18-247-SOL-00010.pdf

SEE ADDENDUMIS CHECKED

CODE 18a. PAYMENT WILL BE MADE BY

CODE

FACILITYCODE

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

OFFEROR

Phoenix AZ 85004-4424 Suite 507, Attn: Division of Acquisition Mgmt Two Renaissance Square, 40 North Central Ave Phoenix Area Indian Health Service

CODE 16. ADMINISTERED BYCODE

X

X

621111

SIZE STANDARD:

% FOR:SET ASIDE:UNRESTRICTED OR10

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

BRIAN NUMKENA

(No collect calls)

INFORMATION CALL:

FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIME

12/22/2017 1700 LT

b. TELEPHONE NUMBERa. NAME

4. ORDER NUMBER3. AWARD/ 5. SOLICITATION NUMBER

18-247-SOL-00010

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

1 3 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

15. DELIVER TO

Phoenix AZ 85004-4450 Suite 507 Attn: Division of Acquisition Mgmt Two Renaissance Square, 40 North Central Ave

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$11.00

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

6. SOLICITATION

ISSUE DATE

12/11/2017

DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULE

12. DISCOUNT TERMS

THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

Phoenix Area Indian Health Service

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

Contractor shall provide non-personal Professional Orthopedic Surgeon Physician Services at the Whiteriver Indian Hospital, Whiteriver, Arizona on an as needed basis in accordance with the terms specified in the attached Scope of Work and contract terms and conditions.

Period of Performance is to start on January 1, 2018 through December 31, 2018.

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

HEREIN, IS ACCEPTED AS TO ITEMS:

DATED . YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

ARE

31c. DATE SIGNED

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

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

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

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

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

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

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

OFFER

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

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

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

29. AWARD OF CONTRACT:

REF.

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.

1 2080 HR

2 2080 HR

3 2080 HR

4 2080 HR

Closing Date is December 22, 2017 at 1700 hours local time (AZ time). Deadline for questions is on December 18, 2017 at 1700 hours local time (AZ time).

Contractor shall state in their proposal that the quote shall remain effective for 120 calendar days after close of solicitation.

The Government reserves to right to make a single award, multiple awards or no awards in accordance with provision at FAR 52.215-1 which is included in this solicitation.

Contractor is to follow and submit proposals in accordance to Section E Solicitation Provisions and Addendum to FAR 52.215-1 Instructions to

Offerors - Competitive Acquisitions.

See attached pages for additional information, terms and conditions.

Orthopedic Surgical Services

Option Year I: Orthopedic Surgical Services

Option Year II: Orthopedic Surgical Services

Option Year III: Orthopedic Surgical Services

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

3 2 of

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 3

CONTINUATION SHEET

PAGE OF

(A) (B) (C) (D) (E) (F)

REFERENCE NO. OF DOCUMENT BEING CONTINUED

18-247-SOL-00010

5 Option Year IV: Orthopedic Surgical Services 2080 HR

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110

RFP 18-247-SOL-00010, 12/11/2017, ORTHOPEDIC SURGEON SERVICES FOR THE

WHITERIVER HOSPITAL

Continuation from SF 1449

Table of Contents

SECTION B – CONTINUATION OF SF 1449

B.1 CONTRACT ADMINISTRATION DATA

B.2 SPECIAL CONTRACT REQUIREMENTS

A. PHYSICAL DEMAND AND WORK ENVIRONMENT

B. PATIENT CULTURAL BACKGROUND

C. REVIEW AND APPROVAL AND EVALUATION

D. VERIFICATION OF LICENSURE

E. POST-AWARD ADMINISTRATION MONITORING

F. BACKGROUND CHECK

G. PERIOD OF PERFORMANCE

H. DESIGNATION OF CONTRACTING OFFICER REPRESENTATIVE (COR)

I. CONTRACTOR OFFICER REPRESENTATIVE (COR)

J. CONTRACTING OFFICER (CO) RESPONSIBILITIES

K. CHILD CARE NATIONAL AGENCY CHECK & INVESTIGATION (CNACI)

L. SECURITY

M. INFORMATION TECHNOLOGY SECURITY

SECTION C - CONTRACT CLAUSES

A. 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

B. 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUES

OR EXECUTIVE ORDER – COMMERCIAL ITEMS (NOV 2017)

C. 52.216.18 ORDERING (OCT 1995)

D. 52.216-19 ORDER LIMITATIONS (OCT 1995)

E. 52.216-22 INDEFINITE QUANTITY (OCT 1995)

F. 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

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

H. 52.237-7 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE (JAN 1997)

I. HEALTH & HUMAN SERVICES ACQUISITION REGULATION CLAUSES, 48 CFR

CHAPTER 3 CLAUSES (INCORPORATED BY REFERENCE):

http://farsite.hill.af.mil/vfhhsara.htm

SECTION D - CONTRACT DOCUMENTS, EXHIBITS OR ATTACHMENTS

A. ATTACHMENT A: PRICE SCHEDULE

B. ATTACHMENT B: BUSINESS ASSOCIATES AGREEMENT

C. ATTACHMENT C: TAX EXEMPTION LETTER

D. ATTACHMENT D: STATEMENT OF WORK

SECTION E - SOLICITATION PROVISIONS

A. 52.215-1 INSTRUCTIONS TO OFFERORS - COMPETITIVE ACQUISITIONS (JAN 2017)

B. ADDENDUM TO FAR 52.215-1 - INSTRUCTIONS TO OFFERORS - COMPETITIVE

ACQUISITIONS.

C. 52.212-2 EVALUATION – COMMERCIAL ITEMS (OCT 2014)

D. ADDENDUM TO FAR 52.212-2 EVALUATION – COMMERCIAL ITEMS

E. 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS – COMMERCIAL

ITEMS (NOV 2017)

F. 52.216-1 TYPE OF CONTRACT (APR1984)

G. 52.233-2 SERVICE OF PROTEST (SEPT 2006)

H. DEPARTMENT OF HEALTH AND HUMAN SERVICES TOBACCO POLICY

B.1 CONTRACT ADMINISTRATION DATA

(continuation from Standard Form 1449, block 18A.)

OFFERORS MUST COMPLETE AND RETURN ALL INFORMATION DESIGNATED IN 52.215-

1, INSTRUCTIONS TO OFFERORS - COMMERCIAL ITEMS, PARAGRAPH “b”, ADDRESS

ALL TECHNICAL FACTORS IN 52.212-2 EVALUATION- COMMERCIAL ITEMS, AND

COMPLETE 52.212-3, OFFEROR REPRESENTATIONS AND CERTIFICATIONS -

COMMERCIAL ITEMS PRIOR TO THE TIME SPECIFIED IN BLOCK 8 OF SF 1449 IN

ORDER TO BE CONSIDERED FOR AWARD.

NOTIFICATION TO ALL OFFERORS:

1. Federal Acquisition Regulations (FAR) require all Contractors conducting business with the

Government to be registered in the online database: 1) The System Awards Management System (SAM) Government-wide online database for the provision of basic information relative to contract awards [refer to FAR Clause 52.212-4, para (t)].

You may accomplish these registrations online at the following web sites:

SAM – http://www.sam.gov

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

a. CONTRACTOR:

DUNS Number: ___________________________________

[See FAR 52.212-1 Instructions… (j) Data Universal Numbering System (DUNS) Number]

TAX ID: _________________________________________

b. GOVERNMENT:

Verna Kuwcanhoyioma, Contracting Officer

Indian Health Service (IHS) Phoenix Area Office Division of Acquisition Management Two Renaissance Square 40 N. Central Avenue, Ste 507 Phoenix, AZ 85004-0931

3. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the Contractor shall be electronically reimbursed:

[X] 52.232-34, Payment by Electronic Funds Transfer- Other than Central Contractor Registration http://www.sam.gov/

[ ] 52.232-36, Payment by Third Party

4. INVOICES: Invoices shall be submitted in ARREARS:

a. Quarterly [ ]

b. Semi-Annually [ ]

c. Other [X] Monthly in Arrears

5. GOVERNMENT INVOICE ADDRESS: All invoices from the Contractor shall be submitted electronically.

INVOICING/BILLING:

Contractor shall establish a recordkeeping system of Contractor services provided. Contractor may only bill for actual hours worked on-site at the IHS. At the end of each month the Contractor will submit an invoice for payment.

Invoice Requirements and Supporting Documentation: Supporting documentation and invoices must be submitted no later than the 30th workday of the month after services have been provided.

Changes or corrections shall be submitted by separate invoice. In addition to information required for submission of a “proper” invoice in accordance with FAR 52.212-4 (g) all invoices must include:

Name and address of Contractor Invoice Date Contract Number and Purchase/Task Order Number Date of Service

CLIN-Number: Example: 0001 Physician Physician’s Name

Electronic Invoicing: The Phoenix Area Indian Health Service has initiated an important change in the accounts payable process that is mandatory and will ensure Contractors are paid promptly. All invoices are to be submitted by email to PHXAreaAP-team@ihs.gov.

Indian Health Service (IHS) Phoenix Area Office Attn: Financial Management Branch Two Renaissance Square 40 N. Central Avenue Phoenix, AZ 85004

Service Unit Representatives: tbd@ihs.gov

A copy of the invoice should be sent electronically to the Service Unit Representative(s) at the address listed above.

Payments in Full/ No Billing IHS Beneficiaries: The Contractor shall accept payment for services rendered under this contract as payment in full. IHS beneficiaries shall not under any circumstances be charged nor shall their insurance companies including Medicare be charged for services rendered by the Contractor under this contract, even if IHS does not pay for those services. The Contractor shall not bill, charge, collect a deposit from, seek compensation, remuneration, or reimbursement from, or have any recourse against, any person or entity other than the IHS for services provided pursuant to mailto:PHXAreaAP-team@ihs.gov mailto:tbd@ihs.gov this contract. It shall be considered fraudulent for the Contractor to bill other third parties for services rendered under this contract. This provision shall survive the termination or ending of the contract.

ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

AMENDMENT NO DATE

B.2 SPECIAL CONTRACT REQUIREMENTS

1. PHYSICAL DEMAND AND WORK ENVIRONMENT:

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

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

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

2. PATIENT CULTURAL BACKGROUND:

Some of the IHS patients receiving services under this contract may only speak a native language or Spanish or may have limited comprehension of the English language, and/or may reside on a Native American Indian Reservation. The Contractor is expected to demonstrate sensitivity to cross-cultural and language difference and have the ability to work through government provided interpreters as necessary.

Consideration must be given to potentially limited transportation and/or home environment facilities.

3. REVIEW AND APPROVAL AND EVALUATION:

Service evaluation:

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

b) Work performed by the Contractor’s employee assigned to the facility, shall be subject to all quality assurance monitors and performance improvement studies performed by the facility.

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

d) The COR will issue a performance review in CPARS at the end of the base and each option year. The contractor will have an opportunity to review and approve or dispute the COR’s performance reviews.

4. VERIFICATION OF LICENSURE:

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

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

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

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

5. POST-AWARD ADMINISTRATION MONITORING:

a) The Contractor’s employee will be required to comply with the Service Units Policies & Procedures and shall meet the same licensing/educational requirements as permanent IHS employees prior to providing services in this facility. These providers will be subject to the same peer review as permanent members of our medical team.

b) The Service Unit shall provide an ongoing method of monitoring and evaluation of the quality and appropriateness of patient care and of identifying deficiencies in the quality of services performed before the level of performance becomes unacceptable.

c) If a Contractor’s employee fails to arrive at the service unit for a scheduled shift, the Contractor must provide coverage by another provider with temporary, provisional or courtesy privileges approved by the Service Unit Medical staff and the Governing Body. If no coverage is provided, the Contractor shall be required to pay the IHS for the cost incurred for providing that coverage. Not providing coverage on more than one occasion will be reviewed and discussed by the Chief Medical Officer and the Contracting Officer as to whether there was a compromise of patient care. All compromised situations that arise from lack of patient care by the Contractor shall be referred to the Contracting Officer for action and resolution.

d) Once the Contract is awarded, Contractor(s) must complete all credentialing and privileging paperwork in accordance with TJC, CMS and the Service Unit Staff by-laws and Rules and Regulations. The Contractor’s employee must meet the same licensing/certification requirements as permanent IHS employee before being allowed to provide services in this facility. The Contractor’s employee must also complete all CMS-8551 and CMS-855R Medical Enrollment Applications and any other insurance paperwork. Copies and/or access to patient medical records will be provided to the business office personnel for the purpose of financial matters regarding billing and insurance collections.

Service Units will process all eligible third party claims for reimbursement for services provided by the Contractor(s).

e) The Contractor shall provide both the COR and CO copies of its certificates of insurance and its sub-

Contractors’ certificates of insurance prior to performing services under this contract. All Contractor and sub-Contractor certificates of insurance shall name the Whiteriver Indian Hospital and Whiteriver Service Unit as an additional insured.

f) CONTRACTOR QUALITY CONTROL PROGRAM:

The Contractor shall have a Quality Control program to assure compliance with contract. Quality Control program shall minimally have the following elements:

(1) A method for identifying deficiencies in the quality of services performed before the level of performance becomes unacceptable.

(2) A file of all quality control inspections, inspection results, and any corrective action required shall be maintained by the Contractor throughout the duration of this contract.

This file shall be the property of the Government and shall be available to the Project Officer during normal working hours. The file shall be turned over to the Government within 14 days of completion or termination of the contract.

g) PERIODIC PERFORMANCE EVALUATION MEETINGS:

The Contractor shall meet, via in-person or teleconference meeting, with the Contracting Officer’s representative (COR) at the Whiteriver Indian Hospital a minimum of every six months according to availability. The purpose of these meetings shall be to review the Contractors performance to the critical minimum performance standards set forth in this contract, as documented by the COR’s periodic surveillance of the Contractors performance to these standards.

The issuance of a Contract Discrepancy Report (CDR) may be cause for the scheduling of additional meeting(s) between the Contractor and PO. A mutual effort will be made to resolve all problems identified. The PO will prepare written minutes of these meetings. Should the Contractor not concur with the minutes, a written statement will be presented to the Contracting Officer (CO), and the Contractor will be notified of the decision in writing by the CO.

h) PERFORMANCE STANDARDS:

(a) Introduction – Performance Requirements:

(1) A Quality Assurance Surveillance Plan (QASP) has been developed for in-house operations or to implement a service contract. It is designed to aid the PO in providing effective and systematic surveillance of all aspects of professional nursing services. This plan provides for monitoring the contract requirements

(b) The objective of this surveillance plan is to evaluate how the Contractor is performing in key areas. The government is primarily interested in the final service being provided and not in the details of accomplishment.

(c) The principal method of surveillance will be daily in some cases or by use or periodic inspections. Appropriate indicators are provided for recording observations in this type of surveillance.

(d) How to Use the Performance Based Matrix

(i) Each defect observed will be recorded on the tally report. These documents will then become a formal record for later reference. The tally of defects at the end of each clinic or year (dependent on criteria) will be compared to the acceptable number of defects appearing in the surveillance plan. Errors detected by the PO in the course of surveillance will be transmitted to the Contractor or in-house personnel for correction. Notification of errors will take place within five (5) working days. Specifics concerning any errors should be recorded on the tally checklist. The Contractor or in-house personnel, as applicable, should be asked to initial this record.

(ii) Project Officer shall forward a copy of Contractor’s compliance with performance and non-performance compliance reports.

(e) Quality Assurance Surveillance Plan (QASP):

(i) This Quality Assurance Surveillance Plan (QASP) provides a systematic method to evaluate performance for the stated contract. This QASP explains the following:

a. What will be monitored;

b. How monitoring will take place;

c. Who will conduct the monitoring; and

d. How monitoring efforts and results will be documented.

(ii) This QASP does not detail how the contractor accomplishes the work. Rather, the QASP is created with the premise that the contractor is responsible for management and quality control actions to meet the terms of the contract. It is the Government’s responsibility to be objective, fair, and consistent in evaluating performance.

(iii) This QASP is a “living document” and the Government may review and revise it on a regular basis. However, the Government shall coordinate changes with the contractor. Copies of the original QASP and revisions shall be provided to the contractor and Government officials implementing surveillance activities.

The Quality Assurance Surveillance Plan (QASP) outlines required standards and will be a part of the contract.

Task ID Indicator Standard Acceptable Quality Level

Method of Surveillance Incentive

Key Personnel

The Contractor shall supply all necessary personnel to staff the scheduled clinics.

Qualified personnel are available at each of the scheduled clinic dates to provide the scheduled consultations

Less than 3 unfavorable incidences per quarter.

Based on Quarterly Customer Service feedback from clinic management.

Neg: 5-10% payment reduction Pos:

Extension of Option Period.

Specialty physicians will be qualified, and maintain credentialed status

Qualified, credentialed personnel are available at each of the scheduled clinic dates to provide the scheduled consultations

Less than 3 unfavorable incidences per quarter.

Based on Quarterly Customer Service feedback from clinic management or credentialing.

Neg: 5-10% payment reduction Pos:

Extension of Option Period.

Patient Safety 3

Immediate reporting of significant events or errors with potential for morbidity or mortality.

All incidents reported immediately.

100% reporting.

Contractor reporting through the WebCident electronic reporting system.

Neg: 5-10% payment reduction Pos:

Extension of Option Period.

Task ID Indicator Standard Acceptable Quality Level

Method of Surveillance Incentive

Document-ation

4 Electronic Health Record.

The Contractor shall assure that clinical care is properly documented in the

IHS-EHR.

100% of visits are documented, no less than 95% peer review compliance

Based on Quarterly Customer Service feedback from clinic management.

Neg: 5-10% payment reduction Pos:

Extension of Option Period.

Licensure and certification requirements

Required documents are kept current.

100% compliance

Based on Quarterly Customer Service feedback from clinic management or credentialing.

Neg: 5-10% payment reduction Pos:

Extension of Option Period.

(f) INCENTIVES

a. The Government shall use Extension of Option Period based upon past performance

(PPIRS – Past Performance Information Retrieval System).as incentives. Incentives shall be based on exceeding, meeting, or not meeting performance standards.

(g) METHODS OF QA SURVEILLANCE

a. Various methods exist to monitor performance. The COR shall use the surveillance methods listed below in the administration of this QASP.

i. CLINIC MANAGEMENT REPORT (Combines elements of validated user complaints and random sampling. Random survey is conducted to solicit user satisfaction. May also generate inspections and sampling.)

1. ID #1: All scheduled providers available to see scheduled patients.

2. ID #2: Credentials files complete, all requested documents received timely

3. ID #3: WebCident submissions, as indicated

4. ID #4: EHR documentation, peer review

5. ID #5: Requested documents received timely

6. ID #6: Peer review, PI indicator(s)

(h) RATINGS

a. Metrics and methods are designed to determine if performance exceeds, meets, or does not meet a given standard and acceptable quality level. A rating scale shall be used to determine a positive, neutral, or negative outcome. The following ratings shall be used:

ACCEPTABLE Performance meets contractual requirements.

UNACCEPTABLE Performance does not meet contractual requirements.

(i) DOCUMENTING PERFORMANCE

a. ACCEPTABLE PERFORMANCE

i. The Government shall document positive performance. Any report may become a part of the supporting documentation for any contractual action.

b. UNACCEPTABLE PERFORMANCE

i. When unacceptable performance occurs, the COR shall inform the contractor.

This will normally be in writing unless circumstances necessitate verbal communication. In any case the COR shall document the discussion and place it in the COR file.

ii. When the COR determines formal written communication is required, the COR shall prepare a Contract Discrepancy Report (CDR), and present it to the contractor's program manager.

iii. The contractor shall acknowledge receipt of the CDR in writing. The CDR will specify if the contractor is required to prepare a corrective action plan to document how the contractor shall correct the unacceptable performance and avoid a recurrence. The CDR will also state how long after receipt the contractor has to present this corrective action plan to the COR. The Government shall review the contractor's corrective action plan to determine acceptability.

iv. Any CDRs may become a part of the supporting documentation for any contractual action deemed necessary by the CO.

(j) FREQUENCY OF MEASUREMENT

a. Frequency of Measurement.

i. During contract performance, the COR will periodically analyze whether the negotiated frequency of surveillance is appropriate for the work being performed.

b. Frequency of Performance Assessment Meetings.

i. The COR shall meet with the contractor semi-annually to assess performance and shall provide a written assessment.

(k) BACKGROUND CHECK:

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

All Contractor employees are subject to criminal background check prior to performing services in accordance with the contract terms and conditions. The Contractor shall ensure that each of their provider(s) complete the, Certification of Criminal History and Background Check Packet. The completed forms are to be returned to the COR. Additional Background Check packets can be obtained through the COR. Contractors (and their employees) requiring routine, long-term access (i.e., greater than 6 months) to IHS facilities and/or systems; or providing services to children under 18 year of age are subject to criminal background checks prior to performing services. The Contractor shall ensure that each employee(s) complete the Certification of Criminal History and Background Check Packets to initiate the Child & Youth Services National Agency Check with Inquiries (CNACI). The COR is responsible for providing the Contractor with all necessary background check forms. The COR is also responsible for ensuring all background check forms are fully completed and processed prior to commencement of service. The Contractor shall return all completed forms to the Service Unit Human Resource Office located at Phoenix Area Indian Health Service, 40 North Central Avenue #510, Phoenix, AZ 85004.Contractors may be directed to the e-QIP website to complete the necessary background investigation forms online (inquire with the Service Unit should you wish to complete forms electronically). All Contractors (or their employees) must appear in person to IHS (or an IHS facility) with two acceptable forms of identity;

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

FOR MORE INFORMATION ON SECURITY REQUIREMENTS PLEASE REFER TO DHHS SITE:

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

(l) PERIOD OF PERFORMANCE:

Contract performance shall be for a base year and four (4) one (1) year option for renewal commencing from date of the award of the contract. Option year renewals shall be by a written amendment to the contract and approved by the Contracting Officer.

Base Year: January 1, 2018 through December 31, 2018 Option Year 1: January 1, 2019 through December 31, 2019 Option Year 2: January 1, 2020 through December 31, 2020 Option Year 3: January 1, 2021 through December 31, 2021 Option Year 4: January 1, 2022 through December 31, 2022

Option renewals will be on the basis of the existing requirement of the Government, performance of satisfactory service provided during the base year, and contingent upon availability of funds for the appropriate fiscal year.

(m) DESIGNATION OF CONTRACTING OFFICER REPRESENTATIVE (COR):

TBD, 928-737-XXXX is hereby designated the COR to monitor the performance of this order on behalf of the government.

(n) CONTRACTOR OFFICER REPRESENTATIVE (COR):

The Contracting Officer will designate in writing a COR who shall be responsible for:

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

2 Interpreting scope of work;

3 Performing technical evaluations required;

4 Performing technical inspections and acceptances required by this contract;

5 Monitoring funds available for obligation under this contract;

6 The resolution of technical problems encountered during performance of this contract;

In no event is the COR empowered to change any of the terms and conditions of the contract. Changes in the scope of work, contract price, quantity, and quality or delivery schedule shall be made only by the Contracting Officer by a properly exercised modification.

The designation of a COR does not authorize or provide a legal right to change any kind of contractual terms regardless of the Contractor’s apparent difficulties in fulfilling contract requirements.

(o) CONTRACTING OFFICER (CO) RESPONSIBILITIES:

The Contracting Officer is the only person delegated the authority to negotiate changes in terms, conditions, or amounts cited in this contract.

(p) CHILD CARE NATIONAL AGENCY CHECK & INVESTIGATION (CNACI):

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

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

1. DHHS Application Background Survey.

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

3. IHS – Release of Personal Information.

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

5. GSA Form 176 – Statement of Personal History.

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

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

(q) SECURITY:

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

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

(r) INFORMATION TECHNOLOGY SECURITY:

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

IT SECURITY – INFORMATION SYSTEMS SECURITY AWARENESS (ISSA) TRAINING:

Information Systems Security Awareness (ISSA) is mandatory annual security awareness training for all IHS system users and fulfills Federal mandates and regulations. IHS develops the modules in line with National Institute of Standards and Technology (NIST) guidelines on information security awareness and information security trainings.

The ISSA modules fulfill an IHS user's annual requirements for the following:

1. Acknowledgement and acceptance of the IHS Rules of Behavior

2. Privacy training

3. Protecting sensitive information and the Health Insurance Portability and Accountability Act

(HIPAA) & the Health Information Technology for Economic and Clinical Health Act (HITECH)

4. Physical and information security

5. Appropriate email use

6. Protecting mobile devices and portable media

7. Social engineering awareness

8. Incident response and learning from past incidents

You can take the training or learn more at the ISSA website.

All IHS information system users must take annual security and privacy training in order to fulfill federal mandates and regulations. In addition, all new users must successfully complete this course within 24 hours of receiving access unless the user has read the IHS Quick Guide to Information Security, in which case they will have 30 days to complete the training. Failure to complete training requirements will result in the loss of information systems access.

http://www.ihs.gov/ISSA/ http://www.ihs.gov/ISSA/security_pamphlet_slick.pdf

SECTION C - CONTRACT CLAUSES

A. 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es):

https://www.acquisition.gov/far/

FAR

NUMBER

TITLE

DATE

52.202-1 DEFINITIONS NOV 2013

52.203-5 COVENANT AGAINST CONTIGENT FEES MAY 2014

52.203-6 RESTRICTIONS ON SUBCONTRACTOR SALES TO THE

GOVERNMENT

SEP 2006

52.203-7 ANTI-KICKBACK PROCEDURES MAY 2014

52.203-16 PREVENTING PERSONAL CONFLICTS OF INTEREST DEC 2011

52.203-17 CONTRACTOR EMPLOYEE WHISTLEBLOWER RIGHTS AND

REQUIREMENT TO INFORM

APR 2014

52.204-4 PRINTED OR COPIED DOUBLE-SIDED ON POSTCONSUMER FIBER

CONTENT PAPER

MAY 2011

52.204-9 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR

PERSONNEL

JAN 2011

52.204-18 COMMERCIAL AND GOVERNMENT ENTITY CODE MAINTENANCE JUL 2015

52.204-19 INCORPORATION BY REFERENCE OF REPRESENTATIONS AND

CERTIFICATIONS

DEC 2014

52.212-4 CONTRACT TERMS AND CONDITIONS - COMMERCIAL ITEMS JAN 2017

52.222-17 NONDISPLACEMENT OF QUALIFIED WORKERS MAY 2014

52.222-50 COMBATING TRAFFICKING IN PERSONS MAR 2015

52.223-10 WASTE REDUCTION PROGRAM MAY 2011

52.223-18 ENCOURAGING CONTRACTOR POLICIES TO BAN TEXT

MESSAGING WHILE DRIVING

AUG 2011

52.224-1 PRIVACY ACT NOTIFICATION APR 1984

52.224-2 PRIVACY ACT APR 1984

52.225-13 RESTRICTIONS ON CERTAIN FOREIGN PURCHASES JUN 2008

52.225-25 PROHIBITION ON CONTRACTING WITH ENTITIES ENGAGING IN

CERTAIN ACTIVITIES OR TRANSACTIONS RELATING TO IRAN—

REPRESENTATION AND CERTIFICATIONS

OCT 2015

52.232-1 PAYMENTS APR 1984

52.232-7 PAYMENTS UNDER TIME-AND-MATERIALS AND LABOR-HOURS

CONTRACTS

AUG 2012

52.232-18 AVAILABILITY OF FUNDS APR 1984

52.232-39 LIMITATION ON WITHHOLDING OF PAYMENTS APR 1984

52.233-2 SERVICE OF PROTEST SEP 2006

https://www.acquisition.gov/far/

52.233-4 APPLICATION LAW FOR BREACH OF CONTRACT CLAIM OCT 2004

52.237-2 PROTECTION OF GOVERNMENT BUILDINGS, EQUIPMENT, AND

VEGETATION

APR 1984

52.237-3 CONTINUITY OF SERVICES JAN 1991

52.244-6 SUBCONTRACTS FOR COMMERCIAL ITEMS JUN 2016

B. 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUES

OR EXECUTIVE ORDER – COMMERCIAL ITEMS (NOV 2017)

(a) The Contractor shall comply with the following Federal Acquisition Regulation (FAR) clauses, which are incorporated in this contract by reference, to implement provisions of law or Executive orders applicable to acquisitions of commercial items:

(1) 52.203-19, Prohibition on Requiring Certain Internal Confidentiality Agreements or Statements (JAN 2017) (section 743 of Division E, Title VII, of the Consolidated and Further Continuing Appropriations Act, 2015 (Pub. L. 113-235) and its successor provisions in subsequent appropriations acts (and as extended in continuing resolutions)).

(2) 52.209-10, Prohibition on Contracting with Inverted Domestic Corporations (Nov 2015).

(3) 52.233-3, Protest After Award (AUG 1996) (31 U.S.C. 3553).

(4) 52.233-4, Applicable Law for Breach of Contract Claim (OCT 2004)(Public Laws 108-77 and

108-78 (19 U.S.C. 3805 note)).

(b) The Contractor shall comply with the FAR clauses in this paragraph (b) that the Contracting

Officer has indicated as being incorporated in this contract by reference to implement provisions of law or Executive orders applicable to acquisitions of commercial items:

[Contracting Officer check as appropriate.]

_X_ (1) 52.203-6, Restrictions on Subcontractor Sales to the Government (Sept 2006), with Alternate I (Oct 1995) (41 U.S.C. 4704 and 10 U.S.C. 2402).

__ (2) 52.203-13, Contractor Code of Business Ethics and Conduct (Oct 2015) (41 U.S.C.

3509)).

__ (3) 52.203-15, Whistleblower Protections under the American Recovery and Reinvestment Act of 2009 (June 2010) (Section 1553 of Pub. L. 111-5). (Applies to contracts funded by the American Recovery and Reinvestment Act of 2009.)

_X_ (4) 52.204-10, Reporting Executive Compensation and First-Tier Subcontract Awards (Oct 2016) (Pub. L. 109-282) (31 U.S.C. 6101 note).

__ (5) [Reserved].

__ (6) 52.204-14, Service Contract Reporting Requirements (Oct 2016) (Pub. L. 111-117, section 743 of Div. C).

__ (7) 52.204-15, Service Contract Reporting Requirements for Indefinite-Delivery Contracts

(Oct 2016) (Pub. L. 111-117, section 743 of Div. C).

__ (8) 52.209-6, Protecting the Government’s Interest When Subcontracting with Contractors

Debarred, Suspended, or Proposed for Debarment. (Oct 2015) (31 U.S.C. 6101 note).

__ (9) 52.209-9, Updates of Publicly Available Information Regarding Responsibility Matters

(Jul 2013) (41 U.S.C. 2313).

__ (10) [Reserved].

__ (11)(i) 52.219-3, Notice of HUBZone Set-Aside or Sole-Source Award (Nov 2011) (15

U.S.C. 657a).

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__ (ii) Alternate I (Nov 2011) of 52.219-3.

__ (12)(i) 52.219-4, Notice of Price Evaluation Preference for HUBZone Small Business

Concerns (OCT 2014) (if the offeror elects to waive the preference, it shall so indicate in its offer) (15 U.S.C. 657a).

__ (ii) Alternate I (JAN 2011) of 52.219-4.

__ (13) [Reserved] __ (14)(i) 52.219-6, Notice of Total Small Business Set-Aside (Nov 2011) (15 U.S.C. 644).

__ (ii) Alternate I (Nov 2011).

__ (iii) Alternate II (Nov 2011).

__ (15)(i) 52.219-7, Notice of Partial Small Business Set-Aside (June 2003) (15 U.S.C. 644).

__ (ii) Alternate I (Oct 1995) of 52.219-7.

__ (iii) Alternate II (Mar 2004) of 52.219-7.

__ (16) 52.219-8, Utilization of Small Business Concerns (Nov 2016) (15 U.S.C. 637(d)(2) and (3)).

__ (17)(i) 52.219-9, Small Business Subcontracting Plan (Jan 2017) (15 U.S.C. 637(d)(4)).

__ (ii) Alternate I (Nov 2016) of 52.219-9.

__ (iii) Alternate II (Nov 2016) of 52.219-9.

__ (iv) Alternate III (Nov 2016) of 52.219-9.

__ (v) Alternate IV (Nov 2016) of 52.219-9.

__ (18) 52.219-13, Notice of Set-Aside of Orders (Nov 2011) (15 U.S.C. 644(r)).

__ (19) 52.219-14, Limitations on Subcontracting (Jan 2017) (15 U.S.C. 637(a)(14)).

__ (20) 52.219-16, Liquidated Damages.Subcon-tracting Plan (Jan 1999) (15 U.S.C.

637(d)(4)(F)(i)).

__ (21) 52.219-27, Notice of Service-Disabled Veteran-Owned Small Business Set-Aside (Nov

2011) (15 U.S.C. 657 f).

__ (22) 52.219-28, Post Award Small Business Program Rerepresentation (Jul 2013) (15 U.S.C.

632(a)(2)).

__ (23) 52.219-29, Notice of Set-Aside for, or Sole Source Award to, Economically

Disadvantaged Women-Owned Small Business Concerns (Dec 2015) (15 U.S.C. 637(m)).

__ (24) 52.219-30, Notice of Set-Aside for, or Sole Source Award to, Women-Owned Small

Business Concerns Eligible Under the Women-Owned Small Business Program (Dec 2015) (15 U.S.C.

637(m)).

_X_ (25) 52.222-3, Convict Labor (June 2003) (E.O. 11755).

_X_ (26) 52.222-19, Child Labor.Cooperation with Authorities and Remedies (Oct 2016) (E.O.

13126).

_X_ (27) 52.222-21, Prohibition of Segregated Facilities (Apr 2015).

_X_ (28) 52.222-26, Equal Opportunity (Sept 2016) (E.O. 11246).

_X_ (29) 52.222-35, Equal Opportunity for Veterans (Oct 2015)(38 U.S.C. 4212).

_X_ (30) 52.222-36, Equal Opportunity for Workers with Disabilities (Jul 2014) (29 U.S.C.

793).

_X_ (31) 52.222-37, Employment Reports on Veterans (FEB 2016) (38 U.S.C. 4212).

_X_ (32) 52.222-40, Notification of Employee Rights Under the National Labor Relations Act

(Dec 2010) (E.O. 13496).

_X_ (33)(i) 52.222-50, Combating Trafficking in Persons (Mar 2015) (22 U.S.C. chapter 78 and

E.O. 13627).

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__ (ii) Alternate I (Mar 2015) of 52.222-50 (22 U.S.C. chapter 78 and E.O. 13627).

_X_ (34) 52.222-54, Employment Eligibility Verification (OCT 2015). (Executive Order 12989).

(Not applicable to the acquisition of commercially available off-the-shelf items or certain other types of commercial items as prescribed in 22.1803.)

__ (35)(i) 52.223-9, Estimate of Percentage of Recovered Material Content for EPA–Designated Items (May 2008) (42 U.S.C. 6962(c)(3)(A)(ii)). (Not applicable to the acquisition of commercially available off-the-shelf items.)

__ (ii) Alternate I (May 2008) of 52.223-9 (42 U.S.C. 6962(i)(2)(C)). (Not applicable to the acquisition of commercially available off-the-shelf items.)

__ (36) 52.223-11, Ozone-Depleting Substances and High Global Warming Potential Hydrofluorocarbons (JUN 2016) (E.O. 13693).

__ (37) 52.223-12, Maintenance, Service, Repair, or Disposal of Refrigeration Equipment and Air Conditioners (JUN 2016) (E.O. 13693).

__ (38)(i) 52.223-13, Acquisition…