15-249-SOL-00031.docx

15-249-SOL-00031

Revenue Cycle Services

PART I - THE SCHEDULE

SECTION B - SUPPLIES OR SERVICES AND PRICE/COSTS

B.1 PURPOSE OF CONTRACT:

The Tucson Area Indian Health Service (TAIHS) depends on contracting outside resources with a wide range of expertise in order to provide services not readily available within IHS. This firm-fixed unit priced contract will provide Medical Coding, Third-Party Billing, Accounts Receivable and Debt Management services for the Tucson Area Indian Health Services which includes the following facilities, located on the Tohono O’odham Nation (Attachment I):

a) San Xavier Health Center (SXHC): located in Tucson, Arizona.

b) Sells Service Unit – Sells Indian Hospital (SSU): located in Sells, Arizona (60 miles west of Tucson).

c) Santa Rosa Health Clinic (SRHC): located in Santa Rosa, Arizona (87 miles west of Tucson).

d) San Simon Health Center (SSHC): located in San Simon, Arizona (98 miles west of Tucson).

The unit price paid to the Contractor shall be considered as payment in full for services provided under this contract. In no way shall the contractor attempt to bill or collect any monies for services provided under this contract from any IHS patient (or any alternate resource for which the patient may be eligible).

B.2 BACKGROUND:

To ensure proper reimbursement as well as regulatory compliance, the Centers of Medicare/Medicaid Services (CMS) and other third party payers have initiated precise guidelines for all providers. These guidelines include documentation requirements that demonstrate medical necessity, correct coding, and billing that depend on data integrity. The Office of Inspector General (OIG) of the United States Department of Health and Human Services (DHHS) believes that all participants in the Medicare and Medicaid programs have an ethical and legal duty to ensure the integrity of their transactions with CMS, Federal and State rules and regulations. These services will permit service units to move towards strict adherence to CMS, Federal and State compliance guidelines and maintain consistency with the highest standards of business and professional ethics. Coding and billing compliance are key components of Medicare’s condition of participation in fostering and monitoring improved health care outcomes.

Indian Health Service (IHS) uses the official coding guidelines for clinical classification systems such as, but not limited to, current editions of International Classification of Disease-Clinical Modification (ICD-CM), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), American Dental Association (ADA), and complies with the Indian Health Service’s Third Party Resource and Internal Control Policy, and the Indian Health Service’s statistical and reporting systems for all departments.

B.3 SCHEDULE OF FEES:

The quantities in the Schedule are for pricing purposes and basis for evaluation for award and do not represent what the Government will order. The Government is using the Indefinite-Delivery, Requirements type contract because exact quantities cannot be pre-determined. The Government will issue orders in accordance with the Ordering and Requirements Clauses as needs arise and the contractor will be reimbursed for exact quantities performed at the prices quoted. The Government will Order during the life of this contract a minimum of $250,000 and a maximum of $500,000.

a. BASE YEAR PRICING: OCTOBER 01, 2015 – SEPTEMBER 30, 2016

BASE YEAR GRAND TOTAL

b. OPTION YEAR I: OCTOBER 01, 2016 – SEPTEMBER 30, 2017

OPTION YEAR I GRAND TOTAL

c. OPTION YEAR II: OCTOBER 01, 2017 – SEPTEMBER 30, 2018

OPTION YEAR II GRAND TOTAL

d. OPTION YEAR III: OCTOBER 01, 2018 – SEPTEMBER 30, 2019

OPTION YEAR III GRAND TOTAL

e. OPTION YEAR IV: OCTOBER 01, 2019 – SEPTEMBER 30, 2020

ERVICE

OPTION YEAR IV GRAND TOTAL

RECAP:

15-249-SOL-00031

SECTION C - DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK

C.1 SCOPE OF WORK:

The Contractor shall provide on-site/off-site via dial-in connection to the Resource Patient Management System (RPMS), Electronic Health Record (EHR) & Patient Care Component (PCC) system to provide Medical Coding, Third-Party Billing, Accounts Receivable and Debt Management services to Tucson Area Indian Health Service (TAIHS).

The Contractor shall comply with all Federal and State Regulations and IHS’s Third Party Resource and Internal Control Policy, the Debt Collection Policy, and the IHS’s statistical and reporting systems for all departments. The Contractor shall comply with the American Hospital Association (AHA) Official Coding Guidelines for ICD9-CM, ICD-10-CM and the Current Procedural Terminology (CPT) Guidelines, and any specific IHS coding and data entry policies and procedures. The turnaround timeframes that the contractor shall be held to will be those listed in the Internal Control Policy for all processes of the revenue cycle.

The Contractor shall have remote access, with restrictions as defined by the IHS, to the following IHS RPMS modules:

a) Patient Registration System

b) Third Party Billing System

c) Accounts Receivable System

d) Electronic Dental Record System

e) PCC, EHR, Vista Imaging Display

Additional access to other modules shall requested by the Contractor and agreed upon by the COR for Revenue Enhancement purposes.

C.2 MEDICAL CODING SERVICES:

The Contractor shall provide all qualified personnel to perform on-site coding and coding queue services to each TAIHS facility as needed. Medical coding also includes Data Entry, Compliance Auditing and Reporting. The Medical Coding services shall include the following:

a) The Contractor shall code and make complete and accurate all medical visits (ambulatory, inpatient, pharmacy, laboratory, dental with medications, radiology and others) via the IHS RPMS, EHR, PCC and Admission/Discharge/Transfer (ADT) systems using IHS and National Reporting and Coding Guidelines.

b) The Contractor shall have access to the IHS EHR system to view notes and critical information for correct visit information and coding of all evaluation & management, diagnoses, CPT, HCPCS, modifiers and apply medical significance matching of diagnoses to services.

c) Assignment of E/M, CPT, HCPCS shall be completed and modified/appended via the RPMS system using mnemonic CPE.

d) The IHS “visit verification coding queue” (VVQ) shall be accessed for review, accuracy, and completion of all medical visits before a claim can be generated. When a visit cannot be completed in the coding queue, the Contractor shall access the PCC data entry and supervisor option to complete the visit.

e) Upon Report findings via the VVQ shall be documented and presented via phone and written reports as a tool of communication and education for all physician and ancillary staff.

f) When editing, appending, merging, moving data elements and deleting duplicate entries shall be part of the process with application for reporting requirements via the RPMS system.

g) The Contractor shall visit data from PCC/Pick List 1/EHR shall be reviewed (VVQ) for accuracy and completeness to the highest allowable level so the IHS receives the appropriate level of reimbursement. National Coding Guidelines will be applies via PCC. When there is an application of “billing/claims” guidelines based on the payer – the guidelines shall be applied via the Third-Party Billing (TPB) system with feedback to the staff shall be provided.

h) The Contractor shall provide on-site support as needed. This is in the event that remote technology is not available, or problems connecting to the IHS network.

i) Monthly Reporting:

Tally of Reviewed/Completed Visits by Operator. The Contractor shall deliver a standardized report to the Sells Indian Hospital Coding Supervisor on a monthly basis which includes at a minimum the following: (Method of report delivery to be determined by IHS.)

1. HR #

1. Date of Service

1. Date completed

1. Query/Clarification required. Yes or No

1. Reason for Query

Workload report. As part of the contractor’s invoice, the Contractor shall submit to the COR, the number of visits completed per month to include the dates of service involved. No Patient Information shall be on the invoice or report.

j) When working with incomplete visits in EHR, the Contractor shall send the provider “notifications” for any record deficiencies (coding, DE, documentation), utilizing the EHR.

k) Conference Calls will established bi-weekly. Agendas will be provided prior to each conference call.

C.3 THIRD-PARTY RESOURCE BILLING SERVICES:

The Contractor shall provide all qualified personnel to perform off-site Third-Party resource billing services via current IHS/RPMS system for the TAIHS as needed. The Government shall provide technical and program support as needed. The Third-Party Billing services shall include the following:

a) The Contractor shall process and submit claims directly to the appropriate carrier or clearinghouse via modem or other communication means in a format acceptable to the appropriate carrier. Electronic submission of claims, in the HIPPA formats shall be the mode of choice when accepted by the carrier/clearinghouse. The electronic submission of clams is optional and must be requested by the COR.

b) Claims not processed electronically shall be processed and printed on the proper Standard Form (ADA, CMS-1500, UB-40, etc). The Contractor shall send the processed paper claim to the carrier and copies of the form shall be provided to the location originating the claims. The paper submission of claims is optional and must be requested by the COR.

c) Claims that are rejected by the carrier for any reason other than the inappropriate format or claims rejected by the Contractor shall be returned to the service location for correction and resubmitted back to the Contractor for processing. The Contractor shall not charge for any claim rejections prior to submission to the carrier. The claims rejected by the carrier shall be corrected and resubmitted to the carrier by entity that prepared the claim.

d) When editing and approving) inpatient/outpatient (including Dental and Pharmacy) Third-Party resource claims/bills (exporting is optional, electronic or paper).

e) The Contractor shall review visit data from PCC/superbill/EHR for accuracy and completeness for appropriate level of reimbursement based on codes and provider documentation.

f) Errors in processing or submission of transactions shall be limited to reprocessing and resubmission shall be at the Contractor’s expense.

g) The Contractor shall generate and provide reports on a monthly basis to the COR. The COR shall provide the Contractor the type of report to be generated (e.g. PCC’s generated, A/R hours used, rejected/denial claims, etc.)

h) The Contractor shall provide IHS with CMS-1500 and UB-40 data for current and past electronic health record. All electronic transactions shall be HIPPA compliant.

i) The Contractor shall not charge for additional cost of reports that were generated by the Contractor. Upon request, the Contractor shall submit one of the following electronic reports:

1) Monthly accounts receivable aging reports

2) Monthly summary of charges, payments and adjustments

3) Monthly insurance percentage report

4) Accounting disclosures of Protected Health Information (PHI) made on individuals. (Written and shall be submitted 15 days from request date).

f) The Contractor shall schedule conference calls/management meetings as needed to discuss that status of service needs with the COR. The Contractor is responsible for documentation of meeting minutes and shall be provided to the COR.

g) Should the Contractor schedule an on-site meeting, training, etc., the Contractor shall be responsible for all expenses pertaining to travel, lodging and other miscellaneous travel expenses.

h) The Contractor shall comply with all industry standards, applicable IHS rules and regulations, state and federal law including but not limited to OIG recommendations on compliance programs and HIPAA requirements.

i) The Contractor shall determine if the insurance company made correct payment. If the correct payment

j) In the event of overpayment by an Insurance company, the IHS shall prepare a refund documentation letter and shall be sent to the company to ensure prompt payment.

k) Audit requests, subpoenas and summonses: The Contractor shall provide all documentation requested by the insurance payer. The contractor shall delegate a representative and the coders and/or physician shall review the requested information. After a review, the information will be sent to the requesting official. Any monies that may be due in the event of an audit shall be repaid by IHS and the Contractor shall credit the IHS for their billing fees. If an audit should arise after the life of this contract, the Contractor shall be responsible for preparing any documentation necessary that took place during the life of the contract.

C.4 ACCOUNTS RECEIVABLE (PATIENT) AND DEBT MANAGEMENT SERVICES:

The Contractor shall provide all qualified personnel to perform off-site accounts receivable posting and debt management services via current IHS/RPMS system for the TAIHS as needed. The Contractor shall provide accountability and follow-up services from previously submitted, yet unpaid, private insurance claims as identified by the IHS. The Accounts Receivable and Debt Management services shall include the following:

a) The Contractor shall be responsible for assisting the current IHS staff with actual posting or payments and adjustments in the RPMS Accounts Receivable System, utilizing the HIPAA Standard Reason Codes only.

b) The Contractor shall employ the use of Electronic 835 remittance advice capabilities when available by third-party payers.

c) The Contractor shall follow-up on all accounts that have an outstanding balance, with the parameters being set by the IHS Chief Executive Officer and COR.

d) The Contractor shall submit collection letters to the private insurance companies using data generated by the RPMS Accounts Receivable package. The IHS Office of Information Technology (OIT) has a program written into our RPMS Accounts Receivable package to allow our staff to automatically transmit outstanding accounts directly to a Contractor with the capabilities of receiving, with no additional programming requirements or software needed to accomplish the task. The Contractor shall be responsible to obtain the full financial reimbursement the IHS is entitled to.

e) The Contractor shall submit outstanding account third-party collections letters to insurance companies and non-eligible patients based on the information transmitted through RPMS. A minimum of three (3) letters shall be submitted to the insurance company for each account allowing ample time for a response.

f) The Contractor shall submit collection letters to private insurance companies for all outstanding accounts with information received from the RPMS Accounts Receivable Debt Collection Program. Where applicable, the written demands when contacting an insurance company will list the applicable state insurance statutes for reimbursement. The demand letters should mirror those provided to the IHS through the Debt Collection Policy, utilizing preset language in those letters.

g) The Contractor shall complete all tasks utilizing the data generated by the RPMS Accounts Receivable Program. IHS Revenue Enhancement Branch shall generate start and stop records utilizing the RPMS Accounts Receivable Debit Collection Program.

h) The Contractor shall start records are claims that need to be sent to Contractor for first time collection actions. These records shall initiate the collection process. Stop records are claims that have been previously sent to the Contractor for collection action but have had a change in balance. These records either stop the collection action because the balance has bene paid in full or written off, or these records cause an update in information being sent to the payer.

i) The Contractor shall provide a written response and status report on all contacts (verbal and written) made on behalf of the entity, stating the result of the contact, such as status of account, and what further action shall be taken. This response shall be given to the COR on a weekly basis or as needed.

C.5 CONSULTANT/AUDITING SERVICES:

The Contractor shall provide all qualified personnel, travel and lodging to perform on-site consultative services to the TAIHS and an optional service on the revenue generation cycle functions and processes. The Contractor shall provide on the job training for individual staff and program development on various functions pertaining to the revenue generation cycle. The consultant/auditing services shall include the following:

a) The Contractor shall identify key management objectives and accountability in the revenue generation cycle. The Contractor shall develop timeliness to accomplish key management objectives and develop methods for accountability.

b) The Contractor shall eliminate redundancy of work within the revenue generation cycle, refine and implement new workflow processes. The Contractor shall identify the best possible physical location of staff that are in the revenue generation cycle and provide staff training to accommodate new tasks for each job per workflow process changes.

c) In the implementation of new work flow processes, training provided and other consultative services provided, the Contractor shall comply with industry standards, applicable IHS rules and regulations, state and federal law, including but not limited to the OIG recommendations on compliance programs and HIPAA requirements.

d) The Contractor shall work with the pertinent staff and programs to initiate a process change and develop evaluation criteria for the effectiveness of the change.

e) The Contractor shall develop a concurrent program for providers and other staff to improve documentation to ensure proper and accurate coding for revenue generation purposes.

f) The Contractor shall perform audits in individual internal Business Office processes of the TAIHS staff per the request of the COR in accordance with Standard Auditing practices. The Contractor shall not audit their processes.

g) The Contractor shall develop an audit program and measurements for coding, billing, and provider documentation. The audit program shall include baseline metrics, measurable standards to measure current state of coding for effectiveness and to build in accountability and provide staff training on the use of various audit techniques and measurements.

h) The Contractor shall address, define, and implement the use of automated systems as it applies to the revenue generation cycle.

i) The Contractor shall provide staff training on techniques of gathering up front information pertaining to third-party resources (i.e. patient registration, benefit coordination, etc.)

j) The Contractor shall perform a revenue generational cycle assessment that will include auditing and monitoring of coding, provider documentation, billing processes and collection processes per the request of the COR.

C.6 HOURS OF OPERATION & SCHEDULING:

On-Site Services shall be provided between the normal business hours of 8:00 am - 5:00 pm, Monday through Friday and (with the exception of federal holidays as cited at http://www.opm.gov/fedhol/). Off-Site services shall be provided per the Contractor’s normal business hours.

C.7 PERSONNEL QUALIFICATION REQUIREMENTS:

The Contractor shall have a minimum of five (5) years’ experience working with a health care facility in developing revenue enhancement initiatives and must have knowledge of revenue enhancement cycle processes, private insurance carriers and Medicare reimbursement practices and requirements. Also, the Contractor shall be knowledgeable of a compliance program, HIPAA requirements, Arizona Medicaid program, Medicare (Novitas) and other private insurance commercial insurance plans.

All personnel documentation shall be provided to the COR for review prior to starting services.

a) MEDICAL CODING SERVICES:

i. Personnel shall have a minimum of three (3) years’ experience as certified coder in AHIMA, AAPC, etc.) National Coding, IHS and other applicable pertaining to inpatient and outpatient services shall be applied and;

ii. Personnel shall have a minimum of three (3) year experience with RPMS PCC Operator and Supervisor, including Coding Queue in order to process all contracted medical documents as required.

b) THIRD-PARTY RESOURCE BILLING SERVICES:

i. Personnel shall have a minimum of three (3) years with private insurance/Medicaid billing industry and;

ii. Proof of three (3) years’ experience in electronic claim submission and;

iii. Proof of prior experience in Medical records coding (ICD 9/10 and CPT-4) and/or shall be certified coder and;

iv. Personnel shall have a minimum of three (3) years.

c) ACCOUNT RECEIVABLE (PATIENT) AND DEBT MANAGEMENT SERVICES:

i. Personnel shall have a minimum of three (3) years’ experience with posting accounts.

ii. Proof of three (3) years’ experience in adjusting accounts with HIPAA compliant reason codes.

iii. Personnel shall have a minimum of three (3) years’ experience in all aspects of the third-party revenue cycle which includes: Coding, Billing, Accounts Receivable and Debt Management.

d) CONSULTANT/AUDITING SERVICE:

i. Personnel shall have a minimum of five (5) years’ experience in all aspects of the third-party revenue cycle which includes: Coding, Billing, Accounts Receivable and Debt Management.

SECTION D - PACKAGING AND MARKING

FOR THIS CONTRACT, THERE ARE NO CLAUSES FOR THIS SECTION

15-249-SOL-00031

SECTION E - INSPECTION AND ACCEPTANCE

E.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE:

The following contract clauses pertinent to this section are hereby incorporated by reference (by Citation Number, Title, and Date) in accordance with the clause at FAR "52.252-2 CLAUSES INCORPORATED BY REFERENCE" in Section I of this contract. See FAR 52.252-2 for an internet address www.acquisition.gov/far/ (if specified) for electronic access to the full text of a clause.

NUMBER FEDERAL ACQUISITION REGULATION (48 CFR Chapter 1) DATE

SECTION F - DELIVERIES OR PERFORMANCE

15-249-SOL-00031

F.1 PERIOD OF PERFORMANCE:

Performance of this contract shall begin on October 01, 2015 and shall not extend beyond the completion date of September 30, 2016 (base year) plus four (4) option years, unless the period is changed by written modification of the contract issued and signed by the Contracting Officer. If the Government exercises its option to renew pursuant to FAR Clause No. 52.217-9, Option to Extend the Term of the Contract (MAR 2000), the following schedule shall prevail:

1st Option Year: October 01, 2016 – September 30, 2017 2nd Option Year: October 01, 2017 – September 30, 2018 3rd Option Year: October 01, 2018 – September 30, 2019 4th Option Year: October 01, 2019 – September 30, 2020

F.2 PERFORMANCE CONDITIONS:

a) This contract is a non-personal services contract, as defined in FAR 37.101, under which the contractor is an independent contractor;

b) The Contractor shall perform the required services described independently of Government Supervision except as stated therein.

c) No employer-employee relationship exists. Direct supervision aspects of the relationship can be minimized to where they are incidental to the services required and are for administrative guidance only.

d) The Government may evaluate the quality of professional and administrative services provided, but retains no control over the professional aspects of services rendered (e.g., professional judgments, diagnosis for specific medical treatment, etc.).

e) None of the services furnished under the Statement of Work shall be subcontracted or transferred to another Contractor or organization without the specific prior written approval of the Contracting Officer.

F.3 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE:

The following contract clauses pertinent to this section are hereby incorporated by reference (by Citation Number, Title, and Date) in accordance with the clause at FAR "52.252-2 CLAUSES INCORPORATED BY REFERENCE" in Section I of this contract. See FAR 52.252-2 for an internet address www.acquisition.gov/far/ (if specified) for electronic access to the full text of a clause.

52.242-15 STOP-WORK ORDER AUG 1989

SECTION G - CONTRACT ADMINISTRATION DATA

G.1 CONTRACTING OFFICER RESPONSIBILITY:

Authority to negotiate changes in terms, conditions, or amounts cited in this contract is reserved to the Contracting Officer.

G.2 CONTRACTING OFFICER’S REPRESENTATIVE (COR) RESPONSIBILITIES:

The Contracting Officer shall designate in writing the Contracting Officer’s Representative (COR) representing the Government for the purpose of this contract. A copy of this designation will be provided to the Contractor. The major responsibility of the COR is to ensure contractor accountability, monitoring contract performance, and assist the Contractor in the resolution of program problems encountered during the performance of this contract. Other duties specifically delegated are as follows:

a) Interpreting the statement of work.

b) Recommending to the Contracting Officer changes in requirements.

c) Performing technical inspections and acceptances.

d) Receiving and processing invoices for payment.

G.3 GOVERNMENT RESPONSIBILITIES:

a) The Government shall provide proper in-service to the Contractor to familiarize with the Privacy Act and HIPAA requirements.

b) The Contractor shall be provided with the Third-party Internal Control Policy and instructed on the IHS Billing policies and procedures.

c) The Government shall provide work space for on-site services. The Government shall be responsible for retrieving, copying and returning appropriate medical records, according to hospital policy.

d) The Government shall perform random audits two (2) times per year on coding and claim transactions, record keeping/security back up to ensure contract compliance.

e) The Government shall be responsible for working all responses received from the private insurance companies. The Government will resubmit, complete the required research for each of the responses received and/or adjust the open account accordingly.

f) The Government shall be responsible for setting the parameters in the Debt Collection Program which will specify which claims will be submitted to the Contractor. Once a stop is initiated, the Contractor will be responsible for updating the collection letter to the private insurance company or stopping further collection letters once the account is closed.

g) The Government shall perform an on-site courtesy visit to the Contractor’s location within the performance period to ensure privacy, security, and their operations are in compliance with federal, HIPAA and CMS guidelines.

G.4 METHOD OF PAYMENT/INVOICES:

· Name of Vendor

· Invoice Date

· Government Contract No. (Purchase Order No.)

· Description, price, and quantity of goods and services rendered

· Shipping and payment terms

· Taxpayer Identification Number (TIN), EIN or Social Security Number

· Data Universal Numbering System (DUNS) number (to ensure payment is made to the correct bank account) and vendor mailing address, as provided in the System for Award Management (SAM).

· Vendor contact name, title and telephone number

Invoices shall be submitted to the following address:

Also, a copy should be sent to the COR via electronically at: diane.shanley@ihs.gov

SECTION H - SPECIAL CONTRACT REQUIREMENTS

H.1 BUSINESS ASSOCIATE AGREEMENT CLAUSE (APRIL 2005):

Pursuant to the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and its implementing regulation, the Standards of Privacy of Individual Identifiable Health Information at 45 C.F.R. Parts 160 and 164, Subparts A and E ("Privacy Rule"), and 45 C.F.R. Parts 160 and 164, Subparts A and C (“Security Rule”), the Indian Health Service is required to enter into an agreement with the Business Associate, pursuant to which the Business Associate shall comply with and appropriately safeguard Protected Health Information ("PHI”) that it will use and disclose when performing functions, activities or services ("Services") for the Indian Health Service. The Business Associate by signing the contract shall comply with the following terms in addition to other applicable contract terms and conditions relating to the safekeeping, use and disclosure of PHI.

Definitions Terms used in this Agreement, but not otherwise defined, shall have the same meaning as those terms contained within the Privacy Rule.

a) Agreement: “Agreement” shall mean this clause and any other provisions of this contract that are incorporated by reference;

b) Business Associate: “Business Associate” shall mean the Contractor, also known as (INSERT BUSINESS NAME);

c) Covered Entity: “Covered Entity” shall mean the Indian Health Service;

d) Designated Record Set: “Designated Record Set” shall mean (1) a group of records maintained by or for a covered entity that is: (i) The medical records and billing records about individuals maintained by or for a covered health care provider, (ii) The enrollment, payment, claims adjudication, and case or medical management record systems maintained by or for a health plan, or (iii) Used, in whole or in part, by or for the covered entity to make decisions about individuals. (2) For purposes of this paragraph, the term record means any item, collection, or grouping of information that includes protected health information and is maintained, collected, used, or disseminated by or for a covered entity. (45 C.F.R. § 164.501)

e) Individual: “Individual” shall have the same meaning as the term "individual" in 45 C.F.R. § 160.103 and shall include a person who qualifies as a personal representative in accordance with 45 C.F.R. § 164.502(g);

f) Protected Health Information: “Protected Health Information” shall have the same meaning as the term “protected health information” in 45 C.F.R. § 160.103, limited to the information created or received by the Contractor from or on behalf of the IHS.

Section 1 - Privacy Rule Compliance

The Business Associate agrees to comply with the applicable Business Associate Agreement requirements under the Privacy Rule and the provisions of this Agreement throughout the term of this Agreement. The Business Associate agrees that it will require that all of its agents, employees, subsidiaries, affiliates and subcontractors, to whom the Business Associate provides PHI, or who create or: receive PHI on behalf of the Business Associate for the IHS, agree to comply with the Privacy Rule. Any subcontracts shall be let as provided for in this contract but, notwithstanding any exemption from any requirement for written consent contained in the subcontracting clause, the Business Associate shall nonetheless obtain the Contracting Officer's written consent before placing any subcontract pursuant to which the Business Associate discloses PHI to the subcontractor.

Section 2 - Permitted Uses and Disclosures

The Business Associate shall not use or disclose PHI except as provided for in this Agreement, the Privacy Rule or other applicable law, to perform functions, activities or services for or on behalf of the IHS as specified herein. The Business Associate agrees that it may use or disclose PHI on behalf of the IHS only; {I) upon obtaining the authorization of the patient to whom the PHI pertains (45 C.F.R. §§ 164.502(a)(I)(iv) and 164.508(b); (2) without an authorization for the purpose of treatment, payment or health care operations (45 C.F.R. §§ 164.502(a)(I)(ii) and 164.506); or (3) without an authorization or consent, if in accordance with 45 C.F.R. §§ 164.506, 164.510, 164.512, 164.514(e), 164.514(t) or 164.514(g). Except as otherwise limited in this Agreement, the Business Associate may use PHI for the management and administration of the Business Associate or to carry out responsibilities of the Business Associate that are required by law.

Section 3 – Safeguards

The 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 permitted by the Privacy Rule or this Agreement. The 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 in accordance with the applicable requirements of the Privacy Rule.

Section 4 - Safeguards for Electronic PHI

The Business Associate shall implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity and availability of any electronic PHI that it creates, receives, maintains, or transmits on behalf of the IHS as required by the Security Rule and ensure that any agent, including a subcontractor to who it provides such information, agrees to implement reasonable and appropriate safeguards to protect it.

Section 5- Reporting of Disclosure

The Business Associate shall promptly report to the IHS any knowledge of uses or disclosures of PHI that are not in accordance with this Agreement or applicable law and any security incidents involving electronic PHI of which it becomes aware. In addition, the Business Associate shall mitigate, to the extent practicable, any harmful effect that is known to the Business Associate of a use or disclosure of PHI by the Business Associate in violation of the requirements of the Privacy Rule.

Section 6 - Records: IHS Access

The Business Associate shall maintain records of PHI received from or created or received on behalf of the IHS and shall document subsequent uses and disclosures of such information by the Business Associate. The Business Associate shall promptly make available to the IHS, such information as the IHS may require to fulfill its obligations to provide access to, provides a copy of, and account for disclosures with respect to PHI pursuant to the Privacy Rule (e.g.. 45 C.F.R. § 164.528 (individual request for an accounting of PHI disclosure)) and other applicable law. The Business Associate shall provide such information to the IHS in a time frame that permits the IHS to meet obligations under 45 C.F.R. § 164.528.

Section 7 - Records; Individual Access

The Business Associate shall maintain a designated record set, as defined by the Privacy Rule (45 C.F.R. § 164.501), for each patient for whom it has PHI. In accordance with a patient's right to access his PHI under the Privacy Rule, the Business Associate shall make available all PHI in the patient's designated record set to the patient to whom that information pertains, or to the patient's authorized representative, upon request by the patient or his authorized representative in a time and manner sufficient to meet the applicable requirements of 45 C.F.R. § 164.524. The Business Associate shall document all disclosures under this section and shall promptly make such information available to the IHS pursuant to section 6 above.

Section 8 – Disclosure

Upon request, the Business Associate shall make available to the IHS or to the Secretary, PHI and the Business Associate's internal practices, books and records, including its policies and procedures, including any agreements required by Section 1 with subcontractors, vendors and other agents relating to the use and disclosure of PHI received from the IHS, or created or received by the Business Associate on behalf of the IHS, for purposes of determining the IHS’ compliance with the Privacy Rule. The Business Associate shall not disclose PHI to any requesting party other than as provided for in this section and sections 2 and 7 above. The Business Associate shall forward all other requests for PHI to the IHS for handling.

Section 9 - Amendments of Information

The Business Associate shall make PHI available to the IHS for the IHS to fulfill its obligations pursuant to the Privacy Rule to amend PHI and shall, as directed by the IHS, incorporate any amendments into PHI held by the Business Associate and ensure incorporation of any such amendments into PHI held by its agents or subcontractors. The Business Associate shall not make any amendments to PHI and shall forward all amendment requests to the IHS Contracting Officer for approval.

Section 10 - Obligations of the IHS

The IHS Contracting Officer shall provide the Business Associate with its notice of privacy practices, produced under 45 C.F.R. § 164.520 and any changes to the notice. The IHS Contracting Officer shall also provide the Business Associate with any changes in, or revocation of, individuals' authorizations to use or disclose PHI, if such changes affect the Business Associate's permitted or required uses or disclosures of PHI. The IHS Contracting Officer shall notify the Business Associate of any restrictions to the use or disclosure of PHI that the IHS has agreed to pursuant to an individual's request under 45 C.F.R. § 164.522. The IHS shall not request that the Business Associate use or disclose PHI in any manner that would violate the Privacy Rule if done by the IHS.

Section 11 - Material Breach: Termination

If the Business Associate breaches a material obligation of this Agreement or fails to comply with the Privacy Rule or the Security Rule, the IHS will give the Business Associate an opportunity to cure the breach, but if the Business Associate fails to cure the breach, the IHS will terminate the Agreement, as provided in FAR 52.249-8 Default (Fixed-Price Supply and Service) (Apr 1984). If, at the determination of the IHS Contracting Officer, neither cure nor termination are feasible, IHS shall report the material breach to the Secretary. Termination of this Agreement shall not affect any provision of this Agreement which, by its wording or nature, is intended to remain in effect and to continue to operate in the event of termination. Termination of the underlying contract between the parties will result in the termination of this Agreement.

Section 12 - Return or Destruction of Information

When this Agreement/contract terminates, the Business Associate, at the IHS's option, shall return to the IHS, or destroy, all PHI in its possession, and keep no copies of PHI except as requested by the IHS or required by law. The IHS Contracting Officer shall notify the Business Associate whether the Business Associate must return or destroy any PHI in its possession. If the Business Associate or its agent or subcontractor destroys any PHI, then the Business Associate will provide the IHS with documentation evidencing such destruction. Any PHI maintained by the Business Associate shall continue to be extended the same protections set forth in this Agreement for as long as it is maintained.

Section 13 – Term

The term of this Agreement shall begin on the effective date of this modification and or contract award and end with the completion of the contract, except as provided in Section 12, provided that, insofar as any term of this Agreement relates to the Security Rule, compliance with such term is required only on or after April 20, 2005.

Section 14 - Amendment of Agreement

After the date of execution of this Agreement and after learning that material changes have been made to the Privacy Rule or the Security Rule, the parties agree to amend this Agreement to ensure that it complies with the Privacy Rule or the Security Rule as applicable, and that IHS can continue to comply with such.

Section 15 - Miscellaneous Provisions

1) All notices under this Agreement shall be as provided in this contract;

2) This Agreement shall be binding upon, inure to the benefit of and be enforceable by and against the Parties and their successors and assigns. Any novation, assignment, or other transfer of rights, interests, or duties under this Agreement by the Contractor shall be as provided in this contract; Any ambiguity in this Agreement shall be resolved to bring the Agreement into compliance with the most current version of the Privacy Rule. If a court of competent jurisdiction deems any provision of this Agreement unenforceable, such provision shall be severed from this Agreement and every other provision of the Agreement shall remain in full force and effect.

H.2 TAXES:

The Government is tax exempt under A.R.S. 42-5063.C.3(b), 42-5067.B.1, 42-5065.B.2(b), 42-5066.B.3(b), 42-5074.B.8, 42-5071.B.2(a), 42-5061.A.25(b), and 42-5159.A.13(d), STATE OF ARIZONA DEPARTMENT OF REVENUE. (Certificate available upon request.)

H.3 DEPARTMENT OF LABOR:

No contractor or subcontractor holding a service contract for any dollar amount shall pay any of its employees working on the contract less than the minimum wage specified in section 6(a)(1) of the Fair Labor Standards Act (29 U.S.C. 206).

The Department of Labor, Wage and Hour Division has issued a Wage Determination for laborers to be employed under this purchase order. Wage Determination No. 2005-2026, Revision No. 19, dated 07/08/2015 is incorporated into this purchase order pursuant to Federal Acquisition Regulation (FAR) 22.1002-2. (Refer to List of Attachments)

In addition, to paying employees appropriate hourly wages the contractor is responsible for fringe benefits applicable to all classes of service employees engaged in purchase order performance. Fringe benefits are not included in the hourly wages.

PART II - CONTRACT CLAUSES

SECTION I - CONTRACT CLAUSES

I.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE:

The following contract clauses pertinent to this section are hereby incorporated by reference (by Citation Number, Title, and Date) in accordance with the clause at FAR "52.252-2 CLAUSES INCORPORATED BY REFERENCE" in Section I of this contract. See FAR 52.252-2 for an internet address www.acquisition.gov/far/ (if specified) for electronic access to the full text of a clause.

I.2 FAR 52.212-1 INSTRUCTIONS TO OFFERORS – COMMERCIAL ITEMS (APR 2014):

(a) North American Industry Classification System (NAICS) code and small business size standard. The NAICS code and small business size standard for this acquisition appear in Block 10 of the solicitation cover sheet (SF 1449). However, the small business size standard for a concern which submits an offer in its own name, but which proposes to furnish an item which it did not itself manufacture, is 500 employees.

(b) Submission of offers. Submit signed and dated offers to the office specified in this solicitation at or before the exact time specified in this solicitation. Offers may be submitted on the SF 1449, letterhead stationery, or as otherwise specified in the solicitation. As a minimum, offers must show-

(1) The solicitation number;

(2) The time specified in the solicitation for receipt of offers;

(3) The name, address, and telephone number of the offeror;

(4) A technical description of the items being offered in sufficient detail to evaluate compliance with the requirements in the solicitation. This may include product literature, or other documents, if necessary;

(5) Terms of any express warranty;

(6) Price and any discount terms;

(7) “Remit to” address, if different than mailing address;

(8) A completed copy of the representations and certifications at FAR 52.212-3 (see FAR 52.212-3(b) for those representations and certifications that the offeror shall complete electronically);

(9) Acknowledgment of Solicitation Amendments;

(10) Past performance information, when included as an evaluation factor, to include recent and relevant contracts for the same or similar items and other references (including contract numbers, points of contact with telephone numbers and other relevant information); and

(11) If the offer is not submitted on the SF 1449, include a statement specifying the extent of agreement with all terms, conditions, and provisions included in the solicitation. Offers that fail to furnish required representations or information, or reject the terms and conditions of the solicitation may be excluded from consideration.

(c) Period for acceptance of offers. The offeror agrees to hold the prices in its offer firm for 30 calendar days from the date specified for receipt of offers, unless another time period is specified in an addendum to the solicitation.

(d) Product samples. When required by the solicitation, product samples shall be submitted at or prior to the time specified for receipt of offers. Unless otherwise specified in this solicitation, these samples shall be submitted at no expense to the Government, and returned at the sender’s request and expense, unless they are destroyed during preaward testing.

(e) Multiple offers. Offerors are encouraged to submit multiple offers presenting alternative terms and conditions or commercial items for satisfying the requirements of this solicitation. Each offer submitted will be evaluated separately.

(f) Late submissions, modifications, revisions, and…