Award-CRNA - 75H70622500008.pdf

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

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

Fixed Unit Price (Hourly Rate), Non-Personal

Healthcare Service, Indefinite

Delivery/Indefinite Quantity (ID/IQ) Contract to provide Certified Registered Nurse Anesthesiology

(CRNAs) Services for the Pine Ridge IHS Hospital, Pine Ridge, South Dakota. Period of Performance:

January 12, 2022 through January 11, 2023 with

Four Option Years. Contractor is to perform in accordance with the Performance Work Statement.

Period of Performance:

Base Year: 1/12/2022 - 1/11/2023

Option Year One (1): 1/12/2023 - 1/11/2024

Option Year Two (2): 1/12/2024 - 1/11/2025

Option Year Three (3): 1/12/2025 - 1/11/2026

Option Year Four (4): 1/12/2026 - 1/11/2027

IPP Reportable Flag: N IPP Exception Reason:

OTHER AREAS

Period of Performance: 01/12/2022 to 01/11/2027

1 Base Year: 1/12/2022 - 1/11/2023 - CRNA Services, Pine Ridge, South Dakota

Regular Clinic Hours - 3 FTE Maximum (2 Minimum)

- 4800 Hours X $375.00/Hr, totaling $1,800,000.00

Obligated Amount: $0.00

Delivery: 01/11/2023

2 Base Year: 1/12/2022 - 1/11/2023 - CRNA Services, Pine Ridge, South Dakota

On-Call Hours for Weeknights, Weekends, and

Holidays - 1 FTE - 6700 Hours X $50.00/Hr, totaling $335,000.00

Obligated Amount: $0.00

Delivery: 01/11/2023

3 Base Year: 1/12/2022 - 1/11/2023 - CRNA Services, Pine Ridge, South Dakota

Call-Back Hours - As needed - 3000 Hours X

$0.00/Hr, totaling $0.00

Obligated Amount: $0.00

Delivery: 01/11/2023

4 Option Year One (1): 1/12/2023 - 1/11/2024 - CRNA 0.00

Services, Pine Ridge, South Dakota

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Sponsored by GSA

FAR (48 CFR) 53.110

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

Regular Clinic Hours - 3 FTE Maximum (2 Minimum)

- 4800 Hours X $393.75/Hr, totaling $1,890,000.00

Amount: $1,890,000.00(Option Line Item)

01/12/2023

Delivery: 01/11/2024

5 Option Year One (1): 1/12/2023 - 1/11/2024 - CRNA 0.00

Services, Pine Ridge, South Dakota

On-Call Hours for Weeknights, Weekends, and

Holidays - 1 FTE - 6700 Hours X $52.50/Hr, totaling $351,750.00

Amount: $351,750.00(Option Line Item)

01/12/2023

Delivery: 01/11/2024

6 Option Year One (1): 1/12/2023 - 1/11/2024 - CRNA 0.00

Services, Pine Ridge, South Dakota

Call-Back Hours - As needed - 3000 Hours X

$0.00/Hr, totaling $0.00

Amount: $0.00(Option Line Item)

01/12/2023

Delivery: 01/11/2024

7 Option Year Two (2): 1/12/2024 - 1/11/2025 - CRNA 0.00

Services, Pine Ridge, South Dakota

Regular Clinic Hours - 3 FTE Maximum (2 Minimum)

- 4800 Hours X $413.44/Hr, totaling $1,984,512.00

Amount: $1,984,512.00(Option Line Item)

01/12/2024

Delivery: 01/11/2025

8 Option Year Two (2): 1/12/2024 - 1/11/2025 - CRNA 0.00

Services, Pine Ridge, South Dakota

On-Call Hours for Weeknights, Weekends, and

Holidays - 1 FTE - 6700 Hours X $55.13/Hr, totaling $369,371.00

Amount: $369,371.00(Option Line Item)

01/12/2024

Delivery: 01/11/2025

9 Option Year Two (2): 1/12/2024 - 1/11/2025 - CRNA 0.00

Services, Pine Ridge, South Dakota

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

Call-Back Hours - As needed - 3000 Hours X

$0.00/Hr, totaling $0.00

Amount: $0.00(Option Line Item)

01/12/2024

Delivery: 01/11/2025

10 Option Year Three (3): 1/12/2025 - 1/11/2026 - 0.00

CRNA Services, Pine Ridge, South Dakota

Regular Clinic Hours - 3 FTE Maximum (2 Minimum)

- 4800 Hours X $434.11/Hr, totaling $2,083,728.00

Amount: $2,083,728.00(Option Line Item)

01/12/2025

Delivery: 01/11/2026

11 Option Year Three (3): 1/12/2025 - 1/11/2026 - 0.00

CRNA Services, Pine Ridge, South Dakota

On-Call Hours for Weeknights, Weekends, and

Holidays - 1 FTE - 6700 Hours X $57.89/Hr, totaling $387,863.00

Amount: $387,863.00(Option Line Item)

01/12/2025

Delivery: 01/11/2026

12 Option Year Three (3): 1/12/2025 - 1/11/2026 - 0.00

CRNA Services, Pine Ridge, South Dakota

Call-Back Hours - As needed - 3000 Hours X

$0.00/Hr, totaling $0.00

Amount: $0.00(Option Line Item)

01/12/2025

Delivery: 01/11/2026

13 Option Year Four (4): 1/12/2026 - 1/11/2027 - 0.00

CRNA Services, Pine Ridge, South Dakota

Regular Clinic Hours - 3 FTE Maximum (2 Minimum)

- 4800 Hours X $455.82/Hr, totaling $2,187,936.00

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Amount: $2,187,936.00(Option Line Item)

01/12/2026

Delivery: 01/11/2027

14 Option Year Four (4): 1/12/2026 - 1/11/2027 - 0.00

CRNA Services, Pine Ridge, South Dakota

On-Call Hours for Weeknights, Weekends, and

Holidays - 1 FTE - 6700 Hours X $60.78/Hr, totaling $407,226.00

Amount: $407,226.00(Option Line Item)

01/12/2026

Delivery: 01/11/2027

15 Option Year Four (4): 1/12/2026 - 1/11/2027 - 0.00

CRNA Services, Pine Ridge, South Dakota

Call-Back Hours - As needed - 3000 Hours X

$0.00/Hr, totaling $0.00

Amount: $0.00(Option Line Item)

01/12/2026

Delivery: 01/11/2027

This contract does not obligate funds; funds must be obligated prior to starting performance through a delivery/task order. FAR 52.216-18

Ordering, FAR 52.216-19 Ordering Limitations, and

FAR 52.216-22 Indefinite Quantity. Orders may be placed against this contract by issuing task orders and may be submitted electronically by e-mail or mailed by hard copy.

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

The "Unit Price" is an all-inclusive cost. All

"inclusive cost" is defined to include travel, lodging, per diem, fringe benefits, i.e., life insurance, social security, federal, state, and local taxes, plus all other costs pertinent to the performance of this ID/IQ Contract.

Attachments:

- Quote/Proposal

- Performance Work Statement/QASP

- Clauses Incorporated by Reference and in

Full-Text

- Business Associate Agreement

- HHS Residual Standards of Conduct

- Courtesy and Respect in the Workplace

- Violence in the Workplace

- Mandatory Seasonal Influenza Immunizations

- Standards of Ethical Conduct

- Wage Determination No.: 2015-5377

Revision No.: 17

Date of Last Revision: 10/21/2021

SECURITY CLEARANCE:

A security pre-clearance must be performed for any employees referred to IHS through this contract.

Fingerprints must be completed and adjudicated prior to services being performed under this contract.

No contract award shall be made to any vendor or provider listed on the OIG Exclusion List http://exclusions.oig.hhs.gov throughout the duration of the contract. It shall be the responsibility of the contractor to notify the acquisition official if there is a change in provider.

Performance of this contract will require routine access by employees of the Contractor or its subcontractors to facilities or systems controlled by the Indian Health Service (I.H.S.).

Before starting work requiring routine access to

I.H.S. facilities or systems each person must complete a FBI National Criminal History Check

(Fingerprint Check) adjudicated by an I.H.S.

employee using the Office of Personnel Management

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Personnel Investigations Processing System.

Contractors shall allow five business days for

I.H.S. processing of fingerprints taken electronically at an I.H.S. site and thirty business days for non-electronic processing of fingerprints using FBI Form FD-258. A list of

I.H.S. sites with electronic fingerprint capability is available from the Contracting

Officer.

In addition, no Contractor or subcontractor employee shall be permitted to perform work under this contract if listed on the HHS Office of

Inspector General List of Excluded

Individuals/Entities (LEIE), http://exclusions.oig.hhs.gov. As soon as practicable prior to the start of work, the performance of the work the Contractor shall provide to the Contracting Officer the names of all individuals to be used in performance of work for screening against the LEIE. During the performance, the Contractor shall provide the

Contracting Officer the names of any additional or substitute employees for screening before they begin work.

The Contractor is responsible for conducting security preclearance investigations in sufficient depth to ensure that each Contractor or subcontractor employee referred to I.H.S. is not on the LEIE and can obtain a favorable fingerprint clearance. Each security preclearance shall be conducted sufficiently in advance of the start of performance to avoid delays caused by denial of access. If this is a

Time and Materials, Labor-Hour or Cost

Reimbursement contract, the contractor shall not charge for or be reimbursed for labor hours or other costs incurred for employees who are unable to perform due to denial or access or the excess time required to resolve and clear unfavorable security clearance findings. If this is a Fixed

Price contract, denial of access due to security clearance findings shall not be a basis for excusable delay or an increase to the contract amount.

Government will pay for the cost to process the contractors suitability clearances. However, multiple investigations for the same position

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(A) (B) (C) (D) (E) (F) may, at the Contracting Officers discretion, lead to reduction(s) in the contract price of no more than the cost of the extra investigation(s).

Employees that DO NOT have access to LMS, contractors, volunteers, or IHS employees with

IPA's or MOA's to tribal organizations please, click here IHS Sexual Abuse Prevention website.

When the contractors have completed and passed the training, please have them send a copy of the last page of the training with Name, Date, and

Time to their Supervisor, COR, and Kimmen LeBeau, e-mail: Kimmen.LeBeau@ihs.gov

INVOICE SUBMISSION AND PAYMENT:

The contractor shall submit a signed and approved invoice to request payment on at least a monthly basis.

A. The contractor shall submit an original invoice to:

The Great Plains Area Indian Health Service

Attn: Accounts Payable

115 4th Avenue SE, Room 309

Federal Building

Aberdeen, South Dakota 57401

The contractor shall submit a copy of the invoice to:

Pine Ridge IHS Hospital

Attn: Janelle Byrne, COR II

607 Indian Health Rd

Pine Ridge, South Dakota 57770

Phone: 605-455-8223

Janelle.byrne@ihs.gov

B. The contractor shall include the following information on each invoice in accordance with the prompt payment act (5 CFR Part 1315.9(b)):

1. Contractor's name

2. Invoice number and date

3. Entire award number or other authorization number for delivery of goods or services

4. Description (including dates of service), price and quantity of goods and services rendered

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5. Shipping and payment terms

6. Duns number and taxpayer identifying number

(TIN)

7. Contact name (where practicable), title and telephone number

Payment shall be made by the Great Plains Area

Financial Management Branch, 115 4th Avenue SE, Room 309, Federal Building, Aberdeen, South

Dakota 57401.

The Government reserves the right to accept or reject services, if the level of performance is unacceptable.

"Certified Registered Nurse Anesthetist(s) will arrive on a Business Day ONLY to complete all

Orientation and Background procedures. The

Clinical Director or Designee will ensure all

Orientation and Background procedures have been completed and an email will be sent to the

Contracting department to state as such. The

Certified Registered Nurse Anesthetist(s) will

NOT see patients until Background/Fingerprints have been cleared."

"The standards of medical practice and duties of the Contractor through its Certified Registered

Nurse Anesthetist(s) shall be determined pursuant to the bylaws of the Service Unit. The regulations of the hospital, applicable provisions of law, other rules and regulations of any and all governmental authorities relating to licensure and regulation of physicians and hospitals must be followed. Also the standards and recommendations of Centers for Medicare and

Medicaid Services (CMS) or the Accreditation

Organization must be adhered to. The Contract

Certified Registered Nurse Anesthetist(s) shall be required to participate in a quality improvement program, which is consistent with current requirements for ongoing monitoring and evaluation of the quality and appropriateness of care."

A CONTINUING RESOLUTION, also known as a "CR" is legislation enacted by congress that continues funding for specific ongoing activities if the fiscal year appropriation has not been enacted by the beginning of the fiscal year.

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"Due to the Continuing Resolution, funds are presently available through February 18, 2022

(P.L. 117-70). The Government's obligation for performance of this contract beyond that date is contingent upon the availability of appropriated funds. No legal liability on the part of the

Government for any payment may arise for performance under this contract beyond February

18, 2022. If funds are made available to the

Contracting Officer for performance beyond the above cited date, the Contractor will receive notification in writing by the Contracting

Officer."

The total amount of award: $11,797,386.00. The obligation for this award is shown in box 15G.

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Best and Final Proposal – 1/11/2022.

This is my proposal in this particular contract with numbers supplied by the contract negotiator.

I have calculated these numbers using 4800 hours as regular clinic hours.

Base year: January 3, 2022 thru January 2, 2023 Regular Clinic Hours – 3 FTE Maximum (2 Minimum) – 4800 Hrs .. $375.00/hr X 4800 hrs - $1,800,000.00 On-call Hours – Weeknights, Weekends, and Holidays – 6700 Hrs $ 50.00/hr X 6700 hrs - $ 335,000.00 Call – Back Hours – As needed – 3000 hrs …………………………………… $ 0.00 Total Estimated Contract Price for the Base Year …………………. $ $2,135,000.00

Option year 1: January 3, 2023 thru January 2, 2024 Regular Clinic Hours – 3 FTE Maximum (2 Minimum) – 4800 Hrs $393.75/hr X 4800 hrs - $1,890,000.00 On-call Hours – Weeknights, Weekends, and Holidays – 6700 Hrs $ 52.50/hr X 6700 hrs - $ 351,750.00 Call – Back Hours – As needed – 3000 hrs …………………………….….. $ 0.00 Total Estimated Contract Price for the Base Year …………….…… $ $2,241,750.00

Option year 2: January 3, 2024 thru January 2, 2025 Regular Clinic Hours – 3 FTE Maximum (2 Minimum) – 4800 Hrs .. $413.44/hr X 4800 hrs - $1,984,512.00 On-call Hours – Weeknights, Weekends, and Holidays – 6700 Hrs $ 55.13/hr X 6700 hrs - $ 369,371.00 Call – Back Hours – As needed – 3000 hrs …………………………….…… $ 0.00 Total Estimated Contract Price for the Base Year …………….…… $ $2,353,883.00

Option year 3: January 3, 2025 thru January 2, 2026 Regular Clinic Hours – 3 FTE Maximum (2 Minimum) – 4800 Hrs .. $434.11/hr X 4800 hrs - $2,083,728.00 On-call Hours – Weeknights, Weekends, and Holidays – 6700 Hrs $ 57.89/hr X 6700 hrs - $ 387,863.00 Call – Back Hours – As needed – 3000 hrs …………………………….…… $ 0.00 Total Estimated Contract Price for the Base Year …………….…… $ $2,471,591.00

Option year 4: January 3, 2026 thru January 2, 2027 Regular Clinic Hours – 3 FTE Maximum (2 Minimum) – 4800 Hrs .. $455.82/hr X 4800 hrs - $2,187,936.00 On-call Hours – Weeknights, Weekends, and Holidays – 6700 Hrs $ 60.78/hr X 6700 hrs - $ 407,226.00 Call – Back Hours – As needed – 3000 hrs …………………………….…… $ 0.00 Total Estimated Contract Price for the Base Year …………….…… $ $2,595,162.00

Total Estimated Contract Price for the Base + Four (4) Option Years $ 11,797,386.00

This is a fixed rate contract that includes nights, weekends and call-backs within the pricing.

When compared to present anesthesia rates in rural areas of South Dakota and Nebraska, one will find that these rates are competitive in nature with surrounding areas.

SOPOR, LLC

David Stewart CRNA P.O. Box 1287 Manchester, KY 40962 256-476-8697 jdstewartrn@yahoo.com Solicitation #RFP-22-026 Closing Date: December 22, 2021 mailto:jdstewartrn@yahoo.com

DESC RIPTION/ SPECIFICATIONS

PERFORMANCE WORK STATEMENT

ANESTHESIA SERVICES

PINE RIDGE HOSPITAL/CLINICS

Pine Ridge Service Unit, Great Plains Area Indian Health Service

PURPOSE OF CONTRACT

The primary purpose of this non-personal service contract position is to secure direct patient care services of an Anesthesia Provider. The mission of the Pine Ridge Indian Health Service (IHS) Hospital, Pine Ridge Service Unit, and Great Plains Area IHS is to provide the best possible health care services to the Native American people on the Oglala Lakota (Sioux) Indian Reservation in South Dakota. To meet the mission, the Pine Ridge Hospital requires contracting support to assist the service unit in the recruitment of an Anesthesia/CRNA provider who will provide services in the surgery, Emergency Room, Acute Care Nursing department, outpatient clinics/inpatient unit, Labor and Delivery, and Nursery, hereafter referred to as the Contractor. The care and service activities provided shall be as comprehensive as our Service Unit patient’s needs. This contract shall have a contracted service for 24/7 with categories for Regular Hours Monday through Friday, Alternating On Call, and Call Back hours for nights, weekends, and recognized Government Holidays with no gaps in service coverage.

The Contractor will ensure all anesthesia providers work in accordance with the and the established principles and ethics of this specialty medical profession. The Contractor is responsible for direct patient care in the Surgery/ OR, Out Patient clinics, Acute Care /Inpatient unit, Labor and Delivery, Nursery, and Emergency Department, and adhering to the policies and procedures of the Pine Ridge IHS Hospital. PRSU identifies Patients as those who are birth through geriatric age groups, thus including all patient age groups. The Contractor shall ensure that all providers comply with the Pine Ridge Service Unit Medical Staff bylaws, national regulations (Center for Medicaid and Medicare), Joint Commission, HIPAA, and any related National Standards of P ractice of this specialty.

The IHS Pine Ridge Service Unit and Hospital does not currently have an Intensive Care Unit, thus usually, patients which require this level of service, would need to be transferred to a hospital which offers this level of care/services. In the case of inability to transfer patients to a higher level of care, Anesthesia/CRNA will provide care and assist to stabilize patients to the best of their abilities, per their scope of practice including setting up and managing the mechanical ventilator after the patient is intubated. The Surgery department provides general surgery in the specialty areas of podiatry, dental, ENT, obstetrical, orthopedic, general surgery, gynecological, and other types of surgeries. The Anesthesia/CRNA at times will be requested to assist with moderate sedation procedures within PRSU. This is not an all-inclusive list. The contractor shall ensure anesthesia providers are capable of independent and solitary induction and maintenance of general, regional, local, and spinal anesthesia for neonatal to geriatric age ranges. The Nursery at Pine Ridge Hospital is a level 1 Nursery.

The contract resulting from this solicitation shall:

Be a non-personal health care service contract for a Fixed Unit Price (hourly rate) under which the Contractor is under the administrative and medical direction of the Pine Ridge Indian Health Service Hospital's Anesthesia Director (supervisor), Clinical Director, Deputy Clinical Director, or his/her designee. It is of utmost importance to note that the respective contract company supervises the Contractor, not any Government (IHS) employee. If the Contractor seeks time off, they must go through their contract company so the company may make necessary arrangements to secure a qualified replacement candidate without a break in coverage. It is of the utmost importance the contract vending company understands this fact and informs their contract providers to avoid any unnecessary break in coverage.

Allow the government to evaluate the quality of professional and administrative services provided.

This contract can be modified, or terminated for the convenience of the Government if a sufficient number of permanent IHS providers are hired to serve in the capacity described in the . A 3-Months’ notice of a sufficient workforce will be provided prior to Termination for Convenience.

Period of Performance:

Base Year - 1/12/2022 - 1/11/2023 Option Year One (1) - 1/12/2023 - 1/11/2024 Option Year Two (2) - 1/12/2024 - 1/11/2025 Option Year Three (3) - 1/12/2025 - 1/11/2026 Option Year Four (4) - 1/12/20226- 1/11/2027

TECHNICAL EVALUATION FACTOR SELECTION WILL BE USED TO AWARD

SERVICE CONTRACT TO POTENTIAL VENDORS.

The summary is below and documentation forms for Contract Officer Representative monitoring processes will be attached to RF as well as the Technical Evaluation Tool for submission of proposal.

PROPOSAL EVALUATION SUMMARY:

CRITERIA

ADJECTIVAL RATING FINAL RATING

BY REVIEWER

1. Submission of detailed work plan to meet the requirements in the (Problem & Approach)

2. Past Performance and Experience

3. Key personnel are able to complete and be awarded credentialing status, comply with medical record documentation content and submission deadlines as outlined in Pine Ridge Service Unit By-laws, conforms with Center for Medicare Service accreditation regulations or Joint Commission regulations, and participate in quality of care project management. (Quality Assurance Surveillance Plan)

TOTAL POINTS

See RF Attachment Technical Evaluation Plan - Anesthesia

C-1 Required Contractor Administrative Responsibilities:

Contract Provider Background Clearance The contracting company shall be advised via this ( ) that any provider presented to fulfill the requirements of this purchase order shall be required to clear a background investigation clearance via fingerprint investigation. Further, any provider shall first "be cleared" prior to begin any aspect of the requirements of this purchase order. This includes, but not limited to, hospital orientation, electronic health record training, and ancillary service information, attending meetings, participating in medical rounds and evaluating and treating patients. The provider may present to Pine Ridge IHS Hospital with personal escort in order to have fingerprints performed. Once the fingerprints have been completed, the provider shall leave the hospital and not physically report back until the background investigation has cleared and/or yielded a favorable adjudication. If background investigation is found to be unfavorable and the individual is unable to be cleared, the contracting company shall submit a replacement provider immediately or risk breaching this the terms of this purchase order. A delay in securing a replacement provider shall be considered grounds for the Government to terminate the purchase order for the convenience of the Government.

Third Party Enrollment

** All Medicare B and other insurance provider enrollment documentation submitted to the contracted provider by Pine Ridge IHS Hospital Credential and Business Office personnel SHALL BE completed by the Contractor to the satisfaction of the Pine Ridge IHS Billing Department. Initial Contractor hospital orientation list is required to be signed off by the Business Office for insurance enrollment confirmation. NO INITIAL TIME SHEETS

OR INVOICES WILL BE APPROVED AND PROCESSED UNTIL THE

RESPECTIVE PROVIDER HAS COMPLETED ALL INSURANCE FORM

DOCUMENTATION. The deciding authority for provider enrollment insurance documents will be the Supervisor, or Acting, of the Business Department.

EHR/Medical Records

The Contractor will be required to utilize facility Electronic Health Record (EHR) for all patient encounter documentation. Experience with electronic health records is highly recommended. The Contractor shall type all their notes and complete all documentation required by the Health Information Management Department (HIM). This includes completing all coding and purpose of visit diagnoses.

**All patient health record documentation initiated by the contract Anesthesia provider from patient encounters SHALL BE completed to the satisfaction of the supervisor, or designee, of the HIM (Health Information Management) Department & Business Office Supervisor or designee. The approving authority of the Contractor's time sheets will NOT sign off on the final time sheets unless the provider has successfully completed all required patient medical encounter documentation (medical records). Further, if the Contractor has delinquent medical records as determined by the supervisor, or designee, of the HIM department, the approving authority will notify the COR of the deficiency at that time period. If the contractor is notified of medical record deficiencies after they have left PRSU, the contractor will be allowed remote access to complete medical record deficiencies in a timely manner.

Timesheets

Time sheets shall be submitted by the contractor every 2 weeks to the Director of Anesthesia services or designee. Time sheets SHALL BE signed by the Director of Anesthesia, Deputy Clinical Director (or delegate), or Clinical Director. No invoices will be processed unless the Director of Anesthesia / Surgery has provided properly signed time sheets to the Pine Ridge Contract Officer Representative monitoring and overseeing this contract and its invoices. A record must be maintained in order to follow the budget of the contract. This is a fixed unit price/indefinite delivery indefinite quantity contract.

Records will be maintained for the life of the contract as per FAR regulations for contract close processes and will be subject for review and/or audit by the Director of Anesthesia, Contract Officer or Contract Officer Representative at any time during business hours.

C-2 Government Furnished Property Facilities, Services:

The Hospital shall provide a patient examination area and all medical and non-medical equipment and supplies used in the Indian Health Service facility for the care and maintenance of patients as per the standards of care for this specialty.

The Hospital shall provide an on-going method of monitoring and evaluation of the quality and appropriateness of patient care and of identifying deficiencies in the quality of services performed before the level of performance becomes unacceptable. Methodology involves peer review on quality of patient medical record documentation, peer evaluations, support personnel evaluations, documented staff complaints, patient grievances, medical records completion timeliness, PRSU policy compliance, and incident reports.

The Contractor shall be provided with an orientation to the IHS and the Indian Community being served. The Service Unit/Hospital personnel shall provide the initial orientation and continuing orientation.

C-3 Contractor furnished Property, Facilities, or Services:

The Government requires Contractor (anesthesia provider/CRNA) to carry a working form of communication (i.e. a beeper or cell phone, at their expense) and be able to respond within five (5) minutes of receipt of notification.

The Government requires Contractor to perform and monitor licensure from the candidates State Medical Board to ensure real-time notification of alerts and provide verification of National Practitioner Data Bank (NPDB) status and Federation of State Medical Boards status (FSMB). It is the vendor’s responsibility to capture and provide immediate notification to the government of a suspensions/ revocation or issues affecting the licensure of the CRNAs.

C-4 :

The primary functions of the Contractor shall include the following:

Seamless Anesthesia service provided throughout the entire duration of this contract's period of performance.

The Contractor shall been fingerprinted immediately upon arrival to Pine Ridge IHS Hospital in order to be cleared as a background check AND cannot see patients until their fingerprints clear and have been adjudicated.

Per IHS policy, the provider is required to have the annual Flu/ H1NI1 vaccinations, to comply with COVID-19, and all other employee health vaccinations as per policies and procedures. Requirements on the medical staff application form for Medical Health as it pertains to immunization and employee health and infection control policies must be submitted at the time of application and maintained during the duration of the contract.

This includes documentation of Tuberculin Skin Tests (commonly referred to as PPD testing) dates and Tuberculosis screening. Any positive PPD results must have documentation submitted of treatment regimen and current findings of non-active infection (such as Chest X-rays).

Tour of Duty & Responsibilities

The Anesthesia Provider hours may vary depending on the recommendation or direction of the Director of Anesthesia, and/or Leadership of Pine Ridge IHS Hospital. Their respective company must make all Contractors aware that the surgical department hours, clinic hours and CRNA shifts could likely change due to the changing demand of the patient population.

Two FTE Contractors will work Monday through Friday with expected regular hours in 8 hour increments 7:30am – 4:00pm. These normal operating hours may change for time efficiency at the discretion of the Director of Surgical Services, Director of Anesthesia Services, and Clinical Director but will maintain the 8-hour increment. There will be two contracted anesthesia providers available for surgical cases during the workday. One provider will be designated for labor epidural services per duty day (in addition to Surgery cases and other CRNA consults). Fixed Unit Price (hourly) rate with a maximum number of hours per day of 12 hours.

The remainder of the contract will provide 24/7 anesthesia service coverage through a combination of coverage, on call (Consults) and immediate availability, and call back for face-to-face patient care. One (1) Anesthesia Provider will provide on call consultation to

Inpatient, Outpatient, Emergency Department consultation, L&D, Surgery (e.g. C-section Delivery cases), and Nursery after regular hour. Anesthesia will assist with admitted patients who meet Pine Ridge Hospital admission criteria based on hospital capability and capacity requiring specialty care. Anesthesia/ CRNA will provide in person consultation services to Inpatient, Outpatient, Emergency Department and for C-section deliveries and newborn deliveries on L& D. Anesthesia/ CRNA will respond in timely manner appropriate to the condition of the patient, per request of the consulting provider, and in compliance with PRSU policy and medical staff bylaws. Phone Consults must be responded to within 5 minutes and onsite Call Back within 20 minutes response time. Anesthesia / CRNA must be at the patient’s bedside within the 20-minute response requirement in the case of an emergency. All Consults will be documented by on call CRNA in the appropriate electronic health record and per the required format as per policy for that patient. Anesthesia/ CRNA will provide on call and call back services during week, on weekend, and all holidays as scheduled by Director of Anesthesia(Supervisor), Clinical Director, Deputy Clinical Director, or designee.

When on regular duty, the Contractors will work clinic from 7:30 AM to 4:00 PM MST, Monday thru Friday. Contractors will have a mandatory unpaid lunch break for 30 minutes.

The point of contact for the Contractor's patient scheduling is the Director of Anesthesia, Clinical Director, Deputy CD or designee. The Contractor on occasion may need to work for short periods beyond the routine shift, when such extra time is necessary to finish a patient visit. This extra time is billable as Regular Hours. During this shift, the contractor shall take a thirty-(30) minute break for lunch and two fifteen minute (15) breaks during the shift. The total amount of non-billable lunch and rest/break time per normal day (M-F) is sixty-(60).

Depending on the surgical schedule and census, the contractor may have to adjust their 30-minute lunch to patient schedule. The anesthesia provider may leave the hospital premises with clearance from the Clinical Director or the Director of Anesthesia Services only if there are no surgical cases, either pre-operatively or post-operatively, which require his/her attention. The anesthesia provider MAY NOT LEAVE THE PREMISES WHILE A

PATIENT IS RECOVERING AND UNTIL DISCHARGE CRITERIA ARE MET.

Further, the anesthesia provider will be required to carry a working form of communication (i.e. a beeper or cell phone, at their expense) and be able to respond within five (5) minutes of receipt of notification. Once contacted, the anesthesia provider must physically report to the patient’s bedside within twenty (20) minutes.

DEFINITIONS:

Regular Hours = on site coverage for anesthesia services Monday through Friday in 8 hour increments and any applicable time to finish the days patient load.

On Call = all hours after the regular hours in a 24 hour period. (Example 7:30 – 4pm so On call is the remaining 16-hour period) This is the 16 hours is the Max on call in a 24-hour period. If Regular hours exceeding 8 hours to finish the daily workload; then the On Call portion will be subsequently shortened. Phone Consultation will be considered inherent in this section and are not individually billable.

Call Back = any time when an Anesthesia provider returns to the facility (on-site) for face to face patient services as requested by the Attending Provider in the department of need.

Max allowable callback hours per day are equivalent to the On Call, if Called back in the On Call hours will be consequently converted to call back hour’s equivalent to time spent at facility providing direct patient care with a minimum of 1 hour. Max hours for Monday through Friday is 16 and Max for weekend coverage is 48. Time reports are required every 2 weeks.

Contractor Responsibilities

The Contractor shall work in conjunction with and under the direction of the operation surgeon, physician, podiatrist, or dentist presiding over the particular surgery. Depending on the state of licensure and the laws that govern that state’s license, the anesthesia provider may work as an independent practitioner or under the direct supervision of the attending operating physician.

The Contractor will:

• Allow the government to evaluate the quality of profession and administrative services per the Quality Assurance Performance Improvement Plan, and as outlined within the PRSU medical staff bylaws, rules and regulations and the PRSU policies and procedures.

• Keep accurate and full records including accounting records of the service operation covered by these specifications AND time and attendance records.

All records shall be retained for the life of the contract and are subject to audit by the hospital or its representatives at any time during working hours.

• Pre-operative and post-operative anesthesia evaluations will be performed and properly documented and recorded in the patient’s electronic medical record, as required by CMS, Joint Commission, PRSU Policy, IHS policy, and the Pine Ridge Medical Staff Bylaws.

• Pre-operative evaluation will include face to face encounter with the patient with a history and physical relevant to the planned operation and review of current lab and x-rays. The contractor is responsible for obtaining and documenting the appropriate Informed Consent as defined and set for the by the criteria by CMS. The exception to documentation would be in extreme emergent situations where the performance and recording of the evaluation would place the patient's life in danger. After the extreme emergency, the reason for not obtaining an Informed Consent shall be documented in the patient's health record with all pertinent information to support the deviation from routine situations.

• Anesthesia / CRNA will remain present and responsible for the patient’s complete recovery from the anesthetic while in the Post-operative Recovery Care Unit (PRCU). This will include monitoring and management post-extubation airway and breathing, cardiovascular function and level of consciousness. Clearance for discharge from the PRSU will be determined by anesthesia / CRNA with notification and approval of the operating surgeon.

• Each credentialed contractor (CRNA) must have the skills necessary to: induce anesthesia; maintain anesthesia at the required levels; continue life support functions; provide monitored anesthesia care/sedation; initiate and implement regional anesthesia block. The CRNA must be competent to identify and manage emergency anesthesia situations such as malignant hyperthermia, supervision of ventilator assistance both by respirator and by ventilator; and perform cardiopulmonary resuscitation. The vendor shall ensure all anesthesia providers shall be competent and comfortable in performing independent spinal anesthesia, epidural anesthesia, as well as, recognizing and managing complications secondary to spinal/epidural anesthesia.

• On call anesthesia provider will assist in the airway and anesthesia management of patients when contacted by the attending provider during indicated Emergency Department, Acute Care Nursing (medical/surgical ward), and obstetrical ward cases. This shall include but not be limited to competent care to assist with and/or perform intubation and extubation, insert arterial catheters, recommend ventilator management, perform arterial punctures and assist with difficult intravenous line placement in the Emergency Department, Acute Care , Labor and Delivery, and Post- Partum floors in emergent and urgent situations. This also includes assistance with cardioversions within these departments as well. All Consultations requiring face-to-face interventions require electronic health record documentation to be completed within 24 hours to ensure proper communication between CRNA, the attending provider and all other medical departments to ensure coordination of care and high quality outcomes.

• The Director of Anesthesia Services or designee holds clinical oversight over the anesthesia providers, thereby assisting to ensure quality and safe anesthesia services are provided in both the outpatient and in-patient settings. As this is a specialty medical service contract, the COR does not have all the technical knowledge to provide direction and oversite of all aspects of the contract.

• The Director of Anesthesia or designee will validate and approve the time and attendance records. In the event of a face-to-face call back visit, the contractor will keep report of services performed for the Director of Anesthesia Services to reference when verifying the time report. To ensure the contractor does not have medical record deficiencies, the contractor is required to submit the Health Information Management Clearance form bi-weekly. This form is to accompany the completed time report and can be obtained from the Health Information Department.

• The contractor must recognize and take appropriate corrective action including the request for consultation when necessary for abnormal patient responses to anesthesia or any adjunctive medications or observation and resuscitative care until the patient has regained control of his/her vital functions record findings; make critical evaluations.

• Evaluates medical aspects of the plan of care periodically, recognizing the need for reassessment by another specialist or other health professional.

• Works in Consultation and coordination with the Attending Provider to refer patients to appropriate medical (or other) facilities, providing full clinical information for care and diagnostic procedures that cannot be adequately provided at local IHS facilities, including emergent transfer to higher level of care when indicated. All Consultations shall be properly documented in the electronic health record as per the Medical Staff By-

Laws guidelines and PRSU policies. All Call Back encounters must be fully documented in the electronic health record with proper timing sequence of case start time and end time

• Coordinates and integrates information obtained into the ongoing Health Care Program at the Service Unit and assures timely follow-up care as required. Recommends appropriate follow-up to patients and staff, making referrals when necessary.

• Adjust treatment within established standing orders recognizing when to refer the patient to a specialist or other health team members;

• Work collaboratively with health care team in management of selected complex medical problems;

• Provide emergency or crisis intervention in order to stabilize a patient for transport to a higher level facility;

• Maintain records and reports on patients, personal activities and other required information for use in program operation, quality control and other purposes (all medical record information generated in the performance of this contract will remain the property and subject to the exclusive control of the Indian Health Service);

• Participate in certain PRSU committee, medical staff committee meetings, Surgery Department, and Anesthesia department meetings as required;

• Comply with all IHS facility infection control and safety procedures, practices and standards;

• Meet all applicable Joint Commission (TJC) and Centers for Medicare/Medicaid Services (CMS) standards during the performance of this contract, and must be in compliance with the Service Unit's Medical Staff Bylaws;

• Be eligible for enrollment in the service unit's Medicare part B reassignment program;

• Engages in customer services practices with respect to the basic rights of patients, to include but not be limited to personal dignity.

• Participates in PRSU quality assurance performance improvement projects/program, risk management, and infection control programs.

Participates actively in peer review, ongoing, and focused professional practice review.

• Complies with IHS, service unit, and departmental policies/procedures.

Collaborates with PRSU leadership to achieve and maintain certification by accrediting agencies (e.g. Joint Commission, CMS).

ANESTHESIA PROVIDER QUALIFICATIONS:

The contractor's employee(s) providing services under this contract shall meet the following licensure, certification, education, and experience requirements:

1. Be currently certified as a CRNA or licensed as an MDA and shall provide evidence of current certification/licensure by the time of award.

2. Be a graduate of an approved nursing school/medical school as well as an approved program/residency of anesthesia.

3. Possess an active, unrestricted license as a CRNA/MDA from at least one (1) of the 50 United States or Territories of the United States, and maintain an active, unrestricted state license in CRNA/MDA for the duration of this contract.

Meet the criteria for medical staff membership including evidence of current, unrestricted state licensure, relevant training and experience in anesthesia, current health status, which shall be sufficient to perform the work described in the All professional anesthesia procedures requested for credentialing must be supported with proper documentation in the form of professional letters of recommendation, and/or professional skills training courses. This documentation shall be provided to the Hospital's credentialing coordinator verifying CRNAs/ MDAs are competent of performing independently the above procedures.

Documentation must be provided to the Hospital's credentialing coordinator at least a minimum of forty-five (45) calendar days prior to physically arriving at the Hospital. Recommend 60 days for credentialing processes to be completed and allow for affiliations and verification documentation to be accurately reflected on the committee records.

Provide information on previously successful or currently pending challenges to any licensure or registration (including Drug Enforcement Administration) or voluntary relinquishment of such licensure or registration; voluntary or involuntary termination of medical staff membership or voluntary or involuntary limitation, loss, or reduction of clinical privileges at another health care facility;

and current involvement with professional liability actions.

Be certified through American Heart Association in cardiopulmonary resuscitation (CPR/BLS), advanced cardiac life support (ACLS), and Pediatric Advanced Life Support (PALS). Will remain BLS, ACLS, and PALS certified throughout the anesthesia provider's performance under this contract at the Hospital.

Participate in medical staff meetings and review functions, quality improvement activities, safety and infection control programs and surgical/anesthesia program reviews as requested by the Anesthesia Director and Hospital's Clinical Director.

Shall speak, understand, read, and write English fluently and communicate with sufficient clarity to be understood by hospital personnel and patients, Shall possess sufficient initiative, interpersonal relationship skills and social sensitivity such that he/she can relate constructively to patients from Native American communities. Be able to show sensitivity to cross-cultural differences.

Will work through interpreters as necessary for those patients served who speak the Lakota language.

Shall maintain standards of personal hygiene and grooming, such that his/her image, as an anesthesia provider is compatible with the expectations of the Hospital Medical Staff and the Native American Community.

Shall be proficient in providing independent anesthesia care in the following specialties, but will not be limited to pediatric dental surgeries, C-sections, labor epidurals, podiatric surgeries, gynecological surgeries, general surgery, ENT surgery and orthopedics.

Each anesthesiologist/CRNA must maintain current competencies at the very minimum:

Class I privileges: local infiltration, topical application, minor nerve block Class II privileges:

General anesthesia - adult and pediatric; inhalation agents, intravenous agents;

B. IV sedation - barbiturates, ketamine, narcotics, major tranquilizers

C. Regional Anesthesia - subarachnoid block, lumbar epidural block, cervical plexus block, brachial plexus blocks; sciatic-femoral block, ankle block, cervical epidural, thoracic epidural

Special Qualifications: The contractor is responsible for ensuring all employees possess and maintain current certifications, trainings and competencies (as related to the , Medical Staff Bylaws, and Hospital policy and procedures) and a copy will be given to the Director of Anesthesia Services:

HIPAA certificates: yearly Information Systems Security Awareness Training: yearly No FEAR training: yearly EMTALA training: yearly Required annual PRSU trainings – yearly Mandatory IHS trainings - yearly Background Clearance Credentialing Competencies: as appropriate

Medical/Clinical Judgment Communication Cultural Sensitivity Procedures

CREDENTIALS:

Credential Type

Description Status Required Recommended Comment

License Medical/Nursing/

CRNA

Active unrestricted xx To practice

Registration DEA Active CAT 2-5 xx To prescribe

Certification ACLS Active xx Certification ATLS Active xx Certification PALS Active xx Certification ALSO Active xx Certification BLS Active xx Service

Unit Policy

Certification ECFMG Successful completion xx Foreign med grad

Board Certification

FP/IM xx

Specialized Experience

Rural Hospital xx

SAFETY MEASURES AND QUALITY IMPROVEMENT ACTIVITIES

The contractor will take necessary and proper precautions to ensure the safety of patients from hazards:

1. Explosions and fires;

2. Introduction of infections;

3. Contamination of sterile equipment, supplies, and materials;

4. Mistaken identification or dosing of drugs and other anesthetic agents;

5. Equipment malfunction

6. Misinterpretation of bodily vital signs and function and any other known hazards to the patient

QUALITY ASSURANCE PLAN SURVEILLANCE

QUALITY OF CARE

The Contractor shall comply with the following quality of care protocol:

1. It shall be understood that eligible patients under treatment will be rendered services that provide the best medical care within the Contractor's professional training and experience. All services rendered shall be in accordance with current standard medical practices to assure quality of care. The Director of Anesthesia will set the Work Schedule in 30-day increments.

2. The Contractor shall be familiar and adhere to the policy and procedures of the Bylaws of Medical/Dental Staff of the Indian Health Center, Pine Ridge Service Unit in South Dakota.

The credentials of the Contractor shall comply with the Medical Staff By-laws of the service unit for all services provided in Public Health Service clinics. The Contractor shall agree to abide by the HIPAA and CMS standards.

3. The quality of work performed by the Contractor will be subject to review by chart audits/peer reviews, OPPE/FPPE, and site visits by the Contract Officer Technical Representative, Vendor Project Officer or designee as needed. The Director of Anesthesia Services and/or Deputy Clinical Director will conduct quality Review audits.

The Contractor shall comply with the following quality of care protocol:

1. Deliverable 1: The Vendor will provide Curriculum Vitale and education…