OB GYN Physician Services and Support Team

Form / Attachment / Pricing Sheet

This document is the Indian Economic Enterprise (IEE) Representation Form, used in conjunction with 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 required in response to a Sources Sought Notice, Request for Information (RFI), or Solicitation and resultant contract.

• The form requires the offeror to represent whether they meet the definition of an "Indian Economic Enterprise" with "Indian Ownership" under the Buy Indian Act.

• Fields include: Name of Federally Recognized Tribal Entity, Name of the 51% owner of IEE Firm, Business Name, DUNS Number, and Certifying Signature/Print Name.

• It outlines the periods during which the enterprise must meet the definition: at the time of offer, at the time of contract award, and throughout the contract performance period.

• Bidders responding to opportunities that utilize the Buy Indian Act must complete and submit this form.

• Failure to meet the IEE definition or providing false information can lead to penalties and disqualification.

• Offerors must also be registered with the System of Award Management (SAM).

Statement of Work (SOW) / Performance Work Statement (PWS)

To provide onsite Obstetrics and Gynecologic Physician Services and Team Support to the Wagner Indian Health Service (IHS) Health Center, serving patients on the Yankton Sioux Reservation in South Dakota.

• Provide a Board-Certified Obstetrics/Gynecologist (OB/GYN) physician, one (1) Nurse (RN), and one (1) Ultrasound Technician.

• Services to be provided on-site at the Wagner Service Unit, Wagner, SD.

• Services must meet or exceed the American College of Obstetricians and Gynecologists (ACOG) Physician Guidelines.

• The contract physician must be Credentialed and Privileged at a hospital with an Operating/Labor/Delivery Room.

• Services include evaluation, treatment, and management for OB/GYN care, encompassing gestation, childbirth, reproductive disorders, prenatal care, sexually transmitted diseases, pap smears, family planning, and urinary stress incontinence.

• Includes direct patient care (90% of time) and administrative tasks (10% of time).

• Period of Performance: June 1, 2026 through May 31, 2027.

• Place of Performance: Wagner Health Care Center, 111 Washington Ave. NW, Wagner, SD 57380.

• Qualifications: Staff must have current, unrestricted licenses/certifications. Physician must be Board-Certified OB/GYN and certified in Basic Life Support (BLS). Technical proficiency in English is required.

• Training: Mandatory training includes BLS, EHR, IHS Privacy and Information Security Awareness, HIPPA, and Prevention of Workplace Harassment/No Fear.

• Testing: Proof of negative Tuberculosis (PPD) testing, Rubella immunization, and COVID-19 vaccination (or valid exemption) is required.

• Credentialing: Physician must be Credentialed and Privileged at a hospital with an Operating/Labor/Delivery Room.

• Equipment: Contractor to provide an ultrasound machine, maintained on-site.

• Reporting: Various reports required, including Quality Control Plan, licenses, certifications, OIG list verification, insurance proof, training certificates, and contingency plan.

• Billing: Electronic submission of invoice payment requests via the Department of Treasury Invoice Processing Platform (IPP) is required.

• Performance Standards: Evaluation based on Provider Quality, Qualifications of Key Personnel, Scope of Practice/Privileging, Patient Access, Patient Safety, Licensing/Certification, Mandatory Training, and Privacy/HIPAA compliance.