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

The Albuquerque Area Indian Health Service is soliciting proposals under solicitation 75H70726R00002 for professional physician and other ambulatory healthcare services. This unrestricted solicitation seeks local specialty healthcare providers and hospitals to deliver medically necessary inpatient and outpatient services for eligible American Indian and Alaskan Natives through the Purchased/Referred Care program. All services must be performed at the contractor's facility rather than IHS clinics or hospitals. The contract is structured for a base year with options to extend up to a total of 60 months. Award decisions will be based on the most advantageous offer to the government, with a weighted evaluation split equally between price and a combination of technical capability and past performance. Reimbursement is based on the Medicare Like Rate pricing model, where contractors propose a percentage discount or offer above the standard Medicare rate. Providers must maintain Joint Commission accreditation or a CMS equivalent and ensure all professional staff are state licensed and board eligible or certified. Key requirements include strict adherence to the Privacy Act, sensitivity to cross-cultural and language differences, and the necessity of prior authorization for specific high-cost or elective procedures such as organ transplants and non-emergency surgeries. Contractors are prohibited from billing patients for authorized services, as the government serves as the payer of last resort. Proposals must be submitted by February 3, 2027, and must include a completed Standard Form 1449, a Business Associate Agreement, a Provider Contract Summary Sheet, and Provider Certifications. Required documentation also includes evidence of medical malpractice insurance with tail coverage and relevant professional licenses. Claims for payment are processed through a fiscal intermediary, Blue Cross Blue Shield of New Mexico, and require the submission of a CMS 1500, CMS-1450, or ADA claim form along with the original delivery order and an Explanation of Benefits.