Atch D - Statement of Work - Diabetes Ed.REV.pdf

STATEMENT OF WORK

DIABETES EDUCATOR MEDICAL PROVIDER

09 03 2024

It is the intent of the Elko Service Unit (ESU) to acquire non-personal professional Diabetes

Educator Services for the Southern Bands Health Center located in, Elko, NV.

Contractor is requested to provide non-personal professional Diabetes Education Services for a 12-month base period and four (4) one (1) year option periods. The intent of this contract is to establish a method whereby ESU can maintain clinical services. These service shall be for an “on needed basis” requiring (16) hours to full-time (40 hours) per week. Contractor services will provide consistent coverage in a changing healthcare landscape.

The contractor shall provide the necessary education, training, licensing, previous work experience and competence in being able to provide the services within the department. Work performance shall be performed according to the requirements and conditions contained in this

Statement of Work.

All responses to this solicitation and for candidate submission shall contain a complete profile and current work history of the candidate(s) presented, including licensure, certifications and education.

Selected candidate shall undergo the Indian Health Service mandated security clearance requirement prior to commencement of services at the ESU. The security pre-clearance requirement must be adhered to; the process includes a fingerprint check and a screen check of candidates through the office of the inspector general's exclusion list at http://exclusions.oig.hhs.gov/.

SCHEDULES/LOCATIONS/SHIFTS/QUALIFICATIONS/CERTIFICATIONS:

SCHEDULE: Shift times and schedules are subject to change based on the medical needs of the patient populace and clinic operations. The contracted services will augment the current full-time staff.

Diabetes Education: Working hours is to be decided between Chief Nursing Officer (CNO) and Contractor, ranging from 16 hours to 40 hours per week, on an as needed basis.

Day Shift: 8:00 A.M. – 5:00 P.M. (0800 - 1700), Monday through Friday

LOCATION: All services shall be performed at the following location;

Southern Bands Health Center 515 Shoshone Circle

Elko, NV 89801

WORK WEEK: Work week is defined as Monday through Friday.

SHIFTS: Contractors will be expected to abide by the facility’s Uniform Code and shift hour assigned, modalities of charting and care delivery and other rules and regulations of the facility.

http://exclusions.oig.hhs.gov/.%20D

Work within a designated schedule prepared by the Service Unit’s CNO or his/her designee. Any period of absence or changes in the schedule will be communicated with the CNO staff or his/her designee 14 days prior, except for emergency situations.

Total shifts worked shall be in accordance to the total number of work hours allocated for the year by the Service Unit. The Service Unit shall make every effort to submit a schedule two (2) weeks in advance. Shifts may be canceled or shortened without time restriction or monetary penalty before the physician arrives for duty. A 30 minute lunch break is permitted, but the Government does not pay for time taken for lunch.

It is estimated the Service Unit will require services a minimum of 16 hours per week. A minimum of 64 hours per month is required to provide services.

NOTE: The duration of each shift may vary due to patient load, clinical complexity, weather and other circumstances. An estimated patient volume of 6-16 patients in one 8-hour period.

Contractors shall attend assigned meetings, participate fully as staff members, and actively participate in ongoing quality management activities and any other Service Unit or Indian Health

Services initiatives deemed applicable to the specialist’s work.

QUALIFICATIONS/CERTIFICATIONS:

Education and Training:

Experience:

Licensure:

Certification:

Insurance:

Diabetes Educator shall be a 1) Registered Dietitian (RD) preferred or 2)

Registered Nurse (RN) with a Certified Diabetes Care and Education

Specialist (CDCES) designation or 3) an approved plan for achieving the designation for either (1) or (2) above within a specified time not to exceed

(2) years.

The Diabetes Educator should have at least (2) years of diabetes-related experience in an out-patient setting.

Diabetes Educator and or the Registered Nurse must have an active and unrestricted license to practice in the State of Nevada.

Basic Life Support (BLS) is required.

Medical malpractice liability coverage.

1. PRICING SCHEDULE:

The unit price paid to the Contractor shall be considered as payment in full for services provided under this award. In no way, unless directed by the IHS, shall any provider attempt to bill or collect from any IHS patient, or from any alternate resource for which the patient may be eligible, any monies for services provided under this award.

Hourly fixed rate shall be inclusive of all other fees (holiday, overtime, nights, weekend or call services, etc), including travel expenses, per diem, lodging, all city, state, federal and local taxes, and all miscellaneous costs associated with the provision of services. The government will pay one flat rate.

Contractor shall be paid only for actual time services are performed under the terms of the contract at the hourly fixed rate (one flat rate). There is no provision for holiday, overtime, nights, weekend or on-call services etc. *The government does not pay for time taken for lunch.

2. STATEMENT OF WORK RESPONSIBILITIES:

The contractor shall be expected to assist and provide services and duties as may be requested for the normal operational requirements for the department and personnel. The contractor shall provide work that is consistent with the guidelines and procedures of the IHS. Failure of the contractor to meet these standards can result in cancellation of this contract. The contractor’s performance and abilities shall be evaluated based upon performance standards that are contained in this statement of work.

The contractor should be proficient in writing, typing and have a basic working knowledge and understanding of computer hardware and software applications. The contractor shall have sufficient knowledge, competence and experience in providing these services on a regular schedule to the Southern Bands Health Center. The contractor shall possess sufficient initiative, interpersonal relationship skills, social sensitivity and appropriate professional behavior such that the contractor can relate constructively to IHS employees, contractors, vendors and individuals from the Native American community. The contractor shall not have any work or health restrictions, which could directly or indirectly interfere with the performance of providing services. The contractor shall maintain acceptable standards of personal hygiene, grooming and professional attire such that their image as a Federal contract employee is compatible with the expectations of the IHS staff.

The Contractor’s employee(s) shall be sensitive to the unique culture factors of the people they treat, which may include use of an interpreter as necessary in communication of services being rendered.

Unique cultural factors that may contribute to the patient’s treatment include: use of their language communications; village and tribal customs; use of traditional healers; isolation; housing conditions and lack of resources.

3. CONDITIONS FOR REMOVAL/REPLACEMENT OF MEDICAL PERSONNEL:

As mutually agreed between the Contracting Officer and the Contractor there may be grounds for removal and/or replacement of a Contractor employee. The Contractor’s employee shall be removed from an IHS facility if services are not performed in accordance with terms and conditions of this contract.

The Contractor shall request government pre-approval to substitute or replace any of the Contractor’s employee of which it has provided qualifications and resumes under this

Contract. All Contractor-requested substitutes or replacements’ qualifications, experience and professional certifications must be at least equal to or greater than the original Contractor’s employee provided by the Contractor under this contract.

4. CONTRACTOR REQUIREMENTS:

For Medical & Professional Contractors, the contractor shall comply with all IHS facility infection control and safety procedures, and standards. During the performance of this contract, the Contractor shall provide for the consistent performance of patient care process according to the standards of

AAAHC and/or Centers for Medicare Services (CMS) who supplies accreditation to ESU.

For Medical & Professional Contractors, the contractor shall complete in a timely fashion, the medical and other required records for patients he/she admits or in any way provides treatment. Chart notes are to be completed on the day services are rendered. The contractor shall abide by the Service Unit

Medical By-laws and rules and regulations and meet all credentialing requirements in accordance with the Service Unit Medical Staff By-laws. If required by the Service Unit, the IHS will provide training for the Contractor’s employee on Electronic Health Records (EHR). Failure to abide by this requirement is basis for cancellation of this contract. Medical Records will be the property of the U.S.

Government and will be placed in each patient’s chart at the health center. The Medical Records shall not leave the premises.

Medical records used for patients treated by the Contractor’s employee shall conform to the Privacy Act and Standards for Patient Confidentiality. An unauthorized disclosure from a person’s record, protected by the Privacy Act, may be subject to a penalty of up to $5,000 per incident.

The Contractor shall be responsible for notifying the Service Unit staff in case of an emergency or inclement weather that would prevent him/her from providing his/her schedule/shift.

The Contractor shall contact ESU’s Chief Nursing Officer (CNO) and be responsible for all documentation required for eligibility and temporary staff privileges at ESU. The government will provide all space, equipment, supplies and forms to perform services.

The Contractor shall not be authorized to perform any services for the government until the IHS

Governing Body has granted the Contractor such privileges in writing. Federal contract employees do not accrue any form of retirement, social security, insurance or any other form of benefits.

The Contractor shall assist and provide services and duties as may be requested for normal operational requirements for the department and personnel. The Contractor shall provide work that is consistent with the guidelines and procedures of the IHS. Failure of the Contractor to meet these standards can result in the cancellation of the contract.

The Contractor shall inform the COR, Contracting Officer or Program Manager or their designated representative of any problems encountered or which may be encountered in connection with meeting the Contractor’s duties.

The Contractor shall not have any work or health restrictions, which could directly or indirectly interfere with the performance of providing services as there will be some moderate lifting with regard to boxes of office supplies, boxes of medication, and equipment.

The Contractor shall maintain acceptable standards of personal hygiene and grooming such that their image as a Federal contract employee is compatible with the expectations of the IHS staff.

The Contractor shall be required to provide regular report of hours worked to the Designated COR with an invoice. This report shall be verified by the Service Unit’s CNO, or, his/her designee, that can confirm the coverage.

The contractor(s) shall designate an individual who will be the “Project Manager” that will be available to discuss any problems or issues that arise with the COR.

The Contractor shall obtain and maintain, at his/her own expense, all state and/or medical licenses, registrations or certification required in the performance of the contract, and shall comply with all laws, regulations, (Federal, State, Tribal and respective healthcare) ordinances in the performance of this contract.

Pursuant to the Federal Information Security Management Act (FISMA) of 2002 the Contractor shall complete the Computer Security Awareness Training (CSAT) course before computer access is provided or within a few days after receiving their access and annually thereafter. Within the Health and Human Services (HHS), there is a requirement for this training to be completed annually by all employees and contractor candidates.

MAJOR DUTIES REQUIRED:

Specific work duties and services that the contractor shall provide under this contract shall include, but not be limited to the following:

A. Diabetes education for individuals and groups including diet therapy, exercise, self-monitoring of blood glucose, continuous glucose monitoring, and follow-up with patients to ensure optimal self-care. Education for patients with diabetes in pregnancy, pre and post.

B. Preventative lifestyle education for patients with pre-diabetes and/or other risk factors for diabetes.

C. Diet and nutrition education on therapeutic diets as prescribed by service unit physicians.

D. Group education programs on health related problem areas of the service population including hypertension or weight management.

E. In-service education and resources to service unit staff on health education related issues.

F. Development of service unit patient education policies and procedures.

G. Educator makes observations appropriate to the patient’s underlying disease and treatment plan, instructs and counsels patient and family as required.

H. Educator works closely with allied health professionals (e.g. Medical Providers, Nursing, Community Health Nurse, Social Workers, Behavioral Health Providers, Pharmacy, etc.) to utilize and coordinate the services of Health Care Professionals in the management of the patient’s medical, psychological, and social problems.

I. Educator will provide services in person.

J. Supervision: The contract educator shall perform his/her professional work independent of government supervision. However, matters of an administrative and non-technical nature will be referred to ESU’s CNO who is designated as “Supervisor”.

K. The contractor shall record time and attendance which shall be verified by the Supervisor and/or his/her designee.

5. CONTRACTOR MINIMUM REQUIREMENTS:

1. The Contractor shall meet the same credentialing/privileging requirements as permanent IHS employees before being allowed to provide services for the Service Unit. Physical and mental health status with sufficient adequacy to demonstrate to the medical staff and the Governing Body that any patient treated by him/her will receive care at the generally recognized professional level established by the Service Unit.

2. All contractors shall present an original current license when reporting to the Service Unit for duty or for orientation whichever comes first. A copy is required for the contract file. No reimbursement will be made for those individuals who report to work with an expired license or a license that is not in good standing.

3. Contractor is subject to a character investigation in the performance of the contract in accordance with

P.L. 101-630, Indian Child Protection and Family Violence Act of 1990.

4. All contractors must provide a copy of their resume for file. Contractor file will be kept by the

Service Unit for verification of license or certificate, also file will contain personal information such as home address, phone number, next of kin, person to notify in case of emergency, health requirements, mandatory in-service and continuing education, competency assessments, and awards or disciplinary action.

5. Contractor is responsible for maintaining satisfactory standard of competence, conduct, appearance and integrity. The quality of work performance of the contractor shall be subject to review.

6. Contractor shall abide by the Service Unit’s Standard of Conduct and policies and procedures.

Contractor shall adhere to the guidelines for his/her behavior and action as outlined in Service

Excellence Guidelines to enhance relations between employees, departments, patients, patient’s families and visitors. The contractor shall abide by the bylaws, rules and regulations, general conduct of care, and Policy & Procedures set forth at The Service Unit.

7. Contractor shall abide by the lawful ethical principles of his/her profession.

8. Contractor/Contractor Employees is responsible for notifying their immediate supervisor and Project

Officer if he/she will be late or will be unable to work due to illness or any other reason.

9. Contractor is compensated only for scheduled hours actually worked at the agreed rate. Contractors who become sick while on duty will seek medical care from their own private physician, unless contractor is eligible to receive health care from Indian Health Service.

10. Contractor/Contractor Employees is responsible for completing time sheets for actual hours worked which shall be verified by the Service Unit’s Chief Nursing Officer or his/her designee.

11. Contractor shall subject his/her performance to the clinic’s Quality Improvement Program, in accordance with the requirements of AAAHC, the IHS, the responsible peer review organization, and external regulatory agencies.

12. If the performance of a contractor employee is unacceptable, the Federal Government retains the right to restrict further employment.

13. Clinical privileges are documented in writing, signed and granted by the Chief Executive Officer and

Clinical Director, and formally approved by the Governing Body.

14. Contractor shall ensure that proposed providers cooperate with and assist the government in the conduction of any necessary background checks.

15. The contractor(s) shall attend a Service Unit orientation and all Contractors, Students, Volunteers and

Temporary Staff are required to provide immunization records as proof of immunity or disease for

MMR, Varicella, Hepatitis B or declination form, Hepatitis B titer for staff with potential for contact with blood or body fluids, seasonal influenza vaccine (October-March), Tdap, and TB skin tests as currently indicated. Persons with LTBI are required to complete the TB screening form and will be referred to the Employee Health Provider. Meningococcal is required for microbiology staff who are routinely exposed to isolates of Neisseria meningitides, boosters are needed every 5 years if the risk continues. Volunteers, contractors, students and temporary staff without proof of immunity or vaccination cannot report to duty, be scheduled into orientation, or be issued a badge until the immunization status has been confirmed. Employee health creates a file for all contractors, students, volunteers, and temporary staff. Contracting Coordinators/Supervisor are responsible to obtain complete immunization records for contractors and fax to the Employee Health Office for clearance.

16. Contractor’s employee is responsible for his/her own reliable transportation, travel, hotel, and per diem expenses in the performance of this contract.

6. CONTRACTOR CREDENTIALS:

Any candidates submitted for credentialing shall undergo Indian Health Service (IHS) mandated security clearance for work on-site at ESU. The security pre-clearance requirement must be adhered to; the process includes a fingerprint check and a screen check through the Office of the Inspector General's exclusion list at http://exclusions.oig.hhs.gov/ and www.sam.gov (best checked through www.verifycomply.com as this checks all exclusion lists). The clearance and credentialing process may take six (6) weeks or more.

• Current resume

• OF-306 – Declaration for Federal Employment (all questions must be answered and signature with date in 17a is required)

• OF-306 Addendum – Addendum to the OF-306 (Declaration for Federal Employment)

• IHS Provisional Access Memo

• Protecting Children from Sexual Abuse in Health Care Settings Certificate of Completion

• No FEAR Act Training Certificate of Completion

• OFI-86C form along with two fingerprint cards and applicable state forms

• HHS-745, Section A

• Two IDs (driver’s license and social security card – names must match and be unexpired)

• Educational (college & nursing) Certification/License http://exclusions.oig.hhs.gov/ http://www.sam.gov/ http://www.verifycomply.com/

NOTE: No photo submission of forms, please have the forms scanned. Wet signature and date is highly recommended. No PDF signatures will be accepted

SECURITY CLEARANCES:

The contractor shall ensure their employees have been properly screened prior to presenting to ESU for employment under this contract. The contractor shall inform their employees to obtain Fingerprint cards or electronically submit their fingerprints through the IHS Human Resources Department and complete the appropriate background investigation form which will be submitted for processing. No performance under this contract shall be allowed until the contractor’s employee is cleared through the IHS Human Resources Department and issued a badge.

7. CREDENTIALING AND PRIVILEGING:

The contractor will participate in the credentialing and privileging process in accordance with existing procedure. Contractor shall provide no services prior to obtaining approval by the

Government Medical Executive and Governing Board. The Contractor will be provided copies of current requirements and updates as they are published. Privileges will require renewal at least every one or two years in accordance with Government credentialing privileging policy and AAAHC requirements.

8. SUPERVISORY CONTROLS:

The supervisor of the respective department to which Contractor(s) is assigned to work or his/her designee, provide primarily administrative supervision. The Supervisor or designee:

1. Set overall health care objectives and specifies resources available.

2. Provides for clinical supervision during the tour of duty.

3. Assigns work.

4. Reviews work performance on a periodic basis in order to evaluate proficiency in providing health care, discuss deficiencies and problems encountered, outline and/or approve new or changed practice to be employed and provides consultation on specific cases and related problems.

Work which involves out-of-the-ordinary diagnostic decisions or treatment is discussed with Supervisor or designee who keeps aware of the conditions of such patients and all aspects of treatment regimen.

Work performance is reviewed for conformance to IHS policy, procedures and accepted professional practices.

Within established guidelines, contractor(s) may exercise latitude in planning and carrying out health care assignments and in undertaking new procedures, practices and approaches to extend both services provided and increase individual proficiency. Overall work performance is reviewed by the Supervisor for effectiveness in meeting requirements for healthcare services.

9. DELIVERABLES:

The Contractor is required to provide a copy of each Contractor profile to the Contracting Officer

Representative (or service unit representative(s)) prior to providing services at ESU.

Timesheet shall be submitted to the supervisor of the respective department to which the Contractor(s) is assigned to work or his/her designee. The timesheets shall be reviewed for accuracy and certified by signature as accurate and acceptable for payment, then forwarded to the receiving official for further processing of receipt of services through US Treasury utilizing IPP.

10. PERFORMANCE CONDITIONS:

The COR (or service unit representative(s) will submit schedules of required coverage a minimum of

(15) calendar days prior to the first day of coverage requested.

In the event the Contractor is unable to render service on a previously agreed schedule, the Contractor shall provide a minimum seventy-two (72) hour notification to the COR and service unit representative(s). The Contractor shall then make a full, good-faith effort to provide coverage with a replacement.

Both parties recognize that on occasion there shall be a need to fill coverage requests with less than a 15-day notice. In such an emergency scheduling situation, the Contractor shall make a full, good-faith effort to accommodate the emergency request. If the Contractor is unable to meet the emergency scheduling request, they shall immediately notify the COR and service unit representative(s).

11. PERFORMANCE BASED ASSESSMENT:

(a) Introduction – Performance Requirements:

(1) A Quality Assurance Surveillance Plan (QASP) has been developed for in-house operations or to implement a service contract. It is designed to aid the PO in providing effective and systematic surveillance of all aspects of professional nursing services. This plan provides for monitoring the contract requirements

(b) The objective of this surveillance plan is to evaluate how the Contractor is performing in key areas. The government is primarily interested in the final service being provided and not in the details of accomplishment.

(c) The principal method of surveillance will be daily in some cases or by use or periodic inspections. Appropriate indicators are provided for recording observations in this type of surveillance.

(d) How to Use the Performance Based Matrix

(i) Each defect observed will be recorded on the tally report. These documents will then become a formal record for later reference. The tally of defects at the end of each clinic or year (dependent on criteria) will be compared to the acceptable number of defects appearing in the surveillance plan. Errors detected by the PO in the course of surveillance will be transmitted to the Contractor or in-house personnel for correction. Notification of errors will take place within five (5) working days. Specifics concerning any errors should be recorded on the tally checklist. The Contractor or in-house personnel, as applicable, should be asked to initial this record.

(ii) Project Officer shall forward a copy of Contractor’s compliance with performance and non- performance compliance reports.

(e) Quality Assurance Surveillance Plan (QASP):

(i) The Government shall monitor the Contractors’ performance through a Quality Assurance Surveillance Plan (QASP). The QASP is for informational purposes only and not considered part of the contract.

(ii) Surveillance systems will include periodic inspection and acceptance of all deliverables as cited in the contract.

PERFORMANCE-BASED MATRIX

Outcome Required

Services

AQL

Standard Max

Allowable

Degree of Deviation from

Normal Method of

Surveillance

Incentives and Deduction from Contract Price

Non-Personal Minimum Contractor shall 100% Compliant Government Incentive: Government Services Qualification for submit review of approves documentation Contract Health Educator supporting contractors De-incentive: Government documentation documentation reject documentation no for approval for compliance award, Non-

Personal

Licensure for Health Educator

Contractor shall submit

100% Compliant Government review of Incentive: Government approves documentation Services supporting contractors De-incentive: Government

Contract documentation documentation rejects documentation, of Licensure; for compliance payment may be withheld licensure shall be in good standing and not under

Non- Background Contractor shall 100% Compliant Government Incentive: Government personal Investigation in submit review of approves documentation Services compliance with supporting contractors De-incentive: Government

Contract Indian Child documentation documentation reject documentation no Protection and of Background for compliance award.

Family Violence investigation

Prevention Act, results

Public Law 101-

Non- Immunization Contractor shall 100% Compliant Government Incentive: Government Personal Compliance submit review of approves documentation Services supporting contractors De-incentive: Government

Contract documentation documentation reject documentation no of for compliance award Immunization

Unacceptable In the event of Contractor shall 90% Compliant Government shall Incentive: No interruption of

Performance unacceptable replace personnel notify the performance and positive performance, lack within 5 days contractor in evaluation documented in of upon receipt of writing of non- governments’ database.

professionalism, written compliance De-incentive: Two (2) unacceptable notification occurrences of which the conduct, the contractor is unable to replace Contractor shall personnel within the time replace personnel allowance, a cure notice shall be issued and possible termination of contract. Evaluation documenting performance in the

Long-term Filled long-term Contractor shall 100% Government’s Incentive: No disruption of shifts fulfilled (Thirteen (13) week travelers) work shifts as scheduled by the

ESU. Long Term shifts contractor personnel shall provide at least a 4 week notice so that ensure full shift coverage for long term nursing needs at

ESU

review & written documentation/ notification to

Contractor of non-performance; positive evaluation documented in government’s database.

De-incentive: Two notices to the contractor, a cure notice shall be issued and possible the position can be compliance. termination of contract.

filled prior to Evaluation documented in vacancy. national IHS database.

Short-term shifts fulfilled

(Immediate staffing needs)

Filled short-term work shifts as scheduled by the

ESU.

Contractor shall ensure full shift coverage for short term needs at the E SU

85% Same as above Same as above

END OF STATEMENT OF WORK