PWS_rev1_12_July_19.docx

PERFORMANCE WORK STATEMENT

FOR

AMBULANCE SERVICE

FOR

10th MEDICAL GROUP

UNITED STATES AIR FORCE ACADEMY, COLORADO

12 July 2019

1. DESCRIPTION OF SERVICES

The contractor shall provide full emergency medical and transport 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, Douglass Valley housing area, and the I-25 Corridor bordering the base (all locations will be referred to as USAFA hereafter). This emergency patient transport service shall consist of a minimum of three dedicated ambulances positioned on USAFA. One ambulance shall be physically located in or near the cadet area to cover the entire north area of USAFA. The second ambulance shall be roving USAF Academy to include the southern and central areas. A third ambulance will physically be located on the flight line to cover all flight line related incidents. 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 2, 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 shall be transported to Evans Army Community Hospital (EACH) on Ft. Carson in accordance with established protocols and in consultation with an attending provider at the hospital.

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) 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 and South Area ambulances shall provide services 24 hours per day 365 days per year including all holidays. The flight line ambulance shall provide service during flying hours Monday - Saturday from sun up to sundown. After 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 ambulances 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 dispatch 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 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 twelve (12) minutes in accordance with Section 3, Service Summary. This requirement does not apply to non-emergent or transfer calls. For detailed response time requirements, see DoDI 6055-06 Enclosure 3.

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 the Contracting Officers Representative (COR) 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 flight surgeon on call shall be notified 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.

1.1.7.1. During a real or simulated incident, the contractor will operate and communicate under the Incident Command System and follow the directions of the Incident Commander. They will also make notification to the Cadet Clinic as soon as possible after a receiving hospital properly accepts a patient. The notification will include 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.

1.1.7.2. The contractor shall ensure they have capability to maintain radio communications on both the 400MHz system operated by the 10 CS and 800MHz system operated by the Pikes Peak Communications Network. Each vehicle must have a mobile and portable 400MHz and 800MHz radio that allows for immediate voice communications with the USAFA Fire Emergency Services, the Incident Commander, and the El Paso County dispatch center.

1.1.8. Performance of services during crisis 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 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 COR will provide the contractor at least 48 hours 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 and aerial flight operations.

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 services 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 reports: The contractor shall prepare and submit to the COR and 10 MDG Risk Manager, 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 crewmember.

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, paragraph 1.14, Safety Investigations and Reports. This information shall include, but is not limited to: 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 workdays after contract award. Changes/updates to QCP shall be submitted to CO within 14 days after changes/updates.

1.4.2. Contracting Officer Representative (COR) will inspect the services provided. 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. Written minutes of these meetings, signed by the contractor POC and CO or contract administrator, will be provided by the COR for file documentation. Should the contractor not concur with the minutes, such non-concurrence shall be provided in writing to the CO within 10 workdays 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 is 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 7 days before the start of contract performance. Certification of new employees are 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.”

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

1.8.3. Holidays. The government observes the following holidays:

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

1.8.4.1. Operation of an emergency ambulance in the State of Colorado and possessing a valid Class “C” Colorado driver’s license.

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

1.8.4.3. 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.

1.8.5. Contractor shall maintain files to assure that all EMTs performing work under this contract shall have current certifications and/or documents listed 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.

1.8.6. 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.

1.8.7. 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.

1.8.8. 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.

1.8.9. 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.

1.8.10. 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. ITEMS PROVIDED BY THE GOVERNMENT

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

2.2. The 10 AMDS will provide a train-the-trainer course for Special Flight Line Driving in accordance with Paragraph 1.8.4.3 to a contract representative within 15 days of the start of performance. This course will allow the contractor to train their employees.

2.3. The government will provide the contractor with at least two individual facilities/structures for the use of housing ambulances and ambulance crews. The government will provide heat, electricity, water, wastewater service and trash disposal service to these individual structures.

3. 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.

Table 3.1

No.

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

No more than 1 validated customer complaint per quarter.

No more than 1 late report per month. Late reports will be submitted no later than 48 hours following the response.

100% compliance, no validated patient/customer complaints related to improper billing.