PROPOSED PERFORMANCE WORK STATEMENT.pdf

Chinle Comprehensive Health Care Facility Performance Work Statement (PWS) for Nonpersonal Services

ON-SITE NEPHROLOGY PHYSICIAN/SPECIALTY CLINIC SERVICES

Table of Contents

Section Page

1.0 General 1-2

2.0 Definitions 3-4

3.0 Government Furnished Information, Property, & Services 5

4.0 Key Personnel Furnished Property 5

5.0 Performance-Based Requirements: Contractor’s Responsibilities 6-7

6.0 Performance-Based Requirements: Key Personnel’s Responsibilities 8-10

7.0 Key Personnel’s Qualification Requirements 11-12

8.0 Challenges to Conflicts 12

9.0 Performance-Based Matrix: Contractor 13-14

10.0 Performance-Based Matrix: Key Personnel 15-16

11.0 List of Attachments and Exhibits 17

PWS NO. CSU-26-01-NEPH 06 APR 2026

Chinle Comprehensive Health Care Facility Performance Work Statement (PWS) for Nonpersonal Services

ON-SITE NEPHROLOGY PHYSICIAN/SPECIALTY CLINIC SERVICES

1.0 General: This performance work statement describes the requirements for a Non-Personal services On-Site Nephrology Physician/Specialty Clinic services to support the mission of the Indian Health Service (IHS) by raising the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.

1.1 Background: The IHS, an agency within the Department of Health and Human Services, is responsible for providing federal healthcare services to American Indians and Alaska Natives. The provision of healthcare services to members of federally‐recognized tribes grew out of the special government‐to‐government relationship between the federal government and Indian tribes. The IHS is the principal federal health care provider and health advocate for American Indians and Alaska Natives, and its goal is to raise their health status to the highest possible level. The IHS provides a comprehensive health service delivery system for approximately 2.6 million American Indians and Alaska Natives who belong to 573 federally recognized tribes in 37 states.

1.1.1 Navajo Area Indian Health Service (NAIHS) administers health centers and hospitals providing health care to approximately 244,209 members of the Navajo Nation. The Navajo Nation is the largest Indian tribe in the United States and has the largest reservation, which encompasses more than 25,516 square miles in northern Arizona, western New Mexico, and southern Utah, with three satellite communities in central New Mexico. The NAIHS is the primary provider of inpatient, ambulatory care, preventive and community health, and environmental health services for members of the Navajo Nation and the San Juan Southern Paiute Tribe.

1.1.2 Chinle Comprehensive Health Care Facility (CCHCF) is centrally located in the rural and remote area of the Navajo Reservation in Chinle, Arizona. Chinle has three (3) hotels, the Best Western, Holiday Inn and Thunderbird Lodge. There are several restaurants and fast-food establishments in the area, which include Denny’s, Burger King and Church’s Chicken. Chinle has one (1) grocery store, Bashas, with the next grocery store approximately 32 miles away. The nearest towns are Gallup, NM (approximately 90 miles away) and Farmington, NM (approximately 115 miles away). These towns offer more shopping opportunities with Walmart, Safeway, Albertsons, and various box stores.

The CCHCF provides medical care for approximately 35,000 Navajos; many of our patients travel 100 miles round trip to receive care. Some of the patients do not have electricity or running water in their homes. In addition, most of our elderly patients speak only Navajo, and live according to traditional Navajo cultural practices. The CCHCF and Ambulatory Care Center is a 60-bed inpatient hospital and outpatient facility. Services offered are:

• Adult Inpatient • Labor & Delivery • Physical Therapy

• Adult Intensive Care • Mental Health • Podiatry

• Anesthesiology • Native Medicine • Public Health

• Audiology • Nurse Phone Triage Services* • Radiology

• Clinical & Community Nutrition • OB/GYN & Midwifery • Respiratory Therapy

• Dental • Occupational Therapy • School Health

• Emergency Medicine • Optometry • Speech Pathology

• General Surgery • Outpatient Primary Care • Social Services

• Integrated Behavioral Health • Pediatric Inpatient • Urgent Care

• Lab • Pharmacy • Women’s Health *Available after hours.

1.2 Scope: The Key Personnel shall provide On-Site Nephrology Physician/Specialty Clinic services in accordance with Section 6.0: Performance Based Requirements.

1.2.1 Duties and responsibilities: will encompass outpatient, On-Site Nephrology Physician/Specialty Clinic services to IHS patients.

1.2.2 Place of Performance: Services are to be perform in the Specialty Clinic Department at Chinle Comprehensive Health Care Facility, Chinle, Arizona.

1.2.3 Period of Performance: shall be flexible to allow for short term (13 weeks), long term (1-year to 3-year) and, where feasible, include intermittent support to meet unplanned needs that develop on a frequent basis.

1.3 Applicable Documents: Please see the web link listed unless document is listed as an attachment.

1.3.1 The Joint Commission http://www.jointcommission.org/

1.3.2 Centers for Medicare and Medicaid Services (CMS) Standards http://www.cms.hhs.gov/

1.3.3 Accreditation Association for Ambulatory Health Care (AAAHC) http://www.aaahc.org

1.3.4 Section 231 of Public Law 101-647, the Crime Control Act of 1990.

https://www.govinfo.gov/content/pkg/COMPS-11139/pdf/COMPS-11139.pdf

1.3.5 Section 4087 of Public Law 101-630, the Indian Child and Family Violence Act.

http://www.govinfo.gov/content/pkg/COMPS-1401/pdf/COMPS-1401.pdf

1.3.6 Health Insurance Portability and Accountability Act (HIPAA) of 1996.

http://www.hhs.gov/hipaa/index.html

1.3.7 Privacy Act of 1974 http://www.justice.gov/opcl/privacy-act-1974

1.3.8 IHS Service Unit and Health Center Policies, Procedures and Protocols.

(See section 11.0 for a list of attachments and exhibits)

1.3.9 Computer Security Act of 1987 http://csrc.nist.gov/groups/SMA/ispab/documents/csa_87.txt

1.3.10 Federal Code of Conduct https://www.ecfr.gov/current/title-5/chapter-XVI/subchapter-B/part-2635

1.3.11 IHS General Directives http://www.ihs.gov/ihm/

1.3.12 IHS Computer Security Directives https://www.ihs.gov/oit/security/lawsregspolicy/

2.0 Definitions

2.1 Acceptance: Constitutes acknowledgement that the supplies or services conform to the applicable contract quality and quantity requirements, except as provided in FAR subpart 46.5 and subject to other terms and conditions of the contract.

2.2 Approval: Acknowledgment by the designated Government official that submittals, deliverables, or administrative documents (e.g., insurance certificates, installation schedules, planned utility interruptions, etc.) conform to the contractual requirements. Government approval does not relieve the Key Personnel from responsibility for compliance with contract requirements.

2.3 Area: A defined geographical region for Indian Health Service administrative purposes. Each Area Office may administer several Service Units.

2.4 Code of Ethics: The Code of Ethics and Standard of Practice and Care as listed with the American

(Osteopathic) Board of Internal Medicine or American (Osteopathic) Board of Family Practice.

2.5 Contracting Officer (CO): A Government employee of IHS authorized and warranted to issue task orders and to make subsequent task order modification(s) under this contract. The Ordering Activity CO has the authority to make initial determinations on all matters of dispute regarding task orders.

2.6 Contractor: The organization awarded a legal binding contract to provide supplies and/or services; includes the organization’s employees.

2.7 Contracting Officer’s Representative (COR): A federal employee who assists the ordering/issuing activity or contracting officer in the administration of task orders issued under this contract. The COR is primarily responsible for the technical assistance and day-to-day program management of the ordering activity’s task orders. Ordering activities may have different designators for this employee (e.g. GTR – Government Technical Representative, COTR–Contracting Officer’s Technical Representative, or PO - Project Officer).

2.8 Cooperative Attitude: Behavior that is positive and displays a willingness to perform assigned patient care tasks and to be a team player.

2.9 Cultural Awareness: Realization and respect for American Indian and Alaska Native practices.

2.10 Customer: Patients, staff and visitors of an IHS service unit and health center.

2.11 Customer Evaluation/Input: Written comments made to the Contracting Officer regarding the Key

Personnel’s performance. This is one of the criteria used to evaluate the Key Personnel’s performance.

2.12 Dependability: Qualities of being trusted and being able to repeat the same task to yield the same result.

2.13 Federal Acquisition Regulation (FAR): The FAR is the primary regulation for use by all Federal Executive agencies in their acquisition of supplies and services with appropriated funds.

2.14 Government Vehicle: An IHS owned motor vehicle or a vehicle leased by IHS through agreements with the General Services Administration (GSA) or through commercial rental agreements.

2.15 Health Center: A facility physically separated from a hospital, with a full range of ambulatory services including at least primary care providers, nursing, laboratory, and x-ray which are available at least 40 hours a week for outpatient care.

2.16 Key Personnel: Employees of the Contractor, and any subcontractor(s), affiliates, joint venture partners, or members, and consultants engaged by any of these entities.

2.17 Non-Personal Services Contract: a contract under which the personnel rendering the services are not subject, either by the contract’s terms or by the manner of its administration, to the supervision and control usually prevailing in relationships between the Government and its employees, as defined in FAR 37.401.

2.18 Orientation: An activity designed to provide basic familiarization of the facility and transition into the On-site Specialty Clinic, Outpatient Department, IHS Service Unit and/or Health Center and the nursing unit where the services will be provided.

2.19 Past Performance Information: Relevant information regarding a contractor’s actions under previously awarded contracts. This includes the contractor’s record of conformance to specifications and to standards of good workmanship; the contractor’s record of containing and forecasting costs on any previously performed cost reimbursable contracts; the contractor’s adherence to contract schedules, including the administrative aspects of performance; the contractor’s history for reasonable and cooperative behavior and commitment to customer satisfaction; and generally, the contractor’s business-like concern for the interest of the customer.

2.20 Patient Outcome: End result of outpatient, Nephrology physician care.

2.21 Performance Based Matrix: Lists the services to be monitored and the standards to be applied.

2.22 Personal Protective Equipment (PPE): The equipment used to protect medical personnel from exposure to biological, chemical, and radioactive hazards.

2.23 Service Unit: The local administrative unit of IHS.

2.24 Standards of Practice and Standards of Care: Authoritative statements by which the medical profession describes the responsibilities for which its practitioners are accountable. The standards provide direction for professional medical practice and a framework for the evaluation of practice. The standards of professional medical practice may pertain to general or specialty practice.

2.25 Supervisor: Government employee authorized to provide verbal and written performance direction to the

Key Personnel that the Key Personnel must follow without exception.

2.26 Task Order: An order issued in accordance with the terms of the contract that details an ordering activity’s specific requirements. An ordering activity written order to obtain services, at a minimum will include the following where applicable: description of services, skill categories, hours, price, period of performance, contract number, and the ordering activities task order number.

2.27 Tour of Duty: The time of day or shift, the nephrologist is schedule to perform nephrology physician duties.

2.28 Valid Patient Complaint: Justifiable accusation made by a patient and supported by investigation.

2.29 Verifiable Emergency: An unexpected/unplanned absence by the Key Personnel requiring valid documentation to confirm the occurrence.

3.0 Government Furnished Information, Property and Services

3.1 Information: Government unique information related to this requirement, which is necessary for Key Personnel’s performance, will be made available to the Key Personnel. The Contracting Officer or designee will be the point of contact for identification of any required information to be supplied by the Government.

3.2 Joint Use by the Government and the Key Personnel: Except for the property and service listed in 3.3 and 4.0, the Government will provide, for joint use by the Government and the Key Personnel, all necessary equipment, supplies, and clinic space to perform the services under this contract.

3.2.1 Government Vehicle: If required by the position, authorization shall be in accordance with IHS

Chapter 12, Section 13 Motor Vehicle Management.

3.3 Key Personnel Exclusive Use:

3.3.1 Personal Protective Equipment (PPE). The Government shall furnish the Key Personnel with appropriate PPE other than specified in Section 4 of the Performance Work Statement. The Government shall be responsible for any repair, cleaning, and inventory required for the PPE. This does not include any type of uniform or laboratory coat.

3.3.2 The Government will provide facility specific identification badges for each Key Personnel. A minimum fee of $10.00 shall be charged for lost or destroyed badges.

3.4 Training: Facility specific orientation/training necessary for the Key Personnel to perform the required duties, e.g., IHS information technology (IT) systems and operational procedures. Training will be provided ONLY if the subject matter is necessary to improve or enhance the Key Personnel’s service or includes mandates made by the IHS Service Units/Health Centers while the Key Personnel is working under this contract. Training will not be provided for the purpose of continuing education, career development or individual development.

3.5 Inspection: All service rendered in the specialty of On-Site Nephrology Physician/Specialty Clinic services in the delivery of patient care services will be inspected, reviewed and monitored by Donald Miles, MD, Acting Primary Care Director or designee for this order.

3.5.1 Contracting Officer Representative (COR): Alfreda Lee is primarily responsible for monitoring the technical progress including surveillance and assessment of performance for this order.

3.5.2 Points of Contact: Alfreda Lee, (928) 674-7017, and Georgina Nez, (928) 674-7450 are the points of contacts for this requirement.

4.0 Key Personnel Furnished Property

4.1 Except for the property specified in Section 3 as government furnished, the Key Personnel shall provide all uniforms and other personal medical instruments subject to the following:

4.1.1 Uniforms and Lab Coats: Uniforms and Lab Coats shall conform to the requirements of the Indian

Health Service Manual, Part 3 Chapter 4 and meet the approval of the Clinical Director at each IHS facility.

4.1.2 Other personal medical instruments: “Other personal medical instruments” are defined as Key

Personnel owned items may include but not limited to stethoscope, scissors, as appropriate to the work unit. The Key Personnel shall not use unsafe equipment or supplies at any time during performance of this contract. All Key Personnel furnished equipment, and supplies shall be subject to inspection by the Government and must be approved by the Clinical Director prior to use by the Key Personnel. The Government reserves the right to prohibit the use of any materials, supplies, or equipment.

5.0 Performance-Based Requirements: Contractor’s Responsibilities. The contractor shall provide uninterrupted On-Site Nephrology Physician/Specialty Clinic services in the delivery of patient care to the Indian

Health Service.

5.1 Contractor Duties:

5.1.1 The contractor shall provide comprehensive support to accomplish CSU’s mission by ensuring the highest continuity of care with providing On-Site Nephrology Physician/Specialty Clinic services. The contractor shall drive service excellence by exemplifying solutions to operational inefficiencies and integrated strategic planning and management in accordance with the standards of care under the auspices of accrediting entities (Identified in Section 5.6.4) and in accordance with the contractual terms and conditions.

5.2 Patient Care Enablement/Delivery: The contractor shall support CSU by recruiting Nephrology

Physicians; this is essential to CSU’s success for timeliness of advance healthcare delivery to our underserved rural communities/population. The contractor shall ensure the continuity of patient care and shall identify and present a qualified Nephrology Physician within five (5) days for replacement.

5.2.1 The contractor shall provide key information showing evidence of competencies and experience in the providing a On-Site Nephrology Physician/Specialty Clinic services.

5.2.2 The contractor shall provide evidence of experience in providing a On-Site Nephrology Physician/Specialty Clinic services to the Federal Government or other large entities with in the last three (3) years showing past performance in meeting the requirements of Performance Work Statement.

5.2.3 The contractor shall be knowledgeable with CSU expectations and demographics with a vast understanding of the intricacies of serving Native patients, unique needs with remoteness, underserved patient care challenges, and requirements of both the Key Personnel and CSU; thus, leads to more reliable shift fulfillment with appropriate matches securing longer continuity of care fostering a stronger relationship with patients and the Key Personnel.

5.3 Medical Record Documentation: The contractor shall ensure their Key Personnel maintains accurate and thorough patient medical records with documentation of consultations, diagnoses, treatment plans, and medications administered during the contractual period. Payment will be withheld for inaccurate or incomplete medical records per Section 9.0 and 10.0 of this performance work statement.

5.4 Adaptability: The contractor shall acclimate and adjust to CSU’s practice environment with accurate electronic medical records systems, patient demographics, specific clinical protocols, and collaborating with other CSU healthcare staff.

5.4.1 The contractor shall strongly support CSU to ensure all interests align with CSU’s requirement for a Nephrology Physician to bridge staffing gaps during high patient volume periods and maintain access to care. This will keep CSU’s clinics operating, preventing staff burnout, and ensuring CSU patients receive the care they need.

5.5 Communication: The contractor shall be transparent with CSU healthcare professionals regarding placements (red flags), onboarding processes, contract performance, and contract close-out.

5.5.1 The contractor shall be solution-focused and provide program oversight with contract management and shall coordinate Nephrology Physician scheduling. The contractor shall be familiar with position details, present candidates with follow-up candidate discussions, and coordinate completion of the onboarding process with debriefing and status updates. In addition, the contractor shall parallelly see to CSU regulatory compliance with performance, credentials certification renewals, manage reporting with receivables, declining contract balances, pre and post

Nephrology Physician workforce staffing, and deliverables with providing accurate invoices to alleviate IPP invoice rejections and accurate timesheets.

5.6 Collaboration, Compliance, and Credentialing/Accreditation: The contractor shall leverage specialized support to handle all the logistical details such as licensing, certifications, credentialing, travel, housing, malpractice insurance, etc. This allows the contractor to focus on the human relationship and career matching of this Nephrology Physician requirement achieving “A Good Fit for Chinle".

5.6.1 The contractor shall collaborate with CSU healthcare team members and administrative staff to fulfill Nephrology Physician placements.

5.6.2 The contractor shall adhere to all relevant healthcare regulations, licensing requirements (see

Section 7.2), and practice guidelines during the Key Personnel’s contractual period at CSU.

5.6.3 The contractor shall work with the Key Personnel to provide all required documentation and credentials to CSU and be appointed to the CSU Consulting Medical Staff. At CSU, quality and competency are paramount. The contractor shall have and be able to provide evidence of a rigorous internal credentialing process that ensures that every Key Personnel presented to CSU meets the highest standards of competence and professionalism.

5.6.4 The contractor shall be accredited under the auspices of one of the healthcare accrediting entities and shall be maintained throughout the term of the contract without any lapses.

• National Association of Locum Tenens Organizations (NALTO)

• National Association of Health Care Staffing (NAHSS)

• National Committee for Quality Assurance (NCQA)

• Joint Commission (JC)

5.6.5 The contractor shall be responsible for all applicable Federal, State, And Local Taxes, Meals, Travel/Transportation. Lodging is provided but must be paid for by the contractor. Government quarters are available at prevailing rental rates plus utilities, as applicable, if government quarters are utilized. The contractor shall be responsible and liable for the proper care of government owned or leased property furnished in occupied quarters.

5.7 Invoices and Timesheets: The contractor shall upload a proper invoice as required for payment of services rendered via IPP.gov. The contractor shall attach an approved timesheet/work record confirming worked hours.

6.0 Performance-Based Requirements: Key Personnel’s Responsibilities. The Key Personnel shall provide an On-Site Nephrology Physician/Specialty Clinic Services in the delivery of patient care to the Indian Health Service. Specific tasks include the following:

6.1 Key Personnel Duties:

6.1.1 The Key Personnel shall perform outpatient Nephrology duties and manage patient’s needs as described in the (PD), identified by the Service Unit and as directed by Supervisor.

6.1.2 The Key Personnel shall provide professional medical services or direct patient care services under the terms of this contract, appropriate and timely medical services in accordance with the competency standards of care established by recognized medical care organizations and in accordance with the policies and procedures of Service Unit's Medical Staff Bylaws and Rules & Regulations at Chinle hospital.

6.1.3 The Key Personnel shall provide professional medical physician services in direct patient care services as follows:

A. The Key Personnel shall work under the general technical, administrative supervision of Donald Miles, MD, Acting Primary Care Director or designee for this order.

B. In the capacity of a subspecialist or expert within the Key Personnel’s specialty area, the Key

Personnel shall assume responsibility for the diagnosis, prevention therapy, maintenance and rehabilitation of patients by performing interviews and examines each patient, review past medical history and requests or performs complex diagnostic tests and examinations deemed necessary to obtain all possible information related to each case. Make preliminary diagnosis, directs, prescribes or provide treatment or arranges for specialized care or patient referral as required.

Bases decision upon information obtained, professional medical knowledge and skills and prescribed policies and procedures. Documentation of visit and observations to be incorporated into EHR records. Provide definitive management in all medical categories for cases that do not require referral. Give total patient care including prevention, health maintenance, early diagnosis, treatment and follow-up services to patient under his/her care. When on-site, provide emergency care as required if Hospital Incident Command System is activated or perform any life-saving care under the Key Personnel’s care.

C. The Key Personnel may provide specialty consultative services to the clinicians at CSU by staffing an outreach clinic as determined by both parties.

D. The Key Personnel conducts telemedicine consult making observations appropriate to the outpatient’s underlying disease and treatment plan, including current symptoms. Reviews and reconciles the patient’s medications, diet and therapy course, adheres to management plan and patient observations. Modifies regimen as required, instructs and counsels patients and family members as required.

E. The Key Personnel shall collaborate with other members of the CSU healthcare team (physicians, behavioral health specialists, nurse practitioners, physician assistants, public health nurses, and other clinical staff) to ensure comprehensive health care needs are met.

F. The Key Personnel shall work closely with allied health professionals (public health nurses, social workers, community health representatives) by utilizing and coordinating the services of other health care professionals in the management of the patient’s medical, psychiatric and social problems.

G. The Key Personnel shall refer patients to appropriate contracted medical and government facilities providing full clinical information for care and diagnostic procedures that cannot be adequately provided via telehealth or at CSU using Purchased Referred Care methodology.

H. The Key Personnel shall provide consultation on difficult cases to practitioners in the same or other specialties.

I. The Key Personnel shall provide appropriate documentation on rendered patient care utilizing an approved EHR system from the subspecialist remote location.

6.1.4 The Key Personnel shall be familiar with the cultural, social, political, geographic, demographic, economic, and epidemiological characteristic of the patients and the communities served. The Key Personnel shall be receptive and respectful of the culture at CSU. Cultural awareness and cultural diversity include language barriers, rural Native lifestyles and native ceremonies. The Key Personnel shall be aware of the basic traditional medicines and ceremonies that are available to patients, from the womb to geriatrics. CSU has traditional providers on staff providing traditional diagnostic care for all patients who seek it. The Key Personnel shall embrace and incorporate these elements into the care of the patients for positive outcomes. The Key Personnel shall complete a mandatory on-line training made available during orientation.

6.1.5 The Key Personnel shall be subject to peer review per Joint Commission standards.

6.1.6 The Key Personnel shall adhere to the Safety management reporting requirements in accordance with CSU’s Safety Measure Policy.

6.2 Work Schedule: Work shifts as arranged by the Primary Care Director or designee.

6.2.1 The Key Personnel shall work 100% of the contract hours. Work Shifts as arranged by the Primary Care Director or designee. Nephrology Clinic schedule:

The first (1st) Monday & Tuesday (Week 1) from 1 pm and ending at 5 pm.

The second (2nd) Monday & Tuesday (Week 2) from 1 pm and ending at 5 pm.

This schedule will be at the beginning of each month (Week 1 and Week 2).

Note: If there is a Holiday during Week 1, the Nephrology clinic schedule will move up by one week.

6.2.2 Continuity of Patient Care: The Key Personnel shall ensure the continuity of patient care and shall provide a qualified replacement to authorize the approval of time off and within the time frame specified by the Contracting Officer.

6.2.3 Work Flexibility. As directed by the Supervisor, the Key Personnel shall rotate into other duty sections as needed to support patient care.

6.2.4 The Key Personnel shall obtain approval of the department Supervisor or designee prior to any absence from work. If the length of the absence exceeds eight (8) work hours the Key Personnel shall request approval at least fifteen (15) days, (the exception is verifiable emergencies) in advance of the desired absence. Sick/annual leave/compensatory time are not authorized.

6.2.5 The Key Personnel shall provide written documentation from a qualified health care provider for absences of three (3) or more consecutive days, due to illness, stating:

The cause of the current illness or incapacitation AND

Indicating the Key Personnel as contagious or non-contagious.

The Government reserves the right to examine and or re-examine any Key Personnel who meets the criteria.

6.3 Conduct: The Key Personnel shall meet standards as listed in the Federal Code of Conduct.

6.3.1 The Key Personnel shall be subject to character investigation as required by Public Law 101-360, the Indian Health Child Protection and Family Violence Prevention Act prior to performance of a contract by utilizing the National Background Investigation Services Electronic Application (eApp) system and this shall include all fingerprinting procedures and clearances. The Key Personnel shall provide all requested information necessary to perform Level I and Level II background checks. The Key Personnel shall comply with the requirement to obtain security investigations. The Key Personnel shall work with the I.H.S. to ensure that the pre-employment screening process includes the appropriate investigation questionnaires and forms to be completed. All completed forms will be reviewed by the Key Personnel and forwarded to the government personnel. The Key Personnel will be immediately removed from the position if at any time the investigation receives unfavorable adjudication, or if other unfavorable information that would affect the investigation becomes known.

6.4 Performance Evaluation:

6.4.1 The Key Personnel’s performance shall be evaluated in accordance with the standards set forth in the contract and Performance-Based Matrix of Section 10.0.

6.4.2 Customer complaint: substantiated reports written by any customer dealing with patient safety, infection control, or other procedure that adversely affects patient outcome constitutes a breach of contract and shows cause for termination.

6.5 Identification of Key Personnel:

The Key Personnel shall wear a facility specific identification badge during performance of duty.

6.6 Management of Medical Information: The Key Personnel shall manage all patient information in accordance with the HIPAA standards, Privacy Act, and IHS Service Unit and/or Health Center specific policies and protocols.

6.6.1 Medical Records and Other Required Documentation: 100% percent of all medical records (EHR) and other required documentation meets established IHS Medical Facility, Joint Commission, and CMS standards to include, but are not limited to, timeliness, legibility, accuracy, content, date, time, signature and designated profession. Note: payment will be withheld for inaccurate or incomplete medical records per Section 9.0 and 10.0 of this performance work statement..

6.6.2 The Key Personnel shall ensure adherence to DHHS IT system security policies and procedures.

The IT policies and procedures shall be made available to the Key Personnel.

6.6.3 The Key Personnel shall immediately report to the Contracting Officer or COR any information or circumstances that may violate any statute, policy, or procedure.

6.7 IHS Information Technology Systems:

6.7.1 In performance of this contract, the Key Personnel shall adapt to and successfully utilize IHS information technology systems that are deemed by the Acting Primary Care Director or designee as necessary for acceptable Key Personnel performance.

6.7.2 The Key Personnel shall ensure that IHS information technology system security policies and procedures are adhered to. The IT policies and procedures shall be made available to the Key Personnel at each IHS facility.

6.7.3 The contract shall follow all appropriate federal and locally required information Technology security requirements and will be operating under HIPAA and Privacy Act regulations.

7.0 Key Personnel’s Qualification Requirements: The Key Personnel shall meet the qualifications and credentialing standards and retain the qualifications and certification throughout the term of this contract. The Key Personnel must abide by the Medical Staff Bylaws, Rules and Regulations of the CSU and comply with all requirements for appointment to the medical staff, and maintain status as a consultant member of the medical staff.

7.1 Training/Experience. Internal Medicine: The Key Personnel shall have graduated from an accredited medical school and possess a MD or DO degree. The Key Personnel shall have completed thirty-six (36) months of Internal Medicine Residency Training and one (1) year of Subspecialty Fellowship Training with a minimum of six (6) months experience in the specialty required by the contract. There must be no lapse of services of no more than 6 months prior to beginning tour of duty with CCHCF.

7.2 Certification/License/Registration. The Key Personnel shall be board certified with the American

(Osteopathic) Board of Internal Medicine and the American Board of Nephrology. The Key Personnel shall possess a current, valid, unrestricted medical license in any state, the District of Columbia, the Commonwealth of Puerto Rico, or a Territory of the United States, throughout the term of this contract. If the Key Personnel is asked to perform outside the normal training parameters of his/her specialty, then the Key Personnel shall provide certification of hospital privileges in those additional field/s of practice.

7.2.1 Drug Enforcement Administration (DEA) License. The Key Personnel shall maintain a valid, current, full and unrestricted DEA license with Schedule types II through V and maintain certification throughout the term of the contract.

7.2.2 The Key Personnel shall maintain a valid and current Cardiopulmonary Resuscitation (CPR), Basic

Life Support (BLS) and Advanced Cardiac Life Support (ACLS) certifications and are for mandatory to the Key Personnel’s subspecialty. This is the hospital’s requirement and is required for on-site services.

7.2.3 Motor Vehicle Operator’s License. The Key Personnel shall possess a valid state driver’s license throughout the term of this contract and for verification of identity during credentialing.

7.3 Health Requirements/Conditions of Employment:

7.3.1 Medical Evaluation. The Key Personnel shall provide a fitness for duty certificate issued by a licensed physician to perform the proposed job without significant risk to personal health or the health and safety of others.

7.3.2 Immunization. The Key Personnel shall provide documentation as evidence of immunization during credentialing. This is a requirement by the NAIHS Immunization Policy. The Key Personnel will provide the following when providing on-site subspecialist:

Hepatitis A - Two dose series at zero and six months.

Hepatitis B - Three dose series at zero, one, and six months or documented immunity. A signed declination of Hepatitis B vaccination series will be accepted.

Measles, Mumps, Rubella (MMR) - Two doses or titer documentation.

Varicella (chickenpox) – Two doses, titer documentation or history of varicella/shingles.

Tetanus, diphtheria, pertussis (Tdap/Td) - one dose of Tdap, then tetanus (Td) booster every 10 years thereafter.

Meningococcal - Two vaccines (MenACWY and MenB) recommended for microbiologists routinely exposed to N. meningitidis.

Documentation of annual TB test- may include Mantoux TB skin test (PPD). All new employees will require the two step TST.

Acceptable lab testing: Quantiferon Gold or T-Spot test.

For positive TB test results, please submit a copy of recent chest x-ray results.

Influenza – Mandatory annual vaccination.

7.4 Language Requirements and Cultural Awareness. The Key Personnel shall read, understand, speak, and write English to effectively communicate with patients and other health care workers, and shall be respectful of the local, American Indian and Alaska Native culture.

7.5 Information Technology Skills. The Key Personnel shall possess basic knowledge, skills, and abilities to use a computer.

7.6 Orientation. The Key Personnel shall attend mandatory orientations and training specified by the government.

7.7 Background Checks: The Key Personnel shall provide all requested information necessary to perform

Level I and Level II background checks. The Key Personnel shall comply with the requirement to obtain security investigations. The Key Personnel shall work with the I.H.S. to ensure that the pre-employment screening process includes the appropriate investigation questionnaires and forms to be completed. All completed forms will be reviewed by the Key Personnel and forwarded to Credentialing Department. The Key Personnel will be immediately removed from the position if at any time the investigation receives unfavorable adjudication, or if other unfavorable information that would affect the investigation becomes known.

7.8 Credentialing Requirements:

7.8.1 The Key Personnel shall provide three current letters of reference from other health care providers familiar with the Key Personnel’s clinical practice skills within the same discipline. One letter must be from the Chief of Staff/Medical Director or Immediate Supervisor at the hospital in which the Key Personnel either holds or last held staff privileges. If the Key Personnel has just completed a residency program, one of the letters shall be from the program director or service chief.

7.8.2 The Key Personnel shall be subject to Medical Staff Ongoing Professional Practice Evaluation and

Focused Provider Performance Evaluation as specified in the Chinle Service Unit Policy & Procedure, Focused Provider Performance Evaluation & Ongoing Professional Practice Evaluation.

7.8.3 The Key Personnel shall work directly with the Chinle Service Unit Credentials Committee to attain approval of credentials and privileges and shall retain status of appointment throughout the term of this contract.

8.0 Challenges to Conflicts: For any inconsistency between supervisor directions, this Performance Work

Statement, attachments and exhibits, the following order of precedence will apply:

(a) First Priority: Supervisor’s directions

(b) Second Priority: Performance Work Statement Exhibits

(c) Third Priority: Performance Work Statement Narrative

9.0 Performance – Based Matrix for Contractor

Performance- Based Task

Indicator Standard Quality Assurance Incentives

Contractor shall provide On-Site Nephrology Physician/Specialty Clinic Services in the delivery of patient care to the Chinle Comprehensive Health Care Facility, Navajo Area Indian Health Service, Chinle Comprehensive Health Care Facility.

a. Patient Care /

Enablement

b. Communication / Collaboration

c. Credentialing Compliance

d. Registration / Healthcare Accreditation

e. Medical Record

Document

f. Adaptability

g. Invoice &

Timesheet

Contractor identifies a replacement of Key Personnel within five (5) days. A rating of “very good” or “exceptional” must be attain for Patient Care / Enablement.

Contractor collaborates and communicates monthly with CSU healthcare team members and administrative staff during the contract period on all contract activity. A rating of “very good” or “exceptional” must be attain for Communication / Collaboration.

Contractor adheres to CSU’s Bylaws with maintaining and monitoring Key Personnel’s active credentialing expirables. A rating of “exceptional” must be attain for Credentialing Compliance.

Contractor shall maintain an active SAM UEI registration and healthcare accreditation throughout the term of the contract without any lapses. A rating of “exceptional” must be attain for Registration / Healthcare Accreditation.

Contractor’s Key Personnel shall complete Medical Record Documentation within four (4) days of encounter.

Contractor’s Key Personnel shall have no Incomplete Medical Record(s).

A rating of “very good” or “exceptional” must be attain for Medical Record Documentation.

Contractor’s Key Personnel’s full fulfillment of confirmed dates. A rating of “very good” or “exceptional” must be attain for Adaptability.

Contractor shall submit accurate invoices and timesheets to prevent IPP rejections and duplicate invoice submissions. A rating of “very good” or “exceptional” must be attain for Invoice & Timesheet.

Direct observation, 100% inspection, periodic inspection, and/or analysis of Key Personnel’s progress reports shall be the surveillance methods for all the indicators (a – g).

Payment of contract price for “very good” or “exceptional” service.

No payment for incomplete medical record documentation.

Contractor performance will be evaluated using the Contractor Performance Assessment Report (CPAR).

The evaluation will be considered when future IHS contract selections are made.

CPARS

evaluation will be submitted on-line.

9.1 Quality Assurance Monitoring Form (QAMF) - Contractor. The QAMF will be completed for each

Contractor. The QAMF will not be shared or disclosed.

10.0 Performance – Based Matrix for Key Personnel

Performance- Based Task

Indicator Standard Quality Assurance Incentives

Key Personnel shall provide On- Site Nephrology Physician/Specialty Clinic Services in the delivery of patient care Navajo Area Indian Health Service, Chinle Comprehensive Health Care Facility, Chinle, Arizona.

a. Patient Care

b. Compliance

c. Culturally Sensitivity

d. Medical Record

Documentation

e. Professionalism

No reports of breached safety or other procedures that may have adversely affect patient outcomes and full fulfillment of confirmed dates. A rating of “very good” or “exceptional” must be attain for Patient Care.

No reprimands or disciplinary actions for violations of published Policies; Procedures;

Standards of Care or Hospital Protocols. A rating of “exceptional” must be attain for Compliance.

Key Personnels were compassionate and culturally sensitive. A rating of “very good” or “exceptional” must be attain for Culturally Sensitivity.

Key Personnels complete require documentation in clear and legible form within four (4) days of encounter. A rating of “very good” or “exceptional” must be attain for Documentation.

Key Personnels presented in professional appearance, demonstrated exceptional ethical conduct with effective communication, and exhibited exemplary attitude by being flexible and being adaptable. A rating of “very good” or “exceptional” must be attain for Professionalism.

Direct observation, 100% inspection, periodic inspection, and/or analysis of Key Personnel’s progress reports shall be the surveillance methods for all the indicators (a – e).

Payment of contract price for “very good” or “exceptional” service.

No payment for incomplete Medical Record Documentation.

Key Personnel performance will be evaluated using the Contractor Performance Assessment Report (CPAR).

The evaluation will be considered when future IHS contract selections are made.

• CPARS

evaluation will be submitted on-line.

10.1 Quality Assurance Monitoring Form (QAMF). The QAMF will be completed for each Key Personnel. The completed QAMF is a peer review document and is confidential as afforded under Arizona Revised Statutes

36.445 and 36.445-01. The QAMF will not be shared or disclosed.

11.0 List of Attachments and Exhibits. To be provided by the Contracting Officer upon request.

11.1 Attachments

a. Certification Statement for Performance Work Statement No. CSU-26-01 NEPH.

b. Position Description (Service Unit specific) – available upon request.

11.2 Written Competency Assessments

a. Confidentiality/HIPAA/Patient’s Rights

b. EMTALA Compliance Exam, 2004

11.2.1 Standard Emergency Codes

11.2.2 Confidentiality: Legal and Ethical Concerns in Healthcare

11.2.3 An Introduction to the Navajo Culture

11.2.4 Verbal and Telephone Orders

11.2.5 Pain Management

11.2.6 Focus Charting

11.2.7 Medical Staff Bylaws