DRAFT PWS- CRNA STAFFING SERVICES- SYRACUSE VAMC.docx

B.3 PERFORMANCE WORK STATEMENT (PWS) FOR TEMPORARY CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) STAFFING SERVICES

1. GENERAL:

1.1. Services Provided: The Contractor shall provide the Veterans Healthcare Administration Syracuse (VHASYR) with temporary Certified Registered Nurse Anesthetist staffing services of appropriately qualified candidates to perform the requirements of this Request for Quotation (RFQ).

1.2. Place of Performance: The Contractor shall furnish temporary CRNA staffing services to the following location:

Syracuse VA Medical Center Irving Ave Avenue Syracuse, NY 13210

1.3. Authority: FAR Part 13 – Simplified Acquisition Procedures.

1.4. Policy/Handbooks: The contractor shall be subject to the following policies, including any subsequent updates during the period of performance:

1.4.1. VHA Directive 2006-041 “Veterans’ Health Care Service Standards” (expired but still in effect pending revision) https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443

1.4.2. VHA Handbook 1100.17: National Practitioner Data Bank Reports - http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135

1.4.3. VHA Handbook 1100.18 Reporting And Responding To State Licensing Boards http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364

1.4.4. VHA Handbook 1100.19 Credentialing and Privileging - http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910

1.4.5. VHA Handbook 1907.01 Health Information Management and Health Records: http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2791

1.4.6. Privacy Act of 1974 (5 U.S.C. 552a) as amended http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm

1.5. Definitions: Terms used in this contract shall be interpreted as follows unless the context expressly requires a different construction and/or interpretation. In case of a conflict in language between the Definitions and other sections of this contract, the language in this section shall govern.

1.5.1. ACGME: Accreditation Council for Graduate Medical Education

1.5.2. ACLS: Advanced Cardiac Life Support

1.5.3. ATLS: Advanced Trauma Life Support

1.5.4. AOD: Admitting Officer of the Day

1.5.5. BLS: Basic Life Support

1.5.6. CCNE: Commission on Collegiate Nursing Education: www.aacn.nche.edu/accreditation

1.5.7. CDC: Centers for Disease Control and Prevention

1.5.8. CDR: Contract Discrepancy Report

1.5.9. CEU: Certified Education Unit

1.5.10. CIO: Chief Information Officer

1.5.11. CME: Continuing Medical Education

1.5.12. CMS: Centers for Medicare and Medicaid Services

1.5.13. Contracting Officer (CO) – The person executing this contract on behalf of the Government with the authority to enter into and administer task orders and make related determinations and findings.

1.5.14. Contracting Officer’s Representative (COR) – A person appointed by the CO to take necessary action to ensure the Contractor performs in accordance with and adheres to the specifications contained in the contract and to protect the interest of the Government. The COR shall report to the CO promptly any indication of non-compliance in order that appropriate action can be taken.

1.5.15. Contractor: A supplier or contractor awarded a contract to provide specific supplies or services to the government.

1.5.16. COS: Chief of Staff

1.5.17. CPARS: Contractor Performance Assessment Reporting System

1.5.18. CPRS: Computerized Patient Recordkeeping System- electronic health record system used by the VA.

1.5.19. Credentialing: Credentialing is the systematic process of screening and evaluating qualification and other credentials, including licensure, required education, relevant training and experience and current competence and health status.

1.5.20. CS: Contract Specialist- The person administrating this contract on behalf of the Government under the direction of the CO.

1.5.21. DEA: Drug Enforcement Agency

1.5.22. DNR List: Do Not Return List – Individuals placed on this list may not provide services under the contract.

1.5.23. ED: Emergency Department

1.5.24. FSMB: Federation of State Medical Boards

1.5.25. HHS: Department of Health and Human Services

1.5.26. HIPAA: Health Insurance Portability and Accountability Act

1.5.27. HR: Human Resources

1.5.28. ISO: Information Security Officer

1.5.29. Key Personnel: Contractor personnel providing nursing or nursing support services under this contract.

1.5.30. Medical Emergency - a sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably result in: Permanently placing a patient's health in jeopardy, causing other serious medical consequences, causing impairments to body functions, or causing serious or permanent dysfunction of any body-organ or part.

1.5.31. MOD: Medical Officer of the Day

1.5.32. National Contract Physician Identifier (NPI): NPI is a standard, unique 10-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (s).

1.5.33. NCQA: National Council of Quality Assurance

1.5.34. NLNAC: National League for Nursing Accrediting Commission. www.nlnac.org

1.5.35. Non-Contract Contract Physician: any person, organization, agency, or entity that is not directly or indirectly employed by the Contractor or any of its subcontractors

1.5.36. NP: Nurse Practitioner

1.5.37. NPPES: National Plan and Contract Physician Enumeration System

1.5.38. PA: Contract physician Assistant

1.5.39. PALS: Pediatric Advanced Life Support

1.5.40. POP: Period of Performance

1.5.41. PPD: Purified Protein Derivative

1.5.42. PWS: Performance Work Statement

1.5.43. Privileging (Clinical Privileging): Privileging is the process by which a practitioner, licensed for independent practice; e.g., without supervision, direction, required sponsor, preceptor, mandatory collaboration, etc.; is permitted by law and the facility to practice independently, to provide specific medical or other patient care services within the scope of the individual’s license, based upon the individual’s clinical competence as determined by peer references, professional experience, health status, education, training and licensure. Clinical privileges must be facility-specific and contract staff specific.

1.5.44. QA/QI: Quality Assurance/Quality Improvement

1.5.45. QM/PI: Quality Management/Performance Improvement

1.5.46. QASP: Quality Assurance Surveillance Plan

1.5.47. ROC: Report of Contact

1.5.48. TB: Tuberculosis

1.5.49. TJC: The Joint Commission

1.5.50. Veterans’ Health Administration (VHA): The central office for administration of the VA s through throughout the United States. The VHA is located in Washington, D.C.

1.5.51. Veterans Integrated Services Network (VISN): The regional oversight for the VA s in Upstate New York.

1.5.52. VISTA (Veterans Integrated Systems Technology Architecture): A PC based system that will capture and store clinical imagery, scanned documents and other non-textual data files and integrates them into patient’s medical record and with the hospital information system.

1.5.53. VetPro: a federal web-based credentialing program for healthcare contract physicians.

1.5.54. Veterans Affairs (VAMC): Unless identified with the name of a different VA, for purposes of this contract, this term shall mean the VA Fingerlakes Healthcare System.

2. QUALIFICATIONS:

2.1. CRNA Contractor Personnel:

2.1.1. Educational Requirements: Master’s Degree in Nursing

2.1.2. Certifications: CRNAs must have a national certification through the American Association of Nurse Anesthesiology (AANA).

2.1.2.1. A current ACLS/CPR/BLS certificate by the American Heart Association is required.

2.1.3. License: Licensed personnel assigned by the Contractor to perform services covered by this contract shall be currently certified or licensed, as appropriate, in any State, Territory, or Commonwealth of the United States or the District of Columbia. All licenses held by the personnel working on this contract shall be fully valid and without restriction. The qualifications of such personnel shall also be subject to review by the VA Chief of Staff and approval by the VA Facility Director. The Government specifically reserves the right to reject and of the Contractor’s personnel and refuse them permission to provide services under this contract.

2.1.4. Credentialing and Privileging: Credentialing and privileging is to be done in accordance with the provisions of VHA Handbook 1100.19 referenced above. The Contractor is responsible to ensure that proposed contractor staff possesses the requisite credentials enabling the granting of privileges. No services shall be provided by contractor staff prior to obtaining approval by the VA.

2.1.5. If a contractor personnel is not credentialed and privileged or has credentials/privileges suspended or revoked, the Contractor shall furnish an acceptable substitute without any additional cost to the government. Contractor staff shall not begin work until final approval is obtained from the contracting officer.

2.1.6. Contractor shall ensure Contractor personnel will provide appropriate, effective interventions to individual patients needs according to established facility policies, safety standards and procedures as described at the orientations and trainings conducted by VHASYR Education Department.

2.1.7. Technical Proficiency: Contractors staff shall be technically proficient in the skills necessary to fulfill the government’s requirements, including the ability to speak, understand, read and write English fluently. Contractor shall provide verifiable evidence of all educational and training experiences including any gaps in educational history for all Contractors staff and all Contractors staff shall be responsible for abiding by the Facility's Medical Staff By-Laws, rules, and regulations (referenced herein) that govern medical staff behavior. Contractor staff shall be proficient in tasks listed in Section 4.3, Demonstrated Knowledge, Skills and Abilities.

2.1.8. Training (ACLS, BLS, CPRS and VA MANDATORY): Contract staff shall meet all VA educational requirements and mandatory course requirements defined herein; all training must be completed by the Contractors staff as required by the VA. All employees who will be working on this contract and require access to VA information and VA information systems are required to complete the following training before being granted access to VA information and its systems:

· VA Privacy and Information Security Awareness and Rules of Behavior (annually)

· Mandatory Training for Transient Staff (annually)

2.1.8.1. This training is offered through the VA Talent Management System (TMS). Each employee will be required to self-enroll for a profile on the VA TMS site by visiting https://www.tms.va.gov/SecureAuth35/. Once there, they should create a profile, launch the mandatory training, and complete the content prior to starting work at the VA. Upon completion, the Contractor shall provide the CO and COR with the employee’s printed certificates of completion from the TMS. These certificates display the employee’s TMS User ID. Failure to complete the mandatory training annually, within the timeframe required, is grounds for suspension or termination of all physical or electronic access privileges and removal from work on the contract until such time as the training and documents are complete.

2.1.8.2. From time to time, the VHASYR will require training for Contractor employees. The nature of the training varies. VHASYR will pay for required training either based on the hours worked and submitted via submission of the TMS certificate certificates indicating completion of required courses. TMS certificates will be reimbursed based on the hours listed as “Learning Hours” within each course regardless of actual rime expended completing the course. Copies of all completed training will be provided to the COR as they occur.

2.1.8.3. Contractor staff who have not worked at least one shift within the last 90 days will have to be cleared by the COR or designee prior to returning to shift work. Clearance may require attendance at an orientation and/or competency class. The contractor may have to complete PIV request as determined by the COR.

2.1.8.4. Contractor employees who do not maintain their training via TMS will be placed into a Do Not Return (DNR) status.

2.1.9. Standard Personnel Testing (PPD, etc.): Contractor shall provide proof of the following tests for contractor staff within five (5) calendar days after approval of candidates to the COR and Contracting Officer. Tests shall be current within the past year.

2.1.9.1. TUBERCULOSIS TESTING: Contractor shall provide proof of a negative reaction to PPD testing for all Contractors staff. A negative chest radiographic report for active tuberculosis shall be provided in cases of positive PPD results. The PPD test shall be repeated annually.

2.1.9.2. RUBELLA TESTING: Contractor shall provide proof of immunization for all Contractors staff for measles, mumps, rubella or a rubella titer of 1.8 or greater. If the titer is less than 1.8, a rubella immunization shall be administered with follow-up documentation to the COR.

2.1.9.3. COVID-19: Contractor staff will be responsible for compliance with all COVID-19 precautions in place at the site they are performing services at.

2.1.9.4. VARICELLA: Contractor shall provide proof of immunity for all Contractor staff.

2.1.9.5. ACELLULAR PERTUSSIS: Contractor shall provide proof of 1 dose of Tdap vaccination for all Contractor staff.

2.1.9.6. INFLUENZA: Contractor shall provide proof of annual influenza vaccination unless it is contraindicated. If Contractor has a medical contraindication to the vaccine, they shall be required to wear a mask during Influenza season in accordance with VA policy.

2.1.9.7. OSHA REGULATION CONCERNING OCCUPATIONAL EXPOSURE TO BLOODBORNE PATHOGENS: Contractor shall provide generic self-study training for all Contractors staff; provide their own Hepatitis B vaccination series at no cost to the VA if they elect to receive it; maintain an exposure determination and control plan; maintain required records; and ensure that proper follow-up evaluation is provided following an exposure incident.

2.1.9.8. The VAMC shall notify the Contractor of any significant communicable disease exposures as appropriate. Contractor shall adhere to current CDC/HICPAC Guideline for Infection Control in health care personnel (as published in American Journal for Infection Control- AJIC 1998; 26:289-354 http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf) for disease control. Contractor shall provide follow up documentation of clearance to return to the workplace prior to their contract staff return.

2.1.10. Conflict of Interest: The Contractor and all Contractors staff are responsible for identifying and communicating to the CO and COR any conflicts of interest at the time of proposal and during the entirety of contract performance. At the time of proposal, the Contractor and contract staff shall provide a statement which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided. The Contractor must also provide relevant facts that show how it’s organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest. These statements shall be in response to the VAAR provision 852.209-70 Organizational Conflicts of Interest (Jan 2008).

2.1.11. Citizenship Related Requirements:

2.1.11.1. The Contractor certifies that the Contractor shall comply with any and all legal provisions contained in the Immigration and Nationality Act of 1952, As Amended; its related laws and regulations that are enforced by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor as these may relate to non-immigrant foreign nationals working under this contract for the Contractor while providing services to Department of Veterans Affairs patient referrals;

2.1.11.2. While performing services for the Department of Veterans Affairs, the Contractor shall not knowingly employ, contracted or subcontract with an illegal alien; foreign national non-immigrant who is in violation their status, as a result of their failure to maintain or comply with the terms and conditions of their admission into the United States. Additionally, the Contractor is required to comply with all “E-Verify” requirements consistent with “Executive Order 12989” and any related pertinent Amendments, as well as applicable Federal Acquisition Regulations.

2.1.11.3. If the Contractor or their contract staff fail to comply with any requirements outlined in the preceding paragraphs or its Agency regulations, the Department of Veterans Affairs may, at its discretion, require that the foreign national who failed to maintain their legal status in the United States or otherwise failed to comply with the requirements of the laws administered by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor, shall be prohibited from working at the Contractor’s place of business that services Department of Veterans Affairs patient referrals; or other place where the Contractor provides services to veterans who have been referred by the Department of Veterans Affairs; and shall form the basis for termination of this contract for breach.

2.1.11.4. This certification concerns a matter within the jurisdiction of an agency of the United States and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under 18 U.S.C. 1001.

2.1.11.5. The Contractor agrees to obtain a similar certification from its subcontractors. The certification shall be made as part of the Offerors response to the RFQ using the subject attachment in Section D of the solicitation document.

2.1.12. Annual Office of Inspector General (OIG) Statement: In accordance with HIPAA and the Balanced Budget Act (BBA) of 1977, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has established a list of parties and entities excluded from Federal health care programs. Specifically, the listed parties and entities may not receive Federal Health Care program payments due to fraud and/or abuse of the Medicare and Medicaid programs.

2.1.12.1. Therefore, Contractor shall review the HHS OIG List of Excluded Individuals/Entities on the HHS OIG web site at http://oig.hhs.gov/exclusions/index.asp to ensure that the proposed contract Contractors staff and contractor are not listed. Contractor should note that any excluded individual or entity that submits a claim for reimbursement to a Federal health care program, or causes such a claim to be submitted, may be subject to a Civil Monetary Penalty (CMP) for each item or service furnished during a period that the person was excluded and may also be subject to treble damages for the amount claimed for each item or service. CMP’s may also be imposed against the Contractor that employ or enter into contracts with excluded individuals to provide items or services to Federal program beneficiaries.

2.1.12.2. By submitting their proposal, the Contractor certifies that the HHS OIG List of Excluded Individuals/Entities has been reviewed and that contract staff are and/or firm is not listed as of the date the offer was signed. This list will be reviewed prior to the submission of any candidates for FLHCS consideration.

2.2. Clinical/Professional Direction: The qualifications of the contract staff are subject to review by VA Medical Center COS or his/her clinical designee and approval by the Medical Center Director as provided in VHA Handbook 1100.19. Clinical and professional direction of all clinical personnel covered by this contract will be provided by the VAMC COS and/or the Chief of the Service or his/her designee. A clinical COR may be appointed, however, only the CO is authorized to consider any contract modification request and/or make changes to the contract during the administration of the resultant contract.

2.3. Non-Personal Healthcare Services: The parties agree that the Contractor and all Contractor staff shall not be considered VA employees for any purpose.

2.4. Indemnification: The contractor shall be liable for, and shall indemnify and hold harmless the Government against, all actions or claims for loss of or damage to property or the injury or death of persons, arising out of or resulting from the fault, negligence, or act of omission of the Contractor, its agents or employees.

2.5. Inherently Governmental Functions: Contractor and contract staff shall not perform inherently governmental functions. This includes, but is not limited to, student/resident supervision, determination of agency policy, determination of Federal program priorities for budget requests, direction and control of government employees (outside a clinical context), selection or non-selection of individuals for Federal Government employment including the interviewing of individuals for employment, approval of position descriptions and performance standards for Federal employees, approving any contractual documents, approval of Federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy.

2.6. No Employee status: The Contractor shall be responsible for protecting Contractors staff furnishing services. To carry out this responsibility, the Contractor shall provide or certify that the following is provided for all their staff providing services under the resultant contract:

2.6.1. Workers’ compensation

2.6.2. Professional liability insurance

2.6.3. Health examinations

2.6.4. Income Tax withholding, and

2.6.5. Social Security payments.

2.7. Tort Liability: The Federal Tort Claims Act does not cover Contractor or Contractors staff. When a Contractor or Contractors staff has been identified as an individual in a tort claim, the Contractor shall be responsible for notifying their legal counsel and/or insurance carrier. Any settlement or judgment arising from a Contractor’s (or Contractors staff) action or non-action shall be the responsibility of the Contractor and/or insurance carrier. Contractor shall notify the VA as soon as possible of any informal or formal complaint, allegation, claim, legal notice, or legal action, made in any form, by or on behalf of a Veteran, pertaining to care provided by the Contractor under this contract.

2.8. Key Personnel: Key personnel are those Contractor personnel who perform CRNA services and are essential to performance of the contract requirement.

2.8.1. The Contractor shall use the following process for initial submittal of all proposed key personnel candidates:

2.8.1.1. Contractor shall submit candidates to the CS and COR for VA consideration within 72 hours of award notification, ensuring that candidate resumes shall clearly show the qualification requirements in accordance with the PWS and indicate any past VA experience. VA experience is preferred.

2.8.1.2. Upon receipt, candidate resumes and AHA BLS will be forwarded to Anesthesia team for review and approval or disapproval determination.

2.8.1.3. Contractor will be notified of Anesthesia team approval/disapproval determination within 48 hours, barring unforeseen delays.

2.8.1.4. If approved, Contractor is required to submit complete security and credentialing packages within 3 days. See PWS 6.6.8 for detailed submission requirements.

2.8.1.5. If disapproved, Contractor is required to submit replacement candidate(s) within 1 day.

2.9. Personnel Substitutions: During the first ninety (90) calendar days of performance, the Contractor shall make NO substitutions of key personnel unless the substitution is necessitated by illness, death or termination of employment. The Contractor shall notify the CO, in writing, within 15 calendar days after the occurrence of any of these events and provide the information required below. After the 90 calendar days, the Contractor shall submit the information required below to the CO at least 15 calendar days prior to making any permanent substitution submissions.

2.9.1. The Contractor shall provide a detailed explanation of the circumstances necessitating the proposed substitutions, complete resumes for the proposed substitutes, and any additional information requested by the CO as described herein. Proposed substitutes shall have comparable qualifications to those of the persons being replaced. The CO will notify the Contractor within 15 calendar days after receipt of all required information of the decision on the proposed substitutes.

2.9.2. The contract will be modified to reflect any approved changes of key personnel. The Government reserves the right to refuse acceptance of any contractor personnel under this contract any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. Should the VA COS or designee show documented clinical problems or continual unprofessional behavior/actions with any Contractors staff, s/he may request, without cause, immediate replacement of said Contractors staff. The CO and COR shall deal with issues raised concerning any Contractors staff conduct. The final arbiter on questions of acceptability is the CO.

2.9.3. Due to the level of risk involved with anesthesia delivery, the Government retains the right to ask for removal or replacement of any candidate at any time for other situations not included in Section 2.9.2. When applicable, the Contracting Officer may request that a performance plan with a timeline be put into place to evaluate measurable improvement in an area/competency.

3. HOURS OF OPERATION

3.1. VA Business Hours: 24/7, including Weekends, Holidays, Evenings and Nights.

3.2. Work Schedule: Contractor will be required to provide CRNA staff to perform services at Syracuse VA Medical Center. Contractor must organize CRNA staff schedules to ensure that there is 24/7 coverage, to include both onsite and on-call services and keep a detailed record of the Contractor schedule. Contractor scheduling must be flexible to meet VA needs. The Contractor shall present CRNA staff schedules to the Contract Specialist and COR no later than the first day of each month for the subsequent month’s coverage. VA will provide shift confirmations to contractor and contract staff 14 days in advance.The schedule may change based on the needs of the Government.

All permanent changes to scheduling needs will be made through contract modifications. The following schedules apply:

Weekdays

3.2.1. Contractor will have a ½ hour unpaid break each shift.

3.2.2. CRNA Contractors must be willing to work both a mixture of onsite and on-call services to fill VA needs. The shifts for CRNA positions can be fixed or rotating.

3.2.3. There may be occasional overtime, pre-approved, at the discretion of the Chief of Anesthesia.

3.2.4. Contractor shall arrange coverage for planned and unplanned absences of key personnel.

3.2.5. Orientation: CRNAs typically work 7:30AM to 4:00PM on a weekday during their initial Orientation. Typically, initial Orientation lasts 2 days. Upon completion of initial Orientation, contractor will continue to be oriented on the assigned unit according to their scheduled shifts. Reporting instructions (including uniform, parking and other requirements) are provided by the COR upon the CO’s final clearance of a candidate.

3.3. Up to one (1) day of uncompensated scheduled absence is allowed per FTE position per month. Absence shall be scheduled with the Anesthesia Chief, designee and/or COR at least 30 days prior to each occurrence. Unscheduled absences shall be called in to the Anesthesia Chief within the first two (2) hours of each duty day that the contract personnel is unable to work. Contractor shall arrange coverage for both planned and unplanned absences.

3.4. Federal Holidays: The following holidays are observed by the Department of Veterans Affairs:

· New Year’s Day

· President’s Day

· Martin Luther King’s Birthday

· Memorial Day

· Juneteenth

· Independence Day

· Labor Day

· Columbus Day

· Veterans Day

· Thanksgiving

· Christmas

· Any day specifically declared to be a national holiday.

4. POSITION AND DUTY REQUIREMENTS

4.1. Clinical Personnel Required: The Contractor shall provide CRNA staff who are competent, qualified per this performance work statement and adequately trained to perform assigned duties. CRNA staff work under the general supervision of the Lead CRNA and the Chief of Anesthesiology. CRNAs are expected to complete work assignments with relative independence and minimal guidance and capable of personally setting the deadlines for work completion. CRNAs assume responsibility in work assignments in accordance with regulations and independently resolves most conflicts by using considerable judgment and interpretation. The primary age of Veterans receiving services is typically between 18 and 80 years of age. CRNAs must possess or develop an understanding of the needs of patients and demonstrate sensitivity to the special needs of all patients in respect to age, developmental requirements, and culturally related factors. Contractor staff shall be responsible for signing in and out when in attendance. Time sheets will be used by the Anesthesia Chief and COR to confirm hours/day and services provided against the contractor’s invoices.

4.2. Nature/Scope of Position: Nurse anesthesia practice may include, but is not limited to, the following elements: performing a comprehensive history and physical; conducting a pre-anesthesia evaluation; obtaining informed consent for anesthesia; developing and initiating a patient-specific plan of care; selecting, ordering and administering drugs and controlled substances; and selecting and inserting invasive and noninvasive monitoring modalities. CRNAs provide acute chronic, and interventional pain management services, as well as critical care and resuscitation services; order and evaluate diagnostic tests; request consultations; and perform point-of-care testing. CRNAs plan and initiate anesthetic techniques, including general, regional, local, and sedation. Anesthetic techniques may include the use of ultrasound, fluoroscopy and other technologies for diagnosis and care delivery, and to improve patient safety and comfort. Nurse anesthetists respond to emergency situations using airway management and other techniques; facilitate emergence and recovery from anesthesia; and provide post-anesthesia care, including medication management, conducting a post-anesthesia evaluation, and discharge from the post-anesthesia care area or facility.

4.2.1. Customer Service Requirement: CRNA staff must strive to meet the needs of customers while supporting the VA mission. CRNAs must consistently communicate and treat customers (Veterans, families, Veteran representatives, all VA staff) in a courteous, tactful and respectful manner. CRNAs must provide the customers with consistent information according to established policies and procedures and be able to handle conflict and customer problems constructively and appropriately.

4.2.2. Computer Security: CRNAs must protect sensitive and electronic files that must be safeguarded under the provisions of the Privacy Act of 1974 and other applicable laws, federal regulations, VA statutes and policy, and VHA policy. The responsibility includes protecting data from unauthorized release or from loss, altercation, or unauthorized deletion; and for following applicable regulations and instructions regarding access to computerized files and release of access codes.

4.2.3. Physical Demands: This position requires a full range of physical activity, including lifting and carrying, pulling, pushing, reaching at and above the shoulders, use of both hands and fingers, walking, standing, sitting, kneeling, repeated bending, and ability for rapid mental and muscular coordinator simultaneously. Adequate hearing (aid permitted), mental and emotional stability is required.

4.2.4. Work Environment: Work is primarily performed in an operating room setting with varying risks that require safety precautions; the area is adequately lighted, heated and ventilated. However, the work environment requires someone with the ability to handle several tasks at once in sometimes stressful situations.

4.2.5. Infection Control: CRNAs must demonstrate infection control practices for disease prevention (i.e. hand washing, universal precautions/isolation procedures, including TB requirement/precautions).

4.2.6. Management of the Environment of Care: CRNAs will comply with all hospital and service policies to assure a safe, functional, and effective environment for patients, staff and others in the organization.

4.2.7. Safety: CRNAs will support of safety, occupational health, and fire protection program by the application of approved standards, regulations, practices, and work methods.

4.2.8. Green Environmental Management Systems: CRNAs shall follow all policies and procedures to ensure compliance with all applicable environmental regulations and requirements and be good stewards of the environment through pollution prevention, waste minimalization and resource conservation.

4.3. Demonstrated Knowledge, Skills and Abilities:

4.3.1. Skill in conducting and managing anesthesia for a broad range of complex surgical procedures. In addition, the CRNA must be able to adapt/modify anesthesia techniques to optimize patient care.

4.3.2. Ability to complete work assignments selected to add depth and breadth to their technical knowledge and skill competence. Work assignments will vary depending on the progressive acuity required for anesthesia care.

4.3.3. Ability to respond to emergency situations by providing airway management, administration of emergency fluids and drugs, and using basic or advanced cardiac life support techniques in order to perform necessary resuscitation procedures.

4.3.4. Ability to effectively blend technology, skills, and competency for the advancement of anesthesia techniques, pharmacology, and equipment.

4.3.5. Ability to apply new developments and theories to develop and demonstrate the ability to recognize and solve various complex anesthesia situations.

4.3.6. Ability to practice nurse anesthesia with colleagues and peers in a team concept of anesthesia care and blend management skills with technical experience.

4.3.7. Ability to recognize clinical and technical aspects of anesthesia care and has in-depth knowledge of anesthesia methods and techniques for the practice of anesthesia.

4.3.8. Ability to participate in patient care audit processes.

4.4. Standards of Care: Contractors staff services shall cover the range of services as would be provided in a state-of-the-art health care treatment facility and the standard of care shall be of a quality, meeting or exceeding currently recognized national standards as established by:

4.4.1. Relevant professional societies including ANA: https://www.nursingworld.org

4.4.2. VA Standards: VHA Directive 2006-041 “Veterans’ Health Care Service Standards” (expired but still in effect pending revision) https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443

4.4.3. The professional standards of the Joint Commission (TJC) http://www.jointcommission.org/emergency_department/

4.4.4. The standards of the American Hospital Association (AHA) http://www.hpoe.org/resources?show=100&type=8 and;

4.4.5. The requirements contained in this PWS

4.5. Medical Records

4.5.1. Authorities: Contract staff providing nursing and nursing support services to VA patients shall be considered as part of the Department Healthcare Activity and shall comply with all applicable provisions of the following:

4.5.1.1. 5 U.S.C.552a (Privacy Act) http://www.gpo.gov/fdsys/pkg/USCODE-2010-title5/pdf/USCODE-2010-title5-partI-chap5-subchapII-sec551.pdf

4.5.1.2. 38 U.S.C. 5701 (Confidentiality of claimant’s records) http://www.gpo.gov/fdsys/pkg/USCODE-2013-title38/pdf/USCODE-2013-title38-partIV-chap57-subchapI-sec5701.pdf

4.5.1.3. 5 U.S.C. 552 (FOIA)

http://www.gpo.gov/fdsys/pkg/USCODE-2013-title5/pdf/USCODE-2013-title5-partI-chap5-subchapII-sec552.pdf

4.5.1.4. 38 U.S.C. 5705 (Confidentiality of Medical Quality Assurance Records) http://www.gpo.gov/fdsys/pkg/USCODE-2013-title38/pdf/USCODE-2013-title38-partIV-chap57-subchapI-sec5705.pdf

4.5.1.5. 38 U.S.C. 7332 (Confidentiality of certain medical records) http://www.gpo.gov/fdsys/pkg/USCODE-2013-title38/pdf/USCODE-2013-title38-partV-chap73-subchapIII-sec7332.pdf

4.5.1.6. 45 C.F.R. Part 160 General Administrative Requirements http://www.ecfr.gov/cgi-bin/text-idx?tpl=/ecfrbrowse/Title45/45cfr160_main_02.tpl

4.5.1.7. 45 C.F.R. Part 162 Administrative Requirements http://www.ecfr.gov/cgi-bin/text-idx?tpl=/ecfrbrowse/Title45/45cfr162_main_02.tpl

4.5.1.8. 45 C.F.R. 164 (HIPAA)

http://www.ecfr.gov/cgi-bin/text-idx?tpl=/ecfrbrowse/Title45/45cfr164_main_02.tpl

4.5.2. Disclosure: Contractors staff may have access to patient medical records: however, contractors shall obtain permission from the VA before disclosing any patient information. Subject to applicable federal confidentiality or privacy laws, the Contractor, or their designated representatives, and designated representatives of federal regulatory agencies having jurisdiction over Contractor, may have access to VA ‘s records, at VA’s place of business on request during normal business hours, to inspect and review and make copies of such records. The VA will provide the Contractor with a copy of:

4.5.2.1. VHA Handbook 1907.1,Health Information management and Health Records http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3088

4.5.2.2. VHA Handbook 1605.1, Privacy and Release of Information https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1423

4.5.2.3. The penalties and liabilities for the unauthorized disclosure of VA patient information mandated by the statutes and regulations mentioned above, apply to the Contractor.

4.5.3. Professional Standards for Documenting Care: Care shall be appropriately documented in medical records in accordance with standard commercial practice and guidelines established by VHA Handbook 1907.1 Health Information Management and Health Records: http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2791 and all guidelines provided by the VAMC.

4.5.4. Release of Information: The VA shall maintain control of releasing any patient medical information and will follow policies and standards as defined, but not limited to Privacy Act requirements. Contractor will not release or disclose copies of records and will refer such requests to the Release of Information Department at the VA facility where assigned.

4.6. Direct Patient Care: 95% of the time involved in direct patient care. 5% of the time not involved in patient care. This is only an estimate and may vary based on the needs of the Government.

4.7. PERFORMANCE STANDARDS, QUALITY ASSURANCE (QA) AND QUALITY IMPROVEMENT(QI)

4.7.1. Quality Management/Quality Assurance Surveillance: Contract personnel shall be subject to Quality Management measures, such as patient satisfaction surveys, patient safety and timeliness. Contractor performance will be monitored by the government using the standards as outlined in this Performance Work Statement (PWS) and methods of surveillance detailed in the Quality Assurance Surveillance Plan (QASP). The QASP shall be attached to the resultant contract and shall define the methods and frequency of surveillance conducted. Patient Complaints: The CO and COR will resolve complaints concerning contract personnel relations with the Government employees or patients. The CO is final authority on validating complaints. In the event that the contract staff is involved and named in a validated patient complaint, the Government reserves the right to refuse acceptance of the services of such personnel. This does not preclude refusal in the event of incidents involving physical or verbal abuse. Contractor shall notify the VA as soon as possible of any formal complaint, allegation, claim, legal notice, or legal action, made in any form, by or on behalf of a Veteran, pertaining to care provided by the Contractor under this contract.

4.7.2. The Government reserves the right to refuse acceptance of any contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. The CO and COR shall deal with issues raised concerning contract staff conduct. The final arbiter on questions of acceptability is the CO.

4.7.3. Registration with Contractor Performance Assessment Reporting System (CPARS)

4.7.3.1. As prescribed in Federal Acquisition Regulation (FAR) Part 42.15, the Department of Veterans Affairs (VA) evaluates Contractor past performance on all contracts and task orders that exceed $250,000 and shares those evaluations with other Federal Government contract specialists and procurement officials. The FAR requires that the Contractor be provided an opportunity to comment on past performance evaluations prior to each report closing. To fulfill this requirement VA uses an online database, CPARS, which is maintained by the Naval Seal Logistics Center in Portsmouth, New Hampshire. CPARS has connectivity with the Past Performance Information Retrieval System (PPIRS) database, which is available to all Federal agencies. PPIRS is the system used to collect and retrieve performance assessment reports used in source selection determinations and completed CPARS report cards transferred to PPIRS. CPARS also includes access to the federal awardee performance and integrity information system (FAPIIS). FAPIIS is a web-enabled application accessed via CPARS for Contractor responsibility determination information.

4.7.3.2. Each Contractor whose contract award is estimated to exceed $250,000 requires a CPARS evaluation. A government Focal Point will register your contract within thirty days after award and, at that time, you will receive an email message with a User ID (to be used when reviewing evaluations). Additional information regarding the evaluation process can be found at www.cpars.gov or if you have any questions, you may contact the Customer Support Desk @ DSN: 684-1690 or COMM: 207-438-1690.

4.7.3.3. For contracts with a period of one year or less, the contracting officer will perform a single evaluation when the contract is complete. For contracts exceeding one year, the contracting officer will evaluate the Contractor’s performance annually. Interim reports will be filed each year until the last year of the contract, when the final report will be completed. The report shall be assigned in CPARS to the Contractor’s designated representative for comment. The Contractor representative will have sixty (60) days to submit any comments and re-assign the report to the CO.

4.7.3.4. Failure for the Contractor’s representative to respond to the evaluation within those sixty (60) days, will result in the Government’s evaluation being placed on file in the database with a statement that the Contractor failed to respond; the Contractor’s representative will be “locked out” of the evaluation and may no longer send comments.

5. GOVERNMENT RESPONSIBILITIES

5.1. Contract Administration/Performance Monitoring: After award of the contract, all inquiries and correspondence relative to the administration of the contract shall be addressed to the Contract Specialist (CS), Contracting Officer (CO) and Contracting Officer’s Representative (COR).

5.2. CO RESPONSIBILITIES

Danelle Wassink, Contracting Officer Department of Veterans Affairs, Network Contracting Office 2 76 Veterans Avenue Bath, NY 14810

5.2.1. CO: The Contracting Officer is the only person authorized to approve changes or modify any of the requirements of this contract. The Contractor shall communicate with the Contracting Officer on all matters pertaining to contract administration. Only the Contracting Officer is authorized to make commitments or issue any modification to include (but not limited to) terms affecting price, quantity or quality of performance of this contract.

5.2.1.1. The Contracting Officer shall resolve complaints concerning Contractor relations with the Government employees or patients. The Contracting Officer is final authority on validating complaints. In the event the Contractor effects any such change at the direction of any person other than the Contracting Officer without authority, no adjustment shall be made in the contract price to cover an increase in costs incurred as a result thereof.

5.2.1.2. In the event that procured contract services do not meet quality and/or safety expectations, the best remedy will be implemented, to include but not limited to a targeted and time limited performance improvement plan; increased monitoring of the contracted services; consultation or training for Contractor personnel to be provided by the VA; replacement of the personnel and/or renegotiation of the contract terms or termination of the contract.

5.3. COR Responsibilities:

Chari L. Mayer, Administrative Officer/ COR Department of Veterans Affairs, Syracuse VA Medical Center 800 Irving Avenue Syracuse, NY 13210

5.3.1. A COR delegation letter will be provided upon award.

5.3.2. The COR shall be the VA official responsible for verifying contract compliance. After the contract award, any incidents of Contractor noncompliance as evidenced by the monitoring procedures shall be forwarded immediately to the Contracting Officer.

5.3.3. The COR will be responsible for monitoring the Contractor’s performance to ensure all specifications and requirements are fulfilled. Quality Improvement data that will be collected for ongoing monitoring includes but is not limited to: data collected.

5.3.4. The COR will maintain a record-keeping system of services by weekly time and attendance sheets. The COR will review this data monthly when invoices are received and certify all invoices for payment by comparing the hours documented on the VA record-keeping system and those on the invoices. Any evidence of the Contractor's non-compliance as evidenced by the monitoring procedures shall be forwarded immediately to the Contracting Officer.

5.3.5. The COR will review and certify monthly invoices for payment. If in the event the Contractor fails to provide the services in this contract, payments will be adjusted to compensate the Government for the difference.

6. SPECIAL REQUIREMENTS

6.1. Reports/Deliverables: The Contractor shall be responsible for complying with all reporting requirements established within the contract. Contractor shall be responsible for assuring the accuracy and completeness of all reports and other documents as well as the timely submission of each. Contractor shall comply with contract requirements regarding the appropriate reporting formats, instructions, submission timetables, and technical assistance as required.

6.1.1. The following are brief descriptions of required documents that must be submitted by Contractor. If an item is within the PWS and not listed here, the Contractor remains responsible for the delivery of the item.

6.2. Billing:

6.2.1. Invoice requirements and supporting documentation: Supporting documentation and invoice must be submitted to the VA Tungsten Network no later than the 20th workday of the month. Paper timecards must be signed by the CRNA’s VA Supervisor before being submitted. Subsequent changes or corrections shall be submitted by separate invoice. In addition to information required for submission of a “proper” invoice in accordance with FAR 52.212-4 (g), all invoices must include:

6.2.1.1. Name and Address of Contractor

6.2.1.2. Invoice Date and…