TAB 3- CPSU. Amb Care Branch (ACB) RN (PWS)7.15.26.pdf

PBWS No: CPSU-OUTPATIENT July 15, 2026

Crownpoint Service Unit Performance Base Work Statement (PBWS)

For Personal Services

REGISTERED NURSE SERVICE – Ambulatory Care Branch aka OUTPATIENT

DEPARTMENT

Table of Contents

Section Page

1.0 General 1-2

2.0 Definitions 2-5

3.0 Government Furnished Information, Property, & Services 5

4.0 Contractor Furnished Property 6-8

5.0 Performance Based Requirements 8-11

6.0 Contractor Qualification Requirements 12

7.0 Federal Tort Claims 13

8.0 Challenge of Conflict 13

9.0 52.249-12 Termination (Personal Services) (Apr. 1984): 13

10.0 Technical Direction 14

11.0 List of Attachments and Exhibits 17

REGISTERED NURSE SERVICE – OUTPATIENT DEPARTMENT

General: This performance base work statement describes the requirements for a Personal

Service Contract – REGISTERED NURSE SERVICE to support the mission of the Indian Health Service (IHS).

1.1 Background: Crownpoint Service Unit (CPSU) includes Crownpoint Healthcare

Facility (CHF), Thoreau Health Center (THC) and Pueblo Pintado Health Center (PPHC) provides many healthcare services to patients in an area covering 4,200 square miles within four counties in northwest New Mexico (McKinley, Cibola, Sandoval, and San Juan). We are located on the eastern side of the Navajo Nation, and most of our patients are Navajo. Our main facility is in the community of Crownpoint, population 3,041. However, over 20,000 patients utilize services at our facilities. Satellite clinics are located at Pueblo Pintado (40 miles to the east) and Thoreau (25 miles south).

1.2 Scope: The Contractor shall provide nursing services for the Navajo Area Indian

Health Service (NAIHS) in accordance with section 5.0, performance base requirements.

1.2.1 Duties and responsibilities will encompass Ambulatory Care Branch

Nursing services to all patients.

1.2.2 Place of Performance: Services are to be performed in the one of the three sites mentioned above under the Crownpoint Service Unit definition under the Navajo Area Indian Health Service (NAIHS) within the State of New Mexico.

1.2.3 Period of Performance: The contract will consist of a one-year base period with one-year option period.

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

1.3.1 The Joint Commission on Accreditation of Healthcare Organizations. The

Joint Commission (TJC) 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 http://www.jointcommission.org/ http://www.cms.hhs.gov/ http://www.cms.hhs.gov/ 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.sh tml

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/hipaa

1.3.7 Privacy Act of 1974. http://www.usdoj.gov/oip/privstat.htm

1.3.8 Revised American Nurses Association Code of Ethics and Standards of Practice and Care (1996) http://www.nursingworld.org

1.3.9 State Nurse Practice Act for the Contractor’s licensing state. http://medi smart.com/practice.htm

1.3.10 Navajo Area IHS Service Unit and Health Center Policies, Procedures and Protocols. (See section 11.0 for a list of attachments and exhibits)

1.3.11 Location Map (attached)

1.3.12 Sample Task Order (attached)

1.3.13 Customer Evaluation Form (attached)

1.3.14 Computer Security Act of 1980

http://www.ihs.gov/adminmggrresouces/computersecurityact

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

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

1.3.17 IHS Computer Security Directives

http://www.ihs.gov/adminmggresources

1.3.18 Nurse License Look up http://www.nursys.com

2.0 Definitions

2.1. Acceptance: Constitutes acknowledgement that the supplies or 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.

http://www.policyalmanac.org/crime/archive/crs_federal_crime_policy.shtml http://www.policyalmanac.org/crime/archive/crs_federal_crime_policy.shtml http://www.policyalmanac.org/crime/archive/crs_federal_crime_policy.shtml http://www.policyalmanac.org/crime/archive/crs_federal_crime_policy.shtml http://www.nicwa.org/policy/law/protection/index.asp http://www.cms.hhs.gov/hipaa http://www.usdoj.gov/oip/privstat.htm http://www.nursingworld.org/ http://medi%E2%80%90smart.com/practice.htm http://medi%E2%80%90smart.com/practice.htm http://www.ihs.gov/adminmggrresouces/computersecurityact http://www.ihs.gov/adminmggrresouces/computersecurityact http://www.ihs.gov/ http://www.ihs.gov/adminmggrresouces http://www.ihs.gov/adminmggresources http://www.nursys.com/ http://www.nursys.com/

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: The Revised American Nurses Association Code of Ethics and Standards of Practice and Care, published in 1996 by the American Nurses Association which makes explicit primary goals, values and obligations of the nursing profession.

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 an NAIHS service unit and NAIHS health center.

2.11. Customer Evaluation: 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. Pueblo Pintado Health Center (PPHC) & Thoreau Health Center (THC): A facility physically separated from a hospital, with a full range of ambulatory services including at least primary care physicians, nursing, and laboratory, and x-ray which are available at least 40 hours a week for outpatient care.

2.16. Non-Personal Services Contract: 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.

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

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 nurse into the NAIHS Service Unit and/or Health Center and the nursing unit 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 nursing 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. Quality Assurance Surveillance Plan (QASP): Service Unit: Written document prepared and used by the government for Quality Assurance surveillance of the contractor’s performance.

2.25. Quality Control Plan (QCP): Those actions taken by the Contractor to control the quality of services provided. The Contractor’s QCP must be equivalent to the Government’s Quality Assurance Plan.

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

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

2.28. 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.

2.29. Technical Direction: A directive to the Contractor that approves approaches, solutions, designs, or refinements; fills in details or otherwise completes the general description of work or documentation items; shifts emphasis among work areas or tasks; or furnishes similar instruction to the Contractor. Technical direction includes requiring studies and pursuit of certain lines of inquiry regarding matters within the general tasks and requirements in Section 5 of this contract.

2.30. Tour of Duty: The time of day the nurse is scheduled to perform nursing care duties; also considered the shift of the day. The time can vary according to the needs of each NAIHS facility and/or clinic, most shifts are Monday – Friday 0800 to 1630 or 0730 to 1600 depending on the needs of each clinic.

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

2.32. 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 GSA Vehicle: If required by the position, authorization shall be in accordance with NAIHS Chapter 12, Section 13 Motor Vehicle Management. Contractors may ride in Government vehicle but not authorized to drive a Government vehicle.

3.2.2 Government Housing: No government housing is available, unless there is a vacancy. This will be determined by the Housing Committee.

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 PBSOW. 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 minimum fee of $10.00 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 nursing services or includes mandates made by the NAIHS Service Units/Health Centers while the nurse is working under this contract. Training will not be provided for the purpose of continuing education, career development or individual development.

3.5 Supervisor: The contractor is subject to the supervision and direction of Supervisory Nurse (SN) for the Ambulatory Care Branch: Crownpoint, Pueblo Pintado Health Center (PPHC) and Thoreau Health Center (THC).

3.5.1 Contracting Officer Representative (COR): Contracting Office

Representative (COR); Primarily responsible for monitoring the technical programs, including surveillance and assessment of performance for this order. (See Attachment Certificate).

3.5.2 Point of Contact (POC): Ijeoma Nwizu, Acting Supervisory Nurse (ASN)

(505) 786-6298

3.6 Protection of Government Building, Equipment, and Vegetation: The

Contractor shall use reasonable care to avoid damaging existing building, 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 expenses to the Government as the Contracting Officer directs. If the Contractor fails or refuses to make such repair or replacement, the 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 Coats: 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 Nurse Executive at each IHS facility.

4.1.2. Other personal medical instruments: “Other personal medical instruments” are defined as Contractor owned items may include but not limited to stethoscope, scissors, as appropriate to the work unit. The Contractor shall not use unsafe equipment or supplies at any time during performance of this contract. All Contractor furnished equipment and supplies shall be subject to inspection by the Government and must be approved by the COR prior to use by the Contractor. The Government reserves the right to prohibit the use of any materials, supplies, or equipment.

4.1.3 Indemnification and Medical Liability Insurance:

(a) It is expressly agreed and understood that this is a personal 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 the 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 $1,000.000 per specialty per occurrence, $3,000.000 aggregate.

(b) An apparently successful offer or upon request by the Contractor

Officer, shall furnish prior to contract award evidence of its insurability concerning the medical liability insurance required by paragraph (a) of the 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 less than 3 years after the end of the contract term must also be provide.

(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 an 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.

4.1.4 Housing/per diem/travel and other associated cost:

(a) Contractor shall be responsible for housing, per diem, travel and other associated cost for their employee. Government housing will be available ONLY if there is a Vacancy.

5.0 Performance Based Requirements: The Contractor shall provide nursing services in the delivery of patient care to the NAIHS. A specific tasks include the following:

5.1. Nursing Duties:

5.1.1. The Contractor shall perform in accordance with the competency standards listed in Exhibits, paragraph 11.2.

5.1.2. The contractor shall provide professional nursing service in case management of patients as follows:

(a) Contractor shall provide full range of adult and pediatric case management services in the Ambulatory Care and/or Women and Children’s services.

(b) Contractor shall exercise knowledge of the nursing process and its application to clinical practice in order to provide individualized, goal-orientated nursing care to the adult/ pediatric patient.

(c) Develop, implement, and evaluate the service unit patient care coordination and case management program for nursing services to comply with current standards of care.

(d) Collaborate with primary care providers, clinic nurses, public health nursing, case management and social services to ensure that the patient care needs are done timely and cost effective.

(e) Manages all clinic visits and follow-up visits through coordination with multi-disciplinary teams of physicians, nursing personnel, social workers, physical therapists, etc. accomplish this, and chart reviews.

(f) Arranges and facilities patient-care conference with providers, patients, and/or patient’s family as needs. Interprets for patient’s family and providers where applicable.

(g) Monitors and evaluates the effectiveness of the patient care coordination process by reviewing charts of patients to determine if documentation is present.

(h) Provides information to providers based on the diagnoses and implements treatment plan according to age-appropriate health maintenance needs and standards of care. Assists providers and patients/families in meeting treatment plan by coordinating appointments to meet the expected clinical outcome.

(i) Participates in patient care conferences between various disciplines, families and agencies to determine the patient’s plan of care. Utilizes various patient education resources to assist patient/families in understanding, accepting, adjusting to diagnoses/treatment modalities and t heir role responsibilities. Interprets for patients, family and providers when applicable.

(j) Collaboratively works with Purchased & Referred Care (PRC) staff for necessary follow-up on outside testing and obtaining results for the ordering provider. Participates in the primary care team planning and coordination rounds.

(k) Provide appropriate documentation regarding care rendered using

Crownpoint Service Unit (CPSU) Electronic Health Record (EHR) & RPMS system. All documentation by the provider shall be entered electronically using the Electronic Health Record system. The provider is responsible for utilizing the EHR/RPMS system to obtain pertinent patient information in assisting care. It is the responsibility of the provider to use the training resources provided to develop competency in utilizing the Electronic Health Record system/RPMS.

(l) Follows facility policies and procedures, The Joint Commission (TJC), Occupational Safety and Health Administration (OSHA), Indian Health

Services (IHS) and other federal licensing, accreditation and regulating body standards.

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

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

5.1.6 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 each NAIHS facility will provide technical direction on the specific tour of duty. The Contractor shall work 100% of the contracted hours.

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

5.2.3. The Contractor shall obtain approval of the department Supervisor or designee prior to any absence from work. If the length of the absence exceeds eight (8) work hours the Contractor shall request approval at least fifteen (15) days, (the exception is verifiable emergencies) in advance of the desired absence.

5.2.4. Approval of leave is contingent upon availability of a qualified replacement.

5.2.5. The Contractor shall provide written documentation from a qualified health care provider for absences of three (3) or more consecutive days, due to illness, stating:

A. The cause of the current illness or incapacitation AND B. Indicating the Contractor as contagious or non-contagious.

The Government reserves the right to examine and or re-examine any Contractor who meets the criteria.

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 (eQIP) 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 11.0.

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 contractor identification badge during performance of duty. PIV cards are issued after 6 months at Service Unit.

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. 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.

5.6.2. The Contractor shall immediately report to the Contracting Officer or COR for 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 technology systems that are deemed by the Supervisor as necessary for acceptable contractor performance.

5.7.2. The Contractor shall ensure that NAIHS information technology system security policies and procedures are adhered to. The IT policies and procedures will be made available to the Contractor at each NAIHS facility.

5.7.3. The Contractor shall follow all appropriate federal and locally required information Technology security requirements and will be operating under Health Insurance Portability and Accountability (HIPAA) and Privacy Act regulations.

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

6.0 Contractor Qualification Requirements:

6.1 Experience: The Contractor shall have thirty-six {36) months of nursing experience, with a minimum of two (2) years in the specialty required by the· contract, unless otherwise approved by the Contracting Officer.

6.2 License/Registration: All nurses shall possess a current, valid, unrestricted nursing 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 Motor Vehicle Operator's License: If required by the position, the Contractor shall possess a valid state driver's license throughout the term of this contract.

6.4 Certifications: Current Basic Life Support (BLS) is mandatory for all specialties.

Pediatric Advanced Life Support (PALS), and Advanced Cardiac Life Support (ACLS) are recommended for each appropriate duty section at the time of selection for contract award. The contractor shall ensure that the contract nurse's certifications remain valid throughout the term of this contract.

6.5 Health Requirements/Conditions of Employment:

6.5.1 Medical Evaluation. The Contractor shall provide a fitness for duty certificate issued by a licensed physician to perform the proposed job without significant risk to personal health or the health and safety of others.

6.5.2 Immunization. The Contractor shall also provide the following documentation prior to RN Candidate selection:

A. Immunity to Rubella, Mumps, and Rubeola (Measles);

B. Proof of Hep B vaccination x3 OR positive titer OR a signed declination of the Hep B vaccinations will also be accepted;

C. Documented history of chicken pox OR varicella vaccination x2 OR positive varicella titer;

D. History of Tdap vaccination, with subsequent Td vaccination if older than

10 years;

E. Documentation of Tuberculosis testing (TB skin test or IGRA) within the past 12 months with documentation of chest x-ray and follow-up for a positive history; 12 months with documentation of follow-up for a positive test.

F. Proof of influenza vaccination from October -1 thru March 31, per IHS Mandatory Influenza Vaccination Policy.

6.5.3 Travel Status Documentation. Contractor must provide status in writing for the 30 days preceding to contract start date.

6.6 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.

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

6.8 Orientation. All nurses providing service under this contract shall attend mandatory orientations and training specified by the government.

6.9 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.

An Agreement to a Temporary Waiver of character investigation form shall be signed and used pending completion of background investigation.

7.0 Federal Tort Claims Act (28 USC 1346 (B) 1946): FTCA is not extended to Non- Personal Service Contractors, refer to clause 52.237-7 Indemnification and Medical Liability Insurance.

8.0 Challenges to Conflicts: For any inconsistency between supervisor directions, this

Performance Work Statement, attachments and exhibits, the following order of precedence will apply:

(a) First Priority: Supervisor’s directions

(b) Second Priority: Position Description (attached)

(c) Third Priority: Performance Work Statement Exhibits

(d) Fourth Priority: Performance Work Statement Narrative

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 employee demonstrating impaired judgment shall not be allowed to continue working immediately on the contract. The Government reserves the right to remove from the facility any Contractor employee who in the judgment of a licensed healthcare practitioner is impaired.

10.0 Technical Direction.

10.1 Performance of the work under this contract is subject to the written and verbal technical direction of the Nursing Supervisor.

10.2 The Supervisory Nurse does not have the authority to, and shall not, issue any instructions purporting to be technical direction that:

• Constitutes an assignment of additional work outside the performance work statement;

• Constitutes a change as defined in the changes;

• In any manner causes an increase or decrease in the total estimated contract cost, fixed fee (if any), or the time required for contract performance;

• Changes any of the expressed terms, conditions, or specifications of the contract; or the terms and conditions of the contract.

10.3 All technical direction shall be issued in writing by the Supervisory Nurse. All verbal direction will be confirmed in writing within 24 hours (one business day).The Contractor shall proceed promptly with the performance of technical direction duly issued by the Supervisory Nurse in the manner prescribed by this clause and within the authority. If, in the Contractor's opinion, any instructions or direction by the Nursing Supervisor falls within any of the categories defined in paragraph above, the Contractor shall not proceed but shall notify the Contracting Officer in writing within 5 working days after receiving it and shall request the Contracting Officer to take action as described in this clause. Upon receiving this notification, the Contracting Officer shall either issue an appropriate contract modification within a reasonable time or advise the Contractor in writing that the instruction or direction is within the requirements of the contract and does not constitute a change under the changes clause of the contract and that the contractor shall proceed promptly with its performance.

10.4 A failure of the Contractor and Contracting Officer to agree that the instruction or direction is both rescinded in its entirety; or within the requirements of the contract and does not constitute a change under the changes clause, or a failure to agree upon the contract action to be taken with respect to the instruction or direction shall be subject to the Disputes clause of this contract.

10.5 Any action taken by the Contractor in response to any direction given by any person other than the Contracting Officer or the Nursing Supervisor shall be at the Contractor's risk

PWS No.: CPSU-OUTPATIENT DEPARTMENT December 6, 2022

11.0 Performance – based

Matrix

Performance based Task Indicator Standard Quality Assurance Incentives

State the end results or outputs that you, the customer will formally accept or reject.

For the requirement, state the feature(s) of end result that will be surveilled.

For each “indicator,” state a performance level that, when met, means the task has been performed satisfactorily.

This Standard describes “What Success Looks Like.”

For each “Standard”, state the method used to check performance (i.e.

random sampling, 100% inspection, periodic inspection, customer complaints).

List Positive and Negative Incentives. Address method of linking payment to quality of service.

Contractor shall provide Nursing services in the delivery of patient care to the Navajo Area Indian Health Service.

Competency

Compliance

Patient Outcomes

Professionalism

Credentialing

Documentation

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 Nursing Code of Ethics and Federal Code of Conduct.

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

Payment of contract price for satisfactory service.

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

PWS No.: CPSU-OUTPATIENT DEPARTMENT December 6, 2022

Service Quality

Uninterrupted credentialing as defined in

6.0 to 6.8 for period of contract.

100% percent of all documentation meets established IHS Medical Facility, TJC, 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.

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

11.1. Attachments

1. Position Description (Service Unit specific)

11.2. Exhibits Applicable to the Navajo Area HIS

11.2.1. Written Competency Assessments

a. Confidentiality/HIPAA/Patient’s Rights

b. EMTALA Compliance Exam, 2004

c. Age Specific Competency Verification

d. RN Medication Administration Competency Examination

e. RN Medication Administration Competency Verification

f. Intravenous Therapy Exam

g. Venipuncture Procedure Skills competency Verification

h. Pain Management Competency Verification

i. Restraints

j. Soft Restraint Application Competency Verification

11.2.2. Contract Nurse Orientation Check List

11.2.3. Contract Nurse Orientation Competency Verification

Instructions

11.2.4. Contract Nurse Billing Information

11.2.5. Standard Emergency Codes

11.2.6. Confidentiality: Legal and Ethical Concerns in Healthcare

11.2.7. EMTALA – Emergency Medical Treatment and Labor Act

11.2.8. What are Age‐Specific Competencies?

11.2.9. An Introduction to the Navajo Culture

11.2.10. Verbal and Telephone Orders

11.2.11. Medication Administration

11.2.12. Pain Management

11.2.13. Latex Allergy

11.2.14. Focus Charting

11.2.15. Patient Restraints

11.2.16. Charge Nurse Duties: Responsibility and Expectation

11.2.17. Nursing Standards

11.2.18. Standards of Nursing Practice