Non-Personal Healthcare Services-Physicians & Other Professional Ambulatory Services for PRC Program

Solicitation / RFP / RFQ

This solicitation is for non-personal healthcare services, specifically physicians and other ambulatory health care services, for eligible American Indians and Alaskan Natives (AI/AN) through the Purchase Referred Care (PRC) program. The Indian Health Service (IHS) aims to contract with providers who accept reimbursement rates no higher than the prevailing Medicare Fee Schedule, as per a final rule effective May 20, 2016. Services are not limited to inpatient/outpatient specialty care not available through IHS and must be ordered by a designated IHS Contracting Officer or authorized representative. The contract is non-personal, meaning services are provided independently of government supervision.

• Provision of specialty health care services not available through IHS.

• Services include, but are not limited to, cardiology, orthopedics, radiology, general surgery, oncology, podiatry, dialysis, ophthalmology, urology, renal dialysis, and air ambulance.

• Services must be performed at the contractor's place of business.

• Contractor must provide all necessary personnel, facilities, medical equipment, supplies, and pharmaceuticals.

• Patient care consultation and written instructions are required upon discharge or transfer.

• Specific services require prior authorization from the IHS home service unit, including non-emergency surgery, organ transplantation, durable medical equipment, skilled nursing facility placement, home health care, rehabilitation services, and certain prescribed take-home drugs.

• Contract Type: Indefinite-quantity/indefinite-delivery requirement-type contracts.

• Period of Performance: Begins on the date of award and lasts for one year, with potential for option years, not to exceed a total of 5 years.

• Payment: Based on Medicare Like Rate (MLR) or an IHS "Allowable Amount" if MLR does not exist. Discounts from MLR may be negotiated. IHS is the "payor of last resort," meaning alternate resources (Medicare, Medicaid, private insurance) must be utilized first.

• Offers will be evaluated based on technical and past performance, which are combined and considered equal to price.

• The government will award to the responsible offeror whose offer is most advantageous.

• Evaluation of options will be performed by adding the total price for all options to the total price for the basic requirement.

• Not explicitly stated in the provided sections, but services are for eligible AI/AN beneficiaries.

• The document includes extensive definitions of acronyms and terms (e.g., AI/AN, PRC, MLR, CO, COR).

• Specific clauses regarding confidentiality, sterilization, therapeutic abortions, third-party liability, non-discrimination, medical malpractice, quality of patient care, contractor qualifications, and reporting requirements are detailed.

• The document references several attachments and Federal Register rules, including the IHS Final Rule for Medicare Like Rate (MLR).

Form / Attachment / Pricing Sheet

This document provides instructions on how to file claims with the IHS/PRC Fiscal Intermediary (FI) to ensure timely, accurate, and delay-free processing. It outlines the required documentation and submission procedures.

• Required Documents:
  • Purchase Delivery Order (PDO): Must include an exact match for patient name and provider's EIN/billing address as on the claim. For paperless PDOs, the PDO number must be written on the claim in the appropriate box (Box 23 for CMS-1500, Box 63 for CMS-1450, Box 35 for ADA).
  • Claim Form (CMS-1450, CMS-1500, ADA): Must be complete, legible, and include all related charges with the original PDO. Missing or illegible information may cause payment delays. Additional/late charges require a new PDO.
  • Final Explanation of Benefits (EOB) from every insurance carrier: Must match total charges on the claim, patient name, and dates of service. Denial/remark code descriptions are required; missing codes may delay payment.
• Submission Instructions:
  • Mail the complete packet to the address at the top of the form.
  • Do not fax claims, as faxed copies are often illegible.
  • Submit a W9 form with the claim if you have never filed with the FI before.

This document is crucial for any bidder intending to submit claims for services rendered under this opportunity. It details the specific forms, information, and submission methods required to receive payment, directly impacting the administrative and financial aspects of proposal preparation and contract execution.

Form / Attachment / Pricing Sheet

This document is a checklist designed to assist offerors in ensuring that all acceptable minimum documents are submitted with their proposal, signed by an authorized official.

• Standard Form 1449, Solicitation/Contract/Order for Commercial Items: Requires completion of blocks 17a and 30a-30c, and citation of DUNS# in block 17a. (1 Copy with Original Signature)
• Paragraph B-1.b. (General/Purpose of Contract): Enter the type of Professional Health Care Service. (1 Copy)
• Paragraph B-5.b.1.-5. (Fee Schedule/Pricing): Enter Discount/Offer/No-Show Fee. (1 Copy)
• Paragraph C-3 (FAR 52.212-3 Offeror Representation and Certifications – Commercial Items (JAN 2017)): Complete specific paragraphs on pages 17, 18, 22, and 23, with conditional completion based on SAM.gov updates. (1 Copy)
• Appendix D-2: Business Associate Agreement: Complete fillable items in sections I and IIA. (1 Copy)
• Attachment D-6: Provider Contract Summary Sheet: Complete fillable items and sign. (1 Copy with Original Signature)
• Attachment D-7: Provider Certification: Complete fillable items and sign. (1 Copy with Original Signature)
• Copies of Certifications, Licenses, Medical Malpractice Insurance and Specialty Training: For each provider, if applicable. (1 Copy)

This checklist is crucial for bidders to ensure a complete and compliant proposal submission. Failure to include all required documents and signatures may impact the evaluation and award of the contract. Bidders should use this as a guide to prepare their submission package.

Solicitation / RFP / RFQ

This document is a Request for Proposal (RFP) package for Professional Physician and Other Ambulatory Health Care Services for the Albuquerque Area Indian Health Service. It is an open and continuous RFP for a period of 12 months, running through February 3, 2027.

• The RFP is for Professional Physician and Other Ambulatory Health Care Services.

• Contract Period of Performance: 12 months, through February 3, 2027.

• Proposals should be mailed to: Albuquerque Area Indian Health Service Attn: Shandiin DeWolfe/Patricia Trujillo Division of Contracts & Grants 4101 Indian School Road NE, Altura Bldg. Suite 225 Albuquerque, New Mexico 87110

• The RFP package can also be found on the federal government point of entry (GPE) website at sam.gov.

• Not specified in this document.

• This RFP does not commit the government to pay any costs for proposal preparation and submission.

• The Contracting Officer is the sole individual authorized to commit government funds for this acquisition.

• For questions or guidance, contact Shandiin DeWolfe at 505/256-6755.

• Enclosure: cc: RFP 75H70726R00002

Form / Attachment / Pricing Sheet

This document is a "Quick Start Guide for Entities Interested in Being Eligible for Government Contracts." It provides essential information for entities looking to register in the System for Award Management (SAM) to be eligible for federal contracts.

• What is an Entity?: Defines an "Entity" in SAM and clarifies that registration is free. It also notes that entities previously registered in CCR may already have their information in SAM.
• Your Entity's DUNS Number: Explains the requirement for a DUNS number and provides a link to obtain one for free from D&B, noting it takes 1-2 business days.
• Your Entity's Taxpayer Identification Number (TIN): Details the need for a TIN (or EIN for businesses, SSN for sole proprietors) and provides a link to the IRS for obtaining an EIN. It also mentions that foreign entities not paying U.S. employees may not need a TIN.
• Steps For Registering Your Entity in SAM: Outlines a 10-step process for registering, including going to www.sam.gov, creating an account, selecting entity type, indicating interest in bidding, completing core data (DUNS, TIN, CAGE code, business information, EFT, executive compensation, proceedings), assertions (NAICS, PSC, size metrics, EDI, disaster relief), representations and certifications (FAR, Architect-Engineer, DFARS), and points of contact. It notes that registration becomes active after 3-5 days pending IRS TIN validation.

This guide is crucial for any new or existing entity that needs to register or update its information in SAM to be eligible to bid on government contracts. It clearly outlines the prerequisites (DUNS, TIN) and the step-by-step registration process, including key information required and the timeline for activation. It also directs users to further resources like the SAM User Guide, the SAM website, and the SAM Help Desk for additional assistance.

Form / Attachment / Pricing Sheet

This document is a "CERTIFICATION" form that requires providers to certify their educational background, licensure status, and board certification or eligibility. It is used to verify the qualifications of individuals applying for or providing services.

• Educational Background: Details of graduation from an educational institution, degree/certificate awarded, and year of award.
• Foreign University/Exam: Confirmation of graduation from a foreign university and passing of FLEX or ECFMG exams.
• Licensure Status: Certification regarding termination, suspension, or revocation of medical licenses in any state or U.S. territory, and current suspension status.
• Active Medical Licenses: Fields to list states, license numbers, and issued dates for active medical licenses.
• Inactive Medical Licenses: Fields to list states, license numbers, and issued dates for inactive medical licenses, with a note to include the reason for lapse or inactivity.
• Board Certification/Eligibility: Declaration of board certification or eligibility in a specific specialty.
• Certification Statement: A statement certifying the truthfulness and accuracy of the provided information, referencing the Program Fraud Civil Remedies Act of 1986.
• Signatures: Fields for original signature and typed/printed name of the provider, along with the date.

Bidders may need to complete and submit this form as part of their proposal or to demonstrate the qualifications of their personnel. It ensures that providers meet the necessary educational, licensing, and certification requirements for the opportunity.

Form / Attachment / Pricing Sheet

This document is a "Professional Medical Provider's Contract Summary Sheet" that must be completed and submitted with a proposal. It serves to collect essential information about the medical provider and their facility.

• Provider Information: Facility Name, Street Address, City, State, Zip Code, Billing Address, Telephone, Fax, Medical Specialty.
• Identification: Federal Employee or Tax Identification No. (EIN/TIN), DUNS Number, Medicare Participating Provider status, Medicare Provider Number(s), Medicare Carrier, Prevailing Area, National Provider Identifier (NPI), Medicaid Patient acceptance, and Medicaid Provider Number.
• SAM.gov Registration: Status of registration in SAM.gov (Yes, No, In Process).
• Admitting/Staff Privileges: A section to list hospitals where the provider has admitting and/or staff privileges, including Hospital Name, City, and State.
• Group Practice Details: If applicable, a section to list all providers in a group practice, their EIN/TIN or SSN, Specialty, and whether they will bill independently. A note indicates that a spreadsheet should be attached if there are more than 5 providers.
• Provider Certification: A statement certifying the accuracy of the information and authorizing IHS to verify it.
• Notes: Instructions regarding the use of EIN/TIN or SSN for pricing claims, payment addresses, and the assignment of suffixes for unique billing sites or Medicare numbers. It also references Block No. 26, d, of each IHS 843, Purchase-Delivery Order for Health Services.

This form is critical for any medical provider submitting a proposal. It requires detailed information about the provider's facility, identification, registration status, and operational details. Accurate and complete submission of this form is necessary for the proposal to be considered and for payment processing if awarded the contract.

Form / Attachment / Pricing Sheet

This document, "ORDER FOR HEALTH SERVICES," is a form used by the Indian Health Service (IHS) to order and claim medical services for eligible patients. It serves as an authorization for services and a basis for payment.

• Patient Identification: Details about the patient receiving services.
• IHS Ordering Facility: The facility initiating the order.
• Services Ordered: Specific medical services being authorized (e.g., hospital inpatient, dental, other than hospital inpatient).
• Referral and Authorizing Information: Details regarding the reason for referral, referring IHS physician/dentist, and medical/dental priority.
• Pricing Information: Specifies how the provider will be reimbursed, including options for Medicare rates, other rates, or contract/agreement rates.
• Provider Identification: Information about the healthcare provider receiving the order.
• Provider Classification: Options for classifying the provider (e.g., Small Business, Woman-Owned Small Business).
• Instructions: Guidance for providers on submitting claims and understanding payment policies, including the "payor of last resort" principle.
• Provisions and Clauses: Outlines terms and conditions, including requirements for records, quality of care, discharge summaries, and restrictions on billing patients.

This form is crucial for healthcare providers who may receive orders from the IHS. It details the process for receiving authorization, providing services, and submitting claims for payment. Providers must understand the pricing, payment, and reporting requirements outlined in this document to ensure proper reimbursement and compliance with IHS policies, particularly the "payor of last resort" clause and the requirement to assist patients in applying for alternate resources.

Other / Unclassified

This document is a flowchart outlining the 3-stage process for determining if Contract Health Services (CHS) can pay for a referral medical care.

This document is not a solicitation, SOW, amendment, or Q&A. It provides background information on the eligibility and payment process for CHS, which may be relevant for entities that provide medical services to eligible individuals. It details:

• Stage 1: Individual Qualifications: Eligibility based on tribal membership/ancestry, residency, and prior approval.
• Stage 2: Relative Medical Priorities: Criteria for payment approval, including medical necessity, unavailability of local IHS/Tribal facilities, committee prioritization, and fund availability.
• Stage 3: Approval, Billing, Payment: Steps for applying alternate resources, CHS purchase orders, coordination between providers, and CHS acting as a payer of last resort.

It also clarifies what happens if an application is denied or deferred, and notes that specific services may vary based on funding and demand.

Other / Unclassified

This document contains two distinct Federal Register notices. The first notice, from the Department of Health and Human Services (HHS) Indian Health Service (IHS), is a final rule with comment period regarding payment for physician and other health care professional services purchased by Indian Health Programs. It establishes a methodology and payment rates for the Purchased/Referred Care (PRC) program, aligning with Medicare payment methodologies for physician and non-hospital-based services. The second notice, from the Federal Communications Commission (FCC), modifies the compensation rate plan for Video Relay Service (VRS) providers. It temporarily freezes the compensation rate for smaller VRS providers (handling 500,000 or fewer monthly minutes) at $5.29 per minute for a 16-month period.

• Indian Health Service (IHS) Notice: This notice is highly relevant to healthcare providers and organizations that contract with or provide services to Indian Health Programs, Tribes, or Tribal organizations. It details changes in how these services will be paid for, referencing Medicare payment methodologies and establishing new payment rates. Bidders involved in providing healthcare services to eligible beneficiaries under the IHS PRC program should review this to understand potential impacts on their reimbursement.
• Federal Communications Commission (FCC) Notice: This notice is relevant to Video Relay Service (VRS) providers. It outlines a temporary change in the compensation rate structure for smaller VRS providers, which could affect their revenue and operational planning. Providers participating in the VRS program should be aware of this rate adjustment.

Solicitation / RFP / RFQ

This solicitation is for professional physician and other ambulatory health care services for American Indians and Alaskan Natives (AI/AN) eligible for Purchased/Referred Care (PRC). The Indian Health Service (IHS) aims to contract with providers who agree to accept reimbursement rates no higher than prevailing Medicare rates. Services are for care not available through IHS facilities and will be provided at the contractor's location, not IHS facilities. The contract is non-personal services.

• Provision of specialty health care services not available through IHS.

• Services include, but are not limited to, cardiology, orthopedics, radiology, general surgery, oncology, podiatry, orthotics, prosthetics, dialysis, ophthalmology, eye surgery, urology, and renal dialysis.

• Services must be ordered by a designated IHS Contracting Officer.

• Contractors must adhere to specific medical necessity criteria and may require prior authorization for certain services.

• Cultural awareness and sensitivity to cross-cultural and language differences are expected.

• Medical records must be maintained and protected according to the Privacy Act.

• Contract type: Indefinite-quantity/indefinite-delivery requirement-type contract.

• Period of Performance: Begins on award date and lasts for one year, with options for up to five years total.

• Payment: Based on a Medicare Like Rate (MLR) fee schedule. Discounts or negotiated rates may apply.

• Insurance: Medical liability insurance is required.

• Proposals will be evaluated based on technical and past performance, which are combined and considered equal to price.

• Option prices will be evaluated, and significantly unbalanced option prices may lead to an unacceptable offer.

• Key deadlines and submission instructions are detailed within the solicitation.

• The acquisition is set aside for Small Business.

• NAICS Code: 621111 (Offices of Physicians (except Mental Health Specialists)).

• Size Standard: $16 Million.

• The solicitation incorporates FAR and HHSAR provisions and clauses by reference.

• Specific exhibits and attachments are listed, including Federal Register rules, BAA, IHS forms, and a SAM.gov registration guide.