W912BV23SSCW1 DRAFT PWS FOR SOURCES SOUGHT MEDSERV.pdf

PERFORMANCE WORK STATEMENT

Occupational Health Clinic Medical Surveillance Services Tulsa, OK

INTRODUCTION

The Offeror shall provide occupational health medical services as required for the U.S. Army Corps of Engineers (USACE) on-site Occupational Health Clinic (OHC) located in the Tulsa District (SWT) Office in Tulsa, Oklahoma as outlined in the following Performance Work Statement (PWS).

1. Applicable Publications and Other Pertinent Data

a. 29 CFR 1910, OSHA General Industry Standard

b. AR 40-5, Preventive Medicine (12 May 2020)

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

2014or latest version)

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

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

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

e. ER 385-1-92, Safety and Occupational Health Requirements for Hazardous, Toxic, and Radioactive Waste (HTRW) Activities, (1 November 2018)

f. DoDI 6055.05-M Occupational Medical Examinations and Surveillance Manual (2

May 2007, Changes 3, 31 August 2018)

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

h. U.S. Army Pamphlet (DA Pam) 40-11, Preventative Medicine (18 May 2020)

i. AR 40-66, Medical Records Administration and Healthcare Documentation

(17 June 2008), (RAR 4 January 2010)

2. SERVICE AREAS

Medical services are to be performed at Tulsa District (SWT) headquarters office located at 2488 E81st Street Tulsa, Oklahoma 74137. Tulsa District geographical footprint encompasses Kansas, Oklahoma, and Texas.

3. GENERAL

Services to be rendered by the Offeror include but are not limited to the following:

3.1.1 On-site physical examinations for medical surveillance, deployments, pre-placement, travel health, and Fitness for Duty.

3.1.2 Hearing Conservation Program oversight by audiologist or physician trained and experienced in industrial hearing conservation programs.

3.1.3 Automated External Defibrillator (AED) Program oversight.

3.1.4 Provide prescriptive authority and/or standing orders for SWT-OHC nurse.

3.1.5 Telephonic medical consultation, as needed.

3.1.6 Management of medical service providers, if required, to assure services are delivered with quality and in an efficient manner thru adequate provision of trained personnel, supplies, and equipment.

3.1.7 Provide client specific portal for scheduling, examination query and status reporting. Portal shall have the capability to provide exam results (physical, history, x-rays, audiograms, immunizations, etc.),in an electronic format compatible with Microsoft Office or Adobe Acrobat software.

4. PHYSICAL EXAMINATIONS

The USACE Regional Occupational Health Program complies with Occupational Safety and Health Administration (OSHA), Department of Army, U.S. Army 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, U.S. Coast Guard, etc.) and to provide a baseline physical parameter for subsequent medical surveillance comparisons. Periodic physical examinations are utilized to ensure that employees can perform his or her assigned tasks, 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.

4.1.1 Pre-placement examinations are used to ensure that potential employees are fit for duty and to provide a baseline physical parameter for subsequent medical surveillance comparisons.

4.1.2 Medical examinations typically consist of the following components with variations of regulations and Medical Officer mandates:

a. History and physical examination

b. Vision – Near and Far (Titmus Screening normally required)

c. Audiogram

d. EKG

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

f. B-reader for CXR

g. Blood Chemistry Panel and CBC

h. Urinalysis

i. Pulmonary Function Test (baseline for respirator users)

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

k. General physical assessment will include but not limited to evaluation of personal medical health, along with occupational work and health history. Physical examination including: HEENT, Heart and Lungs, Peripheral Vascular system, Abd, Hernia exam, Spine and Musculoskeletal system, Genitourinary system, Skin, and Nervous system. Prostate, testicular, and digital exam for males and breast exam for females are only performed for deployment exams.

l. 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.

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

n. The examination results shall be discussed with the employee after the examination. The examining Health Care Provider shall note any duty restrictions or job limitations on the provided OH clearance form. The SWT-OHC nurse shall 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 resource.

4.1.3 Exit 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.

4.1.4 Return to work post-injury or illness Fitness for Duty exams may be required in specific incidents.

4.1.5 Physical Exams for Department of Transportation (DOT) – When an employee is required to have a Commercial Driver’s License (CDL), the examining health care provider shall be a Certified Medical Examiner (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 health care provider shall document driver fitness determination on FMCSA Form MCSA-5875. The examining health care provider shall be certified by FMCSA, and Offeror shall provide proof of certification of such before award.

4.1.6 Physical Exams for Coast Guard License- When employee is required to have a Merchant Mariner Physical Examination, the examiner shall be a certified physician (M.D. or D.O.), or a Physician’s Assistant or 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 (HCP) shall document physical evaluations on US Coast Guard Form CG- 719K in conjunction with NVIC 04-08.

4.1.7 Physical Exams for USACE Class I 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.

5. MEDICAL SERVICES

5.1.1 The Offeror shall provide one physician who shall be either a Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) licensed in the state of Oklahoma to serve as the SWT Medical Officer (MO) for oversight and consultation in coordination with the SWT-OHC nurse or another designee from SWT. The Medical Officer shall respond no later than the next business day following any inquiries, requests, or other correspondence from the SWT-OHC. The Medical Officer may perform her or his duties via telephone or email. Services will be billed according to the Medical Officer (MO) rate per examination. Services will not be required during any period when the location is closed, for example, during inclement weather or on a locally observed holiday. Federal Holidays are also excluded.

5.1.2 The Offeror shall provide an On-Site Healthcare Provider (OHP). Any approved M.D. or D.O. who serves as the Medical Officer (MO) may also serve as the On-Site Healthcare Provider (OHP); in which case the MO shall be paid at the rate indicated for the “On-Site Healthcare Provider – Medical Officer (OHP-MO)” in the pricing schedule. Otherwise, an approved Physician’s Assistant or Nurse Practitioner licensed in the state of Oklahoma shall serve as the On-Site Healthcare Provider (OHP) and shall be paid at the rate indicated in the pricing schedule for the “On-Site Healthcare Provider - Nurse Practitioner or Physician’s Assistant (OHP- NP/PA).” Scheduling will be as the need arises (PRN) when physical exams are scheduled and will be coordinated with the on-staff Registered Nurse or another designee from SWT. Services will not be required during any period when the location is closed, for example, during inclement weather or on a locally observed holiday. Federal Holidays are also excluded.

5.1.3 On-Site Healthcare Provider (OHP) shall provide physical examinations for medical surveillance and general wellness examinations or consultation during wellness promotion events.

5.1.4 Medical Protocols. The Medical Officer shall provide or approve medical protocols for the SWT- OHC nurse. The SWT-OHC nurse is a full-time position and shall staff the OHC during normal duty hours regardless of the OHP presence. 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 (i.e., nitroglycerin, oxygen, EpiPen, etc.) and the use of Automated External Defibrillators (AEDs) by employees trained in their use.

5.1.5 Offeror shall provide verification of current CPR (cardiopulmonary resuscitation), BLS (Basic Life Support) and/or ACLS (Advanced Cardiovascular Life Support) for all physicians and health care providers included in the quote; and shall provide proof upon the Government’s request throughout the duration of the contract.

6. VIRTUAL SERVICES

The Offeror may, as an alternative to a physical exam, provide an immediate medical evaluation of respirator wearers in compliance with OSHA’s Respiratory Protection Standard 29 CFR 1910.134 through online methods.

These clearances would also be available through the secured electronic portal.

7. HEARING CONSERVATION

7.1.1 The Offeror shall provide an audiologist, otolaryngologist, or a licensed occupational health physician who is trained and experienced in hearing conservation to serve as the Audiometric Data Reviewing Official for medical oversight of the Hearing Conservation Program.

7.1.2 Medical oversight shall 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 40-11 and focuses on assuring compliance with appropriate regulations.

7.1.3 Audiometric testing is to be provided by a Council for Accreditation in Occupational Hearing Conservation (CAOHC) certified technician or audiologist.

7.1.4 The Audiometric Data Reviewing Official shall 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. The report shall 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.

7.1.5 Timely reporting of Standard Threshold Shifts is essential to permit retesting of the employee within the 30-calendar daytime frame for retesting specified in USACE regulation.

7.1.6 The Audiometric Data Reviewing Officer will determine 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 1904.10. If an employee's hearing test (audiogram) reveals that the employee has experienced a work-related Standard Threshold Shift (STS) in hearing in one or both ears, and the employee's total hearing level is 25 decibels (dB) or more above audiometric zero (averaged at 2000, 3000, and 4000 Hz) in the same ear(s) as the STS, the case shall be recorded on the OSHA 300 Log. A Standard Threshold Shift, or STS, is defined in the occupational noise exposure standard at 29 CFR 1910.95(g)(10)(i) as a change in hearing threshold, relative to the baseline audiogram for that employee, of an average of 10 decibels (dB) or more at 2000, 3000, and 4000 hertz (Hz) in one or both ears.

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

7.1.8 The Audiometric Data Reviewing Officer will be available for telephonic and/or email consultation with the SWT-OHC staff as needed.

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

7.1.10 An annual summary report based on calendar year shall be provided to include an employee roster, the number of employees with normal audiograms, the numbers of OSHA standard threshold shifts, and number of OSHA recordable shifts.

7.1.11 Audiological evaluations should determine and answer the following:

a. Is the hearing loss permanent?

b. Is the hearing loss noise related?

c. Is medical follow up indicated?

d. Is alternative hearing protection recommended?

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

8. BLOODBORNE PATHOGENS Program

The Offeror shall provide support for the bloodborne pathogen program for employees who must meet the qualifications for their job requirements.

9. PHYSICIAN OVERSIGHT OF THE AUTOMATED EXTERNAL DEFIBRILLATOR

(AED) PROGRAM

9.1.1 The Offeror shall provide AED program that will comply with all current established regulations which includes physician oversight.

9.1.2 The Offeror 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 calendar days of receipt of summary data.

c. Provide consultation in all aspects of the program.

d. Review AED program annually and update as needed.

e. Prescription for the AED (Class III Medical Device) for the SWT-OHC.

10. 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. All vaccinations shall be provided by Registered Nurses unless otherwise approved by SWT-OHC.

11. GENERAL CONSULTATION

11.1.1 The Offeror shall provide telephonic access to the Medical Officer (MO) for general consultation as needed for all medical-related issues. Charges are to be based on an hourly rate 15-minute increments.

11.1.2 The Medical Officer (MO) shall provide guidance to the SWT-OHC nurse, industrial hygienists, safety personnel, and employees in the event of emergency exposures.

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

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

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

11.1.6 The OHP shall render guidance as needed to the OHNs for voluntary wellness physicals, medical surveillance and provide guidance on the formation of new medical policies and procedures.

12. Government Provided Equipment and Resources

12.1.1. The government will provide nurse to staff the SWT-OHC and assist in the medical surveillance physical examinations and record keeping.

12.1.2 The SWT-OHC nurse will schedule physical examinations with government employees and will coordinate with Offeror the days and times physical examinations will occur.

12.1.3 The SWT-OHC will be a fully functional occupational health clinic and the government will provide the necessary medical and diagnostic equipment to perform medical surveillance examinations.

12.1.4 SWT-OHC will provide all medical consumables necessary for treatment, health promotions and examinations.

12.1.5 SWT-OHC will provide/procure laboratory services.

13. QUALIFICATIONS

13.1.1 A licensed and Board Eligible/Board Certified Doctor of Medicine or Osteopathy who, by virtue of education, specialized training, and experience, has acquired a minimum of five (5) years and is knowledgeable of regulations and resources relating to occupational medicine such as OSHA, NIOSH, DoD, DA and Occupational Medicine Practice Guidelines (ACOEM).

13.1.2 The Medical Officer (MO) who provides oversight shall be Board Certified in Occupational Medicine or be eligible for certification by the Board. The Medical Officer (MO) shall provide oversight of services and competency of professional staff.

13.1.3 The On-site Healthcare Provider (OHP) (this includes Certified Nurse Practitioners and Certified Physician Assistants) shall perform medical examinations and testing in accordance with this contract. If the On-Site Healthcare Provider is a Nurse Practitioner or Physician’s Assistant, they shall have been professionally employed in the practice of medicine for a minimum of three (3) years using their corresponding license.

13.1.4 To perform Commercial Driver License Exams the Occupational Healthcare Provider must be a registered and certified medical examiner with the Federal Motor Carrier Safety Administration.

13.1.5 Proof of medical liability insurance: The Contractor is required to ensure that its subcontractors, if any, for provisions of health care services, contain the requirements of clause 52.237-7, Indemnification and Medical Liability Insurance, including the maintenance of medical liability insurance. Indemnify the Government for any liability-producing act or omission by the Contractor, its employees, and agents occurring during contract performance.

13.1.6 Special Qualifications: The contractor shall ensure all employees possess all required licenses for operating medical surveillance services used in the performance of this contract. A copy of all the required licenses shall be provided to the COR 10 calendar days prior to performance. This does not include education or other qualifications for the position in which the contractor employee is performing, dress codes, or other information.

(NOTE: The Government does not provide training to contractors. Contractors must ensure that any personnel performing under a contract are fully trained, licensed, certified, and otherwise qualified to provide services.)

14. MEDICAL RECORDS

14.1.1 All employee records are considered confidential and are maintained and kept on site at the SWT-OHC located in Tulsa, Oklahoma. All original medical records are the property of USACE.

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

a. Privacy Act Statement of 1974

b. Health Information Portability and Accountability Act, 1996

c. American Recovery and Reinvestment Act, 23 Sept 2009

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

15. KEY PERSONNEL

15.1.1 Offeror shall notify the Government of any proposed personnel changes. The Government shall review and approve any personnel changes for the duration of the contract if any physician or other health care provider are to be replaced for any reason. No personnel changes shall occur without written approval by the Contracting Officer’s Representative (COR). Offeror shall provide all necessary documentation for any replacement personnel for the Government’s review, including but not limited to the items outlined in section 13, or paragraphs 5.1.5 and 4.1.5, or any other location in this PWS or any applicable local, state, or federal laws, rules, or regulations.

16. ANTICIPATED REQUIRED SERVICES

16.1.1 The Government anticipates the need for the contractor to provide the following required services:

General Physicals

Prescribed Burn Physicals

Commercial Driver License Physicals

Crane Class 1 Operator Physicals

Fit for Duty Physicals

Pre-employment/Post employment Physicals

Audiology Review

United States Coast Guard Physicals

Missed Appointment Fee

Physician – Occupational Medicine Consultant

Medical Review Officer Miscellaneous Consulting

Electrocardiogram

Exit Physicals

Respirator medical evaluation/Pulmonary Function Test Review

Telephone Consultation

Travel Cost

Wellness & other events

Any Additional or Follow-up Occupational Health Related Examinations/Medical Laboratory Tests

17. Contractor Travel:

17.1.1 The contractor may be required to travel to site locations during the performance of this contract to complete the exams at the pre-set sites in technical exhibit 3. The contractor will be authorized travel expenses consistent with the substantive provisions of the Joint Travel Regulation (JTR) and the limitation of funds specified in this contract.

All travel requires COR recommendation for approval and/or authorization by the KO prior to travel arrangements being made.