Attach_1_-_SOW.pdf

Performance Based Work Statement

Radiology Ready Whiteriver Service Unit

General: This Performance Based Work Statement (PBWS) describes the requirement for the provision of teleradiology interpretation and on-site radiologist services for the Phoenix Area Indian Health Service (PAIHS), Whiteriver, Phoenix Area Office Servicing Area.

Background: PAIHS is an agency within the US Department of Health and Human Services, DHHS and is responsible for providing health services to American Indians and Alaska Natives. The provision of health services to members of federally recognized tribes grew out of the special government to government relationship between the federal government and Indian tribes. The Indian Health Service (IHS) is the principal federal health care provider and health advocate for Indian people. The goal is to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indians and Alaska Native people. The IHS currently provides health services to approximately 1.5 million American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 34 states.

The Whiteriver Servicing Area is a principal medical provider of comprehensive direct and high priority contract inpatient, ambulatory care, preventive and community health, and environmental health services for members of the surrounding Native American population. The IHS continues to experience difficulties in recruiting and retaining radiologists who can provide radiology services within the IHS medical facilities. Given the current availability of teleradiology/telemedicine technology, the IHS is pursuing contracts to provide these services within the IHS facilities.

DEFINITIONS

Blinded Over-Readings – Second interpretation of imaging study during peer review process to confirm accuracy.

Contracting Officer (CO): A Government employee authorized and warranted to issue contracts, and to make subsequent modification(s). The CO has full authority to make determinations on all changes and disputes regarding the contract.

Contractor: The individual awarded a legal binding contract to provide teleradiology and interpretation services.

Credentialing – The process of verifying provider licensure, certification, training and education through IHS credentialing process.

DICOM – Diagnostic Imaging Communication in Medicine

Federal Acquisition Regulation (FAR): The primary regulation used by all federal executive agencies in the acquisition of supplies and services.

Health Center: A facility, physically separated from a hospital, with a full range of ambulatory services including at least primary care physicians, nursing, laboratory, and x-ray which are available at least 40 hours a week for outpatient care.

HL7 format – The Health Level Seven is one of several American National Standards Institute. (ANSI) – accredited Standards Developing Organizations (SDOs) operating in the healthcare arena. Most SDOs produce standards (sometimes called specifications or protocols) for a particular healthcare domain such as pharmacy, medical devices, imaging or insurance (claims processing) transactions. Health Level Seven’s domain is clinical and administrative data.

SECTION C: (Continued) Description/Specification

Past Performance Information – Relevant information regarding a contractor’s actions under previously awarded contracts. This includes the contractor’s record of conformance to specifications and to standards of good workmanship; the contractor’s record of containing and forecasting costs on any previously performed cost reimbursable contracts; the contractor’s adherence to contract schedules, including the administrative aspect of performance; the contractor’s history for reasonable and cooperative behavior and commitment to customer satisfaction; and generally, the contractor’s business-like concern for the interest of the customer.

Performance-based Services Contracting (PBSC) – Contracts which structure all aspects of an acquisition around the purpose of the work to be performed with the contract requirements set forth in clear, specific, and objective terms with measurable outcome as opposed to either the manner by the work is to be performed or broad and imprecise statement of work.

Peer Review – Quality assurance conducted by the Contractor to insure accurate interpretations are performed by radiologists.

Quality Assurance Surveillance Plan (QASP): A written document prepared and used by the government for Quality Assurance surveillance of the contractor’s performance.

Referring Facility Physician – An IHS medical professional who orders diagnostic radiographic and/or other medical imaging services or designee.

Routine/Standard Interpretations of radiographic/medical images - Interpretations of standard radiographic and other medical images (i.e. ultrasound, CT, MRI, mammography) of a non-emergent nature. Written interpretations required within 24 hrs by telefax or electronic mail.

Stat (includes emergent and or critical): Interpretations of radiographic/medical images - Interpretations of radiographic and other medical images done as stat or on emergency basis. Telephonic interpretations to the referring facility physician or designee required within 60 minutes, (following arrival at the radiologists’ destination) with written interpretation to follow.

Teleradiology – The technology used to transmit digital medical images on a network.

Turnaround Time - The maximum allowable time to receive an interpretation from the Contractor once the Contractor’s radiologist has received the medical images. (24 hours for routine, 60 minutes for STAT.

Written – defined as either electronic or telefax or transcribed transmission. Hand written statements of interpretation are not acceptable.

Business Associate Agreement—A requirement issued by the Government in order to ensure the non-disclosure of patient sensitive information to include information protected under the Health Insurance Portability and Accountability Act.

Statement of Objectives (SOO)

A. The Contractor shall provide routine teleradiology services to the Whiteriver Serving Area.

B. Specific to teleradiology services, the Contractor shall be responsible for:

1. Reading all plain radiographs (X-ray), sonograms, fluoroscope studies, computerized tomography (CT) studies, magnetic resonance imaging (MRI) studies, Dual Energy X-ray Absortiometry (DEXA) scans and other diagnostic radiology studies performed at Whiteriver Hospital and Cibecue Health Center. Studies will be designated by the Whiteriver diagnostic imaging department as “routine” or “emergent” (24/7).

Emergent studies will not exceed 20% of the total study volume.

2. Providing a final written interpretation on all routine studies within 24 hours after receipt of the study.

Interpretations on studies received with <24hrs remaining in the business week (Monday – Friday, excluding holidays) will be provided on the first business day of the following week.

3. Providing a preliminary written interpretation on all emergent studies (24/7) within one hour of receipt of the study. Emergent interpretation services will be available 24 hours per day, seven days per week.

4. Contacting the IHS emergency room physician, or Clinical Director, immediately in the event that the interpretation of a study suggests a significant health risk to the patient that was unappreciated by the referring provider or interpreting radiologist on their preliminary impression.

5. Be available 24/7 for questions from providers concerning the Contractor’s study interpretations.

Contractor will define the method for contacting the Radiologist.

6. Providing teleradiology reception capability compatible with the WRSU teleradiology system. Contractor is responsible for expenses outside of IHS network.

7. Providing all transcription services, including an HL-7 bidirectional interface for transcription reception utilizing “Thin-air Teleris” software or other methods deemed acceptable by government. Contractor is responsible for all expenses including, but not limited to, technical support, license fees, software, etc., to provide the interface and transcription services. Providing any supplies, service personnel and transportation required to perform the contractual services obligation. Provide a point of contact for network and technical issues 24 hours a day, 7 days a week. Provide a point of contact for interpretation/clinical issues 24 hours a day, 7 days a week.

C. Specific to on-site services and departmental administrative responsibilities, the Contractor shall be responsible for:

1. Providing technical assistance and feedback to staff technicians/technologists on quality of films taken.

2. Work closely with the department supervisor to solve problems of an administrative nature to assure that departmental resources are optimally utilized.

3. Annually review and sign off on departmental policies and procedures in the capacity of a technical consultant.

4. Traveling to Whiteriver to provide on-site clinics within the following parameters:

a. Clinics will be one day per week and six hours in length for an average of five (5) patients per clinic. Hours of the clinic will be between 8:00am-2:30pm with a 30 minute lunch break.

Contractor may be released early upon approval of the Contracting Officers Representative

(COR).

b. Clinics shall be scheduled in advance, by mutual agreement between the Clinical Director, Chief of Diagnostic Imaging and the Contractor.

c. The contractor will be responsible for all travel costs and arrangements necessary to provide the on-site services.

5. Demonstrate an active involvement in the following departmental programs to assure compliance with The

Joint Commission (TJC) requirements:

a. Quality Management programs (X-ray, CT, MRI, DEXA, ultrasound and other services.)

b. Safety programs

c. Infection control programs

d. Health information management programs

6. The contractor must meet all applicable criteria to become a credentialed and privileged member of the

Whiteriver medical staff. The contractor shall provide to WRSU a completed credentials file which shall include documentation of:

a. Radiology residency training

b. Board certification radiology

c. Medical school training

d. Tort claims history and liability coverage

e. Experience appropriate to the scope of service

f. Licensure (active unrestricted U.S. medical license)

7. Provide monthly Continuing Medical Education (CME) in-service to medical staff and as needed for diagnostic imaging technical staff.

SECTION C (Continued): Description/Specification

8. Quality management

a. The contractor will have in place a daily proactive monitoring system to ensure that contract interpretation benchmarks are met.

b. Contractor will have a designated coordinator for technical and medical staff issues.

c. Contractor shall have a designated primary technical consultant for computer, network and software issues relative to this contract.

d. Contractor will develop or shall demonstrate a Quality Assurance (QA) program to monitor performance and submit monthly reports to Contracting Officer Representative (COR).

9. Radiology History. Currently there is no known record of anticipated historical reads for the area.

Radiology Statistics by Fiscal Year

YEAR 2012 2013 2014 2015 2016

X-ray 11648 11268 11479 10811 11274

CT 3797 3203 3539 3509 3239

Ultrasound 2059 1834 1870 1824 1606

MRI 509 442 464 461 683

10. Protocol for critical results reporting:

The contractor will call the requesting provider of a radiology exam immediately upon interpretation and determination the results of the interpretation can have a critical impact on the patients care (critical results). Below is a list of the criteria for critical results. This list may be modified through a contract modification. Results will be communicated to the ordering provider. If the provider cannot be reached the results will be called to PAIHS, the Whitriver Servicing desingee in the following protocol:

• If the requesting provider cannot be reached contact the emergency room provider and call the results to provider.

• If the Emergency Room provider is unavailable then give the results to a registered nurse in the emergency room.

The contractor’s report will document the time critical results are called in and the individual receiving the results.

The contractor will also submit a monthly report of all critical results called into PAIHS, Whitriver Hospital to the

COR.

Anatomical Area

• CNS

• ACUTE STROKE

• Cerebral Hemorrhage/Hematoma

• Cervical Spine Fracture

• Depressed Skull Fracture

• Spinal Cord Compression

• Brain Tumor (mass effect)

• Brain Tumor (no mass effect)

• Cerebral Aneurysm

• Orbital Injury

Neck

• Carotid Artery Dissection

• Epiglotitis

• Paratracheal Abscess

• Critical Carotid Stenosis

Chest

• Aortic Dissection

• Tension Pneumothorax

• Pulmonary Embolism

• Ruptured Aneurysm or Impending Rupture

• Hemothorax

• Lung Nodule

• Pericardial Effusion

• Pleura Effusion (massive)

• Pneumothorax (new)

• Pneumonia (new)

• Mediastinal Emphysema

• Evidence of TB (new)

Abdomen

• Appendicitis

• Aortic Aneurysm (leaking)

• Biliary Obstruction

• Bowel Obstruction

• Hemoperitoneum (massive)

• Ischemic Bowel

• Pneumoperitoneum (not post-op)

• Portal Venous Air

• Retroperitoneal Hemorrhage

• Traumatic Visceral Injury

• Volvulus

• Cholecystitis

• Diverticulitis

• Intussusception

• Meckel’s Diverticulum

• Pancreatitis

Uro-Genital

• Ectopic Pregnancy

• Placental Abruption

• Testicular or Ovarian Torsion

• Fetal Demise

• Placental Previa (near term)

Vascular

• Pseudoaneurysm

• DVT or Vascular Occlusion

• Arteriovenous Fistula (new)

Bone

• Spinal Fracture including mechanical or neurological instability (new)

• Spinal Tumor affecting mechanical or neurological stability (new)

• Joint Dislocation (new) New finding suggestive of new fracture (other than those described in Critical

Category)

General

• Misplaced Catheter/Line/Tube

• RETAINED FOREIGN OBJECT

• Unexpected abscess

• New finding highly suggestive of malignancy

11. General

Listed are general requirements and descriptions for the on-site radiologists services which are to be provided weekly.

The department currently uses computed radiography (CR). The department currently uses computed radiography (CR) as the primary means for capturing images. The department operates a Mobile MRI Unit at the site.

Clinics will run from approximately 8:00am- 4:30pm, once a week. Clinic time includes, but is not limited, to radiologist provided services.

The COR may release the contractor earlier if all work is completed. Typically 5-7 procedures will be scheduled a day. Time will be scheduled once a month for radiologist provided CME to the Medical Staff.

In addition the radiologist will act as a subject matter expert in reviewing radiology policies and procedures, protocols, and standard of care relative to meeting all regulatory and compliance issues for Government or accrediting agencies. When deemed necessary by the radiology manager or medical staff the radiology will provide in-services and training to the radiology technical staff to improve or enhance their services.

The on-site radiologist will meet the needs of the medical staff by providing on-site consultations for patient cases with the medical staff when needed or requested.

SECTION D: Packaging and Marking

Submission of Information

All postage, fees and electronic commerce transmission, etc. related to the submission of required and general information, including forms, reports, etc., to the Contracting Officer, the COR, or the person(s) designated to receive, shall be the responsibility of the Contractor.

Electronic commerce format shall be submitted either in Microsoft Office Word and Excel or both.

Marking Deliverables

The Contractor shall mark all shipments in accordance with best commercial practices. Additional packing and packaging, and marking requirements shall include the contract award number.

SECTION E: Inspection and Acceptance

This Quality Assurance Surveillance Plan (QASP) and Performance Based Matrix has been developed to evaluate contractor actions while implementing this Statement of Work. It is designed to provide an effective surveillance method of monitoring contractor performance for services under this contract. The QASP provides a systematic method to evaluate the services the contractor is required to furnish.

The QASP is based on the premise the government desires to maintain a quality standard in operating services to be performed in the best means of achieving that objective.

The contractor and not the government, is responsible for management and quality control actions to meet the terms of the contract. The role of the government is quality assurance to ensure the standards are achieved.

In this contract the quality control program is the driver for service quality. The contractor is required to develop a program of inspections and monitoring actions. The first major step to ensuring a “self-correcting” contract is to ensure the quality control program approved at the beginning of the contract provides the measures needed to lead the contractor to success.

Once the quality control program is approved, careful application of the process and standards presented in the remainder of this document will ensure a robust quality assurance program.

SECTION E: (Continued) Inspection and Acceptance Performance – Based Matrix

Performance- Based Task

Indicator Standard Quality Assurance Incentives/De-Incentives

State the end results or outputs that you will formally accept or reject.

For the Requirement, state the features(s) of end result that will be surveilled.

For each "indicator" state a performance level that, when met, means the task has been performed satisfactorily.

This Standard describes "What Success Looks Like".

For each "Standard", state the method used to check performance (ie. random sampling 100% inspection, periodic inspection, customer input).

List of Positive and Negative Incentives. Address method of linking payment to quality of service.

1) The Contractor shall provide routine, emergent and critical interpretations of x-ray, ultrasound, and computed tomography exams by utilizing Teleradiology.

Timeliness Interpretations

100% of routine interpretations reported within 24 hrs. (See section B.2). 95% rate is considered non-compliance.

100% of stat (emergent and critical) interpretations reported within 60 minutes.

(See Section B.3) 98% rate is considered non-compliance

Surveillance systems will include periodic inspections and customer inputs.

Payment of contract price for satisfactory service.

De-incentive if applied: 2% reduction in monthly payment for each 1% increment below the satisfactory timeliness threshold reduction in timeliness.

2) On-site/Off- Site Radiology Services

Accuracy, Peer Review

98% of interpretations are read without significant discrepancies that adversely affect treatment of IHS patients.

100% compliance with section C of Scope of Services.

Peer Review done by Contractor on 100% of all selected films “Blinded over-readings” by the end of the quarter.

Below 95% is considered non-compliance.

Surveillance systems will include periodic inspections and customer inputs.

The government will periodically conduct random sampling in order to assure compliance.

Contractor performance will be evaluated and posted at the government site, Contractor Performance Assessment Reporting System (CPARS).

Payment of contract price for satisfactory service.

De-incentive if applied: 2% reduction in monthly payment for each 1% increment below the satisfactory timeliness threshold reduction in timeliness.

3) Calling ordering provider with Critical results

Reporting requirements

95% of “Critical results are called to the ordering provider and documented in the report when and whom the report was called into at the facility. Below 93% is considered non-compliance

Surveillance systems will include periodic inspections and customer inputs.

The government will periodically conduct random sampling in order to assure compliance.

Payment of contract price for satisfactory service.

De-incentive if applied: 2% reduction in monthly payment for each 1% increment below the satisfactory timeliness threshold reduction in timeliness.

4) Radiology Reporting Requirements

Timelines, Accuracy, and Compliance

Contractor shall provide monthly statistical reports 100% with sufficient information to identify compliance with all indicators and standards.

Contractor shall provide quarterly reports addressing Quality Assurance standards.

Below 95% is considered non-compliance

Government will surveillance by timeline of reports, review of data to determine compliance with necessary indicators, standards as identified in the scope of work and standards for specific specialty.

Payment of contract price for satisfactory service.

De-incentive if applied: 2% reduction in monthly payment for each 1% increment below the satisfactory timeliness threshold.

SECTION E: (Continued) Inspection and Acceptance

SURVEILLANCE: Surveillance to be done by established timelines, random and periodic government inspections.

Contractor will provide monthly statistical reports for all above listed indicators and standards. WRSU will periodically conduct random sampling of indicators and standards to check for compliance.

PROCEDURES: Explains how government will and how much lead time the contractor will be notified of an inspection, if deficiencies found, type, critical non-critical, time frame for corrective action)

The government will review monthly reports from contractor for contract compliance. Deficiencies in timeliness must be corrected in the following thirty (30 days). Deficiencies in peer review standard must be corrected by the next calendar quarter.

SECTION F: Deliveries or Performance

PERIOD OF PERFORMANCE

The contract period for furnishing services described in the Performance Based Work Statement (PBWS), Section B, shall be from the date of award for one (1) year, plus four (4) sequential one-year options, which may be exercised in accordance with the terms and conditions hereof.

PLACE OF PERFORMANCE

(a) The services(s) specified in Section C shall be provided to the following address:

Whiteriver Servicing Area.

All deliverables shall be in accordance with the attached Performance Work Statement. The Contractor shall provide the deliverables listed in Section C.

GOVERNMENT HOLIDAYS

Performance is 365 days, 24 hours, 7 days per week including all Government Holidays.

CALENDAR YEAR 2018

New Year's Day

Birthday of Martin Luther King, Jr.

Washington's Birthday

Memorial Day

Independence Day

Labor Day

Columbus Day

Veterans Day

Thanksgiving Day

Christmas Day

SECTION G: Contract Administration Data

Contracting Officers Representative (COR)

The Contracting Officer will designate in writing a COR who shall be responsible for:

• Monitoring the Contractor’s technical progress, including surveillance and assessment of performance;

• Interpreting scope of work;

• Performing technical evaluations required;

• Performing technical inspections and acceptances required by this contract;

• Monitoring funds available for obligation under this contract;

• Assisting the Contractor in the resolution of technical problems encountered during performance of this contract;

In no event is the COR empowered to change any of the terms and conditions of the contract. Changes in the scope of work, contract price, quantity, and quality or delivery schedule shall be made only by the Contracting Officer by properly executed modification to the contract. The designation of a COR does not authorize or provide a legal right to change any kind of contractual terms regardless of the Contractor’s apparent difficulties in fulfilling contract requirements.

Invoicing

Invoices shall be submitted in accordance with paragraph (g) of FAR 52.212-4 (See Section I) as follows:

Phoenix Area Indian Health Service (PAIHS) Division of Financial Management , Attn: Accounts Payable 40 North Central Avenue, Suite 504 Phoenix, Arizona 85004 Phone: (602) 364-5131 Fax: 602-364-5114

System for Award Registration

If during the performance of the contract there is any change in the information previously provided for EFT, the Contractor shall revise the information contained in the Central Contractor Registration database at www.sam.gov.

In addition, the Contractor shall notify by email submission of a revised Electronic Funds Transfer in CCR to the Contract Administrator.

Contract Administrator

(a) This contract will be administered by and all written communication to the Contracting Officer shall make reference to the contract number and shall be mailed to the address cited below:

Joshua Pearlman, Contracting Specialist Phoenix Area Indian Health Service (PAIHS) Division of Acquisition Management 40 North Central Avenue, Suite 507 Phoenix, Arizona 85004 Phone: (602) 364-5022 Fax: 602-364-5030

Email: joshua.pearlman@ihs.gov mailto:joshua.pearlman@ihs.gov

SECTION H: Special Contract Requirements

Allied Health Care Professional Credential Policy

Contractor shall have their credentials available for review. Contractor shall be responsible for adherence to all policies and procedures of the Indian Health Service and the Whiteriver Indian Hospital credentialing program.

Security Clearances

All Allied Healthcare Professionals providing services under this award shall undergo IHS mandated security clearance prior to commencement of work.

Prior to the provision of services onsite, the security requirement must be adhered to; the security clearance process includes a Finger Print check, and a screen check of the individual through the Office of Inspector General’s exclusion list at http://exclusions.oig.hhs.gov; documented evidence of the clearances shall be forward to the Contracting Officer at the Phoenix Area Indian Health Service, 40 North Central Avenue Suite 507, Phoenix, Arizona 85004.

Information Technology Security Clearances

All contractors that may have either through remote or direct access and/or interconnected to a federal Information Technology Systems (IT) shall be contractually subject to all Phoenix Area, Indian Health Service (PAIHS) and Federal IT security standards, policies, and reporting requirements. The contractor shall meet and comply with all IHS IT security policies and all applicable standards and guidelines, other Government‐wide laws and regulations for protection and security of all information technology.

Remote or Direct Access to Federal Information Systems

Prior to the contractor’s employees receiving access to the government’s IT systems, IT security awareness training is required.

Information Systems Security Awareness http://www.ihs.gov/ISSA/

Interconnection only to Federal Information Systems:

Referenced are four documents in particular for interconnection, required to be completed:

The following documents are required to be completed and returned to the government before interconnection to the federal system is provided:

• Business Partner Interconnection Security Agreement - (Attachment, see section J – Applicable Document)

• Data Exchange Agreement (DEA) Template (Attachment, see section J – Applicable Document)

• IHS Rules of Behavior for Interconnection Security Agreements

• Business Partner Interconnection Security Agreement Checklist

Collection of Third Party Revenue

The contractor shall provide necessary information for Indian Health Service (IHS) to bill and collect for any third party resources of its patients as a result of services rendered through performance of this contract. Indian Health Service shall be responsible for processing collection of private insurance and/or patient eligible for Medicare and/or Medicaid benefits. Indian Health Services shall have sole right to recover the reasonable costs of services from patients third party resources (also called alternate resources). All third-party billing and collection(s) opportunities derived from this service shall be revenue payable only to the Indian Health Service (IHS). Safeguarding this revenue stream and related assets is vital to IHS health care programs.

http://exclusions.oig.hhs.gov/ http://www.ihs.gov/ISSA/

SECTION G: (Continued) Contract Administration Data

52.237-7 Indemnification and Medical Liability Insurance (JAN 1997)

(a) It is expressly agreed and understood that this is a nonpersonal services contract, as defined in Federal Acquisition Regulation (FAR) 37.101, under which the professional services rendered by the Contractor are rendered in its capacity as an independent contractor. The Government may evaluate the quality of professional and administrative services provided, but retains no control over professional aspects of the services rendered, including by example, the Contractor's professional medical judgment, diagnosis, or specific medical treatments. The Contractor shall be solely liable for and expressly agrees to indemnify the Government with respect to any liability producing acts or omissions by it or by its employees or agents. The Contractor shall maintain during the term of this contract liability insurance issued by a responsible insurance carrier of not less than the following amount(s) per specialty per occurrence:__1 (one) million___.

(b) An apparently successful offeror, upon request by the Contracting Officer, shall furnish prior to contract award evidence of its insurability concerning the medical liability insurance required by paragraph (a) of this clause.

(c) Liability insurance may be on either an occurrences basis or on a claims-made basis. If the policy is on a claims-made basis, an extended reporting endorsement (tail) for a period of not less than 3 years after the end of the contract term must also be provided.

(d) Evidence of insurance documenting the required coverage for each health care provider who will perform under this contract shall be provided to the Contracting Officer prior to the commencement of services under this contract.

If the insurance is on a claims-made basis and evidence of an extended reporting endorsement is not provided prior to the commencement of services, evidence of such endorsement shall be provided to the Contracting Officer prior to the expiration of this contract. Final payment under this contract shall be withheld until evidence of the extended reporting endorsement is provided to the Contracting Officer.

(e) The policies evidencing required insurance shall also contain an endorsement to the effect that any cancellation or material change adversely affecting the Government's interest shall not be effective until 30 days after the insurer or the Contractor gives written notice to the Contracting Officer. If during the performance period of the contract the Contractor changes insurance providers, the Contractor must provide evidence that the Government will be indemnified to the limits specified in paragraph (a) of this clause, for the entire period of the contract, either under the new policy, or a combination of old and new policies.

(f) The Contractor shall insert the substance of this clause, including this paragraph (f), in all subcontracts under this contract for health care services and shall require such subcontractors to provide evidence of and maintain insurance in accordance with paragraph (a) of this clause. At least 5 days before the commencement of work by any subcontractor, the Contractor shall furnish to the Contracting Officer evidence of such insurance.

(End of clause)

SECTION J: List of Documents, Exhibits and Other Attachments

• The Joint Commission (TJC). http://ww.jointcommission.org

• Centers for Medicare and Medicaid Services (CMS). http://www.cms.gov

• Health Insurance Portability and Accountability Act (HIPAA) of 1996. http://www.cms.gov

• Privacy Act of 1974. http://www.cms.hhs.gov/PrivacyActof1974

• Food and Drug Administration http://www.fda.gov/AboutFDA/CentersOffices/cdrh/default.htm

• DICOM http://medical.nema.org

• American College of Radiology http://www.acr.org/s_acr/index.asp

• HHS Office of Chief Information Officer (OCIO) Policy on Privacy Impact Assessments http://www.hhs.gov/ocio/policy/index.html

• Information Systems Security Awareness http://www.ihs.gov/ISSA/ http://ww.jointcommission.org/ http://www.cms.gov/ http://www.cms.gov/ http://www.cms.hhs.gov/PrivacyActof1974 http://www.fda.gov/AboutFDA/CentersOffices/cdrh/default.htm http://www.acr.org/s_acr/index.asp http://www.hhs.gov/ocio/policy/index.html http://www.ihs.gov/ISSA/