PWS - 75H70425R00003 - ND SD PRCDA Expansion Study.pdf

Statewide Purchased/Referred Care Delivery Area Study for North Dakota and South Dakota

Performance Work Statement

SOL# 75H70425R00003

1. Mission The mission of the Indian Health Service (IHS) is to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.

1.1 Background

The Snyder Act provides the formal legislative authority for the expenditure of funds for the “relief of distress and conservation of health of Indians.”1 In 1934, Congress provided the specific authority to enter into medical services contracts for American Indians and Alaska Natives (AI/AN).2 These, among other authorities3, established the basis for the IHS and the Purchased/Referred Care (PRC) Program.4

The IHS Office of Resource Access and Partnership (ORAP) PRC Program is integral to providing comprehensive health care services to eligible AI/AN. The Indian health system delivers care through direct care services provided in an IHS, Tribal or Urban Indian Health Program (I/T/U) facility (e.g., hospitals, clinics) and through PRC services delivered by non-IHS providers. The general purpose of the PRC Program is for I/T/U facilities to purchase services from private health care providers in situations where:

1. No IHS or Tribal direct care facility exists,

2. The direct care element is not capable of providing required emergency and/or specialty care,

3. The direct care element has an overflow of medical care workload, and

4. Full expenditure of alternate resources (e.g., Medicare, private insurance) has been met and supplemental funds are necessary to provide comprehensive care to eligible Indian people.

In addition to meeting the eligibility requirements for direct services at an IHS or Tribal facility, PRC eligibility is determined based on residency within the service unit or Tribal PRC service delivery area; authorization of payment for the each recommended medical service by a PRC authorizing official; medical necessity of the service and inclusion within the established Area

1 The Snyder Act, Public Law 67‐85, November 2, 1921, 25 U.S.C § 13.

2 The Johnson O’Malley Act of April 16, 1934, as amended, 25 U.S.C. § 452.

3 Transfer Act, 42 U.S.C. § 2001; Indian Health Care Improvement Act, as amended, 25 U.S.C § 1601, et seq.

4 The Consolidated Appropriation Act of 2014, Public Law 113‐76, January 18, 2014, adopted a new name for the IHS Contract Health Services (CHS) program to Purchased/Referred Care (PRC). The IHS will administer PRC in accordance with all law applicable to CHS.

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

Indian Health Service Rockville MD 20857

IHS/Tribal medical/dental priorities; and full expenditure of all alternate resources (i.e., Medicare, Medicaid, private insurance, state or other health programs, etc.). Alternate resources must pay for services first because the IHS PRC Program is the payer of last resort. Services purchased may include hospital, specialty physician, outpatient, laboratory, dental, radiological, pharmaceutical, or transportation services.

1.2 Description of Services and Purpose

25 U.S.C. 18 § 1678a directs the IHS to designate North Dakota and South Dakota as PRC delivery areas (PRCDA) for the purpose of providing PRC services to members of Indian tribes in the States of North Dakota and South Dakota. However, Subsection 1678a (b) prohibits the IHS from curtailing any health care services provided to Indians residing on any reservation, or in any county that has a common boundary with any reservation, in the State of North Dakota or South Dakota, if the curtailment is due to the provision of PRC services in those States pursuant to the designation of the States as a PRCDA.

IHS requires contract services to conduct an independent, impartial study and analysis of the implications of expanding North Dakota and South Dakota into statewide PRCDAs. ORAP is coordinating the study to analyze the benefits and costs for North Dakota and South Dakota to be identified as state-wide PRCDAs. Tribal share calculations will also need to be performed to determine the implications on Tribal Shares in the event that the States are identified as a statewide PRCDAs. Tribal Consultation requirements are critical to determining how any cost shifts may be impacted in the budget formulation process for annual appropriations.

2. General Requirements This section describes the general requirements. The following sub-sections provide details of various considerations and requirements for this effort. The following general information, schedule of tasks, and deliverables will outline the requirements necessary to organize, develop, and evaluate expanding North Dakota and South Dakota into statewide PRCDAs.

2.1 Quality Control:

The contractor shall develop and maintain an effective quality control program to ensure services are performed in accordance with this Performance Work Statement (PWS). The contractor shall develop and implement procedures to identify, prevent, and ensure non-occurrence of defective services. The contractor’s quality control program is the means by which he or she assures himself or herself that the work complies with the requirement of the contract.

2.2 Quality Assurance: The government shall evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan. This plan is primarily focused on what the Government must do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

2.3 Non-Personal Services

The Government shall neither supervise contractor employees nor control the method by which the contractor performs the required tasks. Under no circumstances shall the Government assign tasks to, or prepare work schedules for, individual contractor employees. It shall be the responsibility of the contractor to manage its employees and to guard against any actions that are considered personal services, or give the perception of personal services. If the contractor believes that any actions constitute, or are perceived to constitute personal services, the contractor is responsible for immediately notifying the Contracting Officer (CO).

2.4 Business Relations

The contractor shall successfully integrate and coordinate all activities needed to execute the requirement. The contractor shall manage the timeliness, completeness, and quality of the study.

The contractor shall promptly identify issues, establish corrective action plans, and effectively manage any subcontractors if subcontractors are needed. The contractor shall ensure all contractor personnel display professional and ethical behavior.

2.5 Contract Management

The contractor shall establish clear organizational lines of authority and responsibility to ensure effective management of the resources assigned to this contract. The contractor must maintain continuity between the support operations, the contractor's corporate offices, and the IHS ORAP.

2.6 Contract Administration

The contractor shall establish processes and assign appropriate resources to effectively administer this contract. The contractor shall respond to Government requests for contractual actions in a timely fashion. The contractor shall have a single point of contact between the Government and Contractor personnel assigned to support this contract. The contractor shall assign work effort and maintain proper and accurate time-keeping records of personnel assigned to work under this contract as necessary.

The contractor will meet with the Contracting Officer Representative (COR) and IHS officials within 7 days of the contract award to become acquainted with the ORAP staff, review the Statement of Work (SOW), discuss timelines and deliverables, and begin initial planning.

2.7 Subcontract Management

The contractor will be responsible for any subcontract management necessary to integrate work performed on this requirement and will be responsible and accountable for subcontractor performance on this requirement. The prime contractor will manage work distribution to ensure there are no Organizational Conflict of Interest (OCI) considerations. Contractors may add subcontractors to their team after notification to the CO or COR.

2.8 Contractor Personnel, Disciplines, and Specialties

The contractor will accomplish the assigned work by employing and utilizing qualified personnel or subject matter experts (SMEs) with appropriate combinations of education, training, and experience if deemed necessary.

2.9 Location and Hours of Work

Accomplishment of the results contained in this PWS may require work at various contractor/subcontractor locations in the continental United States. Normal workdays are Monday through Friday except US Federal Holidays. Federal Workers typically work eight (8) hours per day, 40 hours per week. Flextime workers start not earlier than 0600 and not later than 0900. Core hours of work are from 0900 to 1500 daily. Contractor/Subcontractor employees are expected to be available to IHS staff during core hours.

2.9 Travel / Temporary Duty (TDY)

Contractor travel may be required under this contract. All travel locations shall be pre-approved by the federal government, only if the contractor plans travel to a facility. Costs for travel to any facility for any work completed under this PWS shall be included in the business proposal and reimbursed in accordance with Joint Travel Regulations.

3. Performance Requirements The Contractor or advisor will be the primary coordinator for the North Dakota and South Dakota PRCDA expansion study. The specific needs for contract support are listed below.

3.1 Scope of Work / Deliverables

1. Minimum Requirements:

A. Conduct monthly calls with the project lead to discuss progress and clarify questions that may arise.

B. Communicate issues or problems with the Contracting Officer’s Representative (COR) within 5 days.

Deliverable:

A001 Provide minimum requirements according to deliverables and time schedule to include monthly calls and communication issues.

2. PRC Analysis Requirements:

A. Conduct a detailed analysis of the PRC implications of a statewide PRCDA in the states of North Dakota and South Dakota.

B. Identify the current PRC eligible population for each current PRCDA.

C. Identify current user population for each state.

D. Identify the number of members of Indian tribes who reside in each county for each states.

E. Identify the increased PRC eligible population for each of the current PRCDAs.

F. Identify the number of AI/ANs currently issued PRC denials based on not being eligible because of residency in each of the current PRCDAs.

G. Include a review of the Medical Priority level currently being authorized in each

PRCDA.

Deliverable:

B001 Detailed analysis or report of the PRC implications of a statewide PRCDA in the states of North Dakota and South Dakota that includes letters A through G according to deliverable and time schedule.

3. Perform an analysis of the cost implications of an expansion to a statewide PRCDA in the states of North Dakota and South Dakota.

A. Identify the current Medical Priority levels being authorized in each PRCDA.

B. Identify the PRC expenditures for each current PRCDA.

C. Identify a cost per capita based on the current PRC-eligible population.

D. Identify a cost per capita based on the expanded population.

E. Identify potential population growth

F. Identify additional IHS workforce needed to address the additional population.

Deliverable:

C001 Detailed analysis of the cost implications of an expansion to a statewide PRCDA in the states of North Dakota and South Dakota that includes letters A through F according to deliverable and time schedule.

4. Prepare a map for each state showing:

A. The current PRCDAs in each State

B. The AI/AN population in each county.

Deliverable:

D001 Prepare a map of North Dakota and South Dakota showing the current PRCDAs and AI/AN population in each county according to deliverable and time schedule.

5. Reporting

A. Complete detailed analysis and final draft report.

B. Complete detailed analysis and final study report (within 180 EDOC).

C. Provide ORAP and Agency Leadership with a detailed briefing and presentation of the analysis for decision-making purposes.

Deliverables:

E001 Provide a final draft report/study and the PowerPoint presentation for the IHS briefing for IHS review that includes all of the deliverable elements listed above and according to the deliverables and time schedule.

E002 Upon IHS feedback, provide a final report/study and the PowerPoint presentation to IHS that includes all of the deliverable elements listed above, with all IHS edits incorporated, and according to the deliverables and time schedule.

E003 Provide ORAP and Agency Leadership with a detailed briefing and PowerPoint presentation of the analysis for decision-making purposes.

Deliverable:

F001 Submit records of meeting logistics (details of meeting, consultation, attendance, summary, etc.) along with each report deliverable.

4. Project Officer A certified IHS Contracting Officer’s Representative and Program Manager will be identified before contract execution.

5. Period of Performance The contract period of performance shall be for 12 months from the effective date of the contract

(EDOC).

6. Contract Type This will be awarded as a fixed-price contract with a cost-reimbursable contract line item number (CLIN) for travel.

7. Data Rights The government has unlimited rights to all the documents and materials produced under this contract. All documents and materials collected or produced under this contract shall be Government owned and are the property of the Government with all rights and privileges of ownership/copyright belonging exclusively to the Government. These documents and materials may not be used or sold by the contractor.

8. Records The contractor shall specifically destroy or return to IHS all data utilized for the project. The contractor shall not use, retain, publish, or add the data to any other data it has collected at any time for any other purpose. The contractor shall use only non-personally identifiable information in the evaluation of the project.

As used in this PWS, "records and data" mean: (1) any handwritten, typed, or printed documents (including, but not limited to, memoranda, letters, writings, books, brochures, transcripts, minutes, electronic transmissions, study findings, laboratory note books, chromatograms, spectra, and maps); (2) documentary material in other forms (such as punch cards, magnetic or paper tapes, instrumentation cards, computer discs, electronically stored information, audio or video recordings, motion pictures, photographs, slides, microfilm, and microfiche); (3) biological samples and pathology materials (pathology slides, paraffin blocks, and wet tissues); and (4) any patient/client data obtained from Tribes or IHS for evaluation of the project. Records and data may or may not constitute a specific deliverable defined under the terms of the contract.

9. Inspection and Acceptance Inspection and acceptance of all other deliverables under this contract shall be performed by the designated Project Manager and/or the Contracting Officer’s Representative (COR).

The basis for inspection/acceptance shall comply with the requirements outlined in the deliverables and time schedule and according to the Government Quality Assurance Surveillance Plan (QASP). Deliverable items rejected shall be corrected in accordance with the QASP for favorable CPARS reporting. The QASP will be shared with the contractor at the Kickoff Meeting.

8. Deliverables and Time Schedule

Deliverables Frequency, Date or Timeframe

Medium and Format Submit To

Contract Kickoff Meeting Once, within 10 working days of contract execution

Teleconference N/A

A001 Provide minimum requirements according to deliverables and time schedule to include monthly calls and communication issues

Monthly beginning within 30 days after the start of the contract start date

Teleconference, Email Program Manager

B001 Detailed analysis or report of the PRC implications of a statewide PRCDA in the states of North Dakota and South Dakota that includes letters A through F according to deliverable and time schedule.

Once within 120 days after the start of the contract start date

The report/analysis must be submitted by email in Microsoft Office or Portable Document Format (PDF).

Program Manager

Date or Timeframe

Medium and Format Submit To

C001 Detailed analysis of the cost implications of an expansion to a statewide PRCDA in the states of North Dakota and South Dakota that includes letters A through F according to deliverable and time schedule.

Once within 120 days after the start of the contract start date

The report/analysis must be submitted by email in Microsoft Office or

D001 Prepare a map of each U.S.A state showing the current PRCDAs and AI/AN population in each county according to deliverable and time schedule.

Once within 120 days after the start of the contract start date

The report/maps must be submitted by email in Microsoft Office or

E001 Provide a final draft report/study for IHS review that includes all of the deliverable elements listed above and according to the deliverables and time schedule.

Once within 120 days after the start of the contract start date

The report/analysis must be submitted by email in Microsoft Office or

E002 Upon IHS feedback, provide a final report/study to IHS that includes all of the deliverable elements listed above, with all IHS edits incorporated, and according to the deliverables and time schedule.

Once within 180 start of the contract start date

The report/analysis must be submitted by email in Microsoft Office or

E003 Provide ORAP and Agency Leadership with a detailed briefing and presentation of the analysis for decision-making purposes.

Once within 180 start of the contract start date

The briefing materials/ presentation must be submitted by email in Microsoft Office and

Date or Timeframe

Medium and Format Submit To

F001 Submit records of meeting logistics (details of meeting, consultation, attendance, summary, etc.)

along with each report deliverable

On the due date with each deliverable listed above

The records must be submitted by email in Microsoft Office or