DIGITAL X-RAY SERVICES ON THE ISLAND OF MAUI

REQUEST FOR

DIGITAL

X-RAY SERVICES

ON

THE ISLAND OF MAUI

(CENTRAL MAUI & LAHAINA)

FOR

THE DEPARTMENT OF HEALTH

NOTICE TO ALL OFFERORS

ONLY THOSE VENDORS THAT ARE

HCE COMPLIANT WILL BE CONSIDERED

This is a HiEPRO Solicitation

for Indefinite Quantity

SPECIFICATIONS

BACKGROUND:

The Tuberculosis (TB) Control Branch located on the island of Oahu at Lanakila Health Center, 1700 Lanakila Avenue, Ground Floor, Honolulu, Hawaii, 96817, referred to as the "BRANCH" of the Department of Health coordinates all efforts to contain and prevent the spread of infectious TB disease, and to ultimately eliminate TB as a public health problem in the State of Hawaii.

The BRANCH maintains a state registry in accordance with state law and registers all skin test statewide to ensure all suspected and confirmed cases of TB in the state are reported and followed. Information from this database is also used to provide data information to the Federal Center for Disease Control (CDC) - TB Elimination Office.

The BRANCH provides comprehensive services (education, counseling, screening, testing, and treatment) for individuals suspected to have or diagnosed with latent (dormant) TB infection and infectious active TB disease. The BRANCH, along with the Hawaii Department of Health (DOH) Public Health Nursing (PHN) Branch on the neighbor islands, provides screening and testing for those who require certification (TB Clearance) that they are negative for communicable TB disease, in accordance with State law.

DESCRIPTION OF SERVICES:

To provide digital X-ray services for individuals suspected of having latent TB infection or active TB disease. Maui public health nurses at the Hawaii DOH Public Health Nursing Branch - Maui Unit (TB Control Program), located at State Office Building, 54 South High Street Rm. #301, Wailuku, Maui, Hawaii 96793, (referred to as "PROGRAM"), refer individuals to receive these X-ray services, when ordered by a DOH TB physician. The radiologic services shall include, but not be limited to:

A. Upon request and authorization of TB Physician and PHN, the ability to take the following Chest X-ray images (rates for services should be comparable to most health insurance rates) for the following CPT codes 71045, 71046, 71047 and 71048.

Approximately 450 images per contract period (number of images are approximation, since taking of X-ray is dependent on medical necessity):

Single view chest x-ray to include primarily the PA (posterior-anterior) view, Lordotic, or Lateral.

Approximately 10 images per contract period (number of images are approximation, since taking of X-ray is dependent on medical necessity):

Double view chest x-ray to include: AP (Anterior-posterior) and Left Lateral views for children under 5 years of age.

B. Radiology office sites should be located at Central Maui and/or Lahaina.

C. Ability to digitally transmit chest x-ray images to the BRANCH's PACS over a virtual private network (VPN, this complies with the Health Information and Accountability Act (HIPAA)).

D. Ability to produce CD copy upon request by PROGRAM's physician or PHN a copy of identified patients' chest x-ray(s).

E. Provide hours of operation for services that meets PROGRAM needs including evenings and/or a weekend day.

- Chest X-ray(s) should be completed within five working days of patient

referral by Maui Public Health Nursing office (not including state or federal

holidays).

F. Submit invoices to PROGRAM for services monthly.

G. Ability to process State of Hawaii PCard transaction.

H. Service period is from October 1, 2026 to, and including, September 30, 2027

I. Total cost of X-ray Services (including taxes) should not exceed $49,500.00.

PROGRAM CONTACT INFORMATION

Heidi Taogoshi, Registered Nurse Supervisor- Maui Unit

Public Health Nursing Branch

State Office Building

54 South High Street Rm. #301

Wailuku, Maui, HI 96793

Phone: 984-2128

e-mail: heidi.taogoshi@doh.hawaii.gov

Genevieve Ley, MD, Branch Chief

TB Control Branch- Oahu

1700 Lanakila Avenue, Ground Floor

Honolulu, Hawaii 96817

Phone: (808) 832-5535

Fax : (808) 832-5846

e-mail : Genevieve.ley@doh.hawaii.gov

The undersigned has carefully read and understands the terms and conditions specified in the Specifications and Special Provisions attached hereto; and hereby submits the following offer to perform the work specified herein, all in accordance with the true intent and meaning thereof. The undersigned further understands and agrees that by submitting this offer, 1) he/she is declaring his/her offer is not in violation of Chapter 84, Hawaii Revised Statutes, concerning prohibited State contracts, and 2) he/she is certifying that the price(s) submitted was (were) independently arrived at without collusion.

OFFEROR MUST BE HAWAII COMPLIANCE EXPRESS COMPLIANT AT TIME OF AWARD. ANY VENDOR SUBMISSION THAT IS NOT COMPLIANT AT TIME OF AWARD WILL NOT BE CONSIDERED FOR THIS BID.

OFFEROR'S QUALIFICATION FORM

Please complete this form as fully and explicitly as possible to facilitate evaluation of your firm. Use additional sheets and substantiating documents when necessary.

A. Exact Legal Name of Contractor:

**____________________________________________________________

Exact Legal Name of Company (Offeror)

**If Offeror is a "dba" or a "division" of a corporation, furnish the exact legal name of the corporation under which the awarded contract will be executed:

______________________________________________________________

Street Address _______________________________________________________________

City State Zip Code

Offeror is:

Sole Proprietor Partnership *Corporation Joint Venture

Other _______________________________________

*State of incorporation_____________________________

Hawaii General Excise Tax License I.D. No._____________________

Payment address (other than business address below):

___________________________________________

City, State, Zip Code: ___________________________________________

Business address (street address):

____________________________________________

City, State, Zip Code: ____________________________________________

Subcontractor Name, if applicable

_______________________________________________________________

Street Address

_________________________________________________________________

City State Zip Code

Contact Person Name: _______________________ Cell No. _______________

Telephone No.: ____________________________ Fax No.: _______________

E-mail Address: _______________________________

Experience and Qualifications (attach any additional documents):

Number of years providing radiology services:

Professional Staff Person(s):

Copy of current License or certificate(s) authorizing operations of a

radiological facility:

References:

Offeror shall list at least three references in the State of Hawaii, for whom offeror has or is performing similar services. The State reserves the right to reject an offer submitted by any offeror whose performance on other jobs for this type of service has been proven unsatisfactory.

Respectfully submitted by:

(x) _______________________________________________ Date:___________

Authorized (Original) Signature

____________________________________________________________________

Name and Title (Please Type or Print)

Telephone No.: ______________________________

Fax No.: ____________________________________

E-mail Address: ____________________________________