36C24525Q0271 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

36C24525Q0271 03/6/2025

Crystal S. Hinton; crystal.hinton@va.gov 410-637-1530 03-27-2025

1400 EST

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

Contracting Officer (90C)

Crystal S. Hinton, Contracting Officer

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

Contractor shall provide Home Oxygen Services for Beckley, VA Medical Center in accordance with the Performance Work Statement (PWS)

This is a Service-Disabled, Veteran Owned Small Business - (SDVOSB) Set-Aside.

Contractor Performance Period: 5 Years

Period of Performance 07/01/2025-06/30/2030

X One

(1)

Crystal S. Hinton

36C24525Q0271

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 PRICE/COST SCHEDULE

B.3 DESCRIPTION/SPECIFICATION/PERFORMANCE WORK STATEMENT

B.4 IT CONTRACT SECURITY

B.5 RECORDS MANAGEMENT OBLIGATIONS

B.6 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 52.204-9 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR

PERSONNEL (JAN 2011)

C.3 52.204-21 BASIC SAFEGUARDING OF COVERED CONTRACTOR

INFORMATION SYSTEMS (NOV 2021)

C.4 52.203-16 PREVENTING PERSONAL CONFLICTS OF INTEREST (JUN 2020) ...52

C.5 52.216-18 ORDERING (AUG 2020)

C.6 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.7 52.216-22 INDEFINITE QUANTITY (OCT 1995)

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

C.9 52.227-14 RIGHTS IN DATA – GENERAL (MAY 2014)

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

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

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 (JAN 2025)

C.22 MANDATORY WRITTEN DISCLOSURES

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

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

D.2 QUALITY ASSURANCE SURVEILLANCE PLAN (ATTACHED SEPARATELY)

D.3 CONTRACTOR CERTIFICATION: IMMIGRATION AND NATIONALITY ACT OF

1952, AS AMENDED (ATTACHED SEPARATELY)

D.4 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 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

E.7 52.212-2 EVALUATION—COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES (NOV 2021)

E.8 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

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

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

Baltimore MD 21201

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

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

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

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

[] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly []

b. Semi-Annually []

c. Other [X]

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.

PAYMENT WILL BE MADE BY

FSC e-Invoice Payment Invoice must be submitted electronically.

http://www.fsc.va.gov/einvoice.asp Invoice Setup Information 1-877-489-6135

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

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

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.

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

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 Baltimore, 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 LB $___________ $________________

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

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 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 $__________ $________________

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 LB $___________ $________________

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

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 LB $___________ $________________

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

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 LB $___________ $________________

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

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 LB $___________ $________________

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

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 LB $___________ $________________

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

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 Proposal (RFP) is to award a single Indefinite Delivery, Indefinite - Quantity (IDIQ) contract to a Service Disabled Veteran Owned Small Business (SDVOSB) providing all the necessary labor, facilities, supplies, materials, equipment supervision, transportation, safety management, infection control, and management to perform home oxygen services, to include storage and management of 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 respiratory therapist to provide ongoing education, assess equipment and supplies, and to submit a quarterly report, (for patients who are using oxygen therapy for cluster headaches, the respiratory therapist visit schedule will only require an annual visit. If the patient also has a concentrator, they will remain on the quarterly visit schedule. The Respiratory Therapist will document the average frequency of use of the therapy by the patient and remind the patient that the oxygen prescription needs to be renewed yearly by either the patient’s primary care or the neurology doctor. The home oxygen prescription must be reviewed with the veteran. The quarterly report (used for all patients except for those stated above using oxygen therapy for cluster headaches) shall include the following data:

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

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

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

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

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

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

g. Inspection/change of bacterial filters.

h. Fire safety issues

i. Fall risks

j. Inspection and replacement of disposable supplies

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

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

l. The patient’s diagnosis.

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

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

o. Assessment of the lung sounds.

p. Monitoring of respiratory medications

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

3. PATIENT EDUCATION

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

The Contractor shall provide to each VA patient a copy of the approved “Patient Instruction Booklet”. This booklet shall be placed in a durable binder with emergency and routine contact information properly annotated before the booklet is given to the patient. Instructions shall cover the use of all equipment delivered. The contact information for the Joint Commission shall be provided in the booklet. The patient/caregiver and contract representative shall sign the approved “Documentation of Set up/Periodic Maintenance” and “Patient Training checklist” acknowledging that the written and oral instructions have been provided. A copy of the signed documents shall be submitted to the COR 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 two (2) set-up charges within a one (1) year period from the latest prescription date. maximum of FOUR (4) set up charges within a one (1) year period from the latest prescription date instead of TWO (2). Subsequent to this, any other oxygen costs will be the patient’s responsibility. It is the Contractor’s responsibility to monitor usage and notify 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…