PWS with addition of Telehealth.pdf

Performance Work Statement

MEDICAL ADVISORY AND MEDICAL DIRECTED

TRANSPORTATION SERVICES

PART 1

GENERAL INFORMATION

1. Introduction: This is a non-personal services contract to provide medical advisory and medical directed transportation services. The Government shall not exercise any supervision or control over the contract service providers performing the services herein.

1.1 Description of Services/Introduction: The Contractor shall provide qualified personnel, supplies, and services necessary to perform the outlined services as defined in this PWS, except for those items specified as Government furnished property and services. The Contractor shall perform to the standards in this PWS and in the resultant contract.

1.2 Background: Military Sealift Command (MSC) is the owner and operator of more than one hundred ten (110) maritime vessels, including Government Operated (GOGO) ships manned by Civil Service Mariners (CIVMARs) and four (4) prepositioned squadrons, and is responsible for ensuring the operational readiness of those ships throughout their active service period. MSC’s mission is to provide sealift for strategic mobility support of national objectives. Specifically, MSC provides cargo and petroleum, oil and lubricants, transportation, fleet auxiliaries and special mission ships in peace, in addition to preparing for and providing strategic sealift during mobilization. While each employee plays a vital role in MSC meeting its worldwide mission in support of varied customers in MSC’s five geographic area commands (Atlantic, Pacific, Europe, Middle

East and Far East), MSC’s ability to successfully execute its mission is dependent on the health of its embarked workforce.

MSC’s Force Surgeon's Office (N02H) is charged with establishing medical policy and providing medical support services to CIVMARS, active duty military personnel, and mission-sponsor personnel embarked on MSC vessels. MSC vessels are staffed with either a Medical Services Officer (MSO) or a Medical Department Representative (MDR) who address acute or emergent medical needs. MSOs have previously trained as a Navy

Independent Duty Corpsman, Registered Nurse, or Physician Assistant. MDRs have been trained and certified to meet the minimum Standard in Training Certification and Watch-keeping for Seafarers (STCW) competencies as a "Person in Charge of Care" required by the United States Coast Guard. MSOs and MDRs are not trained to provide definitive care for all afloat medical problems. There are medical situations where MSOs and MDRs must seek more advanced medical assistance through synchronous and asynchronous communication with others, such as N02H, the United States Navy Fleet Surgeon for the area of operation in which the MSO/MDR’s ship is located, and commercial medical services. Often, these situations will require cooperation amongst many sources to provide the appropriate care and return the patient to home port.

The Contractor is integral to ensuring holistic and proper medical care for MSC’s afloat personnel. The Contractor bridges the communication gap between MSC medical personnel afloat and Navy medical resources, and providing 24/7 medical consultation and medical directed transportation of patients via ground or air.

1.3 Objectives: To award a contract that provides a 24/7 medical advisory and worldwide medical directed transportation services for personnel serving on MSC

GOGO ships and prepositioning units, MSC employees on offical Government orders, CIVMARs, and persons that MSC has contractual obligations to or is otherwise required to move by instruction or other agreements.

1.4 Scope: The Contractor shall provide the above-described services to the extent they are not provided for in Section 3 of this PWS. (Technical Exhibit 1 applies).

Medical advisory services covers the full gamut of medical advice. Medical transportation services will generally be the movement of a person from one shore-based medical facility to another. This is a performance-based contract in accordance with the Federal Acquisition Regulation (FAR) subpart 37.6. The Government will monitor the Contractor's performance under this contract using the performance objectives and standards in the attached Performance Requirements Summary (PRS).

1.5 Period of Performance: The period of performance shall be for one (1) five (5)-year base period and one

(1) six (6)-month option period. The period of performance reads as follows:

5-year Ordering Period 01 April 2028 – 31 March 2033

Option to Extend Services (FAR Part 52.217-8) 01 April 2033 – 30 September 2033

1.6 General Information

1.6.1 Quality Control: The Contractor shall develop and maintain an effective quality control/protocol program to ensure services are performed in accordance with this PWS.

The Contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The Contractor’s quality control program is the means by which it assures itself that its work complies with the requirement of the contract.

1.6.2 Quality Assurance: The Government shall monitor and evaluate the Contractor’s performance under this contract in accordance with the Quality Assurance Surveillance

Plan. This plan is primarily focused on what the Government must do to ensure that the

Contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

1.6.3 Recognized Holidays: The Contractor is required to be available on all holidays worldwide.

1.6.4 Hours of Operation: The Contractor is responsible for conducting business 365/366 days per year, twenty-four

(24) hours per day, seven (7) days per week. Contractor must at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS.

When hiring personnel, the Contractor shall keep in mind that the stability and continuity of the workforce are essential.

1.6.5 Place of Performance: The majority of the work to be performed under this contract shall be performed at the Contractor's site. This facility shall maintain a means of communication with ships at sea and the Contractor's consulting physician, twenty-four

(24) hours per day, seven (7) days per week. Medical transportation may occur worldwide.

1.6.6 Type of Contract: The Government will award a single, Firm-Fixed-Price contract.

1.6.7 Licenses, Permits, and Precautions: The Contractor shall comply with all international, federal, state, and local regulations for the proper handling and disposal of hazardous materials. The Contractor shall, at the Contractor’s expense, be responsible for obtaining any necessary licenses and permits, and for complying with any applicable laws, codes, and regulations, in connection with the performance of work.

1.6.8 Safeguarding of Sensitive or Proprietary Information: The Contractor may work with sensitive or proprietary information under the Privacy Act of 1974, as amended, and the

Health Insurance Portability and Accountability Act of 1996 (HIPAA) in the course of performing this contract. The Contractor shall not disclose any sensitive or proprietary information learned, discovered, or created during the performance of this contract without the written consent of the Contracting Officer. The Contractor shall ensure the proper safeguarding of such information to prevent unauthorized release. The Contractor shall comply with all applicable public laws, Government regulations, and MSC procedures regarding privacy.

1.6.9 Post Award Conference/Periodic Progress Meetings: The Contractor shall attend the post award conference convened by the Contracting Officer (KO), Contracting Officer’s

Representative (COR), Alternate Contracting Officer’s Representative (ACOR) and other

Government personnel, as appropriate, in accordance with FAR Subpart 42.5.

Additionally, the KO, COR, and other Government personnel, as appropriate, may meet with the Contractor on a quarterly basis, or as needed, to evaluate Contractor performance in accordance with FAR 52.212-4, Contract Terms and Conditions and the Performance

Requirements Summary, or regulation. During the meeting, the Government will apprise the Contractor of how the Government views the Contractor's performance, and the

Contractor will apprise the Government of problems, if any, being experienced.

Appropriate action shall be taken to resolve outstanding issues. The Contractor may request a meeting with the KO and COR as needed, at a location mutually agreed upon.

The meetings shall be at no additional cost to the Government.

1.6.10 Contracting Officer’s Representative (COR) and Alternative Contracting Officer’s

Representative (ACOR): The COR and ACOR will be identified by separate letters. The

COR and ACOR monitor all technical aspects of the contract and assists in contract administration. The COR and ACOR are authorized to perform the following functions: Ensure the Contractor performs the technical requirements of the contract;

perform inspections necessary in connection with contract performance; maintain written and oral communications with the Contractor concerning technical aspects of the contract; issue written interpretations of technical requirements, including Government drawings, designs, and specifications; monitor the Contractor's performance and notify both the KO and Contractor of any deficiencies; coordinate availability of Government

Furnished Property (GFP); and provide site entry of Contractor personnel. Letters of designation issued to the COR and ACOR, a copy of which is sent to the Contractor, state the responsibilities and limitations of the COR and ACOR, especially with regard to changes in cost or price, estimates, or changes in delivery dates. The COR and ACOR are not authorized to change any of the terms and conditions of the resulting contract.

1.6.11 Data Rights: The Government has unlimited rights to all medical records or encounter reports produced under this contract. All documents and materials produced under this contract shall be Government owned and are the property of the Government with all rights and privileges of ownership/copyright belonging exclusively to the

Government. These documents and materials may be shared for payment and medical care purposes. Otherwise, it will not be used or disclosed to a third party by the

Contractor without written permission from the Contracting Officer, Force Medical

Officer and/or the patient. All records supplied to the Government shall be the sole property of the Government and may not be used for any other purpose. This right does not abrogate any other Government rights.

1.6.12 File Retention: The Contractor shall maintain electronic medical records of each case for the duration of the contract. The Contractor shall provide a copy within four (4) hours of any changes to the case. The medical record will contain medical forms, letters, documents, consultations, and communications associated with the patient's medical case. Consent forms for release of medical information, verbal and written, shall be provided by the medical facility. A copy of the record file shall be forwarded to MSC

Medical and protected in accordance with HIPAA privacy rules.

1.6.13 Organizational Conflict of Interest: The Contractor and subcontractor personnel performing work under this contract may receive, have access to, or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statements, etc.) or perform evaluation services which may create a current or subsequent Organizational

Conflict of Interests (OCI) as defined in FAR Subpart 9.5. The Contractor shall notify the

Contracting Officer immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and shall promptly submit a plan to the Contracting Officer to avoid or mitigate any such OCI. The Contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the Contracting Officer.

In the event the Contracting Officer unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the Contracting Officer may affect other remedies as he or she deems necessary, including prohibiting the Contractor from participation in subsequent contracted requirements which may be affected by the OCI.

1.6.14 Phase in/Phase out Period: To minimize any decreases in productivity and to prevent possible negative impacts on additional services, the Contractor shall become familiar with performance requirements in order to commence full performance of services on the contract starting date. The objective is to minimize the disruption of emergency medical services. The Government estimates no phase-in transition period.

PART 2

DEFINITIONS & ACRONYMS

2. DEFINTIONS AND ACRONYMS:

2.1 Definitions:

AREA COMMAND: one of MSC’s five geographic area commands: Atlantic, Pacific, Europe, Middle East and

Far East. Abbreviated “geographic location” below. For more information, please reference the following website:

https://www.msc.usff.navy.mil/Organization/Headquarters/MSC-Area-Commands/

COMMON ACCESS CARD (CAC): A common access card (CAC) is a Unites States Department of Defense

(DoD) smart card for multifactor authentication. CACs are issued as standard identification for active-duty military personnel, reserve personnel, civilian employees, non-DoD Government employees, state employees of the

National Guard, and eligible contractor personnel. In addition to its use as an ID card, a CAC is required for access to Government buildings and computer networks.

CONTRACT ADMINISTRATION OFFICE: Contract administration will be executed through MSC, N102B. A

Contracting Officer and Contract Specialist(s) in N102B will be working closely with the COR and ACOR, and will be performing the post award contract administration functions.

CONTRACTING OFFICER (KO): A person with authority to enter into, administer, and/or terminate contracts, and make related determinations and findings on behalf of the Government. Note: The only individual who can legally bind the Government.

CONTRACTING OFFICER'S REPRESENTATIVE (COR): An employee of the U.S. Government appointed by the Contracting Officer to administer the contract. Such appointment shall be in writing and shall state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications.

This individual does NOT have authority to change the terms and conditions of the contract.

CONTRACTOR: A supplier or vendor awarded a contract to provide specific supplies or service to the

Government. The term used in this contract refers to the prime.

DEFECTIVE SERVICE: A service output that does not meet the standard of performance associated with the

Performance Work Statement.

DELIVERABLE: Anything that can be physically delivered, but may include non-manufactured things such as meeting minutes or reports.

PHYSICAL SECURITY: Actions that prevent the loss or damage of Government property.

QUALITY ASSURANCE (QA): The Government procedures to verify that services being performed by the

Contractor are performed according to acceptable standards.

QUALITY ASSURANCE SURVEILLANCE PLAN (QASP): An organized written document specifying the surveillance methodology to be used for surveillance of Contractor’s performance.

QUALITY CONTROL: All necessary measures taken by the Contractor to assure that the quality of an end product or service shall meet contract requirements.

SUBCONTRACTOR: One that enters into a contract with a prime Contractor. The Government does not have privity of contract with the sub-Contractor.

2.2 Acronyms:

ACOR Alternate Contracting Officer's Representative

CFR Code of Federal Regulations CONUS Continental United States (excludes Alaska and Hawaii)

COR Contracting Officer’s Representative

COTR Contracting Officer's Technical Representative

COTS Commercial-Off-the-Shelf

COMSC Commander Military Sealift Command

DON Department of the Navy

DD250 Department of Defense Form 250 (Receiving Report)

DD254 Department of Defense Contract Security Requirement List

DFARS Defense Federal Acquisition Regulation Supplement

DMDC Defense Manpower Data Center

DOD Department of Defense

FAR Federal Acquisition Regulation

GOGO Government Owned Government Operated

IAW In Accordance With

KO Contracting Officer

NLT No Later Than

NMCARS Navy Marine Corps Acquisition Regulation Supplement

OCI Organizational Conflict of Interest

OCONUS Outside Continental United States (includes Alaska and Hawaii)

ODC Other Direct Costs

PIPO Phase In/Phase Out

POC Point of Contact

PRS Performance Requirements Summary

PWS Performance Work Statement

QA Quality Assurance

QAP Quality Assurance Program

QASP Quality Assurance Surveillance Plan

QC Quality Control

QCP Quality Control Program TE Technical Exhibit

PART 3

GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND ITEMS

3. GOVERNMENT FURNISHED PROPERTY, EQUIPMENT AND ITEMS:

3.1 Equipment: No government furnished equipment (GFE) required.

3.2 Information: The Government may provide access to patient records, lists of medical equipment and supplies standard for each ship, medical service officer (MSO) and medical department representative (MDR) position or job descriptions, and DoD medical facilities locations and/or capabilities.

PART 4

CONTRACTOR FURNISHED PROPERTY, EQUIPMENT, AND SERVICES

4. CONTRACTOR FURNISHED PROPERTY, EQUIPMENT AND SERVICES:

4.1 General: The Contractor shall furnish all supplies, equipment, and services required to perform work under this contract that are not listed under Section 3 of this PWS.

4.2 Call Center (24/7): The Contractor shall provide a call center with services that may be handled by telephone and/or email.

5. SPECIFIC TASKS:

PART 5

SPECIFIC TASKS

5.1 General: The Contractor shall provide qualified personnel, supplies, and services necessary to perform medical advisory services and medical directed transportation services in all of MSC’s Area Commands worldwide, including international capabilities.

5.2 Medical Advisory Services: The Contractor shall provide a call center staffed with appropriately trained medical professionals supervised by a licensed physician who use clinical algorithms to evaluate medical complaints and advise callers on their best course of action. The call center shall be available twenty-four (24) hours per day, seven (7) days per week, and 365/366 days a year to provide medical advice to MSC ships, its crewmembers at sea, and all other persons covered by this contract. Standardized clinical protocols and an established escalation system shall be used to address all clinical calls and guide transfer of the case to a licensed physician with a higher level of training and expertise, when necessary. The physicians and/or specialists shall make recommendations to medical personnel aboard MSC ships for the treatment of sick or injured crewmembers and other personnel. The contractor shall provide resources to clinically manage the full range of medical care issues from very serious illness/injuries to routine post-traumatic medical cases including behavioral health conditions.

5.2.1 The advice shall include any and all recommendations for seeking professional medical treatment from

MSC ships or ashore medical resources, when necessary and as available, taking into account the time and distance from sources of professional medical treatment and the expense of obtaining such treatment. The

Contractor shall, upon request, provide MSC personnel with travel advisory services in near real time to meet

MSC’s ashore and afloat staff requirements in addition to medical advisory support. Estimated number of requests from entire fleet is five (5) to ten (10) per month.

5.2.2 The Contractor shall have available, at all times, as ready reference to the physician providing medical advice, the information listed below. Information followed by an asterisk (*) is Government furnished.

5.2.2.1 List of medical facilities worldwide and their respective capabilities.

5.2.2.2 Lists of medical equipment and supplies standard and available on board each ship.*

5.2.2.3 Medical records for active cases, which shall be updated daily until the case is closed.

5.2.2.4 List of medical transportation resources worldwide.

5.2.3 The Contractor shall provide recommendations and assistance to the ship and to MSC activities ashore in selecting the sources and location of appropriate, competent treatment twenty-four (24) hours per day, seven

(7) days per week, and 365/366 days a year. A Contractor representative must act on the medical advisory services request within five (5) minutes of the request. These services are necessary when management of a patient’s condition requires transportation to a facility offering a higher level of care. Recommendations shall identify medical facilities and personnel worldwide, including points of contacts and phone numbers, who can provide such treatment and the means of moving and transporting patients to avoid further injury or illness. The Contractor must also take into account the needs of the patient, the time and distance to the place of treatment, the cost of diversion, if known, and other pertinent factors. Operational and transportation decisions made and/or actions taken by the ship's Master as a result of receiving the medical advice remain the responsibility of the MSC Force Surgeon/Force Medical Officer and the ship's Master.

5.2.4 The Contractor shall maintain a proactive and direct relationship with its providers maintained in all MSC’s Area Commands.

5.2.5 The Contractor shall possess strict guidelines and processes for providers’ assessment and selection, quality criteria (medical level, equipment, reliability, reactivity, environment), credentials (license, insurance, diploma, pricing), agreements, compliance to Code of Conduct, and continuous education that meet the specific standards of the host nation and Federal Government regulations.

5.2.6 The Contractor shall have reasonable knowledge in regards to pricing expertise and cost containment focus in order to ensure reasonable prices.

5.2.7 The Contractor shall maintain an accurate, readily accessible, up-to-date searchable list identifying its providers in each of MSC’s Area Commands. This list should be made available to MSC identified authorized personnel on request.

5.2.8 The Contractor shall maintain insurance and license requirements for all of its providers in the country in which care is to be provided.

5.2.9 Crew Qualifications: The Government will provide a list of specific qualifications of embarked medical personnel after contract award. Such qualifications may be limited to first aid training.

5.2.10 Key Personnel Qualifications: The Contractor personnel utilized to perform medical advisory services under this Contract shall meet the qualifications specified below:

5.2.10.1 Physicians supervising or providing medical advisory services shall be licensed and board certified/board eligible physicians in Emergency Medicine, Internal Medicine, or Family Medicine. All should be experienced in travel medicine and will render medical advice that takes into consideration the medical infrastructure, standard of care, and nuances of social and professional norms in the location in which treatment is being sought.

5.2.10.2 Physicians supervising or providing medical advisory services shall be licensed and certified in the

U.S. or hold equivalent credentials in the country in which the consultation is to be provided.

5.2.10.3 The Contractor shall provide copies of resumes, credentials, and licenses when requested by the

Government. The cost of providing such documents shall be borne by the Contractor. The Contractor shall comply with federal and international governmental regulations in regards to privacy and data protection.

5.3 Medical Directed Transportation Services:

5.3.1 If medical transport is required, the Contractor shall arrange and manage the medical transportation of personnel upon request from any MSC ship. The Contractor is responsible for providing all equipment, fully trained and qualified medical personnel, and any other resources necessary to transport personnel to a medical treatment facility designated by the Government.

5.3.1.1 The Contractor and MSC Force Medical Officer shall collaborate when securing admission to either a local medical facility or a military medical treatment facility.

5.3.1.2 The Contractor and MSC Force Medical Officer will jointly monitor the patient’s admission and progression of care until the patient is accepted into a U.S. facility.

5.3.2 Emergent medical directed transportation services shall not be delayed awaiting approval.

5.3.3 The final MEDEVAC report, which documents the final patient disposition and is required to close a case, is due within ten (10) calendar days after transport. The Contractor shall provide translated medical records and real-time telephonic translation services for patients in local hospitals.

5.3.4 MSC may require the assistance of the Contractor to facilitate admission to an appropriate medical facility. Guarantee of payment is not the responsibility of the Contractor. With respect to this paragraph, neither MSC nor the Contractor shall act as the agent for the other.

5.3.5 Operational and transportation decisions made and/or actions taken by the ship's Master as a result of receiving the medical advice remain the responsibility of the MSC Force Surgeon/Force Medical Officer and the ship's Master. In addition, the ship’s Master has the authority regarding ship’s movement.

5.3.6 Transportation Timelines: All requests for services shall be verified through the COR or ACOR. A

Contractor representative must act on the transportation request within five (5) minutes of the request.

Potential transportation resources must be identified and screened in advance to allow timely access to remote sites. The Contractor shall begin coordinating transport within 12 hours when requested, and will execute expeditiously; however, cases of danger to life, limb, or eyesight are to be handled as emergency situations that require action as soon as possible. Medical transportation must be initiated within one (1) calendar day of

MSC’s determination that the patient must be transported and service is requested. Note: “Initiated” means that the Contractor shall have all necessary arrangements (to include any agreements and/or subcontracts) in place and a plane departing from the case origin. The Contractor will ensure the proper transport units are appropriately staffed and onsite ready for transport at least one (1) hour prior to the estimated time of arrival

(ETA). Reports for these events (MEDEVAC Reports) shall be provided within ten days thereafter.

5.3.7 The Contractor shall maintain a proactive and direct relationship with providers maintained in all

MSC’s Area Commands.

5.3.8 The Contractor shall possess strict guidelines and processes for providers’ assessment and selection, quality criteria (medical level, equipment, reliability, reactivity, environment), credentials (license, insurance, diploma, pricing), agreements, compliance to Code of Conduct, and continuous education that meet the specific standards of the host nation and Federal Government regulations.

5.3.9 The Contractor shall have reasonable knowledge in regards to pricing expertise and cost containment focus in order to ensure reasonable prices.

5.3.10 The Contractor shall maintain an accurate, readily accessible, up-to-date searchable list identifying providers in each of MSC’s Area Commands. This list should be made available to MSC identified authorized personnel on request.

5.3.11 The Contractor shall maintain insurance and license requirements for all providers in the country in which care is to be provided.

5.3.12 The Contractor may be required to arrange repatriation of an injured or ill patient on commercial airlines without a medical attendant (“Booking Services”). In these instances, the Contractor is only responsible for the booking of the airline ticket subject to the commercial airline carriers’ conditions of carriage. The Contractor is responsible for communicating the requirements of reasonable accommodation to the common carrier for the injured or ill patient. The final decision rests with the common carrier as to the reasonable accommodation provided. The booking services include the appropriate ground transportation, recommendations to the common carrier, and the airline tickets necessary to repatriate the patient and any DoD personnel accompanying as a non-medical attendant.

5.3.12.1 The Contractor will provide final patient disposition report only if admitted to a receiving facility coordinated by the Contractor. If the Contractor is not responsible for arranging the receiving care, the case is considered closed upon issuance of the airline ticket(s).

5.3.12.2 MSC acknowledges and agrees that the Booking Services are provided subject to the common carriers’ conditions of carriage, which is incorporated herein by reference. The

Booking Services do not include patient care.

5.4. Key Personnel Qualifications: The Contractor personnel utilized to perform medical transportation services under this Contract shall meet the requirements specified below:

5.4.1 Physicians directing and supervising medical transportation are licensed and board certified / board eligible physicians in Emergency Medicine, Internal Medicine, or Family Medicine. All should be experienced in travel medicine.

5.4.2 Physicians directing and supervising medical transportation shall be licensed and certified in the U.S. or hold equivalent credentials in the country in which the consultation is to be provided.

5.4.3 In-flight medical personnel required to support the patient, such as a licensed physician or nurse, will be licensed or certified in their respective originating country.

5.4.4 The Contractor shall provide copies of resumes, credentials, and licenses, when requested by the

Government. The cost of providing such documents shall be borne by the Contractor. The Contractor shall comply with federal and international governmental regulations in regards to privacy and data protection.

5.5 Medical Quality Assurance/Risk Management (QA/RM): The Contractor shall be available via telephone twenty-four (24) hours per day, seven (7) days per week, and 365/366 days a year for the MSC vessels/personnel designated by this contract. The Contractor shall meet QA/RM documentation requirements as set by the MSC

Force Surgeon. The Contractor shall provide access to files and records of urgent or emergent patient transportation and en route support/treatments provided. All patient care records shall be made available for review by the MSC

Force Surgeon or designated Force Medical Officer within twenty-four (24) hours of the Contractor rendering care and transport of a patient in question.

5.6 Communication Capabilities: The Contractor shall be able to rapidly initiate and maintain direct contact with the medical representative aboard the ship or unit and shall ensure the best possible transmission for clarity, depending upon the medium of communications selected by the ship or unit. The Contractor shall be available to establish initial voice communication with the ship or unit within one (1) minute of a request for service and shall guarantee that a qualified physician, as identified in this contract, is available within five (5) minutes of said request. The Contractor shall maintain an ability to communicate directly by voice or by email. However, when voice communications are not possible, contact via other means shall be accomplished as soon as possible;

however, these communications must be initiated within one (1) hour of receipt of request. The Contractor shall have the following communications capabilities:

5.6.1 One (1) dedicated commercial telephone line and one (1) non-dedicated telephone line for secondary use are the minimum requirements. An operator must cover these lines at all times as defined in this contract.

5.6.2 When email is utilized, the Contractor shall acknowledge receipt of emails as soon as possible, but not later than two (2) hours after receipt of the request and must be in full compliance with HIPAA and ensure the safeguarding of personally identifiable information (PII).

5.7 Develop and Maintain Records of Medical Care.

5.7.1 The Contractor will create within twenty-four (24) hours of the request for assistance a record which it shall maintain for each patient serviced by this contract. The record will contain all forms, letters, documents, consultations, and communications associated with the patient's medical case and a copy of the record file will be forwarded to MSC

Medical office Norfolk. The transmission shall be by electronic means and must be protected in accordance with HIPAA.

Encounter reports shall be provided within twenty-four (24) hours of the medical advisory services request.

5.7.2 The Contractor shall maintain an active case log of all medical advisory services consultations and medical evacuations.

The contractor shall also furnish MSC a summary report of cases on that log weekly, monthly, and annually. The contractor shall also meet with the Government on at least a monthly basis throughout the life of the contract.

5.7.3 The Contractor shall maintain a secured and HIPAA compliant system to allow MSC access to case data.

5.7.4Medical Protocol Manual: The Contractor shall provide a Medical Protocol Manual to the COR and the MSC Force

Medical Officer within thirty (30) calendar days of the contract award. The Contractor shall provide updates with any changes to the Manual within ten (10) calendar days. The Contractor shall develop clear standard operating procedures working with the Force Medical Officer which will result in the Medical Protocol Manual. The Contractor shall incorporate Force Surgeon's Office standards with comments into the distributable version of the Manual.

5.8 CTIP Compliance: The contractor shall comply with FAR clause 52.222-50 (Combatting Trafficking in Persons).

5.9 Additional Services: The contractor may provide the services listed below where the MSC COR or Authorized Person has requested the services.

5.9.1 Repatriation of Mortal Remains: The Contractor shall organize the repatriation of a deceased Member's mortal remains, from the place of death to the Member's home country for personnel who had been transported via

MEDEVAC within the past 30 days. A case fee will be charged to the Government, in addition to the costs charged by the service provider(s). Contractor staff may be deployed on a case-by-case basis. The applicable fees will be agreed with the Government prior to deployment.

5.9.2 Monitoring of Medical Care: The Contractor shall monitor the progress of inpatient or outpatient medical care provided to an Employee by a medical practitioner at the request of the Government.

5.9.3 Medical Necessities: The Contractor shall arrange for the delivery of medicines, drugs and medical supplies which are not available at or near the patient's location, and where practical and legally permissible. This shall be accomplished as soon as possible after authorization by the Government. Expenses for dispatch of medication and medical supplies incurred on behalf of the Government, supported by an invoice, receipt, or voucher will be reimbursed at cost.

5.9.4 Coordination Fees: The contractor shall arrange for the delivery of other travel and medical assistance services, not listed in items 5.1, 2, or 3. Expenses incurred on behalf of the patient, are supported by an invoice, receipt or voucher and reimbursed at cost. I.E. wheelchair or excess baggage transportation costs.

5.9.5 Provider-to-Provider Telemedical Consultation Services

The contractor shall provide real-time, provider-to-provider telemedical consultation services to Medical Services Officers (MSOs) and Medical Department

Representatives (MDRs) on board Military Sealift Command (MSC) vessels. These services must be available twenty-four (24) hours per day, seven (7) days per week, and 365/366 days per year.

The purpose of these consultations is to connect a contractor-employed licensed physician (at a distant site) with the shipboard MSO or MDR (at the originating site) to support clinical assessment, provide treatment guidance, and determine patient disposition in a maritime environment.

The scope of the consultation shall include, at a minimum:

• Clinical assessment based on reported signs, symptoms, and available diagnostic data.

• Interpretation of transmitted clinical information (e.g., images, waveforms, vital signs).

• Issuance of treatment recommendations to the originating site provider.

• Physician oversight for procedures performed by the MSO or MDR.

• Support for Medical Evacuation (MEDEVAC) determination in accordance with Section 5.3.

5.9.5.1 Communication Response Time

The contractor shall establish active voice and video communication on a best-effort basis within five (5) minutes of a consultation request. If the connection cannot support video, a voice-only call shall serve as the failover. This must be consistent with the communication standards in Section 5.6.

5.9.5.2 Physician Qualifications

Physicians providing telemedical consultation shall meet the qualifications identified in Section 5.2.10. All consulting physicians shall be board certified in Emergency

Medicine, Internal Medicine, Occupational Health, or Family Medicine and must be experienced in maritime and travel medicine.

5.9.5.3 Documentation and Reporting

The contractor shall document every telemedical consultation in accordance with Section 5.7.

• Encounter Reports: Must be provided to MSC Medical within twenty-four (24) hours of each consultation.

• Summary Reports: Consultation activity shall be included in the weekly, monthly, and annual summary reports as required by Section 5.7.2.

• Data Security: The contractor must ensure the secure transmission of data in accordance with

HIPAA standards, using the best possible mode to support the vessel requiring services.

• Quality Assurance: All consultation activity is subject to the Quality Assurance/Risk

Management (QA/RM) requirements of Section 5.5.

5.9.5.4 Required Certification

The contractor shall hold and maintain an active ISO 13131 Health Informatics in Telehealth Services certification.

Part 6

6. APPLICABLE PUBLICATIONS (CURRENT EDITIONS):

Public Law 91-596 29 Dec 70 Occupational Safety and Health Administration Public Law

Public Law 104-191 dated 21 Aug 96 Health Insurance Portability and Accountability Act of 1996

Joint Publication 1-02, 8 November 2010 (As Amended Through 15 February 2016) (JP 1-02)

DOD Dictionary of Military Terms

AMA CPT Physician’s Current Procedural Terminology

DoD 1341.2-M DEERS Program Manual

DoDD 5200.2 DoD Personal Security

DoD 6010.8-R Joint Ethics Regulation

DoDI 6000.11 Patient Movement

FM 3-19.30 Physical Security

PL 89-614 Chapter 55, 10 U.S.C. (1071-1088)

Title 29, CFR Occupational Safety and Health Standards

MSC Instruction 6000.1 Series MSC Force Medical Manual FAR Federal Acquisition Regulation

The Contractor must abide by all applicable regulations, publications, manuals, and local policies and procedures.

PART 7

ATTACHMENT/TECHNICAL EXHIBIT LISTING

7. ATTACHMENT/TECHNICAL EXHIBIT LIST:

7.1 Technical Exhibit 1 – Performance Requirements Summary

7.2 Technical Exhibit 2 – Deliverables Schedule

7.3 Technical Exhibit 3 – Estimated Workload Data

7.4 Technical Exhibit 4 – Potential Locations for MEDEVACS

7.5 Technical Exhibit 5 – MEDEVAC Historical Data

7.6 Attachment 1 – Pricing Spreadsheet

TECHNICAL EXHIBIT 1

Performance Requirements Summary (PRS)

The Contractor service requirements are summarized into performance objectives that relate directly to mission essential items. The performance threshold briefly describes the minimum acceptable levels of service required for each requirement. These thresholds are critical to mission success.

Performance Objective

(The Service required—usually a shall statement)

Standard Performance

Threshold (This is the maximum error rate. It could possibly be “Zero deviation from standard”)

Method of

Surveillance

PRS # 1

Reference PWS section 5.7.1.

Encounter reports shall be provided within twenty-four (24) hours of the medical advisory services request.

Within twenty-four

(24) hours of request by MSC ship or Unit.

Within forty-eight

(48) hours of case closure.

Annual Report 5.3.4 within forty-five

(45) days of the end of the calendar year.

100% Inspection:

MSC Force Medical staff reviews all records. Less than satisfactory medical advisory services will be addressed by the Force Medical

Officer to the contractor’s Medical

Director.

PRS #2

Medical Protocol Manual:

Reference PWS section 5.7.4

The Contractor shall incorporate Force

Surgeon's Office standards with comments into the distributable version of the manual.

N/A MSC N02H will review submissions and provide any necessary feedback.

PRS # 3

The Contractor and Government shall have, at a minimum, monthly meetings during the period of

Performance as stated in PWS 5.7.2’s second sentence.

Monthly meetings will be held by tele-conference to review contract.

Every thirty (30) days. COR will be in attendance and will take minutes for the file.

PRS # 4

Reference PWS section 5.7.2’s first sentence.

Maintaining a secured system to allow MSC access to case data and must be HIPAA compliant.

Portal or dashboard available every day.

Daily emails with updates on current hospitalizations and medical evacuations.

COR will maintain reports for discussion during monthly meetings, if required.

PRS #5

Contract Clause: (FAR

52.222-50) Combating

Trafficking in

Persons—please see

PWS section 5.7.8.

Contract requirements must meet the terms of

FAR clause 52.222-50.

100% compliance required in accordance with the

U.S. Zero Tolerance policy.

Periodic Inspection of the requirements of FAR clause

52.222-50.

PRS #6

Medical Advisory Services:

Reference PWS section 5.2.3.

Timeliness Within five (5) minutes from direct establishment of communication as required in PWS section 5.2.3.

COR tracking/customer complaints

PRS #7

Medical Evacuation Services:

Reference PWS section 5.3.6.

The Contractor shall begin coordinating transport within 12 hours when requested, and will execute expeditiously. The contractor shall initiate medical transportation within one calendar day.

Cases of danger to life, limb or eyesight are to be handled as emergency situations.

Reports should be provided with 10 calendar days.

100% compliance 100 % COR inspection

TECHNICAL EXHIBIT 2 DELIVERABLES

Deliverable Frequency # of Copies Medium/Format Submit To

Medical Protocol

Manual (PWS 5.7.4)

Within 30 calendar days of the beginning of the contract, then any updates to manual within 10 calendar days.

1 Searchable .pdf format

COR and Force

Medical Officer

Summary reports

(PWS 5.7.2)

Weekly, monthly, and annually.

1 At the discretion of the contractor.

MSC Medical

Distribution including the COR

Encounter Reports

Medical Advisory

Services (PWS 5.7.1)

Within 24 hours. 1 Searchable .pdf MSC Medical

Distribution

MEDEVAC Reports

(PWS Section 5.3.6)

Within 10 calendar days of patient movement

1 Searchable .pdf MSC Medical

Distribution and

COR.

TECHNICAL EXHIBIT 3

ESTIMATED WORKLOAD DATA

ITEM NAME

ESTIMATED QUANTITY

1 MEDEVAC 3 PER YEAR

Historical data:

2018 – 0

2019 -1

2020 – 3

2021 - 0 2022 - 2

2 Medical Advisory Services - # of cases 450 PER YEAR

Historical data:

2018 – 113

2019 – 91

2020 – 312

2021 – 368 2022 – 425 (based on current average of 35 cases per mo.)

TECHNICAL EXHIBIT 4

POTENTIAL (not limited to) LOCATIONS

FOR MEDEVACs

7th Fleet 6th Fleet 5th Fleet 4th Fleet

Singapore - Sembawang and Changi Naval Base

Rijeka, Croatia

Gaeta, Italy

Al Duqm, Oman

Muscat, Oman

Tumaco, Colombia

Panama City, Panama

Sasebo, Japan Souda Bay, Crete Jebel Ali, UAE Honduras

Yokohama, Japan

Busan, Korea

Rota, Spain Qatar Bahrain

Djibouti

Puerto Barrios, Guatemala

Subic Bay, Philippines

Guam

Santo Domingo, Dominican Republic

Diego Garcia

TECHNICAL EXHIBIT 5

HISTORICAL MEDEVAC DATA

Fiscal Year Departed From Destination Medical Issue

2018 (0)

2019 (1) Guantanamo Bay, Cuba Ft Lauderdale, FL Abdominal pain

2020 (3) Djibouti Ramstein AB Incarcerated hernia

Rijeka, Croatia Ramstein AB Pneumonia Washington Dulles Charleston, SC Pneumonia

2021 (0)

2022 (2) Sigonella, Italy Norfolk, VA Psychiatric

Tel Aviv, Israel Norfolk, VA Psychiatric

ADDITIONAL SERVICES PRICING

The following schedule of fees shall only be applicable to the Services where the Client or Authorized Person has requested Intl.SOS to deliver the Services. Intl.SOS reserves the right to revise this schedule of fees from time to time and will do so through a written modification to the contract.

1. MEDICAL EVACUATION AND REPATRIATION

1.1 By air ambulance

RESERVED – Already Covered Under Existing Contract.

1.2 By air charter

RESERVED – Already Covered Under Existing Contract.

1.3 By scheduled airline

RESERVED – Already Covered Under Existing Contract.

1.4 Other modes of surface transportation– ground or maritime

RESERVED – Already Covered Under Existing Contract.

2. REPATRIATION OF MORTAL REMAINS

Where Intl.SOS organizes the repatriation of a deceased Member's mortal remains for personnel who had been transported via MEDEVAC within the past 30 days, from the place of death to the Member's home country.

i. Repatriation of Mortal Remains Coordination Fee of USD 3,500 case fee will be charged to the Subscriber, in addition to the costs charged by the service provider(s).

ii. Intl.SOS staff may be deployed on a case-by-case basis. The applicable fees will be agreed with the

Subscriber prior to deployment.

3. MONITORING OF MEDICAL CARE, MEDICAL EXPENSE GUARANTEE AND PAYMENT

3.1 Outpatient care

An outpatient is defined as a patient who receives medical services and is not admitted as an inpatient by the treating physician. Outpatient treatment commences the day of the first appointment with a treating medical practitioner. The last outpatient day is the day of the last appointment for the same episode of care.

i. Outpatient Service Fee: where Intl.SOS monitors the progress of outpatient medical care provided to an Employee by a medical practitioner and/ or guarantees and pays service provider costs associated with a Member’s outpatient medical care, the Outpatient Service Fee will be charged to the Subscriber, as follows:

Treatment Duration Outpatient Service Fee

Up to 14 days USD 255 per case*

Additional days above 14 and up to 60 consecutive days An additional fee of USD 170 per case will be charged

61 consecutive days and over Quote provided on a case-by-case basis

*Outpatient Service Fee of USD 255 is a flat fee charged regardless of whether the patient has outpatient treatment once in 14 days of 14 visits in 14 days.

3.2 Inpatient care

An inpatient is defined as a patient who receives medical services at a medical facility and the treating physician has written an order to admit him/ her as an inpatient.

A patient is an inpatient starting the day he/she is formally admitted to a medical facility. The last inpatient day is the day before the patient is discharged.

i. Inpatient Service Fee: where Intl.SOS monitors the progress of inpatient medical care provided to an Employee at a medical facility and/ or guarantees and pays service provider costs associated with a Member’s inpatient medical care. The Inpatient Service Fee is a daily fee that will be charged to the Subscriber, as follows:

Treatment Duration Inpatient Service Fee

First 14 days USD 310 per day

Additional days above 14 and up to 60 consecutive days USD 140 per day

61 consecutive days and over Quote provided on a case-by-case basis

4. DISPATCH OF MEDICATION AND MEDICAL SUPPLIES

Where Intl.SOS arranges for the delivery of medicines, drugs and medical supplies which are not available at or near the Member’s location, and where practical and legally permissible.

i. Coordination Fee is quoted on a case by case basis.

Expenses for dispatch of medication and medical supplies incurred on behalf of the Client, supported by an invoice, receipt, or voucher will be recharged at cost.

5. OTHER SERVICES EXCEPT FOR ITEMS 1,2,3,4 AND 5 ABOVE

Where Intl.SOS arranges for the delivery of other travel and medical assistance services, not listed in items 1, 2, 3, and 4 above.

i. Coordination Fee is quoted on a case-by-case basis. Service provider expenses incurred on behalf of the Client, are supported by an invoice, receipt or voucher and recharged at cost.