RFP245M110003 02252011.docx

OUTPATIENT HEALTH CARE SERVICES-Checkerboard Area

RFP:

245- M1 -0003

- 44 - SECTION B - Supplies or Services/Prices

B.1 Purpose of Contract

Provision of medically necessary health care services inclusive of inpatient/outpatient services with all ancillary/support services, emergency medical services, air transportation, ground ambulance, public health nursing, behavioral health, community based health promotion/disease prevention activities, dental and other necessary health care services to IHS beneficiaries residing within the defined Navajo chapter boundaries and portions of the communities. Henceforth, for the purpose of this contract communities are defined as: Counselor, Ojo Encino, Torreon Chapter; and Star Lake, Cuba, Rincon Marcus, Tinian communities; and southeast of Lybrook School (see attached map).

Note: Public Health Nursing, Diabetes, and Behavioral Health functions of this solicitation may potentially be taken over by the Navajo Nation Division of Health (NNDOH) under PL 93-638, Indian Self-Determination and Education Assistance Act as amended.

B.2 Fee Schedule

The Contractor shall be compensated a fixed monthly amount for health care services provided to IHS beneficiaries residing within the communities in accordance with the terms and conditions set forth in the contract. This is a firm fixed price type contract. The following shall be the fee schedule for the basic contract period with two (2) one (1) year option periods.

Base Year - Date of Award - 31 March 2012

B-2-1 Health Care Services 12 MO $________ $_______________

First Year Option Period – 01 April 2012 – 31 March 2013

B-2-1 Health Care Services 12 MO $________ $_______________

Second Year Option Period – 01 April 2013 – 31 March 2014

B-2-1 Health Care Services 12 MO $________ $_______________

SECTION C - Description/Specifications C-1 Statement of Work

A. The Contractor shall provide all necessary personnel, supplies, medications, equipment (including durable medical equipment), facilities, and liability insurance to provide the necessary health care services.

B. The Contractor shall be financially and medically responsible for services provided to all IHS beneficiaries residing within the communities. The Contractor shall be financially responsible to fund health care services provided at non-IHS referral facilities outside the communities. If IHS beneficiaries residing in the communities noted in Paragraph B-1 are referred to NAIHS facilities, the NAIHS reserves the right to bill third party resources.

C. The Contractor shall have in place an Administrative Mechanism for collection of third party resources. It shall be the Contractor’s responsibility to bill all applicable alternate resources to generate revenue from those sources including assisting residents to enroll with appropriate alternate resources programs.

D. NAIHS shall authorize payment for services provided within the terms of this contract only and will not assume financial responsibility for any expansion of services the Contractor may undertake during the term of this contract.

E. The Contractor shall provide statistical and epidemiological data to NAIHS. The Government will not incur any additional costs developments of said reporting data.

F. Public Law 102-573, Indian Health Care Improvement Act, Section 222 prohibits any contract provider from billing IHS patients. Accordingly, the Contractor shall not bill any community area residents for co-payments/co-insurance or send to collection agencies.

G. In cases where the Contractor provides healthcare services to a patient from outside the communities (listed in Paragraph B), all referrals and notifications will be coordinated with IHS.

H. The Contractor shall adhere to all Federal and State laws and regulations in effect during the term of this contract and shall maintain active, on-going quality improvement and utilization review programs including customer satisfaction surveys among its patient population.

I. End Stage Renal Disease (ESRD) Dialysis and transportation are not included in this contract.

J. The Contractor shall provide services to diabetic patients according to ADA/IHS standard of care. Website: ADA – www.diabetes.org or professional diabetes.org IHS – diabetesprogram@ihs.gov. See note on Page 2, Paragraph B-1, regarding P.L. 93-638.

C-2 Inpatient Services

The Contractor shall be financially responsible for IHS beneficiaries residing in communities referred to a Non-IHS facility for acute healthcare services.

C-3 Outpatient Services

A. The Contractor shall provide outpatient health care services to include routine diagnostic and ancillary support services, pharmacy, lab, radiology, physical therapy, preventive and acute care prenatal, post-natal exams, follow-up, chronic pain management, routine gynecology, pediatric, adolescent, adult medical care and comprehensive vision and health evaluation.

B. Outpatient health care services shall be available to IHS beneficiaries residing in communities identified under paragraph B-1 Purpose of Contract, from 8:00 am to 4:00 pm daily, with extended hours for urgent care two (2) days a week from 8:00 am to 8:00 pm.

C. The Contractor shall notify COTR at Crownpoint Healthcare Facility regarding any hours of operations and any permanent changes in the hours of operation. This excludes holidays and emergency closures

C-4 Emergency Room (ER) Services

The Contractor shall provide emergency services during normal hours of operation to IHS beneficiaries residing in the communities in accordance with applicable Federal and State of New Mexico Standards. If a need for after hour ambulance transport services arise, the Contractor shall be responsible for the service.

C.5 Air and Ground Ambulance Transport Services

A. The Contractor shall possess the capability to stabilize and transport medical emergencies.

B. Ground ambulance services shall be provided in compliance with the standards of the New Mexico Medical Assistance Division (MAD): Medicaid Transportation and Client Medical Transportation Services, New Mexico Human Services Department.

C. All aircraft utilized for transportation services must be accredited by the Commission on Accreditation of Medical Transport Systems (CAMTS), and comply with regulations in Title 14 of the Code of Federal Regulations (CFR), Part 135, as utilized by the Federal Aviation Administration and in accordance with IHS Circular No. 2010-01, dated August 30, 2010, Section 7, Contracting Aircraft Services.

D. Those referrals that are initiated out of Crownpoint Health Care Facility and where air transportation is utilized; Crownpoint CHS will be responsible for making the payment for ONLY the air transport claim if determined CHS eligible. Crownpoint CHS will process through the CHS FI in Albuquerque, NM and upon payment by the CHS FI, Crownpoint will submit an explanation of benefits from the FI to the Contractor who will submit the refund through the CHS FI against the same purchase order, the amount disbursed and paid by IHS effective from the signing of contract.

C.6 Public Health Nursing (PHN)

A. The Contractor shall provide all necessary PHN services in schools, homes, or group settings within the communities. Services under this category shall be provided by a PHN.

B. IMMUNIZATION INITIATIVE: The Contractor’s program shall maintain a goal of 90% level of immunization in all children between the ages of 0-27 months. Immunization levels in school children (pre-school through Grade 8) shall also be maintain at 90%.

C. PHN services provided shall be in accordance with the National Public Health Nursing Standards.

See Note on Page 2, Paragraph B-1, regarding P.L. 93-638.

C.7 Dental Services

A. The Contractor shall provide basic dental care that includes emergency, primary (preventive) dental care and secondary (restorative) care. Basic Dental care is defined as the services specified in the Levels of Care I, II, and III of the NAIHS schedule of dental services.

B. Dental services shall be provided within the professional standards of quality, generally provided by other similarly qualified dentists in the State of New Mexico.

C. Dental Initiatives:

1. By June 01, 2012 and then every June 1 thereafter at least 70% of all Headstart students will have all treatment needs completed at the follow centers:

Torreon I, II, III & Home base Rincon Marcus Home base Ojo Encino Center &Home base

2. By June 1, 2012 and then every June 1 thereafter, at least 80% of all 1st, 2nd, 6th and 7th grade students will have had sealants successfully applied to all pit and fissures of all permanent molars susceptible to caries, at the following schools:

E. Orthodontia services are not included as part of this contract.

C.8 Optometry Services (Eye Care)

A. Contractor shall provide comprehensive vision and health evaluation.

B. Contractor shall provide treatment with the exception of invasive surgical procedures.

C. Any deferred and unmet need case/referral will be coordinated with the Crownpoint Healthcare Facility Optometry Department to track and/or include in their current year processing, if funds are available. Otherwise, it will be reported to Contract Health Service/ COTR along with Budgetary Information for the year.

C.9 Behavioral Health

A. The Contractor shall provide comprehensive behavioral health, social services and mental health. The services will include mental health, social services and substance abuse. That shall include screening, assessment, evaluations and diagnosis; counseling; behavior management; therapy; providing for continuity of care, emergency crisis stabilization and prescription to include monitoring of medications.

B. The Contractor shall be financially responsible for coordinating and transferring all off-reservation referrals for hospitalizations; including inpatient/outpatient for mental health services as well as all other types; provide follow-up on discharge and establish case management processes.

C. The Contractor shall be responsible for assisting IHS beneficiaries in applying for and maintaining eligibility with comprehensive package of services, such as: Navajo Regional Behavioral Health Authority (NRBHA), SALUD/Value Options, and any other available alternate resources.

D. The Contractor’s staff shall be appropriately certified/licensed behavioral health professional counselors inclusive of counselors, social workers, psychiatrists, psychologists, and other mental health staff.

See Note on Page 2, Paragraph B-1, regarding P.L. 93-638.

C.10 Accreditation

The Contractor’s facility and laboratory shall be accredited by The Joint Commission (TJC), Centers for Medicare and Medicaid Services (CMS) or Accreditation Association for Ambulatory Healthcare (AAAHC) certified for the term of the contract. The Contractor shall provide copies of accreditation, certification or any licensure renewals to the COTR upon their renewals for the term of the contract. The Contractor shall also provide copies of all accreditation review reports to the COTR.

A. The Contractor shall maintain proper Medicare/Medicaid provider status throughout the term of this contract.

B. The Contractor shall ensure that all staff are appropriately certified, licensed and credentialed while providing services under this contract.

C.11 Referrals/Notification

A. When the Contractor is unable to provide medical services beyond the provisions of the contract, patients may be referred to the nearest IHS Direct Care Facility capable of providing the care by written referral.

B. In the event that a resident self-refers to an IHS Facility (including emergency services), the Contractor will not be financially responsible, EXCEPT in the following situations:

1. When health care services are provided to a community resident enrolled in the Contractor’s Medical Insurance plan, then IHS will bill for these services;

2. When IHS refers a community resident to a non-IHS facility, IHS shall notify the Contractor for disposition of the patient. Otherwise, the Contractor may request IHS to be responsible for payment. EXCEPTION: In emergency situations, IHS will notify the Contractor within 72 hours.

C. In a non-emergency situation, if a community resident chooses to receive health care services outside the community at a non-IHS facility, WITHOUT a referral, the patient is financially responsible for the health care services received.

D. IHS beneficiaries who seek health care services at the Contractor’s facility and who do not reside within the communities are subject to the IHS-CHS Regulations, i.e., “Alternate Resources”, “Home of Record”, and the “72 Hour Notification” policies.

E. The Contractor must provide patient diagnosis and appropriate medical information consistent with the Consolidated Omnibus Budget Reconciliation Act (COBRA/EMTALA) guidelines that govern the transfer for patients between medical facilities.

C.12 Catastrophic Health Emergency Fund (CHEF)

A. The Contractor shall be responsible to pay for all incurred costs of medical care rendered by non-IHS providers for each catastrophic case up to $25,000.00. If the catastrophic case exceeds the $25,000.00 threshold, the remaining unpaid cost will be submitted to the patient’s Service Unit of residence. The Contractor shall provide all pertinent information necessary to assist the IHS Service Unit of residence in processing the additional unpaid cost beyond the threshold of $25,000.00 within 15 days of discharge and/or visit (no later than 30 days) to avoid delays in submission of CHEF by NAIHS..

B. The Contractor shall notify the NAIHS Service Unit of residence for all catastrophic cases, within five (5) business days of the discharge occurring immediately after the $25,000.00 threshold has been reached.

C. Cost above the threshold will be the responsibility of NAIHS Service Unit of residence for patient(s), only if timely notification is provided by the Contractor to NAIHS Service Unit in accordance with the above. If timely notification and submission is not provided to NAIHS Service Unit of residence for patient(s), the Contractor will be financially responsible for all costs of the catastrophic cases up to and above the defined $25,000.00 level. NAIHS Service Units will assume responsibility for coordinating and reporting reimbursement for CHEF cases to HQE/IHS division of Management Care (Rockville, MD) via NAIHS CHS Office.

D. The Contractor shall submit invoices and all required documents to Ms. Jennifer Tsosie, CHS, Crownpoint Healthcare Facility within 45 days after discharge.

C.13 Client Background

Many of the IHS patients receiving service under this contract may only speak a native language and/or reside on a federally recognized Indian reservation. The Contractor shall demonstrate sensitivity to cross-cultural and language difference and have the ability to work through interpreters as necessary for non-English speaking patients.

C.14 Review Rights

The COTR, Contracting Officer, or his/her professional designee, shall be entitled to review the Contractor's facilities, and all administrative and clinical records, including requests for copies of active or discharged patient records pertaining to IHS beneficiaries at no expense to the Indian Health Service.

Part I – Section D - Packaging and Marking- Not Applicable Part I Section E – Inspection and Acceptance

E.1 52.246-4 Inspection of Services - Fixed-Price. (AUG 1996)

(a) Definition: "Services," as used in this clause, includes services performed, workmanship, and material furnished or utilized in the performance of services.

(b) The Contractor shall provide and maintain an inspection system acceptable to the Government covering the services under this contract. Complete records of all inspection work performed by the Contractor shall be maintained and made available to the Government during contract performance and for as long afterwards as the contract requires.

(c) The Government has the right to inspect and test all services called for by the contract, to the extent practicable at all times and places during the term of the contract. The Government shall perform inspections and tests in a manner that will not unduly delay the work.

(d) If the Government performs inspections or tests on the premises of the Contractor or a subcontractor, the Contractor shall furnish, and shall require subcontractors to furnish, at no increase in contract price, all reasonable facilities and assistance for the safe and convenient performance of these duties.

(e) If any of the services do not conform to contract requirements, the Government may require the Contractor to perform the services again in conformity with contract requirements, at no increase in contract amount. When the defects in services cannot be corrected by re-performance, the Government may -

(1) Require the Contractor to take necessary action to ensure that future performance conforms to contract requirements; and

(2) Reduce the contract price to reflect the reduced value of the services performed.

(f) If the Contractor fails to promptly perform the services again or to take the necessary action to ensure future performance in conformity with contract requirements, the Government may -

(1) By contract or otherwise, perform the services and charge to the Contractor any cost incurred by the Government that is directly related to the performance of such service; or

(2) Terminate the contract for default. (End of clause)

SECTION F- Deliveries or Performance

If the Government exercises its option pursuant to 52.217-9 Option to Extend the term of the Contract, the period of performance will be extended in accordance with the following schedule.

YEAR OPTION PERIODS

The Government Guarantees a minimum 12 month contract under this solicitation pursuant to the Inspection Clauses. However, options for extension periods are not guaranteed if services are no longer required by the Crownpoint Healthcare Facility. The Contractor hereby releases and holds harmless the Navajo Area Indian Health Service and Crownpoint Healthcare Facility, and all of their respective officers, employees and agents, from any and all liability legal proceedings and costs including attorneys’ fees, arising from not extending contract for either the first or second year option periods.

F.2 Reports Requirements

Patient workload reporting that includes:

GPRA/CRS measures one (1) Quarterly

Reportable Disease Summary one (1) Monthly

Notify Mr. Steven Breithaupt, Director, Occupational Health/Safety Management, NAIHS and Ms. Cecelia Belone, COTR, Crownpoint Healthcare Facility within 24 hours of any unusual infection disease outbreaks, i.e. hanta virus, shigella, hepatitis A, etc.

Dental Head Start/School Sealant Report one (1) annually

Outpatient Workload one (1) Monthly

Financial reporting that includes:

Audited Financial Statements-most one (1) annually Recent/current starting with 2011 Copy of TJC/AAAHC survey report

Most recent/current statistical reports, as provided to State of NM Health Services Department.

Furnish one copy every month to: Mr. Steven Breithaupt, Director, Occupational Health/Safety Management, NAIHS and Ms. Cecelia Belone, COTR, Crownpoint Healthcare Facility a list of (names of patients) of Federal Medical Care Recovery Act (FMCRA) cases reported to ORC, DHHS.

Furnish one copy every month to: Ms. Jennifer Tsosie, Contract Health Services, Crownpoint Healthcare Facility a list of (names of patients) of potential and or open CHEF cases reported.

SECTION G – Contract Administration Data

G.1 Contracting Officer’s Responsibility

Authority to negotiate changes in terms, conditions, or amounts cited in this contract is reserved for the Contracting Officer

G.2 Contracting Officer’s Technical Representative (COTR):

Ms. Cecelia Belone has been designated as the COTR. The COTR will be responsible for the following:

A. Monitoring the Contractor’s technical progress, including surveillance and assessment of performance and recommending to the Contracting Officer changes in requirement;

B. Performing technical evaluation as required;

C. Performing technical inspections and acceptance required by this contract; and

D. Assisting the Contractor in the resolution of technical and administrative problems encountered during the performance of this contract.

G.3 Contractor’s Representative:

Designated Contractor’s Representative, whom we may contact for prompt Contract administration:

Name:_________________________________ Title:______________________

G.4 Invoice Submission

A. The Contractor shall submit an original invoice to: Cecelia Belone, COTR, Crownpoint Health Care Facility, and P.O. Box 358, Crownpoint, NM.

B. A proper invoice shall include the following:

SECTION H - Special Contract Requirements

H.1 Authorization for Contract Health Services

A. No payment will be made for medical care and services obtained from non-IHS provider/s or in non-IHS facilities unless the applicable requirements of paragraphs (b) and (c) below have been met and a purchase order for the care and services has been issued by the appropriate ordering official to the medical care provider.

B. In nonemergency cases, a sick or disabled Indian, or an individual or agency acting on behalf of the Indian, or the medical care provider shall, prior to the provision of medical care and services, notify the appropriate ordering official of the need for services and supply the relative medical need for the services and the individual's eligibility. The requirement for notice prior to providing medical care and services under this paragraph may be waived by the ordering official if:

1. Such notice and information is provided within 72 hours after the beginning of treatment or admission to a health care facility; and

2. The ordering official determines that giving of notice prior to obtaining the medical care and services was impracticable or that other good cause exists for the failure to provide prior notice.

C. In emergency cases, a sick or disabled Indian, or an individual or agency acting on behalf of the Indian, or the medical care provider shall, within 72 hours after the beginning of treatment for the condition or after admission to a health care facility notify the appropriate ordering official of the fact of the admission or treatment, together with information necessary to determine the relative medical need for the services and the eligibility of the Indian for the services. The 72hour period may be extended if the ordering official determines that notification within the prescribed period was impracticable or that other good cause exists for the failure to comply.

D. The services could not have been reasonably provided at an IHS facility.

Section 406 of P.L. 102573, of the Indian Health Care Improvement Act (IHCIA) allows the elderly and disabled, 30 days to notify the IHS of emergency care. The interim definition of "Elderly" and "Disabled" being used by the IHS is as follows:

"An elderly Indian means an Indian who is 65 years of age or older."

"A disabled Indian is an Indian who has a physical or mental condition that reasonably prevents him/her from providing or cooperating in obtaining the information necessary to notify the IHS of his/her receipt of emergency care or services from a nonIHS provider or facility within 72 hours after the nonIHS provider began to deliver the care."

H.2 Health Insurance Portability and accountability Act (HIPAA)

The Indian Health Service (IHS) is required to comply with the HIPAA in the provision of health care to IHS patients. HIPPA was implemented by the U.S. Department of Health and Human Services, Office of Civil Rights, under the Code of Federal Regulations, Part 160 and 164. Accordingly, all health care providers, including contracted health care providers are required to comply with HIPPA requirements. (Full text will be furnished upon request.).

H.3 Non-Discrimination in Services, Benefits, and Facilities

A. The Contractor agrees to make no distinctions among patients under this contract on the basis of race, color, creed, sex or national origin. For the purpose of this contract, distinctions on the grounds of race, color, creed, sex, or national origin include, but are not limited to the following: denying a patient any services or benefit or availability of a facility; providing any service or benefit to a patient which is different, or is provided in a different manner or at a different time from that provided to the other patients under this contract; subjecting a patient in any segregation or separated treatment on any manner related to his receipts of any service, restricting a patient in any way in the enjoyment of any advantage or privilege enjoyed by others in determining whether this satisfies any admission, enrollment quote, eligibility, membership or other requirement or condition which an individual must meet in order to be provisions of services on the basis of the race, color, creed, sex or national origin of the patients served.

B. The Government reserves the right to terminate this contract in whole or in part whenever the Contractor fails to comply with the requirements of this clause.

H.4 Alternate Resources

A. Payor of last resort. The Indian Health Service (IHS) is the "payor of last resort" notwithstanding any State or local law or regulations to the contrary in accordance with 42 CFR 136.61. Therefore, IHS is not an entitlement program but is a residual payer. Accordingly, IHS will not be responsible for or authorize payment for Contract Health Services to the extent that:

1. The Indian is eligible for alternate resources, as defined below, or;

2. The Indian would be eligible for alternate resources if he or she were to apply for them, or;

3. The Indian would be eligible for “alternate resources” under State or local law or regulation but for the Indians eligibility for Contract Health Services (CHS), or other health services, from IHS or an IHS funded program.

B. “Alternate resources” means health care resources other than those of the IHS. Such resources include health care providers and institutions, and health care programs for the payment of health services including but not limited to program under Title XVIII and XIX of the Social Security Act (i.e., Medicare, Medicaid (NM MCD), and the Arizona Health Care Cost Containment System (AHCCCS)), State or local health programs and private insurance. This example listing is not exhaustive and is provided only to list some of the possible alternate resources available for the patient/s. The Contractor shall make a good faith effort to assist each patient with his/her application for alternate resources.

A patient is required to complete application for an alternate resource if there is a reasonable indication the individual may be eligible for the alternate resources. Refusal to apply alternate resources, when there is a reasonable possibility that one exists, or refusal to utilize an alternate resource requires the denial of eligibility for IHS CHS; thus, payment responsibility for care rendered will rest with the patient and not with IHS. IHS will apprise the Contractor of any known alternative methods of payment for care provided to Indian beneficiaries as soon as they become apparent to the IHS.

Such information will generally be provided to the Contractor upon referral of each patient, however, such information may not become known to the IHS until after the patient is referred. In such cases, the IHS will withdraw and cancel an authorization to pay for services for which the Government has no financial liability to pay.

C. Refunds will be taken by the Fiscal Intermediary in instances where payment by the IHS has already occurred.

D. The provider will accept Medicare/Medicaid reimbursement allowance for all covered services as full and final compensation regardless of other third party liability. The provider shall not bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from or have any recourse against IHS patients or person acting on their behalf, for covered health services. This provision does not prohibit collection of charges for non-covered health services.

E. If an alternate resource is available, its use is mandatory and IHS or the Fiscal Intermediary (FI) shall be promptly notified of any payment received. The FI shall pay the IHS patient liability amount for medical and dental claims involving alternate resources (third-party payers) as follows:

1. The IHS patient liability amount is defined as the amount for which the patient is held responsible after primary resource(s) have been paid, less any IHS disallowed charges for services not authorized or covered by the IHS.

2. The contractual or regulatory restrictions or limitations imposed by the primary resource(s)/payer(s) will apply in determining the IHS patient liability amount. The IHS patient liability amount shall not exceed the amount which would have been paid by the IHS had IHS been the only payer.

3. The IHS patient liability amount is considered as the remaining balance of allowable charges after all alternate resources/s or payor/s has paid. Except in instances in which the provider is obligated by regulations or by contract with the primary payer(s) to accept the primary payer(s)’s payment as payment in full, e.g., in Medicare and Medicaid/AHCCCS cases, payment by the Federal and State agency may constitute payment in full. If there is no IHS liability for payment, no further payment shall be made.

F. The IHS will reject claims where it has reason to find that the provider failed to investigate other party liabilities/alternate resources or failure to bill alternate resources within their allotted time frames.

H.5 Third Party Liability

Public Law 87-639 (42 USC 2651) provides that the United States shall be entitled to recover the reasonable value of hospital and medical care and treatment furnished or to be furnished to a person who suffers any injury or disease under circumstances indicating the Third Party's Liability to pay damages therefore. Third Party Liability involves the potential legal liability of another person for the injury or disease in question. This other person is commonly referred to as the "third party" since his/her negligent act or failure to act caused an injury or disease to the "first party" necessitating medical treatment by or at the expense of the United States - the "second party." Necessary reporting forms and instructions for execution will be furnished by the appropriate SU CHS Health System Specialist or designee in all cases where "third party" liability exists or may result.

SECTION I –Contract Clauses

I.1 52.252-2 Clauses Incorporated by Reference (FEB 1998)

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/these address (es): http://www.arnet.gov/far

52.203-3 Gratuities. APR 1984

52.203-5 Covenant Against Contingent Fees. APR 1984

52.203-6 Restrictions on Subcontractor Sales to the Government. SEP 2006

52.203-7 Anti-Kickback Procedures. JUL 1995

52.203-8 Cancellation, Rescission, and Recovery of Funds for Illegal or Improper Activity. JAN 1997

52.203-10 Price or Fee Adjustment for Illegal or Improper Activity. JAN 1997

52.203-12 Limitation on Payments to Influence Certain Federal SEP 2007 Transactions.

52.203-13 Contractor Code of Business Ethics and Conduct APR 2010

52.204-4 Printed or Copied Double-Sided on Recycled Paper. AUG 2000

52.215-2 Audit and Records - Negotiation. MAR 2009

52.215-8 Order of Precedence - Uniform Contract Format. OCT 1997

52.215-12 Subcontractor Cost or Pricing Data. OCT 1997

52.219-8 Utilization of Small Business Concerns. DEC 2010

52.219-9 Small Business Subcontracting Plan. JUL 2010 Alternate II (OCT 2001)

52.219-16 Liquidated Damages - Subcontracting Plan. JAN 1999

52.222-3 Convict Labor. JUN 2003

52.222-21 Prohibition of Segregated Facilities. FEB 1999

52.222-26 Equal Opportunity. MAR 2007

52.222-36 Affirmative Action for Workers with Disabilities. JUN 1998

52.222-50 Combating Trafficking in Persons FEB 2009

52.223-6 Drug-Free Workplace. MAY 001

52.223-14 Toxic Chemical Release Reporting. AUG 2003

52.223-15 Energy Efficiency in Energy-Consuming Products DEC 2007

52.224-1 Privacy Act Notification. APR 1984

52.224-2 Privacy Act. APR 1984

52.225-5 Trade Agreements AUG 2009

52.225-13 Restrictions on Certain Foreign Purchases. JUN 2008

52.227-1 Authorization and Consent. DEC 2007

52.227-9 Refund of Royalties. APR 1984

52.229-3 Federal, State, and Local Taxes. APR 2003

52.232-1 Payments. APR 1984

52.232-8 Discounts for Prompt Payment. FEB 2002

52.232-11 Extras. APR 1984

52.232-17 Interest. OCT 2008

52.232-18 Availability of Funds. APR 1984

52.232-23 Assignment of Claims. JAN 1986

52.232-25 Prompt payment. OCT 2008

52.232-33 Payment by Electronic Funds Transfer - Central Contractor Registration. OCT 2003

52.232-36 Payment by Third Party. FEB 2010

52.233-1 Disputes. JUL 2002

52.233-3 Protest after Award. AUG 1996

52.233-4 Applicable Law for Breach of Contract Claim. OCT 2004

52.237-3 Continuity of Services. JAN 1991

52.243-1 Changes - Fixed-Price. (AUG 1987) - Alternate I APR 1984

52.244-2 Subcontracts. JUN 2007

52.244-5 Competition in Subcontracting. DEC 1996

52.246-25 Limitation of Liability - Services. FEB 1997

52.248-1 Value Engineering. FEB 2000

52.249-2 Termination for Convenience of the Government MAY1984 (Fixed Price).

52.249-8 Default (Fixed-Price Supply and Service). APR 1984

52.253-1 Computer Generated Forms. JAN 1991

I.2 52.209-8 Updates of Information Regarding Responsibility Matters (APR 2010)

(a) The Contractor shall update the information in the Federal Awardee Performance and Integrity Information System (FAPIIS) on a semi-annual basis, throughout the life of the contract, by entering the required information in the Central Contractor Registration database at http://www.ccr.gov (see 52.204-7).

(b) (1) The Contractor will receive notification when the Government posts new information to the Contractor's record.

(2) The Contractor will have an opportunity to post comments regarding information that has been posted by the Government. The comments will be retained as long as the associated information is retained, i.e., for a total period of 6 years. Contractor comments will remain a part of the record unless the Contractor revises them.

(3) With the exception of the Contractor, only Government personnel and authorized users performing business on behalf of the Government will be able to view the Contractor's record in the system. Public requests for system information will be handled under Freedom of Information Act procedures, including, where appropriate, procedures promulgated under E.O. 12600.

I.3 52.217-9 Option to Extend the Term of the Contract. (MAR 2000)

(a) The Government may extend the term of this contract by written notice to the Contractor within [30 days ; provided that the Government gives the Contractor a preliminary written notice of its intent to extend at least 60 days before the contract expires. The preliminary notice does not commit the Government to an extension.

(b) If the Government exercises this option, the extended contract shall be considered to include this option clause.

(c) The total duration of this contract, including the exercise of any options under this clause, shall not exceed 36 months or 3 years.

I.4 52.237-7 Indemnification and Medical Liability Insurance. (JAN 1997)

(a)) It is expressly agreed and understood that this is a non-personal services contract, as defined in Federal Acquisition Regulation (FAR) 37.101, under which the professional services rendered by the Contractor are rendered in its capacity as an independent contractor. The Government may evaluate the quality of professional and administrative services provided, but retains no control over professional aspects of the services rendered, including by example, the Contractor's professional medical judgment, diagnosis, or specific medical treatments. The Contractor shall be solely liable for and expressly agrees to indemnify the Government with respect to any liability producing acts or omissions by it or by its employees or agents. The Contractor shall maintain during the term of this contract liability insurance issued by a responsible insurance carrier of not less than the following amount(s) per specialty per occurrence: $1,000,000.

(b) An apparently successful offeror, upon request by the Contracting Officer, shall furnish prior to contract award evidence of its insurability concerning the medical liability insurance required by paragraph (a) of this clause.

(c) Liability insurance may be on either an occurrences basis or on a claims-made basis. If the policy is on a claims-made basis, an extended reporting endorsement (tail) for a period of not less than 3 years after the end of the contract term must also be provided.

(d) Evidence of insurance documenting the required coverage for each health care provider who will perform under this contract shall be provided to the Contracting Officer prior to the commencement of services under this contract. If the insurance is on a claims-made basis and evidence of an extended reporting endorsement is not provided prior to the commencement of services, evidence of such endorsement shall be provided to the Contracting Officer prior to the expiration of this contract. Final payment under this contract shall be withheld until evidence of the extended reporting endorsement is provided to the Contracting Officer.

(e) The policies evidencing required insurance shall also contain an endorsement to the effect that any cancellation or material change adversely affecting the Government's interest shall not be effective until 30 days after the insurer or the Contractor gives written notice to the Contracting Officer. If, during the performance period of the contract the Contractor changes insurance providers, the Contractor must provide evidence that the Government will be indemnified to the limits specified in paragraph (a) of this clause, for the entire period of the contract, either under the new policy, or a combination of old and new policies.

(f) The Contractor shall insert the substance of this clause, including this paragraph (f), in all subcontracts under this contract for health care services and shall require such subcontractors to provide evidence of and maintain insurance in accordance with paragraph (a) of this clause. At least 5 days before the commencement of work by any subcontractor, the Contractor shall furnish to the Contracting Officer evidence of such insurance. (End of clause)

I.5 52.232-19 Availability of Funds for the Next Fiscal Year (APR 1984)

Funds are not presently available for performance under this contract beyond September 30, 2011. The Government’s obligation for performance of this contract beyond that date is contingent upon the availability of appropriated funds from which payment for contract proposes can be made. No legal liability on the part of the Government for any payment may arise for performance under this contract beyond September 30, 2011, until funds are made available to the Contracting Officer for performance and until the Contractor receives notice of availability, to be confirmed in writing by the Contracting Officer.

I.6 DEPARTMENT OF HEALTH AND HUMAN SERVICES ACQUISITION REGULATION HHSAR) (48 CFR CHAPTER 3) CLAUSES

HHSAR

I.7 352.242-70 Key Personnel (January 2006) The key personnel specified in this contract are considered to be essential to work performance. At least 30 days prior to diverting any of the specified individuals to other programs or contracts (or as soon as possible, if an individual must be replaced, for example, as a result of leaving the employ of the Contractor), the Contractor shall notify the Contracting Officer and shall submit comprehensive justification for the diversion or replacement request (including proposed substitutions for key personnel) to permit evaluation by the Government of the impact on performance under this contract. The Contractor shall not divert or otherwise replace any key personnel without the written consent of the Contracting Officer. The Government may modify the contract to add or delete key personnel at the request of the contractor or Government.

I.8 352.237-70 Pro-Children Act (January 2006)

A. Public Law 103–227, Title X, Part C, also known as the Pro-Children Act of 1994 (Act), 20 U.S.C. 7183, imposes restrictions on smoking in facilities where certain federally funded children’s services are provided. The Act prohibits smoking within any indoor facility (or portion thereof), whether owned, leased, or contracted for, that is used for the routine or regular provision of (i) kindergarten, elementary, or secondary education or library services or (ii) health or day care services that are provided to children under the age of 18. The statutory prohibition also applies to indoor facilities that are constructed, operated, or maintained with Federal funds.

B. By acceptance of this contract or order, the Contractor agrees to comply with the requirements of the Act. The Act also applies to all subcontracts awarded under this contract for the specified children’s services. Accordingly, the Contractor shall ensure that each of its employees, and any subcontractor staff, is made aware of, understand, and comply with the provisions of the Act. Failure to comply with the Act may result in the imposition of a civil monetary penalty in an amount not to exceed $1,000 for each violation and/or the imposition of an administrative compliance order on the responsible entity. Each day a violation continues constitutes a separate violation.

I.10 352.237–71 Crime Control Act of 1990-Reporting of Child Abuse (January 2006)

A. Public Law 101–647, also known as the Crime Control Act of 1990 (Act), imposes responsibilities on certain individuals who, while engaged in a professional capacity or activity, as defined in the Act, on Federal land or in a federally-operated (or contracted) facility, learn of facts that give the individual reason to suspect that a child has suffered an incident of child abuse.

B. The Act designates ‘‘covered professionals’’ as those persons engaged in professions and activities in eight different categories including, but not limited to, physicians, dentists, medical residents or interns, hospital personnel and administrators, nurses, health care practitioners, chiropractors, osteopaths, pharmacists, optometrists, podiatrists, emergency medical technicians, ambulance drivers, alcohol or drug treatment personnel, psychologists, psychiatrists, mental health professionals, child care workers and administrators, and commercial film and photo processors. The Act defines the term ‘‘child abuse’’ as the physical or mental injury, sexual abuse or exploitation, or negligent treatment of a child.

C. Accordingly, any person engaged in a covered profession or activity under an HHS contract or subcontract, regardless of the purpose of the contract or subcontract, shall immediately report a suspected child abuse incident in accordance with the provisions of the Act. If a child is suspected of being harmed, the appropriate State Child Abuse Hotline, local child protective services (CPS), or law enforcement agency should be contacted. For more information about where and how to file a report, the Child help USA, National Child Abuse Hotline (1–800–4–A–CHILD•) should be called. Any covered professional failing to make a timely report of such incident shall be guilty of a Class B misdemeanor.

D. By acceptance of this contract or order, the Contractor agrees to comply with the requirements of the Act. The Act also applies to all applicable subcontracts awarded under this contract. Accordingly, the Contractor shall ensure that each of its employees, and any subcontractor staff, is made aware of, understand, and comply with the provisions of the Act.

I.11 352.237-72 Crime Control Act of 1990-Requirement for Background Checks (January 2006)

B. The Contracting Officer will provide the necessary information to the Contractor regarding the process for obtaining the background check. The Contractor may hire a staff person provisionally prior to the completion of a background check, if at all times prior to the receipt of the background check during which children are in the care of the newly-hired person, the person is within the sight and under the supervision of a previously investigated staff person.

C. By acceptance of this contract or order, the Contractor agrees to comply with the requirements of the Act. The Act also applies to all applicable subcontracts awarded under this contract. Accordingly, the Contractor shall ensure that each of its employees, and any subcontractor staff, is made award of understand, and comply with the provisions of the Act.

SECTION J - List of Documents, Exhibits and Other Attachments

Section K - Representations, Certifications, and Other Statements of Bidders K.1 Notice Listing Solicitation Provisions Incorporated by Reference

The following solicitation provisions pertinent to this section are hereby incorporated by reference (by Citation Number, Title, and Date) in accordance with the FAR provision at FAR "52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE" in Section K of this solicitation.