Performance Work Statement (Amendment 1).docx

PERFORMANCE WORK STATEMENT

NOTE 1: The use of "MTF Director" throughout the Performance Work Statement refers to the person who is the MTF Director or his/her designated representative, e.g. Contracting Officer’s Representative, Department Head, Medical Director of Neonatology, etc.

NOTE 2: The term "contractor" shall mean the contractor identified in block 17a of Standard Form 1449.

NOTE 3: The collective term “health care worker(s)” (HCWs) refers to all individual(s) providing services under the contract. When referenced individually, individuals providing services under this contract will be referred to as Neonatologists or Neonatal Nurse Practitioner (NNPs).

NOTE 4: The term “MTF” refers to the Military Treatment Facility.

NOTE 5: The term “COR” refers to the Contracting Officer’s Representative, a government employee appointed in writing by the Contracting Officer to assist in the technical monitoring and administration of the contract and serve as a liaison between the government and the contractor.

SECTION 1 - SCOPE

1.1. The Contractor shall provide comprehensive Neonatologist and Neonatal Nurse Practitioner (NNP) services in the Level II Neonatal Intensive Care Unit (NICU), Mother Baby Unit, and Labor & Delivery Unit (to include the Operating Room (OR) for cesarean sections) at Naval Medical Center Camp Lejeune, NC in accordance with the terms and conditions as specified herein and Appendix 1.

1.2. During the term of the contract, the contractor shall provide the services of Neonatologists and NNPs to perform all services specified herein for treatment of active-duty military dependents, eligible DoD civilian employee dependents, and other eligible beneficiaries in accordance with the terms and conditions of the contract.

1.3. It is essential that continuity of services be maintained to the maximum degree possible; therefore, substitution of health care workers (HCWs) shall be kept to the absolute minimum necessary to perform the services required. All Neonatologists and NNPs are subject to credentials review and privileging prior to performance of services.

1.4. The MTF Director will not privilege more than 6 Neonatologists and 10 NNPs to provide the coverage required in the schedule as described in this PWS.

SECTION 2 - SUITS ARISING OUT OF MEDICAL MALPRACTICE

Neonatologists:

2.1. Neonatologists providing services under the contract shall be rendering non-personal services to the Government. The performance of health care services under a non-personal services arrangement are not 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. The Government shall neither supervise non-personal services employees nor control the method by which the Contractor performs these required tasks. Contract workers under a non-personal services arrangement requiring licensure must maintain an unrestricted license in the U.S. jurisdiction within which the contract worker is performing on the contract as outlined in DHAPM 6025.13, Volume 4 (no licensure portability, included telehealth visits).

2.2. The contractor, and all subcontractors, shall meet the requirements of DHA PM 6025.13, Volume 4 and the FAR Clause 52.237-7, Indemnification and Medical Liability Insurance, for its non-personal service contract workers, in the following amounts for the entire performance period of the contract: $1 million per incident and $3 million total.

Neonatal Nurse Practitioners:

2.3. Neonatal Nurse Practitioners providing services under the contract shall be rendering personal services to the Government. The performance of health care services by contract workers under a personal services arrangement 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. Contract workers under a personal services arrangement requiring licensure may maintain a license in any U.S. jurisdiction as outline in DHAPM 6025-13, Volume 4.

SECTION 3 - DUTY HOURS

3.1. The contractor shall provide sufficient personnel to cover the schedules below.

3.1.1. Neonatal Nurse Practitioner (NNP) Services. The Contractor shall provide continuous NNP coverage 24 hours per day, 7 days per week (24/7), and 52 weeks per period of performance. Coverage shall consist of two (2) shifts per day, with one (1) NNP assigned per shift.

3.1.2. NNP 24-hour Coverage Shift Structure:

3.1.2.1. One (1) NNP will be scheduled per 13-hour shift.

3.1.2.2. Services are required 7 days a week, 24 hours a day to include weekends and holidays.

3.1.2.3. Each shift must include one (1) 30-minute uncompensated meal break.

3.1.2.4. Each shift must include a thirty (30) minute compensated handoff at the scheduled shift start of the oncoming shift.

3.1.2.5. The total compensated time per NNP shift shall equal twelve and a half (12.5) hours.

3.2.1 Neonatologist Services.

3.2.2. The contractor shall assign a Neonatologist to one hundred and eighty-two (182) 24-hour shifts per year alternating with military Neonatologists. An additional twenty-eight (28) 24-hour shifts may be required in order to accommodate any absence of the military Neonatologists, to include but not limited to illness, injury, deployments, temporary duty assignments, annual leave and patient surges. 24-hour shifts shall include weekends and holidays.

3.2.3. During each 24-hour shift, the Neonatologist shall provide in house coverage from 0700-1530 and will then be on-call for the remainder of the 24-hour shift.

3.2.4. Neonatologist On-Call: On-call services shall be required only during the 24-hour shift in which the Contractor is scheduled to provide Neonatologist services. When providing on-call coverage, the Neonatologist shall be available via telephone and respond by telephone within 15 minutes.

3.2.5. Neonatologist Call-back: Call-back services shall be required only during the 24-hour shift in which the contractor is scheduled to provide Neonatologist services. When clinically indicated, the Neonatologist shall report back to the facility within 30 minutes of being called back. The on-call Neonatologist will be required to give clinical consultation to the on duty NNPs.

3.2.6. Neonatologist coverage services to include in-house, on-call and call-back shall not be billed separately but all-inclusive for the 24-hour period of coverage. No additional compensation shall be given for call-backs into the facility during the 24-hour period of coverage.

3.2.3.2.3. The contractor may provide leave and holiday benefits to the HCWs, and Contractor shall ensure continued HCW coverage during exercise of contractor-provided leave and holiday benefits.

3.3. The MTF Director or designated government supervisor will supervise the NNPs. The Contractor shall supervise its Neonatologists.

3.4.1. The Neonatology Department will coordinate with and set the schedule for NNPs, and will forward the schedule to the contractor via the COR. A minimum 72-hour notice of changes to the work schedule is required from the NNP and/or contractor. The 72-hour notice will be waived for emergency situations such as sudden illness or accident. Any other variation in the schedule shall only be approved through mutual agreement between the Government and contractor.

3.4.2. Neonatologist Scheduling: After the Neonatology Department provides the monthly staff schedule, the Contractor shall return the monthly staff schedule to the COR and/or the Neonatology Department prior to the 20th of each month. The contractor shall fill every empty slot with the name of the HCW, and an alternate, who will be providing the coverage in case the scheduled HCW(s) is/are unable to work. For changes to the monthly staff schedule by the Contractor, a minimum 72-hour notice of change to the work schedule is required. The 72-hour notice will be waived for emergency situations such as sudden illness or accident. Any variation in the schedule once returned to the government shall only be approved through mutual agreement between the Government and Contractor.

SECTION 4 - ABSENCES AND LEAVE

4.1. The Government requires coverage of HCW services; therefore, there are no provisions for leave (annual or sick) for HCWs under this contract.

4.2. The contractor shall maintain sufficient backup personnel to ensure coverage during scheduled and unscheduled absences such that all services are provided in the event an HCW scheduled to work and/or an HCW at work during a shift becomes ill, resigns, is terminated, or is otherwise unavailable to work. Services are required during inclement weather, see also paragraph 4.6.

4.3. An HCW with a bonafide medical emergency occurring while on duty or with an on-the-job injury will be provided medical care at the MTF until the condition is stabilized. The contractor shall reimburse the Government for all medical services provided unless the HCW is otherwise entitled to Government medical services.

4.4. The contractor is responsible for providing coverage for a HCW who, for any reason, misses more than 2 hours of a shift and cannot finish the remainder of the shift. The Contractor shall ensure the replacement will cover the remainder of the shift and any subsequent on-call duties as assigned.

4.6. Labor categories deemed essential: Neonatologists, and NNPs.

4.7. Furlough. Unless otherwise authorized by a defense appropriations bill, the contractor shall not be reimbursed by the Government for services not rendered during a Government furlough. In the event of a Government furlough, the MTF Director will determine which HCWs are considered essential and therefore must report to work. The contractor shall be compensated for essential services rendered during a furlough. All other HCWs shall be furloughed until the Government shutdown ends or they are notified by the Contracting Officer’s Representative that they have become essential HCWs.

SECTION 5 - GENERAL REQUIREMENT

5.1. Prior to the commencement of performance under the contract, the COR and/or contractor shall direct each NNP and Neonatologist to in-process through standard facility procedures.

5.2. HCWs shall comply with the standards of the Joint Commission, applicable provisions of law, and the rules and regulations of any and all Government authorities pertaining to licensure and regulation of health care personnel and medical treatment facilities, the regulations and standards of medical practice of the MTF and the bylaws of the MTF’s medical staff. The HCWs shall comply with all applicable federal, state and local laws, DoD, agency specific, and installation policies, procedures, notices, and instructions as applicable at the place of performance

5.3. All HCWs shall comply with Executive Order 12731, October 17, 1990, (55 Fed. Reg. 42547), Principles of Ethical Conduct for Government Officers and Employees, and shall also comply with DoD and other Government regulations implementing this Executive Order.

5.4. All HCWs shall become acquainted with and obey all station regulations, shall perform in a manner to preclude the waste of utilities, and shall not use Government resources (i.e. copiers, telephone, and computers etc.) for personal business. All motor vehicles operated on these installations by HCWs shall be registered with the base security service according to applicable directives. Eating by HCWs is prohibited in patient care areas/clinics and is restricted to designated areas. Smoking is prohibited in all clinic facilities and grounds except as authorized by policy.

5.5. Except as provided in this clause, HCWs are not prohibited from conducting a private practice of their professions or from engaging in other employment. However, the HCWs shall not, simultaneously while performing under this contract, engage in other employment that creates a conflict of interest, violates federal law, or potentially compromises the quality of their work under the contract. Further, such private practice or other employment shall not be conducted during those hours in which the HCW is required to render services under this contract. HCWs shall make no use of the Government facilities or property provided under the contract in connection with other employment.

5.6. While on duty, HCWs shall not advise, recommend, or suggest to individuals authorized to receive services at Government expense that such individuals should receive services from the HCW when they are not on duty, or from a partner or group associated in practice with the HCW or contractor, except with the express written consent of the MTF Director

5.7. Dress and Appearance.

5.7.1. General Appearance and Uniform. Contract workers shall maintain good personal hygiene and present a well-groomed and professional appearance IAW the policy at the place of performance. If a uniform (e.g., smocks, EMT/Paramedic uniform) is mandatory, the uniform will be provided by the Government.

5.7.2.Protective Equipment. IAW the policy at the place of performance, certain protective equipment cannot leave the MTF premises and are unable to be worn to/from home and work. Contractor employees required to wear protective equipment that cannot leave the MTF shall on and off such items on-site at the MTF work location. Unless provided otherwise in an individual task order, time spent changing into and out of required protective clothing shall only occur before the start of and after the conclusion of each shift. Time spent donning and doffing protective equipment is not considered actual time worked and is therefore not compensable and billable. Actual billable hours shall commence when the employee reports or clocks into their assigned unit or area ready to perform patient care.

5.8. HCWs shall read, write, speak, and understand the English language fluently and maintain good communication skills with patients and other health care personnel.

5.9. HCWs shall be physically capable of standing and/or sitting for extended periods of time and capable of normal ambulation.

5.10. HCWs providing services under the contract shall arrive for each scheduled shift in a well-rested condition and shall have had at least 6 hours of rest from all other duties immediately prior to reporting for the shift.

5.11. Neonatologists shall be in good standing, and under no restrictions, with the state licensure board in the state in which the MTF is located within the last 10 years. Also, the Neonatologist shall be in good standing and under no sanction or suspension by the federal government.

5.11.1. NNP shall be in good standing, and under no restrictions, with the state licensure board in any state in which a license is held or has been held within the last 10 years. Also, the NNP shall be in good standing and under no sanction or suspension by the federal government.

5.12. HCWs shall be current with and have completed all continuing education requirements specified by their professional licensure or certification.

5.13. The HCW shall be a U.S. citizen and must complete an SF-85 Questionnaire for National Security Positions or equivalent OPM investigative product.

5.14. HCWs shall represent an acceptable malpractice risk to the Government.

5.15. The contractor and all HCWs shall comply with all MTF checkout processes. These processes include returning government property, e.g., identification badges, pagers, cellular phones, etc., to the MTF upon a HCW’s last day of service. Failure to do so promptly may result in delay of payment to the contractor.

5.16. Any HCW who demonstrates a health or safety risk to patients or staff, demonstrates impaired judgment, or in the judgment of a licensed physician is impaired by drugs or alcohol may be immediately removed from providing service. In the event of such removal, the Contracting Officer will request a replacement from the Contractor and may issue a stop work order specifically for the removed HCW while the Contractor’s response, implementation of the plan, and/or any Government investigation is pending. Removal of a HCW for reasons above does not eliminate the Contractor’s obligations under this contract.

5.17. All financial, statistical, personnel, and technical data which are furnished, produced, or otherwise available to the contractor during the performance of the contract are considered confidential business information and shall not be used for purposes other than performance of work under the contract. Such data shall not be released by the contractor without prior written consent of the COR. Any presentation of statistical or analytical materials, or reports based on information obtained from studies covered by the contract, will be subject to review and approval by the COR before publication or dissemination.

5.18. The Contractor shall comply with all applicable federal, state, and local laws, Department of Defense, Bureau of Medicine and Surgery, and MTF instructions and policies. This includes local command required training. The HCWs shall be required to track hours worked by signing in and out of their work location(s) as coordinated with the COR for NNPs and contractor for Neonatologists for the sole purpose of verifying contractor invoiced hours.

5.19. Contractor staff shall participate in executing the Emergency Preparedness Plan (drills and actual emergencies) as scheduled by the MTF (typically semiannually). HCWs are required to participate in the MTF personnel re-call list with personal contact information for all military, civil service and contractor staff which will be prepared in advance of an actual emergency. Upon commencement of performance, the contractor shall provide the COR with a list of personal contact information for a designated contractor representative as well as all HCWs performing services under this contract. The contractor shall provide an updated list to the COR every two months if required. In the event of an emergency, essential personnel may be required to remain on duty or return to duty in order to maintain continuity of patient care. The designated contractor representative and/or the HCWs will be contacted when emergencies affect a HCWs’ shift.

5.20. HCWs shall comply with the HIPAA (Health Insurance Portability and Accountability Act) privacy and security policies of the MTF. Providers shall obtain/maintain a National Provider Identifier (NPI) in accordance with DOD and MTF policy/instruction.

5.21. Telework is not permitted.

SECTION 6 - GENERAL DUTIES/RESPONSIBILITIES

6.1. The HCWs shall perform a full range of Neonatologist and NNP services for all eligible beneficiaries assigned to NMCCL in accordance with the privileges granted by the MTF Director, on-site using government facilities, supplies, and equipment. This includes a government laptop for clinical documentation and a government furnished pager and/or cell phone when in an on-call status. The standards of performance for all HCWs shall reflect the degree of care, skill, and learning expected of a reasonably prudent HCW in the professional category to which he/she belongs. The HCWs shall:

6.1.1. HCWs shall technically direct, assist, and instruct other health care professionals within the scope of their clinical privileges or responsibilities. Such direction and interaction shall adhere to government and professional clinical standards and accepted clinical protocol. HCWs shall participate in clinical staff performance improvement and peer review functions at the prerogative of the MTF Director at government expense.

6.1.2. HCWs shall promote preventive and health maintenance care, including annual physicals, positive health behaviors, and parental care skills through education and counseling.

6.1.3. HCWs shall request consultation or referral with appropriate physicians, clinics, or other health resources as indicated.

6.1.4. Order diagnostic tests as applicable.

6.1.5. The HCWs shall prescribe and dispense medications as delineated by the Pharmacy and Therapeutics Committee.

6.1.6. The vendor shall be able to bill the Government for orientation at the billable rate.

6.1.7. Meetings, trainings, quality improvement programs and clinical/administrative tasks and data collection shall occur while on shift.

Quality Assurance: The Government will evaluate the Contractor’s performance under this contract IAW Quality Assurance Surveillance Plan (QASP). This Government-only plan is primarily focused on what the Government will do to ensure that the Contractor has performed IAW contract performance standards. The QASP provides a systematic method to evaluate performance to include how the performance standards will be applied, the frequency of surveillance, and the acceptable quality levels for each of the metrics identified.

Quality Control: The Contractor shall have a planned and systematic Quality Control Plan (QCP) that outlines the quality control process covering every aspect of the Contractor’s operation under this contract. The Contractor shall submit a QCP to the COR. The COR will approve the QCP in writing. The Contractor shall submit changes to an approved QCP to the COR for approval throughout the life of the contract. The QCP shall be a part of the contract as attachment 1.

6.2. SPECIFIC DUTIES/RESPONSIBILITIES

6.2.1. NEONATAL NURSE PRACTITIONER

The HCWs shall provide a full range of nurse practitioner services in accordance with privileges granted by the MTF Director. The HCWs shall:

1. Order and administer an approved list of drugs according to protocol.

1. Provide comprehensive medical assessment, examination, consultation, diagnosis, and treatment plans for neonates.

1. Provide medical management of neonates to include neonatal resuscitation, conventional ventilation, stabilization and maintenance of Level II care prior to transport, and prescription of medications (including controlled substances) to treat neonatal medical disorders.

1. Request and interpret laboratory tests, electrocardiograms, radiographic procedures, and other tests.

1. Determine appropriate procedures and perform procedures including sedation, endotracheal intubation, routine phlebotomy, arterial phlebotomy, percutaneous central venous line placement, umbilical line placement, lumbar puncture, suprapubic bladder taps, bladder catheterization, needle thoracentesis, and chest tube placement as credentialed.

1. Attend routine and high-risk deliveries as a member of the Resuscitation Team and perform Neonatal Resuscitation.

1. Provide medical care to neonates awaiting transport to other facilities and arriving from other higher level of care NICUs.

1. Provide outpatient care for routine appointments/NICU follow-up appointments.

1. Provide clinical instruction to students and resident physicians rotating through the nursery.

1. These duties will be performed under the clinical direction of a designated government or contract Neonatologist.

6.2.2. NEONATOLOGIST

The HCWs shall provide a full range of Neonatologist services in accordance with privileges granted by the MTF Director. The HCWs shall:

1. Provide comprehensive medical assessment, examination, consultation, diagnosis, and treatment plans for neonates.

1. Provide medical management of neonates to include neonatal resuscitation, conventional ventilation, stabilization and maintenance of Level II care prior to transport, and prescription of medications (including controlled substances) to treat neonatal medical disorders.

1. Request and interpret laboratory tests, electrocardiograms, radiographic procedures, and other tests.

1. Determine appropriate procedures and perform procedures including sedation, endotracheal intubation, routine phlebotomy, arterial phlebotomy, percutaneous central venous line placement, umbilical line placement, lumbar puncture, suprapubic bladder taps, bladder catheterization, needle thoracentesis, chest tube placement, and circumcision.

1. Attend routine and high-risk deliveries as a member of the Resuscitation Team and perform Neonatal Resuscitation.

1. Provide medical care to neonates awaiting transport to other facilities and arriving from other higher level of care NICUs.

1. Provide outpatient care for routine appointments/NICU follow-up appointments.

1. Provide clinical instruction to students and resident physicians rotating through the nursery.

SECTION 7 - PERSONNEL QUALIFICATIONS

7.1. NEONATAL NURSE PRACTITIONER

The HCWs shall meet and maintain specific minimum qualifications, skills, and knowledge. The following are required:

7.1.1. Possess certification as a NNP from the National Certification Corporation (NCC).

7.1.2. Possess current, full, active and unrestricted license to practice as a neonatal nurse practitioner.

7.1.3. Possess current Neonatal Resuscitation Program (NRP) Provider Completion Card.

7.1.4. Possess current certification in Pediatric advanced Life Support (PALS).

7.1.5. Possess current certification in Basic Life Support (BLS) for Healthcare Providers from the American Heart Association or The American Red Cross. Certification cards must display the American Heart Association or The American Red Cross emblem. Web-based classes do not meet required standards. HCWs, not currently in possession of current certification, must acquire certification prior to initiating contract performance.

7.1.6. Possess a minimum of three years’ experience within the last five years as a Nurse Practitioner in a level II or higher neonatal unit.

7.1.7. Pertinent clinical experience within the past two years sufficient to demonstrate current clinical competency for the setting and procedures required by the contract.

7.2. NEONATOLOGIST

The HCWs shall meet and maintain specific minimum qualifications, skills, and knowledge. The following are required:

7.2.1. 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).

7.2.2. Possess and maintain board certification in Neonatal-Perinatal Medicine as determined by the American Board of Pediatrics.

7.2.3. Possess and maintain a current unrestricted license to practice as a professional neonatologist in the state of North Carolina.

7.2.4. Possess current Neonatal Resuscitation Program (NRP) Provider Completion Card.

7.2.5. Possess current certification in Pediatric advanced Life Support (PALS).

7.2.6. Possess current certification in Basic Life Support (BLS) for Healthcare Providers from the American Heart Association or The American Red Cross. Certification cards must display the American Heart Association or The American Red Cross emblem. Web-based classes do not meet required standards. HCWs, not currently in possession of current certification, must acquire certification prior to initiating contract performance.

7.2.7. Possess one-year clinical experience within the past two years sufficient to demonstrate current clinical competency for the setting and procedures required by the contract.

7.3. CREDENTIALING REQUIREMENTS

7.3.1. Following contract award, the contractor shall submit to the COR complete HCW Credentials Record(s) (CR) not fewer than 30 days prior to required performance of duties. The CR, maintained at the MTF, contains specific information with regard to qualifying degrees and licenses, past professional experience and performance, education and training, health status, and current competency (i.e. within 2 years) as compared to specialty-specific criteria regarding eligibility for defined scopes of health care services. For those HCWs who currently have a CR on file, an updated Personal and Professional Information Sheet (PPIS) for Privileged Providers, with notation that a complete up-to-date CR is on file, shall be submitted no less than 15 days prior to required commencement of services.

7.3.2. In the event the contractor submits an incomplete CR, the COR will notify the contractor. Incomplete CRs will be shredded, or may be returned to the contractor if a prepaid means of return was provided when the original package was submitted. Incomplete CRs will not be retained by the COR. Presentation of incomplete CRs by the contractor may be evaluated as part of the performance evaluation on future awards.

7.3.3. If a negative current clinical competency assessment is made during the Government's evaluation of the CR, then the MTF’s consideration of the HCW’s application for credentials review and privileging will immediately close, and the COR will request that the contractor submit another candidate CR package.

7.3.4. Upon receipt of a complete CR, the COR will forward the package to the MTF’s Medical Staff Services Office (MSSO) for credentials review of the individual HCW. The MSSO shall ensure the CR is complete in accordance with DHA PM Number 6025-13 (and subsequent revisions). HCWs are not authorized to work at the MTF until their CR has been approved by the designated MTF Privileging Authority.

7.3.5. The contractor is responsible for prime source verification of all licenses and certifications prior to submission of the CR to the COR. The contractor shall provide written documentation from the verifying agency that includes the agency POC, their position and contact information, the agency name, and the date of verification. The contractor shall also include a copy of their outgoing letter to the primary issuing agency requesting written verification. Upon receipt by the contractor, the issuing agency's original letterhead verification response shall be provided to the MTF Medical Services Professional, via the COR. Services under this contract shall not be initiated or performed until appropriate clinical privileges have been granted.

7.3.6. The contractor shall ensure that all documentation necessary to keep each individual CR current is submitted to the MSSO, via the COR, for inclusion in each file. The contractor shall maintain a complete and up-to-date credential file for each HCW during the life of this contract which shall be made available for Government inspection upon request.

7.3.7. The government reserves the right to transfer to the awardee Contractor the credentials of a health professional who has been granted delineated clinical privileges on a predecessor Contract without a new or additional credentialing action. This extension may occur only: a) within the same command; b) when there is no increased clinical competency requirement of the HCW in the follow-on contract; c) when there is no significant change in the scope of clinical practice of the HCW in the follow-on contract; d) when there is no gap in performance between the contracts; and e) there has been no documented negative or unsatisfactory performance issues with the HCW during the predecessor contract.

7.3.8. In addition, the Contractor is advised that the Department of Defense participates in the national reporting system established under Part B of the Health Care Quality Improvement Act of 1986, Public Law 99 660. Reports, naming individual practitioners, shall be submitted to the National Practitioner Data Bank in accordance with this Act.

7.3.9. The privileging authority per DHA PM Number 6025-13 (and subsequent revisions) will grant clinical privileges where appropriate to those HCWs requiring privileges to perform services. If a HCWs employment with the contractor ends for any reason, all clinical privileges and medical staff appointments shall be terminated without recourse to the fair hearing and appeals procedures specified by the medical staff bylaws and DHAPM number 6025.13, Volume 3 (and subsequent revisions).

7.3.10. The contractor shall continuously maintain a current list of all individuals who have been privileged for service under the contract. The contractor shall provide a copy of the list to the COR monthly, or more often as requested by the COR.

7.4. Drug Enforcement Agency (DEA) Requirements. HCWs shall have a current, valid DEA registration prior to performing on this contract in accordance with regulatory guidelines. The Contractor shall ensure DEA registrations are renewed throughout the performance of the HCW.

SECTION 8 - FAILURE AND/OR INABILITY TO PERFORM

8.1. An HCW may be subject to request for replacement if the contractor fails to provide the physical certification requested in Section C.10. or privileges are not granted to the HCW by the MTF Director.

8.2. Should a HCW be unable to perform duties due to medical or physical disability for more than 13 consecutive days, that HCW’s ability to perform under the contract may be suspended by the MTF Director until such medical or physical disability is resolved.

SECTION 9 - ORIENTATION

9.1. Each HCW providing services under this contract shall undergo an orientation and shall complete mandatory MTF and DoD on-line training as required. Orientation may be waived for personnel who have previously provided service at the same treatment facility or at a similarly treatment facility. DoD on-line training may require that the HCW enter their Social Security Number to document and track compliance with training requirements. Refusal by HCWs to provide their Social Security Number may result in request for a replacement. HCWs are required to attend orientation which will include familiarization with the facility, introduction to the Quality Improvement Program, introduction to MTF rules and regulations, introduction to military protocols such as military structure, time and rank, acquisition of parking permits, proper infection control protocols and clarification of rights and responsibilities.

9.2. HCWS shall also complete Command Orientation and Information Systems Orientation. Command orientation of up to 40 hours includes annual online training requirements for topics such as but not limited to fire, safety, infection control, family advocacy, Chemical, Biological, Radiological, Nuclear, and Explosive Events (CBRNE) Basic Awareness, and various MTF required on-line trainings.

9.3. Orientation will be provided to HCWs, as required, during initial regularly scheduled shifts under the contract.

9.4. Neonatologists who are required to be oriented during initial regularly scheduled work shifts shall be scheduled by the Contractor for shifts occurring at times when orientation classes are available. The COR will provide a list of training times up to 30 days in advance.

9.4.1. NNPs who are required to be oriented during initial regularly scheduled work shifts shall be scheduled by the COR or department for shifts occurring at times when orientation classes are available.

9.5. The Contractor shall not invoice for orientation, and the government will not reimburse the Contractor for orientation, until such time as the individual has provided an amount of clinical services equal to the amount of orientation received. HCWs shall complete all onboarding and/or orientation requirements within 60 days after commencement of services by the HCW. The Contractor must submit replacement CR packages for HCWs who fail to complete onboarding and orientation within the time specified herein.

9.6. Turnover of HCWs. The Contractor shall use best efforts to minimize the potentially negative impact on continuity of care created by staff turnover and the expense incurred during orientation and in the privileging of new HCWs. The Contractor agrees to use best efforts to minimize turnover and to recruit individuals who indicate interest in a long-term commitment under this contract per Appendix 1.

9.7. BLOODBORNE PATHOGEN ORIENTATION PROGRAM. HCWs shall participate in the Command’s Bloodborne Pathogen Orientation Program. The HCW shall also participate in all required annual training and in periodic training for all procedures that have the potential for occupational exposure to bloodborne pathogens.

9.8. MANAGEMENT OF HIV POSITIVE HCWs. HIV positive HCWs will be managed in accordance with the current CDC guidelines and Section 503 of the Rehabilitation Act (29 U.S.C. 793) and it’s implementing regulations (41 CFR Part 60-741).

9.9. PREVENTION OF THE TRANSMISSION OF THE HIV VIRUS. HCWs shall comply with the CDC’s “Universal Precautions” for the prevention of the transmission of the HIV virus.

9.10. MANAGING THE CLINICAL RISK IN THE WORK ENVIRONMENT. The work environment inherently involves risks typically associated with the performance of clinical procedures. The HCW may be exposed to contagious disease, infections and flying debris, requiring the wearing of personal protection equipment such as scrub attire, gloves, masks, and eye protection.

SECTION 10- REGULATORY COMPLIANCE REQUIREMENTS

10.1. HCW Health Requirements: The Contractor ☒ shall ☐ shall not provide documentation certifying health requirements such as immunizations, annual vaccinations, medical testing (i.e., tuberculosis, N95 particulate respirator duckbill mask fitting) and physical examination when required at the time of initial placement.

10.2. Occupational Health: The HCW ☒shall ☐shall not be required to obtain documentation of required physical testing or a report of a physical examination.

10.3. Tuberculosis Screening: The additional immunization/screening requirements for the risk of exposure to tuberculosis (TB) are as follows:

10.3.1. Health examination, tuberculosis, and immunization screening. After contract award, but prior to performing services, each HCW shall have the Health examination and Immunization screening form (to be provided by the COR after award) completed by a licensed medical practitioner. All HCWs providing services under this contract must meet all the requirements specified under the applicable documentation provided to the contractor by the COR office at the MTF. The facility shall identify incumbent HCWs who are not required to complete this documentation after contract award. Declinations shall be permitted only based on either the HCW’s religious convictions or medical contraindications (as documented by a qualified health care provider).

10.3.2. Hepatitis. Except for those workers who decline, the Hepatitis B requirements given in the “Health Examination and Immunization/Screening Requirement Form” provide that a HCW must either show a positive titer or demonstrate persistent non-response to the vaccine. Declinations shall be permitted only based on either the HCW’s religious convictions or medical contraindications (as documented by a qualified health care provider). The Hepatitis B vaccine declination can be found at https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030AppA.

A HCW may be approved for service at the MTF prior to achieving a Hepatitis B positive titer or demonstrating a persistent non-response according to the following provisions:

10.3.3. A HCW must receive the first vaccination of his/her initial vaccination series prior to commencing service under the contract and must complete the series not later than 6 months after commencing service and, if a negative titer is obtained, must complete the second series within another 6 months; or

10.3.4. A HCW who has completed his/her initial series and obtained a negative titer must begin his/her second vaccine series prior to commencing service and must complete the second series not later than 6 months after commencing service.

10.3.5. HCWs approved according to the provisions above will be considered persistent non-responders until there is evidence to the contrary and will be counseled by a licensed practitioner regarding the implications of non-response.

10.3.6. If a HCW fails to comply with the applicable schedule above, the Contractor shall replace the HCW as directed by the Contracting Officer.

10.3.7. No medical tests or procedures required by the contract may be performed in the MTF. Expenses for all required tests and/or procedures shall be borne by the Contractor at no additional expense to the Government.

10.3.8. HCWs agree to undergo personal health examinations and such other medical and dental examinations at any time during the term of this contract, as the MTF Director may deem necessary for preventive medicine, medical surveillance, performance improvement, or privileging purposes. These examinations will be provided by the Government. If the Contractor chooses, these examinations may be provided by private physician or dentist, at no expense to the Government.

10.3.9. HCWs who do not show a positive antibody titer after immunization and appear to have a “non-immune” status must report varicella exposure to the COR. In accordance with CDC recommendations, such HCWs may be removed from patient care duties beginning on the tenth day following exposure and remain away from work for the maximum incubation period of varicella (21 days).

10.3.10. It is essential that HCWs be vaccinated annually against influenza according to Centers for Disease Control (CDC) guidelines aimed at reducing the impact of influenza disease in health care settings. The Government will provide the influenza vaccine free of charge. If the HCW chooses to be immunized by the Government, the HCW shall sign a waiver releasing the Government from legal liability in accordance with local procedures and policies. Alternately, the HCW may obtain the vaccine at another facility, with the HCW bearing the total cost, and provide proof of vaccination to the Government. If the HCW declines vaccination, a signed declination form shall be provided to the Government in accordance with CDC recommendations and MTF policies.

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Appendix 1 - Surveillance Matrix

Inspection Metrologies:

Inspection of Reports. All reports shall be reviewed upon receipt. The reviewer will report any flaws in the document and categorize the flaws (Editorial, Format, and/or Substance).

CORRECTIVE ACTION REPORT (CAR)

(If more space is needed, use reverse and identify by number)

1. CONTRACTOR

2. CONTRACT NUMBER

3. TYPE OF SERVICES

4. FUNCTIONAL AREA

5. SUSPENSE DATE

6. CONTROL NUMBER

7. DEFICIENCY |_| MAJOR |_| MINOR

FINDING:

FINDING IMPACT:

Please respond with a written corrective action plan that details the corrective action of the cited deficiency, the cause of the deficiency, and actions taken to prevent recurrence by Suspense Date in Block 5. If date was not entered in Block 5, the contractor is not required to provide a response.

8. QUALITY ASSURANCE PERSONNEL (COR)

TYPED NAME AND GRADE

SIGNATURE AND DATE

9. ISSUING AUTHORITY

TYPED NAME AND GRADE

SIGNATURE AND DATE

10. COR RESPONSE TO CONTRACTOR CORRECTIVE ACTION AND ACTION TAKEN TO PREVENT RECURRENCE

11. COR DETERMINATION

|_| ACCEPTED |_| REJECTED

12. CLOSE DATE

CUSTOMER COMPLAINT RECORD

DATE/TIME OF COMPLAINT

SOURCE OF COMPLAINT

ORGANIZATION

BUILDING NUMBER

INDIVIDUAL

PHONE NUMBER

NATURE OF COMPLAINT

CONTRACT REFERENCE

VALIDATION

DATE/TIME CONTRACTOR INFORMED OF COMPLAINT

ACTION TAKEN BY CONTRACTOR

RECEIVED/VALIDATED BY