B08 - Attachment 2_140P1521R0001 (updated) Performance Work Statement (FINAL 03.30.2021)_0001.pdf

Performance Work Statement

Medical Clinic Operations

Part 1 - GENERAL

a. Purpose

This performance-based work statement sets forth the services to be performed with performance standards and performance measures through the quantities, limits or areas applying to the operation of the Grand Canyon Clinic located in the Grand Canyon Village area on the south rim of Grand Canyon National Park. Primary goals of the Grand Canyon Clinic operation include providing local residents, employees, and visitors with year-round access to primary, urgent, preventive and employment related health care and supporting the operation of the National Park Service's Grand Canyon National Park Branch of Emergency Services.

Nonpersonal Healthcare Services – This contract is a nonpersonal health care services contract, as defined in 37.101, under which the contractor is an independent contractor;

The Government may evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of services rendered (e.g., professional judgments, diagnosis for specific medical treatment);

The contractor is required to indemnify the Government for any liability producing act or omission by the contractor, its employees and agents occurring during contract performance;

The contractor is required to maintain medical liability insurance, in a coverage amount acceptable to the contracting officer, which is not less than the amount normally prevailing within the local community for the medical specialty concerned; and

The contractor is required to ensure that its subcontracts for provisions of health care services, contain the requirements of the clause at 52.237-7, including the maintenance of medical liability insurance.

b. Objectives

Provide high quality primary, urgent and preventative care, including telehealth behavioral health services, to both Grand Canyon National Park's visitors and the local community.

Support the National Park Service's Grand Canyon National Park Branch of Emergency Services.

Support Grand Canyon National Park's overall operations by providing high quality employment related health care to both employees of the National Park Service and other local employers.

Ensure operation meets all state federal and local regulations and licensing requirements and that the clinic operates in accordance with general industry standards and best practices.

Provide all services at reasonable and affordable rates.

https://www.acquisition.gov/far/37.101#FAR_37_101 https://www.acquisition.gov/far/52.237-7#FAR_52_237_7

Accept all forms of insurance and provide reasonable methods for patients without insurance to pay for services, including Grand Canyon National Park's foreign visitors.

Collect healthcare-related debts from all patients who are able to pay in accordance with general industry standards and best practices.

Provide efficient pharmacy services.

c. Background

The National Park Service preserves unimpaired the natural and cultural resources and values of the National Park System for the enjoyment, education and inspiration of this and future generations. The National Park Service cooperates with partners to extend the benefits of natural and cultural resource conservation and outdoor recreation throughout this country and the world. For basic information on Grand Canyon National Park, please see the Park Profile at https://www.nps.gov/grca/learn/management/upload/Park-Profile-2019web-final-2.pdf and 2019 visitation numbers at https://irma.nps.gov/STATS/Reports/Park.

National Park Service policy requires Grand Canyon National Park to make reasonable efforts to provide appropriate emergency medical services to persons who become ill or injured while visiting the park.

The first hospital at the South Rim of Grand Canyon National Park began operations in 1930. Since 1985, the National Park Service has authorized an entity to operate a medical clinic for the purpose of providing emergency medical treatment and general health care services to visitors, in-park residents and the community.

The current Grand Canyon Clinic is located in the Grand Canyon Village area on the South Rim of Grand Canyon National Park. The South Rim is 60 miles from the nearest non-emergency medical care provider (located in Williams, Arizona) and 75 miles from the nearest major hospital (located in Flagstaff, Arizona).

d. Park Visitation and Community Population

More than six million people from around the world visit Grand Canyon National Park annually.

Although peak visitation is highest during the summer season and on holidays, the park experiences heavy visitation on the South Rim throughout the year. Visitor activities while at Grand Canyon National Park include spending several hours sightseeing, walking along the rim, day hiking or backpacking in the canyon, and participating in multi-day raft trips on the Colorado River.

The community on the South Rim of Grand Canyon National Park includes both in-park residents and residents of the gateway community of Tusayan, Arizona, located approximately seven miles from the Grand Canyon Village area near the park's south entrance. The local community has a permanent population of approximately 2,500, but during the busy summer season, local employers hire approximately 1,000 seasonal employees. For additional demographic information from the U.S. Census Bureau, go to http://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml and type in 86023 for the zip code under “Community Facts.”

Major employers operating on the South Rim within Grand Canyon National Park include the National Park Service and several businesses providing visitor hospitality services under concessions contract with the National Park Service, which currently include Xanterra South Rim, L.L.C, Delaware North, Bright Angel Bicycles, and the Grand Canyon Railway. Another major employer on the South Rim is Paul https://www.nps.gov/grca/learn/management/upload/Park-Profile-2019web-final-2.pdf https://irma.nps.gov/STATS/Reports/Park http://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml

Revere Transportation, L.L.C., which has a procurement contract with the National Park Service and operates the shuttle bus system. Visitor services in the Grand Canyon Village area include several hotels, restaurants, gift shops, rail services, bike rentals and tours, and a general store. Community services in the Grand Canyon Village area include a K-12 school, a small daycare, a post office, a library, and a bank.

For additional information about the park's current major employers, visit http://www.grandcanyonlodges.com/, http://www.visitgrandcanyon.com/, http://www.thetrain.com/, and www.bikegrandcanyon.com/. For additional information about major employers associated with the park and the gateway community of Tusayan, visit http://grandcanyoncvb.org/.

e. Partnership

The Contractor and the National Park Service will work as partners to be flexible and to provide the best and most efficient services possible while working within the framework of this contract. The National Park Service encourages the Contractor to make suggestions for operational improvement and will respond to requests for modification. The Clinic Manager is a key member of the Grand Canyon National Park community and is required to attend and participate in meetings pertaining to park operations when directed by the National Park Service.

f. Current Operational Conditions

The Grand Canyon Clinic experienced approximately 9,600 total patient visits in 2019. This figure included physician, nurse, mid-level provider, physical therapist and telehealth visits. For additional information about current operational conditions, please see attached Grand Canyon Clinic patient data from 2015 through 2019.

PART 2 - DEFINITIONS AND ACRONYMS

The following terms, when used in this contract, will be construed and/or interpreted as follows, unless the context expressly requires a different construction and/or interpretation. In the event of a conflict in language between the Definitions and other sections of this contract, the language in specifications will govern.

AQL - Acceptable Quality Level - The maximum percent of defective work that can be considered satisfactory on the average. Considered the allowable leeway or variance from a standard before the Government will reject the specific service.

CO - Contracting Officer - means a person with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings. The term includes certain authorized representatives of the contracting officer acting within the limits of their authority as delegated by the contracting officer.

COR - Contracting Officer's Representative - an individual, including a contracting officer’s technical representative (COTR), designated and authorized in writing by the contracting officer to perform specific technical or administrative functions.

DOI - Department of the Interior

FAR - Federal Acquistion Regulation http://www.grandcanyonlodges.com/ http://www.visitgrandcanyon.com/ http://www.thetrain.com/ http://www.bikegrandcanyon.com/ http://grandcanyoncvb.org/

HIPAA - Health Insurance Portability and Accountability Act of 1996

Marketing - Any activity conducted by, or on behalf of, the contractor where information regarding the services offered by the contractor is disseminated in order to persuade eligible persons to enroll, or accept any application for enrollment in the contractor's plan operated pursuant to this contract.

Medical Record or Electronic Medical Record - A single, complete electronic record (CPRS) maintained by the contractor's staff on site, which documents all of the treatment plans developed, identifies problem list, and medical services ordered and received by the patient.

Primary Care - Health care provided by a medical professional (as a general practitioner or a pediatrician) with whom a patient has initial contact and by whom the patient may be referred to a specialist for further treatment

Primary Care Provider - A primary care physician or registered Advanced Practice Nurse, Nurse Practitioner or Physician Assistant practicing in accordance with Arizona State law, who is responsible for supervising, coordinating, and providing initial and primary care to patients, initiating referrals for specialist care, and maintaining the continuity of patient care.

Prior Authorization - The act of authorizing specific services or activities before they are either rendered or occur.

PI - Performance Improvement - The ongoing process of responding to data gathered through quality monitoring efforts, in such a way as to improve the quality of healthcare delivered to individuals. This process necessarily involves follow-up studies of the measures taken to improve clinical activities in order to demonstrate that the desired change has occurred.

PRS - Performance Requirements Summary - The PRS shows the contract requirements, the component requirements related to each contract requirement, may show the price of each work requirement as a percentage of the associated contract requirement (fixed price contract), the standard of performance, and the acceptable quality level (AQL).

Performance Standard - An acknowledged measure of comparison.

QASP - Quality Assurance Surveillance Plan - An organized written document used by Government for quality assurance surveillance. Document contains sampling/evaluation guides, checklists, and the performance requirement summary (PRS).

QA - Quality Assurance - The management of the service quality and responsiveness by the Contractor and starts with the early stages of quality development and runs through every phase to contract close-out.

It colloquially post-award surveillance of the Contractor's work.

QM - Quality Monitoring - The ongoing process of assuring that the delivery of healthcare is appropriate, timely, accessible, available, medically necessary, and in keeping with established guidelines and standards and reflective of the current state of medical knowledge.

Subcontractor - Any organization or person who provides any function or service for the contractor specifically related to securing or fulfilling the contractor's obligations.

Surveillance - The process of monitoring, either by direct evaluation, observation, or other information sources, of Contractor performance.

Urgent Care - Health care provided by a medical professional (as a general practitioner or a pediatrician) with whom a patient has initial contact and by whom the patient may be referred to a specialist for further treatment

USPHS - United States Public Health Service

PART 3 – GOVERNMENT- FURNISHED PROPERTY & SERVICES

a. General Information

The National Park Service will furnish a clinic facility and limited equipment to be used by the Contractor to provide work under this contract. The National Park Service may also permit the contractor to use a limited number of housing units.

b. Equipment

The National Park Service will provide a digital X-Ray machine and associated equipment as well as limited furniture for an exam room, a waiting room and a medical office. See attached property list.

The Contractor must provide all other equipment necessary to provide the required services under this contract.

c. Facilities

At no cost to the Contractor, the National Park Service will:

Provide the use of the existing clinic facilities, which consist of approximately 4,063 square feet of space within the building shared by the Grand Canyon Clinic and the National Park Service Branch of Emergency Services. The Grand Canyon Clinic facility is provided by the National Park Service to the Contractor for the purposes of work under this contract only. See attached Grand Canyon Clinic Building Diagram.

Provide water, sewer and general trash pick-up (not to include medical waste or hazardous material) at the Grand Canyon Clinic facility. The Contractor is responsible for working directly with the provider for all other services, including, but not limited to electricity, phones and Internet. The Contractor or its employees are responsible for the cost of utilities associated with assigned housing units.

Provide snow removal in the parking area, drop off lane and roads leading up to the Grand Canyon Clinic facility.

Provide component renewal, recurring maintenance and major repairs to the assigned facilities.

Component renewal, recurring maintenance and major repair include the planned replacement of a component at the end of its useful life. Component renewal examples include the following:

• replacement of foundations, building frames, window frames, windows, doors, sheathing, subfloors, drainage and roofs;

• replacement of building systems such as electrical distribution systems, built-in heating and cooling systems, and plumbing systems; and

• the rehabilitation of components of facilities.

Component renewal includes the deconstruction of the existing component and the replacement of that component with a new component of equal or superior capability and performance. These actions recur on a periodic cycle of greater than seven (7) years.

Recurring maintenance includes planned work activities to sustain the useful life of an asset or component that reoccur on a periodic cycle of greater than one year. Typical recurring maintenance projects include, but are not limited to, painting, pump and motor replacement, replacement of lighting, engine overhaul, replacement of carpeting and refinishing hardwood floors.

If the repair is the responsibility of the National Park Service, the clinic manager will submit a work order to the Grand Canyon Work Order Desk via email at grca_maintenance_work_order_desk@nps.gov.

d. Housing

In its sole discretion, the National Park Service may permit the Contractor to use available housing for use by Contractor employees at various locations within the Grand Canyon Village area. Housing provided by the National Park Service may include single family homes, apartment style units, trailer sites appropriate for travel trailers or fifth-wheel trailers, or trailer sites appropriate for small manufactured homes.

If the National Park Service permits trailers sites appropriate for travel trailers or fifth wheel trailers, the Contractor or its employees are responsible for providing all travel trailers or fifth wheel trailers. If the National Park Service permits trailer sites appropriate for small manufactured homes, the Contractor or its employees are responsible for providing the manufactured homes.

The Contractor is responsible for reimbursing the cost of all National-Park-Service provided housing rental, including housing units and trailer pads, to the National Park Service and for paying all utilities to the appropriate company. The current housing rental rates are as follows:

• (1-bedroom apartment): $391.98

• (1-bedroom apartment): $291.45

• (2-bedroom furnished apartment): $901.33

• (2-bedroom furnished apartment): $901.33

• (3-bedroom apartment): $726.09

• (3-bedroom home): $1,038.80

• (3-bedroom home): $953.07

The Contractor and its employees must comply with any rules for management and operation of trailer sites and housing in Grand Canyon National Park. The rules are developed by the park concessioners or the National Park Service, who share management responsibilities for the park's housing and trailer park areas.

The Contractor may use housing provided by the National Park Service only as residences for its employees or other personnel who are performing work under this contract.

To provide the adequate staffing necessary to conduct the required operations, the Contractor may need to hire more staff than the housing provided by the National Park Service can accommodate. The Contractor is responsible for providing adequate staffing to provide the required operations regardless of whether or not the housing provided by the National Park Service is sufficient. The Contractor or its employees are mailto:grca_maintenance_work_order_desk@nps.gov responsible for the payment of the cost of additional housing to the provider. Additional housing and trailer sites may be available within the park for rent from the park concessioners or outside the park in the gateway community of Tusayan (approximately 5 miles from the South Rim) or in Valle, Arizona (approximately 35 miles from the South Rim), in Williams, Arizona (approximately 60 miles from the South Rim) or in Flagstaff, Arizona (approximately 75 miles from the South Rim).

To support the current Grand Canyon Clinic operation, the National Park Service currently provides two three-bedroom single family homes; one three-bedroom apartment; two two-bedroom National Park Service furnished apartments, and two one-bedroom apartments. The National Park Service expects to provide a similar level of housing during the term of this contract. It is not anticipated that additional housing will become available during the term of this contract; however, the National Park Service may add, reduce or change assigned housing units at any time before or during the term of this contract. The Contractor must work with the National Park Service Commercial Services Office and Housing Office when making assigned housing requests or changes.

PART 4 - CONTRACTOR FURNISHED ITEMS & SERVICES

a. General Information & Service

The Contractor is responsible for fully operating the Grand Canyon Clinic by providing high-quality, affordable primary healthcare, urgent healthcare, preventative healthcare and employment-related healthcare to the local community, employers and visitors to Grand Canyon National Park. The Contractor is responsible for working with the National Park Service to support the operations of the National Park Service Branch of Emergency Services. The Contractor is responsible for providing a basic diagnostic lab and for providing pharmacy services. The Contractor must ensure that all aspects of the Grand Canyon Clinic operation operate in accordance with all applicable federal, state and local regulations and licensing requirements and in accordance with general industry standards and best practices.

Basic Level Services: Basic Level Services are all services outlined in this PWS, excluding those in section m. Telehealth Mental Health Services and Crisis Intervention. It is primary, urgent, preventive and employment related health care and supporting the operation of the Grand Canyon National Park Branch of Emergency Services.

b. Dates & Hours of Operation

(1) Clinic. The Contractor must operate on a year-round basis all hours and dates agreed to in the award of this contract. The Contractor shall operate seven (7) days per week, Monday through Sunday, with clinic hours of 09:00 a.m. – 06:00 p.m. during peak season (starting the Saturday of Memorial Day weekend through Labor Day weekend). The Contractor shall operate five days per week, Monday through Friday, with clinic hours of 08:00 a.m. – 05:00 p.m. during non-peak/off season (after Labor Day weekend through the Friday before Memorial Day weekend). The clinic will be closed on Christmas, Thanksgiving, and New Year’s Day.

(2) Pharmacy. The Contractor shall operate the Pharmacy five (5) days per week, Monday through Friday, with hours of 08:00 a.m. – 05:00 p.m. during non-peak/off season (after Labor Day weekend to Memorial Day weekend). The Contractor shall operate five (5) days per week, Monday through Friday, with clinic hours of 09:00 a.m. – 05:00 p.m. during peak season (Memorial Day weekend through Labor Day weekend).

c. Walk-in Visits and Appointments

During all hours of operation and for all services provided, the Contractor must accept walk-in patients as well as appointments. The Contractor must work to provide reasonable opportunities for patients to make appointments in line with industry standards and best practices.

d. Personnel

(1) Key Personnel - Prior to commencement of services under this contract, the Contractor must provide to the NPS for its approval the name or names and résumé or résumés of the employee or employees who will perform two primary functions for the performance of the on-site work required under this contract, the Contractor's Representative and the Clinic Manager. The tasks may either be performed separately by two individuals or both tasks may be performed by the same individual. The Clinic Manager or Contractor’s Representative must be physically present a minimum of one (1) day per week and must be available by email and phone to provide support of the clinic operations during all other hours.

Prior to installing a replacement Contractor's Representative or Clinic Manager, the Contractor must submit the employee's résumé to the National Park Service for approval.

i. The Contractor's Representative - The Contractor must provide a Contractor's Representative who will be the Contractor's primary representative having the Contractor's full authority to act on matters pertaining to the performance of services required under this contract.

The Contractor's Representative will follow National Park Service procedures for the reporting of accidents and incidents and will ensure that all required reports, deliverables and bills are submitted to the CO or COR in the timeframe required by the contract.

ii. The Clinic Manager - The Clinic Manager is responsible for the day-to-day operation of the Grand Canyon Clinic including the supervision of clinic staff. The Clinic Manager must be assigned to Grand Canyon National Park throughout the year and be on-site at least one (1) day per week. If the Clinic Manager is not on site, then they must be on-call whenever work is being performed by the Contractor's employees. When the Clinic Manager is or will be unavailable for any reason, the Contractor must promptly notify the COR of the manager’s temporary replacement.

(2) Clinic Staff - During all hour of operation, the Contractor will provide sufficient staffing to meet the requirements of this contract and to support the operations of the National Park Services Branch of Emergency Services and meet the medical needs of the local community and visiting public.

i. Physician or Mid-Level Practitioner - The Contractor must provide at least one physician or mid-level practitioner (i.e. nurse practitioner or physician assistant) qualified and trained to provide primary and urgent care during all hours of operation.

ii. Additional Staff - Staffing must include a sufficient number of medical practitioners, administration and support staff, janitorial staff, pharmacy staff and laboratory and technical staff.

iii. Qualifications and Training - The Contractor must ensure that all clinic staff have received sufficient training and that their qualifications comply with all federal, state and local regulations and licensing requirements as well as general industry standards and best practices for all tasks that the employees are required to perform.

iiii. Human Health and Safety - The National Park Service retains the right to request documentation from the Contractor that demonstrates it is meeting or exceeding industry standards for occupational health and safety. This could, for example, include a request for employee training records on the safe handling of chemicals in the workplace.

e. Licensing

The Contractor is required to comply with all federal, state and local law, regulations and must maintain all required licenses for all clinic operations, equipment and personnel including, but not limited to those associated with, X-Ray services, laboratory services, pharmacy services and general medical services.

The Contractor must provide a copy of all licenses to the CO or COR.

The Contractor must inform the CO or COR of any inspection by any regulatory entity within 24 hours after the inspections and must provide the results or any reports generated from the inspection within 24 hours after the results or report are received.

f. Equipment

The National Park Service will provide a digital X-Ray machine and associated equipment as well as some limited exam room, waiting room and office furniture. See attached property list.

The Contractor must provide all other equipment necessary to provide the required services under this contract.

With the exception of the X-Ray equipment, should any other National Park Service-provided equipment become unusable during the term of this contract, the Contractor will be responsible for providing a replacement.

g. Support of National Park Service Branch of Emergency Services

During all hours of operation, the Contractor must comply with and accept all patients meeting the requirements of the Transportation Decision Matrix developed by the National Park Service Grand Canyon National Park Branch of Emergency Services. See attached Transportation Decision Matrix.

During the term of this contract, the National Park Service may find it necessary to change the Transportation Decision Matrix. In the event that the Transportation Decision Matrix is changed, the National Park Service will collaborate with the Contractor; however, all changes to the Transportation Decision Matrix will require the final approval of the National Park Service.

The Contractor will work with the Branch Chief of Emergency Services to establish general guidelines for appropriate times of day and/or communication consults with the Contractor for situations in which Grand Canyon EMS Providers are considering ambulance transport of patients to the clinic prior to the clinic’s scheduled closing time.

While rare, an unusually high number of near simultaneous field incidents or severe weather events can exhaust or limit the transport capability of local EMS agencies. A willingness of the Contractor to accept ambulance transported patients’ right up to the scheduled clinic closing time in these rare instances (2-3 times per year) will be required.

The Contractor must cooperate with the National Park Service Branch of Emergency Services to plan for mass casualty incidents and/or other disasters that my limit or overwhelm the ambulance transport capability of the area. The Contractor will be required to perform additional duties in the event of a mass casualty incident or disaster.

h. Collaboration with United States Public Health Services

The Contractor must cooperate with representatives from United States Public Health Services working at Grand Canyon National Park. At the discretion of the National Park Service, the Contractor will be required to participate in a United States Public Health Services illness reporting program.

i. Employment-Related and School-Related Health Care

During all hours of operation, the Contractor must provide the staff, equipment and supplies required to perform employment-related health care, including, but not limited to, pre-employment physicals and screening, scheduled and random toxicology screening, Department of Transportation physicals, post-accident screening, respirator protection fit-test physicals, and workers compensation related healthcare.

The Contractor must collaborate with local employers to provide employment-related healthcare and must provide employment-related healthcare during all hours of operation on both a walk-in and appointment basis.

The Contractor must also collaborate with the local school to provide athletic-related physicals.

j. Pharmacy Services

The Contractor must maintain on-site at the Grand Canyon Clinic all supplies and pharmaceuticals commonly used and necessary to provide primary healthcare, urgent healthcare, preventative healthcare, and employment related healthcare.

The Contractor must provide all other prescription drugs within 48 hours.

All supplies and pharmaceuticals must be stored and maintained in a manner that meets federal, state and local law and regulations.

k. Laboratory Services

During all hours of operation, the Contractor must maintain a basic laboratory and staff capable of diagnosing common conditions associated with primary healthcare, urgent healthcare, preventative healthcare and employment-related healthcare.

The Contractor must provide all laboratory equipment and ensure that the operation and equipment are maintained in a manner that meets federal, state and local law and regulations.

All Contractor supplied equipment should be up to date and meet general industry standards and best practices.

l. X-Ray Services

During hours of operation, the Contractor must provide X-Ray services, including, but not limited to, provision of on-site staff qualified to operate the X-Ray equipment and on-site or off-site staff qualified to interpret images and provide a diagnosis.

The National Park Service will provide digital X-Ray equipment. See attached property list.

At its cost, the Contractor must maintain all X-Ray equipment to the standards required by federal, state and local law and regulations as well as general industry standards and best practices.

The Contractor must operate the X-Ray equipment in accordance with federal, state and local law and regulations as well as general industry standards and best practices and must maintain all required licenses for the associated equipment and personnel.

m. Telehealth Mental Health Services and Crisis Intervention

The Contractor must provide scheduled telehealth mental health services. To promote this service to the South Rim community, the Contractor must have a mental health care provider at the South Rim (in person) at least quarterly and provide telehealth mental health as scheduled during clinic hours. At a minimum, Contractor dedicated staff will travel to the clinic once a month and do the following when at the South Rim to promote mental health services:

• meet with local businesses, agencies, and organizations through various means, including, but not limited to, human resources departments and staff meetings;

• meet with local groups and committees, including, but not limited to, the Grand Canyon Chamber of Commerce and the Grand Canyon Health and Wellness Committee;

• look for additional opportunities to provide outreach and advertise available services to the local community, including behavioral health telehealth and in person consults; and

• create, promote and implement a quarterly community health education event that covers behavioral health and health behavior topics by a licensed behavioral health or primary care provider, as well as promote Contractor programs and services.

The Contractor must also proactively market health services including mental health services through a variety of electronic and print methods, including, but not limited to, newsletters, flyers, and advertisements in the local Grand Canyon paper. Promotion of telehealth mental health services must be incorporated into the Contractor’s marketing plan and annual community meeting.

The Contractor will bill for all costs associated with the above services as part of Telehealth Mental Health Services - included in the Line Item Summary under line item option numbers 00020, 00050, 00080, 00110, and 00140. Costs include, but are not limited to, labor, all supplies necessary to perform the tasks, and travel. The contractor shall ensure that no duplicate payments are received for the same service provided.

The Contractor is recognized to not be a crisis mental health agency; however, the Contractor can facilitate linking Grand Canyon employers with community and other resources that provide crisis intervention. The Contractor will facilitate the delivery of critical incident stress debriefing and similar interventions for local Grand Canyon employers when needed. The Contractor will link local employers to arrange for mental healthcare providers, who can respond with crisis intervention/critical incident stress debriefing on the North and South rims. This performance work statement (PWS) only covers the cost of facilitating/arranging for this service. Costs associated with providing the crisis intervention/critical incident stress debriefing will be determined between the Contractor and local employer.

The Contractor will only bill for the facilitation of crisis intervention/critical incident stress debriefing when utilized. It must be billed at the negotiated amount as part of Crisis Intervention - included in the Line Item Summary under line item option numbers 00030, 00060, 00090, 00120, 00150. The facilitation/arranging of crisis intervention/critical incident stress debriefing above twelve (12) instances in a given performance period shall not occur unless prior authorization is granted by the Contracting Officer via a contract modification. The contractor shall ensure that no duplicate payments are received for the same service provided.

n. Community Involvement

The Contractor must hold at least one meeting open to all community members and local employers annually. The Contractor must use the meeting to gain feedback and suggestions regarding the operation of the Grand Canyon Clinic.

The Contractor must collaborate with local employers and the local school to provide influenza shots annually and work with the State of Arizona and Coconino County on distributing and administering the COVID-19 vaccine to the South Rim/Tusayan community whenever applicable.

The Contractor may look for ways to improve outreach to the local community, including, but not limited to, providing opportunities for community service and career planning for high school students, coordinating educational efforts such as sending out regular newsletters on health and nutrition, and providing opportunities for support groups.

o. Patient Payments

The Contractor must charge reasonable and affordable rates for services provided. The rates must be comparable to rates for similar services in surrounding communities, including Williams, Arizona and Flagstaff, Arizona.

In order to serve Grand Canyon National Park's visitors and local residents, the Contractor must accept a broad range of payment types and provide reasonable methods for patients without health insurance to pay for services. The Contractor must inform patients of all payment options available to them. Payment options must accommodate all park visitors, including those visiting from foreign countries.

The Contractor must accept and bill a broad range of health insurance providers, including, but not limited to, the types of health insurance provided by local employers to their employees. The Contractor must ensure money is collected from patients who are able to pay in accordance with general industry standards and best practices.

The Contractor must work with the United States Department of Health and Human Services, Indian Health Services to provide as many services as possible to individuals covered under the programs of the agency. For more information about Indian Health Services, visit http://www.ihs.gov/.

p. Authorized Services

The Contractor may provide additional health related services in support of Grand Canyon National Park's visitors and local community. Additional services could include, but are not limited to, in-person mental health services, physical therapy, dental services, support groups, an after-hours nurse advice line, and specialized services such as women's health or pediatrics. All additional services must be approved by the CO.

q. Hazardous and Medical Waste

The Contractor is required to store and dispose of all hazardous and medical waste in accordance with all federal, state and local law and regulations as well as general industry standards and best practices.

The National Park Service retains the right to request documentation that the contractor is meeting or exceeding industry standards for the handling and disposal of hazardous and medical waste generated within facilities provided to the Contractor within Grand Canyon National Park. This could include, for example, a request to see all manifests associated with the disposal of hazardous and/or medical waste.

The Contractor must develop and implement a spill response plan within 120 days of contract execution that meets or exceeds Grand Canyon’s Parkwide Spill Response Plan to prevent potential poisoning of condors and other wildlife as well as soil and water contamination. A copy of Grand Canyon’s Parkwide Spill Response Plan can be provided to the Contractor upon request to assist in its development.

r. Medical Records

The Contractor is required to store and maintain all medical records in accordance with all Federal, state and local law and regulations as well as general industry standards and best practices. This standard applies to medical records left by previous medical providers who operated in Grand Canyon National Park as well as to new records. The Contractor will evaluate existing medical records stored at the clinic and propose an appropriate disposal schedule consistent with industry standards to the National Park Service. When approved, the Contractor will annually dispose of old medical records in a manner consistent with HIPPA laws and regulations.

The Contractor must maintain all new and existing patients' medical records in an electronic format. The Contractor is responsible for supplying all staff and equipment necessary to store and maintain electronic medical records.

s. Building Maintenance & Janitorial

The Contractor is responsible for all facilities operations and preventative maintenance of the assigned Grand Canyon Clinic facility. Facilities operations are operational actions performed by the Contractor on a recurring basis that meet the daily operational needs of the facilities. Typical facility operations work includes janitorial and custodial services and snow removal on all sidewalks associated with the Grand http://www.ihs.gov/

Canyon Clinic facility. The Contractor or its employees are responsible for all snow removal associated with assigned housing, the operation of utilities, and grounds keeping.

Preventative maintenance includes planned, scheduled periodic facility maintenance activities that are performed weekly, monthly, quarterly, semi-annually or annually on selected facility assets or components. This typically includes, but is not limited to, inspection, lubrication, adjustment, filter changes, minor repairs and consumable parts replacement.

The National Park Service will make all final determinations regarding whether repairs and upkeep are the responsibility of the Contractor.

Modifications to the facility may only be made with the prior written approval of the National Park Service.

The Contractor must also maintain the Grand Canyon Clinic facility in a neat, orderly, clean and safe fashion at all times.

t. Data Collection

The Contractor must provide to the CO or COR quarterly, or within (15) days upon request, basic information about the Grand Canyon Clinic operation, including, but not limited to, the following:

● Total patient numbers by month and provider type;

● Total patient numbers by month broken down by complaint or injury and category of care

(i.e. well woman exam);

● Total patient numbers by month broken down by existing and new patients;

● Total patient numbers by month broken down by local (86023 zip code) and visitor; and

● Brief financial report

The Contractor must work with the National Park Service Branch of Emergency Services on ongoing data collection and research efforts related to search and rescue and emergency operations at Grand Canyon National Park.

The Contractor must provide to the CO or COR annually, or within 30 days upon request, with an annual report that summarizes Clinic operations. The report will include, but not be limited to, financial information, patient data and figures, trends in patient services, challenges and opportunities, and other operational aspects of the Clinic.

The Contractor must provide to the CO or COR annually, or within 30 days upon request, with an audited financial report detailing the operation of the Grand Canyon Clinic. The contractor shall ensure that no duplicate payments are received for the same service provided.

All data and patient figures must be submitted in a clear and concise format.

u. Operating, Maintenance, Quality Control and Safety Plans

The Contractor must submit the following initial plans prior to commencing operations under this contract, and annually thereafter:

● An Operating Plan, detailing the operating requirements for the Clinic operation;

● A Quality Assurance Plan that provides for soliciting and incorporating patient feedback;

● A Marketing Strategy that includes public relations and community outreach by clinic staff;

● A Maintenance Plan, detailing the allocation of responsibility for the maintenance and upkeep of the Clinic facility and how repairs and/or issues will be monitored and addressed; and

● A Safety and Physical Security Plan that details strategies to ensure employee workplace safety and the physical security of the Grand Canyon Clinic facility, supplies and equipment.

The Contractor shall have its own network(s) as they will not be permitted to connect to DOI/NPS networks and shall have its own security clearances/process. The Contractor will not have any access to NPS areas of the building.

v. Insurance

(1) Medical Malpractice Insurance - The Contractor must maintain medical malpractice insurance in a sufficient amount to cover all services, providers and operations offered and conducted at the Grand Canyon Clinic. The insurance type and amount must meet all federal, state and local law and regulations as well as general industry standards and best practices. The Contractor must provide current and valid proof of insurance to the CO or COR. If the Contractor qualifies and is covered by the Federal Tort Claims Authorization, it can submit the appropriate paperwork to the CO or COR to meet this requirement.

(2) General Liability - The Contractor must maintain general liability insurance in a sufficient amount to cover all services, providers and operations offered and conducted at the Grand Canyon Clinic. The insurance type and amount must meet all federal, state and local law and regulations as well as general industry standards and best practices. The Contractor must provide current and valid proof of insurance as they are renewed to the CO or COR.

(3) Property Insurance - The Contractor must maintain property insurance in a sufficient amount to cover the replacement cost of the assigned Grand Canyon Clinic facility. The insurance type and amount must meet all federal, state and local law and regulations as well as general industry standards and best practices. The Contractor must provide current and valid proof of insurance to the CO or COR.

w. Conservation

The Contractor is expected to be conservative in its use of all resources and utilities and must consider the use of innovations that conserve resources as they become available.

x. Phase-in/Phase-out Periods

A transition period is scheduled for the one-month period immediately prior to contract start date (phase-

in) and the one-month period prior to contract end date (phase-out) to allow for orderly contract transition. In order to maximize the effectiveness of the transition process, an initial meeting between the CO, COR and the Contract Representatives for the incumbent Contractor and successor Contractor will be held to address phase-in and phase-out requirements and responsibilities not later than seven days into the phase-in/phase-out period, and subsequent meetings will be held as determined by the CO, but not less than weekly thereafter. When an incumbent Contractor is also the successor Contractor, these meetings will not be waived, since the orderly transition from one work specification to another will also require significant management involvement in the transition process. The Contractor must not engage in any effort toward commencement of phase-in/phase-out until the CO has notified the Contractor to proceed.

(1) Phase-in - During the one-month period immediately prior to contract start date, key Contractor personnel will be permitted to observe operation of the National Park Service pertaining to this contract at no additional cost to the National Park Service. The successor Contractor must ensure that its phase-in operations do not hinder or interfere with normal operations of the incumbent Contractor, and that maximum effort is made to avoid loss of productivity.

During contract phase-in, the successor Contractor must observe operations of the in-place workforce;

interview work force personnel off site, gather and submit submittal data; establish signatory authority for Government Forms which require Contractor completion, secure insurance, licenses and tax documents needed to accomplish contract tasks.

The incumbent Contractor will transfer all work at contract start date to the successor Contractor.

(2) Phase-out - During the one-month period immediately prior to the end of the contract, the Contractor must permit his successor and the successor's key personnel to observe and become familiar with any and all operations under this contract. The Contractor must remain responsible and liable for the completion of all requirements of this contract, which shall begin on or before the final day of this contract. The Contractor must not defer any requirements for the purpose of avoiding responsibility and transferring such responsibility to the successor Contractor or the National Park Service. The Contractor must fully cooperate with the successor Contractor and the National Park Service so as not to interfere with their work or duties.

y. Invoicing Procedures

The Contractor shall invoice monthly via the Invoice Processing Platform (IPP). There shall be a lapse of no more than 30 calendar days between the billing month and submission of the corresponding invoice.

z. Payments to National Park Service

In the event of an overpayment, the Contractor must make all payments due to the National Park Service through pay.gov.

zz Option Periods

The National Park Service and the Contractor will conduct a review 60 to 90 calendar days prior to the expiration of the period of performance (base and/or option periods) to discuss year end financials, needed changes, or anything deemed necessary for the upcoming period of performance.

PART 5 - PERFORMANCE REQUIREMENTS

The National Park Service will assess the following Performance Requirements on a monthly basis. The results of the assessments may affect payments to the Contractor as specified in the attached Performance Requirements Summary.

Performance Requirement 1 - The Contractor must operate the Grand Canyon Clinic year-round to provide ongoing primary, urgent, preventative and employment related healthcare to Grand Canyon National Park's residents, employees and visitors.

The Contractor must satisfactorily provide all services required by the contract.

Performance Measures for Performance Requirement 1:

Direct observation, monitoring and surveillance conducted by the National Park Service;

Adherence to the Contractor's Quality Assurance Plan, including patient feedback and improvement measures;

Reports provided by any regulatory entities; and

Feedback received by the National Park Service from visitors, local residents and local employers.

Performance Standard for Performance Requirement 1:

Services provided by the Contractor meet the needs of Grand Canyon National Park's visitors, local residents and local employers 90% of the time as judged by the National Park Service and based upon performance measures.

Performance Requirement 2 - The Contractor must provide affordable services and must accept a broad range of payment forms. The Contractor must accept payments that accommodate all visitors, including those from foreign countries;

The Contractor must accept and bill a broad range of health insurance providers including those offered by all major local employers; and

The Contractor must ensure that rates for services are, at least, compatible with rates for similar services in surrounding communities, including Williams, Arizona and Flagstaff, Arizona.

Performance…