3. SOW.pdf

EMSC (Emergency Medical Services for Children)

SCOPE OF WORK

NAVAJO AREA – INDIAN HEALTH SERVICE

Emergency Medical Services for Children Telehealth

C-1 INTRODUCTION AND PURPOSE OF CONTRACT

The Shiprock Service Unit is part of the Navajo Area Indian Health Service (NNMC). The SRSU Emergency Department is located in Norther Navajo Medical Center (NNMC) in Shiprock, New Mexico. The NNMC Emergency Department has a Level 4 Trauma designation from the State of New Mexico and offers emergency health care services twenty-four hours per day and seven days per week. The NNMC Emergency Department is staffed with Board Certified or Board prepared Emergency Medicine Physicians and with Advanced Practice Providers.

NNMC has a requirement for Emergency Medical Services for Children provided through telehealth to assist with the care of Pediatric Patients who present to NNMC for Emergency Medical Treatment. Pediatric Patients are defined as those patients presenting to the Emergency Department and are less than 18 years of age.

The purpose of the contract augment capabilities of NNMC Emergency Medicine staff by providing consult Emergency Medical Services for Children through telehealth.

Contractor shall furnish all necessary personnel, supplies, materials, and equipment to perform under the terms of this contract. All services supplied by contractor under the terms of the contract shall be performed in compliance with all requirements and regulations of The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS) and Health Insurance Portability and Accountability Act of 1996 and Privacy Act (HIPAA) and IHS security requirements.

C-2 PROFESSIONAL QUALIFICATIONS

The contractor’s physicians shall:

A. Be a Pediatric Emergency Medicine Department Provider and be Board Eligible or Board Certified (BC/BE) in Pediatric Emergency Medicine or Emergency Medicine.

B. Possess an unrestricted license to practice medicine in the state where they will be providing professional services.

C. Be credentialed by TJC or CMS-approved accreditation processes to provide

Pediatric Emergency Medical Services.

D. Provide under the contract only Pediatric Emergency Medicine professional services within the scope of their credentials as granted by contractor under TJC or CMS accreditation methods.

E. Meet the “Qualifications of Personnel” as defined by the American Board of

Emergency Medicine.

Contractor shall perform Quality Assurance and Peer Review (QA) including review of all Pediatric Emergency Medical care under the terms of this contract as defined in C-3, F of this document. Contractor shall report results of all QA performed as part of this Scope of Work to COR, NNMC as required by C-3, F.

C-3 CONTRACTOR REQUIREMENTS

A. Except as necessary to provide services under the contract, contractor shall not share, distribute or publish any NNMC or NNMC facility business data, patient data or information, or patient images without the express written consent of the originating facility and any such data, information or images shared, distributed or published with the express written consent of the originating facility shall be in accordance with all applicable regulations and requirements of HIPAA, TJC, CMS and other applicable privacy standards.

B. As regards FAR 52-224-1, Privacy Act Notification (Apr 1984)

The Contractor will be required to design, develop, or operate a system of records on individuals, to accomplish an agency function subject to the Privacy Act of1974, Public Law93-579, December 31,1974 (5 U.S.C.552a) and applicable agency regulations. Violation of the Act may involve the imposition of criminal penalties.

C. As regards FAR 52-224-2, (a)The Contractor agrees to:

(1) Comply with the Privacy Act of1974 (the Act) and the agency rules and regulations issued under the Act in the design, development, or operation of any system of records on individuals to accomplish an agency function when the contract specifically identifies-

(i) The systems of records; and

(ii) The design, development, or operation work that the contractor is to perform;

(2) Include the Privacy Act notification contained in this contract in every solicitation and resulting subcontract and in every subcontract awarded without a solicitation, when the work statement in the proposed subcontract requires the redesign, development, or operation of a system of records on individuals that is subject to the Act; and

(3) Include this clause, including this paragraph (3), in all subcontracts awarded under this contract which requires the design, development, or operation of such a system of records.

http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3

(b) In the event of violations of the Act, a civil action may be brought against the agency involved when the violation concerns the design, development, or operation of a system of records on individuals to accomplish an agency function, and criminal penalties may be imposed upon the officers or employees of the agency when the violation concerns the operation of a system of records on individuals to accomplish an agency function. For purposes of the Act, when the contract is for the operation of a system of records on individuals to accomplish an agency function, the Contractor is considered to be an employee of the agency.

(c)(1) "Operation of a system of records," as used in this clause, means performance of any of the activities associated with maintaining the system of records, including the collection, use, and dissemination of records.

(2) "Record," as used in this clause, means any item, collection, or grouping of information about an individual that is maintained by an agency, including, but not limited to, education, financial transactions, medical history, and criminal or employment history and that contains the person’s name, or the identifying number, symbol, or other identifying particular assigned to the individual, such as a fingerprint or voiceprint or a photograph.

(3) "System of records on individuals," as used in this clause, means a group of any records under the control of any agency from which information is retrieved by the name of the individual or by some identifying number, symbol, or other identifying particular assigned to the individual.

D. Privacy or Security Safeguards FAR 52.239-1

(a) The Contractor shall not publish or disclose in any manner, without the Contracting Officer’s written consent, the details of any safeguards either designed or developed by the Contractor under this contract or otherwise provided by the Government.

(b) To the extent required to carry out a program of inspection to safeguard against threats and hazards to the security, integrity, and confidentiality of Government data, the Contractor shall afford the Government access to the Contractor’s facilities, installations, technical capabilities, operations, documentation, records, and databases.

(c) If new or unanticipated threats or hazards are discovered by either the Government or the Contractor, or if existing safeguards have ceased to function, the discoverer shall immediately bring the situation to the attention of the other party.

E. Contractor’s Equipment and Software: Hardware and software utilized by contractor to provide services under the contract shall be compliant with all regulations and requirements of IHS, TJC, CMS, HIPAA and any applicable New Mexico State Law. Vendor will adhere to any applicable Center for Telehealth guidelines.

F. Contractor’s Professional Liability Insurance: Contractor shall maintain, at contractor’s sole expense, Professional Liability Insurance for each of contractor’s Emergency Medicine Physicians providing services under the contract in the amount of at least Two Million Dollars ($2,000,000) per claim and Six Million Dollars ($6,000,000) in the annual aggregate, AND General Liability Insurance in an amount at least commensurate with industry standards.

G. All consults provided to NNMC under the terms of the contract shall be performed by Emergency Medicine Physicians on staff with the vendor and located in the United States of America.

H. Credentialing of Emergency Medicine Physicians: Contractor shall maintain at all times during the contract period certification by TJC (MS 13.01.01 and MS 13.01.03) and/or CMS including credentialing of contractor’s Emergency Medicine Physicians at NNMC under the terms of the contract. Contractor shall notify NNMC immediately in writing of any limitations on contractor’s TJC and/or CMS certification or restrictions on credentials of any of contractor’s Emergency Medicine Physicians. Contractor shall provide to NNMC and subsequently update a list of all Pediatric Emergency Medicine Physicians that will be providing consultations under the terms of the contract, said list including PIN and other identifying information required by government and private third party payers.

Contractor shall provide NNMC with signed billing waivers for each interpreting Pediatric Emergency Medicine Physician as required to facilitate billing of government and private third party payers by NNMC facilities. Contractor shall provide NNMC all documentation, information and permissions required to properly complete their credentialing actions as required by TJC and CMS.

Contractor shall provide NNMC at least five working days (excluding weekends and Federal holidays) notice of any additions to contractor’s i Pediatric Emergency Medicine Physician staff, said notice to be accompanied by all identification, billing, privileging and credentialing documentation specified above this paragraph.

I. Pediatric Emergency Medical Staff Staff Quality Assurance (QA) Activities and

Requirements: The contractor must establish and maintain a QA program consistent with all TJC or CMS requirements including quarterly evaluations of consults by every interpreting Pediatric Emergency Medicine Physician. These requirements may be amended from time to time to maintain compliance with applicable laws, rules and regulations.

a. Said QA evaluations shall classify contractor’s Pediatric Emergency

Medicine Physician’s consultant clinical report as:

1. No Discrepancy: Reviewer fully agreed with initial clinical consult.

2. Minimal Discrepancy: Reviewer noted or disagreed with one or more findings or care plans provided in the consultation that would likely not alter NNMC facility’s patient’s care or clinical course.

3. Significant Discrepancy: Reviewer noted or disagreed with one or more findings or care plans provided in the consultation that would likely alter NNMC facility’s patient’s care or clinical course. Note that contractor shall take action within one (1) hour to communicate to NNMC facility responsible provider notice of any significant discrepancies found in the consultation.

b. Said QA evaluations shall include a sufficient number of interpretations for each of contractor’s Pediatric Emergency Medicine Physician providing services under the contract to meet all TJC and CMS requirements for accredited QA programs.

c. Said QA evaluations shall be conducted by a BC/BE Pediatric Emergency Medicine Physician (not currently in residency training) at contractor’s sole expense.

d. Said QA evaluations must be reported to the NNMC COTR within thirty calendar days of the end of the quarter or as required by TJC and CMS.

e. Performance Improvement Plans (PI Plans) must be included for any of contractor’s interpreting Pediatric Emergency Medicine Physicians with a rate of clinically significant discrepancy greater than 1%.

f. Contractor shall also keep a written or electronic log of telephone and/or fax urgent or stat consult reports and shall conduct review of data consistent with TJC and CMS requirements on a monthly basis, results of said review to be reported to NNMC COTR within twenty calendar days of the end of the report month.

J. Accuracy of Consults: All consults shall be accurate and reflect recommended treatment within current standards of care. Any deviations in care standards found in the consults, must be communicated within 12 hours by telephone and fax to the responsible provider at the referring NNMC facility.

K. Standard Report Turnaround Time: Report turnaround times shall be as specified in section C-5 for consults.

L. Preliminary and Final Interpretations: All consults will be final once BC/BE

Pediatric Emergency Medicine Physician (not currently in residency training) complete the consult and enters the consult into the contractor’s medical record system. The consult will then be made readily available to the NNMC Emergency Department.

M. Contractor’s Customers’ Assistance: Contractor shall provide contacts for NNMC and referring facilities for assistance for clinical, technical and business related issues as follows.

a. Contractor shall provide a customer representative to assist NNMC staff with business questions during regular business hours Monday through Friday, 0800 – 1700 MT.

b. Contractor will maintain an 800 numbers or equivalent telephone service to permit twenty-four hours per day and seven days per week immediate contact with contractor’s clinical staff by clinical providers at NNMC.

c. Contractor will maintain an 800 numbers or equivalent telephone service to permit twenty-four hours per day and seven days per week immediate contact with contractor’s technical staff by clinical providers or technical support personnel at referring facilities.

d. Contractor shall identify a Medical Director for its services. COTR, NNMC clinical providers and administrators may contact contractor’s Medical Director with clinical issues and concerns, and service requests.

e. Contractor shall ensure that telehealth services are staffed as required by an Emergency Department providing services 24 hours per day 7 days per week.

f. If Contractor cannot ensure staffing of telehealth services, contractor will notify NNMC within 24 hours of learning of the staffing shortage.

N. Contractor’s Communications Network and Interface Requirements:

O. NNMC will bill for all third-party insurance for all consults covered in the contract.

The contractor will not bill insurance for services rendered. The contractor will be required to have all participating Pediatric Emergency Medicine Physician sign billing waivers.

P. NNMC will be responsible for its own equipment, connectivity and technical support for its telemedicine system. Parties shall address any technical issues that should arise related to the telemedicine system in a timely fashion so as to avoid any disruption in patient care.

C-4 PERFORMANCE PERIOD

Contract shall be for 12 continuous months beginning from the date of award.

C-5 ESTIMATED VOLUMES OF PEDIATRIC EMERGENCY MEDICAL CONSULTATION

The NNMC Emergency Room sees approximately 4500 patients per year. Workload may vary depending on the varying needs of the NNMC Emergency Department and presentations of pediatric patients including number of onsite Emergency Medicine Physicians and their relative comfort with Pediatric patients.

As an adjunct to consultation, Imaging examinations may be sent to contractor for routine, urgent or stat interpretation twenty-four hours per day, seven days per week.

In all cases, within 30 minutes, the contractor’s Pediatric Emergency Medicine Department shall provide telephone and or video consultation with NNMC clinicians to aid in the evaluation and management of pediatric patients presenting to the NNMC Emergency Department. NNMC reserves the right to alternatively utilize the services of another vendor if the Contractor is not able for any reason to meet the timelines and requirements in C-5of this section of this Scope of Work.

C-6 SITE VISITS

Optional site visits at each of the NNMC medical facilities can be arranged to meet staff physicians, imaging department personnel, and administrative representatives (e.g., Clinical Director, CEO, business office and IRM staff, etc.). Site visit will be at vendor’s own expense.

C-7 FEE SCHEDULE

Individual vendors can submit a fee schedule for the provision of Medical Services rendered by the Pediatric Emergency. Where ever appropriate, the proposed fees should conform to “Medicare and Medicaid-Like Rates”.

C-8 NNMC CONTACT

All administrative and quality assurance communications required under the terms of the contract shall be forwarded to:

Charlotte Francis-Castillo Contracting Officers Representative Northern Navajo Medical Center Shiprock, NM 87420

C-9 Points of Contact

Northern Navajo Medical Center PO Box 160/North Hwy 491 Shiprock, NM 87420

Clinical Director: Ouida Vincent, MD (505) 368-6008 Radiology Supervisor: Gary Williams, (505) 368-7153