signed_SOW_MSA_PRC.pdf

Department of Health and Human Services Indian Health Service

Statement of Work (SOW) Medical Support Assistant to the PRC Manager

1. PURPOSE OF THE PROJECT

The Claremore Indian Hospital (CIH), Indian Health Services (IHS) has a requirement for a two (2) Full-time Medical Support Assistants that will provide support and technical assistance to the service unit PRC Manager on matters involving Purchased Referred Care including medical, surgical, hospital and clinical services to all eligible beneficiaries in conjunction with or in lieu of IHS facilities. In accordance with written policies, procedures, and regulations, the PRC program provides health care to all members of federally recognized Indian tribes living within the boundaries of PRC service delivery are.

2. DETAILED DESCRIPTION OF THE TECHNICAL REQUIREMENTS

The contractor shall perform assignments, which vary in scope and encompass a variety of program activities.

Assignments require basic knowledge of regulatory requirements of the code of federal regulations and alternate resources to perform technical assistance and consultations on referral health care program and alternate resources.

The contractor shall perform the following duties and responsibilities:

• Receive referrals for emergency call-in status, initiates medical authorizations to include hospitalization and professional fees for eligible IHS patients.

• Maintain denial/deferral correspondence files assuring that all appropriate documentation is included in file.

• Coordinate patient appointments with contracted vendors for Medicare rates of reimbursement in the delivery of referral management.

• Provides PRC orientation to health service vendors, and recipients, as well as service unit personnel, to insure that they possess a good understanding of the program methods, policies, procedures and regulations.

• Conduct on –site patient interviews to establish eligibility and complete and maintain application for medical care. Verify records of residence for applications by addressing inquires to a variety of sources.

• Review incoming invoices to determine if authorizations have been issued and if not, incumbent researches and takes appropriate action.

• Verify referral management eligibility for Indian patients using PCR regulatory criteria and determines patient eligibility for third party alternate resources.

• Reviews Fiscal Intermediary pending lists and follow up on requirements for service unit action.

Participate in PRC Review Committee Meetings regarding approval for PRC services.

• Key data into the PRCMIS data system for issuing purchase orders.

• Participate with the Health System Specialist in the development of local PRC procedural guides, compile and interpret various alternate resource references and guides.

• Provide support in the development and presentation of the local preliminary and supplemental PRC budget.

• Answer telephone and written inquiries regarding eligibility requirements, payments, outstanding charges, and other questions concerning the PRC Program. Maintain strict confidentiality in responding to inquiries. Prepare routine correspondence and compile information for periodic special reports.

• Type material from draft form using word processing automation. Maintain appropriate files and perform other office clerical support work as required.

• A qualified typist is required.

• Other duties/assignment when call upon by the PRC Management Staff.

• Key data information for automatic document control commitment register for the health services funds allotted, which requires accurate accountability and comprehensive knowledge of fiscal coding procedure. Provide the supervisor informal reports on undelivered purchase order status expenditures on periodic basis.

• Contact stage agencies and other outside organizations to determine medical eligibility within the service unit jurisdiction. Cross compare proposed authorization with sources prior to obligating funds for referral management services.

• Receive visitors and phone calls to the PRC Department, ascertaining the nature of requests and directing callers to appropriate staff, or personally providing the information desired when routine or procedural matters of the office are involved.

• Incumbent is responsible in making determinations as to patient eligibility and scope of care for referral management. Explain/clarify to the patient an understanding of policies, direct/PRC eligibility and third party billing practice, alternative resources – Medicare, Medicaid, Private Insurance, and Affordable Care Act.

3. PERIOD OF PERFORMANCE

Select One:

The base year Period of Performance will be 12 months from date of award with four (4) twelve (12) month option years.

4. LEVEL OF EFFORT

4.1. The contractor shall ensure complete orientation sessions conducted by the on-site PRC Department and the Human Resource Department.

4.2. The contractor shall have basic knowledge of regulatory requirements of the code of federal regulations and alternate resources to perform technical assistance and consultations on referral health care program and alternate resources.

4.3. Training: Will be provided by CIH on IHS specific rules and regulations.

5. SPECIAL REQUIREMENTS

5.1. In accordance with HHSAR 304.1300(b) non-routine contractor employees shall comply with OPDIV

DHHS/SE Region – Human Resources, Security Clearance Guidance – Visitors (3/29/12) policy for contract performance period. Contractor employees will be required to obtain a visitor’s pass upon arrival for services from Facilities Management. - (Security Clearance for on-site human services)

5.2. The US PHS Claremore Indian Hospital is a tobacco/smoke free environment (buildings and grounds). No tobacco/smoking use will be tolerated during service.

5.3. Security Requirements: Contractor personnel will be required to contact the government designated point of contact upon arrival when reporting for service calls or delivery supplies. The contractor shall be responsible for the security of all organizational information. Current rules and regulations applicable to the premises, where the work shall be performed shall apply to the contractor and its employees while working on the premises. These regulations include but are not limited to, escort by Claremore Indian Hospital official, presenting valid identification, smoking restriction and any safety procedures.

5.4. The contractor shall not disclose or cause to disseminate any information concerning operations of

Claremore Indian Hospital. Such action(s) could result in violation of the contract and possible legal actions.

5.4.1. All inquiries, comments, or complaints arising from any matter observed, experienced or learned of as a result of or in connection with the performance of the contract, the resolution of which may require the dissemination of official information, shall be directed to the government’s designated representative.

6. DELIVERABLES AND REPORTING REQUIREMENTS

6.1. Contractor Point of Contact: The contractor shall furnish one designated point of contact (POC) to the government’s designated representative for coordination of supplies, delivery, and/or maintenance. The POC will be empowered to make daily decisions to ensure that the contract implementation and day-to-day maintenance meets the terms and conditions of this contract.

6.2. Contractor’s Phone Numbers: The contractor shall provide a toll-free telephone number for service calls, which must be answered during at least eight working hours, between 8:00 am and 4:30 pm, Monday through Friday.

6.3. Personnel Qualifications: The Medical Support Assistants Knowledge required for this position are as listed:

• Referring/answering calls and questions

• Determine eligibility for service

• Assemble PRC referrals in their required order and sequence for Alpha letter distribution

• Alternative resources – Medicare, Medicaid, Private Insurance, and Affordable Care Act.

• Medical procedures, various medical specialties and medical terminology are needed to coordinate patient care with contracted vendors.

• Retrieve a variety of physicians’ orders for patient activities, diets, tests, and treatments

• Research/refer patients to appropriate clinics for care

• Answer questions regarding routine procedures

• Relay instructions to patients on referred care decisions

• File referred care results and distribute to appropriate staffs for purchase order (PO) assignment

• Relay information regarding the patient’s referral status

• Compiling/submitting data on referred care and treatment plans

7. GOVERNMENT FURNISHED PROPERTY, FACILITIES AND SERVICES

7.1. The Government shall provide use of furnished facility space, equipment, and supplies required to perform work under the contract.

8. CONTRACTOR FURNISHED PROPERTY, FACILITIES AND SERVICES

8.1. Required personnel, materials, supplies and equipment: The contractor shall furnish all personnel, materials, supplies and equipment required to perform work under the contract.

9. CHANGES TO THE STATEMENT OF WORK (SOW)

Any changes to this SOW shall be authorized and approved only through written correspondence from the Contracting Officer. Costs incurred by the contractor through the actions of parties other than the Contracting Officer shall be borne by the contractor.

10. DELIVERABLES/PERFORMANCE MATRIX

10.1. Contractor was on-time and completed tasks as assigned: Yes No

10.2. Contractor followed the rules and regulations set by OCA: Yes No

10.3. The contractor addressed any complaints or concerns: Yes No

Department Supervisor Signature:_________________________

Administrative Officer Signature:_________________________