PWS_04_Nov_14.docx

PERFORMANCE WORK STATEMENT (PWS) FOR

DENTAL RESTORATIVE CARE

1. Introduction: Soldier readiness determines the Ohio Army National Guard’s (OHARNG) ability to provide ready forces to Combatant Commanders, the Governor, and Defense Support of Civil Authorities. Soldiers must have a Dental Readiness Classification (DRC) of 1 or 2 to attain readiness standards. Dental readiness is a command responsibility and is a primary focus in the OHARNG.

2. Policy Background:

a. The Standardized Dental Classification System is used by the Department of Defense (DoD) to identify dental health and readiness see Appendix A). Soldiers with a DRC of 3 shall be identified and treatment determined to raise their DRC to 2 or 1. Allowable services are listed in Appendix C. Soldier records shall be updated with all treatment and results within 5 working days. All services shall be performed on site at OHARNG armories and facilities across the state, except for Soldiers who are evaluated as DRC 3 and who require extensive in-clinic treatment and/or dental reconstruction. The contractor shall provide qualified personnel, material and other items necessary to perform services in accordance with (IAW) DoD and Department of the Army (DA) standards. Contractor shall comply with OSHA, HIPAA, ADA, Privacy Act requirements and any applicable state and federal regulations and guidelines.

b. Government Furnished Property, Equipment, and Services: The government will provide space, radiology and administrative areas and utilities. The contractor must be able to set up in OHARNG facilities or may bring in a mobile dental facility. All treatment shall be performed inside a government facility, armory or portable dental facility, except as stipulated in 2a.

c. DoD Health Affairs Policy 02-11, Standardization of Oral Health and Readiness Classifications, requires dental remediation be performed and documented on 100% of Soldiers at any dental event. All dental restorative services shall be performed on-site during the dental event, except for extensive in-clinic or dental reconstruction procedures.

3. Basic Services: The contractor shall provide all management, labor, material, equipment, certifications and supplies necessary to provide dental services at designated locations for the Ohio Army National Guard. These services shall be delivered at various armories and training locations throughout Ohio and nearby states. The contractor shall provide mandated dental examinations and/or radiographic studies and/or dental treatment, proper documentation into the Soldier’s military dental record, and data entry of all records into the DENCLASS system, to meet DA standards of medical readiness. The contractor shall insure that their agents are appropriately trained and have access to the DENCLASS system.

4. Objectives and Scope: The contractor shall provide customized comprehensive dental readiness services to include:

a. Dental services as listed in Appendix C and oral health education.

b. Dental services shall be completed using contractor provided portable/mobile dental equipment and government furnished property, equipment or services IAW paragraph 2a above.

c. Specified Dental Specialty Services to include:

(1) Oral and Maxillofacial Surgery (to include pathology reports if indicated

(2) Endodontics

(3) Periodontics

(4) Prosthodontics

(5) Orthodontic

d. Prescriptions for pharmaceuticals and controlled substances necessary for the care and treatment of Soldiers throughout the event, to include but not limited to analgesics and antibiotics.

5. Contractor shall demonstrate the ability to perform these services and treat the Soldier efficiently, provide individual case management of Soldiers who require extensive DRC 3 treatment and schedule dental appointments at selected dental facilities for the DRC 3 Soldiers that require extensive in-clinic treatment and/or dental reconstruction. Dental services shall be performed by licensed dental professionals with the oversight and ultimate approval authority by the OHARNG State Dental Surgeon and State Surgeon.

6. Upon completion of services, medical information shall be documented in accordance with DA Policy and be updated in DENCLASS. The contractor shall also ensure the requirements of Occupational Safety and Health Administration (OSHA) and applicable Federal regulations are met. The contractor shall develop and maintain records that fully document services performed, examination results, and names of soldiers referred to dental specialists. These records shall be made available to the state medical representative.

7. Exam. A comprehensive oral evaluation shall assess the current state of oral health, risk for future dental disease and general health factors that relate to the treatment of the Soldier. The following measures are required for each comprehensive oral evaluation:

a. Blood pressure assessment—Screen Soldiers for hypertension; appropriately refer hypertensive Soldiers to the state medical authority.

b. 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 state medical authority to identify those at high risk for future disease and appropriately manage their care.

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

d. Tobacco risk assessment—Classify Soldiers as a smoker, user of smokeless tobacco or both.

e. Oral cancer screening—Perform a thorough oral cancer screening on all Soldiers as part of all annual examinations.

f. Radiographs shall be taken only for clinical reasons according to FDA and Dental Command guidelines. Radiographs shall be of diagnostic quality, properly identified and dated. A panoramic radiograph of adequate quality for diagnostic/identification purposes shall be part of the dental record. There is no time requirement on updating panoramic radiographs. However, the panoramic radiograph shall adequately represent the current oral condition of the Soldier. Bitewing (or bitewing slice at the discretion of the State Dental Officer) radiographs shall also be part of the dental record. All radiographs provided under this contract shall be digital and transferred to the DENCLASS module within 5 working days of exposure.

g. A listing of all DRC 3 conditions

h. Any condition of significance that is not readily apparent on the radiographs.

8. Documentation. All Soldiers shall have a complete military dental record. No dental record shall be considered complete unless the documentation is complete and in the proper order as outlined in Technical Bulletin MED 250. The contractor shall provide electronic documentation (to include radiographs) in DENCLASS within 5 business days of exam completion and a paper copy as outlined below. A complete record includes the following:

a. Military dental record jacket, DA Form 8005 through 8005-9

b. The automated Health History Form or DA Form 5570 (with notations to “yes” answers and signed by both the Soldier and reviewing Doctor), Health Questionnaire envelope

c. DD Form 2005 (signed), Privacy Act Statement

d. SF 603/603A, Record of Dental Exam

e. Supporting radiographs (panoramic and diagnostic bitewing radiographs, see paragraph 6f above, documenting existing conditions)

(1) All radiographs shall be uploaded into DENCLASS within 5 working days.

(2) A diagnostic quality copy of all radiographs shall be placed in the dental record.

f. The entries on the SF 603/603A shall include the following: date, location, comprehensive oral evaluation, indication/date of x-rays taken, indication/date of x-rays consulted, oral cancer screening, caries risk assessment (based upon caries incidence), PSR, notation of current DRC, listing of current oral condition (class 2 issues identified and a listing of class 3 treatment needs, if any), printed name of examining dentist or dental officer and the dentist’s or dental officer’s signature/initials, as appropriate. These required dental documentation elements shall be entered in DENCLASS and printed and placed into the dental record.

g. All documentation shall be returned to the Ohio Army National Guard Medical Detachment.

9. General Information.

a. Quality Control. The contractor shall adopt a quality assurance program that monitors all service activities and ensures the highest quality customizable dental services available. It is the responsibility of the OHARNG to review and approve dental treatment plans. Treatment is to be IAW Appendices A and C.

b. Quality Assurance. The government shall periodically evaluate the contractor’s performance in accordance with the Quality Assurance Surveillance Plan.

c. Individual case management. The contractor shall ensure accountability and vendor oversight are provided by a qualified and credentialed DDS or DMD. This position shall be a staff position of the vendor.

d. The contractor shall maintain a dedicated and organic emergency toll free call line (manned 24/7) for Soldiers to call if needed after completion of dental work.

e. The contractor shall schedule appointments to dental facilities throughout Ohio for the restorative dental work that cannot be completed at the dental event.

f. The contractor shall have the ability to perform and provide multiple restorative services at multiple dental events concurrently. Projected schedule and estimated workload is contained in Appendix B.

g. The contractor shall provide end of event data as required in paragraph 18, Deliverables.

h. The contractor shall provide a dedicated point of contact.

10. Special Qualifications. Contractor shall maintain appropriate credentialing files on all employees, to include but not limited to, licensure, National Provider Data Base Query results and HIPAA certification. All providers shall be licensed in the state in which they are providing services.

11. Contractor shall ensure compliance with the following requirements prior to utilizing any x-ray producing device on Soldiers:

a. Have established written policies and procedures to ensure compliance with applicable Federal, State, DOD, and DA radiation safety regulations and directives. These documents include staff emergency reaction plans, as necessary, and procedures for investigating and reporting radiation accidents or incidents, possible radiation overexposures to Soldiers or contractor staff, and provisions to ensure the safe use of x-ray producing devices on Soldiers.

b. Upon request by the state medical representative, the contractor shall provide copies of a Qualified Health Physics Expert's acceptance test and most recent health physics survey of each diagnostic x-ray machine. The acceptance test and the most recent survey shall include tests of electrical, mechanical, image quality and radiation (output) dose tests or measurements. This shall include verification of the adequacy of radiation protection shielding in and around the x-ray machine and x-ray facility (e.g., mobile van).

12. Dental Event Information:

a. Hours of Operation/Place of Performance: The Government shall notify the contractor at least 15 days in advance of the dental event of the location and number of Soldiers projected to require dental treatment. Dental events shall be scheduled in Ohio and may be scheduled in nearby states (Michigan, Indiana, Wisconsin and Minnesota), depending on mission requirements. Hours of operation are 0800-1800 hours at all locations. The contractor shall maintain an adequate work force for the uninterrupted performance of all tasks defined within this PWS.

b. Security Requirements: Security shall be in accordance with DD Form 254 (Department of Defense Contract Security Classification Specification).

c. Projected schedule and workload for fiscal year 2015 are provided in Appendix B.

13. Travel Requirements: Travel within the State of Ohio is required; travel outside Ohio may be required on a case-by-case basis. Dental events may be held at Camp Grayling, MI; Camp Atterbury, IN; Camp Ripley, MN and Fort McCoy, WI.

14. Event Coordination: The Contracting Officer’s Representative (COR) shall serve as the principal point of contact for coordinating the dental events.

15. Period of Performance: The government intends to award an IDIQ contract for a base period of 1 year with 1 one year option. Delivery orders/task orders shall be awarded for each dental event.

16. Contractor Furnished Items and Services: Except for those items specifically stated to be government furnished in paragraph 2b above, the contractor shall furnish everything else required to perform the work.

17. Service Contract Specific Information:

a. The McNamara-O’Hara Service Contract Act and the Contract Work Hours and Safety Standards Act apply to this contract.

b. 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://contractormanpower.army.pentagon.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, e-mail 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 sub-contractor if different); (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 sub-contractors perform the work (specified by zip code in U1e 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 sub-contractor 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 30 September 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.

18. Deliverables: The contractor shall prepare and deliver the following items to the Contracting Officer’s Representative (COR):

DELIVERABLE

ACCEPTABLE QUALITY LEVEL (AQL)

METHOD USED / FREQUENCY

On-Location Dental Treatment Services

100% accuracy

Inspections and checks/100% at every event

Sub-Contracted Dental Treatment Services

Inspections and checks/100% post-event

Documentation into DENCLASS

Inspections and checks/100% at every event

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

(1) Date

(2) Location

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

(4) Total number of Soldiers scheduled

(5) Total number of Soldiers examined

(7) Total number of Soldiers receiving treatment

(8) Total number of Soldiers by dental classification: 1, 2, 3

(9) Total number of bitewing radiographic sets taken

(10) Total number of panoramic radiographs taken

(11) Verification of entry into DENCLASS

(12) A by name listing of all Soldiers examined, the dental classification of the Soldier and the treatment provided.

19. Applicable Publications. Publications applicable to this PWS are available via the internet at these websites: https://apps.mods.army.mil/MEDPROS/Secured/ and https://apps.mods.army.mil/denclass/.

20. Quality Assurance Surveillance Plan (QASP):

a. The COR shall monitor contractor performance and complete the Quality Assurance Plan Worksheet provided below on a monthly basis. The Quality Assurance Plan Worksheet shall be submitted directly to the Administrative Contracting Officer (ACO) with a copy to the contractor not later than the 5th day of each month following the service.

b. At the end of the contract period of performance, the COR shall complete a Quality Performance Review to document the quality performance rating during the performance period. This shall be submitted to the ACO.

c. The COR may submit a Quality Assurance Plan Worksheet at any time and as often as necessary to document quality levels. If the contractor’s response to an identified quality deficiency is unsatisfactory, the Contracting Officer and COR shall contact the appropriate contractor POC to determine and implement a plan of action to remedy the identified deficiency.

Rating

Description

Green

Performance is being met at or above AQL.

Yellow

Performance is currently being met at the minimum AQL, but the following service/deliverable needs contractor attention.

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

Red

Performance is not being met at AQL and the following service/deliverable needs immediate contractor resolution.

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

QUALITY ASSURANCE PLAN WORKSHEET

Deliverable/Service

Quality Rating

Causative Factors

Effect on Mission Action Required /Date

On-Location Dental Treatment Services

Yellow

Red

Sub-Contracted Dental Treatment Services

Yellow

Red

Documentation into DENCLASS

Yellow

Red

APPENDICES:

a. Dental Classification

b. Schedule and Estimated Workload

c. Authorized Dental Treatment

APPENDIX A

Standardized Dental Classification System:

Class 1: Soldiers with a current dental examination, who do not require dental treatment or reevaluation within 12 months. Criteria:

a. No dental caries or defective restorations.

b. Arrested caries for which treatment is not indicated.

c. Healthy periodontium, no bleeding on probing; oral prophylaxis not indicated.

d. Replacement of missing teeth not indicated.

e. Unerupted, partially erupted, or malposed teeth that are without historical, clinical, or radiographic signs or symptoms of pathosis and are not recommended for prophylactic removal.

Class 2: Soldiers with a current dental examination, who have oral conditions that, if not treated or followed up, have the potential but are not expected to result in dental emergencies within 12 months. Criteria:

a. Treatment or follow-up indicated for dental caries with minimal extension into dentin or minor defective restorations easily maintained by the Soldier where the condition does not cause definitive symptoms.

b. 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.

c. Edentulous areas requiring prosthesis but not on an immediate basis.

d. Periodontal disease or periodontium exhibiting:

(1) Requirement for oral prophylaxis.

(2) Requirement for maintenance therapy; this includes stable or non-progressive mucogingival conditions requiring periodic evaluation.

(3) Non-specific gingivitis.

(4) Early or mild adult periodontitis.

e. 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.

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

g. Temporomandibular disorder Soldiers in maintenance therapy. The provider anticipates the Soldier can perform duties while deployed without ongoing care and any medications or appliances required for maintenance will not interfere with duties.

Class 3: Soldiers who have oral conditions that if not treated are expected to result in dental emergencies within 12 months. Soldiers should be placed in Class 3 when there are questions in determining classification between Class 2 and Class 3. Criteria:

a. Dental caries, tooth fractures or defective restorations where the condition extends beyond the dentinoenamel junction and causes definitive symptoms; dental caries with moderate or advanced extension into dentin; and defective restorations not maintained by the Soldier.

b. Interim restorations or prostheses that cannot be maintained for a 12 month period. This includes teeth that have been restored with permanent restorative materials but for which protective coverage is indicated.

c. Periodontal diseases or periodontium exhibiting:

(1) Acute gingivitis or pericoronitis.

(2) Active moderate to advanced periodontitis.

(3) Periodontal abscess.

(4) Progressive mucogingival condition.

(5) Periodontal manifestations of systemic disease or hormonal disturbances.

d. Edentulous areas or teeth requiring immediate prosthodontic treatment for adequate mastication, communication, or acceptable esthetics.

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

f. Chronic oral infections or other pathologic lesions including:

(1) Pulpal or periapical pathology requiring treatment.

(2) Lesions requiring biopsy or awaiting biopsy report.

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

h. Temporomandibular disorders requiring active treatment.

Class 4: Soldiers who require dental examinations. This includes Soldiers who require annual or other required dental examinations and Soldiers whose dental classifications are unknown.

APPENDIX B

SCHEDULE AND ESTIMATED WORKLOAD

APPENDIX C

AUTHORIZED DENTAL TREATMENT

Other services not listed below may be authorized on a case-by-case basis.

Diagnostic Services:

D0120 Periodic Oral Evaluation D0150 Comprehensive Oral Evaluation D0272 Bitewings - 2 films D0274 Bitewings - 4 films

Treatment/Restorative Services:

Endodontic Services:

Periodontal Services:

Prosthodontic Services:

Oral Surgery Services:

Orthodontic Services:

D8680 Orthodontic Retention

The following dental procedures are not authorized:

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Microsoft_Office_Excel_Worksheet1.xlsx Sheet1

Date Number Location

4-Oct-14 285 DSCC

5-Oct-14 300 DSCC

18-Oct-14 343 Stow

18-Oct-14 279 Alliance

18-Oct-14 250 North Canton

18-Oct-14 200 Coschocton

18-Oct-14 172 Walbridge

18-Oct-14 190 DSCC

19-Oct-14 200 DSCC

1-Nov-14 140 North Canton

1-Nov-14 170 Toledo

1-Nov-14 170 Middletown

15-Nov-14 450 Hamilton

15-Nov-14 335 McConnelsville

15-Nov-14 250 North Canton

15-Nov-14 225 DSCC

16-Nov-14 150 Rickenbacker

16-Nov-14 210 DSCC

22-Nov-14 250 DSCC

23-Nov-14 225 DSCC

6-Dec-14 330 Youngstown

13-Dec-14 225 DSCC

10-Jan-15 240 DSCC

11-Jan-15 200 DSCC

24-Jan-15 200 DSCC

25-Jan-15 75 DSCC

30-Jan-15 690 over these 3 days Camp Perry building 950

1-Feb-15 Camp Perry building 950

2-Feb-15 Camp Perry building 950

7-Feb-15 250 DSCC

8-Feb-15 260 DSCC

21-Feb-15 235 DSCC

21-Feb-15 286 Springfield

22-Feb-15 225 DSCC

14-Mar-15 200 DSCC

2-May-15 200 DSCC

3-May-15 250 DSCC

16-May-15 200 DSCC

6-Jun-15 240 DSCC

12-Sep-15 200 DSCC