A-01-02_LVN-CNA__PWS_Dec_2016.doc

Performance Work Statement (PWS)

Personal Licensed Vocational Nurse (LVN) and Certified Nurse Assistants (CNAs) Services for the San Antonio Military Health Systems (SAMHS)

1. General.

1.1. This is a personal services contract and is intended to create an employer-employee relationship between the Government and the individual LVN and CNA only to the extent necessary for providing the health care services required under the contract. The performance of health care services by the individual Health Care provider under a personal services contract are subject to day-to-day supervision and control by health care facility personnel comparable to that exercised over military and civil service LVNs and CNAs engaged in comparable health care services. Any personal injury claims alleging negligence by the individual HCP within the scope of the LVN and CNA ’s performance of the personal services contract shall be processed by Department of Defense (DoD) in the same manner as claims alleging negligence by DoD military or civil service LVN and CNA s. 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 LVN and CNA may be associated. The authority for this contract is Title 10 United States Code 1089 and Title 10 United States Code 1091.

1.1.1. The contractor LVNs and CNAs 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 LVN and CNA in, or take charge of, any litigation involved in such an action. The contract LVN and CNA may, at their own expense, participate in defense of such claim or litigation.

1.1.2. All persons performing work under the contract shall be and shall remain employees of the contractor and not employees of the government. Neither uniformed services personnel nor government civilian employees shall be employed to perform services under this contract.

1.1.3. Professional Liability. Pursuant to 10 USC 1089(a), DoD shall process any personal injury claim alleging negligence by the LVN and CNA within the scope of the LVN and CNA ’s performance under this contract as claims alleging negligence by DoD military or civil service LVN and CNA . If any suit or action is filed or any claim is made against the LVN and CNA , which occurred as a result of work performed by the LVN and CNA under this contract, the LVN and CNA shall immediately notify the contractor who will in turn notify the contracting officer’s representative (COR) and the contracting officer (KO) and promptly furnish them copies of all pertinent documents received. The contractor or LVN and CNA 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.

1.2. Background. The mission of the Military Healthcare System (MHS) is to enhance our Nation’s security by ensuring the nation has a healthy military force capable of providing the full range of military operations supported by a combat ready healthcare system sustaining the health of DoD beneficiaries. Health care services for eligible MHS beneficiaries are provided at Military Treatment Facilities (MTFs) located on or near military installations or posts. The MTF may be a clinic, hospital, or medical center. Clinics are outpatient facilities offering primary care or simple specialty care (routine exams, tests, treatments). The clinic may be a stand-alone site or a satellite of a larger clinic, hospital, or medical center. Hospitals offer more complex, resource-intensive secondary care (e.g. inpatient care, surgery under anesthesia) and primary care at outpatient clinics inside and outside the hospital. Medical Centers offer tertiary (sophisticated diagnosis/treatment of any ailment), secondary, and primary care, hospital services, preventive services, blood bank, and outpatient services. In addition, Medical Centers offer graduate medical education programs for physicians and other training programs for nursing and ancillary personnel.

1.2.1. Currently, the San Antonio Military Health System (SAMHS) is supported by direct care MTFs located at Fort Sam Houston, Lackland Air Force Base, Randolph Air Force Base, Port San Antonio, and Camp Bullis.

1.3. Scope of Work. The Contractor shall provide licensed vocational nurses (LVN) and certified nursing assistants (CNA) nurse services for the SAMHS which includes the San Antonio Military Medical Center (SAMMC), Ft. Sam Houston Primary Care Clinic, and McWethy Troop Medical Clinic (TMC), all located at Ft. Sam Houston; Wilford Hall Ambulatory Surgery Center (WHASC) at Lackland Air Force Base; Taylor Burk Health Clinic (TBHC) at Camp Bullis (TBHC operates as a satellite clinic for SAMMC and WHASC); Randolph AFB Clinic (RAFBC); North Central Federal Clinic at San Antonio, Kelly Clinic at Port San Antonio, and the Community Based Medical Home (CBMH) at Schertz. The primary performance location is SAMMC.

1.3.1. SAMMC has a level one trauma center and provides the full spectrum of services associated with this level of health care. SAMMC provides trauma support for 50% of San Antonio’s trauma care. SAMMC has the Institute of Surgical Research, the Burn Center, and the Center for the Intrepid to support America’s Wounded Warriors; as well as provides maternal child and neonatal intensive care unit health care services. SAMMC and WHASC have robust Graduate Medical Education Programs and provides training sites for multiple medical training programs for enlisted and officer medical specialties.

1.3.2. LVNs and CNAs shall provide services to include, but not limited to: Critical Care, Medical/Surgical, Ambulatory, Peri-Operative, Burn Unit, Mother/Baby Units, Psychiatric Units, ER and In and Out Patient areas of the MTFs.

1.3.3. All services shall be provided in accordance with established standards, principles and ethics of the profession and applicable professional specialty organizations, The Joint Commission standards and Accreditation Association for Ambulatory Health Care (AAAHC), applicable Department of Defense (DoD), Army and Air Force specific regulations, directives, and policies, and MTF-specific policies, and procedures. The contractor LVNs and CNAs shall give the highest regard to patient dignity and observe the precepts of the American Hospital Association’s Bill of Rights for Patients.

1.3.4. The LVNs and CNAs shall provide services in conjunction with other non-contract providers to include physicians, nurse practitioners, physician assistants, registered and licensed practical nurses, and support personnel. All LVNs and CNAs shall perform essentially the same functions, within the scope of acceptable practice for the specific specialty or position, as those required by the MTFs or government service health care professionals of similar experience and in similar duty assignments.

1.4. The contractor shall ensure that all LVNs and CNAs provided under this contract shall read, write, and speak English well enough to effectively communicate with all parties and other LVNs and CNAs . The LVNs and CNAs shall be computer literate to ensure patient information is documented in MTF computerized systems.

1.5. The contractor LVNs and CNAs 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.

1.6. The contractor LVNs and CNAs shall be capable of constant standing, walking, lifting and bending. In addition, the LVNs and CNAs may be exposed to highly contagious/infections disease, radiation from portable x-ray, and continuous fluoroscopy equipment.

1.7. All contractor LVNs and CNAs shall have the required education, training, experience and documented current competence in the required specialty position description. All LVNs and CNAs shall have a minimum of one year experience within the past three years in the required specialty.

1.8. Life Support Training. All contractor LVNs and CNAs must possess and maintain current course completion documentation for basic life support (BLS) through an American Heart Association or Red Cross approved training program. Advanced Cardiac Life Support (ACLS) is required in all adult Critical Care, Burn Center, Emergency Room, Operating Room, Recovery Room, or Cardiac Catheterization areas. Pediatric Advanced Life Support (PALS) is required in Inpatient Pediatrics, Pediatric Intensive Care Units (PICU), and Neonatal Resuscitation Program (NRP) is required in the NICU, Labor & Delivery, Ante Partum and Post Partum. Additional requirements will be outlined in Exhibits per specialty.

1.9. All contractor LVN/CNA shall maintain all licenses and certification requirements and meet all continuing education requirement of the U.S. jurisdiction in which are licensed to practice.

1.9.1. The LVNs and CNAs shall possess and maintain a current, active, valid, unrestricted nurse license in at least one U.S. state, District of Columbia, Commonwealth, territory or jurisdiction. All licenses shall be unencumbered and remain in effect during employment. The LVNs and CNAs shall be a graduate of an accredited school of nursing (National League of Nursing) or a current unrestricted certification from a certifiable training school of certified nursing assistants or proof of government-sponsored developmental, as required specialty position description. The contractor shall provide the COR prime source verification of the nursing license, certifications, documentation shall include state, license number, expiration date, method of verification, and names of verifying official.

1.10. The contractor shall ensure the LVN and CNA abides by all MTF standards, rules, and procedures including requirements for any licensure, credentialing and quality assurance requirements. Such regulations include, but are not limited to, general safety, fire prevention, waste disposal, infection control, the Joint Commission and the Accreditation Association for Ambulatory Health Care (AAAHC), and patient safety initiatives.

1.11. License Verification and Credentials Review or Privileging.

1.11.1. The contractor shall follow Army Regulation (AR) 40-68, Clinical Quality Management when providing services within Army facilities, and, Air Force Instruction (AFI) 44-119 Medical Quality Operations, and AFI 46-101 Nursing Services and operations for all health care services provided within Air Force facilities. The AR 40-68 is located at http://www.apd.army.mil, and the AFIs are located at http://www.e-publishing.af.mil/. Complete credentials or profile packages shall be submitted at least 10 days prior to in-processing to the COR/QAE.

1.11.2. The contractor shall perform all primary source verifications and include all verifications with the credentials package or competency assessment folder information for non-privileged staff in accordance with guidance. The contractor shall obtain all paperwork, letters of reference, approvals, work history, certifications, required by the MTF credentialing or licensure verification processes. The MTF staff will not assist the contractor in obtaining any needed information for initial credentialing. The contractor is responsible for the current competence of the contractor LVNs and CNAs used to provide health care services under this contract.

1.11.3. Licensure, certification, registration, or authorizing documents. All contractor LVNs and CNAs must maintain a current, active, valid and unrestricted license or authorizing document from any U.S. state, District of Columbia or U.S. territory or jurisdiction to provide healthcare within the scope of practice for a specific health care discipline. The contractor shall ensure that renewal actions are accomplished well before expiration of the HCP’s license, certification, to ensure compliance with the contract. The licenses and certificates shall be renewed and maintained in a current status during the life of the contract. All licensure and renewals shall be submitted to the appropriate MTF office, failure to do so is grounds for dismissal.

1.11.4. If the contractor adds additional/or replacement LVNs and CNAs during the contract period, the same qualification standards, and health requirements shall apply.

1.11.5. The contractor shall not use any individual to provide direct health care services under this contract if that individual, within the past 5 years:

1.11.5.1. Has had his/her clinical privileges limited, suspended, or revoked by any healthcare facility or agency, public or private, anywhere in the world.

1.11.5.2. Is the subject of a current or pending hearing or appeal brought by any health care facility, public or private, anywhere in the world, which may result in the limitation, suspension, or revocation of the individual’s clinical privileges.

1.11.5.3. This prohibition does not apply to any individual whose clinical privileges, although originally limited, suspended or revoked by a health care facility, were subsequently fully reinstated by the health care facility or agency.

1.11.6. Limitation of clinical privileges, as used in this paragraph, refers to a partial withdrawal/reduction of clinical privileges as a result of a determination that, or pending investigation to determine whether an individual has engaged in unprofessional conduct or substandard medical practice or is incompetent to perform certain medical practices.

1.11.7. When the contractor experiences delays in recruiting or submitting credentials or profile packages, the contractor shall notify the KO and COR immediately. The KO will evaluate the situation to determine if an extension of the dates is appropriate. If an extension is not approved, the Government may terminate the service for default or seek other remedies as appropriate.

1.12. Health and Immunization Requirements. All LVNs and CNAs , to include pool and replacement LVNs and CNAs , performing services under this contract shall comply with the health and immunization requirements identified below at the time of initial request for clinical privileges and annually thereafter. Documentation shall be submitted by the Contractor with the credentialing or profile packages of their LVNs and CNAs . The expense for all physical examinations and immunizations to comply with the health requirements shall be borne by the contractor at no additional cost to the government.

1.12.1. All LVNs and CNAs performing services under this contract shall be immunized against seasonal influenza infection annually unless there is a documented medical or religious reason not to be immunized. The contractor shall submit proof of immunization or documented medical or religious reason not to be immunized, at the time of initial request for clinical privileges and annually thereafter.

1.12.1.1. All contractor LVNs and CNAs services under this contract shall receive a general physical examination prior to commencement of services. The contractor shall provide the COR, 10 calendar days before beginning services under this contract, a physical examination certificate for each contract LVN AND CNA who will provide services. The certification shall state the date on which the physical examination was completed and the name of the physician who performed the examination. This certification shall be signed by the physician performing the examination. For the purposes of this paragraph, a physical examination administered more than 45 days prior to performance of the contract will not be considered adequate. The physical examination shall include the following:

1.12.1.2. A history to show the LVN AND CNA has completed a primary series of immunization with tetanus and diphtheria toxoids and that a booster dose is current (within the past 10 years).

1.12.1.3. A test for the hepatitis (Type B) virus with documentation of the results. A profile shall be established to show immune status to hepatitis. Non‑immune Health Care Workers (lacking anti‑HB(c) or anti‑HB(s)) shall be required to complete an immunization series with a Hepatitis‑B vaccine (e.g., Recombivax, Engerix).

1.12.1.4. The physical examination shall also document serologic evidence of immunity to measles and rubella or to provide documentation of immunization with measles, mumps and rubella (MMR) vaccine using the following guidelines:

1.12.1.4.1. Employees born before 1957 without documentation of previous vaccination with MMR should receive one dose.

1.12.1.4.2. Employees born in or after 1957 who have received one dose of MMR previously shall receive one booster dose.

1.12.1.4.3. Employees born in or after 1957, without documentation of any previous vaccination with MMR, should receive two doses of vaccine, separated by no less than one month.

1.12.1.5. Contractor's LVNs and CNAs shall be screened for tuberculosis by a tuberculin skin test using the Mantoux technique. A skin test result of 10 mm of induration or more shall be required to have a chest roentgenogram and an evaluation performed. A tuberculin skin test of 10 mm of induration or more will require documentation providing an assessment of the patient (status of infection‑ active, inactive; need for preventive treatment or not as determined by age, history of BCG (Bacillus Calmette‑Guerin) vaccination; duration of skin test positively, etc).

1.12.1.5.1. If all of the immunizations and tests set forth in the preceding paragraphs have not been completed, the contractor shall issue a certificate providing evidence of immunizations and tests that have been completed or started and shall provide a schedule for the completion of unfinished immunizations and lab tests. After the schedule is completed, the contractor must provide an updated and complete certificate.

1.12.1.5.2. All contractor LVNs and CNAs performing direct health care services under this contract, who experience a parenteral (e.g., needle‑stick or cut) or mucous membrane (e.g., splash to the eye or mouth) exposure to blood or bloody body fluids, shall receive prompt treatment. The military treatment facility (MTF) will evaluate the source of exposure for risk of communicable diseases and will provide a report of the findings to the contractor and the LVN AND CNA . The contractor shall provide treatment and therapies in accordance with the U.S. Centers for Disease Control and Prevention (CDC).

1.13. Criminal History Background Check Requirement. (MANDATORY if at any time the provider will have the opportunity to be alone with a minor.) The contractor shall ensure that as a condition of employment the individuals providing services under this contract meet the requirements of the Crime Control Act of 1990, as amended, by successfully completing a Criminal History Background Check consisting of a Federal Bureau of Investigation (FBI) fingerprint check and State Criminal History Repository check. The procedures for completing the required background check are outlined in the Department of Defense Instruction (DODI ) 1402.05, dated 14 July 2016; Subject: Criminal History Background Checks on Individuals In Child Care Services; Enclosure 6, paragraph D, Government Contract Employees. DODI 1402.05 is available on the Internet at: http://web7.whs.osd.mil/dodiss/instructions/ins2.html)

1.13.1. If the contract LVN AND CNA has a DoD affiliation such as living or working on an installation (within 5 years) or is a family member of active duty military, an Installation Record Check (IRC) shall be conducted by DoD Component personnel at the installation level. No IRC is required on individuals without DoD affiliation. Upon favorable completion of the IRC, an individual may be selected to provide services to a minor child under line-of-sight supervision until the required background checks are completed.

1.13.2. Personnel may be employed under the contract pending completion of the background checks provided the activity uses line-of-sight supervision (LOSS) while minor children are in the care of that individual. The contract provider shall be within line-of-sight supervision of either military health care personnel, or an individual who has received an approved background check, or is in the presence of the child's parent or guardian.

1.13.3. All background clearance requests shall be submitted by the contractor prior to placement of the employee at the work site. Cost of initial background and clearance requests prior to in-processing is part of the contractor's recruitment costs. The name and address of the COR shall be included in each request as the recipient of the results. Unfavorable results that indicate risk to safe and/or effective delivery of services will constitute grounds for dismissal of the employee. Decisions regarding dismissal of an employee for unfavorable results of a background check are the sole responsibility of the KO.

1.13.4. The individual contract provider has the right to obtain a copy of the background check report from the COR and, if desired, to challenge the accuracy and completeness of the information in the report.

1.13.5. Contractor personnel who have previously received a background check shall provide proof of the check or obtain a new one. A new investigation is required if a break in service to the Department of Defense results in a time-lapse of more than 3 years.

1.14. Profile Application Packets. Full performance is critical and shall begin no later than forty-five (45) days after receiving a task order. Therefore, no later than 10 business days prior to the start of work, the contractor shall submit profile packets on each employee who shall be performing services under this contract to the appropriate COR. The contractor shall coordinate with the COR on the method of transmission (i.e. electronic, hard copy) of the profile application packets. In the event the COR elects to receive only electronic copies of the profile packet, the contractor shall maintain all original documents. Depending on the individual position, the profile packages may be reviewed by department chiefs, supervisors, flight commanders, or clinical nurse officers in charge, as determined by the organizational structure of the department to which the LVN and CNA would be assigned. The COR will notify the contractor within five (5) business days if the proposed Health Care provider has been approved or disapproved.

1.14.1. The profile application packets shall provide the following information:

1.14.1.1. Completed centralized credentials quality assurance system (CCQAS) data entry form.

1.14.1.2. Primary source verification of state licenses with expiration date, license number, name and contact information for individual performing primary source verification attesting to direct state verification and the method of verification.

1.14.1.3.Criminal background check.

1.14.1.4. Education history with primary source verification of college attended/degree. LVNs must be a graduate from an accredited school of nursing (National League of Nursing), a copy of the college transcripts and Diplomas will be submitted. CNAs will have a current unrestricted certification from a certifiable training school of certified nursing assistants or proof of Government-sponsored developmental training.

1.14.1.5. Certifications: Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), Trauma Nursing Core Course (TNCC), and any professional certifications required for the position being applying for.

1.14.1.6. Employment history and resume.

1.14.1.7. Immunization status and health examination date.

1.14.1.8. Skills assessment checklists, competency assessments, medication examinations, telemetry examinations, or any other skills verification necessary for specialty and location (specifics will be outlined in the task orders).

1.15. U.S. Citizenship (copy of birth certificate or naturalization papers required). LVNs and CNAs performing under this contract must be U.S. citizens. In addition, if a contractor personnel fails to meet the citizenship requirements stated herein the contractor shall not hold the government liable for not allowing performance under this contract.

1.16. MTF Hours of Operation

1.16.1. Hospitals and medical centers provide services 24 hours a day, 365 days a year (366 days during leap years) including holidays. Clinics have designated operating hours and their normal hours of operation will be outlined in the task orders.

1.16.2. Recognized Holidays. The following is a list of legal federal holidays. Any of the federal holidays falling on a Saturday will be observed on the preceding Friday, holidays falling on a Sunday will be observed on the following Monday. Contract employees may be required to work on legal holidays as determined by the department chief and stated on the task order.

New Year’s Day, January 1st Martin Luther King’s Birthday, 3rd Monday in January

President’s Day, 3rd Monday in February

Memorial Day, Last Monday in May

Independence Day, July 4th Labor Day, 1st Monday in September

Columbus Day, 2nd Monday in October

Veteran’s Day, November 11th Thanksgiving Day, 4th Thursday in November

Christmas Day, December 25th

1.16.3. 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.

1.16.4. In accordance with DODI 3020.37 and Office of the Surgeon General Memorandum, Continuation of Essential DoD Contractor Services During Crises to MEDCOM Contracts, dated 18 Nov 09, nursing services have been determined to be essential contractor services and LVNs and CNAs will be required to report to work as scheduled during emergencies, disasters or during adverse weather conditions.

1.17. Hours of Performance

1.17.1. Task orders will identify the hours of performance as required.

1.17.2. The contractor shall provide LVNs and CNAs to support a seven (7) day/week, 24 hour/day operation to include holidays. Shift times which consist of eight (8) work hours with a non-paid 30 minute lunch or dinner break, and a 12 hour shift with a 30 minute non-paid lunch or dinner break. The maximum number of shift hours to be scheduled in a twenty-four (24) hour period is twelve (12).

1.17.3. Full-Time LVNs and CNAs . LVNs and CNAs performing services under a full-time line item will normally work 32-40 hours per seven (7) day work week on rotating shifts Sunday through Saturday, including Federal holidays. In emergency situations for continuity of care, LVNs and CNAs shall be required to work over 40 hours in a one week period resulting in overtime. In the event overtime is incurred, it shall be billed to an appropriate overtime line item.

1.17.3.a. Overtime (OT). Defined as hours worked in excess of a 40 hour work week and billed to appropriate overtime line item (CLIN) designated by contracting IAW OT rates requested by contractor over the life of the contract and FAR 22.103-4.

1.17.4. Pool LVNs and CNAs . LVNs and CNAs who will be requested to work in the absence of the full time employee, or during periods of increased patient census. Pool LVN and CNA will not be guaranteed a specific number of hours per billing cycle, however, they must work a minimum of one 12 hour shifts per month to ensure access and competency.

1.17.5. Scheduling Issues. The COR will communicate scheduling issues to the Contractor’s Program Manager for resolution.

1.17.6. Patient Increase/Decrease. Any LVN AND CNA may be floated to perform healthcare services within their scope of practice in another unit if patient census requires this measure. If floating is required, the contractor shall charge the hours used to the appropriate task order and line item for which the services were provided. For situations such as increases and decreases in patient acuity or census, the KO or COR (as authorized by the KO) reserves the right to float the LVN AND CNA to other appropriate patient care units or task orders under this contract, request additional shifts, and/or cancel scheduled shift(s) for LVNs and CNAs . The KO or COR (as authorized by the KO) will notify the contractor’s program manager at least two (2) hours prior to the start of the shift to cancel any LVN AND CNA . If the two (2) hour cancellation option is not met, and the LVN AND CNA is referred to work, the government will pay for the first two hours of the shift. Should an LVN AND CNA be cancelled prior to completion of any shift, the government will pay for actual time worked.

1.17.7. Absences and Leave. The contractor shall have sufficient qualified personnel available so that all services are provided in the event an LVN AND CNA scheduled to work becomes ill, resigns, is terminated, or is otherwise unavailable to perform. All proposed substitutes/replacements (no matter when they are proposed during the performance period) shall have qualifications equal to or higher than the qualifications of the person being substituted or replaced. All proposed substitutes/replacements shall meet the identical application submission procedures specified in paragraph 1.14. prior to performing services.

1.17.7.1. Scheduled absences of contract LVNs and CNAs shall be coordinated with the COR at least 30 calendar days in advance. The contractor shall notify the COR or after hours designee at least 2 hours prior to start of a scheduled shift when an LVN AND CNA will be absent and a replacement will be provided. The contractor shall provide a qualified replacement for any LVN AND CNA who is absent from duty, whether scheduled or unscheduled, within 2 hours of start of absence.

1.18. The use of non-compete conditions in employment agreements or in subcontracts (to prevent loss of personnel by the contractor), effective only during the period of the contract performance, is acceptable. However, the use of non-compete conditions in employment agreements and/or in subcontracts that prevent employees and/or subcontractors of the incumbent from being interviewed by, employed, or accepting offers of employment and/or subcontracts by the new contractor on the follow-on contracts is unacceptable. It hinders the government's ability to accomplish the mission of providing medical care to beneficiaries. Inclusion of such conditions in an employer's employment agreement and/or subcontracts will result in an offeror's proposal being unacceptable. Awardee, and their subcontractors, may not include such conditions in employment agreements and/or subcontracts while performing under this contract.

1.19. Conflict of Interest. The contractor or LVNs and CNAs shall not bill the patient for services rendered under this contract. The contractor or LVNs and CNAs shall not request or 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.

1.19.1. The contractor or LVNs and CNAs shall not, while performing services under this contract, advise, recommend, or suggest to persons eligible to receive medical care at Government expense that such persons should receive care from the contractor or LVNs and CNAs or from any third party at any place other than as designated under this contract.

1.19.2. 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 health care services under this contract. The contractor shall not release any of the above information without prior written consent of the KO. The contractor/LVNs and CNAs shall not use patient care rendered pursuant to this contract as part of a study, research project, or publication. The LVNs and CNAs shall prepare medical records, forms and documents as required, in accordance with the regulations and established guidelines listed in the contract.

1.19.3. The contractor LVNs and CNAs shall abide by federal and local MTF regulations and requirements concerning the nature of limited privileged communication between patients and the LVN AND CNA as may be necessary for security and personnel reliability programs. They shall also abide by federal and local MTF regulations concerning the confidentiality of patient records, as embodied in federal statutes including the Privacy Act of 1974 and the Health Insurance Portability & Accountability Act (HIPAA) of 1996. All regulations referenced are available for review from the MTF, COR, or the KO. All medical records and reports will remain the property of the government.

1.19.4. The contractor or LVNs and CNAs shall not use Government facilities, supplies, or equipment in private practice or for any purpose other than providing the health care services required under this contract.

1.20. Contractor Key Personnel. The contractor shall notify the KO and COR of the primary point(s) of contact for contract management, coordination and administration not later than five (5) business days after receiving notice of contract award. The contractor shall notify the KO and COR of changes in the primary point(s) of contact at least five (5) business days prior to the change. All notifications shall be in writing and shall state the name and contact information for the point(s) of contact.

1.20.1. Contractor Program Manager. The contractor shall provide a full-time Program Manager(s) in the San Antonio area within 10 business days of contract award. The KO and COR shall be notified in writing and the contractor shall state the name(s) and contact information for the Program Manager(s) . The Program Manager(s) shall not be one of the contract LVNs and CNAs providing services.

1.20.2. The Program Manager shall respond to telephone calls from the KO and COR within thirty (30) minutes on a twenty four (24) hour a day, seven day a week basis.

1.20.3. The Program Manager shall meet with the COR monthly during the contract period to discuss any concerns regarding the contract/task order execution. The COR may elect to have this meeting by telephone, video teleconference or in person and will select the time and location.

1.20.4. The contractor’s Program Manager shall be available 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 between the contractor’s program manager and the COR. Any unresolved problems will be referred by the contractor or COR to the KO for resolution.

1.21. Air Force Security and Contractor Verification System (CVS).

1.21.1. The LVN AND CNA shall comply with all applicable Air Force Instructions (AFI), Department of Defense (DoD) Regulations, and Medical Wing Instructions (MDWI) as outlined in Appendix A. NOTE: Copies of referenced MDWI will be furnished to prospective contractors electronically upon their request through the KO.

1.21.2. MTF Orientation. The LVN AND CNA shall attend the MTF Orientation at the outset of their working at MTF. The MTF Orientation will familiarize the LVN AND CNA with the policies and procedures of the MTF and will be scheduled by the COR within two months of employment. Orientation attendance shall be required of the CP during Government paid duty hours.

1.21.3. In-Process. The LVN AND CNA performing service under this Contract shall be required to in-process through the 59th MDW Medical Logistics Contract Personnel Office upon reporting. At this time, the CP shall initiate the process to receive Common Access Card (CAC), Base Identification Passes, Restricted Area Badges, and keys.

1.21.4. Out-Process. Upon termination or expiration of the Contract, the LVN and CNA shall be required to out-process through the same office. Upon completion of performance, termination of the Contract, or termination of performance, the LVN AND CNA shall out-process and turn in Common Access Card (CAC), Base Identification Passes, Restricted Area Badges, and keys.

1.21.5. Air Force Security Requirements

1.21.5.1. General Security Requirements. The LVN and CNA shall follow all guidelines found in the Security Requirements for Solicitations and Contracts clause.

1.21.5.2. Security Training. The LVN and CNA shall be trained in accordance with AFI 31-501 Personnel Security Program Management,) (Entire instruction applies). AFI 31-401AFGM2 Information Security Program Management; (Entire instruction applies). AFI 33-200 Information Assurance Management, (Entire instruction applies); AFI 31-101, Integrated Defense (FOUO) (Entire instruction applies); AFI 33-203V1, Emission Security (EMSEC) (Entire instruction applies), and AFI 33-200, Information Assurance Management, (Entire instruction applies).

1.21.5.3. Internal Operating Instructions (OI). The LVN and CNA shall abide by the MTF's current OIs for internal circulation control, the protection of resources, and the regulated entry into Air Force controlled areas during normal, simulated, and actual emergency operations.

1.21.5.4. Reporting Requirements. The LVN and CNA shall comply with AFI 71-101, Volume 1, Criminal Investigations (Chapter 2, paragraph 2.7) and Volume-2, Protective Service Matters, (Paragraph 1.2). The CP shall report to

Security Forces any information or circumstances which may pose a threat to DoD or CP, resources, or DoD information.

1.21.5.5. Removal of LVN and CNA . The Government, through the KO, may require immediate removal from contract performance on the installation or any Government facility, any individual whose actions raise reasonable suspicion that patient care or services may be compromised in any way, or that pose a threat of harm to other Contractors/Government personnel or self. Removal under other circumstances will be subsequent to, and at the direction of the KO only.

1.21.5.6. If a situation meriting removal occurs as outlined in the previous paragraph, the COR will contact the KO and the LVN and CNA. A meeting may be required with the KO, COR and LVN and CNA to discuss further action.

1.21.5.7. The KO will notify the LVN and CNA if and when permanent removal is required. In the event of a disagreement between the Government and the LVN and CNA , the decision of the KO will be final.

1.21.5.8. The LVN and CNA may be required to submit to drug/alcohol testing. The Government reserves the right to require temporary or permanent removal from contract performance any individual who refuses or fails testing.

1.21.5.9. The LVN and CNA shall conduct themselves in a professional manner while on the installation and refrain from disruptive, offensive, or otherwise improper behavior that undermines order and discipline. The KO may direct the CP to remove from performance of this contract on this installation engaging in such misconduct.

1.22. Army Trusted Associated Sponsorship System (TASS)

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

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

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

1.22.4. The contractor is responsible for absences of LVNs and CNAs due to expired identification and access documents. Such absences shall not relieve the contractor of its obligation to perform the services required under this contract.

1.22.5. In-processing Requirements. The LVNs and CNAs are prohibited from performing services under this contract absent compliance with the in-processing requirements set forth below.

1.22.6 The government will sponsor the contract LVNs and CNAs for an Army Knowledge Online (AKO) account. All LVN AND CNA e-mail addresses will identify them as a contractor and use the format firstname.lastname.ctr@us.army.mil. The AKO will be discontinued by the government when the LVNs and CNAs no longer require access.

1.22.7. The government TA will send a notice through the TASS to the AKO e-mail address provided IAW the above requirement. The LVN and CNA’s user ID and password will be provided in the e-mail and will be require a change at first log-in. In the event the e-mail message is not received, the contractor may request the username and password from the TA and proceed to the website https://www.dmdc.osd.mil/tass to complete the process.

1.22.8. The LVN and CNA shall log into the TASS and complete the verification process by submitting the application back to the TA for approval.

1.22.9. The application will be accepted, returned, or rejected by the TA. Notice as to whether the application has been accepted, returned, or rejected will be provided to the LVN AND CNA ’s e-mail address within 48 hours after submission. If the application is returned or rejected, the LVN AND CNA shall contact the TA and comply with the TA’s guidance to attempt to correct and resolve the issue(s).

1.22.10. Upon approval of the application, the LVN AND CNA will receive an e-mail stating the CAC application was approved. The applicant must then go to a RAPIDS Issuing Facility to have the government credential issued. Effective 1 December 2011, Fort Sam Houston, Randolph Air Force Base and Lackland Air Force Base ID sections require an appointment. To make an appointment, the LVN AND CNA will follow the instructions provided by the TA and contact the COR for instructions. If the LVN AND CNA chooses Randolph or Lackland AFB, the supervisor or government task manager must send a visitor message prior to the LVNs and CNAs arrival on-site. The LVN AND CNA must present two acceptable forms of ID which may include: Driver's License, Military ID, Contractor Company ID with picture and expiration date, charge card with picture imprinted, or passport.

1.22.11. Revalidation Requirements. The TA is required to revalidate all LVNs and CNAs , in the TASS, every 6 months. In the event revalidation is denied, the CAC credentials shall be revoked and the CAC will not be useable to log in.

1.22.12. Out-processing Requirements. When a LVN AND CNA ’s performance under this contract ceases, the LVN AND CNA shall personally bring the CAC to the TA and complete the DA Form 2962. The TA will revoke the CAC from the TASS.

1.23. Sexual Harassment/Assault Response and Prevention (SHARP) Training The contractor shall comply with OTSG/MEDCOM Policy Memo 13-062, Policy for

Reporting Incidents of Sexual Assault and Sexual Harassment under the Sexual Harassment/Assault Response and Prevention (SHARP) Program, 12 Nov 2013. The SHARP reporting requirements apply only to knowledge obtained by contractor personnel while performing services under this contract.

The contractor shall require all Contract Service Providers (CSP) with knowledge of an incident of sexual assault occurring on a Government facility, to include a Government leased facility, where the contractor is providing services under this contract, to report the incident to the contractor who shall immediately (within 24 hours of gaining knowledge of the incident) report the incident in writing to the government's COR. This reporting policy also applies to sexual assault incidents involving MEDCOM personnel that occur on the contractor's owned or leased facility under this contract. All incidents shall be reported whether they involve contractor personnel or Government personnel, or other individuals, when the incidents occur on a Government facility or a Government leased facility.

The contractor shall require all CSPs with knowledge of an incident of sexual harassment occurring on a Government facility, to include a Government leased facility, where the contractor is providing services under this contract, to report the incident to the contractor who shall immediately (within 24 hours of gaining knowledge of the incident) report the incident in writing to the government's COR. This reporting policy also applies to sexual harassment incidents involving MEDCOM personnel that occur on the contractor's owned or leased facility under this contract. All incidents shall be reported whether they involve contractor personnel or Government personnel, or other individuals, when the incidents occur on aGovernment facility or a Government leased facility.

1.24. Safeguarding Material. The contractor shall be responsible for safeguarding all government property provided or obtained in connection with this contract. The contractor shall safeguard information of a confidential or sensitive nature. Neither the contractor nor any of its LVNs and CNAs shall disclose or cause to be disseminated any information concerning the operation of the MTF that could result in or increase the possibility of a breach in security or interrupt the continuity of operations or which breach the requirements of the Federal Privacy Act of 1974. However, the contractor may be required to provide testimony or disposition in cases of due process action.

1.24.1. Media and Other Inquiries. The contractor or LVN AND CNA shall not respond to any media inquiries. Any inquiries from the media, third parties, or public agencies shall be immediately relayed to the COR, who will relay them to the MTF Public Affairs Officer or, after duty hours, to the Administrative Officer of the Day (AOD). There shall be no interviews, comments, or any other response without the prior knowledge and approval of the MTF Commander. Other than routine inquiries from external agencies, all other inquiries and complaints shall be brought to the attention of the COR and the KO.

1.25. Vehicle Operations on Military Installations. The contractor LVNs and CNAs shall comply with the military installation’s requirements for vehicle operation and registration while on the military installation.

1.25.1. If vehicle registration is required, the LVNs and CNAs must register their vehicles with the office responsible for vehicle registration. A valid driver’s license, government-furnished civilian identification, proof of insurance and current registration must be presented to vehicle registration office, at which time a DoD decal may be issued.

1.25.2. If a DoD decal was issued, the LVNs and CNAs shall follow installation procedures for removal and turn-in of the vehicle decal upon termination of services under this contract.

1.25.3. All vehicles entering the installation are subject to search. LVNs and CNAs may encounter long delays for vehicle inspection and identification checks upon entering and exiting the installation. The government will not reimburse the contractor for time spent at installation checkpoints. LVNs and CNAs must plan accordingly and report to work at their scheduled duty time and at their appointed place of duty.

1.26. Keys. The contractor is responsible for any keys issued by the government to LVNs and CNAs for use in the MTF. The keys shall not be duplicated. The contractor shall be financially responsible for the replacement of any lost keys and any associated locks. Lost keys and/or locks shall be reported to the COR immediately upon recognition of the loss; procedures for securing specific areas and replacing locks will be initiated by unit leadership and BAMC Provost Marshal IAW BAMC Policy memorandum 15 and AR 190-13/ 5.

1.27. Removal of LVNs and CNAs . At any time during the performance of this contract, the KO or COR (as authorized by the KO) may direct the contractor to immediately remove any LVN AND CNA whose actions or impaired state raises reasonable suspicion that clear and present danger of physical harm exists to a patient, other LVNs and CNAs , government personnel or to the impaired individual. This provision will be used in emergency situations only and not for the purpose of bringing performance issues or other non-urgent concerns to the attention of the contractor.

1.27.1. The contractor shall not use that individual to perform any health care services required under this contract until the issue has been resolved by the KO or COR (as authorized by the KO). The contractor shall formally meet with the COR to discuss further action in accordance with the MTF, Inspection (QA&I) Plan, AR 40-68, and AFI 44-119. A review of the basis for removal will be made by the KO within 3 working days after the Government directed removal of the LVN AND CNA .

1.27.2. Upon conclusion of the investigation if the KO concludes that the contract LVN AND CNA ’s impairment requires permanent removal from the contract, the contractor will be notified. During the period of time between the removal and the final decision of the KO, the contractor shall provide a backup/replacement contract LVN AND CNA in accordance with the terms and conditions of this contract.

1.27.3. When there is a reasonable cause to doubt the LVNs and CNAs competence to practice or for any cause affecting the safety of patients or others, the MTF Commander has the prerogative to hold in abeyance, to deny, or to summarily suspend clinical privileges in accordance with AR 40-68 and AFI 44-119, which outline…