A21_W91QVN-17-R-0020.docx

W91QVN-17-R-0200

Section SF 1449 - CONTINUATION SHEET

Referral Management Center Clerk

FFP

The Contractor shall provide Referral Management Center Clerk to work in the Referral Management Center (RMC) as specified in the PWS at 8th Medical Group, Kunsan Air Base by Air Force Medical Service (AFMS) Referral Management Center User’s Guide, current edition (currently version 7) as a reference to understand the purpose and objective of the RMC.

The Contractor shall provide all personnel, labor, tools, equipment, materials, supervision, transportation, and necessary facilities for this scope of work.

Note: (1) The Contractor shall provide labor cost breakdown spreadsheet as part of proposal. (2) The Contractor shall propose a fully loaded labor rates

FOB: Destination

NET AMT

Contractor Manpower Report (CMR)

IAW Paragraph 6 of the PWS, Contractor Manpower Report (CMR) must be reported by 31 October of each calendar year during the life of the contract.

NOTE: Not to exceed 20 man hours for data collection and report.

UIC: F2L4MG, Organization: 8th Medical Group, 8 CPTF/FMFL, Kunsan AB, APO AP 96264

NET AMT

Estimated Cost for War Hazard Losses is

Zero (0).

NET AMT

FFP

The Contractor shall provide Referral Management Center Clerk to work in the Referral Management Center (RMC) as specified in the PWS at 8th Medical Group, Kunsan Air Base by Air Force Medical Service (AFMS) Referral Management Center User’s Guide, current edition (currently version 7) as a reference to understand the purpose and objective of the RMC.

The Contractor shall provide all personnel, labor, tools, equipment, materials, supervision, transportation, and necessary facilities for this scope of work.

Note: (1) The Contractor shall provide labor cost breakdown spreadsheet as part of proposal. (2) The Contractor shall propose a fully loaded labor rates

NET AMT

FFP

IAW Paragraph 6 of the PWS, Contractor Manpower Report (CMR) must be reported by 31 October of each calendar year during the life of the contract.

NOTE: Not to exceed 20 man hours for data collection and report.

NET AMT

FFP

NET AMT

FFP

The Contractor shall provide Referral Management Center Clerk to work in the Referral Management Center (RMC) as specified in the PWS at 8th Medical Group, Kunsan Air Base by Air Force Medical Service (AFMS) Referral Management Center User’s Guide, current edition (currently version 7) as a reference to understand the purpose and objective of the RMC.

The Contractor shall provide all personnel, labor, tools, equipment, materials, supervision, transportation, and necessary facilities for this scope of work.

Note: (1) The Contractor shall provide labor cost breakdown spreadsheet as part of proposal. (2) The Contractor shall propose a fully loaded labor rates

NET AMT

FFP

IAW Paragraph 6 of the PWS, Contractor Manpower Report (CMR) must be reported by 31 October of each calendar year during the life of the contract.

NOTE: Not to exceed 20 man hours for data collection and report.

NET AMT

FFP

NET AMT

FFP

The Contractor shall provide Referral Management Center Clerk to work in the Referral Management Center (RMC) as specified in the PWS at 8th Medical Group, Kunsan Air Base by Air Force Medical Service (AFMS) Referral Management Center User’s Guide, current edition (currently version 7) as a reference to understand the purpose and objective of the RMC.

The Contractor shall provide all personnel, labor, tools, equipment, materials, supervision, transportation, and necessary facilities for this scope of work.

Note: (1) The Contractor shall provide labor cost breakdown spreadsheet as part of proposal. (2) The Contractor shall propose a fully loaded labor rates

NET AMT

FFP

IAW Paragraph 6 of the PWS, Contractor Manpower Report (CMR) must be reported by 31 October of each calendar year during the life of the contract.

NOTE: Not to exceed 20 man hours for data collection and report.

NET AMT

FFP

NET AMT

FFP

The Contractor shall provide Referral Management Center Clerk to work in the Referral Management Center (RMC) as specified in the PWS at 8th Medical Group, Kunsan Air Base by Air Force Medical Service (AFMS) Referral Management Center User’s Guide, current edition (currently version 7) as a reference to understand the purpose and objective of the RMC.

The Contractor shall provide all personnel, labor, tools, equipment, materials, supervision, transportation, and necessary facilities for this scope of work.

Note: (1) The Contractor shall provide labor cost breakdown spreadsheet as part of proposal. (2) The Contractor shall propose a fully loaded labor rates

NET AMT

FFP

IAW Paragraph 6 of the PWS, Contractor Manpower Report (CMR) must be reported by 31 October of each calendar year during the life of the contract.

NOTE: Not to exceed 20 man hours for data collection and report.

NET AMT

FFP

NET AMT

PWS

PERFORMANCE WORK STATEMENT REFERRAL MANAGEMENT CENTER CLERK AT

KUNSAN AIR BASE (8TH MEDICAL GROUP), KOREA

1.1. INTRODUCTION.

1.2. The Contractor shall provide the non-personal services of Referral Management Center Clerk to work in the Referral Management Center (RMC) as described in this Performance Work Statement (PWS) at 8th Medical Group (8 MDG), KUNSAN Air Base, Korea. This service shall contribute to a stable workforce tasked with providing quality health care services to a diverse beneficiary population. The contractor shall review and follow the Air Force Medical Service (AFMS) Referral Management Center User’s Guide, current edition, (currently, version 7) as a reference to understand the purpose and objectives of the RMC.

1.3. All services shall be provided in accordance with established standards, principles and ethics of the profession and applicable professional specialty organizations, Accreditation Association for Ambulatory Health Care (AAAHC), applicable Department of Defense (DoD) and Air Force-specific regulations, directives, and policies, and military treatment facilities (MTF) specific policies, procedures, and job descriptions. Contractor shall give the highest regard to patient dignity and observe the precepts of the DoD Patient Rights and Responsibilities, and American Health Association’s Bill of Rights for Patients.

1.4. The contractor shall provide services in conjunction with 8 MDG providers to include physicians, nurses, registered and licensed practical nurses, and support personnel. Contractor shall perform essentially the same functions as those required by Air Force health care professionals of similar experience and in similar duty assignments. The scope of services provided in military treatment facilities cover the same range of services as those provided in civilian treatment facilities of similar size and scope.

1.5. This contract is a non-personal services contract under which the personnel rendering the services are not subject, either by the contract’s terms or by the manner of its administration, to the supervision and control usually prevailing in relationships between the government and its employees.

1.6. Period of Performance:

2. BACKGROUND.

2.1. 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 (MTFs) located on or near military installations or posts.

2.2. The 8 MDG is a clinic that delivers primary care to approximately 2,600 active duty beneficiaries. Annually, the 8 MDG delivers approximately 24,000 patient visits across primary care services. It is staffed by 7 physicians, 3 nurses, 24 medical technicians, and supported by over 100 personnel. It also refers approximately 2,000 patient visits per year for specialty care and sub-specialty care. The sound provision of those referrals and referral results documentation play a key role in ensuring outstanding continuity of care.

3. SCOPE.

3.1. The contractor shall provide medical referral management center (RMC) services and administrative support for the Medical Treatment Facility (MTF) staff and beneficiaries. The contractor shall ensure patient flow is optimized by processing their referrals to specialty care. The contractor shall maintain or assist with a variety of health record storage and retrieval systems. The contractor shall participate with TRICARE Operations Patient Administration (TOPA) Flight staff in providing, assessing, and improving a wide variety of customer services and relations. Performance shall be according to the requirements contained in this PWS, and professional standards of the Accreditation Association for Ambulatory Health Care (AAAHC).

3.2. Administrative.

3.2.1. Contractor Representative. The Contractor shall designate, in writing, a primary point of contact for contract coordination and implementation not later than five business days after receiving notice of contract award. Changes in the primary point of contact (POC), at any time, shall require the Contractor to notify the Contracting Officer (KO) of the new representative at least five working days prior to the change. This notification shall be in writing and shall state the name and contact information for the new point of contact.

3.2.2. The Contracting Officer’s Representative (COR) will be the KO’s authorized representative in administering the contract at the MTF level. The Contractor’s representative shall be available to discuss any problems that the Contractor’s personnel may be experiencing during the performance of this contract. Problems experienced by the Government with the Contractor’s performance will be discussed and resolved. Unresolved problems will be referred to the KO.

3.2.3. The Contractor may use non-compete provisions in its employment agreements to prevent the loss of personnel by the Contractor during the period of performance of this contract. However, the Contractor shall not use non-compete provisions in its employment agreements that would prevent its contract personnel from being employed by or from accepting offers of employment from the new Contractor of the follow-on contract. It would hinder the Government’s ability to accomplish the mission of providing medical care to its beneficiaries.

3.2.4. The Contractor and contract personnel 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, AAAHC, and patient safety initiatives.

3.2.5. Media and Other Inquiries. The Contractor shall not respond to any media inquiries. Any inquiries from the media, third parties, or public agencies shall be immediately relayed to the MTF COR or, after duty hours, to the TOPA Flight Commander, Flight Chief (highest enlisted member in the Flight), or the next in the Flight’s chain of command. There shall be no interviews, comments, or any other response without the knowledge and approval of the MTF Commander.

3.2.6. Emergency health care for contract personnel. 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.

3.3. CONFLICT OF INTEREST.

3.3.1. The Contractor or contract personnel shall not bill the patient for services rendered under this contract. The Contractor or contract personnel 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.

3.3.2. The Contractor or contract personnel shall not, while performing services under this contract, advice, recommend, or suggest to persons eligible to receive medical care at Government expense that such persons should receive care from the Contractor or contract personnel or from any third party.

3.3.3. Confidentiality of Information. Unless otherwise specified, all financial, statistical, personnel, and/or technical data which is furnished, produced or otherwise available to the Contractor 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 Contractor shall not release any of the above information without prior written consent of the KO. The Contractor/contract personnel shall not use patient care rendered pursuant to this contract as part of a study, research project, or publication. The contract personnel shall prepare medical records, forms and documents as required, in accordance with the regulations and established guidelines listed in the contract.

3.3.4. The contractor shall not employ active duty military nor government civilian employees to perform services under this contract.

3.3.5. The Contractor or contract personnel shall not use Government facilities, supplies, or equipment in private practice or for any purpose other than providing the healthcare services required under this contract.

3.4. SECURITY.

3.4.1. Security Identification Badges. The Contractor and contract personnel shall comply with the local installation and MTF personnel identification and access requirements while on site.

3.4.1.1. While in the MTF, each contract personnel shall wear a visible security badge identification, provided by the military installation or the MTF, on the front of his/her outer clothing. The badge must show the full name, title and if required by the Military the word “Contractor” in front. The COR will provide the paperwork to request identification badges.

3.4.1.2. The Contractor is responsible for absences of contract personnel 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.

3.4.1.3. The contract personnel shall immediately report any lost or stolen badges to the COR.

3.4.1.4. The contract personnel shall turn in all identification badges to the COR, or his/her designated representative upon termination of their services under this contract.

3.4.1.5. PHYSICAL SECURITY. The Contractor shall be responsible for safeguarding all medical information provided for Contractor use. At the close of each work period, information shall be secured on the office work site. The contractor must ensure that the protected health information used to perform services of this contract is not removed from this MTF.

3.4.1.6. PATIENT LISTS. Patient lists, no matter how developed shall be treated as privileged information. Lists and/or names of patients shall not be disclosed to or revealed in any way for any use outside the MTF without prior written permission of the Chief of Medical Staff or the Health Insurance Portability and Accountability Act (HIPAA) Privacy Officer.

3.4.2. Vehicle Registration. The MTFs are located on restricted access military installations. The Contractor/contract personnel shall comply with the local installation requirements for vehicle registration and operation on the military installation. All contract personnel 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.

3.4.2.1. All vehicles, with or without a DoD decal, are subject to search. Contract personnel may encounter long delays for vehicle inspection and identification checks upon entering and exiting the installation. The Government will not reimburse the Contractor for time spent at installation checkpoints. Contract personnel must plan accordingly and report to work at their scheduled duty time, at their appointed place of duty within the MTF.

3.4.2.2. Contract personnel shall follow installation procedures for removal and turn-in of the vehicle decal upon termination of services under this contract.

3.4.3. Keys. The Contractor shall be responsible for any keys issued by the Government to contract personnel for use in the MTF. The keys shall not be duplicated. The Contractor shall be financially responsible for the replacement of any lost keys and any associated locks. Lost keys and/or locks shall be reported to the issuing party, Department Chief, or COR immediately upon recognition of the loss.

3.4.4. Safeguarding Material. The contract personnel shall be responsible for safeguarding all Government property. The Contractor shall safeguard information of a confidential or sensitive nature. All patient related information is considered confidential and sensitive. Neither the Contractor nor any of its contract personnel 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 Contractor may be required to provide testimony or disposition in cases of due process action.

3.4.5. Antiterrorism (AT) and Operations Security (OPSEC)

3.4.5.1. This provision/contract text is for contractor employees with an area of performance within an Air Force controlled installation, facility, or area. All contractor employees, to include subcontractor employees, requiring access to Air Force installations, facilities, and controlled access areas shall complete AT Level I awareness training within 50 calendar days after contract start date or effective date of incorporation of this requirement into the contract, whichever is applicable. The contractor shall submit certificates of completion for each affected contractor employee and subcontractor employee to the COR within 20 calendar days after completion of training by all employees and subcontractor personnel.

3.4.5.2. AT Awareness Training for Contractor Personnel Traveling Overseas. This standard language text required US based contractor employees and associated sub-contractor employees to make available and to receive government provided area of responsibility (AOR) specific AT awareness training as directed by AR 525-13. Specific AOR training content is directed by the combatant commander with the unit ATO being the local point of contact.

3.4.5.3. iWATCH Training. This standard language is for contractor employees with an area of performance within an Army controlled installation, facility or area. The contractor and all associated sub-contractors shall brief all employees on the local iWATCH program (training standards provided by the requiring activity ATO). This local developed training will be used to inform employees of the types of behavior to watch for and instruct employees to report suspicious activity to the COR. This training shall be completed within 30 calendar days of contract award and within 5 calendar days of new employees commencing performance with the results reported to the COR NLT 50 calendar days after contract award.

3.4.5.4. For Contracts that Require an OPSEC Standing Operating Procedure/Plan. The contractor shall develop an OPSEC Standing Operating Procedure (SOP)/Plan within 90 calendar days of contract award, to be reviewed and approved by the responsible Government OPSEC officer, per AR 530-1, Operations Security. This SOP/Plan will include the government's critical information, why it needs to be protected, where it is located, who is responsible for it, and how to protect it. In addition, the contractor shall identify an individual who will be an OPSEC Coordinator. The contractor will ensure this individual becomes OPSEC Level II certified per AR 530-1.

3.4.5.5. For Contracts that Require OPSEC Training. Per AR 530-1, Operations Security, new contractor employees must complete Level I OPSEC training within 30 calendar days of their reporting for duty. All contractor employees must complete annual OPSEC awareness training.

3.4.5.6. For Contract Requiring Performance or Delivery in a Foreign Country, DFARS Clause 252.225-7043, Antiterrorism/Force Protection for Defense Contractors outside the US. The clause shall be used in solicitations and contracts that require performance or delivery in a foreign country. This clause applies to both contingencies and non-contingency support. The key AT requirement is for non-local national contractor personnel to comply with theater clearance requirements and allows the combatant commander to exercise oversight to ensure the contractor's compliance with combatant commander and subordinate task force commander policies and directives.

3.5. ORIENTATION AND TRAINING.

3.5.1. MTF in-processing checklist. When commencing work under this contract, the contract personnel shall obtain in-processing checklist(s) from the COR or designated office. All contract personnel are required to complete the applicable items on the checklist and turn it in to the designated office. Upon completion of the duty assignment, the contract personnel need to complete an out-processing checklist and return it to the designated office.

3.5.2. MTF and Unit Orientation. The contract personnel shall be provided with a Government paid orientation to familiarize the contract personnel with the policies and procedures of the MTF, assigned department and specific unit.

3.5.2.1. The 8 MDG orientation shall be completed within 30 days of beginning the performance of this contract.

3.5.3. Annual training requirements. The Contractor shall ensure that contract personnel complete any mandatory annual training requirements in accordance with MTF procedures.

3.5.4. Government unique training. The Government may elect to provide unique Government training to contractors who are 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. When directed by the contracting officer or the COR, the contractor shall attend all such training in a paid status as part of the normal services required and billed under the contract. Such training shall require a performance commitment by the contractor and the contractor shall reimburse the government (by means of a reduction in an invoice) if a contractor fails to satisfy the performance commitment after the contractor receives the notice to attend the unique Government training. The amount of the reimbursement shall be the prorated cost of training, calculated based on the total cost of the training and the number of months by which the contractor fails to complete the performance commitment. The length of the performance commitment shall be 12 months or until the end of all performance under this contract, whichever occurs first.

3.5.5. Computer Training. Contract personnel who have any interaction with the MTF computer systems must receive training for the applicable 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:

3.5.5.1. Composite Healthcare Computer System (CHCS) is the military’s world-wide automated medical information system interfaces with 40 plus external clinical and administrative systems.

3.5.5.2. Armed Forces Health Longitudinal Technology Application (AHLTA) contains the MTF’s appointment scheduling program, pharmacy, lab, and radiology ordering system and is interlinked with other departments in the MTF. In addition, it contains the electronic medical records for MHS beneficiaries.

3.6. MTF HOURS OF OPERATION

3.6.1. The 8 MDG operating hours are from 0800 to 1700, Monday through Friday, 8-hour workday, excluding lunch time.

3.6.2. 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. Contract personnel may be required to work on legal holidays as determined by the COR.

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

NOTE 1: Because the significant majority of patients are American citizens, most Korean holidays are considered duty days unless the Korean holiday falls on a weekend, in which case the duty day resumes on the upcoming weekday. For contractors requesting absences on Korean holidays, please see para 3.7.3. Any holidays that are declared by Presidential Executive Order shall be observed in the same manner as the holidays listed above. If the area in which a contract employee is scheduled to work is closed due to the holiday and the employee 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 shall be handled in the same manner.

3.6.3. Contract personnel shall report to work as scheduled during emergencies, disasters or during adverse weather conditions. Contract services are still required during these situations.

3.6.4. Closures. During anticipated closure of the facility due to Command declared training holidays or during unplanned closure of the facility due to natural disasters, military emergencies, severe weather, or otherwise, the contractor shall not invoice the Government for services not performed and the Government will not be liable to the contractors for any such closures. The Contractors will only be paid for the actual hours that were worked.

3.7. HOURS OF PERFORMANCE.

3.7.1. The schedule of performance is discussed in paragraph 3.6.1.

3.7.1.1. The contractor shall not provide overtime duties.

3.7.1.2. The contractor will not pull on-call duties.

3.7.2. Unanticipated absences: The COR or their designee will be responsible for communicating with the contractor regarding unanticipated absences, such as due to acute illnesses or injuries that necessitate the contractor to seek care from a medical provider and results in absence from duty.

3.7.3. Absences and leave:

3.7.3.1. The contractor shall notify the COR when a scheduled contract personnel cannot fill a shift due to illness or emergency. Notification shall be as early as possible.

3.7.3.2. Scheduled absences of contract personnel shall be coordinated with the COR at least 2 weeks in advance. Depending on the days or hours scheduled for absence, the COR will determine whether or not the contractor supplies a substitute.

3.7.3.3. When the contractor cannot fill a position, the contractor shall notify the COR.

3.7.4. The Contractor is responsible for submitting an accurate invoice.

3.8. RESERVED.

3.9. Health and immunization requirements. All contract personnel performing services under this contract shall comply with 8 MDG 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.

3.10. Criminal History Background Check Requirements. Contract personnel determined by the MTF to be involved in the delivery of health care to children under the age of 18 on a frequent and regular basis must meet the requirements of the Crime Prevention Act of 1990, as specified in the Criminal History Background Check Requirements clause.

3.11. RESERVED.

3.12. Contractor Verification System (CVS).

3.12.1. The Contractor shall comply with agency personal identity verification procedures known as the CVS.

3.12.2. The Contractor shall comply with agency personal identity verification procedures in all subcontracts when the subcontractor is required to have physical access to a federally-controlled facility or access to a Federal information system.

3.12.3. The Contractor shall ensure compliance with the provisions set forth below. For purposes of FAR Clause 52.204-9, the Government will designate a Trusted Agent (TA), and the Contract Officer Representative for this contract. The Government reserves the right to amend or supplement these provisions pursuant to the Changes clause in the contract.

3.12.4. In-processing Requirements. Contractor personnel are prohibited from performing services under this contract until in-processing requirements of the MTF are met.

3.12.4.1. For every contract service provider, the Contractor shall provide the following information to the TA for input into the DEERS/RAPIDS System:

(a) Last Name

(b) First Name

(c) Middle Name

(d) Social Security Number

(e) Date of Birth

(f) E-mail Address (may be either the e-mail address of the incoming individual or the Contractor).

3.12.4.2. The contract service provider shall have an Army Knowledge Online (AKO) account in order to submit the application. AKO registration may be accessed via https://www.us.army.mil.

3.12.4.3. The DEERS/RAPIDS Systems will send a notice to the e-mail address provided IAW the above requirement, in which the contract service provider’s user ID and password are provided. In the event the e-mail message is sent to the Contractor, the Contractor shall notify the employee of the contract service provider’s user ID and password.

3.12.4.4. The contract service provider shall log into the DEERS/RAPIDS System, and submit an application for acceptance into the System, using the user ID and password provided.

3.12.4.5. The application will be accepted, returned, or rejected by the TA. Notice as to whether the application has been accepted, returned or rejected will be provided to the individual’s e-mail address provided within 48 hours after submission. If the application is returned or rejected, the contract service provider shall contact the TA and comply with the TA’s guidance to attempt to correct and resolve the issues.

3.12.4.6. Upon approval of the application, the contract service provider shall receive an e-mail sent to the address provided stating the Common Access Card (CAC) application was approved and to proceed to the Verifying Office (VO) with two photo IDs to obtain a CAC. For CAC issuance, a DD2842 must be completed and taken by the individual with two forms of picture ID. The e-mail will contain a URL to download the form. Acceptable forms of ID are: Driver’s License, Social Security Card, Military ID, Contractor Company ID with picture and expiration date, VISA charge card with picture imprinted, and passport.

3.12.4.7. Revalidation Requirements. The TA is required to revalidate all contract service providers, in the DEERS/RAPIDS System, every 6 months. In the event revalidation is denied, the CAC credentials shall be revoked and the Card will not be useable to login.

3.12.4.8. Out-processing Requirements. When a contract service provider’s performance under this contract ceases, the Contractor shall provide written notice to the TA. The TA will remove the contract service provider from the DEERS/RAPIDS System. The Contractor shall ensure the contract service provider’s CAC is turned in to the Government IAW the out-processing procedures and further guidance from the Pacific Regional Contracting Office.

3.13. QUALITY CONTROL.

3.13.1 The Contractor shall have a planned and systematic quality control process for monitoring and analyzing its contract performance.

3.13.2. The Contractor shall ensure that all contract employees comply with the MTF quality management/process improvement activities.

4. QUALITY ASSURANCE SURVEILLANCE PLAN:

4.1. Inspection. The inspection and acceptance point for all services rendered under this contract will be the COR. The performance by the contract personnel, the quality of services rendered, and any documentation or written material in support of same, shall be subject to continuous inspection, surveillance and review for acceptance by the KO or COR. Any services rendered by the contract personnel 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.

5.0. POSITION DESCRIPTIONS.

5.1 Position Title: Referral Management Center Clerk

5.1.1. Assigned to: TOPA Flight Referral Management Center

5.1.2. Qualifications

5.1.2.1. Education: High School Diploma or General Educational Development (GED) equivalency, or a Korean equivalency as determined by Ministry of Education. Must be able to read, comprehend/understand, speak, and write English fluently. The Foreign National must have a TOEIC score above 550.

5.1.2.2. Experience: At least 2 years of continuous employment with a single company, working in an administrative capacity (business, healthcare, clerical, etc.).

5.1.3. Specific Duties/Tasks:

5.1.3.1. SPECIFIC RMC FUNCTIONS - REFERRAL APPOINTING. The RMC falls under the direction and guidance of the TRICARE Operations and Patient Administration Flight Commander and shall:

5.1.3.1.1. Review all new referral consults (those originating from patient visits, picked up from the clinics or printed at the RMC, for the TRICARE Managed Care Support Contractor (MCSC), emailed, in Referral Management System website, CHCS, AHLTA or faxed to the RMC) to ensure that each includes the following minimum information:

Patient’s name FMP/Sponsor’s social security number Patient’s date of birth Home phone/work phone Originating clinic Specialty clinic being referred to Specific provider if so requested and contact for that provider Originating provider’s name, phone number, and clinic Point of contact at the clinic if the provider is not available Provider’s facsimile number Status of patient (Prime, Plus, Standard, Medicare) Number of visits authorized Time frame for consults Brief summary of reason for consult ICDB and CPT code(s), if required

5.1.3.1.2. If the consult does not include the items listed in 3.1.1.1, the RMC staff shall fill in as much data as possible before returning the consult to the originating provider.

5.1.3.1.3. Appoint patients on referrals they receive the same day the referrals are requested and within 30 minutes of arrival in the RMC.

5.1.3.1.4. Make every effort to book appointments within Access to Care (ATC) standards within the 8 MDG MTF, another MTF or to a host nation hospital at least 95 percent of the time. ATC standards are: emergency transport for “STAT,” within 72 hours for “ASAP (as soon as possible), and within 28 days for “Routine” specialist appointments.

5.1.3.1.5. Advise the patient of the provider, location, time and day of the referral appointment prior to the patient leaving the facility.

5.1.3.1.6. For MTF referrals, direct the patient to call back on the next business day for appointment information if the patient is not provided appointment prior to leaving MTF. If the patient does not call back within one business day, the RMC staff shall contact patient within three business days to book the appointment.

5.1.3.1.7. Book specialty appointments to Network providers and ensure that the referral result has been reviewed by the referring provider.

5.1.3.1.8. Provide monthly reports that show patients requiring referral care were treated with ATC standards.

5.1.3.1.9. Use information systems that link the referral to the appointment to the ATC category and standard.

5.1.3.2. HEALTH BENEFITS FUNCTIONS. The RMC clerk shall:

5.1.4.2.1. Advise all categories of patients of what their referral/health treatment options are as related to their eligibility and beneficiary status (AD, Prime, Standard, civilian).

5.1.4.2.2. Advise on travel benefits and making travel arrangement with the Theater Patient Movement Requirements Center using the TRANSCOM Regulating and Command and Control Evacuation System if patient agrees to care at another Direct Care System MTF that is over 100 miles away and when military aircraft is used.

5.1.4.2.3. Advise and track on all patient categories (AD, Prime, Standard, and Civilian) that are admitted/referred as inpatients to local MOU hospitals.

5.1.4.3. REFERRAL TRACKING. The RMC clerk shall:

5.1.4.3.1. Track all referral requests and results going out of and into the MTF in the Composite Healthcare Computer System (CHCS) system and on the 8 MDG “Referrals Tracking Database.”

5.1.4.3.2. Document patient’s appointment, with whom, either in the MTF, another MTF, in the Network or with a non-network provider.

5.1.4.3.3. Document the name of the referring provider/PCM and MTF for purposes of returning specialty results to the referring provider/PCM.

5.1.4.3.4. Together with the RMC team members, track all 100% of referral requests and results going out of and into the MTF in the Composite Healthcare Computer System (CHCS) system and on the 8 MDG “Referrals Tracking Database.”

5.1.4.3.5. Follow-up with MTF providers who did not complete referral results within 72 hours of the referral episode at 4 working days after the referral episode. Ninety percent of the results shall be completed by 4 working days and 100% by 30 calendar days.

5.1.4.3.6. Ensure that results from other MTFs are returned to the referring provider in CHCS and/or AHLTA and to the medical record within 72 hours of the referral episode; notify the referring provider of the result via email, and by physically visiting and notifying the provider.

5.1.4.3.7. Ensure that results from Network/non-network providers are returned to requesting provider (internal or external) and to the medical record within 10 business days of the kept routine specialty encounter and within 24 hours for preliminary reports on urgent/emergent situations.

5.1.4.3.8. Follow-up with all Direct Care providers who did not complete referral results at 4 working days after the completion of the referral encounter, daily until the complete results are received, signed, acknowledged by the referring provider, and filed into the patient’s medical record.

5.1.4.3.9. Follow-up with Network/Non-Network providers who did not complete referral results at 11 working days after the completion of the referral, daily until the complete results are received, signed, acknowledged by the referring provider, and filed into the patient’s medical record.

5.1.4.3.10. Maintains and tracks referral records, referral results, follow-up referral results, and initiates the routing process to obtain provider’s acknowledgement of results receipt. Specifically, contractor will route the results for provider’s signature, stamp and date. The “RMC Stamp” provided by the 8 MDG will be utilized to initiate this process, and working in conjunction with the Patient Administration staff, oversees the processes to ensure that all referral results are filed into the patient’s original medical record with 100% of results containing the referring provider’s acknowledgement completed.

5.1.4.3.11. Provide monthly reports showing compliance percentage for MTF, other MTF, and Network/non- network providers’ referral return rate. Monthly reporting shall be based on paragraph 5.1.4.7.

5.1.4.4. REFERRAL REVIEW. The RMC clerk shall:

5.1.4.4.1. Review the referral for the following areas:

Suitability Administrative and clinical completeness Covered TRICARE/CHAMPUS benefit for the specific patient via authorizations from MCSC Required tests and pre-work

5.1.4.4.2. Submit referrals to non-network provider to MCSC via the fiscal responsible entity for medical necessity/appropriateness review.

5.1.4.4.3. Contact patient in event referral request is invalid, disapproved by second level review/MCSC and reschedule patient as soon as possible or instruct patient of other health care options.

5.1.4.5. COORDINATION FUNCTIONS. The RMC clerk shall assist the TOPA Flight Commander:

5.1.4.5.1. Recommend where referral will be treated based on rule sets/MOUs/local market conditions, and on MTF capabilities.

5.1.4.5.2. Arrange travel orders, and non-medical attendants as required.

5.1.4.5.3. Ensure patient leaves MTF with all necessary documentation appropriate for the referred care episode and the referral provider knows where to return his/her results; goal is patient has tests and paper work before leaving MTF.

5.1.4.6. CUSTOMER SERVICE. The RMC clerk shall:

5.1.4.6.1. Relieve requesting provider from as many administrative burdens as possible.

5.1.4.6.2. Provide the MTF referring provider with referral results.

5.1.4.6.3. Get the right patient to the right service/provider within Access to Care (ATC) standards.

5.1.4.6.4. Serve as the “central clearing house” for providers and patients needing help with referrals.

5.1.4.7. The RMC shall maintain and provide monthly statistical reports, due by the 15th of the following month. The reportable information and data points may change, but the below entries represent an example:

5.1.4.7.1. Total consults received per specialty broken down into beneficiary category.

5.1.4.7.2. Total consults per provider and specialty.

5.1.4.7.3. Disposition of consults and reasons for deferral and denial.

5.1.4.7.4. Breakdown of time periods to access each specialty, internally and externally

5.1.4.7.5. Total consults denied access to the MTF.

5.1.4.7.6. Rate of return for Direct Care System (72 hours) and Network/non-network providers (10 days) specialty reports.

5.1.4.7.7. Total recaptured care directed to the MTF.

5.1.4.8. REFERRAL APPOINTING.

5.1.4.8.1. Determines TRICARE benefit eligibility.

5.1.4.8.2. Verifies patients are registered in CHCS/DEERS; updates demographic information as needed.

5.1.4.8.3. Determines health care that can be provided within the MTF using Service Availability Listings (SAL) and information systems that link the referral to the patient’s medical appointment.

5.1.4.8.4. Schedules specialty referral appointments to MTF, Direct Care System, or Network/non-network providers within Access to Care standards.

5.1.4.8.5. Coordinates with specialty referral clinics (internal or external) on special patient instructions and tests required prior to appointment.

5.1.4.8.6. Advises patients of the provider, location, time and day of the referral appointment or request the patient call back for appointment information if not provided appointment prior to leaving MTF.

5.1.4.8.7. Provides pre-appointment instructions to patients as indicated.

5.1.4.8.8. Locates referral requests and ensures appropriate documents are available prior to all specialty appointments.

5.1.4.8.9. Prints diagnostic reports and treatment profiles as necessary.

5.1.4.8.10. Ensures patients leave MTF with all necessary documentation appropriate for the referred care episode and the referral provider knows where to return his/her results.

5.1.4.8.11. Contacts patients in event referral requests are invalid, disapproved by second level review and reschedule patients as soon as possible or instruct patients of other health care options.

5.1.4.8.12. Submits referrals to non-network providers to TSC for medical necessity/appropriateness review. 5.1.4.8.13. Receives and appropriately forwards clinical phone consult requests from patients.

5.1.4.9. REFERRAL TRACKING.

5.1.4.9.1. Contractor shall use the 8 MDG “Referrals Tracking Database” to document referrals activity, the receipt of referral results, and filing of those results into the pertinent patient’s medical record for 100% of referrals processed.

5.1.4.9.2. Tracks referrals to include obtaining reports from MTF, Direct Care System, and network/non-network providers within established standards.

5.1.4.9.3. Documents patient’s appointment, with whom, is either in the MTF, another MTF, in the Network or with a non-network provider.

5.1.4.9.4. Documents the name of the referring provider/PCM and MTF for purposes of returning specialty results.

5.1.4.9.5. Follows-up with MTF providers who did not complete referral results within required timelines.

5.1.4.9.6. Ensures that results from other MTFs and from Network/non-network providers are returned to the referring provider and to the medical record within required timelines and follows up with as necessary.

5.1.4.9.7. Documents that referral results are properly filed in patient’s health record.

5.1.4.9.8. Assists in preparation of monthly reports as indicated.

5.1.4.10. CUSTOMER SERVICE.

5.1.4.10.1. Greets patients, screens, and appropriately routes phone calls.

5.1.4.10.2. Relieves requesting provider from as many administrative burdens as possible.

5.1.4.10.3. Serves as the “central clearing house” for providers and patients needing help with referrals.

5.1.4.10.4. PROCEDURE GUIDANCE. The contractor shall perform education services compatible with the medical facility's operating capacity and equipment. New services shall not be introduced without prior recommendation, and approval of the medical treatment facility (MTF) Commander or authorized representative.

5.1.4.10.5. DUTY ASSIGNMENT. The contractor shall be primarily required to perform administrative services related to referrals requests and processing in the RMC.

5.1.4.10.6. OTHER SUPPORT. The contractor shall provide immediate evaluation of emergency problems as they occur and follow established guidelines for seeking assistance.

5.1.4.10.7. DOCUMENTATION. The contractor shall prepare all documentation to meet or exceed established standards of the MTF to include but not limited to timeliness, legibility, accuracy, content and signature. Unless approved for delay, the contractor shall meet all suspense dates. Only MTF and Air Force approved abbreviations shall be used for documentation of care in the health care record. These are available at the 8 MDG upon award of contract.

5.1.4.10.8. SELF-EVALUATION. The contractor shall participate in a continual process of self-evaluation and strive for excellence in nursing practice.

5.1.4.10.9. ATTENDANCE AT MEETINGS. The contractor shall attend and participate in meetings, conferences, and other appropriate meetings as needed.

5.1.4.10.10. INFECTION CONTROL AND SAFETY. The contractor shall comply with all MTF infection control and safety procedures, practices, and standards.

5.1.4.10.11. Accreditation Association for Ambulatory Health Care (AAAHC). The contractor shall meet all applicable AAAHC standards during the performance of this contract that relate to the administrative processing referrals.

5.2. Requirements for all positions.

5.2.1. The Contractor shall ensure that all contract personnel providing services under this contract shall be able to read, write, and speak English well enough to effectively communicate with all parties and other health care providers. In addition, if the position requires the use of computers, the contract personnel shall be computer literate.

5.2.2. The contract personnel shall possess sufficient initiative, interpersonal relationship skills and social sensitivity such that he/she can relate constructively to a variety of patients from diverse backgrounds.

5.2.3 The contract personnel shall have the required education, training, experience and documented current competence in the required specialty position description.

5.3. The Contractor must adhere to all IT requirements for utilizing Government equipment and accessing Government systems.

PERFORMANCE REQUIREMENTS SUMMARY (PRS) Table

Para. 5.1.4.1.3.

2) Corrective action…