WIPCC PWS NP Revised 03-30-2021.pdf

Gallup Indian Medical Center

Performance Work Statement (PWS) for Non Personal Health Care Services

Walk-In Primary Care

Nurse Practitioner Services

Table of Contents

Section Page

1.0 General 1-2

2.0 Definitions 2-5

3.0 Government Furnished Information, Property, & Services 5

4.0 Contractor Furnished Equipment 6

5.0 Performance-Based Requirements 6-8

6.0 Contractor Qualification Requirements 8-10

7.0 37.4 Non-Personal Health Care Service 11

8.0 Performance based Matrix 12

PWS GIMC Mid-Level Nurse Practitioner March 2020

1.0 General: This performance work statement describes the requirements for non-personal health care service as a Walk-In Primary Care Nurse Practitioner to support the mission of the

Indian Health Service (IHS).

1.1 Background: IHS is an agency within the U.S. Department of Health and Human Services and is responsible for providing federal health services to American Indians and Alaska

Natives. The provision of health services to members of federally recognized tribes grew out of the special government to government relationship between the federal government and

Indian tribes. The IHS is the principal federal health care provider and health advocate for the Indian people. The goal is to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indians and Alaska

Natives. The IHS currently provides health services to approximately 2.0 million American

Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 34 states.

There is a nationwide shortage of medical providers in certain specialties which is amplified by the remote and rural areas served by the Indian Health Service. This performance work statement covers requirements for the Navajo Area. The positions to be filled include: Nurse

Practitioners for the provision of outpatient and inpatient medical and surgical services.

1.1.1 Navajo Area Indian Health Service (NAIHS) administers health centers and hospitals providing health care to approximately 201,583 members of the Navajo Nation. The

Navajo Nation is the largest Indian tribe in the United States and has the largest reservation, which encompasses more than 25,516 square miles in northern Arizona, western New Mexico, and southern Utah, with three satellite communities in central

New Mexico. The NAIHS is the primary provider of inpatient, ambulatory care, preventive and community health, and environmental health services for members of the Navajo Nation and the San Juan Southern Paiute Tribe.

1.1.2 Gallup Indian Medical Center is a 78-bed hospital in Gallup, New Mexico, on the border of the Navajo Reservation. Clinical specialties at GIMC include Internal

Medicine, Cardiology, Anesthesia, OB/GYN, General Surgery, Orthopedics, Ophthalmology, ENT, Radiology, Pathology, Pediatrics, Psychology and Emergency

Medicine. The workload at Gallup is one of the largest in the Indian Health Service with 310,000 outpatient encounters and 4,400 inpatient admissions annually. GIMC has the largest staff of all Navajo Area IHS facilities.

1.2 Scope: The Contractor shall provide Mid-Level Nurse Practitioner non-personal healthcare services in accordance with section 5.0, performance based requirements.

1.2.1 Duties and responsibilities may encompass outpatient services to IHS patients.

1.2.2 Place of Performance: Services shall be performed at hospital facility of the Navajo

Area Indian Health Service within the Gallup Indian Medical Center.

1.2.3 Period of Performance: Will be flexible to allow for short term (less than one week), long term (1 year to 3 years) and where feasible, include intermittent support to meet unplanned needs that develop on a frequent basis.

1.3 Applicable Documents: Please see the web link listed unless document is listed as an attachment.

1.3.1 Joint Commission on Accreditation of Healthcare Organizations (TJC) https://www.jointcommission.org/

1.3.2 Centers for Medicare and Medicaid Services (CMS) Standards http://www.cms.hhs.gov

1.3.3 Accreditation Association for Ambulatory Health Care (AAAHC) http:// www.aaahc.org

1.3.4 Section 231 of Public Law 101-647, the Crime Control Act of 1990.

http://www.policyalmanac.org/crime/archive/crs_federal_crime_policy.shtml

1.3.5 Section 3207 of Public Law 101-630, the Indian Child and Family Violence Act https://www.law.cornell.edu/uscode/text/25/3207

1.3.6 Health Insurance Portability and Accountability Act (HIPAA) of 1996 https://aspe.hhs.gov/report/health-insurance-portability-and-accountability-act-1996

1.3.7 Privacy Act of 1974

https://www.justice.gov/opcl/privacy-act-1974

1.3.8 Revised American Nurses Association Code of Ethics and Standards of Practice and

Care (1996) https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/

1.3.9 State Nurse Practice Act for the Contractor's licensing state https://www.ncsbn.org/npa.htm

1.3.10 IHS Service Unit and Health Center Policies, Procedures and Protocols. (See section

11.0 for a list of attachments and exhibits)

1.3.11 Computer Security Act of 1987

https://csrc.nist.gov/csrc/media/projects/ispab/documents/csa_87.txt

1.3.12 Federal Code of Conduct

https://www.law.cornell.edu/cfr/text/34/appendix-to_part_73

1.3.13 IHS General Directives: https://www.ihs.gov/IHM/

1.3.14 IHS Computer Security Directives http://security.ihs.gov/index.cfin.

2.0 Definitions

2.1 Acceptance: Constitutes acknowledgement that the supplies or services conform to the applicable contract quality and quantity requirements, except as provided in FAR subpart https://www.jointcommission.org/ http://www.cms.hhs.gov/ http://www.aaahc.org/ http://www.policyalmanac.org/crime/archive/crs_federal_crime_policy.shtml https://www.law.cornell.edu/uscode/text/25/3207 https://aspe.hhs.gov/report/health-insurance-portability-and-accountability-act-1996 https://www.justice.gov/opcl/privacy-act-1974 https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/ https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/ https://www.ncsbn.org/npa.htm https://csrc.nist.gov/csrc/media/projects/ispab/documents/csa_87.txt https://www.law.cornell.edu/cfr/text/34/appendix-to_part_73 https://www.ihs.gov/IHM/ http://security.ihs.gov/index.cfin

46.5 and subject to other terms and conditions of the contract.

2.2 Approval: Acknowledgment by the designated Government official that submittals, deliverables, or administrative documents (e.g., insurance certificates, installation schedules, planned utility interruptions, etc.) conform to the contractual requirements. Government approval does not relieve the Contractor from responsibility for compliance with contract requirements.

2.3 Area: A defined geographical region for Indian Health Service administrative purposes.

Each Area Office may administer several Service Units.

2.4 Code of Ethics: Code ethics as described by the American Medical Association (AMA) and any code of ethics described by individual specialty organizations.

2.5 Contracting Officer (CO): A Government employee with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings.

2.6 Contractor: The individual awarded a legal binding contract to provide supplies and services.

2.7 Contracting Officer's Representative (COR) or Project Officer (PO): A federal employee who assists the ordering/issuing activity contracting officer in the administration of task orders issued under this contract. The COR is primarily responsible for the technical assistance and day-to-day program management of the ordering activity's task orders.

Ordering activities may have different designators for this employee (e.g. GTR -

Government Technical Representative, COTR-Contracting Officer's Technical

Representative, or PO- Project Officer).

2.8 Cooperative Attitude: Behavior that is positive and displays a willingness to perform assigned patient care tasks and to be a team player.

2.9 Cultural Awareness: Realization and respect for American Indian and Alaska Native practices.

2.10 Customer: Patients, staff and visitors of an IHS service unit and health center.

2.11 Customer Evaluation/Input: Written comments made to the Contracting Officer regarding the Contractors performance. This is one of the criteria used to evaluate the Contractor's performance.

2.12 Dependability: Qualities of being trusted and being able to repeat the same task to yield the same result.

2.13 Federal Acquisition Regulation (FAR): The FAR is the primary regulation for use by all

Federal Executive agencies in their acquisition of supplies and services with appropriated funds.

2.14 Government Vehicle: An IHS owned motor vehicle or a vehicle leased by IHS through agreements with the General Services Administration (GSA) or through commercial rental agreements.

2.15 Health Center: A facility physically separated from a hospital, with a full range of ambulatory services including at least primary care providers, nursing, laboratory, and x-ray which are available at least 40 hours a week for outpatient care.

2.16 Ordering Activity: An authorized user of IHS that may issue a task order to obtain required services under this contract.

2.17 Ordering Activity Contracting Officer: A Government employee of IHS authorized and warranted to issue task orders and to make subsequent task order modification(s) under this contract. The Ordering Activity CO has the authority to make initial determinations on all matters of dispute regarding task orders.

2.18 Orientation: An activity designed to provide basic familiarization of the facility and transition the nurse practitioner into the IHS Service Unit and/or Health Center and the clinical unit where the services will be provided.

2.19 Past Performance Information: Relevant information regarding a contractor's actions under previously awarded contracts. This includes the contractor's record of conformance to specifications and to standards of good workmanship; the contractor's record of containing and forecasting costs on any previously performed cost reimbursable contracts; the contractor's adherence to contract schedules, including the administrative aspects of performance; the contractor's history for reasonable and cooperative behavior and commitment to customer satisfaction; and generally, the contractor's business-like concern for the interest of the customer.

2.20 Patient Outcome: End result of medical and surgical care.

2.21 Performance based Matrix: Lists the services to be monitored and the standards to be applied.

2.22 Personal Protective Equipment (PPE): The equipment used to protect medical personnel from exposure to biological, chemical, and radioactive hazards.

2.23 Service Contracts: a contract that directly engages the time and effort of a contractor whose primary purpose is to perform an identifiable task rather than to furnish an end item of supply. A service contract may be either a nonpersonal or personal contract. It can also cover services performed by either professional or nonprofessional personnel whether on an individual or organizational basis.

2.24 Service Unit: The local administrative unit of IHS.

2.25 Standards of Practice and Standards of Care: Authoritative statements by which the medical profession describes the responsibilities for which its practitioners are accountable.

The standards provide direction for professional medical practice and a framework for the evaluation of practice. The standards of professional medical practice may pertain to general or specialty practice.

2.26 Supervisor. Government employee authorized to provide verbal and written performance direction to the Contractor that the Contractor must follow without exception.

2.27 Task Order: An order issued in accordance with the terms of the contract that details an ordering activity's specific requirements. An ordering activities written order to obtain services, at a minimum will include the following where applicable: description of services, skill categories, hours, price, period of performance, contract number, and the ordering activities task order number.

2.28 Tour of Duty: The time of day the provider is scheduled to perform medical care; also considered the shift of the day. The time can vary according to the needs of each facility and/or clinic, e.g. 12 hour Tour of Duty, 8 hour Tour of Duty, 10 hour Tour of Duty.

Includes nights, weekends and holidays.

2.29 Valid Patient Complaint: Justifiable accusation made by a patient and supported by investigation.

2.30 Verifiable Emergency: An unexpected/unplanned absence by the contractor requiring valid documentation to confirm the occurrence.

3.0 Government Furnished Information, Property and Services

3.1 Information: Government unique information related to this requirement, which is necessary for Contractor performance, will be made available to the Contractor. The

Contracting Officer or designee will be the point of contact for identification of any required information to be supplied by the Government.

3.2 Joint Use by the Government and the Contractor: Except for the property and service listed in 3.3 and 4.0, the Government will provide, for joint use by the Government and the

Contractor, all necessary equipment, supplies, and clinic space to perform the services under this contract.

3.3 Contractor Exclusive Use:

3.3.1 Personal Protective Equipment (PPE): The Government will furnish the Contractor with appropriate PPE other than specified in paragraph 4 of the contract. The

Government will be responsible for any repair, cleaning, and inventory required for the

PPE. This does not include any type of uniform or laboratory coat.

3.3.2 The Government will provide facility specific contractor identification badges for each contractor. A minimum fee of $10.00 will be charged for lost or destroyed badges.

3.4 Training: Facility specific orientation/training necessary for the Contractor to perform the required duties, e.g., IHS information technology (IT) systems and operational procedures.

Training will be provided to improve or enhance the quality of provider services or includes mandates made by the IHS Service Units/Health Centers while the provider is working under this contract. Training will not be provided for the purpose of continuing education, career development or individual development.

4.0 Contractor Furnished Property

4.1 Except for the property specified in paragraph 3.0 as government furnished, the Contractor shall provide all uniforms and other personal medical instruments subject to the following:

4.1.1 Uniforms and Lab Coats: Uniforms and Lab Coats shall conform to the requirements of the Indian Health Service Manual, Part 3 Chapter 4 and meet the approval of the

Clinical Director at each IHS facility.

4.1.2 Other personal medical instruments: "Other personal medical instruments" are defined as Contractor owned items may include but not limited to stethoscope, scissors, as appropriate to the work unit. The Contractor shall not use unsafe equipment or supplies at any time during performance of this contract. All Contractor furnished equipment and supplies shall be subject to inspection by the Government and shall be approved by the COR prior to use by the Contractor. The Government reserves the right to prohibit the use of any materials, supplies, or equipment.

5.0 Performance-Based Requirements. The Contractor shall provide medical services in the delivery of patient care to the Indian Health Service. Specific tasks include the following:

5.1 Provision of Care:

5.1.1 The Contractor shall perform medical duties and manage patient's needs as described in the (PD), identified by the Service Unit and as directed by Supervisor.

5.1.2 The Contractor shall perform in accordance with the approved privileges through the credentialing process.

5.1.3 The contractor shall abide by the Gallup Service Unit Medical and Dental Staff Bylaws and Rules and Regulations.

5.2 Work Schedule:

5.2.1 The Supervisor shall determine specific tour of duty. The contractor shall work 100% of the contracted hours.

5.2.2 Work Flexibility. As directed by the Supervisor, the Contractor shall provide call support as needed to support patient care.

5.2.3 The Contractor shall obtain approval of the department Supervisor or designee prior to any absence from work. If the length of the absence exceeds eight (8) work hours, the

Contractor shall request approval at least fifteen (15) days, (the exception is verifiable emergencies) in advance of the desired absence.

5.2.4 Approval of leave is contingent upon availability of a qualified replacement.

5.2.5 The Contractor shall provide written documentation from a qualified health care provider for absences of three (3) or more consecutive days, due to illness, stating:

The cause of the current illness or incapacitation, AND

Indicating the Contractor as contagious or non-contagious.

The Government reserves the right to examine and or re-examine any Contractor who meets the criteria.

5.3 Conduct: The Contractor shall meet standards as listed in the Federal Code of Conduct.

5.3.1 The Government reserves the right to remove from the facility any Contractor employee failing to abide with the Federal Code of Conduct.

5.4 Performance Evaluation:

5.4.1 The Contractor's performance will be evaluated in accordance with the standards set forth in the contract and Performance-based Matrix of section 9.0.

5.4.2 Substantiated reports written by any customer dealing with patient safety, infection control, inappropriate behavior or any procedures that adversely affects patient outcome constitutes a breach of contract.

5.5 Identification of Contractor:

5.5.1 The Contractor shall wear a government issued contractor identification badge during performance of duty.

5.6 Management of Medical Information: The Contractor shall manage all patient information in accordance with HIPAA standards, Privacy Act, and IHS Service Unit and/or Health

Center specific policies and protocols.

5.6.1 Medical Records and Other Required Documentation: 100% percent of all medical records and other required documentation meets established IHS Medical Facility, TJC, and CMS standards to include, but are not limited to, timeliness, legibility, accuracy, content, date, time, signature and designated profession. (Note: payment will be withheld for inaccurate or incomplete medical records per paragraph 10.0 of this performance work statement).

5.6.2 The Contractor shall ensure adherence to DHHS IT system security policies and procedures. The IT policies and procedures will be made available to the Contractor.

5.6.3 The Contractor shall immediately report to the Contracting Officer or COR any information or circumstances that may violate any statute, policy, or procedure.

5.7 IHS Information Technology Systems:

5.7.1 In performance of this contract, the Contractor shall adapt to and successfully utilize

IHS information technology systems that are deemed by the Supervisor as necessary for acceptable contractor performance, including use of the Electronic Health Record

(EHR).

5.7.2 The Contractor shall ensure that IHS information technology system security policies and procedures are adhered to. The IT policies and procedures will be made available to the Contractor at each IHS facility.

6.0 Contractor Qualification Requirements:

6.1 Experience:

The Contractor shall have a minimum of thirty-six (36) months of experience within their specialty unless otherwise approved by the Contracting Officer.

The Contractor is to provide Nurse Practitioner (NP) services within the Walk-In

Primary Care Clinic at GIMC. The Contractor will be required to work ten hours per twenty-four-hour period, including days, evening and holidays.

6.2 Contractor Requirements:

The Contractor must show the following:

Certificate of Completion/Diploma from an accredited nurse practitioner program

Current, valid, unrestricted state or federal nurse practitioner license

Current certification by the American Nurses Credentialing Center (ANCC) or other nationally recognized credentialing body as an Advanced Nurse

Practitioner

Competency in family medicine, adult medicine or urgent care medicine

Possess BLS, ACLS, PALS certification

Confidentiality of patient care and records

Credentialing by GIMC Medical-Executive Committee

Contractor will complete department orientation and be responsible for submitting all documents required for orientation.

Contractor will be responsible for submitting all invoices for their services.

Contractor will be responsible for processing his or her own federal and state taxes.

Contractor will be responsible for their own transportation, housing, insurance and other personal benefits.

Contractor will be under the supervision of the Chief of Walk-in Primary Care and subject to the rules, regulations, policies and laws of the IHS/Federal Government.

Contractor will sign-in and out for duty in the Walk-In Primary Care Clinic and will only be paid for hours worked.

Contractor will show a working knowledge of protocols, policies and procedures, including patient confidentiality and recordkeeping.

Duties as enumerated in justification for Walk-In Primary Care Nurse Practitioner.

Major Duties and Responsibilities:

Perform initial and/or periodic histories and physical examinations; and documents findings, results and diagnoses in medical record per medical staff rules & regulations.

Manage acute, episodic, and chronic conditions occurring in patients presenting to the Walk-In Primary Care Clinic; and consult with MD/DO when patients’ disease process exceeds the NP’s education, training, and/or experience.

Provide full range of acute and interim primary care services to treat medical conditions, and consulting colleague physicians, primary care physicians and specialty physicians as medically needed.

Order and interpret diagnostic studies such as laboratory tests, radiological exams, electrocardiograms, or other studies as appropriate and specified in the

Contractor’s clinical privileges as a Nurse Practitioner.

Screen patients to determine the need for further healthcare.

Evaluate the medical aspects of treatment plans periodically, recognizing the need for reassignment to other healthcare professionals or specialists.

Works collaboratively with other physicians in management of selected complex medical problems and refers to higher level of care when needed.

Prescribe and dispense medications and durable medical devices and supplies.

Carry out health promotion and disease prevention activities including education and shared decision-making.

Educate and counsel patients and families in preventive care, medical conditions, and the use of prescribed treatments and drugs.

Provide appropriate periodic mental health assessment, screening, and counseling for mental illness, family violence, and diseases of addiction.

Draw blood or obtain other specimens for laboratory testing as needed.

Initiate and expedite requests for consultations and arrange special tests and studies.

Write orders as necessary for the care of the patient and record encounters in the patient’s medical record in accordance with GIMC rules & regulations and

GIMC Medical Records policy & procedure.

Obtain informed consent and document performed procedures as approved in the NP’s training and clinical privileges.

Maintains records and reports on patients, personal activities and other required information for use in program operation, quality assurance and other purposes.

6.3 License/Registration. All providers shall possess a current, valid, unrestricted nurse practitioner license in a state, the District of Columbia, the Commonwealth of Puerto Rico, or a Territory of the United States, throughout the term of this contract.

6.3.1 Motor Vehicle Operator's License. If required by the position, the Contractor shall possess a valid state driver's license throughout the term of this contract.

6.4 Certifications.

6.4.1 Current Basic Life Support (BLS) is mandatory for all specialties. Advanced Cardiac

Life Support (ACLS) and Pediatric Advanced Life Support (PALS) is required for

Walk-In Primary Care.

6.5 Health Requirements/Conditions of Employment:

6.5.1 Medical Evaluation. The Contractor shall provide a fitness for duty certificate issued by a licensed healthcare practitioner to perform the proposed job without significant risk to personal health or the health and safety of others.

6.5.2 Immunization. The Contractor shall also provide the following documentation:

Immunity to Rubella, Mumps, Measles

Immunity to Hepatitis B series

History of chicken pox (varicella) disease or positive titer

Tdap vaccine required

Documentation of receiving a TB Mantoux skin test (PPD) within the past 12 months with documentation of follow-up for a positive test.

A signed declination of the Hepatitis B vaccination series will be accepted.

Current Influenza vaccination

6.6 Language Requirements and Cultural Awareness. The Contractor shall read, understand, speak, and write English to effectively communicate with patients and other health care workers, and shall be respectful of the local, American Indian and Alaska Native culture.

6.7 Information Technology Skills. The Contractor shall possess basic knowledge, skills, and abilities to use a computer.

6.8 Orientation. All Contractors providing service under this contract shall attend mandatory orientations and training specified by the government.

6.9 Background Checks: As directed by the Contracting Officer, the Contractor shall provide all requested information necessary to perform background checks. The Contractor shall comply with the requirement to obtain security investigations. The Contractor shall work with the IHS to ensure that the pre-employment screening process includes the appropriate investigation questionnaires and forms to be completed. All completed forms will be reviewed by the Contractor and forwarded to the Government Personnel. The Contractor will be immediately removed from the position if at any time the investigation receives unfavorable adjudication, or, if other unfavorable information that would affect the investigation becomes known.

6.10 Challenges to Conflicts: For any inconsistency between supervisory directions, this PWS, attachments and exhibits, the following order of precedence will apply:

a) First Priority: Supervisor’s directions

b) Second Priority: Position Description (attached)

c) Third Priority: Performance Work Statement Exhibits

d) Fourth Priority: Performance Work Statement Narrative

6.10 Any Contractor employee demonstrating impaired judgment shall not be allowed to continue working on the contract. The Government reserves the right to remove from the facility any

Contractor employee who in the judgment of a licensed healthcare practitioner is impaired.

7.0 37.4 Non-Personal Health Care Service: The contract shall be a non-personal health care services contract where 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, professional aspects of the services rendered, (e.g., professional judgments, diagnosis for specific medical treatment). The Contractor shall indemnify the Government for any liability producing act or omission by the contractor, its employees and agents occurring during contract performance. The Contractor shall maintain during the term of this contract liability insurance issued by a responsible insurance carrier, m 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 per occurrence.

8.0 Performance - based Matrix

Performance-based Task Indicator Standard Quality Assurance Incentives

Contractor shall provide

Competency

Perform 100% required tasks at 100% of

See QASP. Surveillance

Payment of contract price for medical services in the the required competencies (refer to 6.0) systems will include periodic satisfactory service.

delivery of patient care to the Navajo Area Indian Health

Compliance

100% compliance with IHS Service Units inspections and customer complaints.

Contractor performance will Service, Gallup Indian and/or Health Centers published Policies; be evaluated using the Medical Center Procedures; Standards of Care; and Contractor Performance hospital protocols. Assessment Reporting System

(CPARS).

evaluation Patient Outcomes No reports of breached patient safety, infection control, and other procedures that might adversely affect patient outcome.

Professionalism

Performance characterized by continual cultural awareness and focus on customer service. I00 percent adherence to the Federal Code of Conduct.

Credentialing

Uninterrupted credentialing as defined in

6.0 to 6.9 for period of contract.

Documentation 100% percent of all documentation meets established IHS Medical Facility, TJC, and CMS standards to include, but are not limited to, timeliness, legibility, accuracy, content, date, time, signature and designated profession.

Service Quality Satisfaction with quality of service is evidenced by valid customer inputs.