Atch D- Statement of Work ER RN 19 May 2025REV.pdf

STATEMENT OF WORK: 19 May 2025

It is the intent of the Hopi Health Care Center (HHCC) to acquire non-personal professional registered nursing services for the Emergency Room described herein located in Polacca, Arizona.

Contractor is requested to provide non-personal professional medical services for Registered Nursing Services for a

12-month base period and three (3) 12-month option periods. The intent of this contract is to establish a method whereby the Hopi Health Care Center (HHCC) can minimize disruptions in clinical service because of staff changes and shortages over the next (4) years. Also, even when the best plans are laid to hire and retain staff, our remote location makes this difficult and we can have staff shortages despite trying to hire a full-time employee. Requests for contractor coverage will be based on the consistently changing needs of the clinic.

All responses to this solicitation 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 HHCC. 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/.

Please note: The contractor shall provide and identify at least (3) weeks in advance of the scheduled performance date the candidate for the scheduled shift(s). This is due to the Government’s security clearance and credentialing/ and or privileging requirement. To ensure that the candidate is cleared for commencement of services prior to them reporting at HHCC.

LOCATION:

All services shall be performed at the following location:

Hopi Health Care Center

Hwy 264, MP 388 Polacca, AZ 86042

SHIFTS:

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

HHCC currently has the following operational hours:

Outpatient service, Monday through Friday of 8:00 am to 5:00 pm. Emergency Room and Inpatient services

24 hours 7 days a week. Future possibility for additional day of services as well as after hour coverage. In addition, coverage will be required when any full-time staff is on leave. Specific days may change based upon the needs of

HHCC. All services shall be performed at the Hopi Health Care Center located in Polacca, Arizona. Work week is

Sunday 12:00 AM to Saturday 11:59 PM.

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

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. Work within a designated schedule prepared by the Supervisory Clinical Nurse or his/her designee. Staff may be re-assigned to alternate departments once the contractor has been cross-trained. Any period of absence or changes in the schedule will be communicated with the

Chief Nursing Executive or his/her designee at least 14 days prior, except for emergency situations.

Contractors who accept long full-time assignments (1 continuous week or more) shall attend meetings and training and participate fully as staff members.

Routine Shifts Schedules are:

Emergency Department: 12-hour shifts: 0630 to 1900 and 1830 to 0700

Schedules may be adjusted to 10 hour shifts with a 30-minute unpaid lunch break, depending on the needs of the unit, and timing of peak patient care activity.

* Government does not pay time taken for lunch. Total shifts worked annually shall be in accordance to the total number of work hours allocated for the year by HHCC.

Thirty (30) minute lunch breaks are included in shift hours and Government does not pay time taken for lunch. The

Service Unit shall make every effort to submit a schedule two (2) weeks in advance. Shifts may be cancelled or shortened without time restriction or monetary penalty before the Contractor’s employee arrives for duty.

Contractors who accept long full-time assignments (1 continuous week of 7 days or more) shall attend meetings and training and participate fully as staff members.

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.

Contractor shall provide an hourly fixed rate. Hourly fixed rate shall be inclusive of all the following rates:

holiday, week nights, weekends, call back, all city, state, federal and local taxes and all associated rates with the provision of services and overtime must be priced out separately. The Government will pay one hourly flat fixed rate. The Contractor shall be paid only for actual time services are performed under the terms of the contract at the hourly fixed rate. Overtime is projected to be needed for these services on an on needed basis.

QUALIFICATION/CERTIFICATION – PROFESSIONAL AND RELATED SERVICES:

Contractor shall provide nursing and related professionals with experience in these areas.

A) Registered Nurse (RN) – Specialty (Emergency Department):

1. Years of Experience: Minimum of (2) years of experience as a registered nurse, with (2) years of experience in an Emergency Department.

2. Minimum Education: 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, Council on Accreditation of Nurse Anesthesia Educational Programs, or an accrediting body recognized by the U.S. Department of Education at the time the degree was obtained. Degree from Foreign Nursing School: Official Certification from the

Commission on Graduates of Foreign Nursing Schools is required or individuals who graduated from foreign nursing schools.

3. Current certification in BLS (Basic Life Support).

4. Current certification in ACLS (Advanced Cardiac Life Support).

5. Current certification in PALS (Pediatric Advanced Life Support).

6. TNCC (Trauma Nurse Core Course – preferred but not required).

7. Applicants must have active and unrestricted, current licensure as a Professional

Registered Nurse as a professional nurse in a State, District of Columbia, the

Commonwealth of Puerto Rico, or a Territory of the United States.

MAJOR DUTIES REQUIRED BY POSITIONS:

Nursing services by the contractor will include: Nursing Diagnosis and Treatment within the limits of their nursing job title professional qualification and within the standards of the State of Arizona. In providing these services, the Contractor shall assume and provide guidance and quality of treatment to patients under the terms of this contract, as is provided to the general public.

The work to be performed includes, but not limited to the following:

A. Registered Nurse (RN)-Specialty: Emergency Department

1. Initiate the nursing process for admitted patients. Assess, design, implement and evaluate nursing interventions. Follow through with planned nursing actions and patient education.

2. Receive, initiate and carry out medical orders p la c ed b y physicians: administer medications, blood and/or blood by-products, oxygen, and a variety of treatments and interventions

3. Manage a wide variety of therapeutic devices such as drainage, feeding and suction tubes also respiratory and electrocardiograph machines and other medical equipment and supplies.

4. Measure and assess vital signs, height, weight, and neurological status, effects of medication, visual acuity and hearing.

5. Provide direct patient care; assist patients with activities of daily living and ambulation.

6. Observe and document patient care provided, changes in patient’s conditions, observations and other designated unit activities in the accepted format and form.

7. Collaborate and coordinate patient care with other health care providers and hospital staff.

8. Appropriately assign and direct the patient care provided by ancillary nursing staff.

9. Perform quality control for crash cart checks, lab checks, capillary blood glucose monitoring checks, etc.

10. Collect or assist in collection of specimens, i.e., blood, urine, stool, etc.

11. Recognize life-threatening emergencies, initiate and maintain resuscitation measures and other emergency procedures as appropriate and in collaboration with the medical provider.

12. Recognize adverse reactions to medications, treatments, and procedures and initiate interventions as appropriate and in collaboration with the medical provider.

13. The Emergency Department Nurse will serve as a member of the health care team in Emergency

Department and provide comprehensive, skilled, competent nursing care specific to the age of patients (neonate, infant, school age, adolescent, adult and geriatric) based on nursing assessment, the nursing process, and the provider’s plan of care, where condition and treatments can range from non-critical to critical.

14. Answer and screen telephone calls.

B. All RNs The Contractor shall have strict adherence to any and all Centers for Medicare & Medicaid Services (CMS) and Joint Commission standards. The Contractor, at minimum, will follow approved abbreviation guidelines and will provide timely completion and sign off on all medical records per Joint Commission standards.

Provide comprehensive nursing and discipline appropriate clinical related care in Emergency Room. Must be able to perform as a team player and function as an effective team member.

Utilize nursing and discipline appropriate clinical related service knowledge, skills and critical thinking in the application of nursing and related care by using the nursing process to assess, intervene, and administer nursing related care based on patient needs, problems and provider’s plan of care.

Comply with nationally accepted standards of nursing and discipline appropriate clinical related care practices. Administer medication, treatments, and other therapeutic measures as required by the patient’s condition, diagnosis, and needs.

Provide nursing and discipline appropriate clinical related care to meet age specific physical, emotional, spiritual and socio- cultural needs of the patient, by means of direct care and teaching.

Physical demands – work requires walking, standing, bending and lifting, i.e., to assist patients out of wheelchairs, move patients on and off examining tables, stretchers, etc.

Staff Development and Nursing Unit Supervisors will provide Contractor with staff training and unit specific competencies. Contract staff will be required to complete competency assessment before reporting to the assigned unit to work.

The Contractor shall have tact and diplomacy while working in stressful situations.

The Contractor shall have skill in working with people from a wide variety of backgrounds and different cultures.

STATEMENT OF WORK:

The overall scope of this contract is to provide qualified and experienced healthcare and medical care providers under a Government service contract. The Contractor(s) will be expected to have the necessary education, training, licensing, previous work experience and competence in being able to provide the services within the department(s).

Work performance shall be performed according to the requirements and conditions contained in this Statement of Work. The contract resulting from this solicitation includes:

The Contractors(s) shall be expected to assist and provide services and duties as may be requested for the normal operational requirements for the respective department and personnel. The contractor shall provide work that is consistent with the guidelines and procedures of the IHS, CMS, and TJC. Failure of the contractor to meet these standards can result in cancellation of this contract or at a minimum a request that the Contractor(s) be dismissed and a new Contractor(s) be dispatched. The contractor’s performance and abilities shall be evaluated based upon performance standards that are contained in this statement of work

The Contractor(s) shall prepare and complete in a timely manner the required documents, in accordance with the HHCC Medical By-Laws and Service Unit Policy. Chart notes (where applicable) are to be completed on the day services are rendered and specifically, with rare exception, immediately after finishing with the patient. During the performance of their duties, the contractor shall provide for the consistent performance of patient care processes according to the standards for TJC accreditation within IHS. The Contractor(s) shall:

1. Be proficient in writing, typing and have a basic working knowledge and understanding of computer hardware and software applications.

2. Have sufficient knowledge, competence and experience in providing these services on a regular schedule at

HHCC.

3. Possess sufficient initiative, interpersonal relationship skills, social sensitivity and appropriate professional behavior such that he/she can relate constructively to IHS employees, contractors, vendors and individuals from the Native American community.

4. Have a valid state driver’s license or government issued identification card from any of the 50 United States or the Commonwealth of Puerto Rico.

5. Not have any work or health restrictions, which could directly or indirectly interfere with the performance of providing services.

6. Maintain acceptable standards of personal hygiene, grooming and professional attire such that their image as a Federal contractor is compatible with the expectations of the IHS staff.

7. Be required to utilize the electronic health record for chart documentation (where applicable) after receiving training.

8. Be sensitive to the unique culture factors of the people they serve, 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.

9. Have tact and diplomacy while working in stressful situations.

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 medical personnel.

The Contractor(s) shall be removed from an IHS facility if services are not performed in accordance with terms and conditions of this award.

The Contractor shall relieve contracted staff within 24 hours of notice and, if a replacement is needed, the replacement should be available within one week of the removal.

CONTRACTOR REQUIREMENTS:

Upon award, the selected professional(s) shall undergo Indian Health Service (IHS) mandated security clearance for work on-site at HHCC. 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).

• Current resume

• OF-306 – Declaration for Federal Employment (all questions must 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; complete the Certificate of Completion

• No FEAR Act Training; complete the Certificate of Completion

• OFI-86C form along with two fingerprint cards and applicable state forms http://exclusions.oig.hhs.gov/ http://www.sam.gov/ http://www.verifycomply.com/

• HHS-745, Section A

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

• Educational (college & nursing ) Certification/License

• BLS/ACLS/PALS Certification

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

PDF signatures will be accepted.

MAJOR DUTIES REQUIRED BY POSITION:

SUPERVISORY CONTROLS:

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

1. Sets 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 practices 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 condition 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.

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 HHCC.

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.

CONTRACTING OFFICER REPRESENTATIVE (COR) RESPONSIBILITIES:

The Contracting Officer will designate in writing a COR who shall be responsible for:

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

2. Interpreting scope of work

3. Performing technical evaluations required

4. Performing technical inspections and acceptances required by this contract

5. Monitoring funds available for obligation under this contract

6. The resolution of technical problems encountered during performance of this contract

In no event is the COR empowered to change any of the terms and conditions of the contract. Changes in the scope of work, contract price, quantity, and quality or delivery schedule shall be made only by the Contracting Officer by a properly exercised modification.

The designation of a COR does not authorize or provide a legal right to change any kind of contractual terms regardless of the Contractor’s apparent difficulties in fulfilling contract requirements.

CONTRACTING OFFICER (CO) RESPONSIBILITIES:

The Contracting Officer is the only person delegated the authority to negotiate changes in terms, conditions, or amounts cited in this contract.

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).

PAYMENT AND INVOICING INSTRUCTIONS:

Invoices shall be prepared with the following information CLEARLY identified on the invoice:

1. Invoice Date and Number

2. Contract Number

3. Charges for service or products identified BY LINE ITEM Number

4. Brief description of products or services rendered

5. Charges should follow Line Item structure on contract to include Quantity, Unit of Issue, Unit Price, and

Total Amount as applicable

6. Dates of Service or Shipment

Invoices shall be prepared and submitted electronically and in accordance with rates and terms as stated in the contract. Invoices shall be submitted electronically in IPP through the US Treasury. Notification and a copy of the

Invoice shall be submitted to:

1. Acquisitions: Michele.Lodge@ihs.gov, a copy of the invoice should be sent electronically to the contract specialist(s) at the address listed above.

2. Service Unit Representatives: _TBD______ and __TBD_____________ A copy of the invoice should be sent electronically to the Service Unit Representative(s) at the address listed above.

ADDENDUM:

Pro-Children Act of 1994

The Contractor certifies that it will comply with the provisions of Public Law 103-227, Pro-Children Act of 1994 which imposes restrictions on smoking where federally funded children’s services are provided. The Act requires that smoking should be prohibited in any indoor facility of portion of a facility owned, leased, or contracted for a used for the routine or regular provision of health care, day care, or early childhood development (Head Start) services to children under the age of 18. Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to $1,000 per violation and/or the imposition of an administrative compliance order on the responsible entity. By submitting an offer and entering into a contractual agreement with the Government, Contractors certify that they will comply with the requirements of the Act. Contractors must obtain the same certification from subcontractors.

B. P.L. 101-630, The Indian Child Protection and Family Violence Prevention Act

Contractors whose duties and responsibilities involve regular contact or control over children are subject to a character investigation as required by Public Law 101-630, The Indian Child Protection and Family Violence Act. IHS will conduct these investigations following award of a contract. The character investigation may be waived if, in judgment of the Contracting Officer, in consultation with the Personnel Officer, an investigation has already been conducted and is on file. Until the character investigation has been completed and the Contracting Officer notified of the results, the Contractor must not have unsupervised contact with Indian children.

C. Department of Health and Human Services Tobacco Policy

The Contractor’s employee shall comply with the Department of Health & Human Services Tobacco- Free Policy (copy available upon request). Contractor’s employee shall not use tobacco products of any kind (e.g., cigarettes, cigars, pipes, and smokeless tobacco) while on any HHS Property- owned or controlled.

D. Indian Child Protection and Family Violence Prevention Act

No performance under this contract will be allowed without full compliance with the Indian child protection and family violence prevention act, Public Law 101-630 and the Indian Health Service memo dated February 3, 1997, investigations on child care workers. Contractor shall ensure that proposed providers cooperate with and assist the government in the conduction of any necessary background checks.

B. Crime Control Act of 1990

No performance under this contract will be allowed without full compliance with the crime control act of 1990, Public Law 101-647 and the Indian Health Service memo dated February 3, 1997, investigations on child care workers. Contractor shall ensure that proposed providers cooperate with and assist the government in the conduction of any necessary background checks.

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.

REGISTERED NURSING SERVICES FOR HOPI HEALTH CARE CENTER

PERFORMANCE-BASED MATRIX

Outcome Required

Services

AQL

Standard

Max

Allowable

Degree of

Deviation from

Requirement/

(AQL)

Normal Method of

Surveillance

Incentives and Deduction from

Contract Price

Registered

Nurses

Non-Personal

Services

Contract

Minimum

Qualification for RN services

Contractor shall submit supporting documentation for approval

100% Compliant Government review of contractors documentation for compliance

Incentive: Government approves documentation

De-incentive: Government reject documentation no award, Registered

Nurses

Non-Personal

Services

Contract

Licensure for RN Contractor shall submit supporting documentation of Licensure;

licensure shall be in good standing and

100% Compliant Government review of contractors documentation for compliance

Incentive: Government approves documentation

De-incentive: Government rejects documentation, payment may be withheld

Registered

Nurses

Non-

Personal

Services

Contract

Background

Investigation in compliance with

Indian Child

Protection and Family

Violence Prevention

Act, Public Law 101-

Contractor shall submit supporting documentation of Background investigation results

100% Compliant Government review of contractors documentation for compliance

Incentive: Government approves documentation

De-incentive: Government reject documentation no award, Registered

Nurses Non- Personal

Services

Contract

Immunization

Compliance

Contractor shall submit supporting documentation of

100% Compliant Government review of contractors documentation for compliance

Incentive: Government approves documentation

De-incentive: Government reject documentation no award

Unacceptable

Performance

In the event of unacceptable performance, lack of professionalism, unacceptable conduct, the Contractor shall replace personnel

Contractor shall replace personnel within 5 days upon receipt of written notification

90% Compliant Government shall notify the contractor in writing of non-compliance

Incentive: No interruption of performance and positive evaluation documented in governments’ database.

De-incentive: Two (2) occurrences of which the contractor is unable to replace personnel within the time allowance, a cure notice shall be issued and possible termination of contract. Evaluation documenting performance in the national IHS database.

Long-term shifts fulfilled

(Thirteen (13) week travelers)

Filled long-term work shifts as scheduled by the Colorado River

Service Unit. Long

Term shifts contractor personnel shall provide at least a 4 week notice so that the position can be filled prior to vacancy.

Contractor shall ensure full shift coverage for long term nursing needs at the Colorado

River Service

Unit

100% Government’s review & written documentation/ notification to

Contractor of non-compliance.

Incentive: No disruption of performance; positive evaluation documented in government’s database.

De-incentive: Two notices to the contractor, a cure notice shall be issued and possible termination of contract. Evaluation documented in national IHS database.

REGISTERED NURSING SERVICES FOR HOPI HEALTH CARE CENTER

Short-term shifts fulfilled

(Immediate staffing needs)

Filled short-term work shifts as scheduled by the Colorado River

Service Unit.

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

Colorado River

85% Same as above Same as above

END OF STATEMENT OF WORK