Performance Work Statement.pdf

Attachment A Pharmacist Services, Tohatchi Health Center (THC)

Tohatchi, NM

Statement of Work Pharmacist Services

The overall scope of this contract is to provide temporary professional Pharmacist Services that are qualified and available for mutually agreed upon temporary staffing assignments for the duration of the contract term.

The Contractor shall ensure that the staff meets the qualification requirements set forth in the contract as detailed below. The contractor will be expected to have the necessary ability and education, training, licensing, and previous work experience to perform the work according to the requirements and conditions contained in this Work Statement.

Selected candidate(s) shall undergo the Indian Health Service (IHS) mandated security clearance requirement prior to commencement of services at Tohatchi Health Center (THC) pharmacy. THC is a clinic within the Gallup Service Unit.. The security pre-clearance requirement must be adhered to; the process includes a fingerprint check and a screen check of the medical services and related providers through the office of the inspector general's exclusion list at http://exclusions.oig.hhs.gov/. Documented evidence of the clearances shall be provided to the Contracting Officer Representative at: Tohatchi Health Center 07 Choosghai Drive PO Box 142 Tohatchi, NM 87325.

PHARMACIST

I. STATEMENT OF WORK:

The contractor shall provide pharmacist services on an as needed basis for the Tohatchi Health Center Pharmacy, Tohatchi, NM. Depending on the location assigned, services shall include (1) screening outpatient prescription orders, and patient record for appropriateness, (2) filling/verifying prescriptions, (3) counseling patients on proper use of their medications, (4) functions that support the first three, e.g., drug information, pharmacy and therapeutics function, supply management, quality assurance, pharmacokinetics service, (5) primary care services where the pharmacist operating understanding orders or protocols, monitor or manage patients on chronic medications or those that require OTC medication for an acute limited illness.

1. SPECIFIC REQUIREMENTS:

A. The contractor’s employee must have at least 6 months of prior Indian Health Service pharmacy experience.

B. The contractor’s employee(s) shall be responsible for reviewing all prescribed medication orders in the chart or electronic health record prior to administration or dispensing for safety, appropriateness and efficacy. He/she shares joint responsibility for the safety and efficacy of drug therapy with the physician.

This review or screening process shall include the following steps:

1. Verification of the prescription orders for completeness and legal validity.

2. Ascertain that the patient’s problem/diagnosis is not potentially drug induced or drug related.

3. Validate the appropriateness of the prescribed drug therapy against the diagnosis/data base.

4. Check for known previous adverse reactions/sensitivities or allergies to prescribed medication.

5. Check for the presence of pathological conditions that might require a modification of the choice dosage or dosage form of a drug.

http://exclusions.oig.hhs.gov/

6. Check for the appropriateness of dose, duration of therapy, dosage form and quantity of medication.

7. Check for interaction between drugs, drugs and food or drugs and laboratory tests.

B. If the contractor’s employee(s) believes there is a potential problem, he/she will consult the prescriber for resolution prior to dispensing the medication.

C. The contractor’s employee(s) shall document in the patient record that these services have been performed according to Service Unit Procedures.

D. The contractor’s employee(s) shall fill prescriptions in accordance with federal, state, IHS regulations and principles of professional pharmacy practice. Included in the requirements are:

1. Child and water-resistant containers shall be used.

2. Each prescription container will be prepared and labeled per policy using the pharmacy computer system when available.

E. I.V. admixtures and inpatient drug distribution will be carried out based on patient care needs and following Service Unit policies and procedures.

F. The contractor’s employee(s) shall provide counseling for all patients on the safe and effective use of their medications.

1. Use of two patient identifiers is required prior to consultation.

2. Controlled drug dispensing requires positive proof of identification (e.g.

government issued i.d. such as drivers’ license or tribal identification card).

3. All patients consultations and written supplements should include the following information:

a. Name and purpose of the medication;

b. Dosage schedule including special instruction, e.g., take on an empty stomach;

c. Length of therapy;

d. Expected outcome;

e. Precautions and possible common side effects; and,

f. Storage requirements.

g. Discuss/question patient on other relevant points concerning disease state, drug therapy or potential problems with compliance.

h. Review drug allergy history (either illicit new or verify old).

i. Verify/confirm follow-up appointment with patient.

j. Briefly verify patient understanding of material presented.

4. All consultations are to be done in a private environment, e.g., consultation room if available or unless circumstances prevent it.

5. The contractor shall verify patients understanding of proper use of prescribed medication. The patient or the person who will be responsible for administering the medication is to be counseled.

6. Supplemental written patient instructions are to be used liberally.

7. The contractor shall document this activity using accepted I.H.S. counseling codes according to Service Unit policy and procedures.

G. The contractor’s employee(s) shall participate in training and competency activities including:

1. Annual safety and infection control

2. Other mandatory training as assigned.

H. The contractor’s employee(s) shall provide the following support services:

1. Supply Management – The contractor shall be responsible for maintaining adequate pharmaceutical supplies following hospital procedure. Drugs will include only those on the Service Unit Formulary. “Samples” will not be used, and non-formulary drug requests will be handled via the Service Unit Policy and Procedure Manual.

2. Drug Information – Drug information will be provided by the contractor upon request or when he perceives a need for additional information.

3. Quality Assurance – The contractor shall participate in all clinic quality assurance activities with special emphasis on quality of pharmaceutical care and utilization.

To enable the facility to meet and maintain compliance with all JCAHO, IHS, CMS, APhA, and applicable ASHP standards.

4. Primary Care – The contractor utilizing protocols can provide primary care to selected patients on chronic medication or requiring medication for acute illness.

II. SHIFTS: Contractor’s employee(s) will be expected to abide by the facility’s Uniform Code and shift hour assigned, modalities of charting and care delivery and other rules and regulations of the facility. The contractor shall provide coverage that is needed to meet the needs of the program to maintain safe patient care.

Hours needed to cover emergency leave, vacancies, and other staff shortages:

Monday through Friday 8 am to 4:30 pm with 30 minute lunch.

III. CONTRACTOR MINIMUM REQUIREMENTS/QUALIFICATIONS:

1. Each licensed Pharmacist shall present an original current license when reporting to the Tohatchi

Health Center Pharmacy Department for duty or for orientation whichever comes first. A copy is required for the contract file. No reimbursement will be made for Pharmacists who report to work with an expired license or a license that is not in good standing.

2. All contractor must provide copy of resume for file. Contractor file will be kept by the Pharmacy Department Office for verification of license; also file will contain continuing education, competency assessments, awards, and any disciplinary actions.

3. Contractor is subject to a character investigation in the performance of the contract in accordance with P.L. 101-630, Indian child protection and Family Violence Act of 1990.

4. Contractor is responsible for his/her own reliable transportation, travel and per diem expenses in the performance of this contract.

5. Contractor is responsible for maintaining satisfactory standard of competence, conduct, appearance and integrity. The quality of work performance of the contractor shall be subject to review.

6. Contractor shall abide by the Service Units Standard of Conduct and policies and procedures.

7. Contractor is responsible for notifying the Chief Pharmacist or designee, if he/she will be late or will be unable to work due to illness or any other reason.

8. Contractor is compensated only for hours actually worked at the agreed rate. Contractors who become sick while on duty will seek medical care from their own private physician, unless contractor is eligible to receive health care from Indian Health Service.

9. Contractor is responsible for completing time sheets for actual hours worked and faxing to vendor.

IV. OTHER CONTRACTOR RESPONSIBILITY FACTORS

The Contractor may be an individual, group or organization in which a qualified provider providing services meets the stated qualification requirements described herein.

Pursuant to the Public Law (PL) 101-630, Indian Child Protection and Family Violence Prevention Act and Public Law (PL) 101-647, Crime Control Act, the Contractor shall be responsible for completion of all applications and forms required for the purpose of a background character investigation. If the Contractor is a group practice, all professionals scheduled to provide services at the designated IHS facility are required to complete the appropriate forms. The Contractor shall be required to schedule an appointment with the GIMC Human Resource (HR) Staff Coordinator for completing the forms and for fingerprinting.

The Contractor shall provide services in such a manner as to meet the highest standards of professional ethics and conduct particularly in regard to confidentiality and patient rights. If at any time during the term of the contract, the Government suspect's unprofessional behavior and practices, the Contractor will be contacted and requested to take appropriate action in accordance with applicable Federal Acquisition Regulations (FAR).

The Contractor shall be proficient in writing, typing and have a basic working knowledge and understanding of computer hardware and software.

The Privacy Act of 1974 mandates that the Contractor shall maintain complete confidentiality of all administrative, medical and personnel records and all other pertinent information that comes to his/her attention or knowledge. The Privacy Act carries both civil and criminal penalties for unlawful disclosure of records. Violations of such confidentiality shall be cause for immediate termination of the contract. The IHS shall provide training on the Freedom of Information (as Amended) and the Privacy Act. All IHS regulations and policies applicable to these acts shall be enforced. The Contractor shall not serve as an “expert witness” in any suit against the Federal Government.

The Contractor shall comply with all IHS facility infection control and safety procedures, and standards.

The Contractor shall provide for the consistent performance of patient care process according to the standards of The Joint Commission (TJC), Centers for Medicare Services (CMS) who supplies accreditation to the Navajo Area Indian Health Service hospitals and health centers. These standards shall include: The Comprehensive Accreditation Manual for Hospitals and Ambulatory Care Standards, as they represent the scope of services of this contract.

The Contractor shall assist and provide services and duties as may be requested for normal operational requirements for the department and personnel. The Contractor shall provide work that is consistent with the guidelines and procedures of the IHS. Failure of the contractor to meet these standards can result in the cancellation of the contract.

The contractor shall have sufficient knowledge, competence and experience in providing these services on a regular scheduled clinic in the Gallup Indian Medical Center. The Contractor shall possess sufficient initiative, interpersonal relationship skills, social sensitivity and appropriate professional behavior such that the contractor can relate constructively to IHS employees, contractors, GIMC patients, clients and individuals from the Native American Community.

If appropriate and necessary, the contractor shall provide recommendation to the Supervisor on better improving and enhancing the program environment and delivery of services. The Contractor shall inform the COR, Contracting Officer or Program Manager or their designated representative of any problems encountered or which may be encountered in connection with meeting the needs of the contractor’s duties.

The Contractor shall maintain acceptable standards of personal hygiene and grooming such that their image as a Federal contract employee is compatible with the expectations of the IHS staff.

The Contractor shall be required to utilize the Electronic Health Record for chart documentation, and process medication orders within RPMS after receiving required training.

V. PRICING SCHEDULE:

The unit price paid to the Contractor shall be considered as payment in full for services provided under this award. In no way, unless directed by the IHS, shall any provider attempt to bill or collect from any IHS patient, or from any alternate resource for which the patient may be eligible, any monies for services provided under this award.

Hourly fixed rate shall be inclusive of all the following rates: holiday; week nights; weekends, call back, all city, state, federal and local taxes and all associated rates with the provision of services and overtime must be priced out separately. The Government will pay one flat rate.

Contractor shall be paid only for actual time services are performed under the terms of the contract at the hourly fixed rate (one flat rate). There is no provision for overtime, holiday, nights, weekend or call services.

Item No. Description of Service Estimated Hours per

Year 1 Pharmacist 1040

VI. CLIENT BACKGROUND

Some of the IHS patients receiving services under this contract may only speak a native language or Spanish or may have limited comprehension of the English language, and/or may reside on a Native American Indian Reservation. The Contractor is expected to demonstrate sensitivity to cross-cultural and language difference and have the ability to work through interpreters as necessary.

Consideration must be given to potentially limited transportation and/or home environment facilities. GIMC shall provide translators when needed.

VII. CONTRACTOR CREDENTIALS

At the time of services requested the contractor shall provide a list of qualified candidates and the following documents per candidate:

1. Current Resume or C.V

2. OMB NO 0917, Addendum to Declaration of Federal Employment (OF-306)

3. College Transcripts; conferred degrees and certified training in the field.

4. Two (2) letter of reference from current or previous employers.

5. Past Work Performance Statement, applicants must describe their present/previous experiences in this field.

6. Credentialing documents and degree conferred.

7. Copy of active unrestricted Pharmacist License.

8. Certificate of Immunizations.

9. Child Care Form, Addendum OMB Approved Form-2012

VIII. PERIOD OF PERFORMANCE:

Performance of this contract shall begin on date agreed upon after award for a 6-month period of a base with one (1) 6-month option.

IX. PERFORMANCE CONDITIONS:

The COR will submit schedules of required coverage a minimum of 15 calendar days prior to the first day of coverage requested.

In the event the Contractor’s employee is unable to render service on a previously agreed schedule, the Contractor shall provide a minimum seventy-two (72) hour notification to the COR. The Contractor shall then make a full, good-faith effort to provide coverage with a replacement.

Both parties recognize that on occasion there shall be a need to fill coverage requests with less than a 15-day notice. In such an emergency scheduling situation, the Contractor shall make a full, good-faith effort to accommodate the emergency request. If the Contractor is unable to meet the emergency scheduling request, they shall immediately notify the COR and those involved in scheduling.

X. ACCOUNTABILITY:

Time and attendance logs or sign-in/sign-out sheets shall be kept on file and verified by the supervisor that services called for under the contract have been rendered.

XI. CONTRACTING OFFICER RESPONSIBILITY:

The Contracting Officer is the only person delegated the authority to negotiate changes in terms, conditions, or amounts cited in this contract.

XII. CONDITIONS FOR REMOVAL/REPLACEMENT OF MEDICAL PERSONNEL:

As mutually agreed between the Contracting Officer and the Contractor there may be grounds for removal and/or replacement of a medical personnel.

The Contractor’s employee shall be removed from an IHS facility if services are not performed in accordance with terms and conditions of this award, and/or the Contractor’s VA/FSS contract.

Contractor shall relieve contracted staff from the Tohatchi Health Center Pharmacy, from time to time on an as needed basis and relief must be available within 24 hour notice.

XIII. CONTRACTING OFFICER REPRESENTATIVE (COR):

The Contracting Officer will designate in writing a COR who shall be responsible for:

1. Monitoring the Contractor’s technical progress, including the surveillance and assessment of performance and recommending to the Contracting Officer, changes in requirements;

2. Interpreting scope of work;

3. Performing technical evaluations required;

4. Performing technical inspections and acceptances required by this contract;

5. Monitoring funds available for obligation under this contract;

6. The resolution of technical problems encountered during performance of this contract;

In no event is the COR empowered to change any of the terms and conditions of the contract.

Changes in the scope of work, contract price, quantity, and quality or delivery schedule shall be made only by the Contracting Officer by a properly exercised modification.

The designation of a COR does not authorize or provide a legal right to change any kind of contractual terms regardless of the Contractor’s apparent difficulties in fulfilling contract requirements.

XIV. PAYMENT AND INVOICING:

a. Invoices shall be prepared IAW 352.232-71 Electronic Submission of Payment Requests (FEB 2022)

XV. BACKGROUND CHECK:

Contractor’s employees are not able to work a scheduled shift until the security check is performed and clearance has been obtained by the appropriate agency. At a minimum fingerprints are required and upon clearance at this stage a Contractor’s may work a scheduled shift. However, Contractors are required to complete the detailed background application and is to be completed within 30 days once the Contractor’s employee has been given access.

All Pharmacist(s) Contractors’ are subject to criminal background check prior to performing services in accordance with the contract terms and conditions. The Contractor shall ensure that each of their Pharmacist provider complete the, Certification of Criminal History and Background Check Packet. The completed forms are to be returned to the COR. Additional Background Check packets can be obtained through the COR. Contractors (and their employees) requiring routine, long-term access (i.e., greater than 6 months) to IHS facilities and/or systems; or providing services to children under 18 year of age are subject to criminal background checks prior to performing services. The Contractor shall ensure that each employee(s) complete the Certification of Criminal History and Background Check Packets to initiate the Child & Youth Services National Agency Check with Inquiries (CNACI). The COR is responsible for providing the Contractor with all necessary background check forms. The COR is also responsible for ensuring all background check forms are fully completed and processed prior to commencement of service. The

Contractor shall return all completed forms to the Gallup Service Unit Human Resource Office (GSU-HR).

Contractors may be directed to the e-QIP website to complete the necessary background investigation forms online. All contractors (or their employees) must appear in person to IHS (or an IHS facility) with two acceptable forms of identity; fingerprints will be taken electronically, or on paper, at this time. This must occur prior to the first date of service (realistically allow a 14-30 day processing time before the actual start date). At a minimum, if results are not received within 5 days, the identity credentials can be issued based on a favorable FBI National Criminal History Check (fingerprint check). Note: These timeframes are based on complete and acceptable package, including legible fingerprints.

FOR MORE INFORMATION ON SECURITY REQUIREMENTS PLEASE REFER TO DHHS SITE:

http://intranet.hhs.gov/pivcard/brochure.html

XVI. CHILD CARE NATIONAL AGENCY CHECK & INVESTIGATION (CNACI):

In accordance with the Child Care National Agency Check and Investigation (CNACI) directive, implemented by the IHS, the following documents will be required from the Contractor and all employees they utilize under this awarded contract:

1. DHHS Application Background Survey.

2. DHHS/IHS Required Application Questionnaire for Child Care Positions.

3. IHS – Release of Personal Information.

4. SF-85 Questionnaire for Non-Sensitive Positions.

5. GSA Form 176 – Statement of Personal History.

6. FD-258 Federal Bureau of Investigation Fingerprint Analysis Chart A Contractor whose duties and responsibilities involve regular contract or control over children is subject to a character investigation as required by Public Law 101-630, the Indian Child Protection and Family Violence Prevention Act. The IHS Service Unit conducts these investigations following contract award. The Character investigation may be waived if, in the judgment of the Contracting Officer, in consultation with the Human Resource Officer, an investigation has already been conducted and is on file. Until the character investigation has been completed and the Contracting Officer notified of the results, the Contractor must not have unsupervised contact with the Indian Children

XVII. SECURITY:

The Contractor shall abide by the following Security Standards that are required for the position:

Federal Security Identification Badge Request: It is the responsibility for the department to provide the necessary clearances to the IHS computer system as well as other security requirements needed for the Contractor to perform their dutie http://intranet.hhs.gov/pivcard/brochure.html