Atch D - Performance Work Statement 5 pgs.pdf

STATEMENT OF WORK

NURSE ADVICE PHONE LINE SERVICES

WHITERIVER SERVICE UNIT (WRSU)

1. Introduction/Background:

The Mission of Whiteriver Service Unit (WRSU) is to promote physical, mental, social, and spiritual wellness for Native Americans and their communities. In order to achieve this mission, Indian Health Service (IHS) intends to contract for a Nurse Triage System-Nurse Telephone Advice Line for a period of one 12-month base period and four twelve-month option periods.

2. Scope and Requirements:

CONTRACTOR RESPONSIBILITIES:

The Contractor shall provide a toll-free telephone-based Nurse Triage System for eligible Native Americans and Alaskan Natives (beneficiaries), Monday through Sunday 24 hours per day, 7 days per week to include all federally recognized holidays.

Federally recognized holidays can be found online at http://www.opm.gov/fedhol/index.asp. The contractor shall be notified within a minimum of thirty (30) days by the IHS Point of contact of any planned health center closures during normal business hours.

All WRSU active user beneficiaries in the WRSU area will have access to the contractor’s service.

WRSU estimates approximately 100 calls per month.

1) Toll Free Access to a Nurse Triage System (NTS)- nurse advice telephone line:

This service provides telephone toll-free access to a registered nurse 24 hours per day, 7 days per week throughout the duration of the contract. The registered nurse will advise the caller as to the proper disposition for his/her stated medical concern or problem.

These dispositions will range from home care advice to recommended emergency care immediately.

2) Toll Free Access to a Health Information Library:

This service provides telephone toll-free access to a medical library containing common medical conditions and diseases. The caller speaks initially with a registered nurse that connects the caller with the appropriate medical topic. Caller is prompted to speak to the nurse to access additional topics.

The contractor shall provide personnel, labor, materials, equipment, facility and services for providing a Nurse Triage System (NTS)- nurse advice telephone line. The contractor shall provide a clinical assessment and disposition to an appropriate level of care for all patients who utilize the nurse triage system.

ACCOUNTABILITY:

The Contractor shall send using Secure File Transfer Protocol (SFTP), an encounter form within 24 hours, the caller name, date of birth, purpose of call and the advice given to the patient from the Nurse Triage System.

http://www.opm.gov/fedhol/index.asp

The Contractor shall hold all information provided by WRSU, and its members, as confidential, and any and all such information will not be distributed to any third party, especially medical information of the members. Contractor will take all reasonable steps necessary to safeguard the privacy of member information.

The Contractor is not responsible for Acts of God, acts or omissions of WRSU or other actions beyond the control of the Contractor while performing services under this agreement. The Contracting Officer in discussion with the Contracting Officer’s Representative and the Contractor will make this determination.

The Contractor’s Nurse Triage process shall utilize specialized Nurse Triage processes and shall utilize specialized Microsoft-based software and interactive voice response technology to support the Schmitt-Thompson protocols in use at the contractors call centers.

The Contractor shall utilize readily available, comprehensive guidelines that reflect an extensive, high-quality physician-written, reviewed, and updated medical knowledgebase. The guidelines shall provide consistent, accurate triage information, as well as home care and health education information, and they shall be updated continuously.

The Contractor shall:

(a) Provide technical, operational, administrative and management in support of this contract.

(b) Provide a toll free number for the Nurse Triage System (NTS).

(c) Perform triage caller interaction utilizing nationally recognized and physician approved clinical protocols and guidelines.

(d) Manage patient calls per protocols, maintain call summaries, provide feedback to practices/providers as requested, and provide feedback to program and medical management.

Answering Calls:

The contractor shall answer calls within an average of 30 seconds according to Utilization Review Accreditation Commission (URAC). The contractor will use protocols to determine the urgency of the call, transfer urgent calls directly to a registered nurse and respond to non –urgent calls by a registered nurse preferable within an average of 30 minutes.

Emergency Room/Urgent Care Referral Instructions:

If the patient meets URAC criteria for referral to emergency or urgent care, then the contractor shall direct the patient to go to the closest emergency room/urgent care facility. If information is available, the contractor shall document which facility the patient plans to select. The WRSU project officer shall provide the contractor with a list of local urgent care facilities and emergency rooms, their phone numbers and their hours of operation.

When patients in need of medical assistance call the designated Contractor’s Medical Call Center they will first hear a disclaimer stating that if they are experiencing an emergency, they should hang up and call 911 or their appropriate emergency number. Callers will then have the option of being connected to the audio health library, or speaking immediately with a Registered Nurse.

If a caller chooses to speak with a nurse, the nurse will document and discuss the patient’s symptoms and recommend an appropriate course of action. These courses of action (dispositions) range from “home care procedures” to “seek emergency care.” Depending on the beneficiaries’ disposition, the Contractor’s nurses will place follow-up phone calls to assure that the caller’s condition has improved. The Contractor shall ensure that Caller will never get a busy signal.

A 15-second pre-recorded message will advise callers of their privacy rights and include a disclaimer for IHS payment responsibility for all health care advice. The script will be provided by

WRSU.

The Contractor shall ask for personal details:

Personal details include: Name, Date of Birth, facility where they normally receive services (WRSU), chart number, primary care physician, insurance, and tribal enrollment information. If the patient is not a member of a federally recognized tribe, the contractor shall advise the patient that the service is only for enrolled beneficiaries.

Indemnity: The Contractor shall indemnify and hold WRSU harmless from any claim, demand, loss, lawsuit, settlement, judgement or other liability, and all related expenses which may arise from a negligent act or omission of the Contractor, its agent or employees. WRSU shall indemnify and hold the Contractor harmless for any claim, demand, loss, lawsuit, settlement, judgement or other liability, and all related expenses which may arise from or in connection with a claim of a third party arising from a negligent act or omission of Whiteriver Service Unit, its agent or employees. Indemnify shall include damages, reasonable costs, reasonable expenses, and reasonable attorney’s fees as incurred by the party indemnified. The forgoing indemnification provision shall survive the expiration or termination of this agreement.

3. Deliverables:

Call Statistics Reporting:

The contractor shall submit a monthly status report to the WRSU Project Officer no later than the 10th business day of each month. The monthly report shall include comprehensive analysis of triage activity to include, but not limited to, day of the week, call time, response time, triage nurse identification, chief complaint, disposition, and any unusual circumstance, in order to identify trends and for future planning purposes.

Quality Control:

The contractor shall provide a quality control program based on a combination of clinical and peer review to ensure appropriate triage protocols are used, patient calls are responded to in a timely manner, and that all customers are satisfied with the services received. An example of the policies and procedure will have the following components for a successful call:

(a) Satisfied caller

(b) Adherence to protocols

(c) Complete documentation of assessment and advice

(d) Appropriate medical disposition

(e) Documentation whether patient plans to comply with care advice given

Quality Control Plan:

The contractor shall implement a quality control program to ensure performance is in accordance with the contract requirements and URAC standards. The contractor shall make this plan available to the Project Officer within 30 days after the contract start date for review and approval.

New services shall not be introduced without prior recommendation to, and approval of, the Contracting Officer.

Complaints:

Any complaints shall be forwarded to the IHS Point of contact for action and/or rectification.

Contractor Point of Contact (POC):

The contractor shall provide a POC and an alternate. The contractor shall designate these individuals, in writing, to the Contracting Office 30 days prior to the contract start date. The contractor shall identify specific times when the alternate shall be the primary POC. The contractor’s POC shall be available via pager and/or telephone, 24-hours per day, 7 days a week.

CONTRACTOR QUALIFICATION REQUIREMENTS:

1) Minimum Education Requirements: Associates degree prepared registered nurse.

2) Contractor shall be licensed in accordance with regulations in the State of principal practice, no disruption of services. Copy of credentials shall be on file prior to work performance.

3) The Contractor shall utilize U.S. State Licensed Registered Nurses during the performance of this contract.

4) License/Registration: Registered Nurse (RN) licensed in the state in which the nurse triage service is physically located.

5) Experience: Personnel must have a minimum of three (3) years of experience in nurse triage.

6) The contractor shall maintain URAC accreditation by the American Accreditation Healthcare Commission during the duration of this contract.

7) Cultural Sensitivity: The contractor shall provide cultural sensitivity training specific to the American Indian/Alaska Native people as provided by the Project Officer.

The Contractor shall gather information from the nurse triage service calls. The information shall be entered into a database or spreadsheet application. The information shall consist of: personal data, assessments, documented resolution, and/or further action needed from a Primary Care Provider. The Contractor shall provide call summaries daily and shall be sent using SFTP to the WRSU Project Officer by the next business day.

PERFORMANCE CONDITIONS:

(a) This contract shall be a non-personal services contract, as defined in FAR 37.101, under which the contractor is an independent contractor;

(b) The Contractor shall perform the required services described independently of Government Supervision except as stated therein.

(c) No employer-employee relationship exists. Direct supervision aspects of the relationship can be minimized to where they are incidental to the services required and are for administrative guidance only.

(d) The Government may evaluate the quality of services provided, but retains no control over the services rendered.

(e) None of the services furnished under the Performance Work Statement shall be subcontracted or transferred to another Contractor or organization without the specific prior written approval of the Contracting Officer.

All documented patient encounters are to conform to appropriate records management requirements in accordance with HHS/OCIO’s policy on records management. Patient encounters are to be sent to Whiteriver Service Unit (WRSU) using Secure File Transfer Protocol.

4. Medical Risk In case of a medical emergency, the contractor will stay on the line with the caller until they are relieved by EMS or a responsible individual assumes responsibility for the caller, or Contractor can get pertinent information form the caller and notify EMS if the caller wishes them to do so.

5. Period of Performance The contract period of performance shall be for one 12 month period, with four 12-month option periods.