Request for Proposal (RFP) 75H70421R00002 IHS COVID-19 Critical Care Response Team (CCRT) IDIQ Contracts - Revised 11-10-2020.pdf

Section A

Indian Health Service (IHS) Request for Proposal

National COVID-19 Critical Care Response Teams (CCRT) Indefinite Delivery/ Indefinite Quantity (IDIQ) Contract

(RFP) 75H70421R00002

You are invited to submit a proposal in accordance with the requirements of the following Solicitation.

Proposals must be received by the Government no later than the local time on the Due Date stated in the table below.

Issue Date: Tuesday, October 27, 2020

Due Date: Monday, November 23, 2020

Time: 12:00 p.m., EST

Points of Contact:

Kenneth Truesdale; kenneth.truesdale@ihs.gov Glenda Smith; glenda.smith@ihs.gov mailto:kenneth.truesdale@ihs.gov mailto:kenneth.truesdale@ihs.gov mailto:glenda.smith@ihs.gov

Solicitation # 75H70421R00002 Indian Health Service – COVID-19 Critical Care Response Teams

SECTION B – PRODUCTS OR SERVICES AND PRICES/COSTS

B.1. OVERVIEW

The Indian Health Service (IHS), an agency within the Department of Health and Human Services, is responsible for providing federal health services to American Indians and Alaska Natives. The mission of IHS is to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level and assure that comprehensive, culturally acceptable personal and public health services are available and accessible to members of the 574 federally recognized Tribes across the United States.

The Indian Health Service Strategic Plan for Fiscal Year 2019-2023 guides ongoing efforts to provide health care for American Indians and Alaska Natives across the United States. The plan addresses access to quality health care services, strengthening organizational capacity, and improving operations and communications across the system.

Purpose

In response to the ongoing Coronavirus Disease 2019 (COVID-19) pandemic, on June 2, 2020, the Indian Health Service (IHS) announced the formation of a pilot COVID-19 Critical Care Response Team (CCRT) contract. Patients known or suspected of having COVID-19 who are admitted to the hospital are likely to be in extreme respiratory distress and may require 24 hour/7 days a week intensive medical care. The primary purpose of this contract is to continue to 1). prepare staff to treat critically ill COVID-19 patients by providing hands-on critical care clinical education and training prior to, or in the event of, an influx of critically ill COVID-19 patients; 2) augment existing staff at a facility with a team of expert critical care physicians, Critical Care Registered Nurses (CCRNs), and Registered Respiratory Therapists (RRTs); and 3). Provide critical care virtual training on an as needed basis as new information and evidence-based best practices and guidelines to care and manage critically ill COVID-19 patients emerge.

Since the initial pilot contract for CCRT teams was issued in May 2020, the number of COVID-19 positive cases and critically ill COVID-19 patients has increased across the nation, and across all IHS Areas.1 The Contractor must be able to deploy a CCRT to all 44 hospitals identified in Appendix B: IHS Federal and Tribally Operated Hospitals, when a need arises. As of October 2020, a CCRT has deployed to Choctaw Health Center (Choctaw, MS), Sells Hospital (Sells, AZ), Claremore IHS Hospital (Claremore, OK), Crow Hospital (Crow Agency, MT), Northern Cheyenne Service Unit (Lame Deer, MT), Quentin Burdick Memorial Hospital (Belcourt, ND), Cheyenne River Service Unit (Eagle Butte, SD), and Rosebud IHS Hospital (Rosebud, SD). During the period of performance of the IDIQ contract, a CCRT may be required to revisit one of these facilities.

1Source: IHS daily Coronavirus dashboard: https://www.ihs.gov/coronavirus/ https://www.ihs.gov/newsroom/pressreleases/2020-press-releases/critical-care-response-team-will-further-enhance-patient-care-across-the-indian-health-service/ https://www.ihs.gov/newsroom/pressreleases/2020-press-releases/critical-care-response-team-will-further-enhance-patient-care-across-the-indian-health-service/ https://www.ihs.gov/coronavirus/

B.2. TYPE OF CONTRACT (FAR 52.216-1 (APR 1984))

The Government desires to award a total of three (3) time-and-material (T&M) Performance-based, Indefinite Delivery Indefinite Quantity (IDIQ) contracts resulting from this solicitation depending on the need at the time of award, available funding, and the quality of proposals received. This requirement will be conducted as Full and Open competition for two (2) of the three (3) IDIQs and one (1) will be small business set-aside. The IDIQ(s) will contain fixed loaded hourly labor rates per labor category as well as materials to include travel with applicable per diem and (deliverables – Refer to Appendix D: Schedule of Deliverables).

B.3. CONSIDERATION AND PAYMENT

The Contractor shall provide the services described in Section C, Description/ Statement of Objective (SOO) and the Contractor’s resulting Performance Work Statement (PWS).

Except as otherwise specified in the contract, the Contractor shall furnish the necessary personnel, materials, services, facilities, and otherwise provide all tasks necessary for or incident to the performance of the work set forth herein.

In consideration of satisfactory performance of work described in Section C of this contract, the contractor shall be compensated for the number hours ordered at the fixed loaded hourly rates set forth below along with applicable travel and (deliverables – Refer to Appendix D).

Travel, when applicable, shall be paid at actual cost in accordance with the U.S. General Services Administration (GSA) Federal Travel Regulations (FTR).

Funding for all Orders placed against this IDIQ contract will be subject to the availability and/or limitation of funds. It is the Government’s intent that initial orders will be funded with Coronavirus Aid, Relief, and Economic Security (CARES) Act funding.

B.4. CONTRACT PRICE

a. This is a T&M performance-based IDIQ type contract(s). The guaranteed minimum amount for each contract(s) is $150,000 during the base year of the contract. This minimum shall be met through issuance of one or more task orders. The total aggregate amount of the contract assuming all three (3) option periods are exercised shall not exceed $20,000,000.00 for the entire four year period of the contract.

All rates proposed for this RFP shall be based on the labor categories required for a period of 12-months, including the base and all option periods for each Order placed against the IDIQ contract(s). Contractor shall propose a total contract price which includes fully burdened labor rates for the base and all option contract line item numbers (CLINS), including travel and applicable Per Diem. The offeror shall clearly identify the standard rate and account for any management and administrative resources (such as Medical Director oversight) or other positions the offeror proposes to support the contract, projected overtime, holiday pay, weekend pay, on-call rates, travel pay, sick/self-isolation, retention/referral bonuses, or other compensation anticipated to attract and retain in active and available status, qualified CCRT members proposed for each labor category.

b. Upon delivery and acceptance of the services described in the SOO and resulting

Contractor’s PWS of this contract and identified in the schedule of charges below, the Government shall pay to the Contractor the number of hours specified in individual task orders at the rates specified below per the following Contract Line Item Numbers (CLINs) accordingly:

SCHEDULE OF CHARGES FOR THE BASE PERIOD

CLIN #

Labor Category

Unit Onsite Labor

Rate ($) Offsite Labor Rate

001 Critical Care Response Teams (CCRTs)

001A Physician (Task 2.3.1)

Hour

001B Registered Nurse (Task 2.3.2)

Hour

001C Registered Respiratory Therapist (Task 2.3.3)

Hour

001D Nurse Practitioner – Optional (Task 2.3.4)

Hour

001E Physician Assistant – Optional (Task 2.3.5)

Hour

001F Health Care Professional – Optional (Task 2.3.6)

Hour

002 Key Personnel

002A Program Manager

Hour

002B Physician and Nursing Oversight (Medical Director)

Hour

SCHEDULE OF CHARGES FOR THE OPTION YEAR 1 (OY1)

Onsite Labor Rate

Offsite Labor Rate

1001 Critical Care Response Teams (CCRTs)

1001A Physician (Task 2.3.1)

Hour

1001B Registered Nurse (Task 2.3.2)

Hour

1001C Registered Respiratory Therapist (Task 2.3.3)

Hour

1001D Nurse Practitioner – Optional (Task 2.3.4)

Hour

1001E Physician Assistant – Optional (Task 2.3.5)

Hour

1001F Health Care Professional – Optional (Task 2.3.6)

Hour

1002 Key Personnel

1002A Program Manager

Hour

1002B Physician and Nursing Oversight (Medical

SCHEDULE OF CHARGES FOR THE OPTION YEAR 2 (OY2)

Labor Rate

Offsite Labor Rate

2001 Critical Care Response Teams (CCRTs)

2001A Physician (Task 2.3.1)

Hour

2001B Registered Nurse (Task 2.3.2)

Hour

2001C Registered Respiratory Therapist (Task 2.3.3)

Hour

2001D Nurse Practitioner – Optional (Task 2.3.4)

Hour

2001E Physician Assistant – Optional (Task 2.3.5)

Hour

2001F Health Care Professional – Optional (Task 2.3.6)

Hour

2002 Key Personnel

2002A Program Manager

Hour

2002B Physician and Nursing Oversight (Medical

SCHEDULE OF CHARGES FOR THE OPTION YEAR 3 (OY3)

Labor Rate

Offsite Labor Rate

3001 Critical Care Response Teams (CCRTs)

3001A Physician (Task 2.3.1)

Hour

3001B Registered Nurse (Task 2.3.2)

Hour

3001C Registered Respiratory Therapist (Task 2.3.3)

Hour

3001D Nurse Practitioner – Optional (Task 2.3.4)

Hour

3001E Physician Assistant – Optional (Task 2.3.5)

Hour

3001F Health Care Professional – Optional (Task 2.3.6)

Hour

3002 Key Personnel

3002A Program Manager

Hour

3002B Physician and Nursing Oversight (Medical

Definitions:

Onsite Rates: Onsite labor rate applies only to work completed by CCRT members and/or the Contractor’s Key Personnel assigned to provide Medical and Nursing Oversight. Onsite Deployment Start Date and, if known, Deployment End date will be specified on each task order. If the Contractor believes onsite Key Personnel identified for physician and nursing oversight is necessary, the Contractor shall request approval from the Contracting Officer in advance of incurring expenses. The request must include a rationale and estimated level of effort. A CCRT physician cannot also serve in the role of Key Personnel for the oversight of CCRT physician and nursing services.

Offsite Rate: Offsite labor rate applies when a CCRT member is performing work at a location other than a federal hospital, tribal hospital or other associated medical location. The contractor shall provide the COR and Contracting Officer an estimated level of effort by labor category, identify the CCRT member(s) who will be performing the task, in advance of incurring charges for the preparation of reports, policies, procedures, nursing competencies, or other documents.

Offsite labor rate does not apply for CCRT member to complete required onboarding employment screening paperwork for federal background investigation pre-clearance and credentialing/privileging applications. However, the contractor shall bill only for actual time needed for CCRT member to complete required trainings and orientations, which includes:

i. NTE 4-hours per CCRT member is allotted to complete initial pre-arrival required trainings, Electronic Health Record orientation, and any hospital specific orientation that may be done virtually prior to arrival.

ii. NTE 2-hours per CCRT member is allotted for CCRT member who has already been deployed to at least one facility, in order to complete any pre-arrival facility specific training, facility specific EHR orientation, or new/revised IHS mandatory trainings. The contractor shall bill for only actual time to complete required trainings and orientations. Onsite rate shall apply for trainings, as well as orientations occurring onsite at a facility. The government estimates that facility specific orientation will occur during the first and second onsite days, and typically be completed by the end of the second day, but will vary by facility. CCRT members who have already been on at least one deployment under this purchase order may not need two days of orientation.

Offsite labor rate applies if the CCRT member is requested to participate in pre- or post-deployment meetings.

Offsite labor rate does not apply to CCRT rest period(s) when a rest period is applicable. In accordance with Task 2.5.2 of the SOO, “a minimum 24-hour rest period is required if the CCRT member is working 10 or more 12-hour consecutive shifts, or if deemed necessary by the facility.” In the event the federal or tribal facility determines a rest period is required, the offsite labor rate does not apply to CCRT rest period(s). If a rest period is required, the Contractor may only invoice for actual travel-related costs incurred by each CCRT member that includes: per diem, car rental, hotel, or other authorized expenses, in accordance with GSA Federal Travel Regulations.”

Offsite labor rate applies to only work completed by CCRT members, or the Contractor’s Key Personnel. Offsite labor rate does not apply to other positions identified in the contractor's technical response to the SOO or Contractor's Quality Control Plan, that are included in contractor’s fully burdened labor rates.

Travel Labor Rate: Travel labor rate applies when the CCRT member is in deployment status and traveling between facilities during scheduled 8-hour or 12-hour shift. Travel labor rate does not apply when traveling from the location of lodging to hospital, unless the nearest hotel or other accommodations are 50 or more miles from the job site. Travel rate begins on the first mile of travel after the 50 miles.

Unless work is being conducted en route to or from an IHS or tribal hospital, the offsite rate will apply.

Travel labor rate does not apply to CCRT labor that the contractor may compensate the CCRT member for the individual’s time traveling to/from an IHS or tribal hospital or other medical location to arrive/depart at the deployment location by the Deployment Start Date or Deployment End Date.

The Contractor shall be paid all allowable charges upon submission of an invoice and completion and acceptance (if deliverable) or verification (if service) by the Contracting Officer's Representative (COR), of the deliverables and/or services indicated below. Invoices shall be submitted in accordance with the instructions contained in FAR clause 52.232-25, Prompt Payment, and Section G.2 of this contract.

B.5. OPTION PRICES

a. Pursuant to FAR Clause 52.217-8, Option to Extend Services and FAR Clause 52.217-9, Option to

Extend the Term of the Contract, set forth in Section I – Contract Clauses of this contract, the Government may, by unilateral contract modification, require the Contractor to perform the Option Period(s) as defined in the SOO and resulting Contractor PWS of this contract. If the Government exercises this/these option(s), notice must be given before the expiration date of the contract. Specific information regarding the time frame for this notice is set forth in the Option Provisions of this contract. If an option period is exercised, the estimated amount of labor hours will be increased at the labor rates set forth below.

b. Upon delivery and acceptance of the services described in the SOO and resulting Contractor PWS of this contract and identified in the schedule of charges below, the Government shall pay to the Contractor the number of hours specified in individual task orders at the rates specified below per the following Contract Line Item Numbers (CLINs) accordingly: Refer to Pricing Schedule

B.6. NUMBER OF BILLABLE LABOR HOURS INCURRED

Contractor shall include supporting documentation with each invoice showing the actual number of billable labor hours worked substantiated by the Final CCRT Daily Work Schedule (Appendix D:

Schedule of Deliverable, Deliverable Item 5) verified by the designated IHS or tribal facility point of contact. In accordance with Section F2. Place of Performance and in the event that services are required at additional IHS or tribal facilities, the agreed upon fully loaded (burdened) rates for the same labor categories as above will apply.

Labor Hour Unit: The contractor shall bill for only actual time in .25 hours segments. The segment .25 (1/4 of an hour) shall be the minimum billable charge. The contractor shall bill for only actual time in .25 hours segments. The segment .25 (1/4 of an hour) shall be the minimum billable charge.

SECTION C- STATEMENT OF OBJECTIVES (SOO)

C.1. Scope

The scope of this contract includes 1). identification, staffing and managing multi-disciplinary, expert and mobile Critical Care Response Team(s); 2). prepare staff to treat critically ill COVID- 19 patients by providing hands-on critical care clinical education and training prior to, or in the event of, an influx of critically ill COVID-19 patients; 3) augment existing staff at a facility with a team of expert critical care physicians, Critical Care Registered Nurses (CCRNs), and Registered Respiratory Therapist (RRT); and 4). Provide critical care virtual training on an as needed basis as new information and evidence-based best practices and guidelines to care and manage critically ill COVID-19 patients emerge.

C.2. Program Objectives and Requirements

Objective 1: Increase the survival rate of patients presenting to an IHS or tribal facility for known or suspected COVID-19.

Task Area 1: COVID-19 Critical Care Response Team Management

All patient care and clinical education must be provided within nationally acceptable standards of care and guidelines, or currently available best practices. IHS recognizes that evidence-based standards of care for the treatment of patients with COVID-19 is evolving. The Contractor shall have institutional knowledge and expertise with developing protocols and guidelines for treating patients with suspected or confirmed COVID-19, or shall have access to clinical experts with this knowledge and experience.

1.1 Contractor shall staff, provide all necessary administrative, logistics coordination and management necessary to deploy mobile, agile, and expert critical care rapid response team(s) to provide onsite life-saving, high quality health care to manage and treat critically ill American Indian/Alaskan Native patients.

1.2 Contractor shall staff the Critical Care Response Team(s) with qualified physicians, CCRNs, respiratory therapists and other health professionals, as deemed necessary to meet the needs of the facility when directed by the designated IHS clinical leadership, Contracting Officer/Contract Specialist, or COR that one or more Contractor critical care response team(s) are necessary to be deployed.

1.3 The Contractor shall ensure continuity of patient care at all times during the contract period of performance.

1.3.1 The Contractor shall have adequate back-up/on-call policies, processes, and resources available for this contract, to ensure 100% coverage, for all required services.

1.3.2 The Contractor shall ensure that all CCRT members arrive by the deployment start date. The government anticipates in the event the primary reason for deployment is to provide urgent lifesaving medical care, that a CCRT may be required to be onsite within

24-48 hours of notification from IHS that onsite services are required. In the event a team member is not available for a scheduled deployment or scheduled work shift, the Contractor must provide advance notification to the government, with the reason for delay and contingency plan that includes the replacement CCRT member or timeline for securing an alternate individual to fill that labor category. The government defines the deployment start date and length of deployment.

1.4 Critical Care Response Team management shall include all necessary activities to establish, maintain and make team adjustments when necessary to meet requirements and objectives of the contract.

Task Area 2: Provide evidenced-based/best practice high quality health care to treat critically ill patients, including individuals presenting to IHS or tribal facilities with suspected or confirmed COVID-19, who require intensive medical care.

2.1 The Contractor shall provide 100% coverage for all required labor categories for at least one IHS or tribal hospital in the scope of work. If resources are available, and in the event more than one location requires a team at the same time, the Contractor may be requested to provide a fully resourced team at each of the hospitals or other medical facilities requiring services at the same time.

2.2 Contractor shall ensure that at a minimum, the labor categories identified in Task 2.3 are available for a Critical Care Response Team and that all Critical Care Response Team members meet or exceed the minimum requirements and performance levels during the contract performance period. See Appendix B: IHS National COVID-19 Critical Care Response Team Requirements.

2.2.1 The Contractor shall ensure that all services are performed by individuals who meet the minimum qualification standards identified on Appendix B, as well as general standards for each position established by the Office of Personnel Management General Schedule qualification standards for the equivalent Job Series. Evidence must be substantiated in the individual’s current resume, curriculum vitae (CVs), verifiable references, and other required supporting documentation deemed necessary by the IHS or tribal facility to review the Contractor’s qualifications in order to perform services in a patient care environment.

2.2.2 All Licensed Independent Practitioners (LIPs) must be credentialed and granted privileges to perform services under the contract. See also Task 2.7:

Credentialing and Privileging Process & Requirements.

2.2.3 The Contractor shall ensure that the individual has the necessary knowledge, skills and competencies to perform the essential duties to meet the terms of the SOO.

2.2.4 All Contractors must meet mandatory federal security clearance requirements.

2.2.5 All Contractors must be willing to travel on short notice and abide by national and state travel restrictions and other laws that may be in effect to slow the spread of COVID- 19, which may include the possibility of being under a “Stay at Home” order and/or quarantined in accordance with state, tribal or local laws.

2.3 The Contractor must be able to provide all required labor categories below. At a minimum, for initial onsite deployments, at least one credentialed and privileged Physician, 1-2 critical care RNs (CCRNs), and 1 Registered Respiratory Therapist are required on each onsite team engagement. An Advanced Practice Provider (2.3.4 or 2.3.5) with critical care patient care experience and qualifications may be added to the team if deemed necessary, but cannot be substituted for a Physician. If the primary reason for the onsite deployment is a follow-up / revisit, for non-urgent patient care situations, the location may not require all of the labor categories. Task orders will specify what labor category (ies) are required. In the event additional health professional expertise is required, the government will specify this need under Task 2.3.6 on the task order and request a labor rate from the Contractor for that service, if there is a qualified and available resource.

Required

2.3.1 Physician services

2.3.2 Nursing services

2.3.3 Registered Respiratory Therapist services

Optional

2.3.4 Nurse Practitioner (NP)

2.3.5 Physician Assistant (PA-C)

2.3.6 Other Health Professional services

2.4 The Contractor shall ensure during the performance period(s), each team(s) is fully resourced and each accepted team member completed all required trainings and has been granted Provisional Authorization – pending favorable adjudicated background investigation” status, as deemed by IHS Personal Security Representative/HR designee, prior to performing services in a patient care environment. Critical Care Response Team members shall complete facility specific orientation and required trainings, prior to arriving onsite. In the event Disaster privileges are granted because the primary purpose for the onsite deployment is to provide urgent lifesaving medical care, required training must be completed during required hospital orientation, but no later than 72 hours from when onsite services begin. For this contract, fully resourced shall mean all Critical Care Response Team members meet Appendix B: minimum contract qualifications and comply with the minimum performance standard requirements outlined in Appendix C:

Critical Care Response Team General Requirements (Non-Personal Services).

2.4.1 All LIPs are credentialed and granted privileges, based on the facility or IHS Area

Credentialing and Privileging requirements.

2.4.2 Completed the necessary documentation and ISSA training to ensure appropriate access to required information technology systems (Electronic Health Record and other applications).

2.4.3 Completed facility specific orientation and required IHS and/or facility required trainings.

2.4.4 All CCRT must submit required federal pre-clearance background investigation forms, including fingerprints and any other documentation deemed necessary by IHS to complete a federal pre-clearance background investigation. IHS will determine each CCRT member’s eligibility. Each CCRT member must be granted a “Provisional Authorization – pending favorable adjudicated background investigation” determination, as deemed by IHS Personal Security Representative/HR designee, prior to performing services in a patient care environment. The government will provide all required federal pre-clearance background investigation forms that each CCRT member needs to complete with the pre-clearance package, if offeror is awarded a contract. See Appendix D: Schedule of Deliverables, Item 2 for list of required forms and acceptable supporting identity documentation.

2.5 Deployment Length & CCRT Work Schedule

2.5.1 The IHS Pulmonary Critical Care Chief Clinical Consultant or their designee, in consultation with the facility clinical leadership, will determine the Deployment Start Date and if known, total number of days onsite services are required. The Deployment Start and Deployment End Date (if known), will be specified on each task order. The government anticipates the onsite deployment length to be a minimum of 5-7 consecutive days per deployment, on an as needed basis. Onsite deployments with a primary purpose for the CCRT to conduct hands-on clinical education may require longer consecutive onsite days to complete all required services.

2.5.2 The Contractor shall staff Critical Care Response Team(s) that can provide onsite direct patient care 24-hours/7 days a week. The government anticipates the CCRT member daily work schedule would not exceed 12-hours per shift. In the event that a CCRT member is required to work more than 12-hours in a shift for direct patient care situations only, advance written or verbal approval from the IHS Pulmonary Critical Care Chief Clinical Consultant and Contracting Officer is required. The contractor may bill only for actual hours worked. A minimum 24-hour rest period is required if the CCRT member is working 10 or more 12-hour consecutive shifts, or if deemed necessary by the facility.” The offsite labor rate does not apply to CCRT rest period(s). If a rest period is required, the Contractor may only invoice for actual travel-related costs incurred by each CCRT member that includes: per diem, car rental, hotel, or other authorized expenses, in accordance with GSA Federal Travel Regulations.

2.6 The Contractor shall coordinate logistics and ensure that all Critical Care Response Team members are onsite at all required locations by the deployment start date. The government anticipates in the event the primary reason for deployment is to provide urgent lifesaving medical care, that a CCRT may be required to be onsite within 24-48 hours of notification from IHS that onsite services are required.

Therefore, in accordance with the Contractor’s Performance Work Statement, Notional Government Quality Assurance Surveillance Plan (QASP) (Appendix H), Schedule of Deliverables (Appendix D), and Task 2.7, the contractor shall maintain a pool of qualified and pre-cleared CCRT members. All Critical Care Response Team members must meet the minimum acceptable IHS National COVID-19 Critical Care Response Team minimum contract qualification requirements for each labor category (Appendix B). All Licensed Independent Practitioners (MD, DO, Nurse Practitioner, PA-C, etc.) must be credentialed and granted privileges prior to seeing patients, in accordance with each hospital’s credentialing and privileging policies and application process.

2.7 Credentialing and Privileging Process & Requirements

2.7.1 General

Per the Indian Health Manual (IHM), Chapter 3, all Licensed Independent Practitioners (LIPs) (MDs, DOs; NPs; PA-Cs; etc.) shall be subject to each hospital’s credentialing and privileging requirements prior to being assigned to a patient care environment. Upon confirmation that privileges are granted, the LIP can treat patients. The Contractor shall ensure each hospital’s credentialing and privileging processes are followed and that requirements for Medical Staff appointment and reappointment are met in accordance with IHS policy, each hospital’s Governing Body bylaws, CMS Conditions of Participation, and applicable national accreditation standards.

All required insurances and liability coverage are incumbent upon the Prime Contractor, any Subcontractor, or Licensed Independent Provider (LIP). For purposes of this contract, all physicians or other LIPs must be covered by either an individual policy and/or an insurance policy held by the employing company/organization, with proof that the individual LIP or all LIPs are covered by that umbrella corporate policy. Contractor or Contract LIP applying for privileges shall submit proof of insurance that the policy is current, and coverage is a minimum indemnity amount of $1,000,000 per incident with $3,000,000 aggregate limit. If the Contract LIP’s licensing State requires a higher insurance limit to maintain licenses, the Contractor or Contract LIP must show proof of a current policy that meets each State’s requirement.

2.7.2 IHS Credentialing and Privileging Process & Requirements

For federal hospitals within the scope of this contract, specific full credentialing/privileging requirements for each IHS federal hospital will vary from facility to facility. IHS federal hospitals may also utilize a disaster credentialing and privileging process, in lieu of full credentialing/privileging, at the discretion of the facility. The IHS Disaster credentialing and privileging application process is the exception to the standard IHS credentialing and privileging process, and therefore, is only applicable to LIPs applying to work on the Critical Care Response Team in order to provide care on short-notice, in an emergency situation, and on a short-term basis, to critically ill patients. Specific credentialing /privileging requirements for each tribally managed hospital where services may be performed will vary from facility to facility.

Incomplete and/or inaccurate credentialing and privileging files and supporting documents needed for the Pre-Application file may be basis for the LIP to be disqualified from performing services under this contract, delay the credentialing process and could result in a negative Contractor performance evaluation rating, or other negative performance indicators.

All Locations (Federal or Tribal): Credentialing and Privileging related files for each Licensed Independent contract health care practitioner (LIP) who is approved by IHS to continue the onboarding process. The IHS will review the Contractor's submitted pre-screening package to determine if the contract health care provider meets the minimum contract qualifications.

Federal locations (Scenario A): If the facility requires full credentialing, and that individual is approved to move forward with the onboarding process, a complete credentialing / privileging application and all supporting documentation, is required for all LIP candidates for this contract, which includes the following labor categories: Physician (Task 2.3.1); Nurse Practitioner (Task 2.3.4; Physician Assistant (Task 2.3.5) candidates.

Federal locations (Scenario B): If the facility utilizes Disaster privileges for purposes of the CCRT contract, then the facility will review Appendix M: IHS Emergency Disaster Privilege Pre-Application Checklist and supporting documentation, and notify the Contractor and/or contracted health care provider if additional supporting documentation is needed for the facility to complete the credentialing process and grant Disaster privileges.

2.7.3 Complete and Clean Pre-Application File Requirements

The Contractor shall ensure that all LIPs applying for privileges expeditiously submit a complete pre-application file in accordance with the Schedule of Deliverables.

As deemed by IHS, each Pre-Application file must meet the minimum quality standards and requirements for the likely determination that the LIP will be granted privileges by each hospital:

a) Verification of a current, active, full, and unrestricted license or registration as a Physician from a State, the District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States.

b) Confirmation of relevant training, experience, current competency, and ability to perform privileges.

c) Favorable National Practitioner Data Bank (NPDB) report, and no current or previously successful challenges to licensure or registration; no subjection to involuntary termination of medical staff membership; or no subjection to involuntary limitation, reduction, denial or loss of clinical privileges.

d) Approval from authorized IHS facility leadership.

2.7.4 Additional Disaster Privilege Requirements (Federal locations – Scenario B): If federal hospital facility chooses Disaster credentialing/privileging (Scenario B), then within 72 hours of Disaster privileges granted, each LIP shall be subject to the following:

a) The Government will continue to verify the documents with their primary source and complete peer references and hospital affiliations verifications, according to each hospital’s Disaster privileging processes.

b) If either requirement 2.7.4 (a) or 2.7.4 (b) are not satisfactory within, and up to, 72 hours, of being granted Disaster privileges, the hospital leadership can withdraw Disaster privileges.

2.7.5 CCRT members granted privileges must maintain privileges during the contract performance period for each facility granted privileges. .

2.8 Contractor must have a quality assurance process to ensure all care is delivered in accordance with national standards and best practices. All patient care must be performed and documented in accordance with CMS Conditions of Participation, and if applicable, national accreditation standards. The Critical Care Response Team member (s) shall document the patient encounters in the applicable electronic health record and ensure 100% documentation of patient encounter, as deemed by the designated hospital official (s).

The Government (federal or tribally operated hospital designated officials) will conduct Focused Professional Practice Evaluation (FPPE) in accordance with national accreditation standards and each facility’s peer review policy and procedures. In addition, the Contractor must designate an individual with oversight responsibilities for patient care as well as clinical education services performed by any CCRT member under this contract or subsequent task orders.

Objective 2: Enhance existing IHS and tribal staff’s critical care knowledge and skills

Task Area 3: Critical Care Clinical Education

See also Clinical Education related deliverables (Items 9-13) on Appendix D: Schedule of Deliverables

The Contractor shall ensure qualified CCRT members assess staff skills and competencies, develop training, conduct training, document the results of the training, and evaluate training effectiveness for a diversity of existing IHS or tribal staff, comprised of permanent employees and locums/contractors.

It is the government’s intent that clinical education is practicum-based.

3.1 Hands-On Clinical Education Specific to Management of Patients with COVID-19

3.1.1 The Contractor shall ensure that all Critical Care Response Team members must have expert knowledge performing the necessary lifesaving procedures and teaching physician, nursing, and other health professionals evidence- based/best practices, while treating the patient (at the bedside/at the “elbow”). Clinical education must be taught in a way that will increase both the individual learner’s knowledge, and the overall institutional knowledge.

3.1.2 The Contractor shall assess, identify, deliver and tailor critical care clinical education based on the needs of each facility or needs identified by IHS. The overall goal is that when the team leaves, IHS or tribal physicians, nursing, and other health professionals at that local facility have the ability to perform the procedure(s) to manage critically ill patients, specifically patients with confirmed or suspected cases of COVID-19. IHS understands that since COVID-19 is an emergent infectious disease, best practices for the management of patients with COVID-19 may not be evidence-based and could change frequently. Due to the COVID-19 pandemic, upon contract award, IHS requires at least one (1) critical response team(s) to begin immediately conducting hands-on clinical education at as many facilities as possible in order to prepare the staff at these facilities to care for the significant influx of critically ill patients anticipated.

3.1.3 Practicum-based Clinical Education Topics:

The Contractor shall ensure qualified CCRT members have expert knowledge and recent experience teaching and performing a variety of critical care topics. Since May 2020, over thirty different training topics including the following were taught to over 500 frontline physicians, nurses, nursing assistants, paramedics, respiratory therapists, pharmacists, laboratory technicians, hospital quality managers and administrators, and other frontline IHS federal and tribal staff at the locations that a CCRT deployed. The list below is not all-inclusive and not all locations will require all these topics. Additional topics may be required at each location.

a) Alaris Pump

b) Arterial Blood Gas Procedure/Interpretation

c) Arterial Line/CVP Placement, Monitoring and Care

d) Blood Product Administration

e) COVID Inpatient Review

f) COVID Template Training

g) COVID-19 Bedside Teaching (multiple topics)

h) COVID-19 Code Blue

i) Hand Hygiene

j) Hypoxia Management

k) Management of Airway

l) Management of Peritoneal Dialysis

m) Management of Pneupac Parapac Plus Ventilator

n) Management of RN Assisted Intubation

o) Management of Ventilator Patient

p) Management of Prone Ventilation

q) Nasograstric Tube Insertion

r) Nursing/RT COVID

s) O2 Escalation

t) O2 Management

u) Oxygen Delivery Systems

v) Personal Protective Equipment Donning and Doffing

w) Proning

x) RT/Nursing Care Aline COVID Patient

y) Management of Vapotherm High Flow Oxygen System

z) Weaning of Adjunct Oxygen Delivery

3.2 During the contract performance period, the Contractor may be required to develop new training and/or teach in a virtual and/or clinical setting to train the IHS or tribal workforce to implement new guidelines, standards, policies, and/or practices. In the event that new or custom training is needed, the Contractor shall coordinate the delivery of all pre-planned training sessions with the designated Government or facility clinical education point(s) of contact. All new training/webinars must be in the scope of services for this contract, and be specific to improving IHS or tribal staff’s skills to manage critically ill patients. IHS or tribal staff from any

IHS or tribal facility may participate in trainings conducted by the Contractor, as determined by

IHS.

3.3. Virtual Training:

If virtual training is needed, clinical education must be provided within nationally accepted standards of care and guidelines, or currently available best practices for taking care of critically ill patients with COVID-19. Virtual, web-based training may be delivered via synchronous or asynchronous methods and include simulation, mock drills, or other techniques. The Contractor shall record in-person and/or virtual trainings, when possible. The Contractor shall leverage technology that the local facility staff have access to and are approved technologies to be safely operated in the IHS network; which may include, but not limited to: Health Stream, Adobe Connect, Microsoft Skype, Zoom, Cisco Meeting to deliver online training/courses. The IHS prefers that when possible, virtual trainings have an easy and trackable registration process to capture the number of participants and easily identify invitees and participants. The Contractor may be asked to provide, upon successful course completion, a list of the attendees; and/or individuals certificate of completion to each attendees The Contractor shall ensure adequate lead- time to review content prior to launching training, when possible. All material developed under this contract, unless otherwise agreed to by IHS and the Contractor, is property of IHS.

All training and materials have to be compliant with Section 508-accessibility standards.

C.3. ASSUMPTIONS/CONSTRAINTS:

1.1 Government Furnished Property

Contractor Exclusive Use: Personal Protective Equipment (PPE).

The Government will furnish the Contractor with appropriate PPE other than specified below.

The Government will be responsible for any repair, cleaning, and inventory required for the PPE.

This does not include any type of uniform or laboratory coat, which the CCRT are required to furnish. During the contract performance period, the government will supply all necessary Personal Protective Equipment (PPE) and supplies, where Critical Care Response Team(s) will perform direct patient care services.

1.2 Contractor Furnished Property

The Contractor shall provide all uniforms and other personal medical instruments subject to the following:

1.2.1 Uniforms and Lab Coats: Uniforms and Lab Coats shall conform to the requirements of the Indian Health Service Manual, Part 3 Chapter 4 and meet the approval of the Clinical Director, or their designee at each IHS facility.

1.2.2 Other personal medical instruments: “Other personal medical instruments” are defined as Contractor owned items and may include but not limited to scissors, as appropriate to the work unit. The Contractor shall not use unsafe equipment or supplies at any time during performance of this contract. All Contractor furnished equipment and supplies shall be subject to inspection by the Government. The Government reserves the right to prohibit the use of any materials, supplies, or equipment.

1.3 Government Furnished Information (GFI): Government unique information related to this requirement, which is necessary for Contractor performance will be made available to the Contractor. A list of Government point of contacts will be provided to the Contractor after Contract award. Example of GFI may include hospital-specific policies, procedures and protocols, for example:

• Written Competency Assessments

• Confidentiality/HIPAA/Patient’s Rights

• EMTALA Compliance Exam, 2004

• Standard Emergency Codes

• Confidentiality: Legal and Ethical Concerns in Healthcare

• Verbal and Telephone Orders

• Pain Management

• Focus Charting

• Medical Staff Bylaws and Rules & Regulations

• Department specific policies and procedure manuals such as: Authoritative

Respiratory Therapy Policies and Procedures manual

1.4 Joint Use by the Government and the Contractor: The Government will provide, for joint use by the Government and the Contractor, all necessary equipment, supplies, and clinic space to perform the services under this contract.

1.5 Contractor Employee Training: Unless otherwise required by IHS federal or tribal facility, the training of Contractor employees assigned to this contract shall be performed at the Contractor’s own expense. The Government will provide training necessary to onboard Critical Care Response Team members performing patient care in accordance with each hospital’s employee orientation process and mandatory IHS or facility- specific trainings.

C. 4. PERFORMANCE EVALUATION

The Contractor’s performance will be evaluated in accordance with the standards set forth in the contract, Contractor’s Quality Control Plan, and Government’s Quality Assurance Surveillance Plan. Contractor shall submit a notional Quality Control Plan (QCP) with specific key performance indicators and acceptable quality standards to meet all task area requirements with proposal. The Government will review and determine the acceptability of the QCP proposed by the Contractor. At least one performance measure and acceptable quality level must be included for each major Task Area. Performance measures may include but not limited to:

• Task Area 1: CCRT Management and Task 2.6: The Contractor shall coordinate logistics and ensure that all Critical Care Response Team members are onsite at all required locations by the deployment start date. The government anticipates in the event the primary reason for deployment is to provide urgent lifesaving medical care, that a CCRT may be required to be onsite within 24-48 hours of notification from IHS that onsite services are required.

• Task 1; Task 2.3.1; Task 2.7; and Appendix D: Schedule of Deliverables (Item 6): The Contractor must ensure that all physicians, NPs and other Licensed Independent Practitioners (LIPs) submit a clean and complete Credentialing and Privileging application to each facility where services will be needed. The Contractor must ensure that all approved physicians, NPs, and other LIP granted privileges, maintain credentialing and privileging requirements for each facility services may be needed, during the contract period of performance.

• Task 1; Task: 2; and Appendix D: Schedule of Deliverables (Item 2): The Contractor must ensure all pre-clearance packages for each individual proposed to perform services includes complete and correct pre-clearance federal background investigation forms and acceptable primary source identity verification (Section H.4.5 and Appendix M: IHS Contract Qualification Pre-Clearance Documents); current resume/cv, with complete supporting documentation that includes current licensure, certifications.

• Task Area 2: All CCRT members provide exceptional, high-quality critical care services to all COVID-19 patients or other critically ill patients. In accordance with Task 2.8, Contractor must have a quality assurance process to ensure all care is delivered in accordance with national standards and best practices. All patient care must be performed and documented in accordance with CMS Conditions of Participation, and if applicable, national accreditation standards. The Critical Care Response Team member (s) shall document the patient encounters in the applicable electronic health record and ensure 100% documentation of patient encounter, as deemed by the designated hospital official (s).

• Task Area 3: All CCRT members receive excellent training evaluation feedback from existing staff. Onsite or virtual clinical education trainings enhance the critical care skills and competencies of physicians, nursing, and other staff to care for patients under investigation or confirmed positive for COVID-19.

C.5. Additional Contractor Requirements:

1. Quality Control Program. The Contractor shall establish and maintain a Quality Control Program (QCP) to ensure the requirements of this effort are provided as specified. The Contractor shall submit to the government their quality processes in the form of a Quality Control Plan. This plan shall be submitted to the Contracting Officer’s Representative (COR) for review and acceptance, rejection, or further modification with the Proposal and the Final submission, due in accordance with the Appendix D: Schedule of Deliverables, Deliverable Item #16. The COR will notify the Contractor of acceptance or required modifications to the plan and any adjustment allowed to the performance date. The Contractor shall make appropriate modifications (at no additional costs to the Government) and obtain acceptance of the plan by the COR. The Contractor shall appoint a Quality Control representative that is knowledgeable of the necessary requirements of this program. Updates to the plan to assure compliance to the SOO requirements are the responsibility of the Contractor as part of normal preventive and corrective actions. The plan shall include, but not be limited to, the following:

• Be structured to assure the individual responsible for Quality Control (QC) is authorized by the organization to take actions described.

• Contain procedures for written and verbal communication with the Government regarding performance of the contract

• Contain clear, measurable, and acceptable levels of performance

• Contain procedures for preventing defects and deficiencies, early detection of problems, and handling corrective actions without dependence upon Government intervention

• Contain surveillance procedures for each service to be monitored. These procedures shall identify the solution/service under surveillance, who will perform the surveillance, the frequency and method of surveillance, and procedures for correction of deficiencies.

• Include a system to investigate and resolve customer complaints. The investigation results shall be documented and forwarded to the COR to include immediate corrective actions to prevent future complaints.

• Provide a record of all Contractor QC checks and corrective actions. These files shall be maintained by the Contractor and shall be available upon request to the COR during the performance period.

2. Disclosure of Government Information. Contractor personnel shall comply with security requirements about disclosures of intelligence and…