Attachment_1_Statement_of_Work_U_and_O.docx

Statement of Work for Indian Health Service (IHS), Uintah Ouray ( U & O) IHS Service Unit Telephone Nurse Triage Service

Background

Uintah Ouray Service Unit (U&O Service Unit) provides quality comprehensive medical care and customer service to approximately 10,000 American Indian and Alaska Native active users. The hours of operation are Monday – Friday, 8 AM to 5 PM and the health center is closed on all federally recognized holidays. The transformed from the traditional IHS public health care delivery system and implemented the Family Practice Model utilizing the Care Team approach in January 2010. A Telephone Nurse Triage Service is a key component in Improving Patient Care (IPC) in the U&O Service Unit enhanced patient health care delivery system.

Project Objectives

After hours, weekends and holidays, the U&O SERVICE UNIT is in need of a nurse triage system. This will help our patients decide if they can be treated at home, should go to an urgent care center or an emergency room or if the patient can wait to be seen at the U&O SERVICE UNIT during the next normal business hours.

The objective is to direct patients to the best care option based on their circumstance. The nurse triage service will empower patients to take an active role in managing their health by enhancing access to care by providing medical guidance during non-business hours. Utilizing the nursing advice or suggestion will be the patient’s and/or patient’s parent/guardian’s prerogative.

1.0. Scope of Work. The contractor shall provide all personnel, labor, facility, materials, equipment, and services for providing a telephone-based nurse triage service. The contractor shall provide a clinical assessment and disposition to an appropriate level of care for all patients who utilize the nurse triage service.

The contractor shall provide nurse telephone triage services during normal business hours. The contractor shall provide nurse telephone triage services during health center non-business hours. The contractor shall be available with personnel to answer calls from 5:00pm to 8:00am on weekdays and 24 hours on weekends, federally recognized holidays, and during any other planned health center closure. In accordance with 5 U.S.C. 6103, the following is a list of legal federal holidays as referred to elsewhere in the contract.

New Year’s day Martin Luther King, Jr. Birthday Washington’s Birthday Memorial Day Independence Day Labor Day Columbus Day Veterans Day Thanksgiving Day Christmas Day

The contractor shall be notified within a minimum of 30 days by the Project Officer of any planned health center closures.

The U & O Service Unit estimates approximately 35- calls per month to be processed by the contractor.

A 15-second pre-recorded message will advise callers of their privacy rights and include a disclaimer for IHS payment responsibility for all health care advice. (Script to be provided by U&O SERVICE UNIT)

The nurse shall ask for personal details including name, DOB, facility where they normally receive services, chart #, primary care physician, insurance (information) and tribal enrollment information. If the patient is not a member of a federally recognized tribe, the contractor shall advise the patient the service are only for enrolled beneficiaries. The patient may remain anonymous if they wish.

The nurse triage service shall gather information from the nurse triage service calls and be entered into the contractors database or spreadsheet application to show personal data, assessments, documented resolution, and/or further action needed from a Primary Care Provider. Call summary shall be faxed to the U&O SERVICE UNIT medical records department by the next business day. (Contractor shall provide sample of patient call summary, reference 1.3).

1.1. Telephone Nurse Triage Service.

The contractor shall:

1.1.1. Provide technical, operational, administrative and management support for the beneficiaries.

1.1.2. Provide a toll free 1-800 number for the U & O Service Unit nurse triage system.

1.1.3. Perform triage caller interaction utilizing nationally recognized and physician approved clinical protocols and guidelines.

1.1.4. Manage patient calls per protocols, maintain call summaries, provide feedback to practices/providers as requested, provide feedback to program and medical management (reference 1.3 & 1.4).

1.1.5. Maintain URAC accreditation, formally known as Utilization Review Accreditation Commission.

1.1.7. Answering Calls. The contractor shall answer calls within an average of 30 seconds according to URAC Standards of Accreditation. The contractor will use protocols to determine the urgency of the call, transfer urgent calls directly to a registered nurse and respond to non-urgent calls by a registered nurse preferable within an average of 30 minutes.

1.2. Emergency Room/Urgent Care Referral Instructions. If the patient meets URAC criteria for referral to emergent or urgent care, then the contractor shall direct the patient to go to the closest emergency room/urgent care facility. If information is available, the contractor shall document which facility the patient plans to select.

1.3. Call Summaries. The contractor shall provide call summaries to include patient demographics, subjective and objective assessments, medications, protocol used, plan, intervention, evaluation and follow-up. If a patient is referred, the contractor shall document which facility the patient plans to select for care. Each individual patient’s call summary shall be provided to the U&O SERVICE UNIT by facsimile by the next business day. Communication will be in a written format to facilitate follow-up with referral management and Primary Care Team, as appropriate.

1.4. Call Statistics Reporting: The contractor shall submit a monthly status report to the U&O SERVICE UNIT no later than the 10th working day of each month. The monthly report shall include comprehensive analysis of triage activity to include, but not limited to, day of the week, call time, response time, triage nurse identification, chief complaint, disposition, and any unusual circumstance, in order to identify trends and for future planning purposes.

1.5. Quality Control. The contractor shall provide a quality control program based on a combination of clinical and peer review to ensure appropriate triage protocols are used, patient calls are responded to a timely manner, and that all customers are satisfied with the services received. An example of the policies and procedure will have the following components for a successful call:

1. Satisfied caller

1. Adherence to protocols

1. Complete documentation of assessment and advice

1. Appropriate medical disposition

1. Documentation whether patient plans to comply with care advice given

1.5.1. Quality Control Plan. The contractor shall implement a quality control program to ensure performance is in accordance with the contract requirements and URAC standards. The contractor shall make this plan available to the contracting officer (CO) within 30 days after the contract start date for review and approval.

1.6. Business Associate Agreement. Per the Health Insurance Portability and Accountability Act (HIPAA), the contractor will sign and return Memorandum of Agreement. This document may be renewed during the contract period, and the contractor is required to sign the current version.

1.7.1. Availability of the Contractor. The Sells Service Unit shall notify the contractor of upcoming closures as soon as schedules are available. There may be planned closures of the clinic during what would be normal business hours. In order to properly staff for closures and meet service level performance as noted in section 1.1.5, the contractor requires a minimum of 30-days notice from the U and O Service Unit.

1.7.2. Availability of the Contractor. The contractor shall notify the Project Officer as soon as possible of any disruption of contractor services.

2.0. GOVERNMENT FURNISHED PROPERTY AND SERVICES

2.1 Urgent Care Facilities. The U and Service Unity (Michael Kee) project officer shall provide the contractor with a list of urgent care facilities and emergency rooms, their phone numbers and their hours of operation.

3.0. GENERAL INFORMATION

3.1. Procedural Guidance. Contractor employees shall perform services compatible with a nationally recognized nurse triage protocol, as detailed in Section 1. New services shall not be introduced without prior recommendation to, and approval of, the U and O service unit project officer.

3.2. Privacy and Protection of Patient Information. Contractor employees shall abide by the Patient Privacy Act 1974 and the Health Insurance Portability and Accountability Act. Contractor employees shall provide patient information only to employees, contractors and subcontractors having a need to know such information in the performance of their duties. Patient medical information or lists and/or names of patients shall not be disclosed to or revealed in any way for any use outside the service unit without prior written permission by the HIPAA Point of Contact for the U and O service unit. All individuals answering calls as contractor employees are required to complete HIPPA training provided by the contractor.

3.3. Complaints. Complaints shall be forwarded to the U and O service unit project officer for action/rectification.

3.4. Contractor Employees

3.4.1. Contractor Point of Contact. The contractor shall provide a point of contact that shall be responsible for the performance of the work. The point of contact may be an individual providing service in accordance with this Statement of Work (SOW). The contractor shall designate this individual, in writing, to the Contracting Officer before the contract start date. An alternate shall be designated, but the contractor shall identify those times when the alternate shall be the primary point of contact. The contractor point of contact shall be available via pager or telephone, 24-hours per day, 7 days/week.

3.5. Qualification Requirements.

3.5.1 Minimum Education Requirements. Associates degree prepared registered nurse.

3.5.2. License/Registration. Registered Nurse (RN) licensed in the state in which the nurse triage service is physically located.

3.5.3. Experience. Minimum of three (3) years experience in nurse triage.

3.5.4. Cultural Sensitivity. The contractor shall provide cultural sensitivity training specific to the Tohono O’ohdam and American Indian / Alaska Native people as provided by the U and O service unit.

3.6. Liability Responsibility. This is a non-personal services contract. As such, the contractor employee shall not be afforded coverage under the Federal Tort Claims Act as provided in the Medical Malpractice Immunity Act, 10 U.S.C. 1089.

Version – April 8, 2010