75H71320Q00001 ATTACHMENT SOW.docx
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SOLICITATION NO. 75H71320Q00001
STATEMENT OF WORK
I – BACKGROUND
The Colville Service Unit (CSU) encompasses the mission of the Indian Health Service (IHS) which is to raise the health status of the American Indian and Alaska Native people to the highest possible level. The Service Unit is located in the remote and beautiful north central part of Washington on the Colville Indian Reservation. The Reservation contains incredible diversity of ecosystems from vast stretches of high desert plateau in the south near Grand Coulee Dam to high, forested mountains in the north. The Columbia River marks the southern and eastern borders, the Okanogan River on the west. The reservation and surrounding area encompass ample opportunity for outdoor enthusiasts with the best of four seasons in the Pacific Northwest. The breathtaking lakes and terrain are wrapped in the rich cultural history. Omak is the largest adjacent community to the west side of the Reservation. Spokane and Wenatchee are the largest metropolitan areas located an hour and a half from Nespelem. There are many other rural towns in and around the reservation including Okanogan, Twisp, Chelan, and Grand Coulee Dam.
The Confederated Tribes of the Colville Indian Reservation (Colville Tribes) consist today of 1.4 million acres. The aboriginal territories for the 12 Tribes which comprise the Colville Tribes of the Colville Indian Reservation spanned from British Columbia, along the Eastern Slope of the Cascade Range to the Wenatchee Valley, across Northcentral Washington, the Palouse and North Eastern Oregon. The reservation has four distinct political and geographic districts of Omak, Inchelium, Nespelem and Keller. Ambulatory Health Services are provided in all four. In Nespelem and Omak the Colville Service Unit provide the direct patient care, with Inchelium and Keller operating clinics under the Lake Roosevelt Health Centers. Tribal members utilize any of the four facilities.
Tribal cultural practices are maintained through many ceremonies, activities and practices. Tribal members continue traditional gathering of edible roots, berries, medicines and weaving materials across the traditional areas for the tribes. Additionally, Tribal members include deer, elk and moose as well as salmon and other fish as part of the diet. Traditional dancing, rodeo, sports are some of the activities enjoyed by the membership.
Recognizing that the largest population of tribal members reside in the Omak District the Colville Tribes built a modest facility which is leased by the Indian Health Services. Patient services provided include, medical, laboratory, dental and administration are included. The facility is also utilized by the Women, Infant and Children program which is operated by the Colville Tribes.
The 40,000 square foot Ambulatory care facility is operated by the Portland Area Indian Health Services. And located in Nespelem Washington. CSU’s main campus was completed in June 2007. The service unit is presently accredited by the Accreditation Association for Ambulatory Health Care (AAAHC). CSU offers multiple Medical Home teams comprising a Provider, Nurse, Medical Technologist, PRC Clerk, as well as a Patient Advocate. The comprehensive health services available include; medical, dental, optometry, lab, pharmacy, and x-ray. The Colville Service Unit (CSU) operates an IHS satellite office in Omak and offers a single medical home model of care including medical, dental, and pharmacy services.
The tribal government and other tribal services are also located in Nespelem, WA. The Tribe is governed by a 14 member Business Council elected on staggered two year terms form the four districts of the reservation. The Tribal Government headquarters are located in Nespelem, with governmental services provided in all districts. CSU is the healthcare cornerstone for the community and works embraces the concept of Community-Oriented Primary Care and as such has connections with all programs and staff providing health care services with numerous tribal programs. Collaboration includes, but is not limited to the Colville Tribes Health Programs, Behavioral Health Services, Convalescent and Lake Roosevelt Health Centers. CSU encourages prevention by participating in many different outreach and community activities. Dental patients are educated on home care while they receive treatment at the clinic, encouraged to return for routine follow-ups, and regularly have topical fluoride placed for decay prevention.
II - PURPOSE
a. The primary purpose of this contract is to define the relationship, matters of ownership,management, and relative responsibilities of the selected Dental Provider to provide direct patient care. The purpose of the work is to improve the overall oral health status of the Native American population served. Due to limited Purchase of Referred Care (PRC) formerly known as Contract Health Services (CHS) funding, referrals to external providers are difficult for patients in need of Dental services. An on-site Dentist will provide the needed care including but not limited to comprehensive general dentistry, referrals to outside specialist, and assisting with oral health education initiatives.
III - GENERAL PROVISIONS
| a. | Pursuant to Federal Acquisition Regulations (FAR) Part 37.401: |
| i. | The contract is a non-personal health care services contract, as defined in 37.101, under which the contractor is an independent contractor; |
| ii. | The Government may evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of services rendered (e.g., professional judgments, diagnosis for specific medical treatment); |
| iii. | The contractor is required to indemnify the Government for any liability producing act or omission by the contractor, its employees and agents occurring during contract performance; |
| iv. | Contractor is required to maintain medical liability insurance, in a coverage amount acceptable to the contracting officer, which is not less than the amount normally prevailing within the local community for the medical specialty concerned; and |
| v. | The contractor is required to ensure that its subcontracts for provisions of health care services, contain the requirements of the clause at 52.237-7, including the maintenance of medical liability insurance. |
| b. | To provide general Dental services for four (4) to five (5) days each week as scheduled with the Contracting Officer Representative (COR). The clinics are open five (5) days each week with 8 hour clinics on Monday, Tuesday, Thursday, Friday; Regular clinic hours are from 8:00am to 4:30pm except Wednesday hours are 12:00am to 4:30pm. The contractor shall be entitled to a thirty (30) minute lunch period. This Contractor shall provide part-time or on call servicesfor both clinics one year from date of award. |
| c. | The clinics are not open on federally recognized holidays or certain day(s) of closure pursuant to an Executive Order by the President of the United States. Inclement weather conditions or facility issues (electrical, water, sewage, etc) may also hinder the normal operating hours and notice of closure will be provided as soon as is practicable by the COR or the CSU administrative component. |
| d. | Provides Dental services for a minimum of 10 to12 patients per 8 hour clinic. This requirement will be considered met, even if the patient count is less than this level, if all available patients have been seen for that scheduled day. |
| e. | Services will include, but not limited to, providing direct care to patients in a responsible, respectful and caring manner. Professional duties include: |
· Diagnosis and general management of the teeth
· Care and treatment of oral disease
· Dental procedures and the ordering of medications
· Consulting with Area or Indian Health Service (IHS) Dental Consultant on complex dental cases
· Refer patients requiring other health services to the appropriate health professional
· Provide oral health, dental education and counseling to patients
| f. | Community duties include: maintains liaison with and provides advisory Dental services to other professional personnel on patients or program problems; provides Dental specialty clinics. |
| g. | Contractor shall maintain their own continuing education requirements necessary for licensure. |
| h. | Contractor shall be responsible for recording all patient care examinations and procedures in appropriate hardcopy or electronic health records in compliance with CSU clinic standards. |
| i. | Under regulation at 42 CFR 36.24, the IHS must authorize payment for PRC formerly as CHS, and may, as party of the authorizing process, refer patients to particular contract providers. In the event a patient is in need of additional Dentistry services which cannot be provided during the clinic (i.e., further work up), prior approval to refer is required for authorization and payment to be considered. |
| j. | The contractor will be responsible for all applicable Federal, State, and local taxes and duties. The contractor shall provide all necessary resources (administrative supplies, transportation and personnel) as required, except as provided by the Government, to provide professional Dental services to eligible beneficiaries. Eligible beneficiaries are defined by the CSU’s policy and procedures. Specific supplies needed for clinic services are to be conveyed to the service unit management for procurement outside of this contract. |
| k. | The contractor shall provide proper and adequate Dental services in accordance with the Standards of Care established by recognized health care organizations including the IHS. All services shall be provided within accepted professional standards and be consistent with Accreditation Association for Ambulatory Health Care (AAAHC) accreditation requirements. The contractor is required to maintain active participation in the CSU’s professional medical staff. |
IV - INDIAN HEALTH SERVICE RESPONSIBILITIES:
a. The CSU shall provide a patient examination area and all medical and non-medical equipment and supplies used by the CSU facility for the care of Dental patients. Equipment on-site includes the following:
· 5 Adec Chairs
· 5 Adec Delievery Units
· Kavo Handpieces
· 5 Ultramat-2 Triturators
· 3 Gendrex GX 770 X-RAY
· 5 Dexis Platinum Digital Radiography Systems
· 1 Panorex Orthoralix 9000 Gendrex
· 5 dell Computers and Monitors in Operatory Units
· 1 System B Heat Source Sybro Endo
· 1 Apex Finder
· Master 400 Piezon
· 5 Adec Curing Units
· 1 Maxima Curing Unit
STERILIZATION AREA
· Ultraclave M11
· 1 Aqustat Water Distiller
· 1 Ultra Sonic Cleaner
· 1 Attest Biological Monitoring System
· 2 (2) Gallon Distillers
LAB
· Buffalo Laboratory Handpiece
· Buffalo Vacuformer
· Buffalo Stone Viberator
· Dust Collector
· Wehmer Lathe
· Lanf Aquapress
b. The CSU Clinical Director shall monitor and evaluate the quality and appropriateness of patient care.
c. CSU shall provide an orientation to the CSU and the Indian Community being served. The initial orientation and continuing orientation shall be provided by the CSU’s personnel. The orientation will include, but is not limited to, introduction to:
· Electronic Health Record (EHR)
· Electronic Dental Record (EDR)
· Resource Patient Management System (RPMS)
· Programs and packages necessary to fulfill provider obligations under this contract.
| d. | The CSU reserves the right to cancel a Dental clinic due to illness, vacation, or emergency of the Contractor or to natural or unforeseen circumstances, without compensation for that action. Such cancellation notice shall be made as soon as is practicable as described in Section C, III (c). |
| e. | The CSU will be responsible for the entry of patient information into the RPMS program. |
| f. | The COR will serve as the coordinator of credentialing packages from the contractor. The credentialing packages will include the forms to be submitted by the Contractor in Section H. |
1. The Contracting Officer Representative and Contractor will coordinate provider interviews and credentialing packages.
2. Upon selection of a provider, the Contracting Officer Representative will inform the Contracting Officer by email with: Full Legal Name. ( may require coordination with the Contractor)
3. The Government will complete the e-QIP form and submit it to Human Resources (HR) for further processing.
4. HR will initiate the background check and fingerprint processing upon receipt of the e-QIP form. (will require contact between HR and the Contractor)
5. The Contractor will coordinate the completion of necessary HR forms between the prospective provider and HR.
6. The Government will notify the Contracting Officer Representative of the prospective provider’s status. If favorable, the Contracting Officer Representative shall inform the provider and Contractor as well as agree upon a start date.
To be determined after award.
Colville Service Unit P.O. Box 71 Nespelem, WA 99155 Ph: (509) 634-2918 Email: TBD
Invoices are to be submitted bi-weekly to the COR at the address above or electronically to the COR at the designated email listed above. Payment shall be made only for clinics actually completed at time of invoice submission. Payment will be made by Electronic Funds Transfer (EFT) in accordance with clause 52.212-4(i) Payment.
| b. | The contractor agrees to include the following information on each invoice (Refer to clause 52.212-4(g) Invoice: |
| • | Contractor’s Name and Address and invoice date |
| • | Contract Number |
| • | Contractor’s Employee Identification Number |
| • | Date clinic(s) was held |
| • | Number of patient(s) encountered during clinic |
| • | Description(s) of cost |
· Total amount due.
· If final payment is billed, the last invoice shall state “FINAL.”
| c. | Final Payment shall be made after: |
| (1) | Completion and acceptance of all services |
| (2) | Presentation of a properly executed invoice |
| (3) | Presentation of release of all claims against the Government. A request for Final Payment on the contract must be accompanied by a completed Contractor’s Release for All Contracts form (PHS-3576), which will be provided by the Contracting Officer. |
| (a) | The “Final” Payment will be rejected and returned to the Contractor if all items required under the contract have not been completed, submitted, approved. |
| d. | Payment shall be made in accordance with the hourly rate of the contract for services provided at the clinic site. Payment for services received and approved shall be paid at an hourly rate calculated using the actual number of hours services are provided (rounded to the nearest ¼ hour). |
f. Payment shall be made in accordance with the Prompt Payment Act of 1982, as amended, which states that disbursement will be made within 30 days of an accepted and Approved Invoice by a Contracting Officer when presented to the Finance Office.
II - ON-SITE CONTACT:
a. The COR shall serve as the on-site contact under this contract:
Colville Indian Health Center P.O. Box 71 Nespelem, WA 99155 Ph: (509) 634-2900 The COR responsibilities will be to coordinate with the provider the technical aspects of this service and the review of performance hereunder. The COR does not have the authority to change or alter the order amount, terms or conditions without the approval of the Contracting Officer.
The COR’s responsibilities will be to monitor the contract and to coordinate any contractor requests or service unit contract requests through appropriate steps for a Contracting Officer’s action. The COR does not have the authority to change or alter the order amount, terms or conditions of this contract without the approval of the Contracting Officer.
SPECIAL CONTRACT REQUIREMENTS
I - QUALIFICATIONS:
A. The contractor shall maintain as a minimum:
· Be a graduate of an accredited Dental school
· One (1) year experience in Dentistry
· A current and unrestricted license to practice Dentistry
· Hold a current or valid license to practice in the United States, the District of Columbia, Puerto Rico, or a territory of the United States
b. The contractor shall complete, sign and return the attached forms before award of the contract:
· Certification of Immunization (Attachment A)
· Declaration of Employment (Attachment B), (Attachment B-1)
· Certification of Education, Licensure and Insurance (Attachment C)
· Health Insurance Portability and Accountability Act (HIPAA) Agreement (Attachment D)
· Contractor’s Release for All Contracts (Attachment E)
· Electronic Questionnaires for Investigations Processing (e-QIP – Attachment F)
c. Additional credentialing information may be required by the CSU. The certifications and other required credentialing information by the contractor shall be consistent with credentialing/privileging requirements of the CSU and IHS, and shall be maintained to meet credentialing/privileging requirements.
a. SUBSTITUTE PROVIDERS The Contractor may request the right to provide a substitute Dentist to cover a scheduled clinic when it is impossible for the Contractor to be in attendance due to illness or vacation. The proposed substitute must meet the qualification, credentialing and privileging requirements of the CSU and must be approved by the Contracting Officer and the Contracting Officer Representative fourteen (14) days in advance.
The proposed substitute must possess the same qualifications as specified in this contract prior to a scheduled clinic. Failure to possess or maintain such qualifications shall deem the contractor ineligible and the Government may terminate the contract for cause, in accordance with clause 52.212-4(m) Termination for cause.
b. CREDENTIALING / CLINICAL PRIVILEGES / TERMINATION If the contractor fails to meet or maintain the contract required qualifications, licensure, credentialing requirements or clinical privileges of the CSU, the contract may be terminated without cost to the Government, and the contractor determined ineligible to contract and thus, the contract shall be void.
c. CONTRACTOR GOVERNMENT FURNISHED EQUIPMENT AND FACILITIES The CSU does not anticipate a need for contractor furnished equipment.
| d. | HIPPA REQUIREMENT |
| Pursuant to the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and its implementing regulation, the Standards of Privacy of individual Identifiable Health Information at 45 C.F.R. Part 160 and 164, Subpart A and E (“Privacy Rule”), the Indian Health Service is required to enter into an agreement with the Business Associate, pursuant to which the Business Associate shall comply with and appropriately safeguard Protected Health Information (“PHI”) that it will use and disclose when performing functions, activities or services (“Services”) for the Indian Health Service. The Business Associate by signing the contract shall comply with the following terms in addition to other applicable contract terms and conditions relating to the safekeeping, use and discloser of PHI. (See Attachment for related HIPAA material and Business Associate Agreement Clause). |
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