36C24623Q0383_1.docx

36C24623Q0383

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. SIGNAT

URE 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

565-23-2-025-0028 565-23-2-162-0028 36C24623Q0383 03-16-2023 B. Dawn Darden 757-617-9417 03-30-2023

1:00PM

EDT

Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667 X 621910 $20 Million N/A X 36C246 Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667 36C246 Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667

Department of Veterans Affairs Financial Services Center

PO BOX 149971

Austin TX 78714-9971 512-460-5049 512-460-5221 X See CONTINUATION Page

BASIC LIFE SUPPORT AND ADVANCE LIFE SUPPORT

AMBULANCE SERVICES FOR FAYETTEVILLE NC VA HEALTHCARE SYSTEM.

Period of Performance: One year from date of award with two (2) option years.

See Section B.2 for the Schedule of Services.

See Section B.3 for the Performance Work Statement.

See Section E.1 for the Instruction to Offerors.

This is a requirements type contract and an unrestricted procurement.

Offers shall be submitted IAW the elements and format stipulated in Section E, "QUOTE PREPARATION INSTRUCTIONS".

All technical questions shall be submitted by 11:00AM EST on March 22, 2023.

See CONTINUATION Page X X X Contracting Officer Table of Contents

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:

a. CONTRACTOR:

b. GOVERNMENT: Contracting Officer 36C246 Stephanie Thompson

Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667

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

3. INVOICES: Invoices shall be submitted in arrears:

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.

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

B.2 PRICE/COST SCHEDULE

ITEM INFORMATION

Basic Life Support Svc (BLS) /Advance Life Support Svc (ALS): STAT Base Rate, Load weight Only Contract Period: Base POP Begin: 05-01-2023 POP End: 09-30-2023 PRINCIPAL NAICS CODE: 621910 - Ambulance Services PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Basic Life Support Ambulance Svc (BLS)/ Advance Life Support Svc (ALS): Mileage (beyond the established mileage thresholds) This rate is in addition to the rate trip in LINE 0001 Contract Period: Base POP Begin: 05-01-2023 POP End: 09-30-2023

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Advance Life Support Svc: Base Rate (Non-Emergent) Load Weight Only

POP Begin: 05-01-2023 POP End: 09-30-2023

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Advance Life Support Svc: Base Rate (Emergent) Load Weight Only

POP Begin: 05-01-2023 POP End: 09-30-2023

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Advance Life Support Svc: Mileage (beyond the established mileage thresholds) This rate is in addition to the rate per trip of LINE ITEM 0003 Contract Period: Base POP Begin: 05-01-2023 POP End: 09-30-2023

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Special Mode Transport Svc: Base Rate Load Weight Only

POP Begin: 05-01-2023 POP End: 09-30-2023

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Special Mode Transport Svc: Mileage (beyond the established mileage thresholds) this rate is in addition to the rate trip of Line 0001 Contract Period: Base POP Begin: 05-01-2023 POP End: 09-30-2023

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Oxygen (when ordered)

POP Begin: 05-01-2023 POP End: 09-30-2023

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Basic Life Support Ambulance Svc (BLS)/Advance Life Support Svc (ALS) STAT Base Rate, Load weight Only Contract Period: Option 1 POP Begin: 10-01-2023 POP End: 09-30-2024

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Basic Life Support Ambulance Svc / Advance Life Support Svc: Mileage (beyond the established mileage thresholds)

Contract Period: Option 1 POP Begin: 10-01-2023 POP End: 09-30-2024

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Advance Life Support Svc: Base Rate (Non-Emergent) Load Weight Only

POP Begin: 10-01-2023 POP End: 09-30-2024

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Advance Life Support Svc: Base Rate (Emergent) Load Weight Only

POP Begin: 10-01-2023 POP End: 09-30-2024

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Advance Life Support Svc: Mileage (beyond the established mileage thresholds) This

Contract Period: Option 1 POP Begin: 10-01-2023 POP End: 09-30-2024

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Special Mode Transport Svc: Base Rate Load Weight Only

POP Begin: 10-01-2023 POP End: 09-30-2024

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Special Mode Transport Svc: Mileage (beyond the established mileage thresholds) this

Contract Period: Option 1 POP Begin: 10-01-2023 POP End: 09-30-2024

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Oxygen (when ordered)

POP Begin: 10-01-2023 POP End: 09-30-2024

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Basic Life Support Svc (BLS)/Advance Life Support (Svc): STAT Base Rate, Load weight Only Contract Period: Option 2 POP Begin: 10-01-2024 POP End: 09-30-2025

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Basic Life Support Svc/Advance Life Support Svc: Mileage (beyond the established mileage thresholds)

Contract Period: Option 2 POP Begin: 10-01-2024 POP End: 09-30-2025

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Advance Life Support Svc: Base Rate (Non-Emergent) Load Weight Only

POP Begin: 10-01-2024 POP End: 09-30-2025

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Advance Life Support Svc: Base Rate (Emergent) Load Weight Only

POP Begin: 10-01-2024 POP End: 09-30-2025

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Advance Life Support Svc: Mileage (beyond the established mileage thresholds) This

Contract Period: Option 2 POP Begin: 10-01-2024 POP End: 09-30-2025

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Special Mode Transport Svc: Base Rate Load Weight Only

POP Begin: 10-01-2024 POP End: 09-30-2025

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Special Mode Transport Svc: Mileage (beyond the established mileage thresholds) this

Contract Period: Option 2 POP Begin: 10-01-2024 POP End: 09-30-2025

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Oxygen (when ordered)

POP Begin: 10-01-2024 POP End: 09-30-2025

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

B.3 PERFORMANCE WORK STATEMENT (PWS)

1.0 PURPOSE:

The Fayetteville NC VA Coastal Healthcare System requires a qualified contractor to furnish all labor, materials, insurance, licenses and equipment to provide safe and comfortable services necessary for both Special Mode Transportation for Beneficiary Travel eligible Veterans to include the Wilmington Healthcare Center catchment area and emergent inter-facility advanced life support (ALS)/basic life support (BLS) ground ambulance transport services for the Fayetteville VA Medical Center (VAMC) Emergency Department as needed by FNCVAMC. The contractor shall furnish twenty-four (24) hour ambulance service seven (7) days a week for the beneficiaries of the Fayetteville VAMC Emergency Department, Fayetteville, North Carolina. Contractor shall assist the patient as needed to access the vehicle for transportation. This may include, but is not limited to, bed to stretcher or stretcher to bed transfer when necessary.

The Fayetteville NC VA Coastal Healthcare System is seeking a Firm Fixed-Price contract vehicle to procure these services in a Base plus two option periods.

2.0 BACKGROUND:

The Department of Veterans Affairs Medical Center, 2300 Ramsey Street, Fayetteville, North Carolina, provides diagnostic and therapeutic services in medicine, surgery, rehabilitation medicine, psychiatry, and skilled nursing home care for the beneficiaries of the Department of Veterans Affairs. This facility also provides ambulance services to those veterans not requiring hospitalization. The Contractor shall provide STAT Basic Life Support (BLS) and/or Advanced Life Support (ALS) Ambulance Services. Contractor will respond and be onsite ready to deliver services 15 minutes from the requested service time.

3.0 ACRONYMS:

4.0 REQUIREMENTS:

The Contractor shall provide the following Ambulance Services on an as-needed basis:

4.1 BASIC LIFE SUPPORT (BLS):

Basic Life Support (BLS) Services is defined as a basic level of pre-hospital and inter-hospital emergency care and non-emergency medical services that includes airway management, cardiopulmonary resuscitation (CPR), control of shock and bleeding and splinting of fractures, as outlined in the Basic Life Support national curriculum of the United States Dept. of Transportation and any modifications to that curriculum specified in rules adopted by the Department.

4.1a Staffing:

For BLS services, each ambulance shall be staffed by Emergency Medical Technicians with a current North Carolina EMT-B license or as required by local, state, or regional Government, or public entity by which the ambulance services are governed.

4.2 ADVANCED LIFE SUPPORT (ALS):

Advanced Life Support (ALS) Services is defined as an advanced level of pre-hospital and inter-hospital emergency care and non-emergency medical services that includes BLS, electrocardiography, cardiac defibrillation, cardiac monitoring, IV therapy, administration of drugs and solutions, use of adjunctive medical devices, trauma care, and other authorized techniques and procedures.

4.2a Staffing:

For ALS service, each ambulance shall be staffed by Advanced Emergency Medical Technician-Paramedics with a current North Carolina EMT-P license or as required by local, state, or regional Government, or public entity by which the ambulance services are governed.

4.2b Typical situations when Fayetteville NC VA Coastal Healthcare System would require ALS Services:

· Patients with IVs

· Patients requiring cardiac monitoring with defibrillator and pacing capabilities

· Establishing or maintaining IV to include antiarrhythmic, narcotics, vasopressors and IV fluids

· Monitoring/maintaining respiratory status to include intubation and pulse oximetry

4.3 CONTRACTOR PERSONNEL:

Contractor employees shall be courteous and conduct themselves in a business-like manner at all times while providing services under this agreement. The contractor shall ensure that the following personnel (Emergency Medical Technicians (EMT- Basic, Intermediate and Paramedics), Non-Emergency Attendant/ Drivers) requirements are met:

a) Ensure and certify that personnel performing the services required under this contract are properly licensed and fully trained in the use of the vehicle and equipment that will be used in the carrying out contracted services.

b) The contractor shall ensure minimum staffing requirements as mandated by the State of North Carolina are met. Each vehicle shall be operated with sufficient personnel for adequate patient care, at least one of whom shall be an Emergency Medical Technician (EMT B, I or P Level). Contractor must maintain records of each employee as to character and physical capabilities of performing the services of a driver and/or attendant.

Qualifications: The contractor must be licensed as advanced and basic care transport by the ambulance service by the State of North Carolina to provide Emergency Medical Services. The contractor must maintain licensure/certification with the State of North Carolina, throughout the life of the contract. License/certification lapses or expiration is grounds for termination of the contract of discontinuance of further ordering from this contractor. The contractor must maintain documentation demonstrating they meet all requirements of Federal, State, County or City codes regarding operation of this type of service. Documentation shall be made available to the VA immediately upon request for the duration of this contract. The contractor shall comply with the provisions of the Privacy Act of 1974, the Health Insurance Portability and Accountability Act (HIPAA) of 1996, as well as all applicable regulations pertaining to fire safety and blood borne pathogens, which will be provided by the Contracting Officer’s Representative (COR).

A record of each employee as to character, physical capabilities, and qualifications performing the duties of an ambulance driver or attendant must be maintained at the contractor's establishment and made available for inspection upon request of the contracting officer or COR.

A roster of Emergency Medical Technicians (EMT-All Levels), and Non-Emergency Attendant Drivers (EMTs and LPNs if used to provide these services) shall be furnished to the contracting officer or COR upon request, and shall contain the following information:

· Name

· EMT License Number

· Driver’s License Number

· Date of Initial Training

· Date of Refresher Training

4.3a Paramedics and EMTs Paramedics, EMTs and other medical personnel (as applicable), shall at all times meet the qualifications specified, as well as all applicable federal, state and local Government laws, regulations, and standards. They shall be certified, licensed, or otherwise officially recognized by local, state, or regional Government or public entity by which the emergency service is governed.

4.3b Non-Emergency Attendants/Drivers

i. Attendants/drivers shall be capable of administering oxygen and have successfully completed the Standards and Advanced First Aid Courses of the American Red Cross or US Bureau of Mines or equivalent. Proof in the form of a current certificate for the successful completion of such training must be provided upon request.

ii. All ambulance drivers shall have a valid driver’s license in accordance with state requirements for their place of operation and the services they perform.

4.3c Driver Conduct The following acts are not permissible by drivers which provide services under this agreement or while on Fayetteville NC VA Healthcare System premises:

i. Use of intoxicating liquors, narcotics, or controlled substances of any kind (excluding Dr.’s prescriptions which do not impair driving ability), while on duty or reporting for duty.

ii. Gambling in any form.

iii. Smoking and other uses of tobacco while on duty.

iv. Carrying of pistols, firearms, or concealed weapons.

v. Resorting to physical violence to settle a dispute with a fellow employee(s), customer(s), or the general public while on duty.

vi. Spitting, or any other unsanitary, or offensive practice or behavior while on VAMC premises

vii. Use of loud, indecent, or profane language and/or making threatening or obscene gestures towards customers or other employees.

viii. Stopping for personal business, including use of a restroom, while a patient is in the vehicle.

ix. The driver shall not leave the vehicle with the key in the ignition at any time.

x. Engaging a customer in a verbal confrontation in an attempt to settle a disagreement. Should a disagreement arise, the driver is to contact his dispatcher/supervisor via the radio system.

xi. Soliciting or accepting tips from customers, companions, or others at any time.

4.3d Certification/Licensing Requirements Prior to performing any services under this agreement, the Contractor shall provide evidence of required training, certifications, licensing, and any other qualifications of any personnel performing services under this agreement. If the Contractor wishes to add or replace personnel, it shall provide the above requirements to the COR for approval.

4.3e Tuberculosis (TB) Exposure Control Policy

i. Prior to performance any services under this agreement, the Contractor shall provide Fayetteville NC VA Healthcare System their policy on TB exposure and control, to include TB decontamination.

ii. The Contractor shall have its personnel tested for TB and provide each of these test results to the COR.

4.5 ADDITIONAL SERVICES:

Contractor shall be required to transport patient luggage, medical records, medication, and comfort items from pickup points to destination at no additional cost to the Government. Luggage to be transported is restricted to a suitcase or travel case type bag when patients are transported to Fayetteville NC VA Healthcare System.

The ambulances used under the terms of this contract shall be licensed and meet the minimum requirements governing emergency vehicles that is mandated by the State of North Carolina. Licensure must be maintained in a status throughout the term of the contract and a copy of updates provided accordingly. The contractor must have an adequate number of vehicles to meet the requirements of this contract, along with the evidence of satisfactory vehicle inspection prior to use under this contract. Every ambulance operated must have at least two personnel. At least one person shall be -certified in cardiopulmonary resuscitation or first aid and the person in the emergency compartment shall be certified at the least as an emergency medical technician-basic and/or critical care, EMT-Paramedic preferred.

5.1a The Contractor shall have the capabilities to sufficiently handle simultaneous calls and meet or exceed the minimum time requirements (see section 6.3 under ORDERS).

5.1b BLS vehicles are required to have at a minimum an emergency technician (EMT) attending the patient and a driver meeting minimum ambulance driver requirements of the State of North Carolina.

5.1c Ambulances shall meet all current applicable Federal, State and local regulations and specifications including, but not limited to, licensing, registration, and safety standards. Appropriate licensing by the State of North Carolina is required.

5.1d Specifically, ALS vehicles are required to have at a minimum a paramedic attending the patient and an EMT, meeting requirements as a driver. Vehicles and equipment used in the performance of this contract must be clean, orderly, and in excellent operating condition always, and records of maintenance/preventive maintenance must be made available for inspection upon request. All vehicles shall be smoke free and have “No Smoking” signage posted. Contractor must present standard operating procedure for vehicle and equipment cleaning between patients and provide evidence of compliance with such cleaning processes subject to verification by the COR. The contractor shall notify the contracting officer of any vehicle and equipment added/changed/deleted after award of contract. The Department of Veteran Affairs reserves the right to thoroughly inspect contractor vehicles prior to award and at any time during performance of any awarded contract. Mechanical defects noted at the time of inspection must be corrected and the ambulance (s) re-inspected prior to use under the contract.

5.2 VEHICLE MEDICAL EQUIPMENT AND SUPPLIES

Every ambulance in service under this contract shall be equipped as required by the State of North Carolina and carry at least the minimal equipment necessary for the type of service to be provided, as determined by standards adopted by the State of North Carolina. Each emergency care vehicle shall have patient compartment facilities, oxygen and suction systems and equipment, environmental climatic equipment communications and additional systems equipment accessories and supplies as required by the applicable codes, rules and regulations established by Federal, State and Local regulating authorities. The contractor will be responsible for all medical and non-medical supplies needed to perform services. On Advanced Life Support vehicles, the contractor shall supply intravenous administration pump with the ability to maintain and administer at least two liquid medications in a precise volume-controlled manner.

5.2a The following equipment shall be supplied, but not limited to for proper patient care:

· Medication administration device

· Intravenous infusion pump that delivers a specific amount of fluids

· Medications

· Infusion modules

· Pump Infusion Sets

· Cardiac Monitor

· Defibrillator capable of delivering a minimum up to 200 joules biphasic, monitor 12-leads, synchronize cardioversion, and cardiac pacing

· Equipment to monitor waveform capnography of a breathing and/or tracheal intubated patient

5.2b Linen supplies are the responsibility of the contractor.

6.0 ORDERS:

An order is defined as one incidence of a request for service (BLS or ALS service). But for exceptions approved by authorized VA ordering employees, no more than one (1) patient will be transported per order.

Response Options

Service Level

6.6c Contractor is expected to meet the above response times, not meeting the above response times will result in a deduction from the trip value.

Minutes Late Deduction

61 or more Trip shall be at no cost to the VA *Trip value is the total of the basic trip plus any additional mileage, if applicable, for the

8.0 PATIENT WELFARE AND ABUSE:

8.1 The Contractor shall be held responsible for the patient’s welfare during transport. Contractor shall be held responsible for patient and/or Government property during transport. Any damaged or lost walkers, wheelchairs, crutches, or personal belongings will be replaced at the Contractor’s expense.

8.2 Fayetteville NC VA Healthcare System requires the Contractor to exercise extreme caution and care in the handling of patients. Any abuse of patients will be grounds for default action or immediate termination of the agreement.

8.3 The Contractor shall take into consideration that they will be transporting ill patients. Drivers are required to observe speed limits, sweep vehicles clean, and wash the exteriors periodically. Drivers are to escort patients to and from point of pick-up and destination.

9.0 CANCELLATIONS/NO SHOWS:

9.1 CANCELLATIONS

For trips in which the Contractor is notified of a cancellation before the vehicle is dispatched, there will be no charge to the Government.

9.2 NO-SHOWS

A “no-show” is defined as an order that is cancelled after the Contractor has dispatched a vehicle and the vehicle is enroute or has arrived at the pick-up location, and there is no longer a need for this patient transport. The Contractor may request one-way reimbursement for no-shows, which are based on the base rate for the service (BLS, ALS), and one-way mileage (BLS, ALS) accrued enroute to the pick-up location at time of cancellation. Mileage for no-show cancellations shall be confirmed by the Contractor and reported to the COR or designee as soon as possible from the time of cancellation.

9.3 ADDITIONAL CHARGES

There will be no additional charge for time spent at the site (during, or after the normal hours of coverage) awaiting the arrival of additional Contractor staff and/or delivery of parts.

10.0 INCIDENT REPORTING:

10.1 The Contractor shall be required to notify the Beneficiary Travel Department or AOD of any accidents, and/or safety problems that occur while the patient is being transported. This notification shall occur within one (1) hour by telephone, and if requested by Fayetteville NC VA Healthcare System, a written report of the event shall be delivered to the Fayetteville NC VA Healthcare System Official by the close of business the next working day.

10.2 The COR/designee will monitor the service provided. The Contractor shall cooperate with the COR in providing information and answering questions in a timely manner. The Contractor shall promptly inform the COR of any complaints received directly from patients. If warranted, Fayetteville NC VA Healthcare System may conduct incident investigations and require a written response from the Contractor within 48 hours.

11.0 INVOICING PROCEDURES:

With the exception of “no shows” defined in 9.2, the Contractor shall invoice for loaded (patient onboard) services and mileage only. Contractor shall submit an electronic invoice by the tenth day of each month for services that occurred the preceding month. Electronic invoices shall be submitted to the VAFSC (see pg. 4); invoices shall not include patient information. Also, a copy of the invoice along with secondary documentation shall be sent to Beneficiary Travel and must include the following information:

UNDER NO CIRCUMSTANCES ARE VA BENEFICIARIES, THIRD PARTY INSURANCES, MEDICARE OR MEDICAID TO BE BILLED FOR SERVICES PERFORMED UNDER THIS AGREEMENT WHICH ARE AUTHORIZED BY FAYETTEVILLE NC VA HEALTHCARE SYSTEM.

12.0 CONTRACTOR’S QUALITY CONTROL PROGRAM:

Contractor shall establish and maintain a complete Quality Control Program (QCP) to ensure the requirements of this agreement are provided as specified. The QCP shall address processes and procedures to ensure services are performed in accordance with all state and local standards and codes. Contractor’s QCP shall include the following at a minimum:

13.0 SECURITY AND PRIVACY CONTROL:

The Authorization and Accreditation (A&A) requirements of VHA Handbook 6500.6 do not apply to this requirement, therefore, a Security Accreditation Package is not required. No A&A or MOU/ISA is required. Sensitive information exposure as part of this agreement involves applicable security controls within the facility as part of the Fayetteville NC VA Healthcare System /VA Information Security.

If there are any questions related to privacy, please have a member of your staff, or yourself, contact the VA Privacy Service at (202)461-6309. If there are any questions related to the Information Security, contact the Office of Cyber Security at (304)262-7733.

14.0 THE JOINT COMMISSION (TJC) AND OTHER SPECIAL REQUIREMENTS:

Where the agreement does not require Joint Commission accreditation or other regulatory requirements regarding worker competency, the Contractor must perform the required work in accordance with Joint Commission standards. The Contractor is required to develop and maintain the following for each Contractor employee working on this agreement:

Contractor will provide current copies of these records to the COR at time of agreement award and upon completion of the agreement or upon request, for each Contractor employee working on the contract.

15.4 Rates will apply twenty-four hours a day seven (7) days a week. Payment for mileage traveled beyond the county limits will be limited to “One Way Only” for the distance over which the patient is transported. Mileage cost will be paid in addition to the applicable rate per trip for any trip entirely within the city and county limits. Trip mileage shall be determined by the latest edition of the Google standard Mileage Guide. The Contractor shall receive the base rate quoted in the schedule for all one-way trips ordered. The base rate shall constitute full compensation for one-way trips which go not exceed the mileage threshold as defined herein. The Contractor shall also receive reimbursement of mileage charges for any mileage less than the mileage threshold. The odometer reading at the time of the county line is crossed shall be provided and the odometer reading at the arrival of destination.

The contractor must maintain documentation demonstrating they meet all requirements of Federal, State, County or City codes regarding operation of this type of service.

16.0 TRAINING

Contractor shall be responsible for supervising the daily services provided under this agreement; and shall provide and document orientation and training programs for all employees regarding safety, equipment management, and patient confidentiality appropriate to the service provided.

Contractor shall provide orientation to designated staff regarding agency policy and procedures, and any agency processes necessary for cooperative functioning between the agency and Fayetteville NC VA Healthcare System. Up-dates and refreshers shall be provided upon request and when policy or procedures change.

Contractor may be requested to take part in training in conjunction with Fayetteville NC VA Healthcare System staff to ensure emergency response quality.

Emergency Medical Technicians providing emergency services on this contract must meet the following training requirements:

a. Have completed training in accordance with the standard published by the US Department of Health and Human Services (PL 93-154) and follow State of North Carolina…