shall follow the applicable sections of Air Force Instruction (AFI) 44-102 Medical Care Management for all health care services provided in the Medical Treatment Facility (MTF). Contractor shall submit applications for the credentialing process for those contract personnel who will render full-time performance under this contract. The contractor shall ensure the contract personnel meet the requirements of the PWS before submitting the credentialing/privileging package to the 86th MDG Contracting Officer Representative (COR).

2.5.2. The contractor shall request from the COR, documentation requirements for license verification as required by the position for each contract personnel.

2.5.3. 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 providers. Any and all time and expense incurred relative to presentation of the required credentials packet and the application for clinical privileges will be at the contractor’s expense. 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.

2.5.4. If the contractor adds additional/or replacement contract personnel during the contract period, the same qualification standards, credentialing/privileging and health requirements shall apply.

2.5.5. The contractor shall not use any individual to provide direct health care services under this contract if that individual, within the past five years:

2.5.5.1. Has had his/her clinical privileges limited, suspended, or revoked by any healthcare facility, public or private, anywhere in the world.

2.5.5.2. 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.

2.5.6. 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.

2.5.7. 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.

2.5.8. Contract personnel shall not introduce new procedures or services without prior approval of the Department Chief or representative. If disagreements or deviations from protocols or procedures occur, the Department Chief or representative shall be the deciding authority.

3.0 SERVICES SUMMARY (SS).

ITEM

PERFORMANCE

OBJECTIVE

PWS

SUBTASK(S)

PARA.

REFERENCE PERFORMANCE THRESHOLD

SS#

Provides occupational medicine and administrative support.

2.1.1

No more than two (2) substantiated discrepancies per year.

SS#

Provides preventive medicine activities.

2.1.2. No more than two (2) substantiated

discrepancies per year.

SS#

Advises line supervision and medical staff on occupationally unique exposures, patient management and treatment.

Provides medical advice and guidance.

2.1.3. No more than two (2) substantiated

discrepancies per year.

SS#

Attend and participate in weekly and monthly meetings.

2.1.4. No more than two (2) substantiated

discrepancies per half year.

SS#

Accomplishes clinic based nurse duties.

2.2.1.

subcategories

No more than two (2) substantiated discrepancies per year.

SS#

Accomplishes administrative based nurse duties.

2.2.2 subcategories No more than two (2) substantiated discrepancies per half year.

Note: a “discrepancy” is defined as an action or omission which does not meet standard of care based on Air Force Instructions, American College of Occupational & Environmental Medicine (ACOEM), and/or Occupational Safety & Health Administration (OSHA) guidelines and this Performance Work Statement.

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) business days after receiving notice of contract award. The Contractor shall notify the CO of changes in the primary point-of-contact at least ten (10) 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 DOCUMENTATION. The Contractor shall provide the Contracting Officer’s Representative (COR) the required documentation for all support services personnel within ten (10) business days of contract award notification 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 eight (8) to ten (10) weeks for completion.

4.3 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.

4.4 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.

4.5 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 Medical Treatment Facility (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.

4.6 AUTHORIZATION OF CONTRACT 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 North Atlantic Treaty Organization (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.

4.6.1 AUTHORIZATION OF CONTRACT PERSONNEL DEPENDENTS. Authorized dependents include the Contractor personnel’s: lawful spouse, unmarried child, stepchild, or a lawfully adopted child who will reside in the host country with the Contractor personnel. (Child is defined as: has not passed his/her 21st birthday or, if past, 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.

4.7 LOGISTICAL SUPPORT. The U.S. Government will provide individual logistical support for Contractor personnel and authorized dependents to the extent available and as authorized by NATO Status of Forces Agreement (SOFA) Supplementary Agreement 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 4.6 and 4.6.1.

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

4.8 EMERGENCY HEALTHCARE FOR CONTRACTOR PERSONNEL. The MTF will provide emergency health care for injuries or life threatening medical emergencies occurring while on duty under the provisions of Air Force Instruction (AFI) 41-210. (See 5.1 – Applicable Forms and Publications). In emergencies, transportation in U.S. Government ambulances may be furnished by the U.S. Government on a reimbursable basis. The Contractor shall reimburse the U.S. Government for such services as billed by the MTF.

4.9 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.

4.10 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 SOFAs 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. 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 Forms and Publications)

4.12 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 Forms and Publications) 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. Certification shall be provided to the COR that Contractor personnel have completed medical evaluation required no later than seven (7) business days prior to commencement of work . 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 Occupational Safety Health Administration (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 Forms and Publications) 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 Center for Disease Control (CDC) health records requirement. (See 5.1 – Applicable Forms and Publications)

4.13 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.

4.14 RELATIONSHIP OF THE PARTIES, RESPONSIBILITY AND PROCEDURES

4.14.1. Professional Liability:

4.14.1.1. 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.

4.14.2. Responsibility and Procedures:

4.14.2.1. 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.

4.14.2.2. 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, at the Contractor personnel's own expense, participate in defense of such claim or litigation.

4.15 ADMINISTRATIVE CHECKS AND REQUIREMENTS.

4.15.1 Tier 1 (T1) Background Investigation. Since personnel under this contract will have access to Non- Sensitive government information and/or process information requiring protection under the Privacy Act of 1974, these positions are considered Low Risk Positions. Compliance with DoD Manual 5200.2, _AFMAN 16-1405 and Homeland Security Presidential Directive 12 (HSPD-12) is mandatory for these positions. (See 5.1–Applicable Forms and Publications) A Tier 1 (T1) back- ground investigation 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 T1. T1 investigation requests for employee will be submitted through the Suitability/Fitness Security Office, Ramstein AB, Germany. Member will be fingerprinted and required to complete the appropriate forms (Standard Form 85, Questionnaire for Non-sensitive Positions, any state release forms, and OF 306 Declaration for Federal Employment. (See 5.1–Applicable Forms and Publications) The contractor shall advise employee that a favorable suitability/fitness determination is required as a condition of employment under this specific contract. The employee shall apply for the T1 prior to start of performance. The government is solely responsible for the cost associated with the initiation, application and completion of the T1 investigation with exceptions for expenses incurred for Police Checks for “local hire” personnel.

4.15.2 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 Forms and Publications) The Contractor shall ensure that the personnel follows local MTF policy to provide fingerprints on a properly completed Standard Form 87, Fingerprint Card for Federal Employees. (See 5.1 – Applicable Forms and Publications) The procedures for completing the required CHBC are outlined in the DoDI 1402.5. (See 5.1 – Applicable Forms and Publications)

4.15.3 PENDING COMPLETION OF T1. 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 temporarily occupy non-sensitive positions pending T1. The Contractor personnel will be immediately removed from the position if at any time the T1 receives unfavorable adjudication, or if other unfavorable information that would affect the T1 becomes known. Pending completion of State Criminal History Records Check (SCHRC) 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 T1/SCHRC 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.

4.16 COMMON ACCESS CARD. Common Access Card (CAC) is a DOD-mandated program affecting military, DOD civilians and eligible Contractors. The Contractor shall comply with the requirements of this program. Visit the website for more information: http://www.cac.mil/.

4.17 HOURS OF OPERATION. The healthcare services are to be performed at the 86th MDG, Ramstein Air Force Base, Germany. The 86th MDG’s normal business hours are 0730-1630 hours Monday through Friday, excluding U.S. Federal holidays. Except for USAFE Family Days (see paragraph 4.17.2 below) the contract employee shall work no more than 80 hours within a two-week time period, not to exceed 10 hours a day, with one uncompensated hour off for lunch. (During the absence of other team nurses due to illness, leave or deployment, the contracted nurse shall also work various shifts or augment clinical nursing supports as stated in paragraph 2.2.2.5. The contractor personnel may see an estimated 8 patients per day. (See Attachment 1, Workload Estimates).

4.17.1 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:

January 1 New Year’s Day 3rd Monday in January Martin Luther King, Jr. Day 3rd Monday in February Washington’s Birthday Last Monday in May Memorial Day July 4 Independence Day 1st Monday in September Labor Day 2nd Monday in October Columbus Day November 11 Veterans Day 4th Thursday in November Thanksgiving Day December 25 Christmas Day

4.17.2 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 86 MDG will be closed and the Contractor will not be able to provide services. Therefore, the Contractor shall advise their personnel accordingly and treat these situations as determined appropriate. The USAFE Family days are scheduled by the USAFE Commander.

4.17.3 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 the contractor’s personnel from performing services under this contract, these contractor’s employees shall follow the same departure and reporting directions given to Government personnel and the contractor shall treat its employees as they determine appropriate. The contractor shall not seek additional payments from the Government for any expenses incurred by the contractor as a result of any such unplanned closure.

4.17.4 ABSENCES. The contractor may request, and the COR may approve, based upon the recommendation of the section chief or from personal knowledge, a reduction in contract performance requirements up to a maximum of 20 working days 8 hours per day, scheduled or unscheduled, due to illness, leave, and other justified reasons per 12-month contract performance period. The contractor shall notify the COR of any absences that are justified and the COR will track the number of days the contractor is absent. 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 or unscheduled absences in excess of twenty (20) workdays per 12-month contract performance period 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 referred to as a Request for Confirmation of Exemption from the Requirement to Obtain a Work Permit and is commonly called the “fax-back” process. It 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.

4.17.5 Teleworking is not authorized, except as follows: Alternate Place of Performance - As determined by the COR, contractor employees may be required to work at an alternate place of performance (e.g., home, the contractor's facility, or another approved activity within the local travel area) in cases of unforeseen conditions or contingencies (e.g., pandemic conditions, exercises, government closure due to inclement weather, etc.).

Contractor shall prepare all deliverables and other contract documentation utilizing contractor resources. The MTF will issue the Contractor a government laptop to facilitate teleworking needs. To the extent possible, the contractor shall use best efforts to provide the same level of support as stated in the PWS/SOW. Contractor will report any limiting factors in performance due to telework to the COR.

4.18 CONTRACTOR ORIENTATION AND NEW PERSONNEL REQUIREMENTS.

4.18.1 GENERAL TRAINING. The Contractor shall be responsible for ensuring personnel comply with health information privacy and security policies and procedures. The Government will provide training on Government provided forms and equipment, Air Force directives, MTF policies and procedures. Contractor personnel shall participate in continuing education programs to update and/or maintain skills and knowledge to meet annual requirements.

4.18.2 ORIENTATION TRAINING. The Contractor shall ensure that all Contractor personnel participate in the Government provided MTF orientation program for newly assigned personnel within 30 days of performance start.

Orientation training will be conducted during normal hours of operation, and will be scheduled by the COR.

Orientation shall include training on regulations specific to the professional specialty, and hospital and Air Force policy and procedures, instructions on automation processing, quality assurance policies, and other information systems as they apply to the position.

4.18.3 GOVERNMENT PROVIDED TRAINING.

Alcohol and Drug Abuse Prevention and Treatment Program Annual Block Training Armed Forces Health Longitudinal Technology Application (AHLTA)

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

Composite Healthcare Computer System (CHCS) Cultural Diversity Infection Control

Health Insurance Portability and Accountability Act (HIPAA) – initial and annual certification training. (See

5.1 – Applicable Forms and Publications)

Military Health Care Computer Systems/Procedures New Personnel Orientation On-the-job-training (work center/patient safety, waste disposal, fire prevention etc.)

Personnel Reliability Program Total Force Awareness Training – DoD Information Assurance Awareness Total Force Awareness Training – Information Protection Training Defense Medical Human Resources System – Internet (DMHRSi) Training Aeromedical Services Information Management Systems (ASIMS)

Health Artifact and Image Management Solution (HAIMS) Base Operational Medicine Clinic Computer Based Trainings (CBTs):

Occupational Medical Examination (OME) and Medical Surveillance Exam (MSE) Training Separation Health and Physical Examination (SHPE) Civilian Federal Employee (CFE) pre-placement exams

4.18.4 COMPUTER TRAINING. Contractor personnel who have any interaction with the MTF computer systems must receive training for the applicable system(s). The COR 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 (See 5.1 – Applicable Forms and Publications). 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 Forms and Publications)

4.19 COMMANDER’S TOBACCO USE GUIDANCE. The Air Force recognizes equal work breaks (when these breaks are permitted) for tobacco users and non-tobacco users. The MTF will have a smoke free medical campus with only one authorized smoking area for buildings 2114, 2121 and 2182.

Tobacco use is prohibited in government vehicles, inside buildings and within 50 feet of building‘s direct service entryway. The spitting of such non-smoking tobacco products into cups, cans, or any type of container within the above-restricted areas is prohibited.

4.20 U.S. GOVERNMENT-SHARED PROPERTY, INFORMATION AND SERVICES:

4.20.1. Government furnished property under this contract will be furnished to Contractor employees at no cost and shall be used only in performance of services under this contract.

4.20.2. The Government will provide the Contractor access to Air Force directives, MTF policies and procedures prior to start of contract performance date.

4.20.3. Facilities: During the hours of performance under this contract, the Contractor employees shall have the use of office space available.

4.20.4. Equipment and Supplies: Available equipment and office supplies for the performance of services under this contract, such as desk, chair, lighting, computer, printer, FAX machine, phone, copier, paper, folders, file cabinets, etc.

4.20.5. Electronic Documentation: As available at the local MTF, a standardized electronic documentation system or electronic medical record will be provided, such as, but not limited to CHCS and AHLTA.

4.20.6. Directives/Forms/Work Files: Unless noted otherwise, all required Air Force and Department of Defense directives, forms and other work files applicable to the MTF MM Program/Services will be furnished by the Government and will be retained by the Government.

4.21. CONFORMANCE WITH ENVIRONMENTAL MANAGEMENT SYSTEMS. The Contractor shall perform work under this contract consistent with the relevant environmental policy and objectives identified in the installation environmental management system (EMS) applicable for your contract. The Contractor shall perform work in a manner that conserves water, energy and other resources to the maximum extent feasible and ensure minimum production of waste as possible, giving preference to recycling and reutilization opportunities.

Furthermore, the Contractor shall give preference to less toxic materials whenever available and still reliable for their work. In the event an environmental nonconformance or noncompliance of host nation and USAF environmental laws and regulations associated with the contracted services is identified, the contractor shall take corrective and/or preventative actions. In the case of a noncompliance, the Contractor shall respond and take corrective action immediately. In the case of a nonconformance, the Contractor shall respond and take corrective action based on the time schedule established by the EMS Coordinator. In addition, the Contractor shall ensure that their employees are aware of the environmental management system on base and how these requirements affect their work performed under this contract. All on-site contractor personnel shall receive the installation EMS awareness level information.

4.22. CONFORMANCE WITH ENVIRONMENTAL REQUIREMENTS. The contractor shall perform all work in accordance with applicable German and US Air Force environmental laws, regulations and operating standards, including but not limited to the Final Governing Standards (FGS) for Germany. The contractor shall be immediately capable of understanding and addressing environmental laws and regulations as they pertain to work performed under this contract.

The FGS for Germany and other important environmental laws & requirements are applicable for all contractors working on base.

4.23. CONTRACTOR MANPOWER REPORTING LANGUAGE FOR CONTRACT PERFORMANCE

WORK STATEMENTS

The contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract. The contractor is required to completely fill in all required data fields at http://www.ecmra.mil . Reporting inputs will be for the labor executed during the period of performance for each Government fiscal year (FY), which runs 1 October through 30 September. While inputs may be reported any time during the FY, all data shall be reported no later than 31 October* of each calendar year.

Contractors may direct questions to the CMRA help desk.

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

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.

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

5.0. APPENDIX.

5.1. APPLICABLE PUBLICATIONS AND FORMS. Supplements or amendments to listed publications and/or forms from any organizational level may be issued during the life of this contract. Should any publication or form revision cause a change in the contractor’s processes, procedures and/or standards of operation, the contractor shall advise the CO of such changes in writing within 30 days of receipt of the publication or form revisions.

REFERENCE LONG TITLE

AFI 41-101 Obtaining Alternative Medical and Dental Care AFI 41-217 Health Information Assurance for Military Treatment

Facilities AFI 44-102 Medical Care Management AFI 48-123 Medical Examination and Standards AFI 31-501 Personnel Security Program Management AFI 41-114 Military Health Services System Matrix AFI 44-108 Infection Prevention and Control Program AFI 48-149 Flight & Operational Medicine Program AFI 48-145 Occupational & Environmental Health Program DOCPER DoD Contractor Personnel Office DoDD 5200.2 DoD Personnel Security Program DoDI 1402.5 Criminal History Background Checks on Individuals

In Child Care Services FIPS PUB 201 Federal Information Processing Standards Publication

Health Records Occupational Safety Heatlh Administration Hepatitis B – OSHA Occupational Safety Health Administration

HIPAA Health Insurance Portability and Accountability Act

HSPD 12 Homeland Security Presidential Directive 12 OF 306 Declaration for Federal Employment OMB M-05-24 Office of Management and Budget M-05-24 Privacy Act of 1974 Privacy Act of 1974 Standard Form 85P Questionnaire for Public Trust Positions Standard Form 87 Fingerprint Card for Federal Employees state.gov U.S. Department of State Vaccination/immunization U.S. Department of Health and Human Services

5.2 HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) BUSINESS

ASSOCIATE AGREEMENT

Introduction

In accordance with 45 CFR 164.502(e)(2) and 164.504(e) and paragraph C.3.4.1.3 of DoD 6025.18-R, “DoD Health Information Privacy Regulation,” January 24, 2003, this document serves as a business associate agreement (BAA) between the signatory parties for purposes of the Health Insurance Portability and Accountability Act (HIPAA) and the “HITECH Act” amendments thereof, as implemented by the HIPAA Rules and DoD HIPAA Issuances (both defined below). The parties are a DoD Military Health System (MHS) component, acting as a HIPAA covered entity, and a DoD contractor, acting as a HIPAA business associate. The HIPAA Rules require BAAs between covered entities and business associates. Implementing this BAA requirement, the applicable DoD HIPAA Issuance (DoD 6025.18-R, paragraph C3.4.1.3) provides that requirements applicable to business associates must be incorporated (or incorporated by reference) into the contract or agreement between the parties.

(a) Catchall Definition. Except as provided otherwise in this BAA, the following terms used in this BAA shall have the same meaning as those terms in the DoD HIPAA Rules: Data Aggregation, Designated Record Set,…