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Performance-based Work Statement (PWS)

FOR

Special Needs Coordinator

For 35th Medical Group, Misawa AB, Japan.

Personal Service

35TH CONTRACTING SQUADRON

MISAWA AIR BASE, JAPAN

Date: 30 Oct 2014

Coordination and Review

____________________________ ________________

____Sara M. Chesser___________ ____30 Oct 14____

Contracting Officer Date

TABLE OF CONTENTS

Special Needs Coordinator

Section Description

1. DESCRIPTION OF SERVICES/GENERAL INFORMATION

2. SCOPE OF WORK

3. SPECIFIC DUTIES

4. REQUIRED QUALIFICATIONS

5. SUPERVISION RECEIVED

6. HOURS OF OPERATION

7. WORK SCHEDULE

8. INSTALLATION SECURITY NOTICE TO EMPLOYEES

9. SECURITY REQUIREMENTS

10. PERFORMANCE EVALUATION MEETINGS

11. SPECIAL REQUIREMENTS

12. HEALTH REQUIREMENTS

13. PROFESSIONAL LIABILITY RESPONSIBILITY/MEDICAL MALPRACTICE

14. CONTRACTOR PERSONNEL

15. TRAINING

16. SERVICES SUMMARY

17. GOVERNMENT FURNISHED PROPERTY AND SERVICES

18. APPLICABLE PUBLICATIONS AND FORMS

19. DEPARTMENT OF DEFENSE (DOD) REGULATIONS/MANUALS INSTRUCTIONS/DIRECTIVES

20. AIR FORCE INSTRUCTIONS

21. OTHER REFERENCES

1. DESCRIPTION OF SERVICES/GENERAL INFORMATION. The Government requires one (1) Full Time Equivalent Special Needs Coordinator for this contract within the 35th Medical Group (MDG), Misawa Air Base, Japan. Contractor shall furnish all management and labor necessary to provide services in accordance with the requirements contained in this Performance Work Statement (PWS) and the professional standards, policies and guidelines of the 35 MDG, the Joint Commission (TJC), and all Air Force Instructions (AFIs) and regulations.

2. SCOPE OF WORK. Contractor personnel shall competently perform all tasks ensuring all suspense’s are met; documentation produced is legible, timely, accurate, medically consistent, professionally written, and all patient identifying information is protected.

2.1. Must have knowledge and skills to effectively apply Special Needs Coordinator (SNC) functions:

2.1.a) Assessment: Identification of patients that need special medical and education needs/management; comprehensive collection of patient information and medical status; and continued evaluation of an established plan of care.

2.1.b) Planning: Collaboration with the patient, family/caregiver, primary provider and other members of the health care team for developing an effective plan of care.

2.1.c) Facilitation: Care coordination and communication among all involved parties.

2.1.d) Advocacy: Support for the patient and family/caregivers to ensure identified education and appropriate, timely care coordination is received.

2.2. Must demonstrate mastery of theories, principles, and methodologies underlying psychosocial practice.

2.3. Must have knowledge and understanding of developmental growth; dynamics of human behavior, family, and other social systems; and impact of illness and disability on social functioning.

2.4. Must demonstrate ability in program planning, implementation, and evaluation, and in conducting individual, family, group, and community assessments.

2.5. Must demonstrate ability to work with service members and/or veterans and their families who are experiencing a wide range of complicated mental, emotional, behavioral, physical, psychosocial, and environmental problems.

2.6. Must have knowledge of medical privacy and confidentiality (Health Insurance Portability and Accountability Act [HIPAA], and accreditation standards of Accreditation Association for Ambulatory Health Care (AAAHC) and The Joint Commission (TJC).

2.7. Must demonstrate ability to communicate effectively both orally and written.

2.8. Must be skillful and tactful in communicating skills with people who may be physically or mentally ill, uncooperative, fearful, emotionally distraught, and potentially agitated.

2.9. Must demonstrate ability to apply critical thinking skills and expertise in resolving complicated healthcare, social, interpersonal and financial patient situations.

2.10. Must possess organization, problem-solving and communication skills to articulate medical requirements to patients, families/care givers, medical and non-medical staff in a professional and courteous way.

3. SPECIFIC DUTIES.

3.1. The SNC oversees and manages the installation Exceptional Family Member Program-Medical (EFMP-M) IAW AFI 40-701, Medical Support to Family Member Relocation and Exceptional Family Member Program, and any subsequently implemented guidance.

3.1.1. Uses clinical assessment skills and maintains procedures to identify sponsors whose family members have special medical and educational needs in a timely manner. The SNC uses a multi-disciplinary and collaborative approach with other key service providers, such as installation youth and childcare facilities, and officer and enlisted spouses groups, to ensure effective outreach and identification of special needs. Ensures family members of the AF personnel or family of the AF member are appropriately "Q coded" (EFMP-enrolled).

3.1.2. Ensures all active duty sponsors known to the Air Force Personnel Center, and local Military Personnel Section (MPS) and/or Commander Support Staff (CSS) where applicable, having family members with special needs are identified in AF medical special needs data management systems. Provides oversight for base-level data entry in AF-provided data management systems used in the management of EFMP-M.

3.1.3. Provides training to installation personnel and medical staff; and consultation as needed to support the implementation of EFMP-M base-wide.

3.1.4. Integrally involved in the Family Member Relocation Clearance (FMRC) process. Ensures all FMRC requirements are implemented by all EFMP-M staff. Coordinates the enrollment process and travel screening for all active duty family members’ and travel screening upon request to the families of DoD civilian sponsored assignments going to an overseas base.

3.1.5. Provides oversight to ensure every AF sponsor with one or more family members with special needs assigned to the installation has a special needs file maintained at the Military Treatment Facility (MTF). Ensures Q-coded sponsors assigned to the installation are contacted annually to determine if there are unmet needs and to request updates of information as needed.

3.1.6. Collaborates with the Integrated Delivery System (IDS) and other interagency forums that provide family medical information and referrals to base and civilian agencies. Ensures EFMP families are referred to the Airman and Family Readiness Center for additional community assistance as needed. Maintains a cooperative working relationship with the MPS, CSS, and with Air Force Personnel Center (AFPC). Actively supports the integration of EFMP-M, Exceptional Family Member Program-Family Support (EFMP-FS) and Exceptional Family Member Program-Assignments (EFMP-A) services at the installation. Provides information, appropriate contact information, and coordinates referrals as appropriate.

3.1.7. Accomplishes EFMP quarterly case reviews to discuss/assess newly identified families', complex, or unmet medical needs. Determine the appropriate resources necessary for the families.

3.1.8. Records patient specific assessments and clinical plans of action in Armed Forces Health Longitudinal Assessment (AHLTA) and the Special Needs record. Meeting minutes will not contain patient identifying information.

3.1.9. Coordinates and participates in designated facility meetings.

3.1.10. Participates in the clinic orientation and training of other staff of the Special Needs Program. Participates in committees, work groups, and task forces at the facility. Participates in Wing Right Start as the EFMP Screener.

3.1.11. Must maintain a level of productivity and quality consistent with: complexity of the assignment; facility policies and guidelines; established principles, ethics and standards of practice of professional social work and nursing, Health Services Inspection (HSI); and other applicable DoD and service specific guidance's and policies. Must comply with the Equal Employment Opportunity (EEO) Program, infection control and safety policies and procedures.

3.1.12. Follows applicable local MTF/AF/DoD instructions, policies and guidelines.

3.1.13. Completes medical record documentation and coding and designated tracking logs and data reporting as required by local MTF/AF/DoD instructions, policies and guidance.

3.1.14. Completes all required electronic medical record training, MTF-specific orientation and SNC training programs.

3.2. Documentation. The contractor shall prepare all medical documentation to meet or exceed the standards required by the MTF, applicable Air Force Instructions and the Joint Commission guidelines. Only approved abbreviations shall be used for documentation of care in the health care record. The Department of Defense’s electronic medical record system, AHLTA, shall be used for all patient encounters.

4. REQUIRED QUALIFICATIONS:

4.1. Experience. Minimum of six (6) months full time experience in clinical nursing, social work, care coordination, discharge planning or case management in a medical setting. Applicants meeting the minimum qualifications will be evaluated with consideration to experience in nursing or social work, care coordination, discharge planning or case management in a medical setting.

4.2. Education. Nurse applicants must possess an associate degree (AD) or a baccalaureate degree program in nursing (BSN) accredited by a national nursing accrediting agency recognized by the US Department of Education. Social Worker applicants must possess a Masters of Social Work (M.S.W.) degree from a graduate school of social work fully accredited by the Council on Social Work Education (CSWE). Maintenance of Basic Life Support (BLS) certification is mandatory. Recertification will be provided by the MTF at no cost to the contractor.

4.3. Additional Knowledge. Be capable of performing the full range of medical services commensurate with the degree and/or professional license held. Fluently and proficiently read, write, speak and understand the English language. Possess working knowledge of computer applications and software to include Microsoft Office programs. The ability to input, extract and format data from the Armed Forces Health Longitudinal Technology Application (AHLTA) the Composite Health Care System (CHCS), and the Medical Expense & Performance Reporting System (MEPRS) is required.

4.4. Licensure. Nurse applicants must possess a valid, unrestricted license to practice as a Registered Nurse (RN) from one of the 50 states, and/or the District of Columbia, the Commonwealth of Puerto Rico, or territories of the United States. All licenses must be unencumbered and remain in effect during contract employment. The contractor must be in good standing, and under no restrictions, with the state in which a license is held or has been held, or the national licensure board, within the last 10 years. Social Worker applicants are not required to possess a license to apply.

5. SUPERVISION RECEIVED:

5.1. Direct: Healthcare Integrator

5.2. Indirect: Chief of the Medical Staff (SGH)

6. HOURS OF OPERATION. The 35 MDG provides services 24 hours per day, seven 7 days per week. Normal duty days and hours are Monday-Friday, 0730-1630, with an hour for lunch. The following is a list of legal federal holidays and services are not provided:

- New Year's Day 1st of January

- Martin Luther King's Birthday 3rd Monday of January

- President's Day 3rd Monday of February

- Memorial Day Last Monday of May

- Independence Day 4th of July

- Labor Day 1st Monday of September

- Columbus Day 2nd Monday of October

- Veteran's Day 11th of November

- Thanksgiving Day 4th Thursday of November

- Christmas Day 25th of December

NOTE: Any of the above holidays falling on a Saturday will be observed on the preceding Friday; holidays falling on a Sunday will be observed on the following Monday. The Government may add additional family days in conjunction with these holidays which may result in MTF closures.

7. WORK SCHEDULE. The contractor may be required to perform at least 40 hours per week during normal clinic business hours. If the contractor cannot perform in accordance with the schedule approved by the direct or indirect supervisor, the contractor shall promptly report to the Contracting Officer (CO) for resolution. No shows or sudden disappearances may be cause for termination. The MTF will coordinate the appointment templates with the Contractor. The contractor may be required to work more than 8 hours in a single day or 40 hours in a week, as determined by the supervisor or designee based on the needs of the MTF. However, under no circumstances will the contractor earn premium pay. All hours in excess of 40 hours will be paid at the same hourly rate as regular hours of work. If additional hours are worked, the Government may reduce future scheduled hours to maintain a 40 hour work week average. All hours worked will be recorded accurately on the work schedules. Under no circumstances are the work schedules to reflect hours worked when the contractor was absent or vice versa. This service contract is not classified as “mission-essential” during a crisis as declared by the National Command Authority or Overseas Combatant Commander. In the event of such a crisis, the CO will direct the contractor to discontinue the service due to base closure.

7.1. Down Day/Family Days. Will be marked as leave without pay and is not billable to the Government.

7.2. Closures. If the commander determines the base is closed due to snow, hurricane, or acts of God, the contractor shall annotate their time sheet as such. Such occurrences are not billable to the Government. The contractor shall only invoice for actual hours worked. Under no circumstance will the Government be liable for hours not worked as a result of base closure or Commander Excuses, regardless of the reason (emergency or otherwise).

7.3. Absences. The contractor shall advise the CO, supervisor or designee about absences due to illness or incapacitation. If the contractor is absent for more than five (5) consecutive days due to illness, the Contractor shall provide the Government with a statement that the employee is free from communicable illness before or as the employee returns to work. The government has no interest in tracking the status of individual employees by name when they are absent, only to ensure that they will not pass illnesses onto others. The Government reserves the right to examine and/or re-examine any worker who meets this criterion. The contractor shall provide the MTF with advance notice (14 days) of any absence requests. The MTF will approve or deny absences based on mission needs.

7.4. On-Call. There are no on-call requirements for this position.

8. INSTALLATION SECURITY NOTICE TO EMPLOYEES. The government reserves the right to restrict the contractor who is identified as a potential threat to the health, safety, security, general well-being, or operational mission of the installation and its population. The contractor shall know that they may be subject to search, at the discretion of the installation commander, when entering or leaving the installation.

9. SECURITY REQUIREMENTS.

9.1. Criminal Background Check. Background checks are required on all healthcare workers involved in the delivery of healthcare to children under the age of 18 on a frequent and regular basis as stated in DODI 1402.5 Enclosure 5. Contractor personnel receiving an unfavorable criminal background check status shall not be allowed to perform under this contract. The contractor is responsible completing and submitting the government-provided SF 86 (Security Clearance Application) as part of the credentialing package prior to providing service at the MTF. Contractor shall comply with all security and background check requirements as outlined in DODI 1402.5 and other applicable regulations and guidelines.

9.2. National Agency Check (NAC). The government shall perform security investigations on contractor employees in accordance with DoD 5200.2-R, Personal Security Program and AFI 33-119, Electronic Mail Management and Use. The contractor shall submit a request for a NAC to the Unit Security Manager within 5 working days after the first duty day. Contractor personnel receiving unfavorable NAC status shall not be allowed to perform under this contract.

9.3. Base Access. Prior to start of work, the contractor shall submit a 5 AF Form 99, “Applications for Base Passes” to the 35th Contracting Squadron, Bldg 656, for all employees requiring base access to perform the work. The contractor shall submit a 35 FW Form 54, “Application for Vehicle” and copies of the vehicle inspection certificate, for all the vehicles requiring base access under this contract. The contractor shall turn in all base passes to the Visitor Control Section, 35 SFS/SFAP, Bldg 301, and obtain a return receipt after a pass is no longer needed or the contract expires, whichever comes first. Final payment may be withheld until the required clearances have been accomplished.

9.4. Base Computer Network Access. Contractor personnel are required to have access to the government local area network (LAN). Contractor shall obtain Common Access Card (CAC) for contractor personnel.

9.5. Physical Security. Contractor personnel shall be responsible for safeguarding any and all medical information provided for contractor use. At the close of each work period, information shall be secured.

9.6. Credentialing and Privileging. The contractor shall comply with all applicable DoD, AFMS and 35 MDG credentialing and privileging requirements and be appropriately credentialed and privileged by the 35 MDG Credentials Committee prior to beginning patient care at the MTF. AFI 44-119 governs this credentialing process.

9.7. Reporting. During performance, report any information or circumstances observed that may pose a threat to the security of DoD personnel, contractor personnel, resources, and defense information to the Security Forces. The Contracting Officer Representative (COR) will brief the contractor upon initial on-base assignment of requirements. The contractor shall comply with the requirements of Volume 1, AFI 71-101, Criminal Investigations, and paragraph 1.1 of Volume 2, Protective Security Matters.

10. PERFORMANCE EVALUATION MEETINGS. The contractor may be required to meet periodically with Multi-functional Team Members at the beginning of contract performance. Meetings will be scheduled as needed by the Contracting Officer. The Contractor may request meetings at any time. The written minutes of these meetings shall be signed by the contract administrator and emailed out for all attendees to review. Attendees have five (5) days after minutes are emailed to dispute any items therein.

11. SPECIAL REQUIREMENTS.

11.1. HIPAA Business Associate Agreement

Introduction

In accordance with 45 CFR 164.502(e)(2) and 164.504(e) and paragraph C.3.4.1.3 of DoD 6025.18-R, “DoD Health Information Privacy Regulation,” January 24, 2003, this document serves as a business associate agreement (BAA) between the signatory parties for purposes of the Health Insurance Portability and Accountability Act (HIPAA) and the “HITECH Act” amendments thereof, as implemented by the HIPAA Rules and DoD HIPAA Issuances (both defined below). The parties are a DoD Military Health System (MHS) component, acting as a HIPAA covered entity, and a DoD contractor, acting as a HIPAA business associate. The HIPAA Rules require BAAs between covered entities and business associates. Implementing this BAA requirement, the applicable DoD HIPAA Issuance (DoD 6025.18-R, paragraph C3.4.1.3) provides that requirements applicable to business associates must be incorporated (or incorporated by reference) into the contract or agreement between the parties.

(a) Catchall Definition. Except as provided otherwise in this BAA, the following terms used in this BAA shall have the same meaning as those terms in the DoD HIPAA Rules: Data Aggregation, Designated Record Set, Disclosure, Health Care Operations, Individual, Minimum Necessary, Notice of Privacy Practices (NoPP), Protected Health Information (PHI), Required By Law, Secretary, Security Incident, Subcontractor, Unsecured Protected Health Information, and Use.

Breach means actual or possible loss of control, unauthorized disclosure of or unauthorized access to PHI or other PII (which may include, but is not limited to PHI), where

persons other than authorized users gain access or potential access to such information for any purpose other than authorized purposes, where one or more individuals will be adversely affected. The foregoing definition is based on the definition of breach in DoD Privacy Act Issuances as defined herein.

Business Associate shall generally have the same meaning as the term “business associate” in the DoD HIPAA Issuances, and in reference to this BAA, shall mean Special Needs Coordinator (SNC) Contractor.

Agreement means this BAA together with the documents and/or other arrangements under which the Business Associate signatory performs services involving access to PHI on behalf of the MHS component signatory to this BAA.

Covered Entity shall generally have the same meaning as the term “covered entity” in the DoD HIPAA Issuances, and in reference to this BAA, shall mean 35th Medical Group.

DHA Privacy Office means the DHA Privacy and Civil Liberties Office. The DHA Privacy Office Director is the HIPAA Privacy and Security Officer for DHA, including the National Capital Region Medical Directorate (NCRMD).

DoD HIPAA Issuances means the DoD issuances implementing the HIPAA Rules in the DoD Military Health System (MHS). These issuances are DoD 6025.18-R (2003), DoDI 6025.18 (2009), and DoD 8580.02-R (2007).

DoD Privacy Act Issuances means the DoD issuances implementing the Privacy Act, which are DoDD 5400.11 (2007) and DoD 5400.11-R (2007).

HHS Breach means a breach that satisfies the HIPAA Breach Rule definition of breach in 45 CFR 164.402.

HIPAA Rules means, collectively, the HIPAA Privacy, Security, Breach and Enforcement Rules, issued by the U.S. Department of Health and Human Services (HHS) and codified at 45 CFR Part 160 and Part 164, Subpart E (Privacy), Subpart C (Security), Subpart D (Breach) and Part 160, Subparts C-D (Enforcement), as amended by the 2013 modifications to those Rules, implementing the “HITECH Act” provisions of Pub. L. 111-5. See 78 FR 5566-5702 (Jan. 25, 2013) (with corrections at 78 FR 32464 (June 7, 2013)). Additional HIPAA rules regarding electronic transactions and code sets (45 CFR Part 162) are not addressed in this BAA and are not included in the term HIPAA Rules.

Service-Level Privacy Office means one or more offices within the military services (Army, Navy, or Air Force) with oversight authority over Privacy Act and/or HIPAA privacy compliance.

I. Obligations and Activities of Business Associate

(a) The Business Associate shall not use or disclose PHI other than as permitted or required by this Agreement or as required by law.

(b) The Business Associate shall use appropriate safeguards, and comply with the DoD HIPAA Rules with respect to electronic PHI, to prevent use or disclosure of PHI other than as provided for by this Agreement.

(c) The Business Associate shall report to Covered Entity any Breach of which it becomes aware, and shall proceed with breach response steps as required by Part V of this BAA. With respect to electronic PHI, the Business Associate shall also respond to any security incident of which it becomes aware in accordance with any Information Assurance provisions of this Agreement. If at any point the Business Associate becomes aware that a security incident involves a Breach, the Business Associate shall immediately initiate breach response as required by part V of this BAA.

(d) In accordance with 45 CFR 164.502(e)(1)(ii)) and 164.308(b)(2), respectively, and corresponding DoD HIPAA Issuances, as applicable, the Business Associate shall ensure that any subcontractors that create, receive, maintain, or transmit PHI on behalf of the Business Associate agree to the same restrictions, conditions, and requirements that apply to the Business Associate with respect to such PHI.

(e) The Business Associate shall make available PHI in a Designated Record Set, to the Covered Entity or, as directed by the Covered Entity, to an Individual, as necessary to satisfy the Covered Entity obligations under 45 CFR 164.524 and corresponding DoD HIPAA Issuances.

(f) The Business Associate shall make any amendment(s) to PHI in a Designated Record Set as directed or agreed to by the Covered Entity pursuant to 45 CFR 164.526, or take other measures as necessary to satisfy Covered Entity’s obligations under 45 CFR 164.526, and corresponding DoD HIPAA Issuances.

(g) The Business Associate shall maintain and make available the information required to provide an accounting of disclosures to the Covered Entity or an individual as necessary to satisfy the Covered Entity’s obligations under 45 CFR 164.528 and corresponding DoD HIPAA Issuances.

(h) To the extent the Business Associate is to carry out one or more of Covered Entity's obligation(s) under the HIPAA Privacy Rule, the Business Associate shall comply with the requirements of the HIPAA Privacy Rule that apply to the Covered Entity in the performance of such obligation(s); and

(i) The Business Associate shall make its internal practices, books, and records available to the Secretary for purposes of determining compliance with the HIPAA Rules.

II. Permitted Uses and Disclosures by Business Associate

(a) The Business Associate may only use or disclose PHI as necessary to perform the services set forth in this Agreement or as required by law. The Business Associate is not permitted to de-identify PHI under DoD HIPAA issuances or the corresponding 45 CFR 164.514(a)-(c), nor is it permitted to use or disclose de-identified PHI, except as provided by this Agreement or directed by the Covered Entity.

(b) The Business Associate agrees to use, disclose and request PHI only in accordance with the HIPAA Privacy Rule “minimum necessary” standard and corresponding DHA policies and procedures as stated in the DoD HIPAA Issuances.

(c) The Business Associate shall not use or disclose PHI in a manner that would violate the DoD HIPAA Issuances or HIPAA Privacy Rules if done by the Covered Entity, except uses and disclosures for the Business Associate’s own management and administration and legal responsibilities or for data aggregation services as set forth in the following three paragraphs.

(d) Except as otherwise limited in this Agreement, the Business Associate may use PHI for the proper management and administration of the Business Associate or to carry out the legal responsibilities of the Business Associate. The foregoing authority to use PHI does not apply to disclosure of PHI, which is covered in the next paragraph.

(e) Except as otherwise limited in this Agreement, the Business Associate may disclose PHI for the proper management and administration of the Business Associate or to carry out the legal responsibilities of the Business Associate, provided that disclosures are required by law, or the Business Associate obtains reasonable assurances from the person to whom the PHI is disclosed that it will remain confidential and used or further disclosed only as required by law or for the purposes for which it was disclosed to the person, and the person notifies the Business Associate of any instances of which it is aware in which the confidentiality of the information has been breached.

(f) Except as otherwise limited in this Agreement, the Business Associate may use PHI to provide Data Aggregation services relating to the Covered Entity’s health care operations.

III. Provisions for Covered Entity to Inform Business Associate of Privacy Practices and Restrictions

(a) The Covered Entity shall notify the Business Associate of any limitation(s) in the notice of privacy practices of the Covered Entity under 45 CFR 164.520 and the corresponding provision of the DoD HIPAA Issuances, to the extent that such limitation may affect Business Associate’s use or disclosure of PHI.

(b) The Covered Entity shall notify the Business Associate of any changes in, or revocation of, the permission by an Individual to use or disclose his or her PHI, to the extent that such changes affect the Business Associate’s use or disclosure of PHI.

(c) The Covered Entity shall notify the Business Associate of any restriction on the use or disclosure of PHI that the Covered Entity has agreed to or is required to abide by under 45 CFR 164.522 and the corresponding DoD HIPAA Issuances, to the extent that such changes may affect the Business Associate’s use or disclosure of PHI.

IV. Permissible Requests by Covered Entity

The Covered Entity shall not request the Business Associate to use or disclose PHI in any manner that would not be permissible under the HIPAA Privacy Rule or any applicable Government regulations (including without limitation, DoD HIPAA Issuances) if done by the Covered Entity, except for providing Data Aggregation services to the Covered Entity and for management and administrative activities of the Business Associate as otherwise permitted by this BAA.

V. Breach Response

(a) In general.

(1) In the event of a breach of PII/PHI held by the Business Associate, the Business Associate shall report the breach to the Covered Entity in accordance with Section VII, assess the breach incident, take mitigation actions as applicable, and notify affected individuals, as directed by the Covered Entity.

(2) The Business Associate shall coordinate all investigation actions with the Covered Entity, and at a minimum, follow the breach response requirements set forth in this Part V, which is designed to satisfy both the Privacy Act and HIPAA as applicable. If a breach involves PII without PHI, then the Business Associate shall comply with DoD Privacy Act Issuance breach response requirements only; if a breach involves PHI (a subset of PII), then the Business Associate shall comply with both Privacy Act and HIPAA breach response requirements. A breach involving PHI may or may not constitute an HHS Breach. If a breach is not an HHS Breach, then the Business Associate has no HIPAA breach response obligations. In such cases, the Business Associate must still comply with breach response requirements under the DoD Privacy Act Issuances.

(3) The Business Associate shall, at no cost to the government, bear any costs associated with a breach of PII/PHI that the Business Associate has caused or is otherwise responsible for addressing.

(b) Government Reporting Provisions

(1) If the Covered Entity determines that a breach is an HHS Breach, then the Business Associate shall comply with both the HIPAA Breach Rule and DoD Privacy Act Issuances, as directed by the Covered Entity, regardless of where the breach occurs.. If the Covered Entity determines that the breach does not constitute an HHS Breach, then the Business Associate shall comply with DoD Privacy Act Issuances, as directed by the applicable Service-Level Privacy Office.

(2) This Part V is designed to satisfy the DoD Privacy Act Issuances and the HIPAA Breach Rule as implemented by the DoD HIPAA Issuances. In general, for breach response, the Business Associate shall report the breach to the Covered Entity, assess the breach incident, notify affected individuals, and take mitigation actions as applicable. Because DoD defines “breach” to include possible (suspected) as well as actual (confirmed) breaches, the Business Associate shall implement these breach response requirements immediately upon the Business Associate’s discovery of a possible breach.

(3) The following provisions of Part V set forth the Business Associate’s Privacy Act and HIPAA breach response requirements for all breaches, including but not limited to HHS breaches.

(i) The Business Associate shall report the breach within one hour of discovery to the US Computer Emergency Readiness Team (US CERT), and, within 24 hours of discovery, to the Covered Entity, and to other parties as deemed appropriate by the Covered Entity. The Business Associate is deemed to have discovered a breach as of the time a breach (suspected or confirmed) is known, or by exercising reasonable diligence would have been known, to any person (other than the person committing it) who is an employee, officer or other agent of the Business Associate.

(ii) The Business Associate shall submit the US-CERT report using the online form at . Before submission to US-CERT, the Business Associate shall save a copy of the on-line report. After submission, the Business Associate shall record the US-CERT Reporting Number. Although only limited information about the breach may be available as of the one hour deadline for submission, the Business Associate shall submit the US-CERT report by the deadline. The Business Associate shall e-mail updated information as it is obtained, following the instructions at . The Business Associate shall provide a copy of the initial or updated US-CERT report to the Installation Privacy Act Officer, MTF HIPAA Privacy Officer, and the Contracting Officer (if applicable), if requested. Business Associate questions about US-CERT reporting shall be directed to the Installation Privacy Act Officer or MTF HIPAA Privacy Officer, not the US-CERT office.

(iii) The Business Associate shall comply with the Breach Timeline and Notification Flow Chart processes attached to this Agreement, to include the timelines established for completing the DD Form 2959 and the HIPAA Privacy Incident Report.

(4) If multiple beneficiaries are affected by a single event or related set of events, then a single reportable breach may be deemed to have occurred, depending on the circumstances. The Business Associate shall inform the Covered Entity as soon as possible if it believes that “single event” breach response is appropriate; the Covered Entity will determine how the Business Associate shall proceed and, if appropriate, consolidate separately reported breaches for purposes of Business Associate report updates, beneficiary notification, and mitigation.

(i) When a Breach Report Form initially submitted is incomplete or incorrect due to unavailable information, or when significant developments require an update, the Business Associate shall submit a revised form or forms, stating the updated status and previous report date(s) and showing any revisions or additions in red text. Examples of updated information the Business Associate shall report include, but are not limited to: confirmation on the exact data elements involved, the root cause of the incident, and any mitigation actions to include, sanctions, training, incident containment, and follow-up. The Business Associate shall submit these report updates within three (3) business days after the new information becomes available. Prompt reporting of updates is required to allow the Covered Entity to make timely final determinations on any subsequent notifications or reports. The Business Associate shall provide updates to the same parties as required for the initial Breach Reporting Form. The Business Associate is responsible for reporting all information needed by the Covered Entity to make timely and accurate determinations on reports to HHS as required by the HHS Breach Rule and reports to the Defense Privacy and Civil Liberties Office as required by DoD Privacy Act Issuances.

(ii) In the event the Business Associate is uncertain on how to apply the above requirements, the Business Associate shall consult with the Covered Entity and Contracting Officer (if applicable) when determinations on applying the above requirements are needed.

(c) Individual Notification Provisions

(i) If the Covered Entity determines that individual notification is required, the Business Associate shall provide written notification to individuals affected by the breach as soon as possible, but no later than 10 working days after the breach is discovered and the identities of the individuals are ascertained. The 10 day period begins when the Business Associate is able to determine the identities (including addresses) of the individuals whose records were impacted.

(ii) The Business Associate’s proposed notification to be issued to the affected individuals shall be submitted to the parties to which reports are submitted under paragraph VII. for their review, and for approval by the Contracting Officer, in consultation with the Covered Entity. Upon request, the Business Associate shall provide the Contracting officer and Covered Entity with the final text of the notification letter sent to the affected individuals. If different groups of affected individuals receive different notification letters, then the Business Associate shall provide the text of the letter for each group (PII shall not be included with the text of the letter(s) provided). Copies of further correspondence with affected individuals need not be provided unless requested by the Contracting Office or Covered Entity. The Business Associate’s notification to the individuals, at a minimum, shall include the following:

(A) The individual(s) must be advised of what specific data was involved. It is insufficient to simply state that PII has been lost. Where names, Social Security Numbers (SSNs) or truncated SSNs, and Dates of Birth (DOBs) are involved, it is critical to advise the individual that these data elements potentially have been breached.

(B) The individual(s) must be informed of the facts and circumstances surrounding the breach. The description should be sufficiently detailed so that the individual clearly understands how the breach occurred.

(C) The individual(s) must be informed of what protective actions the Business Associate is taking or the individual can take to mitigate against potential future harm. The notice must refer the individual to the current Federal Trade Commission (FTC) web site pages on identity theft and the FTC’s Identity Theft Hotline, toll-free: 1-877-ID-THEFT (438-4338); TTY: 1-866-653-4261.

(D) A brief description of what the covered entity involved is doing to investigate the breach, to mitigate harm to individuals, and to protect against any further breaches; and

(E) Contact procedures for individuals to ask questions or learn additional information, which shall include a toll-free telephone number, an e-mail address, Web site, or postal address

(F) The individual(s) must also be informed of any mitigation support services (e.g., one year of free credit monitoring, identification of fraud expense coverage for affected individuals, provision of credit freezes, etc.) that the Business Associate may offer affected individuals, the process to follow to obtain those services and the period of time the services will be made available, and contact information (including a phone number, either direct or toll-free, e-mail address and postal address) for obtaining more information. The Contracting Officer, in consultation with the Covered Entity will determine the appropriate level of support services.

(iii) Business Associates shall ensure any envelope containing written notifications to affected individuals are clearly labeled to alert the recipient to the importance of its contents, e.g., “Important information – do not destroy,” and that the envelope is marked with the identity of the Business Associate and/or subcontractor organization that suffered the breach. The letter must also include contact information for a designated POC to include, phone number, e-mail address, and postal address.

(iv) If the Business Associate determines that it cannot readily identify, or will be unable to reach, some affected individuals within the 10 day period after discovering the breach, the Business Associate shall so indicate in the initial or updated Breach Report Form. Within the 10 day period, the Business Associate shall provide the approved notification to those individuals who can be reached. Other individuals must be notified within 10 days after their identities and addresses are ascertained. The Business Associate shall consult with the Covered Entity, which will determine which media notice is most likely to reach the population not otherwise identified or reached. The Business Associate shall issue a generalized media notice(s) to that population in accordance with the Covered Entity approval.

(d) Breaches are not to be confused with security incidents (often referred to as cyber security incidents when electronic information is involved), which may or may not involve a breach of PII/PHI. In the event of a security incident not involving a PII/PHI breach, the Business Associate shall follow applicable DoD Information Assurance requirements under its Agreement. If at any point the Business Associate finds that a cyber security incident involves a PII/PHI breach (suspected or confirmed), the Business Associate shall immediately initiate the breach response procedures set forth here. The Business Associate shall also continue to follow any required cyber security incident response procedures to the extent needed to address security issues, as determined by DoD/DHA.

VI. Termination

(a) Termination. Noncompliance by the Business Associate (or any of its staff, agents, or subcontractors) with any requirement in this BAA may subject the Business Associate to termination under any applicable default or other termination provision of the underlying Contract.

(b) Effect of Termination.

(1) If this Agreement has records management requirements, the Business Associate shall handle such records in accordance with the records management requirements. If this Agreement does not have records management requirements, the records should be handled in accordance with paragraphs VI.(2) and (3) below. If this Agreement has provisions for transfer of records and PII/PHI to a successor Business Associate, or if the Covered Entity gives directions for such transfer, the Business Associate shall handle such records and information in accordance with such Agreement provisions or the Covered Entity’s direction.

(2) If this Agreement does not have records management requirements, except as provided in the following paragraph (3), upon termination of this Agreement, for any reason, the Business Associate shall return or destroy all PHI received from the Covered Entity, or created or received by the Business Associate on behalf of the Covered Entity that the Business Associate still maintains in any form. This provision shall apply to PHI that is in the possession of subcontractors or agents of the Business Associate. The Business Associate shall retain no copies of the PHI.

(3) If this Agreement does not have records management provisions and the Business Associate determines that returning or destroying the PHI is infeasible, the Business Associate shall provide to the Covered Entity notification of the conditions that make return or destruction infeasible. Upon mutual agreement of the Covered Entity and the Business Associate that return or destruction of PHI is infeasible, the Business Associate shall extend the protections of this Agreement to such PHI and limit further uses and disclosures of such PHI to those purposes that make the return or destruction infeasible, for so long as the Business Associate maintains such PHI.

VII. Notices. Any notices to be given hereunder will be made in the most expedient manner, via e-mail, facsimile, U.S. Mail, or express courier to such party’s address given below.

|If to the Business Associate: |If to the Covered Entity: |

| | |

|Attn: | |Attn: | |

|Title: | |Title: |MTF HIPAA Privacy Officer |

|Company: | |Unit: |35th Medical Group |

|Address: | |Address: | |

| | | | |

| | | | |

|Phone: | |Phone: |226-6410 |

|Fax: | |Fax: | |

|E-mail: | |E-mail: | |

| | | | |

|With a copy to: |

| |

|Name: | |Name: | |

|Company: | |Title: |Contracting Officer |

|Address: | |Address: |35th Contracting Squadron |

| | | | |

| | | | |

|Phone: | |Phone: |226-4895 |

|Fax: | |Fax: | |

|Email: | |Email: | |

Each party named above may change its address and that of its representative for notice by the giving of notice thereof in the manner provided in this subsection.

VIII. Miscellaneous

(a) Survival. The obligations of Business Associate under the “Effect of Termination” provision of this BAA shall survive the termination of this Agreement.

(b) Interpretation. Any ambiguity in this Agreement shall be resolved in favor of a meaning that permits the Covered Entity and the Business Associate to comply with the HIPAA Rules and the DoD HIPAA.

12. HEALTH REQUIREMENTS.

12.1. Contract personnel providing services under this contract shall receive a pre-employment physical examination prior to commencement of work and annually thereafter. Health care providers shall report to the Government or contractor’s physician to receive a pre-employment examination and immunizations/shots prescribed by the MTF.

12.2. Prior to commencement of work, certification shall be provided to the contracting officer’s representative that health care providers have completed medical evaluation required above. This certification shall state the date on which the examination was completed, the doctor’s name that performed the examination, and a statement concerning the physical health of the individual. The certification shall also contain the following statement: “(name of contract employee) is suffering from no contagious diseases to include, but not limited to Tuberculosis, Hepatitis, and Venereal Disease.”

12.3. As a condition of this contract, OSHA requires that all contractors who will have occupational exposure to blood or body fluids, or other potentially infectious materials, shall receive Hepatitis B Vaccination series, sign a voluntary declination, or have documented proof of immunity to Hepatitis B infection by titer screening. Personnel who sign declinations may change their minds at any time and receive the Hepatitis B vaccine without penalty. Other tests required upon employment include Tuberculosis Skin Test (TST) along with initial and bi-annual Human Immunodeficiency Virus (HIV) Test. Contractors must show proof of previous Measles, Mumps, Rubella/Rubeola (MMR), Tetanus/Diphtheria/Pertussis (Tdap), and Varicella vaccinations or consent to proof of immunity by titer screening. In addition, contractors must receive an Influenza vaccination annually. Reference Section 17.7., Medical Services.

12.4. It is the Contractor’s responsibility to report (to the appropriate MTF staff member) all information necessary to assure hospital records can be maintained correctly, and therefore comply with the TJC, OSHA, and CDC health records requirement.

12.5. Prior to start of work, no medical tests or procedures required by the contract shall be performed by the Government unless the provider is an eligible beneficiary. Expenses for all required tests and/or procedures shall be borne by the Contractor or provider, not the Government. After start of work, in the event of blood borne exposure, the Government will provide follow up and care protocols according to applicable AFIs.

13. PROFESSIONAL LIABILITY RESPONSIBILITY/MEDICAL MALPRACTICE.

This contract establishes a personal service relationship between the health care worker and the Government while the health care worker is performing services under this contract. This personal services relationship is entered into under the authority of section 1091 of Title 10, United States Code. Accordingly, section 1089 of Title 10, United States Code shall apply to personal injury lawsuits filed against the health care worker(s) based on negligent or wrongful acts or omissions incident to performance within the scope of this contract. This personal services relationship is solely between the health care worker and the Government. Therefore, if the prime contractor is not serving as the health care worker with the Government under this contract then responsibility for insurance and liability no longer rest with the Government for the prime contractor. The health care worker is not required to maintain medical malpractice liability insurance. Health care workers providing services under this contract shall be rendering personal services to the Government and shall be subject to day-to-day supervision and control by Government personnel. Supervision and control is the process by which the individual health care worker receives technical guidance, direction, and approval with regards to a task(s) with the requirements of this contract. All other employer/employee responsibilities (payroll, etc.) remain with the contractor.

14. CONTRACTOR PERSONNEL.

14.1. Conflict of Interest. Contractor shall not employ anyone who is an employee of the Department of the Air Force, either military or civilian, unless such person seeks and receives prior approval in accordance with DOD Directive 5500.7-R, Joint Ethics Regulation. The contractor shall not employ persons for the work of this contract if such employment would create a conflict of interest per AFI 64-106, Air Force Industrial Labor Relations Activities.

14.2. Personnel Appearance. While on duty, contractor personnel shall present a neat, well groomed, clean image and be dressed in appropriate workplace attire. Clothing shall fit correctly, present a professional, modest appearance and be kept neat and clean, free from visible dirt and stains. Facial hair (including beards, mustaches, and sideburns) shall be controlled (restrained) or trimmed and shall not interfere with safe work practices nor look unkempt or unclean. Contractor personnel shall comply with socially acceptable standards of personal hygiene expected of health care workers.

14.3. Protective Clothing. When required and supplied by the MTF, contract personnel shall wear special protective clothing and shoe covers. These items shall remain the property of the Government and shall not be removed from the MTF. Special protective clothing shall be used, then turned in or destroyed as directed by the MTF officer/designee.

14.4. MTF Identification. The Government will supply MTF ID badges, vehicle passes and keys if applicable. The contractor will surrender all identification to the MTF upon termination.

14.5. Installation Services. The Government shall provide Contractor the following logistics support unless specifically excluded by the terms of the US-Japan SOFA:

14.5.1. SOFA status for Contractor employee and their lawful dependents

14.5.2. Duty-free importation privileges IAW SOFA and USFJ regulations

14.5.3. DD From 1173 (Uniformed Services Identification and Privilege Card)

14.5.4. Full Base Exchange (BX) privileges

14.5.5. Full Commissary Privileges

14.5.6. Full Class VI Store Privileges

14.5.7. Purchase of gasoline and petroleum, Oil, and Lubricant (POL) products at BX facilities

14.5.8. Military postal service privileges

14.5.9. Military banking and credit union privileges

14.5.10. Motor vehicle operator’s permit

14.5.11. Registration of one privately owned vehicle per family

14.5.12. Medical services for emergency care only on a reimbursable basis

14.5.13. Dental services for emergency care only on a reimbursable basis

14.5.14. Mortuary services on a reimbursable basis

14.5.15. DoD Dependent School on a space-available, tuition-paying basis

14.5.16. Continuing education programs on a space-available basis

14.5.17. Morale, welfare, and recreation facilities

14.5.18. Armed Forces recreation center facilities on a space-available basis

14.5.19. Legal assistance on a space-available basis

14.5.20. Billeting on a space-available basis

14.5.21. Housing referral services (limited to translation assistance and explanation of host country rental laws)

15. TRAINING. The contractor shall comply with and attend local 35 MDG Government-provided training which will include, but is not limited to, topics such as Compliance, Patient Safety, Newcomers Orientation, Performance Improvement, Risk Management, Infection Control, Fire Protection, Security, Patient Sensitivity, Automation Processing, and local in-service briefings. The classes may be scheduled individually throughout the year or scheduled at one time. These classes may take approximately 20 hours total during one year. This local training will count toward the 40 hour per week requirement. The contractor will assume all costs associated with travel and training attendance, and may not invoice for hours, for any mandatory or voluntary training outside of that provided by the 35 MDG, such as professional conferences, license recertification and/or continuing education.

16. SERVICES SUMMARY.

16.1. Quality Assurance. The government will receive, investigate, and validate complaints from various customers located on the installation. The government shall appoint a representative to monitor contract performance using a variety of means including following-up on customer complaints, conducting random site visits, reviewing documents prepared, etc.

16.2. Continuity of Services. If services are disrupted for more than five (5) consecutive days due to the contractor’s failure or refusal to perform, this contract may be terminated for cause at the discretion of the Contracting Officer. This contract may be also be terminated by the Contracting Officer if after 90 days the contractor fails to meet the standards identified in this PWS. Any worker demonstrating impaired judgment shall not be permitted to work in the MTF. The Government reserves the right to remove from the facility any contractor who in the judgment of a licensed physician is impaired by drugs or alcohol. Contractors removed for alcohol or drug abuse problems, or impaired judgment may only be allowed to return to work with express Government approval.

|Performance Objective |PWS Paragraph |Performance Threshold |Monitoring Method |

|Addresses patients and their care |2.5 |No more than 3 validated deficiencies or |100% inspection of submitted |

|professionally | |customer complaints per year. |complaints |

|Protects patient confidentiality and |11.1 |Zero breaches of confidentiality or |Periodic Inspection |

|privacy | |privacy | |

|Accurate and Proper Records Management|2.0., 3.2. |No more than 2 validated deficiencies or |Periodic Inspection |

| | |customer complaint per quarter | |

|Ensures understanding and compliance |3.0. |No less than 1 staff training per year in |Periodic Inspection |

|with EFMP policies and procedures | |the MTF, to include a review of DoD | |

| | |criteria for mandatory referral for | |

| | |enrollment in EFMP-M | |

|Ensures patient care and adherence to |3.1.5. |Documented evidence of annual contact with|Periodic Inspection |

|EFMP-M policies | |EFMP families’ AD sponsors exists | |

17. GOVERNMENT FURNISHED PROPERTY AND SERVICES.

17.1. FACILITIES. The Government will provide use of all available MTF facilities and support services, materials, publications and forms and equipment required for contract performance (except as designated in the contract). Contract personnel shall keep government furnished supplies, equipment, and work areas in safe, orderly and clean condition. Contract personnel shall notify the Government whenever maintenance of equipment is required.

17.2. WORK AREA/SPACE. Any space used by contract personnel in performance of this contract may be used for other purposes during their absence. Items of clothing, personal effects, or equipment may not be able to be secured. The government will not incur any liability for theft, damage, or loss of such personal items.

17.3. TELEPHONE. The Government will provide defense switching network (DSN) lines limited to matters related to performance of this contract. Personal long distance calls are not authorized and the cost of all personal calls made will be deducted from the Contractor’s invoice.

17.4. COMPUTER SYSTEMS. Contractor shall be granted access to the following computer programs required to perform services under contract, including the issuance of a Common Access Card (CAC): Composite Health Care System (CHCS), TRICARE Online, Referral Management software/applications, Medical Readiness Decision Support System (MRDSS), Armed Forces Health Longitudinal Technology Application (AHLTA), MiCARE, Essentris, and general desktop settings. The government will provide training to the contract personnel on pertinent healthcare computer systems. Access to such patient data systems is considered a position of trust. Prior to being given access to such systems, contractor must have a background check as described in paragraph 1.8 and subparagraphs.

17.5. UTILITIES. Electricity, water, sewage, and heat shall be furnished by the Government, at no cost to the contractor for use in the performance of this contract.

17.6. LOGISTICAL SUPPORT. Individual logistical support is provided under this contract in accordance with FAR 25.802, DFARS 225.802, and the policies and procedures of DoD 4525.6-M and AFI 36-3026. Policies and procedures are subject to change. Examples of support are: DoD Common Access Card; Commissary (including rationed items); Base Exchange (including rationed items); Morale Welfare and Recreation facilities (e.g. chapels, clubs, cinema, fitness center); Military Banking Facilities; Military Postal Service (APO/FPO); Mortuary Services (on reimbursable basis); POV (Privately Owned Vehicle license); Purchase of POL (Petroleum and Oil products); Transient Billets or Visiting Officers Quarters (VOQ) on space-available and reimbursable basis when travel is performed on Official Government Orders; Department of Defense Dependent Schools on a space guaranteed and tuition paying basis; Medical services on a reimbursable basis; Dental care only for emergency conditions on a reimbursable basis; Pet Registration and Control and Housing Referral. Logistical support is not authorized for Local National hires as it is forbidden by the Status of Forces Agreement (SOFA). Local National hires may be authorized a CAC if their duties require access to Government computer programs.

17.6. SECURITY FORCES AND FIRE PROTECTION.

- Security Forces phone number: 911

- Fire Department phone number: 911

17.7. MEDICAL SERVICES. The following vaccinations are mandatory IAW AFI 44-108, Infection Prevention and Control Program. The government will offer them at no cost to the contractor upon contract award:

- Hepatitis B Vaccination Series

- Tuberculosis Skin Test (TST) or documentation of appropriate TB test within 12 months

- Human Immunodeficiency Virus (HIV) Test, every 2 years

- Measles, Mumps, Rubella/Rubeola (MMR) Vaccination or proof of immunity by titer screening

- Varicella Vaccination or proof of immunity by titer screening

- Tetanus/Diphtheria/Pertussis (Tdap) and booster Td booster every 10 years

- Influenza, annual and IAW DoD policy and annual AF/SG seasonal influenza memorandum

17.8. TRAINING. Reference sec. 15. The Government shall provide training on Government provided forms and equipment, and initial and continuing orientation. Training will be provided on the CHCS, Template Management, Automated Data Processing Equipment Custodian responsibilities, Medical Expense and Performance Reporting System (MEPRS), and ICD-9/ICD-10/CPT/ADM coding, AHLTA, MRDSS as required.

17.9. CONTRACTOR-OWNED/CONTRACTOR OPERATED EQUIPMENT.

Except for items or services specifically stated here to be Government furnished, the contractor shall furnish everything else required to perform this contract in accordance with this PWS.

17.9.1. Initial Inspection. All contractor-owned equipment shall be inspected and approved by the biomedical equipment maintenance section prior to use in the facility to ensure the equipment is safe for use and that it meets facility electrical standards. This includes but is not limited to personal items such as coffee makers and radios.

17.9.2. Replacement of Contractor-Owned/Operated Equipment. If, based on diagnostic testing and established industry standards, any contractor-owned/operated equipment is deemed unsafe by biomedical equipment maintenance section personnel, it shall be tagged as unserviceable and removed from use. Replacement of any equipment such removed shall be at contractor expense.

18. APPLICABLE PUBLICATIONS AND FORMS.

18.1. Publications and forms applicable to the performance work statement (PWS) are listed below. The contractor is obligated to follow those publications. Publications are available in the MTF and are maintained by the 35 MDG. Supplements or amendments to the below listed publications may be issued during the life of the contract.

18.1.1. The contractor shall immediately implement those changes in publications which result in no change in the price of the contract and notify the CO in writing as such.

18.1.2. Should the government determine a decrease in contract price results from such a change, the CO shall require a proposal for reduction in the contract price.

18.1.3. For any changes that the contractor determines should result in an increase to the price of the contract, the contractor shall notify the CO and submit a price proposal justifying the increase. This new price proposal shall be submitted to the CO within 30 days of receipt of the changes by the contractor. Failure of the contractor to submit a price proposal to the CO within 30 days from receipt of any changes shall entitle the Government to performance in accordance with such changes at no increase in contract price.

19. DEPARTMENT OF DEFENSE (DOD) REGULATIONS/MANUALS INSTRUCTIONS/DIRECTIVES:

|PUB NO. |TITLE |DATE |CHANGE |

|DODI 1402.5 |Criminal History Background Checks on Individuals in Child Care Services |Jan 93 | |

|DODI 4525.08 |DoD Official Mail Management |Aug 06 | |

|DOD 5200.02 |Personnel Security Program |Mar 14 | |

|DODM 5200.01 |DoD Information Security Program: Overview, Classification, and |Feb 12 | |

| |Declassification, Vol 1 & 2 | | |

|DOD 5210.42R |Nuclear Weapons Personnel Reliability Program (PRP) Regulation |Jun 06 |Nov 09 |

|DOD 5400.7-R |DOD Freedom of Information Act |Sep 98 |Apr 06 |

|DOD 5400.11R |DOD Privacy Program |May 07 | |

|DODD 5500.07 |Standards of Conduct |Nov 07 | |

|DODI 6000.11 |Patient Movement |May 12 | |

|DOD 6010.13- |Medical Expense and Performance Reporting System for Fixed Military Medical |Apr 08 |Apr 14 |

| |and Dental Treatment Facilities | | |

|DODI 6015.23 |Delivery of Healthcare at Military Treatment Facilities: Foreign Service |Oct 02 | |

| |Care; Third Party Collection; Beneficiary Counseling and Assistance | | |

| |Coordinators (BCACs) | | |

|DODM 6025.13 |Medical Quality Assurance (MQA) and Clinical Quality Management in the |Oct 13 | |

| |Military Health System (MHS) | | |

|DOD 6025.18R |DoD Health Information Privacy Regulation |Jan 03 | |

|DODI 6025.40 |Military Health System Data Quality Management Control Procedures |Nov 02 | |

|DODD 6040.41 |Medical Records Retention and Coding at Military Treatment Facilities |Apr 04 | |

|DODI 6040.42 |Medical Encounter and Coding at Military Treatment Facilities |Jun 04 | |

|DODI 6040.43 |Custody and Control of Outpatient Medical Records |Jun 04 | |

|DODD 8520.02 |Public Key Infrastructure (PKI) and Public Key (PK) Enabling |May 11 | |

|DODD 8570.01 |Information Assurance (IA) Training, Certification, And Workforce Management |Aug 04 | |

|DOD 8580.02R |DoD Health Information Security Regulation |Jul 07 | |

20. AIR FORCE INSTRUCTIONS:

|PUB NO. |TITLE |DATE |CHANGE |

|AFI 48-110 |Immunizations and Chemoprophylaxis for the Prevention of Infectious Diseases |Oct 13 | |

|AFPD 33-3 |Information Management |Sep 11 | |

|AFMAN 10-3902 / DoD5210.42 |Nuclear Weapons Personnel Reliability Program (PRP) |Nov 06 |Dec 12 |

|AFMAN 33-363 |Management of Records |Mar 08 |May 14 |

|AFM 31-116 |Air Force Motor Vehicle Traffic Supervision |May 12 | |

|AFI 31-401 |Information Security Program Management |Nov 05 | |

|AFI 31-501 |Personal Security Program Management |Jan 05 | |

|AFI 33-152 |User Responsibilities And Guidance For Information Systems |Jun 12 | |

|AFI 33-129 |Web Management and Internet Use |Feb 05 | |

|AFI 33-200 |Information Assurance Management |Dec 08 | |

|AFI 33-332 |AF Privacy Program |Jun 13 | |

|AFI 33-364 |Records Disposition-Procedures and Responsibilities |Dec 06 |May 14 |

|AFI 34-242 |Mortuary Affairs Program |Apr 08 |Jun 13 |

|AFI 36-2201 |Air Force Training Program |Sep 10 |Aug 13 |

|AFI 36-2910 |Line of Duty (Misconduct) Determinations |Oct 02 |Apr 10 |

|AFI 36-3002 |Casualty Services |Feb 10 |Feb 12 |

|AFI 36-3003 |Military Leave Program |Oct 09 |Feb 14 |

|AFI 40-102 |Tobacco Use in the USAF |Mar 12 | |

|AFI 40-701 |Medical Support to Family Member Relocation and Exceptional Family Member |Feb 12 | |

| |Program | | |

|AFI 41-102 |Medical Expense and Performance Reporting System For Fixed Military Medical |May 14 | |

| |and Dental Treatment Facilities (RCS: DD-HA(AR)1453)) | | |

|AFI 41-210 |Patient Administrative Functions |Jun 12 | |

|AFI 44-102 |Medical Care Management |Jan 12 | |

| | |J | |

|AFI 44-119 |Medical Quality Operations |Aug 11 | |

|AFI 46-101 |Nursing Services and Operations |Oct 11 | |

|AFI 48-105 |Surveillance, Prevention, and Control of Disease and Conditions of Public |Mar 05 |Oct 11 |

| |Health or Military Significance | | |

|AFI 48-123 |Medical Examinations and Standards |Nov 13 | |

21. OTHER REFERENCES:

|Information |Source Location |

|AFMS Referral Management Center User’s Guide | |

|DOD TRICARE Management Agency Medical Management | |

|Guide | |

|TRICARE Policy and Operations Manuals | |

| | |

|The Unified Biostatistical Utility (UBO) programs: | |

|Third Party Collections (TPC), Medical Services | |

|Account (MSA), and Medical Affirmative Claims (MAC) | |

|Appointment Standardization Commander's Guide to | |

|Access Success | |

|Defense Enrollment Eligibility Report System (DEERS) | |

|DOD TRICARE Management Agency Medical Management | |

|Guide | |

|American Joint Committee on Cancer (AJCC) | |

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