3. PRC_MSA_PWS.docx

PERFORMANCE WORK STATEMENT

Medical Support Assistant

I. GENERAL.

1.1. Description of Work. The Contractor shall provide personnel to perform non-personal Medical Support Assistant services for the Indian Health Services Bemidji Area’s Cass Lake Hospital Service Unit. The medical support assistant shall be required to perform services as outlined with-in this document. The contract employee performing this service will hereafter be referred to as Medical Support Assistant (MSA). The locations will be referred to hereafter in this document as (CLH). Services are needed for a term of 12 months, consisting of 5, 8 hour days per week. Further information on requirements are detailed with-in this document.

1.1.1. FAR Subpart 37.4 Non-personal Health Care Services

Agencies may enter into non-personal health care services contracts with physicians, dentists and other health care providers under authority of 10 U.S.C. 2304 and 41 U.S.C. chapter 33, Planning and Solicitation. Each contract shall --

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

(b) State that the Government may evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of services rendered (e.g., professional judgments, diagnosis for specific medical treatment);

(c) Require that the contractor indemnify the Government for any liability producing act or omission by the contractor, its employees and agents occurring during contract performance;

(d) Require that the contractor maintain medical liability insurance, in a coverage amount acceptable to the contracting officer, which is not less than the amount normally prevailing within the local community for the medical specialty concerned; and

(e) State that the contractor is required to ensure that its subcontracts for provisions of health care services, contain the requirements of the clause at 52.237-7, including the maintenance of medical liability insurance.

SPECIFIC TASKS. The contract MSA shall perform essentially the same duties as those required of any Government Civil Service employee in a similar duty assignment.

2.0. The MSA shall be required to perform the following procedures and/or tasks including, but not limited to:

Determines patient eligibility for care under the Purchased/Referred Care Program. Applies PRC rules and regulations on PRC Delivery Areas, geographical facility proximity, tribal membership, and residence. Determines patient eligibility as a prerequisite to the authorization of funds. Participates in the decision making process for the provision or denial of payment for services based upon eligibility criteria.

Defines alternate resources available to patients under the PRC Program and determines patient eligibility for Medicare, Medicaid, Vocational rehabilitation, V.A., private insurance or other third parties. Contacts alternate resource agency or organization via telephone, correspondence or personal visit to insure maximum utilization. Conducts personal interviews with patient or family members to determine potential eligibility for alternate resources.

Interviews in-patients/outpatients to obtain pertinent current patient registration demographic information and enters/maintains in Practice Management and the RPMS Patient Registration system.

Obtains, verifies, and sequences insurance information for billing and maximum reimbursement from all alternate resources. Assures that all information is current and correct prior to billing for services .Identifies the order of billing/coordination of benefits on reason for visit or clinic type. Obtain signatures for Medicare and private insurance patients.

Identify patients whose health benefits are subject to prior approval to determine the extent of health care for both inpatient and outpatients. Explains the program to the beneficiaries, why Medicare, Medicaid and or private/commercial insurance will be billed for rendered services. Initiate all admitting forms to complete the admission with current patient data, including the RPMS patient registration sections utilizing hospital and other local resources.

The incumbent must be flexible in order to undertake a variety of miscellaneous duties as assigned by the Supervisor. Adjusts work assignments as needed to cover peak times, leave requests and vacancies. Prioritizes work to ensure work is disseminated appropriately and notifies immediate supervisor when a backlog of 4 or more days occurs.

Performs other duties as assigned.

II. QUALIFICATIONS AND REQUIREMENTS.

KNOWLEDGE REQUIRED BY THE POSITION

Knowledge of proper processing requirements including forms, authorization documents and standard correspondence.

Knowledge of the various clinical systems, walk-ins and appointments to avoid unnecessary delay or confusion on the part of the patient.

Knowledge of the patient registration function and requirements for obtaining necessary third party information. Knowledge of patient registration and ability to enter and update eligibility, demographic, contact, and insurance information into RPMS accurately.

Knowledge of Privacy and confidentiality considerations.

Skills in operating computers, scanner, copier machines and other standard office equipment.

SUPERVISORY CONTROLS

Under the supervision of the department supervisor. Work is reviewed to insure conformance with current policy and procedures of the Indian Health Service.

COMPLEXITY

The work involves not only demographic data, but also eligibility information and whether or not alternate resources (Medicare, Medicaid and/or private insurance) are available for all patients. Incumbent must be able to effectively communicate to the patient what specific information is needed, the reason for requesting the information and to ascertain this is as accurate as possible.

PERSONAL CONTACTS

Contacts are with service unit professional and Para professional employees, outside contractors and vendors, third party alternate resource organizations regulatory agencies patients and their families.

PURPOSE OF CONTACTS

The purpose of contacts is to coordinate work efforts to exchange or obtain patient information, solve technical problems, and for obtaining information to update the Patient Registration data base

PHYSICAL DEMANDS

Work is primarily sedentary. However, work does demand frequent standing, walking, sitting, bending, carrying of items such as records, supplies, and working with equipment.

WORK ENVIRONMENT

Work is performed in the different departments within the hospital

CONTRACTOR REQUIREMENTS.

The Contractor shall not employ any individual to provide direct health care services who is listed on the Health and Human Services (HHS) list of providers excluded from federally funded health care programs. The list may be found at MSAtp://oig.hhs.gov/fraud/exclusions.asp.

· The MSA shall be a U.S. citizen or otherwise meet other applicable requirements.

· The MSA shall successfully complete a criminal history background check.

· The MSA shall be able to read, write, and speak English well enough and enunciate with sufficient clarity to effectively communicate with patients and other health care providers.

· The MSA shall possess sufficient initiative, interpersonal relationship skills and social sensitivity such that the MSA can relate to a variety of patients from diverse backgrounds.

· The MSA shall be able to operate a personal computer utilizing Microsoft applications, such as Word, Excel, and efficiently utilize an Electronic Medical Record. The MSA shall be able to type and have had experience using computers. The MSA will not be required to type a certain amount of words per minute. CLH will provide computer training on their electronic medical records system. Failure to learn the computer system at the CLH and perform actions independently within 2 weeks of beginning service may be grounds for immediate removal of the MSA.

III. ADMINISTRATIVE.

1.3.1. This is a locum tenens procurement; therefore, the use of short-term rotating MSAs seriously detracts from continuity of patient care that is of utmost importance. Substitutes are permitted during scheduled or unscheduled absences of the primary MSA. The Contractor shall have adequate pre-approved replacement MSAs available in such instances so a lapse in coverage does not occur. Substitutes shall be as qualified as the primary MSA. Substitutes are not allowed so the MSA can accept another assignment or to meet the needs of the Contractor. Note – The Contractor’s attention is directed to the fact that normal approval process can take up to 30 days, and this is the same for replacement personal. There is no allowance/excused lapse in coverage based on a change of personnel, and may be considered grounds for termination for cause.

IV. ORIENTATION AND TRAINING.

Prior to working, the MSA will be provided a Government paid orientation to familiarize the MSA with the policies and procedures of the CLH. Orientation attendance will be required of all MSAs and will be scheduled by the COR during the first normal duty day.

The Contractor shall ensure that each MSA is knowledgeable of the policies and procedures of his/her specific place of duty and of the medical activity. The Contractor shall ensure MSAs receive any staff training required by the CLH, as a precondition/condition to performance. Such training may include instruction on automation processing, quality assurance policies and local in-service and safety briefings. This training shall be conducted during the scheduled shift of the MSA.

Government Unique Training. The Government may elect to provide unique Government training to MSAs who are performing services under this contract. If the Government elects to provide such training, the Government will provide such training at no additional expense to the Contractor or to the MSA. When directed by the Contracting Officer (CO), MSAs shall attend all such training in a paid status as part of the normal services required and billed under the contract. Such training shall require a performance commitment by the Contractor and the Contractor shall reimburse the Government (by means of a reduction in an invoice) if a MSA fails to satisfy the performance commitment after the MSA receives the unique Government training. The amount of the reimbursement shall be the prorated cost of training, calculated based on the total cost of the training and the number of months by which the MSA fails to complete the performance commitment. The length of the performance commitment shall be 12 months or until the end of all performance under this contract, whichever occurs first. Details of any subsequent training agreement will be agreed upon by all parties, and such training agreements will be designated by modification to the contract.

The MSAs shall attend all and take all training prescribed for personnel as required by Cass Lake Indian Hospital. Training shall be part of the workday.

MSAs shall attend training provided by Cass Lake Indian Hospital regarding their unique computer systems and programs. Failure to learn the computer system at Cass Lake Indian Hospital and perform actions independently within 2 weeks of beginning service may be grounds for immediate removal of the MSA.

V. ELECTRONIC MEDICAL RECORD KEEPING SYSTEMS.

The Government will provide training to MSAs in the Electronic Medical Record Keeping Systems and other procedures that the medical support assistant is required to use. Access to such patient data systems is an "Automated Data Processing Sensitive" position requiring compliance with the Health Insurance Portability and Accountability Act (HIPAA) Security Rule. Refer to the Additional Information section “ADP Security Requirements” in this contract for further guidance.

Electronic Health Record (EHR) contains the facilities’ appointment scheduling program, pharmacy, lab, and radiology ordering system and is interlinked with other departments in the CLH. The Government will provide training to MSAs in the EHR and/or other procedures that staff are required to use. Access to such patient data systems is an “Automated Data Processing Sensitive” position requiring compliance with the Health Insurance Portability and Accountability Act (HIPAA) Security Rule.

Training for EHR and other computer training will be scheduled through the COR prior to the MSAs providing direct support. The training will be on-site and during normal duty hours. This training will be at no cost to the Contractor.

If additional training is needed due to mission changes, the CLH Information Management Office will conduct required computer training. This training will be at no cost to the Contractor. The COR will schedule this training.

VI. REPORTING REQUIREMENTS.

The Contractor shall submit reports to the COR as requested for use in monitoring Contractor performance. Such reports may include, but are not limited to: personnel recruitment; time sheets, etc.

Safety. The Contractor shall ensure that its MSAs comply with all installation safety regulations. Such regulations include, but are not limited to, general safety, fire prevention, waste disposal and infection control. Copies of these regulations are on file in the medical activity safety office or may be obtained through the COR.

Hours of Performance.

Billing. The Government will only pay for hours, days or units actually worked/provided. The Contractor shall only submit payment requests for hours, days or units actually worked/provided. Submitting a payment request for more than the amount due based on the number hours, days or units actually worked/provided may constitute fraud or a false claim and may result in administrative or criminal action or both.

The MSA shall be able to provide services 8 hours a day, 5 days a week excluding federal holidays. Shifts will be 8 hours in length. No guarantee can be made that the shift will end as scheduled. A minimum break of 30 minutes will be given during the shift. Work hours and days will be determined by CLH, and confirmed by the contractor. A schedule discussed between a contract MSA and staff is not considered valid. Schedules are subject to change due to cancellations, hospital staff changes, organization day, emergencies, exodus, training holidays and unexpected events. The most a MSA can work is five consecutive days in a row.

Signing in prior to scheduled time will not be considered as hours worked. The above timeframes are subject to change. The hours do not include any break periods to eat. Break times are not billable. The government reserves the right to verify the hours worked by the MSAs by sign-in/sign-out sheet, checking computer logs, use of a time clock, etc.

Shift Scheduling. CLH will provide a schedule of needed shifts to the Contractor 30 days before the first scheduled shift. The Contractor shall furnish the name of the MSA scheduled to work.

On-call Services: On-call services will not be required for these services.

Overtime/Extended Shift: Overtime is not authorized under this contract.

Unscheduled Absences. Unscheduled absences shall be called into the assigned COR by the contractor at least 24 hours before the start of the shift. The contractor shall only be paid for actual hours worked.

Hours worked do not include travel time to reach the facility or other place of performance.

The MSAs shall be rested and fully physically and mentally capable of performing the duties required under this contract. The MSAs shall not have worked the 8 hours before beginning services at a CLH.

Closures. During anticipated closure of the facility due to a CLH’s, declared training, holiday or during unplanned closure of the facility due to natural disasters, emergencies, severe weather, or otherwise, the Contractor shall not invoice the Government for services not performed and the Government will not be liable to the Contractors for any such closures.

Holidays. There are ten federal holidays observed by the facility; the MSA will not be scheduled during these days.

The following is a list of legal federal holidays as referred to elsewhere in the contract.

New Year's Day

Birthday of Martin Luther King, Jr.

President's Day

Memorial Day

Independence Day

Labor Day

Columbus Day

Veterans Day

Thanksgiving Day

Christmas Day

NOTE: Any holidays that are declared by Presidential Executive Order shall be observed in the same manner as the holidays listed above

CONDUCT.

The Contractor shall ensure that each MSA records the time worked according to procedures determined by the CLH to include documenting hours on the time sheet.

The department Director, where services are being performed, or his/her representative, will define the scope of practice. The Contractor shall ensure that its MSAs do not introduce new procedures or services without prior approval of the department Director or COR. In disagreements or deviations from established or new protocols, the department Director, or COR, will be the deciding authority.

The Contractor shall ensure that its MSAs comply with CLH’s policies regarding personal appearance and conduct.

The Contractor shall ensure that its MSAs abide by federal and local CLH’s regulations and requirements concerning the nature of limited privileged communication between patients and the MSA as may be necessary for security and personnel reliability programs. The Contractor shall also ensure that its MSAs abide by federal and local CLH’s regulations concerning the confidentiality of patient records, as embodied in federal statutes including the Privacy Act of 1974 and the Health Insurance Portability & Accountability Act of 1996. All regulations referenced are available for review from the COR. All medical records and reports are and will remain the property of the Government.

Contractor shall abide by all local CLH’s policies/rules. All personnel shall maintain and support the standards necessary to meet Joint Commission (JC) and CMS (Centers for Medicare and Medicaid Services) certification. When commencing work under this contract, Contractor shall obtain an in-processing checklist from the COR and provide the COR a copy when completed. The Contractor shall wear a Cass Lake Service Unit identification badge. The COR will assist the Contractor in obtaining the identification badge through the CLH’s, Division-Security Officer. Upon termination of work at Cass Lake Service Unit, the contractor will be required to return the hospital identification badge and out-process through the activities identified on the out-processing checklist obtained from the COR.

The Contractor shall ensure that its MSAs make use of all appropriate equipment; supplies and services made available by the Government for the optimal care of the patients.

REMOVAL OF Medical Support Assistant (MSA).

Removal of MSA’s. At any time during the performance of this contract, the CO or COR may direct the Contractor to immediately remove any MSA whose actions or impaired/insubordinate state raises reasonable suspicion that clear and present danger of physical harm exists to a patient, other MSA’s, Government personnel or to the impaired individual. This provision will be used in emergency situations only and not for the purpose of bringing performance issues or other non-urgent concerns to the attention of the Contractor.

If the need for a removal occurs, the COR will contact the Contractor's point of contact and direct the Contractor to remove that individual from the facility and to not use that individual to perform any healthcare services required under this contract until the issue has been resolved by the CO. The Contractor shall formally meet with the COR to discuss further action in accordance with the scope of the contract. A review of the basis for removal will be made by the CO within three working days after the COR directed the removal.

If, after any investigation deemed necessary by the CO and discussions with the Contractor's representative, the CO concludes that the MSA’s impairment requires permanent removal from performance under the contract, the CO will notify the Contractor that permanent removal is required. In the event of disagreements between the Government and the Contractor's representative concerning matters of impaired/insubordinate MSAs, the decision of the CO will be final. During the period of time between the removal and the final decision of the CO, the Contractor shall provide a backup/replacement MSA in accordance with the terms and conditions of this contract.

Inquiries. Contractor shall ensure that its personnel do not respond to any media inquiries. Any inquiries from the media shall be immediately relayed to the COR, who will relay them to the Cass Lake Hospitals Chief Executive Officer (CEO). There shall be no interviews, comments, or any other response without the knowledge and approval of the CEO. Other than routine inquiries from external agencies, all other inquiries and complaints shall be brought to the attention of the MSA’s Government supervisor.

Smoking. The Contractor shall ensure that its MSAs comply with the CLH’s smoking policy.

Complaints. Complaints will be validated by the COR and be reported in writing to the CO and to the Contractor for action, if it constitutes a failure to perform, as determined by the Government. Patients may also be a source of legitimate complaints that constitute a failure to perform. The Contractor shall have no more than two substantiated complaints per 12-month period per MSA. Any patient complaints received on services provided by the MSA will be taken very seriously at the Cass Lake Indian Hospital and as such will be considered a part of the inspection process. The department Director will submit documentation to the COR regarding all patient and/or clinical complaints. Receipt of two valid complaints on the MSA within any twelve-month period may be considered grounds for immediate removal.

Conflict of Interest.

The Contractor/MSA shall not bill any patient for services rendered under this contract. The Contractor/MSA shall be prohibited from receiving compensation of any actions performed, except under the terms and conditions of this contract, at the rate specified.

The Contractor shall not use Government facilities or other Government property in connection with conducting a private practice and shall ensure that its employees do not do so.

Confidentiality of Information. Unless otherwise specified, all financial, statistical, personnel, and/or technical data which are 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. The Contractor shall not release any of the above information without prior written consent of the CO and shall ensure that its employees do not do so. The Contractor shall not use patient care rendered pursuant to this contract as part of a study, research project, or publication and shall ensure that its employees do not do so.

Professional Liability. Pursuant to Federal Tort Claims Act, the CLH shall process any personal injury claim alleging negligence by the MSA within the scope of the MSA’s performance under this contract as claims alleging negligence by the CLH. The Government will not reimburse or otherwise pay for such insurance should any be purchased.

RESPONSIBILITY AND PROCEDURES.

If any suit or action is filed or any claim is made against the MSA, which occurred as a result of work performed by the MSA under this contract, the MSA shall immediately notify the Contractor, the CO and the department Director of the appropriate services and promptly furnish them copies of all pertinent documents received.

The Contractor and MSA shall cooperate with the Government, without further compensation, in the processing, review, settlement, or defense of the suit, action, or claim. The MSA may, at the MSA’s own expense, participate in defense of such claim or litigation.

QUALITY MANAGEMENT.

Quality Control Plan (QC). The Contractor is required to follow the current QC program in place at the CLH to ensure that the services are provided at a level of quality that meets Bemidji Area Service Units standards.

Quality Assessment and Improvement (QA&I). The Government will monitor the Contractor's performance under this contract using the QA&I procedures established by the medical activity and pursuant to the Contract Terms and Conditions-Commercial Items clause, paragraph entitled Inspection/Acceptance. Additionally, the Contractor's performance is subject to scheduled and unscheduled review by the QA&I Committee as defined by the medical activity Quality Assurance (QA) Plan.

CONTRACTOR REPRESENTATION.

The Contractor shall designate a representative for this contract. This representative may be employed under another contract/task order with the Contractor at the same Bemidji Area Service Unit. At least ten working days prior to performance start date, the Contractor shall provide in writing to the COR, Contractor representative contact information. Changes in the contract representative, at any time after contract commencement, shall be in writing to the COR at least five working days prior to the change.

The Contractor's representative shall, at no additional cost, meet with the COR when requested by the COR to discuss any problems that the Contractor's personnel may be experiencing during the performance of this contract. Problems experienced by the Government with the Contractor's performance will be discussed and resolved. Unresolved problems will be referred to the CO for resolution.

The Contractor shall provide points of contact (POC) information for administration of the contract during normal business hours. Accordingly, the named individual(s) shall possess sufficient corporate authority to effectively deal with emergency situations and the telephone number provided shall be functioning at all times other than normal business hours. If there are different POCs for different conditions, such as weekdays, weekends, holidays, clearly provide such information.

GOVERNMENT PROPERTY

The Government will provide use of all available CLH’s facilities and support services, materials, publications and forms, equipment, and specialty clothing required for contract performance (except as designated in the contract). The Contractor shall ensure that its MSA’s keep Government-furnished supplies, equipment, and work areas in a safe, orderly and clean condition. The Contractor shall notify the Government whenever maintenance of equipment is required. Personal long distance calls are not authorized and the cost of all personal long distance calls made will be deducted from the Contractor’s invoice.

The Government will provide a Bemidji Area Service Unit identification card and vehicle access stickers/passes. The Contractor shall ensure its MSA’s comply with the CLH’s policy regarding the identification cards and stickers/passes. The MSA shall coordinate with the COR in obtaining an identification badge and vehicle decal. The MSA shall wear the identification badge in accordance with the CLH’s policy. The MSA shall surrender both identification badge and vehicle decal to the COR on his/her last contracted day of duty at the CLH.

Any space or equipment used by the Contractor’s MSA’s in performance of this contract may be used by the Government for other purposes during his/her absence. Items of clothing, personal effects, or equipment may not be able to be secured at all locations. The Government will not incur any liability for theft, damage to, or loss of such personal items.

Emergency Health Care for MSA’s. The Cass Lake Indian Hospital will provide emergency health care for injuries or life threatening medical emergencies occurring while on duty. The Contractor shall reimburse the Government for such services as billed by the Cass Lake Indian Hospital, unless the MSA is otherwise authorized to receive such services at no cost (e.g., is retired military or other).

CONTRACTING OFFICER’S REPRESENTATIVE (COR). The COR will be appointed in writing by the CO after the contract is awarded. The CO will provide a copy of this designation and COR contact information to the Contractor.

VII. ACCESS TO GOVERNMENT INFORMATION SYSTEMS

Contractor Employees Who Require Access to Government Information Systems (IS). All Contractor employees with access to a government info system must be registered in the Information Technology Access Control (ITAC ) at commencement of services, and must successfully complete the Information Systems Security Awareness (ISSA) Training prior to access to the IS and then annually thereafter.