Attachment D. SOW LPN CMA CST CNA final.docx

STATEMENT OF WORK (SOW)

LPN CMA CST CNA Services

PHOENIX INDIAN MEDICAL CENTER (PIMC)

The Contractor shall provide Licensed Practical Nurses (LPN), Certified Medical Assistants (CMA), Certified Surgical Technicians (CST) and Certified Nursing Assistants (CNA) services, as outlined below.

Definitions: Within this document “Contractor” refers to the company that has contracted with Indian Health Service to provide these services. “Contractor-Provided Personnel” refers to the individual LPNs, CMAs, CSTs, and CNAs employed by the Contractor to provide services under this award.

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

Shifts:

Shift times and schedules are subject to change based on the medical needs of the patient population and hospital/clinic operations.

Routine Shift schedules are:

Inpatient:

Outpatient:

10 hour shifts:* 0730 – 1800

*Includes 30 minute unpaid lunch break.

Qualifications:

The Contractor shall supply LPNs/CMAs/CSTs/CNAs that have the requisite qualifications, education, training, licensing, previous work experience, knowledge, and competence to provide all services contained within this Statement of Work. All licenses are required to be current, active, unrestricted, and free from disciplinary action.

Licensed Practical Nurse (LPN):

1. Minimum 1 year experience working as an LPN. Experience working in a specialty area is preferred.

2. Graduate of an accredited nursing school Licensed Practical Nurse (LPN) / Licensed Vocational Nurse (LVN) program.

3. Certification and licensure requirements:

· BCLS (Basic Cardiac Life Support)/CPR (Cardiopulmonary Resuscitation).

· ACLS (Advanced Cardiovascular Life Support).

· PALS (Pediatric Advanced Life Support), NALS (Neonatal Advanced Life Support), and Neonatal Resuscitation Program (NRP) may also be required, depending on specialty assignment

Certified Medical Assistant (CMA):

1. Minimum 1 year experience working as a CMA; experience working in a specialty area is preferred.

2. High school diploma or equivalent. Completion of Medical Assistant training program is preferred.

3. Certification requirements:

· One of the following licenses is required. .

· American Association of Medical Assistant (AAMA)

· American Medical Technologist (AMT)

· Registered Medical Assistant (RMA)

· National Certified Medical Assistant (NCMA)

· BCLS (Basic Cardiac Life Support)/CPR (Cardiopulmonary Resuscitation)

Certified Surgical Technician (CST):

1. Minimum 1 year experience working as a CST.

2. Completion of either an accredited surgical technology program, or a military training program in surgical technology.

3. Certification requirements:

· The National Board of Surgical Technology and Surgical Assisting (NBSTSA), or The Certified Operating and Surgical Technician (CORST), or other equivalent certification.

· BCLS (Basic Cardiac Life Support)/CPR (Cardiopulmonary Resuscitation).

Certified Nursing Assistant (CNA):

1. Minimum 1 year experience working as a CNA.

2. High school diploma or equivalent and completion of Nursing Assistant Training Program.

3. Certification requirements:

· CNA certification.

· BCLS (Basic Cardiac Life Support)/CPR (Cardiopulmonary Resuscitation).

Computer Literacy: Contractor-Provided Personnel shall be proficient in writing, typing, and have a basic working knowledge and understanding of computer hardware and software applications.

Health Restrictions: Duties require walking, standing, bending, and some lifting, e.g., to assist patients out of wheelchairs, move patients on and off examining tables or stretchers, etc. Contractor-Provided Personnel shall not have any work or health restrictions, which could directly or indirectly interfere with the performance of providing services.

Immunizations: Contractor-Provided Personnel shall comply with all immunization requirements; immunization is a condition of employment. Please note, these immunization requirements are subject to change.

Contractor-Provided Personnel will be screened for the following in accordance with the Department of Health & Human Services Indian Health Service Employee Immunization Program and COVID vaccination policy:

· Measles, Mumps, and Rubella (MMR) – 2 doses, or laboratory evidence of immunity, or laboratory confirmation of disease, or born before 1957

· Hepatitis B – 3 doses or laboratory evidence of immunity by positive serum titer

· Varicella shots – 2 doses of live vaccine, or healthcare provider diagnosis of varicella disease, or laboratory evidence of immunity or laboratory confirmation of disease, or employee reports date(s) of chicken pox

· Tetanus, Diphtheria, and Pertussis (Tdap) & Tetanus, Diphtheria (Td) – Single dose of Tdap, or Tdap booster vaccination (one dose within 10 years)

· Tuberculosis – based upon annual TB risk assessment in accordance with the most recent CDC recommendations for skin testing. Current requirement for PIMC is two-step TST process within 12 months of onboarding

· Influenza – mandatory during the CDC-determined influenza season, currently October 1 to March 31.

· COVID-19 vaccinations – unless a medical or religious exemption has been approved.

Cultural and Language Sensitivity: Contractor-Provided Personnel shall demonstrate appropriate/professional behavior, plus possess sufficient initiative, interpersonal relationship skills, and, social sensitivity to constructively relate to IHS employees, contractors, vendors, patients, and members of the Native American community. They shall display sensitivity to the unique cultural factors of the people they treat, including language and communication style, village and tribal customs, use of traditional healers, isolation, housing conditions, and lack of resources. Some patients may not speak English; therefore Contractor-Provided Personnel must be comfortable rendering services while using an interpreter. Contractor-Provided Personnel must excel in a team environment and shall exhibit tact and diplomacy while working in stressful situations.

Security Clearance/Background Investigation: Successfully passing the background investigation/obtaining a security clearance through IHS is a condition of employment. Contractor-Provided Personnel cannot begin work until they have been cleared by IHS and issued a badge. Further details of the security clearance/background investigation process may be found below.

Credentialing/Privileging: Contractor-Provided Personnel shall not provide services prior to obtaining approval by the Medical Executive and Governing Board. Privileges will require periodic renewal, in accordance with Government credentialing/privileging policy and JCAHO requirements. All licenses are required to be current, active, unrestricted, and in good standing with the issuing body.

Duties:

Contractor-Provided Personnel shall provide patient care, assist, and/or perform duties as requested, within their level of competence, the allowed scope of their professional license/certification, and state laws of Arizona. This may include assignments and duties related to the COVID-19 pandemic. Contractor-Provided Personnel may be required to work beyond normal duty hours, on weekends, holidays and after regularly-scheduled duty hours on an as-needed basis during emergencies. The duties contained within this Statement of Work are illustrative of normal duties, however they are not all inclusive. Contractor-Provided Personnel may be required to perform duties within the normal scope of their employment that are not specifically outlined.

As appropriate, Contractor-Provided Personnel shall:

· Provide direct patient care including diagnostic studies, treatments, medications, and other therapeutic measures in accordance with policy and procedure, in support of physician’s orders, and as required by the patient’s condition, diagnosis, and needs.

· Provide appropriate coordination of care and intervention to patients undergoing a medical or psychiatric emergency.

· Address the physical, psychological, emotional, socio-cultural, age-specific, and spiritual needs of patient and family throughout the continuum of care. Provide patient and family education.

Standards of Service: Patient care shall be provided in accordance with the standards outlined by Centers for Medicare Services (CMS), The Joint Commission (TJC), The Comprehensive Accreditation Manual for Critical Access Hospitals, health promotion/disease prevention (HPDP) requirements, IHS PIMC policies such as the Indian Health Services Quality of Care document, Medical By-Laws, IHS rules and regulations as established by the Phoenix Indian Medical Center Medical Staff, and Arizona state law. At a minimum, all Contractor-Provided Personnel shall provide a standard of care consistent with their professional qualifications, and similar to that generally provided by similarly-qualified professionals within the State of Arizona. Contractor-Provided Personnel shall comply with all IHS facility infection control and safety procedures and standards.

Charting: As applicable: In accordance with PIMC by-laws and/or hospital policy, Contractor-Provided Personnel shall complete chart notes, medical records, and other required records on the day care was rendered. This applies to patients they admitted as well as patients they provided with care. Contractor-Provided Personnel shall enter all lab, x-ray, and medication requests using the electronic health record (after undergoing IHS electronic health record training). Contractor-Provider Personnel shall follow approved abbreviation guidelines.

Meetings: Contractor-Provided Personnel that work continuous full-time assignments of a week or longer shall attend assigned meetings and participate fully as staff members.

Uniform Policy: Contractor-Provided Personnel shall comply with the Department of Health & Human Services Indian Health Service Caregiver Identification Program and Uniform Allowances policy which assigns uniform colors by professional discipline. Contractor-Provided Personnel shall maintain acceptable standards of personal hygiene, grooming and professional attire such that their image as a Federal contractor is compatible with the expectations of the IHS staff.

Staff Development: As applicable: Contractor-Provided Personnel will be provided with access to Relias. Contractor-Provided Personnel shall complete all required training prior to reporting to work at PIMC.

Specialized Duty Positions: Duties specific to specialized duty positions are outlined below:

LPN Duties Perform nursing duties in accordance with Arizona’s Nursing Practice Act/Scope of Practice, PIMC nursing policies/procedures, and under the supervision of a Registered Nurse (RN) and/or Physician/Medical Staff Provider.

· Carry out Physician/Medical Staff Provider orders; administer medications, oxygen, and a variety of treatments.

· Obtain chief compliant and/or reason for visit. (Ambulatory Care)

· Manage a wide variety of therapeutic devices such as drainage, feeding and suction tubes and machines, nebulizer, and electrocardiograph machines, etc.

· Measure and assess vital signs, neurological status, effects of medication, visual acuity, hearing, height, and weight. Report abnormal findings to Medical Provider or RN.

· Provide direct patient care; assist patients.

· Observe and document (in the accepted format) changes in patients’ condition, record observations, and other designated activities.

· Collaborate with other health care providers; assist other personnel in patient care. Participate in nursing quality controls, e.g. crash cart checks, refrigerator temperature checks, lab checks, capillary blood glucose monitoring checks, etc.

· Collect or assist in blood, urine, sputum, and stool specimen collection.

· Recognize life-threatening emergencies and initiate resuscitation measures/other emergency procedures as appropriate.

· Recognize adverse reactions to medications, treatments, and procedures – and initiate interventions as appropriate.

CMA Duties Perform routine administrative and clinical tasks.

· Take medical histories and record vital signs. Explain treatment procedures to patients and family. Prepare patients for examination. Assist the Physician during examinations.

· Collect and prepare laboratory tests. Dispose of contaminated supplies. Sterilize medical instruments.

· Instruct patients regarding medication and special diets. Prepare and administer medications as directed by the Physician. Authorize medication refills as directed; telephone prescriptions into the pharmacy. Draw blood. Prepare patients for X-ray. Take electrocardiograms. Apply bandages; remove sutures, change dressings, and other first aid procedures.

· Record patient examinations, treatment, and test results into EHR.

CST Duties (Integrated Surgical Services for OR / Post-Anesthesia Care Unit and Obstetrics)

Functions as primary Operating Room (OR) scrub person responsible for handling instruments, supplies, and equipment during surgical procedures such as Ear, Nose, and Throat; Eye; Orthopedics; Podiatry; Obstetrics/Gynecology; and General Surgery.

· Set up sterile fields with all items required for each procedure; assures all supplies and equipment are available prior to the procedure.

· Observes and responds promptly to each stage of surgical procedures and anticipates the needs of the Surgeon by maintaining a high level of concentration for extended periods of time.

· Utilizes universal precautions and follows infection control policies and procedures when handling specimens, supplies, and equipment.

· In conjunction with the circulating RN, performs sponge and instrument counts to verify accuracy. Accountable for all surgical instruments and equipment during the procedure.

CNA Duties Provide basic nursing care to patients with a variety of conditions, illnesses, and/or injuries under the direct supervision of nursing staff.

· Obtain and record vital signs. Monitor and record blood glucose, and intake/output.

· Shares in the responsibility for monitoring patients for changes in condition, and reporting observations to Charge Nurse.

· Assists patient with activities of daily living.

· Shares in the responsibility of maintaining clinical records and nursing care plans.

· Performs general duties, such as transporting patients, restocking supplies, and cleaning equipment.

Performance Evaluation: Contractor-Provided Personnel will be evaluated based upon the requirements stated in this statement of work. In the event that PIMC determines Contractor-Provided Personnel should be removed from duty, the Contractor shall make a best effort to provide a replacement, who can start the on-boarding process within 48 hours. Should this not be possible, the Contractor shall notify the COR immediately.

Scheduling: Contractor-Provided Personnel shall work all scheduled hours. The COR will provide schedules with a 15-day advance lead time. If Contractor-Provided Personnel cannot work a scheduled shift:

· A 72-hour notice is required. (Provided to the COR and those involved in scheduling.)

· The Contractor shall make a best effort to find a replacement.

There may (on occasion) be a need to fill coverage requests with less than a 15-day lead time. For these emergency situations, the Contractor shall make a best effort to accommodate the request. If they are unable to provide the services needed, the Contractor shall notify the COR and those involved in scheduling immediately.

Security Clearance/Background Investigation:

IHS security clearance/background investigation is mandatory for all Contractor-Provided Personnel provided under this contract. Contractor-Provided Personnel cannot begin work until they have been cleared by IHS and issued a badge.

The Contractor shall pre-screen Contractor-Provided Personnel prior to referring them to PIMC for employment under this contract, including verifying that the Contractor-Provided Personnel is not included on the Inspector General’s exclusion list (currently located at http://exclusions.oig.hhs.gov/).

Contractor-Provided Personnel who have been referred to work at PIMC under this contract shall work directly with IHS to complete all security clearance/background investigation requirements. The following information is for illustrative and planning purposes only. Security clearance/background investigation procedures are subject to change.

Fingerprints: Contractor-Provided Personnel shall contact PIMC Human Resource Staff Coordinator to make fingerprinting arrangements.

Documents: The following documents will need to be returned as instructed by IHS personnel. Most documents will need to be scanned/emailed to IHS Personnel Security at PHXPersonnelSecurity@ihs.gov. For documents that require signatures: Wet signature/date is recommended; PDF signatures will not be accepted.

1. Current resume

2. OF-306 – Declaration for Federal Employment (All questions must be answered; signature and date in box 17a must be completed.)

3. OF-306 Addendum

4. IHS Provisional Access Memo

5. Protecting Children from Sexual Abuse in Health Care Settings (Provide a copy of the Certificate of Completion.)

6. No FEAR Act Training (Provide a copy of the Certificate of Completion.)

7. OFI-86C form

· Include permanent address as well as any temporary addresses used while on assignments.

· Fill in items 1 through 6, plus item 13.

· Leave item 14 blank (IHS personnel security will fill this in.)

· Return the form in fillable format

8. Applicable state forms – these will be identified by IHS personnel security. To preview which forms will be required, please reference Child Care Agency Guide (11/01/21).

NOTE: If it is determined that a full background investigation is needed, IHS will initiate one in e-QUIP.

Additional On-boarding Requirements:

The Contractor shall provide the COR with copies of the following documents for each Contractor-Provided Personnel provided under this contract:

1. Resume

2. Licenses & Certifications (see requirements above)

3. Transcripts

4. Current Health Status Report (a health history indicating that a Provider has medically cleared the Nurse for employment and indicates they do not have any medical conditions that would prevent them from performing their job duties)

5. Immunizations (see requirements above)

Payment and Invoicing:

The hourly unit price paid to the Contractor shall be considered payment in full. The Contractor will be paid for services provided under this contract according to the hourly rate outlined within the contract. Although Contractor-Provided Personnel may be required to work beyond normal duty hours, on weekends, holidays, and after regularly-scheduled duty hours on an as-needed basis during emergencies, it is important to note that firm fixed price contracts are all inclusive per Federal Acquisition Regulation (FAR), and as such, additional charges (such as for holiday, weekend, call-back, or overtime pay) are prohibited. Furthermore, as neither the Contractor, nor the Contractor-Provided Personnel, are entitled to any additional payment, no attempt shall be made to bill/collect from any Indian Health Service (IHS) patient, or from any alternative source.

The Contractor shall submit invoices on a monthly basis. In compliance with HHSAR 352.232-71 – Electronic Submission of Payment Requests, invoices shall be submitted through the Invoice Processing Platform (IPP). More information on IPP may be found at IPP.gov/home

Reserved Rights:

IHS reserves the right to reject any proposed Contractor-Provided Personnel if it is determined to be in the best interest of the Government. Additionally, IHS reserves the right to hire—without penalty—any Contractor-Provided Personnel provided under this contract who applies for positions with the Indian Health Service.

Applicable Laws:

The following legal requirements apply to the Contractor as well as to the Contractor-Provided Personnel provided under this contract.

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 owned, leased, or contracted for or 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 the [Contractor-Provided Personnel] they provide under this contract.

P.L. 101-630, The Indian Child Protection and Family Violence Prevention Act Contracted personnel 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 the 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 has been notified of the results, contracted personnel must not have unsupervised contact with Indian children.

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-Provided Personnel shall not use tobacco products of any kind (e.g., cigarettes, cigars, pipes, and smokeless tobacco) while on any HHS Property- owned or controlled.

Indian Child Protection and Family Violence Prevention Act and Crime Control Act of 1990 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, the Indian Health Service memo dated February 3, 1997, Investigations on Child Care Workers, and the Crime Control Act of 1990, Public Law 101-647. Contractor shall ensure that proposed providers cooperate with and assist the Government in the conduction of any necessary background checks.

END OF STATEMENT OF WORK