ATTACHMENT_02-_17_18NOV18_MARTINDALE_PERFORMANCE_WORK_STATEMENT.pdf

As of 15OCT18

PERFORMANCE WORK STATEMENT: MOBILE MEDICAL AND DENTAL SERVICES

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 Martindale, 5500 IH 10 E, San Antonio, Texas 78219 for the period of 17-18 November 2018. 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 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 expects Martindale, 5500 IH 10 E, San Antonio, Texas 78219.

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/

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

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

C4.1. The overarching objective of this contract is to provide comprehensive mobile medical and dental services to the TXARNG at Martindale, 5500 IH 10 E, San Antonio, Texas 78219. Individual Medial Readiness (IMR) and Full Medical Readiness (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 at Martindale 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.

All contingent upon availability of funds at the beginning of Fiscal Year 2019.

C4.3. Work Location: This FMR Event: Martindale, 5500 IH 10 E, San Antonio, Texas 78219.

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;

• 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

C11.2; C11.3;

and C11.4 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 Texas 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. Providers requiring license shall be licensed in accordance with Army Regulation 40-68, para. 4-8.

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). All corporations must be a Texas Professional Corporation and since events include dental, the owners must be licensed dentists in the State of Texas.

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. Additional operatory for expanded medical services to include Optometry. Optometry with Visual Refraction and ordering of glasses through NOSTRA.

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.

http://www.vaccines.mil/

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

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 post case management and any solider requiring post case management. Upon need of dental treatment recommended by licensed dentist, Contractor to arrange for fulfillment of dental treatment for Soldier

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 & 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.

C12.3 Contingent upon availability of funds.

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: Martindale, 5500 IH 10 E, San Antonio, Texas 78219.

C16. PERIOD OF PERFORMANCE:

C16.1. (1) FMR 17-18 November 2018 includes set up on 16 November 2018 and ends with recovery operations on 19 November 2018.

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. Estimate 365 Service Members (SMs) requiring medical and dental services for the FMR event.

C17.2. Estimate 365 Service Members (SMs) total requiring Soldier Dental Treatment Record (STR) review & maintenance services for the first FMR event.

C17.3. Estimate approximately 66 SMs will require Case Management.

C17.4. Contractor shall provide Adult Routine Immunizations for an estimated 30 SMs for FMR event, as immunizations are available in the general market.

C17.5. Estimate 50 Soldiers will need “over 40” requirement of EKG and expanded labs as required by regulation.

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. Security Requirements: Post security will require all employees and affiliated personnel of the contractor to carry a State recognized identification card or driver’s license and all vehicles are subject to search without reason. The contractor shall comply with all installation security requirements.

C19. REPORTING: Reporting: The contractor shall provide a final report for all services, in accordance with HIPAA guidance, provided to include a by name, unit, and social security number roster of all Soldiers that require SPRINT, Behavior Health, or Dental services not accomplished prior to the event conclusion. The report shall be approved and verified by the COR. See Appendix B ESTIMATED WORKLOAD Reporting

C20. APPENDICES:

C20.1 Deleted

C20.2. APPENDIX B: ESTIMATED WORKLOAD Reporting

C20.3 APPENDIX C: DEPARTMENT OF DEFENSE ORAL HEALTH AND READINESS

CLASSIFICATION SYSTEM

C20.4 Deleted

C20.5 APPENDIX D: AUTHORIZED DENTAL TREATMENT

C20.6 APPENDIX E: BH Reports and Risk Level

C20.7 APPENDIX F: Quality Assurance Plan

C21. GENERAL INFORMATION

C21.1 This contract conveys the basic requirements, performance standards and assessment measures that will apply to the contract. The Contractor shall perform in accordance with the requirements of this PWS. The service requirements are summarized into performance objectives. The performance threshold briefly describes the minimum acceptable levels of service required for each requirement. The event summary request outlines more specific event needs.

C21.2. Government Remedies. The Contracting Officer shall follow the requirements of FAR 52.246-4, Inspection of Services - Fixed-Price (AUG 1996) for Contractor’s failure to correct non-conforming services. In the event that services fail to conform to contract requirements and cannot be remedied by re-performance, the Government reserves the right to reduce the contract price to reflect the reduced value of the non-conforming services. The Government will notify the Contractor of weaknesses or discrepancies as they become apparent. The first notification will be to attempt to obtain re-performance if possible. Deficiencies that exceed the SDS acceptable levels will be issued on a Contract Discrepancy Report.

C21.3. Evaluation of Contractor’s Performance. (Reference FAR 52.246-4, Inspection of Services – Fixed Price). The Contractor’s performance will be evaluated during and at the conclusion of the event. For those tasks listed in the Service Delivery Summary (SDS), the KO and/or the COR will follow the methods of surveillance specified in the Government’s Quality Assurance Surveillance Plan (QASP). Government personnel will record all surveillance observations. When an observation indicates defective performance, the COR will require the Contractor or Contractor’s appointed Manager to initial the observation. The initialing of the observation does not necessarily constitute concurrence with the observation, only the acknowledgment that they have been made aware of the defective performance. Interim evaluations may be prepared at any time during contract performance when determined to be in the best interest of the Government.

C21.4. In the event the Contractor is unable to fulfill requirements in a timely manner, the Government reserves the right to obtain services from another source. A pattern of continued inability to fulfill requirements may constitute the basis for considering remedies under Termination clauses or for not exercising an option period. This is not a requirements contract and the Government reserves the right to obtain services from other sources.

C21.5. The awarded contractor will be required to comply with the Army's policy for Contractor Manpower Reporting. 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. The contractor is allowed a onetime fee for the administrative cost associated with providing the information online. The contractor is required to completely fill in all the information in the format using the following web address: https://contractormanpower.army.pentagon.mil:

Reporting should be provided within 30 days of completion of this contract requirement. The contractor is entitled to quote a reimbursement amount for this reporting. If there is to be no additional charge, please respond with a $0.00 amount or a "no charge".

APPENDIX A: DELETED

APPENDIX B: WORKLOAD Reporting

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

• Date

• Location

• List of contract employees (providers, technicians, and administrative staff)

• Total number of patients scheduled

• Total number of patients examined

• Total number of Soldiers by dental classification: 1, 2, 3

• Total number of bitewing radiographs (sets of 4 per patient) taken

• Total number of panograph radiographs taken

• Total number of PHAs (broken down by clinical services)

• Total number of Hearing Examinations

• A by name listing of SPRINT Tested Soldiers to include conducted and non-conducted SPRINT Tests (identified appropriately)

• A by name listing of Behavioral Health examined Soldier by Risk Level Classification: Low, Medium, Medium High, High. See Appendix E

• A by name listing of Dental Class 3 Soldiers that require dental remediation that did not receive corrective actions at the POS. See Appendix C & D

• A by name listing of Soldiers w/SSN Last 4 with initiated profile forms in the eProfile system

• Verification of entry into MEDPROS & DENCLASS, E-PHA, E-Profile, HRR

• A by name listing of all Soldiers examined and the dental classification of the Soldier

APPENDIX C: DEPARTMENT OF DEFENSE ORAL HEALTH AND READINESS CLASSIFICATION

SYSTEM

The oral health status of uniformed personnel shall be classified as follows:

(A) Class 1 (Oral Health): Patients with a current dental examination, who do not require dental treatment or reevaluation. Class 1 patients are worldwide deployable.

(B) Class 2: Patients with a current dental examination, which require non-urgent dental treatment or reevaluation for oral conditions, which are unlikely to result in dental emergencies within 12 months. Class 2 patients are worldwide deployable. Patients in dental class 2 may exhibit the following:

(1) Treatment or follow-up indicated for dental caries or minor defective restorations that can be maintained by the patient.

(2) Interim restorations or prosthesis that can be maintained for a 12 month period. This includes teeth that have been restored with permanent restorative materials for which protective cuspal coverage is indicated.

(3) Edentulous areas requiring prostheses but not on an immediate basis.

(4) Periodontium that:

(a) Requires oral prophylaxis

(b) Requires maintenance therapy

(c) Requires treatment for slight to moderate periodontitis and stable cases of more advanced periodontitis

(5) Un-erupted partially erupted or malposed teeth that are without historical, clinical or radiographic signs or symptoms of pathosis, but which are recommended for prophylactic removal.

(6) Active orthodontic treatment. The provider should consider placing the patient in passive appliances for deployment up to six months. For longer periods of deployment, the provider should consider removing active appliances and placing the patient in passive retention.

(7) Temporomandibular disorder patients in remission. The provider anticipates the patient can perform duties while deployed without ongoing care and any medications or appliances required for maintenance shall not interfere with duties.

(C) Class 3: Patients who require urgent or emergent dental treatment. Class 3 patients normally are not considered to be worldwide deployable.

(1) Treatment or follow-up indicated for dental caries, symptomatic tooth fracture or defective restorations that cannot be maintained by the patient.

(2) Interim restorations or prostheses that cannot be maintained for a 12 month period.

(3) Patients requiring treatment for the following periodontal conditions that may result in dental emergencies within the next 12 months.

(a) Edentulous areas or teeth requiring immediate prosthodontic treatment for adequate mastication or communication or acceptable esthetics.

(b) Active progressive moderate or advanced periodontitis.

(c) Periodontal abscess

(d) Progressive mucogingival condition

(e) Periodontal manifestations of systemic disease or hormonal disturbances

(f) Heavy subgingival calculus

(4) Edentulous areas or teeth requiring immediate prosthodontic treatment for adequate mastication or communication or acceptable esthetics.

(5) Unerupted, partially erupted or malposed teeth with historical, clinical or radiographic signs or symptoms of pathosis that are recommended for removal.

(6) Chronic oral infections or other pathologic lesions including:

(a) Pulpal, periapical or resorbptive pathology requiring treatment.

(b) Lesions requiring biopsy or awaiting biopsy report.

(7) Emergency situations requiring therapy to relieve pain, treat trauma, treat acute oral infections or provide timely follow-up care (e.g., drain or suture removal0 until resolved.

(8) Acute Temporomandibular disorders requiring active treatment that may interfere with duties.

(D) Class 4. Patients who require periodic dental examinations or patients with unknown dental classifications. Class 4 patients normally are not considered to be worldwide deployable.

APPENDIX D: AUTHORIZED DENTAL TREATMENT

(1) The following dental procedures are authorized:

(a) Diagnostic Services:

• D0120-Periodic Oral Evaluation

• D0150-Comprehensive Oral Evaluation

• D0330-Panoramic Film

• D0272-Bitewings-Two Films

• D0274-Bitewings-Four Films

• D0220/D0230- Periapical (limited)

(b) DELETED

(c) Restorative Services which are funded through the NG6H 2065 ASDRS Funding (provided to Class 3 Soldiers not on alert status):

• D2140-Amalgam-One Surface

• D2150-Amalgam-Two Surfaces

• D2160-Amalgam-Three Surfaces

• D2161-Amalgam-Four or More Surfaces

• D2330-Composite-One Surface

• D2331-Composite-Two Surfaces

• D2332-Composite-Three Surfaces

Posterior composites shall be authorized only when a posterior composite is necessary to provide a quality restoration and no other alternative is available.

• D2335-Composite-Four or More Surfaces

• D2391-Composite-One Surface

• D2392-Composite-Two Surfaces

• D2393-Composite-Three Surfaces

• D2394-Composite-Four or More Surfaces

(d) Oral Surgery Services which are funded through the NG6H 2065 ASDRS Funding (provided to Class 3 Soldiers not on alert status):

• D7140-Extraction, Erupted Tooth or Exposed Root

• D7210-Surgical Removal of Erupted Tooth

• D7220-Romoval of Impacted Tooth, Soft Tissue

• D7230-Removal of Impacted Tooth, Partial Bony

D8680-Orthodontic Retention

(2) The following dental procedures are not authorized:

• Bridges and/or implants

• Removal of Asymptomatic third molars

• Routine Prophylaxes (cleanings)

• Restorations for aesthetics only

• Restorations for small (non-class 3) caries

• Extensive Root plane/scaling

• Osseous Surgery

• Other diagnostic services

(3) The above listings are guides to assist the State Dental Officer or his/her designee in determining treatment to be authorized. The treatment provided by the ARNG is to get the Soldier from a dental class 3 to a dental class 2 only.

Comprehensive Treatment (to dental class I) is not authorized.

(4) If a Soldier needs all of his/her remaining teeth in an arch extracted and a denture placed, the Soldier shall not be available for deployment for at least 6 months and shall be disqualified from immediate deployment. However, if the

Soldier is otherwise deployable (passes all medical, personnel and training requirements) and, after extraction and placement of prosthesis, would be deployable, the dental treatment could be provided and the Soldier could be considered as a replacement at a later date.

(5) DELETED

(6) Deleted

(7) The State Dental Officer (or designated representative) shall review any dental treatment plan for dental care which exceeds $800 to insure that the above clinical guidelines are met. Exceptions can be made, but they shall be coordinated with the State Surgeon/COR

APPENDIX E: BH Reports and Risk Level

BH Requests for FMR Process & Reporting Improvement

Contractor Level

• Better identifiers/specifics from contractor printout (spreadsheet of psychosocial assessments conducted) on which cases need follow-ups so that CPT Wayne Marrs (Psychological Health Coordinator for TXARNG) can appropriately assign the cases (wayne.d.marrs.mil@mail.mil)

• Send spreadsheet at end of the event encrypted to MAJ Geoffrey Powell (Geoffrey.i.powell.mil@mail.mil ) o Provide a column indicating SM’s full name, last four digits of SS #, phone number, SM city of residence, current risk level, if red- what was done.

o If risk level is orange or red, create a profile template (will be reviewed and signed by a profiling officer). These need to be made a priority, with the psychosocial assessments uploaded into HRR same day as event for orange/red cases.

o Follow protocol in place for red soldiers, as a risk assessment is needed and hospitalization may result.

o All psychosocial assessments should be uploaded into HRR in timely fashion, with orange/red assessments uploaded by end of the day that SM was seen.

mailto:Geoffrey.i.powell.mil@mail.mil

• Risk level Identifiers Needed

APPENDIX F: Quality Assurance Plan – refer to PWS Para C4.3

The COR will monitor Contractor performance and complete the Quality Assurance Worksheet provided below as specified in contract. The Quality Assurance Worksheet will be submitted directly to the Contracting Officer with a copy to the Contractor following the evaluated period, not later than the 15th of the month following the event.

The quality rating may change from “Green” to “Red”. The COR may use the “Yellow” quality rating to alert the Contracting Officer and the Contractor of quality issues that have the potential for a “Red” quality rating if corrective action is not taken.

At the end of the event performance or annually, the COR will be asked to complete a Quality Performance Review to document the quality performance rating during the performance period. This will be submitted to the Contracting Officer with a copy to the Contractor.

The COR may submit a Quality Assurance Worksheet at any time and as often as necessary to document quality levels

Unless the award specifies differently, the COR for this Quality Assurance Plan is MAJ Geoffrey Powell, the Office of the State Surgeon, NGTX, at Geoffrey.i.powell.mil@mail.mil , 512-782-1134.

mailto:Geoffrey.i.powell.mil@mail.mil

Rating Description

Green Performance and technical specifications are being met at Acceptable Quality Levels (AQL) – only one error reported and not remedied.

Yellow Performance and technical specifications are currently being met at the minimum AQL, but the following service/deliverable needs contractor. – Two errors have been reported and not remedied.

Red Performance and technical specifications are not being met at AQL and the following service/deliverable needs immediate Contractor resolution.

There are three or more errors reported and not remedied.

QUALITY ASSURANCE PLAN WORKSHEET (Page 1)

Performance Rating

Deliverable/Service √ Quality Rating Causative Factors Effect On Mission Action Required/Date

Vehicle Green Comments Unnecessary for “Green” QA Rating

Yellow

Red

Medical Services Green Comments Unnecessary for “Green” QA Rating

Yellow

Red

Dental Services Green Comments Unnecessary for “Green” QA Rating

Yellow

Red

Prescription Services

Green Comments Unnecessary for “Green” QA Rating

Yellow

Red

Case Management Service – no post case management for these events

Green Comments Unnecessary for “Green” QA Rating

Yellow

Red

Note: Attach Invoice

Period of Performance: From _______________to____________

Reviewed by: Date: ___________________