01. PWS-Telehealth DRAFT.docx

PERFORMANCE WORK STATEMENT

1.0 GENERAL:

This performance work statement (PWS) describes the requirements for non-personal Telehealth Services to support the mission of the Indian Health Service (IHS).

1.1 Background: The Billings Area Indian Health Services (BAIHS) provides healthcare services to much of the Native American population within tribal communities of Montana where there are IHS healthcare facilities. Since most of the communities are in rural and remote areas, where alternative healthcare options are limited, the BAIHS intends to utilize telemedicine and tele-emergency services to provide essential patient care.

The BAIHS requires a contractor to provide comprehensive telehealth services to improve access, quality, and timeliness of specialty and emergency care.

2.0 SCOPE: The contractor shall provide comprehensive Telehealth Specialty Clinic Services, Telehealth Emergency Services Support, and Telehealth Behavioral Emergency Crisis Support Services to the BAIHS facilities. Each service will be provided according to performance standards defined in this PWS. The contractor shall be responsible for the planning, implementation, delivery, and management of these services on a basis of 24 hours per day, 7 days per week, 365 days per year and ensuring high-quality patient care while complying with all applicable federal regulations and standards.

2.1 Places of Performance: Contracted telehealth services shall be performed through the BAIHS Network that consists of the following locations:

2.1.1 Blackfeet Service Unit (BFSU):

· Blackfeet Community Hospital; Browning Montana

· Heart Butte Health Station; Heart Butte, Montana

2.1.2 Crow Service Unit (CSU):

· Crow/Northern Cheyenne Hospital; Crow Agency, Montana

· Lodge Grass Health Clinic; Lodge Grass, Montana

· Pryor Health Station; Pryor, Montana

2.1.3 Fort Belknap Service Unit (FBSU);

· Fort Belknap Hospital; Harlem, Montana

· Eagle Child Health Station; Hays, Montana

2.1.4 Fort Peck Service Unit (FPSU);

· Verne E. Gibbs Clinic; Poplar, Montana

· Chief Redstone Clinic; Wolf Point, Montana

2.1.5 Northern Cheyenne Service Unit (NCSU);

· Northern Cheyenne Health Clinic; Lame Deer, Montana

2.2 Period of Performance:

Base period of 12 months; with four (4) 12-month option periods:

Base: 12-month period Option Year 1: 12-month option period Option Year 2: 12-month option period Option Year 3: 12-month option period Option Year 4: 12-month option period

2.3 Hours of Operation:

Normal Outpatient Hours are Monday thru Friday; 8:00am – 4:30pm (MST) for regularly scheduled appointments and walk-ins.

Emergency Department, Urgent Care, and Inpatient Hours are 24 hours a day, every day of the year.

2.4 Federal Holidays:

The following holidays are observed by the BAIHS: New Year’s Day, Washington’s Birthday, Martin Luther King’s Birthday, Memorial Day, Juneteenth, Independence Day, Labor Day, Columbus Day, Veterans Day, Thanksgiving, Christmas, any day specifically declared to be a national holiday.

3.0 APPLICABLE DOCUMENTS:

· The Joint Commission; http://www.jointcommission.org

· Centers for Medicare and Medicaid Services (CMS) Standards.

· Health Insurance Portability and Accountability Act (HIPAA) of 1996.

· Privacy Act of 1974.

· Computer Security Act of 1987. https://www.congress.gov/bill/100th-congress/house-bill/145

· IHS Information Technology and Records Security and Safeguard Policies.

· IHS Computer Security Directives.

· IHS Director’s initiatives.

· HHS Information Security Program Policy.

· HHS Office of Security and Drug Testing, Personnel Security/Suitability Handbook, dated February 1, 2005.

4.0 DEFINITIONS:

Contracting Officer (CO): A Government employee authorized and warranted to issue contracts, and to make subsequent modification(s). The CO has full authority to make determinations on all changes and disputes regarding the contract.

Contracting Officer’s Representative (COR): An individual who is authorized/appointed by the contracting officer, that is responsible for monitoring the technical and administrative aspects of contractor performance throughout the contract lifecycle.

Contractor: The individual awarded a legal binding contract to provide Telemedicine Services as described in this performance work statement.

Credentialing: The process of verifying information about providers/physicians to ensure legitimacy and experience from the time they receive their degree until they apply at your facility. Credentialing is an activity that may be broken into three distinct phases:

1. Data gathering, verification, storage, dissemination and recommendation to the CMO

2. Analysis of collected information and development of a recommendation (CMO to the Medical Staff)

3. Decision-making based upon recommendations (governing body) Federal Acquisition Regulation (FAR): The FAR is the primary regulation for use by all Federal Executive agencies in their acquisition of supplies and services with appropriated funds.

Health Center: A facility physically separated from a hospital, with a full range of ambulatory services including at least primary care physicians, nursing, laboratory, and x-ray which are available at least 40 hours a week for outpatient care.

HL7 format: Health Level Seven is one of several American National Standards Institute. “Level Seven” refers to the highest level of the International Standards Organization’s (ISO) communications model for Open Systems Interconnection (OSI) – the application level. The application level addresses definition of the data to be exchanged, the timing of the interchange, and the communication of certain errors to the application. The seventh level supports such functions as security checks, participant identification, availability checks, exchange mechanism negotiations and, most importantly, data exchange structuring.

Hospital Representative: An employee designated (by the Contracting Officer) to be the primary contact at a facility. The Hospital Representative is authorized to contact the Contractor regarding problems and/or issues involving the day-to-day operations of the facility. This person does not have the authority to modify or make changes to the contract. This right is reserved solely for the Contracting Officer.

Ordering Activity: An authorized user of IHS that may issue a task order to obtain required services under this contract.

Ordering Activity Contracting Officer: A Government employee of the IHS, who is authorized and warranted to issue task orders and make subsequent task order modification(s) under this contract. The Ordering Activity CO has the authority to make initial determinations on all matters of dispute regarding task orders.

Past Performance Information: Relevant information regarding a contractor’s actions under previously awarded contracts. This includes the contractor’s record of conformance to specifications and to standards of good workmanship; the contractor’s record of containing and forecasting costs on any previously performed cost reimbursable contracts; the contractor’s adherence to contract schedules, including the administrative aspect of performance; the contractor’s history for reasonable and cooperative behavior and commitment to customer satisfaction; and generally, the contractor’s business-like concern for the interest of the customer.

Peer Review: Quality assurance action conducted by the Contractor to ensure accurate performance of the telemedicine services.

Performance-based Services Contracting (PBSC): Contracts which structure all aspects of an acquisition around the purpose of the work to be performed with the contract requirements set forth in clear, specific, and objective terms with measurable outcome as opposed to either the manner by the work is to be performed or broad and imprecise statement of work.

Quality Assurance Surveillance Plan (QASP): A written document prepared and used by the government for Quality Assurance surveillance of the contractor’s performance.

Referring Facility Physician: An IHS medical professional, or his/her designee, who is responsible for patient referrals.

Service Unit: The local administrative unit of IHS.

Written: defined as either electronic or telefax or transcribed transmission.

5.0 GENERAL REQUIREMENTS:

5.1 PERFORMANCE OF CONTRACTED SERVICES:

The tele-health services are to be provided via the agency’s existing video and network infrastructure as delineated in the Appendix D, IT System Environment. Cloud services are not to be utilized for this contract, unless, the contractor’s system meets the requirements described under Appendix F, Cloud Services Definition and Requirement.

The Contractor shall determine and provide necessary equipment and software to enable telehealth solutions (not inclusive of the IHS network). This includes, but is not limited all telehealth acquisition modalities and supporting Health Information Technology (HIT) as required by the scope of the Specialty and Emergency Telehealth Services.

Contractor is expected to use evidence-based diagnostic and treatments protocols and decision-making algorithms that assist in the delivery of the highest quality care in the safest and most reliable manner. Contract providers are expected to follow the IHS formulary list maintained by the IHS facility Pharmacy and Therapeutics Committee. In cases where patients require in-person office visits or other specialized treatment, Contractor will communicate this information to the referring provider and will, when possible, facilitate the patient’s ongoing care.

5.2 EHR / HEALTH RECORDS:

The Contractor shall be required to utilize the facility Electronic Health Record (EHR) for all patient encounter documentation. The contractor shall complete all documentation required by the Health Information management department (HIM). This includes completing all coding and purpose of visit diagnoses.

All medical records must meet acceptable standards as determined by the hospital’s Quality department and the Health Information Management (HIM) Department. All Contract staff are expected to complete all EHR patient encounter notes, Purposes of Visits (POV) and medical levels on every patient, within 24 hours of the patient visit. Medical record deficiencies can seriously impact the ability of the hospital to bill alternate resources. Therefore, any significant medical deficiencies may prevent processing of final purchase orders. If this situation occurs, the Area Office contracting office and contracting company shall be promptly notified in order to quickly rectify. If any provider is not complying with the documentation standards, the contractor will give the provider one opportunity to improve. If the standard is not met after remediation, the contractor will replace the provider.

5.3 CONTRACTOR STAFFING / KEY PERSONNEL / QUALIFICATIONS:

The Contractor shall ensure an adequate level of staffing to meet the requirements and that all contractor staff’s credentials (e.g., security clearance, computer security training, and degrees and/or certifications, etc.) are current and approved within both IHS and Joint Commission accreditation standards.

The Contractor shall be responsible for providing personnel of an adequate skill and educational level. Contractor personnel must maintain their skill and education levels throughout the performance of this contract.

The Government will neither supervise Contractor employees nor control the method of performance. The Contractor is responsible for personnel management and shall promptly notify the Contracting Officer (CO) of any Government action that appears to create a personal services relationship.

Key personnel changes that affect the contract must be communicated to the COR and SU point of contact, within 48 hours of the change.

5.3.1 Project Manager:

· The contractor shall designate a project manager, and alternate, who is responsible for the day-to-day contract matters. The name of this person, and an alternate(s) who must act for the contractor when the manager is absent, must be designated in writing to the contracting officer.

· The project manager or alternate must have full authority to act for the contractor on all contract matters relating to the daily operation of this contract.

· The project manager or alternate must be available within 30 minutes during normal business hours to meet with government personnel (designated by the contracting officer) to discuss problem areas. After normal business hours, the manager or alternate must be available within 4 hours.

· The project manager and alternate(s) must be able to read, write, speak, and understand English.

5.3.2 Clinical Staff:

· Contractor shall ensure that all clinical staff are culturally sensitive and appropriate.

· Contractor shall furnish qualified, licensed, and privileged providers appropriate to the telehealth services that are authorized through this contract.

· The contractor shall be responsible for ensuring that personnel maintain their skill and education levels throughout the life of the contract. Personnel selected by the contractor must already have the necessary education, training and/or certifications to perform the requirements of this contract prior to reporting to work under this contract.

5.3.3 Contractor Employee Security Clearance:

Contractor staff shall complete federal background investigations and PIV enrollment per IHS procedures. Personnel deemed unsuitable must be removed immediately.

5.3.4 Contractor Employee Qualifications:

· General:

Current BLS and ACLS certifications are required of all emergency service contractors. NRP, PALS, and ATLS certifications preferred but not required of all contractors. Licensed independent practitioners must fulfill all the requirements for appointment to the IHS Medical Staff and for the granting of privileges in emergency medicine, in accordance with IHS policies and with the Medical Staff Bylaws of the BAIHS, including absence of exclusions or sanctions from the Medicare/Medicaid programs.

· Physicians:

Must be Board-Eligible or Board Certified in their chosen specialty and have at least 24 months of direct patient care experience with the last 48 months.

· Emergency Physicians:

Must be Board-Eligible or Board Certified, by the American Board of Emergency Medicine, Family Practice, Internal Medicine (with competencies in pediatric emergencies), Pediatrics (with competencies in adult emergencies) or other recognized board. and have at least 24 months of direct patient care experience in a Level 1 or 2 Trauma Center within the last 48 months.

· Advanced Practice Nurses:

Must possess a graduate or higher-level degree in nursing from an accredited educational program in the area of expertise or specialty indicated by the position. Must have passed the National Council Licensure Examination. In addition, must possess a current, active, full, and unrestricted license or registration as a professional nurse from a State, the District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States. At least 24 months of direct patient care experience within the last 48 months.

· Nurses:

Education: A graduate or higher level degree, bachelor's degree, associate degree, or diploma from an accredited professional nursing educational program is required. This education must have been accredited by the Commission on Collegiate Nursing Education(external link), Council on Accreditation of Nurse Anesthesia Educational Programs(external link), Accreditation Commission for Midwifery Education(external link), or an accrediting body recognized by the U.S. Department of Education(external link) at the time the degree was obtained.

Degree from Foreign Nursing School: Official certification from the Commission on Graduates of Foreign Nursing Schools (external link) is required for individuals who graduated from foreign nursing schools.

At least 24 months of direct patient care experience as an emergency department nurse at a Level 1 or 2 Trauma Center within the last 48 months. Sexual Assault Nurse Examiner Registered Nurse with training and certification as a Sexual Assault Nurse Examiner.

5.3.5 Contractor Employee Required Knowledge:

All contract licensed providers assigned by the Contractor to perform services covered by this contract shall have the following:

· Ability to collect, organize, record, and communicate, in a meaningful way, data relevant to primary health assessments including detailed family and medical history, physical examinations and selective laboratory tests in order to evaluate and treat adult medicine patients at a healthcare facility.

· Ability to identify medical conditions that warrant medical treatment available at the local hospital or healthcare facility and when to transfer patient to higher level of care facility for indicated medical care.

· Ability to assess the physical-psychosocial health status of patients and family based upon the knowledge of growth and development patterns and health conditions that require medical management.

· Knowledge of pharmaceuticals in order to recognize the desired effects, side effects and complications of their use.

· Knowledge of human behavior during stressful situations in order to exercise emotional control, tact, patience, and reliability in providing urgent patient care.

· Ability to provide individual and family counseling, guidance, and health instruction to help patients to understand how to prevent disease and maintain good physical and mental health.

5.3.6 Contractor Employee Licensure & Accreditation:

All contract licensed providers assigned by the Contractor to perform the services covered by this contract shall have a current license to practice in any State, the District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States.

All licenses held by the personnel working on this contract shall be full and unrestricted licenses. Contract providers who have current, full, and unrestricted licenses in one or more states, but who have, or ever had, a license restricted, suspended, revoked, voluntarily revoked, voluntarily surrendered pending action, or denied upon application shall not be considered for the purposes of this contract.

The contractor is responsible for assuring that all persons, whether they be staff, agents, subcontractors, providers, or anyone acting on behalf of the contractor, are properly licensed always under the applicable state law and/or regulations of the provider’s license, and shall be subject to credentialing and privileging requirements by IHS.

Contractor staff qualifications, licenses, and certifications shall be maintained throughout the contract period of performance. All actions required for maintaining certification shall be kept up to date always. Documentation verifying current licenses and certifications shall be provided by the contractor upon request.

5.3.7 Contractor Employee Credentialing & Privileging:

Credentialing and privileging of all health care providers who are permitted by law and the facility to practice independently shall be done in accordance with the provisions of IHS. All credentials shall be issued by accredited institutions in the United States and subject to primary source verification. The contractor shall make available their credentialing policy and procedures for review by the IHS which time IHS may decide to offer or decline privileging by proxy.

Upon contract award, the contractor shall ensure all clinical contractor staff meet requirements for being Credentialed and Privileged in accordance with HHS Regulation and IHS policy. Credentialing and Privileging shall include, but is not limited to: verification of U.S. licensure, board-certification, periodic quality assurance review, and provider database queries, including the National Practitioner Data Bank.

5.4 TRAINING & TIER 1 SUPPORT:

The Contractor shall train originating-site staff, on an as-needed basis, to support Tele-ED and Tele-BH workflows and provide Tier 1 troubleshooting for contractor-supplied clinical systems. Network, domain, and enterprise hardware are under IHS OIT control.

5.5 CORRESPONDENCE AND CONFERENCE CALLS:

A bi-weekly conference call will be scheduled between the BAIHS, its applicable team members, and the Contractor. The Contractor shall provide weekly updates and correspondence as determined necessary by the COR and/or BAIHS CMO. The weekly conference call schedule may be adjusted as determined by the COR.

5.6 BILLING:

The Contractor shall provide information concerning Contractor services that are authorized for billing. This information must include, but is not limited to, Medicare/Medicaid billing identification numbers and identifiers. The Contractor shall work with the IHS facilities to facilitate billing for services by IHS facilities. At the time of award billing addresses will be determined for each facility.

5.7 QUALITY CONTROL:

The Contractor shall perform a quarterly Quality Control peer review on the telemedicine services specific to each facility location covered under this contract according to the requirements of the Billings Area Medical Staff peer review procedure. This Quality Control (QC) peer review shall occur as part of the Contractor’s The Joint Commission-Compliance Quality Control program.

The Contractor must also provide a mechanism for independent review of patient visits identified by either the IHS sending facilities and or the Contractor as inaccurate or of concern; this information must include all adverse events that result from the telemedicine services provided by the distant site physician or practitioner to the hospital’s patients and all complaints the hospital has received about the distant-site physician or practitioner. BAIHS reserves the right to request a more focused peer review.

5.7.1 Quarterly reports, via either hard copy or electronic mail, should be forwarded to the COR and the COR will forward to the BAIHS Centralized Credentialing Office. Quarterly reports will be submitted 3 months, 6 months, 9 months and 12 months after the start of the contract. The contractor must submit the quarterly report within 10 working days from the beginning of each marked quarter. These reports shall express peer review discordance rates and any additional information that is pertinent to the Contractor’s performance of quality assurance for the telemedicine services provided.

5.7.2 GOVERNMENT QUALITY ASSURANCE: The Government will evaluate performance per the Inspection of Services clause and the Quality Assurance Surveillance Plan (QASP).

5.7.3 CONTRACT PERFORMANCE WORKING GROUP (CPWG) Meetings:

The contractor and government will convene quarterly CPWS meetings to review contract performance. The members of the CPWG will include, as a minimum, the contractor project manager, the government contracting officer, the COR, and additional members as determined by the CPWG. The CPWG will discuss such issues as the contractor’s performance against the PRS standards and whether they are meeting or exceeding acceptable quality levels, whether performance standards are measuring and incentivizing the right performance outcomes, any changes that need to be made to performance standards or acceptable quality levels, any problems affecting contract/mission performance and steps that can be taken to mitigate risk, other topics as determined by CPWG members. Written minutes of each CPWG meeting must be recorded and signed by the project manager and the contracting officer or contract administrator. If the contractor does not concur with any portion of the minutes, such nonoccurrence must be provided in writing to the contracting officer within five calendar days following receipt of the minutes.

5.7.4 QUALITY CONTROL PLAN: The contractor must provide a quality control plan to the contracting officer for acceptance no later than the pre-performance conference. The contracting officer will notify the contractor of acceptance or required modifications to the plan before the contract start date. The contractor must make appropriate modifications and obtain acceptance of the plan by the contracting officer before the contract start date. The plan must include:

· A description of the methods to be used for identifying and preventing defects in the quality of service performed.

· A description of the records to be kept to document inspections and corrective or preventive actions taken.

5.8 CUSTOMER SERVICE:

The Contractor shall identify a lead point-of-contact for questions and issues related to clinical service delivery. The Contractor shall also identify a customer service representative to assist IHS staff with billing and/or administrative questions during regular business hours 8:00 A.M. to 5:00 P.M. Monday through Friday (Mountain Time). The Contractor shall maintain a toll-free telephone number or equivalent telephone service 24 hours per day with an answering service. A list of POCs for the IHS Billings Area Service Units is provided in Appendix B.

5.9 TRAVEL:

The Contractor will be responsible for coordinating the logistics of all training to include travel, per diem, lodging of non-federal subject matter expert instructors. Travel for training participants will not be covered under this contract unless expressly ordered under a separate CLIN. Travel costs will be all-inclusive.

5.10 PHYSICAL SECURITY

The Contractor shall safeguard Government-furnished property and secure it at the end of each work period.

5.11 RECORDS:

The Contractor shall create, maintain, and produce only those records required by this PWS or mandatory directives. Upon request, provide originals or reproducible copies within five business days.

6.0 PERFORMANCE REQUIREMENTS:

6.1 Telehealth Specialty Clinic Services:

SCOPE:

The primary function of the telehealth provider shall be to provide remote patient care services in the specialty of their training.

REQUIREMENTS:

· Contractor shall be responsible for the planning, coordination, development, and overall management necessary to provide Telehealth Specialty services to IHS patients.

· Telehealth visits shall be scheduled for conditions or problems in which a virtual visit is most likely to be suitable, for example, but not limited to:

1) management of chronic conditions such as diabetes or hypertension;

2) discussion of test results or diagnostic studies

3) counseling about diagnostic and therapeutic options;

5) medication management;

6) nutrition counseling

· Contractor shall receive referrals from a patient’s primary care provider. Referrals will be made via the IHS Electronic Health Record. Virtual visits will be conducted in the outpatient clinic setting and scheduled within the normal business hours.

· Specialties mutually agreed upon based on the needs within the community may include:

· Endocrinology

· Rheumatology

· Dermatology

· Nephrology

· Cardiology

· Neurology

· Gastroenterology

· Hepatology

· Infectious Diseases

· Behavioral Health: Psychiatry, Psychology, Counseling (both Adult and Pediatrics)

· It is expected that patients will be scheduled for a virtual visit within 30 days of the placement of a referral. To maintain continuity, Contractor will provide, when possible, access to the same provider for patients with additional visit needs. It is expected that all visits will be conducted as scheduled, but if they are a no show, the BAIHS is unable to bill for that patient visits. The Contractor will document Telehealth Specialty Clinic visits into the IHS EHR directly. Accurate Common Procedural Terminology (CPT) coding and Evaluation & Management (E/M) coding shall be documented for all clinic patient encounters.

· Assigned work shall be accomplished by qualified personnel with appropriate combinations of education, training, licensure/certification and experience.

STAFFING:

· Physicians

· Advanced Practice Nurses

6.2 Telehealth Emergency Services Support:

SCOPE:

Emergency Consultation -- Services may include assessment of patients upon admission to the ED, interpretation of patient symptoms and clinical tests or data, consultation and assistance to on-site staff administering treatments or pharmaceuticals, assistance in documentation during “code blue” and other emergencies, and/or coordination of patient transfer from the local ED.

Emergency Sexual Assault Forensic Examiner (SAFE): The contractor shall provide an option to have telehealth services that provides sexual assault medical forensic evidentiary examination support from a certified Sexual Assault Nurse Examiner (SANE) or SAFE. Consultative assistance to Service Unit’s emergency department staff for documentation and collection of evidence via audio and video equipment in accordance with the National Protocol for Sexual Medical Forensic Examinations for Adults/Adolescents and National Protocol for Sexual Abuse Medical Forensic Examination Pediatric and Service Unit’s policies, protocols, and procedures. Contractor is expected to use evidence-based diagnostic and treatments protocols and decision-making algorithms that assist in the delivery of best possible patient care. All patients shall be assured of their privacy and personal dignity. The Contractor shall ensure that contract staff maintain open and professional communication with IHS staff. The Contractor will promote culturally appropriate advocacy for all individuals.

REQUIREMENTS:

· It is expected that Emergency Services are available 24 hours/7 days per week. The contractor shall ensure that employees and required services are available 24 hours/7 days per week.

· The Contractor distant site clinical staff shall respond within 2 minutes of being summoned by the originating site.

· The Contractor shall provide real-time tele-Emergency room support services to the IHS BAIHS Emergency and Urgent Care Departments. Distant site Tele-ED providers will evaluate, treat, and follow-up originating site IHS patients facilitated by an originating site Presenter, or will provide consultation services to an originating site IHS provider. Originating site Presenter services will be provided to initiate and conclude each encounter.

· Assigned work shall be accomplished by qualified personnel with appropriate combinations of education, training, licensure/certification and experience.

STAFFING:

· Emergency Physicians

· Nurses

6.3 Telehealth Behavioral Emergency Crisis:

SCOPE:

The Contractor shall provide screening, psychiatric assessment, treatment planning, problem resolution, resource management, mental health services, counseling and crisis management as they relate to the crisis emergency health care and discharge planning needs of the patient/family. The Contractor will be responsible for collaborating with the IHS Emergency Department.

The work shall be performed in a virtual mental health setting with everchanging variables within the BAIHS Emergency and Urgent Care Departments (ED). The work involves contact with patients and families who are demanding, controlling or belligerent. The work involves contact with patients who are mentally impaired, intoxicated, and under duress. Patients can be an imminent risk to self and others. Care may require assistance from other medical staff where the patient is currently presenting.

The contractor must perform the essential duties and responsibilities with or without reasonable accommodation efficiently and accurately without causing a significant safety threat to self or others. The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and/or skills required of all personnel classified in this position.

REQUIREMENTS:

· Contractor shall be responsible for the treatment planning, coordination, development, and overall management necessary to provide Telehealth Behavioral Emergency Crisis Support Services to IHS patients.

· It is expected that Behavioral Emergency Crisis Support Services are available 24 hours/7 days per week. The contractor shall ensure that employees and required services are available 24 hours/7 days per week.

· The Contractor shall provide real-time Telehealth Behavioral Emergency Crisis Support Services to the IHS BAIHS Emergency Departments. Distant site Tele-ED providers will evaluate, treat, and follow-up originating site IHS patients facilitated by an originating site Presenter, or will provide consultation services to an originating site IHS provider. Originating site Presenter services will be provided to initiate and conclude each encounter.

· Contractor shall provide 24 hours/7 days per week, On-Call Behavioral Health Services outside of normal business hours for each facility. On-Call services will be required to call back within 15 minutes of initiated request for behavioral health services.

· Assigned work shall be accomplished by qualified personnel with appropriate combinations of education, training, licensure/certification and experience.

TREATMENT PLANNING:

· Contractor shall complete an Emergency or Psychiatric assessment, and document the findings in the EHR System.

· Contractor shall utilize evidence-based practices, and culturally sensitive models to develop care plans.

ASSESSMENT:

· Contractor shall screen patients using high-risk indicators, including, but not limited to: Suicidal frequent hospitalization support systems; Homelessness; Abuse; Neglect; Exploitation; and Domestic Violence.

· Contractor shall assess for immediate suicidal needs. Contractor shall develop and coordinate a discharge plan as determined by the patient’s medical condition, level of independence, functional capacity, family/social support systems, and financial resources.

· Contractor shall also assess for emergent patient care needs by identifying probable changes in level of suicidality in collaboration with the interdisciplinary care team.

· The assessments will consider the impacts of the social, psychological, and physical/spiritual conditions. Assessments will also include homelessness, isolation, insufficient family support, domestic violence, neglect, and abuse.

· Advocate for patients in a manner supported by the treatment plan. Gather and review client information at each client encounter.

· Coordinate and document inpatient referral process by contacting referral facilities until patient has been accepted and assist clients to complete admission requirements. Monitors progress in treatment and documents in the EHR system tagging the ER doctor, local BHS Director and other mental health providers involved in their follow up care to facilitate a smooth hand-off.

· Contractor shall track adult and adolescent in-patient psychiatric referrals and assessment until patient is transferred to outside referral center.

· Assist with identification and coordination of transportation and utilizes knowledge of locally available public transportation resources.

· Effectively communicates to patient progress in their treatment program.

· Assists patient with completion intake/discharge documentation as needed.

· Assist with maintaining patient files, monitoring for attendance and closing files in the EHR system.

DISCHARGE PLANNING:

· Contractor shall collaborate in discharge planning for patients.

· Contractor shall provide information and education on community resources to empower patient/family decision making once patient is stabilized.

· Contractor shall communicate the discharge plan to patient/family and the interdisciplinary care team by timely documentation in the electronic health care medical record, tagging the ER Doctor and local BHS OP facility for discharge planning or coordination to a higher level of care.

· Contractor shall document assessment and overall discharge plan in EHR reflecting critical thinking regarding patient needs, suicidal ideation, concrete plan in an effort to facilitate a safe discharge plan.

· Contractor shall assure key regulatory requirements are met as defined by the Center for Medicare and Medicaid, Joint Commission, CARF and AAACH.

· Contractor shall develop appropriate and medical necessary care plan dispositions for patients based on clinical assessment and judgment; providing feedback to Emergency Department physicians and attending physicians via phone and documentation in the EHR system.

· Contractor shall coordinate admissions to Inpatient and Outpatient Programs.

STAFFING:

· Psychiatrists

· Psych NP

· LCSW

· LCPC

7.0 OTHER REQUIREMENTS:

7.1 Interconnection Security Agreement (ISA) and Network Security: Prior to connecting to any IHS system or network, the Contractor shall have an executed Interconnection Security Agreement (ISA) in place and shall implement all required security controls; the ISA and associated approvals must be obtained prior to initial connection. The Contractor shall ensure local telecommunication/network firewalls, encryption, and procedures are consistent with HIPAA, applicable FIPS guidance, and ACR requirements, and shall ensure any on-site Contractor personnel are escorted by cleared IHS staff and do not gain network access without meeting IHS access requirements.

7.2 IT Environment: Tele-ED and Tele-BH will operate over IHS’s existing network and video environment as approved by IHS OIT. The Contractor shall use the IHS EHR/RPMS or successor to document care consistent with the established documentation standards of this PWS.

7.3 Handling of Data: The Contractor agrees to the extent that it receives or is given access to data necessary for the performance of contract which contains restrictive markings, the Contractor shall treat the data in accordance with such markings unless otherwise specifically authorized in writing by the Contracting Officer.

7.4 Security of Data: The Contractor shall comply with any security requirements established by HHS to ensure proper and confidential handling of data and information. The Contractor shall refer to “HHS Cybersecurity Program.”, which is HHS’ Information Security Program Policy, dated June 2010.

The contractor shall become familiar with the HHS Departmental Information Security Policies. “HHS Cybersecurity Program” develops policies, procedures, and guidance to serve as a foundation for HHS' information security program. These documents implement relevant Federal laws, regulations, standards, and guidelines that provide a basis for the information security program at the Department. The contractor must become familiar with ‘HHS Cybersecurity Program” guidelines.

Data obtained for this contract shall not be used to create databases or any other product not intended for use specifically in this project. All data containing personal identifiers shall be handled in accordance with the Privacy Act of 1974 (Public Law 93-579). No data is to be released to anyone without the specific approval of the COR and the Contracting Officer

7.5 HHS-Controlled Facilities and Information Systems Security: To perform the work specified herein, Contractor personnel are expected to have routine (1) physical access to an HHS-controlled facility; (2) logical access to an HHS-controlled information system; (3) access to sensitive HHS data or information, whether in an HHS controlled information system or in hard copy; or (4) any combination of circumstances (1) through (3).

To gain routine physical access to an HHS facility, logical access to an HHS-controlled information system, and/or access to sensitive data or information, the Contractor and its employees shall comply with Homeland Security Presidential Directive (HSPD)-12, Policy for a Common Identification Standard for Federal Employees and Contractors; Office of Management and Budget memorandum (M-05-24); and Federal Information Processing Standards Publication (FIPS PUB) Number 201; and with the personal identity verification and investigation procedures contained in the following documents:

HHS Information Security Program Policy.

HHS Office of Security and Drug Testing, Personnel Security/Suitability Handbook, dated February 1, 2005.

List of Attachments and Exhibits:

A1: Part 8 Chapter 12 Information Technology Security A2: Business Associate Agreement A3: Distant Site Telemedicine Entity Credentialing and Privileging Agreement A5: Internal Use Software A6: Indemnification and Governing Law A7: HHSAR FAR Clauses

7.6 Business Associate Agreement (BAA): The Contractor shall complete an approved copy of a BAA to IHS, prior to performance of any actions related to the contract.

7.7 Patient Data Security Plan: The Contractor shall describe the security plan for patient data. This includes location of physical servers and reading centers in support of contractor services. The plan should include any encrypted wireless systems used by reading providers. All wireless systems must be FIPS-140 compliant.

7.8 Encryption Protocols: Contractor will provide the ability to comply with IPsec VPN standards for encrypting communications. All communications between participating facilities and contractor that are transmitted outside the IHS Wide Area Network must be encrypted.

7.9 Section 508 Compliance: Contractor shall conform to Federal 508 requirements which address accessibility for personnel with disabilities. Contractor shall procure a waiver if Section 508 applicability does not exist or relates to the contract. Please refer to http://www.section508.gov for more information.

7.10 Government System User Access Requirements: If Contractor personnel require logical access to any IHS-controlled information system, Government account, or network resource to perform this contract, such access shall not be granted until required access request documentation is approved and the individual has completed Government-required IT Security Awareness Training and signed any applicable Information System Security Agreement (ISSA) and Rules of Behavior (ROB); training must be current prior to initial access and maintained annually. The Contractor shall notify the COR within one (1) business day when personnel no longer require access so accounts may be modified or terminated.

7.11 Additional Requirements Concerning Data, Data Rights, and Computer Software: Notwithstanding any other clause concerning data, data rights and computer software and hardware under this Contract: all data produced, recorded, transferred or manipulated under this Contract shall remain the exclusive property of the Government irrespective or the manner or method of recording or storage and no matter what form of computer mechanism is used in the processing of said information or data. The Government shall retain exclusive right and domain over any by-product produced under this Contract, or any other use of the data produced under this Contract by either plan or accident.

No software will be developed, modified, or enhanced under this acquisition. Copies of the final Reports and Deliverables under each task must be officially sent to the Indian Health Service and kept on file by the Contractor. At the end of the contract, all files must be kept by the Contractor for audit purposes.

Works other than Software Development or Enhancements:

All materials furnished or produced by the Contractor, relating to work performed, researched, or derived under this contract, including but not limited to documents, software, reports and correspondence will remain confidential. The contractor shall not release information to any persons, groups of persons, or organization other than the IHS. Breach of confidentiality may be grounds for rescission of this contract.

Permission for use, maintenance, disclosure, and disposition of data is at the sole discretion of the Indian Health Service.

8.0 DELIVERABLES:

Implementation and Technology Environment: The Contractor shall collaborate with IHS OIT to deploy services within the approved Cisco-based video environment or successor platform. IHS OIT retains control of enterprise network, domain, and security. The Contractor shall recommend clinically appropriate endpoints and peripherals suitable for noisy resuscitation environments. Equipment on the IHS network must meet IHS OIT standards and be approved by OIT before use.

Systems handling PHI shall use encryption in transit and at rest consistent with IHS policy and applicable HHS requirements.

Technical and Network Compatibility Requirements:

The Contractor’s solution shall be fully compatible with the IHS enterprise Cisco-based video environment or successor platform and shall support standards-based interoperability (e.g., SIP/H.323 or successor protocols) without requiring modification to IHS core network architecture or security controls. All audio, video, and data transmissions must be encrypted in accordance with applicable Federal standards and operate within IHS firewall and security policies as approved by IHS OIT. The solution shall function within typical enterprise healthcare network environments, support high-definition real-time video suitable for emergency and behavioral health settings, and be capable of integration with commercially available telehealth carts, PTZ cameras, and clinical audio/visual peripherals. Any equipment, software, or connectivity introduced to the IHS network must be reviewed and approved by IHS OIT prior to deployment.

A001 Site Service Needs Report A002 Equipment and Peripherals Recommendation List A003 OIT Integration and Connectivity Plan A004 Deployment Schedule

EHR Integration and Security Compliance B001 Telehealth Deployment Schedule B002 Security and Privacy Compliance Report

Staffing, Credentialing, and Privileging C001 Site and Area Credentialing and Privileging Status Report C002 Roster with active federal suitability, training, and credential expirations

Quality Assurance and Peer Review D001 Provider Quality Assurance Review Reports D002 Corrective Action Reports, if any

Telehealth Specialty Clinic Services, Telehealth Emergency Services Support Operations F001 Monthly and Annual Complaint Log F002 Chart or Quality Review Reports F003 Quarterly CPT Coding Audit Summary

Telehealth Emergency Services Support Operations G001 Monthly ED Tele-BH Activity Summary G002 Chart or Quality Review Reports

Communication and Culture H001 Annual Cultural Sensitivity Training Attestation H002 Annual Complaint Summary

Reporting and Meetings: Contractor shall provide biannual status reports to the COR for the Telehealth Services provided as authorized through this contract, at a minimum: site volumes, timestamps, level of involvement, acuity, dispositions, EMTALA compliance, provider types, complaints, and adverse outcomes. Reports shall be Section 508 compliant. Contractor shall provide an annual report addressing plan status, accomplishments, fiscal accountability, performance data, any subcontractor performance, and a Contractor self-evaluation. Submit an outline for COR approval per the deliverables schedule and discuss at the annual review.

L001 Biannual Status Reports L002 Annual Performance Report

Section 508 and Accessibility:

· This product must conform to the Revised Section 508 (https://www.access-board.gov/guidelines-and-standards/communications-and-it/about-the-ict-refresh/final-rule/text-of-the-standards-and-guidelines) and WCAG 2.1 Level AA standards as outlined below.

· Solicitations for supplies and services shall require the submission of a Section 508 Product Assessment Template. The template can be found at https://www.itic.org/policy/accessibility/vpat.

All Information and Communication Technology (ICT) deliverables under this contract (e.g., websites, applications, electronic documents, and multimedia) must comply with the Revised Section 508 Standards (36 CFR Part 1194) and the Web Content Accessibility Guidelines (WCAG) 2.1 Level AA standards. The Contractor shall ensure accessibility of all ICT deliverables and provide conformance documentation in the form of a Voluntary Product Accessibility Template (VPAT®) / Accessibility Conformance Report (ACR), or by completing the HHS Section 508 Accessibility Checklists. The current VPAT 2.5 template includes fields for reporting conformance to WCAG 2.1 and shall be used to document accessibility. The Contractor shall remediate any identified accessibility issues at no additional cost. The Contracting Officer will include the applicable Health and Human Services Acquisition Regulation (HHSAR) clauses 352.239-73 and 352.239-74 in the solicitation and resulting contract.

9.0 PERFORMANCE BASED MATRIX:

Surveillance will include periodic inspections and audits by IHS contracting staff. Payment of contracted price for satisfactory service. Contract may be terminated for Contractor failure to meet indicators and/or Contractor’s failure to develop a performance improvement plan to address performance difficulties.

Services

Patient Interactions

Professionalism

Timeliness

Providers are qualified, licensed, privileged and have maintained the qualifications.

Required specialty referrals services have been provided by the contractor in accordance with performance requirements.

No reports of breached patient safety and other procedures that might adversely affect patient outcome.

Performance characterized by continual cultural awareness and focus on customer service with adherence to Code of Ethics and Federal Code of Conduct.

Appointments are made within the 30 days from referral.

Maintain 100% of the required qualification requirements.

All required emergency referrals services have been provided by the contractor in accordance with performance requirements.

No reports of breached patient safety and other procedures that might adversely affect patient outcome.

Performance characterized by continual cultural awareness and…