W912MM-16-T-0004_SDARNG_Medical.docx

W912MM-16-T-0004

Section SF 1449 - CONTINUATION SHEET

General Information

FFP

This solicitation in no way obligates the Government to award a contract, nor does it commit the Government to pay any costs incurred in the preparation and submission of any offer/quote. Furthermore, the Government reserves the right to reject any and all offers, to award multiple contracts, to award contracts for any/all or none of the event service dates, if such action is considered to be in the best interest of the Government.

Questions shall be submitted in writing and are due NLT 1200 PM 6 Feb 16.

Questions shall be e-mailed to monty.c.eisenbraun.mil@mail.mil

To comply with 10 U.S.C. sec. 2227, Department of Defense procedures require electronic submission of payment requests and the contractor’s ability to receive electronic funds transfer (EFT). In accordance with Defense Federal Acquisition Regulation Supplement Clause at DFARS 252.232-7003 payment requests shall be submitted in one of several electronic formats. See clause 252.232-7006 for detailed invoicing information.

The following factors shall be used to find an offer acceptable:

1.Past Performance/ Prior Experience in the last two years that indicates a minimum level of satisfactory service for similar (Military) type requirements. Provide names and addresses of any contracts previously held for two (2) similar requirements.

2.The contracting officer may determine an offer noncompliant with the terms and conditions of the solicitation if the contractor does not provide the information requested, specifically:

•Signed SF1449 (Page 1), •Service Event (Location) Pricing, •References (2) •Copy of General Liabiltiy Insurance Certificate •Completed Provision 252.209-7991 Dev REPRESENTATION BY CORPORATIONS REGARDING AN UNPAID DELINQUENT TAX LIABILITY OR A FELONY CONVICTION UNDER ANY FEDERAL LAW—FISCAL YEAR 2016.

FOB: Destination

4-5 March 2016 Rapid City, SD

Operational – Friday 0900 to 1900, Saturday 0700-1700 Services required - DOEHRS Compatible Audiometer Testing/SPRINT.

Armory Space is Not Available

Approximate number of soldiers 390. Event Price$_______________

11-13 March 2016 Sioux Falls, SD

Services required – Dental Exams and DENCLASS Entry. Requesting 2 Dentists and 2 Dental Techs to complete exams over the identified dates/times. Contractor dentists need to be on site during all times/hours. Contractor responsible to complete data entry in real time in DENCLASS. Military dentists will also be performing exams on the same pool of 330 soldiers needing exams during, Friday 1700 - 2100, Saturday 0700-1700 & Sunday 0700-1200.

Armory Space is Available for dental exams.

Contractor provided DOEHRS Compatible Audiometer Testing/SPRINT for 330 soldiers, Friday 1600 - 2100, Saturday 0700-1700, Sunday 0700-1200 Armory Space is Available for Hearing.

Event Price$_______________

8-10 April 2016 Rapid City, SD

Operational - Friday 1700 - 2100, Saturday 0700-1700, Sunday 0700-1200 Services required – Dental Restoration on 9-10 April for 20 hours of Dental Restoration effort on Saturday 0700-1700 & 10 hours of Restoration effort Sunday 0700-1200. Armory Space is Available for Dental.

Contractor provided DOEHRS Compatible Audiometer Testing/SPRINT for 325 over Friday, Saturday and Sunday. Armory Space is Not Available for Hearing.

2 April 2016 Sioux Falls, SD

Operational - Saturday 0700-1700 Services required – Dental Restoration for 50 hours of effort.

Armory space is Not Available

10-11 Sept 2016 Rapid City, SD

Operational – Friday 1300-1700, Saturday 0700-1600, Sunday 0700-1500 Services required - Full PHA and Dental Exams.

DOEHRS Compatible Audiometer Testing/SPRINT.

Armory Space is Not Available for Hearing.

Approximate number of soldiers 260. Event Price$_______________

Contractor Manpower Reporting

Contractor Manpower Reporting - Services Non-Personal

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 required to completely fill in all the information in the format using the following web address:

https://cmra.army.mil

The required information includes:

(1) Contracting office, Contracting Officer, Contracting Officer’s Technical Representative;

(2) Contract number, including task and delivery order number;

(3) Beginning and ending dates covered by reporting period;

(4) Contractor name, address, phone number, email address, identity of contractor employee entering data; (5) Estimated direct labor hours (including sub-contractors);

(6) Estimated direct labor dollars paid this reporting period (including sub-contractors);

(7) Total payments (including sub-contractors);

(8) Predominant Federal Service Code (FSC) reflecting services provided by contractor (and separate predominant FSC for each subcontractor if different); FSC = Q403

(9) Estimated data collection cost;

(10) Organizational title associated with the Unit Identification Code (UIC) for the Army Requiring Activity (the Army Requiring Activity is responsible for providing the contractor with its UIC for the purposes of reporting this information;

(11) Locations where contractor and subcontractors perform the work (specified by zip code in the United States and nearest city, country, when in an overseas location, using standardized nomenclature provided on website);

(12) Presence of deployment or contingency contract language; and

(13) Number of contractor and subcontractor employees deployed in theater this reporting period (by country).

As part of its submission, the contractor will also provide the estimated total cost (if any) incurred to comply with this reporting requirement. Reporting period will be the period of performance not to exceed 12 months ending September 30 of each government fiscal year and must be reported by 31 October of each calendar year. Contractors may use a direct XML data transfer to the database server or fill in the fields on the website. The XML direct transfer is a format for transferring files from a contractor’s systems to the secure web site without the need for separate data entries for each required data element at the web site. The specific formats for the XML direct transfer may be downloaded from the web site.

(End of Contractor Manpower Reporting)

PERFORMANCE WORK STATEMENT

Performance Work Statement for Medical Readiness Mar2016 to Sep2016

In Support of Individual Medical Readiness (IMR) and Fully Medically Ready (FMR)

South Dakota Army National Guard (SDARNG)

28 January 2016

1. BACKGROUND:

1.1 Individual Medical Readiness (IMR) and Fully Medically Ready (FMR) are the basic principles of force-sustainment for Army National Guard (ARNG) forces. Medical and Dental health is vital for force health protection and failure to achieve a standard of level of medical and dental health could preclude a soldier from deploying. Medical and Dental Readiness is a command responsibility.

1.2 The objective of this Performance Work Statement (PWS) is to conduct and complete the various components of IMR/FMR, Medical and Dental Readiness on all eligible Service Members (SM) of the SDARNG. Services are to be completed on location at various SDARNG Armories & Training Sites across the State. The contractor shall provide all personnel, equipment, tools, materials, supervision, and other items and non-personal Medical or Dental services for Soldiers in the South Dakota Army National Guard as defined in this Performance Work Statement (PWS). The contract will utilize Government Space or provide OSHA, HIPPA, ADA, and Privacy Act Compliant Mobile/Portable, Self-Contained Health Practices depending on the individual site needs for the SDARNG. See event schedule for details.

1.3 Medical Services shall include but not limited to: Blood Pressure, height & weight, Periodic Health Assessments (PHAs), IAW AR 40-501. Laboratory / phlebotomy work such as HIV, urine pregnancy, DNA, G6PD, RPR, Immunizations required for IMR and theater specific compliance such as Hepatitis A/B, TwinRex Influenza, MMR, Varicella. Visual acuity and Optometry exams, DOEHRS compatible audiometric exams and SPRINT testing for H3 Soldier’s. Pre-event coordination with SDARNG team members shall be conducted to validate event requirements at Sixty (60) and thirty (30) days prior to event.

2. MEDICAL SERVICES SCOPE:

The scope of contractor provided Medical Services is to conduct and complete the requirements of IMR/FMR Medical Readiness on all eligible (mobilizing or not) Service Members (SMs). Medical services shall be performed by licensed professionals. Contractor shall be held liable and is responsible to ensure and verify the appropriate level of Credentialing / Privileging (Licensure, Diploma, background checks, Common Access Card privileges etc.) for all contract providers in support of any service event.

· Staff a dedicated and Medical emergency # (manned 24/7) for post event consult.

· Contractor provides a dedicated Event Manager to coordinate and oversee execution of service event. Event Manager should not be busy with other tasks and should be available to correct any issues that may arise. Event manager will work closely with SDARNG representative.

· Onsite data entry.

· A station to administratively input data entry (blood pressure, height & weight, etc) into the MHA module prior to each Soldier seeing the Provider.

· Medical evaluation by a licensed provider (Physician, Physicians Assistant (PA), or Nurse Practitioner (ARNP). RNs must have completed appropriate training IAW DoD service, USCG, and CDC guidelines and act within their scope of practice. Providers must be licensed in South Dakota. Providers need to have completed the ‘Mental Health Assessment Training – Posttest in Accordance with Health Affairs Policy 10-005, “Mental Health Assessments for Members of the Armed Forces Deployed in Connection with a Contingency Operation.”

· All routine and ordered phlebotomy services (lab work) provided on location.

· All LAB/immunization technicians shall be MILVAX certified.

· All routine and theatre specific immunizations administered by contractor when requested in the services delivery schedule must be annotated on a DD Form 2766 - Adult Preventive and Chronic Care Flow sheet. SDARNG will provide immunizations and DD Form 2766

· Electrocardiogram (EKG) service performed on all Soldiers over 40 years of age. This should be performed by a technician other than the providers.

· Vision Screening.

· When Requested Optometric Evaluations for Soldiers scoring worse than 20/40 on screening. Eye exams and prescriptions (DD771s) provided on location for those Soldiers (See Service Event Schedule).

· Audiology H2/H3/H4 and SPRINT testing for all H3’s on location in real time. (See Service Event Schedule).

· DOEHRS certified technicians must perform all audiology input to DOEHRS, point of service data entry is preferred.

· Maintain all records for events for a period of up to 6 months post event.

· Special reporting to State Surgeon/ Deputy State Surgeon for special/unusual situations.

3. MEDICAL TASKS

3.1 Periodic Health Assessments (PHA): The contractor shall conduct PHAs in accordance with AR 40-501 and the PHA guidance set forth by the National Guard Bureau of the Surgeon General. Compliance with OSHA, State & Federal Regulations is mandatory.

Physical Exams: The contractor shall conduct PHA’s, on-site laboratory testing for lipids, glucose, cholesterol, urinalysis, HCG, and hemoglobin, and EKG’s. All professionals shall be licensed and adhere to all requirements of OSHA, State & Federal Regulations is mandatory.

Special Lab/Phlebotomy: The contractor shall conduct/process all phlebotomy services such as HIV, G6PD, RPR blood draws, pregnancy testing, and lipid profiles in accordance with AR 40-501 as required. SDARNG will provide bar codes, HIV tubes and paperwork required for HIV testing. SDARNG MRNCO will assist by providing a by name listing of requirements prior to each event so contractor can project for supplies and equipment needed.

DNA Collection: The contractor shall conduct DNA collection (minimal expected) in accordance with the AR 40-501. The contractor shall utilize the SDARNG Medical Command for all DNA supplies, shipping supplies, and shipping guidance. Adherence to all requirements of OSHA, State & Federal R egulations is mandatory.

Immunizations: The contractor shall administer immunizations in accordance with AR 40-501. Immunizations shall include, but not limited to, influenza, yellow fever, typhoid, tetanus, hepatitis A, hepatitis B, polio, MMR, and varicella. Adherence to all requirements of OSHA and all State & Federal Regulations is mandatory. In such cases, coordination with SDARNG Medical Command and the Office of the Deputy State Surgeon (DSS) to order and transport serum to sites will be made. Government will provide only serum required for event.

Data input: Results entry of all medical related FMR/IMR functions into the MEDPROS module of MODS for soldiers not to exceed 5 calendar days after the last day of services. Preference is at the end of the event.

Vision Screening in accordance with AR 40-501.

3.2 Visual Acuity Testing: (When Requested) The contractor shall conduct visual acuity testing in accordance with AR 40-501. Refraction and SRTS data entry may be required. See service delivery schedule for details.

3.3 DOEHRS Compatible Audiometer Testing: The contractor shall conduct audiometric exams in accordance with AR 40-501. Audiometers must be DOEHRS compatible. Adherence to all requirements of OSHA, State & Federal Regulations is mandatory. Audiology Evaluations and Speech Recognition in Noise Test (SPRINT) testing will be performed IAW all applicable Federal, DoD, MEDCOM, NGB, and State guidelines. Iso-booths to be CAOCH certified.

Medical Service Delivery Schedule The contractor service requirements are summarized into performance objectives that relate directly to mission essential items. The performance threshold briefly describes the minimum acceptable levels of service for each task.

Service Delivery Schedule: Medical Services in support of the South Dakota NG.

Spot Check or inspection

Customer Complaint

1. Contractor personnel to possess appropriate level of credentialing/licensing

Contractor completes all required testing including:

1. Vision and hearing exams

1. Administers immunizations

1. Phlebotomy work

1. DNA, HIV Testing

Contractor completes all required administration including:

· Profile Management

1. Updates to personnel medical files must be error free and confidentiality maintained.

Quality Assurance Surveillance Plan:

The Contracting Officer Representative (COR) will monitor contractor performance and complete the Quality Assurance Surveillance Plan Worksheet provided below for each event location completed. The following information will be provided to the Contracting Officer to ensure services and/or deliverables support the PWS objectives. If the performance rating for any task in this order is “Red” during any time in the performance period, the COR will provide the Contracting Officer the details regarding the deficiency. The quality rating may change from “Green” to “Red” without notice. We anticipate the COR utilizing the “Yellow” quality rating to alert the contracting office of quality issues that have the potential for a “Red” quality rating if corrective action is not taken.

The Quality Assurance Surveillance Plan Worksheet will be submitted to the Contracting Officer following each service event. The COR by signing the form below documents services and/or deliverables with a “Green” quality of performance rating unless otherwise annotated.

At the end of the service period of performance, 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.

If Contractor response to an identified quality deficiency is unsatisfactory, the Contracting Officer will contact the appropriate Contractor representative to implement a plan of action to remedy the identified deficiency.

The COR referred to in this QASP is Major Starr, lori.l.starr.mil@mail.mil Phone 605-737-6073.

Yellow Yes, performance and technical specifications are currently being met at the minimum AQL, but the following service / deliverable needs contractor attention.

The Customer must identify what component of the deliverable and/or service requires attention.

Red No, performance and technical specifications are not being met at AQL and the following service / deliverable needs immediate contractor resolution.

The Customer must identify what component of the deliverable and/or service is below the minimum AQL.

RECEIVERS - MEDICAL QUALITY ASSURANCE PLAN WORKSHEET

Performance Rating

Deliverable/Service

Contractor coordinates with DSS and provides appropriate equipment to accomplish medical services

Yellow

Red

Contractor coordinates with DSS and provides qualified and sufficient personnel during services

Yellow

Red

Contractor provides Event Manager to coordinate and oversee execution of service event

Yellow

Red

Contractor performs services at a rate of 18-19 soldiers per hour

Yellow

Red

Contractor completes all required testing

Yellow

Red

Contractor completes any required administrative paperwork and medical forms for profile management.

Yellow

Red

Contractor completes EPHA electronic entry of data NLT 5 business days after event

Yellow

Red

Contractor completes DOEHRS electronic entry of data NLT 5 business days after event

Yellow

Red

Adheres to Security of sensitive information

Yellow

Red

Signed_________________________________ Dated _________________________________________

4. DENTAL SERVICES SCOPE

Services include the components of dental classifications for the Department of Defense (DOD) in order to identify varying degrees of dental health and readiness. This is to cover the various components of DRC to include: annual dental exams, digital bitewing radiographs, digital panoramic radiographs, DENCLASS data entry of all radiographs and dental records, identification and treatment of all Class 3 soldiers on alert orders and/or eligible (except as Specified in section C-3) through the Army Selected Reserve Dental Readiness System (ASDRS) Program to upgrade Class 3 or Class 4 Soldiers to a Class 2 or 1 status.

· Clinical evaluation by a licensed dentist of the oral cavity using visual, clinical exam supported by bitewings taken by certified dental technicians.

· Individual case management, accountability and vendor oversight provided by a qualified and credentialed Dental Director (licensed DDS or DMD). This position shall be a staff position of the prime vendor.

· Pre-event scrub of records through DENCLASS, ADDRs or CDR

· Staff a dedicated and organic emergency 1-800 # (manned 24/7) call line for Soldiers to call, should dental emergencies emerge upon completion of dental work.

· Oral surgery on location and Endodontic treatment on location at same time as the event

· “Chair-side” dental classification, entered “real-time” (5 business days from the event if no connectivity) 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.

· All services and data entry must be performed by organic staff

· All access to MODS modules (www.mods.army.mil) will be performed by awarded vendor.

· Personnel performing the dental screening examination have a moral and ethical obligation to inform the Soldier if they observe to be apprised of any sign or symptom for which the Soldier should obtain further evaluation or care.

· Provide “real-time” pharmacy prescriptions for each restorative event (and qualified staff to obtain medications) for any Soldier requiring medications post-event.

· Provide a qualified bio-medical machine technician for each examination and restorative event, in case of equipment failure.

· Provide dental screening examination to identify deficiencies (but does NOT include the dental treatment required to restore those deficiencies unless Class 3 status, or in need of full mouth debridement).

· Review of post event Soldier complications to include but not limited to: abscess, dry socket defective filling ETC. within 24hrs of notification by DSS, review shall include a recommended course of action.

· Maintain treatment records for 180 days post event.

5. DENTAL TASKS:

5.1 The contractor shall provide customized comprehensive dental readiness services to include annual dental examinations and clinically indicated radiologic studies (bite-wing x-rays) when requested, and specified treatment outlined in the patient’s treatment plan and IAW AR 40-501 and AR40-35. Upon completion of services, medical information will be documented in accordance with Department of the Army Policy. Reports will be provided to the SDARNG Deputy State Surgeon’s Office. The contractor shall also ensure the requirements of Occupational Safety and Health Administration (OSHA) and applicable federal regulations are met.

5.2. Exam - A periodic oral evaluation shall assess the current state of oral health and 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:

5.3. Caries Risk Assessment – Classify Soldiers as low, moderate, or high risk for caries as described 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.

5.4. Periodontal Assessment – Periodontal Screening and Recording (PSR), a screening procedure endorsed by the American Dental Association and the American Academy of Period ontology, should be utilized to determine the need for periodontal treatment.

5.5. Tobacco Risk Assessment – Classify Soldiers as a smoker, user of smokeless tobacco, both or neither.

5.6. Oral Cancer Screening – Perform a thorough oral cancer screening as part of all examinations

5.7. 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 the dental record and that it is of adequate quality for diagnostic/identification purposes. There is no time requirement on updating panographic radiographs. However, the panographic radiograph will adequately represent the current oral condition of the Soldier.

The contractor shall have experience in and capability to upload all exam and digital radiographs into the DENCLASS system. If upon QA of work performed at event by contractor the SDO or designee finds radiographs that are of not diagnostic quality within 30 calendar days post event, arrangements to obtain repeat radiographs will be made at no expense to the Govt. or SDARNG.

5.8 Treatment. Only treatments that have been identified in the patient’s treatment plan will be accomplished. These treatments are designed to improve the dental classification status of the Soldier from Class 3 to Class 2.

5.9. Documentation. Documentation of exam and treatments shall be returned to the South Dakota Army National Guard Medical Representative (Deputy State Surgeon) from the Office of the State Surgeon. The Contractor will return all functional files maintained by the Contractor to the government upon completion of the required services.

5.10. SF 603/603A, Record of Dental Exam and treatment shall be completed.

5.11. Supporting Radiographs (pantograph/four bitewings) if necessary.

5.12 A diagnostic quality copy of all radiographs must be placed in the dental record as required.

5.13 Treatment Locations. The contractor shall be able to provide services throughout the state of South Dakota (or needs of the SDARNG) as requested by the Government within notification of 15 business days from the requested event date.

Dental Treatment: Based on National Guard Bureau’s national statistics, it is estimated that 30% of the soldier exams will be Classification 3, Non-Deployable. Dental restorative treatment is necessary to get Class 3 soldiers to a Class 2 Status, or deployable, before their Mobilization. The Contractor shall provide approved dental treatment only. See Appendix C- Authorized Dental Treatment.

Case Management services during event & post event: SDARNG intent is for the contractor to resolve any dental issue that develops from treatment post event. History indicates 1case in every 3 events.

· Contractor shall have capability to provide any general & specialty dental and prescription services near event location.

· Upon approval, contractor to arrange for local dental treatment and prescription medication for soldier.

· Government will provide soldier transportation to local dental facility/pharmacy.

· Contractor shall pay local subcontracted provider.

· Contractor shall pay for repeat radiographs.

· Contractor to explain post-operatory instructions to soldier and DSS or Designee.

· Case Manager to track all special dental treatment and medication expenses.

· Contractor to submit itemized invoice of special case costs to DSS for reimbursement within 10 business days post event.

6. APPLICABLE PUBLICATIONS

Publications applicable to this PWS are listed below. The publications must be coded as mandatory or advisory, the date of the publication, and what chapters or pages are applicable to the requirement. All publications listed are available via the Internet at the specified e-mail address:

https://apps.mods.army.mil/MEDPROS/Secured/ https://apps.mods.army.mil/denclass/

Dental Service Delivery Schedule The contractor service requirements are summarized into performance objectives that relate directly to mission essential items. The performance threshold briefly describes the minimum acceptable levels of service for each task.

Service Delivery Schedule: Dental Services in support of the South Dakota NG.

Spot Check or Inspection

Customer Complaint

1. Contractor personnel to posses appropriate level of credentialing

1. Caries risk assessment

1. Periodontal assessment

1. Oral cancer screening

1. Panoramic Radiographs as needed to represent soldiers current condition (filed & DENCLASS)

1. Contract completes and submits final data to Deputy State Surgeon & tracks special cases

Quality Assurance Surveillance Plan:

The Contracting Officer Representative (COR) will monitor contractor performance and complete the Quality Assurance Surveillance Plan Worksheet provided below for each event location completed. The following information will be provided to the Contracting Officer to ensure services and/or deliverables support the PWS objectives. If the performance rating for any task in this order is “Red” during any time in the performance period, the COR will provide the Contracting Officer the details regarding the deficiency. The quality rating may change from “Green” to “Red” without notice. We anticipate the COR utilizing the “Yellow” quality rating to alert the contracting office of quality issues that have the potential for a “Red” quality rating if corrective action is not taken.

The Quality Assurance Surveillance Plan Worksheet will be submitted to the Contracting Officer following each service event. The COR by signing the form below documents services and/or deliverables with a “Green” quality of performance rating unless otherwise annotated.

At the end of the service period of performance, 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.

If Contractor response to an identified quality deficiency is unsatisfactory, the Contracting Officer will contact the appropriate Contractor representative to implement a plan of action to remedy the identified deficiency.

The COR referred to in this QASP is Major Starr, lori.l.starr.mil@mail.mil Phone 605-737-6073.

Yellow Yes, performance and technical specifications are currently being met at the minimum AQL, but the following service / deliverable needs contractor attention.

The Customer must identify what component of the deliverable and/or service requires attention.

Red No, performance and technical specifications are not being met at AQL and the following service / deliverable needs immediate contractor resolution.

The Customer must identify what component of the deliverable and/or service is below the minimum AQL.

RECEIVERS - DENTAL QUALITY ASSURANCE PLAN WORKSHEET

Performance Rating

Deliverable/Service

Contractor provides adequate and appropriate equipment to accomplish required Dental Services

Yellow

Red

Contractor provides qualified and sufficient personnel to conduct all required Dental Services

Yellow

Red

Contractor provides Case Manager (CM)

Yellow

Red

Contractor performs services 8 soldiers per hr

Yellow

Red

Contractor completes Dental Exams

Yellow

Red

Contractor completes dental treatment

Yellow

Red

Contractor coordinates and tracks any special dental requirements

Yellow

Red

Contractor completes required paperwork & final reporting.

Yellow

Red

Contractor completes electronic entry of data in DENCLASS

Yellow

Red

Adheres to Security of sensitive information

Yellow

Red

Signed ____________________________________________ Dated ______________________________

7. SERVICES TASKS - GENERAL

7.1 The contractor shall provide all management, labor, material, equipment, tools, supplies and certifications necessary to provide all listed Medical services in this PWS.

7.2 The Medical Event Schedule identifies services required and the approximate number of personnel requiring services and the availability of event space. The services shall provide mandated medical requirements to meet and deploy ability standards.

8. CONTRACTOR PROVIDED EQUIPMENT AND PERSONNEL:

8.1 The contractor shall provide all material, equipment, and supplies necessary to provide all listed service requirements listed in the event schedule in either mobile/portable space or inside Government facilities.

8.2 Contractors shall provide all necessary mobile/portable events space (see event schedule). Medical mobile/portable facilities shall meet all OSHA, HIPAA and Privacy Act standards to ensure a safe and productive workspace for services under the Individual Readiness Requirements. Mobile and or portable exam/treatment areas must ensure that privacy is observed for all medical exam rooms. There shall be a designated vitals area, visual acuity area, a lab with eye-wash stations, biohazard separated work areas, hearing booth(s) with ISO-Booth for SPRINT testing, all emergency medical resources consistent with OSHA and a large reception area with full office capabilities.

8.3 The Mobile/Portable Medical areas shall have full treatment functionality consistent with traditional, fixed-site, private practice medical offices. Mobile/portable Medical Facilities shall be fully functional offices whereby no additional space will be given inside military buildings during events as these events may be in remote areas.

8.4 If the Service Event Schedule requires use of contractor provided space, space must be able to be moved at short notice of a minimum of 1-hour notice.

8.5 Contractor must have the capability to conduct real-time, point of service E-PHA data upload on location or with the approval of the SDARNG DSS or designee. The contractor shall provide their own mobile internet access for all service events.

8.6 The Contractor must have CAC enabled Event Managers & support staff. The workstations should have Bar-Code Scanning capability to ensure high quality standards of data entry. All Personally Identifiable Information (PII) will be safeguarded, see DoD Directives 5400.11 and 5400.11-R.

9. GOVERNMENT-FURNISHED PROPERTY AND INFORMATION:

9.1 The Government will provide an administrative space for soldier check-in and out and vision run/space for vision tests for all events.

9.2 For Armory Space Events, coordination with the Office of the Deputy State Surgeon prior to the setup for each event is required.

9.3 Only parking will be provided in events identified as mobile/portable.

10. 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 State Medical Command office. The contractor shall provide all documentation concerning medical or dental treatment to the SDARNG Office of the Deputy State Surgeon or Designee.

11. PLACE OF PERFORMANCE

Specific services are required at various locations in South Dakota (See Event Schedule).

12. PERIOD OF PERFORMANCE

The performance period is specific to each event location. (See Event Schedule).

13. OTHER CONDITIONS/ SECURITY

13.1 Safety: The contractor shall establish a 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), the Privacy Act and the American Dental Association (ADA).

13.2 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.

13.3 Quality Control: The contractor shall develop and maintain an effective quality control program to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The contractor’s quality control program is the means by which he assures himself that his work complies with the requirement of the contract.

13.4 Contraction Officer Representative (COR). The COR is identified below, no changes to event will be made without prior consent of:

COR Major Lori Starr The COR monitors all technical aspects of the contract and assists in contract administration. The COR is authorized to perform the following functions: assure that the Contractor performs the technical requirements of the contract: perform inspections necessary in connection with contract performance: maintain written and oral communications with the Contractor concerning technical aspects of the contract: issue written interpretations of technical requirements, specifications: monitor Contractor's performance and notifies both the Contracting Officer and Contractor of any deficiencies; coordinate availability of government furnished property, and provide site entry of Contractor personnel.

A letter of designation issued to the COR, a copy of which is sent to the Contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the resulting order.

13.5 Hours of Operation: Operation hours are specific to each event, see event schedule.

13.6 Security Requirements: All contractor employees and affiliated personnel of the contractor are to possess identification that identifies them as such. All vehicles are subject to search without reason. The contractor shall comply with any and all installation security requirements.

13.7 Installation Access: Contractor shall comply with applicable facility and area access policy. If unescorted access is deemed necessary, contractor will submit to a NCIC background check and a favorable evaluation is required. NCIC check will be conducted by the ATFP office NLT 4 working days prior to installation.

13.8 OPSEC Info: The contractor will protect controlled unclassified information (i.e. training times, number of personnel, etc.) pertaining to daily operations. The COR/POC will brief the vendor on what information needs to be protected, why it needs to be protected, and how to protect it.

13.9 Reporting: The contractor shall provide a final report for all services provided to include a by name, unit, and social security number roster of all soldiers receiving services. The report shall be approved and verified by the SDARNG liaison with the office of the Deputy State Surgeon.

13.10 Event Manager: The contractor shall provide an Event Manager who shall be responsible for the performance of the work. The name of this person and an alternate who shall act for the contractor when the manager is absent shall be designated in writing to the contracting officer. The contract manager or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract.

13.11 Invoice: Contractor shall consolidate all medical services performed on an individual event basis and submit an invoice through Wide Area Work Flow within 10 business days post event.

14. ACCEPTANCE PLAN:

14.1 All work performed, all materials and tasks data to be submitted under this task shall be made available to be inspected for compliance with the PWS and accepted by the COR or authorized representative as specified herein.

15. REFERENCES

· DoD Directive 5400.11 DoD Privacy Program http://dpclo.defense.gov/privacy/

· DoD Directive 5400.11-R DoD Defense Privacy Program http://dpclo.defense.gov/privacy/

· AR 40-501 Standards of Medical Fitness http://www.apd.army.mil/

· AR 40-35 Dental Readiness & Community Oral Health Prevention http://www.apd.army.mil/

· Army National Guard implementation Guidance on Selected Reserve (SELRES) Dental Readiness System (ASDRS) for providing Dental Treatment outside of Alert. (attached)

· Vision Readiness Screening and Classification (VRSC) Tracking in MEDPROS (attached)

· Vision Readiness Screening Guide (MEDPROS)

· OTSG/MEDCOM Policy Memo 11-054 Women’s Readiness (available upon request)

16. APPENDICES:

A. Estimated Workload Data B. ALARACT Vision Readiness

STATEMENT OF WORK – MEDICAL and DENTAL READINESS – AUGUST 2011 DRAFT

APPENDIX A

ESTIMATED WORKLOAD DATA

MEDICAL

The following data elements will 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 prescriptions entered into SRTS Verification of entry into DOEHRS & Electronic PHA A by name listing of all Soldiers examined

APPENDIX B

VISION READINESS

FM DA WASHINGTON DC//DACS-ZD//162214Z APR 05

TO ALARACT

INFO CJCS WASHINGTON DC//J4//

BT

UNCLAS ALARACT

SUBJECT: VISION READINESS SCREENING AND CLASSIFICATION (VRSC) TRACKING IN MEDPROS

REF/A/MSG/RUEWMFU5506/09 NOV 04/SUBJ: ALARACT VISION READINESS AND CLASSIFICATION SYSTEM

1. (U) THE PURPOSE OF THIS MESSAGE IS TO ANNOUNCE THE TRACKING OF THE VISION READINESS SCREENING AND CLASSIFICATION (VRSC) IN MEDPROS.

2. (U) A ONE YEAR PHASE-IN PERIOD FROM THE DATE OF THIS ALARACT IS IN EFFECT. ALL SOLDIERS WILL COMPLETE VRSC DURING THE PHASE-IN PERIOD. VRSC DATA/COMPLIANCE WILL BE RECORDED IN MEDPROS EFFECTIVE IMMEDIATELY BUT WILL NOT BE REPORTED UNTIL THE END OF THE PHASE-IN PERIOD. THE PHASE-IN PERIOD DOES NOT SUPERSEDE THE REQUIREMENT FOR DEPLOYING SOLDIERS TO COMPLETE VRSC AND RECORD IT IAW AR 600-8-101.

3. (U) MORE DETAILED INSTRUCTIONS ON CONDUCTING THE VISION READINESS SCREENING AND RECORDING IT IN MEDPROS CAN BE FOUND IN THE “VISION READINESS SCREENING GUIDE” WITHIN THE VRSC MODULE OF MEDPROS.

4. (U) RESPONSIBILITY:

A. (U) COMMANDERS WILL

1. (U) APPOINT UNIT MEMBERS AS UNIT SCREENERS (MEDICAL MOS NOT RQUIRED) TO PERFORM THE VISION READINESS SCREENING.

2. (U) ENSURE VRSC IS COMPLETED AT LEAST ANNUALLY.

3. (U) ENSURE VISION READINESS SCREENING RESULTS ARE MAINTAINED FOR ONE YEAR. INDIVIDUAL VISION READINESS SF 600 OVERPRINT AND UNIT VISION READINESS DATA WORKSHEET ARE AVAILABLE IN MEDPROS TO RECORD DATA.

B. (U) UNIT SCREENERS:

1. (U) PERFORM VISION READINESS SCREENING AS PRESCRIBED IN THE “VISION READINESS SCREENING GUIDE” AVAILABLE IN MEDPROS.

2. (U) RECORD SCREENING RESULTS ON INDIVIDUAL VISION READINESS SF 600 OVERPRINT AND/OR UNIT VISION READINESS DATA WORKSHEET AND VALIDATE RESULTS WITH THEIR SIGNATURE.

3. (U) IDENTIFY AND REFER SOLDIERS REQUIRING CORRECTIVE ACTION IAW LOCAL STANDARD OPERATION PROCEDURE. (SEE CHIEF OF OPTOMETRY/ UNIT SURGEON/ MEDICAL COMMANDER RESPONSIBILITIES)

C. (U) UNIT MEDPROS USER:

1. (U) ACCURATELY ENTER VISION READINESS SCREENING DATA INTO MEDPROS.

2. (U) ONLY ENTER VISION READINESS SCREENING DATA THAT HAS BEEN VALIDATED BY THE UNIT SCREENER.

3. (U) UNITS WITHOUT PERSONNEL WITH MEDPROS ACCESS MAY REQUEST ACCESS TO MEDPROS FOR DATA ENTRY BY DOWNLOADING THE NISA-9R FORM AT URL: HTTP://WWW.MODS.ARMY.MIL AND CLICKING ON “ACCESS” THEN “WHERE DO I GET A COPY OF THIS NISA FORM?”

D. (U) OIC, MEDICAL STATIONS OF POWER PROJECTION PLATFORMS (PPP)/POWER SUPPORT PLATFORMS (PSP)/SOLDIER READINESS PROCESS (SRP) SITES:

1. (U) WHILE THE PRIMARY RESPONSIBILITY FOR EACH SOLDIER’S VRSC LIES WITH THE UNIT, THE MEDICAL SECTION AT THESE SITES MUST COMPLETE THIS REQUIREMENT WHEN SOLDIERS ARRIVE WITH AN INCOMPLETE VRSC. THE VISION READINESS SCREENING DOES NOT REQUIRE AN EYE TECHNICIAN. IT CAN BE PERFORMED BY ANYONE ON THE SRP TEAM WITH MINIMAL TRAINING (SEE CHIEF OF OPTOMETRY/ UNIT SURGEON/MEDICAL COMMANDER RESPONSIBILITIES).

2. (U) UPDATE PPP/PSP/SRP STANDING OPERATING PROCEDURES TO INCLUDE PERFORMING THE VISION READINESS SCREENING AND RECORDING THE RESULTS IN MEDPROS.

E. CHIEF OF OPTOMETRY/UNIT SURGEON/ MEDICAL COMMANDER

1. (U) PROVIDE TRAINING FOR UNIT SCREENERS OR PPP/PSP/SRP SCREENERS WHEN REQUESTED BY UNIT COMMANDERS OR PPP/PSP/SRP OIC.

2. (U) DEVELOP A LOCAL SOP THAT ADDRESSES CORRECTIVE ACTION FOR ALL SOLDIERS IDENTIFIED AS VISION READINESS CLASS 3 (O OR V).

5. (U) POINTS OF CONTACT FOR THIS INFORMATION ARE AS FOLLOWS:

A. (U) MAJ DEAN S. BANCROFT, PROGRAM MANAGER TRI-SERVICE VISION CONSERVATION AND READINESS, CHPPM, DSN 584-1005, OR CML (410) 436-1005, EMAIL: DEAN.BANCROFT@APG.AMEDD.ARMY.MIL.

B. (U) COL GEORGE L. ADAMS III, OPTOMETRY STAFF OFFICER, OTSG, DSN 761-3152, OR CML (703) 681-3152, EMAIL:GEORGE.ADAMS@OTSG.AMEDD.ARMY.MIL.

C. (U) HQDA AOC-CAT POC IS SURGEON GENERAL DESK (DASG) COMM: 703-693-4821. DSN:223-4821, OR CLASS EMAIL: AADASG@HQDA.ARMY.SMIL.MIL.

D. (U) ACKNOWLEDGE RECEIPT BY EMAIL TO CAT POC IN PARA 5A.

6. EXPIRATION DATE CANNOT BE DETERMINED.

INSPECTION AND ACCEPTANCE TERMS

Supplies/services will be inspected/accepted at:

DELIVERY INFORMATION

05-MAR-2016

POC LISTED IN SCHEDULE

DETAILS IN CLIN OR SCHEDULE

. SD .

SEE POC TELE IN CLIN

W90YD8

13-MAR-2016

W90YD8

10-APR-2016

POC LISTED IN CLIN OR SCHEDULE

DETAILS IN CLIN OR SCHEDULE

. SD .

SEE POC TELE IN CLIN OR SCHEDU

W907KK

02-APR-2016

W907KK

11-SEP-2016

W907KK

W907KK

CLAUSES INCORPORATED BY REFERENCE