SECTION C: PERFORMANCE WORK STATEMENT

TITLE:

Federal Occupational Health (FOH) Private Provider Network (PPN)/ Contractor-Owned Contractor-

Operated (COCO) Client Portal System (CPS).

C.1 Purpose

The purpose of this contract is to acquire a network of occupational health professionals/providers to provide and deliver services through a nationwide private provider network (PPN) to support Program

Support Center (PSC) Federal Occupational Health (FOH) under the Department of Health and Human

Services (HHS). The nationwide PPN will consist of two regions: FOHNet East and FOHNet West (see

Section C.7, Contract Regions for details). The Contractor shall maintain a PPN within the designated

FOHNet Region and deliver a full-range of occupational health services, including but not limited to those listed in Attachment F – Service List.

C.2 Background

FOH improves the health, safety, and productivity of the federal workforce. FOH -Clinical Health Services

(CHS) delivers a full range of occupational health services to other federal agencies and their employees throughout the United States (U.S.), the District of Columbia, and the U.S. Territories through a large network of private-provider physicians and nurses. FOH provides defined health services as well as consultation to federal customer agencies exclusively through Interagency Agreements (IAAs). FOH is the largest provider of occupational health services in the federal government, serving more than 300 federal entities and reaching more than one million federal employees. Agreements are negotiated with federal departments and federal agencies’ national headquarters, or with their regional/local components for products ranging from a standard package of occupational health and safety program components to an array of services, including ambulatory clinical services and expert consultation tailored to a particular federal agency’s occupational health and safety, wellness and health promotion, and Employee Assistance

Program needs.

FOH sets the standard for promoting a culture of health and safety throughout the federal workforce. The effectiveness of FOH programs depends on the expertise and experience of a Contractor-managed PPN, which provides and delivers direct care through both fixed and mobile service providers. The PPN must:

• Provide high-quality services in individual and group settings.

• Place client/patient needs at the forefront of service delivery.

• Ensure all personnel deliver high-quality individualized care that meets FOH customers’ requirements.

Scope

The contractor shall provide all personnel, equipment, supplies, facilities, buildings, transportation, tools, materials, supervision, and other items, and non-personal services, necessary to perform occupational health services, utilizing the contractors private provide network and company owned company operated client portal system, as defined in this Performance Work Statement (PWS) except for those items specified as government furnished property and services. The contractor shall perform to the standards in this contract.

The contractor will complete services for FOH in accordance with work orders and referral documents.

DRAFT

FOH will send appointment referrals to the contractor to schedule clinical services with health care providers. Once examinations are complete, the contractor will return the results of the examination to

FOH. When consultation is requested, the Contractor will return the results of the consultation which may include medical evaluation results, responses to medical questions, and the consultant’s medical recommendations, as requested, to FOH.

The work performed under this contract requires the Contractor to:

• Accept service referrals (via work orders and referral documents), assign provider(s) who possess the appropriate credentials and expertise to provide the requested service, schedule patients and confirm appointments.

• Ensure all supplies and materials to be used at each scheduled exam including supplies and materials from FOH or other FOH vendors are secured in advance of scheduled exam,

• Complete examinations, retrieve, and compile results for all exam items requested using the forms provided by FOH.

• Provide timely follow up with examinee for all medical test results, lab results, and clinical recommendations per standard of care.

• Perform quality assurance reviews as outlined by FOH of the services provided, including monitoring results for accuracy and completeness.

• Ensure timely submission of the required medical examination and results to FOH in a comprehensive report.

• The ability to securely ship and/or transmit all completed medical record reports to a location(s) designated by FOH.

• The ability to securely store, all FOH medical records per FOH’s requirements (e.g., electronic and paper records).

• Notify clients of cancellations or change in schedule within 24 to 48 hours of the original scheduled appointment time.

• The ability to complete all required exams within a specific timeframe and location.

The Contractor will provide and maintain a secure web-based portal or Electronic Health Record (EHR) where FOH can submit patient service referrals and view the real time workflow and status of all referrals, appointments, patient cases, and medical records. The contractor shall submit to FOH for review and evaluation their detailed quality assurance process that will be used for review of medical examinations and records. This review will be part of the evaluation criteria. Examinations, results, forms, and all other patient information, all of which is the property of FOH, shall be uploaded to the Contractor's secure web-based portal. Original documentation may be required to be mailed, shipped, faxed, or otherwise electronically transmitted through secure means to designated FOH location(s).

The Contractor’s primary role is to facilitate the delivery of FOH services in the U.S. and its territories where an OHC is unable to perform the required services for a customer. The Contractor will maintain a network of provider locations and staff capable of performing these services within the distance requirements and timeframes specific herein. Where provider locations and staff are not available or able to be established by the contractor, mobile units, are to be made available by the contractor with no additional cost to the government. FOH must approve the use of a mobile unit prior to service delivery.

Provider Service Locations

Service appointments shall be scheduled in the most efficient way so that the examinee shall make the least number of trips to complete the requested examination and testing at a single provider location to the greatest extent possible. Every effort shall be made to ensure all work order requirements are completed in one visit, unless otherwise stated in the work order. Advance approval from the COR must be obtained if services will be performed at more than one location, or if a second visit is needed due to a failure to complete all requested services on the original work order. Failure to notify and obtain authorization from

FOH will result in penalty. In areas where more than one provider location is available within the

Contractor’s PPN, FOH may dictate which provider location is used to schedule specific FOH customer agencies. FOH may also require that the Contractor discontinue use of a provider at any time if FOH deems the quality of the facility, services, or providers insufficient to meet the needs of the contract. Or, if the provider is unable to follow tenets as set forth in the contract. The COR may require that the use of provider service locations deemed by FOH to be insufficient be discontinued at any time.

If the Contractor is unable to locate a provider, arrangements must be made by the Contractor for requested services to be provided via mobile van when a fixed provider location is unavailable. In such instances, FOH will not be responsible for any charges associated with the mobile van service, hourly outreach practitioner charges, or any charges other than the services provided. The Contractor shall notify FOH in such instances and then obtain approval from the FOH COR to proceed with setting up the mobile service provider(s). The mobile service provider is expected to adhere to the same quality and standards of service as outlined in the contract prior to entering into any provider agreement pertaining to this contract for such service.

New Provider Locations

The Contractor will be expected to verify whether the work order requirements can be satisfied by the

Contractor’s existing PPN or if a new provider location will be required. When requesting new provider locations, FOH will notify the Contractor of the expected locations that comply with the distance (C.8.1) and work/service order requirements, and estimated volume and timing of referrals, if available. The

Contractor shall add new provider locations within the assigned region at no additional cost to the government. If requested location is not covered by the Contractor’s existing PPN, the Contractor shall establish a new provider location, or arrange mobile van services, within 30 calendar days of notification from the COR receiving the referral requirements. Failure to establish a location within the required 30 calendar days may result in a disincentive of $2500.00 each calendar day beyond the 30 calendar days until a new provider location is available for service scheduling. This disincentive shall not exceed $55,000.00 per new provider location referral. In cases where providers are limited and if the services required cannot be provided via mobile van, the contract will provide a plan to FOH within 3 business days that indicates how the requested service can be rendered.

New Provider Startup Call and/or Visit

The Contractor shall support a new provider location “startup” call” or visit with FOH, FOH agency customers, and any other key stakeholder determined by the COR, when requested. The purpose of the call is to identify, learn, and understand the new provider and unique forms, training, provider- specific logistics, or criteria that will need to be addressed prior to scheduling patient care services with the new provider location. The Contractor shall not be disincentivized for timeline delays for which FOH or FOH customer agencies are responsible (e.g., FOH site visit availability, FOH startup call availability, etc.).

The Contractor shall designate a team of program directors and managers with the necessary qualifications and licensure to provide oversight and be responsible for all Contractor operations. The Contractor will be responsible for receipt of all referrals for service requirements sent by FOH and the coordination and administration of the necessary services. The subcontractors and Contractor employees are expected to follow the same requirements as the contractor.

The Contractor shall review all examinations, work order results, and associated documentation for quality assurance prior to submission to FOH. FOH may make the final determination as to the quality of the service provided. FOH must have a point of contact who works with the Quality Assurance team to resolve issues regarding the services provided to FOH by the Contractor. Contractor shall designate an individual to receive FOH inquiries and provide responses to issues within 24 hours or one business day.

PPN Services

Service/work order requirements may be performed through a variety of contractor PPN facilities that are capable of administering FOH examinations and services such as, but not limited to, hospitals, occupational health clinics, general medical clinics, specialty clinics, and urgent care facilities. All required orders and forms will be specified in the work orders and made available to the Contractor by

FOH in advance of service referrals. The Contractor shall distribute within 1 business day of receipt all updated work order required forms, documents, and supplies to the PPN provider responsible for performing services and provide any needed updates. The Contractor shall ensure annually that they receive from FOH an updated set of examination forms, documents, and work orders prior to the start of each FOH fiscal year.

The PPN provider is responsible for ensuring all clients are appropriately notified of exam and testing results and that the examining physician or licensed independent practitioner provides appropriate clinical and follow-up recommendations, as indicated. This shall be documented in the client’s record in the provider’s office where the examination was performed as well as in their examination report that is provided to FOH. The Contractor shall ensure the provider is adhering to all FOH notification requirements for FOH and federal agencies related to examinees, examinations, testing results, and mandated reporting. Certain agencies also require notification for abnormal results or post-exposure testing. The Contractor shall ensure all notification instructions included in the work order are followed.

The following are examples of notifications that are required:

• The Contractor shall notify FOH of positive Tuberculosis (TB) test results and all post-exposure

TB test results (positive and negative) within 24 hours or one business day.

• The Contractor shall ensure providers are following all mandatory infectious disease reporting as required by the federal government, FOH policy, the state, and the Centers for Disease Control and

Prevention.

A full list of required notifications will be provided upon award.

Outreach Services

Outreach services are a key source of health care that are used to provide healthcare services in rural communities. Outreach services are also useful to provide services when a large number of employees located in the same area require similar services (e.g., flu vaccinations). Outreach services shall take place at qualified facilities and with qualified personnel. Outreach services include services that are provided by mobile vans and traveling medical staff who are equipped with appropriate medical equipment and supplies.

Qualified facilities are locations that comply with all federal, state, and local healthcare regulations, guidelines, standards and other recognized best practices, maintain proper licensing and certifications and comply with The Joint Commission standards. The outreach health care services must be delivered by appropriately certified, credentialed, and licensed personnel.

FOH will indicate on a referral when outreach services are required or when a customer referrals services at a specific location. FOH will also notify the Contractor about work order requirements for outreach services. The outreach facilities must ensure patient privacy in accordance with HIPAA and the Federal

Privacy Act, as well as provide safe and suitable environments for providing occupational health services that meet medical standards of care. This requirement also applies to mobile units and temporary setups staffed by trained professionals when fixed facilities are not feasible.

The Contractor must receive approval from the FOH COR prior to scheduling outreach services. The FOH

COR will send the Contractor a referral for outreach services (e.g., audiograms, vaccines, flu shots, etc.)

electronically along with the applicable work order. The Contractor is required to provide a cost estimate to FOH, including possible dates of service, prior to scheduling. Thus, the Contractor’s quote must specify an expiration date.

Mobile Van Outreach Fee

The mobile van outreach fee is utilized when the work order requirements indicate a mobile van outreach service is required. The fee will be billed upon completion of all work order requirements contained within the referral. The fee is intended to cover non-service-related costs incurred by the Contractor – these costs may include but are not limited to a mobile van, setup/cleanup, travel expenses, and/or driver (if other than service practitioner). The fee is intended to be applied on a “per hour/event” basis. Individual services performed during a mobile outreach event shall be invoiced in addition to the Mobile Outreach Fee. Please see C.15.5 Mobile Outreach Fee for additional information.

Mobile Van Outreach Late Cancellation Fee

The Contractor can charge FOH a mobile van outreach late cancellation fee for failure to appear or cancel within three (3) business days of the scheduled event date. The fee is intended to cover non-service-related costs and applied on a “per day/event” basis.

Quality Assurance

The Contractor shall implement a quality assurance process to review all materials for accuracy and completeness. The quality assurance process shall include:

• Monitoring all exam components and forms, including required signatures and dates, to demonstrate that testing is adequate, and that all information is captured accurately and reviewed in accordance with the instructions provided in the work orders.

• A process and accompanying documentation demonstrating that all providers and their staff are properly trained, certified, and licensed to deliver the required services. For example, providers must be trained on

FOH policies and procedures, appropriate forms and documents to complete, and hold professional certifications.

• Verification that all reports, results and documents from requested services undergo quality review. The contractor shall notify FOH of any missing examination items or delays within 24 business hours of the exam appointment. This notification must include the reason for the missing items or delays. In the rare occasion, if the examination has a missing item(s), the contractor may referral additional time but must obtain approval from FOH before proceeding.

• Tracking and maintaining documentation of the transmission of service results to FOH. All documentation and service recommendations shall be submitted to FOH within five business days following the completion of the examination.

Health Care Staff Credentials

All practitioners and professionals engaged under this contract must meet the following requirements:

• Education o Hold degrees from accredited institutions in their respective field (e.g., MD, DO, NP, RN, Audiologist, etc.).

o Complete specialized training required to perform occupational health services, such as required occupational health examinations, audiometry, spirometry, travel medicine, or vaccinations.

• Expertise o Demonstrate proficiency in delivering occupational health services, including preventive care, health assessments, and wellness programs.

o Maintain current knowledge of federal health regulations, The Joint Commission (TJC) standards, and best practices in occupational health.

• Work Experience o Possess relevant clinical experience in occupational health or related healthcare settings.

o Have documented experience providing services in various environments, including fixed facilities and mobile outreach settings.

• Licensure and Certification o Hold and maintain active state licensure for their profession throughout the contract period.

o Maintain certifications such as Basic Life Support, other credentials as required by service type.

• Continuing Education o Principate in ongoing professional development and training to ensure compliance with evolving standards and regulations.

• Compliance and Ethics o Adhere to HIPAA and federal privacy regulations.

o Follow FOH policies and ethical standards for patient care and safety.

FOH is committed to delivering safe, high-quality care to our customers and partner agencies by adhering to The Joint Commission Standards for Ambulatory Care, including the requirements for credentialing and privileging of licensed independent practitioners and other clinical staff. FOH has invested significant time and resources in aligning its policies, procedures, and operational practices with TJC guidance and standards for credentialing, privileging, and assessing staff competency.

The Contractor shall ensure that all testing and services provided under this contract comply with TJC

Standards for Ambulatory Care, including all applicable human resource requirements. The Contractor shall support FOH in its processes to maintain compliance with TJC ambulatory care standards and by actively participating and contributing to FOH’s performance improvement initiatives.

FOH Policy

The quality of services provided by the Contractor shall be guided at a minimum by national healthcare quality standards recognized by relevant national medical specialty boards, established industry best practices and ethics, and the standards of care in the state or locality where the services are provided.

FOH maintains a robust quality, safety, and risk management (QSRM) program to provide and maintain a safe, functional, supportive, and effective environment for customers. The Contractor shall proactively promote a culture of safety by ensuring that all services comply with the national standards referenced above, maintain processes for safety event data collection and reporting, participate in performance improvement activities, administer staff surveys, and support patient safety through effective communication practices with FOH.

C.3 Challenges to be mitigated

The Contractor can expect to face several major challenges throughout the life of this contract. These challenges if not properly managed by the Contractor may result in the Contractor not providing the services required in this PWS and may result in serious negative repercussions to the Contractor as well as jeopardy of FOH’s mission. Key challenges associated with this contract that require the

Contractor’s attention include:

• Efficient Communication: The Contractor is expected to communicate and coordinate efficiently with its PPN providers to ensure timely completion of exams and tests as directed by FOH.

• Missing and Delayed Items: The Contactor is expected to have contingency plans for missing or delayed items to minimize collection of repeat samples for testing.

• Scheduling process: The Contractor must ensure communications facilitate timely scheduling, incorporate an appointment confirmation- process, and address facility closures to help prevent missed or rescheduled visits. This involves identifying an accurate and complete list of required testing for a client prior to scheduling, ensuring necessary equipment and skilled personnel will be at the appointed facility to complete the exam, and submitting complete reports to FOH within the specified timeframe(s).

• Records management: The contractor is expected to oversee the secure and confidential management of federal medical records (paper and electronic) in accordance with Office of Personnel

Management (OPM), the National Archives and Records Administration (NARA), and the Office of the National Coordinator (ONC) requirements for electronic and physical medical records.

• Efficient Billing: The Contractor must ensure proper and timely billing for FOH services through effective and coordinated communication with its PPN providers, thereby preventing improper or misdirected billing. This includes establishing a clear process for identifying FOH clients to ensure charges are directed to the appropriate vendor, rather than accepting clients’ insurance cards or issuing bills directly to clients.

• Service Provision in Medically Underserved Areas: The Contractor is expected to ensure that

FOH clients receive evidence based care that complies with federal regulations, national healthcare quality standards, and industry best practices, consistent with FOH’s location requirements. This includes delivering services within required timeframes in rural, sparsely populated areas, and provider desert locations.

• Reporting Medical Information: The contractor is expected to report abnormal labs and testing results to FOH and clients when necessary and within required timeframes in compliance with applicable federal privacy and record disclosure regulations. The provider must offer follow-up recommendations as needed and document these actions appropriately.

The Contractor must ensure that the PPN providers in their network understand the process for communicating examination and medical test results to the contractor. The Contractor should also establish a process to ensure PPN providers send examinations and test results to the correct recipients.

The contractor shall submit a mitigation plan for all above challenges within 30 days of the effective date of the contract award.

C.4 Definitions/Acronyms/Abbreviations

• ATO – A government acronym for Authority To Operate.

• Contracting Officer’s Representative (COR) - An individual within FOH appointed by the

Contracting Officer to manage and monitor this contract from a technical standpoint.

• CUI – Controlled Unclassified Information

• CONUS – A government acronym for the contiguous US.

• OCONUS - A government acronym referring to locations outside the contiguous U.S., including areas beyond the 48 adjoining states and the District of Columbia. This encompasses foreign countries as well as U.S. states (Alaska, Hawaii) and territories such as Guam and Puerto Rico.

• Contractor Secure Web-Based Portal - A Contractor owned and contractor operated (COCO) secure web-based portal with an HHS issued ATO to be used as an interface to manage FOH client data.

The portal allows selected FOH and agency personnel to access real-time client reports and data. The portal also allows select FOH federal employees to review reports and invoicing data. The portal must have the minimum capabilities listed below:

o Examinee self-scheduling capabilities o Date and Type of Referral o List of Tests Required on individual client o Date of Examination o Date of Exam Cancellation o Date of Exam Reschedule o Date Exam went for Quality Review o Whether Exam has Missing Item and Examinee Notification o Individual Exam Reports including Outreach reports o Case Notes regarding delays and pertinent information o Reports by Agency o Reports by Date

• Federal Occupational Health (FOH) - A service component within the Department of Health and

Human Services offering comprehensive occupational health programs to improve the health, safety and productivity of the federal workforce. FOH’s governing organization is the Program Support

Center (PSC), within the Office of the Assistant Secretary of Administration.

• FOH Customer - A federal agency who has entered into an inter-agency agreement with FOH to have their federal employees receive services from FOH at a Service Provision Site (SPS).

• FOH Private Provider Network (FOHNet) - A network of private provider facilities used by FOH to expand access to services beyond its SPSs or OHCs to meet the health and wellness needs of Federal government employees.

• IME – Independent Medical Examinations

• NIST – A government acronym for National Institute of Standards and Technology.

• NPI – An acronym for National Provider Identifier.

• Mobile Outreach Services – On-site or off-site clinical and occupational health services delivered by

FOH or its Contractor by their healthcare professionals at designated federal agency locations or in the field.

• Mobile Van – A Contractor-operated vehicle equipped to deliver clinical and occupational health services directly at or near federal worksites and/or community locations.

• Occupational Health Centers (OHCs) - FOH managed health clinics and wellness centers located throughout the U.S., offering occupational health and wellness services to Federal government employees. FOH has clinics and wellness centers located outside of the continental U.S. (e.g., Guam, Hawaii, Alaska, Puerto Rico, etc.)

• Outreach Services - Clinical services that are provided at the employee’s worksite or other agency-requested location at a FOH-approved site FOH. Typical services offered as outreach services include immunizations and screenings. Outreach services may be provided using mobile van services.

• PII – A government acronym for Personally Identifiable Information.

• PPN – Private Provider Network

• Service Provision Sites (SPSs) - FOH sites capable of providing occupational health and wellness services. These include FOH Area Offices, FOH OHCs, FOH Fitness Centers and FOH Private

Provider Network (FOH PPN) sites.

Work order - A document with specific information and instruction for health and wellness services that an agency authorizes for their federal employees. A Work Order is part of an FOH referral for services. The work order includes a checklist of approved services based on agency requirements, as determined by the Interagency Agreement (IAA), that may include scheduling instructions. The work order is not specific to a particular Federal government employee.

C.5 Place of Performance

Contract services shall be carried out within the continental U.S. (CONUS) and outside the continental U.S.

(OCONUS), as specified in the contract.

C.6 Contract Regions

The Contractor will be responsible for all PPN referrals within the following four regions:

• NORTHEAST: Connecticut(CT), Maine(ME), Massachusetts(MA), New Hampshire(NH), New

Jersey(NJ), New York(NY), Pennsylvania(PA), Rhode Island(RI), Vermont(VT)

• MIDWEST: Illinois(IL), Indiana(IN), Michigan(MI), Ohio(OH), Wisconsin(WI), Iowa(IA), Kansas(KS), Minnesota(MN), Missouri(MO), Nebraska(NE), North Dakota(ND), South

Dakota(SD)

• SOUTH: Alabama(AL), Arkansas(AR), Delaware(DE), District of Columbia(DC), Florida(FL), Georgia(GA), Kentucky(KY), Louisiana(LA), Maryland(MD), Mississippi(MS), North

Carolina(NC), Oklahoma(OK), South Carolina(SC), Tennessee(TN), Texas(TX), Virginia(VA), West Virginia(WV), Puerto Rico, U.S. Virginal Islands

• WEST: Alaska(AK), Arizona(AZ), California(CA), Colorado(CO), Hawaii(HI), Idaho(ID), Montana(MT), Nevada(NV), New Mexico(NM), Oregon(OR), Utah(UT), Washington(WA), Wyoming(WY), American Samoa, Guam, Northern Mariana Islands

Attachment D – Service Region Map contains an illustrated map of the Regions. The Contractor will be expected to maintain a PPN network capable of servicing all regions at a moment’s notice. The government shall have the unilateral right to adjust the regions on a Task Order based on performance. The Contractor shall maintain a single price for each service on this contract that will be valid nationwide. The “OCONUS

Fee” identified in C.15.3 applies when a new service location is added outside the continental United

States.

Distance Requirements

In general, referrals for work/service order requirements in cities/towns with populations under 100,000 should be within a driving distance of 50 miles of the patient/employee’s location. The Contractor shall notify FOH when it is unable to meet the 50-mile requirement. The Contractor shall submit details to FOH in writing the actions taken by the Contractor to locate a provider location within the specified distance requirement, and detailed information on the closest available provider location. The COR may assess a disincentive up to 20% of the total cost of all work order service requirements per patient/employee referral for any service(s) performed outside the distance requirements without prior COR approval. The distance requirements may be waived on a case-by-case basis, with approval from FOH.

Work order requirements may specify different distance requirements for provider location(s) than identified in the paragraph above. The Contractor shall make every reasonable accommodation and shall not be subject to prior approval from the COR or a disincentive prior to scheduling the requested service when a service scheduled using distance requirements as specified in the applicable work order.

C.7 Overview of Services

Work order requirements must be completed by licensed health care provider(s)(LHCP) whose knowledge, skills, and abilities are commensurate with the scope of practice per the state or territory requirements in which the service is performed. All LHCPs must be board-certified physicians with either a MD or DO degree unless otherwise specified by FOH.

All tests and services need to be performed using accurate, properly calibrated and maintained equipment, and properly trained and credentialed personnel familiar with the required occupational health standards for testing and services. The tests and exams must be performed exactly as outlined per FOH and reviewed for the quality and accuracy of examination and testing, and will include accurate, legible, and complete documentation.

Audiometry equipment and calibration shall meet all requirements set forth in OSHA Standard 1910.95

Occupational noise exposure, and audiograms must be performed and reported as specified in FOH Work

Orders. Performance of spirometry shall meet National Institute for Occupational Safety and Health and the American Thoracic Society’s latest standards. FOH reserves the right to referral calibration and maintenance documentation from the Contractor for any service provider location or mobile provider.

Calibration documentation shall be provided to the FOH within five (5) calendar days of the referral.

The Contractor is responsible for ensuring that necessary training and instructions are given to all PPN personnel dealing directly with FOH examinees, including but not limited to updates in FOH policies, procedures, documents and forms and information regarding penalties for late exams, missing items, and improper billing. Work order requirements may identify services individually or be included as part of customized physical exam referral(s). FOH will initiate all referrals for the Contractor’s PPN to provide service.

The Contractor shall maintain and temporarily store all records and results. The Contractor must submit all results to FOH electronically through the Contractor’s secure web-based portal. All electronic and paper medical records associated with the Contractor’s PPN shall remain the property of FOH. The Contractor and its providers are prohibited from permanently storing paper originals or copies at any location.

The Contractor shall not use electronic medical records outside the scope this contract or for any purpose unrelated to the provision of clinical services under this agreement.

Attachment F – Service List Supplemental Information - The CPT/CDT codes and volume estimates included in Attachment F are designed to assist with initial line item pricing only. The service titles and descriptions provide a general summary of each line item. Additional requirements and instructions for each line item may be included in the individual work or service order, as specified by FOH or the applicable FOH customer agency policy.

Specialized Services

Work order requirements will be clarified in each referral provided to the Contractor. Work order requirements may also include additional referrals for specialized services. Examples of specialized services include tailored operational process flows for scheduling and service timing, specialized services or examinations, use of agency specific forms, and specific practitioner credentials and certifications.

Further clarification beyond the work order requirements may be obtained from FOH upon referral.

Management of the Private Provider Network

The Contractor shall maintain a PPN network and provide FOH with a comprehensive list of all active provider locations with associated practitioners and service capabilities. The complete list will be provided to the COR within 30 days from the effective date of the task order or upon referral from the COR.

Thereafter, updates to PPN locations will be provided to the COR within 3 business days of FOH requesting a PPN change.

Laboratory Services

The Contractor shall prepare laboratory requisitions for FOH examinees and ensure that each client is directed to FOH’s designated laboratory vendor prior to their scheduled appointment. The Contractor shall ensure that each examinee is provided a minimum of seven (7) calendar days to complete the required laboratory work prior to their scheduled appointment.

Vaccines

The Contractor will prepare and ship vaccines, when required. Shipment of vaccines shall meet or exceed

Centers for Disease Control and Prevention (CDC) requirements for vaccine shipment. The Contractor will be responsible for shipping, faxing, and electronically transmitting medical records to specified locations as identified in the work order or as directed by FOH.

Complaint Resolution Plan

The Contractor’s PPN staff shall conduct themselves in a professional and appropriate manner at all times, including in their interactions with patients and in maintaining equipment quality, facility cleanliness, and other related responsibilities. The Contractor shall monitor and manage PPN performance. Providers who fail to meet the requirements of a referral may be subject to removal from providing services to FOH examinees at FOH’s request.

FOH may also require the Contractor to develop a Complaint Resolution Plan. The Contractor must review all service and provider complaints related to inappropriate or unprofessional conduct and poor performance. All complaints that the Contractor receives about services provided under this contract must be submitted to the COR along with a plan for resolution within five (5) business days of the Contractor receiving the complaint. Failure to submit or resolve complaints within 30 business days may result in a negative performance review and escalation of the issue to the Contracting Officer for disciplinary action.

Provider Site Visits

FOH reserves the right to conduct site visits at locations that provide services for this contract. The COR will contact the Contractor’s Program Manager to schedule site visits. Site visits may include a detailed evaluation of the provider’s facility by FOH designated personnel. At any time during the life of the contract, the COR may instruct the Contractor to discontinue using a provider location(s) to perform services for this contract.

C.7.1 Web-Based Portal Capability

The Contractor shall receive all referrals through the Contractor’s secure web-based portal. FOH will place a referral into the Contractor’s secure web-based portal for action. It is the Contractor’s responsibility to check their secure web-based portal and manage each record in accordance with the timeframes outlined within the PWS.

The Contractor is responsible for transmitting patient information to FOH by uploading service results, lab results, forms, and any other required information into the Contractor’s secure web-based portal.

The Contractor shall provide a secure web-based portal that provides FOH staff the following capabilities:

• Ability to upload individual and batch appointment referrals into the secure web-based portal.

• Allow FOH to edit a referral after submission. The portal must track and report information about the edits including the date, time, and identity of the person making the changes.

• Search for examinees and view the status of referrals for services, appointments, and cases within the system.

• Create, retrieve, and download management reports containing case information. For example, the portal must be able to generate reports showing referral statuses such as pending scheduling, scheduled/open, completed, cancelled, and rescheduled, along with the corresponding dates. Reports must include specific details such as processing milestone dates and times and automatically calculate duration.

• Capability to export the data in Excel format. The type, frequency and format of the data will be determined by FOH.

• Retrieve completed exam and laboratory results.

• Create reports with detailed charges associated with a monthly invoice.

• Create reports with FOH-specified quality indicators monthly.

If the referral does not contain sufficient information required to complete the referral, then the

Contractor must notify FOH within 24 hours of receipt of the referral. FOH will provide the requested information and edit the referral within the Contractor’s secure web-based portal. The

Contractor shall complete the assigned work while adhering to the requirements contained this PWS.

Records Management and Retention

The Contractor and any subcontractors must maintain all employee medical information in compliance with Executive Order 13556 (Controlled Unclassified Information), the federal Privacy

Act, OPM guidance, OPM/GOVT-10 Employee Medical File System Records requirements, NARA

General Records Schedules (GRS), and HHS and FOH policies. They must not dispose of, transfer, or alter any medical records without prior written authorization from HHS/FOH. All records must be retained and disposed of according to applicable GRS and agency-specific schedules to ensure confidentiality, integrity, and retrievability throughout their lifecycle.

At the end of contract performance, the COR will provide disposition instructions to the contractor for securely transferring or destroying in accordance with 36 CFR § 1226.24 and NIST SP 800-88. These regulations apply to any records that are in the contractor's (or any subcontractor's) custody or control and subject to the federal Privacy Act that were created or maintained to perform services for this contract .

Under no circumstances may the Contractor or any PPN location destroy, delete, compromise, or disclose medical records except as directed by the COR and in accordance with the Performance

Work Statement (PWS).

The Contractor and any subcontractors must immediately document and report any accidental disposal or destruction of medical records to FOH in accordance with HHS/FOH policy.

Loss or Compromise of Records

The Contractor and any shipping company utilized by the Contractor must notify FOH within 24 business hours of discovering any loss, misplacement, or compromise of records, forms, or other documents containing examinee information. The notification must include, at a minimum:

• Names of all affected examinees

• A description of the incident

• The type of information involved

• Circumstances surrounding the loss

Credit Monitoring

The Contractor must provide credit monitoring services for three (3) years to all affected examinees when PII or protected health information is compromised or disclosed at no cost to the Government or the federal employee.

Corrective Action Plan

Within 72 business hours of discovery, the Contractor must submit a written corrective action plan to FOH. The plan must include:

• Root cause analysis

• Mitigation strategies

• Measures and an implementation timeline to prevent recurrence

Confidentiality of Medical Records

The Contractor shall treat all records containing employee medical information as confidential and maintain them in accordance with:

• 5 U.S.C. 552a, the Privacy Act of 1974

• Federal regulations

• OPM/GOVT-10 Employee Medical File System Records requirements

• FOH policy and procedures

• Executive Order 13556 (Controlled Unclassified Information)

• NARA GRS

Health Insurance Portability Accountability Act (HIPAA) Compliance

HHSAR Subpart 324.70 – HIPAA of 1996 applies to this requirement. The Contractor shall comply with HIPAA in accordance with this subpart and 45 CFR 160 and 164.

Privacy Act Applicability

This contract is subject to the Privacy Act of 1974 because it involves the design, development, or operation of a system of records on individuals. Performing federal occupational health services requires Contractor PPN staff to have access to PII and PHI under federal agency control. The applicable System of Records Notices (SORNs) include:

• OPM/GOVT-10 Employee Medical File System Records, June 21, 2010, 75 FR 35099, updated November 30, 2015, 80 FR 74815 (covers medical records about civilian federal employees)

• OPM/GOVT-5 OPM/GOVT-5, Recruiting, Examining and Placement Records

• Similar SORNs published by any FOH customer agencies that are independent agencies, defense agencies, etc., whose employees are hired under a non-OPM hiring authority.

Emergency and Surge Services

FOH may require the Contractor to provide emergency and surge services to complete referrals for services that are beyond an estimated volume. The Contractor shall maintain emergency and surge capabilities in place to accommodate such referrals should FOH have the need. When emergency or surge services are invoked, the Contractor shall meet service requirements in accordance with the tenets of this contract, prevailing evidence-based medical standards of care and health care industry best practices.

Under emergency or surge circumstances, the COR will notify the Contractor of the specific service(s) required. The Contractor will notify FOH within 24 hours of its plan to meet the requirement. Changes related to the contingency plan should be communicated to FOH within 24 business hours.

C.8 Services

A. Scheduling

The contractor must receive referrals containing work order requirements through the Contractor’s secure web-based portal. The Contractor shall work directly with FOH, FOH customer POCs, or customer employees/applicants, as designated by FOH, to schedule appointments,. The Contractor shall not schedule or complete any services without first receiving a referral from FOH authorizing the services. The

Contractor shall make direct contact with employees/applicants, or FOH customer scheduling POCs, within 48 hours of the referral receipt date annotated within the Contractor’s secure web-based portal. The

Contractor shall make at least three (3) attempts, with at least four (4) hours between each attempt, via phone to contact an applicant, employee, or FOH-specified customer POCs to schedule the appointment.

The Contractor shall continue to attempt to contact the applicant or employee every 72 hours and document all communication attempts and results in the applicant or employee record in the Contractor’s secure web-based portal. The Contractor shall maintain a single toll-free phone number to be used for all return calls from FOH and FOH customers. All outbound and inbound calls shall be answered using an identifier established by the COR. If the Contractor is unable to contact the employee after four attempts, then the Contractor shall notify FOH for further instructions. The referral is to remain open until FOH provides instructions for next steps.

The contractor shall submit on a monthly Self-Assessment Report a list of all work order requirements that could not be scheduled due to applicant, employee, or Contractor PPN provider availability. If attempts to communicate with the requester are successful, the Contractor shall provide the applicant or employee with an appointment confirmation notice via email and phone, immediately after scheduling. The email appointment confirmation shall include, at a minimum, the provider’s physical address location, practitioner’s name, and any special instructions. The content and structure of the appointment confirmation notice email may be changed by the COR at any time. The Contractor shall document the date and time of the phone conversation with the applicant or employee, including whether the individual accepted or declined the appointment. If the Contractor is unable to reach the applicant or employee by phone, then the

Contractor shall document their unsuccessful attempt to confirm the appointment by phone including the date, time, whether a message was left on voicemail or with a person, preferably with a name.

Rescheduling Appointments

The Contractor shall ensure that providers have all necessary forms, supplies and materials to complete scheduled appointments in advance. If an examinee arrives for an appointment and must be rescheduled without advance notice, then the Contractor shall bear full responsibility. Any provider who is not prepared or is unable to provide a referred service without notifying the examinee at least 48 hours in advance of the scheduled appointment, will result in the Contractor incurring a penalty of $1,000.00 per rescheduled appointment.

If an appointment must be rescheduled, the Contractor shall document the reason, specifying whether it was due to the employee, the provider, or another cause. The Contactor must attempt to reschedule the employee within 48 hours of the original appointment. If the Contractor is unable to reschedule the employee, then FOH must be notified in writing within 24 hours. The referral must remain open until

FOH provides instruction to close the referral. The Contractor must document rescheduled appointments or additional appointments needed to complete all work order requirements in the Contactor’s secure web-based portal and in the monthly report Self- Assessment Report.

B. Standard Referral Service Completion

The Contractor shall schedule and complete all work order requirements within 10 business days of referral receipt. The Contractor must confirm receipt of referrals within 48 business hours of FOH submitting the referral. If the Contractor does not schedule and complete all required services (excluding those for the Medical Employability Program) within 10 business days from confirming receipt of the referral, a $500.00 disincentive will be applied. Medical Employability Program referrals must be completed within 30 business days. If the Contractor is unable to complete the work order requirements for the referral within 10 or 30 business days, as indicated in this paragraph, then the Contractor must contact FOH immediately for further instructions. The Contractor must explain to FOH in writing why the work is unable to be completed within the required timeframe and submit a written contingency plan.

C. Expedited Referral Service Completion

The Contractor shall schedule and complete all expedited referral work order requirements within five (5) business days of referral receipt. FOH will mark the referral as “Expedited” in the Contractor’s secure web-based portal.