SoW -ED PHY Services 25 Nov 2025.pdf

Statement of Work

Emergency Department Physician Services

Hopi Health Care Center

17 November 2025

It is the intent of the Hopi Health Care Center (HHCC) to acquire non-personal professional Emergency

Department Physician services as described herein located in Polacca, Arizona. Contractor is requested to provide non-personal professional Physician services for a 12-month base period and four (4) one (1) year option periods. The intent of this contract is to establish a method whereby HHCC can minimize disruptions in clinical services because of staff shortages of the next five (5) years. Also, even when the best plans are laid to hire and retain staff, our remote location makes this difficult and we can have staff shortages despite trying to hire a full-time employee(s). Requests for contractor coverage will be based on the consistently changing needs of the clinic.

Services will be on-needed basis. This location is very rural and planning should be made to ensure that candidate contractors are aware of the sparse lodging, grocery, and entertainment options.

HHCC is a TJC-accredited Critical Access Hospital (CAH) and is the only healthcare facility on the Hopi Reservation (catchment population is approximately 18,000). Hopi Health Care Center currently provides the following services: Emergency Department (24/7); four-bed, short-stay inpatient unit for adult admissions (24/7);

ambulatory medical, dental, physical therapy, optometry, and public health services are operational on business days; onsite pharmacy, laboratory, and radiology services have limited services available 24/7. Additionally, Hopi

Tribal Behavioral Health Services are co-located at HHCC. In CY24, there were more than 80,000 patient visits, including 8,500 Emergency Department visits and 197 admissions.

The overall scope of this contract is recruit and hire a qualified contractor under a Government service contract. The contractor will be expected to have the necessary education, training, licensing, previous work experience and competence in being able to provide the services within the department. Work performance shall be performed according to the requirements and conditions contained in this Statement of Work.

All responses to this solicitation and for candidate submissions shall contain a complete profile and current work history of the candidate(s) presented, including licensure and certifications.

Selected candidate shall undergo the Indian Health Service mandated security clearance requirement prior to commencement of services at the Hopi Health Care Center. The security pre-clearance requirement must be adhered to; the process includes a fingerprint check and a screen check of the physician through the office of the inspector general's exclusion list at http://exclusions.oig.hhs.gov/ .

Please note: The contractor shall provide and identify at least (3) weeks in advance of the scheduled performance date the candidate for the scheduled shift(s). This is due to the Government’s security clearance and credentialing/ and or privileging requirement. To ensure that the candidate is cleared for commencement of services prior to reporting for shift(s).

SHIFTS:

HHCC currently has the following operational hours: Emergency Department services 24 hours 7 days a week.

Specific days may change based upon the needs of HHCC. All services shall be performed at the Hopi Health Care

Center in Polacca, Arizona.

Day shifts: Twelve (12)-hour shifts from 7:00am – 7:00pm seven (7) days per week, inclusive of weekends and federal holidays and a 30-60-minute rest break when feasible. The schedules may be altered by 30 minutes on either end, suiting the individual SERVICE UNIT needs.

Night shifts: Twelve (12)-hour shifts from 7:00pm – 7:00am seven (7) days per week, inclusive of weekends and federal holidays and a 30-60-minute rest break when feasible. The schedules may be altered by 30 minutes on either end, suiting the individual SERVICE UNIT needs.

http://exclusions.oig.hhs.gov/

Typically, shifts are concurrent five (5) to seven (7) day or night stretches. The possibility to work fewer or more concurrent shifts in accordance with the contract physician’s availability and the Service Unit’s agreement. All attempts will be made to limit shift duration to thirteen (13) hours and in the event of extenuating circumstances, a contract physician shall not work more than sixteen (16) consecutive hours.

SHIFTS: Contractors will be expected to abide by the facility’s Uniform Code and shift hour assigned, modalities of charting and care delivery and other rules and regulations of the facility. Work within a designated schedule prepared by the Clinical Director or his/her designee. Any period of absence or changes in the schedule will be communicated with the Clinical Director or his/her designee 15 days prior, except for emergency situations. The Contractor is requested to provide ED Physician Services on an as-needed basis. Shift times and schedules are subject to change based on the medical needs of the patient populace and hospital/clinic operations.

The average daily inpatient census in CY24 was 1.25 patients. Given the limited capacity of the inpatient unit, the inpatient physician will either staff an ambulatory clinic in the afternoon (which are primarily ED follow-up visits), or provide care through the Fast Track service. While supporting the Fast Track service, the inpatient physician is accompanied by a credentialed and privileged Emergency Department physician.

Schedules may be adjusted but will have a 30-minute unpaid lunch break, depending on the needs of the unit, and timing of peak patient care activity. * Government does not pay time taken for lunch. Total shifts worked annually shall be in accordance to the total number of work hours allocated for the year by HHCC.

Thirty (30-60) minute lunch breaks are included in shift hours and Government does not pay time taken for lunch.

The Service Unit shall make every effort to submit a schedule two (2) weeks in advance. Shifts may be cancelled or shortened without time restriction or monetary penalty before the Contractor’s employee arrives for duty.

Unless exempt, medical professionals covered by the Fair Labor Standards Act on a compressed schedule must receive overtime pay for hours worked over 80 in a two week pay period, as defined by the HHS payroll calendar.

PRICING SCHEDULE (Complete Attachment A- Rate Schedule):

The unit price paid to the Contractor shall be considered as payment in full for services provided under this award.

In no way, unless directed by the IHS, shall any provider attempt to bill or collect from any IHS patient, or from any alternate resource for which the patient may be eligible.

Hourly fixed rate shall be inclusive of all other fees (holiday, nights, weekend), including travel expenses, per diem, lodging, all city, state, federal and local taxes, and all miscellaneous costs associated with the provision of services.

The government will pay one flat rate. The Contractor shall be paid only for actual time services are performed under the terms of the contract at the hourly fixed rate.

QUALIFICATION/CERTIFICATION – PROFESSIONAL SERVICES:

Contractor shall provide candidate Physician(s) that have experience with delivering clinical services performed in a rural setting, this is preferred but not required. It is essential that contract physicians must be willing to accept a position in a rural setting. The contractor shall provide the US Government with the qualifications of physicians presented as candidates for assignments, including resume (detail experience in months and years) with references.

Contractor shall provide medical and related professionals with experience for the following:

i. Physician (Family Practice):

a. Current Board Certification or Board Eligible as confirmed by the appropriate and acceptable certifying organization.

b. Years of Experience: Completion of a 2-year or longer residency program in a primary care specialty such as Family Medicine, Emergency Medicine, and/or combined Internal

Medicine/Pediatrics.

c. Minimum Education: Doctorate degree of Osteopathic or Allopathic medicine

d. Recent procedure logs required for privileges to be appointed

e. Current certification in BLS (Basic Life Support) is required.

f. Current certification in ACLS (Advanced Cardiac Life Support) is required.

g. Current certification in ATLS (Advanced Trauma Life Support) is required.

h. Current certification in PALS (Pediatric Advanced Life Support) is required.

i. Applicants must have an active, unrestricted, and free of disciplinary action license as a physician in a State, District of Columbia, the Commonwealth of Puerto Rico, or a Territory of the United

States.

AND

• Current certification by the American Board of Emergency Medicine (ABEM), or American

Osteopathic Board of Emergency Medicine (AOBEM); ABEM- or AOBEM eligibility may be considered for recent (< 3 years) graduates of an ACGME- or an AOA-accredited post-graduate training program in Emergency Medicine.

OR

• Current certification by the American Board of Family Medicine (ABFM), or American

Osteopathic Board of Family Physicians (AOBFP); ABFM- or AOBFP-eligibility may be considered for recent (< 3 years) graduates of an ACGME- or an AOA-accredited post-graduate training program in Family Medicine.

OR

• Current certification by the American Board of Internal Medicine (ABIM) and the

American Board of Pediatrics (ABP); ABIM- and/or ABP-eligibility may be considered for recent (< 3 years) graduates of an ACGME- or an AOA-accredited post-graduate combined training program in Internal Medicine and Pediatrics.

OR

• Current certification by the American Osteopathic Board of Internal Medicine (AOBIM) and the American Osteopathic Board of Pediatrics (AOBP); AOBIM- and/or AOBP-eligibility may be considered for recent (< 3 years) graduates of an ACGME- or an AOA-accredited post-graduate combined training program in Internal Medicine and Pediatrics.

OR

• Current certification by the National Board of Physicians and Surgeons.

Experienced ABEM or AOBEM certified physicians are preferred due to the facility’s limited in-house clinical support. All physician applicants require at least three (3) years of current emergency care experience in an emergency department with an annual volume of at least 10,000 visits. Physicians who are not certified by ABEM or AOBEM should have additional emergency medicine experience, sufficient to demonstrate their ability to serve as the sole provider in this critical access hospital emergency department.

ORIENTATION:

Contract physicians shall participate in facility- and department-specific orientation prior to commencing clinical duties. Orientation is usually accomplished within (2) days. The contract physician is required to have received the necessary background security clearance and have an appointment (through the credentialing and privileging process) prior to commencing orientation. On-site orientation is to commence (2) days prior to candidate(s) working scheduled shift(s).

Each contract physician must complete orientation prior to commencing any clinical duties. Documentation verifying the content of the orientation and a list of the Contractor’s personnel who attended shall be maintained by the Contractor and a copy provided to the Contracting Officer’s Representative (COR). The contract physician should also maintain documentation of having completed orientation.

DUTIES:

The contractor shall be expected to assist and provide services and duties as may be requested for the normal operational requirements for the department and personnel. The contractor shall provide work that is consistent with the guidelines and procedures of the IHS. Failure of the contractor to meet these standards can result in cancellation of this contract. The contractor’s performance and abilities shall be evaluated based upon performance standards that are contained in this statement of work.

The contractor shall prepare and complete in a timely fashion, the medical and other required records for all parties he/she admits or in any way provides care for the hospital or health care facility (Service Unit Medical By-

Laws). Chart notes (EHR documentation) are to be completed on the day services are rendered; however, it may be permissible to allow charting to be completed within 24 hours of clinical encounter. During the performance of their duties, the contractor shall provide for the consistent performance of patient care processes according to the standards for TJC accreditation program within IHS. These standards include: The

Comprehensive Accreditation Manuals for Critical Access Hospitals, and the Laboratory Standards as they represent the scope of services of this contract.

The contract physician shall speak, understand, read and write the English language fluently. The physician should be proficient in typing and have a basic working knowledge and understanding of computer hardware and software applications.

Services shall be periodically assessed and evaluated to ensure medical and health services programs are consistent with current standards of practice.

The contract physician shall consistently ensure confidentiality of all patient medical records. Information contained in these records may not be disclosed to any person or agency, except in accordance with established standards, policies, and procedures. This obligation shall not prevent the disclosure of patient medical records to officials and employees of departments and agencies of the United States US Government acting in performance of official duties pursuant to laws and regulations governing local control of communicable diseases, preventive medicine, and safety programs; to official representative authorized surveying bodies during the conduct of certification and accreditation reviews, or to third party payers to whom the patient has authorized release of information.

Complete administrative control of patient data remains with the US Government. All records produced in the performance of the contract and all evaluations of patients are the property of, and subject to the exclusive control of, the US Government. All records shall be maintained in accordance with medical treatment facility guidelines and standards.

All financial, statistical, personnel, and technical data which is furnished produced or otherwise available to the

Contractor during the performance of this contract are considered confidential business information and shall not be used for purposes other than performance of work under this contract. Such data or information shall not be released nor legal rights claimed by the Contractor without prior written consent of the Contracting Officer. Any presentation of any statistical or analytical materials, or any reports based on information obtained from performance by this contract will be subject to review and approval of the Contracting Officer.

The contractor shall possess a professional medical education from a post-secondary academic institution or be licensed in a field of medical study. The contractor should be proficient in writing, typing and have a basic working knowledge and understanding of computer hardware and software applications. The contractor shall have sufficient knowledge, competence and experience in providing these services on a regular schedule to the Hopi Health Care Center. The contractor shall possess sufficient initiative, interpersonal relationship skills, social sensitivity and appropriate professional behavior such that the contractor can relate constructively to IHS employees, contractors, vendors and individuals from the Native American community. Due to some limited driving requirements, the contractor should have a current, valid state driver’s license from any of the 50 United

States or the Commonwealth of Puerto Rico.

The contractor shall not have any work or health restrictions, which could directly or indirectly interfere with the performance of providing services. The contractor shall maintain acceptable standards of personal hygiene, grooming and professional attire such that their image as a Federal contract employee is compatible with the expectations of the IHS staff.

The contractor shall be required to utilize the electronic health record for chart documentation, after receiving training to enter all lab, x-ray and medication requests.

The Contractor’s employee(s) shall be sensitive to the unique culture factors of the people they treat, which may include use of an interpreter as necessary in communication of services being rendered. Unique cultural factors that may contribute to the patient’s treatment include: use of their language communications; village and tribal customs;

use of traditional healers; isolation; housing conditions and lack of resources.

Contractor may be required to work beyond normal duty hours, on weekends, holidays and after regularly scheduled duty hours on an as needed basis for emergencies or if assigned to inpatient.

Accommodations/Lodging – the Contractor shall provide accommodations or housing allowance for the selected physicians for the duration of the period of performance. Housing availability on HHCC is currently unavailable.

The Hopi Tribe has housing next to our facility, but there may be a wait list for those units. Some of our current contractors rent one of those units and share as roommates. However, they are unfurnished. There is an application for the Tribal Housing called Walpi Housing. No Government housing and no RV Lots are available. Many contractors stay in Winslow about an hour away.

CONDITIONS FOR REMOVAL/REPLACEMENT OF MEDICAL PERSONNEL:

As mutually agreed between the Contracting Officer and the Contractor there may be grounds for removal and/or replacement of a medical personnel.

The Contractor(s) shall be removed from an IHS facility if services are not performed in accordance with terms and conditions of this contract.

The Contractor shall relieve contracted staff within 24 hours of notice and, if a replacement is needed, the replacement should be available within one week of the removal.

CONTRACTOR REQUIREMENTS FOR CREDENTIALS:

Any candidates submitted for credentialing shall undergo Indian Health Service (IHS) mandated security clearance for work on-site at HHCC. The security pre-clearance requirement must be adhered to; the process includes a fingerprint check and a screen check through the Office of the Inspector General's exclusion list at http://exclusions.oig.hhs.gov/ and www.sam.gov (best checked through www.verifycomply.com as this checks all exclusion lists). The clearance and credentialing process may take six (6) weeks or more.

It is the policy of the Indian Health Service (IHS) that all Licensed Practitioners who provide patient care shall be credentialed and privileged through the Medical Staff before providing care. The Contractor and contract physician shall participate in the Credentialing and Privileging process in accordance with the facility’s procedures. The

Contractor is expected to submit all requested materials within (4) business days of receiving the initial request.

The Contractor will be provided copies of current requirements as applicable and updates as they are published.

During the credentialing process, the SERVICE UNIT will request for additional documentation as needed. If the

SERVICE UNIT is unable to Credential and Privilege a contract physician, the Contractor shall work to find a suitable replacement candidate.

The Contractor/Contract Physician shall be prepared to provide the following documents for each physician for

Security clearance and Credentialing and Privileging purposes:

• Current resume

• OF-306 – Declaration for Federal Employment (all questions must be answered and signature with date in 17a is required)

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

• IHS Provisional Access Memo

• Protecting Children from Sexual Abuse in Health Care Settings; complete the Certificate of Completion

• No FEAR Act Training; complete the Certificate of Completion

• Information Systems Security Awareness (ISSA); complete the Certificate of Completion

• OFI-86C form along with two fingerprint cards and applicable state forms

• HHS-745, Section A

• Two IDs (driver’s license and social security card – names must match and be unexpired)

• Educational Certification/License http://exclusions.oig.hhs.gov/ http://www.verifycomply.com/

• Current BLS Certification

• Current ACLS Certification

• Current Board Certification

• Recent procedure logs will be needed for any procedure privileges requested.

• Two forms of unexpired identification with matching full names (e.g., driver’s license and social security card);

• Other trainings as required by SERVICE UNIT

• Any additional documentation as identified during the credentialing and privileging process.

NOTE: No photo submission of forms, please have the original forms scanned and submitted. Wet signature and date are highly recommended. No PDF signatures will be accepted and may result in delay of administrative processing.

For Medical & Professional Contractors, the contractor shall comply with all IHS facility infection control and safety procedures, and standards. During the performance of this contract, the Contractor shall provide for the consistent performance of patient care process according to the standards of The Joint Commission (TJC) and/or

Centers for Medicare Services (CMS) who supplies accreditation to the HHCC hospital. and health centers. These standards shall include: The Comprehensive Accreditation Manual for Critical Access Hospitals, and the Laboratory Standards as they represent the scope of services of this contract.

For Medical& Professional Contractors, the contractor shall complete in a timely fashion, the medical and other required records for patients he/she admits or in any way provides treatment. Chart notes are to be completed on the day services are rendered. The contractor shall abide by the Service Unit Medical By-laws and rules and regulations and meet all credentialing requirements in accordance with the Service Unit Medical Staff By-laws.

Upon award, the selected physician(s) shall undergo Indian Health Service (IHS) mandated security clearance for work on-site for the Hopi Health Care Center. The security pre-clearance requirement must be adhered to; the process includes a fingerprint check and a screen check through the Office of the Inspector General's exclusion list at http://exclusions.oig.hhs.gov/.

MAJOR DUTIES REQUIRED BY THE POSITIONS:

Skill and knowledge of established concepts, principles and practices related to health care assignments and additional training or experience in assessing the conditions of patients, in providing medical care and in advising on health care needs, all with full consideration of mental, emotional and physical factors.

Knowledge of the diagnostic, preventive and therapeutic position related to a variety of medical health care fields to include primary care, OB/GYN, ENT, Pediatric, orthopedics, internal medicine, mental health, dental, emergencies, medicine, minor surgery, nutrition, and hospital medicine.

Assumes responsibility for the diagnosis, care and treatment of inpatient and ambulatory care cases. Admits and manages patients to the inpatient department of HHCC and ability to provide emergency treatment.

Interviews and examines patients, reviews past medical history, and requests and/or performs diagnostic tests and examinations deemed necessary to obtain all possible information related to each case.

Makes preliminary diagnosis, directs, prescribes and/or provides treatment, or arranges for specialized care or patient referral as required. Provides definitive management in all medical categories for cases that do not require referral.

Ability to collect, organize, record and communicate, in a meaningful way, data relevant to primary health assessments including the detailed family and medical history, a physical examination and selective laboratory tests.

Ability to perform special screening and developmental tests and assess routine and specialized laboratory and radiological services.

Assures preparation of appropriate medical records for all patients seen to assure the accumulation and organization of all pertinent clinical data needed to provide comprehensive medical care. Provides other physicians, hospitals and other individuals’ clinical records as required for patient care or reimbursement.

Ability to assess the physical-psychosocial health status of patients and family based upon the knowledge of growth and development patterns and health condition is that require medical management.

Knowledge of human behavior during stressful situations in order to exercise emotional control, tact, patience and reliability in carrying out patient care.

Works closely with Allied Health Professionals (i.e. Social Worker, Public Health Nurse, Health Educator, Discharge Utilization Reviewer, Case Management, etc.) in the provision of broad health program services.

Knowledge of pharmaceuticals in order to recognize their desired effects, side effects and complications of their use.

Knowledge of the availability and use of resources designated as primary care and referral services.

Ability to provide individual and family counseling, guidance and health instruction to help patients to understand how to prevent disease and maintain good physical and mental health.

Knowledge of quality assurance and evaluation process to improve care and facilitate monitoring and program planning.

Ability to provide guidance and leadership to other healthcare providers.

Skill in diplomacy and tact while working in stressful situations.

Skill in working with people from a wide variety of backgrounds and different cultures.

SUPERVISORY CONTROLS

The HHCC Deputy Clinical Director or Chief Medical Officer, or designee, provides primarily administrative supervision. The supervising physician sets overall health care objectives and specifies resources available. The supervising physician provides for clinical supervision on a 24-hour, media and tour of duty coverage. The supervising physician reviews work performance on a periodic basis in order to evaluate proficiency in providing health care, discuss deficiencies and problems encountered, outline and/or approve new or changed practices to be employed, and provides consultation on specific cases and related problems. Work which involves out-of-the-ordinary diagnostic decisions or treatment is discussed with supervisor or supervising emergency department physician who keeps aware of the condition of such patients and all aspects of treatment regimen. Work performance is reviewed for conformance to IHS policy, procedures and accepted professional practices; and the

Quality Assurance improvement Program of the Medical staff of the Service Unit.

Physicians will provide guidance and instruction to the inpatient nursing staff providing services during each shift worked.

Within established guidelines, contractor(s) exercise latitude in planning and carrying out health care assignments and in undertaking new procedures, practices and approaches to extend both services provided and increase individual proficiency. Overall work performance is reviewed jointly by the clinical director/supervising physician for effectiveness in meeting requirements for healthcare services.

DELIVERABLES:

The Contractor is required to provide a copy of each Contractor profile to the Project Officer or Contracting Officer

Representative (or service unit representative(s)) prior to providing services at the Hopi Health Care Center.

Timesheet shall be submitted to the Deputy Clinical Director, Clinical Director, or designee of the Hopi Health

Care Center; the timesheets shall be reviewed for accuracy and certified by signature as accurate and acceptable for payment, then forwarded to the receiving official for further processing of receipt of services through the US

Treasury in IPP.

CONTRACTING OFFICER REPRESENTATIVE (COR) RESPONSIBILITIES:

The Contracting Officer will designate in writing a COR who shall be responsible for:

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

2. Interpreting scope of work

3. Performing technical evaluations required

4. Performing technical inspections and acceptances required by this contract

5. Monitoring funds available for obligation under this contract

6. The resolution of technical problems encountered during performance of this contract

In no event is the COR empowered to change any of the terms and conditions of the contract. Changes in the scope of work, contract price, quantity, and quality or delivery schedule shall be made only by the Contracting

Officer by a properly exercised modification.

The designation of a COR does not authorize or provide a legal right to change any kind of contractual terms regardless of the Contractor’s apparent difficulties in fulfilling contract requirements.

PROJECT OFFICER:

A. The designated Project Officer shall be the Clinical Director of the Hopi Health Care Center.

B. The Project Officer’s responsibilities shall be to coordinate with the provider the technical aspects of this service and the review of performance hereunder. The Project Officer does not have the authority to change or alter the contract amount, terms or conditions.

C. The Project Officer shall review whether services were received as ordered.

D. Upon certification of timesheets, the Project Officer, or designated alternate, will forward the signed timesheets to the receiving official of the Hopi Health Care Center for further processing.

CONTRACTING OFFICER (CO) RESPONSIBILITIES:

The Contracting Officer is the only person delegated the authority to negotiate changes in terms, conditions, or amounts cited in this contract.

Performance Conditions:

The Project Officer will submit schedules of required coverage a minimum of 15 calendar days prior to the first day of coverage requested. In the event the Contractor’s employee is unable to render service on a previously agreed schedule, the Contractor shall provide a minimum seventy-two (72) hour notification to the Project Officer. The

Contractor shall then make a full, good-faith effort to provide coverage with a replacement.

Both parties recognize that on occasion there shall be a need to fill coverage requests with less than a 15-day notice.

In such an scheduling situation, the Contractor shall make a full, good-faith effort to accommodate the request. If the Contractor is unable to meet the emergency scheduling request, they shall immediately notify the Project Officer and those involved in scheduling and provide a suitable replacement. For extenuating and unforeseen circumstances

(e.g., illness or family emergency) must be communicated in a timely manner, with confirmation that the proper

SERVICE UNIT representative and the contract COR and Contracting Specialist have received the communication.

If a Contractor’s employee/candidate fails to arrive at the service unit for a scheduled shift, the Contractor must provide coverage by another provider with temporary, provisional or courtesy privileges approved by the Service

Unit Medical staff and the Governing Body. If no coverage is provided, the Contractor shall be required to pay the IHS for the cost incurred for providing that coverage. Not providing coverage on more than one occasion will be reviewed and discussed by the Chief Medical Officer and the Contracting Officer as to whether there was a compromise of patient care. All compromised situations that arise from lack of patient care by the Contractor shall be referred to the Contracting Officer for action and resolution.

All communication must be inclusive of the appropriate PAO Acquisitions and Service Unit personnel and all email communication must include the contract number in the subject line.

Timesheets:

Timesheet shall be submitted to the Deputy Clinical Director or Clinical Director or designee of the Hopi Health

Care Center; the timesheets shall be reviewed for accuracy and certified by signature as accurate and acceptable for payment. Then Invoicing to be submitted through the US Treasury in IPP.

PAYMENT AND INVOICING INSTRUCTIONS:

Invoices shall be prepared with the following information CLEARLY identified on the invoice:

1. Invoice Date and Number

2. Contract Number

3. Charges for service or products identified BY LINE ITEM Number

4. Brief description of products or services rendered

5. Charges should follow Line Item structure on contract to include Quantity, Unit of Issue, Unit Price, and Total Amount as applicable

6. Dates of Services or Shipment

Invoices shall be prepared and submitted electronically and in accordance with rates and terms as stated in the contract. Invoices shall be submitted electronically in IPP through the US Treasury.

Notification and a copy of the Invoice shall be submitted to:

1. Acquisitions: Michele.Lodge@ihs.gov, A copy of the invoice should be sent electronically to the

Contract specialist(s) at the address listed above.

2. Service Unit Representatives: TO BE DETERMINED AT TIME OF AWARD: A copy of the invoice should be sent electronically to the Service Unit Representative(s) at the address listed above.

ADDENDUM:

A. Pro-Children Act of 1994 The Contractor certifies that it will comply with the provisions of Public Law 103-227, Pro-Children Act of 1994 which imposes restrictions on smoking where federally funded children’s services are provided.

The Act requires that smoking should be prohibited in any indoor facility of portion of a facility owned, leased, or contracted for a used for the routine or regular provision of health care, day care, or early childhood development (Head Start) services to children under the age of 18. Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to $1,000 per violation and/or the imposition of an administrative compliance order on the responsible entity. By submitting an offer and entering into a contractual agreement with the Government, Contractors certify that they will comply with the requirements of the Act. Contractors must obtain the same certification from subcontractors.

B. P.L. 101-630, The Indian Child Protection and Family Violence Prevention Act

Contractors 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. IHS will conduct these investigations following award of a contract. The character investigation may be waived if, in judgment of the Contracting Officer, in consultation with the Personnel

Officer, an investigation has already been conducted and is on file. Until the character investigation has been completed and the Contracting Officer notified of the results, the Contractor must not have unsupervised contact with Indian children.

C. Department of Health and Human Services Tobacco Policy

The Contractor’s employee shall comply with the Department of Health & Human Services Tobacco-

Free Policy (copy available upon request). Contractor’s employee shall not use tobacco products of any kind (e.g., cigarettes, cigars, pipes, and smokeless tobacco) while on any HHS Property- owned or controlled.

D. Indian Child Protection and Family Violence Prevention Act No performance under this contract will be allowed without full compliance with the Indian child protection and family violence prevention act, Public Law 101-630 and the Indian Health Service memo dated February 3, 1997, investigations on child care workers. Contractor shall ensure that proposed providers cooperate with and assist the government in the conduction of any necessary background checks.

E. Crime Control Act of 1990

No performance under this contract will be allowed without full compliance with the crime control act of 1990, Public Law 101-647 and the Indian Health Service memo dated February 3, 1997, investigations on child care workers. Contractor shall ensure that proposed providers cooperate with and assist the government in the conduction of any necessary background checks.

PERFORMANCE BASED ASSESSMENT:

Introduction – Performance Requirements:

A Quality Assurance Surveillance Plan (QASP) has been developed for in-house operations or to implement a service contract. It is designed to aid the PO in providing effective and systematic surveillance of all aspects of professional services. This plan provides for monitoring the contract requirements

The objective of this surveillance plan is to evaluate how the Contractor is performing in key areas. The government is primarily interested in the final service being provided and not in the details of accomplishment.

The principal method of surveillance will be daily in some cases or by use or periodic inspections. Appropriate indicators are provided for recording observations in this type of surveillance.

How to Use the Performance Based Matrix

Each defect observed will be recorded on the tally report. These documents will then become a formal record for later reference. The tally of defects at the end of each clinic or year (dependent on criteria) will be compared to the acceptable number of defects appearing in the surveillance plan. Errors detected by the PO in the course of surveillance will be transmitted to the Contractor or in-house personnel for correction. Notification of errors will take place within five (5) working days. Specifics concerning any errors should be recorded on the tally checklist.

The Contractor or in-house personnel, as applicable, should be asked to initial this record.

Project Officer shall forward a copy of Contractor’s compliance with performance and non- performance compliance reports.

Quality Assurance Surveillance Plan (QASP):

The Government shall monitor the Contractors’ performance through a Quality Assurance Surveillance Plan

(QASP). The QASP is for informational purposes only and not considered part of the contract.

Surveillance systems will include periodic inspection and acceptance of all deliverables as cited in the contract.

PERFORMANCE-BASED MATRIX

Outcome Required Services AQL

Standard

Max Allowable

Degree of Deviation from Requirement/

(AQL)

Normal Method of

Surveillance

Incentives and Deduction from Contract

Price

Physician

Non-Personal

Services Contract

Minimum Qualification for Physician

Contractor shall submit supporting documentation for approval

100% Compliant Government review of contractors documentation for compliance

Incentive: Government approves documentation

De-incentive: Government reject documentation no award, Physician

Non- Personal

Services Contract

Licensure for Physician Contractor shall submit supporting documentation of

Licensure; licensure shall be in good standing and not under investigation.

100% Compliant Government review of contractors documentation for compliance

Incentive: Government approves documentation

De-incentive: Government rejects documentation, payment may be withheld

Physician

Non-Personal

Services Contract

Background Investigation in compliance with Indian

Child Protection and

Family Violence

Prevention Act, Public

Law 101- 630

Contractor shall submit supporting documentation of

Background investigation results

100% Compliant Government review of contractors documentation for compliance

Incentive: Government approves documentation

De-incentive: Government reject documentation no award, Physician

Non-Personal

Services Contract

Immunization

Compliance

Contractor shall submit supporting documentation of

Immunization

Compliance

100% Compliant Government review of contractors documentation for compliance

Incentive: Government approves documentation

De-incentive: Government reject documentation no award

Unacceptable

Performance

In the event of unacceptable performance, lack of professionalism, unacceptable conduct, the

Contractor shall replace personnel

Contractor shall replace personnel within 5 days upon receipt of written notification

90% Compliant Government shall notify the contractor in writing of non- compliance

Incentive: No interruption of performance and positive evaluation documented in governments’ database.

De-incentive: Two (2) occurrences of which the contractor is unable to replace personnel within the time allowance, a cure notice shall be issued and possible termination of contract. Evaluation documenting performance in the national

IHS database.

Long-term shifts fulfilled (Thirteen

(13) week travelers)

Filled long-term work shifts as scheduled by

HHCC. Long Term shifts contractor personnel shall provide at least a 4 week notice so that the position can be filled prior to vacancy.

Contractor shall ensure full shift coverage for long term professional services needs at

HHCC.

100% Government’s review

& written documentation/ notification to

Contractor of non-compliance.

Incentive: No disruption of performance;

positive evaluation documented in government’s database.

De-incentive: Two notices to the contractor, a cure notice shall be issued and possible termination of contract.

Evaluation documented in national IHS database.

Short-term shifts fulfilled (Immediate staffing needs)

Filled short-term work shifts as scheduled by

HHCC.

Contractor shall ensure full shift coverage for short term needs at

HHCC.

95% Same as above Same as above

END OF STATEMENT OF WORK