W912L1-17-R-0006_Amendment_1.pdf

SEE ADDENDUM

(No Collect Calls)

W912L1-17-R-0006 20-Jan-2017

b. TELEPHONE NUMBER

512-782-5503

8. OFFER DUE DATE/LOCAL TIME

02:00 PM 02 Feb 2017

5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA – FAR (48 CFR) 53.212

(TYPE OR PRINT)

(SIGNATURE OF CONTRACTING OFFICER)

ADDENDA ARE

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

23.

CODE 10. THIS ACQUISITION IS

SUCH ADDRESS IN OFFER

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT

BELOW IS CHECKED

TELEPHONE NO.

W912L19. ISSUED BY

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

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

KOLIN R CROWDER

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

(TYPE OR PRINT)

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

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

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

25. ACCOUNTING AND APPROPRIATION DATA

1. REQUISITION NUMBER

20.

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

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

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

ARE NOT ATTACHED

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

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

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

. YOUR OFFER ON SOLICITATION

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

% FOR:SET ASIDE:UNRESTRICTED OR X

SMALL BUSINESSX

17a.CONTRACTOR/ CODE FACILITY

OFFEROR CODE

USPFO FOR TX - PURCHASING & CONTRACTING

ATTN: KOLIN CROWDER

2200 WEST 35TH STREET, BLDG 66

AUSTIN TX 78703-1222

18a. PAYMENT WILL BE MADE BY CODE

RATED ORDER UNDER

DPAS (15 CFR 700)

13a. THIS CONTRACT IS A

13b. RATING

CODE15. DELIVER TO CODE W560JB 16. ADMINISTERED BY

12. DISCOUNT TERMS11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

14. METHOD OF SOLICITATION

RFQ IFB RFPX

W560JB - W8B7 TX ARNG MED DET

W8B7 TX ARNG MED DET

W8B7 TX ARNG MED DET

2200 W 35TH STREET

AUSTIN TX 78703-1222

TEL: 512-782-5001 FAX:

FAX:

TEL: 512-782-5503

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

8(A)

HUBZONE SMALL

BUSINESS

SIZE STANDARD:

$20,500,000

NAICS:

621498

OFFER DATED

29. AWARD OF CONTRACT: REF.

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

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

EMAIL:

TEL:

31c. DATE SIGNED

SEE SCHEDULE

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

24.22.21.19.

WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

(CONTINUED)

PAGE 2 OF68

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

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

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

REPRESENTATIVE

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

37. CHECK NUMBER

FINALPARTIALCOMPLETE

36. PAYMENT35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER

FINAL

33. SHIP NUMBER

PARTIAL

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

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

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

42a. RECEIVED BY (Print)

42b. RECEIVED AT (Location)

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

STANDARD FORM 1449 (REV. 2/2012) BACK

Prescribed by GSA – FAR (48 CFR) 53.212

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

SEE SCHEDULE

20.

SCHEDULE OF SUPPLIES/ SERVICES

21.

QUANTITY UNIT

22. 23.

UNIT PRICE

24.

AMOUNT

19.

ITEM NO.

W912L1-17-R-0006

Section SF 1449 - CONTINUATION SHEET

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 1 Each Huntsville - FMR

FFP

The TXARNG has a requirement for medical/dental FMR event for approximately

450 soldiers at Ellington Field Armory, at 1901 Veterans Memorial Pkwy, Huntsville, TX 77340. Services will be performed in accordance with the performance work statement.

Period of Performance: 10-12 February 2017

FOB: Destination

NET AMT

0002 1 Each

ABIA - FMR

FFP

The TXARNG has a requirement for medical/dental FMR event for approximately

293 soldiers at 5102 Emma Browning Ave, Austin, TX 78719. Services will be performed in accordance with the performance work statement.

Period of Performance: 11-12 February 2017

0003 1 Each Bryan - FMR

FFP

The TXARNG has a requirement for medical/dental FMR event for approximately

260 soldiers at 1700 East 25th Street, Bryan, TX 77802. Services will be

0004 1 Each Houston - FMR

FFP

The TXARNG has a requirement for medical/dental FMR event for approximately

470 soldiers at 900 West Rankin Road, Houston, TX 77067. Services will be

Note: Outside space available for ONLY Dental and Hearing. All other services will be completed inside of the armory.

0005 1 Each

CMR

FFP

The Office of the Assistant Secretary of the Army (Manpower & Reserve Affairs) operates and maintains a secure Army data collection site where the contractor will report ALL contractor manpower (including subcontractor manpower) required for performance of this contract. Submit by September 30, 2017

AT OPSEC

This provision/contract text is for contractor employees with an area of performance within an Army National Guard controlled installation, facility, or area. All contractor employees, to include subcontractor employees, requiring access to Army National Guard installations, facilities and controlled access shall complete AT level I awareness training. The contractor shall submit certificates of completion for each affected contractor employee and subcontractor employee to the Contracting Officer's Representative (COR) and to the Contracting Officer prior to the event. AT level I awareness training is available at the following website: https://atlevel1.dtic.mil/at

INSTRUCTIONS TO OFFERORS

1. SCOPE

1.1. You are invited to submit a proposal in response to our Request for Proposal W912L1-17-R-0005

Mobile Platform Medical and Dental Non-personal Services.

1.2. As a result of this solicitation, the Government may make single or multiple Firm Fixed Price (FFP) contract awards to the responsible offerors whose proposal represents the best value after evaluation in accordance with the factors and sub factors in the solicitation.

1.3. Solicitation is 100% small business.

2. PROPOSAL PREPARATION INSTRUCTIONS

2.1. These instructions prescribe the format of proposals, and describe the approach for the development and presentation of the proposal data. They are designed to ensure the submission of necessary information to provide for the understanding and comprehensive evaluation of proposals. Carefully review this section prior to commencing proposal preparation. All solicitation amendments must be acknowledged in accordance with FAR Provision

52.215-1, Instruction to Offerors – Competitive Acquisition and Instructions to Offerors.

2.2 Offerors are cautioned to strictly comply with all instructions within this solicitation to ensure submission of a complete proposal. Failure to furnish a complete proposal, at the time of proposal submission, may result in the proposal being unacceptable to the Government and eliminated from consideration for award.

3. PROPOSAL CONTENT

Prospective offerors shall submit their proposals as follows:

3.1 Deleted

3.2 Past Performance Information – Three references for same or similar work. The past performance should be relevant and recent. Past performance should include name, address, phone number and email of the contact, contract number, contract value, period of performance, and project/requirement description. Must also state if the work performed was in a prime or as a subcontractor.

3.3 Technical information – Clearly define how you will meet the requirement. Including staff, resources and management to monitor flow of soldiers through the event. Include information on how you will be set up and ready on day one for event and ready to process soldiers all the way until clean up and closing the event. Answer all the questions on the scenario technical-sheet

3.4 Offerors are cautioned to carefully review the proposal requirements for this event and ensure a complete proposal is submitted.

3.5 Proposals should be no longer than five pages for technical, two pages for past performance, and two pages for pricing. Proposals will be evaluated on past performance, technical and price. When combined past performance and technical are approximately equal to price. Reference FAR 52.212-2 Evaluation – Commercial Items.

The following items shall be returned with proposal:

1. Signed copy of the SF 1449

2. Contract Line Items shall be annotated with a price

3. Offeror shall be registered in the System for Award Management Database located at www.sam.gov and shall complete the On-Line Reps and Certification at the ORCA website: link is provided at www.sam.gov AND complete the small business certification at 52.212-3 Alt I.

4. All provisions and clauses in this solicitation shall be completed and returned

5. Written, signed and dated certification that the contractor acknowledges that they will provide all supplies and services identified in each Statement of Work for both Medical and Dental services for each location for the events listed in the line items. There will be no Government furnished equipment, supplies or facilities for the listed events.

The Government intends to make a Firm-Fixed Price award for this event.

EVENT FORMS

Event Name: 72nd IBCT (Huntsville Armory) Event Location: 1901 Veterans Memorial Pkwy, Huntsville, TX 77340

Event Dates:

(1) Medical Event: 10 FEB 17 Set up Date: 09 FEB 17 Recovery Date: 13 FEB 17

(2) Case Management/Records Clerk: 13 FEB 17 – 15 MAR 17

Estimated Personnel*:

(1) Total: 450

(2) PHA: 450

(3) Hearing: 450

(4) Optometry: 450

(5) Dental Exam: 450

(6) Dental Treatment: 135

Additional requirements:

1. Estimate (15 %) Soldiers will need “over 40” requirements of EKG and expanded labs as required by regulation (CVSP, 5 YR EKG, and PSA).

2. Estimate (18%) Soldiers receiving dental treatment will need Case Management

3. Estimated (25%) will need Immunizations provided by the vendor. This includes all Routine

Adult Immunization with the exception of Influenza. Please be advised, the Routine Adult Immunizations profile now includes Measles, Mumps, and Rubella (MMR), Polio, and Varicella. Please refer to ALARACT 255/2014 for additional guidance on requirements.

4. SPRINT Testing with Audiologist for identified Hearing Classification 3.

5. Additional labs will include: Urine pregnancy test, HIV, and G6PD.

6. Behavioral Health Clinicians are required to provide assessments and referrals.

7. Post behavioral data entry is required. MEDIUM to HIGH risk Soldiers will be reported to

TXARNG event representatives immediately.

8. Providers are not allowed to issue Temporary Profiles during the FMRs/SRPs. All medical conditions must be documented according to allow Military Providers the ability to profile http://www.sam.gov/ the medical condition or concern. The documentation will be provided to the TXARNG event representative upon completion of the event.

9. Prescription management is required as needed for Soldiers receiving Dental Treatment.

10. Vision screening ONLY.

11. No Medical Warning Tags.

12. Request that event information updates are provided at the end of each duty day. This information should include at a minimum:

a. Number of personnel seen on duty day, to include the number of no-shows

b. Number of personnel seen for the specific services:

i. Dental: Dental Exams, Dental Treatment, Bite Wings, and Panos

ii. Medical: Visual Acuity, EKGs, PHAs, Vitals, Hearing, Immunizations, and

Labs

TXARNG Space Available for Contractor:

SPACE will be made available for contractor in Armory Drill Hall. Check-in/out, Height/Weight and other administrative workspace will be provided by Government. All other services will be in Mobile units outside of Armory.

*Above totals are estimates and per contract TXARNG requires Contractor to contact TXARNG for actual rosters prior to event in order to adequately provide resources for this event.

Event Name: 36 CAB (ABIA) Event Location: 5102 Emma Browning Ave, Del Valle, TX 78617

Event Dates:

(1) Medical Event: 11-12 FEB 17 Set up Date: 10 FEB 17

(2) Case Management/Records Clerk: 13 FEB 17 – 14 MAR 17

1 Total: 293

2 PHA: 293

3 Hearing: 293 4 Optometry: 293 5 Dental Exam: 293 6 Dental Treatment: 87

1 Estimate (15 %) Soldiers will need “over 40” requirements of EKG and expanded labs as required by regulation (CVSP, 5 YR EKG, and PSA).

2 Estimate (18%) Soldiers receiving dental treatment will need Case Management 3 Estimated (25%) will need Immunizations provided by the vendor. This includes all Routine

Adult Immunization with the exception of Influenza. Please be advised, the Routine Adult Immunizations profile now includes Measles, Mumps, and Rubella (MMR), Polio, and Varicella. Please refer to ALARACT 255/2014 for additional guidance on requirements.

4 SPRINT Testing with Audiologist for identified Hearing Classification 3.

5 Additional labs will include: Urine pregnancy test, HIV, and G6PD.

6 Behavioral Health Clinicians are required to provide assessments and referrals.

7 Post behavioral data entry is required. MEDIUM to HIGH risk Soldiers will be reported to

TXARNG event representatives immediately.

8 Providers are not allowed to issue Temporary Profiles during the FMRs/SRPs. All medical conditions must be documented according to allow Military Providers the ability to profile the medical condition or concern. The documentation will be provided to the TXARNG event representative upon completion of the event.

9 Prescription management is required as needed for Soldiers receiving Dental Treatment.

10 Vision screening ONLY.

11 No Medical Warning Tags.

12 Request that event information updates are provided at the end of each duty day. This information should include at a minimum:

a. Number of personnel seen on duty day, to include the number of no-shows

b. Number of personnel seen for the specific services:

i. Dental: Dental Exams, Dental Treatment, Bite Wings, and Panos

ii. Medical: Visual Acuity, EKGs, PHAs, Vitals, Hearing, Immunizations, and

Labs TXARNG Space Available for Contractor:

SPACE will be made available for contractor in Armory Drill Hall. Check-in/out, Height/Weight and other administrative workspace will be provided by Government. All other services will be in Mobile units outside of Armory.

*Above totals are estimates and per contract TXARNG requires Contractor to contact TXARNG for actual rosters prior to event in order to adequately provide resources for this event.

Event Name: 72nd IBCT (Bryan Armory) Event Location: 1700 East 25th Street, Bryan, TX 77802

Event Dates:

(1) Medical Event: 11-12 FEB 17

1 Total: 260

2 PHA: 260

3 Hearing: 260 4 Optometry: 260 5 Dental Exam: 260 6 Dental Treatment: 78 required by regulation (CVSP, 5 YR EKG, and PSA).

2 Estimate (18%) Soldiers receiving dental treatment will need Case Management 3 Estimated (25%) will need Immunizations provided by the vendor. This includes all Routine

Adult Immunization with the exception of Influenza. Please be advised, the Routine Adult Immunizations profile now includes Measles, Mumps, and Rubella (MMR), Polio, and Varicella. Please refer to ALARACT 255/2014 for additional guidance on requirements.

4 SPRINT Testing with Audiologist for identified Hearing Classification 3.

5 Additional labs will include: Urine pregnancy test, HIV, and G6PD.

6 Behavioral Health Clinicians are required to provide assessments and referrals.

7 Post behavioral data entry is required. MEDIUM to HIGH risk Soldiers will be reported to TXARNG event representatives immediately.

8 Providers are not allowed to issue Temporary Profiles during the FMRs/SRPs. All medical conditions must be documented according to allow Military Providers the ability to profile the medical condition or concern. The documentation will be provided to the TXARNG event representative upon completion of the event.

9 Prescription management is required as needed for Soldiers receiving Dental Treatment.

10 Vision screening ONLY.

11 No Medical Warning Tags.

12 Request that event information updates are provided at the end of each duty day. This information should include at a minimum:

a. Number of personnel seen on duty day, to include the number of no-shows

b. Number of personnel seen for the specific services:

i. Dental: Dental Exams, Dental Treatment, Bite Wings, and Panos

ii. Medical: Visual Acuity, EKGs, PHAs, Vitals, Hearing, Immunizations, and

Labs

TXARNG Space Available for Contractor:

SPACE will be made available for contractor in Armory Drill Hall. Check-in/out, services will be in Mobile units outside of Armory.

*Above totals are estimates and per contract TXARNG requires Contractor to contact TXARNG for actual rosters prior to event in order to adequately provide resources for this event.

Event Name: 56 IBCT (NW Houston AFRC/Rankin Rd) Event Location: 900 West Rankin Road, Houston, TX 77067

Event Dates:

(1) Medical Event: 11-12 FEB 17

1 Total: 470

2 PHA: 470

3 Hearing: 470 4 Optometry: 470 5 Dental Exam: 470 6 Dental Treatment: 141 required by regulation (CVSP, 5 YR EKG, and PSA).

2 Estimate (18%) Soldiers receiving dental treatment will need Case Management 3 Estimated (25%) will need Immunizations provided by the vendor. This includes all Routine

Adult Immunization with the exception of Influenza. Please be advised, the Routine Adult Immunizations profile now includes Measles, Mumps, and Rubella (MMR), Polio, and Varicella. Please refer to ALARACT 255/2014 for additional guidance on requirements.

4 SPRINT Testing with Audiologist for identified Hearing Classification 3.

5 Additional labs will include: Urine pregnancy test, HIV, and G6PD.

6 Behavioral Health Clinicians are required to provide assessments and referrals.

7 Post behavioral data entry is required. MEDIUM to HIGH risk Soldiers will be reported to

TXARNG event representatives immediately.

8 Providers are not allowed to issue Temporary Profiles during the FMRs/SRPs. All medical conditions must be documented according to allow Military Providers the ability to profile the medical condition or concern. The documentation will be provided to the TXARNG event representative upon completion of the event.

9 Prescription management is required as needed for Soldiers receiving Dental Treatment.

10 Vision screening ONLY.

11 No Medical Warning Tags.

12 Request that event information updates are provided at the end of each duty day. This information should include at a minimum:

a. Number of personnel seen on duty day, to include the number of no-shows

b. Number of personnel seen for the specific services:

i. Dental: Dental Exams, Dental Treatment, Bite Wings, and Panos

ii. Medical: Visual Acuity, EKGs, PHAs, Vitals, Hearing, Immunizations, and

Labs

TXARNG Space Available for Contractor:

SPACE will be made available for contractor in Armory Drill Hall. Check-in/out, Height/Weight and other administrative workspace will be provided by Government. Outside space available for ONLY Dental and Hearing. All other services will be completed inside of the armory.

*Above totals are estimates and per contract TXARNG requires Contractor to contact TXARNG for actual rosters prior to event in order to adequately provide resources for this event.

PWS

PERFORMANCE WORK STATEMENT: MOBILE MEDICAL AND DENTAL SERVICES

(revised December 2016)

C1. INTRODUCTION

C1.1. Organization. This Performance Work Statement (PWS) supports the Texas Army National Guard by providing OSHA compliant mobile Medical and Dental Services : at multiple locations. The FMR event shall allow the contractor a day prior to event for set up and a day after for tear down and departure. The Government expects the Contractor to provide excellent support by providing the right expertise at the right place at the right time in accordance with the reference documents provided.

C1.2. Mission. The mission of the Office of the State Surgeon for the Texas Army National Guard

(TXARNG) is to provide medically mission ready units in support of the National Military Strategy.

Our Federal Role: To maintain properly trained and equipped units, available for prompt mobilization for war, national emergency, or as otherwise needed.

Our State Role: To provide trained and disciplined forces for domestic emergencies or as otherwise required by state law.

C.2. REFERENCES

C2.1. Health Affairs Policy 02-011 at http://www.health.mil/Policies?daterange=2000-

2004&page=11#pagingAnchor

C2.2. AR 40-35 Dental Readiness & Community Oral Health Prevention http://armypubs.army.mil/

C2.3. AR 40-3, Medical, Dental and Veterinarian Care http://armypubs.army.mil/

C2.4. Health Insurance Portability and Accountability Act http://en.wikipedia.org/wiki/Health_Insurance_Portability_and_Accountability_Act

C2.5. AR 40-501, Standards of Medical Fitness – http://armypubs.army.mil/ http://www.health.mil/Policies?daterange=2000-2004&page=11#pagingAnchor http://www.health.mil/Policies?daterange=2000-2004&page=11#pagingAnchor http://armypubs.army.mil/ http://armypubs.army.mil/ http://en.wikipedia.org/wiki/Health_Insurance_Portability_and_Accountability_Act http://armypubs.army.mil/

C2.6. NGB Memorandum Post Deployment Health Re-Assessment Screen (Deleted)

C2.7. NGB Memorandum Periodic Health Assessment Interim Guidance (Deleted)

C2.8. TXARNG Office of the State Army Surgeon FMR Checklist (Deleted)

C2.9. Appendix D, Authorized Dental Treatment

C2.10. Women’s Health Readiness Guideline (Deleted)

C2.11. AR 40-562, Immunizations and Chemoprophylaxis for the Prevention of Infectious Diseases http://armypubs.army.mil/Search/ePubsSearch/ePubsSearchForm.aspx?x=AR

ADDED C2.12. Appendix E, Behavioral Health Reporting

ADDED C2.13. NGB Director, Medical Readiness Guidance and Leadership Goals (attached)

C3. ACRONYMS

ADA American Dental Association

AR Army Regulation

BH Behavioral Health

DA Department of the Army

DD DoD (Defense) Department

DenClass Dental Classification (module for ARNG)

DNA Deoxyribonucleic Acid

ECASE Electronic Case (notes)

EMMPS Electronic Medical Management Processing System

EPROFILE Electronic (Medical) Profiling (System)

FMR Fully Medically Ready

HCG Human Chorionic Gonadotropin

HIPAA Health Insurance Portability and Accountability Act

HIV Human Immunodeficiency Virus

HRR Health Readiness Record

IMR Individual Medical Readiness

MEB Medical Evaluation Board

MEDCHART Medical Electronic Data Care History And Readiness Tracking

MEDCOM U.S. Army Medical Command

MEDPROS Medical Protection System

MMRB Medical MOS Retention Board

MODS Medical Operational Data System

NGB National Guard Bureau

OSArS Office of the State Army Surgeon

OSHA Occupational Safety and Health Administration

PDHRA Post Deployment Health Reassessment

PEB Physical Evaluation Board

PHA Periodic Health Assessment

POS Point of Service

PPD Tuberculosis/Tuberculin Skin Test

PWS Performance Work Statement

RDA Registered Dental Assistant

RPR Rapid Plasma Reagin

SM Service Member

SRC Soldier Readiness Check

SRP Soldier Readiness Processing

STR Soldier Treatment Record

PWS Statement of Work

TMC Troop Medical Clinic

TXARNG Texas Army National Guard

QAQC Quality Assurance Quality Control

QASP Quality Assurance Surveillance Program

C4. SUMMARY OF SERVICES

http://armypubs.army.mil/Search/ePubsSearch/ePubsSearchForm.aspx?x=AR

C4.1. The overarching objective of this contract is to provide comprehensive mobile medical and dental services to the TXARNG at multiple locations. Individual Medial Readiness (IMR) and Fully Medically Ready

(FMR) are the basic principles of force-sustainment for Texas Army National Guard (TXARNG) forces. Medical and dental health is vital for force health protection and failure to achieve a standard of level of medical health could preclude a Soldier from performing any military duties or deploying. The contractor shall provide qualified personnel, material and equipment to perform the services to support the TXARNG’s need for fully medically ready forces. The Contractor shall perform mobile medical and dental services that require knowledge of federal, state, and/or local regulations and statutes, as well as Army, DOD, and National Guard regulations and electronic systems, and other documentation. In addition, the Contractor shall support the TXARNG mission by ensuring quality assurance of its products and services. Contractor employees shall perform only those services covered by the

Contract and only during periods covered by the Contract. No other services and only Government business may be conducted on Government premises.

C4.2. This is a firm fixed price contract for mobile medical and dental services. Services required are to conduct and complete the requirements of TXARNG IMR/FMR - Medical Readiness on all eligible Service

Members (SMs) in the TXARNG utilizing an HIPPA, Privacy Act, and OSHA-Compliant mobile health facility.

C4.3. Work Location: This FMR Event: 1) 1901 Veterans Memorial Pkwy, Huntsville, TX 77340.

2) 5102 Emma Browning Ave, Del Valle, TX 78617

3) 1700 East 25th Street, Bryan, TX 77802

4) 900 West Rankin Road, Houston, TX 77067

Service Delivery Summary (SDS)

Deliverable Performance

Standard Acceptable Quality Level (AQL)

Method Used/

Frequency

Vehicles Technical

Specifications

C7.

Adherence to C7 requirements and any deficiencies in compliance must be corrected in 30 minutes.

Contractor must be able to remediate any deficiencies or vehicle equipment malfunctions within 1-2 hrs. One deficiency is still a green rating. Two deficiencies during an event will change rating to yellow and three or more deficiencies will change rating to red.

Periodic

Inspection/

Monthly/

Customer

Comment

Cards and/or

Complaints/

Spot Checks Medical

Services

Technical

Specification

C8

Contractor shall conduct the requested exams/procedures when requested

Contractor enters PHA Part I & II data at POS - errors shall be corrected within days of notice that an error was made by the Contractor.

Contractor enters behavioral case notes for Soldiers required/who request to see the Behavioral Health

Professional into HRR. See Appendix E. High and Medium

High Risk Soldiers will be brought to the attention of the

COR and event on ground POC for safety measures 100% of the time.

Contractor conducts vison acuity test and verified prescription. One error is green rating, two or more error is a yellow rating and three or more errors will be a red rating.

Contractor conducts DOEHRS audiometer testing and

SPRINT testing (for Soldiers needing testing) and enters results into the system of record within 10 days of completion of the SPRINT test. All SPRINT tests required but not conducted at the event will be reported to the

TXARNG POC no later than the end of the event 100% of the time. One error is green rating, two errors yellow rating and three or more errors is a red rating.

Contractor provides required immunizations to the Soldiers at least 98% of the time, as immunizations are available on the market and Soldier are healthy enough to receive the vaccines. Contractor shall input immunizations. . One error is green, two is yellow, and three or more is red.

Phlebotomy/lab samples will be drawn and processed and administratively complete spreadsheets. Samples will be stored and transported IAW industry laboratory standards and delivered to the TXARNG POC for testing as directed by the POC to ensure proper shipping/cold chain requirements 100% of the time. One error is green, two is yellow, and three or more is red.

Dental

Services

Technical

Specification

C9.1; C9.2;

C9.3; C9.4;

C9.5

Contractor shall conduct the requested exams/procedures.

No procedures outside of those listed in App D will be approved. Contractor will provide a list of the 2% of

Soldiers and procedures not conducted and the reason why within 5 working days of the event completion.

Contractor provides or treats all Soldiers identified as needing Class III Dental Treatment at least 98% of the time.

Any Soldier requiring treatment outside of those approved by App D will be referred to their event POC for further guidance. Contractor will provide a list of the 2% of

Soldiers and procedures not conducted and the reason why within 5 working days of the event completion.

Contractor shall enters dental information in DENCLASS within 5 working day of event. Quality assurance will be verified by random sample done by COR, if errors occur they will be addressed/corrected within 2 days of notice.

One error is green, two is yellow, and three or more is red.

Contractor shall review and file dental information in the dental records (DENCLASS and HRR) 100% of the time.

Quality assurance will be verified by random sample done by COR, if errors occur they will be addressed/corrected within 2 days of notice. . One error is green, two is yellow, and three or more is red.

Prescription

Services

Technical

Specifications

C.10

Contractor shall arrange for prescription medications for

100% of the Soldiers who require them at POS for dental procedures as required.

Contractor shall provide a ride to and from a coordinated pharmacy to ensure Soldier receives the prescribed medication. The Soldier will receive care instructions for

100% of prescribed medications, and a process to follow if complications arise.

Case

Management

Services

Technical

Specification

C.11.1;

C11.2; C11.3;

and C11.4

Contractor will provide a list of all Soldiers by category

(dental/Behavioral Health/immunizations) not complete

/conducted and the reason why within 5 working days of the event completion. Behavioral Health Medium High and

High Risk Soldiers seen at the event will be reported to the

COR immediately for Soldier safety. One error is green, two is yellow, and three or more is red.

C5. CONCEPT OF OPERATIONS

C5.1. Background/Information:

C5.1.1. The TXARNG has the need to provide a fully medically ready, diverse and professional Total

Force capable of full spectrum operations that are responsive to both State and Nation. The TXARNG provides the

Governor and the President with ready and trained forces. The forces must be fully qualified in medical and dental readiness to perform their assigned mission. The objective of this PWS is to provide the Contractor with the information necessary to provide mobile medical and dental services to ensure the TXARNG forces are mission ready.

C5.1.2. The Contractor will provide mobile medical and dental services on the prescribed dates. The

Contractor is responsible for providing all medical personnel, support staff, equipment, and materials to accomplish the services outlined in the PWS.

C5.2. Concept of Operations

The Soldiers will sign into the medical/dental portion of the FMR process. Soldiers will ensure their portion of the PHA information is completed on the AKO website. The Soldiers will then begin going through all the medical and dental stations. The Contractor shall render required services necessary for the Soldier to be considered complete for medical readiness for the next 10-12 calendar months. When the Soldier has completed all the medical and dental stations, they will proceed to the check-out desk where their medical information (less women’s health information) will be input in MDWE (MEDPROS web data entry) by the contractor.

If Soldiers require follow on care/case management, the Contractor shall transfer to TXARNG.

The Contractor will input all required data into the MWDE system, DenClass, HRR, and eCase systems as each Soldier’s case requires.

C6. HEALTH CARE PERSONNEL

C6.1. All services shall be performed by properly licensed health care providers in the United States.

C6.2. The Contractor shall ensure all health care providers have the necessary Texas licenses and that all licenses are present, current, active, unrestricted and in good standing.

C6.3. The Contractor shall allow the Government to view health care provider’s credentials when requested.

C6.4. All Contractor provided services shall comply with OHSA, HIPAA and Privacy Act Standards.

C7. MOBILE VEHICLES AND EQUIPMENT:

C7.1. The contractor shall provide mobile medical and dental facilities that are HIPAA, Privacy Act, OSHA &

ADA compliant, and operate in a stand-alone environment. All Medical and Dental Vehicles must

C7.1.1. Be OSHA, ADA, HIPAA compliant

C7.1.2. Have private exam rooms

C7.1.3.Have a lab with an eye-wash station.

C7.1.4. Have biohazard separated work areas

C7.1.5. Have reception area with full office capabilities

C7.1.6. Be maintained at a comfortable temperature level (68 degrees to 74 degrees)

C7.2. Medical Vehicles: All Mobile facilities must be an OSHA compliant and at a minimum contain following:

C7.2.1. Fully Equipped Private Exam Room for full PHA Exam Requirements

C7.2.2 Health Stations to include vital signs, Visual acuity, immunizations, screenings, HIV Blood-Draws, DNA collection, DOEHRs-Compliant audiometry, and all other IMR/FMR requirements

C7.2.3. DOEHRs Compatible Audiometer

C7.2.4. Diagnostic hearing evaluations (H2) and SPRINT Testing (H3) through ISO-booths are a necessary capability on board a 2-Operatory

C7.2.5. DELETED

C7.2.6. CLEA-Waived Rapid Laboratory Screenings (Lipid Profile, Blood Glucose, Total Cholesterol, &

Urine HCG)

C7.2.7. Blood Pressure, Height/Weight

C7.2.8. DELETED

C7.2.9. DELETED

C7.2.10. DELETED

C7.2.11. Ability to Perform Blood Collection for HIV, DNA, G6PD, RPR

C7.2.12. Ability to Perform Immunizations & PPD Screenings (PPD item is deleted)

C.7.2.13. Staffing - All necessary qualified clinicians and medical technicians to Complete Full PHA &/or

Physical Exam Requirements

C7.3. Dental Vehicles: Dental treatment vehicles shall have full treatment functionality consistent with traditional, fixed-site, private practice dental offices. This includes non-portable and professional quality dental chairs, compressor systems, vacuum systems, and treatment instruments for fillings, extractions, root canals, and other authorized treatment by National Guard Bureau. All dental vehicles shall:

C7.3.1 Be fully functional administrative office whereby no additional space is required inside military buildings to complete all requirements of the PWS.

C7.3.2. Contain lead-lined walls for radiograph radiation protection; lead-lined walls for radiograph radiation protection; sterilization equipment in separate sterilization lab area; fully functional standard dental chairs;

and a ventilation system on-board to minimize air-borne pathogens

C7.3.3. Each Operatory OSHA/HIPAA/ADA-Compliant Mobile Dental Practice:

C7.3.3.1. Fully digital exams/Bite-wing radiographs/panos focus

C7.3.3.2. Necessary staffing with proper licensing to meet the PWS.

C7.3.3.3. Treatment available if needed with all necessary clinical supplies, equipment, & instruments.

C7.3.4. Operatory OSHA/HIPAA/ADA- Compliant Mobile Dental Practice:

C7.3.4.1. Treatment only focus with all necessary clinical supplies, equipment, & instruments.

C7.3.4.2. Necessary staffing of Texas Licensed Dentists, RDAs, Project Manager, & Project

Manager Assistant

C7.3.4.3. Digital exams/digital radiographs/panos avalable

C7.3.5. Each Operatory OSHA- Compliant Mobile Dental Practice:

C7.3.5.1. Exams/bite-wing radiographs focus

C7.3.5.2. Necessary staffing of Texas Licensed Dentist, RDAs, Project Manager, & Project

Manager Assistant

C7.3.5.3. Treatment available if needed with all necessary clinical supplies, equipment, & instruments.

C7.3.6. Operatory OSHA- Compliant Mobile Dental Practice:

C7.3.6.1. Treatment only focus with all necessary clinical supplies, equipment, & instruments.

C7.3.6.2. Necessary staffing of Texas Licensed Dentists, RDAs Project Manager, & Project

Manager Assistant

C7.3.6.3. Exams/digital radiograph available if needed

C7.4. Additional Portable Equipment

C7.4.1. Medical Equipment: Contractor shall provide the following additional equipment:

C7.4.1.1. DOEHRs Compatible Audiometer

C7.4.1.2. DELETED

C7.4.1.3. CLEA-Waived Rapid Laboratory Screenings (Lipid Profile, Hemoglobin, Blood

Glucose, Total Cholesterol, Urinalysis, & Urine HCG)

C7.4.1.4. Blood Pressure, Pulse Oximetry, Height/Weight/Temperature

C7.4.1.5. Tonometry

C7.4.1.6. EKG

C7.4.1.7. Visual Acuity

C7.4.1.8. Ability to Perform Blood Collection for HIV, DNA, G6PD, RPR

C7.4.1.9 Ability to Perform Routine Adult Immunizations

C7.4.2. Portable Dental Equipment:

C7.4.2.1. Digital exam/radiograph only

C8. MEDICAL SERVICES

C8 1. Medical Evaluation: Medical services shall be provided by a licensed provider (Physician, Physician’s

Assistant (PA), Nurse Practitioner (ARNP), and licensed Behavioral Health Specialist Professionals IAW prescribed

Army and NGB policy for Periodic Health Assessment, Physical Exams).

C8.2. Periodic Health Assessments (PHA): The contractor shall perform PHA Part I& II exams in accordance with AR 40-501 and record the PHA Part I & II results in the PHA module on MODS PHA Part I & II results will be entered by the provider at POS in the PHA module of MODS. If a Soldier has a temporary or permanent physical limitations per Chapter 3, AR 40-501 the contractor will enter in a draft DA 3349 into the eProfile system in MODS.

The contracted medical providers will not sign the electronic profiles, but report all draft profiles per Appendix B.

C8.3 DELETED

C8.4. Visual Acuity Testing: The contractor shall conduct visual acuity testing in accordance with AR 40-501 in order to determine and/or verify the Soldier’s prescription. The minimum testing authorized is utilization of a

Snellen chart.

C8.5. DOEHRS Compatible Audiometer Testing: The contractor shall conduct audiometry in accordance with

AR 40-501/DA Pam 40-501. Audiology Evaluations and Speech Recognition in Noise Test (SPRINT) testing will be performed IAW all applicable Federal, DOD, MEDCOM, NGB, and State guidelines. The contractor shall coordinate with the TXARNG Hearing Readiness Manger for specific DOEHRS site codes for the TXARNG.

C8.6. Immunizations: The contractor shall conduct immunizations in accordance with AR 40-501.

Immunizations shall include, AR 40-562, Chapter 4 and those listed on www.vaccines.mil . Contractor shall provide and maintain an anaphylaxis kit in the immunization area for use in the event of an adverse reaction. Contractor shall be responsible for providing a qualified medical provider to administer immediate medical attention for any adverse reactions. The OSArS representative will be responsible for all reporting requirements to document adverse reactions.

C8.7. DELETED

C8.8. Phlebotomy/Lab: The contractor shall conduct all phlebotomy services such as HIV and G6PD and DNA in accordance with AR 40-501. All specimens will be turned over to the TXARNG for testing (as coordinated with the OSARs representative at the time of event). The contractor shall conduct all required lab tests on site.

C9. DENTAL SERVICES

C9.1 Dental Exams: A periodic oral evaluation shall assess the current state of oral health, risk for future dental disease as well as assessing general health factors that relate to the treatment of the patient. The following measures are required for each periodic oral evaluation:

C9.1.1. Caries risk assessment – Classify Soldiers as low, moderate or high risk for caries as outlined by the American Dental Association’s 1995 Special Supplement. This assessment will allow the ADCS to identify those at high risk for future disease and appropriately manage their care.

C9.1.2. Periodontal assessment – Periodontal Screening and Recording (PSR), a screening procedure endorsed by the American Dental Association and the American Academy of Periodontology, should be utilized to determine the need for periodontal treatment.

C9.1.3. Tobacco risk assessment – Classify Soldiers as a smoker, user of smokeless tobacco or as both.

C9.1.4. Oral cancer screening – Perform a thorough oral cancer screening on all beneficiaries as part of all annual examinations.

C9.2. Digital Bitewings, Digital Panoramic Radiographs & Dental Exams: The contractor shall perform required dental examinations to include digital bitewings and digital panoramic radiographs if clinically indicated in support of the annual dental screenings in accordance with the AR 40-501 and AR 40-35. Only digital radiographs in its original format shall be uploaded into DENCLASS. Film or ‘digitized’ radiographs will not be accepted.

C9.2.1. Digital radiographs should be taken only for clinical reasons according to FDA guidelines as determined by the patient’s dentist. Radiographs should be of diagnostic quality, properly identified and dated. A panograph is required to be present in dental record and that it is of adequate quality for diagnostic/identification purposes. The panographic radiograph will adequately represent the current oral condition of the Soldier. Digital radiographs shall be performed on all service members who do not have a panograph on file in the DENCLASS system, regardless of when the hardcopy panograph is dated.

C9.3. Dental Treatment. Contractor shall provide dental treatment IAW Appendix D Authorized Dental

Treatment. If the contractor is unable to provide a required treatment then the Contractor shall set up post case management as needed. Contractor will not go over the estimated case management amount without Contracting

Officer approval.

C9.4. Each exam shall be entered into the DENCLASS reporting system and annotated on the SF 603 (Health

Record – Dental) and the SF 5570 (Health Questionnaire for Dental Treatment) of the Soldier’s dental records.

C9.5. Contractor shall enter all data in the DENCLASS database within 5 work days of completion of the

Dental Screening mission, to include uploading all radiographs taken during the event.

C9.6. For Contractor planning purposes, statistics indicate that approximately 30% in the FMR process will require additional dental treatment beyond the periodic oral exam and radiographs. Any number of soldiers over the estimated number would need to be identified and turned over to TXARNG for post case management.

C10. PRESCRIPTION MEDICATION SERVICES

C10.1. Contractor shall setup network & account with local pharmacies near event location.

C10.2. Licensed provider will arrange for fulfillment of prescription medication for Soldier

C10.3. Local Pharmacy & Contractor shall explain prescription medication instructions to the Soldier http://www.vaccines.mil/

C10.4. Follow-up conversations between Contractor and TXARNG treated Soldier & Supervisor may be necessary depending on complexity of treatment and prescription medication

C10.6. Contractor shall provide a copy of the pharmacies invoice to the Government with Contractor’s invoice for payment.

C10.7 Contractor shall enter all prescription documentation into HRR for Soldier medical record.

This event has no post case management and any solider requiring post case management will be referred to the Government for further action.

C11. CASE MANAGEMENT SERVICES: Contractor shall have local, and national network of Case Managers available to assist with expanded medical and dental Case Management functions during & post-event to ensure remediation of pending cases to include/utilizing health record review and maintenance. Contractor will have fully licensed & accredited TX & other State licensed network of general & specialty providers that can treat authorized

TXARNG Soldiers. Contractor will fulfill prescription medication services through local pharmacies as needed during dental events when required.

DELETED C11.1. Audiology Case Management Services:

C11.1.1. Contractor shall setup network & account with audiologists within 25 miles of the event location.

If the nearest audiologist is outside the prescribed distance will need COR or Contract Officer’s approval.

C11.1.2. The contractor shall utilize predetermined specific DOEHRS site codes for the TXARNG when inputting directly into DOEHRS.

C11.1.3. Contractor shall verify if SM has baseline Audiogram, DD2215, or Annual Audiogram, DD2216, on record via the DOEHRS Data Repository.

C11.1.4. Contractor shall not re-establish a Baseline Audiogram, DD2215, on any SM if one is already establish in the DOEHRS Data Repository.

C11.1.5. Contract Case Manager shall provide a by name roster of all Audiology cases and identify on roster positive STS, OSHA reportable hearing loss and SM requiring follow up Audiology Evaluation to the Office of the State Army Surgeon Clinical Operations Office (or identified representative) for review and approval at event closure daily.

C11.1.6. Contractor Audiologist to input all Category 2 and Category 3 required Hearing Profiles (H2 or

H3) into the MND Module of MODS IAW established template provided by the Office of the State Army Surgeon and AR 40-501 within five business day of event conclusion utilizing DOEHRS codes for the TXARNG.

C11.1.7. Contract Case Manager shall identify, track, and provide clinical oversight of Category 2 and

Category 3 TXARNG Soldiers via hardcopy record/spreadsheet, as well as, the MND module of MODS

When required, Contract Case Manager shall coordinate and arrange for fulfillment of required audiology consultations (Audiology Evaluation or SPRINT test)

C11.1.8. Local Audiologist’s & Contractor to explain hearing issues and applicable instructions to

TXARNG treated Soldiers and any other POC at the direction of the Office of the State Army Surgeon:

Follow-up conversations between Contractor and TXARNG treated Soldier & Supervisor may be necessary depending on complexity of treatment and potential additional requirements

C11.2. Behavioral Health Onsite at Event Case Management of Behavioral Health specific conditions/services

C11.2.1. Contract Case Manager shall identify, track, and provide clinical referrals of required Behavioral

Health Assessments TXARNG Soldiers via hardcopy record/spreadsheet.

C11.2.2. When required, Case Manager will coordinate and arrange for fulfillment of required Behavioral

Health consultations – either network or TXARNG ‘organic’ (“Green-Suit”) providers. See Appendix B & E for requirements and reporting.

C11.2.3. Contract Case Manager shall provide a by name roster of all completed Behavioral Health cases to the Office of the State Army Surgeon Clinical Operations Office (or identified representative) for review at event conclusion. Information of SM identified during event as SI/HI will be given immediately at time of identification to TXARNG Behavioral Health Case Manager (or identified representative) and to the Office of the State Army

Surgeon Clinical Operations Office. See Appendix B & E for requirements and reporting.

C11.4. Dental & General/Specialty Treatment Services Onsite at Event - Case Management of Dental

Exam (number of dental case management will be determined at index of FMR event):

C11.4.1 DELETED

C11.4.2. Upon need of dentally treated Soldier & recommended by licensed dentist, Contractor to arrange for fulfillment of dental treatment for Soldier

C11.4.3. DELETED

C11.4.4. Follow-up conversations between Contractor and TXARNG treated Soldier & Supervisor may be necessary depending on complexity of treatment and, if any, prescription medication for post-operatory.

Contractor to collect & tally all expenses of general & specialty dental treatment services & case management related

C11.4.5. Contractor will submit costs to authorized Government representative

C11.4.6 DELETED

C11.4.7 DELETED

C11.4.8. As required provide timely feedback and work progress/ status of number of Dental examinations completed to the Office of the State Army Surgeon’s POC (or designated representative) as to timelines or factors that may negatively impact processing 8 Soldier exams per hour.

C11.4.9. Provide completion status to Office of the State Army Surgeon’s POC (or designated representative) as to time requirements to complete jobs to insure processing 8 Soldier exams per hour.

C12. GOVERNMENT FURNISHED PROPERTY AND INFORMATION:

C12.1. Only parking will be provided for HIPAA, Privacy Act, OSHA & ADA-Compliant, Self-Contained

Mobile Medical Practices. No armory, TMC or office space will be provided to the contractor.

C12.2. TXARNG provide the HIV and DNA supplies required for FMR event.

C13. QUALITY CONTROL PLAN: The contractor’s Quality Control Plan (QCP) shall include equipment training, required electronic systems, occupational safety, health, and fire protection guidance to ensure the protection and health of all work personnel. The Contractor’s QCP must be available for review by the Contracting

Officer when requested.

C14. APPLICABLE DOCUMENTS: The contractor shall ensure that all appropriate DA or DD forms (in accordance with references) are utilized for each service supplied. The forms will be made available through the

OSArS/COR office. The contractor shall provide all hardcopy documentation generated concerning medical treatment to the Office of the State Army Surgeon of the TXARNG at the end of the event.

C15. PLACE OF PERFORMANCE

C15.1. FMR Event: 1) 1901 Veterans Memorial Pkwy, Huntsville, TX 77340.

2) 5102 Emma Browning Ave, Del Valle, TX 78617

3) 1700 East 25th Street, Bryan, TX 77802

4) 900 West Rankin Road, Houston, TX 77067

C16. PERIOD OF PERFORMANCE:

C16.1. (1) See individual Event Sheets

C16.2. DELETED

C16.3. Hours of Operation: Soldiers will be made available to the contractor during regular drill weekends and training periods between the normal hours of operations to be estimated at 10 hours a day. Hours are between 0630 and 1630 unless special arrangements are made.

C17. ESTIMATED SCOPE:

C17.1. See individual event sheets.

C18. OTHER CONDITIONS/ SECURITY

C18.1. Safety: The contractor shall establish an internal written Quality Assurance Quality Control Program

(QAQC Program) or equivalent safety and health program in accordance with the standards of the Federal

Occupational Safety and Health Standard (OSHA), Health Information Portability and Accountability Act (HIPPA), and The Privacy Act.

C18.2. Performance work statement is “UNCLASSIFIED” and under HIPAA guidelines. OSArS shall notify the Contractor if requirement exists for a secret classification and circumstances requiring secret classification for

Readiness impact reporting.

C18.3.