Healthcare for Homeless Veterans | Transitional Housing with rehabilitation and therapeutic services
Added: Oct 28, 2016 11:13 am REQUEST FOR INFORMATION a. The Veterans Health Administration is requesting potential sources and information concerning the transitional housing and treatment for homeless veterans in Sussex, Newcastle, and Kent counties of Delaware. This is a sources sought and request for information for market research purposes only and is not a solicitation. b. The following information is requested from all companies capable of performing services as stated in the below draft statement of work:     1. Vendors Name     2. Contact information to include telephone number and email address     3. Capability statement     4. Similar contracts     5. Lessons learned from similar past contract experience     6. Socio-economic status I.E. large business, small business, service disabled veteran owned business, veteran owned business, women owned business, 8a, Hub Zone, disadvantaged, etc. STATEMENT OF WORK PURPOSE: CONTRACT RESIDENTIAL SERVICES BEDS The Wilmington Veterans Affairs Medical Center (WVAMC) is seeking Contract Residential Service (CRS) beds for 24 hours a day/7 days a week (24/7). Service provides a community-based early recovery model of supportive housing within the State of Delaware and accessible by public transportation that provides therapeutic and rehabilitative services in a safe environment to homeless, eligible Veterans. The purpose of this Request for Information (RFI) is to obtain availability of contractors who can provide housing, outreach services, case management services, and rehabilitative services within the State of Delaware. The areas of coverage would be for the counties of Sussex, Kent, and New Castle. Service is for Veterans experiencing homelessness and/or conic homelessness as defined by the Housing and Urban Development (HUD), including Veterans diagnosed with severe mental illness and substance use disorders, in community-based residential facilities. BACKGROUND: The VA has been providing direct and specialized services for homeless Veterans for nearly 25 years. The Secretary of the VA has set a zero-tolerance policy for homelessness within the Veteran population. As part of the Plan to End Homelessness among Veterans announced in late 2009, the Veterans Health Administration (VHA) has been increasing both capacity of existing programs and services offered to program participants. The plan calls for utilizing new models of care not previously offered by VA. The Health Care for Homeless Veterans (HCHV) program is authorized by 38 U.S.C. 2031, under which VA may provide care and services under section 1710 of this title to veterans suffering from serious mental illness and to veterans who are homeless. The duties of, and standards applicable to, non-VA community-based providers is authorized by 38 U.S.C. 501, 2031, part 63.15. WVAMC is seeking Contractor(s) to assist with the provision of emergency residential placement and treatment services tough the Health Care for Homeless Veterans program. WVAMC intends to issue a multiple award contract in order to service veterans in all tee counties and all priority groups. Priority groups are male veterans, female veterans, veterans with a sex offender status, and sites that can house families. VA is only able to pay for services provided to the veteran themselves. Contract (s) will not exceed a total of 16 homeless Veterans, who need immediate placement in a safe environment with onsite treatment services. Many of these veterans have co-morbid conditions that include serious mental illnesses, substance abuse disorders, and other medical conditions. The goal of the HCHV Contracted Residential Services (CRS) is to rapidly stabilize Veterans medical, mental health, substance abuse and other psychosocial problems in order to place Veterans in other appropriate transitional or permanent housing within 30 to 90 days, but no more than 180 days. Contractor will provide rapid placement of VA-referred Veterans in a safe, residential treatment setting while addressing Veterans complex needs tough on-site case management and therapeutic support services. This housing must meet the criteria established both by HCHV clinical staff and VA fire and safety officials. NOTE: Contractors are urged in the strongest terms to carefully review the requirements outlined in the Statement of Work to ensure that all facilities fire and safety and treatment services criteria can be met in a timely way. Definitions: Conic Homelessness is defined by HUD in 24 CFR parts 91 and 578 to mean a homeless individual with a disability who lives either in a place not meant for human habitation, a safe haven, or in an emergency shelter, or in an institutional care facility if the individual has been living in the facility for fewer than 90 days and had been living in a place not meant for human habitation, a safe haven, or in an emergency shelter immediately before entering the institutional care facility. In order to meet the conically homeless definition, the individual also must have been living as described above continuously for at least 12 months, or on at least four separate occasions in the last 3 years, where the combined occasions total a length of time of at least 12 months. Each period separating the occasions must include at least 7 nights of living in a situation other than a place not meant for human habitation, in an emergency shelter, or in a safe haven. Contracted Residential Services (CRS) is a community-based early recovery model of supportive housing that serves hard to reach, hard to engage homeless individuals with severe mental illness and substance use disorders. Many have not been able to comply with traditional program requirements resulting in high use of emergency room and acute care services and more Veterans living on the streets or in shelters. CRS places no treatment participation demands on residents but expects a transition from unsafe and unstable street life to permanent housing and to re-engage with treatment services. Contracted Emergency Residential Services (CERS) CERS programs target and prioritize homeless Veterans transitioning from literal street homelessness, Veterans being discharged from institutions, including those in need of medical respite, and Veterans who recently became homeless and require safe and stable living arrangements while they seek permanent housing. CERS Programs provide low demand time-limited services such as supporting mental health stabilization, Substance Use Disorder (SUD) treatment services, enhancement of independent living skills, vocational training, and employment services. In some cases, VA may complement the CERS program with added treatment services; such as participation in VA outpatient programs. Emphasis is placed on referral and placement in permanent housing or longer term residential programs utilizing VA and/or community resources. Lengths of stay in CERS typically range from 30 to 90 days with the option to extend based on clinical need. BASIC SERVICES REQUIRED BY THE CONTRACTOR: PROGRAM REQUIREMENTS: The contractor must provide Contracted Emergency Residential Services (CERS) to male and/or female veterans. Contractor is required to ensure that the facility used for this contract meets the Americans with Disabilities Act (ADA) guidelines for accessible accommodations for Veterans with physical limitations or impairments. No funds will be made available for capital improvements under this contract. All of the facility s CRS rooms must be wheelchair accessible, to include entrances/exits, batoom facilities, and common areas. Veterans must not be segregated from the rest of the facility due to physical disability; they must have the same access to the physical plant as well as the treatment services and supports at the facility as any other resident. The contractor will offer a low-demand environment for CERS with a minimum set of rules designed to re-establish trust and engage the Veteran in needed treatment services as follows: Acceptance of treatment cannot be a condition of admission or continued stay Abstinence from alcohol or drugs cannot be a condition of admission or continued stay Repeated admission or past behavior cannot be a condition of admission or continued stay Demands are kept to a minimum Rules focus on staff and resident safety Infractions of rules are used as opportunities for engagement ROOM AND BOARD: Room and Board shall be accessible to the Veteran 7 days a week and 24 hours per day. Accommodations will include a private or semi-private room (no more than 4 per room) with a bed and other furnishings such as a dresser, storage, and personal linens (towels, pillows, blankets and bed sheets). The environment must be conducive to social interaction, supportive of recovery models and the fullest development of the resident s rehabilitative potential. Residents must be assisted in maintaining an acceptable level of personal hygiene and grooming. The Contractor will allow Veteran to store personal belongings for at least 72 hours after formal HCHV discharge. MEALS: Meals shall meet 2015 dietary guidelines set forth by the U.S. Department of Agriculture and U.S. Department of Health and Human Services, including any updates made to the guidelines. A minimum of two meals per day must be provided in a setting that encourages social interaction. In addition, the contractor must provide the availability of snacks of nourishing quality (e.g. fruits, vegetables, protein sources, etc.), between meals and before bedtime for those requiring or desiring additional food, even when it is not medically indicated. There will not be more than a 14 hour span between evening meal and breakfast of the following day. Contractor will provide alternative meals for Veterans with dietary restrictions if medically indicated (e.g. diabetic, renal and soft mechanical diets) and reasonable accommodation for Veterans with cultural/religious preferences around food (e.g. Kosher, Sikh, etc.). If food in centrally prepared, it shall be prepared, served and stored under sanitary conditions. The contractor shall provide storage space in an onsite refrigerator for Veterans to store and freely access personal food. The contractor shall establish and maintain sanitary procedures for washing dishes, cleaning equipment and work areas, and disposing of waste. GENDER SPECIFIC CARE PROVISIONS Special attention needs to be given to meeting the unique treatment needs of homeless women Veterans. These needs often may include assistance with managing sexual trauma, eating disorders, interpersonal violence, and caring for dependents while in treatment. Special emphasis on privacy and security should be noted in mixed-gender facilities. Veteran residents have a right to be treated with dignity in a humane environment that affords them both reasonable protection from harm and appropriate privacy with regard to their personal needs. The living environments of HCHV CRS must include: Residential room and board in an environment that promotes a lifestyle free of sexual discrimination. An environment conducive to social interaction, supportive of recovery models and the fullest development of the resident's rehabilitative potential regardless of gender or sexual orientation. Separate and secure batoom arrangements to ensure an acceptable level of privacy for personal hygiene and grooming. LAUNDRY FACILITIES: Contractor must provide laundry facilities and necessary detergent free of charge and adequate for residents to do their own laundry or to have laundry done at minimum one time per week. TRANSPORTATION: The Contractor will be expected to help the Veteran access public transportation, including providing information and instructions necessary to enable Veterans to utilize public transportation. If VA Liaison and/or other appropriate VA staff determines that adequate public transportation is not available or appropriate for a Veteran, the Contractor shall provide alternative transport by car or taxi between the hours of 08:00am to 10:00pm. Transportation shall not be a barrier for a Veteran receiving service necessary to reach their treatment goals. Thus, if public transportation isn t appropriate or adequate, then the contractor must have the ability to provide transportation to accommodate scheduled admissions, meetings, housing search, and other appointments in the community and at the local VA facility during business hours and after hours as necessary. VA staff may also assist with logistical burdens. ADDITIONAL SERVICES REQUIRED BY CONTRACTOR: THERAPEUTIC/REHABILITATIVE SERVICES: Each Veteran must have an Individual Treatment Plan (ITP) completed by the Contractor with input from the Veteran and with consultation by VA Liaison and/or other appropriate VA staff within 72 hours of admission. Therapeutic and, as appropriate, rehabilitative services must be provided by the contractor. Therapeutic and rehabilitative services must be stated in the ITP based on the veteran s needs. Contractor must provide: Group Activities: Structured group activities, as appropriate, shall occur at a minimum of two times per month examples include group therapy, life skills training, social skills training, financial workshops, Alcoholics Anonymous, Narcotics Anonymous, vocational counseling and recreational activities. For the purposes of this contract House Meetings and VA Housing Resource Groups may not be counted as a structured group activity. Group Activities should have a therapeutic value and facilitation shall be the responsibility of the Contractor. Should a Veteran have mental health, medical, family and/or employment obligations which directly conflicts with their ability to participate with group activities as stated in their ITP, alternate group activities will be arranged and/or the Contractor will clearly document efforts made to accommodate the Veteran. VA Coordination: Collaboration and coordination with VA program staff, as needed, will include coordination of supportive psychosocial services. In particular, coordinated efforts must be made with the VA Liaison or Designee and/or other appropriate VA staff around medical, mental health, admission and discharge needs. Case Management: Case management means arranging, planning, coordinating, or providing direct services and support; referring and providing linkage to VA and non-VA resources, providing crisis management services and monitoring; and intervening and advocating on behalf of veterans to support transportation, credit, legal, and other needs. A thorough written Individualized Care Plan (ITP) will be developed within 72 business hours of admission for each Veteran. This will include structured individual case management on at least a weekly basis to address the Veteran s psychosocial needs, develop treatment goals, and review progress/barriers towards obtaining their goals towards self-sufficiency. For the purpose of this contract, VA discharge meetings do not count towards the weekly structured individual case management requirements. It is understood that these visits do not substitute nor relieve the contractor in any way or the responsibility for the daily care and treatment of the Veteran. The contractor will assist the residents in obtaining community resources and assistance such as, but not limited to, and as appropriate: applying for social service benefits, applying for VA benefits, income assistance and financial planning, employment services, housing resources, religious/spiritual services and access to social/recreational opportunities. The contractor case manager will assist Veteran with referrals to and follow up on all potential financial resources the Veteran may be eligible for (e.g. SSI, SSDI, Food Stamps, NSC pension, SC compensation, etc.). Case Managers will document all structured activities that support Veteran in developing a short and long term plan to understand and address their current financial situation and how to improve it. Financial planning efforts may be accomplished in group but preferably tough one on one case management services. The contractor must also promote community interaction, as demonstrated by scheduled activities or by information about resident involvement with community activities, volunteers, and local consumer activities. Case managers will document all structured activities that support Veteran in applying for employment as appropriate based on needs of Veteran as identified in the assessment. Contractor will provide proper documentation verifying services and case management efforts provided to the resident by all team members including, but not limited to housing, benefit and employment specialists, and program management staff. There will be an expectation that notes are written professionally in a format that utilizes the clear settings of goals and documents progress towards those goals (e.g. SNAP, SOAP, DAP or SMART notes). Professional Counseling: The contractor will provide professional counseling, including counseling on self-care skills, adaptive coping skills, and as appropriate, vocational rehabilitation counseling, in collaboration with VA programs and community resources. In addition, special attention will be made to address High Suicide Risk (HSR) Veterans as identified by the VA Liaison, VA Mental Health Staff and/or the contractor s Case Manager. On a weekly basis the contracted case manager will be required to update the VA Liaison on Veteran progress and/or safety concerns for HSR Veterans. Contracted case manager will review the HSR Safety Plans with the Veteran on a bi-weekly basis. HSR Safety plan reviews and a copy of the Veteran s Safety Plan will be documented in the chart. If a veteran is deemed to be at risk of self-harm or risk of harm to others then contracted staff will immediately contact 911 or mobile crisis as well as notify VA liaison. All Veterans will be referred for VA Primary Care and Contractors will support Veterans in making initial and subsequent appointments. Particular efforts to access care will be made for Veterans who are identified by VA Liaison to be highly acute. Efforts will be documented in the Veterans ITP and reviewed by the VA Liaison at least monthly. Community Outreach: The contractor will participate with Delaware Homeless Planning Council to outreach currently homeless veterans who live in the streets, cars, parks and abandoned buildings. Permanent Housing Search: Programs are required to provide Veterans with direct and ongoing assistance in achieving permanent housing. As a primary goal of the HCHV program, plans for Veterans transition to permanent housing placements must be clearly reflected in each ITP and in weekly case management notes. As part of this plan, Veterans housing history and needs must be assessed tough a formal and thorough Housing Assessment completed within 72 business hours of program admission. Housing Assessments must identify Veterans housing history, strengths (i.e. positive prior rental history), and barriers (i.e. Unlawful Detainers). Should Veteran refuse to engage with program staff regarding plans for permanent housing transition, motivational interviewing and other therapeutic techniques will be used to address Veteran ambivalence. All efforts to engage Veteran regarding housing plans, options, and resources shall be clearly documented and include any therapeutic techniques utilized. Contractor staff must provide direct assistance to Veterans in developing permanent housing plans and accessing appropriate housing resources. These services shall be provided weekly tough one to one case management. Examples of direct assistance include: 1) assistance obtaining and reviewing Veteran s free credit report, identifying housing strengths and/or barriers associated with current credit status; 2) Creating a Tenant Portfolio with Veteran that contains all relevant documents required in the rental process, including a completed sample rental application for Veteran, income verification documents, identification, applicable subsidies, etc.; 3) Reviewing affordable housing rental options and Permanent Supportive Housing (PSH) program offerings, and assisting Veterans with making appropriate rental inquiries and submitting completed rental applications; 4) Conducting regular and individualized housing advocacy efforts, including transportation, assistance scheduling, meeting, and communicating with property managers and landlords, and engage in troubleshooting where rental barriers or denials occur in the housing search process 5) exploring housing option in low-rent areas. All housing efforts by Contractor shall be documented clearly and presented to VA Liaison upon request. Mere communication with Veterans regarding housing, without subsequent Contractor staff action and follow-up, shall not on its own meet the above requirements. Veterans with Sex Offender status will have increased focus on discharge to stable or permanent housing placements as evidenced in ITP. Recovery: Support for an alcohol/drug abuse-free lifestyle provided in an environment conducive to social interaction and the fullest development of the resident s rehabilitative potential. Assistance to gain and to apply knowledge of the recovery process in an environment supportive of recovery models including a focus on Harm Reduction rather than strict abstinence and supportive of a Housing First approach. Pursuant to these principles, drug testing may not be used to admit, discharge or discipline a Veteran but may be used as a clinical intervention to modify behavior. Discharge Planning: Securing permanent housing will be the primary discharge goal for every Veteran. All Veterans must have a discharge plan within one week of admission. Veterans must maintain a minimum of two appropriate housing placement applications until permanent housing is obtained. Contractor must provide computer and telephone access for Veterans to assist with discharge planning and case management needs. Case Managers will provide assistance with discharge planning for every Veteran and report all discharges via email within 24 business hours using a secured process (e.g. HOMES ID number). HOMES exit form is required for discharging a Veteran from any HCHV program via fax within 24 business hours from known discharge. Housing needs will be assessed upon acceptance to the program and resources will be coordinated for discharge to a successful community placement toughout the duration of the Veteran s stay. A negative discharge for undesirable behavior is a committee decision that must include the VA Liaison prior to discharge. All Veterans scheduled for discharge based on behavior must meet with the treatment team and work with team to determine most therapeutic option for Veteran. This does not include violations for safety reasons or physical abuse. Please note: Profanity does not in and of itself constitute abuse and shall not exclusively be considered grounds for discharge. Any and all actual violence will be grounds for discharge. Veterans may be discharged for safety reasons at any time. All negative discharges will be subject to a full team debriefing, including VA Liaison, to look for opportunities missed to intervene sooner. All discharges are subject to the Contractors grievance procedures and must allow clients the opportunity to be represented by the VA Liaison in the grievance process. Reasonable efforts must be made to coordinate with the VA Liaison in order to schedule an appeal. MEDICATION MANAGEMENT: Medications and narcotics shall be properly stored, controlled, issued and recorded in compliance with physician s orders. Contractor shall establish written procedures for ensuring Veterans confidentiality in the storage of and keeping of records concerning medication. Medication Assisted Treatment (MAT) cannot be used to rule out Veterans participation in either of the CRS Programs. This includes prescribed use of Vicodin, morphine, methadone, oxygen, etc. Reasonable accommodation for individuals in MAT is required provided the requested accommodation does not require major financial or administrative commitments that would be considered an undue burden. Examples of reasonable accommodations include: Arranging for the individual to take medication at their clinic, physician s office, or another off-site location when consistent with the individual s treatment plan. Storing an individual s MAT medication in a lock box in the program and having the individual be personally responsible for it. Arranging to have the housing facility keep MAT medications in a locked cabinet (Copies of Inspection Packet requirements relating to medication management are available upon request). CRITICAL INCIDENT REPORTING: All critical incidents will be reported to the VA liaison or Designee within 24 hours. This includes the following: Falls Assault (to Veteran or Staff) Elderly/Dependent Adult Abuse or Neglect Sexual Assault Fire (Veteran Involved) Medical/Psychiatric Emergency (911 Calls) Hospitalization Suicide or Suicide Attempt Homicide Death Drug/Police Raid Medication Problem Infectious Control (bed bugs, TB, etc.) Active Substance Abuse Observation/ Possession of Weapons DOCUMENTATION: The Contractor shall provide treatment and discharge planning that reflects a team based assessment of health, social and vocational needs with the involvement of the Veteran, the VA Liaison and appropriate community resources in resolving problems and setting goals via the ITP. An individual case record will be created for each referred Veteran. Case records shall be maintained in security and confidence as required by the Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR part 2) and the Confidentiality of Certain Medical Records (38 USC 7332). Case records and data normally maintained and included in a medical record as a function of compliance with State or community licensing standards will be made available on a need to know basis to appropriate Department of Veterans Affairs staff members involved with the treatment program of the Veterans concerned. The Contractor shall comply with applicable requirements of the Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR Part II) and the Confidentiality of Certain Medical Records (38 USC 7332). The Contractor shall participate in the Homeless Management Information System (HMIS). HMIS means the information system designated by the Continuum of Care to comply with the HUD's data collection, management, and reporting standards and used to collect client-level data and data on the provision of housing and services to homeless individuals and families and persons at-risk of homelessness: The files shall include: Reasons for referral, data relevant to the Veteran s admission and anticipated length of stay. All essential identifying data relevant to the Veteran and his/her family including a socio-cultural assessment, weekly progress reports or notes, and documentation of any case management interventions or Veteran care conferences. Medication Management/Monitoring- Copies of any medical prescriptions issued by physicians, including orders, if any, for medications to be taken. Contractor must be in compliance with HCHV medication inspection requirements. Case management notes written in a professional manner (i.e. SMART, SOAP, SNAP, DAP) will include the following: 1) A written and thorough Housing Needs Assessment, 2) Individual Care Plan with attendant goals and documented activity indicating Veteran and Case Manager is actively working on identified goals and 3) Discharge Plan. Final summaries on each resident who leaves the program, to include reasons for leaving, the resident s future plans, and if possible, follow-up locator information. Extension approval if relevant. Waivers as appropriate. Upon discharge or death of the patient, medical records on all VA beneficiaries will be retained by the residential housing facility for a period of at least tee years following termination of care. REFERRALS, ADMISSIONS AND ELIGIBILITY: It is understood that the type of Veterans to be cared for under this contract will require care and treatment services over and above the level of room and board. It is also understood that Veterans may need more intensive case management than the general population. To be eligible for placement in emergency contract beds, all Veterans must be homeless and eligible and registered for VA services (24 CFR 576.2). A formal diagnosis is not required for the Veteran to participate in the program. Contractor must provide housing and services to special Veteran populations, such as but not limited to the following: medically compromised Veterans, seriously mentally ill Veterans, Veterans who have abused drugs or alcohol for many years, and/or Veterans who have been involved with the legal system. VA Liaison and Contractor will mutually determine an admission process that includes written eligibility criteria that is fair, objective, and compliant with applicable State and Federal laws. The eligibility information must be made available to clients at intake and staff must provide answers to questions about the admission criteria and process. The VA is responsible for determining eligibility of Veterans prior to acceptance by the Contractor for services. After receipt of a Release of Information (ROI), a written pre-approval from VA Staff is required (hard copy, fax or e-mail are acceptable) and shall be provided to the Contractor for each Veteran referred for services under the contract. The needs of special homeless populations including women, OEF/OIF/OND, serious mental illness, and conically homeless will be prioritized within each subgroup in admission criteria. A list of authorized VA Staff that can make referrals shall be provided to the Contractor upon award of the contract. VA Staff may be added or deleted from the list during the term of the contract at the discretion of the VA liaison. The Contractor shall be provided an updated list of authorized VA Staff whenever such changes are made. Veterans who refuse to allow this communication about their treatment needs and ongoing care will need to receive services elsewhere. Intake Packets: All Veterans must receive and sign a receipt for an intake packet within 72 business hours which includes, at minimum, the following information: Description of the Contractors services Rules and Regulations Grievance Policy Emergency procedures Veteran rights and Reasonable Accommodation Timeliness of Response- Contractor must have a dedicated phone line for VA inquiries and referrals. Return calls from the contractor are expected within 2 hours during business hours Monday tough Friday. This includes calls from VA Liaison or Staff to the program. Admission Criteria: To be eligible for HCHV Contracted Residential Services, a Veteran must meet the requirements of 38 U.S.C. 2031(a) and 38 CFR 63.3. VA will give priority to veterans, in the following order, who; Are new to the VA health care system as a result of VA outreach efforts, and to those referred to VA by community agencies that primarily serve the homeless population, such as shelters, homeless day centers, and soup kitchens. Have service-connected disabilities. All other veterans. Contractor must have the ability to accommodate immediate admissions 24/7. All admissions must have authorization of the VA. In reference to eligibility, provider staff should contact WVAMC eligibility office to verify Veteran status during non-business hours. If unable to verify during non-business hours, a homeless person should be accepted conditionally. Contractor must notify VA Liaison of admissions that occur outside of non-business hours immediately the next business day. Within 72 hours of the notification, VA clinical staff will meet with newly admitted individual and complete an assessment. If glaring safety issues arise before 72 hour time frame, decision to exit individual based on safety concerns will be deferred to contractor. VA staff cannot approve payments for services provided to unauthorized/ineligible Veterans. If, within 72 hours of admission, homeless individual is found to be ineligible for VA healthcare, Contractor will initiate referrals to alternative placements and transition homeless individual to this placement. If, within 72 hours of admission Veteran displays physical evidence of communicable disease and/or tests positive for such, the decision to transition this individual to alternative placement will be deferred to Contractor. If within 72 hours it is determined that the level of care is not appropriate, the Contractor will collaborate with the Veteran and VA to arrange for provision of care tough other VA or community resources. Contractor must have the ability to accommodate the following if a bed is available: Veterans with ambulatory difficulties including wheelchairs and other assistive devices in compliance with Americans with Disabilities Act Accessibility Guidelines Veterans participating in opioid treatment programs Veterans with medical issues that do not meet criteria for inpatient medical or nursing home services. Contractor is not expected to provide home health aide or skilled nursing services. However Contractor may not deny admission based on need for in home services if services are provided by VA or another outside agency. Examples include medication administration, wound care, assistance with activities of daily living (including bowel/bladder incontinence) An extension of the length of stay may be authorized by the VA Liaison, provided that funding is available. The timing of transition to the community is mutually determined by the Veteran, the Contractor, and VA Liaison. Contractor is responsible for ensuring that access barriers to housing and continuing outpatient care (e.g., distance, transportation, scheduling) are reduced or eliminated. TIMEFRAMES: The initial stay for a Veteran in CRS is determined by the need of each individual Veteran. There shall be no minimum stay criteria for admissions. It is understood that the Contractor will not be paid for care provided to a referred Veteran beyond the period authorized in the referral, unless an extension of the authorization is provided in writing by the VA. CERS: The initial length of stay for a Veteran should be no longer than 30 days. Some Veterans may be considered for up to 90 days depending on the needs of the Veteran as mutually determined by the Veteran, Contractor, and VA Liaison. Any extension of the stay after 90 days must be authorized by the VA Liaison or Designee, provided that there is clear clinical indication and availability of funds. Only extraordinary circumstances will be considered in order to extend Service periods in excess of 90 days for individual Veterans and these must be authorized by the VA Liaison or Designee. In the event that a Veteran s length of stay exceeds date of approval, the contractor will retain the responsibility for finding suitable transitional or permanent housing in the community at its own expense. DENIAL OF ADMISSION: Veterans cannot be denied entry to HCHV CRS based solely upon length of current abstinence from alcohol or non-prescribed controlled substances, the number of previous treatment episodes, the time interval since the last program entry, the use of prescribed controlled substances, disability, income, transgender orientation, sexual orientation or legal history. This includes a Veterans status of being a victim of Domestic Violence and as such cannot be considered during the screening process. The screening process must consider each of these special circumstances and determine whether the program can meet the individual Veteran's needs while maintaining the program's safety, security, and integrity. All Contractors must employ a harm reduction approach. ABSENCES AND CANCELLATION: The Contractor shall notify the VA Liaison of unauthorized absences by a referred Veteran from the facility within 2 hours during business hours or immediately the next business day if absence occurs during non-business hours. Should a Veteran absent himself/herself from the Contractor s facility in an unauthorized manner, payment for services for that Veteran shall be continued for a maximum period of 48 hours, provided there is a concurrent documented active outreach attempt on the part of the Contractor s staff to return the Veteran to the facility and only if the Veteran reported that they will return. After 48 hours the Veteran will be discharged from facility. Management of program negative exits as defined by VHA performance measures will be an element of quality assurance review of this program. The VA Liaison may authorize payment for excused absences if there is a compelling medical or mental health need and the excused absence is verified in advance. Excused absence of the Veteran from the facility will not be reimbursed after 72 hours. After 72 hours for an excused absence the veteran does not have to be discharged from facility immediately as long as the contractor is willing to hold the bed without receiving payment at VA request. VA reserves the right to remove any or all Veterans from the facility at any time, without additional cost, when it is determined to be in the best interest of the VA. MEDICAL EMERGENCIES The Contractor shall notify the authorizing VA facility immediately when a medical emergency occurs that requires hospitalization of a referred Veteran. It is agreed that the Veteran will be admitted to the appropriate VA facility for non-life teatening emergencies. When such admission is not feasible because of the nature of the emergency, it is agreed that the veteran will be taken to the closest emergency room. The Contractor will make arrangements for admission and support the Veteran with any transportation issues that may arise. The Contractor shall notify the authorizing VA facility immediately of any incidents involving a referred Veteran. The Contractor shall notify the VA Liaison by telephone during business hours. The Contractor shall notify the Administrator on Duty at the WVAMC by telephone during non-business hours. All incidents that occur during non-business hours, the Contractor should notify the VA Liaison the following business day. The Contractor shall provide the VA Liaison with a copy of the incident report within 24 business hours. The Contractor shall maintain a copy of the incident report in the Veteran s case record. Please see above in section six for details regarding what constitutes Critical Incident Reporting. In the event a beneficiary receiving care under this contract dies, the Contractor will promptly notify the WVAMC and immediately assemble, inventory, and safeguard the Veteran s personal effects. The funds, deposits, and effects left by WVAMC veterans upon the premises of the facility shall be delivered by the Contractor to the person or persons entitled thereto under the laws currently governing the facility for making disposition of funds and effects left by veterans, unless the beneficiary died without leaving a will, heirs, or next of kin capable of inheriting. When disposition has been made, the itemized inventory with a notation as to the disposition of the funds and effects will be immediately forwarded to the WVAMC. Should a deceased patient leave no will, heirs, or next of kin, his/her personal property and funds wherever located vests in and becomes the property of the United States in trust. In these cases the contract facility will forward an inventory of any such property and funds in its possession to WVAMC and will hold them (except articles of clothing necessary for proper burial) under safeguards until instructions are received from the WVAMC concerning disposition. EMERGENCY PROCEDURES: Contractor will train all staff on emergency procedures and have written protocols that are posted to guide staff response to crises including, but not limited to, physical injury, resident suicide attempts, overdoses, and domestic or other violence. Contractors will have at least one designated paid staff on site at all times who has had training and orientation on emergency procedures. Contractor will promptly and appropriately respond to the medical/psychiatric problems of Veterans and staff. There will be first aid equipment and supplies for medical emergencies available at all times. These supplies must be checked regularly to ensure they are up to date and their location in the facility must be clearly marked. Contractor will have all emergency contact numbers posted. Universal precaution practices are used by Contractor to prevent transmission of diseases and are implemented under the presumption that blood and body fluids from any source are to be considered potentially infectious. Supplies necessary for maintaining universal precautions, such as sharps containers, must be available. RULES, POLICIES AND PROCEDURES: The Contractor shall have reasonable rules governing day-to-day life and activities in the facility in accordance with VHA HANDBOOK 1162.09. Such rules clearly inform Veterans of the obligations upon which their continued participation in the program depends and the consequences for non-compliance. Veterans will be provided a copy of the rules and regulations at intake and/or upon Veterans request. In addition, Contractor will post the rules in a location readily accessible to clients and visitors. These rules must include detailed Veteran Rights and the procedures that the Contractor has in place to protect the Veterans rights and dignity. Veterans must be permitted to exercise these rights without fear of reprisal. If requested, Contractors must reasonably accommodate Veterans whose compliance with program rules is limited by the Veterans physical or mental disabilities, in accordance with the Americans with Disabilities Act, the Federal Fair Housing Amendments Act, Section 504 of the Rehabilitation Act, including those requirements covering reasonable accommodations for disabilities and the use of service animals, and all other applicable State or Federal laws. Contractor must equally apply all rules, policies and procedures to Veterans, unless a Veteran has asked for a reasonable accommodation due to his/her disability. PROCEDURES FOR NEGATIVE DISCHARGE OR SANCTION: Contractor must post rules in the Veterans Case Manager s Office and provide Veteran with the rules which specify the reasons or conditions for which a Veteran may be sanctioned or discharged, including those behaviors which constitute gross misconduct and are grounds for immediate discharge from the program and those which would prompt a written warning if violated and potential discharge if violated repeatedly. Contractor will describe the formal appeal procedures tough which clients may appeal program regulations, sanctions or discharges. This information must be provided to Veterans in writing upon intake via rules and regulations and grievance policy and must be clear and easily understandable by Veterans. This information will include: Immediate contact with VA liaison Timely due process provisions which should include two warning notices for violations which do not result in immediate discharge prior to issuance of a discharge notice and an opportunity for a case conference after warning is issued to the client Notice of, and access to, formal appeal procedures Notice of the conditions or process for re-admission to the program. Reasonable efforts to provide an appropriate referral to another facility or appropriate level of care as needed. This does not apply to Veterans who are discharged for danger to others. GRIEVANCE PROCEDURES: Contractor must have an internal grievance process that Veterans can use to resolve conflicts within the program. Contractor must have written policies and procedures for resolving grievances, including a statement regarding the client s right to request reasonable accommodation, each Veteran shall receive a copy of the grievance policies and procedures, upon intake and upon sanction or discharge notice. PERSONNEL: The Contractor will employ sufficient personnel to carry out the policies, contract responsibilities, and the program for the facility. Case management staff must have coverage for staff using authorized and unauthorized leave (e.g. holidays, sick leave, family care, etc.). There must be, at a minimum, one staff member on duty on the premises, or residing at the facility and available for emergencies 24 hours a day, 7 days a week. In addition, there must be an administrative/clinical Designee that will be available for consultation for emergencies 24 hours a day, 7 days a week. The Contractor shall assign personnel that by education, training and when required, certification or licensure, qualified to provide the Basic Services and Additional Services required by this SOW. Staff is defined as a paid professional or para-professional and does not include interns. VA Liaison will have no more than two point of contacts (POC) per program. CERS Staff shall be as follows: Program Director to provide program oversite and implementation, staff supervision and training. Program director will have a master s degree in Social Work, Psychology, or Human Services, or a bachelor s degree with a minimum of 5 years management experience. Case Managers must maintain a caseload ratio of no more than 1:12. Case Managers with a minimum of a bachelor s degree in Social Work, Psychology, Human Services, or at least 3 years of demonstrated case management experience. The contractor will notify the HCHV Liaison immediately of any staffing changes such as the loss of pertinent staff. STAFF TRAINING: Contractor will provide at least one staff person on-site at all times who has had training and orientation on the following topics. Staff shall receive and document at a minimum one-time training per year on these subjects. CPR/ First Aid HIPAA & Privacy Crisis intervention/ Conflict resolution/De-escalation techniques Universal Precautions (disease transmission prevention) Adult abuse/neglect reporting laws Medication management if applicable State and Federal Fair Housing Law and ADA Requirements Contractor will perform criminal background checks on all staff members that work with this contract. Contractors will agree not to hire Staff who are current residents. Contractor must have a policy prohibiting staff from establishing sexual relationships with program clients. The Contractor must identify each person functioning as Key Personnel under this contract, and provide to the VA a description of the services to be provided by such person, together with a resume summarizing that person s relevant skills and experience. During the first ninety (90) calendar days of contract performance, the Contractor shall make NO substitutions of key personnel unless the substitution is necessitated by illness, death, or termination of employment. Within 14 days after substitutions necessitated by situations described above, the Contractor shall provide resumes for the substitute key personnel. For substitutions proposed by the Contractor after the initial 90 calendar day period, the Contractor shall provide resumes for the substitute personnel, together with any other additional information requested by the COR, at least 15 days before the substitution is to occur. The COR shall notify the Contractor within fifteen (15) calendar days after receipt of all required information if the VA refuses to accept the substitute key personnel. The VA reserves the right to refuse or revoke acceptance of key personnel if personal or professional conduct, or lack of required skills or experience, jeopardizes Veteran care or interferes with the regular and ordinary operation of the facility. CONTRACTOR STAFF CONDUCT/COMPLAINTS HANDLING: Contractor personnel shall be expected to treat referred Veterans with dignity and respect and abide by standards of conduct mirroring those prescribed by current federal personnel regulations. The Contractor shall comply with the VA Patient's Bill of Rights as set forth in 38 CFR 17.34a The VA reserves the right to exclude Contractor staff members from providing services to Veterans under this contract based on breaches of conduct, including conduct that jeopardizes Veteran care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, Veteran abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by Veterans or other Staff members to designated Government representatives. The Contractor and Contracting Officer s Representative (COR) shall deal with issues raised concerning Contractor personnel conduct. The Contracting Officer shall be the final arbiter on questions of acceptability and in validating complaints. BASIC RIGHTS AND PROTECTION AGAINST DISCRIMINATION: Contractors must protect the rights and dignity of the individual served in all phases of service delivery. At a minimum, Contractor must afford each Veteran the following rights and protections. Veterans must be permitted to exercise these rights without fear of reprisal. Veterans are entitled to enjoy a safe and healthful environment in the program. Veterans are entitled to be treated in a manner that respects their dignity, privacy and individuality. Veterans with disabilities are entitled to reasonable accommodations under fair housing laws when such accommodations are necessary because of their disability. Veterans are entitled to remain in the program and not be involuntarily removed without reasonable notice, good cause, and just procedures. All Veterans are entitled to just and standardized procedures for determining eligibility, admissions, sanctions and discharges, and resolving grievances. Veterans are entitled to reasonable privacy and confidential treatment of personal, social, financial, medical, mental and behavioral health records, except as necessary to further treatment, information and referral services and in compliance with the resident s consent to release information. Veterans are entitled to the full exercise of their civil, constitutional, and legal rights. Veterans will have on-going opportunities to voice opinions, to participate in program operation and programming, and to make suggestions regarding programming and rules. Veterans rights must be protected against all forms of discrimination, including those based on race, religious creed, color, national origin, ancestry, language, disability (physical or mental health), medical condition, marital status, familial status, age, gender, sexual preference, source of income, or political affiliation. Veterans will receive a written policy indicating that harassment of clients and staff on the basis of race, religious creed, color, national origin, ancestry, language, disability (physical or mental health), medical condition, marital status, familial status, age, gender, sexual preference, source of income, or political affiliation will not be condoned nor tolerated. Contractor will develop a written policy for transgender Veterans that provides for safe, secure and dignified case management as well as accommodate the special requirements needed for privacy. Transgender Veterans will have access to sleeping accommodations and batoom facilities based on their gender of identification, regardless of physical characteristics or gender conformity. People who do not clearly identify as male or female should have access to whichever sleeping and/or batoom accommodation helps them feel safest. Where there are single-use showers and batooms in the facility designated for residents, transgender Veterans will be told about them and welcome to use them but not required. It is the Contractor s responsibility to promote a safe environment for transgender Veterans amongst the general population. Contractor must post basic rights and protection against discrimination policies in a conspicuous place and in appropriate languages. All policies and procedures will be in writing and subject to review by the VA. REASONABLE ACCOMODATION: Contractor must respect and reasonably accommodate personal and cultural differences associated with race, religious creed, color, national origin, ancestry, language, disability (physical or mental health), medical condition, marital status, familial status, age, gender, sexual preference, source of income, or political affiliation. At no point shall program access be denied because of an individual s disability. Information learned about the Veteran s disability from the assessment will not be used as grounds for discharge or other punishment and will be used to guide Veteran to appropriate services. Moreover, a program may not apply different rules to Veterans because of their disabilities, unless the different rules are a result of granting a reasonable accommodation request made by an Veteran with a disability. The Contractor shall not ask questions about a Veteran s disability, including the nature and severity of the disability or the treatment, symptoms, and medications related to the disability. A Veteran is not obligated to reveal that s/he has a disability prior to admission. Veterans with disabilities are entitled to reasonable accommodations. If a Veteran requests a change in a program s policy or procedure as an accommodation of his/her disability, the program should grant the accommodation when the accommodation is both reasonable and necessary because of the Veterans disability. Such an accommodation request must be considered during any stage in the provision of a program, including at intake, during services, and during discharge proceedings. When a reasonable accommodation request is made, the program supervisor may request verification of the individual s disability. The Contractor is required to develop a written policy for their process for reasonable accommodations within 30 days of the award of this contract. This will include: 1) All requests for reasonable accommodation, 2) details of all steps taken to accommodate a Veteran s request for reasonable accommodation, and 3) any explanation for denial of services and/or accommodation, and 4) any appropriate referrals to Veterans who are denied accommodation. All explanations are to be written on formal letterhead from program management to the Veteran and VA Liaison at the time of denial for services or accommodation. Contractor will be aware that violation of the ADA, Section 504 of the Rehabilitation Act and Fair Housing Laws may result in stopping admissions and/or termination of contract for cause. FACILITY: It is the responsibility of the Contractor to properly maintain its facilities and the VA shall have no responsibility for paying or reimbursing the Contractor for such expenses. For example, the contractor would be responsible for alleviating a bed bug infestation by hiring an exterminator at it owns expense. The contract facility must: Pass VA NFPA inspection before the award of this contract if they have not been previously awarded a contract. Contract will not be awarded if facility does not pass initial inspection. Have a current occupancy permit issued by the local and state governments in the jurisdiction where the facility is located. Be in compliance with State and local safety codes, and/or State health and sanitation codes. Be licensed under State or local authority. Where applicable, be accredited by the State. Be equipped with operational air conditioning /heating systems Be kept clean free of dirt, grime, mold, or other hazardous substances and damaged noticeably detract from the overall appearance. Be equipped with first aid equipment and an evacuation plan in case of emergency. Have windows and doors that can be opened and closed in accordance with manufacturer standards. Have an aggressive on-going plan to address bed bug infestation. This policy must be a part of your written response to this solicitation. On-going bed bug infestation will be grounds for immediate discharge of Veterans from the facility Contractor must be able to provide onsite office space for VA Liaison or other VA clinical staff as needed. INSPECTION OF FACILITY AND PROGRAM: Prior to the award of a contract and annually during the contract term, a multidisciplinary VA team consisting of a social worker, dietitian, a representative of the VA Police, and a Facilities Management Safety Officer, Nursing and/or other subject matter experts as determined necessary by the medical center director or HCHV Coordinator shall conduct a survey of the Contractor s facilities to be used to provide Veterans food, shelter, and therapeutic services to assure the facility provides quality care in a safe environment. Inspections may also be carried out at such other times as deemed necessary by the Department of Veterans Affairs. Contractor will allow VA staff to inspect the facility and/or review Veteran participant treatment protocols at any time without prior written notice to the contractor. The Contractor will be advised of the findings of the inspection team. If deficiencies are noted during any inspection, the Contractor will be given a reasonable time (90 days) to take corrective action and to notify the COR that the corrections have been made. A contract will not be awarded until noted deficiencies have been eliminated. Failure by the Contractor to take corrective action within a reasonable time (90 days) will be reported to the VA Contracting Officer. If corrections are not made to the satisfaction of the VA, the Contracting Officer will consult with the appropriate officials so that suitable arrangements can be made to discharge or transfer Veterans and to terminate the existing contract, as appropriate. The inspection of the Contractor facilities will include inspection for conformity to the current Life Safety Code as described, and will also include the following: General observation of residents to determine if they maintain an acceptable level of personal hygiene and grooming. Assessment of whether the facility meets applicable fire, safety and sanitation standards. Determining whether the facility is in attractive surroundings conducive to social interaction and the fullest development of the resident's rehabilitative potential. Observation of facility operations to see if appropriate organized activity programs are available during waking hours (including evenings) and degree to which a high level of activity is observed in the facility, such as individual professional counseling, physical activities, assistance with health and personal hygiene. Seeking evidence of facility-community interaction, demonstrated by the nature of scheduled activities or by information about resident flow out of the facility, e.g., community activities, volunteers, local consumer services, etc. Observation of staff behavior and interaction with residents to determine if they convey an attitude of genuine concern and caring. Inspecting the types of meals and other nutrition provided to residents to see if appetizing, nutritionally adequate meals are provided in a setting, which encourages social interaction and if nutritious snacks between meals and bedtime are available for those requiring or desiring additional food, when it is not medically contraindicated. Making a spot check of Veterans records to ensure accuracy with documentation of Veterans length of stay, ITP, Housing assessment, discharge plan and services provided to the Veterans. All Department of Veterans Affairs reports of inspection of residential facilities furnishing treatment and rehabilitation services to eligible Veterans shall, to the extent possible, be made available to all government agencies charged with the responsibility of licensing or otherwise regulating or inspecting such institutions. Adherence to the agencies written policy on medical management BILLING: Unless specifically excluded in this contract, the per diem rate established will include the services listed in this document and will also include all services or supplies normally provided other residents by the facility without extra charge. VA assumes no responsibility for any damage that may be caused by a Veteran and or their guests. This will be a matter strictly between the contractor and the Veteran. VA assumes no responsibility for any unreturned Contractor property. Payments made by the VA under this contract shall constitute the TOTAL cost of care and housing of the homeless Veterans. Payment is authorized starting from the first day of admission and does not include the day of discharge. VA authorized absences of the Veteran from the facility will not be reimbursed after 72 hours but do not have to be discharged unless the absence is unauthorized and there is no expectation that the Veteran will return to the facility as determined by the VA liaison. The Contractor will submit billing to Austin Payment Center by the 7th of every month. Failure to make timely invoice submissions will be cause for a request for a corrective action. The Contractor shall utilize nightly sign-in logs for the purpose of verifying a Veteran s attendance in the program on a daily basis. These logs are to be submitted to the VA Liaison daily, to ensure accuracy of billing. All excused and unexcused absences will be clearly documented on the daily attendance log including reason for any excused absence (e.g. medical needs). Payment will not be remitted for any unexcused absences over 48 hours and excused absence over 72 hours. No payment will be made without the daily sign-in logs to be verified by VA Liaison and/or designee. VA Liaison will also review Quality Assurance Surveillance Plan (QASP) monthly to verify compliance with acceptable quality level for the various service requirements. NOTE: If Contractor does not meet the acceptable quality levels for additional services a reduction in payment will occur. QUARTERLY REPORTING: The Contractor shall provide the VA Liaison with a written report of program activities on a Quarterly basis. The report should contain, at minimum, the following information: Total Number of Veterans Served and Bed days per Veteran Program Completion Rates Outcomes (e.g. # or % of Veterans discharged to independent housing, increased income/benefits, occupancy, etc.) Other pertinent information, such as: quality improvement projects, changes in staffing or business practices, systems or resource concerns, etc. These reports shall be maintained by the VA Liaison in the contract administrative file, and necessary reports shall be submitted as a part of the annual inspection package. The COR shall forward the summary evaluation of the Contractor performance to the Contracting Officer once a performance period ends. Contractor will work with VA Liaison to meet all relevant VA identified performance measures by end of fiscal year. Performance measures will be assessed monthly with invoicing NOTE: VA National Homeless Program performance measures are subject to change each fiscal year.
VA24417Q0109 Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 4
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