RFP-15-241-SOL-00062_ERPhysiciansFtYatesND2.pdf

SEE ADDENDUMIS CHECKED

CODE 18a. PAYMENT WILL BE MADE BY

CODE

FACILITYCODE

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

OFFEROR

Aberdeen SD 57401 115 Fourth Ave, SE Federal Building Aberdeen Area Indian Health Servic

IHSFTYATES CODE 16. ADMINISTERED BYCODE

X

X

621111

SIZE STANDARD:

% FOR:SET ASIDE:UNRESTRICTED OR159

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

10/02/2015 1800 ET

09/07/2015

CRAIG WELLS

(No collect calls)

INFORMATION CALL:

FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIMEb. TELEPHONE NUMBER a. NAME

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

15-241-SOL-00062

5. SOLICITATION NUMBER

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE OF

1 3 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

FT YATES ND 58538

010 N RIVER RD PO BOX J

IHSFTYATES

15. DELIVER TO

Aberdeen SD 57401 115 Fourth Ave, SE Federal Building

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$11.0

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW

ISSUE DATE

DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULE

12. DISCOUNT TERMS

THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

Aberdeen Area Indian Health Servic

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

The Great Plains Area Indian Health Service is requesting responses to this Request for Proposal to provide for Emergency Room Physician Services at the Fort Yates IHS Healthcare Facility in Fort Yates, North Dakota. Period of performance will be from November 1, 2015 through October 31, 2015 with four (4) single year options.

IHS intends to award an Indefinite Delivery - Indefinite Quantity (ID/IQ) contract, where Individual Task Orders will be issued for

(Use Reverse and/or Attach Additional Sheets as Necessary)

HEREIN, IS ACCEPTED AS TO ITEMS:

XX

DATED

CAROL J. DIAZ

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

ARE

31c. DATE SIGNED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print)

ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDEND

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

OFFER

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

30b. NAME AND TITLE OF SIGNER (Type or print)

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

29. AWARD OF CONTRACT:

REF.

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32c. DATE 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

40. PAID BY39. S/R VOUCHER NUMBER38. S/R ACCOUNT NUMBER

37. CHECK NUMBER

FINALPARTIAL

36. PAYMENT

FINALPARTIAL

35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER33. SHIP NUMBER

COMPLETE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

42d. TOTAL CONTAINERS42c. DATE REC'D (YY/MM/DD)

42b. RECEIVED AT (Location)

42a. RECEIVED BY (Print)

41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

STANDARD FORM 1449 (REV. 2/2012) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

performance of this contract. For details please refer to the attached clauses in full text; FAR

52.216-18, FAR 52.216-19, and FAR 52.216-21.

Period of Performance: 11/01/2015 to 10/31/2016

1 Emergency Room Physician Services (hourly rate) 8760 HR for 8,760 HRS at times there may be multiple providers working at the Fort Yates IHS

Healthcare Facility in Fort Yates, North Dakota.

Delivery: 10/31/2016

2 Emergency Room Physician Services (hourly rate) 8760 HR for 8,760 HRS at times there may be multiple providers working at the Fort Yates IHS

Healthcare Facility in Fort Yates, North Dakota.

(Option Line Item)

Delivery: 10/31/2017

Period of Performance: 11/01/2016 to 10/31/2017

3 Emergency Room Physician Services (hourly rate) 8760 HR for 8,760 HRS at times there may be multiple providers working at the Fort Yates IHS

Healthcare Facility in Fort Yates, North Dakota.

(Option Line Item)

Delivery: 10/31/2018

Period of Performance: 11/01/2017 to 10/31/2018

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

3 2 of

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)

15-241-SOL-00062

4 Emergency Room Physician Services (hourly rate) 8760 HR for 8,760 HRS at times there may be multiple providers working at the Fort Yates IHS

Healthcare Facility in Fort Yates, North Dakota.

(Option Line Item)

Delivery: 10/31/2019

Period of Performance: 11/01/2018 to 10/31/2019

5 Emergency Room Physician Services (hourly rate) 8760 HR for 8,760 HRS at times there may be multiple providers working at the Fort Yates IHS

Healthcare Facility in Fort Yates, North Dakota.

(Option Line Item)

Delivery: 10/31/2020

Period of Performance: 11/01/2019 to 10/31/2020

The Unit Price is an all inclusive cost. All inclusive cost is defined to include travel, lodging, per diem, fringe benefits, i.e., life insurance, social security, federal, state, and local taxes, plus all other costs pertinent to the performance of this Contract.

Contractor will need a DUNS number, TIN number and be registered with the System for Award

Management at www.SAM.gov

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

Sponsored by GSA

FAR (48 CFR) 53.110

TECHNICAL EVALUATION CRITERIA

The primary consideration in evaluating this criteria shall be which the offeror can perform the contract in a manner most advantageous to the Great Plains Area as determined by the evaluation of offer according to established evaluation criteria. Under best value principles, there is no requirement that a contract be awarded on the basis of lowest proposed cost.

Evaluation factors when combined are significantly more important than cost or price.

It is very important that each offeror furnish the Indian Health Service with specific information on the three (3) criteria listed below. Offerors should submit their best offer initially as the Indian Health Service reserves the right to make an award without discussion.

Evaluation factors:

A. Problem and Approach

Evaluation of this criteria will assess the offeror's overall understanding of the complexities and logistical requirements associated with the provision of temporary emergency room physician services at the Standing Rock Indian Health Service Hospital, in Fort Yates, North Dakota and the offeror's ability to successfully manage such project. This criteria will be based upon the offeror adequately addressing each of the following elements and including sufficiently detailed information to allow a complete analysis of the offeror's technical capabilities and responsibility:

1. Understanding of the problems in delivering emergency room services at a rural IHS facility.

2. Understanding of the complexity and logistical requirements of the project.

3. Possession of necessary organization, experience, and technical skills to perform the work.

4. A detailed work plan shall be submitted indicating how each aspect of the Statement of Work is to be accomplished. The technical approach should be in as much detail necessary to fully explain the proposal technical approach or methodology. Particular attention should be directed toward the scheduling of manpower and approach to be overcome.

5. Ability to respond to planned and urgent placement requests.

6. Ability to meet IHS credentialing requirements.

7. Ability to provide Standing Rock Indian Health Service patient documentation and reporting requirements.

B. Past Performance and Experience

The Past Performance and Experience evaluation factor will assess the relevance and breadth of the offeror's experience and the quality of the offeror's past performance on contracts consistent in scope and complexity with temporary emergency room physician services at the Standing Rock Indian Health Service Hospital, in Fort Yates, North Dakota.

1. The technical proposal must include a listing of other emergency room physician services contracts and subcontracts, Government and/or commercial, awarded to the offeror for practice situations serving rural, isolated locations. The contracts should contain the same type of emergency room physician requirements outlined in the Statement of Work. The offeror must include the following information for each contract and subcontract.

a) Name of contracting activity

b) Contract number

c) Contract type

d) Total contract value

e) Description of contract work

f) Contracting officer and telephone number

g) Program manager and telephone number

h) Government project officer and telephone number

i) List of major subcontractors

The offeror must demonstrate its record of successful performance in past contracts and subcontracts, Government and / or commercial. Each offeror will be evaluated on its performance under existing and prior contracts and subcontracts for similar services. The offeror shall include the following past performance information:

For each contract:

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

b. Evidence of timely and acceptable contract performance on similar outlines in the Statement of Work.

c. Evidence indicating for cost control and budgetary considerations.

C. Management

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. Financial capability to perform the Statement of Work.

b. Capability to meet delivery or performance schedules.

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

RFP-15-241-SOL-00062 SECTION C

SECTION C – DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK

C-1

C-1 Purpose of Contract

The purpose of this contract is for the contractor to support the recruitment and replacement of emergency room physicians into temporary duty assignments at Standing Rock Indian Health Service Hospital (SRIHS) within the Great Plains Area. The contractor shall recruit, credential and provide placement of emergency room physicians for assignments on an ongoing basis.

The contract resulting from this solicitation shall:

1. Be a fixed price, indefinite delivery/indefinite quantity (ID/IQ), performance based, non-personal service type contract for Emergency Room Physicians.

2. Allow the Government to evaluate the quality of professional and administrative services provided.

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.

C-2 Special Contract Requirements

Contractors cannot serve as witnesses in any suit against the Federal Government.

Many of the IHS patients receiving services may only speak a native language and/or reside on a Native American Reservation, therefore, the Contractor must demonstrate sensitivity to cross-cultural and language differences.

The Privacy Act of 1974 mandates that the Contractor maintain complete confidentiality of all administrative, medical & personnel records, & all other pertinent information that comes to his/her attention or knowledge. The Privacy Act carries both civil & criminal penalties for unlawful disclosure of records. Violation of such confidentiality shall be cause for adverse action. The IHS shall provide training on the Freedom of Information Act & the Privacy Act. All IHS regulations & policies applicable to these Acts shall be enforced.

The Emergency Room Physician shall demonstrate evidence of continuing education activities to acquire new skills, procedures, or qualifications, which contribute positively toward the quality of service provided and achievement of contract obligations.

When requested, the Emergency Room Physician shall participate on Service Unit quality assurance and peer review activities.

The services to be performed by the Emergency Room Physician shall be performed in accordance with the Indian Health Service policies, procedures and the regulations of the medical staff-by-laws of SRIH.

At times individuals from SRIHS may contact your company on the availability of Physicians covered under this contract. However, if no Task Order has been issued to your company after five (5) days then those physicians placed on hold may be released to work on other assignments.

C-2

C-3 Statement of Work

PERFORMANCE WORK STATEMENT

FOR EMERGENCY ROOM PHYSICIAN SERVICES

FOR STANDING ROCK INDIAN HEALTH SERVICE HOSPITAL IN THE

GREAT PLAINS AREA INDIAN HEALTH SERVICE

INTRODUCTION

The Standing Rock Indian Health Service Hospital (SRIHS) requires contractor support to assist in the recruitment and placement of emergency room physicians into seamless 24/7 temporary duty assignments. The purpose of the contract is for the recruitment, credentialing, and placement of emergency room physicians into SRIHS in the Great Plains Area.

The contract shall be a non personal health care services contract under which the Contractor is an independent contractor and which shall allow the Government to evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of the services rendered, (e.g., professional judgments, diagnosis for specific medical treatment).

The Contractor shall indemnify the Government for any liability producing act or omission by the contractor, its employees and agents occurring during contract performance. The Contractor shall maintain medical liability insurance, in the coverage amount acceptable to the Contracting Officer, which is not less than the amount normally prevailing within the local community for the medical specialty concerned.

PROGRAM OBJECTIVES

The Contractor shall furnish approximately 8 physicians for seamless 24/7 emergency room assignments (12 hour shifts preferable) on an ongoing basis at SRIHS in the Great Plains Area Indian Health Service.

Contract physician care shall cover the range of emergency room care typically provided in a rural civilian practice of similar size. The Contractor shall provide physicians to perform the necessary medical procedures for patients in a variety of emergency room situations. Attachment 1 lists the procedures to be performed. This list represents an estimate and does not intend to be inclusive of all procedures.

Listed below is guidance regarding the utilization of this contract:

Contractor shall provide to the Clinical Director the following documentation within five (5) business days of receipt of task order; Curriculum Vitae and all information necessary to query the National Practitioners Data Bank (NPDB), Health Integrity Protection Data Bank (HIPDB) and the OIG Exclusion List.

In the event the Clinical Director does not accept or reject the provider, the Contractor may present the provider elsewhere. The contractors will be provided with a copy of all rejections.

All rejections by an IHS-Clinical Director of a provider (s) shall be documented and sent to the Contracting Officer's Representative (COR) for review/comments.

In the event of a rejected provider(s) the contractor will have three (3) business days to present a new provider(s).

Upon acceptance of a provider, a full credentialing packet shall be sent to the contractor.

The contractor shall send a fully completed credentialing packet back to the IHS-Clinical Director.

All of the above shall be completed within the previously identified 21-day time frame.

C-3

Upon the receipt of an SRIHS task order, the Contractor shall locate, credential, and have available acceptable and sufficient staffing to provide emergency room physician coverage on a regular emergency room coverage schedule. Task orders shall be issued at least (21) calendar days in advance of the need, but some task orders may provide the Contractor with a limited time in which to respond.

Contractor physicians shall be board certified, or eligible, by the American Board of Emergency Medicine, or Family Practice. Current, Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), and Advanced Trauma Life Support (ATLS) certification is required of physicians not boarded in emergency medicine and placed by the Contractor.

In order to be considered for the Temporary or Expedited Privileging Process, as set forth by the Det Norske Veritas (DNV), Joint Commission and IHS By-Laws, physician candidates who are submitted for consideration by the Contractor must meet the following minimal criteria for the granting of Temporary Privileges:

a. The candidate must have submitted a complete application.

b. The candidate must have a current active and unrestricted license in one of the fifty (50) states or

U.S. territories.

c. The candidate must not have been subject to involuntary termination of medical staff membership at another organization.

d. The candidate must not have been subject to involuntary limitation, reduction, denial, or loss of clinical privileges.

e. The candidate must have no current federal sanctions.

f. The candidate must have no unexplained reports from the National Practitioner Data Bank and the HealthCare Integrity and Protection Data Bank against him/her.

g. The candidate must provide a history of previous or pending malpractice lawsuits.

Candidates who do not meet all of the listed criteria must go through the entire formal credentialing/privileging process, including approval by the Credentialing Committee and the Medical Staff, prior to beginning their scheduled tour. Adequate time must be permitted for this process, typically sixty (60) calendar days.

C-4

Upon presentation of a candidate, the contractor will provide the following information:

1) Provider’s full name

2) Provider’s date of birth

3) Provider’s social security number

4) Provider’s contact phone number

5) Provider’s curriculum vita with listing of any and all Indian Health Service experience

(IHS, Tribal, or Urban sites)

6) Release of information signed by the provider (see Section J – Release of Information)

In accordance with Indian Health Service credentialing policy, (see Section J – IHS Credentialing Policy) the Contractor shall complete a primary source verification for each Contractor Physician performing services under the contract. The service unit credentialing packet and all associated documents will be provided to the contractor prior to the first request for a Task Order. At least five (5) business days prior to the first day of assignment at SRIHS, the service unit must receive the candidate’s completed credentialing packet.

In accordance with the IHS Credentialing Policy, contents of the credentialing packet include:

Application Copies of pre-professional and professional school diplomas Copies of certificates of completion of post-graduate training (i.e. residency) Copy of Board Certification certificate or letter Copies of all current licenses Copy of current DEA certificate Copy of current liability insurance Completed clinical privileges request form – signed Medicare agreement – signed Health Status statement – signed Medical Staff Bylaws Attestation Statement – signed Three (3) letters of reference (from within the past twelve (12) months); one reference must be from a same discipline peer and one reference must be from the current or most recent employer/assignment

Additional documents required at the time of submission of the credentialing packet include:

Photocopy of a government issued photo identification card (e.g. driver’s license or passport) Current CV (within past two (2) months) – explain employment gaps greater than two (2) months Include list of any and all Indian Health Service experience (IHS, Tribal, or Urban sites).

Confidentiality statement – signed Child Care and Indian Child Care Worker Positions agreement – signed CME for the past two years, include copies of BLS, ACLS, PALS, ATLS certification Copy of your National Provider Identifier notification email or letter Provider Signature Card – signed ITAC https://www.ihs.gov/itac/index.cfm?module=home&option=main

C-5

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

All Contract physicians will be held to the same Standards of Conduct as federal employees (See Attached – “Standards of Conduct”, Violence in the Workplace memorandum; Courtesy and Respect in the Workplace Policy. Violations of these policies my lead to contract termination (See Section J).

Any negligent behavior or any behavior jeopardizing patient safety will not be tolerated. Professional Review Action may be taken regarding any member of the Medical staff if activity, demeanor or conduct of the member is detrimental to patient care, disruptive to service unit operation, or in violation of the local Bylaws, Medical Staff Rules and Regulation, IHS policy or ethical. Each incident will be evaluated and documented. Documentation will be submitted to the contractor. These incidents may be grounds for immediate removal. The final decision is at the discretion of the Clinical Director and CEO.

Disciplinary actions giving rise to a hearing or appeals will be in accordance with the local Medical Staff Rules and Regulations. No costs for travel, attorney fees, phone, mail, or other expenses associated with the candidates hearing or appeal will be provided by the IHS, or the local service unit.

The Contractor physician shall provide immediate medical evaluation, treatment, and/or referral of patients who present for care in the IHS facility emergency services area. The Contractor physician shall provide professional advice to emergency room personnel and ward personnel in emergency situations with regard to professional management of patients being treated and/or hospitalized.

Work assignments will be defined by the Clinical Director (or designee) to include shifts within the hours of operation of the facility. Contract physicians will limit consecutive 12-hour shifts to maintain acceptable levels of patient safety. Regular work schedules may include Federal holidays. The Contract physicians regular work duties may include the clinical supervision of midlevels (IHS and locums midlevels), students and residents.

The work hours/shifts cannot be changed/traded/switched without prior approval from the Clinical Director (or designee).

Contract physicians shall generate and maintain proper medical record information on beneficiaries to whom treatment is provided in accordance with Indian Health Service, DNV, Joint Commission, and Centers for Medicare Medicaid regulations. The Contractor physician shall prepare all electronic medical record documentation to meet or exceed the established standards of the IHS facility to include but not be limited to: timeliness, legibility, accuracy, content, and signature. Contractor physicians shall complete all third party reimbursement and referral forms. All medical record information and documentation generated in the performance of this contract must be completed at the time of departure and will remain the property of and subject to the exclusive control of the Indian Health Service. The Medical Records Department shall be notified in advance of the contractor provider’s last workday. The Clinical Director will not sign off on the contractor provider’s timesheet unless the contractor provider is

C-6 cleared by Medical Records utilizing the Medical Records Clearance Form. Failure to complete medical records before leaving may result in a delay of the processing of all invoices from the contractor.

To ensure that contract providers are in compliance with all facility regulations, SRIHS shall provide contract providers an orientation on Cultural Sensitivity, Customer Service, Resource & Patient Management System (RPMS), Referred and Purchased Care (PRC) and Electronic Health Record (EHR) systems. Each contract provider shall be granted access to RPMS and EHR systems for electronic documentation of patient care services.

The contractor’s conformance with the technical requirements of this contract will be monitored for the period of performance. This assessment will include observations of the work system, methods and execution. Examples of monitoring methods include, but are not limited to: compliance with the Indian Health Service credentialing and privileging requirements, appropriateness of candidate placement (e.g.

number of removals, number of early termination of assignments due to personality conflict, poor work habits, inadequate skills for the assignment, unprofessional or discourteous behavior). An assessment spreadsheet with these methods will be monitored by the Clinical Directors and the Contracting Officer’s Representative (COR).

GEOGRAPHICAL AND POPULATION BASE INFORMATION FOR SRIHS:

FORT YATES HOSPITAL - The Fort Yates Service Unit is a 12-bed facility located in the southern part of North Dakota with a dialysis unit, which opened in the spring of 1989. There is also an outpatient health center located in McLaughlin, SD. The population base is 10,000.

C-4 Knowledge required by the position

EMERGENCY ROOM PHYSICIAN WORKLOAD PROCEDURES

GREAT PLAINS AREA INDIAN HEALTH SERVICE

The following workload procedures represent the Government's best estimate of the kind of emergency room procedures performed at the Standing Rock Indian Hospital. This exhibit is not intended to cover all of the workload items, but lists the major categories of work.

1. Cardiopulmonary resuscitation

2. Tracheal intubation, cricothyroidotomy, and tracheostomy

3. Arrhythmia - recognition and control

4. Pleural drainage

5. Control of hemorrhage

6. Shock - including intravenous fluid replacement

7. Venous cutdown and arterial puncture

8. Control of convulsions

9. Management of poisoning

10. Gastric intubation and lavage

11. Peritoneal lavage

12. Closed reduction of dislocations

13. Simple splinting of fractures and sprains

14. Application of pressure dressings

C-7

15. Debridement of minor wounds

16. Suture closure of wounds of depth not greater than surface

17. Wound irrigation

18. Administer local anesthesia ONLY

19. Removal of foreign objects (depending on size and location)

20. Debridement of burns

21. Incision and drainage of superficial abscesses

22. Control of acute respiratory insufficiency

The following work-load procedures data represent the Government's best estimate on the emergency room procedures performed in Great Plains Area Indian Health Service facilities. This exhibit is not intended to cover all of the workload items, but lists the major categories of work.

EMERGENCY ROOM PROCEDURES

A. Provide initial emergency care as is appropriate in true life threatening emergencies.

B. Provide initial management without consultation

1. Minor lacerations

2. Major lacerations

3. Minor respiratory illness

4. Acute respiratory illness

5. Pulmonary embolism

6. Minor gastrointestinal illness

7. Acute abdominal illness

8. Minor burns

9. Critical burns (emergency care only)

10. Minor musculoskeletal trauma

11. Minor dermatologic illness

12. Minor gynecologic problems

13. Acute cardiac emergencies including acute myocardial infarction, arrhythmias and heart failure.

14. Poisonings

15. Near drowning

16. Severe allergic reactions

17. Nose bleeds

18. Hypothermia

19. Hyperthermia

20. Patients with altered level of consciousness

21. Multiple traumas

22. Acute psychiatric illness

23. Alcohol detoxification and drug withdrawal.

24. Animal and human bites

25. Eye trauma and illness

26. Hand infections

27. Seizure disorders

28. Gastrointestinal bleeding

C-8

29. Acute endocrinological emergencies

30. Urinary calculi

31. Urinary tract infections

32. Screening of ambulance calls

33. Minor pediatric illness

C. Procedures:

1. Oral/nasopharyngeal airway insertion

2. Endotracheal intubation

3. Nasotrachael intubation

4. Esophageal obturator airway insertion

5. Transtracheal suctioning

6. Needle cricothyroidotomy

7. Cricothyroidotomy

8. Emergency tracheostomy

9. Direct laryngoscopy

10. Indirect laryngoscopy

11. Removal of upper airway foreign body

12. Ventilation management

13. Interpretation of electrocardiograms

14. Central venous line insertion

15. Peripheral venipuncture

16. Peripheral venous cutdown

17. Placement of emergency electrical pacemaker

(a) Transvenous

(b) Transthoracic

18. Defibrillation and synchronized cardioversion

19. Pericardiocentesis

20. Intracardiac injection

21. Emergency thoracotomy

22. Thoracentesis

23. Tube thoracostomy

24. Needle thoracostomy

25. Arterial puncture

26. Arterial cannula placement

27. Closed chest massage

28. Internal cardiac massage

29. Use of MAST trousers

30. Treatment of burns

31. Debridement and repair of minor lacerations

32. Diagnostic peritoneal lavage

33. Peritoneal dialysis

34. Excision of thrombosed external hemorrhoids/year

35. Incision and drainage of abscesses

36. Reduction of hernias

37. Sigmoidoscopy38. Suprapubic cystotomy

C-9

39. Urinary catheter placement

40. Reduction of paraphimosis, phimosis

41. Culdocentesis

42. Emergency vaginal deliveries

43. Rape exam

44. Emergency retrograde cystogram, IVP

45. Nasogastric intubation

46. Gastric lavage

47. Segstaken-Blakemore tube placement

48. Lumbar puncture

49. Removal of corneal foreign body

50. Schiotz tonometry

51. Anterior nasal packing

52. Posterior nasal packing

53. Cautery (electrical/chemical) of acute mucosal bleeding

54. Reduction of temporomandibular joint dislocation

55. Reduction of simple closed dislocations

56. Reduction of simple closed fractures

57. Placement of molded splints

58. Arthrocentesis:

(a) Diagnostic

(b) Therapeutic

59. Extensor tendon repair

60. Nail trephination/removal

61. Application of cervical traction tongs

62. Simple split thickness grafting

63. Local infiltration anesthesia

64. Regional block anesthesia

65. Pediatric resuscitation

66. Interpret transmitted electrocardiogram rhythm strips

C-5 Applicable Standards

Listed below are some Applicable Standards, but are not limited to;

1. Joint Commission (JC) or what was formally known as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Website: http://www.jointcommission.org/

2. Centers for Medicare and Medicaid Services (CMS)

Website: http://www.cms.hhs.gov/

3. Health Insurance Portability and Accountability Act (HIPAA)

Website: http://www.hhs.gov/ocr/privacy/

4. Privacy Act of 1974 (45 CFR 5b)

Website: http://www.justice.gov/opcl/privstat.htm

5. Indian Heath Service Information Technology and records policies.

Website: http://www.ihs.gov/index.cfm?module=InfoTech

C-10

6. The standards of medical practice and duties of the Temporary Medical Professional shall be determined pursuant to the bylaws of the IHS Hospital, 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, and the standards and recommendations of the Joint Commission on Accreditation of Healthcare Organizations. As appropriate, the Temporary Medical Professional shall participate in a quality improvement program consistent with current DNV, JC and CMS requirements for ongoing monitoring and evaluation of the quality and appropriateness of care.

7. In accordance with the requirements of Federal Acquisition Regulation (FAR) 52.237-7, the

Contract Physician shall provide evidence of insurability in the amount specified by the Contracting Officer prior to providing services at the IHS Hospital. Upon request of the Contracting Officer, the Contractor shall furnish evidence of the insurability of the Contract Physician performing services under this contract. The Contractor shall notify the Contracting Officer if it, or any of the Contract Physician performing under this contract, change insurance providers during the performance period of this contract. The notification shall provide evidence that the Contractor and/or health-care providers will meet all the requirements of this clause including those concerning liability insurance and endorsements.

The Contractor shall insert the substance of this clause in all subcontracts for Contract Physician services under this contract. The Contractor shall be responsible for compliance by any subcontractor with the provisions set forth in this clause.

8. The Contract Physician shall comply with the requirements of the Indian Child Protection and

Family Violence Prevention Act (Public Law 101-630) and Section 231 of the Crime Control Act (Public Law 101-647). The service unit shall assist the contract providers in processing the necessary paperwork for conducting background Investigations on those providers who will have contact with Indian children in Indian Health Service facilities. Included in this requirement is a waiver provision that will permit certain contract providers to begin work prior to the completion of the full background investigation.

9. Upon the completion of the Indian Health Service Health Insurance Portability and

Accountability Act (HIPAA) compliance plan, Contract Temporary Medical Professionals shall comply with the HIPAA compliance plan mandates particularly the requirements that relate to the protection of patient information. Each contract provider shall receive an orientation on specific responsibilities.

C-11

C-6 Performance Surveillance Plan

PERFORMANCE SURVEILLANCE PLAN

FOR

TEMPORARY EMERGENCY ROOM PHYSICIAN SERVICES

Performance surveillance monitors will be established to comply with regulatory guidelines and to monitor contract performance. The performance surveillance plan has been developed to describe the Indian Health Service’s general plan in providing effective and systematic surveillance and reporting of all aspects of contract performance. This plan recognizes the responsibility of the contractor to carry out its own quality control obligations in the performance of this contract.

Surveillance will be accomplished via insight into the contractor’s performance against requirements listed in the work statement and performance standards listed in this plan. Performance-based incentives are consistent with the intent and purpose of the contract and are outlined on the following grid:

Upon completion of the contract, the Government will complete and keep on record the Contractor’s performance evaluation form, see (Section J).

OBJECTIVE/TASK PERFORMANCE

STANDARD

ACCEPTABLE

QUALITY LEVEL

(AQL)

SURVEILLANCE

METHOD/MEASURES

CONTRACTOR

INCENTIVE

PERFORMANCE

OBJECTIVE 1

THE

CONTRACTOR

SHALL

ESTABLISH A

TECHNICAL

APPROACH AND

MANAGEMENT

PLAN FOR THE

PLACEMENT OF

EMERGENCY

ROOM

PHYSICIANS

INTO

TEMPORARY

ASSIGNMENTS AT

SRIHS

ONCE A TASK

ORDER/REQUEST

IS RECEIVED:

CONTRACTOR

SHALL LOCATE A

BOARD ELIGIBLE,

BOARD

CERTIFIED,

PHYSICIAN

WITHIN 21 DAYS

COMPLETE IHS

CREDENTALING

PACKET

INFORMATION &

RETURN TO SRIHS

CD WITHIN 5

DAYS

PLACEMENT OF

STAFF 100% OF

THE TIME

CV’s SHALL

INCLUDE

LOCATION OF

PREVIOUS LOCUM

TENENS

ASSIGNMENT

REFERENCES

FROM

INDIVIDUALS

THAT HAVE

WORKED WITH

APPLICANT

WITHIN LAST 12

MONTHS OR

DOCUMENT WHY

THIS IS NOT

POSSIBLE

CD’S SHALL SUBMIT

MONTHLY

SPREADSHEET OF

PLACEMENT DATES

TO THE

CONTRACTING

OFFICER’S

REPRESENTATIVE

(COR) TO MONITOR

THE 21 DAY

PLACEMENT

REQUIREMENT

SPREADSHEET TO

COR MONTHLY

SRIHS WILL

PROVIDE A

POSITIVE

PERFORMANCE

REPORT ON

EMERGENCY

ROOM PHYSICIAN

PLACEMENT

CAPABILITIES

C-12

OBJECTIVE 2

PROVIDERS

CAPABLE AND

KNOWLEDGABLE

OF EFFECTIVE

COMMUNICATION

PROVIDERS

SHALL BE

RESPECTFUL,

COURTEOUS, AND

CULTURALLY

SENSITIVE TO IHS

PATIENTS AND

STAFF

THREE (3)

ANNUAL

COMPLAINTS PER

PROVIDER ARE

ACCEPTABLE

THE CONTRACTOR

SHALL RESPOND TO

THE CONTRACTING

OFFICER’S

REPRESENTATIVE

(COR) IN WRITING.

WHENEVER, THEY

RECEIVE NOTICE OF

MORE THAN THREE

COMPLAINTS

AGAINST A

PROVIDER WITH AN

EXPLANATION OF

WHAT WAS DONE TO

ADDRESS THE

MATTER

THE INVOICE FOR

THE PHYSICIAN

IN QUESTION

WILL BE PUT ON

HOLD UNTIL THE

COMPLAINT IS

INVESTIGATED

AND RESOLVED

IN 7 WORKING

DAYS

OBJECTIVE 3

COMPLETION OF

MEDICAL

RECORD

DOCUMENTATION

COMPLETES

MEDICAL

RECORD

DOCUMENTATION

PRIOR TO LAST

WORKDAY &

NOTIFIES

MEDICAL

RECORDS

DEPARTMENT OF

LAST WORKDAY

DOCUMENTATION

COMPLETED 100%

OF THE TIME

CLINICAL DIRECTOR

REVIEWS CHECKLIST

FROM MEDICAL

RECORDS PRIOR TO

PHYSICIAN LEAVING

FACILITY

THE INVOICE FOR

THE PHYSICIAN

IN QUESTION

WILL BE PUT ON

HOLD UNTIL

PROPER

DOCUMENTATION

OF THE CHART IS

COMPLETED

C-7 Notice to contractor of certain drug detention procedures:

(a) Pursuant to the agency’s policy applicable to both government and contractor personnel, measures will be taken to prevent the introduction and utilization of illegal drugs and related paraphernalia into Government work areas.

(b) In furtherance of the Agency’s control program unannounced inspections may be conducted by authorities:

(c) Where there is probable cause to believe that a Contractor Physician has been engaged in use, possession, or trafficking of drugs, the authorities may detain said Contractor Physician until the Contractor or employees can be removed from the installation, or can be released to local authorities having jurisdiction.

(d) Trafficking in illegal drug and drug paraphernalia by the contractor may lead to cancellation of services.

(e) The Contractor is responsible for conduct of employees performing work under this contract and is, therefore, responsible to assure that employees are notified of these provisions prior to assignment.

(f) The removal of contractor personnel from a Government facility as a result of the drug offense shall not be cause for an excusable delay, nor shall such action be deemed a basis for an equitable adjustment to price, delivery, or other provisions of this contract.

RFP-15-241-SOL-00062 SECTION E

SECTION E – INSPECTION AND ACCEPTANCE

E-1

Clauses Incorporated By Reference

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this address.

https://www.acquisition.gov/Far/

FAR Clauses Incorporated By Reference

E-1 FAR 52.246-4 INSPECTION OF SERVICES – FIXED PRICE (Aug 1996)

RFP-15-241-SOL-00062 SECTION F

SECTION F – DELIVERIES OR PERFORMANCE

F-1

CLAUSES INCORPORATED BY REFERENCE

This contract incorporates, in accordance with FAR 52.252-2 “Clauses Incorporated By Reference” (See Section I), one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this address.

https://www.acquisition.gov/Far/

F-1 FAR 52.242-15 STOP WORK ORDER (Aug 1989)

F-2 Period of Performance

Performance of this contract shall be for a twelve-month period from November 1, 2015 or “Date of Award” through October 31, 2016 with option to extend performance for four

(4) – one (1) year options.

If the Government exercises its option pursuant to the clause entitled, “Option to Extend the Term of the Contract” (FAR 52.217-9), the period of performance will be extended in accordance with the following schedule:

Option Year Performance Periods

Option Year 1 – From November 1, 2016 Through October 31, 2017

Option Year 2 – From November 1, 2017 Through October 31, 2018

Option Year 3 – From November 1, 2018 Through October 31, 2019

Option Year 4 – From November 1, 2019 Through October 31, 2020

The period of performance encompasses the submission and review of the reports specified in the statement of work.

F-3 Performance Requirement

The contractor must perform to a level that is satisfactory and in accordance to all applicable laws, policies, rules, regulations and the Statement of Work.

RFP-15-241-SOL-00062 SECTION G

SECTION G – CONTRACT ADMINISTRATION DATA

G-1

G-1 Responsibility of the Indian Health Service

(a) Indian Health Service shall prepare and award each task order to the contractor as the need arises;

(b) It is the responsibility of the SRIHS – Clinical Director or designee to authorize the Contractor and the Great Plains Area – Division of Acquisition Management that an Emergency Room Physician has been selected and properly credentialed;

(c) Indian Health Service shall review and approve/disapprove payment of each invoice submitted by the contractor. Indian Health Service shall only reimburse the contractor for completed work/services.

G-2 Physical Demands and Work Environment

The work requires long periods of standing and walking.

G-3 Quality Assurance

The contractor shall work with the Contracting Officer’s Representative (COR) and the SRIHS – Clinical Director or designee assuring that the level of work is satisfactory and in accordance with the Statement of Work. Contractor’s physician shall be thoroughly monitored and approved.

G-4 Government Furnished Property, Facilities, and Services

The contract takes place at the Standing Rock Indian Health Service Hospital with most if not all property, supplies and equipment provided. The Indian Health Service does not anticipate the need for additional Government furnished property, facilities, and services.

G-5 Supervision and Guidance Received:

This is a non-personal service healthcare type of contract. The contractor is an independent contractor, but shall allow the Government to evaluate the quality of professional and administrative services provided. However, the Government does not retain control over the medical professional aspects or technical aspects of the services rendered, (e.g., professional judgments, diagnosis for specific medical treatment).

The contractor shall adhere to the requirements of the entire Statement of Work.

G-6 Contracting Officer Responsibility

Authority to negotiate changes in terms, conditions or amounts cited in this contract is reserved to the Great Plains Area Indian Health Service Contracting Officer.

G-2

G-7 Contracting Officer’s Representative (COR)

The Contracting Officer’s Representative (COR) representing the Government for the purpose of this contract shall be designated in writing by the Contracting Officer, Great Plains Area Indian Health Service, Great Plains, South Dakota 57401.

The Contracting Officer’s Representative (COR) is responsible for:

(a) Monitoring the contractor’s technical progress, including the surveillance and assessment of performance and recommending to the Contracting Officer changes in requirements,

(b) Interpreting statement of work,

(c) Performing technical evaluation as required,

(d) Performing technical inspections and acceptance required by this contract,

(e) Assisting the Contractor in the resolution of technical problems encountered during performance, and

(f) Serving as systems manager to insure compliance with the Privacy Act.

The Contracting Officer is responsible for directing or negotiating changes in the terms, conditions or amounts cited in the contract.

G-8 Designation of Contracting Officer’s Technical Representative (COR)

The person identified below is hereby designated as the Contracting Officer’s Representative (COR) for this contract. The responsibility of the COR (or his/her duly authorized representative) is to ensure that the Government’s technical objectives are met. To this end the COR will provide necessary information, direction, coordination, et cetera, within the contractual work description. Issuance of changes that affect the articles, terms or conditions of this contract will be accomplished through the Contracting Officer who is the only party authorized to bind the Government to contract.

Contracting Officer’s Representative (COR):

Michael A. Candreva, OD Chief of Staff Standing Rock Indian Health Service Fort Yates, ND 58538

(701) 854-8272 michael.candreva@ihs.gov

G-3

G-9 Task Order Agreements

This contract type allows the service unit program offices to place order with the Contractor on an as needed basis. In accordance with the Federal Acquisition Regulation (FAR) 52.216-18, Ordering (OCT 1995), IHS will obligate the funding and order the services by issuing a task order through the Agency’s automated procurement systems, iProcurement and PRISM.

The contract provisions authorize the program offices at each respective service unit to issue the task orders, within their procurement authority, for the commercial item contract for the services needed during the contract term. Each task order will reference the contract number and contain a task order number assigned by the automated procurement systems.

G-10 Task Order Procedures

The terms that apply to the issuance of Task Orders under this contract are set forth below:

A. The Contractor shall initiate work when, so directed by a Task Order issued by the Contracting Officer. No work under any Task Order shall be performed unless specifically authorized by the Contracting Officer. Approval of a Task Order shall not constitute approval to exceed any item listed in the contract or general provisions of the contract. The total dollar amount of all task Orders shall not exceed the estimated total dollars agreed to for said task orders. The contractor shall not exceed the estimated task order amount, or change the task order without prior written approval of the Contracting Officer.

B. In event the Contractor is unable to fulfill the task 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 task order is immediately required. The quantity of hours ordered on the unfilled task order will be applied to the minimum quantity. The government’s right to fulfill its need outside this contract(s) does not waive its right to the issuance of a cure notice nor does it waive its right to terminate for default.

G-11 Issuance of Task Order

A. Task orders shall be issued on a fixed price basis and shall describe the specific work to be performed and the total cost. Each task order shall make reference to the proper funding document, Requisition.

B. The estimated hours for performance of each task shall be set forth in each task order.

Each task order shall not exceed the hour’s specified and total amount obligated for each

G-4 task order. The total amount of all task orders shall not exceed the maximum amount negotiated for the contract period.

C. The task orders shall be issued by the purchasing agents at the Service Unit level utilizing one of the awarded contracts under these Indefinite Delivery / Indefinite Quantity (ID/IQ) Contracts.

1. For task orders under $25,000.00 the purchasing agent shall issue the task order in the PRISM system and approve them locally, if they have signature authority.

2. For task orders over $25,000.00 the purchase agent shall issue the task order in the

Prism system for signature by the Contracting Officer, they shall forward the task order in PRISM and send all the back up documentation to the Contracting Officer for review prior to signing the task orders. The purchasing agents will be responsible for issuing all task orders the Great Plains Area Contracting Officer will sign the task orders over their authority.

The task order files and back up documents shall be maintained at each subsequent service unit.

D. Task orders shall incorporate by reference the provisions of the contract.

E. The Contractor shall not proceed with performance under any task order until such time as approval is granted by the Contracting Officer.

G-12 Contents of the Task Order

A. Each task order shall be numbered sequentially from the automated procurement systems.

B. Each task order shall consist of a completed and a fully executed task order cover sheet, which shall include the following:

1. Contract Number

2. Task Order Number

3. Description of the Work to be performed

4. Estimated hours of performance

5. Place of Performance

6. Period of Performance of the Task Order

7. Total Cost

8. Accounting and Appropriation Data

G-5

G-13 Completion of Task Orders

Upon completion of each task order, the contractor shall submit reports as described in, Section G-14 Invoice Submission.

G-14 Invoice Submission

(a) The contractor shall submit one (1) original and one (1) copy of the same invoice. The original invoice shall be submitted to the Great Plains Area Office – Division of Financial Management and the second (with same invoice number) sent to the SRIHS, where the services have been rendered.

Invoices submitted to the Great Plains Area Office – Division of Financial Management, send to the address listed below:

Attn: Accounts Payable Great Plains Area Indian Health Service Division of Financial Management 115 4th Avenue Southeast Room 309, Federal Building Aberdeen, South Dakota 57401

(b) The Contractor agrees to include the following information on each invoice:

(1) Contractor’s name and address,

(2) Invoice date and invoice number,

(3) Contract number, or other authorization for delivery of property and/or services,

(4) Description, quantity, unit of measure, unit price, and extended price of supplies delivered or services performed,

(5)…