Tidewater Performance Work Statement (revised) Dec 22.doc

Patient Appointing Services (PAS)

Military Treatment Facilities (MTF)

Tidewater, Virginia

1. GENERAL.

2. DEFINITIONS/ACRONYMS.

3. USG FURNISHED INFORMATION AND EQUIPMENT/SERVICES.

4. CONTRACTOR FURNISHED ITEMS AND RESPONSIBILITIES.

5. DESCRIPTION OF WORK.

6. APPLICABLE REGULATIONS AND MANUALS (CURRENT EDITIONS)

7. LIST OF EXHIBITS AND ATTACHEMENTS

Performance Work Statement (PWS)

Patient Appointing Services (PAS)

Military Treatment Facilities (MTF)

Tidewater, Virginia

1. GENERAL.

This is a non-personal services contract to provide Patient Appointing Services (PAS) in support of Military Treatment Facilities (MTFs) in the Tidewater, Virginia area that will significantly enhance appointing procedures and improve service to its customers. The referenced MTFs in the Tidewater area throughout this document are: Naval Medical Center Portsmouth (NMCP) and its ten Branch Medical Clinics (BMCs), (Boone, Dam Neck, TPC Northwest, TPC Chesapeake, TPC VA Beach, TPC Suffolk, BHC Norfolk, BHC Yorktown, MSC NNSY and NMCP MHP clinics); Langley Air Force Base Medical Group; McDonald Army Health including the Williamsburg clinic, its two Troop Medical Clinics (TMCs), and Ft. Story health clinic. The U.S. (USG) shall not exercise any supervision or control over the Contract Service Providers (CSPs) performing the services herein. Such CSPs shall be accountable solely to the contractor who in turn is responsible to the USG.

1.1. Background. A major feature of the military health care benefit for eligible Military Health System (MHS) beneficiaries is access to MTF health care providers via a centralized appointing center. The contractor, through its CSP staff, shall provide appointing services for eligible beneficiaries via telephony. The contractor shall provide appointing services over the telephone from a federal installations, off-site owned/leased facility, or telework from the employee’s home. This requirement augments the capability of the MTF staff to book health care appointments in the direct care system at MTFs for MHS eligible beneficiaries. The PAS designation by the Department of Defense (DoD) is a Market where military service medical treatment facilities operate within a common geographic region with overlapping catchment areas. The contractor shall provide appointing services over the phone. This requirement meets the DoD goal for centralized appointing within the direct care system at the MTFs for Military Health System (MHS) eligible beneficiaries. The PAS has been at the forefront of offering patients a centralized Appointing Center for the Market leveraging a common contractor operated Regional Appointing Center. A centralized Appointing and Call Center offers the advantages of providing patients with a toll free number with extended weekday, weekend, and holiday hours of operation to enhance the patient experience and improving timely access to their health system. Furthermore, the centralized Appointing Center supports the goal of reducing appointing process variability to achieve the service goal of “First Call Resolution” to improve patient satisfaction with health system appointing services.

1.2. Scope of Work. The contractor shall make appointments and coordinate appointments with other direct care system facilities on the Composite Health Care System (CHCS)/MHS GENESIS platform as required. The contractor shall ensure CSPs document the patient’s telephone consultations into the Composite Health Care System (CHCS), Patient Appointment Module Composite Health Care System II (CHCS II), Armed Forces Health Longitudinal Technology Application (AHLTA), MHS Genesis, or other Government appointment information systems. The contractor shall provide performance and management reports on the appointing processes for eligible beneficiaries. The contractor shall ensure CSPs make appointments and coordinate appointments with other direct care system facilities as required. The contractor shall ensure CSPs make outgoing appointment calls to include cancellations, reschedules and warm transfer calls to MTF clinics. The contractor may perform outgoing calls when they are correcting their appointing errors. These corrections may require cancelling an appointment, rescheduling an appointment or transferring to the appropriate clinic if an appropriate appointment is not available. The CSP shall not make appointments with non-MTF (i.e. civilian network and/or non-network) providers or enter non-MTF (civilian network or non-network) information into the appointing system. Appointments shall be made following MTF-provided appointing criteria and comply with access to care standards as required by 32 Code of Federal Regulations (CFR) 199.17. Patient appointments shall be made using only Department of Defense (DoD) approved standard appointment types, business rules, and appointment detail codes as detailed in the DHA IPM. The phone system will be configured with the automated call back feature, which will provide beneficiaries the option to be called back without losing their place in the queue, during high call volume times. There are approximately 750,000 appointing transaction per year. Eligible population for Tidewater is over 400,000 patients.

1.2.1. Orientation and Training.

Appointing services span a range of functions to include, but not limited to verifying beneficiary eligibility via the Defense Enrollment Eligibility Reporting System (DEERS) system, updating patient demographic information, and scheduling beneficiary requests for MTF primary or specialty care appointments, as well as completing requests for cancellations and appointment rescheduling. The work includes completing outbound calls to facilitate the timely scheduling of specialty appointments in support of specialty referrals generated by an MTF Health Care Provider (HCP). Appointing services also include outbound calls to facilitate scheduling of preventative health appointments, surgery reminder calls and calls to schedule specialty care appointments. With the expansion of integrated specialty service lines at sister MTFs, appointing agents will serve an important role in scheduling and coordinating appointments with other MHS MTFs in order to meet beneficiary health care needs within TRICARE access standards. Verify and update patient registration into CHCS/MHS GENESIS. Additionally, the contractor shall perform CHCS/GENESIS sponsor change, when required to book a beneficiary’s medical appointment.

1.3. Safety Requirements: The contractor shall maintain safety and health standards compliant with the requirements of the Occupational Safety and Health Administration (OSHA). The contractor shall ensure that CSPs comply with all installation safety regulations. Such regulations include, but are not limited to, general safety, fire prevention and waste disposal.

1.3.1. The contractor shall ensure that each CSP is knowledgeable of the policies and procedures of his/her specific place of duty. The contractor shall ensure CSPs receive any required staff training as a precondition to performance. Such training may include instruction on automation processing, quality assurance policies, local in‑service, safety briefings, etc. This training will occur during the scheduled shift of the CSPs; provided by the Government and at no additional cost to the Government.

1.3.2. CHCS. The CHCS contains the MTF’s appointment scheduling program and is interlinked with all military medical departments within the Tidewater market that encompasses NMCP and its nine BMCs, Langley Air Force Base Medical Group, McDonald Army Health Clinic, its two TMCs and Ft. Story health clinic.

1.3.3. Training for CHCS, ALTHA and MHS Genesis (Electronic Health Records (EHR) and other computer training will be scheduled through the Contracting Officer’s Representative (COR) and/or Contractor prior to the CSPs providing service. The training will be on-site and during normal duty hours.

1.3.4. If additional training is needed due to mission changes, the DHA Information Management (IM) Division will conduct required computer training. This training will be at no cost to the Contractor. The COR will schedule this training. Training will be provided by the Government and at no additional cost to the Government.

1.3.5 ELECTRONIC HEALTH SYSTEMS (EHR). Contractor personnel shall utilize with the following unique military health care systems/procedures as part of their daily duties (and their successors, if applicable/appropriate):

· Armed Forces Health Longitudinal Technology Application (AHLTA)

· Composite Health Care Systems (CHCS)

· Defense Enrollment Eligibility Reporting System (DEERS)

· MHS GENESIS

1.3.6. Access will be granted by local Military Treatment Facility (MTF) to AHLTA, CHCS, DEERS, MHS GENESIS, or other DHA market connectivity and the contractor shall comply with DHA communications and Government IT security standards and policies. If a new system is implemented as a successor, or in addition to the above systems, the CSPs will be trained on its use by the government.

1.3.7 CHCS/MHS Genesis Levels of Access. The levels of access for CSPs shall correspond to the skill sets necessary for the agents to perform their duties. The contractor may request additional security keys necessary for particular individual agents. The request will also include the following for each agent requiring access: (a) certificate of training, and (b) Privacy Act Statement signed by the agent. The CHCS/GENESIS POC will create and approve log-on authorizations.

1.3.8. The following are the levels of Authorization for Security Keys and Menus: Appointment Clerk (AC) CP Main Menu (includes: CPZ CCP, CPZ OHI, CPZ Label, CPZ Disenroll Cancel-Correct, CPZ HCF Enroll, CPZ OMCP), HMCP, PMCP, DMCP, CMCP, RMCP File man Codes should be & Ss Supervisor/Trainer. All of the above plus Print Consult Report (PCR) & Patient Appointment QA Inquiry (PQA). Additionally, contractor team members in leadership roles will have the following menus: HNBA, HRRP, NBP, ZAP and UNDO.

1.4. Security.

1.4.1. All users are required to adhere to the DHA’s IM/IT and Health Insurance Portability and Accountability Act (HIPAA) security policies and instructions. It’s the user’s responsibility to protect their CHCS/MHS Genesis password including not sharing access with any other personnel at any time. Users are also required to not leave active terminals unattended. The Contractor shall notify the DHA IT Security Administrator of any concerns about security compromises. Any breach of security procedures may result in revocation of CHCS/MHS Genesis access. User holding access will be held accountable for any errors discovered under their codes. The Contractor shall notify the COR when personnel actions occur that would result in the individual no longer requiring CHCS/MHS Genesis access or personnel issues that may have an impact upon the security of CHCS/MHS Genesis.

1.4.2. Information System Security Requirements

1.4.2.1. The contractor shall ensure that all CSPs comply with the local installation requirements for vehicle registration and operation on the military facility. Any vehicle operated by the contractor or its CSPs in performance of this contract must have the minimum liability coverage required by the Commonwealth of Virginia.

1.4.2.2. The contractor shall ensure that its CSPs comply with installation and MTF personnel identification and access requirements. The contractor is responsible for absences of CSPs due to expired identification and access documents.

1.4.2.3. All inquiries, comments or complaints arising from any matter observed, experienced, or learned of as a result of or in connection with the performance of this contract, the resolution of which may require the dissemination of official information, will be directed to the COR and the Contracting Officer (KO).

1.4.2.4. The contractor shall only conduct business with designated USG personnel listed as points of contact (POCs). The USG will provide names of authorized personnel to the Contractor in writing, and updated as necessary throughout the contract period.

1.4.2.5. US USG records, copies of original results and reports, verified original data, corrected data, and corrected supporting final reports are maintained by the contractor, but remain the property of the U.S. USG. These files/results will be surrendered to the COR upon request or contract.

1.4.2.6. Safeguarding Material. The contractor is responsible for safeguarding all USG property provided for Contractor use. The contractor shall safeguard all information of a confidential or sensitive nature. Neither the contractor nor any of its CSPs will disclose or cause the dissemination of any information concerning the operation of the MTF that could result in or increase the likelihood of the possibility of breach of security or interrupt the continuity of operations or which breach the requirements of The Privacy Act of 1974. The contractor may be required to provide testimony or deposition in lawsuits or other administrative, civil, or criminal proceedings.

1.4.2.7. The contractor shall achieve the same level of trustworthiness for CSP or subcontractor CSP as required for USG personnel with similar access to Automated Information Systems (AISs) and networks containing DoD Sensitive Information (SI). The contractor shall meet the personnel security requirements for Automated Data Processing (ADP) access in DoD 5200.2-R, Personnel Security, for employees and subcontractor employees that require access to USG (IT) systems or DoD SI, or are involved in developing, delivering, or supporting IT systems and services, or safeguarding DoD SI within USG or contractor systems. The contractor shall classify ADP/IT or related positions, submit appropriate paperwork for background investigations, ensure individuals receive requisite training, and document compliance. Prior to receiving access, personnel background investigations and training will initiate before granting access to DoD AIS/networks or DoD SI. Following contract award, details for completing and forwarding forms for requesting an investigation will be coordinated with the USG IT Security Officer designated through the COR for the networks and systems being accessed.

1.4.2.8. The contractor shall use Protected Health Information (PHI) for their designated project only. This information will not be used to create databases or any other product not intended for use specifically for this project. All PHI related to the project, but not delivered to the USG, will be destroyed at the conclusion of the tasking. Destruction of the information will comply with The Deputy Secretary of Defense Memorandum, subject: “Destruction of DoD Computer Hard Drives Prior to Disposal,” dated January 8, 2001. The Memorandum requires that all hard drives containing unclassified data being disposed of outside DoD be removed and destroyed through sanitation of SI from storage media in a manner that gives assurance that the information is unrecoverable by technical means.

1.4.2.9. All PHI processed and hard copy output by USG and contractor is as “Controlled Unclassified Information”, (CUI) as directed by DoDI 5200.48, March 6, 2020. Every individual at every level, including contractors providing support to the DoD in accordance with contractual requirements, will comply with the requirements in DoDI 5200.48. Unclassified information associated with a law, regulation, or government-wide policy and identified as needing safeguarding is considered CUI. It requires access control, handling, marking, dissemination controls, and other protective measures for safeguarding.

1.4.2.10. The contractor shall maintain, transmit, retain in strictest confidence, and prevent the unauthorized duplication, use, and disclosure of PHI IAW Standards for Privacy of Individually Identifiable Health Information, March 13, 2019, DoD Health Information Privacy Regulation (DoD 6025.18), the Privacy Act, and DoD Privacy Program (DoD 5400.11). The CSP shall provide patient information only to employees, Contractors, subcontractors, and USG personnel having a need to know such information in the performance of their duties for this project. The KO will approve the release of any patient information prior to the release.

1.4.2.11. The contractor shall comply with the most current version of all USG privacy and security regulations and directives identified in Paragraph 6, Applicable Regulations and Manuals and other applicable DoD Service privacy and security instructions and regulations in effect at the time of contract award. In addition, the Contractor shall comply with the most current version of all relevant rules published in the Federal Register to implement HIPAA of 1996 in effect at the time of contract award. This will include Standards for Privacy of Individually Identifiable Health Information, Final Rule, published December 28, 2000, TRICARE Operations Manual 6010.51-M, August 1, 2002, Chapter 21, Section 3; DoD Health Information Privacy Regulation (DoD 6025.18); the Privacy Act; and DoD Privacy Program (DoD 5400.11). Supplements, amendments, or changes to these distributed publications will issue out during the life of the contract. Any such changes to mandatory publications which cause a change in performance that will either increase or decrease price will be incorporated into the contract by mutual agreement of the parties.

1.4.3. Physical Security Requirements

1.4.3.1. The contractor is responsible for any keys/proximity locks issued by the COR for use in their designated workspace. The keys will not be duplicated and the contractor shall be financially responsible for the replacement of any lost/stolen keys and any associated locks. Lost or stolen keys will be reported to the issuing party and/or COR immediately upon realization of the occurrence. No unauthorized personnel are allowed entry into locked areas. The contractor shall ensure that its CSPs lock all areas for which they possess a key when they are not using the area and at the close of the work period.

1.5. Antiterrorism/Operations Security (AT/OPSEC).

1.5.1. Access to USG IS. All CSPs with access to a USG info system shall successfully complete the DoD Information Assurance Awareness prior to access to the IS and then annually thereafter.

1.5.2. OPSEC Training. New CSP shall complete Level I OPSEC training within 30 calendar days of their reporting for duty. All CSP shall complete annual OPSEC Awareness training thereafter.

1.5.3. Antiterrorism (AT) Level I Training. All CSPs shall complete AT Level I awareness training within 30 calendar days after starting. The contractor shall submit certificates of completion for each affected CSP to the COR or to the KO within 30 calendar days after completion. AT level I Awareness training is available at the following website: http://jko.jfcom.mil/.

1.5.4. Access and General Protection/Security Policy and Procedures. All CSPs shall comply with applicable installation, facility and area commander installation/facility access and local security policies and procedures which will be provided to the contractor by a USG representative within five working days of award. Contractor shall provide all information required for background checks to meet installation access requirements as performed by the installation Provost Marshal Office, Director of Emergency Services or Security Office. The CSPs shall comply with all personal identity verification requirements as directed by DoD and/or local policy. In addition, should the Force Protection Condition (FPCON) at any facility or installation change, the USG may require changes in contractor security processes.

1.5.5. Information Assurance (IA) Awareness Training. All Contractor and sub-contractor personnel requiring network access to USG IS shall successfully complete DoD IA Awareness training. Training certificates provided to the COR immediately upon completion.

1.5.6. The contractor shall complete all required DHA training and provide all training certificates to the COR upon completion.

1.6. The CSPs requiring Common Access Card (CAC). Before CAC issuance, the CSPs require a favorably adjudicated Tier 3 (T3) investigation IAW Navy policy. The CSPs shall receive a CAC only if duties involve one of the following: (1) Both physical access to a DoD facility and access, via logon, to DoD networks on-site or remotely; (2) Remote access, via logon, to a DoD network using DoD-approved remote access procedures; or (3) Physical access to multiple DoD facilities or multiple non-DoD federally controlled facilities on behalf of the DoD on a recurring basis for a period of 6 months or more. At the discretion of the sponsoring activity, a CAC may be issued when a favorable review of the FBI fingerprint check and Standard Form 86 have been conducted, and a T3 investigation has been scheduled with the Defense Counterintelligence and Security Agency.

1.7. Information Assurance (IA)/Information Technology (IT) Training. All CSPs and associated subcontractor CSPs shall complete the DoD IA Awareness training before issuance of network access and annually thereafter.

1.7.1. Threat Awareness Reporting Program (TARP). All CSPs with security clearances shall comply with Navy regulation for annual TARP training by a Counterintelligence (CI) agent or allowed equivalent.

1.8. Data Breach Response and Notification.

1.8.1. The contractor shall adhere to the reporting and response requirements for Personally Identifiable Information (PII) set forth in Memorandum, Office of the Secretary of Defense, Subject: Safeguarding Against and responding to the Breach of PII, June 5, 2009, ALARACT 050/2009, DoD 5400.11, and any amendments.

1.8.2. The contractor shall immediately notify the HIPAA officers upon discovery that a suspected or actual breach of PII occurred. The notification will include, to the greatest extent possible, the identification of each individual who’s PII has been or possibly has been breached. The contractor shall provide this information at the time of the initial notification to the USG or promptly thereafter as information becomes available.

1.8.3. The USG will determine whether a breach of PII has occurred, and whether it requires notification breach notification to affected individuals. If breach notification to affected individuals is required, the USG will determine if the Contractor shall make the required notification.

1.9. COR. The KO will designate and authorize an individual to act as the COR at time of award. The representative appointed will be specifically nominated by letter from the KO. The COR exclusively represents the KO in all technical phases of the work. The COR does not authorize Change Orders, Supplemental Agreements, or direct any contract performance requiring contractual modification or adjustment. Changes in the scope of work can only be made by modification properly executed by the KO. All observations made by persons other than the KO or the COR are strictly advisory and will not influence the contractor's operations except for administrative requirements and responsibilities specified herein. The KO will provide a copy of this designation and COR contact information to the Contractor.

1.10. Contractor Verification System (CVS) For Contractor at USG Facilities.

1.10.1. The contractor shall comply with agency personal identity verification procedures identified in the contract that implement Homeland Security Presidential Directive-12 (HSPD-12), Office of Management and Budget (OMB) guidance M-05-24, and Federal Information Processing Standards Publication (FIPSPUB) Number 201.

1.10.2. The contractor shall comply with agency personal identity verification procedures in all subcontracts when the subcontractor is required to have physical access to a federally-controlled facility or access to a Federal information system.

1.10.3. The contractor shall ensure compliance with the provisions set forth below. For purposes of Federal Acquisition Regulation (FAR) Clause 52.204-9, the USG will designate a Trusted Agent (TA), and the Contractor will designate a Facility Security Officer (FSO), for this contract. The USG reserves the right to amend or supplement these provisions pursuant to the Changes clause in the contract.

1.10.4. In-processing Requirements. Contractor personnel are prohibited from performing services under this contract absent compliance with the in-processing requirements set forth below.

1.10.5. For every CSP, the FSO will provide the following information to the TA for input into the Defense Enrollment Eligibility Reporting System /Real-Time Automated Personnel Identification System (DEERS/RAPIDS)

(a) Last Name

(b) First Name

(c) Middle Name

(d) Social Security Number

(e) Date of Birth

(f) E-mail Address (may be either the e-mail address of the incoming individual or the FSO).

1.10.6. The CSPs shall have a Joint Knowledge Online (JKO) account in order to submit the application. JKO registration may be accessed via http://jko.jten.mil/ URLs.

1.10.7. The DEERS/RAPIDS Systems will send a notice to the e-mail address provided IAW the above requirement, in which the CSPs user ID and password are provided. In the event the e-mail message is sent to the FSO, the FSO will notify the Contractor of the CSPs user ID and password.

1.10.8. The CSPs shall log into the DEERS/RAPIDS System, and submit an application for acceptance into the System, using the user ID and password provided.

1.10.9. The TA will accept, return, or reject the application. An application notice will state accepted, returned or rejected and sent to the CSP by e-mail address within 48 hours after submission. The CSPs will need to contact the TA and comply with the TA’s guidance to attempt to correct and resolve the issues when an application gets returned or rejected.

1.10.10. Once the DEERS/RAPIDS application is approved, an e-mail is generated detailing the next steps for the CSPs to take. They will need to proceed to a Rapids (CAC issuing) office with a completed DD2842 and two forms of picture ID. The e-mail will contain a URL to download the form. Acceptable forms of ID include: Driver’s License, Military ID, Contractor Company ID with picture and expiration date, charge card with picture imprinted, and passport.

1.10.11. Revalidation Requirements. The TA will revalidate all contract service providers in the DEERS/RAPIDS System every 6 months. In the event revalidation is denied, the CAC credentials will be revoked and the Card will not be useable to login.

1.10.12. Out-processing Requirements. When a CSPs performance under this contract ceases, the Contractor or FSO will provide written notice to the TA. The Contractor shall ensure the CSPs CAC and Command ID is turned in to the KO and/or COR within seven days.

1.10.13. The contractor is responsible for absences of their employees due to expired identification and access documents. Such absences will not relieve the contractor of its obligation to perform the services required under this contract.

1.10.14. If a CSP loses their CAC, a CAC is stolen or the CSP walks off the job with their CAC, the appropriate security office shall be immediately notified.

1.11. Identification of Privacy Act. This contract requires the development of a system of records IAW the Privacy Act of 1974.

1.12. Conduct.

1.12.1. The contractor shall ensure that its CSPs abide by federal and local MTF regulations and requirements concerning the nature of limited privileged communication between patients and the CSP as may be necessary for security and personnel reliability programs. The Contractor shall also ensure that its CSPs abide by federal and local MTF regulations concerning the confidentiality of patient records, as embodied in federal statutes including the Privacy Act of 1974 and the Health Insurance Portability and Accountability Act of 1996. All medical records and reports are and shall remain the property of the USG.

1.12.2. The contractor shall abide by all MTF policies, rules and regulation. All CSPs shall maintain and support the standards necessary to meet The Joint Commission (TJC) certification. CSPs shall wear an MTF identification badge. The COR shall assist the CSP in obtaining the identification badge through the MTF Security Officer. Upon termination of work, CSPs shall return the hospital identification badge.

1.12.3. Removal of employees. At any time during the performance of this contract, the KO or COR may direct the Contractor to immediately remove any CSP whose actions or impaired state raises reasonable suspicion that clear and present danger of physical harm exists to a patient, other employees, and USG personnel or to the impaired individual. This provision is for emergency situations only and not for the purpose of bringing performance issues or other non-urgent concerns to the attention of the Contractor.

1.12.3.1. If the need for a removal occurs, the COR shall contact the contractor's point of contact and direct the contractor to remove that individual from the military facility and to not use that individual to perform any healthcare services required under this contract until the issue has been resolved by the KO. The contractor shall formally meet with the COR to discuss further action IAW the MTF Quality Assurance and Inspection (QA&I) Plan. A review of the basis for removal determination by the KO shall be within three working days after the COR directed the removal.

1.12.3.2. If, after any investigation deemed necessary by the KO and discussions with the contractor's representative, the KO concludes that the CSPs impairment requires permanent removal from performance under the contract, the KO shall notify the Contractor of recommendation to permanently removal CSP from the site. In the event of disagreements between the USG and the Contractor's representative concerning matters of impaired employees, the decision of the KO shall be final. During the period of time between the removal and the final decision of the KO, the Contractor shall provide a backup/replacement CSP IAW the terms and conditions of this contract.

1.13. Inquiries. The contractor shall ensure that CSPs do not respond to any media inquiries. Any inquiries from the media shall be immediately relayed to the COR, who shall relay them to the MTF Commanders and to the Tidewater Market leadership. There shall be no interviews, comments or any other response without the knowledge and approval of the MTF Commanders and Tidewater Market leadership.

1.14. Smoking. The contractor shall ensure that its CSPs comply with established installation smoking policies.

1.15. Complaints. The COR shall validate complaints and report in writing to the KO and to the Contractor for action, if it constitutes a failure to perform, as determined by the USG. Patients may also be a source of legitimate complaints that constitute a failure to perform. The Contractor shall have no more than two substantiated complaints per 12-month period per CSP. Any patient complaints received on services provided by the CSP shall be very serious and as such shall be considered a part of the inspection process. Receipt of two valid complaints on a CSP within any twelve-month period may be grounds for immediate removal.

1.16. Specific hours of operation. The contractor shall provide centralized services Monday – Friday from 6:00am to 7:00pm, and Saturday, Sunday and Holidays (except Christmas Day) from 7:00am to 3:30pm. The contractor shall coordinate any changes to the open/closed times (i.e., inclement weather, clinic closures, etc.) with the COR. Further, any closures of MTF or contractor support within duty hours shall be programmed in Automated Call Distribution (ACD) recording with associated guidance for patients and beneficiaries prior to outage. The contractor shall adequately staff employees to meet the mission during the hours the call center is taking into account the demand per day of the week and time of day. Contractor personnel performing under this contract shall abide by the provisions of all applicable regulations and policies and use applicable programs for capturing workload for all Contractor Personnel.

1.16. MISSION ESSENTIAL. All contract staff; i.e.… CSP, Project Manager and Assistant Project Managers are considered “Mission Essential” and must report to work during periods of inclement weather and/or other contingency (less than a crisis) unless directed otherwise by a competent government authority

1.17. Contingency Operations. In the event of services being required during contingency operations natural or man-made disaster, etc.), the contractor may provide services in a decentralized location. The contractor shall provide services IAW this performance work statement.

1.18. Telework – The contractor shall be permitted to telework as needed to support the appointing function in the Tidewater Market. Contractor shall be authorized to enable the employees in the Appointment Call Center to telework upon coordination with Contracting Officer and completion of a signed Telework Agreement. The Contractor shall have written Policy Guidance established and provide adequate oversight of work products to ensure contract compliance while teleworking, which shall be provided to the Government.

**Contractor employees are authorized to telework only if approval is granted by the Contracting Officer.

No software shall be added to government equipment and no external devices plugged into the government laptops. The contractor is responsible for the security and returning all government owned equipment when an employee is terminated or at the end of the contract period.

1.19. Quality Control (QC). The contractor is responsible for quality control of the services provided. The contractor shall establish and maintain a complete Quality Control Plan (QCP) that shall ensure the requirements of the contract are provided as specified in this PWS. The contractor shall provide copies of the QCP to the KO and COR no later than 30 days after contract award, and within 5 days when changes are made thereafter.

1.20. Quality Assurance (QA). The USG shall evaluate the contractor’s performance under this contract IAW the Quality Assurance Surveillance Plan (QASP). The QASP is the USG’s internal plan for performing QA, and as such does not become part of the resultant contract.

1.21. Transition Period Reporting.

1.21.1. The contractor shall submit weekly status reports of phase in and operation activities to the COR.

1.21.2. Transition Period. The CSP shall become familiar with contract requirements, e. g., train CSPs on booking procedures and system interfaces, etc., in order to commence full performance of services on the contract start date. The contractor shall have a two (2) month transition period. In the event the USG requires an accelerated transition plan, the requirement shall be included in the contract and the offeror shall be afforded the opportunity to submit pricing for the requirement. The phase out transition shall occur at the end of the period of performance and shall include the disposition of contractor furnished equipment and personnel.

1.22. Security - All users are required to adhere to the DHA’s IM/IT and HIPAA security policies and instructions. It’s the user’s responsibility to protect their government system/ password including not sharing access with any other personnel at any time. Users are also required to not leave active terminals unattended. The contractor shall notify the COR of any concerns about security compromises. Any breach of security procedures may result in revocation of the government systems access. Users shall be held accountable for any errors discovered under their account.

1.23. Government Systems Confidentiality and Password Protocol Statement. The Privacy Act of 1974 Imposed responsibility to provide misused or compromised data concerning individuals. It has three main provisions.

1.24. Confidentiality of Information. Most of the Information within the government systems are sensitive, unclassified, and personal medical information. Only authorized people or agents are allowed to disclose this Information. Federal Laws impose penalties for illegally using sensitive patient information.

1.25. Data Integrity. Patient treatment decisions are made from government systems information. The Privacy Act requires mechanisms to ensure data in the system is accurate, relevant, timely, end complete. Users of the system shall be responsible for ensuring all data entered into the government systems are accurate.

1.26. Data Security. The third provision of the Privacy Act requires safeguards for confidential and secure records. This entails protective measures for preventing accidental or malicious alteration, destruction or disclosure of personal Information that could affect medical care.

1.26.1. The contractor is responsible for following all security related guidelines as per Department Of Defense and local directives IAW Electronic and Information Technology Accessibility Standards (36 CFR 1194) (PWS paragraph 6.1, 7th in the list). Your ACCESS CODE and VERIFY CODE are unique to YOU, IT MUST BE KEPT CONFIDENTIAL.

1.26.2. The access code replaces a handwritten signature and is legally equal to a handwritten signature.

1.26.3. Passwords are necessary for performance of duties. Passwords shall be memorized. DO NOT write it down or allow anyone else access to YOUR PASSWORD.

If you suspect that someone else is using your confidential password, notify your supervisor immediately arid request a new password

If you change your status or job in anyway (i.e. job description legal name, job title, etc.) You MUST summit title change in writing to the Management Information Department so that system information can be updated.

1.28. Confidentiality and Password is found in Exhibit D

2. DEFINITIONS/ACRONYMS.

2.1. Following is a list of basic definitions.

2.1.1. Appointment Standardization Systems process of booking appointments that starts with identifying the patient’s Access to Care category resulting in the right patient in the right appointment slot with the right provider at the right time.

2.1.2. Call "Blockage rate": Those calls that cannot be completed by the caller due to the call capacity of the telephone switch (i.e., all telephone lines are busy).

2.1.3. Call “Abandonment rate”: Call Abandonment is the number of callers whose calls were received by the telephone switch, but who disconnected (i.e., hung up before reaching an appointing clerk/scheduler) at any time during the call transaction. Abandoned calls should be included in the Call Wait Time and Total Call Hold Time measures. Minimum standard is that the average abandoned call rate should be ≤5% on a monthly average.

2.1.4. Call "wait" time: The initial time the caller waits in queue for the live appointment clerk/scheduler to schedule/cancel/re-schedule an appointment after being placed on hold by the telephone system. This information shall be provided in 15-minute increments.

2.1.5. Call “hold” Time: The total time the patient is placed on hold or in queue by the telephone system or the contractor staff during the call. This includes the initial wait time and any subsequent times the patient is placed on hold/in queue by the telephone system, appointment clerk/scheduler, or other CSP staff. This information shall be provided in 15-minute increments.

2.1.6. CHCS/MHS Genesis: A DoD information systems used to check a patient's eligibility, manage provider appointment templates and schedules, and manage patient appointment information. This is the current primary information system platform for managing appointments in DoD.

2.1.7. Contracting Officer (KO): A USG employee having the authority vested by a Contracting Officer’s Certificate of Appointment to execute, administer, and terminate contracts and orders, and modifications thereto, which obligate USG funds and commit the USG to contractual terms and conditions.

2.1.8. COR: A person designated by the KO to assist in the technical monitoring or administration of a contract. Procedures vary from agency to agency, but generally a COR must be designated in writing with a copy furnished to the Contractor and the contract administration office. The designation does not include any authority to make any commitments or changes that affect price, quality, quantity, delivery, or other terms and conditions of the contract.

2.1.9. Centralized Appointing Services: The contractor’s appointing staff working physically and functionally within a call center on post/base.

2.1.10. Decentralized Appointing Services. The CSP staff working physically and functionally within a call center located on/off post/base. The primary work location for call center staff is the Hampton Road Appointing Center (HRAC); NMCP Building 272, Room 165A. In an event an alternate location is required, the government may elect to provide an alternate locations within the Tidewater Market to include Naval Medical Center Portsmouth and associated clinics, McDonald Army Health Center and associated clinics, and 633rd MDG Langley Medical Group. The government may consider alternate work locations upon request from the contractor based on need and availability. All alternate location requests, must be communicated in writing.

2.1.11. Demilitarized Zone: Dedicated network segment that provides network connectivity for an organization’s publicly accessible servers.

2.1.12. Direct Care System: The DoD's health care system comprised of MTFs that provide care to eligible MHS beneficiaries.

2.1.13. MHS GENESIS: A DoD electronic healthcare record system that is used exclusively in the PAS. GENESIS provides an integrated system for appointment scheduling, referral management functions as well as the management of patient care. The contractor shall receive training by the government to serve as MHS GENESIS trainers during the transition period.

2.1.14. Telephone Consultation:

Receive and electronically deliver telephone messages (Telephone consultation (T- CONS)/AHLTA Tasker) to PCMs and/or clinic nurses using AHLTA (or its successor as applicable/appropriate) per individual clinic guidelines. A T-CON is written communication to a health care professional (to include MTF providers and/or clinics).

2.1.15. TRICARE Prime Enrolled Beneficiary: An MHS eligible beneficiary who is registered on the Defense Enrollment Eligibility Reporting System (DEERS) and who is enrolled with TRICARE Prime, including Active Duty Service Members.

2.1.16. Defense Health Agency: The DHA incorporates all aspects of health services for the Department of Defense.

2.1.17. MHS Beneficiary: Any individual eligible to receive treatment in a MTF or via TRICARE civilian network providers. The categories of MHS beneficiaries shall be broadly interpreted unless otherwise specifically restricted.

2.1.18. MTF: A military medical center, hospital, health center, troop medical clinic, branch health clinic or medical clinic.

2.1.19. MCSC: Contractors supporting the DoD TRICARE program. These contractors support the Department of Defense by combining civilian managed healthcare networks with fiscal and administrative support, and compliment the majority of services provided in and/or by the MTFs.

2.1.20. Tidewater Market: MTF collaborating together to develop a consolidated Business Plan and jointly work resource issues in overlapping catchment areas. These include integrated plans for appointing services, resource sharing, optimization initiatives and DoD/VA sharing opportunities.

2.1.21. Network Care: Care provided by the network of contractor-operated providers and facilities (owned, leased, arranged) that links the providers or facilities with the Managed Care Support Contractor (MCSC) as part of the total contracted delivery system. Thus a “network provider” is one who serves TRICARE beneficiaries by agreement with the MCSC as a member of the TRICARE prime network or of any other preferred provider network or by any other contractual agreement with the MCSC. “Network care” includes any care provided by a MCSC “network provider” or care provided to a TRICARE Prime enrollee under a referral from the MCSC, whether by a “network provider” or not.

2.1.22. Non-enrolled Beneficiary: An MHS eligible beneficiary who is registered on DEERS and not enrolled with TRICARE Prime.

2.1.23. Non-Network Care: Any care not provided by “network providers” except care provided to a TRICARE Prime enrollee by a “non-network provider” upon referral from the MCSC. A “non-network provider” is one who has no contractual relationship with the MCSC to provide care to the TRICARE beneficiaries.

2.1.24. Appointment Error: Mis-booked appointments occur when (1) a patient receives the wrong appointment type for the level and type of care needed, (2) the appointment clerk does not correctly complete the data elements, (3) the patient is sent to the wrong location or the wrong provider, (4) any other booking error that results in inconvenience to the patient, disruption of clinic effectiveness/efficiency, and failure to appropriately match TRICARE Prime beneficiaries to appointment slots reserved for Prime, or (5) and booking errors that affect the non-booked appointment report, i.e. duplicate searches, searches with inappropriate access to care code/search. Feedback regarding mis-booked appointments may be collected from patients, providers, CHCS/MHS Genesis reports, clinic support staff, booking clerks and appointment supervisors.

2.1.25. Warm Transfer: Person to person transfer of caller to MTF identified source and/or clinic. Contractor stays with the caller a minimum of 45 seconds.

2.1.26. Cold Transfer: CSP gives the caller the phone number to the MTF identified source and/or clinic; contractor transfers the call and release the call.

2.1.27. Twenty-four-hour (24HR) appointment type shall be used primarily for patient care conditions requiring care within 24 hours of the request. It may also be used for non-urgent patient conditions, but must be balanced with urgency and availability; this process shall be described in the MTF appointing protocols. To the greatest extent possible, CSPs shall fill all 24HR slots on a daily basis, and all patient issues shall be addressed in a single visit to minimize the need for unnecessary future appointments or repeat visits. These 24HR appointment type is for Primary and Specialty Care.

2.1.28. ATC Category and Standard: For all clinical system booking methods except Referral Booking, CSPs shall use the Acute ATC Category or clinical system search function to book 24HR appointments. To meet the Acute ATC Standard, the appointment needs to be booked and seen within 24 hours or 1,440 minutes from the patient’s request.

2.1.29. FTR appointment type shall be used for patients requesting non-urgent services beyond 24 hours (such as for routine, wellness and follow-up care). The objective is to offer care within seven days, but the goal is to accommodate the patient’s request or provider directed timeline for care at any time in the future. This shall not be used for initial specialty (SPEC) appointments. To the greatest extent possible, all of the patient’s issues are addressed in a single visit to minimize the need for unnecessary future appointments or repeat visits. This appointment type is used in Primary and Specialty Care Clinics.

2.1.30. In the case of healthcare that is characterized as mental health, appointing staffs shall be aware that the (initial or exacerbation of existing condition) mental healthcare requests need to be appointed within 7 calendar days, and can be appointed to the patient’s Primary Care Manager, Primary Care Behavioral Health Provider, or Behavioral/Mental Health Clinics.

2.1.31. Only stand-alone Behavior Health Clinics that are not imbedded within Primary Care may use the Routine (ROUT) appointment type to assist in monitoring access standards based on Service guidance.

2.1.32. The SPEC appointment type is designed for the initial appointment (by consult or referral) to a specialist. A specialty appointment is reserved for care to be delivered by a network or MTF specialist for a specific disease process.

2.1.33. The initial specialty care appointment shall map to the 28-day Specialty ATC category by default, unless a consultation between the referring provider and the specialist specifies that the visit to the specialist must occur sooner. The requirement for a specialist visit to occur sooner than 28 days shall be documented on the electronic CHCS/MHS Genesis Consult Order or other applicable automated consult system.

2.1.34. The PROC appointment type is designated for patients who are determined to be in need of medical procedures except those that are performed in an MTF Ambulatory Procedure Unit (APU - B**5 MEPRS Clinics).

2.1.35. A procedure appointment shall be scheduled with a provider within 8 days or per the referring provider's designation. The provider’s designation must not exceed 28 days.

2.1.36. The GRP (Group) Appointment type shall be used for patients, who must be scheduled for therapy, counseling, or teaching sessions where a provider shall perform the intervention in a group setting. The detail field can be used to provide further information as to what the group appointments type is reserved for (e.g., NPCL for New Prenatal Class).

2.1.37. A Group Appointment shall be scheduled per the referring provider's designation.

2.1.38. The 24HR appointment type is designated for patients who require a routine or acute office visit with their Primary Care Manger (PCM) or a specialist who call in today. Some sites may wish to include wellness appointments. Every effort shall be made to allow patients to see their own physician on the same day that they request an appointment, but the clinic does not open itself into a full walk-in type service. The 24 HR appointment is not an acute, routine, or follow-up type appointment.