A06 - PWS NCSU Locum Physicians Draft.docx

BAO PWS June 30, 2022

Billings Area Performance Work Statement (PWS) for Non-Personal Services

Medical Provider Services

Table of Contents

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Performance Work Statement (PWS) Non-Personal Services Medical Provider Services

1.0 General: This performance work statement (PWS) describes the requirements for non-personal service Medical Provider Services to support the mission of the Indian Health Service (IHS).

1.1 Background: IHS is an agency within the U.S. Department of Health and Human Services and is responsible for providing federal health services to American Indians and Alaska Natives. The provision of health services to members of federally recognized tribes grew out of the special government to government relationship between the federal government and Indian tribes. The IHS is the principal federal health care provider and health advocate for the Indian people. The goal is to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indians and Alaska Natives. The IHS currently provides health services to approximately 1.5 million American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 34 states.

1.2 Northern Cheyenne Service Unit (NCSU), Billings Area-Indian Health Service, Lame Deer, Montana provides support to the Northern Cheyenne Indian Reservation.

2.0 Scope: The Contractor shall provide medical provider services in accordance with Section 7.0, performance-based requirements.

2.1 Duties and responsibilities consist of providing Medical Provider services in an Outpatient (clinic), and Urgent Care settings to IHS patients. If determined necessary, the Contractor may accompany a patient on direct patient care related transports. NCSU is accredited as an Urgent Care facility however due to the rural nature of our clinic the Urgent Care department provides services to all patients that present for care 24/7 and 365 days per year. This can include Obstetrics, the chronically ill, multi-system traumas, and newborns to name a few. The intent is to stabilize and transfer patients when appropriate. Transport to a higher level of care could be delayed due to weather, limited number of ambulances, availability of paramedics and condition of patient. In these scenarios the NCSU Urgent Care will provide services to the patient.

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2.1.1. Place of Performance: Services shall be performed at the Northern Cheyenne Service Unit, Lame Deer, Montana.

2.1.2. Period of Performance: 12/01/2026 – 01/31/2027

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

3.1 The Joint Commission on Accreditation of Healthcare Organizations (The Joint Commission) http://www.jointcommission.org

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

3.3 Need for Background Checks: Section 231 of Public Law 101-647, The Crime Control Act of 1990. https://www.govinfo.gov/content/pkg/STATUTE-104/pdf/STATUTE-104-Pg4789.pdf

3.4 Need for supervision with Children: Section 4087 of Public Law 101-630, the Indian Child and Family Violence Act.

https://www.govinfo.gov/content/pkg/CFR-2002-title42-vol1/xml/CFR-2002-title42-vol1-part136-subpartK.xml

3.5 Section 231 of Public Law 101-647, the Crime Control Act of 1990. https://www.congress.gov/bill/101st-congress/senate-bill/3266

3.6 Section 4087 of Public Law 101-630, the Indian Child and Family Violence Act. http://www.nicwa.org/policy/law/protection/index.asp

3.7 Health Insurance Portability and Accountability Act (HIPAA) of 1996. http://www.cms.hhs.gov/hipaa

3.8 Privacy Act of 1974. http://www.usdoj.gov/oip/privstat.htm http://medi smart.com/practice.htm

3.9 IHS Service Unit and Health Center Policies, Procedures and Protocols. (See section 11.0 for a list of attachments and exhibits)

3.10 Federal Computer Security Act of 1987. https://www.congress.gov/100/statute/STATUTE-101/STATUTE-101-Pg1724.pdf

3.11 Information Systems Security Awareness (ISSA). https://www.ihs.gov/issa/

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

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

3.14 IHS Computer Security Directives. http://www.ihs.gov/adminmggresources

4.0 Definitions:

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4.1. 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.

4.2. 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.

4.3. Area: A defined geographical region for Indian Health Service administrative purposes. Each Area Office may administer several Service Units.

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

4.5. Contractor: The Company awarded a legal binding contract to provide supplies and/or services.

4.6. 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). The Service Unit Clinical Director (CD), designated Supervisory Medical Staff, or Technical Point of Contact (TPOC) providing assistance with management of facility Task Order(s), will be responsible for monitoring the technical progress including surveillance and assessment of performance for this order.

Technical Point of Contact: Torrey Darkenwald, Clinical Services Administrator (406)477-4429.

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

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

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

4.10. 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.

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

4.12. 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.

4.13. 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.

4.14. Health Insurance Portability and Accountability Act (HIPPA): a US law designated to provide privacy standards to protect patients’ medical records and other health information provided to health plans, doctors, hospitals and other health care providers.

4.15. Health Station: A facility physically separated from a hospital, with a wide 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.

4.16. Non-personal Services Contract: A contract under which the personnel rendering the services are not subject, either by the contract’s terms or by the manner of its administration, to the supervision and control usually prevailing in relationships between the Government and its employees, as defined in FAR 37.

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

4.18. 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.

4.19. Orientation: An activity designed to provide basic familiarization of the facility and transition the Contract Provider into the IHS Service Unit and/or Health Center and the department where the services will be provided.

4.20. 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.

4.21. Patient Outcome: End result of Medical Provider care.

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

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

4.24. Service Unit: The local administrative unit of IHS.

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

4.26. Task Order: An order issued in accordance with the terms of the contract that details an ordering activity’s specific requirements. An ordering activity’s 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 activity’s task order number.

4.27. Tour of Duty: The time of day the provider is scheduled to perform medical service duties; to include thirty minutes to one hour lunch as scheduled.

4.28. Urgent Care: Department within the NCSU facility that provides 24/7 access to care for patients. Status as an Urgent Care is established through the accreditation agency. Due to the rural nature of our clinic the Urgent Care department provides services to all patients that prevent for care 24/7 and 365 days per year. This can include Obstetrics, the chronically ill, multi-system traumas, and newborns to name a few. The intent is to stabilize and transfer patients when appropriate. Transport to a higher level of care could be delayed due to weather, limited number of ambulances, availability of paramedics and condition of patient. In these scenarios the NCSU Urgent Care will provide services to the patient.

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

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

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5.0 Government Furnished Information, Property and Services:

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5.1. 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.

5.2. Joint Use by the Government and the Contractor: Except for the property and services listed in 5.3 and 6.0, 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.

5.3. Contractor Exclusive Use:

5.3.1. 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.

5.3.2. The Government will provide facility specific contractor identification badges for each contractor if appropriate ID badge from agency is not provided. A minimum fee of $10.00 will be charged for lost or destroyed badges.

5.4. 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 medical provider services or includes mandates made by the IHS Service Units/Health Centers while the candidates are working under this contract. Training will not be provided for the purpose of continuing education, career development or individual development.

6.0 Contractor Furnished Property:

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6.1. 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:

6.1.1. Uniforms and Lab Coats: Uniforms and Lab Coats shall conform to the requirements of the Indian Health Service Manual, Part 3 Chapter 4 and meet the approval of the Clinical Director at the IHS facility.

6.1.2. Other personal medical instruments: “Other personal medical instruments” are defined as Contractor owned items and may include but is 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, Clinical Director or TPOC prior to use by the Contractor. The Government reserves the right to prohibit the use of any materials, supplies, or equipment.

7.0 Performance-Based Requirements: The Contractor shall provide professional medical providers for the delivery of patient care through performance of provider duties and management of patient’s needs as described in the PWS and as identified by the Service Unit to the Billings Area Indian Health Service hospitals, clinics and health stations. Contractor Candidates shall comply with IHS facility policies, procedures, protocols and Standards of Care.

7.1. The contractor shall provide Medical Provider services in direct patient care setting.

7.2. The Contractor shall ensure 100% of all 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.

7.3. The Contractor Candidate shall perform in accordance with the competency standards listed in Section 24, Exhibits. Specific tasks include the following. The Contractor Candidate shall:

7.3.1. Provide full range of emergency care to patients of all age ranges.

7.3.2. Exercise Knowledge of the medical provider procedures and its application to clinical practices in order to provide individualized, goal oriented medical provider care to the pediatric and adult patient.

7.3.3. Exercise knowledge of scientific and psychosocial medical provider theory, principles, practices, and techniques in order to plan and provide quality medical care which meets the physical, spiritual, and social-cultural needs of the Native American/Alaskan Native patient.

7.3.4. Exercise knowledge of biological aspects of disease processes and illness in order to recognize complications and implement appropriate therapeutic intervention required.

7.3.5. Exercise knowledge of the medications and dosages in order to recognize their desired effects, side effects, and complications of their use.

7.3.6. Exercise knowledge of childhood immunizations, vaccines and up to date patient education resources and information.

7.3.7. Analyze the results of various medical procedures and translate them into appropriate medical interventions.

7.3.8. Work effectively and harmoniously within the health care teams and with Native American/Alaskan Native patients and their families.

7.3.9. Provide Inter-Facility transports when needed and supported by schedule requirements.

7.3.10. Follow facility policies and procedures, Joint Commission, OSHA, IHS and other federal licensing, accreditations, and regulating body standards.

7.3.11. Coordinate care teams, offer guidance, and support to team members.

7.3.12. Teach and offer appropriate health education to staff, patients, and customer owners.

7.3.13. Perform clinical procedures, intravenous access, and phlebotomy, point of care laboratory testing, IVIG infusions, EKG, SVN Respiratory treatments and response to emergency codes.

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7.3. The Contract Provider shall be subject to peer review per Joint Commission standards.

7.4. The Contract Provider shall meet the Safety management reporting requirements in accordance with the Service Unit Safety Measure Policy.

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

8.1. The Government reserves the right to remove from the facility any Contract employee failing to abide with the Federal Code of Conduct.

8.2. A Contract Provider demonstrating impaired judgment will not be allowed to continue working on the contract. The Government reserves the right to remove from the facility any Contract Provider whom in the judgment of a licensed healthcare practitioner is impaired.

9.0 Work Schedule: The Medical Staff Program Assistant, or designee, at the IHS facility will determine specific tour of duty for each Contract Provider within the scope of the task order. Contract Provider shall work in accordance with the tour of duty as scheduled to meet the patient care needs of the Service Unit. The Contract Provider will be scheduled for lunch breaks of thirty minutes to one hour as assigned and/or rotated, based upon department scheduling. The contractor will not be permitted to work more than 24 consecutive work hours unless emergency staffing is declared.

9.1. Overtime, Holiday, Call-Back and On-Call hours shall be performed as agreed upon by the facility and Contract Provider and within the limits of the task order. Overtime hours will be scheduled where there are departmental coverage gaps, to ensure adequate staffing for patient care.

9.2. The Contract Provider shall provide notice of unavailability to their employer (The Contractor) and the Medical Staff Program Assistant or designee prior to any absence from work. The Contract Provider shall provide notification at least fifteen (15) days in advance of a desired absence if the length of the absence exceeds eight (8) work hours. Verifiable emergencies are the only exception to the advanced notification requirements.

9.3. The Contractor shall provide a qualified replacement Provider for any absence of more than 8 work hours.

9.4. All Contract Providers shall complete the credentialing and clearance requirements at the appropriate level before reporting for work.

10.0 Deliverables

10.1. Monthly Data Report: The contractor shall provide a monthly data report that identifies the task order, Contract Line Item Number (CLIN), Contract Provider name, dates of service, quantity of hours worked, and hourly rate. The Contractor shall provide a summary of task order hours authorized, hours worked, balance of hours remaining, estimated monthly invoice amount, and estimated balance of funds remaining.

10.2. The Contractor shall notify the Contracting Officer and the COR via email when 75% of the authorized hours or 75% of the obligated funding has been expended.

11.0 Contract Provider Qualification Requirements:

11.1. Experience. The Contract Provider shall have a minimum of twelve months (12) in the department (Urgent Care or Outpatient) required by the contract, unless otherwise approved by the Contracting Officer and facility Clinical Director or their designee.

11.2. Experience shall equip the Contract Provider with the particular knowledge, skills, and abilities to perform successfully the duties of the position, and that is typically in or related to the work of the provider services category to be filled.

11.3. License/Registration. The Contract Provider shall possess a current, valid, unrestricted medical provider license in a state, the District of Columbia, the Commonwealth of Puerto Rico, or a Territory of the United States, throughout the term of this contract.

11.4. Motor Vehicle Operator’s License. The Contract provider shall possess a valid state driver’s license throughout the term of this contract unless otherwise approved by the Contracting Officer and facility Clinical Director or their designee.

11.5. Certifications. For Outpatient Clinic the Contract Provider shall possess current Basic Life Support (BLS), Advanced Cardiovascular Life Support (ACLS) and Pediatric Advanced Life Support (PALS). For Urgent Care Contract Providers BLS, ACLS, Advanced Trauma Life Support (ATLS) are required. It is also recommended that Contract Providers working in the Urgent Care have Neonatal Resuscitation Program (NRP) and Advanced Life Support in Obstetrics (ALSO) certifications.

11.6. Degree or Diploma. The Contract Provider shall possess a degree or diploma from a professional medical program approved by the legally designated state accrediting agency at the time of the program was completed by the applicant unless otherwise approved by the Contracting Officer and facility Clinical Director or their designee.

11.7. Review of Qualifying Factors. The Clinical Director at the onboarding IHS facility, or their designee, will review all required documentation, conduct candidate interview, and reference checks for each Contract Provider, to ensure verification and compliance prior to proceeding with background check/clearance process.

12.0 Background Checks / Clearance: As directed by the Contracting Officer, the Contract Provider shall provide all requested information necessary to perform background checks. The Contract Provider shall comply with the requirement to obtain security investigations. The Contract Provider shall work with the IHS to ensure that the pre-employment screening process includes the appropriate investigation questionnaires and forms to be completed. All completed forms will be reviewed by the Contract Provider and forwarded to the Government personnel. IHS will immediately remove a Contractor from the position if at any time the investigation receives unfavorable adjudication, or, if other unfavorable information that would affect the investigation becomes known.

13.0 Health Requirements/Conditions of Employment:

13.1. Medical Evaluation: The Contract Provider shall provide a fitness for duty certificate issued by a licensed provider to perform the proposed job without significant risk to personal health or the health and safety of others.

13.2. Immunization: The Contract Provider shall provide the documentation of the following:

1. Hepatitis A – 2 dose series at 0 and 6 months.

1. Hepatitis B – 3 dose series at 0, 1, and 6 months or documented immunity. A signed declination of Hepatitis B vaccination series will be accepted.

1. Measles, Mumps, Rubella (MMR) – 2 doses or titer documentation.

1. Varicella (chickenpox) – 2 doses, titer documentation or history of varicella/shingles.

1. Tetanus, diphtheria, pertussis (Tdap/Td) – 1 dose of Tdap, then tetanus (Td) booster every 10 years thereafter.

1. Meningococcal – Two vaccines (MenACWY and MenB) recommended for microbiologists routinely exposed to N. meningitides.

1. Documentation of annual TB test – may include Mantoux TB skin test (PPD). Acceptable lab testing: Quantiferon Gold or T-Spot test. For positive TB test results, please submit a copy of recent chest x-ray results.

1. Influenza – MANDATORY annual vaccination.

1. Highly encourage COVID vaccination.

14.0 Transportation and Lodging: The Contractor shall be responsible for all applicable Federal, State, and Local Taxes, Meals, Travel/Transportation. Lodging may be available but must be paid for by the Contractor or Contract Provider. 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. Government quarters available to contractors are private bedroom with shared living space.

15.0 Performance Evaluation:

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15.1. The Contractor’s performance will be evaluated in accordance with the standards set forth in the contract and Performance-based Matrix of section 24.0.

15.2. 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.

16.0 Identification of Contractor: The Contract Provider shall wear a government issued contractor identification badge during performance of duty or a company ID badge that meets facility requirements.

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

17.1. The Contract Provider shall ensure adherence to Department of Health and Human Services (DHHS) IT system security policies and procedures. The IT policies and procedures will be made available to the Contract Provider upon request.

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

18.0 IHS Information Technology Systems: The Contract Provider shall possess basic knowledge, skills, and abilities to use a computer.

18.1. The Contract Provider shall adapt to and successfully utilize IHS information technology systems that are deemed by the facility as necessary for acceptable contractor performance.

18.2. The Contract Provider 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.

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19.0 Orientation: The Contract Provider providing service under this contract shall attend mandatory orientations and training specified by the IHS, the Service Unit or the Clinical Director.

20.0 Language Requirements and Cultural Awareness: The Contract Provider 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.

21.0 Challenges to Conflicts: The Contract Provider shall maintain an appropriate professional demeanor in the presence of patients and staff. Harmony and good communication between the staff is necessary to maintain the best patient care environment and all staff members are expected to contribute to a positive milieu. Violent language, profanity, and any threatening behaviors are specifically prohibited.

22.0 Technical Point of Contact: Torrey Darkenwald, Clinical Services Administrator (406) 477-4429

PWS No.: 08-01 April 2015

23.0 Performance – Based Matrix

This Standard describes “What Success Looks Like.”

Contractor shall provide Medical Provider services in the delivery of patient care to the Northern Cheyenne Service Unit, Billings Area Indian Health Service.

Competency

Compliance

Quality

Patient Outcomes

Professionalism

Documentation

Maintain 100% of the required competencies (refer to Section 25.0)

100% compliance with IHS Service Units and/or Health Centers published Policies; Procedures; Standards of Care; and facility Protocols.

Perform 100% of the required tasks (refer to Section 7.0) during scheduled tour of duty (refer to Section 9.0)

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 at 100% adherence to the Code of Ethics and Federal Code of Conduct.

100% of all documentation meets established IHS Medical Facility, Joint Commission, and Centers for Medicare and Medicaid Services (CMS) standards to include, but are not limited to, timeliness, legibility, accuracy, content, date, time, signature and designated profession.

See QASP. Surveillance systems will include direct observation, periodic inspections, validated customer complaints, random sampling, and verification of documentation provided by the contractor.

Payment of contract price for satisfactory service.

Contractor performance will be evaluated using the Contractors Performance Assessment Report (CPAR). The evaluation will be considered when future IHS contract selections are made.

24.0 List of Exhibits and Attachments. To be provided by the Contracting Officer upon request.

24.1. Exhibits

A - Quality Assurance Surveillance Plan (QASP) B - Contract Data Requirements List (CDRL) DD Form 1423

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