PERFORMANCE WORK STATEMENT (PWS)

NON-PERSONAL SERVICE - NURSING

TABLE OF CONTENTS

Page

1.0 General 2

1.0.1 Background 2

1.1 Scope 2-3

1.3 Applicable Documents 3-4

2.0 Definitions 4-7

3.0 Government Furnished Information, Property & Services 7

3.1 Information 7

3.2 Joint Use by the Government and the Contractor 7

3.3 Contractor Exclusive Use 7

3.4 Training 7-8

3.5 Protection of Government Buildings, Equipment and Vegetation 8

4.0 Contractor Furnished Equipment 8

4.1.1 Uniform and lab Coat 8

4.1.2 Other Personal Medical Instruments 8

5.0 Performance-Work Statement (PWS) Requirements 8

5.1 Nursing Duties 8

5.2 Work Schedule 8-9

5.3 Conduct 9

5.4 Performance Evaluation 9

5.5 Identification of Contractor 9

5.6 Management of Medical Information 9

5.7 IHS Information Technology Systems 10

6.0 Business Associate Agreement 10

7.0 Contractor Qualification Requirements 10

7.1 Experience 10

7.2 license/Registration Certifications 10

7.3 Certifications 10

7.4 Health Requirements/Conditions of Employment 10-11

7.5 language Requirement and Cultural Awareness 11

7.6 Information Technology Skills 11

7.7 Orientation 11

7.8 Background Checks 11

8.0 Termination for Cause 11

9.0 Technical Direction 12

10.0 Indemnification and Medical liability Insurance 12-13

11.0 Performance Work Statement (PWS)-Matrix 14

12.0 list of Attachments and Exhibits 15

Attachment A – Performance Work Statement

1.0 General: This performance work statement describes the requirements for Non-Personal

Service Contract for Nursing Services to support the mission of the Indian Health Service (IHS).

1.0.1 Background: IHS is an agency within the U.S. Department of Health and Human

Services and is responsible for providing federal health services to American

Indians and Alaska Natives. The provision of health services to members of federally recognized tribes grew out of the special government to government relationship between the federal government and Indian tribes. The IHS is the principal federal health care provider and health advocate for the Indian people.

The goal is to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indians and Alaska

Natives. The IHS currently provides health services to approximately 1.5 million

American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 34 states.

There is a nationwide shortage of nurses which is amplified by the remote and rural areas served by the Indian Health Service. This performance work statement covers requirements for the Navajo Area. The positions to be filled include:

Registered Nurse (RN) for the provision of outpatient and inpatient nursing services.

1.0.2 Navajo o Area Indian Health Service (NAIHS) administers health centers and hospitals providing health care to approximately 201,583 members of the

Navajo Nation. The Navajo Nation is the largest Indian tribe in the United

States and has the largest reservation, which encompasses more than 25,516 square miles in northern Arizona, western New Mexico, and southern Utah, with three satellite communities in central New Mexico. The NAIHS is the primary provider of inpatient, ambulatory care, preventive and community health, and environmental health services for members of the Navajo Nation and the San Juan Southern Paiute Tribe.

1.0.3 Navajo Area Indian Health Service (NAIHS): The Emergency Medicine Departments in Navajo Area provide care for 80,000 patients, ambulatory care sees 1.1 million per year and 7500 inpatient stays per year. Gallup Indian Medical Center (GIMC) serves as a Level III Trauma Center and Northern Navajo Medical Center (NNMC) as a Level IV Trauma Center. Chinle Comprehensive Health Care Facility (CCHCF), GIMC, and NNMC provide Adult and Pediatric inpatient care, Outpatient Primary Care, Women’s Health, Midwifery, Mental Health, Pharmacy, Optometry, General Surgery, Orthopedics, Podiatry, OB/GYN, Dental, Rehabilitation services, Lab services, Radiology services and Public Health. Crownpoint Service Unit also provides Inpatient Adult services, Outpatient Primary Care, Pharmacy, Optometry, Dental and Public Health. Kayenta Service Unit has a free standing Emergency Department and provides Outpatient Adult and Pediatric Services, Podiatry, Optometry, Dental, Public Health and Mental Health Services.

1.1 Scope: The Contractor shall provide nursing services in accordance with section 5.0, performance work statement requirements.

1.1.1 Duties and responsibilities may encompass outpatient and inpatient nursing services to IHS patients.

1.1.2 Place of Performance: Services are to be performed at hospitals, clinics and other healthcare facilities of the Navajo Area Indian Health Service within the Northern Navajo Medical Center. The award pricing schedule will identify the exact place of performance.

1.1.3 Period of Performance: Shall be 1 Base Period + 1 Option Period

Contract period of performance shall contain a 6 month base period and a 6 month option period.

1.2 Applicable Documents: Please see the web link listed unless document is listed as an attachment.

1.2.1 The Joint Commission (TJC)

http://www.jointcommission.org

1.2.2 Centers for Medicare and Medicaid Services (CMS) Standards http://www.cms.hhs.gov

1.2.3 Accreditation Association for Ambulatory Health Care(AAAHC) https://www.aaahc.org

1.2.4 Section 231 of Public Law 101-647, the Crime Control Act of 1990.

http://www.icctc.org/Crime%20Conrol%20Act%20of%201990.pdf

1.2.5 Section 4087 of Public Law 101-630, the Indian Child and Family Violence Act http://www.icctc.org/IHS-BIA%20CPT%Handbook/PL%201101-630.pdf

1.2.6 Health Insurance Portability and Accountability Act (HIPAA) of 1996.

http://www.cms.gov/HIPAAGeninfo/

1.2.7 Privacy Act of 1974.

http://www.justice.gov/opcl.privacyact1974.htm

1.2.8 Revised American Nurses Association Code of Ethics and Standards of Practice and

Care (1996) http://www.nursingworld.org

1.2.9 State Nurse Practice Act for the Contractor's licensing state.

http://www.medi-smart.com/

1.2.10 IHS Service Unit and Health Center Policies, Procedures a nd Protocols.

(See section 11.0 for a list of attachments and exhibits)

1.2.11 Computer Security Act of 1980

http://security.ihs.gov/index.cfm http://www.cms.hhs.gov/

1.3.12 Federal Code of Conduct:

https:// www.ihs. Gov/IHM/index.cfm?module=dsp_ihm_pc_p323

1.3.13 IHS General Directives

http://www.ihs.gov/index.cfm?module=AtoZ&option=index

1.3.14 IHS Computer Security Directives: http://security.ihs.gov/index.cfm

2.0 Definitions

2.1 Acceptance: Constitutes acknowledgement that the supplies or services conform to the applicable contract quality and quantity requirements, except as provided in FAR subpart 46.5 and subject to other terms and conditions of the contract.

2.2 Approval: Acknowledgment by the designated Government official that submittals, deliverables, or administrative documents (e.g., insurance certificates, installation schedules, planned utility interruptions, etc.) conform to the contractual requirements. Government approval does not relieve the Contractor from responsibility for compliance with contract requirements.

2.3 Area: A defined geographical region for Indian Health Service administrative purposes. Each

Area Office may administer several Service Units.

2.4 Business Associate: Any company or person that is exposed to, handles, or works with the data in medical records is a "Business Associate" of the medical entities they work for.

2.5 Business Associate Agreement {BAA): A business associate agreement (BAA) is a contract between a HIPAA-covered entity and a HIPAA business associate (BA). The contract protects personal health information (PHI) in accordance with HIPAA guidelines.

2.6 Code of Ethics: The Revised American Nurses Association Code of Ethics and Standards of Practice and Care, published in 1996 by the American Nurses Association which makes explicit primary goals, values and obligations of the nursing profession.

2.7 Contracting Officer {CO): A Government employee with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings.

2.8 Contractor: The individual awarded a legal binding contract to provide supplies and services.

2.9 Contracting Officer's Representative (COR): A federal employee who assists the ordering/issuing activity contracting officer in the administration of task orders issued under this contract. The COR is primarily responsible for the technical assistance and day-to-day program management of the ordering activity's task orders. Ordering activities may have different designators for this employee (e.g. COR-contracting Officer's Representative or GTR-Government Technical Representative,).

2.8 Contractor Performance Assessment Report: A report that assesses a contractor's performance and provides a record, both positive and negative, on a given contract for specific period of time.

2.9 Cooperative Attitude: Behavior that is positive and displays a willingness to perform assigned patient care tasks and to be a team player.

2.10 Cultural Awareness: Realization and respect for American Indian and Alaska Native practices.

2.11 Customer: Patients, staff and visitors of an IHS service unit and health center.

2.12 Customer Evaluation/Input: Written comments made to the Contracting Officer regarding the

Contractors performance. This is one of the criteria used to evaluate the Contractor's performance.

2.13 Dependability: Qualities of being trusted and being able to repeat the same task to yield the same result.

2.14 Federal Acquisition Regulation (FAR): The FAR is the primary regulation for use by all Federal

Executive agencies in their acquisition of supplies and services with appropriated funds.

2.15 Federal Tort Claims Act (FTCA): The Federal Tort Claims Act (FTCA) is the waiver of sovereign immunity by the United States and provides the exclusive remedy for personal injury, death, and property damages resulting from the negligence of federal employees.

2.16 Government Vehicle: An IHS owned motor vehicle or a vehicle leased by IHS through agreements with the General Services Administration (GSA) or through commercial rental agreements.

2.17 Health Center: A facility physically separated from a hospital, with a full range of ambulatory services including at least primary care providers, nursing, laboratory, and x-ray which are available at least 40 hours a week for outpatient care.

2.18 Health Insurance Portability and Accountability Act (HIPAA): A US law designed to provide privacy standards to protect patients' medical records and other health information provided to health plans, doctors, hospitals and other health care providers.

2.19 Non-Personal Service Contracts: means a contract under which the personnel rendering the services are not subject, either by the contract's terms or by the manner of its administration, to the supervision and control usually prevailing in relationships between the Government and its employees as defined in FAR 37.

2.20 Ordering Activity: An authorized user of IHS that may issue a task order to obtain required services under this contract.

2.21 Ordering Activity Contracting Officer: A Government employee of IHS authorized and warranted to issue task orders and to make subsequent task order modification(s) under this contract. The Ordering

Activity CO has the authority to make initial determinations on all matters of dispute regarding task orders.

2.22 Orientation: An activity designed to provide basic familiarization of the facility and transition the nurse into the IHS Service Unit and/or Health Center and the nursing unit where the services will be provided.

2.23 Past Performance Information: Relevant information regarding a contractor's actions under previously awarded contracts. This includes the contractor's record of conformance to specifications and to standards of good workmanship; the contractor's record of containing and forecasting costs on any previously performed cost reimbursable contracts; the contractor's adherence to contract schedules, including the administrative aspects of performance; the contractor's history for reasonable and cooperative behavior and commitment to customer satisfaction; and generally, the contractor's business-like concern for the interest of the customer.

2.24 Patient Outcome: End result of nursing care.

2.25 Performance Work Statement Matrix: lists the services to be monitored and the standards to be applied.

2.26 Personal Protective Equipment (PPE): The equipment used to protect medical personnel from exposure to biological, chemical, and radioactive hazards.

2.27 Quality Assurance Surveillance Plan (QASP): A written document prepared and used by the government for Quality Assurance surveillance of the contractor's performance.

2.28 Quality Control Plan (QCP): Those actions taken by the Contractor to control the quality of services provided. The Contractor's QCP must be equivalent to the Government's Quality Assurance plan.

2.29 Service Unit: The local administrative unit of IHS.

2.30 Standards of Practice and Standards of Care: Authoritative statements by which the nursing profession describes the responsibilities for which its practitioners are accountable. The standards provide direction for professional nursing practice and a framework for the evaluation of practice. The standards of professional nursing practice may pertain to general or specialty practice.

2.31 Technical Direction: A directive to the Contractor that approves approaches, solutions, designs, or refinements; fills in details or otherwise completes the general description of work or documentation items; shifts emphasis among work areas or tasks; or furnishes similar instruction to the Contractor. Technical direction includes requiring studies and pursuit of certain lines of inquiry regarding matters within the general tasks and requirements in Section 5 of this contract.

2.33 Tour of Duty: The time of day the nurse is scheduled to perform nursing care duties; also considered the shift of the day. The time can vary according to the needs of each facility and/or clinic, e.g. 12-hour Tour of Duty, 8-hour Tour of Duty, 10-hour Tour of Duty. Includes weekends and holidays.

2.34 Valid Patient Complaint: Justifiable accusation made by a patient and supported by investigation.

2.35 Verifiable Emergency: An unexpected/unplanned absence by the contractor requiring valid documentation to confirm the occurrence.

3.1 Government Furnished Information, Property and Services

3.2 Information: Government unique information related to this requirement, which is necessary for

Contractor performance, will be made available to the Contractor. The Contracting Officer or designee will be the point of contact for identification of any required information to be supplied by the Government.

3.3 Joint Use by the Government and the Contractor: Except for the property and service listed in 3.3 and

4.0, the Government will provide, for joint use by the Government and the Contractor, all necessary equipment, supplies, and clinic space to perform the services under this contract.

3.3.1 Government Vehicle: If required by the position, authorization shall be in accordance with IHS

Chapter 12, Section 13 Motor Vehicle Management.

3.4 Contractor Exclusive Use:

3.4.1 Personal Protective Equipment (PPE). The Government will furnish the Contractor with appropriate PPE other than specified in paragraph 4 of the contract. The Government will be responsible for any repair, cleaning, and inventory required for the PPE. This does not include any type of uniform or laboratory coat.

3.4.2 The Government will provide facility specific contractor identification badges for each contractor.

A minimum fee of $10.00 will be charged for lost or destroyed badges.

3.5 Training: Facility specific training necessary for the Contractor to perform the required duties, e.g., IHS information technology (IT) systems and operational procedures. Training will be provided ONLY if the subject matter is necessary to improve or enhance the quality of nursing services or includes mandates made by the service unit while the nurse is working under this contract. Training will not be provided for the purpose of continuing education, career development or individual development.

3.6 Protection of Government Buildings, Equipment, and Vegetation

The Contractor shall use reasonable care to avoid damaging existing buildings, equipment and vegetation on the Government installation. If the Contractor's failure to use reasonable care causes damage to any of this property, the Contractor shall replace or repair the damage at no expense to the Government as the Contracting

Officer directs. If the Contractor fails or refuses to make such repair or replacement, the Contractor shall be liable for the cost, which may be deducted from the contract price.

4.1 Contractor Furnished Property

4.2 Except for the property specified in paragraph 3.0 as government furnished, the Contractor shall provide all uniforms and other personal medical instruments subject to the following:

4.2.1 Uniforms and Lab Coats: Uniforms and Lab Coats shall conform to the requirements of the

Indian Health Service Manual, Part 3 Chapter 4 and meet the approval of the Chief Nurse Executive at

GIMC.

4.2.2 Other personal medical instruments: "Other personal medical instruments" are defined as

Contractor owned items may include but not limited to stethoscope, scissors, as appropriate to the work unit. The Contractor shall not use unsafe equipment or supplies at any time during performance of this contract. All Contractor furnished equipment and supplies shall be subject to inspection by the

Government and must be approved by the COR prior to use by the Contractor. The Government reserves the right to prohibit the use of any materials, supplies, or equipment.

5.1 Performance Work Statement (PWS) Requirements.

5.2 Nursing Duties:

5.2.1. The Contractor shall perform nursing duties and manage patient's needs as described in the (PD)and in accordance with technical direction provided by NNMC's Nursing

Supervisor.

5.2.2. The Contractor shall perform in accordance with the following competency standards:

5.2.2.1 Written Competency Standards

a. Confidentiality/HIPAA/Patient's Rights

b. EMTALA Compliance Exam, 2004

c. Age Specific Competency Verification

d. RN Medication Administration Competency Examination

e. RN Medication Administration Competency Verification

f. Intravenous Therapy Exam

g. Venipuncture Procedure Skills Competency Verification

h. Pain Management Competency Verification

i. Restraints

j. Soft Restraint Application Competency

k. Hard Leather Restraint Application

5.2.2.2 Contract Nurse Orientation Check List I Health Stream

5.2.2.3 Contract Nurse Orientation Competency Verification Instructions

5.2.2.4 Contract Nurse Billing Information

5.2.2.5 Standard Emergency Codes

5.2.2.6 Confidentiality: Legal and Ethical Concerns in Healthcare

5.2.2.7 EMTALA- Emergency Medical Treatment and Labor Act

5.2.2.8 What are Age-Specific Competencies?

5.2.2.9 An Introduction to the Navajo Culture

5.2.2.10 Verbal and Telephone Orders

5.2.2.11 Medication Administration

5.2.2.12 Pain Management

5.2.2.13 Latex Allergy

5.2.2.14 Charting

5.2.2.15 Patient Restraints

5.2.2.16 Charge Nurse Duties: Responsibility and Expectation

5.2.2.17 Nursing Standards

5.2.2.18 Standards of Nursing Practice

5.3 Work Schedule:

5.3.1 The Nursing Supervisor for each department will provide technical direction on the specific tour of duty the contract nurse will work.

5.3.2 Work Flexibility. The Contractor shall coordinate with the Nursing Supervisor to rotate into other duty sections as needed to support patient care.

5.3.3 The Contractor shall coordinate with the department Nursing Supervisor or designee prior to any absence from work. If the length of the absence exceeds eight (8) work hours and beyond, the Contractor shall coordinate and provide notification to the department Nursing Supervisor (the exception is verifiable emergencies) in advance of the desired absence.

5.3.4 Approval of leave is contingent upon availability of a qualified replacement.

5.3.5 The Contractor shall provide written documentation from a qualified health care provider for absences of three (3) or more consecutive days, due to illness, stating:

A. The cause of the current illness or incapacitation AND

B. Indicating the Contractor as contagious or non-contagious.

The Government reserves the right to examine and or re-examine any Contractor who meets the criteria.

5.3.6 Conduct: The Contractor shall meet standards as listed in the Federal Code of

5.4 Performance Evaluation:

5.4.1 The Contractor's performance will be evaluated in accordance with the standards set forth in the contract and Performance Work Statement Matrix of section 11.0.

5.4.2 Substantiated reports written by any customer dealing with patient safety, infection control, or other procedure that adversely affects patient outcome constitutes a breach of contract.

5.5 Identification of Contractor:

5.5.1 The Contractor shall wear a government issued contractor identification badge during performance of duty.

5.6 Management of Medical Information: The Contractor shall manage all patient information in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards, Privacy Act, and IHS Service Unit and/or Health Center specific policies and protocols.

5.6.1 The Contractor shall ensure adherence to DHHS IT system security policies and procedures. The

IT policies and procedures will be made available to the Contractor.

5.6.2 The Contractor shall immediately report to the Contracting Officer or COR any information or circumstances that may violate any statute, policy, or procedure.

5.7 IHS Information Technology Systems:

5.7.l ln performance of this contract, the Contractor shall adapt to and successfully utilize IHS information technology systems that are deemed by the Supervisor as necessary for acceptable contractor performance.

5.7.2 The Contractor shall ensure that IHS information technology system security policies and procedures are adhered to. The IT policies and procedures will be made available to the Contractor at each IHS facility.

6.0 Business Associate Agreement:

Pursuant to 45 C.F.R. § 164.502(e), the Indian Health Service (IHS), as a covered entity, is required to enter into an agreement with a "business associate," as defined by 45C.F.R. § 160.103, under which the business associate must agree to appropriately safeguard Protected Health Information (PHI) that it will use and disclose when performing functions, activities or services pursuant to its contract with the IHS. The attached Appendix A: Business Associate Agreement shall be completed by the Contractor upon award and become an integral part of this contract

7.1 Contractor Qualification Requirements:

7.2 Experience: The Contractor shall have thirty-six {36) months of nursing experience, with a minimum of two (2) years in the specialty required by the· contract, unless otherwise approved by the Contracting Officer.

7.3 License/Registration: All nurses shall possess a current, valid, unrestricted nursing license in a state, the District of Columbia, the Commonwealth of Puerto Rico, or a Territory of the United States, throughout the term of this contract.

7.3.1 Motor Vehicle Operator's License. If required by the position, the Contractor shall possess a valid state driver's license throughout the term of this contract.

7.4 Certifications: Current Basic Life Support (BLS) is mandatory for all specialties. Pediatric

Advanced Life Support (PALS), Newborn Life Support (NLS), Advanced Trauma Care Nurse

(ATCN) or Trauma Nurse Critical Care (TNCC), and Advanced Cardiac Life Support (ACLS) are required for each appropriate duty section at the time of selection for contract award. The contractor shall ensure that the contract nurse's certifications remain valid throughout the term of this contract.

7.5 Health Requirements/Conditions of Employment:

7.5.1 Medical Evaluation. The Contractor shall provide a fitness for duty certificate issued by a licensed physician to perform the proposed job without significant risk to personal health or the health and safety of others.

7.5.2 Immunization. The Contractor shall also provide the following documentation prior to RN Candidate selection:

• Immunity to Rubella, Mumps, and Rubeola (Measles);

• Proof of Hep B vaccination x3 OR positive titer OR a signed declination of the Hep B vaccinations will also be accepted;

• Documented history of chicken pox OR varicella vaccination x2 OR positive varicella titer;

• History of Tdap vaccination, with subsequent Td vaccination if older than 10 years;

• Documentation of Tuberculosis testing (TB skin test or IGRA) within the past 12 months with documentation of chest x-ray and follow-up for a positive history;

12 months with documentation of follow-up for a positive test.

• Proof of influenza vaccination from October -1 thru March 31, per IHS Mandatory Influenza Vaccination Policy.

Proof of Vaccination against SARS-COV-2, the virus that causes COVID 19

7.6 Language Requirements and Cultural Awareness. The Contractor shall read, understand, speak, and write English to effectively communicate with patients and other health care workers, and shall be respectful of the local, American Indian and Alaska Native culture.

7.61 Information Technology Skills. The Contractor shall possess basic knowledge, skills, and abilities to use a computer.

7.7 Orientation. All nurses providing service under this contract shall attend mandatory orientations and training specified by the government.

7.8 Background Checks: As directed by the Contracting Officer, the Contractor shall provide all requested information necessary to perform background checks. The Contractor shall comply with the requirement to obtain security investigations. The Contractor shall work with the IHS to ensure that the pre-employment screening process includes the appropriate investigation questionnaires and forms to be completed. All completed forms will be reviewed by the Contractor and forwarded to the

Government Personnel. The Contractor will be immediately removed from the position if at any time the investigation receives unfavorable adjudication, or, if other unfavorable information that would affect the investigation becomes known.

e-QIP: Required Background Investigation Information:

Executive Orders 10450, 12968, and HSPD-12 require a background investigation as a condition of employment. This investigation will be processed utilizing the US Office of Personnel Management

(OPM), Electronic Questionnaire for Investigation Processing (eQIP) system.

FINGERPRINT CARD- FBI FD-258 (provided by the Federal Government)

Fingerprint MUST be cleared and approved prior to contract assignment. Contract assignment(s) are conditional on a cleared background check.

8.0 Termination for Cause: The Government may terminate this contract for cause in accordance with FAR 52.212-4 (i) and (m).

8.1 Any Contractor demonstrating impaired judgment shall not be permitted to work in the

NAIHS. The Government reserves the right to remove from the facility any Contractor who in the judgment of a licensed physician is impaired by drugs or alcohol.

9.0 Technical Direction:

9.1 Performance of the work under this contract is subject to the written and verbal technical direction of the Nursing Supervisor.

9.2 The Nursing Supervisor does not have the authority to, and shall not, issue any instructions purporting to be technical direction that:

• Constitutes an assignment of additional work outside the performance work statement;

• Constitutes a change as defined in the changes;

• In any manner causes an increase or decrease in the total estimated contract cost, fixed fee

(if any), or the time required for contract performance;

• Changes any of the expressed terms, conditions, or specifications of the contract; or the terms and conditions of the contract.

9.3 All technical direction shall be issued in writing by the Nursing Supervisor. All verbal direction will be confirmed in writing within 24 hours (one business day).

9.4 The Contractor shall proceed promptly with the performance of technical direction duly issued by the Nursing Supervisor in the manner prescribed by this clause and within the authority. If, in the

Contractor's opinion, any instructions or direction by the Nursing Supervisor falls within any of the categories defined in paragraph 8.2 above, the Contractor shall not proceed but shall notify the

Contracting Officer in writing within 5 working days after receiving it and shall request the Contracting

Officer to take action as described in this clause. Upon receiving this notification, the Contracting

Officer shall either issue an appropriate contract modification within a reasonable time or advise the

Contractor in writing that the instruction or direction is within the requirements of the contract and does not constitute a change under the changes clause of the contract and that the contractor shall proceed promptly with its performance.

9.5 A failure of the Contractor and Contracting Officer to agree that the instruction or direction is both rescinded in its entirety; or within the requirements of the contract and does not constitute a change under the changes clause, or a failure to agree upon the contract action to be taken with respect to the instruction or direction shall be subject to the Disputes clause of this contract.

9.6 Any action taken by the Contractor in response to any direction given by any person other than the Contracting Officer or the Nursing Supervisor shall be at the Contractor's risk.

10.1 FAR 52.237-7 Indemnification and Medical Liability Insurance (Jan 1997)

(a) It is expressly agreed and understood that this is a non-personal services contract, as defined in Federal Acquisition Regulation (FAR) 37.101, under which the professional services rendered by the Contractor are rendered in its capacity as an independent contractor. The Government may evaluate the quality of professional and administrative services provided, but retains no control over professional aspects of the services rendered, including by example, the Contractor's professional medical judgment, diagnosis, or specific medical treatments. The Contractor shall be solely liable for and expressly agrees to indemnify the Government with respect to any liability producing acts or omissions by it or by its employees or agents. The Contractor shall maintain during the term of this contract liability insurance issued by a responsible insurance carrier of not less than the following amount(s) per specialty per occurrence:

$1,000,000.00 and $3M per aggregate.

(b) An apparently successful offer or, upon request by the Contracting Officer, shall furnish prior to contract award evidence of its insurability concerning the medical liability insurance required by paragraph (a) of this clause.

(c) Liability insurance may be on either an occurrences basis or on a claims-made basis. If the policy is on a claims made basis, an extended reporting endorsement (tail) for a period of not less than 3 years after the end of the contract term must also be provided.

(d) Evidence of insurance documenting the required coverage for each health care provider who will perform under this contract shall be provided to the Contracting Officer prior to the commencement of services under this contract. If the insurance is on a claims-made basis and evidence of an extended reporting endorsement is not provided prior to the commencement of services, evidence of such endorsement shall be provided to the Contracting Officer prior to the expiration of this contract. Final payment under this contract shall be withheld until evidence of the extended reporting endorsement is provided to the Contracting Officer.

(e) The policies evidencing required insurance shall also contain an endorsement to the effect that any cancellation or material change adversely affecting the Government's interest shall not be effective until 30 days after the insurer or the Contractor gives written notice to the Contracting Officer. If, during the performance period of the contract the Contractor changes insurance providers, the Contractor must provide evidence that the Government will be indemnified to the limits specified in paragraph

(a) of this clause, for the entire period of the contract, either under the new policy, or a combination of old and new policies.

(f) The Contractor shall insert the substance of this clause, including this paragraph (f), in all subcontracts under this contract for health care services and shall require such subcontractors to provide evidence of and maintain insurance in accordance with paragraph (a) of this clause at least 5 days before the commencement of the contract.

12.1 List of Attachments: The position description will be provided by the Contracting

Officer upon request. The BAA will be provided to the Contractor upon award for their completion/signature. The signed BAA shall be returned to the Contracting Officer for internal filing.

12.2 Attachments

A. Position Description appropriate to area of work

B. Business Associate Agreement (BAA)

C. Exhibits applicable to IHS Nursing

12.3 Appendices to be provided by each service unit

A. Emergency Department

1. Certifications required

2. Department specific competencies

B. Women’s Health

1. Certifications required

2. Department specific competencies

C. Pediatrics

1. Certifications required

2. Department specific competencies

D. Ambulatory Care

1. Certifications required

2. Department specific competencies

E. Inpatient Care

1. Certifications required

2. Department specific competencies

QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

1. PURPOSE

This Quality Assurance Surveillance Plan (QASP) provides the assessment methodology to evaluate performance for the stated contract. This QASP covers the following:

• Identify the services that will be measured;

• Establish the specific standards of performance for each required output;

• Establish the responsibilities for performing the measurement;

• Define the government role in overseeing the performance;

• Provide for feedback to the Contractor regarding quality, quantity, and timeliness of the service outputs;

• Establish timeframes for communicating performance improvements needed.

This QASP does not detail how the contractor accomplishes the work. Rather, the QASP is created with the premise that the contractor is responsible for management and quality control actions to meet the terms of the contract. It is the Government's responsibility to be objective, fair, and consistent in evaluating performance.

This QASP is a "living document" and the Government may review and revise it on a regular basis.

However, the Government shall coordinate changes with the contractor. Copies of the original QASP and revisions shall be provided to the contractor and Government officials implementing surveillance activities.

2. GOVERNMENT ROLES AND RESPONSIBILITIES

The following personnel shall oversee and coordinate surveillance activities:

A. Contracting Officer (CO)- The CO shall ensure performance of all necessary actions for effective contracting, ensure compliance with the contract terms, and shall safeguard the interests of the United States in the contractual relationship. The CO shall also assure that the contractor receives impartial, fair, and equitable treatment under this contract. The CO is ultimately responsible for the final determination of the adequacy of the contractor's performance.

B. Contracting Officer's Representative (COR) - The COR is responsible for technical administration of the contract and shall assure proper Government surveillance of the contractor's performance.

The COR shall keep a quality assurance file. The COR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government's behalf.

C. Other Key Government Personnel

i. The Chief of Emergency Medicine is responsible with monitoring and assessing the contractor's performance specific to Indicators a through e in Section 10 (Performance- Based Matrix) of the Performance Work Statement (Page 15) by completing the Peer Review NAO Provider Exit Profile Form.

ii. The Chief of Staff or the Clinical Director will provide supplementary information in the designated area of the Peer Review NAO Provider Exit Profile Form. This will substantiate the Chief of Emergency medicine’s assessment.

iii. The Peer Review form will be reviewed and completed for each contractor. The Performance- Based Matrix is tailored to the NAO Peer Review Form. The completed NAO Peer Review Form will not be shared with the contractor as afforded under 25 USC Sec § 1675. At the end of the performance period, the following information will be disclosed to the contractor: the conversion of Indicators to Summary Ratings (Average Score) and the Analysis of Results (Contractor’s Performance Measurement Rate & Contractor’s Performance [Meets Requirements of Does Not Meet Requirements]). This will be reported onto the Contractor’s Performance Assessment Report

(CPAR).

3. IDENTIFICATION OF REQUIRED PERFORMANCE STANDARD/QUALITY LEVELS

Performance standards define desired services. The Government performs surveillance to determine if the contractor exceeds, meets or does not meet these standards.

The Performance-Based Matrix Section 11.0 of the Performance Work Statement (Page 14), includes performance standards. The Government shall use these standards to determine contractor performance.

TASK ID INDICATOR STANDARD ACCEPTABLE

QUALITY LEVEL

METHOD OF

SURVEILLANCE

INCENTIVE

Contractor shall provide emergency

Medicine

Physician services in the delivery of patient care to the

Navajo

Area Indian

Health

Service.

A Patient Care Contractors provided fully successful or excellent patient care as rated under

Element 1 & Element 3 of the Peer Review NAO Provider Exit Profile (refer to

Section 10.1 of the PWS).

No reports of breached safety or other procedures that may have adversely affect patient outcomes.

A rating or “Fully

Successfully or

“Exceptional” must be attain on the Peer Review

NAO Provider Exit

Profile Form.

Direct observation, 100% inspection and an analysis of contractor’s progress reports.

Payment of contract price for satisfactory service.

Favorable

CPAR

report

B Compliance No reprimands or disciplinary actions or violations of published

Policies; Procedures;

Standards of Care or

Hospital Protocols

No reprimands or disciplinary actions

Periodic inspection, 100% inspection and an analysis of contractor’s progress reports

Payment of contract price for report

C Culturally Sensitivity

Contractors were compassionate culturally sensitive

A rating or “Fully

Successful” or

“Exceptional” must be attain on the Peer Review

NAO Provider Exit

Profile Form.

Direct observation, 100% inspection and an analysis of contractor’s progress reports.

Payment of contract price for report

D Documentation Contractors completed require documentation in clear and legible form in a timely manner. (Element

6)

A rating or “Fully

Successful” or

“Exceptional” must be attain on the Peer Review

NAO Provider Exit

Profile Form.

Periodic inspection, 100% inspection and an analysis of contractor’s progress reports

Payment of contract price for report

E Professionalism Contractors presented in professional appearance demonstrated exceptional ethical conduct with effective communication, and exhibited exemplary attitude by being flexible and being adaptable.

(Element 4, Element 5 &

Element 8)

A rating or “Fully

Successful” or

“Exceptional” must be attain on the Peer Review

NAO Provider Exit

Profile Form.

Direct observation, 100% inspection and an analysis of contractor’s progress reports.

Payment of contract price for report

4. METHODS OF QUALITY ASSURANCE SURVEILLANCE

In an effort to minimize the performance management burden, simplified surveillance methods shall be exercised by the government to evaluate contractor performance when appropriate. Various methods exist to monitor performance. The COR shall use the surveillance methods listed below in the administration of this QASP that shall be captured from the NAO Peer Review Form.

DIRECT OBSERVATION

• Observation can be performed periodically or through 100% surveillance.

S C N o f D e p a r t m e n t a - Patient Care c- Culturally Sensitivity e - Professionalism

PERIODIC INSPECTION

• Evaluate outcomes or chart reviews on a periodic basis

- Inspections may be scheduled as required.

S C N of D e p a r t m e n t

Assistant

CNE

CNE

b- Compliance d - Documentation

100% INSPECTION

• Evaluates all outcomes from the Peer

Review NAO Provider Exit Profile.

COR

a - Patient Care b- Compliance c - Culturally Sensitivity d - Documentation e - Professionalism

Analysis of Contractor's Progress Reports

• Compile data from the Peer Review CSU Provider Exit Profile.

S C N of D e p a r t m e n t

ACNE

CNE

COR

a - Patient Care b- Compliance c - Culturally Sensitivity d - Documentation e - Professionalism

5. RATING ELEMENTS

Metrics and methods are designed to determine if performance exceeds, meets, or does not meet a given standard and acceptable quality level. A rating scale shall be used to determine a positive, neutral, or negative outcome. The following rating elements are derived from the NAO Peer Review Form.

Indicator Ratings Points Assigned

Level 4: Exceptional (E) 4.00

Level 3: Fully Successful (FS) 3.00

Level 2: Minimally Successful (MS) 2.00

Level 1: Unacceptable (U) 1.00

6. QUALITY ASSURANCE DOCUMENTATION

THE PERFORMANCE MANAGEMENT FEEDBACK LOOP

The performance management feedback loop begins with the communication of expected outcomes.

The performance standards are expressed in the PWS and provided in Item No. 3, page two (2) of the

QASP.

MONITORING FORMS

The government’s quality assurance surveillance, accomplished by the COR, will be reported using the monitoring form in ATTACHMENT 1 (Page 5-7). The form, when completed, will document the government’s assessment of the contractor’s performance under the contract to ensure that the required results of Exceptional or Fully Successful ratings are being achieved. The COR will retain a copy of all completed QA surveillance forms.

7. DOCUMENTING PERFORMANCE

DOCUMENTING ACCEPTABLE PERFORMANCE

The government shall document positive performance. Any report may become a part of the supporting documentation for any contractual action.

DOCUMENTING UNACCEPTABLE PERFORMANCE

When unacceptable performance occurs, Key Government Personnel and the COR shall inform the CO. The CO will notify the Contractor. This will normally be in writing unless circumstances necessitate verbal communication. In any case the COR shall document the discussion and place it in the COR file.

If formal written communication is required, the CO shall prepare a cure notice, and present it to the Contractor. The contractor shall acknowledge receipt of the cure notice in writing. The cure notice will specify if the contractor is required to prepare a corrective action plan to document how the contractor shall correct the unacceptable performance and avoid a recurrence. The cure notice will also state how long after receipt the contractor has to present this corrective action plan to the CO. The Government shall review the contractor’s corrective action plan to determine acceptability.

Any cure notice may become a part of the supporting documentation for any contractual action deemed necessary by the CO.

8. INCENTIVES

Incentives shall be based on exceeding, meeting, or not meeting performance standards.

NEGATIVE

a. No payment for incomplete work

b. An unfavorable contractor performance on the Contractor Performance Assessment Report (CPAR). The evaluation will be considered when future IHS contract selections are made

CPARS evaluation will be forwarded to the GSA/FSS Contracting Officer.

POSTIVE

a. The Government shall use payment of contract price for satisfactory service as an incentive

b. A favorable contractor performance on the Contractor Performance Assessment Report

(CPAR). The evaluation will be considered when future IHS contract selections are made.

CPARS evaluation will be forwarded to the GSA/FSS Contracting Officer.

ATTACHMENT 1

QUALITY ASSURANCE MONITORING FORM

The information collected on this form is derived from the Peer Review Exit Profile Form to determine the overall performance of the contractor in meeting the requirements of the contract. The completed Peer Review Exit Profile form is a confidential and peer review document. The completed form will not be shared or disclosed as it is afforded under 25 USC Sec § 1675.

The resultant overall point values, ratings, and performance checks of the Quality Assurance Monitoring Form will be reported onto the Contractor’s Performance Assessment Report (CPAR). The following information will be disclosed to the contractor:

1. Conversion of Indicators to Summary Ratings

a. Average Score

2. Analysis of Results

a. Contractor’s Performance Measurement Rate

b. Contractor’s Performance

i. Meets Requirements

ii. Does Not Meet Requirements

PURCHASE ORDER INFORMATION

Contractor’s Name (Last, First, Initial)

Specialty:

Vendor Name:

Purchase Order Number:

Appraisal Period: From: To:

MEASURED INDICATORS RATINGS

The following guidance will be followed in determining an overall summary rating:

A rating will be ascribed to each indicator. This rating is derived from Peer Review for NAO Nursing Contractors to which the contractor’s performance meets the standard defined in Section 11 of the Performance Work Statement.

The rating level definitions will be assigned a numerical score as follows:

Indicator Ratings Points Assigned

Level 4: Exceptional (E) 4.00

Level 3: Fully Successful (FS) 3.00

Level 2: Minimally Successful (MS) 2.00

Level 1: Unacceptable (U) 1.00

QUALITY ASSURANCE MONITORING FORM PAGE 2 OF 3

This form MUST be completed by the Contracting Officer’s Representative (COR)

MEASURED INDICATORS

INDICATOR: PATIENT CARE

STANDARD: Contractors provided fully successful or excellent patient care. No reports of breached safety or other procedures that may have adversely affect patient outcomes.

RATING: I I E (4) I I FS(3) I I MS (2) I I U(1)

SURVEILLANCE METHOD

(Check):

I I DIRECT INSPECTION I I 100% INSPECTION

I I PERIODIC INSPECTION I I ANALYSISI of CONTRACTOR’S PROGRESS REPORTS

LEVEL OF SURVEILLANCE

(Check):

I I SEMI-ANNUALLY I I ANNUALLY I I AS NEEDED

INDICATOR: COMPLIANCE

STANDARD: No reprimands or disciplinary actions or violations of published Policies; Procedures; Standards of Care or Hospital Protocols.

RATING: I I E (4) I I FS(3) I I MS (2) I I U(1)

SURVEILLANCE METHOD

(Check):

I I DIRECT INSPECTION I I 100% INSPECTION

I I PERIODIC INSPECTION I I ANALYSISI of CONTRACTOR’S PROGRESS REPORTS

LEVEL OF SURVEILLANCE

(Check):

I I SEMI-ANNUALLY I I ANNUALLY I I AS NEEDED

INDICATOR: CULTURALLY SENSITIVITY

STANDARD: Contractors were compassionate and culturally sensitive (Element 2)

RATING: I I E (4) I I FS(3) I I MS (2) I I U(1)

SURVEILLANCE METHOD

(Check):

I I DIRECT INSPECTION I I 100% INSPECTION

I I PERIODIC INSPECTION I I ANALYSISI of CONTRACTOR’S PROGRESS REPORTS

LEVEL OF SURVEILLANCE

(Check):

I I SEMI-ANNUALLY I I ANNUALLY I I AS NEEDED

INDICATOR: DOCUMENTATION

STANDARD: Contractors completed require documentation in clear and legible form in a timely manner.

RATING: I I E (4) I I FS(3) I I MS (2) I I U(1)

SURVEILLANCE METHOD

(Check):

I I DIRECT INSPECTION I I 100% INSPECTION

I I PERIODIC INSPECTION I I ANALYSISI of CONTRACTOR’S PROGRESS REPORTS

LEVEL OF SURVEILLANCE

(Check):

I I SEMI-ANNUALLY I I ANNUALLY I I AS NEEDED

INDICATOR: PROFESSIONALISM

STANDARD: Contractors presented in professional appearance, demonstrated exceptional ethical conduct with effective communication, and exhibited exemplary attitude by being flexible and being adaptable

RATING: I I E (4) I I FS(3) I I MS (2) I I U(1)

SURVEILLANCE METHOD

(Check):

I I DIRECT INSPECTION I I 100% INSPECTION

I I PERIODIC INSPECTION I I ANALYSISI of CONTRACTOR’S PROGRESS REPORTS

LEVEL OF SURVEILLANCE

(Check):

I I SEMI-ANNUALLY I I ANNUALLY I I AS NEEDED

QUALITY ASSURANCE MONITORING FORM PAGE 3 OF 3

This form MUST be completed by the Contracting Officer’s Representative (COR)

CONVERSION OF INDICATORS TO SUMMARY RATINGS

After rating and assigning a score to each indicator, the COR will total the points and divide that by the number of indicators to arrive at an average score (up to two decimal places). This score will be converted to a summary rating based on the following point values:

Total Point Value:

Divide by the Number of Indicators:

= Average Score:

Average score will be calculated up to 2 (two) decimal places. This numerical score will then be converted to a summary rating as follows:

Analysis of Results

Contractor’s Performance Measurement Average Score:

Contractor’s Performance Measurement Rate: %

COR’s Narrative of Performance during Appraisal Period (Optional):

VALIDATION

I I This form is hereby validated by the COR and signed indicating the contractor meets the requirements of the contract.

I I This form is hereby validated by the COR and signed indicating the contractor does not meet the requirements of the contract.

COR Signature: ____________________________________________________ Date:__________________________

Indicator Ratings Points Assigned

Level 4: Achieved Exceptional Results (E) 3.50 to 4.00

Level 3: Achieved Fully Successful Results (FS) 2.60 to 3.49

Level 2: Achieved Minimally Successful Results (MS) 2.00 to 2.59

Level 1: Achieved Unacceptable Results (U) 1.00 to 1.99

Indicator Ratings Points Assigned Contractor’s Performance Check

Level 4: Achieved Exceptional Results (E) 3.50 to 4.00 Meets Requirements

Level 3: Achieved Fully Successful Results (FS) 2.60 to 3.49 Meets Requirements

Level 2: Achieved Minimally Successful Results (MS) 2.00 to 2.59 Does Not Meet Requirements

Level 1: Achieved Unacceptable Results (U) 1.00 to 1.99 Does Not Meet Requirements

Contractor’s Performance (Check) I I Meets Requirements I I Does Not Meet Requirements