36C24524Q0346 Beckley Home Oxygen 1.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

36C24524Q0346 11/05/2024

Crystal S. Hinton; crystal.hinton@va.gov 410-637-1530 11-22-2024

1400 EDT

Department of Veterans Affairs

VA Maryland Health Care System

Crystal S. Hinton, Contracting Officer

P.O. Box 1000, Bldg. 101, Room 26

Perry Point MD 21902

X 100

X

532283

$41 Million

N/A

Crystal S. Hinton, Contracting Officer

P.O. Box 1000, Bldg. 101, Room 26

Crystal S. Hinton, Contracting Officer

P.O. Box 1000, Bldg. 101C Room 3

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 Beckley VA Medical Center

Contractor Performance Period: 5 Years

Period of Performance 01/01/2025-12/31/2030

Performance Work Statement page 5

Price/Cost Schedule, page 7-22.

See CONTINUATION Page

Crystal S. Hinton

FAC Level II

36C24524Q0346

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 STATMENT

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 (NOV 2023)

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

C.3 52.204-9 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR

PERSONNEL (JAN 2011)

C.4 52.204-21 BASIC SAFEGUARDING OF COVERED CONTRACTOR

INFORMATION SYSTEMS (NOV 2021)

C.5 52.203-16 PREVENTING PERSONAL CONFLICTS OF INTEREST (JUN 2020) ...53

C.6 52.216-18 ORDERING (AUG 2020)

C.7 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.8 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.9 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.10 52.227-14 RIGHTS IN DATA – GENERAL (MAY 2014)

C.11 52.237-3 CONTINUITY OF SERVICES (JAN 1991)

C.12 852.201-70 CONTRACTING OFFICER’S REPRESENTATIVE (DEC 2022)

C.13 852.203-70 COMMERCIAL ADVERTISING (MAY 2018)

C.14 852.211-76 LIQUIDATED DAMAGES - REIMBURSEMENT FOR DATA BREACH

COSTS. (FEB 2023)

C.15 VAAR 852.219-73 VA NOTICE OF TOTAL SET-ASIDE FOR CERTIFIED

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

(DEVIATION)

C.16 VAAR 852.219-75 VA NOTICE OF LIMITATIONS ON SUBCONTRACTING—

CERTIFICATE OF COMPLIANCE FOR SERVICES AND CONSTRUCTION (JAN 2023)

(DEVIATION)

C.17 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV

2018)

C.18 VAAR 852.237-70 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE

(OCT 2019)

C.19 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020)

C.20 SUPPLEMENTAL INSURANCE REQUIREMENTS

C.21 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (MAY 2024)

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 SEPARELTY)

D.4 CONTRACTOR RULES OF BEHAVIOR (ATTACHED SEPARATELY)

D.5 PAST PERFORMANCE QUESTIONNAIRE (ATTACHED SEPARATELY)

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)

1 Boiler House Road

Building 101C, Room 4 Perry Point, MD 21902

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:

Beckley VA Medical Center 200 Veterans Ave, Beckley, WV 25801

304-255-2121x4252

This procurement is under the authority of Title 38 USC 8153 and FAR Part 13.

In accordance with 52.216-22, Indefinite Quantity, the guaranteed minimum that the Government agrees to order during the period of this contract is $55,000.00. The total contract maximum to be ordered is $7,000,000.00. *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 Beckley VA

Medical Center. Period of Performance shall be for 5 years ordering periods starting 01/01/2025-

12/31/2030, 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 Beckley VA Medical Center.

Quantities listed are estimated only and are not guarantees.

Period of Performance: 1/01/2025-12/31/2029 with one six (6) month option period that we may or may not exercise.

Minimum Value: $55K

Estimated Maximum Value: $7,000,000.00

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES

QUANTITY UNIT UNIT PRICE AMOUNT

0001 Contract Months 1-12 5LPM Rental 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.

900 EA

0002 Contract Months 1-12 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 Code E1390.

200 EA $__________ $________________

0003 Contract Months 1-2 Rental Ventilator Concentrator System -PLV or Equivalent

75 EA $___________ $________________

0004 Contract Months 1-2 Trilogy

100 EA $___________ $________________

0005 Contract Months 1-12 Patient Refusal

1000 EA $___________ $________________

0006 Contract Months 1-12 Emergency Set Up

250 EA $___________ No Charge

0007 Contract Months 1-12 Cylinder, Size M or H Setup (Primary)

300 EA $___________ _$______________

0008 Contract Months 1-12 Size M or H refills

700 EA $___________ $________________

0009 Contract Months 1-12 Cylinder, Size E Refills

40000 EA $___________ $________________

0010 Contract Months 1-12 Cylinder, Size D Refills

0011 Contract Months 1-12 Cylinder, Size M6 Refills

25000 EA $___________ $________________

0012 Contract Months 1-12 Compressor 50 PSI- Rental

25 EA $___________ $________________

0013 Contract Months 1-12 Humidified, Heated- Rental

50 EA $___________ $________________

0014 Contract Months 1-12 Demand Nasal Cannula (e.g. Oxymzer) Reservoir or Pendant/Equivalent

25 LB $___________ $________________

0015 Contract Months 1-12 Pulse Conserver Device (Purchase)

10 EA $___________ $________________

0016 Contract Months 1-12 Recovery of VA-Owned Equipment

25 EA $___________ $________________

0017 Contract Months 1-12 Relocation of Equipment Due to Change in Beneficiary

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

250 EA $___________ $________________

0020 Contract Months 1-12 Monthly Ventilator Rental

400 EA $___________ $________________

0021 Contract Months 1-12 Delivery for re-supply and/or relocation of equipment due to change in beneficiary’s residence.

300 EA $____________ No Charge

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

VA111

25 EA $__________ $_______________

Total

Subtotals of items 0001-0022 $___________

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES

QUANTITY UNIT UNIT PRICE AMOUNT

1001 Contract Months 13-24 5LPM Rental 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 Contract Months 13-24 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 Code E1390.

200 EA $__________ $________________

1003 Contract Months 13-24 Rental Ventilator Concentrator System -PLV or Equivalent

75 EA $___________ $________________

1004 Contract Months 13-24 Trilogy

100 EA $___________ $________________

1005 Contract Months 13-24 Patient Refusal

1000 EA $___________ $________________

1006 Contract Months 13-24 Emergency Set Up

250 EA $___________ No Charge

1007 Contract Months 13-24 Cylinder, Size M or H Setup (Primary)

1008 Contract Months 13-24

1009 Contract Months 13-24

1010 Contract Months 13-24

1011 Contract Months 13-24

1012 Contract Months 13-24 Compressor 50 PSI- Rental

1013 Contract Months 13-24

1014 Contract Months 13-24 Demand Nasal Cannula (e.g. Oxymzer) Reservoir or Pendant/Equivalent

1015 Contract Months 13-24

1016 Contract Months 13-24 Recovery of VA-Owned Equipment

25 EA $___________ $________________

1017 Contract Months 13-24 Relocation of Equipment Due to Change in Beneficiary

50 EA $___________ $________________

1018 Contract Months 13-24 Ventilator delivery & set-

up. Code VA 120

1019 Contract Months 13-24 RT monthly assessment of Ventilator patients. Code

VA 120

1020 Contract Months 13-24

1021 Contract Months 13-24 Delivery for re-supply and/or relocation of equipment due to change in beneficiary’s residence.

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

Subtotals of items 1001-1022 $___________

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES

QUANTITY UNIT UNIT PRICE AMOUNT

2001 Contract Months 25-36 5LPM Rental 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 capacity up to 10 LPM

2003 Contract Months 25-36 Rental Ventilator Concentrator System - PLV or Equivalent

2004 Contract Months 25-36 Trilogy

100 EA $___________ $________________

2005 Contract Months 25-36

2006 Contract Months 25-36 Emergency Set Up

250 EA $___________ No Charge

2007 Contract Months 25-36

2008 Contract Months 25-36

2009 Contract Months 25-36

2010 Contract Months 25-36

2011 Contract Months 25-36

2012 Contract Months 25-36

2013 Contract Months 25-36 Humidified, Heated-

2014 Contract Months 25-36 Demand Nasal Cannula

2015 Contract Months 25-36

2016 Contract Months 25-36 Recovery of VA-Owned Equipment

25 EA $___________ $________________

2017 Contract Months 25-36 Relocation of Equipment Due to Change in Beneficiary

50 EA $___________ $________________

2018 Contract Months 25-36

2019 Contract Months 25-36 RT monthly assessment of Ventilator patients.

2020 Contract Months 25-36

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

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

Subtotals of items 2001-2022 $___________

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES

QUANTITY UNIT UNIT PRICE AMOUNT

3001 Contract Months 37-48 5LPM Rental 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 Rental Ventilator

3004 Contract Months 37-48 Trilogy

100 EA $___________ $________________

3005 Contract Months 37-48

3006 Contract Months 37-48 Emergency Set Up

250 EA $___________ No Charge

3007 Contract Months 37-48

3008 Contract Months 37-48

3009 Contract Months 37-48

3010 Contract Months 37-48

3011 Contract Months 37-48

3012 Contract Months 37-48

3013 Contract Months 37-48

3014 Contract Months 37-48 Demand Nasal Cannula

3015 Contract Months 37-48

3016 Contract Months 37-48 Recovery of VA-Owned Equipment

25 EA $___________ $________________

3017 Contract Months 37-48 Relocation of Equipment Due to Change in Beneficiary

50 EA $___________ $________________

3018 Contract Months 37-48

3019 Contract Months 37-48 250 EA $___________ $________________

RT monthly assessment

3020 Contract Months 37-48

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

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

Subtotals of items 3001-3022 $___________

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES

QUANTITY UNIT UNIT PRICE AMOUNT

4001 Contract Months 49-60 5LPM Rental 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 75 EA $___________ $________________

Rental Ventilator

4004 Contract Months 49-60 Trilogy

100 EA $___________ $________________

4005 Contract Months 49-60

4006 Contract Months 49-60 Emergency Set Up

250 EA $___________ No Charge

4007 Contract Months 49-60

4008 Contract Months 49-60

4009 Contract Months 49-60

4010 Contract Months 49-60

4011 Contract Months 49-60

4012 Contract Months 49-60

4013 Contract Months 49-60

4014 Contract Months 49-60 Demand Nasal Cannula

4015 Contract Months 49-60

4016 Contract Months 49-60 Recovery of VA-Owned Equipment

25 EA $___________ $________________

4017 Contract Months 49-60 Relocation of Equipment Due to Change in Beneficiary

4018 Contract Months 49-60 25 EA $___________ $________________

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

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

Subtotals of items 4001-4022 $______________

Grand Total $__________________

Six Month Option Period, we may or may not exercise. 01/01/2030-06/30/2030

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES

QUANTITY UNIT UNIT PRICE AMOUNT

5001 Contract Months 60-66 5LPM Rental 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

450 EA

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 capacity up to 10 LPM Code E1390.

100 EA $__________ $________________

5003 Contract Months 60-66 Rental Ventilator Concentrator System -PLV or Equivalent

35 EA $___________ $________________

5004 Contract Months 60-66 Trilogy

50 EA $___________ $________________

5005 Contract Months 60-66

500 EA $___________ $________________

5006 Contract Months 60-66 Emergency Set Up

125 EA $___________ No Charge

5007 Contract Months 60-66 Cylinder, Size M or H Setup (Primary)

150 EA $___________ _$______________

5008 Contract Months 60-66

350 EA $___________ $________________

5009 Contract Months 60-66

20000 EA $___________ $________________

5010 Contract Months 60-66

20000 EA $___________ $________________

5011 Contract Months 60-66 12500 EA $___________ $________________

5012 Contract Months 60-66 Compressor 50 PSI- Rental

12.50 EA $___________ $________________

5013 Contract Months 60-66

5014 Contract Months 60-66 Demand Nasal Cannula (e.g. Oxymzer) Reservoir or Pendant/Equivalent

12.50 LB $___________ $________________

5015 Contract Months 60-66

5 EA $___________ $________________

5016 Contract Months 60-66 Recovery of VA-Owned Equipment

25 EA $___________ $________________

5017 Contract Months 60-66 Relocation of Equipment Due to Change in Beneficiary

25 EA $___________ $________________

5018 Contract Months 60-66 Ventilator delivery & set-up.

12.50 EA $___________ $________________

5019 Contract Months 60-66 RT monthly assessment of Ventilator patients. Code VA

125 EA $___________ $________________

5020 Contract Months 60-66

200 EA $___________ $________________

5021 Contract Months 60-66 Delivery for re-supply and/or relocation of equipment due to change in beneficiary’s residence.

150 EA $____________ No Charge

5022 Contract Months 60-66 Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111

12.50

EA $__________ $_______________

B.3 DESCRIPTION/SPECIFICATION/PERFORMANCE WORK STATMENT

SECTION 1: INTRODUCTION / BACKGROUND INFORMATION

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

Government. Beckley VAMC is looking to secure a Base plus four option year contract.

SECTION 2: SCOPE / PERFORMANCE REQUIREMENTS: SPECIFIC TASKS

All issuing and follow-up care provided under this contract shall be provided in accordance with all current The Joint Commission standards or equivalent. Contractor’s must be The Joint Commission

Accredited for Home Care or equivalent and must maintain the certification or equivalent for the duration of the contract. If the contractor is re-surveyed by The Joint Commission or equivalent during the contract term, the contractor shall notify the Home Oxygen Coordinator and Contracting

Officer of survey dates, the outcome of the survey, and provide copies of new certificates as issued.

Contractor’s facilities may be inspected by the respective Medical Center prior to the contract award.

Subcontractors must follow The Joint Commission standards or equivalent and shall be monitored by the contractor for compliance. Contracting Officer’s Representative (COR) or Alternate Contracting

Officer’s Representative (ACOR) shall be notified if a subcontractor is utilized. The contractor’s comprehensive procedure manual shall become part of this contract. The manual shall include, but not limited to, delivery/set-up, infection control, safety, rights and responsibilities, inventory, employee training (to include age specific), competency records, and performance improvement. The contractor shall be required to have a DO NOT RESUCITATE (DNR) policy in accordance with State

Regulations. A copy of the DNR policy shall also become part of this contract.

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

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

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

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

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

• Performance Monitor: To the standard, no deviation.

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

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

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

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

d. The Contractor shall notify the Home Oxygen Coordinator or COR/ACOR or prescribing physician during the home visit if the Contractor’s staff determines that the presence of oxygen in the home presents such a danger that the oxygen must be removed, or in the case of an initial set-up, not placed in the home.

e. The Contractor shall verbally notify the Home Oxygen Coordinator or COR or ACOR by the next business day of any unsafe conditions observed in the VA beneficiary’s home and precludes the installation or continuance of oxygen service. Unsafe conditions may include, but are not limited to, fire safety hazards, oxygen safety hazards, patient abuse by family or caregivers, or any instance that places the patient or Contractor’s staff in immediate danger.

The Contractor shall furnish written documentation of the safety hazard to the COR or ACOR within five (5) business days of the incident.

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

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

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

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

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

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

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

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

c. Documentation sent to facility Home Oxygen Coordinator with the next monthly invoice.

d. If the initial home oxygen visit is performed by a contractor technician, a Respiratory Care

Practitioner shall follow up within 72 hours to perform the required patient education and develop a Plan of Care. Documentation of patient education, Plan of Care, and all visits shall be in compliance with the current The Joint Commission Home Medical Equipment (HME) Standards or equivalent and shall be provided to the respective facility Home Oxygen Coordinator or COR or ACOR with the next monthly invoice. Failure to provide the required documentation by the 10th calendar day of each month may result in a 2% reduction applied to the entire monthly billing invoice. Action 1: Modification will be made to the Home Oxygen Vendor Contract to require the vendor make face-to-face in home follow up visits (instead of a phone call) within 30 days of initial oxygen set up to evaluate understanding of equipment use, evaluate safe oxygen use and reinforce safe oxygen practices to patients who have been identified as High Risk. This visit will be documented and communicated to the Home Oxygen Coordinator to ensure coordination of care. For initial set ups* High Risk setups include Veterans that are active smokers or Veterans that have reported incidents of noncompliance with fire safety in the home.

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

• Review of safety and beneficiary education issued, and interventions taken and/or recommendations for equipment maintenance and safety.

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

• Assessment of infection control procedures and the general home environment

• Evidence of smoking in the home

• Cleanliness of equipment/filters and home

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

• Colored tubing that will contrast with home environment.

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

f. Documentation will be provided to the COR with:

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

• Date of visit

• Recommendations and/or problems relating to the beneficiaries’ use of the oxygen equipment.

• Proper name, social security number and phone number

• Review of prescription, verify percent of oxygen concentration.

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

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

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

Task 2.4 Performance Requirement: Equipment Monitoring/Maintenance Visit Requirements and Time Frames

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

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

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

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

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

f. In the event that a monthly visit will not occur, the Home Oxygen Coordinator or COR or ACOR will be notified, and details provided regarding attempts to make contact with the veteran for service.

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

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

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

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

Task 2.6 Performance Requirement: Emergency Protocol

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

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

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

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

e. The cost of backup systems, backup oxygen, and backup equipment shall be borne by the

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

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

Task 2.7 Performance Requirement: Discontinuation of Oxygen Services

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

Final services shall be billed with the next scheduled invoice.

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

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

Task 2.8 Performance Requirement: Service Transition

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

Additionally, if the contractor fails to accomplish the phase-in, the contractor shall be responsible for any duplicate costs the VA may have to pay the incumbent contractor beyond 60 days.

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

c. The successor Contractor shall provide the facility Home Oxygen Coordinator or COR, by

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

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

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

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

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

Task 2.9 Performance Requirement: Equipment Maintenance/Repair

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

b. All current documentation will be forwarded to the appropriate Home Oxygen Coordinator or

COR or ACOR on a monthly basis. Only qualified technicians with documented training will provide these services to this equipment. The contractor shall perform a formal preventive maintenance inspection (PMI) immediately before stored equipment is issued.

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

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

Task 2.10 Performance Requirement: Reserve Supply

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

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

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

Task 2.11 Performance Requirement: VA Beneficiary Records

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

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

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

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

• Plan of Care as developed by Contractor.

• Documentation of the initial and monthly visits, assessments, and services provided.

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

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

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

• Infection control- Contractor will comply with standard precautions in the handling, storing,…