Attachment 4 - SOW.pdf

Evidence-Based Clinical Support Statement of Work

Software License for Evidenced-Based Clinical Criteria

Justification:

The Phoenix Indian Medical Center (PIMC), Phoenix Service Unit (PSU), Phoenix, Arizona, is a 127-bed health care facility that operates 24 hours a day, seven days a week. Whiteriver Indian Hospital (WRSU), is a 40-bed healthcare facility that operates 24 hours a day. This project is located in the following locations:

Phoenix Indian Medical Center (PIMC) 4212 N. 16th St Phoenix, AZ 85016

Whiteriver Indian Hospital (WRSU) 200 W. Hospital Dr, Whiteriver, AZ 85941

PIMC and WRSU require a contractor to provide a site-hosted, evidence-based clinical criteria software and license for use in a hospital utilization review process. The software should be easy to use and allow for expedited workflow.

The software should allow users to evaluate clinical criteria for the following:

1. Observation services

2. Inpatient admissions

3. Continued inpatient stays

4. Evaluation of discharge planning

5. Evaluate ambulatory surgical services for appropriateness of setting

6. Determine appropriate transition of care to rehabilitation care services, subacute services, and skilled nursing services.

7. Evaluate substance use disorders and appropriate transition of care.

8. Evaluate transition of care needs utilizing CMS Durable Medical Equipment.

9. Retrospective evaluation of risk management and quality care delivery evaluation.

The purpose of the evidence-based clinical criteria is to satisfy the Centers for Medicare and Medicaid Services (CMS) Conditions of Participation (CoPs) for a healthcare organization to have a utilization review process in place. The PIMC and WRSU Case Management staff will use this evidenced-based criteria for making utilization review decisions. The software is integral to the performance and function of several departments within PIMC and WRSU.

Case Management’s utilization review function is required by Third Party Billing to complete billing information prior to sending in the claim.

Product Scope Description:

The contractor shall provide a Site-Hosted software license for evidence-based clinical criteria for the following areas:

1) Inpatient adult

2) Obstetrical

3) Newborn

4) Continued inpatient stays

5) Evaluation of discharge planning

6) Evaluation of ambulatory surgical procedures

7) Imaging

The criteria must utilize evidence-based clinical criteria as the foundation of establishing “medical necessity,” must include the source documentation in the criteria, and must incorporate standards of care in the recommended treatment modalities.

Statement of Work

The contractor shall provide evidenced-based clinical criteria for procedures and imaging that are presented in a series of basic and instructional driven questions.

The contractor shall provide comprehensive, clinical evidence-based notations that summarize the standard of care for a specific diagnosis, thus supporting a comprehensive approach to diagnosis and treatment. The notations shall provide an objective source that medical professionals can reference to support their care recommendations for individual patient treatment.

The software shall produce various utilization review reports to include:

Variance days Medical necessity met Observation Others consistent with UR conditions of participation

Acceptance Criteria:

1. The contractor shall provide a non-transferable software license for no less than 12 simultaneous users per location to use in the utilization review process. This will be used to determine the medical necessity of inpatient admissions, continued inpatient stays, evaluation of the discharge plan, to determine observation status and to evaluate the appropriateness of ambulatory surgical procedures through standard report options, not custom queries.

2. The contractor shall provide PIMC and WRSU a site-hosted, interactive software that provides access to criteria and helps automate/streamline the utilization review process.

3. The contractor shall provide software that will allow for searches of relevant criteria by keywords, CPT codes, and ICD-10 codes. This will act as a guide for establishing defensible admissions and continuing to stay positions of PIMC and WRSU’s utilization review processes, thereby enhancing third-party billing collections.

This will be accomplished by decreasing denials and allowing for cost controls. Case management staff, third-party staff, and medical professionals shall have access through a web-hosted program.

4. The contractor shall ensure PIMC is provided with the most current and up-to-date evidence-based clinical criteria software as it becomes available throughout the life of the contract.

5. The contractor shall provide a length-of-stay application and reports with the software for PIMC and WRSU’s utilization review programs.

6. The contractor shall provide initial onsite training and additional other additional training courses that are designed to familiarize end-users with the use of the criteria. These training modules shall be self-paced to accommodate the end-users' schedules. Training courses will be aligned with this scope of work.

7. The contractor will provide technical IT support services as necessary during the life of the contract. A point of contact shall be designated to ensure ad-hoc maintenance and support services are provided for the proper functioning of the site-hosted software license.

8. The contractor will not access, manage or control Protected Health Information (PHI) or other Personally

Identifiable Information (PII)

Phoenix Indian Medical Center

Phoenix, Arizona

Minimum Contractor Qualification:

The contractor’s site-hosted evidenced-based clinical criteria shall comply with the State Operations Manual, Regulations and Interpretive Guidelines for Hospitals, 482.30 Condition of Participation: Utilization Review and be in alignment with Centers for Medicare and Medicaid Services (CMS) and the Health Services Advisory Group (HSAG) for determining “Medical Necessity” and “Quality of Care”.

Quality Assurance:

The contractor shall provide software updates to keep current with any changes to standards of care in their evidenced-based clinical criteria for the diagnosis and treatment of diseases as appropriate.

The contractor shall provide training or training resources, at each site, for a minimum of 12 IHS employees and training and support for the application administrator with a focus on report production. Any additional web-based training shall be included in the original quote.

Section 508 Compliance Standards:

The contractor shall ensure compliance with the requirements herein as it pertains to Section 508 compliance.

HHSAR 352.239-73 Electronic Information and Technology Accessibility Notice. (Dec 2015)

(a) Section 508 of the Rehabilitation Act of 1973 (29 U.S.C. 794d), as amended by the Workforce Investment Act of 1998 and the Architectural and Transportation Barriers Compliance Board Electronic and Information (EIT) Accessibility Standards (36 CFR part 1194), require that when Federal agencies develop, procure, maintain, or use electronic and information technology, Federal employees with disabilities have access to and use of information and data that is comparable to the access and use by Federal employees who are not individuals with disabilities, unless an undue burden would be imposed on the agency. Section 508 also requires that individuals with disabilities, who are members of the public seeking information or services from a Federal agency, have access to and use of information and data that is comparable to that provided to the public who are not individuals with disabilities, unless an undue burden would be imposed on the agency.

(b) Accordingly, any offeror responding to this solicitation must comply with established HHS EIT accessibility standards. Information about Section 508 is available at http://www.hhs.gov/web/508. The complete text of the Section 508 Final Provisions can be accessed at http://www.access-board.gov/guidelines-and-standards/communications-and-it/about-the-section-508-standards.

(c) The Section 508 accessibility standards applicable to this solicitation are stated in the clause at 352.239-74, Electronic and Information Technology Accessibility.

In order to facilitate the Government's determination whether proposed EIT supplies meet applicable Section 508 accessibility standards, offerors must submit an HHS Section 508 Product Assessment Template, in accordance with its completion instructions. The purpose of the template is to assist HHS acquisition and program officials in determining whether proposed EIT supplies conform to applicable Section 508 accessibility standards. The template allows offerors or developers to self-evaluate their supplies and document - in detail - whether they conform to a specific Section 508 accessibility standard, and any underway remediation efforts addressing conformance issues. Instructions for preparing the HHS Section 508 Evaluation Template are available under Section 508 policy on the HHS Web site http://www.hhs.gov/web/508.

In order to facilitate the Government's determination whether proposed EIT services meet applicable Section 508 accessibility standards, offerors must provide enough information to assist the Government in determining that the EIT services conform to Section 508 accessibility standards, including any underway remediation efforts addressing conformance issues.

(d) Respondents to this solicitation must identify any exception to Section 508 requirements. If a offeror claims its supplies or services meet applicable Section 508 accessibility standards, and it is later determined by the Government, i.e., after award of a contract or order, that supplies or services delivered do not conform to the described accessibility

Phoenix Indian Medical Center

Phoenix, Arizona standards, remediation of the supplies or services to the level of conformance specified in the contract will be the responsibility of the Contractor at its expense.

(End of provision)

352.239-74 Electronic and Information Technology Accessibility (DEC 2015)

(a) Pursuant to Section 508 of the Rehabilitation Act of 1973 (29 U.S.C. 794d), as amended by the Workforce Investment Act of 1998, all electronic and information technology (EIT) supplies and services developed, acquired, or maintained under this contract or order must comply with the “Architectural and Transportation Barriers Compliance Board Electronic and Information Technology (EIT) Accessibility Standards” set forth by the Architectural and Transportation Barriers Compliance Board (also referred to as the “Access Board”) in 36 CFR part 1194. Information about Section 508 is available at http://www.hhs.gov/web/508. The complete text of Section 508 Final Provisions can be accessed at http://www.access-board.gov/guidelines-and-standards/communications-and-it/about-the-section-508-standards.

(b) The Section 508 accessibility standards applicable to this contract or order are identified in the Statement of Work or Specification or Performance Work Statement. The contractor must provide any necessary updates to the submitted HHS Product Assessment Template(s) at the end of each contract or order exceeding the simplified acquisition threshold (see FAR 2.101) when the contract or order duration is one year or less. If it is determined by the Government that EIT supplies and services provided by the Contractor do not conform to the described accessibility standards in the contract, remediation of the supplies or services to the level of conformance specified in the contract will be the responsibility of the Contractor at its own expense.

(c) The Section 508 accessibility standards applicable to this contract are:

(d) In the event of a modification(s) to this contract or order, which adds new EIT supplies or services or revises the type of, or specifications for, supplies or services, the Contracting Officer may require that the contractor submit a completed HHS Section 508 Product Assessment Template and any other additional information necessary to assist the Government in determining that the EIT supplies or services conform to Section 508 accessibility standards. Instructions for documenting accessibility via the HHS Section 508 Product Assessment Template may be found under Section 508 policy on the HHS Web site: (http://www.hhs.gov/web/508). If it is determined by the Government that EIT supplies and services provided by the Contractor do not conform to the described accessibility standards in the contract, remediation of the supplies or services to the level of conformance specified in the contract will be the responsibility of the Contractor at its own expense.

(e) If this is an Indefinite Delivery contract, a Blanket Purchase Agreement or a Basic Ordering Agreement, the task/delivery order requests that include EIT supplies or services will define the specifications and accessibility standards for the order. In those cases, the Contractor may be required to provide a completed HHS Section 508 Product Assessment Template and any other additional information necessary to assist the Government in determining that the EIT supplies or services conform to Section 508 accessibility standards. Instructions for documenting accessibility via the HHS Section 508 Product Assessment Template may be found at http://www.hhs.gov/web/508. If it is determined by the Government that EIT supplies and services provided by the Contractor do not conform to the described accessibility standards in the provided documentation, remediation of the supplies or services to the level of conformance specified in the contract will be the responsibility of the Contractor at its own expense.

(End of clause)