Attachment_E_-_Statement_of_Work.pdf

Attachment E: Statement of Work

STATEMENT OF WORK

The overall intent of this contract is to acquire non-personal health care services for a qualified Contractor under a Government service contract. The contractor shall provide the necessary education, training, licensing, previous work experience and competence in being able to provide the services within the department. Work performance shall be performed according to the requirements and conditions contained in this Statement of Work.

The Contractor will provide Professional Registered Nursing (RN) for its Emergency Department at the Hopi Health Care Center.

The Contractor shall provide medically necessary routine RN Services for the Hopi Health Care Center (HHCC), Emergency Department hereafter referred to as the “Service Unit”, located in Polacca, Arizona. The Contractor(s) shall provide professional RN services who can fully provide services to patients within the specifications of the “Scope of Work”, within the standards of practice, and in accordance to The Joint Commission (TJC), Centers for Medicare Services (CMS), HPDP requirements, and HHCC policies.

The overall scope of this contract is to contract for two (2) qualified specialty Emergency Department RN’s to provide Emergency nursing services at the Hopi Health Care Center Service Unit, also referred to herein as the “work site”. The Contractor will be expected to have the necessary ability and education, training, licensing, and previous work experience to perform the work according to the requirements and conditions contained in this Scope of Work Statement.

Services shall be in the form of providing specialized Emergency Department RN services for the Hopi Health Care Center Service Unit.

The HHCC work site is primarily a Critical Access Hospital (CAH) providing, 24/7 inpatient and emergency service with six in-patient beds. The outpatient clinics provide services to about 66,000 patients per year. The services include general medical, ambulatory, Emergency Medicine, pediatric, community health, preventative health, and mental health. Dental care is also available. Special ambulatory services are provided on-site by IHS staff based in Phoenix or professional medical locum tenen contractors. Ground and air transport are available for emergency care. HHCC uses the medical home model and open access model to delivery patient services; a multi-disciplinary team approach to patient care; the Service Unit also provides community-public health programs/services, including public health nursing, social services, mental health, substance abuse, health education, environmental health and nutritional services.

The CAH is accredited by The Joint Commission.

1. SCHEDULES/LOCATIONS/SHIFTS/QUALIFICATIONS/CERTIFICATIONS:

SCHEDULE: The Contractor is requested to provide ER RN services, for a 12 month base period and four (4) 12-month option periods. This service is required by clinic with an estimated fifty-two (52) clinics per contract year. A “Clinic” is defined as one (1) week for a total of forty-eight (48) hours per week. The Clinic will be within the HHCC ER hours of operations 7 days a week between 12 hour day shift of 7:30 am - 8:00 pm (0730 - 2000) and 12 hour night shift of 7:30 pm – 8:00 am (1930 – 0800).

Additional Clinics may be added by mutual agreement of both parties with prior agreement and coordination with the Government.

LOCATION: All services shall be performed at the following location;

Hopi Health Care Center

HWY 264, MP 388

P.O. Box 4000 Polacca, AZ 86042

SHIFTS: Contractors will be expected to abide by the facility’s Uniform Code and shift hour assigned, modalities of charting and care delivery and other rules and regulations of the facility.

Work within a designated schedule prepared by the Chief Nurse Executive or his/her designee. Any period of absence or changes in the schedule will be communicated with the Chief Nurse Executive or his/her designee 14 days prior, except for emergency situations.

Services:

A) ER RN Services

SHIFTS: Total shifts worked shall be in accordance to the total number of work hours allocated for the year by HHCC. 30 minute lunch breaks are included in shift hours and Government does not pay time taken for lunch. The Service Unit shall make every effort to submit a schedule two (2) weeks in advance. Shifts may be cancelled or shortened without time restriction or monetary penalty before the contractor’s employee arrives for duty.

ER RN CLINIC

Day Shift: 12 hours 7:30 am - 8:00 pm (0730 - 2000) Night Shift: 12 hours 7:30 pm – 8:00 am (1930 – 0800) Evening Shift: 12 hours 9:00am - 9:30pm (0900 - 2130) 12 hours 2:30pm – 3:00am (1430 - 0300)

NOTE: The duration of each work “Clinic” shift may vary due to patient load, clinical complexity, weather and other circumstances.

A) ER RN: It is estimated that there will be fifty-two (52) Clinics per contact year at 48 hours per

Clinic week. (2496) hours per year; estimated 150 patients per Clinic)

Contractors shall attend assigned meetings, participate fully as staff members, and actively participate in ongoing quality management activities and any other HHCC or Indian Health Services initiatives deemed applicable to the specialist’s work.

QUALIFICATIONS/CERTIFICATIONS:

Education: Degree or diploma from a professional RN program approved by the legally designated National accrediting agency at the time the program was completed by the applicant.

Experience: The contractor shall provide the Government with the qualifications of Specialized Registered with minimum of 3 years of experience as a registered nurse, with 2 years of experience within the respective specialty; abilities presented as candidates for assignments, including a skills assessment and competency (as applicable), resume (detail experience in months and years), and references.

Licensure: The Registered Nurse must possess and maintain an active unrestricted nursing licensure.

Certification: Current certification is required in BLS (Basic Life Support), ACLS (Advanced Cardiac Life Support), PALS (Pediatric Advanced Life Support), and TNCC (Trauma Nurse Core Course) or equivalent preferred.

Insurance: Appropriate medical malpractice liability coverage.

Registration: Applicants must have active, current unrestricted RN license in a State, District of

Columbia, the Commonwealth of Puerto Rico, or a Territory of the United States.

Contractor shall assure each license is in good standing.

2. PRICE SCHEDULE

The unit prices paid to the Contractor shall be considered as payment in full for services provided under this award. In no way, unless directed by the IHS, shall any provider attempt to bill or collect from any IHS patient, or from any alternate resource for which the patient may be eligible, any monies for services provided under this award.

Firm Fixed rates shall be inclusive of all other fees (holiday, overtime, nights, weekend), including, all city, state, federal and local taxes, and all miscellaneous costs associated with the provision of services. The government will pay one flat weekly fixed rate.

Contractor shall be paid only for actual time services are performed under the terms of the contract at the firm fixed price. The quantities are estimated and estimated totals not to exceed.

(30 minute lunch breaks are included in the shift hours and will not be paid by the Government.)

Contractor’s employee must be present at the facility and must be actually performing the required services to receive payment for services. This is a Base Year with up to four (4) Option Years firm lump sum fixed-price contract for no less than 2 specialty ED RN’s for 48 hours/week per RN. The amount of fixed price monthly payments will be based on the number of RN’s provided (Contractor shall bill 100% of the monthly firm fixed price each month for 2 RN FTEs, 50% for 1 RN FTE, or prorated per month of service if less than 50% for 1 RN FTE).

This firm fixed-price contract also allows for reimbursement of travel expenses for up to 2 specialty ED RN’s; including lodging, MI&E, and mileage rates which are set forth in the Federal Travel Regulations and the GSA Rates for Polacca, AZ. All contractor requests for reimbursement of travel expenses must first be pre-approved by the COR prior to the contractor’s RN traveling to the work site and incurring any travel expenses. The contractor must notify the CO once 75% of the contract not to exceed approved travel allowance has been utilized.

Contractor will be required to submit receipts to the COR for all travel related reimbursable expenses. Charges that are being submitted for reimbursement must be in accordance with the GSA’s Federal Travel Regulations. Any charges that are over the prescribed Government per diem rate for the area will be rejected and a corrected invoice will need to be submitted.

See Attachment A – Price Schedule

Government housing not available.

3. STATEMENT OF WORK:

The overall scope of this contract is to acquire a qualified Contractor under a Government service contract. The contractor shall provide the necessary education, training, licensing, previous work experience and competence in being able to provide the services within the department. Work performance shall be performed according to the requirements and conditions contained in this Statement of Work. The contract resulting from this solicitation includes:

The contract resulting from this solicitation includes:

The Contractor shall be expected to assist and provide services and duties as may be requested for the normal operational requirements for the department and personnel. The Contractor shall provide work that is consistent with the guidelines and procedures of the IHS. Failure of the Contractor to meet these standards can result in termination of this contract. The Contractor’s performance and abilities shall be evaluated based upon performance standards that are contained in this statement of work

During the performance of their duties, the Contractor shall provide for the consistent performance of patient care processes according to the standards for TJC accreditation program within IHS. These standards include: The Comprehensive Accreditation Manuals for Critical Access Hospitals, and the Laboratory Standards as they represent the scope of services of this contract.

The Contractor should be proficient in writing, typing and have a basic working knowledge and understanding of computer hardware and software applications. The Contractor shall have sufficient knowledge, competence and experience in providing these services on a regular schedule to the Service Unit. The Contractor shall possess sufficient initiative, interpersonal relationship skills, social sensitivity and appropriate professional behavior such that the Contractor can relate constructively to IHS employees, Contractors, vendors and individuals from the Native American community. Due to some limited driving requirements, the Contractor should have a current, valid state driver’s license from any of the 50 United States or the Commonwealth of Puerto Rico.

The Contractor shall not have any work or health restrictions, which could directly or indirectly interfere with the performance of providing services. The Contractor shall maintain acceptable standards of personal hygiene, grooming and professional attire such that their image as a Federal contract employee is compatible with the expectations of the IHS staff.

The Contractor must utilize the electronic health record for chart documentation.

The Contractor’s employee(s) and subcontractors shall be sensitive to the unique culture factors of the people they treat, which may include use of an interpreter as necessary in communication of services being rendered. Unique cultural factors that may contribute to the patient’s treatment include: use of their language communications; village and tribal customs; use of traditional healers; isolation; housing conditions and lack of resources.

Prepare and complete, in a timely fashion, the medical and other required records for all patients.

Adhere to the guidelines for his/her behavior and action as outlined in the Service Excellence Guidelines to enhance relations between employees, departments, patients, patient’s families and visitors.

Subject his/her performance to the hospital’s Quality Improvement Program, as the same may from time to time be in effect in accordance with the requirements of TJC and external regulatory agencies

Abide by the lawful ethical principles of his/her profession.

Abide by the bylaws, rules and regulations, general conduct of care, and Policy and Procedures set forth at HHCC.

Documentation in the patient’s health record are to be completed at the time services are rendered. During the performance of their duties, the contractor shall provide for the consistent performance of patient care processes according to the standards for TJC accreditation program within IHS. These standards include: The Comprehensive Accreditation Manuals for Critical Access Hospitals, and the Laboratory Standards as they represent the scope of services of this contract.

The contractor should be proficient in writing, typing and have a basic working knowledge and understanding of computer hardware and software applications. The contractor shall have sufficient knowledge, competence and experience in providing these services on a regular schedule to the Hopi Health Care Center or similar medical clinic or hospital. The contractor shall possess sufficient initiative, interpersonal relationship skills, social sensitivity and appropriate professional behavior such that the contractor can relate constructively to IHS employees, contractors, vendors and individuals from the Native American community. The contractor shall not have any work or health restrictions, which could directly or indirectly interfere with the performance of providing services. The contractor shall maintain acceptable standards of personal hygiene, grooming and professional attire such that their image as a Federal contract employee is compatible with the expectations of the IHS staff.

4. CONDITIONS FOR REMOVAL/REPLACEMENT OF CONTRACTORS

EMPLOYEE):

As mutually agreed between the Contracting Officer and the Contractor there may be grounds for removal and/or replacement of a Contractor employee. The Contractor’s employee shall be removed from an IHS facility if services are not performed in accordance with terms and conditions of this award.

The Contractor shall request government pre-approval to substitute or replace any of the Contractor’s employee of which it has provided qualifications and resumes under this contract.

All Contractor-requested substitutes or replacements’ qualifications, experience and professional certifications must be at least equal to or greater than the original Contractor’s employee provided by the Contractor under this contract.

5. CONTRACTOR REQUIREMENTS:

To be considered for award the offer must comply with the following responsibility factors.

Failure to provide the following responsibility factors in the response may disqualify an offeror from further consideration.

The Contractor may be an individual, group or organization in which a qualified provider providing services meets the stated qualification requirements described herein.

Contractor’s employee shall be in attendance for every scheduled shift.

The Contractor shall provide services in such a manner as to meet the highest standards of professional ethics and conduct particularly in regard to confidentiality and patient rights. If at any time during the term of the contract, the Government suspect's unprofessional behavior and practices, the Contractor will be contacted and requested to take appropriate action to correct the behavior or remove the Contractor’s employee.

The Contractor shall contact the Chief Nurse Executive or the Acting and be responsible for all documentation required for the Specialty ED RN.

The Contractor shall be responsible for notifying the Chief Nurse Executive or the Acting in case of an emergency or inclement weather that would prevent him/her from providing his/her schedule/shift.

The Contractor shall be proficient in writing, typing and have a basic working knowledge and understanding of computer hardware and software.

The Contractor shall not be authorized to perform any services for the Government until the IHS Governing body has granted the Contractor such privileges in writing. Federal contract employees do not accrue any form of retirement, social security, insurance or any other form of benefits.

The Contractor shall comply with all IHS facility infection control and safety procedures, and standards, including influenza vaccines from October through March.

The Contractor shall provide for the consistent performance of patient care process according to the standards of TJC and/or Centers for Medicare Services (CMS) who supplies accreditation to the health center(s). These standards shall include: The Comprehensive Accreditation Manual for Hospitals, the Laboratory Standards, and Ambulatory Care Standards as they represent the scope of services of this contract.

The Contractor shall assist and provide services and duties as may be requested for normal operational requirements for the department and personnel. The Contractor shall provide work that is consistent with the guidelines and procedures of the IHS. Failure of the Contractor to meet these standards can result in the cancellation of the contract.

The Contractor shall have sufficient knowledge, competence and experience in providing these services on a regular scheduled clinic at HHCC. The Contractor shall possess sufficient initiative, interpersonal relationship skills, social sensitivity and appropriate professional behavior such that the Contractor can relate constructively to IHS employees, Contractors, patients, clients and individuals from the Native American Community.

The Contractor shall inform the COR, Contracting Officer or Program Manager or their designated representative of any problems encountered or which may be encountered in connection with meeting the needs of the Contractor’s duties.

The Contractor shall not have any work or health restrictions, which could directly or indirectly interfere with the performance of providing services as there will be some moderate lifting with regard patients, supplies, medications, and equipment.

The Contractor shall maintain acceptable standards of personal hygiene and grooming such that their image as a Federal contract employee is compatible with the expectations of the IHS staff.

The Contractor shall be required to provide regular report of hours worked to the Designated COR with an invoice. This report shall be verified by the Chief Nurse Executive, or, his/her designee, that can confirm the coverage.

The Contractor(s) shall designate an individual who will be the “Project Manager” that will be available to discuss any problems or issues that arise with the COR. (Reference Addendum to FAR 52.212-2 Evaluation – Commercial Items, Technical Evaluation Factors, B. Key Personnel).

The Contract shall obtain and maintain, at his/her own expense, RN licensure and certifications required in the performance of the contract, and shall comply with all laws, regulations, (Federal, State, Tribal and respective hospital) ordinances in the performance of this contract.

If required by the Service Unit, the IHS will provide training for the Contractor’s employee on Electronic Health Records (EHR), the Contractor shall complete medical records on the same day, in the EHR, in accordance with The Joint Commission (TJC) requirements, the Scope of Work Statement. Failure to abide by this requirement is basis for cancellation of this contract.

After given access the EHR, the Contractor(s) shall be required to enter medical patient information, laboratory and X-Rays, etc. into the electronic health record. Medical Records will be the property of the U.S. Government and will be placed in each patient’s chart at the health center. The Medical Records shall not leave the premises.

Pursuant to the Federal Information Security Management Act (FISMA) of 2002 the Contractor shall complete the Computer Security Awareness Training (CSAT) course before computer access is provided or within a few days after receiving their access and annually after that.

Within the Health and Human Services (HHS), there is a requirement for this training to be completed annually by all employees that includes the Contractor.

The Contractor shall comply with all IHS facility infection control and safety procedures, and standards. During the performance of this contract, the Contractor shall provide for the consistent performance of patient care process according to the standards of TJC and/or Centers for Medicare Services (CMS) who supplies accreditation to the Hopi Health Care Center. These standards shall include: The Comprehensive Accreditation Manual for Critical Access Hospitals, and the Laboratory Standards as they represent the scope of services of this contract.

Upon award, the selected Contractor’s employee shall undergo Indian Health Service (IHS) mandated security clearance for work on-site for the health center. The security pre-clearance requirement must be adhered to; the process includes a fingerprint check and a screen check through the Office of the Inspector General's exclusion list at http://exclusions.oig.hhs.gov/.

Documented evidence of the clearances shall be provided to the Contracting Officer Representative at the HHCC.

All financial, statistical, personnel, and technical data which is furnished produced or otherwise available to the Contractor during the performance of this contract are considered confidential business information and shall not be used for purposes other than performance of work under this contract. Such data or information shall not be released nor legal rights claimed by the Contractor without prior written consent of the Contracting Officer. Any presentation of any statistical or analytical materials, or any reports based on information obtained from performance by this contract will be subject to review and approval of the Contracting Officer. (Refer to HHSAR 352.270-4b Protection of Human Subjects).

6. MAJOR DUTIES REQUIRED:

The overall scope of this contract is to temporarily recruit and hire a qualified contractor under a Government Non-Personal Services contract. The Contractor shall have the necessary education, training, licensing, previous work experience and competence in being able to provide the services within the department. The contract resulting from this solicitation shall:

a) The contractor shall show evidence of physical examination within the preceding twelve (12) months wherein a Physician certifies that the Contractor exhibits no medical condition or physical disability which would interfere with the performance of his or her duties.

g) The contractor(s) shall attend a HHCC orientation and all Contractors, Students, Volunteers and Temporary Staff are required to provide immunization records as proof of immunity or disease for MMR, Varicella, Hepatitis B or declination form, Hepatitis B titer for staff with potential for contact with blood or body fluids, seasonal influenza vaccine (October-March), Tdap and two TB Skin tests with results administered in the past 12 months, one must be within 30 days prior to the start date. Persons with LTBI are required to complete the TB screening form and will be referred to the Employee Health Provider. Meningococcal is required for microbiology staff who are routinely exposed to isolates of Neisseria meningitides, boosters are needed every 5 years if the risk continues. Volunteers, contractors, students and temporary staff without proof of immunity or vaccination cannot report to duty, be scheduled into orientation, or be issued a badge until the immunization status has been confirmed. Employee health creates a file for all contractors, students, volunteers, and temporary staff. Contracting Coordinators/Supervisor are responsible to obtain complete immunization records for contractors and fax to the Employee Health Office for clearance.

7. CONTRACTOR MINIMUM REQUIREMENTS/QUALIFICATIONS:

A. The contractor shall provide the Government with the qualifications of a Specialty ED

RN with minimum of 3 years of experience as a registered nurse, with 2 years of experience within the respective specialty; abilities presented as candidates for assignments, including a skills assessment and competency (as applicable), resume (detail experience in months and years), and references.

B. When Registered Nurses have been confirmed for an assignment with the Government, upon request, the contractor will provide the Government with the clinical certification and license requirements found.

C. Basic Requirement: Degree or diploma from a professional RN program approved by the legally designated National accrediting agency at the time the program was completed by the applicant.

D. Registration: Applicants must have active, current unrestricted RN license in a State, District of Columbia, the Commonwealth of Puerto Rico, or a Territory of the United States. Contractor shall assure each license is in good standing.

E. Each licensed RN shall present an original current license when reporting to the HHCC Emergency Department for duty or for orientation whichever comes first. A copy is required for the contract file. No reimbursement will be made for RN’s who report to work with an expired license or a license that is not in good standing.

F. According to current HHCC Policy as referenced by the HHCC Credentialing Education and Competency Plan. All Contractor’s employee’s personnel shall have current certification described.

G. All Contractors must provide copy of resume for file. Contractor file will be kept by the Emergency Department for verification of license or certificate, also file will contain personal information such as home, address, and phone number, next of kin, person to notify in case of emergency, health requirements, mandatory in-service and continuing education, competency assessments and awards or disciplinary action.

H. Contractor is responsible for his/her own reliable transportation, travel, hotel, and per diem expenses in the performance of this contract. Travel Costs may be reimbursed at the Federal Travel Regulation for mileage, lodging, MI&E up to the not to exceed line item dollar value of the award.

I. Contractor is responsible for maintaining satisfactory standard of competence, conduct, appearance and integrity. The quality of work performance of the Contractor shall be subject to review.

J. Contractor shall abide by HHCC Standard of Conduct and policies and procedures.

K. Contractor is responsible for notifying the Chief Nurse Executive or Designee if he/she will be late or will be unable to work due to illness or any other reason.

L. Contractors who become sick while on duty will seek medical care from their own private physician, unless Contractor is eligible to receive health care from Indian Health Service.

M. Contractor is responsible for completing time sheets for actual hours worked.

N. Certification/License: The Registered Nurse must possess and maintain an active unrestricted nursing licensure. Current certification is required in BLS (Basic Life Support), ACLS (Advanced Cardiac Life Support), PALS (Pediatric Advanced Life Support), and NCC (Trauma Nurse Core Course) or equivalent preferred.

8. CONTRACTOR CREDENTIALS:

The contractor shall provide a list of qualified candidates and the following documents per candidate as applicable:

a) Current Resume.

b) Two (2) letters of reference from current or previous employers.

c) Verification of Employment (VOE) required from a current or previous employer within the last three (3) years.

d) Copy of a valid, unrestricted License to practice.

e) Copy of valid BLS (Basic Life Support), ACLS (Advanced Cardiac Life Support), and PALS

(Pediatric Advanced Life Support) certifications.

f) Copy of appropriate medical malpractice liability coverage.

g) OMB NO 0917-0028, Addendum to Declaration of Federal Employment (OF-306).

h) Past Work Performance Statement, applicants must describe their present/previous experience in this field.

i) Current Health Status Report.

j) Copy of College Transcripts; conferred degrees and certified training in the field.

k) Certificate of Immunization.

l) Child Care Form, Addendum OMB Approved Form-2012.

9. SECURITY CLEARANCES:

The contractor shall ensure their employees have been properly screened prior to presenting to HHCC for employment under this contract. The contractor shall inform their employees to obtain Fingerprint cards or electronically submit their fingerprints through the HHCC Human Resources Department and complete the appropriate background investigation form which will be submitted for processing. No performance under this contract shall be allowed until the contractor’s employee is cleared through the HHCC Human Resources Department and issued a badge.

10. SUPERVISORY CONTROLS:

The Chief Nurse Executive, or supervising designee, provides primarily administrative supervision. The supervising designee sets overall health care objectives and specifies resources available. The Chief Nurse Executive provides for clinical supervision on a 24-hour, media and tour of duty coverage. The Chief Nurse Executive reviews work performance on a periodic basis in order to evaluate proficiency in providing health care, discuss deficiencies and problems encountered. Work performance is reviewed for conformance to IHS policy.

11. DELIVERABLES:

The Contractor is required to provide a copy of each Contractor’s employee profile to the Contracting Officer Representative prior to providing services at the HHCC.