16-T-0037Amendment0001.docx

W912MM-16-T-0037

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 30 - BLOCK 14 CONTINUATION PAGE

The following have been added by full text:

QUESTIONS AND ANSWERS

SD ARNG SOLICITATION NO. W912MM-16-T-0037 QUESTIONS:

Q1. Why is the DD 2217 only mentioned with CLINS 0010, 0040, 0060 and 0010? A1. The 2217 Hearing Calibration will not be provided by the Government for any CLIN/Event.

Q2. Will an optometrist be needed on both days of CLIN 0030? A2. Saturday Afternoon 1300-1600 for 15 soldiers.

Q3.Please define “Vision Screening, Optometric Evaluations as needed.”A3. Vision Screening or Optometric Evaluations is specifically requested in each CLIN/event. Optometric Evaluation is required only in CLINs 0030 and0090.

Q4. Will DOEHRS techs have access to DOEHRS repository? This has become a problem in some other states. A4. Access to DOEHRs is a contractor responsibility. SD will not provide access to DOEHRs, .however it is mandatory to complete DOEHRS entry on-sight during the event. Also see A15.

Q5. Are PAP smears required for this contract? A5 No Q6. Is endodontics required for this contract? A6. There is a high probability of root canals or tooth extractions. It is the contractors’ responsibility to determine if a General Practitioner is capable or Endodontist is needed.

Q7. CLIN 0090: are the 40 dental treatments spread over the two days or is it 40 treatments per days? A7. 40 treatments over 2 Days

Q8. For the dental exam and x-ray CLINS (0040, 0060, 0100), can contractor use portable chairs within the armories for the exams? A8. Contractor to provide their own portable chairs and be used to accomplish exams and x-rays.

Q9. 8.1 states, “…in either mobile/portable space or inside Government facilities.” (emphasis, mine) However, 8.3 otherwise in the last sentence with “Mobile/portable Medical/Dental 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. Please clarify. A9. Events where space is available inside Government facilities 8.3 does not apply. If Government space is not available then mobile space must comply with 8.3.

Q10. When CLINS state “ARMORY SPACE is Available,” does that allow for portable audiometers for screenings to be set up in a quiet classroom? An additional small, quiet room for audiologist testing of H2/H3 SMs? A10. Yes, separate room space is available for H2/H3 testing.

Q11.When CLINS state “ARMORY SPACE is NOT Available for Hearing,” does this also mean there is NOT a small, quiet room for the audiologist testing of H2/H3 SMs? A11. No space available includes H2/H3 testing.

Q12. CLIN 0030 calls for 15 optometry exams. Can we complete them on one day or do we have to have the Optometrist available both days? A12. See answer 2.

Q13. A request was made for Behavior Health Specialist. How many are expected to be provided by the contractor per day? Q13. Enough to process 20 soldiers per hour

Q14. Is the contractor entering MEDPROS and HRR post event or will that be completed by the MEDDET? A14. Completed by the MEDDET.

Q15. Is it mandatory to do DOEHRS entry on-sight live during the event? Q15. Yes, but if DOEHRS is down entry must be completed NLT 5 days.

Q16. Nov 4-5 Mission request made for a mobile office for Medical Providers and Behavioral Health Providers. How many rooms will the Medical Provider Trailer Need? Will lab, vision, and immunization space be provided by the government? Q16. One HIPPA Compliant room per provider, enough providers to complete services at a rate of 20 per hour. Government space is available for lab, vision, and immunization only.

Q17. Are contractors to provide Case Managers at all the PHA events? Reference to the Medical Delivery Schedule stating contractor completes all required administrating to include: Profile Management. A17. No Medical Case management is required. Providers must have completed the new E-Profile Training. Governments Intent is for providers to be able to complete temporary profiles.

Q18. Under Dental Services Scope it states that the contractor must provide a Dental Director for case management. Please explain the need and the criteria specifically to this request with having only 1 restoration mission. A18. Dental Case Management required only for CLINs 0080 and0090. Dental Director/Lead to be onsite for management and oversight during these events.

Q19. Is it necessary to provide a bio medical machine technician for all of the dental restoration events and dental exam events? Is a qualified repair technician and an IT personnel that logs in remotely to do any repairs adequate? Q19. Level of Repair/Technical support needed is a contractor responsibility.

Q20. Is this a Single Award Contract? A20. The Government reserves the right to reject any and all offers, to award one or 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.

Q21. PWS 8.6 under Services Task indicates that dental x-rays should be uploaded to ADDR. It is under our understanding that DenClass loads directly into ADDRS the day or evening the x-rays were uploaded. Are we misinterpreting the task at hand? Q21. No DenClass loads to ADDRS automatically.

Q22. Will the contractor use the NOSTRA account of the government to order frames or will the MedDet enter them into the system? Q22. The Government will complete NOSTRA entry.

Q23 Does the contractor provide BGS frame examples for SM to choose from? A23. No

SECTION SF 1449 - CONTINUATION SHEET

The following have been modified:

PERFORMANCE WORK STATEMENT

Performance Work Statement for Medical Readiness FY 2017

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

South Dakota Army National Guard (SDARNG)

July 27, 2016

1. BACKGROUND:

1.1 Individual Medial 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, pelvic exams (pap-smears), DNA, G6PD, RPR, Immunizations required for IMR and theater specific compliance such as Hepatitis A/B, TwinRex, Influenza and PPD. Visual acuity and Optometry exams, DOEHRS compatible audiometric exams and SPRINT testing for H3 Soldier’s. Behavioral Health screenings, including review of EPHA answers of SM. Pre-event coordination with SDARNG team members shall be conducted to validate event requirements at Sixty (60) and thirty (30) days prior to event.

1.4 MEDPROS data entry of all applicable and appropriate IMR/FMR functions with on location data entry or with approval of the SDARNG DSS or Designee data entry not to exceed 5 calendar days after the last day of services. Preference is at the end of the event.

1.5 DoD established a uniform dental classification in HA Policy 02-11. DoD policy requires dental screening examinations and remediation to be accomplished as needed and documented on all service members. Members of the SDARNG shall receive an annual dental screening examination to determine their dental classification, including, digital bitewings radiographs and digital panoramic radiographs. Soldiers alerted and on Mobilization Orders are eligible for Dental Treatment if they are Class 3 Status from examination. Identification and treatment of ALL Class 3 soldiers on alert orders and eligible. Other Class 3 soldiers are to be treated if time allows. The results of that screening examination and radiographs and dental records shall be entered into the DENCLASS database through the Army Selected Reserve Dental Readiness System (ASDRS) Program. The DENCLASS database updates the Army Medical Protection System, MEDPROS. Dental treatment that may be required is essential to be provided at the SRP site to ensure the highest Dental Deployable Rate for the Mobilizing Soldiers. The SDARNG Deputy State Surgeon or Designee shall alert the Contract Event Manager in such cases.

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.

· A Medical POC must be a full time employee available 24hrs/7week for post event consult.

· All services must be performed by organic staff (Exception for Special Case Services).

· All data entry must be performed by organic staff.

· 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.

· 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.

· Vision Screening, Optometric Evaluations as needed.

· Eye exams and prescriptions (DD771s) provided on location for all Soldiers scoring worse than 20/40 on vision screening

· Audiologist / SPRINT testing for all applicable Soldiers.

· Audiology H2/H3/H4 and SPRINT testing on location in real time.

· Audiologist to perform Otoscopic exam and Cerumen Removal prior to Sprint Test

· 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.

· HRR data entry completed not to exceed 5 calendar days after the last day of services. Preference is at the end of the event.

· Behavioral Health screening by a licensed behavioral health provider (Psychiatrist, Psychologist, Master of Social Work, etc) that has completed appropriate training IAW DoD service, and is acting within their scope of practice.

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 and Pulmonary services. 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, pap-smear 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 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 Regulations is mandatory.

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.

3.2 Behavioral Health Screening: The contractor shall conduct on-site screenings of behavioral health questions and scores within the EPHA. A list of all Soldiers needing further follow up and the reason for follow up needs to be reported to the SDARNG’s case manager and health coordinator at the end of the event, either on person or by phone. All professionals shall be licensed and adhere to all requirements of OSHA, State & Federal Regulations is mandatory.

3.3 Optometric Evaluations: The contractor shall conduct eye exams and provide prescriptions (DD771s) on location in accordance with AR 40-501 for identified Soldiers/events, see delivery schedule for details. SRTS data entry may be required.

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

3.4 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.

3.5 Immunizations: The contractor shall administer immunizations in accordance with AR40-501. Immunizations shall include, but not limited to, flu, varicella, MMR, yellow fever, typhoid, tetanus, hepatitis A, hepatitis B, and polio. Adherence to all requirements of the 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 serum required for event.

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

1. Behavioral Health Screening

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 SFC Kelley Crane, kelley.c.crane.mil@mail.mil, Phone 605-737-6225.

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 20 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

Other

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 (panograph/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 1 case 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 possess 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 SFC Kelley Crane, kelley.c.crane.mil@mail.mil, Phone 605-737-6225.

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 20 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

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 and Dental services in this PWS.

7.2 The Medical Dental Event Schedule identifies services required and the approximate number of personnel requiring services and the availability of event space. Simultaneous may requirements exist. The services shall provide mandated medical and dental 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/potable events space (see event schedule). Medical & Dental 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/dental 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. X-Ray-Radiograph Rooms shall be compliant with all radiation safety standards.

8.3 The Mobile/Portable Medical/Dental areas shall have full treatment functionality consistent with traditional, fixed-site, private practice dental/medical offices. This includes professional quality dental chairs, compressor systems, vacuum systems, and treatment instruments for fillings, extractions, root canals, and other authorized dental treatment. Mobile/portable Medical/Dental 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 Due to nature of many drill weekends, Mobile/Portable Medical/Dental units must be able to be moved at short notice of a minimum of 1-hour notice to follow movement of patient base to be served.

8.5 Contractor must have the capability to conduct real-time, point of service E-PHA, HRR, DENCLASS and MEDPROS data upload on location or with the approval of the SDARNG DSS or designee. Data entry shall not to exceed 5 calendar days after event. 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. Contractor must be able to do Post-Operatory Panoramic X-rays upon completion of treatment whereby the forensics image will change materially. Also, Contractor must be able to upload images to the Active Duty Dental Repository (ADDRs) system for DENCOM requirements of deployability. 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 Commands 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 is SFC Kelley Crane, kelley.c.crane.mil@mail.mil, Phone 605-737-6225.

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 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.

13.8 Event Manager: The contractor shall provide a 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.

13.9 All care givers (data entry/admin technicians, Physicians, Dentists, phlebotomists, Nurses, etc) at each and every location for this contract must be direct employees of the prime contractor.

13.10 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. Dental Classification C. Authorized Dental Treatment D. ALARACT Vision Readiness

W912MM-16-T-0037

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, nurses, and administrative staff) Total number of patients scheduled Total number of patients examined Verification of entry into MEDPROS & Electronic PHA A by name listing of all Soldiers examined and the medical classification of the Soldier A by name listing of all Soldiers requiring Behavioral Health follow up and main concern

DENTAL

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

Date Location List of contract employees (providers, dental 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 Verification of entry into DENCLASS A by name listing of all Soldiers examined and the dental classification of the Soldier

APPENDIX B

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) Periodotium 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) Unerupted 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 will 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) Periodontontal 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 resorptive 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 C

AUTHORIZED DENTAL TREATMENT

1. The following dental procedures are authorized:

(a) Diagnostic Services which are funded through NG6H 2065 Medical Readiness Funding:

D0120-Periodic Oral Evaluation D0150-Comprehensive Oral Evaluation D0330-Panoramic Film D0272-Bitewings-Two Films D0274-Bitewings-Four Films D0220/D0230- Periapical (limited)

(b) Restorative Services which are funded through the VFRE 2020 Dental Treatment Funding (provided only to soldiers alerted to an OCONUS Mission):

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 will 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 D2799-Provisional Crown D2931-Prefabricated Stainless Steel Crown D2950-Core Buildup, including any pins D2954-Prefabricated Post and Core

(c) Endodontic Services which are funded through the VFRE 2020 Dental Treatment Funding (provided only to Soldiers alerted to an OCONUS Mission):

D3310-Anterior Root Canal Therapy D3320-Bicuspid Root Canal Therapy D3330-Molar Root Canal Therapy D3346-Anterior Root Canal Retreatment D3347-Bicuspid Root Canal Retreatment D3348-Molar Root Canal Retreatment

(d) Periodontal Services which are funded through the VFRE 2020 Dental Treatment Funding (provided only to Soldiers alerted to an…