Tohatchi Health Center Performance Work Statement (PWS) for Non-Personal Dentist Services

TABLE OF CONTENTS

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1. General: This performance work statement (PWS) describes the requirements for non-personal service Dentist Services to support the mission of the Indian Health Service (IHS).

a. Background: IHS is an agency within the U.S. Department of Health and Human Services and is responsible for providing federal health services to American Indians and Alaska Natives. The provision of health services to members of federally recognized tribes grew out of the special government to government relationship between the federal government and Indian tribes. The IHS is the principal federal health care provider and health advocate for the Indian people. The goal is to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and Alaska Natives. The IHS currently provides health services to approximately 2.0 million American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 34 states.

There is a nationwide shortage of Dentist services which is amplified by the remote and rural areas served by the Indian Health Service. This performance work statement covers requirements for the Navajo Area. The positions to be filled include: Dentists.

b. Navajo Area Indian Health Service (NAIHS): administers health centers and hospitals providing health care to approximately 201,583 members of the Navajo Nation. The Navajo Nation is the largest Indian tribe in the United States and has the largest reservation, which encompasses more than 25,516 square miles in northern Arizona, western New Mexico, and southern Utah, with three satellite communities in central New Mexico. The NAIHS is the primary provider of inpatient, ambulatory care, preventive and community health, and environmental health services for members of the Nation Nation and the San Juan Southern Paiute Tribe.

c. Tohatchi Health Center (THC): is one of the newest outpatient facilities operated by NAIHS and is located in the southeastern portion of the Navajo Nation approximately 25 miles north of Gallup, NM. THC is an outpatient health care facility staffed by primary care providers and specialty clinics are operated by consultant staff from Gallup Indian Medical Center (GIMC). THC is a health center under the Gallup Service Unit. THC provides 40 hour/week physician services for approximately 8,000 nearby residents. THC is closed after 5pm on weekdays and is closed on weekends. In addition to pediatrics, internal medicine and family medicine, services provided include pharmacy, physical therapy, x-ray, laboratory, public health nursing, optometry, dental and health education. Inpatient needs are met by referral to GIMC.

2. Scope: The Contractor shall provide physician services in accordance with Section 7, Performance-Based Requirement.

a. Duties and responsibilities consist of providing outpatient services to the Tohatchi Health Center IHS patients who present for treatment.

b. Period of Performance: The period of performance consists of a one-year base period beginning on date of award and two one-year options.

3. Applicable Documents:

a. The Indian Health Service. www.ihs.gov

b. The Joint Commission Standards https://www.jointcommission.org/

c. Centers for Medicare and Medicaid Services (CMS) Standards https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices

d. Need for Background Checks: Section 231 of Public Law 101-647, The Crime Control Act of 1990. https://www.govinfo.gov/content/pkg/STATUTE-104/pdf/STATUTE-104-Pg4789.pdf

e. Need for supervision with Children: Section 4087 of Public Law 101-630, the Indian Child and Family Violence Act. https://www.govinfo.gov/content/pkg/CFR-2002-title42-vol1/xml/CFR-2002-title42-vol1-part136-subpartK.xml

f. Health Insurance Portability and Accountability Act (HIPPA) of 1996. https://www.govinfo.gov/content/pkg/PLAW-104publ191/html/PLAW-104publ191.htm

g. IHS Service Unit and Health Center Policies, Procedures, and Protocols

h. Federal Computer Security Act of 1987: https://www.congress.gov/100/statute/STATUTE-101/STATUTE-101-Pg1724.pdf

i. Federal Code of Conduct for Federal Employees: https://www.govinfo.gov/content/pkg/CFR-2012-title1-vol1/pdf/CFR-2012-title1-vol1.pdf

j. Information Systems Security Awareness (ISSA): https://www.ihs.gov/issa/

4. Definitions

a. Acceptance: Constitutes acknowledgement that the supplies or services conform to the applicable contract quality and quantity requirements, except as provided FAR subpart 46.5 and subject to other terms and conditions of the contract.

b. Approval: Acknowledgement by the designated Government officials that submittals, deliverables, or administrative documents (e.g., insurance certificates, installation schedules, planned utility interruptions, etc.) conform to the contractual requirements. Government approval does not relieve the Contractor from responsibility for compliance with contract requirements.

c. Area: A defined geographical region for Indian Health Service administrative purposes. Each Area Office may administer several Service Units.

d. Code of Ethics: Code of ethics is described by the American Medical Association (AMA) and any code of ethics described by individual specialty organizations.

e. Contracting Officer (CO): A Government employee with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings.

f. Contractor: The individual awarded a legal binding contract to provide supplies and services.

g. Contracting Officer’s Representative (COR) or Project Officer (PO): A federal employee who assists the ordering/issuing activity contracting officer in the administration of task orders issued under this contract. The COR is primarily responsible for the technical assistance and day-to-day program management of the ordering activity’s task orders. Ordering activities may have different designators for this employee (e.g. GTR – Government Technical Representative, COTR – Contracting Officer’s Technical Representative, or PO – Project Officer).

h. Contractor Performance Assessment Report (CPAR): A report that assesses a contractor’s performance and provides a record, both positive and negative, on a given contact for specific period of time.

i. Cooperative Attitude: Behavior that is positive and displays a willingness to perform assigned patient care tasks and to be a team player.

j. Cultural Awareness: Realization and respect for American Indian and Alaska Native practices.

k. Customer: Patients, staff and visitors of an IHS Service Unit and Health Center.

l. Customer Evaluation/Input: Written comments made to the Contracting Officer regarding the Contractor’s performance. This is one of the criteria used to evaluate the Contractor’s performance.

m. Dependability: Qualities of being trusted and being able to repeat the same task to yield the same result.

n. Federal Acquisition Regulation (FAR): The FAR is the primary regulation for use by all Federal Executive agencies in their acquisition of supplies and services with appropriated funds.

o. Government Vehicle: An IHS owned motor vehicle or a vehicle leased by IHS through agreements with the General Services Administration (GSA) or through commercial rental agreements.

p. Health Center: A facility physically separated from a hospital, with a full range of ambulatory services including at least primary care providers, nursing, laboratory and x-ray which are available at least 40 hours a week for outpatient care.

q. Health Insurance Portability and Accountability Act (HIPAA): A US law designed to provide privacy standards to protect patients’ medical records and other health information provided to health plans, doctors, hospitals and other health care providers.

r. Non-Personal Service Contracts: means a contract under which the personnel rendering the services are not subject, either by the contract’s terms or by the manner of its administration, to the supervision and control usually prevailing in relationships between the Government and its employees as defined in FAR 37.

s. Orientation: An activity designed to provide basic familiarization of the facility and transition the nurse into the IHS Service Unit and/or Health Center and the nursing unit where the services will be provided.

t. Past Performance Information: Relevant information regarding a contractor’s actions under previously awarded contracts. This includes the contractor’s record of conformance to specifications and to standards of good workmanship; the contractor’s record of containing and forecasting costs on any previously performed cost reimbursable contracts; the contractor’s adherence to contract schedules, including the administrative aspects of performance; the contractor’s history for reasonable and cooperative behavior and commitment to customer satisfaction; and generally, the contractor’s business-like concern for the interest of the customer.

u. Patient Outcome: End result of medical and surgical care.

v. Performance Requirements Summary: List the services to be monitored and the standards to be applied.

w. Personal Protective Equipment (PPE): The equipment used to protect medical personnel from exposure to biological, chemical, and radioactive hazards.

x. Service Unit: The local administrative unit of IHS.

y. Standards of Practice and Standards of Care: Authoritative statements by which the medical profession describes the responsibilities for which its practitioners are accountable. The standards provide direction for professional medical practice and framework for the evaluation of practice. The standards of professional medical practice may pertain to general or specialty practice.

z. Tour of Duty: The time of day the provider is scheduled to perform medical care; also considered the shift of the day. THC Tour of Duty is an 8 hour day, from 8:00 am to 4:30 pm with a 30-minute lunch break.

aa. Valid Patient Complaint: Justifiable accusation made by a patient and supported by investigation.

ab. Verifiable Emergency: An unexpected/unplanned absence by the contractor requiring valid documentation to confirm the occurrence.

5. Clinical Privileges: Contractor shall be credentialed and have clinical privileges granted by the Gallup Service Unit’s Credentialing Committee prior to providing services. Contractor shall provide the following appropriate forms for privileging to GIMC’s credentialing specialist upon award of this contract.

a. Completed Application for IHS Medical Staff Appointment

b. Privileges Request Form

c. Completed NPDB Query Form

d. Medicare/Medicaid Acknowledgement Form

e. Medical Staff Bylaws, Rules & Regulations Acknowledgement Form

f. All Hazards Plan Acknowledgement Form

g. Copies of all active state licenses (license must indicate an expiration date)

h. Copy of DEA Registration License/Controlled Substance

i. Copies of all Board certifications

j. Copy of dental school degree

k. Copy of residency certificate(s)

l. Copy of NPI and UPIN notification letter

m. Copies of applicable BLS, ACLS, ATLS, PALS NRP ( as indicated in Rules & Regulations)

n. Copies of CME (Continuing Dental Education) for past 2 years

o. Copy(s) of malpractice insurance

p. Current Photo (Driver’s License or Passport)

q. Curriculum Vitae (CV)

6. Government Furnished Information, Property and Services:

a. Information: Government unique information related to this requirement, which is necessary for Contractor performance, will be made available to the Contractor. The Contracting Officer or designee will be the point of contact for identification of any required information to be supplied by the Government.

b. Joint Use by the Government and the Contractor: Except for the property and service listed in 3.3 and 4.0, the Government will provide, for joint use by the Government and the Contractor, all necessary equipment, supplies and clinic space to perform the services under this contract.

i. Government Vehicle: If required by the position, authorization shall be in accordance with IHS Chapter 12, Section 13 Motor Vehicle Management.

c. Contractor Exclusive Use:

i. Personal Protective Equipment (PPE): The Government will furnish the Contractor with appropriate PPE other than specified in paragraph 4 of the contract. The Government will be responsible for any repair, cleaning, and inventory required for the PPE. This does not include any type of uniform or laboratory coat.

d. The Government will provide facility specific contractor identification badges for each contractor. A minimum fee of $10.00 will be charged for lost or destroyed badges.

e. Training: Facility specific orientation/training necessary for the Contractor to perform the required duties, e.g., IHS information technology (IT) systems and operational procedures. Training will be provided ONLY if the subject matter is necessary to improve or enhance the quality of physician service or includes mandates made by the IHS Service Units/Health Centers while the physician is working under this contract. Training shall not be provided for the purpose of continuing education, career development or individual development.

7. Contractor Furnished Property: Except for the property specified in paragraph 5.0 as government furnished, the Contractor shall provide all uniforms and other personal medical instruments subject to the following:

a. Uniforms and Lab Coats: Uniform and Lab Coats shall conform to the requirements of the Indian Health Service Manual, Part 3 Chapter 4 and meet the approval of the Clinical Director at each IHS facility.

b. Other personal medical instruments: “Other personal medical instruments” are defined as Contractor owned items may include but not limited to loupes, scissors, as appropriate to the work unit. The Contractor shall not use unsafe equipment or supplies at any time during performance of this contract. All Contractor furnished equipment and supplies shall be subject to inspection by the Government and must be approved by the COR prior to use by the Contractor. The Government reserves the right to prohibit the use of any materials, supplies or equipment.

8. Performance-Based Requirements: The contractor is to provide dental services within the outpatient clinic at Tohatchi Health Center. The contractor will be required to work eight hours per twenty-four period. No overtime, no comp-time, no calls, and no holidays.

a. Major Duties and Responsibilities:

i. Contractor will sign-in and out for duty at the Tohatchi Health Center and will be paid for actual hours worked. These additional hours will be at the same pay rate. Contractor must show a working knowledge of protocols, policies and procedures, including patient confidentiality and record keeping.

ii. This contract is for the provision of professional dental services. Dental Services shall be provided in the Dental setting.

iii. The contractor shall provide dental services under the terms of this contract, appropriate and timely dental services in accordance with the standards of care established by recognized dental care organizations and in accordance with the policies and procedures of the service unit’s medical/dental staff bylaws, rules and regulations, including attendance at department and medical staff meetings.

iv. Contractor shall perform diagnosis, care and treatment of dental patients and dental consults from other departments or facilities.

v. Contractor shall interview and examine dental patients, review past dental history, and requests and/or perform diagnostic tests and examinations, deemed necessary to obtain all possible information related to each case.

vi. Contractor shall make preliminary diagnoses, directs, prescribes, or provides treatment, or arranges for specialized care or patient referral as required. Bases decisions upon information obtained, professional medical knowledge and skills and prescribed policies and procedures.

vii. Contractor shall consult with other dentist from other dental clinics within IHS whenever necessary to more clearly define a patient’s problem and seek assistance to safely provide the necessary dental interventions.

viii. Contractor shall make notes of observations to be incorporated into clinical records.

ix. Contractor shall provide emergency care as required.

x. Contractor shall provide definitive management in all Dental care cases that do not require referral. Gives dental patient care services including health maintenance, early diagnosis, and treatment and arranging of follow up services to dental patients under his/her care.

xi. Contractor shall refer dental patients to appropriate contracted dental or other Governmental facilities, providing full dental information for care and diagnostic procedures that cannot be adequately provided at local IHS facilities. Coordinated and integrates information obtained into the ongoing dental health care and assures the provision of timely follow up care as required.

xii. Contractor shall prepare appropriate dental record for patients seen to assure the accumulation and organization of all pertinent clinical data needed to provide comprehensive medical care. Contractor shall complete dental reports and correspondence on patients under their care in a timely fashion. Clinical data reports for the records of each patient shall be maintained in compliance with Joint Commission and CMS standards.

xiii. Contractor shall evaluate patient symptoms, designing treatment plans and educate the patient and family about their condition and initiating care.

xiv. Contractor shall prepare prescriptions accurately following Federal and U.S. Public Health Service laws and policies. Contractor agrees to assure appropriateness of drug therapy. The provider will assure that drug therapy is safe, efficacious and cost effective. Standards of care developed or adopted by the professional staff of the facility shall be the criteria for appropriateness of drug therapy. The provider shall screen the patient health record to avoid inappropriate drug interactions and monitor patients for the appropriateness of therapy.

xv. Contractor shall perform in accordance with the approved privileges through the credentialing process.

xvi. Contractor is subject to the Privacy Act and shall complete the Privacy Act training required of all Professional Service Contractors through staff development.

9. Adherence to Policies and Quality Improvement Processes:

a. Contractor shall provide services in accordance with standards of The Joint Commission (TJC) and professional standards of the American Boards in their appropriate specialty.

b. Contractor agrees to participate in THC’s peer review system and to make practice modifications in accordance with the peer review group’s findings and recommendations.

c. Contractor agrees to participate in THC’s performance improvement program within the scope of dental activity.

d. Contractor agrees to maintain patient records in the Problem Oriented Medical Record format utilizing the Patient Care Component of the Resource Patient Management System. Patient records require close attention to documentation policies for frequency and content of note, dictated summaries, abbreviation use, timeliness for processing and legibility. Signatures in all places should be clarified with a printed or stamped name beneath the scripted entry in accordance with Gallup Service Unit/Tohatchi Health Center policies.

e. Contractor shall complete all dental medical records at the end of each work session. The contractor will be reviewed in the routine performance assessment system, performance improvement program, and surgical performance improvement program.

10. Key Personnel Qualification Requirements:

a. Experience: The Contractor shall have a minimum of twenty-four (24) months of experience, including residency unless otherwise approved by the Contracting Officer.

b. License: All dentists shall possess a current, valid, active, unrestricted license to practice dentistry in a state, the District of Columbia, the Commonwealth of Puerto Rico, or a Territory of the United States, throughout the term of this contract.

c. All dental providers shall possess a current Board certification, Exception being that they are Board eligible.

d. All providers shall possess a current, valid, unrestricted driver’s license in any state.

i. Motor Vehicle Operator’s License: If required by the position, the Contractor shall possess a valid state driver’s license throughout the term of this contract.

e. Certifications: Current Basic Life Support (BLS) and is mandatory.

The contractor will comply with the following listed regulations:

PRIVACY, INDEMNIFICATION AND GOVERNING LAW:

- Privacy Act, 5 U.S.C. 552a - Office of Privacy and Civil Liberties | Privacy Act of 1974

- Health Insurance Portability and Accountability Act (HIPAA) - eCFR :: 45 CFR Part 164 -- Security and Privacy

- CFR 42 Part 2 - eCFR :: 42 CFR Part 2 -- Confidentiality of Substance Use Disorder Patient Records

11. Health Requirements/Conditions of Employment:

a. Medical Evaluation: The Contractor shall provide a fitness for duty certificate issued by a licensed physician to perform the proposed job without significant risk to personal health or the health and safety of others.

b. Immunization: The Contractor shall also provide the following documentation:

i. Immunity to Rubella, Mumps, Measles

ii. Immunity to Hepatitis B Series

iii. History of chicken pox (varicella) disease or positive titer

iv. Tdap vaccine required

v. Documentation of receiving a TB Mantoux skin test (PPD) within the past 12 months with documentation of follow-up for a positive test.

vi. A signed declination of the Hepatitis B vaccination series will be accepted.

vii. Current influenza vaccination

12. Billing of Professional and Facility Fees:

a. Tohatchi will bill for and collect all applicable reimbursement monies associated with the contracted service. Contractor shall provide THC with the National Practitioner Identification (NPI) number and DEA of the contracted dental provider.

13. Conduct: The Contractor shall meet standards as listed in the Federal Code of Conduct.

a. The Government reserves the right to remove from the facility any Contractor employee failing to abide with the Federal Code of Conduct.

14. Performance Evaluation:

a. The Contractor’s performance will be evaluated in accordance with the standards set forth in the contract and Performance-Based Matrix.

b. Substantiated reports written by any customer dealing with patient safety, infection control, inappropriate behavior or any procedures that adversely affects patient outcome constitutes a breach of contract.

15. Identification of Key Personnel:

a. The Contractor shall wear a government issued contractor identification badge during performance of duty.

16. Management of Medical Information: The Contractor shall manage all patient information in accordance with HIPAA standards, Privacy Act, and IHS Service Unit and/or Health Center specific policies and protocols.

a. Medical Records and Other Required Documentation: 100% percent of all medical records and other required documentation meets established IHS Medical Facility, The Joint Commission (TJC), and CMS standards to include, but are not limited to, timeliness, legibility, accuracy, content, date, time, signature and designated profession. (Note: payment will be withheld for inaccurate or incomplete medical records.)

b. The Contractor shall ensure adherence to DHHS IT system security policies and procedures. The IT policies and procedures will be made available to the Contractor.

c. The Contractor shall immediately report to the Contracting Officer or COR any information or circumstances that may violate any statute, policy or procedure.

17. IHS Information Technology Systems:

a. In performance of this contract, the Contractor shall adapt to and successfully utilize IHS information technology systems that are deemed by the Supervisor as necessary for acceptable contractor performance, including use of the Electronic Health Record (EHR).

b. The Contractor shall ensure that IHS information technology system security policies and procedures are adhered to. The IT policies and procedures will be made available to the Contractor at each IHS facility.

18. Language Requirements and Cultural Awareness: The Contractor shall read, understand, speak, and write English to effectively communicate with patients and other health care workers, and shall be respectful of the local, American Indian and Alaska Native culture. Many of the patients receiving health care services under this contract shall be capable of demonstrating sensitivity to cross-cultural and language differences. The provider must be able to work through interpreters as necessary for non-English speaking patients, be cognizant of surrounding and adjacent communities, and be able to work with a diverse work force that is predominantly Bi-lingual and Native American staffed.

19. Information Technology Skills: The Contractor shall possess basic knowledge, skills, and abilities to use a computer.

20. Orientation: All providers providing service under this contract shall attend mandatory orientations and training specified by the government.

21. Background Checks: As directed by the Contracting Officer, the Contractor shall provide all requested information necessary to perform background checks. The Contractor shall comply with the requirement to obtain security investigations. The Contractor shall work with the IHS to ensure that the pre-employment screening process includes the appropriate investigation questionnaires and forms to be completed. All completed forms will be reviewed by the Contractor and forwarded to the Government personnel. The Contractor will be immediately removed from the position if at any time the investigation receives unfavorable adjudication, or, if other unfavorable information that would affect the investigation becomes known.

22. Challenges to Conflicts: All personnel are required to maintain an appropriate professional demeanor in the presence of patients and with each other. Harmony and good communication between the staff is necessary to maintain the best patient care environment and all staff members are expected to contribute to a positive milieu. Violent language, profanity, and any threatening behaviors are specifically prohibited.

23. Performance Requirements Summary

This Standard describes "What Success Looks Like."

For each "Standard", state the method used to check performance (i.e. random sampling, 100"/4 inspection, periodic inspection, customer complaints List Positive and Negative Incentives. Address method of linking payment to quality of service.

Compliance

Patient Outcomes

Professionalism

Credentialing

Documentation Perform 100% required tasks at 100% of the required competencies (refer to 11.0)

100% compliance with IHS Service Units and/or Health Centers published Policies; Procedures; Standards of Care; and hospital protocols.

No reports of breached patient safety, infection control, and other procedures that might adversely affect patient outcome.

Performance characterized by continual cultural awareness and focus on customer service. 100 percent adherence to the Federal Code of Conduct

Uninterrupted credentialing as defined in 5.0 for the period of the contract.

100% percent of all documentation meets established IHS Medical Facility, TJC, and CMS standards to include, but are not limited to, timeliness, legibility, accuracy, content, date, time, signature and designated profession.

Contractor performance will be evaluated using the Contractor Performance Assessment Reporting System (CPARS). The evaluation will be considered when future IHS contract selections are made