TPSU - SOW Nurse Advice Triage 11092021.pdf

TAOS PICURIS SERVICE UNIT

DBA: TAOS PICURIS HEALTH CENTER

SCOPE OF WORK

11/09/2021

The Taos Picuris Health Center is a AAAHC (Association for the Accreditation of Ambulatory Health Care) accredited facility and PCMH (Patient-Centered Medical Home. As part of this certification, the facility is required to have 24 hour access to medical assistance for our patients.

The Contractor shall provide a Nurse Triage system for eligible American Indians and Alaskan Natives, Monday through Sunday 24 hours per day, 7 days a week and all federally recognized holidays.

Federally recognized holidays can be found online at http://www.opm.gov/fedhol/index.asp. The contractor shall be notified within a minimum of thirty (30) days by the Project Officer of any planned health center closures during normal business hours.

The contractor shall provide facility, personnel, labor, materials, equipment, and services for providing a telephone-based nurse triage system. The contractor shall provide a clinical assessment and disposition to an appropriate level of care for all patients who utilize the nurse triage system. TPSU estimates approximately 1-25 calls per month to be processed by the Contractor.

A 15-second pre-recorded message will advise callers of their privacy rights and include a disclaimer for IHS payment responsibility for all health care advice (script to be provided by

TPSU).

The Contractor shall ask for personal details. Personal details include: Name, Date of Birth, facility where they normally receive services (TPSU), chart number, primary care physician, insurance, and tribal enrollment information. If the patient is not a member of a federally recognized tribe, the contractor shall advise the patient the service are only for enrolled beneficiaries.

The Contractor shall gather information from the nurse triage service calls. The information shall be entered into a database or spreadsheet application. The information shall consist of: personal data, assessments, documented resolution, and/or further action needed from a Primary Care Provider. The Contractor shall provide Call summaries daily and shall be faxed to the TPSU Health Information Management department by the next business day.

-Nurse telephone triage services use standardized computer software protocols developed in compliance with nationally recognized telephone triage guidelines, including the Barton-Schmidt Pediatric Protocols, provided by McKesson Care Enhance.

-Nurse telephone triage services provided by licensed nurses -Medical Director must be credentialed.

-Protocols and guidelines must be approved by the Medical Director.

-Quality Assurance Program to meet AAAHC accreditation standards.

-Toll Free Telephone Service, 24 hours 7 days a week nurse telephone triage.

-Multilingual translation services.

-Hearing and speech impaired TDD/TTY services.

-Delivering advice via internet technologies.

-Faxing follow-up information to Primary Care Provider.

-Provide information about available community resources to member as information is available and as appropriate.

-Call recording system and monitor for quality reviews.

-Behavioral Health Information and linkage to services.

http://www.opm.gov/fedhol/index.asp

-Download of electronic enrollment data.

-Database management.

-Security backup and disaster recovery.

Response Time Targets:

-Answering calls or institute message answering based upon national and state standards.

-Assuring the average waiting time to communicate with a nurse does not exceed national or state standards.

-Assuring 85% of calls are connected with a nurse within 2 minutes of member’s call.

-Allow members to leave message when the wait time exceeds established national and state standards.

-Blockage not to exceed 0.5% of the total calls.

-Call abandonment rate not to exceed 5% per month with the exception of this requirement for public health emergencies and/or pandemics as defined by state and/or federal public health authorities.

Reports Provided at the Request of Client:

-Abandonment rate.

-Call detail reporting as available and in compliance with state and federal regulations.

-Primary reasons for call.

-Average wait time of members who call Nurse Telephone triage service.

-Average call length.

-Conduct semi-annual satisfaction surveys of members who call Nurse Telephone triage service.

-Be responsive to Client’s requests and complaints as appropriate.

Required Minimum Qualification:

Certified as a Registered Nurse and with at least one year experience.

Schedule of deliverables/reporting requirements:

Service to be delivered on a daily basis to the patients of Taos Picuris Service Unit.

Provide and maintain Certificate of Liability Insurance.

Invoice to be submitted on a monthly basis to alb_aopinvoices@ihs.gov.

Improperly prepared invoices will be returned to the contractor which may delay payment.

The invoice shall include:

-Name of Vendor -Invoice Date

-Government contract number or other authorization reference number for delivery of goods or services -Vendor invoice number, account number, and/or any other identifying number agreed to by contract -Description (including, for example, contract line/subline number), price, and quantity of goods and services rendered -Shipping and payment terms (unless mutually agreed that this information is only required in the contract -Taxpayer identifying Number (TIN), unless agency procedures provide otherwise; IHS contractors are required to include its Data Universal Numbering System (DUNS) number on each invoice in lieu of the TIN.

-Banking information, unless agency procedures provide otherwise, or except in situations where the EFT requirement is waived under 31 CFR 208.4

-Contact name, title, and telephone number