Helpline__Tobacco_Quit-Line-Shaw_AFB.docx

STATEMENT OF WORK

FOR

TABACCO CESSATION

21 December 2015

1.0. DESCRIPITON OF SERVICES

1.1. Scope of Work. Contractor shall provide telephone support/counseling for the tobacco cessation program. Contractor shall provide a live operator and a toll-fee tobacco cessation quit-line.

1.2. Basic Services. The contractor shall provide telephone support/counseling for the tobacco cessation program.

1.2.1. Contractor shall provide access to registered nurse and/or respiratory therapists and/or certified Tobacco Treatment Specialists as counselors via a toll-free tobacco cessation quit-line. All methodologies and practices used by counselors will be Federal Drug Administration (FDA) approved strategies. Each caller/patient shall receive individualized tobacco cessation counseling and a free packet of information outlining the cessation process. The contractor specialists will inform caller/patient of the tobacco cessation medications available to them, explain medication therapy and discuss local installation protocol for tobacco cessation.

1.2.1.1 At the end of each phone conversation, it is the responsibility of the contractor to email Health Promotions at the designated email account/address, a copy of the Subjective Objective Action Plan (SOAP) note detailing the call and needs of the patient.

1.2.1.2 Although most patients will be able to quit within a 3-4 month period, the contractor does not limit the time involved with a patient.

1.2.1.3 Fax referral form, provided by the contractor may be used by Health Promotion to refer callers to the telephone counseling services.

1.2.1.4 The contractor will provide Health Promotion with a quarterly list of the patients who have participated in tobacco cessation counseling.

1.2.1.5 The contractor will contact every patient that has participated in tobacco cessation counseling at 7 months after enrollment to follow-up on the current tobacco use status of the patient. Three attempts will be made to contact patient and each attempt with be documented and sent to the Health Promotion designated e-mail account/address.

1.2.2. If the patient requests medications (Chantix or Zyban) or nicotine replacement therapy (nicotine patch/nicotine gum), they are required to enroll in the tobacco cessation telephonic counseling and make weekly calls and/or enroll in the Health Promotion tobacco cessation course. There will be no limit on the number of calls a patient may make and are welcomed to call as frequently as they would like.

1.2.3. The contractor will provide a detailed listing of patients remaining current and active in the program via an established email account for local follow-up.

1.2.4. The contractor will provide data on 7 month quit rates of patients in the Tobacco Cessation program.

1.3. Hours of Operation. The contractor shall provide services between the hours of 0700hrs to 2300hrs CST, 7 days a week on the provided 1-800 (no cost) phone number to clients once enrolled in the Health Promotion tobacco cessation program. There is a dedicated military toll free number for beneficiaries to use. If staff is busy assisting callers, the client has the option to hold or leave a message. Messages are returned the next business day. All messages are tracked to monitor completion.

2.0. GOVERNMENT FURNISHED PROPERTY AND SERVICES

2.1. Government Furnished Property. N/A

3.0. GENERAL INFORMATION

3.1. Account Manager. Contractor shall provide an Account Manager who shall be responsible for contract performance and can act for the contractor on all matters relating to daily operation of the contract. The name of this person and an alternate, who shall act for the contractor when the manager is absent, shall be designated in writing to the Contracting Officer (CO) whining five days of contract award. The account manager and alternate must be able to read, write, speak and understand English.

3.1.1. Availability of Account Manager. The Account Manager or alternate shall be available 7:30 A.M. through 4:30 P.M. Monday through Friday, for contact by telephone, to resolve any problems that may arise.

3.2 Working Hours. The Contractors shall provide services Monday – Sunday between the hours of 0700hrs and 2300hrs CST.

4.0 GOVERNMENT PROVIDED DUTY SCHEDULES

4.1 The processing schedule for the contract period will be annually.

5.0 CONTINUIUTY OF SERVICES

5.1 Failure to provide service may subject the contractor to reimbursement of any additional cost incurred by the government. In the event counseling services cannot be performed, the Contractor must promptly notify the Health Promotion Flight Commander.

6.0 ENGLISH LANGUAGE REQUIREMENT

6.1 Counseling shall be in English.

7.0 LICENSURE/REGISTRATION

7.1 Awarded contract company is responsible to ensure counselors are qualified to perform counseling services to patients.

8.0 FOR OFFICIAL USE ONLY

8.1 The contractor shall create and maintain FOUO material IAW DoD 5400-7,R, DoD Freedom of Information Act Program, AFI 33-129, Transmission of Information Via the Internet; and AFI 33- 201, Communications Communications Security (COMSEC), Table 1. Mark all documents meeting the requirements identified in DoD Regulation 5400.7/Air Force Supplement as “For Official Use Only”. Safeguard all sensitive data IAW DoD Regulation 5400.7/Air Force Supplement. When documents containing FOUO material are authorized for destruction, shred the records so that the pieces cannot be reconstructed.

9.0 PATIENT LISTS

9.1 Patient lists, no matter how developed, shall be treated as privileged information. Add the following to the bottom of all patient lists: “FOR OFFICIAL USE ONLY. This document contains information exempt from mandatory disclosure under the Freedom of Information Act (FOIA)., Title 5 U.S.C 552(b)(2) High and (b)(6) apply.” Lists and/or names of patients shall not be disclosed or revealed in any way for any use outside the MTF without prior written permission by the Chief of Hospital Services.

10.0 PRIVACY ACT PROGRAM

10.1 The contractor shall create and maintain Privacy Act data IAW AFI 33-129, Transmission of Information Via the Internet, paragraphs 7.4, 8.2.3, 16 and 17 and supplements; AFI 33-201, Communications Security (COMSEC), Table 1; AFI 33-332, Air Force Privacy Act Program, Privacy Act systems of records notice(s), which are posted on the internet at (http://www.defenselink.mil/privacy/notices/usaf). The contractor shall not create or maintain a Privacy Act system of records prior to public notice. If the contractor receives a Privacy Act request, the contractor shall be responsible for searching for the records and providing those records to the government official who, as authorized official, will make the decision on releasing government records.

11.0 RELEASE OF MEDICAL INFORMATION

11.1 The Contractor shall release medical information obtained during the course of this contract to MTF staff involved in the care and treatment of that individual patient only.