36C24523R0055.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. UEI: EFT:

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. NOV 2021)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

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

36C24523R0055 01/04/2024

Crystal S. Hinton, crystal.hinton@va.gov

410-637-1530 1-23-2024

1400 EDT

Department of Veterans Affairs VA Maryland Health Care System Crystal S. Hinton, Contracting Officer P.O. Box 1000, Bldg. 101, Room 4 Perry Point MD 21902

X 100

X

532283

$41 Million

N/A

Crystal S. Hinton, Contracting Officer P.O. Box 1000, Bldg. 101, Room 4

Crystal S. Hinton, Contracting Officer P.O. Box 1000, Bldg. 101, Room 26

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

The Clarksburg VA Medical Center is need of Home Oxygen Services.

This is a SDVOSB Set-Aside Requirement.

Contractor Performance Period: 5 Years (04/01/2024-3/31/2029)

Period of Performance of Work Statement page 8.

Schedule of Services on page 28.

Contractor shall be responsible for correct wages, titles, And compliance with all applicable wage and hour laws of Wage Determination: 2015-3457.

See CONTINUATION Page

X 1

Crystal S. Hinton Contracting Officer

36C24523R0055

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 PRICE/COST SCHEDULE

B.3 DESCRIPTION/SPECIFICATION/PERFORMANCE WORK STATEMENT

B.4 IT CONTRACT SECURITY

B.5 CONTRACTOR’S RESPONSIBILITY – CONTRACTORS PERFORMANCE

ASSESSMENT REPORTING SYSTEM (CPARS)

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL PRODUCTS

AND COMMERCIAL SERVICES (DEC 2022)

C.2 52.216-18 ORDERING (AUG 2020)

C.3 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.4 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.5 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.6 52.237-3 CONTINUITY OF SERVICES (JAN 1991)

C.7 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

(End of Addendum to 52.212-4)

C.8 VAAR 852.201-70 CONTRACTING OFFICER'S REPRESENTATIVE (DEC 2022) 80

C.9 VAAR 852.219-73 VA NOTICE OF TOTAL SET-ASIDE FOR CERTIFIED SERVICE-

DISABLED VETERAN-OWNED SMALL BUSINESSES (JAN 2023) (DEVIATION)

C.10 VAAR 852.219-75 VA NOTICE OF LIMITATIONS ON SUBCONTRACTING—

CERTIFICATE OF COMPLIANCE FOR SERVICES AND CONSTRUCTION (JAN 2023)

(DEVIATION)

C.11 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV

2018)

C.12 VAAR 852.237-70 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE

(OCT 2019)

C.13 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020)

C.14 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (SEP 2023)

C.15 MANDATORY WRITTEN DISCLOSURES

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 WAGE DETERMINATION (WDOL) (ATTACHED SEPARATELY)

D.2 QUALITY ASSURANCE SURVEILLANCE PLAN (ATTACHED SEPARATELY)

D.3 CONTRACTOR CERTIFICATION: IMMIGRATION AND NATIONALITY ACT OF

1952, AS AMENDED (ATTACHED SEPARATELY)

D.4 CONTRACT RULES OF BEHAVIOUR (ATTACHED SEPARATELY)

D.5 PAST PERFORMANCE QUESTIONNAIR

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (SEP 2023)

PROPOSAL PREPARATION INSTRUCTIONS

E.2 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (NOV 2021)

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

E.4 52.216-1 TYPE OF CONTRACT (APR 1984)

E.5 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.6 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (OCT 2018)

E.7 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

E.8 52.212-2 EVALUATION—COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES (NOV 2021)

E.9 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—

COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (SEP 2023)

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:

BUSINESS NAME

ADDRESS

CITY/STATE/ZIP CODE

Unique Entity ID (UEI)

CONTACT POC

PHONE NUMBER

EMAIL ADDRESS

b. GOVERNMENT: Crystal S. Hinton, Contracting Officer (36C245)

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

Baltimore MD 21201

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]

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

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

AMENDMENT NO DATE

6. CONTRACT MODIFICATIONS: The Contractor is advised that only the Contracting Officer, acting within the scope of the contract and his/her duties and responsibilities and after advice and consultation with the Contracting Officer’s Representative (COR), has the authority to make changes that will affect contract prices, quantity, quality, delivery terms and conditions, or the term of the contract. In no event shall any understanding or agreement, modification, change order, or other matters in deviation from the terms of this contract between Contractor and a person other than the Contracting Officer be effective or binding upon the Government. All such actions must be formalized by the proper contractual document executed by the Contracting Officer.

7. CONTRACT PERFORMANCE: Contractor shall be required to begin providing Home Oxygen Services under Indefinite Delivery Indefinite Quantity (IDIQ) any contract awarded beginning on the first date of the base period listed in the Schedule of Services. Failure to understand the contract requirements shall not relieve the Contractor from performing in accordance with-in the strict meaning and intent of the specifications. The Government will not reimburse any costs not incorporated into the Contractor’s price.

8. STATUS AS INDEPENDENT ENTITIES: None of the provisions of this contract are intended to create or shall be deemed or construed to create any relationship between VA and the Contractor other than that of independent entities contracting with each other solely for the purpose of effecting the provisions of this contract. Neither VA nor the Contractor, nor any of their respective agents, employees or representatives, shall be construed to be the agent employee or representative of the other.

9. NON-SOLICITATION: Neither the Contractor nor any employee, agent or subcontractor of the Contractor shall solicit or attempt to convince or otherwise persuade any veteran not to participate or to discontinue participation in the services provided under this contract.

10. PRIVACY AND CONFIDENTIALITY: Contractors to the Department of Veterans Affairs may be exposed to sensitive information. Information may be overheard, seen on documents or electronic devices, or observed that could potentially violate the privacy and confidentiality of our Veterans, employees, volunteers and their families. Regulations such as, but not limited to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Freedom of Information (FOIA) and Privacy Act of 1974 have been enacted to protect sensitive information from being improperly disclosed. Information should not be divulged or released to anyone unless specifically authorized by this contract or its attached documents accordance with the contracted services. Failure to comply with applicable statutes and regulation can result in the termination of this contract and civil and criminal penalties, including fines and imprisonment. All suspected or actual breeches of privacy and confidentiality should be reported immediately to the Contracting Officer, Contracting Officer Representative (COR) or the Facility Privacy Officer.

B.2 PRICE/COST SCHEDULE

ORDERING & INVOICES: Per VHA Directive 1173.13(1) Home Oxygen Program 5.o., the prescribing provider is responsible for completing the annual prescription for home oxygen after the need is determined. Only credentialed staff are authorized via VA access controls to access and complete the prescriptions via the prosthetic consult module. The prosthetic consult is the order. Prosthetics and Sensory Aids Service (PSAS) and the Contracting Officer’s Representative (COR) or designee shall provide the Contractor with notification via facsimile, email or VA approved portal in addition to a phone call to initiate individual patient service requirements. The consult includes the patient’s oxygen prescription, oxygen prescription expiration date, equipment, supplies and services to be provided including the date and place of delivery. The Contractor shall confirm receipt within two (2) working hours of notification. The Contractor shall confirm by facsimile, secure email or documentation in VA approved portal to COR or designee for Home Oxygen and Respiratory Service initiations, plan of care changes and discharges. The COR or designee shall provide notification of VA initiated discontinuance of service via facsimile or email or through VA approved portal. All changes to patient care shall be confirmed through one of the above mechanisms in writing. The documents shall include the authorizing VA official’s signature. The prescription is terminated the day the patient expires. For additional ordering instructions refer to 52.216-18.

Invoices shall be submitted monthly upon completion of complete delivery/pickup/setup.

Invoices shall be submitted using the CLIN structure, i.e. CLIN #, Descriptions, Quantity, Unit Price, Units and Total Price. Invoices not following the CLIN structure will be rejected. Send invoices with proper documentation to the appropriate VA Medical Center listed below:

Louis A. Johnson VAMC 1 Medical Center Drive Clarksburg, WV 26301

304-623-3461 ext. 7695

This procurement is under the authority of Title 38 USC 8153 and FAR Part 15.

In accordance with 52.216-22, Indefinite Quantity, the guaranteed minimum that the Government agrees to order during the period of this contract is $155,000.00. The total contract maximum to be ordered is $11,500,000.00. *Contract pricing is all-inclusive per section 2.3 of the Performance Work Statement (PWS). The contractor shall provide all management, tools, supplies, equipment, and labor necessary for the delivery of Home Oxygen Services within the VA Health Network of Louis A. Johnson VAMC. Period of Performance shall be for 5 years ordering periods starting 04/01/2024-3/31/2029, but this is an estimate only, subject to change.

This is an Indefinite-Delivery Indefinite-Quantity Contract (IDIQ). Accordingly, funds are not obligated on this contract at award; rather, funds are obligated via task orders issued against this contract.

The contractor shall provide all management, tools, supplies, equipment, and labor necessary for the delivery of Home Oxygen within the Louis A. Johnson VA Medical Center

Quantities listed are estimated only and are not guarantees.

Period of Performance: 4/01/2024-3/31/2029 with one six (6) month option period that we may or may not exercise.

Minimum Value: $155K

Estimated Maximum Value: $11,500,000.00

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES

QUANTITY UNIT UNIT PRICE AMOUNT

0001 Contract Months 1-12 5LPMRental Concentrator with back-up system consisting of compressed gas source, regulator, stand (nasal cannula or mask and humidifier when specified). Concentrator will have flow rate capacity up to 5LPM Code E1390.

EA

0002 10 LPM Rental concentrator with backup system consisting of compressed gas source, regulator, stand, (nasal cannula or mask and humidifier when specified). Concentrator must have flow rate capacity up to 10 LPM

20 EA $__________ $________________

0003 Contract Months 1-12 Monthly rental of M/H cylinder setup Code VA 120.

2 EA $___________ $________________

0004 Contract Months 1-12 M/H cylinder resupply.

(Primary/Backup Code E0443)

26 EA $___________ $________________

0005 Contract Months 1-12 Monthly rental of portable cylinder. Code E0431

72 EA $___________ $________________

0006 Contract Months 1-12 Set-up portable concentrator. Code

45 EA No Charge

0007 Contract Months 1-12 500 EA $___________ _$______________

Monthly rental of portable concentrator.

Code E1392

0008 Contract Months 1-12 E cylinder resupply.

Code E0443

733 EA $___________ $________________

0009 Contract Months 1-12 B cylinder resupply.

1196 EA $___________ $________________

0010 Contract Months 1-12 50 psi Air Compressor and supplies. Code E0565

4 EA $___________ $________________

0011 Contract Months 1-12 RT quarterly assessment of O2 patients. Code VA120

200 EA $___________ $________________

0012 Contract Months 1-12 Stationary liquid oxygen system. Code E0439

1 EA $___________ $________________

0013 Contract Months 1-12 Portable liquid oxygen system. Code E0444

3 EA $___________ $________________

0014 Contract Months 1-12 Liquid oxygen resupply.

Code E0444

357 LB $___________ $________________

0015 Contract Months 1-12 Consumables:

Conserver/ Demand Pulsing nasal cannula

96 EA $___________ $________________

0016 Consumables:

Conserver/Oxygen conserving device cannula

5 EA $___________ $________________

0017 Consumables: Oxygen Firesafe Valves/Oxysafe Valve. Code E1399

50 EA $___________ $________________

0018 Contract Months 1-12 Ventilator delivery & set-

up. Code VA 120

0019 Contract Months 1-12 RT monthly assessment of Ventilator patients.

Code VA 120

0020 Contract Months 1-12 Monthly Ventilator Rental

0021 Contract Months 1-12

Delivery for re-supply and/or relocation of equipment due to change in beneficiary’s residence.

5 EA $____________ No Charge

0022 Contract Months 1-12 Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent.

VA111

75 EA $__________ $_______________

0023 Contracts Months 1-12 Covid Set-up

1 EA $___________ $_________________

Total

Subtotals of items 1-23 $_________

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES

QUANTITY UNIT UNIT PRICE AMOUNT

1001 Contract Months 13-24 5LPMRental Concentrator with back-up system consisting of compressed gas source, regulator, stand (nasal cannula or mask and humidifier when specified). Concentrator will have flow rate capacity up to 5LPM

1002 10 LPM Rental concentrator with backup system consisting of compressed gas source, regulator, stand, (nasal cannula or mask and humidifier when specified). Concentrator must have flow rate

1003 Contract Months 13-24 Monthly rental of M/H

1004 Contract Months 13-24 M/H cylinder resupply.

(Primary/Backup Code E0443)

26 EA $___________ $________________

1005 Contract Months 13-24 Monthly rental of

1006 Contract Months 13-24 Set-up portable 13-24 concentrator. Code

45 EA No Charge

1007 Contract Months 13-24 Monthly rental of

500 EA $___________ _$______________

1008 Contract Months 13-24

1009 Contract Months 13-24

1010 Contract Months 13-24 50 psi Air Compressor

1011 Contract Months 13-24 RT quarterly

1012 Contract Months 13-24

1013 Contract Months 13-24

1014 Contract Months 13-24

1015 Contract Months 13-24 Consumables:

1016 Consumables: 13-24 Conserver/Oxygen conserving device cannula

5 EA $___________ $________________

1017 Contract Months 13-24 50 EA $___________ $________________

Consumables: Oxygen Firesafe Valves/Oxysafe Valve. Code E1399

1018 Contract Months 13-24

1019 Contract Months 13-24 RT monthly assessment

1020 Contract Months 13-24 Monthly Ventilator

1021 Contract Months 13-24 Delivery for re-supply and/or relocation of equipment due to

1022 Contract Months 13-24 Demand Nasal Cannula (e.g. Oximyzer) Reservoir or

1023 Contract Months 13-24

Subtotals of items 1001-1023 $___________

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES

QUANTITY UNIT UNIT PRICE AMOUNT

2001 Contract Months 25-36 5LPMRental Concentrator with back-up system consisting of compressed gas source, regulator, stand (nasal cannula or mask and humidifier when specified). Concentrator will have flow rate capacity up to 5LPM

2002 Contract Months 25-36 10 LPM Rental concentrator with backup system consisting of compressed gas source, regulator, stand, (nasal cannula or mask and humidifier when specified). Concentrator must have flow rate

2003 Contract Months 25-36 Monthly rental of M/H

2004 Contract Months 25-36 M/H cylinder resupply.

(Primary/Backup Code E0443)

26 EA $___________ $________________

2005 Contract Months 25-36 Monthly rental of

2006 Contract Months 25-36 Set-up portable 13-24 concentrator. Code

45 EA No Charge

2007 Contract Months 25-36 Monthly rental of

2008 Contract Months 25-36

2009 Contract Months 25-36 1196 EA $___________ $________________

2010 Contract Months 25-36 50 psi Air Compressor

2011 Contract Months 25-36 RT quarterly

2012 Contract Months 25-36

2013 Contract Months 25-36

2014 Contract Months 25-36

2015 Contract Months 25-36 Consumables:

2016 Contract Months 25-36 Conserver/Oxygen conserving device cannula

5 EA $___________ $________________

2017 Contract Months 25-36 Consumables: Oxygen Firesafe Valves/Oxysafe Valve. Code E1399

50 EA $___________ $________________

2018 Contract Months 25-36

2019 Contract Months 25-36 RT monthly assessment

2020 Contract Months 25-36

2021 Contract Months 25-36 Delivery for re-supply and/or relocation of equipment due to

2022 Contract Months 25-36 Demand Nasal Cannula (e.g. Oximyzer) Reservoir or

2023 Contract Months 25-36

Subtotals of items 2001-2023 $___________

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES

QUANTITY UNIT UNIT PRICE AMOUNT

3001 Contract Months 37-48 5LPMRental Concentrator with back-up system consisting of compressed gas source, regulator, stand (nasal cannula or mask and humidifier when specified). Concentrator will have flow rate capacity up to 5LPM

3002 Contract Months 37-48 10 LPM Rental concentrator with backup system consisting of compressed gas source, regulator, stand, (nasal cannula or mask and humidifier when specified). Concentrator must have flow rate

3003 Contract Months 37-48 Monthly rental of M/H

3004 Contract Months 37-48 M/H cylinder resupply.

(Primary/Backup Code E0443)

26 EA $___________ $________________

3005 Contract Months 37-48 Monthly rental of portable cylinder. Code

3006 Contract Months 37-48 Set-up portable 13-24 concentrator. Code

45 EA No Charge

3007 Contract Months 37-48 Monthly rental of

3008 Contract Months 37-48

3009 Contract Months 37-48

3010 Contract Months 37-48 50 psi Air Compressor

3011 Contract Months 37-48 RT quarterly

3012 Contract Months 37-48

3013 Contract Months 37-48

3014 Contract Months 37-48

3015 Contract Months 37-48 Consumables:

3016 Contract Months 37-48 Conserver/Oxygen conserving device cannula

5 EA $___________ $________________

3017 Contract Months 37-48 Consumables: Oxygen Firesafe Valves/Oxysafe Valve. Code E1399

50 EA $___________ $________________

3018 Contract Months 37-48 1 EA $___________ $________________

3019 Contract Months 37-48 RT monthly assessment

3020 Contract Months 37-48

3021 Contract Months 37-48 Delivery for re-supply and/or relocation of equipment due to

3022 Contract Months 37-48 Demand Nasal Cannula (e.g. Oximyzer) Reservoir or

3023 Contract Months 37-48

Subtotals of items 3001-3023 $______________

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES

QUANTITY UNIT UNIT PRICE AMOUNT

4001 Contract Months 49-60 5LPMRental Concentrator with back-up system consisting of compressed gas source, regulator, stand (nasal cannula or mask and humidifier when specified). Concentrator will have flow rate capacity up to 5LPM

4002 Contract Months 49-60 10 LPM Rental concentrator with backup system consisting of compressed gas source, regulator, stand, (nasal cannula or mask and humidifier when specified). Concentrator must have flow rate

4003 Contract Months 49-60 Monthly rental of M/H

4004 Contract Months 49-60 M/H cylinder resupply.

(Primary/Backup Code E0443)

26 EA $___________ $________________

4005 Contract Months 49-60 Monthly rental of

4006 Contract Months 49-60 Set-up portable 13-24 concentrator. Code

45 EA No Charge

4007 Contract Months 49-60 Monthly rental of

4008 Contract Months 49-60

4009 Contract Months 49-60

4010 Contract Months 49-60 50 psi Air Compressor

4011 Contract Months 49-60 RT quarterly

4012 Contract Months 49-60

4013 Contract Months 49-60

4014 Contract Months 49-60 Liquid oxygen resupply.

4015 Contract Months 49-60

Consumables:

4016 Contract Months 49-60 Conserver/Oxygen conserving device cannula

5 EA $___________ $________________

4017 Contract Months 49-60 Consumables: Oxygen Firesafe Valves/Oxysafe Valve. Code E1399

50 EA $___________ $________________

4018 Contract Months 49-60

4019 Contract Months 49-60 RT monthly assessment

4020 Contract Months 49-60

4021 Contract Months 49-60 Delivery for re-supply and/or relocation of equipment due to

4022 Contract Months 49-60 Demand Nasal Cannula (e.g. Oximyzer) Reservoir or

4023 Contract Months 49-60

Grand Total $__________________

Six Month Option Period, we may or may not exercise. 04/01/2029-09/30/2029

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES

QUANTITY UNIT UNIT PRICE AMOUNT

5001 Contract Months 60-66 5LPMRental Concentrator with back-up system consisting of compressed gas source, regulator, stand (nasal cannula or mask and humidifier when specified). Concentrator will have flow rate capacity up to 5LPM

5002 Contract Months 60-66 10 LPM Rental concentrator with backup system consisting of compressed gas source, regulator, stand, (nasal cannula or mask and humidifier when specified). Concentrator must have flow rate

5003 Contract Months 60-66 Monthly rental of M/H

5004 Contract Months 60-66 M/H cylinder resupply.

(Primary/Backup Code E0443)

26 EA $___________ $________________

5005 Contract Months 60-66 Monthly rental of

5006 Contract Months 60-66 Set-up portable concentrator. Code

45 EA No Charge

5007 Contract Months 60-66 Monthly rental of

5008 Contract Months 60-66 E cylinder resupply.

5009 Contract Months 60-66

5010 Contract Months 60-66 50 psi Air Compressor

5011 Contract Months 60-66 RT quarterly

5012 Contract Months 60-66

5013 Contract Months 60-66

5014 Contract Months 60-66

5015 Contract Months 60-66 Consumables:

5016 Contract Months 60-66 Consumables:

Conserver/Oxygen conserving device cannula

5 EA $___________ $________________

5017 Contract Months 60-66 Consumables: Oxygen Firesafe Valves/Oxysafe Valve. Code E1399

50 EA $___________ $________________

5018 Contract Months 60-66

5019 Contract Months 60-66 RT monthly assessment

5020 Contract Months 60-66

5021 Contract Months 60-66 Delivery for re-supply and/or relocation of equipment due to

5022 Contract Months 60-66 Demand Nasal Cannula (e.g. Oximyzer) Reservoir or

5023 Contract Months 60-66

B.3 DESCRIPTION/SPECIFICATION/PERFORMANCE WORK STATEMENT

1. SCOPE: This Performance Wort Statement (PWS) defines the effort required for the setup, installation, and management of Home Oxygen and Ventilation, in accordance with Joint Commission (JC) standards for Homecare, to Veteran beneficiaries serviced by Louis A.

Johnson VA Medical Center. This PWS includes the associated program management, human engineering, and logistic support planning requirements. The use of the terms, “beneficiary”, “Veterans”, “Patients”, and “Patient” are used interchangeably and refer to the recipient of required supplies, equipment, and services required under the contract.

1.1 BACKGROUND: The acquisition of Home Oxygen is being initiated to provide Home Oxygen to Veteran beneficiaries serviced by Louis A. Johnson VA Medical Center. The Louis A.

Johnson VA Medical Center does not have the capacity to provide these supplies, so a contract has been sought for the provision of home oxygen and all associated products and services.

1.2 VETERANS SERVED: The Department of Veterans Affairs Medical Centers (VAMC) at:

Louis A. Johnson VAMC currently serves an estimated 569 oxygen-using patients. The volumes or amounts shown in the solicitation are estimates only and impose no obligation on the VA. The contract shall be for the needs of the VA as determined and ordered by the VA during the life of the contract. The Contracting Officer’s Representative (COR) or designee shall provide (via encrypted email, fax, or VA approved portal) the contractor with notification to initiate individual Patient delivery requirements, including the Patient's oxygen prescription, equipment, supplies and incidental services to be provided including date and place of delivery.

The Contractor shall confirm receipt (via encrypted email, fax or through VA approved portal) of the request within one (2) working hour of notification; Per Facilities discretion the COR or designee shall also provide (via encrypted email, or fax or through VA approved portal) notification if VA owned equipment is to be provided; the COR or designee shall also provide notification (via encrypted email, or fax, or VA approved portal) to the contractor of VA initiated discontinuation of service. The discontinuation notifications shall be made (via encrypted email, or fax or VA approved portal) within 24 hours. The written documents shall include the authorizing official's signature, electronic or written.

1.3 LOCATIONS: The Contractor shall provide Home Oxygen within a defined area of responsibility/jurisdiction to the patients’ residence, or other location as indicated on the order for Home Oxygen. Area of responsibility/jurisdiction for each VA facility includes the counties identified (See section A to define) below within this section for specific counties covered by each facility) as applicable to the area of responsibility/jurisdiction.

NOTE: (1) The Government reserves the right to purchase the services from the Contractor awarded a contract whose area of responsibility/jurisdiction includes the location of the patient’s place of residence. (2) Contractors must provide home oxygen to Veterans that are traveling in the contractor’s area of responsibility/jurisdiction as outlined in section 3.8.

A. LOUIS A. JOHNSON_VETERANS AFFAIRS MEDICAL CENTER (VAMC) LOCATED

IN CLARKSBURG, WEST VIRGINIA_AND CBOC’S IN BRAXTON, MONONGALIA,

TUCKER AND WOOD COUNTY: Contractor shall provide delivery, setup, installation, and management of Home Oxygen services to any Patients that are treated at the Louis A. Johnson VA Medical Center and all Community Based Outpatient Centers (CBOC’s) supported therein (Clinic of Jurisdiction/Primary Service Area COJ/PSA), regardless of their physical location. The listing of these counties does not exclude other counties.

This includes Patients who reside near bordering states catchment areas but prefer to be seen in Louis A. Johnson VAMC. Portable cylinders, regulators, regulator keys and 02 carriers shall be delivered to the Louis A. Johnson VAMC within one (1) business day of request to accommodate Home Oxygen beneficiaries who are visiting the VA or being discharged and require a tank of oxygen to go home. This shall be provided at no additional charge.

COUNTIES IN:

West Virginia: Barbour, Braxton, Calhoun, Clay, Doddridge, Gilmer, Harrison, Jackson, Lewis, Marion, Marshall, Monongalia, Nicholas, Pocahontas, Pleasants, Preston, Randolph, Ritchie, Roane, Taylor, Tucker, Tyler, Upshur, Webster, Wetzel, Wirt, Wood.

Ohio: Athens, Monroe, Noble, Belmont, Morgan, Washington.

Pennsylvania: Greene, Fayette, Westmoreland

Maryland: Garrett.

Patients in other counties of West Virginia and in the general vicinity of southwestern PA, eastern OH and western MD may be added to the program from time to time and Contractor will support these patients in accordance with the terms and conditions of this contract.

1.4 PORTABLE EQUIPMENT AT VA MEDICAL CENTERS: 500 portable cylinders, regulators, regulator keys, nasal cannulas, fire safety valves (two (2) per tank), and 02 carriers shall be continuously maintained by the Contractor at the VA Medical Centers located in Clarksburg, WV. These cylinders shall be used only to accommodate Home Oxygen beneficiaries who are visiting VA or being discharged and require a tank of oxygen to go home. This service shall be provided at no additional cost to the Government. VA shall furnish storage space and maintain all security for this equipment. Contractor shall be permitted access to the space and equipment when requested, by telephone, with 24 hours’ notice to the VA Medical Center’s Respiratory Therapy Department. Contractor shall maintain an updated inventory of all equipment on a quarterly basis.

2. ORDERS, NOTIFICATION AND DELIVERY:

2.0 ORDERS: The Contracting Officer Representative (COR) or VA designee shall provide the Contractor with the orders/prosthetic consult, via facsimile, secured email or through VA approved portal in addition to phone contact to initiate individual patient service requirements.

This shall include patient’s oxygen prescription, oxygen prescription expiration date, equipment, supplies, and services to be provided including the date and place of delivery. The Contractor shall confirm receipt of the request within two (2) working hours of notification. Contractor shall confirm by facsimile, secure email or documentation in VA approved portal to VA designee/designated staff for all Home Oxygen initiations, plan of care changes, and discharges. The VA designee shall also provide notification of VA initiated discontinuance of service via facsimile, secured email, or entry in VA approved portal. All changes to patient care shall be confirmed in one of the above mechanisms. The prescription is terminated the day the patient expires.

2.1 NOTIFICATION TO VA REGARDING STATUS OF DELIVERY OF HOME OXYGEN

SERVICES:

a. The contractor shall notify the appropriate VA designee and/or COR monthly of initial delivery of home oxygen equipment by sending copies of individual delivery tickets via FEDEX/UPS/USPS or similar. The delivery ticket shall be signed and dated by the patient or their designated representative. This notification shall be made when patient requires changes in medical equipment or equipment switch-outs.

b. The Contractor shall notify the appropriate VA designee and/or COR by secure email or facsimile within one (1) working day if expected delivery of medical equipment is not completed. This notification shall include reason/explanation as to why the delivery was not able to be completed; and a plan of action to resolve delivery failure.

c. The Contractor shall notify the appropriate VA designee and/or COR by secure email or facsimile or documentation in VA approved portal within one (1) working day if the patient refuses delivery of medical equipment and/or signs the Contractor’s AMA form. Copy of the AMA form signed by patient shall be included in this notification.

2.2 DELIVERY OF MEDICAL EQUIPMENT:

a. The Contractor shall deliver and set up in the patient’s residence all equipment and supplies ordered. This contract is a full-service contract. Set-up shall include establishment of operational parameters of equipment to VA prescription, ensures purity of O2, Veteran training on system operations, review of safety checks and discussion of home safety issues. Services are required to be provided 24 hours a day, seven (7) days a week, including holidays, including all emergency service calls. Contract prices are all-inclusive.

The Contractor shall not be reimbursed for costs incurred in excess of the contract prices in the Schedule of Supplies/Services for services provided in accordance with the Schedule of Supplies/Services.

b. Patients shall be notified of expected delivery times by the Contractor. Veterans shall be provided with a four (4) hour delivery time window for expected time of delivery.

c. Deliveries of medical equipment and supplies shall be made in full. If the contractor is unable to fulfill the full prescribed medical equipment and supplies list, they may choose partial delivery. Contractor shall notify the VA Designee and/or COR via secured email or facsimile or entry in VA approved portal within one (1) calendar day in the event of a partial delivery. In such cases where a partial delivery is made, the remainder of the delivery will be made within one (1) calendar day. Payment shall only be issued for full deliveries.

Contractor shall maintain sufficient stock (or have available) to ensure all deliveries can be made within the contractual timeframes. The cost for additional deliveries to complete the order shall be at no additional cost to VA.

d. The Contractor shall deliver portable oxygen equipment to previously established and new patients being discharged to their home from non-VA Facilities and other facilities as requested by VA Staff per the needs of the Veteran. Equipment shall be delivered within four (4) hours of the request.

2.3 EXCESS DELIVERY: The Contractor shall not deliver supplies and/or equipment in excess of those prescribed, and the Contractor shall not be paid for any excess deliveries.

SERVICE SPECIFICATIONS:

3.0 PRESCRIPTION CHANGES: 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. A request to change tank size does not require a Physician’s signature, as long as liter flow rate is not altered.

3.1 HOME VISITS:

a. The Contractor shall visit patients’ residences for regularly scheduled maintenance visits in performance of this contract by appointment only; between the hours of 7:00 a.m. and 7:00 p.m. Exceptions shall be made in the cases of emergencies.

b. The Contractor is responsible for scheduling the appointments to the patient’s home 24-48 hours prior to the appointment.

c. On each scheduled set-up/delivery the Contractor shall reassess the need to instruct the patient on the use and care of the equipment and supplies as necessary. The Contractor shall perform and document a home safety assessment that will include assessing for fall risk, evidence of smoking around oxygen equipment, working smoke detectors, posted “No Smoking” signs in addition to all other JC requirements for home safety assessments.

d. Contractor shall re-instruct patient, family or caregivers as necessary without formal order from the VA.

3.2 INITIAL SET-UPS: Initial set-ups are services provided to those patients who have not been provided a VA authorized oxygen therapy delivery system to their place of residence on a previous occasion or have not used such a system continuously for the past 60 days. Once initial set-up has been completed, the Contractor shall develop a regular delivery schedule for home oxygen and supplies to patients. All Initial 50 PSI setups shall include all disposables, large bore tubing, large volume nebulizers, drain bags and masks.

a. Initial set-ups shall be completed within eight (8) hours of request. Failure to deliver within the required time shall result in the VA obtaining oxygen from another source. Any costs in excess of contract pricing for services provided shall be billed to contractor or credited to next invoice at the discretion of the ordering facility. The Contractor shall notify the appropriate VA designee and/or COR via secured email, facsimile, or documentation in within one (1) calendar day if expected delivery is not completed. This notification shall include reason why delivery was unable to be completed.

b. Switch-outs are services provided to those patients who are presently using an oxygen delivery system or have used such a system continuously within the past 60 days. The Contractor shall provide equipment switch-outs by staff with documented competency training on the manufacturer’s recommended assembly, use, and maintenance of the equipment used under this contract.

c. Switch outs are to be completed within two (2) calendar days. Failure to complete switch out within the required time shall result in the VA obtaining oxygen from another source. Any costs in excess of contract pricing for services provided shall be billed to contractor or credited to next invoice at the discretion of the ordering facility.

d. Failure to perform the switch-outs as prescribed by VA prescription shall result in no cost to the government. Payment shall be made once switch-outs are completed as prescribed.

Payments shall be assessed based on the provider’s established rate and pro-rated from set-up date. Medical equipment switch-out requested to increase the patient’s quality of life or due to changes in the patient’s oxygen requirement shall be made at no additional charge to the government.

e. Set-up of Home Oxygen includes setting up and ensuring the appropriate oxygen system is operational, instruction and training of patient, and/or caregiver and home environment safety check. Failure to deliver within the required time shall result in the VA obtaining oxygen from another source. Any costs in excess of contract pricing for services provided shall be billed to contractor or credited to next invoice at the discretion of the ordering facility.

f. The Contractor is responsible for establishing appointments with patients when initiating set-ups, switch-outs, and deliveries.

3.3 ASSESSMENT REQUIREMENTS:

a. The Contractor shall perform an assessment of the patient’s home and environment in accordance with Joint Commission (JC) accreditation standards for Homecare and maintain documentation of assessments in the individual patient file or folder.

b. The Contractor shall notify the VA designee and/or COR 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.

c. The Contractor shall notify the VA designee and/or COR by telephone or email within two

(2) hours if any unsafe conditions are observed in the patient’s home that preclude the installation or continuance of oxygen service. Unsafe conditions shall include fire safety hazards, oxygen safety hazards, patient abuse by family or caregivers, or any instance that places the patient or Contractor’s staff in immediate danger. The Contractor shall provide written documentation of the safety hazard to the VA designee and/or COR within one (1) business day of incident.

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

3.4 PATIENT EDUCATION REQUIREMENTS:

a. The Contractor shall provide education to each patient at the time of set-up, and every six

(6) months thereafter, and assess the need for reinforcement during visits. This information shall be presented verbally, in demonstration and material covered shall be in written form to be left with the patient/caregiver. The written material shall be in English as well as the foreign language of the patient, should the patient not speak English. In the case of such an occurrence the Contractor is to advise the VA facility to facilitate adequate instructions. All patient education material must be presented in written form to VA designee and/or COR for approval prior to distribution to patients. The Contractor shall implement any new or revised education material as directed by the VA designee and/or COR. The VA shall determine whether the Contractor shall use his/her forms or forms supplied by the VA for documentation of services provided to patients. Regardless of whether the VA provides a VA Patient Rights & Responsibilities document and/or forms to the Contractor, and/or the Contractor uses his/her VA Patient Rights & Responsibilities and/or forms, the Contractor is responsible for duplication of the documents/forms when copies are needed to give to patients.

b. Patients shall be provided a copy of VA Patient Rights & Responsibilities, and Advance Directives as appropriate. The Contractor shall document that the patient/caregiver has been instructed in accordance with JC Standards for Homecare.

3.5 DISCONTINUATION OF SERVICE:

a. The Government shall notify the Contractor in the event of an order to discontinue oxygen service to any patient covered under this contract as soon as identified. Notification shall be by via secured email or facsimile. At least two (2) weeks prior to the scheduled termination of prescription the Contractor shall notify the VA designee and/or COR via secured email or facsimile, if removal of home oxygen may be detrimental to the patient.

Payment shall be pro-rated based upon the notification date of discontinuance of service. In the event that the contractor is notified that a patient has moved out of the service area, or is deceased, the Contractor shall notify the VA designee and/or COR within one (1) business day of this discovery.

b. The Contractor shall remove equipment from the patient’s residence at the earliest possible time but no later than five (5) business days after notification of Discontinuation of Service (DC) unless approved by the VA Designee and/or COR. The date and time of equipment pickup shall be coordinated with the patient and/or next of kin and/or significant other. The Contractor shall make every effort to meet the patient’s or patient’s families’ requests for pickup times. The Contractor shall honor family’s requests pickup equipment before or after funerals or family gatherings relative to patient funerals. The Contractor shall treat such requests with the utmost courtesy and give such requests the highest priority. In the event the patient refuses to release the equipment the Contractor shall immediately notify the VA designee and/or COR. Billing of services ends at time of VA-issued notification to discontinue order and/or date of patient’s death.

3.6 EMERGENCY SERVICES:

a. The Contractor shall provide emergency services on a 24-hour basis, and the contractor shall provide services at the patient’s home no more than four (4) hours of receiving a call. If the Contractor is unable to respond to an emergency service call within four (4) hours, the Contractor shall be responsible for making arrangements with another supplier to provide oxygen, and the Contractor shall be responsible for any excess cost above the contract reimbursed price. A written explanation of why the Contractor was unable to respond to the emergency must be provided to the VA Designee and/or COR within one (1) business day.

b. An emergency exists if the VA Designee and/or COR informs the Contractor that he/she considers the situation an emergency, or if the patient states in a telephone call to the

Contractor that an emergency exists in regard to the function of the home oxygen equipment or use of the equipment. The Contractor shall provide written details of the patient emergency to the VA Designee and/or COR within one (1) business day of notification by the patient. This written report shall contain time of initial call and time contractor arrived at the patient’s house.

c. The Contractor shall maintain a telephone number for emergency purposes so that the

VA and patients who have been authorized to receive home oxygen may contact the Contractor outside of normal business hours. The Contractor shall provide the telephone number to the patients.

d. The Contractor shall notify the VA designee and/or COR immediately in the event of a disaster, natural or otherwise, that may affect the services covered under this contract.

e. The Contractor shall be prepared to provide services on an emergency basis. Contractor shall provide initial setups and emergency service seven (7) days a week, twenty-four

(24) hours a day, this includes holidays. Patient discharges requiring initial setups after 7:00 pm shall be completed that same day.

3.7 SIGNAGE: The Contractor shall provide the patient signs for all entrances into the patient’s residence, 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/Caregiver is instructed in the safe use of oxygen and equipment per OSHA regulations. The Contractor shall attach patient education and expectations placard to all concentrators and liquid oxygen stationary systems. In the event the Veteran refuses the signage, the contractor shall notify the VA Designee and/or COR immediately after the visit, for documentation purposes by the VA.

3.8 TRAVELING PATIENTS:

a. The Contractor shall be responsible for coordinating all home oxygen for patients who travel both within and outside their respective contracted area of responsibility/jurisdiction, unless otherwise indicated. The VA designee and/or COR shall be responsible for notifying the Contractor where/when the patient is traveling to and the mode of transportation. The Contractor is responsible for coordinating with the patient when travel has been completed.

b. Traveling patients shall be provided with a Federal Aviation Administration (FAA) approved portable concentrator for travel purposes at the request of the VA designee and/or COR.

These units shall not be standard for long term use.

c. Invoices for travel patients shall be provided to the VA with the next monthly invoice.

d. Patients traveling within the Contractor’s area of responsibility/jurisdiction shall be provided all home oxygen under the contract at the contract rate. Patients traveling within contracted areas of responsibility/jurisdiction covered under other VA contracts for home oxygen, but not within the Contractor’s area of responsibility/jurisdiction, shall be provided all required oxygen services at whatever contract rate that applies to the area the patient is traveling.

The Contractor currently providing home oxygen shall work with the VA designee and/or COR, the Home Oxygen Coordinator, and the Prosthetic Representative to notify and arrange for home oxygen with the contractor whose area the patient is traveling.

e. For patients traveling outside the areas of responsibility/jurisdiction covered by other VA contracts for home oxygen, and/or temporarily relocating, the Contractor shall arrange for home oxygen from an area provider. The Contractor shall obtain pre-approval from the Contracting Officer or designee on pricing if it is above the contract price on the Contractor’s contract. If approved, the Contractor shall be reimbursed the contract rate plus the additional cost incurred for providing appropriate home oxygen. The Contractor shall provide the VA designee and/or COR evidence of any additional costs involved in providing the services outside the areas of responsibility / jurisdiction covered by other VA contracts for home oxygen.

f. Home oxygen for travel outside of the continental USA, overseas travel, and cruises are the responsibility of the patient.

g. Patients not travelling but are permanently relocating outside of established contracted area of coverage will be provided up to 90 days of…