Performance Work Statement (Updated Draft).docx

PERFORMANCE WORK STATEMENT | Certified Nurse-Midwife Services | Rosebud IHS Hospital

PERFORMANCE WORK STATEMENT | Advanced Practice Provider (APP) Services | Rosebud IHS Hospital Performance Work Statement for Rosebud Outpatient Primary Care Advanced Practice Provider Services Two Physician Assistants or Nurse Practitioners at Rosebud IHS Hospital

1. BACKGROUND AND PURPOSE

The Indian Health Service (IHS) is responsible for providing federal health services to American Indians and Alaska Natives (AI/AN). The Rosebud IHS Hospital is a 35-bed comprehensive medical and surgical facility located on the Rosebud Sioux Indian Reservation in Rosebud, South Dakota. The hospital serves as the primary healthcare provider for members of the Rosebud Sioux Tribe (Sicangu Oyate) and surrounding communities — a predominantly rural and medically underserved population.

Health disparities among AI/AN populations are well-documented and include elevated rates of chronic disease, behavioral health needs, and limited access to consistent primary care. Sustained access to qualified Advanced Practice Provider (APP) services is essential to improving population health outcomes, supporting chronic disease management, and providing culturally responsive primary care on the Rosebud Reservation. This Performance Work Statement (PWS) establishes the requirements for two (2) full-time Advanced Practice Provider (APP) contractor positions either Physician Assistants (PAs) or Nurse Practitioners (NPs) to provide outpatient primary care services in the Rosebud IHS Hospital Outpatient Department (OPD) Clinic.

2. PERIOD OF PERFORMANCE

The total potential period of performance is twelve (12) months: a three (3) month base period followed by three (3) three-month option periods. The Government may exercise each option period by written notice to the Contractor in accordance with FAR 52.217-9. Exercise of an option is contingent upon continued Government need, satisfactory Contractor performance, availability of funds, and Contracting Officer approval.

3. SCOPE OF WORK

The Contractor shall provide professional Advanced Practice Provider (APP) services consistent with the published competencies and standards of practice of the National Commission on Certification of Physician Assistants (NCCPA) and the American Academy of Physician Associates (AAPA) for Physician Assistants, and the American Association of Nurse Practitioners (AANP) and American Nurses Credentialing Center (ANCC) for Nurse Practitioners; IHS clinical policies; applicable South Dakota state licensure requirements; and Rosebud IHS Hospital medical staff bylaws and credentialing standards. This is a non-personal services contract. The Contractor is an independent contractor responsible for managing its own personnel and shall not be subject to the supervision or control of Government employees in the day-to-day performance of work. The Government retains the right to evaluate the quality, timeliness, and completeness of services delivered against the performance standards set forth in this PWS.

Services shall be delivered in the following setting:

1. Outpatient Department (OPD) Clinic — scheduled clinic sessions for adult and pediatric primary care, chronic disease management, preventive services, and acute outpatient visits.

The Contractor's APP personnel shall adhere to the clinical protocols, credentialing requirements, and collaborative practice framework established by the Rosebud IHS Hospital medical staff bylaws and credentialing committee. Such adherence reflects the professional standard of care and facility access requirements and does not constitute employer-employee supervision by the Government.

4. SPECIFIC TASKS AND DELIVERABLES

4.1 Outpatient Clinic Services

Each assigned APP shall provide the following services during scheduled OPD clinic hours, generally Monday through Friday consistent with facility operating hours and Section 6.

4.1.1 Adult Primary Care

· Conduct comprehensive new-patient intake visits, including detailed medical, surgical, family, social, and medication history; complete physical examination; and review of systems.

· Develop individualized primary care plans in accordance with current nationally recognized evidence-based clinical practice guidelines and applicable IHS clinical policies.

· Perform routine adult primary care visits: vital signs review, focused physical assessment, medication reconciliation, problem-list management, and care plan adjustment.

· Order and interpret routine primary care laboratory and diagnostic studies, including but not limited to: complete blood count (CBC), comprehensive metabolic panel (CMP), lipid panel, hemoglobin A1c, thyroid-stimulating hormone (TSH), urinalysis, hepatitis screening, HIV, STI panels, and age-appropriate cancer screening tests.

· Diagnose and manage common chronic conditions including hypertension, type 2 diabetes mellitus, hyperlipidemia, asthma, COPD, hypothyroidism, depression, and anxiety, with timely physician consultation or referral for conditions exceeding APP scope of practice.

· Screen for intimate partner violence (IPV), substance use disorders, and behavioral health concerns using validated screening tools (e.g., PHQ-9, GAD-7, AUDIT-C); initiate appropriate referrals to behavioral health and social services.

· Provide patient education on chronic disease self-management, nutrition, physical activity, tobacco cessation, medication adherence, and preventive care.

· Facilitate and document referrals to specialty care, ancillary services, and care coordination resources as clinically indicated.

4.1.2 Pediatric and Adolescent Care

· Perform well-child examinations consistent with the AAP/Bright Futures periodicity schedule, including developmental and behavioral screening.

· Administer and document childhood and adolescent immunizations in accordance with the current ACIP/CDC immunization schedule.

· Diagnose and manage common acute pediatric conditions including upper respiratory infections, otitis media, pharyngitis, asthma exacerbations, gastroenteritis, dermatologic complaints, and minor injuries, within the APP’s scope of practice.

· Manage common chronic pediatric conditions (e.g., asthma, allergic rhinitis, ADHD when appropriate to scope) and coordinate referral to pediatric subspecialty care as clinically indicated.

· Conduct adolescent confidential preventive visits, including risk-behavior screening (HEEADSSS), reproductive health counseling, and behavioral health screening.

· Provide anticipatory guidance to caregivers on nutrition, sleep, safety, school performance, and developmental expectations.

4.1.3 Preventive and Wellness Services

· Perform age- and risk-appropriate preventive examinations consistent with current nationally recognized evidence-based preventive care recommendations.

· Order and interpret evidence-based screening tests including, but not limited to, colorectal cancer screening, cervical cancer screening (per ASCCP guidelines), breast cancer screening referral, lung cancer screening for eligible patients, and abdominal aortic aneurysm screening.

· Administer and document adult immunizations in accordance with current ACIP guidelines (e.g., influenza, Tdap, pneumococcal, shingles, hepatitis B, COVID-19).

· Provide tobacco-cessation, alcohol-misuse, and substance-use counseling and referrals consistent with USPSTF and SAMHSA guidance.

· Coordinate care for patients with multiple comorbidities, including documentation in the patient’s problem list and care plan.

4.1.4 Acute Outpatient Care and Minor Procedures

· Evaluate and manage acute outpatient complaints presenting during clinic hours, including upper respiratory infections, urinary tract infections, skin and soft tissue infections, sprains and strains, and uncomplicated musculoskeletal pain.

· Perform minor outpatient procedures consistent with APP scope, training, and facility privileges (e.g., simple laceration repair, incision and drainage of superficial abscesses, cerumen removal, removal of skin lesions, joint injections, and toenail procedures) per facility policy.

· Provide point-of-care testing as available (e.g., rapid strep, rapid influenza, rapid COVID-19, urinalysis, glucose) and interpret results.

· Identify patients whose acute presentation exceeds APP scope or facility outpatient capability, and arrange timely referral to a higher level of care or appropriate specialty consultation.

· Coordinate prescription management, including controlled substance prescribing within APP scope, DEA authority, and facility policy.

· Document all acute care encounters in the Government electronic health record within twenty-four (24) hours of the patient encounter unless otherwise authorized by applicable medical staff bylaws or facility policy.

4.2 Documentation and Health Records

· Complete documentation of all patient encounters, assessments, diagnoses, orders, and care plans in the Government electronic health record (RPMS/EHR or successor system) within twenty-four (24) hours of the patient encounter unless otherwise authorized by applicable medical staff bylaws or facility policy.

· Complete required IHS performance measure documentation, including Government Performance and Results Act (GPRA) clinical measures applicable to outpatient primary care (e.g., diabetes care, hypertension control, cancer screening, tobacco use screening, immunizations, and behavioral health screening).

· Maintain accurate and legible medical records in compliance with IHS medical records standards, Joint Commission standards (if applicable), and applicable federal regulations.

· Utilize CPT and ICD-10-CM coding accurately for all encounters to support billing and reporting requirements.

4.3 Coordination and Communication

· Participate in multidisciplinary meetings, case conferences, and clinical huddles as necessary to coordinate patient care, maintain continuity of services, support credentialing requirements, and participate in quality improvement activities.

· Communicate effectively with consulting physicians, nursing staff, social workers, behavioral health providers, and other members of the patient care team.

· Maintain collaborative practice relationships consistent with AAPA and AANP professional practice standards and Rosebud IHS Hospital medical staff bylaws.

· Complete all facility access, patient safety, privacy, information security, infection prevention, and system-access training necessary to perform the requirements of this contract and maintain clinical privileges.

4.4 Quality Improvement

· Participate in facility quality improvement (QI) initiatives, peer review, and morbidity and mortality (M&M) review processes related to outpatient primary care services.

· Contribute to development and review of clinical protocols and standing orders relevant to APP primary care practice areas.

· Monitor and support achievement of IHS GPRA clinical performance metrics pertaining to chronic disease management (diabetes, hypertension), cancer screening, immunizations, behavioral health screening, and tobacco-use screening and cessation.

5. MINIMUM QUALIFICATIONS AND PERSONNEL REQUIREMENTS

All APP Contractor personnel assigned to perform services under this contract shall meet the following requirements at all times during the period of performance, consistent with the personnel’s applicable provider type (Physician Assistant or Nurse Practitioner):

5.1 Education

· For Physician Assistants: Graduation from a Physician Assistant education program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA).

· For Nurse Practitioners: Graduation from a Nurse Practitioner education program accredited by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN), with possession of a Master of Science in Nursing (MSN), Doctor of Nursing Practice (DNP), or equivalent graduate or higher-level degree from an accredited institution, consistent with OPM GS-0610 qualification standards. PA candidates shall hold a master’s degree from an ARC-PA accredited program consistent with OPM GS-0603 qualification standards.

5.2 Certification

· Current, valid national certification appropriate to the APP role: Physician Assistants must hold current PA-C certification issued by the National Commission on Certification of Physician Assistants (NCCPA). Nurse Practitioners must hold current national certification in the appropriate population focus (e.g., FNP, AGNP) issued by the American Nurses Credentialing Center (ANCC) or the American Academy of Nurse Practitioners Certification Board (AANPCB). Certification must remain active and unencumbered throughout the period of performance.

5.3 Licensure

· Current, active, unrestricted license to practice as a Physician Assistant or Nurse Practitioner, as applicable, issued by any State, the District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States. Licensure shall remain current and unrestricted throughout the period of performance.

· Prescriptive authority consistent with South Dakota law; DEA registration (Schedule II–V) required.

5.4 Required Certifications and Competencies

· Current Basic Life Support (BLS) certification — American Heart Association (AHA) or equivalent.

· Completion of or willingness to complete facility-required training in: chronic disease management protocols, opioid-stewardship and controlled substance prescribing, behavioral health screening tools (PHQ-9, GAD-7, AUDIT-C), and IHS GPRA clinical performance measures.

5.5 Experience

Consistent with OPM grade-level qualification criteria for the applicable APP role (GS-0603 for Physician Assistants; GS-0610 for Nurse Practitioners):

· GS-12 equivalent: At least one (1) year of professional APP clinical experience equivalent to the GS-11 level, demonstrating progressive responsibility in outpatient primary care across the lifespan.

· GS-13 equivalent: At least one (1) year of professional APP clinical experience equivalent to the GS-12 level, including demonstrated competence in management of patients with multiple chronic conditions, performance of common outpatient procedures, and independent clinical decision-making.

· Experience in federally qualified health centers (FQHCs), Indian Health Service facilities, or other rural or underserved community settings is strongly preferred.

· Demonstrated familiarity with AI/AN health disparities, cultural competency in care delivery to Native American populations, and commitment to patient-centered, culturally respectful care.

5.6 IHS Credentialing and Privileging

· All APP Contractors shall complete and maintain IHS credentialing and privileging requirements prior to providing patient care, in accordance with IHS credentialing policy (IHS Manual Chapter 3-1.3).

· Contractor shall cooperate fully with the Rosebud IHS Hospital credentials committee and provide all required documentation, including but not limited to: proof of education, NCCPA or ANCC/AANPCB certification (as applicable), state licensure, malpractice insurance certificate, DEA registration, BLS/ACLS/PALS cards as applicable, and professional references.

5.7 Background Investigation

· Each APP Contractor shall undergo a suitability/background investigation as required for federal healthcare workers providing direct patient care in IHS facilities, consistent with 45 CFR Part 5 and IHS policy.

· Contractor shall not begin patient care services until a favorable preliminary background determination has been received.

5.8 Health Requirements

1. MMR (Measles, Mumps, Rubella):

· EITHER: 2 documented MMR vaccines

· OR: Positive antibody titers for each (Measles, Mumps, and Rubella)

· OR: 2 separate live vaccines for Measles and Mumps, plus 1 Rubella vaccine

2. Varicella (Chickenpox):

· EITHER: 2 documented varicella vaccines

· OR: A positive varicella antibody titer

· OR: Physician-documented diagnosis of previous infection

3. Tetanus, Diphtheria, and Pertussis (Tdap):

· Documentation of a Tdap vaccine at some point in the past

· AND a tetanus-containing vaccine (Td or Tdap) within the last 10 years

4. Hepatitis B:

· EITHER: 3 documented Hepatitis B vaccinations

· OR: A positive Hepatitis B surface antibody titer

· OR: A signed declination form if you choose not to receive the vaccine

5. Tuberculosis (TB):

· EITHER: 2 negative TB skin tests (done within the last 12 months)

· OR: 1 negative IGRA blood test (done within the last 12 months)

· If you have a history of a positive TB test or IGRA:

Provide a chest X-ray report dated within the last 5 years Include dates of TB treatment, if applicable

6. Influenza (Flu) Vaccine:

· Required annually

· If your start date is before October 31, the vaccine will be administered on site

· If your start date is after October 31, provide written proof of vaccination

7. COVID-19 Vaccination:

· Documentation of COVID-19 vaccination is required

6. PLACE AND HOURS OF PERFORMANCE

6.1 Clinic Hours

Services shall be performed at the Rosebud IHS Hospital Outpatient Department Clinic, located at 800 Hospital Drive, Rosebud, SD 57570. Standard clinic hours are Monday through Friday, 8:00 AM to 5:00 PM, excluding federal holidays. The Contractor shall coordinate specific daily schedules in writing with the Clinical Director or designee and the COR. Schedules may be adjusted by mutual written agreement to meet operational needs.

6.2 Federal Holidays

APP personnel are not generally required to provide clinic services on federal holidays. Any scheduled clinic services on a federal holiday shall be agreed in advance in writing by the Contractor, the COR, and the Clinical Director or designee.

7. GOVERNMENT-FURNISHED PROPERTY AND INFORMATION

The Government shall provide the following at no cost to the Contractor:

· Clinical workspace, examination rooms, and equipment within the OPD clinic adequate for APP practice.

· Access to the IHS electronic health record system (RPMS/EHR or successor) and related clinical information systems, including necessary training.

· Laboratory services, diagnostic imaging, and pharmacy support consistent with Rosebud IHS Hospital capabilities.

· Medical supplies, medications, and equipment available in the OPD clinic for performance of patient care duties.

· Access to IHS clinical policies, standing orders, clinical protocols, and applicable Indian Health Manual (IHM) chapters.

· Office space, telephone, and secure computer access necessary to perform administrative and documentation functions.

· Required IHS mandatory training materials and computer-based training (CBT) modules.

8. CONTRACTOR RESPONSIBILITIES

· Provide professional APP services of the highest quality, consistent with the standard of care applicable to the APP’s credential (Physician Assistant or Nurse Practitioner) in outpatient primary care.

· Maintain all required licenses and national certifications (NCCPA for PAs; ANCC or AANPCB for NPs) in good standing throughout the period of performance and notify the COR immediately of any change, lapse, investigation, restriction, or adverse action affecting licensure or certification.

· Maintain professional malpractice liability insurance at levels consistent with IHS policy and South Dakota requirements; provide certificate of insurance to the COR prior to commencement of services and upon renewal.

· Adhere to all IHS policies, Rosebud IHS Hospital medical staff bylaws, clinical protocols, patient safety standards, HIPAA privacy and security requirements, and applicable federal regulations.

· Maintain patient confidentiality at all times and comply with 45 CFR Parts 160 and 164 (HIPAA).

· Report adverse patient events, near misses, and sentinel events through the IHS ISTAR Reporting System in accordance with facility policy.

· Comply with the Indian Child Protection and Family Violence Prevention Act (25 U.S.C. § 3201 et seq.) requirements, including mandatory reporting of child abuse and neglect.

· Complete all required IHS mandatory training within the timeframes specified by IHS.

9. CONTRACTOR MANAGEMENT AND NON-PERSONAL SERVICES

This is a non-personal services contract in accordance with FAR 37.101. The Contractor shall be solely responsible for managing, supervising, and directing its own personnel. Government employees shall not exercise any supervision or control over Contractor personnel in the manner of work performance, work hours, or methods of accomplishment.

To avoid the creation of an unauthorized personal services relationship, the following shall apply:

· Government personnel shall communicate requirements and evaluate results through the Contracting Officer's Representative (COR), not through direct supervision of individual APP personnel.

· The Contractor shall designate a point of contact responsible for day-to-day coordination with the COR.

· Scheduling of clinic sessions shall be proposed by the Contractor and agreed upon in writing with the Clinical Director/Designee and COR in advance of each performance period.

· Government employees shall not assign additional tasks to Contractor personnel outside the scope of this PWS.

Consultation and collaboration with IHS physicians and clinical staff required by clinical protocols, credentialing bylaws, or standard of care (e.g., physician referral for cases exceeding APP scope of practice) reflects professional practice norms and does not constitute Government supervision of Contractor personnel for purposes of FAR 37.104 (and any applicable agency Revolutionary FAR Overhaul (RFO) Class Deviation in effect).

10. MONTH-OF-SERVICE AND INVOICING REQUIREMENTS

10.1 Month-of-Service Standard

One (1) Month of Service (MOS) consists of complete performance for the applicable contract month, including provision of two (2) qualified and credentialed APPs; scheduled outpatient clinic services; clinical documentation; care coordination; and all other requirements of this PWS. The Contractor shall manage staffing and other resources necessary to satisfy these requirements for the firm-fixed monthly price. Clinic activity may be tracked for scheduling, workload analysis, quality assurance, and performance surveillance, but shall not serve as the basis for invoice payment.

10.2 Invoicing Requirements

Invoices shall be submitted monthly and identify the contract number, applicable task order (if any), contract line item number (CLIN), month and billing period, firm-fixed monthly MOS amount billed, cumulative Months of Service and contract value invoiced, and Contractor point of contact. Unless otherwise specified in the resulting contract, invoices shall be submitted no later than the tenth (10th) calendar day following the billing month. The Monthly Contract Utilization Report required by Section 12.1 shall accompany each invoice.

Invoices may be submitted only for services satisfactorily performed and accepted by the Government. The Contractor shall not invoice based on actual labor hours unless specifically authorized by a written contract modification signed by the Contracting Officer. Payment shall be made in accordance with the applicable payment clauses and the Prompt Payment Act.

11. PERFORMANCE STANDARDS

The following standards govern the services in this PWS. The companion Government Quality Assurance Surveillance Plan describes how the COR will document and assess performance; it does not alter the contract requirements.

12. CONTRACT VALUE AND UTILIZATION MONITORING

12.1 Monthly Contract Utilization Report

The Contractor shall submit a Monthly Contract Utilization Report to the COR no later than the tenth (10th) calendar day following each contract month. The report shall state contract number and applicable CLIN; the performance period and Month of Service; the firm-fixed monthly price; the authorized value for that period; current and cumulative amounts invoiced; the percentage invoiced and value remaining; completed and remaining Months of Service; the status of pending, unpaid, rejected, or unsubmitted invoices; and any staffing, scheduling, credentialing, privileging, or performance issue affecting continued service.

Clinic activity and labor-hour information, if maintained, shall be used only for workload monitoring, performance surveillance, quality assurance, and contract administration. Such information shall not serve as the basis for invoice payment under the firm-fixed-price Month-of-Service contract. Only the Contracting Officer may modify contract price, scope, or period of performance.

12.2 Sixty Percent (60%) Contract Value Threshold Notification The Contractor shall notify the COR and Contracting Officer in writing within five (5) calendar days after determining that cumulative amounts invoiced for an applicable performance period have reached, or are reasonably projected to reach, sixty percent (60%) of the authorized value for that period. Each notice shall identify the contract number, CLIN, and performance period; authorized value; cumulative amount and percentage invoiced; remaining value; completed and remaining Months of Service; pending invoices; anticipated performance issues; and any need for Contracting Officer action.

12.3 Additional Contract Value Threshold Notifications

The Contractor shall provide the same written notification to the COR and Contracting Officer upon reaching, or reasonably projecting, eighty percent (80%) and ninety percent (90%) of the authorized value for the applicable performance period, within the timeline established in Section 12.2. A threshold notification does not authorize additional work, an increase in contract value, or an extension of the period of performance.

12.4 Workload and Service Activity Reporting

The Contractor shall maintain records sufficient to demonstrate performance during each Month of Service. For contract administration, the Government may request a report of scheduled clinic coverage and missed sessions; APP staffing and credential status; service interruptions or replacement personnel; status of clinical documentation and mandatory training; and corrective actions or unresolved deficiencies. Such activity information is for performance monitoring and shall not establish hourly payment.

12.5 Government Acceptance of Month of Service

The Government will accept a Month of Service upon verification that the Contractor furnished the required APP staffing and scheduled clinic coverage; maintained required credentials and privileges; completed documentation; complied with applicable privacy, security, patient-safety, and professional standards; and otherwise satisfied this PWS for the month. If a material portion of required services is missing or nonconforming, the Government may exercise rights and remedies under the resulting contract.

12.6 Service Interruptions and Corrective Action

The Contractor shall promptly notify the COR of an anticipated or actual service interruption affecting outpatient coverage or continuity of patient care. The Contractor remains responsible for qualified replacement personnel and required service coverage. Upon Government request, the Contractor shall provide a corrective-action response identifying the issue, action taken or planned, responsible personnel, completion timeline, and recurrence prevention measures. These reporting and corrective-action requirements do not alter the firm-fixed-price Month-of-Service structure.

13. APPLICABLE REGULATIONS AND REFERENCES

· Indian Health Service — Indian Health Manual (IHM), Part 3, Chapter 3-1.3 (Credentialing and Privileging)

· OPM GS-0603 Physician Assistant Series and OPM GS-0610 Nurse Series Position Classification Standards (current revisions)

· OPM Qualification Standards for the Physician Assistant Series (GS-0603) and the Nurse Series (GS-0610), Advanced Practice Nurse

· OPM Professional Work in the Medical and Healthcare Group, 0600 (September 2017)

· AAPA Competencies for the Physician Assistant Profession (current edition)

· AANP Standards of Practice for Nurse Practitioners (current edition) and ANCC NP Certification Standards

· South Dakota Codified Law Title 36, Chapter 36-4A (Physician Assistants) and Chapter 36-9 / 36-9A (Nurse Practice Act / Advanced Practice Nursing)

· 45 CFR Parts 160 and 164 (HIPAA Privacy and Security Rules)

· 25 U.S.C. § 3201 et seq. (Indian Child Protection and Family Violence Prevention Act)

· FAR Part 37 — Service Contracting, including any agency Revolutionary FAR Overhaul (RFO) Class Deviation in effect (e.g., GSA Class Deviation RFO-2025-37 and applicable HHS/IHS deviations)

· FAR 37.101 (Definitions) and FAR 37.103 (Contracting Officer Responsibility), as applied through the agency’s current FAR Part 37 RFO Class Deviation

· IHS Great Plains Area — applicable area office policies and clinical standards

· FAR Part 12 – Acquisition of Commercial Products and Commercial Services

· FAR 52.212-4, Contract Terms and Conditions—Commercial Products and Commercial Services

· FAR 52.217-9, Option to Extend the Term of the Contract

· FAR 37.104, Personal Services Contracts

14. APPROVAL AND CERTIFICATION

This Performance Work Statement has been reviewed and approved by the undersigned.

PWS ADDENDUM

1. Authority

PWS 2