RFQ-22-134 SAM solicitation EMS PR packet.pdf

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IHS1451541

RFQ-22-134

Ursula Maslonka, Contract Specialist

605-226-7274

Pine Ridge IHS Hospital 607 Indian Health Road; E. Hwy 18 Pine Ridge, SD 57770

DHHS - Great Plains Area IHS Contracting Fed. Bldg. Room 309;

115 4th Ave SE; Aberdeen, SD 57401

DHHS - Great Plains Area IHS Finance Fed. Bldg. Room 309;

115 4th Ave SE; Aberdeen, SD 57401

Emergency Medical Services (EMS) for the Pine Ridge IHS Hospital, LaCreek IHS Clinic, Kyle IHS Health Center, Wanblee IHS Health Center & Mobile Unit on Reservation.

1 Paramedic Regular Hours Four (4) Candidates 9,408 hrs 2 560 hrs

Paramedic Overtime Hours Four (4) Candidates EMT Regular Hours Five (5) Candidates 11,760 hrs

4 EMT Overtime Hours Five (5) Candidates 616 hrs

2022-J451147-25637

621910

$16.5 million

7/13/2022

7/27/2022 3:00 pm CST

DHHS - Great Plains Area IHS Contracting Fed. Bldg. Room 309;

115 4th Ave SE; Aberdeen, SD 57401 Email: Ursula.Maslonka@ihs.gov

STOCK RECORD (S/R)

STANDARD FORM 1449 (REV. 11/2021) BACK

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ITEM NUMBER

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SCHEDULE OF SUPPLIES/SERVICES

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QUANTITY

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36. PAYMENT

COMPLETE PARTIAL FINAL

Pine Ridge Indian Health Service Emergency Medical Services Performance Work Statement

Performance Work Statement (PWS) Emergency Medical Services (EMS)

Background

The mission of the Pine Ridge Indian Health Service (PRIHS) is to raise the physical, mental, social & spiritual health of American Indians and Alaska Natives to the highest level. At a minimum, the Contractor shall maintain a staff of four (4) Paramedics and five (5) EMTs throughout the duration of this contract. Pine Ridge Reservation is located in the southwestern corner of South Dakota, approximately 100 miles from Rapid City. Surrounded by rolling plains, Badlands and Black Hills, the Pine Ridge Reservation is home to the Oglala Lakota Nation.

Pine Ridge Reservation possesses low life expectancy in the United States. Unemployment is very high in this population. Closest higher level of care is 35 minutes away by life flight and 1 hour & 30 minutes by ground ambulance. Transfer weather conditions at times can be challenging thus precluding air or even ground transfer.

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. PRIHS is linked to the Great Plains Area Office (IHS) in Aberdeen, South Dakota.

PRIHS is comprised of one hospital, three outlying clinics and a mobile unit.

1. Pine Ridge Hospital (located in Pine Ridge, SD)

2. LaCreek Clinic (outlying clinic, located in Martin, SD)

3. Kyle Health Center (outlying clinic, located in Kyle, SD)

4. Wanblee Health Center (outlying clinic, located in Wanblee, SD)

5. Mobile Unit (parked at PRH, deployed throughout Pine Ridge Reservation)

The Pine Ridge Hospital provides an expanded level of health care services including, but not limited to:

Emergency Room Department, Pharmacy, Physical Therapy, Public Health Nursing, Radiology, Inpatient Care, Laboratory, Dental, Optometry, Purchased Referred Care, Mental Health, Outpatient Clinic, Pediatric Clinic, Dietitians, Cardiology, Ear Nose & Throat, OB/GYN, Podiatry and Orthopedics.

Requirements

Purpose of Contract The purpose of this non-personal service contract is to provide uninterrupted Emergency Medical Services (EMS), supporting current Emergency Medical personnel. The Contractor shall provide licensed, experienced, competent, qualified & adequately trained personnel to perform the assigned duties. Pine Ridge Indian Health Service (PRIHS) shall not exercise any supervision over the contract Providers performing the services herein. Such contract Providers shall be accountable solely to the Contractor who, in turn is responsible to PRIHS. The Contractor shall perform the services required under this contract within PRIHS’ bylaws, policies and procedures.

Contractor shall submit a Curriculum Vitae (CV), including licensure, for each contract Provider as a prerequisite to the Pine Ridge Indian Health Service (PRIHS) EMS Director & Contract Officer Representative. Curriculum Vitae (CV), including licensure, shall be delivered before contract Provider deployment to Pine Ridge for acceptance or denial. Pine Ridge EMS Director will review CV/licensure and provide response to Contractor via email.

Contract Type Labor hour, fixed unit price (hourly rate), performance based, service contract.

Scheduled contract Providers who show up for work, will be paid based upon hours worked indicated on their approved timesheet & Health Information Management Clearance form.

Business Relations The Contractor shall successfully integrate and coordinate all activity needed to execute the requirement. The Contractor is required to provide quality assurance services. The Contractor shall seek to ensure customer satisfaction and professional & ethical behavior of all contract Providers.

Contract Management The Contractor shall establish clear organizational lines of authority and responsibility to ensure effective management of the resources assigned to the requirement. The Contractor shall convene a contract kick-off meeting with the Contract Officer Representative (COR) and necessary Indian Health Service officials no later than five (5) business days from the effective date of this contract. In addition, the Contractor shall participate in status update calls & ad-hoc meetings when requested by Pine Ridge Indian Health Service. Meetings provide opportunity to discuss contract activity including, but not limited to, issues, corrective actions and/or challenges. The Contractor shall identify key personnel responsible for accomplishing each task, alternates and identify challenges that may impede success.

PRIHS may request status reports from the Contractor for action items obtained from meetings. The status reports shall identify Contractor leads responsible for completing tasks and how challenges or delays are being mitigated. Contractor status reports shall be submitted electronically to the COR and PRIHS EMS Director.

The Contractor shall deliver a quality control plan (QCP) describing specific activities planned to meet the requirements of this contract. The QCP shall include how quality assurance will be accomplished and monitored, based on the quality assurance surveillance plan provided by PRIHS. QCP shall be submitted no later than thirty (30) calendar days from the effective date of contract award. The Contractor shall describe the use of any consultants or subcontractors hired to carry out elements within the Performance Work Statement (PWS) under this contract. The Contractor shall notify the Contract Officer and Contract Officer Representative in writing within five (5) business days of any new subcontractors or consultants retained to perform services required under this contract. Subcontractors retained for purposes of this contract must comply will all provisions, terms & conditions of this contract. The QCP shall include an estimated turn around time for filling vacancies for EMTs and/or Paramedics but not to exceed five (5) calendar days. The Contractor shall provide specifics regarding recruitment and retaining contract Providers.

Conflict of Interest The Contractor and all contract Provider(s) are responsible for identifying and communicating to the CO and COR conflicts of interest at the time of proposal and during the entirety of contract performance. At the time of proposal, the Contractor shall provide a statement which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided. The Contractor shall also provide statements containing the same information for any identified consultants or subcontractors who shall provide services. The Contractor must also provide relevant facts that show how it’s organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest.

Inherent Government Functions Contractor and contract Provider(s) shall not perform inherently governmental functions. This includes, but is not limited to, determination of agency policy, determination of Federal program priorities for budget requests, direction and control of government employees (outside a clinical context), selection or non-selection of individuals for Federal Government employment including the interviewing of individuals for employment, approval of position descriptions and performance standards for Federal employees, approving any contractual documents, approval of Federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy, as wells as other functions specified under FAR 7.503 (c).

Contract Administration The Contractor shall assign effort and maintain proper and accurate time keeping records of contract providers assigned to work on the requirement.

Contract Provider Administration The Contractor shall make necessary travel arrangements for contract Providers and maintain adequate infrastructure to support contract tasks. Labor hours worked does not include travel time to reach Pine Ridge Indian Health Service (PRIHS).

At a minimum, the Contractor shall maintain a staff of four (4) Paramedics and five (5) EMTs throughout the duration of this contract.

Location and Hours of Work Pine Ridge Indian Health Service 607 Indian Health Road PO Box 1201 Pine Ridge, SD 57770

Accomplishment of the results contained in this PWS requires work at various PRIHS facilities, throughout the Pine Ridge Reservation and includes transports to off-reservations medical facilities for patients needing higher level of care. EMS base stations are located in Pine Ridge, Kyle & Wanblee, South Dakota.

Work shifts will be:

At a minimum, the Contractor shall maintain a staff of four (4) Paramedics and five (5) EMTs throughout the duration of this contract.

0600 hours to 1830 hours for day shift (two Paramedics for day shift) 1800 hours to 0630 hours for night shift (two Paramedics for night shift)

0600 hours to 1830 hours for day shift (two or three EMTs for day shift) 1800 hours to 0630 hours for night shift (two or three EMTs for night shift)

Assignments shall require shifts of no more than sixteen (16) hours in a 24- hour period for a maximum total of 96 hours in a 14-day period. 80 hours in a 14-day period is considered Regular Hours, any hours over 80 hours is considered overtime. Holidays and weekends shall be considered regular hours.

Overtime shall be pre-approved by the PRIHS EMS Director or designee where overtime hours in a 14-day period is expected to exceed 16 hours (that is, exceed 96 total hours in a 14-day period). A 30-minute unpaid meal break will be included with each shift. Lunch breaks are to be taken at the approximate midpoint of the shift and will not be saved in order to leave 30 minutes early.

PRIHS work schedules shall occasionally change as directed by the PRIHS EMS Director or designee to support patient care. Contract Providers shall adhere to their PRIHS assigned hours of responsibility & will paid based upon hours worked of their PRIHS assigned work scheduled.

In the event a contract Provider is not scheduled for work by Pine Ridge Indian Health Service (PRIHS) & has a day off, day off hours are not billable to PRIHS. PRIHS shall not request contract Providers to be on-call/standby. On-call hours/standby hours or on-site status is not billable to Pine Ridge Indian Health Service. Pine Ridge Indian Health Service may call contract Provider(s) & ask if they are willing to pick up an unscheduled work shift. If an unscheduled work shift is accepted by a contract Provider, the hours are billable. If unscheduled work shift causes the contract Provider to exceed 80 hours in a 14-day period, this will be classified as overtime hours. However, Pine Ridge Indian Health Service is not requiring contract Provider(s) to be on-call/stand-by.

Scope The Contractor shall furnish Providers to support PRIHS Emergency Medical Services (EMS) which operates four (4) to five (5) ambulances. Pine Ridge Indian Health Service (PRIHS) expects & relies on four (4) Paramedics and five (5) EMTs every calendar day. (see above work shifts, page 3)

Emergency Medical Services (EMS) include, but are not limited to: advance life support ambulance service, PRIHS administrative transfers, transports to and from aero-medical evacuation sites, patient transports and field ambulance services as defined in Indian Health Manual Part 3 Chapter 17 – Emergency Medical Services and by the state of South Dakota. (see attachment)

Services provided by the contract Provider shall be in accordance with the PRIHS policies & procedures, quality assurance, The Joint Commission (TJC) and Centers for Medicaid & Medicare Service (CMS) standards. Contractor shall adhere to all operational rules, standards, clinical standards and directives of the PRIHS EMS Director or designee. Contract Providers will meet and maintain a high level of patient and customer satisfaction at all times.

PRIHS reserves the right to refuse acceptance of any contract Provider at any time after performance begins, if personal or professional conduct jeopardizes patient care, counters the I.H.S Standards of Conduct, or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by the patient or other staff members to designated Government representatives. Standards of conduct shall mirror those prescribed by current federal personnel regulations at 5 CFR part 2635. Should the PRIHS EMS Director or designee show documented clinical problems or continual unprofessional behavior/actions with any contract health care Provider(s), s/he may request, without cause, immediate replacement of said contract Provider. Each complaint will be addressed on an ad-hoc basis, based on the outcome, may be grounds for immediate removal of the contract Provider.

Quality assurance procedures established by PRIHS shall be used for continuous monitoring. The performance by the contract Provider, the quality of services rendered, and any documentation or written material in support of same, shall be subject to continuous inspection, surveillance and review for acceptance by the Contracting Officer Representative (COR) or designated representative.

Performance evaluation factors include: medication administration, contract providers not meeting the minimum qualification standards and patient customer service complaints.

Qualifications Contract Providers shall be certified and/or licensed through National Registry of Emergency Medical Technicians or recognized state licensing agency. All contract Providers shall possess cardiopulmonary resuscitation (CPR)/basic life support (BLS) certification. Paramedics are required to have Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) certifications. Certifications and licensure shall be kept current throughout the contract lifecycle. Contract Providers shall be technically proficient in the skills necessary to fulfill PRIHS requirements, including the ability to speak, understand, read and write English fluently. Possess sufficient initiative, interpersonal relationship skills and social sensitivity such that the contract Provider can relate to a variety of patients from diverse backgrounds.

Able to operate a computer utilizing Microsoft applications such as, Word, Excel, etc. Contract Providers shall meet Continuing Education (CE) requirements as determined by the Emergency Medical Technicians (EMT) State of Licensure. PRIHS will not reimburse or cover these costs.

New Employee Orientation (NEO) & Trainings After receiving a favorably adjudicated security clearance, the New Employee Orientation (NEO) process is to begin. NEO is required for all new staff, occurs every other week and is held at the PRIHS Nursing Library. NEO must be completed before performing any services of this contract. NEO labor hours are billable to PRIHS.

In addition, contract Providers shall complete all PRIHS mandatory trainings on time & submit certificate of completion to the PRIHS EMS Director or designee.

Pine Ridge Indian Health Service New Employee Orientation Point of Contact:

1) Heather Brehmer, Staff Development 2) Jacklyn Miller, Nurse Educator Office: 605 867 3334 Office: 605 867 3261 Email: Heather.Brehmer@ihs.gov Email: Jacklyn.Miller@ihs.gov

Health Information Management / Electronic Health Record Contract Providers shall use PRIHS Electronic Health Record (EHR) system, Imagetrend, to maintain accurate and up-to-date information on clinical care provided to patients. Experience with EHR is highly recommended. This includes completing all coding and purpose of visit diagnoses. All patient health record documentation initiated by the Contractor shall be completed to the satisfaction of PRIHS. The PRIHS approving authority of the Contractor’s timesheets will not sign off on/approve timesheets unless the Contractor has successfully completed all required patient medical encounter documentation (medical records). To ensure medical records are complete with no deficiencies, the Contractor shall submit a Health Information Management Clearance From (HIMCF) with each timesheet. The Contracting Officer (CO) and Contract Officer Representative (COR) shall be notified within two business days, should the HIMCF indicate deficiency.

mailto:Heather.Brehmer@ihs.gov mailto:Jacklyn.Miller@ihs.gov

Medical documentation shall be completed within 12 hours after assigned shift. All medical record documentation shall meet or exceed established standards for PRIHS to include, but not limited to:

timeliness, legibility, accuracy, content and signature. All medical record information generated in the performance of this contract will remain the property of and subject to the exclusive control of Pine Ridge Indian Health Service.

Patient Safety Compliance and Reporting The contract Provider(s) shall follow all established patient safety and infection control standards of care. The contract Provider(s) shall make every effort to prevent medication errors, falls, and patient injury caused by acts of commission or omission in the delivery of care. All events related to patient injury, medication errors, and other breeches of patient safety shall be reported to PRIHS Risk Manager via iStar reporting system, per IHS Safety Policy. As soon as practicable (but within 24 hours) contract Provider shall notify PRIHS EMS Director or designee & COR of incident.

Customer Service Contract Provider(s) shall refer all patient/customer service issues to the PRIHS EMS Director or designee and COR.

Employee Health Requirements The Contractor shall adhere to PRIHS Employee Health Program policy. The purpose is to provide uniform guidelines for ensuring all staff are free from communicable disease or any other diseases, which may be debilitating or render the Contractor not able to perform his/her assigned duties. The Contractor shall also adhere to receiving annual vaccinations required. The immunization records are required to be turned into Employee Health Department within 7 days of employment. (see attached policy for full details)

PRIHS Employee Health Nurse Point of Contact:

1) JoDee Bettelyoun Office: 605 867 3286 Email: Jodee.Bettelyoun@ihs.gov

Security – Character Investigation Contractor staff will be required to follow PRIHS procedures for obtaining a full Federal background investigation and preliminary clearance. Favorable security clearance must be granted prior to beginning any aspect of the contract requirements. Contractor must ensure every contract Provider possess and maintains sufficient suitability while performing under this contract. The preliminary clearance process ranges from 5-30 business days. Most Contractors initially experience a Federal background investigation that provides security clearance for 120 days. When 120 days is exceeded, the security clearance expires and a reinvestigation is to occur. The reinvestigation is a lengthier, more in-depth, time consuming process that involves Electronic Questionnaires for Investigations Processing (e-QIP). In order to obtain a Personal Identity Verification (PIV) card, Contractor staff shall complete e-QIP and pass a Federal background investigation conducted by the Office of Personnel Management. PRIHS will process the investigations through the Office of Personnel Management on all Contractor staff. If the Contractor completes the e-QIP background investigation in its entirety and receives a favorable adjudication, security clearance is active for five (5) years. Please work with the point of contacts below in advance, to ensure every Contractor has & maintains active security clearance while performing under this contract.

mailto:Jodee.Bettelyoun@ihs.gov

Processing of PIV cards shall be completed by Great Plains Area HSPD-12/Suitability Office in conjunction with PRIHS PIV card stations. The contractors will be required to be physically present at one of the HSPD-12 enrollment and issuance workstations to obtain a PIV Card. Two forms of identification are needed for PIV related matters.

Each Contractor shall complete each of the requirements below and receive pre-employment clearance from GPA/PRIHS prior to performing services under this contract.

1) Fingerprints must be captured for digital processing. Contractor may have fingerprints captured via hard copy, then sent to PRIHS by postal service (at Contractor’s expense), tracking is highly recommended. Note, FD-258 fingerprint card is the only acceptable hard copy. Please consult with PRIHS HSPD-12 representatives located in the Procurement and Administration Departments at Pine Ridge Hospital;

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

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

4) Provisional Waiver form shall be completed;

5) Copy of Curriculum Vitae/Resume;

6) 86 C form shall be completed;

7) General Release form shall be completed;

8) eQIP (if applicable initially otherwise, required after 120 days of PRIHS employment);

9) The Contractor shall be enrolled for PIV if eQIP is completed;

10) State Requirements, individualized documents shall be completed, please consult with PRIHS HSPD- 12 representative for guidance.

The Contractor shall ensure that the employees it proposes for work under this contract have a reasonable chance for approval. If at any point during the investigation process a Contractor staff is deemed ineligible or found to have other than favorable suitability, the individual must be removed from providing services under this contract. PRIHS shall investigate Contract Providers at no cost to the Contractor.

PRIHS security clearance is a pre-requisite. It is imperative to note; all Contract Providers must receive a favorable adjudicated security clearance in order to perform any services/requirements of this contract. Contract personnel are not permitted to wait in any PRIHS facility while awaiting adjudication.

If pre-security clearance is deemed unfavorable, the contract company shall submit a replacement provider immediately or risk breaching the terms and conditions of this contract.

Please address (FD-258) hard copy fingerprint card to:

Pine Ridge I.H.S Hospital Attn: Lois Cross 607 Indian Health Road P.O. Box 1201 Pine Ridge SD, 57770

PRIHS Purchasing Agent/Character Investigation - Primary Point of Contact

1) Lois Cross Office: 605 867 3020 Email: Lois.Cross@ihs.gov mailto:Lois.Cross@ihs.gov

PRIHS Character Investigation - Secondary Point of Contact

1) Annie Means 2) Diane Little Hawk Office: 605 867 3403 Office: 605 867 3390 Email: Annie.Means@ihs.gov Email: Diane.LittleHawk@ihs.gov

PRIHS Information Technology In order for a Contractor to gain Indian Health Service electronic access, the person must obtain a favorable adjudicated security clearance. Indian Health Service (I.H.S) electronic access will automatically disable after fourteen (14) calendar days of inactivity and their electronic account will delete after ninety (90) calendar days of inactivity. When a Contract Provider returns after being away & their electronic access is disabled/deleted, most times this leads to a service delay. It is very important to ensure the Contract Provider has computer access upon arrival. The Contractor shall reach and work with the PRIHS Information Technology Department in advance to ensure the Contract Provider has active access prior to arrival.

Information Technology Department Contact Information:

Email: ABR_PRHITAdminsDL@ihs.gov Office: 605 867 3244

Work Identification Badge When the contract Provider receives a favorable adjudicated security clearance & is cleared to start providing service, upon arrival, he/she shall obtain a PRIHS work identification badge from PRIHS Information Technology. The Contractor is required to wear the work identification badge at all times when in working status. If the contract Provider terminates their service at PRIHS, the work identification badge must be returned to PRIHS Information Technology.

Contractor Furnished Property PRIHS requires the Contractor to carry a working form of communication (i.e. cellular phone or pager) at their expense.

Contractor Line Item Numbers (CLINs) #1 Regular Hours Scheduled working hours, Monday through Sunday up to 80 hours in a 14-day pay period.

#2 Overtime Hours

Scheduled working hours greater than 80 hours but less than 96 hours in a 14-day period does not require prior approval. However, scheduled working hours exceeding 96 hours in a 14-day period does require prior approval from the Pine Ridge Indian Health Service EMS Director or designee. To the extent total scheduled working hours cannot exceed 96 hours in a 14-day period, this means the contract Provider cannot exceed 16 overtime hours in a 14-day period.

In the event a contract Provider is not scheduled for work by Pine Ridge Indian Health Service (PRIHS) & has a day off, day off hours are not billable to PRIHS. PRIHS shall not request contract Providers to be on-call/standby. On-call hours/standby hours or on-site status is not billable to Pine Ridge Indian Health Service.

Timesheet mailto:Annie.Means@ihs.gov mailto:Diane.LittleHawk@ihs.gov mailto:ABR_PRHITAdminsDL@ihs.gov

Timesheets shall capture daily time in and time out of PRIHS’ assigned hours of responsibility per their PRIHS scheduled shift. Please tally time on timesheet in 15-minute increments. Contractor time from 1 to 7 minutes shall be rounded down, and thus not counted as hours worked, but Contractor time from 8 to 14 minutes must be rounded up and counted as a quarter hour of time worked. Overtime exceeding 96 hours in a 14-day period requires prior approval from the PRIHS EMS Director or designee. A Health Information Management Clearance Form (HIMCF) shall be submitted by the contractor Provider with each timesheet. All timesheets & HIMCFs shall be signed by the PRIHS EMS director or designee. No invoices will be processed unless the timesheet & HIMCF have been approved. The contractor Provider shall send a copy of these approved records to their company & all originals are to be delivered to the PRIHS EMS Director or designee.

The contract Provider shall adhere to their PRIHS work schedule and will be paid for hours of work within their assigned PRIHS work schedule. Hours worked includes overtime hours. Work schedule hours shall be reflected on their timesheet. Contractor invoices are based off approved timesheets & approved HIMCFs. It is important to note; no timesheets or invoices will be processed is the contract Provider has an unapproved HIMCF(s).

Contract Providers shall be responsible for reporting time worked accurately. Contract Providers shall not be paid for time documented prior to their assigned work schedule hours, unless early arrival is requested by the PRIHS EMS Director or designee. This justification shall be displayed in writing on the timesheet. If assigned to work at 0600 hours or 1800 hours, the expectation is be ready for work at that exact time, time sheet shall reflect this.

Invoicing The Contractor shall submit an invoice on a minimum monthly basis, via email. Contractor shall include the approved timesheet(s) and approved HICF(s) with each invoice. The Contractor will be paid for their hours worked, at the fixed hourly rate, by labor category. Hours worked includes overtime hours. Please address invoices to the PRIHS EMS Director, PRIHS EMS Supervisor, Contract Officer Representative (COR) assigned at contract award and Great Plains Area (GPA) Accounts Payable (AP) Accountant.

It is important to note; no invoices will be processed for unapproved timesheets and/or unapproved HIMCFs.

Carl.Occhipinti@ihs.gov – Pine Ridge Indian Health Service (PRIHS) EMS Director Matthew.Lordino@ihs.gov – PRIHS EMS Supervisor Rachel.Olson@ihs.gov – Great Plains Area Accounts Payable Accountant Sammi.Herman@ihs.gov – PRIHS COR

Pine Ridge Indian Health Service will verify every invoice before paying. Verification requirements consist of ensuring contract Providers possess I.H.S approved security clearance, timesheet is approved by PRIHS EMS Director & Health Information Clearance form is approved by PRIHS EMS Director.

PRIHS Furnished Property PRIHS will provide all medical (including ambulances), non-medical equipment and supplies for the care and maintenance of patients as per the standards of care.

Work Environment mailto:Carl.Occhipinti@ihs.gov mailto:Matthew.Lordino@ihs.gov mailto:Rachel.Olson@ihs.gov mailto:Sammi.Herman@ihs.gov

Exposure to contagious diseases is possible while working for PRIHS. Potential exposure to bodily fluids may occur in the course of caring for trauma patients. Contract Providers shall expect long transport times; encompassing extended patient care. Encountering numerous high acuity patients within a limited resource environment (i.e. first responders).

Weather Pine Ridge, South Dakota, is a geographic area with wide temperature span. The winters can be very cold and windy. Contractors should expect to drive in weather conditions for which they may not be accustomed. The sole authority to close PRH or outlying clinics rests with the Chief Executive Officer (CEO). If the hospital remains open, the Contractor will be expected to report to work on time, as all other hospital employees will be required. Reliable transportation to report for duty within the specified timeframe of this contract is the contractor’s responsibility and at their expense.

Meals Breakfast, lunch and dinner (supper) is available in the PRIHS hospital cafeteria with the purchase of a meal ticket. Meal tickets can be purchased in the Finance Department between the hours of 09:30 am to 11:30 am and 2:00 pm to 4:00 pm, Monday through Friday. Cash, check or money order are the acceptable payment options. PRIHS Hospital is not equipped to perform credit/debit card transactions.

Tort Liability The Federal Tort Claims Act does not cover Contractor or contract provider(s). When a Contractor or contractor provider(s) has been identified as a provider in a tort claim, the Contractor shall be responsible for notifying their legal counsel and/or insurance carrier. Any settlement or judgment arising from a Contractor’s (or contract provider(s)) action or non- action shall be the responsibility of the Contractor and/or insurance carrier.

Housing If available, Pine Ridge Indian Health Service (PRIHS) housing can be offered. The Contractor is required to pay rent timely for offered housing. The rental rate is determined by PRIHS Guidelines. PRIHS will invoice the individual renting.

PRH Housing point of contact:

Martin “Marty” Zephier Office: (605) 867-3071 Email: Martin.Zephier@ihs.gov

Contract Officer Responsibilities The Contracting Officer (CO) is the only person authorized to approve changes or modify any of the requirements of this contract. The Contractor shall communicate with the CO on all matters pertaining to contract administration. Only the CO is authorized to make commitments or issue any modification to include (but not limited to) terms affecting price, quantity or quality performance of this contract. The Contracting Officer, Contract Officer Representative and PRIHS EMS Director shall deal with issues raised concerning contract Provider(s).

Quality Assurance Surveillance Plan (QASP) The QASP is based on the premise that the Contractor is responsible for managing and ensuring quality control meets the terms of the contract. The QASP is an evergreen Government document that specifies mailto:Martin.Zephier@ihs.gov how the Government will verify and document that the Government is receiving quality of services called for under the contract. The Contractor’s performance will be measured based on the following requirements. (see attached QASP)

Contractor Performance Assessment Reporting System (CPARS) During the life of this contract, Contractor performance will be evaluated on an interim and final basis pursuant to FAR subpart 42.15. This evaluation shall become a part of the contract file and shall be used as past performance information in evaluating the Contractor’s past performance on future contracts.

Contract Performance Assessment Reporting System (CPARS) is an online reporting system www.cpars.gov.

As prescribed in the Federal Acquisition Regulation (FAR), Indian Health Service evaluates Contractor past performance on all contracts that exceed the simplified acquisition threshold and shares those evaluations with other Federal Government Contract Specialists & Procurement officials. The FAR requires that the Contractor be provided an opportunity to comment on past performance evaluations prior to each report closing. This report becomes a permanent record for the Contractors past performance.

Deliverables

Deliverable Frequency Number of copies to

PRIHS

Delivery format to

PRIHS

Submit to at

PRIHS

Curriculum Vitae (must include education documentation)

Once, prior to contract performance.

1 copy Email Carl Occhipinti, EMS Director

National Registry of Emergency Medical Technicians -certification(s), licensure and qualification(s)

Once, prior to contract performance & as needed thereafter

1 copy Email Carl Occhipinti, EMS Director

Health Information Management Clearance Form

Every week 1 original Hand deliver Carl Occhipinti, EMS Director

Employee Health Requirements

Within 7 days of contract performance & annually thereafter.

1 copy Hand deliver Employee Health Nurse

Character Investigation Requirements

Once, prior to contract performance & as needed thereafter

1 copy Via fax or via secure data transfer email

Lois Cross, Purchasing Agent

Timesheet Every week 1 original Hand deliver Carl Occhipinti, EMS Director

Invoice Minimum monthly 1 copy Via email EMS Director, GPA

Accountant &

COR

Quality Control Plan no later than 30 calendar days from the effective date of contract award

1 copy Via email Contract Officer Representative

New subcontractors or consultants retained to perform services

In writing within 5 business days of any new subcontractors or consultants retained

1 copy Via email Contract Officer Representative

Mandatory Training Upon arrival after receiving favorable Character Investigation adjudication and as required thereafter

1 copy Hand Deliver Carl Occhipinti, EMS Director

Memorandum

To: Supervisor of child care covered position incumbent From: Human Resources/Personnel Security Office Subject: Child Care Position Provisional Authorization Date:

This is notice you will supervise a position that is covered by Public Laws (P.L.) 101-630, Indian Child Protection and Family Violence Prevention Act and 101-647, Crime Control Act. The Indian Health Service is required to compile a list of all authorized positions with duties and responsibilities that involve regular contact with or control over Indian children and investigate the character of each individual who is employed or is being considered for employment in such a position. The requirement is that the individual is to be under the supervision and in sight (chaperoned) of a previously investigated staff person (favorably adjudicated).

The position and individual identified below has been designated as a covered position and has been granted provisional authorization:

Name:

Position title:

The following criteria must be met for the above mentioned individual:

Pre-employment suitability has been favorably adjudicated prior to entrance on duty.

Continue with processing of background investigation – Tier 1 with child care (minimum).

Provide requested documentation/information as requested from the Personnel Security/HR

Office.

Employee/Contractor/Affiliate must be 100% chaperoned at all times by a staff person and/or alternates who have at a minimum a favorably adjudicated Tier 1 with child care (Tier 1C) or CNACI investigation.

The following individuals listed below agree and accept responsibility of the chaperone role.

Chaperone name: Case type favorably adjudicated Chaperone name: Case type favorably adjudicated Chaperone name: Case type favorably adjudicated

I have verified a favorable investigation is on file for identified chaperones:

Personnel Security/HR Office designee Date

Your signature indicates you are accepting responsibility, will comply with the above criteria, and will assure the above named individual will be chaperoned at times while on site.

Department Supervisor/Designee Date

This provisional authorization is in effect until the favorably adjudicated certification of investigation is in place. I am aware that failure to comply with the above criteria could result in removal and termination of the granted provisional authorization.

Employee/Contractor/Affiliate Date

Indian Health Service Office of Human Resources

OMB Approved Form No. 0917-0028 Expiration Date: 2/28/2022

Addendum to Declaration for Federal Employment (OF 306) Indian Health Service

Child Care & Indian Child Care Worker Positions Item 16. Agency Specific Questions

Name: ___________________________ Social Security Number: __________________ (Please print)

Job Title in Announcement: ____________________ Announcement Number: ___________

Section 231 of the Crime Control Act of 1990, Public Law (Pub. L.) 101-647, requires employment applications for individuals seeking employment in a position involved with the provision to children under the age of 18 of “child care services,” as defined in 42 U.S.C. § 13041(a)(2), contain a question asking whether the individual has ever been arrested for or charged with a crime involving a child and for the disposition of the arrest or charge.

Under 42 U.S.C. § 13041(a)(2), the term "child care services" means child protective services (including the investigation of child abuse and neglect reports), social services, health and mental health care, child (day) care, education (whether or not directly involved in teaching), foster care, residential care, recreational or rehabilitative programs, and detention, correctional, or treatment services. Individuals hired for such positions must undergo a criminal history background check.

Section 408 of the Indian Child Protection and Family Violence Prevention Act, Pub. L. 101-630, contains a related requirement for positions in the Department of Health and Human Services that involve regular contact with or control over Indian children. The agency must ensure that persons hired for these positions have not been found guilty of or pleaded nolo contendere or guilty to certain crimes. The law requires the agency conduct an investigation of the character of each individual who is being considered for employment in such a position and prescribe in regulations the “minimum standards of character” that must be met in order for an individual to fill such a position. The regulations specify that “[t]he minimum standards of character shall be considered met only after the individual has been the subject of a satisfactory background investigation,” which includes a criminal history background check.

42 C.F.R. § 136.406.

To assure compliance with the above laws, the following questions are added to the Declaration for Federal Employment:

1. Have you ever been arrested for or charged with a crime involving a child?

YES_____ NO______

[If “YES”, provide the date, explanation of the violation, disposition of the arrest or charge, place of occurrence, and the name and address of the police department or court involved.]

2. Have you ever been found guilty of, or entered a plea of nolo contendere (no contest) or guilty to, any felonious or misdemeanor offense under Federal, State, or tribal law involving crimes of violence; sexual assault, molestation, exploitation, contact or prostitution; or crimes against persons; or offenses committed against children?

YES______ NO______

[If “YES”, provide the date, explanation of the violation, disposition of the arrest or charge, place of occurrence, and the name address of the police department or court involved.]

I certify that (1) my response to these questions is made under penalty of perjury, which is punishable by fine under title 18 of the U.S. Code, or imprisonment of not more than five years, or both; and (2) I have received notice that a criminal check will be conducted. I understand my right to obtain a copy of any criminal history report made available to the Indian Health Service and my right to challenge the accuracy and completeness of any information contained in the report.

Applicant’s Signature (sign in ink) Date

Public Burden Statement: In accordance with Paperwork Reduction Act [5 CFR § 1320.8 (b)(3)], a Federal agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Respondents must be informed (on the reporting instrument, in instructions, or in a cover letter) the reasons for which the information will be collected; the way the information will be used to further the proper performance of the functions of the agency;

whether responses to the collection of the information are voluntary, required to obtain a benefit (citing authority), or mandatory (citing authority); and the nature and extent of confidentiality to be provided, if any (citing authority). Public reporting burden for this collection of information is estimated to average 12 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the necessary data, and completing and reviewing the collection information. Send comments regarding the burden estimate or any other aspect of this collection of information to the IHS Information Collection Clearance Officer, Indian Health Service, Office of Management Services, Division of Regulatory Affairs, 5600 Fishers Lane, Rockville, Mail Stop 09E70, MD 20857. Please do not send completed data collection instruments to this address.

(PLEASE COMPLETE AND RETURN)

LICENSURE REQUIREMENT

PERSONAL AND NONPERSONAL SERVICES CONTRACTORS SHALL BE SUBJECT TO THE SAME

QUALITY ASSURANCE, CREDENTIALS, LICENSURE, AND OTHER QUALIFICATION STANDARDS

AS THOSE REQUIRED OF IHS PERSONNEL. IN ADDITION, HEALTH CARE PROVIDERS, OTHER

THAN PROFESSIONALS, MUST BE LICENSED IN A STATE, THE DISTRICT OF COLUMBIA, PUERTO

RICO, OR A TERRITORY OF THE UNITED STATES TO PERFORM THE CONTRACT SERVICES

WITHIN IHS FACILITIES. THE CONTRACTING OFFICER WILL INSERT THE FOLLOWING

CERTIFICATION STATEMENT IN ALL PURCHASE ORDERS AND CONTRACTS FOR

PROFESSIONAL MEDICAL SERVICES:

MY LICENSE TO PRACTICE HAS HAS NOT BEEN TERMINATED, SUSPENDED, OR

REVOKED IN ANY STATE, THE DISTRICT OF COLUMBIA, PUERTO RICO, OR A TERRITORY OF

THE U.S..

I CURRENTLY HOLD AN ACTIVE MEDICAL LICENSE IN THE FOLLOWING STATE(S):

STATE LICENSURE NO. ISSUE DATE

I HAVE AN INACTIVE MEDICAL LICENSE IN THE FOLLOWING STATE(S):

STATE LICENSURE NO. ISSUE DATE

I HEREBY CERTIFY THAT THE PURPOSES OF APPLICATION OF THE FALSE STATEMENTS

PROVISIONS OF THE PROGRAM FRAUD CIVIL REMEDIES ACT OF 1986 (45 CFR 79), THAT TO THE

BEST OF MY KNOWLEDGE, EACH OF THE ABOVE STATEMENTS IS TRUE, ACCURATE, AND

DOES NOT OMIT ANY MATERIAL FACT THAT WOULD RENDER THE STATEMENT FALSE,

FICTITIOUS, FRAUDULENT AS A RESULT OF THE OMISSION.

SIGNATURE OF PRACTITIONER DATE

CLAUSES INCORPORATED BY REFERENCE

(Firm Fixed-Price, Non-Personal Service-Commercial Items)

FAR CITATION: 52.252-1: Solicitation Provision Incorporated by Reference. (FEB 1998) This solicitation incorporates one or more solicitation provisions by reference, with the same force and defect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. The offeror is cautioned that the listed provisions may include blocks that must be completed by the offeror and submitted with its quotation or offer. In lieu of submitting the full text of those provisions, the offeror may identify the provision by paragraph identifier and provide the appropriate information with its quotation or offer. Also, the full text of a solicitation provision may be accessed electronically at this/these address(es): http://arnet.gov/far/index.html.

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://arnet.gov/far/index.html

I. Federal Acquisition Regulations (FAR) (48 CFR Chapter 1) Clauses

No. FAR Citation Clause Title Clause Date ____

1. 52.202-1 Definitions June 2020

2. 52.203-3 Gratuities April 1984

3. 52.203-12 Limitation on Payments to Influence Certain June 2020 Federal Transactions

4. 52.204-13 System for Award Management Maintenance October 2018

5. 52.204-7 System for Award Management October 2018

6. 52.204-9 Personal Identify Verification of Contractor January 2011 Personnel

7. 52.204-16 Commercial and Government Entity Code August 2020 Reporting

8. 52.204-18 Commercial and Government Entity Code August 2020 Maintenance

9. 52.204-19 Incorporation by Reference of Representations December 2014 and Certifications

10. 52.212-1 Instructions to Offerors-Commercial Items November 2021

11. 52.212-4 Contract Terms and Conditions-Commercial Items November 2021 Items

12. 52.217-5 Evaluation of Options…