ISBEE Sol Pkg 25Q00154.pdf

Combined Synopsis 1

COMBINED SYNOPSIS

INDIAN SMALL BUSINESS ECONOMIC ENTERPRISE (ISBEE) SET-ASIDE

A. This is a combined synopsis/solicitation for commercial items prepared in accordance with the format in Federal Acquisition Regulation (FAR) Subpart 12.6, as supplemented with additional information included in this notice, FAR Part 12, Acquisition of Commercial Items (Title VIII of the Federal Acquisition Streamlining Act of 1994) (Public Law 103-355). This announcement constitutes the only solicitation; quotes are being requested, and a written solicitation will not be issued.

B. The Great Plains Area Indian Health Service (IHS) intends to award a Firm-Fixed Price, Non- Personal Healthcare Service, Purchase Order with a Base Plus Nine (9) Option Periods in response to Request for Quote (RFQ) 75H70625Q00154. *Base period will be six (6) Months, and each option period will be six (6) months.

C. This solicitation document and incorporated provisions and clauses are those in effect through Federal Acquisition Circular 2025-05, 08/07/2025.

D. This RFQ is issued as a 100% Indian Small Business Economic Enterprise (ISBEE) Set-Aside, and the associated NAICS Code is #561320 (Temporary Help Services), which has a small business standard size $34.0. Quoter is required to fill out the attached Indian Firm Representation Form.

E. The quoted unit pricing must be all-inclusive (to include, but not be limited to, travel, lodging, per diem, fringe benefits, federal, state, and local taxes) plus all other costs pertinent to the performance of this contract. Utilize your most competitive and reasonable rates. Complete the attached Request for Quote #75H70625Q00154 SF 18 for an Outpatient Physical Therapist, along with the Business Associates Agreement. The quoter must acknowledge the Business Associates Agreement.

F. Firm Fixed Price, Non-Personal, Healthcare Services to be provided for the Woodrow Wilson Keeble Memorial Health Care Center-Sisseton Indian Health Service, 100 Lake Traverse Drive, Sisseton, South Dakota 57262. See the Performance Work Statement (PWS) attached. The period of performance will be a Base Period with nine (9) Option Periods. *Base period will be six (6) Months, and each option period will be six (6) months.

Complete the SF 18 Price Schedule:

Total Amount: $___________________________________

Combined Synopsis 2

G. FAR 52.212-1 Instructions to Offerors-Commercial Products and Commercial Services (SEP 2023).

* Quotes shall be submitted on company letterhead stationery, signed, dated, and shall include:

1. Solicitation number: 75H70625Q00154.

2. Closing Date: September 25, 2025, at 12:00 pm CT.

3. Name, address, and telephone number of company and e-mail address of contact person.

4. Technical description of the item/service being offered in sufficient detail to evaluate compliance with the requirements of the solicitation. This may include product literature or other documents, if necessary.

5. Terms of any express warranty.

6. Price and any discount terms.

7. "Remit to" address, if different than mailing address.

8. A completed copy of the representations and certifications at FAR 52.212-3 (see FAR 52.212- 3(b) for those representations and certifications that the offeror shall complete electronically).

9. Acknowledgment of Solicitation Amendments (if any issued)

10. Past performance information, when included as an evaluation factor, should consist of recent and relevant contracts for the same or similar items and other references (including contract numbers, points of contact with telephone numbers, and other relevant information).

11. A statement specifying the extent of agreement with all terms, conditions, and provisions included in the solicitation. Offerors that fail to furnish required representations or information, or reject the terms and conditions of the solicitation, may be excluded from consideration.

H. Basis for Award: The Government will evaluate quotations in accordance with the procedures outlined in 52.212-2 Evaluation - Commercial Products and Commercial Services (November 2021). The Government intends to evaluate and make an award without discussion with the offerors, except for minor clarifications, unless discussions are deemed necessary. A decision on the technical acceptability of each offeror's quotations will be made. In addition to price, the government will consider the evaluation factors in determining the successful quote that represents the best value to the government. There is no requirement that a contract be awarded based on the lowest price. Below are the mandatory criteria:

Combined Synopsis 3

* The technical evaluation process will be accomplished as follows: Technical Acceptability will be comprised of four (4) subfactors:

Criteria 1: Problem and Approach

Proposals, which merely offer a statement to conduct/provide services in accordance with the requirements in the Government's Performance Work Statement (PWS), will not be eligible for award. The offeror must submit an explanation of the proposed technical approach in completing all tasks in the PWS, including, but not limited to, all elements in the description of services. The plan must include how the requirements in the character investigation shall be accomplished to ensure compliance before candidate placement. The detailed work plan must be submitted, outlining how each aspect of the Performance Work Statement will be achieved.

The technical approach should be detailed to fully explain the proposed technical requirements in the PWS and reflect a clear understanding of the nature of the work being undertaken.

Criteria 2: Past Performance

The technical proposal must include at least three other similar Physical Therapy Service contracts, Government and/or commercial, awarded to the offeror. The similar contracts must contain the same type of Physical Therapy Service requirements outlined in the Performance Work Statement. The offeror must demonstrate its record of successful performance in the past contracts by including the following information for each contract:

a. Identify the one contract that you consider to be the most successful, and the reason for this determination.

b. Identify other similar contracts and indicate your record of performance.

c. In the event your firm did not have contracts that meet the PWS requirements of this solicitation, list up to five other contracts that you deem similar.

d. For each of the above contracts, furnish the name, address, and telephone number of the contracting organization, a point of contact in the organization to be used as a reference, the contract number, dollar value, and dates of contract performance.

Criteria 3: Key Personnel

The technical proposal must include a list of professional personnel that will be assigned to this project, and at least one Physical Therapist who is qualified to perform the duties listed as defined in the contract provider responsibilities in the PWS. Curriculum vitae/resume must be submitted for the professional personnel and the Physical Therapist candidate.

Criteria 4: Management

Combined Synopsis 4

The technical proposal, at a minimum, must include the following information in sufficient detail to allow a complete analysis of the offeror's management capabilities and responsibility.

a. Evidence of ability to organize staff and manage the contract.

b. Financial capability statement completed by qualified personnel, including core competencies, differentiators, corporate data, contact information, etc., to meet the needs outlined in the PWS.

c. Capability to meet delivery or performance schedules to provide seamless coverage.

d. Possession of necessary experience and technical skills to perform the work, or the ability to obtain them.

Combined Synopsis 5

PROPOSAL EVALUATION SUMMARY

MEDICAL PHYSICIST SURVEYS

Woodrow Wilson Keeble Memorial Health Care Center

The following are the technical criteria that will be used to evaluate the proposals for this contract effort, along with their relative weight of importance. The individual members of the evaluation team will determine an overall rating based on completeness of information, qualifications, experience, and education.

1. PROBLEM AND APPROACH

2. PAST PERFORMANCE

3. KEY PERSONNEL

4. MANAGEMENT

Technical Factor Rating Definitions

ADJECTIVAL RATINGS 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; and has no significant weaknesses or deficiencies.

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

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

proposal needs major revisions; very low probability of success.

**In categorizing positive and negative aspects of the information submitted for the component elements of each technical factor, the evaluator shall consider the degree to which the response to the element, or lack of response, contributes to the overall risk of performance.

Missing information for a single element may not materially affect the risk of performance when considered together with the responses to the other elements. In that case, the omission would be categorized as a weakness, rather than a deficiency.

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

Combined Synopsis 6

1. Contractor MUST COMPLETE AND SIGN the following documents:

a. SF18 Request for Quotation.

b. Licensure Requirement.

c. Agreement to a temporary provisional of character investigations (for government contractors only).

d. OF-306 Declaration of Federal Employment.

e. Addendum to the Declaration of Federal Employment (OF-306).

f. Temporary waiver.

2. Contractor MUST SUBMIT A COPY of the following documents:

a. Copy of all licenses (if applicable).

b. Copy of malpractice insurance coverage (Certificate of Insurance). The contractor shall maintain insurance coverage for the duration of the contract.

3. Resume stating qualifications and meeting the requirements of the Performance Work Statement.

4. Minimum of three (3) references for similar work in the last five (5) years. Include addresses and phone numbers.

5. Past performance – the government reserves the right to conduct its own investigations, other than the contractors provided list.

6. Contractor must have a UEI (Unique Entity ID) number to be awarded the contract.

7. Contractor must have an “active registration” in SAM (System for Award Management) using the assigned UEI number.

8. Ability to meet the performance schedule.

9. Ability to meet the requirements and qualifications in the Performance Work Statement.

10. Reasonableness of Price.

11. Responsiveness to requirement.

ATTACHMENTS:

1. SF 18 Solicitation

2. Performance Work Statement

Combined Synopsis 7

3. Provisions and Clauses

4. Contractors Performance, Conditions & Responsibilities

5. Business Associate Agreement

6. OF-306 Declaration of Federal Employment

7. Addendum to the Declaration of Federal Employment (OF-306)

8. Licensure Requirement

9. Agreement to a Temporary Waiver of Character Investigation

10. Indian Firm Representative Form

I. FAR 52.212-3 Offer Representations and Certifications-Commercial Products and Commercial Services (MAY 2024). See attachment for full text. The Offeror shall complete only paragraphs

(b) of this provision if the Offeror has completed the annual representations and certification electronically via the System for Award Management (SAM) website accessed through http://www.acquisition.gov. If the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (p) of this provision.

J. FAR 52.212-4 Contract Terms and Conditions-Commercial Products and Commercial Services (NOV 2023). Applied to this acquisition and its by reference.

K. FAR 52.212-5 Contract Terms and Conditions Required to Implement Statutes or Executive Orders Commercial Products and Commercial Services (JAN 2025). See attachment for full text.

L. FAR 52.214-16 Minimum Bid Acceptance Period (April 1984). See attachment for full text.

M. Attached are the Federal Acquisition Regulations (FAR) & Health & Human Services Acquisition Regulation (HHSAR) clauses that are applicable, including below.

N. SECURITY CLEARANCE

A security pre-clearance must be performed for any employees referred to IHS through this contract.

Fingerprints must be completed and adjudicated before services are performed under this contract.

No contract award shall be made to any vendor or provider listed on the OIG Exclusion List http://exclusions.oig.hhs.gov throughout the contract. It shall be the responsibility of the contractor to notify the acquisition official if there is a change in provider. Performance of this

Combined Synopsis 8 contract will require routine access by employees of the Contractor or its subcontractors to facilities or systems controlled by the Indian Health Service (IHS). Before starting work requiring routine access to IHS facilities or systems, each person must complete an FBI National Criminal History Check (Fingerprint Check) adjudicated by an IHS employee using the Office of Personnel Management Personnel Investigations Processing System. Contractors shall allow five (5) business days for IHS processing fingerprints taken electronically at an IHS site and thirty (30) business days for non-electronic processing of fingerprints using FBI Form FD-258. A list of IHS sites with electronic fingerprint capability is available from the Contracting Officer.

In addition, no Contractor or subcontractor employee shall be permitted to perform work under this contract if listed on the HHS Office of Inspector General List of Excluded Individuals/Entities (LEIE), http://exclusions.oig.hhs.gov. As soon as practicable before the start of work, the Contractor shall provide to the Contracting Officer the names of all individuals to be used in the performance of the work for screening against the LEIE. During the performance, the Contractor shall provide the Contracting Officer the names of any additional or substitute employees for screening before they begin work.

The Contractor is responsible for conducting security preclearance investigations in sufficient depth to ensure that each Contractor or subcontractor employee referred to IHS is not on the LEIE can obtain a favorable fingerprint clearance. Each security preclearance shall be conducted sufficiently in advance of the start of performance to avoid delays caused by the denial of access. If this is a Time and Materials, Labor-Hour, or Cost Reimbursement contract, the contractor shall not charge for or be reimbursed for labor hours or other costs incurred for employees who are unable to perform due to denial of access or the excess time required to resolve and clear unfavorable security clearance findings. If this is a Fixed Price contract, denial of access due to security clearance findings shall not be a basis for excusable delay or an increase to the contract amount.

The Government will pay the cost to process the contractor's suitability clearances. However, multiple investigations for the same position may, at the Contracting Officer's discretion, lead to reduction(s) in the contract price of no more than the cost of the extra investigation(s).

Employees who do not have access to LMS, contractors, volunteers, or IHS employees with IPAs or MOAs to tribal organizations, please click here for the IHS Sexual Abuse Prevention website.

Once the contractors have completed and passed the training, please have them send a copy of the last page of the training, including their name, Date, and Time, to their Supervisor, COR, and Kimmen LeBeau at e-mail: Kimmen.LeBeau@ihs.gov.

"Contract Personnel will arrive on a Business Day ONLY to complete all Orientation and Background procedures. The Clinical Director or Designee will ensure all Orientation and

Combined Synopsis 9

Background procedures have been completed, and an e-mail will be sent to the Contracting department to state as such. The Contract Personnel will NOT see patients until Background/Fingerprints have been cleared."

"The standards of medical practice and duties of the Contractor through its Contract Personnel shall be determined pursuant to the bylaws of the Service Unit. The regulations of the hospital, applicable provisions of law, other rules and regulations of any governmental authorities relating to licensure and regulation of Contract Personnel and hospitals must be followed. Also, the standards and recommendations of the Centers for Medicare and Medicaid Services (CMS) or the Accreditation organization must be adhered to. The Contract Personnel 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."

O. Offers will be accepted electronically. Submit via e-mail to the following: Great Plains Area Indian Health Service Division of Acquisition Management; Attn: David Jones, Contract Specialist.

Any questions, please submit by e-mail to: David.Jones@ihs.gov; before September 18, 2025, by 12:00 pm CT. Contractors will need a Unique Entity ID (UEI) number, TIN, and be registered with www.sam.gov.

Invoice Processing Platform (IPP)

The Indian Health Service (IHS) has implemented an electronic invoicing system. In compliance with the Office of Management and Budget (OMB) M-15-19 memorandum "Improving Government Efficiency and Saving Taxpayer Dollars Through Electronic Invoicing," directing Federal agencies to adopt electronic invoicing as the primary means to disburse payments to vendors. Invoices submitted under any award will be required to utilize the Invoice Processing Platform (IPP) in accordance with HHSAR 352.232-71, Electronic Submission and Processing of Payment Requests".

IPP is a secure, web-based electronic invoicing system provided by the U.S. Department of the Treasury's Bureau of the Fiscal Service, in partnership with the Federal Reserve Bank of St. Louis (FRSTL). Respondents to this solicitation are encouraged to register an account with IPP if they have not already done so. If your organization is already registered to use IPP, you will not be required to re-register. However, we encourage you to make sure your organization and designated IPP user accounts are valid and up to date. The IPP website address is:

https://www.ipp.gov.

If you require assistance registering or IPP account access, please contact the IPP Helpdesk at

(866) 973-3131 (M-F 8 AM to 6 PM ET), or IPPCustomerSupport@fiscal.treasury.gov. Should the contractor feel that the use of the IPP would be unduly burdensome, their response to this

Combined Synopsis 10 solicitation should include an explanation of this position for a determination by the contracting officer.

INSTRUCTION TO QUOTERS: To be determined responsive, your quote must include all of the information below. If the offeror/bidder fails to complete and return the forms, your offer/bid will be considered non-responsive.

75H70625Q00154

1. REQUEST NO.

5a. ISSUED BY

NAME

a. NAME

c. STREET ADDRESS

d. CITY

10. PLEASE FURNISH QUOTATIONS TO

THE ISSUING OFFICE IN BLOCK 5a ON

OR BEFORE CLOSE OF BUSINESS (Date)

2. DATE ISSUED 3. REQUISITION/PURCHASE REQUEST NO. 4. CERT. FOR NAT. DEF.

UNDER BDSA REG. 2

AND/OR DMS REG.1

RATING

6. DELIVERY BY (Date)

7. DELIVERY

9. DESTINATION

a. NAME OF CONSIGNEE

b. STREET ADDRESS

PAGE OF PAGES

5b. FOR INFORMATION CALL: (No collect calls)

TELEPHONE NUMBER

AREA CODE NUMBER

8. TO:

b. COMPANY

e. STATE f. ZIP CODE

c. CITY

d. STATE e. ZIP CODE

IMPORTANT: This is a request for information, and quotations furnished are not offers. 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)

THIS RFQ

REQUEST FOR QUOTATION

(THIS IS NOT AN ORDER)

IS IS NOT A SMALL BUSINESS SET ASIDEX

09/11/2025 IHS1513249

1 3

Federal Building 115 Fourth Ave, SE Aberdeen SD 57401

Aberdeen Area Indian Health Servic Multiple

IHSSISSETON

100 LAKE TRAVERSE DRIVE

SISSETON SD 57262

SISSETON

SD 57262

DAVID JONES1

09/25/2025 1200 CT

FOB DESTINATION

OTHER

(See Schedule)X

ITEM NO.

(a)

SUPPLIES/SERVICES

(b)

QUANTITY

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOUNT

(f)

1 Base Period - Physical Therapist NTE 1040HRS

Delivery: 04/30/2026 Period of Performance: 11/01/2025 to 04/30/2026

2 Option Period One (1) - Physical Therapist NTE

1040HRS

(Option Line Item) 05/01/2026

Delivery: 10/31/2026 Period of Performance: 05/01/2026 to 10/31/2025

Continued ...

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

13. NAME AND ADDRESS OF QUOTER

b. STREET ADDRESS

c. COUNTY

d. CITY e. STATE f. ZIP CODE

14. SIGNATURE OF PERSON AUTHORIZED TO

SIGN QUOTATION

16. SIGNER

a. NAME (Type or print)

c. TITLE (Type or print)

a. NAME OF QUOTER

AREA CODE

NUMBER

15. DATE OF QUOTATION

b. TELEPHONE are are not attached

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition not usable

STANDARD FORM 18 (REV. 6-95)

Prescribed by GSA - FAR (48 CFR) 53.215-1(a)

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

2 3

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H70625Q00154

3 Option Period Two (2) - Physical Therapist NTE

1040HRS

(Option Line Item)

11/01/2026

Delivery: 04/30/2027

Period of Performance: 11/01/2026 to 04/30/2027

4 Option Period Three (3) - Physical Therapist NTE

1040HRS

(Option Line Item)

05/01/2027

Delivery: 10/31/2027

Period of Performance: 05/01/2027 to 10/31/2027

5 Option Period Four (4) - Physical Therapist NTE

1040HRS

(Option Line Item)

11/01/2027

Delivery: 04/30/2028

Period of Performance: 11/01/2027 to 04/30/2028

6 Option Period Five (5) - Physical Therapist NTE

1040HRS

(Option Line Item)

05/01/2028

Delivery: 10/31/2028

Period of Performance: 05/01/2028 to 10/31/2028

7 Option Period Six (6) - Physical Therapist NTE

1040HRS

(Option Line Item)

11/01/2028

Delivery: 04/30/2029

Period of Performance: 11/01/2028 to 04/30/2029

8 Option Period Seven (7) - Physical Therapist NTE

1040HRS

(Option Line Item)

05/01/2029

Delivery: 10/31/2029

Period of Performance: 05/01/2029 to 10/31/2029

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 3

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H70625Q00154

9 Option Period Eight (8) - Physical Therapist NTE

1040HRS

(Option Line Item)

11/01/2029

Delivery: 04/30/2030

Period of Performance: 11/01/2029 to 04/30/2030

10 Option Period Nine (9) - Physical Therapist NTE

1040HRS

(Option Line Item)

05/01/2030

Delivery: 10/31/2030

Period of Performance: 05/01/2030 to 10/31/2030

Total Amt: $___________________________________

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

Performance Work Statement 1

WOODROW WILSON KEEBLE MEMORIAL HEALTH CARE CENTER

INDIAN HEALTH SERVICE

PERFORMANCE WORK STATEMENT

PHYSICAL THERAPY SERVICES

GENERAL

The Mission of the Sisseton Indian Health Service (IHS)/Woodrow Wilson Keeble Memorial Health Care Center (WWKMHCC) is to provide the best possible healthcare services to the patients on the Lake Traverse Reservation in South Dakota. To fulfill this mission, the WWKMHCC is requesting an all-inclusive, non-personal service contract for a Physical Therapist.

BACKGROUND

The IHS is an agency within the Department of Health & Human Services, 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 is divided into twelve (12) 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 19 Indian Health Service Units and Tribal Managed Service Units to provide healthcare to approximately 130,000 Native Americans 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 WWKMHCC, falls under the GPAO. WWKMHCC provides medical care for approximately 7,000 tribal members living on the Lake Traverse Reservation. Serving rural areas, many of our patients travel 100 miles round-trip to receive care. The WWKMHCC was established in 2007 to provide an expanded range of outpatient healthcare services, specifically designed to meet the needs of the WWKMHCC population. Services include Pharmacy, Physical Therapy, Public Health Nursing, Radiology Services, Laboratory, Dental, Community Health, purchased and referred care services, Nutrition Services, Behavioral Health, and Optometry.

OBJECTIVES

To provide uninterrupted physical therapy services in the delivery of patient care for the WWKMHCC. The Contract Physical Therapist shall provide physical therapy services that are compatible with the IHS medical facility's operating capacity and equipment on the Lake Traverse Reservation. The care shall cover the care typically provided in a rural civilian practice of similar size.

PERIOD OF PERFORMANCE

The period of performance will be a base period with nine (9) option periods. *Base period will be six (6) months, and each option period will be six (6) months.

Performance Work Statement 2

PLACE OF PERFORMANCE

Woodrow Wilson Keeble Memorial Health Care Center Indian Health Service 100 Lake Traverse Drive Sisseton, SD 57262

DESCRIPTION OF SERVICES

Upon the receipt of an IHS purchase order, the Contractor shall locate, credential, and have sufficient staffing available to provide coverage for a Physical Therapist in the WWKMHCC IHS in Sisseton, SD, during periods of permanent staffing absences. The Contractor shall provide a complete orientation of this scope of work to the Contract Physical Therapist before submitting the confirmation service agreement.

The contract resulting from this solicitation shall:

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

2. Allow the Government to evaluate the quality of professional and administrative services provided, but retain no control over the medical, professional aspects of the services rendered.

3. Require the Contractor to indemnify the Government for any liability-producing act or omission by the Contractor, its employees, and agents occurring during contract performance.

4. Require the Contractor to maintain medical liability insurance, in the coverage amount acceptable to the Contracting Officer, which is not less than the amount normally prevailing within the local community for the medical specialty concerned.

5. Require the Contractor to assume sole and exclusive responsibility for employee federal taxes, social security, unemployment insurance, and workman’s compensation.

6. Require the Contractor to provide daily compensation and travel reimbursements to each Contract Physical Therapist as appropriate.

CANDIDATE PRESENTATION. The Contractor shall present a candidate to the WWKMHCC Contracting Officer’s Representative (COR) for review by the Physical Therapy Supervisor within five (5) business days of the purchase order and will include the following documentation:

1. Full name

2. Date of birth

3. Social security number

4. Phone number

5. E-mail address

6. Current curriculum vitae with listing of all work experience, and explanations for any employment gaps

7. Signed release of information

8. Minimum of three (3) letters of reference (preferably within the past 6 months); must have (1) clinical supervisor and (2) peers from the same discipline

In the event the Physical Therapy Supervisor does not accept the Contract Physical Therapist, the documentation will be sent to the COR for review/comments, and the Contractor will have three (3) business

Performance Work Statement 3 days to present a new Contract Physical Therapist.

Upon acceptance of a Contract Physical Therapist, a complete background investigation and credentialing packet shall be sent to the contractor. The Contractor is responsible for ensuring that the proposed Contract Physical Therapist possesses the requisite credentials to enable the granting of privileges by the Sisseton Medical Staff, sufficient to allow for the performance of all tasks identified. The contractor shall send a fully completed background investigation and credentialing packet back within seven (7) days. The entire candidate presentation and paperwork completion shall be accomplished within thirty (30) days.

Once a Contract Physical Therapist has been cleared for suitability with a completed eApp and has been granted privileges, the Contractor shall submit a confirmation service agreement and include the following information:

1. Contract Physical Therapist name and phone number

2. Dates of service

3. Confirmation of completion of Contract Physical Therapist’s orientation to this scope of work

4. Point of contact and phone number

Before assumption of duty on any scheduled work shift, the Contract Physical Therapist may be briefed by the service unit Physical Therapy Supervisor or his/her designee concerning any matter relevant to the Contract Physical Therapist’s responsibilities under the terms of this contract. The Contractor shall advise the COR or his/her designee of any problem encountered in connection with meeting the needs of patients treated by the Contract Physical Therapist.

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 Health and Human Services (HHS) unless such a person seeks and receives approval in accordance with the Department of HHS.

CONTINUITY OF SERVICES. The Contract Physical Therapists’ services are considered vital to the Government and must be continued with minimal interruption. To minimize interrupted services, the Contractor shall exercise best efforts and cooperation to provide coverage during periods of permanent staff absence.

In the event the Contractor is unable to fulfill the purchase order requirements for whatever reason; the government reserves the right to fulfill its need outside of this contract. A written confirmation from the contractor indicating the inability to fulfill the purchase order is immediately required. The government’s right to fulfill its need outside this contract does not waive its right to the issuance of a cure notice, nor does it waive its right to terminate.

TECHNICAL REQUIREMENTS

The Contractor shall possess the following:

1. Ability to provide a Contract Physical Therapist in a timely manner who provides on-site physical therapy services to beneficiary patients of all ages that present for care to the WWKMHCC.

2. Ability to assist with completion of background investigation paperwork, E-APP, and credentialing

Performance Work Statement 4

Contract Physical Therapists by the established deadlines.

3. Ability to provide Contract Physical Therapists who can interact with patients and clinical staff in a customer-friendly and culturally sensitive manner.

4. Ability to provide Contract Physical Therapists who possess Electronic Health Record experience.

CONTRACT PHYSICAL THERAPIST REQUIREMENTS

COMPUTER SKILLS. Computer efficiency and experience with Electronic Health Records are required.

ENGLISH LANGUAGE REQUIREMENT. The Contract Physical Therapist(s) shall read, understand, speak, and write English fluently, and communicate with sufficient clarity to be understood by WWKMHCC personnel and patients.

HEALTH REQUIREMENTS. The Contract Physical Therapist shall not have any work or health restrictions that interfere with the performance of primary care provider services. The Contract Physical Therapist shall provide proof of current immunizations (Hep B, MMR, Varicella, Tdap, Flu, COVID) status or proof of immunity via a copy of laboratory findings. A current PPD within the past year is also required.

QUALIFICATIONS. Contract Physical Therapist shall have a degree from an accredited Physical Therapy program, maintain continuing education, and have a current Basic Life Support (BLS). The Contract Physical Therapist must have a minimum of 1 year of experience as a Physical Therapist within the past 36 months, and must meet all credentialing and background investigation requirements (see pages 6, 7, and 8).

CONTRACT PHYSICAL THERAPIST RESPONSIBILITIES

APPEARANCE. Contract Physical Therapists are expected to comply with reasonable dress, grooming, and hygiene standards, based on comfort, productivity, health, and the type of position occupied, as compatible with the expectations of the WWKMHCC IHS and the Native American community. Contract Physical Therapists' attire will be professional and in compliance with the expectations of the WWKMHCC Policy and Procedures, including displaying their identification badge on their outer clothing at all times.

CLINICAL DUTIES. The Contract Physical Therapist’s actual clinical duties will be in accordance with his/her credentialed privileges within the Medical Staff Bylaws of the WWKMHCC, and will include the following:

1. Evaluate and provide rehabilitation services for disabled patients as requested by the physicians.

The types of disabilities may include post-stroke, head injury, arthritis, burns, cardiac conditions, polio, muscular dystrophy, cerebral palsy, muscle or bone disorders, including strains, sprains, post-fractures, bursitis, and scoliosis, post-surgical, and both acute and chronic pain patients. The Physical Therapist will also see patients with non-disabling conditions, such as prenatal and postpartum patients, as requested by their physician.

2. Initiate an appropriate physical therapy program involving the patient and family in developing goals and objectives.

3. Provide physical therapy treatments with periodic evaluations of the program to determine the patient’s status and the effectiveness of the treatment regimen.

4. Consult with referring physicians regarding the progress of their patients.

5. Develop and teach written home treatment programs to patients and family when necessary.

Performance Work Statement 5

6. Participating in the Patient Centered Medical Home (PCMH) model and encourage patient engagement.

7. Utilize Electronic Health Record (EHR) computer software to document services provided to the patient.

8. Establish interpersonal, intra-departmental relationships, and social sensitivity such that he/she can relate constructively to patients from Native American communities to enhance optimal patient care.

9. Exhibit professional conduct among staff and patients, and respect and maintain the basic rights of patients, to include but not be limited to personal dignity, cultural sensitivity, privacy, and confidentiality. Violations of these policies may lead to the immediate removal of the Contract Physical Therapist from this contract and the facility.

10. Maintain familiarity and comply with Federal, State, Indian Health Service, accreditation standards, CMS regulations, and departmental regulations and requirements.

11. Participate in committees as assigned (Medical Staff, Purchase & Referred Care, Quality Assurance, Pain Management, Pharmacy & Therapeutics, Outpatient Department, etc.).

12. Staff development/education as assigned by Physical Therapy Supervisor.

13. Peer reviews/competencies as assigned.

COMMUNICATIONS. Contract Physical Therapists shall maintain open and professional communication with members of the Physical Therapy Staff and the OPD. Complaints validated by the Performance Improvement Coordinator and Physical Therapy Supervisor shall be reported in writing to the COR and the Contractor for action.

When the Physical Therapy Supervisor is absent, the Contract Physical Therapist shall follow the delegation of authority and perform duties as assigned by the Physical Therapy Supervisor’s designee.

ORIENTATION. All new Contract Physical Therapists will participate in the WWKMHCC facility orientation.

The orientation must be completed before providing services at the facility and will be scheduled for the first one (1) to three (3) days of arrival at the facility.

PRIVACY OF INDIVIDUALLY IDENTIFABLE HEALTH INFORMATION. The Contract Physical Therapists shall provide patients with the utmost care and attention. All patients shall be assured of their privacy and personal dignity. The Contract Physical Therapist 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, Health Insurance Portability and Accountability Act (HIPAA), and General Guidelines on Releasing Medical Information.

RECORDS. The Contract Physical Therapist shall generate and maintain proper medical record information on beneficiaries to whom treatment is provided in accordance with Indian Health Service regulations and policies set forth by the Health Information Management (HIM) Department. Verbal orders are to be used only in emergencies. In the event of a significant disaster or code, all verbal orders are to be signed off immediately following the code or disaster. The Contract Physical Therapist shall prepare all medical record documentation to meet or exceed the established standards of the IHS facility, including, but not limited to, timeliness, accuracy, content, and signature.

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All deadlines as determined by the facility shall be met, including:

1. All chart documentation is completed within 72 hours.

2. Notifications received in the Electronic Health Record (EHR) shall be completed within one (1) day.

3. Any deficiencies (documentation that is found incomplete by the HIM department) must be completed within one (1) day after notification.

All medical record information generated in the performance of this contract will remain the property of and subject to the exclusive control of the Indian Health Service.

QUALITY IMPROVEMENT. The standards of medical practice and the duties of the Contractor shall be determined in accordance with the bylaws of the WWKMHCC, the facility's regulations, applicable provisions of law, other rules and regulations of all governmental authorities related to the licensure and regulation of physical therapists, and accrediting standards. All Contract Physical Therapists shall be required to participate in a quality improvement program, which is consistent with current accreditation standards and Medicaid Services (CMS) Conditions of Participation (CoP) requirements for ongoing monitoring and evaluation of the quality and appropriateness of care.

PRIVILEGING REQUIREMENTS

A Contract Physical Therapist shall not perform physical therapy services until professional staff membership and clinical privileges have been granted in writing by the Governing Body of the WWKMHCC and the GPA in accordance with IHS policy. Any failure to comply with IHS privileging requirements shall be considered a breach of this contract.

In accordance with the Indian Health Service credentialing policy, a primary source verification shall be completed for all Contract Physical Therapists performing services under this contract. The WWKMHCC will provide the credentialing packet and all associated documents to the Contractor. The Contract Physical Therapist shall complete and return all documents within seven (7) business days of accepting the candidate.

Re-appointment shall occur no less than every two years, in accordance with WWKMHCC Medical Bylaws.

When submitting a potential candidate, the following documents are required for credentialing:

1. Medical Staff Application (provide explanations to any “yes” questions on liability, final judgments, settlements, or claims from the application); Must have evidence of good standing at all facilities where the Contract Physical Therapist practices; Must not have been subject to involuntary limitation, reduction, denial or loss of clinical privileges, and have no current federal sanctions and provide a history of previous or pending malpractice lawsuits

2. Copies of pre-professional and professional school diplomas showing proof of graduation from an accredited school of their profession.

3. Copy of Board Certification certificate or letter

4. Copies of all current licenses (active and inactive); Must maintain a current active and unrestricted license in at least one of the 50 United States or US territories

5. Copy of current liability insurance

6. Completed and signed clinical privileges request form (must be specific to the facility assigned and specific to the applicant’s abilities/competencies)

7. Signed Medicare Agreement form

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8. Signed Health Status Statement, including provider signature

9. Copy of immunization record (PPD within past year with x-ray if positive)

10. Signed Medical Staff Bylaws Attestation Statement

11. Three (3) letters of reference within the past year (one reference must be from the same discipline peer, and one reference must be from the current or most recent physical therapy supervisor)

12. Copy of a government-issued photo identification card (Driver’s license or passport)

13. Copy of Social Security card

14. Signed Confidentiality Statement

15. Signed Child Care and Indian Child Care Worker Positions Agreement

16. Current Continuing Medical Education (CME) for the past two (2) years

17. Copies of Basic Life Support (BLS) and if applicable, Acute Cardiac Life Support (ACLS) certification

18. Copy of National Provider Identification (NPI) notification letter

19. Signed Provider Signature Card

20. A current copy of the proposed Contract Physical Therapist’s professional curriculum vitae

(submitted with initial candidate presentation)

Exceptions to the Indian Health Service credentialing review and clinical privileges process will not be considered. The Contractor's failure to submit successful applicants shall not excuse nonperformance of contract requirements. Any Contract Physical Therapist who fails to maintain medical staff appointment and clinical privileges will not be permitted to perform services under the contract and shall be promptly replaced by the Contractor.

HOMELAND SECURITY PRESIDENTIAL DIRECTIVE-12 (HSPD-12)

The Homeland Security Presidential Directive 12 (HSPD-12) is the directive issued for the "Policy for a Common Identification Standard for Federal Employees and Contractors." HSPD-12 calls for all federal employees and contractors to use a standard smart credential to verify their identity for secure access to federal buildings and information systems. HSPD-12 called upon the National Institute of Standards and Technology (NIST) to develop the actual technical standard, and the Office of Management and Budget (OMB) to manage implementation of the credentials. The uses of the credentials are left to the agencies themselves to decide. The purpose of HSPD-12 is to establish a standard and reliable method for verifying the identification of government employees and contractors. It will help to protect against a variety of threats, including:

In compliance with HSPD-12, the Health and Human Services, Indian Health Service (IHS), Woodrow Wilson Keeble Memorial Health Care Center, establishes the requirement to evaluate and investigate all federal employees and contractor employees before issuing a Personal Identification Verification (PIV) card. Thus, all persons privileged to be employed in the Federal Government shall be reliable, trustworthy, of good conduct and character, and of complete and unwavering loyalty to the United States. The HSPD-12 link below outlines the federal law requiring PIV cards for accessing federal networks. A PIV card ID is required after the 120-day waiver period, with no exceptions. Homeland Security Presidential Directive 12:

Policy for a Common Identification Standard for Federal Employees and Contractors https://www.dhs.gov/homeland-security-preseidential-directive-12. It is a mandatory requirement that all IHS

Performance Work Statement 8 information system users must complete annual security training to fulfill Federal mandates and regulations.

Additionally, all new users must complete this course within 24 hours of onboarding. Failure to complete the training requirements will result in the loss of access to information systems.

CRIMINAL BACKGROUND CHECK REQUIREMENT. The Government will conduct, at its expense, a Tier 2 with Subject Interview (T2S) and state criminal history checks on individuals providing direct, unsupervised childcare services under this contract. This investigation will be conducted at the expense of the Government and will be based upon the Federal Bureau of Investigation (FBI), state, and local criminal history repositories.

The Contract Physical Therapist is subject to Public Law 101-630, The Indian Child Protection and Family Violence Prevention Act. The Indian Health Service Personnel Office will conduct the criminal background investigations and obtain fingerprints on each Contract Physical Therapist provided by the Contractor. Until the character investigation has been completed and the Contracting Officer notified of the results, the Contract Physical Therapist must not have unsupervised contact with Indian children or access to Federal Information Systems that contain Personally Identifiable Information (PII) or Protected Health Information (PHI). The investigation may take several months to complete. Contract Physical Therapists receiving unfavorable background investigations shall not be employed. If at any time the contractor fails to meet or maintain suitability or eligibility for Federal employment, the contractor will be removed from providing services at the WWKMHCC.

The Contractor shall submit completed personnel background check applications within seven (7) working days after candidate acceptance. Any corrections needed to the background investigation process must be completed and resubmitted within seven (7) days.

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.

SCHEDULING

ADMINISTRATIVE TIME. Each provider may receive up to one (1) hour of administrative time per shift, as allowed based on the patient workload. All documentation shall be completed during the allowed administrative time. On the last scheduled working day, the Contract Physical Therapist shall receive administrative time to ensure that all documentation is completed before departing, and shall check out with the Health Information Management (HIM) department to confirm completion of all records.

PATIENT SCHEDULING. Facility personnel will assist in patient scheduling. The initial patient evaluation will be scheduled for seventy-five (75) minutes in length for the first two (2) weeks of orientation. Thereafter, initial patient evaluations will then be scheduled for sixty (60) minutes. Follow-up patient visits will be scheduled for sixty (60) minutes for the first two (2) weeks of orientation. Thereafter, follow-up patient visits will be scheduled for forty-five to sixty (45-60) minutes, depending on patient need.

TIMESHEETS. The Contract Physical Therapist will be responsible for reporting to work at the scheduled time. All Contract Physical Therapists will utilize the time clock to ensure accurate documentation of hours worked, which will be verified with submitted timesheets and invoices before payment is processed. Only hours authorized by the Physical Therapist Supervisor or designee will be authorized for payment.

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WORK SCHEDULE. Work shifts will be eight (8) hours, Monday through Friday, 8:00 am to 4:30 pm (30-minute lunch break). Occasionally, additional hours may be required if an emergency evaluation is requested.

The average number of hours worked per week is 40. There are no weekend or holiday requirements. Work hours will be scheduled by the Physical Therapy Supervisor or their designee to correspond with the facility's needs and are subject to change. Any work performed beyond 40 hours per week requires pre-approval from the Physical Therapy Supervisor or their designee.

EVALUATION AND PERFORMANCE REQUIREMENTS

The Contractor shall allow the Government to evaluate the quality of the professional and administrative services provided in accordance with the technical requirements of this contract. This assessment will include observations of the work system, methods, and execution.