After_Hours_Access_To_Care_SOW.DOC

SOW WITH ATTACHMENTS

AFTER HOURS ACCESS TO CARE

STATEMENT OF WORK

INTRODUCTION

The contractor is a firm that provides telephone answering services for the Naval Health Clinic Annapolis.

During the term of this contract, the contractor agrees to provide, on behalf of the Government, telephone answering services for eligible patients enrolled to Naval Health Clinic Annapolis.

DEFINITIONS

Commander: The use of “Commander” throughout this section means: Commander, Naval Health Clinic, Annapolis MD or designated representative (e.g., Technical Liaison of Department Head).

Sponsor: A uniformed services member – whether active duty, retired or deceased – whose relationship to the patient makes them eligible for TRICARE benefits. The sponsor’s Social Security number (with a two- number prefix added) is used to identify the sponsor and all their Family Members.

Active Duty (AD) - The person that actually works for the Military. He/she typically is the person that wears the Uniform.

Midshipman: AD servicemember enrolled at the United States Naval Academy (USNA).

Non-Active Duty (NAD): Most generally refers to retired military - and this does NOT refer to age. For example, if someone joins the Navy at 18 years of age & retires from the service at 38 years of age, he/she is a retired military or Non Active Duty.

Family Member (FM) and Family Member Prefix: The sponsor’s dependents. The Sponsor and Family Member’s identification number is the sponsor's social security number, plus a "Family Member Prefix" which indicates who they are in the family. This number comes before the social security number. (20/Active Duty; 30/spouse; 01/eldest child; 02/next child, etc.) For example: Joe Doe is AD = Active Duty, social security number: 123-45-6789; Joe Doe's Wife is a Family Member, her ID: 30/123-45-6789; Tommy Doe is Joe's first born son, his ID: 01/123-45-6789

Non-Active Duty Family Members (NADFM): Family members of Non Active Duty. Another similar term for Non Active Duty Family Member is Non Active Duty Dependent (NADD). In its most general terms (where it is used for certain data analysis), NAD & NADD can refer to everyone who is not an Active Duty (AD) nor Active Duty Dependent (ADD) - including over 65, etc.

Primary Care Manager (PCM): A military or civilian provider or medical clinic. A PCM provides health care and coordinates specialty medical needs. If a Military Treatment Facility (MTF) is the PCM, the MTF assigns an individual provider in the facility.

Provider: Healthcare Specialist (Doctor, Nurse Practitioner, Physician Assistant, etc.) that cares for the Patient and coordinates any specialty services or needs. At Naval Health Clinic Annapolis, there are Uniformed Providers = Active Duty Providers, and Civilian Providers = not in uniform but work with the Military.

TRICARE: is the Department of Defense health care program for members of the uniformed services and their families and survivors, and retired members and their families. TRICARE brings together the health care resources at Military Treatment Facilities (MTFs) and supplements them with networks of civilian health care professionals to provide quality care and better access to our beneficiaries. For eligible beneficiaries, the TRICARE program offers a triple-option health care plan:

· TRICARE Prime. A TRICARE choice where Military Treatment Facilities (MTFs) are the principal source of health care. TRICARE Prime is the managed care option offered by the Department of Defense. It integrates military and civilian health care into a single health care system. Beneficiaries who choose this option agree to a one-year enrollment, and select a Primary Care Manager (PCM) to provide or arrange for their health care needs. The TRICARE Prime option offers additional wellness and preventive care services.

· TRICARE Standard. A fee-for-service option that is the same as the former CHAMPUS benefit. Beneficiaries using this option have the greatest choice of civilian providers, but at a higher cost. The beneficiary is responsible for a deductible plus co-payments. Enrollment is not required to participate.

DUTY HOURS

The contractor shall provide services commencing on the date specified in this contract. Specific clinic hour coverage is defined in Attachment A. The contractor shall provide answering services during the hours of 1800-0630 Monday through Friday, and all day Saturday, Sunday, Holidays and occasionally depending on the US Naval Academy schedule of evolutions. The contractor shall be compensated for all actual calls handled during the specified coverage, including calls handled during regular clinic hours of operation.

DUTIES

The contractor shall provide an answering service in an off-site location, using contractor-provided, fully-trained staff (answering operators are to be intelligible and English-speaking), facilities, equipment, information technology support, and supplies. The contractor shall provide services to the Naval Health Clinic Annapolis.

The contractor shall receive incoming calls from beneficiaries and shall record the following:

Midshipman’s Information : First & Last Name

Social Security Number

Date of birth

Midshipman’s Phone Number Reason for Call.

The contractor shall then contact the appropriate provider following the instructions listed in Attachment A. The Government will review Attachment A monthly and update same as required to ensure all contact information is correct. NOTE: As required, the contractor shall accommodate unexpected provider and pager number changes without impact to the manner the answering service is conducted.

Note: Under this contract, Naval Health Clinic Annapolis will certify and pay only for the actual number of beneficiary calls placed with the contractor.

REPORTING AND REPORTS

For reporting purposes and technical cognizance –

Government Point of Contact:

Telephone No. xxx-xxx-xxxx

Fax No. xxx-xxx-xxxx

E-mail Address: xxx.xxx@med.navy.mil

OTHER REQUIREMENTS

If the contractor is not located in the local Annapolis, MD area, the contractor must have a toll-free phone line for the use of Naval Health Clinic Annapolis staff members who may need to contact the contractor.

The contractor must have the personnel, organization, and administrative control necessary to ensure that the services performed under this contract are satisfactory and fully satisfy the Government’s requirements. The contractor must also have the requisite information technology capability to accommodate script changes, deploy new scripts, and a backup plan in the event of a system malfunction or during scheduled and unscheduled system maintenance.

The contractor shall ensure services performed under this contract are fully compliant under the Health Insurance Portability and Accountability Act (HIPAA). The contractor shall protect patient privacy and security in the use and disclosure of protected health information.

Contractor personnel assigned to this contract shall meet the experience, training, and answering service background requirements necessary in support of a medical treatment facility. Services shall be performed in an efficient, reliable, courteous, and professional manner. The contractor shall make every effort necessary to resolve staffing replacement, substitution, and other issues if the Government questions the qualifications or competence of any contractor personnel.

The services rendered by the Contractor are rendered in a non-personal service contract capacity. The Government may evaluate the quality of administrative services rendered for purposes of contract inspection and acceptance. The Government retains no direct control over contractor personnel assigned to this contract and the services they perform. The Contractor shall be solely responsible for any and all liability caused by the acts or omissions of its agents or employees. The contractor shall not in any manner represent or infer that it is an instrumentality or agent of the United States Government. The Contractor shall recognize that the Commander, Naval Health Clinic Annapolis, 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 U.S. Navy Regulations.

Qualifications:

The contractor’s past performance information must reflect relevant experience in support of a medical treatment facility in the last three years.

The contractor’s call management plan must include a brief description of the knowledge, training, and experience of the call/program manager and the call handlers that will be assigned to the performance of this contract.

Personnel assigned by the contractor to the performance of this contract shall, at a minimum

· read, write, speak and understand the English language;

· be familiar with medical terminology; and

· be fully trained and competent to handle all call situations.

- End of Statement of Work -