Ambulance_Services_PWS_2013.docm

PERFORMANCE WORK STATEMENT

FOR

AMBULANCE SERVICES AT THE

UNITED STATES AIR FORCE ACADEMY

COLORADO

1 May 2013

SECTION 1- Description of Services

SECTION 2- Service Delivery Summary

SECTION 3- Government-Furnished Property and Services

SECTION 4- Health Requirement

SECTION 5- Certification Requirements

SECTION 6- Reimbursement

SECTION 7- General Information

SECTION 8- USAFA Map

1. DESCRIPTION OF SERVICES

The contractor shall provide full emergency patient transport services at the United States Air Force Academy (USAFA) to include but not limited to the USAFA flight line, cadet area, community center, Pine Valley and Douglas Valley housing areas (all locations will be referred to as USAFA hereafter). This emergency patient transport service shall consist of two dedicated ambulances positioned on USAFA. One ambulance shall be physically located in the cadet area to cover the entire north area of USAFA (herein referred to as the North Area). The second ambulance shall be physically located at the USAFA flight line to cover the entire south areas of USAFA (herein referred to as the South Area). See Section 8 for the USAFA map. The contractor shall participate in USAFA base exercises, special events, sports/athletic events, specialized training, and in-flight emergencies. The contractor shall furnish all labor, management, supervision, vehicles, supplies, equipment, and transportation except as provided in Section 3, Government-Furnished Property, and Services. The contractor shall, at a minimum, be responsible for providing the full range of Emergency Medical Technician (EMT), paramedic, and ambulance services provided in the local community to include local protocols or standing orders and staffing minimums in accordance with current and future State of Colorado regulations and protocols. Performance shall be according to the requirements contained in this Performance Work Statement (PWS) and professional standards of the Accreditation Association of Ambulatory Health Care (AAAHC) and the Colorado State Department of Public Health and Environment, Health Facilities and Emergency Medical Services Division.

1.1 EMERGENCY MEDICAL RESPONSE AND PATIENT TRANSPORT

The contractor shall provide ambulance and EMT/paramedic resources in order to respond to emergencies as requested by the USAFA Fire Department. Patients shall typically be transferred to the nearest appropriate civilian medical facility. Patients with minor acute injuries and illnesses may be transported to the 10th Medical Group Cadet Clinic in accordance with established protocols and in consultation with an attending provider at the Clinic.

1.1.1. The contractor is authorized to and shall bill/invoice separately for patient transport and emergency response services by seeking reimbursement in accordance with paragraph 6. The contractor may seek reimbursement for Advanced Life Support (ALS) level of services only if the services were actually provided to the patient, are not excessive, and are medically indicated and required. If the contractor fails to adhere to proper “ALS levels of care”, or if the contractor provides care or services which are not medically indicated or necessary (such as unneeded ALS services, wheelchair accessible ambulance services, etc.), then the contractor shall recognize this claim for reimbursement may be denied by the insurance carrier. In such cases where the denied billings are deemed as unnecessary or excessive expenses by the insurance carrier, the contractor agrees not to seek further direct reimbursement from the patient or the government. The government will not be liable for expenses incurred by local civilians or non-Department of Defense (DoD) patient emergencies.

1.1.2. The North Area ambulance shall provide services 24 hours per day 365 days per year including all holidays and the South area ambulance shall provide service during flying hours Monday - Saturday from 0600-2000 hours. After 2000 hours, or upon termination of flight line operations, the contractor shall be responsible for emergency ambulance service throughout USAFA and performance shall be in accordance with PWS standards. Occasionally, ambulance service shall be required on Sunday. The government will notify the contractor within 24 hours of the Sunday service requirements. This contract is the sole avenue for USAFA emergency patient transport. The contractor shall establish and maintain a system to ensure that backup ambulance and related emergency support is provided in the event of simultaneous responses, equipment failures, or other unforeseen circumstances. Services must always be available.

1.1.3. The contractor shall travel to response sites in an appropriate medical response vehicle. The contractor shall respond to requests from the USAFA Fire Department and shall provide the full range of EMT, paramedic, and ambulance services provided in the local community to include local protocols or standing orders and staffing minimums in accordance with the most current State of Colorado and local regulations and protocols.

1.1.4. Response time is defined as the time of receipt of call from USAFA Fire Department/ Dispatcher to the time of arrival at the emergency location identified. Response time for all emergent requests for service on USAFA, to include Basic Life Support (BLS) and Advanced Life Support (ALS) shall be within nine (9) minutes in accordance with Section 2, Service Summary. This requirement does not apply to non-emergent or transfer calls.

1.1.5. Providing medical care and treatment appropriate to patient’s condition. The contractor shall respect and maintain the basic rights of patients, demonstrating concern for personal dignity and human relationships. The contractor will be notified if an EMT or EMT-P receives complaints validated by Quality Assurance Personnel (QAP) and Chief of the Medical Staff.

1.1.6. The contractor shall provide in-field care and emergency medical flight line care with capability to address decompression sickness and injuries related to in-flight emergencies, to include ALS, in accordance with protocols developed by the contractor’s physician advisor. USAFA/SGP will review/approve flight line related protocols.

1.1.6.1 USAFA flight surgeon on call shall be notified at 719 333-5187 of ambulance transport of any in-flight emergency patient as soon as medically possible.

1.1.7. The contractor will coordinate patient transport with local civilian and military hospitals when transporting patients from USAFA to local hospitals. Prior to contract start, the contractor will be briefed regarding local military medical capabilities and instructed concerning USAFA transport protocols.

1.1.7.1. The contractor shall notify the Cadet Clinic via telephone at 719-333-5187 when a cadet is transported to a local hospital. During a real or simulated incident, notification will instead be made to the on scene incident response commander or his/her designee before departing the scene. This notification shall be provided as soon as possible in accordance with protocols after receiving hospital properly accepts patient: name of person, name of hospital, and medical condition. If notification is delayed due to response to another emergent call, then notification must be made ASAP.

1.1.7.2. The contractor shall equip their emergency medical response vehicles operating at USAFA with radio communications equipment which allows for immediate voice communications between its vehicles to include communications within its operations or dispatch center. The contractor shall also provide the government with two base stations to be used for monitoring communication between the contractor’s emergency medical response vehicles and the contractor’s internal operations and dispatch center. The contractor shall deliver one base station to the 10th MDG/SGSI, bldg 4102, and one base station to the Cadet Clinic, bldg 2355, not later than two days prior to contract start date. The contractor shall be solely responsible for the operational readiness, maintenance and servicing of the two communication base stations. The two base stations will be individually located in the Medical Control Center and in the Cadet Clinic.

1.1.8. Performance of Services During Crises Declared by the President/Secretary of Defense/USAFA Base Commander. The service provider shall perform services during a crises or emergency situation per the contractual requirements on a modified schedule provided by the Contracting Officer. The service provider shall supply a list of employees performing duties during the crises to including name, address and phone number, to the Contracting Officer. All services identified in the Performance Work Statement (PWS) shall continue unless otherwise directed by the Contracting Officer.

1.2. 10th AIR BASE WING, USAFA AND MTF EXERCISE/SPECIAL EVENTS/SPORTS EVENTS/SPECIALIZED TRAINING.

The contractor shall be responsible for participating in 10th Air Base Wing, USAFA and Medical Treatment Facility (MTF) training, exercises, and special events to include but not limited to sporting/athletic events, cadet graduation, Basic Cadet Training, and other related events. The contractor shall provide approximately 780 hours in ambulance stand-by coverage per year in addition to normal coverage hours specified in paragraph 1.1.2. The government will notify the contractor of the number of dedicated ambulances required for each event. This amount is subject to change each year. The QAP will provide the contractor at least 7 days advance notice prior to the exercise/event/training date. Specific contractor responsibilities include:

1.2.1. Participating in advance and post exercise meetings.

1.2.2. Responding with EMTs to exercise sites and performing simulated duties.

1.2.3. Coordinating all activities during exercises with the On-Scene Medical Director and Incident Commander.

1.2.4. Providing ambulance stand-by during live-structural fire training and aerial flight operations.

1.2.5. Providing one (1) ambulance to stand-by during sporting/athletic events and special events. Periodically, up to two (2) ambulances may be required for these types of events. The ambulance requirements set forth in 1.2.5 are in addition to the ambulance service identified in section 1.1.

1.2.6. Providing a written plan to the MTF for contractor’s response to a mass casualty event.

1.3. DELIVERABLES

1.3.1. Run report - The contractor shall prepare and submit documentation of each ambulance response within 24 hours following the response to USAFA EMS Director. The report shall be timely, legible, accurate, thorough, and must contain a signature of an ambulance crew member.

1.3.1.1. The contractor shall provide reasonable access to information related to transports to the MTF within 24 hours. The report shall be accomplished according to relevant HIPAA guidelines and IAW Air Force Instruction 91-204, Safety Investigations and Reports. This information shall include, but is not limited to: Date, Response time, type of run (BLS or ALS), whatever available patient information [full name, military (last 4 of SSN) or civilian, patient condition, address responded to, the name of the hospital transported to] and an explanation of any exceptions to response time contained in Section 2, Service Delivery Summary. All patient refusals shall be documented to the same level of information described within this paragraph.

1.3.1.2. Patient information shall be treated as privileged information. Lists and/or names of patients shall not be disclosed to or revealed in any manner for any use outside the MTF without prior written permission by the MTF Commander. All patient information shall be handled in accordance with all applicable HIPPA regulations and guidelines

2. SERVICES SUMMARY (SS)

Table 2.1

SERVICE

Providing full emergency patient transport services.

AMBULANCE RESPONSE

Nine Minutes response time for all emergent calls.

PATIENT CARE

Providing medical care and treatment appropriate to patient’s condition

2.1. The contractor shall establish and maintain a complete Quality Control Plan (QCP) to ensure the requirements of the contract are provided as specified. The Contractor’s QCP shall address risk management issues to include the contractor’s established processes which are in place to evaluate the standard of care is met in all cases. The contractor shall insure that risk management issues are addressed in its written audit procedures. The contractor’s QCP shall be delivered to the CO for acceptance no later than 15 work days after contract award. The CO will notify the contractor of acceptance or required modifications within 10 work days after receipt. Changes to the QCP must be accepted by the CO no later than 15 work days after implementation.

2.2. Government Quality Assurance Personnel shall periodically evaluate and monitor the Contractor’s performance to ensure services are received. The QAP will evaluate the Contractor’s performance through inspections of call logs/reports and receive and investigate all complaints from base personnel and patients transported. The Government may inspect each task as completed or increase the number of quality control inspections if deemed appropriate because of repeated failures discovered during quality control inspections if performance dictates. The Government representative will make final determination of the validity of customer complaint(s). The contractor will not be held responsible for being unable to meet the response time due to factors beyond their control. This will include, but is not limited to, road construction or unplanned road closures, vehicle failures, inclement weather, communications problems, employee incapacitation not related to misconduct or negligence, and distance travelled when the primary response vehicle is out of service.

2.3. If any of the services do not conform to contract requirements, the Government may require the Contractor to perform the services again in conformity with contract requirements, at no cost to the Government. When the defects in services cannot be corrected by re-performance, the Government may:

(1) Require the Contractor to take necessary action to ensure that future performance conforms to contract requirements; and

(2) Reduce the contract price to reflect the reduced value of the services performed. 1% of the monthly invoice per SS occurrence, as listed above, shall be deduced for each performance objective missed.

2.4. Performance Evaluation Meetings. The CO may require the contractor or representative to meet with the CO, contract administrator, QAP and other government personnel as often as deemed necessary. The contractor may request a meeting with the CO when necessary. Meetings will be documented in the contract file with written minutes signed by the contract manager, CO, or contract administrator. Should the contractor not concur with the minutes, such non-concurrence shall be provided in writing to the CO within 10 work days of receipt of the minutes.

3. GOVERNMENT-FURNISHED PROPERTY AND SERVICES

3.1 The government will provide the contractor copies of the USAFA’s most recent grid-map prior to start of performance and AFI 91-204 Safety Investigations and Reports.

3.2 The Government will provide a train-the-trainer course for Special Flight Line Driving in accordance with Paragraph 7.2.3. to a contract representative within 30 days of the start of performance. This course will allow the contractor to train their employees.

3.3 The government will furnish the contractor with two individual facilities/structures to house the ambulances and the ambulance crews. The government will furnish heat, electricity, water, waste water service and trash disposal service to the individual structures.

4. HEALTH REQUIREMENTS

4.1 Contractor personnel providing services under this contract shall receive a pre-employment physical examination, TB testing, and appropriate immunizations as required for other 10 MDG health care contractors prior to commencement of work and annually thereafter. Payment for required examinations, testing, and immunizations will not be provided by the 10th Medical Group/United States Government.

4.2 Not later than five (5) working days prior to commencement of work, certification shall be provided to the QAP that paramedics have completed medical evaluation, testing and all immunizations 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 Sexually-Transmitted Diseases.”

4.3 Also, as a condition of employment, OSHA requires that all contract 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. Personnel who sign declinations may change their minds at any time and receive the Hepatitis B vaccine without penalty. Payment for immunizations is the responsibility of the contractor.

4.4 It is the Contractor’s responsibility to report (to the appropriate MTF staff member) all information necessary to assure medical records can be maintained correctly, and thereafter comply with the AAHC, OSHA, Health Services Inspection (HSI), and CDC heath records requirements.

5. CERTIFICATION REQUIREMENTS

5.1 The contractor shall provide the following:

5.1.1. Current Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) certification, and National Registry for Emergency Medical Technicians (NREMT) paramedic certification.

5.1.2. A copy of the proposed contract paramedic’s professional resume, accompanied by that individual’s sworn affidavit of the truthfulness of same, indicating experience, training, and technical expertise in the type of care to be rendered.

5.1.3. A list of all states in which contract provider currently holds or has held a license to practice related services.

5.1.4. Certification of current physical examination and immunization status for each employee. The certification shall contain a signed statement by the examining physician stating that the employee is free of any contagious diseases.

5.2. The Contractor is required to begin full performance of the contract requirements upon the effective date of the contract award. It is absolutely critical that certification be granted to a sufficient number of contract paramedics to meet the contract requirements by the commencement date of performance.

6. REIMBURSEMENT

6.1. For TRICARE eligible beneficiaries, the contractor will be reimbursed up to the CHAMPUS Maximum Allowable by Wisconsin Physician Services (WPS) P.O. Box 77028 Madison, WI 53707-7028. If the contractor does not obtain full reimbursement or collects less than the billed amount from WPS, the contractor will not balance bill any TRICARE eligible member for the balance due. In these circumstances, the contractor will contact WPS billing for resolution. If WPS cannot resolve the issue, the contractor will contact the 10th Medical Group Tricare Operations and Patient Administration (TOPA) Flight.

6.2 For non-TRICARE eligible beneficiaries, the contractor will seek reimbursement through its normal billing procedures such as billing private insurance, Medicare, or the individual patient.

6.3 The contractor’s failure to obtain reimbursement, or collection of less than the billed amount, will not financially obligate the 10th Medical Group, the United States Air Force, or the United States Government.

6.4. The contractor will seek the appropriate reimbursement for the type of ambulance services provided. If only BLS service is provided, then the contractor will bill for a BLS, not ALS, response. The contractor will not send and bill for wheelchair accessible ambulances unless medically indicated.

7. GENERAL INFORMATION.

7.1. Contract Manager: The contractor shall provide a contract manager who shall be responsible for the performance of the work as specified in the SOW. The name of this person and an alternate(s) who shall act for the contractor when the manager is absent shall be designated in writing to the contracting officer and 10th Medical Group Contracting Officer’s Technical Representative prior to contract start date and prior to each contract renewal period.

7.1.1. The contract manager or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract and be available during normal business hours (0800 -1700 hours). The contract manager must be available or respond to the QAP and Contracting Officer for any contract issues or questions within 10 minutes between 0800 – 1700 hours, Monday through Friday (excluding Federal Holidays), and within one hour (via pager or cell phone access) during all other hours. The senior vehicle crew member will also be available to the QAP or Contracting Officer if questions arise. If questions or direction to the crew are deferred to the Contract Manager, the above response time limits apply. The contractor shall be responsible for ensuring contractor employees have appropriate communication equipment to include pagers or cellular telephones. The contractor shall inform the QAP and Contracting Officer in writing of the phone numbers for this equipment and notify the Government immediately upon any subsequent changes.

7.1.1.1. Holidays. The Government observes the following:

7.1.2. The contract manager and alternate(s) must be able to read, write, speak, and understand English.

7.2. The contractor shall ensure that all employees involved in activities that require certification or licensing shall meet all such requirements for:

7.2.1 Operating an emergency ambulance in the State of Colorado and possessing a valid Class “C” Colorado driver’s license. Drivers must not have any reckless or dangerous driving citations within the previous 24-month period and have no Driving While Intoxicated (DWI) or Driving Under the Influence (DUI) convictions in the previous three years. Drivers shall have no more than six points per calendar year assessed under the state of Colorado driving infraction system.

7.2.2 Possessing a current license to perform EMT and Paramedic services in the State of Colorado and El Paso County, CO.

7.2.3 Providing Special Flight Line Driving Certification to all drivers performing services under this contract within thirty (30) days after the start of contract performance or within thirty (30) days of employment.

7.3 Contractor shall maintain files to assure that all EMTs performing work under this contract shall have current certifications and/or documents listed in 7.2 above. Upon request the contractor shall allow the Government access to review these documents for any EMTs performing under this contract. The contractor will provide copies of certifications upon request.

7.4 All EMTs stationed on USAFA will have a State of Colorado background check, which includes a Criminal Record Check. No individuals will be assigned to the USAFA site until their background check is verified as not having felony convictions.

7.5 The contractor shall be solely responsible for compliance with Occupational Safety and Health Act (OSHA) (Public Law 91-596) and the resulting standards, OSHA standard 29 CFR 1910, 1926, and the protection of their employees. The contractor shall be responsible for insuring that all safety requirements are met.

7.6. Employees. The contractor shall not employ persons for work on this contract if such employee is identified to the contractor by the contracting officer as a potential threat to the health, safety, security, well-being or operational mission of the installation and its population.

7.6.1. Contractor personnel shall present a neat appearance and be easily recognized as contractor employees. The contractor shall furnish an identifying badge, which shall include as a minimum the person’s name, the name of the contractor and the function. Each employee shall wear the badge on the outer garments at all times.

7.6.2. The contractor shall not employ any person who is an employee of the US Government if employing that person would create a conflict of interest or interfere with the performance of their government position. Additionally, the contractor 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 according to DODD 5500.7 Standards of Conduct. The contractor shall not employ any person who is an employee of the Department of the Air Force if such employment would be contrary to the policies in AFI 64-106 Air Force Industrial Labor Relations Activities.

7.6.3. The contractor is cautioned that off-duty active military personnel hired under this contract may be subject to permanent change of station, change in duty hours, or deployment. Military Reservists and National Guard members may be subject to recall to active duty. The abrupt absence of these personnel could adversely affect the contractor's ability to perform; however, their absence at any time shall not constitute an excuse for nonperformance under this contract.

7.6.4. Personnel Skills and Qualifications. The contractor shall provide its staff with the knowledge, expertise, education and experience necessary to successfully complete all PWS requirements. Contractor personnel must be available on contract start date. The nature of the work may require close contact with government representatives at all levels of the organizations, and requires working in a team environment. The contractor shall be expected to act in a professional manner and provide courteous customer service at all times.

7.7. Security and Privacy Requirements. All personnel employed by the contractor in the performance of this contract, or any representative of the contractor entering the government installation, shall abide by all security regulations of the installation. The government reserves the right to direct the removal of an employee for misconduct or security reasons. This action does not relieve the contractor from total performance of the contract tasks specified herein.

7.7.1. The contractor shall ensure employees driving on USAFA Air Force Base have a valid automobile driver’s license.

7.7.2. Privacy. The contractor shall comply with the provisions of the Privacy Act of 1974 and the Health Insurance Portability and Accountability Act of 1996 to protect personal health information that the contractor may encounter while completing the tasks associated with this contract.

7.7.3. The contractor shall comply with existing Colorado Department of Public Health and Environment, Health Facilities and Emergency Medical Services Division, 6CCR 1015-3, State Board of Health, Rules Pertaining to Emergency Medical Services and future amendments thereto, and current and future emergency medical service rules, regulations, and directives. published for El Paso County, CO.