PWS - PT.pdf

Performance Work Statement 1

WOODROW WILSON KEEBLE MEMORIAL HEALTH CARE CENTER

INDIAN HEALTH SERVICE

PERFORMANCE WORK STATEMENT

PHYSICAL THERAPY SERVICES

GENERAL

The Mission of the Sisseton Indian Health Service (IHS)/Woodrow Wilson Keeble Memorial Health Care Center (WWKMHCC) is to provide the best possible healthcare services to the patients on the Lake Traverse Reservation in South Dakota. To fulfill this mission, the WWKMHCC is requesting an all-inclusive, non-personal service contract for a Physical Therapist.

BACKGROUND

The IHS is an agency within the Department of Health & Human Services, responsible for providing federal health services to American Indians and Alaska Natives. The Indian Health Service provides a comprehensive health service delivery system for approximately 1.9 million American Indians and Alaska Natives who belong to 567 federally recognized tribes in 35 states. The Indian Health Service Headquarters is located in Rockville, MD, and is divided into twelve (12) physical areas: Alaska, Albuquerque, Bemidji, Billings, California, Great Plains, Nashville, Navajo, Oklahoma, Phoenix, Portland, and Tucson.

The Great Plains Area Office (GPAO) works in conjunction with 19 Indian Health Service Units and Tribal Managed Service Units to provide healthcare to approximately 130,000 Native Americans located in North Dakota, South Dakota, Nebraska, and Iowa. The Area Office's service units include seven hospitals, eight health centers, and several smaller health stations and satellite clinics.

Our facility, the WWKMHCC, falls under the GPAO. WWKMHCC provides medical care for approximately 7,000 tribal members living on the Lake Traverse Reservation. Serving rural areas, many of our patients travel 100 miles round-trip to receive care. The WWKMHCC was established in 2007 to provide an expanded range of outpatient healthcare services, specifically designed to meet the needs of the WWKMHCC population. Services include Pharmacy, Physical Therapy, Public Health Nursing, Radiology Services, Laboratory, Dental, Community Health, purchased and referred care services, Nutrition Services, Behavioral Health, and Optometry.

OBJECTIVES

To provide uninterrupted physical therapy services in the delivery of patient care for the WWKMHCC. The Contract Physical Therapist shall provide physical therapy services that are compatible with the IHS medical facility's operating capacity and equipment on the Lake Traverse Reservation. The care shall cover the care typically provided in a rural civilian practice of similar size.

PERIOD OF PERFORMANCE

The period of performance will be a base period with nine (9) option periods. *Base period will be six (6) months, and each option period will be six (6) months.

Performance Work Statement 2

PLACE OF PERFORMANCE

Woodrow Wilson Keeble Memorial Health Care Center Indian Health Service 100 Lake Traverse Drive Sisseton, SD 57262

DESCRIPTION OF SERVICES

Upon the receipt of an IHS purchase order, the Contractor shall locate, credential, and have sufficient staffing available to provide coverage for a Physical Therapist in the WWKMHCC IHS in Sisseton, SD, during periods of permanent staffing absences. The Contractor shall provide a complete orientation of this scope of work to the Contract Physical Therapist before submitting the confirmation service agreement.

The contract resulting from this solicitation shall:

1. Be a non-personal health care services contract under which the Contractor is an independent contractor.

2. Allow the Government to evaluate the quality of professional and administrative services provided, but retain no control over the medical, professional aspects of the services rendered.

3. Require the Contractor to indemnify the Government for any liability-producing act or omission by the Contractor, its employees, and agents occurring during contract performance.

4. Require the Contractor to maintain medical liability insurance, in the coverage amount acceptable to the Contracting Officer, which is not less than the amount normally prevailing within the local community for the medical specialty concerned.

5. Require the Contractor to assume sole and exclusive responsibility for employee federal taxes, social security, unemployment insurance, and workman’s compensation.

6. Require the Contractor to provide daily compensation and travel reimbursements to each Contract Physical Therapist as appropriate.

CANDIDATE PRESENTATION. The Contractor shall present a candidate to the WWKMHCC Contracting Officer’s Representative (COR) for review by the Physical Therapy Supervisor within five (5) business days of the purchase order and will include the following documentation:

1. Full name

2. Date of birth

3. Social security number

4. Phone number

5. E-mail address

6. Current curriculum vitae with listing of all work experience, and explanations for any employment gaps

7. Signed release of information

8. Minimum of three (3) letters of reference (preferably within the past 6 months); must have (1) clinical supervisor and (2) peers from the same discipline

In the event the Physical Therapy Supervisor does not accept the Contract Physical Therapist, the documentation will be sent to the COR for review/comments, and the Contractor will have three (3) business

Performance Work Statement 3 days to present a new Contract Physical Therapist.

Upon acceptance of a Contract Physical Therapist, a complete background investigation and credentialing packet shall be sent to the contractor. The Contractor is responsible for ensuring that the proposed Contract Physical Therapist possesses the requisite credentials to enable the granting of privileges by the Sisseton Medical Staff, sufficient to allow for the performance of all tasks identified. The contractor shall send a fully completed background investigation and credentialing packet back within seven (7) days. The entire candidate presentation and paperwork completion shall be accomplished within thirty (30) days.

Once a Contract Physical Therapist has been cleared for suitability with a completed eApp and has been granted privileges, the Contractor shall submit a confirmation service agreement and include the following information:

1. Contract Physical Therapist name and phone number

2. Dates of service

3. Confirmation of completion of Contract Physical Therapist’s orientation to this scope of work

4. Point of contact and phone number

Before assumption of duty on any scheduled work shift, the Contract Physical Therapist may be briefed by the service unit Physical Therapy Supervisor or his/her designee concerning any matter relevant to the Contract Physical Therapist’s responsibilities under the terms of this contract. The Contractor shall advise the COR or his/her designee of any problem encountered in connection with meeting the needs of patients treated by the Contract Physical Therapist.

CONFLICT OF INTEREST. The Contractor shall not employ any person who is an employee of the United States Government if the employment of that person would create a conflict of interest. The Contractor shall not employ any person who is an employee of Health and Human Services (HHS) unless such a person seeks and receives approval in accordance with the Department of HHS.

CONTINUITY OF SERVICES. The Contract Physical Therapists’ services are considered vital to the Government and must be continued with minimal interruption. To minimize interrupted services, the Contractor shall exercise best efforts and cooperation to provide coverage during periods of permanent staff absence.

In the event the Contractor is unable to fulfill the purchase order requirements for whatever reason; the government reserves the right to fulfill its need outside of this contract. A written confirmation from the contractor indicating the inability to fulfill the purchase order is immediately required. The government’s right to fulfill its need outside this contract does not waive its right to the issuance of a cure notice, nor does it waive its right to terminate.

TECHNICAL REQUIREMENTS

The Contractor shall possess the following:

1. Ability to provide a Contract Physical Therapist in a timely manner who provides on-site physical therapy services to beneficiary patients of all ages that present for care to the WWKMHCC.

2. Ability to assist with completion of background investigation paperwork, E-APP, and credentialing

Performance Work Statement 4

Contract Physical Therapists by the established deadlines.

3. Ability to provide Contract Physical Therapists who can interact with patients and clinical staff in a customer-friendly and culturally sensitive manner.

4. Ability to provide Contract Physical Therapists who possess Electronic Health Record experience.

CONTRACT PHYSICAL THERAPIST REQUIREMENTS

COMPUTER SKILLS. Computer efficiency and experience with Electronic Health Records are required.

ENGLISH LANGUAGE REQUIREMENT. The Contract Physical Therapist(s) shall read, understand, speak, and write English fluently, and communicate with sufficient clarity to be understood by WWKMHCC personnel and patients.

HEALTH REQUIREMENTS. The Contract Physical Therapist shall not have any work or health restrictions that interfere with the performance of primary care provider services. The Contract Physical Therapist shall provide proof of current immunizations (Hep B, MMR, Varicella, Tdap, Flu, COVID) status or proof of immunity via a copy of laboratory findings. A current PPD within the past year is also required.

QUALIFICATIONS. Contract Physical Therapist shall have a degree from an accredited Physical Therapy program, maintain continuing education, and have a current Basic Life Support (BLS). The Contract Physical Therapist must have a minimum of 1 year of experience as a Physical Therapist within the past 36 months, and must meet all credentialing and background investigation requirements (see pages 6, 7, and 8).

CONTRACT PHYSICAL THERAPIST RESPONSIBILITIES

APPEARANCE. Contract Physical Therapists are expected to comply with reasonable dress, grooming, and hygiene standards, based on comfort, productivity, health, and the type of position occupied, as compatible with the expectations of the WWKMHCC IHS and the Native American community. Contract Physical Therapists' attire will be professional and in compliance with the expectations of the WWKMHCC Policy and Procedures, including displaying their identification badge on their outer clothing at all times.

CLINICAL DUTIES. The Contract Physical Therapist’s actual clinical duties will be in accordance with his/her credentialed privileges within the Medical Staff Bylaws of the WWKMHCC, and will include the following:

1. Evaluate and provide rehabilitation services for disabled patients as requested by the physicians.

The types of disabilities may include post-stroke, head injury, arthritis, burns, cardiac conditions, polio, muscular dystrophy, cerebral palsy, muscle or bone disorders, including strains, sprains, post-fractures, bursitis, and scoliosis, post-surgical, and both acute and chronic pain patients. The Physical Therapist will also see patients with non-disabling conditions, such as prenatal and postpartum patients, as requested by their physician.

2. Initiate an appropriate physical therapy program involving the patient and family in developing goals and objectives.

3. Provide physical therapy treatments with periodic evaluations of the program to determine the patient’s status and the effectiveness of the treatment regimen.

4. Consult with referring physicians regarding the progress of their patients.

5. Develop and teach written home treatment programs to patients and family when necessary.

Performance Work Statement 5

6. Participating in the Patient Centered Medical Home (PCMH) model and encourage patient engagement.

7. Utilize Electronic Health Record (EHR) computer software to document services provided to the patient.

8. Establish interpersonal, intra-departmental relationships, and social sensitivity such that he/she can relate constructively to patients from Native American communities to enhance optimal patient care.

9. Exhibit professional conduct among staff and patients, and respect and maintain the basic rights of patients, to include but not be limited to personal dignity, cultural sensitivity, privacy, and confidentiality. Violations of these policies may lead to the immediate removal of the Contract Physical Therapist from this contract and the facility.

10. Maintain familiarity and comply with Federal, State, Indian Health Service, accreditation standards, CMS regulations, and departmental regulations and requirements.

11. Participate in committees as assigned (Medical Staff, Purchase & Referred Care, Quality Assurance, Pain Management, Pharmacy & Therapeutics, Outpatient Department, etc.).

12. Staff development/education as assigned by Physical Therapy Supervisor.

13. Peer reviews/competencies as assigned.

COMMUNICATIONS. Contract Physical Therapists shall maintain open and professional communication with members of the Physical Therapy Staff and the OPD. Complaints validated by the Performance Improvement Coordinator and Physical Therapy Supervisor shall be reported in writing to the COR and the Contractor for action.

When the Physical Therapy Supervisor is absent, the Contract Physical Therapist shall follow the delegation of authority and perform duties as assigned by the Physical Therapy Supervisor’s designee.

ORIENTATION. All new Contract Physical Therapists will participate in the WWKMHCC facility orientation.

The orientation must be completed before providing services at the facility and will be scheduled for the first one (1) to three (3) days of arrival at the facility.

PRIVACY OF INDIVIDUALLY IDENTIFABLE HEALTH INFORMATION. The Contract Physical Therapists shall provide patients with the utmost care and attention. All patients shall be assured of their privacy and personal dignity. The Contract Physical Therapist shall ensure strict compliance to the release of Protected Health Information in accordance with the Code of Federal Regulation, Title 45, Public Welfare, Subtitle A, Department of Health and Human Services, Part 164, Security and Privacy (45 CFR 164) and AFI 41-210, Patient Administration Functions, Health Insurance Portability and Accountability Act (HIPAA), and General Guidelines on Releasing Medical Information.

RECORDS. The Contract Physical Therapist shall generate and maintain proper medical record information on beneficiaries to whom treatment is provided in accordance with Indian Health Service regulations and policies set forth by the Health Information Management (HIM) Department. Verbal orders are to be used only in emergencies. In the event of a significant disaster or code, all verbal orders are to be signed off immediately following the code or disaster. The Contract Physical Therapist shall prepare all medical record documentation to meet or exceed the established standards of the IHS facility, including, but not limited to, timeliness, accuracy, content, and signature.

Performance Work Statement 6

All deadlines as determined by the facility shall be met, including:

1. All chart documentation is completed within 72 hours.

2. Notifications received in the Electronic Health Record (EHR) shall be completed within one (1) day.

3. Any deficiencies (documentation that is found incomplete by the HIM department) must be completed within one (1) day after notification.

All medical record information generated in the performance of this contract will remain the property of and subject to the exclusive control of the Indian Health Service.

QUALITY IMPROVEMENT. The standards of medical practice and the duties of the Contractor shall be determined in accordance with the bylaws of the WWKMHCC, the facility's regulations, applicable provisions of law, other rules and regulations of all governmental authorities related to the licensure and regulation of physical therapists, and accrediting standards. All Contract Physical Therapists shall be required to participate in a quality improvement program, which is consistent with current accreditation standards and Medicaid Services (CMS) Conditions of Participation (CoP) requirements for ongoing monitoring and evaluation of the quality and appropriateness of care.

PRIVILEGING REQUIREMENTS

A Contract Physical Therapist shall not perform physical therapy services until professional staff membership and clinical privileges have been granted in writing by the Governing Body of the WWKMHCC and the GPA in accordance with IHS policy. Any failure to comply with IHS privileging requirements shall be considered a breach of this contract.

In accordance with the Indian Health Service credentialing policy, a primary source verification shall be completed for all Contract Physical Therapists performing services under this contract. The WWKMHCC will provide the credentialing packet and all associated documents to the Contractor. The Contract Physical Therapist shall complete and return all documents within seven (7) business days of accepting the candidate.

Re-appointment shall occur no less than every two years, in accordance with WWKMHCC Medical Bylaws.

When submitting a potential candidate, the following documents are required for credentialing:

1. Medical Staff Application (provide explanations to any “yes” questions on liability, final judgments, settlements, or claims from the application); Must have evidence of good standing at all facilities where the Contract Physical Therapist practices; Must not have been subject to involuntary limitation, reduction, denial or loss of clinical privileges, and have no current federal sanctions and provide a history of previous or pending malpractice lawsuits

2. Copies of pre-professional and professional school diplomas showing proof of graduation from an accredited school of their profession.

3. Copy of Board Certification certificate or letter

4. Copies of all current licenses (active and inactive); Must maintain a current active and unrestricted license in at least one of the 50 United States or US territories

5. Copy of current liability insurance

6. Completed and signed clinical privileges request form (must be specific to the facility assigned and specific to the applicant’s abilities/competencies)

7. Signed Medicare Agreement form

Performance Work Statement 7

8. Signed Health Status Statement, including provider signature

9. Copy of immunization record (PPD within past year with x-ray if positive)

10. Signed Medical Staff Bylaws Attestation Statement

11. Three (3) letters of reference within the past year (one reference must be from the same discipline peer, and one reference must be from the current or most recent physical therapy supervisor)

12. Copy of a government-issued photo identification card (Driver’s license or passport)

13. Copy of Social Security card

14. Signed Confidentiality Statement

15. Signed Child Care and Indian Child Care Worker Positions Agreement

16. Current Continuing Medical Education (CME) for the past two (2) years

17. Copies of Basic Life Support (BLS) and if applicable, Acute Cardiac Life Support (ACLS) certification

18. Copy of National Provider Identification (NPI) notification letter

19. Signed Provider Signature Card

20. A current copy of the proposed Contract Physical Therapist’s professional curriculum vitae

(submitted with initial candidate presentation)

Exceptions to the Indian Health Service credentialing review and clinical privileges process will not be considered. The Contractor's failure to submit successful applicants shall not excuse nonperformance of contract requirements. Any Contract Physical Therapist who fails to maintain medical staff appointment and clinical privileges will not be permitted to perform services under the contract and shall be promptly replaced by the Contractor.

HOMELAND SECURITY PRESIDENTIAL DIRECTIVE-12 (HSPD-12)

The Homeland Security Presidential Directive 12 (HSPD-12) is the directive issued for the "Policy for a Common Identification Standard for Federal Employees and Contractors." HSPD-12 calls for all federal employees and contractors to use a standard smart credential to verify their identity for secure access to federal buildings and information systems. HSPD-12 called upon the National Institute of Standards and Technology (NIST) to develop the actual technical standard, and the Office of Management and Budget (OMB) to manage implementation of the credentials. The uses of the credentials are left to the agencies themselves to decide. The purpose of HSPD-12 is to establish a standard and reliable method for verifying the identification of government employees and contractors. It will help to protect against a variety of threats, including:

In compliance with HSPD-12, the Health and Human Services, Indian Health Service (IHS), Woodrow Wilson Keeble Memorial Health Care Center, establishes the requirement to evaluate and investigate all federal employees and contractor employees before issuing a Personal Identification Verification (PIV) card. Thus, all persons privileged to be employed in the Federal Government shall be reliable, trustworthy, of good conduct and character, and of complete and unwavering loyalty to the United States. The HSPD-12 link below outlines the federal law requiring PIV cards for accessing federal networks. A PIV card ID is required after the 120-day waiver period, with no exceptions. Homeland Security Presidential Directive 12:

Policy for a Common Identification Standard for Federal Employees and Contractors https://www.dhs.gov/homeland-security-preseidential-directive-12. It is a mandatory requirement that all IHS

Performance Work Statement 8 information system users must complete annual security training to fulfill Federal mandates and regulations.

Additionally, all new users must complete this course within 24 hours of onboarding. Failure to complete the training requirements will result in the loss of access to information systems.

CRIMINAL BACKGROUND CHECK REQUIREMENT. The Government will conduct, at its expense, a Tier 2 with Subject Interview (T2S) and state criminal history checks on individuals providing direct, unsupervised childcare services under this contract. This investigation will be conducted at the expense of the Government and will be based upon the Federal Bureau of Investigation (FBI), state, and local criminal history repositories.

The Contract Physical Therapist is subject to Public Law 101-630, The Indian Child Protection and Family Violence Prevention Act. The Indian Health Service Personnel Office will conduct the criminal background investigations and obtain fingerprints on each Contract Physical Therapist provided by the Contractor. Until the character investigation has been completed and the Contracting Officer notified of the results, the Contract Physical Therapist must not have unsupervised contact with Indian children or access to Federal Information Systems that contain Personally Identifiable Information (PII) or Protected Health Information (PHI). The investigation may take several months to complete. Contract Physical Therapists receiving unfavorable background investigations shall not be employed. If at any time the contractor fails to meet or maintain suitability or eligibility for Federal employment, the contractor will be removed from providing services at the WWKMHCC.

The Contractor shall submit completed personnel background check applications within seven (7) working days after candidate acceptance. Any corrections needed to the background investigation process must be completed and resubmitted within seven (7) days.

Individuals shall have the right to obtain a copy of any background check pertaining to themselves and to challenge the accuracy and completeness of the information contained in the report.

SCHEDULING

ADMINISTRATIVE TIME. Each provider may receive up to one (1) hour of administrative time per shift, as allowed based on the patient workload. All documentation shall be completed during the allowed administrative time. On the last scheduled working day, the Contract Physical Therapist shall receive administrative time to ensure that all documentation is completed before departing, and shall check out with the Health Information Management (HIM) department to confirm completion of all records.

PATIENT SCHEDULING. Facility personnel will assist in patient scheduling. The initial patient evaluation will be scheduled for seventy-five (75) minutes in length for the first two (2) weeks of orientation. Thereafter, initial patient evaluations will then be scheduled for sixty (60) minutes. Follow-up patient visits will be scheduled for sixty (60) minutes for the first two (2) weeks of orientation. Thereafter, follow-up patient visits will be scheduled for forty-five to sixty (45-60) minutes, depending on patient need.

TIMESHEETS. The Contract Physical Therapist will be responsible for reporting to work at the scheduled time. All Contract Physical Therapists will utilize the time clock to ensure accurate documentation of hours worked, which will be verified with submitted timesheets and invoices before payment is processed. Only hours authorized by the Physical Therapist Supervisor or designee will be authorized for payment.

Performance Work Statement 9

WORK SCHEDULE. Work shifts will be eight (8) hours, Monday through Friday, 8:00 am to 4:30 pm (30-minute lunch break). Occasionally, additional hours may be required if an emergency evaluation is requested.

The average number of hours worked per week is 40. There are no weekend or holiday requirements. Work hours will be scheduled by the Physical Therapy Supervisor or their designee to correspond with the facility's needs and are subject to change. Any work performed beyond 40 hours per week requires pre-approval from the Physical Therapy Supervisor or their designee.

EVALUATION AND PERFORMANCE REQUIREMENTS

The Contractor shall allow the Government to evaluate the quality of the professional and administrative services provided in accordance with the technical requirements of this contract. This assessment will include observations of the work system, methods, and execution. Examples of monitoring methods include, but are not limited to, compliance with the Indian Health Service credentialing and privileging requirements, as well as the appropriateness of candidate placement (e.g., number of removals, number of early terminations of assignments due to personality conflicts, poor work habits, inadequate skills for the assignment, or unprofessional or discourteous behavior). An assessment spreadsheet with these methods will be monitored by the Physical Therapy Supervisor and the Contracting Officers' Representative (COR). The Contract Physical Therapist's performance will be monitored through peer review/competency, identifying deficiencies in the quality of services performed before the level of performance becomes unacceptable. These evaluations may be used as a record of contract performance history for evaluation in other competitive or non-competitive acquisitions.

It shall be understood that eligible patients under treatment will be provided with services that offer the best medical care within the Contract Physical Therapist's professional training and experience. All services rendered shall be in accordance with current standard medical practices to ensure quality of care. The contractor must perform at a satisfactory level and in accordance with all applicable laws, policies, rules, regulations, and within the Performance Work Statement.

DENIAL/TERMINATION OF PRIVILEGES. Any negligent behavior or any behavior jeopardizing patient safety will not be tolerated. Professional Review Action may be taken regarding any member of the medical staff if activity, demeanor or conduct of the member is detrimental to patient care, disruptive to the service unit operation, or in violation of the local bylaws, medical staff rules and regulations, IHS policy or is unethical.

Each incident will be evaluated and documented, and the Physical Therapy Supervisor will notify the COR, and provide copies of pertinent documentation as soon as possible when the necessity to exercise such authority becomes apparent. Disciplinary actions giving rise to a hearing or appeals will be in accordance with the local medical staff rules and regulations. No costs for travel, attorney fees, phone, mail or other expenses associated with the candidates hearing or appeal will be provided by the IHS or the WWKMHCC.

These incidents may be grounds for immediate removal.

PERFORMANCE SURVEILLANCE PLAN. Performance surveillance monitors will be established to ensure compliance with regulatory guidelines and to monitor contract performance effectively. The performance surveillance plan has been developed to outline the Indian Health Service's general plan in providing effective and systematic surveillance and reporting of all aspects of contract performance. This plan acknowledges

Performance Work Statement 10 the contractor's responsibility to conduct its own quality control obligations in the performance of this contract.

Surveillance will be accomplished through a review of the contractor's performance against the requirements listed in the work statement and the performance standards outlined in this plan. Performance-based incentives align with the contract's intent and purpose.

Upon completion of the contract, the Government will complete and keep on record the Contractor’s performance evaluation form based on the following objectives.

OBJECTIVE/

TASK

PERFORMANCE

STANDARD

ACCEPTA

BLE

QUALITY

LEVEL

(AQL)

SURVEILLANCE

METHOD/

MEASURES

CONTRACT

OR

INCENTIVE

DISINCENTIV

E/

DEDUCT

PERFORMAN

CE

OBJECTIVE 1

The contractor shall establish a technical approach and management plan for the placement of Physical Therapists into temporary assignments at

WWKMHCC,

providing coverage when requested.

Once a purchase order/request is received, the Contractor shall locate a physical therapist and complete all necessary paperwork within the established time frames.

Present the candidate within five

(5) days of the purchase order. If found unacceptable, locate a replacement within three (3) days.

Complete IHS credentialing packet and background investigation information and return to WWKMHCC within 7 days.

Placement of staff 100% of the time

The Physical Therapy Supervisor shall submit a monthly spreadsheet of placement dates to the COR to monitor the placement requirement for coverage requested.

Favorable contractor performance evaluation

Unfavorable contractor performance evaluation

PERFORMAN

CE

OBJECTIVE 2

Care provided is within clinical standards of care

100% Focused Provider Performance Evaluation

Favorable contractor performance

Unfavorable contractor performance

Performance Work Statement 11

All Contract Physical Therapist(s) shall perform in accordance with clinical standards.

(FPPE) and Ongoing Provider Performance Evaluation (OPPE) data will review the following elements:

- Patient care performance

- Medical/clinical knowledge

- Practiced-based learning and improvement

- Interpersonal and communication skills

- Professionalism

- System-based practice evaluation evaluation, removal from contract until such time the Contract Physical Therapist(s) meet qualification standards

PERFORMAN

CE

OBJECTIVE 3

Contract Physical Therapist(s) are capable and knowledgeabl e of effective communicatio n.

Contract Physical Therapists shall be respectful, courteous, and culturally sensitive to IHS patients and staff.

No more than two

(2) valid complaints per Contract

Therapist

The contractor shall respond to the COR in writing whenever they receive notice of more than two complaints against a Contract Physical Therapist, with an explanation of what was done to address the matter.

Favorable contractor performance evaluation

The invoice for the Contract Physical Therapist will be put on hold until the complaint is investigated and resolved within seven working days, and removal from contract until such time the Contract Physical Therapist(s) meets qualification standards.

PERFORMAN

CE

OBJECTIVE 4

Completes medical record documentation by

Document ation completed

The Physical Therapy Supervisor

Favorable contractor performance

The invoice for the Contract

Performance Work Statement 12

Completion of medical record documentation deadlines as required in the scope of work

Completes check-out with Health Information Department (HIM) on the last scheduled day to confirm completion of records.

Documentation is completed by the deadline at least 95% of the time.

by deadline at least 95% of the time reviews the weekly documentation report from HIM, and the contractor shall respond to the COR in writing whenever documentation does not meet the deadlines.

evaluation. Therapist in question will be put on hold until proper documentation of the chart(s) is completed

PERFORMAN

CE

OBJECTIVE 5

Contract Physical Therapist(s) shall complete all required trainings on time

All required training is completed on time

95% completion , no deviations

Periodic sampling Favorable contractor performance evaluation

Unfavorable contract performance evaluation, suspension or termination of all physical and/or electronic access privileges and removal from contract until training is completed

PERFORMAN

CE

OBJECTIVE 6

Contract Physical Therapist(s) are aware of all laws, regulations, and policies related to Privacy, All Contract Physical Therapist(s) comply with all laws, regulations, and policies relating to Privacy, Confidentiality, and

HIPAA

100% complianc e, no deviation

Contract Physical Therapist shall provide copies of all required training to Physical Therapy Supervisor, HIM will report any violation to the Physical Therapy Supervisor for review

Favorable contractor performance evaluation

Immediate removal of Contract Physical Therapist(s) from the contract

Performance Work Statement 13

SECURITY

PHYSICAL ACCESS. The Contract Physical Therapist shall return identification badges to the Physical Therapy Supervisor upon completion/termination of the contract.

PHYSICAL SECURITY. The Contract Physical Therapist shall safeguard all government property, including controlled forms provided for contractor use. All PHI shall be secured at all times and not left unattended in unsecure areas. At the close of each work period, government equipment, facilities, and other valuable materials shall be secured, and all PHI shall be returned to the HIM department.

REPORTING REQUIREMENTS. Contract Physical Therapist shall report to an appropriate authority any information or circumstances of which they are aware that may pose a threat to the security of IHS personnel, contractor personnel, or patients.

WEAPONS, FIREARMS, AND AMMUNITION. Contract Physical Therapists are prohibited from possessing weapons, firearms, or ammunition on themselves or within their contractor-owned or privately owned vehicle while on the WWKMHCC grounds.

GOVERNMENT FURNISHED PROPERTY AND SERVICES

The WWKMHCC shall provide office space, including a desk, chair, computer, printer, and office supplies.

The Contract Physical Therapists will be authorized to use all areas of the medical treatment facility available to civil service and commissioned personnel in similar positions. The same restrictions on using these items for official Indian Health Service business apply.

The Contract Physical Therapist will be authorized to use all administrative and professional support available to IHS personnel. This will include, but not be limited to, copy machines, telefax machines, and telephone service. The same restrictions to use these items for official Indian Health Service business apply.

The WWKMHCC shall provide all medical and non-medical equipment and supplies used in the IHS facility for the care and management of patients.

CONTRACTOR FURNISHED ITEMS AND SERVICES

Except for those items or services specifically stated to be Government furnished, the Contractor shall provide everything required to perform this contract in accordance with all its terms. The WWKMHCC does not anticipate a need for contractor-furnished equipment.

Confidentiality, and HIPAA, and comply with all standards of privacy.

Performance Work Statement 14

HOUSING. The Contractor shall be responsible for all applicable Federal, State, and Local Taxes, Meals, Travel/Transportation, lodging, and per diem.

COMMUNICATION BETWEEN ALL PARTIES

POINT OF CONTACT. The Contractor shall provide a point of contact who shall be responsible for the performance of the work. The point of contact shall have full authority to act for the Contractor on all matters relating to the daily operation of this contract. The Contractor shall designate this individual, in writing, to the Contracting Officer before the contract start date. An alternate may be designated, but the Contractor shall identify those times when the alternate shall be the primary point of contact.

Any communication regarding the contract shall be communicated between the Contractor’s designated point of contact and the Contracting Officer’s Representative (COR) at WWKMHCC.

CONTRACTING OFFICER’S REPRSENTATIVE DESIGNATION

The Contracting Officer’s Representative (COR) representing the Government for the purpose of this contract shall be designated in writing by the Contracting Officer at the Great Plains Area Indian Health Service.

The COR is responsible for:

1. Monitoring the Contractor's technical progress, including surveillance, assessment, and performance, and recommending to the Contracting Officer changes in requirements,

2. Interpreting the Performance Work Statement,

3. Performing technical evaluation as required,

4. Performing technical inspection and acceptance required by this contract,

5. Assisting the Contractor in the resolution of technical problems encountered during performance, and

6. Serving as systems manager to ensure compliance with the Privacy Act.

The designated COR for this contract is:

Ella Mae Greybuffalo Admin Support FAC-COR III 100 Lake Traverse Drive Sisseton, SD 57262 Direct Phone: (605) 742-3862 ella.greybuffalo@ihs.gov

Issuance of changes which affect the articles, terms, or conditions of this contract will be accomplished through the Contracting Officer who is the only party authorized to bind the Government to the agreement.

PURCHASE ORDERS

PURCHASE ORDER AGREEMENTS. This contract type enables the service unit program offices to place orders with the Contractor on an as-needed basis. In accordance with the Federal Acquisition Regulation (FAR) 52.216-18, Ordering (OCT 1995), IHS will obligate the funding and order the services by issuing a mailto:ella.greybuffalo@ihs.gov

Performance Work Statement 15 purchase order through the Agency's automated procurement systems, iProcurement and PRISM.

The contract provisions authorize the program offices at WWKMHCC to issue purchase orders, within their procurement authority, for the commercial item contract to cover the services required during the contract term. Each purchase order will reference the contract number and contain a purchase order number assigned by the automated procurement systems.

PURCHASE ORDER PROCEDURES. The Contractor shall initiate work when directed by a purchase order issued by the Contracting Officer. No work under any purchase order shall be performed unless specifically authorized by the Contracting Officer. Approval of a purchase order shall not constitute approval to exceed any item listed in the contract or general provisions of the contract. The total dollar amount of all purchase orders shall not exceed the estimated total dollar agreed to for the said purchase orders. The contractor shall not exceed the estimated purchase order amount or change the purchase order without prior written approval by the Contracting Officer.

ISSUANCE OF PURCHASE ORDERS. Purchase orders shall be issued on a fixed price basis and shall describe the specific work to be performed and the total cost. Each purchase order shall make reference to the proper funding document (requisition).

The estimated hours for performing each task shall be specified in each purchase order. Each purchase order shall not exceed the specified hours, and the total amount obligated for that purchase order. The total amount of all purchase orders shall not exceed the maximum amount negotiated for the contract period.

The Contractor shall not proceed with performance under any purchase order until the Contracting Officer grants such time approval.

COMPLETION OF PURCHASE ORDERS. Upon completion of each purchase order, the contractor shall submit invoice as outlined in the payment process.

COMPENSATION

The Contractor shall be responsible for all inclusive costs, and there will be no differential pay for government holidays, overtime, compensatory time, or night differential. "All inclusive" is defined to include travel, lodging, per diem, fringe benefits, Federal/State/Local taxes, plus any other costs pertinent to the performance of this contract, including overtime and holiday pay.

PAYMENT PROCESS

The Contractor shall submit a weekly invoice of services rendered for each Contract Physical Therapist;

The Contractor shall submit a weekly invoice of services rendered for each Contract Provider in the IPP electronic invoicing system. Each invoice shall include the following:

1. Contractor/Vendor Name

2. Mailing Address

Performance Work Statement 16

3. Telephone Number

4. Tax Identification Number (TIN)

5. Invoice Date and Number

6. Purchase Order Number and Purchase order (in Block #3 of the OF-347 form)

7. UEI Number (Unique Entity Identification)

8. Description of services provided, quantity, unit of issue, unit price, and total amount due

PRIVACY ACT NOTIFICATION (APR 1984)

The Contractor will be required to design, develop, or operate a system of records on individuals, to accomplish an agency function subject to the Privacy Act of 1974, Public Law 93-579, December 31, 1974 (5 U.S.C. 552a) and applicable agency regulations. Violation of the Act may involve the imposition of criminal penalties.

PRIVACY ACT (APR 1984)

(a) The Contractor agrees to—

(1) Comply with the Privacy Act of 1974 (the Act) and the agency rules and regulations issued under the Act in the design, development, or operation of any system of records on individuals to accomplish an agency function when the contract specifically identifies—

(i) The systems of records; and

(ii) The design, development, or operation work that the contractor is to perform.

(2) Include the Privacy Act notification contained in this contract in every solicitation and resulting subcontract and in every subcontract awarded without a solicitation, when the work statement in the proposed subcontract requires the redesign, development, or operation of a system of records on individuals that is subject to the Act; and

(3) Include this clause, including this paragraph (3), in all subcontracts awarded under this contract that require the design, development, or operation of such a system of records.

(b) In the event of violations of the Act, a civil action may be brought against the agency involved when the violation concerns the design, development, or operation of a system of records on individuals to accomplish an agency function, and criminal penalties may be imposed upon the officers or employees of the agency when the violation concerns the operation of a system of records on individuals to accomplish an agency function. For purposes of the Act, when the contract is for the operation of a system of records on individuals to accomplish an agency function, the Contractor is considered to be an employee of the agency.

(c) (1) “Operation of a system of records,” as used in this clause, means performance of any of the activities associated with maintaining the system of records, including the collection, use, and dissemination of records.

(2) “Record,” as used in this clause, means any item, collection, or grouping of information about an individual that is maintained by an agency, including, but not limited to, education, financial transactions, medical history, and criminal or employment history and that contains the person’s name, or the identifying number, symbol, or other identifying particular assigned to the individual, http://uscode.house.gov/uscode-cgi/fastweb.exe?getdoc+uscview+t05t08+2+3++%285%29%20%20AND

Performance Work Statement 17 such as a fingerprint or voiceprint or a photograph.

(3) “System of records on individuals,” as used in this clause, means a group of any records under the control of any agency from which information is retrieved by the name of the individual or by some identifying number, symbol, or other identifying particular assigned to the individual.

Privacy or Security Safeguards (Aug 1996)

(a) The Contractor shall not publish or disclose in any manner, without the Contracting Officer’s written consent, the details of any safeguards either designed or developed by the Contractor under this contract or otherwise provided by the Government.

(b) To the extent required to carry out a program of inspection to safeguard against threats and hazards to the security, integrity, and confidentiality of Government data, the Contractor shall afford the Government access to the Contractor’s facilities, installations, technical capabilities, operations, documentation, records, and databases.

(c) If new or unanticipated threats or hazards are discovered by either the Government or the Contractor, or if existing safeguards have ceased to function, the discoverer shall immediately bring the situation to the attention of the other party.

Privacy Act (December 18, 2015)

This contract requires the Contractor to perform one or more of the following: (a) design; (b) develop; or (c) operate a Federal agency system of records to accomplish an agency function in accordance with the Privacy Act of 1974 (Act) (5 U.S.C. 552a(m)(1)) and applicable agency regulations.

The term system of records means a group of any records under the control of any agency from which information is retrieved by the name of the individual or by some identifying number, symbol, or other identifying particular assigned to the individual. Violations of the Act by the Contractor and/or its employees may result in the imposition of criminal penalties (5 U.S.C. 552a(i)).

The Contractor shall ensure that each of its employees knows the prescribed rules of conduct in 45 CFR part 5b and that each employee is aware that he/she is subject to criminal penalties for violation of the Act to the same extent as Department of Health and Human Services employees. These provisions also apply to all subcontracts the Contractor awards under this contract which require the design, development or operation of the designated system(s) of records (5 U.S.C. 552a(m)(1)). The contract work statement:

(a) Identifies the system(s) of records and the design, development, or operation work the Contractor is to perform; and

(b) Specifies the disposition to be made of such records upon completion of contract performance.

Indemnification, Liability, Statute of Limitations: Any provisions in the TOS related to indemnification and filing deadlines are hereby waived and shall not apply except to the extent expressly authorized by law.

Liability for any breach of the TOS as modified by this Amendment, or any claim arising from the TOS as modified by this Amendment, shall be determined under the Federal Tort Claims Act, or other governing federal authorities. Federal Statute of Limitations provisions apply to any breach or claim.

Governing law: Any arbitration, mediation, or similar dispute resolution provision in the TOS is hereby

Performance Work Statement 18 deleted. The TOS and this Amendment shall be governed by and interpreted and enforced in accordance with the laws of the United States of America without reference to conflict of laws. To the extent permitted by federal law, the laws of the State of [Company to insert name of state if one is mentioned in its TOS] (excluding [Company's state] choice of law rules) will apply in the absence of applicable federal law.

1 Authority

1.1 No person other than the Contracting Officer has authority to bind the Government with respect to this contract;

1.2 No action or omission of any government employee or representative other than the Contracting Officer shall increase or decrease the scope of this contract or shall otherwise modify the terms and conditions of this contract;

1.3 In no event shall any of the following be effective or binding on the Government or imputed to the Contracting Officer with respect to this contract;

1.3.1 An understanding or agreement between the Contractor and anyone other than the Contracting Officer;

1.3.2 A purported modification or change order issued by anyone other than the Contracting Officer;

1.3.3 A promise by anyone other than the Contracting Officer to provide additional funding or make payments or;

1.3.4 An order, direction, consent, or permission from anyone other than the Contracting Officer to;

1.3.4.1 Incur costs in excess of a specified estimated cost, allotment of funds, or other ceiling or;

1.3.4.2 Expend hours in excess of a specified level of effort.