RFP_16-245-SOL-00001.pdf

REQUEST FOR PROPOSAL: 16-245-SOL-00001

ISSUE DATE: March 11, 2016

DUE DATE: April 11, 2016

This is a combined synopsis/solicitation for commercial services prepared in accordance with the format in FAR 12, as supplemented with additional information included in this notice. This announcement constitutes the only solicitation. This office is Requesting for Proposals from interested Offerors to provide Inter-Facility and Intra-Facility Non-Emergent and Emergent Ground Transportation Services to the Kayenta Service Unit; Kayenta Health Center (KHC), Inscription House Health Center (IHHC), Dennehotso Health Center (DHC) and the Four Corners Regional Health Center (FCRHC). It is requested that you review the enclosed RFP proposal instructions and provide this office with a proposal, utilizing the information contained therein.

COMPLETION OF SOLICITATION REQUIREMENTS

Ensure all forms and additional information is completed in its entirety. Verify calculations before signing the proposal.

A. Standard Form 1449 – Solicitation/Contract/Order or Commercial Items.

B. Section B – Fee Schedule and PBSOW C. Section C – Contract Clauses D. Section D – Contract Documents, Exhibits or Attachments E. Section E – 52.212-3 Offeror Representation & Certifications - Commercial Items

(FEB 2016).

F. Prospective Offerors are required to complete registration in the System for Award

Management in accordance with FAR 52.232-33.

Your proposal shall be prepared and submitted in accordance with Paragraph E-1, Instructions to Offeror-Commercial Items. This paragraph shall stipulate the submission of all required documents, certifications, etc., to determine your responsibility of providing the required services. All proposals must be received in the Branch of Acquisition Management and Contracts by the due date listed above.

Attn: Kerri Gilmore, Contract Specialist Navajo Area Indian Health Services (NAIHS) Kayenta Service Unit Branch of Acquisition Management & Contracts P.O. Box 368 Highway 163, Building KA-2010 Kayenta, AZ 86033

MARK YOUR ENVELOPE “GROUND TRANSPORTATION SERVICES, RFP #16-245-SOL-00001”

The anticipated period of performance will be for one (1) base year with two (2) option years.

THIS IS 100% BUY INDIAN SET ASIDE per 25 U.S.C. 47

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

Highway 163, Bldg. KA-2010 PO Box 368 Acquisition Department Kayenta Health Center

25 CODE 16. ADMINISTERED BYCODE

X

X

621910

SIZE STANDARD:

100.00 % FOR:SET ASIDE:UNRESTRICTED OR25

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

04/11/2016 1700 ET

03/11/2016

928-697-4293KERRI GILMORE

(No collect calls)

INFORMATION CALL:

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

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

16-245-SOL-00001

5. SOLICITATION NUMBER

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

1 75 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

Kayenta AZ 86033

TELEPHONE NO.

17a. CONTRACTOR/

ARIZONA

Four Corners Regional Health Center Kayenta Service Unit NAIHS Medical Facilities

15. DELIVER TO

Kayenta AZ 86033 Highway 163, Bldg. KA-2010 PO Box 368 Acquisition Department

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$15.0

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)

Kayenta Health Center

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.

For the provision of Inter-Facility and Intra-Facility Non-Emergent and Emergent Ground Transport medical services for Navajo Area Indian Health Service (NAIHS) Indian Health Services (IHS), Kayenta Service Unit (Kayenta Health Center, Inscription House Health Center and Dennehotso Health Center) and Four Corners Regional Health Center.

Period of Performance: 05/01/2016 to 04/30/2019

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

HEREIN, IS ACCEPTED AS TO ITEMS:

X

XX

DATED

MARGARET J. SHIRLEY-DAMON

. 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.

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

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

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

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

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

37. CHECK NUMBER

FINALPARTIAL

36. PAYMENT

FINALPARTIAL

35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER33. SHIP NUMBER

COMPLETE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

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

42b. RECEIVED AT (Location)

42a. RECEIVED BY (Print)

41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

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

STANDARD FORM 1449 (REV. 2/2012) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

75 2 of

Kayenta Service Unit and Four Corners Regional Health Center Ground Transportation

Services

SOLICITATION NO.: 16-245-SOL-00001

Table of Contents Section A – SF1449 Solicitation/Contract/Order for Commercial Items

Section B – Continuation Block

B-1 Purpose of Contract

B-2 Fee Schedule

B-3 Workload Data

B-4 Definitions

B-5 Contractor Furnished Property

B-6 Performance Based Statement of Work (PBSOW)

B-7 Government Furnished Information, Property and Services

B-8 Applicable Documents

B-9 Period of Performance

B-10 Contracting Officer Responsibility

B-11 Contracting Officer’s Representative (COR)

B-12 Official Authorized to Place Orders Against This Contract

B-13 Invoice Submission

B-14 Contractor’s Representative

B-15 Contractor’s Responsibilities

B-16 FAR 52.237-7 Indemnification and Medical Liability Insurance (Jan 1997)

B-17 FAR 52.204-9 Personal Identity Verification of Contractor Personnel (Jan 2011)

Section C – Contract Clauses

C-1 HHS 352.244-70 Privacy Act (Dec 2015)

C-2 HHS 352.224-71 Confidential Information (Dec 2015)

C-3 FAR 52.212-4 Contract Terms and Conditions – Commercial Items (May 2015)

C-4 FAR 52.212-5 Contract Terms and Conditions Required to Implement Statues or Executive Orders

– Commercial Items (Feb 2016)

C-5 FAR 52.216-21 Requirements (Oct 1995)

C-6 FAR 52.217-9 Option to Extend the Term of the Contract (May 2000)

C-7 FAR 52.232-18 Availability of Funds for the Next Fiscal Year (Apr 1984)

C-8 Department of Health and Human Services Acquisition Regulation (HHSAR) (48 CFR Chapter 3)

Clauses

Section D – Contract Documents, Exhibits, or Attachments

Section E – Solicitation Provisions

E-1 FAR 52.212-1 Instructions to Offerors – Commercial Items (Oct 2015)

E-2 FAR 52.212-2 Evaluation – Commercial Items (Oct 2014)

E-3 FAR 52.212-3 Offeror Representations and Certifications – Commercial Items (Feb 2016)

E-4 FAR 52.216-1 Type of Contract (Apr 1984)

E-5 FAR 52.217-5 Evaluation of Options (July 1990)

E-6 FAR 52.233-2 Service of Protest (Sept 2006)

B-1 PURPOSE OF CONTRACT

1.1 GENERAL: This performance based statement of work describes the requirements for a non-personal service contract for the provision of Inter-Facility and Intra-Facility Non-Emergent and Emergent Ground Transportation Medical Services for Navajo Area Indian Health Service (NAIHS) Indian Health Services (IHS), Kayenta Service Unit (KSU);

Kayenta Health Center (KHC), Inscription House Health Center (IHHC) Dennehotso Health Center(DHC) and Four Corners Regional Health Center (FCRHC).

1.2 BACKGROUND: The Indian Health Service (IHS), an agency within the Department of Health and Human Services, is responsible for providing federal healthcare services to American Indians and Alaska Natives. The provision of healthcare services to members of federally-recognized tribes grew out of the special government-to-government relationship between the federal government and Indian tribes. This relationship, established in 1787, is based on Article I, Section 8 of the Constitution, and has been given form and substance by numerous treaties, laws, Supreme Court decisions, and Executive Orders. The IHS is the principal federal health care provider and health advocate for Indian people and its goal is to raise their health status to the highest possible level. The IHS provides a comprehensive health service delivery system for approximately 1.9 million American Indians and Alaska Natives who belong to 564 federally recognized tribes in 35 states. The goal is to insure comprehensive and qualitative ground transport service is available for Kayenta Service Unit (KSU) and Four Corners Regional Health Center (FCRHC).

B-2 FEE SCHEDULE

The Contractor shall be compensated a fixed monthly amount for Ground

Transportation Service provided in accordance with the Performance Based Statement of Work (PBSOW).

KAYENTA SERVICE UNIT

BASIC YEAR: MAY 1, 2016 THRU APRIL 30, 2017

Unit Estimated

SERVICE Quantity Unit Price Total

2.1 Ground Transport 12 MOS $________ $___________

FIRST OPTION YEAR: MAY 1, 2017 THRU APRIL 30, 2018

2.2 Ground Transport 12 MOS $_________ $___________

SECOND OPTION YEAR: MAY 1, 2018 THRU APRIL 30, 2019

2.3 Ground Transport 12 MOS $__________ $___________

FOUR CORNERS REGIONAL HEALTH CENTER

BASIC YEAR: MAY 1, 2016 THRU APRIL 30, 2017

2.4 Ground Transport 12 MOS $________ $___________

FIRST OPTION YEAR: MAY 1, 2017 THRU APRIL 30, 2018

2.5 Ground Transport 12 MOS $_________ $___________

SECOND OPTION YEAR: MAY 1, 2018 THRU APRIL 30, 2019

2.6 Ground Transport 12 MOS $__________ $___________

B-3 WORKLOAD DATA

3.1 Contractor shall provide one (1) full time Advanced Life Support (ALS) Medical Unit and one (1) Basic Life Support (BLS) Medical Unit services for the Kayenta Service Unit. Kayenta Service Unit workload is reflected in Table A.

3.2 Contractor shall provide one (1) full time Advanced Life Support (ALS) Medical

Unit services for the Four Corners Regional Health Center. FCHRC workload is reflected in Table B.

KAYENTA SERVICE UNIT WORKLOAD DATA

(TABLE A)

2011 2012 2013 2014 2015

Month ALS BLS ALS BLS ALS BLS ALS BLS ALS BLS

January 71 44 76 128 103 57 85 48 92 32

February 55 23 93 134 101 51 92 31 82 51

March 69 49 77 119 86 40 101 37 77 61

April 58 41 65 107 107 33 68 43 78 52

May 64 28 89 128 97 56 74 47 81 42

June 45 36 81 119 59 51 72 54 72 47

July 68 29 90 142 70 49 78 42 72 40

August 71 55 104 150 86 39 91 33 87 19

September 86 56 115 170 104 39 100 46 80 37

October 96 75 54 92 70 48 87 36 87 46

November 77 41 73 110 79 51 68 44 63 31

December 94 43 115 149 79 44 85 39 81 36

TOTAL 854 520 1032 1548 1041 558 1001 500 952 494

Destination

Average Monthly frequency

Distance Round Trip (miles)

Expected Absence Time (hours)

Flagstaff 1.5 312 6

Tuba City 24 150 3

Chinle 16 142 3

Kayenta Airport 47 8 0.5

Shiprock 2.25 208 5

Farmington 0.8 264 6.5

Fort Defiance 0 282 6

Black Mesa Airstrip 0 0 0

IHHC 0 88 2

Page 0.2 196 3

Prescott 0 490 4

Gallup 0 316 6.5

Albuquerque 0 620 12

Phoenix 0.1 606 12

Tucson 0 840 12.5

FOUR CORNERS REGIONAL HEALTH CENTER WORKLOAD DATA

(TABLE B)

2011 2012 2013 2014 2015 Total

Month ALS BLS ALS BLS ALS BLS ALS BLS ALS BLS

January 2 5 7 12 4 4 2 15 4 9 64

February 5 7 5 9 6 3 10 9 2 15 71

March 6 15 2 14 10 6 3 8 4 10 78

April 4 8 2 4 7 9 5 5 5 13 57

May 2 10 3 6 3 7 4 11 5 2 53

June 1 12 4 8 2 7 5 6 4 12 61

July 4 5 2 3 0 22 0 7 1 9 53

August 3 11 5 10 10 8 4 13 1 12 77

Sept. 1 11 4 7 3 6 2 13 1 5 53

Oct 2 6 1 9 6 2 2 11 1 5 45

Nov 3 11 2 4 3 10 2 7 2 10 54

Dec. 2 11 3 10 2 17 2 8 1 2 58

Total 35 112 40 96 56 101 36 113 31 104 724

B-4 DEFINITIONS:

4.1 Acceptance: An authorized representative of the Government has inspected and agreed that the work meets all requirements of this contract, to include documentation requirements.

4.2 Advanced Life Support (ALS): Emergency medical care for sustaining life, including defibrillation, airway management, and drugs and medications.

4.3 Approval: The Government has reviewed submittals, deliverables, or administrative documents (e.g., insurance certificates, installation schedules, planned utility interruptions, etc.) and has determined the documents conform to contract or contract requirements. Government Approval shall not relieve the

Destination

Average Monthly frequency

Distance Round Trip

(miles)

Expected Absence

Time (hours)

Flagstaff 1 409.4 7

Tuba City 1 260.02 5

Chinle 1 160.2 3

Kayenta Airport 1 116.2 2

Shiprock 10 86.04 2

Farmington 3 148.42 2

Fort Defiance 0 274 5

Black Mesa Airstrip 1 107.8 1.6

IHHC 1 254 4

Page 0 306 4.5

Prescott 0 698 10.5

Gallup 0 269.2 5

Albuquerque 1 543.42 8

Phoenix 1 732 12

Tucson 0 924 13

Contractor from responsibility for complying with contract requirements.

4.4 Active Labor: Contractions less than (<) 5 minutes apart and/ or greater than (>) 4 cm dilation.

4.5 Award Term Plan: Relative to Performance Based Contracting and rewarding the

Contractor for satisfactory performance with option of contract term extension.

4.6 Basic Life Support (BLS): A specific level of pre-hospital medical care provided by trained and certified responders, including Emergency Medical Technicians (EMTs). BLS consists of a number of life-saving techniques e.g. the use of airway adjuncts such as respirators, emergency oxygen therapy; application of Cardiopulmonary resuscitation and other non-invasive emergency procedures.

4.7 CMS: Centers for Medicare & Medicaid Services.

4.8 Contracting Officer (CO): Individual at the IHS authorized and warranted to issue contracts and to make subsequent modification(s). The CO has the authority to make determinations on all matters of dispute regarding this contract.

4.9 Contracting Officer Representative (COR): A federal employee who assists the ordering/issuing activity-contracting officer in the administration of task orders issued under this contract. The COR is primarily responsible for the day-to-day program management of the ordering activity’s task or delivery orders.

4.10 Contractor: The individual/company awarded this contract.

4.11 Eligible Beneficiaries: Services will be made available, as medically indicated to persons of Indian descent belonging to the Indian community served by the local facilities and program. Services will also be made available, as medically indicated, to a non-Indian woman pregnant with an eligible Indian’s child but only during the period of her pregnancy through postpartum (generally about six weeks after delivery)

4.12 EMTALA: Emergency Medical Treatment And Labor Act

4.13 Emergency Medical Service (EMS): Those services that do qualify for basic life support or advance life support.

4.14 EMT: means the same as “certified emergency medical technician”. A person who is specially trained and certified to give emergency medical care to patients before they reach a healthcare facility.

4.15 EMT-B: means the same as basic emergency medical technician.

4.16 EMT-I: means the same as intermediate emergency medical technician.

4.17 EMT-P: means the same as emergency paramedic.

4.18 Federal Acquisition Regulation (FAR): The FAR is the primary regulation for use by all Federal Executive agencies in their acquisition of supplies and services with appropriated funds.

4.19 Ground Ambulance: A vehicle equipped for transporting Patients in need of

Emergency care.

4.20 Health insurance portability and accountability act (HIPAA) - Acronym that stands for the Health Insurance Portability and Accountability Act, a US law designed to provide privacy standards to protect patients' medical records and other health information provided to health plans, doctors, hospitals and other health care providers. Developed by the Department of Health and Human Services.

4.21 Inter-facility: Between two health facilities.

4.22 Intra-facility: Between two Indian Health Service facilities.

4.23 Log Run Report: A summary of the number, destination, type of run and outcome that is provided to Purchased/Referred Care and Contracting Officer Representative.

4.24 Ordering Activity: An authorized user of IHS that may issue a task or delivery order to obtain required services under this contract.

4.25 Ordering Activity Contracting Officer: An employee of IHS authorized and warranted to issue task orders and to make subsequent task order modification(s) under this contract. The Ordering Activity CO has the authority to make initial determinations on all matters of dispute regarding task orders.

4.26 Past Performance Information: Relevant information regarding a contractor’s http://www.medterms.com/script/main/art.asp?articlekey=31786 http://www.medterms.com/script/main/art.asp?articlekey=10711 http://www.medterms.com/script/main/art.asp?articlekey=10711 actions under previously awarded contracts. It includes the contractor’s record of conforming to Scope of Work: state standards; the contractor’s record of containing and forecasting costs on any previously performed cost reimbursable contracts; the contractor’s adherence to contract schedules, including the administrative aspects of performance; the contractor’s history for reasonable and cooperative behavior and commitment to customer satisfaction; and generally, the contractor’s business- like concern for the interest of the customer.

4.27 Quality Assurance Surveillance Plan (QASP): An organized written document prepared and used by the Government for Quality Assurance surveillance of the contractor’s performance.

4.28 RN: means the same as a Registered Nurse.

4.29 Root Cause: A situation where performance does not meet expectations. Cause suggests responsibility or a factor to blame for a problem.

4.30 Run Report: A summary of a completed transport that is left with the emergency department personnel that are taking over the care of the patient.

4.31 Sentinel Event: An event/incident that is unique and not planned for. JCAHO definition: unexpected occurrence resulting in death or serious physical injury or the risk there of.

4.32 Service Unit: A facility that houses Service Unit administrative staff and is responsible for the administration, coordination, and implementation of the Indian Health program/s in a designated geographic portion of the Area.

4.33 Task Order: An order issued in accordance with the terms of the contract and ordering activity’s specific requirements. An ordering activities written order to obtain services, at a minimum will include the following where applicable:

description of services, skill categories, hours, price, period of performance, contract number, and the ordering activities task or delivery order number.

4.34 Urgent Care: The delivery of ambulatory medical care outside of a hospital emergency department on a walk-in basis without a scheduled appointment.

4.35 Verifiable Emergency: An unexpected/unplanned episode requiring valid documentation to confirm the occurrence.

4.36 911: A telephone number in the US that links the public to the police and mobile rescue units to provide emergency care.

B-5 CONTRACTOR FURNISHED PROPERTY:

The Contractor shall provide all supplies, personnel, equipment, vehicles, drugs, medical equipment, and expertise necessary for or incidental to providing EMS in accordance with Arizona Department of Health Services Emergency Medical Service requirements.

B-6 PERFORMANCE BASED STATEMENT OF WORK (PBSOW)

The Contractor shall provide ground transport services as required for IHS patients. The

Contractor’s performance will be evaluated in accordance with the standards set forth in the Performance-based Matrix of paragraph 6.13. Specific tasks include:

6.1 Place of Performance: The contractor shall provide Inter-Facility and Intra-

Facility Non-Emergent and Emergent Ground Transportation Services for IHS Patients as requested by the KSU AND FCRHC authorizing official.

6.1.1 Provision of ground transport services shall include medical transport outside the primary response area as medically necessary, which may include intra-facility transports and to other IHS and Public Law 93-638 facilities.

6.1.2 Ground transports shall include inter-facility transports to regional medical facilities off the Navajo Nation reservation

6.1.3 Services may also include flight crew pick up at airstrip/airport and transport to Emergency Room/Urgent Care; patient load up and transport by ground from facility to regional airstrips/airports for the purpose of medical air transfer.

6.1.4 The Contractor shall be an active participant in Emergency Management:

actual and planning of drills and Continuity of Operations Plan (COOP).

6.1.5 The Navajo Nation Emergency Medical Service shall remain the first responder for emergency (911) calls. However, only in mass-casualty or other complex medical incidents occurring on the Navajo Nation, the

Contracting Officer Representative (COR), Contracting Officer (CO) or designee may authorize the Contractor assist in the transport of patients from the field to an appropriate health care facility.

6.1.6 The Contractor shall receive and respond to all requests for ALS/BLS transports as defined by the Arizona Department of Health (http://www.azsos.gov/public_services/title_09/9-25.htm), as authorized by the Contracting Officer (CO), the Emergency Medical Director, designee or physician on duty.

6.1.7 Transport crews and vehicles to be within 10 minutes of Kayenta hospital and airport when not in service

6.1.8 Transport crews and vehicles to be within 30 minutes of Dennehotso

Clinic when not in service.

6.1.9 Transport crews and vehicles to be within 60 minutes of Inscription

House Clinic when not in service.

6.1.10 Transport crews and vehicles to be within 10 minutes of Four Corners Regional Health Center when not in service.

6.2 The Contractor shall perform as follows:

6.2.1 The Contractor shall perform all duties in a professional manner, to include displaying a positive and cooperative attitude and neat appearance.

6.2.2 The Contractor shall immediately report to the Contracting Officer

Representative (COR) or designee any circumstances that may jeopardize the patient care.

6.2.3 The Contractor shall communicate directly with Emergency Department or Urgent Care Staff when the patient is in transit and their condition has changed.

6.2.4 The Contractor shall maintain patient confidentiality in accordance with

HIPPA regulations and Privacy Act of 1974.

6.2.5 The Contractor shall not have unauthorized person/s on board during transports. Unauthorized means: hitchhikers and non-medical personnel.

6.2.6 The Contractor shall not make any unauthorized or personal stops. Non-medically related stops or deviations from direct routes are strictly prohibited.

6.2.7 The Contractor shall utilize the most current Physician’s Medical

Necessity Form for all patients as applicable.

6.2.8 The Contractor shall have a backup vehicle available in the event a primary vehicle becomes disabled.

6.2.9 The Contractor shall maintain vehicles in good repair in order to perform transports without any delays.

6.2.10 The Contractor shall maintain hospital affiliation as an emergency based station.

6.2.11 Impaired Judgment. Any Contractor personnel demonstrating impaired judgment shall not be permitted to work. The Government reserves the right to require removal of Contractor’s employees who may jeopardize health care of IHS patients served under this contract.

6.3 Required Reports: Reports that are mandatory.

6.3.1 The Contractor shall provide Workload Data Report, which reflects private insurance, and CMS eligible patients served under this contract.

This report shall be provided to Contracting Officer Representative and/or designee and KSU or FCRHC.

6.3.2 The Contractor shall submit Run Reports to the Emergency Department at KSU at the time services are rendered. The Contractor shall submit Run Reports to the Urgent Care Clinic at FCRHC within one (1) hour of return to FCRHC The only exception will be in cases where the Contractor performs back-to-back transports. The Run Reports for the back-to-back transports will be provided upon completion of the last run as required by EMT-P License.

6.3.3 The Contractor’s vehicle safety inspection reports shall be maintained and available upon request.

6.3.4 The Contractor shall provide a monthly staffing report detailing the number of available ALS and BLS vehicle and crew for each shift.

6.3.5 The Contractor shall provide a monthly run log, detailing crew utilized, destination, and unforeseen event or outcome. The reports shall be submitted to the Contracting Officer Representative seven days after the previous calendar month.

6.4 Billing and Collections:

6.4.1 The Contractor shall have an administrative mechanism for collection of third party resources. It shall be the Contractor’s responsibility to bill all applicable alternate resources including encouraging patients to enroll with the appropriate entitlement programs.

6.4.2 The Contractor shall not bill any IHS beneficiaries for co-payments and/or co-insurance; Public Law 102-573, Indian Health Care Improvement Act, Section 222 prohibits any provider from billing IHS PRC eligible beneficiaries.

6.5 Supplies, Equipment, and Vehicles:

6.5.1 Transportation: The Contractor shall provide vehicles that meet state/federal laws governing the licensing and certification of an emergency medical transportation vehicle as set forth in the CMS guidelines.

I.

A. Kayenta Service Unit: The Contractor shall provide one (1) ALS Medical Unit and one (1) BLS Medical Unit, Ground Transportation Service, 24 hours daily, 7 days per week including holidays.

B. Four Corners Regional Health Center: The Contractor shall provide one (1) full time Advanced Life Support (ALS) Medical Unit, Ground Transportation Services, from 8:00 AM to 8:00 PM, Monday through Friday, excluding Federal Holidays.

II. In the case of inclement weather, the decision as to whether or not an

IHS beneficiary will be transported will be discussed with the Contractor.

However; the final decision as to whether a patient transport will be ordered or cancelled remains with the IHS.

6.5.2 Patient Transportation:

6.5.2.1 Number of Patients: It is understood and agreed that only one (1) patient will be transported on a trip unless specifically authorized by the IHS. When more than one (1) patient is transported on a (ALS) trip there shall be sufficient staffing provided by the contractor.

6.5.2.2 Contractor shall not release the patient from their custody, unless custody is released to same level of care, or higher. Contractor shall take every reasonable measure to assure the well-being of the patient at their destination.

6.5.2.3 Contractor shall notify the Contracting Officer or her designee of any unusual events, including but not limited to accidents and safety problems that occur that involve IHS beneficiaries being transported under this contract. This notification shall be made within one (1) hour by telephone and, if requested, a written report of the event shall be delivered to the Contracting Officer or her designee by close of business the next working day. Failure to comply with this provision may be grounds for default.

6.5.2.4 An authorized official of the health center may, in the best interest of the patient, allow one (1) relative or concerned other to accompany him or her at no additional cost to the Government when accompaniment will not interfere with care of patient.

6.5.2.5 All Obstetrical (OB) Patients shall be transported following the criteria:

OB Patient Triage Criteria:

I. Low Risk – may be transported safely by ground crews

A. Any gestational age without evidence of active labor B. Ruptured membranes at any gestation with no labor C. Fetal demise, stable maternal vital signs D. Placenta Previa without active bleeding or active labor E. Abnormal fetal lie without active labor F. Previable fetus less than (<) 23 weeks EGA G. Multiple fetus without active labor H. Anomalous fetus without active labor

I. Mild pre-eclampsia- BP < 160/110 with proteinuria; no visual changes, headache or neurological abnormalities, no RUQ pain

J. Postpartum mother and infant after observation > 1 hour postpartum with stable mother and infant

II. High Risk – Not recommended for standard ground transport. If air transport not advisable (inclement weather) or available, referring institution will designate appropriate personnel to accompany patient en route and will assume care for patient.

A. Gestational age < 37 weeks in active labor B. Non reassuring fetal status: abnormal fetal heart rate tracing C. Maternal eclampsia or severe pre-eclampsia, maternal

HELLP syndrome D. Placental abruption E. Placenta Previa with bleeding F. Gestational or preexisting diabetes with evidence of diabetic ketoacidosis Patients deemed to be in active labor will not be sent by ground

6.5.2.6 The final decision as to whether a patient transport will be ordered or cancelled remains with the IHS.

I. Referring Facility Assessment

A. All antepartum patients referred for transport will have a reassessment of status of labor and cervical dilation a maximum of 15 minutes prior to departure from the facility. This may be accomplished by a pelvic exam or sterile speculum exam at the discretion of the referring provider.

B. All postpartum patients will be monitored for a minimum of 1 hour post-delivery. All infants will have at least one glucose determination, temperature monitoring, and oximetry on room air documented before transport.

Mothers will have documentation of any postpartum hemorrhage, uterine tone, and vital signs a maximum of 15 minutes before departure. Use of Intravenous (IV) Pitocin will be at the discretion of the referring and receiving providers but consultation will be documented by the referring provider.

II. Tocolysis – for patients with labor deemed stable for transport A. To minimize the possibility of delivery en route to the receiving facility, at the discretion of the referring and receiving providers, tocolysis with Terbutaline or Magnesium Sulfate may be used. The patient must be monitored for a minimum of 1 hour after starting the tocolysis to ensure that active labor is not progressing prior to ground transport. If contractions are reduced to > 5 minutes in frequency, and cervical effacement is stable, the option for ground transfer if no other disqualifying conditions exist, may be used.

6.6 Qualification Requirements: The Contactor shall meet the following requirements throughout the term of the contract.

6.6.1 Experience. The Contractor shall ensure that all personnel are trained and licensed to meet Arizona State EMS Guidelines and CMS Guidelines and requirements to perform emergency transportation.

6.6.2 License/Registration. All transportation personnel shall possess a current and valid state driver’s license.

6.6.3 Certifications.

6.6.3.1 The Contractor’s personnel performing services under this contract shall follow the CMS Guidelines set forth on Page 4 of the Medicare Ambulance Transports:

A BLS ambulance vehicle must be staffed by at least two individuals, one of whom must be qualified in accordance with State and/or local laws as an EMT-Basic and is legally authorized to operate all lifesaving and life-sustaining equipment on board the vehicle. An ALS ambulance vehicle must be staffed by at least two individuals, one of whom must be qualified in accordance with State and/or local laws as an EMT- Intermediate or an EMT-Paramedic.

6.6.3.2 The Contractor shall provide, to the COR, a roster that provides the employee’s name, certification number and certification expiration date. The Contractor shall furnish, to the COR, copies of renewals of any licenses and certifications for all employees providing services under this contract.

6.7 Background Checks: The contractor shall complete required SF-85 background check form identifying the character (background checks) of each employee performing services under this contract. Also, the contractor shall complete OF- 306 for compliance with the Public Law 102-573, Indian Child Welfare Protection Act. Fingerprinting will be performed by the IHS HR personnel department.

6.8 Immunizations: The contractor shall provide proof of employee immunizations for Measles, mumps, rubella, influenza, Hepatitis, and Tuberculosis or declination statements.

6.9 Vehicles: The Contractor shall provide vehicles that meet state/federal laws governing the licensing and certification of an emergency medical transportation vehicle as set forth in the CMS guidelines.

6.9.1 Ambulance Service Licensure and Registration (Arizona)

6.9.2 The Contractor shall maintain Full Vehicle Comprehensive Coverage, including Medical reimbursement at no less the $1,000,000 per occurrence, throughout the term of this contract.

6.9.3 The Contractor shall not utilize unlicensed or unchartered ambulances to provide services under this contract.

6.9.4 The Contractor shall submit copies of routine vehicle

maintenance, upon request.

6.10 Language Requirement and Cultural Awareness: The Contractor shall read, understand, speak and write English and be fluent in the Navajo Language in order to effectively communicate with patients and health care workers, and shall be culturally respectful to all clients.

6.11 Key Personnel: Advance Life Support (ALS) Base Hospital Director. The

Contractor shall have a medical director qualified for transport services, be Arizona Emergency Medical Services Regulatory Board (AMSRB) certified; shall be a physician who accepts responsibility for the quality of care provided during transport by attendants; provides standards for training and orientation of personnel; prescribes any standing orders for the provision of life support care;

provides triage, treatment, and transporting protocols to ensure that patients requiring care are transported appropriately; assists with the development and operation of an internal quality assurance mechanism that includes a review of services provided; and provides written procedures for the storage and administration of drugs. The contractor shall ensure Transport Drivers meet all Arizona Department of Health Services, Bureau of Emergency Medical Services (ADHSBEMS) regulations and comply with paragraph 6.7 Qualification Requirements.

6.12 Scheduling: When scheduling, the mode of transportation, i.e., Basic Life Support

(BLS), or ALS, will be discussed with the Contractor and determined by IHS referring physician; however, Contractor shall transport per its policies and standard industry practice. If mode of transport differs from what was agreed upon, contractor shall submit documentation to IHS Contracting Officer explaining reasons for change.

Kayenta Service Unit and Four Corners Regional Health Center Ground Transportation Services

6.13 – PERFORMANCE-BASED MATRIX

PERFORMANCE

OBJECTIVES

INDICATOR

PERFORMANCE

STANDARD

SURVEILLANCE

PLAN

CONTRACTOR

INCENTIVE

The Contractor shall provide Intra-Facility and Inter-Facility Non- Emergent and Emergent Ground Transport Medical services for Navajo Area Indian Health Service, between all points as required by Kayenta Service Unit and Four Corners Regional Health Center.

1. Response Time

2. Quality of care

3. Documentation of care

4. Providing reports

1. Contractor shall respond within the logistics response time as stated in section 6.1.7-6.1.10.

2. Adherence to standards and guidelines noted in

PBSOW.

3. 100% of patients will arrive at the provider’s facilities with no adverse outcome or patient complaint resulting from negligent care provided during transport.

4. Reports are complete and timely 100% of scheduled report time.

1. Reports from nursing staff and random sampling.

2. Review of all concerns raised by staff, patients, or receiving facilities;

ongoing PI reviews.

3. Nursing staff, Clinical Director, and COR reports.

1. Payment of monthly rate for satisfactory performance;

successful evaluation using the CPAR; and exercise option years.

2. Extension of contract option years.

B-7 GOVERNMENT FURNISHED INFORMATION, PROPERTY AND SERVICES

7.1 Information - All Government unique information related to this requirement, which is necessary for Contractor performance, will be made available to the Contractor. The Contracting Officer or designee will be the point of contact for identification of any required information to be supplied by the Government.

Federal Housing Quarters are not available for the contractor to utilize at the Kayenta Service Unit.

Federal Housing Quarters are available at FCRHC, contractor may apply and shall follow FCRHC Housing Committee policies.

B-8 APPLICABLE DOCUMENTS

8.1 Section 231 of Public Law 101-6&7, the Crime Control Act of 1990.

8.2 Section 4087 of Public Law 101-630, the Indian Child Protection and Family

Violence Act.

8.3 Public Law 104-191, Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the National Standards to Protect the Privacy and Security of Protected Health Information (PHI).

8.4 Privacy Act of 1974.

8.5 Service Unit and Health Center Policies, Procedures and Protocols.

8.6 Arizona Department of Health Services, Bureau of Emergency Medical Services, Statutes/Rules related to Ground Ambulance Regulations, Title 9, Chapter 25, Articles 9 through 12 of the Arizona Administration Code (AAC).

8.7 Arizona Department of Health Services, Article 4, EMT Certification.

8.8 Arizona Department of Health Services, Article 5, Medical Direction Protocols for

Emergency Medical Technicians.

8.9 Accessibility Specifications for Transportation Vehicles (Part 38).

8.10 Public Law 102-573, Indian Health Care Improvement Act, Section 222

8.11 42 Code of Federal Regulations (CFR) 136.11-136.21 Contract Health Care

Services.

8.12 Public Law 93-638, Indian Self-Determination Act

8.13 Medicare Benefit Policy Manual, Chapter 10-Ambulance Services

8.14 Department of Health and Human Services: Centers for Medicare & Medicaid

Services. Medicare Ambulance Transports. ICN 903194, April 2013.

B-9 Period of Performance: The tentative effective date of this contract is from May 1, 2016 through April 30, 2017, one (1) base contract year and two (2) one year options period.

If the Government exercises its option pursuant to 52.217-9 Option to Extend the term of the Contract, the period of performance will be extended in accordance with the following schedule.

YEAR OPTION PERIODS

FIRST YEAR OPTION: May 01, 2017 through April 30, 2018 SECOND YEAR OPTION: May 01, 2018 through April 30, 2019

The Government Guarantees a minimum 12-month contract under this solicitation pursuant to the Inspection Clauses. However, options for extension periods are not guaranteed if services are no longer required by the Kayenta Service Unit and Four Corners Regional Health Center.

The Contractor hereby releases and holds harmless the Navajo Area Indian Health Service and Kayenta Service Unit and Four Corners Regional Health Center, and all of their respective officers, employees and agents, from any and all liability legal proceedings & costs including attorneys’ fees, arising from not extending contact for either the first or second year option periods.

B-10 CONTRACTING OFFICER RESPONSIBILITY: Authority to negotiate changes in term, conditions, or amounts cited in this contract is reserved for the Contracting

Officer.

B-11 CONTRACTING OFFICER’S REPRESENTATIVE (COR):

Charles Atcitty, Health Systems Administrator, KSU, is designated COR for this contract.

Laverne Holly, Director of Nursing, FCRHC, will be the designee for FCRHC.

Mr. Atcitty and Ms. Holly will be responsible for the following:

1. Monitoring the Contractor’s technical progress, including surveillance and assessment of performance and recommending to the Contracting Officer changes in requirement;

2. Performing technical evaluation as required;

3. Performing technical inspections and acceptance required by this contract; and

4. Assisting the Contractor in the resolution of problems encountered in performance.

B-12 OFFICIAL AUTHORIZED TO PLACE ORDERS AGAINST THIS CONTRACT

12.1 The authorized ordering officials, as listed below, shall represent the Government for the purpose of issuing and signing Individual Task Orders under this agreement.

12.2 The authority to obligate the Government shall be in accordance with the acquisition delegation of his/her authority.

12.3 The authorized individuals listed under Navajo Area Indian Health Service

(NAIHS) shall issue task order ONLY in the absence of the Service Unit Procurement Staff.

NAIHS NAME LIMITATION

Division of Acquisition Management & Contracts Window Rock, AZ 86515 Phone: 928-871-1386 Fax: 928-871-1447

Maxine Dineyazhe, Contract Specialist Priscilla Duncan, Contract Specialist Margaret Shirley-Damon, Contract Specialist Thomasina Willie, Business Specialist

$500,000

Unlimited

Unlimited

$150,000

Kayenta Health Center Kayenta, AZ Phone: 928-697-4293 Fax: 928-697-4078

Kerri Gilmore, Contract Specialist

$500,000

Inscription House Health Center Shonto, AZ Phone: 928-672-3000 Fax: 928-672-3112

See Kayenta above

Dennehotso Health Center Dennehotso, AZ Phone: 928-658-3377 Fax: 928-697-4078

See Kayenta above

Northern Navajo Medical

Shiprock, NM Phone: 505-368-6089 Fax: 505-368-6362

Linda Conn, Contract Specialist

$500,000

Four Corners Regional Health

Red Mesa, AZ Phone: 928-656-5000 Fax: 928-656-5162

See NNMC above

B-13 INVOICE SUBMISSION:

a. The Contractor shall submit an original invoice to:

Kayenta Service Unit Kayenta Financial Management P.O. Box 1276 Kayenta, AZ. 86033

Four Corners Regional Health Center HCR 6100 Box 30 Teecnospos, AZ 86514

b. A proper invoice shall include:

1. Contractor’s Name

2. EIN Number;

3. DUNS #

4. Contract number, and purchase order number;

5. Period of performance;

6. And, remit to address.

B-14 CONTRACTOR’S REPRESENTATIVE:

Designated Contractor’s Representative, whom we may contact for prompt Contract

Administration:

Name:____________________________ Title:______________________________

ADDRESS:_____________________________________________________________

TELEPHONE:______________________

E-MAIL ADDRESS:______________________________________

B-15 CONTRACTOR’S RESPONSIBILITIES:

Contractors are required to comply with applicable Federal and State worker’s compensation and occupational disease statues.

Contractors shall also be required to maintain automobile liability insurance written on the comprehensive form of policy. The policy shall be required to provide for bodily injury and property damage liability covering the operation of all automobiles used in connection with performance of the contract. Policies covering automobile operated in the United States minimum requirements or be in the amount of at least $200,000 per person and $500,000 per occurrence for bodily injury and $20,000 per occurrence for property damage, whenever is greater, the amount of liability coverage on other policies shall be commensurate with any legal requirements of the locality and sufficient to meet normal and customary claims.

B-16 52.237-7 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE (JAN 1997)

a. It is expressly agreed and understood that this is a nonpersonal services contract, as defined in Federal Acquisition Regulation (FAR) 37.101, under which the professional services rendered by the Contractor are rendered in its capacity as an independent contractor. The government may evaluate the quality of professional and administrative services provided, but retains no control over professional aspects of services rendered, including by example, the contractor’s professional judgment. The Contractor shall be solely liable and expressly agrees to indemnify the Government with respect to any liability producing acts or omissions by it or by its employees or agents. The contractor shall maintain during the term of this contract liability insurance issued by a responsible insurance carrier of not less than the following amount(s) per specialty per occurrences: $1,000,000.

b. An apparently successful Offeror, upon request by the Contracting Officer, shall furnish prior to contract award evidence of its insurability concerning the medical liability insurance required by paragraph (a) of this clause.

c. Liability insurance may be on either an occurrences basis or on a claims-made basis. If the policy is on a claims-made basis, an extended reporting endorsement (tail) for a period of not less than 3 years after the end of the contract term must also be provided.

d. Evidence of insurance documenting the required coverage for each provider who will perform under this contract shall be provided to the Contracting Officer prior to the commencement of service under this contract. If the insurance is on a claims-made basis and evidence of an extended reporting endorsement is not provided prior to the commencement of services, evidence of such endorsement shall be provided to the Contracting Officer prior to the expiration of this contract. Final payment under this contract shall be withheld until evidence of the extended reporting endorsement is provided to the Contracting Officer.

e. This policy evidencing required insurance shall also contain an endorsement to the effect that any cancellation or material change adversely affecting the Government’s interest shall not be effective until 30 days after the insurer or the Contractor gives written notice to the Contracting Officer. If, during the performance period of the contract the Contractor changes insurance providers, the Contractor must provide evidence that the Government will be indemnified to the limits specified in paragraph

(a) of this clause, for the entire period of the contract, either under the new policy, or a combination of old and new policies.

f. The Contractor shall insert the substance of this clause, including this paragraph (f), in all subcontracts under this contract for services and shall require such subcontractors to provide evidence of and maintain insurance in accordance with paragraph (a) of this clause. At least 5 days before the commencement of work by any subcontractor, the Contractor shall furnish to the Contracting Officer evidence of such insurance.

g. Indemnification/Insurance: If the acuity of the patient requires the contractor’s staff to assist and work with IHS staff at the patient’s bedside, the contractor shall provide liability insurance coverage for their staff while working in the IHS facility, and shall indemnify the NAIHS facility and staff from all claims resulting from the performance of contractor’s employees.

h. Liability: Contractor shall indemnify and hold the IHS harmless against any and all liability, loss, expense, fee, claim, suit, judgment or damage on account of (i) any injury to the person or property of any registrant, guest, invitee, employee, agent or representative of Contractor for bodily injury, including death, property damage, personal injury an discrimination arising out of the willful or negligent acts or omissions of Contractor, its agents, Contractors, employees, agents and representatives, or (ii) any breach of the promises, representations and warranties of Contractor made herein. The IHS shall not be responsible for any property damage caused by Contractor.

B-17 52.204-9 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR PERSONNEL (JAN

2011)

a. The Contractor shall comply with agency personal identity verification procedures identified in the contract that implement Homeland Security Presidential Directive-12

(HSPD-12), Office of Management and Budget (OMB) guidance M-05-24 and Federal

Information Processing Standards Publication (FIPS PUB) Number 201.

b. The Contractor shall account for all forms of Government-provided identification issued to the Contractor employees in connection with performance under this contract.

The Contractor shall return such identification to the issuing agency at the earliest of any of the following, unless otherwise determined by the Government:

(1) When no longer needed for contract performance.

(2) Upon completion of the Contractor employee’s employment.

(3) Upon contract completion or termination.

c. The Contracting Officer may delay final payment under a contract if the Contractor fails to comply with these requirements.

d. The Contractor shall insert the substance of this clause, including this paragraph (d), in all subcontracts when the subcontractor’s employees are required to have routine physical access to a Federally-controlled facility and/or routine access to a Federally-controlled information system. It shall be the responsibility of the prime Contractor to return such identification to the issuing agency in accordance with the terms set forth in paragraph (b) of this section, unless otherwise approved in writing by the Contracting

Officer.

PART C – CONTRACT CLAUSES

C-1 352.224-70 PRIVACY ACT (DECEMBER 2015)

This contract requires the Contractor to perform one or more of the following: (a) design; (b) develop; or (c) operate a Federal agency system of records to accomplish an agency function in accordance with the Privacy Act of 1974 (Act) (5 U.S.C. 552a(m)(1)) and applicable agency regulations.

The term system of records means a group of any records under the control of any agency from which…