36C24420Q0381-011.docx

PERFORMANCE WORK STATEMENT (PWS)

1.0. INTRODUCTION.

1.1. The Government requires a contract for paramedic and ambulance services and all-inclusive services to include medical equipment necessary for the transportation of qualified Veterans of the Lebanon VA Medical Center (LVAMC) and associated Community Based Outpatient Clinics (CBOCS) that is state certified by the Pennsylvania Department of Health and Human Service, Bureau of Emergency Medical Services, LVAMC consists of one main campus/location: Lebanon VA Medical Center, 1700 South Lincoln Avenue, Lebanon, PA., 17042, which includes but is not limited to, a medical center, emergency room, and psychiatric care. In addition, it supports six VA Community Clinics (VACCCBOCS) in Berks, Camp Hill, Frackville, Lancaster, Pottsville, and York, Pennsylvania. The use of LVAMC throughout this document shall be interpreted as the Lebanon VA Medical Center and all six CBOCs associated with it. The Contractor shall provide ambulance coverage for the LVAMC, 24 hours per day/7 days per week, 365 days per year.

2.0. DESCRIPTION / SCOPE / OBJECTIVE.

2.1. The Contractor shall provide all vehicles, supplies, materials, equipment, labor, personnel, supervision, management, and transportation to furnish Basic Life Support and Advanced Life Support (BLS/ALS) ground ambulance emergency transport services to eligible VA beneficiaries of the LVAMC. The Contractor shall provide response in ALS/BLS vehicles and/or car and wheelchair transports with the time frames specified in the contract. Contractor's ambulance vehicles used in the performance of this contract shall meet the current specifications of Federal Specification KKK-A-1822E. The Contractor shall comply with all licensing and other applicable requirements of federal, state, and local government regarding the operation of patient transport ambulance services. Contractor care shall cover the full range of paramedic and ambulance services as provided in the local community. Paramedics responding shall bring equipment/supplies required by state regulations. The Contractor shall supply ALS equipment and medication to include, but not limited to, cardiac monitoring, intubation equipment, automated external defibrillator (AED), laryngoscope, pulse oximetry, glucometer, portable 02, protective clothing, and written procedures. Performance shall be in accordance with the requirements contained in this PWS and standards of the Pennsylvania Department of Health and Human Service, Bureau of Emergency Medical Services. The Contractor shall complete all required training by the LVAMC to include, but not limited to, Privacy Training and Computer Security Training.

2.2. Performance Location and Hours: Services shall be provided twenty-four (24) hours a day, seven (7) days a week, three hundred and sixty-five (365) days a year, including government holidays. Service shall include transportation to points dictated by the LVAMC, for beneficiaries located within catchment areas of the facility. Ambulance transportation services shall be furnished on an as needed basis.

2.3. Period of Performance: The period of performance will be five (5) years.

3.0. APPLICABLE DOCUMENTS.

3.1. The following laws, regulations, policies, and procedures in effect on date of contract issuance and all subsequent changes or updates apply:

Pennsylvania Department of Health Pennsylvania Department of Health and Human Service, Bureau of Emergency Medical Services.

4.0. Definitions:

4.1. Ambulance: Vehicles for emergency medical care which provide a driver compartment and a patient compartment that will accommodate an Emergency Medical Technician (EMT), Paramedic (or RN as needed), equipment and supplies for emergency care at the scene as well as during transport, and; communication device and equipment for light rescue procedures. The ambulance is designed and constructed to afford relative safety and comfort, and to avoid aggravation of the patient's condition. Transports requiring higher level of care than a Basic Life Support (BLS) transport are those equipped with an Advance Life Support (ALS) System and qualified staff.

4.2. Advanced Life Support (ALS) — Emergency: When medically necessary, the provision of ALS services, as specified above, in the context of an emergency response. An emergency response is one that, at the time the ambulance provider or supplier is called, it responds immediately. An immediate response is one in which the ambulance provider/supplier begins as quickly as possible to take the steps necessary to respond to the call.

4.3. Administrative Officer of the Day (AOD): VA official that works in the admissions area during evenings and nights; and monitor hospital activities during other than normal working hours. This person is located at LVAMC and acts as hospital administrator during off-hours.

4.4. Base Rate: Base Rate is defined as the rate paid for one-way transportation from a designated pick up point to a designated delivery point. This rate will be paid for all authorized one-way trips ordered under this contract action, with employees receiving at minimum the Department of Labor Service Contract Act wage rates (included under attachments), during all phases of the trip made on behalf of the Government. That Base Rate shall constitute full compensation for one-way trips which do not exceed the "Mileage Threshold" as shown in Section B.

4.5. Basic Life Support (BLS) — Emergency: When medically necessary, the provision of BLS services, as specified above, in the context of an emergency response. An emergency response is one that, at the time the ambulance provider or supplier is called, it responds immediately. An immediate response is one in which the ambulance provider/supplier begins as quickly as possible to take the steps necessary' to respond to the call.

4.8. Beneficiary: Veterans and other members determined to be eligible for benefits by the VA.

4.9. Business Hours/Days: Business hours/days defined as the time of 8:00AM to 4:30PM, Monday through Friday, except Federal holidays. Federal holidays include: New Year's Day, Maltin Luther King Day, President's Day, Memorial Day, Independence Day, Labor Day, Columbus Day, Veterans' Day, Thanksgiving Day, Christmas Day and other specifically designated days by the President of the United States to be a Federal holiday. Off business hours/days are defined as the time of 4:30 p.m. to 7:59 a.m., Monday through Friday, all day Saturday and Sunday and Federal holidays.

4.10. Contracting Officer (CO): VA official with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings, and is a member of the vehicle inspection team.

4.11. Contracting Officer's Representative (COR): VA official responsible for providing contract oversight and technical guidance to the Contracting Officer. Responsibilities include certification of invoices, placing orders for service, providing technical guidance, overseeing technical aspects of the contract, and are a member of the vehicle inspection team. All administrative functions remain with the Contracting Officer.

4.12. Contractor: The term "Contractor' as used herein refers to both the prime Contractor and his/her employees, and any subcontractors and their employees. The Contractor shall be responsible for assuring that his/her subcontractors comply with the provisions of this contract.

4.13. Dry Run: Dry Run/No Patient charge: These trips are defined as either a request for service by authorized Medical Center personnel, whereby the Contractor arrives at the designated pick-up point and no patient is transported due to a change in the Medical Center's needs or scheduled pick-ups for which due to circumstances beyond the Contractor's control (i.e., patient refuses pick-up, patient not home, patient not medically/mentally suitable for transport, etc.). The Contractor will be entitled to the applicable base rate only due to no fault or negligence of the Contractor. No charge shall be assessed on scheduled pick-ups that are cancelled by the VA and/or the patient prior to the departure of the transport.

4.14. Durable Medical Equipment (DME): Medical equipment that is ordered by a provider for use in the home, such as walkers, wheelchairs, etc.

4.15. Escort: A relative of the patient or a LVAMC representative accompanying the patient when the LVAMC has determined such an escort is in the best interest of the patient.

4.16. Excess Cost: The difference between prices regularly charged by another source utilized and the applicable contract prices.

4.17. The Joint Commission (TJC): A national organization dedicated to improving the care, safety and treatment of beneficiaries in a health care facility and environment.

4.18. KKK Specification: Each ground ambulance used in the performance of this contract must meet the current specifications of Federal Specification KKK-A- 1822E.

4.19. Mileage Rate: Mileage for ground ambulance services is the rate paid for each mile traveled beyond the specified Mileage Threshold of 2() miles, with the source being either the origination facility or one of the CBOCS. This rate applies to one-way transportation only, whether loaded or unloaded. In no event shall the Contractor receive this rate for miles traveled within the specified Mileage Threshold.

4.20. On-Site Vehicle: A functional, suitable vehicle, which will remain on campus at all times, for transporting paramedics and equipment to the location of all codes and conditions on the campus.

4.21. Quality Assurance: Those actions taken by the Government to assure services meet the requirements of this contract.

4.22. Quality Assurance Evaluator: Government personnel responsible for surveillance of Contractor performance.

4.23. Quality Assurance Surveillance Plan (QASP): An organized written document used for quality assurance surveillance. The document contains specific methods for performing surveillance of the Contractor's continuous performance.

4.24. Quality Control: Those actions taken by the Contractor to control the production of goods or services so they will meet the requirements of a contract.

4.25. Scheduled Trip(s): The term "Scheduled Trip" as used in this contract refers to those trips in which the Contractor has been given advance notice (advance notice is defined as notice given by 4:30 p.m. the prior business day) of required services and a specific pick-up time.

4.26. Unscheduled Trip(s): The term "Unscheduled Trip" as used in this contract refers to those trips required on an as needed basis and advance notice is not given.

4.27. Vehicle(s): The term "Vehicle(s)" as used in this contract refers to all modes of ground transportation provided under the requirements of this contract, a specific mode of transportation is identified.

4.28. Waiting: Waiting, as used in this contract, is defined as the time required (and verified by authorized medical facility personnel) for the Contractor to wait at designated pick-up and/or delivery points while performing contract services.

4.29. Waiting Grace Period: The waiting grace period is defined as fifteen (15) minutes prior to the time waiting charges commence. The base rate for ambulance, car and wheelchair van services shall include a fifteen (15) minute waiting grace period at origin and destination.

5.0. PERFORMANCE REQUIREMENTS.

5. l. Contractor Employees:

5.1.1. Under this contract, LVAMC reserves the right to demand corrective action for unsatisfactory performance or misconduct by contractor employees providing services to the LVAMC. Unsatisfactory performance and misconduct are determined at the LVAMC's sole discretion. The Contracting Officer may proceed with any and all remedies available to it under this contract and applicable law, including termination, if corrective actions are not taken and the performance of the contract is endangered.

5.1.2. The Contractor shall furnish qualified personnel as required by the contract specifications to accomplish all services under this contract.

5.1.3. Contractor personnel performing services to the LVAMC shall at all times conduct themselves in a professional manner, maintain personal hygiene, wear clean, neat uniforms and be identified by having the company name, and employee name affixed to the uniform. The Contractor shall be responsible for furnishing all vehicles, personnel, equipment and supplies, vehicle fuel, uniforms, nametags and/or badges for performance of services under this contract. Employee identifications shall be worn in clear view above the waist. Contractor personnel shall not smoke in vehicles at any time or while transporting VA beneficiaries.

5.2. Contractor Personnel Qualifications:

5.2.1. All Contractor personnel performing contract services shall meet the qualifications as specified in this contract, as well as any qualifications required by Federal, State, County and local government entities from the place in which they operate. Contractor personnel shall meet these qualifications at all times while performing contract services.

5.2.2. During the contract period of performance, if the Contractor proposes to add-on or replace personnel to perform contract services, the Contractor shall submit required evidence of training, certifications, licensing, background and security clearances, and any other qualifications to the designated COR. At no time shall the Contractor utilize add-on or replacement personnel to perform contract services who do not meet the qualifications under the terms and conditions of this contract.

5.2.3. Within seven (7) days after receipt of award notification, the contractor shall provide evidence of required training, certifications, licensing and any other qualifications of any personnel who will be performing services under this contract. The initial documentation shall be provided to the Contracting Officer and COR.

5.2.4. The Contractor shall comply with the provisions of the Privacy Act of 1974, the Health Insurance Portability and Accountability Act (HIPAA) of 1996, as well as all applicable (Veterans Health Administration) VHA regulations pertaining to Fire and Safety, VA Directive 7701, Occupational Safety and Health. Issued March 2003 VA Handbook 7701.1, Occupational Safety and Health Program Procedures. Current Joint Commission Standards and Department of Labor's Occupational Safety and Health Administration (OSHA) Policy on Blood Airborne Pathogens issued March 2003.

5.2.5. Per VHA Directive 2008-020, Patient Transportation Program, the Contractor must provide the COR an annual statement of certification of state driving records, license verification, and insurance. This shall include an annual statement that drivers are screened, trained, and competent to safely transport beneficiaries. This annual statement of the driver competency must include any advanced certifications, such as Advanced Cardiac Life Support or specialized training to assist and secure beneficiaries by stretcher or wheelchair.

5.2.6. The Contractor shall certify all paramedics on direct emergency medical response processes, upon notice of contract award and annually thereafter. The Contractor will submit the list of paramedics to the COR.

5.2.7. The Contractor shall assess competence and performance of personnel who will be performing services under this contract upon notice of award and annually thereafter, per Department of Health and Human Services, Emergency Medical Services.

5.3. Paramedic Qualifications: Paramedics providing services under this contract shall have the following qualifications, in addition to those required by Federal, State, and Local Government:

5.3.1. Have completed training in accordance with the standards published by the Department of Health and Human Services with the minimum curriculum or equivalent including an in-hospital training period. Such training programs must also be acceptable under the regulating requirements for local EMS Systems supported by DHHS under PL 93-154, Federal Register 39:24304. (1974).

5.3.2. Shall submit evidence of re-certifications and equivalent training program successfully completed to the COR.

5.3.3. Shall be certified, or otherwise officially recognized, by Bureau of Emergency Medical Services Office, Pennsylvania Department of Health.

5.3.4. Shall attend all refresher continuing education, or advance training programs as required by the local or state government entity in which service is rendered. In no instance shall this be less frequent than every two (2) years. Such refresher training shall be equivalent to that developed by the Department of Transportation, National Highway Safety Administration.

5.3.5. All personnel assigned to the LVAMC shall be evaluated by the Contractor to be competent to perform critical emergency functions.

5.4. Ambulance Driver Qualifications: Drivers shall have a valid operator's or chauffeur's license in accordance with Federal, State and local government requirements for their place of operation, for the services they perform, be capable of administering oxygen and have successfully completed the Standard and Advanced First Aid Course for the American Red Cross or U.S. Bureau of Mines or equivalent and be capable of providing necessary medical assistance.

5.5. Authorized Medical Center Personnel: Prior to performance, the Contracting Officer shall provide the Contractor with a list of names or position titles and phone numbers of authorized Government personnel who may request services and receive calls from Contractor regarding contract performance. This list will be updated and submitted to the Contractor as changes occur. The Contractor shall ensure that requests for services are received from authorized medical center personnel. Services rendered in response to requests from other than authorized personnel shall be at the risk of the Contractor and any cost related thereto shall be borne by the Contractor.

5.6. Contractor Equipment, Vehicles, and Inspection:

5.6.1. The LVAMC reserves the right to inspect contractor's equipment and vehicles or require documentation of compliance with contract specifications, and State laws, rules, regulations and guidelines governing emergency medical transport vehicles (ambulances). LVAMC inspections of contractor facilities shall in no way constitute a warranty by the LVAMC that the contractor's vehicles and equipment are properly maintained. The LVAMC reserves the right to restrict the contractors use of equipment and vehicles which are in need of repair, unclean, damaged on the interior or exterior body, and are not in compliance with contract requirements, determined by the sole discretion of the LVAMC. The restriction of such equipment and vehicles shall not relieve the contractor from performing in accordance with the strict intent and meaning of the contract and without additional cost to the LVAMC. If any ambulance equipment is added or replaced after inspection, subsequent to the award of this contract, it shall be inspected and approved by the Contracting Officer or his/her representative before being placed in use under this contract.

5.6.2. Ambulances shall meet all current applicable Federal, State and local specifications and regulations including, but not limited to, licensing, registration, and safety standards. Current and appropriate licensing, issued by the Bureau of Emergency Medical Services Office, Pennsylvania Department of Health Under 28 Pa. Code 1005.10(c) and 1007.7(c)., is required.

5.6.3. Contractor's ambulance vehicles used in the performance of this contract shall meet the current specifications of Federal Specification KKK-A-1822E.

5.6.4. All ambulances/care and wheelchair transports shall be clean and maintained in good repair in accordance with manufacturer's instructions and specifications, at all times during the performance of this contract, and shall contain:

5.6.4.1. An emergency safety kit,

5.6.4.2. Portable oxygen unit (s),

5.6.4.3. Fire suppression equipment,

5.6.4.4. Appropriate road emergency warning equipment.

5.6.5. BLS ambulance transports shall, in conjunction with the above, be equipped with stretchers to accommodate beneficiaries over 500 lbs. and have an on-board EMT or Paramedic, qualified to perform basic airway management. Overweight or obese patient transport rates shall be the same as those for non-overweight patients.

5.6.6. ALS ambulance transports shall, in conjunction with the above, be equipped with pulse oximetry and on-board Paramedic, perform cardiac monitoring, provide Advanced Cardiac Life Support (ACLS) drugs and procedures, and perform advanced airway management and medication monitoring and administration. Advanced airway management means the ability to intubate a patient and provide appropriate respiratory care, which does not include tracheotomies, cricoidotomies, or cricotracheotomies.

5.6.7. The Contractor shall provide oxygen when it is requested by authorized medical facility personnel or required by the beneficiaries' medical condition. Oxygen required for ambulance services shall be at the rate and price shown in section B.

5.6.8. The Contractor shall provide all medications required while in transport, sheets and blankets and other equipment and supplies required for use while in transport, for direct beneficiary care. The Contactor shall at no time and under any circumstances exchange supplies, equipment and/or medications with LVAMC. The prices quoted in the schedule of services shall be inclusive of consumables used in transport. All vehicles used for critical patient care (ex. ALS, BLS), shall include, but not be limited to, monitors, defibrillator with external pacemaker, intubation equipment, intravenous equipment, medications, patient compartment facilities, oxygen and suction equipment and accessories.

5.7. Request for Services:

5.7.1. LVAMC Travel Office or the Administrative Officer of the Day (AOD) will make requests for services. ALS or BLS mode of transport shall be discussed and determined by the contractor and the VA clinician providing the level of care. The Contractor shall transport per its policies and standard industry practices. If mode of transport differs from what was agreed upon, the Contractor shall submit documentation explaining the reasons for alternate course of action.

5.7.2. Authorized personnel will place scheduled and unscheduled transportation requests to the contractor's dispatch office. All requests will be placed against pertinent schedule items, on a unit price basis in accordance with schedule B and will be verified against invoices. The Contractor is responsible for providing all routing and directions to drivers prior to arrival at the pickup location and shall use the most direct route. When ordering services, (whether it is by telephone, facsimile, mail, e-mail, and/or in person), the LVAMC will provide the Contractor with the following type of information:

5.7.2.1. Mode of transportation required,

5.7.2.2. Required date and time of arrival,

5.7.2.3. Name of beneficiary,

5.7.2.4. Pick-up and delivery point,

5.7.2.5. Any other special instructions.

5.7.3 Requests for transportation services will be made to the Contractor dispatch personnel identified below:

Company:

Address:

City/State/Zip:

Contact Person:

Normal Hours Telephone No.:

After Hours Contact Person:

After Hours Services Telephone No:

5.7.4. Auxiliary Service: The Contractor may be required at times to transport beneficiary luggage, medical records, medication and other items including, but not limited to, wheelchairs, Stryker frames, litters, and nutritional supplements, from the pick-up point to destination. The Contractor shall not open, manipulate or otherwise seek information from these records or personal effects. The records and personal effects shall be delivered intact to the prearranged destination. Luggage to be transported shall be restricted to suitcase and valise type. These services shall be provided at no additional cost, however, should there not be room to transport these items and a second vehicle is needed, payment will be considered to only half (1/2) the charge from the first transport.

5.7.5. The Contractor shall be required to transport non-ambulatory Veterans, who are not in need of emergency transportation or medical attention, on gurneys, litters, and Geri chairs.

5.7.6. When transporting beneficiaries to a VA Community Nursing Home, upon arrival at the nursing home, the driver shall give the VA Nursing Home Packet that accompanies the beneficiary to the responsible Nursing Home staff member. The driver shall sign and date the packet's signature form. If there are any discrepancies between the address listed on the Nursing Home Packet and the address listed in the trip request, the driver shall clarify the correct destination address with the LVAMC Travel Office, or AOD if after hours.

5.7.7. When transporting a beneficiary to a local hospital, upon arrival at the hospital, the driver shall give the hospital the copy of the medical information accompanying the beneficiary and the history of present illness, vital signs, and medical actions or medications provided during transport.

5.7.8. If the Contractor's place of business is located beyond the local telephone call zone of the LVAMC (area code 717), the Contractor shall install and provide to the LVAMC, a toll-free number for accepting the LVAMC calls. It is estimated that 95% of all requests for service will be placed by telephone. Requests for service may also be in writing or oral from an authorized representative of the LVAMC, and may be completed by telephone, facsimile, mail, e-mail, or in person (by giving a written or verbal request).

5.7.9. Electronic Transmissions: The Contractor shall, at all times during the contract period, have on his/her premises a functioning fax machine to communicate requirements with the LVAMC (i.e., patient incidents, requests for service, special correspondence, etc.). Each Contractor shall indicate if there is e-mail availability for their company to complete communications with the LVAMC (use of this communication system will be mutually agreed upon after award of contract before any communications are completed in this manner).

5.8. Contractor Notification:

5.8.1. The Contractor shall be responsible for providing all transports, vehicle, and manpower necessary to meet all ALS and BLS transport requirements and may find it necessary to utilize another ambulance service. If the Contractor utilizes another ambulance service company, as a subcontractor, to complete any transport requests, the subcontractor must follow all laws, regulations, policies, and procedures and all subsequent changes or updates as referenced in 3.1 of the performance work statement. All invoices for this subcontracted service will be paid directly to the Contractor at the contract rate, and the contractor shall reimburse the subcontractor at their agreed rate. In the event, the Contactor is unable to perform services or have services performed as required the Contractor shall immediately notify the LVAMC Travel Office or AOD. The LVAMC reserves the right to re-procure services which cannot be performed by the Contractor, in accordance with the terms, conditions, and schedule of this contract. The Contractor shall indemnify and reimburse the LVAMC for all costs associated with excess re-procurement costs. Payment of re-procurement costs shall not relieve the Contractor from any terms and conditions in this contract. The LVAMC will be the sole judge in determining when services will be re-procured. The failure of the contractor to perform services within the required time frames and in accordance with terms and conditions may also provide cause for termination of the contract for "Default".

5.8.2. Should the LVAMC determine that immediate transportation is essential to prevent loss of life or serious bodily harm, transportation services may be procured without referral to the ambulance contractor. However, in these extremely rare cases, no charge shall be levied against the Contractor.

5.8.3. There are occurrences when a beneficiary will be scheduled for appointments requiring transportation from different VA facility, nursing home, or beneficiary place of residence. At no time shall a beneficiary be required to wait arrival of a pre-scheduled trip beyond thirty (30) minutes. Failure of the vehicle to arrive at the beneficiary's residence or VA facility /nursing home within the allotted time frame (30 minutes) may result in automatic cancellation of the trip, and services may be secured from other sources which may result in action taken against the Contractor, up to and including default.

5.9. Ambulance Service Response Time:

5.9.1. The Contractor shall respond to all calls for ground ambulance transport service by being on-site at the designated point of pick-up within 30 minutes of notification for an Advanced Life Support (ALS) vehicle and/ or within 45 minutes for Basic Life Support (BLS) vehicle. The Contractor shall respond to all calls immediately for emergency ground ambulance transport. The Contractor shall provide service 24 hours per day/7 days a week.

5.9.2. If the time period for pick-up, stated herein, is physically impossible due to location of veteran beneficiary, the Contractor shall contact the LVAMC Travel Office and inform him/her of the anticipated time required for pick-up and delivery of said beneficiary.

5.9.3. The Contractor shall provide and respond to all emergency calls in accordance with Federal, State, and Local regulations, governing dispatch of emergency medical (ambulance) vehicles and medical care of on-board beneficiaries, to include the use of sirens and other measures to ensure timely arrival at the designated LVAMC Medical facility.

5.9.4. Immediate Notification: It is the responsibility of the Contractor to immediately notify the LVAMC Travel Office when unable to make a pick-up or delivery by the exact time specified for previously scheduled trips, or unable to dispatch an ambulance to a designated pick-up point within the required time frame for unscheduled request for services. The immediate notification shall include the reason for the delay and whether the pick-up or delivery can be made at a later time and if so, specification of that time. However, it shall be the sole discretion of the LVAMC Travel Office to accept the later pick-up or delivery time or pursue services from another source. If the LVAMC Travel Office orders the services from another source, the excess paid to another ambulance company will be deducted from the total invoice of the Contractor.

5.9.5. Response Time Compliance Rate: The Contractor shall maintain at a minimum, a 98% compliance rate on responses to pick-up or deliver during the contract year. Travel office and/or AOD will track reported late pick up or delivery. This will be accomplished by Validated User/Customer Complaints and reviewing trip tickets with medical center requests. Failure of the contractor to perform in accordance with this compliance rating may constitute sufficient cause for termination of the contract.

5.10. Waiting Time:

5.10.1. For scheduled trips, waiting charges shall commence fifteen minutes from the scheduled pick-up time or from the time the Contractor actually arrives at the designated pick-up point, whichever is later.

5.10.2. If the designated pick-up and/or delivery points are at locations other than the VA Medical facilities and waiting beyond the required fifteen (15) minute grace period is anticipated, the Contractor shall notify the Travel Office or AOD. This call is only for the purpose of verifying and documenting the contractor's time for a record of arrival at pick-up and/or delivery points and is not necessary if the Contractor does not anticipate a delay for which waiting charges will be claimed. The Contractor's failure to notify the Travel Office or AOD when waiting beyond the grace period shall result in non-payment for waiting time.

5.11. Escort: The LVAMC reserves the right to have an escort, such as a relative, care provider, or staff accompanies the beneficiary when the LVAMC determines that such an escort is in the best interest of the beneficiary. The LVAMC clinician providing the level of care will be the sole judge in determining when an escort is required. In the event, that a staff member of the LVAMC accompanies a beneficiary, it does not relieve the Contractor from responsibility to provide appropriate care to the beneficiary. There shall be no charge to the LVAMC when escorts are authorized to travel with the beneficiary. Contractor shall only be required to transport the escort with the beneficiary and shall not be required to return the escort back to point of origin.

5.12. Substitution of Beneficiary: The LVAMC reserves the right to substitute the beneficiary requiring services at any time during the performance of this contract, to prevent delays, cancellations, or dry runs. There shall be no additional charge to the LVAMC when such changes occur.

5.13. Number of Beneficiaries:

5.13.1. The contractor shall transport one Veteran beneficiary per trip, under ambulance services, unless specifically authorized by LVAMC personnel to transport more than one, and at no time shall the Contractor transport more than two (2) beneficiaries.

5.13.2. When more than one (1) beneficiary is transported on a trip in a single vehicle, reimbursement will be made at 70% of the base rate established in Part I — Section B (Prices) for each beneficiary (as noted under the Social Security Act (SSA) [42 U.S.C. 1302, 1395hh,1395rr(b)(1)], Section 414.1). Incidents of trips with more than one (1) beneficiary are not expected to exceed eight (8) trips per contract year. The Contractor shall be entitled to a full base rate for each beneficiary traveling concurrently in a single vehicle, if the maximum expected eight (8) annual trips have been exceeded. When travel is beyond the medical facility's contract mileage threshold area of coverage, mileage may be claimed at 50% of the longest distance over which a beneficiary is transported in a single vehicle, for each beneficiary, as noted in the SSA reference.

5.14. Invoice Procedure:

5.14.l. Invoices and copies of trip tickets that provide al] aspects of the transport with regards to the Veteran name, pickup point and time, destination with arrival time, type of transport and any additional services provided to include wait time, if applicable, as described in the price schedule. This information shall be submitted to the LVAMC Travel Office via secured correspondence (electronic or standard) no later than ten (10) calendar days following the end of the month of services and are to include all contract services furnished for the preceding month.

5.14.2. Contractor shall file invoices electronically to the VA Financial Service Center (VAFSC) via 0B 10. More information on the FSC electronic invoicing process can be found at http ://www.fsc.va.gov/einvoice.asp.

5.14.3. All billing invoices shall specify items 5.14.3.1. through 5.14.3.8. listed below:

5.14.3 Patient's name,

5.14.3.7. Base charge plus an itemization of additional charges, if applicable, and name of VA Official who authorized trip and,

5.14.3.8. Copies of the Trip Ticket (Trip tickets for unscheduled request for transports will include the date and time of the request from LVAMC to contractor)

5.14.4. The Government will review and reconcile invoices with trip tickets and LVAMC requests for transport. Unauthorized Commitments/charges will be suspended pending investigation. Unauthorized charges are those that are being disputed or have not been pre-approved by designated authorized government personnel, delegated the authority to commit government funds. A final determination will be made, within thirty (30) days, after notifying the Contractor of charges being suspended of whether or not payment will be issued. If it is determined that a trip was the result of either an unauthorized commitment and/or transport of an individual ineligible for Government coverage, such payment will not be made, and the ineligible person transported and/or person/entity that made the unauthorized commitment becomes responsible for payment for the transport. The Government may authorize the Contractor to collect the payment directly.

5.14.5. Contractor Remittance Address:

5.14.5.1 All payments by the Government to the Contractor should be mailed to the following address:

(Address will be incorporated upon award of contract)

5.15. Infection Control Procedures: The Contractor shall follow the LVAMC Infection Prevention and Control policies and procedures to prevent and control the spread of infectious agents to all persons.

5.15.1. The Contractor shall identify and submit a list of all their Reusable Medical Equipment (RME) to the LVAMC. RME will be determined to be Critical, Semi-Critical or Non —critical, Critical and Semi-critical RME will have a Standard Operating Procedure (SOP), a document detailing all steps and activities of a process or procedure that follows manufacturers' cleaning, disinfection and/or sterilization guidelines. These SOPs will be developed by the Contractor with the input and approval from the LVAMC RME chairpersons or the Infection Control department. All Non-critical RME will be classified into 2 categories based on manufacturer's instructions for cleaning and/or disinfection. If surface disinfection with the approved surface disinfectant will damage the equipment a specific SOP will need to be developed by the Contractor with the input and approval from the LVAMC RME chairpersons or the Infection Control department. If surface disinfection with the approved surface disinfectant will not damage the equipment, it may be used.

5.15.2. The Contractor shall submit the RME list yearly to the COR.

5.15.3. The Contractor shall review and submit the RME SOPs on a yearly basis, or when a change in manufacturer's recommendation occurs, to the COR.

5.15.4. The Contractor shall not re-use or re-sterilize Single (disposable) medical devices.

5.16. Incident/Accident Report:

5.16.1. Any adverse events involving the welfare of a LVAMC beneficiary while in the care of the contractor during transport shall be recorded and reported to the COR during normal business hours or to the AOD after normal business hours (4:30pm-8:00am) within 24 hours of the event.

5.16.2. The Contractor shall make contact immediately notifying the Government of any incident, accidents, or medication or transfusion errors involving injury to LVAMC beneficiaries during transport. The government will provide POC's and phone numbers after contract award and prior to service start.

5.16.3. The Contractor shall prepare and submit a detailed incident report with all information necessary to conduct a full review (date, time, beneficiary, place of pick, place of incident, names of parties involved, a detailed summary of events etc.) with recommended/implemented corrective action within 24 hours of such incident to the Contracting Officer, COR, and the Chief, Health Administration Service, Lebanon VA Medical Center.

5.17. Origin and Destination:

5.17.1. Beneficiaries may be transported to or from LVAMC facilities or between the VA facility and a facility that provides care under VA auspices (i.e. Contract Nursing Home, Community Outpatient Clinics,) and/or between the home of the beneficiary receiving travel services and the VA facility. The LVAMC Travel Office or AOD will specify the points of origin and the destination of every trip.

5.17.2. Direct Patient Transfer: All patient transfers between LVAMC facilities shall be direct transfers. Direct Patient Transfer does not include trips between the vet's home and a facility that provides care under VA auspices.

5.17.3. Mileage Threshold for Ground Ambulance Services: The mileage threshold for the LVAMC is a 20-mile radius from the designated pick-up point for each trip (i.e., Contractor is required to pick up beneficiaries at the LVAMC, the mileage threshold would be a 20-mile radius from the LVAMC). Charges for travel within this mileage threshold shall be inclusive with the base rate. One-way mileage for travel beyond the 20-mile mileage threshold shall be claimed under the applicable mileage rate.

5.17.4. Reimbursement for Mileage outside of Mileage Threshold Areas of Coverage: Reimbursement for mileage outside the contract Mileage thresholds of coverage, shall be at the mileage rate stated in schedule B, and shall be based upon the miles from the pick-up point and the specified destination. Distances beyond the contract mileage threshold areas of coverage shall be calculated using the shortest route from Bing Maps. Allowable charges for mileage outside the contract mileage threshold areas of coverage shall not exceed +5% of the current Bing Maps.

5.17.5. Should the LVAMC make a determination that a previously scheduled trip may be cancelled, and a vehicle has already been dispatched to the designated pick-up point, LVAMC may notify the Contractor to cancel the order. For orders that are cancelled while the Contractor is already in route to the designated pick-up, the Contractor shall be entitled to receive the base rate for the trip, as provided in Schedule of Supplies or Services and Prices/Costs. This charge shall not include any mileage charge.

5.17.6. Should the Contractor arrive at the destination before LVAMC cancels the order, or if the Contractor is unable to perform a scheduled pick-up, because of LVAMC or beneficiaries such as incorrect address, beneficiary absence, or beneficiary refusal then the Contractor shall receive the base rate for the trip as provide in Schedule of Supplies or Services and Prices/Costs, and applicable mileage if outside contract mileage threshold areas of coverage.

5.17.7. Other Charges-It is understood that the prices listed in the accepted Schedule of Supplies or Services and Prices/Costs shall be inclusive of any and all ferry, bridge, tunnel or road toll charges. Contractor shall not bill the LVAMC for any such separate charges.

5.18. Patient Rights:

5.18.1. The Contractor shall be courteous to LVAMC beneficiaries and will not smoke while transporting beneficiaries. Beneficiaries may bring a reasonable amount of equipment, such as folding wheelchair, consumable medical supplies and personal suitcase.

5.18.2. The Contractor shall notify the COR, Travel Office (during normal operating hours), or the AOD (if after hours) in writing within 24 hours of any complaints made by the beneficiaries with regards to the ambulance service. The Contractor may provide recommendations for improved services along with the beneficiary complaints for the LVAMC's review. No recommendation shall be construed as being effective until and unless it is provided as a written modification to the contract from the Contracting Officer.

6.0. DELIVERABLES.

6.1. Trip Tickets — See paragraph 5.14. Invoice Procedure

6.0. REQUIRED REPORTS AND DOCUMENTS. Seven (7) days after contract award, the contractor shall provide the following:

7.1. Contractor Personnel Roster- In this document, Contractor shall identify the employee information listed below:

7.1.1. Name;

7.1.2. Position,

7.1.3. Title and,

7.1.4. Work assignment area.

7.1.5. Thereafter, any personnel changes shall be submitted within three (1) business day prior to the change.

7.2. Certification of Minimum Liability Insurance Coverage-A certificate of insurance as evidence of insurance coverage is required prior to providing any services to the medical facilities (ref. VAAR 852.237-70) Contractor shall provide the required proof of insurance with ten (10) calendar days after award and prior to providing any services. Thereafter, all changes shall be submitted within seven (7) days after changes occur.

8.0. CONTRACTOR'S QUALITY CONTROL PROGRAM (QCP). The Contractor shall establish and maintain a complete QCP to assure the requirements of this contract are provided as specified. The Contractor's QCP shall include the following or have incorporated into during performance of contract, at a minimum:

8.1.1. An inspection plan covering all services, equipment and supplies (glucometers, 02, medications, defibrillators, etc.) required by this contract. The inspection plan must specify the areas to be inspected on either a scheduled or unscheduled basis, how often inspections will be accomplished and documented, and the title of the individual(s) who will perform the inspections,

8.1.2. On-site records of all inspections conducted by the contractor noting necessary corrective action taken. The Government reserves the right to request copies of any and/or each inspection,

8.1.3. Incorporation of either active or established internal policy and procedures for updating medical service protocols that may affect performance of contract,

8.1.4. The methods for identifying and preventing deficiencies in the quality of service performed, before the level of performance becomes unacceptable, and organizational functions noting intermediate supervisory responsibilities and overall management responsibilities for ensuring total acceptable performance,

8.1.5. On-site records of all vehicle maintenance and repairs performed on vehicles used in the performance of this contract. The methods of identifying and preventing vehicle breakdowns, and detailed procedure for alternative transportation of beneficiaries in the event of mechanical breakdown of ambulance,

8.1.6. On —site records identifying the character, physical capabilities, certifications and ongoing training of each employee performing services under this contract,

8.1.7. The methods of identifying and preventing radio communication breakdowns. A detailed procedure for alternative communications in the event of electronic and mechanical breakdown of vehicle two-way radios,

8.1.8. A log to account for all requests for service. The log shall indicate the date and time of service call, name of beneficiary requiring services, and required Medicare/Medicaid form with Doctor's signatures, type of transportation requested, designated pick-up and delivery points, actual time of arrival at pick-up and delivery points and actual waiting time at pick-up and delivery points, if waiting charges are claimed,

8.1.9. On-site records of any complaints or problems, with procedures taken to allow for corrections and/or elimination before effects caused interruption of performance of contract and,

8.1.10. Log of quality control procedures to include, but not limited to, glucometers calibrated to the manufacturer’s specifications and/or no less than daily.

8.1.11. Drug Testing Policy: The Contractor shall have internal policies and procedures for addressing drug and alcohol testing and abuse.

9.0. IN SERVICE MEETINGS. Due to developments of new techniques or VA policy changes or to resolve problem issues in the handling and transporting of LVAMC beneficiaries, the Contractor may be required to attend meetings at the LVAMC facility at no additional charge to the VA. The Contracting Officer will schedule all in-service meetings.

10.0. RARE SITUATIONS. It may become necessary for the contractor to be called upon to transport the remains of a deceased Veteran between the various LVAMC facilities or to the county morgue for purposes of post-mortem. The Contractor shall agree to accept such assignments when called upon under the provisions of the contract and to supply personnel nom-rally assigned non-emergency vehicles in performing this service.

11.0. QUALIFICATIONS OF OFFERORS. Offers will be considered only from Contractors who are regularly established in the business called for and who in the judgment of the Contracting Officer is financially responsible and able to show evidence of their reliability, ability, experience, equipment, facilities, and personnel directly employed or supervised by them to render prompt and satisfactory service. All services are expected to be performed by competent qualified personnel, to complete the specific services required. All work performed shall be done in a first-class manner and in accordance with good commercial practices. Please reference Addendum to FAR 52.212-1 Instructions to Offerors.

12.0. METRIC CONVERSIONS. Any measurements stated in this specification or in any documents associated with the proposed contract as normally used inch-pound units can be converted to metric units providing they fall within the tolerances specified using conversion tables contained in the latest revision of Federal Standard No. 376. Any measurements only given in inch-pound units are not meant to be restrictive. If the General Requirements require replacement of parts to be included as part of the contract and a product (pan) is manufactured to metric dimensions and those dimensions exceed the tolerances specified in the inch-pound units, a request should be made to the Contracting Officer to determine if the product is acceptable.

13.0. GENDER. For the purpose of equal rights, wherever the masculine gender is used in this solicitation, and the resulting contract, it shall be considered to include both masculine and feminine gender.

14.0. CONTRACTING OFFICER'S REPRESENTATIVE (COR). The COR responsibilities include, but not be limited to surveillance of services required under this contact; determining the adequacy of Contractor…