CRHC21-47.pdf

REQUEST FOR QUOTATIONS

(THIS IS NOT AN ORDER)

THIS RFQ IS A SMALL BUSINESS SET-ASIDE

PAGE OF PAGES

1. REQUEST NO.

CRHC-21-47

2. DATE ISSUED

7/15/2021

3. REQUISITION/PURCHASE REQUEST NO.

IHS1432191

4. CERT.FOR NAT. DEF.

UNDER BDSA REG.2

AND/OR DMS REG. 1

RATING

5A. ISSUED BY

Eagle Butte Indian Health Service, Cheyenne River Service Unit 24276 166th St, PO Box 1012, Eagle Butte, SD 57625

6. DELIVER BY (Date)

See schedule

5b. FOR INFORMATION CALL (NO COLLECT CALLS) 7. DELIVERY OTHER

FOB DESTINATION (See Schedule)

NAME

Paige Kerstiens paige.kerstiens@ihs.gov

TELEPHONE NUMBER 9. DESTINATION

AREA CODE

NUMBER

964-1565

a. NAME OF CONSIGNEE

Cheyenne River Service Unit

8. TO: b. STREET ADDRESS

24276 166th St, PO Box 1012

a. NAME b. COMPANY c. CITY

Eagle Butte

c. STREET ADDRESS

d. CITY e. STATE f. ZIP CODE d. STATE

SD

e. ZIP CODE

57625

10. PLEASE FURNISH QUOTATIONS TO

THE ISSUING OFFICE IN BLOCK

5a ON OR BY 1:00 PM MST ON (Date)

July 29, 2021

IMPORTANT: This is a request for information, and quotations furnished are not offiers. If you are unable to quote, please so indicate on this form and return it to the address in Block 5a. This request does not commit the Government to pay any costs incurred in the preparation of the submission of this quotation or to contract for supplies or services. Supplies are of domestic origin unless otherwise indicated by quoter. Any representations and/or certifications attached to this Request for

Quotations must be completed by the quoter.

11. SCHEDULE (Include applicable Federal, State and local taxes)

ITEM NO.

(a)

SUPPLIES/SERVICES

(b)

QUANTITY

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOUNT

(f)

Firm-Fixed Price Purchase Order for One

(1) Pediatric Physician for the Outpatient

Department at the Cheyenne River Health

Center, Eagle Butte, SD. Period of

Performance: 8/18/2021 – 2/18/2022. The quoted “unit price” shall be an all-inclusive price.

See attached Performance Work

Statement.

Pediatrician Services

Regular Hours

1200 hours $________ = $__________

12. DISCOUNT FOR PROMPT

PAYMENT

a. 10 CALENDAR DAYS

b. 20

CALENDAR

DAYS%

c. 30 CALENDAR DAYS

d. CALENDAR DAYS

NUMBER PERCENTAGE

NOTE: Additional provisions and representations are are not attached.

13. NAME AND ADDRESS OF QUOTER 15. SIGNATURE OF PERSON AUTHORIZED TO

SIGN QUOTATION

15. DATE OF

QUOTATIONa. NAME OF QUOTER

b. STREET ADDRESS

c. COUNTY 16. SIGNER

a. NAME (Type of print) b. TELEPHONE

AREA CODE

d. CITY e. STATE f. ZIP CODE c. TITLE (type or print) NUMBER

AUTHORIZED FOR LOCAL REPRODUCTION FormFlow/Delrina Inc. STANDARD FORM 18 (REV 6-95) Previous edition not usable Prescribed by GSA-FAR (48 CFR) 53-215-1(a) mailto:paige.kerstiens@ihs.gov

ITEM

NO.

(a)

SUPPLIES/SERVICES

(b)

QUANTITY

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOUNT

(f)

DUNS & Bradstreet Number:

(The Duns & Bradstreet number is required.

Provided you do not have it, you may call 866-705-

5711 and obtain one.) You will need a DUNS &

Bradstreet NUMBER to be awarded the purchase order and registered with the System for Award

Management; you can register at www.sam.gov

The quoter is hereby notified that they must be registered in the System for Award Management

(SAM) before the Government will issue an award. You may do this by going to www.sam.gov to register and you are required to update this registration every year prior to the expiration date.

No contract award shall be made to a vendor listed on the OIG Exclusion List

(http://exlusions.oig.hhs.gov) throughout the duration of the contract.

Federal Tax ID Number:

Email Address:

Net Terms:

http://www.sam.gov/ http://exlusions.oig.hhs.gov/

NOTICE TO QUOTERS

REQUEST FOR QUOTES (RFQ): CRHC21-47

QUOTE DUE DATE: Quotes are due July 29, 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 Purchase Order for One Pediatric Physician to perform services in the Outpatient Department at the Cheyenne River Health Center, Eagle Butte, SD. Period of

Performance: 8/18/2021 – 2/18/2022. Contractor shall perform in accordance with the PWS. The quoted “unit price” shall be an all-inclusive price. Multiple awards may be made against this RFQ, if advantageous for the government.

This RFQ is issued as a 100% Indian Economic Enterprise (IEE) Small Business Set-Aside and the associated

NAICS code is 621111 with a small business size standard of $12.0 million.

BASIS FOR AWARD:

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, 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:

CRHC21-47: Pediatric Physician Services

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.

RELATIVE IMPORTANCE OF EVALUATION CRITERIA

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. 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, to meet cost and performance objectives in the provision of Pediatric 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 continuous coverage over the period of performance 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 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 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.)

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

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.

These evaluation factors are of prime importance. A marginal or unacceptable rating in any of these factors shall be considered sufficient grounds for declaring the entire proposal unacceptable.

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. 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.

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.

Contractor must be registered and active within the System for Award Management. The website to register is at: www.sam.gov

ADJECTIVAL RATINGS

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 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-18 (Signature required)

2. Complete the Buy Indian Certification

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

4. Candidate Resume (to include last employer), must include DOB on Resume.

5. Candidate License (active and inactive)

6. DUNS number included in proposal

7. Proposal addressing each evaluation factor

7. Price/Cost Proposal http://www.sam.gov/

ATTACHMENTS:

1. SF-18 Request for Proposals

2. Notice to Quoters

3. Buy Indian Certification

4. Performance Work Statement

5. Clauses incorporated by reference

6. Clauses incorporated in full text

7. Business Agreement

8. Ethics

9. Service Labor Standards

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 July 27, 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

EXLUSION LIST http://exlusions.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.

Quotation must set forth full, accurate, and complete information as required by this Solicitation, Offer and

Award form, and be returned no later than the date referenced in Block #10 of the RFQ Form SF-18.

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

http://exlusions.oig.hhs.gov/

PERFORMANCE WORK STATEMENT

Cheyenne River Indian Health Service

Pediatrician Physician

General

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

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, Pain Management, 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 placement of a Pediatrician Physician for the Outpatient Department (OPD), Cheyenne River Health Center.

Period of Performance

August 18, 2021 through February 18, 2021

Work Schedule

(8) Hour shifts, Monday through Friday - 5 days per week, 0800 - 1700 or 1030 - 1900. This is subject to change at the Clinical Directors discretion based on the needs of the Facility.

Place of Performance

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

DESCRIpTION oF SERVICES: The contractor shall provide Pediatrician Physician services required for the

Cheyenne River lndian Health Service Hospital.

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

The Great plains Area lndian Health Service (GPAIHS) requires contractor support to assist in the recruitment and placement of an pediatrician physician into temporary duty assignments in health centers and hospitals in the Great irlains Area lHS. The purpose of the contract is for the recruitment, credentialing, and placement of an Pediatrician

Physician at Cheyenne River Health Center.

This contract is a non-personal health care services contract, as dellned at Far Part 37 .101under 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., professionailudgements, diagnosis for specific medical treatment). The Contractor shall indemnify the Goveinm6nt for any tiability producing acfor omission by the contractor, its employees and agents occurring during contract performance. The Contractor shall maintain medical liability insurance, in the coverage amount

,c..[tabl. to tre Contracting Officer, which is not less than the amount normally prevailing within the local community for the medical specialty concemed.

The Contractor shall fumish a Pediatrician Physician to provide services to beneficiaries in the Outpatient

Department (OpD) in IHS in Eagle Butte, South Dakota. Contract Pediatrician Physician care shall cover the range of medicine typically provided in a rural civilian practice of similar size.

Upon the receipt of an IHS purchase order, the Contractor shall locate, credential, and have available sufficient staffing to provide a Pediatrician Physician coverage for the Outpatient Department (8 hours shifts, Monday through Fiiday, 0800 - 1700. Ih,s ls sub.1'ect to change at the Clinical Directors discretion based on the needs of the Facility.

The standards of medical practice and duties of the Contractor through its providers shall be determined pursuant to

Goveming Body bylaws, medial staff bylaws, rules and regulations of the appropriated IHS hospital, applicable provisioni of law including but not limited to rules and regulations of any and all governmental,authorities relating to iicensure and regulation of physicians and hospitals, and standards and recommendations of CMS (Centers for

Medicare and Medicaid Services) compliance. The Contract Pediatilcian Physician(s) shall be required to participate in a quality improvement program, which is consistent with current requirements for ongoing monitoring and evaluation of the quality and appropriateness of care.

The contract resulting from this solicitation shall:

1. be a non-personal health care services contract under which the Contractor is an independent contractor;

2. allow the Government to evaluate the quality of professional aspects of the services rendered, (e.9.

professional judgments, diagnosis for specific medical treatment);

3. require the Contractor to indemnify the govemment for any liability-producing act or omission by the

Contractor, its employees and agents occurring during contract performance;

4. require the Contractor to 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 specific specialtY; and

5, require the Contractor to ensure its subcontracts for provisions of health care service, contain the requirements of the clause at FAR 52.237-7 , including the maintenance of medical liability insurance.

1.1 CONTRACTOR RESPONSIBILITY

1.1.1. Provides on-site Pediatrician Physician medical services to beneficiary patients that present for care to the

Cheyenne River IHS Outpatient Department (OPD). The Outpatient Department sees approximately 1500 patient visits per month ranging in age from newborn to geriatric. Due to the volume of patients, the irediatric physician must biab-le to provide high quality, effective and efficient care to patients. Provider shall see uP to 18 Patients Per daY'

1.1.2. The incumbent must possess specialized knowledge of the concepts, principles and practices of Pediatrics, as demonstrateO Oy .r..6.ful completion of a Pediatric Residency accredited by the American Board of

Medical Specialties and be cunently Board Certified/Board Eligible by the American Board of Pediatrics.

1.1,3. The pediatrician physician's actual clinical duties will be in accordance with his/her credentialed privileges.

1.1.4. The pediatrician physician shall practice within the Medical Staff Bylaws of the Cheyenne River lndian

Health Service.

1.1 .5. primary duty will be to provide outpatient care to pediatric patients in the OPD. Examines and diagnoses the health related conditions of individuals requesting care, refers individuals for consultation when appropriate, prescribes and carries out, or directs othens in carrying out, appropriate therapy in conformance witn approve'O Clinical Privileges. Educates individuals in the nature of health related conditions, recommended therapy and in the general promotion of health and prevention of disease. Documents consultations in the patient's health care record.

1.1.6. lmplements, evaluates and is consulted on pediatric Outpatient procedures and instructions in accordance to their clinical Privileges.

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

1.1.8. Demonstrates competent and effective oral and written communication.

1.1.9. Utilizes RPMS/EHR computer software/program for entering and signing of medical orders such as laboratory studies, and directly signing and dating radiological studies, etc.

1.1.10. Obtains necessary information on patients seen in the Outpatient Department, such as medicalrecords, x-ray films and reports, and pathology slides and reports and documents pertinent normal and abnormal test results in the patient's medical record.

1.1.11. Maintains familiarity and complies with hospital antiseptic policies and procedures. Maintain familiarity and comply with all Federal, State, lndian Health Service, CMS regulations, and departmental regulation and requirements.

1.1.12. Ensures a safe work environment and employee safe work habits.

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

1.1.14. pRESCRIPTIONS, The provider shall use and follow the IHS formulary for prescriptions for all patients.

The formulary list is approved and maintained by the Cheyenne River IHS Pharmacy and Therapeutics

Committee. Any drug not listed on the formulary must be approved by the Pharmacy and Therapeutics

Committee.

1.1.15. CONTRACTOR TIMESHEETS. The Pediatrician Physician will be responsible for obtaining Medical

Records (HlM) signature prior to Clinical Director or representative signature for the completion of their timesheet. lnvoices submitted without the signed timesheet including Medical Records (HlM) and Clinical

Directo/s signatures will not be paid.

1.2 PROCEDURE GUIDANCE. Contractor providers shall perform procedures compatible with the medicalfacility's operating capacity and equipment. New medical procedures/services shall not be introduced without prior recommendation to, and approval of the Clinical Director or authorized representative.

1.3 pRlVACy 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 lnformation 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 AFl41-210, "Patient Administration

Functions" panagraph 2.2.3, "Health lnsurance Portability and Accountability Act (HIPAA)'and paragraph 2.3, "General Guidelines on Releasing Medical lnformation".

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

1.4.1 ENGLISH LANGUAGE REQUIREMENT. The Contractor provide(s) shall read, understand, speak and write English fluently.

1.5 DOCUMENTATIONS. Contractor perconnel shall prepare all documentation to meet or exceed established

CMS standards and Cheyenne River IHS Medical Staff Bylaws.

1.6 AVAILABILITY:

1.6.1 HOURS OF QPEMTION: Contractor coverage will be for the Outpatient Department (8 hour shifts, Monday through Friday, 0800 - 1700 occasionally additional hours may be required. Work hours will be scheduted by the Clinical Director to conespond to the needs of the facility and are subiect to change. fhe Pediatrician Physician shall anive for each scheduled shift in a well-rested condition and shall have had at least six hours' rest from all other duties. Providens will be expected to attend the Moming Purchased

Refened Care Meeting.

1.6.2 CONTINUITY 0F SERVICES/REPLACEMENT STAFF. The Contractor point of contact shall ensure qualified personnel are available to provide coverage at all times even during scheduled absences of contract providers.

1.6.3 The Pediatrician Physician services are considered vital to the Government and must be continued with the minimal intenuption. ln order to minimize interrupted services, the incumbent contractor shall exercise its best efforts and cooperation to effect an orderly and efficient transition to a successor.

1.6.4 PERFORMANCE OF SERVICES DURING CRISIS DECLARED BY THE NATIONAL COMMAND

AUTHORIry. 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.

1.7 ORIENTATION. The Contractor shall ensure that all new contract providens participate in the Cheyenne River

IHS 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.

1.8 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. ln 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 providers and charge ticket completed at the end of the visit. All Medical

Records are to be completed within 24 hours of the provide/s scheduled shift. All documentation shall meet the current CMS guidelines.

1.7 .1.2Final payment will be withheld until all medical records are completed by the contract provider.

1.9 PERSONNEL REQUIREMENTS

1.9.1 CONTTNUTNG MEDTCAL EDUCATTON (CME)/ CERTIFtED EDUCATION UNITS (CEU) REOUIREMENTS.

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 cunent. CME hours shall be reported to the credentials office for tracking by the Clinical Director.

1.g.2 LICENSURE/REGISTRATION. Non-pensonal services contract personnel providing care at the Cheyenne

River IHS facility must maintain a current active and unrestricted license in at least one of the 50 United States or US territoiles.

1.9.3 CERTIFICATION. Board Certification or Board Eligible required.

1.9.4 FORMAL EDUCATION, Must possess either a Doctor of Medicine or Doctor of Osteopathy degree from an accredited medical or osteopathic school and passed all requirements to obtain a valid unrestricted medical license from either one of the 50 states of the United States, District of Columbia, or Commonwealth of Puerto Rico.

1 .9.5 EXPERIENCE. The Provider must have a minimum of 3 years of experience as a Pediatrician within the past

36 months prior to provider beginning performance at Cheyenne River lHS.

1,9.6 Maintain certification in Basic Life Support (BLS) and Pediatric Advanced Life Support (PALS).

1.9.7 LIABILITY INSURANCE. The Contractor shall maintain current 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.

1.9.8 Computer efiiciency required. Preferred Electronic Health Record experience.

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

Govemment 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.

PEDIATRICIAN PHYSICIAN

Performance TasURequirement lndicator Standard/(AQL) Acceptable Quality

Level

Surveillance (QA)

Quality Assurance lncentive

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 For every shift not covered by Agency, the shift rate will be deducted from next submitted invoice

Credentialing Agency is allowed 5 business to submit required credentialing documentation

100% Credential Report 5% deduction from weekly invoice.

Deductions will increase by 1% in subsequent months.

2.1 Performance Evaluation. lf the contractor fails to perform required services at the acceptable quality level, payment may be withheld until the contractor makes corrections. ln the event that the contractor fails to perform any iequired 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 contracto/s response to the CDR for tasks surveilled, the contracto/s payment for the month in which the performance is question occurred will be calculated as outlined above.

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

Contractinq Officer's Representative Desiqnation The Contracting Officer Representative (COR) designated for this Project is:

Stephanie Red Elk Charger, COR

Cheyenne River Health Center 24276 166!f' Street, Airport Road

's$fitfH?^:i,':f Far 605-964-7737

The COR is responsible for:

a. Monitoring the Contracto/s technical progress,

b. lnterpreting 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.

2.3 Compensation. The contractor shall be paid a fixed flat rate of per hour. No differential pay for govemment holidays, compensation time, and night differential. Overtime is defined as any hours worked beyond any 40-hour time period.

2.4 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 contracto/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.

3. GOVERNMENT FURNISHED PROPERTY AND SERVICES.

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

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

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

3.3 IDENTIFICAITON CREDENTIALS. The Cheyenne River IHS will provide each contract provider with the required identifi cation card,

3.4 FORMS. The Cheyenne River IHS will provide required Govemment forms used in the performance of services.

3.S SUPPLIES. The Cheyenne River IHS 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.

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

Govemment Housinq: Lodging is available in govemment housing at prevailing rates, if available, and must be paid by the contractor. There are limited furnished units available for contnact 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). There are unfurnished units available at regular employee rates.

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

3.7 SERVICES.

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

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

3.7.3 Cheyenne River IHS will provide all other ancillary personnel services required, including pensonnel to move patients or equipment.

3.8 CONTRACTOR FURNISHED ITEMS AND SERVICES

3.8.1 GENERAL. Except forthose items or services specifically stated in Section lll to be Govemment fumished, the

Contractor shall fumish everything required to perform this contract in accordance with all of its terms.

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

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

4. GENERAL INFORMATION

4.1 PERSONNEL.

4.1 .1 PQINT 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

Offlcer before the contract start date. An altemate may be designated, but the Contract shall identify those times when the altemate shall be the primary point of contact.

4.1.2 CRIMINAL BACKGROUND CHECK REQUIREMENT/CHILD CARE NATIONAL AGENCY CHECK WITH

INQUIRIES (CNACI). The Government will conduct at govemment expense, a CNACI and state criminal history checks on individuals providing direct, unsupervised child care services under this contract. As a minimum, the

Contractor shall contact the Cheyenne River IHS Contnacting 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 twenty (20) working 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 Govemment no later than five (5) working days from the employee's first duty day. Contnactor shall provide a list of substitute contract personnel fulfilling contingency situations (i.e. absences of certificated contact personnel). Names of subslitutes and credenlials snitt Oe provided 30 calendar days in advance to accomplish background checks. Contractor personnel receiving unfavorable CNACIs shall not be employed, IHS may employ an individual pending completion of successful background checks.

4.1.2.1Background checks will be based on fingerprints of individual obtained by a Govemment law enforcement officer and inquiries conducted through the Federal Bureau of lnvestigation (FBl) and state criminal history repositories.

4.l.z.2lndividuals 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.

4.1.2.3lndividuals who have previously received a background check shall provide proof of the check to the Clinical

Director or obtain a new one.

4.1.2.4 CONFLICT OF INTEREST. The Contractor shall not employ any person who is an employee of the United

States Govemment if the employment of that person would create a conflict of interest. The Contractor shall not employ any percon 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.

4.1.2.5 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.

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

4.1.2.7 PROTECTIVE CLOTHING, When required and supplied bythe Govemment, the providershallwearspecial 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 lnfection Control Policy.

4.2 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 Medical Staff sufficient to allow for performance of al tasks identified. Medical Services cannot be performed by a contract Pediatrician

Physician until professional staff membership and the Great Plains lndian Health Service Goveming Body has granted clinical privileges in writing.

4.2.1 lnitial 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 IHS 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, Documentation of continuing education and training.

c. Cunent Basic Life Support (BLS) and Pediatric Advanced Life Support (PALS). (Submission required with proposal).

d. A signed consent for release of information.

e. Cunent copy of Drug Enforcement Agency (DEA) Certificate.

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

g. A cunent copy of the proposed contract providers 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.

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

4.2.3 Professional staff appointments and clinical privileges actions will be based on review of documents listed in paragraph 4.2.1 above. Re-appointment shall occur no less than every two years, in accordance with Cheyenne

River IHS Medical Bylaws.

4.2.4 DENALfl'ERMINATION 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.

4.2,5 REVIEW OF CREDENTIALS PACKAGES. The Govemment reserves the right to limit the number of credentialing packages it will evaluate,

4.3 HEALTH REQUIREMENTS

4.3.1 The contract provider shall provide proof of cunent immunizations (Hep B, MMR, Varicella, Tdap, Flu) status and a current TST within the…