75H71019R00015_-_Teleradiology_Services.pdf

Request for Proposal: 75H71019R00015 ISSUE DATE: April 17, 2019

DUE DATE: May 16, 2019

This office is soliciting proposals from interested offeror to provide Teleradiology Services to the Navajo Area Indian Health Service (NAIHS) medical facilities, NAIHS requests that you review the enclosed Request for Proposal (RFP) and proposal instructions and provide this office with a response, utilizing the information contained therein.

COMPLETION OF SOLICITATION REQUIREMENTS:

Ensure all forms and additional information is completed in their entirety and verify calculations before signing the proposal. The following sections must be complete upon proposal submission:

Your proposal shall be prepared and submitted in accordance with Paragraph E-1 Instructions to Offeror – Commercial Items (pages 43 – 46). This paragraph shall stipulate the submission of all required documents and certifications, to determine your responsibility of providing the required services. All proposals must be received in the Division of Acquisition Policy by due date listed above.

ATTN: DeeAndra Salabye, Contract Specialist Navajo Area Indian Health Services (NAIHS)

272 HWY 264, St. Michaels; Room 119 P.O. Box 9020

Window Rock, AZ 86515-9020

MARK YOUR ENVELOPE “Teleradiology Services”

THIS IS 100% TOTAL SMALL BUSINESS SET ASIDE

DEPARTMENT OF HEALTH & HUMAN SERVICES

Public Health Service

Health Services Administration

Navajo Area Indian Health Service

Section Title Page No.

A. Standard Form (SF) 1449 Block 17A Page 1

B. Section B.2 Fee Schedule Pages 3 – 8

C. Section C.2 52.209-5 Certification Regarding Responsibility Matters (OCT 2015)

Pages 24 – 26

D. Section C.3 52.209-11 Representation by Corporation Regarding Delinquent Tax Liability or a Felony Conviction under any Federal Law (FEB 2016)

Pages 26

E. Section E.2 52.212-2 Evaluation – Commercial Items (OCT 2014) Page 47

F. Section E.3 52.212-3 Offeror Representation & Certification – Commercial Items (OCT 2018)

Pages 47 – 61

Teleradiology Services Solicitation No.: 75H71019R00015

TABLE OF CONTENTS

Section Title Page No.

A SF-1449 1 – 2

B.1 Purpose of Contract 3

B.2 Fee Schedule 3 – 8

B.3 Performance Work Statement (PWS) 9 – 17

Section 6.0 Performance-Based Matrix 18

B.4 Period of Performance 19

B.5 Contracting Officer’s Responsibility 19

B.6 Contracting Officer Representative (COR) 19

B.7 Customer Point of Contact 20

B.8 Medical Director Point of Contact 20

B.9 Reports 20 – 21

B.10 Invoice Submission 21 – 22

B.11 Officials Authorized to Place Orders Against the Contract 22

B.12 Medical Facility Points of Contact 23

C.1 52.252-2 Clauses Incorporated by Reference (FEB 1998) 24

C.2 52.209-5 Certification Regarding Responsibility Matters (OCT 2015) 24 – 26

C.3 52.209-11 Representation by Corporation Regarding Delinquent Tax Liability or a Felony Conviction under any Federal Law (FEB 2016)

C.4 52.212-4 Contract Terms & Conditions – Commercial Item (OCT 2018) 26 – 31

C.5 52.212-5 Contract Terms & Conditions Required to Implement Statutes or Executive Orders – Commercial Items (OCT 2018)

31 – 37

C.6 52.216-18 Ordering (OCT 1985) 37

C.7 52.216-19 Order Limitations (OCT 1995) 37

C.8 52.216-21 Requirements (OCT 1995) 38

C.9 52.217-8 Option to Extend Services (NOV 1999) 38

C.10 52.217-9 Option to Extend the Term of the Contract (MAR 2000) 39

C.11 52.232-18 Availability of Funds (APR 1984) 39

C.12 52.237-7 Indemnification and Medical Liability Insurance (JAN 1997) 39 – 40

C.13 Department of Health and Human Services Acquisition Regulation (HHSAR) Clauses – 48 CFR Chapter 3

C.14 352.237-70 Pro-Children Act (DEC 2015) 40 – 41

D List of Attachments 42

E.1 52.212-1 Instructions to Offerors – Commercial Items (OCT 2018) 43 – 46

E.2 52.212-2 Evaluation – Commercial Items (OCT 2014) 47

E.3 52.212-3 Offeror Representations and Certifications – Commercial Items

(OCT 2018)

47 – 61

E.4 52.216-1 Type of Contract (APR 1984) 62

E.5 52.233-2 Service of Protest (APR 1984) 62

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

Window Rock AZ 86515 PO Box 9020 Navajo Area Office

IHSNAVAJO CODE 16. ADMINISTERED BYCODE

X

X

X

621111

SIZE STANDARD:

100.00 % FOR:SET ASIDE:UNRESTRICTED OR29

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

05/16/2019 1700 MS

04/17/2019

928-871-1317DEEANDRA SALABYE

(No collect calls)

INFORMATION CALL:

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

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

75H71019R00015

5. SOLICITATION NUMBER

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

1 101 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

WINDOW ROCK AZ 86515

P.O. BOX 9020

IHSNAVAJO

15. DELIVER TO

Window Rock AZ 86515 PO Box 9020

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$11.00

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 SCHEDULE

12. DISCOUNT TERMS

THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

Navajo Area Office

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.

This is 100% Total Small Business Set Aside.

The Contractor shall provide Teleradiology Services to the Navajo Area Indian Health Service (NAIHS) medical facilities located in Arizona and New Mexico.

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

HEREIN, IS ACCEPTED AS TO ITEMS:

X

XX

DATED

PRISCILLA DUNCAN

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

ARE

31c. DATE SIGNED

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

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

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

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

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

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

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

OFFER

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

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

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

29. AWARD OF CONTRACT:

REF.

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

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

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

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

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

37. CHECK NUMBER

FINALPARTIAL

36. PAYMENT

FINALPARTIAL

35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER33. SHIP NUMBER

COMPLETE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

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

42b. RECEIVED AT (Location)

42a. RECEIVED BY (Print)

41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

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

STANDARD FORM 1449 (REV. 2/2012) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

1 Base Period: June 1, 2019 to September 30, 2019

2 Option Period 1: October 1, 2019 to September 30, 3 Option Period 2: October 1, 2020 to September 30, 4 Option Period 3: October 1, 2021 to September 30, 5 Option Period 4: October 1, 2022 to September 30, 32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

101 2 of

B-1 PURPOSE OF CONTRACT

The purpose of the contract is to obtain interpretation of electronic medical images. Contractor shall furnish all necessary personnel, supplies, materials, and equipment to perform under the terms of this contract. All services supplied by contractor under the terms of the contract shall be performed in compliance with all requirements and regulations of Food and Drug Administration (FDA), Mammography Quality Standards Act (MQSA), the Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS) and Health Insurance Portability and Accountability Act of 1996 and Privacy Act (HIPAA).

The Facilities to be serviced are as follows:

1. Chinle Comprehensive Healthcare Facility

2. Kayenta Health Center

3. Inscription House Health Center

4. Northern Navajo Medical Center

5. Crownpoint Comprehensive Healthcare Facility

6. Gallup Indian Medical Center

B-2 FEE SCHEDULE

The facilities stated in Section B-1 may submit imaging examinations of varying numbers, types, severity, urgency, and days and hours of transmission for interpretation under the terms of the contract.

Workload may vary depending on the varying needs of the referring facilities including number of onsite radiologists, type and/or time of examination, and a number of other factors.

Imaging examinations may be sent to contractor for routine, urgent or stat interpretation twenty-four hours per day, seven days per week.

The following are annual volumes of different categories of imaging examinations.

Cost estimates should be submitted per exam category. Additionally, contractor may estimate costs based on number of images per examination for cross sectional imaging exams (e.g., CT and MRI).

(continued next page)

Base Period: June 1, 2019/Date of Award to September 30, 2019

Type of Reads per Facility Chinle Comprehensive

Healthcare Facility

Kayenta Health Center

Inscription House Health Center

Northern Navajo Medical Center

Crownpoint Comprehensive

Healthcare Facility

Gallup Indian Medical Center

CT Est. Volume 3,850 3,500 0 5,000 400 6,745

$ per Volume

Total Per Read

CTA Est. Volume 0 300 0 400 400 500

$ per Volume

Total Per Read

Mammo Est. Volume 1,200 1,920 0 85 500 1

$ per Volume

Total Per Read

MRI Est. Volume 450 180 0 250 0 1

$ per Volume

Total Per Read

Ultrasound Est. Volume 250 1,500 200 20 20 775

$ per Volume

Total Per Read

X-Ray Est. Volume 5,650 10,000 1,500 800 865 500

$ per Volume

Total Per Read

DEXA Est. Volume 0 500 0 1,000 0 0

$ per Volume

Total Per Read

Total per Facility

Option Period 1: October 1, 2019 to September 30, 2020

Comprehensive

Healthcare Facility

Kayenta Health Center

Inscription House Health Center

Northern Navajo Medical Center

Crownpoint Comprehensive

Healthcare Facility

Gallup Indian Medical Center

CT Est. Volume 3,850 3,500 0 5,000 400 6,745

$ per Volume

Total Per Read

CTA Est. Volume 0 300 0 400 400 500

$ per Volume

Total Per Read

Mammo Est. Volume 1,200 1,920 0 85 500 1

$ per Volume

Total Per Read

MRI Est. Volume 450 180 0 250 0 1

$ per Volume

Total Per Read

Ultrasound Est. Volume 250 1,500 200 20 20 775

$ per Volume

Total Per Read

X-Ray Est. Volume 5,650 10,000 1,500 800 865 500

$ per Volume

Total Per Read

DEXA Est. Volume 0 500 0 1,000 0 0

$ per Volume

Option Period 2: October 1, 2020 to September 30, 2021

Comprehensive

Healthcare Facility

Kayenta Health Center

Inscription House Health Center

Northern Navajo Medical Center

Crownpoint Comprehensive

Healthcare Facility

Gallup Indian Medical Center

CT Est. Volume 3,850 3,500 0 5,000 400 6,745

$ per Volume

Total Per Read

CTA Est. Volume 0 300 0 400 400 500

$ per Volume

Total Per Read

Mammo Est. Volume 1,200 1,920 0 85 500 1

$ per Volume

Total Per Read

MRI Est. Volume 450 180 0 250 0 1

$ per Volume

Total Per Read

Ultrasound Est. Volume 250 1,500 200 20 20 775

$ per Volume

Total Per Read

X-Ray Est. Volume 5,650 10,000 1,500 800 865 500

$ per Volume

Total Per Read

DEXA Est. Volume 0 500 0 1,000 0 0

$ per Volume

Option Period 3: October 1, 2021 to September 30, 2022

Comprehensive

Healthcare Facility

Kayenta Health Center

Inscription House Health Center

Northern Navajo Medical Center

Crownpoint Comprehensive

Healthcare Facility

Gallup Indian Medical Center

CT Est. Volume 3,850 3,500 0 5,000 400 6,745

$ per Volume

Total Per Read

CTA Est. Volume 0 300 0 400 400 500

$ per Volume

Total Per Read

Mammo Est. Volume 1,200 1,920 0 85 500 1

$ per Volume

Total Per Read

MRI Est. Volume 450 180 0 250 0 1

$ per Volume

Total Per Read

Ultrasound Est. Volume 250 1,500 200 20 20 775

$ per Volume

Total Per Read

X-Ray Est. Volume 5,650 10,000 1,500 800 865 500

$ per Volume

Total Per Read

DEXA Est. Volume 0 500 0 1,000 0 0

$ per Volume

Option Period 4: October 1, 2022 to September 30, 2023

Comprehensive

Healthcare Facility

Kayenta Health Center

Inscription House Health Center

Northern Navajo Medical Center

Crownpoint Comprehensive

Healthcare Facility

Gallup Indian Medical Center

CT Est. Volume 3,850 3,500 0 5,000 400 6,745

$ per Volume

Total Per Read

CTA Est. Volume 0 300 0 400 400 500

$ per Volume

Total Per Read

Mammo Est. Volume 1,200 1,920 0 85 500 1

$ per Volume

Total Per Read

MRI Est. Volume 450 180 0 250 0 1

$ per Volume

Total Per Read

Ultrasound Est. Volume 250 1,500 200 20 20 775

$ per Volume

Total Per Read

X-Ray Est. Volume 5,650 10,000 1,500 800 865 500

$ per Volume

Total Per Read

DEXA Est. Volume 0 500 0 1,000 0 0

$ per Volume

B-3 PERFORMANCE WORK STATEMENT (PWS)

1.0 INTRODUCTION

The Navajo Area Indian Health Service (NAIHS) includes five Federal Service Units located in the northern portions of the States of Arizona and New Mexico. NAIHS facilities offer a wide range of health care services with varying levels, types and hours of service, up to twenty-four hours per day and seven days per week, at the various Service Units. NAIHS facilities perform a variety of imaging examinations in support of their clinical activities with all images captured, stored and displayed in DICOM format.

NAIHS Service Units have a requirement for Teleradiology Services to assist Service Units with the interpretation of medical images including X-ray (CR/DR), Computed Axial Tomography (CT), Mammography (MM), Ultrasound (US), Magnetic Resonance Imaging (MRI), and Dual Energy x-ray (DEXA).

2.0 DEFINITIONS/ACRONYMS:

A. Acceptance: Constitutes acknowledgement that the supplies or services conform to applicable contract quality and quantity requirements, except as provided in FAR subpart 46.5 and subject to other terms and conditions of the contract.

B. Approval: Acknowledgment by the designated Government employee that submittals, deliverables, or administrative documents (e.g., insurance certificates, installation schedules, planned utility interruptions, etc.) conform to the contractual requirements. Government approval does not relieve the Contractor from responsibility for compliance with contract requirements.

C. Area: A defined geographical region for Indian Health Service administrative purposes. Each Area Office may administer several Service Units.

D. Authorized Ordering Official: A Government employee with the authority to order/issue and sign individual task orders for a specific healthcare facility

E. Award Term Plan: plan of action to extend the contract per the Option Years for successful completion of the quality assurance plan.

F. Contracting Officer (CO): A Government employee with the authority to enter into, administer, and/or terminate a contract and make related determinations and findings.

G. Contracting Officer’s Representative (COR): A Government employee responsible for administration of this contract. The COR closely monitors the contract for Contractor compliance and provides feedback to the Contracting Officer.

H. Contractor: The entity awarded legal binding contract to provide supplies and services.

I. Customer: Patients, staff and visitors of a NAIHS service unit and medical facility.

J. Customer Evaluation/Input: Written comments made to the Contracting Officer regarding the Contractor’s performance. This is one of the criteria used to evaluate the Contractor’s performance.

K. Facility Point of Contact: A Government employee designated by the facility receiving service, who assists the Authorized Ordering Official in the administration of task orders and payment of invoices issued under this contract.

Has limited authority to contact Contractor regarding routine daily service issues and special requests within the scope of the contract. Assists the Contracting Officer’s Representative to monitor the Contractor for performance.

L. Federal Acquisition Regulation (FAR): The FAR is the primary regulation for use by all Federal Executive agencies in their acquisition of supplies and services with appropriated funds.

M. Holiday: A day marked by a general suspension of work in commemoration of an event.

N. Ordering Official: A Government employee with the authority to order/issue and sign individual task orders.

O. Past Performance Information: Relevant information regarding a contractor’s actions under previously awarded contracts. This includes the contractor’s record of conformance to specifications and to standards of good workmanship; the contractor’s record of containing and forecasting costs on any previously performed cost reimbursable contracts; the contractor’s adherence to contract schedules, including the administrative aspects of performance; the contractor’s history for reasonable and cooperative behavior and commitment to customer satisfaction; and generally, the contractor’s business-like concern for the interest of the customer.

P. Performance-Based Acquisition: Structuring all aspects of an acquisition around the purpose of the work to be performed with the contract requirements set forth in clear, specific, and objective terms with measurable outcome as opposed to either the manner by which the work is to be performed or a broad and imprecise performance work statement.

Q. Performance-Based Matrix: Lists the services to be monitored and the standards to be applied.

R. Quality Assurance Surveillance Plan (QASP): A written document prepared and used by the government for Quality Assurance surveillance of the contractor’s performance.

S. Quality Control: Those actions taken by the contractor to control quality of services provided.

T. Task Order (SF1449): An order issued in accordance with the terms of the contract that details an ordering activity’s specific requirements. An authorized ordering official’s written order to obtain services, at a minimum will include the following where applicable: description of services, skill categories, hours, price, period of performance, contract number, and the ordering activity’s task order number.

ACRONYMS:

A. ACR: American College of Radiology (ACR)

B. CMS: Center for Medicaid and Medicare Services

B. DICOM: Digital Imaging and Communications in Medicine, standard for the communication and management of medical information and related data

C. DUNS: Data Universal Numbering System (Dun and Bradstreet)

D. FDA: Food and Drug Administration

E. HIPAA: Health Insurance Portability and Accountability Act

F. HL7: Health Level 7, Medical informatics standard that facilities communication among different digital systems.

G. MQSA: Mammography Quality Standard Act

H. NAIHS: Navajo Area Indian Health Service

I. NAO: Navajo Area Office

J. OIG: Office of Inspector General

K. PACS: Picture Archiving and Communications System

L. TJC: The Joint Commission

3.0 CONTRACTOR REQUIREMENTS

A. NAIHS Facility Data and Images: Except as necessary to provide services under the contract, Contractor shall not share, distribute or publish any NAIHS or NAIHS facility business data, patient data or information, or patient images without the express written consent of the originating facility and any such data, information or images shared, distributed or published with the express written consent of the originating facility shall be in accordance with all applicable regulations and requirements of Health Insurance Portability and Accountability Act (HIPAA), Privacy Act, The Joint Commission (TJC), Center for Medicaid and Medicare Service (CMS) and other applicable privacy standards.

B. The contractor shall be in compliance with CMS requirements §§482.12(a)

(1) through (a) (7) and §482.12 (e) stated in the written agreement.

C. Contractor’s Equipment and Software: Hardware and software utilized by contractor to provide services under the contract shall be compliant with all regulations and requirements of FDA, ACR, TJC, CMS and HIPAA. Shall be able to receive DICOM images for interpretation of exams.

D. Contractor’s Professional Liability Insurance: Contractor shall maintain, at contractor’s sole expense, Professional Liability Insurance for each of contractor’s radiologists providing services under the contract in the amount of at least Two Million Dollars ($2,000,000) per claim and Six Million Dollars ($6,000,000) in the annual aggregate, AND General Liability Insurance in an amount at least commensurate with industry standards.

E. All interpretations provided to NAIHS facilities under the terms of the contract shall be performed by radiologists located in the United States of America.

F. Credentialing of Contractor’s Radiologists: Contractor shall maintain at all times during the contract period certification by TJC (MS 13.01.01 and MS 13.01.03) and CMS, §482.22 (a) (3) and §482.22 (a) (4) including credentialing of contractor’s radiologists providing services to NAIHS facilities under the terms of the contract. Contractor shall notify NAIHS immediately in writing of any limitations on contractor’s TJC and/or CMS certification or restrictions on credentials of any of contractor’s radiologists. Contractor shall provide to NAIHS Contracting Officer Representative (COR) and subsequently update a list of all radiologists that will be providing interpretations under the terms of the contract, said list including Provider Identification Number (PIN) and other identifying information required by government and private third party payers.

Contractor shall provide each NAIHS facility with signed billing waivers for each interpreting radiologist as required to facilitate billing of government and private third party payers by NAIHS facilities. Contractor shall provide NAIHS all documentation, information and permissions required by referring Service Units to properly complete their credentialing actions as required by TJC and CMS. Contractor shall provide NAIHS at least five working days (excluding weekends and Federal holidays) notice of any additions to contractor’s interpreting radiologist staff, said notice to be accompanied by all identification, billing, privileging and credentialing documentation specified above this paragraph.

G. Radiology Staff Quality Assurance (QA) Activities and Requirements: The contractor shall establish and maintain a QA program consistent with all TJC or CMS requirements including quarterly evaluations of interpretations by every interpreting radiologist. These requirements may be amended from time to time to maintain compliance with applicable laws, rules and regulations.

a. Said QA evaluations shall classify contractor’s radiologist’s imaging examination clinical report as:

1. No Discrepancy: Reviewer fully agreed with initial clinical interpretation.

2. Minimal Discrepancy: Reviewer noted or disagreed with one or more findings reported on the initial interpretation that would likely not alter NAIHS facility’s patient’s care or clinical course.

3. Significant Discrepancy: Reviewer noted or disagreed with one or more findings on the initial interpretation that would likely alter NAIHS facility’s patient’s care or clinical course. Note that contractor shall take action within one (1) hour to communicate to NAIHS facility responsible provider notice of any significant discrepancies found in initial reads.

b. Said QA evaluations shall include a sufficient number of interpretations for each of contractor’s radiologists providing services under the contract to meet all TJC and CMS requirements for accredited QA programs.

c. Said QA evaluations shall be conducted by a Board Eligible/Board Certified (BC/BE) radiologist (not currently in residency training) at contractor’s sole expense.

d. Said QA evaluations must be reported to the NAIHS COR within thirty calendar days of the end of the quarter or as required by TJC and CMS.

e. Performance Improvement Plans (PI Plans) must be included for any of contractor’s interpreting radiologists with a rate of clinically significant discrepancy greater than 1%.

H. Preliminary and Final Interpretations: All interpretations will be final once

BC/BE radiologist (not currently in residency training) complete the report and transfers the report into the referring facilities medical record. All interpretations will be final.

I. Digital Mammography Requirements: Contractor shall provide the following services related to NAIHS referring facility screening and diagnostic mammography programs including support for Mammography Quality Standards Act (MQSA) activities with FDA and ACR. Contractor may be required to provide the following services depending on the needs of the individual referring facility.

a. Lead Interpreting Physician, as defined by MQSA.

b. Medical Physicist Survey, as required by MQSA, with all required reporting to COR as required by MQSA. Contractor shall maintain full MQSA accreditation while performing mammography services under the terms of the contract.

c. Contractor’s Lead Interpreting Physician and Medical Physicist shall consult with and assist referring facilities with all clinical issues and MQSA accreditation issues as requested by the referring facilities and required by MQSA. Contractor shall be responsible for physician’s portions of MQSA accreditation and annual inspections.

d. Contractor’s Lead Interpreting Physician and staff Mammographers shall be available to assist NAIHS referring facilities’ clinical providers with clinical consultations related to mammography services performed under the terms of the contract.

J. Contractor’s Customers’ Assistance: Contractor shall provide contacts for NAIHS and referring facilities for assistance for clinical, technical and business related issues as follows.

a. Contractor shall provide a customer representative to assist NAIHS and referring facilities staff with business questions during regular business hours Monday through Friday, 0800 –

1700 MT.

b. Contractor will maintain an 800 numbers or equivalent telephone service to permit twenty-four hours per day and seven days per week immediate contact with contractor’s clinical staff by clinical providers at referring facilities.

c. Contractor will maintain an 800 numbers or equivalent telephone service to permit twenty-four hours per day and seven days per week immediate contact with contractor’s technical staff by clinical providers or technical support personnel at referring facilities.

d. Contractor shall identify a Medical Director for its services.

COR, NAIHS clinical providers and administrators may contact contractor’s Medical Director with clinical issues and concerns, and service requests.

K. Contractor’s Communications Network and Interface Requirements

a. Communications Interface: Contractor shall interface with Government furnished PACS (Picture Archiving and Communication System) communications platform(s) at NAIHS referring facility sites.

b. Storage and Display of Imaging Examinations: All interpretations shall be performed on FDA, TJC, CMS and HIPAA compliant equipment operating FDA, TJC, CMS and HIPAA compliant software. All equipment and software shall be calibrated and maintained to FDA, TJC, CMS and HIPAA compliant standards.

c. Required Communications and Information Systems Agreements: Contractor shall work with NAIHS and facility Information Technology (IT) Departments to complete all IHS required Information Systems Agreements.

d. Contractor’s network must have established firewalls and procedures to ensure patient confidentiality and security consistent with HIPAA regulations and American College of Radiology (ACR) guidelines.

e. Contractor shall transmit reports to NAIHS facilities by electronic means in format acceptable to referring facility.

f. Contractor shall upon request work with NAIHS and referring facilities to develop: a) direct HL – 7 interface with IHS database to allow direct communications of patient demographic and clinical information, imaging examination information and work orders from NAIHS referring facilities’ database to contractor’s information system and b) direct HL – 7 interface for transmission of imaging examination reports from contractor’s information system back to NAIHS referring facilities’ database.

g. Contractor’s server and telecommunications network must have built in redundancy to allow for 100% receipt and processing of all NAIHS data.

L. Contractors providers shall not be mentioned or a party on the OIG (Office of Inspector General) Exclusions List and Excluded Party List.

M. Contractor shall perform quarterly Quality Assurance and Peer Review

(QA) including review of all radiologists providing interpretive services under the terms of this contract as defined in section B-3, subsection (3.0) item no. (F) of this document. Contractor shall report results of all QA performed as part of this Performance Work Statement (PWS) to the Contracting Officer Representative (COR), NAIHS as required by section B- 3, subsection (3.0) item no. (F).

N. The Contractor shall notify the Navajo Area Indian Health Service upon the appearance of a provider on the National Data Bank with a new event or has a change in license status.

4.0 THIRD PARTY BILLING:

NAIHS medical facilities will bill for all third party insurance for all studies covered in the contract. The contractor shall not bill insurance for services rendered. The contractor shall be required to have all participating radiologist sign billing waiver.

5.0 PROFESSIONAL QUALIFICATIONS

The Contractor physicians shall:

A. Be Board Eligible or Board Certified (BE/BC) in Diagnostic Radiology by the

American Board of Radiology (ABR).

B. Possess an unrestricted license to practice medicine in the state where they will be providing professional services (the state where contractors’ radiologist will be located while interpreting and reporting exams). The states services to be provided are in the state of New Mexico and Arizona.

C. Be credentialed by Contractor under The Joint Commission (TJC) or Center for Medicaid/Medicare Services (CMS) accredited methods to provide diagnostic imaging professional services.

D. Provide under the contract only diagnostic imaging professional services within the scope of their credentials as granted by contractor under TJC or CMS accredited methods.

E. Meet the “Qualifications of Personnel” in the America College of Radiology

(ACR) Technical Standard for Teleradiology, Section III, A. Physician (http://www.acr.org/Hidden/Economics/FeaturedCategories/useful_links /medicare_info/teleradiology/ACRTechnicalStandardsDoc4.aspx).

http://www.acr.org/Hidden/Economics/FeaturedCategories/useful_links/medicare_info/teleradiology/ACRTechnicalStandardsDoc4.aspx http://www.acr.org/Hidden/Economics/FeaturedCategories/useful_links/medicare_info/teleradiology/ACRTechnicalStandardsDoc4.aspx

6.0 Performance – Based Matrix

Performance-based Task Indicator Standard Quality Assurance Incentives

Contractor shall provide teleradiology services.

Competency

Compliance

Patient Outcomes

Professionalism

Reports

Credentialing

Perform 100% required tasks at 100% of the required competencies (refer to 5.0)

100% compliance with IHS Service Units and/or Health Centers published Policies; Procedures;

Standards of Care; and hospital and Laboratory Protocols.

No reports of breached patient safety, infection control, and other procedures that might adversely affect patient outcome.

Performance characterized by continual cultural awareness and focus on customer service. 100 percent adherence to the Code of Ethics and Federal Code of Conduct.

100% percent of meeting requested timeline as stated in Section B-9.

100% meets requirements as stated under section B-3, subsection 3.0, item

no. F of the PWS.

See QASP and the reports submitted by the Contractor as stated in section B-3, Contractor Requirements, section M.

Positive performance review on Contractor Performance Assessment Report System (CPARS).

Payment for services performed in accordance with PWS.

Exercise of Option Period as identified in Section B-4.

B-4 PERIOD OF PERFORMANCE

1. The effective date of this contract is from June 1, 2019 or Date of Award to September 30, 2019 with four (4) one (1) year option periods.

2. If the Government exercises its option pursuant to FAR 52.217-9 Option to Extend the Term of the Contract, the period of performance will be extended in accordance with the following schedule:

OPTION PERIODS PERIOD OF PERFORMANCE

Option Period One (1) October 1, 2019 to September 30, 2020 Option Period Two (2) October 1, 2020 to September 30, 2021 Option Period Three (3) October 1, 2021 to September 30, 2022 Option Period Four (4) October 1, 2022 to September 30, 2023

B-5 CONTRACTING OFFICER (CO) RESPONSIBILITY

Authority to negotiate changes in terms, conditions and amounts cited in this contract is reserved to the Contracting Officer (CO).

B-6 CONTRACTING OFFICER REPRESENTATIVE (COR):

The COR for this contract shall be:

Gary Williams, Supervisory Diagnostic Radiologic Technologist, Level II Northern Navajo Medical Center Shiprock, NM 87420 Email: gary.williams@ihs.gov Phone: (505) 368-7153

The COR is responsible for:

1. Monitoring the Contractor’s technical progress, including surveillance and assessment of performance and recommending to the Contracting Officer changes in requirement(s).

2. Performing technical evaluation as required.

3. Performing technical inspections and acceptance required by this contract; and,

4. Assisting the Contractor in the resolution of problems encountered in performance.

mailto:gary.williams@ihs.gov

B-7 CUSTOMER POINT OF CONTACT:

Name:

Title:

Phone Number:

Email:

B-8 MEDICAL DIRECTOR POINT OF CONTACT:

As stated in section B-3, Contractor Requirements, section J, d:

Name:

Title:

Phone Number:

Email:

B-9 REPORTS

The following are the required timelines for reports sent as ‘routine’, ‘urgent’ and/or ‘stat’:

1. Routine: Interpretation should be available at the referring facility by noon the following day.

2. Urgent or Stat: Interpretation should be called, and faxed or transmitted to the responsible provider at the referring facility within thirty (30) minutes. Contractor shall also keep a written or electronic log of telephone and/or fax urgent or stat reports and shall conduct review of data consistent with TJC and CMS requirements on a monthly basis, results of said review to be reported to NAIHS COR within twenty calendar days of the end of the report month.

3. In all cases, within one (1) hour the Contractor’s radiologists shall provide immediate telephone consultation with NAIHS clinicians to report any abnormal findings that might significantly alter the treatment and care of NAIHS patients or any errors discovered.

4. Accuracy of Reports: All reports shall maintain a 99% clinically significant accuracy rate. Any errors found in reports, must be communicated within 12 hours by telephone and fax to the responsible provider at the referring NAIHS facility.

B-10 INVOICE SUBMISSION

1. The Contractor shall submit an original monthly invoice(s) to the attention of the individuals identified in section B-10, d. The individuals will then forward the invoices to the identified medical facility point of contacts identified in Section B-12. The point of contact will then forward the invoice to the authorized ordering official. The authorizing official will then forward to the approving official for processing of payment.

2. The Contractor is required to include its Data Universal Numbering System (DUNS) number on each invoice. For additional information about the Dun & Bradstreet (D&B) DUNS number, please visit http://fedgov.dnb.com/webform.

3. In accordance with FAR 52.212-4(g), a proper invoice must include the following:

a. Contract Number, Task Order Number, Contractor’s name, and invoice date and payment terms;

b. The following certification shall be cited on each order/invoice submitted for payment:

“I certify that all services concerned with this invoice are accurate and complete as of the date of this invoice and that all payments requested are for appropriate purposes and in accordance with the contract terms.”

c. The Contractor shall include the following citation on each invoice submitted for payment:

“Services have been received and are acceptable in accordance with the terms of the contract.”

Facility Representative’s Signature Date

Authorized Ordering Official: “I hereby approve this invoice for payment”

Authorized Ordering Official’s Signature Date http://fedgov.dnb.com/webform

d. The Contractor shall email to the following list of individuals:

Email to: Gary Williams, COR, gary.williams@ihs.gov Email to: DeeAndra Salabye, Contract Specialist Email to: All Point of Contacts identified on each issued Task Order

B-11 OFFICIALS AUTHORIZED TO PLACE ORDERS AGAINST THIS CONTRACT:

1. The authorized ordering officials, as listed below, shall represent the Government for the purpose of issuing and signing Individual Task Orders under this agreement.

2. The authority to obligate the Government shall be in accordance with the acquisition delegation of his/her authority.

3. The authorized individuals listed under Navajo Area Office shall issue task orders ONLY in the absence of the medical facilities Acquisition points of contact.

Navajo Area IHS Medical Facilities Contracting Officers Navajo Area Office Margaret Shirley-Damon, Contract Specialist St. Michaels, AZ 86511 Priscilla Duncan, Contract Specialist DeeAndra Salabye, Contract Specialist Thomasina Willie, Business Specialist

Chinle Comprehensive Healthcare Facility Tanya Begay, Supervisory Contract Specialist Chinle, AZ 86503

Kayenta Health Care Roxanne Franklin, Contract Specialist Kayenta, AZ 86033 DeeAndra Salabye, Contract Specialist

Inscription House Health Center Roxanne Franklin, Contract Specialist Shonto, AZ 86054 DeeAndra Salabye, Contract Specialist

Northern Navajo Medical Center Margaret Shirley-Damon, Contract Specialist Shiprock, NM 87420 Priscilla Duncan, Contract Specialist DeeAndra Salabye, Contract Specialist

Crownpoint Healthcare Facility Margaret Shirley-Damon, Contract Specialist Crownpoint, NM 87313 Priscilla Duncan, Contract Specialist DeeAndra Salabye, Contract Specialist

Gallup Indian Medical Center Michelle James, Contract Specialist Gallup, NM 87301 Margaret Shirley-Damon, Contract Specialist Priscilla Duncan, Contract Specialist DeeAndra Salabye, Contract Specialist mailto:gary.williams@ihs.gov

B-12 MEDICAL FACILITY POINTS OF CONTACT

1. Chinle Comprehensive Healthcare Facility PO Box Drawer-PH Chinle, AZ 86503

Physician Contact: Eric Ritchie, MD, 928-674-7019 Acting Radiology Supervisor: Andrew Baker, MD, 928-674-7198

2. Crownpoint Healthcare Facility PO Box 358 Crownpoint, NM 87313

Physician Contact: Charlene Avery, MD, 505-786-6354 Radiology Supervisor: Henrietta Bushman, 505-786-6363

3. Gallup Indian Medical Center 516 E. Nizhoni Blvd

PO Box 1337 Gallup, NM 87301

Physician Contact: Stephen Friedman, MD, 505-722-1652 Radiology Supervisor: Aaron Yuselew, 505-722-1000

4. Northern Navajo Medical Center PO Box 160/North Hwy 491 Shiprock, NM 87420

Physician Contact: Ouida Vincent, MD 505-368-6008 Radiology Supervisor: Gary Williams 505-368-7153

5. Inscription House Health Center PO Box 7397 Shonto, AZ 86054

Physician Contact: James Thomas, MD 928-672-3091 Radiology Supervisor: Marvin Ketchum, 928-672-3077

6. Kayenta Health Center PO Box 368 Kayenta, AZ 86033

Physician Contact: Barbara Vize, MD, 928-697-4234 Acting Radiology Supervisor: Scott Mitchell, 928-697-4310

SECTION C – CONTRACT CLAUSES

C.1 52.252-2 Clauses Incorporated by Reference (FEB 1998)

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

https://acquisition.gov/browsefar

FAR Clause No. Title Date

52.202-1 Definitions NOV 2013

52.204-7 System for Award Management OCT 2018

52.224-1 Privacy Act Notification APR 1984

52.224-2 Privacy Act APR 1984

52.232-40 Providing Accelerated Payments to Small Business Sub-Contractors DEC 2013

C.2 52.209-5 Certification Regarding Responsibility Matters (OCT 2015)

(a)(1) The Offeror certifies, to the best of its knowledge and belief, that—

(i) The Offeror and/or any of its Principals—

(A) Are □ are not □ presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agency;

(B) Have □ have not □, within a three-year period preceding this offer, been convicted of or had a civil judgment rendered against them for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) contract or subcontract; violation of Federal or State antitrust statutes relating to the submission of offers; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, violating Federal criminal tax laws, or receiving stolen property (if offeror checks “have”, the offeror shall also see 52.209-7, if included in this solicitation);

(C) Are □ are not □ presently indicted for, or otherwise criminally or civilly charged by a governmental entity with, commission of any of the offenses enumerated in paragraph (a)(1)(i)(B) of this provision;

(D) Have □, have not □, within a three-year period preceding this offer, been notified of any delinquent Federal taxes in an amount that exceeds $3,500 for which the liability remains unsatisfied.

(1) Federal taxes are considered delinquent if both of the following criteria apply:

(i) The tax liability is finally determined. The liability is finally determined if it has been assessed. A liability is not finally determined if there is a pending administrative or judicial challenge. In the case of a judicial challenge to the liability, the liability is not finally determined until all judicial appeal rights have been exhausted.

https://acquisition.gov/browsefar https://acquisition.gov/sites/default/files/current/far/html/52_207_211.html#wp1144964

(ii) The taxpayer is delinquent in making payment. A taxpayer is delinquent if the taxpayer has failed to pay the tax liability when full payment was due and required. A taxpayer is not delinquent in cases where enforced collection action is precluded.

(2) Examples.

(i) The taxpayer has received a statutory notice of deficiency, under I.R.C. § 6212, which entitles the taxpayer to seek Tax Court review of a proposed tax deficiency. This is not a delinquent tax because it is not a final tax liability. Should the taxpayer seek Tax Court review, this will not be a final tax liability until the taxpayer has exercised all judicial appeal rights.

(ii) The IRS has filed a notice of Federal tax lien with respect to an assessed tax liability, and the taxpayer has been issued a notice under I.R.C. § 6320 entitling the taxpayer to request a hearing with the IRS Office of Appeals contesting the lien filing, and to further appeal to the Tax Court if the IRS determines to sustain the lien filing. In the course of the hearing, the taxpayer is entitled to contest the underlying tax liability because the taxpayer has had no prior opportunity to contest the liability. This is not a delinquent tax because it is not a final tax liability.

Should the taxpayer seek tax court review, this will not be a final tax liability until the taxpayer has exercised all judicial appeal rights.

(iii) The taxpayer has entered into an installment agreement pursuant to I.R.C. § 6159. The taxpayer is making timely payments and is in full compliance with the agreement terms. The taxpayer is not delinquent because the taxpayer is not currently required to make full payment.

(iv) The taxpayer has filed for bankruptcy protection. The taxpayer is not delinquent because enforced collection action is stayed under 11 U.S.C. 362 (the Bankruptcy Code).

(ii) The Offeror has o has not o , within a three-year period preceding this offer, had one or more contracts terminated for default by any Federal agency.

(2) “Principal,” for the purposes of this certification, means an officer, director, owner, partner, or a person having primary management or supervisory responsibilities within a business entity (e.g., general manager; plant manager; head of a division or business segment; and similar positions).

This Certification Concerns a Matter Within the Jurisdiction of an Agency of the United States and the Making of a False, Fictitious, or Fraudulent Certification May Render the Maker Subject to Prosecution Under Section 1001, Title 18, United States Code.

(b) The Offeror shall provide immediate written notice to the Contracting Officer if, at any time prior to contract award, the Offeror learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

(c) A certification that any of the items in paragraph (a) of this provision exists will not necessarily result in withholding of an award under this solicitation. However, the certification will be considered in connection with a determination of the Offeror’s responsibility. Failure of the Offeror to furnish a certification or provide such additional information as requested by the Contracting Officer may render the Offeror nonresponsible.

(d) Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render, in good faith, the certification required by paragraph (a) of this provision. The knowledge and information of an Offeror is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

(e) The certification in paragraph (a) of this provision is a material representation of fact upon which reliance was placed when making award. If it is later determined that the Offeror knowingly rendered an erroneous certification, in addition to other remedies available to the Government, the Contracting Officer may terminate the contract resulting from this solicitation for default.

C.3 52.209-11 Representation by Corporations Regarding Delinquent Tax Liability or a Felony Conviction under any Federal Law (FEB 2016)

(a) As required by sections 744 and 745 of Division E of the Consolidated and Further Continuing Appropriations Act, 2015 (Pub. L. 113-235), and similar provisions, if contained in subsequent appropriations acts, the Government will not enter into a contract with any corporation that—

(1) Has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability, where the awarding agency is aware of the unpaid tax liability, unless an agency has considered suspension or debarment of the corporation and made a determination that suspension or debarment is not necessary to protect the interests of the Government; or

(2) Was convicted of a felony criminal violation under any Federal law within the preceding 24 months, where the awarding agency is aware of the conviction, unless an agency has considered suspension or debarment of the corporation and made a determination that this action is not necessary to protect the interests of the Government.

(b) The Offeror represents that—

(1) It is □ is not □ a corporation that has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability; and

(2) It is □ is not □ a corporation that was convicted of a felony criminal violation under a Federal law within the preceding 24 months.

C.4 52.212-4 Contract Terms & Conditions-Commercial Items (OCT 2018)

(a) Inspection/Acceptance. The Contractor shall only tender for acceptance those items that conform to the requirements of this contract. The Government reserves the right to inspect or test any supplies or services that have been tendered for acceptance. The Government may require repair or replacement of nonconforming supplies or reperformance of nonconforming services at no increase in contract price. If repair/replacement or reperformance will not correct the defects or is not possible, the Government may seek an equitable price reduction or adequate consideration for acceptance of nonconforming supplies or services. The Government must exercise its post-acceptance rights—

(1) Within a reasonable time after the defect was discovered or should have been discovered; and

(2) Before any substantial change occurs in the condition of the item, unless the change is due to the defect in the item.

(b) Assignment. The Contractor or its assignee may assign its rights to receive payment due as a result of performance of this contract to a bank, trust company, or other financing institution, including any Federal lending agency in accordance with the Assignment of Claims Act (31 U.S.C.

3727). However, when a third party makes payment (e.g., use of the Governmentwide commercial purchase card), the Contractor may not assign its rights to receive payment under this contract.

(c) Changes. Changes in the terms and conditions of this contract may be made only by written agreement of the parties.

(d) Disputes. This contract is subject to 41 U.S.C. chapter 71, Contract Disputes. Failure of the parties to this contract to reach agreement on any request for equitable adjustment, claim, appeal or action arising under or relating to this contract shall be a dispute to be resolved in accordance with the clause at FAR 52.233-1, Disputes, which is incorporated herein by reference.

The…