Pawnee Chiro SOW.docx

STATEMENT OF WORK – CHIROPRACTIC SERVICES

I. General:

This Statement of Work describes the requirement for the provision of chiropractic services at Pawnee Indian Health Center, Pawnee, Oklahoma for patients of the Pawnee Service Unit.

II. Background:

The Pawnee Indian Health Center is a Joint Commission accredited clinic. Chiropractic care is medical modality that has been deemed necessary to augment our pain management services. Therefore, contracted chiropractic services are necessary to support and supplement health care within the Service Unit.

III. Scope:

Provide diagnostic and treatment services and procedures as determined by evaluation and provide follow-up care as identified by treatment plan as outlined within Oklahoma statutes governing chiropractic care. This includes diagnostic procedures including orthopedic exams, neurological exams, range of motion exams, muscle strength testing; diagnostic imaging procedures including MRI, CT, x-ray, and ultrasounds; and treatment modalities including chiropractic adjustment procedures (manipulation, both spinal and extra-spinal), exercise and rehabilitation, strength and conditioning, passive stretch (independently or in conjunction with cryotherapy substance), bio-feedback, electrical modalities such as diathermy, interferential, current, galvanic, TENS, thermal modalities, ultrasound and phonophoresis, all type of traction, and bracing and supports. Modalities outside of the above, even if accepted in other chiropractic care settings, are explicitly excluded.

Services shall be fully coordinated and integrated with the patient’s primary care provider within the Service Unit with respect to services provided and professional relationships.

IV. Responsibilities:

Contractor shall:

a. Provide chiropractic care as outlined within Scope as noted above.

b. Communicate, in a timely fashion, to the referring primary care provider all clinical information necessary for continuity of care and documentation of quality of performance.

c. Provide patient schedule to accommodate a minimum of eighteen (18) patient encounters per full day (8 hour) clinic and nine (9) for half day (4 hour) clinics. Additional provider encounters shall be allowed and will be coordinated by manager. Patients who no show or cancel their appointment with no time to schedule another appointment may impact overall patient encounters and will be assessed in contract evaluation.

d. Observe and assess patient’s clinical condition; recognizing, identifying and interpreting situation and immediately deciding proper action and therapeutic care plan.

e. Formulate proper diagnosis and develop plan of care for individual patients.

f. Recommend proper therapeutic measures (exercise, stretches) for augmenting services.

g. Document all patient encounters in the patient’s electronic health record.

h. The Pawnee Indian Health Center shall have the right to provide continual review of all patient encounters and ensure all required documentation is provided.

i. Failure, on the part of the Contractor, to provide care as identified may result in the suspension of contract for services.

j. Work is to be performed at the Pawnee Indian Health Center. No payment will be rendered for services outside of the facility.

k. The Pawnee Indian Health Center shall retain the right to implement additional contractor responsibilities if, during the course of the contract, additional responsibilities become necessary to maintain continuity of care and quality of performance, however, these additional responsibilities, if implemented, do not alter nor effect negotiated and contracted rate fees.

V. Period of Performance: Approximately one year.

VI. Contractor Qualification Requirements:

The Chiropractor must possess a current, unrestricted license through the Oklahoma Board of Chiropractic Examiners and have been taught by an accredited Chiropractic College.

VII. Special Terms and Conditions:

Contractor shall comply with the Stark Law that prohibit physician self-referral if the physician (or an immediate family member) has a financial relationship with that entity.

VIII. Schedule of Work:

Contractor shall provide one eight (8) hour clinic twice a month as agreed upon between Contractor and the Clinton Indian Health Center. The government reserves the right to negotiate the addition/reduction of hours as mutually agreed upon by contractor.

IX. Rates of Payment:

Contracted rates shall be established as identified within the attached quote for services and shall be invoiced on a total completed clinic hourly rate based invoice and submitted to and as identified in sections IX of this Statement of Work.

X. Indemnity and Insurance:

The government assumes no responsibility of negligent acts of the Contractor. Therefore, the Contractor is responsible for personal insurance if the Contractor indicates that it is necessary. The Contractor will hold harmless and indemnify the government against any or all loss, cost, damage, claims, expense or liability whatsoever as a result from the performance of the Contractor. The Contractor will hold the Federal Government and its agents including the Clinical Director and the Governing Body immune from civil or professional liability for all acts related to quality care management and enforcement of this contract.

XI. Government Furnished Information, Property and Services:

All records of consultation, examination, surgeries/procedures and services of patients’ required in the performance of this contract will remain the property of and subject to the exclusive control of the Pawnee Indian Health Center. The Pawnee Indian Health Center will provide materials, support staff and equipment necessary for the performance of this contract. The Contractor shall provide all at the Pawnee Indian Health Center.

Outside equipment brought on site shall be checked and approved by Pawnee Indian Health Center Bio-Med department prior to its usage in patient care. If equipment requires preventive maintenance, calibration or Quality Control, then all documentation shall be provided by contractor before use in the Pawnee Clinic.

XII. Contract Evaluation Contractor shall be evaluated yearly upon completion of each contract term. The government reserves the right to conduct evaluations more frequently if deemed necessary. Evaluation shall include patient/customer satisfaction, patient encounters/clinic, chart review and adherence to scope and contract term.

XIII. Immunizations

Persons born after December 31, 1956, shall provide proof of immunity to Rubella and Measles prior to award of contract. Serological testing to confirm Contractor’s immunity and/or immunizations shall be provided to the Government. Contractors requesting privileges shall submit documentation of a current (within the past 12 months) TB skin test or chest x-ray if the skin test was previously positive. Special considerations may be allowed to individuals, who are allergic to component of a vaccine, has history of severe reaction of a vaccine or who are currently pregnant.

Contractor shall provide documented evidence of annual current season influenza and any other influenza-related vaccination, unless medically contraindicated.

Contractor shall provide a series of three (3) Hepatitis B immunizations or serologic proof of past infection.

XIV. Contact with Indian Children

The Contractor shall perform in accordance 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, and failure to comply with these statutes shall result in immediate removal. Individuals providing services which involve regular contact with, or control over, Indian children, are subject to a character investigation. IHS personnel offices will conduct these investigations following award of non-Personal services 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 Contracting Officer has been notified of the result of the investigation, such individuals shall not have unsupervised contact with Indian children.

XV. Invoicing Requirements

a. The Contractor shall be required to provide an original and two (2) copies of the invoice to Oklahoma City Area Indian Health Service, Division of Financial Management, 701 Market Center Drive, OKC, 73114.

b. Each invoice shall include the following information:

i. Contractor’s name and invoice date.

ii. Contract number or authorization for delivery of services.

iii. Description, price and quantity of services actually rendered.

iv. Name, title, phone number, and complete mailing address of official to whom payment is to be sent.

c. Invoice shall be submitted no later than ten (10) calendar days following last calendar day of the month.

XVI. Qualifications

1. The Chiropractor must possess a current, unrestricted license through the Oklahoma Board of Chiropractic Examiners and have been taught by an accredited Chiropractic College.

1. Shall provide liability insurance in the appropriate amount of $1,000,000 per occurrence and $3,000,000 aggregate.

1. Shall be registered in System Award Management (SAM) database.

1. Provide a resume

1. Provide documentation of two past performances

1. Resume

XVII. Applicable Documents

Joint Commission http://jointcommission.org

Section 4087 of Public Law 101-630, Indian Child Protection and Family Violence Prevention Act

Health Insurance Portability and Accountability Act (HIPPA) of 1996 http://www.hhs.gov/ocr/hippa

Privacy Act of 1974 http://www.access.gpo.gov/nara/cfr/waisidx

Indian Health Service (IHS) Information Technology and Records Security and Safeguard Policies http://home.ihs.gov/ITSC-CIO/security/index.asp Government Performance and Results Act (GPRA)

System for Award Management (SAM) http://www.sam.gov