PERFORMANCE_WORK_STATEMENT_revised_6_July_2017.pdf

PERFORMANCE WORK STATEMENT

Bariatric Surgeon

CARL R. DARNALL ARMY MEDICAL CENTER, FORT HOOD, TX

C.1. GENERAL

C.1.1. This is a personal services contract and is intended to create an employer-employee relationship between the Government and the individual contract health care providers only to the extent necessary for providing the healthcare services required under this contract. The performance of healthcare services by the individual contract health care providers under a personal services contract are subject to day-to-day supervision and control by healthcare facility personnel comparable to that exercised over military and civil service health care providers engaged in comparable healthcare services. Any personal injury claims alleging negligence by the individual contract health care providers within the scope of the health care provider’s performance of the personal services contract shall be processed by the Department of Defense (DoD) in the same manner as claims alleging negligence by DoD military or civil service health care providers. The contract does not create an employer-employee relationship between the Government and any corporation, partnership, business association or other party or legal entity with which the contract health care provider may be associated. The authority for this contract is 10 United States Code 1089 and 10 United States Code 1091.

C.1.1.2. Professional Liability. Pursuant to 10 USC 1089(a), DoD shall process any personal injury claim alleging negligence by the HCP within the scope of the HCP’s performance under this contract as claims alleging negligence by the DoD military or civil service HCP. The contractor or HCP is not required to maintain medical malpractice liability insurance, and the Government will not reimburse or otherwise pay for such insurance should any be purchased.

C.1.1.3. Responsibility and Procedures. If any suit or action or filed or any claim is made against the contract HCP, which occurred as a result of work performed by the HCP under this contract, the HCP shall immediately notify the contractor and the Contracting Officer and the chief of the appropriate services and promptly furnish them copies of all pertinent documents received.

C.1.1.4. The contractor and Contractor HCP shall cooperate with the government, without further compensation, in the processing, review, settlement, or defense of the suit, action, or claim; and authorize government representatives to settle or defend the claim and to represent the HCP in, or take charge of, any litigation involved in such an action. The Contractor HCP may, at the Contractor HCP's own expense, participate in defense of such claim or litigation.

C.1.1.5.Period of Performance. The Contractor shall provide the services of one (1) bariatric surgeon for Carl R.

Darnall Army Medical Center (CRDAMC), Fort Hood, Texas. Period of Performance (POP) is 1 December 2017 through 30 Sep 2022. Services shall be provided as required in accordance with the performance work statement (PWS) and the terms and conditions of any resulting contract.

C.1.1.6. Description of Work. The contract health care provider (HCP) performing services shall be required to provide services in an out-patient environment. The contract HCP shall possess qualifications meeting or exceeding currently recognized national standards as established by the Joint Commission. Contract HCPs shall provide the highest consideration to patient dignity and observe the precepts of the American Hospital Association’s “Bill of Rights for Patients.” Services provided under this contract shall be as comprehensive as Government-supplied facilities, equipment, and support services permit.

C.1.1.7. Compensation. Total compensation for health care providers shall not exceed either $400,000 per year (to include bonuses and incentives) based on Title 10 USC Section 1091 or the FTER of $208.33 as established under

DHA-PI Instruction 6025.5.

C.1.1.4. Performance Measures.

C.1.1.4.1. Outcome. The contractor shall provide qualified personnel to fill the requirement for these services at a standard enabling the military treatment facility to maintain a high level of quality.

C.1.1.4.2. Acceptable measures include: position shall be filled within 90 days of date of award (defined in SF1449, block 3); in the event the contract service provider vacates the position, the position shall be filled within 90 days of vacancy; ensure a fill-rate of at least 95% of requested shifts; turnover rate of not more than one person per year; no more than two substantiated complaints in any twelve-month period against any one provider; and no physician initiated cancellations of treatments except as medically required by patient. Other performance evaluation factors that will be monitored but that are not quantified by numerical measurements include: contractor providing personnel exceeding the minimum qualification standards; no inappropriate prescriptions; patient customer service comments; provider and contractor relationship with hospital staff/government contracting personnel; compliance with hospital policy and procedures.

C.1.1.4.3. Performance measurements. The Government shall monitor each contract HCP’s performance under this contract using the PWS Quality Assurance Plan, Army Regulation 40-68, and any other MTF standards.

Additionally, HCP’s performance will be monitored by department personnel and the Contracting Officer’s Representative (COR) through government information systems and records, patient records, customer service information, contractor reports, and time sheets. Other methods may be implemented at the Government’s discretion.

C.1.1.5.2.1. LICENSE AND CREDENTIALS REVIEW OR PRIVILEGING.

C.1.1.5.2.1.1. The MTF Commander must grant privileges to contract HCPs for which credentialing is required prior to HCPs providing any services. The privileging process shall be in accordance with all requirements in ARs 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 is contained in chapter 4 of AR 40-68. Any failure to meet these requirements is considered nonperformance and the basis for termination for cause.

C.1.1.5.2.1.2. The contractor shall request from the COR documentation requirements for privileging for each contract HCP. Required documentation shall be completed and returned to the COR within 45 calendar days of the provider accepting the position. The contractor shall perform all primary source verifications and include all verifications with the credentials. The Contractor shall obtain all paperwork, letters of reference, approvals, work history, etc. required by the MTF credentialing process. MTFs will not assist the contractor in obtaining any needed information.

C.1.1.5.2.1.3. Should the contractor need to add additional/or replacement providers during the contract period, the same qualification standards, credentialing and health requirements shall apply.

C.1.1.5.2.1.4. The Credentials Committee may have questions which they will wish to present to the contractor’s provider verbally or in writing. The Contractor’s provider shall answer questions presented by the Credential’s Committee either verbally or in writing.

C.1.1.5.2.1.5. If at time of contract award and subsequent performance, the provider whose credentials have been reviewed by the Credentials Committee is no longer available to provide required contract services, the contractor shall provide a candidate whose credentials are clearly equal or greater than those of the original candidate within 30 days after the contractor receives notification that provider will no longer be available or is no longer available.

C.1.1.5.2.1.6. The MTF Credentials Committee will maintain control of the credentialing/privileging aspects for all providers who will be providing independent healthcare services at the MTF or under our auspices.

C.1.1.5.2.1.7. No contract provider shall provide services under this contract without prior approval of the

Commander as recommended by the MTF Credentials Committee.

C.1.5.2.1.8. Contractor shall investigate, verify, maintain and submit documentation of curriculum vitae for each provider proposed to provide services at the MTF. Proof of original documentation of degrees and licensure shall be presented and prime source verified. All periods of training must be supported by copies of training certificates.

Contractor shall provide documentation of all continuing health education certification. This submission must occur prior to any provider performing work under this contract.

- Legible copies of education degrees/diplomas qualifying the provider to perform as a provider, and of any required postgraduate training certificates involving the intended area of work (such as internship, residency, etc.).

All copies must be certified that it is a true copy of the original.

- Legible copies of all current state licenses, professional certification cards, basic certification card, plus additional Cardiac Pulmonary Resuscitation (CPR) requirements for that specialty, any current DEA certificate, and any specialty or subspecialty boards and/or fellowship certificates. In addition, a complete list of all licenses ever held, with explanations of any that are not current or which have been subject to disciplinary action will be provided.

Once initial privileges have been granted, the Contractor shall ensure providers maintain such licensure/required certification and provide copies of renewed documents in support of same.

- A curriculum vitae accounting for all periods of time subsequent to obtaining the initial qualifying professional degree/training, and including date of birth, to permit any required query of the National Practitioner Data Bank.

- Proof of current competence (within 6 months) and experience in the area of work will be provided in the form of at least two reference letters from the sources listed below; and names, mailing addresses and telephone numbers will be provided to permit direct reference query. Reference letters must be received on letterhead paper directly from the author to the MTF (or to the contractor if it’s a corporation, vice an individual). Letters should address the provider's professional competence, experience, quality of care, relations with patients and staff members, any personal problems or mental/physical health problems that have interfered with any professional practice, and previous participation in medical staff functions/compliance with medical staff bylaws and number and type of procedures performed.

- Letter from the chief of staff, clinic administrator, professional supervisor, or department head of any hospital or clinic at which the provider holds current privileges or with which the provider is clinically associated.

- Letter from a peer practitioner having personal knowledge of the provider's professional standing, character and ability, or from the president or secretary of the local professional society.

- Letter from the director or faculty member of any professional training program, if the provider has participated in such training program within the last year.

- Statement by the provider regarding physical and mental health, to include any history of substance abuse.

Statement of involvement in malpractice cases and claims, including a brief description of the facts of any case settled on behalf of the provider, and a history of any disciplinary action taken by hospitals, state licensure boards, or other government agencies. At a minimum, DA Form 5754-R will be used for this purpose; it will be completed upon initial application for privileges, and at the time of privilege renewal.

C.1.5.2.1.9. Unless otherwise required, the Contractor shall submit completed credentials packets for any additional providers 45 calendar days from the provider accepting the position. Once initial privileges are granted, not less than 90 days prior to expiration, the MTF will provide renewal documents to the contractor for completion by the provider; completed forms will be returned to the Credentials Coordinator at least 45 calendar days prior to the expiration of previous privileges. Affiliate privileges are granted for the first year based upon their expiration date and every two years afterwards.

C.1.5.2.1.10. The credentialing documents specified in the above paragraphs will be provided to the Contractor through the COR by the Credentials Coordinator in photocopy-ready state. The Contractor shall reproduce forms as necessary. The Contractor shall submit all completed forms and documentation specified above to the Credentials Coordinator.

C.1.5.2.1.11. Presentation of a provider to the MTF by the Contractor shall, on a continuous basis, constitute evidence that the contractor has investigated and verified all information presented to the MTF for the purpose of provider credentialing. During the term of the contract, the contractor shall notify the Credentials Coordinator at the MTF within 72 hours upon becoming aware of any information which may compromise a contract provider's credentials at the MTF. This shall include, but is not limited to, information linking a contract provider with chemical dependence, misdemeanor, felony, or medical malpractice. This information shall be reviewed by the MTF Credentialing Committee and may result in the rescinding of credentials. The MTF Credentialing Committee is the sole agency authorized to recommend to the Commander that a particular contract provider be granted privileges. The Commander of the MTF is the final authority for approving/denying clinical privileges to any and all contract providers.

C.1.5.2.1.12. If the credentials of any provider are revoked, he/she shall not be permitted to continue practicing medicine at the MTF. Such action will not relieve the Contractor from responsibility to perform the services required by this contract. The contractor shall provide a candidate whose credentials are clearly equal to or greater than those of the original candidate within 30 days after the contractor receives notification that a provider’s credentials have been revoked.

C.1.5.2.1.13. All contractor personnel shall attend newcomers training at the start of their employment at the MTF and quarterly training thereafter. All contractor personnel shall participate in orientation to their work area and maintain a competency file (which is different from a credentials file) at the worksite (JC standards

C.1.5.2.1.14. Profile Application Packets. The Contractor shall submit Profile Application Packets to the COR for review prior to beginning performance. Application packets shall include the following at a minimum: education history, certifications required by the individual task orders (BCLS, etc.), certifications with expiration and license number, employment history/resume, health exam date, type of specialty, and immunization history. Contractor shall monitor profile packets and provide updated information with appropriate credentials on continuous basis. The COR will approve or disapprove the application packet(s) within five (5) business days. A personal interview of candidates shall not be conducted by the MTF. It is the contractor’s (contract company’s) responsibility to interview their prospective employees prior to presenting them as candidates to the MTF.

C.1.5.3. Each day that services are performed the contract HCP provider may be required to sign-in his/her time of arrival and departure on a log sheet that will be maintained at a designated area. These attendance logs are for the sole use of the government officials to ensure compliance with FTE hours and will not be provided to the contractor for any reason and/or purpose. In addition, under no circumstances will the Government employees sign or verify the contractor's time sheets for the contractor's health care providers.

C.1.5.4. Orientation and Training. Newly hired HCP providers shall be required to complete new employee orientation which is provided by the MTF. Thereafter, contract HCP providers shall be required to complete mandatory training to meet competency requirements. Orientation and annual training requirements are a condition of employment for which the contractor will be compensated at the hourly rate reflected in the contract.

C.1.5.4.1. Computer Training. Contract providers who interact with the MTF computer systems must receive training for the applicable system. The COR or appropriate government designee will coordinate computer training.

The training will be on-site and during normal duty hours. This training will be at no cost to the contractor. These systems may include but are not limited to:

C.1.5.4.1.1. Composite Health Care System (CHCS). The government will provide training to contract HCPs in the CHCS and/or other procedures that the medical activity's staff is required to use. Access to such patient data systems is an "Automated Data Processing Sensitive" position requiring compliance with AR 380-67. Refer to Supplemental PWS, “ADP Security Requirements” for further guidance.

C.1.5.4.1.2. Armed Forces Health Longitudinal Technology Application (AHLTA) which was formerly known as Composite Healthcare Computer System II (CHCS II). AHLTA contains the MTF’s appointment scheduling program, pharmacy, lab, and radiology ordering system and is interlinked with other departments in the MTF.

C.1.5.4.1.3. Ambulatory Data System (ADS). This computer system produces forms on which the providers identify the appropriate billing codes for diagnoses and procedures for each patient.

C.1.5.4.1.4. Essentris Inpatient Medical Record. This computer system is an electronic medical record (EMR) system that is used by DoD MTF’s to document inpatient care provided by providers, nurses, and health care support staff.

C.1.2. QUALIFICATIONS. In addition to the minimum contractual qualifications listed below, the contract HCP working under this contract shall have sufficient education and recent experience to perform the tasks and procedures listed in this PWS. Contract HCP providing services shall meet the following:

Bariatric Surgeon:

The contract health care providers shall be a Bariatric Surgeon who is competent, qualified and adequately trained to perform assigned duties. The contractor shall meet the following minimum qualifications.

C.1.2.1. Meet and maintain all licensing/certification requirements to perform as a general surgeon in accordance with requirements of the basic contract to include:

C.1.2.1.1. Be a Doctor of Medicine (M.D.) or Osteopathy (D.O.). Must have and maintain a valid, unrestricted license in the State of Texas.

C.1.2.1.2. Be board-certified by the American Board of Surgeons or equal certifying body, if more than five years have passed since conclusion of the service provider’s residency. Formal didactic training in bariatric surgery, which includes completion of an accredited bariatric surgery fellowship and documentation of previous bariatric surgery experience. Supporting documentation, including a case log list or bariatric surgery training certificate, should be provided to allow the credentialing committee to assess the surgeon to allow the surgery experience.

C.1.2.1.3. Foreign medical graduate physicians shall possess a valid certificate from the Educational Council for Foreign Medical Graduates.

C.1.2.2. Experience. Have a minimum of two years recent experience having been continuously employed in the practice of bariatric or in training in the United States for the two years prior to commencement of services under this contract.

C.1.2.2.1. Commonly practiced procedures include but are not limited to the following:

Gastric restrictive surgery, such as vertical gastroplasty Gastric bypass surgery; such as roux-en-y gastric bypass, whether resectional or non-resectional Total or near-total gastrectomy for those situations where the effects of prior bariatric surgery make restoration of a normal gastric reservoir impractical.

Reversal of jejunoileal bypasses surgery, with or without conversion to gastric bypass or vertical gastroplasty.

Reversal of vertical gastroplasty or non-resectional gastric bypass.

Endoscopy - Therapeutic bronchoscopy of secretions, choledochoscopy, diagnostic sigmoidoscopy and colonoscopy, (including biopsy), diagnostic esophagogastroscopy (including biopsy), laparoscopy, operative and diagnostic. Primary direct investigation of mechanical defects within the luminal system of the bariatric patient (push enteroscopy).

Abdomen - Repair of hernias, operations on the gastrointestinal tract, biliary tract, pancreas, spleen, liver, adrenals, rectum and anus, kidney, urethra, bladder, uterus, tubes and ovaries and external genitalia.

Reduction and repair of Hiatal and Par esophageal hernia in bariatric patients (most of whom have some component of the same). Intra liminal therapy for stricture and anastomotic ulceration Intra luminal therapy for structure and anastomotic ulcerations.

Intensive Care Management - Placement and interpretation of arterial, central venous and pulmonary artery lines and management of fluid and electrolyte problems including hyper alimentation.

Diagnostic procedures - Introduction of radiological contrast materials in conjunction with operative procedures or assessment of trauma.

Use of mechanical, electro cautery for the excision, coagulation, vaporation and/or repair of tissue. Utilizes advance laparoscopic and/or robotic techniques.

Intra luminal therapy-stent deployment. OVESCO and hemoclip applications.

Primary surgical and medical management of the bariatric leak patient.

C.1.2.3. Contract bariatric surgeon must possess a valid Basic Cardiac Life Support (BCLS) and (Advanced Cardiac Life Support (ACLS) certification during the contract period of performance. Certification shall be renewed biannually. Certification will be done by the American Heart Association and/or Red Cross approved training program.

C.1.2.4. Possess and maintain a current Drug Enforcement Administration (DEA) registration.

C.1.2.5. Contract Healthcare Provider (HCP) shall be able to read, write, and speak English fluently to effectively communicate with patients and other HCPs.

C.1.2.6 Contract HCPs shall be required to meet Continuing Medical Education (CME) requirements. The government will not reimburse for these costs.

C.1.2.7. The contract HCPs have received Occupational Safety and Health Administration (OSHA) required training for the position in which they will perform, and that training currency is maintained. Documentation of such training shall be provided to the Contracting Officer’s Representative (COR).

C.1.2.8. The positions require access to Department of Defense computer systems; therefore, each bariatric surgeon shall be a United States citizen, or otherwise meet the requirements of Army Regulation (AR) 25-2.

C.1.2.9. Must be able to obtain and maintain privileges at Carl R Darnall Army Medical Center (CRDAMC) through approval of the Credentials Committee.

C.1.2.10. Shall possess sufficient initiative, interpersonal relationship skills and social sensitivity such that he/she can relate constructively to a variety of patients from diverse backgrounds.

C.1.2.11. Graduates of foreign medical schools are required to possess both a medical license and other certification by the Educational Commission for Foreign Medical Graduates (ECFMG) or 5th Pathway.

C.1.2.12. Position requires access to Department of Defense computer systems, therefore provider shall be a U.S.

Citizen or otherwise meet the requirements of AR 25-2.

C.1.2.13. The surgeon shall be able to type and have had experience using computers especially Microsoft programs.

The physician will not be required to type a certain amount of words per minute. CRDAMC will provide computer training for the CRDAMC computer system.

C.1.2.14. Active participation within a structured bariatric program that provides or coordinates comprehensive, interdisciplinary care of the bariatric patient. HCP shall attend a minimum of three Metabolic and Bariatric Surgery committee meetings a year, at least one of which is comprehensive review.

C.1.2.15. Assists with immediate resuscitative measures as required.

C.1.3. Reserved.

C.1.4. HOURS OF PERFORMANCE

C.1.4.1. Clinic hours. The HCP contract provider shall provide surgical services (outpatient, inpatient, surgical time).

The normal duty hours when working in the clinic are 7:30 AM- 4:30 PM, but may be changed based on mutual agreement between the contract service provider and the contracting officer's representative, based on input from the Chief, Department of Surgery or designee. Clinic hours will consist of patient consults, group appointments, walk-ins, etc. and to provide care and surgical intervention accordingly. Includes time spent attending Metabolic and Bariatric Surgery committee meetings.

C.1.4.1.1. The HCP shall remain on duty, if necessary, until the replacement physician arrives. He/she shall ensure that continuity of care is provided to the patient.

C.1.4.2. ON-CALL/CALL BACK HOURS: Call services are required. Carrying a beeper or pager shall qualify as being On-Call and is defined as availability for telephonic consultation for advice on the management and disposition of patients with neurologic disease to include potential bedside evaluation of these patients. This includes, but is not limited to, TPA administration for the treatment of acute stroke. Call-back service is defined as actual patient care performed at CRDAMC when the on-call contract HCP is called back to provide care at the MTF. The Contract HCP is required to perform call during hours other than routine duty hours, Monday through Friday, including weekends and legal federal holidays.

C.1.4.2.1. The contract bariatric surgeon shall share rotating on-call schedules with any other bariatric surgeon providers in the MTF. The HCP contract provider shall be available to provide consultation for bariatric patients from Monday at 0700 to Friday at 1700. The HCP will be scheduled for call for bariatric patients only at least one weekend per month at CRDAMC, surgeons are normally scheduled for on-call 24 hours per day, any day of the week, including federal holidays. When the contract provider is on call, they are required to carry the government furnished pager. The Contract HCP is not required to remain at a place of residence while on call, but shall be available by Government furnished pager during on-call periods. The Contract HCP shall respond telephonically within 15 minutes of the page being sent and shall be prepared to provide telephone consultation and/or return to the MTF to provide assistance within 45 minutes of the page being sent or as soon as needed.

C.1.4.2.2. The MTF will pay the beeper rate for time the provider is required to carry the government pager while on-call. Each time that the Contract Provider is called back to the MTF and Call-Back services are performed, the contractor shall sign-in the time of commencement/termination of services on a log maintained in the location where services are performed. If the contract provider is required to respond to the MTF, the Neurologist may bill at the regular rate for actual hours of service performed. Where an emergency response requires services for periods longer than 1 hour, the provider may round periods of 30 minutes or more to the next whole hour. Periods of less than 30 minutes shall not be billed to the Government.

C.1.4.3. Closures. During anticipated closure of the facility due to Command declared training holidays or unplanned closure of the facility due to natural disasters, military emergencies, severe weather, or otherwise, the contractor will only be paid for the actual hours that were worked.

C.1.4.4. The employees may be required to work at different locations due to transitioning services, staff shortages, or peak/surge workloads.

C.1.4.5. Contract service providers shall sign in and out on a time sheet to be maintained in the Department. The U.S.

Government reserves the right to review hours worked by the contract service providers as part of its quality assurance surveillance program not only by implementing sign in/sign-out procedures, but also by any means, including requiring the contract service provider to utilize a time clock should one be available. It shall be the contractor’s responsibility to verify the hours worked by the contract HCP.

C.1.4.6. When necessary and directed by the Department Chief, contractor shall remain after duty hours to provide medical attention to patients in need of emergency care.

C.1.4.7. Scheduled and Unscheduled Absences.

C.1.4.7.1. Scheduled absences. The contractor will provide the COR or his designated government representative with 45 day notice prior to any planned absence. No backup personnel will be required during absence. The contractor shall not invoice for periods when not performing services.

C.1.4.7.2. Unscheduled absences. In the event the contractor is unable to perform on an assigned duty day, he/she shall notify the Department Chief or the COR not later than 0730 (7:30 A.M.) hours on the duty day to be missed.

C.1.4.7.3. If the contractor becomes sick on a normal duty day, he/she shall notify the COR or the Department Chief.

C.1.4.7.4. HCP contract provider may be required to work beyond the end of the shift while providing patient care in emergent situations. Extended time will be used for direct patient care only. The contract provider will not receive additional compensation for working beyond his/her shift in order to accomplish administrative tasks. Signing in early does not constitute an extended shift. Extended time will be calculated as follows: 10-20 minutes = ¼ hour; 21 to 40 minutes = ½ hour; 41 to 59 minutes = ¾ hour, and 60 minutes = 1 hour.

C.1.5. SPECIFIC TASKS:

Bariatric Surgeon - Duties shall consist of, but are not limited to the following:

C.1.5.1. Contract bariatric surgeon shall have sufficient training/experience to be able to perform the duties of a bariatric surgeon and essentially the same duties as those required of any Medical Corps Officer or Government Civil Service Surgeon of similar experience and in similar duty assignments to include, but not limited to the following:

C.1.5.2. Facilitate patient access to medical care by recommending appropriate referrals to other health care providers in accordance with MTF policies and regulations.

C.1.5.3. Prepare all records and reports as may be required in support of services rendered and as required by the

MTF.

C.1.5.4. Take part in clinic Quality Assurance Program as required to meet the standards of the Joint Commission.

C.1.5.5. Active participation within a structured bariatric program that provides or coordinates comprehensive, interdisciplinary care of the bariatric patient. HCP shall attend a minimum of three Metabolic and Bariatric Surgery committee meetings a year, at least one of which is comprehensive review.

C.1.5.6. May teach and provide consultation and clinical supervision to other health care providers (nurse practitioners, physician’s assistants, medical students, interns, residents, and fellows). Serves as occasional consultation service for patients admitted to the hospital. The contract HCP should have hospital admitting privileges.

C.1.5.7. Reserved.

C.1.5.8. Works under the general supervision of the Chief, Department of Surgery who discusses policies and objectives. The individual exercises independent judgment in selection and performance of the full range of diagnostic evaluations for patients. Incumbent works independently in accordance with methods and practices of the medical profession and established administrative policies as an expert in the field. Medical diagnoses are not reviewed and the individual has considerable latitude for professional technical decisions, overall effectiveness, and accomplishment of objectives. The quality of professional and administrative work is evaluated using the quality assurance principles; policies and regulations as mandated by the Joint Commission, and as structured by appropriate Army and local regulations and policies.

C.1.5.9. Complete out-patient and in-patient evaluations appropriate for the patient to determine current levels of function/dysfunction using standardized and clinically accepted measurement and evaluation tools, clinical observations, patient and staff interviews, and review of medical histories. Examinations will include the spectrum of therapy examination skills and must be adequate to differentially diagnose the cause of the patient's problem.

Provides comprehensive rehabilitation problems/objectives/goals for individual patients with current and expected deficits in functional performance and occupational roles.

C.1.5.10. Directly participates in all patient treatment and directly oversees any treatment applied by other rehabilitation personnel in a clinical capacity. Evaluate and document each patient's response to treatment on an ongoing basis.

C.1.5.11. Plan and implement complex goal oriented treatment plans for patients presenting a multiplicity of complex dysfunction. Revise treatment plans when patients fail to respond or show adverse reactions to treatment.

C.1.5.12. Complete all necessary documentation according to Joint Commission and Medicare standards to include computer data entry on all patients and close out encounter by the required time.

C.1.5.13. Make timely and appropriate referrals to other providers when medically indicated. Progress treatment as appropriate and demonstrates ongoing discharge planning

C.1.5.14. Assist in developing and conducting professional short courses and in-service education programs for peers, subordinates, other health care providers and members of the military and civilian communities. Provide professional guidance, counseling, and evaluation and assist in directing activities and training of any assigned student.

C.1.5.15. Interact effectively with patients and health professionals to maintain a high quality standard of health care.

C.1.5.16. Participate in Trauma Care, Discharge Planning, Utilization Management, Continuous Quality Improvement, Risk Management, Multi-Disciplinary meetings, and other vital functions.

C.1.5.17. Perform all duties with minimal supervision or guidance. Contract employees shall consult with the section chief for their assigned area when issues cannot be resolved at the section level.

C.1.5.18. Take part-clinic Quality Assurance Program as required meeting the standards of the Joint Commission on Accreditation of Healthcare Organizations.

C.1.5.19. Provide clinical direction to supporting government personnel assigned to their area during the performance of clinical procedures.

C.1.5.20. Complete all necessary documentation according to Joint Commission and Medicare standards to include computer data entry on all patients and close out encounter by the required time.

C.1.5.21. Consult with supervisor and/or colleagues, which are normally available, regarding problems either professional or administrative.

C.1.5.22. Interact effectively with patients and health professionals to maintain a high quality standard of health care.

C.1.5.23. Examines, diagnoses, and treats or prescribes course of treatment for bariatric surgical patients. Provides and plans comprehensive surgical care to the bariatric surgery population.

C.1.5.24. Enters, retrieves, and updates clinical documentation in CHCS, ALHTA, and Essentris. Responsible for maintaining accurate clinical records and receiving consultations and laboratory work of specific patients. Data entry proficiency is required.

C.1.5.25. Active participation within a structured bariatric program that provides or coordinates comprehensive, interdisciplinary care of the bariatric patient, which includes bariatric seminars. HCP shall attend a minimum of three Metabolic and Bariatric Surgery committee meetings a year, at least one of which is a comprehensive review.

C.1.5.26. Serves are primary call for CRDAMC Bariatric Call (patients who will need urgent or emergent operative management) and provides and/or assists with immediate resuscitative measures as required.

C.1.5.27. May serve as first assist to departmental surgeons in the laparoscopic surgical care in (especially) advanced fore gut cases as well as anterior abdominal wall reconstruction and hind gut applications.

C.1.5.28. Reserved.

C.2. SPECIAL INSTRUCTIONS.

C.2.1. Sign-on Bonus. A sign-on bonus shall be paid to contract provider for services on a full time basis for a period of 12 months and shall not exceed $10,000.00 per provider. Full time basis is considered to be a 40 hour work week.

The contractor shall provide a letter of commitment with their invoice stating that the provider has agreed to provide full time/part time services for a 12 month period. Reimbursement may be requested with the first invoice that contains time sheets for each provider. In the event the contract provider does not complete the 12 months, the remaining pro-rated portion sign-on bonus will be recouped from the contractor's normal invoices for the unfulfilled portion of the 12-month period. This is a one-time sign-on bonus per individual, and does not apply to incumbents. In the event the contractor does not have any future invoices from which to withhold the unfilled portion of a pro-rated sign-on bonus, the contractor shall issue a cashier's check to the U. S. Treasury within 14 calendar days of notification by the contracting officer for the portion due.

C.2.2. The sign-on bonus shall only be applicable to new employees. A new employee is defined as an employee that did not provide services as a contract employee under an existing contract at the CRDAMC any time in the 60 days preceding their actual begin/start date.

C.2.3. Retention Bonus. A retention bonus will be paid upon completion of a 12-month period on the condition that the provider agrees to provide full-time service for the following 12-month period and shall not exceed $10,000.00 per provider. If the provider fails to provide the additional 12 months of service the retention bonuses will not be paid to the same HCP who in the preceding 12 months received a sign-on bonus.

C.2.4. Relocation Expenses. Appropriate documentation shall be provided with the invoice to support payment of the relocation expenses, i.e., receipts for movement of household goods, POV mileage, and per diem (food and lodging) and will be paid in accordance with FAR 31.205-35. Reimbursements for actual travel costs will be paid in accordance with Federal Travel Regulation not exceed $5,000.00 per provider. If the three actual expenses just listed are less than the amount of the actual expenses shall be paid. Renting of an apartment/hotel room, rental car, airline ticket, bus ticket and/or train ticket and expense money for a dermatologist to live in the MTF area during the week then return to a permanent residence during the weekends/holidays/periods of time off work are not considered relocation expenses and shall not be invoiced for or paid. In the event the contract provider does not complete the 12 month tour of duty, the entire relocation expenses will be recouped from the contractor. This is a one-time payment of relocation expenses per individual.

C.3. Publications. Following is a list of basic publications applicable to this contract/task order. Current issues of many DA publications can be accessed at http://armypubs.army.mil/. Current issues of many forms can be accessed at http://armypubs.army.mil/. Publications and forms not on the internet can be obtained from the MTF.

C.3.1. The Publications have been coded as mandatory or advisory. The Contractor is obligated to follow those coded as mandatory only to the extent that they apply to this contract/task order. Supplements, amendments, or changes to these mandatory publications may be issued during the life of the contract. Advisory publications may be used for information and guidance but are not binding for compliance.

Public Law 101-552, §3101, November 5, 1990 Occupational Safety and Health Administration Public Law 104-191 21 Aug 96 Health Insurance Portability and Accountability Act of 1996 Current Edition Joint Commission Manual Medical Centers Medical By-Laws AR 25-2 Information Assurance AR 40-1 Composition, Mission, and Functions of the Army Medical Department AR 40-3 Medical, Dental, and Veterinary Care AR 40-4 Army Medical Department Facilities/Activities

AR 40-5 Preventive Medicine AR 40-66 Medical Records Administration and Healthcare Documentation AR 40-68 Clinical Quality Management AR 40-501 Standards of Medical Fitness AR 40-562 Immunizations and Chemoprophylaxis AR 340-21 The Army Privacy Program (05 Jul 85) AR 380-5 Department of the Army Security Program AR 385-40 Army Accident and Investigations and Reporting AR 600-85 The Army Substance Abuse Program

C.4. RESERVED

C.5. ANTI-TERRORISM/OPERATIONS SECURITY

1. AT Level I Training. This provision/contract text is for contractor employees with an area of performance within an Army controlled installation, facility or area. All contractor employees, to include subcontractor employees, requiring access Army installations, facilities and controlled access areas shall complete AT Level I awareness training within 10 calendar days after contract start date or effective date of incorporation of this requirement into the contract, whichever is applicable. The contractor shall submit certificates of completion for each affected contractor employee and subcontractor employee, to the COR or to the contracting officer, if a COR is not assigned, within [2] calendar days after completion of training by all employees and subcontractor personnel. AT level I awareness training is available at the following website: https://atlevel1.dtic.mil/at.

2. Access and General Protection/Security Policy and Procedures. This standard language text is for contractor employees with an area of performance within an Army controlled installation, facility or area. Contractor and all associated sub-contractors employees shall comply with applicable installation, facility and area commander installation/facility access and local security policies and procedures (provided by government representative). The contractor shall also provide all information required for background checks to meet installation access requirements to be accomplished by installation Provost Marshal Office, Director of Emergency Services or Security Office.

Contractor workforce must comply with all personal identity verification requirements as directed by DOD, HQDA and/or local policy. In addition to the changes otherwise authorized by the changes clause of this contract, should the Force Protection Condition (FPCON) at any individual facility or installation change, the Government may require changes in contractor security matters or processes.

3. AT Awareness Training for Contractor Personnel Traveling Overseas. This standard language text required US based contractor employees and associated sub-contractor employees to make available and to receive government provided area of responsibility (AOR) specific AT awareness training as directed by AR 525-13. Specific AOR training content is directed by the combatant commander with the unit ATO being the local point of contact.

4. iWATCH Training. This standard language is for contractor employees with an area of performance within an Army controlled installation, facility or area. The contractor and all associated sub-contractors shall brief all employees on the local iWATCH program (training standards provided by the requiring activity ATO). This local developed training will be used to inform employees of the types of behavior to watch for and instruct employees to report suspicious activity to the COR. This training shall be completed within 30 calendar days of contract award and within 10 calendar days of new employees commencing performance with the results reported to the COR NLT [2] calendar days after contract award.

5. Contractor Employees Who Require Access to Government Information Systems. All contractor employees with access to a government info system must be registered in the ATCTS (Army Training Certification Tracking System) at commencement of services, and must successfully complete the DOD Information Assurance Awareness prior to access to the IS and then annually thereafter.

6. For Contracts that Require an OPSEC Standing Operating Procedure/Plan. The contractor shall develop an OPSEC Standing Operating Procedure (SOP)/Plan within 90 calendar days of contract award, to be reviewed and approved by the responsible Government OPSEC officer, per AR 530-1, Operations Security. This SOP/Plan will include the government's critical information, why it needs to be protected, where it is located, who is responsible for it, and how to protect it. In addition, the contractor shall identify an individual who will be an OPSEC Coordinator. The contractor will ensure this individual becomes OPSEC Level II certified per AR 530-1.

7. Contracts that Require OPSEC Training. Per AR 530-1, Operations Security, new contractor employees must complete Level I OPSEC training within 30 calendar days of their reporting for duty. All contractor employees must complete annual OPSEC awareness training.

8. Information Assurance (IA)/Information Technology (IT) Training. All contractor employees and associated sub-contractor employees must complete the DoD IA awareness training before issuance of network access and annually thereafter. All contractor employees working IA/IT functions must comply with DoD and Army training requirements in DoDD 8570.01, DoD 8570.01-M and AR 25-2 within six months of employment.

9. Information Assurance (IA)/Information Technology (IT) Cortication. Per DoD 8570.01-M , DFARS

252.239.7001 and AR 25-2, the contractor employees supporting IA/IT functions shall be appropriately certified upon contract award. The baseline certification as stipulated in DoD 8570.01-M must be completed upon contract award.

10. Contractors Authorized to Accompany U.S. Armed Forces Deployed Outside the United States. The clause shall be used in solicitations and contracts that authorize contractor personnel to accompany US Armed Forces deployed outside the US in contingency operations; humanitarian or peacekeeping operations; or other military operations or exercises, when designated by the combatant commander. The clause discusses the following AT/OPSEC related topics: required compliance with laws and regulations, pre-deployment requirements, required training (per combatant command guidance), and personnel data required.

11. Contracts Requiring Performance or Delivery in a Foreign Country, DFARS Clause 252.225-7043, Antiterrorism/Force Protection for Defense Contractors Outside the US. The clause shall be used in solicitations and contracts that require performance or delivery in a foreign country. This clause applies to both contingencies and non-contingency support. The key AT requirement is for non-local national contractor personnel to comply with theater clearance requirements and allows the combatant commander to exercise oversight to ensure the contractor’s compliance with combatant commander and subordinate task force commander policies and directives.

12. Contracts That Require Handling or Access to Classified Information. Contractor shall comply with FAR 52.204- 2, Security Requirements. This clause involves access to information classified “Confidential,” “Secret,” or “Top Secret” and requires contractors to comply with— (1) The Security Agreement (DD Form 441), including the National Industrial Security Program Operating Manual (DoD 5220.22-M); any revisions to DOD 5220.22-M, notice of which has been furnished to the contractor.

C.6. SHARP. The contractor shall ensure all service providers receive Sexual Harassment/Assault Response and Prevention (SHARP) training not later than 60 calendar days after contractor personnel begin performance under this contract. Training can be obtained either online or in person. Contractor personnel can attend SHARP training provided by MEDCOM on an every other month basis by contacting (210) 221-6118 for class date/time and availability. If the employee has an AKO account, they can access online the Team Bound Self Study course through Army Learning Management System (ALMS) at http://www.atsc.army.mil/tadlp/delivery/alms.asp.

C.7. Contractor Manpower Reporting.

ACCOUNTING FOR CONTRACT SERVICES -The Office of the Assistant Secretary of the Army (Manpower & Reserve Affairs) operates and maintains a secure Army data collection site where the contractor will report ALL contractor manpower (including subcontractor manpower) required for performance of this contract. The contractor is required to completely fill in all the information in the format using the following web address https:ficinra.ariny.mili . The required information includes: (1) Contracting Office, Contracting Officer, Contracting Officers Technical Representative; (2) Contract number, including task and delivery order number; (3) Beginning and ending dates covered by reporting period; (4) Contractor name, address, phone number, email address, identity of contractor employee entering data; (5) Estimated direct labor hours (including subcontractor); (6) Estimated direct labor dollars paid this reporting period (including sub-contractor); (7) Total payments (including subcontractor); (8) Predominant Federal Service Code (FSC) reflecting services provided by contractor (and separate predominant FSC for each sub-contractor if different); (9) Organizational title associated with the Unit Identification Code (UIC) for the Army Requiring Activity (the Army Requiring Activity is responsible for providing the contractor with its UIC for the purposes of…