CRHC-24-001.pdf

A. a. This is a combined synopsis/solicitation for commercial items prepared in accordance with the format in Federal Acquisition Regulation (FAR) Subpart 12.6, as supplemented with additional information included in this notice, FAR Part 12, Acquisition of Commercial Items (Title VIII of the Federal Acquisition Streamlining Act of 1994) (Public Law 103-355) & FAR 37.4, Non-Personal Health Care Services Contract (10 U.S.C. 2304 and 41 U.S.C 253). This announcement constitutes the only solicitation; proposals are being requested and a written solicitation will not be issued.

b. The Indian Health Service/Cheyenne River Health Center intends to award a Firm Fixed-Price, Non- Personal Service Contract to provide ENT (Ears, Nose, & Throat) Services for the Medical Department at the Cheyenne River Health Center located in Eagle Butte, South Dakota. All orders may be submitted via email to Danielle.chasinghawk@ihs.gov

(i) This solicitation is being issued under solicitation number CRHC-24-001.

(ii) The solicitation document and incorporated provisions and clauses are those in effect through Federal Acquisition Circular 2023-05 dated 09/22/23.

(iii) This is a 100% IEE and Small Business Set-Aside and the associated NAICS code is 621111 Offices of Physicians (except Mental Health Specialist), with a Small business Size Standard of $16.0 Million, Product Service Code is Q514 Otolaryngology Services .

(iv) Services purchased through this contract will be ENT Services for patient care. A list of line items, quantities/units of measure at attached. The “Unit Price” is an all-inclusive cost. All “inclusive cost” is defined to include, but not limited to travel, lodging, per diem, benefits, fuel, freight etc., plus all other costs pertinent to the performance of this contract. The period of performance will be a base year, plus the option to exercise, Four-one(1) year option terms.

See Attached Pricing/Cost Schedule.

(v) Description of Services: Include, continuous ENT Services, required by the attached Performance Work Statement, for the Cheyenne River Health Center, Eagle Butte, South Dakota.

(vi) The period of performance will include one base year, plus the option to exercise four-1 year option years. Delivery and acceptance terms for this order are with the PWS. POP: Base Year: 12/1/2024 – 11/30/2024, OY1: 12/1/2024 – 11/30/2025, OY2: 12/1/2025 –11/30/2026, OY3: 12/1/2026 – 11/30/2027, and OY4: 12/1/2027 – 11/30/2028.

(vii) The provision at 52.212-1, Instructions to Offerors – Commercial Products and Commercial Services (Sept 2023), applies to this acquisition. Quotes shall be submitted on company letterhead stationery, signed and dated; it shall include, at a minimum;

1. Solicitation number CRHC-24-001

2. Closing Date: November 27, 2023 at 1:00pm MST

3. Name, address, telephone number of the offeror and email address of the contact person

4. Technical description of the item/service being offered in sufficient detail to evaluate compliance with the requirements in the solicitation.

5. Terms of any express warranty

6. Price and any discount terms

7. “Remit to” address, if different than mailing address mailto:Danielle.chasinghawk@ihs.gov http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/52_000.htm#P1579_222340

8. A completed copy of the representations and certifications at FAR 52.212-3

9. Acknowledgement of Solicitation Amendments, if issued

10. A statement specifying the extent of agreement with all terms, conditions, and provisions included in the solicitation. Offers that fail to furnish required representation or information, or reject the terms and conditions of the solicitation may be excluded from consideration.

Quotes shall also include the following to be considered acceptable.

1. Price/Cost Schedule.

2. IEE (Indian Economic Enterprise) Representation Form

3. At least 2 Past Performance Questionnaire’s filled out and submitted.

4. Proof of Malpractice Insurance Coverage.

5. Certify they understand and can meet all requirements listed in this Solicitation, Performance Work

Statement and Attachments.

6. Candidate information, to include: Resume, current/up-to-date licenses & certifications as requested in the PWS, completed Background clearance forms attached to this solicitation, proof of Mandatory Employee Health Records Requirements as spelled out in the PWS, and guarantee report date.

Basis of award is Lowest Price, Technically Acceptable “LPTA” bid package. All of the above is required in order to be considered technically acceptable.

(viii) The clause at 52.212-2, Evaluation-Commercial Products and Commercial Services (Nov 2021) applies to this acquisition – See attachment for Full Text.

(ix) Offerors must include a completed copy of the provision at 52.212-3, Offeror Representations and Certifications – Commercial Products and Commercial Services (Sept 2023), with its offer. The offeror shall complete only paragraphs (b) of the provision if the Offeror has completed the annual representations and certification electronically via the System for Award Management (SAM) Web site located at http://www.sam.gov

(x) The clause at 52.212-4, Contract Terms and Conditions—Commercial Products and Commercial Services (Dec 2022), applies to this acquisition – See attachment for Full Text.

(xi) The clause at 52.212-5, Contract Terms and Conditions Required To Implement Statutes or Executive Orders – Commercial Products and Commercial Services (Sept 2023) – See attachment for Full Text.

(xii) Offerors are due on November 27, 2023 by 1:00 PM MST, and can be e-mailed to Email:

Danielle.chasinghawk@ihs.gov

Questions in reference to this solicitation shall be submitted to the email address listed above. The last day to submit questions is November 09, 2023 at 1:00pm MST. No questions will be answered after this date/time. Please be advised that the Government reserves the right to transmit those questions and answers of a common interest to all prospective vendors through a solicitation amendment.

(xiii) Points Of Contacts: Danielle Chasing Hawk, Supervisory Contract Specialist, Danielle.ChasingHawk@ihg.gov, 605/964-0605 or Stephanie Red Elk, COR, Stephanie.RedElk@ihs.gov, 605/964-0507,

(xiv) Contractor will need a UEI number, TIN number, and be active & registered in SAM at www.sam.gov.

https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1060530 http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/52_000.htm#P1657_236576 http://www.sam.gov/ http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/52_000.htm#P1974_281919 http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/52_000.htm#P2174_322700 mailto:Danielle.chasinghawk@ihs.gov mailto:Danielle.ChasingHawk@ihg.gov mailto:Stephanie.RedElk@ihs.gov http://www.sam.gov/

Request for Proposals RFP-24-001 ENT Services

SERVICES AND PRICES/COSTS

(Fixed-Price, Services, Commercial Items)

Firm Fixed Price, Non-Personal Services contract, to provide ENT Services, for the Cheyenne River Health Center, located in Eagle Butte, South Dakota. The Period of Performance will be from Date of Award through One(1) Year, with Four-One(1)Year option periods.

1. BASE YEAR: 12/01/2023 – 11/30/2024

Item No

Descript of Service Estimated Qty

Unit Unit Price Total Amount

1. ENT Specialty Clinic Services

192 HRS $ $

TOTAL Base Year: $

1. OPTION YEAR ONE (1): 12/01/2024 – 11/30/2025

Descript of Service Estimated Qty

Unit Unit Price Total Amount

1. ENT Specialty Clinic Services

1. OPTION YEAR TWO (2): 12/01/2025 – 11/30/2026

Descript of Service Estimated Qty

Unit Unit Price Total Amount

1. ENT Specialty Clinic Services

2. OPTION YEAR THREE (3): 12/01/2026 – 11/30/2027

Descript of Service Estimated Qty

Unit Unit Price Total Amount

1. ENT Specialty Clinic Services

192 HRS $ $

1. OPTION YEAR FOUR (4): 12/01/2027 – 11/30/2028

Descript of Service Estimated Qty

Unit Unit Price Total Amount

1. ENT Specialty Clinic Services

Request for Proposals RFP-24-001 ENT Services

2. AGGREGRATED TOTALS

TOTALS

1. Base Year (12/01/2023 – 11/30/2024) $

2. Option Year One (12/01/2024 – 11/30/2025) $

3. Option Year Two (12/01/2025 – 11/30/2026) $

4. Option Year Three (12/01/2026 – 11/30/2027) $

5. Option Year Four (12/01/2027 – 11/30/2028) $

AGGREGRATED TOTAL FOR ALL FIVE

YEARS:

DEPARTMENT OF HEALTH & HUMAN SERVICES

INDIAN HEALTH SERVICE

BUY INDIAN ACT

INDIAN ECONOMIC ENTERPRISE

REPRESENTATION FORM

Indian Health Service Office of Management Services

Division of Acquisition Policy (DAP) 5600 Fishers Lane

Rockville, MD 20857

SOLICITATION/SOURCES SOUGHT/RFI #:

PROJECT TITLE:

DATE:

In accordance with 25 U.S.C. 47 the Buy Indian Act, the signature below constitutes self-certification that the Offeror meets the definition of an “Indian Economic Enterprise” (HHSAR 326.601) in response to this Sources Sought Notice, Request for Information (RFI) or Solicitation and resultant contract.

The enterprise must meet the definition of “Indian Economic Enterprise” throughout the following time periods:

(1) At the time an offer is made in response to this solicitation;

(2) At the time of contract award; and

(3) During the full term of the contract performance period. At any point during these periods, if the Contractor no longer meets the eligibility requirements, the contractor must provide immediate written notification to the Contracting Officer.

Individual Contracting Officers may require documentation of eligibility before awarding a set-aside or sole source contracts under the Buy Indian Act and awards may be subject to protest if the eligibility of the successful Offeror is in question. In addition to the self-certification requirements, successful Offerors must also be registered with the System of Award Management (SAM).

Any false or misleading information submitted by an enterprise when submitting an offer in consideration of an award set-aside under the authority of the Buy Indian Act is a violation of the law and punishable under 18 U.S.C. 1001.

False claims submitted as part of contract performance are subject to the penalties enumerated in 31 U.S.C. 3729 to 3731 and 18 U.S.C. 287.

REPRESENTATION

The Offeror represents as part of its offer that it does _ , does not _ _ meet the definition of an “Indian

Economic Enterprise” with “Indian Ownership” under the authority of the Buy Indian Act.

Name of Federally Recognized Tribal Entity Name of the 51% owner of IEE Firm

Business Name Certifying Signature

UEI SAM Number Print Name

PERFORMANCE WORK STATEMENT

Cheyenne River Health Center (CRHC)

Ear, Nose, and Throat (ENT) Physician

General

This performance based work statement describes the requirements for non-personal services for ENT to support the mission of the Indian Health Service (IHS)/Cheyenne River Health Center (CRHC).

The mission of the Cheyenne River Indian Health Service Hospital in Eagle Butte, South Dakota is to provide the best possible health care services to Cheyenne River Reservation in South Dakota.

Background

The Indian Health Service (IHS) an agency within the Department of Health & Human Services is responsible for providing federal health services to American Indians and Alaska Natives. The Indian Health Service provides a comprehensive health service delivery system for approximately 1.9 million American Indians and Alaska Natives who belong to 567 federally recognized tribes, in 35 states. The Indian Health Service Headquarters is located in Rockville, MD and then divided into twelve physical areas: Alaska, Albuquerque, Bemidji, Billings, California, Great Plains, Nashville, Navajo, Oklahoma, Phoenix, Portland and Tucson.

The Great Plains Area Office (GPAO) works in conjunction with its 19 Indian Health Service Units and Tribal Managed Service Units to provide health care to approximately 122,000 Native American located in North Dakota, South Dakota, Nebraska, and Iowa. The Area Office’s service units include seven hospitals, eight health centers, and several smaller health stations and satellite clinics.

Our facility, the Cheyenne River Health Center (CRHC), falls under the GPAO. Cheyenne River Health Center (CRHC) provides medical care for approximately 9,000 tribal members living on the CRST Reservation. Serving a rural area, many of our patients travel 100 miles’ round trip to receive care. The CRHC was built in 2011 to provide an expanded level of health care services specifically designed to meet the needs of the CRHC population. Services include: Emergency Room Department, Pharmacy, Physical Therapy, Public Health Nursing, Radiology Services, Inpatient Care, Laboratory, MRI, Dental, Community Health, Contract Health Services, Dietitians, Audiology, Eye Care, Inpatient, and Specialist Clinics: OB/GYN, ENT, and Podiatry. The Cheyenne River Sioux Tribe through a 638 contract with IHS, operates four satellite health stations which offer basic ambulatory services at Cherry Creek, Red Scaffold, Swiftbird, and Whitehorse communities.

Objective

To provide ENT services 2 days per month as needed in support of the monthly ENT clinics during the term of the contract.

Period of Performance

December 1, 2023 through November 30, 2028. Base year, to include 4 option years.

Base Year: December 1, 2023 through November 30, 2024 Option Year One: December 1, 2024 through November 30, 2025 Option Year Two: December 1, 2025 through November 30, 2026 Option Year Three: December 1, 2026 through November 30, 2027 Option Year Four: December 1, 2027 through November 30, 2028

Work Schedule

Provide 2 days of ENT consultation per month, scheduling of which will be determined by the Clinical Director.

Place of Performance

Cheyenne River Health Center ENT Department 24276 166th Street Airport Road Eagle Butte, South Dakota 57625

DESCRIPTION OF SERVICES: The contractor shall provide ENT services required for the Cheyenne River Indian Health Service Hospital.

This contract is a non-personal health care services contract, as defined at Far Part 37.101 under which the Contractor is an independent contractor and which shall allow the Government to evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of the services rendered, (e.g., professional judgements, diagnosis for specific medical treatment). The Contractor shall indemnify the Government for any liability producing act or omission by the contractor, its employees and agents occurring during contract performance. The Contractor shall maintain medical liability insurance, in the 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.

Upon the receipt of an IHS purchase order, the Contractor shall locate, credential, and have available sufficient staffing to provide ENT coverage for the ENT Department.

The standards of medical practice and duties of the Contractor through its physicians shall be determined pursuant to Governing Body bylaws, medial staff bylaws, rules and regulations of the appropriated IHS hospital, applicable provisions of law including but not limited to rules and regulations of any and all governmental authorities relating to licensure and regulation of physicians and hospitals, and standards and recommendations of CMS (Centers for Medicare and Medicaid Services) compliance. The Contract ENT Physician 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.

CONTRACTOR RESPONSIBILITY

Perform individual ENT examinations using the operating microscope nashopharyngeal and laryngeal mirrors, nasal speculum, head mirror, fiber-optic flexible endoscope, curettes, alligator forceps, suction.

Utilizes audiometric and tympanometric data performed by the contract ENT Physician.

Provide Allergy Testing and follow up.

Provide examination, diagnosis, and follow-up and recommend treatment plans as part of the patient assessment.

Perform routine clinical procedures as part of the clinical examination, such as the following listed below:

• Cautery and paper patch of small tympanic membrane perforations;

• Microscopic ear examinations

• Removal of cerumen

• Removal of foreign bodies of ear and nose

• Microscopic cleaning of mastoid cavities

• Flexible nasophyngoscopy-laryngoscopy

Instruct and counsel patients, parents, and/or family members regarding the diagnosis, treatment, and surgical management of ENT disorders.

Provides ENT coverage in the event of any post-op complications.

The provision of comprehensive direct patient care services and serves as a referral source non-surgical management of patients with ENT disorders.

The ENT Physician consultant provides phone consultation services to assure proper management of patients presenting at Cheyenne River Service Unit ENT with complications and emergencies.

Improve the coordination of care between ENT and ENT patients. Improve the quality of care for ENT patients.

As requested, meet with Family and/or Pediatric providers who provide medical care.

Regular and routine consultation with CRSU and Family Practitioner.

Review of care provided to ENT patients.

Establishes inter-personal and intra-departmental relationships to enhance optimal patient care.

Ensures a safe work environment and employee safe work habits.

Demonstrates competent and effective oral and written communication.

Computer efficiency required. Preferred 5 years of Electronic Health Record experience.

Maintain certification in Basic Life Support (BLS) or CPR.

Quarterly meetings with the CRSU Clinical Director if needed.

The ENT Physician shall locate, credential, and have available sufficient staffing to provide professional ENT services on a regular schedule to the Cheyenne River Health Center. Will also provide credentialing information of nursing staff that he/she provides to assist them.

The ENT consultant physician will be responsible for all travel and other personal expenses.

The ENT Physician must abide by the Cheyenne River Health Center Bylaws, Rules, and Regulations and Clinical Duties.

REFERRALS AND CONSUSLTS. The ENT Physician shall follow IHS Purchased Referred Care regulations and policies when arranging for a referral or consult. The ENT Physician shall be required to consult with other specialty practitioners for consultative opinions and continuation of care. The ENT Physician shall inform patients of the required referral or consult by indicating the specialty involved.

CONTRACTOR TIMESHEETS. The ENT Physician will be responsible for obtaining Medical Records (HIM) signature prior to Clinical Director or representative signature for the completion of their timesheet. Invoices submitted without the signed timesheet including Medical Records (HIM) and Clinical Director signatures will not be paid.

PROCEDURE GUIDANCE. Contractor ENT Physician shall perform procedures compatible with the medical facility’s operating capacity and equipment.

PRIVACY OF INDIVIDUALLY IDENTIFABLE HEALTH INFORMATION. The Contract health care providers shall provide patients with the utmost care and attention. All patients shall be assured of their privacy and personal dignity. The Contractor shall ensure strict compliance to the release of Protected Health Information in accordance with the Code of Federal Regulation, Title 45, Public Welfare, Subtitle A, Department of Health and Human Services, Part 164, Security and Privacy (45 CFR 164) and AFI 41-210, “Patient Administration Functions” paragraph 2.2.3, “Health Insurance Portability and Accountability Act (HIPAA)” and paragraph 2.3, “General Guidelines on Releasing Medical Information”.

COMMUNICATIONS. The Contractor shall ensure contract ENT Physicians maintain open and professional communication with members of the Medical Staff. Complaints validated by the Hospital Accreditation Specialist and Clinical Director or shall be reported in writing to the Contracting Officer (CO) and the Contractor for action.

ENGLISH LANGUAGE REQUIREMENT. The Contract ENT Physician shall read, understand, speak and write English fluently.

DOCUMENTATIONS. Contractor personnel shall prepare all documentation to meet or exceed established CMS standards and Cheyenne River IHS Medical Staff Bylaws.

AVAILABILITY:

HOURS OF OPERATION: 2 days per month (8 hours per day).

CONTINUITY OF SERVICES/REPLACEMENT STAFF. The Contractor point of contact shall ensure qualified personnel are available to provide coverage at all times.

PERFORMANCE OF SERVICES DURING CRISIS DECLARED BY THE NATIONAL COMMAND AUTHORITY. On occasion, services may be required to support an activation or exercise of contingency plan outside the normal duty hours. Emergency situations (i.e. accident and rescue operations, civil disturbances, natural disasters) may necessitate the contractor provide increased or reduced with the contractor for the cost of these emergency requirements.

RECORDS. The contractor shall document all patient encounters legibly in the patient medical record. All documentation shall be timed and dated. Verbal orders are to be used as infrequently as possible. In the event of a major disaster or code all verbal orders are to be signed off immediately following the code or disaster. All Medical Records must be signed by the ENT Physician and charge ticket completed at the end of the visit. All Medical Records are to be completed within 24 hours of the ENT Physicians scheduled shift. All documentation shall meet the current CMS guidelines.

Final payment will be withheld until all medical records are completed by the contract ENT Physician.

PERSONNEL REQUIREMENTS

CONTINUING MEDICAL EDUCATION (CME) / CERTIFIED EDUCATION UNITS (CEU) REQUIREMENTS.

Maintain CME and review pertinent journals, books and publications. Health care providers registered or certified by the national/medical associations shall continue to meet the minimum standards for CME to remain current. CME hours shall be reported to the credentials office for tracking by the Clinical Director.

LICENSURE/REGISTRATION. Contractor must maintain a current active and unrestricted license in at least one of the 50 United States or US territories.

CERTIFICATION. Board certified in field of specialty is favorable.

FORMAL EDUCATION. The ENT Physician must possess an ASHA accredited graduate degree from an accredited American College or University.

EXPERIENCE. The ENT Physician must have a minimum of 5 years of experience within ENT to include fellow and residency time within the past 36 months prior to ENT Physician beginning performance at Cheyenne River Health Center.

PERFORMANCE-BASED SERVICE DELIVERY SUMMARY. The contractor’s performance will be measured based on the following Performance Requirements. The Performance Requirements will be measured against

Government Performance Standards and monitored in accordance with the following Methods of Government Surveillance or what is known as a Quality Assurance Surveillance Plan (QASP) to determine compliance. A 5% deduction will be assigned to each Performance Requirements not met. Deductions shall be assessed against individual invoices when services are not performed or do not meet contract requirements. Deductions will be done by the category that was deficient.

Performance Standards

Performance

Task/Requirement Indicator Standard/(AQL)

Acceptable Quality Level

Surveillance (QA) Quality Assurance

Incentive

Completion of All patient 100% Random 5% deduction documentation of records must be observation and from weekly patient record documented HIM Report invoice.

accurately, Deductions will correctly, and increase by 1% in completely within subsequent 24 hours of months.

patient visit

Prompt and continuous coverage

Agency must provide a competent Mid-

100% Provider Schedule For every shift not covered by Agency, the shift

Level to ensure rate will be no gaps in deducted from coverage. next submitted invoice Credentialing Agency is 100% Credential Report 5% deduction allowed 3 from weekly business to invoice.

submit required Deductions will credentialing increase by 1% in documentation subsequent months.

Performance Evaluation. If the contractor fails to perform required services at the acceptable quality level, payment may be withheld until the contractor makes corrections. In the event that the contractor fails to perform any required services, the COR will provide written notice of such to the Contracting Specialist and CCO and the contractor. The Contracting Office will issue the contractor a Contract Discrepancy Report (CDR). The contractor shall have seven

(7) calendar days to provide the Contracting Office with their response to the CDR. Upon evaluation of the contractor’s response to the CDR for tasks surveilled, the contractor’s payment for the month in which the performance is question occurred will be calculated as outlined above.

Contractor Payment. If the contractor fails to perform required services at the acceptable quality level, payment may be withheld until contractor makes corrections.

Contracting Officer’s Representative Designation

The Contracting Officer Representative (COR) designated for this Project is:

Cheyenne River Health Center

COR: Stephanie Red Elk 24276 166th Street, Airport Road

Eagle Butte, SD 57625 Office: 605-964-7724 Fax: 605-964-0522

The COR is responsible for:

a. Monitoring the Contractor’s technical progress;

b. Interpreting the statement of work;

c. Technical evaluation as required;

d. Technical inspections and acceptance required by this contract; and,

e. Assisting the Contractor in the resolution of technical problems encountered during performance of this contract.

The contractor shall be paid a fixed flat rate of per hour. No differential pay for government holidays, compensation time, and night differential. Holidays and weekends shall be included as part of the work period and considered regular hours.

Quality Assurance Surveillance Plan (QASP). The purpose of the QASP is to provide a government developed system to assure the use of quality assurance methods in the administration of the performance based acquisition standards. The intent is to ensure that the Contractor performs services for the Cheyenne River Health Center that are provided in accordance with performance requirements set forth in the contract documents, that the government receives the quality of services called for in the contract and that the government only pays for the acceptable level of services received.

The plan provides the basis for the COR to evaluate the quality of the contractor’s performance. The oversight provided for in the contract and in this plan will help ensure that service levels reach and maintain the required levels throughout the contract term. Further, this plan provides the COR with a proactive way to avoid unacceptable or deficient performance and provides verifiable input for the required past performance evaluations.

GOVERNMENT FURNISHED PROPERTY AND SERVICES.

EQUIPMENT. Contract providers shall have joint use of all available equipment for performing services required by this contract.

PERSONAL PROTECTIVE EQUIPMENT (PPE). The Government will furnish the contract provider(s) with appropriate PPE. The Government will be responsible for any repair, cleaning and inventory required for the PPE.

This does not include any type of uniform or laboratory coat.

IDENTIFICAITON CREDENTIALS. The Cheyenne River Health Center will provide each contract provider with the required identification card.

FORMS. The Cheyenne River Health Center will provide required Government forms used in the performance of services.

SUPPLIES. The Cheyenne River Health Center will provide medical and non-medical supplies commonly used in the facility for the care and management of patients and the performance of the requirements of this contract.

HOUSING. Contractor shall be responsible for all applicable Federal, State, and Local Taxes, Meals, Travel/Transportation, lodging, and per diem.

Government Housing: Lodging is available in government housing at prevailing rates, if available, and must be paid by the contractor. There are limited furnished units available for contract employees and prevailing rates range from Single -$34.72 daily, Shared $16.58 daily and Trailer Pads - $8.00 daily (Rates are subject to change).

Local Hotel: Cheyenne River Motel (605) 964-8888.

SERVICES

ORIENTATION. The Contractor shall ensure that all new contract providers participate in the Cheyenne River Health Center Facility Orientation with an overlap of services to include one additional day. Providers must arrive on a Monday-Friday excluding holiday and participate in the orientation, which must be completed in the Monday- Friday timeframe, prior to providing services at the hospital.

Administrative Support. Cheyenne River Health Center will provide normal office administrative support services, to include telephone and utilities.

Patient Scheduling. Facility personnel will assist in patient scheduling. Complete administrative control of the patient shall remain with the facility.

CONTRACTOR FURNISHED ITEMS AND SERVICES

GENERAL. Except for those items or services specifically stated above to be Government furnished, the Contractor shall furnish everything required to perform this contract in accordance with all of its terms.

CONTRACTOR OWNED EQUIPMENT. The provider will provide his/her own stethoscope.

INITIAL INSPECTION. Contractor owned equipment will be inspected and approved by the biomedical equipment maintenance section prior to use in the facility.

Staff: Contractor must provide appropriately licensed/trained nursing staff to assist with patient care.

GENERAL INFORMATION

PERSONNEL.

POINT OF CONTACT. The Contractor shall provide a point of contact who shall be responsible for the performance of the work. The point of contact shall have full authority to act for the Contractor on all matters relating to the daily operation of this contract. The Contractor shall designate this individual, in writing, to the Contracting Officer before the contract start date. An alternate may be designated, but the Contract shall identify those times when the alternate shall be the primary point of contact.

CRIMINAL BACKGROUND INVESTIGATION. The Government will conduct at government expense, a state criminal history check on individuals providing direct, unsupervised child care services under this contract. As a minimum, the Contractor shall contact the Cheyenne River Health Center Contracting Officer for obtaining all necessary forms and directions for filing background check information in writing and electronically on personnel hired at the beginning of the contract. This action shall take place no later than five (5) working days from contract award date. Contractor shall submit completed personnel background check applications within Five (5) business days after award date to the Contracting Officers for processing. Contractor personnel will be required to be fingerprinted. Requests for personnel hired subsequent to the contact start date shall be submitted to the Government no later than five (5) working days from the employee’s first duty day. Contractor shall provide a list of substitute contract personnel fulfilling contingency situations (i.e. absences of certificated contact personnel). Names of substitutes and credentials shall be provided 15 calendar days in advance to accomplish background checks.

Contractor personnel receiving an unfavorable background check shall not be employed. Cheyenne River Health Center may employ an individual pending completion of successful background checks.

Background checks will be based on fingerprints of individual obtained by a Government law enforcement officer and inquiries conducted through the Federal Bureau of Investigation (FBI) and state criminal history repositories.

Individuals shall have the right to obtain a copy of any background check pertaining to themselves and to challenge the accuracy and completeness of the information contained in the report.

CONFLICT OF INTEREST. The Contractor shall not employ any person who is an employee of the United States Government if the employment of that person would create a conflict of interest. The Contractor shall not employ any person who is an employee of HHS (Health and Human Services), unless such a person seeks and receives approval in accordance with the Department of HHS.

APPEARANCE. Employees are expected to comply with reasonable dress, grooming and hygiene standards based on comfort, productivity, health and type of position occupied. Employee attire will be in good repair, and should not be considered offensive, disruptive or unsafe.

Contract providers shall display their identification badge on their outer clothing.

PROTECTIVE CLOTHING. When required and supplied by the Government, the provider shall wear special protective clothing and shoe covers. When duties will be performed in specified areas, a disposable protective hood shall be worn to ensure infection control standards are met. The Government will provide this hood. These items shall remain the property of the Government and shall not be removed from the facility. After use, protective clothing shall be turned in or destroyed as directed by the Infection Control Policy.

PRIVILEGING REQUIREMENTS. The contract providers’ credentials shall be reviewed by the Credentialing Specialist and the Credentialing Committee. The Contractor is responsible for ensuring that proposed providers possess the requisite credentials to enable granting of privileges by the Cheyenne River Health Center Medical Staff sufficient to allow for performance of al tasks identified. Medical Services cannot be performed by a contract ENT Physician until professional staff membership and the Great Plains Indian Health Service Governing Body has granted clinical privileges in writing.

Initial applications for clinical privileges, to include credentials action history, malpractice history, and certified true copies of the documents listed below, shall be submitted to the Cheyenne River Health Center Credentialing Committee, through the Credentialing Specialist, no later than 3 calendar days after receipt of notice of contract award.

a. Copy of valid, current unrestricted state license and applicable Board Certification. (Submission of required with proposal).

b. Possess a ASHA accredited graduate degree from an accredited American College or University.

c. Documentation of continuing education and training.

d. Current Basic Life Support (BLS) or CPR. (Submission required with proposal).

e. A signed consent for release of information.

f. A list of all states in which contract ENT Physician currently holds or has held a license to practice related services.

g. A current copy of the proposed contract ENT Physician professional resume.

h. Certification of current physical examination. The certification shall have a statement signed by the examining physician stating that the employee is free of any contagious diseases. The physical examination shall be current as of 12 months prior to application for privileges.

Applications for privileges will be screened through the National Practitioners Data Bank.

Re-appointment shall occur no less than every two years, in accordance with Cheyenne River Health Center Medical Bylaws.

DENIAL/TERMINATION OF PRIVILEGES. Actions to limit, suspend, or revoke clinical privileges will be in accordance with the procedures outlined in the Medical Staff Bylaws. The Clinical Director, will notify the Contracting Officer, and provide copies of pertinent documentation, as soon as possible when the necessity to exercise such authority becomes apparent. The Contracting Officer will notify the Contractor of the initiation of the revocation process if such action becomes apparent.

REVIEW OF CREDENTIALS PACKAGES. The Government reserves the right to limit the number of credentialing packages it will evaluate.

HEALTH REQUIREMENTS

The contract ENT Physician shall provide proof of current immunizations (Hep B, MMR, Varicella, Tdap, Flu) status and a current TST within the past year.

EMERGENCY HEALTH CARE. Cheyenne River Health Center will provide emergency health care for the contract ENT Physician for injuries incurred while on duty in the facility. These services will be billed to the Contractor at the current full reimbursement rate.

MEDICAL QUALITY IMPROVEMENT/RISK MANAGMENET (QI/RM).

The contract ENT Physician (s) shall participate in QI/RM activities to the extent required by Section 2C, AFI 44-119 and the individual Cheyenne River Health Center QI/RM plan or regulation.

The Government will evaluate the ENT Physician’s professional, as differentiated from administrative, performance under this contract using Quality Improvement standards specified in paragraphs 2.1 and 2.2. Nothing in this paragraph precludes the Government from also conducting inspections under the Inspection/Acceptance requirement of FAR clause 52.212-4.

PERFORMACE EVALUATION

The Cheyenne River Health Center will evaluate the contractors’ performance under this contract. Evaluations will be provided to the contactor, in writing. These evaluations may be used by as a record of contract performance history for the purpose of evaluation in other competitive or non-competitive acquisitions.

FREEDOM OF INFORMATION ACT (FOIA) PROGRAM. All FOIA request shall be delivered immediately to the Medical Records Supervisor.

PHYSICAL ACCESS. The Contractor shall return identification badge to the IT Department and house keys to the Housing Officer, upon completion/termination of the contract.

Physical Security. The contractor shall safeguard all government property, including controlled forms provided for contractor use. At the close of each work period, government equipment, facilities, and other valuable materials shall be secured.

Weapons, Firearms, And Ammunition. Contractor employees are prohibited from possessing weapons, firearms, or ammunition, on themselves or within their contractor-owned vehicle or privately-owned vehicle while on the Cheyenne River IHS compound.

Reporting Requirements. Contractor personnel shall report to an appropriate authority any information or circumstances of which they are aware may pose a threat to the security of IHS personnel, contractor personnel or patients.

The contractor shall prohibit their use of keys, issued by the government, by any persons other than the contractor’s employees and the opening of locked areas by contractor employees to permit entrance of person other than contractor employees engaged in performed of contract work requirement in those areas.

Past Performance Questionnaire Past Performance Information

OFFEROR INSTRUCTIONS: A separate record must be completed for each Past Performance Information and Survey; Offeror must directly send to the evaluator, requesting they complete and return as indicated on the attached Past Performance Survey, no later than to Danielle.chasinghawk@ihs.gov.

Further, Offeror must include a copy of each requested Past Performance Information page with proposal submission, showing the date and time you send to evaluator.

Name of Offeror being evaluated:

Address of Offeror:

Contract Details (i.e. Contract #/ Delivery or Task Order #, Title, Location, etc)

Evaluator’s Full Name:

Evaluator’s Position held or function in relation to project:

Evaluator’s Company/Organization Name, Address and Phone number:

Evaluator’s email address:

Please complete and return to: Danielle.chasinghawk@ihs.gov No Later Than: November 27, 2023 @ 1:00pm MST

Past Performance Questionnaire

Reference Instructions: The Indian Health Service/Cheyenne River Health Center is considering the Offeror listed above for award of a firm-fixed price, non-personal service, contract, for ENT Services.

Your comments would be appreciated regarding this firm’s past performance. Your comments are considered Source Selection Sensitive; therefore, you are advised that the Federal Acquisition Regulation (FAR) 15.506 prohibits the release of the names of the individuals providing reference information about the Offeror’s past performance. Survey should be completed by the evaluator and returned to Danielle Chasing Hawk at Danielle.chasinghawk@ihs.gov, no later than the date specified at the bottom of the form.

Please evaluate the Past Performance using only the following ratings without variation. If the rating is Marginal or Unacceptable, provide additional information in the appropriate block or in the remarks section of this form.

O = Outstanding = Performance greatly exceeded contract requirements A = Above Average = Performance exceeded contract requirements S = Satisfactory = Performance met contract requirements M = Marginal = Performance met the minimum contract requirements but some material aspects of the contractor’s performance were less than satisfactory.

U = Unacceptable = Performance was poor and/or did not satisfy contract requirements

NOTE: Do not use a color marking pen to circle the response. Best to use a ball point pen (Black or Blue) to circle your response.

Describe exactly what type of ENT or similar service(s) were provided to your company/organization?

Length of the Service (Provide dates):

Rate the following questions if the company provided temporary medical staffing or similar services. Provide information/comments in the Remarks Section below.

Circle One

Q1. To what extent did the contractor comply with contract requirements? O A S M U

Q2. How timely was the contractor’s performance? O A S M U

Q3. How well did the contractor comply with the labor and safety standards? O A S M U

Q4. Rate the effectiveness of the contractor’s management of the contract? O A S M U

Q5. Rate the contractor’s handling of staff integrity issues. O A S M U

Q6. Rate the contractor’s personnel management practices. O A S M U

Q7. Quality Control: Rate the overall quality of contractor’s work. O A S M U

Q8. How well did the contractor comply with the training requirements with respect to its employees?

O A S M U

Q9. What extent was contractor flexible in responding to changing needs? O A S M U

Q10. To what extent was the contractor reliable and responsive? O A S M U

Q11. To what extent did the contractor have continuous uninterrupted service?

Q12. Have any cure notices, show cause letters, suspension of payment, or termination been issued? If yes, explain on the following page.

Yes No

Q13. Would you award another contract to this contractor? If no, explain on the following page.

Q14. Was the customer satisfied with the service provided? If no, explain on the following page.

Q15. To what extent did contractor notify you of problems of potential issues?

Q16. Did the Contractor submit accurate invoices during the performance period? Yes No

Q17. Was the contractor professional and courteous in its interaction with you? Yes No

Q18. Did the contractor respond promptly to requests? Yes No Q19. Did the contractor meet all expectations under the contract? Yes No

Past Performance Questionnaire – Remarks Section

Evaluator’s Additional Remarks regarding services:

Signature of Evaluator: Date of Evaluation:

Print Name of Evaluator:

Please email scanned copy directly to Danielle.chasinghawk@ihs.gov

Do NOT return survey to the company you are evaluating

Contract Clauses (Fixed-Price, Non-Personal Healthcare Services, Commercial Items)

I. 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://www.acquisition.gov/browse/index/far

(End of clause)

FAR Citation Clause Title Clause Date

52.202-1 Definitions (Jun 2020)

52.203-3 Gratuities (Apr 1984)

52.203-12 Limitations on Payments to Influence Certain Federal Transactions

(Jun 2020)

52.203-17 Contractor Employee Whistleblower Rights and Requirement To Inform Employees of Whistleblower Rights

(Jun 2020)

52.204-7 System for Award Management (Oct 2108)

52.204-9 Personal Identity Verification of Contractor Personnel (Jan 2011)

52.204-13 System for Award Management Maintenance (Oct 2018)

52.204-16 Commercial and Government Entity Code Reporting. (Aug 2020)

52.204-17 Ownership or Control of Offeror. (Oct 2020)

52.204-18 Commercial and Government Entity Code Maintenance (Aug 2020)

52.204-19 Incorporation by Reference of Representations and Certifications (Dec 2014)

52.212-1 Instructions to Offerors, Commercial Products and Commercial Services (Sept 2023)

52.212-4 Contract Terms and Conditions-Commercial Products and Commercial Services

(Dec 2022)

52.217-5 Evaluation of Options (July 1990)

52.217-8 Option to Extend Services (Nov 1999)

52.219-1 Small Business Program Representations (Sep 2021)

52.222-54 Employment Eligibility Verification (May 2022)

52.224-1 Privacy Act Notification (Apr 1984) https://www.acquisition.gov/browse/index/far https://www.acquisition.gov/far/52.204-16?searchTerms=52-204-16 https://www.acquisition.gov/far/52.204-17?searchTerms=52-204-17

52.224-2 Privacy Act (Apr 1984)

52.225-25 Prohibition on Contracting With Entities Engaging in Certain Activities or Transactions Relating to Iran—Representation and Certifications.

(June 2020)

52.232-39 Unenforceability of Unauthorized Obligations (Jun 2013)

52.232-40 Providing Accelerated Payments to Small Business Subcontractors (March 2023)

52.233-2 Service of Protest (Sept 2006)

52.237-1 Site Visit (April 1984)

52.237-2 Protection of Government Buildings, Equipment and Vegetation

(April 1984)

52.237-7 Indemnification and Medical Liability Insurance (Jan 1997)

52.242-13 Bankruptcy (July 1995)

52.253-1 Computer Generated Forms (Jan 1991)

II. Federal Acquisition Regulations (FAR) (48 CFR Chapter 1) Clauses in Full Text

FAR Citation Clause Title Clause Date

52.204-24

Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment

(Nov 2021)

52.209-5 Certification Regarding Responsibility Matters (Aug 2020)

52.209-7 Information Regarding Responsibility Matters (OCT 2018)

52.212-2 Evaluation-Commercial Products and Commercial Services (Nov 2021)

52.212-3 Offeror Representation and Certifications-Commercial Products and Commercial Services

(Sept 2023)

52.212-5

Contract Terms & Conditions Required to Implement Statues or

(Sept 2023)

Executive Orders – Commercial Products and Commercial Services

52.217-9 Option to Extend the Term of the Contract (March 2020)

52.232-19 Availability of Funds for the Next Fiscal Year (APR 1984)

52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS AND VIDEO

SURVEILLANCE SERVICES OR EQUIPMENT (NOV 2021)

The Offeror shall not complete the representation at paragraph (d)(1) of this provision if the Offeror has represented that it "does not provide covered telecommunications equipment or services as a part of its offered products or services to the Government in the performance of any contract, subcontract, or other contractual instrument" in paragraph (c)(1) in the provision at 52.204-26, Covered Telecommunications Equipment or Services—Representation, or in paragraph (v)(2)(i) of the provision at 52.212- 3, Offeror Representations and Certifications-Commercial Products or Commercial Services. The Offeror shall not complete the representation in paragraph (d)(2) of this provision if the Offeror has represented that it "does not use covered telecommunications equipment or services, or any equipment, system, or service that uses covered telecommunications equipment or services" in paragraph (c)(2) of the provision at 52.204- 26, or in paragraph (v)(2)(ii) of the provision at 52.212-3.

(a) Definitions. As used in this provision— https://www.acquisition.gov/far/52.204-26#FAR_52_204_26 https://www.acquisition.gov/far/52.212-3#FAR_52_212_3 https://www.acquisition.gov/far/52.212-3#FAR_52_212_3 https://www.acquisition.gov/far/52.204-26#FAR_52_204_26 https://www.acquisition.gov/far/52.204-26#FAR_52_204_26 https://www.acquisition.gov/far/52.212-3#FAR_52_212_3

Backhaul, covered telecommunications equipment or services, critical technology, interconnection arrangements, reasonable inquiry, roaming, and substantial or essential component have the meanings provided in the clause 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

(b) Prohibition.

(1) Section 889(a)(1)(A) of the John S. McCain National Defense Authorization Act for Fiscal Year

2019 (Pub. L. 115-232) prohibits the head of an executive agency on or after August 13, 2019, from procuring or obtaining, or extending or renewing a contract to procure or obtain, any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. Nothing in the prohibition shall be construed to—

(i) Prohibit the head of an executive agency from procuring with an entity to provide a service that connects to the facilities of a third-party, such as backhaul, roaming, or interconnection arrangements; or

(ii) Cover telecommunications equipment that cannot route or redirect user data traffic or cannot permit visibility into any user data or packets that such equipment transmits or otherwise handles.

(2) Section 889(a)(1)(B) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Pub. L. 115-232) prohibits the head of an executive agency on or after August 13, 2020, from entering into a contract or extending or renewing a contract with an entity that uses any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. This prohibition applies to the use of covered telecommunications equipment or services, regardless of whether that use is in performance of work under a Federal contract. Nothing in the prohibition shall be construed to—

(i) Prohibit the head of an executive agency from procuring with an entity to provide…