Performance Work Statement.pdf

PERFORMANCE WORK STATEMENT (PWS)

FOR

NON-PERSONAL SERVICES FOR ANESTHESIA SERVICES

AT THE

MILITARY TREATMENT FACILITY

39th MEDICAL GROUP (39 MDG)

DATE: 11 JUNE 2010

PERFORMANCE WORK STATEMENT

FOR

NON-PERSONAL ANESTHESIA SERVICES

AT

MILITARY TREATMENT FACILITY

39th MEDICAL GROUP

TABLE OF CONTENTS

SECTION TITLE PAGE

C-1 DESCRIPTION OF SERVICES 3

C-2 SERVICE DELIVERY SUMMARY 18

C-3 GOVERNMENT FURNISHED PROPERTY AND SERVICES 19

C-4 GENERAL INFORMATION 21

C-5 APPENDICES 27

TECHNICAL EXHIBITS:

1. ESTIMATED PROCEDURES DATA 27

SECTION C-1

DESCRIPTION OF SERVICES

1.1. SCOPE OF WORK. The Anesthesiologist shall provide services to perform inpatient and outpatient Anesthesia services required for Government beneficiaries. The Anesthesiologist shall provide care to eligible beneficiaries at the 39th Medical Group (also referred to as the “medical treatment facility” [MTF] herein) or in local civilian hospitals as required to support the anesthesia needs of the MTF. Anesthesiologist shall furnish all labor, management, supervision, consultations and reports. Anesthesiology care shall be as comprehensive as government-supplied facilities, equipment and support services permit. Performance shall be according to the requirements contained in this Statement of Work (SOW) and professional standards of the Joint

Commission on Accreditation of Healthcare Organization and/or the Accreditation Association for Ambulatory Health Care (AAAHC).

1.2. CONTRACT PERSONNEL

1.2.1. POINT OF CONTACT. The Anesthesiologist shall be responsible for the performance of the work. The Anesthesiologist shall have full authority to act on all matters relating to the daily operation of this contract. The contractor shall provide care in accordance with this PWS.

1.2.2. ROUTINE AVAILABILITY. Anesthesiologist shall perform outpatient, hospital, emergency and regular clinic services in the MTF and designated local civilian hospitals which have active Preferred Provider Agreements with the 39 MDG. Regular Clinical Services, consultation and services occurring at local hospitals shall be provided for 80 hours per month.

Unscheduled callback time IN EXCESS of the 80 hours per month are estimated at 30 hours per month and will be paid at rates which may include either “fee for service” or “hourly-rate” payment or a combination of both as delineated in the contract attachment. The MTF staff will schedule the anesthesiologist for up to 40 hours weekly (up to 80 hours per month) for in-house service dependent upon the needs of the U.S. Government Regular Clinical services and consultation shall be coordinated with the 39 MDG staff for maximum support of anesthesia requirements for the population’s needs for care. Major and minor outpatient/inpatient procedures shall be performed during regular clinical services and consultations. On call, 24-hour telephone standby shall be provided. Emergency consultations shall be performed as needed. Authorized callers (for call back) will be all 39th Medical Group medical providers assigned to the MTF. The provider will maintain privileges at the major local hospitals in which the 39 MDG maintains Preferred Provider Network agreements.

1.2.2.1. ON-CALL RESPONSE TIME REQUIREMENTS. On call telephone standby shall be provided on a 24 hour basis on a monthly rotating schedule. As required and directed by the

MTF, the anesthesiologist shall be required to provide Anesthesia services after normal duty hours and also to respond to requests for "on call" support at any hour of the day since services may be required during night hours and on weekends. The anesthesiologist shall provide anesthesia services on-site or at the local civilian hospital as directed by MTF within 60 minutes of notification by the 39th Medical Group’s medical provider(s) of a routine on-call consultation requirement and within 30 minutes of an emergency requirement.

1.2.2.2. HOURS OF OPERATION. The anesthesiologist shall not schedule regular clinic services or anesthesia during Goal days, Family days, Federal or Turkish Holidays. Clinic hours or anesthesia shall be scheduled for another day if the regular clinic hours land on a holiday or scheduled day off. The change in schedule shall be coordinated with the Quality Assurance

Personnel (QAP). The anesthesiologist shall account for these and any other non-working days to ensure that he/she is available for the time periods as delineated in 1.2.2. Care rendered under this contract while performing in local civilian hospitals is included in this contract, up to and including 80 hours per month. Dual compensation in accordance with United States Code (USC)

55-36 shall not be reimbursed to the anesthesiologist by US Government or TRICARE as anesthesiologist is already considered a contract employee of the US government. As stated in

1.2.2., care rendered in excess of 80 hours per month will be paid at rates which may include either “fee for service” or “hourly-rate” payment or a combination of both.

1.2.2.3. FEDERAL HOLIDAYS. There are ten (10) Federal holidays each year. They are

New Year’s Day, Martin Luther King JR’s Birthday, President’s Day, Memorial Day, Independence Day, Labor Day, Columbus Day, Veterans Day, Thanksgiving Day and Christmas

Day. If New Years Day, Independence Day, Veteran’s Day or Christmas falls on a Saturday it is observed on Friday, if it falls on Sunday, it is observed on Monday.

1.2.2.4. TURKISH NATIONAL HOLIDAYS. There are seven (7) observed Turkish national holidays each year. They are New Year’s Day, Sugar Festival, Sovereignty and Children’s Day, Sovereignty and Youth Sports Day, Feast of Sacrifice, Victory Day, and Republic Day. Note:

The dates of Muslim holidays change year to year.

1.2.2.5. WORK SCHEDULE. Personnel will be scheduled in accordance with the MTF dictated work schedule for maximum heath care utilization. A flexible schedule may be requested based on the needs of the MTF. Normal MTF clinic hours are 7:30AM-4:30PM.

Policy regarding daily lunch or other breaks will follow the Government’s standard procedures for contract personnel. The contract personnel should follow command announcement for reporting to work as it relates to inclement weather or base closures.

1.2.2.6. ARRANGE FOR REPLACEMENT STAFF. During excused absences the anesthesiologist shall arrange for a replacement anesthesiologist with equal qualifications and skill to care for eligible beneficiaries in case of emergencies or post operative complications at the anesthesiologist’s expense. Excused absence shall not exceed 3 weeks per year with no more than 2 consecutive weeks taken at a time. The replacement anesthesiologist shall treat the patients at a civilian facility. The name of qualified and credentialed anesthesiologist shall be submitted to the MTF at start of contract and will be maintained on file for adequate anesthesiology coverage. The replacement anesthesiologist shall meet the same credential criteria as that of the anesthesiologist. The Government reserves the right to accept the recommended replacement anesthesiologist. If not accepted, a qualified substitute shall have to be resubmitted by the anesthesiologist for acceptance by the government.

1.2.3. PERSONNEL REQUIREMENTS.

1.2.3.1. ENGLISH LANGUAGE REQUIREMENT. The anesthesiologist shall be able to read, write, speak and understand English. Language should be spoken with sufficient structural accuracy and vocabulary to participate effectively in most formal and informal conversations on practical and professional topics.

1.2.3.2. CRIMINAL BACKGROUND CHECK REQUIREMENT. Criminal background check will be conducted by the government by means of written professional reference and screening of all prior and existing lawsuits and their outcomes. Screening of lawsuits will be requested in writing to the Turkish Health Department at the address listed below:

Saglik Mudurlugu

Stadyom Giris Kapisi Karsisi

Hifzisihha Mlid Bitisigi Adana

1.2.3.3. Concurrent with the consent of the Contracting Office, contract providers may provide contract services prior to completion of background checks. However, at all times while children are in the care of that individual, the contractor shall be within sight and continuous supervision of a staff person, whose background check has been completed, a chaperone or parent/guardian.

1.2.3.4. Contractors shall have the right to obtain a copy of any background check pertaining to them and to challenge the accuracy and completeness of the information contained in the report.

1.2.3.5. Contractors who have previously received a background check shall provide to the

Contracting Office or QAP proof of the check or obtain a new one.

1.2.3.6. All contractors shall provide all reasonable and necessary assistance to the government.

1.2.3.7. UNIFORMS/PERSONAL APPEARANCE. Contractor shall present a neat appearance and be easily recognized as contract employees. Clothing should fit correctly to provide a professional, modest appearance in keeping with the normally accepted community standards of dress for the work being performed, no jeans allowed. In all cases, clothing shall be neat and clean. This includes being free from visible dirt, stains, strong cologne, and offensive odors. When required and supplied by the MTF, contractor shall wear special protective clothing and shoe covers. These items shall remain the property of the Government and shall not be removed from the MTF. Special protective clothing shall be used then turned in or destroyed as directed by the QAP.

1.2.3.7.1. All contractors shall wear a Contractor provided name tag with the company name or phrase “CONTRACT ANESTHESIOLOGIST”, individual’s name and specialty displayed, e.g., CONTRACT ANESTHESIOLOGIST

JANE A. SMITH, MD

This nametag shall be worn on the outermost garment, i.e., shirt/blouse or sweater.

1.2.3.7.2. FACIAL HAIR. Facial hair including beards, mustaches and sideburns shall be controlled (restrained) or trimmed to have a professional appearance and to maintain safe work practices. When duties are performed in specified areas, a disposable protective hood shall be worn to ensure infection control standards are met. The Government will provide this hood.

1.2.3.7.3. OFFICE/WORK AREA APPEARANCE. Those areas (office examination rooms, etc.) provided for contractor’s use shall present an orderly appearance. The anesthesiologist shall ensure these areas are tidy and any decorations present a professional and modest appearance in keeping with acceptable community standards.

1.2.3.8. PROTECTIVE EQUIPMENT. When required and supplied by the MTF, contractor shall wear special protective clothing and shoe covers. These items shall remain the property of the government and shall not be removed from the MTF. Special protective clothing shall be used then turned in or destroyed as directed by the QAP.

1.2.3.9. CONFLICT OF INTEREST. The Anesthesiologist shall not employ any person who is an employee of the United States Government if the employment of that person would create a conflict of interest. The Anesthesiologist may not refer patients to themselves without prior permission from the Chief of the Medical Staff. The Anesthesiologist shall not employ any person who is an employee of the Department of the Air Force, either military or civilian, unless such person seeks and receives approval in accordance with DOD Directive 5500.7 and Air Force policy.

1.3. PRIVILEGING REQUIREMENTS.

1.3.1. PRIVILEGING. The credentials of all anesthesiologists shall be reviewed as outlined in

AFI 44-119. The anesthesiologist is responsible to ensure that proposed credentials are sufficient to enable the granting of privileges by the MTF sufficient to allow for performance of all tasks identified in Section C-5 of this SOW. The MTF is the final authority for determining if a contractor shall be granted privileges.

1.3.2. The Anesthesiologist is required to begin full performance of the contract requirements within 5 days after contract award.

1.4. REVIEW OF CREDENTIALS PACKAGES. The Government reserves the right to limit the number of credentialing packages it will evaluate.

1.5. DENIAL/TERMINATION OF PRIVILEGES.

1.5.1. Actions to limit, suspend or revoke clinical privileges shall be in accordance with the procedures outlined in AFI 44-119.

1.5.2. The QAP shall notify the Contracting Office as soon as possible when the necessity to exercise such authority becomes apparent. The QAP will also provide the Contracting Officer with copies of documentation initiating the revocation process, if such actions become apparent.

The Contracting Officer has the responsibility to notify the Anesthesiologist.

1.6. EDUCATION AND TRAINING REQUIREMENTS.

1.6.1. FORMAL EDUCATION. The anesthesiologist shall have graduated from an approved school of medicine or osteopathy and completed a residency or fellowship in anesthesiology acceptable to the Turkish Doctor’s Chambers. Anesthesiologist is required to turn in copies of all supporting documents prior to contract performance.

1.6.2. LICENSE/REGISTRATION. The anesthesiologist shall possess a valid unrestricted license to practice anesthesia in the Republic of Turkey. Anesthesiologist is required to turn in copies of all supporting documents prior to contract performance.

1.6.3. BOARD CERTIFICATION. The contractor shall be certified by Turkish Ministry of

Health as an Anesthesia Specialist who can solely run an anesthesia clinic. Contractor is required to turn in copies of all supporting documents prior to contract performance

1.6.4. EXPERIENCE. The contractor shall be actively practicing Anesthesia and shall have a minimum of 6 months experience within the past 12 months. The total experience in practicing the specialty should be 5 years or more. Anesthesiologist is required to turn in copies of all supporting documents prior to contract performance. The anesthesiologist must have current training and experience in Rapid Sequence Intubation and must demonstrate competency in the proper protocols for the use of Dantrolene for the treatment of Malignant Hyperthermia.

1.6.5. OTHER CERTIFICATIONS. Anesthesiologist shall maintain current training in Basic

Life Support (BLS), Pediatric Advanced Life Support (PALS), and Advance Cardiac Life Support

(ACLS). Anesthesiologist is required to turn in copies of all supporting documents prior to contract performance. Membership in United States Professional Organization commensurate with medical specialty is highly encouraged.

1.7. HEALTH REQUIREMENTS:

1.7.1. The contractor providing services under this contract shall receive a pre-employment physical examination prior to commencement of work and annually thereafter. At contract cost, health care providers shall report to the anesthesiologist’s physician to receive a pre-employment examination and immunizations/shots prescribed by the MTF. Anesthesiologist is required to turn in copies of all supporting documents prior to contract performance.

1.7.2. Not later than five (5) working days prior to commencement of work, certification shall be provided to the Contracting Officer’s representative that health care providers have completed medical evaluation required above. This certification shall state the date on which the examination was completed, the doctor’s name that performed the examination, and a statement concerning the physical health of the individual. The certification shall also contain the following statement: “(name of contract employee) is suffering from no contagious diseases to include but not limited to Tuberculosis, Hepatitis and Venereal Disease.”

1.7.3. It is the Anesthesiologist’s responsibility to report (to the appropriate MTF staff member) all information necessary to assure hospital records can be maintained correctly, and therefore comply with the Joint Commission on Accreditation of Hospital Organizations, Occupation

Safety and Health Administration, Center of Disease Control health records requirements.

1.7.4. The contractor shall ensure that his/her employees are in compliance with preventive, prophylactic and follow-up procedures, as well as infection control and employee health program procedures, as established by the MTF. Required preventive, prophylactic and follow-up procedures will be provided by the Government to contract employees in the military MTF. The

Contractor shall reimburse payment for these services. If care is received elsewhere, the

Contractor shall provide written verification of treatment.

1.7.5. Contract employees should report their pregnancy to the contractor. It is the responsibility of the contractor to notify the QAP of the pregnancy. MTF Employee Health Office will provide information concerning any work hazards in that area. The contractor is to notify their pregnant employee of any work hazards. It will be the employee and the contractor’s joint decision whether the contracted employee works in the environment.

1.8. EMERGENCY HEALTHCARE. The MTF will provide emergency health care for contract personnel for injuries occurring while on duty in the MTF. These services will be billed to the Anesthesiologist at the current full reimbursement rate as directed by the Uniform Business

Office Billing Procedures as directed by the Department of Defense.

1.9. MEDICAL QUALITY ASSURANCE/RISK MANAGEMENT (QA/RM).

1.9.1. Contractors shall participate in QA/RM activities to the extent required by AFI 44-119 and the individual MTF Quality Assurance plan and/or Operating Instructions..

1.9.2. The Government will evaluate the anesthesiologist’s professional, as differentiated from administrative, performance under this contract using quality assurance standards specified in AFI

44-119.

1.10. ORIENTATION. The Anesthesiologist shall ensure participation in the MTF orientation procedures for newly assigned providers to include regulations specific to their professional specialty and hospital and Air Force policy and procedures.

1.11. CONTINUING MEDICAL EDUCATION (CME) REQUIREMENTS. Contractors registered or certified by national/medical associations shall continue to meet the minimum standards for CME to remain current as prescribed in AFI 41-117, Medical Service Officer

Education, CME shall be obtained at no additional cost to the Government and shall be reported to the QAP. CME must be approved, category I CME, or must be approved by the MDG Chief of

Medical Staff.. All anesthesiologists should complete a minimum of 60 Category I CME hours every three years based upon the fiscal year. For the purpose of privileging and reprivileging, at least 20 hours of approved CME must be completed annually. Periodic CME may be conducted at the MTF and will be available at no cost to any contractor desiring to attend.

1.12. PATIENT SENSITIVITY TRAINING. Anesthesiologist receiving more than two (2) valid complaints (as determined by the QAP or Contracting office) within 100 hours of service shall not be permitted to provide services through the MTF with this SOW until the anesthesiologist successfully completes a Government approved patient sensitivity training class within a month of second complaint. Training may include attendance at Customer College and or computer based customer sensitivity training. Anesthesiologist participation in the training class shall be at no cost to the Government.

1.13. COMMUNICATION. The Anesthesiologist shall ensure open and professional communication with members of the MTF. Complaints validated by the QAP and Chief of the

Medical Staff shall be reported in writing to the contract administrator and the Anesthesiologist for action. Failure of the Anesthesiologist to correct validated complaints raised by the MTF staff and the contracting office will be considered a failure to perform.

1.14. MEDICAL MALPRACTICE LIABILITY INSURANCE. This contract is a non-personal services contract and the anesthesiologist shall provide and maintain adequate medical malpractice liability insurance in accordance with the Federal Acquisition Regulation (FAR)

52.237-7 listed in Section D. Anesthesiologist is required to turn in copies of all supporting documents prior to contract performance.

1.15. GENERAL AND SPECIFIC TASKS

1.15.1. GENERAL. The contractor shall perform professional anesthesia services required for patients’ health care needs as stated in Technical Exhibit 2. The quality of medical practice shall meet or exceed reasonable standards of professional practice for anesthesia health care as determined by the same authority that governs military medical professionals in anesthesia and will be audited for Quality Assurance/Risk Management (QA/RM), Reference AFI 44-119. A percentage of all records will be reviewed by the USAFE command anesthesiology consultant or an appropriate reviewer designated by the Chief of Medical Staff.

1.16. SPECIFIC PROCEDURES FOR WHICH THE ANESTHESIOLOGIST SHALL BE

RESPONSIBLE.

1.16.1. PROCEDURE GUIDANCE. The Anesthesiologist shall perform procedures compatible with the MTF’s operating capacity and equipment. Medical procedures/services other than those included in Technical Exhibit 2 shall not be introduced by the contract provider without prior recommendation to, and approval of the MTF Commander or authorized representative. New medical procedures/services shall not be introduced without prior recommendation to, and approval of the MTF Commander or authorized representative and the

Contracting Officer.

1.16.2. DUTY ASSIGNMENT. Anesthesiologist shall be primarily required to perform anesthesia services. When the services are not required or the anesthesiologist services are more urgently required elsewhere, the anesthesiologist may be assigned by the Chief of Medical Staff to provide support in other sections/departments of the MTF commensurate with their experience.

1.16.3. CLINIC SUPPORT AND OUTPATIENT ANESTHESIA. The anesthesiologist shall provide outpatient services for patients as scheduled by the government. This shall include but not be limited to examinations, diagnosis and treatment using anesthesia procedures. This shall include initial visits as well as follow up visits.

1.16.3.1. The anesthesiologist shall provide clinic visits at a minimum average of four (4) patients each duty hour. This shall include initial visits as well as follow up visits.

1.16.3.2. In those cases of a patient not present for care, the Government reserves the right to provide a different patient.

1.16.3.3. The anesthesiologist shall maintain proficiency in all types anesthesia to include anesthesia for multiple trauma victims. The anesthesiologist shall maintain a log of anesthetics done outside of MTF as proof of anesthesia delivery proficiency. This log shall be presented to

QAP upon request on a quarterly basis.

1.16.3.4. The Government will not schedule the physician to provide outpatient visits at the same time the Government schedule training, meeting, conference, etc. The time the contractor is attending Government scheduled training, meeting, conferences, etc., will not be included in the computation of minimum quality of visits required.

1.16.3.5. The Contractor shall maintain proficiency in all types of major and minor surgeries to include multiple trauma. The contractor will maintain a log of surgeries done outside of MTF as proof of surgical proficiency. This log will be presented to QAP upon request on a quarterly basis.

1.16.4. TYPES OF ANESTHESIA: All types of anesthesia shall be performed:

1.16.4.1. Examples:

General anesthesia

Spinal blocks

Epidural Anesthesia

Peripheral nerve block

Monitored anesthesia care

1.16.5. DOCUMENTATION. The contractor shall prepare all documentation to meet established standards of the MTF and AFI 41-210 to include but not limited to: timeliness, legibility, accuracy, content, and signature. Only MTF and Air Force approved abbreviations can be used to document patient care in the health care record. MTF staff practitioners will note defects, omissions, agenda etc. in medical documentation. If errors or discrepancies exist, a request will be made to have contract personnel make required corrections.

1.16.5.1. Indicate responsibility for the content and correctness of all prepared and transcribed reports by affixing the contract personnel’s own signature to the documents and validating their contents.

1.16.5.2. Prepare appropriate narrative summaries, document recommendations for medical boards, profile changes, and job retraining recommendations.

1.16.5.3. Write patient progress note at appropriate intervals as determined by the MTF’s executive committee. Ensure postoperative note and discharge summaries are prepared and signed within the MTF required time frame.

1.16.5.4. Provide and document appropriate history, physical examination, required laboratory and x-ray examination, provisional diagnosis and preoperative diagnosis, as required. Contract personnel shall complete these procedures prior to the performance of any treatment.

1.16.5.5. The contractor shall ensure complete patient identifying information is on all documentation that is Chronological Record of Medical Care; SF 513, Medical Record –

Consultation Sheet and AF Form 781, Multiple Item Prescription shall be stamped with a rubber stamp, provided by the contractor, which includes the following information: Physician name, social security number, professional degree (M.D., D.O.), and facility.

1.16.5.6. Documentation of patient visits shall be on the SF 600 in the Subjective, Objective, Assessment, Plan (SOAP) or as required by the Executive Committee of the Medical Staff

1.16.5.7. All contractors shall be trained and required to use Composite Health Care System

(CHCS).

1.16.6. MEDICAL CODING OF PROCEDURES/OFFICE VISITS. The Anesthesiologist will be required to accurately and timely code all medical encounters in the Ambulatory Data

Module (ADM) of CHCS or AHLTA. Coding encounters shall meet the documentation in the medical records for procedures and services performed. Coding of all encounters shall be completed within 24 hours of medical encounter.

1.16.7. REFERRALS AND CONSULTS. The Anesthesiologist shall follow Department of

Defense, Air Force and MTF regulations and policies when arranging for a referral or consult.

The Anesthesiologist shall inform patients of the required referral or consult by indicating the specialty involved. The Anesthesiologist shall not recommend to the patient that he/she should consult a specific practitioner or use a specific practice in the local civilian community. The

Anesthesiologist may not refer patients for consult to him/herself outside of this MTF without prior permission from the MTF Chief, Medical Staff. The contractor may not refer patients for consult to him/herself outside of this MTF unless (1) the services cannot be performed at the MTF due to facility limitations or (2) the patient condition warrants services be performed outside of the MTF and, in all cases, (3) The Chief of the Medical Staff reviews the referral and deems that it is appropriate for the care to be rendered by the contractor outside of the MTF.

The contractor will be paid for procedures conducted outside of the MTF on a “per procedure” basis at a rate based on a conversion multiple of the standard Turkish procedure payment schedules from the Tabipleri Birligi Asgari Ucret Tarifesi, as delineated in the CLIN.

1.16.8. PRESCRIPTIONS. The Anesthesiologist shall use and be guided by the MTF formulary and enter all prescriptions into CHCS. The pharmacy and Therapeutics Committee must approve drugs not listed on the formulary.

1.16.9. TOTAL QUALITY IMPROVEMENT. The anesthesiologist shall assess anesthesia care to assure its quality. The anesthesiologist shall also respect and maintain the basic rights of patients, to include but not limited to, personal dignity.

1.16.10. ATTENDANCE AT MEETINGS. The anesthesiologist shall attend and participate in meetings, professional staff conferences, and other appropriate professional activities within the

MTF as directed by the Chief of Hospital Services.

1.17. GOVERNMENT ORIENTATION/TRAINING.

1.17.1. INITIAL ORIENTATION. The anesthesiologist shall attend Government provided initial training for procedures and use of Government provided equipment, supplies and forms;

safety, infection control and quality assurance (QA) procedures and policies, personnel reliability program and facility orientation.

1.17.2. CONTINUING ORIENTATION. The anesthesiologist shall participate in orientations for new equipment, procedures, etc., as determined by the Chief of the Medical Staff.

1.17.3. ANNUAL TRAINING. All anesthesiologist providing services at the MTF shall attend annual training. This training will include topics such as safety, QA, IAW HIPPA, AAAHC and/or Joint Commission requirements, Risk Management, infection control, fire protection, security, patient sensitivity training, AF Computer Security Policy and AF Safety Policy. The classes may be scheduled individually throughout the year or scheduled at one time. These classes will take approximately eight hours total per individual.

1.17.3.1. SECURITY REQUIREMENTS. The Contractor Manager or alternate shall complete a Request for Identification Credential (AFMC Form 496) for each employee of the contractor requiring access to Incirlik Air Base. The request shall be submitted to Pass and Registration

Building 833. The Government shall provide a completed Identification Credential (AFMC Form

3876), which shall be issued, displayed and surrendered as directed in AFI 31-209, The Air Force

Resource Protection Program

1.17.3.2. COMPUTER SECURITY. A National Agency Check must occur for clearance for appropriate security of privacy act information. Contractor is responsible for completing SF85P

Worksheet and providing fingerprint cards for each employee immediately with the hiring process, complying with regulations, DoD 5200.2-R, appendix K, and AFSSSI 5027, Section

5.3.3.

1.17.4. RECORDS. The Anesthesiologist shall be responsible for creating, maintaining and disposing of mainly those Government required records which are specifically cited in this SOW or as may be required by the provisions of a mandatory directive listed in Section C-4 of this

SOW. If requested by the Government, the Anesthesiologist shall provide the original record or a reproducible copy of any such records within five working days of receipt of the request.

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

1.17.6. PATIENT SENSITIVITY. The contractor shall respect and maintain the basic rights of patients, demonstrating concern for personal dignity and human relationships. Contractors receiving complaints validated by the QAP and Chief of the Medical Staff shall be subject to counseling and depending on the nature and severity of the complaint, separation from performing services under this contract.

1.17.7. RELEASE OF MEDICAL INFORMATION. The contractor shall only release medical information obtained during the course of this contract to other MTF staff involved in the care and treatment of that individual patient.

1.17.7.1. HEALTH INSURANCE PORTABILITY ACCOUNTABILITY ACT (HIPAA).

Anesthesiologist shall be briefed and trained on HIPAA and the requirements for protecting patient information and confidentiality, along with release of information. Anesthesiologist shall assist the MTF in ensuring all network providers or local providers comply with HIPAA to the maximum extent practicable. Anesthesiologist shall assist with ensuring all local providers have on file a signed acknowledgement of all HIPAA requirements. Anesthesiologist shall assist in resolving disputes in the health care arena for the MTF.

1.17.8. PRIVACY OF PROTECTED HEALTH INFORMATION.

1.17.8.1. (a) Definitions. As used in this clause:

Individual has the same meaning as the term ``individual'' in 45 CFR 164.501 and shall include a person who qualifies as a personal representative in accordance with 45 CFR 164.502(g).

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

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

Protected Health Information has the same meaning as the term ``protected health information'' in

45 CFR 164.501, limited to the information created or received by The Contractor from or on behalf of The Government.

Required by Law has the same meaning as the term ``required by law'' in 45 CFR 164.501.

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

Terms used, but not otherwise defined, in this Agreement shall have the same meaning as those terms in 45 CFR 160.103 and 164.501.

(b) The Contractor agrees to not use or further disclose Protected Health Information other than as permitted or required by the Contract or as Required by Law.

(c) The Contractor agrees to use appropriate safeguards to prevent use or disclosure of the

Protected Health Information other than as provided for by this Contract.

(d) The Contractor agrees to mitigate, to the extent practicable, any harmful effect that is known to the Contractor of a use or disclosure of Protected Health Information by the Contractor in violation of the requirements of this Contract.

(e) The Contractor agrees to report to the Government any use or disclosure of the Protected

Health Information not provided for by this Contract.

(f) The Contractor agrees to ensure that any agent, including a subcontractor, to whom it provides Protected Health Information received from, or created or received by the Contractor on behalf of the Government agrees to the same restrictions and conditions that apply through this

Contract to the Contractor with respect to such information.

(g) The Contractor agrees to provide access, at the request of the Government, and in the time and manner designated by the Government to Protected Health Information in a Designated

Record Set, to the Government or, as directed by the Government, to an Individual in order to meet the requirements under 45 CFR 164.524.

(h) The Contractor agrees to make any amendment(s) to Protected Health Information in a

Designated Record Set that the Government directs or agrees to pursuant to 45 CFR 164.526 at the request of the Government or an Individual, and in the time and manner designated by the

Government.

(i) The Contractor agrees to make internal practices, books, and records relating to the use and disclosure of Protected Health Information received from, or created or received by the

Contractor on behalf of, the Government, available to the Government, or at the request of the

Government to the Secretary, in a time and manner designated by the Government or the

Secretary, for purposes of the Secretary determining the Government’s compliance with the

Privacy Rule.

(j) The Contractor agrees to document such disclosures of Protected Health Information and information related to such disclosures as would be required for the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

(k) The Contractor agrees to provide to the Government or an Individual, in time and manner designated by the Government, information collected in accordance with this Clause of the

Contract to permit the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

General Use and Disclosure Provisions: Except as otherwise limited in this Agreement, the

Contractor may use or disclose Protected Health Information on behalf of, or to provide services to, the Government for the following purposes, if such use or disclosure of Protected Health

Information would not violate the Privacy Rule or the Department of Defense Health Information

Privacy Regulation if done by the Government:

Specific Use and Disclosure Provisions:

(a) Except as otherwise limited in this Agreement, the Contractor may use Protected Health

Information for the proper management and administration of the Contractor or to carry out the legal responsibilities of the Contractor.

(b) Except as otherwise limited in this Agreement, the Contractor may disclose Protected Health

Information for the proper management and administration of the Contractor provided that disclosures are required by law or the Contractor obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and used or further disclosed only as required by law or for the purpose for which it was disclosed to the person and the person notifies the Contractor of any instances of which it is aware in which the confidentiality of the information has been breached.

(c) Except as otherwise limited in this Agreement, the Contractor may use Protected Health

Information to provide Data Aggregation services to the Government as permitted by 45 CFR

164.504(e)(2)(i)(B).

(d) Contractor may use Protected Health Information to report violations of law to appropriate

Federal and State authorities, consistent with 45 CFR 164.502(j)(1).

Obligations of the Government. Provisions for the Government to Inform the Contractor of

Privacy Practices and Restrictions:

(a) Upon request the Government shall provide the Contractor with the notice of privacy practices that the Government produces in accordance with 45 CFR 164.520, as well as any changes to such notice.

(b) The Government shall provide the Contractor with any changes in, or revocation of, permission by Individual to use or disclose Protected Health Information if such changes affect the Contractor's permitted or required uses and disclosures.

(c) The Government shall notify the Contractor of any restriction to the use or disclosure of

Protected Health Information that the Government has agreed to in accordance with 45 CFR

164.522.

Permissible Requests by the Government: The Government shall not request the Contractor to use or disclose Protected Health Information in any manner that would not be permissible under the Privacy Rule if done by the Government, except for providing Data Aggregation services to the Government and for management and administrative activities of the Contractor as otherwise permitted by this clause.

Termination:

(a) Termination. A breach by the Contractor of this clause, may subject the Contractor to termination under any applicable default or termination provision of this Contract.

(b) Effect of Termination.

(1) If this contract has records management requirements, the records subject to the Clause should be handled in accordance with the records management requirements. If this contract does not have records management requirements, the records should be handled in accordance with paragraphs (2) and (3) below

(2) If this contract does not have records management requirements except as provided in paragraph (3) of this section upon termination of this Contract, for any reason, the Contractor shall return or destroy all Protected Health Information received from the Government or created or received by the Contractor on behalf of the Government. This provision shall apply to

Protected Health Information that is in the possession of subcontractors or agents of the

Contractor. The Contractor shall retain no copies of the Protected Health Information.

(3) If this contract does not have records management provisions and the Contractor determines that returning or destroying the Protected Health Information is infeasible, the Contractor shall provide to the Government notification of the conditions that make return or destruction infeasible. Upon mutual agreement of the Government and the Contractor that return or destruction of Protected Health Information is infeasible, the Contractor shall extend the protections of this Contract to such Protected Health Information and limit further uses and disclosures of such Protected Health Information to those purposes that make the return or destruction infeasible for so long as the Contractor maintains such Protected Health Information.

Miscellaneous:

(a) Regulatory References. A reference in this Clause to a section in the Privacy Rule means the section as in effect or as amended, and for which compliance is required.

(b) Survival. The respective rights and obligations of Business Associate under the ``Effect of

Termination'' provision of this Clause shall survive the termination of this Contract.

(c) Interpretation. Any ambiguity in this Clause shall be resolved in favor of a meaning that permits the Government to comply with the Privacy Rule.

1.17.9. PERFORMANCE EVALUATION MEETINGS. The Contracting Officer shall require the Anesthesiologist to meet with the Contracting Officer, contract administrator, QAP and other government personnel at least quarterly, and as often as deemed necessary. The

Anesthesiologist may request a meeting with the Contracting Officer when he deems such necessary. Meetings will be documented in the contract file with written minutes signed by the contract manager and the Contracting Officer, or contract administrator. Should the

Anesthesiologist not concur with the minutes, such nonoccurrence shall be provided in writing to the Contracting Officer within ten (10) calendar days of receipt of the minutes.

1.17.10. EMERGENCY RESPONSE. The anesthesiologist shall be required to respond to cardiac arrests when on call. In addition, the anesthesiologist is considered mission essential personnel and shall be required to respond to the MTF if the National Command Authority declares an emergency.

1.17.11. PERSONAL RELIABILITY PROGRAM (PRP). The anesthesiologist shall be responsible for knowing and adhering to the regulations and guidelines under PRP, as outlined in

AFI 36-2104 and AFR 205-32. The Anesthesiologist accepts full responsibility for any missed notifications that result from the actions or negligence.

1.17.12. ACCREDITATION ASSOCIATION FOR AMBULATORY HEALTH CARE,

INC. Contractor shall meet all applicable AAAHC standards during the performance of this contract.

SECTION C-2

SERVICE DELIVERY SUMMARY

2. GENERAL INFORMATION.

2.1. QUALITY CONTROL. Anesthesiologist shall develop and maintain a quality program to ensure services are performed in accordance with commonly accepted commercial practices.

Develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. As a minimum, the anesthesiologist shall develop quality control procedures that address the areas identified in Section 2.2.1, Service Delivery Summary. The Government evaluator must have a specific quality control inspector to notify in case of customer complaints.

2.2. QUALITY ASSURANCE. The Government will periodically evaluate the anesthesiologist’s performance by appointing a representative(s) to monitor performance and patient satisfaction surveys to ensure services are received. The Government will also receive and investigate complaints from various customers located on the installation. The Government will give the anesthesiologist a written copy of the complaint and the anesthesiologist shall sign for the copy. The anesthesiologist shall reply in writing to the Government on the complaint within 10 calendar days from the date of receipt of the complaint from the Government. The

Government representative will evaluate the anesthesiologist’s performance through intermittent on-site surveys with customers and receipt of complaints from customers. The Government may inspect each task as completed or increase the number of quality assurance inspections if deemed appropriate because of repeated failures discovered during quality assurance inspections or because of repeated customer complaints. Likewise, the Government may decrease the number of quality assurance inspections if performance dictates. The anesthesiologist shall be responsible for initially validating customer complaints. However, the Government representative shall make a final determination of the validity of customer complaint(s) in cases of disagreement with customer(s).

2.2.1. SERVICE DELIVERY SUMMARY.

2.2.1. SERVICE DELIVERY SUMMARY.

Performance Objective PWS Reference Performance Measure Performance

Threshold

Routine Availability 1.2.2. Contract personnel available for duty (monthly)

100%

Provider Licensure 4.19. Contract provider shall possess valid, unrestricted license

(annual)

100%

Board Certification 1.5.3. Contract provider shall be board eligible or board certified

(annual)

100%

Annual Medical

Evaluation

1.6.3. Contractor provides certificates

of annual medical evaluation for contract staff to the QAP

(annual)

100%

Continuing Medical

Education

1.10. CME shall be obtained at no

additional cost to the

Governement and shall be reported to the QAP and MTF

Credentials Committee semi-annually and at time of reprivileging

100%

Attendance at

Meetings

1.16.10. Contract personnel attend and

participate in meetings, professional staff conferences, and other appropriate professional activities as directed (monthly)

95%

HIPAA Training 1.11. Contractor employees complete all required HIPAA training

(annual)

100%

On-all/After Duty

Response Time

1.2.2.1. Within 60 minutes of

notification for routine on-call consultation and 30 minutes for emergency requirement

100%

Referrals and Consults 1.16.7. Contract personnel shall follow

DoD, Air Force and MTF regulations and policies when arranging for a referral or consult

95%

Documentation

Accuracy/Timeliness

1.16.7. Contract personnel shall follow

DoD, Air Force and MTF regulations and policies when arranging for a referral or

100% consult

Medical Coding of

Procedures/Office

Visits

1.16.6. Contract personnel must

accurately and timely code medical encounters

100%

Patient Sensitivity 1.17.6. Contract personnel shall respect the basic rights of patients, demonstrating concern for personal dignity

100%

SECTION C-3

GOVERNMENT FURNISHED PROPERTY AND SERVICES

3. GENERAL. The Government will provide the following equipment, supplies, and services listed below.

3.1. EQUIPMENT. The anesthesiologist shall have joint use of all available equipment for performing services required by this contract only. A computer for use while in MTF and a beeper for on call coverage. Protective equipment for Chemical Gear and Training will be required and provided to the anesthesiologist to work during times of war.

3.2. PERSONAL PROTECTIVE EQUIPMENT (PPE). The Government will furnish provider with appropriate PPE. The Government will be responsible for any repair, cleaning and inventory required for the PPE. This does not include any type of uniform or laboratory coat.

3.3. FORMS. The MTF will provide required Government forms used in the performance of services.

3.4. SUPPLIES. The MTF will provide medical and non-medical supplies commonly used in the facility for the care and management of patients. This does not include any type of uniform or laboratory coat, except “scrubs” for use in those parts of the MTF where they are commonly worn by government personnel.

3.5. SERVICES.

3.5.1. PATIENT SCHEDULING. MTF personnel shall arrange patient scheduling. Complete administrative (managing forms) control of the patient shall remain with the Government.

3.5.2. ADMINISTRATIVE SUPPORT. Contractor will be authorized to use selected administrative support available to Government employees. This will include but not be limited to copy machines, telephone-fax machines, medical library, installation distribution, Government

E-Mail account, Class-A telephone lines and Defense Switching Network (DSN) lines. The same restrictions to use these items for Government official business only apply.

3.5.3. HOUSEKEEPING. Routine housekeeping will be provided by the Government as part of the MTF housekeeping contract.

3.5.4. GOVERNMENT ORIENTATION/TRAINING. The government will provide training on Government provided forms and equipment, initial orientation and continuing orientation.

3.5.5. TRANSCRIPTION SERVICES. The MTF will provide transcription services. Legible handwritten documentation of medical records is acceptable in place of recorded dictation.

3.5.6. CENTRAL STERILE SUPPLY. The MTF will provide Central Sterile Supply services to anesthesiologist. Sterile equipment trays, instrument packs, and supplies will be provided by this service. After use, contractor shall follow local policies and procedures to have the

Government clean and re-sterilize the supplies. This service will be available to contract personnel on an equal basis with those of other MTF personnel/services.

3.5. RECORDS, FILES, DOCUMENTS, AND WORK PAPERS. All records, files, document and work papers provided by the Government remain Government property (per current HIPAA guidelines). The QAP will provide guidance for contractors who shall maintain and dispose of these records, files, documents, and work papers.

SECTION C-4

GENERAL INFORMATION

4. GENERAL DEFINITIONS. As used throughout this work statement, the following terms shall have the meaning set forth below:

4.1. CLINICAL PRIVILEGES. Those inpatient and ambulatory clinical activities permitted the provider in the granting medical treatment facility (MTF) after evaluation by the credentials function and approved by the MTF Commander..

4.2. CONTRACTING OFFICER (CO). A person duly appointed with the authority to enter into, administer, and terminate contracts on behalf of the Government.

4.3. CREDENTIALS. Documents providing evidence of education, training, licensure, experience, board certification and expertise of a health care provider.

4.4. CREDENTIALS COMMITTEE. The professional body set up to review credentials, to make recommendation on clinical privileges for providers and to promote quality control practice.

4.5. CRISIS SITUATION. Any emergency so declared by the National Command Authority

(NCA), or the overseas Combatant commander, whether or not U.S. Armed Forces are involved, minimally encompassing civil unrest or insurrection, civil war, civil disorders, terrorism, hostilities buildup, wartime conditions, disasters or international…