SOW - OPD PA-NP CNMW PSYCH Revised 01.12.21.doc

STATEMENT OF WORK

PHYSICIAN ASSISTANT/NURSE PRACTITIONER/NP (CNMW)/NP (PSYCH) FOR THE

ROSEBUD IHS OUTPATIENT DEPARTMENTS

Rosebud Service Unit, Great Plains Area Indian Health Services

Revised 1/14/2021

A. PURPOSE OF CONTRACT:

The mission of the Rosebud Comprehensive Healthcare Facility (Rosebud) is to provide the best possible health care services to the Native American population of the Rosebud Reservation in South Dakota. To meet this mission this requires contractor support to provide primary care Physician Assistant/Nurse Practitioner (PA/NP [CNMW/PSYCH]) services on a short-term temporary basis.

Many of the IHS patients receiving services may only speak a native language and/or reside on a Native American Reservation, therefore, the Contractor must demonstrate sensitivity to cross-cultural and language differences.

The Rosebud Comprehensive Healthcare Facility requires assistance in the recruitment and placement of primary care physician assistant/nurse practitioners on the medical staff for a temporary duty assignment. The purpose of the contract is for the recruitment, credentialing and placement of primary care primary care physician assistant/nurse practitioner for Rosebud.

B. SPECIFICATIONS OF SERVICES:

The contract is a non-personal health care services contract, as defined at Federal Acquisition Regulation (FAR) part 37.01 under which the contractor is an independent contractor and shall allow the Government to evaluate the quality of professional and administrative services provided, but retains no control over the medical, professionals aspects of the services rendered (e.g., professional judgments, diagnosis for specific medical treatment). A Non-Personal Service Contract is established to provide primary care PA/NP (PA/NP [CNMW/PSYCH]) services. The contract provider will work 5 days of clinic per week from 0800- 5 PM (some days may be designated for evening clinic until 9 PM), Monday through Friday in Rosebud, South Dakota. Administration time the contractor provider may be required to attend meetings, see patients or may not be required to work depending on current service unit needs. If a Saturday Clinic may be needed if determined needed by the service unit. The contractor will perform according to this Statement of Work.

The Contractor shall indemnify the Government for any liability producing act or omission by the contractor its employee and agents occurring during contract performance. The Contractor shall maintain medical liability insurance in the coverage amount acceptable to the Contracting Officer, which is not less than the amount normally prevailing within the local community for the medical specialty concerned.

The contractor shall furnish a primary care PA/NP (PA/NP [CNMW/PSYCH]) as needed for primary care assignments for Rosebud. Contract provider care shall cover the range of primary care or if needed a more specialized NP such as a CNMW/PSYCH NP typically provided in a rural civilian practice of similar size. The Contractor shall provide a skilled clinician to perform the necessary medical procedures.

Upon the receipt of contract, the contractor shall locate, credential, and have available sufficient staffing to provide “seamless” coverage on a regular work schedule. Failure to provide “seamless” coverage will result in the contract going into default.

The standards of medical practice and duties of the contractor through, its providers shall be determined pursuant to the governing body bylaws, medical staff bylaws, rules and regulations of the Indian Health Service (IHS), applicable provisions of law including but not limited to Centers for Medicare, Medicaid Services (CMS) compliance, rules and regulations of any and all governmental authorities related to licensure and regulations of PA/NP (PA/NP [CNMW/PSYCH]) in health care and standards and recommendations of the Accreditation Association for Ambulatory Health Care (‘AAAHC’).

In accordance with the Indian Health Service credentialing policy, the contractor shall complete primary source verification for the contract provider performing services under the contract. Upon the placement of a PA/NP at Rosebud IHS, the provider shall complete a credentials packet and be credentialed by the Rosebud Governing Body. Compliance with IHS privileging requirements is essential in the performance of the contract.

The contractor shall provide a PA/NP (PA/NP [CNMW/PSYCH]) for the professional management of patients being treated at the Rosebud Hospital. The contract providers shall provide medical support for the outpatient departments.

The Contractor health care providers shall provide patients with the utmost care and attention. All patients shall be assured of their privacy and personal dignity. The Contractor shall ensure strict compliance to the release of Protected Health Information in accordance with the Coder of Federal Regulation, Title 45, Public Welfare, Subtitle A, Department of Health and Human Services, Part 164, Security and Privacy (45 CFR 164) and AFI 41-210, “Patient Administration Functions” paragraph 2.2.3, “Health Insurance Portability and Accountability Act (HIPPA)” and paragraph 2.3, “General Guidelines on Releasing Medical Information”.

The Contractor shall ensure contract providers maintain open and professional communication with members of the Medical Staff. Complaints validated by the Quality Assurance Personnel (QAP) and Clinical Director shall be reported in writing to the Contracting Officer (CO) and the Contractor for action.

Contract providers shall perform procedures compatible with the medical facility’s operating capacity and equipment. New medical procedures/services shall not be introduced without prior recommendation to, and approval of, the Rosebud I.H.S Clinical Director or authorized representative.

The contractor shall generate and maintain proper medical record information on beneficiaries to who treatment is provided in accordance with Indian Health Service, AAAHC and CMS regulations. The contractor shall prepare all medical record documentation exclusively on the Electronic Health Record (EHR) to meet or exceed the established standards of the IHS facility to include but not limited to: timeliness, legibility, accuracy, content and signature. An orientation to the EHR will be given by the Clinical Applications Coordinator (CAC) prior to any patient care. All medical recording information and documentation generated in the performance of this contract must be completed at time of departure and will remain the property of and subject to the exclusive control of IHS. All medical records remain the property of the IHS service unit.

The Rosebud Hospital will provide support personnel to assist with clinic to equivalent of a licensed practical nurse, the provider at times may have to perform some administrative duties to assist the patient.

The contractor shall document all patient encounters legibly on all medical records, such as downtime forms and in the EHR. All documentation shall be signed, timed and dated. Verbal orders are to be used in an emergency basis only and should not be routinely used. All Medical records are to be completed by the end of the provider’s scheduled shift. All documentation shall meet the current CMS/JC guidelines.

Final payment will be withheld until all medical records are completed by the contractor. The contractor will be required to create a time work record by utilizing a timecard demonstrating hours worked. Any hours beyond the 9 hours scheduled on any given day must have pre-authorization by administrative staff. Upon arriving for each shift the contractor shall document time of arrival, time away for lunch, and the end time. All providers must have a documented lunch time. On a weekly basis, or per the contractor policy, timesheets will be turned in to the Clinical Director or designee for verification and signature prior to submitting to the contractor’s timekeeper. No invoices shall be processed for payment until a complete, signed, and verified work record is submitted along with the medical records documentation completion is verified.

**All patient health record documentation initiated by the contractor from patient encounters SHALL BE completed to the satisfaction of the supervisor, or designee, of the HIM (Health Information Management) Department & Business office supervisor or designee. The approving authority of the contract provider’s time sheets will NOT sign off on the final time sheets unless the provider has successfully completed all required patient medical encounter documentation (medical records). Further, if the provider has delinquent medical records as determined by the supervisor, or designee, of the HIM department, the approving authority will NOT sign off on any time sheets or process any invoices generated from “unauthorized” time sheet signatures. This is a condition of the Statement of Work (SOW). The contractor is to meet with the HIM department and clear up all records prior to leaving the service unit. Usually the last afternoon of duty is reserved for completion of this work. All assigned patients and patients notifications must be transferred to another provider at the service unit prior to leaving.

The contract will provide at least One-(1) PA/NP (PA/NP [CNMW/PSYCH]), additional staff may be requested and supplied as needed for coverage to staff the described Outpatient duty shift(s) for the entire contract period providing “seamless coverage” AKA “continuous coverage”. It is ABSOLUTELY IMPERATIVE the contracting company ensures a qualified and credentialed PA/NP (PA/NP [CNMW/PSYCH]) as determined necessary, and will be physically present in the Rosebud OPD every day throughout the entirety of this contract.

Skills and knowledge of established concepts, principles, and practices related to health care assignments requiring training equivalent to a Physician Assistant/Nurse Practitioner licensure and additional training and experience in assessing the conditions of patients, in providing medical care and in advising on health care needs, all with full consideration of mental, emotional, and physical factors. Extensive knowledge of routine disease entities are required to serve the population.

Knowledge of diagnostic, preventive and therapeutic procedures related to a variety of medical and health care fields provides for well-rounded patient care.

Ability to collect, organize, record and communicate, in a meaningful way, data relevant to primary health assessments including detailed family and medical history, physical examinations and selective laboratory tests. Provides recommendations for treatments and therapies based on those findings.

Skill in making diagnoses and in choosing, initiating, and modifying selected therapies, and ability to provide emergency treatments for acute walk in patients. Skill in simple laceration repair, casting/ splinting, and in other ER or urgent care- related procedures. Skill in the management of simple fractures.

Ability to assess the physical-psychosocial health status of patients and family based upon the knowledge of growth and development patterns and health conditions that require medical management. Knowledge of human behavior during stressful situations in order to exercise emotional control, tact, patience and reliability in providing emergency/ urgent patient care.

Knowledge of pharmaceuticals in order to recognize the desired effects, side effects and complications of their use.

Ability to provide individual and family counseling, guidance, and health instruction to help patients to understand how to prevent disease and maintain good physical and mental health.

The contract providers’ medical documentation will undergo peer review to ensure acceptable medical care is being provided. The Contractor shall secure a thorough health history from the patient or patient’s parent and record findings. Physical examination shall be performed which is consist with the patient’s presenting complaints and/or presenting signs and symptoms. Appropriate diagnostic testing shall be ordered, reviewed, interpreted, and acted upon to address and treat the patients’ complaints, signs, symptoms, and in the patient’s best medical interests. The Contractor will discriminate between normal and abnormal findings to recognize early stages of serious physical, emotional, or mental problems. The Contactor will consult available in-house medical services when indicated and available. If consulting services are not available in-house the Contractor will consult with the shift OPD physician about appropriate referrals.

Provides direct medical care in the presence of illness or disability in order to maintain life, provide comfort, reduce distress and enhance coping ability.

Provides surveillance over medical practices applied to stabilize chronically ill persons; adjusts treatment within established standing orders, recognizing when to refer the patient to a physician or other health team members.

Works collaboratively with physicians in management of selected complex medical problems. When clinically engaged with a medically complex patient the Contractor will present the case to the physician clinic consultant for the day for proper follow up and disposition.

C. GOVERNMENT FURNISHED EQUIPMENT, FACILITIES AND PROPERTY:

The Hospital shall provide a patient examination area and all medical and non-medical equipment and supplies used in the Indian Health Service facility for the car and maintenance of patients. The contractor will be authorized to use all areas of the medical treatment facility available to civil service and commission personnel in similar positions. The same restrictions apply to the contractor as any other Indian Health Service personnel to use these areas for official business activities only.

The contract provider will be authorized to use all administrative and professional support available to Indian Health Service personnel. This will include but not limited to copy machines, fax machines, medical library, and telephone services. The same restrictions to use these items for official Indian Health Service business apply.

The facility shall provide all medical and non-medical equipment and supplies used in the Rosebud Hospital for the care and management of patients.

The facility shall provide all blank government forms applicable to the Indian Health Service. The facility personnel will provide an appropriate orientation to the necessity of such forms.

The facility shall provide an ongoing method of monitoring and evaluation of the quality and appropriateness of patient care and identifying deficiencies in the quality service performed before the level of performance becomes acceptable.

The facility shall provide to the contractor, a contractor orientation to the facility, of which must be completed timely.

D. CONTRACTOR FURNISHED EQUIPMENT, FACILITIES, AND PROPERTY:

The Rosebud Hospital does not anticipate a need for contractor furnished equipment beyond a stethoscope.

The contract provider and support staff shall provide his or her own uniforms.

E. WORK SCHEDULE/PAYMENT SCHEDULE:

The PA/NP (PA/NP [CNMW/PSYCH]) work schedule is as follows: Each work day will consist of one-(1) nine-(9) hour tour of duty in the Rosebud IHS hospital Outpatient Department (OPD), weekdays, Monday through Friday. Some days may be designated for evening clinic. The provider will start their work shift at normally at 0800 hours, however these start times may fluctuate if the provider is need for the afternoon/evening shift of clinic which would be 12000 hours to 2100 hours. Times may also very if there are meetings. Provider will begin seeing patients in the OPD at 0800 and work until 17:30 HRS (5:30PM) CST with a minimum of a 30 minute lunch break required. The contract provider, on occasion may need to work for short periods of time beyond their respective shift hours, at times when such extra time is necessary to finish a patient visit, increased number of patients that need to be seen.

The Contractor will adhere to work duties and schedule for shifts in accordance with the SOW with no more than one (1) unplanned absence per quarter. Any changes more than that on the side of the contractor, resulting in any open shifts on the schedule may result in the contract going into default. Providers are needed to cover the shift and see the patients so it is imperative that the providers are there consistently. The provider shall adhere to work duties and schedule for shifts in accordance with SOW with no more than one (1) unplanned absence per quarter.

F. QUALITY ASSURANCE:

Is under the administrative supervision of the Medical Director the Rosebud Service Unit or his/her designee. Will participate with the Rosebud Hospital medical staff Chart Review Processes for the facility and/or department as well as participate in Corrective Actions, if needed. Incumbent performs assignments under general supervision, and will work directly under the Medical Director. In addition, the Supervisor will monitor the contractors work and provide feedback to the contractor.

Performance objectives will include a written summary provided to the Contract Provider as well as the Contractor summarizing the provider’s performance while on duty at the Rosebud Hospital. Criteria for evaluation will be as follows:

· Medical practice must be within the standards of their credentialed specialty

· Documents medical assessments, History and Physicals, observations, discharge summaries and daily progress notes all must be consisted with current standards and meet billing requirements.

· Utilizes EHR/RPMS computer system to enter and sign off lab results, pharmacy orders, notes; must be signed off at the end of each shift

· Complies with safety policies.

· Complies with all required trainings within the scheduled timeline.

· Consults with other specialty practitioners when needed.

· Maintains patient privacy/confidentiality and meets all HIPPA compliance standards.

· Adheres to work duties and scheduled shifts consistently without tardiness or absences.

· Understands that we have an FPPE and OPPE process and process improvement needs will be reviewed with the provider. Failure to improve may result in removal of the provider.

· Complaints on quality of care and/or conduct will be not more than 4 per quarter. There is zero tolerance for negligence or incompetence resulting in morbidity or mortality. Zero tolerance for violence or sexual harassment in the work place.

Rosebud Hospital’s Clinical Director or designee will conduct an exit interview with the provider to obtain any feedback from the contract provider regarding the work conducted. If the contract provider is unable to meet with the Clinical Director in person, the Rosebud Hospital requests feedback to be provided in writing within 2 days prior to departure from the Rosebud facility.

G. REPORTING REQUIREMENTS:

The Contractor shall ensure that all new contract providers participate in the Rosebud I.H.S. Facility Orientation, some of which can be completed prior to arrival, with an overlap of services to include one additional day to ensure new provider has completed orientation. Providers must arrive on a Monday – Friday excluding holiday and participate in the orientation prior to providing services at the Rosebud I.H.S. Hospital. Ideally the providers arrive on the pre-scheduled every-other week orientation. Prior to arrival the provider must have completed credentialing & privileging, provide proof of all required immunizations, background clearance completed, and completed all of the required steps for provider enrollment. Failure to have all steps completed prior to arrival will in the provider delay in being able to start orientation and these would not constitute billable hours.

H. PROFESSIONAL QUALIFICATIONS CRITERIA:

The Contractor must hold an active, current, and unrestricted state Medical Doctor or Doctor of Osteopathy license from any of the 50 United States or the Commonwealth of Puerto Rico. It is the contractor & providers responsibility to provide evidence of any change in licensure when it is done, including a renewing, retiring, or adding any additional state licensure or DEA numbers.

The Contractor cannot be under any exclusions or sanctions from the Medicare/ Medicaid programs. If the provider does have any resultant exclusions or sanctions after starting at the facility they will immediately cease seeing patients and report this to the Clinical Director and the Credentialing Specialist.

The Contractor must have a Medical Doctor (MD) or Doctor of Osteopathy (DO) degree from an accredited college or university in the specialty area required to provide medical services. It is ideal that all providers maintain board certification as this is a teaching institution. A provider who is presented who does not have board certification, it would have to be determined if they would meet the goals of the service unit and may or may not be usable.

The Contractor must fulfill all the requirements for appointment to the Rosebud IHS Medical Staff for the granting of privileges, in accordance with IHS policies and with the Service Unit Medical Staff Bylaws.

The Contractor must have current BLS at a minimum when working in the clinic. Also required for them to have ACLS for working with adults and for working with children PALS is required. A recommendation of NALS or NRP for those working with neonates including for the CNMW.

The provider shall have basic core privileges granted upon verification of all credentialing processes. The provider shall have the onus of supplying documentation supporting any requested privilege that is deemed outside the normal basic scope of practice. Requested privileges shall be denied by the medical director if the provider is unable to prove sufficient training, and State law citing specific allowance to perform requested privileges.

Required credential and appointment documents needed to allow initial provisional and subsequent active privileges and appointment shall include but not limited to the following items.

1) Unrestricted active State license photocopied, primary source verification will be completed at the service unit.

2) Photo of Individual that is recognizable, example driver’s license or passport work well.

3) Evidence of a two-step PPD skin test with annual TB testing evidence that followed or Interferon Gold with results not less than one-(1) year old:

*If TB positive then chest radiograph reading results must be submitted.

*If TB positive then record of treatment must be submitted.

*If TB skin test is positive secondary to BCG shots, do IFG blood test.

4) Immunization Required Prior to Arrival:

Rosebud Service Unit Health Requirements

1. 2 documented MMR vaccines OR positive antibody titers on each Measles, Mumps, and Rubella.

2. 2 documented varicella vaccines OR a positive antibody titer OR paperwork indicating by a physician diagnosis of the disease (must be complete documentation).

3. TDAP documented in past history AND at least a tetanus vaccine within the past 10 years.

4. 3 documented hepatitis B vaccines OR a positive hepatitis B antibody titer OR a signed declination of refusal.

5. 2 negative TB skin tests within the last 12 months OR a negative IGRA within the last 12 months.

a. If history of a positive reaction to either TB skin testing (secondary to BCG then do IGRA, if exposure need CXR and dates treated) or to an IGRA we will need the last chest x-ray, and dates of treatment (if treated).

-All Civil Service employees, contract staff, temporary employees, students, and volunteers, who work in an IHS health care facility, must receive a seasonal influenza vaccination by October 31 of each year or have on file a valid medical exemption for vaccination signed by a licensed independent practitioner

*Individuals with a valid medical exemption for vaccination will be required to wear a mask provided by IHS during the influenza season (November 1 through March 31) and during other periods of increased influenza activity as defined by the Centers for Disease Control and Prevention and/or State public health authorities.

5) Complete Curriculum Vitae with complete and current medical provider work history listing months and years. All gaps of medical employment eight-(8) weeks or greater must include an explanation by the applicant to the reason of this prolonged period of unemployment.

6) Current and active BLS, ACLS, and PALS as listed above with recommendation of NALS, NRP or any other certifications which will remain active throughout the provider’s tour while seeing patients in Rosebud Hospital.

7) Three-(3) letters of professional reference from peers not less than three-(3) months old.

8) Active DEA license including prescription privileges of Schedule 2 & 2N.

9) Current Liability Insurance of not less than $300,000/$1,000,000.

10) Record of recent (2 years) continuing education units (CEUs) or (CMEs). Must possess CME/CEUs that satisfies state licensing requirements if credentialing is to be beyond a 120-day Temporary medical staff appointment.

Providers must furnish adequate number of CMEs New residency graduates are exempt from 30 hours CME/CEUs as they have just successfully completed their training. However; fully credentialed new graduates with active medical staff membership will be required to provide an adequate number of CME/CEUs before they can be re-credentialed in two-(2) years with active medical staff membership.

I. CHARACTER INVESTIGATION FOR CONTRACTORS WHO WILL HAVE CONTACT WITH INDIAN CHILDREN:

The contractor is prohibited from having any unsupervised contact with Indian Children in the performance of this contract unless:

1. They act under the direct supervision and within the sight of a Government employee who has obtained a satisfactory “Criminal History Check” in accordance with the “Indian Child Protection and Family Violence Prevention” P.L. 101-630 and “Crime Control Act” P.L. 101-647.

Prospective contractors who duties and responsibilities involve regular contact or control over children are subject to a character investigation as required by P.L. 101-630, the Indian Child Protection and Family Violence Prevention Act. IHS personnel offices will conduct these investigations following award of a contract. The character investigations may be waived if, in judgment of the Contracting Officer, in consultation with the Personnel Officer, and investigation has already been conducted and is on file. Until the character investigation has been completed and the Contracting Officer notified or the results, the Contractor must not have unsupervised contact with Indian Children.

2.

The provider has obtained a satisfactory “Criminal History Check” which satisfies the requirements for the “Indian Child Protection and Family Violence and Prevention Act” P.L. 101-630 and “Crime Control Act” P. L. 101-647.

J. REQUIRED MALPRACTICE INSURANCE:

Current Liability Insurance of not less than $300,000/$1,000,000 covering the duration of the contract.

A Certificate of Insurance evidencing the required coverage shall be provided to the Contracting Officer prior to the commencement of services under this contract. If the insurance is on claims-made basis, evidence of an extended reporting endorsement shall be provided to the Contracting Officer prior to the expiration of this contract. Final payment under this contract shall be withheld until evidence of the extended endorsement is provided to the Contracting Officer.

K. COMPLIANCE WITH IHS RULES AND REGULATIONS:

Medical Practices must be within the medical standards of their established credentialed specialty and maintains continuing medical education, licensing, registration and certifications 100% of the time.

Complies with all policies, By-laws, Safety, Infection Control, and rules and regulations of HHS/IHS/Rosebud Hospital with zero (0) violations.

Maintains patient privacy/confidentiality/HIPAA with zero (0) breaches of privacy.

The contractor shall follow IHS Purchase Referred Care (PRC) regulations and policies when arranging for a referral or consult. The contractor shall consult with specialty practitioners for consultative opinions and continuation of care. The provider shall inform patients of the required referral or consult by indicating the specialty involved. The contractor will be required to facilitate transportation arrangements for patients referred to facilities for a higher level of care.

The contract provider shall use and follow the Rosebud IHS formulary list which is approved and maintained by the Rosebud IHS Pharmacy and Therapeutics Committee. Any drug not listed on the formulary must be approved by the Pharmacy and Therapeutics Committee.

Timely documentation that is completed 100% of the time which is to be completed PRIOR to the end of the daily shift and PRIOR to signing an invoice for payment.

Complaints on quality of care and/or conduct should be minimal and no more than three (3) per quarter (all issues will be addressed in writing to the contractor so that action can be taken).

The standards of medical practice and duties of the Contractor shall be determined pursuant to the bylaws of the Service Unit. 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 practitioners and hospitals must be followed. Also the standards and recommendations of Centers for Medicare and Medicaid Services (CMS) or the Accreditation Organization must be adhered to. The contract providers shall be required to participate in a quality improvement program, which is consistent with current requirements for ongoing monitoring and evaluation of the quality and appropriateness of care.

L. ANY SPECIAL REQUIREMENTS:

Must be able to use EHR to access, document and order in. Provider must be able to type fluently to document in the EHR. No dictation systems are used and all documentation, other than downtime forms, must be documented in the EHR.

FAR 52-237-7 - IDENTIFICATION AND MEDICAL LIABILITY INSURANCE:

A. It is expressly agreed and understood that this is a Non-Personal Service Contract, as defined in Federal Acquisition Regulations (FAR) 37.101, under which the professional services rendered by the Contractor are rendered in its capacity as an independent contractor.

The Government may evaluate the quality of professional and administrative services provided, but retain no control over professional medical judgment diagnoses, or specific medical treatments.

The Contractor shall be solely liable for and expressly agrees to indemnify the government with respect to any liability producing acts or omissions by it or by its employees or agents.

The Contractor shall maintain liability insurance issued by a responsible insurance carrier in the amount of not less than the minimum requirements established by the state in which the contract is performed during the term of the contract.

B. An apparently successful offer, upon request by the Contracting Officer shall furnish, prior to the contract award, evidence if its insurability concerning the medical liability insurance required by paragraph (1.) of this clause.

C. Liability insurance may be either on occurrence basis or a claims-made basis. If the policy is on claims-made basis, an extended reporting endorsement (tail) for a period of not less than 3 years after the end of the contract term must also be provided.

D. A Certificate of Insurance evidencing the required coverage shall be provided to the Contracting Officer prior to the commencement of services under this contract. If the insurance is on claims-made basis, evidence of an extended reporting endorsement shall be provided to the Contracting Officer prior to the expiration of this contract. Final payment under this contract shall be withheld until evidence of the extended endorsement is provided to the Contracting Officer.

E. The policies evidencing required insurance shall also contain an endorsement to the effect that any cancellation or material change adversely affecting the government’s interest shall not be effective until 30 days after the insurer or the Contractor gives written notice to the Contracting Officer. If during the performance period of the contract, the Contractor changes insurance providers, the Contractor must provide evidence that the Government will be indemnified to the limits specified in paragraph (a) of this clause for the entire period of the contract, either under the new policy or a combination of old and new policies.

F. The Contractor shall insert the substance of this clause, including this paragraph in all subcontracts under this contract or health care services and shall require such subcontractors to provide evidence of and maintain insurance in accordance with paragraph (a) of this clause. At least 5 days before the commencement of work by any subcontractor, the Contractor shall furnish to the Contracting Officer, evidence of such insurance.

G. The contract terminates when the performance period expires or the Hospital (i.e. lack of funding, workload, etc.) no longer requires services.

M. CONTRACTING OFFICER REPRESENTATIVE (COR):

For the purpose of this contract, the Clinical Director or designee will act as the COR and serve as the contractor’s supervisor.