RFQ_Neonatal_Services.pdf

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

Phoenix Indian Medical Center 4212 North Sixteenth Street Phoenix, Arizona 85016

May 28, 2015

Dear Prospective Offeror, This Request for Proposal (RFP) package (15-247-SOL-00092) provides the Indian Health Services (IHS) requirement for Neonatal Services at the Phoenix Indian Medical Center (PIMC) located in Phoenix, Arizona. Offerors must meet the minimum qualifications requirements set forth within the Request for Proposal (RFP) and must be capable of meeting the Scope of Work (SOW) in the solicitation. If your company is interested in providing a quote please complete the attached package and return to my attention.

For your convenience a Document Submission Checklist has been provided to assist you in responding to the minimum requirements of the RFP. To meet the requirements, the enclosed forms will need to be completed and returned with the necessary documents, no later than 6/15/15, 12:00 pm, Arizona Time to the address on page 1, block 9 of the RFP.

You may submit a completed RFP package on the Federal Supply Schedule (FSS) Website (eBuy).

Note that the selected contractor shall be registered in the System Award Management (SAM.GOV) website prior to award of any government contract.

Should you have any questions please call the undersigned at 602-200-5371.

Sincerely, Bradley Platero Contract Specialist

Enclosures

CC: RFQ 15-247-SOL-00092

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

Phoenix AZ 85016 4212 North 16th Street Phoenix Indian Medical CTR

CODE 16. ADMINISTERED BYCODE

X

X

621399

SIZE STANDARD:

% FOR:SET ASIDE:UNRESTRICTED OR12

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

06/15/2015 1200 MT

06/01/2015

(602) 200-5371BRADLEY PLATERO

(No collect calls)

INFORMATION CALL:

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

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

15-247-SOL-00092

5. SOLICITATION NUMBER

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

1 2 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

15. DELIVER TO

Phoenix AZ 85016 4212 North 16th Street

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$7.5

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)

Phoenix Indian Medical CTR

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.

The Health and Human Services (HHS), IndianHealth Service (IHS), Phoenix Indian Medical Center (PIMC), located in Phoenix Arizona, has a requirement for Neonatal Services for the PIMC Pediatric Department.

Offers must meet the minimum qualifications and/or requirements set forth within the Request for Proposal (RFP) and must be capable of providing all core services set forth in the Scope of Work (SOW).

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

HEREIN, IS ACCEPTED AS TO ITEMS:

DATED

BRIAN G. NUMKENA

. 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. ADDEND

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.

bradley.platero Typewritten Text bradley.platero Typewritten Text bradley.platero Typewritten Text Phoenix Indian Medical CTR Finance Department 4212 North 16th Street Phoenix AZ 85016 bradley.platero Typewritten Text Phoenix Indian Medical CTR 4212 North 16th Street Phoenix AZ 85016

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.

Please see attachments for additional information, terms and conditions.

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

2 2 of

Document Submission Checklist

Request for Quote (RFP: 15-247-SOL-00092)

Neonatal Services

The following checklist is to assist you in ensuring that the acceptable minimum documents are submitted with your quote and signed by an official authorized to bind your organization.

Document Requirement Number of Copies

1. Standard Form 1449, Solicitation/Contract/Order for Commercial Items.

Complete Sections 17(a) and 30(a), (b) and (c). 1 Copy (Page 1 of 20)

2. Data Universal Numbering System Provide Number (Type on page 1 of the SF1449)

3. Price Schedule 1 Copy (Page 6)

4.Medical Liability Insurance 1 Copy (Page 26)

5.Instructions of Offerors 1 Copy (Page 44)

6.Attachment A 1 Copy

7.Attachment B 1 Copy

Note: A complete copy of the RFP package is to be retained for your reference.

This checklist is provided for your assistance; however it is the responsibility of each Offeror to submit all documents as required in the solicitation package.

SOLICITATION NO. 15-247-SOL-00092: PERFORMANCE WORK STATEMENT FOR NEONATAL

SERVICES FOR THE PHOENIX INDIAN MEDICAL CENTER (PIMC), INDIAN HEALTH

SERVICE

1. INTRODUCTION:

This award is to support the Health and Human Services (HHS), Indian Health Service (IHS), Phoenix Indian Medical Center (PIMC), located in Phoenix Arizona, by locating a vendor who can provide Neonatal Nurse Practitioners for its Pediatric Department. The Phoenix Indian Medical Center is a general medical and surgical hospital which provides comprehensive health services primarily to Arizona Indians and also to a few other eligible beneficiaries. PIMC serves as a referral hospital for the more difficult and complex cases from other hospitals and health centers located throughout the Phoenix Area Indian Health Service. It also serves as the primary health facility for a large number of urban Indians.

2. BACKGROUND:

PIMC is committed to the provision of top quality health services for all patients and their families who receive health care services at this facility. The PIMC Pediatrics department provides health care for newborn infants that focus on the provision of quality Neonatal Services. The Contractor shall provide medically necessary routine Neonatal Specialty Service for the Phoenix Indian Medical Center (PIMC), PIMC Pediatric Department, located in Phoenix, Arizona. The Contractor(s) shall provide Neonatal Specialist, who can fully provide Neonatal services to patients within the specifications of the “Scope of Work”, within the standards of practice, and in accordance to Joint Commission of Accreditation of Health Care Organizations (JCAHO), Centers for Medicare Services (CMS), HPDP requirements, and PIMC policies. The Neonatal Nurse Practitioners professional(s) need to have a minimum of 2 years of concurrent provider experience in a Level 3 Neonatal Nursery.

The Indian Health Service (IHS), Phoenix Indian Medical Center (PIMC), will award one contract for this solicitation.

3. NON-PERSONAL SERVICES CONTRACT:

Pursuant to the Federal Acquisition Regulations (FAR), Part 37, Subpart 37.101, this contract is awarded as a non-personal services contract; to mean a contract under which the personnel rendering services are not subject to supervision and control of the Government. However, minimum administrative orientation may be provided by the Government for purpose of work assignment.

4. PHYSICAL DEMAND AND WORK ENVIRONMENT:

4.1 Contractor must be able to lift 40 pounds and must be able to bend, lift and pull.

4.2 Some shifts may be longer than 8 to 12 hours due to heavy patient load or census.

4.3 Contractor may be exposed to hazardous materials, such as chemicals and blood and blood-borne pathogens and will be exposed to infectious diseases and mentally and physically impaired patients.

5. SUPERVISORY CONTROLS AND GUIDELINES:

The contractor shall work under the supervision of the Chief of Pediatrics or designee and shall follow established guidelines and Service Unit and Unit Specific Policies and Procedures. Generally contractors work independently with assigned duties and report urgent or unusual problems to the nurse and/or physician in charge of the care of the patient or Unit.

6. STATEMENT OF WORK (SOW):

6.1 The Contractor shall provide the PIMC Pediatric Department, level 2 nursery and perinatal staff, an average of 64 hours per week of overnight coverage of the level 2 nursery service. This coverage will not be entirely in-house, but by community standards, will consist of Neonatal Specialists (experienced Neonatal Nurse Practitioners) assigned to beeper call for the PIMC level 2 nursery and attendance in-house at all high-risk deliveries as well as management by phone and/or in-house as needed for any sick neonates. The Contractor must be within 30 minutes from PIMC at all times during their shift.

6.2 The Contractor shall provide 24/7 consultative services as well as transport arrangements for sick neonates to higher levels of care.

6.3 The Contractor shall deliver provider support and education to ensure “recency” and competency, to include Neonatal Resuscitation Program instruction and certification.

6.4 The Contractor shall provide Nursing support and education to ensure “recency” and competency, to include NRP instruction and certification.

6.5 The Contractor shall provide program development and support.

6.6 The Contractor shall provide performance improvement and support that include services as perinatal Morbidity and Mortality, quality improvement activities, Arizona Perinatal Trust visit support, NRP and Sugar and Safe care, Temperature, Airway, Blood Pressure, Lab work, Emotional Support (S.T.A.B.L.E. - neonatal education program that focuses exclusively on the post-resuscitation/pre-transport stabilization care of sick infants) training and certification, transport reviews and feedback.

6.7 Work within a designated schedule prepared by the Chief of Pediatrics or his/her designee. Any period of absence or changes in the schedule will be communicated with the Chief of Pediatrics or his/her designee 14 days prior, except for emergency situations.

6.8 Prepare and complete in a timely fashion the medical and other required records for all patients.

6.9 Adhere to the guidelines for his/her behavior and action as outlined in the Service Excellence Guidelines to enhance relations between employees, departments, patients, patient’s families and visitors.

6.10 Subject his/her performance to the hospital’s Quality Improvement Program, as the same may from time to time be in effect in accordance with the requirements of the Joint and external regulatory agencies

6.11 Abide by the lawful ethical principles of his/her profession.

6.12 Abide by the bylaws, rules and regulations, general conduct of care, and Policy and

Procedures set forth at PIMC.

6.13 Provide documentation of immunity by record of laboratory evidence of immunity or documented immunization with live virus vaccine. Contract Physicians are required to be immunized. Indian Health Services (IHS) employee immunization policy requires all IHS employees working in an IHS hospital or clinic to be immunized for the following: Hepatitis B, tetanus, Rubeola/Rubella and PPD screening yearly

6.14 The Contractor shall show evidence of physical examination within the preceding twelve (12) months wherein a Physician certifies that the contractor exhibits no medical condition or physical disability which would interfere with the performance of his or her duties.

6.15 The Department of Pediatrics will request the medical charts, as needed, and Medical Records/Pediatric staff will pull the charts. No health record shall leave the premises.

6.16 The Contractor shall provide IHS patients treated under the terms of this contract proper and adequate medical care within accepted professional standards.

6.17 The Contractor shall ensure that the following requirements are met and that he/she possesses the following qualifications:

6.18 Completion of credentialing and privileging after award of contract as a member of the medical Staff of PIMC.

6.19 Professional certifications and current unrestricted state license

6.20 Maintain clinical credentials at PIMC. Privileges will require renewal at least every two years in accordance with government credentialing privileging policy and JCHAO requirements.

6.21 Service Location is at the following address:

Pediatric Department Phoenix Indian Medical Center 4212 N. 16th Street Phoenix, AZ 85016

7. SCHEDULE:

7.1 Completion of credentialing and privileging after award of contract as a member of the medical Staff of PIMC.

7.2 Professional certifications and current unrestricted state license.

7.3 Maintain clinical credentials at PIMC. Privileges will require renewal at least every two years in accordance with government credentialing privileging policy and JCHAO requirements.

7.4 Neonatal Specialists will be expected to abide by the Uniform Code and shift hour assigned, modalities of charting and care delivery, and other rules and regulations of the facility.

7.5 Neonatal Specialists shall maintain current continuing education at their own costs.

7.6 Neonatal Specialists who accept long term full time assignments (1 Continuous week or more) shall attend meetings and participate fully as staff members. Usual routine shift schedules are:

Monday to Friday: 11:00pm – 7:00am (2300-0700) Saturday to Sunday: 7:00pm – 7:00am (1900 – 0700) 10 Federal Holidays: 7:00pm – 7:00am (1900 – 0700)

7.7 The Neonatal Specialist will either be “in house” or be able to report for a delivery within 30 minutes of when called.

7.8 The facility reserves the right to accept or reject any particular Neonatal Nurse Practitioners who is not suitable for their assignment at any time during this contract period or; the facility may cancel this contract in its entirety.

7.9 The Service Unit shall make every effort to submit a schedule two (2) weeks in advance for long term assignments.

7.10 Shifts may be cancelled or shortened without time restriction or monetary penalty before the Neonatal Nurse Practitioners arrives on duty.

7.11 Contractors who apply for positions with the Indian Health Service may be hired without penalty to the contractor Neonatal Nurse Practitioners or the Indian Health Service.

8. PRICE/COST:

Enter price quote for the base year period of performance for twelve months. Add the total cost to calculate the grand total for the base year.

PIMC does not authorize Holiday or Overtime pay.

Contractor shall provide Unit Cost, Total Cost and Grand Total.

Estimated Cost:

Item Number

Description of Service QTY UNIT Unit Price Total Price

A.1 Neonatal Nurse Practitioners (Monday- Friday)

2000 Hour $ $

A.2 Neonatal Nurse Practitioners (Saturday- Sunday)

1248 Hour $ $

A.3 Neonatal Nurse Practitioners (Federal Holidays)

120 Hour $ $

GRAND TOTAL $

The Contractor shall be compensated at the agreed contract amount based on invoices submitted and only for services in direct performance of this contract.

The Contract does not allow for annual or sick leave or other fringe benefits.

Per mandate by the U. S. Department of Treasury and effective July 1996, payments by Electronic Funds Transfer System (EFTS) will be made to the Contractors designated financial institute.

The Federal Government DOES NOT WITH HOLD taxes from the Contractor, any Local, State or Federal taxes. It is the Contractor’s sole-responsibility to pay their own taxes and other personal obligations that they may have.

9. CONTRACTORS MINIMUM REQUIREMENTS/QUALIFICATIONS:

9.1 Licensure shall be from any state, District of Columbia, the Commonwealth of Puerto Rico or a territory of the United States. The contractor shall validate individual Neonatal Nurse Practitioners license and assure each license is in good standing.

9.2 Each licensed Neonatal Nurse Practitioners shall present an original current license when reporting to the PIMC Pediatric Department for duty or for orientation whichever comes first. A copy is required for the contract file. No reimbursement will be made for Neonatal Nurse Practitioners who report to work with an expired license or a license that is not in good standing.

9.3 According to current Phoenix Indian Medical Center (PIMC) Policy as referenced by the Nursing Program Unit Specific Education and Competency Plan. All Neonatal Nurse Practitioners Personnel shall have current certification described.

9.4 All contractors must provide copy of resume for file. Contractor file will be kept by the Department of Pediatrics for verification of license or certificate, also file will contain personal information such as home, address, and phone number, next of kin, person to notify in case of emergency, health requirements, mandatory in-service and continuing education, competency assessments and awards or disciplinary action.

9.5 Contractor is responsible for his/her own reliable transportation, travel and per diem expenses in the performance of this contract.

9.6 Contractor is responsible for maintaining satisfactory standard of competence, conduct, appearance and integrity. The quality of work performance of the contractor shall be subject to review.

9.7 Contractor shall abide by the Service Unit’s Standard of Conduct and policies and procedures.

9.8 Contractor is responsible for notifying the immediate supervisor or House Supervisor if he/she will be late or will be unable to work due to illness or any other reason.

9.9 Contractors who become sick while on duty will seek medical care from their own private physician, unless contractor is eligible to receive health care from Indian Health Service.

9.10 Contractor is responsible for completing time sheets for actual hours worked.

10. CONTRACTORS RESPONSIBILITY FACTORS:

10.1 To be considered for award the offer must comply with the following responsibility factors. Failure to provide the following responsibility factors in the response may disqualify an offeror from further consideration.

10.2 The Contractor may be an individual, group or organization in which a qualified provider providing services meets the stated qualification requirements described herein.

10.3 A qualified provider shall be in attendance at every scheduled clinic.

10.4 The Contractor shall provide services in such a manner as to meet the highest standards of professional ethics and conduct particularly in regard to confidentiality and patient rights. If at any time during the term of the contract, the Government suspect's unprofessional behavior and practices, the Contractor will be contacted and requested to take appropriate action in accordance with applicable Federal Acquisition Regulations (FAR)

10.5 The Contractor shall possess a professional medical education from a post-secondary academic institution or be licensed in a field of medical study.

10.6 The Contractor shall contact the Chief of Pediatrics and be responsible for all documentation required for eligibility and temporary nursing staff privileges at

PIMC.

10.7 The Contractor shall be responsible for notifying the Chief of Pediatrics in Paragraph 22 in case of an emergency or inclement weather that would prevent him/her from providing his/her schedule/shift.

10.8 The Contractor shall proficient in writing, typing and have a basic working knowledge and understanding of computer hardware and software.

10.9 The Contractor shall not be authorized to perform any services for the Government until the IHS Governing body has granted the contractor such privileges in writing.

Federal contract employees do not accrue any form of retirement, social security, insurance or any other form of benefits.

10.10 The Contractor shall comply with all IHS facility infection control and safety procedures, and standards.

10.11 The Contractor shall provide for the consistent performance of patient care process according to the standards of the JCAHO or Accreditation Association for Ambulatory Health care (AAAHC) and/or Centers for Medicare Services (CMS) who supplies accreditation to the Phoenix Area Indian Health Service hospitals and health centers. These standards shall include: The Comprehensive Accreditation Manual for Hospitals, the Laboratory Standards, and Ambulatory Care Standards as they represent the scope of services of this contract.

10.12 The Contractor shall assist and provide services and duties as may be requested for normal operational requirements for the department and personnel. The Contractor shall provide work that is consistent with the guidelines and procedures of the IHS.

Failure of the contractor to meet these standards can result in the cancellation of the contract.

10.13 The contractor shall have sufficient knowledge, competence and experience in providing these services on a regular scheduled clinic at PIMC. The Contractor shall possess sufficient initiative, interpersonal relationship skills, social sensitivity and appropriate professional behavior such that the contractor can relate constructively to IHS employees, contractors, PIMC patients, clients and individuals from the Native American Community.

10.14 If appropriate and necessary, the contractor can provide recommendations to the Supervisor on better improving and enhancing the program environment and delivery of services. The Contractor shall inform the COR, Contracting Officer or Program Manager or their designated representative of any problems encountered or which may be encountered in connection with meeting the needs of the contractor’s duties.

10.15 The Contractor shall not have any work or health restrictions, which could directly or indirectly interfere with the performance of providing services as there will be some moderate lifting and moving of furniture as well as boxes of office supplies and equipment.

10.16 The Contractor shall maintain acceptable standards of personal hygiene and grooming such that their image as a Federal contract employee is compatible with the expectations of the IHS staff.

10.17 The Contractor shall be required to actively participate in quality assurance/performance improvement activities and policy development for the medical record.

10.18 The Contractor shall be required to provide regular report of hours worked to the Designated COR with an invoice. This report shall be verified by the Chief of Pediatrics, or, his/her designee, that can confirm the coverage.

10.19 If the Contractor is a locum tenens company, the Contractor(s) shall designate an individual who will be the “contact person” that will be available to discuss any problems or issues that arise with the COR.

10.20 The Contract shall obtain and maintain, at his/her own expense, all state and/or medical licenses, registrations or certification required in the performance of the contract, and shall comply with all laws, regulations, (Federal, State, Tribal and respective hospital) ordinances in the performance of this contract.

10.21 The Contractor shall complete medical records in a timely fashion, in the Electronic Health Record (EHR) and/or via hand written notes, in accordance with JCAHO requirements, the Statement of Work, and in accordance with the Phoenix Indian Medical Center Medical Staff By-laws and Rules and Regulations. Failure to abide by this requirement is basis for cancellation of this contract. After the establishment of the EHR, the Contractor(s) shall be required to enter medical patient information, laboratory and X-Rays, etc. into the electronic health record.

Medical Records will be the property of the U.S. Government and will be placed in each patient’s chart at PIMC.

10.22 Pursuant to the Federal Information Security Management Act (FISMA) of 2002 the Contractor shall complete the Computer Security Awareness Training (CSAT) course before compute access is provided or within a few days after receiving their access and annually after that. Within the Health and Human Services (HHS), there is a requirement for this training to be completed annually by all employees that includes the Contractor.

10.23 Contractor is responsible for Quality of Care as follows:

10.23.1 Improve quality of care through evidenced-based practice and continued improvement.

10.23.2 Peer-Review (SOAP, department-specific) and M&M reviews meet department goals.

10.23.4 Teaching sessions given monthly and rated by staff as helpful and informative and meet department goals.

10.23.5 Positive feedback on colleague surveys.

10.24 The Contractor is responsible for Professional Practice as follows:

10.24.1 On time for shifts over 95% of the time.

10.24.2 Not shifts left uncovered.

10.24.3 Schedules given to Department 2 weeks prior to beginning of the month.

10.24.4 Maintains necessary requirements for medical license, medical staff, and department criteria.

10.24.5 Medical license and medical staff credentials and privileges are current with no unexplained expirations.

10.24.6 NRP is current with no unexplained expirations.

9.12.1 Keeps current with mandatory facility or IHS in-service (ex.

NetLearning) and completes on-time.

10.25 The Contractor is responsible for Communications as follows:

10.25.1 Verbal/email/written communication of all individual contractors is respectful and professional, respecting privacy of information. Addresses complaints or conflicts when they occur as per hospital policy (grievance policy).

10.25.2 Displays the organizations' values by developing positive relationships, exceptional communication skills, questioning and active listening; builds trust, empathy and mutual understanding.

10.25.3 No more than one valid issue reported from patients/staff on any communication that is disrespectful, inappropriate or unprofessional

10.25.4 Adheres to facility/agency requirements for release of information with no valid HIPAA violations.

10.25.5 Immediately addresses others complaints or conflicts at the lowest level, rarely requires assistance.

10.26 The Contractor is responsible for Resource Utilization as follows:

10.26.1 Resource utilization is appropriate with minimal waste of goods or services. Transfers are appropriate.

10.26.2 Aware and compliant with safety protocols.

10.26.3 Delivers care in accordance with PIMC policies/procedures, OSHA and relevant safety and infection control guidelines.

10.27 The Contractor is responsible for Documentation as follows:

10.27.1 Records are completed in timely fashion to meet billing requirements.

10.27.2 Records/charts are completed on time at least 95% of the time.

10.27.3 Documentation is complete to appropriately support coding and billing within departmental standards.

10.27.4 Electronic Health Record (EHR) records are complete, comprehensive and accurate, with deficiencies under 5% of time.

11. INSPECTION AND ACCEPTANCE:

11.1 The Quality Assurance Surveillance Plan (QASP) and Performance Based Matrix have been developed to evaluate contractor actions while implementing this performance work statement. It is designed to provide an effective surveillance method to monitor contractor performance for services under this contract. (See Attachment A)

11.2 SURVEILLANCE: Surveillance to be done by established timelines and periodic government peer reviews of contractor performance quality.

11.3 The QASP will be monitored by the Government Contracting Officer’s Representative (COR), or designee, and the Chief of Pediatrics to ensure the Contractor is successfully performing services in accordance to the Performance Standards and meeting the QASP Acceptance Quality Levels (ACL).

12. PATIENT CUTURAL BACKGROUND:

Some of the IHS patients receiving services under this contract may only speak a native language or Spanish or may have limited comprehension of the English language, and/or may reside on a Native American Indian Reservation. The Contractor is expected to demonstrate sensitivity to cross-cultural and language difference and have the ability to work through interpreters as necessary. Consideration must be given to potentially limited transportation and/or home environment facilities. PIMC shall provide translators when needed.

13. CONTRACTOR CREDENTIALS:

13.1 The contractor shall provide a list of qualified candidates and the following documents per candidate:

13.1.1 Current Resume or C.V

13.1.2 College Transcripts; conferred degrees and certified training in the field.

13.1.3 Two (2) letter of reference from current or pervious employers.

13.1.4 Past Work Performance Statement, applicants must describe their present/previous experiences in this field.

13.1.5 Credentialing documents and degree conferred.

13.1.6 Copy of active unrestricted Neonatal Nurse Practitioners

13.1.7 Current Health Status Report.

13.1.8 Certificate of Immunization.

13.1.9 Child Care Form, Addendum OMB Approved Form-2012

14. REVIEW AND APPROVAL AND EVALUATION:

14.1 Service evaluation:

14.1.1 Individual providers will be evaluated at the end of the 1st full day of services, daily or at end of an extended assignment or as needed.

14.1.2 Work performed by Neonatal Nurse Practitioner(s) assigned to the facility, shall be subject to all quality assurance monitors and performance improvement studies performed by the facility.

14.1.3 The Contractor shall be informed of any quality of work problems identified by the facility. If notice of problem is issued, the Contractor shall take corrective action and report the corrective action to the facility in writing within one week of receiving the notice.

15. VERIFICATION OF LICENSURE:

To assure that all medical, Professional, and Technical professionals providing services under this contract are properly licensed and that the IHS is aware of any disciplinary actions, which may have been taken against them the Contractor shall:

Verify through appropriate State Boards of Neonatal Nurse Practitioners, all licenses or certifications, active/inactive/lapsed that are providing services under this contract may hold or have held.

Inform the IHS of the statuses of all licenses/certifications, including the reasons for inactive or lapsed licenses; furnish a letter of reference from other health care providers familiar with the candidate’s professional technical practice skills. Provide any performance of disciplinary data that they may have on a candidate and found no reason to reject the candidate.

The information shall be provided to the COR of the receiving facility no fewer than 15 working days prior to the Candidate’s projected date of arrival at the facility. In emergency situations, where there is no time available, a telephone call from the Contractor providing assurance of the above is acceptable. These instances must be well documented, justified and kept to a minimum.

16. POST-AWARD ADMINISTRATION MONITORING:

16.1 The Contract Neonatal Nurse Practitioners provider will be required to comply with the PIMC Policies & Procedures and shall meet the same licensing/educational requirements as permanent IHS or Neonatal Nurse Practitioners provider prior to providing nursing services in this facility. These providers will be subject to the same peer review as permanent members of our Department of Pediatrics team.

16.2 PIMC shall provide an ongoing method of monitoring and evaluation of the quality and appropriateness of patient care and of identifying deficiencies in the quality of services performed before the level of performance becomes unacceptable.

16.3 If a contract Neonatal Nurse Practitioners provider fails to arrive at the PIMC for a scheduled shift, the contractor must provide coverage by another provider with temporary, provisional or courtesy privileges approved by the PIMC Medical staff and the Governing Body. If no coverage is provided, the contractor shall be required to pay the IHS for the cost incurred for providing that coverage. Not providing Neonatal Nurse Practitioners coverage on more than one occasion will be reviewed and discussed by the Chief of Pediatrics and the Contracting Officer as to whether there was a compromise of patient care. All compromised situations that arise from lack of patient care by the contractor shall be referred to the Contracting Officer for action and resolution.

16.4 Once the Contract is awarded, contractor(s) must complete all credentialing and privileging paperwork in accordance with JCAHO, CMS and the PIMC Staff Bi-laws and Rules and Regulations. The Contract Neonatal Nurse Practitioner(s) provider must meet the same licensing/certification requirements as permanent IHS Neonatal Nurse Practitioner(s) provider before being allowed to provide nursing services in this facility. The Neonatal Nurse Practitioner(s) provider must also complete all CMS-8551 and CMS-855R-Medical Enrollment Applications and any other insurance paperwork. Copies and/or access to patient medical records will be provided to the business office personnel for the purpose of financial matters regarding billing and insurance collections. PIMC will process all eligible third party claims for reimbursement for services provided by the contractor(s).

17. BACKGROUND CHECK:

17.1 Contractor’s employees are not able to work a scheduled shift until the security check is performed and clearance has been obtained by the appropriate agency. At a minimum fingerprints are required and upon clearance at this stage a contractor’s may work a scheduled shift. However, contractors are required to complete the detail background application and application is to be completed within 30 days once the contractor’s employee has been given access.

17.2 All or Neonatal Nurse Practitioner(s) Contractors’ are subject to criminal background check prior to performing services in accordance with the contract terms and conditions. The contractor shall ensure that each of their Neonatal Nurse

Practitioner(s) provider complete the, Certification of Criminal History and Background Check Packet. The completed forms are to be returned to the COR.

Additional Background Check packets can be obtained through the COR.

Contractors (and their employees) requiring routine, long-term access (i.e., greater than 6 months) to IHS facilities and/or systems; or providing services to children under 18 year of age are subject to criminal background checks prior to performing services. The contractor shall ensure that each employee(s) complete the Certification of Criminal History and Background Check Packets to initiate the Child & Youth Services National Agency Check with Inquiries (CNACI). The COR is responsible for providing the contractor with all necessary background check forms. The COR is also responsible for ensuring all background check forms are fully completed and processed prior to commencement of service. The contractor shall return all completed forms to the PIMC Human Resource Office (PIMCHR) located at the Phoenix Indian Medical Center (PIMC), Phoenix, Arizona.

Contractors may be directed to the e-QIP website to complete the necessary background investigation forms online (inquire with the PIMCHR should you wish to complete forms electronically). All contractors (or their employees) must appear in person to IHS (or an IHS facility) with two acceptable forms of identity;

fingerprints will be taken electronically, or on paper, at this time. This must occur prior to the first date of service (realistically allow a 14-30 day processing time before the actual start date). At a minimum, if results are not received within 5 days, the identity credentials can be issued based on a favorable FBI National Criminal History Check (fingerprint check). Note: These timeframes are based on complete and acceptable package, including legible fingerprints.

FOR MORE INFORMATION ON SECURITY REQUIREMENTS PLEASE

REFER TO DHHS SITE: http://intranet.hhs.gov/pivcard/brochure.html

18. IT SECURITY:

The Indian Health Service (IHS) is responsible for maintaining an information security program that provides protection for information collected or maintained by or on behalf of the Agency; and information systems used or operated by the Agency or by a contractor of the Agency or other organization on behalf of the Agency.

19. INCIDENT RESPONSE PROCEDURES:

To meet federal requirements and provide IHS with centralized incident reporting and response services, IHS established the IHS Incident Response Team (IRT) to coordinate IHS-wide cyber security information sharing, analysis, and response activities. The IHS IRT provides a centralized resource for collecting, analyzing, and disseminating information technology security incident-related information.

http://intranet.hhs.gov/pivcard/brochure.html

20. INCIDENT RESPONSE PROCEDURES:

20.1 If you witness an IHS suspicious event or a potential incident, IMMEDIATELY do the following:

20.1.1 Contact - via email, phone or in person - your site manager or local ISSO.

Be prepared to provide the date, time, location, and any other information you feel may be useful.

20.1.3 If you do not reach your site manager or local ISSO, contact your Area

ISSO.

20.1.4 If you do not reach the Area ISSO, contact the IHS IRT using the information at the bottom of this page.

20.1.5 Do not discuss any suspicious activity with others to minimize impact on a possible investigation.

20.1.6 If the potential incident involves an information system:

20.1.6.1 STOP using the information system. Wait for further instructions

20.1.6.2 from your ISSO or the IRT.

20.1.6.3 LOCK the system (e.g., Ctrl+Alt+Delete ' Lock Computer).

20.1.6.4 Do NOT turn it off, logout, or otherwise change anything.

20.1.6.5 If possible, prevent others from physically accessing the system.

21. PERIOD OF PERFORMANCE:

Contract performance shall be for a base year commencing from the award of the contract for a total of 12 months. Extensions to the period of performance are not executed unless by written modification to the contract and approved by the Contracting Officer.

22. DESIGNATION OF CONTRACTING OFFICER REPRESENTATIVE (COR):

Dr. Diana Dunnigan, MD, Chief of Pediatrics, Telephone No.: (602) 263-1200 ext. 1551 is hereby designated the COR to monitor the performance of this order on behalf of the government.

23. CONTRACTING OFFICER REPRESENTATIVE (COR) AUTHORITY:

23.1 The Contracting Officer shall designate the COR representing the Government for the purpose of this contract in writing. Such designation will set forth the duties specifically delegated in regard to the performance of this contract. A copy of the designation will be provided to the contractor.

23.2 The major responsibility of the COR is to ensure Contractor accountability, monitor contract performance, and assist the Contractor in the resolution of program problems encountered during the performance of this contract.

23.3 The COR shall be responsible for:

23.3.1 Monitoring the Contractor’s technical progress, including the surveillance and assignment of performance and recommending to the contracting Officer changes in requirements;

23.3.2 Interpreting Statement of Work;

23.3.3 Performing technical evaluation as required;

23.3.4 Performing technical inspection and acceptance required by the contract;

23.3.5 Assisting the contractor in the resolution of technical problems encountered during performance.

23.4 The COR does not have authority to modify or change the terms and conditions of the contract.

24. INVOICE SUBMISSION:

24.1 Payment shall be made in ARREARS per month;

24.2 Electronic Funds Transfer (EFT) shall be utilized as method for processing payment;

24.3 Upon receipt of the Contractor’s properly prepared invoice, the COR is responsible for certifying the invoice for acceptance of service;

24.4 Improperly prepared invoices will be returned to the Contractor resulting in delayed payment.

24.5 Invoices shall be prepared and submitted electronically and in accordance with rates and terms as stated in the contract.

24.6 Invoices should be sent electronically to the following departments:

Finance:PHX_PIMCAPInvoice@ihs.gov

Acquisitions: Bradley.Platero@ihs.gov

COR: Diana.Dunnigan@ihs.gov

A proper invoice shall include, but not limited to the following:

24.6.1 Purchase Order Number/Contract Number;

24.6.2 Period of performance or Shipment Information;

24.6.3 Charges for services or products identified by LINE ITEM NUMBER;

24.6.4 Description, quantity, unit of price and extended total per line item; total amount of invoice.

24.6.5 Contractors contact information (name, title, phone number of point of contact in event of defective of invoice).

mailto:PHX_PIMCAPInvoice@ihs.gov mailto:Bradley.Platero@ihs.gov mailto:Diana.Dunnigan@ihs.gov

25. PAYMENT:

The PIMC Financial Management Office shall make payment in accordance with Section 8, Price/Cost.

26. NON-DISCRIMINATION IN SERVICES, BENEFITS, AND FACILITIES:

The Contractor shall make no distinction among patients under this contract on the basis of race, color, creed or national origin, including but not limited to the following: Denying a patient any service or benefit or availability of a facility; providing any service or benefit to a patient which is different or is provided in a different manner or at a different time from that provided to other patients under this contract, subjecting a patient to segregation or restricting a patient in any way in the enjoyment of any advantage or privilege enjoyed by others in determining whether he satisfies any admission, enrollment quota, eligibility, membership or other requirement or conditions which an individual must beat in order to be provided any service or benefits; the assignment of time or places for the provisions of services on the basis of race, color, creed or national origin of the patients served.

27. CHILD CARE NATIONAL AGENCY CHECK & INVESTIGATION (CNACI):

In accordance with the Child Care National Agency Check and Investigation (CNACI) directive, implemented by the IHS, the following documents will be required from the selected contractor and all employees they utilize under an awarded contract:

1. DHHS Application Background Survey.

2. DHHS/IHS Required Application Questionnaire for Child Care Positions.

3. IHS – Release of Personal Information.

4. SF-85 Questionnaire for Non-Sensitive Positions.

5. GSA Form 176 – Statement of Personal History.

6. FD-258 Federal Bureau of Investigation Fingerprint Analysis Chart

A Contractor whose duties and responsibilities involve regular contract or control over children is subject to a character investigation as required by Public Law 101-630, the Indian Child Protection and Family Violence Prevention Act. The Phoenix Area IHS Office of Human Resources or the IHS Service Unit conducts these investigations following contract award. The Character investigation may be waived if, in the judgment of the Contracting Officer, in consultation with the Human Resource Officer, an investigation has already been conducted and is on file. Until the character investigation has been completed and the Contracting Officer notified of the results, the Contractor must not have unsupervised contact with the Indian Children.

28. SECURITY:

The Contractor shall abide by the following Security Standards that are required for the position:

Federal Security Identification Badge Request: It is the responsibility for the department to provide the necessary clearances to the IHS computer system as well as other security requirements needed for the Contractor to perform their duties.

29. ARIZONA STATE TAXES:

The Department of Health and Human Services, Phoenix Indian Medical Center, is Tax Exempt under A.R.S.42-5063(C)(3)(a), A.R.S.42-5067(B)(1), A.R.S.42-5065(B)(2)(a), A.R.S.42-5066(B)(3) (a), A.R.S.42-5074(B)(8), A.R.S.42-5071(B)(2)(a), A.R.S.42- 5061(A)(25)(a), and A.R.S.42-5159(A)(13)(a),(b),(c), State of Arizona Department of Revenue. (Copy of Certificate available upon request).

Contractor is responsible for determining and paying all required taxes. The final quotation amount shall include all applicable taxes.

Award amount shall not be adjusted due to failure of the offeror to include taxes into the quotation.

30. LIST OF DOCUMENTS, EXHIBITS & OTHER ATTACHMENTS:

a. Attachment A – Quality Assurance Surveillance Plan (QASP)

b. Attachment B – Continuation of SF

31. HEALTH INSURANCE PORTABILITY & ACCOUNTABILITY ACT (HIPAA):

Business Associate Agreement

I. Authority:

Pursuant to 45 C.F.R § 164.52(e), the Indian Health Service (IHS), as a covered entity, is required to enter into an agreement with a “business associate,” as defined by 45 C.R.R. § 160.103, under which the business associate must agree to appropriately safeguard Projected Health Information (PHI) that it will use and disclose when performing functions, activities or services pursuant to its contract with the IHS. By signing Contract No. ___________ (Solicitation), 15-247-SOL- 00079 agrees that it is a Business Associate and will comply with the terms below, in addition to other applicable Contract terms and conditions, and applicable law, relating to the safekeeping, use, and disclosure of PHI. This Appendix comprises the Business Associate Agreement (Agreement).

II. Definitions:

The following terms shall have the same meaning as those terms in 45 C.F.R. Part 160 and Part 164, which are the federal regulations implementing the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as amended:

Breach, Designated Record Set, Disclosure, Health Care Operations, Individual, Minimum Necessary, Notice of Privacy Practices, PHI, Required by Law, Secretary, Security Incident, Subcontractor, Unsecured PHI, and Use.

A. Business Associate. “Business Associate” shall generally have the same meaning as the term “business associate” at 45 C.F.R. § 160.103, and in reference to the party to this Agreement shall mean .

B. Covered Entity. “Covered Entity” shall generally have the same meaning as the term “covered entity” at 45 C.F.R. § 160.103, and in reference to the party to this Agreement, shall mean the IHS.

C. HIPAA Rules. “HIPAA Rules” shall mean the Privacy, Security, Breach

Notification, and Enforcement Rules at 45 C.F.R. Part 160 and Part 164.

D. Master Patient Index (MPI). The “Master Patient Index” or “MPI” is composed of a unique list of patients and a current list of medical centers where each patient has been seen. This enables the sharing of patient data between operationally and regionally diverse systems. Each record (or index entry) on the MPI contains a small amount of patient data used to identify individual entries. The mission of the MPI is to uniquely identify a patient and to “link” that patient’s data throughout the IHS facilities using the Integration Control Number (ICN). The MPI is the authoritative source of a patient’s ICN, the enterprise-wide identifier for IHS facilities and the key to accessing a patient’s record. The accuracy of patient information and patient identification directly affects clinical, administrative, billing, and interdepartmental processes.

III. Obligations and Activities of Business Associate:

A. Compliance: Business Associate agrees not use or disclose PHI other than as authorized by the Agreement or as required by law. Business Associate acknowledges that it is directly liable under the HIPAA Rules and subject to civil and, in some cases, criminal penalties for making uses and disclosures of PHI that are not authorized by the Agreement or required by law. Business Associate agrees that it will require all of its agents, employees, subsidiaries, and affiliates, to whom Business Associate provides PHI, or who create or receive PHI on behalf of Business Associate for Covered Entity, to comply with the HIPAA Rules and to enter into written agreements with Business Associate that provide the same restrictions, terms, and conditions as set forth in the Agreement.

B. Subcontractors: In accordance with 45 C.F.R. §§ 164.502(e)(1)(ii) and

164.308(b)(2), which govern relations with subcontractors, Business Associate agrees to ensure that any subcontractors that create, receive, maintain, or transmit PHI on behalf of Business Associate agree to the same restrictions, terms, and conditions that apply to Business Associate with respect to such

PHI.

C. Safeguarding PHI: Business Associate shall develop and use appropriate procedural, physical, and electronic safeguards to protect against the use or disclosure of PHI in a manner not authorized by this Agreement or required by law. Business Associate will limit any use, disclosure, or request for use or disclosure of PHI to the minimum amount necessary to accomplish the intended purpose of the use, disclosure, or request.

D. Safeguarding Electronic PHI: Business Associate agrees to use appropriate safeguards, as set forth in Subpart C of 45 C.F.R.