Atch D- Statement of Work NP 2 July 2025.pdf

STATEMENT OF WORK

2 July 2025

INTRODUCTION:

The contractor herein, shall provide Non-Personal Nurse Practitioner (NP) (Family & Adult Geriatric) services as described herein. This will be an award with a one-year base period of performance with four (4) 12-month option year periods of performance. Nurse Practitioner will complete the Indian

Health Service mandated security clearance requirements prior to commencement of services.

The Phoenix Area Service Unit/ Phoenix Indian Medical Center will be assuming the clinical and administrative functions of the AK-Chin Health Center. The clinic is currently operated by the Gila River

Indian Community and has an estimated 6,000 Ambulatory visits per year. The estimated need for clinical staffing is October 1, 2025.

The work site is primarily an Ambulatory Health Clinic providing, services Monday – Friday from 0800-

1700. The AK-Chin Clinic provides Community-focused services to address the primary health care needs of the various patient populations within the AK-Chin Indian Community. The AK-Chin clinic offers medical assessment, treatment, referral, education and coordination of patient care. The clinical function provides

Family, Internal, and Pediatric Medicine. The services provide comprehensive care from the newborn child to elders. Special ambulatory services are provided on-site by IHS staff based in Phoenix or professional medical locum tenens contractors. Ground transport is available for emergency care. The AK-Chin Health Clinic is accredited by The Joint Commission.

AK-Chin Health Clinic: Located in Maricopa, Arizona. The clinic is located 38 miles from Phoenix, Arizona. AK-Chin Clinic is staffed by physicians, mid-level providers, registered nurses, and ancillary staff.

The Clinic provides outpatient care, as well as community outreach programs.

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, education, and references.

Selected candidate shall undergo the Indian Health Service mandated security clearance requirement prior to commencement of services at the AK-Chin Health Clinic. 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.

SCHEDULES/LOCATION/SHIFTS/QUALIFICATIONS/CERTIFICATIONS:

Schedules: The clinic operates Monday through Friday from 8:00a to 5:00p with the exception of federally recognized holidays. Shift times and schedules are subject to change based on the medical needs of the patient populace and hospital and clinic operations.

All services will be performed at the following location: Ak-Chin Clinic located in Maricopa, Arizona.

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

Nurse Practitioner services (NP), Family & Adult Geriatric at Ak-Chin Clinic located in

Maricopa, Arizona

SHIFTS:

Four - 10 hour shifts with 30-minutes unpaid lunch (shift times TBD)

Five - 8 hours shifts with 30-minute unpaid lunch (shift times TBD)

Five - 8 hours shifts with 60-minute unpaid lunch (shift times TBD)

LOCATION: The Ak-Chin Clinic is located at 48203 W. Farrell Road, Maricopa, AZ 85239

QUALIFICATION/CERTIFICATION - NURSE PRACTITIONER (FAMILY & ADULT

GERIATRIC)

Nurse Practitioners must possess and maintain an active, valid, and current certification as a Nurse

Practitioner by the American Nurse Credentialing Center from a nationally recognized certifying body. Current Basic Life Support (BLS) certification is required.

Degree or diploma from a professional nursing or physician assistant program approved by the legally designated State accrediting agency at the time the program was completed by the applicant. Nurse

Practitioner(s) must be a member in good standing with the Association of Nurse Practitioners (AANP) or the American Nurses Credentialing Center (ANCC).

Applicants must have active, current registration as a professional nurse or physician assistant in a State, District of Columbia, the Commonwealth of Puerto Rico, or a Territory of the United States. Applicants must have completed a Nurse Practitioner training program of at least 4 months in duration.

Experience: Nurse Practitioners must have a minimum of three (3) years’ experience. On-Call services are not required.

Demonstrate proficiency in writing, typing and possess basic knowledge and understanding of computer hardware and software applications;

Possess sufficient initiative, interpersonal relationship skills, social and cultural sensitivities and appropriate professional behavior in order to relate constructively to IHS employees, contractors, vendors and individuals from various Native American communities or Tribes;

Possess a current, valid state driver’s license from any of the 50 United States or the

Commonwealth of Puerto Rico;

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.

PRICING SCHEDULE – See Attachment A - Rate Schedule

The Unit Price paid to the Contractor shall be considered as Payment in Full for services provided under this award. Under no circumstances, unless directed by IHS, shall any provider attempt to bill or collect from an IHS patient; bill or collect from any alternate resource which the patient may be eligible for; or any monies for services provided under this award.

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

Nurse Practitioners 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 nights, weekends, and holidays.

Lunch breaks are included in the shift hours and will not be paid by the Government.

SCOPE OF WORK:

The overall scope of this government service contract is to provide clinical Nurse Practitioner services in Internal Medicine or Family Practice at the assigned location. Clinic day services shall be performed in accordance with a work schedule established by the Chief of Primary Care or Internal Medicine or designee.

The healthcare provider shall conform to all Primary Care Family Nurse Practitioner standards of care as established by the Indian Health Services Physician Quality of Care document. The following describes knowledge, skills and abilities NPs must possess:

Skill and knowledge of established 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;

Knowledge of the diagnostic, preventive and therapeutic position related to a variety of medical health care fields to include Nurse Practitioners, , emergencies, medicine, minor/major surgery and nutrition;

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

Knowledge of the availability and use of resources designated as primary care and referral services;

Skills in making diagnosis and in choosing, initiating and modifying selected therapies; and ability to provide emergency treatment;

Skill in diplomacy and tact while working in stressful situations;

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

Ability to assess the physical-psychosocial health status of patients and family based upon the knowledge of growth and development patterns and health condition is that require medical management;

Ability to provide individual and family counseling, guidance and health instruction to help patients to understand how to prevent disease and maintain good physical and mental health;

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 special screening and developmental tests and assess routine and specialized laboratory and radiological services;

Ability to provide guidance and leadership to other healthcare providers;

Attend required training in order to utilize the Electronic Health Record (EHR) for chart documentation to enter all lab, x-ray and medication requests.

Shall be sensitive to the unique cultural factors of the patients they treat, which may include, use of an interpreter to communicate services being rendered. Unique cultural and socio- economic factors that may contribute to the patient’s treatment outcome include: use of their language communications;

village and tribal customs; use of traditional healers; isolation; housing conditions and lack of resources.

Nurse Practitioners may be required to work beyond normal duty hours, on weekends, holidays and after regularly scheduled duty hours on an as needed basis for emergencies.

There will be no provision for Government housing as housing is readily available within metropolitan Phoenix, Arizona.

CONDITIONS FOR REMOVAL/REPLACEMENT OF NURSE PRACTITIONER(S)

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

The Contractor’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 Contractor’s contract.

CONTRACTOR REQUIREMENTS

For Medical & Professional Contractors, the Nurse Practitioners shall comply with IHS facility infection control; safety policy and procedures; and standards. During the performance of this contract, the Contractor shall provide consistent performance of patient care processes according to TJC and/or Centers for Medicare and Medicaid Services (CMS) who issues 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 Nurse Practitioners 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 providers 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.

CONTRACTOR CREDENTIALS:

The Contractor shall provide candidates qualified as Nurse Practitioners and the following documents for each provider at time of credentialing:

• 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

• NoFEAR 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)

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 administrative supervision and conducts the following:

1. Sets overall health care objectives and specifies available resources

2. Provides clinical supervision during tour of duty during clinic operating hours

3. 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

4. Work which involves out-of-the-ordinary diagnostic decisions or treatment is discussed with supervisor or supervising department physician who keeps aware of the condition of such patients and all aspects of treatment regimen

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

6. Assures participation in Quality Assurance and Performance Improvement activities

Within established guidelines, Nurse Practitioners 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 performance reviews will be conducted jointly by the clinical director/supervising physician for effectiveness in meeting requirements for healthcare services.

QUALITY ASSURANCE

Contractor to submit a proposed quality assurance surveillance plan for the government’s consideration.

SECURITY CLEARANCES

The Contractor shall ensure their Nurse Practitioners complete the following security clearance activities prior to reporting to work:

1. Obtain Fingerprint cards or

2. Process their fingerprints electronically, in person, at the PIMC Human Resources

Department

3. Complete the appropriate background investigation form which will be submitted for processing to the Office of the Inspector General's exclusion list at http://exclusions.oig.hhs.gov/

No performance under this contract shall be allowed until security clearances have been received by the

PIMC Human Resources Department and a PIMC employee badge has been issued.

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

CREDENTIALING AND PRIVILEGING

The Nurse Practitioners/Physician Assistants will participate in the credentialing and privileging process in accordance with existing procedures. Nurse Practitioners shall provide no services prior to obtaining approval by the Government Medical Executive and Governing Board. The Nurse Practitioners will be provided copies of current requirements and updates as they are published. Privileges will require renewal at least every one to two years in accordance with Government credentialing privileging policy and TJC requirements.

DELIVERABLES

The Contractor is required to provide a copy of each Contractor’s employee profile to the COR prior to providing services at Ak-Chin Health Clinic.

Timesheets (Attachment E) 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 by the Practice Manager; or his/her designee; and forwarded to the receiving official for further processing of receipt of services

CONTRACTING OFFICER REPRESENTATIVE (COR)

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

A. The COR will submit schedules of required coverage a minimum of 15 calendar days prior to the first day of coverage requested.

B. 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.

C. 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:

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: Randy.Saria@ihs.gov and Sandra Chica@ihs.gov copy of the invoice should be sent electronically to the Service Unit Representative(s) at the address listed above.

D. ADDENDUM

a. 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.

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 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 mailto:Michele.Lodge@ihs.gov mailto:Randy.Saria@ihs.gov mailto:Sandra%20Chica@ihs.gov

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.

e. 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.

Nurse Practitioner Services

PERFORMANCE-BASED MATRIX

Outcome Req uire d Serv ices

AQL

Standard

Max Allowable Degree of Deviation from Requirement/

(AQL)

Normal Method of Surveillance

Incentives and Deduction from Contract Price

Nurse

Practitioner

Non-Personal Services Contract

Minimum Qualification for CMA 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, Nurse Practitioner Services Contract

Certification for

CMA

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

Nurse Practitioner 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, Nurse Practitioner Non-Personal Services Contract

Immuniz ation Complia nce

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.

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

Nurse Practitioner Services

END OF STATEMENT OF WORK