Q -- Medical Appointment Clerk

SECTION 1DESCRIPTION OF SERVICES 1.1 SCOPE: The contractor shall perform all duties and tasks required to provide medical appointment services to the 28th Medical Group beneficiaries. Performance shall be according to the requirements contained in this statement of work (SOW). Appointments shall be made following the 28th Medical Treatment Facility (MTF) appointing protocols, and comply with Military Health System (MHS) Access to Care standards (as required by 32 CFR 199.17). Appointments shall be made using a government provided electronic system -- Composite Health Care System (CHCS). 1.1.1 PLACE OF PERFORMANCE: The Contractor shall provide services at the 28th Medical Group, Ellsworth AFB, SD. 1.2 SPECIFIC TASKS: 1.2.1 Contractor shall register beneficiaries, when necessary, into the appointing and registration system, book appointments, book follow-up appointments, input cancellations, and reschedule appointments according to government provided appointing protocols and guidelines. The government may revise the appointment protocols and guidelines on an as needed basis and will provide updates to the contractor as necessary. Contractor errors in booking appointments will be tracked and used as a performance measure. These are not all inclusive, but examples may include sending a T-Con to the wrong provider, not obtaining and providing appropriate information from the patient, booking appointments contrary to 28 MDG appointing protocols, etc.(reference appendix 5, exhibit 1) 1.2.2 The contractor shall accept appointments by face-to-face contact and telephonically from authorized beneficiaries, MTF staff members, or by the automated appointment system. At no time will callers be asked to call back, even if appointments for a particular day are unavailable. Telephone calls shall be answered within 90 seconds. Time in Queue for customers should average no greater than 90 seconds as an overall monthly average. (reference appendix 5, exhibit 2) 1.2.3 Blocked calls shall never exceed 5%. Blocked call rates are based on the number of calls that can not be completed by the caller due to the call capacity of the telephone switch (i.e., all telephones lines are busy). (reference appendix 5, exhibit 3) 1.2.4 The abandoned rate for calls shall fall within acceptable levels of not greater than 18% as an overall monthly average. Calls are considered abandoned after a customer reaches the appointment queue then hangs up before talking with an appointing clerk. (reference appendix 5, exhibit 4) 1.2.5 All contractor personnel shall follow Air Force Medical Service customer service tenets/basics. Adherence to these tenets will be monitored as a performance measure using government validated staff and customer complaints received on written patient complaint forms, in e-mails, or other written staff feedback. They will include all transactions, T-Cons and appointments. (reference appendix 5, exhibit 5) 1.2.6 Automated appointment system to be used is the government provided CHCS. The contractor shall verify and update, as required, patient registration information (i.e., patient demographics, patient contact, and any additional health insurance data). Perform an eligibility check in the government provided Dependant Eligibility Enrollment Requirement System (DEERS). When necessary, perform a CHCS mini-registration. Issues with enrollment shall be referred to the onsite Tricare Service Center. 1.3 PERSONNEL. 1.3.1 The Contractor shall provide a point of contact. The point of contact shall have full authority to act for the Contractor on all matters relating to the daily operation of this contract. 1.3.2 The contractor's personnel shall read, write, and speak English. The contractor shall provide personnel that have an adequate skill level to interpret the patient's request for a medical appointment and apply the appropriate MTF appointing protocols to the request. 1.3.3 TRAINING. The government will provide the following training: (1) Composite Health Care System (CHCS) Training Note: The Contractor shall be required to sign and submit a Request for Functional Automated Information Systems Access memorandum for CHCS access. (2) DEERS (3) Newcomers Orientation (4) Medical Facility Unique Training (5) Security Training (6) Medical Treatment Facility (MTF) appointing protocols (7) Military Health System (MHS) Access to Care standards (8) Section specific safety briefing 1.3.4 Contractor personnel shall be required to be tested for tuberculosis annually at the 28 MDG at the expense of the government. 1.4 HOURS OF OPERATION. The contractor shall provide services normally Monday-Friday, 0630-1600. Peak times for appointments are usually 0630-0800. Call volumes will be expected to increase following holidays, extended weekends, and/or inclement weather. The contractor shall alter their staffing schedule, as necessary, to accommodate days/times of expected peak call volumes. The Contractor may be required to work during days that have been designated by installation commander or organizational leadership as days for reduced operations (i.e., MTF will be open but minimally manned; example - UTE days). The contractor is encouraged to conduct in-house training when clinic services are limited and/or call volumes are below normal. The MTF Group Practice Manager will coordinate any changes to the provider staffing schedules (i.e., inclement weather, clinic closures, etc.) with the contract QAPs and the Contractor. 1.4.1 HOLIDAYS and Designated ACC Down Days (i.e., ACC Family Day). The Contractor is not required to provide services on the observance day for the following federal holidays and any/all down days: New Year's Day Martin Luther King Day President's Day Memorial Day Independence Day Labor Day Columbus Day Veteran's Day Thanksgiving Day Christmas Day ACC Down Days (# per yr will vary) SECTION 2 SERVICE DELIVERY SUMMARY 2.1 The following Service Delivery Summary identifies 5 major performance objectives for the contractor. The appointing SOW paragraph and performance threshold for each are identified below. SERVICE DELIVERY SUMMARY Performance Objectives SOW Paragraph Performance Threshold 1. Error free appointments (See Exhibit 1, Appendix 5) 1.2. 99% 2. Calls answered within 90 seconds (See Exhibit 2, Appendix 5) 1.2.2. 90 sec overall avg/mth 3. Blocked Calls (See Exhibit 3, Appendix 5) 1.2.3. Shall not exceed 5% 4. Abandoned Calls (See Exhibit 4, Appendix 5) 1.2.3. Shall not exceed 18% 5. Customer Service Complaints (See Exhibit 5, Appendix 5) 1.3.2. 4 Complaints per month 2.2 Performance metrics: Please refer to Appendix 5 for the examples of metrics that will be used to track the performance of the contractor. SECTION 3 GOVERNMENT FURNISHED PROPERTY (GFP) AND SERVICES 3.1 Government Furnished Facilities/Services. The government will provide approximately 300 square feet within building 6000 for the appointing clerks. No alterations to the facilities shall be made without specific written permission and approval. In case of alterations necessary for compliance with OSHA, such permission shall not be unreasonably withheld. The contractor shall return the facilities to the government in the same condition as received, except for fair wear and tear and approved modifications. These facilities shall only be used in performance of this contract. 3.1.1 Government Furnished Utilities. These utilities include heating, electricity, water, and sewer. 3.1.2 Refuse Collection. The contractor shall comply with the Ellsworth AFB Recycling Program (EAFB PAM 32-1). 3.1.3 The appropriate medical care shall be provided, when necessary, in accordance with AFH 41-114 Military Health Services System Matrix. 3.1.4 Housekeeping 3.2 Government Furnished Equipment. All equipment necessary to accomplish the appointing procedures. List located in Appendix 4. 3.3 The government will provide, telephony (including telephones and headsets). The MTF will be responsible for the maintenance of the GFP. The Contractor shall be responsible for replacing or purchasing additional telephone headsets beyond the initial eight that have been provided. If, at any time, GFP is determined by contractor personnel to be broken, damaged, or inoperable in any way, the contractor shall notify the QAP(s) in writing. If it is determined that GFP was broken, damaged, or made inoperable by contractor personnel, whether by accident, neglect, or otherwise, the contractor shall be responsible for replacement &/or repair cost. 3.4 An inventory of all government furnished equipment must be accomplished annually or at any time deemed necessary by the QAP(s). The QAP(s) will coordinate a day/time with the contractor to accomplish this task together. An equipment property listing is provided as Appendix 4. SECTION 4 GENERAL INFORMATION 4.1 QUALITY ASSURANCE. The government will periodically evaluate the contractor's performance by appointing Quality Assurance Personnel (QAP) to monitor performance to ensure services are received. The QAP may evaluate the contractor's performance through intermittent on-site inspections of the contractor's performance and receipt of validated complaints. The government may increase or decrease the number of inspections based on contractor performance. The QAP shall make determination of the validity of customer complaint(s). In the event there is a dispute, the Contracting Officer will make the final determination. Government personnel will record all surveillance observations. The preferred method, when possible, of correcting contract defects is re-performance at no additional contract cost. At a minimum, contractor shall provide documentation of their efforts to preclude repeat deficiencies. 4.2 QUALITY CONTROL. The contractor shall develop, submit for CO acceptance, and maintain a quality control plan to ensure appointing services are performed in accordance with this statement of work and specifically address the Service Delivery Summary (SDS) items. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The plan shall be submitted within 15 days of award. 4.2.1 Minimum Requirements. The contractor's quality plan shall include, as a minimum: (1) Inspection System. A description of the inspection methodology used to cover all tasks and services. The description shall include specifics as to the areas to be inspected on a scheduled and unscheduled basis, frequency of inspections, submission of quality control inspection schedule, and the title and organizational placement of the inspectors. (2) Identification/Prevention Methods. A description of the methods to be used for identifying and preventing defects in the quality of service performed. (3) Documentation. The contractor shall document inspections and corrective or preventive actions taken. The record of inspections shall be kept and made available to the government throughout the contract performance period and for the period after contract completion until final settlement of any claims under this contract. (4) Key/Combination Control. The contractor shall establish and implement methods of making sure all keys/combinations issued to the contractor by the government are not lost or misplaced and are not used by unauthorized persons. The contractor shall not duplicate any keys issued by the government. The contractor shall immediately report to the QAP or contracting officer any occurrences of lost or duplicated keys. In the event keys, other than master keys, are lost or duplicated, the contractor may be required, upon written direction of the contracting officer, to re-key or replace the affected lock or locks without cost to the government. The government may, however, at its option, replace the affected lock or locks or perform re-keying and deduct the cost of such from the monthly payment due the contractor. In the event a master key is lost or duplicated, the government shall replace all locks and keys for that system, and deduct total cost from the monthly payment due the contractor. 4.3 SECURITY REQUIREMENTS. All personnel employed by the contractor in the performance of this contract, or any representative of the contractor entering the Government installation, shall abide by all security regulations of the installation. All employees shall possess base provided identification cards and Vehicle Registration Certificates for personal vehicles requiring access to Ellsworth AFB. When any employee no longer works for the contractor at the installation, the contract manager shall return any Government-furnished identification to the Government. These passes are at no cost to the contractor. QAP's shall act as the focal point for assisting the contractor in attaining the proper identification and badges. 4.3.1 Contractor employees shall wear visible identification badges on the front of outer clothing, between the neck and waist. 4.3.2 The contractor's employees shall have, a National Agency Check (NAC) completed in order to have access to government systems. Contractor is responsible for completing SF85P Worksheet and providing fingerprint cards for each employee prior to access to the installation. The contractor shall comply with regulations, DoD 5200.2-R, appendix K, and AFSSSI 5027, Section 5.3.3. Note: the contractor may request an interim clearance for access to government systems when the NAC has not been finalized at the time of employment. However, this interim access must be approved by the 28 MDG Commander, and evidence must be presented that shows the NAC has been initiated, pending favorable final approval. The POC for this will be the 28 MDG Security Officer. 4.4 PHYSICAL SECURITY: The contractor shall be responsible for safeguarding all government property provided for contractor use. At the end of each work shift, all government facilities, equipment, and materials shall be secured. The contractor shall designate a custodian and alternate(s) to receipt for and account for government-furnished facilities and equipment. 4.5 PRIVACY AND CONFIDENTIALITY 4.5.1 Patient Health Information (PHI). The contractor shall comply with all Health Insurance Portability and Accountability Act (HIPAA) guidelines. Patient information, lists and/or names of patients shall not be disclosed or revealed in anyway for any use outside the MTF without prior written permission by the MTF commander. Any unauthorized disclosures shall be immediately documented and forwarded to the QAP. The contractor shall maintain, transmit, retain in strictest confidence, and prevent the unauthorized duplication, use, and disclosure of PHI in accordance with Standards for Privacy of Individually Identifiable Health Information, final rule, December 28, 2000 DoD Health Information Privacy Regulation (DoD 6025.18-R), the Privacy Act, and DoD Privacy Program (DoD 5400.11-R). The contractor shall provide patient information only to employees, contractors, subcontractors, and government personnel having a need to know requirement for such information in the performance of their duties for this tasking. The MTF shall approve the release of any patient information prior to the release. 4.6 This section intentionally left blank 4.7 PERFORMANCE EVALUATION MEETINGS. The CO shall require the Contractor or his representative to meet with the CO, contract administrator, QAP, and other government personnel at least quarterly, and as often as deemed necessary. The Contractor may request a meeting with the CO when he deems such necessary. Meetings will be documented in the contract file with written minutes signed by the CO or designated official. Should the Contractor not concur with the minutes, such non-concurrence shall be provided in writing to the CO within ten (10) calendar days of receipt of the minutes. 4.8 PHASE-IN PERIOD. Up to 30 days orientation period may be provided prior to contract start date. This period is allowed for the new contractor to become thoroughly familiar with current work requirements and procedures. There will be no additional cost to the Government in offering this phase in period. 1.1 APPENDICES 1.1.1 APPENDIX 1 - ESTIMATED HISTORICAL DATA The following data is provided for information only. 1. EXEPECTED VOLUME OF WORK. The approximate annual level of effort is 48,383 appointing transactions per year. The beneficiary population consists of 12,000 TRICARE Prime enrollees. Majority (96%) of requests for appointments will be received telephonically. Approximately (4%) will be face-to-face or written requests from the MTF personnel. 2. SURGE REQUIREMENTS. Peak appointment hours are 0630 - 0800 Monday through Friday, with Monday morning being the heaviest, especially after long weekends. The summer months normally have a higher volume than the winter months. 1.1.2 APPENDIX 2 - DEFINITIONS/ACRONYMS 1. GENERAL DEFINITIONS. As used throughout this document, the following terms shall have the meaning set forth in accordance with the terms of this SOW and the contract. 1.1. CONTRACTING OFFICER (CO). A person duly appointed with the authority to enter into, administer, and terminate contracts on behalf of the Government. 1.2. GOVERNMENT. The federal government of the United States of America. 1.3. GOVERNMENT QUALITY ASSURANCE. Those actions taken by the Government to assure contractor services meet the requirements of the contract. 1.4. MEDICAL TREATMENT FACILITY (MTF). Air Force hospitals or clinics, including all activities providing outpatient and/or in-patient healthcare services for authorized personnel. 1.5.. STATEMENT OF WORK (SOW). A document that accurately describes a service in terms of the output requirements. 1.6. QUALITY ASSURANCE PERSONNEL (QAP). Government personnel who survey contractor compliance. They are the contractor's first point of contact for contract issues. 1.7. QUALITY CONTROL (QC). Those actions taken by a Contractor to control the quality of output and to ensure that they conform to contract requirements and reasonable standards of medical care. 1.8. BLOCKED CALL. Blocked calls are those that can not be completed by the caller due to the call capacity of the telephone switch (i.e., all telephones lines are busy; a call that cannot get through or gets a busy signal). 1.9. ABANDONED CALL. Calls are considered abandoned after a customer reaches the appointment queue then hangs up before talking with an appointing clerk. 1.10. APPOINTING ERRORS. A mistake in making an appointment. This could include booking the wrong type of appointment, overbooking a provider, booking to the wrong time slot, booking to the wrong provider, or failing to make a follow-up appointment. 2. ACRONYMS CHCS Composite Health Care System DEERS Dependant Eligibility Enrollment Requirement System MTF Medical Treatment Facility MHS Military Health System QAP Quality Assurance Personnel SOW Statement of Work 1.1.3 APPENDIX 3 - APPLICABLE PUBLICATIONS Publications and forms applicable to the SOW are listed below. The Contractor is obligated to follow those publications. These publications are available in the MTF and maintained by the Government. Supplements or amendments to listed publications from any organizational level may be issued during the life of the contract. 32 CFR 199.17 Appointment Standard Commander's Guide to Access Success DoD 5400.11-R, DoD Privacy Program DoD Directive 5500.7, Standards of Conduct DoD 6025.18-R, DoD Health Information Privacy Regulation AFH 41-114 Military Health Services System Matrix The Contractor shall abide by all Medical Group (unit level) Instructions published. The government is responsible to update these publications periodically. If updates cause a change in the contract (cost to increase or decrease) the contractor will be responsible to submit a written proposal to address the changes. 1.1.4 APPENDIX 4 - Government furnished equipment Property list Item Amt Computers 8 Printers 1 Telephones 8 Telephone Headsets 8 Telephone Software 1 Telephone Switch 1 Desks 7 Hutches 6 File Cabinets 5 Cabinet 1 Bookshelves 1 Chairs 10 Coffee Pots 2 APPENDIX 5 - Government performance metrics 1.1.5.1 Error Free Appointments 1.1.5.2 Calls Answered Within 90 Seconds 1.1.5.3 Percentage of Blocked Calls 1.1.5.4 Percentage of Abandoned Calls 1.1.5.5 Customer Service Complaints (All Transactions) 1.1.5.6 Customer Service Complaints (Appt Transactions only)