W911YP-16-R-0003_(2_Mar_16).pdf

SEE ADDENDUM

(No Collect Calls)

W911YP-16-R-0003 18-Feb-2016

b. TELEPHONE NUMBER

801-432-4094

8. OFFER DUE DATE/LOCAL TIME

02:00 PM 21 Mar 2016

5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA – FAR (48 CFR) 53.212

(TYPE OR PRINT)

(SIGNATURE OF CONTRACTING OFFICER)

ADDENDA ARE

26. TOTAL AWARD AMOUNT (For Gov t. Use Only )

23.

CODE 10. THIS ACQUISITION IS

SUCH ADDRESS IN OFFER

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT

BELOW IS CHECKED

TELEPHONE NO.

W911YP9. ISSUED BY

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a. UNLESS BLOCK

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

1LT OTHA B. HENDERSON

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NUMBER

(TYPE OR PRINT)

30b. NAME AND TITLE OF SIGNER 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a.UNITED STATES OF AMERICA

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1. 52.212-4. FAR 52.212-3. 52.212-5 ARE ATTACHED.

25. ACCOUNTING AND APPROPRIATION DATA

1. REQUISITION NUMBER

20.

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, AND 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

0010787199

ARE NOT ATTACHED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

. YOUR OFFER ON SOLICITATION

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

% FOR:SET ASIDE:UNRESTRICTED OR X

SMALL BUSINESS

17a.CONTRACTOR/ CODE FACILITY

OFFEROR CODE

USPFO FOR UTAH - W911YP

12953 S MINUTEMAN DRIVE

DRAPER UT 84020

18a. PAYMENT WILL BE MADE BY CODE

RATED ORDER UNDER

DPAS (15 CFR 700)

13a. THIS CONTRACT IS A

13b. RATING

CODE15. DELIVER TO CODE W911YP 16. ADMINISTERED BY

12. DISCOUNT TERMS11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

14. METHOD OF SOLICITATION

RFQ IFB RFPX

USPFO FOR UTAH/OTHA HENDERSON

1LT OTHA B. HENDERSON

12953 S MINUTEMAN DRIVE

DRAPER UT 84088

TEL: 801-432-4094 FAX: 801-432-4843

(801) 432-4843FAX:

TEL: (801) 432-4093

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

X 8(A)

HUBZONE SMALL

BUSINESS

SIZE STANDARD:

$15,000,000

NAICS:

541611

OFFER DATED

29. AWARD OF CONTRACT: REF.

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

EMAIL:

TEL:

31c. DATE SIGNED

SEE SCHEDULE

SCHEDULE OF SUPPLIES/ SERVICESITEM NO. QUANTITY UNIT UNIT PRICE AMOUNT

24.22.21.19.

WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

(CONTINUED)

PAGE 2 OF125

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: ______________________________________________________

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f . TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

37. CHECK NUMBER

FINALPARTIALCOMPLETE

36. PAYMENT35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER

FINAL

33. SHIP NUMBER

PARTIAL

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

42a. RECEIVED BY (Print)

42b. RECEIVED AT (Location)

42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS

STANDARD FORM 1449 (REV. 2/2012) BACK

Prescribed by GSA – FAR (48 CFR) 53.212

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

SEE SCHEDULE

20.

SCHEDULE OF SUPPLIES/ SERVICES

21.

QUANTITY UNIT

22. 23.

UNIT PRICE

24.

AMOUNT

19.

ITEM NO.

W911YP-16-R-0003

Section SF 1449 - CONTINUATION SHEET

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 1,280 Each Senior Mgr. Medical Operations

FFP

1 FTE. 1280 Hours. See Appendix A of attached PWS.

Year 1.

FOB: Destination

PURCHASE REQUEST NUMBER: 0010787199

NET AMT

0002 1,280 Each QA/QC and Data Analysis

1 FTE. 1280 Hours. See Appendix B of the attached PWS.

0003 1,280 Each RN Non-Clinical Senior Case Manager

1 FTE. 1280 Hours. See Appendix C of the attached PWS.

0004 6,400 Each Non-Clinical Case Managers

5 FTEs. 6400 Hours. See Appendix D of the attached PWS.

0005 6,400 Each Admin Assistant to Case Manager

5 FTEs. 6400 Hours. See Appendix E of the attached PWS.

0006 1,280 Each Senior Medical Records Custodian

1 FTE. 1280 Hours. See Appendix F of the attached PWS.

0007 5,120 Each Medical Records Custodians

4 FTEs. 5120 Hours. See Appendix G of the attached PWS.

0008 1,280 Each Health Benefits Advisor

1 FTE. 1280 Hours. See Appendix H of the attached PWS.

0009 1 Each Intentionally Left Blank. Do not price.

FFP

Do not price this CLIN.

0010 1 Each Travel Allowance (NTE $10,000)

FFP

Only approved and allowable travel expense shall be reimbursed. All travel shall be in accordance with the Joint Travel Regulation and total travel expense for all travel under this contract shall not exceed the funded amount for this CLIN. No payment will be made under this CLIN if no travel has occurred. Travel is an estimated allowance and shall not exceed $10,000.

0011 1 Each Contractor Manpower Reporting

FFP

Section 2330a of title 10, United States Code (10 USC 2330a), requires the

Secretary of Defense to submit to Congress an annual inventory of contracts for services performed during the prior fiscal year for or on behalf of the Department of Defense (DoD). The inventory must include the number of contractor employees using direct labor hours and associated cost data collected from contractors. The contractor shall be required to provide the necessary manpower information relating to this contract on at least an annual basis.

1001 1,920 Each OPTION Senior Mgr. Medical Operations

1 FTE. 1920 Hours. See Appendix A of attached PWS.

Option years are subject to the availability of funds. Actual hours and FTE may be adjusted due to unforeseen budget changes and restriction. These adjustments may include the elimination of this CLIN from the contract.

CLIN 0001 option year 1 (contract year 2).

1002 1,920 Each OPTION QA/QC and Data Analysis

1 FTE. 1920 Hours. See Appendix B of the attached PWS.

adjusted due to unforeseen budget changes and restrictions. These adjustment may

CLIN 0002 option year 1 (contract year 2).

1003 1,920 Each OPTION RN Non-Clinical Senior Case Manager

1 FTE. 1920 Hours. See Appendix C of the attached PWS.

adjusted due to unforeseen budget changes and restrictions. These adjustments may

CLIN 0003 option year 1 (contract year 2).

1004 9,600 Each OPTION Non-Clinical Case Managers

5 FTEs. 9600 Hours. See Appendix D of the attached PWS.

CLIN 0004 option year 1 (contract year 2).

1005 9,600 Each OPTION Admin Assistant to Case Manager

5 FTEs. 9600 Hours. See Appendix E of the attached PWS.

include the elimination of this CLIN from the contract

CLIN 0005 option year 1 (contract year 2).

1006 1,920 Each OPTION Senior Medical Records Custodian

1 FTE. 1920 Hours. See Appendix F of the attached PWS.

CLIN 0006 option year 1 (contract year 2).

1007 7,680 Each OPTION Medical Records Custodians

4 FTEs. 7680 Hours. See Appendix G of the attached PWS.

CLIN 0007 option year 1 (contract year 2).

1008 1,920 Each OPTION Health Benefits Advisor

1 FTE. 1920 Hours. See Appendix H of the attached PWS.

adjusted due to unforeseen budget changes and restrictions. The adjustments may

CLIN 0008 option year 1 (contract year 2).

1009 1 Each OPTION Intentionally Left Blank. Do not price.

FFP

Do not price this CLIN.

1010 1 Each OPTION Travel Allowance (NTE $10,000)

FFP

Only approved and allowable travel expense shall be reimbursed. All travel shall be in accordance with the Joint Travel Regulation and total travel expense for all travel under this contract shall not exceed the funded amount for this CLIN. No

CLIN 0010 option year 1 (contract year 2).

1011 1 Each OPTION Contractor Manpower Reporting

FFP

Section 2330a of title 10, United States Code (10 USC 2330a), requires the

Secretary of Defense to submit to Congress an annual inventory of contracts for services performed during the prior fiscal year for or on behalf of the Department of Defense (DoD). The inventory must include the number of contractor employees using direct labor hours and associated cost data collected from contractors. The contractor shall be required to provide the necessary manpower information

2001 1,920 Each OPTION Senior Mgr. Medical Operations

CLIN 0001 option year 2 (contract year 3).

2002 1,920 Each OPTION QA/QC and Data Analysis

CLIN 0002 option year 2 (contract year 3).

2003 1,920 Each OPTION RN Non-Clinical Senior Case Manager

CLIN 0003 option year 2 (contract year 3).

2004 9,600 Each OPTION Non-Clinical Case Managers

CLIN 0004 option year 2 (contract year 3).

2005 9,600 Each OPTION Admin Assistant to Case Manager

CLIN 0005 option year 2 (contract year 3).

2006 1,920 Each OPTION Senior Medical Records Custodian

CLIN 0006 option year 2 (contract year 3).

2007 7,680 Each OPTION Medical Records Custodians

CLIN 0007 option year 2 (contract year 3).

2008 1,920 Each OPTION Health Benefits Advisor

CLIN 0008 option year 2 (contract year 3).

2009 1 Each OPTION Intentionally Left Blank. Do not price.

FFP

2010 1 Each OPTION Travel Allowance (NTE $10,000)

FFP

Only approved and allowable travel expense shall be reimbursed. All travel shall be in accordance with the Joint Travel Regulation and total travel expense for all travel under this contract shall not exceed the funded amount for this CLIN. No

CLIN 0010 option year 2 (contract year 3).

2011 1 Each OPTION Contractor Manpower Reporting

FFP

Section 2330a of title 10, United States Code (10 USC 2330a), requires the

Secretary of Defense to submit to Congress an annual inventory of contracts for services performed during the prior fiscal year for or on behalf of the Department of Defense (DoD). The inventory must include the number of contractor employees using direct labor hours and associated cost data collected from contractors. The contractor shall be required to provide the necessary manpower information

3001 1,920 Each OPTION Senior Mgr. Medical Operations

CLIN 0001 option year 3 (contract year 4).

3002 1,920 Each OPTION QA/QC and Data Analysis

CLIN 0002 option year 3 (contract year 4).

3003 1,920 Each OPTION RN Non-Clinical Senior Case Manager

CLIN 0003 option year 3 (contract year 4).

3004 9,600 Each OPTION Non-Clinical Case Managers

CLIN 0004 option year 3 (contract year 4).

3005 9,600 Each OPTION Admin Assistant to Case Manager

CLIN 0005 option year 3 (contract year 4).

3006 1,920 Each OPTION Senior Medical Records Custodian

CLIN 0006 option year 3 (contract year 4).

3007 7,680 Each OPTION Medical Records Custodians

CLIN 0007 option year 3 (contract year 4).

3008 1,920 Each OPTION Health Benefits Advisor

CLIN 0008 option year 3 (contract year 4).

3009 1 Each OPTION Intentionally Left Blank. Do not price.

FFP

3010 1 Each OPTION Travel Allowance (NTE $10,000)

FFP

Only approved and allowable travel expense shall be reimbursed. All travel shall be in accordance with the Joint Travel Regulation and total travel expense for all travel under this contract shall not exceed the funded amount for this CLIN. No

CLIN 0010 option year 3 (contract year 4).

3011 1 Each OPTION Contractor Manpower Reporting

FFP

Section 2330a of title 10, United States Code (10 USC 2330a), requires the

Secretary of Defense to submit to Congress an annual inventory of contracts for services performed during the prior fiscal year for or on behalf of the Department of Defense (DoD). The inventory must include the number of contractor employees using direct labor hours and associated cost data collected from contractors. The contractor shall be required to provide the necessary manpower information

4001 1,920 Each OPTION Senior Mgr. Medical Operations

CLIN 0001 option year 4 (contract year 5).

4002 1,920 Each OPTION QA/QC and Data Analysis

CLIN 0002 option year 4 (contract year 5).

4003 1,920 Each OPTION RN Non-Clinical Senior Case Manager

CLIN 0003 option year 4 (contract year 5).

4004 9,600 Each OPTION Non-Clinical Case Managers

CLIN 0004 option year 4 (contract year 5).

4005 9,600 Each OPTION Admin Assistant to Case Manager

CLIN 0005 option year 4 (contract year 5).

4006 1,920 Each OPTION Senior Medical Records Custodian

CLIN 0006 option year 4 (contract year 5).

4007 7,680 Each OPTION Medical Records Custodians

CLIN 0007 option year 4 (contract year 5).

4008 1,920 Each OPTION Health Benefits Advisor

CLIN 0008 option year 4 (contract year 5).

4009 1 Each OPTION Intentionally Left Blank. Do not price.

FFP

4010 1 Each OPTION Travel Allowance (NTE $10,000)

FFP

Only approved and allowable travel expense shall be reimbursed. All travel shall be in accordance with the Joint Travel Regulation and total travel expense for all travel under this contract shall not exceed the funded amount for this CLIN. No

CLIN 0010 option year 4 (contract year 5).

4011 1 Each OPTION Contractor Manpower Reporting

FFP

Section 2330a of title 10, United States Code (10 USC 2330a), requires the

Secretary of Defense to submit to Congress an annual inventory of contracts for services performed during the prior fiscal year for or on behalf of the Department of Defense (DoD). The inventory must include the number of contractor employees using direct labor hours and associated cost data collected from contractors. The contractor shall be required to provide the necessary manpower information

PERFORMANCE WORK STATEMENT

PERFORMANCE WORK STATEMENT (PWS)

FOR

OFFICE OF THE STATE SURGEON CONTRACTED SERVICES

1. General:

1.1. Scope:

The purpose of this requirement is to provide medical and dental non-clinical administrative staffing in support of Individual Medical Readiness (IMR). This requirement is designed to be flexible, responsive, and meets the ever-evolving needs of the government. DoDI 6025.19 establishes aggressive quarterly and annual metric goals for the separate IMR elements and for the overall IMR category of Fully Medically Ready (FMR) soldiers. The ultimate goals are to produce real-time reports based on complete, accurate data. The minimum goal for overall medical readiness is more than 85% of Service members FMR, with the ideal goal being 100%. The UT Army National Guard (ARNG) Surgeon’s Office requires a highly responsive process whereby the government can quickly obtain needed support and services. This PWS reflects existing National Guard Bureau policies and regulations.

1.1.1. UTARNG State Surgeon’s Office requires contractor administrative support services to support statewide medical readiness.

1.1.2. The Contractor shall furnish all labor and services required to provide a wide range of Medical and Dental Non-clinical Administrative support services.

1.1.3. Period of Performance (PoP): The basic period of performance shall be 01 May 2016 - 31 December 2016. With option years covering 1 January 2017 – 31 December 2020.

1.2. Quality Control (QC): The Contractor shall provide a preliminary quality control plan (QCP) with their proposal. The QCP shall include a detailed discussion of the steps proposed to ensure quality, proactive communication and adherence to budget and schedule. The QCP shall include a description of corrective action steps to take should the contractor performance be substandard. An organizational depiction of the project team and chain(s)-of-command shall also be included in the QCP. The QCP shall be submitted as part of the proposal.

1.2.1. Quality Assurance (QA): The government shall develop and utilize a quality assurance plan. This plan shall be primarily focused on what the government must do to ensure the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and acceptable quality level(s) (defect rate(s)).

1.2.2. Recognized Holidays: The following are recognized US holidays. The contractor is available 365 calendar days a year and is available to perform services on these days:

1.2.2.1. New Year’s Day: January 1st

1.2.2.2. Martin Luther King, Jr. Day

1.2.2.3. President’s Day

1.2.2.4. Memorial Day

1.2.2.5. Independence Day: July 4th

1.2.2.6. Labor Day

1.2.2.7. Columbus Day

1.2.2.8. Veteran’s Day: November 11th

1.2.2.9. Thanksgiving Day

1.2.2.10. Christmas Day: December 25th

1.2.3. Place and Performance of Services: Location of work may be at three locations;

Joint Forces Headquarters Building 12953 S. Minuteman Dr. Draper, UT 84020 (Office of the State Surgeon) with attachments to the Readiness Center, 17800 S. Camp Williams Road, Riverton, Utah 84065, as well as Army Aviation Support Facility, 7602 South Airport Road, West Jordan UT 84084. In rare instances, work performance may be required at location(s) within a 50 mile radius of primary location (Other UTARNG locations). In the event the work location is outside of the 50 mile radius the task order will be modified to include travel (mileage IAW JTR VOL II) for those instances.

1.2.3.1. Unscheduled gate closures by the Security Police may occur at any time causing all personnel entering or exiting a closed installation to experience a delay. This cannot be predicted or prevented. Contractors are not compensated for unexpected closures or delays. Vehicles operated by contractor personnel are subject to search pursuant to applicable regulations. Any moving violation of any applicable motor vehicle regulation may result in the termination of the contractor employee’s installation driving privileges.

1.2.3.2. Contractor employees will become familiar with and obey the regulations of the installation; including fire, traffic, safety and security regulations while on the installation.

Contractor employees should only enter restricted areas when required to do so and only upon prior approval. All contractor employees shall carry proper identification with them at all times. The contractor shall ensure compliance with all regulations and orders of the installation which may affect performance.

1.2.4. Awareness Training (AT) Level 1 security requirements: The contractor shall comply with all applicable installation/facility access and local security policies and procedures, which may be obtained from the contracting officer’s representative (COR).

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. The contractor shall ensure compliance with all personal identity verification requirements as directed by DoD, HQDA and/or local policy. Should the force protection condition change, the government may require changes in contractor security matters or processes.

1.2.4.1. COMSEC/IT Security. All communications with DoD organizations are subject to communications security (COMSEC) review. All telephone communication networks are continually subject to intercept by unfriendly intelligence organizations. DoD has authorized the military departments to conduct COMSEC monitoring and recording of telephone calls originating from, or terminating at, DoD organizations. Therefore, the contractor is advised any time that a contractor places or receives a call they are subject to COMSEC procedures. The contractor shall ensure wide and frequent dissemination of the above information to all employees dealing with DoD information.

The contractor shall abide by all government regulations concerning the authorized use of the government's computer network, including the restriction against using the network to recruit government personnel or advertise job openings.

1.2.4.2. Use of government information systems (IS) and access to government networks is a revocable privilege, not a right. Users are the foundation of the DoD strategy and their actions affect the most vulnerable portion of the AEI. Contractor employees shall have a satisfactory background investigation (BI) or hold a security clearance and access approvals commensurate with the level of information processed or available on the system. Contractor employees shall: comply with the command's Acceptable Use Policy (AUP) for government owned IS and sign an AUP prior to or upon account activation. Complete initial and/or annual information assurance (IA) training as defined in the IA Best Business Practices (BBP) training (https://informationassurance.us.army.mil). Mark and safeguard files, output products, and storage media per classification level and disseminate them only to individuals authorized to receive them with a valid need to know. Protect IS and IS peripherals located in their respective areas in accordance with physical security and data protection requirements. Practice safe network and Internet operating principles and take no actions threatening the integrity of the system or network.

1.2.4.3. Protection of Personally Identifiable Information (PII): The contractor shall protect all PII encountered in the performance of services in accordance with DFARS

224.103 and DoDD 5400.11, DoD Privacy Program, and DoD 5400.11-R. If a PII breach results from the contractor’s violation of the aforementioned policies, the contractor shall bear all notification costs, call-center support costs, and credit monitoring service costs for all individuals who’s PII has been compromised. Maintain Health Insurance Portability and Accountability Act of 1996 (HIPAA) standards and guidelines.

1.2.4.4. CAC Requirements: The Common Access Card (CAC) is the DoD Federal personal identity verification (PIV) credential. In accordance with directive type memorandum (DTM) 08-003, December 1, 2008, incorporating Change 5, October 8, 2013, initial issuance of a CAC requires at a minimum the completion of FBI fingerprint check with favorable results reflecting "no record" and submission of a National Agency Check with Inquiries (NACI) to the Office of Personnel Management (OPM), or a DoD-determined equivalent investigation. The issuance of a CAC will be based on four https://informationassurance.us.army.mil/ criteria; (a) eligibility for a CAC; (b) verification of DoD affiliation from an authoritative data source; (c) completion of background vetting requirements according to the Federal Information Processing Standards Publication 201-1, PIV of Federal Employees and Contractors, March 2006, and DoD Regulation 5200.2-R, Department of Defense Personnel Security Program, January 1987, and (d) verification of a claimed identity.

CAC eligible personnel must be registered in the Defense Enrollment Eligibility Reporting System (DEERS) through either an authoritative personnel data feed from the appropriate Service or Agency or Trusted Associate Sponsorship System (TASS).

1.2.4.4.i. HSPD-12 BI Requirements: The contractor will ensure that CACs are obtained by all contract or subcontract personnel assigned to work on the government site and personnel requiring access to a DoD network (and other eligible populations as specified in DTM-08-003 attachment 3, paragraph 3a). They are required to, at a minimum, have received a favorable FBI fingerprint check and must have submitted to the OPM, a NACI or equivalent/higher investigation. It is the responsibility of the contractor to ensure all employees requiring an initial BI complete a Personnel Security Investigation Portal (PSIP) form at attachment, at the earliest possible date and that this form is forwarded to the COR immediately. The COR will review the form for completeness and accuracy and forward to the National Guard Bureau personnel security manager who will initiate the investigation process via the PSIP. Contractor personnel will then receive two e-mail messages; the first will confirm the request has been received by the OPM, and the second will provide instructions for the completion of the appropriate form via the Electronic Questionnaires for Investigations Processing (e-QIP) system. Upon completion of the e-QIP questionnaire and submittal of all required documents, including fingerprint card to the security manager, the BI will be initiated. The contractor shall ensure all instructions regarding BI processing, including those provided verbally, by e-mail or via a government system are complied with immediately. The contractor is cautioned that the entire process from submittal of the PSIP form to return of the FBI fingerprint check may routinely take 2-6 weeks and shall factor this lead time into their hiring/placement process. The contractor shall make all reasonable efforts to ensure contractor employees meet CAC eligibility standards upon assignment to the contract and shall be held responsible for delays, failure to meet performance requirements or decreases in efficiency in accordance with the applicable inspection clause.

1.2.4.4.ii. TASS: The contractor is responsible for processing applications for CAC cards for every contractor employee who deploys with the military force OR who has need to access any government computer network in accordance with FAR 52.204-9, "Personal Identity Verification of Contractor Personnel." The contractor is responsible for managing requests for new or renewal CAC cards in sufficient time to ensure all contractor employees have them when needed to perform work under this contract. The norm is at least ten calendar days advance notice to the Trusted Agent (TA), unless there are extenuating circumstances approved by the COR or Contracting Officer. It is recommended that a "Corporate Facility Security Officer" (FSO) be designated to serve as your firm's single point of contact for BI, the TASS application process and other CAC and security related matters. If a FSO is not established, each contractor employee requiring a CAC will be required to process their own applications. CAC applications shall be processed through the TASS. The contractor's FSO or contractor employee shall submit requests for a CAC via email to the designated TASS TA before accessing the TASS website. The TASS TA for this requirement will be: The government will establish a TASS application account for each CAC request and will provide each contractor employee a user ID and password, via email, to the FSO. The FSO or contractor employee shall access the TASS account and complete the CAC application (entering/editing contractor information as applicable) https://www.dmdc.osd.mil/tass/. The FSO or contractor employee will submit completed applications in TASS and will follow up to ensure the TA is processing the request. A CAC cannot be issued without evidence the FSO has initiated a NACI. The government will inform the contractor's applicant, via email, of one of the following: Approved. *Upon approval, the information is transferred to the DEERS database and an email notification is sent to the contractor with instructions on obtaining their CAC. The contractor proceeds to a Real-Time Automated Personnel Identification System (RAPIDS) station (RAPIDS Site Locator: http://www.dmdc.osd.mil/rsl/). Rejected. *The government, in separate correspondence, will provide reason(s) for rejection. Returned.

*Additional information or correction to the application required by the contractor employee. The contractor shall maintain records of all approved and rejected applications. At the RAPIDS station, the RAPIDS verification officer will verify the contractor by SSN and two forms of identification. Identity source documents must come from the list of acceptable documents included in Form I-9, OMB No. 115-0136, "Employment Eligibility Verification." Consistent with applicable law, at least one document from the Form I-9 list shall be a valid (unexpired) state or federal government-issued picture identification. The Identity documents will be inspected for authenticity and scanned and stored in the DEERS upon issuance of an ID. The photo ID requirement cannot be waived, consistent with applicable statutory requirements. The verification officer will capture primary and alternate fingerprints, picture, and updates to DEERS and will then issue a CAC. Issued CACs shall be for a period of performance not longer than three (3) years or the individual's contract end date (inclusive of any options), whichever is earlier. The contractor shall return issued CAC's to the COR/KO office upon departure or dismissal of each contractor employee. Obtain a receipt for each card.

1.2.4.4.iii. The contractor shall obtain an Army Knowledge Online (AKO) email address for each applicant, including subcontractors, who may be deployed or require logical access to a government computer network. This can be done by going to:

http://www.us.army.mil and registering as an "Army Guest," with the sponsor being the COR or a COR designated individual if the COR is ineligible to serve as an AKO Sponsor. Note: If an employee of a contractor loses the privilege to access AKO, they lose the ability to renew their CAC, therefore it is critical that contractor employees maintain their AKO accounts.

1.2.5. Physical Security: The contractor shall safeguard all government property provided for contractor use. At the close of each work period government facilities, equipment and materials shall be secured.

https://www.dmdc.osd.mil/tass/ http://www.dmdc.osd.mil/rsl/ http://www.us.army.mil/

1.2.5.1. Key Control: Each contractor will sign for and be responsible for their own workstation key.

1.2.5.2. Lock Combinations: Not applicable.

1.2.6. 1 position - Senior Manager Medical Operations (Appendix A) (start 01 May

2016) 1 position - Quality Assurance Quality Control and Data Analyst (Appendix B) (start 01 May 2016) 1 position - Registered Nurse Non-Clinical Case Manager (Appendix C) (start 01 May 2016) 5 position - Non-Clinical Case Manager (Appendix D) (5 position start 01 May 2016) 5 position - Administrative Assistant to the Case Manager (Appendix E) (start 01 May 2016) 1 position - Senior Medical Records Custodian (Appendix F) (start 01 May 2016) 4 positions – Medical Records Custodian (Appendix G) – (start 01 May 2016) 1 Position - Health Benefits Advisor (Appendix H) (start 01 May 2016)

1.3. Post award conference/periodic progress meetings: The contractor agrees to attend any post award conference convened by the KO. The KO, COR, and other government personnel, as appropriate, may meet periodically with the contractor to review the contractor performance.

1.4. The contractor shall provide a primary point of contact and alternate who shall ensure performance under this contract. The name of this person and an alternate shall be designated in writing to the COR/KO. The alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract. The individual shall work with the COR, or the KO if a COR is not assigned, to resolve issues, receive technical instructions, and ensure adequate performance of services.

The individual(s) shall ensure contractor employees do not perform any services outside the scope of the contract without an official modification issued by the KO. The individual(s) shall ensure contractor employees understand services performed outside the scope of the contract are not permitted.

1.5. Identification of Contractor Employees: Contractor employees will require badges to be worn at all times in the performance of this contract. All contractor personnel attending meetings and answering government telephones are required to identify themselves as contract employees to avoid creating an impression that they are government employees. The contractor shall ensure all documents or reports produced by contractor personnel are suitably marked as contractor products or contractor participation is appropriately disclosed. The contractor’s status as a “contractor” shall be predominantly displayed in all correspondence types (to include signature blocks on e-mail) and dealings with government or non-government entities. Contractor personnel shall wear identification badges distinguishing themselves as such. The badges shall have the company name, employee name and the word “contractor” displayed. The contractor shall retrieve all identification media (including vehicle passes) from their employees who depart employment for any reason. All identification media (i.e., badges and vehicles passes) shall be returned to the COR/KO within 14 calendar days of an employee’s departure.

1.6. Combating Trafficking in Persons: The United States Government has adopted a zero tolerance policy regarding trafficking in persons. Contractors and contractor employees shall not engage in severe forms of trafficking in persons during the period of performance of the contract; procure commercial sex acts during the period of performance of the contract; or use forced labor in the performance of the contract. The contractor shall notify its employees of the United States Government’s zero tolerance policy and the actions that will be taken against employees for violations of this policy.

Such actions may include, but are not limited to, removal from the contract, reduction in benefits, or termination of employment. The contractor shall take appropriate action up to and including termination of employees or subcontractors that violate the US Government policy as described at FAR 22.17.

1.7. Contractor Travel: Travel shall be in accordance with the Joint Travel Regulation (JTR). Travel may be required for all contractor personnel performing on this requirement. Contractor shall be required to comply with travel policies as outlined in the DoD Financial Management Regulation and the JTR.

1.8. Data Rights. Not Applicable

1.9. Organizational Conflicts of Interest (OCI): The contractor and subcontractor personnel performing services under this contract may receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statements, etc.) or perform evaluation services which may create current or subsequent OCIs, as defined in FAR Subpart 9.5. The contractor shall notify the KO immediately whenever they become aware that access or participation may result in any actual or potential OCI and shall promptly submit a plan to the KO to avoid or mitigate any such OCI. The contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the KO. In the event the KO unilaterally determines any such OCI cannot be satisfactorily avoided or mitigated, the KO may affect other remedies as he or she deems necessary, including prohibiting the contractor from participation in subsequent contracted requirements which may be affected by the OCI.

2. Definitions and Acronyms:

2.1.1. CONTRACTOR. A supplier or vendor awarded a contract to provide specific supplies or service to the government. The term used in this contract refers to the prime.

2.1.2. CONTRACTING OFFICER (KO). A person with authority to enter into, administer, and or terminate contracts, and make related determinations and findings on behalf of the government. Note: The only individual who can legally bind the government.

2.1.3. COR. An employee of the U.S. Government designated by the KO to monitor contractor performance. 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 the 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.

2.1.4. DEFECTIVE SERVICE. A service output which does not meet the standard of performance associated with the PWS.

2.1.5. DELIVERABLE. Anything that can be physically delivered and includes non-manufactured things such as meeting minutes or reports.

2.1.6. KEY PERSONNEL. Contractor personnel who may be required to be used in the performance of a contract as key personnel listed in the PWS.

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

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

2.1.9. QUALITY ASSURANCE SURVEILLANCE PLAN (QASP). An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

2.1.10. QUALITY CONTROL. All necessary measures taken by the contractor to assure the quality of an end product or service meets contract requirements.

2.1.11. SUBCONTRACTOR. One that enters into a contract with a prime contractor.

The government does not have privacy of contract with the subcontractor.

2.1.12. WORK HOURS. The number of hours per day the contractor provides services in accordance with the contract. Hours of Operation: The contractor shall perform the services required under this contract within the operating hours of 5:30 a.m. – 6:00 p.m.

MST, 10 hours maximum.

2.1.13. WORK WEEK. Monday through Thursday, unless specified otherwise.

2.2. ACRONYMS:

AFARS Army Federal Acquisition Regulation Supplement

AKO Army Knowledge Online AR Army Regulation ARNG Army National Guard AT Awareness Training AT/OPSEC Antiterrorism/Operational Security AUP Acceptable Use Policy BBP Best Business Practices BI Background Investigation CAC Common Access Card CFP/M/E Contractor Furnished Property, Materials, and Equipment CFR Code of Federal Regulations CM Case Management CMRA Contractor Manpower Reporting Application CNA Certified Nurse’s Assistant COMSEC Communications Security CONUS Continental United States (excludes Alaska and Hawaii) COR Contracting Officer Representative COTS Commercial-Off-the-Shelf DA Department of the Army DD250 Department of Defense Form 250 (Receiving Report) DD254 Department of Defense Contract Security Requirement List DEERS Defense Enrollment Eligibility Reporting System DFARS Defense Federal Acquisition Regulation Supplement DoD Department of Defense DoDI Department of Defense Instruction DTM Directive Type Memorandum e-QUIP Electronic Questionnaires for Investigations Processing FAR Federal Acquisition Regulation FMR Fully Medically Ready FSO Facility Security Officer FY Fiscal Year GFP/M/E/S Government Furnished Property/Material/Equipment/Services HIPAA Health Insurance Portability and Accountability Act of 1996 HRR Health Readiness Record IA Information Assurance IS Information System IMR Individual Medical Readiness JTR Joint Travel Registration IS Information System(s) KO Contracting Officer MM Medical Management MHS Military Health System NACI National Agency Check with Inquiries NCQA National Committee for Quality Assurance OCI Organizational Conflict of Interest OCMO Office of the Chief Medical Officer

ODC Other Direct Costs OPM Office of Personnel Management OPSEC Operational Security PHMMD Population Health and Medical Management Division PII Personally Identifiable Information PIPO Phase In/Phase Out PIV Personal Identity Verification POC Point of Contact PoP Period of Performance PRS Performance Requirements Summary PSIP Personnel Security Investigation Portal PWS Performance Work Statement QA Quality Assurance QAP Quality Assurance Program QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Program RAPIDS Real-Time Automated Personnel Identification System SRP Soldier Readiness Processing STR Soldier Treatment Record TA Trusted Agent TASS Trusted Associate Sponsorship System TMA TRICARE Management Activity TE Technical Exhibit UM Utilization Management URAC Utilization Review Accreditation Commission UTARNG Utah Army National Guard

3.0. Government Furnished Property, Materials, and Equipment (GFP/M/E):

3.1. Property: Not Applicable

3.2. Materials: Not Applicable

3.3. Equipment: The government will provide required computers, scanners, telephones, workstations, and materials necessary to comply with contract requirements at the job site.

3.4. Services: Not Applicable

3.5. Utilities: Not Applicable

4.0. Contractor Furnished Property, Materials, and Equipment (CFP/M/E):

4.1. General: Except for those items specifically stated to be government furnished in Paragraph 3.0, the contractor shall furnish everything required to perform these services as required by the contract.

4.2. Secret Facility Clearance: Not Applicable

5.0. Requirements: The intent of this requirement is to provide case management services for the ARNG in support of surge and contingency requirements as well as its steady-state mission. Any changes to the initial staffing will be completed through a bilateral supplemental agreement.

5.1. Contractor shall provide contractor support personnel as annotated in 1.3.7. to provide IMR support to the UTARNG. Personnel assigned to this requirement shall possess the required technical skills and expertise to perform the functions with minimum guidance. Technical skills for all contracted personnel will include PC proficiency, specifically Microsoft Word and Excel.

5.1.1. The government will provide training via VTC for eCase to the contractor.

Contact Clinical Operations Branch, Chief Surgeon’s Office 30 days prior to anticipate award to schedule training.

5.2. Contractor Manpower Reporting Application (CMRA):

5.2.1. The contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract for the National Guard Bureau via a secure data collection site.

5.2.2. The contractor shall completely fill in all required data fields using the following web address: http://www.ecmra.mil/. Reporting inputs shall be for the labor executed during the period of performance during each government 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 2015. Contractors may direct questions to the help desk at http://www.ecmra.mil.

http://www.ecmra.mil/ http://www.ecmra.mil/

Appendix A

SENIOR MANAGER MEDICAL OPERATIONS

A.1. Special Qualifications: The senior non-clinical case manager requires the expertise as dictated by the Office of the State Surgeon- the systematic application of substantial specialized knowledge and skills derived from the care, treatment, counsel, and health education of individuals who are experiencing changes in the normal health processes or who require assistance in the maintenance of health and the prevention or management of illness, injury, or disability.

A.2. The senior manager medical operations knowledge domains consist of assessment, planning, implementation, coordination, monitoring and evaluations of the options and services required to meet the ARNG Soldier’s health and human service’s needs.

A.3. Contractor personnel will not perform inherently governmental functions (i.e., representation of government, decision authority, etc.)

A.4. Responsible to ensure the tracking of medical status of ALL Soldiers in the

UTARNG.

A.5. Responsible for ensuring all case management personnel are charting medical and dental information into eCase.

A.6. Supervise case management teams during the inputting of profiles, exams/evaluations and audiology exams during physical health assessment.

A.7. Supervise case management teams who are actively working with Soldier’s about their treatment plans with appropriate medical facilities.

A.8. Pull reports from automated systems to show that referrals are indicated in MEDCHART, eProfile, eCase, MRR, DENCLASS, and AVS.

A.9. Oversee all documentation from evaluations, records reviews, and updates by MACOM case managers/coordinators. Ensure case processing, medical documentation and profiles are completed correctly and submitted to the MACOM Leadership/military provider.

A.10. Immunizations: Track MACOM percentages, help write policies, ensure that updates with current needs/industry standards are met. Provide updates on current immunizations for worldwide deployments, and make updates for specific OCONUS immunizations.

A.11. Attend case management meetings with MACOM and case management team assigned to MACOM, and provide education resources and training for the case management teams.

A.12. Supervise Soldier’s care from the identification of the condition to when the Soldier is either:

- Considered medically ready.

- Administratively separated from the military.

A.13. Follow the regulations and policies applicable to IMR and deployment, to include the AR 40-501 and other applicable guidance.

A.14. Provide guidance in situations that other case managers are unable to resolve.

Cover administrative issues utilizing administrative background to evaluate steps to clear the Soldier medically.

A.15. Investigate, develop timelines, and gather documentation on specific Soldier issues at the request of the G1 directorate (AR) 40-66.

A.16. Review for approval all applications for AGR/ADOS positions within the UTARNG.

A.17. Serve as an interim case manager when MACOM case manager is not available or when there is an open case manager position within the UTARNG.

A.18. Educate MACOM commanders on resources available to improve medical and dental readiness.

A.19. Maintain Health Insurance Portability and Accountability Act of 1996 (HIPAA) standards and guidelines.

A.20. Develop and provide a spreadsheet of Soldiers medical issues to each MACOM.

A.21. Maintain and review medical case management meeting notes and publish within the Office of the State Surgeon.

A.22. Verify that all documents being uploaded by case management teams are correctly processed.

A.23. Review the quality of Indexed medical documents by case management teams.

A.24. Supervise MODS entry of immunizations, designation of pregnancy, eye exams, medical warning tags, and exemption codes.

A.25. Ensure all medical documents received for case management are properly delivered to the medical records custodian to be filed.

A.26. Supervise that case management teams are ensuring all administrative charting in eCase is complete. Develop a standard for input into eCase.

A.27. Ensure the tracking of all medical appointments or communication with Soldier and unit in eCase is complete.

A.28. Ensure contact is made with Soldier at a minimum every 30 days and logged in eCase.

A.29. Communicate with delegated government personnel to track compliance versus noncompliance.

A.30. Run MEDPROS report pre and post PHA/SRP event.

A.31. Monitor MEDPROS to ensure all scheduled services are completed/updated and current medical status is reflected.

A.32. Review the reports on medical readiness prior to the release to commanders.

A.33. Ensure Soldiers with T3, T4, P3 or P4 profiles are case managed in the eCase module.

A.34. Contractor shall maintain business casual dress standard during all work assignments.

A.35. Comply with the following Government directives in order to successfully complete the tasks: AR 40-66, Health Insurance Portability Act (HIPAA), Privacy Act of 1974, For Official Use Only (FOUO), Operational Security (OPSEC)

Appendix B

QUALITY ASSURANCE QUALITY CONTROL AND DATA ANALYST

B.1. Special Qualifications: The QA/QC Data Analyst will provide professional expertise, program coordination and data quality review service in support of the Medical Management Processing System (MMPS). Contractor shall be knowledgeable and proficient in the methodologies and requirements inherent to MMPS and provide suggestions, course of action options, and tracking on revised techniques/methods to correct program deficiencies. MMPS includes all aspects of medical readiness (case management, health systems administration, medical records, medical operations, etc.)

Education requirements: Must have higher education, preferably Bachelor degree or higher. Possess additional Army/Air Guard practical experience directly related to the requirements of the task order. Has a working understanding of the position functions and has sufficient knowledge to perform the work of the position described in the task order. Desired two years’ experience with MMPS. Familiarity with Army medical regulations and State Surgeon operations and procedures.

All reports, plans and programs shall be reviewed and approved by an authorized government representative prior to release.

B.2. Coordinate methods for quality control to include: monitor process and system compliance; provide deficiency reports and subsequent course of action options.

Record and monitor implementation plans and evaluations of the MMPS system.

B.3. Contractor personnel shall not perform inherently governmental functions (i.e., representation of government, decision authority, etc.)

B.4. Support the UTARNG throughout each phase of the Deployment Cycle (before, during, and after). Contractor shall have a monthly team meeting with the Senior Manager of Medical Operations, DSS, and applicable attendees, monitor MMPS systems and processes. Provide course of action options for improvement, and document progress.

B.5. Coordinate with MMPS staff to provide compliance reports, deliver suggestions and briefings regarding protocol and standards and monitor methods for improvement. The standard expectation for response to inquiries shall be upon receipt/notification or two business days from date of notification with a resolution or follow-up contact. Initial contact with Soldier shall be performed immediately (if notified in person) or NLT two business days of notification of the issue.

B.6. Upon request of DSS or G1, schedule services, reviews and audits that are consistent with the accepted standards of ethical and professional health care as governed by local policy, Army Regulation, and DoD Directive/Instruction.

B.7. Manage medical plans and data quality in the MMPS in conjunction with the DSS and Admin Assistant. Document appointments and ensure documentation is retrieved from appointments and placed in appropriate electronic…