SOW - Chiro services B4.pdf

Department of Health and Human Services Indian Health Service

Clinton Indian Health Center

Statement of Work (SOW) Chiropractic Services

1. PURPOSE OF THE PROJECT

The purpose of this contract is to provide chiropractic services for the Clinton Service Unit (CSU), including Clinton/El Reno/Watonga Indian Health Center’s (CIHC/EIHC/WIHC). The Indian Health Services (IHS) requires chiropractic services without interruption during the term of this contract. The CSU facilities are an outpatient federal facility that provides ambulatory care for eligible Native American patients that are registered for services. To meet the CSU’s mission, CSU requires contractor support to provide chiropractic services.

2. DETAILED DESCRIPTION OF THE TECHNICAL REQUIREMENTS

The contractor shall provide part-time chiropractic services at the CSU facilities, no less than 3 days per week, 8 hours per day twice a week and 4 hours a day once a week minimum, as mutually agreed upon by the contractor and IHS for patient’s over 18 years of age as well as applicable patients under the age of 18 with legal guardian authorization. Services shall include but not limited to the following:

1. Evaluates the neuro-musculo-skeletal systems as they pertain to the patient’s referral for treatment.

2. Records the evaluation and designs a treatment program with goals set appropriately for the diagnosis.

3. Provides on-going treatment and re-evaluations of the response to treatment as they relate to the goals.

4. Utilizes appropriate manual skills and physical agents to realize the goals for the patient.

5. Documents on-going progress towards reaching goals and appropriate changes I the neuro-musculo- skeletal systems in the Electronic Health Record (EHR).

6. Contract chiropractor shall not have any work or health restrictions, which interfere with the performance of

Chiropractic services.

7. Conduct patient visits for the purpose of determining appropriate plan of care regarding management of patient’s chronic pain.

8. Provide diagnostic and treatment services and procedures as determined by evaluation and provide follow-up care as identified by treatment plan as outlined within Oklahoma statutes governing chiropractic care. This includes diagnostic procedures including orthopedic exams, neurological exams, range of motion exams, muscle strength testing; diagnostic imaging procedures including MRI, CT, x-ray, and ultrasounds; and treatment modalities including chiropractic adjustment procedures (manipulation, both spinal and extra-spinal), exercise and rehabilitation, strength and conditioning, passive stretch (independently or in conjunction with cryotherapy substance), bio-feedback, electrical modalities such as diathermy, interferential, current, galvanic, TENS, thermal modalities, ultrasound and phonophoresis, all type of traction, and bracing and supports. Modalities outside of the above, even if accepted in other chiropractic care settings, are explicitly excluded.

9. Services must be fully coordinated and integrated with the patient’s primary care provider within the Service Unit with respect to services provided and professional relationships.

10. Documents all visits in Resource and Patient Management System (RPMS) and EHR. Medical record documentation must meet or exceed the established standards of the CSU to include, but not limited to timeliness, legibility, accuracy, and content. All medical record information generated in the performance of this contract will remain the property of and subject to exclusive control of the IHS.

11. Perform all required training timely for HIPPA and computer access, as required by CSU.

12. Performs manual and manipulative therapies with an emphasis on spinal manipulation as feasible and appropriate.

13. Contractor shall work with the Government designee to ensure proper licensure, credentialing and privileging of staff required to provide these services at CSU.

14. Contractor shall work with the Physical Therapy Supervisor and/or designees to establish the dates and times for the clinic.

The clinic schedule may be expanded or extended, if patient demand justifies such, and with permission and agreement of all parties. The contractor shall notify the Physical Therapy Supervisor and/or designee as soon as possible if unable to work during scheduled hours, no weekend or federal holidays are worked.

15. The contractor shall not bill for patients seen as CSU nor bill any third party payors for services provided at CSU. The contractor shall be eligible for enrollment in the service unit’s Medicare/Medicaid program and any other alternate resource payor, to all the hospital to bill these entities for the contractor’s services, as applicable.

16. The contractor shall respect and maintain the basic rights of patients, to include but not limited to personal dignity. The contractor shall possess sufficient initiative, interpersonal relationship skills and social sensitivity such that he/she can relate constructively to patients for the Native American community.

17. The Clinton Service Unit shall have the right to provide continual review of all patient encounters and ensure all required documentation is provided.

18. The contractor shall adhere to CSU dress code policy and ensure that his/her image, as a chiropractor is compatible with the expectations of CSU staff and community.

19. The contractor shall perform special assignments as requested to fulfill objectives of the department, facility or service unit.

These will be discussed in advance with the contractor and agreement reached before any new duties are assigned.

2.1. Special Terms and Conditions:

2.1.1. Privacy Act:

In accordance with Privacy Act, the Contractor shall direct any questions regarding maintaining system of records to this contract to the Oklahoma City Area Privacy Act Coordinator, Jennifer Farris at 405-951-3708.

2.1.2. Non-personal Services:

2.1.2.1. This contract is a non-personal health care service contract, as defined in FAR 37.101, under which the contractor is an independent contractor.

2.1.2.2. The professional services of the contractor will be evaluated for quality by the Government via routine IHS staff members review of patient charts on a quarterly basis or more often as appropriate, however, the Government retains no control over the medical professional aspects of services rendered (e.g. professional judgments, diagnosis for specific medical or psychological treatment).

2.1.3. Contractor Qualifications:

The contractor shall:

2.1.3.1. Obtain a Doctorate in Chiropractic;

2.1.3.2. Have at least one (1) year experience as a chiropractor;

2.1.3.3. Have current professional liability insurance;

2.1.3.4. Apply for and be credentialed at the Clinton Service Unit;

2.1.3.5. Be within 65-mile radius of CSU facilities.

Quote/Contract Documentation Requirements to be submitted:

2.1.3.6. Copy of current resume or CV;

2.1.3.7. Copy of current unrestricted license to practice medicine through the Oklahoma Board of Chiropractic Examiners;

2.1.3.8. Copy of current professional liability insurance;

2.1.4. Schedule of Work:

Contractor shall provide part-time chiropractic services no less than 3 days per week, 8 hours per day twice a week and 4 hours a day once a week minimum in the clinic. Contractor shall work with the Physical Therapy Supervisor and/or designee to establish the days and times for the clinic. The clinic schedule may be expanded or extended, if patient demand justifies as such, and with the permission and agreement of all parties. The contractor shall notify the Physical Therapy Supervisor and /or designee as soon as possible if unable to work during scheduled hours. No weekends or federal holiday are worked.

2.1.5. Rates of Payment:

The rate shall be an all-inclusive clinic fee (eight-hour shift) for conduction of the study, assessment of the results, and production of written report detailing the findings and any recommendations for improvement.

2.1.6. Indemnity and Insurance:

The government assumes no responsibility of negligent acts of the Contractor. Therefore, the Contractor is responsible for personal insurance if the Contractor indicates that it is necessary. The Contractor will hold harmless and indemnify the government against any or all loss, cost, damage, claims, expense or liability whatsoever as a result from the performance of the Contractor. The Contractor will hold the Federal Government and its agents including the Physical Therapy Supervisor and the Governing Body immune from civil or professional liability for all acts related to quality care management and enforcement of this contract.

3. PERIOD OF PERFORMANCE

Base plus an additional four (4) option years.

4. LEVEL OF EFFORT

4.1. The contractor shall ensure all providers furnished by the contractor complete orientation sessions conducted by the on-site

Health Records Department and the Human Resource Department.

4.2. The contractor’s professional services shall be subject to evaluation on quality by the Government via routine staff members review of emergency department/urgent care charts on a quarterly basis or more often as appropriate, however, the government retains no control over the medical professional aspects of services rendered (e.g. professional judgements, diagnosis for specific medical treatment).

4.3. The contractor shall be required to develop familiarity and abide by current policies, procedures, by-laws and regulations of the on-site clinical and medical staff.

4.4. The contractor shall perform services in compliance with applicable standards of The Joint Commission (TJC), which is available to the general public and the Professional Services Policies of the IHS Manual, which is available from the IHS.

4.5. The contractor shall communicate, in a timely fashion, to the referring primary care provider all clinical information necessary for continuity of care and documentation of quality of performance.

5. SPECIAL REQUIREMENTS

5.1. Security Requirements: All contractors shall undergo a fingerprint check and shall be cleared prior to hire. Contractor’s continued employment is contingent upon the outcome of a complete and favorable background investigation as determined by the sensitivity level of the position. If contractors are found not suitable, they will be removed.

5.2. This is a designated position covered by Public Law 101-647, 101-630, Crime Control Act of 1990, and the Indian Child Protection and Family Violence Prevention Act, requiring contact or control over Indian children. Contractors shall be required to complete, sign, and submit the Addendum to OF-306, Child Care & Indian Child Care Worker Position form. Due to this requirement, the agency shall ensure that persons hired for these positions have not been found guilty of or pleaded nolo contendere or guilty to certain crimes. Failure to comply with these statutes shall result in immediate removal.

5.3. The contractor shall provide during the term of the contract documentation of provider’s immunization record to reflect CDC’s

Recommended Vaccines for Healthcare Workers (specifically MMR, Tdap, varicella, Hep B immunity, current (within the past year) influenza vaccination) and current annual tuberculosis screening. Documentation shall be provided with the completed Application for Appointment to Medical Staff and continual updates to the immunization record supplied to the Employee Health Nurse.

5.4. The US PHS Clinton Indian Health Center is a tobacco/smoke free environment (buildings and grounds). No tobacco/smoking use will be tolerated during service.

5.5. The contractor shall be responsible for the security of all organizational information. Current rules and regulations applicable to the premises, where the work shall be performed shall apply to the contractor and its employees while working on the premises.

These regulations include but are not limited to, escort by Clinton Indian Health Center official, presenting valid identification, smoking restriction and any safety procedures.

5.6. The contractor shall not disclose or cause to disseminate any information concerning operations of Clinton Indian Health Center.

Such action(s) could result in violation of the contract and possible legal actions.

5.6.1. All inquiries, comments, or complaints arising from any matter observed, experienced or learned of as a result of or in connection with the performance of the contract, the resolution of which may require the dissemination of official information, shall be directed to the government’s designated representative.

6. DELIVERABLES AND REPORTING REQUIREMENTS

6.1. Contractor Point of Contact: The contractor shall furnish one designated point of contact (POC) to the government’s designated representative for coordination of services. The POC will be empowered to make daily decisions to ensure that the contract implementation and day-to-day maintenance meets the terms and conditions of this contract.

6.2. Contractor’s Phone Numbers: The contractor shall provide a telephone number for service calls, which must be answered during at least eight working hours, between 8:00 am and 4:30 pm, Monday through Friday at the discretion of the Government contract monitoring designee.

7. GOVERNMENT FURNISHED PROPERTY, FACILITIES AND SERVICES

7.1. The Government will provide the facilities, supplies and the equipment of the hospital and support staff. A person to provide orientation to contract physicians. Use of government furnished facility space, equipment, supplies, and personnel are for the provision of care and services set forth in this contract only.

7.2. A written Orientation Manual of Policies and Procedures for the hospital or service unit, and application forms for appointment and privileging as associate staff members and will also be provided by the Government.

8. CHANGES TO THE STATEMENT OF WORK (SOW)

Any changes to this SOW shall be authorized and approved only through written correspondence from the Contracting Officer. Costs incurred by the contractor through the actions of parties other than the Contracting Officer shall be borne by the contractor.

9. DELIVERABLES/PERFORMANCE MATRIX

Measureables to be evaluated at the conclusion of awarded contract:

Performance is acceptable ☐YES ☐NO ☐N/A

Responsibilites of contractor have been fulfilled, including reports submitted on time.

☐YES ☐NO ☐N/A

Upheld Standards & Guidelines of accrediting organizations, national, state, and local regulating agencies, and CSU Policy and Procedures

Quality Control met and provided when required ☐YES ☐NO ☐N/A

Quality Improvement information provided when required. ☐YES ☐NO ☐N/A

Customer Service was provided to CSU Vision “Exceed the Need”. ☐YES ☐NO ☐N/A

Additional Measureables to be evaluated for awarded contract providing temporary employees (excluding medical staff).

License / BLS were maintained, current at all times and provided to CSU Human Resources prior to expiration

Evidence of staff competency provided when requested & required prior to expiration (Q3 years).

Staff competency conducted by contractor is acceptable and submitted prior to expiration (Q3 years).

Comments:

Department Supervisor Signature:___ ______________________

Administrative Officer Signature:_________________________