PWS_Medical_Surveillance.pdf

PERFORMANCE WORK STATEMENT

SOUTH CAROLINA OCCUPATIONAL HEALTH

PROCUREMENT OF OCCUPATIONAL HEALTH EXAMS

1. GENERAL

The Performance Work Statement (PWS) supports the South Carolina Army National Guard (SCARNG) for Occupational Medical Surveillance Examination Program in accordance with the Occupation Safety and Health Association (OSHA) and other regulations. Examinations are required for approximately 450 SCARNG full time employees. The government reserves the right to increase and/or decrease the number of employees requiring examinations, during the contract period, based on the requirement. Places of Performance. Examination dates will be conducted at the following building address.

Armed Forces Readiness Center (AFRC) 860 South Carolina Road McEntire Joint National Guard Base Eastover, South Carolina 29044

2. PURPOSE

2.1. The purpose of the Occupational Medical Surveillance Examination Program is to provide job-related Occupational Health Examinations and Medical Surveillance Services to the SCARNG full-time support (FTS) and/or temporary personnel who are exposed to OSHA level PEL health hazards in the work environment. The examination shall include personnel assigned to positions requiring specific standards of physical fitness. Personnel not included under these examinations are State Employees, civilian contractors, Active Guard Reserve, Active Duty for Operational Support (ADOS) and part-time traditional Soldiers.

2.2. The Government will evaluate the quality of professional and administrative services provided, but retain no control over the medical professional aspects of services rendered such as testing procedures, etc. The Contractor will provide Board Certified Physician(s) with experience in Occupational Health, supervision, all labor, tools, materials, equipment, and incidentals required to conduct the Occupational Health Examinations / Medical Surveillance Services for the SCARNG.

3. PROCEDURES and STANDARDS

3.1. This contract is for “Non Personal” Health Care “Services”, as defined in 37.101. In accordance with FAR Part 37.4 the Government may enter into a non-personal health care services contract with physicians, dentists and other health care providers under authority of 10

U.S.C. 2304 and 41 U.S.C. 253. The Government shall evaluate the quality of professional and administrative services provided, while the Government retains no control over the medical, professional aspects of services rendered.

3.2. Contractor shall ensure all procedures are conducted in accordance with applicable American Board of Occupational and Environmental Medicine (ABOEM), American Association of Occupational Health Nurses (AAOHN), U.S. Department of Labor, Occupational Safety and Health Administration (OSHA), and the National Institute for Occupational Safety and Health (NIOSH) Standards.

3.3. Contractor shall ensure all clinical laboratory services are performed by a laboratory licensed through the U.S. Department of Health and Human Services (DHHS), Health Care Financing Administration pursuant to the terms of the Clinical Laboratories Improvement Act of 1967 (42 U.S.C. 263a) and the College of American Pathologies.

3.4. Contractor shall provide a Board eligible or Certified Occupational Medicine Physician to conduct job-related medical surveillance physical examinations and occupational health specialty examinations.

3.5. Contractor shall arrange for the opportunity to consult with the Occupational Health Nurse (OHN) of the SCARNG by telephone to coordinate or resolve issues that might arise before, during, and after the testing period.

3.6. Contractor shall perform a comprehensive review and evaluation within 30-days following the conclusion of testing. The Contracting Officer’s Representative (COR) will contact and schedule a follow-up review and evaluation meeting to discuss positive and negative aspects of testing.

3.7. Contractor will use documentation provided by SCARNG to conduct and document the physicals and is responsible to ensure all equipment and personnel are available to complete specific exams requirements.

3.8. Contractor will provide a Job Functional Analysis or Kraus-Weber that includes back strength and flexibility if requested. Note any pain or recommended lifting limitations if less than 50 lbs.

3.9. Contractor shall ensure audiogram must be certified by the Council for Accreditation in Occupational Hearing Conservation (CAOHC) or the equivalent military Defense Occupational and Environmental Health Readiness System-Hearing Conservation (DOEHRS-HC) training in accordance with 29 CFR 1910.95. The estimated number of personnel to receive audiograms are approximately 5.

a. Hearing screenings will be conducted on employees designated by the OHN to include all workers exposed to occupational noise > 85 dBA or 140 dBA impact noise as part of their job duties.

b. All hearing tests will be entered into DOEHRS-HC by the contractor.

c. An otoscopic exam will be conducted to ensure

d. Test Only 500, 1000, 2000, 3000, 4000 and 6000.

e. Hearing aids must be removed.

f. Contractor must verify that worker has been noise free for at least 14 hours prior to screening.

g. All hearing screenings besides the baseline will be compared against the employee’s baseline to determine if there is a Significant Threshold Shift (STS) and retested immediately to verify results. Contractor will notify the Occupational Health Nurse within 10 days so that timely follow-up can be scheduled.

3.10. Contractor shall ensure Pulmonary Function Tests (PFTs) Performed by a licensed physician, Certified Pulmonary Function Technologist, or Registered Respiratory Therapist in accordance with 29 CFR 1910.1001. The estimated number of personnel to receive PFTs is approximately 10.

a. Screenings will only be conducted on employees designated by the OHN to include all those exposed to respiratory hazards that will require a respirator to mitigate hazards identified as above the action level.

b. Test will include as a minimum Forced Expiratory Volume in one second

(FEV1), Forced Vital Capacity (FVC), comparison with recognized normal’ s for the individual's height and weight, sex, race, age and a documented interpretation by a pulmonologist or certified Occupational Health physician.

c. Follow NIOSH and ATS-ERS standard requirements:

1. Continue testing individual when the patient is improving until improvement is <30ml.

2. Test results are acceptable with a minimum of three acceptable maneuvers that are free from a leak, obstructed mouthpiece, hesitation, false starts, cough, glottis closure, early termination, and have a good curve of at least 6 seconds duration.

3. Test results are reproducible in that they have the same result from the individual (two largest FVCs are within 0.150 L of each other and two largest FEV1's are within 0.150 L of each other) when the test is repeated several times. Testing is continued until criteria are met or 8 trials are attempted, or the employee being tested cannot or should not continue.

4. If three (3) acceptable and two (2) repeatable tests cannot be obtained, the technician performing the PFT must document the reason the standard could not be met.

5. Always use measured height not reported height by the nearest half inch without footwear.

6. Always indicate source of reference value on reports for adjusted predicted value

7. No smoking within 1 hour prior

8. No cold, flu or allergies within two weeks

9. No inhaler use prior to test that would still be in the patient’s system

d. Specifications regarding equipment guidelines and calibration, test administration, and test interpretation must meet applicable OSHA and ANSI standards.

Supporting documentation will be provided to this office daily or annually depending on manufacturing guidelines of spirometer.

e. Respirator clearance documented and a copy given to employee at time of visit.

3.11. Contractor will ensure that vision screenings are in accordance with DA PAM 40-506 using multiphasic vision screening equipment to measure the following primary visual skills and will be documented on a form provided by SCARNG.

a. Visual acuity for distance and near.

b. Lateral phorias for distance and near.

c. Vertical phorias for distance and near.

d. Depth perception.

e. Color perception.

f. Peripheral vision.

3.12. Contractor shall ensure laboratory tests will be processed by certified clinical laboratories and performed by personnel certified under the American Society of Clinical Pathology. The supporting laboratory will provide employee instruction and equipment necessary for tests requiring special collection methods and/or containers. Document that employee has been counseled by examining provider about laboratory test results. Provide a copy of lab results to employee for their primary care physician.

3.13. Contractor shall ensure a review of systems on physical examinations must be performed by a physician with emphasis on areas most likely to be affected by the employee's occupational exposures or desired certification.

3.14. Contractor shall ensure that chest X-rays will be performed by a certified X-ray technician. The interpretation and classification will be performed by a B-reader, or a board eligible or certified radiologist meeting the requirements of 29 CFR 1910.1001 Appendix E:

The estimated number of personnel to receive chest X-rays are none, but services must be available if requested.

a. Chest X-rays are only performed for employees that have documented enrollment into an asbestos program or other medical surveillance program as required.

b. Chest X-ray will include posterior-anterior and left lateral view.

3.16. Contractor shall ensure instrumentation must meet or exceed appropriate performance standards, and accuracy must be verified in accordance with current Occupational Medicine Certification standards.

3.17. Contractor shall provide the COR with a Quality Assurance Medical Surveillance Plan listing the procedures or processes, which shall be utilized to meet the requirements discussed in the PWS.

3.18. Contractor Manpower Reporting Application (CMRA):

3.18.1. The contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract for the South Carolina National Guard via a secure data collection site.

3.18.2. The contractor shall completely fill in all required data fields using the following web address:

http://www.ecmra.mil/. Reporting inputs shall be for the labor executed during the period of performance during each Government fiscal year (FY), which runs October 1 through September 30. While inputs may be reported any time during the FY, all data shall be reported no later than October 31 of each calendar year, beginning with 2019. Contractors may direct questions to the help desk at http://www.ecmra.mil.

4. PERSONAL PROTECTIVE EQUIPMENT (PPE)

4.1. Contractor shall furnish and assure healthcare workers are provided with the appropriate PPE such as, but not limited to: gloves, protective eyewear, and etc., where there is a potential for exposure to blood or other potentially infectious materials.

4.2. Contractor shall ensure each healthcare worker complies with the requirements of 29 CFR

1910.1030 Blood borne Pathogens Standard.

5. INFECTIOUS WASTE DISPOSAL

5.1. Disposal of all infectious waste shall be in accordance with local, state, and federal regulation and disposed of by the contractor unless other accommodations have been coordinated in writing.

5.2. Contractor shall ensure puncture resistant sharps containers are readily accessible to healthcare workers and located in all treatment areas where sharps could potentially be used.

6. MEDICAL REPORTS AND RECORDKEEPING

6.1. Contractors shall immediately contact the Occupational Health Nurse by telephone at 803- 299-1634 if results of medical surveillance screening(s), which are questionable and / or of critical significance and / or require follow-up. Contractor shall ensure that all results to include all diagnostic tests, graphs, charts, reports, questionnaires, waivers, employee consent forms, physical findings, and examination results are made available to the Occupational Health Nurse within 30 working days of completion of testing. Any electronic access to records must be in printable format suitable to be filed in the employee’s medical record. Mailed documentation will be sent to the address listed below and the contractor is responsible for all postage fees.

6.2. Contractor shall identify all medical records with the employee’s full name, social security number, date of birth, job code, and the name of the employee’s work place or facility at a minimum. The contractor shall ensure work / health history forms and medical reports are complete and legible (typed / printed).

6.3. Contractor shall ensure that each employee signs the Privacy Act Statement (DD Form 2005) during the registration process.

7. SUMMARY REPORT:

The Contractor will provide a comprehensive report as follows:

7.1 Reports will be provided every six months directly to shops that were supported.

Addresses and a point of contact for each shop will be provided. Each report will include a summary of shops employees by name and the date and type of physical(s) performed and indicate qualified or not qualified for each type and expiration. Documentation of these qualifications with expirations will be provided as a certification card for each worker examined and copies of these cards will be included in the report. All information contained within the report must be sufficient for the supervisor to refer to during an inspection without violating HIPAA. A duplicate report will be sent to the Occupational Health Nurse via electronic format.

8. EXAMINATION SCHEDULING

8.1. Coordination of scheduling shall be a joint effort between the Facility Supervisor and the Contractor, a draft copy of the scheduled will be initiated by the Facility Supervisor and sent to the Contractor for review and any needed adjustments. Contractor will provide the Occupational Health Nurse the estimated time needed for each employee based on physical components required to ensure efficient use of scheduled time. Scheduling of employees to be examined at clinic location will be accommodated by the Contractor within 30 days for routine visits and 7 days for urgent.

8.2. In the event of a Contractor equipment failure, specific testing and / or parts of examinations that are not completed during the testing period shall be completed at a scheduled time mutually convenient for the Contractor, Occupational Health Nurse and the Shops. Unfinished testing / examinations will be completed at no additional cost to the Government. The option to schedule physicals not completed due to equipment failure, through a local occupational medical facility shall be done at no cost to the Government. The Contractor shall be directly responsible to cover costs for completing these make-up screenings.

9. SERVICE DELIVERY SUMMARY (SDS)

9.1. The service delivery summary is designed to be a concise statement of key deliverables which are measured to determine the contractor's performance success or failure.

PERFORMANCE OBJECTIVE PERFORMANCE SCHEDULE

Insurance & Licensed and/or certified staff for all physicians and technicians, 100% of the time

Equipment Certification Instrumentation meets or exceed performance standards, 100% of the time

Occupational Exams Scheduled within contract timeframe and proper exam elements performed 100 % of the time

Infectious Waste Disposal urine

All sharp instruments, blood, and is handled and disposed of in accordance with federal, state, and local regulations, 100% of the time

Medical Reports and Recordkeeping

Completed records are accessible within agreed time frame and reports are submitted in a timely manner, 100% of the time

10. DESCRIPTION OF SERVICES

Examinations are determined based upon job codes and identified occupational hazard exposure.

10.1 The following standard services are to be provided under this PWS:

10.1.1 Lab Services

10.1.1.2 - Frequently Used Labs Units Schedule Unit

a) Occ Health Profile (Bundle: CBC, liver function test, BUN, Creatinine, Urinalysis) Each

b) CBC (HGB, HCT, WBC, MCV, MCH, MCHC) with diff Each

c) CBC (HGB, HCT, WBC, MCV, MCH, MCHC) without diff Each

d) Liver Function Test (AST, ALT, ALB, ALK PHOS, dBil, TBil, Protein) Each

e) BUN /Creatinine Each

f) Urinalysis with Micro Each

g) Urinalysis without Micro Each

h) Blood Glucose Each

10.1.1.3 - Infrequently Used Labs Units Schedule Unit Price

a) Cadmium Profile (Per Lab Corp)

b) Human Chorionic Gonadotropin HCG beta

c) Chromium (Blood)

d) Lead, industrial whole blood

e) ZPP, Blood Protoporphyrins, zinc

10.1.2 Procedures

a) Audiometry

b) B-Reading

c) Chest X-Ray (PA & Lat View)

d) Spirometry

e) Comprehensive Vision

f) Vital Signs / Body Ht and Wt. (no charge with exam) Each

g) Venipuncture and Specimen Handling Each

10.1.3 Exams Units Schedule Unit Price

a) Comprehensive Exam (Medical Surveillance)

b) Billing Terms

c) OHC Terms Units Schedule Unit Price

d) Record Processing services as related to Exams or Clearances

e) Record Processing (Mailing of X-rays)

f) Missed Work-up or missed procedure

g) Missed Exam

12. PERIOD OF PERFORMANCE: 01 May 2019 –30 April 2020. The majority of the Medical Surveillance Examinations will be held 01 May 2019 through 30 May 2019. Depending on availability, remaining personnel may be screened through 30 April 2019. As per section 8, the Contractor will work with both the Facility Supervisor and Occupational Health Nurse to establish examination dates. This contract includes four (4) option years.

13. INVOICE: The contractor will upload an invoice, for all services performed under this contract, to the Wide Area Workflow (WAWF) Website and will send an electronic copy to the COR in the SCARNG SOH Office.

14. REFERENCES

14.1. Title 29, Code of Federal Regulations, Part 1910: Occupational Safety and Health Standards.

14.2. Title 29, Code of Federal Regulations, Part 1960: Safety and Health Provisions for Federal Employees.

14.3. American National Standards Institute (ANSI) 288.6-1884, American National Standard for Respiratory Protection, Respirator Use, Physical Qualifications for Personnel.

14.4. Threshold Limit Values and Biological Exposure Indices (TLVs), American Conference of Governmental Industrial Hygienists (ACGIH), Cincinnati, Ohio.

14.5. Army Regulation 40-5, Preventive Medicine

14.6. Department of Defense 6055.05M, Occupational Medical Surveillance Manual

14.7. U.S. Department of Labor, Code of Federal Regulations 29 (CFR) 1910.120 (b) (5), (f), Medical Surveillance

14.8. Army Regulation 11-34, The Army Respiratory Protection Program

14.9. Headquarters, Department of the Army Pamphlet (DA PAM) 40-501 Hearing Conservation

14.10. Headquarters, Department of the Army Pamphlet (DA PAM) 40-506 Vision Conservation

QUALITY ASSURANCE PLAN

Annual OSHA Physicals for South Carolia National Guard Employees Exposed to

Occupational Health Hazards

Performance Objective PWS Ref

Performance Threshold Method of Surveillance or

Frequency

1. Provided all required examinations 10.0

Able to support all employees requiring an

100%

2. Provided examinations in required locations

1.0 Able to provide examinations

@ all sites specified

3. Responds to requests for exams from SOH Office & Supervisors in timely manner

8.1 Schedules & notifies of all

exams/changes within 48 hours of receipt

4. Only provides exams to approved employees

10.1 Only provides/charges for

exams to approved employees

Monthly

5. Upload invoices to WAWF & submit to SOH office

14.4 Provides/Uploads invoices Monthly

6. Provides only exam services as specified in

10 Provides all annual exam, resp eval, lead screening

7. AS REQUIRED properly screen/refer employees for respirator eval or lead screening

10.1.1.3 Additional procedures

are ordered by medical provider only if deemed necessary and approved ahead of time

100%

8. Receive approval for spirometry tests, lead screening prior to approving procedure

10.1.1.3 Contacts SOH office prior to

lead screening unless previously approved

100%

9. Spirometry procedure properly conducted/documented if approved

13.10.a Conducted by appropriate personnel as specified

Random inspection

10. Training/Credentialing of personnel providing services

3.4 3.9

All personnel providing services shall be properly trained, licensed and/or certified

Random

11. Provide a POC for all services provided @ all facilities

7.1 Provide SOH office with current

POCs

Ongoing

12. Notify the SOH office within 24 hours of events specified

6.1 Notify SOH Office when a listed

problem comes up

100%

13. Provide copies of all examination paperwork SOH office, as required

6.1 Copies of all paperwork to the

SOH Office

QUALITY ASSURANCE WORKSHEET

Performance Objectives Rate Comments Required Fix

1. Provides all required examinations Green No Comment Required for Green Yellow

Red

2. Provide Examinations in required Locations

Green No Comment Required for Green

Yellow

Red

3. Responds to requests for exam SOH Office & Supervisors in timely manner.

Green No Comment Required for Green

Yellow

Red

4. Only Provides exams to approved employees

Green No Comment Required for Green

Yellow

Red

5. Uploads monthly invoice to WAWF & submites to SOH Office

Green No Comment Required for Green

Yellow

Red

6. Provides only exam services specified

Green No Comment Required for Green

Yellow

Red

7. As required - screen/reffer employees

ie. resp eval, lead screening

Green No Comment Required for Green

Yellow

Red

8. Receives apporval for lead screening & PFT prior to diagnostic test

Green No Comment Required for Green

Yellow

Red

9. Spirometry procedure properly conducted/documented

Green No Comment Required for Green

Yellow

Red

10. Personnel providing services are properly trained, licensed, and/or certified

Green No Comment Required for Green

Yellow

Red

11. Provide updated POC for all services to supervisors and OHN

Green No Comment Required for Green

Yellow

Red

12. SOH office is notified in 24 hours of any problems

Green No Comment Required for Green

Yellow

Red

13. Copies of all examination paperwork SOH, as required

Green No Comment Required for Green

Yellow

Red