Teleradiology_Svcs_Solicitation.pdf

Solicitation No.: RFP245-M13-0003 Teleradiology Interpretation Service Navajo Area Indian Health Service

SECTION B – SUPPLIES OR SERVICES/PRICES

B-1 BACKGROUND STATEMENT

The Indian Health Service (IHS), an agency within the Department of Health and Human Services, is responsible for providing federal health services to American Indians and Alaska Natives. The provision of health services to members of federally-recognized tribes grew out of the special government-to-government relationship between the federal government and Indian tribes. This relationship, established in 1787, is based on Article I, Section 8 of the Constitution, and has been given form and substance by numerous treaties, laws, Supreme Court decisions, and Executive Orders. The IHS is the principle federal health care provider and health advocate for Indian people and its goal is to raise their health status to the highest possible level. The IHS provides a comprehensive health service delivery system for approximately 1.9 million American Indians and Alaska Natives who belong to 564 federally recognized tribes in 35 states.

The Navajo Area Indian Health Service (NAIHS) desires and has an ongoing program to furnish teleradiology services (transmission of digitized medical images for diagnostic purposes) and related services for eligible IHS beneficiaries. It is NAIHS’s intention to solicit proposals, and establish contract (s) on a competitive basis. Resultant contract(s) will be non-personal in nature, as defined by FAR 37.101, and as such, will be provided independent of Government supervision.

B-2 DESCRIPTION OF SERVICES

The Navajo Area Indian Health Service (NAIHS) has a requirement for Teleradiology Interpretation services for Indian Health Service facilities, which includes five Service Units located in the northern portions of the States of Arizona and New Mexico. NAIHS facilities offer a wide range of health care services with varying levels, types, and hours of service, up to twenty-four hours per day and seven days per week, at the various Service Units. NAIHS facilities perform a variety of imaging examinations in support of their clinical activities with all images captured, stored, and displayed in Digital Imaging and Communications in Medicine (DICOM) format. All data and reports are to be sent back to the Service Units not the Clinics.

To meet this requirement, the NAIHS requires Contractor’s support to assist in the interpretation of medical images, including X-ray (CR/DR), Computed Axial Tomography (CT), Mammography (MM), Ultrasound (US) and Magnetic Resonance Imaging (MRI).

1. Chinle Comprehensive Health Care Facility, Chinle, AZ Pinon Health Center, Pinon, AZ Tsaile Health Center, Tsaile, AZ

2. Crownpoint Health Care Facility, Crownpoint, NM

3. Gallup Indian Medical Center, Gallup, NM Tohatchi Health Center

4. Kayenta Health Center, Kayenta, AZ Inscription House Health Center

5. Northern Navajo Medical Center, Shiprock, NM Dzilth-Na-O-Dith-Hle Health Center, Bloomfield, New Mexico Four Corners Regional Health Center, Red Mesa, Arizona

The Contractor shall furnish all necessary personnel, supplies, materials, and equipment to perform under the terms of this contract. All services supplied by Contractor under the terms of the contract shall be performed in compliance with all requirements and regulations of Food and Drug Administration (FDA), Mammography Quality Standards Act (MQSA, for mammography services), The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS) and Health Insurance Portability and Accountability Act of 1996 (HIPAA), and Privacy Act.

B-3 FEE SCHEDULE/PRICES: THE FOLLOWING FEE SCHEDULES ARE BY LOCATIONS

This is a firm fixed price (FFP) Requirements-type, non-personal services contract. Each line item shall be an all-inclusive rate (labor, supplies, and equipment), etc. as specified in the scope of work.

The quantities of services specified in the schedule are estimated only and are not purchased by this contract. Delivery or performance shall be made only as authorized by orders issued by each Service Unit.

Reimbursement for services provided, as specified in the Scope of Work, will be processed upon documentation of acceptability by the designated Contracting Officer Representative Officer (COR).

Individual vendors can submit an offer on one, more than one, or on all types of examinations and/or facilities listed in the fee schedule.

BASE YEAR: 01 JULY 2013 THROUGH 30 JUNE 2014

Line items are estimated quantities that include respective Health Centers.

Fee Schedule A: Chinle Comprehensive Health Care Facility Estimated Unit Estimated CLIN Type of Service Quantities Unit Price Amount

A-1 Routine X-Ray Interpretations 45 EA $________ $_____________

A-2 Emergency X-Ray Interpretations 1 EA $________ $_____________

A-3 Routine Ultrasound Interpretations 208 EA $________ $_____________

A-4 Emergency Ultrasound Interpretations 1 EA $________ $_____________

A-5 C.T. Interpretations 4648 EA $________ $_____________

A-6 Mammo-Digital 1059 EA $________ $_____________

Fee Schedule B: Crownpoint Health Care Facility

CLIN Type of Service Quantities Unit Price Amount

B-1 Routine X-Ray Interpretations 864 EA $________ $_____________

B-2 Emergency X-Ray Interpretations 1 EA $________ $_____________

B-3 Routine Ultrasound Interpretations 549 EA $________ $_____________

B-4 Emergency Ultrasound Interpretations 1 EA $________ $_____________

B-5 C.T. Interpretations 485 EA $________ $_____________

B-6 Mammo-Digital 467 EA $________ $_____________

Fee Schedule C: Gallup Indian Medical Center

CLIN Type of Service Quantities Unit Price Amount

C-1 Routine X-Ray Interpretations 493 EA $________ $_____________

C-2 Emergency X-Ray Interpretations 1 EA $________ $_____________

C-3 Routine Ultrasound Interpretations 774 EA $________ $_____________

C-4 Emergency Ultrasound Interpretations 1 EA $________ $_____________

C-5 C.T. Interpretations 6745 EA $________ $_____________

C-6 Mammo-Digital 1 EA $________ $_____________

C-7 MRI Exam Interpretations 1 EA $________ $_____________

Fee Schedule D: Kayenta Health Center

CLIN Type of Service Quantities Unit Price Amount

D-1 Routine X-Ray Interpretations 6690 EA $________ $_____________

D-2 Emergency X-Ray

D-3 Routine Ultrasound Interpretations 825 EA $________ $_____________

D-4 Emergency Ultrasound Interpretations 1 EA $________ $_____________

Fee Schedule E: Northern Navajo Medical Center Estimated Unit Estimated CLIN Type of Service Quantities Unit Price Amount

E-1 Routine X-Ray Interpretations 101 EA $________ $_____________

E-2 Emergency X-Ray Interpretations 1 EA $________ $_____________

E-3 Routine Ultrasound Interpretations 2 EA $________ $_____________

E-4 Emergency Ultrasound Interpretations 1 EA $________ $_____________

E-5 C.T. Interpretations 2833 EA $________ $_____________

E-6 Mammo-Digital 83 EA $________ $_____________

E-7 MRI Exam Interpretations 20 EA $________ $_____________

FIRST YEAR OPTION: 01 JULY 2014 TO 30 JUNE 2015

Estimated Unit Estimated CLIN Type of Service Quantities Unit Price Amount

A-1 Routine X-Ray Interpretations 45 EA $________ $_____________

A-2 Emergency X-Ray Interpretations 1 EA $________ $_____________

A-3 Routine Ultrasound Interpretations 208 EA $________ $_____________

A-4 Emergency Ultrasound

CLIN Type of Service Quantities Unit Price Amount

B-1 Routine X-Ray Interpretations 864 EA $________ $_____________

B-2 Emergency X-Ray Interpretations 1 EA $________ $_____________

B-3 Routine Ultrasound Interpretations 549 EA $________ $_____________

B-4 Emergency Ultrasound Interpretations 1 EA $________ $_____________

CLIN Type of Service Quantities Unit Price Amount

C-1 Routine X-Ray Interpretations 493 EA $________ $_____________

C-2 Emergency X-Ray Interpretations 1 EA $________ $_____________

C-3 Routine Ultrasound Interpretations 774 EA $________ $_____________

C-4 Emergency Ultrasound Interpretations 1 EA $________ $_____________

C-5 C.T. Interpretations 6745 EA $________ $_____________

C-6 Mammo-Digital 1 EA $________ $_____________

CLIN Type of Service Quantities Unit Price Amount

D-1 Routine X-Ray Interpretations 6690 EA $________ $_____________

D-2 Emergency X-Ray Interpretations 1 EA $________ $_____________

D-3 Routine Ultrasound Interpretations 825 EA $________ $_____________

D-4 Emergency Ultrasound

Fee Schedule E: Northern Navajo Medical Center

CLIN Type of Service Quantities Unit Price Amount

E-1 Routine X-Ray Interpretations 101 EA $________ $_____________

E-2 Emergency X-Ray Interpretations 1 EA $________ $_____________

E-3 Routine Ultrasound Interpretations 2 EA $________ $_____________

E-4 Emergency Ultrasound Interpretations 1 EA $________ $_____________

E-5 C.T. Interpretations 2833 EA $________ $_____________

SECOND YEAR OPTION: 01 JULY 2015 THROUGH 30 JUNE 2016

Estimated Unit Estimated CLIN Type of Service Quantities Unit Price Amount

A-1 Routine X-Ray Interpretations 45 EA $________ $_____________

A-2 Emergency X-Ray Interpretations 1 EA $________ $_____________

A-3 Routine Ultrasound Interpretations 208 EA $________ $_____________

A-4 Emergency Ultrasound Interpretations 1 EA $________ $_____________

CLIN Type of Service Quantities Unit Price Amount

B-1 Routine X-Ray Interpretations 864 EA $________ $_____________

B-2 Emergency X-Ray Interpretations 1 EA $________ $_____________

B-3 Routine Ultrasound Interpretations 549 EA $________ $_____________

B-4 Emergency Ultrasound Interpretations 1 EA $________ $_____________

CLIN Type of Service Quantities Unit Price Amount

C-1 Routine X-Ray Interpretations 493 EA $________ $_____________

C-2 Emergency X-Ray Interpretations 1 EA $________ $_____________

C-3 Routine Ultrasound Interpretations 774 EA $________ $_____________

C-4 Emergency Ultrasound Interpretations 1 EA $________ $_____________

C-5 C.T. Interpretations 6745 EA $________ $_____________

C-6 Mammo-Digital 1 EA $________ $_____________

CLIN Type of Service Quantities Unit Price Amount

D-1 Routine X-Ray Interpretations 6690 EA $________ $_____________

D-2 Emergency X-Ray Interpretations 1 EA $________ $_____________

D-3 Routine Ultrasound Interpretations 825 EA $________ $_____________

CLIN Type of Service Quantities Unit Price Amount

E-1 Routine X-Ray Interpretations 101 EA $________ $_____________

E-2 Emergency X-Ray

E-3 Routine Ultrasound Interpretations 2 EA $________ $_____________

E-4 Emergency Ultrasound Interpretations 1 EA $________ $_____________

E-5 C.T. Interpretations 2833 EA $________ $_____________

THIRD YEAR OPTION: 01 JULY 2016 THROUGH 30 JUNE 2017

Estimated Unit Estimated CLIN Type of Service Quantities Unit Price Amount

A-1 Routine X-Ray Interpretations 45 EA $________ $_____________

A-2 Emergency X-Ray Interpretations 1 EA $________ $_____________

A-3 Routine Ultrasound Interpretations 208 EA $________ $_____________

A-4 Emergency Ultrasound Interpretations 1 EA $________ $_____________

CLIN Type of Service Quantities Unit Price Amount

B-1 Routine X-Ray Interpretations 864 EA $________ $_____________

B-2 Emergency X-Ray Interpretations 1 EA $________ $_____________

B-3 Routine Ultrasound Interpretations 549 EA $________ $_____________

B-4 Emergency Ultrasound Interpretations 1 EA $________ $_____________

CLIN Type of Service Quantities Unit Price Amount

C-1 Routine X-Ray Interpretations 493 EA $________ $_____________

C-2 Emergency X-Ray Interpretations 1 EA $________ $_____________

C-3 Routine Ultrasound Interpretations 774 EA $________ $_____________

C-4 Emergency Ultrasound Interpretations 1 EA $________ $_____________

C-5 C.T. Interpretations 6745 EA $________ $_____________

C-6 Mammo-Digital 1 EA $________ $_____________

Schedule D: Kayenta Health Center

CLIN Type of Service Quantities Unit Price Amount

D-1 Routine X-Ray Interpretations 6690 EA $________ $_____________

D-2 Emergency X-Ray Interpretations 1 EA $________ $_____________

D-3 Routine Ultrasound Interpretations 825 EA $________ $_____________

CLIN Type of Service Quantities Unit Price Amount

E-1 Routine X-Ray Interpretations 101 EA $________ $_____________

E-2 Emergency X-Ray Interpretations 1 EA $________ $_____________

E-3 Routine Ultrasound Interpretations 2 EA $________ $_____________

E-4 Emergency Ultrasound Interpretations 1 EA $________ $_____________

E-5 C.T. Interpretations 2833 EA $________ $_____________

FOURTH YEAR OPTION: 01 JULY 2017 THROUGH JUNE 30, 2018

Estimated Unit Estimated CLIN Type of Service Quantities Unit Price Amount

A-1 Routine X-Ray Interpretations 45 EA $________ $_____________

A-2 Emergency X-Ray Interpretations 1 EA $________ $_____________

A-3 Routine Ultrasound Interpretations 208 EA $________ $_____________

A-4 Emergency Ultrasound Interpretations 1 EA $________ $_____________

CLIN Type of Service Quantities Unit Price Amount

B-1 Routine X-Ray Interpretations 864 EA $________ $_____________

B-2 Emergency X-Ray Interpretations 1 EA $________ $_____________

B-3 Routine Ultrasound Interpretations 549 EA $________ $_____________

B-4 Emergency Ultrasound Interpretations 1 EA $________ $_____________

CLIN Type of Service Quantities Unit Price Amount

C-1 Routine X-Ray Interpretations 493 EA $________ $_____________

C-2 Emergency X-Ray Interpretations 1 EA $________ $_____________

C-3 Routine Ultrasound Interpretations 774 EA $________ $_____________

C-4 Emergency Ultrasound Interpretations 1 EA $________ $_____________

C-5 C.T. Interpretations 6745 EA $________ $_____________

C-6 Mammo-Digital 1 EA $________ $_____________

CLIN Type of Service Quantities Unit Price Amount

D-1 Routine X-Ray Interpretations 6690 EA $________ $_____________

D-2 Emergency X-Ray Interpretations 1 EA $________ $_____________

D-3 Routine Ultrasound Interpretations 825 EA $________ $_____________

CLIN Type of Service Quantities Unit Price Amount

E-1 Routine X-Ray Interpretations 101 EA $________ $_____________

E-2 Emergency X-Ray Interpretations 1 EA $________ $_____________

E-3 Routine Ultrasound Interpretations 2 EA $________ $_____________

E-4 Emergency Ultrasound Interpretations 1 EA $________ $_____________

E-5 C.T. Interpretations 2833 EA $________ $_____________

B-4 STATEMENT OF WORK

A. SCOPE OF WORK. The Contractor shall provide teleradiology interpretation support services and reports of electronic medical images for x-ray, computed axial tomography (CT), mammography, ultrasound and MRI exams.

B. The Contractor shall provide written and oral (when necessary) interpretations reports of medical images for x-ray, computed axial tomography (CT), conventional mammography, ultrasounds and MRI exams for all image modalities to NAIHS Service Units listed in Paragraph B.2.

1. The Contractor shall furnish all necessary personnel, supplies, materials, equipment necessary to perform services under this contract.

2. The Contractor shall perform quarterly Quality Assurance and Peer Review (QA) including review of all radiologists providing interpretive services under the terms of this contract as defined herein. Contractor shall report results of all QA performed as part of this Scope of Work to Contracting Officer’s Representative (COR).

3. The Contractor shall not share, distribute or publish any NAIHS Facility Data and Images, business data, patient data or information, or patient images; except as necessary to provide services under the contract, without the express written consent of the originating facility and any such data, information or images shared, distributed or published with the express written consent of the originating facility, and shall be in accordance with all applicable regulations and requirements Health Insurance Portability and Accountability Act (HIPAA), The Joint Commission Standards (TJC), Centers for Medicare and Medicaid Services (CMS) and other applicable privacy standards.

4. The Contractor shall have Equipment and Software: Hardware and software utilized by Contractor to provide services under the contract shall be compliant with all regulations and requirements of Food Drug Administration (FDA), TJC, CMS, and HIPAA.

5. Teleradiology interpretation shall not be performed by physicians in training or residency.

6. Radiology Staff Quality Assurance (QA) activities and requirements: The Contractor shall have and maintain a QA program consistent with all TJC or CMS requirements including quarterly evaluations of interpretations by every interpreting radiologist. These requirements may be amended from time to time to maintain compliance with applicable laws, rules, and regulations.

a. The Contractor’s QA evaluations shall classify Contractor’s radiologist’s imaging examination clinical report as:

i. No Discrepancy: Reviewer fully agreed with initial clinical interpretation.

ii. Minimal Discrepancy: Reviewer noted or disagreed with one or more findings reported on the initial interpretation that would likely not alter NAIHS facility’s patient’s care or clinical course.

iii. Significant Discrepancy: Reviewer noted or disagreed with one or more findings on the initial interpretation that would likely alter NAIHS facility’s patient’s care or clinical course. Note: Contractor shall take action within one (1) hour to communicate to NAIHS facility responsible provider notice of any significant discrepancies found in initial reads.

b. The Contractor’s QA evaluations shall include a sufficient number of interpretations for each of Contractor’s radiologists providing services under the contract to meet all TJC and CMS requirements for accredited QA programs.

c. The Contractor’s QA evaluations shall be conducted by a Board Eligible/Board Certified (BE/BC) radiologist (not currently in residency training) at Contractor’s sole expense.

d. The Contractor’s QA evaluations must be reported to the NAIHS COR within thirty calendar days of the end of the quarter or as required by TJC and CMS.

e. Performance Improvement Plans (PI Plans) must be included for any of Contractor’s interpreting radiologists with a rate of clinically significant discrepancy greater than 1%.

f. The Contractor shall also keep a written or electronic log of telephone and/or fax urgent or stat reports and shall conduct review of data consistent with TJC and CMS requirements on a monthly basis, results of said review to be reported to NAIHS COR within twenty calendar days of the end of the report month.

B-5 DEFINITIONS

1. Teleradiology – The technology used to transmit digital medical imaging images on a network.

2. PACS – Picture Archiving and Communication System. Equipment used to manage, send, and store digital medical images within a facility.

3. DICOM – Diagnostic Imaging Communication in Medicine.

4. HL7 Format – Health Level Seven is one of several American National Standards Institute. “Level seven” refers to the highest level of the International Standards Organization’s (ISO) communications model for Open Systems Interconnection (OSI) – the application level.

The application level addresses definition of the data to be exchanged, the timing of the interchange, and the communication of certain errors to the application. The seventh level supports such functions as security checks, participant identification, availability checks, exchange mechanism negotiations and, most importantly, data exchange structuring.

5. Point of Contact – an employee designated (by the Contracting Officer) to be the primary contact at a facility for the Contractor and Contracting Officer Representative. The Point of Contact is authorized to contact the Contractor regarding facility requirements serviced by this contract.

B-6 CONTRACTOR FURNISHED PROPERTY. The Contractor shall provide all necessary personnel, supplies, equipment, and facilities to perform this contract.

B-7 GOVERNMENT FURNISHED PROPERTY. Images performed on site by the NAIHS facilities will be made available electronically to the Contractor for diagnostic radiological interpretations along with any clinical information available to the radiologic technologist.

All digital images and accompanied data shall remain the property of and subject to the exclusive control of

U.S. Government. All related reports, images and documents prepared by the Contractor for diagnostic imaging interpretation in fulfillment of this contract shall become the property of the U.S. Government.

B-8 PROFESSIONAL QUALIFICATIONS.

The Contractor’s physicians shall:

1. Be Board Eligible or Board Certified (BE/BC) in Diagnostic Radiology by the American Board of

Radiology (ABR).

2. Possess an unrestricted license to practice medicine in the state where they will be providing professional services (the state where Contractors’ radiologist will be located while interpreting and reporting exams).

3. Be credentialed and privileged by Contractor under TJC or CMS accredited methods to provide diagnostic imaging professional services.

4. Provide under the contract only diagnostic imaging professional services within the scope of their credentials and privileging as granted by Contractor under TJC or CMS accredited methods.

5. Meet the “Qualifications of Personnel” in the America College of Radiology (ACR) Technical

Standard for Teleradiology, Section III, A. Physician http://www.acr.org/Hidden/Economics/FeaturedCategories/useful_links/medicare_info/teleradiology/AC RTechnicalStandardsDoc4.aspx).

6. Contractor’s Professional Liability Insurance: Contractor shall maintain, at Contractor’s sole expense, Professional Liability Insurance for each of Contractor’s radiologists providing services under the contract in the amount of at least Two Million Dollars ($2,000,000) per claim and Six Million Dollars ($6,000,000) in the annual aggregate, and General Liability Insurance in an amount at least commensurate with industry standards.

7. All interpretations provided to NAIHS facilities under the terms of the contract shall be performed by radiologists located in the United States of America.

B-9 CREDENTIALING OF CONTRACTOR’S RADIOLOGISTS:

1. The Contractor shall Maintain at all times during the contract period certification by THC (MS

13.01.01 and MS 13.01.03), and/or CMS including credentialing and privileging of Contractor’s radiologists providing services to NAIHS facilities under the terms of the contract.

2. The Contractor shall notify NAIHS immediately in writing of any limitations on Contractor’s TJC and/or CMS a restriction on credentialing and privileging of any of Contractor’s radiologists. Contractor http://www.acr.org/Hidden/Economics/FeaturedCategories/useful_links/medicare_info/teleradiology/ACRTechnicalStandardsDoc4.aspx http://www.acr.org/Hidden/Economics/FeaturedCategories/useful_links/medicare_info/teleradiology/ACRTechnicalStandardsDoc4.aspx shall provide to NAIHS COR and subsequently update a list of all radiologists that will be providing interpretations under the terms of the contract, said list including PIN and other identifying information required by government and private third party payers.

3. The Contractor shall provide each NAIHS facility with signed billing waivers for each interpreting radiologist as required to facilitate billing of government and private third party payers by NAIHS facilities.

4. The Contractor shall provide NAIHS all documentation, information, and permissions required by referring Service Units to properly complete their credentialing and privileging actions as required by TJC and CMS.

5. The Contractor shall provide NAIHS at least five working days (excluding weekends and Federal holidays) notice of any additions to Contractor’s interpreting radiologist staff, said notice to be accompanied by all identification, billing, privileging, and credentialing documentation specified above this paragraph.

B-10 ACCURACY OF REPORTS: All reports shall maintain a 99% clinically significant accuracy rate.

Any errors found in reports, must be communicated within 12 hours by telephone and fax to the responsible provider at the referring NAIHS facility.

B-11 ESTIMATED VOLUMES OF MEDICAL IMAGING EXAMINATIONS PER YEAR BY CATEGORY

AND STANDARD REPORT TURNAROUND TIME:

a. The following NAIHS Service Units may submit imaging examinations of varying numbers, types, severity, urgency, and days and hours of transmission for interpretation under the terms of the contract:

Chinle Comprehensive Health Care Facility(TJC)

Crownpoint (CMS)

Gallup Indian Medical Center (TJC)

Inscription House Health Center(IHHC)

Kayenta Health Center(TJC)

Northern Navajo Medical Center(NNMC) – Shiprock (TJC)

b. Workload may vary depending on the varying needs of the referring facilities, including number of onsite radiologists, type and/or time of examination, and a number of other factors.

c. Imaging examinations may be sent to Contractor for routine, urgent or stat interpretation twenty-four hours per day, seven days per week.

d. The following are annual volumes of different categories of imaging examinations. Price shall be submitted per exam category. Additionally, Contractor may estimate costs based on number of images per examination for cross sectional imaging exams (e.g., CT and MRI).

e. The following Report turnaround times shall be required timelines for imaging examination reports sent as ‘routine’, ‘urgent’ and/or ‘stat’:

1. Routine: Interpretation shall be available at the referring facility by noon the following day.

2. Urgent or Stat: Interpretation shall be called, and faxed or transmitted to the responsible provider at the referring facility within thirty (30) minutes.

3. In all cases, within one (1) hour the Contractor’s radiologists shall provide immediate telephone consultation with NAIHS clinicians to report any abnormal findings that might significantly alter the treatment and care of NAIHS patients or any errors discovered.

f. NAIHS facilities reserve the right to alternatively utilize the services of another vendor if the Contractor is not able, for any reason, to meet the timelines and requirements listed herein.

B-12 PRELIMINARY AND FINAL INTERPRETATIONS: All interpretations shall be final once BE/BC radiologist (not currently in residency training), complete the report and transfers the report into the referring facilities medical record. All interpretations shall be final.

B-13 DIGITAL MAMMOGRAPHY REQUIREMENTS: provide the following services related to NAIHS referring facility screening and diagnostic mammography programs including support for Mammography Quality Standards Act (MQSA) activities with FDA and ACR. Contractor may be required to provide the following services depending on the needs of the individual referring facility.

a. Lead Interpreting Physician, as defined by MQSA.

b. Medical Physicist Survey, as required by MQSA, with all required reporting to COR as required by MQSA. Contractor shall maintain full MQSA accreditation while performing mammography services under the terms of the contract.

c. Contractor’s Lead Interpreting Physician and Medical Physicist shall consult with and assist referring facilities with all clinical issues and MQSA accreditation issues as requested by the referring facilities and required by MQSA. Contractor shall be responsible for physician’s portions of MQSA accreditation and annual inspections.

d. Contractor’s Lead Interpreting Physician and staff mammographers shall be available to assist NAIHS referring facilities’ clinical providers with clinical consultations related to mammography services performed under the terms of the contract

Service Units CT Mammo MRI Ultrasound X-ray

Chinle SU 4648 1059 0 208 45

Crownpoint 485 467 0 549 864

GIMC 6745 1 1 774 493

IHHC/Kayenta 0 1 0 825 6690

NNMC 2833 83 20 2 101

B-14 CUSTOMER SERVICE ASSISTANCE: Provide contacts for NAIHS and referring facilities for assistance for clinical, technical, and business related issues as follows.

a. Contractor shall provide a customer representative to assist NAIHS and referring facilities staff with business questions during regular business hours Monday through Friday, 0800 – 1700, Mountain Time.

b. Contractor shall maintain an 800 telephone number or equivalent telephone service to permit twenty-four hours per day and seven days per week immediate contact with Contractor’s clinical and technical staff by clinical providers or technical support at referring facilities.

c. Contractor shall identify a Medical Director for its services. COR, NAIHS clinical providers, and administrators may contact Contractor’s Medical Director with clinical issues and concerns and service requests.

B-15 CONTRACTOR’S COMMUNICATIONS NETWORK AND INTERFACE REQUIREMENTS SHALL

MEET THE FOLLOWING:

a. Communications Interface: shall interface with Government furnished Picture Archiving and Communication System (PACS) communications platform(s) at NAIHS referring facility sites.

b. Storage and Display of Imaging Examinations: All interpretations shall be performed on

FDA, TJC, CMS, and HIPAA compliant equipment operating FDA, TJC, CMS, and HIPAA compliant software. All equipment and software shall be calibrated and maintained to FDA, TJC, CMS and HIPAA compliant standards.

c. Required Communications and Information Systems Agreements: Contractor shall work with NAIHS and facility IRM Departments to complete all IHS required Information Systems Agreements.

d. Contractor’s network shall have established firewalls and procedures to ensure patient confidentiality and security consistent with HIPAA regulations and ACR guidelines.

e. Contractor shall transmit reports to NAIHS facilities by electronic means in format acceptable to referring facility.

f. Contractor shall work with NAIHS and referring facilities to develop a) direct HL – 7 interface with IHS database, to allow direct communications of patient demographic and clinical information, imaging examination information, and work orders from NAIHS referring facilities’ database to Contractor’s information system and b) direct HL – 7 interface for transmission of imaging examination reports from Contractor’s information system back to NAIHS referring facilities’ database, during the contract period.

g. Contractor’s server and telecommunications network shall have built in redundancy to allow for 100% receipt and processing of all NAIHS data.

B-17 PERIOD OF PERFORMANCE

a. Performance of this contract shall begin on July 01, 2013 through June 30, 2014, unless the period is changed by written modification of the contract. This contract will be effective for one (1) base contract year and five (5) one (1) year option periods.

b. If the Government exercises its option pursuance 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 PERIOD

BASE YEAR July 01, 2013 through June 30, 2014

FIRST YEAR OPTION July 01, 2014 through June 30, 2015 SECOND YEAR OPTION July 01, 2015 through June 30, 2016

THIRD YEAR OPTION July 01, 2016 through June 30, 2017 FOURTH YEAR OPTION July 01, 2017 through June 30, 2018

B-18 CONTRACTING OFFICER RESPONSIBILITY: Authority to negotiate changes in terms, conditions, or amounts cited in this contract are reserved to the Contracting Officer.

B-19 CONTRACTING OFFICER’S REPRESENTATIVE (COR): The Contracting Officer will designate in writing a COR who shall be responsible for:

1. Monitoring the Contractor’s technical progress to include the surveillance and assessment of performance;

2. Interpreting the Statement of Work;

3. Technical inspections and acceptances required by this contract; and

4. Assisting the Contractor in resolution of technical problems encountered during performance of this contract.

B-20 POINT OF CONTACTS FOR NAIHS FACILITIES:

1. Chinle Comprehensive Healthcare Facility c/o Radiology Imaging PO Box Drawer-PH Highway 191 Hospital Drive Chinle, AZ 86503

Kevin Rand, MD, Clinical Director, (928) 674-7019 Patrick J. Ashley, R.T., Radiology Manager, (928) 674-7144

2. Crownpoint Healthcare Facility PO Box 358 Junction SR 371 & Route 9 Crownpoint, NM 87313

Jess West, Radiology Supervisor, (505) 786-6451 John J. Johnson, Clinical Director, (505) 786-6354

3. Gallup Indian Medical Center 516 E. Nizhoni Blvd

PO Box 1337 Gallup, NM 87301

Stephen Friedman, MD, (505) 722-1162 Jonie Guerro, Radiology Supervisor, (505) 722-1162

Aaron Yuselew, PACS Manager, (505) 722-1162

4. Northern Navajo Medical Center PO Box 160

North Highway 491 Shiprock, NM 87420

George Baake, MD, Clinical Director, (505) 368-6008 Maybelle Holiday-Descheny, (505) 368-7157

5. Kayenta Health Center PO Box 368 Highway 163, Bldg. KA-2010 Kayenta, AZ 86033

Dr. Kathy Wood, Clinical Director, (928) 697-4234

B-21 TASK ORDERS

a. Individual task orders by each medical facility under this contract will be issued in accordance with the Schedule of Prices utilizing Optional Form (OF-347), which will set the scope of services and costs.

b. Individual (s) authorized to sign and place orders against this contract are as follows:

Division of Acquisition Management Frank Dayish, CCO NAIHS-Window Rock, AZ 86515 Priscilla Duncan, CS Telephone No.: (928) 871-5863 Maxine Dineyazhe, CS Margaret Shirley, CS

USPHS-Chinle Comprehensive Healthcare Facility Tanya M. Johnson, CS

Chinle, Arizona 86503 Edith Denny, PA Telephone No.: (928) 674-7635

USPHS-Crownpoint Healthcare Mary Cecil, PA Crownpoint, NM 87313 Stefanie Atene, CS Telephone No.: (505) 786-2527

USPHS-Gallup Indian Medical Center Natasha Chee, CS Gallup, New Mexico 87301 Duwayne Begay, BS

Telephone No.: (505) 722-1549

USPHS-Northern Navajo Medical Center Linda Conn, CS Shiprock, New Mexico 87420 Yvonne Jumbo, PA Telephone No.: (505) 368-6087

USPHS-Kayenta Indian Health Center Tanya Johnson, CS Kayenta, AZ 86033 Telephone No.: (928) 674-7635

SECTION C - CONTRACT CLAUSES

C.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

FAR NUMBER TITLE DATE

52.224-1 Privacy Act Notification Apr 1984 52.224-2 Privacy Act Apr 1984 52.243-1 Changes-Fixed Price (Alternate 1) Aug 1987

C-2 52.212-4 CONTRACT TERMS AND CONDITIONS-COMMERCIAL ITEMS (FEB 2012)

(a) Inspection/Acceptance. The Contractor shall only tender for acceptance those items that conform to the requirements of this contract. The Government reserves the right to inspect or test any supplies or services that have been tendered for acceptance. The Government may require repair or replacement of nonconforming supplies or reperformance of nonconforming services at no increase in contract price. If repair/replacement or reperformance will not correct the defects or is not possible, the Government may seek an equitable price reduction or adequate consideration for acceptance of nonconforming supplies or services. The Government must exercise its post-acceptance rights—

(1) Within a reasonable time after the defect was discovered or should have been discovered;

and

(2) Before any substantial change occurs in the condition of the item, unless the change is due to the defect in the item.

(b) Assignment. The Contractor or its assignee may assign its rights to receive payment due as a result of performance of this contract to a bank, trust company, or other financing institution, including any Federal lending agency in accordance with the Assignment of Claims Act (31 U.S.C. 3727). However, when a third party makes payment (e.g., use of the Government wide commercial purchase card), the Contractor may not assign its rights to receive payment under this contract.

(c) Changes. Changes in the terms and conditions of this contract may be made only by written agreement of the parties.

(d) Disputes. This contract is subject to the Contract Disputes Act of 1978, as amended (41 U.S.C. 601- 613). Failure of the parties to this contract to reach agreement on any request for equitable adjustment, claim, appeal or action arising under or relating to this contract shall be a dispute to be resolved in accordance with the clause at FAR 52.233-1, Disputes, which is incorporated herein by reference. The Contractor shall proceed diligently with performance of this contract, pending final resolution of any dispute arising under the contract.

(e) Definitions. The clause at FAR 52.202-1, Definitions, is incorporated herein by reference.

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(f) Excusable delays. The Contractor shall be liable for default unless nonperformance is caused by an occurrence beyond the reasonable control of the Contractor and without its fault or negligence such as, acts of God or the public enemy, acts of the Government in either its sovereign or contractual capacity, fires, floods, epidemics, quarantine restrictions, strikes, unusually severe weather, and delays of common carriers. The Contractor shall notify the Contracting Officer in writing as soon as it is reasonably possible after the commencement of any excusable delay, setting forth the full particulars in connection therewith, shall remedy such occurrence with all reasonable dispatch, and shall promptly give written notice to the Contracting Officer of the cessation of such occurrence.

(g) Invoice.

(1) The Contractor shall submit an original invoice and three copies (or electronic invoice, if authorized) to the address designated in the contract to receive invoices. An invoice must include—

(i) Name and address of the Contractor;

(ii) Invoice date and number;

(iii) Contract number, contract line item number and, if applicable, the order number;

(iv) Description, quantity, unit of measure, unit price and extended price of the items delivered;

(v) Shipping number and date of shipment, including the bill of lading number and weight of shipment if shipped on Government bill of lading;

(vi) Terms of any discount for prompt payment offered;

(vii) Name and address of official to whom payment is to be sent;

(viii) Name, title, and phone number of person to notify in event of defective invoice; and

(ix) Taxpayer Identification Number (TIN). The Contractor shall include its TIN on the invoice only if required elsewhere in this contract.

(x) Electronic funds transfer (EFT) banking information.

(A) The Contractor shall include EFT banking information on the invoice only if required elsewhere in this contract.

(B) If EFT banking information is not required to be on the invoice, in order for the invoice to be a proper invoice, the Contractor shall have submitted correct EFT banking information in accordance with the applicable solicitation provision, contract clause (e.g., 52.232-33, Payment by Electronic Funds Transfer—Central Contractor Registration, or 52.232-34, Payment by Electronic Funds Transfer—Other Than Central Contractor Registration), or applicable agency procedures.

(C) EFT banking information is not required if the Government waived the requirement to pay by EFT.

(2) Invoices will be handled in accordance with the Prompt Payment Act (31 U.S.C. 3903) and Office of Management and Budget (OMB) prompt payment regulations at 5 CFR Part 1315.

(h) Patent indemnity. The Contractor shall indemnify the Government and its officers, employees and agents against liability, including costs, for actual or alleged direct or contributory infringement of, or inducement to infringe, any United States or foreign patent, trademark or copyright, arising out of the performance of this contract, provided the Contractor is reasonably notified of such claims and proceedings.

(i) Payment. — (1) Items accepted. Payment shall be made for items accepted by the Government that have been delivered to the delivery destinations set forth in this contract. (2) Prompt payment. The https://www.acquisition.gov/far/current/html/52_232.html#wp1153351 https://www.acquisition.gov/far/current/html/52_232.html#wp1153375 http://uscode.house.gov/uscode-cgi/fastweb.exe?getdoc+uscview+t29t32+1665+30++%2831%29%20%20AND%20%28%2831%29%20ADJ%20USC%29%3ACITE%20%20%20%20%20%20%20%20%20

Government will make payment in accordance with the Prompt Payment Act (31 U.S.C. 3903) and prompt payment regulations at 5 CFR Part 1315. (3) Electronic Funds Transfer (EFT). If the Government makes payment by EFT, see 52.212-5(b) for the appropriate EFT clause. (4) Discount. In connection with any discount offered for early payment, time shall be computed from the date of the invoice. For the purpose of computing the discount earned, payment shall be considered to have been made on the date which appears on the payment check or the specified payment date if an electronic funds transfer payment is made. (5) Overpayments. If the Contractor becomes aware of a duplicate contract financing or invoice payment or that the Government has otherwise overpaid on a contract financing or invoice payment, the Contractor shall—(i) Remit the overpayment amount to the payment office cited in the contract along with a description of the overpayment including the—(A) Circumstances of the overpayment (e.g., duplicate payment, erroneous payment, liquidation errors, date(s) of overpayment); (B) Affected contract number and delivery order number, if applicable; (C) Affected contract line item or subline item, if applicable; and (D) Contractor point of contact. (ii) Provide a copy of the remittance and supporting documentation to the Contracting Officer. (6) Interest. (i) All amounts that become payable by the Contractor to the Government under this contract shall bear simple interest from the date due until paid unless paid within 30 days of becoming due. The interest rate shall be the interest rate established by the Secretary of the Treasury as provided in Section 611 of the Contract Disputes Act of 1978 (Public Law 95-563), which is applicable to the period in which the amount becomes due, as provided in (i)(6)(v) of this clause, and then at the rate applicable for each six-month period as fixed by the Secretary until the amount is paid. (ii) The Government may issue a demand for payment to the Contractor upon finding a debt is due under the contract. (iii) Final decisions. The Contracting Officer will issue a final decision as required by 33.211 if—

(A) The Contracting Officer and the Contractor are unable to reach agreement on the existence or amount of a debt within 30 days; (B) The Contractor fails to liquidate a debt previously demanded by the Contracting Officer within the timeline specified in the demand for payment unless the amounts were not repaid because the Contractor has requested an installment payment agreement; or (C) The Contractor requests a deferment of collection on a debt previously demanded by the Contracting Officer (see 32.607- 2). (iv) If a demand for payment was previously issued for the debt, the demand for payment included in the final decision shall identify the same due date as the original demand for payment. (v) Amounts shall be due at the earliest of the following dates: (A) The date fixed under this contract. (B) The date of the first written demand for payment, including any demand for payment resulting from a default termination. (vi) The interest charge shall be computed for the actual number of calendar days involved beginning on the due date and ending on—(A) The date on which the designated office receives payment from the Contractor; (B) The date of issuance of a Government check to the Contractor from which an amount otherwise payable has been withheld as a credit against the contract debt; or (C) The date on which an amount withheld and applied to the contract debt would otherwise have become payable to the Contractor.

(vii) The interest charge made under this clause may be reduced under the procedures prescribed in 32.608-2 of the Federal Acquisition Regulation in effect on the date of this contract.

(j) Risk of loss. Unless the contract specifically provides otherwise, risk of loss or damage to the supplies provided under this contract shall remain with the Contractor until, and shall pass to the Government upon:

(1) Delivery of the supplies to a carrier, if transportation is f.o.b. origin; or (2) Delivery of the supplies to the Government at the destination specified in the contract, if transportation is f.o.b. destination.

(k) Taxes. The contract price includes all applicable Federal, State, and local taxes and duties.

(l) Termination for the Government’s convenience. The Government reserves the right to terminate this contract, or any part hereof, for its sole convenience. In the event of such termination, the Contractor shall http://uscode.house.gov/uscode-cgi/fastweb.exe?getdoc+uscview+t29t32+1665+30++%2831%29%20%20AND%20%28%2831%29%20ADJ%20USC%29%3ACITE%20%20%20%20%20%20%20%20%20 https://www.acquisition.gov/far/current/html/52_212_213.html#wp1203358 https://www.acquisition.gov/far/current/html/Subpart%2033_2.html#wp1079912 https://www.acquisition.gov/far/current/html/Subpart%2032_6.html#wp1031290 https://www.acquisition.gov/far/current/html/Subpart%2032_6.html#wp1031290 https://www.acquisition.gov/far/current/html/Subpart%2032_6.html#wp1031326 immediately stop all work hereunder and shall immediately cause any and all of its suppliers and subContractors to cease work. Subject to the terms of this contract, the Contractor shall be paid a percentage of the contract price reflecting the percentage of the work performed prior to the notice of termination, plus reasonable charges the Contractor can demonstrate to the satisfaction of the Government using its standard record keeping system, have resulted from the termination. The Contractor shall not be required to comply with the cost accounting standards or contract cost principles for this purpose. This paragraph does not give the Government any right to audit the Contractor’s records. The Contractor shall not be paid for any work performed or costs incurred which reasonably could have been avoided.

(m) Termination for cause. The Government may terminate this contract, or any part hereof, for cause in the event of any default by the Contractor, or if the Contractor fails to comply with any contract terms and conditions, or fails to provide the Government, upon request, with adequate assurances of future performance. In the event of termination for cause, the Government shall not be liable to the Contractor for any amount for supplies or services not accepted, and the Contractor shall be liable to the Government for any and all rights and remedies provided by law. If it is determined that the Government improperly terminated this contract for default, such termination shall be deemed a termination for convenience.

(n) Title. Unless specified elsewhere in this contract, title to items furnished under this contract shall pass to the Government upon acceptance, regardless of when or where the Government takes physical possession.

(o) Warranty. The Contractor warrants and implies that the items delivered hereunder are merchantable and fit for use for the particular purpose described in this contract.

(p) Limitation of liability. Except as otherwise provided by an express warranty, the Contractor will not be liable to the Government for consequential damages resulting from any defect or deficiencies in accepted items.

(q) Other compliances. The Contractor shall comply with all applicable Federal, State and local laws, executive orders, rules and regulations applicable to its performance under this contract.

(r) Compliance with laws unique to Government contracts. The Contractor agrees to comply with 31 U.S.C. 1352 relating to limitations on the use of appropriated funds to influence certain Federal contracts;

18 U.S.C. 431 relating to officials not to benefit; 40 U.S.C. 3701, et seq., Contract Work Hours and Safety Standards Act; 41 U.S.C. 51-58, Anti-Kickback Act of 1986; 41 U.S.C. 265 and 10 U.S.C. 2409 relating to whistleblower protections; 49 U.S.C. 40118, Fly American; and 41 U.S.C. 423 relating to procurement integrity.

(s) Order of precedence. Any inconsistencies in this solicitation or contract shall be resolved by giving precedence in the following order: (1) The schedule of supplies/services. (2) The Assignments, Disputes, Payments, Invoice, Other Compliances, and Compliance with Laws Unique to Government Contracts paragraphs of this clause. (3) The clause at 52.212-5. (4) Addenda to this solicitation or contract, including any license agreements for computer software. (5) Solicitation provisions if this is a solicitation. (6) Other paragraphs of this clause. (7) The Standard Form 1449. (8) Other documents, exhibits, and attachments.

(9) The specification.

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