Emergency_Department_Questions_and_Responses.docx

Emergency Department Questions and Responses – 17-236-SOL-00010

1) In the event of a malpractice claim against a contractor’s provider, would the contractor be subject to tribunal jurisdiction/arbitration? We did not find any evidence of this indicated in the RFP, but we wanted to confirm as this can impact our insurance.

Response: This is a question for the Contractor’s General Counsel and Insurance Company.

2) What is the likelihood that additional locations will be added to the resulting contract after award?

Response: The Government has added Fort Yates to this solicitation. The Government is unable at this time to predict the addition of future locations.

3) Page 5, 1.3.2, Define the term “Contractor in this instance. Are you referring to the contractor as the contract awardee? Or are you referring to contractor as the contracted physician?

Response: The “Contractor” in this instance is the contract awardee and any staff they utilize to perform the contract.

4) Page 5, 1.3.3, Define the term “Contractor in this instance. Are you referring to the contractor as the contract awardee? Or are you referring to contractor as the contracted physician?

Response: See previous response.

5) Page 9, 2.5.5, Who is capable of determining the operational performance of the ED? Will this be someone employed by the contractor? Or will it be a contracted physician?

Response: The operational performance will be determined by the Federal ED Director, Clinical Director, COR and Area CMO with the Governing Body having ultimate responsibility for safe, quality care and operational performance of the ED. The contractor(s) will be required to comply with the terms and conditions of the awarded contract(s).

6) Page 12, 3.3, Will you consider awarding this contract to a vendor who can only staff under the Federally managed scenario?

Response: Yes, the Government will consider awarding IDIQs for just the staffing requirement as defined in sections 3.3.2. and 3.4.

7) Page 14, 4.4, Do you mean contractor as in contracted physician? Or contractor as in the awardee?

Response: The “Contractor” in this instance is the contract awardee and any staff they utilize to perform the contract.

8) Page 21, 5.1.9.3, Will OSHA training of contract physicians still be required of the contract awardee under the Federally managed scenario?

Response: Yes

9) Page 22, 5.5, Will contractors that utilize physicians on a 1099 basis still be required to certify that the requirements from 5.5.1 through 5.5.5 are provided?

Response: Contractor must comply with the RFP requirements.

10) Page 23, 5.8, Who will be considered Key Personnel?

Response: See response to question number 66 below.

11) Page 30, 7.5.4.1, In this instance, does contractor refer to the contract awardee or to the contract providers?

Response: The “Contractor” in this instance is the contract awardee and any staff they utilize to perform the contract.

12) Page 34, 8.2.1, What constitutes supporting documentation?

Response: Supporting documentation is any evidence that can be used to verify the services have been rendered. Please refer 8.2.1.1 – 8.2.1.8 for what must be included with invoices. All such items may be considered supporting documentation.

13) Page 59, I.15, What is the Federal Executive Schedule Level II threshold?

Response: The Federal Executive Schedule Level II threshold is $187,000.

14) Page 69 – Does past performance have to be within 3 years or 7 years?

Response: Three (3) years.

15) By requiring resumes/certifications of ED personnel at the time of submission, the Government appears to be aiming this solicitation towards locums/temporary staffing companies as long-term healthcare staffing solutions companies do not typically have Specialty Physician candidates “on the shelf” for submission with proposals. By refocusing the solicitation towards more permanent staffing solutions, the Government can typically receive greater staffing stability and a more cost-effective solution. Would the Government consider removing the requirement for offerors to submit resumes and certifications at the time of proposal submission? If not, will the Government consider extending the due date of the solicitation to allow non-locums firms greater time to identify the required candidates? (pg 67, L.1.1. Technical Excellence)

Response: See proposed response to question number 66 below.

16) Would the Government consider holding a bidder’s conference for interested vendors to allow industry to have a more thorough understanding of the Government’s “pressure points” to allow for more focused technical solutions to your needs?

Response: The Government determined that a bidder’s conference was not necessary prior to posting the RFP.

17) Can you let me know if you will be awarding BPA’s to some companies that are interested in the staffing piece for physicians vs managing the whole ED.

Response: No, the Government will not award BPAs, the Government intends to issue an IDIQ contract(s). Yes, the Government will consider issuing an IDIQ contract(s) for just the staffing requirement as defined in sections 3.3.2. and 3.4.

18) I am hoping to find out if there is an incumbent contractor currently performing these services or if this is a new requirement. If there is an incumbent, could you please provide the contract number?

Response: Yes, there is an incumbent who is responsible for managing and staffing three EDs.

19) Can you please tell me if this is a new requirement? If not, who is the incumbent, and what is the contract number?

Response: This is a follow-on requirement. See the preceding response.

20) Page 8, 1.3, Why is the Great Plains request for Emergency Department Services being re-solicited?

Response: IHS determined that this approach is in the Government’s best interests.

21) Page 8, 1.3.1, Can IHS provide an overview of the ED including types of equipment available and what it means by “support services permit”? What is lacking from a traditional Emergency Department?

Response:

· Fort Yates Hospital - No CT/MRI or Ultrasound services on site. Fort Yates ED does meet ND State Trauma Level IV designation and all equipment and support services required for said designation.

· Omaha/Winnebago Hospital - Welch Allen ProPaQ Vital Sign Monitor, G.E EKG Machine, Plum IV Pumps, Philip Fetal Heart Monitor/Tocometer, Hill Rom Baby Warmer, G.E. Venue S0 Port U?S, Scaletronix Scale, Ped/Infant Scales, Lithotomy Bed, Temporal Thermometer, Wall Air/O2/Suction, Gay Mar Meditherm warm/cool blanket warmer and Cabinet, Fax/Copier/Printer/scanner, Data Ray Printers, Ultra Violet Exam Light, Cast cutter, Ring Cutter, Vein Finder, Doppler, Pyxis, Otoscope, Ophthalmoscope, Accu/check, Phone System.

· Rosebud Hospital - The ED has 5 bays, 1 trauma room, 1 isolation room, 1 orthopedics room and one labor/OB room. Nurse station and doctor area are collocated. Tribally operated EMS, flight team contracted and stationed at Rosebud. CT and xray available 24/7. U/s may be available. Crash carts, RSI, Glidescope, ventilator, cardiac monitors, warmers, OB kit and OB/Labor room, Peds crash cart and Braslow, ultrasound in ED.

· Pine Ridge Hospital - Crash Cart, RSI Kit, Video Laryngoscope, Alternative airway, Ventilator, BiPAP, ETCO2 Detector, Defibrillator, Cardiac Monitor, IO Needle, IV Pump, Chest Tube Kit, Drainage System, Needle Thoracentesis Kit, Patient Warming Device, Fluid Warming Device, Blanket Warmer. Emergency OB Kit, PEDS Broselow Tape/Cart, Blood Tubing, IV Pressure Bag, and Ultrasound.

22) Page 8,1.3.2, Can we have copies of the bylaws outlined within this section at least to assess their impact on provision of services and how their requirements might differ from the PWS?

Response: Medical Staff Bylaws will be provided to the winning contractor(s) when a task order is issued.

23) Page 9, 1.3.6, How long does the mandated security clearance take?

Response: If the contractor’s candidate submits a complete package and has clear fingerprint images, typical pre-clearance to begin work can usually be provided on an average of 72 hours. If the candidate has issues that need to be adjudicated, the time to provide pre-clearance is contingent upon when supporting documents are received and if they meet the requirements for favorable adjudication. Generally, if all documents are obtained as requested, it is a 5-business day turn around. In some cases, we are able to do this more quickly, and in others it takes longer. It depends on the number of issues and the responsiveness of the candidate to all of the requested documentation. All Contractor’s employees must be cleared prior to having access government facilities.

24) Page 9, 2.1, What is the expected timeframe to complete recruitment of staff to meet requirement one?

Response: The government expects the Contactor to staff the EDs as soon as qualified staff are cleared, credentialed, and privileged. The Contractor should discuss in its technical proposal based on the option selected, staffing, or staffing and ED management, how soon you could have a pool of candidates ready to begin work (for each facility selected). The government anticipates for ED management option, approximately 60-90 days transition, and staffing only, approximately 30-45 days from effective task order date.

25) Page 9, 2.2.2, What is the standard length of time to credential a provider at each Service Unit?

Response: Upon receipt of all required documentation, it typically takes four to six weeks for verification of credentials, background checks, fingerprinting and Medical Staff and Governing Body approval.

26) Page 9, 2.5.4, Section 2.5.4 says the Contractor will have 14 calendar days to fill vacancies for providers and 7 days for support staff. Does that mean those are the requirements to fill an otherwise unfilled shift? What happens if we are unable to fill the shift?

Response:

· Section 2.5.4. states the Contractor shall provide full staffing coverage at all times and shall provide suitable short-term coverage in the event of a vacancy. Short-term coverage however is limited to 14 calendar days to fill vacancies for providers and 7 days for support staff.

· If the Contractor is unable to fill a shift, either through short-term coverage or filling the position permanently, RFP sections 8.4 - Performance Deductions and 7.5.4.4. – Measure: Patient Access provides the requirements and disincentive for failure for the Contractor to provide health care provider(s) in accordance with the operating hours and GPA clinical schedule. Other contractual remedies may be used depending on the frequency and severity of the failure/deficiency.

27) Page 10, 2.5.1, What tasks does IHS want to see a timeline for?

Response: The Contractor shall include a complete project plan in the technical proposal for all required tasks.

28) Page 11, 2.5.5 What type of reports are currently being ran on a daily, weekly and monthly basis?

Response: Monthly progress reports. Contractor to recommend frequency of individual provider performance evaluations and frequency of ED operations dashboard reporting. This includes how feedback will be communicated to the MEC/GB, individual providers, and IHS about this feedback, as well as what actions the Contractor will take to resolve issues, concerns and complaints.

29) Page 11, 2.5.6, Does the vendor need to be TJC accredited?

Response: Yes

30) Page 11, 2.5.6, This section indicates the Contractor will put measures in place to ensure providers and support staff are in compliance with CMS Conditions of Participation and TJC accreditation standards. Those are very broad requirements that are not all the responsibility of a contractor. Which specific COPs and TJC standards is IHS including here?

Response: Under the 3.3.1. Contractor Managed and Staffed scenario, the contractor is responsible for all CoPs and TJC standards normally expected to be the responsibility of a ED Director and ED Nurse Supervisor and staff positions (ED Physicians, PA, APN, RN, and MSA). Under the 3.3.2., Federally Managed and Staffed scenario, the contractor is responsible for all CoPs and TJC standards normally expected to be the responsibility of ED Physicians, PAs, APNs, RNs, and MSAs.

31) Page 11, 2.5.4, Will the peer review be limited to chart reviews?

Response: Peer review will be defined by the facilities medical staff bylaws but includes FPPE, OPPE, morbidity and mortality, provider profiles, peer reviews and chart reviews.

32) Page 11, 2.5.7, What is the current status of each Service Unit with CMS?

Response: Fort Yates Hospital has deemed status and is CMS accredited. Omaha/Winnebago Hospital - currently only certified for Ambulatory Clinic Services. Will be submitting 855A Application to CMS for survey of entire hospital after May 25, 2017. Rosebud Hospital is under a Systems Improvement Agreement with CMS until July 30, 2017. Pine Ridge Hospital is under a Systems Improvement Agreement with CMS until July 30, 2017.

33) Page 11, 2.6, If IHS review does not imply approval, and the contractor supervisor is responsible for approval, why does IHS wait until a submitted invoice is approved?

Response: The IHS review ensures federal contract oversight that the hours claimed were worked. IHS cannot supervise the contractor employees and so approving time cards is the Contractor’s responsibility.

34) Page 11, 2.6, When the IHS signs the Health Information Management Provider Clearance Form does that mean the chart is clear of errors and that the provider’s time will be paid?

Response: At that time of review by HIM, if there are indications that charts are current and correct, timesheets will be signed.

35) Page 11, 3.1, Who does the ED Director, ED Nurse Supervisor report to within IHS?

Response: Federal staff do not supervise contactor’s employees, however, on a day to day basis, the following scenarios are applicable and the RFP has been modified to reflect the scenarios (3.3.1. and 3.3.2.).

· Under the 3.3.1. Contractor Managed and Staffed scenario, the Contractor’s ED Director and ED Nurse Supervisor, HCPs and services are monitored by the Federal Clinical Director, Chief Executive Officer and Contracting Officer’s Representative (COR) with the Governing Body having ultimately responsible for safe, quality care and operational performance of the ED.

· Under the 3.3.2. Federally Managed and Staffed scenario the Contractor’s HCPs and services are monitored by the Federal ED Director, ED Nurse Supervisor, Clinical Director, Chief Executive Officer and Contracting Officer’s Representative (COR) with the Governing Body having ultimately responsible for safe, quality care and operational performance of the ED.

· Under both of the scenarios, the COR appointed by the CO takes necessary action to ensure the Contractor performs in accordance with and adheres to the specifications contained in the contract and to protect the interest of the Government. The COR shall report to the CO promptly any indication of non-compliance in order that appropriate action can be taken.

36) Page 12, 3.2, For those with qualifying experience, will IHS accept providers from any of the 24 ABMS Member Boards?

Response: Yes, with the appropriate certifications, ATLS, ACLS, PALS and ED experience as outlined in the solicitation and graduation from an accredited residency program.

37) Page 12, 3.3, PWS indicates that the Contractor will perform the services for either or both of the scenarios which include Contractor managed and staffed ED or Federally managed ED. How does a Contractor perform services under both scenarios? They seem to be mutually exclusive.

Response: Page 13, 3.6, there are multiple places of performance as indicated. Therefore, a contractor might provide “Contractor Managed and Staffed” services at one place of performance and at another site that is “Federally Managed” provide just staffing services.

38) Page 12, 3.3.2, With ED Staff under IHS medical direction, will IHS assume medical liability? Will IHS indemnify the vendor? If not, what is the reasoning?

Response: No, the Government will not assume medical liability or indemnify the vendor. The RFP has been modified to remove the reference to “medical direction”. Under the 3.3.2. Federally Managed and Staffed scenario, the Contractor’s HCPs and services are monitored by the Federal ED Director, ED Nurse Supervisor, Clinical Director, Chief Executive Officer and Contracting Officer’s Representative (COR) with the Governing Body having ultimate responsibility for safe, quality care and operational performance of the ED. The COR appointed by the CO takes necessary action to ensure the Contractor performs in accordance with and adheres to the the contract requirements and to protect the Government’s interests. The COR shall report to the CO promptly any indication of non-compliance so appropriate action can be taken.

39) Page 12, 3.4, Does IHS view this as a long term or short term contract?

Response: The contract(s) will have a one-year base period with four option years. Each task order will have a specified period of performance based on the needs of the facility at the time. IHS' intent is to establish long term contract relationships with the vendor and the vendor’s employees to ensure continuous, uninterrupted support with reliable staff that build trust and relationships with the tribal members serviced by the hospital.

40) Page 12, 3.4, Section 3.4 indicates the Government will continue to recruit for positions that are the subject of this RFP. How does the Government propose that the Contractor determine its pricing to cover fixed overhead costs when the volume is indeterminate and subject to drastic change?

Response: Per the RFP, IHS requested burdened labor rates to address this type of issue.

41) Page 13, 3.6, What type of back up services are available at each Service Unit? (Surgery, Anesthesia, OB, Trauma Team, etc.)

Response:

· All GPA sites will have access to Avera eEmergency by the end of June, 2017, with additional support for telespecialisty referrals by the end of 2017.

· Fort Yates Hospital - Sanford Bismarck; St. Alexius; both 70 miles away for Fort Yates Hospital.

· Omaha/Winnebago Hospital - Mercy Medical Center, Mercy Cardiology, Mercy Stroke Center, Unity Point Medical Center, Unity Point OB, CNOS Orthopedics Group, Siouxland Orthopedics, Siouxland Paramedics, Midwest Paramedic and Air Flight, Mercy Air Ambulance, Life Net Paramedical and Air Ambulance, Winnebago EMS and Omaha Tribal EMS, Whirling Thunder Diabetic Education, Children’s Hospital Omaha, UNMC Trauma Center and UNMC Physician Consultation

· Pine Ridge Hospital - Surgery, Anesthesia, OB, Hospitalist, Respiratory Therapy and Pediatrics.

· Rosebud Hospital - Current staff include 1 general surgeon, 1 CRNA, 1 OB/GYN, 2 midwives, FP/IM. Currently Pediatrics is 2 weeks on/2 weeks off. Adult and pediatric inpatient services. Outpatient BH services. Purchase referral care/Contract Health for referrals outside of facility if meet eligibility requirements.

42) Pages 13-14, 3.7.2 and 3.7.3, Rosebud indicates “0” for ED Director and Pine Ridge doesn’t list a quantity for ED Director or Nurse Supervisor. That doesn’t seem to be consistent with the pricing requests? Does Section 3.7.2 and 3.7.3 indicate IHS’ true intentions with regards to Contractor management at those two facilities?

Response: Pricing requests are consistent; the Government is requesting all Contractors use the Attachment B – Pricing Template as the basis for the Government’s price evaluation. Also see L.1.5, Element 1.

IHS’ intentions with regards to Contractor management facilities are defined as stated: Page 13, 3.7, “Current staffing plans for each place of performance may vary by time of award and during the contract performance periods based upon the options described in paragraph 3.6 of this PWS.”

43) Page 14, 3.7.3, Does Pine Ridge have a director in place since they don’t have one marked? Does Pine Ridge have a RN supervisor in place since they don’t have one marked? Pine Ridge has an annual patient volume of 22,778/year but has the least amount of RN’s and MSA’s in their staffing plan. Please explain why.

Response: Page 14, 3.7.3, Staffing plan indicates that Pine Ridge plans to be in the “Federally Managed” option as defined on Page 12, 3.3.2 which explains why the table does not reflect the ED Director or Nurse Supervisor positions. This is also explained by what is stated on Page 13, 3.7, “Current staffing plans for each place of performance may vary by time of award and during the contract performance periods based upon the options described in paragraph 3.6 of this PWS.”

As to Pine Ridge having an annual patient volume of 22,778/year but has the least amount of RN’s and MSA’s in their staffing plan, federal RN’s and MSA’s will also staff the ED as explained on Page 12, 3.5., “The Government is continuing to recruit to fill positions for the Emergency Departments within the GPA.”

44) Page 14, 4.3, How do the contract providers interact with the governing board? Do they have to present their privileges? Does the governing board have a probation period before privileges are granted? What does the peer review process consist of?

Response: Governing Board is the entity that grants privileges. Privileges are not presented by the individual contractors to the governing board but in the form of a credentialing file that is compiled. MEC/Med staff or CMO/CD will present applicants recommended for approval for the medical staff to the Governing Body. There is a 1 year provisional period/probationary period for credential and privileges. Peer review will be defined by the facilities medical staff bylaws but includes Focused Professional Practice Evaluation (FPPE), Ongoing Professional Practice Evaluation (OPPE), morbidity and mortality, provider profiles, and chart reviews.

45) Page 14, 4.4, Orientation Policy, how long is the hospital orientation per Service Unit?

Response: 2-5 days depending on the service unit.

46) Page 19, 5.1.2.2, Can ABEM or AOBEM provider’s board certification count for the ATLS requirement?

Response: For all places of performance listed in the RFP, except for Pine Ridge Hospital, if board certified in Emergency Medicine, this will count for ATLS. If board eligible or certification in any other specialty, ATLS is a requirement.

47) Page 19, 5.1.3, Is the credentialing process the same between the Service Units? Is there a standard privileging application the three Service Units utilize should we want to cross privilege staff? OR do providers have to apply three times to work at the hospitals listed?

Response: At this time, there is no standard process across the Great Plains Area, or a centralized credentialing verification office at the Area-level. Providers will need to be credentialed and privileged at each hospital. IHS is looking at ways to streamline credentialing but each service unit has specific applications that must be completed.

48) Page 21, 5.1.10, Section 5.1.10 indicates that the Contractor shall have or obtain appropriate NPI, et al. Why would the Contracting Company require NPI? Should this actually refer to the Contractor HCPs? Likewise, 5.1.11 should actually say that the Contractor shall provide a copy of current DEA for its providers?

Response: The Contractor’s HCPs shall have or obtain appropriate NPI and, if pertinent, the Taxonomy Code confirmation notice issued by the Centers for Medicare and Medicaid Services (CMS) National Plan and Provider Enumeration System (NPPES) be provided to the Contracting Officer with the proposal. The Contractor shall provide a copy of current DEA for each HCP.

49) Page 23, 5.4, This paragraph seems to indicate that Contractors and Health Care Provider’s “cannot provide direction and control of government employees (outside a clinical context)”. Is it the Government’s position that Contractors and their HCPs can provide direction and control of government employees in a clinical setting (i.e., manage government employees work while performing services in the ED)?

Response: Contractors cannot provide supervisory function of government employees but could provide direction in a clinical setting. If there are personnel issues, conduct issues or any other complaints, this need to brought to the federal employee’s supervisor.

50) Page 23, 5.5, The second sentence indicates that the Contractor shall provide or certify that workers compensation insurance, income tax withholding and social security payments are provided to all Contractor staff providing services under a resultant contract. Is the Government indicating that all staff should be W-2 employees of the Contractor and none can be independent contractors (ICs)? Many physicians are treated as ICs and are therefore not subject to Contractor workers’ compensation insurance, or income tax/social security payments.

Response: Contractors must comply with the RFP requirements.

51) Page 24, 5.8.1, What positions are considered key personnel?

Response: See response to question number 66.

52) Page 18, 5., What are the qualifications for Midlevels, RN’s, MSA’s, ED Director, RN Supervisor? We don’t see them listed under the qualifications section (5).

Response: Page 19, 5.1.2.3. – 5.1.2.7, Added to the RFP to include qualifications for Nurse Practitioners, Advanced Practice Nurses, Physician Assistants, and Medical Technicians/Assistants.

53) Page 25, 7.3, What EHR program does each Service Unit use?

Response: Contractors awarded a contract will be required to use the current EHR, and not install or use a separate EHR system as part of this contract. The model for the RPMS EHR is the Veterans Health Administration (VHA) electronic medical record, the Computerized Patient Record System (CPRS).

54) Page 27, 7.4.2.4, Can the government explain in what context contractor physician(s) working under this contract shall be present on time for any scheduled clinics? What clinics is the government referring to?

Response: Page 27, 7.4.2.4, updated as indicated in the amendment: “Contractor physician(s) shall be present on time for any scheduled shift as documented by physical presence in the ED at the scheduled start time.”

55) Page 29, 7.4.3.4, Please confirm the IHS EHR system allows for 90% direct patient care as stated. Typically, this percentage is much lower.

Response: IHS clarifies that the EHR allows for all elements of a visit to be entered from measurements/vitals, education, pharmacy/lab/x-ray order entry, care plan updates and provider note documentation. Documentation into the EHR is considered part of direct patient care. Therefore, the Government has moved section 7.3.3.4 Specialized EHR Documentation Procedures from Administrative to Direct Patient Care (7.4.2.10.).

56) Page 30, 7.5.4.1, Does 100% peer review refer to reviewing every single chart generated by all HCP’s (including physicians, APNs and RNs) during their first 30 days? That seems like an excessive amount of time required on chart review given 15 or so charts per day.

Response: Section 7.5.4.1 has been updated to: “In addition, the contractor will conduct peer review on the first 30-40 charts for FPPE for the first 30 days of being assigned to the location and then a random 10 chart per month OPPE. Trigger chart reviews will be part of an ongoing monitoring of high risk charts and patient care.”

57) Page 30, 7.5.4.1, Please include a copy of the OPPE form IHS would like completed by the contractor.

Response: The Government added the OPPE form to the FBO site.

58) Page 30, 7.5.4.1, Under “frequency” the government seems to ask if the potential triggers for focused review are relevant. Is the government asking the offeror to comment on that?

Response: Page 30, 7.5.4.1, updated as indicated in the amendment. This statement has been removed: “POTENTIAL TRIGGERS FOR FOCUSED REVIEW (PLEASE INDICATE IF RELEVANT).”

59) Page 31, 7.5.4.1, Are OPPE’s applicable to nursing and admin positions?

Response: OPPE includes components of professionalism, interpersonal and communication skills, and system based practice. There are documentation and accuracy chart reviews completed on nursing personnel. Nursing administrator is reviewed using that tool if they do shift work, but are largely monitored by facility meeting engagement and participation in improvement activities

60) Page 31, 7.5.4.1, Disincentive includes deductions. It seems extreme to claim a 25% deduction as staff are orienting and getting acclimated during their first “30 days of being assigned to the location”. Will IHS reconsider broadening the standard beyond the first 30 days?

Response: Yes. The Government had updated the RFP as follows.

· Section 7.5.4.1. has changed the following text: “In addition, the contractor will conduct 100% peer Review on new HCP’s for the first 30 days of being assigned to the location.” to “In addition, the contractor will conduct peer review on the first 30-40 charts for FPPE for the first 30 days of being assigned to the location and then a random 10 chart per month OPPE. Trigger chart reviews will be part of an ongoing monitoring of high risk charts and patient care”. Contractor’s compliance with this on a daily basis will assist in the Contractor’s staff being oriented and getting acclimated during their first “30 days of being assigned to the location”.

· Section 8.4.1. has been updated to reduce the reduction from 25% to 15%. The text “reduction of monthly invoice” has been deleted and replaced with the text “reduction of funds invoiced for the actual Contractor’s employee(s) who fails to meet the Acceptable Quality Level on any performance measure that references a deduction as a disincentive”.

· It should be noted that of the 9 performance measures only 2 contain a performance deduction as one of the choices, 7.5.7.1. Measure – Provider Quality Performance and 7.5.4.4. Measure – Patient Access.

· The Contractor should submit a QASP which addresses any additional concerns.

61) Page 32, 7.5.4.7, Please provide a breakout of the mandatory training expected by specialty. Is training completed in orientation?

Response: All required mandatory training is reviewed at orientation and policies and procedures are reviewed.

62) Page 33, 7.5.4.9, Determining if a contractor physician is 100% compliant with EMTALA standards is a subjective judgment based on interpretations of the charts and circumstances of a specific situation. Who makes the final judgment in that regard?

Response: EMTALA violations will be reviewed by risk management at the facility and reviewed by senior medical staff including but not limited to the federal ED Director, Clinical Director, and Area CMO. The Governing Body is ultimately responsible for safe and quality care and will have final judgment within IHS. CMS will determine if EMTALA violation has occurred.

63) Page 8, 1.3.1, Respiratory Therapists are not listed, does the Service Unit(s) provide these services? If not, would they consider adding them to the solicitation since they are a key service to the ED?

Response: Respiratory Therapists have been added to the RFP labor rate category.

64) Page 33, 7.5.4.8 and 7.5.4.9, Should there be a discrepancy on what is a Privacy, Confidentiality, HIPPA or EMTALA violation, who is makes the final verdict?

Response: Privacy, Confidentiality, HIPAA or EMTALA violations will be reviewed by risk management at facility and reviewed by senior medical staff including but not limited to the federal ED Director, Clinical Director, Area CMO and the IHS Privacy Officer. The Governing Body with ultimately responsible for safe and quality care and will make the final judgment within IHS. CMS will determine if EMTALA violation has occurred.

65) Page 36, 8.7.1, Will there ever be a time the reduction would be discounted below 25%.

Response:

· Section 8.4.1. has been updated to reduce the reduction from 25% to 15%. The text “reduction of monthly invoice” has been deleted and replaced with the text “reduction of funds invoiced for the actual Contractor’s employee(s) who fails to meet the Acceptable Quality Level on any performance measure that references a deduction as a disincentive”.

· It should be noted that of the 9 performance measures only 2 contain a performance deduction as one of the choices, 7.5.7.1. Measure – Provider Quality Performance and 7.5.4.4. Measure – Patient Access.

· Also, see the response to Question 60 above.

66) Page 41, G4, Section G.4 indicates that basically every person working on the contract will be considered Key Personnel. Given the natural attrition in staffing a large group that seems to be an onerous burden. Did the government intend on classifying all personnel working under this contract as key personnel?

Response: No, the Government did not intend on classifying all personnel working under this contract as key personnel? The Government understands the natural attrition in staffing a large group will be an onerous burden. Understanding that, here is the Government’s logic as to who should be identified as key personnel.

· The Government must evaluate doing the technical evaluation of the Offeror’s plan to establish and maintain an adequate pool of credentialed and privileged physicians, medical staff, and other contractor personnel necessary to successfully meet the requirement of the contract without any performance lapse. This requires the Contractor to provide information on candidate’s specialized training and expertise, significant private practice clinical experience that will exemplify contract staff’s knowledge, judgment, adaptability, clinical skills, technical facility and personal characteristics to carry out the entire scope of services required.

· Section 2.1. requires the Contractor to identify a point of contact and alternate point of contact (POC) or these responsibilities listed. These POCs identified by the Contractor will be considered as key personnel. An individual may be assigned to more than one of the areas of responsibilities.

· Coordination of credentialing and privileging application review and submission.

· Coordination of weekly time card verification and approvals.

· Reviewing and approving invoices and supporting documentation and other payment questions.

· Providing management and oversight of ED Directors, ED physicians, ED Advanced Practice Providers (APPs), ED nurse supervisors, ED nurses and MSAs.

· Quality Assessment and Performance Improvement Monitor.

· Health Information Portability and Accountability Act (HIPAA), Privacy Act (PA), and records management compliance.

· Submission of weekly/monthly staffing rosters.

· Under the 3.3.1. Contractor Managed and Staffed scenario, the Contractor ED Leadership/Supervisory positions: ED Director and ED Nurse Supervisor are key personnel. If the Contractor cannot identify these individuals at the time proposals are due the Government, then the Contractor will identify the person(s) who will be responsible for the hiring and selection of these individuals. The hiring/selection person(s) will be considered key personnel.

· Under the 3.3.2. Federally Managed – Contractor provides ED staff (ED Physicians, PA, APN, RN, and MSA) scenario the ED Physicians are key personnel. If the Contractor cannot identify these individuals at the time proposals are due the Government, then the Contractor will identify the person(s) who will be responsible for the hiring and selection of these individuals. The hiring/selection person(s) will be considered key personnel.

· Contractor’s Program Manager.

67) Page 44, H6 – FD 258, FD 258 – Are electronic fingerprint cards allowed or do they all have to be hard copy forms?

Response: We need both. Preferably, we would like to fingerprint them electronically and enroll for a PIV card prior to clearance; however, hard-copy cards can also be scanned in to transmit the fingerprints to the OPM system for the pre-clearance fingerprint check. The candidates will be physically present to enroll for a PIV card (at the duty location) where we will electronically fingerprint them. Hard copy cards are required for the supplemental state check to comply with Public Law 101-630, the Indian Childcare Protection Act.

68) Page 44, I.2, Why is 52.215-13 “Pension Adjustments and Asset Reversions” and 52.215-18 “Reversion or Adjustment of Plans for Postretirement Benefits Other than Pensions” included in this RFP? They don’t seem to have any applicability to the services contemplated by this RFP?

Response: The clauses are not applicable so they were deleted.

69) Page 46, I.3., FAR 52.212-5, None of the contract terms and conditions set forth in “b” or “c” are checked. Does this mean that none of the clauses are applicable to a resultant contract?

Response: The contract terms and conditions have been checked accordingly.

70) Page 57, 1.10, What weight will the Government provide in its evaluation factors for the Indian Preference Program pursuant to Clause 352.226-2?

Response: IHS will review all subcontracting Plans provided.

71) Page 59, 1.15, This section indicates that contract funds cannot be used to pay for direct salaries in excess of the Federal Executive Schedule Level II. Direct salary is defined as base salary and excludes fringe benefits. The 2017 schedule limits salaries to $187,000. The following questions apply:

a. Does this limitation apply to all HCPs providing services under the contract to include W-2 employees and independent contractor physicians?

b. Does this limitation flow down to subcontractors and their employees and ICs?

c. Does this limitation apply to Contractor staff personnel who are not billable under this contract (treated as overhead)?

d. Since physician salaries are substantially above the schedule limit of $187,000, can the additional salary or IC cost be recovered through the indirect rate factor?

Response: Please see responses to #9 and #50.

72) Page 67, L.1.1, This section requires a listing of all professional staff that will provide required services including resume of proposed candidate and a variety of other documentation. Are these excluded from the 30-page limitation? This section requires a listing of all professional staff that will provide required services.

a. Does “professional staff” include all clinical health care professionals that will provide services including physicians, RNs, APNs, etc.?

b. If “yes”, does IHS expect that these will become “key personnel” and deliverable to provide services upon contract award?

c. Will IHS consider a technical response greater than 30 pages? Qualifications of personnel could take up 50+ pages based off how many staff are submitted.

d. Does IHS want to see qualifications of midlevel, nursing and leadership providers?

Response:

a. The Government wants to see qualifications of midlevel, nursing and leadership providers. All providers will need to be credentialed and privileged, even for leadership positions in order to be part of the medical staff.

b. See question number 66 regarding key personnel.

c. Section L - Instructions, Conditions, and Notice to Offerors in the RFP has been updated. Please review the updates which will address the number of pages and other issues. Resumes are not counted in the number of pages.

d. Page 19, 5.1.2.3. – 5.1.2.7, Added to the RFP to include qualifications for Nurse Practitioners, Advanced Practice Nurses, Physician Assistants, and Medical Technicians/Assistants.

73) Page 67, L1.1, Who consists of the Technical Panel? Will the Tribal Communities be a part of the selection process?

Response: The Government will evaluate each proposal on their merits. A representative from each of the Tribes serviced by each service unit may be a non-voting advisory member to the government technical evaluators and source selection board, but will not evaluate offerors.

74) Page 92, Appendix E, Will the subcontracting plan play any part in the technical proposal? If so, which section?

Response: All non-small business offerors are required to submit their subcontracting plan.

Sources Sought Notice Questions

75) Please share the X-ray, CT, and MRI capabilities for each of the four Service Units referenced.

Response:

· Fort Yates Hospital - X-Ray only, no CT or MRI

· Pine Ridge Hospital - X-ray available 24/7 for plain films studies. Interpretation by Radiologist available M-F during business hours; Emergency Department provider staff are expected to do preliminary X-ray reads after hours. CT is available 24/7, and radiologist interpretation is available 24/7 through contracted service. MRI is not available on site.

· Omaha/Winnebago Hospital - X-ray, Mammography and will have the CT scan operational and installed on August 9, 2017 (Construction in progress).

· Rosebud Hospital – CT, X-ray available 24/7. U/S available on call. Contracted radiology on call for emergency/stat reads. Staff expected to review fills and give preliminary reading.

76) What is the role of the successful vendor with CMS?

Response: IHS is responsible for oversight of the ED. If selected for an award, all successful vendors will be expected to ensure compliance with CMS Conditions of Participation, and Emergency Medical Treatment and Labor Act (EMTALA).

77) Is it the responsibility of the ED Management Company to get the Service Units out from under the SIA?

Response: IHS is responsible for oversight of the ED. If selected for an award, all successful vendors will be expected to ensure compliance with CMS Conditions of Participation and Emergency Medical Treatment and Labor Act (EMTALA). Failure of the contractor to ensure compliance may jeopardize IHS ability to ensure that the terms of the SIA are met.

78) What responsibility will the ED Management Company have to get the Hospitals JCR accredited?

Response: IHS is responsible for meeting JCR accreditation requirements. If selected for an award, all successful vendors will be expected to ensure compliance with JCR accreditation requirements. Failure of the contractor to ensure compliance may jeopardize IHS ability to ensure accreditation requirements are met.

79) Respiratory Therapists were not listed under the ED personnel, does the hospital provide respiratory staff? If not, how is respiratory managed in the ED?

Response:

· Fort Yates Hospital – No Respiratory Therapy, handled by ED provider or sent to higher level of care if beyond provider competency.

· Pine Ridge Hospital - There is one Respiratory Therapist on staff. RT services are generally available M-F 8 am to 4:30 pm.

· Omaha/Winnebago Hospital - Respiratory Service is not available. Does not have permanent Respiratory staff.

· Rosebud Hospital - No Respiratory Therapy, uses CRNA or nurses to assist with respiratory management.

80) Will the contract office consider responses from individual hospitals?

Response: Yes. Technical approach should clearly identify if your company has the capacity to provide services at one or multiple service units, and which sites.

81) Do the hospitals have urgent care and/or walk in clinic services? If not, which hospitals do not have these offerings?

Response:

· Fort Yates Hospital - Urgent care/walk-in from 0800-1630.

· Pine Ridge Hospital - Has urgent care/walk in clinic on site.

· Omaha/Winnebago Hospital - Does not currently have an Urgent Care or Walk in clinic.

· Rosebud Hospital – No urgent care or walk-in clinics. OPD is improving process to be able to see these patient in the primary care clinic.

82) Are there medical protocols currently in place in these ED’s?

Response: Yes

83) What are the major referral centers for each facility and the EMS availability/training?

Response:

· Fort Yates Hospital - Sanford Bismarck and CHI/St. Alexius. EMS available through each facility.

· Pine Ridge Hospital - Major referral center is Rapid City Regional Hospital. Ambulance service is provided through tribal contract, and available 24/7.

· Omaha/Winnebago Hospital - Mercy Medical Center, Sioux City, Iowa: Level 2 Trauma Center, Cardiac Capability, Ob/GYN; Unity Point Hospital, Level 3, Trauma Center, Cardiac Capability, Ob/GYN; University of Nebraska Medical Center, Omaha Nebraska: Level 1 Trauma Center; Pediatric Children’s Hospital: Omaha, Nebraska: Level 1 Trauma Center; Psychiatric: Omaha UNMC, Great Plains, Med. Center, North Platte, Ne, Regional West Medical Center, Scottsbluff, NE, Kearney-Richard Young Hospital, Kearney, NE., Mercy Medical center, Sioux City, IA, Veterans Affairs Inpatient Psychiatric Unit, Omaha, NE.

· Rosebud Hospital - Sioux Falls-Avera and Sanford, Rapid City Regional health system, Pierre Avera St. Mary’s are major referral centers. Winner Regional and Valentine are similar service level facilities and have current OB and general surgery capability. Pine Ridge also a referral source as well. EMS is tribally run with EMS director from Pierre, SD. BH utilize Avera, Yankton Health and Human services, Rapid City Regional West BH.

84) Is OB available at each site and if not what do the hospitals do with pending imminent deliveries?

Response:

· Fort Yates Hospital - No OB at Fort Yates, imminent deliveries performed by ED provider.

· Pine Ridge Hospital - Pine Ridge has OB available on site, as well as certified nurse midwives.

· Omaha/Winnebago Hospital - Expectant mothers presenting to Omaha/Winnebago Hospital Emergency Department with Pending Imminent delivery are given MSE to determine if they can safely transported to the nearest OB Hospital in Sioux City, 25 miles away at either Mercy Medical Center or Unity Point Medical Center. They can be transported by either Basic Level EMS, Advanced Level EMS or Air Flight based on the medical needs. If unsafe to transport and no option is available they may deliver in the Emergency Department.

· Rosebud Hospital - Currently have 1 OB/GYN and 2 midwives, 1 vacant position. Labor and delivery as well as general surgery are currently on divert status due to staffing and construction. Deliveries are done in ED and either admitted or transferred.

85) What is the facility plan for rapid influx of patients or mass casualty?

Response:

· Fort Yates Hospital - Emergency Response System with Staff, Tribe and State.

· Pine Ridge Hospital - Has a facility plan in place for mass casualty situations.

· Omaha/Winnebago Hospital - The Service Unit has developed a policy “Managing Emergency Department Excess Volume” and it is currently being reviewed and processing for approval.

· Rosebud Hospital - ED dept. staff and call back list of Federal staff for mass casualty situation. Emergency response plan to be activated.

86) Do all the facilities have stable/permanent leadership to aid in transition?

Response:

· Fort Yates Hospital - Yes

· Pine Ridge Hospital - Yes

· Omaha/Winnebago Hospital - Yes

· Rosebud Hospital – No, currently permanent position of CMO/CD.