Billings Area Performance Work Statement (PWS) for Non-Personal

Services

Dental – Oral Surgeon Services

Table of Contents

Section Page

0.0 TABLE OF CONTENTS 1

1.0 BACKGROUND/PERFORMANCE/LOCATION 2

2.0 SCHEDULE 2

3.0 SCOPE OF WORK 3

4.0 CONDITIONS FOR REMOVAL/REPLACEMENT 3

5.0 CONTRACTOR REQUIREMENTS 3 - 4

6.0 TASKS 4

7.0 CONTRACTOR CREDENTIALS 5

8.0 SECURITY CLEARANCES 5 - 7

9.0 LICENSURE, CREDENTIALING AND PRIVILEGING 7

10.0 SUPERVISORY CONTROLS 8

11.0 DELIVERABLES 8

12.0 CONTRACTING OFFICER REPRESENTATIVE (COR) RESPONSIBILITIES 9

13.0 CONTRACTING OFFICER (CO) RESPONSIBILITIES 9

14.0 PERFORMANCE CONDITIONS 10

15.0 CONTRACTOR RESPONSIBILITIES 11-12

16.0 CONDITIONS FOR PAYMENT 12

17.0 PATIENT CULTURAL BACKGROUND 12

18.0 INFORMATION TECHNOLOGY SECURITY 12 - 13

19.0 GOVERNMENT/FACILITY FURNISHED PROPERTY 13

20.0 CONTRACTOR FURNISHED PROPERTY 13 DRAFT

Performance Work Statement (PWS) Non-Personal Services

Dental Oral Surgeon Services

1. BACKGROUND:

This service contract intends to provide a Dental Oral Surgeon and shall provide comprehensive oral and maxillofacial surgery services at the Blackfeet Community Hospital, to include consultations, minor, and major surgical procedures, at the Blackfeet Service Unit (BFSU), Blackfeet Community Hospital, Billings Area-Indian Health Service, Browning, MT, that are qualified and available to cover fixed coverage hours and other mutually agreed upon as needed staffing assignments for the duration of the contract term.

The Contractor shall ensure that staff meet the qualification requirements outlined in the contract as detailed below. The contractor's staffing will have the ability, education, training, licensing, certification, registration, and previous work experience to perform the work according to the requirements and conditions contained in this Performance Work Statement.

Responses to this solicitation shall contain a complete profile and current work history of the candidate presented, including certifications and training.

1.1 PERFORMANCE/LOCATION:

1.1.1 Period of Performance:

The Period of Performance for this Order shall be for a base period of twelve (12) months from the date of award, plus four (4), one-year option periods. Option periods, if exercised, shall start immediately after the Base Year ends. The exercise of any option is at the sole discretion of the Government, subject to the availability of funds (see FAR 52.232-19) and contractor performance.

1.1.2 Location: All services shall be performed at the following location:

Blackfeet Community Hospital Dental Department 760 Hospital Circle Browning, MT 59417

2. SCHEDULE:

2.1 The Contractor shall agree to a recurring schedule of three (3) dental visits per month. Any unused visits in a given month may be rolled over to the following month within the same contract year, provided that the total visits do not exceed 36 in any given 12-month period.

2.2 Contracted personnel work Monday through Friday, 8:00 a.m. to 4:30 p.m. local time, excluding Overtime, Weekends and federal holidays. Schedule shall be coordinated with the Dental Supervisor or designee.

DRAFT

3. SCOPE OF WORK:

3.1 Services include but are not limited to management of impacted teeth, facial trauma, pathologies, oral biopsies, infections, and pre-prosthetic surgery. Tooth Extractions: Removing impacted, severely decayed, or damaged teeth (such as wisdom teeth):

i. Tooth Extraction: Removing severely damaged, non-restorable teeth or difficultly impacted teeth

ii. Dental Implants: Placing titanium posts to replace missing teeth.

iii. Bone Grafting: Preparing the jawbone for dental implants.

iv. Oral Pathology: Diagnosing and excising benign cysts and oral lesions.

v. Anesthesia Delivery: Administering local anesthesia.

3.2 The Contractor has no obligation to provide callback, on-call, or emergency coverage outside of the scheduled dental visit days identified in Section 2. Facial trauma or other urgent/emergent oral conditions presenting outside scheduled visit days shall be managed by the Service Unit through alternate means (e.g., referral, transfer, or emergency department management), in accordance with Service Unit policy.

4. CONDITIONS FOR REMOVAL/REPLACEMENT:

4.1 Personnel:

4.1.1 The Government reserves the unilateral right to request the removal or replacement of any contractor employee from an IHS facility at any time. The Contracting Officer may issue a removal request for any reason, including but not limited to failure to perform services in accordance with the terms and conditions of this contract. Upon notification by the Government, the Contractor shall immediately remove the employee from the facility

4.1.2 The Contractor shall request government preapproval to substitute or replace any of the Contractor's employees for whom it has provided qualifications and resumes under this contract. All Contractor-requested substitutes or replacements' qualifications, experience, and professional Certifications must be at least equal to or greater than the original Contractor's employee provided by the Contractor under this contract.

5. CONTRACTOR REQUIREMENTS:

i. Specialized experience: At least one (1) to two (2) full years of post-residency professional experience performing specialized oral and maxillofacial surgery.

ii. Clinical Competencies: Documented capability to independently evaluate, diagnose, and surgically manage complex hard and soft tissue pathologies. This includes routine and surgical extractions, bony/tissue impactions, jaw fracture management, biopsies, intra/extra-oral incision and drainage of abscesses, alveoloplasty, and management of medically complex patients.

iii. The contractor shall comply with all IHS facility infection control and safety procedures and standards. During the performance of this contract, the Contractor shall provide for the consistent performance of the patient care process according to the standards of the Joint Commission (JC) and/or Centers for Medicare Services (CMS), which supplies accreditation to the Blackfeet Service Unit, Indian Health Service hospital, and health centers. These standards shall include: The Comprehensive Accreditation Manual for Critical Access Hospitals and the Laboratory Standards, as they represent the scope of services of this contract.

iv. The contractor shall complete in a timely fashion the medical and other required records for patients he/she admits or in any way provide treatment. Chart notes are to be completed on the day services are rendered.

v. The contractor shall abide by the Service Unit Medical By-laws and rules and regulations and meet all credentialing requirements in accordance with the Service Unit Medical Staff By-laws.

vi. Upon award, the selected medical professional(s) shall undergo Indian Health Service (IHS) mandated security clearance for work on-site for the Blackfeet Service Unit (BFSU).

vii. The security pre-clearance requirement must be adhered to; the process includes a fingerprint check and a screen check through the Office of the Inspector General's exclusion list at http://exclusions.oig.hhs.gov/. Documented evidence of the clearances shall be provided to the Human Resources Personnel Security Officer at the Blackfeet Service Unit (BFSU), Indian Health Service, 760 Hospital Circle, Browning, MT 59417.

6. TASKS:

6.1 Specific Tasks:

i. Comprehensive Care: Conduct diagnostic examinations and surgical treatments for oral infections, trauma, and pathology.

ii. Procedural Proficiency: Perform surgical removal of impacted teeth, dental implants, biopsies, and related dental surgeries.

iii. Consultation: Provide expert consultative services to dental and medical staff.

The Service Unit will provide site-specific orientation and competency assessments as needed.

6.2 The contractor(s) shall attend BFSU orientation, and all contractors are required to provide immunization records as proof of immunity or disease before the performance of work (Reference Indian Health Service Circular 95-9A). Tuberculosis: Annual PPD or Chest X-ray, if there is a history of positive skin test. (b) Documentation of two (2) MMR (Measles, Mumps& Rubella) vaccinations or proof of immunity. Employees born before 1957 do not need MMR or proof of immunity. (c) Documentation of two (2) varicella (chicken pox) vaccinations or proof of immunity or history of having the disease. (d) Documentation of Hepatitis B series vaccination.

(e) Documentation of influenza vaccination during flu season. (f) Documentation of COVID-19 vaccination.

6.3 Personal Hygiene – The contractor(s) must be clean and neat in appearance and comply with the Service Unit dress code (e.g., standard medical scrubs, lab coats, and required personal protective equipment). Contractors must present themselves in a professional manner commensurate with the nature of their profession.

7. CONTRACTOR CREDENTIALS:

7.1 The contractor shall provide a list of qualified candidates and the following documents per candidate:

i. Current resume

ii. OF-306 - Declaration for Federal Employment (all questions must be answered, and a signature with date in 17a is required)

iii. OF-306 Addendum -Addendum to the OF·306 (Declaration for Federal Employment)

iv. IHS Provisional Access Memo

v. Protecting Children from Sexual Abuse in Health Care Settings; complete the Certificate of Completion

vi. No FEAR Act Training; complete the Certificate of Completion

vii. OF1 - 86C form, along with two fingerprint cards and applicable state forms

viii. HHS - 745, Section A

ix. Two IDs (driver's license and social security card - names must match and be unexpired)

NOTE: No photo submission of forms, please have the forms scanned. A wet signature and date are highly recommended. No PDF signatures will be accepted.

8. SECURITY CLEARANCES:

8.1 All contractor employees who require access to the IHS IT and RPMS systems shall be the subject of a background investigation and must receive a favorable adjudication from the HIS prior to performance. The contractor will be responsible for the actions of those Individuals they provide to perform work for the IHS; they must pass background checks, fingerprinting, and badging. The contractor’s credentials/ qualifications are subject to review by the Government.

These qualifications, at a minimum, will meet the Joint Commission for Critical Access Hospitals.

8.2 The Contractor shall abide by the following Security Standards that are required for the position: Federal Security Identification Badge Request: It is the responsibility of the department to provide the necessary clearances to the HIS computer system, as well as other security requirements needed for the Contractor to perform their duties.

8.2.1 Background investigation: The level of background investigation commensurate with the required level of access is required and complied with the contract award.

(Contractor shall ensure that upon selection and acceptance of a qualified candidate, fingerprints will be secured and submitted to the Government within 72 hours from notification of a selected qualified candidate).

8.2.2 Must be authorized to work in the United States.

8.2.3 The contractor, when notified of an unfavorable determination by the Government, shall withdraw the employee from consideration for working under the contract.

(Failure to comply with the contractor personnel security requirements may result in corrective actions to protect the Government’s interests.)

8.2.4 Background Check: Contractor’s employees cannot work a scheduled shift until the security check is performed, and clearance has been obtained by the appropriate agency. At a minimum, fingerprints are required, and upon clearance at this stage, a Contractor’s employee may work a scheduled shift. However, Contractors are required to complete the detailed background application, and the application is to be completed within 30 days once the Contractor's employee has been given access.

8.3 All contractor employees are subject to a criminal background check before performing services in accordance with the contract terms and conditions. The Contractor shall ensure that each of their provider(s) completes the certification of the Criminal History and Background Check Packet. Additional Background Check packets can be obtained through the Human Resources Personnel Security Officer at the Blackfeet Service Unit (BFSU). Contractors (and their employees) require routine, long-term access (i.e., greater than 120 days) to IHS facilities and/or systems or providing services to children under 18 years of age, are subject to criminal background checks before performing services. The contractor shall ensure that each employee completes the Certification of Criminal History and Background Check Packets to initiate the Child & Youth Services National Agency check with Inquiries (CNACI).

8.3.1 The Dental Program Manager is responsible for ensuring all background check forms are fully completed and processed before commencement of service. The Contractor shall return all completed forms to the Human Resource Office located at the Blackfeet Service Unit (BFSU), 760 Hospital Circle, Browning, MT 59417.

8.4 Contractors may be directed to the e-QIP website to complete the necessary background Investigation forms online (inquire with the Service Unit should you wish to complete forms electronically). All Contractors (or their employees) must appear in person to IHS (or an IHS facility) with two acceptable forms of identity; fingerprints will be taken electronically, or on paper, at this time. This must occur before the first date of service (realistically allow a 14 – 30-day processing time before the actual start date). At a minimum, if results are not received within 5 days, the identity credentials can be issued based on a favorable FBI National Criminal History Check (fingerprint check). Note: These timeframes are based on a complete and acceptable package, including legible fingerprints.

For More Information on Security Requirements, Please Refer to the DHHS Site:

http://intranet.hhs.gov/ personal identity verification (PIV) card / brochure.html

8.5 Child Care National Agency Check & Investigation (CNACI) In accordance with the Child Care National Agency Check and Investigation (CNACI) directive. Implemented by the IHS, the following documents will be required from the Contractor and all employees they utilize under this awarded contract:

i. OHHS Application Background Survey.

ii. DHHS/IHS Required Application Questionnaire for Child Care Positions.

iii. IHS- Release of Personal Information.

iv. SF-85 Questionnaire for Non-sensitive Positions.

v. GSA Form 176-Statement of Personal History.

vi. FD-258 Federal Bureau of Investigation Fingerprint Analysis Chart

8.6 A Contractor whose duties and responsibilities involve regular contact or control over children is subject to a character investigation as required by Public Law 101-630, the Indian Child Protection and Family Violence Prevention Act. The Billings Area Office of Human Resources or the IHS Service Unit conducts these investigations following contract award.

Character investigation may be waived if, in the judgment of the Contracting Officer, in consultation with the Human Resource Officer, an investigation has already been conducted and is on file. Until the character investigation has been completed and the Contracting Officer is notified of the results; the Contractor must not have unsupervised contact with the Indian Children.

9. LICENSURE, CREDENTIALING AND PRIVILEGING:

9.1 Licensure:

9.1.1 Must hold a valid, unrestricted license to practice dentistry in Montana State and be board-certified or eligible by the American Board of Oral and Maxillofacial Surgery

(ABOMS).

9.2 Credentialing and Privileging:

9.2.1 The contractor will participate in the credentialing and privileging process in accordance with existing procedures. Contractors should provide no services before obtaining approval from the Government. The Contractor will be provided copies of current requirements and updates as they are published. Privileges will require renewal at least every one to two years in accordance with the Government credentialing privileging policy and JCAHO requirements.

10. SUPERVISORY CONTROLS:

10.1 The Supervisory Department Officer, or other appointee, provides primarily administrative oversight. The Supervisory Department Officer, or other appointee sets overall health care objectives and specifies resources available. The supervising designee reviews work performance periodically to evaluate proficiency in providing health care, discuss deficiencies and problems encountered, outline and/or approve new or changed practices to be employed, and provide consultation on specific cases and related problems. Work that involves out-of-the-ordinary diagnostic decisions or treatment is discussed with a supervisory department officer or designee who keeps aware of the condition of such patients and all aspects of the treatment regimen.

Work performance is reviewed for conformance to IHS policy, procedures, and accepted professional practices, and the Quality Assurance improvement Program of the Medical staff of the Service Unit.

10.2 BFSU Medical professional(s) will provide guidance and instruction to the contractor's staff providing services during each shift worked. Within established guidelines, contractor(s) exercise latitude in planning and carrying out healthcare assignments and in undertaking new procedures, practices, and approaches to extend both services provided and increase individual proficiency. Overall work performance is reviewed jointly by the clinical director/supervising physician for effectiveness in meeting requirements for healthcare services.

11. DELIVERABLES:

11.1 The Contractor is required to provide a copy of each Contractor's employee profile to the Dental Program Manager before providing services at the Blackfeet Service Unit (BFSU).

11.2 Timesheets shall be submitted to the Supervisor or designee of the department at BFSU;

the timesheets shall be reviewed for accuracy and certified as accurate and acceptable for payment, then forwarded to the receiving official for further processing of receipt of services through the Invoice Processing Platform (IPP), U.S. Department of the Treasury.

11.3 Contractor shall provide the Dental Supervisory:

i. Monthly reports detailing surgical cases performed, including types of procedures and complication rates.

ii. Patient evaluations and treatment plans.

iii. Invoices submitted via the Invoice Processing Platform (IPP) to the COR or designee.

iv. Logs of hours worked maintained by the Dental Supervisor.

(Staffing updates and coverage plans provided to ensure continuous service).

12. CONTRACTING OFFICER REPRESENTATIVE (COR) RESPONSIBILITIES:

12.1 The Contracting Officer will designate in writing a COR who shall be responsible for:

i. Monitoring the Contractor's technical progress, including the surveillance and assessment of performance, and recommending changes in requirements to the Contracting Officer.

ii. Interpreting the scope of work.

iii. Performing technical evaluations required.

iv. Performing technical Inspections and acceptances required by this contract.

v. Monitoring funds available for obligation under this contract.

vi. IHS Support Personnel, Services, or Equipment: The IHS will provide medical supplies and standard surgical equipment necessary to perform these services, as detailed in Section 19 of the Performance Work Statement, except for uniforms, personal-related items, and the specialized equipment identified as Contractor-furnished in Section 20.

vii. The resolution of technical problems encountered during performance of this contract.

12.2 In no event is the COR empowered to change any of the terms and conditions of the contract. Changes in the scope of work, contract price, quantity, and quality or delivery schedule shall be made only by the Contracting Officer by a properly exercised modification. The designation of a COR does not authorize or provide a legal right to change any kind of contractual terms, regardless of the Contractor's apparent difficulties in fulfilling contract requirements.

12.3 Government Responsibilities and Compliance:

i. Safety and Regulations: The Government is responsible for ensuring compliance with all safety and health laws, regulations, and standards during the contractor's assignment. This includes Joint Commission standards (or equivalent) and HIPAA regulations.

ii. Training and Equipment: The Government will provide all site-specific training, orientation, equipment, and evaluations required by federal, state, or local laws for government workforce members.

iii. Scope of Work: The Government will only assign contract personnel to work within their specific professional qualifications and clinical specialty areas.

Personnel will only be utilized for the specific tasks requested.

13. CONTRACTING OFFICER (CO) RESPONSIBILITIES:

The Contracting Officer is the only delegated authority to negotiate changes in terms, conditions, or amounts cited in this contract.

14. PERFORMANCE CONDITIONS:

14.1 The contract states required coverage for weekdays. The Dental Program Manager will submit schedules as requested, with coverage of a minimum of 15 calendar days before the first day of coverage requested.

14.2 In the event the Contractor’s employee is unable to render service on a previously agreed schedule; the Contractor shall provide a minimum of seventy-two (72) hours' notification to the Dental Program Manager. The Contractor shall then make a full, good-faith effort to provide coverage with a replacement.

14.3 Both parties recognize that, on occasion, there shall be a need to fill coverage requests with less than 15-day notice. In such an emergency scheduling situation, the Contractor shall make a full, good-faith effort to accommodate the emergency request.

(If the Contractor is unable to meet the emergency scheduling request, they shall immediately notify the COR and those Involved In scheduling.)

14.4 The contractor may not substitute for or replace any sub-contractor for whom has not provided qualifications, resumes, background check clearances, employee health clearances, or new employee orientation clearances under this contract. All contractor-requested substitutes or replacements shall abide by and be preapproved through the credentialing process before their start date.

14.5 The Government reserves the right to accept or not accept the contractor-provided sub-contractor. If any contracted personnel are determined unacceptable by the Government point of contact at any time during the performance period, the Contracting Officer (CO), via the COR, will request a replacement and will notify the contractor’s point of contact that the unacceptable individual shall not be resubmitted to provide service under this contract.

14.6 non-acceptance of a sub-contractor does not relieve the contractor from fulfilling the terms and conditions of this contract. In the event of a dispute between the designated contracts, the Contracting Officer’s decision is final.

14.7 The Contractor shall provide both the CO and COR copies of its certificates of insurance and its subcontractors’ certificates of insurance before performing services under this contract. All contractors and subcontractor certificates of insurance shall name the BFSU as an additional insured.

15. CONTRACTOR RESPONSIBILITIES:

15.1 The contractor shall provide all necessary sub-contractors upon request of the IHS for those services as stated:

i. Find sources for requested contract staff positions and shifts.

ii. Provide contract staff selection choices with the Government.

iii. Onboard the selected contract staff.

iv. Maintain required documents.

v. Off-board contract-staff when no longer needed.

vi. Contractor shall be responsible for meeting or exceeding the Indian Health Service or the Accreditation Standards of The Joint Commission for Critical Access Hospitals.

vii. Contractors are responsible for maintaining the integrity of this contract in relationships with subcontractors and professional liability insurance.

viii. Subcontracting, corporate partnering, and/or teaming arrangements are permitted under this contract. Any subcontractor providers utilized during this contract shall maintain the qualifications as required by the prime contractor.

ix. Performance Standards: The Quality Assurance Surveillance Plan (QASP) outlines required standards and will be a part of the resultant contract.

x. The contractor shall prescreen all personnel requiring access to the computer system to ensure they are eligible for employment and can read, write, speak, and understand the English language.

xi. All patient safety incidents shall be reported immediately to the Dental Program Manager in accordance with the Service Unit policy. The COR, the contractor’s supervisor, and the Contracting Officer shall be notified of the contracted personnel is to be investigated for negligence.

16. CONDITIONS FOR PAYMENT:

i. Contractor's employees must be present at the facility and must be performing the required services to receive payment for services. Contractor shall only receive payment for the actual number of hours worked on-site at the specified facility.

ii. Contractor shall submit signed invoices to the Dental Supervisor. The invoice shall include the following information: Contract number, invoice number, date of service, type of service, time and hours of service, dollar amount, and a brief depiction of services performed and the name.

iii. The Contractor shall submit a monthly invoice in arrears. Invoices must be submitted through Invoice Processing Platform (IPP) within fourteen (14) calendar days following the end of each billing period.

17. PATIENT CULTURAL BACKGROUND:

Some of the IHS patients. Receiving services. Under this contract, one may only speak a native language or Spanish, or may have limited comprehension of the English language, and/or may reside on a Native American Indian Reservation. The Contractor is expected to demonstrate sensitivity to cross-cultural and language differences and can work through government-provided interpreters as necessary.

Consideration must be given to potentially limited transportation and/or home environment facilities.

18. INFORMATION TECHNOLOGY SECURITY:

18.1 The Indian Health Service (IHS) is responsible for maintaining an information security program that protects information collected or maintained by or on behalf of the Agency, and information systems used or operated by the Agency or by a contractor of the Agency or other organization on behalf of the Agency.

18.2 IT SECURITY – INFORMATION SYSTEMS SECURITY AWARENESS (ISSA) TRAINING:

18.2.1 Information Systems Security Awareness (ISSA) is mandatory annual security awareness training for all IHS system users and fulfills Federal mandates and regulations. IHS develops the modules in line with the National Institute of Standards and Technology (NIST) guidelines on Information security awareness and information security training.

i. The ISSA modules fulfill an IHS user's annual requirements for the following:

ii. Acknowledgement and acceptance of the IHS Rules of Behavior

iii. Privacy Training

iv. Protecting sensitive information and the Health Insurance Portability and

Accountability Act (HIPAA)& The Health Information Technology for Economic and Clinical Health Act (HITECH)

v. Physical and information security

vi. Appropriate email use

vii. Protecting mobile devices and portable media

viii. Social engineering awareness

ix. Incident response and learning from past incidents

(You can take the training or learn more on the ISSA website).

18.3 All IHS information system users must take annual security and privacy training to fulfill federal mandates and regulations. In addition, all new users must complete this course within 24 hours of receiving access, unless the user has read the IHS Quick Guide to Information Security, in which case they will have 30 days to complete the training. Failure to complete training requirements will result in the loss of information systems access.

19. Government/Facility Furnished Property

i. The facility will provide dental chairs, surgical equipment, supplies, and instruments.

ii. Dental assistants and reception staff will be provided to support the surgeon

iii. Specialized dental handpieces, specific rotating/extraction instrument cassettes, and standard 3D imaging are not supplied.

20. Contractor Furnished Property

i. The contractor shall provide their own professional liability insurance (malpractice).

ii. Personal protective equipment (if not supplied) and specialized instruments not typically found in a standard surgical unit.

END OF PERFORMANCE WORK STATEMENT (PWS)