SOW_-_Claremore_Chiropractor.docx

STATEMENT OF WORK – Chiropractic Services

I. General:

The purpose of this contract is to provide chiropractic services for the Claremore Indian Hospital (CIH), Claremore, Ok. The Indian Health Service requires chiropractic services without interruption of during the term of this contract and to limit the scope of work to the patient’s pain.

II. Background:

The mission of the Claremore Indian Hospital is to provide the best possible health care services to the Native American population. To meet the mission, CIH requires contractor support to provide chiropractic services.

III. Scope:

Contractor shall provide part-time chiropractic services, no less than 2 days per week, 8 hours per day at Claremore Indian Hospital as mutually agreed upon by the contractor and Indian Health Service for patients over 18 year of age. Services shall include but may not be limited to the following:

IV. Responsibilities:

a. Evaluates the neuro-musculo-skeletal systems as they pertain to the patient’s referral for treatment.

b. Records the evaluation and designs a treatment program with goals set appropriately for the diagnosis.

b. Provides on-going treatment and re-evaluations of the response to treatment as they relate to the goals.

c. Utilizes appropriate manual skills and physical agents to realize the goals set for the patient.

d. Documents on-going progress towards reaching goals and appropriate changes in the neuro-musculo-skeletal systems in Electronic Health Record (EHR).

e. Contract chiropractor shall not have any work or health restrictions, which interfere with the performance of Chiropractic services.

f. Conduct patient visits for the purpose of determining appropriate plan of care regarding management of patient’s chronic pain.

g. Document all visists in Resource and Patient Management System (RPMS) and E H R. Medical record documentation must meet or exceed the established standards of the CIH to include, but not limited to timeliness, legibility, accuracy, and content. All medical record information generated in the performance of this contract will remain the property of and subject to exclusive control of the I H S.

h. Perform all required training timely for HIPPA and computer access, as required by CIH.

i. Performs manual and manipulative therapies with an emphasis on spinal manipulation as feasible and appropriate at CIH.

j. Contractor shall work with the Clinical Director to ensure proper licensure, credentialing and privileging of staff required to provide these services at CIH.

k. Contractor shall work with the Clinical Director and/or designess to establish the dates and times for the clinic. The clinic schedule may be expanded or extended, if patient demand justifies such, and with permission and agreement of all parties. The contractor shall notify the Clinical Director and/or designee as soon as possible if unable to work during scheduled houres. No weekend or federal holidays are worked.

l. Using the Resource and Patient Management System (RPMS) package and Electronic Health Record ( E H R), the contractor shall perform chiropractic treatment for pain at CIH on adult patients.

m. The contractor shall not bill for patients seen as CIH nor bill any third party payors for services provided at CIH. The contractor shall be eligible for enrollment in the serive unit’s Medicare/Medicaid program and any other alternate resource payor, to allow the hospital to bill these entitites for the contractor’s services, as applicable.

n. The contractor shall respect and maintain the basic rights of patients, to include but not limited to personal dignity. The contractor shall possess sufficient initiative, interpersonal relastionship skills and social sensitivity such that he/she can relate constructively to patients from the Native American community.

o. The contractor shall adhere to CIH dress code policy and ensure that his/her image as a chiropractor is compatible with the expectations of the CIH staff and community.

p. The contractor shall perform special assignments as requested to fulfill objectives of the department, facility or service unit. These will be discussed in advance with the contractor and agreement reached before any new duties are assigned.

Period of Performance:

Base year, plus an additional (4) four option years

Contractor Qualification Requirements:

The Contractor shall provide the services described in the Statement of Work independent of Government Supervision.

The Contractor will provide Indian Health Service patients under the terms of this contract proper and adequate accommodations and services, which are the same or equal to those provided to non-Indian Health Service patients and shall include compliance with The Joint Commission or other certifying body.

Contractor shall have a current, unrestricted chiropractor license from any US state or territory.

Contractor must document annual continuing medical education if required.

Contractor must have one year experience as a chiropractor

Contractor will use the Indian Health Service medical records system to record appropriate diagnostic and evaluation summaries for each patient seen. These records are to be a permanent part of the Indian Health Service records system and subject to peer reviews and review by other accrediting entities.

Prior to providing treatment, contractor or designee, is required to provide all the necessary forms and information required to obtain background investigations and complete the orientation process.

Contractor shall be required to develop familiarity with current policies, procedures,by-laws and regulations of the clinical and medical staff of the Claremore Indian Hospital.

V. Special Terms and Conditions:

A. Privacy Act: In accordance with the Privacy Act, the Contractor shall direct any questions regarding maintaining system of records to this contract to the Oklahoma City Area Privacy Act Coordinator, Jennifer Farris at 405-951-3708.

b. Non-personal Services:

(1) This contract is a non-personal health care services contract, as defined in 37.101, under which the contractor is an independent contractor,

(2) The professional services of the contractor will be evaluated for quality by the Government via routine IHS staff members review of patient charts on a quarterly basis or more often as appropriate, however, the Government retains no control over the medical professional aspects of services rendered (e.g. professional judgments, diagnosis for specific medical or psychological treatment)

c. Contractor Qualifications:

The contractor shall:

(1) Have one year experience as a chiropractor;

(2) Have current professional liability insurance;

(3) Apply for and be credentialed at Claremore Indian Hospital;

Quote/Contract Documentation Requirements to be submitted:

(1) Copy of current resume or CV;

(2) Copy of current license to practice medicine;

(3) Copy of current professional liability insurance;

VI. Schedule of Work:

The contractor shall provide part-time chiropractic services no less than 2 days per week, 8 hours per day. Contractor shall work with the Clinical Director and/or designee to establish the days and times for the clinic. The clinic schedule may be expanded or extended, if patient demand justifies as such, and with the permission and agreement of all parties. The contractor shall notify the Clinical Director and /or designee as soon as possible if unable to work during scheduled hours. No weekends or federal holiday are worked.

VII. Rates of Payment:

The rate shall be an all-inclusive clinic fee (eight-hour shift) for conduction of the study, assessment of the results, and production of written report detailing the findings and any recommendations for improvement.

VIII. 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.

IX. Government Furnished Information, Property and Services:

Claremore Indian Hospital shall provide office space including room for patient examination and treatment. The contract chiropractor will be authorized to use all areas of the medical treatment facility available to civil service and commissioned personnel in similar positions. The same restrictions apply to the chiropractor as any other Indian Health Service personnel to use these areas for official business activities only.

The contract chiropractor will be authorized to use all administrative and professional support available to I H S personnel. The will include but not be limited to copy machines, telefax machines, and telephone service. The same restrictions to use these items for official I H S business.

All medical record information generated in the performance of this contract will remain the property of and subject to the exlcusive control of the I H S.

X. 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.

XI. Invoicing Requirements

a. The Contractor shall be required to provide an original 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 upon successful completion of the development and implementation phase and no later than ten (10) calendar days following last calendar day of the month for the maintenance phase.