Sol_75H71026Q00297.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

51CODE 16. ADMINISTERED BYCODE

X

X

513210

SIZE STANDARD:

% FOR:SET ASIDE:UNRESTRICTED OR51

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

09/15/2026 1200 MD

09/09/2026

FELECIA CHAVEZ

(No collect calls)

INFORMATION CALL:

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

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

75H71026Q00297

5. SOLICITATION NUMBER

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

1 40 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

15. DELIVER TO

Gallup NM 87301

1808 W. Aztec Avenue

Acquisition Department

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$47

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)

Gallup Indian Medical Center WOMEN-OWNED SMALL

BUSINESS (WOSB)

ECONOMICALLY DISADVANTAGED

WOMEN-OWNED SMALL

BUSINESS (EDWOSB)

Gallup New Mexico 87301

1808 W. Aztec Ave

Gallup Indian Medical Center

Gallup NM 87301

1808 W. Aztec Avenue

Acquisition Department

Gallup Indian Medical Center

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

**This Acquisition is an Indian-Owned Small Business Economic Enterprise (ISBEE) set-aside.**

This contract is subject to the electronic payment process by the Department of Treasury.

All invoices complying to the requirements at 52.212-4(g) must be submitted through www.ipp.gov. For additional information, refer to the incorporated clause at 352.232-71 Electronic Submission of Payment Requests (APR

2026)(DEVIATION)

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

HEREIN, IS ACCEPTED AS TO ITEMS:

XX

DATED

JERLYN R. BEGAY

. 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.

The Government will keep the solicitation posted and open for quotes until September 15, 2026 at

12:00 pm MT.

Period of Performance: 10/01/2026 to 09/30/2027

1 Base Period:

Contractor shall provide a site-hosted, evidence-based clinical criteria software and license for the use in hospital utilization review process. The software should allow users to evaluate clinical criteria for the following:

1. Observation services

2. Inpatient admissions

3. Continued inpatient stays

4. Evaluation of discharge planning

5. Evaluate ambulatory surgical services for appropriateness of setting

6. Determine appropriate transition of care to rehabilitation care services, subacute services, and skilled nursing services

7. Evaluate substance use disorders and appropriate transition of care

8. Evaluate transition of care needs utilizing

CMS Durable Medical Equipment

9. Retrospective evaluation of risk management and quality car delivery evaluation

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

40 2 of

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 40

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H71026Q00297

**See Attachment A - Statement of Work for more specifications and details

2 Option Period 1:

Contractor shall provide a site-hosted, evidence-based clinical criteria software and license for the use in hospital utilization review process. The software should allow users to evaluate clinical criteria for the following:

1. Observation services

2. Inpatient admissions

3. Continued inpatient stays

4. Evaluation of discharge planning

5. Evaluate ambulatory surgical services for appropriateness of setting

6. Determine appropriate transition of care to rehabilitation care services, subacute services, and skilled nursing services

7. Evaluate substance use disorders and appropriate transition of care

8. Evaluate transition of care needs utilizing

CMS Durable Medical Equipment

9. Retrospective evaluation of risk management and quality car delivery evaluation

**See Attachment A - Statement of Work for more specifications and details

(Option Line Item)

10/01/2027

Period of Performance: 10/01/2027 to 10/30/2027

3 Option Period 2:

Contractor shall provide a site-hosted, evidence-based clinical criteria software and license for the use in hospital utilization review process. The software should allow users to evaluate clinical criteria for the following:

1. Observation services

2. Inpatient admissions

3. Continued inpatient stays

4. Evaluation of discharge planning

5. Evaluate ambulatory surgical services for appropriateness of setting

Continued ...

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

Sponsored by GSA

FAR (48 CFR) 53.110

4 40

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H71026Q00297

6. Determine appropriate transition of care to rehabilitation care services, subacute services, and skilled nursing services

7. Evaluate substance use disorders and appropriate transition of care

8. Evaluate transition of care needs utilizing

CMS Durable Medical Equipment

9. Retrospective evaluation of risk management and quality car delivery evaluation

**See Attachment A - Statement of Work for more specifications and details

(Option Line Item)

10/01/2028

Period of Performance: 10/01/2028 to 09/30/2029

4 Option Period 3:

Contractor shall provide a site-hosted, evidence-based clinical criteria software and license for the use in hospital utilization review process. The software should allow users to evaluate clinical criteria for the following:

1. Observation services

2. Inpatient admissions

3. Continued inpatient stays

4. Evaluation of discharge planning

5. Evaluate ambulatory surgical services for appropriateness of setting

6. Determine appropriate transition of care to rehabilitation care services, subacute services, and skilled nursing services

7. Evaluate substance use disorders and appropriate transition of care

8. Evaluate transition of care needs utilizing

CMS Durable Medical Equipment

9. Retrospective evaluation of risk management and quality car delivery evaluation

**See Attachment A - Statement of Work for more specifications and details

(Option Line Item)

10/01/2029

Period of Performance: 10/01/2029 to 09/30/2030

Continued ...

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

5 40

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H71026Q00297

5 Option Period 4:

Contractor shall provide a site-hosted, evidence-based clinical criteria software and license for the use in hospital utilization review process. The software should allow users to evaluate clinical criteria for the following:

1. Observation services

2. Inpatient admissions

3. Continued inpatient stays

4. Evaluation of discharge planning

5. Evaluate ambulatory surgical services for appropriateness of setting

6. Determine appropriate transition of care to rehabilitation care services, subacute services, and skilled nursing services

7. Evaluate substance use disorders and appropriate transition of care

8. Evaluate transition of care needs utilizing

CMS Durable Medical Equipment

9. Retrospective evaluation of risk management and quality car delivery evaluation

**See Attachment A - Statement of Work for more specifications and details

(Option Line Item)

10/01/2030

Period of Performance: 10/01/2030 to 09/30/2031

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

Rev. 04/29/2026

SECTION B – CONTINUATION OF SF-1449

This page is intentionally left blank

SECTION C – CONTRACT CLAUSES

52.212-4 CONTRACT TERMS AND CONDITIONS –

COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES

NOV 2025

(DEVIATION)

The following Federal Acquisition Regulation clauses also apply:

☐ 52.203-3 GRATUITIES APR 1984

☐ 52.203-6 RESTRICTIONS ON SUBCONTRACTOR SALES TO THE GOVERNMENT Alt I

NOV 2021

☐ 52.203-12 LIMITATION OF PAYMENTS TO INFLUENCE CERTAIN FEDERAL

TRANSACTIONS

JUN 2020

☐ 52.203-13 CONTRACTOR CODE OF BUSINESS ETHICS AND CONDUCT NOV 2021

☐ 52.203-16 PREVENTING PERSONAL CONFLICTS OF INTEREST JUN 2020

☒ 52.203-17 CONTRACTOR EMPLOYEE WHISTLEBLOWER RIGHTS NOV 2023

☒ 52.203-19 PROHIBITION ON REQUIRING CERTAIN INTERNAL CONFIDENTIALITY

AGREEMENTS OR STATEMENTS

JAN 2017

☐ 52.204-9 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR PERSONNEL JAN 2011

☒ 52.204-13 SYSTEM FOR AWARD MANAGEMENT MAINTENANCE NOV 2025

(DEVIATION)

☐ 52.204-14 SERVICE CONTRACT REPORTING REQUIREMENTS NOV 2025

(DEVIATION)

☐ 52.204-15 SERVICE CONTRACT REPORTING REQUIREMENTS FOR INDEFINITE-

DELIVERY CONTRACTS

NOV 2025

(DEVIATION)

☐ 52.204-91 CONTRACTOR IDENTIFICATION NOV 2025

(DEVIATION)

☒ 52.209-6 PROTECTING THE GOVERNMENT’S INTEREST WHEN

SUBCONTRACTING WITH CONTRACTORS DEBARRED, SUSPENDED, OR

PROPOSED FOR DEBARMENT

NOV 2025

(DEVIATION)

☐ 52.209-9 UPDATES OF PUBLICLY AVAILABLE INFORMATION REGARDING

RESPONSIBILITY MATTERS

NOV 2025

(DEVIATION)

☒ 52.209-10 PROHIBITION ON CONTRACTING WITH INVERTED DOMESTIC

CORPORATIONS

NOV 2025

(DEVIATION)

☐ 52.213-1 RESERVED

☐ 52.219-3 NOTICE OF HUBZONE SET-ASIDE OR SOLE-SOURCE AWARD NOV 2025

(DEVIATION)

☐ 52.219-6 NOTICE OF TOTAL SMALL BUSINESS SET-ASIDE NOV 2025

(DEVIATION)

☐ 52.219-6 Alt I

NOTICE OF TOTAL SMALL BUSINESS SET-ASIDE, WITH ALTERNATE I NOV 2025

☐ 52.219-7 NOTICE OF PARTIAL SMALL BUSINESS SET-ASIDE NOV 2020

☐ 52.219-7 Alt I

NOTICE OF PARTIAL SMALL BUSINESS SET-ASIDE, WITH ALTERNATE I MAR 2020

☐ 52.219-8 UTILIZATION OF SMALL BUSINESS CONCERNS NOV 2025

(DEVIATION)

☐ 52.219-9 SMALL BUSINESS SUBCONTRACTING PLAN NOV 2025

(DEVIATION)

☐ 52.219-9 Alt I

SMALL BUSINESS SUBCONTRACTING PLAN, WITH ALTERNATE I NOV 2025

(DEVIATION)

☐ 52.219-9 Alt II

SMALL BUSINESS SUBCONTRACTING PLAN, WITH ALTERNATE II NOV 2025

(DEVIATION)

☐ 52.219-9 Alt III

SMALL BUSINESS SUBCONTRACTING PLAN, WITH ALTERNATE III NOV 2025

(DEVIATION)

☐ 52.219-9 Alt IV

SMALL BUSINESS SUBCONTRACTING PLAN, WITH ALTERNATE IV NOV 2025

(DEVIATION)

☐ 52.219-13 NOTICE OF SET-ASIDE OF ORDERS MAR 2020

☐ 52.219-13 Alt I

RESERVED

☐ 52.219-16 LIQUIDATED DAMAGES—SUBCONTRACTING PLAN NOV 2025

(DEVIATION)

☐ 52.219-27 NOTICE OF SET-ASIDE FOR, OR SOLE-SOURCE AWARD TO, SERVICE-

DISABLED VETERAN-OWNED SMALL BUSINESS (SDVOSB) CONCERNS

ELIGIBLE UNDER THE SDVOSB PROGRAM

NOV 2025

(DEVIATION)

☒ 52.219-28 POSTAWARD SMALL BUSINESS PROGRAM REREPRESENTATION NOV 2025

(DEVIATION)

☐ 52.219-28 Alt I

POSTAWARD SMALL BUSINESS PROGRAM REREPRESENTATION, WITH

ALTERNATE I

NOV 2025

(DEVIATION)

☐ 52.219-29 NOTICE OF SET-ASIDE FOR, OR SOLE-SOURCE AWARD TO,

ECONOMICALLY DISADVANTAGED WOMEN-OWNED SMALL BUSINESS

CONCERNS

NOV 2025

(DEVIATION)

☐ 52.219-30 NOTICE OF SET-ASIDE FOR, OR SOLE-SOURCE AWARD TO, WOMEN-

OWNED SMALL BUSINESS CONCERNS ELIGIBLE UNDER THE WOMEN-

OWNED SMALL BUSINESS PROGRAM

NOV 2025

(DEVIATION)

☐ 52.219-33 NONMANUFACTURER RULE NOV 2025

(DEVIATION)

☒ 52.222-3 CONVICT LABOR NOV 2025

(DEVIATION)

☒ 52.222-19 CHILD LABOR—COOPERATION WITH AUTHORITIES AND REMEDIES NOV 2025

(DEVIATION)

☐ 52.222-35 EQUAL OPPORTUNITY FOR VETERANS NOV 2025

(DEVIATION)

☒ 52.222-36 EQUAL OPPORTUNITY FOR WORKERS WITH DISABILITIES NOV 2025

(DEVIATION)

☐ 52.222-36

ALT I

EQUAL OPPORTUNITY FOR WORKERS WITH DISABILITIES, WITH

ALTERNATE I

JUL 2014

☐ 52.222-37 EMPLOYMENT REPORTS ON VETERANS NOV 2025

☐ 52.222-40 NOTIFICATION OF EMPLOYEE RIGHTS UNDER THE NATIONAL LABOR

RELATIONS ACT

NOV 2025

(DEVIATION)

☐ 52.222-41 SERVICE CONTRACT LABOR STANDARDS NOV 2025

(DEVIATION)

☐ 52.222-43 FAIR LABOR STANDARDS ACT AND SERVICE CONTRACT LABOR

STANDARDS-PRICE ADJUSTMENT (MULTIPLE YEAR AND OPTION

CONTRACTS)

NOV 2025

(DEVIATION)

☐ 52.222-44 FAIR LABOR STANDARDS ACT AND SERVICE CONTRACT LABOR

STANDARDS-PRICE ADJUSTMENT

NOV 2025

(DEVIATION)

☒ 52.222-50 COMBATING TRAFFICKING IN PERSONS NOV 2025

(DEVIATION)

☐ 52.222-50 Alt I

COMBATING TRAFFICKING IN PERSONS NOV 2025

(DEVIATION)

☐ 52.222-51 EXEMPTION FROM APPLICATION OF THE SERVICE CONTRACT LABOR

STANDARDS TO CONTRACTS FOR MAINTENANCE, CALIBRATION, OR

REPAIR OF CERTAIN EQUIPMENT—REQUIREMENTS

NOV 2025

(DEVIATION)

☐ 52.222-53 EXEMPTION FROM APPLICATION OF THE SERVICE CONTRACT LABOR

STANDARDS TO CONTRACTS FOR CERTAIN SERVICES—

REQUIREMENTS

NOV 2025

(DEVIATION)

☒ 52.222-54 EMPLOYMENT ELIGIBILITY VERIFICATION NOV 2025

(DEVIATION)

☐ 52.222-55 MINIMUM WAGES FOR CONTRACTOR WORKERS UNDER EXECUTIVE

ORDER 14026

NOV 2025

(DEVIATION)

☐ 52.222-62 PAID SICK LEAVE UNDER EXECUTIVE ORDER 13706 NOV 2025

(DEVIATION)

☒ 52.222-90 ADDRESSING DEI DISCIMINATION BY FEDERAL CONTRACTORS APR 2026

(DEVIATION)

☐ 52.223-2 REPORTING OF BIOBASED PRODUCTS UNDER SERVICE AND

CONSTRUCTION CONTRACTS

NOV 2025

(DEVIATION)

☐ 52.223-5 POLLUTION PREVENTION AND RIGHT-TO-KNOW INFORMATION MAY 2024

☐ 52.223-11 OZONE-DEPLETING SUBSTANCES NOV 2025

(DEVIATION)

☐ 52.223-12 MAINTENANCE, SERVICE, REPAIR, OR DISPOSAL OF REFRIGERATION

EQUIPMENT AND AIR CONDITIONERS

NOV 2025

(DEVIATION)

☒ 52.223-23 SUSTAINABLE PRODUCTS NOV 2025

(DEVIATION)

☒ 52.224-1 PRIVACY ACT NOTIFICATION APR 1984

☒ 52.224-2 PRIVACY ACT APR 1984

☒ 52.224-3 PRIVACY TRAINING JAN 2017

☐ 52.224-3

ALT I

PRIVACY TRAINING, WITH ALTERNATE I JAN 2017

☐ 52.225-1 BUY AMERICAN-SUPPLIES NOV 2025

(DEVIATION)

☐ 52.225-1 Alt I

BUY AMERICAN-SUPPLIES, WITH ALTERNATE I OCT 2022

☐ 52.225-3 BUY AMERICAN-FREE TRADE AGREEMENTS-ISRAELI TRADE ACT NOV 2025

(DEVIATION)

52.225-3

ALT I

RESERVED

☐ 52.225-3 Alt II

BUY AMERICAN-FREE TRADE AGREEMENTS-ISRAELI TRADE ACT,

WITH ALTERNATE II

NOV 2025

(DEVIATION)

☐ 52.225-3 Alt III

BUY AMERICAN-FREE TRADE AGREEMENTS-ISRAELI TRADE ACT,

WITH ALTERNATE III

NOV 2025

(DEVIATION)

☐ 52.225-3 Alt IV

BUY AMERICAN-FREE TRADE AGREEMENTS-ISRAELI TRADE ACT,

WITH ALTERNATE IV

NOV 2025

(DEVIATION)

☒ 52.225-5 TRADE AGREEMENTS NOV 2023

☐ 52.225-14 INCONSISTENCY BETWEEN ENGLISH VERSION AND TRANSLATION OF

CONTRACT

FEB 2000

☐ 52.225-19 CONTRACTOR PERSONNEL IN A DESIGNATED OPERATIONAL AREA OR

SUPPORTING A DIPLOMATIC OR CONSULAR MISSION OUTSIDE THE

UNITED STATES

MAY 2020

☐ 52.225-26 CONTRACTORS PERFORMING PRIVATE SECURITY FUNCTIONS

OUTSIDE THE UNITED STATES

OCT 2016

☒ 52.226-1 UTILIZATION OF INDIAN ORGANIZATIONS AND INDIAN-OWNED

ECONOMIC ENTERPRISES

NOV 2025

(DEVIATION)

☐ 52.226-5 RESTRICTIONS ON SUBCONTRACTING OUTSIDE DISASTER OR

EMERGENCY AREA

NOV 2025

(DEVIATION)

☐ 52.226-6 PROMOTING EXCESS FOOD DONATION TO NONPROFIT

ORGANIZATIONS

NOV 2025

(DEVIATION)

☐ 52.226-7 DRUG-FREE WORKPLACE MAY 2024

☒ 52.226-8 ENCOURAGING CONTRACTOR POLICIES TO BAN TEXT MESSAGING

WHILE DRIVING

MAY 2024

☐ 52.229-12 TAX ON CERTAIN FOREIGN PROCUREMENTS AUG 2025

(DEVIATION)

☐ 52.232-18 AVAILABILITY OF FUNDS APR 1984

☐ 52.232-29 TERMS FOR FINANCING OF COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES

NOV 2021

☐ 52.232-30 INSTALLMENT PAYMENTS OF COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES

NOV 2021

☒ 52.232-33 PAYMENT BY ELECTRONIC FUNDS TRANSFER—SYSTEM FOR AWARD

MANAGEMENT

OCT 2018

☐ 52.232-34 PAYMENT BY ELECTRONIC FUNDS TRANSFER—OTHER THAN SYSTEM

FOR AWARD MANAGEMENT

JUL 2013

☐ 52.232-36 PAYMENT BY THIRD PARTY NOV 2025

(DEVIATION)

☒ 52.232-40 PROVIDING ACCELERATED PAYMENTS TO SMALL BUSINESS

SUBCONTRACTORS

MAR 2023

☐ 52.232-90 FAST PAYMENT PROCEDURE NOV 2025

(DEVIATION)

☒ 52.233-3 PROTEST AFTER AWARD NOV 2025

☒ 52.233-4 APPLICABLE LAW FOR BREACH OF CONTRACT CLAIM NOV 2025

(DEVIATION)

☐ 52.237-2 PROTECTION OF GOVERNMENT BUILDING, EQUIPMENT, AND

VEGETATION

APR 1984

☐ 52.237-3 CONTINUITY OF SERVICES JAN 1991

☒ 52.240-91 SECURITY PROHIBITIONS AND EXCLUSIONS NOV 2025

(DEVIATION)

☐ 52.240-91 Alt I

SECURITY PROHIBITIONS AND EXCLUSIONS, WITH ALTERNATE I NOV 2025

(DEVIATION)

☐ 52.240-92 SECURITY REQUIREMENTS NOV 2025

(DEVIATION)

☐ 52.240-92 Alt II

SECURITY REQUIREMENTS WITH ALTERNATE II NOV 2025

(DEVIATION)

☐ 52.240-93 BASIC SAFEGUARDING OF COVERED CONTRACTOR INFORMATION

SYSTEMS

NOV 2025

(DEVIATION)

☐ 52.242-5 PAYMENTS TO SMAL BUSINESS SUBCONTRACTORS JAN 2017

☐ 52.242-13 BANKRUPTCY JUL 1995

☐ 52.244-2 SUBCONTRACTS JUN 2020

☒ 52.244-6 SUBCONTRACTS FOR COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES

NOV 2025

(DEVIATION)

☐ 52.245-1 GOVERNMENT PROPERTY SEP 2021

☐ 52.245-2 GOVERNMENT PROPERTY INSTALLATION OPERATION SERVICES APR 2012

☐ 52.245-9 USE AND CHARGES APR 2012

☐ 52.247-64 PREFERENCE FOR PRIVATELY OWNED U.S.-FLAG COMMERCIAL

VESSELS

NOV 2025

(DEVIATION)

☐ 52.247-64 Alt I

PREFERENCE FOR PRIVATELY OWNED U.S.-FLAG COMMERCIAL

VESSELS, WITH ALTERNATE I

APR 2003

☐ 52.247-64 Alt II

PREFERENCE FOR PRIVATELY OWNED U.S.-FLAG COMMERCIAL

VESSELS, WITH ALTERNATE II

NOV 2021

52.219-14 LIMITATIONS ON SUBCONTRACTING NOV 2025

(a) This clause does not apply to the unrestricted portion of a partial set-aside.

(b) Definition. Similarly situated entity, as used in this clause, means a first-tier subcontractor, including an independent contractor, that—

(1) Has the same small business program status as that which qualified the prime contractor for the award (e.g., for a small business set-aside contract, any small business concern, without regard to its socioeconomic status); and

(2) Is considered small for the size standard under the North American Industry Classification System (NAICS) code the prime contractor assigned to the subcontract.

(c) Applicability. This clause applies only to—

(1) Contracts that have been set aside for any of the small business concerns identified in 19.000(a)(3);

(2) Part or parts of a multiple-award contract that have been set aside for any of the small business concerns identified in 19.000(a)(3);

(3) Contracts that have been awarded on a sole-source basis in accordance with subparts 19.105, 19.106, 19.107, and 19.108;

(4) Orders expected to exceed the simplified acquisition threshold and that are set aside for small business concerns under multiple-award contracts, as described in 8.4 and 16.5;

(5) Orders, regardless of dollar value, that are set aside in accordance with section 19.105, 19.106, 19.107, and 19.108 under multiple-award contracts, as described in 8.4 and 16.5; and

(6) Contracts using the HUBZone price evaluation preference to award to a HUBZone small business concern unless the concern waived the evaluation preference.

(d) Independent contractors. An independent contractor shall be considered a subcontractor.

(e) By submission of an offer and execution of a contract, the Contractor agrees that in performance of a contract assigned a North American Industry Classification System (NAICS) code for—

(1) Services (except construction), it will not pay more than 50 percent of the amount paid by the Government for contract performance to subcontractors that are not similarly situated entities. Any work that a similarly situated entity further subcontracts will count towards the prime contractor's 50 percent subcontract amount that cannot be exceeded. When a contract includes both services and supplies, the 50 percent limitation shall apply only to the service portion of the contract;

(2) Supplies (other than procurement from a nonmanufacturer of such supplies), it will not pay more than 50 percent of the amount paid by the Government for contract performance, excluding the cost of materials, to subcontractors that are not similarly situated entities. Any work that a similarly situated entity further subcontracts will count towards the prime contractor's 50 percent subcontract amount that cannot be exceeded. When a contract includes both supplies and services, the 50 percent limitation shall apply only to the supply portion of the contract;

(3) General construction, it will not pay more than 85 percent of the amount paid by the Government for contract performance, excluding the cost of materials, to subcontractors that are not similarly situated entities. Any work that a similarly situated entity further subcontracts will count towards the prime contractor's 85 percent subcontract amount that cannot be exceeded; or

(4) Construction by special trade contractors, it will not pay more than 75 percent of the amount paid by the Government for contract performance, excluding the cost of materials, to subcontractors that are not similarly situated entities. Any work that a similarly situated entity further subcontracts will count towards the prime contractor's 75 percent subcontract amount that cannot be exceeded.

(f) The Contractor shall comply with the limitations on subcontracting as follows:

(1) For contracts, in accordance with paragraphs (c)(1), (2), (3) and (6) of this clause—

☐ By the end of the base term of the contract and then by the end of each subsequent option period; or

☒ By the end of the performance period for each order issued under the contract.

(2) For orders, in accordance with paragraphs (c)(4) and (5) of this clause, by the end of the performance period for the order.

(g) A joint venture agrees that, in the performance of the contract, the applicable percentage specified in paragraph (e) of this clause will be performed by the aggregate of the joint venture participants.

(1) In a joint venture comprised of a small business protégé and its mentor approved by the Small Business Administration, the small business protégé shall perform at least 40 percent of the work performed by the joint venture. Work performed by the small business protégé in the joint venture must be more than administrative functions.

(2) In an 8(a) joint venture, the 8(a) participant(s) shall perform at least 40 percent of the work performed by the joint venture. Work performed by the 8(a) participants in the joint venture must be more than administrative functions.

(End of Clause)

52.252-2 CLAUSES INCORPORATED BY REFERENCE FEB 1998

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es):

Revolutionary FAR Overhaul - FAR Overhaul - FAR Part Deviation Guidance | Acquisition.GOV

Federal Acquisition Regulation - https://www.acquisition.gov/browse/index/far

Department of Health and Human Services Acquisition Regulation – https://www.acquisition.gov/hhsar

(End of clause)

52.252-6 AUTHORIZED DEVIATIONS IN CLAUSES NOV 2020

(a)The use in this solicitation or contract of any Federal Acquisition Regulation (48 CFR Chapter 1) clause with an authorized deviation is indicated by the addition of "(DEVIATION)" after the date of the clause.

(b)The use in this solicitation or contract of any Department of Health and Human Services (48 CFR Chapter 3) clause with an authorized deviation is indicated by the addition of "(DEVIATION)" after the name of the regulation.

(End of clause)

The following Department of Health and Human Services Acquisition Regulation clauses also apply:

☐ 352.203-70 ANTI-LOBBYING DEC 2015

☐ 352.208-70 PRINTING AND DUPLICATION DEC 2015

☐ 352.211-3 PAPERWORK REDUCTION ACT DEC 2015

☐ 352.219-71 MENTOR-PROTÉGÉ PROGRAM REPORTING REQUIREMENTS JAN 2010

☐ 352.223-70 SAFETY AND HEALTH DEC 2015

☒ 352.224-70 PRIVACY ACT DEC 2015

☒ 352.226-6 INDIAN ECONOMIC ENTERPRISE SUBCONTRACTING

LIMITATIONS

MAR 2022

☐ 352.227-70 PUBLICATIONS AND PUBLICITY DEC 2015

☐ 352.231-70 SALARY RATE LIMITATION DEC 2015

☐ 352.237-70 PRO-CHILDREN ACT DEC 2015

☐ 352.237-71 CRIME CONTROL ACT – REPORTING OF CHILD ABUSE DEC 2015

☐ 352.237-72 CRIME CONTROL ACT – REQUIREMENTS FOR BACKGROUND

CHECKS

DEC 2015

☐ 352.237-73 INDIAN CHILD PROTECTION AND FAMILY VIOLENCE ACT DEC 2015

352.232-71 ELECTRONIC SUBMISSION OF PAYMENT

REQUESTS

APR 2026

(a) Definitions. As used in this clause –

Payment request means a bill, voucher, invoice, or request for contract financing payment with associated supporting documentation. The payment request must comply with the requirements in FAR 32.905(b) and the applicable payment clause included in this contract.

(b) Submission instructions. Except as provided in paragraph (c) of this clause, the Contractor must submit payment requests electronically using the Department of Treasury Invoice Processing Platform (IPP) or successor system. Information regarding IPP, including IPP Customer Support contact information, is available at www.ipp.gov or any successor site.

(c) Alternate submission procedures. The Contractor may submit payment requests using other than IPP only when the Contracting Officer authorizes alternate procedures in writing.

(d) Submission of alternate payment procedures authorization. If alternate payment procedures are authorized, the Contractor shall include a copy of the Contracting Officer’s written authorization with each payment request.

(End of clause)

352.239-74 ELECTRONIC AND INFORMATION TECHNOLOGY

ACCESSIBILITY

DEC 2015

(a) Pursuant to Section 508 of the Rehabilitation Act of 1973 (29 U.S.C. 794d), as amended by the Workforce Investment Act of 1998, all electronic and information technology (EIT) supplies and services developed, acquired, or maintained under this contract or order must comply with the “Architectural and Transportation Barriers Compliance Board Electronic and Information Technology (EIT) Accessibility Standards” set forth by the Architectural and Transportation Barriers Compliance Board (also referred to as the “Access Board”) in 36 CFR part

1194. Information about Section 508 is available at http://www.hhs.gov/web/508. The complete text of Section 508 Final Provisions can be accessed at http://www.access-board.gov/guidelines-and-standards/communications-and-it/about-the-section-508-standards.

(b) The Section 508 accessibility standards applicable to this contract or order are identified in the Statement of Work or Specification or Performance Work Statement. The contractor must provide any necessary updates to the submitted HHS Product Assessment Template(s) at the end of each contract or order exceeding the simplified acquisition threshold (see FAR 2.101) when the contract or order duration is one year or less. If it is determined by the Government that EIT supplies and services provided by the Contractor do not conform to the described accessibility standards in the contract, remediation of the supplies or services to the level of conformance specified in the contract will be the responsibility of the Contractor at its own expense.

(c) The Section 508 accessibility standards applicable to this contract are:

Federal Information Security Modernization Act (FISMA)

Health Insurance Portability and Accountability Act (HIPAA) National Institute of Standards and Technology (NIST) guidelines and controls (including

NIST SP 800 series as applicable) HHS and IHS information security and privacy policies Applicable Federal Information Processing Standards (FIPS)

(d) In the event of a modification(s) to this contract or order, which adds new EIT supplies or services or revises the type of, or specifications for, supplies or services, the Contracting Officer may require that the contractor submit a completed HHS Section 508 Product Assessment Template and any other additional information necessary to assist the Government in determining that the EIT supplies or services conform to Section 508 accessibility standards. Instructions for documenting accessibility via the HHS Section 508 Product Assessment Template may be found under Section 508 policy on the HHS Web site: (http://www.hhs.gov/web/508). If it is determined by the Government that EIT supplies and services provided by the Contractor do not conform to the described accessibility standards in the contract, remediation of the supplies or services to the level of conformance specified in the contract will be the responsibility of the Contractor at its own expense.

(e) If this is an Indefinite Delivery contract, a Blanket Purchase Agreement or a Basic Ordering Agreement, the task/delivery order requests that include EIT supplies or services will define the specifications and accessibility standards for the order. In those cases, the Contractor may be required to provide a completed HHS Section 508 Product Assessment Template and any other additional information necessary to assist the Government in determining that the EIT supplies or services conform to Section 508 accessibility standards. Instructions for documenting accessibility via the HHS Section 508 Product Assessment Template may be found at http://www.hhs.gov/web/508. If it is determined by the Government that EIT supplies and services provided by the Contractor do not conform to the described accessibility standards in the provided documentation, remediation of the supplies or services to the level of conformance specified in the contract will be the responsibility of the Contractor at its own expense.

(End of clause)

The following local Indian Health Service, Navajo Area terms also apply:

NAIHS-ACQ-09 UNAUTHORIZED COMMITMENTS NOV 2025

(a) Definitions.

Contracting Officer means a person with the authority to enter into, administer, and/or terminate contracts and make related determination and findings.

Ratification means the act of approving an unauthorized commitment by an official who has the authority to do so.

Unauthorized Commitment (UAC) means an agreement that is not binding solely because the Government representative who made it lacked the authority to enter into that agreement on behalf of the Government.

(b) Policy.

The Government is not bound by agreements with, or contractual commitments made to, prospective contractors by individuals who do not have delegated contracting authority. Unauthorized commitments do not follow the appropriate process for the expenditure of Government funds. Consequently, the Government may not be able to ratify certain actions, putting a contractor at risk for taking direction from a Federal official other than the contracting officer (see FAR 1.403-2). Government employees responsible for unauthorized commitments are subject to disciplinary action. Contractors perform at their own risk when accepting direction from unauthorized officials. Failure to follow statutory and regulatory processes for the expenditure of Government funds is a very serious matter.

(c) Procedure.

Any agreement, modification, or change to a contractual agreement made by a government personnel who lack authority will be deemed an unauthorized commitment. The Government is not liable to the Contractor or under the terms of the contract, financially or otherwise – unless the unauthorized commitment successfully passes the ratification process.

The ratification process does not have any lead time, nor does the Government make any promise that an unauthorized commitment will be ratified and, therefore, the Contractor would be paid. The Contractor proceeds at its own risk if any of the terms of the contract are altered, changed, or modified without the written concurrence by a Contracting Officer.

NAIHS-ACQ-18 COVERED ENTITIES AND BUSINESS

ASSOCIATES

APR 2025

The Standards for Privacy of Individually Identifiable Health Information ("Privacy Rule") establishes, for the first time, a set of national standards for the protection of certain health information. The U.S. Department of Health and Human Services ("HHS") issued the Privacy Rule to implement the requirement of the Health Insurance Portability and Accountability Act of 1996 ("HIPAA").1 The Privacy Rule standards address the use and disclosure of individuals' health information—called "protected health information" by organizations subject to the Privacy Rule

— called "covered entities," as well as standards for individuals' privacy rights to understand and control how their health information is used. Within HHS, the Office for Civil Rights ("OCR") has responsibility for implementing and enforcing the Privacy Rule with respect to voluntary compliance activities and civil money penalties.

A major goal of the Privacy Rule is to assure that individuals' health information is properly protected while allowing the flow of health information needed to provide and promote high quality health care and to protect the public's health and well being. The Rule strikes a balance that permits important uses of information, while protecting the privacy of people who seek care and healing. Given that the health care marketplace is diverse, the Rule is designed to be flexible and comprehensive to cover the variety of uses and disclosures that need to be addressed.

Individuals, organizations, and agencies that meet the definition of a covered entity under HIPAA Rules at 45 CFR

160.103 must comply with the Rules' requirements to protect the privacy and security of health information and must provide individuals with certain rights with respect to their health information. If a covered entity engages a business associate to help it carry out its health care activities and functions, the covered entity must have a written business associate contract or other arrangement with the business associate that establishes specifically what the business associate has been engaged to do and requires the business associate to comply with the Rules’ requirements to protect the privacy and security of protected health information. In addition to these contractual obligations, business associates are directly liable for compliance with certain provisions of the HIPAA Rules.

Under this contract the contractor and its employees agree to the Business Associate Agreement labeled as Attachment C that has been incorporated into this solicitation or contract.

NAIHS-ACQ-20 PROTECTING FEDERAL EMPLOYEES AND

THE PUBLIC FROM EXPOSURE TO TOBACCO

SMOKE IN THE FEDERAL WORKPLACE

APR 2026

In accordance with Executive Order 13058 “Protecting Federal Employees and the Public from Exposure to Tobacco Smoke in the Federal Workplace,” and the Assistant Secretary for Health memorandum “Prohibition of Tobacco Use in HHS Occupied Facilities,” the use of tobacco products, in any form, is strictly prohibited at IHS-operated properties including, but not limited to:

1. All interior and exterior spaces of IHS-operated properties.

2. All HIS-operated spaces in multi-tenant buildings.

3. All Government vehicles regardless of their location.

4. Private vehicles while on IHS property.

The IHS continues to recognize the value and efficacy of patients’ traditional beliefs and ceremonial practices. The use of tobacco products for ceremonial purposes is allowed in the designated traditional healing room, including any space designated for a ceremony, or in a patient’s hospital room.

To the maximum extent practicable, Contractor must notify the Contracting Officer’s Representative in advance of using tobacco products in a ceremony.

SECTION D – DOCUMENTS, EXHIBITS, ATTACHMENTS, ETC.

Attachment A – Statement of Work

Attachment B – Indian Health Service Buy Indian Act Indian Economic Enterprise Representation Form

Attachment C – Business Associate Agreement

Evidence Based Clinical Support, Gallup Service Unit

Statement of Work: Software License for Evidenced-Based Clinical Criteria

Background:

The Gallup Indian Medical Center, Gallup Service Unit (GSU), Gallup NM, is a 127-bed health care facility, which operates 24 hours a day, seven days a week. This project is located at the following location:

Gallup Indian Medical Center 516 East Nizhoni Blvd Gallup, NM 87301 Phone: 505-722-1000

GIMC requires a contractor to provide a site-hosted, evidence-based clinical criteria software and license for use in a hospital utilization review process. The software should be easy to use and allow for expedited work flow.

The software should allow users to evaluate clinical criteria for the following:

1. Observation services

2. Inpatient admissions

3. Continued inpatient stays

4. Evaluation of discharge planning

5. Evaluate ambulatory surgical services for appropriateness of setting

6. Determine appropriate transition of care to rehabilitation care services, subacute services, and skilled nursing services.

7. Evaluate substance use disorders and appropriate transition of care.

8. Evaluate transition of care needs utilizing CMS Durable Medical Equipment.

9. Retrospective evaluation of risk management and quality care delivery evaluation.

The purpose of the evidenced based clinical criteria is to satisfy the Centers of Medicare and Medicaid Services (CMS) Conditions of Participation (CoPs) for a healthcare organization to have a utilization review process in place. The GIMC Case Management staff will use this evidenced-based criteria for making utilization review decisions. The software is integral to the performance and function of several departments within PIMC. Case Management’s utilization review function is required by Third Party Billing to complete billing information prior to sending in the claim.

Product Scope Description:

The contractor shall provide a Site Hosted software license for an evidenced based clinical criteria for the following area:

1) Inpatient adult

2) Obstetrical

3) Newborn

4) Continued inpatient stays

5) Evaluation of discharge planning

6) Evaluation of ambulatory surgical procedures

7) Imaging

The criteria must utilize evidence-based clinical criteria as the foundation of establishing “medical necessity”, must include the source documentation in the criteria, and must incorporate standards of care in the recommended treatment modalities.

The contractor shall provide evidenced-based clinical criteria for procedures and imaging that are presented in a series of basic and instructional driven questions.

The contractor shall provide comprehensive, clinical evidence-based notations that summarize the standard of care for a specific diagnosis, thus supporting a comprehensive approach to diagnosis and treatment. The notations shall provide an objective source that medical professionals can reference to support their care recommendations for individual patient treatment.

The software shall produce various utilization review reports to include:

• Variance days

• Medical necessity met

• Observation

• Others consistent with UR conditions of participation.

Acceptance Criteria:

1. The contractor shall provide a non-transferable software license for no less than 12 simultaneous users per location to use in the utilization review process. This will be used to determine the medical necessity of inpatient admissions, continued inpatient stays, evaluation of the discharge plan, to determine observation status and to evaluate the appropriateness of ambulatory surgical procedures through standard report options, not custom queries.

2. The contractor shall provide GIMC a site-hosted, interactive software that provides access to criteria and helps automate/streamline the utilization review process.

3. The contractor shall provide software that will allow for searches of relevant criteria by key words, CPT codes, ICD-10 codes. This will act has a guide for establishing defensible admissions and continuing stay positions of the PIMC’s utilization review process, thereby, enhancing third party billing collections. This will be accomplished by decreasing denials and allow for cost controls. Case management staff, third party staff and medical professionals will have access through a web-hosted program.

4. The contractor shall ensure GIMC is provided with the most current and up-to-date evidenced-based clinical criteria software as it becomes available throughout the life of the contract.

5. The contractor shall provide a length-of-stay application and reports with the software for GIMC utilization review programs.

6. The contractor shall provide initial onsite training and other additional training courses that are designed to familiarize end-users with the use of the criteria. These training modules shall be self-paced to accommodate the end-users’ schedules. Training courses will be aligned with the scope of work.

7. The contractor will provide technical IT support services as necessary during the life of the contract. A point of contact shall be designated to ensure ad-hoc maintenance and support services are provided for the proper functioning of the site-hosted software license.

8. The contractor will not access, manage or control Protected Health Information (PHI) or other Personally Identifiable Information (PII)

Minimum Contractor Qualification:

The contractor’s site-hosted evidenced-based clinical criteria shall comply with the State Operations Manual, Regulations and Interpretive Guidelines for Hospitals, 482.30 Condition of Participation: Utilization Review and be in alignment with Centers for Medicare and Medicaid Services (CMS) and the Health Services Advisory Group (HSAG) for determining “Medical Necessity” and “Quality of Care”.

Quality Assurance:

The contractor shall provide software updates to keep current with any changes to standards of care in their evidenced-based clinical criteria for the diagnosis and treatment of diseases as appropriate.

The contractor shall provide training or training resources, at each site, for a minimum of 12 IHS employees and training and support for the application administrator with a focus on report production. Any additional web-based training shall be included in the original quote.

PRIVACY

Privacy & PHI/PHII does apply for this request.

508 Section:

All Information and Communication Technology (ICT) deliverables under this contract (e.g., websites, applications, electronic documents, and multimedia) must comply with the Revised Section 508 Standards (36 CFR Part 1194) and the Web Content Accessibility Guidelines (WCAG) 2.1 Level AA standards. The Contractor shall ensure accessibility of all ICT deliverables and provide conformance documentation in the form of a Voluntary Product Accessibility Template (VPAT®) / Accessibility Conformance Report (ACR), or by completing the HHS Section 508 Accessibility Checklists. The Contractor shall remediate any identified accessibility issues at no additional cost.

Although the Revised Section 508 standards reference WCAG 2.0 Level AA, HHS requires vendors to meet the updated WCAG 2.1 Level AA criteria. The current VPAT 2.5 template includes fields for reporting conformance to WCAG 2.1 and shall be used to document accessibility.

For medical diagnostic equipment (MDE) with information technology components (such as digital displays, software-driven controls, or data interfaces), Section 508 applies to those ICT functions to ensure that individuals with disabilities have equivalent access to the equipment’s electronic information and controls. This requirement is in addition to the accessibility standards established under Section 510 of the Rehabilitation Act, which focus on the physical usability of MDE. Together, Sections 508 and 510 ensure that both the digital and physical aspects of biomedical devices are accessible.

FedRAMP Certification Requirement for Cloud-Based Solutions

If the proposed solution is cloud-based, it must hold a current FedRAMP Certification in accordance with the FedRAMP Consolidated Rules for 2026 (CR26). Quoters/Offerors proposing a cloud-based solution must include documentation confirming the solution's FedRAMP Certification status and applicable Certification Class as part of their quote or proposal. Quoters/Offerors may verify and confirm their solution's FedRAMP Certification status through the FedRAMP Marketplace, the authoritative repository of all FedRAMP Certified cloud service offerings, at:

https://www.fedramp.gov/marketplace/products/

Cloud-based solutions that are not FedRAMP Certified at the time of submission will not be considered for award.

Server-based solutions hosted on Government or facility infrastructure are not subject to this requirement.

Period of Performance:

Base Year: 10/01/2026-09/30/2027 Option year one: 10/01/2027-09/30/2028 Option year two: 10/01/2028-09/30/2029 Option year three: 10/01/2029-09/30/2030 Option year four: 10/01/2030-09/30/2031 https://www.fedramp.gov/marketplace/products/

DEPARTMENT OF HEALTH & HUMAN SERVICES

Indian Health Service

Office of Management Services Division of Acquisition Policy (DAP)

5600 Fishers Lane Rockville, MD 20857

INDIAN HEALTH SERVICE

BUY INDIAN ACT

INDIAN ECONOMIC ENTERPRISE

REPRESENTATION FORM

SOLICITATION/SOURCES SOUGHT/RFI #: _________________________________________________

PROJECT TITLE: ________________________________________________________

DATE: ___________________________________________________________________

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

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

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

(2) At the time of contract award; and

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

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

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

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

REPRESENTATION

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

Name of the 51% owner of IEE Firm

Certifying Signature

Print Name

Name of Federally Recognized Tribal Entity

Business Name

DUNS Number

Appendix___: Business Associate Agreement

I. Authority:

Pursuant to 45 C.F.R. § 164.502(e), the Indian Health Service (IHS), as a covered entity, is required to enter into an agreement with a “business associate,” as defined by 45 C.F.R. § 160.103, under which the business associate must agree to appropriately safeguard Protected Health Information (PHI) that it will use and disclose when performing functions, activities or services pursuant to its contract with the IHS. By signing Contract No. ________ (Contract), _______________ agrees that it is a Business Associate and will comply with the terms below, in addition to other applicable Contract terms and conditions, and applicable law, relating to the safekeeping, use, and disclosure of PHI. This Appendix comprises the Business Associate Agreement (Agreement).

II. Definitions:

The following terms shall have the same meaning as those terms in 45 C.F.R. Part 160 and Part 164, which are the federal regulations implementing the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as amended: Breach, Designated Record Set, Disclosure, Health Care Operations, Individual, Minimum Necessary, Notice of Privacy Practices, PHI, Required by Law, Secretary, Security Incident, Subcontractor, Unsecured PHI, and Use.

A. Business Associate. “Business Associate” shall generally have the same meaning as the term “business associate” at 45 C.F.R. § 160.103, and in reference to the party to this Agreement shall mean ____________.

B. Covered Entity. “Covered Entity” shall generally have the same meaning as the term “covered entity” at 45 C.F.R. § 160.103, and in reference to the party to this Agreement, shall mean the IHS.

C. HIPAA Rules. “HIPAA Rules” shall mean the Privacy, Security, Breach Notification, and Enforcement Rules at 45 C.F.R. Part 160 and Part 164.

D. Master Patient Index (MPI). The “Master Patient Index” or “MPI” is composed of a unique list of patients and a current list of medical centers where each patient has been seen. This enables the sharing of patient data between operationally and regionally diverse systems. Each record (or index entry) on the MPI contains a small amount of patient data used to identify individual entries.

The mission of the MPI is to uniquely identify a patient and to “link” that patient’s data throughout the IHS…