SOW - Retinal Consultation and Laser Treatment 2024 - 2029.docx

Department of Health and Human Services Indian Health Service Oklahoma City Area

Statement of Work (SOW) Retinal Consultation and Laser treatment

1. PURPOSE OF THE PROJECT

The Indian Health Services (IHS) has a requirement for non-personal contract for on-site Retinal Consultation and Treatment services in the Optometry department of the Pawnee Indian Health Center (PIHC). Contractor shall provide on-site services once monthly (but up to twice monthly if required). Pawnee offers acute and chronic, as well as Pediatrics, Audiology, Behavioral Health, Community Health, Dental, Laboratory, Medical Imaging, Optometry, Podiatry and Physical Therapy.

The Pawnee Indian Health Center is a Joint Commission accredited federal facility. To meet the mission, Ophthalmology care is a medical modality that has been deemed necessary to augment the services within the facility and as such are necessary to support and supplement health care. Services shall include intravitreal injections, laser treatments, pre and post treatment evaluations, and other services dealing with ophthalmological disorders. Requesting Licensed Ophthalmologist to come on-site to perform services.

2. DETAILED DESCRIPTION OF THE TECHNICAL REQUIREMENTS

The care provided by the contractor shall be as comprehensive as the Indian Health Service supplied facilities; equipment and support services permit. The contractor shall provide Ophthalmology services for patients as required by this statement of work (SOW) and in accordance with the terms and conditions of this contract.

Contractor shall provide services to eligible beneficiaries of the Indian Health Service who present themselves for treatment. Contractors shall provide diagnostic and treatment services including minor procedures as determined by evaluation and provide follow-up care as identified by treatment plan.

Services shall be fully coordinated and integrated with the Optometrist within the Pawnee Indian Health Center with respect to services provided and professional relationships.

Contractor shall furnish services to include but not limited to the following:

1. Retinal Consultation and Treatment Clinic at the Pawnee Indian Health Center once monthly, up to two days if necessary. Contractor's services will include:

a. Intravitreal injections, laser treatments, pre and post treatment evaluations, and other services dealing with ophthalmological disorders.

b. Treatment provided to patients with diabetic retinopathy will adhere to the current American Academy of Ophthalmology Preferred Patterns of Practice for Diabetic Retinopathy.

c. It is anticipated that approximately twenty to thirty (20-30) individual patient consultations and three (3) laser treatments and ten (10) intravitreal injections will be performed during the course of each one-day clinic.

2. Contractor shall provide portable laser equipment which is compatible with equipment presently in place at the Pawnee Indian Health Center.

a. Contractor and Pawnee Indian Health Center medical staff shall define potential risks and complications associated with any treatment and the associated post-treatment period. Specific responsibilities and procedures to be followed in the event of complications shall be identified.

b. Pawnee Indian Health Center professionals shall participate with Contractor in conducting the Treatment Clinic, including pre-Clinic preparation and post- Clinic activities, to ensure the delivery of quality care in an efficient and timely fashion.

c. Pawnee Indian Health Center shall employ and supervise office personnel for reception, telephone answering, patient scheduling, nursing service, billing, filing and assistance to professionals.

3. Chart, record and document in the Electronic Health Record (EHR) system provided by the facility or on any paper forms approved by the facility in case of EHR outage.

4. All patient encounters shall be documented in the patient’s electronic health record (EHR) within 24 hours of clinic completion. All such records shall be and remain the property of Pawnee Indian Health Center. While on-site, Contractor shall have access to such records at all times and may use such records and the information therein in connection with its treatment efforts. Contractor acknowledges that the information derived from the treatment and consultation services will remain confidential at all times.

5. Physician shall be proficient in electronically documenting services utilizing the appropriate electronic medical record system for patient encounters; complete all required administrative paperwork day of the patient encounter to include electronic consults, referrals, co-signatures, completion of chart or Risk Management Reviews.

6. Documentation of services shall be in accordance with clinic practice standards and applicable to all regulatory guidelines.

7. Contractor shall participate in quality assurance activities that ensure quality patient care as well as efficient use of hospital resources. These activities may include, but not limited to, chart review and discussion with the Clinical Director or his designee.

8. Contractor shall schedule in advance clinic based on facility needs and the vendor’s availability.

9. Contractor (Provider as well as any/all support staff/techs) shall complete orientation prior to beginning work.

10. Retinal clinic shall be scheduled during Pawnee Indian Health Center’s operating hours of Monday-Friday, 8:00 AM through 4:30 PM.

11. Clinic dates shall be scheduled 4 months in advance and if cancelled due to vendor unavailability shall be rescheduled within 30 calendar days.

12. Any changes to the proceeding shall require mutual agreement of the Contractor and the Contracting Officer.

13. The contractor shall advise the Optometrist or Ancillary Services Director of any problem encountered, in connection with meeting the patient care needs.

14. Develop a working understanding of the Joint Commission standards, the Centers for Disease Control guidelines and Association of Infection Control guidelines.

15. Pawnee Indian Health Center will bill third party reimbursement for treatment services provided and rendered by Contractor and shall retain all revenues received from such billings. Contractor shall not directly or indirectly bill any party, other than the Pawnee Indian Health Center, for any services provided. This contract shall not be construed to create any type of partnership, joint venture or employer- employee relationship between Pawnee Indian Health Center and Contractor.

16. The Contractor shall not assign or transfer their respective rights or obligations under this contract.

3. PERIOD OF PERFORMANCE

The base year Period of Performance will be 12 months from date of award with four (4) twelve (12) month option years.

4. LEVEL OF EFFORT

4.1. The contractor shall complete orientation sessions conducted on-site by the Human Resources Department.

4.2. The contractor shall be required to develop familiarity and abide by current policies, procedures, and regulations of the Pawnee Indian Health Center.

4.3. Contractor shall perform services in compliance with applicable standards of The Joint Commission (TJC), which is available to the general public and the Professional Services Policies of the IHS Manual, which is available from the IHS.

4.4. The contractor shall be subject to evaluation on quality by the Government via routine staff members’ review of charts on a routine basis as established by the Pawnee Indian Health Center.

4.5. The contractor shall be required to be familiar with all Emergency Codes. Reference publications are available on-site.

5. SPECIAL REQUIREMENTS

5.1. In accordance with HHSAR 304.1300(b) non-routine contractor employees shall comply with OPDIV DHHS/SE Region – Human Resources, Security Clearance Guidance – Visitors (3/29/12) policy for contract performance period. Contractor employees will be required to obtain a visitor’s pass upon arrival for services from Facilities Management.- (Security Clearance for on-site human services)

5.2. The USPHS Pawnee Indian Health Center is a tobacco/smoke free environment (buildings and grounds). No tobacco/smoking use will be tolerated during service.

5.3. Security Requirements: All contractors shall undergo a fingerprint check and shall be cleared prior to hire. Contractor’s continued employment is contingent upon the outcome of a complete and favorable background investigation as determined by the sensitivity level of the position. If contractors are found not suitable, they will be removed.

5.2.1 This is a designated position covered by Public Law 101-647, 101-630, Crime Control Act of 1990, and the Indian Child Protection and Family Violence Prevention Act, requiring contact or control over Indian children. Contractors shall be required to complete, sign, and submit the Addendum to OF-306, Child Care & Indian Child Care Worker Position form. Due to this requirement, the agency shall ensure that persons hired for these positions have not been found guilty of or pleaded nolo contendere or guilty to certain crimes. Failure to comply with these statutes shall result in immediate removal.

5.4. The contractor shall provide during the term of the contract documentation of immunization record to reflect CDC’s Recommended Vaccines for Healthcare Workers (specifically MMR, Tdap, varicella, and Hep B immunity). Contractor shall provide documented evidence of annual current season influenza and any other influenza-related vaccination, unless medically contraindicated. COVID-19, and current annual tuberculosis screening. Documentation shall be provided to the Employee Health Nurse.

5.5. The contractor shall not disclose or cause to disseminate any information concerning operations of Pawnee Indian Health Center. Such action(s) could result in violation of the contract and possible legal actions.

5.5.1. All inquiries, comments, or complaints arising from any matter observed, experienced or learned of as a result of or in connection with the performance of the contract, the resolution of which may require the dissemination of official information, shall be directed to the government’s designated representative.

6. DELIVERABLES AND REPORTING REQUIREMENTS

6.1. Delivery: The contractor will coordinate the orientation and clinic dates with the designated government employee.

6.2. Contractor Point of Contact: The contractor shall furnish one designated point of contact (POC) to the government’s designated representative for coordination of services. The POC will be empowered to make daily decisions to ensure that the contract implementation and day-to-day services meets the terms and conditions of this contract.

6.3. Contractor’s Phone Numbers: The contractor shall provide a toll-free telephone number for calls, which must be answered during at least eight working hours, between 8:00 am and 4:30 pm, Monday through Friday.

6.4. Personnel Qualifications:

Physicians shall comply with the policies, procedures and by-laws of the hospital/clinic. The physician shall also be required to perform this service in compliance with applicable standards of The Joint Commission and Quality Improvement. The contractor shall provide a provider who meets the following minimum professional qualifications and requirements:

6.4.1. Permanent, current, full and unrestricted license to practice medicine in the United States, District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States.

6.4.2. Physicians shall be Board Certified in or Board Eligible in Ophthalmologic Medicine

6.4.3. Shall be a United States Citizen.

6.4.4. Physicians shall apply and be accepted as clinic/hospital associate member of on-site Medical Staff.

6.4.5. Shall provide a copy of documentation of physician’s current Basic Life Support (BLS).

6.4.6. Shall speak, understand, read and write English fluently and communicate with sufficient clarity to be understood by IHS personnel and patients.

6.4.7. Shall possess sufficient initiative, interpersonal relationship skills and social sensitivity such that he/she can relate constructively to patients of the Native American/Alaska Native communities

6.4.8. Shall maintain standards of personal hygiene and grooming such that his/her image as a physician is compatible with the expectations of the on-site Clinical Director.

6.3.10. Shall have a current DEA license.

6.4.9. Shall provide a complete IHS Medical Staff Application to include documentation of work history since graduation from professional school to present day in chronological order. Any time period of gaps greater than 30 days since graduation from professional school, shall be explained in writing along with contact information of an individual who can verify the gaps.

6.4.10. Shall provide a copy of documentation of current and past insurance carriers and contact information during the past 10 years.

6.4.11. Shall provide documentation of and maintain current professional liability insurance coverage in the amount of $1 million per occurrence and $3 million aggregate per provider.

6.5. Credentials:

6.5.1. Physicians shall be credentialed and have privileges as active members of the medical staff. The physician shall be required to provide completed applications for Medical Staff appointments and privileges, as specified in the By-laws, for all providers to the Clinical Director and at least 30 (thirty) days prior to assignment for periods of coverage.

6.5.2. Credentialing activities shall require a minimum of thirty (30) calendar days to insure (1) that written or printed information is received at the on-site Hospital Quality Assurance Department from the National Physicians Data Bank, (2) that three letters of reference for each sub-contractor are received in the Credentials Office and are recent within the last year, and (3) the credentialing package (application for appointment and request for privileges) is completed and received by the Medical Executive Committee and OCA IHS Governing Board.

6.6. Verification of Credentials:

To ensure that physicians providing services under this contract are properly licensed, and that the IHS is made aware of all disciplinary actions taken against each physician, the Contractor shall:

6.6.1. Verify in writing to the IHS through the Federation of State Medical Boards database, all active, inactive, and lapsed licenses that are held or have been held by physicians who provide services in IHS hospitals and clinics under this blanket purchase agreement.

6.6.2. Inform the IHS of the status of all licenses for each physician including all reasons for each inactive or lapsed license.

6.6.3. Obtain at least three (3) letters of reference from health care providers whom have knowledge of the applicant’s clinical practice skills. One letter shall be from the Chief of Staff, or Service at the hospital where the physician holds or last held staff privileges. If the physician has just completed a residency, one letter shall be from the residency program director or serve chief.

6.6.4. Provide all information regarding performance and disciplinary actions that are collected on physicians who would be placed under this contract to the receiving IHS facility Clinical Director. This includes all information that is collected and compiled on such physicians at the time of initial hire by the Contractor, and/or information that is reported during periods that the Contractor is an agent of such physicians for a placement under this contract.

7. GOVERNMENT FURNISHED PROPERTY, FACILITIES AND SERVICES

7.1. The Government shall provide work station, computers, PPE, and other supplies necessary to perform services on-site.

8. CONTRACTOR FURNISHED PROPERTY, FACILITIES AND SERVICES

8.1. Required personnel, materials, supplies and equipment: The contractor shall furnish all personnel, materials, supplies and equipment required to perform work under the contract, to include but not limited to: Portable Laser equipment.

9. CHANGES TO THE STATEMENT OF WORK (SOW)

Any changes to this SOW shall be authorized and approved only through written correspondence from the Contracting Officer. Costs incurred by the contractor through the actions of parties other than the Contracting Officer shall be borne by the contractor.

10. DELIVERABLES/PERFORMANCE MATRIX

The contractor shall be evaluated over the contract period using the following metrics:

Department Supervisor Signature:_________________________

Chief Executive Officer Signature:_________________________ image1.png image2.png