Attachment B - PWS Nurse Practitioner.pdf

PERFORMANCE WORK STATEMENT

Family Nurse Practitioner (Same-Day Ambulatory Care Coverage)

Fort Yuma Health Care Center (FYHCC)

BPA - Multi-Specialty Ambulatory Care Services

1. Background and Purpose

Fort Yuma Health Care Center (FYHCC) is an Indian Health Service (IHS) facility located in Winterhaven, California, serving a primarily Native American patient population. FYHCC requires contractor-provided clinical services from time to time to maintain same-day access and continuity of ambulatory primary care services. This

Performance Work Statement (PWS) defines the required service outcomes, performance standards, deliverables, and operating constraints for contractor-provided Family Nurse Practitioner (FNP) services in the Family Practice

Clinic and/or Focused Care/Same-Day Clinic.

This PWS is structured as a nonpersonal services requirement. It does not establish a requirement to fill

Government staffing vacancies or to augment Government supervisory chains. The contractor remains responsible for managing and supervising its workforce while the Government evaluates whether BPA call services meet applicable BPA, call, and PWS requirements.

2. Scope and Required Service Outcomes

The contractor shall provide same-day and acute ambulatory care services at FYHCC during BPA call coverage periods through qualified, credentialed, and privileged Family Nurse Practitioner (FNP) clinicians. Services shall be performed in accordance with applicable licensure, granted clinical privileges, professional standards of practice, FYHCC policies and procedures provided during onboarding, current IHS requirements, applicable privacy and security rules, and current accreditation standards applicable to the facility.

• Evaluate, diagnose, treat, stabilize, and disposition patients presenting for same-day or acute ambulatory care within the clinician's granted privileges.

• Order and interpret appropriate diagnostic tests; prescribe medications and other therapies; provide patient education; and perform minor procedures within scope of practice and granted privileges.

• Document patient encounters, assessments, orders, referrals, procedures, prescriptions, follow-up instructions, and disposition accurately and timely in the Government electronic health record (EHR).

• Coordinate referrals, consultations, and transfers to a higher level of care in accordance with local clinical protocols when a patient's needs exceed the clinic's capability or the clinician's granted privileges.

• Support safe clinic flow, timely patient access, and continuity of care during BPA call coverage periods while applying independent professional judgment to each encounter.

• Protect patient rights, informed consent, privacy, dignity, and cultural considerations in all interactions.

• Comply with infection prevention, safety, mandatory reporting, and emergency response requirements applicable to the clinic setting.

• Participate in required orientation, patient safety, credentialing, peer review, and quality activities reasonably associated with the BPA call services.

• Meet the measurable performance standards and deliverable requirements stated in this PWS and the applicable BPA call.

3. Nonpersonal Health Care Services and Independent Contractor Relationship

This requirement is for nonpersonal health care services. The contractor and all contractor personnel perform in the capacity of independent contractors and are not Government employees. Contractor personnel shall not receive Government employee benefits, shall not be integrated into Government personnel-management systems, and shall not be supervised or managed as Government employees.

The Government may identify required workload, clinic coverage periods, patient access requirements, service outcomes, Government-furnished systems and facility rules, and performance expectations. The Government may also evaluate the quality, timeliness, completeness, and acceptability of services for contract administration, credentialing, privileging, peer review, quality assurance, patient safety, and compliance purposes. These functions do not create an employer-employee relationship and do not authorize Government personnel to perform contractor supervisory functions.

The contractor is solely responsible for recruiting, employing, compensating, scheduling, directing, supervising, training, evaluating, disciplining, retaining, and replacing its personnel. Government personnel shall not assign daily work to contractor employees, approve contractor employee leave, prepare contractor employee performance appraisals, discipline contractor employees, direct contractor staffing decisions, or otherwise exercise employer authority over contractor personnel.

Routine contract administration, staffing continuity, leave coverage, backfill, performance deficiencies, corrective action, and personnel matters shall be communicated through the Contracting Officer, COR, and the contractor's designated contract manager. Communications needed for patient scheduling, clinic workflow, emergency response, referral pathways, EHR use, infection control, safety, privacy, or compliance with granted privileges and facility rules are clinical and operational coordination only and do not constitute Government supervision of contractor personnel.

The Government retains no control over professional medical judgment, diagnosis, or specific treatment decisions. Contractor clinicians remain responsible for exercising independent professional judgment within their licensure, scope of practice, and granted privileges, while complying with applicable facility rules, patient safety requirements, and clinical policies.

4. Place of Performance

All services shall be performed on-site at Fort Yuma Health Care Center (FYHCC), 401 Picacho Road, Winterhaven, California 92283.

Remote or telework performance is not authorized unless specifically ordered in writing by the Contracting

Officer. FYHCC does not provide housing.

5. Period of Performance and BPA Calls

• Services shall be performed during the period of performance identified in each BPA Call issued under the resulting BPA.

• Each BPA call will identify required clinic coverage dates, session times, anticipated start and end dates, required service outcomes, and any unique operating constraints.

• The contractor shall submit a complete candidate package for each proposed clinician at least forty-five (45) calendar days before the proposed start date unless a shorter lead time is expressly approved by the

Contracting Officer.

• No contractor employee may begin performance until all required security, onboarding, credentialing, and privileging actions are completed and the Government issues written authorization to start.

• The Government will not direct which contractor employee must be assigned to a BPA call. The contractor may use any qualified, cleared, privileged, and authorized personnel who meet BPA, call, and PWS requirements.

6. Clinic Coverage, Scheduling, and Staffing Responsibility

Normal clinic operating hours are Monday through Friday, 0800-1700 Pacific Time, excluding Federal holidays, unless otherwise stated in the BPA call. BPA call coverage may consist of full-day, partial-day, or intermittent clinic sessions. The Government will identify required clinic coverage windows, service requirements, and performance expectations. The contractor is responsible for scheduling and managing its personnel to meet those requirements.

The contractor shall maintain staffing continuity sufficient to perform all BPA call clinic sessions with personnel who are qualified, cleared, privileged, oriented, and authorized to begin performance. The contractor shall designate a contract manager and an alternate contract manager responsible for staffing plans, schedule coordination, coverage continuity, leave coverage, backfill, and prompt communication with the CO and COR.

During BPA call sessions, contractor personnel shall be available to provide direct patient care, complete required

EHR documentation, communicate clinically necessary follow-up instructions, and coordinate referrals or transfers. Under normal clinic conditions, a full-day same-day clinic session typically involves approximately 12-

20 patient encounters. This planning estimate does not establish a production quota and does not override clinical judgment, patient safety, patient acuity, case mix, documentation requirements, interpreter needs, facility workflow, or system availability.

Coverage beyond BPA call periods, including after-hours care, on-call coverage, weekends, holidays, or additional sessions, requires prior written authorization under the BPA or applicable BPA call.

If a contractor employee becomes unavailable for a BPA call session, the contractor remains responsible for maintaining or restoring required service coverage through any qualified and authorized personnel. The

Government may coordinate patient-care priorities and clinic-flow needs, but the contractor determines how to staff the BPA call requirement.

7. Minimum Qualifications and Credentials

• Master's or doctoral degree in nursing from an accredited educational institution.

• Current Family Nurse Practitioner certification from AANP, ANCC, or an equivalent nationally recognized certifying body.

• Active, unrestricted Nurse Practitioner licensure in any U.S. State, the District of Columbia, the

Commonwealth of Puerto Rico, or a U.S. Territory.

• Minimum two (2) years of recent clinical experience in ambulatory care, primary care, urgent care, or a closely related practice setting.

• Current Basic Life Support (BLS) certification from an American Heart Association or American Red Cross approved provider.

• Demonstrated ability to document care in an electronic health record system.

• Ability to obtain and maintain FYHCC security access, credentialing, and clinical privileges.

• Any registration, certification, or authority required to prescribe or order controlled substances or perform privileged procedures under local policy and granted privileges.

• Compliance with continuing education, immunization, and mandatory training requirements applicable to the clinician and the facility.

8. Security, Credentialing, Privileging, and Onboarding

The contractor shall submit complete and accurate onboarding material for each proposed clinician as required by the Contracting Officer, the FYHCC Security Office, and the Credentialing and Privileging Office. Required materials may include, as applicable, a resume or curriculum vitae, licensure and certification verification, education verification, references, immunization records, background or security forms, mandatory training certificates, and other documents necessary to obtain system access and clinical privileges.

The contractor is responsible for ensuring all credentials remain current throughout the period of performance and for immediately notifying the Contracting Officer and COR of any adverse licensure action, exclusion, sanction, lapse, investigation, loss of certification, loss of prescribing authority, or other change that affects the clinician's fitness for duty, scope of practice, or ability to maintain privileges.

The Government may deny a proposed start date, suspend system or facility access, reject services, or require removal from performance when security, credentialing, privileging, training, licensure, safety, privacy, or conduct prerequisites are incomplete, expired, inaccurate, or no longer meet BPA, call, and PWS requirements.

Such action is a contractual, facility access, credentialing, privileging, or patient-safety action and does not constitute Government discipline of contractor personnel.

9. Performance Standards and Quality Assurance Surveillance Plan (QASP)

The following outcome-based standards establish the basis for Government acceptance and surveillance of BPA call services. Surveillance will focus on service outcomes, compliance, deliverables, and BPA/call performance rather than day-to-day supervision of individual contractor employees. The Government may assess performance through credential file review, coverage verification, invoice reconciliation, sample chart audit, EHR audit, incident and complaint review, compliance review, deliverable review, and peer review or quality processes consistent with the BPA, applicable BPA call, and applicable law.

Performance Objective Performance Standard Government Surveillance / Acceptance

Method BPA call clinic coverage 100% of BPA call clinic sessions covered by qualified, cleared, privileged, and authorized contractor personnel. Any anticipated coverage gap reported to the

CO and COR as soon as known with a proposed continuity plan.

Review of BPA calls, coverage reports, access rosters, staffing records submitted by the contractor, and invoice support records.

Licensure, security, credentialing, and privileging status

100% current before start of performance and maintained throughout performance for each clinician providing services.

Document review; verification of licensure, exclusions, security status, mandatory training, credentialing, and privileging status.

Patient access and clinic-flow support Contractor clinician available during BPA call coverage windows and performs services consistent with patient safety requirements, accepted standards of care, clinic operating procedures, and BPA call requirements. Historical clinic utilization may average approximately 12-20 encounters per full-day same-day clinic session; however, actual workload may vary based on patient acuity, case complexity, patient safety requirements, and clinical judgment.

Coverage verification, appointment and encounter review, EHR timestamps, patient-flow documentation, complaint review, and

COR review of outcome data.

EHR documentation timeliness At least 95% of encounter documentation completed on the day of service; 100% completed within 24 hours absent documented system outage or emergency circumstances.

EHR audit and sample record review.

Clinical services within scope and privileges 100% compliance with granted privileges, applicable professional standards, and required referral or transfer protocols for care outside clinic capability.

Chart audit, incident review, quality review, and peer review as applicable.

Referrals, consults, and follow-up instructions At least 95% completed and documented the same day or by the next business day, as clinically appropriate.

EHR audit and review of referral, consult, and follow-up documentation.

Patient rights, privacy, and informed consent 100% compliance with applicable patient rights, consent, privacy, confidentiality, and culturally respectful care requirements.

Complaint review, compliance review, privacy incident review, and sample chart audit.

Infection prevention and safety 100% compliance with applicable infection control, occupational safety, exposure response, and emergency response requirements.

Observation of service outcomes, incident review, safety documentation review, and compliance review.

Required orientation, training, and quality activities 100% completion of mandatory orientation and training and participation in required patient safety, credentialing, peer review, and quality activities reasonably associated with the BPA call services.

Training records, attendance records, credentialing records, peer review documentation, and quality documentation review.

Deliverable timeliness and completeness 100% of required reports, invoice support records, incident notices, and corrective action responses submitted by the due date and containing the required information.

Deliverable log, invoice reconciliation, COR review, and CO/COR acceptance records.

Corrective action responsiveness Written corrective action plan submitted within the required timeframe when requested, with root cause, immediate corrective action, preventive action, and implementation status.

CO/COR review of corrective action plan, follow-up evidence, and subsequent performance data.

If performance does not meet BPA, call, or PWS standards, the Contracting Officer may require a written corrective action plan within three (3) business days or another stated period. Continued failure to meet standards may result in rejection of services, denial or suspension of access, reduction of BPA call quantities, removal from performance, or other contractual remedies available under the BPA or applicable BPA call. Communications regarding performance deficiencies shall be made through the contractor's designated contract manager, except where immediate patient safety, privacy, security, or facility access action is required.

10. Government-Furnished Support and Interfaces

• The Government will provide access to clinic space, exam rooms, Government-furnished equipment and supplies customarily available to clinic providers, and access to the Government EHR and required systems necessary to perform BPA call services. Such orientation is limited to facility-specific operating requirements and does not constitute contractor employee training, supervision, performance management, or personnel administration.

• The Government will provide orientation to local clinical procedures, emergency response procedures, security and safety rules, documentation requirements, referral pathways, facility-specific administrative processes, and other operating constraints required for integration into FYHCC operations.

• The Contracting Officer, COR, and any designated BPA call ordering or technical points of contact will address BPA/call administration, acceptance, surveillance, ordering, and performance matters.

• FYHCC staff may coordinate patient schedules, clinic flow, referral pathways, EHR documentation procedures, and local operating procedures necessary to furnish the BPA call service. Such coordination does not authorize Government supervision of contractor personnel, contractor employee scheduling, contractor employee discipline, or control over professional medical judgment.

• The Government may communicate directly with contractor clinicians when necessary for immediate patient care, safety, privacy, emergency response, credentialing, privileging, or facility access matters. Routine personnel-management and performance-deficiency communications shall be routed through the contractor's contract manager.

11. Contractor Management, Staffing Continuity, Removal, and Substitution

The contractor shall designate a contract manager and an alternate contract manager with authority to resolve staffing, coverage, performance, and administrative issues. The contractor shall provide the names, titles, telephone numbers, and email addresses of both individuals and shall update the Government within one (1) business day of any change.

The contractor's contract manager is the primary interface with the Contracting Officer and COR for scheduling coordination, staffing continuity, leave coverage, backfill, corrective action, performance management, and substitution decisions affecting contractor personnel. The contractor remains responsible for employee supervision, schedule management, work assignments, internal performance management, corrective actions, and any employee-relations matters.

If the Government determines that a contractor employee fails to meet BPA, call, or PWS requirements, poses a patient safety or security risk, lacks required credentials or privileges, violates privacy or conduct rules, or otherwise is unsuitable for continued performance, the Contracting Officer may require removal from performance or may deny continued access. For immediate patient safety, security, privacy, or compliance concerns, removal or access suspension may be effective immediately.

The requirement is continuity of BPA call services, not replacement of any specific individual. When a clinician is removed, unavailable, or otherwise unable to perform, the contractor shall maintain or restore compliant coverage using any qualified, cleared, privileged, and authorized personnel who satisfy BPA, call, and PWS requirements. The contractor shall acknowledge any Government removal or coverage-deficiency notice within one (1) business day and provide an interim coverage plan within one (1) business day unless a shorter period is required for immediate patient safety or security concerns.

Any proposed substitute or additional clinician must satisfy all security, onboarding, credentialing, training, and privileging requirements before beginning performance. The contractor shall submit a complete candidate package for any proposed substitute as required by Section 8 and the applicable BPA call. The contractor shall not provide services through unapproved personnel.

12. Deliverables Deliverable Content / Description Due Date Recipient Contract manager contact information Name, title, phone number, and email address for the contractor's primary and alternate points of contact.

Within 2 business days after award and within 1 business day of any change.

CO and COR

Candidate package Complete security, credentialing, privileging, and qualification documentation for each proposed clinician.

At least 45 calendar days before proposed start date, unless otherwise approved by the Contracting Officer or BPA call.

CO/COR and designated FYHCC offices

Monthly Coverage and

Credential Status

Report

Clinician name(s), BPA call coverage dates, scheduled coverage, actual coverage provided, qualification/credential status, and any anticipated staffing risks affecting BPA call services.

Monthly, by the fifth (5th) business day after the end of the service month, unless otherwise stated in the BPA call.

CO and COR

Monthly coverage report BPA call sessions or hours, completed sessions or hours, unfilled or partially filled sessions, explanation for any coverage gap, and contractor action taken to maintain or restore coverage.

Monthly, with invoice support record or by the fifth (5th) business day after the end of the service month.

CO and COR

Monthly Service

Performance Summary Summary of required quality, peer review, patient safety, documentation, training, and compliance participation for the reporting month; include known issues, trends, and corrective actions when applicable.

Monthly, by the tenth (10th) business day after the end of the service month, unless otherwise stated in the BPA call.

CO and COR

EHR encounter documentation Complete documentation for each patient encounter, including assessment, orders, referrals, prescriptions, patient instructions, and disposition.

Same day of service; 100% within 24 hours absent documented system outage or emergency circumstances.

Entered in

Government EHR

Incident or status notification Notification of any patient safety incident, privacy issue, security issue, credentialing problem, exclusion, licensure action, lapse, loss of certification, or other event affecting performance.

Within 1 business day of discovery, or sooner when immediate patient safety, privacy, security, or facility access action is required.

CO and COR

Corrective action response Written plan or response describing root cause, immediate corrective action, preventive measures, responsible contractor official, and implementation status when requested by the

Government.

Within 3 business days of request unless another period is stated.

CO and COR

Monthly invoice support record Dates of service, authorized sessions or hours completed, clinician name(s), BPA call or line item reference, coverage confirmation, and any other information needed for acceptance and reconciliation. Clinician names are included for credentialing, EHR reconciliation, invoice reconciliation, and acceptance verification only.

With each monthly invoice. CO/COR/IPP as applicable

13. Invoicing and Payment

Invoices shall be submitted electronically through the Invoice Processing Platform (IPP) or other Government-designated payment system. Each invoice shall include, at a minimum, the invoice number and date, BPA number, BPA call number, applicable BPA line item or call line item number, dates of service, clinician name(s), units or sessions actually authorized and performed, unit price, total amount billed, and the supporting service record required for Government acceptance and reconciliation. Clinician names are required for credentialing, privileging, EHR reconciliation, invoice reconciliation, and acceptance verification only and shall not be used to establish Government supervision or labor-hour control over contractor personnel.

The Government will pay only for accepted services that were authorized under the BPA call and performed.

Additional coverage beyond BPA call quantities or periods requires prior written authorization under the BPA or applicable BPA call. The contractor shall not bill IHS patients or alternate resources for services furnished under the BPA or any resulting BPA call.

14. Applicable Requirements

Services shall comply with the current versions of the following, as applicable during performance:

• Applicable provisions of the Indian Health Manual relating to credentialing, privileging, peer review, medical records, patient rights, infection control, and security.

• Current FYHCC medical staff bylaws, formularies, clinical policies, referral procedures, and local standard operating procedures provided at onboarding. Contractor clinicians remain responsible for exercising independent professional judgment. Facility policies and procedures establish operating requirements but do not direct specific diagnoses, treatment decisions, or clinical judgment.

• Current accreditation standards applicable to FYHCC ambulatory services.

• The Health Insurance Portability and Accountability Act (HIPAA), the Privacy Act, and applicable Federal information security and privacy requirements.

• Applicable Federal and State licensure, certification, prescribing, workplace safety, and child protection requirements.

• Applicable HHS and IHS mandatory training, tobacco-free workplace, and facility access rules.

• Applicable solicitation, BPA, and BPA call terms, including inspection, acceptance, invoicing, security, privacy, and service-performance requirements.

This PWS states the required results and operating constraints for the service requirement. BPA terms, BPA call terms, contract clauses, pricing terms, insurance requirements, and other legally operative terms shall be addressed in the solicitation and resulting BPA or BPA calls. The solicitation and resulting BPA or BPA calls shall include nonpersonal health care services clause requirements, including FAR 52.237-7, Indemnification and

Medical Liability Insurance, when applicable.