36C24519Q0156-001.docx

36C24519Q0156

OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL

BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

DUNS:

DUNS+4:

PHONE:

FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SI

GN THIS DOCUMENT AND RETURN _______________

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGN

ATURE OF OFFEROR/CONTRACTOR

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR

LOCAL REPRODUCTION

(REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

36C24519Q0156 04-18-2019 Linda.Smith6@va.gov 304-263-0811 04-29-2019 Department of Veterans Affairs

VAMC (517)

VISN 5 Contract Satellite Office 200 Veterans Way Beckley WV 25801 X X 532283 $32.5 Million X N/A X Department of Veterans Affairs

VAMC (517)

VISN 5 Contract Satellite Office 200 Veterans Way Beckely WV 25801 Department of Veterans Affairs

VAMC (613)

VISN 5 Contract Satellite Office 510 Butler Avenue, Building 308B Martinsburg WV 25405

PAYMENT WILL BE MADE BY

Purchase Card

See CONTINUATION Page Beckley WV VAMC anticipates awarding a 5-year IDIQ contract for home oxygen services as described in the Statement of Work.

All questions must be submitted in wrining to the Contracting Officer - Linda.Smith6@va.gov no later than April 24, 2019, close of business.

All offers must be submitted no later than April 29, 2019, 1400 EST.

See CONTINUATION Page X X X

LINDA SMITH

Contracting Officer Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR:

b. GOVERNMENT: Contracting Officer 36C245 Department of Veterans Affairs

VAMC (517)

VISN 5 Contract Satellite Office 200 Veterans Way Beckley WV 25801

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

3. INVOICES: Invoices shall be submitted in arrears:

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.

PAYMENT WILL BE MADE BY

Purchase Card ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

36C24519Q0156

Page 1 of Page 1 of Statement of Work Home Oxygen Service

SECTION 1: INTRODUCTION / BACKGROUND INFORMATION

Beckley, WV Department of Veterans Affairs Medical Center (VAMC) provides services to beneficiaries in West Virginia and Virginia. There is a possibility of infrequent instances of services required in Kentucky. The Contractor shall be responsible for providing Home Oxygen Services to all beneficiaries serviced by Beckley VAMC. The contractor shall provide all supplies, materials, equipment, transportation of equipment, equipment services, labor, supervision, patient education, safety management, and infection control, as necessary, for patients on home respiratory care therapy, as specified under this Request for Quote RFQ. These services shall be required 24 hours a day, seven (7) days a week, including holidays. The contractor shall be staffed and stocked to render services provided in accordance with all terms and conditions of this RFP for the duration of the performance period. Offerors should thoroughly review the specifications and be familiar with the area of coverage before submitting their proposal to be fully aware of the supplies and services required. Lack of understanding will not relieve the offeror from performing in accordance with the strict intent and meaning of the specifications and will not authorize additional cost to the Government. Beckley VAMC is looking to secure a 5-year Indefinite Delivery Contract (IDIQ)

SECTION 2: SCOPE / PERFORMANCE REQUIREMENTS: SPECIFIC TASKS

All issuing and follow-up care provided under this contract shall be provided in accordance with all current Joint Commission standards or equivalent. Contractor’s must be Joint Commission Accredited for Home Care or equivalent and must maintain the certification or equivalent for the duration of the contract. If the contractor is re-surveyed by Joint Commission or equivalent during the contract term, the contractor shall notify the Contracting Officer of survey dates, the outcome of the survey, and provide copies of new certificates as issued. Contractor’s facilities may be inspected by the respective Medical Center prior to the contract award. The contractor’s comprehensive procedure manual shall become part of this contract. The manual shall include, but not limited to, delivery/set-up, infection control, safety, rights and responsibilities, inventory, employee training (to include age specific), competency records, and performance improvement. The contractor shall be required to have a DO NOT RESUCITATE (DNR) policy in accordance with State Regulations. A copy of the DNR policy shall also become part of this contract.

Task 2.1 Performance Requirement: New Patient Set-ups-Oxygen Systems:

1.1 Upon receipt of a VA prescription, the Contractor shall deliver and set up in the veteran’s residence all equipment and supplies ordered. New set-ups shall be performed as described:

· All new patient set-ups placed by the VA and received by the Contractor shall be delivered within 24 hours.

· In the event Contractor is unable to meet those delivery times, the Contractor must notify the VA immediately. VA reserves the right to obtain the service from another source and to charge the Contractor with any excess cost which may result there from.

· Contractor shall notify the ordering facility COR or Prosthetics and Sensory Aid Service (P&SAS) if the contractor is unable to contact the patient or caregiver, no later than 4 hours after receipt of the delivery order.

· Performance Monitor: To the standard, no deviation.

Task 2.2 Performance Requirement: Initial Set-ups - Oxygen Systems

a. Performed by a contractor trained and qualified technician, Registered Respiratory Therapist, or Certified Respiratory Therapist.

b. Provide up to 15 tanks with initial set up when portable is ordered. The government shall determine the size of tanks upon set up.

c. The Contractor shall perform an assessment of the beneficiary’s home and environment in accordance with Joint Commission standards or equivalent, and maintain documentation of assessments in the individual patient file or folder.

d. The Contractor shall notify the COR/ACOR or prescribing physician during the home 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.

e. The Contractor shall verbally notify the COR or ACOR by the next business day of any unsafe conditions observed in the VA beneficiary’s home and 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 written documentation of the safety hazard to the COR or ACOR within five (5) business days of the incident.

f. The Contractor will document and report to the VA Home Oxygen Coordinator or COR any patient who is noncompliant with safety guidelines set forth in the education and orientation material and/or whose behavior poses a risk of self harm or harm to others (e.g. smoking while on oxygen), despite warnings and ongoing educational interventions.

g. The Contractor will check the adequacy of the electrical outlets in the patient’s home and immediately report unsafe conditions to the COR or ACOR. VA shall not be responsible or liable for any unsafe electrical conditions caused by the Contractor. Any alterations to the veteran’s residence will be the responsibility of the veteran. If ordered equipment cannot be safely installed, the COR or ACOR may provide an alternative oxygen delivery system after approval by the COR, until a new prescription can be obtained. If no alternative is available, the prescribing VA physician will be notified.

h. The Contractor will verify the presence of the smoke alarms and instruct the patient to test all smoke alarms monthly. In any home where smoke alarms are not present, the contractor will notify the COR for further review and potential action.

i. If the oxygen set up is performed by a technician only, the visit shall be limited to set- up and instruction, solely focusing on the equipment use and safety and not providing instruction for deriving the intended medical benefit. If the set-up visit is performed by a Respiratory Care Practitioner, in addition to set up and instruction in the use and safety of equipment, the patient shall receive patient education relevant to his/her medical condition, the prescription, and on the intended medical benefit of the applicable home oxygen treatment.

j. Performance Monitor: To the standard, no deviation.

Task 2.3 Performance Requirement: Initial Oxygen Follow Up Visit - Required when initial set-up is performed by a contractor qualified technician

a. Performed by a Respiratory Care Practitioner only, within 72 hours after initial set-up by a qualified technician.

b. Proof of initial set up, patient Plan of Care and Education.

c. Documentation sent to facility COR with the next monthly invoice.

d. If the initial home oxygen visit is performed by a contractor technician, a Respiratory Care Practitioner shall follow up within 72 hours to perform the required patient education and develop a Plan of Care. Documentation of patient education, Plan of Care, and all visits shall be in compliance with the current Joint Commission Home Medical Equipment (HME) Standards or equivalent and shall be provided to the respective facility COR or ACOR with the next monthly invoice. Failure to provide the required documentation by the 10th calendar day of each month may result in a 2% reduction applied to the entire monthly billing invoice.

e. The initial oxygen equipment set-up in the home shall address at a minimum, the following:

· Review of safety and beneficiary education issued and interventions taken and/or recommendations for equipment maintenance and safety

· Monitoring of all equipment for proper functioning (i.e. internal/external batteries, settings, humidifiers, suction machines temperature probes)

· Assessment of infection control procedures and the general home environment

· Evidence of smoking in the home

· Cleanliness of equipment/filters and home

· Check of function of smoke detectors in the patient’s home

· Colored tubing that will contrast with home environment

· Providing a cylinder stand capable of holding a minimum of 12 cylinders, sizes E, D, C & M-6 as appropriate

f. Documentation will be provided to the COR with:

· Name of the contractor’s branch/division servicing the patient

· Date of visit

· Recommendations and/or problems relating to the beneficiaries use of the oxygen equipment

· Proper name, social security number and phone number

· Review of prescription, verify percent of oxygen concentration

· Manufacturer’s model and serial number for Government Owned Equipment

g. In addition to the above list, the contractor shall also provide review of on-site environmental conditions that includes a check of electrical sockets if powered equipment is provided and make all appropriate site preparations (e.g., uncluttered area for storage of standing tanks, fire safety notation of observable safety hazards, etc.) before placing oxygen equipment in the home.

h. Performance Monitor: To the standard, no deviation.

Task 2.4 Performance Requirement: Initial Set-Up-CPAP/BiPap

a. Performed by a Respiratory Care Practitioner only: Proof of initial set up, patient Plan of Care and Education.

b. Documentation sent to facility COR or ACOR with the next monthly invoice.

c. All VA issued CPAP/BiPap shall be delivered and set-up by a Respiratory Care Practitioner within 10 business days of the VA prescription, unless otherwise notified by the ordering facility. Set-up shall include the pressure setting(s), instructions, mask fitting, safety, and any other instruction necessary. VA will provide sufficient supplies to last between maintenance visits.

d. Oxygen orders with CPAP and BiPap units shall be delivered within 24 hours in accordance with Task 2.1.

e. Performance Monitor: To the standard, no deviation.

Task 2.5 Performance Requirement: Equipment Monitoring/Maintenance Visit Requirements and Time Frames

a. As part of the equipment monitoring visit, the contractor shall ensure the patient has adequate supplies (mask supplies, colored tubing, filters, water for humidification) to last between visits.

b. The Contractor (via qualified technician) shall provide and deliver prescribed equipment and supplies to each beneficiary as needed monthly. There is to be only one (1) visit per month, or twelve visits per year, unless additional visits are authorized by the facility COR or ACOR. The Contractor shall visit beneficiaries' residences in performance of this contract by appointment only, between the hours of 8 a.m. and 8 p.m., Monday through Saturday, exceptions will be made in the cases of emergencies. Monthly visit will occur within 20 to 31 days from the previous visit.

c. During the monthly visit, the Contractor shall be responsible for carrying out the plan of care by monitoring issues of patient compliance, completion of a home safety assessment, verification of the patients’ ability to operate equipment, cleaning and maintenance and patient re-education as indicated. Documentation of each visit will be provided to the COR or ACOR with the monthly billing. Coordination and accomplishment of the mandatory monthly visit with the patient is the responsibility of the contractor.

d. In the event the contractor shorts the portable system at the regularly scheduled visit, the contractor must make a return trip, at no additional charge to the government, to fulfill the patient’s portability requirements. At no time can the contractor leave more tanks than the current prescription.

e. All beneficiaries have the right of refusal of service. In the event a beneficiary refuses service or orders the equipment to be removed from the home, the Contractor shall comply with the beneficiary’s wishes, however, in addition to a written report, the Contractor shall report the specifics of the refusal to the COR by telephone within one (1) hour. The contractor shall have the veteran sign a letter of refusal. If the refusal occurs during a home visit, the Contractor’s staff shall make an attempt to notify the COR or ACOR of the refusal during the home visit. Payment for monthly rental, service or supplies will not be rendered without this required documentation. Visit refusals or failure to keep a scheduled appointment shall be faxed or emailed daily to each COR or ACOR for action.

f. If a monthly visit will not occur, the COR or ACOR will be notified and details provided regarding attempts to contact the veteran for service.

g. All prescription revisions will be handled in the manner described under Task 2.3.

h. Prescription renewals are a continuation of services required for documentation in the patient’s file, no change to current services request.

i. The Contractor shall not change or alter a VA beneficiary’s oxygen prescription or equipment requirements without a new prescription from the beneficiary’s VA physician.

j. Performance Monitor: To the standard, no deviation.

Task 2.6 Performance Requirement: Emergency Protocol

a. The contractor shall have a well-established communication system providing 24-hour emergency services and the ability to provide services at the beneficiary’s home within a maximum of four (4) hours of a call. An emergency exists if the appropriate P&SAS staff or COR informs the Contractor that he/she considers the situation an emergency, of if the VA beneficiary states in a telephone call to the Contractor that an emergency exists in regard to the function or use of the respiratory related equipment or use of the equipment.

b. In emergent situations, the Contractor shall provide service to the beneficiary within four (4) hours; in the event the Contractor is unable to meet the appropriate response times, the Government has the right to obtain services from another source. A mandatory written justification detailing why emergency service was not available shall be provided by the Contractor to the facility COR and the Contracting Officer within 12 hours from the original time the Contractor was called to provide the service.

c. The Contractor shall provide a written Emergency Contingency Plan for natural disasters, which provides for continued uninterrupted care and support, in the event of an emergency resulting in an interruption of service. At a minimum, the plan shall address such items as severe weather, power outages, loss of personnel, damage to the Contractor’s site, and communications. A copy of this plan shall be provided in the proposal.

d. The Contractor shall ensure all patients have, at a minimum, a non-electrical oxygen supply to last at least 24 hours. The minimum supply will consider each patient’s prescription flow-rate and distance from the contractor’s location, so actual supply levels may differ from patient to patient. If the Contractor is unable to respond to an emergency service call within 4 hours, the Contractor is responsible for making arrangements with another supplier to provide oxygen at the Contractor’s expense. A written explanation of why the Contractor was unable to respond to the emergency must be provided to the COR or ACOR within two (2) business days.

e. The cost of backup systems, backup oxygen, and backup equipment shall be borne by the Contractor. If H tanks are used for backup, the Contractor shall furnish an H tank stand for each H tank at no cost to the government. Liquid oxygen supply may be considered backup oxygen, however, the oxygen supply must be at a prescribed rate of flow for 24 hours, and the cost of any additional equipment such as extra stationary units used solely to maintain the minimum level of backup oxygen shall be borne by the Contractor. The cost of liquid oxygen used solely for backup purposes shall be borne by the Contractor.

f. Performance Monitor: To the standard, no more than one (1) deviation per month.

Task 2.7 Performance Requirement: Discontinuation of Oxygen Services

a. Upon termination of oxygen service to the beneficiary, either by physician’s prescription or the death of a beneficiary, the Contractor shall pick up all oxygen equipment and supplies at the earliest possible time, but no later than five (5) business days after receipt of notification from the appropriate P&SAS staff or COR. Payment of services shall cease upon this notification. The final invoice shall be prorated from the date of notification. Final services shall be billed with the next scheduled invoice.

b. In the event the contractor gains knowledge of the patient’s death prior to the servicing VA, the contractor shall immediately notify the COR of the patient’s death and the date the contractor was made aware of the death. Billing shall cease on the day the contractor becomes aware of the patient’s death. The final invoice shall be prorated from the date of notification.

c. Performance Monitor: To the standard, no more than one (1) deviation per month.

Task 2.8 Performance Requirement: Service Transition

a. In the event award is made to other than the incumbent contractor, the new contractor shall arrange with the incumbent Contractor for exchange of equipment, ensuring that there is no disruption of supplies/services to veteran beneficiaries. Transition of services to the new contractor shall be complete as soon as possible, but no later than 60 calendar days from the date of award of a new contract. Failure to accomplish this task in 60 days will result in a 10% reduction of the contractor’s overall monthly invoice until the phase-in is complete. Additionally, if the contractor fails to accomplish the phase-in, the contractor shall be responsible for any duplicate costs the VA may have to pay the incumbent contractor beyond 60 days.

b. This period will be designated as the period for the transfer of VA veteran beneficiaries from the incumbent to the successor contractor. The change shall, at a minimum, include oxygen care and instructions, usage, set-up, emergency service. Contractor shall coordinate the schedule of initial patient visits with the Prosthetics COR or ACOR for each facility through the Contracting Officer. The transition shall be coordinated through the Contracting Officer and facility COR. The appropriate VA facility shall provide the successful contractor with an up-to-date prescription.

c. The successor Contractor shall provide the facility COR, by 12:00 p.m. each Friday during the transition period, a detailed listing of the VA beneficiaries whose oxygen service has been changed over from the incumbent to the successor Contractor. The list shall include the exact date of the change for each beneficiary. Along with this list, the successor Contractor shall also provide documentation showing that the incumbent Contractor has been notified to pick up their equipment.

d. Payment to the incumbent contractor shall be made up to the day services were transferred to the successor contractor. Payment shall be pro-rated based upon the unit prices in affect during the most recent contract year. Coordination during the transition period shall be accomplished at no additional expense to the Government.

e. Transition Period: At the end of the contract period, a transition period will be required during which the incumbent Contractor will continue to provide services at the contract prices, while the incoming Contractor is taking over.

f. After award of the contract, the contractor, at no additional cost to the VA, shall be responsible for picking up existing inventory from the incumbent contractor’s storage facility within 15 calendar days after the effective date of the Notice to Proceed.

g. Performance Monitor: To the standard, no more than one (1) deviation per month.

Task 2.9 Performance Requirement: Equipment Maintenance/Repair

a. Contractor shall have written equipment preventive maintenance policies and procedures and will maintain a system for tracking all equipment preventative maintenance by model and serial number. The safety and working condition of the equipment shall be monitored on an ongoing basis, including maintaining preventative maintenance logs, calibration logs, recalls, logs of oxygen cylinder lot, batch numbers, and the results documented by serial number. This documentation will be maintained for the term of the contract.

b. All current documentation will be forwarded to the appropriate COR or ACOR monthly. Only qualified technicians with documented training will provide these services to this equipment. The contractor shall perform a formal preventive maintenance inspection (PMI) immediately before stored equipment is issued.

c. The Contractor shall have a written recall plan or system in place for identification of equipment recalls, hazardous or defective equipment, and action taken.

d. The Contractor is responsible for repairing VA owned equipment under this contract, when specified by the COR or ACOR. If the COR or ACOR requires the Contractor to repair VA owned equipment, the VA reserves the right to furnish replacement parts or obtain services to repair any item, if, in the opinion of the COR or ACOR, the contractor's cost for such services is deemed to be excessive and the matter cannot be mutually resolved. Contractor shall provide loaner equipment equal to or exceeding existing equipment while repairs are being made to patient's equipment. All repairs are to be pre-approved by the COR or ACOR.

e. Performance Monitor: To the standard, no deviation.

Task 2.10 Performance Requirement: Reserve Supply

a. An adequate supply of liquid tanks, aluminum/composite compressed O2 tanks, with regulator, and E-tank stands shall be provided and stored at each facility as directed by the COR. Quantities and sizes of tank will vary and shall be agreed upon by the Contractor and facility COR.

b. The reserve supply shall accommodate home oxygen patients who are either being discharged from the hospital or visiting (appointments) and require a supply of oxygen to enable the VA beneficiary to reach home. Adequate inventory shall be maintained by the Contractor.

c. Performance Monitor: To the standard, no more than one (1) deviation per month.

Task 2.11 Performance Requirement: VA Beneficiary Records

a. An individual beneficiary account record shall be maintained by the Contractor in compliance with the Privacy Act and maintain HIPPA compliance. Copies of these beneficiary records shall be provided to the COR upon request or when a patient is discharged from the Home Oxygen Healthcare program or upon death. The individual patient medical records shall be maintained and housed at the Contractor’s individual branch providing the oxygen service. At a minimum, the record shall include the following:

· Beneficiary identifying information (full name, SSN, home address, phone number of beneficiary caregiver, serial number, and type of VA owned equipment)

· Emergency contact phone number at a separate residence other than the beneficiary

· Copy of physician’s prescription (original or renewal)

· Plan of Care as developed by Contractor

· Documentation of the initial and monthly visits, assessments, and services provided

· Initial and continuing verbal and written instructions to the beneficiary and/or care giver (to include, but not limited to basic home safety, safe and appropriate use of equipment, handling, cleaning, precautions on smoking, and storage-universal precautions)

· Patient complaints, accidents, injuries, and safety hazards identified and corrective actions taken

· Documentation of all beneficiary education, to include, course of action in emergency situations

· Infection control- Contractor will comply with standard precautions in the handling, storing, cleaning, delivery of home oxygen equipment, and shall maintain a system for reporting, documenting, and evaluating records of infection among beneficiaries and contractor staff

b. Performance Monitor: To the standard, no deviation.

Task 2.12 Performance Requirement: Plan of Care

a. An initial Plan of Care shall be developed and implemented by a Respiratory Care Practitioner during the initial setup by the Contractor for each VA beneficiary and a copy shall be forwarded to the respective facility COR with the monthly invoice. At a minimum, the plan shall include the following:

· A statement of the patient’s needs and problems

· Measurable beneficiary goals

· Notation of the services recorded and action taken

b. The Plan of Care shall be signed by the visiting Respiratory Care Practitioner and VA beneficiary or care giver. The beneficiary shall retain the original. The Contractor shall retain one (1) copy and forward one (1) copy to the COR.

c. The contractor shall maintain records of all visits for the term of the contract.

d. The Plan of Care for CPAPs and BiPaps shall be requested at the direction of the COR. At a minimum, the assessment shall include the beneficiaries’ tolerance and compliance to equipment and mask fitting.

e. Performance Monitor: To the standard, no more than one (1) deviation per month.

Task 2.13 Performance Requirement: Education/Instruction

a. Education regarding all equipment, supplies, and smoking shall be provided to the beneficiary/caregiver by the contractor in accordance with Joint Commission standards or equivalent. At a minimum, the Contractor shall document and provide instruction to the patient/caregiver on the safe and appropriate use of the medical equipment, including basic home safety, storage, handling, required maintenance, electrical safety, equipment hazards and malfunctions, infection control, emergency preparedness, and the beneficiary’s responsibilities in the care and use of all equipment.

b. The Contractor shall provide, as a part of the technical proposal, all patient education materials to be used during the contract. Updates and changes to the education materials must be submitted to the COR or ACOR prior to making any changes.

c. The Contractor shall provide education to each veteran at the time of set-up, and assess the need for reinforcement during visits. This information is to be presented verbally in demonstration and material covered shall be in written form, to be left with the beneficiary/caregiver. All patient education material must be presented in written form to the COR or ACOR for approval, prior to award. The contractor, as directed by COR or ACOR, shall implement any new or revised education material. The VA will determine whether the contractor shall use their forms or forms supplied by the VA for documentation of services provided to VA beneficiaries.

d. The Contractor shall document that the beneficiary/caregiver is instructed in accordance with Joint Commission Standards or equivalent. The contractor shall provide educational and/or warning information for patients, their families, or caregivers on the hazards of smoking and using an open flame near oxygen while in use. The educational materials must be provided upon initial delivery and minimally every six (6) months thereafter.

e. On each scheduled setup/delivery, the Contractor shall reassess the need to instruct the beneficiary on the use and care of the equipment and supplies as necessary.

f. Performance Monitor: To the standard, no more than one (1) deviation per month.

Task 2.14 Performance Requirement: Traveling Beneficiaries

a. The contractor shall be responsible for arranging and coordinating all oxygen services for veterans who travel both within and outside their respective contracted jurisdiction, unless otherwise indicated. The veteran and/or respective VA facility will be responsible for notifying the contractor where the veteran is traveling to and the mode of transportation. Arranging and coordinating travel services shall be provided at no additional cost to the VA. Coordination of oxygen needed for air transportation is the responsibility of the veteran.

b. For veterans traveling outside the areas covered by Beckley VAMC and/or temporarily relocating, the contractor shall arrange for oxygen services at no additional cost to the VA. 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.

c. In the event the contractor must has been approved use of a subcontractor for oxygen services related to travel, and additional costs are incurred, the contractor shall provide copies of all subcontractor invoices with the monthly invoice for reimbursement.

d. Performance Monitor: To the standard, no more than one (1) deviation per month.

Task 2.15 Performance Requirement: Equipment Specifications

a. Oxygen concentrator systems: Contractor shall provide Underwriters Laboratories (UL) approved concentrators, complete with standard hour meter and must meet the following requirements: Oxygen concentrations must provide at a minimum the following flow rates of oxygen:

· >/= 95% FIO2 at </= 2L/minute

· >/= 92% FIO2 at 3-5L/minute

· >/= 90% FIO2 at > 5L/minute

b. Each system shall have an operating pressure not to exceed 15 PSI with power requirements prescribed at 115 /VAC, 60 Hertz and will operate at a sound level not to exceed 53 dB@ 1 meter. Each system shall have a battery powered built-in audible alarm “ALERT SYSTEM” to alert patient in the event of equipment or electrical power failure. This system shall self-test each time the unit is turned on. During normal operation, the unit will alert the user that it may be necessary to switch to another alternate source of oxygen supply. Concentrator unit will supply the user with the prescribed oxygen flow through connecting tubing of up to 50 feet in length.

c. Each CONCENTRATOR SET-UP will include disposable humidifiers (when ordered), tubing connectors, extension tubing (up to 50 feet in length with sufficient diameter to deliver the prescribed flow of oxygen), 5 (soft) nasal cannulas(Medline soft cannula ref#HCSU45145) to all patients/masks as ordered per month, two thermal fuses must be provided and installed in each home oxygen delivery system one at the patient end and one at oxygen source( primary and portable oxygen therapy equipment) to be replaced per manufacturer’s guidelines /if actuated or involved in a fire, a back-up system with the capacity to provide continuous, uninterrupted delivery of oxygen at the prescribed rate of flow for 24 hours.

d. The BACK-UP SYSTEM contingency plan shall consist of compressed gas cylinders (H or M type) with a tank stand(s), regulator-flow meter, tubing, connectors, nasal cannulas, and expendable supplies as required for use during the event of a power failure or mechanical problem. The contractor will provide a 24-hour emergency backup system in the event of a power failure or when it is necessary to shut down the concentrator. Each unit shall have an attached sticker with the correct vendor name and emergency telephone number, date with the serial number, and date including the Hobb meter hours when last serviced.

e. If the Contractor is unable to respond to an emergency service call within 4 hours, the Contractor is responsible for making arrangements with another supplier to provide oxygen at the Contractor’s expense. A written explanation of why the Contractor was unable to respond to the emergency must be provided to the COR or ACOR within two (2) business days.

f. The cost of backup systems, backup oxygen, and backup equipment shall be borne by the Contractor. If H tanks are used for backup, the Contractor shall furnish an H tank stand for each H tank, at no cost to the government. Liquid oxygen supply may be considered backup oxygen, however, the oxygen supply must be maintained at the prescribed rate of flow for 24 hours and the cost of any additional equipment such as extra stationary units, used solely to maintain the minimum level of backup oxygen, shall be borne by the Contractor. The cost of liquid oxygen used solely for backup purposes shall be borne by the Contractor.

g. The Contractor shall furnish, install, and service all oxygen equipment to dispense oxygen and supplies ordered under this contract. All equipment is to be current state-of-the-art model and all supplies are to be new. A label with the contractor’s name and emergency telephone number where they can be reached 24 hours/day shall be affixed to all equipment.

h. Portable System: The Contractor shall provide, as part of the monthly concentrator rental fee, a “system” of Portable Oxygen Cylinders for patient ambulatory use outside the home. Refills are billed according to the schedule page. Safety holders shall be provided, at no charge, for all veterans with a prescription for four (4) or more cylinders.

i. Oxygen Cylinders: All oxygen cylinders provided by the contractor shall be limited to the size and quantity authorized by the prescription. Adequate storage racks will be provided to accommodate each tank/cylinder placed in the home or place of residence. Oxygen cylinders shall have the pin index safety systems for oxygen that is 2-5. Oxygen cylinders will be maintained, filled, marked, labeled, and shipped in compliance with all current regulations. Each cylinder furnished under this contract shall be color-coded according to the trade practices for that type of gas.

· "E" cylinder orders shall include lightweight, aluminum oxygen tank/cylinder, storage rack, one (1) "E" handcart (wheeled) per patient, one (1) regulator-flow meter, and all expendable supplies as required. The contractor shall provide the number of tanks as prescribed. Any change to the number of tanks will require a prescription revision.

· "D" cylinder (minimum 240 liters capacity) orders shall include lightweight, aluminum oxygen tank/cylinder, storage rack, one (1) "D" handcart (wheeled) per patient, one (1) carrying bag per patient, one (1) regulator-flow meter, and all expendable supplies as required.

· "B" / “M6” cylinder orders shall include lightweight, aluminum oxygen tank/cylinder, storage rack, one (1) carrying bag per patient, one (1) regulator-flow meter, and all expendable supplies as required.

· "H or M" cylinder orders shall include oxygen tank/cylinder, storage rack, one (1) regulator-flow meter, and all expendable supplies as required.

j. Liquid System: Standard setup includes stationary reservoir, two (2) portable devices, transfilling equipment, regulator, and all expendable supplies as required. Each liquid oxygen setup shall also include an emergency back-up system with the capacity to provide continuous, uninterrupted delivery of oxygen, at the prescribed rate of flow for 24 hours. The back-up system will consist of compressed gas cylinders ("H" or "M" type), stand(s), regulator-flow meter, tubing, connectors, nasal cannulas/mask, as ordered, storage rack, and expendable supplies as required for use during the event of a power failure or mechanical problem necessitating the use of the back-up system cylinder. The cost of necessary expendable supplies, as required for use, shall be included in the monthly rental/service cost.

k. Ventilators: Rental equipment to be a PLV 102 brand or equal to remain consistent with VA owned equipment. The setup of a ventilator system is to include per patient: Initial set-up, necessary supplies as ordered, home assessment, patient training and education, preventative maintenance, RRT monthly visits, evaluation of patient/equipment in home environment as per physician prescription and plan of care. Set-up to include an emergency back-up system placed in the home with the capacity to provide continuous uninterrupted delivery of care. Monthly charge includes up to six (6) ventilator circuits per month. *NOTE: The intent of the contract regarding ventilators is for the contractor to set-up VA Owned equipment, see Item below. The standard procedure for the contractor is to deliver VA owned ventilators and other VA owned equipment to VA beneficiaries as priority and rental equipment when VA equipment is not available.

l. VA Owned Ventilators: Includes initial set-up, supplies as ordered, home safety assessment, RRT monthly visits, patient education and training, evaluation of patient/equipment in home environment as per physician prescription and plan of care. Contractor shall provide complete preventative maintenance service on VA owned equipment as required by the manufacturers’ specifications. Includes up to six (6) ventilator circuits per month.

m. Each respective VA Medical Center will be provided with the names of equipment, uses, the manufacturer’s guidelines and specifications for safe use, maintenance requirements, any warnings, cleaning procedures, and output assurances. The Contractor must maintain the serial number of all equipment provided and be able to track equipment to each individual patient. All equipment will be checked to ensure that it is working properly according to manufacturer’s guidelines, documented on a tag or label affixed to the equipment, dated, and signed. Failure to check or clean equipment prior to delivery shall result in non-payment for delivery. This includes equipment delivered to the respective VA Medical Center. All reissued oxygen equipment delivered shall be cleaned/sanitized/disinfected by approved methods and be in first-class operating condition, in accordance with the manufacturer’s recommendations. In the event that a piece of faulty oxygen equipment is delivered, or the delivery is incomplete, as determined by the COR or ACOR, subsequent trips shall be made without additional cost to the veteran.

n. Performance Monitor: To the standard, no deviation.

Task 2.16 Equipment Management/Handling/Transportation

a. Recovered equipment will be separated from new and cleaned equipment during transport, in accordance with Joint Commission requirements or equivalent.

b. The delivery truck shall be kept in a sanitary condition, so that contamination of the equipment will not occur during transport.

c. The contractor shall have all vehicles used in the performance of services under the contract clearly marked with company identification.

d. The contractor shall provide a designated secure holding area for equipment awaiting cleaning, disinfecting, servicing, or refurbishing. The holding area shall be separated from the clean equipment storage area to prevent the possibility of contamination of clean equipment per Joint Commission standards or equivalent.

e. Contractor shall have written policies and procedures relating to the cleaning and storage of recovered/dirty /reusable equipment.

f. Prior to being placed in the clean equipment storage area, all recovered equipment will be cleaned/disinfected using an appropriate cleaning solution according to manufacturer’s instructions, checked for proper operation, safety, serviceability, and covered with plastic for protection.

g. Performance Monitor: To the standard, no deviation.

Task 2.17 Equipment Inventory – VA Owned

a. The contractor shall provide the COR or ACOR with a complete inventory of all VA owned equipment and supplies on hand at the end of each month. The listing will include, but not limited to, issuable, non-issuable (scrap), broken, serial numbers, manufacturer’s name, and model. This information shall be included on the listing. Discrepancies noted will be reconciled between both parties before the next monthly invoice is due. Failure to forward the listing shall result in delayed payment of the Contractor’s invoice.

b. The Contractor bears sole responsibility to notify the COR or ACOR when he/she questions the serviceability of VA owned equipment and/or supplies that are required for this contract. The COR or ACOR retains the sole right to condemn equipment and will notify the Contractor of arrangements for disposition of VA owned equipment. Under no circumstances should any VA equipment be disposed of without the COR’s authority. When available, recovered equipment that has been repaired for re-issuance under the terms of this contract, shall be delivered to beneficiaries first.

c. The Contractor must provide a Certificate for Repairs in order to perform repairs to VA owned concentrators. As the Government has a three (3) year warranty on all VA owned concentrators, there shall not be any additional cost to the Government for repairs.

d. The Contractor shall notify the COR or ACOR via telephone, fax, or email when experiencing repeated problems and/or breakdowns with equipment/supplies furnished, to assist the COR or ACOR in the submission of Quality Improvement Reports.

e. Labeling of VA Equipment: The contractor shall provide each facility with a roll of labels to be placed on VA owned equipment. The labels shall provide the Contractor’s emergency contact information in the event the equipment fails and needs to be replaced. The Contractor must ensure the labels are attached to all VA owned equipment already in the field and any new equipment issued to VA patients. The COR or ACOR will arrange with the Contractor for pickup of equipment ordered and received by the VAMC and marked as belonging to the VAMC. The Contractor shall return equipment picked up during monthly maintenance to the location specified by the COR or ACOR. VA owned equipment, will be cleaned, sanitized, tagged, and stored or returned to the designated VAMC within seven (7) working days. In the case of emergencies, the contractor shall provide back-up equipment. The contractor shall communicate-by telephone or fax this change of equipment within 24 hours to the COR or ACOR.

f. Performance Monitor: To the standard, no deviation.

B.2 PRICE/COST SCHEDULE

ITEM INFORMATION

W065 - Rental Concentrator System - up to 5 LPM Contract Period: Base POP Begin: 07-01-2019 POP End: 06-30-2020

W065 - Rental Concentrator System - up to 10 LPM

W065 Rental Ventilator System - PLV or Equivalent

W065 - Rental Ventilator System - Trilogy or Equivalent

W065 - Missed Patient Visit/Patient Refusal at Home

W065 - Emergency Visit/Setup

W065 - Cylinder, Size M or H Setup (Primary)

W065 - Cylinder, Size M or H Refill

W065 - Cylinder, Size E Refills

W065 - Cylinder, Size D Refills

W065 - Cylinder, Size M6 Refills

W065 - Compressor - 60 PSI - Rental

W065 - Humidified, Heated - Rental