PWS_Bridge_June_2019.docx

Performance Work Statement Registered Nursing Services San Antonio Military Healthcare System

1.0. INTRODUCTION.

1.1. The contractor shall provide the personal services of registered nurses (RNs) for the San Antonio Military Healthcare System (SAMHS) which is compriised of the San Antonio Miliatry Medical Center (SAMMC), formerly Brooke Army Medical Center (BAMC), Fort Sam Houston, Texas; with their outlying clinics throughout the San Antonio area. SAMMC provides a broad scope of services including a level one trauma center, the Burn Unit, Amputee Center, multiple Critical Care/Intensive Care Units, Step Down Units, Medical-Surgical Units, Pediatrics, Maternal Child, Surgical Services, extensive specialty/subspecialty services supported by Graduate Medical Education program, and ambulatory clinics.

1.2. 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, applicable Department of Defense (DoD), Army and Air Force specific regulations, directives, and policies, and military treatment facility (MTF) specific policies, procedures, and job descriptions. Contract health care providers 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. The contract health care providers 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 contract health care providers 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. The scope of services provided at SAMMC cover the same range of services as those that are provided in civilian hospitals of similar size and scope of services.

1. 4. Relationship of the Parties, Professional Liability Responsibility and Procedures.

1.4.1. This is a personal services contract (as defined by FAR Subpart 37.104) and is intended to create an employer-employee relationship between the Government and the individual health care providers 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 providers (HCPs) 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 HCPs engaged in comparable health care services. Any personal injury claims alleging negligence by the individual HCPs within the scope of the HCP’s performance of the personal services contract shall be processed by DoD in the same manner as claims alleging negligence by DoD military or civil service HCPs. 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 HCP may be associated. The authority for this contract is 10 United States Code 1089 and 10 United States Code 1091.

1.4.2 Professional Liability.

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

Responsibility and Procedures.

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

1.4.3.2. The contractor and contract HCP shall cooperate with the government, without further compensation, in the processing, review, settlement, or defense of the suit, action, or claim; and authorize government representatives to settle or defend the claim and to represent the HCP in, or take charge of, any litigation involved in such an action.

The contract HCP may, at the contract HCP’s own expense, participate in defense of such claim or litigation.

2.0 BACKGROUND.

2.1. 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.

2.2. Currently, the San Antonio MHS is supported by care military treatment facilities located at Fort Sam Houston (SAMMC), and Camp Bullis. The Camp Bullis clinic operates as a satellite clinic for SAMMC. In addition, the North Central Federal Clinic is a joint venture between the Veterans Affairs and the Department of Defense. SAMMC both have level one trauma centers and currently provide trauma support for 50% of San Antonio’s trauma care. SAMMC has the Institute of Research Burn Center and the Amputee Center to support America’s Wounded Warriors and provided the maternal child services and neonatal intensive care unit. SAMMC provide the full spectrum of services associated with level one trauma centers and robust Graduate Medical Education Programs. In addition, both sites provide training sites for multiple medical training programs for enlisted and officer medical specialties.

3.0. SCOPE OF WORK.

3.1. Administrative.

3.1.1. This is an indefinite delivery/ indefinite quantity contract; this Performance Work Statement applies to all positions encompassed within this contract.

3.1.2. Contractor point of contact. The contractor shall notify the contracting officer (KO) of a primary point of contact for contract implementation, coordination and administration not later than five (5) business days after receiving notice of contract award. The contractor shall notify the KO of changes in the primary point of contact at least five business days prior to the change. All notifications shall be in writing and shall state the name and contact information for the point of contact. In addition, task orders may require a program manager or local point of contact.

3.1.3. Contractor Program Manager. The contractor shall provide a full time program manager in the San Antonio area within 10 business days of contract award. The KO shall be notified in writing and the contractor shall state the name and contact information for the program manager. The Program Manager shall not be one of the contract health care providers providing services.

3.1.3.1. The Program Manager responsibilities include coordinating work schedule requests, filling the requests, resolving staffing problems or other issues requiring immediate attention, and the handling the day-to-day functioning of the contract. The Program Manager shall respond to telephone calls from the Contracting Officer’s Representative (COR)/Quality Assurance Evaluator (QAE) or nursing supervisors within thirty (30) minutes on a twenty four (24) hour a day, seven days a week basis.

3.1.3.2. The Program Manager shall meet with the COR/QAEs monthly during the contract period to discuss any concerns regarding the contract/task order execution.

3.1.4. The contracting officer’s representatives will be the KO’s authorized representatives in administering the contract at the MTF or department level. 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. Unresolved problems will be referred to the KO for resolution.

3.1.5. Full performance is critical and shall begin upon issuance of the task order. Credentialing shall be completed no later than forty-five (45) days after receiving the task order.

3.1.5.1. The profile application packets shall be sent to the COR/QAE 10 days prior to in processing and provide the following: completed centralized credentials quality assurance system (CCQAS) data entry form, 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, criminal background check, education history with primary source verification of college attended/degree, certifications (basic life support {BLS}, advanced cardiac life support {ACLS}, Pediatric Advanced Life Support {PALS}, Trauma Nursing Critical Care {TNCC}, professional certifications, etc. employment history, resume immunization status, health examination date skills assessment checklists, competency assessments, medication examinations, or any other skills verification necessary for specialty and location (specifics will be outlined in the task orders). Depending on the individual position, the profile packages may be reviewed by Department Chiefs, supervisors, flight commanders, etc as determined by the organizational structure of the department to which the contract support provider would be assigned. The COR/QAE will notify the contractor within five (5) business days if the proposed contract service provider has been approved or disapproved.

3.1.5.2. The contractor shall monitor licensure, certifications, health and immunization status and provide updated information on a monthly basis. The monthly report provided to the COR/QAEs shall be include expiration dates and renewals of mandatory requirements including licensure, certifications, life support courses, annual training requirements, and health requirements (TB tine, influenza).

3.1.6. The contractor and contract HCPs shall abide 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 patient safety initiatives.

3.1.7. Media and Other Inquiries. The contractor or contract service provider shall not respond to any media inquiries. Any inquiries from the media, third parties, or public agencies shall be immediately relayed to the COR/QAE, 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/QAE.

3.1.8. Emergency health care for contract HCPs. The MTF will provide emergency health care for injuries or life threatening medical emergencies occurring while on duty. The contractor shall reimburse the government for such services as billed by the MTF.

3.1.9. Reports. On a monthly basis, the contractor shall submit a written report to the KO identifying all current task orders and the distribution of performance between the prime and subcontractors. The contractor shall submit additional reports to the KO or COR/QAE as requested for use in monitoring contractor performance. Such reports include, but are not limited to, personnel recruitment/credential status, projected losses, HCP locations, etc.

Regularly recurring reports will be specified on the task order; however, the KO or COR/QAE may request additional information at any time.

3.1.10. The contractor shall not use non-compete provisions in its employment agreements that would prevent its HCPs from being employed by or accepting offers of employment from the new contractor of the follow-on contract. It would hinder the Government’s ability to accomplish the mission of providing medical care to its beneficiaries.

3.1.11. Sexual Assault and Sexual Harassment under the Sexual Assault Prevention and Response Program (SHARP). The contractor shall comply with OTSG/MEDCOM Policy Memo 13-062, Policy for Reporting Incidents of Sexual Assault and Sexual Harassment under the Sexual Assault Prevention and Response Program (SHARP), 12 Nov 2013. The SHARP reporting requirements apply only to knowledge obtained by contractor personnel while performing services under this contract.

3.1.11.1. 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. All incidents shall be reported whether they involve contractor personnel or Government personnel, or other individuals.

3.1.11.2. 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. All incidents shall be reported whether they involve contractor personnel or Government personnel, or other individuals.

3.2. Conflict of Interest

3.2.1. The contractor or contract HCPs shall not bill the patient for services rendered under this contract. The contractor or contract HCPs 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.

3.2.2. The contractor or contract HCPs 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 contract HCPs or from any third party at any place other than as designated under this contract.

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

3.2.3.1. Contract HCPs shall abide by federal and local MTF regulations and requirements concerning the nature of limited privileged communication between patients and the HCP 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/QAE, or the KO. All medical records and reports will remain the property of the government.

3.2.4. The contractor shall not employ active duty military or government civilian employees to perform services under this contract.

3.2.5. The contractor or contract HCPs 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.

3.2.6. Each contract service provider shall have proof of U.S. Citizenship (certified copy of birth certificate or naturalization papers required.)

3.3. Security

3.3.1. Army Trusted Associated Sponsorship System (TASS)

3.3.2. 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.

3.3.3. 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.

3.3.4. 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.

3.3.5. The contractor is responsible for absences of HCPs 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.

3.3.6. In-processing Requirements. The HCPs are prohibited from performing services under this contract absent compliance with the in-processing requirements set forth below.

3.3.7. The government will sponsor the contract HCPs for an Army Knowledge Online (AKO) account. All HCP 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 HCPs no longer require access.

3.3.8. The government TA will send a notice through the TASS to the AKO e-mail address provided IAW the above requirement. The HCP’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.

3.3.9. The HCP shall log into the TASS and complete the verification process by submitting the application back to the TA for approval.

3.3.10. 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 HCP’s e-mail address within 48 hours after submission. If the application is returned or rejected, the HCP shall contact the TA and comply with the TA’s guidance to attempt to correct and resolve the issue(s).

3.3.11. Upon approval of the application, the HCP 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 HCP will follow the instructions provided by the TA and contact the COR for instructions. If the HCP chooses Randolph or Lackland AFB, the supervisor or government task manager must send a visitor message prior to the HCPs arrival on-site. The HCP 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.

3.3.12. Revalidation Requirements. The TA is required to revalidate all HCPs, 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.

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

3.4. Orientation and Training.

3.4.1. MTF in-processing checklist. When commencing work under this contract, the contract HCPs shall obtain in-processing checklist(s) from the COR/QAE or designated office. All contract HCPs are required to complete the applicable items on the checklist and turn it in to the designated office. Upon completion of the duty assignment, the contract HCPs shall complete an out-processing checklist and return it to the designated office.

3.4.2. MTF and Unit Orientation. The expectation of a contract health care provider is that they are fully trained, therefore the contract HCPs will be provided with a Government paid orientation to familiarize the contract HCPs with the policies and procedures of the MTF, assigned department and specific unit.

3.4.2.1. Unit orientation will be scheduled and accomplished by the appropriate department and will be tailored to the needs of the unit and the individual HCPs. The first two shifts a new employee works will be orientation shifts.

Pool personnel will be scheduled for two consecutive days on the same unit. Operating Room RNs shall have a five

(5) day orientation. Orientation for the burn unit HCPs varies depending on their experience with burn patients.

The unit orientation is eight hours a day and normally provided during the day shift.

3.4.2.2. The unit orientation consists of but is not limited to familiarization with the work-center, uses of ESSENTRIS (automated documentation), Pyxis, military time, military hospital protocol, unit level quality assurance program, and location of emergency equipment. If the supervisors, department COR/QAE, or the agency deem additional orientation is necessary it will be at the government’s expense.

3.4.3. Annual training requirements. The contractor shall ensure that contract HCPs complete any mandatory annual Government or medically unique training requirements in accordance with MTF procedures. All contract HCPs shall meet continuing education (CME) requirements. The government will not reimburse for these costs. The COR/QAE may approve contractor HCPs to attend, in an unpaid status, MTF continuing education classes on a space available basis.

3.4.4. Government unique training. The government may elect to provide unique government training to contract HCPs who are performing services under this contract. If the government elects to provide such training, the government will provide such training at no additional expense to the contractor or to the contract HCP. When directed by the KO, contract HCPs shall attend all such training in a paid status as part of the normal services required and billed under the contract. Such training shall require a performance commitment by the contract HCP and the contractor shall reimburse the government (by means of a credit on the next invoice) if a contract HCP fails to satisfy the performance commitment after the contract HCP receives the unique government training. The amount of the reimbursement shall be the prorated cost of training, calculated based on the total cost of the training and the number of months by which the contract HCP fails to complete the performance commitment. The length of the performance commitment will be stated in the task order.

3.4.5. Computer Training. Contract HCPs who have any interaction with the MTF computer systems must receive training for the applicable system(s). The COR/QAE will coordinate the necessary computer training. The training will be on-site and during normal duty hours. This training will be at no cost to the contractor. These systems include but are not limited to:

3.4.5.1. Composite Healthcare Computer System (CHCS) is the military’s world-wide automated medical information system that interfaces with 40 plus external clinical and administrative systems.

3.4.5.2. Armed Forces Health Longitudinal Technology Application (AHLTA) contains the MTF’s appointment scheduling program, pharmacy, lab, and radiology ordering system and is interlinked with other departments in the MTF. In addition, it contains the electronic medical records for MHS beneficiaries.

3.4.5.3. Ambulatory Data System (ADS). This computer system produces forms on which the providers identify the appropriate billing codes for diagnoses and procedures for each patient. In addition, contract HCPs working in Labor and Delivery will be trained on the Labor and Delivery Statistics System (LADS).

3.4.6. The contractor shall ensure contract HCPs have received Occupational Safety and Health Administration (OSHA) required training for the position in which they will perform, and that training currency is maintained.

Documentation of such training shall be provided to the COR/QAE.

3.4.7. Anti-Terrorism (AT) Level I Training. This provision/contract text is for contractor employees with an area of performance within an Army controlled installation, facility or area. All contractor employees, to include subcontractor employees, requiring access to Army installations, facilities and controlled access areas shall complete AT Level I awareness training within XX calendar days after contract start date or effective date of incorporation of this requirement into the contract, whichever is applicable. The contractor shall submit certificates of completion for each affected contractor employee and subcontractor employee, to the COR or to the contracting Officer, if a COR is not assigned, within XX calendar days after completion of training by all employees and subcontractor personnel.

AT Level I awareness training is available at the following website: https://atlevel1.dtic.mil/at.

3.4.7.1. Access and General Protection/Security Policy and Procedures. This standard language text is for contractor employees with an area of performance within an Army controlled installation, facility or area.

Contractor and all associated sub-contractors employees shall comply with applicable installation, facility and area commander installation/facility access and local security policies and procedures (provided by government representative). The contractor shall also provide all information required for background checks to meet installation access requirements to be accomplished by installation Provost Marshal Office, Director of Emergency Services or Security Office. Contractor workforce must comply with all personal identity verification requirements as directed by DOD, HQDA and/or local policy. In addition to the changes otherwise authorized by the changes clause of this contract, should the Force Protection Condition (FPCON) at any individual facility or installation change, the Government may require changes in contractor security matters or processes.

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

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

3.4.7.4. SHARP Training. The contractor shall ensure all service providers receive Sexual Harassment/Assault Response and Prevention (SHARP) training not later than 60 calendar days after contractor personnel begin performance under this contract. Training can be obtained either online or in person. Contractor personnel can attend SHARP training provided by MEDCOM on an every other month basis by contacting (210) 221-8361 for class date/time and availability. If the employee has an AKO account, they can access online the Team Bound Self Study course through Army Learning Management System (ALMS) at http://www.atsc.army.mil/tadlp/delivery/alms.asp.

3.5. MTF Hours of Operation

3.5.1. 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. Hours of operation will be outlined in the task orders.

3.5.2. 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

3.5.3. Contract HCPs may be required to report to work as scheduled during emergencies, disasters or during adverse weather conditions. Contract services will still be required during these situations if stated on the task order.

3.5.4. 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.

3.6. Hours of Performance

3.6.1. Scheduling process will be created and managed by the Government COR. Schedule process may include open scheduling or self-scheduling and may include rotating shifts (days, evenings, nights, weekends). Government COR maintains the right to change schedules to meet government needs.

3.6.1.2. The contractor shall provide employees to support a seven (7) day/week, 24 hour/day operation to include holidays. Below is an example of common 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 hour period is twelve.

Day Shift 0645~l5l5 (See note below) Evening Shift 1445-2315 Night Shift 2245-07 15

7A -7P 0645-1915 7P -7A 1845-0715 11A-11P 1045-2315

NOTE: Any eight- (8) hour day shift may begin between the hours of 0600 to 1300.

The contractor will provide employees with written instructions on how to properly fill out time sheets. If an employee does not write “no lunch” on the time slip when the employee did not take the 30 minute lunch, 30 minutes of time is automatically deducted from the hours worked.

3.6.1.3. Full Time Personnel (FTE)(FTE=1920 hours): Employees will normally work 32-40 hours per week on rotating shifts Sunday through Saturday, including Federal holidays. Nurses may be required to work over 40 hours in a one week period resulting in overtime. Overtime must be approved by the Section Supervisor or Eve/Night Supervisor. Any employee may be “floated” to work within their scope of practice in another unit if patient census requires this measure.

3.6.1.4. Pool Personnel: Employees who will be requested to work in the absence of the full time employee, or during periods of increased patient census. Pool nurses will not be guaranteed a specific number of hours per pay period. Pool nurses must work a minimum of three (3) shifts per month to ensure competency and maintain employment.

3.6.2. Scheduling. The COR/QAE or their designee will be responsible for communicating with the program manager regarding scheduling issues. The shift supervisor may act as point of contact after normal duty hours, weekends, and holidays. In such cases, the COR/QAE will confirm all actions on the next normal working day.

3.6.3. Absences and leave.

3.6.3.1. The contractor shall notify the COR/QAE when a scheduled contract HCP cannot fill a shift due to illness or emergency. Employees who cancel a shift do so by contacting the contractor who then notifies the COR/QAE or Nursing Supervisor (after hours) 2 hours prior to the scheduled shift.

3.6.3.2. If required by the task order, the contractor shall have sufficient qualified personnel available so that all services are provided in the event an HCP scheduled to work becomes ill, resigns, is terminated, or is otherwise unavailable to work. 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 3.1.5.1. prior to performing services.

3.6.3.3. Full Time Nurses (FTE) - The contractor shall provide a replacement nurse for any nurse who is absent from duty, whether scheduled or unscheduled upon request of COR/QAE, Head Nurse or Nursing Supervisor.

3.6.3.4. Pool Nurses - If pool nurses, for whatever reason, become unavailable for their scheduled shift the contractor shall provide a substitution within 2 hours upon notification of absenteeism of such personnel.

3.6.3.5. When the contractor experiences delays in recruiting or submitting credentials or profile packages, the contractor shall notify the ordering KO immediately. The ordering 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 task order for default or seek other remedies as appropriate.

3.6.3.6. Scheduled absences of contract HCPs shall be coordinated with the COR/QAE at least 30 calendar days in advance.

3.7. PATIENT INCREASE. In addition to the monthly schedule from the COR/QAE, any additional requirements will be projected as far in advance as possible; however, for situations such as increases in patient acuity or census, the government reserves the right to request additional shifts.

3.8. PATIENT DECREASE. In the event that patient acuity or census decreases, the COR/QAE or the on-duty supervisor will provide the following alternatives; float the contracted nursing personnel to other appropriate patient care units to administer nursing care or cancel any scheduled shift or shifts for the pool nurses. If a contract nurse refuses to float to another area although the work required is within their scope of practice, disciplinary action or termination may result. The Deputy Commander for Nursing or the COR/QAE will notify the contractor’s point of contact at least two (2) hours prior to the start of the shift to cancel any pool nurse. If the two (2) hour cancellation option is not implemented by the government, and the pool nurse is referred to work, the government will pay for the first two hours of the shift. Should a pool nurse be cancelled prior to completion of any shift, the government will pay for actual time worked.

3.9. License Verification and Credentials Review or Privileging (If Applicable).

3.9.1. The contractor shall follow Army Regulation (AR) 40-68, Clinical Quality Management and Air Force Instruction (AFI) 44-119 Clinical Performance Improvement for all health care services provided in the MTFs.

Army Regulation 40-68 is located at http://www.usapa.army.mil/pdffiles/r40_68.pdf. Air Force Instruction is located at http://www.e-publishing.af.mil/. Complete credentials or profile packages shall be submitted within the time frames stated in the task orders.

3.9.1.1. 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, etc. 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 HCPs used to provide health care services under this contract.

3.9.1.2. Licensure, certification, registration, or authorizing documents. All contract HCPs under a personal services task order 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. In addition, contract HCPs who write prescriptions for controlled substances must have a current Drug Enforcement Agency (DEA) certificate or Controlled Drug Substance number as appropriate.

The contractor shall ensure that renewal actions are accomplished well before expiration of the provider’s license and/or DEA certification to ensure compliance with the contract. DEA certificates are not necessary at overseas location. The licenses and certificates shall be renewed and maintained in a current status during the life of the task order. All licensure and renewals shall be submitted to the appropriate MTF office as appropriate, failure to do so is grounds for dismissal.

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

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

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

3.9.3.2. 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.

3.9.3.3. 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.

3.9.3.4. 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.

3.9.5. Removal of Contract HCPs. At any time during the performance of this contract, the KO or COR/QAE may direct the contractor to immediately remove any contract HCP whose actions or impaired state raises reasonable suspicion that clear and present danger of physical harm exists to a patient, other contract HCPs, 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.

3.9.5.1. If the need for a removal occurs, the COR/QAE will contact the program manager or the contractor's point of contact and direct the contractor to remove that individual from the military facility and to not use that individual to perform any health care services required under this contract until the issue has been resolved by the KO. The contractor shall formally meet with the COR/QAE to discuss further action in accordance with the MTF and Inspection (QA&I) Plan and AR 40-68. A review of the basis for removal will be made by the KO within 3 working days after the COR/QAE directed the removal.

3.9.5.2. If, after any investigation deemed necessary by the KO and discussions with the contractor's representative, the KO concludes that the contract HCP’s impairment requires permanent removal from performance under the contract, the KO will notify the contractor that permanent removal is required. In the event of disagreements between the government and the contractor's representative concerning matters of impaired contract HCPs, the decision of the KO will be final. During the period of time between the removal and the final decision of the Contracting Officer, the contractor shall agree to provide a backup/replacement contract HCP in accordance with the terms and conditions of this contract.

3.9.6. The MTF Commander has the prerogative to hold in abeyance, to deny, or to summarily suspend clinical privileges/practice when there is a reasonable cause to doubt the health care provider’s competence to practice or for any cause affecting the safety of patients or others. AR 40-68 outlines the adverse clinical privileging and practice actions for privileged personnel and adverse practice actions and peer review for nonprivileged personnel.

3.10. Health. All HCPs performing services under this contract shall comply with the health and immunization requirements as stated in the Supplement to the Performance Work Statement.. Documentation shall be submitted with credentialing or profile packages. Backup/replacement contract HCPs shall be required to provide equally current certification of health at the time of initial request for clinical privileges and annually thereafter. The expense for all physical examinations to comply with the health requirements shall be borne by the contractor at no additional cost to the government.

3.11. Contract HCPs determined by the MTF to be involved in the provision of child care services to children under the age of 18 such as health care on a frequent and regular basis shall comply with the requirements of the Crime Control Act of 1990 and Department of Defense Instruction (DODI) Number 1402.5, January 19, 1993, Criminal History Background Checks on Individuals in Child Care Services as specified in the Supplement to the Performance Work Statement, Criminal History Background Check Requirements. Contractor shall ensure that proposed HCPs cooperate with and assist the Government in conducting any necessary background checks. Performance under this contract will not be allowed without full compliance with Crime Control requirements.

3.12. Contractor Manpower Reporting. The contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract for the CHCC via a secure data collection site. The contractor is required to completely fill in all required data fields using the following web address: http://www.ecmra.mil/. Reporting inputs will be for the labor executed during the period of performance during each USG fiscal year (FY), which runs October 1 through September 30. While inputs may be reported any time during the FY, all data shall be reported no later than October 31 of each calendar year, beginning with 2017. Contractors may direct questions to the help desk at http://www.ecmra.mil/.

3.13 Quality Control

3.13.1 The contractor shall have a planned and systematic quality control plan for monitoring, analyzing and improving their contract performance. In addition, the contractor shall have processes that address: initial verification of employee licensure, certifications, education and life support training ensuring employees maintain licensure, certifications, education and life support training; skills verification/competency assessment; and the performance evaluation process to include management of individuals with performance or compliance issues.

3.13.2. The contractor shall ensure that all contract HCPs comply with the MTF quality management/process improvement activities.

3.13.3. The contractor shall provide a copy of their proposed quality control plan (QCP) with the technical proposal, which when approved, will become part of the contract by incorporation.

4.0. QUALITY ASSURANCE SURVEILLANCE PLAN: The Quality Assurance Surveillance Plan (QASP) in identifies the metrics to measure success of the overall contract. Performance Measures (Outcomes, Standards, and How Measured) and QASP will be included on each task order.

4.1. The overall performance objective for this contract is the provision of technically proficient registered nurses (RNs), licensed vocational nurses (LVNs) and certified nursing assistants (CNAs) which will contribute to a stable workforce tasked with providing quality health care services to a diverse beneficiary population at the MTFs.

4.1.2. In order to achieve the overall objective of the contract, the contract health care providers shall:

practice within the guidelines established in paragraph 1.1.2. document nursing care within the guidelines established appropriately notify the physician when the patient’s condition warrants maintain patient privacy and confidentiality adhere to work duties and schedules have less than two substantiated patient complaints per year comply with mandatory and annual training requirements maintain licensure, certification and life support training.

4.2. Inspection. The inspection and acceptance point for all services rendered under this contract will be the COR for each task order. The performance by the contract HCPs, the quality of services rendered, and any documentation or written material in support of same, will be subject to continuous inspection, surveillance and review for acceptance by the KO or COR. Quality Assurance procedures established by the MTF shall be used for continuous monitoring. Other performance evaluation factors that will be monitored include: contractor providing personnel not meeting the minimum qualification standards; patient customer service comments; substantiated customer complaints; contractor relationship with hospital staff/government contracting personnel; compliance with hospital health care policy and procedures; fill rates especially for the critical care areas; and employee turnover rates.

4.2.1. The standards for the fill rates are shown in QASP.

4.2.1.1. By the 5th day of each month, the contractor shall report the fill rates by specialty and area using the form at

QASP.

4.2.1.2. Overall employee turnover rates will be monitored; satisfactory turnover rates are less than 20% per year.

4.2.1.3 The contractor shall have less than 5% of potential contract HCPs rejected by the COR because they do not meet minimum standards.

4.2.1.4. The COR will review all patient complaints and maintain a log. All patient complaints regarding services are taken very seriously and will be investigated. Upon receipt of two substantiated complaints within a year, or one major complaints to include gross negligence, incorrect practices, and other contractual failures, the COR has the right to request that the contract HCP not be employed at the facility.

4.2.1.5. The contractor shall submit a monthly report that identifies compliance with the annual and mandatory requirements; compliance shall be 100%. If a contract employee is not in compliance with all these requirements, they cannot work until they have complied with:

Health, ocular and immunization (PPD) requirements Fit testing requirements if needed Licensure renewals Certification renewals Life support training renewals Annual competency requirements and annual training requirements

4.3. Additional reports include monthly submission of work hours per task order by work center to the department COR with each invoice cycle.

4.4. Contract Employee Performance Monitoring. The Nurse Managers/Department Chiefs/Clinic supervisory personnel will monitor the contract HCPs clinical competence through observation, government information systems and records, customer service information and competency assessment checklists. The contractor shall evaluate their own employees. At no time will a government representative perform evaluations, merit evaluations, or officially rate the contract HCP’s performance.

5.0 POSITION DESCRIPTIONS. Specific qualifications and tasks for each specialty and unit are located in the exhibits (A-X).

5.1. Requirements for all positions.

5.2. The contractor shall ensure that all contract HCPs providing services under this contract shall be able to read, write, and speak English well enough to effectively communicate with all parties and other health care providers. In addition, since documentation of patient is computerized, the contract HCP shall be computer literate.

5.3. The contract HCPs shall possess sufficient initiative, interpersonal relationship skills and social sensitivity such that he/she can relate constructively to a…