HT0011-12-R-0009 Amendment.doc

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 30 - BLOCK 14 CONTINUATION PAGE

The following have been added by full text:

CHANGE PAGE

E - Below are the Amendments to the RFP:

· C.2.2.1.6.3, Third line, Add the word “The” before SC/Unit Group Event Point.

· C.2.2.2.6, Last bullet point, Second Line, Removed “and Health Records Custodian (HRC) for USCG/USCGR.

· Section E, Below the Performance Standards Summary Matrix, Removed “*To be agreed upon post award based on proposed criteria from the (Contractor)”.

· Section F, Deliverables, d. Deliverable Schedule, Deliverable 42, Added “Quarterly” under the Subsequent column.

· Section G, Key Government Personnel, Acquisition Manager, Changed the Address to “14501 George Carter Way – Suite #105, Chantilly, VA 20151) Voice: 703-735-4390 Fax: 703-735-4944”.

· L.4.1.2, Third bullet point, changed the word vaccinations to “vaccines”.

· L.4.3.4.3, Second line, changed Attachment 11 to “Attachment 26”.

· M.4.1, Line two, deleted the word “color”.

· M.6.3, Sub-factor 3.3, line 8, changed PBSOW to “PWS”.

SECTION C - DESCRIPTIONS AND SPECIFICATIONS

The following have been modified:

PERFORMANCE WORK STATEMENT

Section C - Descriptions and Specifications

PERFORMANCE WORK STATEMENT

PERFORMANCE WORK STATEMENT

C.1.0 Background

C.1.1 Scope

This Performance Work Statement (PWS) provides health readiness support services to the Service Components (SC), which are composed of the Reserve Components (RC), Active Components (AC) and Department of Defense (DoD) civilians. This requirement provides services to meet the necessary medical and dental standards and requirements essential in maintaining a deployable force.

Reserve Health Readiness Program (RHRP) services include immunizations, physical examinations, Periodic Health Assessments (PHA), Post-Deployment Health Reassessments (PDHRA), Mental Health Assessments (MHA), dental examinations and x-rays, dental treatment, laboratory services, occupational health services, and other services as required to satisfy SC health readiness needs. The Integrated Network (IN) will consist of the Contractor’s network of private sector providers (physician and dentist offices and clinics and individual Health Care Professionals [HCPs]).

These services are provided in every state, U.S. Territory, the District of Columbia, and Germany, in group events (gatherings of Service Members [SMs] for provision of services face-to-face) at SC-designated sites (e.g., Armories, drill halls), through the Contractor’s Call Center, and within the Integrated Network. Group events occur when daily minimums for services are met and while typically over a weekend, can last anywhere from one (1) day to thirty-one (31) days at a single location.

The SC requirements vary widely depending upon a number of factors to include time of year, deployment cycle, time of the month, and competing demands. Therefore, the Contractor must be able to meet surges in the demand for various services. The greatest requirement thus far was a week in which more than 18,600 PHAs, 16,500 dental examinations, 52,000 immunizations, 6,550 audiograms, 13,900 blood draws, 3,300 panograph x-rays, 3,150 EKGs, and 19,550 vision screens were requested to be conducted in 351 locations in 49 states and Territories. Almost 4,200 professional and administrative staff were at these group events, using almost 1,900 Contractor-purchased laptops. Monthly ranges over the last two years for completed PHAs, dental examinations, and immunizations conducted in group events have been 7,000 to 26,000, 8,000 to 24,000, and 7,000 to 61,000, respectively. For services in the Contractor network, the monthly ranges for completed numbers for PHAs, dental examinations, and immunizations are 5,000 to 10,000, 3,000 to 5,000, and 2,000 to 5,000 respectively. For the PDHRAs, the monthly ranges have been from 1,200 to 7,000 in group events and 3,900 to 8,500 in the call center.

The SCs are governed by rules and regulations of their parent Services. All references to regulations, forms or electronic information systems of a SC refer to that of its parent Service, unless it is a DoD regulation, form or electronic information system, or if it is a SC specific system not used by the parent Service.

Note: AC services will be limited to PDHRA, Mental Health Assessments, and Individual Medical Readiness requirements for SMs in geographically remote areas. Services to DoD civilians will be limited to deployment readiness services required by DoD Directives or their parent DoD agency and will be provided to DoD civilians working/residing in areas geographically remote from military or other DoD medical facilities C.1.2 Objectives

The Contractor shall develop, administer, train, and coordinate a nationwide network of private sector HCPs used to provide health readiness services in support of the SC, shall obtain and distribute necessary supplies to all involved parties; and shall receive and process all medical documentation, paper and electronic, related to services delivered within this PWS.

C.1.3 Non-Personal Services

This award identifies services that are strictly non-personal in nature as defined by FAR Section 37.101 “Definitions” and described at FAR Subpart 37.4 “Nonpersonal Health Care Services.”

C.1.4 Inherently Governmental Functions

This requirement has been reviewed and contains no services that are inherently governmental functions, as defined in FAR Section 2.101“Definitions” and FAR Subpart 7.5 “Inherently Governmental Functions.”

C.2.0 CONTRACT ADMINISTRATION

C.2.1 Contract Management The Contractor shall provide contract/project administration to ensure that tasks are performed efficiently, accurately, on-time, and in compliance with the requirements of this contract. Specifically, the Contractor shall designate a single manager to oversee this contract. In addition to the Government-approved plans for provision of various services that will be provided during the Incoming Transition period, the Government reserves the right to have the Contractor provide management plans as new services are developed or significant changes to the service delivery process is envisioned.

C.2.1.1 Non-Disclosure Agreement

Prior to performing work under the contract, the Contractor shall sign one copy of the non-disclosure agreement (Attachment 3) on behalf of their company and shall also ensure that all staff including all employees, subcontractors and consultants assigned to or performing under this PWS, execute, sign, and adhere to the terms of the non-disclosure agreement (Deliverable 1).

C.2.1.2 Reports

A matrix of reports currently received is in Attachment 14. A draft of all proposed reports shall be provided to the Government within 60 calendar days after date of award and the Government shall either approve or propose modifications to those reports within 15 work days of receipt (Deliverable 48). The Contractor can expect reports to evolve as the contract matures. The Contractor can expect at least three work days’ notice before a report is due unless there are extenuating circumstances, e.g., Congressional or senior DoD request.

C.2.1.2.1 Monthly Progress Reports (MPR) The Contractor shall submit a MPR (Deliverable 2) of services provided, by the 15th of each month, and shall include at a minimum the following: command, provider name and site, individual names and services provided, and costs to RHRP from the Contractor. The MPR will outline expenditures, billing (purchase order detail), progress, status, and any problems/issues encountered performing this task. The Contractor shall submit a copy of the MPR electronically to the Contract Officer Representative (COR); (See Section G for address). As part of the MPR, the Contractor shall supply reports as required by the COR and SCs including but not limited to the number of services by service type and location (group event vs. in-clinic [i.e., within the Contractor network]) provided to members of each Component both for the current month and fiscal year to date by month, and a summary of any Unusual Incidents/Adverse Reactions/Emergent Referrals to include the action taken and Specialist/Consultation Referrals. The Contractor will provide other reports on a monthly basis to include but not be limited to procedure frequency and avoidable costs (no-shows/cancellations) (Deliverable 10); Individual Medical Readiness (IMR) metrics (e.g., dental classification, PHA deployability) (Deliverable 13); speed of entry into SC databases (Deliverable 19); customer satisfaction survey results including resolution of complaints (Deliverable 20); accessibility to the Customer Service, PDHRA, and other service-related toll-free telephone lines (Deliverable 38); the rapidity of response to SC requests for group events (Deliverable 46); and adherence to report schedule (Deliverable 47) to the COR, who will forward aggregated results to the SC.

The customer satisfaction survey reports shall include a summary of all less than satisfactory responses and the resolution of those responses, including total number of less than satisfactory responses appropriately grouped into the following categories: PHA/IMR/Dental Group Event, PHA Call Center/In-Clinic, PDHRA Group Event, PDHRA Call Center, PHA, Medical, and Dental in-clinic services, and Point of Contact (POC) surveys for Group events for each of PDHRA, IMR, Dental, and PHA/IMR/Dental Services. The satisfaction survey categories shall include the total number of individual surveys returned. Additionally, the Contractor shall detail the aforementioned categories in terms of SC breakdown and shall have the capability to track services and complaints by provider and clinic.

C.2.1.2.2 Annual Summary Report

The Contractor shall provide an Annual Summary Report (Deliverable 6) of services rendered by category, with an overview of the services provided throughout the contract period and shall include any requested changes for the future. This report shall provide a summary of the preceding contract period for services and charges using the same requirements as the MPR. The Contractor shall submit the Annual Summary Report in electronic form to the COR. The Contractor shall provide this report thirty (30) Days After (DA) each contract year.

C.2.1.2.3 DoD Unusual Incidents/Adverse Reaction/Emergency Referral Report

The Contractor shall notify the COR within one working day of the contractor’s awareness of any incident that may have or will result in risks to health and safety or any event which could result in a legal claim or media coverage. Legible notification must be made on DoD Unusual Incidents/Adverse Reaction Report (Deliverable 7) which shall include client identity, provider identity and contact, location, date, time, circumstances, action, notifications and follow-up. The Contractor shall include a description of the service being provided at the time of the Unusual Incident/Adverse Reaction/Emergency Referral. An unusual incident is when during the course of provision of service something unusual occurs that may have or will result in risks to health and safety or any event which could result in a legal claim or media coverage, e.g., Service Member (SM) fainting during a blood draw, all falls, accidents or injuries even if no significant injury occurred, medical errors made by the healthcare providers, or a SM becoming extremely belligerent about a service and stating she or he was going to complain to their Congressional representative. The Vaccine Adverse Event Reporting System (VAERS) report is completed when an adverse reaction (e.g., rash) is possibly due to a vaccine. An Emergency Referral report is required when there is any significant occurrence or extraordinary event which requires immediate care or assessment because of an acute or unstable health condition, e.g., very high blood pressure, high risk behavioral health issues expressed by SM or identified by healthcare professional, suicide risk, and/or if the SM is turned over to Command, sent to the VA or Emergency Department, etc. In addition, the Contractor shall notify the SM’s command within one working day of the Contractor’s awareness of the incident. Listings of these reports will be included in the MPR.

C.2.1.2.4 SC-Specific Reports SCs require reports detailing completed and to-be-completed activity on a monthly basis (Deliverable 8).

C.2.1.2.5 Other Reports As the contract evolves, the COR will require new or revised reports to better manage the program and assist the SCs. These reports shall be based on data the Contractor currently obtains and the format and timing of the reports will be determined by the COR and the Contractor.

C.2.1.2.6 Training

The Contractor shall provide for the Government’s approval materials to achieve the training required within this PWS as part of the Transition Plan (Deliverable 3) and not later than 10 working days prior to implementation of new service processes or requirements (Deliverable 50). Training materials developed for the purpose of this contract shall be the property of the Government.

C.2.1.3 Transition Support

a. Incoming Transition

The Government has allowed for a four (4) month transition period from the date of contract award, after which the incoming Contractor is expected to provide the full complement of RHRP services to meet the SCs’ needs. Upon award, the Contractor shall collaborate with the Government to develop and deliver a final Transition Plan (Deliverable 3). The Government will also designate a transition period for the incoming Contractor to coordinate and work with Government representatives. This transition plan shall include as applicable, but is not limited to:

· Coordination with Government representatives,

· Review, evaluation and transition of current reporting services,

· Transition of historic data to incoming Contractor systems,

· Government-approved training and certification processes,

· Government-approved plans for provision of various services,

· Orientation phase and program to introduce Government personnel, programs, and users to the Contractor's team, tools, methodologies, computer equipment, provider and staff training, and business processes, etc.,

· Transfer of all necessary documentation,

· Distribution of Contractor-purchased, Government owned assets, including facilities, equipment, furniture, phone lines, computer equipment, etc.,

· Transfer of Government Owned Property and Government Furnished Information (GFI), and

· Government Owned Property inventory management assistance.

b. Outgoing Transition

The Contractor shall provide a plan (Deliverable 4) for outgoing transition of four (4) months for transitioning work from an active contract/order to a follow-on contract/order or Government entity. This transition may be to a Government entity, another Contractor or to the incumbent Contractor under a new contract/order. In accordance with the Government-approved plan, the Contractor shall assist the Government in planning and implementing a complete transition from this Contract and/or orders issued under this Contract to a successor entity. This shall include formal coordination with Government staff and successor staff and management and weekly or as requested status updates with the Government staff. It shall also include delivery of electronic copies of existing policies and procedures, and delivery of required metrics and statistics. This transition plan shall include as applicable, but is not limited to:

· Coordination with Government representatives,

· Review, evaluation and transition of current support services,

· Transition of historic data to incoming Contractor systems,

· Government-approved training and certification process,

· Transfer of all necessary documentation,

· Transfer of Government Owned Property, Equipment and GFI, and

· Government Owned Property inventory management assistance.

C.2.1.4 Quality Control and Improvement Plan

The Contractor shall establish, maintain, and submit a prospective Quality Control and Improvement Plan (QCIP) with proposal submission and provide a finalized plan within thirty (30) days of contract award (Deliverable 5). Following Government approval of this plan, the Contractor shall implement the plan, ensuring that all Contractor activities and products are consistent with the plan. The Contractor shall submit designated and accepted management reports on a monthly basis following contract award. A QCIP is an organized written document which outlines the Contractor’s own steps to control the quality of the output, ensure conformance to contract requirements and reasonable standards of healthcare, and seek improvements in program effectiveness, efficiency, and quality. The plan shall include initiatives and self-reviews to ensure that services are provided on a timely and quality basis, that network HCPs meet contract requirements, that records are properly maintained, that Government databases are updated quickly and accurately, and the level of service remains high. The plan shall also include government-approved satisfaction surveys (Deliverable 20) made available to SMs upon completion of the service and the lead unit POC for group events.

C.2.1.5 Post Award Conference

A post award conference (Deliverable 24) shall be required within ten (10) days of award of contract to clarify details of the contract and to work out a transition plan.

C.2.2 Tasks

The Contractor shall not charge the government for any service provided in error (e.g., incorrect immunization) or not provided due to Contractor error (e.g., malfunction of equipment or not delivering needed resources).

C.2.2.1 Task 1 – General Requirements C.2.2.1.1 Privacy and Security

The Contractor shall ensure that all findings are clearly recorded on Government or other approved forms, and are protected by Privacy Act of 1974 and Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated safeguards to ensure confidentiality of health information. The Contractor shall work with the SCs and the SC units to maximize privacy when sensitive medical information may be shared during group events.

C.2.2.1.2 Licensure and Certifications

C.2.2.1.2.1 General Licensure and Certifications

The Contractor shall ensure all providers (Physicians, Dentists, Nurse Practitioners, Physician Assistants, Audiologists, Optometrists, and Behavioral Health Specialists) maintain at least minimum amounts of malpractice insurance as required by state licensing requirements. The Contractor shall ensure that all providers, technicians and other HCPs performing services under this agreement have current licenses, registrations, and/or certifications according to industry standard and as required for the specific state, commonwealth, district or Territory in which they are providing contract services. If services are provided in another country (e.g., Germany), the Contractor shall ensure all providers have a current U.S. license, registrations, and/or certifications to practice at an independent level as well as Defense Base Overseas Insurance. The Contractor shall ensure that all HCPs have a current certification in basic life support or cardiopulmonary resuscitation (CPR). Exception: Behavioral health specialists who will be attending a group event where other HCPs are present who do have a current certification in at least CPR and Call Center personnel. Contractor shall provide a monthly report by group event of compliance (Deliverable 43). The Government has the right to review the documentation regarding the above requirements.

C.2.2.1.2.2 Occupational Health Services

The Contractor shall ensure that all Occupational Health Services shall be performed by Board Certified examiners and Council for Accreditation in Occupational Hearing Conservation (CAOHC) certified audiometric technicians. Pulmonary Function Testing is performed to National Institute for Occupational Safety and Health (NIOSH) standards. Chest x-rays will be read by a board certified radiologist with the exception of asbestos exposure which requires a NIOSH certified B reader. In addition, a physician (MD/DO), an audiologist, or an audiometric technician who is certified by the Council for Accreditation in Occupational Hearing Conservation (CAOHC) can administer audiometric tests. All audiometric testing will be input into the Defense Occupational and Environmental Health Readiness System-Hearing Conservation (DOEHRS-HC) database. Audiometric technicians must administer audiometric tests under the supervision of a physician or an audiologist. This includes performance of Chemical, Biological, Radiological, Nuclear (CBRN) exams, Fire Fighter examinations and lab services.

C.2.2.1.3 Customer Service Department

The Contractor shall provide a toll-free, dedicated customer service department and a dedicated scheduling line available M-F 7:00 am -10:00 pm Central Standard Time (CST) and Saturday 7:00 am – 3:00 pm CST to perform all appointment scheduling and customer service related services. Access to all RHRP II–related toll free lines will be reported monthly (Deliverable 38).

C.2.2.1.4 Handling of Vaccines

The Contractor shall provide centralized storage and distribution of vaccine in a controlled and monitored environment, utilizing a 21 Code of Federal Regulations (CFR) Part 11 compliant monitoring system. This shall include using proper shipping and delivery protocols to ensure vaccine efficacy and viability. Centralized storage, distribution and delivery of the vaccine shall follow all applicable state and federal regulations. The Contractor shall ensure each provider administering vaccines is trained on proper vaccine storage and handling. The Contractor shall have pharmaceutical distribution licenses in all states, U.S. Territories, and the District of Columbia. The Contractor shall provide reports of vaccine handling, distribution, and recovery to the COR on a monthly basis as well as to others as determined by the COR (Deliverable 44).

Vaccines shall be stored, transported, recovered if not used, administered and documented in accordance with FDA and manufacturer guidelines. For anthrax vaccine, the Contractor shall report current monthly inventory with lot number and expiration date to COR and the U.S. Army Medical Materiel Agency (USAMMA) (Deliverable 36).

For U.S. Army Reserve (USAR) only, on a monthly basis the Contractor shall report to Defense Logistics Agency (DLA), USAMMA, and the COR the listing of flu vaccine shipments with no alarm, alarm/released, and alarm destroyed from the Contractor location to provider locations (Deliverable 25).

C.2.2.1.5 Data Entry.

Unless otherwise noted, the Contractor shall enter the required data generated electronically and in hard copy into the appropriate SC readiness database 95% of the time within five (5) working days of group events and ten (10) working days of in-clinic appointments, except in-clinic dental examinations and treatment which shall be entered into the SC database 95% of the time within fifteen (15) working days of the examination and last treatment appointment. The SCs will provide training on access to and use of their readiness databases and provide advance notice of any changes to these databases. Contractor providers will complete required training, e.g., the U.S. Army Profiling Course completion is required prior to use of eProfile, and have appropriate Contractor-verified credentials prior to using the SC databases. The Government retains the right to review documentation of the above training. Unless otherwise agreed to by the RHRP, the SCs will be the approval authority for access to its databases.

C.2.2.1.5.1 Point of Service Data Entry:

For ARNG group events, the Contractor shall enter data from the assessments, examinations, treatments, and other services performed on-site directly into the ARNG readiness databases. When applicable, profiling (see C.2.2.2.2.2, C.2.2.2.2.3, C.2.2.2.5.6, C.2.2.2.6, C.2.2.2.6.1, C.2.2.3.7, and C.2.2.3.10) shall occur on-site. Quality assurance of the service documentation shall be accomplished during the group event. The Contractor shall provide all information technology equipment, including internet connectivity, to accomplish this.

In the event there is no internet connectivity or there are readiness system slow-downs which are negatively affecting the provision of services, the Contractor shall upload the documentation within five (5) working days into the ARNG’s readiness databases.

The Contractor shall be prepared to document the assessments in hard copy should their information system equipment fail. In that case, the Contractor shall leave a copy of the paperwork with the military unit representative.

C.2.2.1.6 In-clinic and Group Event No-show and Cancellation Policy C.2.2.1.6.1 In-clinic No-show Policy:

The Contractor shall verify with the assigned HCP office that the SM showed for their scheduled appointment. If the HCP’s office reports the SM failed to report, the Contractor shall annotate their status as a “No show”.

· Exceptions:

· The SM never received an appointment confirmation call from the Contractor after the appointment was scheduled,

· The kit with paperwork and supplies was not delivered to the SM prior to scheduled appointment,

· SM is late for the appointment, but the HCP is available to perform services, or

· An emergency situation beyond the SM’s control (e.g., accident, illness, family emergency, bad weather).

C.2.2.1.6.2 In-clinic Cancellation Policy:

SM has until 24 hours prior to the appointment to cancel or reschedule services.

· Exceptions:

· An emergency situation beyond the SM’s control (e.g., accident, illness, family emergency, bad weather).

C.2.2.1.6.3 Group Event No-show/Cancellation Policy:

The Contractor shall coordinate services based on the approved number of requested services annotated on the Group Event voucher or authorization letter. The Contractor shall verify the number and types of services requested with the SC/Unit Group Event Point of Contact. The SC/Unit Group Event Point of Contact has up until 14 calendar days prior to the scheduled Group Event date to change or cancel the event. Changes made to a Contractor-accepted event between 14 and 5 calendar days prior to the Group Event date are subject to a Cancellation fee per service type. Changes between 5 calendar days prior to the Group Event date and completion of the event are subject to a No-show fee per service type only (e.g., immunizations, laboratory, or miscellaneous medical service, PHA, PDHRA, MHA, dental services, audio, vision).

· Exceptions:

· Cancellation and No-shows due to bad weather or other emergencies (e.g., humanitarian mobilizations).

C.2.2.1.7 Group Event Oversight

The Contractor shall have one person at each group event with oversight of all services to be provided at that site and, through Contractor-provided training and experience is knowledgeable about the services being performed and the processes to complete a group event in an efficient and effective manner. This individual shall identify themselves to the SC/Unit Group Event Point of Contact to assist with any issues that may arise.

C.2.2.1.8 SM-Provided Documentation

SMs may bring copies of pertinent evaluations or treatment to group events or individual appointments. That documentation is to be considered in the provision of services and forwarded with other documentation to the Contractor if further review is to be accomplished. The Contractor shall review all supporting documentation provided by the SM and SC. The Contractor shall upload the supporting documentation into the appropriate SC medical readiness databases and/or forward copies of documentation to the SC designated medical record custodian.

C.2.2.1.9 Scheduling Group Events

SC/Unit Group Event Point of Contacts shall provide the Contractor with the request for services prior to 14 calendar days from the start of the Group Event. The Contractor may accept request for services with less notice.

The Contractor shall accept or reject increases in services within 24 hours (Deliverable 46) of receipt of request from the SC/Unit Group Event Point of Contact.

C.2.2.2 Task 2 – Periodic Health Assessment (PHA)

C.2.2.2.1 Periodic Health Assessment (PHA) Provider Requirements

The Contractor shall provide face-to-face review of the SM’s health assessment tool with a licensed HCP. An acceptable HCP includes Medical Doctor (MD), Doctor of Osteopathy (DO), Nurse Practitioner (NP), or Physician Assistant (PA). The Contractor shall work with the COR and SCs to ensure that all providers, including subcontractors, possess current HIPAA certification and that all contractor staff and providers, as appropriate, have a valid/active Army Knowledge Online (AKO) account. The Contractor shall work with the COR and SC to ensure that all providers as needed, have access to the Medical Protection System (MEDPROS) and eProfile module in MEDPROS Web Data Entry Medical Operational Data System (MWDE MODS), Medical Readiness Reporting System (MRRS), MEDCHART, eCase, Health Readiness Record (HRR), PHA Module, Preventive Health Assessment and Individual Medical Readiness (PIMR), and any other SC system as appropriate. The Government reserves the right to inspect the above requirements.

C.2.2.2.2 Review of the Health Assessment Tool

C.2.2.2.2.1 Health Assessment Tool The Contractor shall perform PHA interviews using a completed health assessment tool (Health Assessment Review Tool or other health assessment tool supplied by the SC). The SM will provide the Contractor with a completed health assessment tool in either paper or electronic format which will be accessible through the IT resources provided by the SC or the Contractor if the SC does not provide the IT system.

C.2.2.2.2.2 Provider Interview The Contractor provided HCP shall:

· Validate SM responses to the health assessment tool, provide health promotion counseling, and obtain additional information related to positive responses. Counseling shall be targeted to individual, occupational, and environmental risk factors and behaviors identified in the health assessment tool. Information that shall be addressed includes but is not limited to: diet and exercise, dental health, tobacco, alcohol and substance abuse, solar injury protection (skin cancer prevention), heat and cold injury prevention, physical and/or sexual abuse, injury prevention, stress management, and suicide and violence prevention. Health promotion educational materials are available on designated Service websites;

· For all personnel, focus on answers to mental health-related questions to determine if any behavioral health related issues are unresolved or require referral for additional evaluation;

· Perform appropriate focused examinations for identified problems, documenting examinations and follow-up referrals. This and all other documentation shall be legible and in sufficient detail to allow reviewers a good understanding of the findings. Group event SC POCs shall be informed of any referrals;

· If an emergent referral is deemed necessary, for in-clinic, the COR/designee and SC POC shall be notified within one (1) working day (Deliverable 7). For Group events, the unit Commander/designee, COR/designee and SC POC shall be notified within one (1) working day (Deliverable 7).

· Counsel the SM on identified health risk and age/gender specific United States Preventive Services Task Force (USPSTF), (Attachment 2) screening recommendations. The Contractor shall spend a maximum of fifteen (15) minutes on the counseling process;

· Assess for future deployability that shall include a review of the medical history and available medical administrative issues, including documentation presented by the SM (e.g., pregnancy requirements, medical or dental problems), ensuring any potential future deployability issues or health concerns are addressed according to the current SC guidance. To be deployment ready, SMs should not be before a physical evaluation board, in the disability evaluation system, pregnant or in the postpartum period; for Army National Guard (ARNG)/USAR, on a temporary or permanent profile with a 3 or 4 without having been adjudicated by a board process, or before a Military Medical Readiness Review Board (MMRB)/MAR2 or Medical Evaluation Board (MEB);

· Document any counseling conducted on the electronic PHA survey and on Government provided forms;

· Document PHA completion, including whether or not a SM was referred for further follow-up with the individual’s medical provider;

· Document SM ability to deploy into an austere environment defined as: an area that regularly experiences significant environmental hazards (e.g., heat, cold, altitude, aerosolized particles) that would exacerbate existing medical conditions when protection (such as climate control) is not available; an area that has limited access to a reliable source of electricity; and/or an area where force protection levels mandate prolonged use of body armor and/or chemical protection equipment (ability to carry 60 pounds for prolonged periods).

· For ARNG/USAR/AC Army TRICARE Prime Remote (TPR), document and assign Military Physical Profile Serial System (PULHES) (Attachment 4) using the Physical Profile Functional Capacity Guide, AR 40-501, Chapter 3, 7, 8 and 11 and ARNG/USAR specific supplemental profiling guidance, on the electronic PHA survey and e-Profile module. Referral recommendations are to be entered into eCase or its successor, as requested by the SC;

· For AFR, assign profiles to USAFR members in accordance with AFI 48-123, Medical Examinations and Standards 1.7, Table 1.1 and Attachment 3; and

· For U.S. Navy Reserve (USNR), Marine Forces Reserve (MFR), U.S. Coast Guard (USCG) and U.S. Coast Guard Reserve (USCGR), recommend deployment limiting status based on “Manual of the Medical Department, Chapter 15” and additional SC guidance.

C.2.2.2.2.3 Quality Assurance (QA), Profiling and Deployment Limiting Conditions

The Contractor shall perform the following services:

· For ARNG, USAR, and AC Army TPR, final Quality Assurance evaluation and PHA completion based on completed focused exams, SF 507 Functional Capacity Certificate (Attachment 15), current active temporary or permanent profiles, documentation in the Contractor’s database and any supporting documentation provided by the Service member.

· For USCG/USCGR and USNR/MFR, review the disqualifying limiting conditions, make recommendations and document on the Memo to Command;

· For ARNG, USAR, and AC Army TPR, per SC guidance, PHA completion shall include designation of the SM’s PULHES, initiation of a temporary or permanent Duty-limiting Profile (DA Form 3349) and an assessment of the SM’s ability and limitations to perform their duties in an austere environment; and

· For ARNG, USAR, and AC Army TPR, the Contractor shall write per SC guidance any appropriate temporary profiles (NP, PA) electronically, or any temporary/permanent profiles (DO, MD as the first signature) in the e-Profile module; and

· All ARNG, USAR, and AC Army TPR PHAs with a temporary and/or permanent profile shall be routed through e-Profile for processing and military review by the Regional Support Command Surgeon, State Surgeon, Regional Medical Command, or Human Resource Command (USAR IRR).

C.2.2.2.2.4 Medical Review Officer

The Contractor shall provide a Medical Review Officer to review and update medical records on DoD designated forms to include:

· For ARNG, forward original PHA documents and reviewing comments in memorandum format to requesting unit authority or other designated entity per SC direction.

· For USAR, send electronic PHA file, supporting documentation and reviewing comments in memorandum format to HRR.

· For AC Army TPR, send electronic PHA file, supporting documentation and reviewing comments in memorandum format to Regional Medical Command.

C.2.2.2.3 PHAs and Behavioral Health Specialist When requested by the SC at least two weeks prior to the PHA group event, the Contractor shall have a behavioral health specialist (BHS) present during that group event. The BHS shall have as a minimum requirement, state license (or certification in a state which does not have licensure) to practice independently in mental health and a Master’s Degree or higher from an accredited institution of higher learning, e.g., social workers, psychologists, marriage and family therapists, professional counselors. Licensed psychiatric nurse practitioners qualify as BHS. Alternatively, the Contractor shall, if requested by the SC at least two weeks prior to the group PHA event, have a BHS readily available via a toll free number during the event.

If a Service member calling to set up an appointment for an in-clinic PHA or is attending a Group event meets criteria agreed to by the COR/designee which indicate the need for an immediate BHS interaction, the Contractor will transfer the Service member to the BHS. The BHS will speak with the Service member; attempt to provide the Service member emotional stabilization; assess the Service member for potential referral, including emergent referral; provide the PHA health care provider, if any, with an assessment of the Service member's emotional status and referral needs; and document the interaction as directed by the COR/designee. If an emergent referral is deemed necessary, for the Call Center, the COR/designee and SC POC shall be notified within one (1) working day (Deliverable 7). For Group events, the unit Commander/designee, COR/designee and SC POC shall be notified within one (1) working day (Deliverable 7).

C.2.2.2.4 PHA In-clinic Services

The Contractor shall perform PHA services as a stand-alone service or in conjunction with other RHRP services. The Contractor shall perform PHA services as individual SM office visits as approved by the SC POC. Services shall be scheduled within a fifty (50) mile driving distance of the SM’s residence, place of duty, or civilian place of business. The choice between the SM’s residence, place of duty, or civilian place of business as a proximity point shall be given to each individual SM. For all SCs combined, in-clinic PHAs have historically consisted of 75,000 to 87,000 SMs annually. The Contractor shall provide in-clinic PHAs with focused examination services for the SCs. The Contractor shall supply a toll free number that can be utilized by any SC to contact the Call Center to schedule an appointment. PHA in-clinic services shall include a SM initiated process and a Contractor initiated process as directed by the SC POC. PHA Call Center utilization for SCs has historically averaged 750,000 calls per year for inbound and outbound calls combined. After receiving a SC request to schedule SMs for a PHA, the Contractor shall attempt to reach the SM within 24 hours (Deliverable 45).

C.2.2.2.4.1 Service Member Initiated Process For ARNG/USAR/AC Army TPR, SMs will complete their portion of the PHA form via their AKO account. The SM will contact the Contractor via the toll free number to initiate a review of the PHA form and voucher creation. If the PHA form is not filled out by the SM prior to calling the call center, the Contractor shall review the PHA form with the SM and create a voucher if necessary. Voucher creation for USAR shall be linked to the Automatic Voucher System (AVS).

For USCG, the Contractor shall review the IMR report in MRRS and build an order based on the SM’s discrepancies.

For USNR, the unit POC will generate the discrepancy list and email or fax to the Contractor.

For the U.S. Air Force Reserve (USAFR), the Contractor shall review PIMR and build an order based on the SM’s discrepancies.

C.2.2.2.4.2 Contractor Initiated Process

Upon request, the Contractor shall make outbound calls based on IMR deficiencies identified by SC Unit POCs.

The Contractor shall complete the SC designated PHA form (Attachment 16, 17, 18, 19, 20) with the SM on the phone, begin the initial PHA voucher creation, and proceed with the review process.

C.2.2.2.4.3 Review of PHA Form and Order Creation

The Contractor shall review PHA form and shall:

· Receive and verify demographic data;

· Assess United States Preventive Services Task Force (USPSTF) screening requirements;

· Assess additional IMR requirements (e.g., HIV, DNA, Immunizations, Dental screening, etc.) per SC requirements;

· Create initial PHA order and voucher for Medical/Dental readiness services if applicable; and

· Forward the initial vouchers to the Command approval authority for review and approval. For USAR, USCG, USNR and MFR, vouchers will be auto-approved. For ARNG, vouchers and reports of SMs needing treatment will be sent to State approval authority for review and approval.

C.2.2.2.4.4 Completion of the PHA Order The Contractor completion of the PHA Order shall include:

· Delivering all required documents and supplies to the SM prior to the scheduled services;

· Contacting the SM to schedule all approved services with a minimum of three attempts to each valid phone number;

· Contacting the SM within twenty-four (24) hours after scheduling the appointment;

· Contacting the SM seventy-two (72) hours in advance of the scheduled services to remind the SM of the time and location of the scheduled services; and

· In the unusual instances when the Contractor does not have a provider within a 50 mile driving distance of the SM’s choice of either the SM’s residence, place of duty, or civilian place of business capable of conducting the PHA, the Contractor will be expected to obtain and train a provider within 25 working days.

C.2.2.2.4.5 Data Entry

The contractor shall document and record PHA results in the SM’s medical record using DD Form 2766 or the most current and appropriate SC form/electronic format. Completed PHA forms shall be forwarded into the SC database(s) as required.

C.2.2.2.5 PHA Group Event Services

C.2.2.2.5.1 PHA Scheduling for Group Events

The Contractor shall schedule group event PHA and focused examination services when requested, with a minimum of fourteen (14) calendar days advance notice. The Contractor may accept requests for services with less notice and provide the same level of quality as if more notice were given. The Contractor shall receive requests for services from SC POCs through: the AVS for ARNG and USAR; by fax through a Contractor supplied toll free, secure fax number; by a dedicated scheduling line, Contractor supplied online scheduling system, or by other methods agreed upon by the COR, specific SC and the Contractor.

C.2.2.2.5.2 PHA Provision of Services

The Contractor shall perform PHA services as a stand-alone service or in conjunction with other RHRP services. For all SCs combined, PHA review has historically consisted of 170,000 to 190,000 SMs at group events annually. PHA services shall be rendered by the Contractor as approved by the SC POC in group events at locations specified by the SC POC. For Group events, the Contractor shall be present at a minimum one (1) day prior to the PHA event start. The Contractor shall provide sufficient IT resources needed for the PHA group event. The Contractor shall provide, and be prepared to utilize, paper copies of all necessary forms for completion of the PHA event in case their IT resources are unavailable. The Contractor shall be responsible for providing all supplies and medical equipment, including exam tables, necessary for the PHA process and not rely on or expect the SCs to provide any. The Contractor shall provide quality control (QC) review of the surveys to ensure accuracy. Prior to any group event, the Contractor shall ensure that the HCP possesses HIPAA certification training within one (1) year of any event. If needed, the Contractor shall ensure that the HCP has completed Information Awareness Training in order to qualify for access to DoD IT systems; holds a valid/active Army Knowledge Online (AKO) account for ARNG and USAR services; has access to MEDPROS, PHA Module MWDE, eProfile module in MODS and eCase and HRR in MEDCHART for ARNG and USAR; and has access to MRRS for USNR, and MFR, and PIMR for the ANG and USAFR or other SC equivalents. The SCs will provide approval authority to these databases unless that authority delegation to the RHRP Office (RHRPO) is agreed to by the COR.

For ARNG and USAR, the Contractor shall ensure HCP issuing profiles in the eProfile module have completed the U.S. Army Profiling Course.

The Contractor shall provide the following sub-tasks of service as approved by the requesting SC:

C.2.2.2.5.3 Initial Screening The Contractor shall measure and record the SM’s height and weight, blood pressure and visual acuity testing results (visual acuity screening distant/near vision) either binocular (ARNG/USAR/USCG) or monocular (USNR/MFR), per SC requirement. The Contractor shall review current medical problems, medications, required preventive services and review and update Medical Readiness requirements. The Contractor shall review and update the PHA form, Adult Preventive and Chronological Care Flowsheet, and any other SC required documentation (electronic or paper) associated with the PHA process.

C.2.2.2.5.4 PHA Interviews The Contractor shall perform PHA interviews using a completed health assessment tool (Health Assessment Review Tool or other health assessment tool supplied by the SC). For ARNG, USAR and AC Army TPR, the Contractor will complete the Functional Capacity Certificate SF 507. For USNR, the Contractor shall also complete and review the Report of Medical History, DD Form 2807-1. The SM will provide the Contractor with a completed health assessment tool in either paper or electronic format which will be accessible through the IT resources provided by the SC or Contractor.

C.2.2.2.5.5 Data Entry

The contractor shall document and record PHA results in the SM’s medical record using DD Form 2766 or the most current and appropriate SC form/electronic format. Completed PHA forms shall be forwarded into the SC database(s) as required.

C.2.2.2.5.6 PHA Lite

PHA Lite retains the key components of the group event PHA while providing the SC with greater autonomy in assigning PULHES, profiling, and determining follow-up courses of action.

The Contractor shall provide face-to-face review of the SM’s health assessment tool with a licensed HCP. An acceptable HCP includes Medical Doctor (MD), Doctor of Osteopathy (DO), Nurse Practitioner (NP), or Physician Assistant (PA). The Contractor provided HCP shall:

· Validate SM responses to the health assessment tool and provide health promotion counseling and obtain additional information related to positive responses. Counseling shall be targeted to individual, occupational, and environmental risk factors and behaviors identified in the health assessment tool. Information that shall be addressed includes, but is not limited to: diet and exercise, dental health, tobacco, alcohol and substance abuse, solar injury protection (skin cancer prevention), heat and cold injury prevention, physical and/or sexual abuse, injury prevention, stress management, and suicide and violence prevention. Health promotion educational materials are available on designated Service websites;

· Focus on answers to mental health-related questions to determine if any behavioral health related issues are unresolved, requiring referral for additional evaluation;

· Perform appropriate focused examinations for identified problems, documenting examinations and follow-up referrals. Group event SC POCs shall be informed of any referrals;

· Counsel the SM on identified health risk and age/gender specific United States Preventive Services Task Force (USPSTF), (Attachment 2) screening recommendations. The Contractor shall spend a maximum of fifteen (15) minutes on the counseling process;

· Document any counseling conducted on the electronic PHA survey and on Government-provided forms;

· Provide a copy of the PHA to the event POC or designee; and

· The Contractor shall input information into the designated SC PHA database at the end of each event day.

· For ARNG/USAR/AC Army TPR, at the end of each event day, the Contractor will upload the data into the PHA Module, providing visibility to the SC within 24-48 hours of the data transfer. The SC will be responsible for review and sign-off of the PHA, which includes data entry and sign-off of all profiles in the E-Profile module. This process is designed to allow the entity’s organic health care providers to immediately address concerns following the group event.

· The Contractor shall input Cardiovascular Screening Program (CVSP) results date of service and EKG date of service into the PHA Module for ARNG, USAR, and AC Army TPR within five (5) working days of the Date of Service.

C.2.2.2.6 Medical Readiness Review and Update (In-clinic & Group Event) The Contractor shall ensure that the medical record and medical IT tracking systems are updated for the following medical readiness requirements and shall provide health services as approved by the SC POC for the following:

· Individual medical equipment, the Contractor shall:

· Indicate referral to Optometry if distance or near binocular visual acuity is worse than 20/40 or if SM complains of decreased visual acuity. For USAR, the Contractor shall create an eyewear voucher;

· If required corrective eyeglasses, check to ensure SM has two (2) pairs and gas mask inserts, record in appropriate SC information system. For USNR/MFR and USCG/USCGR, check to ensure SM has two (2) pair of glasses; and

· If member has severe allergies, check to ensure member has medical warning tags and record in appropriate SC information system. If SM has severe allergies, for ARNG/USAR/Army AC TPR, the Contractor shall document the need for red medical warning tags on the Memorandum to Command and profile in eProfile module.