Atch D Statement of Work -Nurse Triage REV.pdf

STATEMENT OF WORK

Nurse Telephone Triage

12 February 2025

1. INTRODUCTION/BACKGROUND

Phoenix Indian Medical Center (PIMC) is a general medical and surgical hospital which provides comprehensive health services primarily to Native Americans and Alaskan Natives. PIMC serves as a referral hospital for difficult and complex cases from other hospitals and health centers located throughout the Phoenix Area Indian Health Service.

It also serves as the primary health facility for a large number of urban Indians. The Phoenix Indian Medical Center intends to contract for a Nurse Triage System - Nurse Telephone Advice Line for a period of one 12-month base period and four 12-month option periods. PIMC estimates approximately 250 calls per month. The contractor will provide PIMC patients answers to medical, dental, and behavioral health questions via a Registered Nurse using evidenced based triage protocols. The contractor based on their assessment, will for example, provide clinical advice that ranges from offering at home self-care instructions, how to make a next day appointment, or directing them to the emergency room. The Contractor may provide education about the PIMC process to renew prescriptions and how to schedule non-emergent appointments.

2. SCOPE AND REQUIREMENTS

Contractor Responsibilities:

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

Federally recognized holidays can be found online at http://www.opm.gov/fedhol/index.asp.

The contractor shall be notified within a minimum of thirty (30) days by the IHS Point of Contact of any planned health center closures during normal business hours.

All PIMC active user beneficiaries in the Phoenix Service Unit will have access to the contractor's service.

a. Toll Free Access to a Nurse Triage System (NTS) - nurse advice telephone line - This service provides telephone toll-free access to a registered nurse 24 hours per day, 7 days per week throughout the duration of the contract. The registered nurse will advise the caller as to the proper disposition for his/her stated medical concern or problem.

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

b. Toll Free Access to a Health Information Library - This service provides telephone toll-free access to a medical library containing common medical conditions and diseases.

The caller speaks initially with a registered nurse that connects the caller with the appropriate medical topic. Caller is prompted to speak to the nurse to access additional topics.

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

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. 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 a per call fixed rate. The per call fixed rate shall be inclusive of all the following rates: holiday, week nights, weekends, all city, state, federal and local taxes and all associated rates with the provision of services. The Government will pay a fixed per call rate.

Contractor shall be paid only for actual time services are performed under the terms of the contract at the per call fixed rate. Any initial fees or otherwise need to be clearly included on submission of the Attachment A – Rate Schedule.

Accountability:

The Contractor shall provide by secure data transfer within 24-hours to the PIMC staff (as designated), the caller name, date of birth, purpose of call and the advice provided to the patient from the Nurse Advice Line.

The Contractor must abide by HIPPA and Privacy rules and shall hold all information provided by PIMC and its members as confidential, and any and all such information will not be distributed to any third party, including medical information of the members. Contractor will take all reasonable steps necessary to safeguard the privacy of member information.

The Contractor is not responsible for Acts of God, acts or omissions of PIMC or other actions beyond the control of the Contractor while performing services under this agreement.

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

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

The Contractor shall:

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

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

c. Perform triage caller interaction utilization nationally recognized and physician approved clinical protocols and guidelines.

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

Answering Calls:

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

Emergency Room/Urgent Care Referral Instructions:

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

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

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

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

PIMC.

Contractor request for personal data:

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

Indemnity:

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

3. DELIVERABLES

Call Statistics Reporting:

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

The Contractor shall gather information from the nurse triage service calls. The information shall be entered into a database or spreadsheet application. The information shall consist of personal data, assessments, documented resolution and/or further action needed from a Primary Care Provider.

The Contractor shall provide call summaries daily or will provide access to all records and patient data generated by the encounters to IHS via a secure transfer method. Connectivity will need to meet IHS and Federal requirements including, but not limited to, FEDRAMP and BPISA requirements. The method of secure transfer will have final approval by the Government. If access cannot be provided, Contractor shall send call summaries and all records/data via alternate secure method as approved by the Contracting Officer or their designee.

Quality Control:

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

a. Caller satisfaction

b. Adherence to protocols

c. Complete documentation of assessment and advice

d. Appropriate medical disposition

e. Documentation whether patient plans to comply with care advice given

Quality Control Plan:

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

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

Complaints:

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

Contractor Point of Contact (POC):

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

Contractor Qualification Requirements:

a. Minimum Education Requirements: Associates degree prepared registered nurse?

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

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

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

e. Experience: Minimum of three (3) years of experience in nurse triage.

f. The Contractor shall maintain URAC accreditation by the American Accreditation

Healthcare Commission during the duration of this contract.

g. Cultural Sensitivity: The Contractor shall provide cultural sensitivity training specific to the American Indian/Alaska Native people as provided by the PIMC POC.

Performance Conditions:

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

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

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

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

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

4. MEDICAL RISK

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

5. PERIOD OF PERFORMANCE

Contract performance shall be for a base year and four (4) one (1) year options for renewal commencing from the date of the award of the contract. Option year renewals shall be by a written amendment to the contract and approved by the Contracting Officer.

Option renewals will be on the basis of the existing requirement of the Government, performance of satisfactory service provided during the base year, and contingent upon availability of funds for the appropriate fiscal year.

*The QASP with required standards is listed below and will be a part of the contract*

Measures Performance Requirement Standard Acceptable Quality

Level

1 - Key Personnel Provide required care service as specified in the requirements.

Qualified personnel are available and in location as needed to properly perform tasks as specified.

100%

2 - Patient Safety

Timely reporting of any potential or actual patient risk management incidents to the supervisor immediately.

All incidents reported within 24 hours.

100%

3 - Maintains licensing, registration, and certification

Updated Licensing, registration and certifications will be provided as they are renewed.

Licensing and registration information kept current.

Contract Provider records will be kept

99% up-to-date

4 - Privacy, Confidentiality and HIPPA

Contractor is aware of all laws, regulations, policies and procedures relating to Privacy, Confidentiality and HIPPA and complies with all standards

Zero breaches of privacy or confidentiality 100%

END OF STATEMENT OF WORK