PWS TeleHealth Speciality-JR 8-14-2024.docx

Section Performance Work Statement (PWS)

1.1 Background

1.1.1 Organization Overview. The Billings Area Office (BAO) of the Indian Health Service (IHS) is charged with providing healthcare services to the eligible Native American population within Montana and Wyoming. In order to achieve IHS' commitment for improving BAO health care system to allow better access and efficient spending to patients, the IHS intends to continue the utilization of health care services provided through telehealth specialty services.

1.1.2 BAO Network.

The BAO IHS Facilities include: Blackfeet Service Unit-Blackfeet Community Hospital with ER, Browning, Montana and Heart Butte Health Station, Heart Butte, Montana; Crow Service Unit-Crow/Northern Cheyenne Hospital with ER, Crow Agency, Montana, Lodge Grass Health Clinic, Lodge Grass, Montana and Pryor Health Station, Pryor, Montana; Fort Belknap Service Unit-Fort Belknap Hospital with ER, Harlem, Montana and Eagle Child Health Station, Hays, Montana; Fort Peck Service Unit-Verne E. Gibbs Clinic, Poplar, Montana and Chief Redstone Clinic, Wolf Point, Montana; Northern Cheyenne Service Unit-Northern Cheyenne Health Center with ER, Lame Deer, Montana; Little Shell Service Unit-Little Shell Clinic, Great Falls, Montana.

1.2. Scope of Work

The primary function of the telehealth provider shall be to provide remote patient care services in the specialty of his or her training. The Contractor will be responsible for the planning, coordination, development, implementation, deliver, management of program and quality assurance of telehealth solutions that will allow IHS patient’s access to Telehealth Specialty service for defined clinical domains and Scope of Service withing the specific Service Unit, significantly improving access to care by reducing the delay and costs involving patient travel. Telehealth visits will be scheduled for conditions or problems in which a virtual visit is most likely to be suitable, for example, but not limited, 1) management of chronic conditions such as diabetes or hypertension; 2) discussion of test results or diagnostic studies; 3) counseling about diagnostic and therapeutic options; 4) dermatology; 5) medication management; 4) nutrition counseling.

The Government shall neither supervise contractor employees nor control the method by which the contractor performs the required tasks. Under no circumstances shall the Government assign tasks to, or prepare work schedules for, individual contractor employees.

It shall be the responsibility of the contractor to manage its employees and to guard against any actions that are of the nature of personal services, or give the perception of personal services. If the contractor believes that any actions constitute, or are perceived to constitute personal services, it shall be the contractor's responsibility to notify the Contracting Officer (CO) immediately.

1.2.1. Contract Administration and Management

The contractor shall successfully integrate and coordinate all activity needed to execute the requirement. The contractor is required to provide quality assurance services and effective management of subcontractors. The contractor shall seek to ensure customer satisfaction and professional and ethical behavior of all contractor personnel.

1.2.2. Project Manager.

The contractor must provide a project manager who is responsible for the performance of the work. The name of this person, and an alternate(s) who must act for the contractor when the manager is absent, must be designated in writing to the contracting officer.

1.2.2.1. The project manager or alternate must have full authority to act for the contractor on all contract matters relating to the daily operation of this contract.

1.2.2.2. The project manager or alternate must be available during normal business hours within 30 minutes to meet with government personnel (designated by the contracting officer) to discuss problem areas. After normal business hours, the manager or alternate must be available within four hours.

1.2.2.3. The project manager and alternate(s) must be able to read, write, speak, and understand English.

1.2.2. Contract Employees

1.2.2.1 BAO needs the contractor to accomplish the assigned work by employing and utilizing qualified personnel with appropriate combinations of education, training, licensure/certification, and experience.

1.2.2.2 The contractor will maintain accreditation for Telehealth services from a nationally recognized accreditation organization. The contractor shall ensure the labor categories and labor rates utilized for the performance under the awarded contract will be maintained throughout the performance period.

1.2.2.3 The Contractor shall be responsible for establishing, implementing, and maintaining Tele-health specialty service program to be deployed across the IHS service units within the BAO, including options for provider-to-provider consultations.

1.2.2.4 The contractor shall use the IHS EHR system to maintain accurate and up-to-date information on clinical care provided to patients.

1.2.2.5 The Tele-Health service is to be provided via the agency's existing video and network infrastructure.

1.2.2.6 The contractor shall ensure an adequate level of staffing is organized to meet the requirements and all contractor staff’s credentials (e.g., security clearance, computer security training, and degrees and/or certifications, etc.) are current. Including Clinical Contractor Staff meet requirements for being "Credentialed and Privileged" in accordance with the Commissioned Corps of the Public Health Service, the Office of Personnel Management, HHS Regulation and IHS policy. Existing regulations require that these individuals be graduates of approved recognized programs in their fields and legally qualified to practice in a federal facility. Providers working with contractor and must be approved by the Governing Body by being privileged prior to performing any services within BAO Indian Health Service.

1.2.2.7 Ensure all contractor staff are culturally sensitive and appropriate. The Contractor shall provide adequate level of training to the IHS staff to support the Tele-Health services at the originating site, shall support and maintain Tele-Health systems and provide helpdesk support for Tele-Health equipment, associated software, and other system issues for IHS in the BAO.

1.2.2.8 The contractor shall establish clear organizational lines of authority and responsibility to ensure effective management of the resources assigned to the requirement. The contractor must maintain and ensure continuity of the tele-health operations between the contractor's corporate offices and the Indian Health Service.

1.2.3. Contract Administration

The contractor shall establish processes and assign appropriate resources to effectively administer the requirement. The contractor shall respond to Government requests for contractual actions in a timely fashion. The contractor shall have a single point of contact (Project Manager) between the Government and Contractor personnel assigned to support contracts or task orders. The contractor shall assign work effort and maintain proper and accurate time keeping records of personnel assigned to work on the requirement.

1.2.3.1. The Contractor and the Project Manager will meet with the Contracting Officer Representative (COR) and HIS officials within seven days of the contract award to become acquainted with the IHS staff, review the Performance Work Statement (PWS), discuss timelines and deliverables, and to begin initial planning. The Contractor, the Project Manager, and COR will hold kick-off meetings at the beginning of each option year of the contract to revisit and adjust (if necessary) to the comprehensive action plan, quality assurance plan, communications plan, evaluation plan, and project plan, to discuss ongoing tasks in the PWS, and deliverables for each option year.

1.2.4 Personnel Administration

The contractor shall maintain the currency of their employees by providing initial and refresher training as required to meet the PWS requirements. The contractor shall make necessary travel arrangements for employees and maintain adequate infrastructure to support contract tasks.

1.2.5 Subcontract Management

The contractor shall be responsible for any subcontract management necessary to integrate work performed on this requirement and shall be responsible and accountable for subcontractor performance on this requirement. The prime contractor will manage work distribution to ensure there are no Organizational Conflict of Interest (OCI) considerations. Contractors may add subcontractors to their team after notification to the CO and COR.

1.2.7 Location and Hours of Work

Accomplishment of the results contained in this PWS requires work at various Government (IHS) facilities. Normal workdays are Monday through Friday except US Federal Holidays. Workers typically work eight (8) hours per day, 40 hours per week. Flextime workers start not earlier than 0600 and not later than 2100 (Mountain time zone). Core hours of work are from 0900 to 1700 daily. All employees and required services are expected to be available during core hours.

2. Travel / Temporary Duty (TDY) All travel requirements (including plans, agenda, itinerary, or dates) shall be pre-approved by the government (subject to IHS and local policy procedures), and is on a strictly cost reimbursable basis. Costs for travel shall be billed in accordance with the regulatory implementation of Public Law 99-234 and FAR 31.205-46 Travel Costs (subject to IHS and local policy & procedures; may reference FAR).

The Contractor will be responsible for coordinating the logistics of all training to include travel, per diem, lodging of non-federal subject matter expert instructors. Travel for training participants will not be covered under this contract.

3. Performance Requirements Contractor shall receive referrals from a patient’s primary care provider. Referrals will be made via the IHS Electronic Health Record. Virtual visits will be conducted in the outpatient clinic setting and will usually be scheduled to occur Monday through Friday between 0800 and 1630 Mountain Time.

Specialties will be mutually agreed upon based on the needs within the community and may include:

• Endocrinology

• Rheumatology

• Dermatology

• Nephrology

• Cardiology

• Neurology

• Gastroenterology

• Hepatology

• Infectious Diseases

• Behavioral Health: Psychiatry, Psychology, Counseling both Adult and Pediatrics)

It is expected that patients will be scheduled for a virtual visit within 30 days of the placement of a referral. To maintain continuity, Contractor will provide, when possible, access to the same provider for patients with additional visit needs.

It is expected that all visits will be conducted as scheduled, but if they are a no show then we will pay a percentage of the original visit cost per the fee schedule for that specialty.

The Contractor will document Telehealth Specialty Clinic visits into the IHS EHR directly.

Accurate Common Procedural Terminology (CPT) coding shall be documented for all clinic patient encounters.

Contractor is expected to use evidence-based diagnostic and treatments protocols and decision-making algorithms that assist in the delivery of best possible patient care. Contract providers are expected to follow the IHS formulary list maintained by the IHS facility Pharmacy and Therapeutics Committee. In cases where patients require in-person office visits or other specialized treatment, Contractor will communicate this information to the referring provider and will, when possible, facilitate the patient’s ongoing care.

All patients shall be assured of their privacy and personal dignity. The Contractor shall also ensure that contract providers maintain open and professional communication with IHS staff, including a willingness to receive telephone and electronic communications from primary care providers in order to optimize coordination of patient care.

4. EHR/Health Records:

The Contractor will be required to utilize the facility Electronic Health Record (EHR) for all patient encounter documentation. The contractor shall complete all documentation required by the Health Information management department (HIM). This includes completing all coding and purpose of visit diagnoses.

All medical records must meet acceptable standards as determined by the hospital’s Performance Improvement (PI) department and the Health Information Management (HIM) Department. All Contract staff are expected to complete all EHR patient encounter notes, Purposes of Visits (POV) and medical levels on every patient and in a timely manner.

Medical record deficiencies can seriously impact the ability of the hospital to bill alternate resources. Therefore, any significant medical deficiencies may prevent processing of final purchase orders. If this situation occurs the Area Office contracting office and contracting company shall be promptly notified in order to quickly rectify.

5. Knowledge Required:

Ability to collect, organize, record, and communicate, in a meaningful way, data relevant to primary health assessments including detailed family and medical history, physical examinations and selective laboratory tests in order to evaluate and treat adult medicine patients on an inpatient ward facility.

Ability to identify medical conditions that warrant medical treatment available at the local hospital facility and when to transfer patient to higher level of care hospital facility for indicated medical care.

Ability to assess the physical-psychosocial health status of patients and family based upon the knowledge of growth and development patterns and health conditions that require medical management.

Knowledge of pharmaceuticals in order to recognize the desired effects, side effects and complications of their use.

Knowledge of human behavior during stressful situations in order to exercise emotional control, tact, patience, and reliability in providing urgent patient care.

Ability to provide individual and family counseling, guidance, and health instruction to help patients to understand how to prevent disease and maintain good physical and mental health.

6. Qualifications:

6.1 General

Licensed independent practitioners must fulfill all the requirements for appointment to the IHS Medical Staff and for the granting of core privileges in their chosen specialty, in accordance with IHS policies and with the Medical Staff Bylaws of the facility, including absence of exclusions or sanctions from the Medicare/Medicaid programs.

6.2 Physicians

Must be Board-Eligible or Board-Certified in their chosen specialty and have at least 24 months of direct patient care experience within the last 48 months.

6.3 Advanced Practice Nurse Positions:

Must possess a graduate or higher-level degree in nursing from an accredited educational program in the area of expertise or specialty indicated by the position. Must have passed the National Council Licensure Examination. In addition, must possess a current, active, full, and unrestricted license or registration as a professional nurse from a State, the District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States.

At least 24 months of direct patient care experience within the last 48 months.

6.4. The Contractor shall implement telehealth systems for health care facilities in the Billings Area. This will include Specialty Referrals Clinics, including options for provider-to-provider consultations

6.5. The Contractor shall determine and provide necessary equipment and software to enable telehealth solutions (not inclusive of the IHS network). This includes, but is not limited all telehealth acquisition modalities and supporting Health Information Technology (HIT) as required by the scope of the Specialty Telehealth Clinics

Performance Standards and Acceptable Quality Level (AQL)

1) Timely

a. AQL: Deployment shall occur in accordance with the deliverables schedule

2) Services

a. AQL: All required specialty referrals services shall be provided by the contractor.

3) Space

a. AQL: Contractor shall design and execute the tele-health system implementation based on availability of space at the originating site.

4) Complexity

a. AQL: Tele-health equipment must be easily used by a wide range of staff with minimal training.

b. AQL: At minimum, Tele-health support equipment shall be composed of remote control enabled monitor, camera, and microphone.

c. AQL: All medical devices or medical components of devices shall be FDA approved for their intended use.

d. AQL: All video/audio conferencing equipment shall be Cisco/Polycom compatible.

Deliverables A001 Telehealth Equipment Deployment Schedule If needed A002 Catalog of Available Equipment A003 Site Service Needs Report A004 Training Agenda

6.6. The contractor shall use the IHS Electronic Health Record (EHR) system to maintain accurate and up-to-date information on clinical care provided to patients.

EHR systems are located at each IHS facility and remote access to each EHR system will be enabled through the IHS VPN system. The tele-health services are to be provided via the agency’s existing video and network infrastructure as delineated in the Appendix D, IT System Environment. Cloud services are not to be utilized for this contract, unless, the contractor’s system meets the requirements described under Appendix F, Cloud Services Definition and Requirement.

Performance Standards and AQL

1) Timely

a. AQL: Tele-health solution shall integrate with IHS system environment in accordance with the PWS subsection 4.1 - Deliverables Schedule.

2) Security

a. AQL: Telehealth equipment shall encrypt Personally Identifiable Information (PII) for storage and transmission.

3) Connectivity

a. AQL: Prior to deployment, contractor shall assess network and system connectivity at each originating site for a proper guide service.

Deliverables B001 Telehealth Deployment Schedule B002 Security Compliance Report B003 Site Connectivity Report

6.7. Upon contract award, the contractor shall ensure an adequate level of staffing is organized to meet the requirements and all contractor staff’s credentials (e.g., security clearance, computer security training, and degrees and/or certifications, etc.)

are current.

Performance Standards and AQL

1) Timely

a. AQL: Site and/or Area Credentialing and Privileging Report shall be provided in accordance with the deliverables schedule in accordance with subsection 4.1 – Deliverables Schedule.

2) Security Standard

a. AQL: All contractor staff shall meet the required minimum standards under Title 42 CFR Part 136 Subpart K. and Title 5 CFR 731.

Deliverables C001 Site and/or Area Credentialing and Privileging Report C002 Fingerprints, eQIP questionnaire and all required accompanying documents

6.8. Upon contract award, the contractor shall ensure all clinical contractor staff meet requirements for being Credentialed and Privileged in accordance with HHS Regulation and IHS policy. Credentialing and Privileging shall include, but is not limited to: verification of U.S. licensure, board-certification, periodic quality assurance review, and provider database queries, including the National Practitioner Data Bank.

Performance Standards and AQL

1) Credentialing and Privileging

a. AQL: Clinical staff shall be fully credentialed and privileged at each site they practice in.

2) Quality Assurance Reviews

a. AQL: No delinquent Quality Assurance Reviews

3) Credential Standard

a. AQL: All credentials shall be issued by accredited institutions in the United States and subject to Prime Source Verification. The contractor will make available their credentialing policy and procedures for review by IHS after which time IHS may decide to offer or decline privileging by proxy.

Deliverables D001 Site and/or Area Credentialing and Privileging Report D002 Provider Quality Assurance Reviews

6.9. The Contractor shall provide adequate level of training to the IHS staff to successfully support the telehealth services at the originating site.

Performance Standards and AQL

1) Timely

a. AQL: Contractor will schedule regular, ongoing training regarding the use and support of the telehealth equipment.

2) Materials

a. AQL: Contractor will develop and/or provide enduring training materials in the form of recorded video or online learning modules in appropriate formats consistent with current technology and accessibility standards.

b. AQL: Contractor will guide and assist with the development of IHS-approved standardized protocols for initiation of Tele-ED services, to include indications and method(s) for initiation.

3) Evaluation

a. AQL: Training plans and materials will be provided at the request of IHS and are subject to review and approval by IHS no less than annually.

Deliverables E001 Training Agenda & Schedule E002 Training Materials

6.10. The Contractor shall support and maintain telehealth systems for IHS (not inclusive of the IHS network) in Billings Area. The Contractor shall establish and support specialty referrals clinics (Appendix C) at BAO health care sites (Appendix B). Distant site specialty telehealth providers will evaluate, treat, and follow-up originating site IHS patients facilitated by an originating site Presenter, or will provide consultation services to an originating site IHS provider. Originating site Presenter services will be provided to initiate and conclude each encounter. Upon request of the distant site specialist and/or the originating site IHS patient, the Presenter may depart the encounter but remain available nearby to conclude the encounter upon notification.

Performance Standards and AQL

1) Documentation

a. AQL: Contracted staff will document all patient encounters in the IHS EHR.

b. AQL: Accurate Common Procedural Terminology (CPT) coding shall be documented for all patient encounters.

2) Timely

a. AQL: Contracted staff will provide telehealth clinics at the appointed time agreed upon by the site, during regular business hours, and meeting access to care standards for the visit type.

b. Documentation will be completed within 48 hours of patient contact.

3) Communication

a. AQL: As evidenced by no more than two substantiated complaints from the originating site in any three month period.

4) Best-Practice care

a. AQL: No practice below the level of Best-Practice shall be provided, as determined by chart and/or quality assurance review.

b. AQL: If Specialty Consultant employs mid-level providers, the Specialty Consultant must be directly involved in every medical encounter.

Deliverables F001 Published Schedule and Contact Information F002 Quarterly CPT Coding Audit Report F003 Monthly and Annual Report of Complaints F004 Chart or Quality Assurance Review Reports

6.11. The Contractor shall ensure an adequate level of staffing to meet the requirements and that all contractor staff’s credentials (e.g., security clearance, computer security training, and degrees and/or certifications, etc.) are current and approved within either IHS or nationally recognized accreditation standards

Performance Standards and AQL

1) Credential continuity maintenance

a. AQL: Contractor staff shall meet all federal, HHS and IHS rules, regulations, and policies regarding security, protected information, etc.

b. AQL: There shall be no lapse involving contract staff security credentials or training.

2) Service availability

a. AQL: Services shall be adequately staffed with required security clearance status at all time.

b. AQL: Immediate action shall be taken to remove unsuitable/ineligible staff from services and replacement of the staff shall be made within 24 hours with appropriately cleared staff.

3) New Credentials

a. AQL: All required documentation required for security clearance process shall be submitted at least 30 days prior to the subject staff’s performance start date.

Deliverables G001 Report on contractor staff’s security and training status G002 Reports of service lapses.

6.12. The Contractor shall ensure all clinical contractor staff are eligible for Credentialing and Privileging at each site. Credentialing and Privileging may include, but is not limited to: U.S. licensure, board-certification, peer review, and provider database queries.

Performance Standards and AQL

1) Credentialing and Privileging

a. AQL: Clinical staff that are fully credentialed and privileged for each site they practice in.

2) Quality Assurance Reviews

a. AQL: No delinquent Quality Assurance Reviews.

Deliverables H001 Site and/or Area Credentialing and Privileging Report H002 Provider Peer Reviews

6.13. The Contractor shall ensure all contractor staff communicate and coordinate effectively and efficiently with the originating site staff.

Performance Standards and AQL

1) Communication

a. AQL: No more than two substantiated complaints related to communication within a year.

2) Adverse Events

a. AQL: No more than one substantiated adverse patient event within a year due to communication errors.

Deliverables I001 Annual Report of Staff Complaints I002 Site-Specific Reports of Adverse Events

6.14. The Contractor shall ensure all contractor staff are culturally sensitive and appropriate.

Performance Standards and AQL

1) Training Provides evidence of training in cultural sensitivity/competence

a. AQL: All contractor staff shall take one hour of CME/CE training on cultural sensitivity/competence each year.

2) Customer Service

a. AQL: No more than two substantiated complaints from patient or staff related to culture sensitivity/competence within a year Deliverables J001 Annual Training Report J002 Annual Report of Patient & Staff Complaints

7. Special Requirements This section describes the special requirements for this effort. The following sub-sections provide details of various considerations on this effort.

7.1. Security and Safety

Contractor staff will be required to follow the procedures for obtaining a full Federal background investigation and preliminary clearance. No 3rd party investigation is allowed.

In order to obtain a Personal Identity Verification (PIV) card, contractor staff shall complete and pass a Federal background investigation conducted by the Office of Personnel Management. IHS will process the investigations through the Office of Personnel Management on all contractor staff.

Processing of PIV cards shall be completed by the Billings Area HSPD-12/Suitability Office in conjunction with the physical locations throughout IHS and HHS that have PIV card stations. The contractors will be required to be physically present at one of the HSDP- 12 enrollment and issuance workstations to obtain a PIV card. Biometric identification is required.

Each contractor shall complete each of the requirements below and receive pre-employment clearance from IHS prior to performing services under this contract:

1) Fingerprints must be captured electronically at a HHS enrollment workstation or via hard-copy card then sent to the Billings Area (GPA) for digital processing;

2) The OF-306, Declaration for Federal Employment, shall be completed;

3) The Addendum to the OF-306, shall be completed;

4) eQIP Information request must be turned into the HSPD-12/Suitability Office;

5) The eQIP questionnaire must be fully and accurately submitted; and

6) The contractor must be enrolled for a PIV card at a HHS HSPD-12 enrollment workstation. Upon receipt of the card, the contractor must activate it at a HHS HSPD- 12 card issuance workstations.

The Contractor shall ensure that the employees it proposes for work under this contract have a reasonable chance for approval. If at any point during the investigation process a contractor staff is deemed ineligible or found to have other than favorable suitability, the individual must be removed from providing services under this contract.

The Government may investigate personnel at no cost to the Contractor. However, multiple investigations for the same position due to contractor personnel’s employment change, termination, or consequent re-investigations within one (1) year period, will lead to the reduction in the contract price of no more than the cost of the additional investigation.

7.2. Reporting

The contractor shall follow the reporting plan submitted as part of the proposal and keep the Government fully informed of status throughout the contract period. Throughout the contract periods, it is essential that attention be given to minimize interruptions or delays to work in progress that would impact the mission. All reports generated under the scope of the contract shall be Section 508 compliant.

7.3. The Contractor shall provide bi-annual status reports to the COR to include:

Telehealth Specialty Clinics:

• Number of patients seen o By clinic o By site

• Number of patients referred back to the referral source for continued care

• Number of patients requiring continued referral care via telehealth

• Number of patients requiring additional unique referrals to other specialists

• Any official complaints

• Any adverse outcomes

7.4. Annual Performance Report

The Contractor shall provide to the COR, annual performance reports that include but are not limited to project plan status and accomplishments, fiscal accountability, evaluation data, sub-Contractor performance reports (if applicable) and a Contractor self-evaluation report. The Contractor shall provide a written outline of the annual report to the COR for approval according to the deliverable schedule. The annual reports shall be delivered by e-mail and postal service according to the deliverable schedule before the end of the contract period. The annual report shall be discussed at the kick-off meeting.

Deliverables K001 Bi-Annual Status Report K002 Annual Performance Report

7.5. Storage and Disposition of Materials

Disposition of any national training and marketing materials will be determined in the kickoff meeting. Storage should be available as soon as national materials are generated. A disposition schedule will be discussed with the COR during the kick-off meeting.

7.6. Correspondence and Conference Calls

The Contractor shall provide weekly updates and correspondence as determined necessary by the COR or GPA CMO. The weekly conference call schedule may be adjusted as determined by the COR.

7.7. Deliverables

The contractor shall provide deliverables as described in subsequent task orders. Deliverables shall be specified by the Government.

SECURITY CLEARANCE

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

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

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 prior to the start of work, the performance of the work the Contractor shall provide to the Contracting Officer the names of all individuals to be used in performance of 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 I.H.S. is not on the LEIE and 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 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 or 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.

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

Employees that DO NOT have access to LMS, contractors, volunteers, or IHS employees with IPA’s or MOA’s to tribal organizations please, click here IHS Sexual Abuse Prevention website. When the contractors have completed and passed the training, please have them send a copy of the last page of the training with Name, Date, and Time to their Supervisor, COR, and Head of Billings Area Office Security Clearance.

ACCEPTANCE PERIOD: Your proposal must stipulate that it is predicated upon all the terms and conditions of this RFP. In addition, it must contain a statement to the effect that it is firm for a period of at least 90 days from the date of receipt by the Government.

No contract award shall be made to any vendor listed on the OIG Exclusions List at http://exclusions.org.hhs.gov throughout the duration of the contract.

Contractor must be registered with the System for Award Management (SAM) at www.sam.gov

“Contractor Personnel will arrive on a Business Day ONLY to complete all Orientation and Background procedures, as necessary. The Clinical Director or Designee will ensure all Orientation and Background procedures have been completed and an email will be sent to the Contracting department to state as such. The Contractor Personnel will NOT see patients until Background/Fingerprints have been cleared.”

“The standards of medical practice and duties of the Contractor through its Contracting 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 and all governmental authorities relating to licensure and regulation of physicians and hospitals must be followed. Also the standards and recommendations of Centers for Medicare and Medicaid Services (CMS) or the Accreditation Organization must be adhered to. The Contract Contracting 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.”

INTERCONNECTION SECURITY AGREEMENT (ISA)

Before an entity to the IHS connects to any IHS System, an ISA must be in place and appropriate security controls must be implemented or configured.

All of the staff members are off-site and do not require physical or network access. Any staff member that comes on-site needs to be accompanied by a cleared IHS staff member at all times and cannot gain access to the IHS network without meeting the requirements as outlined in

HANDLING OF DATA

The Contractor agrees to the extent that it receives or is given access to data necessary for the performance of contract which contains restrictive markings, the Contractor shall treat the data in accordance with such markings unless otherwise specifically authorized in writing by the Contracting Officer.

SECURITY OF DATA

The Contractor shall comply with any security requirements established by HHS to ensure proper and confidential handling of data and information. The Contractor shall refer to “HHS Cybersecurity Program.”, which is HHS’ Information Security Program Policy, dated June 2010.

The contractor shall become familiar with the HHS Departmental Information Security Policies which may be found at http://www.hhs.gov/ocio/policy/2007-0002.html.

“HHS Cybersecurity Program” develops policies, procedures, and guidance to serve as a foundation for HHS' information security program. These documents implement relevant Federal laws, regulations, standards, and guidelines that provide a basis for the information security program at the Department. The contractor must become familiar with ‘HHS Cybersecurity Program” guidelines as presented at http://www.hhs.gov/ocio/policy/index.html#Security.

Data obtained for this contract shall not be used to create databases or any other product not intended for use specifically in this project. All data containing personal identifiers shall be handled in accordance with the Privacy Act of 1974 (Public Law 93-579). No data is to be released to anyone without the specific approval of the COR and the Contracting Officer.

HHS-CONTROLLED FACILITIES AND INFORMATION SYSTEMS SECURITY

a. To perform the work specified herein, Contractor personnel are expected to have routine

(1) physical access to an HHS-controlled facility; (2) logical access to an HHS-controlled information system; (3) access to sensitive HHS data or information, whether in an HHScontrolled information system or in hard copy; or (4) any combination of circumstances

(1) through (3).

b. To gain routine physical access to an HHS facility, logical access to an HHS-controlled information system, and/or access to sensitive data or information, the Contractor and its employees shall comply with Homeland Security Presidential Directive (HSPD)-12, Policy for a Common Identification Standard for Federal Employees and Contractors; Office of Management and Budget memorandum (M-05-24); and Federal Information Processing

Standards Publication (FIPS PUB) Number 201; and with the personal identity verification and investigation procedures contained in the following documents:

1. HHS Information Security Program Policy.

http://www.hhs.gov/read/irmpolicy/121504.html

2. HHS Office of Security and Drug Testing, Personnel Security/Suitability Handbook, dated February 1, 2005. http://www.knownet.hhs.gov/acquisition/pssh.pdf

3. HHS HSPD-12 Policy Document, v. 2.0.

http://www.whitehouse.gov/sites/default/files/omb/assets/omb/memoranda/fy2005 /m05-24.pdf

c. This contract/order will entail the following position sensitivity level(s): Level 5: Public Trust - Moderate Risk.

d. The personnel investigation procedures for Contractor personnel require that the Contractor prepare and submit background check/investigation forms based on the type of investigation required. The minimum Government investigation for a non-sensitive position is a National Agency Check and Inquiries (NACI) with fingerprinting. More restricted positions--i.e., those above non-sensitive, require more extensive documentation and investigation. The Contractor shall notify the Contracting Officer in advance when any new personnel, who are subject to a background check/investigation, will work under the contract and if they have previously been the subject of national agency checks or background investigations.

e. Investigations are expensive and may delay performance, regardless of the outcome of the investigation. Delays associated with rejections and consequent re-investigations may not be excusable in accordance with the FAR clause, Excusable Delays--see FAR 52.249-14.

Accordingly, the Contractor shall ensure that any additional employees whose names it submits for work under this contract have a reasonable chance for approval.

f. Typically, the Government investigates personnel at no cost to the Contractor. However, multiple investigations for the same position may, at the Contracting Officer's discretion, justify reduction(s) in the contract price of no more than the cost of the additional investigation(s).

g. The Contractor shall include language similar to this ``HHS-Controlled Facilities and Information Systems Security'' language in all subcontracts that require subcontractor personnel to have the same frequency and duration of (1) physical access to an HHS controlled facility; (2) logical access to an HHS-controlled information system; (3) access to sensitive HHS data/information, whether in an HHS-controlled information system or in hard copy; or (4) any combination of circumstances (1) through (3).

h. The Contractor shall direct inquiries, including requests for forms and assistance, to the Contracting Officer or designee.

i. Within 7 calendar days after the Government's final acceptance of the work under this contract, or upon termination of the contract, the Contractor shall return all identification badges to the Contracting Officer or designee.''

THE SUITABILITY DETERMINATION AND SECURITY CLEARANCE

Suitability determination and security clearance may be conducted by the Office of Personnel Management (OPM), by another Federal Agency, or by a commercial firm under contract to a Federal Agency. The suitability determination may include, but is not limited to, review of prior government/military personnel records; review of FBI records and fingerprint files; searches of credit bureaus; personal interviews; and, written inquiries covering the subject's background.

For each employee position under the contract, the Contractor shall submit forms and information listed below:

SF 85P – Questionnaire for Public Trust Position (Form to be completed for positions designated as Levels 5, SC, 6, or 6C).

FD 258 – Fingerprint Charts (2 sets each).

ADDITIONAL REQUIREMENTS CONCERNING DATA, DATA RIGHTS AND COMPUTER SOFTWARE

Notwithstanding any other clause concerning data, data rights and computer software and hardware under this Contract: all data produced, recorded, transferred or manipulated under this Contract shall remain the exclusive property of the Government irrespective or the manner or method of recording or storage and no matter what form of computer mechanism is used in the processing of said information or data. The Government shall retain exclusive right and domain over any by-product produced under this Contract, or any other use of the data produced under this Contract by either plan or accident.

No software will be developed, modified, or enhanced under this acquisition.

Copies of the final Reports and Deliverables under each task must be officially sent to the Indian Health Service and kept on file by the Contractor. At the end of the contract, all files must be kept by the Contractor for audit purposes.

Works other than Software Development or Enhancements:

All materials furnished or produced by the Contractor, relating to work performed, researched, or derived under this contract, including but not limited to documents, software, reports and correspondence will remain confidential. The contractor shall not release information to any persons, groups of persons, or organization other than the IHS. Breach of confidentiality may be grounds for rescission of this contract.

Permission for use, maintenance, disclosure, and disposition of data is at the sole discretion of the Indian Health Service.

Appendix B Blackfeet Service Unit- Blackfeet Community Hospital with ER, Browning, Montana Heart Butte Health Station, Heart Butte, Montana;

Crow Service Unit- Crow/Northern Cheyenne Hospital with ER, Crow Agency, Montana, Lodge Grass Health Clinic, Lodge Grass, Montana, Pryor Health Station, Pryor, Montana;

Fort Belknap Service Unit- Fort Belknap Hospital with ER, Harlem, Montana, Eagle Child Health Station, Hays, Montana;

Fort Peck Service Unit- Verne E. Gibbs Clinic, Poplar, Montana, Chief Redstone Clinic, Wolf Point, Montana, White Buffalo Clinic, Poplar, Montana;

Northern Cheyenne Service Unit- Northern Cheyenne Health Center with ER, Lame Deer, Montana;

Little Shell Service Unit- Little Shell Clinic, Great Falls, Montana.

Appendix C Specialty Telehealth Clinics Requirement Required:

• Behavioral Health

• Cardiology

• Maternal/Child Health

• Nephrology

• Pain Management

• Pediatric Behavioral Health

• Rheumatology

• Wound Care

• ENT

• Dermatology

Optional:

• Acute Care

• Bariatric Surgery

• Diabetes/Endocrinology

• Eating Disorders

• Genetic Counseling

• Gynecological/Oncology

• Hematology/Oncology

• Hospice

• Infectious Disease

• Long-Term Care

• Occupational Medicine

• Orthopedic Surgery

• Palliative Care

• Pediatric Endocrinology

• Sleep Medicine

• Pediatric Sleep Medicine

• Pulmonology

• Reproductive Medicine

• Neonatology

• Dialysis

• Dietary/Nutrition