ATAMMC_PWS_12.14.23.pdf

Department of Defense Defense Health Agency Alexander T. Augusta Military Medical Center (ATAMMC) Ambulatory Care Centers (ACC)

Performance Work Statement

Solicitation Number: HT001523R0030 Version: FINAL Date: 14 Dec 2023

1. PART 1 GENERAL INFORMATION

1.1. Introduction: The Ambulatory Care Centers (ACCs), formerly called Family Health Centers (FHCs) but now referred to as ACCs in this document, are part of the Alexander T. Augusta Military Medical Center (ATAMMC), operate as extensions of ATAMMC, and serve as feeder clinics for the inpatient services provided at ATAMMC and Walter Reed National Military Medical Center (WRNMMC).

1.2. Background: Historically, the ACCs began operation as PRIMUS (Primary Care for the Uniformed Services) clinics in 1984 to improve patient access to military medicine and reduce CHAMPUS (now TRICARE) costs. These contractor-owned contractor-operated Military Medical Treatment Facility (MTF) extension clinics have evolved into their current role as an integrated component of ATAMMC and Defense Health Network (DHN) National Capital Region (NCR). ATAMMC provides comprehensive health care to the largest enrolled population in the NCR and the second largest enrolled population in TRICARE East Region.

1.3. Scope: This requirement is for the continued provision of strategically located ACCs, delivering community-based health care services (as described in this PWS), at contractor provided and managed sites, for eligible military beneficiaries residing predominately in the southern (I-95) and western (I-66) corridors of the NCR satisfying the 30-min drive time standard for Primary Care for eligible beneficiaries. The Contractor’s ACC facility locations should not be within the 30-minute drive time of ATAMMC, see Exhibit V_ATAMMC Drive Time. Stand-alone ACC buildings are preferred but not required. All work under this contract is unclassified.

1.3.1. Program Objectives: The Contractor shall meet the following program objectives:

1.3.1.1. Quality: The Contractor shall provide quality, comprehensive primary care, urgent care, and select specialty care in a community-based environment that meets or exceeds The Joint Commission (TJC) and Defense Health Agency (DHA) standards, or any industry standard that the DHA would use in accrediting its MTFs, in accordance with DoD Manual (DoDM) 6025.13, Medical Quality Assurance (MQA) and Clinical Quality Management in the Military Health System (MHS).

1.3.1.2. Utilization Management: The Contractor shall establish programs and goals to aggressively manage the 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 ACC enrollee utilization; specialty service program management that targets maximum recapture of care).

1.3.1.3. Access to Care: The Contractor shall meet or exceed DHA access standards for Primary and Specialty Care.

1.3.1.4. Patient Satisfaction: The Contractor shall support the comprehensive customer satisfaction program through the Joint Outpatient Experience Survey (JOES) and the contractor employee (Patient Advocate) by being responsive to patient needs, establishing a provider/patient foundation of trust, and ensuring healthier patient outcomes.

1.3.1.5. Facilities: The Contractor shall provide and maintain the ACC facilities and provide all management, staffing (except Behavioral Health (BH) providers and Information Technology (IT) support and maintenance), supplies, and equipment (other than Government furnished) necessary to support the provision of the services described in this PWS.

1.3.1.6. Clinical Care: The Contractor shall provide medical, clinical, ancillary, and administrative services to support an ambulatory/primary care program for the treatment of authorized TRICARE beneficiaries with acute and chronic care conditions. The expected number of primary care enrollees/beneficiaries is approximately 51,000. The beneficiaries’ demographics at time of draft are included in Exhibit A, Beneficiaries’ Enrollment and Zip Code Data.

1.3.1.7. Graduate Medical Education (GME): The Contractor shall provide administrative support to GME programs to include report generation and checking patients in (Medical Support Assistant). Support to GME providers is part of the Primary Care support required in para 5.13.2.1.5.

1.3.2. The Government will provide all required IT support and maintenance, as well as BH provider services; therefore, such services are considered out of scope for this requirement.

1.4. The Automated Data Processing (ADP)/IT levels and position sensitivity designation for positions under this contract is: ADP/IT I: Non-sensitive position.

1.5. Place of Performance: The Contractor shall perform all work under this contract at the Contractor’s ACC facilities, location to be determined by the Contractor in accordance with para 1.3 and Exhibit A, except Labor and Delivery and/or Operating Room services, which shall be performed at DHA NCR facilities.

1.5.1. MTF Standards: The Contractor shall comply with all applicable federal, state, and local laws, DoD, agency-specific, installation and MTF policies, procedures, and instructions as applicable at the place of performance.

1.6. Period of Performance (PoP): The PoP shall consist of a 5-year ordering period, from the date of award, with one base year and four option years. The anticipated period of performance is as follows:

Base Period 31 Jul 24 through 30 Jul 25 Option Period 1 31 Jul 25 through 30 Jul 26 Option Period 2 31 Jul 26 through 30 Jul 27 Option Period 3 31 Jul 27 through 30 Jul 28 Option Period 4 31 Jul 28 through 30 Jul 29 6-mo extension 31 Jul 29 through 27 Jan 30

1.7. Transition

1.7.1. Phase-in Transition Period. (Applies to all non-incumbent contractors and to the incumbent contractor if it proposes to use new facilities.) The period between the contract award date and full healthcare delivery performance start date constitutes the phase-in period. If a transition from the incumbent contractor is required, then the one-year base period (first period of performance) of this contract, will include the phase-in transition period, which may not exceed nine (9) months, with the exact length of the phase-in transition depending on the incoming contractor’s proposed transition schedule.

1.7.1.1. During the phase-in transition period, the Contractor shall prepare to meet all contract requirements.

1.7.1.2. Administrative and Personnel Transition Requirements: The Contractor shall conduct all activities necessary to prepare itself to manage and administer the ACCs, and deliver all required services to beneficiaries, beginning on the full healthcare delivery performance start date. Among other things, the Contractor shall ensure it has sufficient staff (both providers and non-providers) in place, and functionally trained and qualified, by the healthcare delivery performance start date. Incoming replacement personnel hired after contract award shall be trained and qualified no later than 30 days before the start of healthcare delivery. The Government will make equipment and materials accessible to the Contractor during the phase-in transition period, so long as doing so does not interfere with ongoing ACC operations.

1.7.1.3. Facility Transition Requirements: The Contractor shall conduct all activities necessary to prepare its physical ACC facilities for healthcare delivery. This includes acquiring/leasing, designing, updating, remodeling, and refurbishing the facilities (if/as needed); implementing security measures; installing cabling and installing phones, physically moving equipment between facilities (if applicable), and all other activities associated with preparing the physical facilities for use under the contract.

1.7.2. Incoming Transition Plan. The Contractor shall provide a detailed Incoming Transition Plan. This plan will show the activities that will be carried out to ensure smooth transition of all aspects of service and support covered in this PWS. The Contractor shall demonstrate how it will provide service and support at or above the current level of service and support, with no break or downtime in service and support. The plan shall identify the overall strategy of transitioning and include transition plans for each provided service, transition schedule, roles and responsibilities, communication plan, escalation process, progress review meetings, status reporting, milestones, clearly identified risks, and mitigation plan.

1.7.3. Phase-Out Transition Period. During this transition period, at the end of the contract period of performance, the Contractor shall implement its Outgoing Transition Plan and assist in transferring responsibilities to the next contractor.

1.7.4. Outgoing Transition Plan. The Contractor shall provide an Outgoing Transition Plan for thirty (30) days of outgoing transition time for transitioning work to a follow-on contract/order or Government entity.

The Contractor shall assist the Government in planning and implementing a complete transition from this contract and/or orders issued under this contract to another healthcare delivery performance entity. This shall include formal coordination with Government staff and successor staff and management. It shall also include delivery of copies of existing policies and procedures, and delivery of required metrics and statistics.

1.8. Recognized Holidays: Each ACC will be closed on the day of an observed federal holiday. The Contractor is not required to perform services, and no billable services will be performed on the listed holidays. Any holidays that are declared by Presidential Executive Order shall be observed in the same manner as the holidays listed below:

New Year’s Day Labor Day Martin Luther King Jr.’s Birthday Columbus Day President’s Day Veteran’s Day Memorial Day Thanksgiving Day Juneteenth Christmas Day Independence Day

1.9. Unplanned Closures: The Contractor shall receive approval from the ATAMMC Director before closing the facility on any days other than those specified in para 1.8.

1.9.1. Mission Essential: The Obstetrics provider(s) is/are designated as Mission Essential and shall follow mission essential requirements, including reporting to work requirements during recognized closures (see DFARS clause 252.237-7023).

1.10. Contracting Officer’s Representative (COR): The Government will identify a COR for the contract and Alternate CORs (ACORs) for each ACC facility.

1.11. Personal and Non-Personal Services: This contract requires the Contractor to provide both non-personal services and personal services. Specifically, all contractor personnel who serve as Skill Type 1 and 2 Health Care Providers (HCPs) (see Exhibit S) shall perform on a personal services basis. All other contractor personnel (including personnel in Skill Type 3, 4, and 5 positions) shall perform on a non-personal services basis.

1.11.1. Personal services HCP licensure: Personal services HCPs requiring licensure shall have and maintain a current, valid, unrestricted license specific to the position (with no limitations, stipulations or pending adverse actions) in any U.S. jurisdiction as outlined in the applicable DoD/DHA regulation or instruction. All provider licenses must be unencumbered and remain in effect at all times during contract employment.

1.11.2. Personal services HCP medical malpractice insurance requirements: The DoD will process any personal injury claim alleging negligence by personal services HCPs within the scope of their performance as claims alleging negligence by DoD military or civil service HCP, pursuant to 10 USC Section 1089.

Therefore, personal services HCPs are not required to provide or obtain medical malpractice insurance in order to perform services under the contract.

1.11.3. The Contractor shall insert paragraphs 1.11.1, 1.11.2, and this paragraph 1.11.3 in all subcontracts for or involving personal services HCPs.

1.11.4. Non-personal services employee licensure: The Contractor shall ensure that personnel working under the contract on a non-personal services basis (see para 1.11) who are in positions requiring licensure (e.g., RNs and LPNs) maintain current, valid, unrestricted licenses specific to their position (with no limitations, stipulations, or pending adverse actions) from the Commonwealth of Virginia.

1.11.5. Non-personal services employee insurance requirements: The Contractor shall indemnify the Government for any liability producing act or omission by a non-personal services contractor (or subcontractor) employee occurring during contract performance. The Contractor shall maintain, as appropriate, medical liability insurance which is not less than the amount normally prevailing within the local community for the position(s) concerned, and the Contractor shall ensure that its subcontracts for non-personal services employees contain these requirements.

1.12. Quality Assurance: The Government will evaluate the Contractor’s performance under this contract utilizing a Quality Assurance Surveillance Plan (QASP). The QASP provides the Government with a systematic method of evaluating performance to include how the performance standards in Exhibit B, Performance Requirement Summary will be applied, the frequency of surveillance, surveillance method, and the acceptable quality levels (AQLs) for each of the performance objectives. Further, the QASP provides the COR with a proactive tool for addressing and averting unacceptable or deficient contractor performance and obtaining verifiable input for the required past performance documentation.

1.12.1. The Government will finalize the QASP immediately following award and will provide a copy to the Contractor after award. The QASP is a living document and may be updated by the Government as necessary.

1.13. Quality Control (QC)/Performance Improvement (PI) Programs. The Contractor shall actively participate in the ATAMMC Performance Improvement (PI) Program.

1.13.1. Productivity and Quality Standards: The Contractor shall comply with all MTF productivity and quality standards and maintain a level of productivity and quality comparable with that of other individuals performing similar services to include Health Plan Employer Data and Information Set (HEDIS) measures in Exhibit Q and Encounter Requirements in Exhibit AA-4.

1.13.1.1. The Contractor shall establish and maintain an active and effective quality control program to ensure services are performed in accordance with the PWS. The Contractor shall develop and implement procedures to identify and prevent the recurrence of defective services. The Contractor’s quality control program is the means by which the Contractor assures the work complies with the requirement of the contract, which includes methods and tools to detect, correct, monitor, benchmark and report QC deficiencies that adversely affect contract compliance or performance. The Contractor shall submit its QC plan to the COR and Contracting Officer (CO) a minimum of 15 days prior to healthcare delivery performance start date.

1.13.2. The Contractor's PI program shall conform to and operate as an integrated element of the command wide ATAMMC PI plan. The Contractor shall submit ACC Data Quality/PI meeting minutes monthly for review and inclusion into the ATAMMC Executive Committee of the Medical Staff (ECOMS) PI Program.

1.14. Risk Management. The Contractor shall support the government’s Risk Management and Internal Control (RMIC) Program, as described in DoDI 5010.40, by meeting established RMIC goals and responding to government Assessable Unit Manager requests for data and provide information necessary to evaluate the government’s management control processes.

1.15. Hours of Operation: The Contractor shall conduct business on the days and hours specified in the PWS except when the Government facility is closed, as described in para 1.8 and 1.9 of this PWS. All times listed are in the Eastern Time zone.

1.15.1. Operating Hours for Primary Care Services. The ACCs operating hours for Primary Care services shall be:

0700 to 2000 Monday through Friday

0700 to 1200 Saturday

1.15.1.1. The ACCs’ Primary Care services shall be closed on Sundays and Federal Holidays per PWS para 1.8.

1.15.2. Operating Hours for Specialty Care Services. The operating hours for Specialty Care Services shall be:

Physical Therapy and Occupational Therapy: 0700 to 1800 Monday through Friday

Optometry, Orthopedic, Dermatology, Sports Medicine, Podiatry, and Behavioral Health: 0730 to 1630 Monday through Friday

Obstetrics: Monday to Friday to include on call services to support Obstetrics/Certified Nurse Midwife (CNM) as required. On-call is scheduled in shifts as follows:

Obstetrician and CNM On Call Services:

Obstetrician: In ATAMMC operative procedures 0700 to 1630 one to two days per week

In-House: 1630 to 0730 Monday to Friday and 0700 Saturday to 0730 Sunday

On-Call: 1630 to 0730 Monday to Friday and 0700 Saturday to 0730 Sunday

CNM: In-House Labor and Delivery 0700 to 1930 or 1900 to 0730 Sunday to Saturday

In-House call will be scheduled a minimum of one 12-hour shift per week, and may be scheduled any day of the week, Monday to Sunday, including weekends and holidays.

1.15.3. Operating Hours for Pharmacies, Laboratory, and Radiology. The pharmacies, laboratory, and radiology at each ACC shall be operational:

0700 to 2000 Monday through Friday

0700 to 1400 Saturday

1.15.4. Operating Hours for Urgent Care. A minimum of two (2) urgent care locations to support the beneficiary population may be co-located with an ACC and shall be operational:

0700 to 2000 Monday through Friday, with last patient check in at 1930

0700 to 1400 Saturday, with last patient check in at 1330

1.15.5. Operating Hours for Nurse Triage Services. The Contractor shall provide nurse triage services during routine call center hours:

0600 to 2000 Monday through Friday

0600 to 1400 Saturday

1.16. Post Award Conference/Periodic Progress Meetings: The Contractor shall attend a contract post award conference established by the CO within 20 days of contract award. The Contractor also shall attend any post award conference or progress meeting convened by the contracting activity or contract administration office IAW Federal Acquisition Regulation (FAR) Subpart 42.500, Post-award Orientation.

1.16.1. The Contractor shall conduct and/or participate in periodic briefings/updates to the ATAMMC Director or Agency representatives to discuss Contractor performance. The Government will provide at least five (5) days’ notice of required Contractor attendance at meetings.

1.17. Reports. Reports and/or data requests may occur routinely on a weekly, monthly, or quarterly basis or may be requested on an Ad hoc basis to support specific command initiatives. The Contractor shall submit reports/data to the government as noted in Part 9 of this PWS, Reporting Requirements and Deliverables.

1.18. Contractor Key Personnel: The Contractor shall submit names and resumes of all key personnel and contact information (email addresses and phone numbers) to the COR for Government review no later than five (5) business days after contract award. Any changes to key personnel must be communicated in writing to the COR with resumes for review three (3) business days before the change is made.

1.18.1. Contract Program Manager: The Contractor shall designate as key personnel a primary and alternate representative who will be the Contractor’s Points of Contact (POC) at the contract level. The POC primary and alternate shall be individuals who are knowledgeable of the terms and conditions of the contract and authorized to make decisions regarding the contract.

1.18.2. Key Administrative Personnel: The Contractor shall designate as key personnel a Clinic Administrator, Alternate Clinic Administrator, and Nursing Supervisor at each ACC.

1.18.3. The Contractor shall also designate a Lead Physician in charge of contractor medical personnel.

1.19. Record Contractor Employee Time: The Contractor shall submit required Defense Medical Human Resources System – internet (DMHRSi) information on 100% of all contracted personnel and the DMHRSi information shall be approved by the supervisor of the Contractor not later than close of business (COB) the second business day after the close of the government pay period.

1.19.1. The Contractor shall comply with DHA guidance in DHA-Procedures Manual (PM) 6010.13, Volumes 1 and 2 requiring the timely collection of manpower data. The accurate collection of manpower data has a direct impact on analysis of provider productivity and data quality accuracy.

1.20. Dress and Appearance: Contractor personnel shall maintain good personal hygiene and present a well-groomed and professional appearance IAW ATAMMC policy.

1.20.1. The Contractor shall ensure all contractor personnel wear contractor provided identification/name tags that identify each person by picture, name, and professional degree: i.e., medical doctor (MD), registered nurse (RN), etc. In addition, the Contractor shall ensure that all contractor personnel wear a secondary badge indicating profession type and following current applicable ATAMMC guidelines. The secondary badge shall bear the name of the business entity under which the person is employed, or for which they are serving as a subcontractor, and bear the ATAMMC logo to identify personnel as part of the ATAMMC Network. The nameplate shall also contain a picture of the employee (contractor provided).

1.21. Medical Protocols: The Contractor shall follow established government and professional clinical standards and accepted clinical protocols in the performance of duties as outlined in ATAMMC policies and procedures.

1.22. Referrals and Consults: The Contractor shall follow DoD and ATAMMC regulations and policies when arranging for a referral or consult.

1.23. Peer Review: The Contractor shall ensure all credentialed providers participate in peer review and other staff requirements in the ACC.

1.24. Scope of Practice: The Contractor shall not introduce new procedures or services without prior approval through established MTF practice guidelines and individual privileges granted.

1.25. Health Requirements: The Contractor shall ensure all contractor employees comply with all health requirements. No earlier than 60 days prior to physical performance of services by the Contractor, the Contractor shall provide to the Government documentation certifying its employees meet all health requirements such as immunizations, annual vaccinations, and medical testing (i.e., tuberculosis, N95 particulate respirator and duckbill mask fitting). (Exhibit F, Immunization Form)

1.25.1. Annual Immunizations: The Contractor shall ensure all contractor employees under this contract are immunized annually with the seasonal influenza vaccine and any other vaccine recommended by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control (CDC) for contractors or service/ATAMMC specific guidance as outlined in DoDD 6205.02e, Policy and Program for Immunizations to Protect the Health of Service Members and Military Beneficiaries. The annual influenza vaccine may be provided by the Government, if available, as determined by ATAMMC. If a contractor employee chooses to be immunized by the Government, the contractor employee shall sign a waiver releasing the Government from the legal liability IAW local procedures and policies. Alternately, the contractor employee may obtain the vaccine at another facility, at no cost to the Government, and provide proof of vaccination to the Government. If a contractor employee declines vaccination, the Contractor shall provide a signed declination form to the COR IAW CDC recommendations and ATAMMC policy.

1.25.1.1. Immunization Tracking: The Contractor shall maintain its own process and system of tracking the currency of health immunizations and shall not rely on the Government for ensuring its contractor employees are in compliance.

1.25.2. Blood Borne Pathogen Exposure: All contract providers/technicians performing health care services shall participate in the ATAMMC’s Blood Borne Pathogen Program, which outlines the post blood borne exposure protocols for testing, treatment, and monitoring.

1.25.3. Occupational Health: If required by the government, the Contractor shall obtain, at contractor expense, documentation of required physical testing, and a statement from the Contractor’s licensed medical practitioner or a report of a physical examination. The physical examination shall indicate that the Contractor is free from mental or physical impairments that would restrict the Contractor from providing the services described in the contract.

1.25.4. Universal Precautions: The Contractor shall comply with the CDC’s “Universal Precautions” for the prevention of the transmission of the human immunodeficiency virus (HIV). HIV positive contractor employees will be managed IAW the current CDC guidelines and Section 503 of the Rehabilitation Act (29 U.S.C. Section 793) and any implementing regulations (41 CFR § 60-741).

1.25.5. Tuberculosis Screening: Prior to reporting for service at an ACC, the contractor employees shall be screened at Contractor expense for risk of exposure to tuberculosis as part of the health examination and immunization/screening requirement outlined in the contract. If the contractor employee is determined to have a low risk of exposure, no further screening or testing is required under this contract. The initial screening may be waived, at the discretion of ATAMMC, if the contractor employee provides evidence of a prior low risk assessment by a licensed physician. If the initial screening results in a determination that the Contractor has an increased risk of exposure to tuberculosis, the Contractor shall ensure that the contractor employee receives targeted screening and testing IAW CDC Guidelines for Health-Care Settings at Contractor expense and submitting timely records of subsequent screening or testing to the COR.

1.25.6. Health Notifications: The Government will notify the Contractor of any known work hazards. If work hazards exist, it will be the Government’s decision whether the Contractor continues work in the environment.

1.25.7. Medical Tests: No medical tests or procedures required by the contract will be performed by the Government with the exception post blood borne exposure protocols after exposure; and occupational exposure programs such as the Thermoluminescent Dosimetry monitoring program.

1.26. 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 NCR training locations and ship training aids to these locations in support of this PWS. Travel will not be separately priced.

1.27. Other Conflicts of Interest. The Contractor shall ensure HCPs employed under this contract comply with the following requirements:

1.27.1. Contractor HCPs shall not use patient care rendered pursuant to this agreement as a part of a study, research grant, or publication without the prior written consent of the ATAMMC Director.

1.27.2. Contractor HCPs shall not bill the patient, an insurer, or anyone else for services rendered.

Contractor HCPs are prohibited from receiving compensation of any kind for eligible patients treated, procedures performed, or any other actions performed, except under the terms and conditions of the contract.

1.27.3. Contractor HCPs shall not, while performing services under this contract, advise, recommend, or suggest to persons eligible to receive medical care at the governments’ expense that such persons should receive care from the Contractor HCP at any place other than at the ACCs or an MTF. The Contractor HCP shall not refer any patients to any entity or service to which they have a direct or indirect involvement (including partnership programs and ancillary services not offered by the ACCs or a local MTF).

1.27.4. Contractor HCPs are not prohibited by reason of their employment under this contract from conducting a private practice or engaging in other employment so long as there is no conflict between such practice or employment and their performance of services under this contract.

1.27.5. Contractor HCPs shall not use Government facilities or other Government property in connection with conducting a private practice.

1.27.6. Contractor HCPs shall not be active-duty military or government civilian employees of the United

States Government. Furthermore, the Contractor shall not hire Department of Defense ancillary or administrative staff if doing so will create a conflict of interest (for the Contractor or the employees) of any kind.

1.27.7. The Contractor shall maintain U.S. Government records, copies of original results and reports, verified original data, corrected data, and corrected supporting final reports in accordance with the Privacy Act of 1974. Although these records are maintained by the Contractor, they remain the property of the U.S.

Government, and the Contractor shall surrender them to the COR. (PWS Part 6)

1.27.8. Media Inquiries: Neither the Contractor nor its employees shall respond to any media inquiries. Any inquiries from the media shall be promptly relayed to the COR who will relay them to the ATAMMC Director or designee. There shall be no interviews, comments, or any other response without the knowledge and approval of the ATAMMC Director or designee.

2. PART 2 DEFINITIONS AND ACRONYMS

2.1. Definitions

2.1.1. ACCEPTABLE QUALITY LEVEL (AQL): The minimum level of performance a Contractor shall meet to be satisfactory on this contract.

2.1.2. ACUTE: A condition which requires medical attention within 24 hours, or the medical condition may be aggravated or deteriorate. Such a disorder is acute, but not necessarily severe.

2.1.3. AMBULATORY PROCEDURE VISIT (APV). The MHS Coding Guidelines define APVs as outpatient procedures or surgical interventions that require pre-procedure care, a procedure, immediate post-procedure care, directed by a qualified privileged provider, and are not expected to require an overnight stay following the surgical procedure. The nature of the procedure and the medical status of the patient combine to require short-term, but not inpatient care. These procedures are appropriate for all types of patients (obstetrical, surgical, and non-surgical) who, by virtue of the procedure or anesthesia, require post-procedure care or monitoring by medical personnel.

2.1.4. BENEFICIARY: An individual eligible for medical care in the Military Health System under the TRICARE Program, at an MTF or an ACC, as outlined in 10 U.S.C. Chapter 55.

2.1.5. CERTIFICATION: Official recognition of an individual health care professional by a national agency or association that is intended to assure the public that the health care professional has successfully completed an approved education program and evaluation. This includes a formal process designed to assess the knowledge, experience, and skills required to provide quality patient care in that specialty.

2.1.6. CHRONIC: Diagnosed conditions that last one year or more and require ongoing medical attention or limit activities of daily living or both.

2.1.7. CLINICAL PRIVILEGES: Elements of medical care which define the scope and limits of practice for individual providers. Clinical privileges are based on the capability of the health care facility and the provider’s licensure, relevant training and experience, current competence, health status, and demonstrated judgment.

2.1.8. COMPETENCY: The ability to integrate knowledge, skills, and attitudes in their job performance.

In addition, the performance is equivalent to stated requirements and to professional standards of care and practice.

2.1.9. CONTRACT AWARD DATE: The Contract Award Date is the effective date of the contract found in Block 3 of Standard Form 1449, Solicitation/Contract.

2.1.10. CONTRACTOR: The vendor awarded the subject contract to deliver the specified services to the Government. The term used as in this contract refers to the Prime Contractor.

2.1.11. CONTRACTING OFFICER (CO): A person with authority to enter into, administer, and or terminate contracts, and make related determinations and findings on behalf of the Government.

2.1.12. CONTRACTING OFFICER’S REPRESENTATIVE (COR): An employee of the U.S. Government appointed by the CO to perform specific technical or administrative functions. Such appointment shall be in writing and shall state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the contract.

2.1.13. CONTRACTOR PERFORMANCE ASSESSMENT REPORTING SYSTEM (CPARS): The web-enabled application that collects government assessments on contractor performance, both positive and negative, based on objective facts captured during a specific period of time.

2.1.14. CREDENTIALING PACKAGE: The documents that provide the necessary information for the Government to validate credentials on a contractor employee prior to performance at an ACC. The type of information in a credentialing package includes, but is not limited to, qualifying degrees, education, professional experience, licensure/registration, and certification requirements. The type of information in a credentialing package for a privileged HCP also includes verification of clinical competency.

2.1.15. CREDENTIALED HCP: Any individual identified in the MTF or DHA credentialing instructions/regulations as credentialed. This may include an individual who maintains professional qualifications such as education, internship/fellowship, licensure, registration, and/or certification to practice in a clinical discipline.

2.1.16. CREDENTIALS REVIEW: The process by which the health care professional’s credentials are determined to be appropriate for the position requested or held prior to being granted clinical privileges or assigned patient care responsibility. It is based on the following four core criteria: current licensure; relevant education, training, or experience; current competence; and ability to perform the requested privileges or scope of practice. Credentials review is conducted on HCPs prior to selection and receipt of services from

HCP.

2.1.17. DELIVERABLE: Anything that can be physically delivered, which may include non-manufactured items such as meeting minutes or reports.

2.1.18. DISINTERESTED OFFICER: Personnel not assigned to Department who will conduct audit within Department. For example, Pharmacy Narcotics Inventory. Government only responsibility.

2.1.19. EMERGENT: A condition which requires immediate medical attention and for which delay is harmful to the patient. Such disorder is acute and potentially threatens life, limb, or eyesight (and/or functional abilities).

2.1.20. EMPANELED BENEFICIARY: A beneficiary who is enrolled to an ACC and is assigned (empaneled to) a Primary Care Manager in the ACC.

2.1.21. ENROLLED BENEFICIARY: A beneficiary who is enrolled to TRICARE Prime and assigned to an ACC for primary care. A Beneficiary can only be enrolled to only one facility at a time. Enrollment and disenrollment processing is handled by a third party.

2.1.22. FULL-TIME EQUIVALENT (FTE): The ratio of the required number of contractor employee hours by 1912 hours.

2.1.23. GHOST EMPANELED BENEFICIARY: A beneficiary who is enrolled to an ACC but who is not assigned to a PCM or who is assigned to a PCM who is no longer providing services under the contract.

2.1.24. GOVERNMENT FURNISHED EQUIPMENT: Equipment in the possession of, or directly acquired by, the government and subsequently furnished to the contractor (includes sub-contractors and alternate locations) for performance of a contract.

2.1.25. GOVERNMENT SUPERVISOR: Government individual who provides professional oversight of the clinical activities of personal services contractor HCPs. For personal services contract arrangements, this may be the individual who establishes the work schedule and directs the clinical work of the HCP. For purposes of evaluating performance and recommending clinical privileges, the clinical supervisor is a peer (if practicable) who is an appointed member of the medical staff and is the individual best qualified, on the basis of background and training, to judge the practice of the provider under review.

2.1.26. HEALTHCARE DELIVERY PERFORMANCE START DATE: The date on or after contract award on which the Contractor shall begin delivering healthcare on the contract. This date may immediately follow a Phase-In Transition Period.

2.1.27. HEALTH CARE PROVIDERS (HCPs): A healthcare provider is a credentialed contract worker (Skill Type 1 or 2) who is licensed and privileged to provide medical care or treatment dependently or independently. A HCP possesses appropriate credentials and is granted authorized clinical privileges to diagnose, initiate, alter, or terminate regimens of healthcare with defined scope of practice. HCPs contracted for on a personal services basis must perform duties that are primarily clinical in nature. If the duties associated with a position are primarily administrative or clerical in nature or consist of primarily maintenance or security services, then the position is not an HCP position that may be contracted for on a personal services basis.

2.1.28. INCOMING TRANSITION PLAN: A plan developed by the Contractor which outlines the milestones, timelines, tasks, training program, resources, and other required information to ensure a smooth transition into a new contract. This plan describes recruiting, hiring, and onboarding plans and timelines for incoming personnel, and how the Contractor plans to maintain continuity of service and ensure the Contractor is fully transitioned by the contract Healthcare Delivery Performance Start Date. This plan shall be subject to the CO’s approval.

2.1.29. KEY PERSONNEL: Personnel designated by the Contractor who are knowledgeable of the terms and conditions of the contract and authorized to make decisions on behalf of the Contractor.

2.1.30. LABORATORY DISCREPANCY: The difference between two measured values of a quantity, such as the difference between two measured values of the same quantity obtained by two laboratory personnel.

2.1.31. LICENSE: A grant of permission by an official agency of a State, the District of Columbia, or a Commonwealth, territory, or possession of the United States to provide health care within the scope of practice of a specified discipline. Licenses shall be current, active, valid, and unrestricted.

2.1.32. MALPRACTICE: A dereliction of professional duty, incorrect or negligent treatment, failure of professional skill or learning, as well as illegal or immoral conduct by any provider/professional responsible for health care, that results in death, injury, loss, illness, or damage to the health care beneficiary.

2.1.33. MARKET: A DHA Market is a group of MTFs working together in one geographic area, operating as a system to support the sharing of patients, staff, budget, and other functions across facilities to improve readiness and the delivery and coordination of health services to drive value for beneficiaries. (See also

NETWORK)

2.1.34. MEDICAL/PATIENT RECORDS: Those documents generated in conjunction with, or as a result of, an episode of preventive, diagnostic, or therapeutic and rehabilitative care.

2.1.35. MILITARY HEALTH SYSTEM (MHS): The combination of military and civilian medical systems used to provide health care to DoD medical beneficiaries. The MHS incorporates all aspects of health care services for DoD.

2.1.36. MILITARY TREATMENT FACILITY (MTF): A military hospital or clinic to include dental clinics. An MTF includes satellite areas such as standalone clinics and medical operations (i.e., health and wellness centers). The MTF may be a clinic, hospital, or medical center. Clinics are outpatient facilities offering primary care or simple specialty care (i.e., routine exams, tests, treatments). A clinic may be a stand-alone site or a satellite of a larger clinic, hospital, or medical center, to include patient centered medical homes. Hospitals offer more complex, resource-intensive secondary care (i.e., inpatient care, surgery under anesthesia) and primary care. Medical centers offer tertiary (i.e., sophisticated diagnosis/treatment of any ailment), secondary, and primary care, hospital services, preventive services, and other services. An MTF is often referred to as a Medical Treatment Facility.

2.1.37. NETWORK: This term that will be replacing “Markets” within DHA. Markets and Networks may be used interchangeably within the context of DHA geographic areas.

2.1.38. NON-ENROLLEE PATIENT VISIT: The metric used, for contractor invoicing/payment and other purposes, to describe the occurrence of a patient who is not enrolled/assigned to the ACC physically presenting for services (laboratory, radiology, urgent care, and primary care) at the ACC.

2.1.39. ON-CALL HOUR: An hour scheduled for the HCP to carry a communication device (e.g., cell phone, pager) to respond to calls when away from the MTF.

2.1.40. OUTGOING TRANSITION PLAN: A plan developed by the Contractor which outlines the milestones, timelines, tasks, training program, resources, and other required information to ensure a smooth transition to a new contractor after contract end date, ensuring continuity of service is maintained, and the new contractor is transferred responsibilities for each division of work. This plan shall be subject to the CO’s approval.

2.1.41. PERFORMANCE MEASURE: A method or instrument to estimate or monitor the extent to which the actions of health care practitioners or personnel conform to clinical practice guidelines.

2.1.42. PERSONAL SERVICES CONTRACT: A contract that, by its expressed terms or as administered, makes the contractor personnel appear, in effect, to be government employees. The performance of health care services by HCPs under a personal services contract are subject to day-to-day supervision and control by health care facility personnel comparable to that exercised over military and civil service health care personnel engaged in comparable health care services. HCPs under a personal services arrangement are covered under the Federal Tort Claims Act (FTCA) for malpractice claims.

2.1.43. PERSONALLY IDENTIFIABLE INFORMATION. Any information about an individual maintained by an agency, including, but not limited to: education; financial transactions; medical history;

criminal or employment history; and information which can be used to distinguish or trace an individual’s identity such as their name; social security number; date and place of birth; mother’s maiden name; biometric records; etc., including any other personal information which is linked or linkable to an individual.

2.1.44. PHASE-IN TRANSITION PERIOD. The time period beginning at contract award and ending on an agreed upon date in which Contractor healthcare delivery performance on the contract shall begin (Healthcare Delivery Performance Start Date). The purpose of the transition period is for the Contractor to execute its Incoming Transition Plan and conduct other related duties to fully transition into responsibilities of the contract. The Phase-In Transition Period may be in conjunction with an incumbent Contractor’s Phase-Out Transition Period, in which a handoff of information and materials is conducted.

2.1.45. PHASE-OUT TRANSITION PERIOD. The time period before the end of the contract period of performance in which the Contractor executes its Outgoing Transition Plan with an incoming entity to transition responsibilities of the contract. The Contractor shall provide sufficient experienced personnel during the phase-out period to ensure that the services called for by this contract are maintained at the required level of proficiency.

2.1.46. PHYSICAL SECURITY: Actions taken to prevent the loss or damage of government property and to prevent harm to personnel at or within government facilities.

2.1.47. PHYSICIAN EXTENDER: A provider defined as a Physician Assistant, Nurse Practitioner, or Certified Nurse Midwife.

2.1.48. PROGRAM MANAGEMENT OFFICE (PMO): The organization that manages the requirements on the contract.

2.1.49. PRIMARY CARE: Primary Care includes Internal Medicine, Family Medicine, Pediatrics, and General Primary Care.

2.1.50. PRIMARY CARE MANAGER (PCM): A primary care provider with a panel of assigned beneficiaries who are enrolled/assigned to the ACCs to whom the provider delivers primary care management services.

2.1.51. PRIMARY SOURCE VERIFICATION: The process utilized to authenticate the accuracy of a specific credential or qualification as reported by an individual health care worker or professional. The primary source is the institution, agency, or body that is the original source of the credential or qualification.

2.1.52. PRIVILEGED HCP: A provider who possesses professional qualifications such as education, internship/fellowship, licensure, registration, and/or certification, and clinical competency to practice in a clinical discipline.

2.1.53. PRIVILEGING: The process whereby the privileging authority, upon recommendation from the credentials committee, grants to individuals the authority and responsibility for making independent decisions to diagnosis, initiate, alter, or terminate a regimen of medical or dental care.

2.1.54. QUALITY: The degree of adherence to generally recognize contemporary standards of good practice and the achievement of anticipated outcome for a particular service, procedure, diagnosis, or clinical problem.

2.1.55. QUALITY ASSURANCE (QA): The Government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

2.1.56. QUALITY ASSURANCE SURVEILLANCE PLAN (QASP): An organized written document specifying the surveillance methodology the Government uses for surveillance of contractor performance.

2.1.57. QUALITY CONTROL: All necessary measures taken by the Contractor to assure that the quality of an end product or service shall meet contract requirements.

2.1.58. ROUTINE: Healthcare that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems.

2.1.59. SAFETY: The degree to which the health care environment is free from danger or hazard; the degree to which the health care intervention minimizes risks of adverse outcomes for both patients and staff.

2.1.60. SUBCONTRACTOR: An entity that enters into a contract with the Prime Contractor. The Government does not have privity of contract with a subcontractor.

2.1.61. THE JOINT COMMISSION (TJC): An independent, not-for-profit organization that is a standards-setting and accrediting body in health care. TJC accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.

Formerly Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

2.1.62. TIER 1 (T1) INVESTIGATION (FORMERLY NACI): Lowest level of investigation for suitability, for individuals who will not have access to classified information. Consists of a National Agency Check with written inquiries (NACI) and searches of records during the past five years. A Standard Form (SF)85 Questionnaire for Non-sensitive Positions is completed for the NACI. This check also includes FBI and fingerprint file checks. Inquiries are sent to current and past employees, schools attended, and local law enforcement authorities.

2.1.63. UNFILLED POSITION: A position that was filled, but not currently filled due to turnover.

2.1.64. URGENT: Care for an illness, injury or condition serious enough that a reasonable person would seek care right away through a ‘walk-in’; a non-appointment patient, but not so severe it requires emergency room care. A condition which requires immediate medical attention and for which delay is harmful to the patient. Such disorder is acute and potentially threatens life, limb, or eyesight (and/or functional abilities).

2.2. Acronyms and Abbreviations:

ACC Ambulatory Care Center ACGME Accreditation Council for Graduate Medical Education ACIP Advisory Committee on Immunization Practices ACOR Alternate Contracting Officer Representative AQL Acceptable Quality Level

ATAMMC Alexander T. Augusta Military Medical Center, formerly Fort Belvoir Community Hospital

BH Behavioral Health BHDP Behavioral Health Data Portal BLS Basic Life Support c GLP Current Good Laboratory Practices CA Clinic Administrator CAC Common Access Card CAHEA Committee of Allied Health Education and Accreditation CAL Calibration/Verification CCS Certified Coding Specialist CCS-P Certified Coding Specialist for the Physician’s Office CDC Centers for Disease Control

CE Continuing Education CEU Continuing Education Unit CFR Code of Federal Regulations CIVNET Civilian Network CGFNS Commission on Graduates of Foreign Nursing Schools CLIA or CLIA 88 Clinical Lab Improvement Amendments of 1988 CLIN Contract Line-Item Number CLR Clearly Legible Reports CM Case Management CME Continuing Medical Education CNM Certified Nurse Midwife CO Contracting Officer COB Close of Business COR Contracting Officer Representative CPARS Contractor Performance Assessment Reporting System CQM Clinical Quality Management DEA Drug Enforcement Administration DEERS Defense Enrollment Eligibility Reporting System DFARS Defense Federal Acquisition Regulation Supplement DHA Defense Health Agency DMHRSi Defense Medical Human Resources System – internet DoD Department of Defense System EA Enterprise Architecture ECFMG Educational Commission for Foreign Medical Graduates ECOMS Executive…