PWS - PHC-24-0610 PMHNP.pdf

PWS No. PHC-23-0602-PSYCH 12 Aug 2026

Pinon Health Center Performance Work Statement (PWS)

For Nonpersonal Services

Psychiatric Mental Health Nurse Practitioner

Table of Contents Section Page

1.0 General 1-3

2.0 Definitions 5-7

3.0 Government Furnished Information, Property, & Services 8

4.0 Contractor and Key Personnel Furnished Property 9

5.0 Performance-Based Requirements 10-16

6.0 Contractor and Key Personnel Qualification Requirements 16-20

7.0 Performance Requirements Summary 21

8.0 Peer Review CSU Provider Exit Profile 22

9.0 List of Attachments and Exhibits 23

10.0 Quality Assurance Surveillance Plan 24

PWS No. PHC-23-0610-PSY 12 Aug 2026

Pinon Health Center Performance Work Statement (PWS)

For Nonpersonal Services

Psychiatric Mental Health Nurse Practitioner

1.0 General: This performance work statement describes the requirements for non-personal services for a Psychiatric Mental Health Nurse Practitioner 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 Indian Health Service (IHS) is an agency within the U.S. Department of Health and Human Services and is responsible for providing federal health services to American Indians and Alaska Natives. The provision of health services to members of federally recognized tribes grew out of the special government to government relationship between the federal government and Indian tribes. This relationship, established in 1787, is based on Article I, Section 8 of the Constitution, and has been given form and substance by numerous treaties, laws, Supreme Court decisions, and Executive Orders. The IHS is the principal federal health care provider and health advocate for Indian people. The goals of IHS include: to ensure that comprehensive, culturally appropriate personal and public health services are available and accessible to American Indian and Alaska Native people; to promote excellence and quality through innovation of the IHS into an optimally performing organization; and to strengthen IHS program management and operations. The IHS currently provides a comprehensive health service delivery system for approximately 2.6 million American Indians and Alaska Natives who belong to 574 federally recognized tribes in 37 states.

1.1.1 Navajo Area Indian Health Service (NAIHS) is one of twelve (12) regional administrative units of IHS. The NAIHS delivers health services to a user population of over 244,000 American Indians in five (5) Federal service units on and near the Navajo Nation. The Navajo Nation is one of the largest Indian reservations in the United States with a population of approximately 399,494 enrolled members;

NAIHS provides healthcare to approximately 244,209 members in the Navajo Area (includes Federal and Tribal Service Units). The Navajo Nation consists of approximately 27,413 square miles in the states of Arizona, New Mexico, and Utah, with three (3) satellite communities in New Mexico. NAIHS primarily delivers health services to members of the Navajo Nation and the San Juan Southern Paiute Tribe, and also provides services to other Native Americans, including Zunis, Hopis, and other American Indian beneficiaries. The five (5) Federal Service Units (SUs) include Chinle, Crownpoint, Gallup, Kayenta, and Shiprock SUs.

NAIHS provides inpatient, emergency, outpatient, public health, and other services at four (4) hospitals, with seven (7) full-time health centers providing outpatient, community health, preventive health, and other services; there are also five (5) part-time health stations.

In addition to the NAIHS, the Navajo health care system includes an urban health program in Flagstaff, Arizona, the Navajo Department of Health (NDOH), and five Tribal health care corporations, who have contracts with NAIHS under the auspices of Public Law 93-638, the Indian Self Determination and Education Assistance Act. The P.L. 93-638 contracts and compacts with Tribal health corporations are authorized by the Navajo Nation to provide health care services in the respective regions served by the corporations, including facilities such as the Fort Defiance Indian Hospital/Tsehootsooi Medical Center, Winslow Indian Health Care Center, Inc., Tuba City Regional Health Care Corporation, Sage Memorial Hospital, and Utah Navajo Health System, Inc.

1.1.2 Chinle Service Unit (CSU) based in Chinle, Arizona (Northeast Arizona near Canyon

De Chelly National Monument), CSU serves a population of approximately 40,000 members with half of the population under age 25 years. CSU consists of one (1) 60 bed hospital, Chinle Comprehensive Health Care Facility (CCHCF), and two (2) full-time satellite facilities, Pinon Health Center (PHC) located in Pinon, Arizona, and Tsaile Health Center (THC) in Tsaile, Arizona. Services are also provided at the Many Farms and Rock Point Clinics on a part-time basis. CCHCF, located in Chinle, Arizona, serves as the health care hub for the region, and offers routine outpatient and inpatient primary care services, including Adult Intensive Care, General Surgery (including laparoscopic surgery), routine and operative Obstetrics, and 24-Hour Emergency Room Services. Strong Navajo cultural traditions exist within the community, offering an opportunity to learn the Navajo language, or to learn about traditional Navajo medicine.

1.1.3 Pinon Health Center (PHC) Serving a rural area, Pinon Health Center is an outpatient clinic associated with Chinle Service Unit - Indian Health Service in the Heart of the Navajo Reservation - Northern Arizona. Pinon Health Center provides care to approximately 11,000 patients - the majority of which are Navajo and many are traditional Navajo who still speak the language. A collegial group of providers offer services in primary care, women's health, counseling, dental, dietary and community nutrition, health promotions, lab, x-ray, native medicine, optometry, pharmacy, physical therapy, speech therapy, podiatry and public health nursing.

The facility consists of fifteen (15) exam rooms, four (4) Optometry exam rooms, fourteen (14) Dental bays, as well as large areas for Physical Therapy and Pharmacy.

1.2 Scope: The Contractor and their Key Personnel shall provide outpatient Psychiatric

Mental Health Nurse Practitioner services in accordance with Section 5.0, Performance-Based Requirements.

1.2.1 Duties and responsibilities will encompass outpatient Psychiatric Mental Health Nurse Practitioner Services to I.H.S. patients

1.2.2 Place of Performance: Services are to be performed at the Pinon Health Center

Counseling Services, Outpatient department, including the Ambulatory Care (Walk-

in) and Teen Clinic, and may, as needed, be performed at Chinle Comprehensive Health Care Facility Outpatient Departments including the Emergency Room (ER)/ Ambulatory Care (Walk-in) as well as other hospitals, clinics, and other healthcare facilities in the Navajo IHS Areas within the Chinle Service Unit. Other off-site locations may include Pinon High School Teen Clinic and community immunization and other public health events within the region served by Pinon Health Center, Chinle Service Unit and Navajo IHS Area. Telehealth services audio only or synchronous audio and visual may be provided for patients served through various sites across the Chinle Service Unit. Telehealth Services (work from an alternate designated work site) may be arranged for agreed upon timeframes upon meeting IHS environmental, privacy and technology requirements.

1.2.3 Period of Performance: 5 months (20 weeks).

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):

https://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:

https://uscode.house.gov/view.xhtml?req=granuleid%3AUSC-prelim-title25-chapter34&edition=prelim

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

https://www.hhs.gov/hipaa/for-professionals/index.html

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

1.3.7 IHS Service Unit and Health Center Policies, Procedures and Protocols:

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

1.3.8 Computer Security Act of 1987:

http://www.jointcommission.org/ http://www.cms.hhs.gov/ https://www.aaahc.org/ https://www.govinfo.gov/content/pkg/COMPS-11139/pdf/COMPS-11139.pdf https://uscode.house.gov/view.xhtml?req=granuleid%3AUSC-prelim-title25-chapter34&edition=prelim https://uscode.house.gov/view.xhtml?req=granuleid%3AUSC-prelim-title25-chapter34&edition=prelim https://www.hhs.gov/hipaa/for-professionals/index.html https://www.justice.gov/opcl/privacy-act-1974 http://csrc.nist.gov/groups/SMA/ispab/documents/csa_87.txt

1.3.9 Federal Code of Conduct: http://www.ihs.gov

1.3.10 IHS General Directives: https://www.ihs.gov/

1.3.11 IHS Computer Security Directives https://www.ihs.gov/issa/ http://csrc.nist.gov/groups/SMA/ispab/documents/csa_87.txt http://www.ihs.gov/ https://www.ihs.gov/ https://www.ihs.gov/issa/

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 Contractor and 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 Board Certification: Completion of requirements and application testing for board certification by the American Nurses Credentialing Center (ANCC). The ANCC Psychiatric-Mental Health Nurse Practitioner (PMHNP) (Across Lifespan) board certification examination is a competency-based examination that provides a valid and reliable assessment of the entry-level clinical knowledge and skills of the PMHNP.

2.5 Code of Ethics: The Code of Ethics for Psychiatric Mental Health Nurse Practitioner as approved by the American Board of Psychiatry and Neurology.

2.6 Contracting Officer (CO): A Government employee with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings.

2.7 Contracting Officer’s Representative (COR): An individual, including a contracting officer’s technical representative (COTR), designated and authorized in writing by the contracting officer to perform specific technical or administrative functions. 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 Contractor: The vendor, firm, or company awarded a legal binding contract to provide services.

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

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

2.11 Customer: Patients, staff and visitors to an IHS service unit and health center.

2.12 Customer Evaluation/Input: Written comments made to the Contracting Officer regarding the Contractor and Key Personnels performance. This is one of the criteria used to evaluate the Contractor and Key Personnel’s performance.

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

2.14 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.

2.15 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.

2.16 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.

2.17 Key Personnel: The Contractor's employee providing medical provider Services.

2.18 Non-personal Services Contract: a contract under which the personnel rendering the services are not subject, either by the contact’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.

2.19 Orientation: An activity designed to provide basic familiarization of the facility and transition the provider into the IHS Service Unit and/or Health Center and the clinical area(s) where the services will be provided.

2.20 Patient Outcome: End result of outpatient licensed independent provider care.

2.21 Performance Requirement Summary (PRS): Lists of 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 Purchase Order: An offer by the Government to buy supplies or services from a commercial source upon specified terms and conditions using simplified acquisition procedures (SAP).

2.24 Revolutionary FAR Overhaul (RFO): The Revolutionary FAR Overhaul (RFO) is a government-wide initiative to comprehensively streamline and simplify the Federal Acquisition Regulation (FAR) by returning it to its statutory roots. The RFO represents the most significant update to the FAR in over 40 years.

2.25 Service Unit: The local administrative unit of IHS.

2.26 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 directions 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.

2.27 Supervisor. A Government employee providing technical direction to the Contractor and Key Personnel but does not supervise them.

2.28 Tour of Duty: The time of day the provider is scheduled to perform patient care duties;

also considered the shift of the day, The time can vary according to the needs of each facility and/or clinic, e.g. 12-hour Tour of Duty, 8-hour Tour of Duty, 10-hour Tour of Duty.

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

2.30 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 Contractor and Key Personnel performance, will be made available to the Contractor and 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 will furnish Key Personnel with appropriate PPE other than specified in paragraph 4 of the contract. The Government will 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 Key Personnel identification badges for each Key Personnel. A minimum fee of $10.00 will 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 quality of provider service or includes mandates made by the IHS Service Units/Health Centers while the provider 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 services rendered in the specialty of Psychiatry in the delivery of patient care services will be inspected, reviewed and monitored by the Pinon Health Center Chief Medical Officer or designee for this order. Contracting Officer Representative (COR Phillip Antonio (928-725-9810) is primarily responsible for monitoring technical progress including surveillance and assessment of performance for this order.

3.5.1 Point of Contact: Sean Meade (928-725-9746) is the point of contact for this requirement.

4.0 Contractor and Key Personnel Furnished Property

4.1 Except for the property specified in paragraph 3 as government furnished, the Contractor and 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 4.4.A.7 and meet the approval of the Clinical Director at each IHS facility.

4.1.2 SmartCard/Subscriber Identity Module (SIM) USB Token: Contract Staffing Agencies are required to purchase SmartCard/SIM token access for assigned clinical contracting staff to utilize securely throughout the term of the contract. Model Recommendations will be provided upon request.

4.1.3 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 COR 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. The Contractor and their Key Personnel shall provide Psychiatric Mental Health Nurse Practitioner Services in the delivery of patient care to the Indian Health Services. Specific tasks include the following:

5.1 Psychiatric Mental Health Nurse Practitioner Duties:

5.1.1 Work under the general technical and administrative direction of the Pinon

Health Center (PHC) Chief Medical Officer or designee.

5.1.2 The Contractor and their Key Personnel shall provide professional psychiatric medical services or direct patient care services under the terms of this contract, appropriate and timely medical services in accordance with the standards of care established by recognized medical care organizations and in accordance with the policies and procedures of Chinle Service Unit’s Medical Staff Bylaws and Rules & Regulations, including attendance at department and medical staff meetings at Chinle Service Unit facilities. The Key Personnel shall provide acute, chronic, and urgent psychiatric clinical services in the Pinon Health Center Counseling Services Department and Outpatient Department, in accordance with the terms and conditions of this contract and in accordance with the standards of The Joint Commission, professional standards of their licensing board, Indian Health Service, Navajo Area and Chinle Service Unit policy and procedures and Chinle Service Unit Medical Staff Bylaws.

5.1.3 The Contractor and their Key Personnel shall provide professional medical services or direct patient care services as permitted by medical staff credentialing privileges as follows:

A. Interviews and examine patients within the full age spectrum, reviews past mental health history, and requests and/or performs complex diagnostic tests and examinations deemed necessary to obtain all possible information related to each case. Makes preliminary diagnosis utilizing health risk screening practices, directs, prescribes or provides treatment and monitors adverse and metabolic effects of psychiatric medications, evaluating for and acting upon abnormal vital signs including heart rate, blood pressure, weight and BMI. Works with clinical support staff to ensure applicable active Clinical Reminders are completed and appropriately addressed.

Arranges for specialized care or patient referral as required. Evaluates psychiatric walk-in patients within the full age spectrum who come to Ambulatory Care (Walk-in) when assigned or as needed. Based decisions upon information obtained, professional psychiatric medical knowledge and skills, and prescribe policies and procedures. Make notes of observations to be incorporated into clinical records. Provides emergency care as required. Provides definitive management in all psychiatric medical categories for cases that do not require referral. Gives total patient care in accordance with the Psychiatric Mental Health Nurse Practitioner’s training and experience and based on psychiatric standards of care, to include, but not limited to individual psychotherapy, family and couple psychotherapy, pharmacotherapy, evaluation services (to DES, court ordered evaluations, DSW, etc.) group therapy, relaxation therapy, cognitive and behavior therapy, and child and adolescent therapies to patients under his/her care.

Obtain consultation as needed. As clinically appropriate, provides care to patients for wide spectrum of acute and chronic illness. Unless otherwise delineated in the approved medical staff privileges, provides acute and chronic psychiatric care for patients 5 years and older (or younger if specialized training and certification in Child and Adolescent Psychiatry). In urgent cases, provides initial psychiatric evaluation for patients under 5 years with appropriate referrals to further specialized psychiatric care as indicated.

B. Provider must be certified in BLS. ACLS and PALS certification are not required but are highly recommended. Based on level of life support training and certification, serves as a member of the code team in life threatening situations for which the “code blue” or “medical emergency” activation system has been initiated.

C. Conducts psychiatric outpatient clinics making observations appropriate to the patient’s underlying disease and treatment plan, including current symptoms, provided with a sensitive understanding of culturally relevant issues. Reviews the patient’s medications, diet, therapy course, adherence to management plan and patient observations, when necessary. Make recommendations to modify regimen as indicated. Instructs and counsels patients and family members as required. Acts as a resource for treatment of acute and chronic mentally ill patients and an expert clinical advisor to counseling services case management and to primary care clinicians and other health professionals.

D. Refers patients to appropriate contracted medical or other government facilities, providing full clinical information for care and diagnostic procedures that cannot be adequately provided at local I.H.S. facilities.

Coordinates and integrates information obtained into the ongoing Health Care Program at the Service Unit and assures the provision of timely follow up care as required.

E. Works closely with patient’s primary care provider and other allied health professionals (i.e., Community Health Nurse, Social Workers, Health Educator, etc.) to utilize and coordinate the services of other health care professionals in the management of the patient’s medical, psychological and social problems. Ensures appropriate referrals are made and appropriate consultations are obtained after primary complete evaluation and documentation has been completed. Contributes to use of psychiatric standards to care, and monitors compliance with such standards for prevalent conditions with the Service Unit (substance abuse, depression, etc.)

F. Within specialty area, assumes responsibility for the mental health diagnosis, prevention therapy, maintenance and rehabilitation of patients in the capacity of a senior specialist or expert.

G. Key Personnel shall provide appropriate documentation regarding care rendered using the Chinle Service Unit’s (CSU) Electronic Health Record (EHR) system. All documentation by the provider will be entered into electronically using the electronic health record system. The provider is responsible for utilizing the CSU electronic health record system to obtain pertinent patient information in assisting care. It is the responsibility of the provider to use the training resources provided by the CSU to develop competency in utilizing the electronic health record system.

H. Produces timely clinical and non-clinical correspondence to ensure prompt coordination of care and feedback to patients, families, other professionals and organizations in accordance with HIPAA and other applicable standards. Assures preparation of appropriate medical records for all patients seen to ensure the accumulation and organization of all pertinent clinical data needed to provide comprehensive medical care. Create clinical reports for use by providers, hospitals, and other individuals and facilities.

Works closely with primary care providers and other allied health professionals (community health nurses, social workers, health education, etc.) in the provision of broad health programs services.

I. Dictates, electronically enters, or writes and assures preparation of appropriate medical records for all patients seen to assure the accumulation and organization of all pertinent clinical data needed to provide comprehensive medical care. Clinical data reports shall be completed in a timely manner and shall be maintained in compliance with CSU Medical Staff and The Joint Commission standards.

J. Assures preparation of appropriate medical records for all patients seen to assure the accumulation and organization of all pertinent clinical data needed to provide comprehensive medical care. Creates clinical reports for use by medical providers, hospitals, and other individuals and facilities.

Works closely with allied health professionals (community health nurses, social workers, health education, etc.) in the provision of broad health programs services.

K. Contractor and their Key Personnel shall submit invoices as required for payment of services rendered and hours worked. Key Personnel shall submit an original invoice. Invoice shall be certified by Key Personnel that services have been provided and attach daily sign in/sign out sheets that verify the hours worked. Invoices will also include certification statement of services received, which are to be signed by the Supervisor or designee and Contracting Officer Representative.

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

5.1.5 Key Personnel shall meet the Safety management reporting requirements in accordance with the Service Unit Safety Measure Policy.

5.1.6 Contractor and their Key Personnel shall be responsible for all applicable

Federal, State, And Local Taxes, Meals, Travel/Transportation. Lodging is available but must be paid for by the Key Personnel or contract agency.

Government quarters are available at prevailing rental rates plus utilities, as applicable, if government quarters are utilized. The Contractor and their Key Personnel shall be responsible and liable for the proper care of government owned or leased property furnished in occupied quarters.

5.2 Work Schedule:

5.2.1 Work shifts as arranged by Counseling Services Supervisor in coordination with the Chief Medical Officer for Pinon Health Center:

The Key Personnel shall work 100% of the contracted hours. The contracted hours shall be arranged by Primary Care Director or designee in conjunction with the Chief Medical Officer. Tour of Duty: Regular work hours are 8:00 a.m.

– 5:00 p.m. Monday, Tuesday, Wednesday, Thursday and Friday (40) hours per week. Pinon Health Center is closed on Federal Holidays and the IHS does not compensate for holidays. IHS does not compensate for work or time in tenant housing, unless pertaining to an emergency circumstance, Continuity of Operations Plan (COOP), or authorized by direct supervisor or covering supervisor, CMO or HSA.

Work hours beyond 5:00 p.m. maybe needed to meet patient care needs due to increased workload or patients pending transport to a higher level of care, for completion of time-sensitive projects and/or for required training. Overtime is compensated for at the same hourly rate and typically not 2 additional hours daily. Additional overtime amount will be authorized on an as-needed basis depending on patient workload and supervisory approval. Supervisor signing the timecard will be considered Supervisor approval. Patterns or trends of continuous overtime will need to be reviewed with Supervisor and Key Personnel for workflow improvement and plan to reduce regular overtime.

• Infectious Disease: In case of elevated spread of infectious disease(s), Key

Personnel shall be subject to working longer hours and/or beyond the Tour of Duty if patient load demands are present and rotating shifts to provide coverage within CSU outpatient settings including call-backs and weekends. Key Personnel will abide by Infectious Disease policies and guidance to mitigate contraction and or spread of infectious disease(s) including up-to-date policy on Personal Protective Equipment (PPE). PPE will be provided in accordance with Center for Disease Control guidelines.

5.2.2 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. If no replacement is determined in the timeframe specified, this shall be considered grounds for Termination or Default.

5.2.3 Work Flexibility. As directed by the Supervisor, the Key Personnel shall rotate into other duty sections as needed to support patient care; this will include Teen Clinic and/or Ambulatory Care Walk-in, Telehealth Services or other agreed-upon locations and services.

5.2.4 The Contractor and their 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 of at least fifteen (15) days (the exception is verifiable emergencies) in advance of the desired absence. Sick/annual leave/compensatory time are not authorized.

5.2.5 Contractor and Key Personnel shall provide a qualified replacement to authorize the approval of leave.

5.2.6 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:

A. The cause of the current illness or incapacitation AND

B. Indicating Key Personnel as contagious or non-contagious.

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

5.2.8 Emergencies, such as clinic closure will enable to the Key Personnel to work at alternate sites within the Chinle Service unit at the same rate. Travel to and from the alternate location, nor lodging at the designated site will be reimbursed. Telehealth may be authorized in emergent circumstances given the Key Personnel already has a secure telephone and internet line.

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

5.3.1 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 US Office of Personnel Management (OPM), Electronic Questionnaire for Investigation Processing (eQIP) 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. Within 10 business days after candidate is presented by the Contracting Agency, The Key Personnel will be required to have already signed a release for the most recent Medical License Board(s), American Board of Psychiatry and Neurology or applicable Board, National Provider Data Bank (NPDB) report. This report is to be dated within 10 business days of presentation of the Key Personnel, as part of the Key Personnel’s file to review by the onboarding team, including the Contracting Officer. 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.

5.4 Performance Evaluation:

5.4.1 The Contractor and their Key Personnel’s performance will be evaluated in accordance with the standards set forth in the contract and Performance-based Matrix of section 10.0.

5.4.2 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.

5.5 Identification of Key Personnel:

5.5.1 The Key Personnel shall visibly wear a government issued Key Personnel identification badge at all times during performance of duty.

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

5.6.1 Medical Records and Other Required Documentation: 100% percent of all medical records and other required documentation meet established IHS Medical Facility, The 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 paragraph 10.0 of this performance work statement.)

5.6.2 The Key Personnel shall ensure adherence to DHHS IT system security policies and procedures. The IT policies and procedures will be made available to Key Personnel.

5.6.3 The Key Personnel shall immediately report to the Contracting Officer or

COR any information or circumstances that may violate any statute, policy, or procedure.

5.7 IHS Information Technology Systems:

5.7.1 In performance of this contract, the Key Personnel shall adapt to and successfully utilize IHS information technology systems that are deemed by the Supervisor as necessary for acceptable Key Personnel performance. Proficiency of Electronic Health Record will be gauged by the ability to complete all patient notes within 24hrs of the visit. Utilizing overtime to complete notes is acceptable for up to 2 hours per day.

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

5.7.3 The Key Personnel shall follow all appropriate federal and locally required

Information Technology security requirements and will be operating under HIPAA and Privacy Act regulations.

6.0 Contractor and Key Personnel Qualification Requirements:

Administrative/Application/Onboarding/Credentialing. The Contractor or Key Personnel will provide from the beginning all accurate Candidate information for the application, onboarding, credentialing, security clearance, computer access, required computer-based learnings and throughout contract if awarded. The applicant will list one working email that they check on a daily basis for this process. The applicant will regularly check their spam email for any email from xxx.IHS.gov or xxx.na.ihs.gov. The applicant should be easily and readily contacted from initiation of the process, meaning from initial application/presentation of the candidate, to the first day of work to the end of contract.

For any candidate contact information change, IHS needs to be updated within 2 days of the change with acknowledgement from either Acquisitions, Hiring Manger, Credentialing, HR, Security or IT. All outbound IHS queries shall be responded to with pertinent answer within 3 business days. The answer should come from who was directly asked to who was asking.

If there are new Agency employees in management of the Key Personnel, there will be an introduction as to who the Agency employee is and what their role is. Within 10 business days after candidate as presented by the contracting agency, the key personnel will be required to have already signed a release for the most recent physician medical board, National Provider Databank (NPDB) report. This report is to be dated within 10 days of presentation of the Key Personnel, as part of the Key Personnel's file to review by the onboarding team, including the Contracting Officer. The Key Personnel shall 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. Key Personnel shall not redact candidate’s names from report.

6.1 Experience. The Key Personnel shall have completed an accredited Psychiatry

Residency Training program with a minimum of six (6) months experience in Psychiatry work experience, unless otherwise approved by the CSU Credentials Committee or Contracting Officer. There must be no lapse of services of more than six (6) consecutive months for at least six (6) months prior to beginning tour of duty with CSU.

6.1.1 Key Personnel shall have completed training and experience as a

Psychiatric Mental Health Nurse Practitioner (ages 5 and older).

6.1.2 Key Personnel shall have a fully valid and active license as a Psychiatric

Mental Health Nurse Practitioner throughout the term of the contract and complete requisite training and experience in the field.

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

American Board of Psychiatry and Neurology that is appropriate to specialty, and shall possess a current, valid, unrestricted appropriate 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 that additional scope of practice(s).

6.2.1 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.

6.2.1 The Key Personnel shall maintain a valid and current Cardiopulmonary

Resuscitation (CPR), Basic Life Support (BLS). Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS) and certifications are highly recommended.

6.2.2 Motor Vehicle Operator’s License. If required by the position, the Key

Personnel shall possess a valid state driver’s license throughout the term of this

6.2.3 The Key Personnel shall meet the qualifications and credentialing standards.

6.3 Health Requirements/Conditions of Employment:

6.3.1 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.

6.3.2 Immunization. The Key Personnel shall provide documentation as evidence of immunization as required by NAIHS immunization policy for the following:

• 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) within the past twelve (12) months. 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.

6.4 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.

6.5 Information Technology Skills. The Key Personnel shall possess basic knowledge, skills, and abilities to use and effectively navigate a computer and the subsequent electronic programs.

6.6 Orientation and Mandatory Training. The Key Personnel shall attend mandatory orientations and training specified by the government.

6.6.1 The Key Personnel will complete the most recent Information Systems

Security Awareness (ISSA) Training within 24 hours of reporting for duty and provide certificate of completion to direct supervisor.

6.6.2 The Key Personnel will complete the Protecting Children from Sexual Abuse by Health Care Providers Training within 24 hours of reporting for duty and provide certificate of completion to the direct supervisor.

6.7 Background Checks: 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 US Office of Personnel Management (OPM), Electronic Questionnaire for Investigation Processing (eQIP) 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. Within 10 business days after candidate is presented by the Contracting Agency, The Key Personnel will be required to have already signed a release for the most recent Nursing and Advanced Practice Nurse Board or applicable Board, National Provider Data Bank (NPDB) report. This report is to be dated within 10 business days of presentation of the Key Personnel, as part of the Key Personnel’s file to review by the onboarding team, including the Contracting Officer. 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.

6.8 General Requirements:

6.8.1 Key Personnel shall provide at minimum three current letters of reference from other health care providers familiar with the candidate'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 provider either holds or last held staff privileges. If the Key Personnel's provider has just completed a residency program, one of the letters shall be from the program director or service chief. If the Key Personnel was in private practice, they will be asked to provide the name of the hospital they were affiliated with or had privileges to and will authorize IHS to contact their direct supervisor or contact within their credentialing department or other sources that can attest to the Key Personnel as a reference. If the Key Personnel reports they were not hospital affiliated, the Key Personnel will be subject to peer review by other Providers/peers within the local practice community at the same time the Key Personnel was in private practice, and the choice of reviewing reference to be selected by IHS onboarding team.

6.8.2 The Key Personnel shall be subject to Medical Staff Ongoing Professional Practice Evaluation (OPPE) and Focused Provider Performance Evaluation (FPPE) as specified in the Chinle Service Unit Policy & Procedure, Focused Provider Performance Evaluation & Ongoing Professional Practice Evaluation.

6.8.3 Key Personnel shall work directly with the Chinle Service Unit Credentials

Committee to attain approval of credentials and privileges. The Key Personnel is to complete requested Human Resource and Credentialing paperwork and online background investigation within the required time frame determined by Human Resources and Credentialing Policy and Procedure. (Failure or delays in completing this paperwork may result in delays for the provider to complete check-in and begin clinical work.)

7.0 Performance Requirements Summary

Performance-based Task Indicator Standard Quality Assurance Incentives

Contractor and Key Personnel shall provide outpatient Psychiatric Mental Health Nurse Practitioner services in the delivery of patient care to the Navajo Area Indian Health Service, Pinon Health Center.

Competency

Compliance

Patient Outcomes

Professionalism

Credentialing

Documentation

Service Quality

Perform 100% required tasks at 100% of the required competencies (refer to 11.0)

100% compliance with IHS Service Units and/or Health Centers published Policies;

Procedures; Standards of Care; and Hospital and Laboratory Protocols.

No reports of breached patient safety, infection control, and other procedures that might adversely affect patient outcome.

Performance is characterized by continual cultural awareness and focus on customer service. 100 % adherence to the Code of Ethics and Federal Code of Conduct.

Uninterrupted credentialing as defined in

6.0 to 6.8 for period of contract.

100% of all medical records and other required documentation meet established IHS Medical Facility, Joint Commission, and CMS standards to include, but are not limited to, timeliness, legibility, accuracy, content, content, date, time, signature and designated profession.

Satisfaction with quality of service is evidenced by valid customer input. 100% adherence to ensure continuity of patient care and to provide replacement on time.

COR surveillance systems will include periodic inspections and customer complaint review.

Medical Staff supervisor will conduct periodic review of customer satisfaction and provider’s medical care.

Payment of contract price for satisfactory service.

No payment for incomplete work.

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

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

CPARS evaluation will be forwarded to the GSA/FSS Contracting Officer.

8.0 Peer Review CSU Provider Exit Profile. The Peer Review Exit Profile will be reviewed for each Key Personnel. A rating of “Fully Successful” or “Exceptional” must be attained.

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

9.1 Attachments

9.1.1 Position Description (Service Unit specific) – available upon request

9.1.2 Certification Statement for Performance Work Statement (PWS) No. CSU-14-01 (PHC-22-0610-PSY)

9.1.3 OMB Certification of Vaccination, OMB Control No. 3206-0277

9.2 Written Competency Assessments

a. Confidentiality/HIPAA/Patient’s Rights

b. EMTALA Compliance Exam, 2004

9.2.1 Standard Emergency Codes

9.2.2 Confidentiality: Legal and Ethical Concerns in Healthcare

9.2.3 An Introduction to Navajo Culture

9.2.4 Verbal and Telephone Orders

9.2.5 Pain Management

9.2.6 Focus Charting

9.2.7 Medical Staff by Laws

10.0 Quality Assurance Surveillances Plan. The Quality Assurance Surveillance Plan (QASP) is a document detailing the systematic surveillance method for Contract Services and describes the methodology by which the Key Personnel’s performance will be monitored.