SOW - Pawnee Podiatry.docx

`STATEMENT OF WORK – PODIATRY SERVICES

I. Purpose of Contract:

The purpose of this contract is to provide podiatry services for the Pawnee Indian Health Services (PIHS), Pawnee, OK. The Indian Health Service requires podiatry services without interruption during the term of this contract.

II. Background:

The Pawnee Service Unit is Joint Commission accredited with facilities in Pawnee, Oklahoma. To meet the mission, podiatry care is medical modality that has been deemed necessary to augment the services within the service unit. Therefore, contracted podiatry services are necessary to support and supplement health care within the Service Unit.

III. Scope:

Contractor shall provide part-time podiatry services, no less than 1 day per month, 8 hours per day at Pawnee Indian Health Services as mutually agreed upon by the contractor and Indian Health Service. The Contractor shall provide services to include, but not limited to the following:

a) Provide comprehensive assessment of the feet of person with diabetes to identify individuals at high risk for lower extremity amputations.

b) Manage foot complications such as osseous and soft tissue deformities, neuropathy, etc. through the use of orthopedic, medical and/or surgical intervention.

c) Provide palliative foot care including nail, callus, corn and skin care.

d) Management of ulcerations through biomechanics, medical, and surgical means.

e) Identify and treat lower extremity pathology of the diabetic and non-diabetic populations as it relates to the areas of sports medicine, pediatrics, geriatrics, and traumatic injuries.

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. If the scheduled clinic falls on a Holiday, the clinic can be rescheduled.

IV. Responsibilities:

Contractor shall:

a. Provide podiatry care as outlined within scope noted above.

b. 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.

c. Observe and assess patient’s clinical condition; recognizing, identifying and interpreting situation and immediately deciding proper action and therapeutic care plan.

d. Formulate proper diagnosis and develop plan of care for individual patients.

e. Recommend proper therapeutic measures (exercise, stretches, etc.) for augmenting services.

f. Document all visits in Resource and Patient Management System (RPMS) and E H R. Medical record documentation must meet or exceed the established standards of the PIHS 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 I H S.

g. Perform all required training timely for HIPPA, as required by PIHC.

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

i. Perform all required training timely for HIPPA and computer access, as required by PIHS.

j. Contractor shall work with the Clinical Director 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 Clinical Director and/or designee as soon as possible if unable to work during scheduled hours. No weekend or federal holidays are worked.

k. The contractor shall not bill for patients seen at PIHS nor bill any third party payers for services provided at PIHS. The contractor shall be eligible for enrollment in the service unit’s Medicare/Medicaid program and any other alternate resource payer, to allow PIHS to bill these entities for the contractor’s services, as applicable.

l. 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 from the Native American community.

m. The Pawnee Service Unit shall retain the right to implement additional contractor responsibilities if, during the course of the contract, additional responsibilities become necessary to maintain continuity of care and quality of performance, however, these additional responsibilities, if implemented, do not alter nor effect negotiated and contracted rate fees.

V. Period of Performance: Base plus one option year.

VI. Contractor Qualification Requirements:

A. The podiatrist must be board certified and possess a current, unrestricted podiatry license.

B. Shall provide liability insurance in the appropriate amount of $1,000,000 per occurrence and $3,000,000 aggregate.

C. Shall be registered in System Awards Management (SAM) database.

D. Provide a resume.

E. Provide two references.

VII. Special Terms and Conditions:

Contractor must comply with the Stark Law that prohibit self-referral if the podiatrist (or an immediate family member) has a financial relationship with that entity.

Contractor shall possess the following requirements:

a. Rubella immunity must be documented either by serologic test or proof of immunization

b. A yearly PPD is required for all persons who have had no previous positive tuberculin skin test

c. A series of three (3) Hepatitis B immunizations or serologic proof of past infection is required

d. A yearly influenza vaccination

VIII. Schedule of Work:

Contractor shall provide an 8 hour day once a month as agreed upon between Contractor and the Pawnee Service Unit. The government reserves the right to negotiate the addition/reduction of hours, location, etc. as mutually agreed upon by contractor.

IX. Rates of Payment:

Contracted rates shall be established as identified within the attached quote for services and shall be invoiced on a total completed clinic hourly rate based invoice and submitted to and as identified in sections IX of this Statement of Work.

X. 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 Clinical Director and the Governing Body immune from civil or professional liability for all acts related to quality care management and enforcement of this contract.

XI. Government Furnished Information, Property and Services:

All records of consultation, examination, surgeries/procedures and services of patients’ required in the performance of this contract will remain the property of and subject to the exclusive control of the Pawnee Service Unit. The Pawnee Service Unit will provide materials, support staff and equipment necessary for the performance of this contract. The Contractor shall provide all services within the Pawnee Service Unit facilities.

XII. Contract Evaluation Contractor shall be evaluated yearly upon completion of each contract term. The government reserves the right to conduct evaluations more frequently if deemed necessary. Evaluation shall include patient/customer satisfaction, patient encounters/clinic, chart review and adherence to scope and contract term.

XIII. Invoicing Requirements

a. The Contractor shall be required to provide an original and two (2) copies of the invoice to Oklahoma City Area Indian Health Service, Division of Financial Management, 701 Market Center Drive, OKC, 73114.

b. Each invoice shall include the following information:

i. Contractor’s name and invoice date.

ii. Contract number or authorization for delivery of services.

iii. Description, price and quantity of services actually rendered.

iv. Name, title, phone number, and complete mailing address of official to whom payment is to be sent.

c. Invoice shall be submitted no later than ten (10) calendar days following last calendar day of the month.

XIV. Applicable Documents

Joint Commission http://jointcommission.org

Section 4087 of Public Law 101-630, Indian Child Protection & Family Violence Prevention Act

Health Insurance Portability and Accountability Act (HIPPA) of 1996 http://www.hhs.gov/ocr/hippa

Privacy Act of 1974 http://www.access.gpo.gov/nara/cfr/waisidx

Indian Health Service (IHS) Information Technology and Records Security and Safeguard Policies http://home.ihs.gov/ITSC-CIO/security/index.asp

System for Award Management (SAM) http://www.sam.gov

Clinical Director _______________________________ Date: ____________

CEO_________________________________________ Date: ____________