ATTACHMENT 2-STATEMENT OF WORK.docx

STATEMENT OF WORK NURSE ADVICE LINE SERVICES FOR

THE WESTERN OREGON SERVICE UNIT (WOSU)

I. PURPOSE OF CONTRACT:

This is a request to establish a Purchase Order request to provide non-personal service contract for a toll free telephone Nurse Advice line services for to the Western Oregon Service Unit (WOSU), 3750 Chemawa Road NE, Salem, Oregon, 97305-1119.

a. The Contractor shall provide a 24-hour per day, Pacific Time, 7 days per week nurse advice hotline service for patients of the Western Oregon Service Unit (WOSU) including Federal holidays. The contractor will provide WOSU a phone number that the clinic can provide to patients. Patients will be able to call this number to ask medical, dental and behavioral health questions. The contractor will provide WOSU patients answers to the medical, dental and behavioral health questions via Registered Nurses using evidence based triage protocols. The contractor will provide WOSU documentation of all calls received by WOSU patients, to include name, date of birth, concern, and advice provided by the contractor. This documentation will be provided to the WOSU in a HIPAA compliant manner within 24 hours of receiving the call. The contactor will provide monthly reports to the WOSU that include data about the type and volume of calls the contractor receives from WOSU patients.

II. OBJECTIVE:

The objective is to decrease emergency room visits by American Indian patients, to a non-Indian Health Service (IHS) facility. Great costs are incurred for emergency room (ER) visits. Many of these ER visits by patients are unnecessary and/or inappropriate. The patient toll free access to a Nurse Advice line has proven to decrease unnecessary ER visits. It direct patients to the appropriate care at the WOSU, or to emergent care if needed.

III. PERFORMANCE OF PERFORMANCE AND LOCATION

Salem, OR 97305-1119

IV. STATEMENT OF WORK:

A. The Contractor shall provide toll free access for Nurse Advice on a 24 hour/7-days per week, Pacific Time to Western Oregon Service Unit. All WOSU active beneficiaries will have access to the Contractor’s service.

B. The Contractor has defined the term “Member”, as used in this agreement as, those members and their immediate family that are beneficiaries of the WOSU active user population.

C. The Contractor shall fax an encounter form within 24-hours to the WOSU staff, this fax to include all encounters. The fax shall include the caller’s name, date of birth, purpose of the call and the advice provided to the patient from the Nurse Advice Line.

D. The Contractor shall hold all information provided by WOSU and its members as confidential, and any and all such information will not be distributed to any third party, especially medical information of the members. The Contractor will take all reasonable steps necessary to safeguard the privacy of member information.

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

F. The Contractor’s Nurse Triage 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 Contractor’s call centers.

G. 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 education information, and they shall be updated continuously.

H. The Contractor shall utilize appropriate software to run established guidelines that the Contractor utilizes so the call centers have access to state of the art triage supported software platform I. 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 hand 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 (dispositions) range from “home care procedures” to “seek emergency care”. Depending on the disposition, the Contractor’s nurses will place follow-up phone calls to assure that the caller’s condition has improved. The Contractor shall ensure that the Caller will never get a busy signal.

J/ Indemnity-The Contractor shall indemnify and hold WOSU 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 agents or employees. WOSU 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 or in connection with a claim of a third party arising from a negligent actor or omission of WOSU, its agents or employees. Indemnity shall include damages, reasonable costs, reasonable expense, and reasonable attorney’s fees as incurred by the party indemnified. The forgoing indemnification provision shall survive the expiration or termination of this Agreement.

V.INDIAN HEALTH SERVICE RESPONSIBILITIES:

A. To monitor the Contractor’s technical progress including surveillance and assessment of performance and the day to day contract administration, however, does not have authority to change orders or otherwise authorize changes, which would affect the contract price, conditions, or period of performance.

B. Interpreting the Scope of Work.

C. Technical evaluation as required.

D. Technical inspection and acceptance required by this contract.

E. Assisting the Contractor in the resolution of technical and administrative problems encountered during the performance.

VI. QUALIFICATIONS:

The Contractor shall be responsible for ensuring that all the nurses answering the advice line are licensed in accordance with regulations in the State or principal practice.

The Contractor will demonstrate culturally sensitive interactions appropriate to the care and interactions with our American Indian/Alaska Native population.

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

VII. PROJECT OFFICER:

The following individual or their designee shall serve as the Contracting Officer’s Representative (COR) under this contract:

Michelle Livingston, Director of Nursing Western Oregon Service Unit

(503) 304-7641

The COR’s responsibilities will be to coordinate with the provider the technical aspects of this service and the review of performance hereunder. The COR does not have the authority to change or alter the order amounts, terms or conditions of the contract.

VIII. PAYMENT SCHEDULE:

A. A. The Contractor shall be paid a fixed monthly amount based on the current active user population. This an all-inclusive price that covers all related costs to provide services off-site. The contract price includes full compensation for providing all services off-site. For example, the contractor is responsible for applicable federal/State/local/sales and all other applicable taxes, etc.

B. Payment shall be made by Electronic Funds Transfer (EFT) method under this contract. The Electronic Payment Information is Mandatory.

C. The Government is obligated only to the extent of authorized purchases actually made and received under this agreement.

INVOICE SUBMITTAL

Invoice shall be submitted to:

Attention: TBD, Accounting Technician Portland Area Indian Health Service, Division of Financial Management 1414 NW Northrup, Suite 800 Portland, OR 97209-2790

Payment shall be made only for completed invoice submission. Payment will be made by Electronic Funds Transfer.

IX. ADDITIONAL TERMS & CONDITIONS:

CONTRACTOR GOVERNMENT FURNISHED EQUIPMENT AND FACILITIES

The Western Oregon Service Unit does not anticipate a need for contractor furnished equipment.

HIPPA Business Associate Agreement Provided by the Contractor:

This agreement form shall be signed by both parties in this contract, attached.

HIPPA REQUIREMENT

Pursuant to the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and its implementing regulation, the Standards of Privacy of individual Identifiable Health Information at 45 C.F.R Part 160 and 164, Subpart A and E (“Privacy Rule”), the Indian Health Service is required to enter into an agreement with the Business Associate, pursuant to which the Business Associate shall comply with and appropriately safeguard Protected Health Information (“PHI”) that it will use and disclose when performing functions, activities or services (“Services”) for the Indian Health Service. The Business Associate by signing the contract shall comply with the following terms in addition to other applicable contract terms and conditions relating to the safekeeping, use and discloser of PHI. (See Attachment G for related HIPPA material and Business Associate Agreement Clause).

(End of Statement of Work)