W91QVN-17-R-0090_Case_&_Utilization_Manager_-51st_MDG_Osan.pdf

SEE ADDENDUM

(No Collect Calls)

W91QVN-17-R-0090 02-Jun-2017

b. TELEPHONE NUMBER

(02) 7914-7161

8. OFFER DUE DATE/LOCAL TIME

12:00 AM 03 Jul 2017

5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA – FAR (48 CFR) 53.212

(TYPE OR PRINT)

(SIGNATURE OF CONTRACTING OFFICER)

ADDENDA X ARE

26. TOTAL AWARD AMOUNT (For Gov t. Use Only )

23.

CODE 10. THIS ACQUISITION IS

SUCH ADDRESS IN OFFER

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT

BELOW IS CHECKED

TELEPHONE NO.

W91QVN9. ISSUED BY

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a. UNLESS BLOCK

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

MRS. NUMA, ERICA NICOLE

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NUMBER

(TYPE OR PRINT)

30b. NAME AND TITLE OF SIGNER 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a.UNITED STATES OF AMERICA

1 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1. 52.212-4. FAR 52.212-3. 52.212-5 ARE ATTACHED.X

25. ACCOUNTING AND APPROPRIATION DATA

1. REQUISITION NUMBER

20.

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, AND 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

F3J4MD7046AQ01

ARE NOT ATTACHED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

. YOUR OFFER ON SOLICITATION

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

% FOR:SET ASIDE:UNRESTRICTED ORX

SMALL BUSINESS

17a.CONTRACTOR/ CODE FACILITY

OFFEROR CODE

411TH CONTRACTING SUPPORT BRIGADE, KOREA

RCC YONGSAN, UNIT #15289

APO AP 96205-5289

UNITED STATES OF AMERICA (THE)

18a. PAYMENT WILL BE MADE BY CODE

RATED ORDER UNDER

DPAS (15 CFR 700)

13a. THIS CONTRACT IS A

13b. RATING

CODE15. DELIVER TO CODE F3J4MD 16. ADMINISTERED BY

12. DISCOUNT TERMS11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

14. METHOD OF SOLICITATION

RFQ IFB RFPX

51 MDG/FM

MR. PAK, CHI

MEDICAL EQUIPMENT MANAGEMENT

APO AP 96278

UNITED STATES OF AMERICA (THE)

TEL: 784-2601 FAX:

FAX:

TEL: SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

8(A)

HUBZONE SMALL

BUSINESS

SIZE STANDARD:

$7,500,000

NAICS:

621399

X

OFFER DATED

29. AWARD OF CONTRACT: REF.

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

EMAIL:

TEL:

31c. DATE SIGNED

SEE SCHEDULE

SCHEDULE OF SUPPLIES/ SERVICESITEM NO. QUANTITY UNIT UNIT PRICE AMOUNT

24.22.21.19.

WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

(CONTINUED)

PAGE 2 OF92

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: ______________________________________________________

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f . TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

37. CHECK NUMBER

FINALPARTIALCOMPLETE

36. PAYMENT35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER

FINAL

33. SHIP NUMBER

PARTIAL

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

42a. RECEIVED BY (Print)

42b. RECEIVED AT (Location)

42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS

STANDARD FORM 1449 (REV. 2/2012) BACK

Prescribed by GSA – FAR (48 CFR) 53.212

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

SEE SCHEDULE

20.

SCHEDULE OF SUPPLIES/ SERVICES

21.

QUANTITY UNIT

22. 23.

UNIT PRICE

24.

AMOUNT

19.

ITEM NO.

W91QVN-17-R-0090

Section B - Supplies or Services and Prices

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 1,920 Hours Case/Utilization Manager Base Year

FFP

Case/Utilization Manager to provide personal services in accordance with the Performance Work Statement for 51st Medical Group, Osan Air base, Korea.

FOB: Destination

PURCHASE REQUEST NUMBER: F3J4MD7046AQ01

NET AMT

CMRA Base Year

FFP

The Department of Defense requires Contractor Manpower Reporting Application (CMRA) to be completed by 31 October of each calendar year during the life of the contract. The Contractor shall provide all of the information requested and in the required format, using the following web address: http://www.ecmra.mil (select "Department of Air Force CMRA" icon) for the purpose of capturing contractor and subcontractor manpower utilized during the performance of this contract.

Estimated Cost is zero dollars ($0.00).

War Hazard Losses

FFP

Estimated Cost for War Hazard Losses is Zero dollars ($0.00).

1001 1,920 Hours OPTION 1st Option

FFP

Case/Utilization Manager to provide personal services in accordance with the Performance Work Statement for 51st Medical Group, Osan Air base, Korea.

OPTION CMRA 1st Option

FFP

The Department of Defense requires Contractor Manpower Reporting Application (CMRA) to be completed by 31 October of each calendar year during the life of the contract. The Contractor shall provide all of the information requested and in the required format, using the following web address: http://www.ecmra.mil (select "Department of Air Force CMRA" icon) for the purpose of capturing contractor and subcontractor manpower utilized during the performance of this contract.

OPTION War Hazard Losses

FFP

2001 1,920 Hours OPTION 2nd Option

FFP

Case/Utilization Manager to provide personal services in accordance with the

OPTION CMRA 2nd Option

FFP

The Department of Defense requires Contractor Manpower Reporting Application (CMRA) to be completed by 31 October of each calendar year during the life of the contract. The Contractor shall provide all of the information requested and in the required format, using the following web address: http://www.ecmra.mil (select "Department of Air Force CMRA" icon) for the purpose of capturing contractor and subcontractor manpower utilized during the performance of this contract.

OPTION War Hazard Losses

FFP

3001 1,920 Hours OPTION 3rd Option

FFP

Case/Utilization Manager to provide personal services in accordance with the

OPTION CMRA 3rd Option

FFP

The Department of Defense requires Contractor Manpower Reporting Application (CMRA) to be completed by 31 October of each calendar year during the life of the contract. The Contractor shall provide all of the information requested and in the required format, using the following web address: http://www.ecmra.mil (select "Department of Air Force CMRA" icon) for the purpose of capturing contractor and subcontractor manpower utilized during the performance of this contract.

OPTION War Hazard Losses

FFP

4001 1,920 Hours OPTION 4th Option

FFP

Case/Utilization Manager to provide personal services in accordance with the

OPTION CMRA 4th Option

FFP

The Department of Defense requires Contractor Manpower Reporting Application (CMRA) to be completed by 31 October of each calendar year during the life of the contract. The Contractor shall provide all of the information requested and in the required format, using the following web address: http://www.ecmra.mil (select "Department of Air Force CMRA" icon) for the purpose of capturing contractor and subcontractor manpower utilized during the performance of this contract.

OPTION War Hazard Losses

FFP

Estimated Cost for War Hazard Losses is Zero ($0.00)

Section C - Descriptions and Specifications

PERFORMANCE WORK STATEMENT

Case/Utilization Manager (C/UM)

51st Medical Group Osan Air Base, Korea

Part 1

General Information

1. GENERAL: This is a personnel services contract for one (1) Case/Utilization Manager (C/UM) with performance at 51st Medical Group Medical Treatment Facility (MTF), Osan Air Base, Korea. This is a personal service contract (as defined by FAR Subpart 37.104) and is intended to create an employer-employee relationship between the Government and the individual health care providers only to the extent necessary for providing the health care services required. The performance of health care services by individuals under a personal services contract are subject to day-to-day supervision and control by health care facility personnel comparable to that exercised over military and civil service individuals engaged in comparable health care services. Any personal injury claims alleging negligence by personnel within the scope of performance of the personal services contract shall be processed by DoD in the same manner as claims alleging negligence by DoD military or civil service personnel. The contract does not create an employer-employee relationship between the Government and any corporation, partnership, business association or other party or legal entity with which the individual may be associated. The authority for this contract is 10 United States Code 1089 and 10 United States Code 1091.

1.1 Description of Services/Introduction: The C/UM shall provide all services, labor, and other items required to accomplish performance of Case/Utilization Manager duties as specified, in strict accordance with all terms, conditions, general and special provisions, specifications, and attachments contained herein or incorporated by reference, as described in this Performance Work Statement (PWS) except those items specified as government furnished property and services. The C/UM shall perform to the standards in this contract.

1.2 Background: The mission of the military healthcare system (MHS) is to ensure the nation has available at all times a healthy military force supported by a combat ready healthcare system. Health care services for eligible MHS beneficiaries are provided at Military Treatment Facilities (MTF) located on or near military installations or posts. The military treatment facility may be a clinic, hospital, or medical center. Clinics are outpatient facilities offering primary care or simple specialty care (routine exams, tests, and treatments). The clinic may be stand-alone site or satellite of a larger clinic, hospital, or medical center.

The 51st Medical Group mission is to seamlessly transition from community healthcare to contingency operations and respond to a full spectrum of health requirements, prepare medically ready forces, expand medical capabilities, and sustain war reserve materiel in support of 7 Air Force (AF) and United States Forces Korea (USFK). The C/UM provides Medical Management services to over 12,000 beneficiaries. The C/UM works with other members of the Medical Management Team, all clinical and patient administrative areas of the MTF to provide individualized care and promote a positive outcome for the beneficiaries through collaborative and effective nursing practices.

1.3 Objectives: Perform the full spectrum of services as a Case/Utilization Manager to support 51st Medical Group’s mission. The contractor shall provide all labor, materials, tools, equipment, transportation, and materials necessary to recruit, qualify, and retain a C/UM throughout the duration of this contract.

1.3.1 All services shall comply with established standards, principles, and ethics of the Case/Utilization Management profession and applicable professional specialty organization, the Joint Commission (JC) standards, the professional standards at the MTF, the Accreditation Association for Ambulatory Heath Care (AAAHC), applicable Department of Defense (DoD), Air Force Instructions (AFI)-44-174 & 44-173, AF Guide to Population

Health, DoD Medical Management Guide and Medical Group Instruction (MDGI) 44-106. These documents are available in the MTF and maintained by the Government. Supplements or amendments to instructions or publications from any organizational level may be issued during the life of the contract. The Contractor shall immediately implement those changes. The C/UM shall give the highest regard to patient dignity and observe the precepts of the American Hospital Association’s Bill of Rights for patients. The C/UM shall be held accountable for compliance to the standards listed in the Comprehensive Accreditation Manual for Hospitals (CAMH) dated 2011 or current version.

1.3.2 The C/UM shall provide services in conjunction with other non-contract providers to include physicians, nurse practitioners, physician assistants, registered and licensed practical nurses, and other support personnel. All contact personnel shall perform essentially the same functions, within scope of acceptable practice for the specific specialty or position, as those required by Air Force or Government service health care professionals of similar experience and similar duty assignments. The scope of services provided in military treatment facilities cover the same range of services as those that are provided in civilian treatment facilities of similar size and scope of services.

1.4 Scope: The C/UM shall serve as a professional nurse to ensure the Department of Defense beneficiaries receive timely, appropriate in scope and level, cost effective, quality, sensitive, and coordinated care to effect desired outcomes utilizing the major components of Medical Management which are Utilization Review, Third Party Collection Review, Referral/Capacity management, Discharge Planning, TRICARE Programs, and Case Management. Utilizing specialized nursing knowledge and experience, develop protocols and procedures to manage the utilization review for third party reimbursements. Provide discharge/disposition planning (DP) services to all beneficiaries. Discharge/disposition planning is an interdisciplinary process that coordinates a patient’s transition to the next level of care. These services will be applied across a continuum of care and in whatever environment the patient is in. Coordinate with third party payers and those covered by TRICARE Contractors to provide requested clinical information to accomplish pre-certification and continued stay reviews to ensure maximum reimbursement to the MTF. Identify and case manage the care of military healthcare beneficiaries with referral issues and complex needs requiring frequent interventions across a continuum of care. Participate in a collaborative process assessing, planning, implementing, monitoring and evaluating cases to improve outcomes and meet an individual’s need in a quality cost effective manner.

1.5 Period of Performance: The period of performance shall be for one (1) Base Year of 12-months and four (4)

12-month option years.

1.6 General Information

1.6.1 Quality Management: The Contractor shall have a planned and systematic quality management process for monitoring and analyzing contract performance to ensure the service is performed in accordance with applicable laws and pertinent regulations, and commercial practices. The contractor shall develop and implement procedures to identify, prevent and ensure non-recurrence of defective services. The C/UM shall comply with the MTF quality management/process improvement activities. The Contractor shall ensure the C/UM participates in the MTF’s Medical Quality Assurance/Risk Management (QA/RM) Orientation procedures for newly assigned C/UMs to include regulations specific to their professional specialty, hospital, and Air Force policy and procedures.

1.6.2 Quality Assurance: The government will evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan. This plan primarily focuses on what the Government must do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

1.6.2.1 Inspection: The inspection and acceptance point for all services rendered under this contract will be the COR. The performance by the C/UM, the quality of services rendered, and any documentation or written material in support of the same, shall be subject to continuous inspection, surveillance and review for acceptance by the KO or COR. Any services rendered by the C/UM to patients or interaction with military/civilian personnel deemed unprofessional, threatening, or dangerous by the KO will be grounds for immediate termination for default or cause.

Quality Assurance procedures established by the MTF shall be used for continuous monitoring. Other performance evaluation factors will be monitored that are not quantified by numerical measurements which include: Contractor providing personnel not meeting the minimum qualification standards; inappropriate prescriptions; patient customer service comments; Contractor relationship with hospital staff/Government contracting personnel; compliance with hospital healthcare policies and procedures.

1.6.3 Recognized Holidays: The following is a list of legal federal holidays. Any of the federal holidays falling on a Saturday will be observed on the preceding Friday. Holidays falling on a Sunday will be observed on the following Monday.

New year’s Day, January 1st Martin Luther King’s Birthday, 3rd Monday in January President’s Day, 3rd Monday in February Memorial Day, Last Monday in May Independence Day, July 4th Labor Day, 1st Monday in September Columbus Day, 2nd Monday in October Veteran’s Day, November 11th Thanksgiving Day, 4th Thursday in November Christmas Day, December 25th

1.6.3.1 Any holidays that are declared by Presidential Executive Order shall be observed in the same manner as holidays listed above. If the area in which the C/UM is scheduled to work is closed due to the holiday declared by an Executive Order and the C/UM is not required to report in, payment will not be made for those hours. Closures of the installation due to inclement weather or other such acts of God shall be handled in the same manner. The C/UM will not provide services on PACAF’s family days, PACAF Holidays, training days, or 51st Fighter Wing Down Days.

1.6.3.2 The C/UM shall report to work as scheduled during emergencies, disasters, or during adverse weather conditions which does not result in installation/facility closure. Contract services are still required during these situations. However, if transit to work is not possible, the C/UM shall immediately notify the COR and supervisor.

1.6.3.3 During anticipated closure of the facility due to Command declared training holidays or unplanned closure of the facility due to natural disasters, military emergencies, severe weather, or otherwise the Contractor will only be paid for the actual hours that were worked.

1.6.3.4 The Contractor shall not invoice the Government for services not performed and the Government will not be liable for any such closures.

1.6.4 Hours of Operation: The MTF provides services 24 hours a day, 365 days a year (366 days during leap years) including holidays. Clinics have designated operating hours. Duty hours will be dayshift hours, no weekends and Federal holidays. Duty hours may include Korean holidays and base exercise days where limited military staffing is available. The C/UM will only be paid for hours actually worked. When hiring personnel, the Contractor shall keep in mind that the stability and continuity of the workforce are essential.

1.6.4.1 Work Schedule: A normal work week is 40 hours (8 hours per day excluding 1-hour lunch break) from 0730hrs to 1630hrs. The C/UM shall conduct business, between the hours of 0730 to 1630 Monday thru Friday.

The C/UM will be compensated only for time actually devoted to delivery of services in this contract. There may be occasions when mission and workload changes require employees to adjust work schedules to meet demand. The C/UM will need to participate in Air Force Medical Management Team Teleconference calls which may be outside normal duty hours due to the time differences between the United States and Korea. The COR will be responsible for communicating with the contractor regarding scheduling. The Chief of Medical Staff may act as point of contact after normal duty hours, weekends, and holidays. In such cases, the COR shall confirm all actions on the next normal working day. The C/UM shall not provide overtime or on-call duties under this contract; however, the C/UM may need to be available via phone to address emergent Case/Utilization Management needs after normal duty hours. In any instances where the Government supervisor directs the provider to remain on duty in excess of their scheduled shift due to an unforeseen emergencies or to participate in after normal duty hours activities such as teleconference calls, the C/UM’s schedule shall be adjusted for additional hours such that the number of hours on the contract is not exceeded and no overtime is required.

1.6.4.2 Absences and leave: The C/UM will be allowed 160 hours of absences per year for vacation, sick leave, and miscellaneous reasons. The absences are to be coordinated with and at the discretion of the Health Care Integrator.

Absences will not excuse the performance of any duty under this contract. The Contractor shall notify the COR when scheduled C/UM cannot fill a shift due to illness or emergency. Notification shall be as early as possible; but no later than 2 hours prior to start of scheduled shift. Scheduled absences for vacation shall be coordinated with the COR at least 30 calendar days in advance. All scheduled absences, including sick absences and emergency absences are unpaid. The Contractor is responsible for submitting accurate invoices.

1.6.4.3 Continuity of Services/Replacement Staff: The Contractor’s point of contact shall ensure qualified replacement C/UMs are available to provide coverage when the primary C/UM's scheduled absence is expected to exceed two work weeks (80 hours). The Contractor shall ensure timely replacement of C/UM is provided to reduce any interruption of 51st Medical Group’s mission. The Contractor shall ensure that a stable workforce is maintained with minimal turnover of personnel. The Contractor shall notify the COR in writing when he/she cannot fill a position.

1.6.5 Place of Performance: The work to be performed under this contract will be performed at 51st Medical Group Military Treatment Facility at Osan Air Base, Republic of Korea.

1.6.5.1 Performance of services during crisis declared by the National Command Authority or Overseas Combatant Commander: On occasion, services may be required to support an activation or exercise of contingency plans outside the normal duty hours. Emergency situations (i.e. accident and rescue operations, civil disturbances, natural disasters, military contingency operations, and exercises) may necessitate the C/UM provide increased or reduced support as determined by the Contracting Officer. The Government will negotiate an equitable adjustment with the Contractor for the cost of these emergency requirements.

1.6.6 Type of Contract: The Government contemplates award a Firm-Fixed Price contract.

1.6.7 Security Requirements: The C/UM shall coordinate with the COR to obtain the following pass, registration, and identification items required for contract performance:

a. DD Form 1172, Application for Uniformed Services Identification Card (if applicable)

b. AETC Form 58, Civilian Identification Card (if applicable)

c. AF Form 2219 (series), Registered Vehicle Expiration Tab

d. DD Form 2220, DoD Registered Vehicle and Installation Tab

e. AF Form 75, Visitor/Vehicle Pass

f. AF Form 1199, USAF Restricted Area Badge, or locally developed badge

The C/UM shall return all identification media, including vehicle decals, to the Pass & ID office upon completion/termination of the contract as appropriate.

The Contractor shall implement local base procedures for entry to Air Force controlled/restricted areas where C/UM will work.

1.6.7.1 National Agency Check: The C/UM shall successfully complete a National Agency Check (NAC) before operating government-furnished workstations that have access to Air Force automated information systems.

Requests for C/UMs hired at the beginning of the contract, shall be submitted to the Government not later than five

(5) workdays after the performance start date. C/UMs receiving unfavorable NACs shall not be employed under this contract. The Government will submit requests for investigations on AF Form 2583 Request for Personnel Security Action, at no additional cost to the Contractor. The C/UM shall comply with the requirements of DoD 5200.2-R Personnel Security Program, and AFI 33-119 Electronic Mail (e-mail) Management and Use. The C/UM shall comply with the requirements of Volume 1 AFI 71-101 Criminal Investigations and paragraph 1.1 of Volume 2 Protective Service Matters. The C/UM shall report any information or circumstances of which they are aware that may pose a threat to the security of DoD personnel, contract personnel, resources, and classified or unclassified defense information to the Chief Pharmacology Services. The C/UM’s immediate supervisor shall brief him/her upon initial on-base assignment and as required thereafter.

1.6.7.2 Identification Badge: The Contractor and C/UM shall comply with local installation and MTF personnel identification and access requirements. While on site, each C/UM shall wear visible security badge identification, provided by the military installation or the MTF, on the front of his/her outer clothing. The badge shall show the full name, title, and the word “CONTRACTOR” in front. The COR will provide the paperwork to request identification badges. The C/UM shall immediately report any lost or stolen badges to the COR. The contractor is responsible for absences of C/UM due to expired identification and access documents. Such absences shall not relieve the Contractor of its obligation to perform the healthcare services required under this contract. The Contractor will only be paid for services actually performed and shall not bill the Government during the C/UM’s absence. The C/UM shall turn in all identification badges to the COR upon termination of their services under this contract.

1.6.7.3 Vehicle Registration: The MTFs are located on restricted access military installations. The Contractor & C/UM shall comply with the local installation requirements for vehicle registration and operation on the military installation. All C/UMs must register their vehicles with the office responsible for vehicle registration to gain access onto the military installation. A valid driver’s license, Government-furnished civilian identification, proof of insurance, and current registration must be presented to the Provost Marshal’s Office, at which time a DoD decal will be issued. The decal shall be placed on the vehicle’s front windshield in accordance with instructions. All vehicles, with or without a DoD decal, are subject to search. The C/UM may encounter long delays for vehicle inspection and identification checks upon entering and exiting the installation. The Government will not reimburse the C/UM for time spent at installation checkpoints. The C/UM must plan accordingly and report to work at their scheduled duty time, at their appointed place of duty within the MTF. The C/UM shall follow installation procedures for removal and turn-in of the vehicle decal upon termination of services under this contract. A personally owned vehicle (POV) is not required. It is up to the C/UM whether or not he/she wants to bring his/her POV. It is the C/UM’s responsibility to pay with his/her own funding out-of-pocket for all related costs for shipping a POV. The C/UM may also decide if he/she wants to procure a POV in-country with his/her own funding out-of-pocket.

1.6.7.4. Safeguarding Government Property/Information: The C/UM shall be responsible for safeguarding all government equipment, information and property (including controlled forms) provided for C/UM use. The C/UM shall safeguard information of a confidential or sensitive nature. All patient related information is considered confidential and sensitive. If working remotely during contingency, C/UMs are prohibited from reproducing patient information in any way (this includes printing). Neither the Contractor nor any of its C/UM shall disclose or cause to be disseminated any information concerning the operation of the MTF that could result in or increase the possibility of a breach in security or interrupt the continuity of operations or which breach the requirements of the Federal Privacy Act of 1974. However, the C/UM may be required to provide testimony or disposition in cases of due process action. At the close of each work period, government facilities, equipment, and materials shall be secured.

1.6.7.4.1 C/UMs are advised that the 51st Medical Group Commander has placed restrictions on the smoking of tobacco products in and around facilities. AFI 40-102, Tobacco Use in the Air Force, and its supplements, outline the procedures used by the commander to control smoking in our facilities. As of now, the medical treatment facility is a smoke free campus. C/UM and visitors are subject to the same restrictions as government personnel.

Smoking is not permitted anywhere on the medical campus.

1.6.7.5 Key Control: The Contractor shall establish and implement methods of making sure all keys/key cards issued to the C/UM by the Government are not lost or misplaced and are not used by unauthorized persons. NOTE:

All references to keys include key cards. The Contractor shall be financially responsible for the replacement of any lost keys and any associated locks. No keys issued to the C/UM by the Government shall be duplicated. The C/UM shall turn-in any issued keys when they no longer require access to locked areas. The C/UM shall immediately report any occurrences of lost or duplicate keys/key cards to the COR or Contracting Officer.

1.6.7.5.1. In the event keys, other than master keys, are lost or duplicated, the Contractor shall, upon direction of the Contracting Officer, re-key or replace the affected lock or locks; however, the Government, at its option, may replace the affected lock or locks or perform re-keying. When the replacement of locks or re-keying is performed by the Government, the total cost of re-keying or the replacement of the lock or locks shall be deducted from the monthly payment due the Contractor. In the event a master key is lost or duplicated, all locks and keys for that system shall be replaced by the Government and the total cost deducted from the monthly payment due the Contractor.

1.6.7.5.2. The Contractor shall prohibit the use of Government issued keys/key cards by any persons other than the assigned C/UM. The C/UM shall prohibit the opening of locked areas by Contractor employees to permit entrance of persons other than C/UM engaged in the performance of assigned work in those areas, or personnel authorized entrance by the Contracting Officer.

1.6.8 Special Qualifications:

1.6.8.1 Education: The C/UM shall be a graduate of a Baccalaureate Degree program in nursing from a nationally accredited educational institution authorized to grant baccalaureate degrees.

1.6.8.2 License: The C/UM shall possess and maintain throughout the course of the contract a current, active, valid, unrestricted (with no limitations, stipulations, or pending adverse actions) state nursing license in one of the fifty United States, the District of Columbia, the Commonwealth of Puerto Rico, Guam, or the U.S. Virgin Islands.

License must be recognized and accepted by the U.S. State or Territory of practice in accordance with governing regulations.

1.6.8.3 Certification:

1.6.8.3.1 The C/UM shall possess and maintain throughout the course of the contract a current Basic Life Support (BLS) certification through an American Heart Association approved training program. The MTF will provide BLS refresher courses.

1.6.8.3.2 The C/UM shall possess a certification of current physical examination. The physical examination shall be current within 12 months prior to contract award. Initial documentation is required for: MMR (immunization or titer levels for Rubella and Rubeola), history of chicken pox disease or positive titer (varicella vaccination must be accomplished if lack of immunity), Tetanus Diphtheria (Td), TB Mantoux skin test (IPPD) if positive, minimum requirement will be follow-up with the Contractor’s physician and a chest x-ray. This certification shall state the date on which the examination was completed, the name of the doctor who performed the examination, and a statement concerning the physical health of the individual. The certification shall also contain the following statement: “(insert C/UM’s name) is suffering from no contagious diseases to include, but not limited to, Tuberculosis, Hepatitis, and Venereal Disease”. A physician must provide documentation of “no active respiratory disease.” It is the contractor’s responsibility to pay for any medical examinations necessary to ensure this public health compliance requirement is met.

1.6.8.3 English Language Requirement: The C/UM working on this contract shall be able to communicate in the English language at a proficiency level of a native speaker (as demonstraed by TOEFL proficiency) and as exemplified in their written and verbal skills in the performance of their duties under this contract. Government will assess language skills of all contract employees who are required by terms of this PWS to be proficient at speaking English through performance of services. If the Government, at its sole discretion, determines that the language skills of the C/UM does not meet the language proficiency skills required of the position, the Government reserves the right to require the Contractor to provide a replacement C/UM that does possess the required language proficiency skills required of the position, at no additional cost to the Government.

1.6.8.5 Prior Experience: C/UM shall have at least one (1) year of clinical nursing experience within the last five

(5) years.

1.6.9 Post Award Conference/Periodic Progress Meetings: The Contractor agrees to attend any post award conference convened by the contracting activity or contract administration office in accordance with Federal Acquisition Regulation Subpart 42.5. The Contracting Officer's Representative (COR) may meet periodically with the Contractor to review the C/UM’s performance. These meetings shall be at no additional cost to the Government.

1.6.10 Contracting Officer Representative (COR): The (COR) will be identified by separate letter. The COR monitors all technical aspects of the contract and is the KO’s authorized representative in administering the contract at the MTF level. The COR is authorized to perform the following functions: assure that the C/UM performs the technical requirements of the contract; perform inspections necessary in connection with contract performance;

maintain written and oral communications with the C/UM concerning technical aspects of the contract; issue written interpretations of technical requirements, including Government drawings, designs, specifications; monitor C/UM's performance and notifies both the Contracting Officer and Contractor of any deficiencies; coordinate availability of government furnished property; and provide site entry of C/UM. 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. The COR is not authorized to change any of the terms and conditions of the resulting contract. The COR will be available during normal duty hours (0700-1630) Monday through Friday to discuss any problems that may be experienced during the performance of this contract.

1.6.11 Conflict of Interest: The Contractor or C/UM shall not bill the patient for services rendered under this contract. The Contractor or C/UM shall not request or accept compensation of any kind for patients treated, procedures performed, or any other actions performed, except under the terms and conditions of this contract at the rate specified. The Contractor or C/UM shall not, while performing services under this contract, advise, recommend, or suggest to persons eligible to receive medical care at Government expense that such persons should receive care from the Contractor or C/UM or from any third party at any place other than as designated under this contract.

1.6.12 Confidentiality of Information: Unless otherwise specified, all financial, statistical, personnel, and/or technical data which is furnished, produced or otherwise available to the C/UM during the performance of this contract are considered confidential business information and shall not be used for purposes other than performance of healthcare services under this contract. The C/UM shall not release any of the above information without prior written consent of the KO. The Contractor/C/UM shall not use patient care rendered pursuant to this contract as part of a study, research project, or publication. The C/UM shall prepare medical records, forms and documents as required, in accordance with the regulations and established guidelines listed in the contract. The C/UM will comply with all AFMS requirements for safe keeping, handling, release, and disposal of any of the above information.

1.6.14 Communication: The Contractor shall ensure that C/UM maintains open and professional communication with the COR. Complaints validated by the COR shall be reported in writing to the Contracting Officer and Contractor for action. Failure of the Contractor to correct validated complaints raised by the COR and/or the KO will be considered a failure to perform.

1.6.15 Professional Liability: Pursuant to 10 United States Code 1089 (a), DoD shall process any personal injury claim alleging negligence by the C/UM within the scope of the C/UM’s performance under this contract as claims alleging negligence by DoD military or civil service personnel. The contractor or C/UM is not required to maintain medical malpractice liability insurance, and the Government will not reimburse or otherwise pay for such insurance should any be purchased.

1.6.15.1 Responsibility and Procedures: If any suit or action is filed or any claim is made against the C/UM, which occurred as a result of work performed by the C/UM under this contract, the C/UM shall immediately notify the Contractor, the COR, Contracting Officer and the chief of the appropriate services and promptly furnish them copies of all pertinent documents received. The C/UM shall cooperate with the government, without further compensation, in the processing, review, settlement, or defense of the suit, action, or claim; and authorize government representatives to settle or defend the claim and to represent the C/UM in, or take charge of, any litigation involved in such an action. The C/UM may, at the C/UM’s own expense, participate in defense of such claim or litigation.

1.6.16 Contractor Responsibility: The Contractor shall accomplish the assigned work by employing and utilizing qualified candidates with appropriate combinations of education, experience, knowledge, training, abilities and skills. The C/UM shall begin performance in the MTF at start of performance period. All Status of Forces Agreement (SOFA) or host nation requirements, health, security, and credentialing/privileging requirements shall be met prior to start of performance by an initial or replacement provider. The C/UM is responsible for obtaining all passports, visas, or other documents necessary for the provider to enter and or exit the foreign country where performance is required.

1.6.17 In/Out-Processing, Orientation, and Training: The C/UM shall complete all specified orientation programs, initial and annual training requirements, and comply with all MTF policies, procedures, productivity standards and instructions as provided by the MTF.

1.6.17.1 In/Out-Processing: At start of the performance period, C/UM shall obtain an in-processing checklist(s) from the COR. The C/UM is required to complete the applicable items on the checklist and turn it in to the designated office. Upon completion of contract performance, the C/UM need to complete an out-processing checklist and return it to the designated office.

1.6.17.2 MTF Orientation: The Contractor shall ensure that all C/UM participate in the MTF orientation procedures for newly assigned providers. The purpose of the orientation is to familiarize C/UM with policies and procedures of the MTF, regulations specific to their professional specialty, and Air Force policy and procedures. The Contractor and C/UM shall abide by all MTF standards, rules, and procedures including requirements for any licensure, credentialing, and quality assurance requirements. Such regulations include but are not limited to general safety, fire prevention, waste disposal, infection control, Joint Commission (JC), and patient safety initiatives.

1.6.17.3 Training Requirement: The C/UM shall complete any mandatory annual training requirements in accordance with 51st Medical Group procedures. The Government may elect to provide unique Government training to C/UMs performing services under this contract. If the Government elects to provide such training, the Government will provide such training at no additional expense to the Contractor or to the C/UM. When directed by the KO, the C/UM shall attend all such training in a paid status as part of normal services required and billed under the contract. 51st Medical Group may provide life support training (ACLS/BLS) required by the position and 51st Medical Group’s mission. The Contractor shall ensure that all JCAHO/AAAHC/HIS standards for professional medical care are met and maintained throughout the duration of this contract.

1.6.17.4 Computer Training: The C/UM shall receive training for applicable MTF computer system(s). The COR will coordinate the necessary computer training. The training will be on-site and during normal duty hours. This training will be at no cost to the Contractor. These systems include but are not limited to: Composite Healthcare Computer System (CHCS), Armed Forces Health Longitudinal Technology Application (AHLTA), and Ambulatory Data System (ADS).

1.6.17.5 Job Specific Training: The C/UM shall undergo on-line training through the MHS Learn site on the Fundamentals of Medical Management. This on-line training shall be completed within two (2) months of beginning work.

1.6.17.6 Continuing Medical/Health Education (CME): The C/UM shall maintain all license and certification requirements and meet all continuing education requirements of the U.S. jurisdiction in which he/she is licensed to practice. Pursuant to AR 40-68 Chapter 8-7, the C/UM’s file must have evidence of approved continuing medical/health education. Such evidence will be accumulated by the provider for intervals of not less than 2 years and made available to the credentials manager for initial privileges/appointment and for biennial renewal. The annual requirement for CME credits according to AR 351–3 or as determined by the provider’s State of licensure, whichever is more stringent. If the state has no CME requirements, provide documentation showing this.

1.6.18 Health and Immunization Requirement: The C/UM providing services under this contract shall receive a pre-employment physical examination prior to commencement of work and annually thereafter. In accordance with the Integrated Health Organization Policy # 18-59, the 51st Medical Group COR will ensure that all contract employees report to Occupational Health Services (OHS) for pre-placement evaluation, annual medical examination, and termination evaluation. The request for physical examination shall be made using USFJ Form 10 to verify the credibility of the physician being called on to perform this action before services are rendered. It is the contractor’s responsibility to pay for any medical examinations necessary to ensure this public health compliance requirement is met.

1.6.18.1 The C/UM performing services under this contract shall comply with the health and immunization requirements as stated in Section H para H-3, Health & Immunization Requirements. Backup/replacement C/UMs shall meet the same health and immunization requirements. The expense to comply with the health and immunization requirements shall be borne by the Contractor at no additional cost to the Government.

1.6.18.2 Occupational Safety and Health Administration (OSHA) requires that all contract personnel who will have occupational exposure to blood, body fluids, or other potentially infectious materials shall receive Hepatitis B vaccine, sign a voluntary declination , or have documented proof of immunity to Hepatitis B infection. Personnel who sign declinations may change their minds at any time and receive the Hepatitis B vaccine without penalty.

1.6.18.3 The contractor is responsible for reporting to the Health Care Integrator all information necessary to assure hospital records can be maintained correctly and therefore comply with the JCAHO, OSHA, and CDC health record requirements.

1.6.19 Media and Other Inquires: The Contractor or C/UM shall not respond to any media inquiries. Any inquiries from the media, third parties, or public agencies shall be immediately relayed to the COR, who will relay them to the

MTF Public Affairs Officer or the Administrative Officer of Day (AOD) after duty hours. There shall be no interviews, comments, or any other response without the knowledge and approval of the MTF Commander. Other than routine inquiries from external agencies, all other inquiries and complaints shall be brought to the attention of the COR.

1.7 Administrative:

1.7.1 Contractor Representative: The Contractor shall designate in writing, a primary point of contact (POC) for contract coordination and implementation not later than five (5) business days after receiving notice of contract award. The Contractor shall notify the Contracting Officer of changes in the primary point of contact at least five working days prior to the change. This notification shall be in writing and shall state the full name, phone number, and email address of the point of contact.

1.7.2 Records: The C/UM shall create and maintain Government-owned/C/UM-held records, regardless of media, in accordance with AFI 33-119, Electronic Mail (E-mail) Management and Use, paragraph 8; AFI 33-202, Computer Security, paragraphs 3.5.1 and 3.6.1; AFI 33-322, Records Management Program, paragraphs 7,8,9 and 10 and supplements; AFMAN 37-123, Management of Records, Chapters 2 – 6, paragraphs 7.10 – 7.29, AFMAN 33-323, AFI 37-138, Records Disposition—Procedures and Responsibilities, Chapters 2, 3 and 6, and supplements;

and Electronic Records. Upon completion of this contract, all government-owned/C/UM-held records (regardless of media) received, created, maintained or provided in the performance of the performance work statement shall be turned over to the Government. Background electronic data and records specified for delivery to the contracting agency must be accompanied by sufficient technical documents to permit the Air Force to use the data. In the event of default or non-performance, the Government will have access to all records in order to ensure mission support is not interrupted.

1.7.3 Emergency Healthcare for C/UM: The MTF will provide emergency healthcare for injuries or life threatening medical emergencies occurring while on duty at the MTF. The Contractor shall reimburse the Government for such services as billed by the MTF.

1.7.4 HIPAA Compliance: The C/UM agrees to abide by all the requirements of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 (Public Law 104-191) as codified at 45 CFR Part 160 and Part 164, subparts A and E, and implemented by DoD 6025.18-R regarding the privacy and confidentiality of health records and information being provided and shared under the resulting contract. The C/UM shall also comply with the Business Associate Agreement (BAA) listed in the appendix A under Privacy of Protected Health Information and hereby incorporated into this Performance Work Statement as Attachment 2.

1.7.5 The C/UM shall abide by federal, state, and local MTF regulations and requirements concerning the nature of limited privileged communication between patients and the C/UM as may be necessary for security and personnel reliability programs. They shall also abide by federal, state, and local MTF regulations concerning the confidentiality of patient records, as embodied in federal statutes including the Privacy Act of 1974 and the Health Insurance Portability and Accountability Act (HIPAA) of 1996. All medical records and reports will remain the property of the Government.

1.7.6 Criminal History Background Check Requirement: The C/UM involved in the delivery of health care to children under the age of 18 on a frequent and regular basis shall meet the requirements of the Crime Prevention Act of 1990, as specified in the Criminal History Background Check Requirements Clause.

1.7.7 Patient Sensitivity: The C/UM shall respect and maintain the basic rights of patients, demonstrating concern for personal dignity and human relationships. The C/UM receiving complaints validated by the COR shall result in counseling, Contract Deficiency Report, and/or termination depending on the nature and severity of the complaint.

1.7.8 The C/UM shall not introduce new procedures or services without prior approval of the Health Care Integrator (Supervisor) or representative. If disagreements or deviations from protocols or procedures occur, the Chief of Medical Staff or representative shall be the deciding authority.

1.7.9 The C/UM providing medical services under this contract shall ensure his/her rubber stamp contains his/her full name, degree, title, DEA License number, and the word “CONTRACTOR”. The stamp shall be placed on all forms and documentation having the C/UM’s signature.

Example:

John J. Jones, RN, BC…