A1 - PWS Telebehavioral and ER Health Services.pdf

PERFORMANCE WORK STATEMENT

Performance Work Statement: Tele-Emergency and Tele-Behavior Health Section 1 General Information

1.1 Background

1.1.1 Organization Overview. The Billings Area Office (BAO) of the Indian Health Service (IHS) is charged with providing healthcare services to the eligible Native American population within Montana and Wyoming. In order to achieve IHS' commitment for improving BAO health care system to allow better access and efficient spending to patients, the IHS intends to continue the utilization of health care services provided through telehealth specialty services.

1.1.2 BAO Network.

The BAO IHS Facilities include: Blackfeet Service Unit-Blackfeet Community Hospital with ER, Browning, Montana and Heart Butte Health Station, Heart Butte, Montana; Crow Service Unit-Crow/Northern Cheyenne Hospital with ER, Crow Agency, Montana, Lodge Grass Health Clinic, Lodge Grass, Montana and Pryor Health Station, Pryor, Montana; Fort Belknap Service Unit-Fort Belknap Hospital with ER, Harlem, Montana and Eagle Child Health Station, Hays, Montana; Fort Peck Service Unit-Verne E. Gibbs Clinic, Poplar, Montana and Chief Redstone Clinic, Wolf Point, Montana; Northern Cheyenne Service Unit-Northern Cheyenne Health Center with ER, Lame Deer, Montana.

1.2 Scope of Work

BAO needs the Contractor to be responsible for the planning, coordination, development, implementation, delivery, management of program and quality assurance of telehealth solutions that will allow IHS patient's access to Telehealth 24 hours/seven days per week Emergency Room and Behavior Health services for defined clinical domains and Scope of Service within the specific Service Unit, significantly improving access to care by reducing the delay and costs involving patient travel.

The Government shall neither supervise contractor employees nor control the method by which the contractor performs the required tasks. Under no circumstances shall the Government assign tasks to, or prepare work schedules for, individual contractor employees. It shall be the responsibility of the contractor to manage its employees and to guard against any actions that are of the nature of personal services, or give the perception of personal services. If the contractor believes that any actions constitute, or are perceived to constitute personal services, it shall be the contractor's responsibility to notify the Contracting Officer (CO) immediately.

Emergency Services and Behavior Health are 24 hours/seven days per week. All employees and required services are expected to be available during 24 hours/seven days per week. All travel requirements (including plans, agenda, itinerary, or dates) shall be pre-approved by the government (subject to IHS and local policy procedures), and is on a strictly cost reimbursable basis. Costs for travel shall be billed in accordance with the regulatory implementation of Public Law 99-234 and FAR 31.205-46 Travel Costs (subject to IHS and local policy & procedures; may reference FAR). The Contractor will be responsible for coordinating the logistics of all training to include travel, per diem, lodging of non-federal subject matter expert instructors. Travel for training participants will not be covered under this contract.

Contractor will provide 24 hours/seven days per week on-call Behavioral Health Services to include outside of business hours for each facility. On-call services will be required to call back within 15 minutes of initiated request for behavioral health services.

The Contractor shall provide real-time tele-Emergency room and Behavior Health support services to the IHS BAO Emergency Departments. Distant site Tele-ED providers will evaluate, treat, and follow-up originating site IHS patients facilitated by an originating site Presenter, or will provide consultation services to an originating site IHS provider. Originating site Presenter services will be provided to initiate and conclude each encounter.

1.3 Contractor Personnel

1.3.1 Project Manager. The contractor must provide a project manager who is responsible for the performance of the work. The name of this person, and an alternate(s) who must act for the contractor when the manager is absent, must be designated in writing to the contracting officer.

1.3.1.1 The project manager or alternate must have full authority to act for the contractor on all contract matters relating to the daily operation of this contract.

1.3.1.2 The project manager or alternate must be available during normal business hours within 30 minutes to meet with government personnel (designated by the contracting officer) to discuss problem areas. After normal business hours, the manager or alternate must be available within four hours.

1.3.1.3 The project manager and alternate(s) must be able to read, write, speak, and understand English.

1.3.2 Contractor Employees.

1.3.2.1 BAO needs the contractor to accomplish the assigned work by employing and utilizing qualified personnel with appropriate combinations of education, training, licensure/certification and experience.

1.3.2.2 The contractor will maintain accreditation for Telehealth 24 hours/seven days per week Emergency room and Behavior Health by a nationally recognized accreditation organization. The contractor shall ensure the labor categories and labor rates utilized for the performance under the awarded contract will be maintained throughout the performance period.

1.3.2.3 The Contractor shall be responsible for establishing, implementing, and maintaining a Tele-Emergency room and Behavior Health program to be deployed across the IHS Emergency Departments within the BAO, including options for provider-to-provider consultations.

1.3.2.4 The contractor shall use the IHS EHR system to maintain accurate and up-to-date information on clinical care provided to patients.

1.3.2.5 The Tele-ED service is to be provided via the agency's existing video and network infrastructure.

1.3.2.6 The contractor shall ensure an adequate level of staffing is organized to meet the requirements and all contractor staffs credentials (e.g., security clearance, computer security training, and degrees and/or certifications, etc.) are current. Including Clinical Contractor Staff meet requirements for being "Credentialed and Privileged" in accordance with the Commissioned Corps of the Public Health Service, the Office of Personnel Management, HHS Regulation and IHS policy. Existing regulations require that these individuals be graduates of approved recognized programs in their fields and legally qualified to practice in a federal facility. Providers working with contractor and must be approved by the Governing Body by being privileged prior to performing any services within BAO Indian Health Service.

1.3.2.7 Ensure all contractor staff are culturally sensitive and appropriate. The Contractor shall provide adequate level of training to the IHS staff to support the Tele-ED services at the originating site, shall support and maintain Tele-ED systems and provide helpdesk support for Tele-Ed equipment, associated software, and other system issues for IHS in The BAO.

1.3.3 Security Requirements.

1.3.3.1 Contractor staff will be required to follow the procedures for obtaining a full Federal background investigation and preliminary clearance. No 3rd party investigation is allowed.

In order to obtain a Personal Identity Verification (PIV) card, contractor staff shall complete and pass a Federal background investigation conducted by the Office of Personnel Management.

IHS will process the investigations through the Office of Personnel Management on all contractor staff. Processing of PIV cards shall be completed by the BAO HSPD-12/Suitability Office in conjunction with the physical locations throughout IHS and HHS that have PIV card stations. The contractors will be required to be physically present at one of the HSDP- 12 enrollment and issuance workstations to obtain a PIV card. Biometric identification is required.

1.3.3.2 Each contractor shall complete each of the requirements below and receive pre-employment clearance from IHS prior to performing services under this contract:

1) Fingerprints must be captured electronically at a HHS enrollment workstation or via hard-copy card then sent to the BAO for digital processing;

2) The OF-306, Declaration for Federal Employment, shall be completed;

3) The Addendum to the OF-306, shall be completed;

4) eQIP Information request must be turned into the HSPD-12/Suitability Office;

5) The eQIP questionnaire must be fully and accurately submitted; and

6) The contractor must be enrolled for a PIV card at a HHS HSPD-12 enrollment workstation. Upon receipt of the card, the contractor must activate it at a HHS HSPD- 12 card issuance workstation.

1.3.3.3 The Contractor shall ensure that the employees it proposes for work under this contract have a reasonable chance for approval. If at any point during the investigation process a contractor staff is deemed ineligible or found to have other than favorable suitability, the individual must be removed from providing services under this contract.

The Government may investigate personnel at no cost to the Contractor. However, multiple investigations for the same position due to contractor personnel’s employment change, termination or consequent re-investigations within one (1) year period, will lead to the reduction in the contract price of no more than the cost of the additional investigation.

1.3.4 Employee Training. The contractor is responsible for providing personnel of an adequate skill and educational level. Personnel must maintain their skill and education levels throughout the life of the contract.

Personnel selected by the contractor must already have the necessary education, training and/or certifications to perform the requirements of this contract prior to reporting to work under this contract.

1.4 Quality Control

a. BAO needs the contractor to successfully integrate and coordinate all activities needed to execute the Telehealth 24 hours/seven days per week Emergency room and Behavior Health requirement. Requirement to provide quality assurance services and effective management of subcontractors, and seek to ensure customer satisfaction and professional and ethical behavior of all contractor personnel.

b. Quarterly quality checks include the number of provider contacts and orders processed and verified.

The contractor must ensure that services are performed in accordance with the PWS.

1.4.1 Quality Control Plan. The contractor must provide a quality control plan to the contracting officer for acceptance not later than the pre-performance conference. The contracting officer will notify the contractor of acceptance or required modifications to the plan before the contract start date. The contractor must make appropriate modifications and obtain acceptance of the plan by the contracting officer before the contract start date.

The plan must include:

1.4.1.1 A description of the methods to be used for identifying and preventing defects in the quality of service performed.

1.4.1.2 A description of the records to be kept to document inspections and corrective or preventive actions taken.

1.4.2 Records. The records of inspections must be kept and made available to the contracting officer, when requested, throughout the contract performance period and for the period after contract completion until final settlement of any claims under this contract.

1.5 Quality Assurance

According to the Inspection of Services clause located in the contract additional terms and conditions addendum, the government will evaluate the contractor’s performance under this contract. For those tasks listed on the PRS (Technical Exhibit 1), the contracting off icer’s representative (COR) will follow the methods of surveillance specified in Quality Assurance Surveillance Plan (QASP). Government personnel will record all surveillance observations. When an observation indicates defective performance, the COR will require the project manager or representative at the site to initial the observation. The initialing of the observation does not necessarily constitute concurrence with the observation, only acknowledgment that he or she has been made aware of the defective performance. Government surveillance of tasks not listed in the PRS or by methods other than those listed in the PRS (such as provided for by the Inspection of Services clause) may occur during the performance period of this contract. Such surveillance will be done according to standard inspection procedures or other contract provisions. Any action taken by the contracting officer as a result of surveillance will be in accordance with the terms of this contract.

1.5.1 Contract Performance Working Group (CPWG) Meetings. The contractor and government will convene quarterly CPWS meetings to review contract performance. The members of the CPWG will include, as a minimum, the contractor project manager, the government contracting officer, the COR, and additional members as determined by the CPWG. The CPWG will discuss such issues as the contractor’s performance against the PRS standards and whether they are meeting or exceeding acceptable quality levels, whether performance standards are measuring and incentivizing the right performance outcomes, any changes that need to be made to performance standards or acceptable quality levels, any problems affecting contract/mission performance and steps that can be taken to mitigate risk, other topics as determined by CPWG members. Written minutes of each CPWG meeting must be recorded and signed by the project manager and the contracting officer or contract administrator. If the contractor does not concur with any portion of the minutes, such nonoccurrence must be provided in writing to the contracting officer within five calendar days following receipt of the minutes.

1.6 Physical Security

The contractor must be responsible for safeguarding all government property provided for contractor use. At the end of each work period, all government property, equipment and materials must be secured.

1.7 Hours of Operation

1.7.1 Normal Hours of Operation. The contractor must perform the services required under this contract provide 24 hours/seven days per week on-call. The contractor must provide services regardless of inclement weather or office closings and early dismissals, unless otherwise approved by the CO.

1.7.2 Federal Holidays. Contractor services will required on federal holidays: New Year’s Day, Martin Luther King’s Birthday, President’s Day, Memorial Day, Juneteenth Day, Independence Day, Labor Day, Columbus Day, Veterans’ Day, Thanksgiving, and Christmas Day.

1.8 Records

The contractor must be responsible for creating, maintaining, and disposing of only those government required records that are specifically cited in this PWS or required by the provisions of a mandatory directive listed in section 6, Applicable Publications and Forms. If requested by the government, the contractor must provide the original record or a reproducible copy of any such record within five working days of receipt of the request.

1.9 Travel / Temporary Duty (TDY)

All travel requirements (including plans, agenda, itinerary, or dates) shall be pre-approved by the government (subject to IHS and local policy procedures), and is on a strictly cost reimbursable basis. Costs for travel shall be billed in accordance with the regulatory implementation of Public Law 99-234 and FAR 31.205-46 Travel Costs (subject to IHS and local policy & procedures; may reference FAR).

The Contractor will be responsible for coordinating the logistics of all training to include travel, per diem, lodging of non-federal subject matter expert instructors. Travel for training participants will not be covered under this contract.

Section 2 Definitions and Acronyms

2.1 Definitions

2.1.1 Contractor. A supplier or vendor having a contract to provide specific supplies or service to the government.

2.1.2 Contracting Officer. A person with authority to enter into, administer, and/or terminate contracts, and make related determinations and findings on behalf of the government. The only individual who can legally bind the government.

2.1.3 Contracting Officer's Technical Representative. An employee of the U.S. Government appointed by the contracting officer to administer the contract. Such an appointment must be in writing and must state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have the authority to change the terms and conditions of the contract.

2.1.4 Credentialing: Is the process of verifying information about providers/physicians to ensure legitimacy and experience from the time they receive their degree until they apply at your facility. Credentialing is an activity that may be broken into three distinct phases:

Data gathering, verification, storage, dissemination and recommendation to the CMO Analysis of collected information and development of a recommendation (CMO to the Medical Staff) Decision-making based upon recommendations (governing body)

2.1.5 Defective Performance. A service output that does not meet the standard of performance associated with the Performance Work Statement.

2.1.6 Deliverable. Anything that can be physically delivered but may include non-physical things such as meeting minutes.

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

2.1.8 HL7 format: Health Level Seven is one of several American National Standards Institute. “Level Seven” refers to the highest level of the International Standards Organization’s (ISO) communications model for Open Systems Interconnection (OSI) – the application level. The application level addresses definition of the data to be exchanged, the timing of the interchange, and the communication of certain errors to the application. The seventh level supports such functions as security checks, participant identification, availability checks, exchange mechanism negotiations and, most importantly, data exchange structuring.

2.1.9 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 aspect 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.

2.1.10 Physical Security. Actions that prevent the loss or damage of Government property.

2.1.11 Quality Assurance. The government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

2.1.12 Quality Assurance Surveillance Plan. An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

2.1.12 Quality Control. All necessary measures taken by the Contractor to assure that the quality of an end product or service must meet contract requirements.

2.1.13 Written: defined as either electronic or telefax or transcribed transmission.

2.2 Acronyms

AQL Acceptable Quality Level BAO Billings Area Office BBIA Bureau of Banking Inspection and Audit BD Business Days COR Contracting Officer’s Representative CO Contracting Officer IAVA Information Assurance Venerability Assessment IAVB Information Assurance Vulnerability Bullet IT Information Technology IHS Indian Health Service NAS Network-Attached Storage OSHA Occupational Safety and Health Act PC Personal Computer PRS Performance Requirements Summary PWS Performance Work Statement QASP Quality Assurance Surveillance Plan

Section 3 Specific Requirements/performance Requirements

3.1 Tele-Emergency

3.1.1 Emergency Consultation: Services may include assessment of patients upon admission to the ED, interpretation of patient symptoms and clinical tests or data, consultation and supervision of on-site staff administering treatments or pharmaceuticals, assistance in documentation during “code blue” and other emergencies, and/or coordination of patient transfer from the local ED.

3.1.2 Emergency Sexual Assault Nurse Examiner (SANE): The contractor will provide an option to have telehealth services that provides sexual assault medical forensic evidentiary examination support from a certified Sexual Assault Nurse Examiner (SANE). Consultative assistance to Service Unit’s emergency department staff for documentation and collection of evidence via audio and video equipment in accordance with the National Protocol for Sexual Medical Forensic Examinations for Adults/Adolescents and National Protocol for Sexual Abuse Medical Forensic Examination Pediatric and Service Unit’s policies, protocols, and procedures. Contractor is expected to use evidence-based diagnostic and treatments protocols and decision-making algorithms that assist in the delivery of best possible patient care. All patients shall be assured of their privacy and personal dignity. The Contractor shall ensure that contract staff maintain open and professional communication with IHS staff. The Contractor will promote culturally appropriate advocacy for individuals consulted upon.

3.1.3 Timely: Contractor distant site clinical staff will respond within 2 minutes of being summoned by the originating site. Operating 24/hours/day, 365 days/year.

3.2 Tele-Behavior Health

3.2.1 The Contractor provides screening, psychiatric assessment, planning, problem resolution, resource management, mental health services, counseling and crisis management as they relate to the crisis emergency health care and discharge planning needs of the patient/family.

The Contractor will be responsible for collaborating with the IHS Emergency Department, inpatient wards, outpatient clinics and working with other community resources in meeting/achieving client service needs.

3.2.2 The work is performed in the following settings: virtual mental health services are in the Billings Area Emergency Departments, inpatient wards, outpatient clinics with the provider accessing services at the ER, outpatient clinics or in the patient's home.

3.2.3 The work involves contact with patients and families who are demanding, controlling or belligerent. The work involves contact with patients who are mentally impaired, intoxicated, and under duress. Patients can be an imminent risk to self and others. It may require assistance from other medical staff where the patient is currently presenting.

3.2.4 The contractor will work in an environment with ever changing variables. These variables include working with a wide range of patients who are suicidal or in crises in a virtual health environment.

3.2.5 The contractor must perform the essential duties and responsibilities with or without reasonable accommodation efficiently and accurately without causing a significant safety threat to self or others. The above statements is intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and/or skills required of all personnel classified in this position.

3.2.6 Performs other duties that may be necessary in the best interest of the Billings Area Billings Area IHS system.

3.3 Treatment Planning

3.3.1 Completes an Emergency or psychiatric assessment, documents findings in the government EHR system.

3.3.2 Contractor must be licensed at the independent level in order to provide services.

3.3.3 Completes case management assessment and aftercare services on all clients entering caseload.

3.3.4 The contractor utilizes evidenced based practices, and culturally sensitive models to develop care plans.

3.4 Assessment and Case Management

3.4.1 Screens patients using high-risk indicators, including, but not limited to: suicidal, frequent hospitalization support systems, homelessness, abuse, neglect, exploitation, and domestic violence. Assesses for immediate suicidal needs; develops and coordinates a discharge plan as determined by the patient's medical condition, level of independence, functional capacity, family/social support systems, and financial resources. Assesses for emergent patient care needs by identifying probable changes in level of suicidality in collaboration with the interdisciplinary care team. The assessments will consider the impacts of the social, psychological, and physical/ spiritual conditions. Assessments will also include homelessness, isolation, insufficient family support, domestic violence, neglect, and abuse.

3.4.2 Advocates for patients in a manner supported by treatment plan. Gathers and reviews client information at each client encounter. Coordinates and documents in-patient referral process and assists clients to complete admission requirements. Monitors progress in treatment and documents in the EHR system tagging the ER doc, local BHS Director and other mental health providers involved in their follow up care to facilitate a smooth hand-off.

3.4.3 Contractor will track adult and adolescent in-patient psychiatric referrals and assessment.

3.4.4 Must maintain current knowledge of in-patient treatment facilities admission requirements.

3.4.5 Assists with identification and coordination of transportation and utilizes knowledge of locally available public transportation resources.

3.4.6 Effectively communicates to patient progress in their treatment program.

3.4.7 Assists patient with completion intake/discharge documentation as needed.

3.4.8 Assist with maintaining patient files, monitoring for attendance and closing files in the EHR system.

3.5 Discharge Planning

3.5.1 Manages and collaborates in discharge planning for patients with all needs and coordinates with agencies providing post hospital care.

3.5.2 Provides information and education on community resources to empower patient/family decision making once patient is stabilized.

3.5.3 Communicates the discharge plan to patient/family and the interdisciplinary care team by timely documentation in the electronic health care medical record, tagging the ER Doctor and local BHS OP facility for discharge planning or coordination to a higher level of care.

3.5.4 Documents assessment and overall discharge plan in EHR reflecting critical thinking regarding patient needs, suicidal ideation, concrete plan in an effort to facilitate a safe discharge plan.

3.5.5 Assures key regulatory requirements are met and are defined by the Center for Medicare and Medicaid, Joint Commission, CARF and AAACH.

3.5.6 Develops appropriate and medical necessary care plan dispositions for patients based on clinical assessment and judgment; providing feedback to Emergency Department physicians and attending physicians via phone and documentation in the EHR system.

3.5.7 Coordinates admissions to Inpatient and Outpatient Programs, other hospitals, and community providers, communicating with clinical staff, physicians, referral sources, and insurers/managed care companies.

3.6 Continuity in Care

3.6.1 The incumbent provides continuity in care based by assessing the appropriate level of patient care. Care settings may include: follow-up with outpatient clinic, outpatient mental health care, hospitalization, transitional living, residential treatment facilities, group homes, nursing homes, substance use rehabilitation facilities, and in-home care. The incumbent includes patients and families in this decision making process when appropriate.

3.6.2 The incumbent will provide continuity of care by collaborating with the whole health care team. These may include: behavioral health services, primary care providers, Public Health Nurses, and school counselors when appropriate releases are obtained.

3.6.3 The incumbent will provide on-going supportive aftercare and case management functions in accordance with the problem, needs, and strategies identified within the service plan in order to help the clients to achieve the goals and objectives of the psychiatric treatment plan.

3.7 Documentation

3.7.1 The incumbent utilizes established standards in assessment, safety planning, and treatment, and follow up. Documentation will follow the required standards of the health profession, accreditation entities such as CMS, The Joint Commission, CARF and

AAACH.

3.7.2 Documents all service contacts in a timely manner including virtual interviews, collateral and networking contacts, and correspondence.

3.7.3 Appropriate documentation will be made available to the care team, including initial assessment, safety plans, and care plan updates.

3.7.3.1 The contractor will be required to utilize the facility Electronic Health Record (EHR) for all patient encounter documentation. The contractor shall complete all documentation required by the Health Information management department (HIM). This includes completing all coding and purpose of visit diagnoses. All medical records must meet acceptable standards as determined by the hospital’s Performance Improvement (PI) department and the Health Information Management (HIM) Department. All Contract staff are expected to complete all EHR patient encounter notes, Purposes of Visits and medical levels on every patient and within 24hours of visit, during normal BD of the organization. Medical record deficiencies can seriously impact the ability of the hospital to bill alternate resources.

Therefore, any significant medical deficiencies may prevent processing of final purchase orders. If this situation occurs the Area Office contracting office and contracting company shall be promptly notified in order to quickly rectify.

3.7.4 Contractor will tag all medical care team members in the EHR/RPMS system and use the government approved WebEx system for all virtual services.

3.7.5 Contractor utilizes Electronic Health Record to document all encounters, collateral contacts, referrals, and telephone calls regarding care.

3.7.6 Incumbent appropriately and timely notifies medical staff of contact via tasking or other mode of communication to ensure delivery of appropriate message and documented completion of follow-through.

3.7.7 Contractor maintains an organized and appropriate record keeping system with regard to referral and coordination of services for “common” encounters and activities.

4. Qualifications:

4.1 General

Current BLS and ACLS certifications are required of all contractors. NRP, PALS, and ATLS certifications preferred but not required of all contractors.

Licensed independent practitioners must fulfill all the requirements for appointment to the IHS Medical Staff and for the granting of privileges in emergency medicine, in accordance with IHS policies and with the Medical Staff Bylaws of the facility, including absence of exclusions or sanctions from the Medicare/Medicaid programs.

4.2 Physicians

Must be Board-Eligible or Board-Certified in Emergency Medicine and have at least 24 months of direct patient care experience in a Level 1 or 2 Trauma Center within the last 48 months.

4.3 Nurses

A graduate or higher level degree, bachelor’s degree, associate degree, or diploma from an accredited professional nursing educational program is required. This education must have been accredited by the Commission on Collegiate Nursing Education, or an accrediting body recognized by the U.S. Department of Education (external link) at the time the degree was obtained.

Advanced Practice Nurse Positions: For Advanced Practice Nurse (APN) positions, applicants must possess a graduate or higher level degree in nursing from an accredited educational program in the area of expertise or specialty indicated by the position.

Must have passed the National Council Licensure Examination. In addition, must possess a current, active, full, and unrestricted license or registration as a professional nurse from a State, the District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States.

At least 24 months of direct patient care experience as an emergency department nurse at a Level 1 or 2 Trauma Center within the last 48 months years.

Sexual Assault Nurse Examiner Registered Nurse with training and certification as a Sexual Assault Nurse Examiner.

Section 5 The Contractor shall implement telehealth systems for health care facilities in the BAO. This will include Tele-ED deployments, including options for provider-to-provider consultations

5.1 The Contractor shall determine and provide necessary equipment and software to enable telehealth solutions (not inclusive of the IHS network). This includes, but is not limited all telehealth acquisition modalities and supporting Health Information

Technology (HIT) as required by the scope of the Tele-ED Performance Standards and Acceptable Quality Level (AQL)

1) Timely

a. AQL: Deployment shall occur in accordance with the deliverables schedule in accordance with subsection– Deliverables Schedule.

2) Services

a. AQL: All required specialty referrals services shall be provided by the contractor.

3) Space

a. AQL: Contractor shall design and execute the tele-health system implementation based on availability of space at the originating site.

4) Complexity

a. AQL: Telehealth equipment must be easily used by a wide range of staff with minimal training.

b. AQL: At minimum, Tele-ED support equipment shall be composed of remote control enabled monitor, camera, and microphone.

c. AQL: All medical devices or medical components of devices shall be FDA approved for their intended use.

d. AQL: All video/audio conferencing equipment shall be Cisco/Polycom compatible.

Deliverables A001 Telehealth Equipment Deployment Schedule If needed A002 Catalog of Available Equipment A003 Site Service Needs Report A004 Training Agenda

5.2. The contractor shall use the IHS Electronic Health Record (EHR) system to maintain accurate and up-to-date information on clinical care provided to patients.

EHR systems are located at each IHS facility and remote access to each EHR system will be enabled through the IHS VPN system. Cloud services are not to be utilized for this contract.

Performance Standards and AQL

1) Timely

a. AQL: Tele-health solution shall integrate with IHS system environment in accordance with the PWS

2) Security

a. AQL: Telehealth equipment shall encrypt Personally Identifiable Information (PII) for storage and transmission.

3) Connectivity

a. AQL: Prior to deployment, contractor shall assess network and system connectivity at each originating site for a proper guide service.

Deliverables B001 Telehealth Deployment Schedule B002 Security Compliance Report B003 Site Connectivity Report

5.3 Upon contract award, the contractor shall ensure an adequate level of staffing is organized to meet the requirements and all contractor staff’s credentials (e.g., security clearance, computer security training, and degrees and/or certifications, etc.)

are current.

Performance Standards and AQL

1) Timely

a. AQL: Site and/or Area Credentialing and Privileging Report shall be provided in accordance with the deliverables schedule in accordance with subsection 4.1 – Deliverables Schedule.

2) Security Standard

a. AQL: All contractor staff shall meet the required minimum standards under Title 42 CFR Part 136 Subpart K. and Title 5 CFR 731.

Deliverables C001 Site and/or Area Credentialing and Privileging Report C002 Fingerprints, eQIP questionnaire and all required accompanying documents

5.4 Upon contract award, the contractor shall ensure all clinical contractor staff meet requirements for being Credentialed and Privileged in accordance with HHS Regulation and IHS policy. Credentialing and Privileging shall include, but is not limited to: verification of U.S. licensure, board-certification, periodic quality assurance review, and provider database queries, including the National Practitioner Data Bank.

Performance Standards and AQL

1) Credentialing and Privileging

a. AQL: Clinical staff shall be fully credentialed and privileged at each site they practice in.

2) Quality Assurance Reviews

a. AQL: No delinquent Quality Assurance Reviews

3) Credential Standard

a. AQL: All credentials shall be issued by accredited institutions in the United States and subject to Prime Source Verification. The contractor will make available their credentialing policy and procedures for review by IHS after which time IHS may decide to offer or decline privileging by proxy.

Deliverables D001 Site and/or Area Credentialing and Privileging Report D002 Provider Quality Assurance Reviews

5.5 The Contractor shall provide adequate level of training to the IHS staff to successfully support the telehealth services at the originating site.

Performance Standards and AQL

1) Timely

a. AQL: Contractor will schedule regular, ongoing training regarding the use and support of the telehealth equipment.

2) Materials

a. AQL: Contractor will develop and/or provide enduring training materials in the form of recorded video or online learning modules in appropriate formats consistent with current technology and accessibility standards.

b. AQL: Contractor will guide and assist with the development of IHS-approved standardized protocols for initiation of Tele-ED services, to include indications and method(s) for initiation.

3) Evaluation

a. AQL: Training plans and materials will be provided at the request of IHS and are subject to review and approval by IHS no less than annually.

Deliverables E001 Training Agenda & Schedule E002 Training Materials

5.6 The Contractor shall support and maintain telehealth systems for IHS (not inclusive of the IHS network) in BAO.

Performance Standards and AQL

1) Documentation

a. AQL: Contracted staff will document all patient encounters in the IHS EHR.

b. AQL: Accurate Common Procedural Terminology (CPT) coding shall be documented for all patient encounters.

2) Timely

a. AQL: Contracted staff will provide telehealth clinics at the appointed time agreed upon by the site, during regular business hours, and meeting access to care standards for the visit type.

b. Documentation will be completed within 24 hours BD of patient contact.

3) Communication

a. AQL: As evidenced by no more than two substantiated complaints from the originating site in any three month period.

4) Best-Practice care

a. AQL: No practice below the level of Best-Practice shall be provided, as determined by chart and/or quality assurance review.

b. AQL: If Specialty Consultant employs mid-level providers, the Specialty Consultant must be directly involved in every medical encounter.

Deliverables F001 Published Schedule and Contact Information F002 Quarterly CPT Coding Audit Report F003 Monthly and Annual Report of Complaints F004 Chart or Quality Assurance Review Reports

5.7 The Contractor shall provide real-time tele-emergency support services to the IHS Emergency Departments upon request.

Performance Standards and AQL

1) Meets Schedules

a. AQL: Services shall be available 24 hours a day, seven days a week, every day of the year.

2) Timely

a. AQL: Contractor distant site clinical staff will respond within 2 minutes of being summoned by the originating site.

3) Communication

a. AQL: As evidenced by no more than two substantiated complaints for the originating site in any three month period.

4) Best-Practice consultations/recommendations

a. AQL: No consultations/recommendations below the level of Best-Practice shall be provided, as determined by chart and/or quality review.

5) EHR Utilization for Tele-emergency care

a. AQL: All documentation of care shall be completed in the IHS EHR within 24 hours.

Care orders will be documented and signed timely during the episode of care and completed/finalized prior to patient disposition. Documentation for patient transfers will be completed in accordance with CMS and/or JCAHO regulations/policies/requirements.

6) Qualification

a. AQL: Physicians shall be board certified, or eligible, by the American Board of Emergency Medicine, Family Practice, Internal Medicine (with competencies in pediatric emergencies), Pediatrics (with competencies in adult emergencies) or other recognized board.

Deliverables G001 Published Schedule and Contact Information G002 Monthly and Annual Report of Complaints G003 Chart or Quality Assurance Review Reports

5.8 The Contractor shall ensure an adequate level of staffing to meet the requirements and that all contractor staff’s credentials (e.g., security clearance, computer security training, and degrees and/or certifications, etc.) are current and approved within either IHS or nationally recognized accreditation standards Performance Standards and AQL

1) Credential continuity maintenance

a. AQL: Contractor staff shall meet all federal, HHS and IHS rules, regulations, and policies regarding security, protected information, etc.

b. AQL: There shall be no lapse involving contract staff security credentials or training.

2) Service availability

a. AQL: Services shall be adequately staffed with required security clearance status at all time.

b. AQL: Immediate action shall be taken to remove unsuitable/ineligible staff from services and replacement of the staff shall be made within 24 hours with appropriately cleared staff.

3) New Credentials

a. AQL: All required documentation required for security clearance process shall be submitted at least 30 days prior to the subject staff’s performance start date.

Deliverables H001 Report on contractor staff’s security and training status H002 Reports of service lapses.

5.8 The Contractor shall ensure all clinical contractor staff are eligible for

Credentialing and Privileging at each site. Credentialing and Privileging may include, but is not limited to: U.S. licensure, board-certification, peer review, and provider database queries.

Performance Standards and AQL

1) Credentialing and Privileging

a. AQL: Clinical staff that are fully credentialed and privileged for each site they practice in.

2) Quality Assurance Reviews

a. AQL: No delinquent Quality Assurance Reviews.

Deliverables I001 Site and/or Area Credentialing and Privileging Report I002 Provider Peer Reviews

5.8 The Contractor shall ensure all contractor staff communicate and coordinate effectively and efficiently with the originating site staff.

Performance Standards and AQL

1) Communication

a. AQL: No more than two substantiated complaints related to communication within a year.

2) Adverse Events

a. AQL: No more than one substantiated adverse patient event within a year due to communication errors.

Deliverables J001 Annual Report of Staff Complaints J002 Site-Specific Reports of Adverse Events

5.9 The Contractor shall ensure all contractor staff are culturally sensitive and appropriate.

Performance Standards and AQL

1) Training Provides evidence of training in cultural sensitivity/competence

a. AQL: All contractor staff shall take one hour of CME/CE training on cultural sensitivity/competence each year.

2) Customer Service

a. AQL: No more than two substantiated complaints from patient or staff related to culture sensitivity/competence within a year Deliverables K001 Annual Training Report K002 Annual Report of Patient & Staff Complaints

6. Special Requirements This section describes the special requirements for this effort. The following sub-sections provide details of various considerations on this effort.

6.1 Reporting The contractor shall follow the reporting plan submitted as part of the proposal and keep the Government fully informed of status throughout the contract period. Throughout the contract periods, it is essential that attention be given to minimize interruptions or delays to work in progress that would impact the mission. All reports generated under the scope of the contract shall be Section 508 compliant.

6.2 The Contractor shall provide bi-annual status reports to the COR to include:

Tele-ED:

• Number of consultations by site

• Date and Time of consultations

• Level of involvement (second opinion/consultation, providing direction, issuing orders, overseeing/assisting with procedure(s), total management in the presence of another provider (non-ED trained physician, physician assistant, nurse practitioner)

• Acuity of all patients seen

• Dispositions of all patients

• Compliance with EMTALA regulations

• Types of Contractor providers involved in care

• Any official complaints

• Any adverse outcomes

6.3 Annual Performance Report

The Contractor shall provide to the COR, annual performance reports that include but are not limited to project plan status and accomplishments, fiscal accountability, evaluation data, sub-Contractor performance reports (if applicable) and a Contractor self-evaluation report. The Contractor shall provide a written outline of the annual report to the COR for approval according to the deliverable schedule. The annual reports shall be delivered by e-mail and postal service according to the deliverable schedule before the end of the contract period. The annual report shall be discussed at the kick-off meeting.

Deliverables L001 Bi-Annual Status Report L002 Annual Performance Report

6.4 Storage and Disposition of Materials

Disposition of any national training and marketing materials will be determined in the kickoff meeting. Storage should be available as soon as national materials are generated. A disposition schedule will be discussed with the COR during the kick-off meeting.

6.5 Correspondence and Conference Calls

The Contractor shall provide weekly updates and correspondence as determined necessary by the COR. The weekly conference call schedule may be adjusted as determined by the COR.