Attachment F - Credentialing and Privileging.pdf

ATTACHMENT F

CREDENTIALING AND PRIVILEGING REQUIREMENTS

1. PURPOSE

This attachment establishes the credentialing, privileging, onboarding, and professional qualification requirements applicable to all Contractor personnel proposed under this contract.

No Contractor personnel may begin performance until all credentialing, privileging, onboarding, and security requirements have been successfully completed and written authorization to begin performance has been provided by the Government.

2. GENERAL REQUIREMENTS

The Contractor shall provide psychiatric physician services through qualified personnel who meet all requirements identified in the Statement of Work and this attachment.

The Contractor shall be responsible for obtaining, maintaining, and submitting all documentation required to support credentialing and privileging.

The Government reserves the right to reject any proposed provider who fails to meet credentialing, privileging, licensing, certification, or professional qualification requirements.

3. MINIMUM PROVIDER QUALIFICATIONS

Each proposed psychiatrist shall:

A. Education

Possess a Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) degree from an accredited institution.

B. Licensure

Possess and maintain a current, unrestricted license to practice medicine in a State, Territory, or the District of Columbia.

The license shall remain active and unrestricted throughout contract performance.

C. DEA Registration

Possess and maintain a current Drug Enforcement Administration (DEA) registration appropriate for the scope of practice.

D. Board Certification

Be Board Certified or Board Eligible in Psychiatry.

E. Clinical Experience

Possess the experience required by the Statement of Work.

F. Professional Standing

Have no current adverse licensure actions, exclusions, suspensions, revocations, or restrictions that would prevent credentialing or privileging.

4. REQUIRED CREDENTIALING DOCUMENTATION

The Contractor shall provide a complete credentialing package for each proposed provider.

Documentation shall include, at a minimum:

Identification

• Government-issued photo identification

Education

• Medical school diploma

• Graduate medical education documentation

• Residency documentation

Licensure

• Current professional license(s)

Board Certification

• Board certification documentation, if applicable

DEA

• Current DEA registration

Curriculum Vitae

• Current CV

• Complete chronology

• No unexplained gaps in employment

Professional References

• References as required by the Medical Staff Office

Work History

• Verification of relevant employment history

Malpractice History

• Professional liability claims history

• Malpractice carrier information

Professional Liability Insurance

• Current certificate of insurance

Sanctions Screening

• NPDB query authorization

• OIG exclusion screening

• SAM exclusion screening

Additional Documentation

• Any forms required by the facility Medical Staff Office

5. PRIVILEGING REQUIREMENTS

The Contractor shall ensure each proposed provider obtains privileges appropriate to the services required under the contract.

Privileges shall be granted through the applicable Indian Health Service credentialing and privileging process.

The Government retains sole authority to grant, deny, limit, suspend, or revoke privileges.

Award of the contract does not guarantee the granting of privileges.

6. RE-CREDENTIALING

The Contractor shall ensure all licenses, certifications, registrations, and credentials remain current throughout contract performance.

The Contractor shall provide updated documentation upon request.

The Contractor shall immediately notify the Contracting Officer and COR of:

• License restrictions

• License suspension

• License revocation

• DEA suspension

• Board actions

• Exclusions

• Criminal actions

• Professional disciplinary actions

7. PROVIDER REPLACEMENT

If a proposed provider:

• Fails credentialing,

• Fails privileging,

• Becomes unavailable,

• Loses qualifications, the Contractor shall provide a replacement provider meeting all contract requirements.

Replacement personnel shall be subject to the same credentialing and privileging requirements.

The Contractor shall bear all costs associated with replacement personnel.

8. TIMELINESS

The Contractor shall submit credentialing packages sufficiently in advance to allow Government review and processing.

Incomplete credentialing packages may delay performance.

The Government shall not be responsible for delays resulting from incomplete, inaccurate, or untimely submissions by the Contractor.

9. SECURITY REQUIREMENTS

Prior to performance, Contractor personnel shall complete all required:

• Identity verification

• Background screening

• Facility access requirements

• Information security requirements

• Privacy training requirements as directed by the Government.

10. HIPAA AND CONFIDENTIALITY

Contractor personnel shall comply with:

• HIPAA

• Privacy Act requirements

• Business Associate Agreement (Attachment D)

• Information Security requirements throughout contract performance.

11. GOVERNMENT RIGHTS

The Government reserves the right to:

• Review credentialing information;

• Require additional documentation;

• Reject proposed personnel;

• Suspend privileges;

• Revoke privileges;

• Require replacement personnel;

when determined necessary to protect patient safety, comply with credentialing standards, or ensure successful contract performance.

12. Contractor Responsibility

The Contractor shall ensure that all personnel proposed under this contract meet the qualifications, credentialing, privileging, licensing, certification, and security requirements identified in this attachment and the Statement of Work.

The Contractor shall provide all required documentation and updates necessary to support credentialing and privileging throughout contract performance.