Amendment 1 to 23R00002.pdf

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

(a) By completing items 8 and 15, and returning or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

E. IMPORTANT: Contractor is not is required to sign this document and return copies to the issuing office.

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT 1. CONTRACT ID CODE

2. AMENDMENT/MODIFICATION NUMBER 3. EFFECTIVE DATE 4. REQUISITION/PURCHASE REQUISITION NUMBER 5. PROJECT NUMBER (If applicable)

7. ADMINISTERED BY (If other than Item 6) CODE

STANDARD FORM 30 (REV. 11/2016)

Prescribed by GSA FAR (48 CFR) 53.243

FACILITY CODE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED (SEE ITEM 11)

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED (SEE ITEM 13)

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers is extended. is not extended.

12. ACCOUNTING AND APPROPRIATION DATA (If required) copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted;

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS.

IT MODIFIES THE CONTRACT/ORDER NUMBER AS DESCRIBED IN ITEM 14.

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER

NUMBER IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation data, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15C. DATE SIGNED

15A. NAME AND TITLE OF SIGNER (Type or print)

16C. DATE SIGNED

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

PAGE OF PAGES

6. ISSUED BY CODE

8. NAME AND ADDRESS OF CONTRACTOR (Number, street, county, State and ZIP Code) (X)

CODE

15B. CONTRACTOR/OFFEROR

(Signature of person authorized to sign)

16B. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

Previous edition unusable

Craig Wells, CCO

Amendment one (1) as follows:

1. See attached revised Performance Work Statement (PWS).

2. See attached revised Provisions and Clauses.

There are no other changes made by reason of this amendment.

75H70623R00002

12/21/2022

12/09/2022

Pine Ridge Indian Health Service Certified Nurse Midwife Performance Work Statement

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Performance Work Statement (PWS) Certified Nurse Midwife Services

Background

The mission of the Pine Ridge Indian Health Service (PRIHS) is to raise the physical, mental, social and spiritual health of American Indians and Alaska Natives to the highest level. To meet this mission, Certified Nurse Midwifery (CNM) services are extensively utilized through the reservation for nearly all aspects of CNM Obstetric & Gynecologic health care, including Labor & Delivery services. Pine Ridge Reservation is located in the southwestern corner of South Dakota, approximately 100 miles from Rapid City. Surrounded by rolling prairie, Badlands and Black Hills, the Pine Ridge Reservation is home to the Oglala Lakota Nation.

Pine Ridge Reservation possesses low life expectancy in the United States and high infant mortality rates. Adding, consistently been the poorest county (Oglala Lakota County) in the US according to the US Government. Unemployment is very high in this population. Note, closest higher level of care is 35 minutes away by life flight and 1 hour and 30 minutes by ground ambulance. Transfer weather conditions at times can be challenging thus precluding air or even ground transfer.

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. PRIHS is linked to the Great Plains Area Office (IHS) in Aberdeen, South Dakota.

The Pine Ridge Hospital provides an expanded level of health care services including, but not limited to:

Emergency Room Department, Pharmacy, Physical Therapy, Public Health Nursing, Radiology, Inpatient Care, Laboratory, Dental, Optometry, Purchased Referred Care, Mental Health, Outpatient Clinic, Pediatric Clinic, Dietitians, Cardiology, Ear Nose & Throat, OB/GYN, Podiatry and Orthopedics.

General Requirements

Purpose To provide direct patient care, supporting the current Nurse Midwifery staff, especially in times of temporary staffing shortages. It is of utmost importance the Contractor renders seamless coverage and provides continuity care. PRIHS is seeking one (1) to five (5) qualified CNMs as full-time equivalents (FTEs). The contract company shall furnish licensed, experienced personnel, with the relevant background in accordance with the terms and conditions specified in the resulting contract.

At a maximum, the Government may order five (5) CNMs under each task order during a specific period of time. At a minimum, the Government may order one (1) CNM under each task order during a specific time period.

Contract Type Firm fixed unit price (hourly rate), non-personal health care service, Indefinite Delivery, Indefinite Quantity contract. The contract will be administered by issuing task orders (TOs) for the performance of work. Only an authorized Government Contracting Officer (CO) can issue a TO under this contract. TOs

Page 2 of 17 Version 0000 12/2022 shall be issued in accordance with Federal Acquisition Regulation provisions. TO periods may vary and will be no longer than a 12-month period.

Scheduled contract Providers who show up for work, will be paid based on labor hours worked documented on their approved timesheet and Health Information Management Clearance form.

Performance Period The contract performance period will be base year plus four option years. Every 12 months, dependent upon the need of PRIHS, is the option to extend the term of the contract. If PRIHS needs the service, an authorized government CO shall request to exercise a new option year. A preliminary written notice shall be delivered to contractor, at least 60 days before the current option year expires.

Place of Performance PRIHS is comprised of one hospital, three outlying clinics and a mobile unit. The Contractor’s primary duty station will be at Pine Ridge Hospital (PRH). At times, the Contractor may be asked to provide services at any of the outlying clinics or mobile unit.

1. Pine Ridge Hospital (located in Pine Ridge, SD)

2. LaCreek Clinic (outlying clinic, located in Martin, SD)

3. Kyle Health Center (outlying clinic, located in Kyle, SD)

4. Wanblee Health Center (outlying clinic, located in Wanblee, SD)

5. Mobile Unit (parked at PRH, deployed throughout Pine Ridge Reservation)

In cases where the Contractor must travel to an outlying clinic, authorization will be granted to operate a government owned vehicle while in performance of the duties outlines in this work statement. Pre-requisite criteria must be met for authorization.

1. Possess a valid driver’s license

A. provide a copy to the Contract Officer Representative (COR) and PRIHS OB/GYN Supervisor

2. Complete the Drivers Overview and Fleetcard Use training in the Health & Human Services Learning Management System (LMS) A. provide a copy of the certificate of completion to the COR and PRIHS OB/GYN Supervisor B. training must be recertified on the 2-year anniversary of the initial certification.

Travel time to the Pine Ridge Hospital, mobile unit, or any of the outlying clinics is not billable to Pine Ridge Indian Health Service.

Performance Requirements

Pre-requisites to determine contract CNM eligibility for contract performance:

1. Please submit contract CNM Curriculum Vitae/Resume to PRIHS OB/GYN Supervisor

2. Pre-Application Questionnaire to the PRIHS OB/GYN Supervisor

If approved/accepted by the PRIHS OB/GYN Supervisor. The background investigation & credentialing & privileging processes are to immediately follow.

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Scope The Contractor shall furnish uninterrupted CNM primary care services. These services will be compatible with the facilities’ operating capacity and equipment. The contract CNM shall perform services within the PRIHS bylaws, policies and procedures. The Contractor shall provide Midwifery services to beneficiaries served by PRIHS. The Contractor shall report to the PRIHS OB/GYN Supervisor and/or Clinical Director. It is important to note; the respective contract company supervises the CNM contract personnel. Contract services shall cover the range of Midwifery services typically provided in rural civilian practice, including the following:

a. Management of intrapartum period for normal and high-risk mothers; provide health care for newborns; provides women’s health care and adult/adolescent sexual assault forensic exams (SAFE) related to sexual assault, educate, counsel, and advise patients on all aspects of the reproductive cycle and related psychosocial issues;

b. Provides on call & consultative Midwifery services. On call services include Labor and Delivery, care of the postpartum patient, emergent women’s health issues, and sexual assault examinations.

c. Routine duties shall include providing maternal health care services.

d. Knowledge of nurse-midwifery and medical management practices in caring for well-women, mothers and newborns and patients affected by sexual assault throughout the lifespan.

e. Knowledge of frequently used drugs including normal dosage, administration, action, adverse effects and ability to perform and interpret specified laboratory tests.

f. Ability to teach, counsel and facilitate participation throughout the lifespan.

g. Ability to utilize, implement and supervise electronic data collection equipment; to interpret and apply the informational output in managing care.

h. Contract staff shall comply with all PRIHS infection control and safety procedures, practices and standards. This includes COVID-19 policies/procedures, appropriate use of Personal Protective Equipment (PPE), and hand hygiene policies, to which include, requirements to wear masks at all times during work hours.

i. Contract staff shall respect and maintain basic rights of patients to include, but not be limited to, personal dignity.

The Federal Tort Claims Act does not cover the Contractor nor contract Providers. The Contractor shall be responsible for providing current liability insurance.

The work may require prolonged periods of standing; walking over rough, uneven or rocky surfaces, recurring bending, crouching, stooping, stretching, reaching; recurring lifting of moderately heavy items such as patients or equipment (occasionally over 50 pounds). The work may require specific, but common, physical characteristics of ability such as above average agility and dexterity. Round-the-clock coverage for patient care needs may cause physical and emotional stressors unique to the role.

Pine Ridge Indian Health Service (PRIHS) reserves the right to refuse acceptance of any contract CNM at any time after performance begins, if personal or professional conduct jeopardizes patient care, counters the I.H.S Standards of Conduct, or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal

Page 4 of 17 Version 0000 12/2022 complaints by the patient or other staff members to designated Government representatives. Standards of conduct shall mirror those prescribed by current federal personnel regulations at 5 CFR part 2635.

Should the PRIHS Supervisory OB/GYN or designee show documented clinical problems or continual unprofessional behavior/actions with any contract CNM, s/he may request, without cause, immediate replacement of said contract CNM. Each complaint will be addressed on an ad-hoc basis, based on the outcome, may be grounds for immediate removal of the contract CNM.

Quality assurance procedures established by PRIHS shall be used for continuous monitoring. The performance by the contract CNM, the quality of services rendered, and any documentation or written material in support of same, shall be subject to continuous inspection, surveillance and review for acceptance by the Contracting Officer Representative (COR) or designated representative.

New Employee Orientation (NEO) & Trainings After receiving a favorable adjudicated security clearance, New Employee Orientation (NEO) is to begin.

NEO is required for all new staff, occurs every other week & is held at the PRIHS Nursing Library. NEO must be completed before performing any services of this contract. NEO labor hours are billable to

PRIHS.

In addition, the contract CNM shall complete all PRIHS required trainings as requested. Certificates of completion shall be submitted to the PRIHS OB/GYN Supervisor.

Pine Ridge Indian Health Service New Employee Orientation Contacts:

1) Heather Brehmer, Staff Development 2) Jacklyn Miller, Nurse Educator Office: 605 867 3334 Office: 605 867 3261 Email: Heather.Brehmer@ihs.gov Email: Jacklyn.Miller@ihs.gov

Credentialing & Privileging (C&P) The standards of Midwifery practice and duties of the Contractor shall be pursuant to current Medical Staff Bylaws, Nurse Midwifery guidelines and protocols/policies of the Pine Ridge Indian Health Service (PRIHS). In addition, contract CNMs shall perform services per their CNM licensure and within Nurse Midwifery scope of practice in compliance with The Joint Commission (TJC) standards and CMS regulations. The Contractor shall be required to participate in a quality improvement program, which is consistent with TJC requirements for ongoing monitoring and evaluation of the quality and appropriateness of care.

Midwifery services shall not be performed by a contract CNM until PRIHS Governing Body has granted professional staff membership and clinical privileges in writing. As a prerequisite to performance under the resultant contract, the contract CNM performing the services must be privileged in accordance with PRIHS/Great Plains Area credentialing policy. Therefore, compliance with the PRIHS privileging requirements is essential in the performance of the contract. Any failure to comply with Indian Health Service requirements shall be considered to be non-performance of the contract. The Governing Body will not grant clinical privileges until it is determined that credentials information has been verified and until the contract CNM has completed and passed the background clearance process The Credentialing and Privileging process on average may take up to 30-45 business days.

mailto:Heather.Brehmer@ihs.gov mailto:Jacklyn.Miller@ihs.gov

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The Contractor shall have basic core privileges granted upon verification of all credentialing processes.

The PRIHS Supervisory OB/GYN and/or Clinical Director shall deny privileges if the Contractor is unable to prove sufficient training, requested procedure logs, and state law citing specific allowance to perform requested privileges.

Required credential and appointment documents needed to allow initial provisional, subsequent active privileges and appointment shall include yet not limited to the following items.

1. Photo of individual that is recognizable.

2. Unrestricted active CNM State license photocopied.

3. Proof of Board certification by American College of Nurse Midwives (ACNM) as a Certified Nurse Midwife.

4. Complete Curriculum Vitae (CV) with complete and current medical provider work history, listing months and years. All gaps of medical employment eight-(8) weeks or greater must include an explanation by the applicant to the reason of this prolonged period of unemployment.

5. Current and active Basic Life Support (BLS), Advance Life Support (ACLS) and NRP, which will remain active throughout the provider’s tour, while seeing patients in Pine Ridge IHS Hospital/Clinics/ED.

6. Three-(3) letters of professional reference less than six-(6) months old from at least (1) supervisor and (2) from peers.

7. Active Drug Enforcement Administration (DEA) license including prescription privileges of Schedule 2 & 2N.

8. Current Liability Insurance of not less than $300,000/$1,000,000.

9. Record of recent (< 3 years) continuing education units (CEUs) or continuing medical education (CMEs) consisting of at least 20 credits of ongoing education in the area of OB/GYN care yearly.

10. Contractors not furnishing adequate number of CMEs before the expiration of their medical staff appointment will not have their credential file submitted for their next two-(2) year permanent medical staff appointment and clinical privileges.

PRIHS Credentialing & Privileging Point of Contact:

Tammy Bailey Office: 605 867 3043 Fax: 605 867 3271 Email: Tammy.Bailey@ihs.gov

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Certified Nurse Midwife Qualifications The contract Nurse Midwife shall illustrate competence in the basic Nurse Midwifery skills as defined by the American College of Nurse Midwives’ (ACNM) Core Competencies and certified to practice as a Nurse Midwife by successful completion of an ACNM accredited school and passing of the ACNM Board Certification Test. Applicant must be licensed to practice as a Nurse Midwife in one of the 50 states. The Contractor shall have the onus of supplying documentation supporting any requested privilege that is deemed outside the normal basic scope of a CNM.

Patient Safety Compliance and Reporting The contract CNM shall follow all established patient safety standards of care. The contract CNM shall make every effort to prevent medication errors, falls, and patient injury caused by acts of commission or omission in the delivery of care. All events related to patient injury, medication errors, and other breeches of patient safety shall be reported to PRIHS Risk Manager via iStar reporting system, per IHS Safety Policy. As soon as practicable (but within 24 hours), the contract CNM shall notify PRIHS Supervisory OB/GYN or designee & COR of incident.

Health Information Management (HIM)/Electronic Health Record (EHR) The contract CNM shall use PRIHS Electronic Health Record (EHR) system to maintain accurate and up-to-date information on clinical care provided to patients. Experience with EHR is highly recommended.

This includes completing all coding and purpose of visit diagnoses. All patient health record documentation initiated by the contract CNM shall be completed to the satisfaction of PRIHS. The PRIHS approving authority of the contract CNM’s timesheets will not sign off on/approve timesheets unless the contractor CNM has successfully completed all required patient medical encounter documentation (medical records). To ensure medical records are complete with no deficiencies, the contract CNM shall submit a complete Health Information Management Clearance From (HIMCF) with each timesheet. If the contract CNM has a deficiency, please work with a Health Information Management official to remedy.

The contract CNM completes the medical, obstetrical, family, socio-economic and dietary history.

Medical documentation shall be completed in a timely manner, in accordance to PRIHS policies and medical staff bylaws. All medical record documentation shall meet or exceed established standards for PRIHS to include, but not limited to: timeliness, legibility, accuracy, content and signature. All medical record information generated in the performance of this contract will remain the property of and subject to the exclusive control of PRIHS.

Medical quality assurance records created by or for any Indian Health program or a health program of an urban Indian organization as part of a medical quality assurance program are confidential and privileged. Such records may not be disclosed to any person or entity, except as provided in subsection

(d) 25 USC 1675 attached.

Health Information Management Clearance Forms are obtained from the Health Information Management Department. These forms must be completed and signed by a Health Information Management official.

Health Information Management Point of Contact:

1. Flora “Ellie” Bettelyoun, Coding Supervisor 2. Troylynn Weston Office: (605) 867-3208 Office: (605) 867-3254

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Email: Flora.Bettelyoun@ihs.gov Email: Troylynn.Weston@ihs.gov

Purchased Referred Care (PRC) Treatment of patients shall be performed at PRIHS facilities except in certain instances where patients are referred to private facilities for performance of special diagnostic procedures or definitive care, not offered at PRIHS. This warrants a referral in EHR on behalf of the patient. The contract CNM shall consult with the PRIHS Supervisory OB/GYN prior to making a referral. The contract CNM shall follow PRIHS procedures when referring patients out through the Purchased Referred Care (PRC) system. Once the referral is made, it is picked up by PRIHS Purchased Referred Care Department. PRC meets daily to review and approve, deny, or defer patient referrals. Sufficient justification is very important when making a referral on behalf of the patient.

Pharmaceuticals The contract CNM authorized to prescribe Pharmaceuticals shall do so according to the availability of drugs listed in the PRIHS formulary. PRIHS Pharmacy services will provide instructions to the prescribing Contractor as to substitute of generic drugs for prescribed drugs. PRIHS Pharmacy & Therapeutics Committee’s policies shall determine any approval of medications not on the formulary. Any non-formulary drug request must be first initiated by the completion of a non-formulary drug request form.

This completed non-formulary drug request will be reviewed at the next Pharmacy & Therapeutics meeting.

Tour of Duties The contract CNM hours may vary due to changing needs of PRIHS including, but not limited to, contract budget, varying complexity of medical needs and/or patient volume. The Supervisory OB/GYN and/or Clinical Director of PRIHS will address these changes to the contract company. The contract company must make all contractor staff aware of the OB/GYN Department and Women’s Health Department hours, including on-call shifts.

The contract staff shall be available for a work schedule that will be established by the PRIHS Supervisory OB/GYN and/or Clinical Director. Work shifts will vary between clinic schedules and on-call rotation. Clinic rotation is an eight (8) or ten (10) hour day and will be worked between the hours of 8:00 am and 4:30 pm or 8:00 am and 6:30 pm. These hours are classified as Regular Hours.

A thirty (30) minute lunch break is required, is not billable and is not to adversely affect patient care. If work is performed over the 12:00 pm (Noon) lunch period, a 30-minute lunch may be taken at a more convenient time.

On-call rotation hours vary between 4:30 pm to 8:00 am; 6:30 pm to 8:00 am; 8:00 am to 8:00 pm; 8:00 pm to 8:00 am. The contract CNM shall participate in the weeknight, weekend and holiday Midwifery call schedule. These hours are classified as On-call Hours.

The contract CNM will respond in a timely manner appropriate to the condition of the patient, per request of the consulting Provider, and in compliance with PRIHS policy & Medical Staff bylaws. Phone consults must be responded to within 5 minutes and onsite call back within 20 minutes response time.

mailto:Flora.Bettelyoun@ihs.gov mailto:Troylynn.Weston@ihs.gov

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Contract CNM must be at the patient’s bedside within the 20-minute response requirement in the case of an emergency.

Prior to assumption of duty on any scheduled work shift, the contract CNM will be briefed by the PRIHS Supervisory OB/GYN or his/her designated representative regarding patient(s) situation, background, assessment and recommendation (SBAR). If the contract CNM encounters any problems or issues that interfere with provision of care to patients, the PRIHS Supervisory OB/GYN shall be advised. The briefing shall also include conditions of any inpatients for whom the contract CNM is caring for, to the following duty Nurse Midwife or Physician. The contract CNM shall report continuing problems of any nature or concerns to the PRIHS Supervisory OB/GYN.

In the event a contract CNM is not scheduled for work by Pine Ridge I.H.S. and has a day off work, day off hours are not billable to Pine Ridge Indian Health Service (I.H.S.). The contract CNM shall adhere to their PRIHS assigned hours of responsibility and will be paid based upon hours worked of their PRIHS assigned work schedule.

The contract CNM on occasion may need to work for short periods of time beyond their Regular assigned shift when such extra time is necessary to finish a patient visit. Also, when scheduled to be on-call after Regular hours, the contract CNM may be called back into work for an onsite face-to-face patient visit. The additional work time is billable. Overtime rate applies when a contract CNM exceeds 40 hours in the week. Documentation is required on the timesheet for all overtime, including call back time, meaning returning on site for direct patient care while on call.

Employee Health Requirements The Contractor shall adhere to PRIHS Employee Health Program policy. The purpose is to provide uniform guidelines for ensuring all staff are free from communicable disease or any other diseases, which may be debilitating or render the Contractor not able to perform his/her, assigned duties. The contract CNM shall also adhere to receiving annual vaccinations required. The immunization records are required to be turned into Employee Health Department within 7 days of employment. (see attached policy for full details)

PRIHS Employee Health Nurse Point of Contact:

JoDee Bettelyoun Office: 605 867 3286 Email: Jodee.Bettelyoun@ihs.gov

Third Party Enrollment All Medicare B and other insurance provider enrollment documentation shall be submitted to the Contract CNM by PRIHS Business Office (BO) during New Employee Orientation. Enrollment documentation shall be to the satisfaction of PRIHS BO for insurance enrollment confirmation. No initial timesheets or invoices will be approved & processed until the contract CNM has completed all insurance form documentation. This enrollment process generally takes 2 – 3 business days to approve.

Special Requirements

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Security Clearance - Background Investigation Contractor staff will be required to follow PRIHS procedures for obtaining a full Federal background investigation and preliminary clearance. The preliminary clearance process ranges from 5-30 business days. In order to obtain a Personal Identity Verification (PIV) card, Contractor staff shall complete and pass a Federal background investigation conducted by the Office of Personnel Management. PRIHS will process the investigations through the Office of Personnel Management on all Contractor staff.

Processing of PIV cards shall be completed by Great Plains Area HSPD-12/Suitability Office in conjunction with PRIHS PIV card stations. The contract CNM will be required to be physically present at one of the HSPD-12 enrollment and issuance workstations to obtain a PIV Card. Two forms of identification are needed for PIV related matters.

Each contract CNM shall complete the necessary requirements below and receive pre-employment clearance from GPA/PRIHS prior to performing services under this contract.

1) Fingerprints must be captured for digital processing. Contractor may have fingerprints captured via hard copy, then sent to PRIHS by postal service (at contractor’s expense), tracking is highly recommended. Note, FD-258 fingerprint card is the only acceptable hard copy. Or, Contractor may have their fingerprints captured electronically, upon arrival at PRH. Two forms of identification are also required if the contractor is being fingerprinted upon arrival at PRIHS. Please consult with PRIHS HSPD- 12 representatives located in the Administration & Procurement Departments at PRH;

1) The OF-306, Declaration for Federal Employment shall be completed;

2) The Addendum to the OF-306, shall be completed;

3) Provisional Waiver form shall be completed;

4) Copy of Curriculum Vitae/Resume;

5) 86 C form shall be completed;

6) General Release form shall be completed;

7) eQIP (if applicable initially otherwise, required after 120 days of PRIHS employment);

8) The contractor shall be enrolled for PIV if eQIP is completed;

9) State Packets, individualized documents shall be completed, please consult with PRIHS HSPD-12 representative for guidance.

The Contractor shall ensure that the employee it proposes for work under this contract have a reasonable chance for approval. If at any point during the investigation process a contract CNM is deemed ineligible or found to have other than favorable suitability, the individual must be removed from providing services under this contract. PRIHS shall investigate personnel at no cost to the contractor.

PRIHS pre-security clearance is a pre-requisite. It is imperative to note; all Contract personnel must receive a favorable adjudicated pre-security clearance in order to perform any services/requirements of this contract. Contract personnel are not permitted to wait in any PRIHS facility while awaiting adjudication.

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If pre-security clearance is deemed unfavorable, the contract company shall submit a replacement provider immediately or risk breaching the terms and conditions of this contract. A delay in securing a replacement Contractor greater than 30 calendar days shall warrant a Cure Notice

Please address (FD-258) hard copy fingerprint card(s) to:

Pine Ridge I.H.S. Hospital Attn: Lois Cross 607 Indian Health Road P.O. Box 1201 Pine Ridge SD, 57770

PRIHS HSPD-12/Background Investigation Point of Contact:

Primary Secondary

1. Lois Cross 2. Annie Means Procurement Department at PRH Administration Department at PRH Office: (605) 867-3020 Office: (605) 867-3403 Email: Lois.Cross@ihs.gov Email: Annie.Means@ihs.gov

PRIHS Information Technology In order for a contract CNM to gain Indian Health Service electronic access, the person must obtain a favorable adjudicated security clearance. Indian Health Service (I.H.S) electronic access will automatically disable after fourteen (14) calendar days of inactivity and their electronic account will delete after ninety (90) calendar days of inactivity. When a contract CNM returns after being away & their electronic access is disabled/deleted, most times this leads to a service delay. It is very important to ensure the contract CNM has computer access upon arrival. The Contractor shall contact and work with the PRIHS Information Technology Department in advance to ensure the contract CNM has active access prior to arrival.

Pine Ridge I.H.S. utilizes Microsoft Outlook email for communication. An email account will be established while attending PRIHS New Employee Orientation. Contract CNMs are encouraged to check their email account as a way of staying informed and communicating to I.H.S. colleagues.

Information Technology Department Contact Information:

Email: ABR_PRHITAdminsDL@ihs.gov Office: 605 867 3244

Work Identification Badge When the contract CNM receives a favorable adjudicated security clearance & is cleared to start providing service, upon arrival, he/she shall obtain a PRIHS work identification badge from PRIHS Information Technology. The contractor is required to wear the work identification badge at all times when in working status. When contract CNM services terminate at PRIHS, the work identification badge must be returned to PRIHS Information Technology Department.

Contractor Furnished Property PRIHS requires the Contractor to carry a working form of communication (i.e. cellular phone or pager) at their expense.

mailto:Lois.Cross@ihs.gov mailto:Annie.Means@ihs.gov mailto:ABR_PRHITAdminsDL@ihs.gov

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Additional Requirements

Contract Line Item Numbers (CLINs) # 1 Regular Hours On site coverage, Monday through Friday, 8 or 10 hours shift(s).

# 2 On Call Hours

Hours after the Regular Hours in a 24-hour period. Maximum allowable On Call Hours during a weekday is 14 hours. Maximum allowable On Call Hours during the weekend and Holiday is 12 hours per day.

# 3 Overtime

Overtime applies when a contract CNM works greater than 40 Regular Hours in a week, excluding On-Call Hours.

Documentation is required on the timesheet for all overtime, including call back time, meaning returning on site for direct patient care while on call.

Timesheet Timesheets shall capture daily time in, time out and 30-minute (unpaid/required) lunch break. Please tally time on timesheet in 15-minute increments. Contractor time from 1 to 7 minutes shall be rounded down, and thus not counted as hours worked, but Contractor time from 8 to 14 minutes must be rounded up and counted as a quarter hour of time worked. A Health Information Management Clearance Form (HIMCF) shall be submitted by the Contractor with each timesheet. All timesheets & HIMCFs shall be signed by the PRIHS Supervisory OB/GYN or designee for approval. No invoices will be processed unless the timesheet & HIMCF is approved by PRIHS. The contract CNM shall be responsible for sending a copy of the approved records to their contract company. Contract CNMs shall report time worked accurately.

The contract CNM shall adhere to their PRIHS work schedule and will be paid for hours of work within their assigned PRIHS work schedule. Hours worked include overtime hours. Work schedule hours shall be documented on their timesheet. Contractor invoices are based off approved timesheets and approved HIMCFs. It is important to note; no timesheet or invoice will be processed if the contract CNM has an unapproved HIMCF due to a medical record deficiency.

Invoicing The Contractor shall submit an invoice on a minimum monthly basis, via the Invoice Processing Platform (IPP). Contractor shall include the approved timesheet(s) and approved HIMCF(s) with each invoice. The Contractor will be paid for contract CNM hours worked, at the fixed hourly rate, by labor category. The Contractor shall group all contract CNMs to one invoice per billing cycle. Pine Ridge I.H.S. will not accept one invoice for each individual.

Pine Ridge I.H.S. will verify every invoice before paying. Verification consists of, but not limited to, contract CNM possesses I.H.S. approved security clearance, timesheet is approved by PRIHS, sufficient

Page 12 of 17 Version 0000 12/2022 overtime documentation is on the timesheet, and HIMCF is approved. If the invoice is not approved by Pine Ridge I.H.S. and rejected, the Contractor will receive prompt notice.

Invoice Processing Platform (IPP) The Indian Health Service (IHS) has implemented an electronic invoicing system.

In compliance with the Office of Management and Budget (OMB) M-15-19 memorandum “Improving Government Efficiency and Saving Taxpayer Dollars Through Electronic Invoicing” directing Federal agencies to adopt electronic invoicing as the primary means to disburse payments to vendors. Invoices submitted under any award will be required to utilize the Invoice Processing Platform (IPP) in accordance with HHSAR 352.232-71, Electronic Submission and Processing of Payment Requests”

IPP is a secure, web-based electronic invoicing system provided by the U.S. Department of the Treasury’s Bureau of the Fiscal Service, in partnership with the Federal Reserve Bank of St. Louis (FRSTL).

Respondents are encouraged to register an account with IPP if they have not already done so. If your organization is already registered to use IPP, you will not be required to re-register – however, we encourage you make sure your organization and designated IPP user accounts are valid and up to date.

The IPP website address: https://www.ipp.gov

If you require assistance registering or IPP account access, please contact the IPP Helpdesk at (866) 973- 3131 (M-F 8 AM to 6 PM ET), or IPPCustomerSupport@fiscal.treasury.gov

Should the Contractor feel that use of the IPP would be unduly burdensome, their response to this solicitation should include an explanation of this position for a determination by the Contracting Officer.

Additional Information

PRIHS Furnished Property PRIHS will provide a patient examination area, all medical, non-medical equipment and supplies used in the facilities for the care and maintenance of patients as per the standards of care.

Work Environment Exposure to contagious diseases is possible in the PRH, outlying clinics and mobile unit. Potential exposure to bodily fluids may occur in the course of caring for trauma patients.

Weather Pine Ridge, South Dakota, is a geographic area with wide temperature span. The winters can be very cold and windy. Contractors should expect to drive in weather conditions for which they may not be accustomed. The sole authority to close PRH or outlying clinics rests with the Chief Executive Officer (CEO). If the hospital remains open, the Contractor will be expected to report to work on time, as all other hospital employees will be required. Reliable transportation to report for duty within the specified timeframe of this contract is the contractor’s responsibility and at their expense.

https://www.ipp.gov/ mailto:IPPCustomerSupport@fiscal.treasury.gov

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Meals Breakfast, lunch and dinner (supper) is available in the PRIHS hospital cafeteria with the purchase of a meal ticket. Meal tickets can be purchased in the Finance Department between the hours of 09:30 am to 11:30 am and 2:00 pm to 4:00 pm, Monday through Friday. Cash (preferred), check or money order are the acceptable payment options. PRIHS Hospital is not equipped to perform credit/debit card transactions.

Housing If available, PRIHS Hospital housing can be offered to ensure timely response to on-call responsibilities.

The Contractor is required to pay rent for offered housing. The rental rate is determined by PRIHS guidelines. PRIHS will invoice the individual renting. To request a Government Housing application, please contact Martin “Marty” Zephier.

PRH Housing point of contact:

Martin “Marty” Zephier Office: (605) 867-3071 Email: Martin.Zephier@ihs.gov

Business Relations The Contractor shall successfully integrate and coordinate all activity needed to execute the requirement. The Contractor is required to provide quality assurance services. The Contractor shall seek to ensure customer satisfaction and professional & ethical behavior of all contract Providers.

Contract Management The Contractor shall establish clear organizational lines of authority and responsibility to ensure effective management of the resources assigned to the requirement. The Contractor shall convene a contract kick-off meeting with the Contract Officer Representative (COR) and necessary Indian Health Service officials no later than five (5) business days from the effective date of this contract. In addition, the Contractor shall participate in status update calls & ad-hoc meetings when requested by Pine Ridge Indian Health Service. Meetings provide opportunity to discuss contract activity including, but not limited to, issues, corrective actions and/or challenges. The Contractor shall identify key personnel responsible for accomplishing each task, alternates and identify challenges that may impede success.

PRIHS may request status reports from the Contractor for action items obtained from meetings. The status reports shall identify Contractor leads responsible for completing tasks and how challenges or delays are being mitigated. Contractor status reports shall be submitted electronically to the COR and PRIHS EMS Director.

The Contractor shall deliver a quality control plan (QCP) describing specific activities planned to meet the requirements of this contract. The QCP shall include how quality assurance will be accomplished and monitored, based on the quality assurance surveillance plan provided by PRIHS. QCP shall be submitted no later than thirty (30) calendar days from the effective date of contract award. The Contractor shall describe the use of any consultants or subcontractors hired to carry out elements within the Performance Work Statement (PWS) under this contract. The Contractor shall notify the Contract Officer and Contract Officer Representative in writing within five (5) business days of any new subcontractors or consultants retained to perform services required under this contract. Subcontractors retained for purposes of this contract must comply will all provisions, terms & conditions of this contract. The QCP mailto:Martin.Zephier@ihs.gov

Page 14 of 17 Version 0000 12/2022 shall include an estimated turn around time for filling vacancies for CNMs but not to exceed five (5) calendar days. The Contractor shall provide specifics regarding recruitment and retaining contract CNMs.

Meetings may be recorded. By joining a meeting, you are providing your consent to have your voice, image and/or content you contribute during the meeting recorded.

Conflict of Interest The Contractor and all contract CNMs are responsible for identifying and communicating to the CO and COR conflicts of interest at the time of proposal and during the entirety of contract performance. At the time of proposal, the Contractor shall provide a statement which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided. The Contractor shall also provide statements containing the same information for any identified consultants or subcontractors who shall provide services. The Contractor must also provide relevant facts that show how it’s organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest.

Inherent Government Functions Contractor and contract CNMs shall not perform inherently governmental functions. This includes, but is not limited to, determination of agency policy, determination of Federal program priorities for budget requests, direction and control of government employees (outside a clinical context), selection or non-selection of individuals for Federal Government employment including the interviewing of individuals for employment, approval of position descriptions and performance standards for Federal employees, approving any contractual documents, approval of Federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy, as wells as other functions specified under FAR

7.503 (c).

Contract Administration The Contractor shall assign effort and maintain proper and accurate time keeping records of contract providers assigned to work on the requirement.

Contract Provider Administration The Contractor shall make necessary travel arrangements for contract Providers and maintain adequate infrastructure to support contract tasks. Labor hours worked does not include travel time to reach Pine Ridge Indian Health Service (PRIHS).

The Contractor shall fulfill staffing requirements under each task order throughout the specified timeframe.

Customer Service Contract CNM shall refer all patient/customer service issues to the PRIHS Supervisory OB/GYN or designee and COR.

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Contract Officer Responsibilities The Contracting Officer (CO) is the only person authorized to approve changes or modify any of the requirements of this contract. The Contractor shall communicate with the CO on all matters pertaining to contract administration. Only the CO is authorized to make commitments or issue any modification to include (but not limited to) terms affecting price, quantity or quality performance of this contract. The Contracting Officer, Contract Officer Representative and PRIHS Supervisory OB/GYN shall deal with issues raised concerning contract CNMs.

Quality Assurance Surveillance Plan (QASP) The QASP is based on the premise that the Contractor is responsible for managing and ensuring quality control meets the terms of the contract. The QASP is an evergreen Government document that specifies how the Government will verify and document that the Government is receiving quality of services called for under the contract. The Contractor’s performance will be measured based on the following requirements. (see attached QASP)

Contractor Performance Assessment Reporting System (CPARS) During the life of this contract, Contractor performance will be evaluated on an interim and final basis pursuant to FAR subpart 42.15. This evaluation shall become a part of the contract file and shall be used as past performance information in evaluating the Contractor’s past performance on future contracts.

Contract Performance Assessment Reporting System (CPARS) is an online reporting system www.cpars.gov.

As prescribed in the Federal Acquisition Regulation (FAR), Indian Health Service evaluates Contractor past performance on all contracts that exceed the simplified acquisition threshold and shares those evaluations with other Federal Government Contract Specialists & Procurement officials. The FAR requires that the Contractor be provided an opportunity to comment on past performance evaluations prior to each report closing. This report becomes a permanent record for the Contractors past performance.

Technical Evaluation The Technical Evaluation Team (TET) will utilize adjectival ratings when assessing each offeror. Factors include: Technical Capabilities, Key Personnel & Past Performance. The technical evaluation factors are of equal importance.

Outstanding Greatly exceeds all minimum requirements of the criteria; has a high probability of success; contains no weaknesses or deficiencies.

Good Exceeds all the minimum requirements of the criteria; has an above average probability of success; contains no significant weaknesses and only minor correctable weaknesses exist.

Acceptable Meets all the minimum requirements of the criteria; has an average probability of success; no significant weaknesses and no deficiencies.

Marginal Fails to meet one or more of the minimum requirements of the criteria; low probability of success; major weaknesses and/or significant number of deficiencies exists.

Unacceptable Fails to meet any of the minimum requirements of the criteria;

proposal needs major revisions; very low probability of success.

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Deliverables

Deliverable Frequency Number of copies to

PRIHS

Delivery format to

PRIHS

Submit to at

PRIHS

Curriculum Vitae & Pre- Application Questionnaire

Once, prior to contract performance.

1 copy Via fax or via secure data transfer email

Supervisory

OB/GYN

Credentialing & Privileging Requirements

Once, prior to contract performance & as needed thereafter

1 copy Via fax or via secure data transfer email

Tammy Bailey, Medical Staff Coordinator

Health Information Management Clearance Form

Minimum bi-weekly

1 original or copy

Via email or hand deliver

Supervisory OB/GYN, Contract Officer Representative (COR) as alternate.

Employee Health Requirements

Within 7 days of contract performance & as needed thereafter.

1 copy Hand deliver Employee Health Nurse

Character Investigation Requirements

Once, prior to contract performance & as needed thereafter

1 copy Via fax or via secure data transfer email

Lois Cross

Timesheet Minimum bi-weekly

1 original or copy

Via email or hand deliver

Supervisory OB/GYN, Contract Officer Representative as alternate.

Invoice Minimum monthly 1 copy Via IPP Upload to IPP with required attachments (timesheet &

HIMCF)

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Quality Control Plan no later than 30 calendar days from the effective date of contract award

1 copy Via email Contract Officer Representative

New subcontractors or consultants retained to perform services

In writing within 5 business days of any new subcontractors or consultants retained

1 copy Via email Contract Officer and

COR

Mandatory Training Upon arrival after receiving favorable Background Investigation and as required thereafter

1 copy Hand Deliver Supervisory

OB/GYN

CLAUSES INCORPORATED BY REFERENCE

(Firm Fixed-Price, Non-Personal Service-Commercial Items)

FAR CITATION: 52.252-1: Solicitation Provision Incorporated by Reference. (FEB 1998) This solicitation incorporates one or more solicitation provisions by reference, with the same force and defect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. The offeror is cautioned that the listed provisions may include blocks that must be completed by the offeror and submitted with its quotation or offer. In lieu of submitting the full text of those provisions, the offeror may identify the provision by paragraph identifier and provide the appropriate information with its quotation or offer. Also, the full text of a solicitation provision may be accessed electronically at this/these address(es): http://arnet.gov/far/index.html.

52.252-2 Clauses Incorporated by…