75H70623R00002 CNM Solicitation Package.pdf

SEE ADDENDUMIS CHECKED

CODE 18a. PAYMENT WILL BE MADE BY

CODE

FACILITYCODE

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

OFFEROR

Aberdeen SD 57401 115 Fourth Ave, SE Federal Building Aberdeen Area Indian Health Servic

IHSPINERIDGE CODE 16. ADMINISTERED BYCODE

X

X

X

621399

SIZE STANDARD:

100.00 % FOR:SET ASIDE:UNRESTRICTED OR159

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

12/30/2022 1500 CT

12/09/2022

605-226-7571NICHOLE LEREW

(No collect calls)

INFORMATION CALL:

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

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

75H70623R00002

5. SOLICITATION NUMBER

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

1 4 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

PINE RIDGE SD 57770

E. Hwy 18 607 Indian Health Road

IHSPINERIDGE

15. DELIVER TO

Aberdeen SD 57401 115 Fourth Ave, SE Federal Building

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$9.0

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

ISSUE DATE

DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULEX

12. DISCOUNT TERMS

THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

Aberdeen Area Indian Health Servic

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

100% Indian Small Business Economic Enterprise Set-Aside.

Firm Fixed-Price, Non-Personal Health Care Services, Single Award, ID/IQ contract, Commercial Item, to provide Certified Nurse Midwife Services for the Pine Ridge IHS Hospital, Pine Ridge, South Dakota. Up to five (5) providers, minimum of one (1) provider. The period of performance will be for one (1) year from the Date of Award, with four (4), one (1) option year periods. The award resulting from

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

HEREIN, IS ACCEPTED AS TO ITEMS:

X

XX

DATED

CRAIG J. WELLS

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

ARE

31c. DATE SIGNED

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

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

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

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

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

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

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

OFFER

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

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

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

29. AWARD OF CONTRACT:

REF.

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

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

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

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

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

37. CHECK NUMBER

FINALPARTIAL

36. PAYMENT

FINALPARTIAL

35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER33. SHIP NUMBER

COMPLETE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

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

42b. RECEIVED AT (Location)

42a. RECEIVED BY (Print)

41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

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

STANDARD FORM 1449 (REV. 2/2012) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

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SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

this solicitation will not obligate funds; funds must be obligated prior to the starting performance through a task order.

Period of Performance: 02/01/2023 to 01/31/2024

1 Base Year: 02/01/2023 thru 01/31/20224 10400 HR

Regular Hours-estimated 10,400 hours.

2 Base Year: 02/01/2023 thru 01/31/2024 4888 HR

On-Call Hours (including weeknights, weekends and holidays)-estimated 4,888 hours.

3 Base Year: 02/01/2023 thru 01/31/2024 1040 HR

Call Back/Overtime Hours (including weeknights, weekends and holidays)-estimated 1,040 hours.

4 Option Year One (1): 02/01/2024 thru 01/31/2025 10400 HR

Regular Hours-estimated 10,400 hours.

(Option Line Item)

11/06/2023

5 Option Year One (1): 02/01/24 thru 01/31/2025 4888 HR

On-Call Hours (including weeknights, weekends and holidays)-estimated 4,888 hours.

(Option Line Item)

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

4 2 of

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 4

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H70623R00002

11/06/2023

6 Option Year One (1): 02/01/2024 thru 01/31/2025 1040 HR

Call Back/Overtime Hours (including weeknights, weekends and holidays)-estimated 1,040 hours.

(Option Line Item)

11/06/2023

7 Option Year Two (2): 02/01/2025 thru 01/31/2026 10400 HR

Regular Hours-estimated 10,400 hours.

(Option Line Item)

11/06/2024

8 Option Year Two (2): 02/01/2025 thru 01/31/2026 4888 HR

On-Call Hours (including weeknights, weekends and holidays)-estimated 4,888 hours.

(Option Line Item)

11/06/2024

9 Option Year Two (2): 02/01/2025 thru 01/31/2026 1040 HR

Call Back/Overtime Hours (including weeknights, weekends and holidays)-estimated 1,040 hours.

(Option Line Item)

11/06/2024

10 Option Year Three (3): 02/01/2026 thru 01/31/2027 10400 HR

Regular Hours-estimated 10,400 hours.

(Option Line Item)

11/06/2025

11 Option Year Three (3): 02/01/2026 thru 01/31/2027 4888 HR

On-Call Hours (including weeknights, weekends and holidays)-estimated 4,888 hours.

(Option Line Item)

11/06/2025

12 Option Year Three (3): 02/01/2026 thru 01/31/2027 1040 HR

Call Back/Overtime Hours (including weeknights, weekends and holidays)-estimated 1,040 hours.

(Option Line Item)

Continued ...

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

Sponsored by GSA

FAR (48 CFR) 53.110

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

4 4

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H70623R00002

11/06/2025

13 Option Year Four (4): 02/01/2027 thru 01/31/2028 10400 HR

Regular Hours-estimated 10,400 hours.

(Option Line Item)

11/06/2026

14 Option Year Four (4): 02/01/2027 thru 01/31/2028 4888 HR

On-Call Hours (including weeknights, weekends and holidays)-estimated 4,888 hours.

(Option Line Item)

11/06/2026

15 Option Year Four (4): 02/01/2027 thru 01/31/2028 1040 HR

Call Back/Overtime Hours (including weeknights, weekends and holidays)-estimated 1,040 hours.

(Option Line Item)

11/06/2026

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

Sponsored by GSA

FAR (48 CFR) 53.110

Pine Ridge Indian Health Service Certified Nurse Midwife Performance Work Statement

Performance Work Statement (PWS) Certified Nurse Midwife Services

C.1) 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.

C.2) General Requirements

C.2.1 Purpose of Contract 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.

C.2.2 Contract Type Fixed Unit Price, Non-Personal Service, Indefinite Delivery, Indefinite Quantity contract and shall not exceed the parent contract ceiling amount. 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 shall be issued in accordance with Federal Acquisition Regulation provisions.

TO periods may vary and will be no longer than a 12-month period.

C.2.3 Contract Performance Period The fixed 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.

In addition, this contract can be terminated for the convenience of PRIHS if, a sufficient number of permanent Government Providers are hired to serve in this work capacity. In this event, an authorized Government CO shall provide a preliminary written notice to contractor, 60 days in advance.

C.2.4 Contract 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)

C.3) Performance Requirements

Pre-requisites to determine contract CNM eligibility for contract performance: Please submit contract CNM Curriculum Vitae and Pre-Application Questionnaire to the PRIHS OB/GYN Supervisor and/or PRIHS Deputy/Clinical Director. If approved/accepted by the PRIHS OB/GYN Supervisor and/or PRIHS Deputy/Clinical Director, character investigation & credentialing & privileging processes are to immediately follow.

C.3.1 Scope The Contractor shall furnish CNM primary care services. These services will be compatible with the facilities’ operating capacity and equipment. 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. Knowledge of frequently used drugs including normal dosage, administration, action, adverse effects and ability to perform and interpret specified laboratory tests.

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

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

i. 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.

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

Pursuant to Section 224 of the Public Health Service Act, 42 USC 233, the Federal Tort Claims Act coverage for medical related claims is extended to individuals providing services pursuant to these contracts. The services performed must have been within the scope of the contract.

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

C.3.2 New Employee Orientation (NEO) & Annual Trainings New Employee Orientation (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.

Contract staff shall complete all PRIHS required annual trainings.

C.3.3 Credentialing & Privileging (C&P) The standards of Midwifery practice and the 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.

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

C.3.4 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.

C.3.5 Health Information Management (HIM)/Electronic Health Record (EHR) The Contractor 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 Contractor shall be completed to the satisfaction of PRIHS. The PRIHS approving authority of the Contractor’s timesheets will not sign off on/approve time sheets unless the Contractor has successfully completed all required patient medical encounter documentation (medical records). To ensure medical records are complete with no deficiencies, the Contractor shall submit a Health Information Management Clearance From (HIMCF) with each timesheet. The Contract Officer (CO) and Contract Officer Representative (COR) shall be notified within two business days, should the HIMCF indicate deficiency.

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.

C.3.6 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 or deny patient referrals. Sufficient justification is very important when making a referral on behalf of the patient.

C.3.7 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.

C.3.8 Tour of Duties The contract CNM hours may vary due to changing needs of PRIHS, 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.

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.

C.3.9 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 Contractor 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). Employee Health Requirements are as follows (see attached policy for full details):

a. Measles, Mumps, & Rubella (MMR)

b. Varicella (Chicken Pox)

c. Tetanus, Diphtheria, Pertussis (Tdap)

d. Tuberculosis

e. Hepatitis A

f. Hepatitis B

g. Influenza

h. Meningococcal

i. Shingles Vaccination (Shringrix)

j. COVID-19 Vaccination series

PRIHS Employee Health Nurse Point of Contact:

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

C.3.10 Third Party Enrollment All Medicare B and other insurance provider enrollment documentation shall be submitted to Contractor staff 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 contractor has completed all insurance form documentation. This enrollment process generally takes 2 – 3 business days to approve.

C.4) Special Requirements

C.4.1 Security – Character 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 contractors 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 contractor shall complete each of the 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 Department 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 employees it proposes for work under this contract have a reasonable chance for approval. If at any point during the investigation process a contractor staff 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.

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 contract CNM greater than 14 calendar days shall be considered grounds for PRIHS to terminate the contract for convenience.

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

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

PRIHS HSPD-12/Background Investigation Point of Contracts:

1)Diane Little Hawk 2)Annie Means Administration Department at PRH Administration Department at PRH Office: 605 867 3390 Office: 605 867 3403 Email: Diane.LittleHawk@ihs.gov Email: Annie.Means@ihs.gov

C.4.2 Work Identification Badge When the contract CNM 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.

C.4.3 Contractor Furnished Property PRIHS requires the contractor to carry a working form of communication (i.e. cellular phone or pager) at their expense.

mailto:Diane.LittleHawk@ihs.gov

C.5) Additional Requirements

C.5.1 Contract Line Item Numbers (CLINs) # 1 Regular Hours On site coverage, Monday through Friday, 8 or 10 hours shift(s).

# 2 On Call Hours

All 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/Holiday is 12 hours per day.

# 3 Call Back/Overtime

Call Back applies when the contractor returns to the facility (on-site) for face to face patient services as requested by the attending provider in the department of need.

Overtime applies when the contractor works beyond their regular scheduled 8/10-hour duty day. For Overtime, the contractor shall seek prior approval from the PRIHS Supervisory OB-GYN or designee.

C.5.2 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. Ensure prior approval for overtime is obtained from the PRIHS Supervisory OB/GYN or designee. 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 has been approved. The Contractor shall send a copy of these approved records to their company & all originals to the PRIHS Supervisory OB/GYN.

The contract CNM will be paid for actual labor hours worked based on their approved timesheet & HIMCF. Contractor invoices are based off approved timesheets & approved HIMCFs. It is important to note, no timesheets or invoices will be processed for unapproved HIMCFs.

C.5.3 Invoicing The Contractor shall submit an invoice on a minimum monthly basis, via email. Contractor shall include the approved timesheet(s) and approved HICF(s) with each invoice. The Contractor will be paid for their hours worked, at the fixed hourly rate, by labor category. Please address invoices to the PRIHS Supervisory OB/GYN, Contract Officer Representative (COR) assigned at contract award and Great Plains Area (GPA) Accounts Payable (AP) Accountant.

It is important to note; no invoices will be processed for unapproved timesheets and/or unapproved HIMCFs.

Donald.Brown@ihs.gov – PRIHS Supervisory OB/GYN Rachel.Olson@ihs.gov – GPA AP Accountant Sammi.Herman@ihs.gov – PRIHS COR Janelle.Byrne@ihs.gov – PRIHS COR

C.6) Additional Information

C.6.1 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.

C.6.2 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.

C.6.3 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.

C.6.4 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, check or money order are the acceptable payment options. PRIHS Hospital is not equipped to perform credit/debit card transactions.

C.6.5 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.

PRH Housing point of contact:

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

C.7) Deliverables

Deliverable Frequency Number of copies to

PRIHS

Delivery format to

PRIHS

Submit to at

PRIHS

mailto:Donald.Brown@ihs.gov mailto:Rachel.Olson@ihs.gov mailto:Sammi.Herman@ihs.gov mailto:Janelle.Byrne@ihs.gov mailto:Martin.Zephier@ihs.gov

Curriculum Vitae & Pre- Application Questionnaire (C.3)

Once, prior to contract performance.

1 copy Via fax or via secure data transfer email

Supervisory OB/GYN and/or Deputy/CD

Credentialing & Privileging Requirements (C.3.3)

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 (C.3.5)

Every week 1 original Hand deliver Supervisory OB/GYN, Contract Officer Representative (COR) as alternate.

Employee Health Requirements (C.3.9)

Within 7 days of contract performance & annually thereafter.

1 copy Hand deliver Employee Health Nurse

Character Investigation Requirements (C.4.1)

Once, prior to contract performance & as needed thereafter

1 copy Via fax or via secure data transfer email

HSPD-12

Representative

Timesheet (C.5.2) Every week 1 original Hand deliver Supervisory OB/GYN, Contract Officer Representative as alternate.

Invoice (C.5.3) Minimum monthly 1 copy Via email Supervisory

OB/GYN, GPA

Accountant & CORs

CONTRACTORS PERFORMANCE CONDITIONS & RESPONSIBLITIES:

1. Contractor is responsible for reporting all taxes from wages earned under this contract to the appropriate State and Federal Agencies, provided the awardee is an individual.

2. Contractor is responsible for his/her own reliable transportation in the performance of the contract.

3. Contractor is responsible for Fringe Benefits and other benefits such as health, retirement, etc. for his/her employees, if other than self.

4. Contractor is responsible for maintaining satisfactory standards of competence, conduct, appearance and integrity. The quality of work performance of the contractor shall be subject to review.

5. Contractor is responsible for notifying the designated supervisor/director if he/she will be late, ill or unable to work for other reasons.

6. Contractor earns no leave and is compensated only for hours actually worked at the agreed compensatory rate.

7. Contractor is responsible for signing-in and signing-out of immediate work area, utilizing in-house system of accountability.

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 Reference. (FEB 1998) This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es):

http://arnet.gov/far/index.html

I. Federal Acquisition Regulations (FAR) (48 CFR Chapter 1) Clauses

No. FAR Citation Clause Title Clause Date ____

1. 52.202-1 Definitions June 2020

2. 52.203-3 Gratuities April 1984

3. 52.203-12 Limitation on Payments to Influence Certain June 2020 Federal Transactions

4. 52.204-13 System for Award Management Maintenance October 2018

5. 52.204-7 System for Award Management October 2018

6. 52.204-9 Personal Identify Verification of Contractor January 2011 Personnel

7. 52.204-16 Commercial and Government Entity Code August 2020 Reporting

8. 52.204-18 Commercial and Government Entity Code August 2020 Maintenance

9. 52.204-19 Incorporation by Reference of Representations December 2014 and Certifications

10. 52.212-1 Instructions to Offerors-Commercial Items November 2021

11. 52.212-4 Contract Terms and Conditions-Commercial Items November 2021 Items

12. 52.217-5 Evaluation of Options July 1990

13. 52.217-8 Option to Extend Services November 1999

14. 52.224-1 Privacy Act Notification April 1984

15. 52.224-2 Privacy Act April 1984

16. 52.232-39 Unenforceability of Unauthorized Obligations June 2013

17. 52.232-40 Providing Accelerated Payments to Small November 2021 Business Subcontractors http://arnet.gov/far/index.html http://arnet.gov/far/index.html

18. 52.237-1 Site Visit April 1984

19. 52.237-2 Protection of Government Buildings, Equipment April 1984 and Vegetation

20. 52.237-7 Indemnification and Medical Liability Insurance January 1997

21. 52.253-1 Computer Generated Forms January 1991 II. Federal Acquisition Regulations (FAR) (48 CFR Chapter 1) Clauses in Full Text

No. FAR Citation Clause Title Clause Date______

1. 52.204-21 Basic Safeguarding of Covered Contractor November 2021 Information Systems

2. 52.212-2 Evaluation-Commercial Products and November 2021 Commercial Services

3. 52.212-3 Offeror Representation & Certification- October 2022 Commercial Items

4. 52.212-5 Contract Terms & Conditions Required to October 2022 Implement Statues or Executive Orders- Commercial Items

5. 52.216-18 Ordering August 2020

6. 52.216-19 Ordering Limitations October 1995

7. 52.216-22 Indefinite Quantity October 1995

8. 52.217-9 Option to Extend the Term of the Contract March 2000

9. 52.232-19 Availability of Funds for the Next Fiscal Year April 1984

10. 52.223-99 Ensuring Adequate COVID-19 Safety Protocols October 2021 for Federal Contractors

52.204-21 Basic Safeguarding of Covered Contractor Information Systems.

As prescribed in 4.1903 , insert the following clause:

BASIC SAFEGUARDING OF COVERED CONTRACTOR INFORMATION SYSTEMS (NOV 2021)

(a) Definitions. As used in this clause—

Covered contractor information system means an information system that is owned or operated by a contractor that processes, stores, or transmits Federal contract information.

Federal contract information means information, not intended for public release, that is provided by or generated for the Government under a contract to develop or deliver a product or service to the Government, but not including information provided by the Government to the public (such as on public websites) or simple transactional information, such as necessary to process payments.

https://www.acquisition.gov/far/4.1903#FAR_4_1903

Information means any communication or representation of knowledge such as facts, data, or opinions, in any medium or form, including textual, numerical, graphic, cartographic, narrative, or audiovisual (Committee on National Security Systems Instruction (CNSSI) 4009).

Information system means a discrete set of information resources organized for the collection, processing, maintenance, use, sharing, dissemination, or disposition of information ( 44 U.S.C. 3502).

Safeguarding means measures or controls that are prescribed to protect information systems.

(b) Safeguarding requirements and procedures.

(1) The Contractor shall apply the following basic safeguarding requirements and procedures to protect covered contractor information systems. Requirements and procedures for basic safeguarding of covered contractor information systems shall include, at a minimum, the following security controls:

(i) Limit information system access to authorized users, processes acting on behalf of authorized users, or devices (including other information systems).

(ii) Limit information system access to the types of transactions and functions that authorized users are permitted to execute.

(iii) Verify and control/limit connections to and use of external information systems.

(iv) Control information posted or processed on publicly accessible information systems.

(v) Identify information system users, processes acting on behalf of users, or devices.

(vi) Authenticate (or verify) the identities of those users, processes, or devices, as a prerequisite to allowing access to organizational information systems.

(vii) Sanitize or destroy information system media containing Federal Contract Information before disposal or release for reuse.

(viii) Limit physical access to organizational information systems, equipment, and the respective operating environments to authorized individuals.

(ix) Escort visitors and monitor visitor activity; maintain audit logs of physical access;

and control and manage physical access devices.

(x) Monitor, control, and protect organizational communications (i.e., information transmitted or received by organizational information systems) at the external boundaries and key internal boundaries of the information systems.

http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3

(xi) Implement subnetworks for publicly accessible system components that are physically or logically separated from internal networks.

(xii) Identify, report, and correct information and information system flaws in a timely manner.

(xiii) Provide protection from malicious code at appropriate locations within organizational information systems.

(xiv) Update malicious code protection mechanisms when new releases are available.

(xv) Perform periodic scans of the information system and real-time scans of files from external sources as files are downloaded, opened, or executed.

(2) Other requirements. This clause does not relieve the Contractor of any other specific safeguarding requirements specified by Federal agencies and departments relating to covered contractor information systems generally or other Federal safeguarding requirements for controlled unclassified information (CUI) as established by Executive Order 13556.

(c) Subcontracts. The Contractor shall include the substance of this clause, including this paragraph (c), in subcontracts under this contract (including subcontracts for the acquisition of commercial products or commercial services, other than commercially available off-the-shelf items), in which the subcontractor may have Federal contract information residing in or transiting through its information system.

(End of clause)

52.212-2 Evaluation—Commercial Products and Commercial Services.

As prescribed in 12.301(c), the Contracting Officer may insert a provision substantially as follows:

EVALUATION—COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (NOV 2021)

(a) The Government will award a contract resulting from this solicitation to the responsible offeror whose offer conforming to the solicitation will be most advantageous to the Government, price and other factors considered. The following factors shall be used to evaluate offers:

__ P'ROBL.EM AND' APPROACH

1. Evaluation of this criterion will assess the bidders overall understanding of the complexities and logistical requirements associated with the provisional agreed upon CNM Services - as applicable to the Inpatient, Outpatient, Nursery, and ED https://www.acquisition.gov/far/12.301#FAR_12_301 consultation departments at PRIHS Hospital. This criterion will be evaluated based upon the available bids in concert with submitted portfolios addressing each of the following points as noted below:

a. Understanding of the complexity and logistical requirements of the organization template of rendered care. (housing, travel conditions, travel time, etc.)

b. Understanding of the inherent difficulties encountered in deliverance of hospital-based care within a small rural Indian Health Service facility. (Limited resources, limited geographic area, socio-economic conditions of the patient population, etc.)

c. Possession of necessary organization, experience and technical skills to perform such services understanding cultural diversities .and incurred work ethics required to function within such a milieu.

d. A detailed work plan shall be submitted that outlines how each aspect of the work statement is to be accomplished. The technical approach shall be sufficiently detailed, taking into account such aforementioned methodology.

Particular attention should be directed toward the scheduling of work force and potential problems and solutions for the CNM work statement components.

e. Ability to respond to planned and unplanned emergency replacement requests.

f. Ability to submit qualified CNM applicants with appropriate experience for credentialing and character investigation requirements.

g. Ability to meet and/or exceed PRIHS credentialing and character investigation requirements.

h. Ability to comply with PRIHS medical documentation (via use of electronic health record) and reporting requirements.

PAST PERFORMANCE & EXPERIENCE

This evaluation shall asses the relevance and breadth of offeror's experience and quality of the performance within the scope and complexity with the Provider coverage of the PRIHS requirement.

2. The technical proposal must include a listing of offeror's previous performance history regarding agreed upon contractual obligations on contracts, other primary care service contracts and subcontracts, Government and/or commercial enterprises awarded to the responsible organization submitting such offers in not dissimilar environmental conditions serving at times challenging rural, isolated locations. The contracts must contain the same type of primary care requirements outlined in the work statement. The respective contractor must include the following information for each contract and subcontract:

a. List of other Medical Staff contracts or subcontracts with these categories:

description of contracted work, Program Manager as reference with contact information and list of major achievements.

b. Demonstration of successful performance ·of past contracts to include: at least 1 contract that was most successful and the reason for this consideration, evidence of timely and acceptable contract performance.

c. Evidence of concern for cost control and budgetary considerations.

KEY PERSONNEL

3. This factor will be evaluated utilizing quantitative personnel availability/mobility for potential last minute assignment to the project. The proposal shall identify key personnel who have relevant experience in performing the tasks required of this solicitation in other projects that are similar in function, scope, and complexity to the PRIHS Hospital requirement. The bidder must provide a staffing plan to provide the availability of qualified staff that assures the requirements of the work statement are fulfilled in a timely manner. The agreed upon contractor shall specify the extent to which staff will participate in contract performance.

Curriculum vitae (CV)/resume of key personnel that will be directly involved in contract performance shall be included in the proposal. CV/resume must demonstrate that the vendor/ agency has the personnel with the necessary knowledge and experience to perform the tasks outlined in the work statement to include such management duties as they may arise in patient services, medical services, medical-obstetrical emergencies, emergency room and the 08/GYN specialty area.

Identify the key personnel available for assignment to this contract, specify the extent to which the staff will participate in this contract, submit evidence of licensure and CEU to demonstrate offer has required knowledge, experience, and educational background to perform the tasks outlined in the complete work statement. All potential staff must be free of OIG sanctions and achieve credentialed status at

PRIHS.

a. Recruiter

b. Finance/Accounting staff

c. Credential Liaison

d. Any other…