Attachment 1 PWS Version 3.pdf

DHA PWS Template V13 November 16, 2021

Department of Defense Defense Health Agency

Performance Work Statement

Ambulance Transportation Services 633rd Medical Group, Langley AFB, VA

Solicitation Number:

HT940624R0037

Version: 3 Date: 9 August2024

PART 1

1.0 GENERAL INFORMATION

1.1 This is a non-personal services contract to provide ambulance transport services. The Contractor is required to have their own insurance.

1.2 Description of services/introduction: The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform ambulance services as defined in this Performance Work Statement (PWS) except for those items specified as government furnished property and services. The contractor shall perform to the standards in this PWS.

1.3 Background: The Contractor shall provide ambulance transport services for 633rd Medical Group, Langley AFB, VA (hereafter referred to as 633 MDG and/or “MTF” including both critical and non-critical transports.

Services shall include all necessary personnel, ambulances, equipment and supplies, and travel. Transports shall be proivdedwithin a 100 (100) mile radius of 633rd Medical Group.

Transports include, but is not limited to the following locations/facilities.

- Naval Medical Center Portsmouth VA, 23708

- Riverside Regional, New Port News, VA 23601

- Sentara Careplex Hospital, Hampton VA 23666

- Kempsville Center for Behavioral Health, Norfolk VA 23502

- CHKD- Children’s Hospital of the King’s Daughters, Norfolk VA 23507

- Sentara Norfolk General Hospital, Norfolk VA 23507

This Contract is a nonpersonal health care services contract, under which the Contractor is an independent contractor.

1.4 Objectives: The Contractor shall provide ambulance transport services as directed by the Langley AFB MTF.

Actual work involved in performance of the contract shall include:

• Critical Care/Emergency Advanced Life Support – arrive 45 minutes or less

• Non-Emergency Advanced Life Support – arrive 90 minutes or less

• Basic Life Support – arrive 180 minutes or less

The Contractor is required to provide ambulance transportation services 24 hours a day, 365 days per year.

The Contractor will be the primary transfer service for all BLS and ALS dispatches. If mobilization services are unavailable for any period or for any reason other than active mobilization under this contract, the Government reserves the right to procure such services from another source pending full restoration of full ambulance mobilization services by the Contractor.

1.5 Scope: The Contractor shall provide ambulance transport services for 633 MDG located at 77 Nealy Ave., Joint Base Langley-Eustis, VA. 23665. Service includes: transport services between the Contractor and MTF, transport services between 633 MDG and other hospitals within a 100 mile radius. Services are required on an as needed basis. The estimated quantity is five hundred eighty four (584) transports per year consisting of 342 advanced Life Saving Patient Transport and 242 Basic Life Support Patient Transport. The actual number of transports/mileage may vary.

1.6 Period of Performance (PoP):

Base: 13 September 2024 – 12 September 2025 Option 1: 13 September 2025 – 12 September 2026 Option 2: 13 September 2026 – 12 September 2027

1.7 Administrative specifications

1.7.1.

The Contractor shall receive and coordinate the transport of critical and non-critical patients. Requests for service will be made by a credentialed provider assigned to 633 MDG, the Commander of 633 MDG, or his or her authorized representative. Priority of critical transports and non-critical transports shall be based on medical need and will be a joint decision between the Contractor and 633 MDG.

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1.7.2.

In those emergencies where the patient's condition becomes critical during transport and requires immediate care, the Contractor’s transport team shall rapidly stabilize the patient, according to the level of the Emergency Medical Technician’s (EMT) level of certification and in accordance with regional protocols and EMS written Standard Operating Procedures (SOP) protocol, along with the Contractor’s guidelines for ambulance transports.

1.7.3 The Contractor shall deliver the patient to the appropriate personnel upon arrival at the receiving facility in accordance with verbal instructions provided by the requestor.

1.7.4 The Contractor shall maintain medical control of the patient and shall direct care provided by the transport team.

The Contractor shall call the receiving official at the MTF to provide a verbal medical report and to transfer medical control. 633 MDG retains the right to review the run report generated by the Contractor’s transport team for patients transported under this Contract.

1.7.5 The Contractor shall respond to each request for service with a staffed, fully equipped vehicle, as defined by the Tidewater Emergency Medical Services Council, which is specifically designed for the transport of critically ill patients. A MTF credentialed provider will determine the type and level of care to be provided to the sick or injured patient, which will be specified verbally when the request for service is made.

1.7.6 The Contractor shall coordinate a response time with 633 MDG for each transport required. The response time will vary based on the criticality of the patient and the Contractor’s workload.

1.7.7 The Contractor shall notify the MTF while in route of the patient's condition. The number of phone calls will vary depending on the severity of the patient; however, a minimum of one (1) phone call is required per transport.

1.7.8 The Contractor shall be responsible for getting the patient from their bed to the ambulance and provide assistance transporting off the litter/stretcher at the receiving facility. The Contractor shall escort patients into the receiving facility and remain with patients until care is transferred to the receiving facility.

1.7.9.

The Contractor shall place the patient on appropriate equipment (e.g., monitors), administer needles, IVs, oxygen, and apply dressings and redressings to the patient’s wounds as appropriate. Note this is not an exhaustive list meant to limit the type of service provided. This list is provided for informational purposes only.

1.7.10.

The Contractor shall obtain the patient records at the time of pick up and shall present them to the appropriate personnel at the receiving facility.

1.7.11.

The Contractor shall maintain a dispatcher log with a record for each patient transported. The log shall contain at least the following information: requester's name and telephone number, time of request, name of physician ordering patient transfer, name of receiving facility, name of physician accepting patient; dispatch time, time of arrival and time of departure at the requesting facility, time of arrival at the receiving facility, name of patient, and reason for transport. The dispatcher log shall be submitted to the Contracting Officer’s Representative (COR) monthly.

1.7.12.

The Contractor shall maintain a log in each vehicle with a record for each patient transported. The log shall contain at least the following information: dispatch time, time of arrival and time of departure at the referral facility, time of arrival at the receiving facility, name of patient, and reason for transport.

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1.7.13.

The Contractor shall document and include in the patient’s chart all treatment provided to the patient during the transport. For each patient transported, the Contractor shall complete a Contractor Run Sheet, which shall be provided to the COR. Each Contractor Run Sheet must include, at a minimum, the name of the referring physician and the name of the accepting physician. The Contractor Run Sheet shall be faxed to the COR.

1.7.14.

The Contractor shall provide paper copies of all records produced in the performance of this Contract and all evaluations of patients to 633 MDG. The Contractor is authorized to provide any information required by law to the Virginia Department of Health for each transport. The disclosure of any other information must be authorized by

NMCP.

1.7.15 The Contractor shall be responsible for the control and disposal of all medical waste incurred during transport.

1.7.16.

The Contractor shall ensure all ambulances utilized in the performance of this Contract are safe to operate, sanitary, and properly functioning. The Contractor shall not operate unsafe vehicles. The Contractor shall ensure that vehicle security is maintained at all times.

1.7.17.

The Contractor shall report suspected cases of child abuse/neglect in accordance with Virginia law.

1.7.18. The contractor shall provide a point of contact that shall be available via telephone 24 hours a day, every day of the year. This individual is designated by the Contractor. This ndividual (or individuals) will act as a liaison between the Contractor and MTF for communication purposes

1.7.19 Hours of operation: Requests for service shall be made at any time Monday through Sunday, including after hours, weekends and Federal holidays

1.8 Contractor travel: NA

1.9 Other Direct Costs (ODC): NA

1.10 Quality

1.10.1 Quality Control (QC): The contractor shall develop and maintain an effective QC program to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure nonrecurrence of defective services. The contractor’s QC program is the means by which the work complies with stated requirements. The QCP is to be delivered, within 30 days after contract award, a comprehensive written QCP shall be submitted to the CO and COR within 5 working days when changes are made thereafter. After acceptance of the Quality Control Plan (QCP) the contractor shall receive the CO’s acceptance in writing of any proposed change to his QC system. See Part 7, Technical Exhibit 1 - CDRL A001.

1.10.2 Quality assurance (QA): The government will evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan (QASP). This plan provides a systematic method for the Government to evaluate performance and to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

1.11 Contractor Identification

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1.11.1 Contractor personnel performing services in a contractor capacity in a Government facility are required to possess and wear an identification badge that displays his or her name and the name of their company. All contractor personnel shall identify themselves as contractor support personnel in all forms of communication with all entities with whom DHA/Deputy Assistant Director for Acquisition (DAD-A)/Head of the Contracting Activity (HCA) has business dealings. The contractor shall: Answer all telephone calls and have a personalized voice message with an introductory statement that includes the fact that the person is contractor support personnel. Ensure all those with whom the person interacts in any face-to-face dealings while supporting the DAD-A understands that the person is contractor support personnel. Include a title block in all emails that states the fact that the person is contractor support personnel. Ensure all those with whom the person interacts in any face-to-face dealings while supporting DHA/DAD-A/HCA understands that the person is contractor support personnel.

1.11.2 Contractor personnel will be required to attend meetings or otherwise communicate with Government and/or other contract representatives to meet the requirements of this order. Contractor personnel shall make their contractor status known during introductions.

1.11.3 Contractor personnel, while performing in a contractor capacity, are prohibited from using their retired or reserve component military rank or title in any written or verbal communications associated with the contracts in which they provide services.

1.12 Personnel Security

1.12.1 The contractor shall comply with DoD 8570.01-M, “Information Assurance Workforce Improvement Program, CH4” November 10, 2015 as amended; 8500.01, “Cybersecurity”, dated March 14, 2014; DoD Manual (DoDM) 6025.18, “Implementation of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule Compliance in DoD Health Care Programs” dated March 3, 2019, Department of Defense Instruction (DoDI)

6025.18 “HIPAA Privacy Rule Compliance in DoD Health Care Programs”, dated March 13, 2019; and DoDM

5200.02 “Procedures for the DoD Personnel Security Program (PSP),” incorporation change 3, effective September 24, 2020. Contractor responsibilities for ensuring personnel security include, but are not limited to, meeting the following requirements:

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PART 2

2.0 DEFINITIONS, ACRONYMS, AND APPLICABLE PUBLICATIONS/INSTRUCTIONS

2.1 Definitions:

2.1.3 Contracting Officer (CO): A person with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings.

2.1.4 Contracting Officer’s Representative (COR): An individual, including a contracting officer’s technical representative (COTR), designated and authorized in writing by the CO to perform specific technical or administrative functions. This individual does NOT have authority to change the terms and conditions of the contract.

2.1.5 Nonpersonal services contract: a contract under which the personnel rendering the services are not subject, either by the contract’s terms or by the manner of its administration, to the supervision and control usually prevailing in relationships between the Government and its employees.

2.1.6 Quality Assurance Surveillance Plan (QASP): An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance. The Government may either prepare the QASP or require the offerors to submit a proposed quality assurance surveillance plan for the Government’s consideration in development of the Government’s plan.

2.2 Acronyms:

Advanced Cardiac Life Support (ACLS): Requires more advanced in route medical equipment and medical care.

These missions require attendants with credentials of EMT or Paramedic.

Basic Life Support (BLS): Trips which require use of oxygen or intravenous drugs being administered to patients during transport by one or more medical attendants.

Contracting Officer (CO): The Contracting Officer responsible for administering the contract afterward. The CO is the only individual who can make changes in the contract, bind the government monetarily, and direct the contractor.

Contracting Officer Representative (COR): A government person responsible for assessment of contractor performance.

Military Treatment Facility (MTF): Air Force hospitals or clinics, including all activities providing outpatient and/or in-patient health care services for authorized personnel.

Performance Work Statement (PWS): A document that accurately describes a service in terms of the output requirements.

Quality Assurance/Risk Management Committee (QA/RMC): Committee responsible for the execution of the MTF QA/RM plan to include the duties outlined in DHA-PM 6025.13. The committee ensures an ongoing assessment of the quality and appropriateness of all medical care and will put in priority sequence suspected problems for evaluation, resolution, and follow-up.

Quality Assurance/Risk Management Plan (QA/RMP): An organized document which describes the methods of doing quality assurance (QA) reviews within the MTF. It designates the areas of responsibility and accountability for the QA program and the mechanisms for monitoring and evaluating patient care. It is consistent with The Joint Commission (TJC) monitoring and evaluation approach and the Air Force risk management (RM) efforts.

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Services Summary (SS): Identifies the key service outputs of the contract that will be evaluated by the government to assure contract performance standards are met by the Contractor.

2.3 Applicable Publications, DHA Administrative Instructions (AI), etc

PUB NO. TITLE DATE

Health Insurance Portability and Accountability Act 1996

DEPARTMENT OF DEFENSE (DOD) INSTRUCTIONS/DIRECTIVES

DoD Directive 5500.7 Standards of Conduct Nov 07

DoD Instruction 6040.40 Military Health System Data Quality Management Control Procedure

Dec 19

DODI 6055.06 Fire and Emergency Services Programs Oct 19

DEFENSE HEALTH AGENCY (DHA) PROCEDURAL INSTRUCTIONS/PROCEDURES MANUALS

DHA-PM 6025.13 Clinical Quality Management in the Military Health Systems

Aug 19

DHA-AI 6055.02 EMS Program Medical Components Aug 23

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PART 3

3.0 GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND SERVICES

The Requiring Activity Authority has assessed the need for Government Furnished Property, Equipment, and Services and determined:

3.1 Services: The Government:

☒ Will NOT provide Government Furnished Services in support of this contract/task order. As a result, this paragraph is Not Applicable.

☐ WILL provide Government Furnished Services required in support of this contract/task orders. These Services are described below: provide [

3.2 Facilities: The Government:

☒ Will NOT provide Facilities in support of this contract/task order. As a result, this paragraph is Not Applicable.

☐ WILL provide Facilities in support of this contract/task orders. The Government provided Facilities are described below

3.3 Utilities: The Government:

☒ Will NOT provide Utilities in support of this contract/task order. As a result, this paragraph is Not Applicable.

☐ WILL provide Utilities in support of this contract/task orders. The Government provided Utilities are described below:

3.4 Equipment: The Government:

☒ Will NOT provide Equipment in support of this contract/task order. As a result, this paragraph is Not Applicable.

☐ WILL provide Equipment in support of this contract/task orders. The Government provided Equipment is described below:

3.4.1 Procurement Integrated Enterprise (PIEE), GFP Module Application NA

3.5 Materials: The Government:

☒ Will NOT provide Materials in support of this contract/task order. As a result, this paragraph is Not Applicable.

☐ IS providing Materials in support of this contract/task orders. The Government-provided Materials are described below

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PART 4

4.0 CONTRACTOR FURNISHED ITEMS AND SERVICES

4.1 Services: The Contractor:

☒ Will NOT provide Contractor Furnished Services in support of this contract/task order. As a result, this paragraph is Not Applicable.

☐ WILL provide Contractor Furnished Services required in support of this contract/task orders. These Services are described below: provide

4.2 General: The contractor shall furnish all supplies, equipment, facilities and services required to perform work listed under Section 5 of this PWS.

4.3 Secret Facility Clearance: NA

4.4 Materials: NA

4.5 Equipment: NA

4.6 Facilities: NA

4.7. AUTOMOBILE LIABILITY INSURANCE.

Before commencing work under this Contract, the Contractor shall certify to the Contracting Officer in writing that the required automobile insurance has been obtained. The following insurance as referenced in Federal Acquisition Regulations (FAR) Clause 28.307, is the minimum insurance required:

Automobile liability insurance written on the comprehensive form of policy. The policy shall provide for bodily injury and property damage liability covering the operation of all automobiles used in connection with performing this Contract. Policies covering automobiles operated in the United States shall provide coverage of at least $200,000 per person and $500,000 per occurrence for bodily injury and $20,000 per occurrence for property damage. The amount of liability coverage on other policies shall be commensurate with any legal requirements of the locality and sufficient to meet normal and customary claims.

4.8. WORKERS’ COMPENSATION AND EMPLOYER’S LIABILITY

The Contractor shall comply with applicable Federal and State workers' compensation and occupational disease statutes. If occupational diseases are not compensable under those statutes, they shall be covered under the employer's liability section of the insurance policy, except when contract operations are so commingled with the Contractor's commercial operations that it would not be practical to require this coverage. Employer's liability coverage of at least $100,000 shall be required, except in states with exclusive or monopolistic funds that do not permit workers' compensation to be written by private carriers.

4.9. MEDICAL LIABILITY

The Contractor shall comply with applicable requirements of the FAR Clause 52.237-7, Indemnification and Medical Liability Insurance (JAN 1997).

The Contractor shall complete the Malpractice Insurance Certification Form, Attachment 4, as part of the Quote and shall provide an updated form to the COR upon request.

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PART 5

5.0 SPECIFIC TASKS

5.1 AMBULANCE TRANSPORTATION/MOBILIZATION: The Contractor shall provide ambulance transportation services as directed by the Langley AFB MTF. Actual work involved in performance of the contract shall include but not limited to:

• Critical Care/Emergency Advanced Life Support – arrive 45 minutes or less

• Non-Emergency Advanced Life Support – arrive 90 minutes or less

• Basic Life Support – arrive 180 minutes or less

5.2 DOCUMENTATION: All Contractor prepared documentation shall be timely, legible, accurate, and thorough and must contain a signature. Reports to be generated:

5.2.1. Monthly Run Report: The contractor shall prepare and submit not no later than the 5th business day of each month a report containing details for all services performed the previous month by the 10th day of every month.

5.3. TOTAL QUALITY IMPROVEMENT. The Government shall assess response time to calls and documentation of care in order to ensure quality.

5.4. RECORDS. Contractor shall be responsible for creating, maintaining, and disposing of only those Government required records which are specifically cited in this document or as may be required by the provisions of a mandatory directive listed in Appendix A of the PWS. If requested by the Government, the Contractor shall provide the original record or a reproducible copy of any such records within five (5) working days of receipt of the request.

5.5. RELEASE OF MEDICAL INFORMATION. Under this PWS, the contractor will be considered a ‘Business Associate’ under the terms of the Health Insurance Portability & Accountability Act of 1996 (HIPAA), Public Law 104-191, and its implementing regulations, including D0D 6025.18-R. In the performance of this contract, the contractor shall, when performing as a ‘Business Associate,’ comply with all rules and requirements applicable to a ‘Business Associate’ under HIPAA and its implementing regulations including DoD 6025.18-R, see Appendix D, HIPAA guidelines. Violation of HIPAA may involve the imposition of fines and/or imprisonment. The Contractor shall include this notification and requirement in every subcontract for ‘Business Associate’ service.

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

5.2 Special Qualifications

The transport team provided shall comply with Chapter 31 of the Virginia Administrative Code, 12VAC5 Chapter 31 Virginia Emergency Medical Services Regulations. In addition to the requirements specified in the Virginia Administrative Code, the minimum position* qualifications are outlined below.

*The positions listed herein are those specified in the Virginia Administrative Code or identified by the Contractor as part of the transport team.

5.3.

Contract employees shall maintain current certification in American Heart Association Basic Life Support (BLS), American Heart Association Healthcare Provider Course, American Red Cross CPR (Cardio Pulmonary Resuscitation), or equivalent. Training shall be the responsibility of the Contractor and is at no cost to the government. Contract employees, not in possession of current certification, must acquire certification prior to initiating contract performance. Web based classes do not meet these standards.

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5.4.

Contract employees shall be U.S. Citizens

5.5.

Contract employees shall maintain all necessary certification, licenses, and other permits required to perform their duties under this Contract.

5.6.

The Contractor shall ensure, prior to employment that all contract employees are at least eighteen (18) years and have at least a high school education or equivalent.

5.7.

Contract employees shall be proficient in the operation of ambulance radio equipment.

5.8.

Documentation of all required experience, certifications and licenses for contract employees shall be current, on file, and made available, upon request, for COR review.

5.9. POSITION SPECIFIC QUALIFICATIONS

5.9.1. The Contractor is responsible for determining the specific labor categories needed to provide the services described herein; however, if the Contractor employs one of the positions listed below, the minimum qualifications identified apply.

5.9.2. EMERGENCY MEDICAL TECHNICIAN (EMT)

5.9.2.1. Possess a high school diploma or GED certificate.

5.9.2.2. Possess and maintain certification as an EMT by the National Registry of Emergency Medical Technicians or applicable state EMT certification.

5.9.3. PHYSICIAN

5.9.3.1. Possess a Doctorate Degree in Medicine from an accredited college approved by the Liaison Committee on Medical Education and Hospitals of the American Medical Association, a Doctorate degree in Osteopathy from a college accredited by the American Osteopathic Association, or permanent certification by the Educational Commission for Foreign Medical Graduates (ECFMG).

5.9.3.2. Successful completion of a residency program which has been approved by the Accreditation Council for Graduate Medical Education or the Committee on Postdoctoral Training of the American Osteopathic Association or those Canadian training programs approved by the Royal College of Physicians and Surgeons of Canada or other appropriate Canadian medical authority.

5.9.3.3. Possess and maintain a current, valid, unrestricted license to practice medicine in one (1) of the fifty (50) states, the District of Columbia, the Commonwealth of Puerto Rico, Guam, or the U.S. Virgin Islands.

5.9.4. PHYSICIAN ASSISTANT (PA)

5.9.4.1. Possess a Baccalaureate degree from a Physician Assistant Program accredited by the Accreditation Review Commission for the Physician Assistant (ARC-PA) of the Commission on Accreditation of Allied Health Education Programs (CAAHEP).

5.9.4.2. Possess and maintain current certification as a Physician Assistant from the National Commission on the Certification of Physician Assistants (NCCPA).

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5.9.4.3. Possess and maintain a current, unrestricted license to practice as a Physician Assistant in any one (1) of the fifty (50) states, the District of Columbia, the Commonwealth of Puerto Rico, Guam or the U.S. Virgin Islands.

5.9.5. REGISTERED NURSE (RN)

5.9.5.1. Possess a Baccalaureate Degree in Nursing, a Graduate Diploma in Nursing, or an Associate Degree in Nursing, from an accredited agency such as the Accreditation Commission for Education in Nursing (ACEN) or the Commission on Collegiate Nursing Education (CCNE).

5.9.5.2. Possess and maintain a current unrestricted license to practice as a registered nurse in any one (1) of the fifty

(50) States, the District of Columbia, the Commonwealth of Puerto Rico, Guam or the U.S. Virgin Islands.

5.9.6. RESPIRATORY THERAPIST (CERTIFIED)

5.9.6.1. Graduate from a respiratory therapy education program education by the Commission on Accreditation or Allied Health Education Program (CAAHEP) or the Committee on Accreditation for Respiratory Care (CoARC).

5.9.6.2. Possess and maintain a certification as a Certified Respiratory Therapist (CRT) by the National Board for Respiratory Care (NBRC).

5.9.10. RESPIRATORY THERAPIST (REGISTERED)

5.9.10.1. Graduate from a respiratory therapy education program education by the Commission on Accreditation or Allied Health Education Program (CAAHEP) or the Committee on Accreditation for Respiratory Care (CoARC).

5.9.10.2. Possess a current registration as a Registered Respiratory Therapist (RRT) by the National Board for Respiratory Care (NBRC).

5.10. When using education/certification in conjunction with labor categories, the COR in coordination with the CO must establish a review process of contractor personnel to ensure labor category requirements are met.

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PART 6

7.0 ATTACHMENTS/TECHNICAL EXHIBIT LISTING

7.1 The following forms are to be completed by the FSO/Security POC, or COR once the contractor is granted the proper background investigation.

7.1.1 Contractor CAC Request Process.

DHA CAC Request Process.pdf

DMDC TASS

Application.xlsx

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PART 7, ATTACHMENT 1

PERFORMANCE REQUIREMENTS SUMMARY

The contractor service requirements are summarized into performance objectives that relate directly to mission essential items. The performance threshold briefly describes the minimum acceptable levels of service required for each requirement. These thresholds are critical to mission success.

SS # Performance Objective

PWS

Para

Performance Measure Performance Threshold

1 Transportation Response Times

1.5.7.2 Response time for all ambulance transportation will

not exceed timelines outlined in para, 1.1

100% Compliance

2 Communication 5.6 Contractor shall ensure contract providers maintain open and professional communication with members of the MTF.

100% Compliance

3 Availability 1.7.18 Contractor shall provide a POC that shall be available via telephone 24 hours a day, every day of the year.

100% Compliance

THE GOVERNMENT WILL PERIODICALLY EVALUATE THE CONTRACTOR’S PERFORMANCE BY APPOINTING A REPRESENTATIVE(S) TO MONITOR PERFORMANCE TO ENSURE SERVICES ARE RECEIVED. THE GOVERNMENT REPRESENTATIVE WILL EVALUATE THE CONTRACTOR’S PERFORMANCE THROUGH INSPECTIONS OF CALL LOGS/REPORTS AND RECEIVE AND INVESTIGATE ALL COMPLAINTS FROM MTF PERSONNEL. THE GOVERNMENT MAY INSPECT EACH TASK AS COMPLETED OR INCREASE THE NUMBER OF QUALITY CONTROL INSPECTIONS IF DEEMED APPROPRIATE BECAUSE OF REPEATED FAILURES DISCOVERED DURING QUALITY CONTROL INSPECTIONS OR REPEATED CUSTOMER COMPLAINTS. LIKEWISE, THE GOVERNMENT MAY DECREASE THE NUMBER OF QUALITY CONTROL INSPECTIONS IF PERFORMANCE DICTATES. THE GOVERNMENT REPRESENTATIVE SHALL

MAKE FINAL DETERMINATION OF THE VALIDITY OF CUSTOMER COMPLAINT(S).

7.2 Other

PART 7

Metrics

ITEM NAME ESTIMATED QUANTITY

1 ALS Patient Transport 342 runs per period of performance

2 BLS Patient Transport 242 runs per period of performance

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PART 7, TECHNICAL EXHIBIT 1

DELIVERABLES SCHEDULE

Deliverable Frequency Medium/Format Submit To Applicable to:

CDRL A001 – Quality Control Plan

Within 30 days of task order award

Contractors discretion CDRL A001 to CO All, See PWS 1.10.1

Monthly Run Report 5th day of the month. Contractors Discretion COR All, See PWS 5.2.1.

APPENDIX A – MEDICAL DISCLOSURE

D. 1. PRIVACY AND CONFIDENTIALITY

1. PATIENT LISTS. Patient lists, no matter how developed shall be treated as privileged information. Lists and/or names of patients shall not be disclosed to or revealed in any way for any use outside the MTF without prior written permission by the Chief of Hospital Services.

1. 2. PATIENT SENSITIVITY. Contractors shall respect and maintain the basic rights of patients, HIPAA regulations, demonstrating concern for personal dignity and human relationships. Contractors receiving complaints validated by the QAP and Chief of the Medical Staff shall be subject to counseling and, depending on the nature and severity of the complaint, separation from performing services under this contract.

1. 3. RELEASE OF MEDICAL INFORMATION. The contract employee shall only release medical information obtained during the course of this contract to other MTF staff involved in the care and treatment of the individual patient.