Audiological Services

Dobbins Air Reserve Base is issuing this sources sought synopsis as a means of conducting market research to identify parties having an interest in and the resources to support this requirement for an Installation of Manhole/Duct System and Fiber communication cables. The result of this market research will contribute to determining the method of procurement. The applicable North American Industry Classification System (NAICS) code assigned to this procurement is 621340. If your company can supply the service listed in the PWS/Specifications, please respond with an email stating your ability to satisfy this requirement and your socio-econimic category. This is a request for information "only" and may or may not actually result in the posting of a solicitation or an actual award. If you choose to participate, the due date for your submittal will be no later (NLT) 12:00pm Friday August 25, 2017. Thank you in advance for your interest and participation in our RFI process. We sincerely look forward to your timely submittal. THERE IS NO SOLICITATION AT THIS TIME. This request for capability information does not constitute a request for proposals; submission of any information in response to this market survey is purely voluntary; the government assumes no financial responsibility for any costs incurred. BASED ON THE RESPONSES TO THIS SOURCES SOUGHT NOTICE/MARKET RESEARCH, THIS REQUIREMENT MAY BE SET-ASIDE FOR SMALL BUSINESSES OR PROCURED THROUGH FULL AND OPEN COMPETITION. Telephone inquiries will not be accepted or acknowledged, and no feedback or evaluations will be provided to companies regarding their submissions Performance Work Statement (PWS) Audiological Services Dobbins ARB, Georgia 15 August 2017 1.1. Mission. 1.2. Scope. This contract shall serve as a vehicle to provide certified physicians who can perform audiological services for Department of Defense Civilians and United States Air Force Military members located at Dobbins Air Reserve Base, Georgia 1.3. Non-Personal Services. The services performed under this contract shall be non-personal services and are not inherently government. The prime contractor's staff, including all teaming partners, subcontractors and their staff at the corporate level involved in the company's or team's administration of this contract will hereafter be referred to as "contractor management staff." The prime contractor retains responsibility for any teaming partner or subcontractor and shall be accountable for their performance. The contract or management staff shall provide all tools, labor and materials required to recruit, qualify, train, place, manage and retain the medical suppose service supporting healthcare operations of the Air Force in accordance with the terms and conditions of this contract. 1.4. Definitions Authorized Agency is an agency point of contact who is authorized to make appointments with the contract. Contractor is a term used in this contract which refers to the prime contractor. Contracting Officer is a person with authority to enter into, administer or terminate contracts and make related determinations and findings on behalf of the Government. NOTE: The only individual who can legally bind the Government 1.5. Acronyms AFI Air Force Instruction ASTS Aeromedical Staging Squadron ARB Air Reserve Base BES Bioenvironmental Engineering Services BLDG Building DoD Department of Defense FAR Federal Acquisition Regulation HIPAA Health Insurance Portability and Accountability Act OH Occupational Health PPE Personal Protective Equipment PWS Performance Work Statement SF Standard Form Std Standard STS Standard Threshold Shift TIG Technical Implementation Guide WAWF Wide Area WorkFlow 2. General Requirements 2.1. The contractor shall ensure that audiology testing is performed by a licensed, credentialed and board certified audiologist who has graduated from an accredited audiology program and/or school. 2.2 Validation of qualifications, licensure, and certification (as applicable). The contractor shall provide written verification (to include photocopies where necessary) showing licensure, board certification, hospital affiliation (if any) and furnish a report of audiology examination test results to the 94 ASTS/SGP via contracting officer within 10-days after contract award. 2.3. HIPAA. Protected Health Information is the information protected by the Health Insurance Portability and Accountability Act of 1996. Access is limited to an official need to know, restricted to the minimum necessary to accomplish the purpose and is restricted to authorize discloses. Improper disclosure of the attached medical information will result in penalties (administrative actions, fines or imprisonment) as outlined in the Act itself. 3. Description of Services 3.1. The contractor shall provide all personnel, equipment, materials, and facilities necessary to perform audiology examinations. All services will be for DoD civilian personnel and USAF military members located on Dobbins ARB, GA. The contractor shall perform all work in accordance with this PWS and the contract. 3.2. Audiology examination will not be performed on non-DoD civilian personnel nor military personnel who are non-members of Dobbins ARB, GA. 3.3. The following examinations and services associated with examination will be performed by contractor ordered solely by 94 ASTS/SGP as needed for the performance period: CPT 92557 Complete Audiological Evaluation CPT 92567 Tympanogram CPT 92550 Tympanogram and Acoustic Reflexes CPT 92553 Air/Bone Conduction CPT 92568 Impedance Acoustic Reflex CPT 69210 Cerumen Removal CPT 92577 Stenger Speech CPT 92565 Stenger Pure Tone 3.4. Additional examinations may be provided but only if identified by audiologist and preauthorized by 94 ASTS/SGP and the CO. Additional examinations will not be priced 3.5. Contractor shall conduct audiology examinations and test under this contract between the hours of 8:00 am and 5:00 pm EST, Monday through Friday excluding federal holidays. Federal holidays excluded are: New Year's Day Martin Luther King Jrs' Day President's Day Memorial Day Independence Day Labor Day Columbus Day Veteran's Day Thanksgiving Day Christmas Day 3.6. All examinations and tests shall be performed in accordance with requirements which have been established, approved and documented by 94 ASTS/SGP or any of the forms identified below. The forms shall be provided to the contractor by the members at the time of the service unless prior coordination has been established between the contractor and 94 ASTS/SGP: AF 1753 Hearing Conservation Examination DD 2216 Hearing Conservation Data SF 513 Patient Referral 3.6.1. Audiology examination techniques must comply or be equal to the examination requirements prescribed by any of the following directives: AFI 48-123 Medical Examinations and Standards AFOSH Std 48-20 Air Force Hearing Conservation Program QSH Qualifications Standards Handbook USAF Technical Implementation Guide 1582-03 for NFPA Std 1582 4. Audiograms 4.1. The contractor shall be responsible to review audiograms IAW AFOSH Std 48-20 accomplished at 94 ASTS/SGP for all DoD Civilians and USAF military members identified on a DD 2216 4.2. The competed DD 2216 shall serve as written notification of audiogram results. However, this does not preclude the contractor from providing other written patient disposition when warranted to describe the patient's medical disposition. 4.3. Whenever a threshold shift has been verified by the 94 ASTS/SGP, the civilian or military member shall make an appointment the contractor and provide them with a completed completed DD 2216 and AF 1753. The contractor will perform an examination of the patient and then using the criteria found in AFOSH Std 48-20, shall determine whether a physiological problem caused the threshold shift and provide results to the civilian/military member and 94 ASTS/SGP. 4.4. A clinical examination of the ears, nose and throat will be performed by the examining practitioner on both the civilians and military members. During the examination the practitioner must note: (1) Cerumen plugging the ear canals (2) Otitis externa (3) Condition of the tympanic membranes (4) Any middle ear disease (5) Eustachian tube function (6) Any other ENT disease or condition, which might adversely affect the audiogram results (7) Any condition that may interfere with the wearing of hearing protection (permanently or temporary) 4.5. The contractor shall deliver all medical documentation IAW guidelines identified under section of eight (8) of this PWS. 5. Final Assessment and Disposition 5.1. The contracted physician shall review all examination results and histories to make a final determination if the individual is at an increased risk due to his/her health from any occupational exposures to which he/she is potentially exposed. 5.2. All assessments and dispositions shall be documented on any form identified under paragraph 3.5 of this PWS and any other accompanying documentation shall be delivered as identified under section seven (7) of this PWS. 5.3. The contractor shall verify audiology examination findings through verification of the original tests or any additional testing as prescribed by the contracting audiologist and after telephone coordination with 94 ASTS/SGP. 6. Relationship of Parties 6.1. It is expressly agreed and understood that the services rendered by the contractor and its employees are rendered in the capacity of an independent contractor. Although the government may evaluate the quality of both professional and administrative services for purposes of contract inspection and acceptance, it retains no control over the services rendered, including but not limited to professional judgements, diagnosis or specific treatments. 6.2. The contractor shall be solely responsible for any and all liability caused by the acts or commissions of its agents or employees 7. Indemnification 7.1. The contractor expressly agrees to indemnity, hold harmless, and to defend the government of the United States for all of its employees and agents acting officially or otherwise, from any and all liability, claims, demands, actions, debts and attorney fees arising out of claimed on account of or in any manner predicated on to loss or damage to the property of the injuries to, or death of any person whatsoever, which may occur as a result of or in connection with the services being provided under the contract. 8. Deliverables 8.1. The contractor shall provide to the 94 ASTS/SGP a current copy of any standards, guidelines and/or reference ranges used to interpret audiology test results 8.2. Contract physicians shall complete required form(s) and/or documentation in accordance with the corresponding Air Force Instructions, directive and policies identified under section 3.4.3. & 3.4.4. of this PWS 8.3. All examination results shall be reported on any forms identified under paragraph 3.6 and faxed to 94 ASTS/SGP at (678) 655-5297. Copies of results may be provided to civilian or military member at time of examination. 9. Monthly Lists/Reports 9.1. The contractor shall provide 94 ASTS/SGP a monthly list of all personnel tested prior to submitting invoices in WAWF. 9.2. List shall be itemized of all tests administered to include the date and cost of each test per individual. 9.3. The contractor shall annotate the monthly examination roster as follows: Status Disposition Completed Date Completed No-Show Date and reason, if any, if the individual failed to meet their schedule appointment 9.4. The contractor shall provide technical review of all examination data to ensure the highest level of quality control and accuracy of the completed audiology examination. In addition, the audiologist shall sign any form(s) identified under paragraph 3.6. of this PWS provided by the member at time of appointment as having provided an audiology exam.