36C24521Q0174 02242021.pdf

PAGE 1 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 SIGN 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. SIGNATURE 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 123

36C24521Q0174 02/24/2021

Crystal Hinton, Contracting Officer 410-637-1530 03/10/2021

2pm EST

36C245

Department of Veterans Affairs

VA Maryland Health Care System

Crystal Hinton, Contracting Officer (90C)

209 West Fayette, Street, Suite 611

Baltimore MD 21201

X 100

X

532283

$35 Million

N/A

36C613

Department of Veterans Affairs

VA Maryland Health Care System

Crystal Hinton, Contracting Officer (90C)

510 Butler Avenue

Martinsburg, WV 25401

36C512

Department of Veterans Affairs

VA Maryland Health Care System

Crystal Hinton, Contracting Officer (90C)

209 West Fayette Street, Suite 611

PAYMENT WILL BE MADE BY

FSC e-Invoice Payment

Invoice must be submitted electronically http://www.fsc.va.gov/einvoice.asp

Invoice Setup Information 1-877-489-6135

See CONTINUATION Page

Home Oxygen Services for VA Medical Center, Martinsburg, WV.

Contractor Performance Period: 5 Years.

Period of Performance: 04/01/2021-03/31/2026.

Scope of Contract and Performance Work Statement, page 6.

Price/Cost Schedule, page 28.

$0.00

See CONTINUATION Page

Crystal S. Hinton

36C24521Q0174

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 SCOPE OF CONTRACT AND PERFORMANCE WORK STATEMENT

B.3 PRICE/COST SCHEDULE

ITEM INFORMATION

B.4 IT CONTRACT SECURITY

B.5 SUBCONTRACTING COMMITMENTS--MONITORING AND COMPLIANCE (JUN

2011)

B.6 CONTRACTOR’S RESPONSIBILITY – CONTRACTORS PERFORMANCE

ASSESSMENT REPORTING SYSTEM (CPARS)

SECTION C - CONTRACT CLAUSES

C.1 52.203-16 PREVENTING PERSONAL CONFLICTS OF INTEREST (JUN 2020) ..59

C.2 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS (OCT

2018)

C.3 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (NOV 2020)

C.4 52.216-18 ORDERING (AUG 2020)

C.5 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.6 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.7 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.8 52.227-14 RIGHTS IN DATA—GENERAL (MAY 2014)

C.9 52.232-18 AVAILABILITY OF FUNDS (APR 1984)

C.10 52.237-3 CONTINUITY OF SERVICES (JAN 1991)

C.11 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.12 VAAR 852.212-70 PROVISIONS AND CLAUSES APPLICABLE TO VA

ACQUISITION OF COMMERCIAL ITEMS (APR 2020)

C.13 VAAR 852.212-71 GRAY MARKET ITEMS (APR 2020)

C.14 VAAR 852.219-10 VA NOTICE OF TOTAL SERVICE -DISABLED VETERAN-

OWNED SMALL BUSINESS SET-ASIDE (JUL 2019) (DEVIATION)

C.15 VAAR 852.219-74 LIMITATIONS ON SUBCONTRACTING—MONITORING AND

COMPLIANCE (JUL 2018)

C.16 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS

(NOV 2018)

C.17 VAAR 852.237-70 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE

(OCT 2019)

C.18 MANDATORY WRITTEN DISCLOSURES

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

SECTION E - SOLICITATION PROVISIONS

E.1 52.204-16 COMMERCIAL AND GOVERNMENT ENTITY CODE REPORTING

(AUG 2020)

E.2 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (OCT 2020)

E.3 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

E.4 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS (JUN 2020) 98

E.5 52.212-2 EVALUATION—COMMERCIAL ITEMS (OCT 2014)

E.6 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—

COMMERCIAL ITEMS (OCT 2020)

E.7 52.216-1 TYPE OF CONTRACT (APR 1984)

E.8 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.9 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

E.10 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION

(OCT 2018)

E.11 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (OCT 2018)

E.12 VAAR 852.273-70 LATE OFFERS (JAN 2003)

E.13 VAAR 852.273-74 AWARD WITHOUT EXCHANGES (JAN 2003)

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: Crystal S. Hinton, Contracting Officer 36C245

Department of Veterans Affairs VA Maryland Health Care System Contracting Officer (90C) 209 West Fayette Street, Suite 611

Post Award Orientation: The Contracting Officer will schedule a post award orientation for contract orientation purposes as required by Procurement Policy memorandum (PPM) 2019-01.

https://www.va..gov/oal/docs/business/pps/ppm201901.pdf

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

[X] 52.232-33, Payment by Electronic Funds Transfer—System for Award Management, or

[] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly []

b. Semi-Annually []

c. Other [X] (Monthly 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

FSC e-Invoice Payment Invoice must be submitted electronically http://www.fsc.va.gov/einvoice.asp Invoice Setup Information 1-877-489-6135 http://www/

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

AMENDMENT NO DATE

B.2 SCOPE OF CONTRACT AND PERFORMANCE WORK STATEMENT

B.2.1 DEFINITIONS AND ACRONYMS

AQL: Acceptable Quality Level

Acceptable Quality Level: An AQL is the maximum allowable degree of deviation from the standard and it is expressed as either a percentage of deviation from the performance standard or as an absolute number; an AQL with a deviation of zero, for example, means that no deviation from the standard is acceptable.

Bi-Level Positive Air Pressure (Bi-PAP): A type of noninvasive ventilation used to provide two pressure levels—inspiratory and expiratory positive air pressures—of ventilation of a patient.

Caregiver: An individual providing or assisting the Veteran patient with personal care. This may also be a family member.

CDR: Contract Discrepancy Report

Concentrator: An electrical device that produces oxygen by physical separation of oxygen from ambient air.

Continuous Positive Air Pressure (C-PAP): A type of noninvasive ventilation used to provide continuous ventilation of a patient.

Contract: An agreement between two or more parties that is legally binding.

Contract Discrepancy Report: Formal documentation of a contractor’s failure to some aspect of a contract that explains why performance was unsatisfactory, how performance will be returned to satisfactory levels and how recurrence of the problem will be prevented in the future.

CO: Contracting Officer

COR: Contracting Officer Representative

Contracting Officer: A Government official with designated authority to enter into, administer, and terminate a contract and to make related determinations and findings on behalf of the Government.

Contracting Officer’s Representative: A Government official designated by the CO that’s responsible for providing contract oversight and technical guidance to the Contracting Officer.

Contractor: The entity that enters into a contract with the government.

FAR: Federal Acquisition Regulation.

F.O.B. Destination: Free on Board at Destination. The seller or consignor pays for the cost of shipping and assumes risk of loss.

Home Oxygen: See Home Respiratory Care

Home Respiratory Care: The provision of home oxygen/respiratory care services necessary to assist the eligible person (i.e., Veteran patient) with home respiratory care. There are 3 primary methods of providing oxygen therapy in the home: (1) oxygen concentrators; (2) compressed gas; and (3) liquid oxygen.

HIPAA: Health Insurance Portability and Accountability Act.

IAW: In accordance with.

VAMC: VA Medical Center

Liquid Oxygen: Medical oxygen dispensed by the pound.

Liquid Stationary System: A device used to store and dispense liquid oxygen therapy and generally consists of large reservoir and portable unit that is filled from the reservoir. A standard reservoir holds 110 pounds of liquid oxygen and a portable unit holds 3-5 pounds of liquid oxygen.

Liters per Minute: A unit of measurement that indicates the volumetric flow rate of a gas.

LPM: Liters per minute.

Nebulizer: A device used to dispense medication with the use of an electrically operated compressor.

Oxygen Conserving Device: An electric or pneumatic -powered device that limits oxygen flow to inspiration only and thereby increases the duration of the oxygen supply.

Oxygen Tank: A metal, cylindrical container used to store and dispense oxygen in a gaseous state.

Patient: Veteran who is authorized by VHA Prosthetics and Sensory Aids Service (PSAS) to receive health care services as a VA beneficiary.

Practice of Respiratory Care: The practice of respiratory care means the practice of respiratory care, and any part of respiratory care, by a licensed person and shall be limited to that which has been learned through formal or special training including performance evaluation to evaluate competence. The practice of respiratory care includes, but is not limited to:

1. Delivery of respiratory care using devices such as positive pressure and negative pressure devices (e.g., CPAP, BiPAP, Intrapulmonary Percussive Ventilation, etc.);

2. The administration of pharmacological, diagnostic therapeutic agents related to respiratory care procedures necessary to implement a treatment, disease prevention, pulmonary rehabilitative or diagnostic regimen prescribed by a physician;

3. Transcription and implementation of written or verbal orders of a physician or other legally authorized person with prescriptive authority, pertaining to the practice of respiratory care;

4. Observing and monitoring signs and symptoms, general behavior, general physical response to respiratory care treatment and diagnostic testing, including determination of whether such signs, symptoms, reactions, behavior or general response exhibit abnormal characteristics;

5. Implementation of respiratory care protocols or changes in treatment pursuant to the written or verbal orders of a person with prescriptive authority.

PSAS: Prosthetics and Sensory Aids Service.

PSAS Representative: VHA Employee of the Prosthetics and Sensory Aids Service.

Quality Assurance Surveillance Plan (QASP): A written document that’s used by the Government to monitor a contractor’s quality assurance program.

Respiratory Therapist (RT): A person that is licensed to practice respiratory care by the appropriate State Agency. A licensed Respiratory Therapist can either be Certified (a CRT) or Registered (a RRT).

Sentinel Event: A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase, "or the risk thereof" includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome. Such events are called "sentinel" because they signal the need for immediate investigation and response.

Solicitation: A request to submit offers or quotations to the government.

Task Order: An order for services placed against an established task order contract.

Task Order Contract: A contract for services that does not procure or specify a firm quantity of services and that provides for the issuance of orders for the performance of tasks during the period of the contract.

TJC: The Joint Commission

The Joint Commission: An organization that sets standards by which health care quality is measured.

The Schedule: The following portions of a contract are the schedule: contract form (SF 1449), supplies or services and prices or costs, specification or statement of work, packaging and marking, inspection and acceptance, deliveries or performance, contract administration data, and special contract requirements.

B.2.2 OBJECTIVES

To provide Veteran patients with the most efficient and medically appropriate system for providing oxygen in his/her residence as determined by the prescribing physician and based on the patient’s daily period of usage and desired flow rate (per minute).

The Home Oxygen Services Contractor and Martinsburg VAMC’s PSAS will partner to increase the efficiency of the Home Oxygen program and both parties will collaborate to discover opportunities for service improvement and increased efficiency, consistently evolving to meet or exceed VA and commercial healthcare standards.

B.2.3 SCOPE

The intent of this Request for Quote (RFQ) is to award a single Indefinite Delivery, Indefinite

Quantity (IDIQ) contract to provide all the necessary labor, facilities, transportation, and management to perform home oxygen services, to include storage and management of home oxygen equipment, delivery, set-up, instruction and maintenance of equipment for VA beneficiaries as directed by Martinsburg WV, VA Medical Center (VAMC). The use of the term’s

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

The contract effective period shall be five (5) years, effective date 04/01/2021 - 03/31/2026.

All services will be performed in the Veteran’s place of residence. The equipment needs are subject to change as determined by the prescribing physician. The Contractor shall have a facility or resources physically located in the area of service depicted in which they will provide service. The Contractor’s office location shall include the service office, warehouse, dispatch of vehicles and other functions related to the performance of services of this contract within a fifty

(50) mile radius of the Martinsburg, WV, VA Medical Center (VAMC) at period of performance to facilitate periodic inspections by VA and/or other accrediting agencies.

The services provided shall be all inclusive of deliveries and transportation within the

Martinsburg, WV, VA Medical Center.

Certain tasks described within this Performance Work Statement must be performed in accordance with the standards promulgated by The Joint Commission (TJC). These standards, available at www.jointcommission.org, form a part of this Performance Work Statement and are incorporated herein by reference.

Non-mission-critical functions that can be performed remotely or that do not require in-person interactions may be completed by telephone or other virtual process as determined by the contractor in conjunction with the VA COR.

2. SERVICE SPECIFICATIONS

The Martinsburg VAMC serves an estimated 400 oxygen-using patients. The Home Oxygen

Coordinator (HOC) will provide (via encrypted email or fax) the contractor with notification to initiate individual patient service requirements, including the patient’s oxygen prescription, equipment, supplies and services to be provided including date and place of delivery. The

Contractor shall confirm receipt (via encrypted email or fax) of the request within five (5) working hours of notification; as well as provide notification of VA initiated discontinuance of service. The notification may be made orally but will be confirmed in writing within one (1) working day. The written documents will include the authorizing official’s signature, electronic or written.

BACKUP SYSTEM: The Contractor shall provide Veterans that have a prescription for an oxygen concentrator with a backup system consisting of a compressed gas source and regulator with stand, and cannulas/mask for use during the event of a power failure or mechanical problem with non-electrical oxygen supply to last three (3) times the Contractor’s response time. The Contractor shall provide documentation (via encrypted email or fax) if the

Veteran declines the oxygen back-up system, to include the reason for declining backup system and the Veterans signature. Notification (via encrypted email or fax) shall be provided to the

COR or designee within five (5) business days of the Veteran declining any prescribed equipment or contractor’s inability to deliver the prescribed equipment.

In accordance with the prescription received from the Martinsburg, VAMC, the Contractor shall provide the patient with the following items at the time of set-up and when needed as re-supply.

Any cost for shipping of the following items shall be borne by the Contractor:

http://www.jointcommission.org/

a. Humidifiers and water traps. The number of humidifiers provided must be sufficient to ensure that they are not depleted between re-supply visits. The number of traps will be based on the patient’s flow rate.

b. Disposable oxygen cannulas on hand for change at a minimum of every two (2) weeks with a supply in reserve at all times until the Contractor’s next scheduled visit.

c. Disposable masks for change/wash every two (2) weeks with a 30-day supply in reserve at all times until the Contractor’s next scheduled visit.

d. Twenty-five (25) to fifty (50) feet of oxygen connection tubing shall be replaced every

30 days. months with an equivalent section of tubing in reserve at all times (to be included in initial set-up) until the Contractors next scheduled visit.

e. Trachea collar and accessories (e.g. tubing and large volume nebulizer) with a supply on hand allowing for change every three (3) days with a supply in reserve at all times until the Contractors next scheduled visit.

f. Safety holders shall be provided for all patients with a prescription for four

(4) or more cylinders.

g. Thermal fuses on every concentrator and portable changed annually. Thermal fuses to be supplied by the Contractor.

h. Mandatory requirements for use of thermal fuses are as follows: a. Thermal fuses must be provided for all patients on home oxygen therapy unless there is a documented clinical contraindication (e.g., patients using heated humidity, patients with flow rates in excess of 25 Liters per minute, patients with behavioral conditions that make use of thermal fuses impractical). If thermal fuses are not provided due to clinical contraindication, this must be documented in the patient’s medical record. b.

Two thermal fuses must be provided and installed in each home oxygen delivery system (one at the patient end and one at the oxygen source). This must be done for the patient’s primary oxygen therapy equipment as well as any portable oxygen therapy equipment. c. Thermal fuses are not required for portable pulse dose/intermittent oxygen therapy equipment when the equipment does not have a continuous flow setting. d. Thermal fuses provided must work regardless of their orientation in the oxygen tubing (bidirectional) or have a design that prevents them from being installed in the wrong orientation (e.g., source end of thermal fuse has threads or bayonets that make backwards installation impossible). e. Existing unidirectional thermal fuses that are capable of being installed in the wrong orientation must be replaced at the next scheduled home oxygen visit or sooner if possible. f. At the time of installation, education must be provided to the patient describing the proper use and placement of thermal fuses, including that a thermal fuse does not make it safe to smoke, be near people who are smoking, or be near any source of sparks or flame while using oxygen. g. Thermal fuses must be replaced at the end of their expected life per manufacturer’s guidelines. h. Thermal fuses must be replaced if actuated or involved in a fire.

i. Mandatory requirements for reporting fires involving home oxygen delivery systems

All incidents of fires involving home oxygen delivery systems shall be reported using the VHA Patient Safety Information System. Do not include patient or provider identifiable information in the report. When classifying incidents of fires related to home oxygen delivery systems in JPSR, the following classification must be used in the Event Classification section. Event Type: Environmental Events Event Sub-Type:

Burn incurred from any source in course of patient care process Event Detail: Burn or fire related to home oxygen delivery system The following information must be collected and reported by the VHA facility when a home oxygen fire occurs. Section

1: To be collected by the home oxygen vendor and provided to the local VHA facility or provided by the local VHA facility if a third-party oxygen vendor is not used. a.

What was the reported cause of the fire (primary ignition source)? b. Where did the fire originate (e.g., kitchen, bedroom, vehicle, patio, store)? c. What date and time did the fire occur? d. What was the first item that ignited (e.g., nasal cannula, clothing, bedding)? e. Describe the extent of injury to the patient, family, and others.

f. Describe the extent of property damage. g. How many thermal fuses were in use and where were they installed in the home oxygen delivery system or tubing?

Section 2: To be collected by the local VHA facility. h. Has the patient experienced a home oxygen related fire before? i. Provide the patient’s full problem list from the electronic health record. j. Provide the patient’s full medication list (medication names) from the electronic health record. k. Describe any other information that contributes to understanding of the event.

INITIAL SETUPS: Initial set-ups are considered to be those patients who do not have a VA authorized oxygen therapy delivery system.

a. The Contractor shall provide the initial set-up within 24 hours of request from the

HOC (dependent on Veteran’s availability), to include weekends and holidays; this response time shall also apply to service calls. Initial setups may be provided by the contractor’s Patient Service Technician; does not have to be a Respiratory Therapist.

Martinsburg VAMC reserves the right to obtain the initial set-up service from another source and to charge the contractor with any excess cost which may result there from, if the contractor is unable to meet the 24-hour response time.

All patients receiving services under this contract shall be visited by a Certified

Respiratory Therapist (CRT) or a Registered Respiratory Therapist (RRT) within 24 hours after initial set up and at least annually thereafter. In the event a quarterly visit will not occur, the HOC will be notified and provided details of attempts to contact the veteran for service.

b. Initial set-up of Home Oxygen includes setting up and ensuring the appropriate oxygen system is operational, instruction and training of Patient, and/or caregiver, as well as performing a home environment safety check.

c. The Contractor shall provide patients with a telephone number to contact with any questions or if additional information is required. All equipment shall contain an adhesive type label containing the vendor’s name and emergency 24-hour toll-free phone number. This label shall be placed on the equipment in an area that is viewable to Patients and caregivers at all times. Patient shall be given a document listing a toll-free phone number for routine resupply of oxygen cylinders and supplies.

d. The Contractor shall provide and post on all entrances into the residence, a sign stating "Warning Oxygen in Use, No Smoking" or other verbiage that No Smoking is allowed due to oxygen being present and document that the Patient/care giver is instructed in the safe use of oxygen and equipment per OSHA regulations. Specified sign shall be no smaller than 4” X 6”.

The Contractor shall provide the Operation manual for all equipment to the Patient and/or caregiver upon delivering any equipment. The manual shall contain information on operation, maintenance, and trouble- shooting.

HOME ASSESSMENT REQUIREMENTS: The Contractor shall perform an assessment of the patient’s home and home environment in accordance with the Joint Commission accreditation standards and maintain documentation of assessments in the individual patient records.

a. The Contractor shall notify the COR/HOC 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. Unsafe conditions may include, but are not limited to, fire safety hazards, oxygen safety hazards or any instance that places the patient or Contractor’s staff in immediate danger. The Contractor shall contact the COR/HOC by phone during the home visit and furnish (via encrypted email) written documentation of the safety hazard to the COR/HOC within one (1) business day of the incident.

b. The Contractor shall ensure the electrical outlets in the patient’s home meet the requirements of the contractor’s equipment standards and immediately report unsafe conditions to the COR/HOC. Any alterations to the veteran’s residence will be the responsibility of the veteran.

c. The Contractor shall notify the COR/HOC by telephone at time of set- up if any alteration to the Patient's home is necessary to accommodate the oxygen equipment, including electrical work.

d. The Contractor shall verify the presence of working smoke alarms and instruct the Patient to test all smoke alarms on a monthly basis and include this verification in the documentation of assessment. The Contractor shall document any home where smoke alarms are not present and fully functional, the Contractor shall provide this notification to the COR/HOC (via encrypted email) within five (5) business days of the service.

Every quarter the Contractor shall visit all patients on concentrators to reassess equipment compliance and educational needs. A qualified service technician may perform this service. A report shall be developed, signed and dated by the contract staff and the patient/care giver and a copy shall be left with the patient/care giver. The reports shall be legible and attached to the invoice. All reports shall be submitted to the COR or designee in alphabetical order, with the monthly bills by the 10th business day of the month following service. The written report shall include at a minimum the following data:

a. Name and social security number (SSN) of patient using the equipment.

b. Monitor compliance on prescription (LPM, hours per day).

c. Type of concentrator and hours on concentrator.

d. Inspection results of liter flow rate in monitoring patient compliance (as compared to prescription).

e. Inspection compliance of filters (exchange or clean by patient) according to manufacturer’s guidelines.

f. Follow-up education and/or reinforcement of compliance documented.

PATIENT EDUCATION

The Contractor shall provide education to each patient or caregiver at the time of set-up and assess the need for reinforcement during visits. This information is to be presented by demonstration and material covered shall be in written form to be left with the patient /care giver. The written material shall be in English as well as the foreign language of the patient, should the patient not speak English. The Contractor as directed by COR/HOC will 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 education services provided to patients.

The Contractor shall provide to each VA patient a copy of the approved “Patient Instruction

Booklet”. This booklet shall be placed in a durable binder with emergency and routine contact information properly annotated before the booklet is given to the patient. Instructions shall cover the use of all equipment delivered. The contact information for the Joint Commission shall be provided in the booklet. The patient/caregiver and contract representative shall sign the approved “Documentation of Set up/Periodic Maintenance” and “Patient Training checklist” acknowledging that the written and oral instructions have been provided. A copy of the signed documents shall be submitted to the COR within five workdays of the initial set up. Instruction shall be in accordance with Joint Commission and CMS standards.

The Patient Instruction Booklet shall include connection, removal, emergency procedures and toll free or collect phone number or contractor for emergency repair. The instructions shall be consistent with patient education provided by the VA to the patient. The Contractor must have the patient provide a return demonstration of appropriate use of the equipment. The contractor shall install NO SMOKING signs in each patient’s residence. The Contractor shall test the smoke alarm battery by pressing the test button on the smoke detector to ensure proper function at the time of the initial set up.

The Contractor shall provide educational and warning information for patients, their families, and caregivers on the hazard of smoking while oxygen is in use. The education materials must be provided upon initial delivery. Education materials shall instruct patients on oxygen that smoke to remove the cannula, shut-off the oxygen supply, stand a minimum of 25 feet away and wait for oxygen to dissipate prior to smoking.

Incidents where patients are reported as non-compliant with the guidelines set forth in the education and orientation material or whose behavior poses a risk of self-harm or harm to others shall be documented by the contractor and reported to the Home Oxygen Coordinator and/or the COR.

The Contractor shall provide patients a copy of VA Patient Rights & Responsibilities, and any information concerning advance directives during initial setup. The Contractor shall document that the patient/care giver is instructed in accordance with the Joint Commission standards to include how to contact the Joint Commission.

TRAVELING PATIENTS

The Contractor shall coordinate all oxygen services for patients who travel both within and outside the geographical area covered by this contract. Patients will be instructed by the

Contractor and VA staff to notify the Contractor at least two (2) weeks before intent to travel and earlier if they are relocating. Accommodations shall be made for short notice in the event of a family emergency. The number of paid travels for vacation not related to a temporary relocation

(i.e., for a reason) per year is not defined but should be limited.

Patients receiving oxygen services under this contract are authorized a maximum of thirty (30) days travel, with a maximum of two (2) set-up charges within a one (1) year period from the latest prescription date. Subsequent to this, any other oxygen costs will be the patient’s responsibility. It is the Contractor’s responsibility to monitor usage and notify COR/HOC if the limits will be exceeded.

The Contractor shall provide patients traveling within the geographical area covered by the contract all oxygen service hereunder at the contract rate utilizing Contractor furnished equipment only. The Contractor shall invoice the appropriate VA facility as established herein.

When the Veteran is temporarily traveling outside of the contracted area, the Contractor shall arrange for oxygen services at the same contract rate (billed to the Veteran’s resident VAMC) if the Contractor has a subsidiary office located at the temporary destination. If not, the resident of Martinsburg VAMC will coordinate with the Martinsburg VAMC nearest the Veteran’s destination to arrange for oxygen services.

EMERGENCY SERVICES

Emergency services are for medical equipment provided to patients when an equipment malfunction or natural disaster may threaten a patient's health. The Contractor shall provide to the Contracting Officer a written emergency management plan, in compliance with Joint

Commission standards. This emergency action plan shall address continuity of services for all patients in the affected region.

The Contractor shall have a well-established communication system, providing 24-hour emergency services and shall provide services at the patient’s place of residence within six (6) hours of a call.

The Contractor shall ensure all patients have a minimum of non-electrical oxygen supply to last three (3) times the Contractor’s response time to be on-site at a patient’s residence after receiving a call. The minimum supply shall take into account each patient’s prescription flow-rate and distance from the Contractor’s location; actual supply levels may differ from the patient to patient, as long as each patient has oxygen supply to last a minimum of three (3) times the

Contractor’s response time. If the Contractor is unable to respond to an emergency service call within six (6) hours, the Contractor shall make arrangements with another supplier to provide oxygen at the patient’s residence at the Contractor’s expense. Contractor shall provide a written explanation of Contractor’s inability to provide emergency service to the COR/HOC or authorized personnel within two (2) business days. The cost of backup oxygen systems, backup oxygen, and backup equipment shall be borne by the contractor. If M60 or M tanks are used for backup, the Contractor shall furnish an H or M tank stand for each tank.

The Contractor shall notify the COR/HOC immediately in the event of a disaster, natural or otherwise, that may affect the service covered under this contract. The Contractor shall provide patients with written instructions about what to do in case of a natural disaster or other emergency.

The Contractor shall provide phone numbers of supervisory staff who can be accessed twenty-four (24) hours a day, seven (7) days a week, during emergencies. Any changes to the emergency points of contacts or their contact information shall be communicated to VA within 3 business days.

DISCONTINUANCE OF SERVICE

The Government shall notify the Contractor in the event of an order to discontinue oxygen service to any patient covered under this contract. Notification shall be by telephone, facsimile and/or encrypted email. Payment will be pro-rated for the month in which service is terminated and will be terminated five (5) business days after notification to the Contractor to discontinue service. The Contractor shall notify the COR/HOC or authorized personnel within next business day if Contractor becomes aware of a patient death, or upon finding a patient has moved out of the service area.

After notification to discontinue service, the Contractor shall remove all equipment from the patient’s residence at the earliest possible time, but no later than 5 business days after receiving notice unless approved by COR/HOC. The date and time of equipment pickup shall be coordinated with the patient or next of kin. The Contractor shall make every effort to meet the patient’s or patient’s families’ requests for pickup times. The Contractor shall honor patient’s or family’s requests to pick up equipment before or after funerals or family gatherings relative to patient’s funerals. The Contractor shall treat such requests with the utmost courtesy and give such requests the highest priority.

CONTRACTOR VISITS

The Contractor shall visit the patient’s residence as needed for delivery of equipment in performance of this contract by appointment only, between the hours of 8:00 a.m. and 8:00 p.m., Monday through Friday; exceptions will be made in the cases of emergencies. The

Contractor shall schedule the appointments to the patient’s home 24-48 hours prior to the appointment. On each scheduled setup/delivery, the Contractor shall reassess the need to instruct the patient on the use and care of the equipment and supplies.

All patients receiving services under this contract shall be visited by a Certified Respiratory

Therapist (CRT) or a Registered Respiratory Therapist (RRT) within 24 hours after initial set up and at least annually thereafter. In the event a quarterly visit will not occur, the HOC will be notified and provided details of attempts to contact the veteran for service.

The Contractor shall make every effort to establish appointments with patients when initiating set-ups and deliveries. Deliveries shall not be left unattended at the patient’s home; physical acceptance of deliveries must take place between the Contractor and either the patient or caregiver. If the patient repeatedly fails to meet appointments, the Contractor shall notify the

HOC. The HOC will contact the patient and a corrective action plan will be implemented. The

COR/HOC will notify the Contractor of any changes. If the Contractor has not made valid and documented attempts to contact the patient for set ups and or deliveries the Government reserves the right to call in a third party to provide those services and bill the Contractor for any additional costs the Government incurs as a result of such action.

EXCESS DELIVERY: The VA will not pay for delivery of supplies or equipment in excess of those prescribed without prior authorization by VA.

REPORTS:

Performance Review Report - The Contractor shall provide a written, quarterly report addressing all the Joint Commission Standards for improving organizational performance (The

Joint Commission standards may be accessed at www.jointcommission.org) to the COR. The

Contractor shall submit their Performance Review to the COR via encrypted email. The

Contractor shall assess and score each Joint Commission standard and element of performance that is applicable to the contracted services by entering a self-assessed score.

Any noncompliant finding or gaps in service identified on the self-assessment shall require a plan of action to correct the finding.

Incident Report - The Contractor shall report to the COR/HOC special incidents found or occurring during a home visit; to include finding Patients in need of emergency medical assistance, safety hazards that do not fall into the category of presenting immediate life-threatening danger to the Patient or Contractor’s staff, inability to contact a Patient within a reasonable period of time, and any other incident meeting the Contractor’s written policy for incident reporting according to Joint Commission accreditation standards. All reports shall be provided to the COR via encrypted email within 24 hours. Contractor shall report all life-threatening situations to the proper authorities immediately (e.g. 911, police, and any other emergency).

Patient Satisfaction Report - The Contractor shall collect satisfaction data from Patients and their families on a quarterly basis in accordance with Joint Commission standards. A copy of survey results shall be submitted to COR or designee in quarterly reports via encrypted email.

The quarterly report is due to the COR within the 5th working day after the conclusion of the quarter. The reporting quarters are as follows: October 1st through December 31st, January 1st through March 31st, April 1st through June 30th and July 1st through September 30th

Infection Control Report - The Contractor shall collect, trend, and report on data related to the

Contractor’s Infection Control Program to the COR or designee on a quarterly basis for each http://www.jointcommission.org/ contract performance period via encrypted email. The quarterly report is due to the COR within the 5th working day after the conclusion of the quarter.

Contract Usage Report – Contractor shall provide a quarterly report via email detailing contract usage by each Medical Center. Contractor shall provide to each Facility’s COR or designee their respective facility’s report no later than 15 workdays following the end of a quarter. The report shall include the total units per CLIN, and total dollars invoiced by CLIN. Additionally, a composite report of each facility’s usage, to include the total number of unique Patients, the total number of units used by CLIN, the total dollars invoiced by CLIN is required.

The Contractor shall provide the following emergent patient safety reports, within one (1) business day of the action, throughout the contract period.

a. Sentinel Events - The Contractor is required to inform the Home Oxygen Coordinator and/or COR within one (1) business day of a sentinel event via encrypted email that occurs during the performance of this contract that involves patients serviced under this contract. The Joint Commission defines a sentinel event as a patient safety event that reaches a patient and results in death, permanent harm or severe temporary harm.

b. Refusal of service - All patients have the right of refusal of service. In the event a patient refuses service or orders the equipment to be removed from the home, the Contractor shall comply with the patient’s wishes. The Contractor shall report the specifics of the refusal to the HOC/COR by telephone within one (1) hour. If the refusal occurs during a home visit, the Contractor’s staff shall make an attempt to notify the COR/HOC of the refusal during the home visit.

c. Non-compliant behavior - The Contractor shall report non-compliant behavior with fire safety guidelines set forth in the Patient education and re-assessment material and/or behaviors which pose a risk of self-harm or harm to others. Such behavior shall be reported to the COR/HOC during the home visit if the Contractor's staff determines the patient's non-compliant behavior, within the home environment, is not improving after education. The Contractor shall document noncompliant behavior and any follow-up actions (i.e. education).

EQUIPMENT AND SUPPLY REQUIREMENTS

The Contractor shall, install and service all equipment and supplies ordered under this contract.

All disposable supplies are to be new and unused. 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.

The installation/maintenance of all machines and equipment by the Contractor shall be performed by a competent professional familiar with nature of the equipment involved and fully qualified under the laws of the State in which the services are being rendered. Installation shall be consistent with local Fire and Safety Codes in the respective area of the State of WV and shall conform to National Fire Protection Association (NFPA) 99/101 (Life Safety Codes) NFPA

(Oxygen Cylinder Requirements) which are incorporated herein by reference. The Contractor shall provide a safety/emergency checklist to be completed, then signed by the patient or his/her caregiver and retained in the patient’s account records. The Contractor shall service all equipment at manufacturer recommended intervals. The Contractor shall conduct a check of the concentrator using a certified oxygen analyzer that is calibrated according to the manufacturer standards. The Contractor shall perform maintenance on all equipment according to the equipment manufacturer's guidelines. The Contractor shall change compressor inlet pre-filters and compressor inlet bacteria filters according to the manufacturer recommendations.

The Contractor shall test the alarm battery at each maintenance check; the Contractor shall change the alarm battery as indicated, but at least annually. The Contractor shall track and document maintenance of equipment in accordance with manufacturer specifications and provide these records to the COR for review upon request. Contractor shall furnish parts and labor for routine maintenance. The Contractor shall have recall procedures for equipment and supplies that have been identified for recall.

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

The VISN 5 facilities will not pay for the Contractor’s lost or damaged equipment provided under this contract unless circumstances as reviewed by the Contracting Officer are concluded to be the result of willful negligence on behalf of patients or VAMC employees. Accordingly, this is considered to be the cost of doing business and is the requirement of the Contractor to pay for this type of equipment. Contractor may request payment for lost or damaged equipment by submitting a written summary of the circumstances of lost or damaged equipment to the contracting officer within 30 calendar days of the occurrence of the incident in question. The

Contracting Officer will review the summary, and a written determination will be made to the

Contractor as to the liability. The VISN 5 facilities will not pay for rental on equipment not being used by an authorized patient during the performance of this contract or for equipment that cannot be found.

Contractor shall provide service and preventive maintenance on all equipment as recommended by the manufacturer. Preventive maintenance shall only be performed by a certified service technician that has received the approved training. Contractor shall provide all documentation to the COR with signatures and dates on the contract inception date and upon the COR’s request.

The Contractor shall ensure that every concentrator has a label or pouch that indicates the most recent service date, service hours and technician’s name.

OXYGEN CONCENTRATORS: The Contractor shall provide oxygen concentrators that are

Underwriter Laboratory (UL) approved and must at a minimum meet the following specifications:

a. Electrically powered (115 volts)

b. Shall include a battery-operated audible alarm to indicate a power failure

c. The oxygen concentrator shall not perform below the manufacturer’s specification

d. The oxygen concentrator shall contain an hour meter and oxygen concentration indicator (OCI)

e. The oxygen concentrator shall be grounded internally or plug into a three-prong wall outlet appropriate for the patient’s home (outlet adaptors are not acceptable).

FIVE (5) LPM (LITERS PER MINUTE) CONCENTRATOR: The Contractor shall provide 5 LPM

Concentrators that meet the following specifications:

a. Deliver 90% oxygen at flow rates up to 5 LPM.

b. Operate on 120 VAC, 60 Hz

c. Have thermal protector for compressor

d. Be double insulated and have two - prong plug

e. Have pressure compensated flow meter

f. Have high-low pressure alarm

g. Have power failure alarm

h. Weight 60 pounds or less

i. Be mounted on wheels for easy movement by patient/caregiver

j. Must meet FDA QSR standards

k. Minimum of three-year warranty on concentrator and compressor

l. Sound level of 60db or less

Note: Concentrators shall have oxygen sensing devices.

TEN (10) LPM CONCENTRATOR: The Contractor shall provide 10 LPM Concentrators that meet the following specifications:

a. Deliver oxygen flow rates: (I) 95% to 92% @ 1/2 - 7 LPM flow (II) 95% to 90% @ 7-10

LPM flow (O2 Pressure: 7 PSIG (48 KPA) normal)

b. Alarms for the following failures are required: Power Failure, 02 Concentration

(Optional), and Irregular Pressure

c. Size: shall vary

d. Weight: shall vary (light as possible/easily maneuverable)

e. Be double insulated and have two - prong plug

f. Have power failure alarm

g. Be mounted on wheels for easy movement by patient/caregiver.

h. Must meet FDA QSR standards

i. Minimum of two-year warranty on concentrator and compressor.

j. Sound level of 60db or less

Note: Concentrators shall have oxygen sensing devices.

PNEUMATIC POWERED OXYGEN CONSERVING DEVICES: The Contractor shall provide

Oxygen Conserving Devices that are battery-powered or pneumatic powered devices that limits oxygen flow to inspiration only and thereby increase the duration of the supply. Pneumatic units must meet the following specifications:

a. Flow settings from .25 to 6 or higher

b. Have easy to read content gauge

c. Conservation ratio of 3:1 or higher

d. Have at least 2-year warranty

e. Weight less than 30 oz.

Notes: 1) Pneumatic conservers may use double lumen cannula.

2) Conserving ratios are based on a breath rate of 20 bpm.

Battery-powered Oxygen Conserving Devices must meet the following specifications:

a. Minimum flow settings from 1 to 5

b. Have easy to read content gauge

c. Conservation ratio of 3:1 or higher

d. Bolus delivered per breath of at least 10cc per setting

e. Have continuous flow setting

f. Have at least two-year warranty

g. Weight less than 30 oz.

LIQUID…