MedDet PHA PWS 30June26.pdf

PERFORMANCE WORK STATEMENT

MEDICAL / DENTAL READINESS CONTRACT FOR THE

KANSAS ARMY NATIONAL GUARD

30 June 2026

A. BACKGROUND: Individual Medical Readiness (IMR) and Fully Medically Ready (FMR) are the basic principles of force-sustainment for Kansas Army National Guard (KSARNG).

Medical and dental health is vital for force health protection and failure to achieve and maintain a standard of medical and oral health could preclude a Soldier/Service Member from serving the State or Nation in their intended capacity.

B. This Performance Work Statement for Health Care Services covers the various components of IMR/FMR to include:

a. Dental – Annual dental exams, digital bitewing X-rays, digital panoramic X- rays, data entry of all

X-rays and dental records, identification and on-site treatment of all eligible Class 3 soldiers to convert to Class 2 or better. National Guard Bureau’s national statistics, it is estimated that 15% of eligible Soldier exams will be Classification 3, Non-Deployable without Dental Treatment. Dental restorative services, Oral surgery, Endo-RCT (root canal) will require contractor to provide local sterile location (facility or mobile dental vehicle) to perform these services. (see section G.1.2&3 of accompanied PWS)

b. Audiology, Audiometer Testing- DOEHRS (Defense Occupations and Environmental Health Readiness System) Compatible Audiometer Testing: The Contractor shall conduct audiometric evaluations in accordance with AR 40-501. Contractor will have Audiologist on site of the event. Results of the hearing test need to be forwarded to KSARNG Medical Services Office Representative staff the same day of the event. Audiometric evaluations will be completed by the hearing booths supplied by the KSARNG. The Contractor shall ensure effectiveness and accuracy of tests and create an environment most suited to limit noise pollution than could affect testing.

c. Optometry (deployment) – Will include visual refraction, measuring papillary distance, frame measurement, proficient in lensometer operation, and other testing needed. Flight physicals will include: color vision testing, ran dot testing.

Support vision readiness deployment requirements IAW AR 40-501 for select Vision Class 2 and all Vision Class 3 Soldiers.

C. Department of Defense policy requires an annual Dental Screening Examination for Army

National Guardsmen in order to determine their dental classification and outline treatment plans and priorities. Furthermore, Soldiers who are alerted for Mobilization or Deployment are eligible for Dental Treatment if they result in a Class 3 Status from examination. For Class 3 Soldiers, the results of that screening examination shall be recorded immediately after the exam in order to allow the State Dental Officer to approve treatment plans. For all other Dental Classes the results of the examination shall be recorded to be entered into the DENCLASS database within 3 days from the date of examination. The DENCLASS database updates the Army Medical Protection System (MEDPROS).

D. OBJECTIVES AND SCOPE: The objective of this Performance Work Statement is to conduct and complete the requirements of the KSARNG IMR/FMR – Medical & Dental Readiness on all eligible Service Members (SMs) in the KSARNG utilizing a HIPAA, ADA, Privacy Act, and OSHA-Compliant, Mobile Health/Dental Practice. Medical services will be performed by licensed/registered/certified medical professionals with oversight by the KSARNG Medical Services Office Representative. Facilities will be supplied by the KSARNG to conduct operations. As well, SMs in the KSARNG that are Class 3 Dental Status (non-deployable without approved dental treatment) require an OSHA & ADA- Compliant mobile or fixed dental facility, provided by the contractor, based upon the requirements of the KSARNG. These requirements include:

i. Estimated Workload - Contractor shall be prepared to see an average of 200 to 500 SMs per mission. For planning purposes, estimate 5% Female, 1% over 40 female, 10% over 40 male, 84% males under 40 and 15% dental Class 3 requiring on-site treatment.

ii. Medical evaluation by a licensed provider (Physician, Physician Assistant, or

Nurse Practitioner IAW prescribed Army and NGB policy for Periodic Health Assessments and Physical Exams and licensed to practice within the State of Kansas, or equivalent license to practice within the established laws, regulations and policies pertaining to the KSARNG. Civilian providers are to follow the guidance set forth by the Kansas Board of Healing Arts (http://www.ksbha.org). Army Regulation AR 40-68, Clinical Quality Management also applies.

iii. Hardcopy medical documentation file and organization in accordance with AR40-66 in the Soldier Treatment Record.

iv. Clinical evaluation of the oral cavity and bitewings by a licensed dentist in good standing supported by bitewings taken by dental technicians.

Clinical restoration of the oral cavity by a licensed dentist. Provide inclusive postoperative follow-up dental service in events of complications. Provide necessary medication required for dental treatment to Soldiers.

v. Personnel performing the dental screening examination will inform the

Soldier if they observe or are apprised of any sign or symptom for which the Soldier should obtain further evaluation or care.

vi. A dental screening examination identifies deficiencies but only DRC3 will receive dental treatment or as requested by the State Dental Officer.

vii. Case Management services for non-remediated (remaining Class 3) Soldiers, as required and dictated by the State Dental Officer.

viii. The contractor will have a plan of action in the event of any equipment malfunction during this significant time of operation. Back-up plans will need to be in place. Contractor must maintain continuous operations throughout the period of the event.

E. PERFORMANCE DETAILS:

a. 7-8 AUG 2026 – Lenexa Kansas, estimated participants: 675

b. 18-20 Sept 2026 - Salina Kansas estimated participants: 550 http://www.ksbha.org/

Total number of participants: 1,225

F. Performance locations:

KSARNG Medical Detachment 18200 W 87th St, Lenexa, KS 66219, KSARNG Medical Detachment

2929 SCANLAN AVE

Salina, KS 67401

PERFORMANCE:

i. Arrive / set-up / prep – Day before each event start for dental treatment and 0700 of the first day for examination and PHA

ii. Event – Full duration of event for estimated 11 hours per work day

iii. Tear-down / depart – at the end of the last event day

G. SERVICES

a. Setup and breakdown of the Contractor’s equipment is the sole responsibility of the

Contractor for dental restoration and other than routine vision examination (part of PHA). All automation, to include but not limited to computers, printers, internet access, X-ray equipment and panographic X-ray equipment shall be the sole responsibility of the contractor and shall be tested prior to each event. All equipment, staff and supplies shall be in place prior to scheduled start time of event.

b. The contractor will be required to provide and have available on request credentialing, privileging and prime-source verification of all licenses and specialties of medical professionals that work events for the KSARNG.

1. Providers (Physicians, Physician Assistants, Social Worker, Dentists, Nurse Practitioners etc. must have an unrestricted license).

2. Must have current privileges to perform all requirements outlined within their scope of practice.

c. Optometry Requirements (for mobilization or as needed by the KSARNG) must have the ability to perform Optometry for Visual Refraction.

d. Dental Treatment Requirements:

i. OSHA/HIPAA/ADA Compliant and Self-Contained Mobile Dental Practice at Lenexa location.

ii. Fully digital exams/Bite-wing radiographs/panoramic radiograph focus

iii. Necessary staffing of Dentists, Dental Assistants and RDA / X-ray

Technicians to support dental restoration of an estimated 10-60 SMs per event.

iv. Treatment available if needed with all necessary clinical supplies, equipment and instruments.

v. Reception area for data intake and outtake within vehicle for health history and data processing.

vi. Meets all state radiological requirements including lead-lines walls and trigger systems for RDAs outside of operatory during x-ray exposure.

vii. Separate sterilization area within the Local/Mobile Dental Practice

viii. Equipped with printers that provide AGFA Film-Based printing.

ix. Must contain biohazard waste receptacles.

x. Kodak Sensors or Sensors equivalent and accepted by the KSARNG State

Dental Officer.

xi. Must have a Dental Quality Assurance Consultant with Military

Experience.

e. The contractor shall provide labor to adequately staff PHA/SRP missions as requested by the government. Billing will reflect the actual number of personnel provided by the Contractor. Services listed in the PWS will be delivered throughout the period of performance based on the Medical support needs of the KSARNG, at locations designated by the KSARNG. The services will provide mandated medical and dental requirements per regulation and guidance to meet readiness and deployability standards. The KSARNG will staff missions organically and request contractor’s as needed to supplement any or all services.

f. Typical Medical Requirements:

1. TITMUS Visual Acuity Screener.

2. Optometry with Visual Refraction.

3. CAOHC Certified Hearing conservationist.

4. Typical Medical Staffing (For information purposes only--may not be all inclusive):

a. CAOHC Certified Audiology Technician

b. Optometrist

c. Optometry Technician

d. Audiologist

e. Dentist

f. RDA/Dental X-Ray Technician

g. Clerical Personnel

h. Project Manager

5. Medical Supplies (not all inclusive):

a. Able to customized medical supplies for PHA and/or Full Physical Exams as listed necessary for medical services above.

b. OSHA Required Personal Protective Equipment (PPE).

6. Dental Restoration

a. Dental Restoration will comply with Appendix E.

7. Hearing Requirements:

a. Must be able to export to the DOEHRS Repository in real-time or near real-time.

b. Minimal necessary staffing of 1 Hearing Conservationist.

g. Mobile Portable Requirements: (if applicable)

1. Contractor must be prepared to provide portable office buildings to facilitate the more efficient in/out processing of Soldiers (primarily for administrative functions), only when requested by the KSARNG.

2. All portable office buildings must be climate controlled.

3. All portable office buildings must be HIPAA Compliant and provide appropriate privacy.

H. GOVERNMENT-FURNISHED PROPERTY AND INFORMATION:

i. The government shall only furnish parking for HIPAA Privacy Act, OSHA & ADA-Compliant, Self-Contained Mobile Medical, Dental and Hearing Practices and portable office buildings when requested. No armory, or office space will be provided or utilized unless prior approval from the KSARNG Medical Services Office Representative. KSRNG Armory and clinic space may be provided for optometry services.

ii. For PHA the KSARNG shall provide all supplies associated with hearing examinations, all supplies associated with dental exams and all information technology in the Dental sections.

I. CONTRACTOR FURNISHED ITEMS:

i. Contractors will provide all items and licensed personnel needed to perform the Medical & Dental Readiness requirements except as otherwise indicated in contract.

ii. If contractor uses off-site facility for Dental restorations services, the facility must be with in15min drive to the site and transportation of soldier/patients to and from the facility will be the responsibility of the contractor. The facility shall meet all OSHA, ADA & HIPAA standards to ensure a safe, comfortable, and productive workspace.

iii. If Mobile Dental or Medical Practices are used, the contractor must provide a Mobile Practices that meet all OSHA, ADA & HIPAA standards to ensure a safe, comfortable, and productive workspace.

iv. Each Mobile Dental vehicle or facility shall contain lead-lined walls for radiograph radiation protection, digital bite-wing and panoramic to provide digital radiograph files at the end of the event, all emergency medical resources consistent with OSHA standards such as eye wash stations, distilled water tanks, separate and walled operatories to provide confidentiality for patients, individually temperature controlled rooms, sterilization equipment in separate sterilization area, biohazard waste receptacles, biohazard separated work areas, fully functional standard medical and dental equipment, a designated reception area with fully functional office technology including a local area network (LAN) with redundant computer systems and printing/copying capabilities, and an on-board ventilation system to minimize blood-borne pathogens. For dental treatment to be performed, the Mobile Dental Practice shall have full treatment functionality consistent with traditional, fixed-site, private practice dental offices. This includes non-portable and professional quality dental chairs, compressor systems, vacuum systems, and treatment instruments for fillings, extractions, root canals, and other work authorized by the National Guard Bureau. The contractor’s safety program will include equipment training, occupational safety, health and fire protection guidance, to ensure the protection and health of all work personnel.

v. Digital Bitewings, Digital Panoramic Radiographs and Dental Exams: The

Contractor shall perform required dental examinations to include digital bitewings and digital panoramic radiograph if clinically indicated in support of the annual medical and dental screenings in accordance with the AR 40- 501 and AR 40-35 at an undetermined number of armories and training sites in Kansas. The Contractor will ensure all Soldiers have a current Panoramic Radiograph on file and if missing, the Contractor will perform new radiographs. Adherence to all OSHA requirements, State and Federal Regulations are mandatory. Diagnostic quality IR required or work needs to be re-done.

vi. Each exam shall be annotated on the SF 603 (Health Record – Dental) and the DA Form 5570 (Health Questionnaire for Dental Treatment) of the Soldier’s dental records. All Soldiers shall have a complete military dental record. No dental record is complete unless the documentation is complete and in the proper order as outlined in TB MED 250. The Contractor shall provide electronic documentation (to include radiographs) to the KSARNG and charting of current oral condition Class 2 issues identified and a listing of Class 3 treatment needs.

vii. As required, provide timely feedback and work progress / status of the number of dental examinations completed to the Medical Team Officer in Charge as to timelines or factors that may negatively impact processing the scheduled number of Soldiers.

viii. Contractor shall contact the KSARNG Medical Services Office

Representative or his/her designated representative at the end of each day during the event.

ix. Contractor shall be licensed on any services rendered and equipment operated during the mission.

x. Dental Treatment: Based on National Guard Bureau’s national statistics, it is estimated that 15% of eligible Soldier exams will be Classification 3, Non- Deployable without Dental Treatment. The more likely estimation for the KSARNG at the time of this document is 15%. This creates an estimated population of Soldiers that will require dental treatment to upgrade those Soldiers to a minimum Class 2 Status.

J. REFERENCES (available on armypubs.army.mil)

i. AR-40-35, Preventive Dentistry and Dental Readiness.

ii. AR 40-66, Medical Record Administration and Health Care Documentation.

iii. AR 40-501, Standards of Medical Fitness.

iv. AR 40-562, Immunizations and Chemoprophylaxis for the Prevention of

Infectious Diseases.

v. AR 600-8-101. Personnel Readiness Processing.

vi. Department of Defense Instruction 6025.19, Individual Medical Readiness, 9 Jun 14.

vii. TB MED 250, Dental Record Administration Recording and Appointment

Control, April 2006.

viii. Army MEDCOM Memorandum, “Army Medical Command Individual Medical Readiness (IMR) and Post-Deployment Health Reassessment (PDHRA) Guidance, 15 OCT 07.

ix. AR 635-40 Disability Evaluation for Retention, Retirement, or Separation.

x. DD Form 689 (Individual Sick Slip), dated 01August 2017.

xi. DD Form 2870 (Authorization for Disclosure of Medical or Dental Information, Dtd NOV 2023

xii. SF 600 (Chronological Record of Medical Care)

xiii. DA Form 3365 (Authorization For Medical Warning Tag), Dtd AUG 68

xiv. KSARNG SOP 40-1, Medical Service Program

xv. Assistant Secretary of Defense for Health Affairs [ASD (HA)] Memo. (2003, April 24). Policy for Individual Medical Readiness Metrics.

xvi. Department of the Army Memorandum. (2006, January 23). Post- Deployment Health Reassessment.

xvii. Department of the Army/G-1 PDHRA Memorandum. (2010, May 6).

Post-Deployment Health Reassessment (PDHRA) Compliance.

xviii. Department of Defense Instruction 6490.3. (2019, June 19).

Deployment Health.

xix. Department of Defense Instruction 6490.07 (2010, February 5) Deployment-Limiting Medical Conditions for Service Members and DoD Civilian Employees

b. DEFINITIONS

i. IMR – Individual Medical Readiness: is defined as being free of health-related conditions that limit a Soldier’s ability to actively fulfill his/her assigned mission. Individual Medical Readiness consists of six elements:

Dental Readiness, Immunization Status, Periodic Health Assessment (PHA), No deployment limiting conditions, Medical Readiness Laboratory Tests (HIV testing, DNA sampling, G6PD test), and Individual Medical Equipment (Eyeglasses, hearing protection). When all of these factors are considered, the individual Soldier is classified as:

1. GREEN – Fully Medically Ready. Current in all categories including Dental Class 1 or 2.

2. AMBER – Partially Medically Ready. Lacking one or more immunizations, readiness laboratory studies, or medical equipment. Needs an element that can be corrected prior to mobilization.

3. RED – Not Medically Ready. Existence of a chronic or prolonged deployment limiting condition (per Service-specific physical standards guidelines), including Service members who are hospitalized or convalescing from serious illness or injury, or individuals in dental class

4. Has a limiting condition that requires hospitalization or required medical care not available in the theater of operation.

5. Medical readiness indeterminate. Inability to determine the Service member’s current health status because of missing health information such as a lost medical record, an overdue PHA or being in dental or medical class 4.

6. FMR – Fully Medically Ready: Current in all categories including Dental Class 1 or 2.

ii. MODS - The Medical Operational Data System (MODS) (https://www.mods.army.mil ) is an MHSS objective system that provides the Army Medical Department (AMEDD) with an integrated automation system that supports all phases of Human Resource Life -Cycle Management in both peacetime and mobilization. This on-line system provides commanders, staffs and functional managers of AMEDD organizations with a real time source of information on the qualifications, training, special pay and readiness of Army Medical Department (AMEDD) personnel. MODS currently maintains sixty system interfaces which are updated on a daily, weekly, monthly or semi-annual basis. These interfaces bring in over 75% of the data used in the system. The AMEDD community has a powerful tool with which decision makers and managers can affect their work requirements quickly. As a desktop resource for the personnel manager, MODS places critical assignment, training and qualification information at his fingertips. Time spent acquiring data can now be used in analyzing the information.

iii. DENCLASS – Dental Classification: An approved KSARNG web-based module (through MODS) designed to standardize dental classifications, https://www.mods.army.mil/ https://www.mods.army.mil/ https://www.mods.army.mil/ https://www.mods.army.mil/ https://www.mods.army.mil/ https://www.mods.army.mil/ https://www.mods.army.mil/ https://www.mods.army.mil/ https://www.mods.army.mil/ https://www.mods.army.mil/ https://www.mods.army.mil/ https://www.mods.army.mil/ https://www.mods.army.mil/ https://www.mods.army.mil/ https://www.mods.army.mil/ eliminate duplicate data system entry, facilitate the dental exam workflow, standardize the documentation of the health history and record of dental exam and integrate dental readiness within the MODS architecture. The DENCLASS module has been designed to document the dental readiness requirements of all KSARNG Soldiers. Components of DENCLASS include;

an automated health history, an automated SF603A, an automated letter outlining the dental treatment plan, a repository for dental radiographs, a library of dental readiness policy and statistical reporting of all components of DENCLASS.

iv. MEDPROS –The Medical Protection System (MEDPROS) (available through MODS) was developed by the AMEDD to track all immunization, medical readiness and deployability data for all Active and Reserve components of the Army as well as DA Civilians, contractors and others.

The comprehensive Medical Readiness data includes all medical and dental readiness requirements, IAW AR 600-8-101. They include immunizations, permanent physical profiles/duty limitations, eyeglasses/inserts, blood type, medical warning tags, personal deployment meds, pregnancy screening, DNA, HIV and dental status among other data elements.

v. PHA – Periodic Health Assessment (available through MODS): An annual assessment for changes in health status, especially those that could impact a member’s ability to perform military duties.

vi. DEXIS – All dental section contractors need to be familiar and proficient with DEXIS, a computer program that provides a platform for dental imaging to obtain dental radiographs and uploads them to the SM’s electronic file.

vii. Additional terms defined in Army MEDCOM Memorandum, 15 OCT 07, as cited above.

APPENDIX A ESTIMATED

WORKLOAD DATA

The following data elements will be reported at the end of an event:

• Date

• Location

• List of contract employees (i.e. providers, dental technicians, administrative staff)

• Total number of patients

• Total number of patients examined, by service (i.e., PHA, hearing, labs, immunizations)

• Total number of bitewing radiograph (sets of 4 per patient) taken

• Total number of panoramic radiographs taken

• Total number of Soldiers by FMR classification

• Verification of entry into MEDPROS & DENCLASS

• A “by name” listing of all Soldiers by UIC examined and the medical readiness classification of the Soldier and any referrals/follow-on required.

APPENDIX B

Department of Defense Oral Health and Readiness Classification System

The oral health status of uniformed personnel shall be classified as follows:

a. Class 1 (Oral Health): Patients with a current dental examination, who do not require dental treatment of re-evaluation. Class 1 patients are world-wide deployable.

b. Class 2: patients with a current dental examination, which require non-urgent dental treatment or re-evaluation for oral conditions, which are unlikely to result in dental emergencies within 12-months. Class 2 patients are world-wide deployable. Patients in dental class 2 may exhibit the following:

(1) Treatment or follow-up indicated for dental caries or minor defective restorations that can be maintained by the patient.

(2) Interim restorations or prosthesis that can be maintained for a 12-month period. This includes teeth that have been restored with permanent restorative materials for which protective cuspal coverage is indicated.

(3) Edentulous areas requiring prosthesis but not on an immediate basis.

(4) Periodontium that:

(a) requires oral prophylaxis

(b) requires maintenance therapy

(c) requires treatment for slight to moderate periodontitis and stable cases of more advanced periodontitis

(5) Unerupted partially erupted or malposed teeth that are without historical, clinical or radiographic signs or symptoms or pathosis, but which are recommended for prophylactic removal.

(6) Active orthodontic treatment. The provider should consider placing the patient in passive appliances for deployment up to six-months. For longer periods of deployment, the provider should consider removing active appliances and placing the patient in passive retention.

(7) Temporomandibular disorder patients in remission. The provider anticipates the patient can perform duties while deployed without ongoing care and any medications or appliances required for maintenance will not interfere with duties.

c. Class 3: Patients who require urgent or emergent dental treatment. Class 3 patients normally are not considered to be world-wide deployable.

(1) Treatment or follow-up indicated for dental caries, symptomatic tooth fracture or defective restorations that cannot be maintained by the patient.

(2) Interim restorations or prostheses that cannot be maintained for a 12-month period.

(3) Patients requiring treatment for the following periodontal conditions that may result in dental emergencies within the next 12-months:

(a) Edentulous areas or teeth requiring immediate prosthodontic treatment for adequate mastication or communication or acceptable esthetics.

(b) Active progressive moderate or advanced periodontitis.

(c) Periodontal abscess.

(d) Progressive mucogingival condition

(e) Periodontal manifestations of systemic disease or hormonal disturbances.

(f) Heavy subgingival calculus.

(4) Edentulous areas or teeth requiring immediate prosthodontic treatment for adequate mastication or communication or acceptable esthetics.

(5) Unerupted, partially erupted or malposed teeth with historical, clinical or radiographic signs or symptoms of pathosis that are recommended for removal.

(6) Chronic oral infections or other pathologic lesions including:

(a) Pulpal, periapical or resorptive pathology requiring treatment.

(b) Lesions requiring biopsy or awaiting biopsy report.

(7) Emergency situations requiring therapy to relieve pain, treat trauma, treat acute oral infections or provide timely follow-up care (e.g., drain or suture removal) until resolved.

(8) Acute Temporomandibular disorders requiring active treatment that may interfere with duties.

d. Class 4: Patients who require periodic dental examinations or patients with unknown dental classifications. Class 4 patients normally are not considered to be world-wide deployable.

APPENDIX C

PULHES PHYSICAL PROFILE SYSTEM

The physical profile system is based primarily upon the function of body systems and their relation to military duties. The functions of the various organs, systems, and integral parts of the body are considered. Since the analysis of the individual's medical, physical, and mental status plays an important role in assignment and welfare, not only must the functional grading be executed with great care, but clear and accurate descriptions of medical, physical, and mental deviations from normal are essential.

In developing the system, the functions have been considered under six factors designated "P-U- L-H-E-S." Four numerical designations are used to reflect different levels of functional capacity.

The basic purpose of the physical profile serial is to provide an index to overall functional capacity. Therefore, the functional capacity of a particular organ or system of the body, rather than the defect per se, shall be evaluated in determining the numerical designation 1, 2, 3, or 4.

The factors to be considered are as follows:

(1) P—Physical capacity or stamina. This factor, general physical capacity, normally includes conditions of the heart; respiratory system; gastrointestinal system; genitourinary system;

nervous system; allergic, endocrine, metabolic and nutritional diseases; diseases of the blood and blood forming tissues; dental conditions; diseases of the breast, and other organic defects and diseases which do not fall under other specific factors of the system.

(2) U—Upper extremities. This factor concerns the hands, arms, shoulder girdle, and spine, (cervical, thoracic, and upper lumbar) in regard to strength, range of motion, and general efficiency.

(3) L-Lower extremities. This factor concerns the feet, legs, pelvic girdle, lower back musculature and lower spine (lower lumbar and sacral) in regard to strength, range/of motion, and general efficiency.

(4) H—Hearing and ears. This factor concerns auditory acuity and disease and defects of the ear.

(5) E—Eyes. This factor concerns visual acuity and diseases and defects of the eye.

(6) S—Psychiatric. This factor concerns personality, emotional stability, and psychiatric diseases.

The Contractor shall provide a Review Medical Officer (RMO) to review all exams classified as 2, 3, 4 (~20% of records), a summary of abnormalities detected on physical examinations that the service member should be advised of (a checklist shall be used that shall be the 4th page of the form DD2808), shall determine those service members that need a profile created and initiate DA Form 3349, Physical Profile following the regulations in Army Medical Regulation 40-501 – Standards of medical services (AR 40-501), Chapters 6 and 7 (~20% of records), as well as prepare a memo to the Commander summarizing findings of each service member’s physical exam.

Only Military physicians can assign PULHES to a Soldiers’ records.

1) Visual Acuity Testing: The Contractor shall conduct visual acuity testing in accordance with AR 40-501. Each SM shall be assigned a Vision Readiness Classification and verified by a military Provider for PHAs. Optometrist shall adherence to OSHA, State and Federal Regulations is mandatory. The Contractor shall schedule all vision services in conjunction with other services. The contractor will provide optometry technicians, ancillary staff, and necessary testing equipment. The Contractor shall provide vision screening to include a Snellen test for all SMs, and screening to determine near and far vision measurements, refractions, pupillary distance for SMs requiring prescription lenses. The Contractor shall ensure the HCP (OD) fully completes the DD Form 771. The contractor will provide all necessary testing equipment to provide prescriptions. Upon request the contractor must have the capability to conduct complete optometry exams. The Contractor shall provide all prescriptions to the KSARNG. The contractor will transfer current existing prescriptions to DD Form 771. The contractor must have the capability to verify that the eyeglass/optical insert prescription is correct upon receipt from Naval Ophthalmic Support and Training Activity (NOSTRA) and will assure any prescription eyewear is delivered directly to the SM or the SM’s unit of record as designated by the KSARNG. Visual screening results shall be documented in MEDPROS by the contractor. Each SM shall be assigned a Vision Readiness Classification by a military physician.

2) DOEHRS (Defense Occupations and Environmental Health Readiness System) Compatible Audiometer Testing: The Contractor shall conduct audiometric evaluations in accordance with AR 40-501 for an undetermined number of Soldiers and undetermined locations throughout Kansas. Audiometric evaluations shall be DOEHRS compatible. Adherence to all requirements of OSHA, State and Federal Regulations is mandatory.

SPRINT testing will be performed IAW all applicable OSHA, State and Federal guidelines. Contractor will have Audiologist on site of the event.

Results of the hearing test need to be forwarded to KSARNG Medical Services Office Representative staff the same day of the event.

Audiometric evaluations will be completed by the hearing booths supplied by the KSARNG. As requested by the KSARNG, hearing test may need to be conducted utilizing a Mobile Hearing Practice or clinic. The Contractor shall ensure effectiveness and accuracy of tests and create an environment most suited to limit noise pollution than could affect testing. It is highly preferred to perform all testing on site.

3) Contractor utilizing a Local Dentist Office will provide transportation from the PHA/SRP site to the Local Dental Office. There must be a constant vehicle rotation, at minimum, of every 20 minutes to ensure Soldiers are able to process in a timely manner, due to the time restraints of the event.

SPECIFIC TASKS:

Dental Exam. A periodic oral evaluation shall assess the current state of oral health, risk for future dental disease as well as general health factors that relate to the treatment of the patient. The following measures are required for each periodic oral evaluation:

• Caries risk assessment – Classify Soldiers as low, moderate or high risk for caries as described by the American Dental Association’s1995 Special Supplement. This assessment will identify those at high risk for future disease.

• Periodontal assessment – Periodontal Screening and Recording (PSR), a screening procedure endorsed by the American Dental Association and the American academy of Periodontology, should be utilized to determine the need for periodontal treatment.

• Tobacco risk assessment – Classify Soldiers as a smoker, user of smokeless tobacco or as both.

• Oral cancer screening – Perform a thorough oral Cancer screening on all beneficiaries as part of all annual examinations.

• Radiographs should be taken only for clinical reasons according to

FDA guidelines as determined by the patient’s dentist. Radiograph should be of diagnostic quality property identified and dated. A panoramic radiograph is required to be present in the dental record and that it is of adequate quality for diagnostic / identification purposes. There is no time requirement on updating panoramic radiograph. However, the panoramic radiograph will adequately represent the current oral condition of the Soldier.

APPLICABLE DOCUMENTS:

The Contractor shall ensure that all appropriate DA, DD or other authorized and approved forms (in accordance with referenced) are utilized for each service supplied and utilized IAW AR 40-66 and TB MED 250. The forms will be made available through the KSARNG Medical Services Office Representative. The Contractor will provide all documentation concerning dental and medical treatment to the KSARNG.

PERFORMANCE:

• Arrive / set-up / prep – Day before each event start for dental treatment and 0700 of the first day for examination and PHA

• Event – Full duration of event for estimated 11 hours per work day

• Tear-down / depart – at the end of the last event day

OTHER CONDITIONS / SECURITY:

o Safety: The Contractor must establish a safety and health program in accordance with the standards of the Federal Occupational Safety and Health Standard (OSHA), Health Information Portability and Accountability Act (HIPAA) and The Privacy Act.

o Performance work statement is “UNCLASSIFIED” and under HIPAA regulations. Contractor shall notify the Contracting Officer if requirements exist for “secret” classification and circumstances requiring “secret” classification for Readiness impact reporting.

o Quality Control: The Contractor shall adopt a quality assurance program that monitors all services being provided. The program shall be approved by the KSARNG. Contractor needs to include in their process Military QA, and PULHES assignments.

o Security Requirements: All contractor personnel will be required to comply with all security requirements for entry to closed military training facilities to include completing anti-terrorism level 1 training at https://jcs.mil/JKO/ .

o Recognized identification card or driver’s license and all vehicles are subject to search without reason. The Contractor shall comply with all installation security requirements.

o Reporting: The Contractor shall provide a final report for all services provided to include a by name, unit and social security number roster of all Soldiers receiving services. The report shall be approved and verified by the KSARNG liaison with the KSARNG Medical Services Office Representative of the

KSARNG.

INSPECTION AND ACCEPTANCE: All work performed, all materials and tasks data to be submitted under this task shall be made available to be inspected for compliance with the PWS and accepted by the COR or authorized representative as specified herein.

CONTRACTOR EVALUATION. The Government may evaluate the contractor’s performance using the “Contractor Performance Assessment Reporting System (CPARS)” (http://www.cpars.gov). The Government may evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of services rendered (e.g., professional judgments, diagnosis for specific medical treatment).

https://jcs.mil/JKO/ http://www.cpars.gov/

APPENDIX E

Dental Services Mission Guidance

1. The purpose of this Appendix is to outline the standards of care for KSARNG Soldiers when receiving treatment from contracted dental service providers. The primary mission of the Dental section of the KS Medical Detachment is to have our soldiers medically ready to deploy in support of contingency operations. The Dental Section of the KS Medical Detachment is not a primary care facilitator, and our goal is strictly to identify those soldiers unable to deploy due to dental readiness, and assist them in remedying those deficiencies.

2. The following documents and publications are referenced:

a. DENCOM Calibration Tool

b. HA Policy 02-011

c. TB MED 250

3. All dental care provided by contracted entities will be in accordance with the laws of the State of Kansas, and the Kansas Dental Board. All care will be held to the standards of the specialty under which said care falls. (Oral Surgery, Endodontics etc) Failure to follow standard of care, may result in referral to State Dental Board for further review.

4. Documenting Examinations:

a. In accordance with the most recent DENCOM/Reserve. NGB directive, each 3rd molar requires a specific Class 1, 2, 3 designations in the Additional Comments section of DENCLASS 603A. Use the following as standardized comments (or combinations thereof) when assigning 3rd molar status:

(1) “17, 32 class 2 soldier states no history of problems”

(2) “16,17 class 3 exam verifies soldier claim of history of pain” (#16 and #17 Class 3, clinical findings during exam backs Service Member’s claim of history of pain with these teeth).

(3) “17, 32 class 3 exam shows high pericoronitis potential (#17 and #32 Class 3, clinical findings during exam shows these teeth have high potential for pericoronitis)”.

(4) “1, 16 class 1 exam shows (#1 and #16 fully erupted, no history of caries, asymptomatic, low likelihood of future treatment)”.

(5) If small class 2 caries is present on functioning 3rd molars, class 2 restoration is indicated. If high caries risk is present, or patient requests extraction, class 2 extraction of wisdom teeth is appropriate.

3. Data entry personnel will also follow certain protocols when documenting examinations.

Personnel will make sure that 3rd molar comments are the first comments entered in the Additional Comments box. This assures that they will be visible on the PDF version of the DENCLASS 603A. Due to space limitations use all lower case letters for comments.

4. Caries, Class 3 is defined at caries/fracture being ½ way through the dentin, and/or a reasonable likelihood exists that the soldier will experience a “dental emergency” visit within 12 months as a result of the tooth not being restored, or the tooth is symptomatic. Class 2 is defined as caries/fracture in the enamel or less than ½ through the dentin, with the soldier not expected to require a dental emergency appointment within 12 months. Class 2 does not mean that the soldier should not get the work taken care of with their private dentist, but is a way for the US Army to determine the medical readiness of the soldiers.

5. All treatment planned for ENDO (root canals) during the PHA process require:

a. Pre and Post Op periapical x-ray uploaded into DENCLASS

c. Treatment Planned Restoration of Build-up that covers/caps ALL CUSPS, or

SSC

d. Full coverage crowns (FGC or PFM or All Ceramic) are not authorized by the National Guard Bureau, and should be treatment planned as class 2, with a core b/u or SSC treatment planned class 3.

6. Class 3 gross debridement are indicated when a proper diagnosis is impossible due to the Service Member’s oral hygiene, and a gross debridement is necessary in order to diagnose dental disease. Individual areas deemed class 3 for perio, need to be treatment planned class 3 for SRP for those areas, usually SRP 1-3 teeth, with appropriate justification for the procedure noted on the SF 603.

7. The extraction of a questionable tooth stateside may be the best treatment for the Soldier if other treatment outcomes are questionable.

8. All treatment procedures must be approved by examining dentist on the soldiers SF 603, if CL 3 procedural dentist would like to alter treatment plan, approval must be given by the State Dental Officer if present, or by an examining dentist. If the examining dentist from the most recent SF 603 is unavailable, then approval can be given by another examining dentist.

9. Root Canals: Root canals should in most instances be referred to a specialist for care in that environment; exceptions being anterior and some premolar teeth. Due to the possibility of complications and difficulty, molar root canals should be referred to a specialist, unless direct approval is given by the State Dental Officer or Dental Officer in Charge of the mission.

a. All root canals/pulpectomies will be performed with a rubber dam in place with rubber dam clamp visible on working length and obturation check films.

b. All root canals will have a pre/op, working length, obturation check film, and a final radiograph with final restoration in place.

10. Operative

a. Amalgam is the material of choice on posterior teeth, on occlusal surfaces.

b. Proper technique for interproximal restorations includes matrix band and wedge during placement of filling.

c. Rubber dam should be used if pulp exposure is likely, or if restoring a root canal treated tooth with a core b/u.

(1). If pulp exposure occurs, direct pulp caps are not authorized. Should a pulp exposure occur, the restoring dentist can either temporize the tooth, or begin the root canal at that time. If time or circumstance prohibits the timely completion of the root canal at that appointment, CaOH should be placed in the canals with a cotton pellet and temp material. The Soldier will then referred to case management for the completion of treatment.

(2). Any pulp exposure where the root canal is not fully completed should be stated on the SF 603 and referral procedures initiated for completion of root canal and restoration.

Case Management will be completed by the KSARNG full time personnel.

(3). If a pulp exposure is imminent, indirect pulp capping (leaving a small layer of caries directly over pulp) and temporizing is authorized, with referral procedures initiated for completion of the root canal and restoration.

d. Post-operative radiographs will be taken and examined by the restoring dentist on all restorations placed to ensure that there are no overhangs and that restoration/s are clinically acceptable. ALL POST OP X-RAYS ARE UPLOADED TO DENCLASS.

11. Extractions: Due to probability of complications, all impacted wisdom teeth should be referred to an Oral Surgeon. (Certain exceptions can be made during the mission with approval from the State Dental Officer or Dental Officer in Charge)

a. All roots/ root tips should be extracted. If there is a root tip that the restoring dentist is unable to extract, documentation on the 603 is required and referral procedures will be initiated. Patient will be informed of current status, and patient’s referral will be case managed by KSARNG personnel. An updated panoramic radiograph is required following extractions; the panoramic radiograph will be uploaded into DENCLASS.

12. Following completion of care by restoring dentist, the Soldier will take their post-operative radiographs (PA for fillings, and panoramic radiograph for extractions) to the examining dentist in order to ensure that the prescribed work was completed and sufficient to elevate the Soldier’s dental status.