PWS_(Tele-Radiology_Services).docx

PWS W/ SUPPLEMENT

PERFORMANCE WORK STATEMENT

TELERADIOLOGY

1. General

1.1. It is expressly stated and understood that this solicitation and any resulting contract will be a non-personal services contract, as defined in FAR 37.101. The Government may evaluate the quality of professional and administrative service provided, but retains no control over the medical, professional aspects of services rendered (e. g., professional judgments, diagnosis for specific medical treatment). The Contractor shall indemnify the Government for any liability producing act or omission by the Contractor, its employees and agents occurring during contract performance. The Contractor shall maintain medical liability insurance in the minimum amount of $1 million per incident and $3 million in the aggregate. The Contractor shall ensure that its subcontractors have medical liability insurance in these amounts. Proof of insurance shall be submitted prior to award of contract. Any resultant contract shall not establish an employer-employee relationship between the Army and the Contractor. The Government assumes no responsibility for negligent acts of the Contractor, its employees, or agents. Services rendered by the Contractor shall be rendered in the capacity of an independent contractor. The Contractor shall be solely liable for any liability producing act or omission and shall possess liability insurance, which covers medical care.

1. The Contractor shall provide off-site radiological interpretations 24 hours a day, 7 days a week via teleradiology and transcribe all reports into the Composite Health Care System (CHCS) at Carl R. Darnall Army Medical Center (CRDAMC). The contractor shall determine the number of radiologists required to perform the services and meet the standards in this contract. Period of performance is on or before 1 April 2016 through 30 September 2016, plus one (1) option year ending 30 September 2017.

1.1.2 Performance Measures:

1.1.2.1. Outcome. Thescontractor shall provide qualified general radiologists who will fulfill the requirement to provide services at a standard enabling the MTF to provide such services at a high level of quality.

1.1.2.2. Standards. Substantiated provider complaints concerning quality or adequacy of interpretation. A maximum of two in any twelve-month period per provider. A Third substantiated complaint = unacceptable performance.

1.1.3. Credentials/privileging packets presented initially to the MTF must meet the MTF's complete requiremtnts 95% of the time. All packets (100%) will meet MTF requirements in order for the provider to be credentialed/privileged.

1.1.4. Other performance evaluation factors will be monitored and that are not quantified by numerical measurements include: (1) contractor providing personnel who exceed the minimum qualification standards (2) patient customer service comments; (3) relationship between the contractor/contractor personnel and MTF staff/personnel; and (4) continuous compliance with hospital policies and procedures.

1.1.5. How Measured: Department/clinic supervisory personnel will monitor contractor provided performance through government information systems and records, patient records, customer service information, and contractor reports.

1.1.6. Performance Requirements Summary (PRS). The following minimum Performance Requirements Summary applies. The Government may modify inspection methods in accordance with site specific requirements. Performance rated as Marginal or below may result in the Government initiating procedures to terminate the contract for cause, to include issuing a Cure Notice.

PERFORMANCE

OBJECTIVE

ACCEPTABLE QUALITY

LEVEL

ASSESSMENT

CHCS on the same date (by midnight - CST) as received from

CRDAMC

A. 100% Inspection: Every time a requirement occurs, it will be inspected.

B. Customer Complaint: A customer complaint is a valid complaint when the MTF's appropriate personnel (e.g., Patient Advocate), after a thorough investigation, determines that 100% of Medical Standards of Care have not been met.

C. Non-PRS Items: The Government will periodically evaluate all other items in the PWS (i.e. Exercises, Data Submission, etc.).

1.2. Qualification requirements:

1.2.1. The radiologists shall be Board certified in Diagnostic Radiology or Radiology by the American Board of Radiology or American Osteopathic Board of Radiology. CRDAMC reserves the right to request immediate consultations/over-reads of all films by a Board certified radiologist at the discretion of the requesting health care provider at CRDAMC (e.g.-the ordering ER, primary care or specialist physician).

1.2.2. The providers shall have a minimum of two years active experience as a practicing provider in the field of radiology in the last three years. Time spent in an administrative capacity as a claims reviewer, medical school instructor, medical director, etc. does not qualify as practicing time.

1.2.3. The providers shall be a M.D. or D.O. and be capable of interpreting films on all ages of patients. The radiologists shall be certified as current and maintain such certification at all times to be compliant with the American College of Radiology standards for reading all modalities of radiolgraphic images. The standards may be changed by the American College of Radiology at any time and the contractor shall remain current to meet all requirements. This includes meeting the minimum required number of interpretations per month/year.

1.2.4. Possess and maintain a valid, unrestricted license to practice medicine in one of the 50 United States, District of Columbia, or the territory of the United States where the images are read in addition to a current, active, valid, and unrestricted Texas license, if the reading location is other than Texas. If the contract service provider is located in Texas and will read films in Texas, a Texas license only is sufficient. Providers shall be able to obtain privileges at CRDAMC through approval of the credentials committee. Also see the Employee Credentialing History in the sections of the contract titled 'Supplement to PWS and PWS paragraph 1.8.

1.2.5. The providers shall be able to read, write, and speak English fluently to be able to communicate effectively with patients and other healthcare providers.

1.2.6. CRDAMC will provide computer training on the CHCS computer system. The physician(s) and/or transcriptionist(s) shall be in an ADP sensitive position requiring compliance with AR380-19 and AR280-67. All personnel shall meet HIPPA standards as required by CRDAMC. Training will be provided at CRDAMC. The contractor shall pay all associated travel costs to/from CRDAMC.

1.3 Administrative Requirements:

1.3.1. The Contractor shall provide adequate pre-credentialed replacement physicians available so a lapse in coverage does not occur. The credentialing process takes between 30-45 days. Any lapse in coverage may be considered immediate grounds for termination by cause.

1.3.2. Neither military or Government civilian employees shall be used as a consultant or employee in matters related to this contract.

1.3.3. CRDAMC will provide orientation to familiarize the physician(s) with CRDAMC's policies and procedures. The orientation may be on the phone or in person at CRDAMC. Any trips made to CRDAMC by the contractor shall be at contractor expense. Orientation does not require a trip to CRDAMC.

1.3.4. The contractor shall provide office and cell phone numbers where the radiologists may be contacted at any time for consultations. Answering services, answering machines, beepers, electronic mail or pagers are not acceptable.

1.4. Hours of Performance:

1.4.1. The contractor shall provide off site radiological interpretations 24 hours a day, 7 days a week via teleradiology.

1.4.4.1. The contractor shall provide a minimum and a maximum number of reads for each modality of images over the contract performance period as indicated in the contract line items.

1.4.4.2. If the minimum number of image read services are not provided, the final invoice of the performance period will be decreased for the image reads not performed. The per-image decrease is based on the rate per image type for the performance period as provided by the contractor in attachment six as part of their original quote and incorporated into the resulting contract. The amount to be decreased is calculated by multiplying that image rate by the difference between the actual number of images read and the minimum number of reads required during that particular performance period.

1.4.4.3. CALCULATION EXAMPLE: XYZ Image Reads

Minimum number of XYZ reads required per year is 300. Including 12th month invoice, the total number of XYZ images actually read for the year was 296. The difference between the minimum required (300) and the actual performed (296) is 4 (300 — 296 = 4). For this example, the dollar figure for the contractor's quoted cost per XYZ read received with their quote will be $20.00 for ease of calculation. Therefore, $20.00 per read multiplied times 4 reads below the annual minimum required equals $80.00 ($20.00 X 4 = $80.00). The final or 12th month invoice will be reduced by $80.00 to account for the annual minimum not being met.

1.5. Contractor Representative:

1.5.1. The Contractor shall designate, in writing, at least 5 working days prior to commencement of services, a representative for contract coordination and implementation. This representative may also serve as one of the providers. Changes in the representative, at any time after the contract commencement, shall require the Contractor to notify the Contracting Officer of the new authorized representative five working days prior to said change. This notification shall be in writing and shall state the name of the new representative.

1.5.2. The contractor's representative shall meet with the Contracting Officer's Representative (COR) when requested by the COR to discuss any problems that the contractor's personnel may be experiencing during the performance of this contract. Problems experienced by the Government with the contractor's performance will be discussed and resolved. Unresolved problems will be referred to the contracting officer for resolution.

1.6.1. The providers shall abide by CRDAMC's regulations and requirements concerning the nature of limited privileged communication between patients and health care provider as may be necessary for security and personnel reliability programs. They shall also abide by CRDAMC's regulations concerning the confidentiality of patient records, as embodied in federal statutes including the Privacy Act of 1974. All regulations referenced are available for review at CRDAMC. All medical records and reports will remain the property of the government.

1.6.2. The Chief of Radiology at CRDAMC will define the scope of practice. The providers shall not introduce new medical procedures or services without prior recommendation to and approval of the Contracting Officer.

1.7. Conflict of Interest:

1.7.1. The Contractor shall not bill the patient for services rendered under this contract. The Contractor shall not accept compensation of any kind for patients treated, procedures performed, or any other actions performed, except under the terms and conditions of this contract, at the rate specified in the bid schedule.

1.7.2. The providers are not prohibited, by reason of their employment under this contract, from conducting a private practice. Private practice shall not conflict with the performance of duties under the contract and the providers shall not make use of any Government facilities or other Government property in connection therewith.

1.7.3. The Contractor/providers shall not use patient care rendered pursuant to this contract as part of a study, research project, or publication. The providers shall prepare medical records, forms and documents as required, IAW the regulations and established guidelines listed in the contract.

1.7.4. Confidentiality of Information. Unless otherwise specified, all financial, statistical, personnel and/or technical data which is furnished, produced or otherwise available to the contractor during the performance of this contract are considered confidential business information and shall not be used for purposes other than performance of work under this contract. None of the above information shall be released by the contractor without prior written consent of the COR.

1.8. Credential Review/Privileging:

1.8.1. The providers providing services under the provisions of this contract must be credentialed/granted privileges by the Commander of Darnall Army Medical Center prior to beginning work. The privileging process shall be IAW all requirements in AR 40-66 and 40-68 as amended. The privileges granted by the MTF will be sufficient to allow for performance of all specific tasks identified in this contract. Information on the credentialing/privileging process can be printed or read in chapter 4 of Army Regulation 40-68 located on the internet at website http://www.usapa.armv.mil/pdffiles/r40 68.pdf.

1.8.2. The COR will identify documentation required for privileging. The contractor shall submit required documentation for each physician e.g. evidence of a medical degree, internship, residency, licensure, curriculum vitae, CMEs (50 per year), and request for clinical privileges form as required by this contract. The contractor shall perform all primary source verifications and include all verifications with the credentials packet. The Contractor shall obtain all paperwork, letters of reference, approvals, work history, etc. required by the CRDAMC credentialing process. CRDAMC shall not assist the Contractor in obtaining any needed information.

1.8.3. The contractor shall ensure that replacement personnel are privileged in accordance with paragraph 1.8.

1.8.4. The MTF Commander is the sole authority that can revoke or otherwise restrict the privileges of any contract physician who he/she determines is not qualified to perform the contract services.

1.8.5. Once privileges are granted, subsequent actions taken concerning the privileges of contract physicians, including any limitation on privileges, will be governed by the procedures in AR 40-68. Action that suspends, revokes, places in abeyance or otherwise restricts the privileges of the physician(s) results in that physician not being authorized to perform under the contract. Such action does not excuse the contractor from performing. A replacement physician(s) must be provided according to the terms of this contract.

1.9. Quality Assessment and Improvement (QA&I):

1.9.1. The Government shall monitor the contractor's performance under this contract using the QA&I procedures established by CRDAMC. Additionally, the contractor's performance is subject to scheduled and unscheduled review by the QA&I Committee defined in CRDAMC's quality assurance plan and AR 40-68. The contractor shall be responsible for Quality Control (QC) of interpreted films. The contractor shall provide their QC plan to CRDAMC for approval before beginning performance. Results of the contractors QC process shall be sent to CRDAMC monthly. As necessary, the contractor's performance will be subject to additional monitoring by CRDAMC as deemed necessary.

1.10. INSPECTION AND ACCEPTANCE OF SERVICES:

1.10.1. The inspection and acceptance point for all services rendered under this contract will be by the Chief of Radiology. The performance by the providers, the quality of services rendered, and any documentation or written material in support of same, shall be subject to continuous inspection, surveillance and review for acceptance by the CO or designated representative. Any services rendered by the provider to patients or interaction with CRDAMC/military/civilian personnel deemed unprofessional/threatening/dangerous by the Chief of Radiology will be considered as grounds for immediate removal of the provider. Quality Assurance procedures established by CRDAMC shall be used for continuous monitoring at a minimum, unless the contractor's QA plan is deemed appropriate by CRDAMC. Other performance evaluation factors will be monitored that are not quantified by numerical measurements which include: contractor providing personnel not meeting the minimum qualification standards; provider and contractor relationship with hospital staff/government contracting personnel; compliance with hospital policy and procedures. Services provided by the providers shall be reviewed and rated in accordance with CRDAMC by-laws and JC standards. A poor rating shall be grounds for immediate removal of any provider.

1.11. ADDITIONAL SECURITY REQUIREMENTS:

1.11.1 General Security Requirements. The Contractor shall establish appropriate administrative, technical, and physical safeguards to protect any and all Government data, to ensure the confidentiality, integrity, and availability of the encrypted tunnel for this data to traverse. At a minimum, this shall include provisions for network personnel, electronic security nd physical security as listed in the sections that follow.

1.11.2 Personnel Security. The Contractor's responsibilities for ensuring personnel security for any and all network personnel who have access to the Contractor's firewall and VPN equipment include, but are not limited to, meeting the following requirements:

1.11.2.1. Since the (Vendor) Network personnel should not have access to the actual data being transmitted, they would not be required to follow the Army guidelines for submittal of Automated Data Processer/Information Technology (ADP/IT) background.

1.11.2.2. Initiate, maintain, and document personnel security investigations appropriate to the individual's network responsibilities and required access to information systems within the logical boundaries of the (Vendor) facility local area network (LAN).

1.11.2.1. The Contractor shall comply with DoD 8500.1, "Information Assurance (IA)," DoD Instruction 8500.2, "Information Assurance (IA) Implementation," DoD Directive 5400.11, "DoD Privacy Program," DoD 6025.18-R, "DoD Health Information Privacy Regulation," DoD 5200.2-R, "Personnel Security Program Requirements," AR25- 1, "Army Knowledge Management and Information Technology", AR 25-2 "Information Assurance," and local regulations as deemed appropriate by the activity Information Assurance personnel.

1.11.2.2.3 Immediately report to the Clinic Information Assurance Security Office, and deny access to any automated information system (AIS), network, or information if a contractor employee filling a sensitive position receives an unfavorable adjudication, if information that would result in an unfavorable adjudication becomes available, or if directed to do so by the appropriate government representative for any reason.

1.11.2.2.4 Ensure that all contractor personnel receive information assurance (IA) training before being granted access to the firewallNPN equipment that supports this DoD AIS/network device and data transmission function.

1.11.3. Electronic Security.

1.11.3.1 Contractor Information Systems (IS)/networks that are involved in the operation of or are part of this VPN in support of the Clinic-Vendor BPN tunnel shall operate in accordance with controlling laws, regulations, DoD, Army and local policy.

1.11.3.2 Contractor shall agree to safeguard their point of presence for this for this VPN tunnel and provide a comprehensive evaluation of the technical and non-technical security features and countermeasures employed for their system/network configuration.

1.11.3.3 The Contractor must confirm that there IS/networks are locked down prior to initiating testing.

1.11.3.4 Conformation of system lockdown shall be agreed upon during the definition of the VPN boundary and be signed and documented as part of the testing implementation.

1.11.3.5 Locking down the system means that there shall be no changes made to the configuration of the VPN tunnel system without the approval from Clinic Information Assurance Security Officer and/or the Information Assurance Manager and with appropriate testing.

1.11,3.6 Any re-configuration or change in the system during the initial or subsequent testing process will require a re-baselining of the system and documentation of system changes.

1.11.3.7 Information Assurance mitigation strategies include security updates, service packs, and changes to operating procedures as physical and cyber vulnerabilities are detected. Operating systems, routers, firewall and VPN equipment shall be in compliance with all known applicable Department of Defense Computer Emergency Response Team (DoD-Cert) Alert, Bulletin, and Technical Advisory Notices published during the past 36 months.

1.11.3.8 Disposing of electronic Media. Contractor will be required to follow the DoD standards, procedures, and use approved products to dispose of unclassified hard drives and other electronic media, as appropriate, in accordance with DoD Memorandum "Disposition of Unclassified Computer Hard Drives," June 4, 2001. Contractors are required to also follow DoD guidance on sanitization of other internal and external media components in DODI 8500.2 "Information Assurance(IA) Implementation," 6 Feb 2003 (see PECS-1 in enclosure 4 Attachment5) and DoD 5220.22-M "Industrial Security Program Operating Manual (NISPOM)," (Chapter 8).

1.11.3.9 Information Assurance Vulnerability Management (IAVM). The contractor shall implement an information assurance vulnerability management program. The DoD IAVM program provides electronic security protections against known threats and vulnerabilities. The IAVM program requires the registration of AIS system assets, which then allows for the timely dissemination of critical vulnerability information. It also assists in the documentation and tracking of compliance, providing increased electronic security to Army systems. As part of the program, the contractor shall provide a primary and secondary point of contract in the Vulnerability Management System (VMS) and the MHS Information Assurance Vulnerability Alert (JAVA) Monitor. The point of contact shall provide, upon receipt of a vulnerability message, an acknowledgment or receipt via the VMS. The contractor shall thoroughly test all mitigations for the vulnerability, and upon applying the mitigation to the system, report compliance in the VMS. Receipt and compliance messages to the government shall occur within the stipulated time window, as stated in the vulnerability message, an acknowledgment of receipt via the VMS. The contractor shall thoroughly test all mitigations for the vulnerability, and upon applying the mitigation to the system, report compliance in the VMS. Receipt and compliance messages to the government shall occur within the stipulated time window, as stated in the vulnerability message or in the VMS.

1.11.4 Information System (IS)/Networks Physical Security. The contractor shall employ physical security safeguards for IS/Networks involved in processing or storage of Government Data to prevent the unauthorized access, disclosure, modification, destruction, use, etc., and to otherwise protect the confidentiality and ensure use conforms with DoD regulations. In addition, the contractor will support a Physical Security Audit performed by the Matrix is available at: http://www.tricare.osd.mil/tmis_new/Policy/PSA_Matrix_%20012304%200930%20clean%2Oversion.xls . The contractor shall correct any deficiencies indentified by the Government of the contractor's physical security posture.

1.11.5 Special Requirements for Protected Health Information. Since this agreement centers on the ability of government providers to access PHI on government beneficiaries whose data is stored in the Contractor's medical systems, the Clinic specifies that the Contractor monitor, regulate, and limit the number of and extent to which their staff have access to this VPN and/or the data traffic passing through it. Any deveiation to the above agreement will need to be communicated to the Clinic Information Assurance Security Officer and/or the Information Assurance Manager and additional baselines will need to be reestablished.

1.11.6 Department of Defense Business Associate Agreement.

a. Introduction. In accordance with reference 1.b., the contractor meets the definition of Business Associate. Therefore, a Business Associate Agreement is required to comply with both the HIPAA Privacy and Security regulations. This clause serves as that agreement whereby the Contractor agrees to abide by all applicable HIPAA Privacy and Security requirements regarding health information as defined this clause, and reference l.a. and 1.b., as amended. Additional requirements will be addressed when implemented.

(1) Definitions. As used in this clause generally refer to the Code of Federal Regulations (CFR) definition unless a more specific provision exists in reference l.a. and 1.b..

(a) Individual has the same meaning as the term "individual" in 45 CFR 160.103 and shall include a person who qualifies as a personal representative in accordance with CFR 164.502(g).

(b) Privacy Rule means the Standards for Privacy of Individually Identifiable Health Information at CFR part 160 and part 164, subparts A and E.

(c) Protected Health Information has the same meaning as the term "protected health information" in 45 CFR 160.103, limited to the information created or received by the Contractor from or on behalf of the government pursuant to the Memorandum of Agreement (MOA).

(d) Electronic Protected Health Information has the same meaning as the term "electronic protected health information" in 45 CFR 160.103.

(e) Required by Law has the same meaning as the term "required by law" in 45 CFR 164.103.

(f) Secretary means the Secretary of the Department of Health and Human Services or his/her designee.

(g) Security Rule means the Health Insurance Reform: Security Standards at 45 CFR part 160, 162 and part 164 subpart C.

(h) Terms used, but not otherwise defined, in this clause shall have the same meaning as those terms in 45 CFR 160.103, 164.501 and 164.304.

(2) The Contractor shall not use or further disclose Protected Health Information other than as permitted or required by the MOA or as Required by Law.

(3) The Contractor shall use appropriate safeguards to prevent use or disclosure of the PHI other than as provided for by this MOA.

(4) The Contractor agrees to use administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the e-PHI that it creates, receives, maintains, or transmits in the execution of this MOA.

(5) The Contractor agrees to mitigate, to the extent practicable, any harmful effect that is known to the Contractor of a use or disclosure of PHI by the Contractor in violation of the requirements of this clause.

(6) The Contractor shall report to the government any security incident involving PHI of which it becomes aware.

(7) The Contractor shall report to the government any use or disclosure of the PHI not provided for by this MOA of which the Contractor becomes aware.

(8) The Contractor shall ensure that any agent, including a subcontractor, to whom it provides PHI received from, or created or received by the Contractor, on behalf of the government, agrees to the same restrictions and conditions that apply through this MOA to the Contractor with respect to such information.

(9) The Contractor shall ensure that any agent, including a subcontractor, to whom it provides electronic PHI agrees to implement reasonable and appropriate safeguards to protect it.

(10) The Contractor shall provide access at the request of the government, and in the time and manner reasonably designated by the government to PHI in a Designated record Set, to the government or as directed by the government to an Individual in order to met the requirements under 45 CFR 164.524.

(11) The Contractor shall make any amendment(s) to PHI in a Designated Record Set that the government directs or agrees to pursuant to 45DVR 164.526 at the request of the government and in the time and manner reasonably designated by the government.

(12) The Contractor shall make internal practices, books and records relating to the use and disclosure of PHI received from, or created or received by the Contractor, on behalf of the government, available to the government, or at the request of the government to the Secretary, in a time and manner reasonably designated by the government or the Secretary, for purposes of the Secretary determining the government's compliance with the Privacy Rule.

(13) The Contractor shall document such disclosure of PHI and information related to such disclosures as would be required for the government to respond to a request by an individual for an accounting of disclosures of PHI in accordance with 45 CFR 164.528.

(14) The Contractor shall provide to the government or an individual, in time and manner reasonably designated by the government, information collected in accordance with this clause of the MOA, to permit the government to respond to a request by an individual for an accounting of disclosures of PHI in accordance with 45 CFR 164.528.

b. General Use and Disclosure Provisions. Except as otherwise limited in this clause, the Contractor may use or disclose PHI on behalf of, or to provide service to, the government for treatment, payment, or healthcare operations purposes, in accordance with the specific use and disclosure provisions below, if such use or disclosure of PHI would not violate the HIPAA Privacy Rule, the HIPAA Security Rule, references 1.a. and 1.b., if done by the government.

c. Specific Use and Disclosure Provisions.

(1) Except as otherwise limited in this clause, the Contractor may use PHI for the proper management and administration of the Contractor or to carry out the legal responsibilities of the Contractor.

(2) Except as otherwise limited in this clause, the Contractor may disclose PHI for the proper management and administration of the Contractor, provided that disclosures are required by law, or the Contractor obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and used or further disclosed only as required by law or for the purpose for which it was disclosed to the person, and the person notifies the Contractor of any instances of which it is aware in which the confidentiality of the information has been breached.

(3) Except as otherwise limited in is clause, the Contractor may use PHI to provide Data Aggregation services to the government as permitted by 45 CFR 164.504(e)(2)(i)(B).

(4) Contractor may use PHI to report violations of law to appropriate federal and state authorities, consistent with 45 CFR 164.502 (j)(1).

d. Obligations for the Government. Provisions for the Government to Inform the Contractor of the Privacy Practices and Restrictions.

(1) The government shall provide the Contractor with the notice of privacy practices that the government produces in accordance with 45 CFR 164.520.

(2) The government shall provide the Contractor with any changes in, or revocation of, permission by Individual to use or disclose PHI, if such changes affect the Contractor's permitted or required uses and disclosures.

(3) The government shall notify the Contractor of any restriction to the use of disclosure of PHI that the government has agreed to in accordance with 45 CFR 164.522.

e. Permissible Requests by the Government. The government shall not request the Contractor to use or disclose PHI in any manner that would not be permissible under the HIPAA Privacy Rule, the HIPAA Security Rule, or any applicable government regulations (including without limitation, DoD 6025.18-R and DoD 8580.02-R) if done by the government, except for providing Data Aggregation services to the government and for management and administrative activities of the Contractor as otherwise permitted by this clause.

f. Termination.

(1) Termination. A breach by the Contractor of this clause may subject the Contractor to termination under any applicable default or termination provision of this MOA.

(2) Effect of Termination.

(a) If this MOA has records management requirements, the records subject to the clause should be handled in accordance with the records management requirements. If this MOA does not have records management requirements, the records should be handled in accordance with paragraphs (b) and (c) below.

(b) If this MOA does not have records management requirements, except as provided in paragraph (c) of this section, upon termination of this MOA, for any reason, the Contractor shall return or destroy all PHI received from the government, or created or received by the Contractor on behalf of the government. This provision shall apply to PHI that is in possession of subcontractors or agents of the Contractor. The Contractor shall retain no copies of the PHI.

(c) If this MOA does not have records management provisions and the Contractor determines that returning or destroying the PHI is unfeasible, the Contractor shall provide to the government notification of the conditions that make return or destruction unfeasible. Upon mutual agreement of the government and the Contractor that return or destruction of PHI is unfeasible, the Contractor shall extend the protections of this MOA to such PHI and limit further uses and disclosures of such PHI to those purposes that make the return or destruction unfeasible, for so log as the contractor maintains such PHI.

g. Miscellaneous.

(1) Regulatory References. A reference in this clause to a section in DoD 6025.18-R, DoD8580.02-R, Privacy Rule or Security Rule, means the section currently in effect or as amended and for which compliance is required.

(2) Survival. The respective rights and obligations of Business Associate under the "Effect of Termination" provision of this clause shall survive the termination of this MOA.

(3) Interpretation. Any ambiguity in this clause shall be resolved in favor of a meaning that permits the government to comply with Dod 6025.18-R, DoD 8580.02-R, the HIPAA Privacy Rule or the HIPAA Security Rule.

1.11.7 Effective date. This memorandum of Agreement will be effective upon signature of both parties and will remain in effect indefinitely.

1.11.8 Notify the site HIPAA Security Manager

1.11.9 Follow all DUA and DoD requirements for secure disposal, destruction, and/or sanitization of all equipment that contained PHI.

2. DEFINITIONS/ACRONYMS 2.1. Definitions:

2.1.1. ANCILLARY PERSONNEL: These personnel are commonly referred to as radiology, pathology and/or medical pharmacy technicians/technologists. Clerks, secretaries and receptionist personnel are commonly considered administrative personnel.

2.1.2. CLINICAL PRIVILEGES: Authorization by CRDAMC to provide specific patient care and treatment services in the organization, within well defined limits, based on the individuals license, education, training, experience, competence, judgment, and physical and mental health.

2.1.3. COMPOSITE HEALTH CARE SYSTEM (CHCS): An automated medical information system, which will provide integrated support for the functional work centers of inpatient and outpatient care facilities, patient administration, tient appointments and scheduling, nursing, laboratory, pharmacy, radiology, and clinical dietetics.

2.1.4. CONTINUING EDUCATION. Education beyond initial professional preparation relevant to the type of patient care delivered in the organization, provides current knowledge relevant to the field of practice and is related to findings from quality assurance activities.

2.1.5. CONTRACTING OFFICER: A person with the authority to enter into, administers, and/or terminates contracts and makes related determinations and findings. The only person authorized to make changes in the contract on behalf of the Government.

2.1.6. CONTRACTING OFFICER'S REPRESENTATIVE (COR): A government employee selected and designated in writing by the contracting officer to act as his/her designated representative in administering a contract.

2.1.7. CONTROLLED SUBSTANCE: All regulated drugs.

2.1.8. FACILITIES: Building, equipment and supplies necessary for the implementation of services by personnel.

2.1.9. MILITARY TIME is on a 24-hour clock, e.g.

2.1.10. MILITARY DATES are written as: September 2, 1996 - 2 Sep 96

2.2.11. PRIVILEGING PROCESS: Process established by the medical activity and AR 40-68 for granting clinical privileges to health care providers.

2.1.12. QUALITY ASSESSMENT AND IMPROVEMENT: Those actions taken by the Government to check services to determine if they meet the requirements of the JC, U.S. Army Medical Command, Dental Activity (DENTAC) quality assurance and risk management program, and ensure that the contract personnel comply with the terms and conditions of the contract.

2.1.13. QUALITY CONTROL: Those actions taken by a contractor to control the performance of services to ensure that they meet the requirements of the contract.

2.1.14. REPLACEMENT PERSONNEL: Contract personnel selected to fill a position for the duration of the contract period, which was previously occupied by another contract personnel.

2.2. Acronyms:

2.2.1. CRDAMC— Carl R. Darnall Army Medical Center

2.2.2. AR — Army Regulation

2.2.3. BCLS — Basic Cardiac Life Support

2.2.4. CHCS — Composite Health Care System

2.2.5. CLIN — Contract Line Item Number

2.2.6. COR — Contracting Officer's Representative

2.2.7. CPR — Cardiopulmonary Resuscitation

2.2.8. DA — Department of the Army

2.2.9. DCCS - Deputy Commander for Clinical Services.

2.2.10. DoD - Department of Defense.

2.2.11. DEA - Drug Enforcement Administration.

2.2.12. EKG - Electrocardiogram.

2.2.13. FTE - Full Time Equivalent.

2.2.14. MEDCOM - Medical Command.

2.2.15. IV - Intravenous.

2.2.16. JC - Joint Commission.

2.2.17. KO - Contracting Officer.

2.2.18. MEDDAC - Medical Department Activity.

2.2.19. MTF - Medical Treatment Facility.

2.2.20. PA - Physician Assistant

2.2.21. PAD - Patient Administration Division

2.2.22. Pam - Pamphlet

2.2.23. PCF — Practitioner's credentials file

2.2.24. QA&I — Quality Assurance & Improvement

2.2.25. QC — Quality Control

2.2.26. SF - Standard Form

2.2.27. SOW - Statement of Work

2.2.28. TAB - Therapeutic Agents Board

3. GOVERNMENT FURNISHED PROPERTY. CRDAMC shall pay for and maintain a T1 line.

3.1. CRDAMC, if applicable, may provide training on use of Digital Imaging Network Picture Achieves Communication Systems (DINPACS).

3.2. CRDAMC will establish and maintain computer network and VPN connectivity with the contractor during the life of this contract. Images are furnished to contractor by computer network.

3.3. In case DINPACS or the VPN become unavailable, the Chief, Department of Radiology, will use the following procedures as backup if deemed necessary:

3.3.1. The Government will furnish all film and Standard Forms 519B for diagnostic radiological interpretations.

3.3.2. All films and accompanied forms will remain the property of, and subject to the exclusive control of, the U.S. Government. All reports and documents prepared by the contractor in fulfillment of this agreement will become the property of the U.S. Government.

3.3.3. The Government shall package and ship film or digital images on Compact Disc in manufacturer x-ray cases for delivery to contractor facility, using contractor provided preaddressed labels.

3.3.4. The Government will provide with each shipment of film or digital images on Compact Disc to the contractor a standard packing list, which will be provided by the contractor.

3.3.5. Government furnished computer & CAC (Common Access Card) capability needed to input into CHCS; or, use of an authorized secure shell terminal emulator such as Attachmate Reflections (current version 14.0.3) to access CHCS.

4. CONTRACTOR FURNISHED ITEMS.

4.1. The Contractor shall furnish all personnel and equipment at the contractor's facility and services to comply with the requirements of this contract.

5. SPECIFIC TASKS.

5.1. Interpret and transcribe all reports into CRDAMC's CHCS and provide electronic signature in CHCS for all exams, including computed radiography (CR or "plain film"), Magnetic Resonance (MR), Computed Tomography (CT), ultrasound (US), and fluoroscopic examinations on same day as exam transmission for a majority of the examinations and no later than noon (CST) next day received from the Department of Radiology at CRDAMC. The contractor/radiologist shall be capable of interpreting the complete spectrum of all modalities. The contractor must demonstrate the capability to place reports into CRDAMC's CHCS system. At least 97% of reports, as measured on a monthly basis, shall be interpreted and transcribed into CHCS by noon CST of the day following receipt of study from CRDAMC; at least a 50% average of these studies shall be interpreted and transcribed into CHCS on the same date (by midnight CST) as received from CRDAMC.

5.1.2. Provide unlimited advice and opinions for each examination upon request by CRDAMC in support of diagnostic interpretations of radiological examinations and procedures in conjunction with patient care end treatment as provided by CRDAMC.

5.1.2.1. The contractor shall provide office and cell phone numbers where the radiologist(s) may be contacted at any time for consultations. If these numbers change, the contractor must notify the COR immediately and provide the new number. These numbers may be appended to the radiologist's signature line in CHCS. Answering services, answering machines, beepers, electronic mail or pagers are not acceptable.

5.1.3. The contractor/radiologist shall read stat diagnostic studies within 30 minutes of them being trasmitted from CRDAMC. The contractor shall make the interpreting radiologist immediately available for CRDAMC personnel to discuss the findings of all stat studies.

5.1.4. CRDAMC will push all the images to the contractor at the time of acquisition during the work day or as needed in emergency situations. The contractor shall keep their receiving computers operational at all hours to accommodate incoming transmissions. CRDAMC is not required to notify the contractor when films have been pushed. The contractor shall check their system at intervals of their choosing to comply with the turnaround requirement in paragraph 5.1.

5.1.5. Prepare all records and reports as may be required in support of services rendered and as required by the MTF, Federal law or Army regulation.

5.1.5.1. In accordance with the American College of Radiology Guideline on Communication, the contract radiologist will immediately and directly communicate findings in those situations in which the interpreting radiologist feels that immediate patient treatment is indicated (e.g., pneumothorax). This communication will be directly with the referring provider if a contact number has been provided, other healthcare provider or responsible person. In those situations in which the interpreting physician feels that the findings do not warrant immediate treatment but constitute significant unexpected findings, the interpreting physician or his/her designee should communicate the findings to the referring physician, other healthcare provider, or an appropriate individual in a manner that reasonably insures receipt of the findings. These methods of communication and to whom the message/report was communicated will be documented in the examination interpretation report.

5.1.6. Bilateral exams, while taken together, shall be billed as two separate exams. Examples of such examinations would include bilateral films such as bilateral knees, wrists, or legs. If a second exam is sent for comparison reasons only, that study will not receive a report, and thus will not be billed. The only variance to this rule is when a bilateral study is fully contained on one film and can be ordered using one single CPT code. For instance, a standing bilateral knee study (CPT code 73565) contains a single image with a view of both knees side by side. Other examples of this type of study include, but are not limited to bilateral hip and pelvis studies (73520), or bilateral AC joints (73050). Additionally, CT films of the abdomen often include complete evaluation of the pelvis. These exams shall also be billed as two separate exams. Examples of CPT codes for abdomen CT with contrast is 74160 and CT pelvis with contrast is 72193.

5.1.6.1 Some examinations will have a prior examination sent for comparison purposes. Up to one comparison examination may be sent with the primary examination for interpretation and will be used by the contract radiologist for comparison without additional charge. If the contract radiologist determines that a comparison examination would be beneficial and one has not previously been provided, the contractor will contact CRDAMC Radiology Film File Services to determine if a comparison examination is available that had not been previously transmitted to the contractor. Film File Services will be able to quickly forward the comparison examination or will contact the contractor if it is determined that the examination cannot be retrieved immediately.

5.1.7. Take part in hospital Quality Assurance Programs as required to meet the standards of the JC.

5.1.8. Participate in support of patient care conferences, team conferences, professional staff conferences and other appropriate professional activities only to the extent that such attendance and participation is relative to exams assigned to the contractor. Participation, if required, shall be telephonic.

5.1.9. Facilitate patient care by recommending appropriate referrals to other health care providers in accordance with policies and regulations of CRDAMC.

5.1.10. Perform and provide diagnostic interpretation of radiologic films, and provide diagnostic consultation related to diagnostic imaging to other members of the medical staff. Examinations, procedures, and studies performed will include the full range of diagnostic work that would be performed by a Board certified Diagnostic Radiologist (as tele-radiology processes allow; procedures such as arthrogram, venogram, aspiration, barium studies, etc require onsite radiologist so could not be performed with tele-radiology). Procedures include, but are not limited to:

Head and Neck Chest and Ribs Abdomen/KUB IVP Spine and Pelvis Extremities Ultrasound CT Scan

MRI

Bone Densitometry The contract providers shall perform only those services for which privileges have been granted by the CRDAMC credentials committee.

5.1.11. Quality Control/Assurance. The contractor is required to follow current Quality Control/Assurance plans in place at CRDAMC or the contractor's plan as approved by CRDAMC as long a monthly progress is reported to CRDAMC.

5.1.12. CRDAMC is part of the Department of Defense HMO program called Tricare and as such, the Contractor staff shall be required to adhere to all Tricare rules and regulations. Information on the Tricare program may be obtained at www.tricare.osd.mil.

5.1.13. Utilization Information (UI) is incorporated at no additional cost to the Government

5.1.13.1. UI will be provided on a quarterly basis.

5.1.13.2 Elements of the UI report will be:

5.1.13.2.1. Top Five Radiology Procedures by % -Color Graphic

5.1.13.2.2 Client Summary Report: Data provided most frequently interpreted study:

5.1.13.2.2.1. Type of Study

5.1.13.2.2.2. CPT Code

5.1.13.2.2.3. Quantity

5.1.13.2.2.4. % of total

5.1.13.2.3. Top Ten, Referring Physicians by %-Color Graphic

5.1.13.2.4. Referring Physician Summary Report: Data indicates highest requester of radiology services. Utilization below five studies per month is not required.

5.1.13.2.5. Referring Physician Detail Report: Data indicates detailed physician ordering patterns by:

5.1.13.2.5.1. Physician Name

5.1.13.2.5.2 Type of Study

5.1.13.2.5.3. Quantity

5.1.13.2.5.4. % of total

6. PERFORMANCE REQUIREMENT SUMMARY (PRS). The following PRS applies to the contract as a whole. The Government may modify inspection methods in accordance with site specific requirements.

PERFORMANCE

OBJECTIVE

PERFORMANCE

STANDARD

ASSESSMENT

PERFORMANCE

INCENTIVE

standards shall be

documented in

assessments of the

contractor's