3-RFP-244-17-0007-RDW.doc

RFP-244-17-0007-RDW

SECTION B

PART I - THE SCHEDULE

SECTION B - SUPPLIES OR SERVICES AND PRICE/COSTS

B.1

SERVICES

The Contractor shall provide services, as set forth in Section C, to all eligible Urban Indians, as defined in Section C.1.2, residing in the Billings, Montana urban area. The contract shall be awarded for a 12-month period with four (4) 12-month options, in accordance with the Indian Health Care Improvement Act, P.L. 94-437, as amended, codified at 25 U.S.C. §§ 1651–1660h.

B.2

COSTS

A. Estimated Cost: Limitation of Costs: Subject to Federal Acquisition Regulation (FAR) 52.232-20, Limitation of Cost (APR 1984), the total cost to the Government, including all direct and indirect costs for the performance of this contract, shall not exceed the annual amount of $ until the Contractor is notified in writing, by the Contracting Officer, that the ceiling amount has been increased.

B. Option to Extend the Term of the Contract: If the Government exercises its options pursuant to Section I.5, Option to Extend the Term of the Contract, the estimated cost will be increased as follows:

Term

Estimated Cost Option Year One

Option Year Two

Option Year Three

Option Year Four

Total (A + B)

Before any extension of the term goes into effect, the Contractor and the Indian Health Service must bilaterally agree and amend the existing contract to that effect.

SECTION C - DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK

C.1

DEFINITIONS:

A. URBAN CENTER

Urban center means any community which has a sufficient Indian population with unmet health needs to warrant assistance under Title V, Indian Health Care Improvement Act, as determined by the IHS.

B. URBAN INDIAN ORGANIZATION

The term “Urban Indian Organization” means a nonprofit corporate body situated in an urban center, governed by an urban Indian controlled board of directors, of whom at least 51 percent are American Indians/Alaskan Natives, for the purpose of establishing and administering an urban Indian health program and related activities as described in Title V of the Indian Health Care Improvement Act, and providing for the maximum participation of all interested Indian groups and individuals, which body is capable of legally cooperating with other public and private entities for the purpose of performing the activities described in section 1653(a) of this title.

C. ELIGIBILTY OF GRANTS AND CONTRACTS

To be eligible for a grant or a contract, an Urban Indian Health Program (UIHP) must be a nonprofit corporate body situated in an urban center and governed by a Board of Directors (BOD).

C.2

TARGET POPULATION

The target population for this contract are those eligible Indians residing in the Billings Urban area.

C.3

DESCRIPTION

The Contractor shall operate an Urban Indian Health Program. The program shall provide quality medical, outreach/referral, AIDS prevention and education, direct prevention/intervention, community education, health service referral, inpatient chemical dependency treatment referral, and structured outpatient treatment and aftercare services to chemically dependent Indian individuals and their families, and to eligible Indian people.

C.4

PROVISION OF SERVICES

A.

The overall goal of this contract is to provide a comprehensive health care system that will continue to elevate the health status of eligible Urban Indians to the highest level possible.

B.

To ensure the availability of the services and procedures stated herein in the Billings Urban Area, the Contractor shall provide the services either:

1. On-site; and/or

2. Through a formal referral system to local community provider(s) with whom the Contractor has a written agreement. The agreements shall identify, for example, services, fees, response time, performance standards, and other requirements.

3. Health center provides primary, preventive, and additional health services as appropriate and necessary, either directly or through established written arrangements and referrals C.

The Contractor shall maintain any minimum productivity standards stated in this contract.

D.

The Contractor is committed to and shall provide quality health services that will at all times meet applicable standards of care and practice applicable to each service and, where appropriate, to guidance of the Indian Health Service. Medical and other health services provided by the Contractor or through its sub-contractors shall be guided by the standards of care and practice applicable to those services, current Montana State law, and, to the extent applicable, other guidance such as IHS standards, the Joint Commission for Accreditation of Health Care Organizations (JCAHO) Ambulatory Health Care Standards; the Accreditation Association for Ambulatory Health Care (AAAHC) Standards; Centers for Medicare and Medicaid Services (CMS); and the Public Health Service Act.

E.

If carrying out a program to provide comprehensive public-health oriented services, the contractor shall utilize standards of care and practice regarding electronic data collection and documentation of beneficiary use, including current Montana State law, and, to the extent applicable, guidance such as IHS' practices, and shall use the Resource and Patient Management System (RPMS) or a similar system.

C.5

URBAN INDIAN BENFICIARIES

Pursuant to the Indian Health Care Improvement Act (IHCIA), 25 U.S.C. § 1603(13), (27), (28), the beneficiaries of the services to be provided under this contract are “Urban Indians,” defined as any individual who:

A.

Resides in an urban center, which is any community that has a sufficient urban Indian population with unmet health needs to warrant assistance under the IHCIA, as determined by the Secretary of the Department of Health and Human Services (“HHS”); and who

B.

Meets one or more of the following criteria:

1. Irrespective of whether he or she lives on or near a reservation, is a member of a tribe, band, or other organized group of Indians, including: (a) those tribes, bands, or groups terminated since 1940, and (b) those recognized now or in the future by the State in which they reside; or

2. Is a descendant, in the first or second degree, of any such member described in (1); or

3. Is an Eskimo or Aleut or other Alaska Native; or

4. Is a California Indian;

or

5. Is considered by the Secretary of the Department of the Interior to be an Indian for any purpose; or

6. Is determined to be an Indian under regulations pertaining to the Urban Indian Health Program that are promulgated by the Secretary of HHS.

C.6

PROGRAM OBJECTIVES

The Contractor shall assure quality assurance of programs as indicated in the specific criteria listed in each program description area within this scope of work.

A. Provide, through the cost effective use of IHS funds and additional Federal, State and local funds, direct healthcare services to Indian patients in the areas of: medical, outreach/referral services, and other related services.

B. Provide encounters of medical care with an emphasis on health promotion/maintenance.

C. Provide encounters of outreach/referral services.

D. Ensure that at least 90 percent of all Indian infants serviced by the program (0-27 months) and children (to age 6 years) have completed immunizations according to established protocols.

E. Provide health education information to Indian patients.

F. Provide effective and efficient administration of all the Contractor's programs.

G. Identify unmet health needs and service gaps in the urban Indian community and attempt to implement new services or identify community resources for such services to meet those needs.

H. Develop proposals to support existing and needed additional services, social services, consumer services, etc.

I. Provide assurance for quality care and patient satisfaction.

C.7

SCOPE OF WORK

The Contractor shall provide the qualified personnel, equipment, facilities and support services necessary to carry out the program. The specific services to be provided under each element of the program shall be as follows:

A. Administrative Services:

1. Develop and maintain an arrangement with an external accounting firm to provide accurate and timely fiscal reporting compliance with contract terms.

2. Assure the Board of Directors (BODs) are directly involved in the development, periodic review, and maintenance of policies and procedures related to the administration and management of the services involved in the contract with approval of the BODs.

3. Development and maintenance of appropriate administrative files and records relating to the contract and evaluation criteria, i.e., minutes of BODs meetings, equipment inventory, subcontracts, etc.

4. Provide a minimum of one day of in-service training for health personnel.

5. Provide efficient daily administration of all programs including:

a. Supervision of personnel in medical services, referral, planning, personnel, accounting and maintenance.

b. Coordination of in-house and community health activities.

c. The BODs are directly involved in the Budget development, coordination and monitoring with approval of the same.

d. Implementation of the BODs policies into the daily operation of the program.

6. Provide for timely and accurate reporting of required data and information to the BODs and appropriate Federal, State and local agencies.

7. Identification of unmet community needs and gaps in existing services offered by the Contractor and other agencies.

8. Coordination with other agencies to determine who can best provide the needed services.

9. Develop proposals to support existing and needed additional services, social services, consumer services, etc.

10. Coordinate the Contractor's services with other urban health programs and with other State and Federal agencies to ensure continuity of care to clients.

11. Meet periodically with the Crow Service Unit for the purpose of sharing service delivery activities and discuss problems and concerns of service coordination.

12. Development of joint resource sharing efforts with other urban Indian health programs and community health centers.

13. Develop and maintain a management information system to facilitate collection of up-to-date health services data as follows:

a. A data collection and retrieval system for outreach health/referral services and other related services.

b. A data collection and retrieval system for direct outpatient services.

14. Evaluate the delivery of services to patients.

15. Providers of direct medical care shall meet the following standards and certifications:

a. The Contractor will ensure that all of its clinicians providing medical and behavioral health services, and other services required by State law are a licensed or certified, have a valid, unrestricted license or certification in the State of Montana at all times (primary source verification of provider licensure, registration, or certification).

b. The Contractor shall conduct a credential verification of all clinicians’ professional education, post-graduate training, delineated clinical privileges, and Drug Enforcement Administration number. It will also query and report to the National Practitioner Data Bank in accordance with the requirements of the Health Care Quality Improvement Act.

c. In addition to the certification and licensing requirements of paragraph a, Nurse Practitioners and Physician Assistants shall work under written standing orders and/or protocols that are updated and signed annually; and be supervised clinically by one or more contract physician(s) assigned to the program.

d. Possess of current malpractice coverage issued by a responsible carrier of not less than $1,000,000.00 per occurrence/$3,000,000.00 total aggregate

e. A completed application for medical staff membership or the equivalent.

f. Evidence of current certification in Cardiopulmonary Resuscitation (CPR).

g. Three (3) letters of recommendation from other Healthcare providers with whom the physician has practiced and can attest to the physician’s competence.

h. Immunization and PPD status.

16. Obtain supplies/equipment and related products at reasonable costs, for example, by accessing the Government supply sources (commonly referred to as “Federal sources of supply” or “FSS”) for which the Contractor has received approval in accordance with Part 51 of the FAR. The Contractor’s use of Government supply sources is limited to purchases of supplies/equipment and related products, as well as other resources authorized by law, that are within the scope of this contract. The Contractor should maintain separate dispensing and inventory records for each source from which it obtains supplies/equipment and related products.

B. Outreach/Referral Services:

a. The Contractor shall provide quality and timely information, referral and outreach services to eligible Indian people residing in the Billings Urban area. Outreach services shall include transportation, health instruction and education, liaison, and patient advocacy.

a. Provision of transportation services, at a minimum, shall include routine scheduled trips to the Crow Service Unit/Pryor Health Clinic to allow access to available services for eligible Indians.

b. The Contractor shall assist patients in using other transportation resources that are available in the Billings Urban area by:

1. Providing city system schedules and suggests the use of the system when appropriate.

2. Explore transportation resources for the elderly, youth, veterans and handicapped clients.

b. Referral Services:

a. The Contractor shall maintain a system for referring Indian people to appropriate health service resources. The Contractor shall assist Indian people in becoming familiar with, and utilizing, such health services resources that provide services to Indian people. Referrals and assistance must be documented.

b. The Contractor shall continue to identify health resources at the Federal, State, and local level to provide support for expanded services to the Billings Indian Community. The Contractor shall assist these health service resources in providing services to Indian people. The Contractor will keep a file of resources contacted and the results.

c. Client Advocacy:

a. The Contractor shall maintain an updated advocacy plan for the urban Indian health patients in need of assistance in obtaining health services beyond the scope of the services provided by the Contractor.

b. The Contractor shall provide the Urban Indian Community with information about public and private health service resources, which are or may be available to urban Indians.

C. Health Education Services:

1. The Contractor shall provide basic health education to the Urban Indian Community, which, at a minimum, shall include:

a. Non-personal health information via mass media, workshops, meetings, pamphlets, and individual contacts, which promote an awareness of health attitudes and behaviors.

b. Provide the Urban Indian Community with information on health promotion and disease prevention.

c. Assist the primary care providers in educating the Indian patients about health problems.

2. Training Programs – The Contractor shall establish and implement training programs to accomplish the referral and education services through workshops, meetings, and day-to-day contacts, the Contractor shall train, instruct and educate.

a. Primary Care providers in locating health resources for urban Indians.

b. Urban Indians in becoming familiar with and utilizing available health services resources.

c. Urban Indians on basic health education.

D. Medical Care Services:

The Contractor shall provide each eligible Indian person in the urban community with the opportunity to obtain health care through the provision of direct and indirect medical services within available resources.

1. Direct medical care services shall be provided using regularly scheduled hours that are to be established Monday through Friday, between the hours of 8 am to 5 pm, unless otherwise approved by the Chief of the Contracting Office. These hours are to be posted for the urban Indian population to see. Provision of direct care shall be subject to the availability of funds.

2. All indirect medical care services shall be provided through referral to appropriate providers. These referral determinations and authorizations must be in compliance with an established policy that sets forth priority need criteria to be used by staff in determining method of referral.

3. All clinic staff shall be certified in Basic Life Support (BLS), in accordance with the American Heart Association guidelines. The Contractor shall maintain current cardiopulmonary resuscitation (CPR) certification for all clinic staff and train all staff on the use of Automatic External Defibrillators (AED).

4. Medical services shall include, but not limited to:

a. Taking comprehensive medical histories

b. Administer physical exams.

c. Diagnosis and treatment of illness and other medical problems.

d. Referrals for appropriate specialized care that may not be available from the Contractor.

e. Minor surgical procedures, such as lacerations and repair of dislocated joints.

f. Establish a health maintenance program for adults and children.

5. The medical services provided will be organized in a way that reflects and complies with the standards established in the IHS Onsite Review Manual.

6. The Contractor’s medical policy and procedures manual shall be reviewed and updated on a routine basis, at least bi-annually E. Nursing Services:

The Contractor shall employ a Registered Nurse (RN) or Licensed Practical Nurse (LPN) holding a current license in the State of Montana. Specifically, the Contractor shall provide the following ambulatory care nursing services:

1. Nursing assessment to identify health problems of the individual (including history taking), using triage nursing procedures and current signed protocols.

2. Development and maintenance of a current policy and procedures manual and an active quality assurance monitoring program for the medical department.

3. Patient counseling to provide information and education on diseases, abnormal physical findings, preventive health measures, reason for referrals, need for follow up, and repeat clinic visits. Documentation of education on 80 percent of all patients seen by name.

4. Provision of direct patient care includes the execution of the medical orders. There should be less than one percent error rate in administration of medicine.

5. Follow up of patients referred to other services will be documented on 90 percent of patients’ records including missing appointments and those with abnormal laboratory tests.

6. Managing care for selected patients according to protocols mutually developed by nursing and medical personnel.

7. Participation in the management of the day-to-day clinic operation and maintenance.

8. Coordination of services for patients with other disciplines and agencies.

9. Documentation of nursing services provided will be done 100 percent of the time in the POMR/SOAP format in the patient health record.

F. Indirect Medical Services:

Indirect medical services provided by the Contractor shall include, but not limited to:

1. Referrals to an IHS Service Unit for specialized care after an eligibility determination is made.

2. Dispense prescription medications under the supervision of a physician, procure medical supplies and necessary X-Ray services, process lab work, and issue non-prescription drugs for self-care to patients.

3. Develop networks with private, State, Federal and other medical care sources and facilities.

4. Provide patient follow-up.

G. Clinical Records:

A. The Contractor shall provide a clinical records system for collecting, processing, maintaining, promptly retrieving, releasing, and safeguarding patient records according to established IHS and Urban policies and procedures.

B. The Contractor shall ensure the confidentiality, security, and safety of clinical records entrusted to the designated person responsible for the clinical records department, and shall comply with the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Contractor shall maintain the utmost confidentiality of behavioral health and alcohol/substance abuse records and abide by the following: HIPAA and implementing regulations at 42 CFR Parts 160 and 164; 42 CFR Part 2; and applicable State laws and regulations. All files shall be kept in a locking file cabinet that is kept in a record room that is secured at all times.

C. The Contractor shall assign a person qualified by education, training, and/or experience to be in charge of clinical records, whose responsibilities include, but are not limited to:

1. The confidentiality, security, and physical safety of patient records, which the Contractor shall secure away from public access behind at least two locks;

2. The timely retrieval of individual records upon request;

3. The unique identification of each patient record;

4. The supervision of the collecting, processing, maintaining, storing, retrieving, and releasing clinical records and health information; and

5. The maintenance of the clinical records in a recognized uniform format.

D. The Contractor shall maintain adequate space, facilities, and equipment for the clinical records, including:

1. Properly maintaining work and storage space that is adequate in layout and size.

2. Securing the records in a satisfactory manner, such as in a locking cabinet or a room that can be locked or otherwise secured, and limiting physical access to the records.

E. The Contractor shall establish and implement a Policies and Procedures Manual concerning the clinical records department.

1. The Policies and Procedures Manual shall include and address issues such as, but not limited to, the following:

a. Retention of active records;

b. Retirement of inactive records;

c. Content of records;

d. Timely entry of data in the records;

e. Release of information contained in the records; and

f. Destruction and/or disposal of records.

2. The Policy and Procedures Manual shall be reviewed, updated, and signed by all providers annually.

F. The Contractor shall make the records available to health care practitioners any time the organization is open to patients.

G. The Contractor shall conspicuously document a problem-oriented summary or list of significant past surgical procedures and past and current diagnoses or problems in each patient’s clinical record to facilitate the ongoing provision of medical care. The summary shall be legibly recorded and filed in the same location in all patient charts. The summary shall include, but is not limited to:

1. Chronic medical conditions, including medical diagnoses of conditions for which the patient receives medication or treatment on a repeated or continuing basis;

2. Significant surgical conditions, including major procedures;

3. Any allergies and outward reactions to drugs; and

4. Conditions that are likely to significantly influence future care.

H. The Contractor shall ensure that entries in a patient’s record for each visit shall follow the SOAP (Subjective, Objective, Assessment, Plan) format and shall include, but not be limited to:

1. Date;

2. Practitioner’s name and profession, i.e. MD, RN, etc.

3. Chief complaint or purpose of visit;

4. Objective/Pertinent physical findings;

5. Diagnosis or medical impressions;

6. Studies ordered, such as laboratory or x-ray studies;

7. Therapies administered;

8. Disposition, recommendations and instructions to the patient;

9. Legible signature of practitioner, including the appropriate professional title.

I. When necessary for assuring continuity of care, the Contractor shall obtain summaries of records of a patient who was treated elsewhere (such as by another physician, hospital, ambulatory surgical service, nursing home, or consultant) and file the summaries in the designated location in the clinical record.

H. Medications/Prescriptions:

1. The Contractor shall purchase medications/prescriptions for eligible patients within the resources available.

2. The Contractor must establish a post medication/prescription policy and procedures.

3. The Contractor will periodically obtain technical assistance from a qualified provider to determine the efficacy of the prescription practices of providers.

I. HIVAIDS/STD Education and Prevention Activities:

1. The Contractor shall provide education and prevention activities on HIV/AIDS/STD, including:

a. Education workshops for the community, including community groups, schools, youth groups, and drug and alcohol treatment programs;

b. Annual HIV/AIDS/STD in-service training for staff members; and

c. On-site HIV/AIDS/STD education and counseling for patients.

2. The Contractor shall use evidence-based educational methods, such as those described by the Centers for Disease Control (CDC).

3. The Contractor shall develop a system for identifying patients at risk for HIV/AIDS/STD, including an HIV/AIDS/STD risk assessment form, a flow sheet for sexual history, etc.

4. The Contractor shall engage in HIV/AIDS/STD surveillance and case management activities, including developing:

a. A tracking and surveillance system for monitoring the number of persons tested for and diagnosed with HIV/AIDS/STD.

b. A protocol HIV/AIDS/STD testing, treatment, and referral (including partner notification), consistent with current Centers for Disease Control and Prevention guidelines. The Contractor should actively follow-up on referrals to ensure the patient is receiving high quality, comprehensive treatment services.

J. Quality Assurance Program:

The Contractor shall provide an environment to promote and to strive toward improved quality of care.

A. Operating License: The Contractor shall maintain a valid clinic operating license from the State of Montana.

B. Health Care Professionals: The Contractor shall employ licensed health care professionals with current, unrestricted licenses, and shall, among other things:

1. Provide training for all employees to perform their jobs adequately, including training in: alcohol and substance abuse topics (annually), managing medical and other emergencies, and emergency preparedness;

2. Ensure adequate supervision of all employees;

3. Support a peer review program with written by-laws in which Licensed Practitioners participate; and

4. All clinic staff shall be certified in Basic Life Support (BLS), in accordance with the American Heart Association guidelines. The Contractor shall maintain current cardiopulmonary resuscitation (CPR) certification for all clinic staff and train all staff on the use of Automatic External Defibrillators (AED) C. Accreditation: The Contractor shall have national accreditation from

, or if the Contractor is not accredited, shall prepare for a survey and accreditation during this contract year.

D. Malpractice Insurance: The Contractor shall obtain professional liability insurance that provides coverage for all employees, contractors, and volunteers consistent with the minimum levels of professional liability insurance mandated by the laws of the State of Montana. The professional liability insurance policy must provide for extended reporting endorsement coverage for claims-made policies, also known as “tail coverage,” for a period of not less than three years after the end of the contract term. In states where there is no mandatory professional liability insurance coverage, the Contractor must maintain professional liability insurance coverage of at least $100,000 per claim and annual aggregate of $300,000, with tail coverage for a period of three years after the end of the contract term. The Contractor must provide documentary proof of the insurance coverage to the contracting officer prior to executing this contract. The Contractor shall notify the contracting officer immediately of any material changes in coverage that could negatively impact the Contractor's ability to carry out the scope of work of this contract.

E. Quality Assurance/Continuous Quality Improvement Plan: The Contractor shall:

1.

Develop and implement a written Quality Assurance/Continuous Quality Improvement (QA/CI) plan that describes the objectives, organization, scope, and mechanisms for overseeing the effectiveness of the monitoring, evaluation, and problem-solving activities, consistent with the confidentiality requirements of 25 U.S.C. § 1675. To ensure completeness and avoid unnecessary work, the plan should model a nationally recognized group such as JCAHO.

2.

Create a QA/CI committee that is responsible for the implementation of the plan and reporting information to the Governing Body or Health Board. The committee shall be representative of the various clinic functions and departments and shall not be limited to the clinical disciplines. The Committee shall hold regular meetings and shall document the attendance and activities.

3.

Appoint the medical director as responsible for planning and completing those QA/CI activities assigned to the medical department, including evaluating: clinical performance, quality and appropriateness of diagnostic and treatment procedures, use of medications, lab, and x-ray services, emergency procedures, deaths, and hospitalizations after outpatient visits.

4.

Hold performance improvement meetings with all staff at least quarterly.

5.

Continuously monitor at least one clinically-related and one administratively-related outcome measure.

6.

Develop written documentation of these activities and evaluate any interventions implemented.

7.

Maintain confidentiality of medical quality assurance records and testimony, consistent with 25 U.S.C. § 1675.

F.

Risk Management Program: The Contractor shall develop and implement a Risk Management program, including periodic review of clinical records.

K. Disaster Planning The Contractor shall establish an emergency preparedness plan for the organization and participate in emergency preparedness planning for the community.

L. Facilities The Contractor shall provide a safe and sanitary environment for the delivery of health care services, including compliance with Federal and State laws.

M. Corrective Action Plan:

The Contractor, with the BODs, will plan and implement actions necessary to correct the deficiencies identified by the Corrective Action Plan (CAP) that is developed as a result of the annual evaluation.

N. Chemical Dependency Treatment Program:

a. Program Staff:

The Contractor shall provide, for direct client care, personnel who meet the following minimum qualifications:

1. All newly hired counselors who are chemically dependent shall have a minimum of two years of continuous sobriety.

2. All staff in an applicable position must have background checks that meet the requirements of the Indian Child Care Protection Law.

3. Program staff that has anything to do with direct patient care shall have No documented cases of chemical abuse for two years prior to employment.

4. Direct patient care staff who is involved in a documented case of chemical abuse that brings discredit to the program will be terminated.

5. Terminated staff, when applying for rehire to the program, will be subject to the sobriety and certification requirements with new background checks.

6. Program administrators must affirm in writing that his/her employment performance has not been impaired by alcoholism/substance abuse over the past three years.

7. A certified CD Counselor with at least two (2) years of CD counseling experience will supervise the CD Program after certification.

8. The Director of the chemical dependency program will be a credentialed CD individual.

2. Staff Certification:

1. As part of National Indian Health Service Standards, any alcoholism program staff that has direct contact with chemical dependent clients in the program in a counseling capacity will meet certification standards for the state in which they are practicing. At the time of hire, counselor trainees must meet all the requirements for certification except the supervised work experience. The counselor trainee may obtain supervised work experience after hire into the program providing that this experience satisfies the requirements of the certification board. Upon completion all pre-testing requirements, the counselor trainee has one year to pass the written certification examination and two years to pass the entire examination procedure.

2. Qualification guidelines:

3. Indian Health Service qualification guidelines, as specifically related to Urban Programs will be followed for all new positions when vacancies occur in existing positions.

4. Cardiopulmonary Resuscitation (CPR).

5. Each full time CD Counselor, who does not have documentation of having attended CPR, Inhalant Abuse, and vital signs training, will within four months of performing outpatient services, attend and attain documentation of successful completion of such a course in order to deal with alcohol related emergencies.

6. All CD Counselors will follow the Billings Area IHS ethical standards from chemical dependency counselors.

7. All CD Counselors will follow all regulations regarding Confidentiality (41 C.F.R. Part 2).

8. All CD Counselors will follow Privacy Act regulations pertaining to patients’ rights and privacy.

3. Program Certification:

The Contractor will, for duration of the contract, meet the following criteria:

a. Develop and execute a signed agreement(s) with an existing, State-approved, JCAHO-accredited, or IHS accepted Accreditation Board, i.e., CARF, adult/adolescent outpatient chemical dependency facility to:

1. Provide such adult/adolescent outpatient chemical dependency service under a subcontract; or,

2. Provide professional and technical supervision to the counselors employed by the Urban Chemical dependency program in providing such adult/adolescent outpatient chemical dependency services.

b. The IHS agrees to accept documentation of such affiliation or contract as assurance that the Urban adult/youth outpatient program meets minimum health program and professional standards or until the Urban adult/youth outpatient program receives State approval or JCAHO accreditation; or, the Contractor must possess and maintain State approval, JCAHO or CARF accreditation; or, the Contractor must meet standards, agreed upon by both parties (IHS and Contractor), that are o less stringent than applicable Federal and State standards with an oversight body to review the program for compliance with such standards.

4. Program Services:

1. The Contractor shall provide the direct prevention/intervention, community education, inpatient chemical dependency treatment referral, structured outpatient treatment and aftercare services to chemically dependent Native American individuals and their families in the community.

2. Referrals to Inpatient treatment will be provided to qualified Native Americas according to eligibility criteria in 42 C.F.R. 36-23.

3. The Contractor shall provide intake, diagnostic assessment, and referral services to all clients who see help for their alcohol and/or mood-altering substance abuse problems that are eligible for services.

4. Program chemical dependency staff shall provide intake, diagnostic assessment, problem recognition; treatment planning developed with the client, as well as referral and/or therapy services to a minimum of 40 clients each month.

5. Clients in need of emergency medical detoxification services shall be referred to the appropriate facility.

6. Staff will use ASAM criteria in the referral to patient placement.

7. Those clients that are appropriate for outpatient treatment based on the diagnostic assessment will be internally referred for structured outpatient treatment. This structured program will consist of, at a minimum:

1. Intake/diagnostic assessment/treatment planning

2. Lectures/videos

3. Group Therapy

4. One-to-one counseling

5. Aftercare planning

6. Treatment plans for each clients in charts

8. A recommended modality of treatment to be used in the program would include and encourage Cultural sensitivity to Native American traditions.

9. The Program will develop and administer to adult and adolescent client’s evaluations that will determine overall program effectiveness.

10. Program will utilize the Behavioral Health 3.0 software provided by IHS to report all activities relating to the CD program in reference to client activity and prevention activities in the community.

11. Follow-up will be done and recorded according to Behavioral Health 3.0.

12. The categories for each of these evaluations (adult and adolescent) will focus on:

1. Abstinence rates

2. Improvement of lifestyle

3. Utilization of program’s treatment components

4. Utilization of community resources

Aftercare:

It is required that the client’s home-based counselor be in weekly communication with the inpatient treatment counselors. The home-based counselor, the inpatient treatment counselors and the client design the client’s aftercare treatment plan. Further, while the client is in inpatient treatment, the client’s family receives weekly counseling and continues to be a important participant in the two-year outpatient aftercare plan.

Clients returning from primary residential treatment will be admitted back into the program in the aftercare component and expected to participate for a minimum of two years. Recommended stages and services provided in this two-year aftercare program is as follows (Contract may exceed these services, if they so desire).

Recommended by IHS to stay in compliance with Federal funding in accordance with the continuum of care following client’s recovery for two (2) years after inpatient treatment.

Some of the issues that will need to be addressed in the stages of aftercare are: signs of relapse, feelings and defenses, family dynamics, the enabling process, forgiveness, shame, adult/children issues, relationships and intimacy, family restructuring, grief, and plans for continued recovery. The above would be in addition to Alcoholics Anonymous (AA) and/or other support groups.

Following discharge from the program, the client will be followed up on an 18 and 24-month basis using Behavioral Health 3.0 follow-up. A follow-up report will be placed in the client’s file.

O. General Outpatient Services:

The following outpatient services will be made available to clients:

1. Twenty-four (24) hour-a-day crisis counseling will be available at the program during regular hours or after hours on an on-call basis.

2. If necessary, transportation will be provided to any client wishing to attend AA meetings and/or ceremonial sweats.

3. All clients will be made aware of and referred to the appropriate support services available in the community, including, but not limited to, medical services, as well as medical health services.

4. Each full-time counselor will maintain a minimum caseload of ten active clients, meeting with him or her on a minimum of two hours a week. All clients who missed appointments will be documented on clients’ service worksheet and recorded in the computer system.

5. It is anticipated that there will be times when the client caseload drips below the minimum of ten active clients per counselor. When this is the case, it is expected that the counselors will increase their time providing community prevention/education contacts, as well as promoting the program itself within the community.

P. Prevention Services:

The Chemical Dependency Program will provide chemical dependency prevention/education services to the community. These services will include providing chemical dependency education and chemical dependency evaluations to local schools, judicial system, religious groups, health care programs, youth organizations, parent/community groups, etc.

1. Each full-time chemical dependency counselor will provide community education. These can include, but are not limited to, community presentations, jail and court visits, family crisis intervention, conducting formal interventions, etc.

2. Counselors that have been provided with training in “Beginning Alcohol and Addition Basic Education Studies (BABES)” will advance their skills to creating appropriate psychodramas to administer to schools, community groups, and families.

3. Programs will continue to create public forums in the community addressing the multitude of issues related to alcoholism and chemical dependency, i.e., seminars and workshops, both formal and informal. Where these are reservation-based newspapers or newsletters, the program will publish monthly articles addressing issues related to alcoholism and chemical dependency.

4. All prevention services will be documented and recorded in the Behavioral Health 3.0 software system.

5. Reports will be made available to individuals/agencies providing funding to the program.

6. The program prevention supervisor will maintain a register of prevention/education services provided to the community, which will, at a minimum, include the date of service, target group, type of presentation given, number of participants attending, an attendance roster, and when audience size allows it an evaluation of the service, whether the service was requested, and a staff assessment of the service or how they felt it was received by the target group.

7. The program shall provide, two times per year, a community/family social function that supports and promotes a chemically free lifestyle.

8. Suggested topics to be included in these functions are issues in Co-Dependency, Community Enabling, The Addictive Cycle, Intervention Strategies, Grief Issues related to chemical Dependency, etc.

Q. Follow up and Evaluation:

1. The program will develop and administer to clients an evaluation that will review and help to determine overall inpatient/outpatient program effectiveness. The need is to focus on actual numbers of people staying sober and effectiveness. The need is to focus on actual number of people staying sober and chemically free as well as any evaluation, they may seek technical assistance from the Area Alcoholism Coordinator’s Office.

2. The Chemical Dependency Program will attempt to follow up contact at 6 and 12-month intervals with 100% of clients who have completed the total treatment program. Staff will document in Behavior Health 3.0 and client file progress notes, the follow up attempts, and results.

R. Space and Program Service Hours:

The program will provide a space, which is certified by a Comprehensive Environmental Health Program Survey for the purpose of this contract. The space must be adequate for individual counseling and group activities.

The program will open and be operational 40 hours per week from 8 am to 5 pm Monday through Friday, for a total of 248 days of service. The program will serve as a location where people with chemical dependency problems may be referred for motivational counseling or more intensive treatment. The program will also serve as a location for community education classes, ad for clients to make contact for aftercare service upon returning from primary residential treatment (PRT).

S. Administrative Support Services:

1. Client Charts and Records: All client activity will be documented in the client chart using Behavioral Health 3.0 and PCC forms.

2. Formal interviews with clients, their families, and other significant persons/events during the client’s treatment must be documented as well. The recommended format for formal documentation is the SOAP format:

S = Significant client statements

O = Observation of presenting behavior

A = Counselor assessment of client and/pr issues addressed

P = Plan for continued treatment

3. Protection and confidentiality of client charts and records will be established through program policies and monitored in accordance with the Federal law of Confidentiality (42 CFR), which prohibits the sharing of client information unless the client gives specific written permission to do so.

4. Policies and Procedures: A policy and procedures manual must be available to all program personnel. This manual will be based on the Indian Health Manual, Chapter 18, Part 3, issuance of the Alcohol/Substance Abuse Program and JCAHO, State of Montana, CARF.

5. Staffing Meetings and Client Staffing: The program (through the Program Director or his/her designee) will conduct one staff meeting per week to conduct program business ad one separate staff meetings per week for multidisciplinary screening team evaluation of client treatment referrals, to review and update client and patient aftercare and treatment plans/files.

6. Assessment and Referral: The Contractor will provide Assessment/Priority Rating/Referral Services for clients who are referred from other agencies.

7. All client referrals to the Outpatient Program will receive a social assessment and diagnostic assessment of their substance abuse problem using the Substance Use Disorders Diagnosis (SUDDS), Substance Abuse Subtle Screening Inventory (SASSI) and program choice of one other assessment instrument. An individualized treatment plan will be developed and ongoing counseling services will also be provided. All clients’ will receive a health screening as appropriate. Each client will receive at least two hours per week of counseling and assistance services. Counselors will be responsible for completing Behavioral Health 3.0 forms required, including documentation in progress notes. At least 30 hours of counseling will be provided per week. The remaining 10 hours will appropriately be spent in some type of Prevention.

8. Referral for inpatient treatment: Primary Residential and Intermediate Treatment. In order to focus resources and services on community education and outpatient/family aftercare services, the program will refer clients for primary residential care and intermediate care. When necessary, the Contractor will provide transportation for referred clients.

9. Assessment/Priority Rating/Referral: all referrals for primary residential treatment, both adult and adolescent, must be formally assessed utilizing standardized assessment tools, the SUDDS and SASSI, and present the case to the CD Screening Team.

10. For follow-up objectives, all clients who are referred to inpatient services will have an initial and follow-up Behavioral Health 3.0 worksheet in clients file for outcome information. A weekly log must be kept of all patients discussed by the CD Screening team, with priority rating, disposition, date of referral, referral center, date of admission, and length of actual stay noted. A copy of the weekly log will be provided on a weekly basis for internal monitoring purposes.

11. It is recommended that the CD Screening Team Members, at a minimum, include the Alcohol Program Director, IHS Service Unit Clinical Director, IHS or Tribal Behavioral Health Program Director, and IHS Medical Doctor. Clients needing Primary Residential Treatment for their problem will be referred to appropriate treatment centers. Counselor will provide all necessary information for admission.

12. Upon acceptance to a Primary Residential Treatment facility, the counselor will assist the client in locating appropriate transportation (in accordance with transportation policy).

SECTION D - PACKAGING AND MARKING

[FOR THIS SOLICITATION, THERE ARE NO CLAUSES IN THIS SECTION]

SECTION E - INSPECTION AND ACCEPTANCE

E.1

NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

The following contract clauses pertinent to this section are hereby incorporated by reference (by Citation Number, Title, and Date) in accordance with the clause at FAR "52.252-2 CLAUSES INCORPORATED BY REFERENCE" in Section I of this contract. See FAR 52.252-2 for an Internet address (if specified) for electronic access to the full text of a clause.

E.2 FEDERAL ACQUISITION REGULATION (48 CFR Chapter 1)

NUMBER

TITLE

DATE

52.246-5

INSPECTION OF SERVICES--COST- REIMBURSEMENT

APR 1984

E.3

INSPECTION AND ACCEPTANCE

A. Definition. “Services,” as used in this clause, includes services performed, workmanship, and material furnished or used in performing services.

B. The Contractor shall provide and maintain an inspection system acceptable to the Government covering the services under this contract. Complete records of all inspection work performed by the Contractor shall be maintained and made available to the Government during contract performance and for as long afterwards as the contract requires.

C. The Government has the right to inspect and test all services called for by the contract, to the extent practicable at all places and times during the term of the contract. The Government shall perform unannounced inspections and tests, when deemed necessary, in a manner that will not unduly delay the work.

D. If any of the services performed do not conform to contract requirements, the Government may require the Contractor to perform the services again in conformity with contract requirements, for no additional fee. When the defects in services cannot be corrected by re-performance, the Government may—

1.

Require the Contractor to take necessary action to ensure that future performance conforms to contract requirements; and

2.

Reduce any fee payable under the contract to reflect the reduced value of the services performed.

E. If the Contractor fails to promptly perform the services again or take the action necessary to ensure future performance in conformity with contract requirements, the Government may—

1. By contract or otherwise, perform the services and reduce any fee payable by an amount that is equitable under the circumstances; or

2. Terminate the contract for default.

Review and approval of the overall performance of this contract is the responsibility of the Contracting Officer. Unless otherwise stated in writing, the Contracting Officer Representative (COR) is delegated the authority to accept or reject items delivered under the contract following necessary review. Acceptance shall be offered in the manner described herein, or otherwise as directed by the Contracting Officer.

E.4

ASSESSMENT OF PERFORMANCE

Assessment of performance will be accomplished by utilizing the Urban Indian Organization On-Site Review Manual (revised December 2013), the Professional Health Care Standards, and the submission of Uniform Data Systems Report (UDS) and technical reports.