Atch D- Statement of Work- Fetal Medicine Physician REV2.pdf

STATEMENT OF WORK

Maternal Fetal Medicine Services

It is the intent of the Phoenix Area Indian Health Service to acquire non-personal professional Maternal

Fetal Medicine services as described herein for the Phoenix Indian Medical Center (PIMC) located in

Phoenix, Arizona. Contractor is requested to provide non-personal professional medical for a 12-month base period and four (4) one (1) year option periods. The overall scope of this contract is to acquire a qualified Contractor under a Government non-personal professional contract to provide Maternal Fetal

Medicine services. 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 shall contain a complete profile and current work history of the candidate(s) presented, including licensure and certifications.

Selected candidate shall undergo the Indian Health Service mandated security clearance requirement prior to commencement of services at the PIMC. The security pre-clearance requirement must be adhered to; the process includes a fingerprint check and a screen check of the physician 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 provider for the scheduled shifts. This is due to the Government’s security clearance and credentialing/ and or privileging requirement.

SCHEDULE/LOCATION/SHIFTS/QUALIFICATIONS/CERTIFICATIONS:

SHIFT: This service is required by clinic an estimated 2 clinics at 8 hours per week for 52 weeks. A

“Clinic” is defined as one (1) day for eight (8) hours; estimated 10 patients per Clinic. The Clinic will be within the PIMC hours of operations from Monday to Friday, 5 days a week between 8:00 am - 5:00 pm

(0800 - 1700). Additional Clinics may be added by mutual agreement of both parties with prior agreement and coordination with the Government. Any period of absence or changes in the schedule will be communicated with the Chief of the OB or his/her designee 14 days prior, except for emergency situations.

NOTE: The duration of each work “Clinic” shift may vary due to patient load, clinical complexity, weather and other circumstances.

Clinic Hours (Monday through Friday): 8 hours: 8:00 am - 5:00 pm (0800 - 1700)

Contractor shall schedule for unpaid lunch no longer than 30 minutes. The Service Unit shall make every effort to submit a schedule two (2) weeks in advance. Clinics may be cancelled or shortened without time restriction or monetary penalty before the contractor’s employee arrives for duty.

The services are for a 12-month base period and four (4) 12-month option periods.

MATERNAL FETAL MEDICINE SERVICE:

http://exclusions.oig.hhs.gov/

QUALIFICATION/CERTIFICATION

Experience: - Maternal Fetal Medicine Physician with two (2) years or more experience in hospital medicine are preferred. New residency graduates with significant Maternal Fetal Medicine Physician experience will be considered on a case by case basis.

Training: - Successful completion of an Accreditation Council for Graduate Medical Education

(ACGME) or American Osteopathic Association (AOA) - accredited residency in internal medicine.

Certification:

1. Fully credentialed/privileged after award of the contract and be “Board Certified” or “Board

Eligible” in maternal fetal medicine.

2. Current certification is required in BLS (Basic Life Support).

Licensure: Applicants must have active, current unrestricted medical license in a State, District of

Columbia, the Commonwealth of Puerto Rico, or a Territory of the United States. Contractor shall assure each license is in good standing.

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

Department of Obstetrics & Gynecology Women’s Clinic Phoenix Indian Medical Center 4212 N. 16th Street Phoenix, AZ 85016

The Vendor shall provide Contractors with the competency and experience to perform the following:

a. The Contractor shall provide onsite maternal fetal medicine service and consultation service, per shift.

b. 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.

c. Work within a designated schedule prepared by the Obstetrics & Gynecology Department or his/her designee.

d. 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.

e. 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 termination of this contract.

f. The Contractor’s performance and abilities shall be evaluated based upon performance standards that are contained in this statement of work

g. 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 program within IHS. These standards include: The Comprehensive Accreditation Manuals for Critical Access Hospitals, and the

Laboratory Standards as they represent the scope of services of this contract.

h. The Contractor should be proficient in writing, typing and have a basic working knowledge and understanding of computer hardware and software applications.

i. The Contractor shall have sufficient knowledge, competence and experience in providing these services on a regular schedule to the Service Unit.

j. 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.

k. Driving maybe required, the Contractor should have a current, valid state driver’s license from any of the 50 United States or the Commonwealth of Puerto Rico.

l. The Contractor shall not have any work or health restrictions, which could directly or indirectly interfere with the performance of providing services.

m. 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.

n. The Contractor must utilize the electronic health record for chart documentation.

o. 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.

p. Prepare and complete, in a timely fashion, the medical and other required records for all patients.

q. Adhere to the guidelines for his/her behavior and action as outlined in the Service Excellence

Guidelines to enhance relations between employees, departments, patients, patient’s families and visitors.

r. Subject his/her performance to the hospital’s Quality Improvement Program, as the same may from time to time be in effect in accordance with the requirements of TJC and external regulatory agencies

s. Abide by the lawful ethical principles of his/her profession.

t. Abide by the bylaws, rules and regulations, general conduct of care, and Policy and Procedures set forth at PIMC.

u. Documentation in the patient’s health record are to be completed at the time services are rendered.

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 program within IHS. These standards include: The Comprehensive Accreditation Manuals for Critical Access Hospitals, and the

Laboratory Standards as they represent the scope of services of this contract.

v. Schedule: The contractor shall record time and attendance that shall be verified by the supervisor and/or his/her designee.

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

CONDITIONS FOR REMOVAL/REPLACEMENT OF CONTRACTOR(S):

As mutually agreed between the Contracting Officer and the Contractor there may be grounds for removal and/or replacement of a Contractor.

The Vendor’s employee shall be removed from an IHS facility if services are not performed in accordance with terms and conditions of this award, and/or the Vendor’s VA/FSS contract.

PRICING SCHEDULE:

The unit price paid to the Vendor shall be considered as payment in full for services provided under this contract. 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.

Fixed rate shall be inclusive of all other fees (holiday, nights, weekend and overtime), 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.

Vendor shall be paid only for actual time services are performed under the terms of the contract at the fixed rate (one flat rate). *30-minute lunch breaks are included in the shift hours and will not be paid by the Government.

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 The

Joint Commission (TJC) and/or Centers for Medicare Services (CMS) who supplies accreditation to the Phoenix Area Indian Health Service hospitals and health centers. These standards shall include:

The Comprehensive Accreditation Manual for Critical Access Hospitals, and the Laboratory

Standards as they represent the scope of services of this contract.

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, rules, and regulations and meet all credentialing requirements in accordance with the Service Unit Medical Staff By-laws.

Upon award, the selected physician(s) shall undergo Indian Health Service (IHS) mandated security clearance for work on-site for the PIMC. 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/.

MAJOR DUTIES REQUIRED BY THE POSITION:

Skill and knowledge in the field of maternal fetal medicine; with competency in the concepts, principles and practices related to health care assignments and additional training or experience in assessing the conditions of patients, in providing medical care and in advising on health care needs, all with full consideration of mental, emotional and physical factors.

Ability to collect, organize, record and communicate, in a meaningful way, data relevant to primary health assessments including the detailed family and medical history, a physical examination and selective laboratory tests.

Ability to perform level 2/targeted obstetrical ultrasound services, interpret fetal monitoring tests and procedures and assess routine and specialized laboratory and radiological services.

Skill in making diagnosis and in choosing, initiating and modifying selected therapies and ability to provide medical care in maternal fetal medicine

Knowledge of pharmaceuticals in order to recognize their desired effects, side effects and complications of their use.

Knowledge of human behavior during stressful situations in order to exercise emotional control, tact, patience and reliability in carrying out patient care.

Knowledge of quality assurance and evaluation process to improve care and facilitate monitoring and http://exclusions.oig.hhs.gov/ program planning.

Knowledge of health record aspects of patient care and ability to accurately and completely document related clinical data.

Ability to provide guidance and leadership to other healthcare providers.

A license to practice in the United States is required. Compliance with Indian Health Service – Service

Unit Medical Staff/Governing Body By-laws, Rules and Regulations and compliance with requirements for credentialing/privileging as an active member of the medical staff.

Skill in diplomacy and tact while working in stressful situations.

Skill in working with people from a wide variety of backgrounds and different cultures.

CONTRACTOR CREDENTIALS:

Upon award, the selected professional(s) shall undergo Indian Health Service (IHS) mandated security clearance for work on-site at PIMC. 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). (For Solicitation Responses provide the yellow highlighted items for each proposed candidate)

• 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

• HHS-745, Section A

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

• Educational (college & professional) Certification/License

• BLS/ACLS/ Licenses

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

SUPERVISORY CONTROLS:

The Chief or Supervisor of the Department, or designee, provides primarily administrative supervision.

The supervising physician sets overall health care objectives and specifies resources available. The supervising physician provides for clinical supervision on a 24-hour, media and tour of duty coverage.

The supervising physician 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 http://exclusions.oig.hhs.gov/ http://www.sam.gov/ http://www.verifycomply.com/ 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 supervising emergency department physician 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; and the Quality Assurance Improvement Program of the

Medical staff of the Service Unit.

Within established guidelines, contractor(s) 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 jointly by the clinical director/supervising physician for effectiveness in meeting requirements for healthcare services.

SECURITY CLEARANCES:

The contractor shall ensure their employees have been properly screened prior to presenting to PIMC for employment under this contract. The contractor shall inform their employees to obtain Fingerprint cards or electronically submit their fingerprints through the PIMC 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 PIMC Human

Resources Department and issued a badge.

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 - two years in accordance with Government credentialing privileging policy and JCAHO requirements.

DELIVERABLES:

A. The Contractor is required to provide a copy of each Contractor’s employee profile to the COR prior to providing services at the PIMC.

B. Timesheet shall be submitted to the Chief or Supervisor of the Department, or 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 Platform.

CONTRACTOR OFFICER REPRESENTATIVE (COR):

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

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

• Interpreting scope of work;

• Performing technical evaluations required;

• Performing technical inspections and acceptances required by this contract;

• Monitoring funds available for obligation under this contract;

• 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 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’s employee is unable to render service on a previously agreed schedule, the

Contractor shall provide a minimum seventy-two (72) hour notification to the COR. 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 those involved in scheduling.

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 lssue, Unit

Price, and Total Amount as applicable

6. Dates of Services 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:

Acquisitions: Marilyn.Duran@ihs.govA copy of the invoice should be sent electronically to the

Contract specialist(s) at the address listed above.

Service Unit Representatives: Brian.Numkena@ihs.gov copy of the invoice should be sent electronically to the Service Unit Representative(s) at the address listed above.

mailto:Marilyn.Duran@ihs.gov mailto:Brian.Numkena@ihs.gov

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 owned, leased, or contracted for or 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.

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 the 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.

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.

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.

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.

PERFORMANCE BASED ASSESSMENT:

Introduction – Performance Requirements:

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

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.

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.

How to Use the Performance Based Matrix

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.

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

Quality Assurance Surveillance Plan (QASP):

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.

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

Requirement/

(AQL)

Normal Method of

Surveillance

Incentives and Deduction from

Contract Price

Physician

Non-Personal

Services Contract

Minimum

Qualification for

Physician

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, Physician

Non- Personal

Services

Contract

Licensure for Physician Contractor shall submit supporting documentation of Licensure;

licensure shall be in good standing and not under investigation.

100% Compliant Government review of contractors documentation for compliance

Incentive: Government approves documentation

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

Physician

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, Physician Non-Personal

Services Contract

Immunization Compliance

Contractor shall submit supporting documentation of

Immunization

Compliance

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

PIMC. 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 PIMC.

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.

Short-term shifts fulfilled

(Immediate staffing needs)

Filled short-term work shifts as scheduled by

PIM C .

Contractor shall ensure full shift coverage for short term needs at PIMC.

85% Same as above Same as above

END OF STATEMENT OF WORK