1. 75H70523R00003 RFP Package.pdf

SEE ADDENDUMIS CHECKED

CODE 18a. PAYMENT WILL BE MADE BY

CODE

FACILITYCODE

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

OFFEROR

CODE 16. ADMINISTERED BYCODE

X

X

X

561320

SIZE STANDARD:

100.00 % FOR:SET ASIDE:UNRESTRICTED OR235

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

01/23/2023 1500 CT

12/27/2022

JENNIFER RICHARDSON

(No collect calls)

INFORMATION CALL:

FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIMEb. TELEPHONE NUMBERa. NAME

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

75H70523R00003

5. SOLICITATION NUMBER

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE OF

1 22 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

15. DELIVER TO

Bemidji MN 56601 2225 Cooperative Ct NW, Rm 200

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$30.00

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW

ISSUE DATE

DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULE

12. DISCOUNT TERMS

THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

Indian Health Service

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

(Use Reverse and/or Attach Additional Sheets as Necessary)

HEREIN, IS ACCEPTED AS TO ITEMS:

XX

DATED

WILLIAM F. FISHER

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

ARE

31c. DATE SIGNED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print)

ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

OFFER

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

30b. NAME AND TITLE OF SIGNER (Type or print)

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

29. AWARD OF CONTRACT:

REF.

IEE

DENTAL ASSISTANT SERVICES

jerichardson Highlight jerichardson Highlight jerichardson Highlight jerichardson Highlight jerichardson Highlight jerichardson Highlight jerichardson Highlight

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32c. DATE 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

40. PAID BY39. S/R VOUCHER NUMBER38. S/R ACCOUNT NUMBER

37. CHECK NUMBER

FINALPARTIAL

36. PAYMENT

FINALPARTIAL

35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER33. SHIP NUMBER

COMPLETE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

42d. TOTAL CONTAINERS42c. DATE REC'D (YY/MM/DD)

42b. RECEIVED AT (Location)

42a. RECEIVED BY (Print)

41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

STANDARD FORM 1449 (REV. 2/2012) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

22 2 of

75H70523R00003

DENTAL ASSISTANT SERVICES -WEHC

SECTION A

A.1 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

SECTION B - CONTINUATION BLOCK

B.1 CONTRACT ADMINISTRATION DATA

B.2 INVOICES

B.3 PLACE OF PERFORMANCE

B.4 PERIOD OF PERFORMANCE

B.5 SCHEDULE OF PRICE/COST

B.6 METHOD OF PAYMENT

B.7 CONTRACTING OFFICER REPRESENTATIVE (COR)

B.8 PERFORMANCE WORK STATEMENT

SECTION C - CONTRACT CLAUSES

C.1 FEDERAL ACQUISITION REGULATIONS PROVISIONS AND CLAUSES INCORPORATED BY REFERENCE

C.2 FEDERAL ACQUISITION REGULATIONS FULL TEXT PROVISIONS AND CLAUSES

C.3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ACQUISITION REGULATION

(HHSAR) (48 CFR CHAPTER 3) CLAUSES

C.4 HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 APPLICABLE DOCUMENTS

D.2 DEFINITIONS

D.3 BACKGROUND INVESTIGATION

D.4 SECURITY NOTICE

D.5 BUSINESS ASSOCIATE AGREEMENT

D.6 IEE CERTIFICATION

SECTION E – SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERS by reference

E.2 52.212-2 EVALUATION – COMMERCIAL ITEMS

E.3 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS by reference

SECTION B - SUPPLIES OR SERVICES AND PRICE/COSTS

B.1 CONTRACT ADMINISTRATION DATA

Contract Administration: All contract administration matters will be handled by the following individuals:

CONTRACTOR NAME AND ADDRESS:

SAM Number (UEI): _________________ Cage: _____________

Name: ____________

Phone: ____________ E-Mail: _____________________________

Person responsible for Contractor Performance Assessment Reporting System (CPARS), reporting if different from above:

Name: ______________

Title: _______________

CONTRACTOR REGISTRATION: All required information must be in the System for Award Management (SAM) at www.sam.gov.

GOVERNMENT:

Jennifer Richardson Indian Health Service 2225 Cooperative Ct NW, Rm 202 Bemidji, MN 56601

Jennifer.Richardson@IHS.Gov 218-444-0537

NAICS:

The associated North American Industrial Classification System (NAICS) code for this procurement is 561340 with a small business size standard of $30M

CONTRACT TYPE: Firm-Fixed Price

B.2 INVOICES: In accordance with the Prompt Payment Act, payment will be due 15 days after receipt of services or receipt of a proper invoice, whichever is later.

INVOICE INSTRUCTIONS:

Electronic Invoicing and Payment Requirements - Invoice Processing Platform (IPP) Payment requests must be submitted electronically through the U. S. Department of the Treasury's Invoice Processing Platform System (IPP).

"Payment request" means any request for contract financing payment or invoice payment by the Contractor. To constitute a proper invoice, the payment request must comply with the requirements identified in the applicable Prompt Payment clause included in the contract, or the clause 52.212-4 Contract Terms and Conditions - Commercial Items included in commercial item contracts. The IPP website address is: https://www.ipp.gov.

Under this contract, the following documents are required to be submitted as an attachment to the IPP invoice:

- A copy of the Contractor’s invoice shall be included with the IPP invoice. If no invoice is attached, the Invoice will be rejected;

- Contractor's Invoice shall contain:

* Contract number

* SAM's Registration - Unique Identity Number (UEI Number)

* EIN or Tax ID Number

* List of deliverables;

- Timesheets if applicable - Number of hours worked with corresponding labor category and rate

HHSAR 352.232-71 Electronic Submission of Payment Requests (Feb 2022)

(a) Definitions. As used in this clause— Payment request means a bill, voucher, invoice, or request for contract financing payment with associated supporting documentation.

The payment request must comply with the requirements identified in FAR 32.905(b), “Content of Invoices” and the applicable Payment clause included in this contract.

(b) Except as provided in paragraph (c) of this clause, the Contractor shall submit payment requests electronically using the Department of Treasury Invoice Processing Platform (IPP) or successor system. Information regarding IPP, including IPP Customer Support contact information, is available at www.ipp.gov or any successor site.

(c) The Contractor may submit payment requests using other than IPP only when the Contracting Officer authorizes alternate procedures in writing in accordance with HHS procedures.

Guidance for proper registration and training:

IPP is a secure, web-based electronic invoicing system. Respondents are required to register an account with IPP if they have not already done so. If your organization is already registered to use IPP, you will not be required to re-register-however, we encourage you make sure your organization and designated IPP user accounts are valid and up to date.

The IPP website address is: https://www.ipp.gov Training for vendors can be located at:

https://www.ipp.gov/vendors/training-vendors If you require assistance registering or IPP account access, please contact the Department of the Treasury's IPP Helpdesk at (866) 973-3131 (M-F 8AM to 6PM ET), or IPPCustomerSupport@fiscal.treasury.gov

Improperly prepared invoices or statements shall be returned to the contractor and may delay payment.

B.3 PLACE OF PERFORMANCE:

WHITE EARTH HEALTH CENTER NAYTAHWAUSH HEALTH CENTER

40520 COUNTY HIGHWAY 34 238 CHURCH STREET

OGEMA, MN 56569 NAYTAHWAUSH, MN 56566

PINE POINT SATELLITE CLINIC

47520 282nd STREET

PONSFORD, MN 56575

B.4 PERIOD OF PERFORMANCE: BASE PLUS (4) OPTION YEAR

BASE YEAR: 02/01/2023 – 01/31/2024

OPTION YEAR 1: 02/01/2024 – 01/31/2025

OPTION YEAR 2: 02/01/2025 – 01/31/2026

OPTION YEAR 3: 02/01/2026 – 01/31/2027

OPTION YEAR 4: 02/01/2027 – 01/31/2028

B.5 SCHEDULE OF PRICE /COSTS: (2) Total Dental Assistants ** OVERTIME IS NOT AUTHORIZED**

BASE YEAR HOURS HOURLY RATE TOTAL

0001) DENTAL ASSISTANT 2,080 $ $

0002) DENTAL ASSISTANT 2,080 $ $

OPTION YEAR 1 HOURS HOURLY RATE TOTAL

0003) DENTAL ASSISTANT 2,080 $ $

0004) DENTAL ASSISTANT 2,080 $ $

OPTION YEAR 2 HOURS HOURLY RATE TOTAL

0005) DENTAL ASSISTANT 2,080 $ $

0006) DENTAL ASSISTANT 2,080 $ $

OPTION YEAR 3 HOURS HOURLY RATE TOTAL

0007) DENTAL ASSISTANT 2,080 $ $

0008) DENTAL ASSISTANT 2,080 $ $

OPTION YEAR 4 HOURS HOURLY RATE TOTAL

0009) DENTAL ASSISTANT 2,080 $ $

0010) DENTAL ASSISTANT 2,080 $ $

B.6 ADMINISTRATIVE DATA:

Method of Payment:

a) The IHS Bemidji Division of Finance is designated for payment processing. Payment shall be made by electronic funds transfer (EFT). Payment shall be made in arrears.

b) The Contractor’s rate identified for services described herein is considered as an all-inclusive rate. All-inclusive is defined to include but is not limited to services, travel, lodging, liability insurance, fringe benefits, federal, state and local taxes, and all other costs pertinent to the performance of this contract.

B.7 CONTRACTING OFFICER REPRESENTTIVE (COR). The COR will be appointed in writing by the CO after the contract is awarded. The CO will provide a copy of this designation and COR contact information to the Contractor.

The role of program and technical personnel in monitoring the contract is to assist and advise the Contracting Officer, and act as the COR when so designated by the Contracting Officer. The COR does not have the authority to change or alter the order amount, terms and conditions.

COR activities include—

1. Providing technical monitoring during contract performance and advising the Contracting Officer relating to delivery, acceptance, or rejection of deliverables in accordance with the terms of the contract;

2. Assessing contractor performance;

3. Recommending necessary changes to the schedule of work and period of performance to accomplish the objectives of the contract (The COR shall provide the Contracting Officer a written request along with an appropriate justification and a funding document, if additional funds are needed.)

4. Reviewing invoices/vouchers and recommending approval/disapproval by the Contracting Officer, including providing comments regarding anything unusual discovered in the review;

5. Reviewing and recommending approval or disapproval of technical submissions, subcontractors, overtime, travel, and key personnel changes;

6. Assisting the Contractor in the resolution of technical problems encountered during performance; and

7. Participating, as necessary, in various phases of the contract closeout process;

8. Provide receiving authorization within two days of services/items received or invoiced

POINT OF CONTACT:

Mary Simon Mary.simon2@ihs.gov

B.8 PERFORMANCE WORK STATEMENT (PWS)

Dental Assistants White Earth Health Center

1. GENERAL

This is a non-personnel services contract to provide Dental Assistants. The Government shall not exercise any supervision or control over the Contracted Dental Assistants performing the services herein. Such Contracted Dental Assistants shall be accountable solely to the Contractor who, in turn is responsible to the Government.

1.1 Description of Services/Introduction: The Contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform the duties of Dental Assistants as defined in this Performance Work Statement (PWS), except for those items specified as government furnished property and services. The Contractor shall perform to the standards in this contract.

1.2 Background: The Mission statement for White Earth Health Center is “To partner with our communities to be their healthcare provider of choice”. To meet this mission, the White Earth Health Center has identified a need for a non-personal service contract for providing dental services.

1.3 Objectives: The Contracted Dental Assistants agree to provide all necessary covered services within the Dental Assistants’ scope of practice, under the direction of the Dental Assistant Supervisor or designee.

The Contracted Dental Assistants shall provide a full scope of dental assisting services including: chairside dental assisting, operatory set-up and break down, instrument pre-cleaning, and operatory/equipment/supply disinfection at the White Earth Health Center.

The Contracted Dental Assistants shall provide a full scope of direct patient care services including: sealants, temporary fillings, prophies, fluoride treatments, silver ion antimicrobial treatments, x-rays, patient triaging, and patient education at the White Earth Health Center. The Contracted Dental Assistants are required to assist in the O.R. as part of their routine duties.

The Contracted Dental Assistants shall provide a full scope of clinical documentation services including charting, documentation in the electronic dental record at White Earth Indian Health Service Unit.

1.4 Scope: Assist with provision of dental services. Services include providing direct care to patients of all ages with a variety of medical conditions. The Contractor shall accomplish dental services provided by the Contracted Dental Assistants and shall be as comprehensive as the Indian Health Service supplied facilities, equipment, and support services permit.

The contract resulting from this solicitation shall:

1. Be a non-personal services contract under which the Contractor is an independent contractor;

2. Require the Contractor to promptly provide all requested information to allow for proper background checks;

3. Allow the Government to evaluate the quality of professionalism and the quality of care services provided;

4. Require the Contractor to cover the Government for any liability producing act of omission by the Contractor, its employees and agents occurring during contract performance;

5. Require the Contractor to maintain liability insurance, in the coverage amount acceptable to the

Contracting Officer, which is not less than the amount normally prevailing with the local community;

6. Candidates with pending dental assistant licensure, certification, or registration actions are not eligible for employment with this agency.

1.5 Period of Performance: The Contracted Dental Assistant shall provide dental services for the entire Period of Performance at the White Earth Health Center and the satellite clinics of Naytahwaush, Pine Point, and the Rice Lake Health Station. The usual workday will be from 8:00 AM to 4:30 PM Monday - Friday.

1.6 General Information:

1.6.1 Quality Control: The Contractor shall develop and maintain an effective quality control program to ensure services are performed in accordance with this PWS. The Contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The Contractor’s quality control program (QCP) is the means by which he assures himself that his work complies with the requirement of the contract. The QCP is to be delivered within 30 days after contract award or with the Contractor’s proposal if it is an evaluation factor. Three copies of a comprehensive written QCP shall be submitted to the Contract Officer (CO) and Contracting Officer Representative (COR) within five working days when changes are made thereafter. After acceptance of the quality control plan, the Contractor shall receive the Contracting Officer’s acceptance in writing of any proposed change to his quality control (QC) system.

1.6.2 Quality Assurance: The Government shall evaluate the Contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan. This plan is primarily focused on what the Government must do to ensure that the Contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

1.6.3 Recognized Holidays: The Contracted Dental Assistant will not work on federal government holidays, as depicted on schedules provided upon issuance of Task Order.

New Year’s Day L abor Day Martin Luther King Jr.’s Birthday Columbus Day President’s Day Veteran’s Day Memorial Day Thanksgiving Day Juneteenth Christmas Day Independence Day

1.6.4 Hours of Operation: The contract manager, or alternate, shall be available Monday – Friday 8 AM – 4 PM for administrative concerns. The Contractor must at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS. When hiring personnel, the Contractor shall keep in mind that the stability and continuity of the workforce are essential.

1.6.5 Place of Performance: The work to be performed under this contract will be performed at the White Earth Health Center and satellite clinics, which are Indian Health Service government facilities.

1.6.6 Type of Contract: The Government will award a firm-fixed price, non-personal service contract.

1.6.7 Security Requirements: The Contracted Dental Assistants is subject to a background investigation and shall comply with Section 231 of the Crime Control Act of 1990, P.L. 101-647; and the Indian Child Protection and Family Violence Prevention Act, P.L. 101-630. In addition, the Dental Assistants shall also comply with the Privacy Act of 1974 and the HIPPA Act of 1996. Failure to comply with these statutes will result in immediate removal.

Contracted personnel performing work under this contract, which involve regular contact with, or control over, Indian children, are subject to a character investigation in accordance with the “Indian Child Protection and Family Violence Prevention Act” P.L. 101-630. The Indian Health Service Personnel Office will conduct these investigations following award of a contract unless in the judgment of the Contracting Officer, in consultation with the Personnel Officer, investigation may be waived based on prior investigations on file. Until the character investigation has been completed and the Contracting Officer notified, such individual shall not have unsupervised contact with Contracted Dental Assistants will need to be accompanied by a chaperone until investigation is complete.

The Contracting Officer has the authority to temporarily waive the character investigation of a contracted personnel.

The “Agreement to a Temporary Waiver of Character Investigation” (See Attachment B) authorizes an agency to hire contracted personnel prior to the completion of a background check provided that, at all times, the contracted personnel is within the sight and under the supervision of a government employee who has successfully completed the National Agency Check with written Inquiries (NACI).

This level of security is required, and must be maintained for the life of the contract.

1.6.7.1 Physical Security: The Contracted Dental Assistants shall be responsible for safeguarding all government equipment, information and property provided for Contracted Dental Assistant use. At the close of each work period, government facilities, equipment, and materials shall be secured. The Contracted Dental Assistants shall generate and maintain proper medical record information on beneficiaries to whom treatment is provided, in accordance with Indian Health Service regulations, facility policy and in accordance with HIPPA. The Contracted Dental Assistants shall prepare all medical records documentation to meet or exceed the established standards of the IHS facility to include, but not be limited to: timeliness, legibility, accuracy, content, and signature. All medical record information generated in the performance of the contract will be subject to the exclusive control of the Indian Health Service.

1.6.7.2 Key Control: The Contractor shall establish and implement methods of making sure all keys/key cards issued to the contracted personnel by the Government are not lost or misplaced and are not used by unauthorized persons. NOTE:

All references to keys include key cards. No keys issued to the contracted personnel by the Government shall be duplicated. The Contractor shall develop procedures covering key control that shall be included in the Quality Control Plan. Such procedures shall include turn-in of any issued keys by personnel who no longer require access to locked areas. The Contractor shall immediately report any occurrences of lost or duplicate keys/key cards to the Contracting Officer.

1.6.7.2.1 In the event keys, other than master keys, are lost or duplicated, the Contractor shall, upon direction of the Contracting Officer, re-key or replace the affected lock or locks; however, the Government, at its option, may replace the affected lock or locks or perform re-keying. When the replacement of locks or re-keying is performed by the Government, the total cost of re-keying or the replacement of the lock or locks shall be deducted from the monthly payment due the Contractor. In the event a master key is lost or duplicated, all locks and keys for that system shall be replaced by the Government and the total cost deducted from the monthly payment due the Contractor.

1.6.7.2.2 The Contractor shall prohibit the use of government issued keys/key cards by any persons other than the Contractor’s employees. The Contractor shall prohibit the opening of locked areas by contracted personnel to permit entrance of persons other than Contractor employees engaged in the performance of assigned work in those areas, or personnel authorized entrance by the Contracting Officer.

1.6.8 Special Qualifications: Contracted Dental Assistants must meet at least one of the following qualifications:

a) Experience + Dental Radiology = 6 months experience as a dental assistant and has a dental radiology certificate or certification

b) Military Training Program + Dental Radiology = Completed a military dental assisting training program and has a dental radiology certificate or certification

c) Graduate of Dental Assisting Program = Graduated from a CODA accredited, one year dental assisting degree program that issues a dental assisting degree or certificate

d) National Registration (RDA) = Achieved and maintains registered dental assistant certification through AMT

e) State Registration (RDA) = Achieved and maintains dental assisting registration from any of the 50 United States or Commonwealth of Puerto Rico

f) Certification (CDA) = Achieved and maintains DANB certification

g) State Licensure (LDA) = Maintains a current, unrestricted state dental assisting license from any of the 50 United States of the Commonwealth of Puerto Rico

Licensure, certification, or registration are preferred. It is a condition of this contract that all qualifying registrations, certifications, and/or licensures remain current during the life of this contract.

Must also possess current (BLS) Basic Life Support certification or certificate.

The Contractor is responsible for ensuring the Contracted Dental Assistant shall:

a) Not have any work or health restrictions which interfere with the performance within the dental department.

b) Have skill and knowledge in providing dental assistant services with full consideration of the mental, emotional, physical, and cultural factors involved, such that he/she can relate constructively to patients from the Native American Community.

c) Ability to work with patients, the public, and clinic staff.

1.6.12 Identification of Contractor Employees: All contracted personnel attending meetings, answering government telephones, and working in other situations where their contracted personnel status is not obvious to third parties are required to identify themselves as such to avoid creating an impression in the minds of members of the public that they are government officials. They must also ensure that all documents or reports produced by contractors are suitably marked as contracted personnel products or that contracted personnel participation is appropriately disclosed. The contracted personnel will be required to obtain and wear badges in the performance of this service.

1.6.13 Contractor Travel: The Contractor shall be responsible for arranging travel and all associated costs related to the performance of this contract.

1.6.14 Other Direct Costs: The Contractor shall be responsible for arranging travel, lodging, per diem, labor, fringe benefits, and any applicable Federal, State, and Local taxes, plus any other costs pertinent to the performance of this contract.

1.6.15 Data Rights: The Government has unlimited rights to all documents/material produced under this contract. All documents and materials, to include the source codes of any software, produced under this contract shall be government owned and are the property of the Government with all rights and privileges of ownership/copyright belonging exclusively to the Government. These documents and materials may not be used or sold by the Contractor without written permission from the Contracting Officer. All materials supplied to the Government shall be the sole property of the Government and may not be used for any other purpose. This right does not abrogate any other government rights.

1.6.16 Organizational Conflict of Interest: Contracted and subcontracted personnel performing work under this contract may receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statements, etc.) or perform evaluation services which may create a current or subsequent Organizational Conflict of Interests (OCI) as defined in FAR Subpart

9.5. The Contractor shall notify the Contracting Officer immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and shall promptly submit a plan to the Contracting Officer to avoid or mitigate any such OCI. The Contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the Contracting Officer and in the event the Contracting Officer unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the Contracting Officer may affect other remedies as he or she deems necessary, including prohibiting the Contractor from participation in subsequent contracted requirements which may be affected by the OCI.

PWS PART 3

GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND SERVICES

This section identifies those items such as property, information and/or services that will be provided for the Contractor’s use (without cost to the Contractor) to allow them to provide the required dental services, such as materials, facilities, training, etc. Examples provided below.

3. GOVERNMENT FURNISHED ITEMS AND SERVICES

3.1. Services: The Government will provide personnel to assist with orientation and guidance to the Indian Health Service and its requirements.

3.2 Facilities: The Government will provide the necessary workspace for the contractor staff to provide the support outlined in the PWS to include desk space, telephones, computers, and other items necessary to maintain an office environment for dental services.

3.3 Utilities: The Government will provide all utilities in the facility will be available for the contractor’s use in performance of tasks outlined in this PWS. If utilities are furnished, the following is required: The Contractor shall instruct employees in utilities conservation practices. The Contractor shall be responsible for operating under conditions that preclude the waste of utilities.

3.4 Equipment: The Government will provide equipment and/or what the Contractor will have access to, i.e., computer, phone, scanners, fax machines, printers, shipping crates, lighting and sound, etc.

3.5 Materials: The Government will provide materials, i.e., Standard Operating Procedures (SOPs), policies, and medical supplies and equipment to perform duties.

PWS PART 4

CONTRACTOR FURNISHED ITEMS AND SERVICES

4. CONTRACTOR FURNISHED ITEMS AND RESPONSIBILITIES

4.1 Verification of Licensure, Certification, Certificates, Degrees, or Registration

To ensure that Dental Assistants providing services under this contract are properly qualified and that the IHS is made aware of all disciplinary actions taken against such Dental Assistants, the contractor will:

1. Verify through a State Board of Dentistry database all active, inactive, and lapsed licenses or registrations that are held, or have been held, by Dental Assistants who would provide services in IHS hospitals and clinics under this contract.

2. Verify through DANB all active, inactive, and lapsed certifications that are held, or have been held, by Dental Assistants who would provide services in IHS hospitals and clinics under this contract.

3. Verify through AMT all active, inactive, and lapsed registrations that are held, or have been held, by Dental Assistants who would provide services in IHS hospitals and clinics under this contract.

4. Inform IHS of the status of all dental assisting licenses, registrations, and/or certifications for each Dental Assistant who would provide services under this contract in IHS hospitals and clinics, including all reasons for each inactive or lapsed license.

5. Provide all information regarding performance and disciplinary actions that is collected on Dental Assistants who would be placed under this contract to the receiving IHS facility Dental Assistant Supervisor or Lead Dental Assistant.

This includes all information that is collected and compiled on such Dental Assistants at the time of initial hire by the Contractor, and/or information that is reported during periods that the Contractor is an agent of such Dental Assistants for placement under this contract.

7. Certify that all information obtained on Dental Assistants whom they would assign to IHS hospitals and clinics has been reviewed and verified by the Contractor. This certification must include a statement that the Contractor has found no reason to reject the Dental Assistant’s application. The names of the contacts, their titles, telephone numbers, and dates of representative collecting and reviewing such information must be recorded in writing and made available to the IHS by the Contractor.

The Contractor must provide all of the information required above to the Deputy Dental Director, Dental Director, or designee of the receiving IHS facility no less than ten to fourteen days before the Dental Assistants’ actual report date.

When the requirements or the IHS do not allow for hard copies of information to be received at least ten days before a Dental Assistants placement, the Contractor may provide such assurances to the IHS facility within five days after Dental Assistant placement. Such instances shall be kept to a minimum and the reasons for each instance must be documented and well justified by the Dental Assistant Supervisor at the receiving IHS facility.

4.2 Employee Health Requirements:

White Earth Health Center requires Contracted Dental Assistant onboarding health information for all applicants to whom conditional offers of employment have been made in order to evaluate the applicant’s health and to protect patients and staff from exposure to communicable diseases. If the applicant refuses to provide health information or proof of immunizations, as recommended by the Centers for Disease Control (CDC) and Occupational Safety and Health Administration (OSHA) concerning health-care workers in the United States, the refusal is deemed sufficient grounds for White Earth Health Center to deny employment. Information obtained regarding the medical condition or history of the applicant will be collected and maintained on separate forms and in separate medical files, in accordance with federal law, and will be treated as a confidential medical record. Cass Lake Indian Health Service will not provide immunizations or testing for contract personnel.

GUIDELINES

Contracted Dental Assistant onboarding health information must include the following:

Employee Health reviews previous immunization history. White Earth Health Center requires all potential healthcare workers to provider proof of the following immunization records. If the healthcare worker cannot provide proof of immunizations, appropriate lab testing should be provided prior to onboarding. Lack of immunization history is deemed sufficient grounds for White Earth Health Center to deny employment.

If the potential healthcare worker wishes to request a medical or religious vaccine exemption, a vaccination declination form must be submitted to Employee Health. The declination form must be reviewed and approved by White Earth Health Center prior to acceptance of the contracted employee. Disapproval of a vaccination exemption request is deemed sufficient grounds for White Earth Health Center to deny employment. Required vaccinations, titers, boosters, skin testing, and proof of immunity is accomplished at the expense of the potential contracted healthcare worker. The only vaccines that may be provided to potential contracted healthcare workers at White Earth Health Center at no cost to the potential contracted healthcare worker are COVID-19 and Influenza vaccines.

Hepatitis B

All White Earth Health Center contracted healthcare workers who perform tasks that may involve exposure to blood or body fluids should receive a 3-dose series of hepatitis B vaccine, following the manufacturer recommendations. Test for hepatitis B surface antibody (HBSAB) to document immunity 1-2 months after dose #3. If HBSAB is positive, the healthcare worker is immune and no further testing or vaccination is recommended. For new hires providing proof of previous vaccination, HBSAB testing will be performed. If HBSAB results are >10mIU/mL, the healthcare worker is immune and no additional vaccination is required. If the HBSAB is < 10mIU/mL the healthcare worker should be revaccinated with 3-dose series on an appropriate schedule, with serologic testing repeated in 1-2 months. If HBSAB is negative following 6 doses of vaccine, the healthcare worker is a non-responder. For non-responder blood exposures, consult the White Earth Health Center Infection Control Plan.

Measles, Mumps, Rubella (MMR) All White Earth Health Center contracted healthcare workers must be immune to Measles (Rubeola), Mumps and Rubella.

For healthcare workers without serologic evidence of immunity to each component of the vaccine or without proof of 2vaccinations, recommend additional doses needed per CDC & OSHA guidelines.

Tetanus, Diphtheria, Acellular Pertussis (Tdap) All White Earth Health Center contracted healthcare workers between 19-64 years of age (or per manufacturer recommendation) must receive a 1-time dose of T-dap, with priority given to those having contact with infants younger than age 12 months.

Tuberculosis All White Earth Health Center contracted healthcare workers must have a two-step Tuberculosis skin test (TBST) or show proof of a TBST in the last twelve months. If not completed within 12 months, contracted healthcare worker will need to have the two-step TBST skin test completed at their expense. If a potential contracted healthcare worker is a known TBST reactor, he/she will be required to complete a chest x-ray. The x-ray may be waived if the potential healthcare worker can provide documented proof of a chest x-ray, which was done in the last twelve months and the potential healthcare worker denies signs and symptoms of Tuberculosis. The chest x-ray will be done at the expense of the potential contracted healthcare worker.

Varicella All White Earth Health Center contracted healthcare workers must be immune to varicella. Evidence of immunity for the healthcare worker includes documentation of 2 doses of varicella vaccine give per manufacturer recommendation, history of varicella or herpes zoster, laboratory evidence of immunity, or laboratory confirmation of disease.

Influenza (annual) All White Earth Health Center contracted healthcare workers are required to have annual influenza vaccinations. Influenza vaccines are available to contracted healthcare workers at no cost during annual employee vaccination clinics. If contracted healthcare worker does not participate in the vaccination clinics, they may be required to get the Influenza vaccine elsewhere at their own expense.

COVID – 19

All White Earth Health Center contracted healthcare workers are required to have two doses of COVID-19 vaccine in a two-dose series vaccine, or one dose of COVID-19 vaccine in a single-dose vaccine. They are also required to have boosters if recommended or required by CDC, OSHA, HHS, or IHS. COVID-19 vaccines are available to contracted healthcare workers at no cost during annual employee vaccination clinics. If contracted healthcare worker does not participate in the vaccination clinics, they may be required to get the COVID-19 vaccine elsewhere at their own expense.

PART 5

SPECIFIC TASKS

5. SPECIFIC TASKS

5.1. Basic Services. The contracted Dental Assistant shall provide highly competent direct patient care, patient education, infection control, equipment and supply maintenance, and chairside dental assisting services.

5.2. Tasks. Dental Assistant Services Contract to provide Dental Assistants.

5.3.1 The contracted Dental Assistant will perform infection control, equipment maintenance, and inventory management services per hospital policy, protocols, or standing operating procedures:

5.3.2 Comply with all IHS facility infection control and safety procedures, practices, and standards.

5.3.3 Disinfect equipment, supplies, operatories, and other patient care areas, following manufacturers’ instructions for use.

5.3.4 Pre-clean reusable instruments and supplies prior to sterilization, following manufacturer’s instructions for use.

5.3.5 Follow all dental waterline protocols to keep dental waterlines clean.

5.3.6 Transport instruments to and from sterilization area.

5.3.7 Follow infection control protocols for inventory management and storage.

5.3.8 Dispose of medical waste following standing operating procedures, protocols, and policies.

5.3.9 Follow handwashing and personal protective equipment protocols.

5.3.10 Follow universal masking and distancing protocols, if required by clinic policy.

5.3.11 Perform and document equipment maintenance per daily, weekly, monthly, quarterly, and annual schedules.

5.3.12 Maintain equipment checklists and log books, per departmental protocol.

5.3.13 Work with Lead Dental Assistant to request supplies and maintain adequate stocks.

5.4.1 The contracted Dental Assistant will perform routine chairside dental assisting services:

5.4.2 Assist with dental procedures by suctioning, retracting, irrigating, nitrous oxide administration, and passing instruments / supplies.

5.4.3 Set up and breakdown operatories and panoramic x-ray room. Set up will vary based on anticipated procedure.

5.4.4 Pour up dental models and fabricates custom trays and bruxism and fluoride trays.

5.4.5 Triage dental patients with dental concerns in preparation of dental exam.

5.4.6 Take vital sign measurements, weights, and blood glucose readings and document in electronic dental record.

5.4.7 Verify correct patient chart utilizing 2 patient identifiers.

5.4.8 Chart and document conditions, diagnoses, health histories, treatment plans, procedures, outcomes, and dictated clinical notation in electronic dental chart following protocols and standard operating procedures.

5.4.9 Enter procedure codes into the electronic dental record.

5.4.10 Generate and maintain proper dental record information on beneficiaries for whom treatment is provided, in accordance with Indian Health Service regulations.

5.4.11 Prepare all dental record documentation to meet or exceed the established standards of the IHS facility to include, but not be limited to: timeliness, legibility, accuracy, content, and signatures. All medical and dental record information generated in the performance of the contract will be subject to the exclusive control of the Indian Health Service.

5.4.12 Contact patients to obtain or relay information, as requested by dentist or following standing operating procedures, protocols, or policy.

5.4.13 Contact dental specialists or dental referral offices to obtain or relay information, as requested by dentist or following standing operating procedures, protocols, or policy.

5.4.14 Safeguard patient records and privacy, in accordance to HIPAA regulations.

5.5 The contracted Dental Assistant will perform direct patient care services when training and/or competency assessment permits:

5.5.1 Perform dental prevention services including dental sealants, silver ion antimicrobial treatments, and fluoride varnishes.

5.5.2 Perform oral health education.

5.5.3 Perform dental prophies and gross debridement.

5.5.4 Place temporary fillings, when directed by a dentist.

5.5.5 Take dental impressions.

5.5.6 Take oral radiographs following department standard operating procedures and protocols.

5.6.1 The contracted Dental Assistant will perform the following miscellaneous services:

5.6.2 Promote harmonious relationships and favorable attitudes among the health care team.

5.6.3 Support and adhere to hospital and departmental policies, procedures, protocols, standing orders, and standing operating procedures.

5.6.4 Assist with orientation of new employees.

5.6.5 Participate and contribute to hospital performance improvement activities.

5.6.6 Manage self, patients, and other employees during any emergency.

5.6.7 Maintain professional knowledge and proficiency through continuing education/training and staff meetings.

5.6.8 Adhere to established time and attendance policy.

5.6.9 Assist the Dental Director in the development, implementation, and evaluation or performance improvement indicators to improve outcomes and the work environment.

5.6.10 Performs other related dental duties as assigned.

5.6.11 The Contracted Dental Assistant shall:

a) Participate in a continual process of quality of health care evaluation to assure the provision of quality service.

b) Strive for excellence in providing dental services.

c) Comply with all IHS facility infection control and safety procedures, practices, and standards.

d) Meet all applicable Centers for Medicare and Medicaid Services (CMS) standards during the performance of this contract.

e) Respect and maintain the basic rights of patients, to include but not limited to personal dignity.

f) The contracted Dental Assistant shall generate and maintain proper dental record information on beneficiaries for whom treatment is provided, in accordance with Indian Health Service regulations. The contract Dental Assistants shall prepare all dental record documentation to meet or exceed the established standards of the IHS facility to include, but not be limited to: timeliness, legibility, accuracy, content, and signatures. All medical and dental record information generated in the performance of the contract will be subject to the exclusive control of the Indian Health Service.

PART 8

PRIVACY ACT NOTIFICATION

8. PRIVACY ACT

This contract requires the Contractor, on behalf of the Indian Health Service (IHS), to provide healthcare to American Indians and Alaskan Natives and report selected medical record and financial information to IHS. The Snyder Act (25 U.S.C. 13) and Public Law 83-5658 (42 U.S.C. 2001) authorizes the collection of this information. To be reimbursed by IHS, requested by delivery/task orders issued under this contract. IHS will use the information for financial, legal, research, and health care purposes.

Disclosure of this information may be made by IHS to: other providers of health care for treatment or health maintenance of American Indian or Alaskan Native people; the Office of Worker's Compensation Programs, Department of Labor; the Department of Justice for their representation of the United States; and for congressional inquiry; quality assessment, medical audit, or utilization review; billing third parties for the payment of care; analytical and evaluation studies; to Federal or State agencies as required by law, research purposes supported by IHS; and identification of handicapped children under 10 U.S.C. 1401 et. Seq.

Disclosure of the appropriate medical record information without prior consent of the subject patient may be made by you to: another provider of health care treating the same patient; a Federal or State agency as required by law such as the reporting of communicable diseases, births, deaths, or the commission of crimes (i.e., gunshot wounds, rape, child abuse or neglect, alcohol or drug abuse, etc.); and billing third parties for the payment of care not reimbursed by IHS. You must forward all other requests for information contained on this form to the applicable IHS Ordering Official.

FEDERAL ACQUISITION REGULATIONS

52.252-2 Clauses Incorporated by Reference. This contract incorporates one or more clauses by reference, with same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available.

Also, the full text of a clause may be accessed electronically at this address: www.acquisition.gov

52.202-1 Definitions.

52.204-19 Incorporation by Reference of Representations and Certifications.

52.204-23 Prohibition on Contracting for Hardware, Software, and Services Developed or Provided by Kaspersky Lab and Other Covered Entities.

52.204-25 Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

52.212-4 Contract Terms and Conditions-Commercial Products and Commercial Services 52.223-18 Encouraging Contractor Policies to Ban Text Messaging While Driving.

52.225-13 Restrictions on Certain Foreign Purchases.

52.232-39 Unenforceability of Unauthorized Obligations.

52.232-40 Providing Accelerated Payments to Small Business Subcontractors.

52.233-3 Protest after Award.

52.233-4 Applicable Law for Breach of Contract Claim.

52.217-8 Option to Extend Services (Nov 1999) The Government may require continued performance of any services within the limits and at the rates specified in the contract. These rates may be adjusted only as a result of revisions to prevailing labor rates provided by the Secretary of Labor. The option provision may be exercised more than once, but the total extension of performance hereunder shall not exceed 6 months. The Contracting Officer may exercise the option by written notice to the Contractor within thirty (30) days of contract expiration.

(End of clause)

52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

(a) The Government may extend the term of this contract by written notice to the Contractor within 30 days; provided that the Government gives the Contractor a preliminary written notice of its intent to extend at least 60 days before the contract expires. The preliminary notice does not commit the Government to an extension.

(b) If the Government exercises this option, the extended contract shall be considered to include this option clause.

(c) The total duration of this contract, including the exercise of any options under this clause, shall not exceed 60 (months).

FAR DEVIATION CLAUSE 52.223-99 ENSURING ADEQUATE COVID SAFETY PROTOCOLS FOR FEDERAL

CONTRACTORS (OCT 2021)

52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR.

Funds are not presently available for performance under this contract beyond TBD. The Government’s obligation for performance of this contract beyond that date is contingent upon the availability of appropriated funds from which payment for contract purposes can be made. No legal liability on the part of the Government for any payment may arise for performance under this contract beyond 9/30/2019, until funds are made available to the Contracting Officer for performance and until the Contractor receives notice of availability, to be confirmed in writing by the Contracting Officer.

52.226-1 Utilization of Indian Organizations and Indian-Owned Economic Enterprises

(a) Definitions. As used in this clause:

Indian means any person who is a member of any Indian tribe , band, group, pueblo, or community that is recognized by the Federal Government as eligible for services from the Bureau of Indian Affairs (BIA) in accordance with 25 U.S.C.1452(c) and any "Native" as defined in the Alaska Native Claims Settlement Act ( 43 U.S.C.1601).

Indian organization means the governing body of any Indian tribe or entity established or recognized by the governing body of an Indian tribe for the purposes of 25 U.S.C., Chapter 17.

Indian-owned economic enterprise means any Indian -owned (as determined by the Secretary of the Interior) commercial, industrial, or business activity established or organized for the purpose of profit, provided that Indian ownership constitutes not less than 51…