IHS1519435 - Pawnee IHS Echocardiogram Interpretation Services

Form / Attachment / Pricing Sheet

This document is the "Indian Economic Enterprise Representation Form" required under the Buy Indian Act. It serves as a self-certification for offerors to confirm they meet the definition of an "Indian Economic Enterprise" as defined by HHSAR 326.601. This form is to be submitted in response to a Sources Sought Notice, Request for Information (RFI), or Solicitation.

• Eligibility Criteria: Offerors must meet the definition of an "Indian Economic Enterprise" at the time of offer, contract award, and throughout the contract performance period.
• Representation: Offerors must indicate whether they meet the definition of an "Indian Economic Enterprise" with "Indian Ownership" under the Buy Indian Act.
• Required Information: The form requires the Offeror to provide:
  • Name of Federally Recognized Tribal Entity (if applicable)
  • Name of the 51% owner of the IEE Firm
  • Business Name
  • Certifying Signature
  • UEI Number
  • Print Name

This form is critical for bidders seeking to participate in opportunities designated under the Buy Indian Act. Completing and submitting this form accurately is a mandatory step for self-certification of eligibility. Failure to meet the criteria or provide accurate information can lead to disqualification or penalties. Bidders should also be aware that contracting officers may require further documentation of eligibility, and successful offerors must be registered in the System of Award Management (SAM).

Statement of Work (SOW)

To procure echocardiogram and vascular interpretation services via teleservice for the Pawnee Indian Health Center, Indian Health Services (IHS).

• Interpretation of standard echocardiograms and vascular studies (carotid, venous, and arterial) by teleradiology and direct observation.

• Interpretations to be completed by licensed, trained, and privileged personnel.

• Dictated/transmitted interpretations must be receivable into the current RPMS/EHR system.

• Direct phone access for consultations will be provided.

• Turnaround time for final reports: within 72 hours for routine reports, and 24 hours for urgent reports, beginning upon completion of the exam.

• Base Year: 12 months from date of award (02/01/2026 – 01/31/2027).

• Four (4) option years, each 12 months long, extending through 01/31/2031.

• Routine reports: 72-hour turnaround.

• Urgent reports: 24-hour turnaround.

• Reports must be accurate and complete with all required elements (95% AQL).

• Service/Support must be in accordance with SOW (95% AQL).

• Invoicing must be timely and accurate (95% AQL).

• Services provided Monday through Friday, 8:00 am to 4:30 pm.

• Reports must include patient name, date of birth, and chart number.

• Reports must be compatible with HL7 software package used by IHS.

• Contractor must interface with Government furnished Image Archive and PACS.

• Technologists must be able to access vendor's report database via Internet or Network access.

• Cardiologists must possess a current, valid unrestricted license in a US state, DC, or Puerto Rico.

• Personnel must meet state licensure requirements and maintain ongoing training.

• Cardiologists must be eligible to participate in Medicare and Medicaid programs.

• Contractor must submit a patient data security plan.

• Contractor must provide and complete an Interconnection Security Agreement (ISA).

• Contractor must obtain IHS ISSO Security Clearance.

• Contractor personnel must adhere to security requirements on premises, including escort by IHS official, valid identification, and smoking restrictions.

• Contractor shall not disclose information concerning IHS operations.

• Contractor must provide a designated point of contact (POC).

• Contractor must provide a toll-free telephone number for service calls.

• All digital medical imaging files remain government property.

• Compliance with Section 508 and Accessibility standards is required for electronic information and technology.