S06 - AMENDED - 36C246-21-Q-0544 0001 - REVISED PWS.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 35

0001 12-28-2020

NONE

Department of Veterans Affairs

Network Contracting Office 6

100 Emancipation Drive

Hampton VA 23667

Department of Veterans Affairs

Network Contracting Office 6

100 Emancipation Drive

Hampton VA 23667

To all Offerors/Bidders

36C24621Q0544

05-28-2021

X

X X

** HOUR & DATE for Receipt of Offers is EXTENDED to:

X 1

This Solicitation is amended to provide the following information:

1. Revised B.2 Schedule of Services Base Period and Option Years requirements for all Line Item Numbers.

2. Revised & Edited B.3 Section: Performance Work Statement

3. This Solicitation closing date is being extended: submitall requested documentation by: 13 AUG 2021 @4:00PM EST

4. Please see Continuation Page for detailed changes.

Warren O'Bryant

Administrative Contracting Officer

36C246-21-Q-0544 / A0001

CONTINUATION PAGE

MEDICAL TRANSITIONAL HOMELESS VETERANS HOUSING

(RESPITE-CONVALESCENT CARE) SERVICE

This Amendment is changing the Governments requirement for Contractors shall provide

Transitional Homeless Veterans Housing (Respite Convalescent Program Assistance) for medically fragile Veterans residing within the community, staffed with the following personnel:

nursing staff (Nurse Practitioner, Registered Nurse, CNA or LPN) and clinical staff (LCSW or

LCMHC) for the beneficiaries of W.G. “Bill” Hefner Salisbury VAMC, Salisbury, NC.

Located within the Salisbury community or within a 50 miles radius of the Salisbury VA and located within a 25-miles radius of the Community Based Outpatient Clinics (CBOC) and/or

Health Care Centers (HCC): one (1) location with twelve (12) beds or two (2 )locations with six (6 ) beds.

The Solicitation and the following sections are being affected: Standard Form 1449, Block 20, Schedule of Services, page 5 – 9, Base Year of Performance and all Option Years Line Item numbers: 0001 & 0002, 1001 & 1002, 2001 & 2002, 3001 & 3002 and 4001 & 4002.

B.2 SCHEDULE OF SERVICES

The Government intends to offer single or multiple awards under an estimated Indefinite

Quantity (IDIQ) type firm fixed price (FFP) contract for services specified effective for the periods stated in the Schedule of Services. All quantities are estimates only. The guaranteed minimum quantity of bed services the Government will acquire under this contract for the Base and Option Period is four (4) one-year periods for each contract year.

The Contractor shall provide Off-Site: Transitional Homeless Veterans Housing (Respite

Convalescent Program Assistance) for medically fragile Veterans residing within the community, staffed with the following personnel: nursing staff (Nurse Practitioner, Registered

Nurse, CNA or LPN) and clinical staff (LCSW or LCMHC) for the beneficiaries of W.G. “Bill”

Hefner Salisbury VAMC, Salisbury, NC.

Located within the Salisbury community or within a 50 miles radius of the Salisbury VA and located within a 25-miles radius of the Community Based Outpatient Clinics (CBOC) and/or

Health Care Centers (HCC), one (1) location with twelve (12) beds or two (2) locations with six (6) beds.

Note: The Salisbury VAMC will not be responsible for paying for beds not occupied by a

Veteran.

NOTE: All vendors responding to this solicitation must clearly indicate the line item and location for which the proposal is submitted.

MEDICAL TRANSITIONAL HOMELESS VETERANS HOUSING

(RESPITE-CONVALESCENT CARE) SERVICE

Pricing Instructions:

The offeror is instructed to include all other than price and cost information supporting the proposed price and copies of both the primary and backups proposed candidates CV /

Resumes with their proposals as directed in the Instructions to Offerors addendum to 52.212-1 and/or Section D- Contract Documents, Exhibits, or attachments. Failure to submit the required CV / Copies of requested Certificates, Licenses and NPI reports will deem your response as Non-Responsive.

Period of Performance: BASE PERIOD: 10/01/2021 through 09/30/2022

LINE

ITEM

Description Est. Qty. Unit of

Issue

Unit Cost Total

Annual Cost

0001 Transitional Homeless Veterans

Housing (Respite Convalescent

Program Assistance) and medically fragile care for Veterans from the community to include nursing staff

(Nurse Practitioner, Registered Nurse, CNA, or LPN) and clinical staff

(LCSW or LCMHC). The facility will provide housing, meals, transportation, medical monitoring, Instrumental

Activities of Daily Living assistance and case management services).

Located within the Salisbury community or within a 50 miles radius of the Salisbury VA and located within a 25-miles radius of the Community

Based Outpatient Clinics (CBOC) and/or Health Care Centers (HCC).

One location with twelve (12) beds or

2 locations with six (6) beds each.

(365 days

* 6 beds)

* 12 beds)

EA /

Per

Day

MEDICAL TRANSITIONAL HOMELESS VETERANS HOUSING

(RESPITE-CONVALESCENT CARE) SERVICE

0002 Transitional Homeless Veterans

Housing (Respite Convalescent

Program Assistance) and medically fragile care for Veterans from the community to include nursing staff

(Nurse Practitioner, Registered Nurse, CNA, or LPN) and clinical staff

(LCSW or LCMHC). The facility will provide housing, meals, transportation, medical monitoring, Instrumental of the Salisbury VA and located within a 25-miles radius of the Community

TOTAL FOR BASE YEAR PERIOD

BASE YEAR 1: $__________________

MEDICAL TRANSITIONAL HOMELESS VETERANS HOUSING

(RESPITE-CONVALESCENT CARE) SERVICE

Option Year 1 – Period of Performance: 10/01/2022 through 09/30/2023

Description Qty. Unit Unit Cost Total

Annual Cost

1001 Transitional Homeless Veterans

Housing (Respite Convalescent

Program Assistance) and medically fragile care for Veterans from the community to include nursing staff

(Nurse Practitioner, Registered Nurse, CNA, or LPN) and clinical staff

(LCSW or LCMHC). The facility will provide housing, meals, transportation, medical monitoring, Instrumental of the Salisbury VA and located within a 25-miles radius of the Community

MEDICAL TRANSITIONAL HOMELESS VETERANS HOUSING

(RESPITE-CONVALESCENT CARE) SERVICE

1002 Transitional Homeless Veterans

Housing (Respite Convalescent

Program Assistance) and medically fragile care for Veterans from the community to include nursing staff

(Nurse Practitioner, Registered Nurse, CNA, or LPN) and clinical staff

(LCSW or LCMHC). The facility will provide housing, meals, transportation, medical monitoring, Instrumental of the Salisbury VA and located within a 25-miles radius of the Community

TOTAL FOR OPTION YEAR-1

OPTION YEAR 1: $_________________

MEDICAL TRANSITIONAL HOMELESS VETERANS HOUSING

(RESPITE-CONVALESCENT CARE) SERVICE

Option Year 2 – Period of Performance: 10/01/2023 through 09/30/2024

NE

Description Est. Qty. Unit of

Issu e

Unit Cost Total

Annual Cost

2001 Transitional Homeless Veterans

Housing (Respite Convalescent

Program Assistance) and medically fragile care for Veterans from the community to include nursing staff

(Nurse Practitioner, Registered Nurse, CNA, or LPN) and clinical staff

(LCSW or LCMHC). The facility will provide housing, meals, transportation, medical monitoring, Instrumental of the Salisbury VA and located within a 25-miles radius of the Community

* 12 beds)

MEDICAL TRANSITIONAL HOMELESS VETERANS HOUSING

(RESPITE-CONVALESCENT CARE) SERVICE

2002 Transitional Homeless Veterans

Housing (Respite Convalescent

Program Assistance) and medically fragile care for Veterans from the community to include nursing staff

(Nurse Practitioner, Registered Nurse, CNA, or LPN) and clinical staff

(LCSW or LCMHC). The facility will provide housing, meals, transportation, medical monitoring, Instrumental of the Salisbury VA and located within a 25-miles radius of the Community

TOTAL FOR OPTION YEAR-2

OPTION YEAR 2: $_____________________

MEDICAL TRANSITIONAL HOMELESS VETERANS HOUSING

(RESPITE-CONVALESCENT CARE) SERVICE

Option Year 3 – Period of Performance: 10/01/2024 through 09/30/2025

Description Est. Qty. Unit of

Issue

Unit Cost Total

Annual Cost

3001 Transitional Homeless Veterans

Housing (Respite Convalescent

Program Assistance) and medically fragile care for Veterans from the community to include nursing staff

(Nurse Practitioner, Registered Nurse, CNA, or LPN) and clinical staff

(LCSW or LCMHC). The facility will provide housing, meals, transportation, medical monitoring, Instrumental of the Salisbury VA and located within a 25-miles radius of the Community

MEDICAL TRANSITIONAL HOMELESS VETERANS HOUSING

(RESPITE-CONVALESCENT CARE) SERVICE

3002 Transitional Homeless Veterans

Housing (Respite Convalescent

Program Assistance) and medically fragile care for Veterans from the community to include nursing staff

(Nurse Practitioner, Registered Nurse, CNA, or LPN) and clinical staff

(LCSW or LCMHC). The facility will provide housing, meals, transportation, medical monitoring, Instrumental of the Salisbury VA and located within a 25-miles radius of the Community

TOTAL FOR OPTION YEAR-3

OPTION YEAR 3: $___________________

MEDICAL TRANSITIONAL HOMELESS VETERANS HOUSING

(RESPITE-CONVALESCENT CARE) SERVICE

Option Year 4 – Period of Performance: 10/01/2025 through 09/30/2026

Description Est. Qty. Unit of

Issu e

Unit Cost Total

Annual Cost

4001 Transitional Homeless Veterans

Housing (Respite Convalescent

Program Assistance) and medically fragile care for Veterans from the community to include nursing staff

(Nurse Practitioner, Registered Nurse, CNA, or LPN) and clinical staff

(LCSW or LCMHC). The facility will provide housing, meals, transportation, medical monitoring, Instrumental of the Salisbury VA and located within a 25-miles radius of the Community

One location with twelve (12) beds or 2 locations with six (6) beds each.

MEDICAL TRANSITIONAL HOMELESS VETERANS HOUSING

(RESPITE-CONVALESCENT CARE) SERVICE

4002 Transitional Homeless Veterans

Housing (Respite Convalescent

Program Assistance) and medically fragile care for Veterans from the community to include nursing staff

(Nurse Practitioner, Registered Nurse, CNA, or LPN) and clinical staff

(LCSW or LCMHC). The facility will provide housing, meals, transportation, medical monitoring, Instrumental of the Salisbury VA and located within a 25-miles radius of the Community

One location with twelve (12) beds or 2 locations with six (6) beds each.

TOTAL FOR OPTION YEAR-4

OPTION YEAR 4: $____________________

TOTAL COST FOR BASE AND ALL OPTION YEARS: $______________________

MEDICAL TRANSITIONAL HOMELESS VETERANS HOUSING

(RESPITE-CONVALESCENT CARE) SERVICE

B.3 PERFORMANCE WORK STATEMENT

1. GENERAL:

Services Provided: The Contractor shall furnish Transitional Homeless Veterans Housing

(Respite Convalescent Program Assistance) for medically fragile Veterans residing within the community, staffed with the following personnel: nursing staff (Nurse Practitioner, Registered

Nurse, CNA or LPN) and clinical staff (LCSW or LCMHC) for the beneficiaries of W.G. “Bill”

Hefner Salisbury VAMC, Salisbury, NC, in accordance with the terms and conditions stated herein. The Contractor shall provide these services in accordance with all applicable Federal, State, and local regulations, laws and ordinances and in accordance with their Performance Work

Statement. The contract facility will be located within the Salisbury community or within a 50-mile radius of the Salisbury VA and/or a 25-mile radius of the Community Based Outpatient

Clinic (CBOC) and/or Health Care Centers (HCC) - One location with twelve (12) beds or 2 locations with six (6) beds. The contract facility must have a current occupancy permit or license required by the authority having jurisdiction.

1.1. The Contractor shall provide Temporary Residential Shelter to include but not limited to include beds, ADA accessible restrooms and bath, kitchen facilities, and related furnishings. Adequate security measures in accordance with VA standards and in conformance with state and local safety and health codes as outlined in 38 CFR, Section

17.53. Contractors shall provide food for three (3) nutritionally adequate meals daily and snacks daily to each shelter resident, as well as personal hygiene items, first aid supplies and storage, as needed. The Contract facility must have a current occupancy permit or license required by the State of North Carolina having jurisdiction.

1.2. Authority: Title 38 USC 8153 Sharing of Health-Care Resources and VAAR Part 873 in combination with FAR Parts 15.

1.3. Policy/Handbooks: the contractor shall be subject to the following policies, including any subsequent updates during the period of performance:

1.3.1. VA Directive 1663: Health Care Resources Contracting - Buying https://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=969&FType=2

1.3.2. VHA Directive 1003 “VHA Customer Service Programs and Veterans’ Health Care

Service Standards” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=7475.5

1.3.3. VHA Directive 1192 “Seasonal Influenza Prevention Program” https://www.publichealth.va.gov/docs/flu/VHA_Directive_1192_Sep

1.3.4. VHA Handbook 1100.17: National Practitioner Data Bank Reports – https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135

1.3.5. VHA Handbook 1100.18 Reporting and Responding to State Licensing Boards – https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364

1.3.6. VHA Handbook 1100.19 Credentialing and Privileging –

https://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=969&FType=2 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID= https://www.publichealth.va.gov/docs/flu/VHA_Directive_1192_Sep https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364

MEDICAL TRANSITIONAL HOMELESS VETERANS HOUSING

(RESPITE-CONVALESCENT CARE) SERVICE

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910

1.3.7. VHA Handbook 1907.01 Health Information Management and Health Records:

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3088

1.3.8. VHA Directive 2012-030 Credentialing of Health Care Professionals – https://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=2815

1.3.9. Privacy Act of 1974 (5 U.S.C. 552a) as amended

http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm.

2. Qualifications

2.1. Staff/Facility

2.1.1. License or Certification: Nursing staff (Nurse Practitioner, Registered Nurse, CNA or LPN) and clinical staff (LCSW or LCMHC) assigned by the Contractor to perform the services covered by this contract shall be licensed or certified in the

State of North Carolina. The license must be active, current and unrestricted by the

North Carolina Board of Nursing, North Carolina Social Work Licensing Board and/or the North Carolina Board of Licensed Clinical Mental Health Counseling.

2.1.2. Board Certification: All Contractor’s nursing staffs (RN, CNA or LPN) shall be certified in accordance with the North Carolina Board of Nursing, https://www.ncbon.com/. Clinical staff, LCSW or LCMHC shall be certified in accordance with the North Carolina Social Work Licensure Board, https://www.ncswboard.org/ or North Carolina Board of Licensed Clinical Mental

Health Counselors, https://www.ncblpc.org/. Licensed Clinical Social Workers shall have a degree from an accredited school of Social Work as accredited by the Council on Social Work Education. Licensed Clinical Mental Health Counselors must have received a (Master’s) Degree from a regionally accredited institution of higher education in accordance with the North Carolina Board of Licensed Clinical Mental

Health Counselors.

2.1.3. Technical Proficiency - Contractor’s nursing staff (Nurse Practitioner, Registered

Nurse, CNA or LPN) and clinical staff (LCSW and LCMHC) shall be technically proficient in the skills necessary to fulfill the government’s requirements including:

the ability to speak, understand, read and write English fluently. Contractor shall provide documents upon request of the CO/COR to verify current and ongoing competency, skills, certification and/or licensure related to the provision of care, treatment and/or services performed.

Contractor shall provide verifiable evidence of all educational and training experiences including any gaps in educational history for all nursing staff (Nurse

Practitioner, Registered Nurse, CNA or LPN) and clinical staff (LCSW or LCMHC) whom shall be responsible for abiding by the Facility's Medical Staff By-Laws, rules, and regulations (referenced herein) that govern medical staff behavior.

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3088 https://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=2815 http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm

MEDICAL TRANSITIONAL HOMELESS VETERANS HOUSING

(RESPITE-CONVALESCENT CARE) SERVICE

2.1.4. Continuing Medical Education (CME)/ Certified Education Unit (CEU)

Requirements: Contractor shall provide the COR copies of current CMEs as required or requested by the VAMC. Contractors nursing staff (Nurse Practitioner, Registered Nurse, CNA, or LPN) and clinical staff (LCSW or LCMHC) registered or certified by national/medical associations shall continue to meet the minimum standards for CME to remain current. Contractor shall report CME hours to the credentialing office for tracking.

2.1.5. The following training documents are required for the Contractor’s medical and clinical staff to include: (RN’s, LPN’s, or CNA’s, and LCSW or LCMHC and non-licensed staff).

Training (The following training is mandatory per VHACO for

Contract staff)

Frequency (once a year, etc.) Annual

Hours

Active Threat Training Every 1 Year 1 Hour

Prevention of Workplace

Harassment

Every 1 Year 1 Hour

VA Privacy and Information

Security Awareness and Rules of

Behavior

Every 1 Year 1 Hour

Privacy and HIPAA Training Every 1 Year 1 Hour

AHA ACLS/BLS Every 2 Years 3 to 8 Hours

Cultural Competency Every 1 Year 1 Hour

Suicide Prevention: Suicide Risk

Management Training for

Clinicians

Every 1 Year 1 Hour

Infections Control Policy and

Procedures

Every 1 year 30 Minutes

Fire and Safety Training Every 1 year 1 Hour

Emergency Preparedness/Disaster

Policy and Procedures

Every 1 year 30 Minutes

List other Training per local facility

Courses to be assigned in

TMS as required.

Various

Contractor shall provide to the COR a copy of the training certificates for each applicable employee within one (1) week of the initiation of the contract and annually thereafter, as required. The online courses listed above are located at the following website:

https://www.tms.va.gov/plateau/user/login.jsp.

https://www.tms.va.gov/plateau/user/login.jsp

MEDICAL TRANSITIONAL HOMELESS VETERANS HOUSING

(RESPITE-CONVALESCENT CARE) SERVICE

Detail instructions on account setup will be provided to the successful offeror upon contract award. Failure to complete the mandatory trainings listed above within the timeframe required shall be grounds for suspension or termination of all physical and/or electronic access privileges and removal from work on the contract until such time as the training is completed.

2.1.7.1. OSHA REGULATION CONCERNING OCCUPATIONAL EXPOSURE TO

BLOODBORNE PATHOGENS: Contractor shall provide evidence of completing and passing generic self-study blood-borne pathogen training for all

Contractors nursing staff (Nurse Practitioner, Registered Nurse, CNA or LPN) and clinical staff (LCSW and LCMHC). The medical personnel must provide their own Hepatitis B vaccination series and Hepatitis B surface antigen test results following the Hepatitis B vaccination series; maintain an exposure determination and control plan; maintain required records; and ensure that proper follow-up and evaluation is provided following an exposure incident.

2.1.7.2. The VAMC shall notify the Contractor of any significant communicable disease exposures as appropriate. Contractor shall adhere to current CDC/HICPAC

Guidelines for Infection Control in health care personnel ( as published in

American Journal for Infection Control- AJIC 1998; 26:289-354 http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf) for disease control. Contractor shall provide follow up documentation of clearance to return to the workplace prior to their return.

2.1.11. Non-Personal Healthcare Services: The parties agree that the Contractor and all

Contractor’s nursing staff (RN’s, CNA’s, LPN’s) and clinical staff (LCSW’ or

LCMHCA) shall not be considered VA employees for any purpose.

2.1.13. Prohibition Against Self-Referral: Contractor’s nursing staff (Nurse Practitioner’s, Registered Nurse’s, CNA’s, LPN’s) and clinical staff (LCSW or LCMHC) are prohibited from referring VA patients to contractor’s or their own practice(s).

2.1.14. Inherent Government Functions: Contractor nursing staff (Nurse Practitioner’s, Registered Nurse’s, CNA’s, or LPN’s) and clinical staff (LCSW’s or LCMHCA’s) shall not perform inherently governmental functions. This includes, but is not limited to, determination of agency policy, determination of Federal program priorities for budget requests, direction and control of government employees

(outside a clinical context), selection or non-selection of individuals for Federal

Government employment including the interviewing of individuals for employment, approval of position descriptions and performance standards for Federal employees, approving any contractual documents, approval of Federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy.

http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf

MEDICAL TRANSITIONAL HOMELESS VETERANS HOUSING

(RESPITE-CONVALESCENT CARE) SERVICE

2.1.15. No Employee Status: The Contractor shall be responsible for protecting

Contractor’s nursing staff (Nurse Practitioner’s, Registered Nurse’s, CNA’s, LPN’s) and clinical staff (LCSW’s or LCMHC) who are furnishing services. To carry out this responsibility, the Contractor shall provide or certify that the following is provided for all their staff providing services under the resultant contract:

2.1.15.1. Workers’ compensation

2.1.15.2. Professional liability insurance

2.1.15.3. Health examinations

2.1.15.4 Income tax withholding, and

2.1.15.5. Social security payments.

2.1.16. Tort Liability: The Federal Tort Claims Act does not cover Contractor or

Contractor’s nursing staff (Nurse Practitioner’s, Registered Nurse’s, CNA’s, LPN’s) and clinical staff (LCSW’s or LCMHC’). When a Contractor or Contractor’s nursing staff (Nurse Practitioner’s, Registered Nurse’s, CNA’s, LPN’s) and clinical staff

(LCSW’s or LCMHC’s) have been identified as a provider in a tort claim, the

Contractor shall be responsible for notifying their legal counsel and/or insurance carrier. Any settlement or judgment arising from a Contractor’s nursing staff (Nurse

Practitioner’s, Registered Nurse’s, CNA’s, LPN’s) and clinical staff (LCSW’s or

LCMHC’s) action or non-action shall be the responsibility of the Contractor and/or insurance carrier.

2.1.17. Key Personnel: In the residential treatment facility there must be, at a minimum a licensed / certified nursing staff member (NP, RN, LPN, CNA) ‘available ‘on call’ for consult 24 hours a day, 7 days a week. A licensed or certified medical staff member, (Nurse Practitioner, Registered Nurse, CNA, or LPN) should be employed by the facility to provide oversight and monitoring of the nursing care provided by the facility. All medical staff and clinical staff at the facility should have at least one

(1) year of experience in their medical field.

To provide a continuity of patient care to VA beneficiaries the Contractor shall provide designated personnel to perform the requirements of this contract.

Name: _________________________ Name: _________________________

MEDICAL TRANSITIONAL HOMELESS VETERANS HOUSING

(RESPITE-CONVALESCENT CARE) SERVICE

In the event the scheduled medical professional is unable to begin or complete an assigned shift, the contractor shall provide replacement medical professional coverage within 2 hours and notify the Contracting Office Representative (COR) at the (Salisbury VAMC) immediately of the schedule change.

2.1.18. Personnel Substitutions: During the first ninety (90) calendar days of performance, the Contractor shall make NO substitutions of key personnel unless the substitution is necessitated by illness, death, or termination of employment. The Contractor shall notify the CO, in writing, within five (5) calendar day (s) after the occurrence of any of these events and provide the information required below. After ninety (90) days, the Contractor shall submit the information required below to the CO at least sixty

(60) calendar days prior to making any permanent substitutions.

2.1.18.1. The Contractor shall provide a detailed explanation of the circumstances necessitating the proposed substitutions, complete resumes for the proposed substitutes, and any additional information requested by the CO.

Proposed substitutes shall have comparable qualifications to those of the persons being replaced. The CO will notify the Contractor within seven

(7) calendar days after receipt of all required information of the decision on the proposed substitutes. The contract will be modified to reflect any approved changes of key personnel.

2.1.18.2. For temporary substitutions where the key person shall not be reporting to work for three (3) consecutive workdays or more, the Contractor shall provide a qualified replacement for the key person. The substitute shall have comparable qualifications to the key person. Any period exceeding two weeks will require the procedure as stated above.

2.1.19. The Government reserves the right to refuse acceptance of any Contract personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility.

Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction, or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. Should the VA COS or designee show documented clinical problems or continual unprofessional behavior / actions with any Contractor’s key personnel Physician(s) and Technologist(s), s/he may request, without cause, immediate replacement of said Contractor’s nursing staff (Nurse Practitioner, Registered Nurse, CNA or LPN) and clinical staff

(LCSW’s or LCMHC) and non-clinical staff.

MEDICAL TRANSITIONAL HOMELESS VETERANS HOUSING

(RESPITE-CONVALESCENT CARE) SERVICE

The CO and COR shall deal with issues raised concerning Contractor’s nursing staff

(Nurse Practitioner, Registered Nurse, CNA, or LPN) and clinical staff (LCSW’s or

LCMHC) and non-clinical staff) conduct. The final arbiter on questions of acceptability is the Contracting Officer (CO).

2.1.20. Contingency Plan: Because continuity of care is an essential part of VAMC’s medical services, The Contractor shall have a contingency plan in place to be utilized if the Contractor’s nursing staff ((Nurse Practitioner, Registered Nurse, CNA or LPN) and clinical staff (LCSW’s or LCMHC) and non-clinical staff str unable to continue performance in accordance with the terms and conditions of the resulting contract.

3. VA HOURS OF OPERATION / SCHEDULING

3.1. VA Business Hours: Seven (7) days per week, twenty-four (24) hours per day on call by contacting the Salisbury Health Care System, Emergency

Department for emergent Veteran needs

3.1.1. The W.G. Bill Hefner Salisbury VA Medical Center will provide payment for qualified services as provided by the contracted Transitional Housing

Program as awarded to provide services for the population of the medically fragile Veteran. The Health Care for Homeless Veterans Program will render payment for each bed fully occupied.

3.1.2. Telemedicine or Teleconsultation: VA Video Connect is an offered service which can be utilized between the Veteran and the Veteran’s VA Medical

Center Provider(s) once determined clinically appropriate

3.1.3. Federal Holidays: The eleven (11) holidays are observed by the Department of

Veterans Affairs:

• New Year’s Day

• President’s Day

• Martin Luther King’s Birthday

• Memorial Day

• Juneteenth

• Independence Day

• Labor Day

• Columbus Day

• Veterans Day

• Thanksgiving

• Christmas

• Any day specifically declared by the President of the United States to be a national holiday

MEDICAL TRANSITIONAL HOMELESS VETERANS HOUSING

(RESPITE-CONVALESCENT CARE) SERVICE

When one of the holidays falls on Sunday, the following Monday shall be observed as a Federal Holiday. When a holiday falls on a Saturday, the proceeding Friday shall be observed as a Federal Holiday.

3.2. Off-Duty Hours Coverage: Not required by HCHV COR staff. Twenty-four hour coverage for emergent medical needs of the Veteran is provided by the Salisbury

Health Care System, Emergency Department.

4. CONTRACTOR RESPONSIBILITIES

4.1. Standards of Care: The contractor’s nursing staffs (Nurse Practitioner, Registered Nurse, CNA, or LPN) and clinical staff (LCSW’s or LCMHC) shall cover the range of services as would be provided in a medical transitional housing facility.

4.2. The contractors shall be responsible for meeting or exceeding VA standards in providing nursing staff (Nurse Practitioner, Registered Nurse, CNA or LPN) and clinical staff

(LCSW or LCMHC) in providing the standards of care which shall be of quality, meeting or exceeding current National Standards as established by:

4.2.1. The Professional Standards of The Joint Commission (TJC) http://www.jointcommission.org/emergency_department/.

4.2.2. The North Carolina Social Work Certification and Licensure Board (NCSWCLB).

http://ncswboard.org.

4.2.3. North Carolina Licensed Professional Counseling Board (NCBLCMHC) http://ncblcmhc.org

4.2.4. North Carolina Board of Nursing. http://ncbon.com.

4.2.5. The standards of the American Hospital Association (AHA) http://www.hpoe.org/resources?show=100&type=8

4.2.6. National League for Nursing Accrediting Commission www.nlnac.org.

4.2.7. The requirements contained in this PWS.

4.3. MEDICAL RECORDS

4.3.1. Authorities: Contractor’s nursing staff (Nurse Practitioner, Registered Nurse, CNA or LPN) and clinical staff (LCSW or LCMHC), providing healthcare services to VA patients shall be considered as part of the Department of Health and Human

Services and shall comply with the U.S.C.551a (Privacy Act), 38 U.S.C. 5701

(Confidentiality of claimants records), 5 U.S.C. 552 (FOIA), 38 U.S.C. 5705

(Confidentiality of Medical Quality Assurance Records) 38 U.S.C. 7332

(Confidentiality of certain medical records), Title 5 U.S.C. § 522a (Records

Maintained on Individuals) as well as 45 C.F.R. Parts 160, 162, and 164 (HIPAA).

http://www.jointcommission.org/emergency_department/ http://ncswboard.org/ http://ncblcmhc.org/ http://www.hpoe.org/resources?show=100&type=8 http://www.nlnac.org/

MEDICAL TRANSITIONAL HOMELESS VETERANS HOUSING

(RESPITE-CONVALESCENT CARE) SERVICE

4.3.3.Disclosure: Contractor’s nursing staff (Nurse Practitioner, Registered Nurse, CNA or

LPN) and clinical staff (LCSW or LCMHC) may have access to patient medical records however, Contractor shall obtain permission from the VA before disclosing any patient information. Subject to applicable federal confidentiality or privacy laws, the Contractor, or their designated representatives, and designated representatives of federal regulatory agencies having jurisdiction over Contractor, may have access to VA ‘s records, at VA’s place of business on request during normal business hours, to inspect and review and make copies of such records. The

VA will provide the Contractor with a copy of VHA Handbook 1907.1, Health

Information management and Health Records and VHA Handbook 1605.1, Privacy and Release of Information. The penalties and liabilities for the unauthorized disclosure of VA patient information mandated by the statutes and regulations mentioned above, apply to the Contractor.

4.7. Government Responsibility

4.7.1. Oversight of Service / Performance Monitoring / Contract Administration.

4.7.2. VA Support Personnel, Services or Equipment.

4.8. Scope of Care: The Contractor shall provide Transitional Community Based Residential

Housing comprised of staff from the following disciplines: nursing staff (Nurse

Practitioner’s, Registered Nurse’s, CNA’s, or LPN’s) and clinical staff (LCSW’s, LCMHC) to provide Homeless Veteran Transitional Housing services (Respite

Convalescent Program Assistance Housing) to eligible medically fragile beneficiaries of the Salisbury Health Care System within the W.G. “Bill” Hefner VA Medical Center as part of the Department of Veterans Affairs located in Salisbury, North Carolina.

4.8.1. The Contractor shall provide temporary residential housing to include but not limited to include beds, ADA compliant restroom and bathrooms, kitchen facilities, and related furnishings. Adequate safety and security measures in accordance with

VA standards and in conformance with state and local safety and health codes as outlined in 38 CFR, Section 17.53 shall be in place to provide optimum safety for

Veterans. The Contractor will provide food at a minimum of three (3) balanced meals daily and healthy snacks daily to each Veteran. The Contractor will provide personal hygiene items, first aid supplies, and lockable storage. The Contractor will have assistive equipment available at the facility for use by the Veteran to include: a pulse oximeter, blood pressure monitor, grab bars within the shower, ADA compliant bathrooms and an elevated, ADA compliant toilet seat.

http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1469 http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1469 http://www1.va.gov/vhapublications/viewpublication.asp?pub_id=1423 http://www1.va.gov/vhapublications/viewpublication.asp?pub_id=1423

MEDICAL TRANSITIONAL HOMELESS VETERANS HOUSING

(RESPITE-CONVALESCENT CARE) SERVICE

The Contractor shall provide services to beneficiaries for whom such care is specifically authorized by the Department of Veterans Affairs Medical Center herein after referred to as the VA. The Contractor shall provide to the VA, housing and supportive services for homeless Veterans in accordance with all terms and conditions, provisions and requirements listed herein for the sum listed above. This rate is inclusive of all services as may be necessary in the treatment of the Veteran.

Veterans may also meet any of the following criteria:

a) Homeless Veterans that are diagnosed with ongoing Mental Illnesses such as: Depression, Bipolar, Schizophrenia, Post Traumatic Stress Disorder (PTSD), and/ or Substance Use

Disorder.

b) Veterans discharged from the Military on or after September 11, 2001 and served in a theatre of operation or an area of conflict where the Veteran received hazardous duty pay and/or war of duty pay.

c) VA Eligible, Locally Registered, and Approved to enter program services: Individuals who served in the US Military must be determined eligible for VA benefits and services and registered at the local VA serving the local catchment area. All eligible Veterans must be approved by the VA Representative per the identified process prior to program admittance. While all other Emergency Housing Services require that Veterans be able to demonstrate Instrumental Activities of Daily Living (IADL) this is not a requirement under this contract for Veterans either at the time of entry or upon medical recovery. The

Veteran’s skills in these areas will be evaluated and program eligibility will be determined on a case by case basis by the contractor and the VA representative. The

Veteran is required to be independent within their Activities of Daily Living (ADL) for program eligibility.

1. REQUIREMENTS

The number of beds required will range from 5 to 20. These can be at one facility or spread out over several facilities. The facility will serve a minimum of 5 and a maximum of 20 Veterans at one location.

MEDICAL TRANSITIONAL HOMELESS VETERANS HOUSING

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2. ABSENCES AND CANCELLATION

a) The Contractor shall notify the authorizing VA of Veteran absences from the facility. Absences of the Veteran from the facility more than forty-eight (48) hours shall not be billed except those with the prior approval of the VA Liaison/COR. Should a Veteran be referred to a residential treatment facility, and then become absent in an unauthorized manner, payment for services for that Veteran to the Contractor would be continued for a maximum period of two days provided there is an active outreach attempt on the part of the Contractor to return the Veteran to the facility and a strong likelihood that the Veteran will return. Management of program dropout will be an element of quality assurance review of this program.

b) It is understood that the beneficiary may be provided facility care at the expense of the VA for a period not to exceed of that stated in the length of the treatment plan contracted, unless an extension of the authorization is provided by the VA.

4. CONDUCT

a) The Contractor shall make available to the VA, documentation deemed necessary by the VA to conduct utilization review audits for the mandated national evaluation study as required by the Section 2 of Public Law 100-6:

https://www.govinfo.gov/content/pkg/STATUTE-101-Pg92.pdf

b) Verification of the Contractors patient care quality for Veterans served and confidentiality of the information within the Veteran record will be utilized for the VA to determine completeness and accuracy of financial records prior to payment being rendered.

8. CONTRACTOR FACILITY

a) Facility shall be equipped with operational air conditioning /heating systems. In the event these systems are not operational for any reason, it is expected that the Contractor have the system repaired and operational within 5 business days. During extreme weather conditions if air conditioning or heating system cannot be repaired in 24 hours, alternate accommodations must be arranged within 48 hours.

b) Facility inside and outside shall be kept clean, free of dust, dirt, grime, mold, mildew, clutter, and/or other hazardous substances and damage noticeably detracting from the overall appearance at-all times.

c) Facility shall be equipped with a first aid kit, blood pressure monitor, pulse oximeter, ADA compliant bathrooms and toilets, grab bars securely located within the shower, fire extinguishers, fully charged and non-expired, fire/carbon alarms, and posted evacuation plans.

4.9. PERFORMANCE STANDARDS, QUALITY ASSURANCE (QA) AND QUALITY

IMPROVEMENT(QI)

https://www.govinfo.gov/content/pkg/STATUTE-101-Pg92.pdf

MEDICAL TRANSITIONAL HOMELESS VETERANS HOUSING

(RESPITE-CONVALESCENT CARE) SERVICE

4.9.1. Quality Management/Quality Assurance Surveillance: Contract personnel shall be subject to Quality Management measures, such as patient satisfaction surveys, timely completion of medical records, proper utilization of the Emergency Department

Integration Software (EDIS) used for patient tracking and Peer Reviews. Methods of

Surveillance: Focused Provider Practice Evaluation (FPPE) and Ongoing Provider

Practice Evaluation (OPPE). Contractor performance will be monitored by the government using the standards as outlined in this Performance Work Statement

(PWS) and methods of surveillance detailed in the Quality Assurance Surveillance

Plan (QASP). The QASP shall be attached to the resultant contract and shall define the methods and frequency of surveillance conducted.

4.9.2. Patient Complaints: The CO will resolve complaints concerning Contractor relations with the Government employees or patients. The CO is final authority on validating complaints. If the Contractor is involved and named in a validated patient complaint, the Government reserves the right to refuse acceptance of the services of such personnel. This does not preclude refusal in the event of incidents involving physical or verbal abuse.

4.9.3. The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility.

Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction, or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated

Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. The CO and COR shall deal with issues raised concerning Contractor’s conduct. The final arbiter on questions of acceptability is the

CO.

4.9.4. Performance Standards:

4.9.4.1. Measure: Provider Quality Performance

Performance Requirement: All Contractor’s nursing staff (Nurse

Practitioner, Registered Nurse, CNA, or LPN) and clinical staff (LCSW or

LCMHC) shall perform in accordance with clinical standards.

Standard: (100%) of care provided within clinical standards of care.

Acceptable Quality Level: 100% meet Standards

Surveillance Method: Ongoing Provider Performance Evaluation (OPPE) data pertinent to care performed for each provider working under this contract. OPPE data will review the following elements:

Frequency: Quarterly

A. Patient Care Performance

MEDICAL TRANSITIONAL HOMELESS VETERANS HOUSING

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B. Medical/Clinical knowledge

C. Practiced Based Learning and Improvement

D. Interpersonal and Communication Skills

E. Professionalism

F. System Based Practice

4.9.4.2. Measure: Qualifications of Key Personnel

Performance Requirement: All Contractor’s Registered Nurses (NP’s, RN’s, CNA’s and LPN’s) shall be certified as in accordance with the National

League for Nursing Accrediting Commission. www.nlnac.org. LCSW and

LCSWA shall be certified LCSW and LCSWA shall be certified LCMHC and LCMHCA shall be certified by the North Carolina Board of Licensed

Clinical Mental Health Counselors.

Standard: All (100%) Contract nursing staff (Nurse Practitioner, Registered

Nurses, CNA or LPN) and clinical staff (LCSW or LCMHC).

Acceptable Quality Level: 100%.

Surveillance Method: Verification and or documentation provided by the

Contractor upon request. Contractor provided documentation will be reviewed and verified by the Salisbury VAMC ED Director.

4.9.4.3. Measure: Scope of Practice & Privileging

Performance Requirement: Contractor’s nursing staff (Nurse Practitioner, Registered Nurses, CAN or LPN) and clinical staff (LCSW or LCMHC) should perform within their individual scopes of practice.

Standard: All (100%) Contractor’s nursing staff (Nurse Practitioner, Registered Nurse, CNA, or LPN) and clinical staff (LCSW or LCMHC should perform within their scope of practice 100% of the time.

Acceptable Quality Level: 100%. Contractor’s nursing staff (Nurse

Practitioner, Registered Nurse, CNA or LPN) and clinical staff (LCSW or

LCMHC) should perform within their scope of practice 100% of the time.

Surveillance Method: Direct Observation.

4.9.4.4. Measure: Patient Access

Performance Requirement: The Contractor shall provide patient access by contractor’s nursing staff (Nurse Practitioner, Registered Nurse, CNA or

LPN) and clinical staff (LCSW or LCMHC) in accordance with the operating hours and VA clinical schedule outlined in this PWS.

Standard: All (100%) Contractor’s nursing staff (Nurse Practitioner, Registered Nurse, CNA, or LPN) and clinical staff (LCSW or LCMHC are on time and available to perform services.

http://www.nlnac.org/

MEDICAL TRANSITIONAL HOMELESS VETERANS HOUSING

(RESPITE-CONVALESCENT CARE) SERVICE

Acceptable Quality Level: Contractor’s nursing staff (Nurse Practitioner, Registered Nurse, CNA or LPN) and clinical staff (LCSW or LCMHC) are on-time and available to perform services 95% of the time.

Surveillance Method: Periodic Sampling of Time and Attendance Sheets

4.9.4.5. Measure: Patient Safety

Performance Requirement: Patient safety incidents shall be reported using

Patient Safety Report. All incidents reported immediately (within 24 hours.)

Standard: All (100%) of patient safety incidents are reported using Patient

Safety Report within 24 hours of incident.

Acceptable Quality Level: 100% of patient safety incidents are reported using Patient Safety Report within 24 hours of incident.

Surveillance Method: Direct Observation

Frequency: Quarterly

4.9.4.6. Measure: Maintains licensing, registration, and certification

Performance Requirement: Updated Licensing, registration and certification shall be provided as they are renewed. Licensing and registration information kept current.

Standard: All (100%) licensing, registration(s) and certification(s) for

Contractor’s nursing staff (Nurse Practitioner, Registered Nurse, CNA or

LPN) and clinical staff (LCSW or LCMHC) shall be provided as they are renewed. Licensing and registration information kept current.

Acceptable Quality Level: 100% licensing, registration(s) and certification(s) for Contractor’s nursing staff (Nurse Practitioner, Registered

Nurse, CNA or LPN) and clinical staff (LCSW or LCMHC) shall be provided as they are renewed. Licensing and registration information kept current.

Surveillance Method: Periodic Sampling

4.9.4.7. Measure: Mandatory Training

Performance Requirement: Contractor shall complete all required training on time per VAMC policy.

Standard: All (100%) of required training is completed on time by

Contractor’s nursing staff (Nurse Practitioner, Registered Nurse, CNA or

LPN) and clinical staff (LCSW or LCMHC)

Acceptable Quality Level: 100% completions.

Surveillance Method: Periodic Sampling. Absence of Delinquent TMS

Reports.

MEDICAL TRANSITIONAL HOMELESS VETERANS HOUSING

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4.9.4.8. Measure: Privacy, Confidentiality and HIPAA

Performance Requirement:

Standard: All (100%) Contractor’s nursing staff (Nurse Practitioner, Registered Nurse, CNA or LPN) and clinical staff (LCSW or LCMHC should comply with all laws, regulations, policies and procedures relating to Privacy, Confidentiality and HIPAA.

Acceptable Quality Level: 100% compliance; no deviations.

Surveillance Method: Periodic Sampling; Contractor shall provide evidence of annual training required by VAMC, reports violations per VA

Directive 6500.6.

6. QASP PERFORMANCE REPORT DATE: ___________________

Measures PWS

Reference

Performance

Requirement

Standard Acceptable

Quality

Level

Surveillance

Method

Met

AQL/DID

NOT MEET

AQL- CPAR

RATING/

ADD

COMMENT

S

Provider

Quality

Performance

2.1.1 All Contractor’s nursing staffs

(Nurse Practitioner, Registered

Nurse, CNA, or LPN) and clinical staff (LCSW or

LCMHC) shall perform in accordance with clinical standards.

100% of care provided within clinical standards of care

100% OPPE

Qualifications of Key

Personnel

2.9 The Contractor will employ

licensed personnel to carry out the policies and responsibilities of the program. There must be, at a minimum, a licensed/certified nursing staff or designee of equivalent professional capability on duty such as an:

(NP, RN, LPN, or CNA) on the premises or residing at the contract facility and available for emergencies 24 hours per day, 7 days per week. In accordance with PWS

Requirements

All (100%)

Contractor’…