NAVAHCS Provider PWS.pdf

Contract No.

Rural Health Care Department of Veterans Affairs (VA)

Northern Arizona VA Health Care System (NAVAHCS) Performance Work Statement (PWS)

1. Introduction The Department of Veterans Affairs (VA), through the Northern Arizona VA Health Care System (NAVAHCS), has identified health care challenges that exist in the NAVAHCS service area, to include inadequate access to care and gaps in care coordination for health care services. Inadequate access to care is driven by unique challenges in medical deserts, such as a shortage of medical providers/high turnover due to location and housing challenges, lack of consistency and trust in the health care delivery system, broad social and health care disparities, lower access to care for medically underserved populations, negative impacts of the digital divide, and a lack of reliable patient transportation in highly rural areas. Gaps in health services/care coordination include primary care; mental health; women’s health; a variety of specialty care services, such as obstetrics/gynecology (OB/GYN), occupational therapy (OT)/physical therapy (PT), audiology, and endocrinology, etc. Additional disparities exist for rural areas in ancillary services, such as radiology, health education, home health care, wound care, and laboratory services. Robust and forward-facing clinical providers serving in these remote settings is the best way to meet these unique needs, along with proper care coordination strategies uniquely designed for health care deserts.

2. Scope This is a non-personal services contract. The contractor shall provide all labor and supervision required to alleviate inadequate access to care and gaps in care coordination within the NAVAHCS service area. Required health care categories include adult, family, and mental health services. Provider types include primary care nurse practitioner (NP), psychologist, psychiatrist, psychiatric mental health nurse practitioner (PMHNP), and registered nurse (RN) group educator to provide a range of health care/educational services, as outlined in the objectives and task statement of this Performance Work Statement (PWS). Services have been divided into a “phased approach” that shall start with basic primary care needs identified by NAVAHCS and expand into cardiovascular wellness services and health screening services, in conjunction with telehealth. Services shall be provided via the VA clinic-in-a-clinic concept that NAVAHCS has with the Indian Health Service (IHS)/Tribal (638) clinics, as well as through telehealth services and mobile medical clinic (MMC) operations. To perform the scope of work, the contractor shall meet the following requirements:

• Registration as a professional corporation (PC) able to deliver health care services

• Experience in the staffing, oversight, and administration of multiple clinics

• MMC operational capabilities

• Electronic medical record (EMR) integration experience to ensure services provided via mobile medical operations can be securely and electronically transferred back into the VA EMR system

2.1 Delivery Approach

The contractor shall deliver basic care needs identified by NAVAHCS and, over the course of the contract, expanding incrementally to include more robust wellness care coordination. The goal of the phased approach is to progressively build trust in the health care delivery system through consistency, reliability, and sufficiency of services.

2.2 Objectives

The contractor shall perform clinic staff augmentation, provider management, mobile medical operations, and patient data reporting. Contract objectives are delineated into five tasks to be implemented.

Tasks 1 through 4 are linked to the respective phase, which are further delineated into specific services, as denoted in Section 7, Delivery Schedule.

Task 5, Continuous Patient Data Reporting: When services are provided in the VA and/or IHS clinical locations, contractor clinicians shall be trained by the VA Medical Center (VAMC) training staff to utilize the VAMC electronic medical record system to capture information. When care is provided in a contractor-owned and -operated MMC, the information for the health care services and actions taken for the patients shall be transmitted back to the VAMC through the Health Information Exchange (HIE) CommonWell. This exchange is a secure send-and-receive of information that is well established in the Veterans Health Administration (VHA) system and is also used in the Community Care Network (CCN) to deliver health care service information back to the

VAMC.

Contractor provider staff shall complete training as directed and delivered by NAVAHCS and be granted an appropriate level of account/access to the VA EMR. NAVAHCS shall supply the contractor provider with a VA Personal Identity Verification (PIV) card to access Government-Furnished Equipment (GFE) and the VA EMR. The contractor’s mobile medical clinic shall have the capability to record clinical care encounters with sufficient information for VA record keeping. The contractor’s MMC shall have connectivity to an appropriate HIE to support the exchange of patient information in a secure, electronic format with Veterans Health Information Systems & Technology Architecture (VistA) (or other NAVAHCS-specified EMR), as denoted in Task 5 of this section.

2.2.1 Clinic Staffing Augmentation

Contractors shall augment VA clinic staff with qualified NP, psychologist, psychiatrist, and PMHNP health care providers, as well as RN group educators. All health care providers working under this contract, both in clinic and on contractor MMCs, shall meet all qualification, licensure, and VHA and Indian Health Services (IHS), Tribal Health Program (THP) certification requirements. Providers shall adhere to all contractor and NAVAHCS requirements, to include credentialing, education, and appropriate immunizations as required by the clinic. Provider oversight/reporting includes both administrative and clinical supervision by the contractor. Staff qualification requirements are outlined below.

1. Primary care NP: RN with a Master of Science in nursing (MSN) or Doctor of Nursing practice (DNP) degree and current, unrestricted license to practice as an NP in the state in which they practice under this contract. Drug Enforcement Administration (DEA) prescribing authority is required in the state of practice under this contract.

2. Psychologist: psychologist with current, unrestricted license to practice as a psychologist in the state in which they practice under this contract.

3. Psychiatrist: Doctor of Medicine (MD) or doctor of osteopathy (DO) with current, unrestricted license to practice their specialty in the state in which they practice under this contract. DEA prescribing authority is required in the state of practice under this contract.

4. PMHNP: RN with an MSN or DNP degree, PMHNP certification from an accredited credentialing body, and current, unrestricted license to practice as an NP in the state in which they practice under this contract. DEA prescribing authority is required in the state of practice under this contract.

5. RN group educator: RN with current, unrestricted license to practice as an RN in the state in which they practice under this contract.

6. Licensed vocational nurse (LVN)/licensed practical nurse (LPN): associate’s degree or a certificate from an accredited program and current, unrestricted license to practice as an LVN/LPN in the state in which they practice under this contract.

7. Specialty providers as defined by NAVAHCS Executive Leadership Team (ELT) can be utilized upon request.

8. Providers should be trained to service veteran programs currently utilized by NAVAHCS Psychology department. Mental health providers should be qualified to perform these services and can include Licensed Clinical Social Worker (LCSW), Masters trained Counselor, and/or Psychologist or other mental health trained clinicians as defined by the NAVACS ELT and/or the Mental Health service chief or their delegate.

9. Various tech support such as Architect Engineer, mammography, Xray Services, Audiology and telehealth during MMC deployments.

2.2.2 Mobile Medical Clinic (MMC) Operations

MMC operations shall be provided by the contractor when ordered for special events and/or clinical coverage. Contractor shall schedule MMCs event for agreed upon services with 30 days’ notification of event request. Contractor shall coordinate with NAVAHCS to identify detailed clinical requirements, including volume, examinations, and diagnostic needs. The contractor shall provide medical and logistical staff (e.g., scheduling) to support MMC events, to include a contractor-provided primary care NP or PMHNP from one of the four clinics, and an LVN/LPN to support the NP.

2.2.3 Patient Data Reporting

Services provided by the contractor within VA facilities shall utilize the VHA EMR as noted in Section 2.2, with access and training provided by NAVAHCS accordingly. Any services provided by the contractor via respective MMC operations shall require utilization of contractor’s EMR, with connectivity to the HIE (i.e., Commonwell) to securely transfer patient data to the VHA EMR. Data sharing is required for reporting purposes. Business Associate Agreement (BAA) is required.

3. Period of Performance The contract period of performance will include 1 base year and six (6) one-year Options.

4. Place of Performance Primary performance and service delivery shall take place at the following Government facilities in the NAVAHCS region: Other locations can be serviced within the NAVAHCS catchment area including all VAMC rural and CBOC clinics to include clinic-in-clinic locations.

Chinle VA Clinic Highway 191 and Hospital Drive Chinle, AZ 86503-8000

Kayenta VA Clinic US Highway 160, 1/2 mile south of mile post 394.4 Kayenta, AZ 86033

Polacca VA Clinic/Hopi Health Care Center Highway 264 Mile Post 388 Polacca, AZ 86042

Tuba City VA Clinic 167 North Main Street Tuba City, AZ 86045-0600

Page VA Clinic 801 N. Navajo Dr.

Page, AZ 86040

Dilkon Medical Center 1 Medical center Dr.

Winslow, AZ 86047

Moenkopi Senior Center Inc.

20 Reservoir Ln.

Tuba City, AZ 86045

Contract performances will be at Chinle VA Clinic, Kayenta VA Clinic, Polacca/Hopi, Tuba City VA Clinic, and Page VA Clinic. Potential standalone VA clinic in Tuba City determines by NAVAHCS leadership and Navajo Nation Leadership. Additional performance shall take place at contractor-owned and operated MMCs, as noted in Section 2.2.2.

5. Travel No travel shall be required outside of the NAVAHCS primary service area.

6. Task Statement The contractor should provide a managed service that includes medical staff and services in the areas specified by NAVAHCS as noted below. This includes the recruitment, staffing, and supervision of qualified medical providers; MMC events as ordered; and the transfer of patient data collected outside of VA clinics to VA EMR systems via HIE.

To meet these requirements, the contractor shall provide the following:

1. Clinic staffing

• Primary Care: one (1) full-time equivalent (FTE, Mon-Fri), NP at each of the five clinics. Base number of support days for each clinic are listed below and, upon mutual agreement and with at least a 30-day notice, these days can be adjusted to meet patient volume needs.

– Chinle VA Clinic: 5 days a week

– Kayenta VA Clinic: 5 days a week

– Page VA Clinic: 2 days a week

– Dilkon Medical Center Clinic: 3 days a week

– Moenkopi Village Senior Living Center - Tuba City VA Clinic: 2 days a week

– Polacca/Hopi Clinic: 3 days a week

– Tuba City VA Clinic: 2 days a week

• Mental Health: one (1) full-time equivalent (FTE) mental health provider which would include psychologists, psychiatrists, and psychiatric mental health NP at each of the five clinics. Base number of support days for each clinic are listed below and, upon mutual agreement and with at least a 30-day notice, these days can be adjusted to meet patient volume needs.

– Chinle VA Clinic: 5 days a week

– Kayenta VA Clinic: 3 days a week

– Page VA Clinic: 2 days a week

– Dilkon Medical Center Clinic: 3 days a week

– Moenkopi Village Senior Living Center Polacca/Hopi Clinic: 3 days a week

– Tuba City VA Clinic: 2 days a week

• Group Educator: One (1) RN group educator: one (1) day events up to a total of 52 events per year of RN for group patient health education, as required across any of the five clinics.

2. MMC events

• Up to Fifty (50) MMC events each year as ordered to support outreach in the NAVAHCS catchment area.

3. Telehealth

• Telehealth services shall be delivered in one of two ways, to include either VA-provided telehealth equipment when in the VHA clinic or contractor telehealth technologies when in the MMC

4. EMR system integration

• Retrieval and transfer of patient records from MMCs to VA EMR systems through secure Veterans HIE (VHIE), as previously noted

Section 2.1 specifically addresses the phasing methodology for Tasks 1 through 4. This methodology is also reflected in Section 7, Delivery Schedule.

7. Delivery Schedule Table 1. Delivery Schedule

Task Deliverable Type of Provider/Quantity Delivery Date Task #1 Phase 1

Initial Service Needs

Direct primary care 4 primary care NPs (1 FTE per clinic)

Calendar Year

(CY) Q4 2024

Depression screening NP performs at primary care visit;

refers to psychologist or PMHNP when indicated

Diabetes screening NP performs at primary care visit based on patient need

Medicare diabetes prevention program

NP refers to RN group educator or VAMC or CCN as indicated

Diabetes self-management training NP refers to RN group educator or VAMC or CCN as indicated

Mammography screening NP refers to VAMC or CCN based on patient need

Sleep study NP refers to VAMC or CCN (VHA pulmonology services)

Mental health services NP refers to psychologist or PMHNP; refers to psychiatrist for care beyond psychologist and/or PMHNP scope of practice

Task #2 Phase 2

Audiometry NP refers to VAMC or CCN (VHA audiologist/technician)

CY Q1 2024

Task Deliverable Type of Provider/Quantity Delivery Date

Cardiovascular Wellness Services with Continued Task 1 Services

RN group/individual patient health education, including but not limited to:

tobacco cessation; alcohol/substance abuse education; mental health, such as anxiety, depression, post-traumatic stress (PTS), and grief;

diabetes education, such as checking blood glucose, making healthy choices, and identifying foods to avoid; nutrition to lower high cholesterol or risk of type two diabetes; lifestyle choices, such as exercise, healthy meals, and weight management; high blood pressure management; cardiovascular wellness; and women’s health wellness, such as mammograms and screenings.

NP refers to RN group education

Alcohol misuse screening and counseling

NP performs at primary care visit;

refers to psychologist or PMHNP when indicated

Tobacco screening NP performs at primary care visit;

refers to psychologist or PMHNP when indicated

Medical nutrition therapy NP refers to RN group education Ultrasound abdominal aortic aneurysm (AAA) screening

NP refers to VAMC or CCN (VHA radiology services/ ultrasound technician)

Intensive behavioral therapy (IBT) for cardiovascular disease

NP refers to VAMC or CCN

IBT for obesity NP refers to RN group education Computed tomography (CT) calcium scoring

NP refers to VAMC or CCN (VHA radiology services/CT technician)

Pulmonary function testing NP performs testing Task #3 Phase 3

Screening Services with Continued Task 1 and 2 Services

Hepatitis A/B/C screening NP performs CY Q2 2024 Bone mass measurement NP performs Women’s wellness NP performs Men’s wellness NP performs Age-required wellness NP performs HIV screening NP performs and orders testing as required Sexually Transmitted Infection (STI) screening

NP performs

Mass events for flu shots and pneumococcal vaccines

NP performs

Immunization clinics NP performs Glaucoma testing NP performs Fecal occult NP performs Lung cancer screening NP performs and refers to VAMC or CCN as indicated Advanced health care directives (will, power of attorney, etc.)

NP performs

DNA testing for genetic markers of disease

NP orders testing when indicated

Educational-space sourcing Contractor sources Task #4 Phase 4

Telehealth Services

NAVAHCS patients can attend telehealth appointments with an offsite VA or contractor NP, PMHNP, or psychologist/psychiatrist as

Contractor coordinates/ performs CY 2024

Task Deliverable Type of Provider/Quantity Delivery Date with Continued Task 1, 2, and 3 Services mutually agreed upon throughout the life of the contract

Task #5

Patient Data Reporting

EMR documentation capability that shares information with VistA

N/A Aligned with MMC events

8. Government-Furnished Information (GFI), Equipment (GFE), and Facilities To deliver the needed services for Tasks 1, 2, 3, and 4, contractor’s NPs shall staff the four clinics and follow VHA protocols, policies, and procedures across service delivery using VHA equipment and partners. NAVAHCS shall provide the contractor with the following, when contractor is operating in a NAVAHCS location:

• Access to Government facilities

• Office space as required

• VA and HIS/THP credentialing support; contractor shall credential providers per standard operating procedures.

• Access to adequate office equipment and supplies

• Access to adequate clinic/exam equipment and supplies

• Access to necessary onboarding procedures and trainings

• Access to and training on VA EMR and associated systems

• Access to systems to capture and manage unusual incident reporting of critical events

• VA clinical protocols, policies, procedures, and clinical practice guidelines, including patient education materials

• Front office and back office staff support, including clinical staff

• VHA equipment, such as audiology equipment, pulmonary function equipment, vision screening equipment, and ultrasound machine

• VA referral system for VHA clinical specialists and community-based diagnostics within the VA CCN

• Vaccines as required for patient population

• Telehealth equipment

• VA support of contractor as a partner for onboarding to the VHIE

• Support of the Commonwell HIE interface to receive and send medical documentation to and from the VAMC and contractor’s EMR at MMC events

9. Security Requirements All contractor employees assigned to this contract shall complete initial and annual training required for access to VA systems. Training requirements include, but are not limited to medical confidentiality requirements, including the provisions of the Privacy Act and the Health Insurance Portability and Accountability Act (HIPAA), and the proper use and storage of confidential electronic information. Contractor shall execute a BAA within five days of contract signature.

10. Task Order Quality Assurance Surveillance Plan The Government shall evaluate the contractor's performance in accordance with the Quality Assurance Surveillance Plan (QASP). This plan is primarily focused on what the Government must do to ensure 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 rates.

Table 2. Quality Assurance Surveillance Plan

Deliverable or Requirement Performance Standard Surveillance Method Outcome

PWS 6.

1 FTE primary care NP staff based at each clinic location

90% coverage 100% inspection Poor performance may result in issuance of a Contractor Discrepancy Report (CDR).

The contractor’s performance on this task order will be reported to the Contractor Performance Assessment Reporting System (CPARS) on an annual basis. The contracting officer (CO) and contracting officer’s representative (COR) will make use of information from CDRs, as well as any additional knowledge and information available to them with respect to the contractor’s performance, to complete the CPARS.

The Government will not pay for services that do not conform or do not meet performance standards, or have not been properly rendered.

The contractor will be given an opportunity to correct non-conforming services at no cost to the Government if the services are non-conforming or the contract requirement is unacceptable.

PWS 6.

0.5 FTE psychologist staffed

up to 10 days per month across four clinics with three weeks’ advance notice

90% coverage 100% inspection

PWS 6.

0.25 FTE psychiatrist staffed

up to 5 days per month across four clinics with three weeks’ advance notice

85% coverage 100% inspection

PWS 6.

0.25 FTE psychiatric mental

health NP staffed up to 5 days per month across four clinics with three weeks’ advance notice

85% coverage 100% inspection

PWS 6.

RN group education, 1 day events up to a total of 52 events

90% coverage 100% inspection

PWS 2.2.2

MMC events scheduled with 30 days of notice for agreed upon services

95% of requests completed within 30 days

Direct observation

Glossary of Abbreviations and Acronyms

Abbreviation/Acronym Definition AAA Abdominal Aortic Aneurysm BAA Business Associate Agreement BSN Bachelor of Science in Nursing CY Calendar Year CCN Community Care Network CDR Contractor Discrepancy Report CO Contracting Officer COR Contracting Officer’s Representative CPARS Contractor Performance Assessment Reporting System CT Computed Tomography DEA Drug Enforcement Administration DNP Doctor of Nursing Practice DO Doctor of Osteopathy EMR Electronic Medical Record FTE Full-Time Equivalent GFE Government-Furnished Equipment GFI Government-Furnished Information HIE Health Information Exchange HIPAA Health Insurance Portability and Accountability Act IBT Intensive Behavioral Therapy IHS Indian Health Service LPN Licensed Practical Nurse LVN Licensed Vocational Nurse MD Medical Doctor MMC Mobile Medical Clinic MSN Master of Science in Nursing NAVAHCS Northern Arizona VA Health Care System NP Nurse Practitioner OB/GYN Obstetrics/Gynecology OT Occupational Therapy PC Professional Corporation PIV Personal Identity Verification PMHNP Psychiatric Mental Health Nurse Practitioner PT Physical Therapy PTS Post-Traumatic Stress PWS Performance Work Statement QASP Quality Assurance Surveillance Plan RN Registered Nurse STI Sexually Transmitted Infection UEI Unique Entity ID VA Veterans Affairs VHA Veterans Health Administration VHIE Veterans HIE VistA Veterans Health Information Systems & Technology Architecture