PWS_-_22_Nov_2017.pdf

Source Selection Information – See FAR 2.101 and 3.104

FOR OFFICIAL USE ONLY - Source Selection Information – See FAR 2.101 and 3.104

PERFORMANCE WORK STATEMENT

Reserve Health Readiness Program (RHRP) - 3

Revision November 22, 2017

Attachment NO. 0001

1.0 INTRODUCTION

The Defense Health Agency’s (DHA’s) Reserve Health Readiness Program (RHRP) provides health readiness services to military Service Components (SCs) of the Reserve Components (RCs) (i.e., Army Reserve and Army

National Guard, Air Force Reserve and Air National Guard, Navy Reserve, Marine Forces Reserve, Coast Guard

Reserve), Active Components and Department of Defense (DoD) Service Civilians. RHRP-3 is the third generation of the RHRP contracts. The desired outcome and sole focus of the RHRP-3 contract is to support the DHA as a

Combat Support Agency by responding quickly and effectively to SCs’ requirements for medical and dental readiness support, whether that be in a peacetime or wartime operations tempo.

1.1 Description of Services.

The Reserve Health Readiness Program (RHRP) provides health readiness services to the Service Components

(SCs), which are composed of the Reserve Components (RC), Active Components (AC) and Department of Defense

(DoD)/Service civilians. This requirement provides medical readiness services to meet the medical and dental standards and requirements essential in maintaining a deployable force.

Reserve Health Readiness Program (RHRP) services include immunizations, physical examinations, Periodic Health

Assessments (PHA), Pre-Deployment Health Assessment, Post-Deployment Health Reassessments (PDHRA), Separation History and Physical Examinations (SHPE), Mental Health Assessments (MHA), dental examinations and x-rays, limited dental treatment, laboratory services, occupational health services, and other services as required to satisfy SC health readiness needs. Health readiness services include those which are required under Department of Defense Instruction (DoDI) 6025.19, Individual Medical Readiness, e.g., current dental examinations and PHAs, DoDI 6490.03, Deployment Health, e.g., Deployment Health Assessment Program (DHAP) Pre-Deployment Health

Assessments and Post-Deployment Health Reassessments, and other services determined to be readiness-related.

Routine AC services are limited to PDHRA, Mental Health Assessments, PHAs, Pre-Deployment Health

Assessments, and Individual Medical Readiness (IMR) requirements for SMs in geographically remote areas.

Services to DoD/Service civilians will be limited to deployment readiness services required by DoD Directives or their parent DoD/Service agency and will be provided to DoD/Service civilians working or residing in areas geographically remote from military or other DoD medical facilities. Exceptions will be at SC direction.

These services are provided in every state, within United States and its. Territories, the District of Columbia, and

Germany, in group events (gatherings of Service Members [SMs] for provision of services face-to-face) at SC-designated, government sites (e.g., Armories, drill halls), through the Contractor’s Call Center, and within the

Contractor’s network of private sector providers (physician and dentist offices and clinics and individual Health

Care Professionals [HCPs]). Group events, while typically over a weekend, can last anywhere from one day to 31 days at a single location based on an eight hour work day planning factor.

The SCs are governed by rules and regulations of their parent Services. All references to regulations, forms or electronic information systems of a SC refer to that of its parent Service, unless it is a DoD regulation, form or electronic information system, or if it is a SC-specific system not used by the parent Service. SCs will provide the

COR with their SC-specific guidance which will then be disseminated to the Contractor.

1.2 Historical Data

The SC requirements vary widely depending upon a number of factors to include time of year, deployment cycle, time of the month, and competing demands. Therefore, the Contractor must be able to meet surges for various http://acquisition.gov/far/current/html/Subpart%202_1.html#wp1145507 http://acquisition.gov/far/current/html/Subpart%203_1.html#wp1139244 services. The greatest requirement for group events thus far was a single week in which more than 18,600 PHAs, 16,500 dental examinations, 52,000 immunizations, 6,550 audiograms, 13,900 blood draws, 3,300 panoramic x-rays, 3,150 EKGs, and 19,550 vision screens were requested to be conducted in 351 locations in 49 states and Territories.

Almost 4,200 professional and administrative staff were at these group events, using almost 1,900 Contractor-purchased laptops. Surges for specific types of services can also occur. Up to 21,490 PHAs, 24,000 audiograms, and 23,150 dental exams in group events have been requested in other weeks.

The call center receives approximately 73,000 inbound calls monthly and automated outbound calls have averaged between 149,000 and 238,000 per month. On average, Behavioral Health Specialists (BHSs) have been involved in approximately 8,500 calls per month to assess and intervene but that number is expected to increase to 18,000 per month for RHRP-3 due to new requirements

For fiscal year 2016, the monthly ranges for completed PHAs, dental examinations, and immunizations conducted in group events were 4,250 to 33,900; 4,500 to 28,500; and 1,200 to 56,100, respectively. For all SCs combined, 93,250 in-clinic PHAs were completed in fiscal year 2016. Approximately 23,000 SM and DoD civilian PDHRA

DD Form 2900 screenings and PDHRA clinical interviews occurred during fiscal year 2016.

For digitization and review purposes, the Medical Health Record has historically contained, on average, 40-50 pages based on an eight year tour. The Dental Record has historically contained, on average, 15-20 pages based on an eight year tour.

Historically up to two trips annually have been requested for services in Germany.

1.3 Objectives

The Contractor shall provide all materials, labor and equipment to provide services in group events; shall develop, administer, train, and coordinate a nationwide network of private sector HCPs used to provide health readiness services in support of the SCs; shall obtain and distribute supplies to all involved parties; shall receive and process all medical documentation, paper and electronic, related to services delivered within this PWS; and shall have an information system capable of managing the provision of services and interfacing with SC and DoD Military Health

System information systems to provide the services and enter the data regarding those services.

1.4 Non-Personal Services

This award identifies services that are strictly non-personal in nature as defined by FAR Section 37.101

“Definitions” and described at FAR Subpart 37.4 “Nonpersonal Health Care Services.”

1.5 Inherently Governmental Functions

This requirement has been reviewed and contains no services that are inherently governmental functions, as defined in FAR Section 2.101“Definitions” and FAR Subpart 7.5 “Inherently Governmental Functions.”

2.0 GENERAL INFORMATION AND REQUIREMENTS

2.1. Quality Control Plan

The Contractor shall establish, maintain, and submit a prospective quality assurance process with proposal submission and provide a finalized Quality Control Plan (QCP) within 30 calendar days of contract award.

(Deliverable 1) (IAW CDRL D001). Following Government approval of this plan, the Contractor shall implement the plan, ensuring all Contractor activities and products are consistent with the plan. A QCP is an organized written document which outlines the Contractor’s own steps to control the quality of the output, conform to contract requirements and reasonable standards of healthcare, and proactively seek improvements in program effectiveness, efficiency, and quality. The plan shall include initiatives and self-reviews to ensure services are provided on a timely and quality basis, network HCPs meet contract requirements, records of Contractor activity are properly maintained, Government databases are updated quickly and accurately, and the level of service remains high. The plan shall also include government-approved satisfaction surveys made available to SMs upon completion of the service and the lead unit Point of Contact (POC) for group events.

2.2 Holidays and Hours of Operation

The Contractor shall determine its personnel policies for federal holidays recognizing that capabilities to conduct telephonic Mental Health Assessments and Post-Deployment Health Reassessments must exist on a 24 hours/day, seven days/week basis. Surges to support the military mission may also require work on federal holidays. The medical readiness mission is a seven days/week enterprise with group events typically occurring over the weekend.

2.2.1. The Contractor shall have a 24 hours/seven days a week (including federal holidays) toll free number and

Call Center staffed by HCPs, BHSs, Military Benefits Advisors (MBAs), and administrative personnel who can interview, triage and refer SMs who call to accomplish MHA and PDHRA assessments.

2.2.2. The Contractor shall provide a toll-free, dedicated customer service department and a dedicated scheduling line available M-F 8:00 am -11:00 pm Eastern Standard Time (EST) and Saturday 8:00 am – 4:00 pm EST to perform all appointment scheduling and customer service related services.

2.3 Installation/Facility Access, General Protection, and Installation Passes

2.3.1 The Contractor and all associated sub-contractor personnel shall comply with applicable installation, facility and area commander installation/facility access and local security policies and procedures.

2.3.2 The Contractor shall provide all information required for background checks to meet installation access requirements to be accomplished by the installation Provost Marshal Office or Service equivalent, Director of

Emergency Services, or the Military Treatment Facility (MTF) Security Office.

2.3.2.1 Access to U.S. Coast Guard (USCG) installations. Prior to access, the Contractor shall contact the host unit and provide all requested identifying information of Contractor personnel who will access the installation. This information may include, but is not limited to, name, date of birth, Social Security Number, and citizenship. The

Contractor shall provide the information at least one week in advance unless granted a waiver by the unit POC when an urgent group event is needed. Identification presented at entry must comply with Real ID requirements.

2.3.3 The SC POC will coordinate the issuance of required installation passes to Contractor personnel, if applicable.

2.3.4 Badges. Contract personnel shall wear a badge that clearly identifies them as a contract employee. The badge will contain a personal picture, name of employee, and contractor’s name. The badge shall be worn on the outer garment in full view at all times, attached to the outer shirt or jacket pocket by a button or clip or worn around the neck secured by an appropriate identification card lanyard.

2.3.5 In emergency situations when near-immediate deployments are necessary, installation access requirements above may be modified.

2.4 Proper Identification of Contractor Personnel

2.4.1 Contractors, including subcontractors at all tiers, shall provide for a clear distinction from Government personnel. Contractor employees shall not act, advertise, or presume to be Government employees, agents, or representatives. Contractor employees are required to appropriately identify themselves as contractor employees at all times, including in telephone conversations, formal and informal written correspondence, paper and electronic;

and in any other situation where their actions could be construed as acts of Government officials unless, in the judgment of the Government, no harm can come from failing to identify themselves. Contractor employees shall be introduced as contractor personnel and display distinguishing visible identification at all times when in conversations, meetings, and other forms of communication with Government personnel.

2.4.2 Contractor personnel, while performing in a contractor capacity, shall not use their retired or Reserve

Component military rank or title in written or verbal communications associated with the contracts for which they provide services.

2.4.3 The Contractor shall incorporate the substance of this requirement in all subcontracts awarded under this contract

2.4.4 CONTRACTOR MANPOWER REPORTING (CMR).

The contractor shall report all contractor labor hours (including subcontractor labor hours) required for performanc e of services provided under this contract via secure data collection site. The contractor is required to completely fill in all required data fields using the following address: http://www.ecmra.mil, and then click on “Department of the

Army CMRA” or the icon of the DoD organization that is receiving or benefitting from the contracted services.

Reporting inputs will be for the labor executed during the period of performance during each Government fiscal year

(FY), which runs October 1 through September 30. While inputs may be reported any time during the FY, all data shall be reported no later than October 31 of each calendar year, beginning with 2013. Contractors may direct questions to the help desk by clicking on “Send an email” which is located under the Help Resources ribbon on the right side of the login page of the applicable Service/Component’s CMR website”.

2.5 Post Award Conference

The Contractor shall be responsible for hosting a post award conference (Deliverable 2) (IAW CDRL A001) within

15 calendar days of award of contract. The Contractor shall host the post award conference to clarify details of the contract and review the transition plan provided NLT eight calendar days after award. The contractor is responsible to provide the Government with minutes of the meeting within 5 calendar days upon conclusion of the meeting.

2.6 Transition Support

2.6.1 Incoming Transition

The Government has allowed for up to a twelve month transition period from the date of contract award, after which the incoming Contractor shall provide the full complement of RHRP services to meet the SCs’ needs NLT 12 months after award. Upon award, the Contractor shall provide the Government an incoming Transition Plan within eight calendar days for Government review and collaborate with the Government to develop and deliver a final

Transition Plan (Deliverable 3) (IAW CDRL D002) within 20 calendar days of award. This transition plan shall identify who will be accomplishing the following with detailed milestones and interim steps to include as applicable:

Coordination with Government representatives;

Review, evaluation and transition of current reporting services;

Develop a force of trained personnel with needed licensure, certification, and information system access in sufficient numbers to conduct the services;

Obtain equipment sufficient to conduct services;

Conduct orientation phase and program to introduce Government personnel, programs, and users to the

Contractor's team;

Develop tools, methodologies, computer equipment, provider and staff training, and business processes;

Build IT capability and obtain access to required IT systems; and

Build IT capability to generate required reports.

2.6.2 Outgoing Transition

The Contractor shall provide a plan (Deliverable 4) (IAW CDRL D003) at the Government’s request for outgoing transition of six months for transitioning work from an active contract/order to a follow-on contract/order or government entity. This transition may be to a government entity, another Contractor or to the incumbent

Contractor under a new contract/order. In accordance with the Government-approved plan, the Contractor shall assist the Government in planning and implementing a complete transition from this Contract and orders issued under this Contract to a successor entity. This shall include formal coordination with government staff and successor contractor staff and management and weekly or as requested status updates with the government staff. It shall also include delivery of electronic copies of existing policies and procedures, and delivery of required metrics and statistics. This transition plan shall include as applicable:

Coordination with Government representatives;

Review, evaluation, and transition of current services;

Transfer of all documentation; and

Transfer of government technical data not already loaded into government databases or systems.

2.7 Emergencies, Emergency Referrals, and Notification. The Contractor shall ensure that appropriate emergency supplies and equipment are available at the point of service in case of an adverse, unusual, or emergent event. The

Contractor shall have an approved emergency procedure protocol in place at the point of service. The provider is responsible for determining if an emergency exists and an emergency referral necessary. If the provider determines an emergent referral is necessary:

2.7.1 For in-clinic, the Contractor shall notify the COR/designee and SC POC (for Air National Guard [ANG], the

MAJCOM designee and Medical Group [MDG] designee) within one business day of the referral.

2.7.2 For group events, Contractor shall notify the unit Commander/designee the same day and the COR/designee and SC POC (for ANG, the MAJCOM designee and MDG designee) within one business day.

2.7.3 For emergencies emanating from the Call Center, the Contractor shall notify the COR/designee and SC

POC/designee(s), (e.g., for ANG, the ANG, MAJCOM and MDG) within one business day.

2.8 Provider Licensure, Certifications, and Limitations. The Government has the right to review Contractor documentation regarding provider licensure, certification and training.

2.8.1 General Licensure, Certifications, and Limitations

2.8.1.1 The Contractor shall ensure all providers (Physicians, Dentists, Nurse Practitioners, Physician Assistants, Advance Practice Nurses, Advance Practice Registered Nurses, Audiologists, Optometrists, and Behavioral Health

Specialists) maintain at least minimum amounts of malpractice insurance as required by state licensing regulations.

2.8.1.2 The Contractor shall ensure all providers, technicians and other HCPs performing services under this agreement have not been precluded from participation in government healthcare insurance programs, e.g., are not on the Office of Inspector General, Department of Health and Human Services, List of Excluded Individuals/Entities, and have current licenses, registrations, and certifications according to industry standard and as required for the specific state, commonwealth, district or Territory in which they are providing contract services to include compliance with any requirements of the jurisdiction(s) in which they and the SM are located.

2.8.1.3 If services are provided in another country (e.g., Germany), the Contractor shall ensure all providers have a current U.S. license, registrations, or certifications to practice at an independent level as well as Defense Base

Overseas Insurance. Contractor personnel, when traveling to Germany or other foreign countries, will adhere to the entrance requirements of that country.

2.8.1.3.1 If there are no providers meeting these requirements for providing care in another country, the Contractor shall ensure appropriate coverage through training and qualifications for the country in which services are being provided.

2.8.1.4 The Contractor shall ensure that all HCPs have a current certification in basic life support or cardiopulmonary resuscitation (CPR). Exception: Audiologists, Optometrists, and Behavioral Health Specialists attending a group event where other HCPs are present who do have a current certification in at least CPR. Call

Center personnel are also exempted.

2.8.1.5 Contractor HCPs do not provide treatment to a SM unless it is immediate, lifesaving care or is part of the requirement. HCPs shall not refer SMs to businesses such as imaging or laboratory services in which the HCP has fiduciary interests or receives remuneration.

2.8.2 Occupational Health Services Standards and Certification

2.8.2.1 Providers conducting Occupational Medical and Surveillance exams will preferably be physicians, but per

OSHA, can be mid-level, licensed health care providers credentialed to perform such exams.

2.8.2.2 Pulmonary Function Testing shall be performed to National Institute for Occupational Safety and Health

(NIOSH) standards.

2.8.2.3 Chest x-rays shall be read by a board-certified radiologist with the exception of asbestos exposure which requires a NIOSH-certified B reader.

2.8.2.4 Performance of Chemical, Biological, Radiological, and Nuclear (CBRN) exams, Fire Fighter examinations and lab services shall be under the supervision of a physician.

2.8.2.5 A physician (MD/DO), audiologist, or audiometric technician certified by the Council for Accreditation in

Occupational Hearing Conservation (CAOHC) can administer audiometric tests. All audiometric testing shall be entered into the Defense Occupational and Environmental Health Readiness System-Hearing Conservation Data

Repository (DOEHRS-HC DR) database if that database is used by the SC. If using DOEHRS-HC software, technicians must be certified to do so through an Air Force or DoD course. Audiometric technicians must administer audiometric tests under the supervision of a physician or an audiologist.

2.8.3 PHA providers shall be a licensed HCP who is Medical Doctor (MD), Doctor of Osteopathy (DO), Nurse

Practitioner (NP), Advance Practice Nurse, or Physician Assistant (PA).

2.8.4 PHA record reviewers shall be either a PHA provider, Registered Nurse, Licensed Vocational Nurse, or military medic equivalent.

2.8.5 Behavioral Health Specialist (BHS). The BHS shall have as a minimum requirement, state license (or certification when a state does not have licensure) to practice independently in mental health and a Master’s Degree or higher from an accredited institution of higher learning. Social workers, psychologists, marriage and family therapists, professional counselors, psychiatric nurse practitioners, and psychiatrists qualify as BHS.

2.8.6 Training for Provision of Services and Training Records.

2.8.6.1 The Contractor shall have personnel trained according to the requirements for provision of services.

2.8.6.2 To conduct the Mental Health Assessment, providers must have passed the training and subsequent quiz either at http://www.pdhealth.mil or the training cited in 2.8.6.3 and training required by the SC.

2.8.6.3 To conduct the PHA, personnel must have completed the SC PHA training. The DOD training can be found at https://jkodirect.jten.mil/html/COI.xhtml?course_prefix=DHA&course_number=-US066.

2.8.6.4 Contractor dental providers and key ancillary dental staff shall understand DoD/HA policy letter 02-011, the

US Navy Dental Health and Readiness Classification system (Bureau of Medicine and Surgery Instruction

[BUMEDINST] 6600.18, 23 Aug 2010), and other specific SC guidance for dental classification.

2.8.6.5 The Contractor shall maintain records of completed training and provide access to the Government as requested.

2.9 Disposal of Hazardous Dental/Medical Material/Waste

http://www.pdhealth.mil/

The Contractor shall comply with applicable Local, State, and Federal laws and regulations when disposing of hazardous dental/medical material/waste.

2.10 No-show and Cancellation Policy

2.10.1 In-clinic No-show Policy:

The Contractor shall verify with the assigned HCP office that the SM showed for their scheduled appointment. If the HCP’s office reports the SM failed to report, the Contractor shall annotate their status as a “No show” and a no-show fee will be assessed. The Contractor shall attempt to reschedule the appointment until the in-clinic authorization expires after 90 days and an in-clinic cancellation fee will be assessed.

SMs with two unexcused no-shows will have their in-clinic authorization/order expired and an in-clinic cancellation fee will be assessed.

2.10.1.1 Exceptions:

2.10.1.1.1 The SM never received appointment confirmation (text, email, or call) from the Contractor after the appointment was scheduled.

2.10.1.1.2 The appropriate paperwork and supplies were not delivered to the SM or provider prior to the scheduled appointment.

2.10.1.1.3 SM is late for the appointment, but the HCP is available to perform services.

2.10.1.1.4 An emergency situation beyond the SM’s control (e.g., accident, illness, family emergency, bad weather) occurred.

2.10.2 In-clinic Rescheduling/Cancellation Policy:

SM has until 24 hours prior to the appointment to reschedule services and no fees will be assessed. Appointments that are scheduled on a Monday or following a holiday must be cancelled by the previous business day.

The Contractor shall attempt to reschedule the appointment until the voucher/order expires after 90 days and an in-clinic cancellation fee will be assessed.

SMs are allowed two reschedulings after confirmed initial appointment. After that, an in-clinic cancellation fee will be assessed.

A SM who refuses services with an approved voucher/order will have an in-clinic cancellation fee assessed for the service refused.

2.10.2.1 Exception:

2.10.2.1.1 An emergency situation beyond the SM’s control (e.g., accident, illness, family emergency, bad weather).

2.10.3 Group Event No-show/Cancellation Policy:

The Contractor shall coordinate services based on the approved number of requested services annotated on the

Group Event voucher/order or SC authorization form. The SCs will provide a group event roster to the Contractor for group events, allowing substitution of SMs for a specific service. The Contractor shall verify the number and types of services requested with the SC/Unit Group Event POC and remind the unit POC of the no-show/cancellation policy.

2.10.3.1 The SC/Unit Group Event POC has until 14 calendar days prior to the scheduled Group Event date to change or cancel the event with no fee. Before scheduling a group event within 14 calendar days of the start date, the SC must provide written approval.

2.10.3.2 Changes made to a Contractor-accepted event between 14 and five calendar days prior to the group event date are subject to a Cancellation fee per service type to include changes made to a Contractor-accepted revised voucher/order for services that are less than the last approved number and types of services.

2.10.3.3 Changes five calendar days or less prior to the group event date and completion of the event are subject to a no-show fee per service type (e.g., immunizations, laboratory, miscellaneous medical service, PHA, PDHRA, MHA, dental services, audio, vision).

2.10.3.4 Exceptions:

2.10.3.4.1 Cancellation and no-shows fees due to bad weather or other emergencies (e.g., humanitarian mobilizations, OCONUS mobilization flight return delays, THREATCON CHARLIE or above) where reasonable steps or workaround plans could not have prevented the cancellation or no-show.

2.10.3.4.2 Contractor accepts a revised vouchers/order for services equal to or greater than the original voucher/order request for services.

2.10.4 SC-Requested Direct Outreach Fee:

When the SC sends the Contractor a roster of SMs for direct outreach, e.g., a listing of SMs who are overdue for their PDHRA, which does not require the Contractor’s database review to provide services will be termed Direct

Outreach. The Contractor can assess a “Direct Outreach” fee for those SMs whom the Contractor was not able to reach within 30 days of the initial attempt (of three attempts) to contact.

2.11 Incorrect and Non-performed Services

The Contractor will not be paid for services that are provided in error, to include, but not limited to, incorrect or invalid immunization or services not provided due to malfunction of equipment or contractor personnel absence.

2.12 Scheduling

2.12.1 Customer Service Department. The Contractor shall have one call resolution for calls whenever possible.

2.12.1.1 Calls with customers shall be recorded and kept available for review by contractor or Government personnel for a minimum of six months. The Government shall be able to review Contractor interactions by individual.

2.12.2 Determining when Services to be scheduled

For ARNG and USAR, the Contractor shall access the Automated Voucher System (AVS) and Medpros and identify

IMR services which are needed. For AC Army TRICARE Prime Remote (TPR), the Contractor shall access the

Defense Eligibility Reporting System (DEERS) to verify TPR eligibility and MEDPROS to determine IMR services that are needed. The ANG, Air Force Reserve Command (AFRC), U.S. Navy Reserve (USNR), and Marine Forces

Reserve (MARFORRES) will generate a needs list and send it to the Contractor for scheduling of services.

2.12.3 Scheduling Group Events

2.12.3.1 SC POCs will send the Contractor requests for services from SC POCs through the AVS for ARNG and

USAR; by fax through a Contractor supplied toll free, secure fax number; by a dedicated scheduling line; by a

Contractor-supplied online scheduling system; or by other methods agreed upon by the COR, specific SC and the

Contractor.

2.12.3.2 The Contractor shall have a portal that SCs can use to order group events (both on-location and Call

Center) using required approval authority routing, search for events, cancel events, add services to existing events, upload rosters of expected event attendees, view completed service documentation, view scheduling and clinic information, and obtain reports after event completion. This portal shall have a tutorial and be secure.

2.12.3.3 SC/Unit Group Event POC will provide the Contractor with the request for services prior to 14 calendar days from the start of the group event. The Contractor may accept request for services with less notice and shall provide the same level of quality as if more notice were given.

2.12.3.4 The Contractor shall accept or reject increases in services within one business day of receipt of request from the SC/Unit Group Event POC. The Contractor shall be prepared to conduct group events composed of SMs from more than one SC and to work collaboratively with other providers of service.

2.12.3.5 If the Contractor receives a written SC-approved Group Event request for services (typically to meet urgent requirements such as deployments, special assignments) that do not meet the minimum to schedule as delineated in

Attachment 1 and the Contractor accepts the request, the Government will be charged the minimum number to schedule multiplied by the associated Group Event TIER 1 or per day unit price.

2.12.3.6 During the scheduling process, the Contractor shall ask the SC event POC to remind the SMs of the need to bring pertinent medical records that are not in their SC record.

2.12.3.7 The Contractor shall receive or work to identify specific POCs to work with these units to identify requirements and facilitate service provision. Unit requirements shall be checked for medical and dental readiness adequacy and eligibility.

2.12.4 Scheduling In-Clinic and Call Center Appointments

2.12.4.1 Per SC guidance, SMs may request appointments by hard copy, telephonic or electronic means. The

Contractor shall have a portal that SMs, per SC guidance, can use to request appointments, provide avai lability for appointments, complete required forms (including assessments, e.g., DD Form 3024, Periodic Health Assessment), cancel appointments or services, view scheduling and clinic information, view status of in-clinic appointment kits, and provide feedback on their experience after service completion. This portal shall have a tutorial and be secure.

2.12.4.2 After receiving a SC request to schedule SMs for an in-clinic appointment, the Contractor shall attempt to reach the SM within one business day. The Contractor shall attempt to contact the SM to schedule all approved services with a minimum of three attempts to the primary and secondary valid phone number, email, or text, depending upon SM preference.

2.12.4.2.1 The Contractor shall schedule the SM for the needed in-clinic service within 15 business days of the SM’s first day of availability.

2.12.4.3 After scheduling the in-clinic appointment, the Contractor shall within 24 hours provide a reminder to the

SM of the appointment time, location, the need for the SM to bring pertinent medical documentation, and other directions to the SM to facilitate successful completion of the appointment.

2.12.4.4 After scheduling in-clinic appointments, the Contractor shall ensure the SM receives a kit with the appropriate documentation and information prior to the appointment. That kit shall include needed supplies, e.g., phlebotomy supplies, lab requisition forms, urine collection supplies, service specific mailers, driving directions, pre-populated service appropriate forms for SM and HCP completion with instructions, reminder to bring pertinent medical documentation, provider documentation and information, satisfaction surveys, and all other items needed for successful completion of the required medically related services. The Contractor may with COR approval, send portions of the kit electronically and send supplies to in-clinic providers rather than the SM.

2.12.4.5 The Contractor shall contact the SM 72 hours in advance of the scheduled in-clinic services to remind the

SM of the time and location of the scheduled services.

2.12.4.6 In-clinic services shall be scheduled within a 50 mile driving distance of the SM’s residence, place of duty, or civilian place of business. The choice between the SM’s residence, place of duty, or civilian place of business as a proximity point shall be given to each individual SM. If the SM expresses concern about the distance, the

Contractor shall see if a closer network provider is available.

2.12.4.7 In the unusual instance when the Contractor does not have a provider within a 50 mile driving distance of the SM’s choice of the SM’s residence, place of duty, or civilian place of business capable of conducting the services, the Contractor shall be expected to obtain and train a provider within 25 business days.

2.12.4.8 The Contractor shall make available to the SM the ability to schedule appointments for assessments that per

SC guidance, may be conducted person-to-person, e.g., MHA and PHA, through the Contractor call center.

2.13 Profiling and Deployment Limiting Conditions

2.13.1 The Government will provide the Contractor with clear guidance on identifying conditions resulting in a profile, duty limitations, or deployment limitations based on review of the medical history, including documentation presented by the SM (e.g., pregnancy requirements, medical or dental problems) and other assessments and interactions including physical or focused examinations and interviews. Adhering to those guidelines in documenting profiles or duty limiting conditions, the Contractor shall perform the following services .

2.13.1.1 Contractor providers shall complete required training to meet current and future requirements, e.g., the

U.S. Army Profiling Course completion is required prior to use of eProfile or other SC-required systems, and have appropriate Contractor-verified credentials prior to using the SC databases.

2.13.2 For USNR, MARFORRES, USCG and U.S. Coast Guard Reserve (USCGR)

2.13.2.1 For USNR and MARFORRES recommend deployment limiting status based on “Manual of the Medical

Department, Chapter 15 (http://www.med.navy.mil/directives/Pages/NAVMEDP-MANMED.aspx) and additional

SC guidance.

2.13.2.2 For USNR and MARFORRES group events, the Medical Department Representative (MDR) will make the

Temporarily Not Physically Qualified (TNPQ) or Temporarily Not Dentally Qualified (TNDQ) determination. For in-clinic PHAs, the Contractor shall document the recommendation on the Memo to Command.

2.13.2.1 3 For USCG and USCGR, recommend deployment limiting conditions per “Coast Guard Medical Manual”, COMDTINST M6000.1 (series), Chapter 3 Section F.

2.13.2.4 For USCG/USCGR, the Contractor shall refer to the Health Records Custodian (HRC) to initiate appropriate action for deployment limiting conditions.

2.13.3 For ARNG, USAR, and AC Army TPR, complete quality control evaluation, deployability recommendation, and profiling.

2.13.3.1 The Contractor HCP shall document and assign Military Physical Profile Serial System (PULHES) using the Physical Profile Functional Capacity Guide, AR 40-501, Chapters 3, 7, 8 and 11, the DA PAM 611-21, G-1

Smartbook on Milsuite for occupational MOS/AOC impacts, Army Directive 2016 07 (Redesign of Personnel

Readiness and Medical Deployability), 1 MAR 2016, and ARNG/USAR/AC Army TPR specific supplemental profiling guidance on the electronic PHA and e-Profile module.

2.13.3.2 For ARNG,USAR, and AC Army TPR, the Contractor shall initiate per SC guidance active profiles (NP, PA, DO, MD as the first signature) in the e-Profile module, or per SC guidance, the Contractor shall notify the SC through an agreed upon communication pathway of a condition warranting initiation of a profile.

2.13.3.3 All profiles must have substantiating medical documentation either brought to the encounter or from the examining provider to support the profile.

2.13.3.4 Soldiers eligible for RHRP services can request the Contractor generate a profile with the submission of documentation. The Contractor shall have the discretion to request a face-to-face PHA exam or additional documentation as clinically indicated.

2.13.3.5 The Contractor-provided HCP shall document on the assessment form, e.g., DD Form 2795, Pre-

Deployment Assessment, whether SM has the ability to deploy into an austere environment defined as an area that regularly experiences significant environmental hazards (e.g., heat, cold, altitude, aerosolized particles) that would exacerbate existing medical conditions when protection (such as climate control) is not available; an area with limited access to a reliable source of electricity; or an area where force protection levels mandate prolonged use of body armor or chemical protection equipment (e.g., has ability to carry 60 pounds for prolonged periods).

2.13.3.6 For ARNG/USAR/AC Army TPR, the Contract HCP will consider the SM as non-deployable who is on an active profile with a PULHES of a 3 or 4 without having been adjudicated by a board process as documented either in e-Profile or its successor and available information provided by the SM; on an active profile for more than 15 days; dental readiness class 3; in the disability evaluation system; or in the Miltary Medical Review Board

(MMRB)/MOS Administrative Retention Review (MAR2) or Medical Evaluation Board (MEB) process.

2.13.3.7 Contractor shall route active profiles for the ARNG (see exception below), USAR, and AC Army TPR through e-Profile for processing and military review in accordance with guidance from the ARNG Surgeon’s Office, USARC Surgeon’s Office, Regional Health Command, or Human Resource Command (USAR Individual Ready

Reserve (IRR) and Individual Mobilization Augmentee (IMA)).

2.13.3.7.1 Per ARNG guidance, the Contractor shall route an active profile shall be routed through State Surgeon

Office and not entered into e-Profile.

2.13.3.8 The Contractor shall enter referral recommendations into e-Case or its successor and HAIMS, as requested by the SC.

2.13.4 For the ANG, the Contractor shall assess for potential deployment limiting conditions in accordance with

AFI 10-203 “Duty Limiting Conditions” and the Air Force Medical Standards Directory and shall notify Guard

Medical Unit representatives for further assessment/disposition.

2.13.5 Medical Review Office

The Contractor shall review medical and dental documentation for accuracy, completeness, and compliance with SC direction.

2.14 Vaccines

The Contractor shall be responsible for purchase of vaccines and shall do so through government sources when possible or other low cost, quality-controlled sources. SCs may supply their own vaccines at group events for administration by the Contractor.

2.14.1 The Contractor shall provide centralized storage and distribution of vaccine in a controlled and monitored environment, utilizing a 21 Code of Federal Regulations (CFR) Part 11 compliant monitoring system. This shall include using proper shipping and delivery protocols to maintain vaccine efficacy and viability. The Contractor’s centralized storage, distribution, delivery, and recovery of vaccine shall follow all applicable state and federal regulations and manufacturer guidelines.

2.14.2 Vaccines shall be administered and documented in accordance with FDA regulations and guidelines.

2.14.3 The Contractor shall ensure each provider administering vaccines is trained on proper vaccine storage and handling. The Contractor shall review the procedures of providers of vaccinations for group events and provide oversight of the same.

2.14.4 The Contractor shall have pharmaceutical distribution licenses in all states, U.S. Territories, and the District of Columbia. The Contractor shall have the appropriate import permits and licenses to ship pharmaceuticals to

Germany and arrangements with a shipper when shipping pharmaceuticals overseas for military use.

2.15 Group Events

2.15.1 Upon confirmation of the event, the Contractor shall provide detailed information and a checklist regarding the logistics and process of the event to the lead unit POC. The checklist shall include procedures and Contractor contact information to be used in case of a problem with the group event.

2.15.2 Before making travel arrangements, the Contractor shall contact the lead unit POC to review the checklist and information and verify the number of SMs to receive services.

2.15.3 Not later than four business days prior to the event, the Contractor shall complete final detailed coordination, e.g., travel itineraries, equipment shipment tracking information, etc. with the lead unit POC.

2.15.4 The Contractor shall be present at a minimum of one day prior to the event start.

2.15.5 The unit POC will provide suitable working space with adequate privacy and office capabilities as are available.

2.15.6 The Contractor shall provide the other resources, e.g., internet access, supplies and medical equipment, needed to complete the services.

2.15.7 The Contractor shall have one person at each group event with oversight of all services to be provided at that site. That individual shall be knowledgeable about the services being performed and the processes to complete a group event in an efficient and effective manner. This individual shall identify themselves to the SC/Unit Group

Event POC to assist with issues that may arise.

2.15.8 The Contractor shall work with the SCs and the units to maximize privacy when sensitive medical information may be shared during group events.

2.16 Data Entry

2.16.1 Unless otherwise noted, the Contractor shall enter data resulting from the Contractor-SM interaction into the appropriate SC readiness database 95% of the time within five business days of group events and results from external labs of samples taken at group events within eight business days. The Contractor shall enter the required data into the appropriate SC readiness database 95% of the time within eight business days of in-clinic appointments, except in-clinic dental examinations and treatment and physical exams which shall be entered into the

SC database 95% of the time within 12 business days of the examination and last treatment appointment.

2.16.2 The SCs will make available training on access to and use of their readiness databases and provide advance notice of changes to these databases which will affect the database functionality or data transfer capabilities. The

SCs will provide the Contractor notification or training and training requirements as quickly as possible in advance of new training requirements or new system changes. The Government retains the right to review documentation of the Contractor accomplishment of the training.

2.16.3 Unless otherwise agreed to by the RHRP, the SCs will be the approval authority for access to its databases.

2.17 SC Direction or Guidance. SCs provide guidance or direction on the provision of services for their SMs to the RHRP COR who, in turn, will provide guidance and direction to the Contractor within the scope of the COR duties. The COR will involve the KO when there are questions regarding SC guidance or direction which may affect the terms of the contract.

2.18 Record Disposition

2.18.1 The Contractor shall store dental records and radiographic materials (bitewings and panos) from group events for at least seven years. The Contractor may then destroy these in a manner protecting PHI and PII.

2.18.2 The Contractor shall return the original hard copy of assessments to the SM’s home unit or Command as requested by the SC POC.

2.18.3 Contractor providers shall maintain their medical and dental records according to State and Federal laws and regulations.

2.19 Contractor Travel

2.19.1 Arrangements for and costs of all travel, transportation, meals, lodging, and incidentals are the responsibility of the Contractor. Travel costs shall be incurred and billed in accordance with FAR Part 31. Costs for these expenses shall be reviewed, certified, and approved by the COR. All travel and transportation shall use commercial sources and carriers provided the method used for the appropriate geographical area results in reasonable charges to the Government. Costs for travel shall be reimbursed only if travel was for group events or at the request of the

COR. The Government shall not pay for business class or first class travel. Lodging and meals shall be reimbursed with no fee in accordance with regulations defined in FAR Part 31.

2.19.2 The Contractor shall not incur any costs for travel for general, professional or scientific meetings or foreign travel without prior written approval of the COR. Incurring such costs with the intent of claiming reimbursement as direct costs under this contract shall be at the Contractor’s own risk if done without written authorization .

2.19.3 Travel Outside of the U.S. and its Territories. The Contractor shall be prepared to provide services outside of the U.S. and its Territories as approved by the COR.

2.20 The Contractor shall designate a primary POC for the Government’s communication and overall management of the Contractor’s effort. That individual shall have at least a bachelor’s degree, 10 years of experience in the health care field, and five years’ experience managing large, complex programs dispersed over a wide geographic area. The years of health care and program management experience can be concurrent.

2.21 The Contractor shall identify the date and time it receives documents and other information pertinent to the

PWS requirements, e.g., reports of unusual incidents or emergencies, requests for services, historical update documentation.

3.0 DEFINITIONS AND ACRONYMS

3.1 Definitions

ARNG/USAR/AC TPR. Applies to all of the Army National Guard, US Army Reserve, and Active Army

Component TRICARE Prime Remote SMs.

Behavioral Health Specialist. See licensed mental health professional.

Business Days. Monday through Friday, excluding holidays

Contact. Communication with another party through various means to include telephone, text, email, and other media generally accepted and used by the target audience.

Contractor. When the term Contractor is used, it refers to the Prime Contractor as well as all those entities and personnel who are acting on behalf of the Prime Contractor.

Commander. The individual in charge of a military unit and designees.

COR. The Contracting Officer’s Representative and designees.

Deployment Limiting Condition. Conditions delineated in DoDI 6490.07, Deployment Deployment-Limiting

Medical Conditions for Service Members and DoD Civilian Employees and implementing SC guidance Emergency. A significant occurrence or extraordinary event which requires immediate care or assessment because of an acute or unstable health condition, e.g., very high blood pressure, high risk behavioral health issues expressed by the SM or identified by healthcare professional, suicide risk, or if the SM is turned over to Command or sent to the VA or Emergency Department.

Face-to-face. An encounter when the individuals are physically in the presence of each other.

Focused exam. A limited examination of the affected body area or organ system and other symptomatic or related organ system(s).

Group events. A gathering of SMs, typically at a government facility such as a drill hall or armory, where services are provided.

Health care personnel. Health care providers, nurses including LVNs, or equivalent to military medics.

Health care provider. Licensed or certified physician, physician assistant, nurse practitioner, or advanced practical nurse.

Licensed mental health professional. A psychologist, social worker, psychiatrist, psychiatric nurse practitioner, or other professional licensed at an independent level to provide behavioral health services who has been certified by taking the DoD training and passing the quiz to perform mental health assessments.

Person-to-person. Face-to-face, telephone, or video teleconference dialogue with an individual that is conducted in a private setting to foster trust and openness in discussing sensitive health concerns.

Profile. The military physical profile serial system (known as the acronym PULHES for the medical areas considered) which identifies the broad physical demands of a military job specialty and the physical ability required to perform the duties of the specialty. The physical profile serial system classifies physical abilities in terms of six factors (PULHES).

Provider entity. The company or organization for which the provider/practitioner works, e.g., Blue Earth County

Health Center.

PULHES. The acronym used in establishing the military physical profile to describe the major physical areas of

Physical capacity/stamina, Upper extremities, Lower extremities, Hearing/ear, Eyes, and pSychiatric.

Redeployed. Returned from…