PWS.pdf

PERFORMANCE WORK STATEMENT

Performance Work Statement (PWS)

Personal Care and Support Services

For the Home Health Care Program at Guantanamo Bay, Cuba

Introduction:

1.1. In 1958 when relations between the United States and Cuba were degraded as to limit access to and from the Naval Station Guantanamo Bay (NSGB), special consideration was given to Cuban employees on NSGB. The individuals who became base residents are the individuals later defined as “Special Category Residents” (SCRs) under the 2006 National Defense Authorization Act (NDAA).

1.2. There are currently six SCRs located on NSGB, who are of advanced age and require increasing assistance with daily activities of life, and are enrolled in the Home Health Care Program. There are an additional 9 SCRs located on NSGB who are eligible to enroll in the Home Health Care Program.

The average SCR age is 85 years (not including SCR children). Most of the SCRs currently live independently in government housing on base, with their health care being provided at US Naval Hospital Guantanamo Bay (USNH GB). For those that require additional geriatric assistance, the Home Health Care Program is available. This program is a collaborative effort by NSGB, USNH GB and the Cuban Community Assistance Program (CCAP).

1.3. The Home Health Care Program consists of two divisions: (1) Home Health Nursing Care and (2) Personal Care and Support Services. A description of Home Health Nursing Care and Personal Care and Support Services can be found in PWS paragraph 2.1 below.

1.4. USNH GB staff will provide Home Health Nursing Care for SCRs residing in the Home Health Facility (Building H4) and in the on‐base community. Personal Care and Support Services will be provided by this contract for the residents of H4 and for those enrolled in the Home Health Care Program that still live out in the community. There are residents enrolled in the Home Health Care Program with some residing in H4 and some residing in their homes on NSGB. NSGB has the only on‐base assisted living facility (H4) within the DoD. This facility was created solely for the aging SCR population and is unique in its personnel, administrative and financial composition.

2. General:

2.1. The Contractor will provide Personal Care and Support Services for the SCRs residing in H4 on NSGB and those enrolled in the Home Health Care Program that still reside in their personal residences.

The Home Health Care Program provides SCRs with housing (if needed), meals, personal care and support, 24‐hour supervision, end of life preparation and help with Activities of Daily Living (ADLs) such as resident movement, feeding, bathing, dressing, grooming, and elimination. Nursing care will not be provided via this contract. As SCRs age, it is anticipated that the number of SCRs participating in the Home Health Care Program that will require assistance with ADLs will increase.

These numbers can change at any time, but are not currently expected to deviate by more than + or

– 2 from the current Home Health Care Program roster for some time.

2.2. General Condition of Residents as of March 2024:

2.2.1. H4 Residents: Three (3) are in wheelchairs, three (3) need assistance bathing, all have limited mobility.

2.2.2. At Home Residents: Generally healthy for their age and various conditions, mobile to limited mobility.

2.2.3. No further Resident information will be shared due to Health Insurance Portability and

Accountability Act (HIPAA) restrictions.

2.3. Due to possible increases and decreases in the number of SCRs requiring services, task orders (TO) are planned to be placed to accommodate for this annual fluctuation in SCRs. . This will allow for each task order to accommodate current need, with no greater than 12‐months of performance for each TO, including transition to NSGB. Billing against Contract Line Items (CLINs) shall not occur until the person/vehicle is on base and operational under the confines of the contract at a maximum of 45 days after award of task order. Task Orders may include multiple CLINs or multiple quantities of ADL support. In addition, , Task Orders will be submitted to increase or decrease number of personnel based on non‐medical care services required in support of SCRs.

3. Personal Care and Support Services Requirements Overview:

3.1 A Program Manager will monitor and supervise the staff hired for this requirement. They will be the primary point of contact for the Contracting Officer’s Representative (COR) and other stakeholders.

3.2 A Licensed Clinical Social Worker will be assigned to this program to assist the SCRs and their families with geriatric needs assessment, advocacy, counseling and end‐of‐life preparation once credentialing has been approved by USNH GB.

3.3 Assistance with ADL will be rendered by a Home Health Aide/Health Care Assistant (HHA) or equivalent in H4 to SCRs who are no longer able to safely live on their own and to SCRs enrolled in the program who still live at their own residence.

3.4 There needs to be two (2) vehicles capable of transporting multiple SCR, including those that are mobility impaired.

4 Activities of Daily Living:

4.1 The Home Health Care Program will be staffed by HHA/equivalents who will provide all personal care and support services to the eligible SCRs. For resident safety purposes, at a minimum, H4 requires at least two (2) HHAs to be present during core hours to assist residents and two (2) HHAs to handle the home visits. Preponderance of services will consist of, but not be limited to, providing 12‐hour a day, 7‐days a week assistance of SCRs with the following:

4.2 Tasks associated with activities of daily living (ADL):

4.2.1 Assisting SCR residents with nutrition and hydration as needed to minimize dehydration.

4.2.2 Retrieving residents’ meals from the Hospital Galley twice daily.

4.2.3 Feeding and assisting SCR residents with eating at least three meals a day; ensure proper positioning of residents to optimize nutritional and fluid intake and prevent choking and aspiration.

4.2.4 Assisting with, or dressing and undressing of SCR residents as needed.

4.2.5 Assisting with and encouraging the use of self‐help devices for eating, grooming and other personal care tasks.

4.2.6 Assist with, or provide:

4.2.6.1 Bathing a minimum of once a day.

4.2.6.2 Daily shampooing and caring for hair.

4.2.6.3 Daily shaving of men’s facial hair and weekly shaving of women’s leg hair as needed.

4.2.6.4 Weekly nail care for fingernails and toenails of persons with uncompromised circulation.

4.2.6.5 Oral hygiene at least twice a day, and clean dentures daily and as needed.

4.2.6.6 Skin care to include: application of non‐prescription pediculicides; application of topical barrier creams and ointments for skin care; maintenance of skin integrity; prevention of pressure, friction, and shearing; and use of anti‐pressure devices.

4.2.7 Make residents’ beds daily and clean common areas and residents’ rooms.

4.2.8 Change the bed linens with clean linens weekly. Change bed linens more frequently as needed.

4.2.9 Daily washing, drying, folding, and putting away SCR residents’ clothes.

4.2.10 Daily cleaning of dishes and galley area to include resident refrigerator.

4.2.11 Assisting SCR residents, and or moving and transferring with proper lifting/transfer techniques or resident lifts that prevent resident falls and injury.

4.2.12 Transporting clients in wheelchairs and specialized chairs as needed.

4.2.13 Turning and positioning SCR residents who are unable to move at a minimum every 2 hours and as needed to prevent pressure ulcers.

4.2.14 Performing range of motion exercises with residents who need assistance a minimum of twice a day.

4.2.15 Encourage and assist residents to utilize exercise facilities within the facility.

4.2.16 Transporting and/or escorting SCR residents to and from medical appointments, shopping, and other activities as requested by the SCR resident.

4.3 Tasks associated with communication and interpersonal skills:

4.3.1 The Program Manager, or designee, will provide status updates on SCRs using information from

Home Health Aide encounters. Status updates will be provided to the COR and NHGB medical and nursing staff, Monday through Friday, excluding federal holidays.

4.3.2 Daily written and/or verbal updates (in English) to the COR and USNH GB medical and nursing staff on SCR residents' status.

4.3.3 Report immediately to USNH GB medical/nursing staff any changes of abnormal resident findings, signs or symptoms that require medical attention.

4.3.4 Answering and placing call signals for residents so that they may contact staff for assistance.

4.3.5 Communicating regularly with SCR residents and providing support as needed to meet their needs or requests.

4.3.6 Assist SCR residents in developing and utilizing their maximum potential for self‐care.

4.3.7 Immediately report to USNH GB medical and nursing staff any suspected or actual abuse, mistreatment, and neglect of SCRs.

4.3.8 Maintain resident confidentiality.

4.3.9 Demonstrate respect for the rights, dignity, and property of residents and coworkers.

4.3.10 Document care provided, to include end of life care, at least daily and as needed in the resident’s record.

4.3.11 Assist USNH GB and NSGB staff with the collection of height and weight, vital signs, daily blood glucose readings and documenting in resident’s record.

4.4 Tasks associated with elimination:

4.4.1 Assist SCR residents with toileting as needed.

4.4.2 Assisting with the use of the bedpan, urinal, and bedside commode as needed.

4.4.3 Changing soiled bed linens as they occur.

4.5 Tasks associated with infection control and Standard or Transmission Based Precautions:

4.5.1 Follow standard precautions, including the use of personal protective equipment, to reduce the risk of infection.

4.5.2 Properly dispose of biohazardous wastes and contaminated materials.

4.5.3 Clean and perform low‐level disinfection of common areas, medical equipment, devices, or supplies as needed.

4.6 Tasks associated with safety and emergency procedures:

4.6.1 Staff shall promote a safe, functional, and supportive environment within the facility that is arranged and managed to protect residents, visitors, and staff.

4.6.2 Follow proper procedures for calling emergency medical assistance.

4.6.3 Apply safety concepts in the workplace.

5 Key Personnel and Specific Skills Sets Required:

5.1 Program Manager:

5.1.1 An on‐site Program Manager will be designated in writing to be the primary POC to the COR and NSGB/CCAP staff for all contracted support. The Program Manager will be responsible for maintaining daily HHA staffing levels that support the requirements of this PWS. The Program Manager will also be responsible for deliverables required by this PWS (see section 10 for details) and will be available during business hours Monday through Friday and on call as needed.

Historically, on calls average about 10 times a month outside of regular business hours.

5.1.2 Language Capabilities: Required fluency in English. Prefer that the candidate also demonstrate the ability to speak, write, interpret and translate between Spanish and English languages.

5.1.3 Education: Bachelor’s degree with minimum 24 business credit hours.

5.1.4 Experience: 1 year administrator experience in the geriatric field. 3 years of general managerial experience.

5.1.5 Responsibilities

5.1.5.1 Monitor assignments for aides for proper work flow.

5.1.5.2 Investigate all resident incidents/falls and give summary to USNH GB and to the COR – CCAP Manager.

5.1.5.3 Handle all personnel issues (employee behavior, dereliction of duty, complaints) and report to Nurses and to the COR ‐ CCAP program Manager.

5.1.5.4 Communicate all pertinent shift activity to USNH GB.

5.1.5.5 Assure that issues impeding the quality of care or effectiveness of work are reported to USNH GB and the COR.

5.1.5.6 Manage all emergencies and record all details for COR – CCAP Manager Review.

5.1.5.7 The Program Manager, or designee, will upload daily HHA notes in the Electronic Health Records (EHR) system, Monday through Friday, excluding federal holidays. HHA notes generated over weekends and holidays will be uploaded by the PM, or designee, on the next business day.

5.1.5.8 Provide documentation that HHAs have completed all required trainings and all other trainings required by USNH GB.

5.1.5.9 Participate in the Multidisciplinary Care planning meetings.

5.1.5.10 The program manager will be in charge of the Home Health Aides’ work schedule, and all shift working hours decisions will be made by the Program Manager and a copy of the schedule will be provided to the COR.

5.1.5.11 The Program Manger will work in conjunction with the COR to gauge the staffing needs and make timely recommendations for increases or reductions.

5.1.5.12 Managing Human Resources: Evaluate work performance of subordinates to find ways to improve production or increase work quality.

5.1.5.13 Managing Human Resources: Review and analyze Department of the Navy, and other governing organizations, policies that impact the program. Utilize expertise and sound judgment to interpret and implement existing policies, procedures and regulatory guidance which enhance effectiveness and efficiency of the Contractor’s personnel.

5.2 Licensed Clinical Social Worker (LCSW):

5.2.1 An onsite Clinical Social Worker will be required to plan and carry out assignments as directed by the Program Manager. Works independently and resolves problems. Keeps the CCAP Manager informed on progress of assignments and any controversial issues.

5.2.2 Language Capabilities: Required fluency in English. Shall demonstrate the ability to speak, write, interpret and translate between Spanish and English languages.

5.2.3 Education: Master's degree. Specialization in clinical social work is preferred.

5.2.4 Experience: 3 years of geriatric experience.

5.2.5 Clinical interventions: May provide counseling for SCRs in the Home Health Care Program who feel lonely or who are suffering from mental health disorders. The LCSW is the first line of defense in mental health monitoring; this position will work in conjunction with the mental health care professionals in NSGB. Will encourage the clients to pursue stimulating activities, helping to arrange group outings. The LCSW can help the SCR’s to cope with aging by recording “life stories” and help people say their goodbyes through writing letters, phone calls, and videos.

5.2.6 Service interventions: Acting as a link between the residents and the numerous public and private activities on the NSGB appropriate for the aging population. The Social worker will help the SCR’s apply for appropriate services if needed. They help sort out any problems in the delivery of these services. They will also assist with individual resident budgets, including purchasing items.

5.2.7 Advocacy: With the assistance of the CCAP Manager, and the services of the Legal Assistant Office NSGB, provide, if needed, assistance in the Advance Directive form and explain how to correctly complete it. They are also a frontline defense for stopping elder abuse: a geriatric social worker is mandated by law to report any suspected elder abuse to Adult Protective Services or to NSGB Authorities.

5.2.8 Offer counseling services, which often deal with end‐of‐life issues, bereavement, and other concerns common to senior citizens. They can help guide families through the transition from the home environment to long term care, assist with filing necessary paperwork, and help with access to end‐of life care planning (living wills, advance directives, DNR orders).

5.2.9 Act as a liaison between the patient, family members, and health care staff and can make sure the family stays informed about their loved one’s condition through quarterly updates via phone/email or face‐to‐face communications. They will help develop comprehensive care plans individually suited to the needs of the SCR.

5.2.10 Participates in the Multidisciplinary Care planning meetings.

5.2.11 Recognizes normal and abnormal aging patterns. They can suggest when an elderly client needs to see a doctor and can arrange for a visit.

6 Patient Cultural Background:

6.1 Some of the patients receiving services under this contract may only speak Spanish or may have limited comprehension of the English language, and/or may reside at their home on NSGB. The Contractor is expected to demonstrate sensitivity to cross‐cultural and language difference and have the ability to work in the absence of government provided interpreters as necessary. Consideration shall be given to potentially limited transportation and/or home environment facilities

7 Physical Demands and Work Environment:

7.1 The Contractor employees shall be able to lift 40 pounds and shall be able to bend, lift and pull. The Contractor employee shall not have any work or health restrictions, which could directly or indirectly interfere with the performance of providing services as there will be some moderate lifting with regard to boxes of office supplies, boxes of medication, equipment, patients, etc.

7.2 The work environment will be a mix between H4 and patient homes.

7.3 The Contractor’s employees may be exposed to hazardous items, such as chemicals, blood and blood‐borne pathogens. The Contractor’s employees will be exposed to infectious diseases and mentally and physically impaired patients.

7.4 The Contractor shall inform the COR, Contracting Officer (KO) or Program Manager or their designated representative of any problems encountered or which may be encountered in connection with meeting the needs of the Contractor’s duties.

7.5 The Contractor is responsible for maintaining satisfactory standard of competence, conduct, appearance and integrity. The quality of work performance of the Contractor shall be subject to review.

7.6 The Contractor shall comply with all food handling, facility infection control, and safety procedures and standards. USNH GB will provide food handling, facility infection control, and safety programs for initial and refresher training to ensure compliance with food handling, infection control, and safety requirements and regulations.

7.7 The Contractor shall provide government notice, at a minimum of three (3) business days in advance, or immediately if less than 3 business days, of any substitution or replacement of any of the Contractor’s employees of which it has provided qualifications and resumes under this contract. All Contractor potential substitutes or replacements’ qualifications, experience and professional certifications shall be at least equal to or greater than the minimum standards of the PWS.

7.8 The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. Should the COR or designee show documented clinical problems or continual unprofessional behavior/actions with any Contracted personnel, s/he may request, without cause, immediate replacement of said Contracted personnel. The KO and COR shall deal with issues raised concerning Contracted personnel’s conduct. The final arbiter on questions of acceptability is the KO.

7.9 T‐Mobile is currently the only cell phone carrier for Guantanamo Bay. All housing and facilities will have landlines. During working hours, while on duty, all personnel under this contract need to be accessible. Whether by personal or work phone.

8 Certification, Licensing and Insurance:

8.1 The Home Health Aides shall possess and maintain an active and current certification in their field.

8.2 The LCSW shall possess and maintain an active and current licensure.

8.3 Basic Life Support (BLS) certification is required for all employees under this contract. Additional training, including, but not limited to, HIPAA, food handling and safety, infection control, ergonomics and safe lifting practices, as well as organizational and regulatory requirements, will be provided by Naval Hospital Guantanamo Bay. It is the Contractor’s responsibility to attend and complete all required training. The Program Manager will coordinate with Naval Hospital Staff for training.

8.4 The Program Manager and Licensed Clinical Social Worker shall complete all required training for computer and network access prior to being granted computer and network access. These individuals must complete annual ad hoc training for continued computer and network access.

Trainings will be provided to assigned Contractor employees upon arrival to the island.

8.5 The Licensed Clinical Social Worker shall complete initial credentialing and privileging requirements, maintain licensure and other conditions for continued credentialing and privileging, and comply with medical staff bylaws, rules, and regulations. The Contractor’s foreign national employees shall meet the same or equivalent certification requirements as US Certified Nursing Assistants. This certification requirement may be waived for personnel assigned only as a driver.

8.6 In accordance with Federal Acquisition Regulation (FAR) 37.401:

8.6.1 This contract is a Non‐Personal health care services contract, as defined in FAR 37.101, under which the contractor is an independent contractor (further defined in section 18 of this PWS).

8.6.2 The Government may evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of services rendered.

8.6.3 Indemnification: The Contractor shall be liable for, and shall indemnify and hold harmless the

Government against, all actions or claims for loss of or damage to property or the injury or death of persons, arising out of or resulting from the fault, negligence, or act or omission of the Contractor, its agents, or employees during performance of the contract.

8.6.4 The Contractor shall maintain medical liability insurance for the duration of the contract.

8.6.5 The Contractor shall provide both the COR and KO copies of its certificates of insurance and its subcontractors’ certificates of insurance prior to performing services under this contract in accordance with FAR 52.237‐7.

8.6.6 All Contractor and subcontractor certificates of insurance shall name the NHGB Home Health Care

Program as an additional insured.

8.7 The Contractor shall be responsible for protecting Contracted personnel furnishing services. To carry out this responsibility, the Contractor shall provide or certify that the following are provided for all their staff providing services under the resultant contract:

8.7.1 Workers’ compensation

8.7.2 Professional liability insurance

8.7.3 Health examinations

8.7.4 Income tax withholding (as required)

8.7.5 Social security payments (as required)

9 Medical Records:

9.1 NHGB will provide training for the Contractor’s US employees on their EHR system. The Contractor shall complete medical records in the EHR and/or via hand written notes within one (1) business day of service provided/shift, barring technical difficulties. If the EHR system is unavailable, the

Contractor has one (1) business day to update the records once the system comes back online.

Failure to abide by this requirement is basis for cancellation of this contract. After given access to

EHR, the Contractor(s) shall be required to scan patient ADL information into the EHR. Medical

Records will be the property of the U.S. Government and will be placed in each patient’s chart.

9.2 The SCR’s/patients’ Medical Records shall not leave the premises of USNH GB.

9.3 Medical records used for patients assisted by the Contractor’s employees shall conform to the

Privacy Act and Standards for Patient Confidentiality. An unauthorized disclosure from a Person’s record, protected by the Privacy Act, may be subject to a penalty of up to $5,000 per incident.

9.4 The Contractor shall complete the medical and other required records for patients he/she in any way provides service to within the same business day prior to the end of the

Contractor employee’s shift. Chart notes are to be completed on the day services are rendered. The

Contractor shall abide by the applicable rules and regulations of NHGB.

10 Performance Requirements Summary:

10.1 Contractor shall provide outputs associated with the taskings listed below to include, but not limited to, MS power point briefings, MS Word documents and reports, MS Excel spreadsheets, MS

Access databases, emails and talking points. The Contractor is required to provide the following deliverables under this task order:

Performance Element

Performance Requirement

Surveillance Method

Frequency Acceptable Quality Level

Activities of Daily Living (ADL)

Outlined in PWS paragraph 4.2

Inspection by the

COR

Weekly >95% of the tasks that are needed are performed IAW the PWS

Immediate report signs/symptoms that require medical attention

Outlined in PWS paragraph 4.3.3

Inspection by the COR and assessment by USNH GB staff during care

Weekly 100% of the time with no substantiated complaints

Immediate report of suspected or actual abuse, mistreatment, or neglect of SCRs

Outlined in PWS paragraph 4.3.7

Inspection by the COR and assessment by USNH GB staff during care

As needed, but not less than weekly

100% of the time with no substantiated complaints

Elimination Support

Outlined in PWS paragraph 4.4

Inspection by the COR and assessment by USNH GB staff during care

As needed, but not less than weekly

100% of the tasks that are needed are performed IAW the PWS

Infection Control Outlined in PWS paragraph 4.5

Inspection by the COR and assessment by USNH GB staff during care

As needed, but not less than weekly

100% of the tasks that are needed are performed IAW the PWS

Safety/Emergency Procedures

Outlined in PWS paragraph 4.6

Inspection by the COR and assessment by USNH GB staff during care

As needed, but not less than weekly

100% of the tasks that are needed are performed IAW the PWS

Update daily Electronic Health Records

Outlined in PWS paragraph 5.1.5.7 and PWS Chapter

Inspection by USNH GB staff

Weekly >98% compliance and accuracy

Service Interventions

Outlined in PWS paragraph 5.2.6

Inspection by the

COR

As needed >95% of the time with no substantiated complaints

Participate in Multidisciplinary Meetings

Outlined in PWS paragraphs

5.1.5.9 and 5.2.10

Inspection by the

COR

As required >95% attendance

11 Personnel Security Requirements:

11.1 Work under this contract is considered UNCLASSIFIED and no extra security clearances are required beyond those outlined in this PWS and standard requirements to access a U.S. Navy Installation.

12 Hours of Operations:

12.1 Home Health Aides will work shifts that may start as early as 0600 or end as late as 2400, depending on the needs of the residents and the shift schedule. Individual scheduling decisions will be made by the Program Manager and a copy of the schedule will be provided to the

COR.

12.2 The Program Manager and the Social Worker will be available during business hours (0800 to 1630). On occasion, an emergency arises which requires action from the Program Manager and/or the Social Worker. If an emergency arises after hours, the Program Manager and the Social Worker will respond within one (1) hour of receiving notification of the Government’s call.

13 Government Furnished Property, Material and Services:

13.1 The Government will furnish necessary workspace for Contractor staff providing direct support to the requirements outlined in this PWS to include desk space, telephones, computers and other items necessary to maintain an office environment.

14 Contractor Furnished Property, Material and Services:

14.1 The Contractor will furnish and maintain a total of two (2) vehicles for SCR transportation and general use pertaining to carrying out the duties specified in this PWS for the duration of the contract.

14.2 Vehicle 1 must be able to reliably, safely, and legally (according to U.S. regulations) transport up to 14 passengers, not including driver, and up to 2 wheelchairs. The vehicle must be temperature controlled and provide the ability to roll on and off wheelchairs. Due to energy sources aboard NSGB, the vehicle must be gasoline‐fueled.

14.3 Vehicle 2 must be able to reliably, safely, and legally (according to U.S. regulations) transport up to 4 passengers, not including driver, and up to 1 wheelchair. The vehicle must be temperature controlled and provide the ability to roll on and off wheelchairs. Due to energy sources aboard NSGB, the vehicle must be gasoline‐fueled.

15 Place of Performance:

15.1 Work under this contract and subsequent task orders will only be performed within NSGB, primarily in H4 and base housing.

16 Period of Performance:

16.1 See Delivery Information in the Solicitation.

17 Federal Holidays:

17.1 The following holidays are observed by USNH GB: 17.1.1 New Year’s Day

17.1.2 Martin Luther King Jr’s Birthday

17.1.3 President’s Day

17.1.4 Memorial Day

17.1.5 Juneteenth

17.1.6 Independence Day

17.1.7 Labor Day

17.1.8 Columbus Day

17.1.9 Veterans Day

17.1.10 Thanksgiving

17.1.11 Christmas

17.1.12 Any day specifically declared by the President of the United States to be a national holiday.

17.2 In the event of an emergency, the Contractor shall contact the COR for instructions.

18 Non‐Personal Services:

18.1 The parties agree that the Contractor and all Contracted personnel shall not be considered USNH GB employees for any purpose.

18.2 The Contractor shall work under the general direction of the Home Health Department Head and the Cuban Community Assistance Program Manager and shall follow established USNH GB Guidelines, Policies and Procedures.

18.3 Typically, Contractors work independently with assigned duties and report urgent or unusual problems to the nurse and/or physician in charge of the care of the patient.

18.4 Contractor personnel shall identify themselves as “Contractors” when attending meetings, answering Government telephones, or working in situations where their actions could be construed as official government acts. The Contractor shall ensure that their employee(s) display(s) his or her name and the name of the company while in the work area, and include “CTR” as part of their email address.

19 Inherent Government Functions:

19.1 Contractor and Contracted personnel shall not perform inherently governmental functions. This includes, but is not limited to, determination of agency policy, determination of Federal program priorities for budget requests, direction and control of government employees (outside a clinical context), selection or non‐selection of individuals for Federal Government employment including the interviewing of individuals for employment, approval of position descriptions and performance standards for Federal employees, approving any contractual documents, approval of Federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy.

20 Special Conditions for Naval Station Guantanamo Bay (NSGB):

20.1 Entry Approval for employees: No employee or representative of the Contractor will be admitted to the U.S. Naval Base, Guantanamo Bay, Cuba without prior entry approval. There are multiple approval processes that shall be done concurrently. The Contractor shall work with the Contracting Officer to create and complete a Synchronized Pre‐deployment and Operational Tracker – Enterprise Suite (SPOT‐ES) registration. Information and instructions will be provided upon award.

The background of Contractor personnel will be screened prior to entry to the U.S. Naval Base, Guantanamo Bay, Cuba. The Contractor shall submit to the COR (for vetting through NSGB security) the full name, date and place of birth, Social Security number, and addresses of such persons. This information shall be received by the COR 45 calendar days prior to the scheduled or desired arrival at the Naval Base. In addition to the security access requirements, the Contractor shall provide the following information for each employee to the COR 30 calendar days prior to the scheduled or desired arrival at the Naval Base; if the employee is already on island, then the

Contractor needs to coordinate with the COR and the USNH GB Occupational Health Program Manager to ensure the following immunizations are completed (immunizations will be completed at USNH GB for all Contractor employees already on NSGB):

20.1.1 TUBERCULOSIS TESTING: Contractor shall provide proof of immunization for all Contracted personnel of negative reaction to purified protein derivative (PPD) testing or negative interferon‐ gamma release assay (IGRA). This latter test is recommended for personnel with a previous Bacillus Calmette‐Guerin (BCG) vaccine history. If either is positive, personnel need to have a negative chest radiographic report for active tuberculosis and completed treatment for Latent Tuberculosis Infection (LTBI) or have started and are currently being treated for LTBI before arrival to island. The PPD /IGRA test shall be repeated annually if negative. An annual LTBI visit with provider shall be repeated annually for those who have had a positive test in their history.

20.1.2 RUBELLA TESTING: Contractor shall provide proof of immunization for all Contracted personnel for measles, mumps, rubella or a rubella titer of 1.8 or greater. If the titer is less than 1.8, a rubella immunization shall be administered with follow‐up documentation to the COR.

20.1.3 RUBEOLA TESTING: Contractor shall provide proof of immunization for all Contracted personnel for rubeola titer positivity or two documented rubeola immunizations. If the titer is negative or less than two rubeola immunizations have been administered, a rubeola immunization shall be administered with follow up documentation to the COR.

20.1.4 MUMPS TESTING: Contractor shall provide proof of immunization for all Contracted personnel for mumps titer positivity or two documented mumps immunizations. If the titer is negative or less than two mumps immunization have been administered, a mumps immunization shall be administered with follow up documentation to the COR.

Note: A combination Measles/Mumps/Rubella Titer exists and can be substituted as long as they meet the criteria detailed above.

20.1.5 Influenza Vaccine: Contractor shall provide proof of immunization for all Contracted personnel of influenza vaccine for current year’s flu season to the COR. Annual influenza vaccination is required.

20.1.6 HEPATITIS A VACCINATIONS: Contractor shall provide proof of immunization for all Contracted personnel for Hepatitis A titer or two documented Hepatitis A vaccinations. If titer is negative and less than two Hepatitis A vaccines have been administered, a Hepatitis A immunization shall be administered with follow up documentation to the COR. Completion of two immunizations or titer positivity follow up shall be completed within a year of employment.

20.1.7 HEPATITIS B VACCINATIONS: Contractor shall provide proof of immunization for all Contracted personnel for Hepatitis B titer. If the titer is negative, a Hepatitis B immunization shall be administered with follow up documentation to the COR. Completion of all three immunizations and titer follow up shall be completed within a year of employment. If repeat titer is negative and personnel have completed six total Hepatitis B vaccinations with proven documentation according to Center of Disease Control guidance, this is considered an adequate attempt to meet this requirement.

20.1.8 VARICELLA VACCINATIONS: Contractor shall provide proof of immunization for all Contracted personnel for Varicella titer or two documented Varicella vaccinations. If titer is negative, then a

Varicella immunization shall be administered with follow up documentation to the COR with repeat titer in 30 days.

20.1.9 TETANUS, DIPHTHERIA, AND ACELLULAR PERTUSSIS (TDaP) VACCINATION: Contractor shall provide proof of immunization for all Contracted personnel for TDaP. If no documentation, a TDaP immunization shall be administered with follow up documentation to the COR. If more than 10 years since documented TDaP then the Contractor employee will require a

Tetanus/Diphtheria booster immunization.

20.1.10 INFLUENZA VACCINE: Contractor shall provide proof of influenza vaccine for current year’s flu season to the COR. Annual influenza vaccination is required, as outlined in DHA‐PI 6025.34.

20.1.11 PHYSICAL EXAMINATION: The contractor shall provide proof of a recent physical with results indicating no medical conditions that would impede the employee’s ability to work with the

SCRs or conditions that would negatively impact the health of the SCRs from daily contact with the employee. In particular for food handling, personnel cannot be a carrier for an infectious disease; have a history of persistent vomiting (non‐gravida), history of hepatitis, history of jaundice, or history of untreated tuberculosis. In addition, skin needs to be free of any communicable diseases.

20.2 Medical and Dental services: USNH GB is a small community hospital that provides high quality health care in a remote setting. Health care is provided on a fee‐for‐service basis to contract employees, with prices set annually by the Office of Secretary of Defense. The Contractor or Contractor employee are responsible for paying all medical bills received as part of receiving care at USNH GB. The employee shall be aware that most medical and dental specialties that typically are available at a CONUS military treatment facility cannot be provided due to limited resources.

In addition, urgent and emergent medical and dental cases that exceed the hospital’s capability will be at the expense and responsibility of the employee and/or Contractor. The Contractor is responsible for providing the appropriate level of medical screening for their employees that is in compliance with the Force Health Protection Guidance for Deployment in USSOUTHCOM AOR as of 31 July 2017, and all other applicable instructions. Advise prospective employees of the limited medical and dental services available in Guantanamo Bay; and explain the Contractor's policy concerning the extent of liability and insurance coverage for required treatment. Every reasonable attempt shall be made to prevent personnel with chronic disorders that USNH GB cannot provide medical care for from being sent to U.S. Naval Base Guantanamo Bay.

20.3 Identification of Employees: The Contractor shall be responsible for furnishing to each employee, and for requiring each employee to display, such identification as may be approved and directed by the Contracting Officer. Employees may be fingerprinted prior to employment as a condition of entry onto the Naval Base. Contractors (U.S. Citizens) shall meet personnel security requirements to obtain a U.S. Government Common Access Card (CAC). Prescribed Government identification cards shall be immediately delivered to the Contracting Officer for cancellation upon release of any employee.

20.4 On‐Base Transportation: Bus service is available throughout NSGB however the Contractor may provide company vehicles for use by its employees on a non‐reimbursable basis. Vehicles may be purchased at Guantanamo Bay, but the government makes no representation as to suitability, availability, or pricing. Vehicles may be shipped to Guantanamo Bay. Vehicle registration is mandatory, and shall be provided by the Government at no cost. Contractor shall provide motor vehicle liability insurance to cover bodily injury and property damage to protect the Contractor and the Government against third‐party claims. Drivers shall possess a valid motor vehicle operator’s identification card and shall comply with traffic safety program set forth in OPNAV Instruction

5100.12. The Contractor shall bear the cost of required fuel, oil, lubricants, insurance, and vehicle maintenance.

20.5 Transportation of Personnel: Air travel to and from the base is limited, with demand often far in excess of supply.

20.5.1 Travel to and from Jacksonville, Florida; Norfolk, Virginia; and Kingston, Jamaica is provided by the Air Mobility Command (AMC) at the Contractor’s expense. Passage will be in reserved seats.

20.5.2 Airfare Charges at NSGB, Cuba, as of 1 January 2024, are included in PWS Attachment 1. Rates are subject to change and are only presented to assist interested Contractors with price quote preparation.

20.5.3 Emergency leave travel for verified personal emergencies such as death or serious illness of a family member will be at the responsibility and expense of the Employee and/or Contractor.

Emergency leave travel from NSGB will only be authorized to the above destinations on the next available flight, which remain chargeable to the Contractor at the international tariff rate.

20.6 Food Facilities: Contractor personnel may eat at the Navy Exchange food outlets, galleys, or at other open food service facilities on a cash basis at current prices.

20.7 Contractor Debts: The Contractor shall be liable for debts to the Government incurred by their employees for personal services at Guantanamo Bay, Cuba, including but not limited to private telephone service, medical and dental services, and W.T. Sampson School expenses. If an employee departs the Guantanamo Bay Naval Base without liquidating his or her debts, sufficient funds to cover this type of obligation will be withheld from Contractor payments until the debts are paid.

20.8 Drug Abuse by Contract Employees: The Secretary of the Navy has determined that the illegal possession and use of drugs and paraphernalia by civilian and contract employees in the military setting contributes directly to military drug abuse and undermines command efforts to eliminate drug abuse among military personnel. The policy of the Department of the Navy, including the Marine Corps, is to deter and detect drug offenses by civilian and contract employees on military installations. Measures to be taken to identify drug offenses on military installations, and to prevent introduction of illegal drugs and paraphernalia include routine, random inspections of vehicles and personnel possessions on entry or exit, with drug detection dog teams, when available. Where there is probable cause to believe that a civilian or contract employee on board a

Naval or Marine Corps Installation has been engaged in use, possession, or trafficking of drugs, that employee may be restricted or detained for the period necessary until that employee can be removed from the installation or can be turned over to local law enforcement authorities having jurisdiction, as appropriate. When illegal drugs are discovered during an inspection or search of a vehicle operated by a civilian or contract employee, the employee and vehicle may be detained for a reasonable period of time necessary to turn the employee and the vehicle over to appropriate civil law enforcement officials; action may be taken to suspend, revoke, or deny installation driving privileges. Implicit with the acceptance of this contract is the Contractor's agreement to comply with Federal statutes, laws, and regulations, including those regulations issued by the commander of the military installation.

20.9 Available Living Quarters:

20.9.1 US Citizens: For this contract, the Government will provide two (2) unaccompanied (unfurnished) housing units for the Contractor’s use. These units are reserved for use by unaccompanied personnel. Mixed gender housing is usually not allowed on NSGB for unaccompanied personnel.

If mixed gender housing is required, the Contractor shall notify the KO. The Contractor’s employees shall verify they understand they will be sharing a 2 bedroom house with a person of a different gender.

20.9.2 If accompanied housing becomes available at a later date, housing will be assigned as follows:

Accompanied personnel with maximum family size of three (3) dependents; unaccompanied personnel assignment will be made based on a minimum of one person per bedroom. If house sharing, accompaniment by dependents will not be allowed.

20.9.3 The Government will provide family housing units as available with the following appliances:

Refrigerator, stove, dishwasher, microwave, washer, and dryer. All other furnishings other than the listed appliances will be provided by the Contractor.

20.9.4 Information on Issuances of housing units, rental rates, and utility rates is controlled and distributed by the Housing Department, Building 2295, phone 757‐458‐2807.

20.9.5 Should the Contractor’s assigned units not be fully occupied, the Housing Department will cancel the assignment and return the unit to inventory for other use. Personnel shall abide by all Family Housing instructions, which are not part of this PWS but are available upon request.

20.10 Navy Exchange and Commissary Privilege and Recreation Facilities: Navy Exchange and commissary privileges and recreation facilities are available to Contractor personnel and dependents of Contractor personnel in accordance with current base regulations.

20.11 Department of Defense Education Activity (DoDEA) Schools: If housing becomes available in the future to allow for accompanied housing, and Contractor dependents are authorized to move in to housing, the Contractor dependents may attend DoDEA Schools on a cash reimbursable basis at the prevailing rates.

20.12 Laundry and Dry Cleaning: The Government will make available laundry and dry cleaning facilities for Contractor personnel and dependents of Contractor personnel at current rates as set forth by the Navy Exchange, Guantanamo Bay, Cuba.

20.13 General Information about Guantanamo Bay: The following links will provide basic information about life on Guantanamo Bay and the installation itself.

https://www.cnic.navy.mil/regions/cnrse/installations/ns_guantanamo_bay.html https://www.cnic.navy.mil/regions/cnrse/installations/ns_guantanamo_bay/about/installation\ guide.html

21 Transition Period:

21.1 Being that there is an incumbent for the contract requirement, the Contractor shall be allowed up to a maximum of 60 days for transitioning personnel into place prior to award effective date. The

Contractor shall not bill against CLINs until personnel/vehicles are operational on site for this contract. Task orders shall be written for 12 month increments and submitted invoices shall be pro‐ rated to reflect actual start dates for the first two months in operation.

Attachments:

1. Airfare Charges at NSGB