1440514-ORTHO-SOW.docx

STATEMENT OF WORK – ORTHOPEDIC SERVICES

Pawnee Indian Health Center 1201 Heritage Circle Pawnee, OK 74058

I. General:

The Indian Health Service (IHS), an agency within the Department of Health and Human Services, is responsible for providing federal health services to American Indians and Alaska Natives. The mission of IHS is to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level and assure that comprehensive, culturally acceptable personal and public health services are available and accessible to members of the 573 federally recognized Tribes across the United States.

II. Background:

The Pawnee Service Unit is a Joint Commission accredited with facilities in Pawnee, Oklahoma. To meet the mission, orthopedic care is medical modality that has been deemed necessary to augment the services within the service unit. Therefore, contracted orthopedic services are necessary to support and supplement health care within the Service Unit.

III. Scope:

Vendor shall provide diagnostic and treatment services including minor procedures as determined by evaluation and provide follow-up care as identified by treatment plan as outlined within Oklahoma statutes governing orthopedic care. This shall include: diagnostic procedures, including orthopedic exams, range of motion exams, muscle strength testing; diagnostic imaging procedures including MRI, CT, x-ray, and ultrasounds. The treatment modalities including exercise and rehabilitation, casting, strength and conditioning, oral and injection based medication therapy, passive stretch (independently or in conjunction with cryotherapy substance), referred care for surgical intervention, augmentation for pain management strategies, and any other orthopedic related treatment strategy deemed medically necessary.

Services shall be fully coordinated and integrated with the patient’s primary care provider within the Service Unit with respect to services provided and professional relationships.

IV. Responsibilities:

Vendor shall:

a. Provide orthopedic care as outlined within scope noted above.

b. Provide a minimum of eighteen (18) patient encounters per 8 hours. Additional provider encounters shall be allowed and will be coordinated by specialty clinic manager.

c. Communicate, in a timely fashion, to the referring primary care provider all clinical information necessary for continuity of care and documentation of quality of performance.

d. Observe and assess patient’s clinical condition; recognizing, identifying and interpreting situation and immediately deciding proper action and therapeutic care plan.

e. Formulate proper diagnosis and develop plan of care for individual patients.

f. Recommend proper therapeutic measures (exercise, stretches, etc.) for augmenting services.

g. Document all patient encounters in the patient’s electronic health record within 24 hours of clinic completion.

h. The Pawnee Indian Health Center shall have the right to provide continual review of all patient encounters and ensure all required documentation is provided.

i. Failure, on the part of the Contractor, to provide care as identified may result in the suspension of contract for services.

V. Period of Performance: Approximately one year.

VI. Contractor Qualification Requirements:

The Orthopedic physician must possess a current, unrestricted medical license through the Medical Board.

VII. Special Terms and Conditions:

Contractor shall comply with the Stark Law that prohibit physician self-referral if the physician (or an immediate family member) has a financial relationship with that entity.

Contractor shall possess the following requirements:

a. Rubella immunity must be documented by either serologic test or proof of immunization.

b. A yearly PPD is required for all persons who have had no previous positive tuberculin skin test.

c. A series of three (3) Hepatitis B immunizations or serologic proof of past infection is required.

d. A yearly influenza vaccination.

VIII. Schedule of Work:

Contractor shall provide an 8-hour day twice a month as agreed upon between Contractor and the Pawnee Service Unit. The government reserves the right to negotiate the addition/reduction of hours, location, etc. as mutually agreed upon by contractor.

IX. Rates of Payment:

Contracted rates shall be established as identified within the attached quote for services and shall be invoiced on a total completed clinic hourly rate based invoice and submitted to and as identified in sections IX of this Statement of Work.

X. Indemnity and Insurance:

The government assumes no responsibility of negligent acts of the Contractor. Therefore, the Contractor is responsible for personal insurance if the Contractor indicates that it is necessary. The Contractor will hold harmless and indemnify the government against any or all loss, cost, damage, claims, expense or liability whatsoever as a result from the performance of the Contractor. The Contractor will hold the Federal Government and its agents including the Clinical Director and the Governing Body immune from civil or professional liability for all acts related to quality care management and enforcement of this contract.

XI. Government Furnished Information, Property and Services:

All records of consultation, examination, surgeries/procedures and services of patients’ required in the performance of this contract will remain the property of and subject to the exclusive control of the Pawnee Service Unit. The Pawnee Service Unit will provide materials, support staff and equipment necessary for the performance of this contract. The Contractor shall provide all services within the Pawnee Service Unit facilities.

Outside equipment brought on site shall be checked and approved by Pawnee Indian Health Center Bio-Med department prior to its usage in patient care. If equipment requires preventive maintenance, calibration or Quality Control, then all documentation shall be provided by contractor before use in the Pawnee Clinic.

XII. Contract Evaluation

Contractor shall be evaluated yearly upon completion of each contract term. The government reserves the right to conduct evaluations more frequently if deemed necessary. Evaluation shall include patient/customer satisfaction, patient encounters/clinic, chart review and adherence to scope and contract term.

XIII. Contact with Indian Children

The Contractor shall perform in accordance with Section 231 of the Crime Control Act of 1990, P.L. 101- 647 and the Indian Child Protection and Family Violence Prevention Act, P.L. 101-630, and failure to comply with these statutes shall result in immediate removal. Individuals providing services which involve regular contact with, or control over, Indian children, are subject to a character investigation. IHS personnel offices will conduct these investigations following award of non-Personal services contract unless in the judgment of the Contracting Officer, in consultation with the Personnel Officer, investigation may be waived based on prior investigations on file. Until the Contracting Officer has been notified of the result of the investigation, such individuals shall not have unsupervised contact with Indian children.

XIV. Invoicing Requirements

a. The Contractor shall be required to provide an original and two (2) copies of the invoice to Oklahoma City Area Indian Health Service, Division of Financial Management, 701 Market Center Drive, OKC, 73114.

b. Each invoice shall include the following information:

i. Contractor’s name and invoice date.

ii. Contract number or authorization for delivery of services.

iii. Description, price and quantity of services actually rendered.

iv. Name, title, phone number, and complete mailing address of official to whom payment is to be sent.

c. Invoice shall be submitted no later than ten (10) calendar days following last calendar day of the month.

XV. Evaluation Criteria

1. Contractor shall possess current, unrestricted Orthopedic Medical license through the Oklahoma Medical Board.

2. Shall provide liability insurance in the appropriate amount of $1,000,000 per occurrence and $3,000,000 aggregate.

3. Shall be registered in System Award Management (SAM) database.

4. Provide a resume

5. Provide documentation of two past performances.

6. All- inclusive hourly rate for one year.

XVI. Applicable Documents

Joint Commission http://jointcommission.org

Section 4087 of Public Law 101-630, Indian Child Protection & Family Violence Prevention Act

Health Insurance Portability and Accountability Act (HIPPA) of 1996 http://www.hhs.gov/ocr/hippa

Privacy Act of 1974 http://www.access.gpo.gov/nara/cfr/waisidx

Indian Health Service (IHS) Information Technology and Records Security and Safeguard Policies http://home.ihs.gov/ITSC-CIO/security/index.asp

System for Award Management (SAM) http://www.sam.gov