PWS REV 1.pdf

1.0 General:

1.1 Scope: The Montana Army National Guard (MTARNG) Occupational Health (OH) seeks occupational health medical clinical services, with a physician who is board certified in occupational medicine, to conduct job-related medical surveillance screening examinations and OH services for MTARNG federal technicians (hereafter referred to as technicians) who are exposed or have the potential to be exposed to health hazards in their work environment. This requirement is for “Non-Personal Health Care Services”, as defined in the Federal Acquisition Regulation (FAR) 37.101. In accordance with (IAW) FAR Part 37.4 the Government may enter into a non-personal health care service contract with physicians, dentists, and other health care providers under authority of 10 U.S.C. 2304 and 41 U.S.C. 253. The Government shall evaluate the quality of professional and administrative services provided, while the government retains no control over the medical, professional aspects of services rendered.

1.1.1 Objectives. The Montana Army National Guard (MTARNG) Occupational Health Program encompasses providing job-related medical examinations. The Contractor shall provide a Board-Certified Occupational Medicine Provider (BCOMP) to oversee and/or conduct job-related/hazard based OH medical surveillance examinations and OH consultation services IAW AR 40-5. An occupational medical evaluation is required for each technician designated to be in the MTARNG medical surveillance program at the time of hire or placement in a new position requiring surveillance, periodically while performing work requiring medical surveillance and at the time of termination from a position requiring surveillance. Exams are performed to identify any health ailments precluding an individual from performing the essential functions of their position, to prevent work-related health ailments by assessing the health status of individuals in relation to their work, and making medical recommendations regarding placement, accommodation, and exposure controls. The classification of medical examinations includes medical surveillance and medical qualification examinations.

1.1.1.1 Medical qualification examinations are performed to determine if the employee can safely and efficiently perform the essential job functions of their position, and can include the following examinations: pre-placement, return-to-work, fitness for duty, functional capacity, and medical certification.

1.1.1.2 Medical Surveillance Examinations are performed when workplace exposures may cause illness or injury and encompass hazard baseline, periodic, termination, and incidental evaluations.

1.1.1.3 Personnel not included under these examinations are State Employees, civilian contractors, Active Guard Reserve, Active Duty for Operational Support (ADOS) and part-time traditional Soldiers.

1.2 Background: This is a non-personal services contract to provide job-related Occupational Health Examinations and Medical Surveillance Services to the MTARNG full-time support (FTS) and/or temporary personnel who are exposed to OSHA level Permissible Exposure Limit (PEL) health hazards in the work environment. MTARNG technicians must be monitored for the impacts of known and potential workplace exposures and be provided medical surveillance evaluations based on job code and/or identified exposures.

1.2.1 In accordance with (IAW) the Occupational Safety and Health Administration (OSHA), Title 29 Code of Federal Regulations (CFR) § 1910, Department of Defense Manual 6055.05, Occupational Medical Examinations: Medical Surveillance and Medical Qualification, Army Regulation (AR) 40-5 Army Public Health Program, AR 40-501 Standards of Medical Fitness and National Guard Regulation (NGR) 40-5, ARNG Occupational Health Program, employees must be monitored for the impacts of workplace exposures (known and potential) and provided medical surveillance evaluations based on job code and/or identified exposures. The medical surveillance program is a risk-based medical screening and examination process to monitor adverse health effects due to work related exposures and to improve and maintain technician health. The program incorporates various elements that identify technician workplace exposures to physical, chemical, biological, and radiological hazards, the effects of such exposure and directs measures to prevent occupational illnesses and injuries associated with these exposures. Program requirements vary based on the individual’s job code, the type of work performed, and the exposures at the worksite.

1.3 Period of Performance (PoP): The period of performance shall be twelve (12) months from the award date. This is NOT an options contract.

1.4 General Information

1.4.1 Place and Performance of Service: The contractor shall provide services between their regular clinic hours of operation, Monday through Friday, except of recognized US holidays.

Performance shall be at locations within 50 miles of Helena, Montana where the capability to perform all required testing can be performed.

1.4.2 Recognized Holidays: The following are recognized United States (US) holidays. The contractor shall not perform services on these days:

1.4.2.1 New Year’s Day

1.4.2.2 Martin Luther King, Jr.’s Birthday

1.4.2.3 President’s Day

1.4.2.4 Memorial Day

1.4.2.5 Juneteenth National Independence Day

1.4.2.6 Independence Day

1.4.2.7 Labor Day

1.4.2.8 Columbus Day

1.4.2.9 Veteran’s Day

1.4.2.10 Thanksgiving Day

1.4.2.11 Christmas Day

1.4.3 Contract Manager (CM): The contractor shall designate a CM who shall ensure performance under this contract. The name of this person, and an alternate who shall act for the contractor when the CM is absent, shall be designated in writing to the KO. The CM or alternate shall have full authority to act for the contractor on all contract matters relating to the daily operation of this contract. The CM shall work through the COR, (or the KO if a COR is not assigned), to resolve issues, receive technical instructions, and ensure adequate performance of services. The CM shall ensure that contractor employees do not perform any services outside the scope of the contract without an official modification issued by the KO. The CM shall ensure contractor employees understand that services performed outside the scope of the contract are performed wholly at the expense of the contractor.

1.4.4 Quality Control (QC): The contractor shall develop and maintain an effective Quality Control Plan (QCP) to ensure services are performed IAW this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The contractor’s QCP is how it assures itself that its work complies with the requirements of the contract. As a minimum, the contractor shall develop QC procedures that address the areas identified in the Performance Requirements Summary (PRS). After acceptance of the QCP, the contractor shall obtain the Contracting Officer’s (KO) acceptance in writing of any proposed changes to its QCP. The QCP shall be provided to the KO no later than 15 days after award.

1.4.5 Quality Assurance (QA). The Government will evaluate the contractor's performance under this contract in accordance with the Quality Assurance Surveillance Plan (QASP). This plan is primarily focused on what the Government will 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 acceptable quality level(s) or defect rate(s).

1.4.6 Protection of Personally Identifiable Information (PII). The contractor shall protect all PII encountered in the performance of services in accordance with Defense Federal Acquisition Regulation Supplement (DFARS) 224.103 Personally Identifiable Information and Department of Defense Directive (DoDD) 5400.11, Department of Defense 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 whose PII has been compromised.

1.5 Special Qualifications. The contractor shall provide a Board-eligible or -Certified Occupational Medicine Physician, or other Licensed Practitioner (Nurse Practitioner of Physician Assistant) to conduct job-related medical surveillance physical examinations and occupational health consultation services. A Board-Certified Occupational Medicine Physician (BCOMP)must conduct medical reviews and final determinations for the medical surveillance examinations and Occupational Health Services. Documentation of license and certifications will be made available to the MTARNG OHN no later than 15 days after the award. The personnel will operate under the supervision and direction of a BCOMP.

1.5.1 BCOMPs shall be qualified in occupational health and assisted by trained personnel or physician’s assistants qualified in the occupational health field. Each certified Medical Examiner must be licensed to practice in the state in which they reside. Staff must include certified medical examiners listed on the National Registry of Certified Medical Examiners in accordance with Title 49, C.F.R. §391.41-49

1.5.2 Contractor shall ensure all procedures are conducted in accordance with applicable American Board of Occupational and Environmental Medicine (ABOEM), American Association of Occupational Health Nurses (AAOHN), U.S. Department of Labor, Occupational Safety and Health Administration (OSHA), and the National Institute for Occupational Safety and Health (NIOSH) Standards.

1.5.3 Contractor shall ensure all clinical laboratory services are performed by a laboratory licensed through the U.S. Department of Health and Human Services (DHHS), Health Care Financing Administration pursuant to the terms of the Clinical Laboratories Improvement Act of 1967 (42 U.S.C. 263a) and the College of American Pathologies.

1.5.4 Audiometric testing must be performed by contractor employees in accordance with 29 CFR 1910.95, and who are certified by the Council for Accreditation in Occupational Hearing Conservation (CAOHC) and able to perform an otoscopic examination IAW DA Pam 40-501.

This certificate must be provided to verify training.

1.5.5 Contractor employees performing Pulmonary Function Tests (PFTs) must be a licensed physician, Certified Pulmonary Function Technologist, or a Registered Respiratory Therapist with spirometry certification every five (5) years. Contractor employees reviewing PFTs must be a Board-Certified Occupational Medicine Physician in accordance with 29 CFR 1910.1001.

Personnel conducting pulmonary function testing will be certified through a program approved by the NIOSH and IAW 29 CFR § 1910.134.

1.5.6 Personnel must be appropriately trained and licensed to operate an x-ray machine. The x-ray equipment will be in excellent working conditions, appropriately maintained, calibrated, and licensed prior to use: see appendix E of part§ 1910.1001 of for chest X-Ray schedule and B-reader requirements.

1.5.7 Contractor employees performing laboratory testing must be certified under the American Society of Clinical Pathology.

1.5.8 Personnel performing blood draw and lab operations must be trained and skilled in the task of specimen collection.

1.5.9 Personnel conducting visual acuity test and vision screening must be trained and skilled in performance of task.

1.5.10 All contractor employees accessing patient records, data, or obtaining health information must complete the annual Health Insurance Portability and Accountability Act (HIPM) training and must comply with the requirements stipulated in the Act of 1996.

1.6 Post Award Conference/Periodic Progress Meetings. The contractor agrees to attend any post award conference convened by the Contracting Officer (KO) IAW FAR Subpart 42.5. The KO, COR, and other Government personnel, as appropriate, may meet periodically with the contractor to review the contactor’s performance using performance objectives as outlined in the QASP. At these meetings, the COR will use QASP evaluation factors to apprise the contractor of how the Government views the contractor’s performance and the contractor shall inform the Government of problems, if any, being experienced. The contractor shall resolve any outstanding issues raised by the Government. Contractor attendance at these meetings shall be at no additional cost to the Government.

1.7 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, the actions that will be taken against employees for violations of this policy. The contractor shall take appropriate action, up to and including termination, against employees or subcontractors that violate the US Government policy as described at FAR 22.17.

1.8 Organizational Conflict of Interest. Contractor and subcontractor personnel performing work 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 a current or subsequent Organizational Conflict of Interests (OCI) as defined in FAR Subpart 9.5. The Contractor shall notify the Contracting Officer immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and shall promptly submit a plan to the Contracting Officer to avoid or mitigate any such OCI. The Contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the Contracting Officer and in the event the Contracting Officer unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the Contracting Officer 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.

1.9 COMSEC/IT Security. All communications with DoD organizations are subject to communications security (COMSEC) review. All telephone communications 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 that any time the contractor places or receives a call they are subject to COMSEC procedures. The contractor shall ensure a wide and frequent dissemination of this information to all employees dealing with DoD information. The contractor is not authorized to use the Government's computer network.

1.10. Data Rights. The Government has unlimited rights to all documents/material produced under this contract. All documents and materials, including the drafted reports and photographs produced under this contract shall be Government owned and are the property of the Government with all rights and privileges of ownership/copyright belonging exclusively to the Government.

These documents and materials may not be used or sold by the contractor without written permission from the KO. All materials supplied to the Government shall be the sole property of the Government and may not be used for any other purpose. This right does not abrogate any other Government rights.

1.11 Protected Health Information (PHI). The contractor shall not release any medical or personal information of a technician without first receiving written approval from the COR. The COR will provide the regulations upon request by the contractor IAW FAR 52.212-4, Privacy of Protected Health Information (DEC 2002) [Health Information Portability and Accountability Act (HIPAA)].

2.0 Definitions and Acronyms.

2.1. Definitions.

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 contractor.

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 KO is the only individual who can legally bind the Government.

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

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

2.1.4. DEFECTIVE SERVICE. A service output that does not meet the standard of performance associated with the Performance Work Statement.

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 that are evaluated in a source selection process and that may be required to be used in the performance of a contract by the Key Personnel listed in the PWS. When key personnel are used as an evaluation factor in best value procurement, an offer can be rejected if it does not have a firm commitment from the persons that are listed in the proposal.

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 that 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 that the quality of a product or service shall meet contract requirements.

2.1.11. SUBCONTRACTOR. One that enters into a contract with a prime contractor. The Government does not have a contract with the subcontractor.

2.1.12 WORKDAY. The number of hours per day the Contractor provides services IAW with the PWS.

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

2.2 Acronyms

AR Army Regulation AT/OPSEC Antiterrorism/Operational Security BCOMP Board Certified Occupational Medicine Provider BI Background Investigation CFR Code of Federal Regulations CM Contract Manager COR Contracting Officer Representative DA Department of the Army DFARS Defense Federal Acquisition Regulation Supplement DoD Department of Defense FAR Federal Acquisition Regulation FTS Full Time Support GFP/M/E/S Government Furnished Property/Material/Equipment/Services IA Information Assurance IS Information System(s) KO Contracting Officer MTARNG Montana Army National Guard NGB National Guard Bureau OCI Organizational Conflict of Interest OH Occupational Health OHN Occupational Health Nurse PEL Permissible Exposure Limits PII Personally Identifiable Information POC Point of Contact PPE Personal Protective Equipment PRS Performance Requirements Summary PWS Performance Work Statement QA Quality Assurance QASP Quality Assurance Surveillance Plan

QC Quality Control QCP Quality Control Program SSN Social Security Number TE Technical Exhibit

3.0 Government Furnished Property, Material, Equipment and Services (GFP/M/E/S). The Government will provide materials listed below solely for the purpose of performance under this contract:

3.1 Property. None.

3.2. Materials. The Government will furnish any agency specific forms necessary. Government will furnish specific criteria for testing.

3.3 Equipment. None.

3.4 Utilities. None.

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 section 5.0, the contractor shall furnish the required facilities, materials, and equipment to perform services as indicated in this PWS.

5.0 Requirements: The contractor shall:

5.1 General:

The contractor shall indemnify the Government for any liability producing act or omission by the Contractor, its employees and agents occurring during contract performance. The contractor shall furnish evidence of its insurability concerning the medical liability insurance required by this clause with the contractor’s quote, prior to award.

5.1.1 The contractor shall provide Occupational Health Medical Qualification and Medical Surveillance Examinations to include, but not limited to: Baseline, Periodic, Termination, Transfer, Return-to-Work, Functional Capacity Evaluation, Fit for Duty, Post-exposure, and medical certification. Other occupational health services shall be provided upon request.

5.1.2 Contractor shall ensure all procedures are conducted in accordance with applicable American Board of Occupational and Environmental Medicine (ABOEM), American Association of Occupational Health Nurses (AAOHN), U.S. Department of Labor, Occupational Safety and Health Administration (OSHA), and the National Institute for Occupational Safety and Health (NIOSH) Standards.

5.1.3 Contractor shall provide a Board eligible or Certified Occupational Medicine Physician to conduct or provide oversight of physician assistants or nurse practitioners with appropriate qualifications, training, licensing, and experience in occupational health performing physical examinations and occupational health consultation services.

5.1.4 Contractor shall ensure instrumentation must meet or exceed appropriate performance standards, and accuracy must be verified in accordance with current Occupational Medicine Certification standards.

5.1.5 The services requested are for testing, screening, and evaluation purposes, therefore, medical treatment is not required nor authorized. In the event additional examinations, including testing, are necessary to determine whether a suspected issue or condition is occupationally related; the provider must consult with the MTARNG OHN prior to conducting for approval.

5.2 Examination, Screening, and Testing Services:

5.2.1 Laboratory Tests and Panels. Testing will be requested based on the requirements of the job code/job title and known or suspected exposures for each code or title. The list of testing requirements for each technician will be provided by the MTARNG OHN to the contracted provider. The process for the storage, transport and handling of specimens must be in place to ensure the quality of the specimen to be analyzed. The contractor will be responsible for specimens that are ruined due to reason not the fault of the technician and will coordinate for the re-collection of specimens with the technician. The contractor shall adhere to the Centers for Disease Control (CDC) guidelines related to standard communicable precautions as well as 29 CFR § 1910.30, OSHA Bloodborne Pathogen standard. The MTARNG is not responsible for training contracted staff.

5.2.2. Testing Requirements: The contractor shall ensure all testing, evaluation and examination procedures are conducted IAW applicable American Board of Occupational and Environmental Medicine (ABOEM), U.S. Department of Labor, OSHA, National Institute for Occupational Safety and Health (NIOSH) and Department of Defense (DoD) and Army regulations.

5.2.2.1. Audiogram - IAW Department of the Army Pamphlet (DA PAM) 40-501, Department of Defense (DoD) 6055.05-M.

5.2.2.1.1 All personnel performing audiograms must be certified by the Council for Accreditation in Occupational Hearing Conservation (CAOHC) and able to perform an otoscopic examination IAW DA Pam 40-501.

5.2.2.1.2 All personnel performing audiograms shall ensure hearing aids and any other objects that may interfere with testing are removed prior to administering test.

5.2.2.1.3 Audiometric testing shall be conducted IAW DoDI 6055.12, 4(e) and DA PAM 40-501, chapter 3, (3-6), chapter 7, (7-5) guidelines.

5.2.2.1.4. Annual comprehensive electro-acoustical calibration and daily calibration and functional checks shall be performed for each audiometer. Documentation that these have been completed shall be kept by contractor and made available to the OHN upon request.

5.2.2.1.5 Audiometric testing shall be conducted in a sound booth in a testing environment with noise levels not to exceed the requirements outlined in DA PAM 40-501, Table 3-2, or in an equivalent environment with no outside sound distractions.

5.2.2.2. Chest x-ray (CXR) - IAW DoD 6055.05-M. Standard 2 view CXR per individual technician actual or potential exposure. Contractor personnel shall be appropriately trained and licensed to operate an x-ray machine. The x-ray equipment shall be appropriately maintained, calibrated, and licensed prior to use: see appendix E of part § 1910.1001 for chest X-Ray schedule.

5.2.2.3. Laboratory Testing - IAW DoD 6055.05-M. Contractor personnel shall ensure all clinical laboratory services are performed by a laboratory licensed through the U.S. Department of Health and Human Services (DHHS) Health Care Financing Administration pursuant to the terms of the Clinical Laboratories Improvement Act of 1967 (42 U.S.C. 263a) and the College of American Pathologists. Equipment and instrumentation shall meet or exceed appropriate performance, calibration, and maintenance standards. Contractor personnel performing blood draw and lab operations shall be trained and skilled in the task of specimen collection. Tests may include any or all of the following:

5.2.2.3.1. Complete Blood Count with differential (CBC w/diff)

5.2.2.3.2 Liver Function Testing

5.2.2.3.3 Comprehensive Metabolic Panel (CMP)

5.2.2.3.4 Heavy Metals

5.2.2.3.5 Blood Zinc Protoporphyrin (ZPP)

5.2.2.3.6 Blood Lead (BL)

5.2.2.3.7 Blood Cadmium (CdB)

5.2.2.3.8 Urine Cadmium (CdU)

5.2.2.3.9 Beta 2 Microglobulin

5.2.2.3.10 Urinalysis (UA) - dipstick

5.2.2.4 Spirometry/Pulmonary Function Test (PFT) - IAW DoD 6055.05-M

5.2.2.4.1. Contracting personnel conducting pulmonary function testing will be certified through a NIOSH approved program and IAW 29 CFR § 1910.134.

5.2.2.4.2 Contractor shall ensure Pulmonary Function Tests (PFTs) are performed by a licensed physician, Certified Pulmonary Function Technologist, or Registered Respiratory Therapist in accordance with 29 CFR 1910.1001.

5.2.2.5. Vision Screening. - IAW DoD 6055.05-M, DA PAM 40-506 (corrected near and distant monocular and binocular visual acuity, depth perception, color, confrontational visual fields)

5.2.2.6 Medical Screening. Medical screening shall consist of the following IAW DoD 6055.05-M and rendered on a case-by-case basis as arranged by the OHN. The provider will utilize historical records in the evaluation and examination of technician in the event a termination examination is requested.

5.2.2.7 Medical History – medical history including past, current, and family status, home exposures, work exposures, work related complaints (past and current), hearing, ergonomic, and use of PPE at work.

5.2.2.8 Physical Examination – height and weight, vital signs and assessment of body systems including vision, hearing, cardiopulmonary and musculoskeletal assessments.

5.2.2.9 Screening Examination – interview with technician to discuss available results and questionnaires and annotate notes in medical record.

5.2.2.10 Medical Clearance for Respirator Use – IAW 29 CFR § 1910.13, App C and AR 11- 34; review of spirometry results and OSHA Respirator Medical Questionnaire, as applicable.

Written medical clearance for respirator use signed by physician.

5.2.2.11 Fit Testing - contractor personnel will be appropriately trained to perform qualitative and quantitative fit testing IAW appendix A of 29 CFR § 1910-134 for requested fit testing procedures.

5.2.2.12. Fitness for Duty (FFD) - IAW DoD 6055.5-M; provide written documentation of physician's determination of the technician's ability to perform the assigned duties including essential job functions medically and physically without substantial risk of harm to themselves, others or the workplace.

5.3 Scheduling:

5.3.1 Contractor shall arrange for initial coordination of services with the designated Occupational Health Nurse (OHN) within fifteen (15) working days after award of the contract.

Instructions and required paperwork for technicians will be forwarded to: Montana Army National Guard, Safety and Occupational Health Office, Attn: Occupational Health Nurse, 3333 Skyway Drive, Helena, MT 59602 and be received no later than 15 days prior to the start date of service.

5.3.2 The contractor shall consult with the MTARNG OHN by telephone and/or email to coordinate or resolve issues that may arise before, during, and after the examination period. If the MTARNG OHN is unreachable by telephone, the contractor is authorized to leave a message, as telephones listed for the MTARNG OHN are secure.

5.3.3 The contractor shall work directly with the MTARNG OHN to schedule examinations. If there is a question about examination requirements or specifications, the contractor shall first consult the MTARNG OHN for approval prior to conducting the procedure.

5.3.4 Coordination of scheduling shall be a joint effort between the MTARNG OHN and the contractor. In most cases, the MTARNG OHN will submit an exam request to the contractor, notify the employee and supervisor of the exam request, and then have the employee or supervisor call the contractor directly to schedule the exam. Once an exam is scheduled, the contractor shall call or email the MTARNG OHN to notify the OHN of the scheduled exam date and time. MTARNG employees may be scheduled for their examinations on a routine and/or as needed basis, to be determined by the MTARNG OHN, over a 12-month period. Each employee’s occupational exposures, both real and potential, are different, components of these exams will be determined on a case-by-case basis and communicated by MTARNG’s OHN to the contractor prior to the appointment scheduling.

5.3.5 Prior to scheduling exams, the MTARNG will generate all necessary non-contractor exam paperwork for the corresponding exam type. For medical qualification examinations, the individual’s position description, and optional form 178 will be provided. For medical surveillance examinations, an exposure data summary will be provided. The MTARNG OHN will send all paperwork to the contractor via secured/encrypted email with all attachments.

5.3.6 The contractor shall email the MTARNG a schedule of examination appointments (include employee’s name, date, time, and location of examination) within 10 business days from when a written request is made by the MTARNG OHN.

5.3.7 If coordination of exams is done over the phone, a follow-up email to confirm the information discussed telephonically will be sent by the MTARNG OHN to the contactor by close of business that day.

5.3.8 In the event of an equipment failure in the contracted clinic or a missed or incorrect examination procedure, specific testing and/or parts of examinations that are not completed during the testing period shall be completed, at no cost to the MTARNG, at a later scheduled time that is mutually convenient for the employees and the contractor. The new schedule shall be communicated to the MTARNG OHN via email or phone within 48 hours.

5.3.9 If a MTARNG employee is a “No Show” to a scheduled appointment, the contractor shall contact the employee, or the employee’s supervisor withing 24 hours via telephone to reschedule. The contractor shall also provide a follow-up email notification (within 48 hours of a missed appointment) to the MTARNG OHN, indicating the missed appointment and appointment reschedule date(s).

5.3.10 The contractor shall schedule appointments to allow all examination procedure and testing components to be completed in one day. Exceptions must be approved by the MTARNG OHN.

5.4 Documentation and Reports

5.4.1 Medical Report: Medical examination results that are received after the service date shall be reviewed by Board Certified Occupational Medicine Physician (BCOMP) and be provided to MTARNG OHN via trackable mail, with any recommendations for further care or follow-up.

Results shall include all diagnostic tests, graphs, charts, reports, questionnaires, waivers, consent forms, clearance letters, and physical findings within 15 days of examination completion. One copy shall also be mailed to the employee’s home of record.

5.4.1.1 The Contractor will provide a cover letter to each technician to whom examination documents are sent. The letter will be individualized and will summarize in lay terms individual test results, along with any recommendations as warranted by results, for the technician to follow up with their personal physician as indicated. A copy of the cover letter will also be sent with the examination documents to the MTARNG OHN. At the discretion of the Contractor, a disclaimer may be added to the examination cover letter stating, “If you require further information, and or have questions related to the exam results; you are welcome to reply within thirty days of receipt.

If no response, we presume you acknowledge and accept”.

5.4.2 Contractor shall identify all medical records with the technician’s full name, the last four digits of social security number, date of birth (DOB), and job code at a minimum. The Contractor shall ensure work / health history forms and medical reports are complete and legible (typed / printed) with the date of service annotated on each form and the signature or co-signature of the BCOMP.

5.4.3 If abnormal findings are identified that may be a serious health concern, the contractor shall notify the technician immediately of any recommendations and will also notify the MTARNG

OHN.

5.4.4 The contractor shall abide by applicable Army regulations governing the handling and storage of medical records IAW AR 40-66. Technician personnel and medical documentation will only be provided to the technician and MTARNG OHN. The privacy of the technician must be ensured at all times. Under no circumstances shall written results be given to the employee’s supervisor, or any other MTARNG employees, other than the examined employee and the

MTARNG OHN.

5.4.5 Examination results/reports, invoice copies and any other correspondence will be addressed to MTARNG Safety and Occupational Health, Attn: Occupational Health, 3333 Skyway Drive, Helena, MT 59602. An itemized invoice (1 copy) will be submitted to the MTARNG OHN via encrypted email, within fifteen (15) days of the technician examination.

5.4.5.1 The cover letter and original medical report packet addressed to the MTARNG’s OHN

5.4.5.2 The outside of the interior envelope (containing exam documentation) shall be marked:

CONFIDENTIAL-TO BE OPENED BY ADDRESSEE ONLY

5.4.5.3 Copies provided (sent) in bulk to the MTARNG OHN shall be sent in appropriately secured, correctly sized individual envelopes, not folded.

5.5 Notification of Abnormal Results and Findings

5.5.1 Contractor shall immediately report to the OHN by telephone or encrypted electronic method if results of tests and exams which are questionable, or critical significance, or require follow-up.

5.5.2 For urgent, follow-up, exam-related findings that are not work related, the contractor shall contact the employee directly within 48 hours of examination and provide follow-up instructions.

5.5.3 For all examinations, any critical items, abnormalities, work restrictions, or referrals to other medical specialists identified by the contractor shall be communicated, first via telephone, followed by a secure encrypted email, to the MTARNG OHN within seven (7) business days of a completed exam to ensure continuity of care.

5.6 Invoice and Pricing:

5.6.1 Invoices shall be itemized and include the employee’s name, and all tests/services performed with the cost for each test/service performed as well as the total cost for the patient.

Invoices shall be provided to the MTARNG OHN AND the contracting officer prior to submitting it to Wide Area Workflow. Once approved, the contractor shall upload an invoice, for all services performed under this contract, to the Wide Area Workflow (WAWF) module within the Procurement Integrated Enterprise Environment (PIEE) at https://piee.eb.mil/, unless the Government Purchase Card is used for immediate payment.

5.6.1.2 The contractor shall only invoice for services scheduled by the Montana Occupational Health Nurse and were provided.

5.6.1.3. The contractor shall not invoice the employee, an insurer, or anyone else for services rendered. The only compensation the contractor is entitled to is for the performance of the contract, outlined in paragraph 5.0.

5.6.1.4 The contractor shall invoice by submitting an invoice through WAWF, only for service rendered that were pre-approved by the MTARNG OHN.

5.7. Conduct.

5.7.1. The contractor personnel must always act in a professional manner when interfacing with MTARNG technicians and staff.

5.7.2. All providers and technicians accessing patient records, data or obtaining health information must complete the annual training and comply with the requirements of the HIPAA act of 1996. Training completion certificates will be submitted to the MTARNG OHN within 15 days of service start date for staff.

5.7.3. Personal appearance. The contractor and staff shall present a professional appearance and conduct themselves in a professional manner at all times. Contractors and staff will present with good personal hygiene and ensure clothing is clean and neat on their person. Clothing will not be derogatory or offensive in nature or suggestive of sexual behavior or conduct unbecoming in the presence of MTARNG technicians and staff.

5.7.4. The contractor shall abide by applicable laws and regulations governing safety and health programs.

5.8. Malpractice insurance. The contractor is responsible for purchasing medical malpractice insurance under this contract. Proof of insurance shall be provided to the KO with the contractor’s quote, prior to the award.

5.9. Complete disclosure. Complete disclosure of any past incidents involving the professional duties of staff which might have an impact on their professional standing, such as charges (unless acquitted) involving either felonies or misdemeanors (other than minor traffic violations) is a necessary part of the competency process. This disclosure must also specifically include reports of any actions, claims, charges of malpractice ever brought against any of the staff or subcontractors (either individually or as a part of a group), as well as the outcome (or status) of any such case. Any such incident will be evaluated by the KO who will determine whether it should be disqualifying.

5.9.1. If at any time during the contract period it is discovered through a medical center investigation or any investigation that a contractor employee is currently pending charges, or has previously been convicted of any incidents, the contract may be terminated for cause pending further investigation.

5.10. Litigation. In the event of litigation/investigation of a claim of liability or malpractice the contractor shall cooperate fully with Government authorities and designated officials in the investigation of the claim or preparation of litigation. The contractor shall immediately notify the KO and COR of any claims and promptly furnish copies of all pertinent papers received;

cooperate with the Government in the processing, review, settlement, or defense of the suit, action, or claim; and authorize Government representatives to settle or defend the claims and to represent the healthcare provider in, or take charge of, any litigation involved in such action.

6.0 Applicable Publications.

TECHNICAL EXHIBIT 1

Performance Requirements Summary

This Performance Requirements Summary Includes performance standards. The Government will use these standards to determine the contractor’s performance and will compare contractor performance to the Acceptable Quality Level (AQL).

PWS

Paragraph

Task Performance Standard

Acceptable Quality Levels

(AQL)

Surveillance Method/By

Whom

5.3.10 Contractor shall

be able to provide all exams and testing requirements at location employee is scheduled in one visit

No more than one employee a month will be required to visit an alternate site or more than one visit to complete exams and tests.

Employees will not need to report to more than one site or for more than one visit to complete required testing and exams.

Employee Feedback

5.2 Contractor

ensures each employee receives the correct testing and examinations identified during scheduling

No more than one employee a month is identified as not receiving correct testing or examinations.

Employees receive correct testing and exams

Inspection of medical documentation by the MTARNG

OHN

5.3 Contractor

schedules employees within 15 days of receiving request from the

MTARNG OHN

No more than one employee a month is not scheduled as agreed upon with the

MTARNG OHN

Employees receive scheduled appointments within 30 days of being identified

Employee feedback

5.4.1 Contractor

provides exam and test results within 15 days of exam completion

No more than one employee’s results are received later than 15 days per month

Test results are received by the

MTARNG OHN

within 15 days of exam completion

Date stamp of medical records received in the mail by the

MTARNG OHN

TECHNICAL EXHIBIT 2

Deliverables Schedule

PWS

Reference/Deliverable

Title

Frequency Number of Copies

Medium/Format Submit To:

5.4.5 Invoicing Upon

completion of exams

1 Email and WAWF MTARNG OHN and KO

1.4.4 QC Plan 15 days after

award

1 Email KO

5.4.1 Exam/Test Results 15 days after

exam completion

2 Trackable Mail OHN and Employee

1.5 BCOMP License and

Certification

15 days after award

1 Email MTARNG OHN and KO

5.1 Proof of Insurance At time of quote 1 Email KO

5.3.6 Appointment

Schedules 10 business days after request by

OHN

1 Email MTARNG

OHN

5.5 Abnormal Results Immediately 1 Telephonic then

encrypted email

MTARNG

OHN

5.5.2 Referrals or urgent

follow-up

48 hours after exam completion

1 Telephonic Employee

5.8 Malpractice Insurance At time of quote 1 Email KO

TECHNICAL EXHIBIT 3

Estimated Workload Data

(This information is provided for historical background only. It is not a guarantee of workload quantities)

Location Exam/Test # of Personnel

Helena Surface Maintenance Baseline 10 Aircraft Maintenance Baseline 9

Allied Trades Baseline 1 Electronics Baseline 10

Audiograms 48

Surface Maintenance Baseline

Aircraft Maintenance Baseline

Allied Trades Baseline

Electronics Baseline

Audiogram

Physical Exam X X X X Complete Blood Count w/Diff

X X X X

Comprehensive Metabolic Panel

X X X X

Urinalysis X X X X Lead X X X X

ZPP X X X X

Blood Cadmium and Chromium

X X

Urine cadmium X X Urine Beta 2 Microgloblin

X X

Spirometry (respiratory user Only)

X X X X

Chest Xray, 2 View

X X X X

Audiogram X X X X X Vision: Near, distant, color, depth perception, field of vision

X X X X