Draft_FBCH_Family_Health_Centers_PWS.pdf

PERFORMANCE WORK STATEMENT

NORTH AND SOUTH FAMILY HEALTH CENTERS

FORT BELVOIR COMMUNITY HOSPITAL

TABLE OF CONTENTS

1.0. General Information

1.1. Description of Work

1.2. Personal and Non-Personal Services

1.2.1.1. Personal Services

1.2.1.2. Non-Personal Services

1.3. Family Health Centers Locations

1.3.1. Location Requirements

1.3.2. Place of Performance

1.4. Scope of Service

1.4.1. Health Care Concept

1.4.2. Access

1.4.3. Standards of Care

1.4.4. Government Oversight

1.4.5. Enrolled Population

1.4.6. Level of Effort

1.4.7. Standards of Performance

1.4.8. Identification of Privacy Act

1.5. Program Objectives

1.5.1 Quality

1.5.2. Fiscal Management

1.5.3. Access to Care

1.5.4. Patient Satisfaction

1.5.5. Contractor Personnel

1.5.5.1. Contractor Personnel Quality

1.5.5.2. Health and Immunization Requirements

1.6. Performance Assessment

1.7. Recognized Holidays

1.8. Hours of Performance

1.8.1. Operating Hours for FHCs

1.8.2. Operating Hours for Specialty Services

1.8.3. Operating Hours for Pharmacies

1.9. Facilities Security

1.9.2. Medical Storage Secure Storage

1.9.3. Facility Access

1.9.4. Electronic Surveillance

1.9.5. Armed Security Guard

1.9.6. Panic Buttons

1.9.7. Information Security

1.9.8. Physical Security

1.10. Post Award Conference/Periodic Progress Meetings

1.11. Contracting Officer’s Representative

1.12. Contractor Employee Travel

1.13. Other Direct Costs

1.14. Data Rights

1.15. Organizational Conflict of Interest

1.16. Phase In/Phase Out Period

1.17. Common Access Card Requirement

2.0. Personal Services: Contractor Personnel Qualifications and Duties

2.1. Key Personnel

2.2. Health Care Providers

2.2.1. Removal of Contractor HCPs

2.3. Primary Care

2.3.1. Primary Care Physicians

2.3.2. Physician Extenders

2.3.2.2. Physician Assistant (PA)

2.3.2.3. Nurse Practitioner (NP)

2.3.3. Primary Care Sports Medicine Services

2.3.4. Nurses

2.3.4.1. Nurse Midwife (NM)

2.3.4.2. Registered Nurse (RN)

2.3.4.3. Nursing Supervisor (NS)

2.3.4.4. Other Nursing Personnel

2.3.5. Clinical Support Personnel

2.3.6. Mammography Technologist (Mammographer)

2.3.7. Diagnostic Radiologic Technologist

2.4. Specialty Care

2.4.1. Staffing and Management

2.4.2. Quality Care

2.4.3. Medical Specialties

2.4.3.1. Optometry Services

2.4.3.2. Physical Therapy

2.4.3.3. Orthopedic Services

2.4.3.4. Obstetrics

2.4.3.5. Dermatology Services

2.4.3.6. PCMH

2.5. Conflicts of Interest

2.6. Personnel Qualifications

2.7. Credentials Reviews/Privileging Requirements

3.0. Non-personal Services: Contractor Personnel Qualifications and Duties

3.1. Key Personnel

3.1.1. Clinic Administrator

3.1.2. Alternate Clinic Administrator

3.2. Behavioral Health

3.2.1. Front Desk Clerks

3.3. Administrative Personnel

3.3.1. Family Health Center Patient Representative

3.3.2. Certified Coding Specialist

3.4. Non-Credentialed Personnel Documentation

3.4.3. Contractor Personnel Security Check

4.0. Government Furnished Items and Services

4.0.1. Government Property Administrator

4.1. Equipment Inventory

4.2. Medical Equipment

4.3. Equipment Accountability Upon Contract Completion

4.3. Medical Equipment Maintenance

4.4. Information Technology (IT) Support

4.5. Pharmaceuticals

4.6. Marketing Services

4.7. Family Health Centers Logos

4.8. Courier Services

4.9. Government Personnel Support

4.10. IT Automation Systems

4.11. IT Training

4.12. The Joint Commission Education

4.13. Digital Imaging Network/Picture Archiving and Communications System (DINPACS)

4.15. REES System

4.16. Forms/Pubs

5.0. Contractor Furnished Items and Responsibilities

5.1. General

5.2. ANACI Security Background Investigation

5.3. Signage

5.4. Facilities

5.4.1. Government Employees Spaces

5.4.2. Behavioral Health

5.4.3. Data Center/Server Room

5.4.4. IT Storage

5.4.5. Pharmacy

5.4.6. Utilities

5.4.7. Housekeeping

5.4.8. Phones

5.4.9. Non-Medical Equipment and Supplies

5.4.10. Maintenance

6.0. Administrative and Specific Tasks

6.1. Appointing

6.2. Primary Care/Improved Access Appointing

6.3. Empanelment

6.4. Referral Management

6.5. Clearly Legible Reports (CLRs)

6.6. Case Management

6.7. Nursing Support Programs

6.8. Health Promotion/Disease Management (HPDM)

6.9. Records/Documents Management

6.10. Quality Data

6.11. Third Party Collection (TPC) and Other Health Insurance (OHI) Program

6.12. Ancillary Services

6.12.1. Laboratory Services

6.12.2. Radiology Services

6.12.3. Pharmacy Services

6.12.4. Clinical Pharmacy Services

6.13. Quality Control (QC)/Performance Improvement (PI) Programs

6.13.2. Quality Assurance

6.14. Mobilization and Other Contingency Planning

6.14.1. Emergency Response

6.14.2. Emergency Preparedness Plans

6.15. Customer Service/Satisfaction

6.16. Training Programs

6.17. Recurring Monthly and Ad Hoc Reporting Requirements

6.18. Accounting for Contract Services

7.0. Other Terms, Conditions and Provision

7.1. Non-Disclosure/Non-Use Agreement

7.2. Information Assurance

7.3. Enterprise Architecture

7.4. Protection of Information

7.5. Enterprise-wide Contractor Manpower Reporting Application

8.0. Definitions and Acronyms

8.1. Definitions

8.2. Acronyms

9.0. Applicable Publications (Current Editions)

9.1. Mandatory Publications

9.2. Forms

10.0. PWS Exhibits, subject to change due to increase in enrollment and/or guidelines

1.0. General Information

1.1. Description of Work

1.1.1. This requirement is for the continued provision of no less than two (2) stand-alone, strategically located

Family Health Centers (FHCs), delivering community-based health care services, on contractor provided sites, for eligible military beneficiaries residing predominately in the southern (I-95) and western (I-66) corridors of the

National Capital Region (NCR). These facilities provide family-centered, comprehensive Primary Care, and selected Specialty Care.

1.1.2. The FHCs are part of the Fort Belvoir Community Hospital (FBCH), operate as extensions of FBCH and serve as feeder clinics for the inpatient services provided at FBCH and Walter Reed National Military Medical

Center (WRNMMC). They also promote Graduate Medical Education (GME) programs.

1.1.3. The FHCs are currently known as the Family Health Centers of Fairfax and Dumfries, and shall be referred to in this document as the FHC-North (I-66 corridor) and the FHC-South (I-95 corridor), respectively.

1.1.4. Historically, and under direction of the Assistant Secretary of Defense for Health Affairs, the FHCs began operation as PRIMUS (Primary Care for the Uniformed Services) clinics in the mid-1980s’ as a mean to improve patient access to military medicine and reduce CHAMPUS (now TRICARE) costs. These clinics have evolved into their current role as an integrated component of FBCH and NCR Military Healthcare System (MHS).

1.1.5. Currently, the Healthcare Network (currently comprised of FBCH, FHC-N and FHC-S) provide comprehensive health care to the largest enrolled population in the NCR and the second largest enrolled population in the TRICARE North Region. The current total number of enrollees is approximately 51,000. The current level of effort is found in Exhibit B. The contractor shall provide medical, clinical and administrative services to support an ambulatory/primary care program as defined in Army Regulation (AR) 40-3 for the treatment of authorized military beneficiaries with acute and chronic care conditions. The contractor shall provide all facilities, facility maintenance, management, staffing, supplies and equipment (other than Government furnished) necessary to support the provisions of services. Informatics support and maintenance shall be the responsibility of the government.

1.2. Personal and Non-Personal Services

1.2.1. This requirement is a hybrid contract consisting of non-personal services and personal services.

1.2.1.1. Personal Services: Credentialed health care providers and ancillary support personnel shall be considered as providing personal services, and may be required to perform services within their scope of practice at the Fort

Belvoir Community Hospital (FBCH), also referred to herein as the Military Treatment Facility (MTF), under the authority of Section 1091 of Title 10, United States Code. Accordingly, Section 1089 of Title 10, United States

Code shall apply to any personal injury lawsuits filed against health care workers based on negligent or wrongful acts or omissions incident to performance within the scope of this contract. Credentialed health care providers are not required to maintain medical malpractice liability insurance while performing services under this contract.

1.2.1.2. Non-Personal Services: Health care support personnel (clinical, ancillary and administrative) employed under this contract shall be considered as providing non-personal services covering a diversity of professional disciplines.

1.3. Family Health Centers Locations: The Contractor shall provide no less than two (2) geographically distinct

Family Health Centers, one (1) serving the I-66 corridor, and one (1) serving the I-95 corridor. The FHCs shall be strategically located in areas of dense patient population to provide community based primary health care to enrolled beneficiaries, some select specialty care to enrollees and eligible beneficiaries, and to minimize costs associated with health care network leakage.

1.3.1. Location Requirements

The Family Health Centers shall be located in stand-alone buildings with secure access for patients and staff.

The Family Health Center-North shall be located no more than three (3) miles off Interstate I-66, between

(and including) mile markers 53 through 60.

The Family Health Center-South shall be located no more than three (3) miles off Interstate I-95, between

(and including) mile markers 140 through 148.

1.3.2. Place of Performance: The work to be performed under this contract will be performed at the contractor’s leased or owned facilities. Specialty medical services that require time in Labor and Delivery and Operating Room will be performed at FBCH.

1.4. Scope of Service:

1.4.1. Health Care Concept: The Family Health Centers scope of practice provides for a family centered, patient focused, comprehensive health care model that promote a quality professional/patient relationship with continuity of care per JTF CAPMED I-6025.05, Patient Centered Medical Home (PCMH). This health care concept includes improved access to primary care appointing, individual provider and provider team empanelment with an emphasis on patient outcomes, continuity of care, and quality care as defined in the Joint Commission, JTF CAPMED and

TRICARE standards, and overall patient satisfaction. The Family Health Centers where the contractor shall perform the required services are within the NCR catchment area.

1.4.2. Access: Family Health Centers are designated as primary care entry points for authorized military beneficiaries of the MHS and FBCH and shall provide the full range of primary care, mental health services, optometry services, and other limited specialty care as set forth herein. Limited space shall be made available for care of non-enrolled beneficiaries.

1.4.2.1. Beneficiaries authorized to use the MHS include but are not limited to: members of the Uniformed Services and their families, survivors, retired members and their families, and other authorized beneficiaries of the

Department of Defense's (DOD) regional managed care program, TRICARE, and the Primary Health Care System.

These Family Health Centers are recognized components of the Fort Belvoir Community Hospital and the National

Capital Region, Military Healthcare System.

1.4.3. Standards of Care: The contractor shall provide health care services of a quality nature meeting or exceeding current recognized national standards as established by the American Medical Association (AMA), the American

Osteopathic Association (AOA), the Joint Commission (JC), Comprehensive Accreditation Manual for Hospitals, (CAMH), College of American Pathologists (CAP), Clinical Lab Improvement Act 88 (CLIA 88), the American

Academy of Family Practice, the American College of Radiology, the Federal Drug Administration (FDA), the

MQSA (Mammography Quality Standards Act), the American Pharmaceutical Association current for the year of performance, American Association of Blood Banks (AABB) and other laboratory accrediting agencies of the U.S.

Government according to the respective Code of Federal Regulations (CFR). Additionally the contractor shall perform services in accordance to current Good Laboratory Practices (c GLP).

1.4.4. Government Oversight: The Director for FBCH will provide Command guidance and oversight specific to health care delivery at the FHCs and retains ultimate authority for health care delivery rendered therein.

1.4.4.1. The government shall assign a Medical Director to each FHC. The government Medical Director(s) will be appointed military or civil service clinician. The government Medical Director for each of the FHCs will provide health care delivery oversight and direction particularly as it relates to overall direct health care program content and effectiveness, clinical quality control issues, coordination (through the FBCH Credentials Committee) of adverse actions on health care provider (HCP) privileges, credentialing, privileging, and oversight of Joint Commission standards and compliance. The contractor remains solely responsible for the day-to-day FHC operational/administrative efficiency and contract compliance.

1.4.4.2. The government Medical Director will provide overall clinical administration. The contractor shall accomplish the tasks outlined in this Performance Work Statement (PWS) by furnishing professional, supervisory, administrative, custodial, and technical personnel (e.g., staff physicians, nurses, physician assistants/nurse practitioners, medical assistants, x-ray technicians, lab personnel, pharmacist and pharmacy technicians, appointment personnel, medical clerks and medical records clerks, and coding clerks).

1.4.4.3. FBCH Department Chiefs for each specific specialty will service in an advisory capacity to the FHCs government Medical Director to ensure overall program effectiveness. The Medical Director for each of the FHCs will provide health care delivery oversight and direction particularly as it relates to overall direct health care program content and effectiveness. The Medical Director retains final decision authority for the efficient and effective delivery of health care services to the beneficiaries (hands-on health care delivery). The contractor retains final decision authority for operational/administrative functions of the FHCs and remains solely responsible for program content, effectiveness, compliance, and the day-to-day management of the FHCs.

1.4.5. Enrolled Population: The Government anticipates maintaining an enrolled population of 22,000 enrollees at the FHC North and 29,000 enrollees at the FHC South. The government shall provide the contractor a 90 day notice if the need for increasing enrollment is required. Additional enrollment at the sites is anticipated to involve 3 tiers comprising of an additional 2,000 enrollees at each site for each tier for an additional total enrollment of 6,000 patients at each site. The contractor shall ensure provider, clinical, and administrative staffing is reflective of the needs of the population served and shall adjust staffing as necessary to meet the demand of the enrolled population and the specialty care level of effort detailed in Exhibit B to provide optimal support. The Contractor shall ensure appropriate patient access, quality of care, and optimization of the direct care system.

1.4.6. Level of Effort: The contractor shall, at a minimum, maintain the level of effort noted in Exhibit B.

1.4.6.1. Primary Care and Specialty Care priority of effort at each FHC will be TRICARE Prime enrollees to that specific FHC with some specialty service space availability for other eligible beneficiaries. Staffing adjustments made by the contractor to meet the performance goals/metrics defined with in the PWS will be at no additional cost to the government.

1.4.7. Standards of Performance

1.4.7.1. JC Standards. Contractor shall take part in Department or FBCH programs as required to meet JC standards and those in the Medical Staff Bylaws.

1.4.7.2. Other performance evaluation factors will be monitored that are not quantified by numerical measurements which include: contractor providing personnel exceeding the minimum qualification standards; patient customer service comments; provider and contractor relationship with hospital staff/government contracting personnel;

provider and staff satisfaction surveys; compliance with hospital policy and procedures.

1.4.7.3. Performance Reports, will be provided by the COR annually to ensure acceptable performance of the contract; annual reports provided by COR to Contracting Officer after completion of each performance period will be reported to the DOD Past Performance Information Management System (PPIMS).

1.4.7.4. MTF Formulary. Contractor HCPs authorized to prescribe pharmaceuticals shall do so according to the availability of drugs listed therein. The pharmacy services will provide instructions to all prescribing contract physicians on substitutions and generic drugs for prescribed drugs. The Contractor HCPs shall follow the procedures of the MTF when prescribing drugs.

1.4.7.5. The Contractor shall be responsible for the security of all beneficiary information.

1.4.7.6. Neither the Contractor nor any of its contract service providers shall disclose or cause to disseminate any information concerning operations of military activities. Such action(s) could result in violation of the contract and possible legal actions.

1.4.7.7. All inquiries, comments or complaints arising from any matter observed, experienced, or learned of as a result of or in connection with the performance of this contract, the resolution of which may require the dissemination of official information, shall be directed to the contracting officer representative (COR) and the contracting officer (CO or KO).

1.4.7.8. The Contractor shall only conduct business with designated government personnel listed as points of contact

(POCs). Names of authorized personnel shall be provided to the Contractor by the Government, in writing, and updated as necessary throughout the contract period.

1.4.7.9. U.S. Government records, copies of original results and reports, verified original data, corrected data, and corrected supporting final reports are maintained by the Contractor, but remain the property of the U.S. Government.

These files/results must be surrendered to the COR.

1.4.7.10. Contractor employees shall immediately report any lost or stolen badges to the COR.

1.4.8. Identification of Privacy Act. This contract requires the development of a system of records in accordance with the Privacy Act of 1974.

1.4.9. DOD guidance (DOD 6010.13-m, 21 Nov 00) requires the timely collection of manpower data. As a result, the contractor shall dedicate staff to the timely collection and electronic submission of work-hours per this guidance.

Uniform Chart of Accounts and Personnel Reporting System (UCAPERS)/Defense Medical Human Resource

System-internet (DMHRSi) information on 100% of all contracted employees shall be submitted to Resource

Management Division not later than (NLT) five (5) working days after the end of each month.

1.5. Program Objectives: The contractor shall at a minimum meet the following program objectives:

1.5.1 Quality: Provide quality, comprehensive primary care and select specialty care in community based environment that meets or exceeds the Joint Commission and current industry standards.

1.5.2. Fiscal Management: Establish programs and goals that shall aggressively manage overall cost of health care for the enrolled population (e.g. focused Wellness programs and/or classes that promote education for preventative care and reduce FHC enrollee utilization. Facilitate specialty service program management that targets maximum recapture of revised financing funds). The contractor is responsible for optimizing consults to specialty care by abiding by standardized referral guidelines.

1.5.3. Access to Care: Provide appropriate access to care by incorporating a Primary Care Improved Access model of demand management and ensure specialty care services and ancillary support services meet TRICARE access standards and supports NCR business rules.

1.5.4. Patient Satisfaction: Establish a comprehensive customer satisfaction program that will be responsive to patient needs, establish a provider/patient foundation of trust, and ensure a healthier patient outcome.

1.5.5. Contractor Personnel. The contractor shall accomplish the goals outlined in this Performance Work Statement

(PWS) by furnishing skilled and experienced personnel, to include but not limited to: professional, supervisory, administrative, custodial, and technical. The contractor shall establish a clinical team, an administrative management team, and a clinical support staffing structure for the FHCs. The staffing structure shall clearly delineate areas of responsibilities, establish accountability and authority; enhance productivity; and promote integration with FBCH Performance Improvement (PI) and Joint Commission program components. The administrative management team and clinical support staffing structure shall be responsive to the Medical Director, the Contracting Officer’s Representative, the contract clinic administrator/program manager and shall support the scope of services outlined in this PWS.

1.5.5.1. Contractor Personnel Quality. The contractor shall provide personnel who are competent, qualified and adequately trained to perform all assigned duties and meet goals established in the PWS. The government will evaluate the quality of the contractor's professional and administrative services for purposes of contract inspection and acceptance. The government shall immediately notify the contractor when overall clinical quality fails to meet

Joint Commission standards and the expectations of established FBCH policy standardization.

1.5.5.1.1. All contractor personnel shall maintain active certifications at all times while performing services under this contract. If at any time during the contractor does not renew any of the required certifications prior to the expiration date; they will not be allowed to work. The expense of all certification requirements shall be borne by the contractor.

1.5.5.1.2. All contractor personnel shall be able to read, write, speak and understand English fluently and possess good communication skills sufficient to appropriately evaluate, treat and educate patients assigned to their care and communicate with other staff members.

1.5.5.1.3. All contractor personnel shall possess an appropriate level of computer skills and knowledge to effectively utilize medical computer systems in the treatment and documentation of patient care. Contractor employees shall possess basic understanding of computer use keyboarding. FBCH uses electronic medical records.

1.5.5.1.4. Health Care Providers shall have and maintain current certification in Basic Cardiac Life Support (BCLS), Certificate through the American Heart Association/American Red Cross. Certifications must be maintained and renewed at no additional cost to the Government.

1.5.5.1.5. All contractor employees shall report to work rested and fully physically and mentally capable of performing the duties required under this contract.

1.5.5.1.6. Any Contract personnel found to be unacceptable in administering skills required by the Contract shall be immediately released from duty by the Contracting Officer’s Representative (COR). The COR will immediately notify the Contracting Officer.

1.5.5.1.7. Personal Appearance

1.5.5.1.7.1. Contractor Employees shall present a neat and clean appearance.

1.5.5.1.7.2. All outer clothing shall be laundered or dry cleaned as appropriate, well-fitting and fresh each workday.

1.5.5.1.7.3. Shoes shall cover the foot to meet sanitation and safety requirements. Open-toe shoes or sandals shall not be worn.

1.5.5.1.7.4. Fingernails shall be clean and not extend one quarter of an inch beyond the flesh tips. Acrylic nails or overlays are prohibited.

1.5.5.1.7.5. Hair shall be neatly groomed. The length and bulk of hair shall not be unkempt, or of extreme appearance.

1.5.5.1.7.6. Contractor employees shall wear dresses, pants or slacks, shirt or blouses with collar and sleeves, shoes and socks. Tank tops, cut-off pants, shower shoes or similar items of apparel are specifically prohibited. In all cases, contractor employees shall conform to the established personal appearance policy of MTF.

1.5.5.1.8. All contractor personnel shall wear contractor provided identification/name tags that identify each person by picture, name and professional degree: i.e. MD, RN, etc. The name plate shall bear the name of the business entity under which the personnel are employed, or for which they are employed, or for which they are serving as a subcontractor, and possess a FBCH logo to identify personnel as part of the FBCH Network. Nameplate shall also contain a picture ID of employee (contractor provided).

1.5.5.1.9. Physicians and Physician Extenders shall wear white coats provided by the contractor. Physicians and

Physician Extenders shall remove these coats in food and beverage consumption areas.

1.5.5.1.10. Staff nurses and other clinical and ancillary personnel shall wear uniform-styled white or pastel clothing or attire currently considered appropriate by the military community Family Health Center standards and approved by the Medical Director and COR.

1.5.5.1.11. Clerical/administrative personnel shall wear either uniform-styled clothing as above or other professional office attire as appropriate for a Family Health Center work environment.

1.5.5.1.12. Media Inquiries: The contractor and contractor employees shall not respond to any media inquiries. Any inquiries from the medial shall be immediately relayed to the COR who will relay them to the FBCH Director.

There shall be no interviews, comments, or any other response without the knowledge and approval of the FBCH

Director. Other than routine inquiries from external agencies, all other inquiries and complaints shall be brought to the attention of the COR and the FHC Medical Director.

1.5.5.2. Health and Immunization Requirements

1.5.5.2.1. All contract providers/technicians performing health care services under this contract shall comply with the Health and Immunization requirements identified below at the time of initial request for clinical privileges and annually thereafter (see Attachment 1 for Sample Immunization form).

1.5.5.2.2. All contractor service performing direct health care services under this contract shall receive a general physical examination, at contractor’s expense, prior to commencement of services. The contractor shall provide the

Contracting Officer's Representative, 10 calendar days before beginning services under this contract, a physical examination certificate for each individual direct health care provider who will provide services. The certification shall state the date on which the physical examination was completed and the name of the physician who performed the examination. This certification shall be signed by the physician performing the examination. For the purposes of this paragraph, a physical examination administered more than 45 days prior to performance of the contract will not be considered adequate. The physical examination shall include the following:

1.5.5.2.2.1. Test for the antibody to HIV (Human Immunodeficiency Virus) with documented results of the test.

1.5.5.2.2.2. A history to show that Direct Health Care provider has completed a primary series of immunization with tetanus and diphtheria toxoids and that a booster dose is current (within the past 10 years).

1.5.5.2.2.3. A test for the hepatitis (Type B) virus with documentation of the results. A profile shall be established to show immune status to hepatitis. Non-immune Health Care Workers (lacking anti-HB(c) or anti-HB(s)) shall be required to complete an immunization series with a Hepatitis-B vaccine (e.g., Recombivax, Engerix).

1.5.5.2.2.4. The physical examination shall also document serologic evidence of immunity to measles and rubella or to provide documentation of immunization with measles, mumps and rubella (MMR) vaccine using the following guidelines:

1.5.5.2.2.4.1. Employees born before 1957 without documentation of previous vaccination with MMR should receive one dose.

1.5.5.2.2.4.2. Employees born in or after 1957 who have received one dose of MMR previously shall receive one booster dose.

1.5.5.2.2.4.3. Employees born in or after 1957, without documentation of any previous vaccination with MMR, should receive two doses of vaccine, separated by no less than one month.

1.5.5.2.2.5. Contractor's health care providers shall be screened for tuberculosis by a tuberculin skin test using the

Mantoux technique. A skin test result of 10 mm of induration or more shall be required to have a chest roentgenogram and an evaluation performed. A tuberculin skin test of 10 mm of induration or more will require documentation providing an assessment of the patient (status of infection- active, inactive; need for preventive treatment or not as determined by age, history of BCG (Bacillus Calmette-Guerin) vaccination; duration of skin test positively, etc).

1.5.5.2.2.5.1. If all of the immunizations and tests set forth in the preceding paragraphs have not been completed, the contractor shall issue a certificate providing evidence of immunizations and tests that have been completed or started and shall provide a schedule for the completion of unfinished immunizations and lab tests. After the schedule is completed, the contractor must provide an updated and complete certificate.

1.5.5.2.2.5.2. All contractor personnel performing direct health care services under this contract, who experience a parenteral (e.g., needle-stick or cut) or mucous membrane exposure (e.g., splash to the eye or mouth) to blood or bloody body fluids, shall receive prompt treatment. The medical treatment facility (MTF) will evaluate the source of exposure for risk of Hepatitis-B, Hepatitis-C, and Human Immunodeficiency virus (HIV) and will provide a report of the findings to the contractor and the contract provider. It shall be the contractor's responsibility to provide appropriate treatment as needed to possibly include Tetanus-Diphtheria booster, Immune Globulin, Hepatitis-B vaccine booster, or Hepatitis-B Immune Globulin. The contractor shall be responsible for providing the contract employee with initial testing and if the source of exposure was unknown, positive, or considered at high risk for HIV infection, follow-up testing 3, 6, and 12 months after exposure. In the event of a confirmed or highly suspected parenteral exposure to HIV, the contractor shall insure that the contract provider receives appropriate counseling and is referred immediately to a private infectious disease specialist for consideration of any experimental therapy (e.g., AZT). The Government may require the contractor to provide evidence of the status of treatment and testing of the individual provider under the contract.

1.5.5.2.2.5.3. Failure to meet the requirements stated herein, or when test results determine a contract provider has a contagious disease, the Contracting Officer may, upon the advice of the MTF Director or his clinical staff, determine that such provider is not an acceptable individual to perform services under this contract.

1.5.5.2.2.5.4. Influenza Immunization:

1.5.5.2.2.5.4.1. Contract personnel shall have the current influenza immunization from a non-Government physician and present evidence of the shot to the COR, unless documented by a physician to be medically contraindicated or because of bona fide religious exceptions prior to commencement of work at the MTF.

1.6. Performance Assessment

1.6.1. The government will evaluate the contractor’s overall performance utilizing the government’s Surveillance

Plan. The COR will monitor contractor performance through organized Quality Assurance Evaluator (QAE) team members, visits by government subject matter experts, government information systems and records, patient records, customer service information, contractor reports and personal observation.

1.6.2. In addition to the government’s surveillance plan, performance levels associated will the Health Plan

Employer Data Information Set (HEDIS) metrics in Exhibit C will be monitored.

1.7. Recognized Holidays

The contractor is not required to perform services on the listed holidays, and will not be paid on the listed holidays:

New Year’s Day Labor Day

Martin Luther King Jr.’s Birthday Columbus Day

President’s Day Veteran’s Day

Memorial Day Thanksgiving Day

Independence Day Christmas Day

1.7.1. Any of the above holidays falling on a Saturday will be observed on the preceding Friday; holidays falling on a Sunday will be observed on the following Monday. Any holidays that are declared by Presidential Executive

Order shall be observed in the same manner as the holidays listed above. If the area in which a contract employee is not required to report in, payment will not be made for those hours. Closures of the installation due to inclement weather or other such acts of God shall be handled in the same manner, and the contractor will not be paid during such closured.

1.8. Hours of Performance:

1.8.1. Operating Hours for FHCs: The FHCs operating hours shall be from 0700 to 2000 hours, Monday through

Friday, and 0700 to 1400 hours on Saturdays. The FHCs shall be closed on Sundays and Federal Holidays. Specific in-house MTF and on-call hours for contractor provided Orthopedics and Obstetrics services at FBCH are described in this PWS.

1.8.2. Operating Hours for Specialty Services: The operating hours for Specialty Services shall be 0700 to 2000 hours Monday through Friday only with the exception of Physical Therapy, which shall also be open 0800 to 1200 on Saturdays.

1.8.3. Operating Hours for Pharmacies: The pharmacies at each FHC shall be operational during all FHC hours of operation. The contractor shall establish hours of operation for various internal operational components within the

FHCs such as appointing and FHC specialty services that meets the government’s needs and ensures contract compliance for productivity, access and customer satisfaction and convenience. The contractor shall ensure contractor employee training programs, if conducted during business hours of operation, do not interfere with or impact patient care and that the centers remain open and fully functional during all hours of operation.

1.8.4. The Contractor upon award of the contract shall ensure that at least 90% of the identified personnel staffing requirements are filled by the effective start date of the contract. The final 10% of the staffing requirements are to be filled within 180 calendar days of the contract effective performance start date. The Contractor shall maintain a 95% monthly fill-rate.

1.8.5. The contractor shall adhere to specialty services hours of operation as detailed in the PWS Exhibits, and as noted below:

1.8.5.1 On-Call Services: The contractor shall provide on-call services to support some specialty services as required. On-call specifics are annotated in the PWS Exhibits.

1.8.6. Absences. When anticipated Contractor Employees have not reported for duty, have become ill, or are unable to work during a scheduled shift, they must contact the Contractor.

1.8.7. Payment to the Contractor will not be made for temporary work stoppage due to the observation of holidays, or circumstances beyond the control of the Medical Treatment Facility, such as acts of god, inclement weather, power outages, or temporary closing of facilities.

1.8.8. Interviews. There will be no interviews conducted by government personnel.

1.8.9. Facility Closures. During anticipated closure of the facility due to FBCH Command declared training holidays, administrative leave granted to the entire government staff, or other closure, Contractor HCPs may not be required to perform services, unless specifically scheduled. In the event of unplanned closure of the facility as determined by the FBCH Command due to natural disasters, military emergency, or severe weather, contract workers who are scheduled to work shall not report to work unless notified differently by their agency.

1.8.10. OVERTIME IS NOT AUTHORIZED

1.8.11. Performance Quality. The Contractor shall establish and maintain a complete Quality Control Plan (QCP) that shall ensure the requirements of the contract are provided as specified in this PWS. Within 30 (thirty) calendar days after contract award, a comprehensive written QCP shall be submitted to the COR and within five (5) working days when changes are made thereafter.

1.8.12. Phase-in /Phase-out Period. To minimize any decreases in productivity and to prevent possible negative impacts on additional services, the Contractor shall have personnel on board, at no additional cost to the government, during the one hundred and eighty (180) days phase in/ phase out periods. During the phase in period, the Contractor shall become familiar with test requirements in order to commence full performance of services on the contract start date.

1.9. Facilities Security:

1.9.1. The FHCs shall be stand-alone clinics to provide adequate safety and security for patients.

1.9.2. Medical Storage Secure Storage. Clinics design shall incorporate adequate secure storage for medical records of active patients. Inactive patient records must also be maintained and retired according to AR 40-66.

1.9.3. Facility Access. The contractor shall propose a FHC design that guarantees only authorized personnel access to the FHCs. For security purposes, the contractor shall ensure 100% identification check for all patients and visitors. The contractor shall ensure appropriate signage notifying visitors/patients of the 100% identification check is present at each FHC entrance.

1.9.3.1. Security of the clinics is the sole responsibility of the contractor.

1.9.4. Electronic Surveillance. The contractor shall include an electronic surveillance system into their facility design, to include 24-hour, 365-day video surveillance of all exterior entrances, exterior building access and emergency exits, main lobby, all hallways, all reception and patient waiting areas, including the pharmacy waiting area. Video surveillance footage shall be secured and retained for fourteen (14) calendar days, and immediately presented to the COR, the FBCH Security Office or Law Enforcement upon request.

1.9.5. Armed Security Guard. The contractor shall provide one (1) armed security guard at each FHC on business days at all times, starting thirty (30) minutes before the FHCs open for business and ending thirty (30) minutes after the FHCs close for business.

1.9.6. Panic Buttons. Patient security shall include emergency notification (Panic Buttons) in each room patients will visit, at each FHC.

1.9.7. Information Security

1.9.7.1. Common Access Cards. All contractor personnel requiring access to computer networks and other information management infrastructure shall obtain a government provided Common Access Card (CAC). The contractor is responsible to ensure CAC cards remain current for all active employees. The contractor shall also be responsible to ensure CAC cards for terminated employees are returned to the government within 2 business days of the employee’s termination for proper accountability. Contractor personnel shall follow government processes established for the issuance of the CAC card. Travel for the purposes of obtaining CAC cards will not be reimbursed by the government.

1.9.7.2. Contractor shall adhere to all DOD, Army, Medical Command (MEDCOM), DHA, MEDDAC policies regarding information assurance and HIPAA privacy/security.

1.9.7.3. ADP Security: The contractor HCP under this contract shall have access to and /or process information requiring protection under the Privacy Act of 1974. These positions are considered “ADP Sensitive” position.

Compliance with DoD Directive 5200.28, DoD 5200.2-R, AR 25-2 and AR 380-67 (for Army), and applicable regulations for other services, is mandatory for ADP Sensitive positions.

1.9.8. Physical Security. The contractor shall be responsible for safeguarding all government equipment, information and property provided for contractor use. At the close of each work period, government equipment and materials shall be secured.

1.9.8.1. Key Control. The contractor shall establish and implement methods of making sure all keys/key cards issued to the Contractor by the Government are not lost or misplaced and are not used by unauthorized persons.

NOTE: All references to keys include key cards. No keys issued to the Contractor by the government shall be duplicated. The Contractor shall develop procedures covering key control that shall be included in the Quality

Control Plan. Such procedures shall include turn-in of any issued keys by personnel who no longer require access to locked areas. The Contractor shall immediately report any occurrences of lost or duplicate keys/key cards to the

Contracting Officer.

1.9.8.2. In the event keys, other than master keys, are lost or duplicated, the Contractor shall upon direction of the

Contracting Officer, re-key or replace the affected lock or locks; however, the Government, at its option, may replace the affected lock or locks or perform re-keying. When the replacement of locks or re-keying is performed by the Government, the total cost of re-keying or the replacement of the lock or locks shall be deducted from the monthly payment due to the Contractor. In the event a master key is lost or duplicated, all locks and keys for that system shall be replaced by the Government and the total cost deducted from the monthly payment due to the

Contractor.

1.9.8.3. The Contractor shall prohibit the use of Government issued keys/key cards by any persons other than the

Contractor’s employees. The Contractor shall prohibit the opening of locked areas by Contractor employees to permit entrance of persons other than Contractor employees engaged in the performance of assigned work in those areas, or personnel authorized entrance by the Contracting Officer.

1.9.8.4. Key Control Procedures (IAW Ar 190-51 Appendix D; DoDI 5200-8R; and FBCH Policy 4140 Key

Control): The Contractor will comply with the FBCH-I 4140.06 (Key and Lock Control) in regards to the security of government owned equipment.

1.9.8.5. Lock Combinations: The Contractor shall establish and implement methods of ensuring that all lock combinations are not revealed to unauthorized persons. The Contractor shall ensure that lock combinations are changed when personnel having access to the combinations no longer have a need to know such combinations, the combination has been compromised, or annually, if the previous two requirements have not occurred in a one year time frame. The date, reason for change, and individual making the combination change will be recorded and kept on file. These procedures shall be included in the Contractor’s Quality control Plan.

1.10. Post Award Conference/Periodic Progress Meetings. The contractor agrees to attend any post award conference convened by the contracting activity or contract administration office in accordance with Federal

Acquisition Regulation Subpart 42.5. The Contracting Officer (KO), Contracting Officer’s Representative (COR), and other Government personnel, as appropriate, may meet periodically with the contract to review the contractor’s performance. At these meetings the contracting officer will appraise the contractor of how the government views the contractor performance and the contractor will apprise the Government of problems, if any, being experienced.

Appropriate action shall be taken to resolve outstanding issues. These meetings shall be at no additional cost to the government.

1.11. Contracting Officer’s Representative. The (COR) will be identified by separate letter. The COR monitors all technical aspects of the contract and assists in contract administration. The COR is authorized to perform the following functions: assure that the Contractor performs the technical requirements of the contract; perform inspections necessary in connection with the contract performance; maintain written oral communications with the

Contractor concerning technical aspects of the contract; issue written interpretations of technical requirements, including Government drawings, designs, specifications; monitor Contractor’s performance and notifies both the

Contracting Officer and Contractor of any deficiencies; coordinate availability of government furnished property, and provide site entry of Contractor personnel. A letter of designation issued to the COR, a copy of which is sent to the Contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the resulting order.

1.12. Contractor Employee Travel: Contractor Employees will be required to travel locally, within the NCR, during the performance of this contract to attend meetings, conferences, and training. Contractor Employees may be required to travel to off-site training locations and ship training aids to these locations in support of this PWS.

Travel will be at no additional cost to the government.

1.13. Other Direct Costs: Any other direct cost not specified under Section B or specifically approved elsewhere in this contract, must be preapproved by the Contracting Officer.

1.14. Data Rights: The Government has unlimited rights to all documents/material produced under this contract. All documents and materials, to include the source codes of any software, produced under this contract shall be

Government owned and are the property of the Government with all rights and privileges of ownership/copyright belonging exclusively to the Government. These documents and materials may not be used or sold by the contractor without written permission for the Contracting Officer. All materials supplied to the Government shall be sole property of the Government and may not be used for any other purpose. This right does not abrogate any other

Government rights.

1.15. Organizational Conflict of Interest: The contractor and subcontractor personnel performing work under this contract many not receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statement, etc.)

or perform evaluation services which may create a current or subsequent Organizational Conflict of Interest (OCI) as defined in FAR Subpart 9.5. The Contractor shall notify the Contracting Officer immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and shall promptly submit a plan to the Contracting Officer to avoid or mitigate any such OCI. The contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the Contracting officer and in the event the Contracting

Officer unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the Contracting

Officer may employ other remedies as he or she deems necessary, including prohibiting the Contractor from participation in subsequent contracted requirements which may be affected by the OCI.

1.16. Phase In/Phase Out Period: To minimize any decreases in productivity and to prevent possible negative impacts on additional services, the contract shall have personnel on board according to the terms of the PWS as stated below.

1.16.1. Staffing Phase in Period: The government shall assign a Medical Director to each FHC. The government

Medical Director(s) will be an appointed military or civil service clinician. The government Medical Director for each of the FHC will provide health care delivery oversight and direction particularly as it relates to overall direct health care program content and effectiveness, clinical quality control issues, coordination (through the FBCH

Credentials Committee) of adverse actions on health care provider (HCP) privileges, credentialing, privileging, and oversight of Joint Commission standards and compliance. The contractor remains solely responsible for the day-to-day FHC operational/administrative efficiency and contract compliance.

1.16.2. The contractor shall accomplish the goals outlined in this Performance Work Statement (PWS) by furnishing skilled and experienced professional, supervisory, administrative, custodial, and technical personnel. The contractor shall establish a clinic FHCs and administrative management team and clinical support staffing structure for the FHCs. The staffing structure shall clearly delineate areas of responsibilities, establish accountability and authority; enhance productivity; and promote integration with FBCH Performance Improvement (PI) and Joint

Commission program components. The administrative management team and clinical support staffing structure shall be responsive to the Medical Director, the Contracting Officer’s Representative, the contract clinic administrator/program manager and shall support the scope of services outlined in this PWS.

1.16.3. The contractor shall provide to the Contracting Officer and the Contracting Officer's Representative (COR), not later than 15 calendar days prior to start of Patient Centered Medical Homes operations, the full names and phone numbers of all contractor employees performing services under this contract who are management/supervisory personnel. The list shall include each employee's name, work assignment, work location, and information regarding training, licensure, certification, education, experience, and other qualifications.