Statement of Work

HOME OXYGEN SERVICES - VISN 16

1. SCOPE: This Statement of Work (SOW) defines the effort required for the setup, installation, education, and management of Home Oxygen services and Ventilation, in accordance with Joint

Commission (JC) standards, to Veteran beneficiaries serviced by three (3) stations within VISN 16.

These services include delivery, set-up, education, pick-up, cleaning, preventative maintenance, equipment assessment visits, after-hours support and storage of equipment. The use of the terms

“beneficiary”, “Veterans”, “Patients”, and “Patient” are used interchangeably and refer to the recipient of required supplies, equipment, and incidental services required under the contract.

1.1 BACKGROUND: The acquisition of Home Oxygen services is being initiated to provide Home

Oxygen services to Veteran beneficiaries serviced by VISN 16, 365 days a year, including holidays.

VISN 16 does not have the capacity to provide these services, so a contract is being sought for the provision of home oxygen and all associated products and services.

1.2 LOCATIONS/PLACE OF PERFORMANCE: All services shall be performed in the veteran's place of residence. The area of service shall be all patients serviced by the following locations within

VISN 16. The contractor shall service any patients that are treated at any of these facilities and all associated Community Based Outpatient Clinic (CBOC), supported therein (Clinic of

Jurisdiction/Primary Services Area COJ/PSA, regardless of their physical location. Contractors shall have a facility or resources physically located in the geographic area in which they shall provide service. The geographical boundaries described herein have been determined as the areas of responsibility for each local VA Medical Centers.

A. FAYETTVILLE, AR VAMC AND CBOC’s: Contractor shall service any patients that are treated at the Fayetteville, AR VAMC, and all associated Community Based Outpatient Clinic

(CBOC), supported therein (Clinic of Jurisdiction/Primary Service Area COJ/PSA), regardless of their physical location. This includes but is not limited to the patients in the catchment area delineated below and patients who reside in or near bordering states catchment areas, (i.e., outside

Fayetteville catchment area, to include Muskogee, OK, but prefer to be seen in Fayetteville), Ft.

Smith, AR, Springfield, MO, Jay, OK, Ozark, AR, Bella Vista, AR, Branson, MO, Joplin, MO, and Harrison, AR. The Fayetteville VAMC catchment area includes: 11 counties in Northwest

Arkansas (Benton, Boone, Carroll, Crawford, Franklin, Madison, Marion, Newton, Scott, Sebastian, Washington); 11 counties in Southwest Missouri (Barry, Christian, Dade Greene, Jasper, Lawrence, McDonald, Newton, Stone Taney, Webster); 2 counties in Southeast Kansas

(Cherokee, Crawford); 2 counties in Northwest Oklahoma (Adair, Delaware).

B. LITTLE ROCK, AR MEDVAMC: Contractor shall service any patients that are treated at the

CAVHS and all associated Community Based Outpatient Clinic (CBOC), supported therein

(Clinic of Jurisdiction/Primary Service Area COJ/PSA), regardless of their physical location. This includes, but is not limited to, patients who reside in or near bordering state catchment areas, (i.e., outside Little Rock’s catchment area, but prefer to be seen in CAVHS), All counties in Arkansas:

Arkansas, Ashley, Baxter, Benton, Boone, Bradley, Calhoun, Carroll, Chicot, Clark, Clay, Cleburne, Cleveland, Columbia, Conway, Craighead, Crawford, Crittenden, Cross, Dallas, Desha, Drew, Faulkner, Franklin, Fulton, Garland, Grant, Greene, Hempstead, Hot Springs, Howard, Independence, Izard, Jackson, Jefferson, Johnson, Lafayette, Lawrence, Lee, Lincoln, Little

River, Logan, Lonoke, Madison, Marion, Miller, Mississippi, Monroe, Montgomery, Nevada, Newton, Ouachita, Perry, Phillips, Pike, Poinsett, Polk, Pope, Prairie, Pulaski, Randolph, Saline, Scott, Searcy, Sebastian, Sevier, Sharp, St. Francis, Stone, Union, Van Buren, Washington, White, Woodruff, Yell, COUNTIES IN TEXAS: Bowie, Morris, Franklin, Cass

COUNTIES IN OKLAHOMA: McCurtain, Le Flore

COUNTIES IN MISSOURI: Ozark

C. JACKSON, MS MEDVAMC: Contractor shall service any patients that are treated at the G.V.

“Sonny” Montgomery VA Medical Center in Jackson, MS, and all associated Community Based

Outpatient Clinic (CBOC), supported therein (Clinic of Jurisdiction/Primary Service Area

COJ/PSA), regardless of their physical location. This includes, but is not limited to, patients in the following counties and patients who reside in or near bordering state catchment areas, (i.e., outside Jackson’s catchment area, but prefer to be seen in Jackson or its Outpatient Clinics).

Mississippi counties under G.V. (Sonny) Montgomery VAMC PSA: Washington, Sunflower, Leflore, Carroll, Montgomery, Webster, Choctaw, Oktibbeha, Lowndes, Issaquena, Sharkey, Humphreys, Holmes, Attalla, Winston, Noxubee, Warren, Yazoo, Madison, Leaked, Neshoba, Kemper, Hinds, Rankin, Scott, Newton, Lauderdale, Claiborne, Copiah, Simpson, Smith, Jasper, Clarke, Jefferson, Lincoln, Lawrence, Jefferson Davis, Covington, Jones, Wayne, Adams, Franklin, Wilkinson, Amite, Pike, Walthall, Marion, Lamar, Forrest, and Perry

PARISHES IN LOUISIANA: Madison, Morehouse, East Carroll, West Carroll, Richland, and

Tensas

2. DESCRIPTION OF SERVICES: The Contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to provide home oxygen equipment and services as defined in this SOW. The services associated with this contract include: all logistical/administrative functions involved with the day-to-day operation of providing the service to the Veteran and their families, including, but not limited to, furnishing warehouse space, surplus supplies, monthly in home respiratory therapy visits for patients with a ventilator prescription, and semi-annual technician visits for home oxygen patients. This includes providing a Quality Control (QC) Plan about how the contractor will comply with the requirements of the contract to include coordinating and managing patient care; deliveries consisting of pickup and delivery of supplies; educate the patient and/or caregiver on proper use of equipment;

documenting education and understanding; documenting use of supplies; and inspection of home in relation to home oxygen in accordance with Joint Commission (JC) and Department of Veterans

Affairs (VA) Standards concerning patient use/safety of home oxygen standards, including the Home

Care National Patient Safety Goals. All content contained herein regarding JC standards shall be interpreted in the following manner. All issuing and follow-up care provided under this contract shall be provided in accordance with all current JC and VA standards. The requirement includes providing in home supplies such as the following: low decibel concentrator (rental) with two broad categories of flow rates and replacement parts; various cylinder sizes (rental) to provide oxygen [ex. A (smallest)-E

(largest)H and/or M] and replacement parts; portable oxygen concentrator; liquid oxygen; valved fireproof cannula; procurement/distribution of two types of oxygen and backup/spare parts; nasal cannula to include micro nasal cannula, high flow, Oxymizer pendant, nasal cannula with cushion ear piece, soft pronged nasal cannula/masks to include Oxymask, tracheostomy mask, bi-flow nasal mask, aerosol mask and replacement parts, and any interface, adapter or connection to enhance oxygen delivery/masks to include Oxymask, tracheostomy mask, bi-flow nasal mask, aerosol mask and replacement parts, and any interface, adapter or connection to enhance oxygen delivery; and replacement parts; oxygen bleed in connector; portable oxygen systems (used when a Veteran travels or for primary source for patient mobility).

2.1. VETERANS SERVED: The three (3) stations within VISN 16 currently serve an estimated

3674 oxygen-using Patients and 51 ventilator patients per month. The volumes or amounts shown in the chart below are estimates only and impose no obligation on the VA. The contract shall be for the actual requirements of the VA as ordered by the VA during the life of the contract.

2.2. ORDERING PROCESS: The COR or designee shall provide (via PKI encrypted email and/or fax) the Contractor with notification to initiate individual patient service requirements, including the patient's oxygen prescription by authorized Licensed Independent Practitioner (LIP), equipment, supplies and services to be provided including date and place of delivery. The

Contractor shall confirm receipt (via PKI encrypted email and/or fax) of the request within one

(1) working hour of notification to the ordering facility. The COR or designee shall also provide notification (via PKI encrypted email and/or fax) to the Contractor of VA initiated discontinuation of service. The Contractor shall confirm receipt (via PKI encrypted email and/or fax) of the discontinuation notification within one (1) working hour of the notification. The discontinuation shall be accomplished within 24 hours of the notification receipt confirmation.

The written documents shall include the authorizing official's signature, electronic or written.

The Contractor shall provide a toll-free telephone number, dedicated line, for the purpose of communicating with VA eligible beneficiaries (Veterans) and VA staff. In addition, the

Contractor SHALL NOT place collect telephone calls to the VA or to any VA beneficiary, family member, or caregiver.

Station Est. per Month

Oxygen Patients

Est. per Year Oxygen Patients

Est. per Month Ventilator Patients

Est. Per Year Ventilator Patients

Veterans Health Care System of the Ozarks, Fayetteville, AR 1608 19296 24 288

G.V. "Sonny" Montgomery VA

Medical Center, Jackson, MS 808 9696 16 192

Central Arkansas Veterans Health

Care System, Little Rock AR 1258 15096 11 132

TOTALS 3674 44088 51 612

2.3. HOME VISITS:

A. Initial set-ups are considered to be those beneficiaries who do not have a VA authorized oxygen therapy delivery system or ventilators.

B. Initial setup(s) for Home Oxygen Patients and Ventilator Patients shall be performed by a certified respiratory therapist (CRT) or registered respiratory therapist (RRT), that is licensed in accordance with the governing standards of where the services are to be provided.

C. Home visits shall be performed semi-annually by a professionally trained Technician for all

Patients that utilize home oxygen services.

D. Documentation shall be provided (via encrypted email and fax) to the ordering facility’s COR documenting a thorough review of the Patient's equipment, to include all equipment records, and any re-education of the patient and/or caregiver, if necessary, within five (5) business days of the visit.

E. Documentation shall be provided (via encrypted email and fax) to the ordering facility’s COR for all home visits within five (5) business days of the visit.

F. Patient or caregiver education: The Contractor shall provide education to each patient or caregiver at the time of initial set-up and assess the need for reinforcement during visits on all home oxygen and/or home ventilator equipment which the Veteran and/or caregiver will use. Education information, to include travel literature, is to be presented by demonstration and verbally on equipment, supplies, and services, in the preference of learning style based on

Veteran and/or caregiver need. Material covered shall be in written form to be left with the patient /caregiver. The written material shall be in English as well as the foreign language of the patient, should the patient not speak English. The Contractor, as directed by COR or designee, will implement any new or revised education material at no additional cost to the

Government. The COR will determine whether the contractor shall use their forms or forms supplied by the VA for documentation of education services provided to patients.

1) Patient or caregiver operational education shall be performed on the proper utilization for all issued equipment to include the following:

a. An explanation of services and equipment being provided.

b. Procedures to follow in an event of an emergency.

c. Basic health practices and safety.

d. Infection prevention and control.

e. Basic home safety.

f. Safe and effective use of medical equipment or supplies.

g. Potential hazards and safety considerations related to the equipment.

h. Storage, handling, and access to medical gases.

i. Proper equipment usage.

j. Equipment maintenance, function, and operation system.

k. Equipment power source: electric, battery, compressor air, oxygen, and

UL approved.

l. To provide notification to local power company of need for priority re-connection of power.

m. Proper utilization of oxygen with the prescribed ventilator.

n. Troubleshooting the equipment and system alarms.

o. Equipment and equipment settings that have been prescribed.

p. Emergency Procedures and how to respond to:

i. Power failure

ii. Equipment failure

q. Infection control and patient supply storage:

i. Cleaning or replacement of the oxygen tubing, and humidifier.

ii. Cleaning or replacement of the resuscitation bag and supplies.

iii. Cleaning or replacement of all equipment and accessories.

r. Provide continuing education in equipment operational use as needed or directed by a licensed and privileged Department of

Veteran Affairs Clinician.

s. All education material provided by the Contractor shall be initially reviewed and approved by the VA. Any changes to educational materials shall need to be reapproved prior to providing the documentation to patients.

t. The contractor shall provide a signed document to the ordering facility COR verifying the following:

i. Patient has a safe home environment in accordance with

JC standards.

ii. Patient received proper education and instructions.

iii. Return demonstration has been accomplished with patient and caregiver on the proper use of the home oxygen equipment and other home medical equipment provided through the contract, upon initial set up.

2) Contractor shall provide educational information on infection control issues related to the equipment and supplies provided by the Contractor. Contractor shall document Veteran and/or caregiver demonstration of understanding of the education provided, to include Veteran and/or caregiver verification. The

Contractor shall provide education on how to communicate concerns of patient safety issues that occur before, during, and after home oxygen and/or ventilator equipment/services are received.

3) Contractor shall provide educational and warning information for patients, their families, and caregivers on the hazard of smoking while oxygen is in use. The educational materials must be provided upon initial delivery and every six (6) months (semi-annual) thereafter. Educational materials shall instruct patients, who smoke, to remove the cannula, shut-off the oxygen supply, stand a minimum of twenty-five (25) feet away, and wait for oxygen to dissipate prior to smoking.

4) Incidents where patients are reported as non-compliant with the guidelines set forth in the education and orientation material or whose behavior poses a risk of self-harm or harm to others shall be documented by the contractor and reported to the COR and/or Home Oxygen Coordinator for VA clinical review and/or care plan action, as determined by the prescribing VA provider.

5) Contractor shall provide a copy of the signed education forms to the COR within

24 hours upon request via PKI encrypted email or fax verifying the following:

a. Patient has a safe home environment in accordance with JC standards

b. Patient received proper education and instructions

c. Return demonstration has been accomplished with the patient and caregiver on the proper use of the home oxygen equipment, and other home medical equipment provided through this contract, upon initial set up.

G. All equipment shall contain an adhesive type of label containing the vendor’s name and emergency 24-hour toll-free phone number. This label shall be placed on the equipment in an area that is viewable to patients and/or caregivers at all times. Patient shall be given a document listing toll-free phone number for routine resupply of oxygen cylinders and supplies.

H. The Contractor shall provide and post on all entrances into the residence, a sign stating

"Warning Oxygen in Use, No Smoking" or other verbiage that No Smoking is allowed due to oxygen being present and document that the Patient/care giver is instructed in the safe use of oxygen and equipment per Occupational Safety and Health Administration (OSHA) and JC regulations. Specified sign shall be no smaller than 4” X 6” along with one (1) backup sign.

A sign shall be posed visible and legible from the street.

I. The contractor shall provide initial set-up within four (4) hours of notification for continuous flow oxygen prescriptions and ventilator therapy, or any other therapy as determined by the

VA Clinical Staff to be urgent (as opposed to initial set-up for home oxygen only), to include weekends and holidays.

J. The contractor shall provide initial set-up for discharged patients on the same day regardless of what time the order was received.

K. The Contractor shall provide the initial set-up the same day when the prescription is received by 3:00 PM Central Time to include weekends and holidays; this shall also apply to service calls.

L. The Contractor shall be required to provide initial setup within 24 hours when prescription is received after 3:00 PM Central Time to include weekends and holidays; this shall also apply to service calls.

M. The VAMC reserves the right to obtain the supplies and service from another source and to charge the contractor with any excess cost which shall result there from, if the contractor is unable to meet required response time.

N. Setup of Home Oxygen includes setting up and ensuring the appropriate oxygen system is operational, instruction and training of patient, and/or caregiver and home environment safety check. Failure to deliver within the required time shall result in the VA obtaining oxygen from another source. Any costs more than contract pricing for services provided shall be billed to contractor or credited to next invoice at the discretion of the ordering facility

(Reference 52.212-4(d) Disputes).

O. If any modifications or preparations need to be made to equipment, these changes shall be coordinated with patient caregiver and made before the Patient arrives home from the hospital.

Other items that shall be prepared ahead of time include:

1) Establishing designated Customer Service support phone line for patients to call for in home assistance

2) Posting all emergency numbers by each telephone

3) Marking the circuit breakers and fuses

2.4. ENSURE HOME REQUIREMENTS ARE PRESENT: The Contractor shall perform an assessment of the beneficiary’s home and environment in accordance with JC standards or current

VA auditing agency and maintain documentation of assessments in the individual patient file or folder. Home Environment Assessments shall be done upon initial set-up and semi-annually

(every six (6) months) thereafter. If the patient does not receive a home environment reassessment or a monthly RT equipment/ home environment visit for patients with a ventilator prescription, the Contractor shall provide documentation (via PKI encrypted email and/or fax) to the COR or designee identifying the reason the Home Environment Assessment was not done.

preventive maintenance was not done.

A. The Contractor shall verbally notify the COR or designee during the home environment visit if the Contractor’s staff determines that the presence of oxygen in the home presents such a danger that the oxygen must be removed, or in the case of an initial set-up, not placed in the home. All verbal notifications shall be documented in the patient folder and with the monthly billing.

B. The Contractor shall verbally notify the COR or designee of any unsafe conditions observed in the VA beneficiary’s home that precludes the installation or continuance of oxygen service. Unsafe conditions may include, but are not limited to, fire safety hazards, oxygen safety hazards, patient abuse by family or caregivers, or any instance that places the patient or Contractor’s staff in immediate danger. The Contractor shall furnish verbal and written documentation of the safety hazard of the incident. Notifications, including verbal, immediate, and documented incidents shall be documented in the patient’s folder and submitted with monthly billing.

C. The Contractor shall ensure the electrical outlets being used for oxygen or ventilator purposes, in the patient’s home are adequate and meet the requirements of the contractor’s equipment standards and immediately report unsafe conditions to the COR or designee. VA shall not be responsible or liable for any unsafe electrical conditions or required alterations to the Veteran’s residence.

D. The Contractor shall notify the COR or designee and/or the prescribing VA clinician by telephone, at the time of set-up, if any alterations to the patient’s home is necessary to accommodate the equipment, including electrical work. If ordered equipment cannot be safely installed, the COR or designee may provide an alternative oxygen delivery system, after approval, until new prescription can be obtained. If no alternative is available, Contractor shall contact the COR or Home

Oxygen Coordinator/designee within two (2) hours of determination. Contractor is not responsible for any required alterations to the patient’s/caregiver’s residence.

Any alterations to the Veteran’s residence shall be the responsibility of the veteran.

E. The Contractor shall check for the presence or absence of a working smoke detector and the presence of functional fire extinguisher with a full gauge. The

Contractor shall document equipment presence/absence in the patient’s file and incident report.

F. Expectations of Compliance:

1) Inquire about the presence or absence of a functional smoke detector and fire extinguisher when oxygen is delivered, as well as with subsequent encounters.

a. When smoke detectors, fire extinguishers are present:

i. Ask the patient during each service check visit if they have tested their smoke detectors and checked the condition (charge level) of their fire extinguishers in the last 30 days.

ii. Check all home oxygen/ home ventilator equipment, provided under this contract to home oxygen patients, on each service visit to ensure its fire safety. Document in the home care record that this check has occurred.

b. When smoke detectors, fire extinguishers are not present:

i. Contractor shall provide fire safety education, to include information about Veterans seeking a smoke detector from a local source (e.g.…, fire department)

c. In homes where there is evidence of smoking or there is a potential for open flames, such as heating devices, cooking surfaces, or fireplaces, the contractor shall verify the following:

i. That ‘no smoking’ signage is properly posted.

ii. Patient and/or caregiver understand and confirm understanding verbalizing the dangers of smoking and open flames.

iii. Patient and/or caregiver shall avoid smoking or the presence flames anywhere near oxygen.

iv. COR or designee has been notified if patient/caregiver persists in using open flame devices in the vicinity of oxygen home care record the occurrence of items listed above.

2.5 EMERGENCY SERVICES/EMERGENCY MANAGEMENT PROTOCOL: Emergency services are for medical equipment provided to patients when an equipment malfunction, low/zero balance of oxygen back up, national health crisis or natural disaster may threaten a patient's health.

A. The Contractor shall provide to the Contracting Officer, and COR a written Emergency

Management Plan at time of proposal, within ten (10) business days of contract award, and upon Contractor update or upon request via email or fax, that is in compliance with JC and VA standards. This emergency management plan shall include protocols to ensure refill of low oxygen supply and back-up tanks are filled and ready for use, to meet minimum oxygen supply requirements, and address the following, including but not limited to:

1) Contractor shall activate their Emergency Preparedness Plan (EPP), when a natural disaster (i.e., hurricane, tornado, fire, flooding, etc.) is projected/imminent. Activation of the EPP shall be no later than 24 hours from Contractor notification received from the VA. Contractor shall use best judgement, for the safety of the patients, if EPP should be activated prior to notification from VA. Contractor shall notify facility CORs immediately upon EPP activations, via email or fax.

2) Contractor shall contact one hundred percent (100%) of Veteran’s unless otherwise notified by VA.

a. First Priority contacts: Contractor shall contact all ventilator, concentrator, continuous flow/high oxygen flow, and impacted area patients within twenty-four (24) hours of EPP.

b. Second Priority contacts: Contractor shall contact all other home oxygen patients within forty-eight (48) hours of EPP activation.

3) Continuity of services for all patients covered by this contract, to include procedures and emergency messaging for 100% contact (i.e., message broadcasting using voice with optional text, or voice and text) of patients in the affected Medical Center’s geographical area. Contractor messaging/ broadcasting system shall contain ability for patient to select a numbered option or means to indicate receipt of EPP messaging/ notification, messaging of the type of emergency, and a Contractor contact number/method if services are needed. Patient contact shall begin within 24 hours of notification and results shall be completed within 48 hours of activation of the EPP. Vendor shall begin post-event patient contacts within

24 hours of the end of the emergency/disaster event and shall complete the contacts within 48 hours thereafter.

4) Contractor shall contact the local COR upon completion of the EPP patient contacts via email and/or fax.”

5) Contractor shall submit to the COR and/or Home Oxygen Coordinator a report of completion of 100% EPP patient contacts, to include patient Last

Initial, Last 4 of SS, “contacted” (indicates: patient receipt of notification) and “not contacted” (indicates: no response of patient to notification).

Contractor shall submit report within 48 hours of the EPP activation/ termination (upon contact completion), and within 24 hours upon request by the COR, via email PKI encryption and/or fax for clinical follow-up, if deemed necessary.

6) Contractor shall execute calls using the telephone number for the local contract provider so the veteran will know who is calling should they have caller ID.

7) Contractor shall ensure customer service numbers (Contractor Toll-

Numbers) are effectively managed during a disaster, should contractor staff be unable to travel to the servicing location/office due to damage and/or road closures.

8) Contractor shall ensure times zones for calling, are adjusted to the patient’s time zone being called, allowing for the best opportunity to successfully reach the veteran on the phone.

B. The Contractor shall provide emergency maintenance assistance twenty-four (24) hours, seven (7) days a week. A document listing the emergency telephone number shall be provided to the patient at the time of setup. Contractor shall communicate any changes, to their emergency points of contact or their contact information, to the COR within three (3) business days.

C. The patient shall first call the Contractor in an emergency equipment situation. The

Contractor shall have a well-established communication system, providing 24-hour emergency services and the ability to provide services at the patient's home (or present location) within two (2) hours of a call, but in no case to exceed six (6) hours of a call.

D. The Contractor shall ensure all patients are provided a backup (non-electrical) oxygen supply that shall last a minimum of three times the Contractor’s maximum response time for all Primary Oxygen systems, or a supply no less than eighteen (18) hours, whichever is the greater supply. The minimum supply shall consider each patient’s prescription flow rate, frequency, duration, and distance from the Contractor’s location. Actual supply levels may differ from patient to patient, as long as, each patient has the “greater” oxygen supply as previously defined. The cost of backup systems, backup oxygen, and backup equipment shall be borne by the Contractor. If “H or M” size oxygen cylinder is used for backup, the

Contractor shall furnish an “H or M” size oxygen cylinder stand for each “H or M” size oxygen cylinder. Liquid oxygen supply shall be considered backup oxygen; however, the oxygen supply shall be regularly checked and maintained at the minimum three (3) times the maximum response time or a supply no less than eighteen (18) hours, whichever is the greater supply.

E. The Contractor shall notify the COR or designee, within four (4) hours, in the event of disaster, natural or otherwise, that may/will affect the services covered under this contract.

The Contractor shall provide patients with written instructions about what to do in case of a natural disaster, severe weather event, other emergency, or crisis.

F. Emergency calls made to the Contractor shall be considered life threatening with an immediate response to the site of the veteran beneficiary’s domicile, no matter the distance from the Contractor's place of business. An emergency exists if the COR informs the Contractor that he/she considers the situation an emergency, or if the VA beneficiary states in a telephone call to the Contractor that an emergency exists regarding the function or use of the respiratory related equipment or use of the equipment.

G. The backup system for ventilator patients shall consist of two (2) ventilators on hand.

Contractor shall have a Clinician (RT) available to provide after-hours education and equipment management for patients with a bypassed upper airway or receiving ventilator therapy.

H. If the Contractor is unable to respond to an emergency service call within six (6) hours, the

Contractor shall be responsible for making arrangements with another supplier, who meets all JC standards, to provide oxygen at the Contractor's expense. A written explanation (via

PKI encrypted email and/or fax) of why the Contractor was unable to respond to the emergency shall be provided to the COR or designee within two (2) business days. If the

Contractor is unable to meet the above requirement for another supplier arrangement for emergencies, the Government has the right to obtain the services from another source and to charge the Contractor any costs incurred over and above the contract price. A mandatory written justification detailing why emergency service was not available and the Contractor was not able to make arrangements with another supplier shall be provided by the

Contractor to the facility COR and the Contracting Officer within twelve (12) hours from the original time the Contractor was called to provide the service.

2.6 PREVENTATIVE MAINTENANCE: The Contractor shall perform equipment routine maintenance semi-annually (every six (6) months) for all oxygen patients, and per manufacture’s guidelines, with documentation of these checks on file. The Contractor shall provide all documentation to the COR or designee with signatures and dates on the contract inception date and monthly thereafter. If the patient does not receive equipment preventive maintenance services, the Contractor shall provide documentation (via PKI encrypted email and/or fax) to the

COR or designee identifying the reason preventive maintenance was not done.

A. CONCENTRATORS: The Contractor shall provide service and preventive maintenance

(PM) on all equipment (contractor-furnished equipment and government-owned equipment) as recommended by the manufacturer. The Contractor shall track and document maintenance of equipment in accordance with manufacturer specifications and provide these records to the COR for review upon request. Preventive maintenance shall only be performed by a manufacturer trained service technician that has received the appropriate/approved training. The Contractor shall conduct a check of the concentrator using a manufacturer certified oxygen analyzer that is calibrated according to the manufacturer standards. The Contractor shall change compressor inlet pre-filters and compressor inlet bacteria filters according to the manufacturer recommendations. The Contractor shall test the alarm battery at each maintenance check;

the Contractor shall change the alarm battery as indicated, but at least annually. The Contractor shall ensure that every concentrator has a label or pouch that indicates the most recent service date, service hours and technician’s name. Contractor shall furnish parts and labor for routine maintenance.

B. VENTILATORS: The Contractor shall provide service and preventive maintenance

(PM) on contractor-furnished ventilators as recommended by the manufacturer. The Contractor shall track government-owned ventilators for preventive maintenance (PM) in accordance with manufacturers specifications. If a ventilator needs maintenance, either scheduled or unscheduled, the contractor will pick up the ventilator from the patient’s home and replace with another ventilator. VA owned ventilators, in need of manufacturer’s recommended PM and/or repairs, shall be shipped to the manufacturer by the Contractor. The Contractor shall notify the COR of necessary repairs and the cost. VA is responsible for costs of maintenance and repairs of VA-owned ventilators.

2.7 MANUALS: The Contractor shall provide the Operation and Service manual to the Patient and/or caregiver upon delivering any equipment. The manual shall contain information on operation, maintenance, and troubleshooting for clinicians, users, caregivers and service technicians. Contractor shall provide, to the Government, one (1) copy of the Operation and

Service manual for each type of equipment upon request following award regarding this contract.

2.8 STORAGE CHARGES: The Contractor shall, upon request by the COR/ Home Oxygen

Coordinator or designee, stock portable set-ups at the VA Medical Center to send home with the patient.

A. Contract shall provide an quantity estimated supply of aluminum/composite compressed O2 tanks/cylinders with regulator, an E-tank stand, and tubing to each participating VA Health Care System listed in the Schedule, and/or their respective

Community-Based Outpatient Clinics (CBOC’s), as directed by the facility COR.

Quantities, sizes of tanks, and frequency of restock, will vary from site-to-site, and throughout the contract period, and shall be agreed upon by the Contractor and facility COR.

B. The Contractor shall ensure that the reserve supply accommodates home oxygen patients who are either being discharged from the hospital or visiting (i.e., appointments, etc.) and require a re-supply of oxygen to reach their residence. The stocking of set-up supply, at the Medical Center, does not replace the Contractors’ responsibility of providing initial setup and equipment operational education at the

Veteran’s residence.

C. The Contractor shall maintain adequate inventory levels at the Medical Center, as determined by the facility COR. Contractor shall provide the reserve supply to the

VA at no additional cost to the Government.

2.9 HIGH RISK PATIENTS: High-risk patients are patients who exhibit unsafe behavioral traits involving oxygen and smoking, such as, attempting to hide their smoking materials or activities from staff, having a history of non-compliance with smoking rules; or smoking in a patient’s bedroom or other areas designated as non-smoking areas. VA Home Oxygen Coordinator shall notify the Contractor via encrypted email and/or fax of all high-risk Patients.

Contractor notification to each local COR or designee shall consist of Contractor’s written report/form and shall contain at a minimum Veteran’s name and last four (4) numbers of their social security number, shall clearly document observations, and any precautionary information provided to the patient.

2.10 PATIENT TRAVEL: Travel is defined as those occurrences, in which, the beneficiary stays away from their domicile overnight.

A. Contractor shall provide to patient and/or caregiver, at the time of initial set-up, information/literature on how to request travel services.

B. The Contractor shall be responsible for arranging and coordinating all home oxygen and home ventilator services for Veterans who travel both within and outside their respective contracted jurisdiction. The Contractor shall instruct the patient to notify the Contractor and the VA resident facility Home Oxygen Coordinator or designee at least two (2) weeks before intent to travel, and four (4) weeks, if the patient is permanently relocating. The

VA facility(ies) will be responsible for approving all travel, notifying the contractor of the travel dates, and what equipment are approved. The VA facility will provide approval to

Contractor no later than five (5) calendar days before travel date for non-emergency travel. The Contractor shall not initiate delivery of any equipment or transfer of services prior to receipt of VA travel authorization. Arrangements and coordination of oxygen for

Veterans in a travel status shall be provided at no additional cost to the VA.

C. The Contractor shall provide patients traveling within the areas covered by this contract, all home oxygen and/or home ventilator services, hereunder, at the contract rate utilizing

Contractor furnished equipment only. The Contractor shall contact Veteran to coordinate travel within 48 hours of receipt of VA facility Travel Oxygen Approval form and/or VA prescription. Additional costs incurred as a result of home oxygen support for Veteran travel, temporary relocation or to support infrequent instances of home oxygen supply shall be considered extra contractual and shall be individually discussed with the CO/COR for potential contract modification. Coordination of oxygen needed for air transportation, and associated costs, is not included in the services provided under this contract and is the responsibility of the Veteran.

D. Temporary Relocation (to include outside of contract service area):

1) The Contractor shall arrange for home oxygen and/or home ventilator services, in accordance with VA prescription, at the same contract rate (billed to the patient’s resident VAMC), for Veterans traveling outside the areas covered by the respective VA medical facility and/or temporarily relocating, if the

Contractor has a subsidiary office located near or at the temporary destination.

2) If no subsidiary office is located near or at the temporary destination, it shall be the responsibility of the Contractor to locate an oxygen provider/source at the

Veteran’s travel destination, make the appropriate arrangements and invoice the

VA. The VA shall pay the contractor awarded the contract and will have no interaction with the oxygen provider at the travel destination.

3) All maintenance requirements, as described in this Performance Work Statement, are applicable. All set- up and maintenance forms shall be sent to the facility

COR.

E. Permanent Relocation (outside of contract service area): When the Veteran is permanently relocating to any area not covered under this contract, the Contractor shall:

1) Instruct the patient that they are responsible for notifying the current resident facility four (4) weeks prior to the permanent relocation.

2) Provide the Veteran with Oxygen/Ventilator Supplies until the Veteran has setup service in the new location or up to a 90-day supply, whichever occurs first.

3) The contractor is responsible for providing oxygen equipment and supplies until such time as the destination VAMC enrolls the patient into the Pulmonary/Home

Oxygen Clinic and the destination facility (or contracted vendor) provides their equipment unless other arrangements/agreements have been made between the two

VAMCs. The destination VAMC must enroll the Veteran as soon as reasonably possible (e.g., < 30 days in accordance with VA Clinics “Waits and Delays” measure).

4) Upon arrival at the destination VAMC, any equipment that came with the patient and that is owned by the resident facility or contractor shall be returned. Any cost incurred in the shipping/handling is the responsibility of the resident VAMC.

F. Emergency Travel: Emergency travel is defined as travel requested, for a family emergency (an unexpected occurrence that affects the health or safety of a family member), and with 48 hours or less notice. The Contractor shall accommodate the short notice request and shall arrange for home oxygen for Veterans requiring emergency travel.

1) During normal business hours, the Contractor shall contact Veteran to coordinate travel within one (1) hour of receipt of VA facility Travel Oxygen Approval form and/or VA prescription. The Contractor shall notify VA facility(ies) within 2 (two) hours, but not to exceed four (4) hours, of notification from Veteran(s). VA facility(ies) will respond to the contractor within two (2), not to exceed, four (4) hours.

2) In event of after-hours emergency travel request, Veteran shall contact Contractor directly to coordinate travel. The following business day, the Contractor shall coordinate with the Prosthetics and Sensory Aids Service (P&SAS) and/or

Respiratory Therapy Services at the local VA facility.

G. Leisure Travel Limits: Leisure travel is not considered an emergent/emergency travel.

Patients receiving home oxygen and/or home ventilator services under this contract are authorized a maximum of thirty (30) days of leisure travel, with a maximum of two (2) set-up charges within a one (1) year period. Veteran, medically related travel, is excluded from the leisure travel maximum limit. Contractor shall not provide home oxygen or home ventilator services for leisure travel that exceed the maximum limits unless authorized to do so, in writing, by the local COR. If additional travel is authorized, the Contractor shall bill the Government at the then current contract rates shown in the Price Schedule, for home oxygen or home ventilator services that exceed the maximum limits. The Contractor shall monitor leisure travel usage, and notify COR, when limits are approached (upon second request for travel) and when they are exceeded by COR authorization. Contractor shall inform patient and/or caregiver of the maximum limits and VA authorization requirements, and that any other costs shall be the patient’s responsibility.

H. Authorized Veteran Travel Areas: The Contractor shall be responsible for arranging and coordinating all U.S. States and U.S. territories. Travel outside of the United States, is not covered under this contract.

2.11 DELIVERY SCHEDULE: The Contractor shall develop a consistent delivery schedule for service, equipment, and supplies with each patient following receipt of the facility order. The

Contractor shall ensure deliveries are made on a regular basis with sufficient frequency to ensure the patient maintains a safe reserve of oxygen in case of emergency. Contractor shall ensure specific appointment times include both a date and an estimated time of arrival, with a one (1) hour target allowance, prior to and after the scheduled time but shall not exceed a four

(4) hour period through no fault of the Contractor. If the Contractor cannot meet the one (1) hour target allowance, the Contractor shall contact the COR or designee prior to the four (4) hour period. Contractor shall ensure appointment date and time is updated in the patient’s electronic file prior to the appointment date.

2.12 SERVICE CALL: The Contractor shall respond to service calls (i.e., return call); to include, within two (2) hours to troubleshoot the cause, and shall resolve the service call within six (6) hours of request from the COR or designee (dependent on patient’s availability), to include after normal business hours, weekends, and holidays, and patient request for return call generated by the contractor’s automated return call response system. The Contractor shall also provide 24-hour emergency services and shall provide services at the patient’s place of residence within six (6) hours of a call.

2.13 CONTRACTOR MONTHLY AND SEMI-ANNUAL VISITS: The Contractor’s schedule for visits to beneficiaries' residences in performance of this contract shall be by appointment.

Typical scheduled hours are between 8:00 AM and 6:00 PM Monday through Friday CT.

A. The Contractor shall provide services in support of this contract five (5) days per week;

exceptions shall be made in the cases of emergencies.

B. The Contractor shall be responsible for scheduling the follow-up appointments to the patient's home at least seventy-two (72) hours prior to the appointment. On each scheduled setup/delivery the Contractor shall train the patient on the use and care of the equipment and supplies.

C. Contractor shall ensure specific appointment times include both a date and an estimated time of arrival, with a one (1) hour target allowance, prior to and after the scheduled time but shall not exceed a four (4) hour period through no fault of the Contractor. If the

Contractor cannot meet the one (1) hour target allowance, the Contractor shall contact the COR or designee prior to the four (4) hour period.

D. Contractor shall ensure appointment date and time is updated in the patient’s electronic file prior to the appointment date.

E. Contractor shall make a minimum of three (3) documented attempts, within a seventy-two (72) hour period, to contact the patient to schedule a visit. Multiple attempts may be made in a single day; however, only (1) attempt per day shall be counted towards the seventy-two (72) hour requirement. Contractor shall notify the local Home Oxygen

Coordinator of inability to schedule visit after seventy-two (72) hours to receive instruction.

2.14 EXCESS DELIVERY: The VA shall not authorize payment on the delivery of excess supplies or equipment; excess deliveries are those provided without prior authorization by the COR. Any exceptions will be determined on a case-by-case basis by the COR.

2.15 DISCONTINUATION OF SERVICE:

A. The COR or designee will notify the Contractor of VA initiated discontinuance of service to any patient covered under this contract. Notification shall be by telephone, fax, or encrypted email. The final invoice shall be prorated from the date of notification. Final services shall be billed with the next scheduled invoice.

B. Upon termination of oxygen service to the beneficiary, the Contractor shall pickup all oxygen equipment and supplies no later than two (2) business days after receipt of notification from the VA, unless otherwise approved by the VA authorized

Representative. The date and time of equipment pickup shall be coordinated with the patient or next of kin and shall be accurately documented. SPECIAL NOTE: The

Contractor shall make every effort to meet the patient’s or patient’s families’ requests for pickup times. The Contractor shall honor patient’s or family’s requests to pick up equipment before or after funerals or family gatherings relative to patients’ funeral. The Contractor shall treat such requests with the utmost courtesy and give such requests the highest priority and shall notify the COR of such request within the two (2) business day timeframe.

C. Upon the death of a beneficiary the VA shall notify the Contractor via telephone and/or consult. Arrangement shall be made within two (2) business days to pick up all supplies and equipment. Additional billing shall not be honored after the patients date of death.

D. In the event the Contractor gains knowledge of the patient’s death, or change in requirement status, prior to the servicing VA, the Contractor shall immediately notify the VA of the patient’s death and the date the Contractor was made aware of the death.

Billing shall cease effective the date of the patient’s death. The final invoice shall reflect service discontinuation as the date of death.

E. The Contractor shall notify the COR within the next business day upon finding a patient has moved out of the service area.

2.16 PATIENT RIGHTS AND RESPONSIBILITIES: The Contractor shall provide a copy of VA approved Patient Rights & Responsibilities and any applicable information concerning advance directives during initial setup to all patients.

2.17 REPORTS: The Contractor shall report special incidents found or occurring during a home visit; to include finding Patients in need of emergency medical assistance, safety hazards that do not fall into the category of presenting immediate life-threatening danger to the Patient or

Contractors staff, inability to contact a Patient within a reasonable period of time, and any other incident meeting the Contractors written policy for incident reporting according to Joint

Commission accreditation standards. All reports, containing confidential Patient information, shall be provided to the COR via encrypted email using a standard encryption scheme, such as

PKI and fax within 24 hours. Life threatening situations (i.e., 911, police, and any other emergency) shall be reported to the proper authorities immediately. The Contractor shall maintain a file containing all incident reports at its place of business.

A. Daily Report: Contractor shall provide to each individual station a daily faxed report which shall be received no later than (NLT) 1:00 PM Central Time each workday.

1) Daily report shall identify each request issued by VA to the Contractor the day before. Data shall include, at a minimum, date and time request fax were received

(including time zone if different from sending station), patient first and last name, last 4 of patient social security number, vendor patient identification number, if any, and type of request (initial…