3 PWS.docx

Performance Work Statement (PWS) For Non-Personal Services

Geriatric Dentist

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Performance Work Statement (PWS) For Non-Personal Services

Geriatric Dentist

1.0 GENERAL: This performance work statement describes the requirements for Non-personal services for a Geriatric Dentistry to support the mission of the Indian Health Service (IHS).

1.1. Background: IHS is an agency within the US Dept. of Health and Human Services and is responsible for providing federal health services to American Indians an Alaska Natives. The provision of health 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 the Indian people. The goal is to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indians and Alaska Natives. The IHS currently provides health services to approximately 1.5 million American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 34 states.

There is a nationwide shortage of Dentists which is amplified by the remote and rural areas served by the Indian Health Service. The Dentist vacancy rate within IHS has been consistently at 32%. Often, these vacancies are being filled through the use of contracts.

1.1.1 Navajo Area Indian Health Service (NAIHS) administers health centers and Hospitals providing health care to approximately 201,583 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.

1.2 Scope: The Contractor shall provide dental treatment for the Navajo Area Indian Health Service Patients (NAIHS) in accordance with section 5.0, performance-based requirements.

1.2.1 Duties and responsibilities will encompass outpatient, inpatient, and community health Dental services to all patients.

1.1.1. Place of Performance: Services are to be performed in the Dental Department at Chinle Comprehensive Health Care Facility (CCHCF) under the Navajo Area Indian Health Service (NAIHS) within the State of Arizona.

1.2.2 Period of Performance: Will be flexible to allow for short term (up to 13 weeks), long term (1-year to 3-year) and, where feasible, include intermittent support to meet unplanned needs that develop on a frequent basis.

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

1.3.1 Joint Commission on Accreditation of Healthcare Organizations (JCAHO) 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/archieve/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.hh.sgov/HIPAAGeninfo/Downloads/HIPAALaw.pdf

1.3.7 Privacy Act of 1974

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

1.3.8 OMB/GPRA Standards and IHS Oral Health Program Guide

1.3.9 State Dental Practice Act for the Contractor’s licensing state http://medismart.com/practice.htm

1.3.10 NAIHS Service Unit and Health Center Policies, Procedures and Protocols (See section 11.0 for exhibits 1 through18)

1.3.11 Computer Security Act of 1987

http://csrc.nist.gov/groups/SMA/ispab/documents/csa 87.txt

1.3.12 Federal Code of Conduct

http://www.ihs.gov

1.3.13 IHS General Directives

http://www.ihs.gov/adminmggrresources

1.3.14 IHS Computer Security Directives

http://ihs.gov/adminmggresources

2.0 Definitions:

2.1. Acceptance: Constitutes acknowledgement that the supplies or services conform to the applicable contract quality and 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. Area: A defined geographical region for Indian Health Service Administrative purposes. Each Area Office may administer several Service Units.

2.4. Code of Ethics: American Dental Association and State Dental Practice Act.

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. Contractor: The individual awarded a legal binding contract to provide supplies and services.

2.7. Contracting Officer's Representative (COR) or Project Officer (PO): A federal employee who assists the ordering/issuing activity contracting officer in the administration of task orders issued under this contract. The COR is primarily responsible for the technical assistance and day to day program management of the ordering activity’s task orders. Ordering activities may have different designators for this employee (e.g. GTR – Government Technical Representative, COTR – Contracting Officer’s Technical Representative, or PO – Project Officer).

2.8. Cooperative Attitude: Behavior that is positive and displays a willingness to perform assigned patient care 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 a NAIHS service unit and health center.

2.11. Customer Evaluation/Input: Written comments made to the Contracting Officer regarding the Contractors 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. Government Vehicle: A NAIHS owned motor vehicle or a vehicle leased by NAIHS through agreements with the General Services Administration (GSA) or through commercial rental agreements.

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

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

2.17. Non-personal Services: 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.

2.18. Ordering Activity Contracting Officer: A Government employee of NAIHS 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 transition the dentist into the NAIHS Service Unit and /or Health Center and the Dental Clinic/Department where the services will be provided.

2.20. Past Performance Information: Relevant information regarding a contractor’s actions under previously awarded contracts. This 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. Patient Outcome: End result of outpatient, Dental care.

2.22. Performance based Matrix: Lists the services to be monitored and the standards to be applied.

2.23. Personal Protective Equipment (PPE): The equipment used to protect medical personnel from exposure to biological, chemical, and radioactive hazards.

2.24. Service Unit: The local administrative unit of IHS.

2.25. Standards of Practice and Standards of care: Authoritative statements by which the dental profession describes the responsibilities for which its practitioners are accountable. The standards provide direction for professional Dental practice and a framework for the evaluation of practice. The standards of professional dental practice may pertain to general or specialty practice.

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

2.27. Task Order: An order issued in accordance with the terms of the contract that details an ordering activity’s specific requirements. An ordering activity 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.

2.28. Tour of Duty: The time of day the dentist is scheduled to perform dental treatment; also considered the shift of the day.

2.29. Valid Patient Complaint: Justifiable accusation made by a patient and supported by investigation.

2.30. Verifiable Emergency: An unexpected/unplanned absence by the contractor requiring valid documentation to confirm the occurrence.

3.0 Government Furnished Information, Property and Services

3.1. Information: Government unique information related to this requirement, which is necessary for Contractor Performance, will be made available to the Contractor. The Contracting Officer or designee will be the point of contact for identification of any required information to be supplied by the Government.

3.2. Joint Use by the Government and the Contractor: Except for the property and service listed in 3.3 and 4.0, the Government will provide, for joint use by the Government and the Contractor, all necessary equipment, supplies, and clinic space to perform the services under this contract.

3.2.1. Government Vehicle: If required by the position, authorization shall be in accordance with NAIHS Chapter 12, Section 13 Motor Vehicle Management.

3.3. Contractor Exclusive Use:

3.3.1. Personal Protective Equipment (PPE). The Government will furnish the Contractor with appropriate PPE other than specified in paragraph 4 of the contract. The Government will be responsible for any repair, cleaning and inventory required for the PPE. This does not include any type of uniform or laboratory coat.

3.3.2. The Government will provide facility specific contractor identification badges for each contractor. A $10.00 fee will be charged for lost or destroyed badges.

3.4. Training: Facility specific orientation/training necessary for the Contractor to perform the required duties, e.g., NAIHS 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 dental services or includes mandates made by the IHS Service Units /Health Centers while the dentist is working under this contract. Training will not be provided for the purpose of continuing education, career development or individual development.

3.5. Protection of Government Buildings, Equipment, and Vegetation The Contractor shall use reasonable care to avoid damaging existing buildings, equipment, and vegetation on the Government installation. If the Contractor’s failure to use reasonable care causes damage to any of this property, the Contractor shall replace or repair the damage at no expense to the Government as the Contracting Officer directs. If the Contractor fails or refuses to make such repair or replacement, this Contractor shall be liable for the cost, which may be deducted from the contract price.

4.0 Contractor Furnished Property

4.1. Except for the property specified in paragraph 3 as government furnished, the Contractor shall provide all uniforms and other personal medical instruments subject to the following.

4.1.1. Uniforms and Lab Coat: Uniforms and Lab Coats shall conform to the requirements of the Indian Health Service Manual, Part 3 Chapter 4 and meet the approval of the Chief Dentist at IHS facility.

5.0 Performance Based Requirements. The Contractor shall provide Geriatric Dental services in the delivery of patient care to the Indian Health Service. Specific tasks include the following:

5.1. Dentist Duties:

5.1.1. The Contractor shall perform dentist duties and manage patient’s needs as described on the attached Position Description (PD) and as directed by Supervisor. The incumbent will provide geriatric dentistry services for Diabetic and non-Diabetic patients seen in the dental clinic. Dentist will come to Chinle Hospital with his laboratory technician to perform impressions, jaw relations, and bite registrations on edentulous and partially edentulous patients for the fabrication of full dentures, partial dentures, and combinations thereof, including diagnosis/treatment, intra and extra-oral examinations of the teeth and soft tissues, oral hygiene instructions.

5.1.2. Duties include: The contractor shall provide professional Geriatric Dentistry services in direct patient care as follows:

A. The contractor shall have training in Geriatric Dentistry; have expertise at fabricating full upper and lower dentures, partial upper and lower dentures, or combinations thereof in a timely fashion.

B. The contractor shall perform necessary chairside procedures to fabricate complete and partial dentures on edentulous and partially edentulous patients identified by the Dental Staff.

C. The procedures shall consist of impressions, jaw relations, denture try-in, and laboratory fabrication by the contractor’s own laboratory staff, delivery of the completed prosthesis, and a post insertion visit.

D. Review patient’s dental records including the medical history and examination/treatment plan. Discuss treatment with patients and answer questions.

E. Makes appropriate referrals and obtains appropriate consultations with the general dentist if needed for any prior/after treatment for extractions.

F. Administer local anesthetic to areas in the mouth to make treatment comfortable for patients.

G. Provide oral health instructions to patients or guardians.

H. Complete the necessary Dental encounter and PCC forms and progress notes at the end of the appointment.

I. Provision of full range of geriatric services for Diabetic or non-Diabetic patients seen in the Dental Clinic. Contractor will come to Chinle Hospital for 5 days with his laboratory technician to perform impressions, jaw relations, and bite registrations on edentulous and partially edentulous patients for the fabrication of full dentures, partial dentures, and combinations thereof.

J. Materials/equipment will be provided by the contractor; and facilities and staff will be provided by the CCHCF Dental Program, except for the Contractor’s laboratory technician.

K. Contractor will then perform the necessary laboratory procedures in their facilities, and will return to the Dental Department in Chinle Hospital approximately one month later for two days to try in the prosthetic appliances to ascertain correct function, form and esthetics.

L. Contractor will then return to the Dental Department in Chinle Hospital for 2-3 days in approximately four to five weeks to insert the prosthetic appliances.

M. The final visit to Chinle Hospital by the Contractor will occur in approximately six weeks for approximately one day and a half to two days, to make any appropriate post-insertion adjustments.

N. Interacts in a professional manner with patients and co-workers

5.1.3 Contractor shall be subject to peer review per Joint Commission standards.

5.1.4 Contractor shall meet the Safety management reporting requirements in accordance with the Service Unit Safety Measure Policy.

5.1.5 Contractor shall be responsible for all applicable Federal, State, And Local Taxes, Meals, Travel/Transportation. Lodging is provided but must be paid for by the contractor or contract agency. Government quarters are available at prevailing rental rates plus utilities, as applicable, if government quarters are utilized. The contractor shall be responsible and liable for the proper care of government owned or leased property furnished in occupied quarters.

5.2 Work Schedule:

5.2.1 Work Shift: The Supervisor at IHS facility shall determine specific tour of duty. The contractor shall work 100% of the contracted hours. Works full days from 8 am – 5pm in the Dental Department of the Chinle Hospital. (4) Returns at 3 day each.

5.2.2 Work Flexibility: As directed by the Supervisor, the Contractor shall rotate into other duty sections as needed to support patient care.

5.3 Conduct: The Contractor shall meet standards as listed in the Federal Code of Conduct.

5.3.1 The contractor shall be subject to character investigation as required by Public Law 101-360, the Indian Health Child Protection and Family Violence Prevention Act prior to performance of a contract by utilizing the US Office of Personnel Management (OPM), Electronic Questionnaire for Investigation Processing (e-QIP) system and this shall include all fingerprinting procedures and clearances. 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 I.H.S. 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 government personnel. 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.

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 10.0 and in accordance with Medical Staff Bylaws.

5.4.2 Substantiated reports written by any customer dealing with patient safety, infection control, or other procedure that adversely affects patient outcome constitutes a breach of contract.

5.5 Identification of Contractor:

5.5.1 The Contractor shall wear a government issued identification badge, Service Unit Specific, during performance of duty.

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

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

5.6.2 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.

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

5.7 IHS Information Technology Systems:

5.7.1 In performance of this contract, the Contractor shall adapt to and successfully utilize IHS information systems that are deemed by the Supervisor as necessary for acceptable contractor performance.

6.0 Contractor Qualification Requirements:

6.1. Experience: The Contractor must not have a break in clinical dental work history equaling or exceeding 6 consecutive months during the preceding twelve months.

6.2. License/Registration: All Dentists shall possess a current, valid, unrestricted dental license in a state, the District of Columbia, the Commonwealth of Puerto Rico, or a Territory of the United States, throughout the term of this contract.

6.3. Certifications: Current Basic Life Support (BLS) is mandatory. Dentist shall be certified in Doctor of Dental Surgery (DDS) and Doctor of Dental Medicine (DMD). Dentist must have completed a fellowship for Geriatric Dentistry.

6.4. Health Requirements/Conditions of Employment:

6.4.1. Medical Evaluation: The Contractor shall provide documentation of personal health as required by the Service Unit Credentialing process.

6.4.2. Immunization: The Contractor shall also provide evidence of immunization for Immunity to Rubella, Mumps, Measles, Immunity to Hepatitis B series, History of chicken pox (varicella) disease or positive titer, Tetanus Diphtheria (Td) within the last 5 years, Documentation of receiving a TB Mantoux skin test (PPD) within the past 12 months with documentation of follow-up for a positive test. A signed declination of the Hepatitis B vaccination series will be accepted. Tdap (Tetanus, diphtheria and pertussis).

6.5. Language Requirements and Cultural Awareness. The Contractor shall read, understand, speak, and write English to effectively communicate with patients and other health care workers, and shall be respectful of the local American Indian and Alaska Native culture.

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 NAIHS 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 52.237-7 Indemnification and Medical Liability Insurance 52.237-7 Indemnification and Medical Liability Insurance (Jan 1997)

(a) It is expressly agreed and understood that this is a nonpersonal services contract, as defined in Federal Acquisition Regulation (FAR) 37.101, under which the professional services rendered by the Contractor are rendered in its capacity as an independent contractor. The Government may evaluate the quality of professional and administrative services provided, but retains no control over professional aspects of the services rendered, including by example, the Contractor’s professional medical judgment, diagnosis, or specific medical treatments. The Contractor shall be solely liable for and expressly agrees to indemnify the Government with respect to any liability producing acts or omissions by it or by its employees or agents. The Contractor shall maintain during the term of this contract liability insurance issued by a responsible insurance carrier of not less than the following amount(s) per specialty per occurrence: $1,000,000 per occurrence; $3,000,000 aggregate.

(b) An apparently successful offeror, upon request by the Contracting Officer, shall furnish prior to contract award evidence of its insurability concerning the medical liability insurance required by paragraph (a) of this clause.

(c) Liability insurance may be on either an occurrences basis or on a claims-made basis. If the policy is on a claims-made basis, an extended reporting endorsement (tail) for a period of not less than 3 years after the end of the contract term must also be provided.

(d) Evidence of insurance documenting the required coverage for each health care provider who will perform under this contract shall be provided to the Contracting Officer prior to the commencement of services under this contract. If the insurance is on a claims-made basis and evidence of an extended reporting endorsement is not provided prior to the commencement of services, evidence of such endorsement shall be provided to the Contracting Officer prior to the expiration of this contract. Final payment under this contract shall be withheld until evidence of the extended reporting endorsement is provided to the Contracting Officer.

(e) The policies evidencing required insurance shall also contain an endorsement to the effect that any cancellation or material change adversely affecting the Government’s interest shall not be effective until 30 days after the insurer or the Contractor gives written notice to the Contracting Officer. If, during the performance period of the contract the Contractor changes insurance providers, the Contractor must provide evidence that the Government will be indemnified to the limits specified in paragraph (a) of this clause, for the entire period of the contract, either under the new policy, or a combination of old and new policies.

(f) The Contractor shall insert the substance of this clause, including this paragraph (f), in all subcontracts under this contract for health care services and shall require such subcontractors to provide evidence of and maintain insurance in accordance with paragraph (a) of this clause. At least 5 days before the commencement of work by any subcontractor, the Contractor shall furnish to the Contracting Officer evidence of such insurance.

8.0 Challenges to Conflicts: For any inconsistency between supervisor directions, this Statement of Work, attachments and exhibits, the following order of precedence will apply:

9.0 52.249-12 Termination (personal Services) (Apr 1984): The Government may terminate this contract at any time upon at least 15 days’ written notice by the Contracting Officer to the Contractor. The Contractor, with the written consent of the Contracting Officer, may terminate this contract upon at least 15 days’ written notice to the Contracting Officer.

9.1. Any Contractor demonstrating impaired judgment shall not be permitted to work in the NAIHS. The Government reserves the right to remove from the facility any Contractor who in the judgment of a licensed Dentist is impaired by drugs or alcohol.

10.0 Performance-Based Matrix

Contractor shall provide Geriatric Dentistry services in the delivery of patient care to the Navajo Area Indian Health, Chinle Comprehensive Health Care Facility (CCHCF) Service.

Competency

Compliance

Patient Outcomes

Professionalism

Credentialing

Documentation

Service Quality

Perform 100% required tasks at 100% of the required competencies (refer to 11.0)

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

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

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

Uninterrupted credentialing as defined in 6.0 to 6.8 for period of contract.

100% percent of all documentation meets established IHS Medical Facility, JCAHO, 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 evidenced by valid customer inputs.

See QASP. Surveillance systems will include periodic inspections and customer complaints.

Payment of contract price for satisfactory service.

No Payment for Incomplete work.

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

11.0 List of Attachments and Exhibits. To be provided by the Contracting Officer upon request.

11.1 Attachments

Position Description (Service Unit specific) – available upon request.

11.2 Written Competency Assessments

a. Confidentiality/HIPAA/Patient’s Rights

b. EMTALA Compliance Exam, 2004