Sol 75H70720R00014 - Acoma Canoncito Laguna Service Unit Registered Nurse (RN) Non Personal Healthcare Services.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

Albuquerque NM 87110 4101 Indian School Rd NE, Suite 225 Albuquerque Indian Health Service

IHSACOMA CODE 16. ADMINISTERED BYCODE

X

X

X

621399

SIZE STANDARD:

100.00 % FOR:SET ASIDE:UNRESTRICTED OR203

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

04/13/2020 1200 MD

03/16/2020

505-256-6752ERIC WRIGHT

(No collect calls)

INFORMATION CALL:

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

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

75H70720R00014

5. SOLICITATION NUMBER

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

1 54 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

Acoma New Mexico 87034 80B Veterans Blvd Nursing Department Acoma Canoncito Laguna Service Unit

15. DELIVER TO

Albuquerque NM 87110 4101 Indian School Rd NE, Suite 225

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$8.00

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

ISSUE DATE

DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULE

12. DISCOUNT TERMS

THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

Albuquerque Indian Health Service

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

Solicitation #75H70720R00014 is issued to provide Registered Nurse (RN) Non Personal Healthcare Services at the Albuquerque Area Indian Health Service - Acoma Canoncito Laguna Service Unit.

The Government contemplates to award multiple Indefinite Delivery/Indefinite Quantity (IDIQ) Contracts resulting from this solicitation.

This solicitation is set-aside for Small Business Indian Firms (SBIF) pursuant to the Buy Indian Act 25 U.S.C. 47. If IHS does not receive at least two offers that are reasonably priced

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

HEREIN, IS ACCEPTED AS TO ITEMS:

X

XX

DATED

CLARISA N. GALLEGOS

. 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 FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

OFFER

STANDARD FORM 1449 (REV. 2/2012)

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:

REF.

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. 2/2012) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

offers from SBIF's, IHS will then evaluate quotes and consider award to other small business concerns under the following 5-tier cascading set-aside (in order of first consideration to last consideration):

1st Tier: Small Business Indian Firms

2nd Tier: Service Disabled Veteran Owned Small

Businesses

3rd Tier: Certified HubZone Small Businesses

4th Tier: Small Disadvantage Businesses

5th Tier: All other Small Business Concerns

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

54 2 of

75H70720R00014 – Acoma Canoncito Laguna Service Unit Registered Nurse (RN) Non Personal Healthcare Services

Page# 3 of 54

SECTION 1 - SUPPLIES OR SERVICES AND PRICES/COSTS

1.1 SERVICES

1.1.1 The Indian Health Service (IHS)/Albuquerque Area Office, Acoma-Canoncito-Laguna (ACL) Service Unit has a requirement for ten (10) nurses located in Acoma, New Mexico.

1.1.2 The Government contemplates to award multiple Indefinite Delivery/Indefinite Quantity (IDIQ) Contracts resulting from this solicitation.

1.2 PRICE OR COST

This solicitation will result in multiple Firm-Fixed-Price (FFP) IDIQ Contract with Task Orders being issued with the quantities shown in the Schedule of Charges. They are "estimated" quantities, and are not representative of actual ordering quantities, and serve as a means of arriving at price reasonableness for award purposes. Utilization of the "Requirements" contract has been determined to be appropriate for ten (10) Registered Nurses (RNs) Non-Personal Health Care Services as the government anticipates recurring requirements but cannot pre-determine the precise quantities that will be ordered during the contract period. Pricing proposals should be determined based on the estimated shifts - 8-hour and 12-hour shifts.

1.3 GENERAL CONTRACT INFORMATION

1.3.1 This is a non-personal health care service contract, as defined in Federal Acquisition Regulation (FAR) 37.401, under which the contractor is an independent contractor. The Government may evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of services rendered (e.g., professional judgments, diagnosis for specific medical treatment). The contractor indemnifies the Government for any liability producing act or omission by the contractor, its employees and agents occurring during contract performance. The contract must maintain medical liability insurance. Coverage amount acceptable to the Contracting Officer, which is not less than the amount normally prevailing within the local community for the medical specialty.

The contract is required to ensure that its subcontract for provisions of health care services contain the requirement of the Clause 52.237-7, including the maintenance of medical liability insurance.

1.3.2 As an independent Contractor; billing and collecting for the federal, state and other local city/county taxes is the burden of the Contractor, this includes the New Mexico Gross Receipt Taxes (NMGRT) for services provided in any county of the State of New Mexico.

1.3.3 The Contractor's price/cost for services under this contract should include all applicable taxes for Internal Revenue Service (IRS), State of New Mexico Taxation and Revenue agency and/or other revenue agencies. The Indian Health Service will not withhold taxes nor will it issue a W-2 to the contractor.

1.3.4 FINGERPRINTING REQUIREMENTS FOR SECURITY AND SUITABILITY:

"Prior to start of services specified by the contract scope of work, the Contractor must contact Warren Cheromiah, at Telephone No. (505) 256-6749, AAO, Division of Contracts and Grants, to schedule an appointment to complete the fingerprinting process required by the IHS regulations pertinent to security and character background investigations."

1.4 CONTRACT PRICE

1.4.1 This solicitation will result in an FFP IDIQ Contract.

1.4.2 Upon delivery and acceptance of the item(s) specified in the DELIVERY Article in SECTION F of this contract, the Government shall pay to the Contractor resulting from the awarded contract price.

1.4.3 Upon delivery and acceptance the services described in the Performance Work Statement (PWS) and identified in the schedule of charges below, the Government shall pay to the Contractor the total prices set forth below and will be paid from the following Contract Line Item Numbers (CLINs) accordingly:

SCHEDULE OF CHARGES FOR THE BASE PERIOD

SHIFT HOURS ARE ESTIMATES ONLY

Contract Period Department Shift # of RNs Minimum Maximum Hourly Rate Total

Base Year

Emergency Room

Regular

10400 19976 $_____.___ $_____.___

Over Time 104 208 $_____.___ $_____.___

Holiday 60 2744 $_____.___ $_____.___

Night Differential 1911 3822 $_____.___ $_____.___

Primary Care Regular

1000 2000 $_____.___ $_____.___

Over Time 32 208 $_____.___ $_____.___

Inpatient

Regular

10400 2000 $_____.___ $_____.___

Over Time 104 208 $_____.___ $_____.___

Holiday 32 2288 $_____.___ $_____.___

Night Differential 500 3822 $_____.___ $_____.___

Total Cost for Base Year $_____.___

75H70720R00014 – Acoma Canoncito Laguna Service Unit Registered Nurse (RN) Non Personal Healthcare Services

Page# 4 of 54

Primary Care - 8 Hour Shift (8:00am to 4:30pm) Monday thru Friday (No Federal Holidays to be worked (see Section 9.3))

Inpatient Department - 12 Hour Shifts Monday thru Sunday (Federal Holidays included (see Section 9.3)) **12-hour shift times are 7:00 am to 7:30 pm; 7:00 pm to 7:30 am; and 10:00 am to 10:30 pm; 11:00 a.m. to 11:30 p.m. Scheduler at ACL will schedule shift times based on the needed coverage.

Emergency Room - 12 Hour Shifts Monday thru Sunday, (Federal Holidays included (see Section 9.3)) **12-hour shift times are 7:00 am to 7:30 pm; 7:00 pm to 7:30 am; and 10:00 am to 10:30 pm; 11:00 a.m. to 11:30 p.m. Scheduler at ACL will schedule shift times based on the needed coverage.

1.4.4 The Contractor shall be paid upon submission of an invoice and completion and acceptance (if deliverable) or verification (if service) by the Contracting Officer's Representative (COR), of the deliverables and/or services indicated below. Submit invoices in accordance with the instructions contained in FAR clause 52.232-25, Prompt Payment, and Section G.2 of this contract.

1.5 OPTION PRICES

1.5.1 Unless the Government exercises its option, pursuant to the option clause referenced in the Contract Clauses section, this contract consists only of the Base Period specified in this contract.

1.5.2 Pursuant to either the FAR Clause 52.217-8, Option to Extend Services or the FAR Clause 52.217-9, Option to Extend the Term of the Contract, set forth in Section I, Contract Clauses, of this contract, the Government may, a unilateral contract modification, require the Contractor to perform the Option Period(s) as defined in the PWS of this contract. A notice that the Government intends to exercise any of the options will happen prior to the contract’s expiration date. Specific information regarding the timeframe for this notice is set forth in the OPTION PROVISION of this order. When exercising an option period, the fixed price rate of this contract is set forth below.

1.5.3 Upon the delivery and acceptance of the Option Services described in the Performance Work Statement of the contract and identified in the schedule of charges below, the Government shall pay the Contractor the rate(s) set forth below and will be paid from the following Contract Line Item Numbers (CLINs) accordingly;

1.5.4 If the Government exercises its option pursuant to the OPTION PROVISION of this contract, the Government's total estimated contract amount, represented by the sum of the price of base plus option periods and the period of performance will be as follows:

SCHEDULE OF CHARGES FOR THE OPTION PERIODS

SHIFT HOURS ARE ESTIMATES ONLY

Contract Period Department Shift # of RNs Minimum Maximum Hourly Rate Total

Option Year #1

Emergency Room

Regular

10400 19976 $_____.___ $_____.___

Over Time 104 208 $_____.___ $_____.___

Holiday 60 2744 $_____.___ $_____.___

Night Differential 1911 3822 $_____.___ $_____.___

Primary Care Regular

1000 2000 $_____.___ $_____.___

Over Time 32 208 $_____.___ $_____.___

Inpatient

Regular

10400 2000 $_____.___ $_____.___

Over Time 104 208 $_____.___ $_____.___

Holiday 32 2288 $_____.___ $_____.___

Total Cost for Option Year #1 $_____.___

Contract Period Department Shift # of RNs Minimum Maximum Hourly Rate Total

Option Year #2

Emergency Room

Regular

10400 19976 $_____.___ $_____.___

Over Time 104 208 $_____.___ $_____.___

Holiday 60 2744 $_____.___ $_____.___

Night Differential 1911 3822 $_____.___ $_____.___

Primary Care Regular

1000 2000 $_____.___ $_____.___

Over Time 32 208 $_____.___ $_____.___

Inpatient

Regular

10400 2000 $_____.___ $_____.___

Over Time 104 208 $_____.___ $_____.___

Holiday 32 2288 $_____.___ $_____.___

75H70720R00014 – Acoma Canoncito Laguna Service Unit Registered Nurse (RN) Non Personal Healthcare Services

Page# 5 of 54

Total Cost for Option Year #2 $_____.___

Option Year #3

Emergency Room

Regular

10400 19976 $_____.___ $_____.___

Over Time 104 208 $_____.___ $_____.___

Holiday 60 2744 $_____.___ $_____.___

Night Differential 1911 3822 $_____.___ $_____.___

Primary Care Regular

1000 2000 $_____.___ $_____.___

Over Time 32 208 $_____.___ $_____.___

Inpatient

Regular

10400 2000 $_____.___ $_____.___

Over Time 104 208 $_____.___ $_____.___

Holiday 32 2288 $_____.___ $_____.___

Total Cost for Option Year #3 $_____.___

Option Year #4

Emergency Room

Regular

10400 19976 $_____.___ $_____.___

Over Time 104 208 $_____.___ $_____.___

Holiday 60 2744 $_____.___ $_____.___

Night Differential 1911 3822 $_____.___ $_____.___

Primary Care Regular

1000 2000 $_____.___ $_____.___

Over Time 32 208 $_____.___ $_____.___

Inpatient

Regular

10400 2000 $_____.___ $_____.___

Over Time 105 208 $_____.___ $_____.___

Holiday 32 2288 $_____.___ $_____.___

Night Differential 500 3822 $_____.___ $_____.___

Total Cost for Option Year #4 $_____.___

1.5.5 Note: Unit price shall be an all-inclusive rate of all other fees including travel expenses, per diem, lodging all cities, state, federal, local taxes and miscellaneous cost associated with the above services.

1.5.6 Lunch break of 30 minutes is permitted (as non-paid) under the contract; the contractor cannot invoice time as worked if its’ employee chooses not to take a lunch break. The Contractor also cannot invoice travel times to/from the facility site as time worked.

75H70720R00014 – Acoma Canoncito Laguna Service Unit Registered Nurse (RN) Non Personal Healthcare Services

Page# 6 of 54

SECTION 2 – DEFINITIONS:

2.1 Acceptance: As stated in FAR, subpart 46.5, Constitutes acknowledgement that the supplies or services conform to the applicable contract quality and quantity requirements and subject to other terms and conditions of the contract.

2.2 Approval: Acknowledgment by the designated Government official that submittals, deliverables, or administrative documents

(e.g., insurance certificates, installation schedules, planned utility interruptions, etc.) conform to the contractual requirements.

Government approval does not relieve the Contractor from responsibility for compliance with contract requirements.

2.3 Area: A defined geographical region for Indian Health Service administrative purposes. Each Area Office may administer several Service Units.

2.4 Blanket Purchase Agreement (BPA): is a simplified method of filling anticipated repetitive needs for supplies or services.

2.5 Business Associate (BA): Any company or person that shown to, handles, or works with the data or medical records of the medical entity.

2.6 Business Associate Agreement (BAA): A BAA is a contract between a HIPAA-covered entity and a HIPAA BA. The contract protects personal health information (PHI) in accordance with HIPAA guidelines.

2.7 Code of Ethics: The Revised American Nurses Association Code of Ethics and Standards of Practice and Care, published in

1996 by the American Nurses Association, which makes explicit primary goals, values and obligations of the nursing profession.

2.8 Contract: This is a legal binding document between the Government and the Contractor.

2.9 Contractor: The individual award a legal binding contract to provide supplies and services.

2.10 Contracting Officer (CO): A Government employee with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings.

2.11 Contracting Officer's Representative (COR): A federal employee who assists the CO in the administration of this contract.

The COR is primarily responsible for the technical assistance and day-to-day program management.

2.12 Customer: Patients, staff and visitors of an IHS service unit and health center.

2.13 Customer Evaluation/Input: Written comments made to the COR regarding the Contractors performance. This is one of the criteria used to evaluate the Contractor's performance.

2.14 Federal Acquisition Regulation (FAR): The FAR is the primary regulation for use by all Federal Executive agencies in their acquisition of supplies and services with appropriated funds.

2.15 Health Clinics/Center: A facility physically separated from a hospital, with a full range of ambulatory services including at least primary care providers, nursing, laboratory, and x-ray, which are available at least 40 hours a week for outpatient care.

2.16 Indefinite Delivery/Indefinite Quantity: No set delivery time and no set quantity amount (used for recurring purchases with no set delivery time or quantity).

2.17 Non-Personal Health Care Services: A contract under which the personnel rendering the health care services are not subject, either by the contract's terms or by the manner of its administration, to the supervision and control usually prevailing in relationships between the Government and its employees, as defined in

FAR 37.401

2.18 Ordering Activity: An authorized user of IHS that may issue a task order to obtain required services under this contract.

2.19 Orientation: An activity designed to provide basic familiarization of the facility and transition into the IHS Service Unit and/or

Health Center.

2.20 Past Performance Information: Relevant information regarding a contractor's actions under previously awarded contracts.

2.21 Patient Outcome: End result of nursing care.

2.22 Performance Based Matrix: Lists the services and the standards to determine quality of performance.

2.23 Personal Protective Equipment (PPE): The equipment used to protect medical personnel from exposure to biological, chemical, and radioactive hazards.

2.24 Point of Contact: Person other than the COR or the Alternate COR

2.25 Quality Assurance Surveillance Plan (QASP): A written document prepared and used by the government for Quality

Assurance surveillance of the contractor's performance.

2.26 Service Unit: The local administrative unit of IHS.

2.27 Standards of Practice and Standards of Care: Authoritative statements by which it describes the responsibilities for which its practitioners are accountable.

75H70720R00014 – Acoma Canoncito Laguna Service Unit Registered Nurse (RN) Non Personal Healthcare Services

Page# 7 of 54

2.28 Technical Direction: A directive to the Contractor that approves approaches, solutions, designs, or refinements; fills in details or otherwise completes the general description of work or documentation items; shifts emphasis among work areas or tasks; or furnishes similar instruction to the Contractor.

2.29 Task Order: An order issued in accordance with the terms of a contract (GSA or VA, etc.) that details a specific requirement.

2.30 Valid Patient Complaint: Justifiable accusation made by a patient and supported by investigation.

2.31 Verifiable Emergency: An unexpected/unplanned absence by the contractor requiring valid documentation to confirm the occurrence.

75H70720R00014 – Acoma Canoncito Laguna Service Unit Registered Nurse (RN) Non Personal Healthcare Services

Page# 8 of 54

SECTION 3 – GOVERNMENT-FURNISHED PROPERTY AND SERVICES:

3.1 The Government will provide the following item(s) of Government property to the Contractor for use in the performance of this contract. This property used and maintained by the Contractor in accordance with provisions of FAR Clause 52.245-1, Government Property (found in Section 3).

Item No

Property Description Property Value Qty. Location Date Available

1 Computer 1 Upon Arrival

2 Telephone 1 Upon Arrival

3 Desk/Chair 1 Upon Arrival

4 PIV Card 1 Upon Arrival

5 PPE Equipment Upon Arrival

3.2 Government Furnished Information / Property and Services

3.2.1 Information: Government unique information related to this requirement, which is necessary for Contractor performance, made available to the Contractor. The COR will be the point of contact for identification of any required information to be supplied by the Government.

3.2.2 Joint Use by the Government and the Contractor: Except for the property and service listed in 10.7.1, the

Government will provide, for joint use by the Government and the Contractor, all necessary equipment, supplies, and clinic space to perform the services under this contract.

3.2.3 Contractor Exclusive Use:

3.2.3.1 Personal Protective Equipment (PPE): The Government will furnish the Contractor with appropriate

PPE other than specified in the contract. The Government will be responsible for any repair, cleaning, and inventory required for the PPE. This does not include any type of uniform or laboratory coat.

3.2.3.2 The Government will provide facility specific contractor identification badges for each contractor. For lost or destroyed badges, there is a minimum charge of $20.00.

3.2.3.3 Training: Facility specific orientation/training necessary for the Contractor to perform the required duties, e.g., IHS information technology (IT) systems and operational procedures. Training provided ONLY if the subject matter is necessary to improve or enhance the quality of services or includes mandates made by the IHS Service Units/Health Centers while the providers are working under this contract. Training not provided for the purpose of continuing education, career development or individual development.

3.3 Contractor Furnished Property

3.3.1 Except for the property specified in paragraph 10.9.3 as government furnished, the Contractor shall provide all uniforms and other personal medical instruments subject to the following:

3.3.2 Uniforms and Lab Coats: Uniforms and Lab Coats must conform to the requirements of the Indian Health Service Manual, Part 3, and Chapter 4 and meet the approval of the Chief Nurse Executive at each IHS facility.

3.3.3 Other personal medical instruments: "Other personal medical instruments" defined, as Contractor owned items include but not limited to stethoscope, scissors, as appropriate to the work unit. The Contractor must not use unsafe equipment or supplies at any time during performance of this contract. All Contractor furnished equipment and supplies shall be subject to inspection by the Government and must be approved by the COR prior to use by the Contractor. The Government reserves the right to prohibit the use of any materials, supplies, or equipment.

SECTION 4 - CONTRACTOR FURNISHED ITEMS

4.1 Except for the property specified in Section 10.7, Contractor will provide all other items as required to carry out the services.

75H70720R00014 – Acoma Canoncito Laguna Service Unit Registered Nurse (RN) Non Personal Healthcare Services

Page# 9 of 54

SECTION 5 - PERFORMANCE WORK STATEMENT

5.1 The Contractor shall provide valid registered nurse, particularly focusing in the utilization of his/her professional training and experience in order to perform the following tasks in the Primary Care, Emergency Room and Inpatient Departments.

5.1.1 Utilizes the nursing process in identifying individual patient problems and in developing, implementing and evaluating patient care plans.

5.1.2 Provides nursing care to meet the physical, emotional, spiritual and socio-cultural needs of the patient, by means of direct care and teaching.

5.1.3 Maintains and updates the team's patient panel.

5.1.4 Observes and assesses patient's clinical condition, recognizes, identifies and interprets serious situations and immediately decides proper action, for example, informs physician or takes preplanned measures.

5.1.5 Administers therapeutic measures as prescribed by the physician such as medications, intravenous fluids, and nebulizers.

5.1.6 Operates and monitors specialized equipment such as defibrillator, monitoring devices, transport incubators, nebulizers, fetal monitors, etc.

5.2 Work Schedule: Primary Care works Monday through Friday with no Federal Holidays worked. On occasion, there could be some overtime required; Emergency Room and Inpatient Department scheduled Monday through Sunday with Federal Holidays worked. On occasion there could be some overtime required.

5.2.1 Work Shift: Primary Care hours are from 8:00 am to 4:30 pm

Emergency Room and Inpatient has three different shifts they are as follows: 7:00 am to 7:30 pm;

10:00 am to 10:30 pm and 7:00 pm to 7:30 am (these hours include a 30-minute lunch break).

5.2.3 Scheduling of Shifts: The COR or Alternate COR at the IHS facility will determine specific tour of duty. The scheduler will determine the schedule along with the COR or the Alternate. The Contractor's employee must commit to working a full 52 weeks for the term of the contract (task orders).

5.2.4 Work Flexibility: As directed by the COR, the Contractor's employee must rotate into other duty sections as needed to support patient care.

5.2.5 Work Absence: The Contractor will perform and obtain approval from their agency who will inform the COR and/or

Alternate COR prior to any absence from work. If the length of the absence exceeds working hours the Contractor must request from agency approval at least fifteen (15) days, (the exception is verifiable emergencies) in advance of the desired absence.

5.2.6 The Contractor must perform and maintain documentation from a qualified health care provider for absences of three

(3) or more consecutive days, due to illness, stating:

5.2.6.1 The cause of the current illness or incapacitation AND

5.2.6.2 Indicating the Contractor as contagious or non-contagious.

5.2.7 Training: Not provided to Contractor employees. The only training provided to the Contractor employees will be in-house at ACL Service Unit.

5.3 Performance Evaluation: In accordance with the standards set forth in the contract and Performance Work Statement Matrix

(Section 6).

5.3.1 The Contractor meets with the care team to discuss scheduled patients and communicates the patients’ needs and recommended treatment to care team. Provides assistance to the care team.

5.3.2 The Contractor contacts patients for follow up diagnostic tests, referrals, appointments, or medical follow-up as appropriate. The Contractor provides patient education and self-management support by making weekly/monthly calls to encourage patient to meet goals.

5.3.3 The Contractor maintains, identifies, and creates panel of high-risk patients for care management. The Contractor will track performance measures monthly and shares with the team. The Contractor will triage patients, on the teams’ panel, who walk-in or call for services and directs them appropriately.

5.3.4 The Contractor will in emergency situations, when a physician is not present or immediately available, initiates appropriate measures; for example, takes resuscitation measures in case of cardiac or respiratory arrest, calls for assistance, (begins CPR, call Code Blue).

5.3.5 The Contractor will document observations, nursing interventions, therapeutic measures administered and status of coordinated activities between nursing and other professional disciplines utilizing the problem oriented record system.

5.3.6 The Contractor is responsible for operating specialized equipment during patient visit.

5.4 The contractor will perform work with multicultural patients and interpreters as necessary for non-English speaking patients.

75H70720R00014 – Acoma Canoncito Laguna Service Unit Registered Nurse (RN) Non Personal Healthcare Services

Page# 10 of 54

5.5 Conduct: The Contractor must perform standards as listed in the Federal Code of Conduct.

5.6 Conditions of Contract Services: All RNs’ providing service under this contract must attend mandatory orientations specified by the Service Unit.

5.6.1 The contractor must be subject to character investigation as required by Public Law 101-360, the Indian Health Child Protection and Family Violence Prevention Act prior to performance of a contract by utilizing the US Office of Personnel Management (OPM), Electronic Questionnaire for Investigation Processing (eQIP) system and this shall include all fingerprinting procedures and clearances. The contractor must provide all requested information necessary to perform Level I and Level II background checks. The contractor must comply with the requirement to obtain security investigations. The contractor must work with the IHS to ensure that the pre-employment screening process includes the appropriate investigation questionnaires and forms to be completed. The contractor will review all completed forms and forward onto the Government personnel. The contractor will be immediately removed from the position (at any time the investigation receives unfavorable adjudication, or, if other unfavorable information that would affect the investigation becomes known.

5.6.2 Identification of Contractor: The Contractor must wear a government issued contractor identification badge during performance of duty. After 120 day’s PIV, cards issued at the Service Unit.

5.6.3 Management of Medical Information: The Contractor must manage all patient information in accordance with

HIPAA standards, Privacy Act, and IHS Service Unit and/or Health Center specific policies and protocols. The Contractor must immediately report to the Contracting Officer or COR any information or circumstances that may violate any statute, policy, or procedure.

5.6.4 IHS Information Technology Systems: In performance of this contract, the Contractor must adapt to and successfully utilize IHS information technology systems such as Electronic Health Records (EHR) or RPMS, which the IHS has deemed necessary for acceptable contractor performance. The IT policies and procedures are available to the Contractor at the Service Unit and the Contractor will adhere to the IHS Information Technology System Security Policies and procedures. The Contractor must follow all appropriate federal required information Technology security requirements and will be operating under Health Insurance Portability and Accountability (HIPAA) and Privacy Act regulations.

5.7. CONTRACTOR QUALIFICATION REQUIREMENTS:

5.7.1 Professional Development: The contractor must have a registered license and be a graduate of an accredited school of registered nurses with a bachelor degree. From an accredited program approved by the legally designated State accrediting agency at the time the program was completed by the applicant. All registered nurses must possess a current, valid, unrestricted nursing license in a state, the District of Columbia, the Commonwealth of Puerto Rico, or a Territory of the United States, throughout the term of this contract.

5.7.2 Experience: The Contractor must have thirty-six (36) months of nursing experience, with a minimum of twelve months (12) in the specialty required by the contract, unless otherwise approved by the Contracting Officer. The Contractor must have a resume that provides experience that equips the applicant with the particular knowledge, skills and abilities to perform successfully the duties of the position, and that is typically in or related to the work of the position.

5.7.3 Motor Vehicle Operator's License: Contractors will not operate any Government-Owned vehicles. If required to provide health care services, they are allowed only as passengers in the Government-Owned Vehicle driven by a Federal employee.

5.7.4 Certifications: Current Basic Life Support (BLS), Pediatric Advanced Life Support (PALS) are mandatory. Advanced

Cardiac Life Support (ACLS), Neonatal Resuscitation Provider (NRP), Trauma Nurse Critical Care (TNCC), and Nurse Specialty certification (e.g., CNOR, Fetal monitoring) is preferred for each appropriate duty section at the time of employment and throughout as applicable.

5.7.5 Health Requirements of Contracted Healthcare Providers: Furnish documentation that reflects immunity for the indicated vaccine preventable diseases through documented disease, vaccination history, serology results, and/or any documented episodes of adverse events after vaccination. Any contractor’s employee who is allergic to a component of a vaccine and/or have a history of a severe reaction to a vaccine is not required to receive that vaccine with documented proof of contraindication to the vaccination. The following are additional requirements for specific vaccine preventable diseases.

• Measles:

- Vaccinations with 2 doses of live measles or MMR vaccines administered at least 28 days apart,

- Laboratory evidence of immunity,

- Laboratory confirmation of disease, or

- Birth before 1957.

• Mumps:

- Vaccinations with 2 doses of live mumps or MMR vaccines administered at least 28 days apart,

- Laboratory evidence of immunity,

- Laboratory confirmation of disease, or

75H70720R00014 – Acoma Canoncito Laguna Service Unit Registered Nurse (RN) Non Personal Healthcare Services

Page# 11 of 54

- Birth before 1957.

• Rubella:

- Vaccinations with 1 dose of live rubella or MMR vaccines administered at least 28 days apart,

- Laboratory evidence of immunity,

- Laboratory confirmation of disease, or

- Birth before 1957

• Hepatitis B:

- Vaccinations with three doses of Hepatitis B vaccines, or

- signed declination of Hepatitis B vaccination series.

• Varicella:

- Vaccinations with two doses of varicella at least 4 weeks apart,

- Laboratory evidence of immunity or confirmation of disease,

- Diagnosis or verification of history of varicella disease by a health care provider, or

- Diagnosis or verification of a history of herpes zoster by a health care provider.

• Influenza:

- Vaccination with one dose of current annual influenza season vaccine.

- Documented proof of the contraindication to the influenza vaccination as outlined by Advisory Committee on

Immunization Practices recommendations, or

- Written statement justifying religious exemption from influenza vaccination.

Note: unvaccinated contract staff with an approved medical or religious exemption must wear an IHS-provided surgical or similar mask when working in patient care areas or other areas frequented by patients in an IHS facility during the influenza season.

• Pertussis -Vaccination with one dose of Tdap vaccine.

• Any additional immunization in accordance with IHS Immunization Policy that is available upon request.

The contract staff must have written documentation of TB test (TST or IGRA) within the last 12 months. If documented Positive TB test:

- Provide chest x-ray report of “No active TB disease” following positive TB test.

- Annual sign and symptoms screen:

• If negative sign and symptom screen, follow up chest x-ray not indicated.

• If signs and symptoms screen positive, contract staff must have written documentation of chest x-ray and health care provider evaluation.

Credentialed provider contract staff must have documentation from the provider’s physician or chief of staff that confirms they do not have any health problems (including disability, emotional stability, drug, or alcohol dependency) that might impair his/her ability to care for patient at time of application.

5.7.6 Criminal History Background Check:

Contractor’s employees whose duties and responsibilities involve regular contact or control over children are subject to a character investigation as required by Public Law 101-630, The Indian Child Protection and Family Violence Act.

The minimum standards of character shall ensure that none of the individuals described in this order have been found guilty of, or entered a plea of nolo contendere or guilty to, any felonious offense, or any of two or more misdemeanor offenses, under federal, state, or tribal law involving crimes of violence; sexual assault, molestation, exploitation, contact or prostitution; crimes against persons; or offenses committed against children. These crimes do not hold a time statue and will be evaluated the same under any Child Care “CNACI” investigation with IHS. IHS will conduct these investigations following award of a contract. Until the character investigation has been completed and the Contracting Officer notified of the results, the Contractor‘s employees must not have unsupervised contact with Indian children. Contractor’s employees are not able to work a scheduled shift until the security check is performed and clearance has been obtained by the appropriate agency. At a minimum, fingerprints are required, and upon clearance of this stage, a contractor’s employee may work a scheduled shift. However, Contractor’s employees are required to complete the detailed background application and the application is to be completed within 30 days once the contractor’s employee has been given physical and logical access. All Contractors’ employees are subject to criminal background check prior to performing services in accordance with Task Order terms and conditions. The contractor shall ensure that each of their employees complete the Certification of Criminal History and Background Check Packet. The completed forms are to be returned to the COR. Additional Background Check packets can be obtained through the COR. See HHSAR Clauses 352.237-72 and 352.237-73.

5.7.7 Required Training: Protecting Children from Sexual Abuse as stated in IHM Circular 19-05: Contractor Training

Plan for Implementation of Indian Health Manual Part 3, Chapter 20, Protecting Children from Sexual Abuse by Health Care Providers. Each provider must take this training within 30 days from their start date at the service unit. Certificate should be provided to the COR.

5.7.8 Subpoenas/Testimonies: Contractors are mandated to cooperate with the appropriate IHS managers when the contractors' employees are subpoenaed or requested by Tribal, State or Federal Parties to provide testimony as stated in Section 5-27.3(B)(9) of the Indian Health Manual.

75H70720R00014 – Acoma Canoncito Laguna Service Unit Registered Nurse (RN) Non Personal Healthcare Services

Page# 12 of 54

5.8 Challenges to Conflicts: For any inconsistency between COR and Contractor's employee, the employee should contact their agency. If this situation needs further remedies, then the Contractor will contact the COR

5.9 When the Contractor demonstrates impaired judgement, they cannot continue working on the task order. The Government reserves the right to remove from the facility any Contractor employee who in the judgment of a licensed healthcare practitioner is impaired.

5.10 APPLICABLE DOCUMENTS:

Wage Determinations

Past Performance Survey

Business Associate Agreement

OF 306 – Addendum to Declaration for Federal Employment – Indian Health Service Child Care & Indian Child Care Work Positions

75H70720R00014 – Acoma Canoncito Laguna Service Unit Registered Nurse (RN) Non Personal Healthcare Services

Page# 13 of 54

SECTION 6 0 QUALITY ASSURANCE SURVEILLANCE PLAN

Performance-Based Task

Indicator Standard Quality Assurance Incentives

Utilizes the nursing process in identifying individual patient problems and in developing, implementing and evaluating patient care plans.

Meets with the care team to discuss scheduled patients

Communicates the patients’ needs and recommended treatment to care team.

Outstanding – 100% of patient needs are being meet per visit.

Acceptable – 80 to 99% of patient needs are being meet per visit.

Satisfactory – 65 to 80% of patient needs are being meet per visit.

Monitored on a periodic basis when services occur.

Final determination will happen when job is completed.

Outstanding. Means there are no issues so payments processed promptly.

Acceptable. Means there are some issues so payment is on hold until issues cleared.

Satisfactory – Means there are too many issues and payment not processed until this meets either Satisfactory or Outstanding.

Provides nursing care to meet the physician, emotional, spiritual and socio-cultural needs of the patient, by means of direct care and teaching.

Contacts patients for follow up diagnostic tests, referrals, appointments, or medical follow.

Provides patient education and self-management support by making weekly/monthly calls to encourage patient to meet goals.

Outstanding – 100% of contacts occur per weekly/monthly follow-ups.

Acceptable – 80 to 99% of contacts occur per weekly/monthly follow-ups.

Satisfactory – 65 to 80% of contact occur per weekly/monthly follow-ups.

Monitored on a periodic basis when services occur.

Final determination will happen when job is completed.

Outstanding. Means there are no issues so payments processed promptly.

Acceptable. Means there are some issues so payment is on hold until issues cleared.

Satisfactory – Means there are too many issues and payment not processed until this meets either Satisfactory or Outstanding.

Maintains and updates the team's patient panel.

Maintains, identifies, and creates panel of high-risk patients for care management.

Tracks performance measures monthly and shares with the team.

Triages patients as walk-in or call for services

Outstanding – 100% of updates/triage occurs in a timely manner.

Acceptable – 80 to 99% of updates/triage occurs in a timely manner.

Satisfactory – 65 to 80% of updates/triage occurs in a timely manner.

Monitored on a periodic basis when services occur.

Final determination will happen when job is completed.

Outstanding. Means there are no issues so payments processed promptly.

Acceptable. Means there are some issues so payment is on hold until issues cleared.

Satisfactory – Means there are too many issues and payment not processed until they meet either Satisfactory or Outstanding.

Observes and assesses patient's clinical condition, recognizes, identifies and interprets serious situations and immediately decides proper action, for example, informs physician or takes preplanned measures.

In emergencies, when a physician is not present or immediately available, initiates appropriate measures.

Outstanding – 100% of all observations and assessments occur in a timely manner.

Acceptable – 80 to 99% of all observations and assessments occur in a timely manner.

Satisfactory – 65 to 80% of all observations and assessments

Monitored on a periodic basis when services occur.

Final determination will happen when job is completed.

Outstanding. Means there are no issues so payments processed promptly.

Acceptable. Means there are some issues so payment is on hold until issues cleared.

Satisfactory – Means there are too many issues and payment not processed until they

75H70720R00014 – Acoma Canoncito Laguna Service Unit Registered Nurse (RN) Non Personal Healthcare Services

Page# 14 of 54 occur in a timely manner.

meet either Satisfactory or Outstanding.

Performance-Based Task

Indicator Standard Quality Assurance Incentives

Administers therapeutic measures as prescribed by the physician such as medications, intravenous fluids, and nebulizers.

Document observations, nursing interventions, therapeutic measures administered and status of coordinated activities between nursing and other professional disciplines utilizing the problem oriented record system.

Outstanding – 100% of documentation are being meet.

Acceptable – 80 to 99% of documentation are being meet.

Satisfactory – 65 to 80% of documentation are being meet.

Monitored on a periodic basis when services occur. Final determination will happen when job is completed.

Outstanding. Means there are no issues so payments processed promptly.

Acceptable. Means there are some issues so payment is on hold until issues cleared.

Satisfactory – Means there are too many issues and payment not processed until they meet either Satisfactory or Outstanding.

Operates and monitors specialized equipment such as defibrillator, monitoring devices, transport incubators, nebulizers, fetal monitors, etc.

Responsible for operating specialized equipment during patient visit.

Outstanding – 100% of operates specialized equipment without issue.

Acceptable – 80 to 99% of operates specialized equipment with some issue.

Satisfactory – 65 to 80% of operates specialized equipment with issues.

Monitored on a periodic basis when services occur. Final determination will happen when job is completed.

Outstanding. Means there are no issues so payments processed promptly.

Acceptable. Means there are some issues so payment is on hold until issues cleared.

Satisfactory – Means there are too many issues and payment not processed until they meet either Satisfactory or Outstanding.

75H70720R00014 – Acoma Canoncito Laguna Service Unit Registered Nurse (RN) Non Personal Healthcare Services

Page# 15 of 54

SECTION 7 - PACKAGING AND MARKING

7.1 PACKAGING

All deliverables shall be preserved, packaged, and packed in accordance with normal commercial practices to meet the packing requirements of the carrier including which is necessary to prevent deterioration and damages due to the hazards of shipping, handling, and storing.

7.2 MARKING

Each package/container shall be clearly marked as follows:

• Name of Contractor

• Contract Number

• Description of Items Contained Therein

• Consignee's Name and Address

7.3 DELIVERY

All deliverables delivered to the following addresses:

Acoma-Canoncito-Laguna Service Unit Attention: Melissa Wyaco, Director of Nursing 80B Veterans Blvd. (P.O. Box 130) Acoma, New Mexico 87049

(505) 552-5324

75H70720R00014 – Acoma Canoncito Laguna Service Unit Registered Nurse (RN) Non Personal Healthcare Services

Page# 16 of 54

SECTION 8 - INSPECTION AND ACCEPTANCE

8.1 INSPECTION AND ACCEPTANCE: All work under this contract is subject to inspection and final acceptance by the

Contracting Officer or the duly authorized representative of the government. The COR, as a duly authorized representative of the Contracting Officer, shall assume the responsibilities for monitoring the Contractor's performance, evaluating the quality of services provided by the Contractor and performing final inspection and acceptance of all deliverables and services called for by the contract.

8.2 FEDERAL ACQUISITION REGULATION {48 CFR CHAPTER 1) CLAUSES

FAR Clause No. Title Date

52.246-4 Inspection of Services – Fixed Priced (Aug 1996)

75H70720R00014 – Acoma Canoncito Laguna Service Unit Registered Nurse (RN) Non Personal Healthcare Services

Page# 17 of 54

SECTION 9 - DELIVERIES OR PERFORMANCE

9.1 PERIOD OF PERFORMANCE: The period of performance is a Base Period of 12 months with four -

12-month Option Periods, unless extended by modification to this contract. The Government may exercise options to extend the period of performance in accordance with FAR Clause 52.217-9 - Option to Extend the Term of the Contract (Oct 2014); upon written notification by the Contracting Officer within 30 days of contract expiration.

9.1.1 Services under this contract shall commence NLT 10 days after all clearances occur.

Base Year: TBD, 2020 to TBD, 2021 Option Year 1: TBD, 2021 to TBD, 2022 Option Year 2: TBD, 2022 to TBD, 2023 Option Year 3: TBD, 2023 to TBD, 2024 Option Year 4: TBD, 2024 to TBD, 2025

9.1.2 Performance must be for the period of TBD/2020 to TBD/2021 unless the period changed by written modification to the purchase order in accordance with FAR 52.217-9, Option to Extend the Term of the Contract.

9.1.3 Total contract award must not exceed five years. Based option year renewals on satisfactory services provided availability of funds for the appropriate fiscal year, and existing requirements.

9.2 PLACE OF PERFORMANCE: The contractor must provide ten (10) Registered Nurses non-personal healthcare services to the following Albuquerque Area Indian Health Service Facility:

9.2.1 Acoma-Canoncito-Laguna Service Unit

80B Veterans Blvd., Acoma, New Mexico 87034

9.3 Travel to and from the facility/office site are not included in the tour of duty. See Section 5.2 for shift hours.

9.4 GOVERNMENT HOLIDAYS (https://www.federalpay.org/holidays)

New Year's Day Martin Luther King's Birthday President's Day Memorial Day Independence Day Labor Day Columbus Day Veteran's Day Thanksgiving Day Christmas Day

*Any other day specifically declared by the President of the United States to be a national holiday (see www.opm.gov/fedhol).

75H70720R00014 – Acoma Canoncito Laguna Service Unit Registered Nurse (RN) Non Personal Healthcare Services

Page# 18 of 54

SECTION 10 - CONTRACT ADMINISTRATION

10.1 AUTHORITIES OF GOVERNMENT PERSONNEL: Notwithstanding the Contractor's responsibility for total management during the performance of this Contract, the administration of the Contract will require maximum coordination between the Government and the Contractor. The following individuals will be the Government's points of contact during the performance of this Contract.

10.2 CONTRACTING OFFICER

The IHS Contracting Officer (CO) is the only individual authorized to modify this Contract. The CO responsible for administrative and contractual issues concerning this Contract is:

Clarisa Gallegos (CO) Indian Health Service/Division of Contracts & Grants Management (DCGM) 4101 Indian School Road NE, Suite 225 Albuquerque, NM 87110 Phone: 505-256-6748 Email: Clarisa.gallegos@ihs.gov

Send all communications pertaining to contractual and/or administrative matters to the address above and to the Contract Specialist administering this Contract.

10.3 CONTRACT ADMINISTRATOR

· All Contract administration performed by:

Eric Wright, Contract Specialist (CS) Indian Health Service/Division of Contracts & Grants Management (DCGM) 4101 Indian School Road NE, Suite 225 Albuquerque, NM 87110 Phone: 505-256-6752 Email: eric.wright@ihs.gov

10.4 CONTRACTING OFFICER'S REPRESENTATIVE (COR)

10.4.1 Melissa Wyaco, Director of Nursing, 505-552-5324, is hereby designated as COR for this service.