UCF RFP CRHC21-13.pdf

SOLICITATION, OFFER AND AWARD 1. THIS CONTRACT IS A RATED ORDER

UNDER DPAS (15 CFR 7OO)

lATING OF PAG

2. CONTRACT NUIlIBER 3, SOLICITATION NUMBER cRHC21-13

I. TYPE OF SOLICITATION

! senr-eo BtD (tEB) ffi ruecorrRreo lnre;

5. DATE ISSUED

3t23t2021

6. REQUISITION/PURCHASE NUMBER

l{s1421152 7, ISSUED BY CODE 8. ADDRESS OFFER TO (lf other than item 7)

IHS/Cheyenne River Health 242761661h St. Airport Rd., Center Eagle Butte, SD 57625

NOTE: ln sealed bid solicitations "offer" and "offeror" mean ,'bid,'and ,,bidder',.

SOLICITATION

9. Sealed offers in original and 2 copies for furnishings the supplies or services in the Schedule will be received at the place specified in item B, or if hand carried, in the depository located in

CAUTION- LATE Submissions, Modifications, and Withdrawats: See Section L, contained in this solicitation.

(Hou| @ate) Provision No. 52.214-7 or 52.215-1. All offers are subject to all terms and conditions until local time

. E-MAIL ADDRESS

paige.kerstiens@ihs. gov

TABLE OF CONTENTS

OFFER (Must be fully completed bv offeror)

A. NAME

Paige Kerstiens, Purchasing Agent

B. TELEPHONE (NO COLLECT CALL

(x) SEC. DESCRIPTION PAGE(S) (x) SEC- DESCRIPTION )

PARTI-THESCHEDULE PART II. CONTRACT CLAUSES

x SOLICITATION/CONTRACT FORM x ]ONTRACT CLAUSES x U SUPPLIES OR SERVICES AND PRICES/COSTS PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACH, x DESCRIPTION/SPECS,^NORK STATEMENT x J LIST OF ATTACHMENTS

D PACKAGING AND MARKING PART IV. REPRESENTATIONS AND INSTRUCTIONS

X E INSPECTION AND ACCEPTANCE

x K

REPRESENTATIONS, CERTIFICATIONS AND OTHER

STATEMENTS OF OFFERORSx F DELIVERIES OR PERFORMANCE x G CONTRACT ADMINISTRATION DATA x L INSTRUCTIONS, CONDITIONS, AND NOTICES TO OFFERORS x H SPECIAL CONTRACT REQUIREMENTS x M :VALUATION FACTORS FOR AWARD

NOTE: ltem 12 does not apply if the soficitation includes the provisions at 52.214-16, Minimum Bid Acceptance period.

12. ln compliance with the above, the undersigned agrees, if this offer is accepted within calendar days (60 calendar days unless a different peiod is insefted by the otrero) ltom the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the set opposite each item, delivered at the designated point(s), within the time specified in the schedule.

13, DISCOUNT FOR PROMPT PAYMENT \

(See Sectlon t. Clause No. 52.232-8) 7

CALENDAR DAYS(%)

DATE

16. NAME AND THE TITLE OF PERSON AUTHORIZED TO SIGN

ER(Type or pint)

18. OFFER DATE

(The offeror acknowledges receipt of amendments to the SOLICITATION for offerors and related documents numbered and dated):

NAME AND

ADDRESS

OF OFFER

158, TELEPHONE NUMBER

22, AUTHORITY FOR USING OTHER THAN FULL OPEN COMPETITION

f to u.s.c. zso+ 1c; 41 U.S.C. 3304(a) ( )

24. ADMINISTEREO BY (lf other than ltem 7)

26. NAME OF CONTRACTING OFFICER (Type or pnn\

Craig Wells, Cheif Contracting Officer, GPtulHS

AWARD (To be completed by Government)

1. ACCOUNTING AND

PAYMENT WLL CODE

Financelndian Health Service/Great Plains, 115 4th Ave SE, Room 309 Aberdeen, SD 57401

28, AWARD DATE

20 CALENDAR DAYS (O/O) 30 CALENDAR DAYS (%)

T-..1 15C. CHECK tF REMTTTANCE ADDRESS tS

LJ DIFFERENT FROM ABOVE - ENTER SUCH

ADDRESS IN SCHEDULE.

23. SUBMIT INVOICES TO ADDRESS SHO\^/N IN \

(4 copies unless otherwise specified) 2

27. UNITED STATES OF AMERICA

IMPORTANT - Award will be made on this Form, or on Standard Form 26, or

AUTHORIZEO FOR LOCAL REPRODUCTION

Previous edition is unusable STANDARD FORM 33 (REV. 6/2014)

Prescribed by GSA - FAR (48 CFR) 53.214 (c') other authorized official written notice

NOTICE TO QUOTERS

REQUEST FOR QUOTES (RFQ): CRHC21-13

QUOTE DUE DATE: Quotes are due April 8, 2021 @ 1:00 PM MST

RETURN RFQ TO: Cheyenne River Service Unit

Attn: Paige Kerstiens

PO Box 1012

Eagle Butte, SD 57625

Telephone: 605-964-7724 Ext. 1565

Fax: 605-964-1140

GENERAL DESCRIPTION:

Firm Fixed Price, Non-Personal Service Healthcare Contract for OBGYN Services, at the Cheyenne River

Health Center, Eagle Butte, SD.

The Period of Performance will be from Date of Award through One(1) Year, with Four-One(1)Year option periods. Contractor shall perform in accordance with the Performance Work Statement. The government reserves the discretionary authority to exercise any one of the four option years.

The quoted “unit price” shall be an all-inclusive price.

All “inclusive unit price” is defined to include travel, lodging, per diem, fringe benefits, plus all other costs pertinent to the performance of this contract.

This RFQ is issued as a 100% IEE Set Aside and the associated NAICS code is 621111 with a small business size standard of $11 million.

BASIS FOR AWARD:

The basis for award will be based on "Best Value" with trade-offs that takes in consideration the evaluation factors listed below. Therefore, in addition to price the government will consider the evaluation factors in determining the successful quote that represent best value to the government. Under best value principles, there is no requirement that a contract be awarded on the basis of lowest price. Offeror is to bid on the Base Year and each Option Year. IHS reserves the right to make a single award or multiple awards, whichever is most advantages to the Government. This is a competitive solicitation and the offer your firm submits will be used by the Indian Health Service to determine, which offer is the "Best Value" to the government.

Below are the mandatory criteria:

1. TECHNICAL APPROACH AND MANAGEMENT PLAN

Offeror’s technical capabilities shall be assessed based on a demonstrated understanding of the

Performance Work Statement (PWS) requirements. The contractor shall define a technical approach that integrates contract management and contract performance activities, using a multifunctional team, to meet cost and performance objectives in the provision of OBGYN services .

The technical proposal should also include the Offeror’s experience in providing similar services for the

Government and/or commercial interests. The description should include key accomplishments, results, problems encountered and overcome, and the scope of various projects. Offeror’s proposal will be evaluated on the following sub-factors listed below. Offerors must submit the following requested documentation and information in the following format for evaluation:

1.1. Key Personnel:

The Offeror shall submit resumes for all Key Personnel to be utilized in the performance of these requirements. The contractor is to determine and provide a list of key personnel and their proposed role leading significant areas of operation. Offeror shall clearly state which requirements section that the individual being proposed would work in. Also, the Offeror shall certify that the information on each key personnel submitted is true and complete. Resumes of personnel directly involved in providing services under the contract shall be included in the proposal.

The Government understands the natural attrition in staffing a 24/7 group will be a considerable undertaking. The Government must evaluate doing the technical evaluation of the Offeror’s plan to establish and maintain 24/7 services necessary to successfully meet the requirements of the contract without any performance lapse. This requires the Contractor to provide information on candidate’s specialized training and expertise, significant experience that will exemplify contract staff’s knowledge, judgement, adaptability, reliability and personal characteristics to carry out the entire scope of services required. Understanding that, here is the Government’s logic as to who should be identified as key personnel.

Section 2.1 requires the Contractor to identify a point of contact and alternate point of contact (POC) or these responsibilities listed. These POCs identified by the Contractor will be considered as key personnel. An individual may be assigned to more than one of these areas of responsibilities.

Coordination of Network/Software review.

Coordination and submitting of reporting requirements.

Qualified staff to perform services.

Reviewing and approving invoices and supporting documentation and other payment questions.

Providing management an oversight of assigned providers.

Quality Assessment and Performance Improvement Monitor.

Health Information Portability and Accountability Act (HIPAA), Privacy Act (PA), and records management compliance.

Element 1, Each resume shall be limited to the three (3) pages and shall provide the following information:

a. Name, the currency, educational qualification, quality and depth of experience of the proposed personnel.

Element 2, Relative experience and capability of the project manager to function in an environment with the complexity, diversity and inter-department communication and collaboration and to successfully supervise and coordinate the workforce.

The offeror must provide documents/information demonstrating the qualifications of personnel to meet the requirements to include:

1.1. Qualifications of Personnel: The Technical Panel will evaluate each candidate’s personal qualifications.

The offeror must provide documents/information demonstrating the qualifications of personnel to meet the requirements to include:

1.1.1. A listing of all professional staff who will be assigned to perform the required services

1.1.2. Resume of proposed candidate

1.1.3. Copies of degrees; licenses; accreditations

1.1.4. Information regarding candidates’ specialized training and expertise, i.e.: any education, internships, licenses, certifications, or awards.

1.1.6. Professional accomplishments and awards

1.2. Experience: The Technical Panel will evaluate each candidate’s experience:

The offeror must provide the following documents/information demonstrating the experience of personnel to meet the requirements to include:

1.2.1. Years of experience.

1.2.2. Provide information about experience requiring independent function.

1.3. Skills: The Technical Panel will evaluate each candidate’s skills:

The offer must provide information that demonstrates candidate’s specialized skills and expertise.

This includes information regarding:

1.3.1. Provide information on candidate’s specialized training and expertise, that will exemplify contract staff’s knowledge, judgement, adaptability, accuracy to carry out the entire scope of services required.

1.3.3. Furnish a list of three (3) references including phone numbers of persons with direct knowledge of abilities and expertise.

The Key Personnel Section above, except resumes, is limited to 30 pages.

1.4. Contractor’s Management Capabilities and Responsibility: The Technical Panel will evaluate the Contractor’s management and administrative capabilities and responsibility:

The offer must provide information that demonstrates their company’s ability to provide required services and to manage and administer an awarded contract. This includes information regarding:

1.4.1. Provide information that depicts evidence regarding qualifications and experience of the contractor’s company in management positions within the healthcare community. Include information on company’s financial stability. Does management possess the necessary organization and efficiency of operation to provide the personnel and to perform the services in support of an awarded contract?

1.4.2. Provide information regarding quality assurance, i.e., QA monitors, QA plans and QA performance improvement plans.

1.4.3. Provide information that corroborates your company has adequate personnel to provide the required services and has the capability to maintain continuity of service in a timely manner.

Information provided should include recruitment, staffing, back-up and retention plans.

The Management Approach Selection above is limited to 20 pages.

2. RELEVANT PAST PERFORMANCE

2.1. References: The offeror will provide as part of the proposal three separate and recent references with a description of the contract services provided. Identify other Federal, State, or local government contracts, along with private sector contracts, that are of a similar scope, size, and complexity that are ongoing, or that your company has had within the past three years. For each reference, provide the following information:

(a) Contact person’s name, address, phone, e-mail, and fax number

(b) Description of the requirement, contract number, value of contract, award & completion date

(c) Any problems associated with the contract and how you worked to resolve them.

In evaluating the offeror’s past performance, the Government will consider offeror’s record for:

(a) Quality of Service

(b) Customer Satisfaction

(c) Timeliness of Performance

(d) Medical Liability and Malpractice Judgments (past or pending)

(1) Provide proof of current medical liability coverage

(2) Provide documentation of any past or pending malpractice/tort claims (if any)

2.2. Other Sources of Information: Past performance evaluations will be conducted using information obtained from references and from Government online data bases, i.e. Contractor Performance Assessment

Report System (CPARS) data base which is available to all Federal agencies; and any other sources deemed appropriate. While the Government may elect to consider data obtained from other sources, the burden for providing current and complete past performance information rests with the offeror.

2.3. Offers with no relevant past performance history will not be evaluated favorably or unfavorably on past performance. The past performance information obtained will be used for both this evaluation factor and offeror’s responsibility determination.

EVALUATION PROCESS FOR AWARD

(a) The Government will award one or more contracts resulting from this solicitation to the responsible offeror(s) whose offer, conforming to the solicitation, will be most advantageous to the Government, price and other factors considered. The following factors shall be used to evaluate offers:

(1) Technical Approach and Management Plan

(2) Relevant Past Performance

(b) The Government will conduct a best value evaluation to determine offeror(s) for award. In doing so the

Government may award to other than the lowest priced proposal or other than the highest technically rated proposal. It is anticipated that one or more awards will be made. All proposals shall be evaluated based on the following:

RELATIVE IMPORTANCE OF EVALUATION CRITERIA

All evaluation factors other than cost or price, when combined, are more important than cost or price.

Selection of the firm(s) to perform this Contract will be based on IHS’ assessment of the best value to the

Government.

1. RESPONSIBILITY

To be eligible for an award, an Offeror must be determined responsible in accordance with the standards in

FAR Part 9.104.

2. ADJECTIVAL RATINGS

The Technical Evaluation Team will identify strengths, weaknesses, and deficiencies.

Since factors are listed in descending order of importance, as technical ratings and relative advantages and disadvantages become less distinct, difference in price between proposals are of increased importance in determining the most advantageous proposal. Conversely, as differences in price become less distinct, differences in rating and relative advantages and disadvantages between proposals are of increased importance to the determination.

The technical evaluation will be attained through a determination and analysis of strengths, weaknesses, and risks of each proposal. Technical risks will be included in the final evaluation of each factor and will not be evaluated as a separate factor. In the assessment of technical risk, the Government evaluators will consider all available information.

The following is an adjectival rating system that will be used to evaluate Offeror’s proposals:

ADJECTIVAL

RATING

DESCRIPTION

Outstanding Greatly exceeds all minimum requirements of the criteria; has a high probability of success; contains no weaknesses or deficiencies.

Good Exceeds all the minimum requirements of the criteria; has an above average probability of success; contains no significant weaknesses and only minor correctable weaknesses exist.

Acceptable Meets all the minimum requirements of the criteria; has an average probability of success; no significant weaknesses and no deficiencies.

Marginal Fails to meet one or more of the minimum requirements of the criteria; low probability of success; major weaknesses and/or significant number of deficiencies exists.

Unacceptable Fails to meet any of the minimum requirements of the criteria;

proposal needs major revisions; very low probability of success.

3. PRICE EVALUATION

The price proposal shall be evaluated to determine the Offeror's ability to carry out its proposed technical approach and indicate that the Offeror understands the nature and extent of the work to be performed. The total price of each contract line item shall be added together to arrive at an overall total. The total of all options years shall be added together to arrive at an overall evaluated total, which will be evaluated for overall reasonableness of price. Offerors must include the formulas and factors used in calculation of the data.

4. AWARD WITHOUT DISCUSSIONS & COMPETITIVE RANGE DETERMINATIONS

The Government intends to evaluate proposals and award a contract without discussions with Offerors (except for clarifications as described in FAR 15.306(a)). Therefore, the Offeror's initial proposal should contain the

Offeror's best terms from a price and technical standpoint. The Government reserves the right to conduct discussions if the Contracting Officer later determines them to be necessary. In the event discussions are held, a competitive range determination will be made. If the Contracting Officer determines that the number of proposals that would otherwise be in the competitive range exceeds the number at which an efficient competition can be conducted, the Contracting Officer may limit the number of proposals in the competitive range to the greatest number that will permit an efficient competition among the most highly rated proposals.

5. AWARD

An award will be made on a best value basis; both price and other factors considered. An award will be made only in the event that the Offeror's proposal is found to be technically acceptable, based upon the evaluation criteria, and the Offeror is determined responsive and responsible in accordance with the terms and conditions of this solicitation.

INSTRUCTION TO QUOTERS:

To be considered an acceptable quote, the following items must be completed and returned by the due date stated above.

1. Complete and sign SF-33 – Request for Quotation (Signature required)

2. Complete Taxpayer Identification Form (FAR Part 52.204-3 – Taxpayer Identification)

3. Complete Annual Representations & Certifications form (FAR 52.212-5)

4. Evaluation Proposal (Addressing each evaluation element)

5. Cost/Price Proposal

6. Buy Indian Representation Form (Filled out and signed)

ATTACHMENTS:

1. SF-33 Request for Quotations

2. Notice to Quoters

3. Performance Work Statement

4. Clauses incorporated by reference

5. Clauses incorporated in full text

6. Business Agreement

7. Ethics

8. Background Clearance Forms

9. Representations, Certifications, and other statements

10. Buy Indian Representation Form

11. Evaluation factors

12. Price/Cost Schedule

Questions in regards to this solicitation shall be submitted in writing by email to

(Paige.Kerstiens@ihs.gov). The last day to submit questions is April 3, 2021, 1:00pm, MST.

ACCEPTANCE PERIOD: Your quote must stipulate that it is predicated upon all the terms and conditions of this Solicitation. In addition, it must contain a statement to the effect that it is firm for a period of at least 60 days from the date of receipt by the Government.

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

SECURITY CLEARANCE

Performance of this contract will require routine access by employees of the Contractor or its subcontractors to facilities or systems controlled by the Indian Health Service (I.H.S.). Before starting work requiring routine access to I.H.S. facilities or systems each person must complete a FBI National Criminal History Check

(Fingerprint Check) adjudicated by an I.H.S. employee using the Office of Personnel Management Personnel

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

Quotation must set forth full, accurate, and complete information as required by this Request for Quotation

(RFQ), and be returned no later than the date referenced in Block #10 of the Request for Quotation form SF-18.

All required information must be submitted in order to be considered responsive and eligible for award.

Request for Proposal: CRHC 21-13

OBGYN Services – Section B

SERVICES AND PRICES/COSTS

(Fixed-Price, Services, Commercial Items)

Firm Fixed Price, Non-Personal Services, contract, to provide OBGYN Services, for the Cheyenne River

Health Center, located in Eagle Butte, South Dakota. The Period of Performance will be from Date of

Award through One(1) Year, with Four-One(1)Year option periods.

1. BASE YEAR: 07/01/2021 – 06/30/2022

Item

No Descript of Service Estimated

Qty

Unit Unit Price Total Amount

1. High Risk and Routine

Obstetrical and Gynecological

Services

832 HRS $ $

TOTAL Base Year: $

2. OPTION YEAR ONE (1): 07/01/2022 – 06/30/2023

No Descript of Service Estimated

Qty

Unit Unit Price Total Amount

1. High Risk and Routine

Obstetrical and Gynecological

Services

3. OPTION YEAR TWO (2): 07/01/2023 – 06/30/2024

No Descript of Service Estimated

Qty

Unit Unit Price Total Amount

1. High Risk and Routine

Obstetrical and Gynecological

Services

4. OPTION YEAR THREE (3): 07/01/2024 – 06/30/2025

No Descript of Service Estimated

Qty

Unit Unit Price Total Amount

1. High Risk and Routine

Obstetrical and Gynecological

Services

OBGYN Services – Section B

5. OPTION YEAR FOUR (4): 07/01/2025 – 06/30/2026

No Descript of Service Estimated

Qty

Unit Unit Price Total Amount

1. High Risk and Routine

Obstetrical and Gynecological

Services

6. AGGREGRATED TOTALS

TOTALS

1. Base Year (07/01/2021 – 06/30/2022) $

2. Option Year One (07/01/2022 – 06/30/2023) $

3. Option Year Two (07/01/2023 – 06/30/2024) $

4. Option Year Three (07/01/2024 – 06/30/2025) $

5. Option Year Four (07/01/2025 – 06/30/2026) $

AGGREGRATED TOTAL FOR ALL FIVE

YEARS:

OBGYN Services – Section C-H

PERFORMANCE WORK STATEMENT (PWS)

Cheyenne River Health Center (CRHC)

OB/GYN Physician

General

This performance based work statement describes the requirements for non-personal services for

OB/GYN Physician to support the mission of the Indian Health Service (IHS)/Cheyenne River Health

Center (CRHC).

The mission of the Cheyenne River Indian Health Service Hospital in Eagle Butte, South Dakota is to provide the best possible health care services to Cheyenne River Reservation in South Dakota.

Background

The Indian Health Service (IHS) an agency within the Department of Health & Human Services is responsible for providing federal health services to American Indians and Alaska Natives. The Indian

Health Service provides a comprehensive health service delivery system for approximately 1.9 million

American Indians and Alaska Natives who belong to 567 federally recognized tribes, in 35 states. The

Indian Health Service Headquarters is located in Rockville, MD and then divided into twelve physical areas: Alaska, Albuquerque, Bemidji, Billings, California, Great Plains, Nashville, Navajo, Oklahoma, Phoenix, Portland and Tucson.

The Great Plains Area Office (GPAO) works in conjunction with its 19 Indian Health Service Units and

Tribal Managed Service Units to provide health care to approximately 122,000 Native American located in North Dakota, South Dakota, Nebraska, and Iowa. The Area Office’s service units include seven hospitals, eight health centers, and several smaller health stations and satellite clinics.

Our facility, the Cheyenne River Health Center (CRHC), falls under the GPAO. Cheyenne River Health

Center (CRHC) provides medical care for approximately 9,000 tribal members living on the CRST

Reservation. Serving a rural area, many of our patients travel 100 miles’ round trip to receive care. The

CRHC was built in 2011 to provide an expanded level of health care services specifically designed to meet the needs of the CRHC population. Services include: Emergency Room Department, Pharmacy, Physical Therapy, Public Health Nursing, Radiology Services, Inpatient Care, Laboratory, MRI, Dental, Community Health, Contract Health Services, Dietitians, Audiology, Eye Care, Inpatient, Pain

Management, and Specialist Clinics: OB/GYN, ENT, Audiology & Podiatry. The Cheyenne River Sioux

Tribe through a 638 contract with IHS, operates four satellite health stations which offer basic ambulatory services at Cherry Creek, Red Scaffold, Swiftbird, and Whitehorse communities.

Objective

To ensure uninterrupted OB/GYN services, on an as needed basis, for the delivery of patient care in the

Outpatient Department at the Cheyenne River Health Center. The OB/GYN Physician is to provide medical and surgical care to women with particular expertise in pregnancy, childbirth, and disorders of the reproductive system. This includes preventative care, prenatal care, detection of sexually transmitted diseases, pap tests screening, family planning, etc.

Period of Performance

Base Year: July 1, 2021 through June 30, 2022

Option Year 1: July 1, 2022 through June 30, 2023

Option Year 2: July 1, 2023 through June 30, 2024

Option Year 3: July 1, 2024 through June 30, 2025

Option Year 4: July 1, 2025 through June 30, 2026

Work Schedule

The OB GYN Physician will work every Tuesday and Wednesday between 8:00 a.m. and 8:00 p.m. with a ½ hour lunch break. Contract performance shall not be scheduled during Federal Holidays. The contractor is expected to be available during the clinic day. The Contractor may leave before 4:00 p.m.

with the approval of the Clinical Director, providing all scheduled patient care is completed. Hours are subject to change at the discretion of the Clinical Director or Deputy Clinical Director.

Place of Performance

Cheyenne River Health Center

Outpatient Department

24276 166th Street Airport Road

Eagle Butte, South Dakota 57625

DESCRIPTION OF SERVICES: The contractor shall provide OB/GYN Physician services required for the Cheyenne River Indian Health Service Hospital.

This contract is a non-personal health care services contract, as defined at Far Part 37.101 under which the Contractor is an independent contractor and which shall allow the Government to evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of the services rendered, (e.g., professional judgements, diagnosis for specific medical treatment).

The Contractor shall indemnify the Government for any liability producing act or omission by the contractor, its employees and agents occurring during contract performance. The Contractor shall maintain medical liability insurance, in the coverage amount acceptable to the Contracting Officer, which is not less than the amount normally prevailing within the local community for the medical specialty concerned.

Contract physician care shall cover the range of medicine typically provided in a rural civilian practice of similar size. The OB/GYN Physician is to provide medical and surgical care to women with particular expertise in pregnancy, childbirth, and disorders of the reproductive system. This includes preventative care, prenatal care, detection of sexually transmitted diseases, pap tests screening, family planning, etc.

These services shall be comprehensive as the Indian Health Services supplied facilities, equipment and support services permit while complying with JCAHO/CMS accredited standards.

Upon the receipt of an IHS purchase order, the Contractor shall locate, credential, and have available sufficient staffing to provide physician coverage for the OB/GYN Outpatient Department.

The standards of medical practice and duties of the Contractor through its physicians shall be determined pursuant to Governing Body bylaws, medial staff bylaws, rules and regulations of the appropriated IHS hospital, applicable provisions of law including but not limited to rules and regulations of any and all governmental authorities relating to licensure and regulation of physicians and hospitals, and standards and recommendations of CMS (Centers for Medicare and Medicaid Services) compliance. The Contract

Physician(s) shall be required to participate in a quality improvement program, which is consistent with current requirements for ongoing monitoring and evaluation of the quality and appropriateness of care.

CONTRACTOR RESPONSIBILITY

Utilizes RPMS/EHR computer software/program for entering and signing of medical orders such as laboratory studies, and directly signing and dating radiological studies, etc.

The Physicians actual clinical duties will be in accordance with his/her credentialed privileges.

Contract physician care shall cover the range of medicine typically provided in a rural civilian practice of similar size. The OB/GYN Physician is to provide medical and surgical care to women with particular expertise in pregnancy, childbirth, and disorders of the reproductive system. This includes preventative care, prenatal care, detection of sexually transmitted diseases, pap tests screening, family planning, etc.

These services shall be comprehensive as the Indian Health Services supplied facilities, equipment and support services permit while complying with JCAHO/CMS accredited standards.

The services provided the OB/GYN Physician shall include but not limited to Outpatient Care and procedures; colposcopy with biopsy, endometrial biopsy, cryosurgery, vulvar biopsy and

Inpatient/ER/UCC consultation.

The OB/GYN Physician shall provide patients with a full explanation of diagnosis, procedures and treatments.

The OB/GYN Physicians may be involved in health promotion and disease prevention activities by advising patients about the advantages of healthy lifestyles and specific measurers that may prevent recurrences of ill health.

Ensures a safe work environment and employee safe work habits.

Demonstrates competent and effective oral and written communication.

Computer efficiency required. Preferred 5 years of Electronic Health Record experience.

Maintain certification in Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS).

The Contractor shall provide adequate credentialed staff during the regular scheduled services dates and cover the salary for an ancillary staff brought to the service unit. Ancillary staff must have licensure/certification and competencies on file with the Contracting Officer.

REFERRALS AND CONSULTS. The provider shall follow IHS Purchased Referred Care regulations and policies when arranging for a referral or consult. The Physician shall be required to consult with other specialty practitioners for consultative opinions and continuation of care. The provider shall inform patients of the required referral or consult by indicating the specialty involved.

PRESCRIPTIONS. The provider shall use and follow the IHS formulary for prescriptions for all patients.

The formulary list is approved and maintained by the Cheyenne River Health Center Pharmacy and

Therapeutics Committee. Any drug not listed on the formulary must be approved by the Pharmacy and

Therapeutics Committee.

CONTRACTOR TIMESHEETS. The Physician will be responsible for obtaining Medical Records

(HIM) signature prior to CD or representative signature for the completion of their timesheet. Invoices submitted without the signed timesheet including Medical Records (HIM) and CD signatures will not be paid.

PROCEDURE GUIDANCE. Contractor providers shall perform procedures compatible with the medical facility’s operating capacity and equipment.

PRIVACY OF INDIVIDUALLY IDENTIFABLE HEALTH INFORMATION. The Contract health care providers shall provide patients with the utmost care and attention. All patients shall be assured of their privacy and personal dignity. The Contractor shall ensure strict compliance to the release of

Protected Health Information in accordance with the Code of Federal Regulation, Title 45, Public

Welfare, Subtitle A, Department of Health and Human Services, Part 164, Security and Privacy (45 CFR

164) and AFI 41-210, “Patient Administration Functions” paragraph 2.2.3, “Health Insurance Portability and Accountability Act (HIPAA)” and paragraph 2.3, “General Guidelines on Releasing Medical

Information”.

COMMUNICATIONS. The Contractor shall ensure contract providers maintain open and professional communication with members of the Medical Staff. Complaints validated by the Hospital Accreditation

Specialist and Clinical Director or shall be reported in writing to the Contracting Officer (CO) and the

Contractor for action.

ENGLISH LANGUAGE REQUIREMENT. The Contractor provider(s) shall read, understand, speak and write English fluently.

DOCUMENTATIONS. Contractor personnel shall prepare all documentation to meet or exceed established CMS standards and Cheyenne River IHS Medical Staff Bylaws.

AVAILABILITY:

HOURS OF OPERATION: The OB GYN Physician will work every Tuesday and Wednesday between

8:00 a.m. and 8:00 p.m. with a ½ hour lunch break. Contract performance shall not be scheduled during

Federal Holidays. The contractor is expected to be available during the clinic day. The Contractor may leave before 4:00 p.m. with the approval of the Clinical Director, providing all scheduled patient care is completed. Hours are subject to change at the discretion of the Clinical Director or Deputy Clinical

Director.

CONTINUITY OF SERVICES/REPLACEMENT STAFF. The Contractor point of contact shall ensure qualified personnel are available to provide coverage at all times and will provide makeup days if unable to provide services.

The OB/GYN services are considered vital to the Government and must be continued with the minimal interruption. In order to minimize interrupted services, the incumbent contractor shall exercise its best efforts and cooperation to effect an orderly and efficient transition to a successor.

PERFORMANCE OF SERVICES DURING CRISIS DECLARED BY THE NATIONAL COMMAND

AUTHORITY. On occasion, services may be required to support an activation or exercise of contingency plan outside the normal duty hours. Emergency situations (i.e. accident and rescue operations, civil disturbances, natural disasters) may necessitate the contractor provide increased or reduced with the contractor for the cost of these emergency requirements.

RECORDS. The contractor shall document all patient encounters legibly in the patient medical record.

All documentation shall be timed and dated. Verbal orders are to be used as infrequently as possible. In the event of a major disaster or code all verbal orders are to be signed off immediately following the code or disaster. All Medical Records must be signed by the providers and charge ticket completed at the end of the visit. All Medical Records are to be completed within 24 hours of the provider’s scheduled shift.

All documentation shall meet the current CMS guidelines.

Final payment will be withheld until all medical records are completed by the contract physician.

PERSONNEL REQUIREMENTS

CONTINUING MEDICAL EDUCATION (CME) / CERTIFIED EDUCATION UNITS (CEU)

REQUIREMENTS. Maintain CME and review pertinent journals, books and publications. Health care providers registered or certified by the national/medical associations shall continue to meet the minimum standards for CME to remain current. CME hours shall be reported to the credentials office for tracking by the CD.

LICENSURE/REGISTRATION. Contractor must maintain a current active and unrestricted license in at least one of the 50 United States or US territories.

CERTIFICATION. The Contractor shall be board certified, or board eligible by the American College of

Obstetrics and Gynecology. It is a condition of this contract that all required certification in this statement of work remain current during the life of this contract.

FORMAL EDUCATION. The Physician must have a Medical Doctor (MD) or Doctor of Osteopathic

Medicine (DO) degree from an accredited college or university in the specialty area required to complete the FTE.

EXPERIENCE. The Physician must have a minimum of 3 years of experience in field of primary care, preferably residency trained in Obstetrics and Gynecology to include residency and/or fellowship and show evidence of experience employed as a OB/GYN Physician during this time, prior to beginning performance at Cheyenne River Health Center.

PERFORMANCE-BASED SERVICE DELIVERY SUMMARY. The contractor’s performance will be measured based on the following Performance Requirements. The Performance Requirements will be measured against Government Performance Standards and monitored in accordance with the following

Methods of Government Surveillance or what is known as a Quality Assurance Surveillance Plan (QASP) to determine compliance. A 5% deduction will be assigned to each Performance Requirements not met.

Deductions shall be assessed against individual invoices when services are not performed or do not meet contract requirements. Deductions will be done by the category that was deficient.

Performance Standards

Performance

Task/Requirement

Indicator Standard/(AQL)

Acceptable Quality

Level

Surveillance (QA)

Quality Assurance

Incentive

Completion of documentation of patient record

All patient records must be documented accurately, correctly, and completely within 24 hours of patient visit

100% Random observation and

HIM Report

5% deduction from weekly invoice.

Deductions will increase by 1% in subsequent months.

Prompt and continuous coverage

Agency must provide a competent Mid-

Level to ensure no gaps in coverage.

100% Provider

Schedule

For every shift not covered by

Agency, the shift rate will be deducted from next submitted invoice

Credentialing Agency is allowed 3 business to submit required credentialing documentation

100% Credential Report 5% deduction from weekly invoice.

Deductions will increase by 1% in subsequent months.

Performance Evaluation. If the contractor fails to perform required services at the acceptable quality level, payment may be withheld until the contractor makes corrections. In the event that the contractor fails to perform any required services, the COR will provide written notice of such to the Contracting

Specialist and CCO and the contractor. The Contracting Office will issue the contractor a Contract

Discrepancy Report (CDR). The contractor shall have seven (7) calendar days to provide the Contracting

Office with their response to the CDR. Upon evaluation of the contractor’s response to the CDR for tasks surveilled, the contractor’s payment for the month in which the performance is question occurred will be calculated as outlined above.

Contractor Payment. If the contractor fails to perform required services at the acceptable quality level, payment may be withheld until contractor makes corrections.

Contracting Officer’s Representative Designation

The Contracting Officer Representative (COR) designated for this Project is:

Cheyenne River Health Center

Stephanie Red Elk

24276 166th Street, Airport Road

Eagle Butte, SD 57625

Office: 605-964-7724

Fax: 605-964-0522

The COR is responsible for:

a. Monitoring the Contractor’s technical progress;

b. Interpreting the statement of work;

c. Technical evaluation as required;

d. Technical inspections and acceptance required by this contract; and,

e. Assisting the Contractor in the resolution of technical problems encountered during performance of this contract.

The contractor shall be paid a fixed flat rate of per hour. No differential pay for government holidays, compensation time, and night differential. Holidays and weekends shall be included as part of the work period and considered regular hours.

Quality Assurance Surveillance Plan (QASP). The purpose of the QASP is to provide a government developed system to assure the use of quality assurance methods in the administration of the performance based acquisition standards. The intent is to ensure that the Contractor performs services for the

Cheyenne River Health Center that are provided in accordance with performance requirements set forth in the contract documents, that the government receives the quality of services called for in the contract and that the government only pays for the acceptable level of services received.

The plan provides the basis for the COR to evaluate the quality of the contractor’s performance. The oversight provided for in the contract and in this plan will help ensure that service levels reach and maintain the required levels throughout the contract term. Further, this plan provides the COR with a proactive way to avoid unacceptable or deficient performance and provides verifiable input for the required past performance evaluations.

GOVERNMENT FURNISHED PROPERTY AND SERVICES.

EQUIPMENT/OFFICE. Contract providers shall have joint use of all available equipment for performing services required by this contract. The CRHC will provide office space including a desk, chair, and office supplies. This will also include, but not limited to copy machine, tele-fax machines, and telephone services. The OB/GYN Physician will be authorized to use all areas of the medical treatment facility available to civil service and commissioned personnel in similar positions. The same restrictions apply to the contractor as any other Indian Health Service personnel to use these areas for official business activities only.

PERSONAL PROTECTIVE EQUIPMENT (PPE). The Government will furnish the contract provider(s) with appropriate PPE. The Government will be responsible for any repair, cleaning and inventory required for the PPE. This does not include any type of uniform or laboratory coat.

IDENTIFICAITON CREDENTIALS. The Cheyenne River Health Center will provide each contract provider with the required identification card.

FORMS. The Cheyenne River Health Center will provide required Government forms used in the performance of services.

SUPPLIES. The Cheyenne River Health Center will provide medical and non-medical supplies commonly used in the facility for the care and management of patients and the performance of the requirements of this contract.

HOUSING. Contractor shall be responsible for all applicable Federal, State, and Local Taxes, Meals, Travel/Transportation, lodging, and per diem.

Government Housing: Lodging is available in government housing at prevailing rates, if available, and must be paid by the contractor. There are limited furnished units available for contract employees and prevailing rates range from Single -$34.72 daily, Shared $16.58 daily and

Trailer Pads - $8.00 daily (Rates are subject to change).

Local Hotel: Cheyenne River Motel (605) 964-8888.

SERVICES

ORIENTATION. The Contractor shall ensure that all new contract providers participate in the Cheyenne

River Health Center Facility Orientation with an overlap of services to include one additional day.

Providers must arrive on a Monday-Friday excluding holiday and participate in the orientation, which must be completed in the Monday-Friday timeframe, prior to providing services at the hospital.

Administrative Support. Cheyenne River Health Center will provide normal office administrative support services, to include telephone and utilities.

Patient Scheduling. Facility personnel will assist in patient scheduling. Complete administrative control of the patient shall remain with the facility.

Cheyenne River Health Center will provide all other ancillary personnel services required, including personnel to move patients or equipment.

CONTRACTOR FURNISHED ITEMS AND SERVICES

GENERAL. Except for those items or services specifically stated in Section III to be Government furnished, the Contractor shall furnish everything required to perform this contract in accordance with all of its terms. The Contractor shall provide adequate credentialed staff during the regular scheduled services dates and cover the salary for an ancillary staff brought to the service unit. Ancillary staff must have licensure/certification and competencies on file with the Contracting Officer.

CONTRACTOR OWNED EQUIPMENT. The provider will provide his/her own stethoscope, pen lights, etc., and white physician coat.

INITIAL INSPECTION. Contractor owned equipment will be inspected and approved by the biomedical equipment maintenance section prior to use in the facility.

GENERAL INFORMATION

PERSONNEL.

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

Contract shall identify those times when the alternate shall be the primary point of contact.

CRIMINAL BACKGROUND INVESTIGATION. The Government will conduct at government expense, a state criminal history check on individuals providing direct, unsupervised child care services under this contract. As a minimum, the Contractor shall contact the Cheyenne River Health Center

Contracting Officer for obtaining all necessary forms and directions for filing background check information in writing and electronically on personnel hired at the beginning of the contract. This action shall take place no later than five (5) working days from contract award date. Contractor shall submit completed personnel background check applications within Five (5) business days after award date to the

Contracting Officers for processing. Contractor personnel will be required to be fingerprinted. Requests for personnel hired subsequent to the contact start date shall be submitted to the Government no later than five (5) working days from the employee’s first duty day. Contractor shall provide a list of substitute contract personnel fulfilling contingency situations (i.e. absences of certificated contact personnel).

Names of substitutes and credentials shall be provided 15 calendar days in advance to accomplish background checks. Contractor personnel receiving an unfavorable background check shall not be employed. Cheyenne River Health Center may employ an individual pending completion of successful background checks.

Background checks will be based on fingerprints of individual obtained by a Government law enforcement officer and inquiries conducted through the Federal Bureau of Investigation (FBI) and state criminal history repositories.

Individuals shall have the right to obtain a copy of any background check pertaining to themselves and to challenge the accuracy and completeness of the information contained in the report.

Individuals who have previously received a background check shall provide proof of the check to the

CEO or obtain a new one.

CONFLICT OF INTEREST. The Contractor shall not employ any person who is an employee of the

United States Government if the employment of that person would create a conflict of interest. The

Contractor shall not employ any person who is an employee of HHS (Health and Human Services), unless such a person seeks and receives approval in accordance with the Department of HHS.

APPEARANCE. Employees are expected to comply with reasonable dress, grooming and hygiene standards based on comfort, productivity, health and type of position occupied. Employee attire will be in good repair, and should not be considered offensive, disruptive or unsafe.

Contract providers shall display their identification badge on their outer clothing.

PROTECTIVE CLOTHING. When required and supplied by the Government, the provider shall wear special protective clothing and shoe covers. When duties will be performed in specified areas, a disposable protective hood shall be worn to ensure infection control standards are met. The Government will provide this hood. These items shall remain the property of the Government and shall not be removed from the facility. After use, protective clothing shall be turned in or destroyed as directed by the

Infection Control Policy.

PRIVILEGING REQUIREMENTS. The contract providers’ credentials shall be reviewed by the

Credentialing Specialist and the Credentialing Committee. The Contractor is responsible for ensuring that proposed providers possess the requisite credentials to enable granting of privileges by the Cheyenne

River Health Center Medical Staff sufficient to allow for performance of al tasks identified. Medical

Services cannot be performed by a contract Physician until professional staff membership and the Great

Plains Indian Health Service Governing Body has granted clinical privileges in writing.

Initial applications for clinical privileges, to include credentials action history, malpractice history, and certified true copies of the documents listed below, shall be submitted to the Cheyenne River Health

Center Credentialing Committee, through the Credentialing Specialist, no later than 3 calendar days after receipt of notice of contract award.

a. Copy of valid, current unrestricted state license and applicable Board Certification. (Submission of required with proposal).

b. Documentation of continuing education and training.

c. Current Basic Life Support (BLS), and Advances Cardiac Life Support (ACLS). (Submission required with proposal).

d. A signed consent for release of information.

e. Current copy of Drug Enforcement Agency (DEA) Certificate.

f. A list of all states in which contract provider currently holds or has held a license to practice related services.

g. A current copy of the proposed contract providers professional resume.

h. Certification of current physical examination.