Medical Services PWS 2024-Optometrist.docx

PERFORMANCE WORK STATEMENT

Optometrist Quentin N. Burdick Memorial Health Care Facility.

Part 1

General Information

1. GENERAL: This is a non-personnel services contract to provide a Optometrist. The Government shall not exercise any supervision or control over the contract service providers performing the services herein. Such contract service providers shall be accountable solely to the Contractor who, in turn is responsible to the Government.

1.1 Description of Services/Introduction: The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform the duties of an Optometrist as defined in this Performance Work Statement, except for those items specified as government furnished property and services. The contractor shall perform to the standards in this contract.

1.2 Background: The Mission of the Quentin Burdick Memorial Healthcare Facility Indian Health Service is to provide the best possible healthcare services to the patients of the Quentin Burdick Memorial Healthcare Facility Indian Health Hospital. To meet this mission, the Quentin Burdick Memorial Healthcare Facility Service Unit has identified a need for a Non-Personal Service Contract for providing Optometric services with an Optometrist.

1.3 Objectives: The contract Optometrist, to provide all necessary covered services within the Optometrist’s scope of practice, under the direction of the Clinical Director or designee.

· The Contracted Optometrist shall provide a full scope of services to all age range of patients at the Quentin Burdick Memorial Healthcare Facility Service Unit

1.4 Scope: Provide medical care services for Clinical services. Services include providing direct care to patients of all ages with a variety of Optometric maintenance needs. The Indian Health Service requires the Optometrist services as described above to continue without interruption during the term of this contract. The contractor shall accomplish Optometric care provided by the contracted Optometrist and shall be as comprehensive as the Indian Health Service supplied facilities, equipment, and support services permit.

The contract resulting from this solicitation shall:

a. Be a non-personal health care services contract under which the contractor is an independent contractor;

b. Require the contractor to promptly provide any and all requested information to allow for the proper credentialing and privileging of medical providers.

c. Allow the government to evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of the services rendered, (e.g., professional judgments, diagnosis for specific medical treatment);

d. Require the contractor to indemnify the government for any liability producing act of omission by the contractor, its employees and agents occurring during contract performance;

e. Require the contractor to maintain medical liability insurance, in the coverage amount acceptable to the contracting officer, which is not less than the amount normally prevailing with the local community for the medical specialty concerned; and

f. Require the contractor to ensure its subcontracts for provisions of health care services, contain the requirements of the clause at FAR 52.237-7 (Indemnification and Medical Liability Insurance), including the maintenance of medical liability insurance and meet the Quentin Burdick Memorial Healthcare Facility Indian Health Hospital’s accreditation requirements with regard to professional credentials including any support staff.

g. Candidates with prior Medical Licensure actions are not eligible for temporary privileges. The process of granting of privileges by the facility Governing Body may take up to 3 months.

1.5 Period of Performance: The Period of Performance shall be listed on the Task Order as scheduled with the Clinical Director or designated representative. The contract Optometrist shall provide health care services, for the entire Period of Performance at the Quentin Burdick Memorial Healthcare Facility. The usual work day will be from 8:00 am to 4:30 pm (8 hour shifts). The Optometrist shall schedule and perform procedures as appropriate.

1.6 General Information:

1.6.1 Quality Control: The contractor shall develop and maintain an effective quality control program to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The contractor’s quality control program is the means by which he assures himself that his work complies with the requirement of the contract. The QCP is to be delivered within 30 days after contract award or with the contractors proposal if it is an evaluation factor, three copies of a comprehensive written QCP shall be submitted to the CO and COR within 5 working days when changes are made thereafter. After acceptance of the quality control plan the contractor shall receive the contracting officer’s acceptance in writing of any proposed change to his QC system.

1.6.2 Quality Assurance: The government shall evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan. This plan is primarily focused on what the Government must do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

1.6.3 Recognized Holidays: The provider will not be on-call for Federal Government holidays, weeknights and weekends as depicted in schedules provided upon issuance of Task Order.

1.6.4 Hours of Operation: The contractor is responsible for conducting business, between the hours of 8:00 am-4:30 pm. For other than firm fixed price contracts, the contractor will not be reimbursed when the government facility is closed for the above reasons. The Contractor must at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS when the Government facility is not closed for the above reasons. When hiring personnel, the Contractor shall keep in mind that the stability and continuity of the workforce are essential.

1.6.5 Place of Performance: The work to be performed under this contract will be performed at Quentin N. Burdick Health care facility, Belcourt, ND which is an Indian Health Service government facility.

1.6.6 Type of Contract: The government will award a firm-fixed price, non-personal service contract.

1.6.7 Security Requirements: The contract Optometrist is subject to a background investigation and shall comply with Section 231 of the Crime Control Act of 1990, P.L. 101-647; and the Indian Child Protection and Family Violence Prevention Act, P.L. 101-630. In addition, the Optometrist shall also comply with the Privacy Act of 1974 and the HIPPA Act of 1996. Failure to comply with these statutes will result in immediate removal.

a. Contractor personnel performing work under this contract, which involve regular contact with, or control over, Indian children, are subject to a character investigation in accordance with the “Indian Child Protection and Family Violence Prevention Act” P.L. 101-630. The Indian Health Service Personnel Office will conduct these investigations following award of a contract unless in the judgment of the Contracting Officer, in consultation with the Personnel Officer, investigation may be waived based on prior investigations on file. Until the character investigation has been completed and the Contracting Officer notified, such individual shall not have unsupervised contact with Indian children.

b. The Contracting Officer has the authority to temporarily waive the character investigation of a contractor. The “Agreement to a Temporary Waiver of Character Investigation” (See Attachment B) authorizes an agency to hire a contractor prior to the completion of a background check provided that at all times the contractor is within the sight and under the supervision of a government employee who has successfully completed the National Agency Check with written Inquiries (NACI).

c. This level of security is required, and must be maintained for the life of the contract.

1.6.7.1 PHYSICAL Security: The contractor shall be responsible for safeguarding all government equipment, information and property provided for contractor use. At the close of each work period, government facilities, equipment, and materials shall be secured. The contract Optometrist shall generate and maintain proper medical record information on beneficiaries to whom treatment is provided, in accordance with Indian Health Service regulations. The contract Optometrist shall prepare all medical records documentation to meet or exceed the established standards of the I.H.S. facility to include, but not be limited to: timeliness, legibility, accuracy, content, and signature. All medical record information generated in the performance of the contract will be subject to the exclusive control of the Indian Health Service.

1.6.7.2 Key Control: The Contractor shall establish and implement methods of making sure all keys/key cards issued to the Contractor by the Government are not lost or misplaced and are not used by unauthorized persons. NOTE: All references to keys include key cards. No keys issued to the Contractor by the Government shall be duplicated. The Contractor shall develop procedures covering key control that shall be included in the Quality Control Plan. Such procedures shall include turn-in of any issued keys by personnel who no longer require access to locked areas. The Contractor shall immediately report any occurrences of lost or duplicate keys/key cards to the Contracting Officer.

1.6.7.2.1. In the event keys, other than master keys, are lost or duplicated, the Contractor shall, upon direction of the Contracting Officer, re-key or replace the affected lock or locks; however, the Government, at its option, may replace the affected lock or locks or perform re-keying. When the replacement of locks or re-keying is performed by the Government, the total cost of re-keying or the replacement of the lock or locks shall be deducted from the monthly payment due the Contractor. In the event a master key is lost or duplicated, all locks and keys for that system shall be replaced by the Government and the total cost deducted from the monthly payment due the Contractor.

1.6.7.2.2. The Contractor shall prohibit the use of Government issued keys/key cards by any persons other than the Contractor’s employees. The Contractor shall prohibit the opening of locked areas by Contractor employees to permit entrance of persons other than Contractor employees engaged in the performance of assigned work in those areas, or personnel authorized entrance by the Contracting Officer.

1.6.8 Special Qualifications: It is a condition of this contract that all required certifications remain current during the life of this contract.

The contractor is responsible for ensuring the contract Optometrist shall possess a current, unrestricted state Optometrist license from any of the 50 United States or the Commonwealth of Puerto Rico, be registered with an Optometry Board and registered with an Optometry Licensure.

Possess current (BLS) Basic Life Support certification.

The contractor is responsible for ensuring the contract Optometrist shall

a. Not have any work or health restrictions, which interfere with the performance of general medical services.

b. Have actively performed emergent or non-emergent Optometric procedures.

c. Have skill and knowledge in providing Optometric care with full consideration of the mental, emotional, physical, and cultural factors involved, such that he/she can relate constructively to patients from the Native American community.

d. Ability to work with patients, the public, and hospital staff.

1.6.9 Post Award Conference/Periodic Progress Meetings: The Contractor agrees to attend any post award conference convened by the contracting activity or contract administration office in accordance with Federal Acquisition Regulation Subpart 42.5. The contracting officer, Contracting Officers Representative (COR), and other Government personnel, as appropriate, may meet periodically with the contractor to review the contractor's performance. At these meetings the contracting officer will apprise the contractor of how the government views the contractor's performance and the contractor will apprise the Government of problems, if any, being experienced. Appropriate action shall be taken to resolve outstanding issues. These meetings shall be at no additional cost to the government.

1.6.10 Contracting Officer Representative (COR): The (COR) will be identified by separate letter. The COR monitors all technical aspects of the contract and assists in contract administration The COR is authorized to perform the following functions: assure that the Contractor performs the technical requirements of the contract: perform inspections necessary in connection with contract performance: maintain written and oral communications with the Contractor concerning technical aspects of the contract: issue written interpretations of technical requirements, including Government drawings, designs, specifications: monitor Contractor's performance and notifies both the Contracting Officer and Contractor of any deficiencies; coordinate availability of government furnished property, and provide site entry of Contractor personnel. A letter of designation issued to the COR, a copy of which is sent to the Contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the resulting order.

1.6.11 Key Personnel: The follow personnel are considered key personnel by the government:

Paula Bercier, MD/Acting Clinical Director Jennilee Blue, Credentialing Coordinator Julie Laducer, RN/COR II The contractor shall provide a contract manager who shall be responsible for the performance of the work. The name of this person and an alternate who shall act for the contractor when the manager is absent shall be designated in writing to the contracting officer. The contract manager or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract. The contract manager or alternate shall be available between 8:00 a.m. to 4:30p.m., Monday thru Friday except Federal holidays or when the government facility is closed for administrative reasons.

1.6.12 Identification of Contractor Employees: All contract personnel attending meetings, answering Government telephones, and working in other situations where their contractor status is not obvious to third parties are required to identify themselves as such to avoid creating an impression in the minds of members of the public that they are Government officials. They must also ensure that all documents or reports produced by contractors are suitably marked as contractor products or that contractor participation is appropriately disclosed. The contractor personnel will be required to obtain and wear badges in the performance of this service.

1.6.13 Contractor Travel: The Contractor shall be responsible for arranging travel and all associated costs related to the performance of this contract.

1.6.14 Other Direct Costs The Contractor shall be responsible for arranging travel, lodging, per diem, labor, fringe benefits, and any applicable Federal, State, and Local taxes, plus any other costs pertinent to the performance of this contract.

1.6.15 Data Rights: The Government has unlimited rights to all documents/material produced under this contract. All documents and materials, to include the source codes of any software, produced under this contract shall be Government owned and are the property of the Government with all rights and privileges of ownership/copyright belonging exclusively to the Government. These documents and materials may not be used or sold by the contractor without written permission from the Contracting Officer. All materials supplied to the Government shall be the sole property of the Government and may not be used for any other purpose. This right does not abrogate any other Government rights.

1.6.16 Organizational Conflict of Interest: Contractor and subcontractor personnel performing work under this contract may receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statements, etc.) or perform evaluation services which may create a current or subsequent Organizational Conflict of Interests (OCI) as defined in FAR Subpart 9.5. The Contractor shall notify the Contracting Officer immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and shall promptly submit a plan to the Contracting Officer to avoid or mitigate any such OCI. The Contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the Contracting Officer and in the event the Contracting Officer unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the Contracting Officer may effect other remedies as he or she deems necessary, including prohibiting the Contractor from participation in subsequent contracted requirements which may be affected by the OCI.

PART 2

DEFINITIONS & ACRONYMS

2. DEFINITIONS AND ACRONYMS:

2.1. DEFINITIONS:

2.1.1. CONTRACTOR. A supplier or vendor awarded a contract to provide specific supplies or service to the government. The term used in this contract refers to the prime.

2.1.2. CONTRACTING OFFICER(CO). A person with authority to enter into, administer, and or terminate contracts, and make related determinations and findings on behalf of the government. Note: The only individual who can legally bind the government.

2.1.3. CONTRACTING OFFICER'S REPRESENTATIVE (COR). An employee of the U.S. Government appointed by the contracting officer to administer the contract. Such appointment shall be in writing and shall state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the contract.

2.1.4. DEFECTIVE SERVICE. A service output that does not meet the standard of performance associated with the Performance Work Statement.

2.1.5. DELIVERABLE. Anything that can be physically delivered, but may include non-manufactured things such as meeting minutes or reports.

2.1.6. KEY PERSONNEL. Contractor personnel that are evaluated in a source selection process and that may be required to be used in the performance of a contract by the Key Personnel listed in the PWS. When key personnel are used as an evaluation factor in best value procurement, an offer can be rejected if it does not have a firm commitment from the persons that are listed in the proposal.

2.1.7. PHYSICAL SECURITY. Actions that prevent the loss or damage of Government property.

2.1.8. QUALITY ASSURANCE. The government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

2.1.9. QUALITY ASSURANCE Surveillance Plan (QASP). An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

2.1.10. QUALITY CONTROL. All necessary measures taken by the Contractor to assure that the quality of an end product or service shall meet contract requirements.

2.1.11. SUBCONTRACTOR. One that enters into a contract with a prime contractor. The Government does not have privity of contract with the subcontractor.

2.1.12. WORK DAY. The number of hours per day the Contractor provides services in accordance with the contract.

2.1.12. WORK WEEK. As specified otherwise.

2.2. ACRONYMS:

PART 3

GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND SERVICES

This section identifies those items such as property, information and/or services that will be provided for the contractor’s use (without cost to the contractor) to allow them to provide the required nursing services, such as materials, facilities, training, etc. Examples provided below.

3. GOVERNMENT FURNISHED ITEMS AND SERVICES:

3.1. Services: The Government will provide personnel to assist with orientation and guidance to the Indian Health Service and its requirements.

3.2 Facilities: The Government will provide the necessary workspace for the contractor staff to provide the support outlined in the PWS to include desk space, telephones, computers, and other items necessary to maintain an office environment for Medical services.

3.3 Utilities: The Government will provide all utilities in the facility will be available for the contractor’s use in performance of tasks outlined in this PWS. If utilities are furnished, the following is required: The Contractor shall instruct employees in utilities conservation practices. The contractor shall be responsible for operating under conditions that preclude the waste of utilities, which include turning off the water faucets or valves after using the required amount to accomplish cleaning vehicles and equipment.

3.4 Equipment: The Government will provide equipment and/or what the contractor will have access to, i.e., computer, phone, scanners, fax machines, printers, shipping crates, lighting and sound, etc.

3.5 Materials: The Government will provide materials, i.e., Standard Operating Procedures and Policies.

PART 4

CONTRACTOR FURNISHED ITEMS AND SERVICES

4. CONTRACTOR FURNISHED ITEMS AND RESPONSIBILITIES:

4.1 General: The Contractor shall furnish all supplies, equipment, facilities and services required to perform work under this contract that are not listed under Section 3 of this PWS.

4.2 Verification of Licensure

To ensure that Optometrist providing services under this contract are properly licensed and that the I.H.S. is made aware of all disciplinary actions taken against such physicians, the contractor will:

a. Verify through the National Optometry Boards database all active, inactive, and lapsed licenses that are held, or have been held, by Optometrist who would provide services in I.H.S. hospitals and clinics under this contract.

b. Inform I.H.S. of the status of all licenses for each Optometrist who would provide services under this contract in I.H.S. hospitals and clinics, including all reasons for each inactive or lapsed license.

c. Obtain at least three letters of reference from health care providers whom have knowledge of the applicant’s clinical practice skills within the past six months. One letter must be from the previous supervisor, at the hospital where the Optometrist holds or last provided medical/surgical care.

d. Provide all information regarding performance and disciplinary actions that is collected on a provider who would be placed under this contract to the receiving I.H.S. facility Clinical Director. This includes all information that is collected and compiled on such providers at the time of initial hire by the Contractor, and/or information that is reported during periods that the Contractor is an agent of such Optometrist for placement under this contract.

e. Certify that all information obtained on Optometrist whom they would assign to I.H.S. hospitals and clinics has been reviewed and verified by the Contractor. This certification must include a statement that the Contractor has found no reason to reject the Optometrist application. The names of the contacts, their titles, telephone numbers, and dates of representative collecting and reviewing such information must be recorded in writing and made available to the I.H.S. by the Contractor.

The Contractor must provide all of the information required above to the Clinical Director of the receiving I.H.S. facility no less than ten to fourteen days before the Optometrist actual report date. When the requirements or the I.H.S. do not allow for hard copies of information to be received at least ten days before an Optometrist placement, the Contractor may provide such assurances to the I.H.S. facility Clinical Director within five days after Optometrist placement. Such instances shall be kept to a minimum and the reasons for each instance must be documented and well justified by the Clinical Director at the receiving I.H.S. facility. (Per amend. #2-9/28/95)

4.3 Medical liability Insurance:

The Contractor will be solely liable for and expressly agrees to indemnify the Government with respect to any professional liability producing acts or omissions by it or its employees or agents. The Contractor will maintain during the term of this contract liability insurance issued by a responsible insurance carrier of not less than One (1) Million Dollars per occurrence and $3,000,000.00 aggregate.

An apparently successful offers or upon request by the contracting officer, will furnish prior to contract award evidence of its insurability concerning the medical liability insurance required by this contract.

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

A CERTIFICATE OF INSURANCE EVIDENCING THE REQUIRED COVERAGE WILL 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 (tail) is not provided prior to the commencement of services, evidence of such endorsement will be provided to the Contracting Officer prior to the expiration of this contract. Final payment under this contract will be withheld until evidence of the extended reporting endorsement (tail) is provided to the Contracting Officer.

The policies evidencing required insurance will also contain an endorsement to the effect that any cancellation or material change adversely affecting the Government's interest will 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 will provide evidence that the Government will be indemnified to the limits specified in this Statement of Work. This will be for the entire period of the contract, either under the new policy, or a combination of old and new policies.

The contractor shall insert the substance of this clause, including this paragraph, in all subcontracts under this contract for health care services and will require such subcontractors to provide evidence of and maintain insurance in accordance with this clause.

At least 5 days before the commencement of work by any subcontractor, the contractor will furnish to the contracting officer evidence of such insurance.

4.3 Payment for services

The Government reserves the right to accept or reject services if the level of work is unsatisfactory.

A task order will be used to pay for the services rendered. The payment shall be mutually agreed between the Contractor and the Contracting Officer or designated representative. The Contractor shall submit an original timesheet for review and verification to Medical Services. The Contractor shall submit an original invoice to purchase order instructions.

4.3.1 Invoice information requirements:

Please provide a copy of the invoice to:

Quentin N. Burdick Memorial Healthcare Email: Julie.Laducer@ihs.gov COR II Facility, Indian Health Service ATTN: Property & Supply P.O. 160 Belcourt, ND 58316

4.4 Employee Health Requirements:

Quentin N. Burdick Health Care Facility (QNBMHCF) requires contract provider onboarding health information for all job applicants to whom conditional offers of employment have been made in order to evaluate the applicant’s health, to protect patients and staff from exposure to communicable diseases. If the job applicant refuses to provide health information, proof of immunizations as recommended by the Centers for Disease Control (CDC) concerning health-care workers in the United States, the refusal is deemed sufficient grounds for Quentin N. Burdick Health Care Service Unit to deny employment. Information obtained regarding the medical condition or history of the applicant will be collected and maintained on separate forms and in separate medical files in accordance with federal law and will be treated as a confidential medical record.

GUIDELINES

Contract provider onboarding health information must include the following:

Previous immunization history is reviewed by the Employee Health Nurse. QNBMHCF requires all potential caregivers to provide proof of the following immunization records. If the caregiver cannot provide proof appropriate laboratory testing will be ordered.

Hepatitis B (Vaccination-declination required) All QNBMHCF contract providers who perform tasks that may involve exposure to blood or body fluids should receive a 3-dose series of hepatitis B vaccine according to manufacturer recommendations. Test for hepatitis B surface antibody (HBSAB) to document immunity 1-2 months after dose #3. If HBSAB is positive, the caregiver is immune. No further testing or vaccination is recommended.

For new hires providing proof of previous vaccination: HBSAB testing will be performed. If HBSAB results are >10mIU/mL the caregiver is immune and no additional vaccination is required. If the HBSAB is < 10mIU/mL the care giver should be revaccinated with 3-dose series on an appropriate schedule and serologic testing repeated in 1-2 months. If HBSAB is negative following 6 doses of vaccine, the caregiver is a non-responder.

For non-responder blood exposure: Consult the QNBMHCF Infection Control Plan.

Measles, Mumps, Rubella (MMR) All QNBMHCF contract providers must be immune to Measles (Rubeola), Mumps and Rubella. For HCP without serologic evidence of immunity to each component of the vaccine or proof of 2 vaccinations, recommend additional doses needed per CDC guidelines.

Varicella All QNBMHCF contract providers must be immune to varicella. Evidence of immunity for the Caregiver includes documentation of 2 doses of varicella vaccine give per manufacturer recommendation, history of varicella or herpes zoster, laboratory evidence of immunity or laboratory confirmation of disease. Proof of varicella history will be obtained through laboratory testing if no serologic testing is provided at the time of screening.

All QNBMHCF Caregivers between 19-64 years of age (or per manufacturer recommendation) must receive a 1-time dose of T-dap, with priority given to those having contact with infants younger than age 12 months.

Influenza (Required Vaccination unless approved declination for medical or religious reasons)

Tuberculosis All potential QNBMHCF contract providers must have a two-step (boosted) TBST or are sent to the Laboratory for QuantiFERON TB-Gold blood assay testing if they cannot show proof of a tuberculin skin test in the last twelve months.

If a potential QNBMHCF contract provider is a known TBST reactor, he/she will be required to complete a chest x-ray. The x-ray may be waived if the potential caregiver can provide documented proof of a chest x-ray, which was done in the last twelve months and the potential caregiver denies signs and symptoms of Tuberculosis.

PART 5

SPECIFIC TASKS

5. Specific Tasks:

5.1.0 The contracted Optometrist shall interview and examine patients, review past medical history and request and/or perform diagnostic tests and examinations as necessary to make diagnosis for Optometric services. They make diagnosis after evaluating information obtained and provide Optometric treatment and/or referral as appropriate.

5.1.2 The contracted Optometrist shall provide health care services, for the entire Period of Performance at the Quentin Burdick Memorial Healthcare Facility. The usual work day will be from 8:00 am to 4:30 pm The Optometrist shall schedule and perform procedures as appropriate.

5.1.3 The contracted Optometrist shall counsel and educate patients, families, community, and medical staff about general optometric care.

5.1.4 The Contracted Optometrist should be able to do both non emergent and emergent procedures within their requested scope of privileges.

5.1.5 The Contracted Optometrist shall prescribe drugs and tests necessary to provide care including the use of radiology and laboratory.

a. The contracted Optometrist shall become familiar with and be guided by the Indian Health Service formulary and shall follow I.H.S procedures when prescribing drugs.

b. The contracted Optometrist authorized to prescribe pharmaceuticals shall do so according to the availability of drugs listed in the I.H.S formulary.

c. I.H.S pharmacy services will provide instructions to the prescribing contract Optometrist as to substitutions of generic drugs for prescribed drugs.

d. The service unit pharmacy and therapeutics committee must approve drugs not on the formulary.

5.1.6 The contracted Physician shall:

a. Participate in a continual process of quality of health care evaluation to assure the provision of quality service.

b. Strive for excellence in providing emergency medical services.

c. Comply with all I.H.S. facility infection control and safety procedures, practices, and standards.

d. Meet all applicable Centers for Medicare and Medicaid Services (CMS) standards during the performance of this contract.

e. Respect and maintain the basic right of patients, to include but not be limited to personal dignity.

5.1.7 Referrals – all referrals shall be done utilizing the Contract Health Service (C.H.S.) referral form. The C.H.S committee utilizing C.H.S. guidelines will review these referrals.

5.1.8 The Contracted Optometrist is subject to a background investigation and shall comply with Section 231 of the Crime Control Act of 1990, P.L. 101-647; and the Indian Child Protection and Family Violence Prevention Act, P.L. 101-630. In addition, the physician shall also comply with the Privacy Act of 1974 and the HIPPA Act of 1996. Failure to comply with these statutes will result in immediate removal.

5.1.9 The Contractor shall be responsible for arranging travel, lodging, per diem, labor, fringe benefits, and any applicable Federal, State, and Local taxes, plus any other costs pertinent to the performance of this contract.

5.2 Technical Requirements:

5.2.1 The Contracted Optometrist shall be board certified, or board eligible without additional education or training, by the American Board of Optometry. It is a condition of this contract that all required certifications remain current during the life of this contract.

5.2.2 Possess current (BLS) Basic Life Support certification, is required.

5.2.3 The contracted Optometrist shall:

a. Not have any work or health restrictions, which interfere with the performance of general medical services.

b. Have actively performed emergent or non-emergent procedures within the past year.

c. Have skill and knowledge in providing optometric care in advising on health care needs, all with full consideration of the mental, emotional, physical, and cultural factors involved, such that he/she can relate constructively to patients from the Native American community.

d. Possess a current, unrestricted state medical license from any of the 50 United States or the Commonwealth of Puerto Rico.

e. The Contracted Optometrist shall not perform optometric services until the medical staff have recommended medical staff membership and recommended the contracted Optometrist is granted the requested privileges and the I.H.S. Governing Body in accordance with the I.H.S policy has granted clinical privileges. The Governing Body will not grant clinical privileges until it has determined that credential information has been verified.

f. Ability to provide general optometric services which include consultation, diagnostic, routine and care of all patients.

g. Ability to counsel and educate patients, families, communities, and Medical staff regarding general health care issues.

h. Ability to prescribe drugs and order tests necessary to provide general health care.

i. Ability to complete the medical record and other necessary documents regarding patient care in a timely, accurate manner via the Electronic Health Record System.

j. Ability to work with patients, the public, and hospital staff.

5.3 Reporting Requirements:

The Contracted Physician shall provide a monthly progress report to the Quentin Burdick Memorial Healthcare Facility Indian Health Service Contracting Officer on the 6th of each month.

5.4 Confidentiality of Records:

a. The contracted Optometrist shall generate and maintain proper medical record information on beneficiaries to whom treatment is provided, in accordance with Indian Health Service regulations. The contracted physician shall prepare all medical records documentation to meet or exceed the established standards of the I.H.S. facility to include, but not be limited to: timeliness, legibility, accuracy, content, and signature. All medical record information generated in the performance of the contract will be subject to the exclusive control of the Indian Health Service.

b. In-service on proper Electronic Health Record will be given to the provider upon arrival.

PART 6

APPLICABLE PUBLICATIONS

6. APPLICABLE PUBLICATIONS (CURRENT EDITIONS)

6.1. The Contractor must abide by all applicable regulations, publications, manuals, and local policies and procedures of the Quentin N. Burdick Health Care Facility, Indian Health Service, CMS, HIPPA, OSHA and any other State, Federal regulatory requirements.

PART 7

ATTACHMENT/TECHNICAL EXHIBIT LISTING

7 Attachment/Technical Exhibit List:

7.1 Attachment 1/Technical Exhibit 1 – Performance Requirements Summary

7.2 Attachment 2/Technical Exhibit 2 – Deliverables Schedule

7.3 Attachment 3/Technical Exhibit 3 – Estimated Workload Data

PART 8

PRIVACY ACT NOTIFICATION

8 Privacy Act This contract requires the Contractor, on behalf of the Indian Health Service (IHS), to provide health care to American Indians and Alaskan Natives and report selected medical record and financial information to IHS. The Snyder Act (25 U.S.C. 13) and Public Law 83-5658 (42 U.S.C. 2001) authorizes the collection of this information. To be reimbursed by IHS, you must provide the information requested by delivery/task orders issued under this contract. IHS will use the information for financial, legal, research, and health care purposes.

Disclosure of this information may be made by IHS to: other providers of health care for treatment or health maintenance of American Indian or Alaskan Native people; the Office of Worker's Compensation Programs, Department of Labor; the Department of Justice for their representation of the United States; and for congressional inquiry; quality assessment, medical audit, or utilization review; billing third parties for the payment of care; analytical and evaluation studies; to Federal or State agencies as required by law, research purposes supported by IHS; and identification of handicapped children under 10 U.S.C. 1401 et. Seq.

Disclosure of the appropriate medical record information without prior consent of the subject patient may be made by you to: another provider of health care treating the same patient; a Federal or State agency as required by law such as the reporting of communicable diseases, births, deaths, or the commission of crimes (i.e., gunshot wounds, rape, child abuse or neglect, alcohol or drug abuse, etc.); and billing third parties for the payment of care not reimbursed by IHS. You must forward all other requests for information contained on this form to the applicable IHS Ordering Official.

TECHNICAL EXHIBIT 1

Performance Requirements Summary The contractor service requirements are summarized into performance objectives that relate directly to mission essential items. The performance threshold briefly describes the minimum acceptable levels of service required for each requirement. These thresholds are critical to mission success.

Performance Objective (The Service required—usually a shall statement)

Method of Surveillance

PRS # 1

The contract provider shall provide all performance objects as outlined in PWS paragraph 5.1 Patient Care outcomes

PRS # 2

The contract provider shall provide all performance objects as outlined in PWS paragraph 6.0.

PRS # 3

The contract provider shall provide all performance objects as outlined in PWS paragraph 5.0.

The contractor provided Business Process and Agency Operating Model.

PRS # 4

The contract provider shall provide all performance objects as outlined in PWS paragraph 5.0, paragraph 6.0.

The contractor provided Business Process and Agency Operating Model.

PRS # 5

The contract provider shall abide by all requirement objects as outlined in PWS paragraph 1.6.8.

Medical Services standard for licensure

TECHNICAL EXHIBIT 2

DELIVERABLES SCHEDULE

The Invoice PWS paragraph 4.3.1.

Within 7 days of invoice submission.

2 copies and 1 hard copy mailed after receipt of timesheet.

Hard Copy, email copy to those listed

PWS paragraph 4.3.1

original to be faxed to company after signature and review by Medical services for compliance with schedule.

TECHNICAL EXHIBIT 3

ESTIMATED WORKLOAD DATA

ITEM

NAME

ESTIMATED QUANTITY

Optometrist

40 hrs/week