Attachment_1_-_PWS.pdf

Contract Number: TBD

PERFORMANCE WORK STATEMENT

For

Air Force Medical Operations Agency

(AFMOA)

Nationally Registered Paramedic (NRP) Certification and

Re-Certification Courses

Date: 16 February 2018

TABLE OF CONTENTS

Page

1.0 DESCRIPTION OF SERVICES

1.1 Background 3

1.2 Scope 3

2.0 GENERAL INFORMATION

2.1 Contractor Information 3

2.2 Contractor Training 3

2.3 Contractor/Government Communication 3

2.4 Place of Performance 4

2.5 Travel Requirements 4

2.6 Mission/Emergency Essential 4

2.7 Duty Hours 4

2.8 Federal Holidays 4

2.9 Conduct of Contractor Personnel 4

3.0 CONTRACT REQUIREMENTS

3.1 National Registered Paramedic (NRP) Certification Course 4

3.2 National Registered Paramedic (NRP) Re-Certification Course 6

3.3 Security Requirements 7

3.4 Manpower Reporting Requirements 7

3.5 Post Award Meeting 7

4.0 PERFORMANCE OBJECTIVE

4.1 Service Summary 7

4.2 Initial Contract Performance Review 7

4.3 Service Summary Surveillance 8

5.0 GOVERNMENT FURNISHED PROPERTY 8

6.0 DELIVERABLES 8

APPENDICES

APPENDIX A Acronym and Definition List

APPENDIX B Business Associate Agreement (BAA)

APPENDIX C Customer Complaint Record

APPENDIX D National Medical Emergency Education Standards (EMS)

APPENDIX E National Medical Emergency Education Standards (EMS)

Paramedic Instructional Guidelines

1.0 DESCRIPTION OF SERVICES:

1.1 Background: The Air Force Medical Operations Agency (AFMOA) is responsible for oversight of the Emergency Medical Services (EMS) programs for the U.S. Air Force Medical

Services (AFMS). Its mission covers a broad range of programs including Paramedic, first emergency responders who provide Advanced Life Support (ALS) and Basic Life Support (BLS) medical care to patients at the scene and en-route to the Medical Treatment Facility (MTF). Most of

AFMOA’s Emergency Medical Technician (EMTs) are BLS certified and AFMOA has a shortage of

ALS certified Paramedics. AFMOA has approximately 700 EMTs that need to be trained and certified to the ALS level. Additionally, AFMOA has approximately 100 Paramedics each year that need to be re-certified at the ALS level. Based on the above, contracted services are required to assist with the sustained training and re-certification of AFMS Paramedics.

1.2 Scope: This is a non-personal services contract to provide an Emergency Medical Technicians

(EMT) Paramedic Certification and Re-Certification courses.

1.2.1 Emergency Medical Technicians (EMT) Paramedic Certification course shall certify up to 40

AFMS EMTs annually to the Nationally Registered Paramedic (NRP) level in accordance with the established standards set by the National Registry of Emergency Medical Technicians (NREMT)

Paramedic certification guidelines and the National EMS Education Standards and Paramedic

Instructional Guidelines. Training shall be conducted in no more than two (2) (four) 4 ½ month classes of no less than 15 students and no more than 35 students each, for a total of approximately 40 students trained annually. Course length for each student shall not exceed 134 calendar days.

1.2.2 EMT Paramedic Re-Certification course shall provide re-certification training up to 100

AFMS EMTs annually at the Nationally Registered Paramedic (NRP) level in accordance with the established standards set by the National Registry of Emergency Medical Technicians (NREMT)

Paramedic certification guidelines and will include Tactical Combat Casualty Care (TCCC) certification as well as a minimum of 36 hours of Ride-alongs and/or Clinical time. Training shall be conducted in no more than twelve (12) two week classes of no less than 10 students and no more than 20 students each, for a total of approximately 100 students trained annually. Course length for each student shall not exceed 14 calendar days.

2.0 GENERAL INFORMATION:

2.1 Contractor Identification: N/A

2.2 Contractor Training: N/A

2.3 Contractor/Government Communication: The Contractor shall provide clear and consistent written and verbal responses to Government within 12 business hours of Government initiated communication (e.g., return phone calls, emails or other communication).

2.3.1 The Contractor’s Focal Point shall meet with the Government team at least quarterly, and additional meetings may be requested by the Government or the Contractor as necessary. The

Contractor shall provide an agenda and minutes IAW Contract Data Requirements List (CDRL)

A001 and A002.

2.4 Place of Performance: The primary place of performance will be at the Contractor’s training facilities.

2.5 Travel Requirements: No travel requirements under this Contract.

2.6 Mission/Emergency Essential: None of the services listed in this Performance Work

Statement (PWS) are mission/emergency essential.

2.7 Duty Hours: Normal classroom training hours are eight (8) hours a day between the hours of

7:00 AM and 5:00 PM, local time Monday through Friday; Saturdays may be used for didactic training and/or field internship. Ride-along (field internship)/clinical program hours may be flexible outside of the above stated hours to meet course requirements.

2.8 Federal Holidays: Federal offices are closed on New Year’s Day, Dr. Martin Luther King, Jr.

Birthday, President’s Day, Memorial Day, Independence Day, Labor Day, Columbus Day, Veteran’s

Day, Thanksgiving Day, and Christmas Day.

2.9 Conduct of Contractor Personnel: N/A

3.0 CONTRACT REQUIREMENTS:

3.1 National Registered Paramedic (NRP) Initial Certification Course: The Contractor shall provide NRP Certification Course to support AFMOA/SGN functional area as described in this

PWS.

3.1.1 Provide curricula of training that results in certification of Air Force EMTs to the NRP Level in accordance with the established standards set forth by NREMT, National EMS Education

Standards and Paramedic Instructional Guidelines.

3.1.2 Required training shall include real world, objective-based, “ride along” (field internship) clinical program for all Paramedic students.

3.1.3 Provide a training facility located within 50 miles of a Level 1 Trauma Center; a hospital equipped to handle any level of severity of trauma, and has a trauma surgeon on-site 24/7 and an

Operating Room ready at all times for trauma cases as defined by the American College of

Surgeons.

3.1.3.1 All classes, to include clinicals, vehicular rotations and testing, must take place within 20 miles of an Active Duty Air Force Base.

3.1.4 Shall maintain a medical oversight relationship with a large urban EMS system with an ALS call rate of greater than 35%.

3.1.5 Provide training for EMTs that does not exceed 134 calendar days. Training will consist of

ALS courses for Paramedic certification with NREMT to include:

3.1.5.1 Advanced Cardiac Life Support (ACLS)

3.1.5.2 Pediatric Advanced Life Support (PALS)

3.1.5.3 Basic Life Support (BLS)

3.1.6 Provide all textbooks and afford for each student who successfully completes the program to sit for the National Registry Paramedic psychomotor and cognitive examinations.

3.1.6.1 The Contractor shall order and ship the three (3) textbooks below listed to the students’ addresses provided by AFMOA in the Student Address List within 10 calendar days after the period of performance start date. The Contractor shall provide tracking numbers of the shipments to the

AFMOA/SGN Contracting Officer Representatives (CORs) no later than two (2) calendar days after the shipment has been made. Contractor shall provide textbooks IAW CDRL A003.

3.1.6.1.1 Medical Terminology: A Short Course 6th Edition. Author - Davi-Ellen Chabner ISBN:

978-1-4377-3440-9

3.1.6.1.2 Brady's Anatomy & Physiology for Emergency Care 2nd Edition. Authors: Martini-

Bartholomew-Bledsoe. ISBN: 13:978-0-13-234298-8

3.1.6.1.3 Brady's Anatomy & Physiology for Emergency Care Workbook 2nd Edition. Authors:

Martini-Bartholomew-Bledsoe. ISBN: 9 78-0-13-614021-4

3.1.7 The contract shall afford each student a single NRP testing opportunity after graduation of the course, but prior to student’s departure back to home station.

3.1.8 Pass/Fail Rate: The Contractor shall have a 90% first time pass rate, 90% of the time with students completing the training for certification to the NRP level with NREMT.

3.1.8.1 Provide remedial training for 100% of students following their first time failure of the NRP

Exam. Remedial training days will be in addition to the 134 calendar days allowed for initial training.

3.1.8.2 Re-testing must be scheduled and accomplished prior to the student departing; but will not exceed, under any circumstances, 148 calendar days. In the event of a 2nd time failure, the student will be released from the program to return to their home station.

3.1.9 Provide all course material(s) and any special uniform requirements to each student, (i.e., cargo pants, polo or tee-shirts required for clinical or ride-alongs). Also provide an equipment list, (i.e., stethoscope, trauma shears or utility scissors), and personal protective equipment for training, excluding pens, pencils, and writing paper.

3.1.10 Upon successful completion of training, each student shall receive a Certificate of

Completion and an official transcript reflecting earned credit/semester hours.

3.1.11 Knowledge of and ability to work with standard software programs used by Air Force

Medical Services (AFMS) such as the latest version of Microsoft Office Professional Suite.

3.1.12 Minimum Qualifications:

3.1.12.1 The course provider shall be fully certified and accredited by the Committee on

Accreditation of Educational Programs for the Emergency Medical Services Professions

(CoAEMSP), as granted by the Commission on Accreditation of Allied Health Education Programs

(CAAHEP), as an approved program for paramedic training and certification; a CoAEMSP Letter of Review (LOR) is acceptable.

3.2 National Registered Paramedic (NRP) Re-Certification Course: The Contractor shall provide an NRP Re-Certification course to support AFMOA/SGN functional area as described in this PWS.

3.2.1 Provide curricula of training that results in re-certification of Air Force NRP Level technicians in accordance with the established standards set forth by NREMT.

3.2.2 Required training shall include real world, objective-based, “ride along” (field internship) clinical program for all Paramedics.

3.2.3 Provide a training facility located within 50 miles of a Level 1 Trauma Center; a hospital equipped to handle any level of severity of trauma, and has a trauma surgeon on-site 24/7 and an

Operating Room ready at all times for trauma cases as defined by the American College of

Surgeons.

3.2.4 Shall maintain a medical oversight relationship with a large urban EMS system with an

Advanced Life Support (ALS) call rate of greater than 35%.

3.2.5 Provide training for NRPs that does not exceed 14 calendar days. Training will consist of

ALS courses for Paramedic certification with NREMT to include:

3.2.5.1 Tactical Combat Casualty Care (TCCC)

3.2.6 All classes, to include clinicals, vehicular rotations and testing, must take place within 20 miles of an Active Duty Air Force Base.

3.2.7 Pass/Fail Rate: Contractor shall have as a minimum a 90% first time pass rate 90% of the time with students completing the training for certification to the NRP level with NREMT.

3.2.8 Provide all course material and any special uniform requirements to each student, (i.e., cargo pants, polo or tee-shirts required for clinical or ride-alongs). Also provide an equipment list, (i.e., stethoscope, trauma shears or utility scissors), and personal protective equipment for training, excluding pens, pencils, and writing paper.

3.2.9 Upon successful completion of training, each student shall receive a Certificate of Completion.

3.2.10 Knowledge of and ability to work with standard software programs used by Air Force

Medical Services (AFMS) such as the latest version of Microsoft Office Professional Suite.

3.2.11 Minimum Qualifications:

3.2.11.1 The course provided shall be fully certified and accredited by the Committee on

Accreditation of Educational Programs for the Emergency Medical Services Professions

(CoAEMSP), as granted by the Commission on Accreditation of Allied Health Education Programs

(CAAHEP), as an approved program for paramedic training and certification; a CoAEMSP Letter of Review (LOR) is acceptable.

3.3 Security Requirements: N/A

3.4 Contractor Manpower Reporting Requirements Application (CMRA):

3.4.1 The Contractor shall report all Contractor labor hours (including subcontractor labor hours) required for performance of services provided under this PWS via a secure data collection site. The

Contractor is required to completely fill in all required data fields at: http://www.ecmra.mil

3.4.2 Reporting Period: Reporting inputs will be for the labor executed during the period of performance for 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. Contractors may direct questions to the Contractor Manpower

Reporting Application (CMRA) help desk.

3.4.3 Uses and Safeguarding of Information: Information from the secure web site is considered to be proprietary in nature when the contract number and the 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.

3.4.4 User Manuals: Data for AF service requirements must be input at the AF CMRA link.

However, user manuals for Contractors are available at the Army CMRA link at:

http://www.ecmra.mil.

3.5 Post-Award Meeting: The Government will host a post-award meeting with the Contractor within 10 business days after contract award. The Contracting Officer (CO) shall contact the

Program Manager/ Contracting Officer Representative (PM/COR) and the Contractor to schedule this meeting. Telecon/teleconference is permissible for the post-award meeting. The purpose of the post-award meeting is introduce the Contractor to the Government representatives (PM/COR) the

Contractor will support; provide the Contractor the opportunity to explain in more detail their proposal’s technical approach; and entertain questions from either party. Take-aways from the meeting should be an exchange of contact information; a timeline of when direct support will start, if not yet started; and an understanding by all parties of all the requirements.

4.0 PERFORMANCE OBJECTIVE:

4.1 Services Summary (SS): The Contractor services requirements are summarized into performance objectives that relate directly to mission essential items. The performance threshold briefly describes the minimum acceptable levels of service for each requirement. These thresholds are critical to mission success.

4.2 Initial Contract Performance Review: The initial evaluation of Contractor performance is a joint determination by the multi-functional team that the Contractor has successfully started performance, completed transition, is fully operational, and is within the estimated cost, schedule, and performance parameters of the contract. The initial evaluation will be conducted http://www.ecmra.mil/ by the Government within 30 business days after the Contractor assumes full performance responsibilities.

4.3 Services Summary Table

Services Summary Table

5.0 Government Furnished Property (GFP): No GFP will be provided to the Contractor.

6.0 DELIVERABLES

6.1 The Contractor shall submit all deliverables as specified in this PWS and contract Exhibit A, CDRL.

6.1.1 All deliverables must be submitted electronically to the COR(s).

6.1.2 The COR may approve extensions to the delivery timeline based on magnitude and complexity of the document topic.

6.1.3 Provide informal reports by e-mail as requested by the COR.

6.2 Monthly Status/Financial Report: The Contractor shall prepare and submit a monthly status/financial report identifying all tasks performed, status, issues, and anticipated actions consistent with the PWS each month. The Contractor shall provide the Monthly/Financial Report

IAW CDRL A004.

7.0 APPENDICES:

7.1 APPENDIX A Acronym and Definition List

7.2 APPENDIX B Business Associate Agreement (BAA)

7.3 APPENDIX C Customer Complaint Record

7.4 APPENDIX D National Medical Emergency Education Standards (EMS)

7.5 APPENDIX E National Medical Emergency Education Standards (EMS) Paramedic

Performance Objectives PWS Para. Performance Threshold

Provide curricula of training which results in certification of Air Force

EMTs to the NRP level National EMS

Education Standards and Paramedic

Instructional Guidelines

3.1.8 and 3.2.7 Must obtain 90% first time pass rate, 90% of the time.

Provide real world, objective based

Ride-alongs (field internship)

3.1.2 and 3.2.2 All students shall participate in the objective-based “ride along” program.

Provide remedial training following a first time failure of the NRP Exam.

3.1.8.1 100% of first time failures on the prior to the next scheduled testing opportunity.

Instructional Guidelines

8.0 Exhibits:

8.1 Exhibit A – Contract Data Requirements List

Appendix A – Acronyms and Definition

Appendix A – ACRONYMS and DEFINITIONS

ACRONYM DEFINITIONS

ACLS Advanced Cardiac Life Support

AF Air Force

AFMS Air Force Medical Service

AFMOA Air Force Medical Operations Agency

ALS Advanced Life Support

BLS Basic Life Support

CAAHEP Commission on Accreditation of Allied Health Education Programs

CMRA Contractor Manpower Reporting Application

CoAEMSP

Committee on Accreditation of Educational Programs for the

Emergency Medical Services Professions

COR Contracting Officer’s Representative

DoD Department of Defense

DoDI Department of Defense Instruction

EMS Emergency Medical Services

EMT Emergency Medical Technician

HQ USAF/SG Headquarters United States Air Force Surgeon General

IAW In Accordance With

MTF Medical Treatment Facility

NREMT National Registry of Emergency Medical Technician

NRP Nationally Registered Paramedic

PALS Pediatric Advanced Life Support

PWS Performance Work Statement

SG Surgeon General

SGH Chief of Medical Staff

TO Training Officer

Appendix B – Business Associate Agreement

APPENDIX B

BUSINESS ASSOCIATE AGREEMENT

This BAA can serve as a separate standalone agreement or may be used for new or existing contracts between the MTF and the business associate.

Business Associate Agreement

[USE FOR STANDALONE BAA ONLY] This Business Associate Agreement (this "Agreement") is entered into this ___ day of ________, _____ (the “Effective Date”) between [NAME OF MHS

COVERED ENTITY] ("Covered Entity") and [NAME OF BUSINESS ASSOCIATE], a [type of business entity] ("Business Associate").

Introduction

In accordance with 45 CFR 164.502(e)(2) and 164.504(e) and paragraph C.3.4.1.3 of DoD 6025.18-

R, “DoD Health Information Privacy Regulation,” January 24, 2003, this document serves as a business associate agreement (BAA) between the signatory parties for purposes of the Health

Insurance Portability and Accountability Act (HIPAA) and the “HITECH Act” amendments thereof, as implemented by the HIPAA Rules and DoD HIPAA Issuances (both defined below). The parties are a DoD Military Health System (MHS) component, acting as a HIPAA covered entity, and a DoD contractor, acting as a HIPAA business associate. The HIPAA Rules require BAAs between covered entities and business associates. Implementing this BAA requirement, the applicable DoD HIPAA

Issuance (DoD 6025.18-R, paragraph C3.4.1.3) provides that requirements applicable to business associates must be incorporated (or incorporated by reference) into the contract or agreement between the parties.

(a) Catchall Definition. Except as provided otherwise in this BAA, the following terms used in this

BAA shall have the same meaning as those terms in the DoD HIPAA Rules: Data Aggregation, Designated Record Set, Disclosure, Health Care Operations, Individual, Minimum Necessary, Notice of Privacy Practices (NoPP), Protected Health Information (PHI), Required By Law, Secretary, Security Incident, Subcontractor, Unsecured Protected Health Information, and Use.

Breach means actual or possible loss of control, unauthorized disclosure of or unauthorized access to PHI or other Personally Identifiable Information (PII) (which may include, but is not limited to

PHI), where persons other than authorized users gain access or potential access to such information for any purpose other than authorized purposes, where one or more individuals will be adversely affected. The foregoing definition is based on the definition of breach in DoD Privacy Act Issuances as defined herein.

Business Associate shall generally have the same meaning as the term “business associate” in the

DoD HIPAA Issuances, and in reference to this BAA, shall mean [INSERT NAME OF BUSINESS

ASSOCIATE].

Agreement means this BAA together with the documents and/or other arrangements under which the

Business Associate signatory performs services involving access to PHI on behalf of the MHS component signatory to this BAA.

Covered Entity shall generally have the same meaning as the term “covered entity” in the DoD

HIPAA Issuances, and in reference to this BAA, shall mean [INSERT NAME OF MTF

COMPONENT].

DHA Privacy Office means the DHA Privacy and Civil Liberties Office. The DHA Privacy Office

Director is the HIPAA Privacy and Security Officer for DHA, including the National Capital Region

Medical Directorate (NCRMD).

DoD HIPAA Issuances means the DoD issuances implementing the HIPAA Rules in the DoD

Military Health System (MHS). These issuances are DoD 6025.18-R (2003), DoDI 6025.18 (2009), and DoD 8580.02-R (2007).

DoD Privacy Act Issuances means the DoD issuances implementing the Privacy Act, which are

DoDD 5400.11 (2007) and DoD 5400.11-R (2007).

HHS Breach means a breach that satisfies the HIPAA Breach Rule definition of breach in 45 CFR

164.402.

HIPAA Rules means, collectively, the HIPAA Privacy, Security, Breach and Enforcement Rules, issued by the U.S. Department of Health and Human Services (HHS) and codified at 45 CFR Part

160 and Part 164, Subpart E (Privacy), Subpart C (Security), Subpart D (Breach) and Part 160, Subparts C-D (Enforcement), as amended by the 2013 modifications to those Rules, implementing the “HITECH Act” provisions of Pub. L. 111-5. See 78 FR 5566-5702 (Jan. 25, 2013) (with corrections at 78 FR 32464 (June 7, 2013)). Additional HIPAA rules regarding electronic transactions and code sets (45 CFR Part 162) are not addressed in this BAA and are not included in the term HIPAA Rules.

Service-Level Privacy Office means one or more offices within the military services (Army, Navy, or Air Force) with oversight authority over Privacy Act and/or HIPAA privacy compliance.

I. Obligations and Activities of Business Associate

(a) The Business Associate shall not use or disclose Personal Health Information (PHI) other than as permitted or required by this Agreement or as required by law.

(b) The Business Associate shall use appropriate safeguards, and comply with the DoD HIPAA

Rules with respect to electronic PHI, to prevent use or disclosure of PHI other than as provided for by this Agreement.

(c) The Business Associate shall report to Covered Entity any Breach of which it becomes aware, and shall proceed with breach response steps as required by Part V of this BAA. With respect to electronic PHI, the Business Associate shall also respond to any security incident of which it becomes aware in accordance with any Information Assurance provisions of this Agreement. If at any point the Business Associate becomes aware that a security incident involves a Breach, the

Business Associate shall immediately initiate breach response as required by part V of this BAA.

(d) In accordance with 45 CFR 164.502(e)(1)(ii)) and 164.308(b)(2), respectively, and corresponding DoD HIPAA Issuances, as applicable, the Business Associate shall ensure that any subcontractors that create, receive, maintain, or transmit PHI on behalf of the Business Associate agree to the same restrictions, conditions, and requirements that apply to the Business Associate with respect to such PHI.

(e) The Business Associate shall make available PHI in a Designated Record Set, to the Covered

Entity or, as directed by the Covered Entity, to an Individual, as necessary to satisfy the Covered

Entity obligations under 45 CFR 164.524 and corresponding DoD HIPAA Issuances.

(f) The Business Associate shall make any amendment(s) to PHI in a Designated Record Set as directed or agreed to by the Covered Entity pursuant to 45 CFR 164.526, or take other measures as necessary to satisfy Covered Entity’s obligations under 45 CFR 164.526, and corresponding DoD

HIPAA Issuances.

(g) The Business Associate shall maintain and make available the information required to provide an accounting of disclosures to the Covered Entity or an individual as necessary to satisfy the Covered

Entity’s obligations under 45 CFR 164.528 and corresponding DoD HIPAA Issuances.

(h) To the extent the Business Associate is to carry out one or more of Covered Entity's obligation(s) under the HIPAA Privacy Rule, the Business Associate shall comply with the requirements of the

HIPAA Privacy Rule that apply to the Covered Entity in the performance of such obligation(s); and

(i) The Business Associate shall make its internal practices, books, and records available to the

Secretary for purposes of determining compliance with the HIPAA Rules.

II. Permitted Uses and Disclosures by Business Associate

(a) The Business Associate may only use or disclose PHI as necessary to perform the services set forth in this Agreement or as required by law. The Business Associate is not permitted to de-identify

PHI under DoD HIPAA issuances or the corresponding 45 CFR 164.514(a)-(c), nor is it permitted to use or disclose de-identified PHI, except as provided by this Agreement or directed by the Covered

Entity [MODIFY THIS SECTION IF THE PURPOSE OF THE AGREEMENT/CONTRACT

IS FOR THE BA TO DEIDENTIFY PHI FOR THE CE].

(b) The Business Associate agrees to use, disclose and request PHI only in accordance with the

HIPAA Privacy Rule “minimum necessary” standard and corresponding DHA policies and procedures as stated in the DoD HIPAA Issuances.

(c) The Business Associate shall not use or disclose PHI in a manner that would violate the DoD

HIPAA Issuances or HIPAA Privacy Rules if done by the Covered Entity, except uses and disclosures for the Business Associate’s own management and administration and legal responsibilities or for data aggregation services as set forth in the following three paragraphs.

(d) Except as otherwise limited in this Agreement, the Business Associate may use PHI for the proper management and administration of the Business Associate or to carry out the legal responsibilities of the Business Associate. The foregoing authority to use PHI does not apply to disclosure of PHI, which is covered in the next paragraph.

(e) Except as otherwise limited in this Agreement, the Business Associate may disclose PHI for the proper management and administration of the Business Associate or to carry out the legal responsibilities of the Business Associate, provided that disclosures are required by law, or the

Business Associate obtains reasonable assurances from the person to whom the PHI is disclosed that it will remain confidential and used or further disclosed only as required by law or for the purposes for which it was disclosed to the person, and the person notifies the Business Associate of any instances of which it is aware in which the confidentiality of the information has been breached.

(f) Except as otherwise limited in this Agreement, the Business Associate may use PHI to provide

Data Aggregation services relating to the Covered Entity’s health care operations.

III. Provisions for Covered Entity to Inform Business Associate of Privacy Practices and

Restrictions

(a) The Covered Entity shall notify the Business Associate of any limitation(s) in the notice of privacy practices of the Covered Entity under 45 CFR 164.520 and the corresponding provision of the DoD HIPAA Issuances, to the extent that such limitation may affect Business Associate’s use or disclosure of PHI.

(b) The Covered Entity shall notify the Business Associate of any changes in, or revocation of, the permission by an Individual to use or disclose his or her PHI, to the extent that such changes affect the Business Associate’s use or disclosure of PHI.

(c) The Covered Entity shall notify the Business Associate of any restriction on the use or disclosure of PHI that the Covered Entity has agreed to or is required to abide by under 45 CFR 164.522 and the corresponding DoD HIPAA Issuances, to the extent that such changes may affect the Business

Associate’s use or disclosure of PHI.

IV. Permissible Requests by Covered Entity

The Covered Entity shall not request the Business Associate to use or disclose PHI in any manner that would not be permissible under the HIPAA Privacy Rule or any applicable Government regulations (including without limitation, DoD HIPAA Issuances) if done by the Covered Entity, except for providing Data Aggregation services to the Covered Entity and for management and administrative activities of the Business Associate as otherwise permitted by this BAA.

V. Breach Response

(a) In general.

(1) In the event of a breach of PII/PHI held by the Business Associate, the Business Associate shall report the breach to the Covered Entity in accordance with Section VII, assess the breach incident, take mitigation actions as applicable, and notify affected individuals, as directed by the Covered

Entity.

(2) The Business Associate shall coordinate all investigation actions with the Covered Entity, and at a minimum, follow the breach response requirements set forth in this Part V, which is designed to satisfy both the Privacy Act and HIPAA as applicable. If a breach involves PII without PHI, then the

Business Associate shall comply with DoD Privacy Act Issuance breach response requirements only;

if a breach involves PHI (a subset of PII), then the Business Associate shall comply with both

Privacy Act and HIPAA breach response requirements. A breach involving PHI may or may not constitute an HHS Breach. If a breach is not an HHS Breach, then the Business Associate has no

HIPAA breach response obligations. In such cases, the Business Associate must still comply with breach response requirements under the DoD Privacy Act Issuances.

(3) The Business Associate shall, at no cost to the government, bear any costs associated with a breach of PII/PHI that the Business Associate has caused or is otherwise responsible for addressing.

(b) Government Reporting Provisions

(1) If the Covered Entity determines that a breach is an HHS Breach, then the Business Associate shall comply with both the HIPAA Breach Rule and DoD Privacy Act Issuances, as directed by the

Covered Entity, regardless of where the breach occurs. If the Covered Entity determines that the breach does not constitute an HHS Breach, then the Business Associate shall comply with DoD

Privacy Act Issuances, as directed by the applicable Service-Level Privacy Office.

(2) This Part V is designed to satisfy the DoD Privacy Act Issuances and the HIPAA Breach Rule as implemented by the DoD HIPAA Issuances. In general, for breach response, the Business Associate shall report the breach to the Covered Entity, assess the breach incident, notify affected individuals, and take mitigation actions as applicable. Because DoD defines “breach” to include possible

(suspected) as well as actual (confirmed) breaches, the Business Associate shall implement these breach response requirements immediately upon the Business Associate’s discovery of a possible breach.

(3) The following provisions of Part V set forth the Business Associate’s Privacy Act and HIPAA breach response requirements for all breaches, including but not limited to HHS breaches.

(i) The Business Associate shall report the breach within one hour of discovery to the US Computer

Emergency Readiness Team (US CERT), and, within 24 hours of discovery, to the Covered Entity, and to other parties as deemed appropriate by the Covered Entity. The Business Associate is deemed to have discovered a breach as of the time a breach (suspected or confirmed) is known, or by exercising reasonable diligence would have been known, to any person (other than the person committing it) who is an employee, officer or other agent of the Business Associate.

(ii) The Business Associate shall submit the US-CERT report using the online form at https://forms.us-cert.gov/report/. Before submission to US-CERT, the Business Associate shall save a copy of the on-line report. After submission, the Business Associate shall record the US-CERT

Reporting Number. Although only limited information about the breach may be available as of the one hour deadline for submission, the Business Associate shall submit the US-CERT report by the deadline. The Business Associate shall e-mail updated information as it is obtained, following the instructions at http://www.us-cert.gov/pgp/email.html. The Business Associate shall provide a copy of the initial or updated US-CERT report to the Installation Privacy Act Officer, MTF HIPAA

Privacy Officer, and the Contracting Officer (if applicable), if requested. Business Associate questions about US-CERT reporting shall be directed to the Installation Privacy Act Officer or MTF

HIPAA Privacy Officer, not the US-CERT office.

(iii) The Business Associate shall comply with the Breach Timeline and Notification Flow Chart processes attached to this Agreement, to include the timelines established for completing the DD

Form 2959 and the HIPAA Privacy Incident Report.

(4) If multiple beneficiaries are affected by a single event or related set of events, then a single reportable breach may be deemed to have occurred, depending on the circumstances. The Business

Associate shall inform the Covered Entity as soon as possible if it believes that “single event” breach response is appropriate; the Covered Entity will determine how the Business Associate shall proceed and, if appropriate, consolidate separately reported breaches for purposes of Business Associate report updates, beneficiary notification, and mitigation.

(i) When a Breach Report Form initially submitted is incomplete or incorrect due to unavailable information, or when significant developments require an update, the Business Associate shall submit a revised form or forms, stating the updated status and previous report date(s) and showing any revisions or additions in red text. Examples of updated information the Business Associate shall report include, but are not limited to: confirmation on the exact data elements involved, the root cause of the incident, and any mitigation actions to include, sanctions, training, incident containment, and follow-up. The Business Associate shall submit these report updates within three

(3) business days after the new information becomes available. Prompt reporting of updates is required to allow the Covered Entity to make timely final determinations on any subsequent notifications or reports. The Business Associate shall provide updates to the same parties as required for the initial Breach Reporting Form. The Business Associate is responsible for reporting all information needed by the Covered Entity to make timely and accurate determinations on reports to

HHS as required by the HHS Breach Rule and reports to the Defense Privacy and Civil Liberties

Office as required by DoD Privacy Act Issuances.

(ii) In the event the Business Associate is uncertain on how to apply the above requirements, the

Business Associate shall consult with the Covered Entity and Contracting Officer (if applicable) when determinations on applying the above requirements are needed.

(c) Individual Notification Provisions

(i) If the Covered Entity determines that individual notification is required, the Business Associate shall provide written notification to individuals affected by the breach as soon as possible, but no later than 10 working days after the breach is discovered and the identities of the individuals are ascertained. The 10 day period begins when the Business Associate is able to determine the identities

(including addresses) of the individuals whose records were impacted.

(ii) The Business Associate’s proposed notification to be issued to the affected individuals shall be submitted to the parties to which reports are submitted under paragraph VII for their review, and for approval by the [REMOVE CO REFERENCES FOR STAND-ALONE AGMT] Contracting

Officer, in consultation with the Covered Entity. Upon request, the Business Associate shall provide the Contracting officer and Covered Entity with the final text of the notification letter sent to the affected individuals. If different groups of affected individuals receive different notification letters, then the Business Associate shall provide the text of the letter for each group (PII shall not be included with the text of the letter(s) provided). Copies of further correspondence with affected individuals need not be provided unless requested by the Contracting Office or Covered Entity.

The Business Associate’s notification to the individuals, at a minimum, shall include the following:

(A) The individual(s) must be advised of what specific data was involved. It is insufficient to simply state that PII has been lost. Where names, Social Security Numbers (SSNs) or truncated SSNs, and

Dates of Birth (DOBs) are involved, it is critical to advise the individual that these data elements potentially have been breached.

(B) The individual(s) must be informed of the facts and circumstances surrounding the breach. The description should be sufficiently detailed so the individual clearly understands how the breach occurred.

(C) The individual(s) must be informed of what protective actions the Business Associate is taking or the individual can take to mitigate against potential future harm. The notice must refer the individual to the current Federal Trade Commission (FTC) web site pages on identity theft and the

FTC’s Identity Theft Hotline, toll-free: 1-877-ID-THEFT (438-4338); TTY: 1-866-653-4261.

(D) A brief description of what the covered entity involved is doing to investigate the breach, to mitigate harm to individuals, and to protect against any further breaches; and

(E) Contact procedures for individuals to ask questions or learn additional information, which shall include a toll-free telephone number, an e-mail address, Web site, or postal address

(F) The individual(s) must also be informed of any mitigation support services (e.g., one year of free credit monitoring, identification of fraud expense coverage for affected individuals, provision of credit freezes, etc.) the Business Associate may offer affected individuals, the process to follow to obtain those services and the period of time the services will be made available, and contact information (including a phone number, either direct or toll-free, e-mail address and postal address) for obtaining more information. The [REMOVE CO REFERENCES FOR STAND-ALONE

AGMT] Contracting Officer, in consultation with the Covered Entity will determine the appropriate level of support services.

(iii) Business Associates shall ensure any envelope containing written notifications to affected individuals are clearly labeled to alert the recipient to the importance of its contents, e.g., “Important information – do not destroy,” and the envelope is marked with the identity of the Business

Associate and/or subcontractor organization that suffered the breach. The letter must also include contact information for a designated point of contact to include, phone number, e-mail address, and postal address.

(iv) If the Business Associate determines that it cannot readily identify, or will be unable to reach, some affected individuals within the 10 day period after discovering the breach, the Business

Associate shall so indicate in the initial or updated Breach Report Form. Within the 10 day period, the Business Associate shall provide the approved notification to those individuals who can be reached. Other individuals must be notified within 10 days after their identities and addresses are ascertained. The Business Associate shall consult with the Covered Entity, which will determine which media notice is most likely to reach the population not otherwise identified or reached. The

Business Associate shall issue a generalized media notice(s) to that population in accordance with the Covered Entity approval.

(d) Breaches are not to be confused with security incidents (often referred to as cyber security incidents when electronic information is involved), which may or may not involve a breach of

PII/PHI. In the event of a security incident not involving a PII/PHI breach, the Business Associate shall follow applicable DoD Information Assurance requirements under its Agreement. If at any point the Business Associate finds that a cybersecurity incident involves a PII/PHI breach (suspected or confirmed), the Business Associate shall immediately initiate the breach response procedures set forth here. The Business Associate shall also continue to follow any required cyber security incident response procedures to the extent needed to address security issues, as determined by DoD/DHA.

VI. Termination

(a) Termination. Noncompliance by the Business Associate (or any of its staff, agents, or subcontractors) with any requirement in this BAA may subject the Business Associate to termination under any applicable default or other termination provision of the underlying Contract [FOR

STANDALONE INSERT, REPLACE WITH “this Agreement”].

(b) Effect of Termination.

(1) If this Agreement has records management requirements, the Business Associate shall handle such records in accordance with the records management requirements. If this Agreement does not have records management requirements, the records should be handled in accordance with paragraphs VI.(2) and (3) below. If this Agreement has provisions for transfer of records and

PII/PHI to a successor Business Associate, or if the Covered Entity gives directions for such transfer, the Business Associate shall handle such records and information in accordance with such

Agreement provisions or the Covered Entity’s direction.

(2) If this Agreement does not have records management requirements, except as provided in the following paragraph (3), upon termination of this Agreement, for any reason, the Business Associate shall return or destroy all PHI received from the Covered Entity, or created or received by the

Business Associate on behalf of the Covered Entity that the Business Associate still maintains in any form. This provision shall apply to PHI that is in the possession of subcontractors or agents of the

Business Associate. The Business Associate shall retain no copies of the PHI.

(3) If this Agreement does not have records management provisions and the Business Associate determines that returning or destroying the PHI is infeasible, the Business Associate shall provide to the Covered Entity notification of the conditions that make return or destruction infeasible. Upon mutual agreement of the Covered Entity and the Business Associate that return or destruction of PHI is infeasible, the Business Associate shall extend the protections of this Agreement to such PHI and limit further uses and disclosures of such PHI to those purposes that make the return or destruction infeasible, for so long as the Business Associate maintains such PHI.

VII. Notices. Any notices to be given hereunder will be made in the most expedient manner, via e-mail, facsimile, U.S. Mail, or express courier to such party’s address given below.

If to the Business Associate: If to the Covered Entity:

Attn: Attn:

Title: Title: MTF HIPAA Privacy Officer

Company: Unit:

Address: Address:

Phone: Phone:

Fax: Fax:

E-mail: E-mail:

With a copy to:

Name: Name:

Company: Title: Contracting Officer

Address: Address:

Phone: Phone:

Fax: Fax:

Email: Email:

Each party named above may change its address and that of its representative for notice by the giving of notice thereof in the manner provided in this subsection.

VIII. Miscellaneous

(a) Survival. The obligations of Business Associate under the “Effect of Termination” provision of this BAA shall survive the termination of this Agreement.

(b) Interpretation. Any ambiguity in this Agreement shall be resolved in favor of a meaning that permits the Covered Entity and the Business Associate to comply with the HIPAA Rules and the

DoD HIPAA

[USE FOR STANDALONE BAA ONLY] (c) Counterparts; Facsimiles. This Agreement may be executed in any number of counterparts, each of which shall be deemed an original. The parties acknowledge and agree that faxed and/or electronically affixed signatures shall act as original signatures that bind each faxing, or electronically affixing, signatory to the terms and provisions of this Agreement. Delivery of an executed counterpart of this Agreement by facsimile or electronic mail shall be equally effective as delivery of a manually executed counterpart.

[USE FOR STANDALONE BAA ONLY] (d) Entire Agreement; Amendment. This Agreement embodies the entire understanding between the parties pertaining to the subject matter contained in it; supersedes any and all prior negotiations, correspondence, understandings, or agreements of the parties with respect to its subject matter; and may be waived, altered, amended, modified, revised or repealed, in whole or in part, only on the written consent of the parties to this Agreement.

[USE FOR STANDALONE BAA ONLY] IN WITNESS WHEREOF, the parties have executed this Agreement as of the Effective Date.

[USE FOR STANDALONE BAA ONLY]

BUSINESS ASSOCIATE: COVERED ENTITY:

Signature: Signature:

Print name:

Print name:

Title: Title:

Date: Date:

Appendix C – Customer Complaint Record

APPENDIX C

CUSTOMER COMPLAINT RECORD

DATE/TIME OF COMPLAINT

SOURCE OF COMPLAINT

ORGANIZATION

BUILDING NUMBER

INDIVIDUAL

PHONE NUMBER

NATURE OF COMPLAINT

CONTRACT REFERENCE

VALIDATION

DATE/TIME CONTRACTOR INFORMED OF COMPLAINT

ACTION TAKEN BY CONTRACTOR

RECEIVED/VALIDATED BY

Customer Complaint Record Template, Feb 05 (SAF/AQCP) COMPLAINANT - 1

Customer Complaint Record Template, Feb 05 (SAF/AQCP) COR - 2

Customer Complaint Record Template, Feb 05 (SAF/AQCP) CONTRACTOR – 3

Customer Complaint Record Template, Feb 05 (SAF/AQCP) CONTRACT ADMINISTRATOR – 4

Appendix D – National Medical Emergency Education Standards (EMS)

Appendix D - National Medical Emergency Education Standards (EMS)

National EMS Education Standards.pdf

Appendix E – National Medical Emergency Education Standards Paramedic Instructional Guidelines

Appendix E – National Medical Emergency Education Standards Paramedic Instructional Guidelines

National EMS Education Standards_Paramedic Instructional Guidelines.pdf

Exhibit A – Contract Data Requirements List

Exhibit A – Contract Data Requirements List

CDRL A001 – Meeting Agenda

CDRL A002 – Meeting Minutes

CDRL A003 – Course Textbooks

CDRL A004 – Monthly Status/Financial Report