Attach_1_Ambulance_Service_PWS.pdf

PERFORMANCE WORK STATEMENT

FOR

USAFA AMBULANCE SERVICE

FOR

10th MEDICAL GROUP

UNITED STATES AIR FORCE ACADEMY

COLORADO

19 SEPTEMBER 2013

REVIEWED BY:

FUNCTIONAL COMMANDER DATE

QAPC DATE

CONTRACTING OFFICER DATE

US AIR FORCE ACADEMY, CO

SECTION 1- Description of Services

SECTION 2- Service Summary

SECTION 3- Incidental Furnished Property and Services

SECTION 4 – Appendices

1. DESCRIPTION OF SERVICES

The contractor shall provide full emergency patient response services at the United States Air

Force Academy (USAFA) to include but not limited to the USAFA flight line, cadet area, community center, Jacks Valley, Pine Valley housing area, and Douglass Valley housing area

(all locations will be referred to as USAFA hereafter). During jump and flight line operations, a dedicated ambulance shall be physically located at the jump site. See appendix A 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, Incidental 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 County protocols or standing orders and staffing minimums in accordance with State of Colorado regulations and protocols.

Performance shall comply with 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, and respond to emergencies as requested by the USAFA Fire Department in an appropriate medical response vehicle. Patients shall typically be transferred to the nearest appropriate civilian medical facility.

Patients with minor acute injuries and illnesses may be transported to the 10 th

Medical Group

Cadet Clinic 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 1.7. The contractor may seek reimbursement for Advanced Life Support (ALS) and Basic Life Support

(BLS) 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. USAF Academy ambulance coverage includes services 24 hours per day 365 days per year including all holidays. The flight line ambulance coverage includes service during flying hours Monday - Saturday from 0600-2000 hours (excluding holidays listed in 1.8.3.).

Occasionally, additional ambulance service may be requested for service 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 with surge capabilities.

1.1.3. Response time is defined as the time between the receipt of call and the time of arrival at the emergency location identified. Response time for all emergent requests for service on

USAFA, to include BLS and ALS shall be within nine (9) minutes. This requirement does not apply to non-emergent or transfer calls.

1.1.4. 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 is the subject of complaints, validated by the Contracting Officers Representative (COR).

1.1.5. 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.

1.1.5.1. USAFA flight surgeon on call shall be notified of ambulance transport of any in-flight emergency patient as soon as medically possible.

1.1.6. The contractor will coordinate patient transport with local civilian and military hospitals when transporting patients from USAFA to local hospitals.

1.1.6.1. During a real or simulated incident, notification will be made to the on scene incident response commander or his/her designee before departing the scene, and notification shall be provided to the Cadet Clinic as soon as possible 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. In addition, when a cadet is transported to a local hospital, the contractor shall notify the Cadet Clinic via telephone at 719-333-5187.

1.1.6.2. The contractor shall ensure radio communications which allows for immediate voice communications between its vehicles, its operations or dispatch center and with local USAFA

Fire Emergency Services.

1.1.7. Performance of Services During Crises Declared by the President/Secretary of

Defense/USAFA Base Commander. The service provider shall perform services during a crisis or emergency situation per the contractual requirements on a modified schedule provided by the

Contracting Officer (CO). The service provider shall supply to the CO, a list of employees performing duties during the crises to include name, address and phone number. All services identified in the Performance Work Statement (PWS) shall continue unless otherwise directed by the CO.

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 special events such as 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 requirement is subject to change each year. The COR 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 Medical On-Scene Commander and

Incident Commander.

1.2.4. Providing ambulance stand-by during live-structural fire training.

1.2.5. Providing one (1) ambulance to stand-by during sporting/athletic events and special events. Periodically, up to four (4) ambulances may be required for these types of events. The ambulance requirements set forth in this paragraph 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 to the COR, documentation of each ambulance response within 24 hours following the response. The report shall be legible, accurate, thorough, and must contain a signature of an ambulance crew member. Refer to

Exhibit A - Contract Data Requirements List (CDRL) DD Form 1423 of the solicitation/contract.

1.3.2. 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 Para. 1.14, Safety Investigations and Reports. This information shall include: Date, Response time, type of run (BLS or ALS), 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 required. All patient refusals shall be documented to the same level of information described within this paragraph.

1.3.3. 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

1.4 QUALITY CONTROL

1.4.1. 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. The contractor shall ensure risk management issues are addressed in its written audit procedures. The contractor’s QCP shall be delivered to the CO no later than 30 work days after contract award.

1.4.2. Government Quality Assurance Personnel will inspect the services provided IAW FAR

52.246-4. 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 inaccuracies or communications failures on the part of the government, or employee incapacitation not related to misconduct or negligence.

1.4.3. Performance Evaluation Meetings. The CO may require the contractor or representative to meet with the CO, contract administrator, COR 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 contractor

POC and 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.

1.5 HEALTH REQUIREMENTS

1.5.1. Contractor personnel providing services under this contract must have a pre-employment physical examination; TB testing; Measles, Mumps, Rubella (MMR) immunization; Varicella immunization; Hepatitis B immunization; Diphtheria, Tetanus, Pertussis (TDap) immunization;

Influenza immunization; Polio immunization; and Tuberculin Skin Test prior to commencement of work with updates as required. Payment for required examinations, testing, and immunizations will not be provided by the 10th Medical Group/United States Government.

1.5.2. Not later than five (5) working days prior to commencement of work, certification shall be provided to the COR indicating personnel have completed medical evaluation, testing and all immunizations required above (certification of new employees also required no later than five

(5) days before employee starts work). This certification shall state the date on which the examination was completed, the doctor’s name that performed the examination, and a statement concerning the physical health of the individual. The certification shall also contain the following statement: “(name of contract employee) is suffering from no contagious diseases to include but not limited to Tuberculosis, Hepatitis, and Sexually-Transmitted Diseases.”

1.6 CERTIFICATION REQUIREMENTS

The contractor shall provide current Basic Life Support (BLS) and Advanced Cardiac Life

Support (ACLS) certification and National Registry for Emergency Medical Technicians

(NREMT) paramedic certification to the contracting officer 15 days before the start of contract performance.

1.7 REIMBURSEMENT

1.7.1. 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, no exceptions. 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 and coordinate with the COR.

1.7.2. 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.

1.7.3. 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.

1.7.4. The contractor is to 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. If the contractor responds to an emergency and does not treat any patients, then the contractor must not bill. The contractor must not send and bill for wheelchair accessible ambulances unless medically indicated.

1.8 GENERAL INFORMATION

1.8.1. Contract Point of Contact (POC): The contractor shall provide a POC who shall be responsible for the performance of the work as specified in the Performance Work Statement.

The name of this person and an alternate(s) who shall act for the contractor when the POC is absent shall be designated in writing to the CO and 10th Medical Group COR prior to contract start date and prior to each contract renewal period.

1.8.2. The POC 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 POC must be available or respond to the COR and CO 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 COR or CO if questions arise. If questions or direction to the crew are deferred to the POC, 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 COR and CO in writing of the phone numbers for this equipment and notify the government immediately upon any subsequent changes.

1.8.3. Holidays. The government observes the following holidays:

New Year’s Day Labor Day

Martin Luther King Jr. Birthday Columbus Day

President’s Day Veterans Day

Memorial Day Thanksgiving

Independence Day Christmas

1.8.4. The POC and alternate(s) must be able to read, write, speak, and understand English.

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

1.8.5.1. Operation of an emergency ambulance in the State of Colorado and possessing a valid

Class “C” Colorado driver’s license.

1.8.5.2. Possessing a current license to perform EMT and Paramedic services in the State of

Colorado.

1.8.5.3. Special Flight Line Driving Certification for all drivers performing services under this contract within fifteen (15) days of the start of contract performance or within fifteen (15) days of new employee performance.

1.8.6. Contractor shall maintain files to assure that all EMTs performing work under this contract shall have current certifications and/or documents listed in 1.9.5 above. Upon request the contractor shall allow the government access to review these documents for any EMTs performing under this contract. The contractor shall provide copies of certifications upon request.

1.8.7. 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.

1.8.8. 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 all federal, state, and local regulations insuring that all safety requirements are met.

1.8.9. 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 has received approval according to DODD 5500.7 Standards of Conduct.

1.8.10. 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.

1.8.11. 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, Colorado.

1.9 CONTRACTOR MANPOWER REPORTING

1.9.1. The contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract for the U.S. Air Force via a secure data collection site. The contractor is required to completely fill in all required data fields at http://www.ecmra.mil.

1.9.2. Reporting inputs are for the labor executed during the period of performance during each government fiscal year (FY), which runs 1 October through 30 September. While inputs may be reported any time during the FY, all data shall be reported no later than 31 October of each calendar year for the prior FY. Contractors may direct questions to the CMRA help desk.

1.9.3. Uses and Safeguarding of Information: Information from the secure web site is considered to be proprietary in nature when the contract number and contractor identity are associated with the direct labor hours and direct labor dollars. At no time will any data be released to the public with the contractor name and contract number associated with the data.

1.9.4. User Manuals: Data for Air Force service requirements must be input at the Air Force

CMRA link. However, user manuals for government personnel and contractors are available at the Army CMRA link at http://www.ecmra.mil.

2. SERVICES SUMMARY (SS)

The following list of Services Summary (SS) items have specific Performance Thresholds (PT) assigned. Performance thresholds below establish the minimum acceptable levels of service required for each SS item. These minimums do not relieve the contractor from performing 100% of work performance outlined in the contract and PWS.

http://www.ecmra.mil/

Table 2.1

No. Performance Objective PWS Paragraph Performance Threshold

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. This requirement does not apply to non-emergent or transfer calls

1.1.3.

90% of emergent responses within nine minutes and all responses within twelve minutes in a month

The contractor shall provide the full range of EMT, paramedic, and ambulance transport services, and provide medical care and treatment appropriate to patient’s condition.

1.1.4.

No more than 1validated customer complaint per quarter.

The contractor shall prepare and submit documentation of each ambulance response within 24 hours following the response to the COR.

1.3.1.

No more than 1 late report per month.

Late reports will be submitted no later than 48 hours following the response.

The contractor shall not balance bill TRICARE eligible members for any balance due, no exceptions. Unnecessary or excessive expenses denied by insurance; contractor shall not seek further direct reimbursement from the patient or the government.

1.8, 1.1.1

100% Compliance, No validated patient/customer complaints related to improper billing.

3. INCIDENTAL FURNISHED PROPERTY AND SERVICES

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

3.2. The 10 AMDS will provide a train-the-trainer course for Special Flight Line Driving in accordance with Paragraph 1.8.5.3 to a contract representative within 15 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 for the use of housing ambulances and ambulance crews. The government will furnish heat, electricity, water, waste water service and trash disposal service to the individual structures. These structures are located in the Cadet Area and on the Air Field.

4. Appendices

Appendix A: USAFA Map

Fire Districts 2013.pdf

Sijan Hall

Mitchell Hall Aero Lab CETF

Fairchild Hall

Vandenberg Hall

Arnold Hall Harmon

Hall

Cadet Field House

Falcon Athletic Center

Cadet Phys Ed

Base Exchange

Commissary Community Center

Holaday Athletic Center

Airmansh ip Ramp

Ga te K-2

Community Center

FIRE DISTRICT 2

FIRE DISTRICT 1 FIRE

DISTRICT 3

5 8

2 18

Driving Range

3168000

3168000

3170000

3170000

3172000

3172000

3174000

3174000

3176000

3176000

3178000

3178000

3180000

3180000

3182000

3182000

3184000

3184000

3186000

3186000

3188000

3188000

3190000

3190000

3192000

3192000

3194000

3194000

3196000

3196000

3198000

3198000

Sijan Hall

Mitchell Hall Aero Lab CETF

Fairchild Hall

Vandenberg Hall

Arnold Hall Harmon

Hall

Cadet Field House

Falcon Athletic Center

Cadet Phys Ed

Base Exchange

Commissary Community Center

Holaday Athletic Center

Airmansh ip Ramp

Ga te K-2

Community Center

FIRE DISTRICT 2

FIRE DISTRICT 1 FIRE

DISTRICT 3

5 8

2 18

Driving Range

3168000

3168000

3170000

3170000

3172000

3172000

3174000

3174000

3176000

3176000

3178000

3178000

3180000

3180000

3182000

3182000

3184000

3184000

3186000

3186000

3188000

3188000

3190000

3190000

3192000

3192000

3194000

3194000

3196000

3196000

3198000

3198000

PLAN

MAP:AIR FORCE COMPREHENSIVE PLANNING AFI 32-7062 (01 OCT 97)

Sheet

DATE: 30 Jul 2013

Updated By: FACILITY INFORMATION TECHNOLOGY DEPARTMENT

DIRECTORATE OF ENGINEERING & SERVICES DCS / PRE --- WASHINGTON D.C.

DEPARTMENT OF THE AIR FORCE

UNITED STATES AIR FORCE ACADEMY

COLORADO

FIRE DISTRICTS

REV DATE DESCRIPTION INITIAL

0 1,200 2,400 3,600 4,800 6,000 Feet

Õ Magnetic Declination:

9 Deg. 11 Min. East (03/2008) Approx. annual change:

Source: National Geophysical Data Center (NGDC) 8 minutes West

MAP LEGEND

Fire District 1 Fire District 2 Fire District 3 Firing Range Area Academy Boundary

Buildings Paved Road Unpaved Road Maint. Road Unpaved Parking Paved Parking Sidewalk Area

Airfield Tower Recreational Trail Slab Area Athletic Court Athletic Track Athletic Field

Playground Area Campground Area Lakes & Ponds Golf Course Area Cemetery Area Off Base Road-Collector Off Base Road-Arterial