Source Sought Notice for a Physician Psychiatrist/Child and Adolescent Psychiatristat Pinon Health Center

Form / Attachment / Pricing Sheet

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

• Self-Certification: Offerors must certify whether they meet the definition of an "Indian Economic Enterprise" with "Indian Ownership."
• Eligibility Period: The enterprise must meet the IEE definition at the time of offer, contract award, and throughout the contract performance period. Notification is required if eligibility is lost.
• Documentation: Contracting Officers may require documentation of eligibility, and awards may be subject to protest.
• Registration: Successful Offerors must be registered with the System of Award Management (SAM).
• Penalties: False or misleading information is a violation of law and punishable under 18 U.S.C. 1001 and 31 U.S.C. 3729-3731.
• Required Fields: The form requires the Offeror to provide:
  • Name of Federally Recognized Tribal Entity (if applicable)
  • Name of the 51% owner of IEE Firm
  • Business Name
  • DUNS Number
  • Certifying Signature
  • Print Name

This form is critical for any bidder seeking to participate in opportunities designated for or influenced by the Buy Indian Act. Bidders must accurately complete this form to self-certify their status as an Indian Economic Enterprise. Failure to meet the definition or accurately represent their status can lead to disqualification or penalties. It also highlights the need for SAM registration and potential documentation requirements.

Performance Work Statement (PWS)

This Performance Work Statement (PWS) outlines the requirements for non-personal services for a Physician Psychiatrist/Child and Adolescent Psychiatrist to support the Indian Health Service (IHS) mission of improving the health of American Indians and Alaska Natives.

• Provide outpatient Physician Psychiatrist/Child and Adolescent Psychiatrist services.

• Duties include interviewing and examining patients of all ages, diagnosing mental health conditions, prescribing and monitoring psychiatric medications, providing psychotherapy (individual, family, couple, group), and managing acute and chronic psychiatric conditions.

• Services are to be performed at the Pinon Health Center (PHC) Outpatient department, including the Ambulatory Care (Walk-in) and Teen Clinic. Services may also be required at Chinle Comprehensive Health Care Facility (CCHCF) Outpatient Departments, Emergency Room, and other healthcare facilities within the Navajo IHS Areas of the Chinle Service Unit.

• Off-site locations may include Pinon High School Teen Clinic and community immunization events.

• Contractor shall provide documentation of care using the Chinle Service Unit’s Electronic Health Record (EHR) system.

• Services must be provided in accordance with established standards of care, professional standards, and IHS/Navajo Area/Chinle Service Unit policies and procedures.

• Medical records and documentation must meet IHS Medical Facility, The Joint Commission, and CMS standards for timeliness, legibility, accuracy, content, date, time, signature, and profession.

• Contractor performance will be evaluated based on competency, compliance, patient outcomes, professionalism, credentialing, documentation, and service quality.

• Peer review and Contractor Performance Assessment Reports (CPARs) will be utilized.

• Period of Performance: Flexible, allowing for short-term assignments (13 weeks), one-year purchase orders with two option years, and intermittent support for unplanned needs.

• Place of Performance: Pinon Health Center, Chinle Comprehensive Health Care Facility, and other designated IHS facilities within the Navajo IHS Areas of the Chinle Service Unit.

• Staffing: Contractor must be a board-certified Physician Psychiatrist/Child and Adolescent Psychiatrist with a valid, unrestricted license and DEA license. BLS certification is required; ACLS and PALS are highly recommended.

• Certifications/Licenses: Must possess a fully valid and active license and maintain a current DEA license (Schedule II-V). CPR, BLS, ACLS, PALS certifications are required/recommended.

• Health Requirements: Must provide a fitness for duty certificate and meet immunization requirements (Hepatitis A/B, MMR, Varicella, Tdap/Td, Meningococcal, TB test, Influenza).

• Background Checks: Subject to character investigation (Level I and Level II background checks) via OPM eQIP.

• Insurance: Maintain medical liability insurance of $1,000,000 per occurrence; $3,000,000 aggregate.

• Cultural Awareness: Must be respectful of American Indian and Alaska Native culture.

• IT Skills: Basic knowledge of computer navigation and electronic programs is required. Must utilize IHS information technology systems and adhere to security policies.

• Conduct: Must meet standards in the Federal Code of Conduct.