ATTACHMENT A - PERFORMANCE WORK STATEMENT.pdf

PWS No. GIMC PEDS February 2023

Gallup Indian Medical Center Performance Work Statement (PWS) for Personal Services

Pediatric Physician Services

Table of Contents

Section Page

1.0 General 2

2.0 Scope 2-3

3.0 Applicable Documents 3

4.0 Definitions 3-6

5.0 Government Furnished Information, Property and Services 6-7

6.0 Contractor Furnished Property 7

7.0 Performance-Based Requirements 7-9

8.0 Supervision 9-10

9.0 Work Schedule 10

10.0 Contractor Qualification Requirements 10-11

11.0 Billing of Professional and Facility Fee 11

12.0 Conduct 11

13.0 Performance Evaluation 11

14.0 Identification of Contractor 11

15.0 Management of Medical Information 11-12

16.0 IHS Information 12

17.0 Health Requirements/Conditions of Employment 12

18.0 Language Requirements and Cultural Awareness 12

19.0 Information Technology Skills 13

20.0 Orientation 13

21.0 Background Checks 13

22.0 Challenges to Conflict 13

23.0 52.249-12 Termination (Personal Services) (Apr 1984) 13

24.0 52.224-1 Privacy Act Notification (Apr 1984) 14

25.0 Performance – based Matrix 15

PWS No. GIMC February 2023

1. General: This performance work statement describes the requirements for personal service pediatric physician services to support the mission of the Indian Health Service (HIS).

1.1 Background: IHS is an agency within the U.S. Department of Health and Human Service 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 people. The goal is to assure that comprehensive, culturally acceptable person and public health services are available and accessible to American Indians and Alaska Natives. The IHS currently provides health services to approximately 2.0 million American Indian and Alaska Natives who belong to more than 557 federally recognized tribes in 34 states.

There is a nationwide shortage of medical providers in certain specialties 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:

Physicians for the provision of outpatient and inpatient pediatric medical and level 2 nursery services.

1.2 Navajo Area Indian Health Service (HAIHS) administer 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 Navajo Nation and the San Juan Southern Paiute Tribe.

1.3 Gallup Indian Medical Center is a 78-bed hospital in Gallup, New Mexico, on the border of the Navajo Reservation. Clinical specialties at GIMC include Internal Medicine, Cardiology, Anesthesia, OB/GYN, General Surgery, Orthopedics, Ophthalmology, ENT, Radiology, Pathology, Pediatrics, Psychiatry, Emergency Medicine, and Urology. The workload at Gallup is one of the largest in the Indian Health Service with 310,000 outpatient encounters and 4,400 inpatient admissions annually. GIMC has the largest staff of all Navajo Area IHS Facilities.

2.0 Scope: The Contractor shall provide medical physician services in accordance with section 7.0, performance based requirements.

2.1 Duties and responsibilities may encompass outpatient and inpatient services to HIS patients.

2.2 Place of Performance: Services are to be performed at hospitals, clinics and other healthcare facilities of the Navajo Area Indian Health Service within the Gallup Indian Medical Center. The award pricing schedule will identify the exact place of performance.

2.3 Period of Performance: Will be flexible to allow for short term (less than one week), long term (1-year to 3-years) and, where feasible, include intermittent support to meet unplanned needs that develop on a frequent basis.

3.0 Applicable Documents: Please see the web link listed unless document is listed as an attachments.

3.1 Joint Commission on Accreditation of Healthcare Organizations (TJC) http://www.JAC.org

3.2 Centers for Medicare and Medicaid Services (CMS) Standards http://www.cms.hhs.gov

3.3 Accreditation Association for Ambulatory Health Care (AAAHC) http://www/aaahc.org

3.4 Section 231 of Public Law 101-647, the Crime Control Act of 1990 http://www.policyalmanac.org/crime/archive/crs federal crime policy.shtml

3.5 Section 4087 of Public Law 101-630, the Indian Child and Family Violence Act.

http://www.nicwa.org/policy/law/protection/index.asp

3.6 Health Insurance Portability and Accountability Act (HIPAA) of 1996 http://www.cms.gov/HIPAAGenInfo/

3.7 Privacy Act of 1974

http://www.justice.gov/opcl/privacyact1974.htm

3.8 Revised American Nurses Association Code of Ethics and Standards of Practice and Care (1996) http://www.nursingworld.org

3.9 State Nurse Practice Act for the Contractor’s licensing state http://www.medi-smart.com/

3.10 IHS Service Unit and Health Center Policies, Procedures and Protocols

3.11 Computer Security Act of 1987

http://csrc.nist.gov/groups/SMA/ispab/documents/csa 87.txt

3.12 Federal Code of Conduct

http://www.ihs.gov

3.13 IHS General Directives http://www.ihs.gov/index.cfm?module=AtoZ&option=index

3.14 IHS Computer Security Directives http://security.ihs.gov/index.cfm

4.0 Definitions

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

4.2 Approval: Acknowledgement by the designated Government official that submittals, deliverables, or administrative documents (e.g., insurance certificates, installation schedules, planned utility interruptions, etc.) conform to the contractual requirement.

http://www.jac.org/ http://www.cms.hhs.gov/ http://www/aaahc.org http://www.policyalmanac.org/crime/archive/crs%20federal%20crime%20policy.shtml http://www.nicwa.org/policy/law/protection/index.asp http://www.cms.gov/HIPAAGenInfo/ http://www.justice.gov/opcl/privacyact1974.htm http://www.nursingworld.org/ http://www.medi-smart.com/ http://csrc.nist.gov/groups/SMA/ispab/documents/csa%2087.txt http://www.ihs.gov/ http://www.ihs.gov/index.cfm?module=AtoZ&option=index http://security.ihs.gov/index.cfm

Government approval does not relieve the Contractor from responsibility for compliance with contract requirements.

4.3 Area: A defined geographical region for Indian Health Service administrative purposes.

Each Area Office may administer several Service Units.

4.4 Code of Ethics: Code ethics as described by the American Medical association (AMA) and any code of ethics described by individual specialty organizations.

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

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

4.7 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, CORT-Contracting Officer’s Technical Representative, or PO – Project Officer).

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

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

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

4.11 Customer: Patients, staff and visitors of an IHS service unit and health center.

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

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

4.14 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 appropriate funds.

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

4.16 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.

4.17 Ordering Activity: An authorized user of IHS that may issue a task order to obtain required services under this contract.

4.18 Ordering Activity Contracting Officer: A government employee IHS authorized and warranted to issue task orders ad to make subsequent task order modification(s) under this contract. The Ordering Activity CO has the authority to make initial determinations on all matters of dispute regarding task orders.

4.19 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.

4.20 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.

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

4.22 Performance based Matrix: Lists the services to be monitored and the standards to be applied.

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

4.24 Personal Service Contracts: A contract that, by its express terms or as administered, makes the Contractor appear to be Government employee, as defined in FAR 37.

4.25 Service Unit: The local administrative unit of IHS

4.26 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 a framework for the evaluation of practice. The standards of professional medical practice may pertain to general or specialty practice.

4.27 Supervisor: Government employee authorized to provide verbal and written performance direction to the Contractor that the Contractor must follow without exception.

4.28 Task Order: An order issued in accordance with the terms of the contract that details an ordering activity’s specific requirements. An ordering activite4s written order to obtain services, at a minimum will include the following where applicable: description of services, skill categories, hours, price, period of performance, contract number, and the ordering activities task order number.

4.29 Tour of Duty: The time of day the provider is scheduled to perform medical care; also considered the shift of the day. the time can var4y according to the needs of each facility and/or clinic, e.g. 12 hour Tour of Duty, 8 hour Tour Duty, 10 hour Tour of Duty. Includes nights, weekends and holidays.

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

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

5.0 Government Furnished Information, Property and Services

5.1 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.

5.2 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.

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

5.3 Contractor Exclusive Use:

53.1 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.

54.4 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.

5.5 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 nursing services or includes mandates made by the IHS Service Units/Health Centers while the nurse is working under this contract. Training will not be provided for the purpose of continuing education, career development or individual development.

6.0 Contractor Furnished Property

6.1 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:

6.2 Uniforms and Lab Coats: Uniforms 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.

6.3 Other personal medical instruments: “Other personal medical instruments” are defined as Contractor owned items may include but not limited to stethoscope, 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.

7.0 Performance-Based Requirements. The Contractor shall provide pediatric physician services in the delivery of patient care at the Gallup Indian Medical Center, Gallup, New Mexico.

Specific task include the following:

7.1 Major Duties and Responsibilities:

7.1.1 Contractor shall perform diagnosis, care and treatment of pediatric outpatients and/or inpatients, level 2 nursery patients, pediatrics consults in the Emergency

Department and Urgent Care Department and consultations of the inpatients admitted to other services (Surgery, Orthopedics, OB/GYN).

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

7.1.3 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.

7.1.4 Contractor shall consult with other pediatricians or providers from other medical disciplines whenever necessary to more clearly define a patient’s problem and seek assistance to safely provide the necessary medical interventions.

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

7.1.6 Contractor shall provide emergency care as required.

7.1.7 Contractor shall provide definitive management in all pediatric medical categories for cases that do not require referral. Gives total patient care including health maintenance, early diagnosis, treatments and arranging of follow up services to pediatric patients under his/her care.

7.1.8 Contractor shall refer pediatric patients to appropriate contracted medical or other Governmental facilities, providing full clinical information for care and diagnostic procedures that cannot be adequately provided at local IHS facilities.

Coordinates and integrates information obtained into the ongoing health care program at the Service Unit and assures the provision of timely follow up care as required.

7.1.9 Contractor shall prepare appropriate medical records for pediatric primary care patients seen to assure the accumulation and organization of all pertinent clinical data needed to provide comprehensive medical care. Dictates clinical reports and correspondence concerning pediatric patients under his/her care to physicians, hospitals, and other individuals and facilities.

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

7.1.11 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.

7.1.12 Contractor shall perform other duties as assigned, by Chief of Pediatrics

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

7.2 Adherence to policies and quality improvement processes

7.2.1 Contractor shall provide services in accordance with standards of The Join Commission (TJC) and professional standards of the American boards in their appropriate specialty.

7.2.2 Contractor agrees to participate in the GIMC Pediatric Department peer review system and to make practice modifications in accordance with the peer review group’s findings and recommendations.

7.2.3 Contractor agrees to participate in the GIMC performance improvement program within the scope of clinical activity. This includes working with Discharge Planning to help facilitate timely accommodation of patient needs and prompt dispositions.

7.2.4 Contractor agrees to maintain patient records in the Problem Oriented Medical Record format utilizing the Patient Care Component of the Resource Patient Management System. Inpatient 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 GIMC and Pediatric Department policies.

7.2.5 Contractor shall complete all 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.

8.0 Supervision

8.1 Contractor will be under the supervision of the Chief, Pediatric Department, Gallup Indian Medical Center. Work that involves out of the ordinary diagnostic decisions or

Treatment is discussed with appropriate consultant and supervisor, who shall be kept aware of the condition of such patients and aspects of treatment regimen. Work performance is reviewed for conformance to policies, procedures and practices relating to delivery of adult primary care services.

9.0 Work Schedule:

9.1 The Supervisor shall determine specific tour of duty. The contractor shall work 100% of the contracted hours.

9.2 Contractor will keep the supervisor (or designee) informed of general time of arrival and departure for each day and submit timesheets at the end of wee/ last shift. Contractor will only be paid for actual hours worked in clinic(s). Appropriate accounting and payment is contingent upon accurate timesheet completed.

9.3 Work Flexibility. As directed by the Supervisor, the Contractor shall provide on-call support as needed to support patient care.

9.4 The Contractor shall obtain approval of the department Supervisor or designee prior to any absence from work. If the length of the absence exceeds eight (8) work hours the Contractor shall requ7est approval at least fifteen (15) days, (the exception is verifiable emergencies) in advance of the desired absence.

9.5 Approval of leave is contingent upon availability of a qualified replacement.

9.6 The Contractor shall provide written documentation from a qualified health care provider for absences of three (3) or more consecutive days, due to illness, stating:

9.6.1 The cause of the current illness or incapacitation AND Indicating the Contractor as contagious or non-contagious.

10.0 Contractor Qualification Requirements:

10.1 Experience. The Contractor shall have a minimum f thirty six (36) months of experience within their specialty, including residency unless otherwise approved by the Contracting Officer.

10.2 License. All providers shall possess a current, valid, active, unrestricted license to practice medicine in a state, the District of Columbia, the Commonweath of Puerto Rico, or a Territory of the United States, throughout the term of this contract.

10.3 All providers shall possess a current Board eligibility of certification by the American

Board of Pediatrics.

10.4 All providers shall provide documentation of completion of an ACGME-approved

Pediatric residency program.

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

10.5.1 Mover 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.

10.6 Certification. Current Basic Life Support (BLS) is mandatory for all specialties.

11.0 Billing of Professional and Facility Fees:

11.1 GIMC will bill for and collect all applicable reimbursement monies associated with the contracted service. Contractor shall provide GIMC with the National Practitioner Identification (NPI) number of the contracted medical provider.

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

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

13.0 Performance Evaluation:

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

13.2 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.

14.0 Identification of Contractor:

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

15.0 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.

15.1 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.)

15.2 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.

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

16.0 IHS Information Technology Systems

16.1 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).

16.2 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.

17.0 Health Requirements/Conditions of Employment:

17.1 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.

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

Immunity to Rubella, Mumps, Measles

Immunity to Hepatitis B series

History of chicken pox (varicella) disease or positive titer

Tdap vaccine required

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

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

Current Influenza vaccination

18.0 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 only speak a Native language and/or reside on an Indian reservation. The Contractor 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.

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

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

21.0 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 wok 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 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 any time the investigation receives unfavorable adjudication, or, if other unfavorable information that would affect the investigation becomes known.

22.0 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.

For any inconsistency between supervisor directions, this Performance Work Statement, attachments and exhibits, the following order of precedence will apply:

(a) First Priority: Supervisor’s directions

(b) Second Priority: Position Description (attached)

(c) Third Priority: Performance Work Statement Narrative

23.0 52.249-12 Termination (Personal Services) (Apr 1984): The Government may terminate this contract at any time upon at least 15 days’ written notice by the Contracting Officer to the Contractor. The Contractor, with the written consent of the Contracting Officer, may terminate this contract upon at least 15 days’ written notice to the Contracting Officer.

23.1 Any Contractor employee demonstrating impaired judgment shall not be allowed to continue working on the contract. The Government reserves the right to remove from the facility and Contractor employee who in the judgment of a licensed healthcare practitioner is impaired.

24.0 52.244-1 Privacy Act Notification (Apr 1984) The Contractor will be required to design, develop, or operate a system of records on individuals, to accomplish an agency function subject to the Privacy Act of 1974, Public Law 93-579, December 31, 1974 (5 U.S.C. 552a) and applicable agency regulations. Violation of the Act may involve the imposition of criminal penalties.