CRHC21-55.pdf

REQUEST FOR QUOTATIONS

(THIS IS NOT AN ORDER)

THIS RFQ IS AN IEE SMALL BUSINESS SET-ASIDE

PAGE OF PAGES

1. REQUEST NO.

CRHC-21-55

2. DATE ISSUED

8/18/2021

3. REQUISITION/PURCHASE REQUEST NO.

IHS1436190

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)

10/31/2022

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)

September 1, 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) Hospitalist to perform services at the Cheyenne River Health Center, Eagle

Butte, SD. Period of Performance:

11/1/2021 – 10/31/2022. The quoted “unit price” shall be an all-inclusive price.

See attached Performance Work

Statement.

Hospitalist Services

Regular Hours 1,008 hrs $________ = $_________

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):

QUOTE DUE DATE:

RETURN RFQ TO:

CRHC21-55

Quotes are due September 1, 2021 @ 1:00 PM MST

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(1) Hospitalist to perform services at the Cheyenne River Health Center, Eagle Butte, SD. Period of Performance: 11/1/2021 – 10/31/2022.

Contractor shall perform in accordance with the PWS. The quoted “unit price” shall be an all-inclusive price.

This RFQ is issued as a 100% IEE Set Aside and the associated NAICS code is 621111 with a small business size standard of $12.0 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:

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 Hospitalist 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.

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 with the System for Award Management. The website to register is at:

www.sam.gov

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 – Request for Quotation (Signature required)

2. Complete the Buy Indian Certification

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

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

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

6. Candidate Licenses (active and inactive) http://www.sam.gov/

ATTACHMENTS:

1. SF-18 Request for Quotations

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 August 30, 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 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.

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

PERFORMANCE WORK STATEMENT

Cheyenne River Health Center (CRHC)

Hospitalist

General

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

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

Background

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

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

Our facility, the Cheyenne River Health Center (CRHC), falls under the GPAO. Cheyenne River Health Center (CRHC) provides medical care for approximately 9,000 tribal members living on the CRST Reservation. Serving a rural area, many of our patients travel 100 miles’ round trip to receive care. The CRHC was built in 2011 to provide an expanded level of health care services specifically designed to meet the needs of the CRHC population. Services include: Emergency Room Department, Pharmacy, Physical Therapy, Public Health Nursing, Radiology Services, Inpatient Care, Laboratory, MRI, Dental, Community Health, Contract Health Services, Dietitians, Audiology, Eye Care, Inpatient, Pain Management, and Specialist Clinics: OB/GYN, ENT, Audiology & 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 ensure uninterrupted Inpatient Physician Hospitalist services, on an as needed basis, for the delivery of patient care in the Inpatient Department at the Cheyenne River Health Center. The hospitalist is to provide coverage for current IHS Hospitalist staff needs regarding annual leave, sick leave, needs for staff augmentation, or any other unforeseen emergencies. The Hospitalist shall also have previous experience with care related to COVID-19.

Period of Performance

November 1, 2021 – October 31, 2022

Work Schedule

The Hospitalist will work 12 hour shifts, as needed, either 0800-2000, or 2000-0800. Hospitalist Physician shall be subject to call back. To ensure quality care, the scheduled tour of an individual hospitalist will be no longer than 7 days, and maybe less, dependent on the staffing needs of CRHC. The Contractor is expected to be able to provide 2 hospitalists, if needed, for continuous 24 hour coverage.

CRHC21-55

Hospitalist Services

Place of Performance Cheyenne River Health Center Inpatient Department 24276 166th Street Airport Road Eagle Butte, South Dakota 57625

DESCRIPTION OF SERVICES: The contractor shall provide Hospitalist 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.

Contract physician care shall cover the range of medicine typically provided in a rural civilian practice of similar size.

The Contractor shall provide physicians to perform the necessary medical procedures and care for patients in the Inpatient Department. Hospitalist experience within the past 5 years. The hospitalist shall also have previous experience with care related to COVID-19.

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

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

CONTRACTOR RESPONSIBILITY

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.

Treatment Protocol development. Assist in development of treatment order sets and protocols that may be included in EHR in collaboration with CAC, Medical Staff, Pharmacy, and Nursing.

The Physicians actual clinical duties will be in accordance with his/her credentialed privileges.

Primary duty will be to provide care to Inpatient Department. Performs triage, assesses, and re-assesses patients throughout the patient visits. Ensures documentation of medical assessments and observations are documented accurately in the patient’s health care record. Documents consultations in the patient’s health care record.

Procedures for transfer of patients requiring transfer to facilities where a higher level of care must follow the “Emergency Medical Treatment and Labor Act” (EMTALA) guidelines. Obtains necessary information on patients seen in the Inpatient Department, such as medical records, x-ray films and reports, and pathology slides and reports and documents pertinent normal and abnormal test results in the patient’s medical record.

Implements, evaluates and is consulted on Inpatient procedures and instructions.

CRHC21-55

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), Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS).

REFERRALS AND CONSUSLTS. The provider shall follow IHS Purchased Referred Care regulations and policies when arranging for a referral or consult. The 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 referral or consult by indicating the specialty involved.

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

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

PROCEDURE GUIDANCE. Contractor providers 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 providers 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 Contractor provider(s) shall read, understand, speak and write English fluently.

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

AVAILABILITY:

HOURS OF OPERATION: Contractor coverage will be for the Inpatient Department with the ability to provide personnel to meet the requirements of continuous 12 hour shifts if needed. No individual physician will work more than a 12 hour shift per day, and no more than 7 continuous days. Shifts will be from 0800-2000 and 2000-0800.

The intent is to provide coverage for present IHS hospitalist’s needs regarding annual leave, sick leave, needs for staff augmentation, or any other unforeseen emergencies. Work hours will be scheduled by the CD or to correspond to the needs of CRHC and are subject to change. The hospitalist shall arrive for each scheduled shift in a well-rested condition and shall have had a least six hours of rest from all other duties. Physicians will be expected to attend all patient care related meetings as directed by the CD.

CONTINUITY OF 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.

CRHC21-55

The Hospitalist services are considered vital to the Government and must be continued with the minimal interruption.

In 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.

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 providers and charge ticket completed at the end of the visit. All Medical Records are to be completed within 24 hours of the provider’s scheduled shift. All documentation shall meet the current CMS guidelines.

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

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 Physician must have a Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) degree from an accredited college or university in the specialty area required to complete the FTE.

EXPERIENCE. The Physician must have a minimum of 3 years of experience in field of primary care, preferably residency trained in Family Practice or Internal Medicine to include residency and/or fellowship and show evidence of experience employed as a hospitalist during this time, prior to beginning performance at Cheyenne River Health Center.

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

Performance Standards

Performance Task/Requirement

Indicator Standard/(AQL) Acceptable Quality

Level

Surveillance (QA) Quality Assurance

Incentive

Completion of documentation of patient record

All patient records must be documented

100% Random observation and HIM Report

5% deduction from weekly invoice.

CRHC21-55

accurately, correctly, and completely within 24 hours of patient visit

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 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.

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:

Stephanie Red Elk Charger

COR

Cheyenne River Health Center 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

CRHC21-55

standards. The intent is to ensure that the Contractor performs services for the Cheyenne River Health Center that are provided in accordance with performance requirements set forth in the contract documents, that the government receives the quality of services called for in the contract and that the government only pays for the acceptable level of services received.

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

GOVERNMENT FURNISHED PROPERTY AND SERVICES.

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

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

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

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

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

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

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

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

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

SERVICES

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

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

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

Cheyenne River Health Center will provide all other ancillary personnel services required, including personnel to move patients or equipment.

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.

CRHC21-55

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

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

GENERAL INFORMATION

PERSONNEL.

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

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

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

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

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

Individuals who have previously received a background check shall provide proof of the check to the CEO or obtain a new one.

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.

CRHC21-55

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 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. Documentation of continuing education and training.

c. Current Basic Life Support (BLS), Advances Cardiac Life Support (ACLS), and Pediatric Advanced Life

Support (PALS). (Submission required with proposal).

d. A signed consent for release of information.

e. Current 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 current 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.

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

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

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

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

HEALTH REQUIREMENTS

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

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

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

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

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

CRHC21-55

PERFORMACE EVALUATION

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

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

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

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

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

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

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

CRHC21-55

CLAUSES INCORPORATED BY REFERENCE

(Firm Fixed-Price Service-Commercial Items)

FAR CITATION: 52.252-1: Solicitation Provision Incorporated by Reference. (FEB 1998)

This solicitation incorporates one or more solicitation provisions by reference, with the same force and defect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. The offeror is cautioned that the listed provisions may include blocks that must be completed by the offeror and submitted with its quotation or offer. In lieu of submitting the full text of those provisions, the offeror may identify the provision by paragraph identifier and provide the appropriate information with its quotation or offer.