Medical Tort Claims Peer Reviews SOW - Office of Quality - 75H70425Q00007.pdf

Statement of Work

Tort Claims Peer Review

RFQ # 75H70425Q00007

The Federal Employees Liability Reform and Tort Compensation Act of 1988, P.L. 100-694 (commonly known as the Westfall Act, after the Supreme Court case it overturned), amended the Federal Tort Claims Act to make it the exclusive remedy for torts committed by federal employees sued for torts committed within the scope of their employment, 28 U.S.C. $ 2679(b)(l).

Indian Health Service (IHS) has medical providers employed as Federal Employees practicing medicine at various facilities. Tort claim files will be delivered to the contractor for review. The expected turnaround time for the review once the medical chart is delivered to contractor is 30 – 60 days depending on complexity. The HHS Office of General Counsel will provide all the medical records. The contractor is to review up to 50 peer reviews per year. Vendor will work directly with the Office of Quality , Risk Management Coordinator.

Contract Work: The contract will consist of one major activity:

Claim Review/Reporting: The vendor will be responsible for receiving IHS Tort Claim File(s), reviewing IHS Medical Malpractice Claims, and preparing a written Standard of Care Report to IHS Tort Claims Manager in the agreed format.

Contractor staff qualifications: Contractor must have verifiable proof of a pool of Board Certified physicians that cover all specialities and subspecialities of medicine and medical care. The contractor shall provide a qualifications plan and ensure that all personnel conducting work meet these qualifications. Reviews and/or reports prepared by unqualified staff shall not be reimbursable by the Indian Health Service. As such, any incurred costs for reviews and/or reports prepared by unqualified staff shall be borne by the contractor.

Contract Format: Firm-fixed-price. The contract will consist of base award (annual) covering CLIN 1 through CLIN 5.

Delivery Format: The drafts can be provided by e-mail, however, the final report shall be delivered by Express Mail. All shipping costs after the contractor receives medical records are the responsibility of the contractor.

Privacy/Confidentiality: The contractor is responsible for ensuring they comply with legal and regulatory requirements, including:

- Being Health Insurance Portability and Accountability Act (HIPAA) Compliant;

- Being compliant with The Privacy Act of 1974, which prohibits the disclosure of a record about an individual from a system of records absent the written consent of the individual;

- Ensuring that records/reports are otherwise held in confidence, for official use only.

Section 508 compliance: All materials provided will be accessible to people with disabilities and be compliant with Web Content Accessibility Guidelines (WCAG) 2.1 technical standard and the requirements of Section 508 of the Rehabilitation Act of 1973.

Contract Files: During the engagement, the vendor shall maintain records as required. At the close of the contract, the vendor shall surrender these files in an orderly manner to the Contracting Officers’ Technical Representative (COR) and IHS Tort Claim Manager, as directed by the COR.

Activity/Delivery Schedule:

Tasks (Annual / Recurring Delivery Date Post-award Kickoff Meeting. Within 7 business days of contract award

Monthly Project Status Reviews: Contractor is responsible for reporting the previous month’s activities (including any risks, issues, or concerns, and actual or recommended actions for their mitigation), and projected activities for the following month.

1st Monday of each month

Monthly Program Management Reviews: Contractor shall provide written data and verbal presentations as to the financial status of the project (projected vs. incurred costs), any identified risks, issues, or concerns, and their mitigation or its plans for their mitigation.

TBD

Task Order Kick-Off Meeting Within 7 business days of task award

Task Order Services and Materials TBD Meet with Contracting Officers’ Technical Representative (COR) and IHS Tort Claim Manager to develop a work plan, etc.

Month 1

Claim Review/Reporting

- Receive IHS Tort Claim File(s) Month 1- 12

- Review IHS Medical Malpractice Claims Month 1- 12

- Prepare written report to IHS Tort Claims Manager in the agreed format Month 1- 12

Required Contractor Trainings/Agreements:

- Protecting Children From Sexual Abuse by Health Care Providers

- Records Management

- Business Associate Agreement

- HHS/IHS Confidentiality and Records Sharing Agreement

Period of Performance (Anticipated):

Base: December 17, 2024 to December 16, 2025

Option Period I: December 17, 2025 to December 16, 2026

Option Period II: December 17, 2026 to December 16, 2027

Option Period III: December 17, 2027 to December 16, 2028

Option Period IV: December 17, 2028 to December 16, 2029

Appendix 1: Sample outline for report:

I. Claim (Background) II. Documents and Records Reviewed III. Facts IV. Discussion V. Recommended Decision