W9127820R0006 0002 Amendment 0002.pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER (Type or print)

30-105-04EXCEPTION TO SF 30

APPROVED BY OIRM 11-84

STANDARD FORM 30 (Rev. 10-83)

Prescribed by GSA

FAR (48 CFR) 53.243

The purpose of this Amendment is to extend the closing date until March 06, 2020.

Please see Amendment for solicitation changes.

1. CONTRACT ID CODE PAGE OF PAGES

J 1 15

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

16C. DATE SIGNED

BY 27-Feb-2020

16B. UNITED STATES OF AMERICA15C. DATE SIGNED15B. CONTRACTOR/OFFEROR

(Signature of Contracting Officer)(Signature of person authorized to sign)

8. NAME AND ADDRESS OF CONTRACTOR (No., Street, County, State and Zip Code) X W9127820R0006

X 9B. DATED (SEE ITEM 11)

12-Dec-2019

10B. DATED (SEE ITEM 13)

9A. AMENDMENT OF SOLICITATION NO.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

X The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offer X is extended, is not extended.

Offer must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended by one of the following methods:

(a) By completing Items 8 and 15, and returning 1 copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted;

or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE

RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN

REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS.

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE

CONTRACT ORDER NO. IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(B).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor is not, is required to sign this document and return copies to the issuing office.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

10A. MOD. OF CONTRACT/ORDER NO.

2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO.(If applicable)

6. ISSUED BY

3. EFFECTIVE DATE

27-Feb-2020

CODE

ENDIST MOBILE CONTRACTING DIVISION

109 ST JOSEPH ST

MOBILE AL 36602

W91278 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE

See Item 6

FACILITY CODECODE

EMAIL:TEL:

W9127820R0006

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 1449 - CONTINUATION SHEET

The following have been added by full text:

AMENDMENT 0002 CHANGES

Section 9.1.1 has been updated to reflect the following changes:

Previous:

9.1.1 The Contractor is to provide an onsite health care provider (HCP) who is a MD, DO, CRNP or PA-C for 2 hours twice a month in a fully functional, staffed health unit at the Savannah, GA clinic when exams are scheduled. The starting date of this service will be as agreed upon between the Contractor and the Corps of Engineers.

Updated Changes:

9.1.1 The Contractor is to provide an onsite health care provider (HCP) who is a MD, DO, CRNP or PA-C not to exceed 2 hours twice a month in a fully functional, staffed health unit at the Savannah, GA clinic when exams are scheduled. The starting date of this service will be as agreed upon between the Contractor and the Corps of Engineers.

Per section 4.3 (page 66 of the RFP), the Government may consider the award of the seed project as Task Order 0001, subject to the availability of funds.

Additional task orders may be issued if the Government anticipates additional quantities of services are warranted.

AMENDMENT 0002 UPDATED PWS

OCCUPATIONAL HEALTH MEDICAL SERVICES

SOUTH ATLANTIC DIVISION (SAD)

PERFORMANCE BASED WORK STATEMENT (PWS)

CONTRACT NUMBER: TBD

INTRODUCTION:

The contractor shall provide Medical Services for the U.S. Army Corps of Engineers (USACE) South Atlantic Division (SAD) employees as required under this Indefinite Delivery Indefinite Quantity (IDIQ) contract. It is the Government’s intent for employees to commute to physicians’ offices or clinics within a 50 mile distance (unless a further distance is approved) of a Corps District or field site office.

Occupational Health Physician (OHP) coverage will be provided at the USACE Regional Occupational Health Center’s (ROHC) on-site clinic in Savannah, GA. OHP coverage may be initiated at the Mobile, AL or Jacksonville, FL clinics at a date agreed upon by USACE and the Contractor.

1. Point of Contact: Primary Point of Contact is Linda Englert, Contracting Officer Representative (COR) Regional Nurse Manager, at the Regional Occupational Health Center (ROHC) in Mobile, AL. Telephone number is (251) 690-2670, or Toll Free (866) 521-2774.

2. Applicable Publications and Other Pertinent Data

a. 29 CFR 1910, OSHA General Industry Standard

b. AR 40-5, Preventive Medicine (25 May 2007)

c. EM 385-1-1, Corps of Engineers Safety and Health Requirements Manual (30 November 2014)

d. Public Law 104-191, Health Insurance Portability and Accountability Act of 1996.

e. ER 385-1-40, Occupational Health Program (20 September 2010).

f. ER 385-1-89, Corps of Engineers Hearing Conversation Program (15 October 2012).

g. ER 385-1-92, Safety and Occupational Health Requirements for Hazardous, Toxic, and Radioactive Waste (HTRW) Activities, (1 May 2007).

h. DoDI 6055.05-M Occupational Medical Examinations and Surveillance Manual (2 May 2007, Changes 3, 31 August 2018).

i. AR 600-63, Army Health Promotions (14 April 2015).

j. U.S. Army Pamphlet (DA Pam) 40-11, Preventative Medicine (22 July 2005).

k. AR 40-66, Medical Records Administration and Healthcare Documentation (17 June 2008), RAR 4 January 2010)

3. Service Areas: The Regional Occupational Health Center (ROHC) provides medical services throughout the continental United States and Puerto Rico. The majority of services will be within USACE’s South Atlantic Division (SAD). SAD’s five districts– Mobile, Savannah, Jacksonville, Charleston, and Wilmington- compose a geographical area that includes Alabama, Georgia, Florida, North Carolina, South Carolina, Tennessee, Mississippi, Virginia, Latin America and Puerto Rico. Enclosure (1) contains a list of locations where services are most frequently needed. Clinics, or a traveling medical unit, shall be located within the District's geographical boundaries. The locations of clinics must be submitted with the Contractor's proposal and approved prior to commencement of work.

4. General. Services to be rendered by the contractor include the following:

4.1.1 Physical examinations for medical surveillance, deployments, pre-placement, travel health, and fitness for duty (paragraph 5)

4.1.2 Hearing Conservation Program oversight by audiologist or physician trained and experienced in industrial hearing conservation programs (paragraph 6)

4.1.3 Bloodborne Pathogens Post Exposure evaluation and treatment (paragraph 7)

4.1.4 Automated External Defibrillator (AED) Program oversight. (paragraph 8)

4.1.5 Onsite Clinic Physician services (paragraph 9)

4.1.6 Offsite Physician to serve as Medical Officer for the Occupational Health Units in

Mobile, AL and Jacksonville, FL clinics. As Medical Officer, the contract physician will provide medical oversight and give guidance in form of written protocols for services performed by the District Occupational Health Nurses (OHN) who staff the clinics during hours of operation.

4.1.7 Online respirator medical evaluations (described in paragraph 5).

4.1.8 Physician licensed in multiple states to provide oversight of Registered Nurses deployed for disaster missions (described in paragraph 10).

4.1.9 Health Promotion Program oversight (paragraph11)

4.1.10 Telephonic medical consultation with an occupational health physician as needed

(paragraph 12).

4.1.11 Standardized clinic pricing for exams and exam components. (Enclosure 2)

4.1.12 Management of clinic providers to assure services are delivered in a quality and efficient manner thru adequate provision of trained personnel, supplies, and equipment.

4.1.13 Provide client specific portal for scheduling, examination query and status reporting.

Portal is capable of providing exam results (physical, history, x-rays, audiograms, immunizations, etc.), in an electronic format compatible with Microsoft Office software.

5. Physical Examinations The USACE Regional Occupational Health Program complies with Occupational Safety and Health Administration (OSHA), Department of Army, U.S. Corps of Engineers, and all applicable Federal and State regulations Pre-placement examinations are used to ensure that potential employees are fit for duty (e.g. Crane operator, Commercial Driver, US Coast Guard) and to provide a baseline physical parameter for subsequent medical surveillance comparisons (e.g. audiogram, cholinesterase). Periodic medical examinations are utilized to ensure that employees are able to perform his or her assigned task, detect early signs of exposures to workplace hazards, and provide early detection of any physical conditions that could progress to stages resulting in medical disability. Physical examinations and evaluations are conducted prior to reassignment, retirement, resignation, transfer, or termination when employees have been enrolled in medical surveillance or specific fitness for duty exams.

Return to work post injury or illness fitness for duty exams may be required in specific incidents. These examinations may or may not require a human performance evaluation by physical therapy.

An estimated number of exams and exam components are listed on Enclosure (2).

5.1.1 Off-site clinic Medical Services Process

a. Employee’s name with relevant information, type of exam, exam components and clinic location needed will be provided to the Contract Implementation Team.

The Contract Implementation Team will provide an exam protocol (authorization of services) to the requesting ROHC team member within 48 hours of the request.

b. Examination components have been established and based on federal and state mandates for the employee position and exposure. Exam components and frequency meet the requirements of the Corps of Engineers Occupational Health Program, ER 385- 1-40.

Exams typically consist of the following components with variations as regulations mandate:

(1) History and Physical

(2) Vision – Near and Far (Titmus Screening normally required)

(3) Audiogram

(4) EKG

(5) Chest X-Ray – CXR (2 view with interpretation when indicated)

(6) B-reader for CXR

(7) Blood Chemistry Panel and CBC using ROHC Contracted Lab

(8) Urinalysis Collection using ROHC Contracted Lab

(9) Pulmonary Function Test (baseline for respirator users)

(10) Specific surveillance history (e.g. welding, respiratory, HTRW)

b. The Regional Occupational Health Center shall coordinate the preparation of examination packets to be provided to the employee to take to the exam appointment.

c. The examination packets shall include all or some of the following forms:

(1) Exam Protocol (provided by contractor to authorize services)

(2) Employee Notification Letter.

(3) Privacy Act Statement

(4) SF 78 Certificate of Medical Examination (functional requirements)

(5) DD FORM 2807, Report of Medical History.

(6) OSHA Respirator Questionnaire.

(7) ROHC form 300-R, Audiogram/Hearing Conservation

(8) ROHC Medical Clearance Form 793

(9) Other forms, as applicable.

d. The Health Care Provider (HCP) conducting the physical examination and medical history review will be a Licensed Physician-MD or DO, Certified License Nurse Practitioner, or Physician Assistant-Certified.

e. General physical assessment will include evaluation of eyes, nose, mouth, ears, thyroid, heart, lungs, abdomen, reflexes, generalized skin condition, circulation, spine, back, hernias. Prostate, testicular and digital exam for males and breast exam for females are performed for deployment exams.

f. Physical Exams for Department of Transportation (DOT) – When employee is required to have a Commercial Driver’s License (CDL), the examining physician shall be a Certified Medical Examiners (NRCME). All components of examination and testing shall be as prescribed by 49 CFR Parts 350, 383, 390, and 391 and meet certifications as required by the Federal Motor Carrier Safety Administration (FMCSA) physical qualification standard and guidelines. The examining physician shall document driver fitness determination on DOT Form 649-F (6045).

g. Physical Exams for Coast Guard License- When employee is required to have a

Merchant Mariner Physical Examination, the examiner shall be a certified physician (MD or DO), Physician Assistant/ Nurse Practitioner. All components of examination and testing shall be as prescribed by Navigation and Vessel Inspection Circular 04- 08 (NVIC), Medical and Physical Evaluation Guidelines for Merchant Mariner Credentials. The examining health care provider shall document physical evaluations on US Coast Guard Form CG-719K in conjunction with NVIC 04-08.

h. Physical Exams for Crane Operators- When an employee is required to have a Crane Operator clearance, the clearance must be reviewed and co-signed by a Medical Doctor (M.D.) or Doctor of Osteopathy (D.O.)] stating that the operator has had a physical examination that meets USACE medical requirements when the direct examiner is a physician assistant or nurse practitioner.

i. The health care examiner shall review and evaluate all medical examinations, tests, and findings for completeness, accuracy, and indicate the need for any additional follow-up examinations to determine the employee's ability to meet the physical requirements of the job. The examiner shall note if abnormal findings are job or exposure related.

j. When job exposures are questionable and/or action levels are uncertain, the examiner shall request the ROHC to coordinate workplace assessments by a USACE Industrial Hygienist to quantify exposure and exposure potential.

k. The examination results shall be discussed with the employee after the examination by the HCP. The examining HCP should note any duty restrictions or job limitations on the provided ROHC clearance form. The USACE Occupational Health Nurse may be contacted when duty clarification is needed. Employees with non-work related health concerns are to be referred to their personal physician, dentist, or other community health resources.

l. When an employee is found to have a work or non-work-related condition that may adversely affect performance the examining HCP shall immediately notify the Regional Occupational Health Center. Immediate notification shall be by telephone and shall contain a recommended course of action to included duty limitations, follow-up examination or referrals. The notification shall be followed up with a written report of findings to the Regional Occupational Health Center and the employee within three working days.

m. The Health Care Provider will complete the employee physical examination forms and indicate review of tests and medical reports by initialing the reports.

n. Examination results and all components (e.g. x-rays, audiograms, and immunizations) must be provided to the ROHC in an electronic format compatible with Microsoft Office product within 7 days of examination. Results may also be faxed to the appropriate ROHC clinic. The ROHC clinics in Mobile, AL, Jacksonville, FL, and Savannah, GA maintain employee medical records for SAD.

5.1.2 Virtual Services - The Contractor may, as an alternative to a physical exam, provide an immediate medical evaluation of respirator wearers in compliance with OSHA’s Respiratory Protection Standard-29CFR 1910.134- through online methods. These clearances would also be available through the secured electronic portal.

6. Hearing Conservation-The contractor shall provide an audiologist, otolaryngologist, or a licensed occupational health physician who is trained and experienced in hearing conservation to serve as the Professional Audiometric Data Reviewing Official for medical oversight of SAD’s Hearing Conservation Program. The program currently has an approximate 500 employees enrolled.

6.1.1 Medical oversight will comply with Occupational Safety and Health Administration's (OSHA) Occupational Noise Exposure standard 29 CFR 1910.95, ER 385-1-89, DODI 6055, AR 40-5, DA Pam 40-501 and DA Pam 40-11and focuses on assuring compliance with appropriate regulations.

6.1.2 Audiometric testing is to be provided by a trained and certified Audiometric Technician.

6.1.3 Audiometric test equipment must meet the specifications of and be maintained and used in accordance with ANSI S3.6-1996.

6.1.4 Rooms use for audiometric testing shall not have background sound pressure levels exceeding those in 29 CFR 1910.95 Table D-3 when measured by equipment conforming at least to the Type 2 requirements of American National Standard Specification for Sound Level Meters, S1.4-1971 (R1976), and to the Class II requirements of American National Standard Specification for Octave, Half-Octave, and Third-Octave Band Filter Sets, S1.11-1971 (R1976).

6.1.5 Audiometer Daily Inspection, Functional Test, Annual Acoustical Calibration and Biennial Exhaustive Calibrations shall be done per ER 385-1-89 requirements.

6.1.6 Results from field clinics are to be provided to the Audiometric Data Reviewing Official within 48 hours of completion.

6.1.7 The Audiometric Data Reviewing Officer will conduct a comparison of the baseline and subsequent audiograms to determination whether a Standard Threshold Shift have occurred and provide a baseline revision when indicated. The comparison will not utilize age adjustment factors. A report on each employee’s evaluation shall be provided to the ROHC within 72 hours (excluding weekends) of receipt of the raw data. The report will include a letter to the employee describing the results of his/her evaluation and a report showing the individual’s baseline audiogram in comparison to the current audiogram, hearing threshold averages in the speech and high frequencies, as well as the average threshold at 2K, 3K and 4K.

6.1.8 Timely reporting of Standard Threshold Shifts is essential to permit retesting of the employee within the 30 day time frame for retesting specified in USACE regulation.

6.1.9 Past audio records will be provided to the contractor at the onset of the contract period.

6.1.10 The Audiometric Data Reviewing Officer will make a determination of the work-relatedness of the threshold shifts; identify and communicate potential medical issues; make recommendations if further evaluation is necessary; and identify if the threshold shift meets OSHA criteria as a recordable injury (10 decibel shift and 25 decibels above audiometric zero).

6.1.11 The Audiometric Data Reviewing Officer shall review a minimum of 20% of the normal audiograms and all of the threshold shift audiograms to ensure they meet OSHA/USACE audiogram standards.

6.1.12 The Reviewing Officer will be available for telephonic and/or email consultation with the ROHC staff as needed.

6.1.13 Employees that experience a Standard Threshold Shift on the annual audiogram, shall be scheduled to see an Audiologist within 30 days for a retest audiogram and audiological evaluation. The ROHC will contact the contractor for scheduling and protocol.

6.1.14 Audiological evaluations should determine and document the following:

Is the hearing loss permanent?

Is the hearing loss noise related?

Is medical follow up indicated?

Is alternative hearing protection recommended?

Is employee allowed to return to work in hazardous noise areas with hearing protection?

6.1.15 Contractor will provide comprehensive data for monthly upload in a format compatible with Microsoft Office software.

6.1.16 An annual summary report based on the previous calendar year shall be provided no later than January 15 of the following calendar year and will include an employee roster; the number of employees with normal audiograms, the numbers of OSHA standard threshold shifts, and number of OSHA recordable shifts

7. Bloodborne Pathogens Post Exposure Evaluation and Treatment The contractor shall provide initial evaluation, testing and treatment of Bloodborne Pathogen Exposures for the approximate 400 employees who have an inherent duty to render CPR and 1st Aid as part of their job positions. These employees may work evenings, weekends and holidays schedules.

7.1.1 Post Exposure Evaluation. Currently medical evaluation is recommended within two (2) hours of exposure. When evaluation in the clinic setting is not possible, evaluation in an Emergency Department (ED) is necessary. It is recommended that a post-exposure hotline number be included to ensure rapidity of care.

7.1.2 The medical evaluation is to be performed per current US Public Health Services (USPHS), CDC, and best practices guidelines and will include the following:

a) physician’s review of the incident

b) determination of the risk of HIV, Hepatitis B and Hepatitis C. infection

c) treatment of exposure site when indicated due to injury

d) laboratory testing through accredited laboratory

e) patient counseling

f) prophylactic medications when indicated. If prophylactic medications are indicated, a five (5) day supply is to be provided with recommendations regarding follow up care and monitoring of potential adverse reactions.

7.1.3 Treating physician shall complete the USACE provided forms within 15 days.

7.1.4 This line item is a per incident event.

8 . Physician Oversight of the Automated External Defibrillator (AED) Program. The Regional Occupational Health Center has implemented an AED Program for the South Atlantic Division. The program shall comply with all current established regulations which includes physician oversight.

The Contractor shall have the ability to provide this oversight, which includes the following:

a. Provide post cardiac event follow-up where AEDs are used. This involves reviewing the response documentation form, rescue data and the electrocardiograph tracing of the victim.

b. When an AED is employed, the post event summary data will be reviewed by the physician providing oversight. Physician will determine overall AED system performance and provide a report to include any recommendations needed within 14 days of receipt of summary data.

c. Provide consultation in all aspects of the program.

d. Review AED program annually and update as needed.

d. Prescription for the AED (Class III Medical Device) for all 5 Districts in SAD.

9. Physician services for on-site clinic.

9.1.1 The Contractor is to provide an onsite health care provider (HCP) who is a MD, DO, CRNP or PA-C not to exceed 2 hours twice a month in a fully functional, staffed health unit at the Savannah, GA clinic when exams are scheduled. The starting date of this service will be as agreed upon between the Contractor and the Corps of Engineers.

9.1.2 The On-site Health Care Provider will provide physical examinations for medical surveillance, deployment, pre-employment, post-exposure, fitness for duty, and return to work.

9.1.3 Physical examinations will follow guidance listed under paragraph 5.

9.1.4 A Physician will serve as Medical Officer for the Occupational Health Unit at the

Savannah, GA clinic. As Medical Officer, the contract physician will provide medical oversight and gives guidance in form of written protocols for medical services.

9.1.5 Medical Protocols. The Occupational Health Physician (OHP) will confirm and approve medical protocols for the District Occupational Health Nurses (OHN) who staff the Unit during all hours of operation when a Physician is or is not present. These protocols shall include but are not limited to injections, vaccines, over the counter medications, phlebotomies for specimens, EKGs, Audiograms, Pulmonary Functions testing, applications of dressings, general first aid and response to emergencies. Protocols shall also include the use of emergency prescription medications

(nitroglycerin, oxygen, epipen) and the use of Automated External Defibrillators (AEDs) by employees trained in their use.

10. Physician Services for Disaster Response. The Contractor shall render medical guidance and directives to field nurses deployed during disaster response in any of the 50 states or US territories.

Signed standing orders include provision of first aid, administration of required vaccines, and field case management of USACE employees working disaster response missions at Recovery Field Site operations (set up near disaster site). Orders will be written/revised by a physician licensed in the disaster affected state.

11. Health Promotion Program. The Health Promotion Program consists of medical screening for blood pressure, vision, blood/sugar and cholesterol when funding allows.

Each person screened shall be provided with a record of his or her results. Health promotions may include on-site flu vaccinations at locations of 10 or more employees.

All vaccinations will be provided by Registered Nurses unless otherwise approved by ROHC. RN’s will be required to arrive at least 30 min prior to planned event. The RN’s rate will be a line item price on bid schedule.

12 General Consultation. The Contractor shall provide 24/7 telephonic access to the OHP for general consultation as needed for all medical-related issues. Charges are to be based on an hourly rate in 30 min increments.

12.1.1 The contracted OHP will provide guidance to the ROHC nurses, industrial hygienists, and safety personnel in the event of emergency exposures.

12.1.2 Provide medical advice to safety and occupational health staff as needed for exposure determination.

12.1.3 Review specific medical surveillance examinations based on work related exposures.

12.1.4 The OHP shall be available to discuss abnormal findings with employees as needed by telephone, within 24 hours after notification, during normal duty hours.

12.1.5 The OHP shall review physicals performed by other physicians when the District OHN requests clarification or recommendations on the employee’s ability to perform duties.

12.1.6 The OHP shall render guidance as needed to the Occupational Health

Nurses for the formation of new medical policies and procedures.

13. Qualifications. The Contractor shall have been engaged in occupational health medical services for a minimum of ten years and shall have oversight by a full-time board-certified occupational health physician.

13.1.1. Occupational Health Physician (OHP). The OHP that provides Contractor oversight shall be Board Certified in Occupational Medicine or be eligible for certification by the Board. The OHP will provided oversight of services and competency of professional staff

13.1.2 Field Physicians or other licensed health care provider (LHCP includes Certified Nurse Practitioners and Certified Physician Assistants)- The LHCP performing medical examinations and testing will hold a state license that is in good standing in their area of practice. Certification in Occupational Health Medicine or Nursing is preferred. The LHCP shall have been professionally employed in the practice of medicine for a minimum of three (3) years.

14. Invoicing. Invoices shall be submitted to the Regional Occupational Health Center Attention COR:

109 St. Joseph Street, Mobile, AL 36602 no later than 30 days after the services have been provided. All invoices shall be on company letterhead reflecting the legal name of the company as it appears on the contract and state the word “invoice”. Monthly billing will be itemized by District, Employee, Testing or Procedure, Date of Service, Cost and centrally billed to the Regional Occupational Health Center (ROHC) in Mobile AL, with a separate sub-account for each of the ROHC’s five (5) districts. Monthly Invoices should be received no later than the 10th of each month.

14.1.1 A separate, itemized invoice shall be submitted for each district office and will contain at minimum the following:

(1) Invoice unique number

(2) Name of employee

(3) Date of Service

(4) Date of Invoice

(5) Work location

(6) Total amount due

(7) Employee reference ID

(8) Itemized list of services

(9) Unit cost of services

(10) Contract number

14.1.2 Contractor will respond to accounting questions and concerns from the ROHC on an as needed basis.

15. Medical Records. All employee records are considered confidential and are maintained by the USACE Regional Occupational Health Center Clinic. The Contractor shall provide the copy of the employee medical record to the US Army Corps of Engineers Regional Occupational Health Center at 109 St. Joseph Street, Mobile, AL 36602 to be maintained as part of the employee’s permanent medical chart. All original medical records are the property of the Corps.

All medical record keeping shall be in accordance with the following regulations:

1. Privacy Act Statement of 1974

2. Health Information Portability and Accountability Act, 1996

3. American Recovery and Reinvestment Act, 23 Sept 2009

4. 29 CFR 1910.1020. Access to Medical and Exposure Records

16.Quality Assurance- The contractor will provide a continuous quality assurance review of examination, forms, lab results and other testing to ensure records are completed prior to submitting results in the secure electronic portal.

16.1.1 The contractor shall render review of field physician's medical reports when requested by the

Regional Occupational Health Center.

16.1.2 The Contractor’s Occupational Health Physician (OHP) shall provide periodic quality assurance to ensure that all required medical examinations, testing and evaluations are performed correctly by the examining physicians or other licensed health care provider

An annual summary of the quality assurance performed will be provided prior to each task order.

16.1.3 The Contractor shall evaluate annually, the Medical Surveillance Program elements provided to the Corps and provide a written summary. The summary shall contain the following:

(1) Demographics (sex distribution of employees examined, average age, minimum age, and maximum age).

(2) Exam summary (discussion of exam types performed, number of exams performed by month) by District

(3) Performance statistics by the contractor (average turnaround by the contractor).

(4) Restrictions issued (name, location, date, and type of restriction).

(5) Special consultation (summary of special consultation that occurred).

(6) Trending reports

(7) Recommendations for improvements.

16.1.4 The Contractor shall permit USACE personnel to perform quality assurance visits of any subcontracted clinic without notice to the Contractor. These visits are primarily done in response to employee complaints and/or to ensure compliance with federal and state regulations.

17. A Bid Schedule of required services with estimated quantities and locations is provided as a separate attachment. Contractor must include pricing for the Base and all Option Years for all Districts.

18. Execution of all requirements set forth in the statement of work shall commence Within 30 calendar days after award of contract.

19. DISTRICT OFFICES

US Army Engineer District- Charleston 69A Hagood Ave Charleston, SC 29403-6479

US Army Engineer District- Mobile 109 Saint Joseph Street Mobile, AL 36602-3605

US Army Engineer District – Wilmington 69 Darlington Avenue Wilmington, NC 28403

US Army Engineer District – Jacksonville 701 San Marco Blvd Jacksonville, FL 32207

US Army Engineer District – Savannah 100 West Oglethorpe Avenue Savannah, GA 31401-3640

3.0 AT/OPSEC Requirements:

AT Level I Training. All contractor employees, to include subcontractor employees, requiring access to Army installations, facilities, controlled access areas, or require network access, shall complete AT Level I awareness training within 30 calendar days after contract start date or effective date of incorporation of this requirement into the contract, whichever is applicable. Upon request, 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 5 calendar days after completion of training by all employees and subcontractor personnel. AT Level I awareness training is available at the following website: http://jko.jten.mil/courses/atl1/launch.html; or it can be provided by the RA ATO in presentation form which will be documented via memorandum."

3.1 Access and General Protection Policy and Procedures - All 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/facility 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 (FAR clause 52.204-9, Personal Identity Verification of Contractor Personnel) 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 installation or facility change, the Government may require changes in contractor security matters or processes.

3.2 Contractors requiring Common Access Card (CAC) –The contractor and all sub-contractors employees will be issued a CAC only if duties involve one of the following

(1) Both physical access to a DoD facility and access, via logon, to DoD networks on-site or remotely;

(2) Remote access, via logon, to a DoD network using DoD-approved remote access procedures; or (3) Physical access to multiple DoD facilities or multiple non-DoD federally controlled facilities on behalf of the DoD on a recurring basis for a period of 6 months or more. At the discretion of the sponsoring activity, an interim CAC may be issued based on a favorable review of the FBI fingerprint check and a successfully scheduled NACI at the Office of Personnel Management.

3.3 For contractors who do not require CAC, but require access to a DoD facility or installation.

The Contractor and all associated sub-contractors employees shall comply with adjudication standards and procedures using the National Crime Information Center Interstate Identification Index (NCIC-III) and Terrorist Screening Database (TSDB) (Army Directive 2014-05 / AR 190-13), applicable installation, facility and area commander installation/facility access and local security policies and procedures (provided by government representative, as NCIC and TSDB are available), or, at OCONUS locations, in accordance with status of forces agreements and other theater regulations.

3.4 Suspicious Activity Reporting Training - The contractor and all associated sub-contractors shall receive a brief/training (provided by the RA) on the local suspicious activity reporting program. This locally 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 project manager, security representative or law enforcement entity. This training shall be completed within 30 calendar days of contract award and within 30 calendar days of new employees commencing performance with the results reported to the COR NLT 5 calendar days after the completion of the training.

3.5 OPSEC Training. All new contractor employees will complete Level I OPSEC Training within 30 calendar days of their reporting for duty. Additionally, all contractor employees must complete annual OPSEC awareness training. The contractor shall submit certificates of completion for each affected contractor and subcontractor employee, to the COR or to the contracting officer (if a COR is not assigned), within 5 calendar days after completion of training. OPSEC awareness training is available at the following websites: https://www.iad.gov/ioss/ or http://www.cdse.edu/catalog/operations-security.html;

or it can be provided by the RA OPSEC Officer in presentation form which will be documented via memorandum.

3.6 Will be escorted in areas where they may be exposed to classified and/or sensitive materials and/or sensitive or restricted areas. -All contract employees, including subcontractor employees who are not in possession of the appropriate security clearance or access privileges, will be escorted in areas where they may be exposed to classified and/or sensitive materials and/or sensitive or restricted areas.

3.7 Pre-screen candidates using E-Verify Program -The Contractor must pre-screen Candidates using the E-verify Program (http://www.uscis.gov/e-verify) website to meet the established employment eligibility requirements. The Vendor must ensure that the Candidate has two valid forms of Government issued identification prior to enrollment to ensure the correct information is entered into the E-verify system. An initial list of verified/eligible Candidates must be provided to the COR no later than 3 business days after the initial contract award." *When contracts are with individuals, the individuals will be required to complete a Form I-9, Employment Eligibility Verification, with the designated Government representative.

Enclosure 1- Clinic Locations

City State City State

Abbeville AL Lagrange GA

Demopolis AL Marietta GA

Dothan AL Savannah GA

Jackson AL Amory MS

Millers Ferry AL Savannah GA

Mobile AL Amory MS

Monroeville AL Collinsville MS

Montgomery AL Columbus MS

Tuscaloosa AL Iuka MS

Canal Point-Port Mayaca Lock FL Meridian MS

Canaveral FL Tupelo MS

Clewiston FL Wilkesboro NC

Cocoa FL Cary NC

Ft Myers FL Charlotte NC

Gainesville FL Durham NC

Jacksonville FL Fayetteville NC

Live Oak FL Greenville NC

Melbourne FL Hickory NC

Miami FL Jacksonville NC

Miramar FL Kill Devil Hills NC

Moore Haven FL Morehead City NC

Naples FL New Bern NC

Palatka FL Raleigh NC

Palm Beach Gardens FL Raleigh NC

Panama City FL Wilmington NC

Pensacola FL Carlisle PA

Ponce FL San Juan PR

Sarasota FL Charleston SC

Sebring FL Clarks Hill SC

Stuart FL Columbia SC

Tallahassee FL Myrtle Beach SC

Tampa FL Summerville SC

West Palm Beach FL Johnson City TN

WP Franklin Lock FL Newport News VA

Cartersville GA Chesapeake VA

Duluth GA Martinsville VA

Elberton GA Norfolk VA

Hartwell GA South Hill VA

Johns Creek GA

Enclosure 2- Estimated Number of Services Annually

Description # Needed

Audiogram 420

Audiologic Evaluation 40

Bloodborne Pathogen Exposure Evaluation 5

Blood Collection using USACE lab 150

Consultation -Occupational Health Physician Hours 8

CXR-PA&LAT-Radiologist read 10

EKG 70

Hearing Conservation Oversight/audiogram 420

Hemoccult 5

Hep A Vaccination 10

Hep B vaccination 10

History 725

Human Performance Evaluation per Physical Therapy 5

Inactivated Polio Vaccine 10

Influenza Vaccine 10

Malarial Prophylaxis 10

Meningococcal Vaccinations 5

MMR Vaccination 10

Online Respiratory Protection Clearance 200

Onsite Clinic Health Care Provider Hours (2 sites) 184

Onsite RN -Health Screenings Hours 8

Physical Exam 725

Physical Exam, Coast Guard 60

Physical Exam, DOT 20

Physician AED Program Oversight Hours 3

Pneumococcal Vaccination 10

Pulmonary Function Test 100

Rabies Vaccination (Pre or Post Exposure) 20

Surveillance Specific Questionnaire 350

TBST 10

Tetanus-Diptheria (Td) 10

Tetanus-Diptheria-Pertussis- (TdaP) 10

Twinrix (A&B Combo) vaccination 10

Typhoid Injection 10

Typhoid Oral 8

Urine Collection using USACE lab 75

Varicella vaccine 10

Vision Screen 725

X-ray Knee, Shoulder, Femoral Head 2

Yellow Fever Vaccine 10

(End of Summary of Changes)