Section C

PERFORMANCE WORK STATEMENT

Table of Contents

Section C – Performance Work Statement 2026

SECTION C - DESCRIPTION/SPECIFICATIONS/WORK STATEMENT

ARTICLE C.1 Performance Work Statement

The Contractor shall independently and not as an agent of the Government, be required to furnish all necessary services, qualified personnel, management, supervision, material, equipment and facilities, not otherwise provided by the Government, as needed to perform a comprehensive occupational medical program for the NIH.

The applicable Privacy Act System of Records Number will be specified and shall be used in any design, development, or operation work to be performed under the resultant contract. Disposition of records shall be in accordance with Section C of the contract, and by direction of the Contracting Officer's Representative (COR).

ARTICLE C.2 Background

C.2.1 Introduction

The Division of Occupational Medical Services (DOMS) is a division within the Scientific Resources (SR) cluster of the Office of Research Services (ORS). It consists of the Occupational Medical Service (OMS) and the Employee Assistance Program (EAP). It is a well-developed and highly respected NIH support service that has been recognized by outside reviewers as a role model for the provision of work-related medical care. DOMS’s mission is to enhance health and safety at the NIH by providing a variety of work-related medical and counseling services in partnership with internal and external stakeholders in workplace health and safety such as the Division of Safety (DS), the NIH Clinical Center Hospital Epidemiology Service (HES), the NIH Health and Wellness Council, and leadership across all levels of organization. DOMS provides limited support services to non-NIH employees (see C.5.1).

The Contractor’s staff are required to become fully familiar with the elements of the program (see C.10.2.2) and cross-trained in sufficient numbers to perform the related duties at appropriate staffing levels, with minimal government oversight. The services offered by DOMS have been tailored to address the varied work-related healthcare needs of the NIH workforce, from general medical support to more unusual programs that address specific program requirements.

The Contractor shall attract and retain workers who are detail-oriented, function as a well-trained team, and are committed to providing outstanding clinical care with compassion and respect. The long-term retention of competent staff is critical to the reliable provision of high-quality, customized medical support for the NIH community.

C.2.2 Organization

The NIH is the nation’s primary federal agency for conducting and supporting medical research. NIH scientists conduct a range of basic and clinical biomedical research activities in pursuit of fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to extend healthy life and reduce the burdens of illness and disability. 27 semi-autonomous Institutes and Centers (ICs) of varying size comprise the NIH whose workforce is located across five campuses and embedded with collaborating federal and academic entities. The 350-acre Bethesda campus is an enclosed, essentially self-contained community with its own hospital, police and fire departments, public works, and utility systems. Other NIH facilities include those located in Maryland, North Carolina, Montana and Arizona, and temporary domestic and international duty stations. As a community, the NIH encounters environmental, sociological, and occupational health matters like those found in small towns and on the campuses of major universities, in addition to health hazards associated with human and animal healthcare, work-travel and field research.

Together with the ORS Division of Safety (DS), DOMS provides leadership in the development and implementation of occupational health and safety policies, standards, and procedures designed to create, promote, and support a safe and healthful research environment. DOMS staff work cooperatively with DS safety operations, biorisk management, and radiation safety branches, among others, to investigate and resolve a wide range of occupational safety and health issues; the two divisions share in systematic risk management using joint data acquisition and analysis in support of the NIH research enterprise.

The DOMS clinics are staffed primarily by the contractor. A small federal team, based in Bethesda, consists of the Medical Director, Deputy Medical Director, Staff Physician, a Management Analyst who serves as the COR on the contract, three (3) Nurse Practitioners, one of whom serves as the Technical Representative for this contract, and two (2) EAP counselors, one of whom serves as the EAP manager providing technical direction to the contract EAP consultants. The contractor will be expected to work closely with the federal team to provide seamless coverage in all clinic sites.

C.2.3 Population

The DOMS provides occupational medical services primarily for more than 18,000 NIH employees who work on campus or visit the NIH. Approximately half of the NIH workforce is located on the main NIH campus in Bethesda, MD. Over 8,400 employees are stationed in rental buildings in the same county (Montgomery County), at campuses in Maryland, Montana, and North Carolina, and at field stations throughout the country and abroad (source: NIH Census Data, May 2025). Large NIH satellite facilities in Maryland are located on the Bayview Campus in Baltimore, MD, within Ft. Detrick in Frederick, MD, and the NIH Animal Care Center in Poolesville, MD. The two large campuses remote from the greater DC metropolitan area are the Rocky Mountain Laboratories (RML) in Hamilton, MT, and the National Institute of Environmental Health and Sciences (NIEHS) facilities in Research Triangle Park (RTP), NC. In addition, NIH employees may be affiliated with NIH partner institutions in the United States such as National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) staff with the Indian Health Service in Phoenix, Arizona or assigned to temporary tours abroad.

The NIH population is comprised of professional, scientific, administrative, technical, clerical, and blue-collar personnel. The workforce in each work location is comprised of federal employees, trainees (fellows), and contract workers who are also eligible to receive certain services, including for work-related injuries or hazard exposures.

The occupational categories represented at the NIH include:

· Researchers – microbiologists, chemists, health science administrators, specialized research technicians;

· Healthcare providers – medical doctors, advanced practice providers, nurses, medical technicians, laboratory technicians;

· Research support workers – animal caretakers, laundry workers;

· Professional and administrative staff – executive, administrative, and budget officers; information technology specialists, clerical staff, supply clerks;

· Technical and trades workers – utility engineers, plant operators, plumbers, carpenters, electricians, HVAC technicians; and

· Emergency and Security staff – police, fire, and emergency rescue personnel.

C.2.4 NIH Satellite Campuses and Facilities Supported by DOMS

C.2.4.1 Baltimore, Maryland

The National Institute on Drug Abuse (NIDA), the National Institute on Aging (NIA), and the National Human Genome Research Institute are located in Baltimore at and near the Johns Hopkins Bayview Campus. There are approximately 1,000 NIH employees at this location including summer students, guest researchers, and facility personnel.

C.2.4.2 Frederick, Maryland

The National Institute of Allergy and Infectious Diseases (NIAID) occupies a portion of the Integrated Research Facility (IRF) at Fort Detrick, a partner of the National Interagency Biodefense Campus (NIBC). Currently, there are approximately 130 workers at theIRF-Frederick who conduct and support research, including animal-based studies, in biosafety level (BSL)-2 and BSL-4 laboratories. A medical imaging suite is integral to the high biocontainment space. The building also houses administrative offices and support spaces. About half of the local workforce have access to highly restricted maximum biocontainment spaces and infrastructure.

C.2.4.3 Hamilton, Montana

The RML campus houses a range of NIAID laboratories where currently about 390 workers conduct and support non-clinical biomedical research, including animal-based and disease vector studies. Among about 30 buildings is another restricted-access biocontainment facility, the RML IRF, with BSL-4 laboratories, associated animal quarters, administrative and support spaces. The laboratory environment outside of the RML IRF includes BSL-1 to BSL-3 spaces and support structures. Slightly less than half of the workforce has access to BSL-3 or -4 biocontainment environment.

C.2.4.4 Research Triangle Park, North Carolina

The National Institute of Environmental Health Sciences (NIEHS) employs slightly more than 1,200 workers at the Research Triangle Park (RTP) campus with about 680 being federal employees, 170 fellows, and over 300 contract workers. They conduct bench, animal-, and human-based research.

C.2.4.5 Phoenix, Arizona

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) employs approximately 100 personnel at three leased facilities at the IHS campus. The locations conduct human-based epidemiological research.

C.2.4.6 Special Facilities

Laboratory Animal Facilities. Laboratory animal-based studies are an integral part of the NIH research portfolio across many ICs supported by the centralized program of the Division of Veterinary Resources (DVR). Laboratory animal facilities are found at all NIH campuses and many field stations. The NIH community expects strict adherence to the principles of animal care and use and maintaining full accreditation of all NIH animal-based research by the Association of Assessment and Accreditation of Laboratory Animal Care International (AAALAC). A critical role of OMS is to support NIH activities accredited by AAALAC. The support of AAALAC requires adherence to the Guide for the Care and Use of Animals, 8th edition, and Occupational Health and Safety in the Care and Use of Research Animals (National Research Council, 1997).

High/Maximum Biocontainment Laboratories. Permission to conduct research on biological hazards and toxins categorized into certain high-risk groups hinges on meeting safety and security requirements set forth by the NIH. Specific facility and procedural requirements for BSL-1 to BSL-4 laboratories and animal/insect biological safety level (A/IBSL) 1 through A/IBSL-4 research support facilities are outlined in the Biosafety in Microbiological and Biomedical Laboratories (BMBL) 6th edition. NIH workers with access to A/I/BSL-3 and -4 environment must be enrolled in the NIH Biological Surety Program (BSP, see C.5.3.3). The biological hazards contained in the BSL-4 laboratories are all select agents, and employees who have access to them must also be enrolled in the NIH Select Agent Program. NIH work with select agents requires full compliance with the Federal Select Agent Program as set forth by the Centers for Disease Control and Prevention/Division of Regulatory Science and Compliance and the Animal and Plant Health Inspection Service/Division of Agricultural Select Agents and Toxins.

Clinical/Patient Care Facilities. The NIH’s research includes extensive research with human subjects. NIH activities involve patient and healthy volunteer activities in many locations, the largest being the NIH Clinical Center (CC) on the main NIH campus. This work is subject to strict regulatory requirements, including all applicable OSHA standards, and OMS provides critical support, including during accreditation of the CC by The Joint Commission (TJC).

ARTICLE C.3 DOMS Offices and Hours of Operation

The OMS clinics and EAP Office operate Monday through Friday and are closed on weekends and federal holidays. See C.8 for staffing levels for the clinics and EAP office.

Clinical services by OMS and EAP may be provided onsite or by telehealth based on client preference, clinical indications, and operational feasibility. The use of remote work by contract staff is subject to approval by the OMS Medical Director and shall take into consideration NIH onsite and remote work practices to support effective and efficient service delivery. The Contractor shall leverage telehealth appointments to meet operational needs (e.g., in the case of a campus closure), balance appointment load across clinic sites, optimize provider capacity, and promote equitable access to services. The Contractor will use a telehealth platform approved by the COR and the OMS Medical Director to provide telehealth services.

C.3.1 Main Clinic

The Contractor shall operate OMS Main Clinic on the Bethesda campus. Its hours of operation are Monday to Friday 7:30am to 5:00pm.

C.3.2 Satellite Clinics Locations

C.3.2.1 Baltimore, Maryland

The clinic is in the Gerontology Research Center. Its hours are Monday through Friday 8:00am to 4:30pm.

C.3.2.2 Frederick, Maryland

The clinic is located on the Ft. Detrick campus. Its hours are Monday through Friday 8:00am to 4:30pm.

C.3.2.3 Hamilton, Montana

The clinic is located on the Rocky Mountain Laboratory campus. Its hours are Monday through Friday 8:00am to 4:30pm Mountain Standard Time.

C.3.2.4 Research Triangle Park, North Carolina

The clinic is located on the NIEHS campus. Its hours are Monday through Friday 8:00am to 4:30pm.

C.3.3 EAP Office

The EAP Office is located on the Bethesda campus. Its hours are 8:00am to 4:30pm Monday to Friday. Afterhours (Mountain Time Zone) appointments may be available as determined by the OMS Medical Director or federal EAP Manager and approved by the COR on a case-by-case basis.

C.3.4 Intermittent OMS Locations

The Contractor is required to offer the OMS annual mass influenza immunization program and EAP services in off-campus facilities, upon request by the Technical Representative (TR), in consultation with the COR (see C.5.2.3 and C.5.6).

The Contractor shall not alter the services or hours of operation of OMS clinics or the EAP Office, when providing services at intermittent OMS locations.

ARTICLE C.4 OMS Staffing

C.4.1 Staffing during Routine Office Hours

The Contractor is required to staff DOMS offices during the hours of operation (see C.3).

The Contractor is required to ensure that its patients and EAP clients receive routine, urgent and emergency care in a timely fashion (see C.5.2, C.5.2.1, C.5.2,3, C,5.3.3, C.5.4, C.5.4.1, C.5.4.2, 5.6.2, and 5.6.6).

C.4.2 Staffing after Routine Office Hours

The Contractor is required to schedule and provide on-call support (see C.5.4.2), after routine clinic hours, shared by contract and federal OMS medical providers (nurse practitioners or physicians). The on-call OMS providers, in association with the federal or contract physicians, provide medical advice for occupational exposures to potentially life-threatening biological hazards and serious work-related injuries and illnesses (see C.5.3.3 and C.5.4.2).

C.4.3 Government Adjustments to Staffing

When the government reduces services during furloughs, and OMS including EAP may perform exclusively work deemed excepted, the Contractor is required to staff at a minimum:

· The Main Clinic with a registered nurse (RN), a medical records clerk or specialist, and advanced practice provider (if needed, the contractor may coordinate with the federal providers to ensure coverage);

· The Frederick, Baltimore, and Hamilton clinics with an OMS clinician; and

· The EAP office with one consultant.

In addition, the contractor should be positioned to provide back-up support at NIEHS if requested by the COR. Additional staff may be required and will be communicated by the Medical Director or the COR.

When federal staff are dismissed early for holidays, contractor early dismissal will be at the discretion of the COR or Medical Director. Should OMS have early closure, the Contractor shall:

· Not cancel or reschedule any scheduled appointments

· Attend to all patients being seen in OMS and EAP

· Communicate to NIH staff of early closure of OMS and EAP (e.g. notifying operator, staff, automatic out of office reply, forwarding phone, placing sign outside of the office)

· Plan for on-call providers to receive calls for injuries/exposures

· Not bill for hours not worked

Upon request of the COR or Technical Representative, the Contractor shall adjust the hours of operation at any or all OMS facilities or the hours of any labor category on this contract.

C.4.4 Contractor Requests to Adjust Staffing

The Contractor shall request staffing adjustments when the Contractor anticipates reductions in demands for services (e.g., holiday periods) or increases in demand (e.g., processing summer hires, influenza immunization program, etc.,). The COR must approve in advance any adjustment in staffing or hours of operation for the main or satellite clinics proposed by the Contractor. The intent of this provision is to minimize over- or under-staffing when the Contractor recognizes the potential for the workload to be other than the norm.

The Contractor shall avoid approving leave and/or events that reduces onsite staffing to fewer than two contract consultants, inclusive of the EAP lead, on duty and must consult with the federal EAP lead when this is not possible.

C.4.4.1 Contractor Request Adjustments/Closure of Facility Due to Staff Call Out

The contractor shall notify the TR of adjustments to the schedule when there is a call out. If there is a call out that requires closure of a satellite clinic, the contractor shall communicate to the Medical Director of OMS, COR, and TR for approval prior to closure of the satellite clinic and within 30 minutes of being informed of the callout. If closure of the satellite clinic is approved, the contractor will notify the management team at the satellite clinic of the closure.

C.4.5 Delay Opening, Early Closure, or Closure Due to Inclement Weather

OMS Bethesda clinic will generally follow guidance from OMS Medical Director and/or Office of Personnel Management (OPM) on inclement weather for closure, delayed openings, and early closures. Non-worked hours shall not be billed. In the case of delayed opening, early dismissal, or closure at NIH satellite campuses, contractors will generally follow operational status of their home campus.

Contractors are expected to remain telework-ready in the case of unexpected government closures (e.g., maintain VPN capabilities, maintain government-issued equipment).

When there is a delayed opening by OPM or satellite campus leadership in the affected area, OMS clinic may open at the time indicated by OPM (or satellite campus leadership) or sooner if contract staff can arrive safely prior to delayed opening time. Contract personnel who are scheduled to telework on delayed opening days, will telework their scheduled shift.

When there is early closure by OPM or satellite campus leadership in the affected area, adjustments to clinic operations will be determined by the COR or OMS Medical Director with consideration of staff safety. In case of early inclement weather closure, contract staff who are teleworking will remain teleworking through entire shift. Contract staff working on campus have the option of teleworking the remainder of the day.

When OPM or satellite campus leadership advises closure for an entire workday, affected OMS clinic(s) may open at the discretion of the COR or OMS Medical Director. Contract staff who have already been scheduled to telework will telework. In preparation for anticipated closure due to inclement weather, PM and DPM will determine and provide OMS Medical Director, COR, and TR a list of staff who plan to work on campus. Contract staff who are unable to come to work on campus will telework. Scheduled in-person OMS appointments may be seen as telehealth appointments, if applicable, and scheduled telehealth appointments will be seen as scheduled. Scheduled in-person appointments that cannot be seen by telehealth appointment will be rescheduled.

ARTICLE C.5 Clinical Care Elements

Each year, approximately 18,400 outpatient visits for medical care, excluding flu clinic visits, occur at the various OMS clinics. The OMS Procedure Manual (see C.6.1) contains over 100 standard operating procedures that describe in detail the services OMS provides for the NIH community. This section provides an overview of some of those services.

The Contractor’s staff are required to protect worker’s personally identifying information (PII) and personal health information (PHI) in the records they maintain and in their communications with others (see C.6.8).

The Contractor’s staff shall treat all records, both hard copy and electronic, as medically confidential, and shall maintain the necessary security for the records (see C.6.8).

The Contractor’s staff shall provide care that conforms with the description of the service in the relevant OMS procedure (see C.6.1 and C.10.2.2).

The Contractor shall conduct email surveys of patients evaluated in OMS clinics throughout the year. The surveys shall assess the timeliness and effectiveness of the service provided, as well as whether patients were treated with respect by the Contractor’s staff.

The contractor shall survey all EAP clients to assess their satisfaction and the extent of their stress at work during the intake assessment and three months after last contact.

The Contractor shall include a summary of the survey results for both OMS patients and EAP clients in each quarterly report (see C.10.4.3), maintain surveys for at least up to one month after the end of the quarter in which they were received, and make them available to the TR and COR upon request for performance monitoring purposes.

The Contractor shall develop and maintain a referral list of community-based healthcare providers and ambulatory clinics for each OMS clinic location that can be offered to interested workers. The referral list shall include community practices that accept payment through the Federal Workers’ Compensation Program. The community healthcare resources suggested by Contractor’s staff shall be matched to the employee’s circumstances, location, and insurance coverage. Neither the Contractor nor its staff shall have any personal or financial affiliation with community-based resources shared with OMS visitors. The Contractor shall update the list for each OMS clinic location at least every year (see C.10.6.4).

C.5.1 Care for Non-Federal Employees

The Contractor is restricted from extending OMS coverage to non-federal employees. However, there are several exceptions to this general rule:

1. OMS provides medical support for anyone who develops a medical emergency while on NIH grounds.

2. All work-related injuries that occur in NIH-operated buildings must be reported to the OMS, unless otherwise specified in a contract agreement. OMS staff members record the circumstances of the injury for all occupational injuries and illnesses reported by contractors. If the injury is reported within 24 hours of its occurrence, OMS also provides initial care for the injury.

3. OMS staff provide initial and follow-up medical support for injuries that involve a potential exposure to a hazard that could not readily be treated in the community or is of special interest to the NIH. Examples of these hazards include: the human immunodeficiency virus (HIV-1), Macacine herpesvirus 1 (B virus), biological hazards studied in BSL/ABSL-3 and -4 laboratories, and some radioisotopes.

4. OMS staff provide all relevant medical and EAP services to non-federal employees enrolled in the BSP (see C.5.3.3).

5. OMS may offer the annual influenza vaccine to non-federal employees at NIH facilities.

6. OMS staff will provide all NIDDK contractors full OMS services.

7. EAP support should be offered to all employees who experience a traumatic workplace event, using community-based referrals for longer-term needs.

C.5.2 Non-Urgent Medical Care Provided by Appointment

The Contractor shall assure that the median wait time for an appointment for routine medical care (for example preplacement medical evaluations, immunizations, surveillance and cohort evaluations, etc.,) shall not exceed ten minutes from the individual’s arrival in an OMS clinic.

C.5.2.1 Preplacement Medical Evaluations

The purpose of a preplacement medical evaluation is to determine an individual’s medical readiness to perform designated work. OMS staff perform approximately 940 initial preplacement medical evaluations for full-time employees and another 500 for summer hires each year. With required follow-up appointments such as immunization or testing, these evaluations require approximately 2,000 visits to OMS annually. Typically, summer hires visit OMS in April, May, and June and add significantly to work demands during those months.

The Contractor shall offer a preplacement medical evaluation within five workdays of the request and within two workdays for an urgent request such as a specialist who needs to see patients and unable to wait 5 workdays for an appointment or someone who will be at NIH for a short period needing to start right away. Comment by Chan, Judy (NIH/OD/ORS) [E]: Should we have EH provide data on this? Comment by Bell, Courtney (NIH/OD/ORS) [E]: They are providing information on next available preplacement exam currently, in their weekly report.

The Contractor’s personnel are required to have a detailed appreciation of services provided by OMS and who is eligible to receive them, in order to tailor the preplacement medical evaluation to the worker’s individual needs.

The Contractor’s staff are required to counsel and enroll employees in relevant cohort procedures for employees, based on their work responsibilities and potential health hazards in their workplaces.

C.5.2.2 Immunizations

OMS clinics provide approximately 540 immunizations, excluding flu vaccine, each year. The immunizations currently provided include: hepatitis A and B viruses; human papilloma virus; influenza viruses; Japanese encephalitis virus; measles, mumps, and rubella viruses; meningococcus; polio viruses; rabies virus; tetanus, diphtheria, pertussis; typhoid; vaccinia virus; varicella-zoster virus; pneumococcal; yellow fever virus; and Ebola virus. Special vaccination programs (e.g., U.S.-licensed vaccines against mpox, tickborne encephalitis) are administered according to OMS procedures.

The Contractor shall provide these immunizations and potentially others.

The Contractor shall recall workers for booster doses and identify workers who fail to comply with recommendations to receive a vaccine for work with a biological hazard (e.g., rabies, vaccinia vaccines) and nonhuman primates.

C.5.2.3 Influenza Immunization Program

The annual Influenza Immunization Program accounts for more patient contacts (historically between 8,000 and 15,000) than any other OMS offering and is completed in approximately six weeks. The vaccine is provided on the main campus in Bethesda and may be offered at other off-campus locations in Montgomery County, MD as well as at each of the satellite clinics and Harbor Hospital in Baltimore, MD.

The Contractor shall provide this service without significantly altering the services offered by, or staffing for, the Main or satellite clinics and the median wait time shall not exceed five minutes, and no more than two percent of vaccine recipients should wait twenty minutes or longer.

Clinical Center (CC) management advises that all facility healthcare workers (HCW) as determined by the HES (approximately 4,000 staff) participate in this OMS program each year, i.e., receive the seasonal influenza vaccine or formally decline it. The contractor will facilitate timely entry of outside vaccinations and approved declinations into the appropriate system (as determined by the COR and TR).

C.5.2.4 Support for Investigational New Drug Research Studies

OMS participates in research studies, as requested, involving Investigational New Drugs (IND). The Medical Director is an Associate Investigator.

The Contractor shall provide a nurse to serve as the Study Coordinator. The Study Coordinator provides coordination and day-to-day management for this study and reporting to an Institute’s Institutional Review Board (IRB).

In addition, OMS may develop additional studies involving INDs as a means of enhancing the safety and protection of NIH researchers.

The Contractor’s Study Coordinator shall be responsible for managing the program, ensuring the safety and wellbeing of the participants, anticipating and adhering to all protocols and regulatory requirements, and administering immunizations and related services, and tracking study subjects.

C.5.2.5 Support for International Travelers and Outbreak Response

Each year, OMS processes approximately 110 requests for medical support for work-related international travel before, during, and after completion of travel.

The Contractor shall assure that the medical care and advice provided is current, complete, and timely, including on-call preparedness.

Outbreak response and support of special federal programs may involve NIH staff details to temporary domestic or international duty stations as directed. Rarely, as in the 2014-16 Ebola epidemic in West Africa, the NIH sends a large number of researchers and clinicians to assist in the investigation and stabilization of international epidemics. OMS and EAP contract and federal staff shall provide programmatic support for such NIH endeavors.

C.5.2.6 Physical Therapy

Approximately 90 NIH employees with work-related injuries and illnesses are referred to the OMS physical therapist each year; they account for approximately 500 OMS visits annually. The OMS physical therapist provides approximately 25 trainings a year to the CC Nursing Department and other NIH work groups regarding proper body mechanics to avoid occupational injuries and illnesses. The OMS physical therapist also performs approximately 20 ergonomic assessments and related reports of NIH workstations in the CC each year. Finally, the physical therapist collaborates with the DS ergonomics section and serves on NIH committees that review occupational injuries and illnesses reported to OMS and develops strategies to prevent them.

The Contractor is required to provide physical therapy services in the Main Clinic. Physical therapy services shall be offered only to federal employees with work-related injuries or illnesses who are receiving care from the OMS provider. The number of visits for any occupational injury or illness shall be limited to six. If it is apparent to the physical therapist that the worker will require more than six visits, the physical therapist shall offer the worker community-based healthcare providers for further care (see C.5).

In addition to providing clinical care, the Contractor’s physical therapist shall provide the training and ergonomic assessments and participate on committees, as outlined above.

C.5.2.7 Acupuncture

Based on demand, and at the direction of the COR, the Contractor may be required to provide acupuncture services in the Main Clinic. Access and the duration of care shall be limited as described above for physical therapy services.

Approximately 70 workers are referred to the Contractor’s acupuncturist, and they account for approximately 330 visits to OMS each year.

Utilization of this service may be reevaluated.

C.5.2.8 Contact Studies

OMS offers medical counseling, testing, and potentially treatment for possible occupational exposure to a variety of biologic hazards (e.g., M. tuberculosis, measles, mumps, hepatitis A, varicella, scabies, SARS-CoV-2, mpox virus, etc.). Collectively, contact studies account for approximately 80 visits to OMS each year. Preparedness to meet surges in demand require the Contractor’s clinical staff to be familiar with infection control measures, contact study case assessments and return-to-work guidance; and be able to focus efforts as directed by OMS leadership.

The Contractor shall provide this support and a summary statement for each contact study. This information is shared with the CC Hospital Epidemiology Service (HES), when the suspected exposure occurs in the CC, and other stakeholders in workplace safety and infection control.

C.5.2.9 Reviews of Medical Records

NIH employees who cite a medical condition as a justification for proposed accommodations (i.e., modification of work responsibilities or the use of leave) may submit medical information to support their requests. Annually, OMS processes approximately 300 requests for short-term disability, including applications for leave under the Family and Medical Leave Act (FMLA), premium class travel accommodations, handicapped parking, and extension of healthcare benefits. OMS staff also review about 11 applications for medical disability retirement benefits per year.

The Contractor’s personnel shall provide support for medical reviews as directed by the COR or OMS Medical Director. At a minimum, this support shall consist of:

· Responding to inquiries from the employee, supervisor, the Office of Equal Employment Opportunity (EEO) at Health and Human Services (HHS), and the Office of Human Resources (OHR) Employee Relations Specialists regarding the process;

· Receiving and expeditiously processing requests from management and records from employees;

· Notifying management when employees do not submit medical records by a defined deadline;

· Organizing medical records and drafting medical reviews for OMS physicians, to expedite the review process; and

· Distributing completed reviews and filing related paperwork.

C.5.2.10 Laboratory Support Services

OMS provides laboratory support services approximately 1,240 times each year. Examples of these services include: phlebotomy, blood chemistries, hematology studies, urine analysis, serologies, viral cultures, and serum storage. The testing is performed both at NIH, state and federal laboratories, and community-based laboratories.

The Contractor shall provide at each OMS clinic: phlebotomy services, processing of body fluids for laboratory testing, performing CLIA-waived tests, serum storage, shipping and receiving body fluids for specialized testing at facilities in other states, and tracking and recording laboratory test results.

The Contractor shall store serum specimens for 10 years in -20ºF, non-frost-free freezers in Maryland and Montana. The freezers in Maryland are managed by a commercial repository (see C.5.5.3 and C.9.1.6). The contracting staff maintains the serum of serum specimens to assist in retrieving and discarding samples.

C.5.2.11 Other

The Contractor shall provide a variety of other work-related medical services as defined in the OMS Procedure Manual (see C.6.1). For example, the Contractor shall provide initial medical clearances for participants who are expected to use N-95 respirators and Powered Air-Purifying Respirators (PAPRs) and coordinate their work with DS to ensure compliance with the Occupational Safety and Health Administration (OSHA) regulatory requirements. There are approximately 140 such visits per year. See the OMS Procedure Manual for a listing of services offered to the NIH community.

C.5.3 Non-Urgent Care provided via Recurring Appointments

Participation in OMS Cohort Procedures usually is voluntary. However, employees who have contact with animals used in research or who have access to biological hazards handled in BSL/ABSL-3 or -4 laboratories are required to participate in the related cohort procedure.

The Contractor shall administer the following programs by alerting workers of their eligibility to participate, scheduling and recalling participants, and providing the service as described in the relevant procedure(s) (see C.6.1).

C.5.3.1 Animal Exposure Program

The Animal Exposure Program (AEP) provides health and safety information related to the use and care of animals, occupationally indicated immunizations, and clinical evaluation and treatment for animal-related injuries or illnesses. The AEP tailors the medical services offered to the types of animals with which the employee works: nonhuman primates, large animals, and small animals. The NIH requires all employees who have contact with animals or their living quarters, viable tissues, body fluids, or waste to participate in this program.

Currently, there are 8,000 participants in the AEP. Most AEP-related services are provided during preplacement and Tuberculosis Surveillance Program visits (see C.5.2.1 and C.5.3.6). Approximately 550 additional visits are recorded annually specifically for AEP-related care.

The Contractor shall email AEP participants annually to remind them of recognized health hazards in their workplaces and the steps they must take should they sustain an occupational injury.

C.5.3.2 Asbestos Medical Surveillance Program

The Asbestos Medical Surveillance Program (AMSP) provides medical evaluation and counseling for employees who are suspected to have worked in areas with airborne asbestos.

Currently, there are approximately 10 participants in the AMSP and they account for approximately 14 visits to OMS annually. Approximately 10 chest radiographs are interpreted by a B reader each year. On average, once every three years a participant in this program is referred to a community-based pulmonologist for further evaluation when screening findings suggest asbestos-related lung disease.

The Contractor is required to provide a B reader for the evaluation of chest radiographs (see C.9.1.1).

The Contractor also shall provide a pulmonologist in Montgomery County, Maryland to perform an initial clinical evaluation, including diagnostic studies, for workers with potential evidence of asbestos related lung disease (see C.9.1.2).

C.5.3.3 Biological Surety Program

The Biological Surety Program (BSP) is designed as an overarching service for individuals who work in BSL/ABSL-3 or 4 laboratories or have unrestricted access to either the biological hazards stored there or to the facility’s critical infrastructure. The intent of the program is to determine whether workers are physically and psychologically fit to work in a BSL/ABSL-3 or -4 laboratory environment. Participants who have access to these biological hazards also receive services defined in pathogen-specific procedures during their enrollment and annual BSP visits. The NIH requires both federal employees and contractors who meet the criteria for this program to actively participate in it. The program, which is integrated with the Select Agent Program, requires extensive communication and coordination between the Contractor and other sections of the DS.

Currently, there are approximately 670 participants in the BSP. Eighty percent of those workers are cleared to work in or in support of BSL/ABSL-3 laboratories. The rest are cleared to work in or in support of BSL/ABSL-4 laboratories. Collectively, they account for approximately 1120 visits to OMS annually. Because of the complexity of these encounters and the extent of communication required, the Contractor should anticipate that these visits require significantly more time to process than other clinic visits.

The Contractor is required to provide a BSP visit to program participants within eleven to thirteen months of their last routine BSP visit.

The Contractor’s staff shall be familiar with the OMS pathogen-specific procedures designed to support researchers working with a variety of human pathogens (e.g., B. anthracis, B. mallei and pseudomallei, C. burnetii, flaviviruses, hemorrhagic fever viruses, highly pathogenic influenza viruses, Newcastle disease virus, orthopox viruses, and coronaviruses) and provide the related counseling.

The Contractor’s staff shall participate in approximately three BSP-related drills annually for NIH BSL/ABSL-3 and -4 laboratories in Bethesda and Frederick, Maryland and Montana.

C.5.3.4 Hearing Conservation Program

The Hearing Conservation Program provides medical monitoring for employees who may be exposed at work to noise levels at or exceeding threshold limits values for noise exposure in accordance with standards of the Occupational Safety and Health Administration (OSHA). Currently, there are about 400 employees in the Hearing Conservation Program resulting in about 270 visits to OMS annually.

The Contractor shall monitor employees for health effects from noise exposure and provide related counseling and literature.

C.5.3.5 Police Officers and Firefighters Evaluations

OMS provides approximately 25 medical evaluations for firefighters each year, including preplacement and annual evaluations. The number of preplacement evaluations for police officers varies depending on need.

The Contractor shall provide preplacement medical evaluations for police officers and firefighters that are more detailed than preplacement evaluations for most other workers at the NIH. Firefighters receive similar, annual medical evaluations.

In addition, the Contractor’s staff shall determine the medical readiness of a subset of police officers to participate in an intensive program of physical exercise as part of their proposed work on an emergency response team.

C.5.3.6 Tuberculosis Surveillance Program

The Surveillance Program (TBSP) seeks to minimize transmission of M. tuberculosis at the worksite to employees at significant risk for occupational infection and for the protection of nonhuman primates at the NIH. Currently, the TBSP has approximately 3,000 employees enrolled resulting in roughly 1,700 visits to OMS annually. About 800 TBSP participants are recalled for mandatory screening. Approximately 2,000 workers with low occupational exposure risk to TB are eligible to be tested once a year. Comment by Bell, Courtney (NIH/OD/ORS) [E]: Update. Comment by Bell, Courtney (NIH/OD/ORS) [E]: @Chan, Judy (NIH/OD/ORS) [E]

The Contractor’s staff shall perform TB testing and recall of TBSP participants as described in the TBSP and AEP (see C.6.1).

C.5.3.7 Hazardous Drug Program

The Hazardous Drug Program provides health and safety information related to handling of hazardous drugs, importance of safe work practice to prevent exposure to HD, reporting any work-related injuries and exposures to workplace hazards to OMS, and investigate the potential biological consequence to the hazardous drug exposure.

Hazardous drugs (HDs) are drugs that cause at least one of the following in humans, other animals, or recognized test systems.

1. Serious organ damage at low dose

2. Mutations in genetic material (genotoxicity)

3. Cancer (carcinogenicity)

6. Have a structure or mechanism of action that mimics existing HDs

Federal employees may elect to enroll in the Hazardous Drug Program if they handle HD or handle body fluids or tissue potentially containing HD.

Federal and non-federal employees who handle HD or handle body fluids or tissue potentially containing HD can also be identified by Clinical Center (CC) Pharmacy or Nursing Department or Division of Safety (DS) Safety Specialists, and during preplacement medical examination.

Those enrolled will complete the initial questionnaire for the Hazardous Drug Program and each year after that, they will be emailed an annual recall (1) requesting update of their occupational and medical history in online form (2) reminding staff of safe practices to follow when handling HD, and (3) reminding staff to report all potential HD exposures to OMS.

C.5.3.8 Other

The COR, in consultation with the TR, may direct the Contractor to plan and administer…