PWS_APP_Rosebud_IHS-5-7-26.docx

PERFORMANCE WORK STATEMENT | Certified Nurse-Midwife Services | Rosebud IHS Hospital PERFORMANCE WORK STATEMENT | APP (NP/PA) Services | Rosebud IHS Hospital

PERFORMANCE WORK STATEMENT

Advanced Practice Provider (APP) Services Outpatient Department Primary Care Clinic

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 Period of Performance (PoP) for this contract shall be one (1) year total, consisting of:

1. Base Period: THREE (3) months

2. Option Year 1: THREE (3) months

3. Option Year 2: THREE (3) months

4. Option Year 3: THREE (3) months The Government may exercise the option by written notice to the Contractor within the time specified in the contract, in accordance with FAR 52.217-9. Exercise of the option is contingent upon continued need, satisfactory performance, and availability of funds.

FAR 52.217-9. Exercise of the option is contingent upon continued need, satisfactory performance, and availability of funds.

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 APP Contractor shall provide the following services during scheduled OPD clinic hours (generally Monday–Friday, consistent with facility operating hours, and may include federal holidays):

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 evidence-based guidelines (e.g., USPSTF, ADA, JNC/AHA, GOLD, ACP) and 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 USPSTF 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 EHR on the day of service, including assessment, plan, patient education, and follow-up instructions.

4.3 Documentation and Health Records

· Document all patient encounters, assessments, diagnoses, orders, and care plans in the Rosebud IHS Hospital electronic health record (EHR) system (Resource and Patient Management System [RPMS] / Electronic Health Record [EHR] module, or successor system) on the day of service.

· 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.

4.4 Coordination and Communication

· Participate in scheduled multidisciplinary team meetings, case conferences, and departmental huddles.

· Communicate effectively with supervising 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.

· Attend and complete all required IHS mandatory training (e.g., HIPAA, infection control, fire safety, workplace violence prevention) within established timelines.

4.5 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 licensure from a State, the District of Columbia, the Commonwealth of Puerto Rico or territory the United States appropriate to the APP role: PA’s Current, active, unrestricted licensure from a State, the District of Columbia, the Commonwealth of Puerto Rico or territory the United States appropriate to the APP role.

· 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 – 5:00 PM, excluding federal holidays. The Clinical Director (CD) or designee shall establish specific daily clinic schedules in coordination with the Outpatient Clinic Director. Schedules may be adjusted by mutual written agreement to meet operational needs.

6.2 Federal Holidays

APP Contractors are not generally required to provide services on federal holidays. Any scheduled clinic services required on a federal holiday shall be agreed in advance in writing between 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 all 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 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. TIMEKEEPING AND INVOICING REQUIREMENTS

10.1 Timekeeping Standards

1. All labor hours billed must be recorded in increments of one-quarter (0.25) hour.

2. Billing for increments smaller than fifteen (15) minutes is not permitted.

3. Time must clearly identify scheduled clinic hours and any approved non-clinic administrative time.

4. Documentation must be available to the COR.

5. Hours must align with Monthly Burn Reports.

10.2 Invoicing Requirements

1. Invoices shall be submitted monthly.

2. Due by the 10th calendar day following the billing month.

3. Must include contract info, hours, rates, totals, and cumulative billing.

4. Must align with Burn Reports.

5. Subject to Government review.

6. Paid per Prompt Payment Act.

11. PERFORMANCE STANDARDS

12. CONTRACT BURN RATE AND CAPACITY MONITORING

11.1 Monthly Burn Report

The Contractor shall submit a Monthly Burn Report to the COR no later than the 10th calendar day following the close of each contract month. The report shall provide a cumulative and period-specific accounting of contract capacity expended and shall serve as the primary instrument for financial and performance monitoring of this contract. The Monthly Burn Report shall include, at minimum, the following elements:

· Contract period of performance covered by the report (base year or applicable option period).

· Total authorized contract ceiling value (in dollars and/or hours, as applicable to contract structure).

· Total capacity expended to date, expressed as both a dollar/hour amount and as a percentage of the total contract ceiling.

· Capacity expended during the current reporting month, expressed as both a dollar/hour amount and as a percentage of the total contract ceiling.

· Remaining contract capacity available, expressed as both a dollar/hour amount and as a percentage of the total contract ceiling.

· Projected rate of consumption based on current utilization trends, including an estimated date of contract ceiling exhaustion at the current burn rate.

· Any variances from the projected utilization plan and a brief narrative explanation of the cause and expected impact.

· Status of any pending invoices or unbilled services not yet captured in the cumulative totals.

11.2 60% Capacity Threshold Notification The Contractor shall provide written notification to the COR upon expending sixty percent (60%) of the total authorized contract ceiling for the applicable performance period (base year or any option period). This notification requirement applies separately to each performance period and shall not be satisfied by cumulative multi-year tracking alone.

The 60% Threshold Notification shall:

· Be submitted to the COR in writing (email is acceptable) within five (5) calendar days of the date on which cumulative capacity expended reaches or is projected to reach the 60% threshold.

· State the specific dollar amount and/or hours expended to date, the total contract ceiling for the performance period, and the resulting percentage consumed.

· Include the Contractor's current projected burn rate and estimated date on which the contract ceiling will be fully expended at that rate.

· Identify any known or anticipated changes in service volume, staffing, or other factors that may cause the burn rate to accelerate or decelerate during the remainder of the performance period.

· Recommend, if applicable, whether the Contractor anticipates a need for contract modification, ceiling adjustment, or other action prior to the end of the performance period.

Receipt of the 60% Threshold Notification by the COR does not authorize the Contractor to exceed the contract ceiling. The Contractor shall not perform services in excess of the authorized contract ceiling without a duly executed contract modification signed by the Contracting Officer. The Government is not obligated to pay for any services performed in excess of the contract ceiling without such authorization.

11.3 Additional Threshold Notifications

In addition to the 60% notification, the Contractor shall provide written notice to the COR upon reaching eighty percent (80%) and ninety percent (90%) of the contract ceiling for any performance period, under the same terms and timelines described in Section 12.2. These escalating notifications are intended to provide the Government sufficient lead time to take any necessary contracting action before the ceiling is exhausted.

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

14. CONTRACTING AUTHORITY

Contracting Authority No person other than the Contracting Officer (CO) has the authority to bind the Government with respect to this contract.

No action or omission of any Government employee or representative, other than the Contracting Officer, shall increase or decrease the scope of this contract or otherwise modify its terms and conditions.

In no event shall any of the following be effective, binding on the Government, or imputed to the Contracting Officer with respect to this contract:

· Any understanding or agreement between the Contractor and anyone other than the Contracting Officer

· Any purported modification or change order issued by anyone other than the Contracting Officer

· Any promise by anyone other than the Contracting Officer to provide additional funding or make payments

· Any order, direction, consent, or permission from anyone other than the Contracting Officer to:

· Incur costs in excess of a specified estimated cost, allotment of funds, or other ceiling

· Expend hours in excess of a specified level of effort