C. 2020 Scope of Work.pdf

Scope of Work:

Description of Service:

The Contractor shall provide newborn screen services for Whiteriver Service Unit and Cibecue Health Center in a timely manner allowing for early diagnosis and treatment for any harmful or potentially fatal metabolic disorder that is not apparent at birth.

1. The contractor shall provide the first & second newborn screens and test the following disorders:

AMINO ACID DISORDERS

• Arginase deficiency

• Argininosuccinic acidemia

• Citrullinemia

• Homocystinuria

• Hypermethioninemia

• Phenylketonuria

• Tyrosinemias

ENDOCRINE DISORDERS

• Congenital adrenal hyperplasia

• Congenital hypothyroidism

FATTY ACID OXIDATION DISORDERS

• Carnitine Acyl-carnitine translocase deficiency

• Carnitine palmitoltransferase II deficiency

• Carnitine palmitoltransferase deficiency 1a

• Carnitine uptake deficiency

• Long chain L-3-hydroxy Acyl-CoA dehydrogenase deficiency

• Medium-chain Acyl-CoA dehydrogenase deficiency

• Short-chain Acyl-CoA dehydrogenase deficiency

• Trifunctional protein deficiency

• Very Long chain Acyl-CoA dehydrogenase deficiency

HEMOGLOBINOPATHIES

• Beta-thalassemia major

• Sickle cell anemia

• Sickle cell screening and NCAA Rules

• Hemoglobin SC disease

ORGANIC ACID DISORDERS

• 3-hydroxy-3-methylglutaryl-CoA- Lyase deficiency

• 3-methylcrotonyl-CoA carboxylase deficiency

• 3-methylglutaconic aciduria (3-MGA)

• Beta-ketothiolase deficiency

• Biotinidase deficiency

• Glutaric academia type I

• Glutaric academia type II

• Isovaleric academia

• Malonic academia

• Methylmalonic academias

• Multiple Carboxylase deficiency

• Propionic acidemia

OTHER DISORDERS

• Cystic fibrosis

• Galactosemia

• Severe combined immunodeficiency (SCID)

2. The contractor shall retest the disorders listed under #1, if an unsatisfactory first screen testing is received, or abnormal result was obtained on the first screen or no record of a satisfactory first screen.

3. The contractor shall provide the special filter / blotter forms for testing at no charge.

4. The contractor shall provide pre-addressed mailing envelopes at no charge.

5. The contractor shall conduct testing within 24 hours of receipt of the specimens.

6. The contractor shall send normal results within 7 working days.

7. The contractor shall report immediately by telephone abnormal results to the ordering provider.

In the event the contractor cannot contact the provider, the abnormal test results will be reported to the submitting agency, or, if the birth did not occur in the facility, to the father or mother.

8. Unsatisfactory specimens or specimens with equivocal results will be reported immediately to the submitting agency.

9. The reference laboratory shall provide a copy of their accreditation license to ensure their laboratory is in compliance with federal regulations.

10. The reference laboratory shall have available documentation of their quality control records.

Reporting/Delivery Requirements:

Our facility will collect capillary blood specimens via heel puncture onto the special filter/blotter forms provided by the testing facility and will mail the forms via US ground mail once specimens are dried.

It takes up to 4 hours for blood spots to dry.

Delivery Location:

A) Whiteriver Service Unit B) Cibecue Health Center Laboratory-Send outs Department Laboratory Department

200 West Hospital Drive 2 West 3rd Street PO BOX 860 PO Box 37 Whiteriver, AZ 85941-0860 Cibecue, AZ 85911-0037 928-338-3763 928-332-2560

PERIOD OF PERFORMANCE:

2/1/21-1/31/22 base w/4 option years.

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 Service or Shipment

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

A copy of the invoice should be sent electronically to the Service Unit Representative’s email address listed below or to the following address:

Whiteriver Service Unit Laboratory Department

PO BOX 860

Whiteriver, AZ 85941

Service Unit Representative:

Jennifer Antonio, Laboratory Supervisor 928-338-3761 Jennifer.Antonio@ihs.gov mailto:Jennifer.Antonio@ihs.gov