Performance Work Statement - Audiology Testing - Near Rock Island Arsenal IL.pdf

PERFORMANCE WORK STATEMENT – ROCK ISLAND ARSENAL, ILLINOIS

AUDIOLOGIST EVALUATIONS

1. 0. INTRODUCTION.

1.0.1. The Contractor shall provide health care support for Rock Island Arsenal (RIA), Illinois, which aligns under the Blanchfield Army Community Hospital (BACH), Fort Campbell, Kentucky. The contractor shall perform Audiology evaluations for eligible Department of the Army civilian employees from RIA, referred from the Occupational Health Nurse The contractor shall perform contract services from an office located within a 50-mile radius of RIA. These services will be in support of, as needed, audiometric testing, evaluation, and remedial services for patients with a variety of hearing problems, meeting or exceeding current recognized national standards as established by the Joint Commission and the American Medical Association (AMA). The services will be of a nature and scope described in the paragraphs below. The Contractor shall provide the non-personal services of Audiologist licensed to perform services of the nature and scope described in this Performance Work Statement

(PWS).

1.0.1.1. The quality of care provided by the Contractor HCP shall be of a quality meeting or exceeding currently recognized national standards as established by the Joint Commission (JC). Contractor HCP shall give the highest regard to patient dignity and observe the precepts of the American Hospital Association’s Bill of Rights for Patients.

1.1. GENERAL.

1.1.1. This contract is a non-personal services contract. Performance under a non-personal services contract means the personnel rendering the services are not subject, either by the contract’s terms or by the manner of its administration, to the supervision and control usually prevailing in relationships between the Government and its employees and is viewed as an independent contractor. The Government may evaluate the quality of professional and administrative services provided.

1.1.2. Malpractice Insurance. Direct health care providers in performance of services are not responsible for obtaining medical malpractice insurance under this contract in accordance with the Gonzales Act (10 U.S.C. Section 1089, also known as the Medical Malpractice Immunity Act). The Government will not reimburse or otherwise pay for medical malpractice insurance should it be purchased by the contractor or contractor employees.

1.1.3. Confidentiality / HIPAA. The Contractor HCP shall abide by AR 40-3 and AR 40-66 concerning the nature of limited privileged communication between patient and health care provider for security and personnel reliability programs. The Contractor HCP shall abide by AR 40-66 concerning the confidentiality of patient records, as embodied in federal statutes including the Privacy Act of 1974 and the Drug and Alcohol Act, Public Law 92-129 and HIPAA. The Contractor HCP shall direct all requests for medical information on patients to the Chief, Patient Administration Division. The Contractor HCP shall not release any medical or personal information on a patient without first receiving written approval from the government. Government will provide the regulations upon request by the Contractor HCP. The contractor shall abide by the Standards for Privacy of Individually Identifiable Health Information of the Health Insurance Portability and Accountability Act (HIPAA), Public Law 104-91. The contractor shall not use or further disclose Protected Health Information other than as permitted or required by this contract or as required by Law. The contractor shall use appropriate safeguards to prevent use or disclosure of the Protected Health Information. The contractor shall mitigate, to the extent practicable, any harmful effect that is known to the contractor of a use of disclosure of Protected Health Information by the contractor in violation of the requirements of this contract. The contractor shall report to the government any use of disclosure of the Protected Health Information not provided for by this Contract. The contractor shall document, in a time and manner designated by the government, any disclosure of Protected Health Information as would be required for the government to respond to a request by an individual for an accounting of disclosure of Protected Health Information.

1.1.4. Conflict of Interest.

1.1.4.1. Contractor HCP shall not use patient care rendered pursuant to this agreement as a part of a study, research grant, or publication without the prior written consent of the MTF Commander.

1.1.4.2. Contractor HCP shall not bill the patient, an insurer, or anyone else for services rendered. The Contractor HCP is prohibited from receiving compensation of any kind for eligible patients treated, procedures performed, or any other actions performed, except under the terms and conditions of this contract, at the rate specified in the contract.

1.1.4.3. Contractor HCP shall not, while performing services under this contract advise, recommend, or suggest to persons eligible to receive medical care at Army expense that such persons should receive care from the Contractor HCP at any place other than at the MTF. The Contractor HCP will not refer any patients to any company or service to which they have a direct or indirect involvement (including partnership programs and ancillary services not offered by the MTF).

1.1.4.4. Contractor HCP shall not be an employee of the United States Government if the employment would create a conflict of interest. The Contractor HCP who is an employee of the Department of Defense, either military or civilian, shall not be employed unless such person seeks and receives approval in accordance with DoD 5500.7-R and MEDCOM Reg 600-3.

1.1.5. SCOPE OF WORK: The Contractor shall provide qualified personnel, services, materials, equipment, supplies and facilities necessary to perform Audiology examinations for RIA, Illinois.

1.1.6. ANTITERRORISM / OPERATIONS SECURITY (OPSEC)

1.1.6.1. Contractor personnel shall adhere to facility security policies and restrictions. The Contractor shall immediately report suspicious activities to security personnel.

1.2. SCHEDULE/PERIOD OF PERFORMANCE

1.2.1. The contractor shall perform services during weekdays, Monday through Friday, excluding legal Federal holidays, between the hours of 0800 and 1600, as scheduled by the Occupational Health Clinic (OHC), RIA, Illinois.

1.2.2. The contractor shall schedule patients within 72 hours of telephonic request from the clinical staff of the OHC, RIA, Illinois.

1.2.3. Contractor HCP working under this contract shall be paid only for audiology examinations actually performed at the rates established in the contract.

1.2.4. Holidays. The following is a list of legal federal holidays as referred to elsewhere in the contract/task order.

New Year’s Day, January 1st Martin Luther King’s Birthday, 3rd Monday in January President’s Day, 3rd Monday in February Memorial Day, Last Monday in May Juneteenth, June 19th Independence Day, July 4th Labor Day, 1st Monday in September Columbus Day, 2nd Monday in October Veteran’s Day, November 11th Thanksgiving Day, 4th Thursday in November Christmas Day, December 25th

1.3. DESCRIPTION OF WORK.

1.3.1. PROFESSIONAL QUALIFICATIONS. All Contract employees provided by the contractor shall meet the qualifications for that specialty and perform essentially the same functions, within the scope of acceptable for their technical professional discipline and standard, as those required by Army or government service technical professionals of similar experience and in similar duty assignments.

1.3.1.1 The contract provider may be an audiologist or a physician who has successfully completed a residency in otolaryngology. The contract audiologist and/or contract physician shall be licensed to practice in the state in which the contractor’s office/clinic is located.

1.3.1.2 Audiometric testing must be administered by a physician, audiologist, or an audiometric technician certified by the council for Accreditation in Occupational Hearing Conservation. Audiometric technicians must administer audiometric tests under the supervision of a physician or an audiologist.

1.3.1.3 The contract audiologist/physician shall not be the subject of a current or pending investigation of appeal by any certifying organization to determine whether the individual has engaged in unprofessional conduct or substandard practice which may result in the suspension or restriction of the individual’s licensure. The contract audiologist/physician shall not have had any adverse actions, i.e. suspension or restrictions, in the past.

1.3.1.4 The contract audiologist/physician shall have education and training required for the position that is being applied for.

1.3.1.5 The contract employee performing under this Contract shall be able to read, write, speak and understand English well enough to effectively communicate with all patients and other health care providers.

1.3.2. SPECIFIC DUTIES/TASKS/RESPONSIBILITIES. Duties include but are not limited to the following:

1.3.2.1. Evaluation. The contractor shall perform comprehensive audiology evaluations on Department of the Army civilian employees referred by the Occupational Health Nurse, RIA, Illinois. Our Occupational Health Clinic would contact your office with a referral to set up an appointment for a patient. Only physician may diagnose noise-induced hearing loss. The contractor shall use all reasonable methods of differential diagnosis to include, but not limited to:

Basic Comprehensive Audiometry of the individual’s auditory history and previous hearing tests.

Tympanometry (Impedance Testing) Acoustic Reflex Decay Test Acoustic Reflex Test Pure-tone Audiometry, air and bone conduction measurements.

Pure-tone Audiometry, bone threshold air only.

Speech Audiometry, thresholds only.

Speech Audiometry, threshold & discrimination.

1.3.2.2. Written Evaluation. The contractor shall provide a written report within fifteen (15) calendar days after conducting test(s). The report shall summarize findings and recommendations and will advise if the individual’s hearing condition is work-related and what additional follow-up actions, if any, are recommended. Statements about non-occupational noise exposures (e.g., hunting, motorcycling, chain saw use) must be included in the patient history. The contractor shall send the written report to the Occupational Health Nurse, RIA, Illinois., by fax or mail, address:

Woodson Health Clinic c/o Occupational Health Department 1 Rodman Ave, BLDG. 110 Rock Island Arsenal, IL 61299

1.3.2.2.1. The contractor shall include the following in the written report:

1.3.2.2.2. Descriptive terminology understandable to a lay person.

1.3.2.2.3. A summary of all test results including the type and degree of hearing loss. If the loss is sensorineural, indicate if there is any indication of possible retrocochlear involvement.

1.3.2.2.4. Recommendations for additional testing, medical evaluations and/or amplification. If amplification is discussed, please indicate its benefits and restrictions, e.g., hearing aids are not to be worn while exposed to hazardous noise.

1.3.2.2.5. If diagnostic testing reveals a medically related hearing loss, the contractor shall refer the patient back to the Occupational Health Nurse, RIA, Illinois. Conductive hearing loss is not the result of exposure to loud noise, so treatment for conductive hearing loss is not the responsibility of the government. However, the patient should be advised to seek care at his/her own expense to ensure the medical problem is treated. The contractor shall discuss all finding and recommendations with the patient at the time of evaluation. The contractor shall only perform and receive payment for the audiology evaluation, as requested by the Occupational Health Nurse, RIA, Illinois.

1.3.3. Limitations. Department of the Army employees will not receive any additional testing or services at Government expense. The contractor shall not, while conducting services under this contract, perform any other examinations or services except as identified above.

1.4. TECHNICAL REQUIREMENTS

1.4.1. REQUIRED DOCUMENTATION OF QUALIFICATIONS.

1.4.1.1. The contractor shall submit the following documentation for qualifications no later than ten (10) working days after award.

1.4.1.2. Copy of current license/certification from the state in which services are to be provided.

1.4.2. Certifications/licenses shall be maintained in a current status at all times while performing services under this contract. If at any time during the contract, a contract provider does not renew any of the required certifications/licenses prior to the expiration date he/she will not be allowed to work for RIA. This expense shall be borne by the contractor.

1.4.3. DISQUALIFIERS.

1.4.3.1. No contractor who is chemically dependent or impaired shall be acceptable.

1.4.3.2. No contractor who has been previously convicted of a felony shall be acceptable.

1.4.3.3. No contractor who is awaiting possible adverse administrative action by any certifying board shall be acceptable.

1.5. DELIVERABLES.

1.5.1. Invoicing. Monthly invoices shall be submitted NTL the 30th of each month in Wide Area Workflow (WAWF) in accordance with Clause 252.232-7006 WIDE AREA WORKFLOW PAYMENT INSTRUCTIONS.

The invoice(s) shall be attached in WAWF and include names of individuals, the services provided and the cost. All payments will be paid after each service. Payment will be made at the rate set forth in the bid schedule for the satisfactory performance of services required by the contract.

1.5.2. Contractor’s Point of Contact. The contractor shall provide both the Contracting Officer and the Contracting Officer’s Representative the name and telephone number of an individual to act as his/her representative and Point of Contact no later than five (5) working days after award.

2.0. DEFINITIONS AND ACRONYMS.

2.0.1. DEFINITIONS

CONTRACTOR. The term as used in this contract refers to the prime.

CONTRACTING OFFICER. A person with authority to enter into contracts; administer, or terminate contracts.

Make related determinations and findings on behalf of the government. Note: The only individual who can legally bind the government.

CONTRACTING OFFICER'S REPRESENTATIVE (COR). An employee of the U.S. Government appointed by the contracting officer to monitor contractor performance. Such appointment shall be in writing and shall state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the contract.

MILITARY TIME is on a 24-hour clock, i.e., 8:00 a.m.-0800 9:10 a.m.-0910 Noon -1200 8:00 p.m.-2000 9:10 p.m.-2110 Midnight-2400 12:01 a.m.-0001

MILITARY DATES are written by placing the day of the month, followed by the first three letters of the month, followed by the last two digits of the year, i.e., September 02, 2001 - 02 Sep 01 November 10, 2004 - 10 Nov 04 May 1, 2005 - 01 May 05

QUALITY ASSURANCE. The government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

QUALITY ASSESSMENT AND IMPROVEMENT (QA& I): An ongoing program designed to objectively and systematically monitor and evaluate the quality and appropriateness of patient care, to pursue opportunities to improve patient care, and to resolve identified problems.

QUALITY CONTROL (QC): Those actions taken by the Contractor to control and ensure that performance of duties meet the requirements of the contract.

2.0.2. ACRONYMS.

AR - Army Regulation AMA - American Medical Association COR - Contracting Officer Representative DA - Department of Army DCCS - Deputy Commander for Clinical Services DOD - Department of Defense EFT - Electronic Funds Transfer FAR - Federal Acquisition Regulation HCP - Health Care Provider

HIPAA - Health Insurance Portability & Accountability Act of 1996 HSPD - Homeland Security Presidential Directive JC - Joint Commission KO - Contracting Officer MEDCOM - Medical Command MEDDAC - Medical Department Activity MTF - Military Treatment Facility OSHA - Occupational Safety & Health Association PAD - Patient Administration Division PL - Public Law POC - Point of Contact PPIMS - Past Performance Information Management System PWS - Performance Work Statement QA&I - Quality Assessment & Improvement QA - Quality Assurance QC - Quality Control QAP - Quality Assurance Program QASP - Quality Assurance Surveillance Plan QCP - Quality Control Program SF - Standard Form

3.0. ATTACHMENT/TECHNICAL EXHIBIT LIST

• ATTACHMENT 1 – Quality Assurance Surveillance Plan (QASP)

• ATTACHMENT 2 - Performance Requirement Summary (PRS)

ATTACHMENT # 1 - QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

Removed from the Performance Work Statement

ATTACHMENT #2 - PERFORMANCE REQUIREMENT SUMMARY

The Performance Requirements Summary Matrix, Attachment 1 in the Performance Work Statement, includes performance standards. The Government shall use these standards to determine contractor performance and shall compare contractor performance to the Acceptable Quality Level (AQL).

PERFORMANCE

OBJECTIVE

PERFORMANCE

STANDARD REF PBWS METHOD OF

ASSESSMENT

Designate a point of contact prior to start date of the contract

Written notification must be received by the KO and COR prior to start date of contract. 100%

1.5.2. Written notification to

KO

Provider(s) maintain professional licenses, certifications

100% of licenses and certificates shall be renewed and maintained in current status during life of contract

1.4.1. Credentials records

Comply with Specific Tasks.

Comply at least 99% of the time.

1.3.2. COR maintain log.

Combating Trafficking in persons (awareness program)

100% compliance (zero tolerance) regarding trafficking in persons policy

FAR 52.222-50 and FAR 22.1703.

COR documentation and program review. Any non-compliance must be brought to the immediate attention of the KO.

Satisfactory: Performance meets contractual requirements.

Unsatisfactory: Performance does not meet contractual requirements.

Other performance evaluation factors that will be monitored and documented in the contractor’s performance records but cannot be quantified by numerical measurements:

• Contractor providing personnel exceeding the minimum qualification standards.

Performance above or below the standard, for above factors, will be documented in the Contractor’s Performance Assessment Reporting System (CPARS) for the reporting period.