GIMC NURSE ADVICE TELEPHONE LINE PWS_UPDATED 1.7.2022.doc

Gallup Indian Medical Center Performance Work Statement (PWS) for Non-Personal Services

Gallup Indian Medical Center Performance Work Statement (PWS) for Non-Personal Services

NURSE ADVICE/NURSE TRIAGE TELEPHONE SERVICES

TABLE OF CONTENTS

Section

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NURSE ADVICE/NURSE TRIAGE TELEPHONE SERVICES

1.0 GENERAL

This performance work statement describes the requirements for non-personal services for a Nurse Advice/Nurse Triage Telephone Services to support the mission of the Indian Health Service (IHS) raising the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.

1.1 Background

The Indian Health Service (IHS), an agency within the Department of Health and Human Services, is responsible for providing federal healthcare services to American Indians and Alaska Natives. The provision of healthcare services to members of federally‐recognized tribes grew out of the special government‐to‐government relationship between the federal government and Indian tribes. The IHS is the principal federal health care provider and health advocate for American Indians and Alaska Natives, and its goal is to raise their health status to the highest possible level.

Navajo Area Indian Health Service (NAIHS) administers health centers and hospitals providing health care to approximately 222,826 members of the Navajo Nation. The Navajo Nation is the largest Indian tribe in the United States and has the largest reservation, which encompasses more than 25,516 square miles in northern Arizona, western New Mexico, and southern Utah, with three satellite communities in central New Mexico. The NAIHS is the primary provider of inpatient, ambulatory care, preventive and community health, and environmental health services for members of the Navajo Nation and the San Juan Southern Paiute Tribe.

Gallup Indian Medical Center (GIMC) is a NAIHS facility. GIMC provides medical care for approximately 222,826 patients registered at this facility. Serving in a rural area, many of our patients travel to GIMC to receive care, and do not have electricity or running water in their homes. In addition, most of our elderly patients speak only Navajo, and live according to traditional Navajo cultural practices. GIMC and Ambulatory Care Center is a 60-bed inpatient hospital and outpatient facility. Services offered are:

· Cardiology

*Available after hours.

GIMC receives a considerable amount of inbound calls and some calls result in being unanswered, as they are not properly screen or help. The nurse advice/nurse triage telephone services answers inbound calls from patients using the Rapid Triage Screening Model to address concerns and answer questions according to triage protocols. Through critical thinking and communication with the patient(s), the nurse will determine whether the patient needs pharmacy refill, clinical follow up, referral service or interpreter services.

1.2 Scope: The contractor shall provide Nurse Advice/Nurse Triage Telephone Services in accordance with section 5.0 – Performance Based Requirements.

1.2.1 Duties and responsibilities will encompass nurse advice/nurse triage telephone services to IHS patients.

1.2.2 Place of Performance: Nurse Advice/Nurse Triage telephone services shall be perform through a dedicated toll-free number and simultaneously access to GIMCs EHR for the purposes of retrieving electronic health records via Virtual Private Network (VPN). This will require a BPSA agreement.

1.2.3 Period of Performance: Will be long term (1-year to 3-year) and, where feasible, include intermittent support to meet unplanned needs that develop on a frequent basis. The contractor shall provide 24 x 7 x 365 access to Registered Nurse (RN) advices services via telephone.

1.3 Applicable Documents: Please see the web link listed unless document is reference as an attachment.

1.3.1 The Joint Commission http://www.jointcommission.org/

1.3.2 Centers for Medicare and Medicaid Services (CMS) Standards http://www.cms.hhs.gov/

1.3.3 Accreditation Association for Ambulatory Health Care (AAAHC) http://www.aaahc.org

1.3.4 Section 231 of Public Law 101-647, the Crime Control Act of 1990.

http://www.policyalmanac.org/crime/archive/crs_federal_crime_policy.shtml

1.3.5 Section 4087 of Public Law 101-630, the Indian Child and Family Violence Act.

http://www.nicwa.org/policy/law/protection/index.asp

1.3.6 Health Insurance Portability and Accountability Act (HIPAA) of 1996. http://www.cms.hhs.gov/HIPAAGenInfo/Downloads/HIPAALaw.pdf

1.3.7 Privacy Act of 1974.

http://www.usdoj.gov/oip/privstat.htm

1.3.8 IHS Service Unit and Health Center Policies, Procedures and Protocols.

(See section 11.0 for a list of attachments and exhibits)

1.3.9 Computer Security Act of 1987

http://csrc.nist.gov/groups/SMA/ispab/documents/csa_87.txt

1.3.10 Federal Code of Conduct http://www.ihs.gov

1.3.11 IHS General Directives http://www.ihs.gov/adminmggrresouces

1.3.12 IHS Computer Security Directives http://www.ihs.gov/adminmggresources

2.0 DEFINITIONS

2.1 Acceptance: Constitutes acknowledgement that services conform to the applicable contract quality and quantity requirements, except as provided in FAR subpart 46.5 and subject to other terms and conditions of the contract.

2.2 Approval: Acknowledgment by the designated Government official that submittals, deliverables, or administrative documents (e.g., insurance certificates, installation schedules, planned utility interruptions, etc.) conform to the contractual requirements. Government approval does not relieve the Contractor from responsibility for compliance with contract requirements.

2.3 Authorized Ordering Official: A Government employee with the authority to order/issue and sign individual task orders for MRI services for the GIMC medical facility.

2.4 Code of Ethics: The Code of Ethics and Standard of Practice and Care as listed with the contractor’s accrediting entity.

2.5 Contracting Officer (CO): A Government employee with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings.

2.6 Contracting Officer’s Representative (COR): A Government individual responsible for administration of this contract. The COR closely monitors the contract for contractor compliance and provides feedback to the Contracting Officer.

2.7 Contractor: The organization awarded a legal binding contract to provide supplies and/or services; includes the organization’s employees.

2.8 Cooperative Attitude: Behavior that is positive and displays a willingness to perform assigned tasks and to be a team player.

2.9 Cultural Awareness: Realization and respect for American Indian and Alaska Native practices.

2.10 Customer: Patients, staff and visitors of GIMC.

2.11 Customer Input: Written comments made to the Contracting Officer regarding the contractor’s performance. This is one of the criteria used to evaluate the Contractor’s performance.

2.12 Dependability: Qualities of being trusted and being able to repeat the same task to yield the same result.

2.13 Federal Acquisition Regulation (FAR): The FAR is the primary regulation for use by all Federal Executive agencies in their acquisition of supplies and services with appropriated funds.

2.14 Health Center: A facility physically separated from a hospital, with a full range of ambulatory services including at least primary care providers, nursing, laboratory, and x-ray which are available at least 40 hours a week for outpatient care.

2.15 Holiday: A day marked by the government for general suspension of work in commemoration of an event.

2.16 Non-Personal Services Contract: A contract under which the personnel rendering the services are not subject, either by the contact’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 37.401.

2.17 Ordering Activity: An authorized user of IHS that may issue a task order to obtain required services under this contract.

2.18 Ordering Activity Contracting Officer: A Government employee of IHS authorized and warranted to issue task orders and to make subsequent task order modification(s) under this contract. The Ordering Activity CO has the authority to make initial determinations on all matters of dispute regarding task orders.

2.19 Orientation: An activity designed to provide basic familiarization of the facility and the transition of the contractor into GIMC and/or Health Center.

2.20 Past Performance Information: Relevant information regarding a contractor’s actions under previously awarded contracts. It includes the contractor’s record of conformance to specifications and to standards of good workmanship; the contractor’s record of containing and forecasting costs on any previously performed cost reimbursable contracts; 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.

2.21 Performance Based Matrix: Lists the services to be monitored and the standards to be applied.

2.22 Quality Assurance Surveillance Plan (QASP): An organized written document prepared and used by the Government for Quality Assurance surveillance of the contractor’s performance.

2.23 Service Unit (SU): A facility that houses Service Unit administrative staff and is responsible for the administration, coordination, and implementation of the Indian Health program/s in a designated geographic portion of the Area. The Navajo Area IHS covers approximately 25,000 square miles across North Arizona, Southern Utah, Western New Mexico and Colorado. The IHS medical facilities range from small ambulatory care clinics (health centers) to full service hospitals.

2.24 Standards of Practice and Standards of Care: Authoritative statements with the contractor’s accrediting entity that describes the responsibilities and accountability. The standards provide direction for the professional medical practice and a framework for the evaluation of practice. The standards of professional medical practice may pertain to general or specialty practice.

2.25 Supervisor: Government employee authorized to provide verbal and written performance direction to the contractor that the contractor must follow without exception.

2.26 Task Order: An order issued in accordance with the terms of the contract that details an ordering activity’s specific requirements. An ordering activities written order to obtain services, at a minimum will include the following where applicable: description of services, skill categories, hours, price, period of performance, contract number, and the ordering activities task order number.

3.0

GOVERNMENT FURNISHED INFORMATION, PROPERTY, AND SERVICES

3.1 Information: The Government will provide the contractor with user credentials to access our EHR for the purposes of retrieving electronic health records to fulfill the requested services that is essential for contractor performance. The contracting officer or designee will be the point of contact for identification of any required information supplied by the Government.

3.2 Training: Facility specific orientation/training necessary for the contractor to perform the required duties, e.g., IHS Information Technology (IT) systems and operational procedures. Training will be provided ONLY if the subject matter is necessary to improve or enhance the quality of services or includes mandates made by the IHS Service Units/Health Centers while the services are performed under this contract. Training will not be provided for the purpose of continuing education, career development or individual development.

3.3 Inspection: All rendered Nurse Advice/Nurse Triage Telephone services will be inspected, reviewed, and monitored Clinical Medical Officer and Contracting Officer for this contract.

3.3.1 Contracting Officer Representative (COR): Alonzo Thomas-Becenti is primarily responsible for monitoring the technical progress including surveillance and assessment of performance for this order.

3.3.2 Point of Contact: Clinical Medical Officer(s) or Designee are the points of contact for this requirement.

4.0

CONTRACTOR FURNISHED PROPERTY

4.1 Except for the property specified in Section 3 as government furnished, the contractor shall provide all necessary personnel, supplies, equipment, and facilities to perform this contract.

5.0 PERFORMANCE-BASED REQUIREMENTS

The contractor shall provide professional Nurse Advice/Nurse Triage Telephone Services to GIMC. Specific tasks include the following:

5.1 Nurse Advice/Nurse Triage Duties

5.1.1 The contractor shall provide professional Nurse Advice/Nurse Triage Telephone professional services to the patients of GIMC under the terms of this contract, appropriate and timely services in accordance with the standards of care under the auspices of all accrediting entities and in accordance with GIMC’s policies and procedures, Medical Staff Bylaws and Rules & Regulations.

5.1.2 Nurse Triage and Health Information – Rapid Triage Screening (RTS) Model

a. The contractor will accept calls transferred from GIMC facilities directly through a dedicated toll-free number specific to GIMC.

b. Incoming calls are routed to a dedicated toll-free number and are initially processed through an automated system that includes appropriate disclaimer language.

c. GIMC patients are connected directly with a RN.

d. When the RN is connected with the patient, the RN shall:

i. Notify each patient that the call will be recorded;

ii. Select the appropriate Clinical Guideline to be used in assessing the patient’s medical needs;

iii. Using clinical judgment and the clinical guidelines, the RN will do one of the following:

1. Determine that the call is a life-threatening emergency, direct the patient to the nearest emergency facility, and provide documentation of the emergency facility referral to a person designated by client within 24 hours of the referral or as soon as administratively possible;

2. Determine that the call is urgent but not a life-threatening emergency, advise the patient according to the clinical guideline and make a determination whether the patient should contact his or her physician, a page will be made to his or her physician, or the covering physician, or, given the disposition of the applied triage guideline, the local hospital Emergency Room when medically appropriate. The contractor shall maintain a list of on-call medical staff at GIMC to contact when medically appropriate.

3. Determine that the call is not urgent and not a life-threatening emergency, advise the patient according to the clinical guideline and recommend to the patient that he/she contact their physician in the morning for scheduling an appropriate visit;

4. Determine that the call is not urgent and not a life-threatening emergency, advise the patient according to the clinical guideline, and advise the patient that a visit to their physician is not required; or

5. Determine that the patient is seeking general health information and use established procedures to provide the patient with such information.

iv. Document each telephonic interaction with a patient and securely transfer documentation to GIMC for import into the GIMC Electronic Health Record.

e. Provide GIMC access to specific call reports and tape recordings upon request.

f. Provide GIMC with data reports regarding volume of calls, chief complaints, triage disposition, and other data upon request.

g. The RN will direct the caller to appropriate health care services as needed, and or provide the necessary health education.

h. Provide GIMC with copies of clinical triage guidelines used by RN. GIMC reserves the right to customize clinical guidelines to fit the needs of GIMC patients.

5.1.3 Clinical Follow up Calls

a. Follow up calls to patients will be scheduled based on parameters defined by GIMC, nursing judgment and high-risk patients.

b. The nurse consultant will obtain the caller/patient’s permission for a follow-up call and document this permission. The nurse must document the reason for the follow up, along with permission, in the nurse’s notes.

c. The nurse will respect the patient’s right to refuse follow up calls and will document all refusals in the Triage Encounter Document.

d. When Successful in Reaching the Patient: If the patient’s symptoms have not improved or remain the same (and should have improved with time/home care advice per nursing judgment), the nurse will offer re- triage during the Follow Up call.

e. When Not Successful in Reaching the Patient: If unable to reach the caller after two (2) attempts, the call will be closed from the follow up queue with documentation in the Triage encounter document addendum reflecting the reason why the follow up was closed. (i.e. two outbound call attempts made – no answer; call closed).

5.1.4 Interpreter Services

a.

Provide Patients with access to a trained medical interpreter for Navajo to English translation when requested by the patient.

5.1.5 The contractor shall be subject to Joint Commission standards.

5.1.6 Contractor shall submit original invoices as required for payment of services rendered. The contractor shall remit a certified invoice for rendered service and attach log of calls to be cross reference with the invoice. Invoices will also include certification statement of service rendered that will be signed by the COR.

5.2 Work Schedule: The contractor shall provide 24 x 7 x 365 access to Registered Nurse (RN) advices services via telephone.

5.3 Conduct: The Contractor shall meet standards as listed in the Federal Code of Conduct and the contractor shall be subject to and comply with the provision of Public Law 101-630: Occupational/Classification – Indian Children Protection and Family Violence Protection Act.

5.4 Performance Evaluation:

5.4.1 The contractor’s performance will be evaluated in accordance with the standards set forth in the contract and Performance-Based Matrix of Section 8.0.

5.4.2 Substantiated reports written by any customer dealing with patient safety or other procedure that adversely affects patient outcome constitutes a breach of contract and shows cause for termination.

5.5 Management of Medical Information: The contractor shall manage all patient information in accordance with HIPAA standards, Privacy Act, and IHS Service Unit and/or Health Center specific policies and protocols.

5.5.1 Medical Records and Other Required Documentation: 100% percent of all medical records (EHR) and other required documentation meets established IHS Medical Facility, Joint Commision, and CMS standards to include, but are not limited to, timeliness, legibility, accuracy, content, date, time, signature and designated profession.

5.5.2 The contractor shall ensure adherence to DHHS IT system security policies and procedures. The IT policies and procedures will be made available to the contractor.

5.5.3 The contractor shall immediately report to the Contracting Officer or COR any information or circumstances that may violate any statute, policy, or procedure.

5.6 IHS Information Technology Systems:

5.6.1 In performance of this contract, the contractor shall adapt to and successfully utilize IHS information technology systems deemed by the supervisor as necessary for acceptable contractor performance.

5.6.2 The contractor shall obtain and maintain access to GIMC EHR for the purpose of retrieving electronic health records when requested.

5.6.3 The contractor shall ensure that IHS Information Technology System Security Policies and Procedures are adhered to. The IT policies and procedures will be made available to the contractor.

5.6.4 The contractor shall follow all appropriate federal and locally required Information Technology security requirements and will be operating under HIPAA and Privacy Act regulations.

6.0

CONTRACTOR QUALIFICATION REQUIREMENTS:

6.1 Experience: The contractor shall meet the qualifications, standards, and retain pertinent certification throughout the term of the contract.

6.1.1 Contractor shall provide evidence of Registered Nurses with a current, valid, unrestricted nursing license in any state, the District of Columbia, the Commonwealth of Puerto Rico, or a Territory of the United States, throughout the term of this contract.

6.1.2 Contractor shall provide key information and show evidence of competencies and experience in the providing Nurse Advice/Nurse Triage Telephone Services.

6.1.3 Contractor shall provide evidence of experience in providing services of similar scope and complexity to the Federal Government or other large entities with in the last twelve (12) months thus showing past performance in meeting the requirements of Performance Work Statement.

6.1.4 Contractor shall provide evident of competencies on Confidentiality/HIPPA and Patient’s Right.

6.1.5 Contractor shall provide an acknowledgement of EMTALA Compliance.

6.2 Accreditation: The contractor shall be accredited under the auspices of one of the accrediting entities. The contractor shall maintain its accreditation throughout the term of this contract without any lapses.

6.2.1 The Joint Commission (TJC)

6.2.2 Patient Centered Medical Home (PCMH)

6.2.3 National Committee for Quality Assurance (NCQA)

6.2.4 Utilization Review Accreditation Commission (URAC)

6.2.5 Accreditation Association for Ambulatory Health Care (AAAHC)

6.3 Language Requirements and Cultural Awareness. The contractor shall read, understand, speak, and write English to communicate effectively with patients and shall be respectful of the local, American Indian and Alaska Native culture.

6.4 Information Technology Skills. The contractor shall possess basic knowledge, skills, and abilities to use a computer.

6.5 Orientation. The contractor providing service under this contract shall attend mandatory orientations and training specified by the government.

6.5.1 Information Systems Security Awareness Training (ISSA)

6.5.2 The Privacy Act

6.5.3 Rules of Behavior

6.6 Background Checks: As directed by the contracting officer, the contractor shall provide all requested information necessary to perform Level I and Level II background checks. The contractor shall comply with the requirement to obtain security investigations. The contractor shall work with the IHS to ensure that the pre-employment screening process includes the appropriate investigation questionnaires and forms to be completed. All completed forms will be reviewed by the contractor and forwarded to the supervisor. The contractor will be immediately removed from the position if at any time the investigation receives unfavorable adjudication, or, if other unfavorable information that would affect the investigation becomes known.

7.0 PERFORMANCE – BASED MATRIX

The contractor shall provide a Nurse Advice/Nurse Triage Telephone Services in the delivery of patient care to Gallup Service Unit and the patients of Gallup Service Unit.

Competency

Compliance

Patient Outcomes

Professionalism

Documentation

Service Quality Perform 100% required tasks at 100% of the required competencies (refer to 6.0)

100% compliance with IHS Service Units and/or Health Centers published Policies; Procedures; Standards of Care; and Hospital and Laboratory Protocols.

No reports of breached patient safety and other procedures that might adversely affect patient outcome.

Performance characterized by continual cultural awareness and focus on customer service. 100% adherence to the Code of Ethics and Federal Code of Conduct.

100% of all medical records and other required documentation meets established IHS Medical Facility, Joint Commision, and CMS standards to include, but are not limited to, timeliness, legibility, accuracy, content, date, time, signature and designated profession.

Satisfaction with quality of service is evidence by valid customer inputs.

No payment for incomplete work.

Contractor performance will be evaluated using the Contractor Performance Assessment Report (CPAR). The evaluation will be considered when future IHS contract selections are made.