24/7 Telebehavioral Health Emergency Department Support Services

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SECTION C — PERFORMANCE WORK STATEMENT (PWS)

IDIQ Contract: 24/7

Telebehavioral Health Emergency Department Support Services

1.0 Purpose

This Performance Work Statement (PWS) describes the requirements for an Indefinite-Delivery/Indefinite- Quantity (IDIQ) contract to provide 24/7/365 synchronous audio-video telebehavioral health services supporting Emergency Department (ED) operations for facilities identified in this PWS and/or in individual task orders.

2.0 Background

Patients present to EDs with suicidal ideation, suicide attempts, acute psychiatric crises, substance-related emergencies, and co-occurring disorders. Timely behavioral health assessment and intervention are critical to patient safety, regulatory compliance, and appropriate disposition.

3.0 Objectives

The Contractor shall provide qualified licensed independent behavioral health clinicians (psychologists, psychiatrics, LCSW, LPC-MH, or equivalent) to deliver real-time telebehavioral health services, including suicide risk assessment, CSSRS with SAFE-T assessments, crisis stabilization, Stanley-Brown Safety Planning, culturally responsive care, interpreter access coordination, and placement assistance for patients requiring higher levels of care.

For patients presenting with acute psychiatric crises, qualified prescribing providers (psychiatrists, psychiatric nurse practitioners, or psychologists with prescribing privileges) will be available to provide consultation on appropriate medication stabilization.

4.0 IDIQ Structure, Ordering, and Place of Performance

4.1 Contract Type and Ordering

This contract is an IDIQ. Services will be ordered via written task orders issued by the Contracting Officer (CO) or authorized Ordering Official. Each task order will identify: ordering period of performance (POP) and deliverable schedule; locations/facilities covered; required hours of coverage and staffing/surge expectations;

reporting cadence and site-specific workflows; and applicable performance metrics.

4.2 Ordering Period and Task Order Period of Performance

IDIQ ordering period and task order POP will be as specified in the solicitation/contract and the individual task order.

4.3 Place of Performance (Initial Facilities)

Initial scope supports the following EDs:

• Pine Ridge Hospital, Pine Ridge, SD

• Rosebud Hospital, Rosebud, SD

• Eagle Butte Hospital, Eagle Butte, SD

• Fort Yates Hospital, Fort Yates, ND

• Belcourt Hospital, Belcourt, ND

4.4 Estimated Workload (Not a Guarantee)

Approximate monthly consult volume by facility (for planning only): Pine Ridge (50), Rosebud (50), Eagle Butte (30), Fort Yates (15), Belcourt (20). The Government does not guarantee volumes; actual quantities will be based on clinical demand and task order scope.

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5.0 General Requirements (Applies to All Task Orders)

5.1 Service Delivery Modality and Coverage

The Contractor shall provide synchronous audio-video telebehavioral health services 24 hours/day, 7 days/week, including weekends and federal holidays, unless otherwise specified in a task order utilizing Webex or another platform identified by the Indian Health Service

5.2 Required Clinical Services

The Contractor shall provide the following services when clinically indicated and/or required by facility workflows:

• Suicide risk assessment and completion of CSSRS with SAFE‑T for patients presenting with suicidal ideation or attempt.

• Crisis intervention, de-escalation guidance, and reassessment as indicated.

• Individualized Stanley-Brown safety planning, including lethal means counseling when appropriate.

• Placement coordination for higher levels of care (e.g., inpatient psych, crisis stabilization, detox), including documentation of placement attempts.

• Language access coordination: interpreter services (telephonic/VRI/ASL) available within 15 minutes of request and documented in the EHR.

• Culturally responsive and trauma-informed care, with annual training for clinicians (e.g., cultural competency, implicit bias, trauma-informed care).

For patients presenting with acute psychiatric crises, qualified prescribing providers (psychiatrists, psychiatric nurse practitioners, or psychologists with prescribing privileges) will be available to provide consultation to ED provider on appropriate medication stabilization.

Prior to initiating the consult, the Contractor will receive a report from the referring provider or designee and the telebehavioral health provider will provide a report back to the referring provider at the conclusion of the patient evaluation.

6.0 Staffing and Credentialing (Applies to All Task Orders)

6.1 Minimum Qualifications

Personnel shall hold active, unrestricted licensure in any U.S. state or territory and have at least two (2) years of emergency or crisis behavioral health experience.

6.2 Coverage and Surge

The Contractor shall ensure no lapse in required coverage and maintain surge staffing capability as needed.

6.3 Facility Credentialing

Personnel must meet the credentialing requirements of the facility(ies) served. Proxy credentialing is permissible consistent with CMS regulations and facility policy.

6.4 Security Clearance

A security pre-clearance must be carried out by any employees referred to IHS through this contract.

Fingerprints must be completed and adjudicated prior to services being performed under this contract. No contract award shall be made to any vendor or provider listed on the OIG Exclusion List throughout the duration of this contract. It shall be the responsibility of the contractor to notify the acquisition official if there is a change in provider.

Government will pay for the cost to process the contractors suitability clearances. However, multiple investigations for the same position may, at the Contracting Officers discretion, lead to reduction(s) in the contract price of no more than the cost of the extra investigation(s).

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7.0 Documentation Requirements

All CSSRS assessments, SAFE‑T evaluations, safety plans, interpreter usage, and disposition decisions shall be documented in the EHR prior to discharge or transfer, consistent with facility policy and workflow.

8.0 Government Surveillance

The Government may monitor performance through chart audits, ED log reviews, validation of monthly reports, and periodic quality reviews.

9.0 Deliverables (Applies Unless Modified by Task Order)

Unless otherwise specified in a task order, the Contractor shall provide:

• Monthly performance reports (metrics, volumes, response times, interpreter timeliness, SAFE‑T completion, Safety Plan completion, etc.).

• Staffing coverage plan (including surge approach).

• Quarterly quality improvement summaries.

• Incident reports within 24 hours of critical events, when applicable and consistent with facility reporting procedures.

10.0 Transition Requirements

Task orders may include transition-in activities to validate connectivity, workflows, escalation pathways, documentation standards, and site-specific processes. At task order completion, the Contractor shall support orderly transition-out, including final reporting and transfer/disposition of Government data as directed.

11.0 Non-Personal Services

Services under this contract are non-personal services. Contractor personnel shall not be supervised or controlled by Government personnel.

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ATTACHMENT 1 — PERFORMANCE REQUIREMENTS SUMMARY

(PRS)

This PRS establishes minimum performance standards for task orders issued under the IDIQ. Task orders may add, remove, or modify PRS elements consistent with site-specific workflows and requirements.

Performance Objective Performance Standard/Threshold Acceptable Quality

Level (AQL) Method of Surveillance Remedy/Corrective Action

Telebehavioral consult response time

Telebehavioral clinician joins consult within 30 minutes of ED request.

≥ 95% of consults per month (per site and aggregate).

System timestamps/telehealth logs; ED consult logs; monthly report validation; spot checks.

For any month below AQL: Contractor submits Corrective Action Plan (CAP) within 5 business days; Government may require additional staffing/surge plan updates and increased surveillance for the next month.

CSSRS with SAFE-T completion

Complete CSSRS with SAFE-T for all patients presenting with suicidal ideation or suicide attempt, unless clinically contraindicated and documented.

100% of applicable encounters.

EHR chart review/audit; monthly metric reporting; random sampling as needed.

For any noncompliance: CAP within 5 business days; targeted clinician retraining within 30 days; repeat audit the following month.

Required documentation before disposition

All required assessments, risk determinations, safety plans (if discharged), interpreter use (if applicable), and disposition recommendations documented in EHR prior to discharge/transfer.

100% of encounters. EHR chart review; facility feedback; monthly report validation.

CAP within 5 business days; retraining;

increased chart audit frequency until two consecutive months meet AQL.

Interpreter access timeliness

Interpreter services (telephonic/VRI/ASL) available within 15 minutes of request and documented in

EHR.

≥ 95% of interpreter requests per month.

Interpreter request logs;

telehealth platform logs; EHR documentation review; monthly report validation.

CAP within 5 business days; corrective updates to interpreter workflow/vendor coordination; increased monitoring the next month.

Continuous coverage Maintain required coverage (default 24/7/365) with no unplanned lapse;

backup coverage available.

100% coverage; 0 unplanned lapses.

Staffing schedules; coverage attestations; incident reporting;

Government verification upon notice.

Immediate notification to Government within 1 hour of any lapse; root cause analysis within 5 business days; CAP;

Government may require staffing changes.

Monthly performance report timeliness

Submit monthly performance report in the format required by the task order by the due date (default: 10th business day).

100% on-time submissions.

CO/COR receipt tracking. Late report: notice to cure; repeated late submissions may trigger enhanced surveillance and/or remedies under the contract/task order.

Critical incident reporting

Report critical incidents (as defined by facility/task order) within 24 hours and provide follow-up information within required timeframes.

100% compliance. Incident log review; COR validation with facility.

CAP; retraining on incident procedures; increased monitoring for next quarter.

Note: Remedies above describe minimum corrective actions. The Government reserves the right to apply additional remedies consistent with the contract, task order terms, and applicable acquisition regulations.

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ATTACHMENT 2 — QUALITY ASSURANCE SURVEILLANCE PLAN

(QASP)

IDIQ: 24/7 Telebehavioral Health Emergency Department Support Services

1. Purpose This QASP defines methods used by the Government to monitor Contractor performance, ensuring compliance with performance standards and patient safety.

2. Scope Applies to all task orders under the IDIQ including telebehavioral health consults, crisis intervention, documentation, interpreter access, and staffing.

3. Roles and Responsibilities

• Contracting Officer (CO): Contract authority

• COR: Performance monitoring and validation

• Clinical Staff: Feedback and audits

• Contractor: Service delivery and reporting

4. Surveillance Approach Methods include 100% inspection, random sampling, periodic reviews, customer feedback, and automated monitoring.

5. Performance Standards

• Response Time: ≥95% within 30 minutes

• SAFE-T Completion: 100%

• Documentation: 100%

• Interpreter Access: ≥95% within 15 minutes

• Coverage: 100%

• Reporting: 100% on time

• Incident Reporting: 100% within 24 hours

6. Surveillance Schedule

• Monthly audits and reporting reviews

• Quarterly quality reviews

• Ongoing monitoring

7. AQLs Defined per PRS; failure triggers corrective action.

8. Documentation All surveillance and findings documented in contract file.

9. Corrective Actions CAP required within 5 business days for deficiencies.

10. Incentives and Remedies Includes increased surveillance or contractual remedies.

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11. Continuous Improvement Quarterly reviews and performance trend analysis.

12. Transition Oversight Monitoring during transition-in and transition-out.

13. Non-Personal Services Ensures contractor independence.

14. Updates QASP may be updated as needed.