Referral_Service_PWS_21_Dec_2016.pdf

PERFORMANCE WORK STATEMENT

MEDICAL REFERRAL SERVICES

United States Military Entrance Processing Command (USMEPCOM)

1 GENERAL:

This is a non-personal service contract to provide medical referral services to support 65 Military Entrance Processing Stations (MEPS) and one remote processing unit located in Las Vegas, Nevada, herein referred to collectively as MEPS. Refer to Exhibit A for MEPS locations throughout the continental United States (CONUS), Alaska, Hawaii, and Puerto Rico. Medical referral services will support medical examinations provided to applicants processing into the Active, Reserve and National Guard components of the Armed Forces for Departments of Army, Navy, Air Force, Marine Corps, and United States Coast Guard, and other government agencies such as the National Oceanic and Atmospheric Administration (NOAA).

1.1 Background: The United States Military Entrance Processing Command (USMEPCOM) is the joint military and civilian organization providing a gateway through which qualified applicants enter the U.S. Armed Forces. This mission requires that the physical, mental, and moral qualifications of every new applicant is determined prior to taking the oath to serve the United States. Historically, applicant processing exceeds USMEPCOM resource capacity and as such, contractors are used to sustain mission requirements, through medical referral services.

1.2 Scope of work: The contractor shall provide qualified personnel, services, materials, equipment, supplies, facilities, and supervision necessary to conduct medical referral services that include, but are not limited to medical/dental consultations and ancillary/laboratory services listed in Exhibit G and H. The contractor shall provide results from the medical referral services for use by the government providers who ultimately make determinations to medically qualify (or not) applicants for military service. The contractor shall provide medical providers who will interview and examine applicants and provide diagnoses and prognosis of the applicants’ medical conditions. The contractor shall provide laboratory and ancillary services to support the government providers in their medical determination decisions by handling, processing, testing and reporting results from lab tests, radiologic studies or medical procedures. The contractor shall provide medical services that are performed within a 30 mile radius of the MEPS address locations listed in Exhibit B. 98% of locations shall meet the standard. Performance of services shall be in accordance with this PWS and the established principles and ethics of the medical professions.

1.2.1 Hours of Performance. All hours are specific to the time zone in which the MEPS is located. MEPS duty hours typically cover between 0600 and 1800, Monday through Friday (Excluding Federal Holidays). Each MEPS may be open on Saturdays (see Exhibit F-FY17 Operating Schedule). The government will notify the contractor of any changes to the operating schedule.

1.3 Non-personal services. Services performed under this contract are non-personal

1.3.1 Non-Personal Services - Professional Liability Responsibility and Procedures. The personnel rendering the services under this contract are not subject; either by the contract’s terms or by the manner of its administration, to the supervision and control usually prevailing in relationships between the government and its employees. The government will not be liable for malpractice allegations against the contractor or its medical specialists based upon performance of this contract. Therefore, the contractor and/or the medical specialist shall be required to carry malpractice.

1.3.2 The contractor shall immediately notify the government (the KO and the Contracting Officer Representative (COR)) of any suit, action filed or claim made against the medical specialist (whether performing under a personal or non-personal services contract), which occurred as a result of work performed by the MEDICAL SPECIALIST under this contract. The contractor is responsible for ensuring that the MEDICAL SPECIALIST promptly furnishes copies of all pertinent documents to the above referenced individuals.

1.4 CONTRACTOR REPRESENTATIVE AND OTHER PERSONNEL.

1.4.1 Contractor Representative. The contractor shall designate a representative who will be the Government’s Point of Contact (GPOC) during the life of the contract. The contractor shall submit the representative’s designation, in writing, to the KO and the COR, not-later than ten

(10) business days after receiving notice of contract award. The written designation letter shall include the name, phone number, email address and scope of authority of the contractor’s representative.

1.4.2 Representative Status Change. The contractor shall notify the KO, in writing, of changes in the status (i.e. termination or replacement) of the designated Contractor representative at least five (5) business days prior to the change. The Contractor’s representative shall maintain professional decorum at all times and demonstrate responsiveness to the government as appropriate.

1.4.3 Representative Availability. The Contractor representative shall be available to discuss all aspects of performance during the life of the contract and have the authority to resolve issues and problems as they arise. Problems or issues regarding performance of the contract that cannot be resolved between the COR and the Contractor, will be referred to the KO.

1.4.4 Contractor’s Key Personnel. The contractor shall provide in writing, NLT (30) calendar days prior to commencement of services, the name, phone number, and email address of the contractor's key personnel. Any changes to key personnel will be forwarded to the COR within 5 business days of the change. Such notification shall be in writing and shall state the name, phone number, and email of the new contractor representative. The contractor's key personnel shall be available during MEPS duty hours to discuss with the COR any issues that may arise concerning contract matters relating to daily operations of the contract.

1.4.5 Signature Authority. The Contractor shall provide the name of the individual or individuals who are authorized to sign binding documents between the contractor and the government. If this individual or individuals change, the contractor shall notify the United States Government (USG) immediately and provide another authorized person no later than 5 days after the change.

1.5 SAFETY REQUIREMENTS: The contractor shall maintain safety and health standards compliant with requirements of the Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control and Prevention (CDC) and state and local requirements, if any.

1.6 SECURITY REQUIREMENTS: The contractor shall be responsible for the security of all applicant information and shall ensure compliance with all applicable security requirements of Health Insurance Portability and Accountability Act (HIPAA), Department of Defense (DOD) regulations/guidance (including but not limited to Military Health System Automated Information Security; Privacy Act and this PWS.)

1.6.1 Neither the contractor nor any of its employees shall disclose or cause to disseminate any information concerning operations of military activities. Such action(s) could result in violation of the contract and possible legal actions.

1.6.2 All inquiries, comments or complaints arising from any matter observed, experienced, or learned of as a result of or in connection with the contractor's/MPN's performance of this contract shall be directed to the COR and the Contracting Officer (KO) for resolution.

1.6.3 The contractor shall only conduct business with designated government personnel listed as MEPS GPOCs. Names of authorized personnel shall be provided to the contractor, in writing, within 10 days of contract award by the government. This list will be updated as necessary throughout the contract period.

1.6.4 Data Collection, Unauthorized Disclosure. Confidentiality of Information. All data collected, generated, or retrieved in the performance of the contract, and all reports incorporating such data in any way or form shall be the property of the United States Government. The contractor shall not publish, disclose, or release such data or reports in any manner. Moreover, the contractor understands that they may only release any collected or generated data or any reports produced incorporating such data with the express written consent of the KO. Unless otherwise specified, the government considers all financial, statistical, personnel and/or technical data, which is furnished, produced, or otherwise available to the contractor and their MPNs in the performance of this contract as confidential business information. The contractor shall not use this business information for purposes other than performance of work under this contract.

Furthermore, the contractor and their MPNs shall not release any such information without prior written consent by the KO. These files/results shall be surrendered to the COR upon request.

Any data that is considered proprietary shall be marked accordingly by the contractor. This data is for official use only and will be protected by HQ USMEPCOM.

1.7 IDENTIFICATION OF PRIVACY ACT. This contract requires a system of records in accordance with the Privacy Act of 1974. The said system of records is covered under Record Notice No. A0917.01DASG entitled "Health Care and Medical Treatment Record System" for a description of the safeguards to be taken with these records.

1.8 IDENTIFICATION OF PRIVACY ACT. This contract requires the development of a system of records in accordance with the Privacy Act of 1974.

1.9 PERFORMANCE QUALITY: The Contractor shall establish and maintain a complete Quality Control Plan (QCP) that shall ensure the requirements of the contract are provided as specified in Section 5 of the PWS. The Contractor shall have a planned and systematic quality control process covering every aspect of the Contractor's operation under the contract.

Contractor shall maintain its system to manage quality and contract performance throughout the life of the contract. The Contractor shall ensure that services provided meet performance and quality standards stated in the basic contract and subsequent task orders. Performance and quality standards prescribe acceptable levels of timeliness in accordance with the standards established in the contract. The contractor shall submit to the COR, one copy of a comprehensive written QCP within thirty calendar days after contract award and within 5 working days when changes are made thereafter. The plan shall include the following:

1.9.1 Independent Quality Management. The Contractor’s approach to quality management shall be independent of government performance or participation.

1.9.2 Managing Quality. The Contractor’s system shall include mechanisms and functions that manage the life cycle of quality control.

1.9.3 Monitoring. The Contractors system shall include a process for monitoring contract quality and performance.

1.9.4 Identifying. The Contractors system shall identify deficiencies and trends, before performance becomes unacceptable.

1.9.5 Improvement. The Contractor’s system shall include process improvement strategies.

The Contractors system shall ensure that all FBPs comply with the MEPS quality management and USMEPCOM Regulation 40-2.

1.9.6 Resolution, Corrective Action, and Follow-up. The Contractor’s system shall include a process for resolving issues and concerns, implementing corrective actions, in a responsive and timely manner (within 5 business days of receipt), unless suspense dates are issued by the government. The Contractor shall conduct follow-up to ensure corrective actions are successful.

1.9.7 Documentation. The Contractor shall independently document all performance related issues and have a system for maintaining documentation and reports generated regarding quality control issues. The documentation shall be provided to the COR upon request. The contractor shall maintain copies of quality control documents for the life of the contract.

1.9.8 Notification. The Contractor shall ensure that the COR is promptly notified of performance issues or problems within 3 business days.

1.10 DESIGNATED GOVERNMENT POINTS OF CONTACT. The contractor shall conduct business with MEPS medical personnel designated as GPOCs and Chief Medical Officer (CMO)/ Assistant Chief Medical Officer (ACMO). The COR or KO will provide the names of designated GPOCs and MEPS CMO/ACMO during contract phase-in and within 15 days when any change occurs.

1.11 MEDICAL LIABILITY/FRAUD.

1.11.1 The contractor shall be responsible for the performance and actions of its medical providers under this contract for any liabilities or damages incurred by the contractor, and contractor/subcontractor employees in the performance of this contract.

1.11.2 The contractor shall maintain operational procedures for identifying and developing reported cases of potential fraud or abuse. The contractor shall initially review the case to eliminate obvious billing processing errors.

1.11.3 The contractor shall notify the COR within a 24-business hours of any alleged disciplinary claim or complaint against a medical provider. The contractor shall cease scheduling appointments with the subject medical provider until such time as a proper investigation is completed the government. This does not relieve the contractor of the responsibility to provide services. If necessary, the contractor shall review its agreement with the medical provider for non-compliance and take appropriate action.

1.11.4 The contractor shall respond to inquiries/requests by the COR to review the professional qualifications documentation of any medical provider or ancillary/laboratory facility.

1.11.5 The contractor shall ensure medical providers are trained in the following, prior to starting work:

1.11.6 Department of Defense (DOD) 6025.18-R, "DOD Health Information Privacy Regulation," the HIPAA Privacy Rule, Health Affairs (HA) Policy 06-010, "Health Insurance Portability and Accountability Act Security Compliance" or implementing regulation, the HIPAA Security Rule, and on the policies and procedures identified in this section, as well as its own standing operating procedures.

1.11.7 Refresher training to medical providers whose functions are affected by a HIPAA Privacy Rule or HIPAA Security Rule material change affecting USMEPCOM or the contractor's standard operating procedures and shall occur within 30 days of assignment of the training. The contractor shall conduct subsequent refresher training annually to demonstrate the importance of the Privacy and Security Rules (i.e.: DOD 6025.18-R & HA Policy 06- 010 HIPAA) and to ensure their medical providers understand the rules, policies, and procedures.

1.11.8 Completion of required forms and billing documents. The contractor shall ensure medical providers receive orientation/procedural training with all MEPS policies and procedures at their respective location, e.g., transfer of medical results, consultation results documentation, and billing.

1.11.9 The contractor shall document medical provider training to include, as a minimum, who received the training and on what date. Information should be provided to the COR electronically in a Government approved electronic format (e.g: Excel spreadsheet) that can be easily imported into database fields within 72 hours of request.

1.12 EMERGENCY PROCEDURES. Providers covered by this contract shall not provide non-emergent medical care to applicants.

1.12.1 In the case of life threatening emergencies the medical specialist shall provide on-site emergency stabilization and/or treatment to the applicant until emergency medical services arrive, i.e., the applicant has a heart attack and stops breathing, lifesaving procedures shall be administered. If an emergency civilian hospitalization becomes necessary during a test or procedure referred by the MEPS, due to an acute care/emergency procedure, it will be reported to the referring MEPS GPOC and COR.

1.12.2 The contractor shall notify the Contracting Officer (KO) and the COR within one business day of performing an emergency procedure. The contractor or medical specialists shall bill the applicant directly for any services rendered during the referral process.

1.12.3 CONTRACT PHASE-IN PERIOD. To minimize any decrease in the productivity of the accession mission, the Contractor shall ensure sufficient medical referral services are on board by contract start to support all MEPS locations. During the 3 month phase in period, the Contractor shall become familiar with PWS requirements in order to commence full performance of services on the contract start date. The Contractor shall comply with its phase-in plan. The Contractor shall provide a monthly status report, due the 5th of each month, on efforts to achieve the required electronic customer support system capability until it is complete.

The contractor shall have the ability to electronically schedule appointments correctly on day one of contract start date.

1.12.4 When directed by the Government, the contractor shall participate in, planning, and coordination meetings, teleconferences, briefings and other program forums and events during the phase-in period.

1.12.5 Within 20 days after contract award, the contractor shall submit to the Contracting Officer (KO) and the COR their program implementation plan that includes but is not limited to contractor activities, tasks, deliverables, and milestones to implement the medical consultation contract. The plan shall include the contractor's list of required deliverables, consistent with this contract. The contractor shall list all deliverables by name or title, briefly describe the contents, and provide a table of contents.

1.12.6 Within 20 days after contract award, the contractor shall submit to the KO and the COR for review, the customer services support data elements to include but not limited to real-time services tracking from initial request through completion, including reminders to the MEPS on applicant appointments, no-shows, or cancellations. Changes will be provided to the Government within 5 days of the change(s).

2 DEFINITIONS AND ACRONYMS:

2.1 DEFINITIONS:

2.1.1 ANCILLARY SERVICES refers to the wide range of health care services provided to support the work of a primary physician. These services can be classified into (3) categories:

diagnostic, therapeutic and custodial. Diagnostic services include laboratory tests, radiology, genetic testing, diagnostic imaging and more. For the purposes of this requirement, therapeutic and custodial do not apply. For specialties, see Exhibit G.

2.1.2 BUSINESS DAY. Monday through Friday, excluding federally observed holidays.

2.1.3 CHIEF MEDICAL OFFICER (CMO). Government physician responsible for medical operations at each MEPS. Some MEPS also have Assistant CMOs (ACMOs) who are also Government physicians.

2.1.4 DENTAL CONSULTATIONS are defined as a limited clinical inspection that is performed to identify possible signs of oral or systemic disease, malformation, or injury.

2.1.5 FEE BASIS CHIEF MEDICAL OFFICER (FB-CMO). A FBP (contract employee) who is assigned for a specified work day as the temporary CMO when the CMO is absent and the MEPS does not have an ACMO available. A FB-CMO shall be a physician with profiling qualifications assigned and approved by USMEPCOM. FB-CMO will accomplish medical histories; physical examinations; reviews of required medical tests and documents pertaining to consultations and medical histories; assessing applicant medical documentation to determine an applicant's medical qualification (profiling) for serving in the Armed Forces.

2.1.6 FEE BASIS PROVIDER (FBP). Medical Doctor (MD), Doctor of Osteopathy (DO), Physician Assistant (PA), or Certified Nurse Practitioner (CNP), all of which are contract employees, who conduct enlistment physical medical examination screenings at a MEPS.

2.1.7 CONTRACTOR. The term as used in this contract refers to the prime.

2.1.8 CONTRACTING OFFICER (KO). A Government employee having the authority vested by a Contracting Officer’s Certificate of Appointment to execute, administer, and terminate contracts and orders, and modifications thereto, which obligate Government funds and commit the Government to contractual terms and conditions. Note: The only individual who can legally bind the government.

2.1.9 CONTRACTING OFFICER'S REPRESENTATIVE (COR). An employee of the U.S.

Government appointed by the contracting officer to administer the contract. Such appointment shall be in writing and shall state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the contract.

2.1.10 FEDERAL HOLIDAYS. The U.S. Government observes the below listed days as holidays:

New Year's Day Martin Luther King's Birthday President's Day Memorial Day Independence Day Labor Day Columbus Day Veteran's Day Thanksgiving Day Christmas Day

2.1.11 LABORATORY SERVICES are defined as biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis of disease or assessment of the health or impairment of applicants.

2.1.12 MEDICAL CONSULTATION is defined as an evaluation conducted by a medical specialist at the request of another physician or appropriate source to determine the diagnosis of presenting signs and symptoms or the significance of an existing medical condition. Medical evaluations are submitted to requesting physicians in writing and are used by MEPS Chief Medical Officers to determine qualification or disqualification of applicants in accordance with USMEPCOM and DoD accession medical standards.

2.1.13 MEDICAL SPECIALIST. For the purposes of this contract a medical specialist is defined as any person performing consultation, ancillary, or laboratory services.

2.1.14 MEPS POINT OF CONTACT (POC). An employee of the government, appointed by the COR at each military entrance processing station to function as a technical representative.

This individual has authority to provide technical direction to the contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the contract

2.1.15 MILITARY ENTRANCE PROCESSING STATION (MEPS). DoD activity responsible for administering aptitude tests, medical examinations, and administrative processing of Armed Forces applicants or other Federal Service applicants.

2.1.16 MILITARY DATES. Military dates are written by placing the four digits of the year, followed by the two digits of the month, followed by the two digits of the day, i.e.:

September 2, 2008 = 20080902 September 10, 2008 = 20080910

2.1.17 MILITARY TIME. Military time is on a 24-hour clock, i.e.:

08:00 am - 0800 09:10 am - 0910 Noon - 1200 08:00 pm - 2000 9:10 pm - 2110 Midnight - 2400 12:01 am - 0001

2.1.18 PHYSICAL SECURITY. Actions that prevent the loss or damage of government property.

2.1.19 QUALITY ASSURANCE. The government procedures to verify that services being performed by the contractor are performed according to acceptable standards.

2.1.20 QUALITY CONTROL. All necessary measures taken by the contractor to assure that the quality of an end product or service shall meet contract requirements.

2.1.21 SUBCONTRACTOR. One that enters into a subcontract and assumes some of the obligations of the primary contractor.

2.1.22 U.S. MILITARY ENTRANCE PROCESSING COMMAND (USMEPCOM). Major command responsible for administering the operations of Military Entrance Processing Stations

(MEPS).

2.2 ACRONYMS:

ACMO Assistant Chief Medical Officer AR Army Regulation CAC Common Access Card CAP College of American Pathology CFR Code of Federal Regulations CDC Center for Disease Control CDR Contract Discrepancy Report CLIA Clinical Laboratory Improvement Amendments CLIN Contract Line Item Number CMO Chief Medical Officer CNP Certified Nurse Practitioner CONUS Continental United States (excludes Alaska and Hawaii) COR Contracting Officer Representative CPT Codes Current Procedural Terminology Codes DA Department of the Army

DD 1966

DD Form 1966, Report of Military Processing – Armed Forces of the United States

DO Doctor of Osteopathy DoD Department of Defense DoDI Department of Defense Instruction FB-CMO Fee Basis-Chief Medical Officer GPOC Government Point of Contact

HIPAA

Health Insurance Portability and Accountability Act of

ICD10 International Classification of Diseases 10 IT Information Technology KO Contracting Officer MD Medical Doctor MEDCOM Medical Command MEPS Military Entrance Processing Station

MTF Medical Treatment Facility NCOIC Noncommissioned Officer In Charge NLT No Later Than NOAA National Oceanic and Atmospheric Administration OSHA Occupational Safety and Health Administration OTSG Office of the Surgeon General PA Physician Assistant POC Point of Contact PWS Performance Work Statement QA Quality Assurance QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Program SF 513 Standard Form 513 (Consultation Sheet) SOP Standing Operating Procedures SupMT Supervisory Medical Technician USG United States Government USMEPCOM United States Military Entrance Processing Command VA Veterans Administration

3 GOVERNMENT FURNISHED ITEMS AND SERVICES.

3.1 Materials.

3.1.1 Standard Form (SF) 513. The Government will provide a SF 513, Consultation Sheet (Exhibit E) for each applicant that requires a referral service from any of the MEPS. The Government will also provide a DD Form 1966 (Record of Military Processing – Armed Forces of the United States), Page 5, Section VIII - Parental/Guardian Consent for Enlistment (Exhibit D), which grants parental consent, for those applicants that are identified as minors (less than 18 years of age, and non-emancipated). Further processing is not authorized if this form is not provided.

3.1.2 Operational Schedule. The COR will provide the contractor an USMEPCOM operational schedule during contract phase-in and prior to each option year thereafter. See example in Exhibit F.

3.2 Government Services.

3.2.1 Transportation. The Government will provide transportation for the applicant(s) to and from the contracted facility.

3.3 MEDICAL REFERRALS.

3.3.1 The Government will notify the contractor of medical referrals on a daily basis.

3.3.2 Government Initiated Cancellations. If unforeseen events require the cancellation of any type of appointment by the MEPS, the MEPS POC will notify the medical provider or facility at least 24 hours prior to the scheduled appointment. Appointments cancelled by the MEPS at least 24 hours prior to the scheduled appointment time shall not be billed by the medical provider or facility for services not rendered. Appointments cancelled within 24 hours of a scheduled appointment time shall be billed against the “No Show” CLIN.

3.4 FUTURE INITIATIVES.

3.4.1 During the contract’s lifespan, applicant medical documentation may be provided in both paper and digital formats. Providers will be required to review and respond to requests in the specified format.

3.4.2 During the life of the contract, USMEPCOM expects to implement electronic identify verification technology. The government will establish an applicant's identity using biometrics which will then be used throughout entrance processing. The vendor will be provided a biometric scanner and website access in order to electronically verify an applicant's identity prior to any medical services being performed under the contract.

3.4.3 The Government will monitor the contractor's performance under the following methods:

3.4.4 The Government requires the contractor to perform all services as specified on the effective date of the task order and upon notification of required applicant appointments.

4 CONTRACTOR FURNISHED MATERIAL, EQUIPMENT, AND

QUALIFICATIONS. The Contractor shall furnish all supplies, equipment, facilities and services required to perform work under this contract that are not listed under section 3 of this statement

4.1 PERSONNEL QUALIFICATIONS. An outline of qualifications for the Contractor staff is given below:

4.2 MATERIALS. The Contractor shall:

4.2.1 Furnish materials, supplies, and equipment necessary to meet the requirements for the provision of services established under the terms of this contract.

4.3 EQUIPMENT. The Contractor shall:

4.3.1 Provide equipment and instrumentation necessary to provide a quality referral service.

4.4 CONTRACTOR RESPONSIBILITIES. The Contractor shall: Pay all fees and postage relating to information submitted to the Government including forms, reports, and shipping to network providers or facilities, etc.

4.5 Medical Provider Qualifications:

Physician medical providers shall be graduates from an accredited medical school either by the American Association of Colleges of Osteopathic Medicine or the Liaison Committee on Medical Education and be a qualified Medical Doctor (MD) or Doctor of Osteopathy (D.O.).

98% of physicians shall meet this standard. Providers shall be board certified or board eligible in their medical specialties. The contractor shall only use qualified and licensed Optometrists and/or Ophthalmologists to perform vision tests. Dentists shall be graduates from a dental school accredited by the American Dental Association's (ADA's) Commission on Dental Accreditation.

4.5.1 Medical providers shall possess and maintain a professional license, certification, or registration, as required by the profession and appropriate regulatory bodies through the term of the contract.

4.5.2 Specialty Consultation qualifications require the medical providers be certified by The American Board of Medical Specialties (ABMS) such as those specialties listed in EXHIBIT H or BY THEIR OWN SPECIALTY BOARD. The medical provider shall be competent to render expert medical opinion regarding the specific medical consultation requested by the MEPS. Associate, provisional, or student membership is not acceptable.

Membership or certification must be at the full clinical level. Medical providers that are not board certified must have completed an approved residency within the prior 3 years from the performance start of this contract and must be in the process of obtaining their Boards. Dental specialists do not require board certification.

4.5.3 Resident physicians undergoing specialty training and seeking employment outside their residency will not be used as consultants.

4.5.4 HQ USMEPCOM may exclude the following individuals or entities from participation as a medical provider:

4.5.4.1 Misdemeanor conviction related to health care fraud. Minimum period: 3 years.

4.5.4.2 Conviction related to fraud in non-health care programs. Minimum period: 3 years.

4.5.4.3 Misdemeanor conviction related to obstruction of an investigation. Minimum period: 3 years.

4.5.4.4 Misdemeanor conviction relating to a controlled substance. Minimum period: 3 years.

4.5.4.5 License revocation or suspension. Minimum period: No less than the period imposed by the state licensing authority.

4.5.4.6 Exclusion or suspension under a Federal or State health care program. Minimum period:

No less than the period imposed by Federal or state health care program.

5 DESCRIPTION OF WORK.

5.1 The Contractor shall provide a network of medical/dental providers and ancillary and laboratory services, collectively called referral services, capable of supporting accession services as required by the MEPS medical providers. The medical provider pool shall be maintained at an average of 97%. The Contractor shall ensure that all referral services provided are IAW established standards, principles, and ethics of the profession and applicable professional specialty organizations, The Joint Commission (TJC) standards, applicable DoD and agency specific regulations, directives, and policies. The Contractor shall provide technically competent Medical Specialists who shall give the highest regard to applicant dignity and observe the precepts of the American Hospital Association’s Bill of Rights for Applicants. The Contractor shall ensure quality referral services are provided; conduct thorough consultations and services;

complete credential review and privileges in a timely manner, conduct background investigations; and manage recruitment and retention of healthcare professionals.

5.1.1 The MEPS medical provider is responsible for considering the consultant’s medical opinion. The consultant does not make a final qualification or disqualification determination on the applicant’s acceptance/suitability for the military services, and the United States Coast Guard. Since this is a critical step in the process of qualifying applicants for military service, the consultant should be available for telephonic consultation with the MEPS medical provider, should the need arise.

5.2 MEDICAL REFERRAL SERVICES TYPES. The contractor shall provide Medical Referral Services via one of the four processes:

5.2.1 Consultation Only. The MEPS contacts the contractor with a referral. The contractor schedules the referral for a consultation. A final report is generated and sent, via the contractor’s secure web-based portal to the MEPS. 95% of the reports shall reach the MEPS GPOC within 3 business days.

5.2.2 Consultation followed by ancillary and/or laboratory services. The MEPS contacts the contractor with a referral. The contractor schedules the referral for a consultation, which includes any necessary ancillary and/or laboratory services, as authorized by the MEPS. A final report is generated and sent, via the contractor’s secure web-based portal, to the MEPS. 95% of the reports shall reach the MEPS GPOC within 3 business days.

5.2.3 Ancillary and/or laboratory service followed by consultation. The MEPS contacts the contractor with a referral. The contractor schedules the referral with ancillary and/or laboratory services and then a follow-on appointment with a consultation appoint. A final report with results is generated and sent via the contractor’s secure web-based portal, to the MEPS. 95% of the reports shall reach the MEPS GPOC within 3 business days.

5.2.4 Ancillary and/or laboratory service only. The MEPS contacts the contractor with a referral. The contractor schedules the referral with ancillary and/or laboratory services. A final report with results is generated and sent via the contractor’s secure web-based portal, to the MEPS. 95% of the reports shall reach the MEPS GPOC within 3 business days.

5.3 MEDICAL REFERRALS SERVICES. The contractor shall provide and maintain a medical network specific to medical/dental consultation and ancillary/laboratory services to support medical referral requests for MEPS locations (see in Exhibit G and H).

5.3.1 Medical and Dental Consultation Services. The contractor shall provide medical and dental specialties listed in Exhibit H. Additional specialties may be incorporated during the term of the contract by negotiation of a contract modification. All medical and dental consultation services shall be executed in accordance with standard healthcare industry practices.

5.4 Ancillary services. The contractor shall provide and maintain a medical network specific to ancillary services to include radiologic services with interpretation for each MEPS address location (see in Exhibit B). Upon completion of ancillary services, the contractor shall provide a diagnostic evaluation of tests as appropriate

5.4.1 Laboratory services. The contractor shall provide and maintain a medical network specific to laboratory services for each MEPS address location, as identified in Exhibit B. The contractor shall provide, at a minimum, the full range of clinical and anatomic pathology diagnostic testing capabilities to execute required tests annotated in Exhibit G- Major Medical Consultations and Quantities. All clinical reference laboratory testing shall be executed in accordance with standard industry practices. Upon completion of laboratory services, the contractor shall provide a diagnostic evaluation of tests as appropriate.

5.4.1.1 All Medical referral services shall be executed at the Contractor’s premises (professional office location), or within the Contractor’s network of laboratories [affiliate(s) or qualified subcontractor(s)]. 100% of all medical referral services shall meet this standard. The contractor shall notify the government 30 days prior to changing locations for all medical referral services.

5.4.1.2 Laboratory Regulatory Standards. The contractor shall ensure all laboratories in the medical provider network meet the federal regulatory standards outlined in the Clinical Laboratory Improvement Amendments (CLIA) of 1988 and maintain a CLIA- and College of American Pathologists (CAP)-accredited quality control program. Current CLIA requirements are located at https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/index.html.

Upon request to the COR or KO, the contractor shall provide documentation of quality control policies.

5.4.1.2.1 All laboratory test methods shall be FDA approved. Any non-FDA approved method being performed shall have a documented validation plan. Upon request, the validation plan and validation results shall be made available to the COR, KO or designee.

5.4.1.2.2 The contractor shall telephone, within the same workday as the appointment, all critical results to the MEPS POC after being identified by the contractor. The telephonic report shall be followed by posting the result to the vendor’s secure web-based portal and sending an email notification to the MEPS that the result has been posted.

5.4.2 Lost or Damaged Specimens. The contractor shall immediately report specimens lost due to breakage, spillage/leakage, misplacement, mishandling or any other contractor-related problem(s) to the submitting MEPS. If, in their professional opinion, the MEPS medical provider determines the quality or timeliness of the service requested or is questionable at least three times in a 30 day period, the issue will be raised to the KO and COR for resolution or potential removal of that facility from the contractor’s medical provider network.

5.5 REFERAL PROCESS. Flow chart (Exhibit I)

https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/index.html

5.6 SCHEDULING AND REFERRAL PROCESSING TIMES. MEPS will submit referrals for scheduling between 0800-1600 local standard time, Monday through Friday. Some locations may submit referrals during these hours on Saturdays. The contractor shall ensure that all referral requests are completed within the timeframes stated herein. Referral requests shall be completed within XX business days (X day for schedule +XX days to complete consultation and medical testing and/or laboratory services) from the date the government submits the request.

For all appointments, the contractor shall notify the requesting MEPS no less than 3 days prior to the date of the appointment. Exceptions to these timeframes are listed below:

5.6.1 Same Day Referral Request – Consult plus Ancillary Service only. The MEPS may submit for same day referral services, between 0900 and 1200. For those appointment requests submitted after 1200 local time the contractor shall coordinate with the MEPS to schedule an appointment for a later date. The government defines same day services as the following:

Specialty Service Requested ENT Ear Wash/Irrigation Optometry Refraction, Stereoscopic, Spherical Equivalent, Motility

Measurement, Keratometric-Reading, Contact Tonometry, Corneal Mapping

Cardiology EKG w/interpretation

5.6.2 Dental Appointment Requirements plus services. The contractor shall ensure that the entire dental referral process is completed within XX business days of the contractor receiving the dental appointment request.

5.6.3 Consultations plus Service Appointment Requirements. The MEPS may submit for XX-day referral services, between 0800 and 1600. The contractor shall ensure that the entire medical referral process is schedule within one business day and completed within XX business days of the contractor receiving the XX-day referral request. The government defines same day services as the following:

Specialty Service Orthopedics Consult w/X-ray Psychology With or Without Service Psychiatry With or Without Service Audiology Hearing Test Cardiology Echo w/interpretation Podiatry With or Without Service

5.6.4 Applicant Unavailable for Appointment. In the event that a same day service is requested, but the applicant is unavailable for a same day consultation appointment, the MEPS will notify the contractor when the order is submitted. The specified services shall then be available for consultation completion (within XX business days (1 day for schedule + XX days to complete consultation and medical testing and/or laboratory service.))

5.6.5 Cancellations. If unforeseen events require the cancellation of appointments by a medical provider, the provider shall notify the MEPS POC and the contractor's representative NLT two hours prior to the scheduled appointment. The medical provider shall provide the MEPS POC a course of action to reschedule the appointment by the next business day to meet the provisions of this PWS.

5.7 Authentication/Verification of Applicants. The contractor shall authenticate and verify the identity of the applicant prior to performing any referral services. The applicant shall provide two forms of identification: (1) state issued photo ID, and (2) proof of social security number (SSN). The list below shall be used to verify the SSN of the applicant:

o SSN Card (card issued by the Social Security Administration) (original or legible copy) o SS-5 – Application for a Social Security Card (original or legible copy of receipt) o DD Form 214 (SSN) (original or legible copy) o DD Form 215 (SSN) (original or legible copy) o NGB Form 22 (SSN) (original or legible copy) o Pay Stub/Statement (original or legible copy) o W-2 Tax Statement (original or legible copy) o SSA SSN Printout (original or legible copy) o SSN Card Stub (original or legible copy) o Document/letter on SSA letterhead with applicant’s name and SSN (original or legible copy) o Temporary Identification Number (TIN) (must be original) o Uniform Services Identification and Privilege Card (Photo ) (must be original, unexpired, and display full SSN) o Official School Transcript (SSN) (must be original or legible copy)

5.7.1 Applicants that are minors (less than 18 years of age, and non-emancipated) will also hand carry a copy of DD Form 1966 (RECORD OF MILITARY PROCESSING- ARMED FORCES OF THE UNITED STATES), Page 5, Section VIII- PARENTAL/GUARDIAN CONSENT FOR ENLISTMENT (EXHIBIT D), the consent form for performing medical procedures. This form is required for minors prior to services being completed. Further processing is not authorized if this form is not provided. This standard shall be held to 100%.

5.8 QUALITY AND TIMELINESS.

5.8.1 Quality products are defined as:

5.8.1.1 Consultations: Written report rendering medical diagnosis and prognosis based on face-to-face interview and comprehensive examination of the applicant on the area of concern as specified on Standard Form 513 that is submitted by the government.

5.8.1.2 Ancillary/laboratory services: Diagnostic results of ancillary or laboratory services provided.

5.8.1.3 Consultative reports and diagnostic results are submitted to the MEPS within the established timeframes of the contract.

5.8.1.4 The Contractor shall provide qualified referral services and will ensure a process for credentialing and re-credentialing specialists in a timely manner.

5.9 BILLING PROCESS.

5.9.1 Billing. Any referrals that exceed $2,000, the medical specialist shall immediately contact the MEPS POC and the COR for approval prior to performing the consultation.

5.9.2 The Contractor shall ensure that medical specialists do not treat medical conditions under this contract. Any treatment or preventative services rendered - for example immunizations, prescribing medications or castings - that were not authorized by MEPS staff will not be reimbursed to the Contractor or its subcontractors.

5.9.3 The contractor shall ensure that its medical specialists do not bill the government directly to the government from either the medical provider or the medical testing or laboratory services facility.

5.9.4 The contractor shall use auditable management and billing systems to support this contract. The contractor shall submit itemized invoices and validate all contract medical network provided services for accuracy. The contractor shall ensure that medical providers only charge fees for diagnostic services provided to applicants. In addition, the Government will not be liable for medical services performed outside the scope of the contract.

5.9.5 Invoice reports shall be error-free, and provided in a Government approved electronic format (e.g.: Excel spreadsheet, xml) that can be easily imported into database fields. 95% of reports provided to the COR and KO by the 5th working day of each month.

5.9.6 A monthly summary invoice shall contain:

Invoice Number Invoice Date Contract Line Item Number (CLIN) Type of Specialty Consultation Performed and Associated Ancillary/Laboratory Service Type of Standalone Ancillary/Laboratory Service Performed Quantity Unit Price Invoice Total Amount

5.9.7 The contactor shall validate medical/dental consultations and ancillary/laboratory invoices for accuracy.

5.9.8 The medical/dental consultation and ancillary/laboratory services monthly billing detail shall be sorted by Battalion (Exhibit A-Western and Eastern Sector Battalions and MEPS Stations), then by MEPS and contain:

Battalion Number Name of the MEPS

Invoice Number Order Number Invoice Date CLIN(s) Type of Specialty Consultation Performed (if applicable) Medical Testing and or Laboratory Service(s) Performed (if applicable) Quantity Unit Price Invoice Total Amount Date Service Requested From MEPS Date Service Appointment Scheduled Date Service Received ICD-10 Code CPT(s) Applicant Name (Last Name, First, Ml) Full Social Security Number (SSN) Gender Age Applicant Component/Service Provider Name Visited Provider National Provider Identifier (NPI#) Location of Consult No-Show/Cancel<24hrs Yes/No Service Facility Name Visited (standalone ancillary/laboratory service)

5.10 The contractor shall provide to the COR a monthly report summary titled "MEPS Consultations" outlining the following:

• MEPS, Sorted by Name

• Number of Applicants Evaluated

• Specific Consultation Name (Orthopedic, Cardiology, etc) and Total Cost

• Specific ancillary/laboratory services and Total Cost

5.10.1 The contractor shall provide to the COR a monthly report summary titled "MEPS Consultant and Ancillary/Laboratory Facility Roster" which will include the following information, sorted by Battalion. The report will indicate the current consultants that MEPS POCs will utilize in their immediate location.

• Battalion Number

• MEPS, Sorted by Name

• Name of Provider

• Address of Provider or Facility

• Phone number and Fax number of Provider

• Provider's or Facilities Specialty

• Provider's or Facilities Contract Start Date

• Licensure Date

• Board Certification Date

• Approximate Distance from MAPS

5.11 WEB BASED SOLUTION. The contractor shall provide its commercial based solution as a means to manage the medical referral process. The web-solution shall be HIPAA compliant and shall allow secure access for authorized government personnel. The contractor’s web-solution shall include the ability for USG personnel to schedule referrals, view referral status, access consult and ancillary/laboratory results, review applicant appointment scheduling, monthly reports, statistical data (what was ordered by MEPS, type of consult and ancillary or laboratory service), developed training plan, historical data.. The contractor shall have a process to send appointment notifications (initial, reminders, reschedule, and cancellations) to applicants via text, voicemail, and email. The contractor shall ensure that an email notification, by order number, is sent to the appropriate government personnel who submitted the referral with updated appointment information.

5.11.1 Backup plan. The contractor shall have a plan to ensure continued scheduling so the MEPS can continue to schedule appointments and receive referral reports during periods in which the contractor’s electronic system is unavailable. This plan should include as a minimum, the following:

Telephonic Facsimile Overnight delivery service

5.12 Billing. The contractor shall ensure that it performs periodic checks for billing codes errors. This shall be performed at a minimum with no less than 95% error rate.

6 DELIVERABLES.

Government Deliverables

Item Section Submission Rqts Medium

1. 1.6.3 Government POC Roster within 10 days of contract award Microsoft Word

2 3.1.1

The Government will provide a SF 513, Consultation Sheet (Exhibit E) for each applicant that requires a referral service from any of the MEPS.

3 3.1.2 Operational Schedule during Phase In Period and each otion Adobe year thereafter.

Contractor Deliverables

Item Section Submission Rqts Medium

1 1.4.1 10 business days after contract award contractor shall submit designation letter in writing.

Microsoft Word

2 1.4.4 10 calendar days prior to commencement of services provide key personnel roster

Microsoft Word

3 1.4.5 Provide Signature Authority Microsoft Word

4. 1.9. Quality Control Plan within 30 days after contract aware Microsoft Word

5 1.12.3 Contractor shall provide a monthly status report, due the 5th of…