C_PWS Out-Patient Nursing Service_Final_01_06_2026.pdf

Pine Ridge Indian Health Service Out-Patient Nursing Services Performance Work Statement

Performance Work Statement (PWS) Out-Patient Nursing Services for the Pine Ridge Service Unit

Great Plains Area Indian Health Service

This is a Labor-Hour, Non-Personal Services Requirement. While limited performance – based elements are included, the Government prescribes minimum staffing levels, work schedules, and coverage requirements due to the mission-critical nature of outpatient healthcare services.

1) Background

The mission of the Pine Ridge Service Unit (PRSU) Indian Health Service is to raise the physical, mental, social and spiritual health of American Indians and Alaska Natives to the highest level. To meet this mission, The Pine Ridge Service Unit requires contractor support to assist the nursing department during times of acute nursing staff shortages in the Out-Patient clinics. The Pine Ridge Reservation is located in the southwestern corner of South Dakota, approximately 100 miles from Rapid City. Surrounded by rolling prairie, Badlands and Black Hills, the Pine Ridge Reservation is home to the Oglala Lakota Nation.

C.2) General Requirements

C.2.1 Purpose of Contract The Contractor shall provide qualified Registered and Licensed Practical Nurses to work at the PRSU for acceptance by the Chief Nurse Executive, Deputy Chief Nurse Executive or CEO Designee at PRSU. The purpose of this non-personal service contract is to provide direct patient care, supporting the current Out-Patient Nursing staff which includes all specialty clinics and PRSU outlaying locations i.e. community outreach, especially in times of staffing shortages.

1. Require the contractor to be a temporary nursing agency; No more than 50% of the contractor workforce will be accepted with Licensed Practical Nurse qualifications. Contractor personnel shall work in an Out-Patient Clinic Nursing Department, but may be floated to the Emergency Room or Acute Care In-Patient units to act as a patient observer or pass medications or other intermittent care needs as staffing needs arise. Contractor personnel will be assigned to a shift after orientation that supports the mission of the facility, but may be either a day or evening shift. The shifts are either 8 or 10 hours.

2. Require Contractor to assume sole and exclusive responsibility for withholding federal and State taxes, paying federal and social security taxes.

The minimum staffing requirement for this contract is the equivalent for 0-10 full time Registered Nurses and Licensed Practical Nurse nursing services to the Pine Ridge Service Unit over the course of the contract. Since the PRSU operates 365 days a year, this contract may require multiple individual Contractor Personnel to meet this requirement. The Government may significantly increase or decrease the level of effort of this task order at any time by contract modification in response to staffing requirements. It is of utmost importance the contractor renders seamless coverage and provides continuity care. The contractor shall furnish licensed, experienced personnel, with the relevant background in accordance with the terms and conditions specified in the resulting contract.

The Number of RNs/LPNs are not to exceed 10 providers throughout the duration of this contract. The RNs/LPNs will be assisting in all areas of the outpatient clinic.

C.2.2 Contract Type This is a labor hour type service contract for Out-Patient Nursing Units which includes all specialty clinics and all locations for the Pine Ridge Service Unit which consist of Pine Ridge IHS Hospital, Mobile Clinic, Kyle Health Center, Wanblee Health Center, and the LaCreek Health Center. However, there are significant constraints on the contractor's solution to achieving the purpose of this contract.

The PRSU staffing levels are determined by acuity and standards of care. Therefore, this contract establishes a minimum level of support coverage that must be maintained during each shift. While there are no restrictions on the maximum number of Contractor Personnel hired for this contract, the nursing service physical presence cannot fall below contractually established minimums regardless of patient workload. The practical consequence of this for the Contractor is that although it is a performance-based contract, the staffing requirement takes on the characteristics of a labor hour contract in that the contract identifies specified skill types/levels for a stipulated number of hours.

Throughout this contract, all references to "Contractor" refers to the awardee. All references to "Contractor Personnel” refer to Contractor staffing provided in support of the contract.

C.2.3 Contract Performance Period The contract performance period will be for 90 days from award date.

In addition, this contract can be terminated for the convenience of PRSU if, a sufficient number of permanent government providers are hired to serve in this work capacity. In this event, an authorized government CO shall provide a preliminary written notice to contractor, 60 days in advance.

***The Government may require the removal and replacement of Personnel as a result of security actions or other reasons, e.g., removal of unqualified or habitually careless Personnel or the removal of Personnel that cannot perform the assigned tasks or display unacceptable conduct and behavior.

C.2.4 Contract Place of Performance

1. Pine Ridge Service Unit 607 Indian Health Road, Pine Ridge, SD 57770.

2. Kyle Health Center 1000 Health Center Rd. Kyle SD 57752

3. Wanblee health Center 210 1st St, Wanblee SD 57577

4. Lacreek Health Center 119 S 1st Ave, Martin SD 57551

5. Mobile Unit/Clinic

6. Pine Ridge Jail,

7. Community Outreach (i.e., school activities)

C.3) Labor Hour Type Requirements

C.3.1 Scope

The contractor shall furnish Out-Patient Nursing services. These services will be compatible with the facility’s operating capacity and equipment. The contractor shall report to the Chief Nurse Executive, Deputy Chief Nurse Executive or CEO Designee at PRSU.. Contract services shall cover the range of Out- Patient clinic nursing services typically provided in rural civilian practice, including but not limited to the following: EKG completion, cardiac monitoring, medication administration, immunization administration, patient education related to wellness and chronic illness appropriate to patient learning preference and education level, wound care including vacuum assisted closure dressings, general diabetes education, head-to-toe physical examination and documentation of normal and abnormal findings for all ages, preventative wellness screenings including for intimate partner violence, diabetes foot checks, alcohol use disorder, smoking practices, breast feeding use, falls risk, social determinants of health, Depression screening, vital sign assessment and reassessment, mini-mental screening, measurement and fitting of DME supplies, Point of care testing, lab sample collection, intravenous catheter placement and removal, foley catheter care and placement.

The services to be delivered under this contract by the Contractor to the Government are non-personal services and no employer-employee relationship exists or will exist under the contract between the Government and the Contractor Personnel.

Contractor Personnel under this contract shall not be:

Placed in a position where they are under the supervision or evaluation of a government employee (except for mandatory peer review and authorized "work direction"): or

Placed in a position of supervision, management, or control over government personnel, or personnel of other contractors, or become a part of the government.

Given the nature of the contract requirements and the medical working environment, it may be necessary for specifically designated Government supervisory personnel to provide "work direction" to the Contractor Personnel. This is accomplished while preserving the non-personal services nature of the contract. The operational need to work as a team is accomplished in a manner consistent with preserving the management responsibilities of the Contractor.

The Contractor is at all times responsible for the quality of Contractor Personnel work. It is the direct responsibility of the Contractor to perform all tasks normally associated with an employer-employee relationship, e.g., completing time cards, resolving quality of work issues, ensuring high motivation and morale, and resolving Government-identified Contractor performance concerns.

The physical absence of an on-site Contractor direct line supervisor does not relieve the Contractor of these responsibilities. For example, the completion and accuracy of time cards is a direct responsibility of the Contractor, not the Government. It is also the direct responsibility of the Contractor to ensure any documents needing to go with time cards are also submitted (eg. HIM deficiencies form). Since this is a non-personal services contract, the Government will not assume the supervisory functions except to the extent of providing the work direction addressed above.

The Contractor Personnel will be required to work in both the adult, pediatric, women’s health, orthopedic, podiatry, mobile unit and isolation sections of the clinics. The Contractor Personnel may be assigned to work in the emergency department and the acute care in-patient department as needed for limited nursing actions such as patient observation, medication passes, vitals collection, or point of care testing. The Contractor shall be flexible in rotating temporarily, or permanently moving into, other shifts upon notification by the COR. The Contractor Personnel identified for rotation or temporary move into a new shift will be required to undergo orientation to the new shift and unit. Hours may vary: day shifts, evening shifts, and weekends and holidays. The Contractor Personnel are expected to complete their shift to the end of their scheduled shift. Approval to leave early may be requested and may approved by the Supervisor or designee. In cases of expected inclement weather, contractor personnel are expected to secure quarters close enough to the facility to present for their scheduled shift during snow storms, blizzards, icy road conditions, or cold/heat extremes.

To Request for housing accommodations during inclement weather please contact Housing/Facilities and Contractor Officer Representative (COR):

To function effectively and efficiently as a team member in this environment, the work demands Contractor Personnel with a high degree of knowledge, skills, and abilities. Contractor management plays a key role in sustaining this high performing, highly motivated, and responsive Registered Nurses and Licensed Practical Nurses to support effort that enhances the image of the PRSU and gains the confidence of the supported Native American population.

MAJOR TASKS: Position provides direct care in assessing, planning implementing and evaluating care for patients. Responsible for performing direct patient care duties to all ages of patients with diverse acute & chronic health problems.

1. Provides direct patient care for Outpatient care patients of all ages with diverse medical and nursing diagnoses.

2. Receives patients, conducts proper patient identification x 2.

3. Intervention includes but is not limited to: Dressing changes; ambulation; assists with activities of daily living; range of motion - limited physical therapy; administering medications and vaccines as prescribed by the provider including all routes of administration PO, IM, IV, etc);

respiratory treatment and oxygen therapy; fitting of assistive devices, splints, or durable medical equipment; patient education adjusted to appropriate level; urinary catheter placement;

collection of tissue and biological samples, venipuncture for collection of blood samples; and set-up for minor procedures following aseptic techniques.

4. Preforms nursing reassessments independently to evaluate patient response to nursing interventions and updates/revises plan of care based on changes in health status and reassessments.

5. The Contractor shall provide coverage in the as needed during staff vacancies, vacation, sick leave, etc.

6. Provides instruction to patients on disease process, procedures, plan of care, use of equipment, specimen's collection of health maintenance and document per educational plans and policies.

7. Assess the biophysical, psychosocial, emotional, educational, spiritual, and cultural needs of all medical, surgical and pediatric patients in accordance with established patient care standards.

Plan nursing care for patients utilizing the nursing process and in accordance with established unit standards and license scope.

8. Initiate treatments, medications, emergency and resuscitative measures based on appropriate utilization of standing orders and unit protocols. Document observations, nursing interventions, therapeutic measures administered and patient response to treatment and reevaluation of nursing care according to facility standards.

9. Maintains complete nursing documentation, medical record confidentiality and safeguards medical information. Follows CMS, TJC requirements for nursing documentation, utilizes approved forms and participates in the overall monitoring and compliance with these standards.

10. Consult with primary care providers and other healthcare professionals on patients to coordinate diagnostic and therapeutic regimens for patients.

11. Provide patient and family education which include counseling and assisting the patient/family to understand and accept implications of care, diagnosis, and treatment.

12. The contract Registered Nurse and Licensed Practical Nurse will perform primary functions of assessing, planning, implementing and evaluating the care of all assigned patients in the Outpatient Department, Specialty Clinic Departments, Mobile Clinic, Kyle Health Center, Wanblee Health Center, and LaCreek Health Center. The contract Registered Nurse and Licensed Practical Nurse is responsible for meeting established Unit Standards of Nursing Practice; for managing supplies and equipment on the unit, and promoting teamwork with primary care providers, personnel of other departments and the patient community.

13. The contract Registered Nurse and Licensed Practical Nurse shall generate and maintain appropriate electronic health care information on beneficiaries to whom treatment is provided in accordance with IHS regulations.

14. The contract Registered Nurse and Licensed Practical Nurse shall comply with all IHS facility infection control and safety procedures, practices, and standards.

15. Develops a plan of care for individual patients identifying problems, needs of the patient, and patient driven health goals makes adjustments to the plan of care as needed, and evaluates the plan of care.

16. Contractor personnel must be able to assist in a cardiac arrest situation. This will include knowing CPR and recognizing anaphylaxis and respond to other emergency situations with other staff members. American Heart Association BLS, ACLS, and PALS is required by the Indian Health Service for consideration of a contract candidate.

17. Only perform procedures consistent with the PRSU and PRSU operating capacity and equipment.

Performs quality control checks on point of care equipment, defibrillators, isolation room environment compliance, alarm system functionality, and any other equipment assigned for routine quality control review. This position will be expected to personally perform the full range of nursing procedures offered by the Pine Ridge Service Unit Out-Patient Clinic and Specialty Clinic Nursing Department. These include, but are not limited to Adult and Pediatric Venipuncture and Skin puncture for IV placement and/or blood sample collection, assisting physician with cast application or cast removal placement of nasogastric tubes, oral and nasal airway suction, cardiac telemetry placement and monitoring, placement and monitoring of oxygen therapy, wide range of wound care including vacuum assisted closure dressings, medication and vaccine administration (oral, transdermal, intravenous, intramuscular, sublingual subcutaneous, nasal, rectal, nebulized, etc), application and use of defibrillator including pacing functions, use of patient ambulation assistive devices, fitting of supportive splint devices, durable medical equipment and supplies, orogastric feeding tube devices, placement and care of urinary catheters, care of gastric ostomy and replacement of collection bags, and set up of procedure equipment and supply trays using aseptic technique.

18. Collect, interpret and record; and communicate pertinent patient data relevant to the patient's care before, during and after patient visit.

19. Accurately review, confirm, and complete orders for each patient as placed by medical provider:

admission, transfer, discharge, medication, diagnostic testing, diet, code status, ambulation, infection control precautions, fall risk precautions, and assessment/reassessment orders. Have knowledge of and appropriately utilize facility standing orders.

20. Communicate/document the psychosocial health status of the patient to include patients' perception of care, expectations/goals of care, coping mechanisms, knowledge level, ability to understand, philosophical and religious beliefs and cultural practices.

21. Respect and maintain the basic rights of patients, to include but not be limited to personal dignity.

22. Accurately document according to PRSU policies and the PRSU Nursing Department policies and procedures within EHR, RPMS, and within other systems as required by PRSU.

23. Ensure the appropriate equipment and supplies are available and based upon patient Nursing needs. Monitor and control the environment to include temperature and humidity, sensory environment, and cleanliness. The Nurse must be able to operate equipment similar to: weight scales, IV pumps, Accucheck glucometers, Vital Signs, EKG and Defibrillator and other equipment related to regular Nursing duties. Enter appropriate work orders to BIOMED or FACILITIES for proper resolution of downed instruments or other equipment etc. and tag the equipment appropriately.

24. Ensure equipment is properly- cleaned and monitored. Ensure preventive maintenance is performed as necessary and as needed.

The work may require prolonged periods of standing; walking, recurring bending, crouching, stooping, stretching, reaching; recurring lifting of moderately heavy items such as patients or equipment (occasionally over 50 pounds). The work may require specific, but common, physical characteristics of ability such as above average agility and dexterity. Extended or late shifts for patient care needs may cause physical and emotional stressors unique to the role.

C.3.2 New Employee Orientation (NEO) & Annual Trainings New Employee Orientation is required for all new staff, occurs every other week & is held at the PRSU.

Contract staff shall complete all PRSU required orientation trainings, and mandatory and annual trainings.

Comply with the requirements of Section 231 of Public Law 101-6&7, the Crime Control of 1990 and Section 4087 of Public Law 101-630, the Indian Child Protection and Family Violence Act. Report any information or all circumstances of which Contractor Personnel are aware that may pose a violation to the COR.

C.3.3 Qualifications Before Contractor Personnel commence work and prior to the arrival of Contractor Personnel at the PRSU, the contactor shall ensure the Contractor Personnel meet or exceed the following requirements:

The contract Registered Nurse must hold a current, unrestricted state nursing license from any of the 50 United States, District of Columbia, or any US territory and have passed the NCLEX-RN. Licensed Practical Nurse must hold a current, unrestricted state nursing license from any of the 50 United States, District of Columbia, or any US territory and have passed the NCLEX-PN. LPN’s will not constitute more than 50% of the allotted work force. The contract Registered Nurse and LPN must have current American Heart Association Basic Life Support (BLS), Advanced Cardiovascular Life Support (ACLS) and Pediatric Advance Life Support (PALS).

The Contractor shall have all providers incumbent to adhering to their licensure, certificates through out the duration of the contract. The Contractor provider shall not have no expiration/lapse in certification throughout the duration of contract.

The contract Registered Nurse must have at least two (2) years or more experience in nursing ambulatory care units serving a wide-range of out-patient focused care.

The Contractor Personnel shall read, understand, speak, and write English well enough to effectively communicate with Native American Patients and other health care workers.

The Contractor Personnel shall possess knowledge of computer operations and have proficiency in the use of word processing, email, electronic patient records. Hospital information systems, and other similar software as required.

The Contractor Personnel shall possess sufficient initiative, interpersonal relationship skills and social sensitivity such that Contractor Personnel can relate constructively to patients from the Native American community.

Professional knowledge of Nursing principles, concepts and methodology sufficient to perform a broad range of routine and complex nursing care. Skill and Knowledge sufficient to use and maintain complicated instruments and equipment, knowledge of normal and abnormal physical assessments of all patient ages, knowledge of a wide range of acute and chronic medical conditions and appropriate standard nursing interventions to include appropriate infection control precautions and use of personal protective equipment, knowledge and interpersonal skills sufficient to provide appropriate patient education related to disease process, nursing care interventions, patient self-management support and care coordination instructions. Should have knowledge of regulatory agency requirements sufficient to ensure work is consistent with standards of the agency. The contractor personnel will handle problems and document corrective actions in accordance with the established policies, procedures and instructions. Guidelines include hospital policies, instructions for use manuals, handbooks, clinical care guidelines, logs, and procedural manuals.

C.3.4 Health Information Management (HIM)/Electronic Health Record (EHR)

The contractor shall use PRSU Electronic Health Record (EHR) system to maintain accurate and up-to-date information on clinical care provided to patients. Experience with EHR is highly recommended. All patient health record documentation initiated by the Contractor shall be completed per the PRSU policy.

Prepare all medical record documentation to meet or exceed the established standards of the PRSU, the PRSU Nursing policies and procedures, and TJC/CMS guidelines to include, but not be limited to:

timeliness, legibility, accuracy·, content, and signature. All medical record information generated in the performance of this contract will remain the property and subject to the exclusive control of the Indian Health Service. Use only PRSU approved abbreviations to document care in the health care record.

Ensure complete patient identifying information is on all documentation that is to become part of the health care record.

The Contracting Officer Representative (COR) shall work with the HIM director or designee on retrieving the Health Information Management Clearance Form (HIMCF) on a weekly basis when timesheets are due. The COR shall be working closely with the Nursing designee on signing off/approving of the final time sheets.

C.3.5 Tour of Duties The contract Out-Patient Nursing Service hours may vary due to changing needs of PRSU, varying complexity of medical needs and/or patient volume. The Out-Patient Nursing Supervisor, Deputy Chief Nurse Executive, and/or Chief Nurse Executive at of PRSU IHS will address these changes to the contract company. The contract company must make all contractor staff aware of the Out-Patient Clinic Nursing Department hours.

Regular Schedule: 80 hours per 2-week rotations. Clinic Hours: Shifts will be 10 (ten) 8 hour shifts or 8 (eight) 10-hour shifts with a 30-minute lunch break. Shift will be assigned by the Supervisor of the department or designee based on the staff needs. Potential shifts: Day Shift 0800-1630 (8 hours), 0830 -1900 (10 hours), Evening Shift 1030-1900 (8 hours), Sunday Clinic 1000-1830 (8 hours) depending on work schedule on each clinic needs and Holiday Clinic 1000-1830 (8 hours) depending on work schedule on each clinic needs. The schedule will be maintained and monitored by the Department Nurse Supervisor and will be reassigned as necessary to cover all shifts. Flexibility is expected. Overtime will be paid as regular hours of work. These are the shifts that will need coverage. However, the scheduling of these shifts will be determined by the Department Nurse Supervisor.

A thirty (30) minute lunch break is required, is not billable and is not to adversely affect patient care. If work is performed over the 12:00 pm (Noon) lunch period, a 30-minute lunch may be taken at a more convenient time.

Rest Periods Employees may take a fifteen (15) minute rest period during each four hours of the workday, including overtime, as close as possible to the midpoint of the four hours. Rest periods may not be appended to periods of leave, meal periods, or the beginning or end of the Employee’s workday. Rest periods may be denied in emergency situations where operational necessity requires the Employee to be at the work site and/or may be restricted to the worksite.

The Contractor shall ensure the contractually required support level is maintained at all times. This contract is for specified skill types/levels - not for specific individuals. The Contractor shall ensure that all Contractor Personnel are present for all hours of the workday. If for any reason the specified staffing levels are not maintained, due to vacation, leave, appointments, etc. and replacement Personnel will not be provided, the Contractor shall obtain the written approval of the Supervisor/ designee or the COR II prior to the Contractor Personnel's absence. Otherwise, the Contractor shall provide a fully qualified replacement so there is no gap in service.

The Contractor Personnel shall be available for work in the work area per work direction schedule. The contract Registered Nurses and LPNs can be scheduled to work in any area determined by service unit need. (Out Patient, Acute Care and any of the specialty clinics, Pediatrics, Midwife Clinic, Orthopedics, Podiatry, or Mobile unit)

The Contractor shall ensure Contractor Personnel provide professional effort and conform to Government policies regarding daily lunch breaks and other breaks. The Contractor shall ensure Contractor Personnel communicate to the Supervisor for reporting to work as it relates to inclement weather (late due to travel conditions etc.).

If a Contractor Personnel is absent due to illness for three or more consecutive days, the Contractor shall provide to the Nursing Supervisor/ designee or the COR II written documentation from a qualified health care provider that Contractor Personnel is free from communicable disease and state the cause of the Contractor Personnel's illness. Statement that Contractor Personnel is fit for service may be requested if deemed necessary.

If services are not provided by Contractor Personnel the PRSU reserves the right to procure such services from another source and deduct these costs and all administrative costs from payments due the Contractor.

C.3.6 Quality of Care

The Contractor shall comply with the following quality of care protocol:

It shall be understood that eligible patients under treatment will be rendered services that provide the best medical care within the Contractor's professional training and experience. All services rendered shall be in accordance with current standard medical practices to assure quality of care. A Work Schedule will be provided to the contractor by the Nursing supervisor prior to the dates a nurse is needed.

The contractor personnel will abide by all policies at the Pine Ridge Service Unit and within the Indian Health Service applicable to nursing department staff. The Contractor personnel shall agree to abide by the HIPAA and CMS standards.

The quality of work performed by the Contractor personnel will be subject to review by chart audits and site visits by the Contract Officer Representative. Quality Review audits will be conducted by the

Nursing Supervisor for competency per CLIA guidelines. Quality Review audits will be conducted by the Nursing Supervisor monthly for compliance with critical value reporting, corrected reports, and workload statistics to evaluate the effectiveness of the services provided and if any indicators are not within established QA benchmark parameters a copy will be shared to the COR and the Vendor for evaluation and utilized toward deductions of the contract price as described under PROFESSIONAL EFFORT. Nursing Supervisor or designee will review and complaints submitted by patients. Deductions will be 5% of hourly rate for consistent failure to meet benchmarks more than 1 quarter during the period of performance. Evidence will be provided by the Nursing Supervisor of quality assurance efforts to re-train, and or improve the performance of the staff for good faith efforts to ensure compliance with expectations of Quality Improvement Initiatives.

The quality of work performed by the Contractor personnel will also be subject to review by the Nursing Administration of this facility.

The Contractor shall ensure all Contractor Personnel on site comply with the following:

Balancing the need for complete patient care with the requirement to provide services to all assigned patients during a shift.

C.3.7 Employee Health Requirements The Contractor shall adhere to PRSU Employee Health Program policy. The purpose is to provide uniform guidelines for ensuring all staff are free from communicable disease or any other diseases, which may be debilitating or render the Contractor not able to perform his/her, assigned duties. The Contractor shall also adhere to receiving annual vaccinations required. The immunization records are required to be turned into Employee Health Department prior to entrance on duty. Employee Health Requirements include current series of the following vaccinations or screening (see attached policy for full details):

a. Measles, Mumps, & Rubella (MMR)

b. Varicella (Chicken Pox)

c. Tetanus, Diphtheria, Pertussis (Tdap)

d. Tuberculosis-PPD Annually

e. Hepatitis A

f. Hepatitis B

g. Influenza

h. COVID-19 Vaccination series

PRSU Employee Health Nurse Point of Contact:

JoDee Bettelyoun Office: 605 867 3286 Email: Jodee.Bettelyoun@ihs.gov

C.4) Special Requirements

C.4.1 Security – Character Investigation Contractor staff will be required to follow PRIHS procedures for obtaining a full Federal background investigation and preliminary clearance. The preliminary clearance process ranges from 5-30 business days. In order to obtain a Personal Identity Verification (PIV) card, contractor staff shall complete and pass a Federal background investigation conducted by the Office of Personnel Management. PRSU IHS will process the investigations through the Office of Personnel Management on all contractor staff.

Processing of PIV cards shall be completed by Great Plains Area HSPD-12/Suitability Office in conjunction with PRSU IHS PIV card stations. The contractors will be required to be physically present at one of the HSPD-12 enrollment and issuance workstations to obtain a PIV Card. Two forms of identification are needed for PIV related matters.

Each contractor shall complete each of the requirements below and receive pre-employment clearance from GPA/PRIHS prior to performing services under this contract.

Contractor shall use their legal name on all required documents and provide a formal signature that is legible or electronically signed.

The contracting company shall be advised via this Performance Work Statment (PWS) that any provider presented to fulfill the requirements of this requirement shall be required to undergo a background investigation and be able to obtain Security Clearance at a Level Tier 2.

1) Fingerprints must be captured for digital processing. Contractor may have fingerprints captured via hard copy, then sent to PRIHS by postal service (at contractor’s expense), tracking is highly recommended. Note, FD-258 fingerprint card is the only acceptable hard copy. Or, Contractor may have their fingerprints captured electronically, upon arrival at PRH. Two forms of identification are also required if the contractor is being fingerprinted upon arrival at PRIHS. Please consult with PRIHS HSPD- 12 representatives located in the Administration Department at PRH;

1) The OF-306, Declaration for Federal Employment shall be completed;

2) The Addendum to the OF-306, shall be completed;

3) Provisional Waiver form shall be completed;

4) Copy of Curriculum Vitae/Resume;

5) 86 C form shall be completed;

6) General Release form shall be completed;

7) eAPP (if applicable initially otherwise, required after 120 days of PRIHS employment);

8) The contractor shall be enrolled for PIV if eAPP is completed;

9) State Packets, individualized documents shall be completed, please consult with PRSU IHS HSPD-12 representative for guidance.

The contractor shall ensure that the employees it proposes for work under this contract have a reasonable chance for approval. If at any point during the investigation process a contractor staff is deemed ineligible or found to have other than favorable suitability, the individual must be removed from providing services under this contract. PRSU IHS shall investigate personnel at no cost to the contractor.

Please address (FD-258) hard copy fingerprint card to:

Pine Ridge I.H.S Hospital Attn: COR & TPOC 607 Indian Health Road P.O. Box 1201 Pine Ridge SD, 57770

PRSU IHS HSPD-12/Background Investigation Point of Contact:

Name: Annie Means Administration Department at PRH Office: 605 867 3403 Email: annie.means@ihs.gov

Name: Casey Weston Administrative Department at PRH Office: 605 867 3061 Email: casey.weston@ihs.gov

C.4.1 Past Performance Information Relevant Information regarding a Contractor's actions under previously awarded contracts. It includes the Contractor's record of conforming to requirements; the Contractor 's. adherence to contract schedules, including the administrative aspects of performance: the contractor's history for reasonable and cooperative behavior and commitment to customer satisfaction; and generally, the Contractor's business - like concern for the interest of the customer.

C.4.2 Develop Staff Satisfaction Survey Ongoing throughout the period of performance: Contractor shall develop a Staff Satisfaction Survey (see below) and shall be submitted it to the COR II and Nursing Supervisor, and Quality Assurance Coordinator on a quarterly basis on the calendar year cycle (Jan, Apr, July, Oct)

C.4.3 Performance Evaluation Meeting

The Contractor shall meet with the CO at least annually and as requested by the CO. The Contractor may request a meeting with the CO when necessary. Contractor shall sign meeting minutes. Should the Contractor not concur with the minutes, such non-concurrence shall be provided in writing to the CO within ten (10) calendar days of receipt of the minutes.

C.4.4 Quality Assurance/Performance Improvement/Risk Management (QA/PI/RM) The Contractor shall ensure Contractor Personnel participate in QA/PI/RM activities to the extent required by QA/PI/RM plan or regulation. None of the functions to be performed are inherently governmental. The Government will evaluate the Contractor's professional and administrative mailto:annie.means@ihs.gov mailto:casey.weston@ihs.gov performance under this contract using quality assurance standards specified by The Joint Commission and CMS Conditions of Participation.

C.4.5 Work Identification Badge When the contractor personnel is cleared to start providing service, upon arrival, he/she shall obtain a PRSU IHS work identification badge from PRSU IHS Information Technology Department. The contractor is required to wear the work identification badge at all times when in working status.

C.4.6 Contractor Furnished Property The contract Registered Nurse shall wear follow the uniform policy for the department.

The Indian Health Service does not anticipate a need for any other contractor furnished equipment

PRSU IHS requires the contractor to carry a working form of communication (i.e. cellular phone or pager) at their expense. Contractor will be required to have an electric time clock, with necessary software.

Time Clock Solution and Internet connectivity for timeclock system provided by contractor, connectivity preferred method is LTE/Cellular connected solution.

C.5.1 Timesheet Timesheet shall capture daily time in, time out and 30-minute (unpaid/required) lunch break. Please tally time on timesheet in 15-minute increments. Contractor time from 1 to 7 minutes shall be rounded down, and thus not counted as hours worked, but contractor time from 8 to 14 minutes must be rounded up and counted as a quarter hour of time worked. Ensure prior approval for overtime is obtained from the Out-Patient Nursing Supervisor, Deputy Chief Nurse Executive, and/or Chief Nurse Executive. Note, the contractor personnel shall be responsible for returning the approved documents to their contract company.

C.5.3 Invoicing The contractor shall submit an invoice on a minimum bi-weekly basis via the Invoice Processing Platform

(IPP).

Contractor shall include the approved timesheet(s) and approved HICF(s) with each invoice.

The contractor will be paid for their hours worked, at the fixed hourly rate, by labor category.

Please address invoices to the Out-Patient Nurse Supervisor, Deputy Chief Nurse Executive, Contract Officer Representative (COR) assigned at contract award and Great Plains Area (GPA) Accounts Payable (AP) Accountant.

bobette.stead@ihs.gov - Out-Patient Nurse Supervisor Arrow.banks@ihs.gov -Deputy Chief Nurse Executive Rachel.Olson@ihs.gov – GPA AP Accountant Sara.lout@ihs.gov – PRSU Contracting Officer Representative – COR Level II Simone.Miyasato@ihs.gov PRSU Technical Point of Contact

C.6) Additional Information

C.6.1 PRSU IHS Furnished Property mailto:bobette.stead@ihs.gov mailto:Arrow.banks@ihs.gov mailto:Rachel.Olson@ihs.gov mailto:Sara.lout@ihs.gov mailto:Simone.Miyasato@ihs.gov

PRSU IHS will provide a patient examination area, all medical and non-medical equipment and supplies used in the facilities for the care and maintenance of patients as per the standards of care.

In the provision of medical services, the Contract Contractor Personnel will be authorized to use all areas of the medical treatment facility available to civil services and commissioned personnel in similar positions. The same restrictions apply to the Contractor Personnel as any other Indian Health Service personnel to use these areas for official business activities only.

The Contractor Personnel will be authorized to use all administrative and ancillary support available to PRSU personnel. This will include but not be limited to copy machines, fax machines, medical library, Internet, and telephone services. The same restrictions to use these items for official PRSU business apply.

The PRSU shall provide all required blank Government forms applicable for documentation in the Indian Health Service patient record system. Applicable forms shall include Patient Care Component (PCC) forms. An appropriate orientation to the necessity of such forms will be provided by PRSU personnel.

The Pine Ridge Service Unit shall provide all medical and non-medical equipment and supplies used in the care and management of patients for all locations identified in this Performance Work Statement.

The PRSU shall assume the responsibility of patient care coordination. The service unit shall provide a multidisciplinary approach in order for patient to receive the best care possible. The PRSU shall encourage patients to be independent, well informed and active participants in their own healthcare.

Therefore, coordinating care must balance between fostering this independence and ensuring that patients receive optimal and appropriate healthcare.

The Government will provide emergency health care for the Contractor Personnel for injuries incurred on duty at reimbursable cost to the government.

C.6.2 Work Environment Exposure to contagious diseases is possible in the PRH, outlying clinics and mobile unit. Potential exposure to bodily fluids may occur in the course of caring for trauma patients.

The Contractor Personnel shall present a professional, conservative and neat appearance. Contractor Personnel shall ensure hygiene, grooming, and dress must meet hospital and service unit standards, in compliance with TJC/CMS, and PRSU infection control and safety policies. The Contractor Personnel shall report for duty in a professional manner, in appropriate attire befitting a health care setting, and display a positive and cooperative attitude. A PRSU issued name tag will be provided designating "Contractor".

C.6.3 Weather Pine Ridge, South Dakota, is a geographic area with wide temperature span. The winters can be very cold and windy. Contractors should expect to drive in weather conditions for which they may not be accustomed. The sole authority to close PRH or outlying clinics rests with the Chief Executive Officer (CEO). The Out-Patient Nursing Unit is an essential unit and may not totally close for inclement weather but may only open late. Contractor Personnel are expected to be present for scheduled shifts. Contracted personnel will be expected to report to work on time, as all other hospital employees working in essential units will be required. Reliable transportation to report for duty within the specified timeframe of this contract is the contractor’s responsibility and at their expense.

C.6.4 Meals Breakfast, lunch and dinner (supper) is available in the PRIHS hospital cafeteria with the purchase of a meal ticket. Meal tickets can be purchased in the Finance Department between the hours of 10:00 am to 11:55 am and 2:00 pm to 4:00 pm, Monday through Friday. Cash, check or money order are the acceptable payment options. PRIHS hospital is not equipped to perform credit/debit card transactions.

C.6.5 Housing If available, PRSU housing can be offered to ensure timely response during times of inclement weather.

The contractor is required to pay rent for offered housing. The rental rate is determined by PRSU IHS Guidelines. PRSU IHS will invoice the individual renting.

PRH Housing point of contact:

Ilene Packard Office: (605) 867-3023 Email: Ilene.Packard@ihs.gov

C.7) Deliverables

Technical Evaluation Criteria- IDIQ

Required Services

Performance Standards Acceptable Levels

Method of Surveillance Incentive

Problem and Approach

• Understanding of problems/ issues arising with nursing care in rural Indian Health Service Facility

• Complexity and Logistical requirements of project

• Possession of necessary organization, experience, and technical skills to accomplish Statement of Work

100% • Performance Evaluation quarterly and annual during entire contract period of performance

Performance evaluation reflected on this element

Candidates – Work Scheduling

• Adhere to work schedule

100% • Acceptance/Approval by department Nursing Supervisor

Performance evaluation reflected on this element

Candidates Candidates meet identified criteria for suitability

100% • Candidate submission packets by contractor

• Acceptance/approval by GPA Governing

Performance evaluation reflected on this element mailto:Ilene.Packard@ihs.gov

Body for Security Background Clearance at onset of award

Past Performance and Experience

Accepted contracted services with other Indian Health Services to show effective and efficient completion of clinical requirements as outlined in Performance Work Statement

50% Initial Annual Contract Performance Review of Past Performance and Final Performance Period

Performance evaluation reflected on this element

Quality of Care Activity

Consistent and Accurate vendor records entered directly into RPMS & EHR medical records.

100% Monthly/Quarterly review of:

• EHR Deficiency

Reports

• Timeliness of EHR completion

Used for Internal Monitoring of Contract

Quality of Care Activity

Contractor Personnel documented care will be reviewed and determined to meet or not meet Performance improvement and quality assurance projects monitoring:

critical results notifications, completion and timeliness of medication orders, completion of preventative health screenings, completion of falls risk screening and implementation of interventions, completion of nursing notes, entry of vital signs and accurate weight (kg) and height (cm) into EHR, compliance with CIWA monitoring, immunization administration, diabetic foot exam completion, documented patient education, documented patient allergy, documented last menstrual period in reproductive tab, and any other measure activated during the contract period.

90% Monthly review of the QA/QC program after concurrence by IHS Performance Improvement Team– conducted by the Manager/ Supervisor

Will be provided to the Vendor upon request at any time.

Shall be provided to the Vendor if at any time benchmarks are not met as per documentation towards reductions in price determinations

Performance evaluation reflected on this element

– May be used for rate reductions

Quality of Care Activity 3-

Review of complaints submitted by patients

100% • Patient Satisfaction Surveys Conducted by PRSU QA Dept

Performance evaluation reflected on

Deliverable #2

Vendor will create a satisfaction survey of their contract staff to assess:

a. How orientation/ training went

b. Feedback of quality of policy and procedure manual internal to nursing for assisting them to complete the required job duties

c. Assessment of workload statistics

• Staff Satisfaction Surveys Conducted by the Vendor and submitted quarterly to COTR and Manager/Supervisor

Pricing / Invoicing – Deliverable #3

Upon Completion of services – an invoice accounting will be provided to the government upon the agreed upon cycle for the duration of the contract

100% • Accuracy of Invoicing

• Review of

Deliverables for evaluation of Rate/ Reductions

Performance evaluation reflected on

Definitions

Professional Effort – That effort expended by the Contractor to ensure all contactor employees perform all work specified in this contract. This effort includes providing required qualified personnel, properly supervised, and following professionally accepted medical methodologies and practices. The effort is further characterized by the Contractor and Contractor Personnel operating at all times with the Government's best interest in mind, using efficient and effective methods. Failure to provide this required effort by either the Contractor or Contractor Personnel may result in a contract deduction for loss of value. For Contractor Personnel performance that does not qualify as "professional effort" this may mean a contract price deduction that reflects decreased value of services received.

Contracting Officer (CO) – Individual at the PRSU authorized and warranted to issue contracts and to make subsequent modification (s). The CO has the authority to make determinations on all matters of dispute regarding this contract.

Contractor – The firm awarded this contract.

Contracting Officer's Representative (COR) – A federal employee designated by the contracting officer who assists the contracting officer in the administration of this contract. The COR is primarily responsible for the day - to - day management of the contract.

Customer Complaints: A criticism or grievance submitted against the Contractor or Contractor Personnel to the PRSU by a patient or facility staff. This is one of the methods used to monitor the Contractor's performance.

Full time. 80 hours every two weeks.

Non - personal services contract: A contract under which the personnel rendering the services are not subject, either by the contract's terms or by the manner of its administration to the supervision and control usually prevailing in relationships between the Government and its employees as defined in FAR 37.

Orientation: An activity designed to provide basic familiarization of the facility and transition the technologist/technician into the PRSU and department where the services will be provided.

Past Performance Information: Relevant Information regarding a Contractor's actions under previously awarded contracts. It includes the Contractor's record of conforming to requirements; the Contractor 's.

adherence to contract schedules, including the administrative aspects of performance: the contractor's history for reasonable and cooperative behavior and commitment to customer satisfaction; and generally, the Contractor's business - like concern for the interest of the customer.

Personal Protective Equipment (PPE): The equipment used to protect medical personnel from exposure to biological. chemical, and radioactive hazards, Providers: Physicians, Advanced or Independent Licensed Practitioners, Surgeons, Midwives, etc (See Medical By-laws)

Quality Assurance Surveillance Plan (QASP): A written document prepared and used by the government for Quality Assurance Monitoring of the Contractor 'performance.

Quality Control (QC): Those actions taken by the Contractor to control quality of services provided. The Contractor’s equivalent of the Government's Quality Assurance Surveillance Plan.

Verifiable Emergency: An unexpected unplanned episode requiring valid documentation to confirm the occurrence.

Specifically Designated Government Personnel. At the provider's initial orientation, the identity of this individual will be provided.