Attachment 3 - SOW.pdf

Attachment 3: Statement of Work Indian Health Service

Early Childhood Neuropsychological Evaluation PAO

STATEMENT OF WORK

GENERAL SCOPE:

The Contractors shall provide all personnel, equipment, supplies, and needed resources for personnel required in order to provide culturally sensitive in-person neuropsychologic assessments and evaluations of referred American Indian/Alaskan Native patients that reside within the Phoenix Area (PAO) of the Indian Health Service (IHS). The PAIHS covers the states of Arizona, Nevada, Utah, and parts of California. PAO Integrated

Behavioral Health (IBH) will only be paying for the evaluations. Referrals for evaluations will originate from the following Service Unit locations: Phoenix Indian

Medical Center, Phoenix, AZ, Ft. Yuma Service Unit, Ft. Yuma, Arizona; Elko Service

Unit, Elko, Nevada; Uintah and Ouray (U&O) Service Unit, Ft. Duchesne, Utah; and

Colorado River Service Unit (CRSU) Parker, AZ. The preferred place of performance would be within these five (5) listed states. Referrals of patients for evaluations will originate from Referral Programs operated by IHS/Tribal/Urban programs, hospitals, and health clinics, which are to be considered “Customers.”

The reservation areas in these states are remote and have limited behavioral health services, and these Service Units operate as health organizations that facilitate care for

The Indian Health Care system. Specifically, assessment for various cognitive and learning/developmental impairments is severely lacking, inaccessible due to insurance or resource challenges, or completely non-existent. PAIHS recognizes that State, Federal, Tribal, and private sector resources for these specific areas of need are minimal to none, and major gaps exist. This Statement of Work (SOW) seeks to address these gaps in service.

Assessments provided by the Contractors are required to be submitted in a timely manner, and quick access to these assessment services will be a priority for these referrals. Evaluations will be performed by Contractors with experience providing such services to children, adolescents, and young people, with preference given for those with experience in serving American Indian/Alaskan Natives and/or tribal communities.

The Contractor will utilize data from applied assessments to compose an integrated written report to inform relevant parties. Contractor will be expected to provide information on supportive resources related to newly identified diagnoses or disorders as part of the assessment.

The Contractor will be submitted an evaluation request from a provider associated with

Phoenix Area Indian Health care system via PAO IBH, and the Contractor will confirm authorization for evaluation payment by ensuring that the provided Neuropsychological

Testing Authorization form is included in the request. The Contractor will then have (15) business days to respond to evaluation request and then provide and communicate a scheduled evaluation appointment date. From the evaluation appointment date, the

Contractor has (15) months maximum “faster processing is preferred” to provide a completed evaluation. For payment, the Contractor is to provide via secure email a written report evaluation to the requesting provider and PAO IBH. Contractor will also submit an invoice to PAO IBH via the IPP system. The maximum allowable time for the entire process as described above is (15) months or a lesser period based on the

Contractor's availability and/or scheduling to provide such evaluations.

The PAIHS anticipates an estimated 50 referrals per annual year. Minimum referrals will be between one (1) and fifty (50) per year. The PAIHS is seeking 4-8 contracts to meet this requirement, and most desirably with evaluation office locations physically in these 5 states near these listed Service Units if possible.

PROGRAM IDENTIFICATION:

The behavioral health service treatment components for this target population shall include the following for child, adolescent and young adult neuropsychologic evaluations.

A. Comprehensive evaluations for referred child, adolescent and young adult with suspected neurodevelopmental disorders (e.g., learning/developmental disorders, autism, ADHD) or other psychological/behavioral health concerns.

TARGET POPULATION:

The target population is IHS Eligible Patients, from Phoenix Area tribes, referred from eligible federally recognized tribal programs, IHS programs, or IHS Urban Programs within the Phoenix Area as described in the aforementioned general scope. These referrals will be approved by PAO before a commitment to pay for services will be provided to the referring program by the PAO.

This referred target population consists of children, adolescents, and young adults in need of formalized neuropsychological evaluation and diagnoses.

PROGRAM DESCRIPTION:

The Contractor shall provide all the necessary evaluation services for the identified target population. The following service components that are included are not all-inclusive, but serve as the minimum requirements that are necessary for the delivery of these services:

A. Comprehensive evaluations for referred children and adults with suspected neurodevelopmental disorders (e.g., learning/developmental disorders, autism, attention deficit hyperactivity disorder (ADHD), fetal alcohol spectrum disorder

FASD, intellectual ability, and adaptive behavior) or other psychological/behavioral health concerns.

1. Based on the results of evaluations, make impactful and actionable recommendations to individuals and/or caregivers for support to improve educational, employment, and personal outcomes. As part of the comprehensive evaluation process, components of the evaluation will consist of:

▪ Conduct intake interview and review of past records, to assess for relevant historic psychosocial information and current functioning.

▪ Administer relevant cognitive, achievement, and personality measures to provide diagnostic clarity in addressing the cause for referral.

▪ Utilize data from applied assessments to compose an integrated written report to inform relevant parties.

▪ Provide actionable, relevant, and helpful recommendations to assist the client in obtaining needed academic, vocational, or behavioral health resources.

▪ Provide feedback to clients in both verbal and written format to provide an understanding of the results.

▪ Maintain continuance of patient care through consultation, referral, and follow-up with recommended agencies.

B. The Contractor(s) evaluation services will occur in person.

C. The Contractor will schedule evaluation services during normal business hours and will not schedule appointments during major US holidays.

D. The Contractor shall be available for consultations “for the purpose of evaluation completion and related communication” with the referring provider “Customer”, either by telephone or in person.

E. The Contractor will maintain industry standards of ethical and professional competence in the effort to integrate personal and group identities to provide informed and culturally sensitive assessment practices.

EXPECTED ASSESSMENT PERIOD:

The Contractor will be provided with an evaluation request from a provider “Customer” associated with PAO IBH, and the Contractor will confirm authorization for evaluation payment by ensuring that the Neuropsychological Testing Authorization form is included in the request. The Contractor will then have (15) business days to respond to evaluation request and then provide and communicate a scheduled evaluation appointment date.

From the evaluation appointment date, the Contractor has (15) months maximum to provide a completed evaluation. For payment, the Contractor is to provide via secure email a written report evaluation to the requesting Customer and PAO IBH. Contractor will also submit an invoice to PAO IBH via the IPP system. The maximum allowable time for the entire process as described above is (15) months or a lesser period based on the Contractor's availability and/or scheduling to provide such evaluations.

ANNUAL ESTIMATED NUMBER OF PATIENT REFERRALS

Individuals estimated to be referred annually for this Statement of Work will be as follows: minimum referrals will be one (1) per year, with a maximum of fifty (50) per year. The need for the referring programs may increase or decrease depending on the needs of the overall PAIHS community of referring programs, but the maximum referral allotment shall not exceed 50 individuals in a single year.

CONTRACTOR PERSONNEL EDUCATION AND LICENSURE:

The Contractor represents and warrants that the Contractor has and shall continue to have the ability, expertise, qualifications, licensure, and capacity to render the requested services. Contractor’s clinical providers shall meet or exceed educational and licensure requirements for their particular profession/discipline in accordance with State of location, Federal, and/or another appropriate regulatory licensure authority.

Potential programs to meet this requirement will need to be located in AZ, NV, UT and parts of CA. The programs will need to offer neurodevelopmental testing services to children and young adults. Native American culturally specific services preferred.

Services must be provided by Psychologist providers licensed in the State of provided service who are authorized by said State to provide neuropsychology evaluations. Prefer pediatric neuropsychologists with specialty training in evaluations of neurodevelopmental disorders or neuropsychologists with specialty training in evaluations of pediatric neurodevelopmental disorders. Pediatric neuropsychologists will receive a higher ranking.

The evaluations provided by the Contractor will need to meet State Developmental

Disability eligibility requirements for psychological evaluations including the use of

"standardized, culturally appropriate, and psychometrically sound measures". To be clear, the evaluations provided must be accepted by State Developmental Disability offices for recognition of disabilities or needs of the referred patients.

CONTRACTOR CULTURAL COMPETENCY:

Cultural competency is the ability to respond to the needs of populations with different cultures. Contractors with experience serving American Indian and Alaskan Native patients and /or Tribal communities are highly desired for this requirement.

REFERRAL PROCESS AND PRIOR AUTHORIZATIONS:

Eligible tribal and IHS programs “the Customers” will obtain initial financial approval from the Phoenix Area Behavioral Health (PAO IBH) program and then the requesting provider, referred to as “Customer,” will contact the Contractor either by telephone, secure email or fax to initiate the referral process for completing the necessary documentation for evaluations.

The Contractor will be submitted an evaluation request from a Customer associated with

PAO IBH, and the Contractor will confirm authorization for evaluation payment by ensuring that the Neuropsychological Testing Authorization form is included in the request. The Contractor will then have (15) business days to respond to evaluation request and then provide and communicate a scheduled evaluation appointment date.

From the evaluation appointment date, the Contractor has (15) months maximum to provide a completed evaluation. For payment, the Contractor is to provide via secure email a written report evaluation to the requesting Customer and PAO IBH. Contractor will also submit an invoice to PAO IBH via the IPP system. The maximum allowable time for the entire process as described above is (15) months or a lesser period based on the Contractor's availability and/or scheduling to provide such evaluations.

The Phoenix Area Indian Health Service will pay for the approved evaluation via a formalized reimbursement process in the Invoice Processing Payment (IPP) system. Once the requesting provider “Customer” and IBH have confirmed receipt of the evaluation and PAO IBH receives the evaluation and invoice in IPP, payment for completed evaluations will be sent to the Contractor.

PAO IBH is not financially responsible for the payment of invoices for evaluations exceeding the allotted time period for receipt of referral, scheduling, evaluation, and report, in this case 15 months or a lesser period, nor is IBH responsible for the payment for evaluations that did not receive authorization prior to evaluation.

PROGRAM EVALUATION/REVIEW:

The Contractor shall have program files available to IHS evaluators on request for purposes of an on-site program inspection/review. The program evaluation may include a review of policy and procedures and related program documents such as intake forms, assessment tools, and licenses. Additionally, all administrative and clinical records pertaining to the patients.

PLACE OF PERFORMANCE:

The Contractor shall provide services at their facilities. States to be considered are AZ, NV, UT, parts of CA.

PERIOD OF PERFORMANCE:

Performance under this contract shall consist of a base year with 12 months of service followed by four(4) option years for consecutive 12-month periods. The contract shall also include a month-by-month option not to exceed a total of six months of service exercisable at any point in the period of performance.

Base Year ___________ 2025 through 2031

No. Description Date:

01 Base Year TBD

02 Option Year TBD

03 Option Year TBD

04 Option Year TBD

05 Option Year TBD

06 6-Month Option TBD

OPTION PERIOD OF PERFORMANCE:

All options shall be exercised under the authorities of FAR 52.217-8, Option to Extend the Services of the Contract and FAR 52.217-9 Option to Extend the Terms of the

Contract.

SCHEDULE OF DELIVERABLES/REPORTING REQUIREMENTS:

1. Unless otherwise agreed to by the contracting officer per HHSAR 352.232-71(c), the use of IPP shall take precedence over previously established invoicing procedures.

If you require assistance registering or IPP account access, please contact the IPP

Helpdesk at (866) 973-3131 (M-F 8AM to 6PM ET), or

IPPCustomerSupport@fiscal.treasury.gov

The Contractor shall invoice separately for each patient. The invoice shall contain the following terms:

- Name and address of Contractor

- Taxpayer Identification Number (TIN)

- Invoice date and invoice number

- Contract number

- Description of services (no identifying patient information), i.e., Neuropsychological Evaluation provided at

- Dates of service (no patient information)

- Number of evaluations multiplied by unit price

Send a copy of the completed evaluation via secure email to IPP.

PHOENIX AREA INDIAN HEALTH SERVICE

OFFICE OF HEALTH PROGRAMS

INTEGRATED BEHAVIORAL HEALTH

ATTN: CDR SCOTT PEAKE

II RENAISSANCE SQUARE

40 N. CENTRAL AVE. STE. 606

PHOENIX, AZ 85004

INVOICE AND EVALUATION:

For payment, the Contractor is to provide a written report evaluation to the requesting

Customer and PAO IBH. Contractor will also submit an invoice to PAO IBH via the IPP system, which will contain no Patient Identifiable Information per HIPAA regulations and The Privacy Act. The evaluation date will serve as the identifier for our office. The maximum allowable time for the entire process as described above is (15) months or a lesser period based on the Contractor's availability and/or scheduling to provide such evaluations.

The Phoenix Area Indian Health Service will pay for the approved evaluation via a formalized reimbursement process in the Invoice Processing Payment (IPP) system. Once the requesting provider “Customer” and IBH have confirmed receipt of the evaluation via secure email and IBH has received he invoice in IPP, payment for completed evaluations will be sent to the Contractor.

Key Personnel:

Any changes to the Key Personnel shall be requested in writing and submitted to the

Contracting Officer for approval.

Key Personnel:

(a) Clinical Providers

(b) CEO

(c) Chief Operating Officer and/or Chief Financial Officer

(d) Vice Presidents (if applicable)

Property Inventory:

DUE DATE Annually

* No person other than the Contracting Officer may bind the government in any way.