Mid-Level Provider for Outpatient Department

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.

• Eligibility Requirements: Offerors must meet the definition of an "Indian Economic Enterprise" at the time of offer, contract award, and throughout the contract performance period. Failure to meet these requirements necessitates immediate written notification to the Contracting Officer.
• Self-Certification: The form includes a representation section where the offeror self-certifies whether it meets the definition of an "Indian Economic Enterprise" with "Indian Ownership."
• Required Information: 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 and Print Name
• Legal Consequences: False or misleading information is a violation of law, punishable under 18 U.S.C. 1001, and false claims are subject to penalties under 31 U.S.C. 3729-3731 and 18 U.S.C. 287.
• Additional Requirements: Offerors must also be registered with the System of Award Management (SAM).

This form is critical for any bidder seeking to participate in opportunities designated under the Buy Indian Act. Bidders must accurately complete this form to self-certify their eligibility. Failure to meet the IEE definition or to properly complete this form could disqualify an offeror from consideration for awards under this authority. The form also highlights the ongoing obligation to maintain IEE status throughout the contract performance period.

Solicitation / RFP / RFQ

This solicitation is for a Firm Fixed-Price, Non-Personal Services, Commercial Services Purchase Order for Mid-Level Providers for the Outpatient Department at the Wagner IHS Healthcare Center. The goal is to provide uninterrupted Outpatient Service.

• Provide a minimum of three (3) Outpatient Mid-Level Providers (Certified Nurse Practitioner or Certified Physician Assistant).

• Only one (1) provider will be covering the tour of duty/work schedule at any given time.

• Providers must be able to provide high quality, effective, and efficient care.

• Services include examination, diagnosis, referral, therapy, and patient education.

• Providers must utilize the RPMS/EHR computer software/program.

• Maintain familiarity and comply with all Federal, State, Indian Health Service, CMS regulations, and departmental regulations.

• Follow IHS Purchased Referred Care regulations and policies for referrals and consultations.

• Use the IHS formulary for prescriptions.

• Obtain Clinical Director or representative signature for timesheets; invoices without signed timesheets will not be paid.

• Maintain CME and CEU requirements.

• Possess a current active and unrestricted license in at least one of the 50 United States or US territories.

• Be Nationally Certified by their respective National Professional Board and State Licensed (for Nurse Practitioners and Physician Assistants).

• Have a minimum of 3 years of experience in Family Medicine/General Medicine within the past 36 months.

• Maintain certification in Basic Life Support (BLS).

• Maintain current medical liability insurance.

• Possess computer efficiency, with preferred Electronic Health Record experience.

• Contract Type: Firm Fixed-Price, Non-Personal Services, Commercial Services Purchase Order.

• Period of Performance: 06/20/2026 to 06/19/2027.

• Estimated Value: Not explicitly stated, but the schedule shows 2080 HR.

• Delivery: 06/19/2027.

• Offer Due Date: 07/06/2026 1200 CT.

• Proposals must be submitted by the Offer Due Date.

• Performance will be measured based on Government Performance Standards and monitored via a Quality Assurance Surveillance Plan (QASP).

• Deductions may be assessed for services not performed or not meeting contract requirements.

• A 2% incentive bonus is available for prompt and continuous coverage.

• This acquisition is set aside for SMALL BUSINESS.

• NAICS Code: 561320

• Size Standard: $34 Million

• Offerors must be registered in the System for Award Management (SAM) prior to award.

• A Business Associate Agreement will be enforced and executed upon award.

• Invoices must be submitted through the Invoice Processing Platform (IPP).

• Background checks and health requirements are mandatory for all personnel.

• Indian Preference requirements apply.