Draft_PWS_Teleradiology_Services.pdf

Attachment 1 January 13, 2017

PERFORMANCE WORK STATEMENT

FOR

DIAGNOSTIC RADIOLOGY, TELERADIOLOGY SERVICES

WRIGHT PATTERSON MEDICAL TREATMENT FACILITY

TABLE OF CONTENTS

SECTION TITLE PAGE

1 DESCRIPTION OF SERVICES 3

2 SERVICE SUMMARY 12

3. GOVERNMENT FURNISHED PROPERTY/EQUIPMENT 13

4. CONTRACTOR FULL-TIME EQUIVALENT 13

REPORTING

APPENDICES

A. DEFINITIONS 14

B.HIPAA REQUIREMENTS 16

C.APPLICABLE PUBLICATIONS AND FORMS 21

D.ESTIMATED WORKLOAD DATA 22

1. DESCRIPTION OF SERVICES.

1.1. SCOPE OF WORK. The Contractor shall provide Diagnostic Radiologist services via Teleradiology connecting to Air Force Information Networks (referred to hereafter as AFIN) to provide image interpretation services for the Diagnostic Imaging Flight, 88th Medical Group (88 MDG), Wright-Patterson AFB, OH, also referred to as the "military treatment facility" (MTF) herein. Contractor must currently be authorized to connect to US Air Force networks to receive diagnostic imaging studies from the MTF and to return interim and final reports of diagnoses to the

MTF.

1.1.1. The Contractor shall have and maintain an active Department of Defense Risk Management Framework (RMF) accreditation, Authorization to Operate, and Authorization to Connect for the Air Force, a DISA Business-to-Business (B2B) connection and HL-7 feed into CHCS for automatic upload into a patients file in the Electronic Medical Record (EMR). The contractor employee(s) shall possess a security clearance and DoD Common Access Card (CAC) for each radiologist/transcriptionist that is required to log into the PACS for the life of the agreement.

1.2. RELATIONSHIP OF THE PARTIES. This is a non-personal services agreement.

Contractor personnel are not subject to the supervision and control of a Government officer or employee. (FAR 37-104(a)(1)(ii)). The contractor personnel shall perform their duties IAW specific tasks outlined in this Performance Work Statement/contract. Supervisory functions and managing contractor employees, such as hiring, directing, counseling, and firing of contractor personnel are the responsibility of the contractor and performed by the contractor, not the Government.

1.3. SPECIFIC PROCEDURES FOR WHICH THE CONTRACTOR SHALL BE

RESPONSIBLE. The Contractor shall perform procedures compatible with the MTF’s operating capacity and equipment. New medical procedures/services shall not be introduced without prior recommendation and written approval of the MTF Commander or authorized representative.

1.3.1. DIAGNOSTIC IMAGING STUDIES. The contract radiologist shall interpret diagnostic imaging studies to include: radiographic, computed tomography, magnetic resonance imaging, ultrasound studies, and nuclear medicine.

1.3.1.1. The contract radiologist shall provide technical assistance in all diagnostic imaging studies (and participate in protocoling an exam if a radiologist input is necessary for administration of contrast agent or other issues).

1.3.1.2. Interpretation shall consist of medical evaluation of diagnostic imaging studies consistent with the American College of Radiology’s “Practice Parameter for Communication of Diagnostic Imaging Findings”. The radiologist shall provide interpretation and dictation on a daily basis for all services performed. The name of the interpreting radiologist shall be clearly noted on all interpretation reports.

1.3.3.3. For STATUM /Emergent studies, the preliminary read shall be completed within 1 hour (60 minutes) and final report within 4 hours (240 minutes) of receipt of the exam.

1.3.3.4. For non-emergent/routine studies, the final report shall be completed within 48 hours (2880 minutes) of receipt of the exam.

1.3.2. TRANSCRIPTIONS. The teleradiology service shall provide a final interpretation report into the CHCS within 2 days if there is a break in network connections preventing a report transfer.

This may be by facsimile, secure e-mail or other communication acceptable by the Government representatives and the MTF.

1.3.3. CONSULTATION. The radiologist who performs the teleradiology shall provide consultation for diagnostic imaging studies within one hour with MTF practitioners if MTF radiologist is unavailable.

1.3.4. MEETINGS. The designated diagnostic radiologist who performs teleradiology service shall attend meetings as requested by government personnel. Attendance can be in-person, via teleconference, or video conference based on the type of meeting and prior coordination and acceptance by the Diagnostic Imaging personnel.

1.4. GENERAL INFORMATION.

1.4.1. PERSONNEL.

1.4.1.1. POINT OF CONTACT. The Contractor shall provide a point of contact that shall be responsible for the performance of the work. The point of contact shall have full authority to act for the Contractor on all matters relating to the operation of this contract. The Contractor shall designate this individual, in writing, to the Contracting Officer and Contracting Officer Representative (COR) before the contract start date and as changes occur.

1.4.1.2. AVAILABILITY. The Contractor shall provide a point of contact who shall be available via telephone at seven (7) days a week, 24-hours per day, Monday through Sunday, including Federal Holidays.

1.4.1.3. MISSION ESSENTIAL STATUS. The teleradiology services are mission essential functions. Mission essential functions include those organizational activities that must be performed under all circumstances to achieve DoD component missions or responsibilities as outlined in DFARS 252.237-7023(a)(2).

1.4.1.4. REPLACEMENTS & ABSENCES: The contractor will maintain sufficient numbers of credentialed radiologists and arrange the radiologists’ schedule of anticipated absences to maintain adequate coverage to read exams without interruption to providing the service.

1.4.2. PERSONNEL REQUIREMENTS.

1.4.2.1. ENGLISH LANGUAGE REQUIREMENT. Personnel shall read, understand, speak, and write English.

1.4.2.2. CONFLICT OF INTEREST. The Contractor shall not employ any person who is an employee of the United States Government if the employment of that person would create a conflict of interest. The Contractor shall not employ any person who is an employee of the Department of the Air Force, either military or civilian, unless such person seeks and receives written approval in accordance with DOD Directive 5500.7 and Air Force policy.

1.4.3. PROVIDER CREDENTIALS REQUIREMENTS.

1.4.3.1. PRIVILEGING. The credentials of all providers shall be reviewed and privileges granted as outlined in the most current version of Air Force Instruction (AFI) 44-119, Medical Quality Operations. The Contractor employees shall possess the requisite credentials enabling the granting of privileges by the MTF for performance of all tasks.

1.4.3.2. Initial applications for clinical privileges, to include credentials action history, malpractice history, and completed copies of the below listed documents, shall be submitted to the MTF Credentials Committee thirty (30) calendar days from receipt of notice of contract award, and as requested by the Government. All proposed health care providers shall be available for interview by the MTF during the credentialing process.

a. Copy of valid, current, unrestricted Diagnostic Radiology license from any U.S. state and applicable Board Certification.

b. Provider education and training.

c. A signed consent for release of information.

d. Copy of Drug Enforcement Agency (DEA) certificate, if applicable.

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

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

1.4.3.3. Applications for privileges shall be screened through the National Practitioners Data Bank. The contractor shall notify the CO and 88 MDG credentialing staff of any changes to maintain the Centralized Credentials Quality Assurance System data current.

1.4.3.4. Professional staff appointments and clinical privilege actions will be based on review of documents listed, in accordance with AFI 44-119. Reappointment shall occur not less than every two (2) years, in accordance with AFI 44-119. The contractor shall report any incident that may impact the continued privileging of a physician to the CO and 88 MDG credentialing staff.

1.4.3.5. Applications for clinical privileges for replacement contract providers shall be submitted to the MTF Credentials Committee through the Government Supervisor not later than thirty (30) calendar days prior to the provider assuming duty. The credentials requirements are the same as those identified in para 1.4.3.2.

1.4.3.6. The Contractor shall provide sufficient number of employees to meet all contract requirements by the commencement date.

1.4.3.7. The Contractor must submit complete credentials applications for processing. Incomplete applications (those that do not fully comply with the requirements) will not be accepted by the Government and will be returned without action.

1.4.3.8. The Contractor must take specific action, including Primary Source Verification, to ensure that contract provider applications meet the required prerequisites for privileging and do not have disqualifying impediments for privileges at the MTF. This is a non-delegable responsibility of the Contractor.

1.4.4. INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE. The Contractor shall provide and maintain adequate liability coverage for their employees, consistent with the risks associated with the performance of all services required by this PWS/contract. Refer to Federal Acquisition Regulation (FAR) clause 52.237-7, "Indemnification and Medical Liability Insurance".

1.4.5. DENIAL/TERMINATION OF PRIVILEGES.

1.4.5.1. Actions to limit, suspend, or revoke clinical privileges shall be in accordance with the procedures outlined in AFI 44-119, Medical Quality Operations.

1.4.5.2. The CO and the Contractor shall be notified by the Government Supervisor of denial/termination of privileges. The CO and Contractor shall have copies of documentation initiating the revocation process.

1.4.6. EDUCATION AND TRAINING REQUIREMENTS.

1.4.6.1. EDUCATION. The contract provider shall provide a Doctor of Medicine or Doctor of Osteopathic Medicine degree.

1.4.6.2. LICENSURE/REGISTRATION. The contract provider shall possess a valid unrestricted license from any U.S. state to practice Diagnostic Radiology.

1.4.6.3. BOARD CERTIFICATION. The provider shall successfully complete a certification examination and be certified by the American Board of Radiology (ABR) or the American Osteopathic Board of Radiology (AOBR) in Diagnostic Radiology.

1.4.7. HOURS OF OPERATION. The contract employee(s) shall provide services seven (7) days per week, twenty-four (24) hours per day, Monday through Sunday on an "as-required" basis.

Diagnostic imaging studies shall be given to the contractor’s teleradiology service and coordinated with the MTF to ensure that the complete study is received by the service.

The interim and final reports of interpretation shall be received by the MTF within the time limits specified by MTF policies, national standards of care and this PWS.

1.4.8. ON CALL/AFTER DUTY RESPONSE TIME. The contractor shall provide "as-needed" on-call services seven (7) days per week, twenty-four (24) hours per day, Monday through Sunday.

1.4.9. FEDERAL HOLIDAYS. Contract personnel shall provide service “as needed” on recognized Federal Holidays during the period of the contract. The recognized Federal Holidays and the days they are observed can be found on the US Office of Personnel Management website at the web address http://www.opm.gov/operating_status_schedules/fedhol/2015.asp. The Federal Holidays include: New Year’s Day, Martin Luther King, Jr's Birthday, Presidents' Day, Memorial Day, Independence Day, Labor Day, Columbus Day, Veterans Day, Thanksgiving Day, and Christmas Day.

1.4.10. MEDICAL QUALITY ASSURANCE/RISK MANAGEMENT (QA/RM).

1.4.10.1. Health care providers shall participate in Quality Assurance/Risk Management QA/RM) activities as required by AFI 44-119 and the individual MTF QA/RM plan or regulation.

1.4.10.2. The Government shall conduct inspections under the Inspection of Services clause.

Inspections will include a review and evaluation of the provider's professional qualifications, as differentiated from administrative, per quality assurance standards specified in AFI 44-119.

1.4.11. ORIENTATION. The Contractor employees shall participate in the MTF orientation and service/clinic specific orientation prior to furnishing services under this contract, if required by the MTF. Clinic orientation must occur within five (5) duty days of employment start date. Medical Center orientation shall be accomplished within thirty (30) calendar days of employment start date.

1.4.12. CONTINUING MEDICAL EDUCATION (CME) REQUIREMENTS. Health care certified providers shall continue to meet the standards for CME to remain current as prescribed in AFI 41-117, Chapter 4. CME shall be obtained at no additional cost to the Government and shall be reported in writing to the Government point of contact (POC) and MTF Credentials Committee within forty-five (45) days of the beginning of the contract. Periodic CME may be conducted at the MTF and available, at no cost, to any healthcare provider.

1.4.13. ANNUAL TRAINING REQUIREMENTS. All contract employees must complete annual training required IAW federal law and Air Force instruction, to include, but not limited to Healthcare Insurance Portability and Accountability Act (HIPAA) mandates, The Joint Commission (TJC) requirements, USAF Computer Security Policy, and USAF Safety Policy.

Certificates received upon completion are maintained by the Contractor with copies provided to the Government upon request. Training will be provided by the MTF, and can be of the form, but not limited to, in-residence briefings, readings, multimedia computer presentations, and via other DOD web sites and web services. Information regarding TJC standards is found at this website:

http://www.jointcommission.org/standardsinformation/standards.aspx

1.4.14. MTF PROVIDER DIRECTORY. Contract providers shall provide information for paper and web-based MTF provider directory. Credentialed providers shall include information such as first and last name, degree, specialty, board status, office telephone and fax number, and licensing information. A picture of the provider is optional.

1.4.15. GOVERNMENT COMPUTER ACCESS. The contractor employees shall comply with the requirement to obtain the minimum personnel security investigations as prescribed by DODI 5200.2-R and AFI 3 1-501, paragraphs 3.27.3.7 to 3.27.3.7.2. The contractor shall work with the MTF to ensure that the pre-employment screening process for each employee classified as ADP I, II, III (as defined in DODI 5200.2-R) includes the appropriate investigations and that each contract employees have the appropriate questionnaires and forms to be completed. All completed forms will be reviewed by the contractor and forwarded to the MTF for processing. The contractor understands that, while the MTF Commander may allow contractor personnel to temporarily occupy non-critical sensitive positions pending National Agency Check (NAC), employee will be immediately removed from the position if at any time the NAC receives unfavorable adjudication, or, if other unfavorable information that would affect the NAC becomes known.

1.4.16. CUSTOMER COMPLAINTS. Any customer complaints regarding professional services or care rendered will be discussed and documented in writing as part of MTF process improvement initiatives.

1.4.17. EMERGENCY HEALTH CARE. The MTF will provide emergency health care for contract personnel for injuries occurring while on duty in the MTF. These services will be billed to the Contractor at the current full reimbursement rate.

1.4.18. THE JOINT COMMISSION (TJC) AND THE AIR FORCE INSPECTION

PROGRAM. The Contractor shall meet all applicable standards during the performance of this contract. The 88 MDG Organizational Improvement Office provides all MDG staff members with training and resources on inspection compliance.

1.4.19. RECORDS. The Contractor shall create, maintain, and dispose of only those Government records related to patient diagnosis and care, mandatory training, regulatory compliance documentation, or as directed by the Diagnostic Imaging (DI) Flight Commander, the DI Director of Medicine, or the COR. If requested by the Government, the Contractor shall provide the original record or a reproducible copy of any records within specified time frame.

1.4.20. PATIENT LISTS. All patient lists, no matter how developed, shall be treated as privileged information. Lists and/or names of patients shall not be disclosed to or revealed in any way to any unauthorized person or for any use outside the MTF without prior written permission by the Chief of Hospital Services, in accordance with federal law, and Air Force and Medical Group Instructions, to include the Privacy Act, the Health Insurance Portability and Accountability Act (HIPAA) (see Appendix 2), and AFI 41-210, TRICARE Operations and Patient Administration Functions.

1.4.21. COMPUTER SECURITY. A National Agency Check must occur for clearance for appropriate security of privacy act information. Contractor shall complete a SF85P Worksheet and providing fingerprint cards for each employee with the hiring process, complying with regulations, DODI 5200.2-R, Appendix K and AFSSSI 5027, Section 5.3.3.

1.4.22. RELEASE OF MEDICAL INFORMATION. The provider shall only release medical information obtained during the course of this contract to other MTF staff involved in the care and treatment of that individual patient. All patient information will comply with HIPAA standards.

1.4.23. COMMUNICATION. The Contractor shall ensure contract providers maintain open and professional communication with providers in the MTF. Complaints validated by the COR and Chief of the Medical Staff shall be reported in writing to the contract administrator and the Contractor for action. Failure of the Contractor to correct validated complaints raised by the MTF staff and the CO will be considered a failure to perform.

1.4.24. PERFORMANCE EVALUATION MEETINGS. The Contractor or his representative shall meet with the CO, contract administrator, Government Supervisor, and other government personnel at least quarterly, and as requested. The Contractor may request a meeting with the CO as necessary. Meetings will be documented in the contract file with written minutes signed by the Contractor and the CO. Should the Contractor not concur with the minutes, such non-concurrence shall be provided in writing to the CO within ten (10) calendar days of receipt of the minutes.

1.4.25. DOCUMENTATION. All contract personnel shall prepare all documentation to meet established standards of the MTF to include but not limited to: timeliness, legibility, accuracy, content and signature. Only MTF and Air Force approved abbreviations shall be used to document of care in the health care record. A list of these abbreviations is provided to all staff members upon in-processing and during period MDG training, and is available on the MDG internal website.

Contractor personnel shall complete patient identifying information is on all documentation that is part of the health care record. Contract providers shall review other providers' medical records as required by the Diagnostic Imaging Flight Commander or Director of Medicine for quality assurance, accuracy and compliance with the standard of care. Corrections to documentation will be made by the Government.

1.4.26. OTHER SUPPORT. Contract personnel shall provide evaluation and management of emergency cases. During medical emergencies or patient care during a disaster response the contractor shall provide support to other providers and staff members within the MDG.

1.4.27. CONTINUATION OF CONTRACTOR SERVICES DURING BASE

EXCERCISES, LOCAL EMERGENCIES OR CONTINGENCIES, AND

IMPLEMENTATION OF LOCAL CONTINGENCY PLANS.

1.4.27.1. It has been determined that all services specified in the PWS/contract shall be performed during (and/or in support of, whichever is appropriate) base exercises, local emergencies or contingencies and implementation of local contingency plans. However, the Contracting Officer will notify the contractor in the event that the contractor is relieved from performing any of the services during base exercises, local emergencies or contingencies or implementation of local contingency plans.

1.4.27.2. The Government establishes contingency plans and training missions to support mobilization and national emergencies, and to augment local Governments in the event of natural disasters. The Government must be able to react to such events without undue delay. These sudden or unusual events may impact the Contractor’s operations. The Contractor shall provide the tasks as required by this PWS to support a contingency operation or exercise of contingency plans 7 days a week, 24 hours a day, for the duration of the contingency or exercise (4-5 times per year).

Examples of such events include natural disasters (e.g., tornados, major storms, flash floods);

exercises, mobilizations, deployments, or sudden buildup of forces (e.g., war, police action, international crisis, and civil disturbance), including backfill of Contractor personnel in the event of activation, draft or recall to active duty; terrorism or other threats to personnel or property;

utility outages; and local Government emergencies (e.g., accidents and fires).

2. SERVICE SUMMARY.

Performance Objective PWS Para Performance Threshold SS-1. Contractor arranges for replacement staff

1.4.1.4. 100 % Compliance

SS-2. Contractor point of contact is available for performance issues

1.4.1.1. 100 % Compliance

SS-3. Providers maintain appropriate licensure

1.4.6.2. 100% Compliance

SS-4. Providers maintain appropriate board certification

1.4.6.3. 100% Compliance

SS-5. Contractor point of contact attends meetings as requested

1.3.4. 100% Compliance

SS-6. Contractor submits proof of Continuing Medical Education to credentials office and Government point of contact

1.4.12. 100% Compliance

SS-7. Contract personnel complete required Annual Trainings

1.4.13. 100% Compliance

SS-8. Contractor provides the MTF with a Provider Directory

1.4.14. 100% Compliance

SS-9. Contract personnel in compliance with security investigations to receive Government computer access

1.4.15. 100% Compliance

SS-10. Interpretation of medical evaluation of diagnostic imagining studies completed within specified time frame.

1.3.3.3. 100% Compliance

SS-11. Interpretation of medical evaluation of diagnostic imagining studies completed within specified time

1.3.3.4. 100% Compliance

3. GOVERNMENT –FURNISHED PROPERTY AND SERVICES.

3.1. The government did not provide any property or services to the contractor for this contract.

3.2. All digital images and accompanied data shall remain the property of, and subject to the exclusive control of the U.S. Government. All related reports, images, and documents prepared by the contractor for diagnostic imaging interpretation and support in fulfillment of this contract will become the property of the U.S. Government

4. CONTRACTOR FULL-TIME EQUIVALENT REPORTING.

The contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract for the 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.

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 reported no later than 31 October* of each calendar year. Contractors may direct questions to CMRA help desk.

*REPORTING PERIOD: Contractors are required to input data by 31 October of each year.

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.

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.

APPENDIX A – DEFINITIONS

DEFINITIONS. As used throughout this work statement, the following terms shall have the meaning set forth in accordance with the terms of this PWS and the contract.

ADMINISTRATIVE CONTRACTING OFFICER (ACO). A person duly appointed with the authority to enter into, administer, and terminate contracts on behalf of the Government.

BASIC LIFE SUPPORT (BLS) CERTIFICATION: Also known as CPR or cardiopulmonary training; required every 2 years for all personnel, including contract personnel, working at the

MTF.

CLINICAL PRIVILEGES. Those inpatient and ambulatory clinical activities permitted the provider in the granting medical treatment facility (MTF) after evaluation by the credentials function and approved by the medical center commander.

CONTRACT PROVIDER. Any healthcare personnel providing medical services at this MTF who are either directly employed by, or who provide services pursuant to a contract with the Contractor.

CREDENTIALS. Documents providing evidence of education, training, licensure, experience, board certification and expertise of a health care provider.

CREDENTIALS FUNCTION. The professional body set up to review credentials, make recommendations on clinical privileges for providers, and to promote quality control in professional practice.

HEALTH CARE PROVIDER. Any contract healthcare professional who, under regulations of a Military Department, is granted clinical practice privileges in a military MTF or Dental Treatment Facility or who is licensed or certified to perform healthcare services by a Governmental board or Agency or professional health care society or organization.

HEALTH CARE WORKER. Abbreviated HCW; Another term for a health care provider.

MILITARY TREATMENT FACILITY (MTF). Air Force hospitals or clinics, including all activities providing outpatient and/or in-patient healthcare services for authorized personnel.

PERFORMANCE WORK STATEMENT (PWS). A document that describes a service in terms of the output requirements.

PREPRIVILEGING. The application of a screening process whereby prospective DoD healthcare providers, required to be privileged to provide patient care within MTFs, have their education, training, and past performance evaluated preliminary to their being considered for an active contractual relationship.

PRIMARY SOURCE VERIFICATION. The verification in writing or by documented telephone conversation from the original medical or nursing school, training or residency program, licensing or certifying boards, etc. The training and credentials claimed by a health care provider and used in the privileging process.

PRIVILEGING. Frequently referred to as credentialing. The process whereby the medical center commander, or the major command surgeon general, upon recommendations from the MTF credentials function, grants to individual health care providers the privileges and responsibility of providing specified medical and dental care within the MTF.

QUALITY IMPROVEMENT/RISK MANAGEMENT (QI/RM) COMMITTEE. Committee responsible for the execution of the MTF QI/RM plans to include the duties outlined in AFI 44-

119. The committee ensures an ongoing assessment of the quality and appropriateness of all medical care and will put in priority sequence suspected problems for evaluation, resolution, and follow-up.

QUALITY IMPROVEMENT/RISK MANAGEMENT (QI/RM) PLAN. An organized document which describes the methods of doing QI reviews within the MTF. It designates the areas of responsibility and accountability for the QI program and the mechanisms for monitoring and evaluating patient care. It is consistent with The Joint Commission (TJC) monitoring and evaluation (M&E) approach and Air Force risk management (RM) efforts.

QUALITY CONTROL (QC). Those actions taken by a Contractor to control the quality of output of service and to ensure that they conform to contract requirements and standards of medical care.

VALID LICENSE. A grant of permission by an official agency of the District of Columbia, a state, commonwealth, or territory of the United States to provide care independently as a health care professional. Licenses must be current.

APPENDIX B – HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT

(HIPAA) OF 1996 REQUIREMENTS

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) OF

1996. All individuals performing services at the 88th Medical Group are required to complete HIPAA Act of 1996 Privacy Rule training and will be held accountable for complying with the 88th Medical Group's specific health information privacy policies and procedures:

PRIVACY AND SECURITY OF PROTECTED HEALTH INFORMATION

(a) Definitions. As used in this clause:

Individual has the same meaning as the term "individual" in 45 CFR 164.501 and

164.103 and shall include a person who qualifies as a personal representative in accordance with 45 CFR 164.502(g).

Privacy Rule means the Standards for Privacy of Individually Identifiable

Health Information at 45 CFR part 160 and part 164, subparts A and E.

Protected Health Information has the same meaning as the term

''protected health information" in 45 CFR 164.501, limited to the information created or received by The Contractor from or on behalf of The Government.

Required by Law has the same meaning as the term "required by law" in

45 CFR 164.501 and 164.101

Secretary means the Secretary of the Department of Health and Human

Services or his/her designee.

Security Rule means the Health Insurance Reform: Security Standards at 45

CFR part 160, 162 and part 164 subpart C.

Terms used, but not otherwise defined, in this Agreement shall have the same meaning as those terms in 45 CFR 160.103, 164.501 and 164.304.

(b) The Contractor agrees to not use or further disclose Protected Health

Information other than as permitted or required by the Contract or as Required by Law.

(c) The Contractor agrees to use appropriate safeguards to prevent use or disclosure of the Protected Health Information other than as provided for by this Contract.

(d) The Contractor agrees to use administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic protected health information that it creates, receives, maintains, or transmits in the execution of this Contract.

(e) The Contractor agrees to mitigate, to the extent practicable, any harmful effect that is known to the Contractor of a use or disclosure of Protected Health Information by the Contractor in violation of the requirements of this Contract.

(f) The Contractor agrees to report to the Government any security incident involving protected health information of which it becomes aware.

(g) The Contractor agrees to report to the Government any use or disclosure of the Protected Health Information not provided for by this Contract.

(h) The Contractor agrees to ensure that any agent, including a subcontractor, to whom it provides Protected Health Information received from, or created or received by the Contractor on behalf of the Government agrees to the same restrictions and conditions that apply through this Contract to the Contractor with respect to such information.

(i) The Contractor agrees to ensure that any agent, including a subcontractor, to whom it provides electronic Protected Health Information, agrees to implement reasonable and appropriate safeguards to protect it

(j) The Contractor agrees to provide access, at the request of the Government, and in the time and manner designated by the Government to Protected Health Information in a Designated Record Set, to the Government or, as directed by the Government, to an Individual in order to meet the requirements under 45 CFR 164.524.

(k) The Contractor agrees to make any amendment(s) to Protected Health

Information in a Designated Record Set that the Government directs or agrees to pursuant to 45 CFR 164.526 at the request of the Government or an Individual, and in the time and manner designated by the Government.

(l) The Contractor agrees to make internal practices, books, and records relating to the use and disclosure of Protected Health Information received from, or created or received by the Contractor on behalf of, the Government, available to the Government, or at the request of the Government to the Secretary, in a time and manner designated by the Government or the Secretary, for purposes of the Secretary determining the Government's compliance with the Privacy Rule.

(m) The Contractor agrees to document such disclosures of Protected Health

Information and information related to such disclosures as would be required for the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

(n) The Contractor agrees to provide to the Government or an

Individual, in time and manner designated by the Government, information collected in accordance with this Clause of the Contract, to permit the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

General Use and Disclosure Provisions

Except as otherwise limited in this Agreement, the Contractor may use or disclose Protected Health Information on behalf of, or to provide services to, the Government for the following purposes, if such use or disclosure of Protected Health Information would not violate the Privacy Rule, the Security Rule or the Department of Defense Health Information Privacy Regulation if done by the Government: [List Purposes].

Specific Use and Disclosure Provisions

(a) Except as otherwise limited in this Agreement, the Contractor may use Protected Health Information for the proper management and administration of the Contractor or to carry out the legal responsibilities of the Contractor.

(b) Except as otherwise limited in this Agreement, the Contractor may disclose Protected

Health Information for the proper management and administration of the Contractor, provided that disclosures are required by law, or the Contractor obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and used or further disclosed only as required by law or for the purpose for which it was disclosed to the person, and the person notifies the Contractor of any instances of which it is aware in which the confidentiality of the information has been breached.

(c) Except as otherwise limited in this Agreement, the Contractor may use Protected

Health Information to provide Data Aggregation services to the Government as permitted by 45 CFR 1 64.504(e)(2)(i)(B).

(d) Contractor may use Protected Health Information to report violations of law to appropriate Federal and State authorities, consistent with 45 CFR 164.502(j) (1).

Obligations of the Government

Provisions for the Government to Inform the Contractor of Privacy Practices and Restrictions

(a) Upon request the Government shall provide the Contractor with the notice of privacy practices that the Government produces in accordance with 45 CFR 164.520, as well as any changes to such notice.

(b) The Government shall provide the Contractor with any changes in, or revocation of, permission by Individual to use or disclose Protected Health Information, if such changes affect the Contractor's permitted or required uses and disclosures.

(c) The Government shall notify the Contractor of any restriction to the use or disclosure of Protected Health Information that the Government has agreed to in accordance with 45 CFR 164.522.

Permissible Requests by the Government

The Government shall not request the Contractor to use or disclose Protected Health Information in any manner that would not be permissible under the Privacy Rule if done by the Government, except for providing Data Aggregation services to the Government and for management and administrative activities of the Contractor as otherwise permitted by this clause.

Termination

(a) Termination. A breach by the Contractor of this clause, may subject the Contractor to termination under any applicable default or termination provision of this Contract.

(b) Effect of Termination.

(1) If this contract has records management requirements, the records subject to the

Clause should be handled in accordance with the records management requirements. If this contract does not have records management requirements, the records should be handled in accordance with paragraphs (2) and (3) below:

(2) If this contract does not have records management requirements, except as provided in paragraph (3) of this section, upon termination of this Contract, for any reason, the Contractor shall return or destroy all Protected Health Information received from the Government, or created or received by the Contractor on behalf of the Government. This provision shall apply to Protected Health Information that is in the possession of subcontractors or agents of the Contractor. The Contractor shall retain no copies of the Protected Health Information.

(3) If this contract does not have records management provisions and the

Contractor determines that returning or destroying the Protected Health Information is infeasible, the Contractor shall provide to the Government notification of the conditions that make return or destruction infeasible. Upon mutual agreement of the Government and the Contractor that return or destruction of Protected Health Information is infeasible, the Contractor shall extend the protections of this Contract to such Protected Health Information and limit further uses and disclosures of such Protected Health Information to those purposes that make the return or destruction infeasible, for so long as the Contractor maintains such Protected Health Information.

Miscellaneous

(a) Regulatory References. A reference in this Clause to a section in the Privacy Rule or Security Rule means the section as in effect or as amended, and for which compliance is required.

(b) Survival. The respective rights and obligations of Business Associate under the "Effect of Termination" provision of this Clause shall survive the termination of this Contract.

(c) Interpretation. Any ambiguity in this Clause shall be resolved in favor of a meaning that permits the Government to comply with the Privacy Rule or Security Rule.

APPENDIX C – APPLICABLE PUBLICATIONS AND FORMS

Publications and forms applicable to the PWS are listed below, but this list is not all-inclusive. The Contractor is obligated to follow the most current published version of these publications. These publications are available at http://www.e-publishing.af.mil/ and maintained by USAF and DOD publishing, and Medical Group publications are maintained by the hospital and can be obtained from the COR or Government representative in the facility. Supplements or amendments to listed publications from any organizational level may be issued during the life of the contract. All of the publications are applicable in its entirety.

1. DEPARTMENT OF DEFENSE (DOD) INSTRUCTIONS AND DIRECTIVES

DOD Directive 5500.7, Standards of Conduct

2. AIR FORCE INSTRUCTIONS, HANDBOOKS, AND PAMPHLETS

AFI 41-117, Medical Service Officer Education AFI 44-119, Medical Quality Operations AFI 48-148, Ionizing Radiation Protection

3. 88TH MEDICAL GROUP INSTRUCTIONS

MDGI 3 1-102, Resource Protection Program MDGI 40-134, Medical Use of Radioactive Materials and Radiation Protection MDGI 41-134, Health Information Privacy MDGI 44-112, Infection Control Program

4. American College of Radiology, ACR Practice Parameter For Communication Of Diagnostic Imaging Findings.

APPENDIX D – ESTIMATED WORKLOAD DATA

The following workload data represent the Government's best estimate of the volume of expected teleradiology work for twelve months shown for each item listed, based on data from the Fiscal Years 2011 through 2015. This exhibit is not intended to cover all of the workload items, but lists the major categories of work outside of regular business hours.

PROCEDURES ESTIMATED QUANTITY

(Selected modalities) (number of exams) Computed Radiography 1,200 Computed Tomography 1,800 Magnetic Resonance Imaging 600 Ultrasound 600 Nuclear Medicine 75 Total Procedures 4,275