CRHC21-12 UCF.pdf

SOLICITATION, OFFER AND AWARD

,I

. THIS CONTRACT IS A RATED ORDER \

UNDER DPAS (15 CFR 7OO) 7

TATING PAGE OF PAGES

2, CONTRACT NUi/BER 3. SOLICITATION NUMBER

CRHC21-12

TYPE OF SOLICITATION

I senr-eo BID (rFB) fil necolnreo (nrp)

DATE ISSUED

4t1t2021

6. REQUISITION/PURCHASE NUMBER

tHS1421160

7. ISSUED BY CODE 8. ADDRESS OFFER TO (lf other than item 7)

I HS/Cheyenne River Health 24276 1661h St. Airport Rd., Center Eagle Butte, SD 57625

NOTE: ln sealed bid solicitations "offer" and "offeror" mean "bid" and "bidder"

SOLICITATION

9. Sealed offers in original and 2 copies for furnishings the supplies or services in the Schedule will be received at the place specified in item 8, or il hand carried, in the depository located in

CAUTION - LATE Submissions, Modifications, and Wthdrawals: See Section L, Provision No.52.214-7 or 52.215-1 contained in this solicitation local time (Hou1 @ate)

All offers are subject to all terms and conditions

10. FOR

INFORMATION

CALL:

C. E.MAIL ADDRESS

paige.kerstiens@ihs. govPaige Kerstiens, Purchasing Agent

B. TELEPHONE (NO COLLECT CALLS)

1 1. TABLE OF CONTENTS

(x) SEC DESCRIPTION PAGE(S) (x) SEC. DESCRIPTION AGE(S)

PART I. THE SCHEDULE PART II - CONTRACT CLAUSES

X SOLICITATION/CONTRACT FORM x I CONTRACT CLAUSES x B SUPPLIES OR SERVICES AND PRICES/COSTS PART III . LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACH x c DESC R I PTI ON/SPECS./WOR K STATEMENT x J LIST OF ATTACHMENTS

D PACKAGING AND MARKING PART IV. REPRESENTATIONS AND INSTRUCTIONS

X E INSPECTION AND ACCEPTANCE x K

REPRESENTATIONS, CERTIFICATIONS AND OTHER

STATEMENTS OF OFFERORSx F DELIVERIES OR PERFORMANCE x G CONTRACT ADMINISTRATION DATA x L INSTRUCTIONS, CONDITIONS, AND NOTICES TO OFFERORS x H SPECIAL CONTRACT REQUIREMENTS x M EVALUATION FACTORS FOR AWARD

OFFER (Must be fully completed by offeror) NOTE: ltem 12 does not apply if the solrcitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period

'12. ln compliance with the above, the undersigned agrees, if this offer is accepted within calendar days (60 calendar days unless a different peiod is inseded by the offeror) lrom the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the set opposite each item, delivered at the designated point(s), within the time specified in the schedule.

completed by Government)

1. ACCOUNTING AND APPROPRIATION

22. AUTHORITY FOR USING OTHER THAN FULL OPEN COMPETITION

I ro u.s.c. zao+ 1c; [ +r u.s.c. 3304(a) ( )

24. ADMINISTERED BY (lf other than ltem 7) 25. PAYMENT WlLL CODE

Financelndian Health Service/Great Plains, 1154thAveSE, Room309 Aberdeen, SD 57401

26. NAME OF CONTRACTING OFFICER (Type or pint) 28. AWARD DATE

Craio Wells. Cheif C Officer, GPA/lHS IMPORTANT - Award will be made on this Form, or on Standard Form 26, or by other authorized official written notice

1O CALENDAR DAYS (O/O)I 20 CALENDAR DAYS (%) 30 CALENDAR DAYS (%) CALENDAR DAYS(%)

14, ACKNOWLEDGMENT OF AMENDMENTS AMENDMENT NO. DATE AMENDMENT NO. DATE

the SOLICITATION tor offerors and related documents numbered and dated).

15A, NAME AND

ADDRESS

OF OFFER(

coDE | | FACILITY 16. NAME AND THE TITLE OF PERSON AUTHORIZED TO SIGN OFFER(Type or pint)

1 58. TELEPHONE R

T-1 15C. CHECK rF REMTTTANCE ADDRESS tS

IJ DIFFERENT FROM ABOVE - ENTER SUCH

ADDRESS IN SCHEDULE.

17. SIGNATURE 18. OFFER DATE

AREA \U [i]BER EXTENSION

AWARD (7o be

23. SUBMIT INVOICES TO ADDRESS SHOWN IN \

(4 copies unless otherwise specified) 7

27. UNITED STATES OF AMERICA

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is unusable

STANDARD FORM 33 (REV. 6/2014)

Prescribed by GSA - FAR (48 CFR) 53.214 (c)

CRHC 21-12 pg 1

1:00 PM 4/14/2021The Cheyenne River Health Center, Eagle Butte, SD

Notice - 1

NOTICE TO QUOTERS

REQUEST FOR QUOTES (RFQ): CRHC21-12

QUOTE DUE DATE: Quotes are due April 14, 2021 @ 1:00 PM MST

RETURN RFQ TO: Cheyenne River Service Unit

Attn: Paige Kerstiens

PO Box 1012

Eagle Butte, SD 57625

Telephone: 605-964-7724 Ext. 1565

Fax: 605-964-1140

GENERAL DESCRIPTION:

Firm Fixed Price, Non-Personal Service Healthcare Contract for Ear Nose and Throat Physician Services, at the

Cheyenne River Health Center, Eagle Butte, SD.

The Period of Performance will be from Date of Award through One(1) Year, with Four-One(1)Year option periods. Contractor shall perform in accordance with the Performance Work Statement. The government reserves the discretionary authority to exercise any one of the four option years.

The quoted “unit price” shall be an all-inclusive price.

All “inclusive unit price” is defined to include travel, lodging, per diem, fringe benefits, plus all other costs pertinent to the performance of this contract.

This RFQ is issued as a 100% IEE Set Aside and the associated NAICS code is 621111 with a small business size standard of $12 million.

BASIS FOR AWARD:

The basis for award will be based on "Best Value" with trade-offs that takes in consideration the evaluation factors listed below. Therefore, in addition to price the government will consider the evaluation factors in determining the successful quote that represent best value to the government. Under best value principles, there is no requirement that a contract be awarded on the basis of lowest price. Offeror is to bid on the Base Year and each Option Year. IHS reserves the right to make a single award or multiple awards, whichever is most advantages to the Government. This is a competitive solicitation and the offer your firm submits will be used by the Indian Health Service to determine, which offer is the "Best Value" to the government.

Below are the mandatory criteria:

FACTOR 1 - TECHNICAL APPROACH AND MANAGEMENT PLAN

Offeror’s technical capabilities shall be assessed based on a demonstrated understanding of the

Performance Work Statement (PWS) requirements. The contractor shall define a technical approach that integrates contract management and contract performance activities, using a multifunctional team, CRHC 21-12 pg 2

Notice - 2 to meet cost and performance objectives in the provision of ENT services .

The technical proposal should also include the Offeror’s experience in providing similar services for the

Government and/or commercial interests. The description should include key accomplishments, results, problems encountered and overcome, and the scope of various projects. Offeror’s proposal will be evaluated on the following sub-factors listed below. Offerors must submit the following requested documentation and information in the following format for evaluation:

1.1. Key Personnel:

The Offeror shall submit resumes for all Key Personnel to be utilized in the performance of these requirements. The contractor is to determine and provide a list of key personnel and their proposed role leading significant areas of operation. Offeror shall clearly state which requirements section that the individual being proposed would work in. Also, the Offeror shall certify that the information on each key personnel submitted is true and complete. Resumes of personnel directly involved in providing services under the contract shall be included in the proposal.

The Government understands the natural attrition in staffing a 24/7 group will be a considerable undertaking. The Government must evaluate doing the technical evaluation of the Offeror’s plan to establish and maintain 24/7 services necessary to successfully meet the requirements of the contract without any performance lapse. This requires the Contractor to provide information on candidate’s specialized training and expertise, significant experience that will exemplify contract staff’s knowledge, judgement, adaptability, reliability and personal characteristics to carry out the entire scope of services required.

Understanding that, here is the Government’s logic as to who should be identified as key personnel.

Section 2.1 requires the Contractor to identify a point of contact and alternate point of contact (POC) or these responsibilities listed. These POCs identified by the Contractor will be considered as key personnel. An individual may be assigned to more than one of these areas of responsibilities.

O Coordination of Network/Software review.

o Coordination and submitting of reporting requirements.

o Qualified staff to perform services.

o Reviewing and approving invoices and supporting documentation and other payment questions.

o Providing management an oversight of assigned providers.

o Quality Assessment and Performance Improvement Monitor.

o Health Information Portability and Accountability Act (HIPAA), Privacy Act (PA), and records management compliance.

Element 1, Each resume shall be limited to the three (3) pages and shall provide the following information:

a. Name, the currency, educational qualification, quality and depth of experience of the proposed personnel.

Element 2, Relative experience and capability of the project manager to function in an environment with the complexity, diversity and inter-department communication and collaboration and to successfully supervise and coordinate the workforce.

The offeror must provide documents/information demonstrating the qualifications of personnel to meet the requirements to include:

1.1. Qualifications of Personnel: The Technical Panel will evaluate each candidate’s personal

CRHC 21-12 pg 3

Notice - 3 qualifications.

The offeror must provide documents/information demonstrating the qualifications of personnel to meet the requirements to include:

1.1.1. A listing of all professional staff who will be assigned to perform the required services

1.1.2. Resume of proposed candidate

1.1.3. Copies of degrees; licenses; accreditations

1.1.4. Information regarding candidates’ specialized training and expertise, i.e.: any education, internships, licenses, certifications, or awards.

1.1.6. Professional accomplishments and awards

1.2. Experience: The Technical Panel will evaluate each candidate’s experience:

The offeror must provide the following documents/information demonstrating the experience of personnel to meet the requirements to include:

1.2.1. Years of experience.

1.2.2. Provide information about experience requiring independent function.

1.3. Skills: The Technical Panel will evaluate each candidate’s skills:

The offer must provide information that demonstrates candidate’s specialized skills and expertise.

This includes information regarding:

1.3.1. Provide information on candidate’s specialized training and expertise, that will exemplify contract staff’s knowledge, judgement, adaptability, accuracy to carry out the entire scope of services required.

1.3.3. Furnish a list of three (3) references including phone numbers of persons with direct knowledge of abilities and expertise.

The Key Personnel Section above, except resumes, is limited to 30 pages.

1.4. Contractor’s Management Capabilities and Responsibility: The Technical Panel will evaluate the Contractor’s management and administrative capabilities and responsibility:

The offer must provide information that demonstrates their company’s ability to provide required services and to manage and administer an awarded contract. This includes information regarding:

1.4.1. Provide information that depicts evidence regarding qualifications and experience of the contractor’s company in management positions within the healthcare community. Include information on company’s financial stability. Does management possess the necessary organization and efficiency of operation to provide the personnel and to perform the services in support of an awarded contract?

1.4.2. Provide information regarding quality assurance, i.e., QA monitors, QA plans and QA performance improvement plans.

1.4.3. Provide information that corroborates your company has adequate personnel to provide the required services and has the capability to maintain continuity of service in a timely manner. Information provided should include recruitment, staffing, back-up and retention plans.

The Management Approach Selection above is limited to 20 pages.

Evaluation Factor 2 – Relevant Past Performance (provide strengths and weaknesses then assign an adjectival rating).

CRHC 21-12 pg 4

Notice - 4

2.1. References: The offeror will provide as part of the proposal three separate and recent references with a description of the contract services provided. Identify other Federal, State, or local government contracts, along with private sector contracts, that are of a similar scope, size, and complexity that are ongoing, or that your company has had within the past three years. For each reference, provide the following information:

(a) Contact person’s name, address, phone, e-mail, and fax number

(b) Description of the requirement, contract number, value of contract, award & completion date

(c) Any problems associated with the contract and how you worked to resolve them.

In evaluating the offeror’s past performance, the Government will consider offeror’s record for:

(a) Quality of Service

(b) Customer Satisfaction

(c) Timeliness of Performance

(d) Medical Liability and Malpractice Judgments (past or pending)

(1) Provide proof of current medical liability coverage

(2) Provide documentation of any past or pending malpractice/tort claims (if any)

2.2. Other Sources of Information: Past performance evaluations will be conducted using information obtained from references and from Government online data bases, i.e. Contractor Performance

Assessment Report System (CPARS) data base which is available to all Federal agencies;

and any other sources deemed appropriate. While the Government may elect to consider data obtained from other sources, the burden for providing current and complete past performance information rests with the offeror.

2.3. Offers with no relevant past performance history will not be evaluated favorably or unfavorably on past performance. The past performance information obtained will be used for both this evaluation factor and offeror’s responsibility determination.

EVALUATION PROCESS FOR AWARD

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

(1) Technical Approach and Management Plan

(2) Relevant Past Performance

(b) The Government will conduct a best value evaluation to determine offeror(s) for award. In doing so the

Government may award to other than the lowest priced proposal or other than the highest technically rated proposal. It is anticipated that one or more awards will be made. All proposals shall be evaluated based on the following:

RELATIVE IMPORTANCE OF EVALUATION CRITERIA

All evaluation factors other than cost or price, when combined, are more important than cost or price.

Selection of the firm(s) to perform this Contract will be based on IHS’ assessment of the best value to the

Government.

1. RESPONSIBILITY

To be eligible for an award, an Offeror must be determined responsible in accordance with the standards in

FAR Part 9.104.

2. ADJECTIVAL RATINGS

The Technical Evaluation Team will identify strengths, weaknesses, and deficiencies.

Since factors are listed in descending order of importance, as technical ratings and relative advantages and disadvantages become less distinct, difference in price between proposals are of increased importance in determining the most advantageous proposal. Conversely, as differences in price become less distinct, CRHC 21-12 pg 5

Notice - 5 differences in rating and relative advantages and disadvantages between proposals are of increased importance to the determination.

The technical evaluation will be attained through a determination and analysis of strengths, weaknesses, and risks of each proposal. Technical risks will be included in the final evaluation of each factor and will not be evaluated as a separate factor. In the assessment of technical risk, the Government evaluators will consider all available information.

The following is an adjectival rating system that will be used to evaluate Offeror’s proposals:

ADJECTIVAL

RATING

DESCRIPTION

Outstanding Greatly exceeds all minimum requirements of the criteria; has a high probability of success; contains no weaknesses or deficiencies.

Good Exceeds all the minimum requirements of the criteria; has an above average probability of success; contains no significant weaknesses and only minor correctable weaknesses exist.

Acceptable Meets all the minimum requirements of the criteria; has an average probability of success; no significant weaknesses and no deficiencies.

Marginal Fails to meet one or more of the minimum requirements of the criteria; low probability of success; major weaknesses and/or significant number of deficiencies exists.

Unacceptable Fails to meet any of the minimum requirements of the criteria;

proposal needs major revisions; very low probability of success.

3. PRICE EVALUATION

The price proposal shall be evaluated to determine the Offeror's ability to carry out its proposed technical approach and indicate that the Offeror understands the nature and extent of the work to be performed. The total price of each contract line item shall be added together to arrive at an overall total. The total of all options years shall be added together to arrive at an overall evaluated total, which will be evaluated for overall reasonableness of price. Offerors must include the formulas and factors used in calculation of the data.

4. AWARD WITHOUT DISCUSSIONS & COMPETITIVE RANGE DETERMINATIONS

The Government intends to evaluate proposals and award a contract without discussions with Offerors (except for clarifications as described in FAR 15.306(a)). Therefore, the Offeror's initial proposal should contain the

Offeror's best terms from a price and technical standpoint. The Government reserves the right to conduct discussions if the Contracting Officer later determines them to be necessary. In the event discussions are held, a competitive range determination will be made. If the Contracting Officer determines that the number of proposals that would otherwise be in the competitive range exceeds the number at which an efficient competition can be conducted, the Contracting Officer may limit the number of proposals in the competitive range to the greatest number that will permit an efficient competition among the most highly rated proposals.

5. AWARD

An award will be made on a best value basis; both price and other factors considered. An award will be made only in the event that the Offeror's proposal is found to be technically acceptable, based upon the evaluation

CRHC 21-12 pg 6

Notice - 6 criteria, and the Offeror is determined responsive and responsible in accordance with the terms and conditions of this solicitation.

INSTRUCTION TO QUOTERS:

To be considered an acceptable quote, the following items must be completed and returned by the due date stated above.

1. Complete and sign SF-33 – Request for Quotation (Signature required)

2. Complete Taxpayer Identification Form (FAR Part 52.204-3 – Taxpayer Identification)

3. Complete Annual Representations & Certifications form (FAR 52.212-5)

4. Evaluation Proposal (Addressing each evaluation element)

5. Cost/Price Proposal

6. Buy Indian Representation Form (Filled out and signed)

ATTACHMENTS:

1. SF-33 Request for Quotations

2. Notice to Quoters

3. Performance Work Statement

4. Clauses incorporated by reference

5. Clauses incorporated in full text

6. Business Agreement

7. Ethics

8. Background Clearance Forms

9. Representations, Certifications, and other statements

10. Buy Indian Representation Form

11. Evaluation factors

12. Price/Cost Schedule

Questions in regards to this solicitation shall be submitted in writing by email to

(Paige.Kerstiens@ihs.gov). The last day to submit questions is April 9, 2021, 1:00pm, MST.

ACCEPTANCE PERIOD: Your quote must stipulate that it is predicated upon all the terms and conditions of this Solicitation. In addition, it must contain a statement to the effect that it is firm for a period of at least 60 days from the date of receipt by the Government.

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.

SECURITY CLEARANCE

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 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.

CRHC 21-12 pg 7

Notice - 7

Quotation must set forth full, accurate, and complete information as required by this Request for Quotation

(RFQ), and be returned no later than the date referenced in Block #10 of the Request for Quotation form SF-18.

All required information must be submitted in order to be considered responsive and eligible for award.

CRHC 21-12 pg 8

DEPARTMENT OF HEALTH & HUMAN SERVICES

Indian Health Service

Division of Acquisition Policy (DAP) 5600 Fishers Lane

Rockville, MD 20857

INDIAN HEALTH SERVICE

BUY INDIAN ACT

INDIAN FIRM REPRESENTATION FORM

SOLICIATION NUMBER: _________________________________________________

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 Firm” (HHSAR 326.602) with “Indian Ownership” (HHSAR 326.603), in response to this solicitation and resultant contract.

The enterprise must meet the definition of “Indian Firm” 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 DUN and Bradstreet (D&B) and 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 Firm” with “Indian Ownership” under the authority of the Buy Indian Act.

Business Name Certifying Signature

DUNS Number Print Name

CRHC 21-12 pg 9

Request for Proposal: CRHC 21-12

ENT Services – Section B

B-1

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: 07/01/2021 – 06/30/2022

Item

No Descript of Service Estimated

Qty

Unit Unit Price Total Amount

1. ENT Specialty Clinic

Services

192 HRS $ $

TOTAL Base Year: $

2. OPTION YEAR ONE (1): 07/01/2022 – 06/30/2023

No Descript of Service Estimated

Qty

Unit Unit Price Total Amount

1. ENT Specialty Clinic

Services

3. OPTION YEAR TWO (2): 07/01/2023 – 06/30/2024

No Descript of Service Estimated

Qty

Unit Unit Price Total Amount

1. ENT Specialty Clinic

Services

4. OPTION YEAR THREE (3): 07/01/2024 – 06/30/2025

No Descript of Service Estimated

Qty

Unit Unit Price Total Amount

1. ENT Specialty Clinic

Services

CRHC 21-12 pg 10

ENT Services – Section B

B-2

5. OPTION YEAR FOUR (4): 07/01/2025 – 06/30/2026

No Descript of Service Estimated

Qty

Unit Unit Price Total Amount

1. ENT Specialty Clinic

Services

6. AGGREGRATED TOTALS

TOTALS

1. Base Year (07/01/2021 – 06/30/2022) $

2. Option Year One (07/01/2022 – 06/30/2023) $

3. Option Year Two (07/01/2023 – 06/30/2024) $

4. Option Year Three (07/01/2024 – 06/30/2025) $

5. Option Year Four (07/01/2025 – 06/30/2026) $

AGGREGRATED TOTAL FOR ALL FIVE

YEARS:

CRHC 21-12 pg 11

ENT Services – Section C-H

C-H 1

PERFORMANCE WORK STATEMENT (PWS)

Cheyenne River Health Center (CRHC)

OB/GYN Physician

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, Purchase Referred Care Services, Dietitians, Audiology, Eye Care, Inpatient, Pain

Management, and Specialist Clinics: OB/GYN, ENT, Audiology, 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.

CRHC 21-12 pg 12

C-H 2

Period of Performance

Base Year: July 1, 2021 through June 30, 2022

Option Year 1: July 1, 2022 through June 30, 2023

Option Year 2: July 1, 2023 through June 30, 2024

Option Year 3: July 1, 2024 through June 30, 2025

Option Year 4: July 1, 2025 through June 30, 2026

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 ancillary 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, medical 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

CRHC 21-12 pg 13

C-H 3 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 nasopharyngeal 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 CRHC 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.

CRHC 21-12 pg 14

C-H 4

The Contractor shall provide adequate credentialed staff during the regular scheduled services dates and cover the salary for an ancillary staff brought to the service unit. Ancillary staff must have licensure/certification and competencies on file with the Contracting Officer.

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 CONSULTS. 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.

CRHC 21-12 pg 15

C-H 5

AVAILABILITY:

HOURS OF OPERATION: 2 days per month ( Up to 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.

CRHC 21-12 pg 16

C-H 6

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 documentation of patient record

All patient records must be documented accurately, correctly, and completely within 24 hours of patient visit

100% Random observation and

HIM Report

5% deduction from weekly invoice.

Deductions will increase by 1% in subsequent months.

Prompt and continuous coverage

Agency must provide a competent Mid-

Level to ensure no gaps in coverage.

100% Provider

Schedule

If all shifts are covered with no gaps in coverage the contractor may submit request for a 1% bonus.

This shall be assessed on a yearly basis, dictated by the period of performance.

Credentialing Agency is allowed 3 business to submit required credentialing documentation

100% Credential Report 5% deduction from weekly invoice.

Deductions will increase by 1% in 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.

CRHC 21-12 pg 17

C-H 7

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 Charger

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.

CRHC 21-12 pg 18

C-H 8

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 $39.27 daily, Shared $22.65 daily and

Trailer Pads - $11.20 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, fax, computer, and utilities.

CRHC 21-12 pg 19

C-H 9

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 in Section III to be Government furnished, the Contractor shall furnish everything required to perform this contract in accordance with all of its terms. The Contractor shall provide adequate credentialed staff during the regular scheduled services dates and cover the salary for an ancillary staff brought to the service unit. Ancillary staff must have licensure/certification and competencies on file with the Contracting Officer.

CONTRACTOR OWNED EQUIPMENT. The provider will provide his/her own stethoscope, penlights, etc., and white physician coat.

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

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.

CRHC 21-12 pg 20

C-H 10

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.