RFQ-24-050 4.2.24 Final.pdf

A. This is a combined synopsis/solicitation for commercial items prepared in accordance with the format in Federal Acquisition Regulation (FAR) Subpart 12.6, as supplemented with additional information included in this notice, FAR Part 12, Acquisition of Commercial Items (Title VIII of the Federal Acquisition Streamlining Act of 1994) (Public Law 103-355) & FAR 37.4, Non-Personal Health Care Services Contract (10 U.S.C. 2304 and 41 U.S.C. 253). This announcement constitutes the only solicitation; proposals are being requested and a written solicitation will not be issued.

B. The Great Plains Area Indian Health Service (IHS) intends to award a Firm-Fixed Price, Non-Personal Healthcare Service, Commercial Item, Purchase Order in response to Request for Quote (RFQ) RFQ-24-050.

C. This solicitation document and incorporated provisions and clauses are those in effect through Federal Acquisition Circular 2024-03/2-23-2024.

D. This RFQ is issued as 100% Buy Indian/Small Business, and the associated NAICS Code is 561320, which has a small business standard of $34 Million Dollars.

E. The quoted 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 contract. Utilize your most competitive and reasonable rates.

Complete the attached Price Schedule for:

1. Lab Technician Services 1008 HRS x $_________________,Totaling $__________________________.

F. Lab Technician Services for 6 months.

G. To be provided for Lower Brule Indian Health Center, Lower Brule, South Dakota, 57548. See Statement of Work attached.

The period of performance will be Date of Award through 6 months.

H. FAR 52.212-1 Instructions to Offerors-Commercial Products and Commercial Services (September 2023).

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

1. Solicitation number RFQ-24-050.

2. Closing Date: April 16, 2024 at 12:00 pm CST.

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

4. Technical description of the item/service being offered in sufficient detail to evaluate compliance with the requirements of the solicitation. This may include product literature, or other documents, if necessary.

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 (see FAR 52.212-3(b) for those representations and certifications that the offeror shall complete electronically).

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).

10. A statement specifying the extent of agreement with all terms, conditions, and provisions included in the solicitation.

Offerors that fail to furnish required representations or information, or reject the terms and conditions of the solicitation may be excluded from consideration.

In addition, Contractors shall provide the following:

Name and phone number of three (3) current professional references.

Complete and sign Buy Indian Act Indian Representation Form.

Complete and sign Child Care Position/Personnel Security Office form.

Complete and sign the Declaration for Federal Employment – Optional Form 306.

Complete and sign Addendum to Declaration for Federal Employment (OF306).

Complete and sign Licensure Requirement Form. (if applicable) Copy of malpractice insurance coverage.

Shall meet the Qualifications and Knowledge Requirements in the Statement of Work and provide copies of the required documents (if needed).

Copy of current Board Certification. (if applicable) Copy of active, current, full and unrestricted license to practice. (if applicable)

Copy of a recent Health Examination.

Copy of Diplomas/Specialty Certifications.

Copies of Continuing Education.

Current CV/resume.

I. Basis of award is Lowest Price, Technically Acceptable “LPTA” factors determining the successful contractor.

J. FAR 52.212-3 Offer Representations and Certifications-Commercial Products and Commercial Services (February

2024) See attachment for full text. The Offeror shall complete only paragraphs (b) of this provision if the Offeror has completed the annual representations and certification electronically via the System for Award Management (SAM) website

K. FAR 52.212-4 Contract Terms and Conditions-Commercial Products and Commercial Services (November 2023) –

See attachment; in by reference.

L. FAR 52.212-5 Contract Terms and Conditions Required to Implement Statutes or Executive Orders-Commercial

Products and Commercial Services (February 2024) - See attachment for full text.

M. Attached are the Federal Acquisition Regulations (FAR) & Health & Human Services Acquisition Regulation (HHSAR) clauses that are applicable including below.

N. Offers will be accepted electronically, Submit via e-mail to the following:

Great Plains Area Indian Health Service Attn: Samantha Marcellais, Contract Specialist 115 4th Ave. SE, Room 309 Aberdeen, SD 57401 Email: samantha.marcellais@ihs.gov

Any questions, please submit by April 11, 2024 by 12:00 pm CST.

Contractors will need a UEID, TIN number, and be registered with www.sam.gov.

SECURITY CLEARANCE:

A security pre-clearance must be performed for any employees referred to IHS through this contract.

Fingerprints must be completed and adjudicated prior to services being performed under this contract.

No contract award shall be made to any vendor or provider listed on the OIG Exclusion List http://exclusions.oig.hhs.gov throughout the duration of the contract. It shall be the responsibility of the contractor to notify the acquisition official if there is a change in provider.

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 (I.H.S.). Before starting work requiring routine access to I.H.S. facilities or systems each person must complete a FBI National Criminal History Check (Fingerprint Check) adjudicated by an I.H.S. employee using the Office of Personnel Management Personnel Investigations Processing System. Contractors shall allow five business days for I.H.S.

processing of fingerprints taken electronically at an I.H.S. site and thirty business days for non-electronic processing of fingerprints using FBI Form FD-258. A list of I.H.S. sites with electronic fingerprint capability is available from the Contracting Officer.

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 I.H.S. 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.

Government will pay for the cost to process the contractors suitability clearances. However, multiple investigations for the same position may, at the Contracting Officers discretion, lead to reduction(s) in the contract price of no more than the cost of the extra investigation(s).

Employees that DO NOT have access to LMS, contractors, volunteers, or IHS employees with IPA’s or MOA’s to tribal organizations please, click here IHS Sexual Abuse Prevention website. When the contractors have completed and passed the training, please have them send a copy of the last page of the training with Name, Date, and Time to their Supervisor, COR, and Kimmen LeBeau, e-mail:

Kimmen.LeBeau@ihs.gov

No contract award shall be made to any vendor listed on the OIG Exclusions List at http://exclusions.org.hhs.gov throughout the duration of the contract.

Contractor must be registered with the System for Award Management (SAM) at www.sam.gov

ACCEPTANCE PERIOD: Your proposal 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 30 days from the date of receipt by the Government.

The Government reserves the right to accept or reject services, if the level of performance is unacceptable.

"Lab Technician will arrive on a Business Day ONLY to complete all Orientation and Background procedures. The Clinical Director or Designee will ensure all Orientation and Background procedures have been completed and an email will be sent to the Contracting department to state as such. The Lab Technician will NOT see patients until Background/Fingerprints have been cleared.

"The standards of medical practice and duties of the Contractor through its Lab Technician shall be determined pursuant to the bylaws of the Service Unit. The regulations of the hospital, applicable provisions of law, other rules and regulations of any and all governmental authorities relating to licensure and regulation of physicians and hospitals must be followed. Also, the standards and recommendations of Centers for Medicare and Medicaid Services (CMS) or the Accreditation Organization must be adhered to. The Lab Technician shall be required to participate in a quality improvement program, which is consistent with current requirements for ongoing monitoring and evaluation of the quality and appropriateness of care."

DEPARTMENT OF HEALTH & HUMAN SERVICES

Indian Health Service

Division of Acquisition Policy (DAP) 5600 Fishers Lane

Rockville, MD 20857

INDIAN HEALTH SERVICE

BUY INDIAN ACT

INDIAN FIRM REPRESENTATION FORM

SOLICIATION NUMBER: _________________________________________________

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 Firm” (HHSAR 326.602) with “Indian Ownership” (HHSAR 326.603), in response to this solicitation and resultant contract.

The enterprise must meet the definition of “Indian Firm” 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 DUN and Bradstreet (D&B) and 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 Firm” with “Indian Ownership” under the authority of the Buy Indian Act.

Business Name Certifying Signature

DUNS Number Print Name

Statement of Work: Medical Laboratory Technologist/Technician Page 1 of 13

LOWER BRULE HEALTH CENTER

INDIAN HEALTH SERVICE

PERFORMANCE STATEMENT OF WORK

MEDICAL LABORATORY TECHNOLOGIST/TECHNICIAN SERVICES

GENERAL

The Mission of the Lower Brule Health Center (LBHC) Indian Health Service (IHS) is to provide the best possible healthcare services to the patients on the Lower Brule Sioux Tribe Reservation in South Dakota. To meet this mission, the LBHC is requesting an all-inclusive, non-personal service contract for a Medical Laboratory Technologist/Technician.

BACKGROUND

The IHS is an agency within the Department of Health & Human Services and is responsible for providing federal health services to American Indians and Alaska Natives. The Indian Health Service provides a comprehensive health service delivery system for approximately 1.9 million American Indians and Alaska Natives who belong to 567 federally recognized tribes, in 35 states. The Indian Health Service Headquarters is located in Rockville, MD and then divided into twelve (12) physical areas: Alaska, Albuquerque, Bemidji, Billings, California, Great Plains, Nashville, Navajo, Oklahoma, Phoenix, Portland, and Tucson.

The Great Plains Area Office (GPAO) works in conjunction with 19 Indian Health Service Units and Tribal Managed Service Units to provide health care to approximately 130,000 Native American located in North Dakota, South Dakota, Nebraska, and Iowa. The Area Office’s service units include seven hospitals, eight health centers, and several smaller health stations and satellite clinics.

Our facility, the LBHC, falls under the GPAO. LBHC provides medical care for many tribal members living on the Lower Brule Reservation and surrounding areas. Serving a rural area, many of our patients travel many miles round trip to receive care. Services include: Community Health, Laboratory, Pharmacy, Public Health Nursing, Purchased & Referred Care Services, and Radiology Services.

OBJECTIVES

To provide one (1) medical laboratory technologist/technician services, in the delivery of patient care for the LBHC. The Contract Provider(s) shall perform laboratory services compatible with the IHS medical facility’s operating capacity and equipment, on the Lower Brule Reservation. The care shall cover the care typically provided in a rural civilian practice of similar size.

PERIOD OF PERFORMANCE

Date of the award through six (6) months.

Statement of Work: Medical Laboratory Technologist/Technician Page 2 of 13

PLACE OF PERFORMANCE

Lower Brule Health Center Indian Health Service 601 Gall St Lower Brule, SD 57548

DESCRIPTION OF SERVICES

Upon the receipt of an IHS task order, the Contractor shall locate, and have available sufficient staffing to provide coverage for one (1) Laboratory Technologist/Technician(s) at LBHC IHS in Lower Brule, SD during periods of permanent staffing absences. The Contractor shall provide a full orientation of this scope of work to the Contract Providers prior to submitting the confirmation service agreement.

The contract resulting from this solicitation shall:

1. Be a non-personal health care services contract under which the Contractor is an independent contractor.

2. Allow the Government to evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of the services rendered.

3. Require the Contractor to indemnify the Government for any liability producing act or omission by the Contractor, its employees and agents occurring during contract performance.

4. Require the Contractor to maintain medical liability insurance, in the coverage amount acceptable to the Contracting Officer, which is not less than the amount normally prevailing within the local community for the medical specialty concerned.

5. Require the Contractor to assume sole and exclusive responsibility for employee federal taxes, social security, unemployment insurance, and workman’s compensation.

6. Require the Contractor to provide daily compensation and travel reimbursements to each Contract Provider as appropriate.

CANDIDATE PRESENTATION. The Contractor shall present candidate(s) to the LBHC Contracting Officer’s Representative (COR) for review by the Laboratory Supervisor within five (5) business days of the task order and will include the following documentation for the Contract Provider:

1. Full name

2. Date of birth

3. Social security number

4. Phone number

5. E-mail address

6. Current curriculum vitae with listing of all work experience, and explanations for any employment gaps

7. Signed Release of information

8. Minimum of three (3) letters of reference (preferably within the past 6 months); must have (1) clinical supervisor and (2) peers from the same discipline

Statement of Work: Medical Laboratory Technologist/Technician Page 3 of 13

In the event the Laboratory Supervisor does not accept the Contract Provider(s), the documentation will be sent to the COR for review/comments and the Contractor will have three (3) business days to present new Contract Provider(s).

Upon acceptance of Contract Providers, a full background investigation shall be sent to the contractor. The Contractor is responsible for ensuring that proposed Contract Provider(s) possess the requisite credentials to allow for performance of all tasks identified. The contractor shall send a fully completed background investigation back within seven (7) days. The entire candidate presentation and paperwork completion shall be accomplished within thirty (30) days.

Once the Contract Provider(s) have been cleared for suitability with a completed eQIP and has been granted privileges, the Contractor shall submit a confirmation service agreement and include the following information:

1. Name and phone number for each Contract Provider

2. Dates of service

3. Confirmation of Contractor’s completion of Contract Provider’s orientation to this scope of work

4. Point of contact and phone number

Prior to assumption of duty on any scheduled work shift, the Contract Provider(s) may be briefed by the service unit Laboratory Supervisor or his/her designee concerning any matter relevant to the Contract Provider’s responsibilities under the terms of this contract. The Contractor shall advise the COR or his/her designee of any problem encountered in connection with meeting the needs of patients treated by the Contract Provider(s).

CONFLICT OF INTEREST. The Contractor shall not employ any person who is an employee of the United States Government if the employment of that person would create a conflict of interest. The Contractor shall not employ any person who is an employee of Health and Human Services (HHS) unless such a person seeks and receives approval in accordance with the Department of HHS.

CONTINUITY OF SERVICES. The Contract Providers’ services are considered vital to the Government and must be continued with minimal interruption. In order to minimize interrupted services, the Contractor shall exercise best efforts and cooperation to provide coverage during periods of permanent staff absences.

In the event the Contractor is unable to fulfill the task order requirements for whatever reason; the government reserves the right to fulfill its need outside of this contract. A written confirmation from the contractor indicating the inability to fulfill the task order is immediately required. The government’s right to fulfill its need outside this contract(s) does not waive its right to the issuance of a cure notice nor does it waive its right to terminate.

TECHNICAL REQUIREMENTS

The Contractor shall possess the following:

1. Ability to provide one (1) Medical Laboratory Technologists/Technician in a timely manner who provide on-site laboratory services to beneficiary patients of all ages that present for care to the

Statement of Work: Medical Laboratory Technologist/Technician Page 4 of 13

LBHC.

2. Ability to assist with completion of background investigation paperwork for each Contract Provider in a timely manner prior to assignment.

3. Ability to provide one (1) Contract Provider(s) who can interact with patients and clinical staff in a customer friendly and culturally sensitive manner.

4. Ability to provide Contract Providers who possess Electronic Health Record experience, if possible.

CONTRACT PROVIDER REQUIREMENTS

COMPUTER SKILLS. Computer efficiency and Electronic Health Record experience is appreciated.

ENGLISH LANGUAGE REQUIREMENT. The Contract Provider(s) shall read, understand, speak and write English fluently, and communicate with sufficient clarity to be understood by LBHC personnel and patients.

HEALTH REQUIREMENTS. The Contract Provider(s) shall not have any work or health restrictions which interfere with the performance of their services. The Contract Provider(s) shall provide proof of current immunizations (Hep B, MMR, Varicella, Tdap, Flu, Covid-19 series) status and a current PPD within the past year.

QUALIFICATIONS. The Contract Provider(s) shall have a degree from a qualified medical laboratory science program, maintain continuing education/certification, and have a current (within 2 years) Basic Life Support (BLS) certification. The Contract Provider(s) must have a minimum of 2 years of experience as a Laboratory Technologist/Technician within the past 36 months, and must meet all credentialing and background investigation requirements (see page 7).

CONTRACT PROVIDER(S) RESPONSIBILITIES

APPEARANCE. Contract Provider(s) are expected to comply with reasonable dress, grooming and hygiene standards based on comfort, productivity, health and type of position occupied as compatible with the expectations of the LBHC IHS and the Native American community. Contract Providers’ attire will be professional and in compliance with the expectations of the LBHC Policy and Procedures, including displaying their identification badge on their outer clothing at all times.

CLINICAL DUTIES. The Contract Provider(s) will prepare specimen for transport, record and report individual testing results, assist with monthly reports, and other departmental paper work as requested. The Contract Provider(s) are expected to perform independently and utilize standard procedural guidelines, technical knowledge and experience to recognize discrepancies in procedure and test results; supervisory guidance and technical assistance is available as needed.

Primary duties will include:

1. Provide high quality and efficient care to patients.

2. Perform venipuncture and capillary punctures on patients.

Statement of Work: Medical Laboratory Technologist/Technician Page 5 of 13

3. Perform basic calculations, use Quality Control Procedures and rechecks questionable results, checks instruments in case of malfunctions as stated in manufacturer’s directives and performs general checking and testing procedures following established departmental procedures.

Chemistry

- Perform chemistry testing on the Abaxis Piccolo Xpress

- Perform patient testing, quality control, and troubleshooting on specimens as needed.

Coagulation

- Complete INR testing using the CoaguChek analyzer.

- Perform quality control and verifies it has been performed before running specimens.

Hematology

- Maintain quality control as applicable in the procedure manual. Has the knowledge to operate testing for complete blood counts (CBC).

- Perform ESR testing.

Microbiology/Molecular

- Obtain, preserve, and handle bacteriological specimens.

- Advise physicians, midlevel providers, nurses, assistants, and patients in this to assure maximum recovery of bacteria to ensure appropriate diagnosis.

- Prepare specimens (wound cultures, urines, viral cultures) for transport.

- Ensure cultures are prepared for shipment to reference laboratory.

- Read wet mount preparations under microscope.

- Perform patient testing and quality control using the Abbott ID Now analyzers.

Serology

- Perform Rapid Respiratory Syncytial Virus (RSV) testing.

- Perform qualitative screening tests such as the pregnancy test, urine Human Chorionic

Gonadotropin (hCG).

Urinalysis

- Instruct patients in proper collection, handling and preservation of urine specimens.

- Perform routine analysis on the Clinitek Status+ Urinalysis analyzer, examine sediment microscopically and reports findings.

- Operate microscope and centrifuges.

4. Participate in Patient Centered Medical Home (PCMH) model and encourage patient engagement.

5. Educate individuals on laboratory tests.

6. Utilize EHR computer software/program.

7. Document complete and timely consultations in the patient’s health care record.

8. Establish interpersonal, intra-departmental relationships, and social sensitivity such that he/she can relate constructively to patients from Native American communities to enhance optimal patient care.

9. Exhibit professional conduct among staff and patients, and respect and maintain the basic rights of patients, to include but not be limited to, personal dignity, cultural sensitivity, privacy, and confidentiality. Violations of these policies may lead to the immediate removal of the Contract Provider from this contract and the facility.

10. Maintain familiarity and comply with Federal, State, Indian Health Service, accreditation standards, Centers for Medicare & Medicaid Service (CMS) regulations, Accreditation Association for Ambulatory Health Care (AAAHC) regulations, Clinical Laboratory Improvement Amendments

Statement of Work: Medical Laboratory Technologist/Technician Page 6 of 13

(CLIA), the Commission on Office Laboratory Accreditation (COLA), and departmental regulation and requirements.

11. Staff development/education as assigned by the Laboratory Supervisor.

12. Peer reviews/competencies as assigned.

13. Must be able to work independently and may also be required to work as the sole

Technologist/Technician on certain occasions when the permanent staff is attending meetings, completing administration assignments, or on leave.

COMMUNICATIONS. Contract Provider(s) shall maintain open and professional communication with members of the Laboratory Staff and the OPD. Complaints validated by the Performance Improvement Coordinator and Laboratory Supervisor shall be reported in writing to the COR and the Contractor for action.

When the Laboratory Supervisor is absent the Contract Provider(s) shall follow the delegation of authority and perform duties as assigned by the Laboratory Supervisor’s designee.

ORIENTATION. All new Contract Provider(s) will participate in the LBHC facility orientation. The orientation must be completed prior to providing services at the facility, and will be scheduled for the first one (1) to three

(3) days of arriving at the facility.

PRIVACY OF INDIVIDUALLY IDENTIFABLE HEALTH INFORMATION. The Contract Provider(s) shall provide patients with the utmost care and attention. All patients shall be assured of their privacy and personal dignity. The Contract Provider(s) shall ensure strict compliance to the release of Protected Health Information in accordance with the Code of Federal Regulation, Title 45, Public Welfare, Subtitle A, Department of Health and Human Services, Part 164, Security and Privacy (45 CFR 164) and AFI 41-210, Patient Administration Functions, Health Insurance Portability and Accountability Act (HIPAA), and General Guidelines on Releasing Medical Information.

RECORDS. The Contractor Provider(s) shall generate and maintain proper medical record information on beneficiaries to whom treatment is provided in accordance with Indian Health Service regulations and policies set forth by the Health Information Management (HIM) Department. Verbal orders are to be used for emergencies only. In the event of a major disaster or code all verbal orders are to be signed off immediately following the code or disaster. The Contract Provider(s) shall prepare all medical record documentation to meet or exceed the established standards of the IHS facility including, but not be limited to, timeliness, accuracy, content, and signature.

All deadlines as determined by the facility shall be met including:

1. All chart documentation completed within 72 hours.

2. Notifications received in the Electronic Health Record (EHR) shall be completed within one (1) day.

3. Any deficiencies (documentation that is found incomplete by the HIM department) completed within one (1) day after notification.

All medical record information generated in the performance of this contract will remain the property of and subject to the exclusive control of the Indian Health Service.

QUALITY IMPROVEMENT. All Contract Provider(s) shall be required to participate in a quality improvement program, which is consistent with current accreditation standards and Medicaid Services (CMS) Conditions

Statement of Work: Medical Laboratory Technologist/Technician Page 7 of 13 of Participation (CoP) requirements and CLIA for ongoing monitoring and evaluation of the quality and appropriateness of care.

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(s) are 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 investigation has been completed and the Contracting Officer notified of the results, the Contract Provider must not have unsupervised contact 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. Contract Providers receiving unfavorable background investigations 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 the LBHC.

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.

SCHEDULING

TIMESHEETS. The Contract Provider(s) will be responsible to report to work at the scheduled time and utilize the timecard process. All submitted timesheets will be verified with the invoices before payment is processed. Only hours authorized by the Laboratory Supervisor or designee will be authorized for payment.

WORK SCHEDULE: Work shifts will normally be eight (8) hours in length and will be worked between the hours of 8:00am and 4:30pm with a one-half hour lunch break. The Contract Provider(s) will provide care Monday through Friday, excluding federal holidays. The typical work week will be 40 hours per week. The Contract Provider(s) will not work on federal holidays, overtime, or compensation time. Hourly fixed rate shall be inclusive of all the following rates: all city, state, federal and local taxes and all associated rates with the provision of services and overtime must be priced out separately. The Government will pay one flat rate.

Contractor shall be paid only for actual time services are performed under the terms of the contract at the hourly fixed rate (one flat rate). The Contract Provider(s) shall arrive for each scheduled shift in a well-rested condition before the scheduled start of his/her shift.

Statement of Work: Medical Laboratory Technologist/Technician Page 8 of 13

EVALUATION AND PERFORMANCE REQUIREMENTS

The Contractor shall allow the Government to evaluate the quality of professional and administrative services provided with the technical requirements of this contract. This assessment will include observations of the work system, methods and execution. Examples of monitoring methods include, but are not limited to:

appropriateness of candidate placement (e.g. number or removals, number of early termination of assignments due to personality conflict, poor work habits, inadequate skills for the assignment, unprofessional or discourteous behavior). An assessment spreadsheet with these methods will be monitored by the Laboratory Supervisor and the Contracting Officers’ Representative (COR). The Contract Provider’s performance will be monitored through peer review/competency, identifying deficiencies in the quality of services performed before the level of performance becomes unacceptable. These evaluations may be used as a record of contract performance history for the purpose of evaluation in other competitive or non-competitive acquisitions.

It shall be understood that eligible patients, under treatment, will be rendered services that provide the best medical care within the Contract Provider’s professional training and experience. All services rendered shall be in accordance with current standard medical practices to assure quality care. The Contractor must perform at a level that is satisfactory and in accordance to all applicable laws, policies, rules, regulations, and within the Statement of Work.

NEGLIGENT BEHAVIOR. Any negligent behavior or any behavior jeopardizing patient safety will not be tolerated. Professional Review Action may be taken if activity, demeanor or conduct of the member is detrimental to patient care, disruptive to the service unit operation, or in violation of IHS policy or is unethical.

Each incident will be evaluated and documented, and the Laboratory Supervisor will notify the COR, and provide copies of pertinent documentation as soon as possible when the necessity to exercise such authority becomes apparent. These incidents may be grounds for immediate removal.

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

Surveillance will be accomplished through review of the Contractor’s performance against requirements listed in the work statement and performance standards listed in this plan. Performance-based incentives are consistent with the intent and purpose of the contract.

Upon completion of the contract, the Government will complete and keep on record the Contractor’s performance evaluation form based on the following objectives.

OBJECTIVE/

TASK

PERFORMANCE

STANDARD

ACCEPTABL

E QUALITY

LEVEL (AQL)

SURVEILLANCE

METHOD/

MEASURES

CONTRACTOR

INCENTIVE

DISINCENTIVE/

DEDUCT

Statement of Work: Medical Laboratory Technologist/Technician Page 9 of 13

PERFORMANCE

OBJECTIVE 1

The Contractor shall establish a technical approach and management plan for the placement of Laboratory Technologists/ Technicians into temporary assignments at LBHC providing coverage when requested

Once a task order/request is received: Contractor shall locate a Laboratory Technologist/Technician and complete all paperwork within established time frames

Present candidate within five (5) days of task order and if found unacceptable locate a replacement within three (3) days.

Complete IHS background investigation information and return to LBHC within 7 days.

Placement of staff 100% of the time

Laboratory Supervisor shall submit monthly spreadsheet of placement dates to the COR to monitor the placement requirement of coverage when requested

Favorable Contractor performance evaluation

Unfavorable Contractor performance evaluation

OBJECTIVE 2

All Contract Provider(s) shall perform in accordance with clinical standards

Care provided is within clinical standards of care

100%

Laboratory competencies will be completed for all procedures

Unfavorable performance evaluation, removal from contract until such time the Contract Provider(s) meet qualification standards

OBJECTIVE 3

Contract Provider(s) are capable and knowledgeable of effective communication

Contract Providers shall be respectful, courteous, and culturally sensitive to IHS patients and staff

No more than two (2) valid complaints per Contract Provider

The Contractor shall respond to the COR in writing whenever they receive notice of more than two complaints against a Contract Provider with an explanation of what was done to address the matter

The invoice will be put on hold until the complaint is investigated and resolved in 7 working days, removal from contract until such time the Contract Provider(s) meet qualification standards

OBJECTIVE 4

Contract Provider(s) shall complete all required trainings on time

All required training is completed on time

95% completion, no deviations

Periodic sampling

Unfavorable contract performance evaluation, suspension or termination of all physical and/or electronic access privileges and removal from contract until training is

Statement of Work: Medical Laboratory Technologist/Technician Page 10 of 13

SECURITY

PHYSICAL ACCESS. The Contract Provider(s) shall return identification badges to the Laboratory Supervisor upon completion/termination of the contract.

PHYSICAL SECURITY. The Contractor Provider(s) shall safeguard all government property, including controlled forms provided for use. All PHI shall be secured at all times and not left unattended in unsecure areas. At the close of each work period, government equipment, facilities, and other valuable materials shall be secured, and all PHI shall be returned to the HIM department.

REPORTING REQUIREMENTS. The Contract Provider(s) shall report to an appropriate authority any information or circumstances of which they are aware that may pose a threat to the security of IHS personnel, personnel or patients.

WEAPONS, FIREARMS, AND AMMUNITION. The Contract Provider(s) are prohibited from possessing weapons, firearms, or ammunition, on themselves or within their contractor-owned vehicle or privately-owned vehicle while on the LBHC grounds.

GOVERNMENT FURNISHED PROPERTY AND SERVICES

The LBHC shall provide office space including a desk, chair, computer, printer, and office supplies. The Contract Provider(s) will be authorized to use all areas of the facility available to civil service and commissioned personnel in similar positions. The same restrictions apply to Contract Provider(s) as any other IHS personnel to use these areas for official business activities only.

The Contract Provider(s) will be authorized to use all administrative and professional support available to IHS personnel. This will include, but not be limited to, copy machines, telefax machines, and telephone service.

The same restrictions to use these items for official Indian Health Service business apply.

completed

PERFORMANCE

OBJECTIVE 6

Contract Provider(s) is aware of all laws, regulations and policies related to Privacy, Confidentiality and HIPAA, and complies with all standards of privacy

All Contract Provider(s) comply with all laws, regulations and policies relating to Privacy, Confidentiality and HIPAA.

100% compliance, no deviation

Contract Provider shall provide copies of all required trainings to the Laboratory Supervisor, HIM will report any violation to the Laboratory Supervisor for review

Immediate removal of Contract Provider(s) from contract

Statement of Work: Medical Laboratory Technologist/Technician Page 11 of 13

The LBHC shall provide all medical and non-medical equipment and supplies used in the IHS facility for the care and management of patients.

CONTRACTOR FURNISHED ITEMS AND SERVICES

Except for those items or services specifically stated to be Government furnished, the Contractor shall furnish everything required to perform this contract in accordance with all of its terms. The LBHC does not anticipate a need for Contractor furnished equipment.

HOUSING. The Contractor shall be responsible for all applicable Federal, State, and Local Taxes, Meals, Travel/Transportation, lodging, and per diem. No housing is provided on the LBHC grounds.

COMMUNICATION BETWEEN ALL PARTIES

POINT OF CONTACT. The Contractor shall provide a point of contact who shall be responsible for the performance of the work. The point of contact shall have full authority to act for the Contractor on all matters relating to the daily operation of this contract. The Contractor shall designate this individual, in writing, to the Contracting Officer before the contract start date. An alternate may be designated, but the Contractor shall identify those times when the alternate shall be the primary point of contact.

Any communication regarding the contract shall be communicated between the Contractor’s designated point of contact and the Contracting Officer’s Representative (COR) at LBHC.

CONTRACTING OFFICER’S REPRSENTATIVE DESIGNATION

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

The COR is responsible for:

1. Monitoring the Contractor's technical progress including surveillance, assessment, and performance and recommending to the Contracting Officer changes in requirements,

2. Interpreting the Statement of Work,

3. Performing technical evaluation as required,

4. Performing technical inspection and acceptance required by this contract,

5. Assisting the Contractor in the resolution of technical problems encountered during performance, and

6. Serving as systems manager to ensure compliance with the Privacy Act.

Statement of Work: Medical Laboratory Technologist/Technician Page 12 of 13

The designated COR for this contract is:

Michelle Chmela, MLS Laboratory Supervisor, Acting Quality Manager, COR 601 Gall St Lower Brule, SD 57548 Direct Phone: (605) 473-8172 Michelle.chmela@ihs.gov

Issuance of changes which affect the articles, terms, or conditions of this contract will be accomplished through the Contracting Officer who is the only party authorized to bind the Government to the contract.

Statement of Work: Medical Laboratory Technologist/Technician Page 13 of 13

COMPENSATION

The Contractor shall be responsible for all inclusive costs, and there will be no differential pay for government holidays, overtime, compensation time and night differential. “All inclusive” is defined to include travel, lodging, per diem, fringe benefits, Federal/State/Local taxes, plus any other costs pertinent to the performance of this contract, including overtime and holiday pay.

PAYMENT PROCESS

The Contractor shall submit a bi-weekly invoice of services rendered for each Contract Provider(s), that is mutually agreed upon by the Contractor and the COR or his/her designated representative, to the following address.

Great Plains Area Indian Health Service ATTN: Finance Department Room 309 Federal Building 115 4th Avenue S.E.

Aberdeen, SD 57401

With a copy of the invoice to:

Lower Brule Health Center - Indian Health Service ATTN: Property & Supply P.O. Box 248 601 Gall St Lower Brule, SD 57548

The following information MUST be included on each invoice submittal for the Finance Department to process payment:

1. Contractor/Vendor Name

2. Mailing Address

3. Telephone Number

4. Tax Identification Number (TIN)

5. Invoice Date and Number

6. Purchase Order Number and Task Order (in Block #3 of the OF-347 form)

7. Unique Entity Identifier Number (UEI)

8. Description of services provided, quantity, unit of issue, unit price, and total amount due

To:

Subject:

New Hire and Supervisor of position covered by Public Law 101-630

Provisional Authorization- pending favorably adjudicated background investigation

This serves as not ice to the supervisor and new hire/contractor/volunteer/affiliate that they will be performing work and/or occupying 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. An individual employed/working or being considered for employment (Federal, contractor, volunteer, or affiliate) at the Indian Health Service with duties and responsibilities involving regular contact with or control over Indian children must undergo a background investigation. Prior to the receipt of a favorably adjudicated background investigation, the individual will have provisional status. At all times whenever Indian children are in the care, custody, and/or control of an individual in a provisional status, the individual is required to be under the supervision and in sight of a staff person who has a favorably adjudicated background investigation that includes child care coverage.

The following individual has been granted provisional authorization for the identified position, which has been designated as a position covered by P.L. 101-630:

Name: _________________________________ Position title: ____________________________

The following conditions must be met for the individual:

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

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

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

Supervisor must ensure that new hires/contractors/affiliates who are in a provisional status and have Indian children in their care, custody, and/or control, are within the sight and supervision of a staff person who has a favorably adjudicated background investigation that includes child care coverage.

Supervisors are required to sign indicating your acceptance, responsibility, and compliance with the above criteria, and will ensure that the above named individual is assigned to appropriate personnel whenever Indian children are in their care, custody, and/or control. Failure to comply with the above criteria can result in disciplinary action, up to and including removal.

Department Supervisor/Designee Date

The facility/service unit is required to work with the Area Personnel Security/HR Office designee to maintain a list of staff members who have a favorably adjudicated background investigation with child care coverage on file for supervisors to identify and assign personnel to provide coverage to individuals in a provisional status.

I have verified that I have worked with the facility/service unit to ensure that a list of favorably adjudicated staff members is available for the supervisor’s use.

Personnel Security Representative/HR 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 disciplinary action, up to and including removal/termination.

Employee/Contractor/Affiliate Date

1 / 2018

Indian Health Service Office of Human Resources

Declaration for Federal Employment* (*This form may also be used to assess fitness for federal contract employment)

Form Approved:

OMB No. 3206-0182

U.S. Office of Personnel Management

5 U.S.C. 1302, 3301, 3304, 3328 & 8716

Optional Form 306 Revised October 2019

Previous editions obsolete and unusable

Instructions The information collected on this form is used to determine your acceptability for Federal and Federal contract employment and your enrollment status in the Government's Life Insurance program. You may be asked to complete this form at any time during the hiring process. Follow instructions that the agency provides. If you are selected, before you are appointed you will be asked to update your responses on this form and on other materials submitted during the application process and then to recertify that your answers are true.

All your answers must be truthful and complete. A false statement on any part of this declaration or attached forms or sheets may be grounds for not hiring you, or for firing you after you begin work. Also, you may be punished by a fine or imprisonment (U.S. Code, title 18, section 1001).

Either type your responses on this form or print clearly in dark ink. If you need additional space, attach letter-size sheets (8.5" X 11").

Include your name, Social Security Number, and item number on each sheet. We recommend that you keep a photocopy of your completed form for your records.

Privacy Act Statement The Office of Personnel Management is authorized to request this information under sections 1302, 3301, 3304, 3328, and 8716 of title 5, U. S. Code. Section 1104 of title 5 allows the Office of Personnel Management to delegate personnel management functions to other Federal agencies.