N68908-16-T-0009.pdf

NAVAL HOSPITAL BEAUFORT

RECEIVING OFFICER

1 PINCKNEY BOULEVARD

BEAUFORT SC 29902-6148

TEL: 843-228-5375 FAX: 843-228-5532

N6133716RCED003

REQUEST FOR QUOTATIONS

(THIS IS NOT AN ORDER) 1

PAGE OF PAGES

1. REQUEST NO. 2. DATE ISSUED RATING

N68908-16-T-0009 19-Nov-2015

5a. ISSUED BY

8. TO: NAME AND ADDRESS, INCLUDING ZIP CODE

IMPO RTANT: This is a request for information, and quotations furnished are not offers. If you are unable to quote, please so indicate on this form and return it to the address in Block 5a. This request does not commit the Government to pay any costs incurred in the preparation of the submission of this quotation or to contract for supplies or services. Supplies are of domestic origin unless otherwise indicated by quoter. Any representations and/or certifications attached to this

Request for Quotations must be completed by the quoter.

11. SCHEDULE (Include applicable Federal, State, and local taxes)

ITEM NO.

(a)

SUPPLIES/ SERVICES

(b)

QUANTITY

(c)

UNIT

(d)

UNIT PRICE

(e) (f)

SEE SCHEDULE

AMOUNT

% No. %

NO TE: Additional provisions and representations [ ] are [ ] are not attached.

13. NAME AND ADDRESS OF QUOTER (Street, City, County, State, and ZIP Code)

14. SIGNATURE OF PERSON AUTHORIZED TO

SIGN QUOTATION

15. DATE OF

QUOTATION

16. NAME AND TITLE OF SIGNER (Type or print) ( Include area code)

TELEPHONE NO.

AUTHORIZED FOR LOCAL REPRODUCTION STANDARD FORM 18 (REV. 6-95)

PREVIOUS EDITION NOT USABLE Prescribed by GSA

FAR (48 CFR) 53.215-1(a)

THIS RFQ X[ ] IS [ ] IS NOT A SMALL BUSINESS SET-ASIDE

6. DELIVER BY (Date)

SEE SCHEDULE

AND/OR DMS REG. 1

UNDER BDSA REG. 2

4. CERT. FOR NAT. DEF.3. REQUISITION/PURCHASE

REQUEST NO.

NAVY MEDICINE EAST

SUITE 1400

620 JOHN PAUL JONES CIRCLE

PORTSMOUTH VA 23708-2106

9. DESTINATION (Consignee and address, including ZIP Code)

7. DELIVERY

[ ]X FOB

DESTINATION

[ ] OTHER

(See Schedule)

23-Nov-2015(Date)

PLEASE FURNISH QUOTATIONS TO THE ISSUING OFFICE IN BLOCK 5a ON OR BEFORE CLOSE OF BUSINESS:10.

757-953-2671MICHAEL G. DAVIS

(Name and Telephone no.) (No collect calls)5b. FOR INFORMATION CALL:

d. CALENDAR DAYSc. 30 CALENDAR DAYSb. 20 CALENDAR DAYS12. DISCOUNT FOR PROMPT PAYMENT a. 10 CALENDAR DAYS

N68908-16-T-0009

Section A - Solicitation/Contract Form

CLAUSES INCORPORATED BY FULL TEXT

TIN:

CAGE:

DUNS:

Vendor Point of Contact:

Phone:

Vendor email:

Billing/Payment in Arrears.

Naval Medical Center Contracting POC:

Michael G. Davis

Phone: 757-953-7537

Email: michael.g.davis179.civ@mail.mil

Product/Services for:

Naval Hospital Beaufort, SC

Vendor to reference RFQ number N68908-16-T-0009 on all inquires.

Reference:

PROMPT PAYMENT

For Prompt Payment Act Purposes, this contract is:

Subject to the 7-calender day constructive acceptance period.

mailto:michael.g.davis179.civ@mail.mil

Section B - Supplies or Services and Prices

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 208 Each Early Intervention

FFP

Treatment is determined per Individualized Patient Care Plan (IPCP) as ordered by the Naval Hospital Beaufort, SC (NHBSC). Services are assigned based on patient need and ellgibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

The Government cannot state any minimum guarantees of EIS for the Period of

Performance or renewal years.

Family Training shall be made available to include the following as prescribed:

Contractor to perform EDIS with patient and/or patient family for evaluation;

training; specialized patient/care provider instruction; or similarly qualifying treatment/information session.

Contractor must adhere to IPCP as specified by the NHBSC and the patient family.

Contractor may bill in 15 minute units. Contractor will be reimbursed only for visits and 15 minute units actually documented and performed.

Family Training Provider must have at least a BS degree related to the Human

Services field and have a certification in special education, teaching, therapy, or similar specialized training or experience.

Rate per Unit (15 minute):

Estimated units at 208 for Period of Perforamcne.

FOB: Destination

MILSTRIP: N6133716RCED003

PURCHASE REQUEST NUMBER: N6133716RCED003

NET AMT

0002 208 Each Orientation and Mobility

FFP

Treatment is determined per Individualized Patient Care Plan (IPCP) as ordered by the Naval Hospital Beaufort, SC (NHBSC). Services are assigned based on patient need and ellgibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

Orientation and Mobility Training shall be made available to include the following as prescribed:

training; specialized patient/care provider instruction specifically designed for children diagonised with visual impairment.

Family Training Provider must have at least a BS degree (preferrably an MS degree) related to the Human Services field and have a certification in special education, teaching, therapy, or similar specialized training or experience for persons with a visual impairment.

0003 208 Each Beginning American Sign Language

FFP

Treatment is determined per Individualized Patient Care Plan (IPCP) as ordered by the Naval Hospital Beaufort, SC (NHBSC). Services are assigned based on patient need and ellgibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

Beginning American Sign Language shall be made available to include the following as prescribed:

Beginning American Sign Language Provider should have at least a BS degree related to the Human Services field and have a certification in specialized sign language training.

0004 26 Hours American Sign Language Interpreting

FFP

Treatment is determined per Individualized Patient Care Plan (IPCP) as ordered by the Naval Hospital Beaufort, SC (NHBSC). Services are assigned based on patient need and ellgibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

American Sign Language shall be made available to include the following as prescribed:

Contractor to perform service with hearing impaired primary care giver during patient/care giver EDIS to ensure primary care member is fully involved with patient training specialized patient/care provider instruction; or similarly qualifying

Contractor may bill in 2 hour minimum units. Contractor will be reimbursed only for visits and units actually documented and performed.

American Sign Language Provider should have at least a BS degree related to the

Human Services field and have a certificatication in specialized sign language training.

Weekday Rate per Unit (per hour / minimum 2 2 hours): $

Weekend Rate per Unit (per hour / minimum 2 hours): $

Estimated units at 26 for Period of Performance.

0005 52 Each Travel Expenses

FFP

Travel is based on the estimated treatment frequency as determined per

Individualized Patient Care Plan (IPCP) per order by the Naval Hospital Beaufort, SC (NHBSC). Contractor is required to travel to patient normal place of living environment to include but not limited to home, daycare, school, and other therapy facility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance. The

Government cannot state any minimum guarantees of EIS for the Period of

Contractor may a flat rate travel charge per treatment visit. Contractor will be reimbursed only for travel charges actually documented and performed.

Flat Rate for Travel (billed per visit): $

Rate is in accordance to Joint Travel Regulations.

Estimated visits per Period of Performance is 52.

0006 208 Each OPTION Early Intervention Option 1

FFP

Treatment is determined per Individualized Patient Care Plan (IPCP) as ordered by the Naval Hospital Beaufort, SC (NHBSC). Services are assigned based on patient need and ellgibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

0007 208 Each OPTION Orientation and Mobility Option 1

FFP

Treatment is determined per Individualized Patient Care Plan (IPCP) as ordered by the Naval Hospital Beaufort, SC (NHBSC). Services are assigned based on patient need and ellgibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

0008 208 Each OPTION Beginning American Sign Language Opt. 1

FFP

Treatment is determined per Individualized Patient Care Plan (IPCP) as ordered by the Naval Hospital Beaufort, SC (NHBSC). Services are assigned based on patient need and ellgibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

0009 26 Each OPTION American Sign Language Interpreting Op.1

FFP

Treatment is determined per Individualized Patient Care Plan (IPCP) as ordered by the Naval Hospital Beaufort, SC (NHBSC). Services are assigned based on patient need and ellgibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

0010 52 Each OPTION Travel Expenses Option 1

FFP

Travel is based on the estimated treatment frequency as determined per

Individualized Patient Care Plan (IPCP) per order by the Naval Hospital Beaufort, SC (NHBSC). Contractor is required to travel to patient normal place of living environment to include but not limited to home, daycare, school, and other therapy facility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance. The

0011 208 Each OPTION Early Intervention Option 2

FFP

Treatment is determined per Individualized Patient Care Plan (IPCP) as ordered by the Naval Hospital Beaufort, SC (NHBSC). Services are assigned based on patient need and ellgibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

0012 208 Each OPTION Orientation and Mobility Option 2

FFP

Treatment is determined per Individualized Patient Care Plan (IPCP) as ordered by the Naval Hospital Beaufort, SC (NHBSC). Services are assigned based on patient need and ellgibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

0013 208 Each OPTION Beginning American Sign Language Opt. 2

FFP

Treatment is determined per Individualized Patient Care Plan (IPCP) as ordered by the Naval Hospital Beaufort, SC (NHBSC). Services are assigned based on patient need and ellgibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

0014 26 Each OPTION American Sign Language Interpreting Op.2

FFP

Treatment is determined per Individualized Patient Care Plan (IPCP) as ordered by the Naval Hospital Beaufort, SC (NHBSC). Services are assigned based on patient need and ellgibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

0015 52 Each OPTION Travel Expenses Option 2

FFP

Travel is based on the estimated treatment frequency as determined per

Individualized Patient Care Plan (IPCP) per order by the Naval Hospital Beaufort, SC (NHBSC). Contractor is required to travel to patient normal place of living environment to include but not limited to home, daycare, school, and other therapy facility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance. The

0016 208 Each OPTION Early Intervention Option 3

FFP

Treatment is determined per Individualized Patient Care Plan (IPCP) as ordered by the Naval Hospital Beaufort, SC (NHBSC). Services are assigned based on patient need and ellgibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

0017 208 Each OPTION Orientation and Mobility Option 3

FFP

Treatment is determined per Individualized Patient Care Plan (IPCP) as ordered by the Naval Hospital Beaufort, SC (NHBSC). Services are assigned based on patient need and ellgibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

0018 208 Each OPTION Beginning American Sign Language Opt. 3

FFP

Treatment is determined per Individualized Patient Care Plan (IPCP) as ordered by the Naval Hospital Beaufort, SC (NHBSC). Services are assigned based on patient need and ellgibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

0019 26 Each OPTION American Sign Language Interpreting Op.3

FFP

Treatment is determined per Individualized Patient Care Plan (IPCP) as ordered by the Naval Hospital Beaufort, SC (NHBSC). Services are assigned based on patient need and ellgibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

0020 52 Each OPTION Travel Expenses Option 3

FFP

Travel is based on the estimated treatment frequency as determined per

Individualized Patient Care Plan (IPCP) per order by the Naval Hospital Beaufort, SC (NHBSC). Contractor is required to travel to patient normal place of living environment to include but not limited to home, daycare, school, and other therapy facility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance. The

0021 208 Each OPTION Early Intervention Option 4

FFP

Treatment is determined per Individualized Patient Care Plan (IPCP) as ordered by the Naval Hospital Beaufort, SC (NHBSC). Services are assigned based on patient need and ellgibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

0022 208 Each OPTION Orientation and Mobility Option 4

FFP

Treatment is determined per Individualized Patient Care Plan (IPCP) as ordered by the Naval Hospital Beaufort, SC (NHBSC). Services are assigned based on patient need and ellgibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

0023 208 Each OPTION Beginning American Sign Language Opt. 4

FFP

Treatment is determined per Individualized Patient Care Plan (IPCP) as ordered by the Naval Hospital Beaufort, SC (NHBSC). Services are assigned based on patient need and ellgibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

0024 26 Each OPTION American Sign Language Interpreting Op.4

FFP

Treatment is determined per Individualized Patient Care Plan (IPCP) as ordered by the Naval Hospital Beaufort, SC (NHBSC). Services are assigned based on patient need and ellgibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

0025 52 Each OPTION Travel Expenses Option 4

FFP

Travel is based on the estimated treatment frequency as determined per

Individualized Patient Care Plan (IPCP) per order by the Naval Hospital Beaufort, SC (NHBSC). Contractor is required to travel to patient normal place of living environment to include but not limited to home, daycare, school, and other therapy facility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance. The

Section C - Descriptions and Specifications

PERFORMANCE WORK STATEMENT

EDUCATIONAL AND DEVELOPMENTAL INTERVENTION SERVICES

1. OBJECTIVE.

This contract is for non-personal services. It does not create employment rights with the

U.S. Government whether actual, inherent, or implied. By agreeing to perform the services described in these specifications, the contractor acknowledges that he/she is not, and will not become an employee of the U.S.

Government. The Contractor further agrees that he/she will not bring any cause of action in any forum claiming that he/she has become an employee of the U.S. Government.

2. BACKGROUND INFORMATION.

This is a non-personal service contract covering a professional discipline, which provides healthcare services to eligible beneficiaries of the Department of Defense (DoD) direct care system. The system comprises service-owned, staffed and operated hospitals and clinics throughout the world. On behalf of the Naval Hospital Beaufort

South Carolina (NHBSC), the Naval Medical Center Portsmouth, Management Materiel Department, Contracting

Division has been chosen as a strategy to permit expansion of the healthcare capacity of DoD facilities by overcoming shortfalls in the number of uniformed practitioners and support personnel.

3. SCOPE OF WORK.

3.1. The Naval Hospital Beaufort, SC Educational and Developmental Intervention Services (EDIS) Program

Manager (PM) has the need for Early Intervention Services (EIS) to meet the developmental needs of children with a disability, birth through 36 months of age, and the family’s needs related to having a child with a disability.

3.2. Early Educational Services. The Contractor shall supply in accordance with (IAW) an Individual Patient Care

Plan (IPCP) the necessary non-personal services as specified herein to address the NHBSC patient’s physical, cognitive, communication, social, emotional needs, adaptive delays or conditions with a high probability of delay and/or the family member’s needs for various conditions resulting in an identified disability or propensity to develop a disability.

3.3 Service to include, but limited to: family training, counseling, home visits, special education, speech pathology and audiology, occupational therapy, physical therapy, psychology, service coordination, medical services for diagnostic or evaluation purposes, early identification, screening and assessment, orientation and mobility instruction, ophthalmology, and social work.

3.4 Assistive Technology. Technology devices and services, health services necessary to enable an infant or toddler to benefit from the above early intervention services, and transportation and related costs necessary to enable an infant or toddler and the family to receive EIS.

3.5 IPCP. The contractor will act as part of the EDIS team to collaborate with the NHBSC EDIS PM and family to develop an IPCP to measure and achieve specific goals in child progress.

3.6 Treatment/Training Sessions. Contractor should make certain, to the maximum extent possible patient care is provided in natural environments and across daily routines and activities, which are settings that are natural and normal (e.g. home, preschool, or daycare) for children without disabilities.

3.7 Industry Practices. All EIS shall be conducted in a family-centered, comprehensive, multi-disciplinary, and culturally competent, community based and foster collaborative partnerships IAW all State, County, DoD, Navy, and Naval Hospital guidelines and reporting requirements.

3.8 Entitlement of Services. Services are provided based on eligibility to enroll in a Domestic Dependent

Elementary and Secondary School (DDESS) and meeting DoD development delay eligibility criteria as defined in

DODI 1342.12, DoD Inter-Component Operating Procedures (ICOP), BUMED Instructions 1755.1 and 1755.2.

4. SPECIFIC TASKS.

4.1. The Contractor shall provide sensory services to infants, toddlers, and their families deemed eligible by the

NHBSC for EIS through the EDIS PM. Each evaluation must be a standardized reference evaluation tool, with documentation on the tool used. Services will be conducted in the patient’s natural environment and no services will be provided at the NHBSC.

4.2. Provide an environment that maintains a family’s rights to privacy and confidentiality of record, as embodied in TRICARE, separate Uniformed Service and DoD policies and rules, 45 CFR Parts 180, 162, and 164 under

Health Insurance Portability and Accountability Act of 1996, and the Privacy Act of 1974. Additionally, the contractor and assigned health care worker (HCW) shall abide by TRICARE, separate Uniform Services and DoD policies and rules governing the release of information on matters pertaining to, or services delivered under, the agreement to the public, including advance approval before publication of technical papers in professional or scientific journals.

4.3. Assigned HCW(s) as required by the IPCP to each child and family eligible to receive EIS. No deviation shall be made to the type of frequency of services specified in the IPCP without concurrence of the family and approval by the NHBSC.

4.4. Reserve the right to refuse services based on upon any concern for safety and well being of the HCW. Provide written findings of each evaluation to the EDIS PM within 10 business days following the evaluation. Evaluations may be mailed or faxed IAW all privacy act provisions to the EDIC PM.

4.5. The Contractor shall identify new and available teaching and learning resources and make recommendations to the EDIS PM to incorporate new and available resources within the IPCP.

4.6. The Contractor shall be responsible for the management of all travel and logistical support of HCW in order to provide EIS in the patient’s natural environment.

5. CONTRACTOR FURNISHED ITEMS.

5.1. The contractor shall furnish the supplies, services, and personnel necessary to perform the requirements of the contract.

5.2. Insurance. The contractor shall comply with applicable provisions of the Federal Acquisition Regulation

(FAR) 52.237. The contractor shall comply with the Workers Compensation Insurance Laws of the State of South

Carolina.

6. STANDARDS OF CONDUCT.

6.1. Independent Contractor. The services by the contractor are rendered in the capacity of an independent contractor. The Government will evaluate the quality of both professional and administrative services for the purposes of contract inspection and acceptance. The Government retains no direct control over professional assessments and/or recommendations. The contractor shall be solely responsible for any and all liability cause by the acts or omissions of its agents or employees. The contractor shall not in any manner represent or infer that it is an agent of the United States Government. The contractor shall recognize the NHBSC Commanding Officer maintains administrative and operational responsibility for all activities within the command and may take such actions as necessary to preserve and maintain the integrity of the command, subject to the limitations prescribed by law and US Navy regulations.

6.2. The Contractor shall present a neat, well-groomed, professional appearance at all times. Wearing of denim jeans is not permitted, unless otherwise approved by the Contracting Officer’s Representative.

6.3. Alcohol/Drug use in the workplace will not be tolerated. Any contractor found to be under the influence of, consuming, or using alcohol or drugs while on duty will be subject to administrative action from the Contracting

Officer, which may include termination of this contract.

6.4. The Contractor shall remove from the site any individual whose continued employment is deemed by the

Contracting Officer to be contrary to the public interest or inconsistent with the best interests of National

Security.

7. IDENTIFICATION OF CONTRACTOR EMPLOYEES.

7.1. The Contractor shall provide each employee with an identification (ID) badge, easily readable and including employee's name, contractor's name, functional area of assignment. The assigned HCW shall always have in possession a valid state issued identification card.

7.2. Display of ID Badges. Contractor personnel shall wear the ID badge at all times when performing work under this contract. Unless otherwise specified in the contract, each Contractor employee shall wear the ID badge in a conspicuous place on the front of exterior clothing and above the waist except when safety or health reasons prohibit such placement.

8. ADMINISTRATIVE MATTERS.

8.1. Physical Security. The Contractor shall safeguard all patient information property in and outside of the work area.

8.2. The Contractor must possess and present the following credentials and/or comparable qualifications to the

EDIS PM prior to start of services:

(a) Proof of college degree.

(b) Proof of specialized training applicable to EDIS.

(c) Health Exam and Immunization Record.

(d) Criminal History Form

8.3. Substitutes. The Contractor shall advise the COR of anticipated absences, for any reason, as far in advance as possible.

8.4. The Contractor shall provide and compensate a suitable and acceptable substitute for all periods of time that the Contractor is unable to perform the services IAW the normally scheduled IPCP.

8.5. All substitutes must be approved in advance by the EDIS PM and Contracting Officer. The substitute must have comparable credentials to those of the Contractor. Substitutes shall have no claim whatsoever against the

Government for services rendered and compensation shall be considered a business relationship between the

Contractor and the chosen subcontractor. Failure to arrange for a qualified substitute in a timely manner may be considered breach of contract.

8.6. Modifications. The Contracting Officer will designate and authorize an individual to act as the Contracting

Officer’s representative (COR). A letter from the KO will specifically designate any such represented appointed.

The COR exclusively represents the KO in all technical phases of the work, but is NOT authorized to issue Change

Orders, Supplemental Agreements, or direct any contract performance requiring contractual modification or adjustment. Changes in scope of work can only be made by modification properly executed by the KO. All observations made by persons other than the KO or the COR are strictly advisory and shall not influence the contractor’s operation except for administrative requirements and responsibilities specified herein.

9. QUALITY ASSURANCE.

9.1. Quality of Service. The services specified in this performance work statement shall be performed in accordance with established principles and ethics of the medical profession. The quality of healthcare provided will meet or exceed the current recognized standards established by the Joint Commission on Accreditation of Healthcare

Organizations (Joint Commission), the American Hospital Association (AHA), American Medical Association

(AMA), and the complimentary professional associations, which specify standards of performance for the medical profession, EDIS, and EIS. The contractor shall comply with applicable provisions of law and rules and regulations of any and all Government authorities pertaining to licensure and regulation of healthcare personnel and medical treatment facilities, the regulations and standards of the medical practice, and regulations and standards of the treatment location. In all cases, the dignity of the patient will be given the highest regard, and the precepts of the

American Hospital Association’s “Bill of Rights for Patients” shall be observed.

9.2 . The Quality Assurance method of surveillance will be by periodic inspection and customer feedback.

9.3. The Contractor will be provided feedback on performance evaluations and the observations of

Government personnel, as well as patient family evaluations and comments.

9.4. Failure to correct any adverse findings resulting from observations and feedback, or failure to deliver all services described in this contract, may result in non-acceptance of the services by the Government.

9.5. The Quality Assurance performance objectives are as follows:

Performance Objective PWS Paragraph Performance Threshold

Early Educational Services 3.1 - 3.8, 4.2, 4.3 Provide services IAW IPCP to achieve designed goals and results.

Manage HCW transportation and logistical support

3.6, 4.6 Ensure HCW is at the right place, at the right time, ready to provide appropriate level of EIS treatment

IAW IPCP.

Provide general administrative support for patient evaluations

4.1, 4.2, 4.4 Contractor HCW shall complete all evaluations on time and document information sessions, and completed work IAW IPCP and submit reports within set timeline and without error.

Treatment recommendations to include introducing family, patient, and EDIS PM with new and available treatment opportunities, instruction, materials, and resources directly enhancing the patient treatment experience.

3.6, 3.7, 4.5 Provide continuous, family-center, evidence-based treatment in order to deliver the best practices adopted within the industry.

Standards of Conduct 6 The Contractor shall adhere to these standards 100% of the time.

Section E - Inspection and Acceptance

INSPECTION AND ACCEPTANCE TERMS

Supplies/services will be inspected/accepted at:

CLIN INSPECT AT INSPECT BY ACCEPT AT ACCEPT BY

0001 Destination Government Destination Government

0002 Destination Government Destination Government

0003 Destination Government Destination Government

0004 Destination Government Destination Government

0005 Destination Government Destination Government

0006 Destination Government Destination Government

0007 Destination Government Destination Government

0008 Destination Government Destination Government

0009 Destination Government Destination Government

0010 Destination Government Destination Government

0011 Destination Government Destination Government

0012 Destination Government Destination Government

0013 Destination Government Destination Government

0014 Destination Government Destination Government

0015 Destination Government Destination Government

0016 Destination Government Destination Government

0017 Destination Government Destination Government

0018 Destination Government Destination Government

0019 Destination Government Destination Government

0020 Destination Government Destination Government

0021 Destination Government Destination Government

0022 Destination Government Destination Government

0023 Destination Government Destination Government

0024 Destination Government Destination Government

0025 Destination Government Destination Government

Section F - Deliveries or Performance

DELIVERY INFORMATION

CLIN DELIVERY DATE QUANTITY SHIP TO ADDRESS DODAAC

0001 POP 01-DEC-2015 TO

30-NOV-2016

N/A NAVAL HOSPITAL BEAUFORT

RECEIVING OFFICER

1 PINCKNEY BOULEVARD

BEAUFORT SC 29902-6148

843-228-5375

N61337

0002 POP 01-DEC-2015 TO

N/A (SAME AS PREVIOUS LOCATION)

0003 POP 01-DEC-2015 TO

N/A (SAME AS PREVIOUS LOCATION)

0004 POP 01-DEC-2015 TO

N/A (SAME AS PREVIOUS LOCATION)

0005 POP 01-DEC-2015 TO

N/A (SAME AS PREVIOUS LOCATION)

0006 POP 01-DEC-2016 TO

30-NOV-2017

N/A (SAME AS PREVIOUS LOCATION)

0007 POP 01-DEC-2016 TO

N/A (SAME AS PREVIOUS LOCATION)

0008 POP 01-DEC-2016 TO

N/A (SAME AS PREVIOUS LOCATION)

0009 POP 01-DEC-2016 TO

N/A (SAME AS PREVIOUS LOCATION)

0010 POP 01-DEC-2016 TO

N/A (SAME AS PREVIOUS LOCATION)

0011 POP 01-DEC-2017 TO

30-NOV-2018

N/A (SAME AS PREVIOUS LOCATION)

0012 POP 01-DEC-2017 TO

N/A (SAME AS PREVIOUS LOCATION)

0013 POP 01-DEC-2017 TO

N/A (SAME AS PREVIOUS LOCATION)

0014 POP 01-DEC-2017 TO

N/A (SAME AS PREVIOUS LOCATION)

0015 POP 01-DEC-2017 TO

N/A (SAME AS PREVIOUS LOCATION)

0016 POP 01-DEC-2018 TO

30-NOV-2019

N/A (SAME AS PREVIOUS LOCATION)

0017 POP 01-DEC-2018 TO

N/A (SAME AS PREVIOUS LOCATION)

0018 POP 01-DEC-2018 TO

N/A (SAME AS PREVIOUS LOCATION)

0019 POP 01-DEC-2018 TO

N/A (SAME AS PREVIOUS LOCATION)

0020 POP 01-DEC-2018 TO

N/A (SAME AS PREVIOUS LOCATION)

0021 POP 01-DEC-2019 TO

30-NOV-2020

N/A (SAME AS PREVIOUS LOCATION)

0022 POP 01-DEC-2019 TO

N/A (SAME AS PREVIOUS LOCATION)

0023 POP 01-DEC-2019 TO

N/A (SAME AS PREVIOUS LOCATION)

0024 POP 01-DEC-2019 TO

N/A (SAME AS PREVIOUS LOCATION)

0025 POP 01-DEC-2019 TO

N/A (SAME AS PREVIOUS LOCATION)

Section G - Contract Administration Data

252.232-7006 WIDE AREA WORKFLOW PAYMENT INSTRUCTIONS (MAY 2013)

(a) Definitions. As used in this clause--

Department of Defense Activity Address Code (DoDAAC) is a six position code that uniquely identifies a unit, activity, or organization.

Document type means the type of payment request or receiving report available for creation in Wide Area

WorkFlow (WAWF).

Local processing office (LPO) is the office responsible for payment certification when payment certification is done external to the entitlement system.

(b) Electronic invoicing. The WAWF system is the method to electronically process vendor payment requests and receiving reports, as authorized by DFARS 252.232-7003, Electronic Submission of Payment Requests and Receiving Reports.

(c) WAWF access. To access WAWF, the Contractor shall--

(1) Have a designated electronic business point of contact in the System for Award Management at https://www.acquisition.gov; and

(2) Be registered to use WAWF at https://wawf.eb.mil/ following the step-by-step procedures for self-registration available at this Web site.

(d) WAWF training. The Contractor should follow the training instructions of the WAWF Web-Based Training

Course and use the Practice Training Site before submitting payment requests through

WAWF. Both can be accessed by selecting the “Web Based Training” link on the WAWF home page at https://wawf.eb.mil/.

(e) WAWF methods of document submission. Document submissions may be via Web entry, Electronic Data

Interchange, or File Transfer Protocol.

(f) WAWF payment instructions. The Contractor must use the following information when submitting payment requests and receiving reports in WAWF for this contract/order:

(1) Document type. The Contractor shall use the following document type(s).

2 IN 1 SERVICES ONLY

(Contracting Officer: Insert applicable document type(s). Note: If a “Combo” document type is identified but not supportable by the Contractor's business systems, an “Invoice” (stand-alone) and

“Receiving Report” (stand-alone) document type may be used instead.)

(2) Inspection/acceptance location. The Contractor shall select the following inspection/acceptance location(s) in

WAWF, as specified by the contracting officer.

DESTINATION / DESTINATION

(Contracting Officer: Insert inspection and acceptance locations or “Not applicable”.)

(3) Document routing. The Contractor shall use the information in the Routing Data Table below only to fill in applicable fields in WAWF when creating payment requests and receiving reports in the system.

Routing Data Table*

Field Name in WAWF Data to be entered in WAWF

Pay Official DoDAAC HQ0248

Issue By DoDAAC N68908

Admin DoDAAC N68908

Inspect By DoDAAC ____

Ship To Code N61337

Ship From Code ____

Mark For Code ____

Service Approver (DoDAAC) ____

Service Acceptor (DoDAAC) ____

Accept at Other DoDAAC ____

LPO DoDAAC N61337

DCAA Auditor DoDAAC ____

Other DoDAAC(s) ____

(*Contracting Officer: Insert applicable DoDAAC information or “See schedule” if multiple ship to/acceptance locations apply, or “Not applicable.”)

(4) Payment request and supporting documentation. The Contractor shall ensure a payment request includes appropriate contract line item and subline item descriptions of the work performed or supplies delivered, unit price/cost per unit, fee (if applicable), and all relevant back-up documentation, as defined in DFARS Appendix F, (e.g. timesheets) in support of each payment request.

(5) WAWF email notifications. The Contractor shall enter the email address identified below in the “Send

Additional Email Notifications” field of WAWF once a document is submitted in the system.

laurie.a.beck5.mil@mail.mil (Contracting Officer: Insert applicable email addresses or “Not applicable.”)

(g) WAWF point of contact. (1) The Contractor may obtain clarification regarding invoicing in WAWF from the following contracting activity's WAWF point of contact.

usn.detrick.navmedlogcomftdmd.list.nmlc-wawf@mail.mil

(Contracting Officer: Insert applicable information or “Not applicable.”)

(2) For technical WAWF help, contact the WAWF helpdesk at 866-618-5988.

(End of clause) mailto:laurie.a.beck5.mil@mail.mil mailto:usn.detrick.navmedlogcomftdmd.list.nmlc-wawf@mail.mil

Section H - Special Contract Requirements

N00183-0004 PRIVACY AND SECURITY OF PROTECTED HEALTH INFORMATION

1. Introduction

In accordance with DoD 6025.18-R “Department of Defense Health Information Privacy Regulation,” January 24, 2003, the Business Associate meets the definition of Business Associate. Therefore, a Business Associate

Agreement is required to comply with both the Health Insurance Portability and Accountability Act (HIPAA)

Privacy and Security regulations. This clause serves as that agreement whereby the Business Associate agrees to abide by all applicable HIPAA Privacy and Security requirements regarding health information as defined in this clause, and in DoD 6025.18-R and DoD 8580.02-R, as amended. Additional requirements will be addressed when implemented.

a. Definitions. As used in this clause generally refer to the Code of Federal Regulations (CFR) definition unless a more specific provision exists in DoD 6025.18-R or DoD 8580.02-R.

(1) HITECH Act shall mean the Health Information Technology for Economic and Clinical Health Act included in the American Recovery and Reinvestment Act of 2009.

(2) Individual has the same meaning as the term “individual” in 45 CFR 160.103 and shall include a person who qualifies as a personal representative in accordance with 45 CFR 164.502(g).

(3) Privacy Rule means the Standards for Privacy of Individually Identifiable Health Information at 45 CFR part 160 and part 164, subparts A and E.

(4) Protected Health Information has the same meaning as the term “protected health information” in 45 CFR

160.103, limited to the information created or received by the Business Associate from or on behalf of the

Government pursuant to the Contract.

(5) Electronic Protected Health Information has the same meaning as the term “electronic protected health information” in 45 CFR 160.103.

(6) Required by Law has the same meaning as the term “required by law” in 45 CFR 164.103.

(7) Secretary means the Secretary of the Department of Health and Human Services or his/her designee.

(8) Security Incident will have the same meaning as the term “security incident” in 45 CFR 164.304, limited to the information created or received by Business Associate from or on behalf of Covered Entity.

(9) Security Rule means the Health Insurance Reform: Security Standards at 45 CFR part 160, 162 and part

164, subpart C.

(10) Terms used, but not otherwise defined, in this Clause shall have the same meaning as those terms in 45

CFR 160.103, 160.502, 164.103, 164.304, and 164.501.

b. The Business Associate shall not use or further disclose Protected Health Information other than as permitted or required by the Contract or as Required by Law.

c. The Business Associate shall use appropriate safeguards to maintain the privacy of the Protected Health

Information and to prevent use or disclosure of the Protected Health Information other than as provided for by this

Contract.

d. The HIPAA Security administrative, physical, and technical safeguards in 45 CFR 164.308, 164.310, and

164.312, and the requirements for policies and procedures and documentation in 45 CFR 164.316 shall apply to

Business Associate. The additional requirements of Title XIII of the HITECH Act that relate to the security and that are made applicable with respect to covered entities shall also be applicable to Business Associate. The Business

Associate agrees to use administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic protected health information that it creates, receives, maintains, or transmits in the execution of this Contract.

e. The Business Associate shall, at their own expense, take action to mitigate, to the extent practicable, any harmful effect that is known to the Business Associate of a use or disclosure of Protected Health Information by the

Business Associate in violation of the requirements of this Clause. These mitigation actions will include as a minimum those listed in the TMA Breach Notification Standard Operating Procedure (SOP), which is available at:

http://www.tricare.mil/tmaprivacy/breach.cfm

f. The Business Associate shall report to the Government any security incident involving protected health information of which it becomes aware.

g. The Business Associate shall report to the Government any use or disclosure of the Protected Health

Information not provided for by this Contract of which the Business Associate becomes aware.

h. The Business Associate shall ensure that any agent, including a sub Business Associate, to whom it provides

Protected Health Information received from, or created or received by the Business Associate, on behalf of the

Government, agrees to the same restrictions and conditions that apply through this Contract to the Business

Associate with respect to such information.

i. The Business Associate shall ensure that any agent, including a subBusiness Associate, to whom it provides electronic Protected Health Information, agrees to implement reasonable and appropriate safeguards to protect it.

j. The Business Associate shall provide access, at the request of the Government, and in the time and manner reasonably designated by the Government to Protected Health Information in a Designated Record Set, to the

Government or, as directed by the Government, to an Individual in order to meet the requirements under 45 CFR

164.524.

k. The Business Associate shall make any amendment(s) to Protected Health

Information in a Designated Record Set that the Government directs or agrees to pursuant to 45 CFR 164.526 at the request of the Government, and in the time and manner reasonably designated by the Government.

l. The Business Associate shall make internal practices, books, and records relating to the use and disclosure of

Protected Health Information received from, or created or received by the Business Associate, on behalf of the

Government, available to the Government, or at the request of the Government to the Secretary, in a time and manner reasonably designated by the Government or the Secretary, for purposes of the Secretary determining the

Government’s compliance with the Privacy Rule.

m. The Business Associate shall document such disclosures of Protected Health Information and information related to such disclosures as would be required for the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

n. The Business Associate shall provide to the Government or an Individual, in time and manner reasonably designated by the Government, information collected in accordance with this Clause of the Contract, to permit the

Government to respond to a request by an Individual for an accounting of disclosures of Protected Health

Information in accordance with 45 CFR 164.528.

2. General Use and Disclosure Provisions

Except as otherwise limited in this Clause, the Business Associate may use or disclose Protected Health Information on behalf of, or to provide services to, the Government for treatment, payment, or healthcare operations purposes, in accordance with the specific use and disclosure provisions below, if such use or disclosure of Protected Health

Information would not violate the HIPAA Privacy Rule, the HIPAA Security Rule, DoD 6025.18-R or DoD

8580.02-R if done by the Government. The additional requirements of Title XIII of the HITECH Act that relate to privacy and that are made applicable with respect to covered entities shall also be applicable to Business Associate.

3. Specific Use and Disclosure Provisions

a. Except as otherwise limited in this Clause, the Business Associate may use Protected Health Information for the proper management and administration of the Business Associate or to carry out the legal responsibilities of the

Business Associate.

b. Except as otherwise limited in this Clause, the Business Associate may disclose Protected Health Information for the proper management and administration of the Business Associate, provided that disclosures are required by law, or the Business Associate obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and used or further disclosed only as required by law or for the purpose for which it was disclosed to the person, and the person notifies the Business Associate of any instances of which it is aware in which the confidentiality of the information has been breached.

c. Except as otherwise limited in this Clause, the Business Associate may use Protected Health Information to provide Data Aggregation services to the Government as permitted by 45 CFR 164.504(e)(2)(i)(B).

d. Business Associate may use Protected Health Information to report violations of law to appropriate Federal and State authorities, consistent with 45 CFR 164.502(j)(1).

4. Obligations of the Government

Provisions for the Government to Inform the Business Associate of Privacy Practices and Restrictions

a. The Government shall provide the Business Associate with the notice of privacy practices that the Government produces in accordance with 45 CFR 164.520.

b. The Government shall provide the Business Associate with any changes in, or revocation of, permission by

Individual to use or disclose Protected Health

Information, if such changes affect the Business Associate’s permitted or required uses and disclosures.

c. The Government shall notify the Business Associate of any restriction to the use or disclosure of Protected

Health Information that the Government has agreed to in accordance with 45 CFR 164.522.

5. Permissible Requests by the Government

The Government shall not request the Business Associate to use or disclose

Protected Health Information in any manner that would not be permissible under the HIPAA Privacy Rule, the

HIPAA Security Rule, or any applicable Government regulations (including without limitation, DoD 6025.18-R and

DoD 8580.02-R) if done by the Government, except for providing Data Aggregation services to the Government and for management and administrative activities of the Business Associate as otherwise permitted by this clause.

6. Termination

a. Termination. A breach by the Business Associate of this clause, may subject the Business Associate to termination under any applicable default or termination provision of this Contract.

b. Effect of Termination.

(1) If this contract has records management requirements, the records subject to the Clause should be handled in accordance with the records management requirements. If this contract does not have records management requirements, the records should be handled in accordance with paragraphs (2) and (3) below

(2) If this contract does not have records management requirements, except as provided in paragraph (3) of this section, upon termination of this Contract, for any reason, the Business Associate shall return or destroy all

Protected Health Information received from the Government, or created or received by the Business Associate on behalf of the Government. This provision shall apply to Protected Health Information that agents of the Business

Associate may come in contact. The Business Associate shall retain no copies of the Protected Health Information.

(3) If this contract does not have records management provisions and the Business Associate determines that returning or destroying the Protected Health Information is infeasible, the Business Associate shall provide to the

Government notification of the conditions that make return or destruction infeasible. Upon mutual agreement of the

Government and the Business Associate that return or destruction of Protected Health Information is infeasible, the

Business Associate shall extend the protections of this Contract to such Protected Health Information and limit further uses and disclosures of such Protected Health Information to those purposes that make the return or destruction infeasible, for so long as the Business Associate maintains such Protected Health Information.

7. Miscellaneous

a. Regulatory References. A reference in this Clause to a section in DoD 6025.18-R, DoD 8580.02-R, Privacy

Rule or Security Rule means the section currently in effect or as amended, and for which compliance is required.

b. Survival. The respective rights and obligations of Business Associate under the “Effect of Termination” provision of this Clause shall survive the termination of this Contract.

c. Interpretation. Any ambiguity in this Clause shall be resolved in favor of a meaning that permits the

Government to comply with DoD 6025.18-R, DoD 8580.02-R, the HIPAA Privacy Rule or the HIPAA Security

Rule.

INFORMATION ONLY: This document has been designated for posting to the Navy Electronic Commerce Online

(NECO) at http://www.neco.navy.mil

Section I - Contract Clauses

CLAUSES INCORPORATED BY REFERENCE

52.203-3 Gratuities APR 1984

52.204-7 System for Award Management JUL 2013

52.204-13 System for Award Management Maintenance JUL 2013

52.219-6 Notice Of Total Small Business Set-Aside NOV 2011

52.222-50 Combating Trafficking in Persons MAR 2015

52.232-1 Payments APR 1984

52.232-8 Discounts For Prompt Payment FEB 2002

52.232-23 Alt I Assignment of Claims (May 2014) - Alternate I APR 1984

52.232-39 Unenforceability of Unauthorized Obligations JUN 2013

52.233-3 Protest After Award AUG 1996

52.237-2 Protection Of Government Buildings, Equipment, And

Vegetation

APR 1984

52.237-3 Continuity Of Services JAN 1991

252.203-7002 Requirement to Inform Employees of Whistleblower Rights SEP 2013

252.203-7002 Requirement to Inform Employees of Whistleblower Rights SEP 2013

252.204-7003 Control Of Government Personnel Work Product APR 1992

252.225-7002 Qualifying Country Sources As Subcontractors DEC 2012

252.232-7003 Electronic Submission of Payment Requests and Receiving

Reports

JUN 2012

252.239-7001 Information Assurance Contractor Training and Certification JAN 2008

252…