36C24521R0034 03192021.pdf

PAGE 1 OF 113 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

581-20-2-6814-0172

36C24521R0034 03/19/2021

Crystal S. Hinton; Contracting Officer 410-637-1530 04-01-2021

1400 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

X

36C581

Department of Veterans Affairs

VA Maryland Health Care System

Crystal Hinton, Contracting Officer (90C)

1540 Spring Valley

Huntington WV 25704

36C512

Department of Veterans Affairs

VA Maryland Health Care System

Crystal Hinton, Contracting Officer (90C)

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 Huntington WV

Contractor Performance Period: 5 Years

Period of Performance 5/01/2021-04/30/2026

Performance Work Statement page 5

Schedule of Services page 25

Contractor shall be responsible for correct wage title and

Compliance with all applicable wage and hour laws.

See CONTINUATION Page

X X

Paschal Dawson

FAC-C Level III

36C24521R0034

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 DESCRIPTION/SPECIFICATION/PERFORMANCE WORK STATEMENT

B.3 PRICE/COST SCHEDULE

ITEM INFORMATION

B.4 IT CONTRACT SECURITY

B.5 LIMITATIONS ON SUBCONTRACTING-- MONITORING AND COMPLIANCE (JUN 2011) .. 45

B.6 SUBCONTRACTING COMMITMENTS--MONITORING AND COMPLIANCE (JUN 2011)

B.7 CONTRACTOR’S RESPONSIBILITY – CONTRACTORS PERFORMANCE ASSESSMENT

REPORTING SYSTEM (CPARS)

SECTION C - CONTRACT CLAUSE

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

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 (OCT 1995)

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 1014)

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 852.219-11 VA NOTICE OF TOTAL VETERAN-OWNED SMALL BUSINESS SET-

ASIDE (JUL 2019) (DEVIATION)

C.15 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2018)

C.16VAAR 852.237-70 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE (OCT 2019)

C.17 VAAR 852.237-75 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2018)

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) . 82

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 (JUN2020)

PROPOSAL PREPARATION INSTRUCTIONS

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)

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] Billed Monthly 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

ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the

Solicitation numbered and dated as follows:

AMENDMENT NO DATE

http://www/

B.2 DESCRIPTION/SPECIFICATION/PERFORMANCE WORK STATEMENT

Performance Work Statement for Home Oxygen

Department of Veteran Affairs Medical Center (VAMC) has a requirement for providing Home Oxygen

Services for Huntington, WV. Set Aside for SDVOSB

Hershey Woody Williams, Huntington, WV, VA Medical Center

1540 Spring Valley Drive

Huntington, WV 25704

1. SCOPE OF WORK

1.1 The intent of this Request for Proposal (RFP) is to award a single Indefinite Delivery, Indefinite -

Quantity (IDIQ) contract to a Service Disabled Veteran Owned Small Business (SDVOSB) providing all the necessary labor, facilities, supplies, materials, equipment supervision, transportation, safety management, infection control, and management to perform home oxygen services, to include storage and management of both Contractor owned and Government-owned home oxygen equipment, delivery, set-up, instruction and maintenance of equipment for VA beneficiaries as directed by the VISN 5 Department of Veteran Affairs Healthcare Systems (VAHCS) facility listed herein. The Contractor shall maintain at the proposed servicing facility adequate licensed registered respiratory therapy staff to provide instructions, safety management, perform respiratory evaluation (under the direction of the physician), and follow-up and/or emergency visits. 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.

1.2 The contract effective period shall be for 5 years.

1.3 All services will be performed in the Veteran’s place of residence or in a nursing home housing and community living centers, if applicable. 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 listed in the PWS, 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 twenty (20) mile radius of the VA, Huntington WV facility to facilitate periodic inspections by VA and/or other accrediting agencies at the period of performance.

1.4 The geographical boundaries are described in the PWS.

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

http://www.jointcommission.org/

2. SERVICE SPECIFICATIONS

2.1 Huntington currently serves an estimated 1,000 oxygen-using patients. The Contracting Officer’s

Representative (COR) or designee will provide (via encrypted email and 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 and fax) of the request within (2) two working hours of notification; the COR or designee will provide notification if VA owned equipment is to be provided; the

COR or designee will also 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.

2.2 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, humidifiers and cannulas/mask for use during the event of a power failure or mechanical problem with non-electrical oxygen supply to last (3) three times the Contractor’s response time. The Contractor shall provide documentation (via encrypted email and 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 and fax) shall be provided to the COR and VA Medical Center Respiratory Therapist contact within five (1) business day of the Veteran decline COR or designee within five (5) business days of the Veteran declining any prescribed equipment or Contractor’s inability to deliver the prescribed equipment.

2.3 In accordance with the prescription received from the 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:

a. Humidifiers and water traps. The number of humidifiers provided must be enough 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 always 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 three

(3) 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 seven (7) days with a supply in reserve at all times until the

Contractors next scheduled visit.

f. Fire Safe Valves on every concentrator machine and portable oxygen system changed annually.

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

(4) or more cylinders.

2.4 INITIAL SETUPS: Initial set-ups are considered to be those patients who do not have a VA authorize oxygen therapy delivery system currently in place by the VA.

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

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 monthly visit will not occur, the COR will be notified and provided details of attempts to contact the veteran for service.

The VISN 5 facilities 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.

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 and any current applicable regulations in addition to OSHA. Specified sign shall be no smaller than 4” X 6”.

e. Scanning home oxygen orders/email system to vendor so verification made that they received the order.

f. No additional charge for same day delivery

2.5 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.

2.6 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/designee 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 or designee by phone during the home visit and furnish (via encrypted email) written documentation of the safety hazard to the COR or designee 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 or designee. Any alterations to the veteran’s residence will be the responsibility of the veteran.

c. The Contractor shall notify the COR or designee 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 or designee (via encrypted email) within five (5) business days of the service.

2.7 Every two (2) months the Contractor shall visit all patients on concentrators to reassess equipment compliance and educational needs. A qualified service technician shall 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 last four (4) of the 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.

g. If vendor is unable to contact Veteran specifics on why the Veteran was not available must be documented.

The Contractor's assessment form shall include the diagnosis of the veteran for the visiting respiratory therapist to provide ongoing education, assess equipment and supplies, and to submit a quarterly report, (for patients who are using oxygen therapy for cluster headaches, the respiratory therapist visit schedule will only require an annual visit. If the patient also has a concentrator, they will remain on the quarterly visit schedule. The Respiratory Therapist will document the average frequency of use of the therapy by the patient and remind the patient that the oxygen prescription needs to be renewed yearly by either the patient’s primary care or the neurology doctor. The home oxygen prescription must be reviewed with the veteran. The quarterly report (used for all patients except for those stated above using oxygen therapy for cluster headaches) shall include the following data:

a. Name and last four of the social security number (SSN) of beneficiary using the equipment.

b. Review of prescription (Liters Per Minute, hours per day).

c. Type, serial number, and hours on concentrator.

d. Average usage of oxygen per day monitored through concentrator hour usage and actual observed setting of liter flow rate.

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

f. Inspection results of intake filters (exchange or clean).

g. Inspection/change of bacterial filters.

h. Fire safety issues

i. Fall risks

j. Inspection and replacement of disposable supplies

k. Clinical assessment (if ordered, see below for requirements).

A Clinical Assessment by credentialed Respiratory Therapist shall include the following:

l. The patient’s diagnosis.

m. Vital signs to include blood pressure, heart rate, respiratory rate.

n. Oxygen saturation by pulse oximetry (if ordered) on room air and on the oxygen liter flow prescribed at rest and w/patients’ normal activity

o. Assessment of the lung sounds.

p. Monitoring of respiratory medications

q. All requirements for clinical assessments and documentation according to JC standards.

3. PATIENT EDUCATION

3.1 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 or designee 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.

3.2 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 and every six (6) month thereafter. 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.

3.3 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.

3.4 The Contractor shall provide patients a copy of VA Patient Rights & Responsibilities, and any information concerning advance directives during initial setup. VA Patient Rights & Responsibilities will be provided to the Contractor by the COR/HOC. 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.

4. TRAVELING PATIENTS

4.1 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.

4.2 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. maximum of FOUR (4) set up charges within a one (1) year period from the latest prescription date instead of TWO (2). 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 if the limits will be exceeded. we ourselves should track this as I don’t like that idea of the next company alerting us and solely relying on that

4.3 When the Veteran is temporarily traveling outside of the contracted area, the Contractor shall arrange for oxygen services at the same contract rate (billed timely to the Veteran’s resident VAMC) if the

Contractor has a subsidiary office located at the temporary destination the oxygen will be billed at the same contract rate.

5. EMERGENCY SERVICES

5.1 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.

5.2 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 by patient and family member.

5.3 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 with 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 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 H or M tanks are used for backup, the Contractor shall furnish an H or M tank stand for each tank.

5.4 The Contractor shall notify the COR or designee 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.

5.5 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.

6. DISCONTINUANCE OF SERVICE

6.1 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 adjusted 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 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.

6.2 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 or designee. 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.

7. CONTRACTOR VISITS

7.1 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 monthly visit will not occur, the COR will be notified and provided details of attempts to contact the veteran for service.

7.2 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 COR or designee. The COR or designee will contact the patient and a corrective action plan will be implemented. The COR 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.

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

9. REPORTS

9.1 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.

9.2 Incident Report - The Contractor shall report to the COR 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).

9.3 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.

9.4 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 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.

9.5 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 http://www.jointcommission.org/ 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.

9.6 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 COR by telephone within one (1) hour. If the refusal occurs during a home visit, the Contractor’s staff shall try to notify the COR or designee 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 or their designee 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).

9.7 Trilogy Report:

Monthly compliance and/or clinical information regarding patient settings provided to the Huntington VA

Medical Center.

10. EQUIPMENT AND SUPPLY REQUIREMENTS

10.1 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.

10.2 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 and shall conform to National Fire Protection

Association (NFPA) 99/101 (Life Safety Codes) NFPA (Oxygen Cylinder Requirements) which are incorporated herein by reference and any current applicable regulations. . 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.

10.3 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.

10.4 The Huntington VA 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 VA Huntington, WV Medical Center employees. Accordingly, this is 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. The Contractor shall be liable for, and shall indemnify and hold harmless the Government against, all actions or claims for loss of or damage to property or the injury or death of person(s), resulting from the fault, negligence, or wrongful act or omission of the

Contractor, its agents, or employees

10.5 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.

10.6 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).

10.7 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 5LPM.

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.

10.8 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 60 db or less

Note: Concentrators shall have oxygen sensing devices.

10.9 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 2-year warranty

g. Weight less than 30 oz.

10.10 LIQUID OXYGEN SYSTEM: Liquid oxygen system consists of large reservoir and portable unit that is filled from the reservoir. Standard reservoir holds 110 pounds of liquid oxygen and portable unit holds 3-5 pounds of liquid oxygen. The Contractor shall provide liquid oxygen systems that meet the following specifications:

a. Reservoir must have condensation collection tray

b. Must have quick release valve for easy refilling

c. Flow meter range of ¼ to 6 LPM, or 1-15LPM for high flow systems

d. Portable unit must come with shoulder strap

e. Shall have electrical or mechanical content indicators

f. Shall have a portable cart or vented backpack bag for portability

10.11 LIQUID OXYGEN SYSTEM WITH CONSERVING DEVICE: Liquid oxygen system with conserving device consists of large reservoir and portable unit that is filled from the reservoir. Standard reservoir holds 110 pounds of liquid oxygen and portable unit holds 0.9 pounds of liquid oxygen. The standard reservoir weighs 165 pounds full and the portable unit weighs 4 to 8 pounds full. The Contractor shall provide liquid oxygen systems with conserving devices that meet the following specifications:

a. Reservoir must have condensation collection tray

b. Must have quick release valve for easy refilling

c. Must have flow settings of 1-6 or 1-15

d. Portable unit must come with shoulder strap and belt loop holder

e. Shall have electrical or mechanical content indicators

10.12 SELF-FILL OXYGEN SYSTEM

The Contractor shall provide self-fill oxygen systems to include 4 self-fill compatible oxygen tanks (sizes

M6, C, D or E), carrying cart, conserving device, fill station and self-fill compatible concentrator.

10.13 PORTABLE OXYGEN CONCENTRATOR

The Contractor shall provide portable oxygen concentrators that can provide continuous flow (FAA

Approved) and shall be able to provide a minimum of 2 LPM and a pulse setting of 5, weigh 20 pounds or less, AC/DC capability, up to 12 hours battery life, continuous and pulse doses (40 ml or greater) flow option. pulse dose to 5 LPM on the smaller POC’s and a continuous flow of 3lpm and pulse dose of 6

LPM on the continuous machines on the larger POC’s

Portable Concentrator (FAA Approved) shall be 1-6 LPM flow capability, weight 10 pounds or less, AC/DC capability, 12 hours battery life, continuous and pulse doses (40 ml or greater) flow option, carry bag and strap, Intelligent Oxygen Delivery-(daytime and nighttime delivery), Auto Oxygen

Delivery(Automatically delivers oxygen if breath not detected), overseas power (converts to proper voltage) and easy-to-read Lighted LCD Display(Constant Oxygen Purity Monitoring).

10.14 VENTILATORS

Ventilators Rental equipment to be a PLV 102 brand or equal to remain consistent with VA owned equipment. The set-up 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.

The Huntington VA 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 Huntington 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.

BACKUP SYSTEM: Veterans with a prescription for an oxygen concentrator and/or portable oxygen concentrators shall be provided with a backup system consisting of a compressed gas source and regulator with stand, humidifiers, and cannulas/masks for use during the event of a power failure or mechanical problem with electrical home oxygen equipment. The cost of replacement for the above-mentioned backup system shall be borne by the Contractor. The cost of replacement of equipment damaged, lost or misplaced not through Patient's negligence shall be borne by the Contractor. The Contractor shall provide documentation (via encrypted email and fax) if the Patient declines the oxygen back-up system, to include the reason for declining backup system and the veterans signature. Notification (via encrypted email and fax) shall be provided to COR or designee within five (5) business days of the veteran declining any prescribed equipment or contractor’s inability to deliver the prescribed equipment.

10.16 Any H or M size oxygen cylinder furnished by the Contractor shall include an H or M size oxygen cylinder safety stand. This stand shall remain Contractor owned. Cylinders shall be clean (free of dust, insects, rodent residue or other soil) when delivered to patient’s residence.

10.17 The Contractor agrees to provide cylinders without assessing demurrage charges on the

Government.

10.18 Oxygen provided meet United States Pharmacopoeia (USP) standards.

11. REQUIREMENTS AND STANDARDS

11.1 Periodic, unscheduled on-site Contractor and home oxygen patient visits will be made by the COR or designee to monitor the Contractor’s performance under this contract. The Contractor shall make available all records and documentation necessary during the monitoring visits. Other visits shall be made by the Joint Commission surveyors and the Home Oxygen Coordinator for each facility

11.2 The Contractor shall develop and maintain a patient account record no more than five (5) days after the initial oxygen set-up and maintain it in compliance with the Privacy Act and Health Insurance

Portability and Accountability Act (HIPAA). All patient records are subject to review by designated

VISN 5 officials and accreditation surveyors on the behalf of VISN 5 during accreditation surveys or consultation. These records shall include prescription, plan of care, patient education documentation, reports of infections, safety inspection, initial setup with safety check, invoices/delivery…