Attachment D - PWS Certified_Medical_Assistant.pdf

PERFORMANCE WORK STATEMENT

Certified Medical Assistant (Ambulatory Clinical Support Services)

Fort Yuma Health Care Center (FYHCC)

BPA - Multi-Specialty Ambulatory Care Services Revised Draft - 12 June 2026

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 ambulatory clinical support services from time to time to maintain continuity of outpatient clinic operations, patient flow, rooming, specimen-collection support, basic clinical support activities, and timely access to care. This

Performance Work Statement (PWS) defines the required service outcomes, performance standards, deliverables, and operating constraints for contractor-provided Certified Medical Assistant (CMA) services at FYHCC.

2. Scope and Required Service Outcomes

The contractor shall provide ambulatory clinical support services at FYHCC during BPA call clinic sessions through qualified, certified, cleared, trained, and competency-validated Certified Medical Assistant personnel. Services shall be performed consistent with applicable law, required training and documented competency, patient-specific orders or standing orders when required, FYHCC policies and procedures provided during onboarding, current IHS requirements, applicable privacy and security rules, and current accreditation standards applicable to the facility.

Contractor personnel shall perform only basic administrative, clerical, and technical supportive services that are lawful for medical assistants to perform in California. Contractor personnel shall not diagnose, independently assess, independently triage, prescribe, or perform professional medical, optometric, nursing, laboratory, radiologic, or other licensed-practitioner functions reserved to licensed or privileged practitioners.

• Prepare, stock, and turn over examination or treatment rooms; set up supplies, instruments, and equipment customarily used for BPA call outpatient services.

• Greet and room patients; obtain and accurately record vital signs, height, weight, allergies, medication lists, reason for visit, and other factual intake information within the role's lawful scope and facility procedures.

• Prepare patients for examination or treatment, assist licensed providers during examinations and minor procedures, and perform routine technical supportive services within documented training, lawful scope, and facility policy.

• Collect, label, and route specimens; perform finger sticks, venipuncture, specimen collection, and waived or point-of-care support tasks only when trained, authorized, and permitted by law and facility policy.

• Administer medications, immunizations, inhalation treatments, skin tests, or injections only when the assigned contractor employee has documented training and competency, the task is permitted by law and facility policy, and the required order, verification, and supervision are in place.

• Enter required factual clinical support documentation in the Government electronic health record (EHR) and related systems in a timely manner consistent with role permissions and local procedures.

• Provide administrative and front-desk support incidental to clinic operations, such as appointment preparation, message routing, document scanning, referral packet support, and supply tracking, when identified in the BPA call and local procedures.

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

• Comply with infection prevention, sanitation, occupational safety, emergency response, and mandatory reporting requirements relevant to the assigned setting and tasks.

• Participate in required orientation, mandatory training, competency validation, patient safety, and quality activities reasonably associated with the BPA call services.

3. Nonpersonal Services and Independent Contractor Relationship

This requirement is for nonpersonal 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-flow requirements, service outcomes, Government-furnished systems and facility rules, and performance expectations. The Government may evaluate the quality, timeliness, completeness, accuracy, and acceptability of services for contract administration, patient safety, training, competency validation, privacy, security, compliance, quality assurance, and acceptance 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.

Government clinicians or authorized facility personnel may issue patient-specific orders, standing orders, task authorizations, medication or dosage verifications, specimen-routing directions, patient-flow coordination, clinical-interface instructions, or on-site supervision of specific patient-care tasks when required by applicable law, facility policy, scope limitations, or patient safety. Such lawful clinical or operational direction for a patient-care task does not create a personal services relationship and does not transfer contractor personnel management to the

Government.

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 approved in writing by the Contracting Officer for an administrative purpose that does not involve patient care. 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, operating constraints, and any unique support requirements applicable to the BPA call services.

The contractor shall submit a complete candidate package 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, training, employee health, competency validation, and access requirements 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, certified, trained, competency-validated, 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.

During BPA call coverage periods, contractor personnel shall be available to support patient rooming, clinic flow, same-day factual EHR entries within the role's authorized permissions, specimen collection and routing, supply management, exam-room turnover, provider support activities, and administrative support activities described in the

BPA call. Workload may vary based on appointment mix, walk-in demand, case complexity, equipment availability, clinic priorities, patient safety requirements, provider orders, standing orders, and system availability.

Contractor personnel shall perform only those technical supportive services for which they have documented training and competency and for which the required licensed supervising practitioner, patient-specific order, standing order, verification, and facility authorization are present when required by law or policy. Applicable law, facility policy, patient safety, and required clinical supervision or authorization govern the pace and sequence of services.

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 coverage period, the contractor remains responsible for maintaining or restoring required service coverage through any qualified and authorized personnel.

7. Minimum Qualifications and Credentials

• Completion of a postsecondary medical assistant training program or another training pathway permitted by applicable law.

• Current medical assistant certification from a nationally recognized certifying organization acceptable to the

Government.

• Minimum two (2) years of recent outpatient, ambulatory, or clinic-based medical assistant or comparable clinical support experience.

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

• Documented training and competency for any injections, medication-administration support, skin tests, inhalation treatments, venipuncture, specimen collection, or waived testing the assigned employee may perform.

• Demonstrated ability to document care support activities in an electronic health record system and to use basic clinic information systems.

• Ability to obtain and maintain FYHCC security access, employee health clearance, mandatory training completion, competency validation, and any other access prerequisites required for the BPA call services.

• For services performed in California, assigned personnel shall meet applicable California training, scope, and supervision requirements for medical assistants.

8. Security, Onboarding, Training, and Competency Validation

The contractor shall submit complete and accurate onboarding material for each proposed contractor employee as required by the Contracting Officer, the FYHCC Security Office, Occupational Health or employee health office, and any designated departmental office. Required materials may include, as applicable, a resume, education and certification verification, identification documents, immunization records, background or security forms, exclusion-screening documentation, mandatory training certificates, competency records, and other documents necessary to obtain system access and clearance to work.

The contractor is responsible for ensuring all qualifications, certifications, training records, competency records, employee health clearances, and access prerequisites remain current throughout the period of performance and for immediately notifying the Contracting Officer and COR of any exclusion, sanction, lapse in certification or training, failed competency, investigation, scope limitation, supervision requirement, or other change that affects the employee's fitness for duty or ability to perform BPA call services.

The Government may deny a proposed start date, suspend system or facility access, reject services, or require removal from performance when security, onboarding, employee health, training, competency, certification, privacy, conduct, or access prerequisites are incomplete, expired, inaccurate, or no longer meet BPA, BPA call, or PWS requirements. Such action is a contractual, facility access, competency validation, patient-safety, or compliance 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/BPA call performance rather than day-to-day supervision of individual contractor employees. The Government may assess performance through qualification and access-file review, schedule and coverage verification, invoice reconciliation, sample EHR audit, competency documentation review, incident and complaint review, compliance review, deliverable review, and other quality processes consistent with the BPA, applicable BPA call, and applicable law and policy.

If performance does not meet BPA, 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, nonpayment for unaccepted services, removal from performance, reduction of BPA call quantities, 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, infection control, or facility access action is required.

Performance Objective Standard Government Surveillance / Acceptance

Method BPA call clinic coverage 100% of BPA call clinic sessions covered by qualified, cleared, certified, trained, competency-validated contractor personnel who have completed required security, onboarding, employee health, and access requirements.

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.

Qualifications, required training, and competency records 100% current before start and maintained throughout performance for all tasks actually performed.

Document review; verification of certification, training, competency records, exclusions, employee health clearance, and access status.

Patient rooming, intake, and factual EHR documentation At least 95% of required rooming, vitals, and factual intake entries completed accurately on the day of service; 100% completed within 24 hours absent documented system outage or emergency circumstances.

Sample EHR audit, record review, and complaint review.

Services within lawful scope, training, orders, and authorization 100% compliance with applicable law, documented training and competency, patient-specific orders or standing orders, required medication or dosage verification, required supervision or authorization, and facility policy for the tasks performed.

Chart review, incident review, observation, and compliance review.

Medication, immunization, specimen collection, and point-of-care support safety 100% compliance with applicable verification, labeling, dosage, specimen handling, chain-of-custody when applicable, waived testing, documentation, and escalation requirements for the tasks performed.

Observation, sample chart audit, incident review, and departmental quality review.

Patient rights, privacy, and informed consent support 100% compliance with patient rights, privacy, confidentiality, and informed-consent support requirements applicable to the assigned duties.

Complaint review, compliance review, and sample chart audit.

Infection prevention, room turnover, equipment, and supply handling 100% compliance with applicable infection control, cleaning, sanitation, stock rotation, exposure response, and occupational safety requirements.

Observation, incident review, and compliance review.

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

Training records, attendance records, and quality documentation review.

Required deliverables 100% of required reports, notifications, documentation, and corrective action responses submitted by the due dates stated in this PWS or applicable BPA call.

Deliverable log review, invoice support review, correspondence review, and COR acceptance records.

10. Government-Furnished Support and Interfaces

The Government will provide access to clinic space, examination or treatment rooms, Government-furnished equipment and supplies customarily available to clinic support personnel, and access to the Government EHR and required systems necessary to perform accepted BPA call services.

The Government will provide orientation to local clinical procedures, emergency response procedures, infection-control requirements, documentation requirements, specimen routing processes, medication or vaccine handling processes as applicable, and facility-specific administrative processes required for integration into FYHCC operations. Such orientation is limited to facility-specific operating requirements and does not constitute contractor employee training, supervision, or personnel management.

The Contracting Officer, COR, and any designated ordering or technical points of contact will address contract administration, acceptance, and BPA call matters. FYHCC staff may coordinate patient flow, room assignments, provider orders, standing orders, specimen routing, medication or vaccine handling requirements, EHR or system use, and local operating procedures necessary to furnish the BPA call services. Such coordination does not authorize

Government supervision of contractor personnel in employment or contractor-management matters.

11. Contractor Management, Continuity of Services, 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. Government personnel shall not approve contractor employee leave, discipline contractor employees, or perform contractor supervisory functions.

If the Government determines that a contractor employee fails to meet BPA, BPA call, or PWS requirements, poses a patient safety, infection control, privacy, conduct, scope, competency, medication safety, specimen integrity, or security risk, lacks required qualifications or access, violates privacy or conduct rules, cannot safely perform required duties, or otherwise is unsuitable for continued performance, the Contracting Officer may require removal from performance or may deny continued access. For immediate patient safety, privacy, security, infection control, medication safety, or compliance concerns, removal or access suspension may be effective immediately.

The contractor shall acknowledge any removal notice within one (1) business day and provide an interim coverage plan within one (1) business day unless another period is stated in the notice. The contractor shall restore required coverage using qualified, cleared, certified, trained, competency-validated, and authorized personnel as necessary to meet BPA call service requirements. Any newly proposed contractor employee must satisfy all onboarding, security, training, employee health, competency validation, and system access requirements before beginning performance.

The Government may reject services that fail to meet BPA, BPA call, or PWS requirements; requiring removal from performance, denying access, rejecting services, or requiring corrective action does not constitute Government supervision or discipline of contractor 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, onboarding, qualification, certification, employee health, and access documentation for each proposed contractor employee.

At least 45 calendar days before proposed start date, unless otherwise approved.

CO/COR and designated

FYHCC offices

Task-specific competency documentation Documentation of training and competency for injections, skin tests, inhalation medication administration, venipuncture, specimen collection, waived testing, or other technical supportive services the assigned employee may perform.

Before start and updated as needed during performance.

CO/COR and designated departmental office upon request

EHR clinical support documentation Required factual rooming, vitals, specimen, medication-administration support, and related documentation for each patient encounter within the employee's role and access permissions.

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, exclusion, lapse in certification or training, failed competency, or other event affecting performance.

Within 1 business day of discovery, or sooner if immediate patient safety or security action is required.

CO and COR

Deliverable Content / Description Due Date Recipient Corrective action plan Written plan describing root cause, immediate corrective action, and preventive measures 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, BPA call sessions or hours completed, contractor employee name(s), BPA call or line item reference, coverage confirmation, and any other information needed for acceptance and reconciliation. Names are included for credentialing, competency validation, EHR reconciliation, invoice reconciliation, and acceptance verification only.

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

Monthly staffing report Monthly coverage report identifying personnel who performed services, credential status, coverage provided, and any anticipated risks to continuity of 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 coverage; 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

Report Summary of documentation timeliness, competency status, patient safety, infection control, privacy, specimen or medication support issues, training completion, quality participation, 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

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 and BPA call number, applicable BPA or BPA call line item number, dates of service, contractor employee name(s), authorized units, sessions, or hours actually ordered and performed, unit price, total amount billed, and the supporting service record required for Government acceptance and reconciliation. Contractor employee names are required for credentialing, competency validation, employee health and access verification, EHR reconciliation, clinic-service verification, invoice reconciliation, and acceptance verification only. Inclusion of contractor employee names in invoice support records shall not be used to establish Government supervision, labor-hour control, or employee-management authority over contractor personnel.

The Government will pay only for accepted services that were ordered 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 this BPA or applicable 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 and current FYHCC policies relating to ambulatory operations, patient rights, medical records, infection control, medication handling, specimen handling, occupational safety, emergency response, and security.

• Current accreditation standards applicable to FYHCC ambulatory care and clinic support services.

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

• Applicable California statutes and regulations governing medical assistants, including California Business and

Professions Code sections 2069 through 2071 and related training, scope, authorization, and supervision requirements for medical assistant duties performed in California.

• Applicable Federal and State workplace safety, bloodborne pathogen, child protection, exclusion-screening, immunization, employee health, exposure control, and facility access 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, patient safety, and service-performance requirements.

• The solicitation, resulting BPA, and applicable BPA calls shall include FAR 52.237-7, Indemnification and

Medical Liability Insurance, with the required medical liability insurance amount inserted by the Contracting

Officer, when determined applicable to the nonpersonal health care services requirement.

This PWS states the required results and operating constraints for the service requirement. Solicitation clauses, BPA terms, pricing terms, insurance requirements, and other legally operative terms shall be addressed in the solicitation, resulting BPA, and applicable BPA calls.