3 PWS - PHC-24-0610-Psychiatrist - updated 5-16-24.pdf

PWS No. PHC-24-0602-PSYCH 19 DEC 2023

Pinon Health Center Performance Work Statement (PWS)

For Nonpersonal Services

PHYSICIAN PSYCHIATRIST SERVICES

Table of Contents

Section Page

1.0 General 1-3

2.0 Definitions 4-6

3.0 Government Furnished Information, Property, & Services 7

4.0 Contractor Furnished Property 8

5.0 Performance-Based Requirements 9-13

6.0 Contractor Qualification Requirements 14-16

7.0 Indemnification and Medical Liability Insurance (Jan 1997) 17

8.0 Challenges to Conflicts 18

9.0 Contract Termination 18

10.0 Performance-based Matrix 19

11.0 List of Attachments and Exhibits 20

12.0 Quality Assurance Surveillance Plan 21

Pinon Health Center Performance Work Statement (PWS)

For Nonpersonal Services

PHYSICIAN PSYCHIATRIST SERVICES

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

Physician Psychiatrist Services to support the mission of the Indian Health Service (IHS) by raising the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.

1.1 Background: The Indian Health Service (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. This relationship, established in 1787, is based on Article I, Section 8 of the Constitution, and has been given form and substance by numerous treaties, laws, Supreme Court decisions, and Executive Orders. The IHS is the principal federal health care provider and health advocate for Indian people. The goals of IHS include: to ensure that comprehensive, culturally appropriate personal and public health services are available and accessible to American Indian and Alaska Native people; to promote excellence and quality through innovation of the IHS into an optimally performing organization; and to strengthen IHS program management and operations. The IHS currently provides a comprehensive health service delivery system for approximately 2.6 million American Indians and Alaska Natives who belong to 574 federally recognized tribes in 37 states.

1.1.1 Navajo Area Indian Health Service (NAIHS) is one of twelve (12) regional administrative units of

IHS. The NAIHS delivers health services to a user population of over 244,000 American Indians in five (5) Federal service units on and near the Navajo Nation. The Navajo Nation is one of the largest Indian reservations in the United States with a population of approximately 399,494 enrolled members; NAIHS provides healthcare to approximately 244,209 members in the Navajo Area (includes Federal and Tribal Service Units). The Navajo Nation consists of approximately 27,413 square miles in the states of Arizona, New Mexico, and Utah, with three (3) satellite communities in New Mexico. NAIHS primarily delivers health services to members of the Navajo Nation and the San Juan Southern Paiute Tribe, and also provides services to other Native Americans, including Zunis, Hopis, and other American Indian beneficiaries. The five (5) Federal Service Units (SUs) include Chinle, Crownpoint, Gallup, Kayenta, and Shiprock SUs.

NAIHS provides inpatient, emergency, outpatient, public health, and other services at four (4) hospitals, with seven (7) full-time health centers providing outpatient, community health, preventive health, and other services; there are also five (5) part-time health stations.

In addition to the NAIHS, the Navajo health care system includes an urban health program in Flagstaff, Arizona, the Navajo Department of Health (NDOH), and five Tribal health care corporations, who have contracts with NAIHS under the auspices of Public Law 93-638, the Indian Self Determination and Education Assistance Act. The P.L. 93-638 contracts and compacts with Tribal health corporations are authorized by the Navajo Nation to provide health care services in the respective regions served by the corporations, including facilities such as the Fort Defiance Indian Hospital/Tsehootsooi Medical Center, Winslow Indian Health Care Center, Inc., Tuba City Regional Health Care Corporation, Sage Memorial Hospital, and Utah Navajo Health System, Inc.

1.1.2 Chinle Service Unit (CSU) based in Chinle, Arizona (Northeast Arizona near Canyon De Chelly

National Monument), CSU serves a population of approximately 40,000 members with half of the population under age 25 years. CSU consists of one (1) 60 bed hospital, Chinle Comprehensive Health Care Facility (CCHCF), and two (2) full-time satellite facilities, Pinon Health Center (PHC) located in Pinon, Arizona, and Tsaile Health Center (THC) in Tsaile, Arizona. Services are also provided at the Many Farms and Rock Point Clinics on a part-time basis. CCHCF, located in Chinle, Arizona serves as the health care hub for the region, and offers routine outpatient and inpatient primary care services, including: Adult Intensive Care, General Surgery (including laparoscopic surgery), routine and operative Obstetrics, and 24-Hour Emergency Room Services. Strong Navajo cultural traditions exist within the community, offering an opportunity to learn the Navajo language, or to learn about traditional Navajo medicine.

1.1.3 Pinon Health Center (PHC) Serving a rural area, Pinon Health Center is an outpatient clinic associated with Chinle Service Unit - Indian Health Service in the Heart of the Navajo Reservation

- Northern Arizona. Pinon Health Center provides care to approximately 11,000 patients - the majority of which are Navajo and many are traditional Navajo who still speak the language. A collegial group of providers offer services in primary care, women's health, counseling, dental, dietary and community nutrition, health promotions, lab, x-ray, native medicine, optometry, pharmacy, physical therapy, speech therapy, podiatry and public health nursing. The facility consists of fifteen (15) exam rooms, four (4) Optometry exam rooms, fourteen (14) Dental bays, as well as large areas for Physical Therapy and Pharmacy.

1.2 Scope: The Contractor shall provide outpatient Physician Psychiatrist Services in accordance with

Section 5.0, Performance-Based Requirements.

1.2.1 Duties and responsibilities will encompass outpatient primary care counseling and walk-in urgent care intervention, Physician Psychiatrist Services to I.H.S. patients

1.2.2 Place of Performance: Services are to be performed at the Pinon Health Center Outpatient department, including the Urgent Care and Teen Clinic, and may, as needed, be performed at Chinle Comprehensive Health Care Facility Outpatient Departments including the Emergency Room (ER)/Urgent Care as well as other hospitals, clinics, and other healthcare facilities in the Navajo IHS Areas within the Chinle Service Unit. Other off-site locations may include Pinon High School Teen Clinic and community immunization events within the region served by Pinon Health Center, Chinle Service Unit and other Navajo IHS Areas.

1.2.3 Period of Performance: Will be flexible to allow for short term assignments (13 weeks), long term one-year purchase orders with 2 additional option years, and, where feasible, include intermittent support to meet unplanned needs that develop on a frequent basis.

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

1.3.1 The Joint Commission: http://www.jointcommission.org/

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

1.3.3 Accreditation Association for Ambulatory Health Care (AAAHC): http://www.aaahc.org

1.3.4 Section 231 of Public Law 101-647, the Crime Control Act of 1990:

http://www.policyalmanac.org/crime/archive/crs_federal_crime_policy.shtml

1.3.5 Section 4087 of Public Law 101-630, the Indian Child and Family Violence Act:

http://www.nicwa.org/policy/law/protection/index.asp

1.3.6 Health Insurance Portability and Accountability Act (HIPAA) of 1996:

http://www.cms.hhs.gov/HIPAAGenInfo/Downloads/HIPAALaw.pdf

1.3.7 Privacy Act of 1974: http://www.usdoj.gov/oip/privstat.htm http://www.jointcommission.org/ http://www.cms.hhs.gov/ http://www.policyalmanac.org/crime/archive/crs_federal_crime_policy.shtml http://www.nicwa.org/policy/law/protection/index.asp http://www.usdoj.gov/oip/privstat.htm

1.3.8 IHS Service Unit and Health Center Policies, Procedures and Protocols:

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

1.3.9 Computer Security Act of 1987:

http://csrc.nist.gov/groups/SMA/ispab/documents/csa_87.txt

1.3.10 Federal Code of Conduct: http://www.ihs.gov

1.3.11 IHS General Directives: http://www.ihs.gov/adminmggrresouces

1.3.12 IHS Computer Security Directives http://www.ihs.gov/adminmggresources http://csrc.nist.gov/groups/SMA/ispab/documents/csa_87.txt http://www.ihs.gov/ http://www.ihs.gov/adminmggrresouces http://www.ihs.gov/adminmggresources

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 Board Eligible: All Internal Medicine or Family Medicine physicians and subspecialist physicians who have met the standards for Board Certification in general Internal Medicine/Family Nurse Practitioner or any of its subspecialties to be “Board Eligible” in the relevant specialty for a period of 7 years. The 7-year period of Board Eligibility shall begin upon the candidate's successful completion of the initial certification requirements in their field or July 1, 2012, whichever is later. During the period of Board Eligibility, the candidate may apply for the certifying examination in the relevant specialty. If the candidate does not become Board Certified during the 7-year period of Board Eligibility, the candidate will no longer be deemed “Board Eligible” and may no longer represent himself or herself as “Board Eligible.”

2.5 Code of Ethics: The Code of Ethics for Nurses with Interpretive Statements as approved by the American

Nurses Association.

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

2.7 Contractor: The organization awarded a legal binding contract to provide supplies and/or services;

includes the organization’s employees.

2.8 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. GTR – Government Technical Representative, COTR–Contracting Officer’s Technical Representative, or PO - Project Officer).

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 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.

2.16 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.

2.17 Non-personal Services Contract: a contract under which the personnel rendering the services are not subject, either by the contact’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 37.401.

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

2.19 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.

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

2.21 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.

2.22 Patient Outcome: End result of outpatient, licensed independent provider care.

2.23 Performance based Matrix: Lists the services to be monitored and the standards to be applied.

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

2.25 Service Unit: The local administrative unit of IHS.

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

2.27 Supervisor. Government employee authorized to provide verbal and written performance direction to the Contractor that the Contractor must follow without exception.

2.28 Task Order: An order issued in accordance with the terms of the contract that details an ordering activity’s specific requirements. An ordering activities written order to obtain services, at a minimum will include the following where applicable: description of services, skill categories, hours, price, period of performance, contract number, and the ordering activities task order number.

2.29 Tour of Duty: The time of day the provider is scheduled to perform patient 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.

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

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

3.0 Government Furnished Information, Property and Services

3.1 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.

3.2 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.

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

Chapter 12, Section 13 Motor Vehicle Management.

3.3 Contractor Exclusive Use:

3.3.1 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.

3.3.2 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.

3.4 Training: Facility specific orientation/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 provider service or includes mandates made by the IHS Service Units/Health Centers while the provider is working under this contract. Training will not be provided for the purpose of continuing education, career development or individual development.

3.5 Supervisor: The contractor is subject to the supervision and direction of Sean Meade, MD, Chief Medical

Officer, or his designee for this order.

3.5.1 Contracting Officer Representative (COR): Nora Nutlouis, Ph: 928-725-9624, is primarily responsible for monitoring the technical progress including surveillance and assessment of performance for this order.

3.5.2 Point of Contact: Clinical Services Secretary, (928) 725-9538, is the point of contact for this requirement.

4.0 Contractor Furnished Property

4.1 Except for the property specified in paragraph 3 as government furnished, the Contractor shall provide all uniforms and other personal medical instruments subject to the following:

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

Indian Health Service Manual, Part 3, Chapter 4.4.A.7 and meet the approval of the Clinical Director at each IHS facility.

4.1.2 SmartCard/Subscriber Identity Module (SIM) USB Token: Contract Staffing Agencies are required to purchase SmartCard/SIM token access for assigned clinical contracting staff to utilize securely throughout the term of the contract. Model Recommendations will be provided upon request.

4.1.3 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.

5.0 Performance-Based Requirements. The Contractor shall provide uninterrupted Psychiatrist Physician (MD or DO) Services in the delivery of patient care to the Indian Health Service. Specific tasks include the following:

5.1 Physician Psychiatrist Duties:

5.1.1 Work under the general technical, administrative supervision of the Pinon Health Center (PHC)

Outpatient Department Director or their designee.

5.1.2 The Contractor shall provide professional medical services or direct patient care services under the terms of this contract, appropriate and timely medical services in accordance with the standards of care established by recognized medical care organizations and in accordance with the policies and procedures of Chinle Service Unit’s Medical Staff Bylaws and Rules & Regulations, including attendance at department and medical staff meetings at Chinle Service Unit facilities. The contractor shall provide acute, chronic, and urgent psychiatric clinical services in the Pinon Health Center Integrative Behavioral Health Clinic, in accordance with the terms and conditions of this contract and in accordance with the standards of The Joint Commission, professional standards of the their licensing board, Indian Health Service, Navajo Area and Chinle Service Unit policy and procedures and Chinle Service Unit Medical Staff Bylaws.

5.1.3 The Contractor shall provide professional medical services or direct patient care service as permitted by medical staff credentialing privileges as follows:

A. Interviews and examines patients, reviews past mental health history, and requests and/or performs complex diagnostic tests and examinations deemed necessary to obtain all possible information related to each case. Makes preliminary diagnosis utilizing health risk screening practices, directs, prescribes or provides treatment and monitors adverse and metabolic effects of psychiatric medications, evaluating for and acting upon abnormal vital signs including heart rate, blood pressure, weight and BMI. Arranges for specialized care or patient referral as required. Evaluates psychiatric walk-in patients who come to Urgent Care when needed. Bases decisions upon information obtained, professional psychiatric medical knowledge and skills, and prescribe policies and procedures. Makes note of observations to be incorporated into clinical records. Provides emergency care as required.

Provides definitive management in all psychiatric medical categories for cases that do not require referral. Gives total patient care in accordance with psychiatric standards of care, to include, but not limited to: individual psychotherapy, family and couple psychotherapy, pharmacotherapy, evaluation services (to DES, court ordered evaluations, DSW, etc.)

group therapy, relaxation therapy, cognitive and behavior therapy, and child and adolescent therapies to patients under his/her care. Obtains consultation as needed. As clinically appropriate, provides care to patients for wide spectrum of acute and chronic illness.

B. Provider must be certified in BLS. ACLS and PALS certification are highly recommended.

Serves as a member of the code team in life threatening situations for which the “code blue” or “medical emergency” activation system has been initiated.

C. Conducts psychiatric outpatient clinics making observations appropriate to the patient’s underlying disease and treatment plan, including current symptoms, provided with a sensitive understanding of culturally relevant issues. Reviews the patient’s medications, diet, therapy course, adherence to management plan and patient observations, when necessary. Makes recommendations to modify regimen as indicated. Instructs and counsels patients and family members as required. Acts as a resource for treatment of acute and chronic mentally ill patients and an expert clinical advisor to counseling services case management and to primary care clinicians and other health professionals.

D. Refers patients to appropriate contracted medical or other government facilities, providing full clinical information for care and diagnostic procedures that cannot be adequately provided at local I.H.S. facilities. Coordinates and integrates information obtained into the ongoing Health Care Program at the Service Unit and assures the provision of timely follow up care as required.

E. Works closely with patient’s primary care provider and other allied health professionals

(i.e., Community Health Nurse, Social Workers, Health Educator, etc.) to utilize and coordinate the services of other health care professional in the management of the patient’s medical, psychological and social problems. Ensures appropriate referrals are made and appropriate consultations are obtained after primary complete evaluation and documentation has been completed. Contributes to use of psychiatric standards to care, and monitors compliance with such standards for prevalent conditions with the Service Unit (substance abuse, depression, etc.)

F. Within specialty area, assumes responsibility for the mental health diagnosis, prevention therapy, maintenance and rehabilitation of patients in the capacity of a senior specialist or expert.

G. Contractor shall provide appropriate documentation regarding care rendered using the

Chinle Service Unit’s (CSU) Electronic Health Record (EHR) system. All documentation by the provider will be entered electronically using the electronic health record system. The provider is responsible for utilizing the CSU electronic health record system to obtain pertinent patient information in assisting care. It is the responsibility of the provider to use the training resources provided by the CSU to develop competency in utilizing the electronic health record system.

H. Produces timely clinical and non-clinical correspondence to ensure prompt coordination of care and feedback to patients, families, other professionals and organizations in accordance with HIPAA and other applicable standards. Assures preparation of appropriate medical records for all patients seen to assure the accumulation and organization of all pertinent clinical data needed to provide comprehensive medical care.

Creates clinical reports for use by providers, hospitals, and other individuals and facilities.

Works closely with primary care providers and other allied health professionals (community health nurses, social workers, health education, etc.) in the provision of broad health programs services.

I. Dictates, electronically enters, or writes and assures preparation of appropriate medical records for all patients seen to assure the accumulation and organization of all pertinent clinical data needed to provide comprehensive medical care. Clinical data reports shall be completed in a timely manner and shall be maintained in compliance with CSU Medical Staff and The Joint Commission standards.

J. Assures preparation of appropriate medical records for all patients seen to assure the accumulation and organization of all pertinent clinical data needed to provide comprehensive medical care. Creates clinical reports for use by medical providers, hospitals, and other individuals and facilities. Works closely with allied health professionals (community health nurses, social workers, health education, etc.) in the provision of broad health programs services.

K. Contractor shall submit invoices as required for payment of services rendered and hours worked. Contractor shall submit an original invoice. Invoice shall be certified by Contractor that services have been provided and attach daily sign in/sign out sheets that verify the hours worked. Invoices will also include certification statement of services received, which are to be signed by the Supervisor or designee and Contracting Officer Representative.

5.1.4 Contractor shall be subject to peer review per The Joint Commission standards.

5.1.5 Contractor shall meet the Safety management reporting requirements in accordance with the

Service Unit Safety Measure Policy.

5.1.6 Contractor shall be responsible for all applicable Federal, State, And Local Taxes, Meals, Travel/Transportation. Lodging is available but must be paid for by the contractor or contract agency. Government quarters are available at prevailing rental rates plus utilities, as applicable, if government quarters are utilized. The contractor shall be responsible and liable for the proper care of government owned or leased property furnished in occupied quarters.

5.2 Work Schedule:

5.2.1 Work shifts as arranged by Counseling Services Supervisor in coordination with the Chief Medical

Officer for Pinon Health Center:

• The contractor shall work 100% of the contracted hours. The contracted hours shall be arranged by Primary Care Director or designee in conjunction with the Chief Medical Officer. Tour of Duty: Regular work hours are 8:00 a.m. – 5:00 p.m. Monday, Tuesday, Wednesday, Thursday and Friday (40) hours per week. Pinon Health Center is closed on Federal Holidays and the IHS does not compensate for holidays.

• Work hours beyond 5:00 p.m. maybe needed to meet patient care needs due to increased workload or patients pending transport to a higher level of care, for completion of time-sensitive projects and/or for required trainings. Overtime is compensated at the same hourly rate and typically should not exceed 2 additional hours beyond the 40 hour work week. Work beyond 45 hours per week is not compensated unless specifically pre-approved in writing by the department supervisor.

• COVID-19: Contractor shall be subject to working longer hours and/or beyond the Tour of

Duty if patient load demands are present and rotating shifts to provide coverage within CSU outpatient settings including call-backs and weekends. Contractor will abide by COVID-19 related policies including 100% universal mask wearing and up-to-date policy on Personal Protective Equipment (PPE). PPE will be provided in accordance with Center for Disease Control guidelines.

5.2.2 Continuity of Patient Care: The contractor shall ensure the continuity of patient care and shall provide a qualified replacement to authorize the approval of time off and within the time frame specified by the Contracting Officer. If no replacement is determined in the timeframe specified, this shall be considered grounds for Termination or Default. If the CCHCF staff need to provide patient care coverage for any of the contracted shifts noted herein, the Contractor will be assessed a penalty fee of $75.00 per hour for each hour of coverage provided. Penalty fee will be deducted from the invoice payment.

5.2.3 Work Flexibility. As directed by the Supervisor, the contractor shall rotate into other duty sections as needed to support patient care; this will include Teen Clinic and/or Urgent Care.

5.2.4 The contractor shall obtain approval of the department Supervisor or designee prior to any absence from work. If the length of the absence exceeds eight (8) work hours the Contractor shall request approval at least fifteen (15) days, (the exception is verifiable emergencies) in advance of the desired absence. Sick/annual leave/compensatory time are not authorized.

5.2.5 Contractor shall provide a qualified replacement to authorize the approval of leave.

5.2.6 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.

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

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

5.3.1 The contractor shall be subject to character investigation as required by Public Law 101-360, the Indian Health Child Protection and Family Violence Prevention Act prior to performance of a contract by utilizing the US Office of Personnel Management (OPM), Electronic Questionnaire for Investigation Processing (eQIP) system and this shall include all fingerprinting procedures and clearances. The contractor shall provide all requested information necessary to perform Level I and Level II background checks. The contractor shall comply with the requirement to obtain security investigations. The contractor shall work with the I.H.S. 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.

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-based Matrix of section 10.0.

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 and shows cause for termination.

5.5 Identification of Contractor:

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

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

5.6.1 Medical Records and Other Required Documentation: 100% percent of all medical records and other required documentation meets established IHS Medical Facility, The Joint Commission, and CMS standards to include, but are not limited to, timeliness, legibility, accuracy, content, date, time, signature and designated profession. (Note: payment will be withheld for inaccurate or incomplete medical records per paragraph 10.0 of this performance work statement.)

5.6.2 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.

5.6.3 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:

5.7.1 In 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.

5.7.3 The contractor shall follow all appropriate federal and locally required Information Technology security requirements and will be operating under HIPAA and Privacy Act regulations.

6.0 Contractor Qualification Requirements:

6.1 Experience. The Contractor shall have a minimum of thirty-six (36) months of Psychiatrist work experience, unless otherwise approved by the CSU Credentials Committee or Contracting Officer. There must be no lapse of services of more than six (6) consecutive months for at least twelve (12) months prior to beginning tour of duty with CSU.

6.1.1 Contractor shall have completed all requirements of residency training and experience in

Psychiatry.

6.2 Certification/License/Registration. The Contractor shall be board certified or board eligible with the American Board of Psychiatry and Neurology, and shall possess a current, valid, unrestricted physician license in any state, the District of Columbia, the Commonwealth of Puerto Rico, or a Territory of the United States, throughout the term of this contract. If the contractor is asked to perform outside the normal training parameters of his/her specialty, then the contractor shall provide certification of hospital privileges in those additional field/s of practice.

6.2.1 Drug Enforcement Administration (DEA) License. The contractor shall maintain a valid, current, full and unrestricted DEA license with schedule types II through V and maintain certification throughout the term of the contract.

6.2.2 The contractor shall maintain a valid and current Cardiopulmonary Resuscitation (CPR), Basic Life

Support (BLS). Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS) and Advanced Trauma Life Support (ATLS) certifications are highly recommended.

6.2.3 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.

6.2.4 The contractor shall meet the qualifications and credentialing standards.

6.3 Technical Evaluation Criteria.

6.3.1 All selections will be evaluated by the technical evaluation criteria below. The technical evaluation criteria are listed in order of importance including criteria weights. The technical evaluation criteria from one (1) through eight (8) are the minimal requirements to meet CSU's credentialing and privileging standards. Attaining the maximum points of eight (8) points is preferred in meeting the requirements, but any source selection below four (4) points will not be considered, as they cannot be credentialed.

CSU must exercise its due diligence to be 100% in compliance with The Joint Commission in Maintaining CSU's accreditation with Medical Staff Services.

CRITERIA POINTS ASSIGNED

• Credentialed and privileged to CSU Medical Staff 1 point

• Board Certified or Board Eligible 1 point

• Completed accredited Psychiatry Residency 1 point

• Completed Medical School or ECFMG certificate 1 point

• Active and unrestricted medical license 1 point

• Active and unrestricted BLS, ACLS, PALS and DEA license 1 point

• Current experience within past 6 months, or prior IHS experience 1 point

• NO malpractice suits (less than 3 cases) 1 point

* All suits will be thoroughly reviewed by Clinical Medical Officer

TOTAL MAXIMUM POINTS = EIGHT (8) POINTS

SCORES BELOW FOUR (4) POINTS WILL NOT BE CONSIDERED

7.0

6.4 Health Requirements/Conditions of Employment:

6.4.1 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.

6.4.2 Immunization. The contractor shall provide documentation as evidence of immunization as required by NAIHS immunization policy for the following:

• Hepatitis A - Two dose series at zero and six months.

• Hepatitis B - Three dose series at zero, one, and six months or documented immunity. A signed declination of Hepatitis B vaccination series will be accepted.

• Measles, Mumps, Rubella (MMR) - Two doses or titer documentation.

• Varicella (chickenpox) – Two doses, titer documentation or history of varicella/shingles.

• Tetanus, diphtheria, pertussis (Tdap/Td) - one dose of Tdap, then tetanus (Td) booster every

10 years thereafter.

• Meningococcal - Two vaccines (MenACWY and MenB) recommended for microbiologists routinely exposed to N. meningitidis.

• Documentation of annual TB test- may include Mantoux TB skin test (PPD) within the past twelve (12) months. All new employees will require the two step TST. Acceptable lab testing:

Quantiferon Gold or T-Spot test. For positive TB test results, please submit a copy of recent chest x-ray results.

• Influenza – Mandatory annual vaccination.

6.5 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.

6.6 Information Technology Skills. The Contractor shall possess basic knowledge, skills, and abilities to use and effectively navigate a computer and the subsequent electronic programs.

6.7 Orientation and Mandatory Training. The contractor shall attend mandatory orientations and training specified by the government.

6.7.2 The contractor will complete the most recent Information Systems Security Awareness (ISSA)

Training within 24-hours of reporting for duty and provide certificate of completion to direct supervisor.

6.7.3 The contractor will complete the Protecting Children from Sexual Abuse by Health Care

Providers Training within 24-hours of reporting for duty and provide certificate of completion to the direct supervisor.

6.8 Background Checks: The contractor shall be subject to character investigation as required by Public Law

101-360, the Indian Health Child Protection and Family Violence Prevention Act prior to performance of a contract by utilizing the US Office of Personnel Management (OPM), Electronic Questionnaire for Investigation Processing (eQIP) system and this shall include all fingerprinting procedures and clearances.

The contractor shall provide all requested information necessary to perform Level I and Level II background checks. The contractor shall comply with the requirement to obtain security investigations.

The contractor shall work with the I.H.S. 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.

6.9 General Requirements:

6.9.2 Contractor shall provide at minimum three current letters of reference from other health care providers familiar with the candidate's clinical practice skills within the same discipline. One letter must be from the Chief of Staff/Medical Director or Immediate Supervisor at the hospital in which the provider either holds or last held staff privileges. If the contractor's provider has just completed a residency program, one of the letters shall be from the program director or service chief.

6.9.3 The contractor shall be subject to Medical Staff Ongoing Professional Practice Evaluation

(OPPE) and Focused Provider Performance Evaluation (FPPE) as specified in the Chinle Service Unit Policy & Procedure, Focused Provider Performance Evaluation & Ongoing Professional Practice Evaluation.

6.9.4 Contractor shall work directly with the Chinle Service Unit Credentials Committee to attain approval of credentials and privileges. The contractor is to complete requested Human Resource and Credentialing paperwork and online background investigation within the required time frame determined by Human Resources and Credentialing Policy and Procedure.

Failure or delays in completing this paperwork may result in delays for the provider to complete check-in and begin clinical work.

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

a) It is expressly agreed and understood that this is a nonpersonal 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 per occurrence; $3,000,000 aggregate.

b) An apparently successful offeror, 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 work by any subcontractor, the Contractor shall furnish to the Contracting Officer evidence of such insurance.

8.0 Challenges to Conflicts: For any inconsistency between supervisor directions, this Performance Work Statement, attachments and exhibits, the following order of precedence will apply:

a) First Priority: Supervisor’s directions

b) Second Priority: Position Description (attached)

c) Third Priority: Performance Work Statement Exhibits

d) Fourth Priority: Performance Work Statement Narrative

9.0 Termination.

9.1 Termination (Personal Services) (52.249-12, Apr 1984): The Government may terminate this contract at any time upon at least 15 days’ written notice by the Contracting Officer to the Contractor. The Contractor, with the written consent of the Contracting Officer, may terminate this contract upon at least 15 days’ written notice to the Contracting Officer.

9.2 Contract Terms and Conditions-Commercial Items (52.212-4, MAY 2015): Termination for cause. The Government may terminate this contract, or any part hereof, for cause in the event of any default by the contractor, or if the contractor fails to comply with any contract terms and conditions, or fails to provide the Government, upon request, with adequate assurances of future performance. In the event of termination for cause, the Government shall not be liable to the contractor for any amount for supplies or services not accepted, and the contractor shall be liable to the Government for any and all rights and remedies provided by law. If it is determined that the Government improperly terminated this contract for default, such termination shall be deemed a termination for convenience.

9.3 Any Contractor employee demonstrating impaired judgment shall not be allowed to continue working on the contract. The Government reserves the right to remove from the facility any Contractor employee who in the judgment of a licensed healthcare practitioner is impaired.

10.0 Performance – Based Matrix

Performance-based Task Indicator Standard Quality Assurance Incentives

State the end results or outputs that you, the customer will formally accept or reject.

For the requirement, state the feature(s) of end result that will be surveilled.

For each “indicator,” state a performance level that, when met, means the task has been performed satisfactorily.

This Standard describes “What Success Looks Like.”

For each “Standard”, state the method used to check performance (i.e. random sampling, 100% inspection, periodic inspection, customer complaints).

List Positive and Negative Incentives. Address method of linking payment to quality of service.

Contractor shall provide outpatient Psychiatrist services in the delivery of patient care to the Navajo Area Indian Health Service, Pinon Health Center.

Competency

Compliance

Patient Outcomes

Professionalism

Credentialing

Documentation

Service Quality

Perform 100% required tasks at 100% of the required competencies (refer to 11.0)

100% compliance with IHS Service Units and/or Health Centers published Policies;

Procedures; Standards of Care; and Hospital and Laboratory Protocols.

No reports of breached patient safety, infection control, and other procedures that might adversely affect patient outcome.

Performance characterized by continual cultural awareness and focus on customer service. 100 % adherence to the Code of Ethics and Federal Code of Conduct.

Uninterrupted credentialing as defined in

6.0 to 6.8 for period of contract.

100% of all medical records and other required documentation meets established IHS Medical Facility, Joint Commission, and CMS standards to include, but are not limited to, timeliness, legibility, accuracy, content, date, time, signature and designated profession.

Satisfaction with quality of service is evidence by valid customer inputs. 100% adherence to ensure continuity of patient care and to provide replacement on time.

COR surveillance systems will include periodic inspections and customer complaint review.

Medical Staff supervisor…