RFQ-Audiology.pdf

REQUEST FOR QUOTATIONS

(THIS IS NOT AN ORDER)

THIS RFQ IS A SMALL BUSINESS SET.ASIDE

PAGE OF PAGES

1of2

I REQUEST NO

cRSU-18-36

2 DATE ISSUED

o8t17t2018

3 REQUISITION/PURCHASE RI]QUEST NO

tHs

4, CERT FOR NAT DEF

UNDER BDSA REG.2

AND/ORDMS REC I

RATING

5A ISSUED BY

Eagle Butte Indian Health Service, Cheyenne River Service Unit 24276 16€tn St, PO Box 1012,Eagle Butte, SD 57625

6 DELMR BY (Date)

5b FOR INFORMATION CALL (NO COLLECTCALLS) 7 DELIVERY OTHER

! roe oesrnnrrcN fr6"e scn"o,,"l

NAML

Stephanie Charger stephanie.redelk@ihs.sov

,EPHONE NUMBER 9 DESTINATION

AREA CODE

NUMBER

964-0507 a NAME OF CONSICNEE

Cheyenne River Service Unit 8 TO: b. STREET ADDRESS

24276 166th St , PO Box 1012 a NAME b COMPANY c CITY

Eagle Buftec STREE I ADDRESS

d. CI TY e STATE I. ZIP CODE d. STATE

SD

e. ZIP CODE

57625

IU PLLASL }URNISH QUOTATIONS TO

TI{E ISSUINC OFFICE IN BT,OCK

5a ON OR BY l2:00 PM MST ON

August 31, 2018

IMPORTANT This is a request for information, and quotations so indicate on is forn and retum it to the address in Block 5a.

for supplies or servic€s. Supplies are of cenifications attached to this Request for

I l. SC HEDULE (Include aDqlicable Federul. Stote and locat toxps) ll'lrM NO.

(4, SUPPLIES/SERVICES

(b)

QUANTITY

(c)

L'NIT

(d)

IJNIT PRICE

(e)

AMOUNT

(f) Firm Fixed Price, Non Personal.

Perlormance Based, Healthcare Service confact for Audiology Services, I - 2 Clinics per month.6-8 hours per Clinic, at the Cheyenne River Health Center, located in Eagle Butte, South Dakota. The Period of Performance will a base year +4 option years, with an estimated start date of September 23, 201 8. Contractor shall perform in accordance with the pWS. Th€ quoted "unit price" shall be an all inclusive price, UIJUUUI\ I I!,K TKUMTI

PAYMENT

A, JO LALENDAR DAYS

b 20 CALENDAR DAYS c 30 CALENDAR DAYS vo d CALENDAR DAYS

NUMBER I PERCENTACE

r\u I E Aootrronat provtstons and representallons are are not attached 13 NAME AND ADDRESS OF OUOTEN- l5 StcNATURE oF pERsoN AUTHoRIZED T-

SICN QUOTATION

5 DATE OF

QUOTATION

a NAME OF QUOTER b STREET ADDRESS

C L(]UN I Y

a NAME (Type o/p nt) b, TELEPHONE

AREA CODE

d LI IY e STATE I] ZIP CODE c 'tlTLE (lype or priht) NUMBER

IUK LULAL STANDARD FORM I8 (REV 6-95) PreviousInc cdition not usable Prescflbed by CSA-FAR {48 CFR) 5l-2 | 5-l(a)

ITEM

NO.

(a)

SUPPLIES/SERVICES

(b)

QUANTITY

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOI.]NT

(0 l.

3.

4.

Base Year: 9123/2018 - 9122/2019 Audiology Services, l-2 days a month, 6-8 hour clinics.

Option Year One( 1):912312019 - 9/2212020 Audiology Services, l-2 days a month, 6-8 hour clinics.

Option Year Two(2):912312020 - 9l22ll02l Audiology Services, l-2 days a month, 6-8 hour clinics.

Option Year Three(3): 91231202'l - 912212022 Audiology Services, l-2 days a month, 6-E hour clinics.

Option Year Four(4): 9/2312022 - 9/2212023 Audiology Services, 1-2 days a month, 6-8 hour clinics.

DUNS & Bradstreet Number:

(The Duns & Bradstreet number is required.

Provided you do not have it, you may call 866-705- 571 I and obtain one.) You will need a DUNS & Brudsfieet NaMBER to be qwqlded the purchase t92

Hrs

Hrs

Hrs

Hrs

Hrs

Aggregated Total:

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 gqy to register and you are required to update this registration every year prior to the expiration date.

Federal Tax ID Number:

Email Address:

Net Terms:

NOTTCE TO QUOTERS

REOUEST FOR OUOTES RFO): CRSU-18-36

OUOTE DUE DATE: Quotes are due August 31, 2018 @ 12t00 PM MST

RETURN RFO TO: Cheyenne River Service Unit Attn: Stephanie Charger PO Box 1012 Eagle Butte, SD 57625 Telephone: 605-964-7724 Ext. 0507 Fax: 605-964-1140

GENERAL DESCRIPTION:

Firm Fixed Price, Non Personal, Performance Based Healthcare Service contract for Audiology Services, I 2 Clinics a month, 6-8 hours per Clinic, at the Cheyenne River Health Center, located in Eagle Butte, South Dakota. The Period of Performance will a base year +4 option years, with an estimated start date of September 23,2018. Contractor shall perform in accordance with the PWS. The quoted "unit price" shall be an all inclusive price.

BASIS FOR AWARD:

Quoters are advised that, in addition to price, the Govemment will consider the following factors in determining the successful contractor.

1. Ability to meet performance schedule/specifications.

2. Reasonableness of price.

3. Responsiveness to requirement.

4. Contractor must be registered with the System for Award Management. The website to register at is:

www.sam.gov

Thc Govemment reserves the rieht to make award on othcr than the low estimated o r based on technical qualilications.

INSTRUCTION TO OUOTERS:

To be considered an acceptable quote, the following items 49! be completed and retumed by the due date stated above.

1. Complete and sign SF-18 - Request for Quotation (Signature required)

2. Complete Taxpayer Identification Form (FAR Part 52.204-3 - Taxpayer Identification) part of SFl8

3. Complete Annual Representations & Certifications form or if in Sam state on Quote.

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

5. Candidate License (active and inactive)

ATTACHMENTS:

1. SF-l8 Request for Quotations

2. Performance Work Statement

3. Clauses incorporated by reference

4. Clauses incorporated in full text

5. Business Agreement

6. Ethics

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 (l.H.S.). Before starting work requiring routine access to l.H.S. facilities or systems each person must complete a FBI National Criminal History Check (Fingerprint Check) ad,udicated by an LH.S. employee using the Otfice of Personnel Management Personnel Investigations Processing System. Contractors shall allow five business days for LH.S. processing of fingerprints taken electronically at an l.H.S. site and thirty business days for non-electronic processing of fingerprints using FBI Form FD-258, Alistof LH.S. sites with electronic fingerprint capability is available from the Contracting Otficer.

Quotation must set forth full, accurate, and complete information as required by this Request for Quotation (RFQ), and be retumed no later than the date referenced in Block #10 ofthe Request for Quotation form SF-18.

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

PERFORMANCE WORK STATEMENT

Cheyenne River Health Center (CRHC)

Audiologist

General

This performance based wo* statement describes the requirements for non-peFonal seruices forAudiology to support the mission ofthe Indian Health Service (lHS)/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, Backqround

The Indian Health Service (lHS) an agency within the Department of Health & Human Services is responsible for providing federal health services to American lndians and Alaska Natives. The Indian Health Service orovides a comprehensive health service delivery system for approximately 1.9 million American Indians and Alaska Natjves who belong to 567 federally recognized tribes, in 35 states. The Indian Health Service Headquartem is located in Rockville, MD and then divided into twelve physical areas: Alaska, Albuquerque, Bemidji, Billings, Califomia, 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 Tdbal Managed Service Unib to provide health care to approximately 122,000 Native American located in North Dakota, South Dakota, Nebraska, and lowa. The Area Office's service units include seven hospitals, eight health centers, and several smaller health stations and satellite ciinics.

Orr facility, the Cheyenne River Health Center (CRHC), falls under the GPAO. Cheyenne River Health Center (CRHC) provides medical cate for approximately 9,000 tibal members living on the CRST Reservation. Servrng a rural area, many ofour patients tnvel 100 miles'mund trip to receive care. The CRHC was built in 2011 to orovide 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, MRl, Dental, Community Health, Contract Health Services, Dietitians, Audioiogy, Eye care, lnpatient, Pain Management, and specialjst clinics; oB/GyN, ENT, podiatry & Neuosurgery, The Cheyenne River Sioux Tribe through a 638 contract with lHS, operates four satellite health stations which offer basic ambulatorv services at Cherry Creek, Red Scaffold, Swiftbird, and Whitehorse mmmunities.

Obiective

To provide Audiology services 1-2 days per month as needed in support of the monthly ENT clinics during the term of the contract.

Period of Performance

September 23, 2018 through September 22, 2023. Base year, to include 4 optron years.

Base Year: September 23, 2018 through September 22,20j9 Option Year One: September 23, 20,|9 through September 22,2020 Option Year Two: September 23, 2020 through September 22,2021 Option Year Three: September 23, 2021 through September 22, 2022 Option Year Four: September 23, 2022 through September 22,2023

Work Schedule

Provide 1-2 days per month (6-8 hours per day) as needed Audiology consultation every month, scheduling of which will be agreed to by the contract ENT Physician, contract Audiologist, and Clinical Director.

Place of Performance

Cheyenne River Health Center Audiology Department

24276 '166'h Street AirDort Road Eagle Butte, South Dakota 57625

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

This contract is a non-personal health care services contract, as defined at Far Part 37,101 underwhich the Contractor is an independent contractor and which shall allow the Govemment to evaluate the quality of professional and administrative services povided, but rekins no control over the medical, professional aspects of the services rendered, (e.9., professional judgements, diagnosis for specific medical treatrnent). The Contractor shall indemnify the Govemment for any liability producing act or omission by the contractor, its employees and agents occumng during contract performance, The Contractor shall maintain medical liabilig insurance, in the coverage amount acceptable to the Contracting officer, which is not less than the amount normally prevailing within the local communjty for the medical specialty concerned.

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

The standards of medical practice and duties of the Contractor through its physicians shall be determined pursuant to Governrng Body bylaws, medial staff bylaws, rules and regulations of the appiopriated IHS hospital, applicabp provisions of law including but not limited to rules and regulations of any and all govemmental authoriiies relating to licensure and regulation of physicians and hospitals, and standards and recommlndations of CMS (Centers for Medicare a . The Contract Audiologist shall be required to participate in a qualityimproveme h cunent requirements for ongoing monitoring and evaluation of the quality and

CONTMCTOR RESPONSIBILIW

Provide audiological services at the Cheyenne River Service Unit for the purpose of testing hearing screening failures p€rform hearing aid evaluations and fiftings on appropriate candidates, and hearing rehabiiitation ind follow up.

Perform otoscopic examination of all patients.

Perform routine tympanometric and reflex testing as pan of audiological work up of all patients being evaluated for hearing loss except when medically contraindicated (chronic suppuiative otitis media,eic.).

Perform routine pure tone and bone conduction testing as part of audiological work up of new patients and dunng pre and post-operative hearing assessment.

Perform routrne speech reception (SRT) and speech discrimination testjng of all patients as part of initial audiotogical woft up and during pre and posl-operative hearing assessment, Performs special audiological tests (Stenger, Tone Decay, SlSlS, and ABLB) as indicated by routine audiologrcar testing or when requested by the ENT physician.

ldentifies and refers patients with conductive hearing loss or other medically treatable abnomalities of the ear.

Provides counseling, earplugs and annual follo$/ up of children and adulb showing indications of noise induced hearing loss as part of hearing conservation program.

Takes ear mold impressions and oders custom earplugs for dry ear care for patients with susceptibility to draining ears on the recommendation of ENT Physician.

Provides counseling for patienb regarding potential amplification options and aids patients in selectjon of appropriate ear, type, and make/model of hearing aids.

Provides evaluation of hearing aid performance using any combination of real ear measurement, functional gain, speech discrimination, and sound field tests as circumstances and equipment availability dictate.

The Audiologist will follow established procedure for odering hearing aids and repairing hearing aids. All policies and procedures are clearly defined in each service unit.

The Audiologist shall locate, credential, and have available sufficient stafting to provide professional audiology services 0n a regular schedule to the Cheyenne Rjver Heallh Center. Will also provide credentialing information of nursing staff that he provides to assist them.

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. Prefened S years of Electronic Health Record exoerience.

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

The Audiologist must abide by the Cheyenne River Healtir Center Bylaws, Rules, and Regulations and Clinical Duties.

REFERMLS AND CONSUSLTS. The Audiologist shall follow IHS Purchased Refened Care regutations and policies when_ ananging for a referral or consult. The Audiologist shall be required to consult wifli other specialty practitione$ for consultative opinions and continuation of care, The Audiologist shall inform patienb of the required refenal or consult by indicating the specialty involved.

CONTMCTOR TIMESHEETS. The Audiologist will be responsible for obtaining Medicat Records (HtM) signarure priorto Clinical Dileclor or representatlve signature for the completion of their tiriesheet. Invoices iubmitteo without the signed timesheet including Medical Remrds (HlM) and Clinical Director signatures will not be paid.

PROCEDURE GUIDANCE. Conhactor Audiologists shall perform procedures compatible with the medical facility's operating capacity and equipment.

Y IDENTIFABLE HEALTH INFORMATION. The Contract health care providens shall ost care and attention. All patients shall be assured of their privacy and personar ensure strict compliance to the release of Protected Health Information in accoruance with th^e_Code of Fedenl Regulation, Tifle 45, public Welfare, of Health and Human Servjces, Part 164, secudty and Privacy (45 cFR 164) and AFI 4'l-210, runctions" paralr,aftr z.z.a, 'Health Insrrance Portability and Accountability Act (HlpAA)' neral Guideiines-on Releasing Medical Information".

COMMUNICATIONS. The Contractor shall ensure contract Audiologisb maintain open and professional communication with membeB of the j\4edical Stafi. Complaints validited by the Hospital Accreditation Specialist and Clinical Director or shall be reported in writing to the Contnr ing Officer (CO) and the Contnactot toi ..tion

ENGLISH LANGUAGE REOUIREMENT. The Contractor Audiologist shall read, understand, speak and write Engtish fluentlv.

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

AVAILABILIW:

HOURS OF OPEMTIoN: 1-2 days per month (6-8 hours per day).

CONTINUITY OF SERVICES/REPLACEMENT STAFF. The Contractor point of contact shall ensure qualifed p€rsonnel are available to provide coverage at all times.

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

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 infrequenfly as possible. In the event of a maior disaster or code all verbal orders are to be signed off immediately following he-mde or disaster. All Medical Records must be signed by the Audiologist and charge ticket completed at the end of the visit. All Medical Records are t0 be completed within 24 hours of the Audiologists scheduled shift. All documentation shall meet the curent CMS guidelines.

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

PERSONNEL REQUIREMENTS

coNTTNUtNG MEDTCAL EDUCAT|0N (CME) / CERT|FIED EDUCATTON UNTTS (CEU) RE Maintain cME and review pertinent joumals, books and publications. Health care providers rtified by the national/medical associations shall contrnue to meet the mrnimum standards for cME to cME hours shall be reported to the credentials office for tracking by the Clinical Director.

LICENSURE/REGlSTMT|ON Conlractor must maintain a curent active and unrestricted license in at least one of the 50 United States or US tenitories.

CERTIFICATION, Board certifed in feld of specialty is favorabte.

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

EXPERIENCE. The Audiologist must have a minimum of 3 yeam of experience within Audiology to include fellow and residency time within the past 36 months prior to Audiologist beginning performance at Chiyenne niver neam Center.

PERFoRMANCE-BASED SERVICE DELIVERY SUMMARY. The contracto/s performance will be measureo besed on the following Performance Requiremenls. The Performance Requirembnts will ue measureJ aginst Govemment Performance Standards and monitored in accordance with the following rr,rettroas oieovemirent Surveillance o s plan yo deductron will h met.

individual invo o coot one by the category that was deficient.

Performance Standards

Performance TasUReouirement

Indicator Standardl(AQL) Acceptable Quality

Level

Surveillance (QA)

Quality Assurance lncentive

Completion of documentation of patient rccord

All patient records must be documented accuraety, corectly, and completely within 24 hours of patient visit

100% Random observation and HIM Report

5olo deduction from weekly Inv0rce.

Deductions will increase by 1% in subsEuent months.

Prompt and continuous coverage

Agency must provroe a competent Mid- Level to ensure n0 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 lnv0rce.

Deductions will increase by 1olo in suDsequent months.

Performance Evaluation. lf the contractor fai may be withheld until the contractor makes c services, the COR will plovide wriften notice Contracting Oflice will issue the contractor a repancy Report (CDR). The contractor shall have seven

(7) calendar days to provide the Contracting Office with theirresponse to the CDR. Upon evaluation of the contractofs response to the CDR for tasks surveilled, the contractois payment for the month in which the performance is question occuned will be calculated as ouflined above.

Contractor Payment lf the contractor fails to perform required services at the acceptable quality level, payment may be withheld until contractor makes corrections, Contractino Officer's Representative Desiqnation

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

Cheyenne River Health Center COR: Robert Carison, OD

24276 166th Street, AirDort Road Eagle Butte, SD 57625 Office: 605-964-7724 Fax: 605-964-0522

The COR is responsible for:

Monitoring the Contractot s technicaj progress;

lnterpreting the statement of work;

Technical evaluation as reouired:

Technical inspections and acceptance required by this contract; and, Assisting the Contractor in the resolution of technical problems encountered dudno performance of this contract.

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The contractor shall be paid a fixed flat rate of per hour. No differentral pay for govemment holidays, compensation tlme, and night differenlal- Holidays and weekends shall be included as part of the work period and considered regurar nours.

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

GOVERNMENT FURNISHED PROPERTY AND SERVICES.

EQUIPMENT. Contract providers shall have joint use of all available equipment for performing services required by thrs contract, PERSONAL PROTECTIVE EQUIPMENT (PPE). The Govemment will fumish 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 mat.

IDENTIFICAITON CREDENTIALS. The Cheyenne River Health Center will provide each contract povider with the required identifi cation card.

FoRMS' The cheyenne River Health center will provide required Govemment 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 patienb and the performance of the requirements of this contract.

HouslNG. contnctor shall be responsible for all applicable Federal, state, and Local raxes, Meals, Travel/Transportation, lodging, and per diem.

GoyernrnenlHousino: 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 contnait employees and prevailing rates tange from Single -$34.72 daily, Shared $16.58 daily and Trailer Pads - 98.00 daity (Rates are subject to change).

Local Hotel: Cheyenne River Motel (605) 964-8ggg.

SERVICES

ORIENTATI0N. The Contractor shall ensure that all new contract providers particlpate in the Cheyenne River Health Center Facility Orientation with an overiap of services to include one additional day, providers must anive on a Monday-Frid-ay excluding holiday and participate in the odentation, which must bi completed in the Monday- Friday timeframe, prior to providing services at the hospital, Adminiskative Support. Cheyenne River Health Centerwill provide normal office administrative support servlces, to include telephone and utilities.

Patient Scheduling. Facility personnei will assist in patient scheduling. Complete administrative control of the patient shall remain with the facilitv, Cheyenne River Health Center will provide all other ancillary personnel services equired, including pemonnel to move patients or equipment.

CONTRACTOR FURNISHED ITEMS AND SERVICES

GENEML. Except for those items or services specifcally shted above to be Govemment fumished, the Contractor shall fumish everything required to perlorm this contract in accordance with all of ib terms.

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

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

PERSONNEL,

int of mntact who shall be responsible for the performance any fore

CRIMINAL BACKGR0UND rNVESTrcATroN, The Govemment wiil conduct at govemment expense, a stare pervised child care services undel this contract. As a

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

Individuals shall have the right to obtain a copy of any background check pertaining to themselves and to chalenge the accuracy and completeness of the informaiion containei in the reoort.

lndividuals who have previously received a background check shall provide proof of the check to the clinical Director or obtain a new one.

CoNFLICT 0F INTEREST. The Contractor shall not emptoy oyee of the United States Govemment if the employment of that person would creaie i ntractor shall not emproy anypenion who js an employee of HHS (Health and Human Serv seeks and receives approval in accordance with the Department of HHS.

APPEAMNCE, Employees are expected_to comply with reasonable dress, grooming and hygiene standards based 0n comfort, prcductivity, health and type of position occupied. Employee attire will Ueingooiiepair, anJihouto 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 Govemment, the provider shall wear specia.

protective clothing and shoe covers. When duties will be performed in specified areas, a disposable protective hood shall be wom to ensure infection control standards are met, The Govemment will provide this hood. These items shall remain the property of the Govemment and shall not be removed from the facility. After use, protective clothing shall be tumed in or destroyed as directed by the Infection Control Policy.

PRIVILEGING REQUIREMENTS. The contnact providers' credentials shall be reviewed by the Credentialing Specialist and the Credentialing Committee. The Contractor is responsible for ensuring that proposed proviaers 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 Audiologist until professional staff membership and the Great Plains Indian Health Service Goveming Body has granted clinical privileges in writing.

Initial appltcations for clinical privileges, lo include credentials action history, malpractice history, and certified rue copies of the documents listed below, shall be submitted to the Cheyenne hiver Health CenteiCredentialing Committee, through the Credentialing Specialist, no later than 3 calendar days after receipt of notice of coniact awar0.

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

Possess a ASHA accredited graduate degree from an accredited American college or univesity.

Documentation of continuing education and training.

Cunent Basic LifeSupport (BLS) or CpR. (Submission required with proposaq.

A signed consent for release of information, A list of all states in which confact Audiologist cunently holds or has held a license to practice related services.

A cuffent copy of the proposed contract Audiologi Certifiration of cufient physical examination, The entsigned bythe examining physician stating that the employee is fne

-ptrysicit examination shall be cunent as of 12 months orior

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Applications for privlleges 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.

DENALTIERMINATION 0F PRIVILEGES. Actions to limit, suspend, or revoke ctinical priviteges wi1 be in Stafi Bylaws. The Clinical Director, will notify the Contracting as soon as possible when the necessig to exercise such ill I otify the Contractor of the initiation of the revocatron

REVIEW oF CREDENTIALS PACKAGES. The Govemment reserves the right to timit the number of credentiating packages it will evaluate.

HEALTH REQUIREMENTS

The contract Audiologist shall provide proof of cufl.ent immunizations (Hep B, MMR, Vadcella, Tdap, Flu) status and a cunent TST within the past year.

EMERGENCY HEALTH CARE. Cheyenne River Health Center will povide emergency health care for the contract Audiologist for injuries incuned while on duty in the facility. These services will be-bitteo to the Contractoriitne cunent full reimbursement rate.

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

The contract Audiologist (s) shall participate in QI/RM activities to the extent required by Section 2C, AFI 44-119 and the individual Cheyenne River Health Center Ql/Rl\/ plan or regulation, The Govemment will evaluate the Audiologist's professional, as differentiated from administratjve, performance under this contract using Quality lmprovement standards specified in paragraphs 2.1 and 2,2. Nothing in this paragraph precludes the Govemment from also conducting inspections under the Inspection/Acceptance requhement oi FAR clause 52.212-4.

PERFORMACE EVALUATION

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

FREEDOM OF INFORMATION ACT (FOIA) PROGRAM. All FOIA rcquest shall be delivered immediatety ro the Medical Records Suoervisor.

PHYSICAL ACCESS The Contractor.shall retum identification badge to the lT Department and house keys to the Housing 0fficer, upon completion/terminatjon of the contract.

Physical Secudty The contractor shall safeguard all government property, including controlled forms provided for contractor use. At the close of each work period, govemment equipment, facilitjes, ind other valuable materiajs shall be secured, weapons, Firearms, And Ammunition. contractor employees are pohibited from possessing weapons, firearms, or ammunitlon, on themselves or within their contractor-owned vehicle or privatelyowned veniie wnite on'tfre

Cheyenne River IHS compound.

Reporting Requirements. Contractor personnel shall report to an appopriate authority any information or circumstances of which they are aware may pose a threat to the security of IHS peoo'nnei .ontraitoi personnel or patients.

The contractor shall prohibit thelr use of keys, issued by the govemment, by any persons other than the contracrors employees and the opening of locked_areas.by- contracior employees to permit entrance of person other than contfactor employees engaged in performed of contract work requirement in those areas, CLAUSES INCORPORATED BY REFERENCE

(Firm Fixed-Price Service-Commercial ltems)

FAR CITATIONI 52.252-lt 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 ofthose provisions, the offeror may identif,, the provision by paragraph identifier and provide the appropriate information with its quotation or offer. Also, the full text ofa solicitation provision may be accessed electronically at this/these address(es):

I. Federal Acouisition Reeulations (FAR) (48 CFR Chapter 1) Clauses

No. FAR Citation Clause Title Clause Date

I.

2.

3.

4.

5.

6.

7.

8.

9.

10.

IL

t2.

t3.

t4.

15.

16.

1',7 .

18.

19.

20.

52.204-i System for Award Management (P)

52.204-9 PersonalldentityVerificationofContractorPersonnel

52.204-13 System for Award Management Maintenance

52.204-16 Commercial and Government Entity Code Reporting

52.204- 18 Commercial and Government Entity Code Maintenance

52.204-21 Basic Safeguarding of Covered Contractor Information Systerns

52.212-l Instructions to Offerors - Commercial ltems

52.212-4 Contract Terms and Conditions - Commercial ltems

52.215-5 FacsimileProposals

52.217 -5 Evaluation of Options

52.222-3 Convict Labor

52.222-26 EqualOpportunity

52.222-41 Service Contract Labor Standards

52.222-43 Fair Labor Standards Act and Service Contract Labor Standards

52.222-44 Fair Labor Standards Act and Service Contract Act-Price Adjustments

52.222-55 Minimum Wage Under Executive Order 13658

52.223-5 PollutionPreventionand Right-To-Knowlnformation

52.223-6 Drug-FreeWorkplace

52.224-l Privacy Act Notification

52.224-2 Privacy Act

Oct 2016

Jan 201 |

OcI2016

Jul 2016

Jul 2016

Jun 20l6

Jan 2017

Ian 2017

Oct 1997

Jul I990

Jun 2003

Sep 2016

May 20t,4

May 2014

May 2014

Dec 201 5

May 201 I

May 2001

Apr 1984

Apr 19E4

Page I of22

21. 52.225-t3

22. 52.232-l

23. 52.232-8

24. 52.232-18

25. 52.232-25

26. 52.232-33

27. 52.232-39

28. 52.232-40

29. 52.233-l

30. 52.233-3

3 1. 52.233-4

32. 52.237-l

33. s2.237-2

34. 52.237-3

35. 52.237-7

36. 52.242-t5

37. 52.243-l

38. s2.244-6

39. 52.246-4

40. 52.249-l

52.249-E

{? rs?-l

41.

Restrictions on Certain Foreign Purchases

Payments

Discounts for Prompt Payment

Availability of Funds

Prompt Payment

Payment by Electronic Funds Transfer - System for Award Mgtm

Unenforceability of Unauthorized Obligations

Providing Accelerated Payments to Small Business Subcontractors

Disputes

Protest After Award

Applicable Law for Breach ofContract Claim

Site Visit (P)

Protection of Govemment Buildings, Equipment and Vegetation

Continuity of Services

Indemnification and Medical Liability lnsurance

Stop-Work Order

Changes-Fixed-Price

Subcontracts for Commercial ltems

Inspection of Services - Fixed-price

Termination for Convenience of the Government (Fixed-Price)(Short Form)

Default (Fixed-Price Supply and Service)

Computer Generated Forms

Jun 2008

Apr 1984

Feb 2002

Apr 1984

Ian2017

Jul 2013

Jun 2013

Dec 2013

May 2014

Aug 1996

Oct 2004

Apr 1984

Apr 1984

Jan 199 |

Jan 1997

Aug 1989

Aug 1987

Jan 201'l

Aug 1996

Apr 1984

Apr 1984

Jan I99l

Federal Acquisition Regurations (FAR) (48 cFR chapter l) crauses in Fu[ Text

52.204-3

52.212-2

Taxpayer Identifi cation (P)

Evaluation-Commercial ltems

3. 52.2t2-3

4. 52.212-5

5. 52.216-t8

6. 52.217-8

7 . 52.217 -9

Offeror Representation and Certifications

- Commercial Items

Contract Terms and Condition Required to Implement Statutes or Executive Orders - Commercial Items

Ordering

Option to Extend Services

Option to Extend the Term ofthe Contract

Jan2017 lan 201'7

Oct 1995

Nov 1999

Mar 2000

52,204-3 Taxpayer Identifi cation

As prescribed in 4.905, insert the following provision:

TAXPAYER IDENTIFICATION (OCT 1998)

(a) Definitions.

"Common parent," as used in this position, means that corporate entity that owns or controls an affiliated group of corporations that files its Federal income tax returns on a consolidated basis, and of which the offeror is a member.

"Taxpayer Identification Number (TIN)," as used in this provision, meaas the number required by the Intemal Revenue )fferor in reporting income tax and other retums. The TIN may be eithe er.(b) All offerors must this provision to comply with debt collection requirements of 3l U.S.C. 77 uirements of 26 U.S.C.

6041'4051A, and 6050M, and implementing regulations issued by the IRS. If the resulting conrract is subject to the pa).rnent reporting requirements described in Federal Acquisition Regulation (FAR) 4.904, the failure or refusal by the offeror to fumish the information may resuli in a 31 peicent reduction of payments otherwise due under the conftact.

(c) The TIN may be used by the Government to colle the offeror's relationship with the Govemment (3 to the payment reponing requirements described i matched with IRS records to verify the accuracy o(d) Taxpayer Identification Number (TIN) n n n n n n tn, TIN has been applied for.

TIN is not required because:

Offeror is a nonresident alien, foreign corporation, or foreign partnership that does not have income effectively connected with the conduct ofa trade or business in the Uniied States and does not have an office or place ofbusiness or a fiscal paying agent in the United States;

Offeror is an agency or instrumentality of a foreign Government;

Offeror is an agency or instrumentality of the Federal Government.

Page 3 of22

(e) Type of organization.

n Sole proprietorship;

n Partnership;

n Corporate entity (not tax-exempt);

n Corporate entity (tax-exempt);

n Government entity (Federal, State, or local);

n Foreign govemment, n Intemational organization per 26 CFR 1.6049-4;

! other

(f) Comrnon parent.

n offeror is not owned or controlled by a common parent as defined in paragraph (a) of this provision.

n Name and TIN of common parent:

Name

TIN

(End ofprovision)

52,212-2 -- Evaluation -- Commercial Iterns.

As prescribed in 12.301(c), the contracting officer may insert a provision substantialy as follows:

Evaluation -- Commercial Items (Oct 2014) is solicitation to the responsible offeror whose offer the Government, price and other factors considered. The meet performance schedule/specifications, price

Technical and past perfonnance,.when combined, are significantly more important than cost or p'ce.

(b) Options. The Covernment will evaluate offers for award price for the basic requirement. The Government mav deter significantly unbalanced. Evalualion ofoprions shall nor ob

(c) A $rinen notice ofaward ot u...ptuni. ofan offer, mai time for acceptance specified in the offer, shall result in a binding contract without further action by either party. Before the offer's specified expiration time, the Government muy u.""piun offer (or part ofan offer), whetirer or not there are negotiations after its receipt, unless a wriften notice of withdrawal is received iefore award.

(End of Provision)

52.212-3 -- offeror Repres€ntations and certifications -- commerciar Items, As prescribed in 12.301(b)(2), insert the following provision:

offeror Representations and Certifications -- Commerciar Items (Jan 2017) The offeror shall complete only paragraphs (b) ofthis provision if the offeror has compteteo tne annual representations and certification electronically via the system for Award Management (SAM) web siti located at

Page 4 of22 http://www.sam. gov/portal. Ifthe Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (u) ofthis provision.

h) Dertnitions. As used in this provision- "Administrative merits determination" means ceftain notices or findings of Iabor law violations issued by an enforcement agency following an investigation. An administrative merits determination may be final or be subject to appeal or further review. To determine whether a particular notice or finding is covered by this definition, it is necessary to consult section II.B. in the DOL Guidance.

"Arbitral award or decision" means an arbitrator or arbitral panel determination that a labor law violation occurred, or that enjoined or restrained a violation of labor law. lt includes an award or decision that is not final or is subject to being confirmed, modified, or vacated by a court, and includes an award or decision resulting from private or confidentiai proceedings. To determine whether a particular award or decision is covered by this definition, it is necessary to consult section II.B. in the DOL Guidance.

"Civil judgment" means-

( I ) ln paragraph (h) of this provision: A judgment or finding of a civil offense by any court of cornpetent jurisdiction.

(2) ln paragraph (s) ofthis provision: Any judgment or order entered by any Federal or State court in which the court determined that a labor law violation occurred, or enjoined or restrained a violation of labor law, It includes ajudgment or order that is not final or is subject to appeal. To determine whether a particular judgment or order is covered by this definition, it is necessary to consult section It.B. in the DoL Guidance.

(DOL) Guidance entitled: .,Guidance for Executive Order 13673, .Fair dated August 25, 2016, can be obtained from

"Economically disadvantaged women-owned small business (EDWoSB) concem" means a small business concem that is at least 5 | percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens ofthe United States and who are economically disadvantaged in accordance with l3 CFR palr l2'1 .lt automatically qualifies as a women-owned small business eligible under i-he WOSB Program.

"Enforcement agency" means any agency granted authority to enforce the Federal labor laws, lt includes the enforcement components ofDOL (Wage and Hour Division, Office ofFederal Contract Compliance programs, and Occupational Safety and Health Administration), the Eqral Employment opportunity Commission, the oJcupational Safety and Health Review Commission, and the National Labor Relations Boari. It also means a State agency designated to administer an OSHA-approved State Plan, but only to the extent that the State agency is acting in itJcapacity a's administrator ofsuch plan. It does not include other Federal agencies which, in their cap.-acity as contr"acting agencie"s, conduct investigations ofpotentiaf labor law violations. The enforcement agencies ass ,ciatid with each labor la*-unae.l.Cl. 13673 are--

( l) Department of Labor Wage and Hour Division (WHD) for_

(i) The Fair Labor Standards Act;

(ii) The Migrant and Seasonal Agricultural Worker protection Act;

(iii) 40 u.s.c. chapter 31, subchapter IV, formerly known as the Davis-Bacon Act;

(v) 4l U.S.C. chapter 67, formerly known as the Service Contract Act:

(vi) The Family and Medical Leave Act; and

(vii) E.o. 13658 of February r2,2014 (Estabrishing a Minimum wage for conrractors);

(2) Department of Labor Occupational Safety and Health Administration (OSHA) for-_

(i) The Occupational Safety and Health Act of 1970; and

(ii) OSHA-approved Srate plans;

(3) Department ofLabor office ofFederal contract compliance programs (oFCCp) for--

(i) Section 503 ofthe Rehabilitation Act of 1973;

(ii) The Vietnam Era Veterans' Readjustment Assistance Act of 1972 and the Vietnam Era Veterans' Readjustment Assistance Act of 1974; and

(iii) E.O. I 1246 of Septemb er 24, 1965 (Equal Employment Opporruniry);

(4) National Labor Relations Board (NLRB) for the National Labor Reiitions Aci; and

(5) Equal Employment Opportunity Commission (EEOC) for_

(i) Title VII of the civil Rights Act of 1964;

(ii) The Americans with Disabilities Act of 1990;

(iii) The Age Discrimination in Employment Act of 1967; and

(iv) Section 6(d) ofthe Fair Labor Standards Act (Equal pay Act).

Pase 5 of22

"Forced or indentured child labor" means all work or service-

(6) Exacted from any person under the age of l8 under the menace of any penalty for its nonperformance and for which the worker does not offer himself voluntarily; or

(7) Performed by any person under the age of I 8 pursuant to a contract the enforcement of which can be accomplished by process or penalties.

"Highest-level o*'ner" means the entity that owns or controls an immediate owner ofthe offeror, or that owns or controls one or more entities that control an immediate owner ofthe offeror. No entity owns or exercises control ofthe highest level owner.

"lmmediate owner" means an entity, other than the offeror, that has direct control ofthe offeror. lndicators ofcontrol include, but are not limited to, one or more ofthe following: Ownership or interlocking management, identiO/ of interests among family members, shared facilities and equipment, and the common use ofemployees.

"Tnverted domestic corporation," means a foreign incorporated entity that meets the definition ofan inverted domestic corporation under 6 U.S.C. 395(b), applied in accordance with the rules and definitions of6 U.S.C. 395(c).

"Labor compliance agreement" means an agreement entered into between a contractor or subcontractor and an enforcement agency to address appropriate remedial measures, compliance assistance, steps to resolve issues to increase compliance with the labor laws, or other related matters.

"Labor laws" means the following labor laws and E.O.s:

( 1) The Fair Labor Standards Act.

(2) The Occupational Safety and Health Act (OSHA) of 1970.

(3) The Migrant and Seasonal Agricultural Worker protectton Act.

(4) The National Labor Relations Act.

(5) 40 U.S.C. chapter 3 l, subchapter IV, formerly known as the Davis_Bacon Act.

(6) 4l U.S.C. chapter 67, formerly known as the Service Contract Act.

(7)E.O. I1246 ofSeptember24, 1965 (Equal Employment Opporrunity).

(8) Section 503 ofthe Rehabilitation Act of 1973.

(9) The Vietnam Era Veterans' Readjustment Assistance Act of 1972 and the Vietnam Era Veterans' Readjustment Assistance Act of 19'74 ( I 0) The Family and Medical Leave Act.

(l l) Title VII of the Civil Rights Ac of 1964.

( I2) The Americans with Disabitities Act of 1990.

( l3) The Age Discrimination in Employment Act of l96j .

( I4) E o. 1365 8 of February 12, 2014 (Estabrishing a Minimum wage for contractors).

(15) Equivalent State laws as defined in the DoL Guidance. (The orily equivalent State laws implemented in the FAR are OSHA-approved State plans, which can be found aI

"Labor tion, arbitral award or decision, or civiljudgment, which resulted from a violation ofone or more ofthe laws listed in definition of,.labor laws,'.

"Manufactured end product" means any end product in product and service codes (pSCs) 1000-9999, except-(l) PSC 5510, Lumberand Related Basic Wood Materials;

(2) Product or Service Group (pSG) 87, Agricultural Supplies;

(3) PSG 88, Live Animars;

(4) PSG 89, Subsisrence:

(5) PSC 9410, Crude Grades ofplant Materials;

(6) PSC 9430, Miscellaneous Crude Animal products, Inedible;

(7) PSC 9440, Miscellaneous Crude Agricultural and Forestry products;

(8) PSC 9610, Ores;

(9) PSC 9620, Minerals, Natural and Synthetic; and

(10) PSC 9630, Additive Metat Materials.

"Place of manufacture" means the place where an end product is assembled out of components, or otherwise made or processed from raw materials into the finished product that is to be provided to the Government. lf a product is disassembled and reassembled, the place of reassembly is not the place of manufacture.

"Predecessor" means an entity that is replaced by a successor and includes any predecessors ofthe predecessor.

"Restricted business operations" means business operations in Sudan that inciude power production activities, mineral extraction activities, oil-related activities, or the production of military equipment, as those terms are defined in the Sudan Accountability and Divestment Act of2007 (Pub. L. I l0-174). Restricted business operations do not include business

Pase 6 of22 operations that the person (as that term is defined in Section 2 ofthe Sudan Accountability and Divestment Act of2007) conducting the business can demonstrate-

( I ) Are conducted under contract directly and exclusively with the regional govemment of southern Sudan;

(2) Are conducted pursuant to specific authorization from the Office of Foreign Assets Control in the Department ofthe Treasury, or are expressly exempted under Federal law from the requirement to be conducted under such authorization:

(3) Consist of providing goods or services to marginalized populations of Sudan;

(4) Consist of providing goods or services to an internationally recognized peacekeeping force or humanitarian organization;

(5) Consist of providing goods or services that are used only to promote health or education; or

(6) Have been voluntarily suspended.

Sensitive technology- ( I ) Means hardware, software, telecommunications equipment, or any other technology that is to be used specifically-

(i) To restrict the free flow of unbiased information in lran; or

(ii) To disrupt, monitor, or otherwise restrict speech of the people of lran; and

(2) Does not include information or informational materials the export of which the President does not have the authority to regulate or p^rohibit pursuant to section 203(b)(3) ofthi Intemational Emergency Economic powers Act (50 U.S.C. 1702(bX3)).

"Service-disabled veteran-owned small business concem"- ( I ) Means a small busincss concern-

(i) Not less than 5l percent of which is owned by one or more service-disabled veterans or, in the case of any publicly owned business,.not less than 5l percent ofthe stock of which is owned by one or more service-disabled veterans; and

(ii) The managementand daily business operations of which are controlled by one or more service-disabled veterans or, in the case of a service-disabled veteran with permaneni…