36C24525Q0271 0002.pdf

5. PROJECT NUMBER (if applicable)

CODE 7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER 3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO. 1. CONTRACT ID CODE

FACILITY CODE CODE

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office. is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER 16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30 PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243

(Type or print) (Type or print)

(Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code)

(If other than Item 6)

(Specify type of modification and authority)

(such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer)

1 108

0002 None

Department of Veterans Affairs VA Maryland Health Care System Contracting Officer (90C) P.O. Box 1000, Bldg. 101 C, Room 3 Perry Point MD 21902

Department of Veterans Affairs VA Maryland Health Care System Contracting Officer (90C) P.O. Box 1000, Bldg. 101C Room 3 Perry Point MD 21902

To all Offerors/Bidders 36C24525Q0271

X

X X

** HOUR & DATE for Receipt of Offers is EXTENDED to: 04-04-2025 10:00am EDT

See CONTINUATION Page

X

1. The purpose of this amendment is to update pages 6,7, CLIN Schedule 7-14, pages 15,20,22,87 and 94.

2. Update the due date of the solicitation from April 1, 2025, to April 4, 2025.

See updated solicitation along with question 12 response.

Crystal S. Hinton Contracting Officer

04/02/2025

36C24525Q0271

Page 32 states: “NOTE: Failure to obtain a signature from the patient for deliveries shall result in suspension of payment for these invoices

Question: This statement appears to show we are to bill the VA for deliveries, however there is no contract line item referring to deliveries. Please add a contract line item for deliveries in accordance with the PWS.

No line item will be added-we do not pay or delivery fees.

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.

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 $25,000.00. 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 07/01/2025 - 06/31/2030, 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. Task orders shall only be issued by a warranted VA CO. VA CO will issue task orders to the Contractor authorizing services via Standard Form 1449. Each task order shall clearly identify the dollar amount authorized under the individual task order and the period of performance of the individual task order. When a task order period of performance is completed, additional services shall not be provided unless a new task order is issued in accordance with the contract.

The minimum dollar amount guaranteed under this contract for the performance period of five

(5) years is $25,000.00. The maximum dollar amount or contract ceiling for this contract is $7,000,000.00. The maximum amount is not guaranteed. The combined total of all orders placed against this contract cannot exceed the maximum amount/ceiling of this contract. The minimum guarantee will be awarded by task order concurrently with the award of the IDIQ.

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: 7/01/2025-6/30/2030 with one six (6) month option period that we may or may not exercise.

Minimum Value: $25K

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

5,565 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.

158 EA $__________ $________________

0003 Contract Months 1-12 Rental Ventilator Concentrator System -PLV or Equivalent

5 EA $___________ $________________

0004 Contract Months 1-12 Trilogy

176 EA $___________ $________________

0005 Contract Months 1-12 Patient Refusal

10 EA $___________ $________________

0006 Contract Months 1-12 Emergency Set Up

47 EA $___________ $________________

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

5 EA $___________ $______________

0008 Contract Months 1-12 Size M or H refills

177 EA $___________ $________________

0009 Contract Months 1-12 Cylinder, Size E Refills

4599 EA $___________ $________________

0010 Contract Months 1-12 Cylinder, Size D Refills

5294 EA $___________ $________________

0011 Contract Months 1-12 Cylinder, Size M6 Refills

3171 EA $___________ $________________

0012 Contract Months 1-12 Compressor 50 PSI- Rental

62 EA $___________ $________________

0013 Contract Months 1-12 Humidified, Heated- Rental

60 EA $___________ $________________

0014 Contract Months 1-12 Demand Nasal Cannula (e.g.

Oxymzer) Reservoir or Pendant/Equivalent

0 EA $___________ $________________

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

0 EA $___________ $________________

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

0 EA $___________ $________________

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

11 EA $___________ $________________

0018 Contract Months 1-12 Ventilator delivery & set-up. Code VA

4 EA $___________ $________________

0019 Contract Months 1-12 RT monthly assessment of Ventilator patients. Code VA 120

221 EA $___________ $________________

0020 Contract Months 1-12 Portable Oxygen Concentrator Rental

267 EA $___________ $________________

0021 Contract Months 1-12 Single Thermal Fuses

629 EA $___________ $________________

0022 Contract Months 1-12 RT Follow-ups

168 EA $___________ $________________

Total

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

1002 Contract Months 13-24 158 EA $__________ $________________

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.

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

5 EA $___________ $________________

1004 Contract Months 13-24 Trilogy

176 EA $___________ $________________

1005 Contract Months 13-24 Patient Refusal

10 EA $___________ $________________

1006 Contract Months 13-24 Emergency Set Up

47 EA $___________ $________________

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

5 EA $___________ $______________

1008 Contract Months 13-24 Size M or H refills

177 EA $___________ $________________

1009 Contract Months 13-24 Cylinder, Size E Refills

4599 EA $___________ $________________

1010 Contract Months 13-24 Cylinder, Size D Refills

5294 EA $___________ $________________

1011 Contract Months 13-24 Cylinder, Size M6 Refills

3171 EA $___________ $________________

1012 Contract Months 13-24 Compressor 50 PSI- Rental

62 EA $___________ $________________

1013 Contract Months 13-24 Humidified, Heated- Rental

60 EA $___________ $________________

1014 Contract Months 13-24 Demand Nasal Cannula (e.g.

Oxymzer) Reservoir or Pendant/Equivalent

0 EA $___________ $________________

1015 Contract Months 13-24 Pulse Conserver Device (Purchase)

0 EA $___________ $________________

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

0 EA $___________ $________________

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

11 EA $___________ $________________

1018 Contract Months 13-24 Ventilator delivery & set-up. Code VA

4 EA $___________ $________________

1019 Contract Months 13-24 RT monthly assessment of Ventilator patients. Code VA 120

221 EA $___________ $________________

1020 Contract Months 13-24 Portable Oxygen Concentrator Rental

267 EA $___________ $________________

1021 Contract Months 13-24 Single Thermal Fuses

629 EA $___________ $________________

1022 Contract Months 13-24 RT Follow-ups

Total $___________ $________________

ITEM 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

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 Code E1390.

158 EA $__________ $________________

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

5 EA $___________ $________________

2004 Contract Months 25-36 Trilogy

176 EA $___________ $________________

2005 Contract Months 25-36 Patient Refusal

10 EA $___________ $________________

2006 Contract Months 25-36 Emergency Set Up

47 EA $___________ $________________

2007 Contract Months 25-36 Cylinder, Size M or H Setup (Primary)

5 EA $___________ $______________

2008 Contract Months 25-36 Size M or H refills

177 EA $___________ $________________

2009 Contract Months 25-36 Cylinder, Size E Refills

4599 EA $___________ $________________

2010 Contract Months 25-36 Cylinder, Size D Refills

5294 EA $___________ $________________

2011 Contract Months 25-36 Cylinder, Size M6 Refills

3171 EA $___________ $________________

2012 Contract Months 25-36 Compressor 50 PSI- Rental

62 EA $___________ $________________

2013 Contract Months 25-36 Humidified, Heated- Rental

60 EA $___________ $________________

2014 Contract Months 25-36 Demand Nasal Cannula (e.g.

Oxymzer) Reservoir or Pendant/Equivalent

0 EA $___________ $________________

2015 Contract Months 25-36 Pulse Conserver Device (Purchase)

0 EA $___________ $________________

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

0 EA $___________ $________________

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

11 EA $___________ $________________

2018 Contract Months 25-36 Ventilator delivery & set-up. Code VA

4 EA $___________ $________________

2019 Contract Months 25-36 RT monthly assessment of Ventilator patients. Code VA 120

221 EA $___________ $________________

2020 Contract Months 25-36 Portable Oxygen Concentrator Rental

267 EA $___________ $________________

2021 Contract Months 25-36 Single Thermal Fuses

629 EA $___________ $________________

2022 Contract Months 25-36 RT Follow-ups

Total $___________ $________________

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 Code E1390.

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 capacity up to 10 LPM Code E1390.

158 EA $__________ $________________

3003 Contract Months 25-36 Rental Ventilator Concentrator System -PLV or Equivalent

5 EA $___________ $________________

3004 Contract Months 25-36 Trilogy

176 EA $___________ $________________

3005 Contract Months 25-36 Patient Refusal

10 EA $___________ $________________

3006 Contract Months 25-36 Emergency Set Up

47 EA $___________ $________________

3007 Contract Months 25-36 Cylinder, Size M or H Setup (Primary)

5 EA $___________ _$______________

3008 Contract Months 25-36 Size M or H refills

177 EA $___________ $________________

3009 Contract Months 25-36 Cylinder, Size E Refills

4599 EA $___________ $________________

3010 Contract Months 25-36 Cylinder, Size D Refills

5294 EA $___________ $________________

3011 Contract Months 25-36 Cylinder, Size M6 Refills

3171 EA $___________ $________________

3012 Contract Months 25-36 Compressor 50 PSI- Rental

62 EA $___________ $________________

3013 Contract Months 25-36 Humidified, Heated- Rental

60 EA $___________ $________________

3014 Contract Months 25-36 Demand Nasal Cannula (e.g.

Oxymzer) Reservoir or

0 EA $___________ $________________

Pendant/Equivalent 3015 Contract Months 25-36

Pulse Conserver Device (Purchase)

0 EA $___________ $________________

3016 Contract Months 25-36 Recovery of VA-Owned Equipment

0 EA $___________ $________________

3017 Contract Months 25-36 Relocation of Equipment Due to Change in Beneficiary address

11 EA $___________ $________________

3018 Contract Months 25-36 Ventilator delivery & set-up. Code VA

4 EA $___________ $________________

3019 Contract Months 25-36 RT monthly assessment of Ventilator patients. Code VA 120

221 EA $___________ $________________

3020 Contract Months 25-36 Portable Oxygen Concentrator Rental

267 EA $___________ $________________

3021 Contract Months 25-36 Single Thermal Fuses

629 EA $___________ $________________

3022 Contract Months 25-36 RT Follow-ups

168 EA $__________ $________________

Total $__________ $________________

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

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 capacity up to 10 LPM Code E1390.

158 EA $__________ $________________

4003 Contract Months 49-60 Rental Ventilator Concentrator System -PLV or Equivalent

5 EA $___________ $________________

4004 Contract Months 49-60 Trilogy

176 EA $___________ $________________

4005 Contract Months 49-60 Patient Refusal

10 EA $___________ $________________

4006 Contract Months 49-60 Emergency Set Up

47 EA $___________ $________________

4007 Contract Months 49-60 Cylinder, Size M or H Setup (Primary)

5 EA $___________ _$______________

4008 Contract Months 49-60 Size M or H refills

177 EA $___________ $________________

4009 Contract Months 49-60 Cylinder, Size E Refills

4599 EA $___________ $________________

4010 Contract Months 49-60 Cylinder, Size D Refills

5294 EA $___________ $________________

4011 Contract Months 49-60 Cylinder, Size M6 Refills

3171 EA $___________ $________________

4012 Contract Months 49-60 Compressor 50 PSI- Rental

62 EA $___________ $________________

4013 Contract Months 49-60 Humidified, Heated- Rental

60 EA $___________ $________________

4014 Contract Months 49-60 Demand Nasal Cannula (e.g.

Oxymzer) Reservoir or Pendant/Equivalent

0 EA $___________ $________________

4015 Contract Months 49-60 Pulse Conserver Device (Purchase)

0 EA $___________ $________________

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

0 EA $___________ $________________

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

11 EA $___________ $________________

4018 Contract Months 49-60 Ventilator delivery & set-up. Code VA

4 EA $___________ $________________

4019 Contract Months 49-60 RT monthly assessment of Ventilator patients. Code VA 120

221 EA $___________ $________________

4020 Contract Months 49-60 Portable Oxygen Concentrator Rental

267 EA $___________ $________________

4021 Contract Months 49-60 Single Thermal Fuses

629 EA $___________ $________________

4022 Contract Months 49-60 RT Follow-ups

168 EA $__________ $________________

Six Month Option Period, we may or may not exercise. 07/01/2030-12/31/2030

SUPPLIES/SERVICES

QUANTITY UNIT UNIT PRICE AMOUNT

5001 Contract Months 61-66 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

2782 EA

5002 Contract Months 61-66 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.

79 EA $__________ $________________

5003 Contract Months 61-66 Rental Ventilator Concentrator System -PLV or Equivalent

2 EA $___________ $________________

5004 Contract Months 61-66 Trilogy

88 EA $___________ $________________

5005 Contract Months 61-66 Patient Refusal

5 EA $___________ $________________

5006 Contract Months 61-66 Emergency Set Up

23 EA $___________ $________________

5007 Contract Months 61-66 Cylinder, Size M or H Setup (Primary)

2 EA $___________ _$______________

5008 Contract Months 61-66 Size M or H refills

88 EA $___________ $________________

5009 Contract Months 61-66 Cylinder, Size E Refills

2299 EA $___________ $________________

5010 Contract Months 61-66 Cylinder, Size D Refills

2647 EA $___________ $________________

5011 Contract Months 61-66 Cylinder, Size M6 Refills

1585 EA $___________ $________________

5012 Contract Months 61-66 Compressor 50 PSI- Rental

31 EA $___________ $________________

5013 Contract Months 61-66 Humidified, Heated- Rental

30 EA $___________ $________________

5014 Contract Months 61-66 Demand Nasal Cannula (e.g.

Oxymzer) Reservoir or Pendant/Equivalent

0 EA $___________ $________________

5015 Contract Months 61-66 Pulse Conserver Device (Purchase)

0 EA $___________ $________________

5016 Contract Months 61-66 Recovery of VA-Owned Equipment

0 EA $___________ $________________

5017 Contract Months 61-66 Relocation of Equipment Due to Change in Beneficiary address

5 EA $___________ $________________

5018 Contract Months 61-66 Ventilator delivery & set-up. Code VA

2 EA $___________ $________________

5019 Contract Months 61-66 RT monthly assessment of Ventilator patients. Code VA 120

110 EA $___________ $________________

5020 Contract Months 61-66 Portable Oxygen Concentrator Rental

133 EA $__________ $________________

5021 Contract Months 61-66 Single Thermal Fuses

314 EA $__________ $________________

5022 Contract Months 61-66 RT Follow-ups

84 EA $__________ $________________

B.3 DESCRIPTION/SPECIFICATION/PERFORMANCE WORK

STATEMENT

Department of Veteran Affairs Medical Center (VAMC) has a requirement for providing Home Oxygen Services for Beckley, WV.

Beckley VAMC, WV, VA Medical Center 200 Veterans Drive Beckley, WV 25801

1. SCOPE OF WORK

1.1 The intent of this Request for Quotes (RFQ) is to award a single Indefinite Delivery, Indefinite - Quantity (IDIQ) contract to a Service Disabled Veteran Owned Small Business (SDVOSB) providing all the necessary labor, facilities, supplies, materials, equipment supervision, transportation, safety management, infection control, and management to perform home oxygen services, to include storage and management of Contractor home oxygen equipment, delivery, set-up, instruction and maintenance of equipment for VA beneficiaries as directed by the VISN 5 Department of Veteran Affairs Medical Center VAMC) facility listed herein. The Contractor shall maintain at the proposed servicing facility adequate licensed registered respiratory therapy staff to provide instructions, safety management, perform respiratory evaluation (under the direction of the physician), and follow-up and/or emergency visits. The use of the term’s “beneficiary”, “Veteran”, and “Patient” are used interchangeably and refer to the recipient of required supplies, equipment, and incidental services required under the contract.

1.2 The contract effective period shall be for 5 years.

1.3 All services will be performed in the Veteran’s place of residence or in a nursing home housing and community living centers, if applicable. The equipment needs are subject to change as determined by the prescribing physician. The Contractor shall have a facility, or resources physically located in the area of service listed in the PWS, in which they will provide service. The Contractor’s office location shall include the service office, warehouse, dispatch of vehicles and other functions related to the performance of services of this contract within a twenty (20) mile radius of the VA, Beckley WV facility to facilitate periodic inspections by VA and/or other accrediting agencies at the period of performance.

1.4 The geographical boundaries are described in the PWS.

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

http://www.jointcommission.org/

2. SERVICE SPECIFICATIONS

2.1 The Contracting Officer’s Representative (COR) or designee (Home Oxygen Coord.) will provide (via encrypted email and fax) the Contractor with notification to initiate individual patient service requirements, including the patient’s oxygen prescription, equipment, supplies, and services to be provided including date and place of delivery. The Contractor shall confirm receipt (via encrypted email and fax) of the request within (2) two working hours of notification;

the COR or designee will also provide notification of VA initiated discontinuance of service. The notification may be made orally but will be confirmed in writing within one (1) working day. The written documents will include the authorizing official’s signature, electronic or written.

2.2 BACKUP SYSTEM: The Contractor shall provide Veterans that have a prescription for an oxygen concentrator with a backup system consisting of a compressed gas source and regulator with stand, humidifiers and cannulas/mask for use during the event of a power failure or mechanical problem with non-electrical oxygen supply to last (3) three times the Contractor’s response time. The Contractor shall provide documentation (via encrypted email and/or fax) if the Veteran declines the oxygen back-up system, to include the reason for declining backup system and the Veterans signature. Notification (via encrypted email and/or fax) shall be provided to the VA Home Oxygen Coordinator and/or COR within five (5) business day of the Veteran decline and five (5) business days of the Veteran declining any prescribed equipment or Contractor’s inability to deliver the prescribed equipment.

2.3 In accordance with the prescription received from the VAMC, the Contractor shall provide the patient with the following items at the time of set-up and when needed as re-supply. Any cost for shipping of the following items shall be borne by the Contractor:

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

b. Disposable oxygen cannulas on hand for change at a minimum of every, one (1) week with a supply in reserve always until the Contractor’s next scheduled visit.

c. Disposable masks for change/wash everyone (1) week with a 30-day supply in reserve at all times until the contractor’s next scheduled visit.

d. Twenty-five (25) to fifty (50) feet of oxygen connection tubing shall be replaced every, one (1) month with an equivalent section of tubing in reserve at all times (to be included in initial set-up) until the Contractors next scheduled visit.

e. Trachea collar and accessories (e.g. tubing and large volume nebulizer) with a supply on hand allowing for change every seven (7) days with a supply in reserve at all times until the Contractors next scheduled visit.

f. Fire Safe Valves on every concentrator machine and portable oxygen system changed annually if they do not have a 5-year life.

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

(4) or more cylinders.

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

a. The Contractor shall provide the initial set-up within 24 hours of request from the COR or designee (dependent on Veteran’s availability), to include weekends and holidays; this response time shall also apply to service calls. Initial setups may be provided by the Contractor’s Patient Service Technician; does not have to be a Respiratory Therapist.

All patients receiving services under this contract shall be visited by a Certified Respiratory Therapist (CRT) or a Registered Respiratory Therapist (RRT) within 24 hours after initial set up and at least annually thereafter. In the event a monthly visit will not occur, the Home Oxygen Coordinator will be notified and provided details of attempts to contact the veteran for service.

The Beckley, WV facilities reserve the right to obtain the initial set-up service from another source and to charge the Contractor with any excess cost which may result there from, if the Contractor is unable to meet the 24-hour response time.

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

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

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

e. No additional charge for same day delivery

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

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

a. The Contractor shall notify the COR/designee or prescribing physician during the home visit if the Contractor’s staff determines that the presence of oxygen in the home presents such a danger that the oxygen must be removed, or in the case of an initial set-up, not placed in the home. Unsafe conditions may include, but are not limited to, fire safety hazards, oxygen safety hazards or any instance that places the patient or Contractor’s staff in immediate danger. The Contractor shall contact the COR or designee by phone during the home visit and furnish (via encrypted email) written documentation of the safety hazard to the COR or designee within one (1) business day of the incident.

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

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

d. The Contractor shall verify the presence of working smoke alarms and instruct the

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

2.7 Every, one (1) month the Contractor shall visit all patients on concentrators to reassess equipment compliance and educational needs. A qualified service technician shall perform this service. A report shall be developed, signed and dated by the contract staff and the patient/care giver and a copy shall be left with the patient/care giver. The reports shall be legible and attached to the invoice. All reports shall be submitted to the COR or designee in alphabetical order, with the monthly bills by the 10th business day of the month following service. The written report shall include at a minimum the following data:

a. Name and last four (4) of the social security number (SSN) of patient using the equipment.

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

c. Type of concentrator and hours on concentrator.

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

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

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

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

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

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

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

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

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

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

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

g. Inspection/change of bacterial filters.

h. Fire safety issues

i. Fall risks

j. Inspection and replacement of disposable supplies

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

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

l. The patient’s diagnosis.

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

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

o. Assessment of the lung sounds.

p. Monitoring of respiratory medications

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

3. PATIENT EDUCATION

3.1 The Contractor shall provide education to each patient or caregiver at the time of set-up and assess the need for reinforcement during visits. This information is to be presented by demonstration and material covered shall be in written form to be left with the patient /care giver. The written material shall be in English as well as the foreign language of the patient, should the patient not speak English. The Contractor as directed by COR or designee will implement any new or revised education material. The VA will determine whether the Contractor shall use their forms or forms supplied by the VA for documentation of education services provided to patients.

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

Instruction shall be in accordance with Joint Commission and CMS standards.

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

3.2 The Contractor shall provide educational and warning information for patients, their families, and caregivers on the hazard of smoking while oxygen is in use. The education materials must be provided upon initial delivery and every six (6) months thereafter. Education materials shall instruct patients on oxygen that smoke to remove the cannula, shut-off the oxygen supply, stand a minimum of 25 feet away and wait for oxygen to dissipate prior to smoking.

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

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

4. TRAVELING PATIENTS

4.1 The Contractor shall coordinate all oxygen services for patients who travel both within and outside the geographical area covered by this contract. Patients will be instructed by the Contractor and VA staff to notify the Contractor at least two (2) weeks before intent to travel and earlier if they are relocating. Accommodations shall be made for short notice in the event of a family emergency.

4.2 Patients receiving oxygen services under this contract are authorized a maximum of thirty

(30) days travel, with a maximum of four (4) set-up charges within a one (1) year period from the latest prescription date instead of TWO (2). Subsequent to this, any other oxygen costs will be the patient’s responsibility. It is the Contractor’s responsibility to monitor usage and notify Home Oxygen Coordinator (HOC) if the limits will be exceeded.

4.3 When the Veteran is temporarily traveling outside of the contracted area, the Contractor shall arrange for oxygen services at the same contract rate (billed timely to the Veteran’s resident VAMC) if the Contractor has a subsidiary office located at the temporary destination the oxygen will be billed at the same contract rate.

5. EMERGENCY SERVICES

5.1 Emergency services are for medical equipment provided to patients when an equipment malfunction or natural disaster may threaten a patient's health. The Contractor shall provide to the Contracting Officer a written emergency management plan, in compliance with The Joint Commission standards. This emergency action plan shall address continuity of services for all patients in the affected region.

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

5.3 The Contractor shall ensure all patients have a minimum of non-electrical oxygen supply to last three (3) times the Contractor’s response time to be on-site at a patient’s residence after receiving a call. The minimum supply shall take into account each patient’s prescription flowrate and distance from the Contractor’s location; actual supply levels may differ from the patient to patient, as long as each patient has oxygen supply to last a minimum of three (3) times the Contractor’s response time. If the Contractor is unable to respond to an emergency service call within six (6) hours, the Contractor shall make arrangements with another supplier to provide oxygen at the patient’s residence at the Contractor’s expense. Contractor shall provide a written explanation of Contractor’s inability to provide emergency service to the HOC or authorized personnel within two (2) business days. The cost of backup oxygen systems, backup oxygen, and backup equipment shall be borne by the contractor. If H or M tanks are used for backup, the Contractor shall furnish an H or M tank stand for each tank.

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

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

6. DISCONTINUANCE OF SERVICE

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

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

7. CONTRACTOR VISITS

7.1 The Contractor shall visit the patient’s residence as needed for delivery of equipment in performance of this contract with a reasonable notice and within established working hours, Monday through Friday; exceptions will be made in the cases of emergencies. The Contractor shall schedule the appointments to the patient’s home with a reasonable notice prior to the appointment. On each scheduled setup/delivery, the Contractor shall reassess the need to instruct the patient on the use and care of the equipment and supplies.

All patients receiving services under this contract shall be visited by a Certified Respiratory Therapist (CRT) or a Registered Respiratory Therapist (RRT) within 24-72 hours after initial set up and at least annually thereafter. In the event a yearly visit will not occur, the HOC will be notified and provided details of attempts to contact the veteran for service.

7.2 The Contractor shall make every effort to establish appointments with patients when initiating set-ups and deliveries. Deliveries shall not be left unattended at the patient’s home;

physical acceptance of deliveries must take place between the Contractor and either the patient or caregiver. If the patient repeatedly fails to meet appointments, the Contractor shall notify the COR or designee. The COR or designee will contact the patient, and a corrective action plan will be implemented. The COR will notify the Contractor of any changes. If the Contractor has not made valid and documented attempts to contact the patient for set ups and or deliveries the Government reserves the right to call in a third party to provide those services and bill the Contractor for any additional costs the Government incurs as a result of such action.

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

9. REPORTS

9.1 Performance Review Report - The Contractor shall provide a written, quarterly report addressing all The Joint Commission Standards for improving organizational performance (The Joint Commission standards may be accessed at (www.jointcommission.org) to the HOC. The Contractor shall submit their Performance Review to the HOC via encrypted email. The Contractor shall assess and score each The Joint Commission standard and element of performance that is applicable to the contracted services by entering a self-assessed score.

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

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

9.3 Patient Satisfaction Report - The Contractor shall collect satisfaction data from patients and their families on a quarterly basis in accordance with The Joint Commission standards. A copy of survey results shall be submitted to HOC or designee in quarterly reports via encrypted email. The quarterly report is due to the HOC within the 5th working day after the conclusion of the quarter. The reporting quarters are as follows: October 1st through December 31st, January 1st through March 31st, April 1st through June 30th and July 1st through September 30th.

9.4 Infection Control Report - The Contractor shall collect, trend, and report on data related to the Contractor’s Infection Control Program to the HOC or designee on a quarterly basis for each contract performance period via encrypted email. The quarterly report is due to the HOC within the 5th working day after the conclusion of the quarter.

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

Additionally, a composite report of each facility’s usage, to include the total number of unique Patients, the total number of units used by CLIN, the total dollars invoiced by CLIN is required.

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

a. Sentinel Events - The Contractor is required to inform the Home Oxygen Coordinator and/or COR within one (1) business day of a sentinel event via encrypted email that occurs during the performance of this contract that involves patients serviced under this contract.