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Statement of Work

Diabetic Foot Supplies and Services Haskell Indian Health Center

2023

1. Background

Indian Health Service (IHS) wants to improve its current accessibility when purchasing Diabetic Foot Supplies & Services (DFSS) for the Community Directed Diabetes Grant program, within the Haskell Indian Health Center; specifically, Topeka, Lawrence, and Kansas City metro areas. This project shall ensure accessibility of optimal patient outcomes, while assuring that purchased services are best value. Patient care shall be optimized, which aligns with the mission of IHS. All patients who have been diagnosed with diabetes mellitus should receive an annual foot examination to prevent any foot problems as indicated with IHS standards of care. This service shall help reduce the risk of lower limb complications by providing professionally fitted shoes to patients with diabetes who are served by Haskell Indian Health Center (HIHC). Each year when a diabetic foot exam is performed, the patient with an abnormal result or improperly fitting shoes shall have access to properly fitted shoes, as requested by provider and/or patient. In an effort to achieve this goal, the Contractor shall provide services for the patients served by HIHC.

1. Statement of Work

The Contractor shall perform the following activities:

1. 
   
   
   
   1. Provide an all-encompassing Diabetic Foot Supply and Orthotic Services program for referred patients from HIHC. The services program will be required to be accredited by the Accredited Facilities Program of the Board for Orthotist-Prosthetist Certification (BOC) and provide an American Board Certified (ABC) pedorthist on site when providing services to HIHC patients.
   
   
   2. Shall have experience with evaluating and fitting the feet of diabetic patients
   
   
   3. Vendors main office with fitting clinic shall be located within 20 miles of the HIHC 2415 Massachusetts St. Lawrence, KS 66046. Vendor shall have other fitting locations in surrounding metropolitan areas of KS (Kansas City metro area, Topeka, and Wichita).
   
   
   4. Ensure adequate fit and function of the shoes at time of delivery to participant.
   
   
   5. Services shall be fully coordinated and integrated with the Project Manager with respect to services provided and professional relationships.
   
   
   6. Contractor shall measure each patient's foot and provide appropriate shoes.
   
   
   7. Shall have competent/effective oral and written communication. Supplies and services provided to each patient shall be appropriately documented on each monthly invoice.
   
   
   8. Maintain familiarity and comply with all Federal and State regulations and requirements
   
   
   9. Shall maintain patient privacy/confidentiality
   
   
   10. Accountability requires that all services be under professional direction, therefore, the Contractor shall be fully responsible for any subcontracts (if applicable), professionally, administratively, and financially.
   
   
   
   

1. Government Furnished Information, Property and Services
   
   
   
   
   1. Provide written patient referrals with individual identification number to the
   
   
   
   

Contractor, with specified expiration (vouchers).

1. Period of Performance and Work Schedule
   
   
   
   
   1. One year from the date of award with three (3) option years.
   
   
   2. Work Schedule maybe be coordinated between the Contractor and Project Manager
   
   
   
   

1. Specific Requirements
   
   
   
   
   1. Diabetic Foot evaluations (measuring of feet, testing for protective sensation, palpating and checking for range of motion and foot deformities and gait evaluation)
   
   
   2. Patient shall be fitted at vendor’s clinic in patient’s area. The vendor’s main office with fitting clinic shall be located within 20 miles of HIHC (2415 Massachusetts St. Lawrence, KS 66046) and shall offer fitting clinic offices in major metropolitan areas of KS (Kansas City metro area, Topeka, and Wichita).
   
   
   3. Adjustments and modifications of shoes and/or inserts if necessary
   
   
   4. After wearing the shoes at home or at the gym (without wearing outside), the Contractor shall replace if the shoe does not fit well or is causing pain within 15 days. The Contractor shall replace with a more appropriate fitting shoe.
   
   
   5. Vendor shall communicate any issues with services provided or patient compliance immediately to HIHC project manager.
   
   
   
   

1. Reporting Requirements
   
   
   
   
   1. The Contractor shall provide services for patients referred within 30 days of receipt of the written referral.
   
   
   2. The Contractor shall provide a Monthly Report of Services, a narrative report with comparison of actual services provided according to requirements established and the quantity of shoes, inserts, and compression stockings provided as well as the number of problems encountered and circumstances, if any, adversely affecting the delivery of services and recommendations.
   
   
   
   

1. Vendor Performance Evaluation
   
   
   
   
   1. Provide multiple footwear options based on needs of patients.
   
   
   2. Patients must have a favorable satisfaction rate, this will be determined through follow up phone calls, online evaluations, or written evaluations through Haskell Diabetes Program or obtained from Vendor.
   
   
   3. Successful patient follow up for fit, comfort, and needs met.
   
   
   4. Accurate and timely invoice submission.
   
   
   5. HIPAA compliant with PII and PHI.
   
   
   
   

1. Rates of Payment
   
   
   
   
   1. Payments on diabetic shoes and inserts shall not exceed Medicare-Like Rates for the services provided.
   
   
   2. Vendor shall provide invoices for services no later than 30 days after services have been provided.
   
   
   3. If the Contractor's price changes as a result of notification from CMS or cost to charge ratio, they shall provide a letter from CMS to Haskell Indian Health Center within 30 days of receipt along with a corrected price list in order to be paid at the new rate.
   
   
   4. The Contractor shall not bill any patient for any amounts not paid under this purchase order unless the patient is determined by IHS to be ineligible for services under this purchase order and demonstrated by a letter of denial of the Community Directed Diabetes Grant Program services payment.
   
   
   5. IHS is the payor of last resort for persons defined as eligible for Diabetic Foot Supply and Services.
   
   
   
   

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