Attachment B - PWS.pdf

Performance Work Statement Psychiatric Services Fort

Yuma Health Clinic 21

It is the intent of the Fort Yuma Health Clinic (FYHC) to acquire non-personal professional

Psychiatric Physician services as described herein located in Fort Yuma, Arizona.

Contractor is requested to provide non-personal professional Psychiatric services for a 12-month base period and four (4) one (1) year option periods. Current need is for full-time.

The intent of this contract is to establish a method whereby FYHC can minimize disruptions in clinical services due to staff shortages over the next five (5) years. Also, even when the best plans are laid to hire and retain staff, our remote location makes this difficult and we can have staff shortages despite trying to hire a full-time employee(s). Requests for contractor coverage will be based on the consistently changing needs of the clinic. Services will be on-needed basis.

The Fort Yuma Service Unit is located on the Quechan/Ft. Yuma Indian Reservation and serves approximately 2,434 tribal members. This site gives residents of both the Quechan and Cocopah tribes access to our facilities within one hour. The facility is right across the river from Yuma. A small, family-oriented city, Yuma offers a good choice of housing and shopping centers, as well as recreational and educational opportunities. In addition to elementary and high schools, Arizona

Western College is based here, and extension courses are available from Northern Arizona

University. The municipality also includes an airport and a Marine Corps Air Station.

The services provided include general medical, ambulatory, pediatric, community health, preventative health, mental health, and dental care. Special ambulatory services are provided on-site by IHS staff based in Phoenix or private contract specialists. Obstetric patients and those requiring surgery are referred to the Yuma Regional Medical Center (YRMC), in Yuma, or to

Phoenix Indian Medical Center (PIMC), in Phoenix. Ground and air transport are available for emergency care.

The overall scope of this contract is recruit and hire a qualified contractor under a Government service contract. The contractor will be expected to have the necessary education, training, licensing, previous work experience and competence in being able to provide the services within the department. Work performance shall be performed according to the requirements and conditions contained in this Statement of Work.

All responses to this solicitation and for candidate submissions shall contain a complete profile and current work history of the candidate(s) presented, including licensure and certifications.

Selected candidate shall undergo the Indian Health Service mandated security clearance requirement prior to commencement of services at the Fort Yuma Health Clinic. The security pre-clearance requirement must be adhered to; the process includes a fingerprint check and a screen check of the physician through the office of the inspector general's exclusion list at http://exclusions.oig.hhs.gov/ .

Please note: The contractor shall provide and identify at least (3) weeks in advance of the scheduled performance date the candidate for the scheduled shift(s). This is due to the

Government’s security clearance and credentialing/ and or privileging requirement. This is to ensure that the candidate is cleared prior to the commencement of services.

http://exclusions.oig.hhs.gov/

SCHEDULES/LOCATIONS/SHIFTS/QUALIFICATIONS/CERTIFICATIONS:

FYHC currently has the following operational hours: Monday through Friday, 8:00 AM to 5:00

PM. Specific days may change based upon the needs of FYHC.

LOCATION: All services shall be performed at the following location:

Fort Yuma Service Unit (FYSU)

401 E. Picacho Road Winterhaven, California 92283

SHIFTS: Contractors will be expected to abide by the facility’s Uniform Code and shift hour assigned, modalities of charting and care delivery and other rules and regulations of the facility.

Work within a designated schedule prepared by the Clinical Director or his/her designee. Any period of absence or changes in the schedule will be communicated with the Clinical Director or his/her designee 15 days prior, except for emergency situations. The Contractor is requested to provide PSYCHIATRIC SERVICES full-time. Shift times and schedules are subject to change based on the medical needs of the patient populace and hospital/clinic operations.

Day shift: 8:00 A.M. – 5:00 P.M. (0800-1700) with exception of Federal Holidays.

NOTE: The duration of each shift may vary due to patient load, clinical complexity, weather and other circumstances. 100% of the Clinics shall be in person and there will be no overtime approved.

Work Schedule: There will be (5) clinical visits or clinic days each week.

Schedules may be adjusted but will have a 30-minute unpaid lunch break, depending on the needs of the unit, and timing of peak patient care activity. * Government does not pay time taken for lunch. Total shifts worked annually shall be in accordance to the total number of work hours allocated for the year by FYHC.

Thirty (30-60) minute lunch breaks are included in shift hours and Government does not pay time taken for lunch. The Service Unit shall make every effort to submit a schedule two (2) weeks in advance. Shifts may be cancelled or shortened without time restriction or monetary penalty before the Contractor’s employee arrives for duty.

Unless exempt, medical professionals covered by the Fair Labor Standards Act on a compressed schedule must receive overtime pay for hours worked over 80 in a two week pay period, as defined by the HHS payroll calendar.

Time Off: The provider shall give a two week notice for requested time off unless there is an emergency. The contractor shall notify their immediate supervisor, the COR, and their Contractor for the requested time off. The contractor will adjust the timecards/invoices accordingly given the requested time off.

Contractors shall attend assigned meetings, participate fully as staff members, and actively participate in ongoing quality management activities and any other FYSU or Indian Health Services initiatives deemed applicable to the specialist’s work.

QUALIFICATIONS/CERTIFICATIONS-PROFESSIONAL SERVICES:

It is preferable that Physician have experience and/or practice in remote settings.

• Psychiatry Physician/Specialist shall have four (4) years of accredited medical school leading to MD/DO doctorate level diploma.

• Minimum three (3) years of residency training in Psychiatry.

• Two (2) years experience in appropriate specialty.

• Current Board Certification or Board Eligible as confirmed by the appropriate and acceptable certifying organization.

• Recent procedure logs required for privileges to be appointed

• Current certification in BLS (Basic Life Support) is required.

• Current certification in ACLS (Advanced Cardiac Life Support) is required.

• Current certification in PALS (Pediatric Advances Life Support) is required.

• Applicants must have an active, unrestricted, and free of disciplinary action license as a physician in a State, District of Columbia, the Commonwealth of Puerto Rico, or a

Territory of the United States.

• Medical malpractice liability coverage.

• Physician must be eligible for billing to Medicare and Medicaid (CMS).

NOTE: According to current FYSU Policy as referenced by the FYSU Credentialing

Education and Competency Plan. (All Contractor’s employee’s personnel shall have current certifications/licenses described above).

a. Shall have successfully completed an Accreditation Council for Graduate Medical

Education (ACGME)- or an American Osteopathic Association (AOA)- accredited post-graduate training program in Psychiatry.

b. Contract psychiatrists shall possess ABMS, AOA, and/or NBPAS-board certification in

Psychiatry or related specialty as deemed appropriate by the Clinical Director; all board certification(s) must be in a clinically active status. Relevant ABMS- or AOA board-eligibility may be considered for recent (< 3 years) graduates of a relevant ACGME- or an AOA-accredited post-graduate psychiatry training program.

c. The psychiatrist may be requested to provide documentation of the number and types of relevant cases during the past 24 months. Contractors have the burden of producing information deemed necessary for a proper evaluation of current competence, qualifications, and/or for resolving any doubts.

PRICING SCHEDULE (Complete Attachment A- Rate Schedule):

The unit prices 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, any monies for services provided under this award.

Hourly fixed rate shall be inclusive of all other fees (holiday, nights, weekend), including travel expenses, per diem, lodging, all city, state, federal and local taxes, and all miscellaneous costs associated with the provision of services. The government will pay one flat rate. The Contractor shall be paid only for actual time services are performed under the terms of the contract at the hourly fixed rate. The clinic quantities are estimated and estimated totals are not to be exceeded.

There is no provision for OVERTIME or ON CALL SERVICES.

SCOPE OF WORK:

The contractor shall be expected to assist and provide services and duties as may be requested for the normal operational requirements for the department and personnel. The contractor shall provide work that is consistent with the guidelines and procedures of the IHS. Failure of the contractor to meet these standards can result in cancellation of this contract. The contractor’s performance and abilities shall be evaluated based upon performance standards that are contained in this statement of work.

The contractor shall prepare and complete in a timely fashion, the medical and other required records for all parties he/she admits or in any way provides care for the hospital or health care facility (Service Unit Medical By-Laws). Chart notes are to be completed on the day services are rendered. During the performance of their duties, the contractor shall provide for the consistent performance of patient care processes according to the standards for TJC accreditation program within IHS. These standards include: The Comprehensive Accreditation Manuals for

Critical Access Hospitals, and the Laboratory Standards as they represent the scope of services of this contract.

The contract physician shall speak, understand, read and write the English language fluently. The physician should be proficient in typing and have a basic working knowledge and understanding of computer hardware and software applications.

Services shall be periodically assessed and evaluated to ensure medical and health services programs are consistent with current standards of practice.

The contractor shall possess a professional medical education from a post-secondary academic institution or be licensed in a field of medical study. The contractor should be proficient in writing, typing and have a basic working knowledge and understanding of computer hardware and software applications. The contractor shall have sufficient knowledge, competence and experience in providing these services on a regular schedule to the Ft Yuma Medical Center or similar medical clinic or hospital. The contractor shall possess sufficient initiative, interpersonal relationship skills, social sensitivity and appropriate professional behavior such that the contractor can relate constructively to IHS employees, contractors, vendors and individuals from the Native American community. The contractor shall not have any work or health restrictions, which could directly or indirectly interfere with the performance of providing services. The contractor shall maintain acceptable standards of personal hygiene, grooming and professional attire such that their image as a Federal contract employee is compatible with the expectations of the IHS staff.

The contract physician shall consistently ensure confidentiality of all patient medical records.

Information contained in these records may not be disclosed to any person or agency, except in accordance with established standards, policies, and procedures. This obligation shall not prevent the disclosure of patient medical records to officials and employees of departments and agencies of the United States US Government acting in performance of official duties pursuant to laws and regulations governing local control of communicable diseases, preventive medicine, and safety programs; to official representative authorized surveying bodies during the conduct of certification and accreditation reviews, or to third party payers to whom the patient has authorized release of information.

Complete administrative control of patient data remains with the US Government. All records produced in the performance of the contract and all evaluations of patients are the property of, and subject to the exclusive control of, the US Government. All records shall be maintained in accordance with medical treatment facility guidelines and standards.

All financial, statistical, personnel, and technical data which is furnished produced or otherwise available to the Contractor during the performance of this contract are considered confidential business information and shall not be used for purposes other than performance of work under this contract. Such data or information shall not be released nor legal rights claimed by the Contractor without prior written consent of the Contracting Officer. Any presentation of any statistical or analytical materials, or any reports based on information obtained from performance by this contract will be subject to review and approval of the Contracting Officer.

The contractor shall be required to utilize the electronic health record for chart documentation, after receiving training (at Government expense) to enter all lab, x-ray and medication requests.

The Contractor shall comply with federal "EMTALA" regulation and hospital policies regarding the transfer of patients to and from other facilities and whenever possible shall utilize contracted medical services and facilities.

The Contractor’s employee(s) shall be sensitive to the unique culture factors of the people they treat, which may include use of an interpreter as necessary in communication of services being rendered. Unique cultural factors that may contribute to the patient’s treatment include: use of their language communications; village and tribal customs; use of traditional healers; isolation; housing conditions and lack of resources.

All Contractors must provide copy of resume for file. Contractor file will be kept by the FYSU for verification of license or certificate, also file will contain personal information such as home, address, and phone number, next of kin, person to notify in case of emergency, health requirements, mandatory in-service and continuing education, competency assessments and awards or disciplinary action.

Accommodations/Lodging – the Contractor shall provide accommodations or housing allowance for the selected physicians for the duration of the period of performance of the contract. No housing is available at FYHC.

MAJOR DUTIES REQUIRED:

The contractor shall provide direct review of medications, direct psychiatric clinical evaluations, diagnosis, treatment and treatment planning providing psychotherapeutic and other psychological services. Services provided may include the following: individual services, group therapy, relaxation therapy, behavior therapy, and child and adolescent therapies. These are all provided with a sensitive understanding of culturally relevant issues.

The contractor shall prescribe, make preliminary diagnosis, direct, provide treatment or refer for specialized care following Indian Health Services guidelines for referrals.

• Psychiatric Physician Services shall be provided on-site at the Fort Yuma Indian Health

Center. Psychiatric services to be provided shall include but limited to:

• Review of medication

• Interview and assessment

• Formulation of treatment plan

• Treatment and follow-up

• Phone consultation with service unit medical staff as needed

• Contractor shall send a monthly report to the project officer on the clinical status of each patient seen during the month

Skill and knowledge of established concepts, principles and practices related to health care assignments and additional training or experience in assessing the conditions of patients, in providing medical care and in advising on health care needs, all with full consideration of mental, emotional and physical factors.

Knowledge of the diagnostic, preventive and therapeutic position related to a variety of medical health care fields to include primary care, OB/GYN, ENT, Pediatric, orthopedics, internal medicine, mental health, dental, emergencies, medicine, minor surgery, nutrition, and hospital medicine.

Assumes responsibility for the diagnosis, care and treatment of inpatient and ambulatory care cases.

Admits and manages patients to the inpatient department of FYHC and ability to provide emergency treatment.

Interviews and examines patients, reviews past medical history, and requests and/or performs diagnostic tests and examinations deemed necessary to obtain all possible information related to each case.

Makes preliminary diagnosis, directs, prescribes and/or provides treatment, or arranges for specialized care or patient referral as required. Provides definitive management in all medical categories for cases that do not require referral.

Ability to collect, organize, record and communicate, in a meaningful way, data relevant to primary health assessments including the detailed family and medical history, a physical examination and selective laboratory tests.

Ability to perform special screening and developmental tests and assess routine and specialized laboratory and radiological services.

Assures preparation of appropriate medical records for all patients seen to assure the accumulation and organization of all pertinent clinical data needed to provide comprehensive medical care. Provides other physicians, hospitals and other individuals’ clinical records as required for patient care or reimbursement.

Ability to assess the physical-psychosocial health status of patients and family based upon the knowledge of growth and development patterns and health condition is that require medical management.

Knowledge of human behavior during stressful situations in order to exercise emotional control, tact, patience and reliability in carrying out patient care.

Works closely with Allied Health Professionals (i.e. Social Worker, Public Health Nurse, Health

Educator, Discharge Utilization Reviewer, Case Management, etc.) in the provision of broad health program services.

Knowledge of pharmaceuticals in order to recognize their desired effects, side effects and complications of their use.

Knowledge of the availability and use of resources designated as primary care and referral services.

Ability to provide individual and family counseling, guidance and health instruction to help patients to understand how to prevent disease and maintain good physical and mental health.

Knowledge of quality assurance and evaluation process to improve care and facilitate monitoring and program planning.

Ability to provide guidance and leadership to other healthcare providers.

Skill in diplomacy and tact while working in stressful situations.

Skill in working with people from a wide variety of backgrounds and different cultures.

CONDITIONS FOR REMOVAL/REPLACEMENT OF CONTRACTORS CANDIDATE(S):

As mutually agreed between the Contracting Officer and the Contractor there may be grounds for removal and/or replacement of medical personnel.

The Contractor’s employee shall be removed from an IHS facility if services are not performed in accordance with terms and conditions of this contract.

The Contractor shall relieve contracted staff within 24 hours of notice and, if a replacement is needed, the replacement should be available within one week of the removal.

The Contractor shall request government pre-approval to substitute or replace any of the

Contractor’s employee of which it has provided qualifications and resumes under this contract.

All Contractor-requested substitutes or replacements’ qualifications, experience and professional certifications must be at least equal to or greater than the original Contractor’s employee provided by the Contractor under this contract.

CREDENTIALS AND PRIVILEGING:

The contractor will participate in the credentialing and privileging process in accordance with existing procedure. Contractor shall provide no services prior to obtaining approval by the

Government Medical Executive and Governing Board. The Contractor will be provided copies of current requirements and updates as they are published. Privileges will require renewal at least every one - two years in accordance with Government credentialing privileging policy and

JCAHO requirements.

CONTRACTOR REQUIREMENTS FOR CREDENTIALS:

Any candidates submitted for credentialing shall undergo Indian Health Service (IHS) mandated security clearance for work on-site at FYHC. The security pre-clearance requirement must be adhered to; the process includes a fingerprint check and a screen check through the Office of the

Inspector General's exclusion list at http://exclusions.oig.hhs.gov/ and www.sam.gov (best checked through www.verifycomply.com as this checks all exclusion lists). The clearance and credentialing process may take six (6) weeks or more.

It is the policy of the Indian Health Service (IHS) that all Licensed Practitioners who provide patient care shall be credentialed and privileged through the Medical Staff before providing care.

The Contractor and contract physician shall participate in the Credentialing and Privileging process in accordance with the facility’s procedures. The Contractor is expected to submit all requested materials within (4) business days of receiving the initial request. The Contractor will be provided copies of current requirements as applicable and updates as they are published.

During the credentialing process, the SERVICE UNIT will request for additional documentation as needed. If the SERVICE UNIT is unable to Credential and Privilege a contract physician, the

Contractor shall work to find a suitable replacement candidate.

The Contractor/Contract Physician shall be prepared to provide the following documents for each physician for Security clearance and Credentialing and Privileging purposes:

• Current resume

• OF-306 – Declaration for Federal Employment (all questions must be answered and signature with date in 17a is required)

• OF-306 Addendum – Addendum to the OF-306 (Declaration for Federal Employment)

• IHS Provisional Access Memo

• Protecting Children from Sexual Abuse in Health Care Settings; complete the Certificate of

Completion

• No FEAR Act Training; complete the Certificate of Completion

• Information Systems Security Awareness (ISSA); complete the Certificate of Completion

• OFI-86C form along with two fingerprint cards and applicable state forms

• HHS-745, Section A

• Two IDs (driver’s license and social security card – names must match and be unexpired)

• Educational Certification/License

• Current BLS Certification

• Current ACLS Certification

• Current Board Certification

• Recent procedure logs will be needed for any procedure privileges requested.

• Two forms of unexpired identification with matching full names (e.g., driver’s license and social security card);

• Other trainings as required by SERVICE UNIT

• Any additional documentation as identified during the credentialing and privileging process.

NOTE: No photo submission of forms, please have the original forms scanned and submitted. Wet signature and date are highly recommended. No PDF signatures will be accepted and may result in delay of administrative processing.

For Medical & Professional Contractors, the contractor shall comply with all IHS facility infection control and safety procedures, and standards. During the performance of this contract, the Contractor shall provide for the consistent performance of patient care process according to the standards of The Joint Commission (TJC) and/or Centers for Medicare Services (CMS) who supplies accreditation to the FYHC hospital/health center. These standards shall include: The

Comprehensive Accreditation Manual for Critical Access Hospitals, and the Laboratory Standards as they represent the scope of services of this contract.

For Medical& Professional Contractors, the contractor shall complete in a timely fashion, the medical and other required records for patients he/she admits or in any way provides treatment.

Chart notes are to be completed on the day services are rendered. The contractor shall abide by the Service Unit Medical By-laws and rules and regulations and meet all credentialing requirements in accordance with the Service Unit Medical Staff By-laws.

Upon award, the selected physician(s) shall undergo Indian Health Service (IHS) mandated security clearance for work on-site for the FYHC. The security pre-clearance requirement must be adhered to; the process includes a fingerprint check and a screen check through the Office of the

Inspector General's exclusion list at http://exclusions.oig.hhs.gov/.

SUPERVISORY CONTROLS:

The FYHC Deputy Clinical Director or Chief Medical Officer, or designee, provides primarily administrative supervision. The supervising physician sets overall health care objectives and specifies resources available. The supervising physician provides for clinical supervision on a

24-hour, media and tour of duty coverage. The supervising physician reviews work performance on a periodic basis in order to evaluate proficiency in providing health care, discuss deficiencies and problems encountered, outline and/or approve new or changed practices to be employed, and provides consultation on specific cases and related problems. Work which involves out-of-the-ordinary diagnostic decisions or treatment is discussed with supervisor or supervising emergency department physician who keeps aware of the condition of such patients and all aspects of treatment regimen. Work performance is reviewed for conformance to IHS policy, procedures and accepted professional practices; and the Quality Assurance improvement Program of the

Medical staff of the Service Unit.

Within established guidelines, contractor(s) exercise latitude in planning and carrying out health care assignments and in undertaking new procedures, practices and approaches to extend both services provided and increase individual proficiency. Overall work performance is reviewed jointly by the clinical director/supervising physician for effectiveness in meeting requirements for healthcare services.

DELIVERABLES:

The Contractor is required to provide a copy of each Contractor profile to the Project Officer or

Contracting Officer Representative (or service unit representative(s)) prior to providing services at the Fort Yuma Health Clinic. Timesheet shall be submitted to the Deputy Clinical Director, Clinical Director, or designee of the Fort Yuma Health Clinic; the timesheets shall be reviewed for accuracy and certified by signature as accurate and acceptable for payment, then forwarded to the receiving official for further processing of receipt of services through the US Treasury in IPP.

CONTRACTING OFFICER REPRESENTATIVE (COR) RESPONSIBILITIES:

The Contracting Officer will designate in writing a COR who shall be responsible for:

1. Monitoring the Contractor’s technical progress, including the surveillance and assessment of performance and recommending to the Contracting Officer, changes in requirements

2. Interpreting scope of work

3. Performing technical evaluations required

4. Performing technical inspections and acceptances required by this contract

5. Monitoring funds available for obligation under this contract

6. The resolution of technical problems encountered during performance of this contract

In no event is the COR empowered to change any of the terms and conditions of the contract.

Changes in the scope of work, contract price, quantity, and quality or delivery schedule shall be made only by the Contracting Officer by a properly exercised modification.

The designation of a COR does not authorize or provide a legal right to change any kind of contractual terms regardless of the Contractor’s apparent difficulties in fulfilling contract requirements.

PROJECT OFFICER:

A. The designated Project Officer shall be the Clinical Director of the Fort Yuma Health Clinic.

B. The Project Officer’s responsibilities shall be to coordinate with the provider the technical aspects of this service and the review of performance hereunder. The Project Officer does not have the authority to change or alter the contract amount, terms or conditions.

C. The Project Officer shall review whether services were received as ordered.

D. Upon certification of timesheets, the Project Officer, or designated alternate, will forward the signed timesheets to the receiving official of the Fort Yuma Health Clinic for further processing.

CONTRACTING OFFICER (CO) RESPONSIBILITIES:

The Contracting Officer is the only person delegated the authority to negotiate changes in terms, conditions, or amounts cited in this contract.

Performance Conditions:

The Project Officer will submit schedules of required coverage a minimum of 15 calendar days prior to the first day of coverage requested. In the event the Contractor’s employee is unable to render service on a previously agreed schedule, the Contractor shall provide a minimum seventy-two (72) hour notification to the Project Officer. The Contractor shall then make a full, good-faith effort to provide coverage with a replacement.

Both parties recognize that on occasion there shall be a need to fill coverage requests with less than a 15-day notice. In such an scheduling situation, the Contractor shall make a full, good-faith effort to accommodate the request. If the Contractor is unable to meet the emergency scheduling request, they shall immediately notify the Project Officer and those involved in scheduling and provide a suitable replacement. For extenuating and unforeseen circumstances (e.g., illness or family emergency) must be communicated in a timely manner, with confirmation that the proper SERVICE UNIT representative and the contract COR and Contracting Specialist have received the communication.

If a Contractor’s employee/candidate fails to arrive at the service unit for a scheduled shift, the

Contractor must provide coverage by another provider with temporary, provisional or courtesy privileges approved by the Service Unit Medical staff and the Governing Body. If no coverage is provided, the Contractor shall be required to pay the IHS for the cost incurred for providing that coverage. Not providing coverage on more than one occasion will be reviewed and discussed by the Chief Medical Officer and the Contracting Officer as to whether there was a compromise of patient care. All compromised situations that arise from lack of patient care by the Contractor shall be referred to the Contracting Officer for action and resolution.

Contractor is responsible for notifying the Chief Medical Officer and the on-call Chief Medical

Officer if he/she will be late or will be unable to work due to illness or any other reason.

Contractors who become sick while on duty will seek medical care from their own private physician, unless Contractor is eligible to receive health care from Indian Health Service.

All communication must be inclusive of the appropriate PAO Acquisitions and Service Unit personnel and all email communication must include the contract number in the subject line.

Timesheets:

Timesheet shall be submitted to the Deputy Clinical Director or Clinical Director or designee of the Hopi Health Care Center; the timesheets shall be reviewed for accuracy and certified by signature as accurate and acceptable for payment. Then Invoicing to be submitted through the US

Treasury in IPP.

PAYMENT AND INVOICING INSTRUCTIONS:

Invoices shall be prepared with the following information CLEARLY identified on the invoice:

1. Invoice Date and Number

2. Contract Number

3. Charges for service or products identified BY LINE ITEM Number

4. Brief description of products or services rendered

5. Charges should follow Line Item structure on contract to include Quantity, Unit of Issue, Unit

Price, and Total Amount as applicable

6. Dates of Services or Shipment

Invoices shall be prepared and submitted electronically and in accordance with rates and terms as stated in the contract. Invoices shall be submitted electronically in IPP through the US Treasury.

Notification and a copy of the Invoice shall be submitted to:

1. Acquisitions: Michele.Lodge@ihs.gov, A copy of the invoice should be sent electronically to the Contract specialist(s) at the address listed above.

2. Service Unit Representatives: TO BE DETERMINED AT TIME OF AWARD: A copy of the invoice should be sent electronically to the Service Unit Representative(s) at the address listed above.

ADDENDUM:

A. Pro-Children Act of 1994

The Contractor certifies that it will comply with the provisions of Public Law 103-227, Pro-

Children Act of 1994 which imposes restrictions on smoking where federally funded children’s services are provided. The Act requires that smoking should be prohibited in any indoor facility of portion of a facility owned, leased, or contracted for a used for the routine or regular provision of health care, day care, or early childhood development (Head Start) services to children under the age of 18. Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to $1,000 per violation and/or the imposition of an administrative compliance order on the responsible entity. By submitting an offer and entering into a contractual agreement with the Government, Contractors certify that they will comply with the requirements of the Act. Contractors must obtain the same certification from subcontractors.

B. P.L. 101-630, The Indian Child Protection and Family Violence Prevention Act

Contractors whose duties and responsibilities involve regular contact or control over children are subject to a character investigation as required by Public Law 101-630, The Indian Child Protection and Family Violence Act. IHS will conduct these investigations following award of a contract. The character investigation may be waived if, in judgment of the Contracting Officer, in consultation with the Personnel Officer, an investigation has already been conducted and is on file.

Until the character investigation has been completed and the Contracting Officer notified of the results, the Contractor must not have unsupervised contact with Indian children.

C. Department of Health and Human Services Tobacco Policy

The Contractor’s employee shall comply with the Department of Health & Human Services Tobacco-Free Policy (copy available upon request). Contractor’s employee shall not use tobacco products of any kind (e.g., cigarettes, cigars, pipes, and smokeless tobacco) while on any HHS

Property- owned or controlled.

D. Indian Child Protection and Family Violence Prevention Act

No performance under this contract will be allowed without full compliance with the Indian child protection and family violence prevention act, Public Law 101-630 and the Indian Health Service memo dated February 3, 1997, investigations on child care workers. Contractor shall ensure that proposed providers cooperate with and assist the government in the conduction of any necessary background checks.

E. Crime Control Act of 1990

No performance under this contract will be allowed without full compliance with the crime control act of 1990, Public Law 101-647 and the Indian Health Service memo dated February 3, 1997, investigations on child care workers. Contractor shall ensure that proposed providers cooperate with and assist the government in the conduction of any necessary background checks.

PERFORMANCE BASED ASSESSMENT:

Introduction – Performance Requirements:

A Quality Assurance Surveillance Plan (QASP) has been developed for in-house operations or to implement a service contract. It is designed to aid the PO in providing effective and systematic surveillance of all aspects of professional services. This plan provides for monitoring the contract requirements

The objective of this surveillance plan is to evaluate how the Contractor is performing in key areas.

The government is primarily interested in the final service being provided and not in the details of accomplishment.

The principal method of surveillance will be daily in some cases or by use or periodic inspections.

Appropriate indicators are provided for recording observations in this type of surveillance.

How to Use the Performance Based Matrix

Each defect observed will be recorded on the tally report. These documents will then become a formal record for later reference. The tally of defects at the end of each clinic or year (dependent on criteria) will be compared to the acceptable number of defects appearing in the surveillance plan. Errors detected by the PO in the course of surveillance will be transmitted to the Contractor or in-house personnel for correction. Notification of errors will take place within five (5) working days. Specifics concerning any errors should be recorded on the tally checklist. The Contractor or in-house personnel, as applicable, should be asked to initial this record.

Project Officer shall forward a copy of Contractor’s compliance with performance and non-performance compliance reports.

Quality Assurance Surveillance Plan (QASP):

The Government shall monitor the Contractors’ performance through a Quality Assurance

Surveillance Plan (QASP). The QASP is for informational purposes only and not considered part of the contract.

Surveillance systems will include periodic inspection and acceptance of all deliverables as cited in the contract.

PERFORMANCE-BASED MATRIX

Outcome Required Services AQL

Standard

Max Allowable

Degree of Deviation from Requirement/

(AQL)

Normal Method of

Surveillance

Incentives and Deduction from Contract

Price

Physician

Non-Personal

Services Contract

Minimum Qualification for Physician

Contractor shall submit supporting documentation for approval

100% Compliant Government review of contractors documentation for compliance

Incentive: Government approves documentation

De-incentive: Government reject documentation no award, Physician

Non- Personal

Services Contract

Licensure for Physician Contractor shall submit supporting documentation of

Licensure; licensure shall be in good standing and not under investigation.

100% Compliant Government review of contractors documentation for compliance

Incentive: Government approves documentation

De-incentive: Government rejects documentation, payment may be withheld

Physician

Non-Personal

Services Contract

Background Investigation in compliance with Indian

Child Protection and

Family Violence

Prevention Act, Public

Law 101- 630

Contractor shall submit supporting documentation of

Background investigation results

100% Compliant Government review of contractors documentation for compliance

Incentive: Government approves documentation

De-incentive: Government reject documentation no award, Physician

Non-Personal

Services Contract

Immunization

Compliance

Contractor shall submit supporting documentation of

Immunization

Compliance

100% Compliant Government review of contractors documentation for compliance

Incentive: Government approves documentation

De-incentive: Government reject documentation no award

Unacceptable

Performance

In the event of unacceptable performance, lack of professionalism, unacceptable conduct, the

Contractor shall replace personnel

Contractor shall replace personnel within 5 days upon receipt of written notification

90% Compliant Government shall notify the contractor in writing of non- compliance

Incentive: No interruption of performance and positive evaluation documented in governments’ database.

De-incentive: Two (2) occurrences of which the contractor is unable to replace personnel within the time allowance, a cure notice shall be issued and possible termination of contract. Evaluation documenting performance in the national

IHS database.

Long-term shifts fulfilled (Thirteen

(13) week travelers)

Filled long-term work shifts as scheduled by

HHCC. Long Term shifts contractor personnel shall provide at least a 4 week notice so that the position can be filled prior to vacancy.

Contractor shall ensure full shift coverage for long term professional services needs at

FYHC.

100% Government’s review

& written documentation/ notification to

Contractor of non-compliance.

Incentive: No disruption of performance;

positive evaluation documented in government’s database.

De-incentive: Two notices to the contractor, a cure notice shall be issued and possible termination of contract.

Evaluation documented in national IHS database.

END OF STATEMENT OF WORK

Short-term shifts fulfilled (Immediate staffing needs)

Filled short-term work shifts as scheduled by

FYHC.

Contractor shall ensure full shift coverage for short term needs at

FYHC.

85% Same as above Same as above