Statement_of_work_Eagle_Butte_PA_CNP_2.docx

OUTPATIENT DEPARTMENT SERVICES

DESCRIPTION/SPECIFICATIONS/WORK STATEMENT

Cheyenne River Indian Health Service Outpatient Department

The mission of the Cheyenne River Service Unit is to provide the best possible health care services to the Native American population on the Cheyenne River Reservation in South Dakota. To meet the mission, the Cheyenne River Service Unit requires contractor support to assist the service unit in the recruitment and placement of a Mid-Level into a temporary duty assignment in the Cheyenne River IHS Hospital. The contract effort must provide full time Mid-Level services.

1. PURPOSE OF CONTRACT:

The purpose of the contract is for the recruitment, credentialing, and placement of an Outpatient Mid-Level into the Eagle Butte Indian Health Service Hospital. The care provided by the Contractor must be as comprehensive as the Indian Health Service supplied facilities, equipment, and support services permit. The Indian Health Service requires medical services to continue without interruption during the term of this contract. The continuity of services is vital and must be consistently prearranged during the term of this contract.

The Contractor must furnish a Mid-Level for the Outpatient medical services at the Cheyenne River Service Unit located in Eagle Butte SD. The contract Mid-Level must perform Mid-Level services compatible with the Eagle Butte Indian Health Service medical facilities’ operating capacity and equipment. The Contractor must provide Mid-Level services for Indian Health Service beneficiaries served by the service unit. Contract Mid-Level services must cover the range of Mid-Level services typically provided in a rural civilian practice of similar size. Contract performance must be according to the requirements contained in this Statement of Work.

Department: Outpatient Scheduled Tour of Duty: Monday through Friday, Sunday Clinic, Some Evening Clinics Hours of Performance: 8 hours; variable combination of 8 a.m. to 5:00 p.m., 10:00 a.m.

to 6:00 p.m. or 11:00 a.m. to 7:00 p.m.

Solicitation: One Mid-Level (PA or CNP)

2. STATEMENT OF WORK:

The provider will provide on-site mid-level medical services to patients that present for care to the Eagle Butte Indian Health Service Outpatient Department. Scheduled tour of duty will be variable for a total of 40 hours per week. Hours of performance will be variable 8 hours shifts. No Mid-Level can work consecutive shifts. A shift is defined as hours of performance. These shifts are subject to change at the discretion of the Clinical Director. The contract Mid-Level(s) must be primarily required to perform services according to the schedule presented by the Clinical Director.

The Contractor will be currently licensed and fully credentialed Mid-Level at the Indian Health Service Hospital at Eagle Butte, SD. Due to the volume of patients that can present to the Outpatient Department, provider must be able to provide a wide range of high quality, effective and efficient care to patients. Examines and diagnoses the health related conditions of individuals requesting care, refers individuals for consultation when appropriate, prescribes and carries out, or directs others in carrying out, appropriate therapy in conformance with approved clinical privileges. Educates individuals in the nature of health related conditions, recommended therapy and in the general promotion of health and prevention of disease. Services must be inclusive of, but not limited to, examination, diagnosis, prognosis, treatment plan, follow up, and consultation to all patients presenting for care to the Outpatient Department.

The Mid-Level is required to record patient-provider transactions in the problem oriented medical record format and complete required data collection instruments, referrals and medical records as required in Electronic Health Records. Maintains Medical Staff clinical privileges as granted by the facility Governing Body or Service Unit Credentials Committee. If requested, fully participates in medical staff functions such as medical program review, quality assurance activities, and organizational functions including attending meetings and accepting committee assignments. Assists in the provision of continuing education, on-the-job training, and orientation of Indian Health Service and Tribal Staff as requested. Also, assists in the provision of technical assistance to tribal and community groups as requested.

The standards of medical practice and duties of the Contractor through its medical officer must be determined pursuant to the bylaws of the Eagle Butte IHS Hospital, the regulations of the hospital, applicable provision of law, other rules and regulations of any and all governmental authorities relating to licensure and regulation of Mid-Level and hospitals, and the standards and recommendations of the CMS and DNV-GL. The Contractor must be required to participate in a quality improvement program, which is consistent with current CMS and DNV-GL requirements for ongoing monitoring and evaluation of the quality and appropriateness of care.

Medical services cannot be performed by a contract Mid-Level until professional staff membership and the Indian Health Service Governing Body has granted clinical privileges in writing. As a prerequisite to performance under the resultant contract, the Contract Mid-Level performing the services must be privileged in accordance with Indian Health Service/Aberdeen Area Credentialing policy. Therefore, compliance with the Indian Health Service privileging requirements is essential in the performance of the contract. Any failure to comply with IHS privileging requirements must be considered to be non-performance of the contract. The Governing Body will not grant clinical privileges until it is determined that credentials information has been verified. Exceptions to the IHS credentialing review and clinical privilege process will be considered only in the direst of emergencies. Any contract Mid-Level who fails to maintain medical staff appointment and clinical privileges will not be permitted to perform services under the contract and must be promptly replaced by the Contractor.

Exceptions to the IHS credentialing review and clinical privileges process will not be considered. Any contract Mid-Level who fails to maintain medical staff appointment and clinical privileges will not be permitted to perform services under the contract and must be promptly replaced by the Contractor.

3. CONTRACTOR’S RESPONSIBILITY:

A. Contractor must comply that eligible patients under treatment will be rendered services that provide the best medical care within the Contractor’s professional training and experience. All services rendered must be in accordance with current standard medical practices to assure quality care.

B. Document patient services in the electronic medical record system, using standard Patient Care Component forms. This includes a diagnosis and treatment plan.

Contract Mid-Level providers must generate and maintain proper medical record information on beneficiaries to whom treatment is provided, in accordance with Indian Health Service regulations. The Contract Mid-Level/provider must prepare all medical records documentation to meet or exceed the established standards of the IHS facility to include, but not limited to timeliness, legibility, accuracy, content and signature. All medical record information generated in the performance of this contract will remain the property of, and subject to the exclusive control of the Indian Health Service. Contract Provider must complete all proper charge tickets/sheets necessary for proper collection of all third party reimbursement to the Cheyenne River Indian Health Service. Procedures for transfer of patients requiring transfer to facilities where a higher level of care must follow the “Outpatient Medical Treatment and Labor Act” (EMTALA) guidelines.

C. The incumbent must possess a specialized knowledge of the concepts, principles and practices of Internal Medicine or General Medicine, Pediatrics or Family Practice, or Obstetrics and Gynecology such as is obtained through the successful completion of a course of study leading to the or Accredited Nurse Practitioner or Physician’s Assistant Program and the successful completion of post graduate training. Training and experience in Orthopedics and Rheumatology favorable.

D. Participates in the peer review process as part of the quality improvement program and conducts in-services if required.

E. Abides by the Cheyenne River Hospital’s By-laws, Rules and Regulations and Clinical Duties.

F. Will submit to a background check.

G. Have medical privileges elsewhere.

H. Will certify by signature on “Statement of Physical and Mental Fitness” form in Clinical Director’s office that he/she is in good physical and mental health, free of any contagious disease and all required immunizations are up to date.

I. In performing work under this contract in an Indian Health Service facility, the Contractor must conform to the specific safety requirements established by the Indian Health S facility. Comply with the safety rules of the Indian Health Service facility that concern related activities not directly addressed this contract. Take all reasonable steps and precaution to prevent accidents and preserve the life and health of Contractor and Government personnel connected in any way with performance under this contract.

J. Contract Mid-Level must remain in the IHS facility during their shift unless required to respond to a medical related Emergency disaster call. Before departing on an emergency response, the contract Mid-Level must ensure the on-call IHS Physician has been notified and will be available if necessary.

The Clinical Director must schedule the Mid-Level to ensure the best possible care of the patients served.

K. Prior to assumption of duty on any scheduled work shift, the Contract Mid-Level may be briefed by the Service Unit Clinical Director or his/her designated representative concerning any matter relevant to the Contract Mid-Level’s assumption and discharge of responsibilities under the terms of this contract. The Contract Mid-Level must advise the clinical director or his designated representative of any problem encountered, or which may be encountered, in connection with meeting the needs of patients treated by the Contract Mid-Level. The briefing shall also include conditions of any Outpatients for whom the contract Mid-Level may reasonably be expected to attend during the work shift. The contract Mid-Level shall provide a shift briefing to the following duty Mid-Level.

L. Contract Mid-Level must not be considered an IHS employee for any purpose.

A sign-in/sign-out log must be maintained in an office of contractors department.

The contract Mid-Level must sign-in upon arrival at the service unit and sign-out upon departure. Review of the sign-in/sign-out will be performed by the timekeeper for the Clinical Director, prior to payment of invoices to ensure hours requested are actual hours worked. Contract Mid-Level must contact the Health Information Management Supervisor (HIMS) or her delegate to obtain notice of outstanding documentation deficiencies needing to be completed, complete all documentation deficiencies and obtain the HIMS signature on each timesheet prior to or at the end of each scheduled tour of duty signifying the Mid-Level has completed all documentation requirements. Failure of contract personnel to adhere to the above sign-in/sign-out and HIMS signature requirements may have adverse effect on the processing of invoices and delay payments. Also, failure to comply with the strict intent of the sign-in/sign-out and HIMS signature procedures may be considered a breech of the contract and may be considered as grounds for default.

M. At all times, must respect and maintain the basic rights of patients, to include but not limited to personal dignity, cultural sensitivity, privacy and confidentiality.

N. Make every effort to accommodate travel and arrival 12 hours prior to scheduled tour of duty to avoid weather related transportation problems and gaps in coverage under the terms of this contract which our frequent in rurally remote areas such as ours.

O. Provide personal use headphone or microphone if contractor chooses to utilize optional Dragon Speak version 10.1 voice recognition software provided by the Indian Health Service to augment documentation capabilities.

The Clinical Director will determine period of performance 9/1/2015 to 12/31/2015 with 8 hour shifts. The contract terminates when the period of performance expires, if no funds are available or a permanent provider is hired.

3. GOVERNMENTS RESPONSIBILITY:

A. Make available for the use of the Mid-Level during the term of this Agreement and during the hours of service of the provider a designated work space that hereafter may be occupied by contractor in the Outpatient department.

B. The Hospital will provide all necessary medical equipment, drugs, supplies, furniture for the use of the Mid-Level providers so that they may carry out their services in an efficient and skillful manner.

C. Maintain and repair all equipment and provide utilities and services such as water, heat, electricity, janitorial services, telephone services all of which is required in the line of duties of the provider.

D. Provide the services of licensed, registered and practical nurses and other non-Mid-Level technicians and assistants necessary for the efficient operation of the Outpatient department.

E. Establish charges for services rendered by the Mid-Level to patients of the Hospital. the Hospital must bill for, collect and retain all appropriate fees charged for the Mid-Level provider services under this contract.

F. As this is a personal service contract, the said provider will be covered by the Federal TORT Act for liability coverage in accordance with all Federal Regulations.

CONTACT PERSON: Clinical Director, Eagle Butte PHS Indian Health Hospital Eagle Butte, ND 57625; T: (605) 964-7724 F: (605)964-0552

4. QUALIFICATIONS:

The Contractor must provide sufficient verifiable credentials to warrant the granting of clinical privileges by the Eagle Butte IHS Hospital.

1. Must hold and submit active, current, full and unrestricted license to practice individual’s profession in a State, Territory or Commonwealth of the U.S. or the District of Columbia as required for IHS employment in addition to licensure requirements, and a DEA license. Staff must maintain active certification from appropriate national board.

2. Possess a MD degree from an accredited school of medicine or certification of training for Midlevel providers.

3. Current certification in BLS, ACLS, PALS, ALSO or NPR and any other certifications and CME’s needed to maintain their license.

4. Submit a signed and dated copy of a current physical examination (within the past 2 years) with current immunizations for MMR, DT, Hepatitis B, and annual PPD (Measles, Mumps, Rubella, Diphtheria and Tetanus, annual Tuberculosis Skin Test).

5. Submit a current CV/resume that must include last employer, two previous employers with their current phone numbers/email addresses and outline of work related duties and responsibilities.

6. Submit at least three current letters of reference with current phone numbers and email addresses.

7. Completed and signed OF306 and childcare forms.

8. Upon acceptance for service to fulfill the contract needs the contractor must furnish to the Eagle Butte IHS Hospital Credentialing Specialist a fully completed credentialing package as supplied by the Eagle Butte IHS Hospital no later than five working days beginning the day after acceptance notification was issued.

9. The Contract Mid-Level seeking clinical privileges must request in writing the specific clinical privileges desired on the privileging document for approval by the Service Unit Governing Body.

THE CONTRACTOR WILL:

a. The Contractor will make available to the Eagle Butte Service Unit their library resources as well as necessary academic and professional consultations.

b. Aberdeen Area Indian Health Service will pre-approve all researches, studies, etc., involving the Contractor, the AAIHS, as well as its patients. No research will be allowed without such prior approval in writing from AAIHS. All publications and statements of the Contractor and collaborating parities will include clarification that they do not reflect official AAIHS policy. All parties must strictly follow AAIHS patient privacy and right policies and procedures.

Character Investigation for Contractors who will have contact with Indian Children

The individual performing services under this contract will have regular contact with or control over Indian children and is subject to a character investigation in accordance with the “Indian Child Protection and Family Violence Prevention Act: P.L. 101-630. The contractor and its employees must perform in accordance with section 231 of the Crime Control Act of 1990, P.L. 101-647. Failure to comply with these statutes results in immediate removal.

Compliance with IHS Rules and Regulations

The standards of medical practice and duties of the Contractor through its medical officer shall be determined pursuant to the bylaws of the Cheyenne River IHS Hospital, the regulations of the hospital, applicable provisions of law, other rules and regulations of any and all governmental authorities relating to licensure and regulation of Mid-Level and hospitals, and the standards and recommendations of the DNV GL Healthcare USA, Inc. and the Centers for Medicare and Medicaid Services. The Contractor shall be required to participate in a quality improvement program which is consistent with current the Centers for Medicare and Medicaid Services (CMS) and the DNV GL Healthcare USA, Inc. requirements for ongoing monitoring and evaluation of the quality and appropriateness of care.