36C24118Q9262-002.docx

Performance Work Statement – Shelter Per Diem Program

***To be for all qualified shelters in the White River Junction Catchment area (State of Vermont and the counties of: Coos, Grafton, Sullivan, and Cheshire in the State of New Hampshire) for a total of 5 emergency shelter beds.

1. PURPOSE.

The Department Affairs Medical White River Junction, VT (“VAMC”) requires contractors to provide services as part of its Community Based Health Care for Homeless Veterans (HCHV) program. The goal of the HCHV program is to remove homeless Veterans from the street or habitation unfit for Veterans and place them in community-based, residential environments with sufficient therapeutic services to meet the needs of those Veterans.

1. BACKGROUND.

Through the HCHV program, VA provides coordination of services to Veterans and facilitates their access to a broad range of medical, mental health, and rehabilitative services. The purpose of this solicitation is to obtain offers from contractors who can provide care, treatment and rehabilitative services to homeless veterans, who may also be suffering from serious mental illness, including veterans who are homeless, in community-based treatment facilities offering a safe and secure environment that supports their rehabilitation goals. The Contractor will be required to provide therapeutic and rehabilitative services, but will not be required to provide detoxification or other hospital level treatment – those services will be provided by the VA at VA facilities.

C. SERVICES TO BE PROVIDED

BASIC SERVICES. The contractor shall furnish each Veteran referred for care under this contract with the following basic services:

a. ROOM AND BOARD: Room and Board to include a bed and other furnishings such as a dresser, storage, and personal linens (towels and bed sheets). Meals to include at least two (2) nutritionally adequate meals a day, 7 days a week and availability of nutritious snacks between meals and bedtime for those requiring or desiring additional food, when it is not medically contraindicated.

b. LAUNDRY FACILITIES: Laundry facilities for residents to do their own laundry or to have laundry done.

c. THERAPEUTIC AND REHABILITATIVE SERVICES: Therapeutic and Rehabilitative Services determined to be needed by each individual Veteran referred for treatment as stated in the plan developed by the contractor, with input from the Veteran and the VA Homeless Program Coordinator (or designee). Services which the contractor must be able to furnish shall include:

0. Collaboration with the HCHV VA program staff, which will provide supportive psychosocial services. Confidential space will be made available at Contractor’s site for HCHV program staff and Veteran meetings.

0. Assistance to develop responsible living patterns, to maintain an acceptable level of personal hygiene and grooming, and to achieve a more adaptive level of psychosocial functioning, upgraded social skills, and improved personal relationships.

0. 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

0. Assistance to gain knowledge of the process of recovering from homelessness, mental health and or addiction.

0. Case Management services related to psychosocial needs, to include but not limited to: Facilitate and support access to community / VA based services i.e.: SSDI, Food Stamps, health care, public transportation, GI Bill, Service connected pensions, Non Service connected pensions, unemployment, General assistance, supported or independent housing programs (VA and Non VA)

0. A program that promotes community interaction.

0. Outreach services to engage homeless Veterans at shelters (statewide), soup kitchens, social clubs, etc.

In addition, the Contractor shall provide treatment and discharge planning reflecting a team assessment of health, social and vocational needs and the involvement of the Veteran, the VA staff and appropriate community resources in resolving problems and setting goals.

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 comply with the principles listed in 38 CFR 17.707(b) to provide housing and supportive services in a manner that is free from religious discrimination.

SUPPLEMENTAL SERVICES. All services shall be provided at no additional charge to the stated daily fixed fee, except for those services specifically stated below to be Supplemental Services.

[INCLUDE DESCRIPTION OF SUPPLEMENTAL SERVICES, IF ANY, OFFERED BY CONTRACTOR]

D. ADDITIONAL CONTRACT REQUIREMENTS

1. PERSONNEL

The contractor will employ sufficient personnel (minimum requirement is a Mental Health Rehabilitation Technician Certified) to carry out the policies, responsibilities, and the program for the facility. There must be, as a minimum, at least one administrative staff member, or designee of equivalent professional capability, on duty on the premises or residing at the house and available for emergencies 24 hours a day, 7 days a week.

The Contractor shall assign to this contract personnel that by education and training (and, when required, certification or licensure) are qualified to provide the Basic Services and Supplemental Services required by this SOW.

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 Contracting Officer, at least 15 days before the substitution is to occur. The Contracting Officer 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 patient care or interferes with the regular and ordinary operation of the facility.

Temporary substitutions of key personnel shall be permitted in accordance with the Contractor’s contingency plan. The Contractor’s contingency plan to be utilized if personnel leave Contractor’s employment or are unable to continue performance in accordance with the terms and conditions of the resulting contract must be submitted as part of the Contractor’s offer.

All Contractor staff providing services to Veterans under this contract must undergo the appropriate background investigation as required by the VA.

REFERRALS

A. The VA is responsible for determining eligibility of Veterans prior to referral to the Contractor for treatment. A written referral (hard copy, fax or e-mail are acceptable) signed by an authorized VA HCHV staff member shall be provided to the Contractor for each Veteran referred for services under the contract.

B. A list of authorized VA ordering officials for the contract shall be provided to the Contractor upon award of the contract. Ordering officials may be added or deleted from the list during the term of the contract at the discretion of VA Contracting Officer. The Contractor shall be provided an updated list of authorized VA ordering officials whenever such changes are made.

C. 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.

D. The initial referral period for a Veteran may be up to 30 days, depending upon the needs of the Veteran as mutually determined by the Veteran, the Contractor’s staff, and VA HCHV Staff member, an extension of the referral period up to a total of 60 days may be authorized by the VA HCHV staff member or designee, provided that funding is available. Treatment periods in excess of 60 days for individual Veterans must be authorized by a HCHV staff member.

3. ABSENCES AND CANCELLATION

A. The contractor shall notify the VA of unauthorized absences by a referred Veteran from the facility. 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 3 days, provided there is an active outreach attempt on the part of the Contractor’s staff to return the Veteran to the facility and there is a reasonable belief that the Veteran will return. Management of program dropout will be an element of quality assurance review of this program. Absences of the Veteran from the facility in excess of three days will not be reimbursable unless authorized in advance by a HCHV Staff member.

B. 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 or the Veteran.

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. When such admission is not feasible because of the nature of the emergency, it is agreed that hospitalization in a non-federal hospital may be accomplished provided that VA authorization is obtained. If hospitalization of a non-emergency nature is required it is agreed that admission to the appropriate VA facility will be accomplished promptly.

The contractor shall notify the authorizing VA facility immediately of any incidents involving veterans residing in the residential program. The contractor shall notify the VA case manager by telephone during the hours of 8:00am and 4:30pm. For all incidents that occur after normal business hours, the contractor should notify the Administrator on Duty (AOD). The contractor shall provide the HCHV case manager and the COTR with a copy of the incident report within 24 hours. The contractor shall maintain a copy of the incident report in the Veteran’s case record.

1. CONTRATOR 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 (copy available upon request).

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 patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient 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 Technical Representative 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.

4. TRANSPORTATION

The Contractor shall assist the Veterans with local transportation to scheduled meetings and appointments. 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 staff determines that adequate public transportation is not available or appropriate for a Veteran, the Contractor shall arrange for alternative transport by car.

5. FACILITY

A. 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. The contract facility must:

i. have a current occupancy permit issued by the local and state governments in the jurisdiction where the facility is located.

ii. Be in compliance with existing standards of State safety codes and local, and/or State health and sanitation codes.

iii. Be licensed under State or local authority.

iv. Where applicable, be accredited by the State.

be equipped with operational air conditioning /heating systems

v. be kept clean free of dirt, grime, mold, or other hazardous substances and damaged noticeably detract from the overall appearance.

vi. be equipped with first aid equipment and an evacuation plan in case of emergency.

vii. have windows and doors that can be opened and closed in accordance with manufacturer standards.

B. The contractor facility must meet fire safety requirements, as follows:

i. The building must meet the requirements of the applicable residential occupancy chapters of the current version of NFPA 101, National Fire Protection Association's Life Safety Code. Any equivalencies or variances must be approved by the appropriate Veterans Health Administration Veterans Integrated Service Network (VISN) Director.

ii. All residents in the facility must be mentally and physically capable of leaving the building, unaided, in the event of an emergency

iii. Fire exit drills must be held at least quarterly. Residents must be instructed in evacuation procedures when the primary and/or secondary exits are blocked. A written fire plan for evacuation in the event of fire shall be developed and reviewed annually. The plan shall outline the duties, responsibilities and actions to be taken by the staff and residents in the event of a fire emergency. This plan shall be implemented during fire exit drills.

iv. A written policy regarding tobacco smoking in the facility shall be established and enforced.

v. Portable fire extinguishers shall be installed at the facility. Use NFPA 10, Portable Fire Extinguishers, as guidance in selection and location requirements of extinguishers.

vi. Requirements for fire protection equipment and systems shall be in accordance with NFPA 101. All fire protection systems and equipment, such as the fire alarm system, smoke detectors, and portable extinguishers, shall be inspected, tested and maintained in accordance with the applicable NFPA fire codes and the results documented.

vii. The annual inspection by a VA team required by paragraph 7 shall include a fire and safety inspection conducted at the facility unless a review of past Department of Veterans Affairs inspections or inspections made by the local authorities indicates that a fire and safety inspection would not be necessary, in which case the fire and safety inspection may be waived by the VA.

7. 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, and other subject matter experts as determined necessary by the medical center director or HCHV staff member 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.

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 to take corrective action and to notify the Contracting Officer 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 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 discontinue plans to award a contract, or to discharge or transfer patients 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 in paragraph 6, 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 respect to veterans’ length of stay 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.

8. CONTRACT CHANGES/TECHNICAL DIRECTIONS.

The Contracting Officer is the only person authorized to approve changes or modify any of the requirements of this contract. The Contractor shall communicate with the Contracting Officer on all matters pertaining to contract administration. Only the Contracting Officer is authorized to make commitments or issue changes that shall affect price, quantity or quality of performance of this contract.

IN THE EVENT THE CONTRACTOR AFFECTS ANY SUCH CHANGE AT THE DIRECTION OF ANY PERSON OTHER THAN THE CONTRACTING OFFICER WITHOUT AUTHORITY, NO ADJUSTMENT SHALL BE MADE IN THE CONTRACT PRICE TO COVER AN INCREASE IN COSTS INCURRED AS A RESULT THEREOF.

The COTR will be responsible for the overall technical administration of this contract as outlined in the COTR Delegation of Authority, including monitoring of the Contractor’s performance.

Appendix A: Contract Security IAW VA Handbook 6500.6:

1. GENERAL

a. Contractors, contractor personnel, subcontractors, and subcontractor personnel shall be subject to the same Federal laws, regulations, standards, and VA Directives and Handbooks as VA and VA personnel regarding information and information system security.

2. ACCESS TO VA INFORMATION AND VA INFORMATION SYSTEMS

3. VA INFORMATION CUSTODIAL LANGUAGE

4. INFORMATION SYSTEM HOSTING, OPERATION, MAINTENANCE, OR USE

5. SECURITY INCIDENT INVESTIGATION

6. LIQUIDATED DAMAGES FOR DATA BREACH

(1) Nature of the event (loss, theft, unauthorized access);

(2) Description of the event, including:

(3) Number of individuals affected or potentially affected;

(4) Names of individuals or groups affected or potentially affected;

(5) Ease of logical data access to the lost, stolen or improperly accessed data in light of the degree of protection for the data, e.g., unencrypted, plain text;

(6) Amount of time the data has been out of VA control;

(7) The likelihood that the sensitive personal information will or has been compromised (made accessible to and usable by unauthorized persons);

(8) Known misuses of data containing sensitive personal information, if any;

(9) Assessment of the potential harm to the affected individuals;

(1) Notification;

(2) One year of credit monitoring services consisting of automatic daily monitoring of at least 3 relevant credit bureau reports;

(3) Data breach analysis;

(4) Fraud resolution services, including writing dispute letters, initiating fraud alerts and credit freezes, to assist affected individuals to bring matters to resolution;

(5) One year of identity theft insurance with $20,000.00 coverage at $0 deductible; and

(6) Necessary legal expenses the subjects may incur to repair falsified or damaged credit records, histories, or financial affairs.

7. TRAINING

a. All contractor employees and subcontractor employees requiring access to VA information and VA information systems shall complete the following before being granted access to VA information and its systems:

(1) Sign and acknowledge (either manually or electronically) understanding of and responsibilities for compliance with the Contractor Rules of Behavior, Appendix E relating to access to VA information and information systems;

(2) Successfully complete the VA Cyber Security Awareness and Rules of Behavior training and annually complete required security training;

(3) Successfully complete the appropriate VA privacy training and annually complete required privacy training; and

(4) Successfully complete any additional cyber security or privacy training, as required for VA personnel with equivalent information system access [to be defined by the VA program official and provided to the contracting officer for inclusion in the solicitation document – e.g., any role-based information security training required in accordance with NIST Special Publication 800-16, Information Technology Security Training Requirements.]