Sources Sought - 24/7 Telebehavioral Health Emergency Dept. Support Services

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

This Performance Work Statement (PWS) outlines the requirements for an Indefinite-Delivery/Indefinite-Quantity (IDIQ) firm-fixed-price contract to provide 24/7/365 synchronous audio-video telebehavioral health services to support Emergency Department (ED) operations for specified facilities.

• Provide licensed independent behavioral health clinicians (psychologists, psychiatrists, LCSW, LPC-MH, or equivalent) for real-time telebehavioral health services.

• Services include suicide risk assessment (CSSRS with SAFE-T), crisis stabilization, safety planning (Stanley-Brown), culturally responsive care, interpreter coordination, and placement assistance.

• Provide consultation on medication stabilization for acute psychiatric crises by qualified prescribing providers (psychiatrists, psychiatric nurse practitioners, or psychologists with prescribing privileges).

• Services will be ordered via written task orders, each specifying the period of performance, locations, coverage hours, staffing expectations, reporting cadence, workflows, and performance metrics.

• Response Time: Clinician joins consult within 30 minutes of ED request (≥ 95% of consults).

• Assessment Completion: 100% completion of CSSRS with SAFE-T for applicable encounters unless clinically contraindicated.

• Documentation: All required assessments, safety plans, interpreter use, and disposition recommendations documented in EHR prior to discharge/transfer (100% of encounters).

• Interpreter Access: Services available within 15 minutes of request (≥ 95% of requests).

• Coverage: Maintain 100% required coverage with no unplanned lapses.

• Reporting: Monthly performance reports submitted on time (100% compliance).

• Incident Reporting: Critical incidents reported within 24 hours (100% compliance).

• Remedies: Corrective action plans (CAPs) required for non-compliance, with potential for increased surveillance or staffing changes.

• IDIQ Ordering Period & Task Order Period of Performance: As specified in the solicitation/contract and individual task orders.

• Initial Facilities: Pine Ridge Hospital (SD), Rosebud Hospital (SD), Eagle Butte Hospital (SD), Fort Yates Hospital (ND), Belcourt Hospital (ND).

• Estimated Workload: Approximate monthly consult volumes provided for planning purposes (e.g., Pine Ridge 50, Rosebud 50, Eagle Butte 30, Fort Yates 15, Belcourt 20), but not guaranteed.

• Staffing: Minimum two years of emergency or crisis behavioral health experience; active, unrestricted U.S. state/territory licensure; facility credentialing required; maintain surge staffing capability.

• Security: Pre-clearance, fingerprinting, and adjudication required prior to services; no OIG Exclusions List vendors.

• Compliance: Adherence to Privacy Act, HIPAA, HHS/IHS privacy and security requirements, and applicable clinical standards of care.

• Insurance: Contractor must maintain medical liability insurance; providers must maintain professional liability insurance ($1M per occurrence/$3M aggregate minimum).

• Services: Non-personal services; contractor personnel not supervised by Government personnel.

Form / Attachment / Pricing Sheet

This document is the "Indian Economic Enterprise Representation Form" required by the Buy Indian Act. It serves as a self-certification for offerors to confirm they meet the definition of an "Indian Economic Enterprise" (IEE) 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 IEE definition at the time of offer, contract award, and throughout the contract performance period.
• Notification Requirement: Contractors must immediately notify the Contracting Officer if they no longer meet eligibility requirements.
• 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 subject to penalties.
• Representation Section: Requires the offeror to check a box indicating whether they meet the definition of an IEE with "Indian Ownership."
• Required Fields: Name of Federally Recognized Tribal Entity, Name of the 51% owner of IEE Firm, Business Name, DUNS Number, Certifying Signature, and Print Name.

This form is critical for any bidder seeking to be considered for contracts under the Buy Indian Act. Bidders must accurately complete this form to self-certify their eligibility as an Indian Economic Enterprise. Failure to meet the criteria or accurately represent the business's status can lead to disqualification or penalties.