SOL 75H70626Q00214.pdf

SEE ADDENDUMIS CHECKED

CODE 18a. PAYMENT WILL BE MADE BY

CODE

FACILITYCODE

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

OFFEROR

172IHSSISSETON CODE 16. ADMINISTERED BYCODE

X

X

X

621320

SIZE STANDARD:

100.00 % FOR:SET ASIDE:UNRESTRICTED OR172

REQUEST FOR

PROPOSAL

(RFP)

INVITATION

FOR BID (IFB)

10. THIS ACQUISITION ISCODE

REQUEST FOR

QUOTE (RFQ)

14. METHOD OF SOLICITATION

13b. RATING

NORTH AMERICAN INDUSTRY

CLASSIFICATION STANDARD

(NAICS):

SMALL BUSINESS

10/30/2026 1300 CT

09/30/2026

605-268-2022ANDREA WHIPPLE

(No collect calls)

INFORMATION CALL:

FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIMEb. TELEPHONE NUMBER a. NAME

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

75H70626Q00214

5. SOLICITATION NUMBER

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE OF

1 41 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

15. DELIVER TO

Sisseton SD 57262

100 Lake Traverse Drive

Indian Health Service

Health Care Center

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$9

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW

ISSUE DATE

DELIVERY FOR FREE ON BOARD

(FOB) DESTINATION UNLESS

BLOCK IS MARKED

11.

SEE SCHEDULEX

12. DISCOUNT TERMS THIS CONTRACT IS A RATED

ORDER UNDER THE DEFENSE

PRIORITIES AND ALLOCATIONS

SYSTEM - DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

(SDVOSB)

HUBZONE SMALL

BUSINESS

8(A)

Woodrow Wilson Keeble Memorial WOMEN-OWNED SMALL

BUSINESS (WOSB)

ECONOMICALLY DISADVANTAGED

WOMEN-OWNED SMALL

BUSINESS (EDWOSB)

SISSETON SD 57262

100 LAKE TRAVERSE DRIVE

SISSETON

Sisseton SD 57262

100 Lake Traverse Drive

Indian Health Service

Health Care Center

Woodrow Wilson Keeble Memorial

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

100% Indian Small Business Economic Enterprise (ISBEE) Set-Aside.

Firm Fixed-Price, Non-Personal Service, Commercial Item, Purchase Order to provide Optometry Services for the Woodrow Wilson Keeble Memorial Healthcare Center, Sisseton, South Dakota. Period of Performance will be one year from the date of award.

The quoted "unit price" is an all-inclusive cost.

(Use Reverse and/or Attach Additional Sheets as Necessary)

HEREIN, IS ACCEPTED AS TO ITEMS:

DATED

LADONNA L. COLLINS

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

ARE

31c. DATE SIGNED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print)

ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

27a. SOLICITATION INCORPORATES BY REFERENCE (FEDERAL ACQUISITION REGULATION) FAR 52.212-1, 52.212-4. FAR 52.212-3

AND 52.212-5 ARE ATTACHED. ADDENDA

26. TOTAL AWARD AMOUNT (For Government Use Only)

OFFER

STANDARD FORM 1449 (REV. 11/2021)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

30b. NAME AND TITLE OF SIGNER (Type or print)

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

29. AWARD OF CONTRACT: REFERENCE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32c. DATE 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

40. PAID BY39. S/R VOUCHER NUMBER38. S/R ACCOUNT NUMBER

37. CHECK NUMBER

FINALPARTIAL

36. PAYMENT

FINALPARTIAL

35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER33. SHIP NUMBER

COMPLETE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

42d. TOTAL CONTAINERS42c. DATE REC'D (YY/MM/DD)

42b. RECEIVED AT (Location)

42a. RECEIVED BY (Print)

41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

STANDARD FORM 1449 (REV. 11/2021) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

All "inclusive cost" is defined to include travel, lodging, per diem, fringe benefits, federal, state and local taxes plus all other costs pertinent to the performance of this purchase order.

Delivery: 11/30/2027

1 Two (2) Optometrist Physician Services

See the Performance Work Statement

Period of Performance: 12/01/2026 to 11/30/2027

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

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

41 2 of

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 41

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H70626Q00214 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

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110

4 41

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H70626Q00214 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).

Invoice Processing Platform (IPP)

The Indian Health Service (IHS) is 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

"Should the contractor feel that use of the IPP would be unduly burdensome, their response to this solicitation should include an explanation of this position for a determination by the contracting officer".

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

5 41

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H70626Q00214

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

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

Performance Work Statement: Optometrist Page 1 of 15

WOODROW WILSON KEEBLE MEMORIAL HEALTH CARE CENTER

INDIAN HEALTH SERVICE

PERFORMANCE WORK STATEMENT

OPTOMETRIST SERVICES

GENERAL

The Mission of the Sisseton Indian Health Service (IHS)/Woodrow Wilson Keeble Memorial Health Care Center (WWKMHCC) is to provide the best possible healthcare services to the patients on the Lake Traverse Reservation in South Dakota. To meet this mission, the WWKMHCC is requesting a Firm Fixed-Price Non- Personal Service for Optometrists.

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.

WWKMHCC falls under the GPAO and provides medical care to approximately 7,000 tribal members living on the Lake Traverse Reservation. Serving a rural area, many of our patients travel 100 miles round trip to receive care. The Service Unit was built in 2007 to provide an expanded level of outpatient health care services specifically designed to meet the needs of our population. Services include: Behavioral Health, Community Health, Dental, Laboratory, Nutrition Services, Optometry, Pharmacy, Physical Therapy, Public Health Nursing, Purchased & Referred Care Services, and Radiology.

OBJECTIVES

To provide uninterrupted Optometry services to the Optometry Department at WWKMMHCC. The Contractor shall utilize up to two (2) contract optometrists to deliver services that are compatible with the facilities, equipment, and operating capacity of the Indian Health Service (IHS) Medical Service Unit. The scope of care shall be equivalent to that typically provided in a rural civilian practice of similar size.

PERIOD OF PERFORMANCE

Date of Award for one year

Performance Work Statement: Optometrist Page 2 of 15

PLACE OF PERFORMANCE

Woodrow Wilson Keeble Memorial Health Care Center Indian Health Service 100 Lake Traverse Drive Sisseton, SD 57262

DESCRIPTION OF SERVICES

Upon the receipt of an IHS Purchase Order, the Contractor shall locate, credential, and have available sufficient staffing to provide optometrist(s) coverage at the Service Unit during periods of permanent staffing absences. The Contractor(s) shall provide a full orientation of this performance work statement to the Contract Optometrist 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 (e.g., professional judgments, diagnosis for specific medical treatment).

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 Optometrist as appropriate.

CANDIDATE PRESENTATION. The Contractor shall present a candidate to the Service Unit Contracting Officer’s Representative (COR) for review by the Optometry Supervisor within five (5) business days of the Purchase Order. When submitting any Contract Optometrist candidate for presentation, it MUST include the following documentation:

1. Full name

2. Date of birth

3. Phone number

4. E-mail address

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

6. License

7. Basic Life Support (BLS) Certification

8. Signed Release of information

9. Immunization documentation (see CONTRACT OPTOMETRIST REQUIREMENTS – HEALTH

Performance Work Statement: Optometrist Page 3 of 15

REQUIREMENTS)

10. Minimum of three (3) letters of recommendation within the past 6 months; one (1) must be from a supervisor and two (2) from peers from the same discipline

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

Upon acceptance of a Contract Optometrist, a full background investigation shall be sent to the contractor.

The Contractor is responsible for ensuring the proposed Contract Optometrist possess the requisite credentials to allow for performance of all tasks identified. The contractor shall assist the Contract Optometrist in completion of the background requirements and 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 a Contract Optometrist has been cleared for suitability with a completed eApp, the Contractor shall submit a confirmation service agreement and include the following information:

1. Contract Optometrist name and phone number

2. Dates of service

3. Confirmation that the Contractor has completed the Contract Optometrist’s orientation to this performance work statement and the date completed

4. Point of contact and phone number

Prior to assumption of duty on any scheduled work shift, the Contract Optometrist may be briefed by the service unit Optometry Supervisor or his/her designee concerning any matter relevant to the Contract Optometrist’s responsibilities under the terms of this contract.

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 services provided by the Contract Optometrist are deemed essential to the Indian Health Service at Woodrow Wilson Keeble Memorial Health Care Center operations and must be maintained without interruption. To minimize any disruption of services, the Contractor shall use best efforts and cooperate fully to ensure appropriate coverage during periods of permanent staff absence.

In the event the Contractor is unable to fulfill the Purchase 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 Purchase 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

Performance Work Statement: Optometrist Page 4 of 15

The Contractor shall possess the following:

1. Ability to provide qualified Optometrist coverage within a timely manner (see CANDIDATE

PRESENTATION);

2. Ability to assist Contract Optometrists with completion of background investigation paperwork and credentialing in a timely manner to meet the established deadlines (see CANDIDATE PRESENTATION, PRIVILEGING REQUIREMENTS and CHARACTER INVESTIGATION -

CRIMINAL BACKGROUND CHECK REQUIREMENT);

3. Ability to provide clinically competent Contract Optometrists who can interact with patients and clinical staff in a customer friendly and culturally sensitive manner.

4. Ability to provide Contract Optometrists who possess Electronic Health Record (EHR) experience.

CONTRACT OPTOMETRIST REQUIREMENTS

COMPUTER SKILLS. Computer efficiency is required with documentation completed using the Computerized EHR.

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

HEALTH REQUIREMENTS. The Contract Optometrists shall not have any work or health restrictions which interfere with the performance of their services. The Contract Optometrists shall provide proof of current immunizations status, including Hep B, MMR, Varicella, Tdap, Influenza, COVID, current PPD within the past year, and if positive, a chest x-ray confirming no active disease and review of symptoms. The list of immunizations must be submitted and reviewed by the Infection Preventionist/Employee Health Nurse prior to working.

QUALIFICATIONS. Contract Optometrist shall

1. Have a Doctor of Optometry degree from an educational program that is accredited by the Accreditation Council on Optometric Education (ACOE) at the time the degree was obtained;

2. Possess a current, active, unrestricted license to practice optometry from any of the 50 Unites States, the Commonwealth of Puerto Rico, the District of Columbia or a territory of the United States;

3. Maintain continuing education/certification, and have a current Basic Life Support (BLS) certification;

4. Have a one-year completion of a residency program in an institution accredited for such training; or one year of professional experience as an optometrist in the last 24 months;

5. Must meet all credentialing and background investigation requirements (see PRIVILEGING

REQUIREMENTS and CHARACTER INVESTIGATION).

CONTRACT OPTOMETRIST RESPONSIBILITIES

APPEARANCE. Contract Optometrists 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 IHS and the Native American community. Contract Optometrists attire will be professional

Performance Work Statement: Optometrist Page 5 of 15 and in compliance with the expectations of IHS Policy and Procedures, including displaying their identification badge on their outer clothing at all times.

CLINICAL DUTIES. The Contract Optometrists primary duties will be providing optometric care to beneficiary patients of all ages that present for care in accordance with his/her credentialed privileges within the Medical Staff Bylaws of the WWKMHCC. Due to the volume of patients, the Contract Optometrists must be able to provide high quality, effective and efficient care to patients, seeing an average of 12-16 patients per day.

Primary duties will include:

1. Provide examination, diagnosis, prognosis, treatment plan, follow-up and consultation in accordance with clinical privileges. The services shall include specialty emergency care, consultative, diagnostic, and routine care;

2. Refer individuals for consultation when appropriate, prescribe and carry out or direct others in carrying out appropriate therapy in conformance with approved clinical privileges;

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

4. Educate individuals in the nature of optometry related conditions, recommended therapy and in the general promotion of health and prevention of disease related to optometry care;

5. Utilize EHR computer software/program for entering and signing of medical orders;

6. Document complete and timely consultations in the patient’s health care record according to facility standards;

7. 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.

8. 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 Optometrist from this contract and the Service Unit;

9. Maintain familiarity and comply with Federal, State, Indian Health Service, accreditation standards, Centers for Medicare & Medicaid Service (CMS) regulations, and departmental regulation and requirements;

10. Staff development/education as assigned by the Clinical Director.

11. Work independently.

COMMUNICATIONS. Contract Optometrists shall maintain open and professional communication with members of the Optometry Staff and other clinical departments. Complaints validated by the Optometry Supervisor or his/her designee shall be reported in writing to the COR to communicate with the Contractor.

When the Optometry Supervisor is absent, the Contract Optometrist shall follow the delegation of authority and perform duties as assigned by the Optometry Supervisor’s designee.

ORIENTATION. All new Contract Optometrists shall be provided with an orientation to the Service Unit prior to the performing his/her assignments. Alternate resource enrollment applications with the Business Office must be completed within two (2) days of onboarding.

PRESCRIPTIONS. The Contract Optometrist shall receive pharmacy specific orientation and follow Indian

Performance Work Statement: Optometrist Page 6 of 15

Health Service procedures when prescribing medications. Contract Optometrists authorized to prescribe pharmaceuticals shall do so according to the availability of drugs listed in the IHS formulary. The formulary list is approved and maintained by the WWKMHCC Pharmacy and Therapeutics Committee. A completed provider note is required before pharmacy can process medication orders in EHR as an IHS Standard of Care.

PRIVACY OF INDIVIDUALLY IDENTIFABLE HEALTH INFORMATION. The Contract Optometrist shall provide patients with the utmost care and attention. All patients shall be assured of their privacy and personal dignity. The Contract Optometrist 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.

PROCEDURE GUIDANCE. Contract Optometrists shall perform procedures compatible with the medical facility’s operating capacity and equipment. New medical procedures/services shall not be introduced without prior recommendation to, and approval from the Clinical Director or authorized representative.

RECORDS. The Contract Optometrist 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. The Contract Optometrist shall prepare all medical record documentation to meet or exceed the established standards of the IHS Service Unit including, but not be limited to, timeliness, accuracy, content, and signature.

All deadlines as determined by the Service Unit shall be met including:

1. All chart documentation shall be completed within 72 hours;

2. Notifications received in the 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 IHS.

REFERRALS AND CONSULTS. The provider shall follow IHS Purchased & Referred Care regulations and policies when arranging for a referral or consult. The Contract Optometrist shall be required to consult with other specialty practitioners for consultative opinions and continuation of care. The Contract Optometrist is responsible for continuing any services/treatment as recommended by the consultant and shall communicate any patient care issues with the specialist as needed.

QUALITY IMPROVEMENT. The standards of medical practice and duties of the Contract Optometrist shall be determined pursuant to the bylaws of the WWKMHCC, 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 accrediting standards. All Contract Optometrists shall be required to participate in a quality improvement program, which is consistent with current accreditation standards and Medicaid Services (CMS) Conditions of Participation (CoP) requirements for ongoing monitoring and evaluation of the quality and appropriateness of care.

Performance Work Statement: Optometrist Page 7 of 15

PRIVILEGING REQUIREMENTS

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 and the GPA in accordance with IHS policy. Any failure to comply with IHS privileging requirements shall be considered to be nonperformance of this contract.

In accordance with the Indian Health Service credentialing policy, a primary source verification shall be completed for all Contract Optometrists performing services under this contract. The WWKMHCC will provide the credentialing packet and all associated documents to the Contractor and the Contract Optometrist shall complete and return all documents within seven (7) business days of accepting the candidate. Re-appointment shall occur no less than every two years, in accordance with WWKMHCC Medical Bylaws.

When submitting a potential candidate, the following documents are required for credentialing:

1. Medical Staff Application (provide explanations to any “yes” questions on liability, final judgments, settlements, or claims from the application); Must have evidence of good standing at all facilities where the Contract Provider practices; Must not have been subject to involuntary limitation, reduction, denial or loss of clinical privileges, and have no current federal sanctions and provide a history of previous or pending malpractice lawsuits

2. Copies of pre-professional and professional school diplomas showing proof of graduation from an accredited school of their profession; must be in good standing with National Practitioner’s Data Bank and the Health Integrity Protection Data Bank

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

4. Copy of Board Certification certificate or letter

5. Copies of all current licenses (active and inactive); Must maintain a current active and unrestricted license in at least one of the 50 United States or US territories

6. Copy of current DEA certificate

7. Copy of current liability insurance

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

9. Signed Medicare Agreement form

10. Three (3) letters of reference within the past year (one reference must be from the same discipline peer and one reference must be from the current or most recent medical supervisor)

11. Copy of a government issued photo identification card (Driver’s license or passport)

12. Copy of Social Security card

13. Signed Confidentiality Statement

14. Signed Child Care and Indian Child Care Worker Positions Agreement

15. Current Continuing Medical Education (CME) for the past two (2) years

16. Copies of Basic Life Support (BLS) and if applicable, Acute Cardiac Life Support (ACLS) certification

17. Copy of National Provider Identification (NPI) notification letter

18. Signed Provider Signature Card

19. A current copy of the proposed contract provider’s professional curriculum vitae (submitted with initial candidate presentation)

Exceptions to the Indian Health Service credentialing review and clinical privileges process will not be

Performance Work Statement: Optometrist Page 8 of 15 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.

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 shall 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 Optometrist 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 Optometrist provided by the Contractor. Until the character investigation has been completed and the Contracting Officer notified of the results, the Contract Optometrist 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 Optometrists receiving unfavorable background investigations shall not be employed. If at any time the Contract Optometrist fails to meet or maintain suitability or eligibility for Federal employment, the Contract Optometrist will be removed from providing services.

The Contractor is responsible for completion of all 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

ADMINISTRATIVE TIME. On the last scheduled working day, the Contract Optometrist shall receive administrative time to ensure that all documentation is completed before departing and shall check out with the Health Information Management (HIM) department to confirm completion of all records.

PATIENT SCHEDULING. Facility personnel will assist with patient scheduling. Patient appointments will typically be scheduled for thirty (30) minutes in length except for those appointments requiring additional time as determined by the facility.

Performance Work Statement: Optometrist Page 9 of 15

TIMESHEETS. Optometrists will be responsible for reporting to work at the scheduled time. All submitted timesheets will be verified with the invoices before payment is processed. Only hours authorized by the Optometry Supervisor or designee will be authorized for payment.

HOURS OF OPERATION: The contractor is responsible for providing personnel for normal clinic hours and shifts, between the hours of 8:00 a.m. – 4:30 p.m. Monday thru Friday except Federal holidays or when the Government facility is closed due to local or national emergencies, administrative closings, or similar Government directed facility closings. The Contractor must maintain an adequate workforce for the uninterrupted performance of all tasks as requested defined within this PWS when the Government facility is not closed for the above reasons. When hiring personnel, the Contractor shall keep in mind that the stability and continuity of the workforce are essential.

RECOGNIZED HOLIDAYS: The Contract Staff will not work these Federal Holidays.

New Year’s Day Martin Luther King’s Birthday President’s Day Memorial Day June 19th Independence Day

Labor Day Columbus Day Veteran’s Day Thanksgiving Day Christmas Day

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 terminations 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 Optometry Supervisor and the COR. The Contract Optometrist’s performance will be monitored through peer review, Focused Professional Practice Evaluations (FPPE) and On-going Professional Practice Evaluations (OPPE) as required in the WWKMHCC by-laws, 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.

All services rendered shall be in accordance within the Contract Optometrist’s professional training and experience, and with current standard medical practices to assure quality care. The Contract Optometrist must perform at a level that is satisfactory and in accordance to all applicable laws, policies, rules, regulations, and within the Performance Work Statement.

NEGLIGENT BEHAVIOR/TERMINATION OF PRIVILEGES. 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 Contract Optometrist is detrimental to patient care, disruptive to the service unit

Performance Work Statement: Optometrist Page 10 of 15 operation, in violation of IHS policy, or is unethical. Each incident will be evaluated and documented, and the Optometry Supervisor will notify the COR, and provide copies of pertinent documentation as soon as possible when the necessity to exercise such authority becomes apparent. 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 the IHS or the WWKMHCC. 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 performance 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

ACCEPTABLE

QUALITY

LEVEL (AQL)

SURVEILLANCE

METHOD/

MEASURES

CONTRACTOR

INCENTIVE

DISINCENTIVE/

DEDUCT

PERFORMANCE

OBJECTIVE 1

The Contractor shall establish a technical approach and management plan for the placement of Optometrists

Once a Purchase Order/request is received:

Contractor shall locate an Optometrist and complete all paperwork within established time frames

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

Complete IHS background investigation information and return to the Service Unit within seven (7) days.

Placement of staff within designated 95% of the time

Optometry Supervisor shall submit quarterly spreadsheet of placement dates to the

COR

Favorable Contractor performance evaluation

Unfavorable

OBJECTIVE 2

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

Care provided is within clinical standards of care

≥ 80% found on peer reviews and acceptable

FPPE/OPPE

Optometry peer reviews and FPPE/OPPE will be completed in accordance with Medical Staff by-laws performance evaluation, removal from contract until such time the Contract Optometrists meet qualification standards

Performance Work Statement: Optometrist Page 11 of 15

SECURITY

PHYSICAL ACCESS. The Contract Optometrists shall return identification badges to the Optometry Supervisor upon completion/termination of the contract.

PHYSICAL SECURITY. The Contractor Optometrists 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.

OBJECTIVE 3

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

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

No more than two (2) valid complaints per Contract Optometrist annually

The Contractor shall respond to the COR in writing whenever they receive notice of a valid complaint against a Contract Optometrist 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 seven

(7) working days, removal from contract until such time the Contract Optometrist(s) meet qualification standards

OBJECTIVE 4

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

All required training is completed on time

95% completion within established deadline

Optometry Supervisor shall submit quarterly spreadsheet of training completion to the COR contract performance evaluation, suspension or termination of all physical and/or electronic access privileges and removal from contract until training is completed

OBJECTIVE 6

Contract Optometrist is aware of all laws, regulations and policies related to Privacy, Confidentiality and HIPAA, and complies with all standards of privacy

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

95% compliance

Contract Optometrist shall provide copies of all required trainings to the Optometry Supervisor, HIM will report any HIPAA violation to the Optometry Supervisor for review (this includes any reported violations of safeguarding his/her Personal Identity Verification (PIV) card)

Immediate removal of Contract Optometrist from contract

Performance Work Statement: Optometrist Page 12 of 15

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

WEAPONS, FIREARMS, AND AMMUNITION. Contract Optometrists are prohibited from possessing weapons, firearms, or ammunition, on themselves or within their contractor-owned vehicle or privately-owned vehicle while on the Service Unit grounds.

GOVERNMENT FURNISHED PROPERTY AND SERVICES

The Service Unit shall provide workspace including a desk, computer, printer, and office supplies. The Contract Optometrist will be authorized to use all areas of the Service Unit available to civil service and commissioned personnel in similar positions. The same restrictions apply to Contract Optometrists as any other IHS personnel to use these areas for official business activities only.

The Contract Optometrist 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.

The Service Unit shall provide all medical and non-medical equipment and supplies used in 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 Service Unit 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.

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 COR at the Service Unit.

Performance Work Statement: Optometrist Page 13 of 15

CONTRACTING OFFICER AND CONTRACTING OFFICER REPRESENTATIVE (COR) AUTHORITY

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.

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.

The COR is responsible for monitoring all technical aspects of the contract and assists in contract administration.

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

2. Interpreting the Performance Work Statement;

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;

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

The designated COR for this contract is:

Ella Greybuffalo

ASA- COR III

100 Lake Traverse Drive Sisseton, SD 57262 Direct Phone: (605) 742-3824 ella.greybuffalo@ihs.gov

COMPENSATION

There is no differential pay for government holidays, nights, weekends, compensation time, or overtime will be approved.

PAYMENT PROCESS

The contractor shall submit a weekly invoice for services rendered for each contract provider(s), that is mutually agreed upon by the contractor and the COR.

Invoice submission and payment: 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 mailto:ella.greybuffalo@ihs.gov

Performance Work Statement: Optometrist Page 14 of 15

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 to 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.

The Contractor shall submit a signed and approved invoice to request payment 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:

WWKMHCC - Indian Health Service ATTN: Property & Supply 100 Lake Traverse Drive Sisseton, SD 57262

The Contractor shall include the following information on each invoice in accordance with the Prompt Payment Act (5 CFR Part 1315.9(b)):

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 Purchase Order (in Block #3 of the OF-347 form)

7. Data Universal Number (DUNS)

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

1. Authority

1.1. No person other than the Contracting Officer has authority to bind the Government with respect to this contract.

https://www.ipp.gov/ mailto:IPPCustomerSupport@fiscal.treasury.gov

Performance Work Statement: Optometrist Page 15 of 15

1.2. No action or omission of any government employee or representative other than the Contracting Officer shall increase or decrease the scope of this contract or shall otherwise modify the terms and conditions of this contract.

1.3. In no event shall any of the following be effective or binding on the Government or imputed to the

Contracting Officer with respect to this contract:

1.3.1. An understanding or agreement between the Contractor and anyone other than the Contracting Officer;

1.3.2. A purported modification or change order issued by anyone other than the Contracting Officer;

1.3.3. A promise by anyone other than the Contracting Officer to provide additional funding or make payments; or

1.3.4. An order, direction, consent, or permission from anyone other than the Contracting Officer to:

1.3.4.1. Incur costs in excess of a specified estimated cost, allotment of funds, or other ceiling; or

1.3.4.2. Expend hours in excess of a specified level of effort.

1.4. Funding Notification Threshold (75%)

1.4.1. The Contractor shall notify the Contracting Officer in writing whenever cumulative funding obligated, invoiced, or expended under this contract and/or any task order reaches or is expected to exceed seventy-five percent (75%) of the total funding obligated for the contract or applicable task order. The notice shall include the Contractor’s best estimate of the additional funding required to continue performance through completion (or through the end of the period of performance, as applicable) and shall identify the basis for the estimate. Such notice shall be provided no later than two (2) calendar days after the Contractor becomes aware of the condition.

1.4.2. No Authorization Implied: This notice does not authorize an increase in funding or any additional work.