Attachment_1 _PWS _6_May_2013.pdf

Attachment 1 Performance Work Statement (PWS)

Medical Surveillance Examination Services Dobbins ARB, Georgia

6 May 2013

1. Introduction.

1.1. Mission. Provides manpower to support the Contingency Aeromedical Staging Facility (CASF).

Administratively prepares patients for flight, making sure patients are clinically supported while in the CASF awaiting transportation and assisting with transportation to and from mode of transport;

accomplishes Reserve Component Periodic Health Assessment (RCPHA) ensuring the wing’s medical requirement for deployment is met.

1.2. Scope. This contract shall serve as a vehicle to provide certified physicians who can perform annual health and Occupational physicals for a variety of Duty specific career fields. Annual health physicals would include all duty specific with specialties identified for Firefighters, Air Traffic Controllers, and Security Forces personnel at Dobbins Air Reserve Base, GA.

1.3. Non-Personal Services. The services performed under this contract shall be non-personal services and are not inherently governmental. The prime contractor’s staff, including all teaming partners, subcontractors and their staff at the corporate level involved in the company’s or team’s administration of this contract will hereafter be referred to as “contractor management staff.” The prime contractor retains responsibility for any teaming partner or subcontractor and shall be accountable for their performance.

The contractor management staff shall provide all tools, labor and materials required to recruit, qualify, train, place, manage and retain the medical support services supporting healthcare operations for the Air Force in accordance with the terms and conditions of this contract.

1.4. Definitions

Authorized Agency is an agency point of contact who is authorized to make appointments with the contractor. Those agencies are:

94 ASTS/SGP 94th Aeromedical Staging Squadron 94 FSS/FSMC Civilian Personnel 94 SFS/SFMC Security Forces 94 OG/MCIB Air Traffic Controller 94 MSG/CEF Fire Department

Contractor is a term used in this contract which refers to the prime contractor.

Contracting Officer is a person with authority to enter into, administer or terminate contracts, and make related determinations and findings on behalf of the Government. Note: The only individual who can legally bind the Government.

Medical Surveillance Examinations are identified as pre-placement, periodic, special purpose, termination and fitness-for-duty examinations, Audiograms and Respirators that are determined by the 94 ASTS/SGP with assistance from 94 FSS/FSMC and federal directives. Examinations are to be performed to assess the health status of individuals as it relates to their workplace.

Pre-placement examinations are tests and examinations accomplished to establish and document baseline data for future use in the evaluation of occupational health hazards from the workplace.

Periodic Examinations are tests and physical examinations that are accomplished at intervals to evaluate and document the health of employees.

Special Purpose Examinations are physical examination given when an employee is exposed to a chemical or human body fluids during an incident or accident. This would include but is not limited to occupational exposures to blood borne pathogens.

Termination Examinations are tests and examinations that are accomplished to establish and document the health of employees at termination of employment.

Annual FAA Class II Flight Physicals are tests and examinations that are accomplished to establish fitness and document the health of employees within Air Traffic Control IAW FAR part 67, FAA Medical Certification.

Fitness-for-Duty Examinations are conducted to assess and provide a determination concerning the employee’s fitness for efficient performance of their assigned duties.

1.5. Acronyms

AFCEC Air Force Civil Engineering Center AFI Air Force Instruction ASTS Aeromedical Staging Squadron BES Bioenvironmental Engineering Services BLDG Building DD Department Defense DoD Department of Defense FAA Federal Aviation Agency FAR Federal Air Regulation FEV Forced Expiratory Volume FVC Forced Vital Capacity HIPAA Health Insurance Portability and Accountability Act NFPA National Fire Protection Agency OH Occupational Health PFT Pulmonary Function Test PPE Personal Protective Equipment PWS Performance Work Statement SF Standard Form Std Standard STS Standard Threshold Shift TIG Technical Implementation Guide WAWF Wide Area Work Flow

2. General Requirements.

2.1. The contractor shall ensure that medical services are performed by a licensed physician who has graduated from an accredited medical school and has completed a residency program approved by the Council on Medical Education and Hospitals, American Medical Association, and be board certified in either occupational medicine or preventive medicine by the American Board of Preventive Medicine or

Osteopathic Council of Preventive Medicine. The provider must possess a valid current license to practice medicine in Georgia.

2.2. Validation of qualifications, licensor, and certification (as applicable). The contractor shall provide written verification (and photocopies where necessary) showing licensor, board certification, hospital affiliation, and furnish a report of health examinations to the 94 ASTS/SGP via contracting officer within 21 calendar days of any changes and prior to performing any services under this contract for the Prime or subcontractor.

2.3. HIPAA. Protected Health Information is the information protected by the Health Insurance Portability and Accountability Act of 1996. Access is limited to an official need to know, restricted to the minimum necessary to accomplish the purpose and is restricted to authorized disclosures. Improper disclosure of the attached medical information will result in penalties (administrative actions, fines or imprisonment) as outlined in the Act.

3. Description of Services.

3.1 The contractor shall provide all personnel, equipment, materials, and facilities necessary to perform chest x-rays and physical examinations. All services will be for DoD civilian personnel located on Dobbins ARB, Georgia. The contractor shall perform all work in accordance with the PWS and this contract.

3.2. Physical examinations will not be performed on Government-Owned property. All services shall be executed at the contractor’s premises or within the Contractor’s network of facilities (affiliate or qualified subcontractor) which must be located within a 25-mile radius of Dobbins ARB, GA (zip code 30069).

3.3. DoD civilian employees will consist of estimated 75 – 150 medical surveillance examination on an annual basis. The period of performance is one year from date of award plus 4-option years.

3.4. Medical Surveillance Examinations

3.4.1. Contractor shall conduct physical examinations and tests under this contract between the hours of 7:00 am and 5:00 pm EST, Monday through Friday excluding federal holidays. Federal holidays excluded are:

New Year's Day Martin Luther King Jr's Day President's Day Memorial Day Independence Day Labor Day Columbus Day Veteran's Day Thanksgiving Day Christmas Day

3.4.2. Contractor shall perform the following types of medical surveillance examinations: Pre-placement, Periodic, Special Purpose, Termination, Fitness-for-Duty, Audiograms and Respirators. Additional examinations may be provided but only if identified by the physician and coordinated with 94 ASTS/SGP and/or 94 FSS/FSMC.

3.4.3. All examinations and tests shall be performed in accordance with requirements which have been established, approved and documented by 94 ASTS/SGP on any of the forms identified below. The forms shall be provided to the contractor by the members at the time of the service unless prior coordination has been established between the contractor and 94 ASTS/SGP:

AF 1753 Hearing Conservation Examination AF 2766 Clinical Occupational Health Exam Requirements DD 2216 Hearing Conservation Data FAA 8500-8 Application for Airman Medical Certificate or Airman Medical & Student Pilot

Certificate FAA 8500-9 White Certificate (provided to the employee) SF78/OF178 Certificate of Medical Examination SF 88 Report of Medical Examination SF 513 Medical Record Consultation Sheet

3.4.4. Physical examination techniques must comply or be equal to the examination requirements prescribed by any of the following directives:

AFI 48-123 Medical Examinations and Standards AFOSH Std 48-20 Air Force Hearing conservation Program FAR Part 67 FAA Medical Certification NFPA 1851 Standard on Selection, Care, and Maintenance of protective ensembles for

Structural Fire Fighting and Proximity Fire Fighting NFPA 1582 Standard Comprehensive Occupational Medical Program for Fire Department QSH Qualifications Standards Handbook USAF TIG 1582-03 Technical Implementation Guide 1582-03 for NFPA Std 1582

3.4.5. Medical Surveillance examinations shall be conducted within 30-calendar days after the request from 94 ASTS/SGP or authorized agency.

3.4.6. The contractor shall determine if the government employee meets existing physical requirements and medical standards. NOTE: When non-occupational medical problems are identified, the patient will be informed of the abnormality and advised to seek proper medical care (private physician). If a non-occupational abnormality is remedial (e.g., otosclerosis) or is likely to be temporary (e.g., external otitis), but may interfere with the ability of the person to wear PPE such as hearing protection and/or respiratory protection, or unable to perform their job, etc., appropriate temporary duty restrictions shall be recommended. The physician determination as to whether the employee meets physical requirements and medical standards shall be documented on any form identified under paragraph 3.4.3 of this PWS by the contractor.

3.5. Pre-placement, Special Purpose, Termination Examinations.

3.5.1. Pre-placement physical examinations shall be performed within five (5) working days after receipt of verbal request for appointment from 94 ASTS/SGP.

3.5.2. Examination requirements which include a PFT shall include a FVC and FEV, when required.

3.5.3. The equipment must be of an approved type, as recommended by the American Thoracic Society, and be properly calibrated.

3.5.4. Persons, other than licensed physicians, who administer the PFT shall have completed a training course in spirometry sponsored by an appropriate academic or professional institution and be supervised by a physician.

3.5.5. The professional medical staff shall evaluate and make appropriate recommendations based on findings and indicate whether an employee is physically able to perform their work while wearing the prescribed respiratory protection.

3.5.6. The contractor shall deliver all medical documentation IAW guidelines identified under section four (4) of this PWS.

3.6. Periodic Examinations.

3.6.1. Periodic examinations shall be performed within five (5) working days after receipt of verbal request for appointment from 94 ASTS/SGP or authorized agency.

3.6.2. Examination requirements will require certified physicians to perform specialty examinations for Firefighters and Air Traffic Controllers.

3.6.2.1. Firefighter physicals shall obtain physical examinations IAW NFPA Std 1851 as amended by

AFCEC 1851 TIG.

3.6.2.2. Air Traffic Controllers shall obtain FAA Class II Flight examinations from a certified FAA Flight Surgeon IAW FAR part 67 and contractor shall provide member with FAA 8500-9.

3.6.3. The contractor shall deliver all medical documentation IAW guidelines identified under section four (4) of this PWS.

3.7. Fitness-for-Duty Examinations.

3.7.1. The Fitness-for-Duty exam is scheduled by the 94 ASTS/SGP and/or 94 FSS/FSMC. All requirements for the physical will be listed on SF 78/OF178.

3.7.2. The physical shall be accomplished within five (5) working days.

3.7.3. In cases where there is a question about physical fitness-for-duty, the Government has an immediate need to determine whether to remove the employee from the duty area; therefore, the physical exam shall be accomplished as soon as possible.

3.7.4. The physician shall contact 94 ASTS/SGP & 94 FSS/FSMC not later than (NLT) the morning of the next workday to provide diagnosis. SF78/OF178 will be pick-up by 94 ASTS/SGP and/or 94

FSS/FSMC.

3.8. Audiograms.

3.8.1. The contractor shall be responsible to review audiograms IAW AFOSH Std 48-20 accomplished at 94 ASTS/SGP for all DoD civilians identified on a DD 2216.

3.8.2. The completed DD 2216 shall serve as written notification of audiogram results. However, this does not preclude the contractor from providing other written patient disposition when warranted to describe the patient’s medical disposition.

3.8.3. Whenever a threshold shift has been verified by the second follow-up through audiometric testing, 94 ASTS/SGP will provide the contractor with the completed DD 2216 and AF 1753. The contractor will perform an examination of the patient and then using the criteria found in AFOSH Std 48-20, shall determine whether a physiological problem caused the threshold shift. If so, notify 94 ASTS/SGP.

3.8.4. A clinical examination of the ears, nose and throat will be performed by the examining practitioner on all employees getting a reference audiogram check, those with STS, those required to be examined based on history and those undergoing a fitness and risk evaluation.

3.8.5. During the examination the practitioner must note:

(1) Cerumen plugging the ear canals

(2) Otitis externa

(3) Condition of the tympanic membranes

(4) Any middle ear disease

(5) Eustachian tube function

(6) Any other ENT disease or condition, which might adversely affect the audiogram results

(7) Any condition that may interfere with the wearing of hearing protection (permanently or temporarily)

3.8.6. The contractor shall deliver all medical documentation IAW guidelines identified under section four (4) of this PWS.

3.9. Respirators.

3.91. Contractor shall review OSHA respirator questionnaire, evaluate and make appropriate recommendations based on findings and indicate whether an employee is physically able to perform their work while wearing the prescribed respiratory protection. If additional testing is required, notify 94

ASTS/SGP.

3.9.2. The contractor shall deliver all medical documentation IAW guidelines identified under section four (4) of this PWS.

3.10. Final Assessment and Disposition.

3.10.1. A physician shall review all examination results and histories to make a final determination if the individual is at an increased risk due to his/her health from any occupational exposures to which he/she is potentially exposed.

3.10.2. All assessments and dispositions shall be documented on any form identified under paragraph

3.4.3 of this PWS and any other accompanying documentation shall be delivered as identified under section four (4) of this PWS.

3.10.3. The contractor shall verify physical examination findings through verification of the original tests or any additional testing as prescribed by the attending contract physician and after telephone coordination with the 94 ASTS/SGP. Further coordination/consultation shall be acquired from the 94 FSS/FSMC concerning pre-placement and fitness-for-duty examinations.

3.10.4. The case shall be coordinated with 94 ASTS/SGP if a determination cannot be conclusively determined if an individual is/is not physically able to perform their job.

3.10.5. An individual may be recommended for temporary removal from his/her work area or limitations recommended from specific working conditions or exposures until the specific nature of their medical condition can be determined through verification or additional testing. The contractor shall verbally notify the 94 FSS/FSMC immediately at (678) 655-5036 and coordinated with 94 ASTS/SGP, but no later than one (1) workday after the determination that a limiting condition exists or that removal from the work area is recommended.

3.11. Relationship of Parties.

3.11.1. It is expressly agreed and understood that the services rendered by the contractor and its employees are rendered in the capacity of an independent contractor. Although the government may evaluate the quality of both professional and administrative services for purposes of contract inspection and acceptance, it retains no control over the services rendered, including, but not limited to; professional judgments, diagnosis, or specific treatments.

3.11.2. The contractor shall be solely responsible for any and all liability caused by the acts or commissions of its agents or employees.

3.12. Indemnification.

3.12.1. The contractor expressly agrees to indemnity, hold harmless, and to defend the government of the United States for all of its employees and agents acting officially or otherwise, from any and all liability, claims, demands, actions, debts, and attorney fees arising out of, claimed on account of, or in any manner predicated on loss or damage to the property of the injuries to, or death of any person whatsoever, which may occur as a result of or in connection with the services being provided under this contract.

4. Deliverables

4.1. The contractor shall provide to the 94 ASTS/SGP a current copy of any standards, guidelines and/or reference ranges used to interpret laboratory test results. Provide each time it is changed.

4.2. Contract physicians shall complete required form(s) and/or documentation in accordance with the corresponding Air Force instructions, directives and policies identified under section 3.4.3 & 3.4.4 of this

PWS.

4.3. Reporting of Examination Results.

Type of Exam Organization delivered to

Time period

Pre Placement Fitness for Duty

94 ASTS/SGP

94 FSS/FSMC

Within 3-work days after completed exam

Periodic Special Purpose Termination Audiograms Respirators

94 ASTS/SGP

Within 3-work days after completed exam

4.3.1. All physical examination results that medically disqualify employees and /or abnormal laboratory results must be telephoned to the responsible office at (678) 655-4827/4829 and email 94asts.medical@us.af.mil immediately after receipt.

4.3.2. The contractor will note the date, time and person contacted.

4.3.3. The 94 ASTS/SGP will note the date, time and name of person reporting the abnormal data, and name of provider notified with date and time.

4.3.4. Telephone notification is not normally necessary for normal examination results; however, it must be provided for fitness-for duty examinations (see section 3.7), when an individual is recommended temporary removal from his/her duties (see paragraph 3.10.5) and/or if requested by 94 ASTS/SGP and/or

94 FSS/FSMC.

4.3.5. All examination results will be reported on any forms identified under paragraph 3.4.3. (with additional documents as necessary) and distributed with original file in the employee’s medical folder and three (3) copies mailed to the following recipients:

a. 94 ASTS/SGP

b. Employee (preferred at time of examination)

c. 94 FSS/FSMC

4.4. Monthly Lists/Reports.

4.4.1. The contractor shall provide 94 ASTS/SGP a monthly list of all personnel tested prior to submitting an invoice in WAWF.

4.4.2. List shall be itemized of all tests administered to include the date and cost of each test per individual.

4.4.3. The contractor shall annotate the monthly examination roster as follows:

Status Disposition Completed Date Completed

No-Show Date and reason, if any, if the individual failed to meet their scheduled appointment

4.4.4. The contractor medical personnel shall provide technical review of all examination data to ensure the highest level of quality control and accuracy of the completed medical surveillance examination. In addition, the contractor’s physician, nurse or technician shall sign any form identified under paragraph

3.4.3. of this PWS provided by the member at time of appointment as having provided a medical examination. The copies of the completed forms shall be delivered under section four (4) of this PWS.