RFQ 230120014 Optometrist.pdf

A. This is a combined synopsis/solicitation for commercial services prepared in accordance with the format in Federal Acquisition Regulation (FAR) Subpart 12.6, as supplemented with additional information included in this notice. This announcement constitutes the only solicitation; proposals are being requested and a written solicitation will not be issued.

B. The Woodrow Wilson Keeble Memorial Health Care Center, Indian Health Service (IHS) intends to award a Firm-Fixed Price, Commercial Service, Purchase Order in response to

Request for Quote (RFQ) 23-012-0014. This is an RFQ only and in no way obligates the

Government to award a Purchase Order or to reimburse offeror(s) for any costs incurred in preparing their quote.

C. This solicitation document and incorporated provisions and clauses are those in effect through

Federal Acquisition Circular 2023-04.

D. This RFQ is a 100% Indian Small Business Economic Enterprise (ISBEE) Set-Aside and the associated NAICS Code is 561320, which has a small business standard of $27.5 in millions of dollars.

E. The unit pricing must be all inclusive (to include but not be limited to travel, lodging, per diem, fringe benefits, federal, state and local taxes) plus all other costs pertinent to the performance of this purchase order. Utilize your most competitive and reasonable rates.

F. Optometrist (1), Short Term.

G. Delivery: Woodrow Wilson Keeble Memorial Health Care Center, Sisseton Service Unit, 100

Lake Traverse Drive, Sisseton, SD 57262. The delivery period is the date of award x 39 weeks.

H. FAR 52.212-1 Instructions to Offerors-Commercial Products (March 2023).

Quotes shall be submitted on company letterhead stationery, signed, dated and it shall include:

1. Solicitation number RFQ-23-012-0014.

2. Closing Date: September 9, 2023 at 3:00 pm CST

3. Name, address and telephone number of company and email address of contact person.

4. Technical description of the service being offered in sufficient detail to evaluate compliance with the requirements of the solicitation.

5. Price and any discount terms

6. “Remit to” address, if different than mailing address.

7. A completed copy of the representations and certifications at FAR 52.212-3

8. Acknowledgment of Solicitation Amendments (if any issued)

9. Past performance information, when included as an evaluation factor, to include recent and relevant contracts for the same or similar items and other references (including contract numbers, points of contact with telephone numbers and other relevant information); and

10. Include a statement specifying the extent of agreement with all terms, conditions, and provisions included in the solicitation. Offers that fail to furnish required representations or information, or reject the terms and conditions of the solicitation may be excluded from consideration.

Basis of Award: Lowest Price, Technically Acceptable (LPTA). LPTA factors in determining the successful contractor:

• Meet the Delivery Schedule

• Completed and signed Indian Firm Representation Form

I. FAR 52.212-3 Offeror Representations and Certifications-Commercial Products and

Commercial Services (December 2022) See attachment for full text.

J. FAR 52.212-4 Contract Terms and Conditions-Commercial Products and Commercial

Services (December 2022) Applied to this acquisition and it is incorporated by reference.

K. FAR 52.212-5 Contract Terms and Conditions Required to Implement Statutes or

Executive Orders-Commercial Products and Commercial Services (June 2023) See attachment for full text.

L. Attached are the additional contract requirements:

• Statement of Work

• Federal Acquisition Regulations (FAR) & Health & Human Services Acquisition

Regulation (HHSAR) provisions and clauses that are applicable.

• Contractors Performance, Conditions & Responsibilities

• Courtesy and Respect in the Workplace Policy

• Workplace Violence

• Violence in the Workplace

• HHS Residual Standards of Conduct

• Standards of Ethical Conduct

• Business Associate Agreement

• OF-306 Declaration of Federal Employment

• Addendum to the Declaration of Federal Employment (OF-306)

• Licensure Requirement

• Provisional Authorization-pending favorably adjudicated background

• Mandatory Seasonal Influenza Immunizations for the Civilian Health Care Personnel

M. Submit quote to:

Woodrow Wilson Keeble Memorial Health Care Center

Attn: Shannon Cordell, Purchasing Agent

100 Lake Traverse Drive

Sisseton, SD 57262-7046

Or fax to 605-742-3896 or email Shannon.Cordell@ihs.gov

Questions in regards to this solicitation shall be submitted in writing by either email, fax or mail. The last day to submit questions is September 5, 2023, 4 pm, CST.

ACCEPTANCE PERIOD: Your quote must stipulate that it is predicated upon all the terms and conditions of this RFQ. In addition, it must contain a statement to the effect that it is firm for a period of at least 60 days from the date of receipt by the Government.

Quoters will need a UEI number, TIN number and must be registered with an active registration with the System for Award Management (SAM.gov).

Note to the proposed Contractor:

The selected offeror must complete the fingerprint process. Awardees must make arrangements with Ella Mae Greybuffalo, Procurement and Contracting Administrative Assistant to complete this process prior to starting the work of this contract and at this facility. She can be reached at

605-742-3862 or email ella.greybuffalo@ihs.gov.

SECURITY CLEARANCE:

Performance of this contract will require routine access by employees of the Contractor or its subcontractors to facilities or systems controlled by the Indian Health Service (IHS).

Before starting work requiring routine access to IHS facilities or systems, each person must complete a Federal Bureau of Investigations (FBI) National Criminal History Check (fingerprint check) adjudicated by an IHS employee using the Office of Personnel Management Personnel

Investigations Processing System. Contractors shall allow five (5) business days for IHS processing of fingerprints taken electronically at an IHS site and thirty (30) business days for non-electronic processing of fingerprints using FBI Form FD-258. A list of IHS sites with electronic fingerprint capability is available from the Contracting Officer.

The Indian Health Service utilizes the eQIP (Electronic Questionnaire Investigations

Processing) system to process background investigations. Contractors are required to work with the Service Unit Background Coordinator or other designee to properly complete their eQIP entry without error. Proper submission of the eQIP entry to the Office of Personnel Management

(OPM) is required prior to the individual being allowed to begin their performance under this contract. Computers have been provided to the service unit for this purpose.

In addition, no Contractor or subcontractor employee shall be permitted to perform work under this contract if listed on the HHS Office of Inspector General List of Excluded

Individuals/Entities (LEIE), http://exclusions.oig.hhs.gov. As soon as practicable prior to the start of work, the performance of the work the Contractor shall provide to the Contracting

Officer the names of all individuals to be used in performance of work for screening against the

LEIE. During the performance, the Contractor shall provide the Contracting Officer the names of any additional or substitute employees for screening before they begin work.

The Contractor is responsible for conducting security preclearance investigations in sufficient depth to ensure that each Contractor or subcontractor employee referred to IHS is not on the LEIE and can obtain a favorable fingerprint clearance. Each security preclearance shall be conducted sufficiently in advance of the start of performance to avoid delays caused by denial of access. If this is a Time and Materials, Labor-Hour or Cost Reimbursement contract, the contractor shall not charge for or be reimbursed for labor hours or other costs incurred for employees who are unable to perform due to denial or access or the excess time required to resolve and clear unfavorable security clearance findings. If this is a Fixed-Price contract, denial of access due to security clearance findings shall not be a basis for excusable delay or an increase to the contract amount.

The Government will pay for the cost to process the contractor's suitability clearances.

However, multiple investigations for the same position may, at the Contracting Officer's discretion, lead to reduction(s) in the contract price of no more than the cost of the extra investigation(s).

In the event that an individual does not obtain clearance prior to performance, the agreement to a temporary waiver of character investigation must be completed and signed by all parties before any services maybe rendered and accepted by the Government.

A Childcare National Agency check and Inquiries (CNACI) suitability screening will be performed and cleared according to the information provided to us on the OF-306.

Invoice Processing Platform (IPP):

In compliance with the Office of Management and Budget (OMB) M-15-19 memorandum

“Improving Government Efficiency and Saving Taxpayer Dollars Through Electronic Invoicing” directing Federal agencies to adopt electronic invoicing as the primary means to disburse payment to vendors. Invoices submitted under any award resulting from this solicitation will be required to utilize the Invoice Processing Platform (IPP) in accordance with HHSAR 352.232-

71, Electronic Submission and Processing of Payment Requests”

IPP is a secure, web-based electronic invoicing system provided by the U.S. Department of the

Treasury’s Bureau of the Fiscal Service, in partnership with the Federal Reserve Bank of St.

Louis (FRSTL). Respondents to this solicitation are encouraged to register an account with IPP if they have not already done so. If your organization is already registered to use IPP, you will not be required to re-register- however, we encourage you make sure your organization and designated IPP user accounts are valid and up to date.

The IPP website address is: https://www.ipp.gov

If you require assistance registering or IPP account access, please contact the IPP Helpdesk at

(866) 973-3131 (M-F 8AM to 6PM ET), or IPPCustomerSupport@fiscal.treasury.gov

Woodrow W. Keeble Memorial Health Care Center Sisseton Indian Health Service

Statement of Work Optometrist Services

Background

The mission of the Woodrow Wilson Keeble Memorial Health Care Center (also known as Sisseton Indian Health Service or WWKMHCC throughout this Statement of Work) in Sisseton, South Dakota is to provide the best possible health care services to the Native American population on the Lake Traverse Reservation.

To meet the mission, the WWKMHCC requires Contractor support to assist the Optometry Clinic in the recruitment and placement of a certified Optometrist.

Purpose

The purpose of this contract is to provide Optometry Services for the WWKMHCC and for recruitment, credentialing and placement of a currently licensed Optometrist as needed by the Optometry Clinic. The services provided by the Optometrist shall be as comprehensive as the clinic supplied facilities, equipment, and support services permit.

The Contractor shall provide an Optometrist to provide clinical services for patients as required by this Statement of Work (SOW) and in accordance with the terms and conditions of this contract. The Optometrist shall provide primary optometric care. An Optometrist who will provide primary eye care always examines patients receiving eye care at the optometry clinic first. Patients who need ocular surgery or a second opinion are referred to an ophthalmologist for secondary or tertiary care through the Purchased and Referred Care (PRC) referral process. The Optometrist shall work in close cooperation with referral specialists as needed to meet the ocular needs of the patient.

The Contract Optometrist shall provide services to eligible beneficiaries of the Indian Health Service who present themselves for treatment at the Optometry Clinic. The Contractor must be capable of responding to rapidly changing and unexpected needs for temporary coverage. It is anticipated that WWKMHCC will have a need for optometry services for an estimated thirty-nine (39) weeks.

Individual providing services under contract, which involve regular contact with or control over Indian children, are subject to a character investigation in accordance with the “Indian Child Protection and Family Violence Prevention Act” P.L. 101-630. The Indian Health Service Personnel Office will conduct these investigations following an award of a contract, unless in the judgement of the Contracting Officer in consultation with the Personnel Officer, investigation may be waived based on prior investigations on file. Until the character investigation has been completed and the Contracting Officer notified, such individual shall not have unsupervised contact with Indian children.

The Contracting Officer has the authority to temporarily waive the character investigation of a contractor. The “Agreement to a Temporary Waiver of Character Investigation” authorizes an agency to hire a contractor prior to the completion of a background check provided that at all times the contractor is within the sight and under the supervision of a government employee who has successfully completed the National Agency Check with written Inquiries (NACI).

The need for services is expected to remain constant during the term of the contract period. Therefore, the Contractor shall maintain the continuity of services to the maximum extent possible.

Each contract resulting from this solicitation shall:

(a) Be a fixed-price non personal health care services contract under which the Contractor is an independent contractor:

(b) Allow the Government to evaluate the quality of professional and administrative services provided, but retain no control over the medical, professional aspects of the services rendered (e.g., professional judgments, diagnosis for specific medical treatments);

(c) Require the Contractor to indemnify the Government for any liability producing act or omission by the Contractor, its employees and agents occurring during contract performance;

(d) Require that the contractor maintain medical liability insurance, in a coverage amount acceptable to the Contracting Officer, which is not less than the amount normally prevailing within the local community for the medical specialty concerned; and

(e) Require the contractor to ensure that its subcontracts for provision of health care services contain the requirements of the clause at FAR 52.237-7 (Section I-4), including the maintenance of medical liability insurance.

Period of Performance

The period of performance will be Date of Award x 39 weeks, Monday-Friday, 8:00am – 4:30pm, as scheduled with the Chief Optometrist or designated representative. Federal Government holidays and overtime are excluded.

Contractor Furnished Property, Facilities, and Services

The Contract Optometrist shall provide his/her own white lab coat, if required.

Government Furnished Property, Facilities, and Services

The Contract Optometrist will be authorized to use all areas of the medical treatment facility available to civil service and commissioned personnel in similar positions. The same restrictions apply to the contract Optometrist as any other Indian Health Service personnel to use areas for official business activities only.

The WWKMHCC shall provide administrative and professional ancillary support deemed necessary to support the optometry staff. These services shall be available eight (8) hours per day.

The equipment necessary for optometry clinic evaluation at this facility will be provided.

This equipment includes the following: Haag-Streit BQ900 Slit Lamp; Nidek Tonoref II Auto Ref/Kerato/Tonometer; Keller All pupil II Binocular Indirect Ophthalmoscope;

Reliance Optometry Exam Chair; Optos California RG Retinal Imaging System; Zeiss Cirrus 6000 HD-OCT; Carl Zeiss HFA3-860 Visual Field Analyzer; minor procedure surgical instruments (various forceps, spud).

The Optometrist placed by the Contractor shall be provided with an orientation to WWKMHCC and the Indian community being served. WWKMHCC personnel shall provide the orientation.

The WWKMHCC shall provide all equipment and medical supplies deemed necessary to provide medical care at the optometry clinic with the exception of those items to be supplied by the Contractor as listed on page 2-Contractor Furnished Property.

The WWKMHCC shall provide all required blank Government forms applicable to the Indian Health Service. WWKMHCC personnel will also provide appropriate orientation to the necessity of such forms.

The WWKMHCC shall provide an ongoing method of monitoring and evaluation of the quality and appropriateness of patient care, and of identifying deficiencies in the quality of services performed before the level of performance becomes unacceptable.

For specialty backup, the WWKMHCC has one Pediatrician, one Family Practice physician, and also contract Physicians and Nurse Practitioners that are available for questions.

The age of patients’ range from one day old and up which represents all age groups.

Most of the illnesses involved patients with chronic diseases such as diabetes, hypertension, cardiac disease, cancer, and then those with acute illnesses.

Statement of Work

The Contractor shall furnish optometry services for in-house medical services at the WWKMHCC in Sisseton, South Dakota. The Contract Optometrist shall perform services compatible with the clinic’s medical facilities operating capacity and equipment.

The Contractor shall provide services for Indian Health Service beneficiaries served by the WWKMHCC. The Contract services shall cover the range of optometry services typically provided in a rural civilian practice of similar size. Contract performance shall be according to the requirements contained in this statement of work. The services shall include specialty emergency care, consultative, diagnostic, and routine care. In performance of this contract, the Optometrist shall specifically carry out the tasks listed below.

1. Provide examination, diagnosis, prognosis, treatment plan, follow-up and consultation for all patients examined with the conditions listed in Appendix A, which is not entirely inclusive. The contract Optometrist shall refer patient issues, listed in Appendix A, that are ophthalmology issues to the optometry department for referral to an ophthalmologist.

2. The contract Optometrist will input all emergency referrals into the PRC Referred

Care Information System (RCIS). All such referrals will be processed in accordance with PRC regulations.

3. All Ocular surgeries will be performed on a referral basis through the PRC office. All such referrals will be processed in accordance with PRC regulations.

4. On the clinic days, optometry patients will be scheduled every thirty (30) minutes and the optometry clinic will run from 8:00am – 4:30pm, with a one-half hour lunch break. A typical clinic day will involve examining 12-16 patients.

5. The contract Optometrist shall work with the optometry clinic staff to arrange the scheduling.

6. The contract Optometrist will be responsible to report to work at the scheduled time and ensure accurate documentation of hours are entered and reflected on his/her timesheets. Submission of the timesheets and invoices will be verified before payment is processed. Only hours authorized by the Chief Optometrist or designee will be authorized for payment.

7. The Contractor shall not allow any employee to perform work under this contract who is under the influence of alcohol, drugs, or any other incapacitating agents.

8. The Contractor shall provide a project manager who shall be responsible for the overall management and coordination of this contract and who shall act as the central point of contact with the WWKMHCC’s Contracting Officer Representative (COR).

9. The contractor shall be responsible for all labor, travel, lodging, per diem, fringe benefits, i.e., life insurance, Social Security, Federal/State/Local taxes, plus any other costs pertinent to the performance of this contract.

APPENDIX A

172 Neoplasms 360 Disorders of the globe 361 Retinal detachments and defects 362 Other retinal disorders 363 Chorioretinal inflammations, scars and other disorders of the choroid 364 Disorders of iris and ciliary body 365 Glaucoma 366 Cataract 370 Keratitis 371 Corneal opacity and other disorders of the cornea 372 Disorders of the conjunctiva 373 Inflammation of the eyelids 374 Disorders of the eyelids 375 Disorders of the lacrimal system 376 Disorders of the orbit 377 Disorders of the optic nerve and visual pathways 378 Strabismus and other disorders of binocular eye movements 379 other disorders of the eye 742 Congenital anomalies of the nervous system 743 Congenital anomalies of the eye 870 Open wound of ocular adnexa 871 Open wound of globe 921 Contusions of eye and adnexa 930 Foreign body on external eye 950 Injury to optic nerve and pathways

The standards of medical practice and duties of the contractor through its Optometrist shall be determined pursuant to the bylaws of the WWKMHCC. The regulations of WWKMHCC, applicable provisions of law, other rules and regulations of any and all governmental authorities relating to certification must be followed. Also, the standards and recommendations of the Accreditation Association of Ambulatory Health Care (AAAHC) and Center for Medicare and Medicaid Services (CMS) must be adhered to.

The Contract Optometrist shall be required to participate in a quality improvement program, which is consistent with current AAAHC requirements for ongoing monitoring and evaluation of the quality and appropriateness of care.

The Contractor will agree to provide for the consistent performance of patient care processes according to the standards of the AAAHC who supply accreditation to the

WWKMHCC Clinic in Sisseton, South Dakota. These standards shall include: the Comprehensive Accreditation Manual for Clinics, The Laboratory Standards, and Ambulatory Care Standards as they represent the scope of services of this contract.

Prior to assumption of duty on any scheduled work shift, the Contract Optometrist may be briefed by the Clinical Director or his/her designated representative concerning any matter relevant to the Contract Optometrist assumption and discharge of responsibilities under the terms of this contract. The Contractor shall advise the Clinical Director or his/her designated representative of any problem encountered, or which may be encountered, in connection with meeting the needs of patients treated by the Contract Optometrist. The Contractor shall report continuing problems of any nature to the WWKMHCC Contracting Officer Representative.

The Contract Optometrist shall generate and maintain proper medical record information on beneficiaries to whom treatment is provided, in accordance with AAAHC and WWKMHCC regulations. The Contract Optometrist shall prepare all electronic medical record documentation to meet or exceed the established standards of the Clinic to include, but not be limited to: timeliness, legibility, accuracy, content, and signature. All medical record information generated in the performance of this contract shall remain the property of and subject to the exclusive control of the WWKMHCC.

Treatment of patients shall be performed at the Clinic, except in certain instances when patients are referred to private facilities for performance of special diagnostic procedures or definitive care not available in the Clinic. All referrals to private facilities or providers for specialized diagnostic studies or definitive care not available at the Clinic shall follow WWKMHCC regulations and policies on patient referrals.

The Contract Optometrist shall assess operative services care to ensure its quality. The Contract Optometrist will participate in a continual process of self-evaluation and strive for excellence in optometry services.

The Contract Optometrist shall comply with all Clinic infection control and safety procedures, practices and standards.

The Contract Optometrist shall participate in medical staff functions, such as medical program reviews, performance improvement activities and organizational functions, including attending committee meetings and accepting committee assignments if and when requested by the Clinical Director. The Contract Optometrist shall meet all applicable AAAHC and OSHA standards during the performance of the contract.

The Contract Optometrist may be required to provide formal or informal continuing education to members of the Clinic Medical/Nursing staff. The training shall be in regard to the Optometrist’s field of expertise.

The Contract Optometrist shall respect and maintain the basic rights of patients, to include but not be limited to personal dignity.

Health Requirements

The contract provider shall not have any work or health restrictions which interfere with the performance of primary care provider services. The Contract Provider shall provide proof of current immunizations (Hep B, MMR, Varicella, Tdap, Flu) status and current PPD within the past year.

Optometrist Qualifications

The Contractor shall ensure that the appropriate certification agency or equivalent has certified the contract Optometrist.

It is a condition of this contract that all required certifications in this Statement of Work remain current during the life of this contract.

The Contractor Optometrist shall not have any work or health restrictions, which interfere with the performance of optometry services.

The Contractor Optometrist shall speak, understand, read, and write English fluently and communicate with sufficient clarity to be understood by Great Plains Area (formerly Aberdeen Area) Indian Health Service personnel and patients.

The Contractor Optometrist shall possess sufficient initiative, interpersonal relationship skills and social sensitivity such that he/she can relate constructively to patients from Native American communities in the Great Plains Area.

The Contractor Optometrist shall maintain standards of personal hygiene and grooming such that his/her image as a health care professional is compatible with the expectations of the Great Plains Area Indian Health Service clinical staff and the Native American community.

Verification of Licensure

To ensure that Optometrist(s) providing services under this contract are properly licensed or properly documented as an Optometrist, and that the I.H.S. is made aware of all disciplinary actions taken against such Optometrist, the contractor will:

1. Verify through the Federation of State Optometry Boards or equivalent database all active, inactive, and lapsed licenses that are held or have been held, by an Optometrist who would provide services in W.W.K.M.H.C.C Clinic and clinics under this contract.

2. Inform W.W.K.M.H.C.C of the status of all licenses for each Optometrist who would provide services under this contract at W.W.K.M.H.CC. Notify the clinic for all reasons for each inactive or lapsed license.

3. Obtain at least three (3) letters of reference from health care providers whom have knowledge of the applicant’s Optometrist practice skills in the past 6 months to 1 year. One letter must be from the Clinical/Medical Director at the Clinic where the Optometrist holds or last held privileges.

4. Provide all information regarding performance and disciplinary actions that is collected on the Optometrist who would be placed under this contract to the receiving WWKMHCC Clinical Director. This includes all information that is collected and compiled on such Optometrists at the time of initial hire by the Contractor, and/or information that is reported during periods that the Contractor is an agent of such Optometrist for placement under this contract.

5. Certify that all information obtained on Optometrist whom they would assign to

WWKMHCC clinic, has been reviewed and verified by the Contractor. This certification must include a statement that the Contractor has found no reason to reject the Optometrist application.

In order to be considered for the Clinical Privileging process, the contract Optometrist shall meet the following criteria:

• Board certified or Board Eligible as an Optometrist

• Current Basic Life Support (BLS)

• Completed Medical Staff Application

• Current, active, and unrestricted license in of the fifty (50) states or U.S. t territories

• Must not have been subject to involuntary limitation, reduction, denial, or loss of clinical privileges

• Must have no current federal sanctions

• Must provide a history of previous or pending malpractice lawsuits

Upon presentation of a candidate, the Contractor shall provide the following information:

• Provider’s full name

• Provider’s date of birth

• Provider’s social security number

• Provider’s contact phone number

• Provider’s current curriculum vitae with listing of any and all Indian Health

Service experience (IHS, Tribal, or Urban sites), and employment gaps greater than two (2) months, if any

• Release of information signed by the provider (see attached)

In accordance with the Indian Health Service credentialing policy, the Contractor shall complete a primary source verification for each primary care physician performing services under this contract. The WWKMHCC will provide the credentialing packet and all associated documents to the Contractor, and the Contractor shall complete and return all documentation within five (5) business days.

Contents of the credentialing packet include:

1. Medical Staff Application – can be completed online at:

http://www.ihs.gov/NonMedicalPrograms/dhr/Documents/ApplicantInfo/IHS_Me di.pdf.•Provide explanations of any “yes” questions on liability, final judgments, settlements, or claims from the application

2. Copies of pre-professional and professional school diplomas

3. Copies of certificates of completion of post-graduate training (i.e. residency)

4. Copy of Board Certification certificate or letter

5. Copies of all current licenses

6. Copy of current DEA certificate

7. Copy of current liability insurance

8. Completed clinical privileges request form – signed (must be specific to the facility assigned and specific to the applicant’s abilities/competencies)

9. Medicare Agreement form – signed

10. Health Status Statement – signed

11. TB Status/Immunization Record within past one (1) year

12. Medical Staff Bylaws Attestation Statement – signed

13. Three (3) letters of reference within the past 12 months; one reference must be from a same discipline peer and one reference must be from the current or most recent medical supervisor

14. Photocopy of a government issued photo identification card (e.g. driver’s license or passport)

15. Confidentiality Statement – signed

16. Child Care and Indian Child Care Worker Positions Agreement – signed

17. Current CME (Continuing Medical Education) for the past two (2) years, include copies of BLS, ACLS certification

18. Copy of National Provider Identifier notification letter

19. Provider Signature Card – signed

All contract Optometrists will be held to the same Standards of Conduct as federal employees (see attached Standards of Conduct, Violence in the Workplace memorandum, and Courtesy and Respect in the Workplace Policy). Violations of these policies may lead to contract termination.

Any negligent behavior or any behavior jeopardizing patient safety will not be tolerated.

Professional Review Action may be taken regarding any member of the medical staff if activity, demeanor or conduct of the member is detrimental to patient care, disruptive to service unit operation, or in violation of the local Bylaws, Medical Staff Rules and Regulations, IHS policy or ethical. Each incident will be evaluated and documented.

Documentation will be submitted to the contractor. These incidents may be grounds for immediate removal. The final decision is at the discretion of the Clinical Director and

CEO.

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

WWKMHCC.

The standards of medical practice and duties of the Contractor through its Optometrists shall be determined pursuant to the bylaws of the WWKMHCC - IHS, the regulations of the facility, applicable provisions of law, other rules and regulations of any and all governmental authorities relating to licensure and regulation of Optometrists and outpatient facilities, and the standards and recommendations of the Joint Commission.

All Contract Optometrists shall be required to participate in a quality improvement program which is consistent with current AAAHC requirements for ongoing monitoring and evaluation of the quality and appropriateness of care. Medical services shall not be performed by a Contract Optometrist until professional staff membership and clinical privileges have been granted in writing by the Governing Body of the WWKMHCC. As a prerequisite to performance under the resultant contract, the Contract Optometrist performing the services must be privileged in accordance with Indian Health Service policy. Therefore, compliance with the Indian Health Service privileging requirements is essential in the performance of the contract. Any failure to comply with WWKMHCC privileging requirements shall be considered to be nonperformance of the contract. The Governing Body will not grant clinical privileges until it is determined that information of credentials has been verified.

Exceptions to WWKMHCC credentialing review and clinical privileges process will not be considered. The Contractor's failure to submit successful applicants shall not excuse nonperformance of contract requirements. Any Contract Optometrist who fails to maintain medical staff appointment and clinical privileges will not be permitted to perform services under the contract and shall be promptly replaced by the Contractor.

Prior to assumption of duty on any scheduled work shift, the Contract Optometrist may be briefed by the service unit clinical director or designee concerning any matter relevant to the Contractor's assumption and discharge of responsibilities under the terms of this contract. The Contractor shall advise the clinical director or designee of any problem encountered, or which may be encountered, in connection with meeting the needs of patients treated by the Contract Optometrist. The Contract Optometrist shall provide a shift briefing to the following duty provider. Continuing problems of any nature shall be reported by the Contractor, to the WWKMHCC COR.

Character Investigation

CRIMINAL BACKGROUND CHECK REQUIREMENT. The Government will conduct, at the government expense, a Tier 2 with Subject Interview (T2S) and state criminal history checks on individuals providing direct, unsupervised child care services under this contract. This investigation will be conducted at the expense of the Government and will be based upon the Federal Bureau of Investigation (FBI), state and local criminal history repositories.

The Contract Provider is subject to Public Law 101-630, The Indian Child Protection and Family Violence Prevention act. The Indian Health Service Personnel Office will conduct the criminal background investigations, and obtain fingerprints on each Contract Provider provided by the Contractor. Until the character of investigation has been completed and the Contracting Officer is notified of the results, the Contract Provider must not have unsupervised contract with Indian children or access to Federal Information System that contain Personally Identifiable Information (PII) or Protected Health Information (PHI). The investigation may take several months to complete.

Contracting Providers receiving an unfavorable background investigation shall not be employed. If at any time the contractor fails to meet or maintain suitability or eligibility for Federal employment, the contractor will be removed from providing services at

WWKMHCC.

The Contractor shall submit completed personnel background check applications within seven (7) working days after candidate acceptance. Any corrections needed to the background investigation process must be completed and resubmitted within seven (7) days.

Individuals shall have the right to obtain a copy of any background check pertaining to themselves and to challenge the accuracy and completeness of the information contained in the report.

Technical Requirements

The Contractor shall recruit, credential and place one (1) qualified Optometrist at the Clinic. Work shifts will normally be eight (8) hours in length and will be worked between the hours of 8:00am and 4:30pm. The contract Optometrist will provide care Monday through Friday, excluding Federal Government holidays.

Upon assignment, the Contractor shall provide the curriculum vitae and other required documentation to the WWKMHCC COR

The Contractor shall investigate, verify, maintain, and submit documentation of education, training, licensure and certifications held for each Optometrist that is proposed to provide services at the Clinic. Such documentation must show compliance with provisions shown under Optometrist Qualifications on page 5 of this Statement of Work, and contain the following additional information:

(a) Letters of recommendation including character reference from:

- Residency Director if applicable

- Professional Supervisor/Department Chairman

- Professional Colleagues

(b) Statement concerning prior professional privileges, malpractice, drug/alcohol abuse, Health, and history of disciplinary actions from a State Board of Optometric Examiner, Federation of State Medical Boards, etc.

If a Contract Optometrist’s privileges are revoked at any time during the term of the contract, the Contractor shall remove the Optometrist from providing services to the Indian Health Service under the terms and conditions of this contract. The Contractor shall provide a qualified Optometrist as a replacement. If at any time it is determined that improper or falsified credentials have been submitted or any of the contract Optometrist’s credentialing documents expire or be revoked, privileges for the Optometrist to which they pertain will be revoked, initially by verbal notification, followed by written notification to the Contractor. The replacement Optometrist’s travel costs to the Clinic shall be the responsibility of the Contractor.

The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care 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 patient or other staff members to designated Government representatives. Standards of conduct shall mirror those prescribed by current federal personnel regulations. The CO and COR shall deal with issues raised concerning Contractors conduct. The final arbiter on questions of acceptability is the CO.

The Contractor shall provide a project manager who shall be responsible for the overall management and coordination of this contract and who shall act as the central point of contact with the WWKMHCC COR.

Medical Liability Insurance

The Contractor will be solely liable for and expressly agrees to indemnify the Government with respect to any professional liability producing acts or omissions by it or its employees or agents. The Contractor will maintain medical liability insurance during the term of this contract issued by a responsible insurance carrier.

Privacy Act Notification

a. This contract requires the Contractor, on behalf of the Indian Health Service (IHS), to provide health care to American Indians and Alaskan Natives and report selected medical record and financial information to IHS. The Snyder Act (25 U.S.C. 13) and Public Law 83-5658 (42 U.S.C. 2001) authorizes the collection of this information. To be reimbursed by IHS, you must provide the information requested by delivery orders issued under this contract. IHS will use the information for financial, legal, research, and health care purposes.

b. Disclosure of this information may be made by IHS to: other providers of health care for treatment or health maintenance of American Indian or Alaskan Native people; the Office of Worker's Compensation Programs, Department of Labor; the Department of Justice for their representation of the United States; and for congressional inquiry; quality assessment, medical audit, or utilization review;

billing third parties for the payment of care; analytical and evaluation studies; to Federal or State agencies as required by law, research purposes supported by IHS;

and identification of handicapped children under 10 U.S.C. 1401 et. Seq.

c. Disclosure of the appropriate medical record information without prior consent of the subject patient may be made by you to: another provider of health care treating the same patient; a Federal or State agency as required by law such as the reporting of communicable diseases, births, deaths, or the commission of crimes (i.e., gunshot wounds, rape, child abuse or neglect, alcohol or drug abuse, etc.); and billing third parties for the payment of care not reimbursed by WWKMHCC. The contract Optometrist must forward all other requests for information contained on this form to the applicable IHS Ordering Official.

Until the character investigation has been completed and the Contracting Officer notified, such individuals shall not have unsupervised contact with Native American children.

COR Designation

The designated Contracting Officer’s Representative (COR) for this contract is:

Ella Mae Greybuffalo Admin Support Asst. FAC-COR II Procurement & Contracting

Woodrow W. Keeble Memorial Health Care Center Indian Health Service 100 Lake Traverse Drive Sisseton, SD 57262 Phone: (605)742-3862 Fax: (605) 742-3896 Email: ella.greybuffalo@ihs.gov

Method of Payment/Invoice Submission

The Contractor shall submit a signed and approved invoice to request payment. For services, it should be submitted at least on a weekly basis.

Payment shall be made by the:

GREAT PLAINS AREA DIVISION OF FINANCIAL MGMT.

ROOM 309 FEDERAL BLDG., 115 4th AVENUE SE

ABERDEEN, SOUTH DAKOTA 57401

mailto:ella.greybuffalo@ihs.gov

DEPARTMENT OF HEALTH & HUMAN SERVICES

Indian Health Service

Office of Management Services Division of Acquisition Policy (DAP)

5600 Fishers Lane Rockville, MD 20857

INDIAN HEALTH SERVICE

BUY INDIAN ACT

INDIAN ECONOMIC ENTERPRISE

REPRESENTATION FORM

SOLICITATION/SOURCES SOUGHT/RFI #: _________________________________________________

PROJECT TITLE: ________________________________________________________

DATE: ___________________________________________________________________

In accordance with 25 U.S.C. 47 the Buy Indian Act, the signature below constitutes self-certification that the Offeror meets the definition of an “Indian Economic Enterprise” (HHSAR 326.601) in response to this Sources Sought Notice, Request for Information (RFI) or Solicitation and resultant contract.

The enterprise must meet the definition of “Indian Economic Enterprise” throughout the following time periods:

(1) At the time an offer is made in response to this solicitation;

(2) At the time of contract award; and

(3) During the full term of the contract performance period. At any point during these periods, if the Contractor no longer meets the eligibility requirements, the contractor must provide immediate written notification to the Contracting Officer.

Individual Contracting Officers may require documentation of eligibility before awarding a set-aside or sole source contracts under the Buy Indian Act and awards may be subject to protest if the eligibility of the successful Offeror is in question. In addition to the self-certification requirements, successful Offerors must also be registered with the System of Award Management (SAM).

Any false or misleading information submitted by an enterprise when submitting an offer in consideration of an award set-aside under the authority of the Buy Indian Act is a violation of the law and punishable under 18 U.S.C. 1001.

False claims submitted as part of contract performance are subject to the penalties enumerated in 31 U.S.C. 3729 to 3731 and 18 U.S.C. 287.

REPRESENTATION

The Offeror represents as part of its offer that it does _____, does not _____ meet the definition of an “Indian Economic Enterprise” with “Indian Ownership” under the authority of the Buy Indian Act.

Name of the 51% owner of IEE Firm

Certifying Signature

Print Name

Name of Federally Recognized Tribal Entity

Business Name

DUNS Number

Solicitation Provisions Incorporated By Reference (Non-Personal Service)

52.252-1 Solicitation Provisions Incorporated by Reference.

This solicitation incorporates one or more solicitation provisions 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. 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: www.acquisition.gov/far

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

No. FAR Citation Clause Title Clause Date

1. 52.203-11 Certification and Disclosure Regarding Payments to Influence

Certain Federal Transactions September 2007

2. 52.203-18 Prohibition on Contracting with Entities that Require Certain

Internal Confidentiality Agreements or Statements -Representation January 2017

3. 52.204-7 System for Award Management October 2018

4. 52.204-22 Alternative Line Item Proposal January 2017

5. 52.209-2 Prohibition on Contracting with Inverted Domestic

Corporations-Representation November 2015

6. 52.212-1 Instructions to Offerors—Commercial Products and

Commercial Services March 2023

7. 52.222-50 Combating Trafficking in Persons November 2021

8. 52.223-22 Public Disclosure of Greenhouse Gas Emissions and Reduction

Goals-Representation December 2016

9. 52.225-25 Prohibition on Contracting With Entities Engaging in Certain

Activities or Transactions Relating to Iran—Representation and Certification June 2020

II. Federal Acquisition Regulations (FAR) (48 CFR Chapter 1) Provisions in Full Text

52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment.

As prescribed in 4.2105(a), insert the following provision:

REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT

(NOV 2021)

The Offeror shall not complete the representation at paragraph (d)(1) of this provision if the Offeror has represented that it "does not provide covered telecommunications equipment or services as a part of its offered products or services to the Government in the performance of any contract, subcontract, or other contractual instrument" in paragraph (c)(1) in the provision at 52.204-26, Covered Telecommunications Equipment or Services—Representation, or in paragraph (v)(2)(i) of the provision at 52.212-3, Offeror Representations and Certifications-Commercial Products or Commercial Services.

The Offeror shall not complete the representation in paragraph (d)(2) of this provision if the Offeror has represented that it "does not use covered telecommunications equipment or services, or any equipment, system, or service that uses covered telecommunications equipment or services" in paragraph (c)(2) of the provision at 52.204-26, or in paragraph (v)(2)(ii) of the provision at 52.212-3.

(a) Definitions. As used in this provision— Backhaul, covered telecommunications equipment or services, critical technology, interconnection arrangements, reasonable inquiry, roaming, and substantial or essential component have the meanings provided in the clause 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

(b) Prohibition.

http://www.acquisition.gov/far https://www.acquisition.gov/far/4.2105#FAR_4_2105 https://www.acquisition.gov/far/52.204-26#FAR_52_204_26 https://www.acquisition.gov/far/52.212-3#FAR_52_212_3 https://www.acquisition.gov/far/52.204-26#FAR_52_204_26 https://www.acquisition.gov/far/52.212-3#FAR_52_212_3 https://www.acquisition.gov/far/52.204-25#FAR_52_204_25

(1) Section 889(a)(1)(A) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Pub. L. 115-

232) prohibits the head of an executive agency on or after August 13, 2019, from procuring or obtaining, or extending or renewing a contract to procure or obtain, any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. Nothing in the prohibition shall be construed to—

(i) Prohibit the head of an executive agency from procuring with an entity to provide a service that connects to the facilities of a third-party, such as backhaul, roaming, or interconnection arrangements; or

(ii) Cover telecommunications equipment that cannot route or redirect user data traffic or cannot permit visibility into any user data or packets that such equipment transmits or otherwise handles.

(2) Section 889(a)(1)(B) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Pub. L.

115-232) prohibits the head of an executive agency on or after August 13, 2020, from entering into a contract or extending or renewing a contract with an entity that uses any…