Circular Exhibit 20-07-B

1. Purpose This Collaborative Agreement for Volunteer Services (Agreement) is between the Specific Area Indian Health Service, a component of the Indian Health Service (IHS), which is an agency of the United States Department of Health and Human Services, and Person (Volunteer), a licensed healthcare provider volunteering to provide healthcare services to IHS patients in response to the public health emergency caused by the coronavirus disease 2019 (COVID-19) pandemic. The parties contemplate that the healthcare services provided by the Volunteer will increase the quality of patient care that is provided by the IHS to eligible individuals, without increasing the cost to the IHS of providing such care, and the Volunteer will be used to supplement, rather than displace, personnel employed in the IHS.
2. Authority
   1. 42 U.S.C. § 217b permitting the Secretary of the Department of Health and Human Services and/or her designee to accept volunteer services in facilities to broaden and strengthen the delivery of health services, contribute to the comfort and well being of patients in hospitals or clinics, or expand the services required in the operation of a health care facility.
   2. 25 U.S.C. § 1680c(e) implemented by IHS so volunteer physicians, physician assistants, and advance practice nurse at IHS direct care facilities can be designated “non-Service health care practitioners” through IHS’ privileging process to provide clinical care services to IHS patients in response to the public health emergency caused by the COVID-19 pandemic.
   3. 45 C.F.R. Part 57 (acceptance of volunteer and uncompensated services for use in the operation of any health care facility of the Department).
   4. Coronavirus Aid, Relief, and Economic Security Act (CARES Act), Section 3215.
3. Volunteer. The Volunteer is a [retired/active/resident] [specific type of healthcare provider] [if active/resident, state where they work].
4. Method of Selection. Final selection and placement of the Volunteer is the responsibility of IHS area officials.
5. Physical Requirements. The Volunteer must be able to pass the same healthcare requirements as civil service employees, be free of any contagious disease, and meet the requirements of IHS employee immunization policies.
6. Supervisory Controls. Supervision and direction will be provided by the Service Unit [state the position of the supervisor] or his/her designee to whom the Volunteer has been assigned for all matters, including training on (1) Federal Privacy Act and Health Insurance Portability and Accountability Act of 1996 (HIPAA) policies and procedures, and (2) the IHS Information Systems Security Awareness (ISSA) Training. The Service Unit [position] or his/her designee shall establish the days and hours the volunteer shall work and/or shall be available for consultations. All duties shall be performed under the supervision of the Service Unit [position] or his/her designee.
7. Duties and Obligations. The Volunteer will function as a member of the healthcare staff, providing and/or observing direct patient care under the supervision of a designated IHS employee. The Service Unit [position] or his/her designee shall unilaterally decide which patients should be treated by the Volunteer and who shall act as the Volunteer’s supervisor. All applicable medical supplies shall be furnished by the Service Unit. The Service Unit [position] or a designated employee shall review the charts in order to monitor the quality of care attributable to the Volunteer.

   The Volunteer, while performing volunteer services, shall conform to all applicable administrative instructions and requirements of the United States Department of Health and Human Services, Indian Health Service, and IHS area, including all regulations and procedures concerning conduct, safety, and patient care. The volunteer is to adhere to the Standards of Conduct provisions of Executive Order 11222.

8. Clinical privileges. All volunteer non-Service health care practitioners will be privileged in accordance with the appropriate IHS clinical privileges. See IHS Indian Health Manual, Chapter 1, Part 3, § 3-1.4.
9. Employment Status. The Volunteer shall provide all services strictly in a volunteer capacity, without compensation or other benefit from the federal government or any other state, local, or tribal government or public or private entity. The Volunteer understands and waives any and all claims for compensation from the IHS and the United States Government for any services performed relating to the voluntary assignment. Likewise, Volunteer service is not creditable for leave or any other employee benefits.
10. Benefits and Services for Volunteer. The Volunteer is not to be considered an employee of the IHS or the United States Government, except for the following limited purposes (note all Area offices may not have the ability to offer the following benefits), while treating patients at IHS facilities during the public health emergency caused by the COVID-19 pandemic:
    1. Benefits provided by 5 U.S.C. § 8101 for work related injuries or diseases;
    2. Coverage under the Federal Tort Claims Act (FTCA), 28 U.S.C. §§ 1346(b), 2401(b), and 2671–2680, if expressly authorized by federal law;
    3. Immunity from liability for services providing services due to the COVID-19 pandemic when the requirements of the CARES Act are met;
    4. Travel and transportation expenses under 5 U.S.C. § 5703;
    5. Government vehicles for official purposes in accordance with established policy;
    6. Protective clothing and equipment under 5 U.S.C. § 7903;
    7. Use of the physical facility, including conference areas, equipment, and supplies to provide medical services within the clinical setting;
    8. Orientation to the facility, resources, and records as appropriate;
    9. Attendance at any continuing education programs held at the facility;
    10. Meals may be provided to volunteers without charge when scheduled assignment extends over an established meal period.
    11. Quarters may be furnished temporarily, if available, at no charge to the volunteer, in case of emergency, or when necessitated by the special nature of volunteer assignment;
    12. Physical examination must be undertaken by all volunteers, for, the protection of volunteers, patients, and employees. These examinations may be administered within IHS facilities without charge to the individual.
    13. Emergency outpatient treatment for injuries sustained while performing assigned volunteer services will be provided to volunteers. Volunteers may also be provided temporary care and treatment in Department facilities under the same circumstances and to the same extent such care and treatment is available to paid employees.
    14. Permitted disclosure of patient records and other protected health information as needed to perform the assigned clinical duties under this Agreement.
11. Confidentiality of Records. The content of patient medical records shall be held in confidence and in accordance with the Privacy Act of 1974, 5 U.S.C. § 552a; Privacy Act Regulations, 45 C.F.R. Part 5b; Drug Abuse Prevention, Treatment, and Rehabilitation Act, as amended, 42 U.S.C. § 290dd-2; Confidentiality of Alcohol and Drug Abuse Patients Records, 42 C.F.R. Part 2; HIPAA, 45 C.F.R. Parts 160 and 164; and any applicable state law in which the IHS facility is located.
12. Medical Records
. All medical records and related documentation concerning any patient for whose treatment and care the volunteer provided either directly or by consultation, are the sole and exclusive property of the IHS and shall not be used by the volunteer for any purpose not contemplated herein. All medical records are subject to applicable IHS records-retention policies.
13. Background Investigation and Child Care Statement. The volunteer must adhere to established background investigation requirements, including a preclearance check prior to beginning work. Additionally, for any volunteer who will have regular contact with, or control over, Indian children, a State Criminal History Repositories check will be required pursuant to the Indian Child Protection and Family Violence Prevention Act, 25 U.S.C. §§ 3201-3210, and the Crime Control Act of 1990, Subtitle E, Child Care Worker Employee Background Checks, 34 U.S.C. § 20351, as well as all regulations promulgated pursuant to such laws.

    A background investigation will not be required for any health care licensed volunteer whose services are limited to telehealth consultations. If these volunteers have logical access to the IHS network (D1 account), they also need to go through a background check.

    Alternatively, until the background investigation is completed and a favorable determination is made, the volunteer must be within sight and under the supervision of a staff person who has favorable background investigation that includes the additional state checks during times when the volunteer has contact with or control over Indian Children. See 34 U.S.C. § 20351(b)(3).

14. Recognition. The Volunteer will not receive recognition or award as a result of participation under this Agreement.
15. Volunteer Service Records. This Agreement, the Letter of Authorization, and all other Volunteer service records will be maintained as part of the Government-wide system of records for purposes of the Privacy Act.
16. Term and Termination of Agreement. This Agreement will become effective upon signatures of all parties and will continue during the duration of the COVID-19 pandemic, unless terminated at any time by either party by written notice to the other and for any reason.
17. Entirety of Agreement. It is expressly agreed that this written Agreement represents the entire understanding between the parties and supersedes any prior agreements or understanding with respect to the subject matter herein. Any changes or modifications to this Agreement must be in writing and be signed by both parties.
18. Third Parties. Nothing in this Agreement, expressed or implied, is intended to confer any rights, remedies, claims, or interests upon an individual or entity not a party hereto. Neither party shall have the right to assign or transfer its rights to any third party under this Agreement without the prior written consent of the non-transferring party.

IN WITNESS WHEREOF: The parties hereto have duly executed this Agreement in accordance with the terms and provisions contained herein. The persons signing this Agreement warrant that they have full authority to do so and that their signatures shall bind the parties for which they sign.

Volunteer:

By: ________________________________
Name: ________________________________
Date: ________________________________

For the IHS:

By: ________________________________
Name: Name of Area Director
Title: Area Director, Specific Area Indian Health Service
Date: ________________________________