W91242-17-R-0011.pdf

COMBINED

SYNOPSIS/SOLICITATION

W91242-17-R-0011

ISSUED SEPTEMBER 1, 2017

Part: U.S. Government Procurements Subpart: Services Class Code: 25.6 Medical Care

Address of Contracting Office: USPFO for North Carolina, 4201 Reedy Creek Rd., Raleigh, NC 27607, United States of America

Subject: Medical and Dental Services

Solicitation Number: W91242-17-R-0011

Reponses Due: October 2, 2017 at 1:00 P.M. local time (Raleigh, NC)

Point of Contact: Heather Bushouse, e-mail: heather.m.bushouse.civ@mail.mil, phone: 984-664-

Contracting Officer Point of Contact: MAJ Brandon Elliott, e-mail:

brandon.b.elliott.mil@mail.mil Phone: 984-664-6205

Web Address: http://nc.ng.mil/uspfo/

Description of Requirement: This is a combined synopsis/solicitation for commercial items prepared in accordance with the format in Federal Acquisition Regulation (FAR) Subpart 12.6 and 13.5, as supplemented by additional information included in this notice. This acquisition is a 100% set-aside for women-owned small business. This announcement constitutes the only solicitation and additional information will not be provided. Proposals are requested under Request for Proposals (RFP) W91242-17-R-0011 for services listed on pages 3-5.

The performance period is from 23 October 2017 through 3 December 2017. Delivery is FOB Destination.

The Government intends to award a contract resulting from this solicitation to the lowest-priced, technically acceptable offer with acceptable past performance. The USPFO of NC, Acquisition Support Division (USPFO-NC-ASD), reserves the right to conduct discussions prior to award. Any deviation from the terms, conditions, or requirements of this solicitation may result in offers being determined ineligible for award. Potential offerors are encouraged to submit any questions regarding this solicitation to the USPFO- NC-ASD Points of Contact provided herein prior to the offer due date and time.

mailto:heather.m.bushouse.civ@mail.mil mailto:derek.t.meilinger.mil@mail.mil http://nc.ng.mil/uspfo/

W91242-17-R-0011

This RFP incorporates provisions and clauses in effect through Federal Acquisition Circular 2005-83.

FAR provision 52.212-3 Offeror Representations and Certifications-Commercial Items applies to this acquisition. Offerors shall complete this provision in the System for Award Management (SAM). SAM is an official U.S. Government system and all offerors are required to be registered in this system. There is NO fee to register for this site. Please provide your CAGE Code from SAM with your offer.

The Government contemplates award(s) of a Firm Fixed Price contract resulting from this combined synopsis/solicitation for performance of medical and dental services in North Carolina.

Proposals must be received no later than 1:00 PM local time (Raleigh, NC) on October 2, 2017. Offers shall be submitted via email to heather.m.bushouse.civ@mail.mil. When submitting offers, please note the RFP number W91242-17-R-0011 in the subject line of the email. A confirmation of receipt will be sent to you once your offer has been received. Please note that the offeror assumes all risk for any delay in the transmission of their proposals.

Any offers received after the above deadline will not be considered. All offerors are encouraged to review FAR 52.212-1 INSTRUCTIONS TO OFFERORS. All offerors are further encouraged to submit their proposals early.

This effort is a high priority requirement in support of the National Guard. Funds are not presently available to make award. If funds become available for award, and prices are deemed fair and reasonable, it is the Government’s intent to make award.

This is not a commitment of funds or contract award.

mailto:heather.m.bushouse.civ@mail.mil

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 1 Job

Medical & Dental PHA, Franklin, NC

FFP

1-Day Event: 23 October 2017; PAX: 163, Address: 192 Industrial Park Loop, Franklin, NC 28734. See Medical Event Request Form for details.

FOB: Destination

NET AMT

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0002 1 Job

Medical & Dental PHA, Raleigh, NC

FFP

1-Day Event: 3 November 2017; PAX: 100, Address: 1636 Gold Star Drive, Raleigh, NC 27607. See Medical Event Request Form for details.

FOB: Destination

NET AMT

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0003 1 Job

Medical & Dental PHA, Asheville, NC

FFP

2-Day Event: 4-5 November 2017, PAX: 245; Address: 100 Minuteman Dr., Asheville, NC 28806. See Medical Event Request Form for details.

FOB: Destination

NET AMT

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0004 1 Job

Medical & Dental PHA, Greensboro, NC

FFP

2-Day Event: 4-5 November 2017; PAX: 335; Address: 110 Franklin Boulevard, Greensboro, NC 27401. See Medical Event Request Form for details.

FOB: Destination

NET AMT

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0005 1 Job

Medical & Dental PHA, Morrisville, NC

FFP

2-Day Event: 4-5 November 2017; PAX: 334; Address: 2050 National Guard, Morrisville, NC 27560. See Medical Event Request Form for details.

FOB: Destination

NET AMT

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0006 1 Job

Medical & Dental PHA, Kinston, NC

FFP

2-Day Event: 1-2 December 2017, PAX: 250, Address: 2875 Dobbs Farm Rd, Kinston, NC 28504. See Medical Event Request Form for details.

FOB: Destination

NET AMT

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0007 1 Job

Medical & Dental PHA, Butner, NC

FFP

1-Day Event: 2 December 2017; PAX: 100, Address: 105 Central Avenue, Butner, NC 27509. See Medical Event Request Form for details.

FOB: Destination

NET AMT

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0008 1 Job

Medical & Dental PHA, Mooresville, NC

FFP

1-Day Event: 2 December 2017; PAX: 75; Address: 720 N Broad Street, Mooresville, NC 28115. See Medical Event Request Form for details.

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0009 1 Job

Medical & Dental PHA, Raeford, NC

FFP

2-Day Event: 2-3 December 2017, PAX: 400; Address: 305 Teal Drive, Raeford, NC 28376. See Medical Event Request Form for details.

FOB: Destination

NET AMT

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0010 1 Job

Medical & Dental PHA, Charlotte, NC

FFP

2-Day Event: 2-3 December 2017, PAX: 225, Address: 4240 West Boulevard, Charlotte, NC 28208. See Medical Event Request Form for details.

FOB: Destination

NET AMT

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0011 1 Job

Contract Management Reporting

FFP

eCMRA reporting requirement for FY18 ending September 30, 2018

INSPECTION AND ACCEPTANCE TERMS

Supplies/services will be inspected/accepted at:

CLIN INSPECT AT INSPECT BY ACCEPT AT ACCEPT BY

0001 Destination Government Destination Government 0002 Destination Government Destination Government 0003 Destination Government Destination Government 0004 Destination Government Destination Government 0005 Destination Government Destination Government 0006 Destination Government Destination Government 0007 Destination Government Destination Government 0008 Destination Government Destination Government 0009 Destination Government Destination Government

Government Destination Government 0010 Destination 0011 Destination Government Destination Government

DELIVERY INFORMATION

CLIN DELIVERY DATE QUANTITY SHIP TO ADDRESS DODAAC

0001 POP 23-OCT-2017 TO

23-OCT-2017

N/A W8BP NCARNG ELEMENT, JF HQ

JFHQ - NORTH CAROLINA

1636 GOLD STAR DRIVE

RALEIGH NC 27607-6410

FOB: Destination

W802JL

0002 POP 03-NOV-2017 TO

03-NOV-2017

N/A W8BP NCARNG ELEMENT, JF HQ

JFHQ NORTH CAROLINA

1636 GOLD STAR DRIVE

RALEIGH NC 27607-6410

FOB: Destination

W802JL

0003 POP 04-NOV-2017 TO

05-NOV-2017

N/A W8BP NCARNG ELEMENT, JF HQ

JFHQ NORTH CAROLINA

1636 GOLD STAR DRIVE

RALEIGH NC 27607-6410

FOB: Destination

W802JL

0004 POP 04-NOV-2017 TO

05-NOV-2017

N/A W8BP NCARNG ELEMENT, JF HQ

JFHQ - NORTH CAROLINA

1636 GOLD STAR DRIVE

RALEIGH NC 27607-6410

W802JL

0005 POP 04-NOV-2017 TO

05-NOV-2017

N/A W8BP NCARNG ELEMENT, JF HQ

JFHQ - NORTH CAROLINA

1636 GOLD STAR DRIVE

RALEIGH NC 27607-6410

0006 POP 01-DEC-2017 TO

02-DEC-2017

N/A W8BP NCARNG ELEMENT, JF HQ

JFHQ - NORTH CAROLINA

1636 GOLD STAR DRIVE

RALEIGH NC 27607-6410

0007 POP 02-DEC-2017 TO

02-DEC-2017

N/A W8BP NCARNG ELEMENT, JF HQ

JFHQ - NORTH CAROLINA

1636 GOLD STAR DRIVE

RALEIGH NC 27607-6410

0008 POP 02-DEC-2017 TO

02-DEC-2017

N/A W8BP NCARNG ELEMENT, JF HQ

JFHQ - NORTH CAROLINA

1636 GOLD STAR DRIVE

RALEIGH NC 27607-6410

0009 POP 02-DEC-2017 TO

03-DEC-2017

N/A W8BP NCARNG ELEMENT, JF HQ

JFHQ - NORTH CAROLINA

1636 GOLD STAR DRIVE

RALEIGH NC 27607-6410

0010 POP 02-DEC-2017 TO

N/A W8BP NCARNG ELEMENT, JF HQ

JFHQ - NORTH CAROLINA

1636 GOLD STAR DRIVE

RALEIGH NC 27607-6410

0011 POP 23-OCT-2017 TO

N/A W8BP NCARNG ELEMENT, JF HQ

JFHQ - NORTH CAROLINA

1636 GOLD STAR DRIVE

RALEIGH NC 27607-6410

SECTION C

Performance Work Statement for

Contract Periodic Health Assessment (PHA) and

Ancillary Laboratory, Audiology and Medical Support Services

PART 1

GENERAL INFORMATION

1.1 Description of Services/Introduction: The contractor shall provide all personnel, equipment, tools, materials, supervision, and other items and non-personal services necessary to perform medical service support as defined in this Performance Work Statement except as Specified in section 3.

1.2 Background: Individual Medial Readiness (IMR) and Fully Medically Ready (FMR) are the basic principles of force-sustainment for North Carolina Army National Guard (NCARNG) forces. Medical readiness is vital for combined force health protection and failure to achieve a standard of level of medical health could preclude a soldier from deploying. Medical Readiness is a command responsibility.

1.3 Objectives: The objective of this PWS is to conduct and complete, either selective services or as a complete service, the requirements of NCARNG IMR/FMR - Medical Readiness on all eligible (mobilizing or not) Service Members (SMs) in the NCARNG utilizing a HIPPA, Privacy Act, and OSHA-Compliant portable health facility.

• Medical evaluation by a licensed provider (Physician, Physicians Assistant (PA), or Nurse Practitioner (ARNP) IAW prescribed Army and NGB policy for Periodic Health Assessment, Physical Exams (Over-40, flight, and Specialty schools).

• All routine and ordered phlebotomy services provided on location or shipped to the required processing center(CDD for HIV).

• Electrocardiogram (EKG) service performed on all Soldiers over 40 years of age provided on location IAW CVSP guidelines.

• All routine and theatre specific immunizations provided by contractor, administered and annotated on a DD Form 2766 - Adult Preventive and Chronic Care Flowsheet provided on location.

• All baseline audiology (DD Form 2215 DD or DD Form 2216 Hearing Conservation Form), to include required follow-up for SPRINT Testing provided on location (if Audiologist is requested).

• Height, weight and blood pressure taken, recorded and stored electronically provided on location.

• Vision screening provided on location.

• Eye exams provided on location for all Soldiers scoring worse than 20/40 on vision screening (if

Optometry is requested).

• Routine urinalysis for pregnancy testing and >40 years of age services (and specialty schools) provided on location.

• DNA and ABO-Rh testing/collection provided on location.

• Exams will be entered into the PHA module of MODS on location and required documentation loaded into HRR as required.

• Results entry and input/entry of all medical related FMR/IMR functions into the MEDPROS module of

MODS provided/entered on location.

• Annotation and entry of services into the DD Form 2766 – Adult Preventive and Chronic Care Flow sheet or appropriate document.

1.4 General Information

1.4.1 Quality Control: The contractor shall develop and maintain an effective quality control program to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The contractor’s quality control program is the means by which he assures himself that his work complies with the requirement of the contract. As a minimum, the contractor shall develop quality control procedures that address the areas identified in Technical Exhibit 1, “Performance Requirements Summary”. After acceptance of the quality control plan the contractor shall receive the contracting officer’s acceptance in writing of any proposed change to his QC system.

1.4.2 Quality Assurance: The government shall evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan. This plan is primarily focused on what the Government must do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

1.4.3 Government Remedies: The contracting officer shall follow FAR 52.212-4, “Contract Terms and Conditions- Commercial Items” or 52.246-4, “Inspection of Services-Fixed Price” for contractor’s failure to perform satisfactory services or failure to correct non-conforming services.

1.4.4 Recognized Holidays: The contractor is not required to perform services on these days Holidays or if the facilities are closed.

New Year’s Day Labor Day

Martin Luther King Jr.’s Birthday Columbus Day

President’s Day Veteran’s Day

Memorial Day Thanksgiving Day

Independence Day Christmas Day

1.4.5 Hours of Operation/Place of Performance: The contractor is responsible for conducting the tasks listed in section

5.0 during drill weekends and/or as requested. Soldier Readiness Processing for deployment and other training periods that would require physician support during normal hours of operations to be estimated at 10 hours a day. Usual hours are between 0700 and 1900 unless special arrangements are made. Services are to be completed on site at various NC-ARNG Armories & Training Sites across the State.

1.4.6 Travel Requirements: Contractor travel will be the sole responsibility of the contractor and should be included in the price schedule provided for services.

1.4.7 Qualifications: Providers holding a license to practice medicine. A provider is defined as: Advanced Registered Nurse Practitioner (ARNP), Physician’s Assistant (PA) or Physician (MD, DO). Medical services shall be performed by licensed medical professionals, who are board certified in their respective fields and have a license to practice medicine. Ancillary services (lab, vision, etc) will be provided by credentialed contractors but will work under the auspices of the licensed provider at [that] particular location. Contractor shall be held liable and is responsible for ensuring and verifying the appropriate level of Credentialing / Privileging (Licensure, Diploma, background checks, etc.) for all contact providers in support of any NCARNG event.

1.4.8 Special Requirements:

• OSHA & HIPAA-Compliant

• Full PHA &/or Physical Exam Requirements

• Real-time Data Processing & Uploading capability.

Additional MODS Medical Resources required:

• MEDPROS Wed Data Entry (MWDE) access/entry

• Electronic PHA Upload

• Entry of all work performed in the HRR module

• Entry of profiles into the e-Profile module

Contractor shall have network of local pharmacies for prescription medication services available for service members during contracted events.

1.4.9 Contracting Officer Representative (COR): The (COR) is identified below:

Primary: 2LT Jacquelyn Kahn, North Carolina Army National Guard HSS, G1-JFHQ, 919-664-6804 email Jacquelyn.a.kahn.mil@mail.mil

The COR monitors all technical aspects of the contract and assists in contract administration The COR is authorized to perform the following functions: assure that the Contractor performs the technical requirements of the contract: perform inspections necessary in connection with contract performance: maintain written and oral communications with the Contractor concerning technical aspects of the contract: issue written interpretations of technical requirements, including Government drawings, designs, specifications: monitor Contractor's performance and notifies both the Contracting Officer and Contractor of any deficiencies; coordinate availability of government furnished property, and provide site entry of Contractor personnel. A letter of designation issued to the COR, a copy of which is sent to the Contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the resulting order.

1.4.10 Contract Manager: The contractor shall provide a contract manager who shall be responsible for the performance of the work. The name of this person and an alternate who shall act for the contractor when the manager is absent shall be designated in writing to the contracting officer. The contract manager or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract.

1.4.11 Identification of Contractor Employees: All contract personnel attending meetings, answering Government telephones, and working in other situations where their contractor status is not obvious to third parties are required to identify themselves as such to avoid creating an impression in the minds of members of the public that they are Government officials. They must also ensure that all documents or reports produced by contractors are suitably marked as contractor products or that contractor participation is appropriately disclosed.

mailto:Jacquelyn.a.kahn.mil@mail.mil

1.5 Security Training Requirements:

1.5.1 Base security will require all employees and affiliated personnel of the contractor to carry a State recognized identification card or drivers license and all vehicles are subject to search without reason. The contractor shall comply with all installation security requirements.

1.5.2 AT Level 1 Training: All contractor employees, to include subcontractor employees, requiring access Army installations, facilities and controlled access areas shall complete AT Level I awareness training. The contractor shall obtain and have on file all certificates of completion for each affected contractor employee and subcontractor employee and must be able to provide copies whenever required to the COR or to the contracting officer. AT level I awareness training is available at the following website: https://atlevel1.dtic.mil/at.

1.5.3 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.

1.5.4 iWATCH Training. This standard language is for contractor employees with an area of performance within an Army controlled installation, facility or area. The contractor and all associated sub-contractors shall brief all employees on the local iWATCH program (training standards provided by the requiring activity ATO). This local developed training will be used to inform employees of the types of behavior to watch for and instruct employees to report suspicious activity to the COR.

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

1.5.6 For Contracts that Require OPSEC Training. Per AR 530-1, Operations Security, new contractor employees must complete Level I OPSEC training and must complete annual OPSEC awareness training.

1.5.7 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.

1.5.8 For information assurance (IA)/information technology (IT) cortication. Per DoD 8570.01-M , DFARS

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

https://atlevel1.dtic.mil/at

PART 2

DEFINITIONS & ACRONYMS

AR Army Regulation

DA Department of the Army

DD (Defense) Department

FMR Fully Medically Ready

HIPAA Health Insurance Portability and Accountability Act

IMR Individual Medical Readiness

MEDCOM U.S. Army Medical Command

MEDPROS Medical Protection System

MMRB Medical MOS Retention Board

MODS Medical Operational Data System

NGB National Guard Bureau

OSArS Office of the State Army Surgeon

OSHA Occupational Safety and Health Administration

PEB Physical Evaluation Board

PHA Periodic Health Assessment

SRC Soldier Readiness Check

SRP Soldier Readiness Processing

STR Soldier Treatment Record

SOW Statement of Work

TMC Troop Medical Clinic

NCARNG North Carolina Army National Guard

PART 3

GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND SERVICES

No armory, TMC, or office space will be provided or utilized unless prior approval is obtained from the Office of the State Army Surgeon. The Deputy State Surgeon of the NCARNG has the option to provide any and all management, labor, material, equipment, and supplies necessary for the contract medical provider to function operationally. It is expected that any contracted assets will integrate and work seamlessly with the contracted work staff. The services that the Deputy State Surgeon shall provide for the contract provider will meet readiness and deployability standards to ensure mission capability of the NCARNG. A Common Access Card (CAC) sponsored by the G1/Deputy State Surgeon shall also be provided.

PART 4

CONTRACTOR FURNISHED ITEMS AND SERVICES

4.1 General: Except for those items specifically stated to be government furnished in Part 3, the contractor shall furnish everything required to perform this PWS.

PART 5

SPECIFIC TASKS

5.1 Periodic Health Assessments (PHA): The contractor shall conduct PHAs in accordance with the PHA interim guidance set forth by the National Guard Bureau of the Surgeon General.

5.2 Periodic Health Assessments and Physical Exams: the contractor shall conduct Periodic Health Assessments (PHA) and other physical exams (Over-40, Chapter 2, Flight, etc.) in accordance with the AR 40-501 and the CVSP guidelines.

5.3 Visual Acuity Testing: The contractor shall conduct visual acuity testing in accordance with AR 40-501

5.4 Onsite at Post-Event Case Management of Temporary and Permanent Profiles:

• Licensed provider will identify and initiate the required Temporary and Permanent Profiles (T2 and T3, P2 and P3) to NCARNG soldiers via hardcopy record/spreadsheet, as well as, the MND module of MODS. A copy of the spreadsheet will be provided to the NCARNG case management staff at the event.

• The only permanent profiles to be written are for hearing (after SPRINT evaluation) or digital entry of a previously handwritten copy of a permanent profile.

• When required, contract manager will coordinate with Deputy State Surgeon and Health Services Section and arrange for fulfillment of required consultations and follow up.

• Follow-up conversations between Contractor and NCARNG treated soldier & Supervisor may be necessary depending on complexity of treatment and potential additional requirements.

5.5 Prescription Medication Services:

• Contractor shall set up network & account with local pharmacies near event location.

• Upon need of dentally treated soldiers & recommended by licensed dentist, Contractor to arrange for fulfillment of prescription medication for soldier.

• Contractor shall be invoiced by & submit payment to subcontracted local pharmacy utilized

• Follow-up conversations between Contractor and NCARNG treated soldier & Supervisor may be necessary depending on complexity of treatment and prescription medication, but will always engage Deputy State Surgeon.

• Contractor to collect & tally all expenses of prescription medication services & case management related

• Contractor shall submit costs to the COR.

5.6 Documentation:

• The contractor shall ensure that all appropriate DA or DD forms (in accordance with references) are utilized for each service supplied. The forms will be made available through the North Carolina Army National Guard Medical Command office. The contractor shall provide all documentation concerning medical treatment to the NCARNG Deputy State Surgeon.

• Reporting: The contractor shall provide a final report for all services provided to include a by name, unit, and social security number roster of all soldiers receiving services. The report shall be approved and verified by the NCARNG liaison with the office of the G1/Deputy State Surgeon of the NCARNG.

The following data elements will be reported at the end of an event:

Date Location List of contract employees Total number of patients scheduled Total number of patients examined Verification of entry into all necessary MODS modules (MEDPROS & e-PHA, HRR, etc).

A by name listing of all Soldiers examined and the dental classification of the Soldier (if dental services were requested)

The provider shall document the results on the same day examinations are performed.

5.7 Electrocardiogram Testing:

• The contractor shall conduct electrocardiogram testing on all Soldiers as required IAW prescribed Army and NGB policy and IAW AR 40-501for Periodic Health Assessment and Physical Exams (Over 40 years, flight, and Specialty Schools).

• All electrocardiogram testing services shall be provided on location and loaded into HRR.

5.8 Phlebotomy Service:

• The contractor shall perform all Phlebotomy services on location to any Service member requiring the services to include G6PD, PSA, full Lipid Panels, Cholesterol, Sickledex, Hematocrit, and HgB as required IAW prescribed Army and NGB policy and IAW AR 40-501 for Periodic Health Assessment and Physical Exams.

5.9 Eye Exam Testing:

• Eye exams provided on location for all Soldiers scoring worse than 20/40 on vision screening by a certified

Optometrist IAW AR 40-501 (if optometry services are requested).

5.10 DNA and ABO-Rh:

• Testing provided on location as required by AR 40-501.

5.11 HIV

• The contractor shall perform HIV tests to all Soldiers requiring as required IAW prescribed Army and NGB policy and IAW AR 40-501.

• All phlebotomy service required for HIV testing must be provided on location and specimens shipped to the

CDD.

5.12 IMMUNIZATIONS

• The contractor shall identify through MEDPROS immunizations required for each Soldier then administer necessary vaccines IAW AR 40-562, TB MED 114, Army and NGB policy.

• The contractor shall utilize all MILVAX and AR 40-562 requirements for the transportation and storage of vaccines.

• All immunization services must be provided on location.

5.13 HEARING

• The contractor shall conduct hearing test IAW DA PAM 40-501 in a certified booth using DOEHRS approved equipment.

• The booth and equipment will be provided by the contractor unless otherwise specified in the solicitation.

• The current audiometric booth certification must be posted on the outside of the booth in an easily seen location or available for review.

5.14 Contractor Management Reporting (CMR): The contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract for ARMY 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 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 31of each calendar year. Contractors may direct questions to the help desk at http://www.ecmra.mil.

Unit Identification Code (UIC) for the Requiring Activity: W8BPAA Issuing Office DoDAAC: W91242 http://www.ecmra.mil/

PART 6

APPLICABLE PUBLICATIONS

6.1 Publications applicable to this PWS are listed below.

• AR 40-501 Standards of Medical Fitness

• NGB Memorandum Post Deployment Health Re-Assessment Screen (attached)

• NGB Memorandum Periodic Health Assessment Interim Guidance (attached)

All publications listed are available via the Internet at the specified web address. (http://www.usapa.army.mil/)

TECHNICAL EXHIBIT 1

Performance Requirements Summary

Specification Item Performance

Objective AQL Method of

Surveillance Sample Size

Frequency

Health Assessments (5.1, 5.2)

Exams are performed in accordance with all regulations

97% Inspection 100% 100%

Visual Acuity Testing (5.3)

Testing is performed in accordance with Army Regulation 40-501

97% Inspection 100% 100%

Management of Profiles (5.4)

Contractor will maintain files and follow-up on profiled soldiers

97% Inspection 100% 100%

Prescription Management (5.5)

Contractor provides prescription services and oversight

97% Customer Feedback

100% 100%

Administrative Functions (5.6)

All reports and documents are submitted and input appropriately as defined

100% Inspection 100% 100%

Electrocardiogram Testing (5.7)

Testing is performed in accordance with Army Regulation 40-501

97% Inspection 100% 100%

Phlebotomy Services (5.8)

Testing is performed in accordance with Army Regulation 40-501

97% Inspection 100% 100%

Eye Exam Testing (5.9)

Testing is performed in accordance with Army Regulation 40-501

97% Inspection 100% 100%

DNA and ABO-Rh Testing (5.10)

Testing is performed in accordance with Army Regulation 40-501

97% Inspection 100% 100%

HIV Testing (5.11)

Testing is performed in accordance with Army Regulation

100% Inspection 100% 100%

Immunizations (5.12)

Testing is performed in accordance with Army Regulation

Hearing (5.13)

Testing is performed in accordance with

DA PAM 40-51

Performance Work Statement (PWS)

For

Dental Restorative Care

PART 1

GENERAL INFORMATION

1.1 Description of Services/Introduction: The contractor shall provide all personnel, equipment, tools, materials, supervision, and other items and non-personal services necessary to perform Dental Restorative Care as defined in this Performance Work Statement except as Specified in section C-3 as government furnished property and services within the state of North Carolina. The contractor shall perform to the standards in this contract.

1.2 Background: The North Carolina Army National Guard (NCARNG) recognizes the importance of Soldiers’ Dental Readiness. Individual Medical Readiness (IMR) and Fully Medically Ready (FMR) are the basic principles of force sustainment. Dental health is vital for force health protection and failure to achieve a standard level of oral health may preclude a Soldier from deployment status. The performance work statement includes the components of dental classifications for the Department of Defense (DOD) in order to identify varying degrees of dental health and readiness. This is to cover the various components of IMR/FMR to include; annual dental exams, digital bitewings radiographs, digital panoramic radiographs, DENCLASS data entry of all radiographs and dental records, identification and treatment (no less than 90+%) of all Class 3 soldiers eligible for treatment. Services are to be completed on site at NCARNG Armories & Training Sites across the State. The SOW identifies the purpose of the work to be performed by the contractor and provides a description of the work to be completed and any required outcomes. The contractor shall provide qualified personnel, material to perform the services, and /or OSHA, HIPPA, ADA, and Privacy Act Compliant Mobile, Self-Contained Dental Practices depending on the individual site needs for the NCARNG.

DoD established a uniform dental classification in HA Policy 02-11. DoD policy requires dental screening examinations and remediation to be accomplished and documented on 90%+ of service members. Members of the NCARNG shall receive an annual dental screening examination to determine their dental classification. The initial results of that screening examination shall be entered into the DENCLASS database on the date of examination.

Final data input by the contractor will be completed within 48 hours of state approval of the proposed treatment.

The DENCLASS database updates the Army Medical Protection System, MEDPROS. Dental treatment that may be required is essential to be provided at the SRP site to ensure the highest Dental Deployable Rate for the Mobilizing Soldiers.

1.3 Objectives:

• Conduct and complete FULL Restorative Care for the requirements of the NCARNG mobilizing and non-mobilizing Soldiers

• Conform to the standards of HIPPA, Privacy Act, and OSHA-Complaint mobile dental facility

• Dental services to be performed by licensed dental professionals

• Input to Medical Protection System (MEDPROS)

• Input to DENCLASS

• Upon completion of each event, must submit a detailed list of services performed

• Submit a DENCLASS and MEDPROS input summary report

1.4 Scope:

The scope of this contract is to fulfill the requirements of NCARNG IMR/FMR - Dental Readiness on all eligible (mobilizing or not) Service Members (SMs) in the NCARNG utilizing an HIPPA, Privacy Act, and OSHA- Compliant mobile health facility. Dental services shall be performed by licensed professionals with oversight by the NCARNG Office of the State Army Surgeon. As well, the NCARNG Soldiers that are Class 3 Dental Status (non-deployable without approved dental treatment) require OSHA & ADA-Compliant dental treatment.

1.5 Period of Performance: 23 October 2017 – 3 December 2017

1.6 General Information

1.6.1 Quality Control: The contractor shall develop and maintain an effective quality control program to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The contractor’s quality control program is the means by which he assures himself that his work complies with the requirement of the contract. As a minimum, the contractor shall develop quality control procedures that address the areas identified in Technical Exhibit 1, “Performance Requirements Summary”. After acceptance of the quality control plan the contractor shall receive the contracting officer’s acceptance in writing of any proposed change to his QC system.

1.6.2 Quality Assurance: The government shall evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan. This plan is primarily focused on what the Government must do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

1.6.3 Government Remedies: The contracting officer shall follow FAR 52.212-4, “Contract Terms and Conditions- Commercial Items” or 52.246-4, “Inspection of Services-Fixed Price” for contractor’s failure to perform satisfactory services or failure to correct non-conforming services.

1.6.4 Recognized Holidays: The contractor is required to perform services accordingly except on these Holidays:

New Year’s Day Labor Day

Martin Luther King Jr.’s Birthday Columbus Day

President’s Day Veteran’s Day

Memorial Day Thanksgiving Day

Independence Day Christmas Day

1.6.5 Hours of Operation/Place of Performance: The contractor is responsible for conducting restorative Care upon request between the hours of 0700-1900 on any required day of the week, except Federal holidays or when the Government facility is closed due to local or national emergencies, administrative closings, or similar Government directed facility closings. The Contractor must at all times maintain an adequate work force for the uninterrupted performance of all tasks defined within this statement of work when the Government facility is not closed for the above reasons. When hiring personnel, the Contractor shall keep in mind that the stability and continuity of the work force are essential.

1.6.6 Type of Contract: The Government intends to award a Firm-Fixed Price contract. This Performance Work Statement will be incorporated into contract.

1.6.7 Travel Requirements: Contractor will be fully responsible for the travel and all expenses for their staff. Travel is only limited to all and any duty station within the state of North Carolina.

1.6.8 Qualifications: Contractors must have a full understanding of Individual Medical Readiness (IMR) and Fully Medically Ready (FMR) in order to provide services to the NCARNG Soldiers. They must know the requirements of Dental Readiness for the state of North Carolina and be proficient with DENCLASS and MEDPROS.

• HIPAA certified

• Privacy Act

• OSHA & ADA compliant

1.6.9 Special Qualifications: The contractor is responsible for ensuring that all staff members are certified dental professionals. All dental assistants and staff shall be trained and professional with good morals and ethics.

1.6.10 Security Requirements: The contractor shall be responsible for safeguarding all government property provided for contractor use. At the close of each work period, government facilities, equipment, and materials shall be secured.

1.6.10.2 Key Control. (If Necessary) The Contractor shall establish and implement methods of making sure all keys/key cards issued to the Contractor by the Government are not lost or misplaced and are not used by unauthorized persons. NOTE: All references to keys include key cards. No keys issued to the Contractor by the Government shall be duplicated. The Contractor shall develop procedures covering key control that shall be included in the Quality Control Plan. Such procedures shall include turn-in of any issued keys by personnel who no longer require access to locked areas. The Contractor shall immediately report any occurrences of lost or duplicate keys/key cards to the Contracting Officer.

1.6.10.2.1. In the event keys, other than master keys, are lost or duplicated, the Contractor shall, upon direction of the Contracting Officer, re-key or replace the affected lock or locks; however, the Government, at its option, may replace the affected lock or locks or perform re-keying. When the replacement of locks or re-keying is performed by the Government, the total cost of re-keying or the replacement of the lock or locks shall be deducted from the monthly payment due the Contractor. In the event a master key is lost or duplicated, all locks and keys for that system shall be replaced by the Government and the total cost deducted from the monthly payment due the Contractor.

1.6.10.2.2. The Contractor shall prohibit the use of Government issued keys/key cards by any persons other than the Contractor’s employees. The Contractor shall prohibit the opening of locked areas by Contractor employees to permit entrance of persons other than Contractor employees engaged in the performance of assigned work in those areas, or personnel authorized entrance by the Contracting Officer.

1.6.10.3 Lock Combinations. (If necessary) The Contractor shall establish and implement methods of ensuring that all lock combinations are not revealed to unauthorized persons. The Contractor shall ensure that lock combinations are changed when personnel having access to the combinations no longer have a need to know such combinations.

These procedures shall be included in the Contractor’s Quality Control Plan.

1.6.10.4 Conservation of Utilities. The contractor shall instruct employees in utilities conservation practices. The contractor shall be responsible for operating under conditions that preclude the waste of utilities, which include turning off the water faucets or valves after using the required amount to accomplish cleaning vehicles and equipment.

1.6.11 Contracting Officer Representative (COR): The (COR) is identified below:

Primary: 2LT Jacquelyn Kahn, North Carolina Army National Guard HSS G1- JFHQ, 919-664-6804 email Jacquelyn.a.kahn.mil@mail.mil

The COR monitors all technical aspects of the contract and assists in contract administration The COR is authorized to perform the following functions: assure that the Contractor performs the technical requirements of the contract:

perform inspections necessary in connection with contract performance: maintain written and oral communications with the Contractor concerning technical aspects of the contract: issue written interpretations of technical requirements, including Government drawings, designs, specifications: monitor Contractor's performance and notifies both the Contracting Officer and Contractor of any deficiencies; coordinate availability of government furnished property, and provide site entry of Contractor personnel. A letter of designation issued to the COR, a copy of which is sent to the Contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the resulting order.

1.6.12 Contract Manager: The contractor shall provide a contract manager who shall be responsible for the performance of the work. The name of this person and an alternate who shall act for the contractor when the manager is absent shall be designated in writing to the contracting officer. The contract manager or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract.

1.6.13 Identification of Contractor Employees: All contract personnel attending meetings, answering Government telephones, and working in other situations where their contractor status is not obvious to third parties are required to identify themselves as such to avoid creating an impression in the minds of members of the public that they are Government officials. They must also ensure that all documents or reports produced by contractors are suitably marked as contractor products or that contractor participation is appropriately disclosed.

1.7 Security Training Requirements:

1.7.1 Base security will require all employees and affiliated personnel of the contractor to carry a State recognized identification card or drivers license and all vehicles are subject to search without reason. The contractor shall comply with all installation security requirements.

1.7.2 AT Level 1 Training: 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 15 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 15 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.

1.7.3 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.

mailto:Jacquelyn.a.kahn.mil@mail.mil https://atlevel1.dtic.mil/at

1.7.4 iWATCH Training. This standard language is for contractor employees with an area of performance within an Army controlled installation, facility or area. The contractor and all associated sub-contractors shall brief all employees on the local iWATCH program (training standards provided by the requiring activity ATO). This local developed training will be used to inform employees of the types of behavior to watch for and instruct employees to report suspicious activity to the COR.

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

1.7.6 For Contracts that Require OPSEC Training. Per AR 530-1, Operations Security, new contractor employees must complete Level I OPSEC training and must complete annual OPSEC awareness training.

1.7.7 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 .

1.7.8 For information assurance (IA)/information technology (IT) certification. Per DoD 8570.01-M , DFARS

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

PART 2

DEFINITIONS & ACRONYMS

ADA American Dental Association

AR Army Regulation

DA Department of the Army

DD DoD (Defense) Department

FMR Fully Medically Ready

HIPAA Health Insurance Portability and Accountability Act

IMR Individual Medical Readiness

MODS Medical Operational Data System

NGB National Guard Bureau

OSArS Office of the State Army Surgeon

OSHA Occupational Safety and Health Administration

RDA Registered Dental Assistant

SRC Soldier Readiness Check

SRP Soldier Readiness Processing

STR Soldier Treatment Record

SOW Statement of Work

TMC Troop Medical Clinic

NCARNG North Carolina Army National Guard

PWS – Performance Work Statement

Contracting Officer’s Representative (COR): A representative from the requiring activity assigned by the Contracting Officer to perform surveillance and to act as liaison to the contractor

CCE– Contracting Center of Excellence

Defective Service. A service output that does not meet the standard of performance associated with it in the Performance Work Statement.

Quality Assurance Surveillance Plan (QASP). An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

Quality Control. Those actions taken by a contractor to control the performance of services so that they meet the requirements of the PWS.

Quality Assurance. Those actions taken by the government to assure services meet the requirements of the Performance Work Statement.

PART 3

GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND SERVICES

3.1 GENERAL: Only parking will be provided for HIPAA, Privacy Act, OSHA & ADA-Compliant, Self Contained Mobile Medical/Dental Practices. No inside armory, TMC, or office space will be provided or utilized without prior approval from the Office of the Deputy State Surgeon.

PART 4

CONTRACTOR FURNISHED ITEMS AND SERVICES

4.1 General: Except for those items specifically stated to be government furnished in Part 3, the contractor shall furnish everything required to perform this PWS.

PART 5

SPECIFIC TASKS

5.1 Digital Bitewings, Digital Panoramic Radiographs & Dental Exams: The contractor shall perform required dental examinations to include digital bitewings and digital panoramic radiographs if clinically indicated in support of the annual dental screenings in accordance with the AR 40-501 and AR 40-35 in an undetermined number of Armories and training sites in North Carolina to be determined in each delivery order. The contractor must use HIPAA, Privacy Act, OSHA & ADA-Compliant Mobile Dental Practice or Portable Dental equipment. The contractor shall have experience in and capability to upload all exam and digital radiographs into the DENCLASS system. The contractor shall ensure all soldiers have a current Panoramic Radiograph on file and if missing, the contractor shall perform new radiographs. Adherence to all OSHA requirements, State and Federal Regulations are mandatory.