36C24818Q0683-002.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. DUNS: DUNS+4:

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 X 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. 2/2012)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 76

516-18-1-890-0002

36C24818Q0683 06-08-2018

Mark Cline 727-399-3342 07-09-2018

1:00 PM EST

Department of Veterans Affairs Network Contracting Office 8 (248) Room 327, Bldg. 2 10,000 Bay Pines Blvd Bay Pines FL 33744

X 100

X

532283

$32.5 Million

N/A

X

MCC: 90D

Department Of Veteran Affairs C.W. Bill Young VA Medical Center Bldg 100 Warehouse 10,000 Bay Pines Blvd.

Bay Pines FL 33744

00516

Department of Veterans Affairs Network Contracting Office 8 (NCO 8) C.W. Bill Young VA Medical Center 10000 Bay Pines Blvd. Room 327, Bldg. 2 Bay Pines FL 33744

Department of Veterans Affairs

FMS-VA-2(101)

Financial Services Center PO Box 149971 Austin TX 78714-9971

The Contractor shall provide Home Oxygen to support the Bay Pines VA Healthcare System.

This contract will be awarded for a base year with four (4)

- one (1) year options.

Reference Attachment 1 for the detailed price/cost schedule.

This RFQ is a service disabled veteran owned small business (SDVOSB)/veteran owned small business (VOSB) set-aside. Please see Addendum to FAR 52.212-2 Evaluation of Commercial Items on page 53.

X

X 1

Brett Cook

36C24818Q0683

Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 LIMITATIONS ON SUBCONTRACTING-- MONITORING AND COMPLIANCE (JUN

2011)

B.3 SUBCONTRACTING COMMITMENTS--MONITORING AND COMPLIANCE (JUN

2011)

B.4 PRICE/COST SCHEDULE

ITEM INFORMATION

B.5 DELIVERY SCHEDULE

B.6 PERFORMANCE WORK STATEMENT

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS (JAN

2017)

C.2 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (JAN 2018)

C.3 52.216-21 REQUIREMENTS (OCT 1995)

C.4 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.5 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

C.6 VAAR 852.203-70 COMMERCIAL ADVERTISING (JAN 2008)

C.7 VAAR 852.219-11 VA NOTICE OF TOTAL VETERAN-OWNED SMALL BUSINESS

SET-ASIDE (JUL 2016) (DEVIATION)

C.8 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV

2012)

C.9 VAAR 852.237-7 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE

(JAN 2008)

C.10 VAAR 852.237-70 CONTRACTOR RESPONSIBILITIES (APR 1984)

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

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 DETAILED PRICE/COST SCHEDULE ........................................... SEE ATTACHMENT 1 D.2 CONTRACTOR CERTIFICATION .................................................. SEE ATTACHMENT 2 D.3 QUALITY ASSURANCE SURVEILLANCE PLAN ........................ SEE ATTACHMENT 3 D.4 ORGANIZATIONAL CONFLICT OF INTEREST .......................... SEE ATTACHMENT 4 D.5 CONTRACTOR RULES OF BEHAVIOR ........................................ SEE ATTACHMENT 5 D.6 PAST PERFORMANCE QUESTIONNAIRE ................................... SEE ATTACHMENT 6

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS (JAN 2017)

E.2 52.212-2 EVALUATION—COMMERCIAL ITEMS (OCT 2014)

E.3 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL

ITEMS (NOV 2017)

E.4 52.209-5 CERTIFICATION REGARDING RESPONSIBILITY MATTERS (OCT 2015) 71

E.5 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (JUL 2013)

E.6 52.216-1 TYPE OF CONTRACT (APR 1984)

E.7 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.8 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION

(JAN 2008)

E.9 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (JAN 1998)

E.10 52.252-1 RFQ PROVISIONS INCORPORATED BY REFERENCE (FEB 1998)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

(continuation from Standard Form 1449, block 18A.)

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. Contractor: __________________________________________ Title: __________________________________________ Address: __________________________________________ Telephone: __________________________________________ Facsimile: __________________________________________ E-mail: __________________________________________ Federal Taxpayer Identification ___________________________________________ Number Dun and Bradstreet Number ___________________________________________

b. Government:

Administrative Contracting Officer 36C248

Mark Cline Department of Veterans Affairs Network Contracting Officer (NCO) 8 10000 Bay Pines Blvd, Bldg 2

Phone: 727-399-3342

Contracting Officer 36C248

Brett Cook Department of Veterans Affairs Network Contracting Officer (NCO) 8 10000 Bay Pines Blvd, Bldg 2

Phone: 727-399-3326

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] Monthly

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.

Department of Veterans Affairs Financial Services Center P.O. Box 149971 Austin TX 78714-9971

5. ACKNOWLEDGMENT OF AMENDMENTS: The quoter acknowledges receipt of amendments to the RFQ numbered and dated as follows:

AMENDMENT NO DATE

6. REQUEST FOR QUOTES : Quotes for furnishing items identified within the schedule will be submitted electronically to the Contract Specialist at Mark.cline@va.gov until the date and time specified in block eight (8) of this RFQ.

7. CAUTION: Quoters must complete and return all information designated in FAR 52.212-1, Instructions to Quoters – Commercial Items, Paragraph (b) prior to the time specified in block 8 of SF1449 in order to be considered for award. Late submissions, Modification, and Withdrawals: See Provision 52.212-1. All quotes are subject to all terms and conditions of this RFQ.

8. POST AWARD ORIENTATION: The Contracting Officer will schedule a post award orientation conference for contract orientation purposes as required by IL 003A3-12-04.

http://www.va.gov/oal/docs/library/ils/il12-04.pdf

B.2 LIMITATIONS ON SUBCONTRACTING-- MONITORING AND

COMPLIANCE (JUN 2011)

This solicitation includes FAR 52.219-4 Notice of Price Evaluation Preference for HubZone Small Business Concerns. Accordingly, any contract resulting from this solicitation will include this clause. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) retained by VA to assist in assessing the contractor's compliance with the limitations on subcontracting or percentage of work performance requirements specified in the clause. To that end, the support contractor(s) may require access to contractor's offices where the contractor's business records or other proprietary data are retained and to review such business records regarding the contractor's compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor's compliance with the limitations on subcontracting or percentage of work performance requirement.

B.3 SUBCONTRACTING COMMITMENTS--MONITORING AND

COMPLIANCE (JUN 2011)

This solicitation includes VAAR 852.215-70, Service-Disabled Veteran-Owned and Veteran-Owned Small Business Evaluation Factors, and VAAR 852.215-71, Evaluation Factor Commitments.

Accordingly, any contract resulting from this solicitation will include these clauses. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) to assist in assessing contractor compliance with the subcontracting commitments incorporated into the contract. To that end, the support contractor(s) may require access to the contractor's business records or other proprietary data to review such business records regarding contract compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor compliance with the subcontracting commitments.

B.4 PRICE/COST SCHEDULE

The Government intends to award a Requirements contract for home oxygen to support the Bay Pines VA Healthcare System to a Service Disabled Veteran Owned Small Business (SDVOSB) or Veteran Owned Small Business (VOSB).

Post Award Conference: The Contracting Officer will schedule a post award conference for contract orientation purposes.

Pricing Instructions: The quoter is instructed to complete the unit price, amount, and grand total below.

Quoters must fill out the cells in the following columns for each CLIN. For pricing and evaluation purposes, quoters must also complete the additional detailed price/cost schedule found under Attachment 1 of this RFQ. The total amounts of the detailed price schedule under Attachment 1 must mirror the totals in the Item Information below.

ITEM INFORMATION

ITEM

NUMBE

R

DESCRIPTION OF

SUPPLIES/SERVIC

ES

QUANTIT

Y

UNI

T UNIT PRICE AMOUNT

0001 Home Oxygen to support the Bay Pines VA Healthcare System (Base Year:

10/1/2018 - 9/30/2019)

1.00 YR ________________

1001 Home Oxygen to support the Bay Pines VA Healthcare System (Option Year 1: 10/1/2019 - 9/30/2020)

1.00 YR ________________

2001 Home Oxygen to support the Bay Pines VA Healthcare System (Option Year 2: 10/1/2020 – 9/30/2021)

3001 Home Oxygen to support the Bay Pines VA Healthcare System (Option Year 3: 10/1/2021 – 9/30/2022)

4001 Home Oxygen to support the Bay Pines VA Healthcare System (Option Year 4: 10/1/2022 – 9/30/2023)

GRAND TOTAL ________________

B.5 DELIVERY SCHEDULE

ITEM NUMBER QUANTITY

DELIVERY

DATE

1.00 30 Sep 2019

1.00 30 Sep 2020

1.00 30 Sep 2021

1.00 30 Sep 2022

1.00 30 Sep 2023

B.6 PERFORMANCE WORK STATEMENT

1.0 - Scope:

The Department of Veterans Affairs (VA) Bay Pines VA Healthcare System (BPVAHS) located at 10000 Bay Pines Blvd, Bay Pines, Florida has a requirement for Home Oxygen. The Contractor shall provide all supplies, materials, equipment, labor, supervision, management, transportation, safety management, infection control, repairs, maintenance and in-service training for patients to include patient education.

The Contractor shall furnish, provide, install and service medical oxygen equipment, high-pressure cylinder, concentrator and/or liquid systems, portable systems, emergency back-up systems and supplies to eligible VA patients as required by the BPVAHS. The Contracting Officer’s Representative (COR) or designee will provide the Contractor with notification to initiate individual patient service requirements via fax or encrypted electronic means (telephonic for emergencies) and will also provide the Contractor with notification of VA initiated discontinuance of home oxygen. The Prosthetics and Sensory Aids Service (PSAS) staff will notify the vendor that a delivery shall commence by fax, telephonically or by encrypted e-mail. The vendor shall confirm receipt of order immediately and prior to delivery.

2.0 - Geographic Area of Coverage:

The Contractor is responsible for deliveries to VA patients in the following Florida counties:

Pinellas, Lee, Collier, DeSoto, Hardee, Highlands, Manatee, Pasco, Sarasota, Hernando, Polk and Charlotte.

MONTHLY AVERAGE: 877 patients

Distribution of patients on Bay Pines Home Oxygen will vary from month to month as patients are added and discharged from the program for a variety of reasons.

3.0 - Contractor Qualifications:

The Contractor shall possess all licenses, permits, accreditations, and certificates as required by local, state and federal law. The Contractor shall meet the Home Care part of the Joint Commission (JC) standards. The Contractor shall meet or exceed Join Commission accreditation of healthcare standards.

The Joint Commission standards can be accessed at www.jointcommission.org. The Contractor shall maintain this accreditation through the life of the contract and evidence of accreditation shall be submitted to the Contracting Officer (CO) and COR prior to contract award and at the time of option exercise. If the Contractor is resurveyed by an accrediting body during the contract term, the contractor shall notify the Contracting Officer of survey date, the outcome of the survey and provide copies of new certificates as issued.

The contractor shall have a physical location at award of the contract which houses the service office, warehouse, dispatch of vehicles and other functions related to the performance of the contract within the Bay Pines VA catchment area.

The Contractor shall have at least three (3) years’ experience in successfully administering basic home oxygen, aerosol therapy to adult and geriatric patients and experience in providing Home Oxygen equipment and supplies for gas 02, liquid 02, and ventilators.

The Contractor shall replace all appropriate BPVAHS authorized equipment presently located in homes of patients with his/her own equipment as soon as possible after award, but not to exceed 30 calendar days from the date of contract award. The change shall include delivery, setup, instructions and shall be accomplished with the least disruption in home oxygen to the VAMC patient as possible. Cost will be prorated upon setup and discontinuance with equipment pickup no more than one billing cycle.

All services will be performed in the patient’s place of residence. The equipment needs are subject to change as determined by the prescribing physician.

4.0 - Work Hours:

The Contractor shall, at a minimum, provide home oxygen in performance of this contract through scheduled visits, Monday through Friday between the hours of 8:00am and 4:30pm EST. Exceptions shall include the case of emergencies.

The VA observes the ten (10) Federal Holidays listed below:

New Year’s Day, Martin Luther King’s Birthday, Presidents Day, Memorial Day, Independence Day, Labor Day, Columbus Day, Veteran’s Day, Thanksgiving Day and Christmas Day.

5.0 - Emergencies:

The Contractor shall have an established communication system that supports 24-hour emergency services seven days a week. The Contractor shall be able to provide home oxygen at the patient’s home within a maximum of four (4) hours of call.

The Contractor shall ensure all patients have a minimum of non-electrical oxygen supply to last three times the Contractor’s response time to a call. The minimum supply shall take into account each patient’s prescription flow-rate and distance from the Contractor’s location; actual supply levels may differ from patient to patient, as long as each patient has oxygen supply to last a minimum of three times the Contractor’s response time. If the Contractor is unable to respond to an emergency service call within four (4) hours a written explanation of Contractor’s inability to provide emergency service shall be provided to the COR or designee within one (1) business days. Liquid oxygen supply may be considered for backup oxygen; however oxygen must be maintained at the minimum three times the Contractor’s response time, and the cost of any additional equipment such as extra stationary units used solely to maintain the minimum level of backup oxygen shall be done by the Contractor.

The Contractor shall notify the COR or designee immediately in the event of a disaster, natural or otherwise, that may affect the home oxygen covered under the contract.

Contractor shall submit an Emergency Contingency Plan for natural disasters with a detailed proposal.

An updated Emergency Contingency Plan shall be provided annually to the COR and in addition, the Contractor will perform with the COR during yearly hurricane or natural disaster drills as decided by BPVAHS leadership. Contractor shall provide names and phone numbers of suppliers that will provide home oxygen in the event of any disaster where the Contractor cannot meet the needs of VA patients.

6.0 - Patient Travel:

In some instances the patients may travel out of the service area and require oxygen for travel. The Contractor shall be responsible for subcontracting for oxygen for these patients. The subcontract vendor shall comply with JC standards. The Contractor shall instruct and inform patients in writing and patients must agree that they will be financially responsible for any/all non-returned equipment taken outside the catchment area. The Contractor shall obtain the patient’s signature indicating that they agree to the terms.

It shall be the Contractor’s responsibility to invoice the BPVAHS separate from the monthly billing charges to be paid on an individual basis. Invoices received directly from the sub-contractor shall be rejected. The BPVAHS will be responsible for the first ninety (90) days after a patient moves to another location. It will be the patient’s responsibility to enroll at the nearest VHA, make an appointment with Respiratory/Pulmonary for transfer of home oxygen and receive a new prescription. In cases involving vacation travel (via automobile, marine vessel, and/or air) contractor shall provide Contractor owned transport loaner concentrator for travel.

The Contractor shall be responsible for infection control and function/maintenance check prior to issue/reissue.

7.0 - Patient Assessment:

The Contractor shall provide an in-home initial patient setup and installation of prescribed equipment within six (6) hours of notification. The Contractor shall provide the patient a welcome packet and complete a Home Oxygen Equipment check when required, per manufacturer’s instructions, or complete quarterly at a minimum. An adhesive sticker, depicting the date of inspection and the date of the next required inspection will be annotated using a permanent marker, on said equipment. If indicated by the COR (or designee), the Contractor will assess or reassess Home Oxygen Equipment and/or patient’s needs. The Contractor shall document the patient receipt of all forms in their patient database.

The Delivery Driver or Contractor designee will immediately contact the BPVAHS COR when one of the following occurs:

Non-Compliance of prescription

Any unsafe conditions observed which may preclude the installation or continuance of oxygen.

The COR will inform the Bay Pines Respiratory Care Section who will alert the Bay Pines clinical provider and communicate appropriate interventions to the Contractor.

The Delivery Driver will provide the patient with a Bay Pines “Home Oxygen Welcome Packet” on the first visit. This packet will include, but not be limited to, the following:

BPVAHS Patient Information Guide that includes information regarding Advance Directives, Patient’s Rights & Responsibilities, and other general information.

Mission, Vision and Scope of Home Oxygen.

Complaint Process.

Emergency Preparedness Information.

Emergency Contact Names and Phone Numbers.

Consent for Participation in Home Oxygen Care.

Pain Information.

**The presence of the “Home Oxygen Welcome Packet” shall be inspected upon each subsequent delivery to the patient and will be replaced if the packet is missing.

8.0 - Care Planning:

The BPVAHS clinical staff will be responsible for the initiation and direction to the patient’s plan of care and prescription requirements. The Pulmonologist will determine the individual prescription of the patient.

The Contractor will be responsible for providing documentation of the initial home installation, assessment and reassessment. The contractor shall provide educational materials that cover compressed gas, liquid 02 and ventilators reflecting the Joint Commission Standards.

The Contractor is responsible for the patient’s individual home care plans. Each home assessment and reassessment will be reviewed and an individualized plan of care will be implemented based upon the information gathered from the assessment/reassessment forms. The Contractor’s initial care plan shall be completed within seven (7) days of receipt of the Delivery Driver’s initial assessment.

9.0 - Quality Assurance, Coordination, Supervision and Evaluation of Care:

BPVAHS clinical staff will coordinate, supervise and evaluate the care required by outpatients to include:

initiation of prescriptions for home oxygen and various equipment items, devices or other appliances which may be medically indicated for the continuation of care in their home environment.

The COR will have oversight responsibility to ensure Contractor home oxygen is in compliance with the terms of the contract. The contractor shall be required to submit to the COR on a quarterly basis a Quality Assurance (QA) Plan to include a Care plan, Performance Improvement (PI) reports and complaint logs that demonstrate the ability to meet the standards of the Joint Commission.

Chief of Prosthetics, COR or Prosthetic Representatives will make unannounced Contractor site visits at a minimum bi-annually.

Chief of Prosthetics, COR or Prosthetic Representatives will make random patient home visits on a quarterly basis. A Contractor’s representative might be expected to join the team on these visits and will be provided a seven (7) calendar day notification in advanced notice to participate. In addition, the Chief of Prosthetics, COR or Prosthetic Representatives may request to take part on a random day delivery schedule to accompany the Delivery Driver during their BPVAHS delivery schedule. On a limited basis, it may be necessary to make an emergent visit which will be coordinated with the Contractor.

BPVAHS Chief of Prosthetics, COR or designee will communicate with the Contracting Officer any high risk, problem-prone, and quality improvement issues. The Contracting Officer will determine if a Cure Notice or any administrative action will be taken place.

9.1 Performance Standards:

9.1.1 Measure: Emergency calls delivered by 6 hours of call placement.

Numerator and Denominator: Number of VA patients delivered.

Quantity of Surveillance: Randomly pull 5% of files.

Acceptable Quality Level: 100% Method of Surveillance: Random Sampling

9.1.2 Measure: Patient Travel Memos.

Numerator and Denominator: Number of VA patients satisfied with contractors home oxygen.

Satisfaction survey developed by vendor, but approved by VA. Number of VA patients audited for patient satisfaction.

Quantity of Surveillance: Randomly pull 10% of files.

Acceptable Quality Level: 100% Method of Surveillance: Random Sampling

9.1.3 Measure: Audit of VA patients satisfaction to be issue specific, including comments and complaints.

Numerator and Denominator: Number of VA patients satisfied with contractors home oxygen.

Satisfaction survey developed by vendor, approved by VA. Number of VA patients audited for patient satisfaction.

Quantity of Surveillance: Random survey results quarterly.

Acceptable Quality Level: 90% Method of Surveillance: 100% Review

9.1.4 Measure: Audit of VA patient records for proof of receipt of equipment installation within 6 hours of notification.

Numerator and Denominator: Number of VA patient files with documentation of patient and/or caregiver signing for receipt of DME equipment. Number of VA patients receiving DME equipment.

Quantity of Surveillance: Randomly pull 10% of files.

Acceptable Quality Level: 95% Method of Surveillance: Random Sampling

9.1.5 Measure: Audit of all accidents, malfunctions, injuries, deaths and sentinel events associated with the provisions, delivery and use of home oxygen equipment.

Numerator and Denominator: Number of VA patients who had an incident related to DME Equipment to include fires, accidents, malfunctions, injuries, deaths, and sentinel events.

Number of VA patients receiving DME equipment.

Quantity of Surveillance: Randomly pull 10% of files.

Acceptable Quality Level: 100% Method of Surveillance: Random Sampling

9.1.6 Measure: Home Oxygen Welcome Packet and Initial Care plan.

Numerator and Denominator: Number of VA patients who received the packet the first visit. Initial Care plan assessment completed within 7 days. Assessment of veterans home in patient’s folder.

Quantity of Surveillance: Randomly pull 10% of files.

Acceptable Quality Level: 95% Method of Surveillance: Random Sampling

9.1.7 Measure: Home Oxygen Therapy Program checklist.

Numerator and Denominator: Number of VA patients who received the initial and reassessments Checklist should be in file.

Quantity of Surveillance: Randomly pull 10% of files.

Acceptable Quality Level: 95% Method of Surveillance: Random Sampling

9.1.8 Measure: Audit of VA patient treatment files for proper documentation of patient education.

Numerator and Denominator: Number of VA patient files with documentation of patient and Caregiver education to include return demonstration of equipment and use of equipment. Number of VA patients files.

Quantity of Surveillance: Randomly pull 10% of files.

Acceptable Quality Level: 90% Method of Surveillance: Random Sampling

9.1.9 Measure: Audit of warehouse delivery vehicles employees for compliance with infection control protocols.

Numerator and Denominator: Number of deficiencies observed in infection control protocol in warehouse and delivery vehicles, employees. Number observed infection control protocols.

Number observed infection control protocols. Number of employee vaccination files.

Quantity of Surveillance: Randomly pull 10% of files.

Acceptable Quality Level: 100% Method of Surveillance: Periodic Inspection

9.1.10 Measure: Delivery and Set-ups.

Numerator and Denominator: Number of VA patients discharge and delivery done within 5 hours.

New delivery within 24 hours of order and contractor notify the veteran within 24 hours.

Quantity of Surveillance: Randomly pull 5% of files.

Acceptable Quality Level: 100% Method of Surveillance: Random Sampling

10.0 - Scheduling Visits:

See the Provision of Home Oxygen selection below for the Contractor’s responsibility for the scheduling of equipment installation, assessment, monthly reassessments and equipment pickup.

11.0 - Discharge Planning:

Discontinuation of any treatment or discharge from a treatment plan will be determined by BPVAHS clinical staff. The Contractor shall not have any role and is relieved of any responsibility for the discharge of patients from the BPVAHS Home Oxygen Program, however, the Contractor is responsible for notifying the COR or designee if a patient requests their equipment be picked up prior to discharge planning taking place. The Contractor shall be notified via consult requesting discharge of the Home Oxygen Program.

12.0 - Documentation:

All documentation associated with the above patient activities/encounters will be the responsibility of attending hospital clinical staff and will be entered into appropriate patient records on a recurring basis.

The Contractor shall keep on file a copy of the Home Oxygen Therapy Program checklist for all-initial assessments and reassessments. All documentation kept on file by the Contractor shall be accessible to the Chief of Prosthetics, COR or Prosthetic Representatives Site Visit team to ensure compliance of the Contractor.

13.0 - Government Furnished Property:

The Contractor shall maintain an inventory of Government Furnished Equipment (GFE) that is inventoried and provided to the COR via email on a quarterly basis. This equipment will include all items that have not been issued to a patient for use. This equipment shall be available for audit during a site visit by the COR, Prosthetic Representatives or Chief and/or Prosthetics.

14.0 - Infection Control:

The Contractor shall comply with JC and BPVAHS policies and procedures on infection control and infection surveillance. The Contractor employee health files shall contain a copy of the Contractor Staff Member’s annual TB test results and Hepatitis B vaccination documentation. If a Contractor staff member refuses to either test, such refusal shall be documented in writing and shall be maintained in their file. All Contractor staff involved in the delivery, pickup and storage of home oxygen will be instructed on the importance of infection control and personal hygiene and their responsibilities in the infection control program. Procedures shall address personal hygiene, aseptic procedures, staff health and transmitted infections and appropriate cleaning, sanitation and storage of equipment. Appropriate staff shall be instructed in the identification, handling and disposal of hazardous and/or waste materials in a safe and sanitary manner in accordance with applicable laws and regulations.

Contractor staff members with contagious illnesses shall have no contact with patients or clean equipment. Exceptions would be Contractor staff members with a mild cold or similar condition. In such cases, gloves will be worn and contact will be extremely limited.

Contractor staff members responsible for the delivery, setup, cleaning, repairs and/or storage of medical equipment shall be instructed in the safe and appropriate use of said equipment. Upon delivery, they shall provide appropriate instructions to the patient and/or caregiver regarding the safe and appropriate use of the equipment and basic home safety matters in regard to said equipment. This instruction shall include a return demonstration from the patient/caregiver showing that they understand what they were shown.

Any accidents or injuries related to equipment and safety management will be investigated by the Contractor. Equipment malfunctions resulting in any sentinel event such as serious injury or death will be reported to the manufacturer and the Chief of Prosthetics or COR within forty-eight (48) hours of the Contractor’s knowledge of said event(s). The Contractor will promptly notify the PSAS of any hazards, defects or recalls by the manufacturer for any equipment purchased from the Contractor.

The Contractor shall have an Emergency Contingency Plan designed to provide continuing support appropriate to the home oxygen provided in the event of an emergency that would result in interruption of patient home oxygen. The Contractor shall have a disaster plan and appropriate personnel who are aware of this plan and their roles/responsibilities in the event of a contingency.

15.0 - Provision of Home Oxygen:

The VA is to furnish the Contractor a roster of current patients fifteen (15) calendar days prior to the preceding of the contract. All deliveries (if there is a change of vendors) must be in place and operational within thirty (30) calendar days of the start of the contract. All initial deliveries must be done in a methodical sequence. Contractor is to provide a plan of installation to the Contracting Officer within five

(5) calendar days after the start of the contract.

Installations will be completed in a systematic and methodical manner, i.e. all patients in any two/three counties per week. Setup of all patients in any given area must be completed before the beginning installation in another area. Upon completion of installation each patient is to begin using the equipment and cease using the incumbent’s equipment. After completion of installation, the Contractor will immediately notify the BPVAHS, who will, in turn, advise the incumbent Contractor to pick up their equipment.

Delivery/Setups are required to be made to the destination of the patient’s residence within five (5) hours after discharge from the BPVAHS. New Home Oxygen Outpatient delivery/setups are required to be completed within twenty-four (24) hours after Contractor receives the script via fax. The Contractor must contact the patient within two (2) hours after the receipt of the fax.

Upon delivery of oxygen refills, the Contractor shall inspect the patient’s existing equipment and supplies, and clean, sterilize or replace same whenever necessary or required the awardee’s contract.

16.0 - Placement of Orders:

Individual orders for Home Oxygen may be authorized by phone/fax/email by the following:

Home Oxygen Coordinator (COR)

Chief of Prosthetics

PSAS Staff Representative

Clinical Program Leader Cardio-Pulmonary Services

17.0 - Hospital Discharge:

The Home Oxygen Coordinator will act as intermediary between discharging ward, oxygen contactor and patient/caregiver to facilitate time; date of oxygen delivery/setup in the patient’s residence.

Upon discharge from hospital, the patient will be provided a portable E system by PSAS to facilitate oxygen therapy while in transition to home. Portable system consists of one (1) E tank cylinder with regulator and nasal cannula. An established inventory of these items will be maintained in the PSAS area and replaced, as needed, by the Contractor. The prescription received by the Contractor will notify Contractor that patient has been discharged with equipment so that items can be incorporated into patient’s inventory of equipment/supplies.

Orders for supplies will be placed by the COR or designee. Prior to the delivery of equipment/supplies for the setup in the patient’s residence, the Contractor shall setup, adjust and instruct the patient and caregiver on all equipment that is being prescribed and instruct the patient in the proper use of equipment and supplies as necessary. The Contractor shall provide education to each patient and caregiver at the time of setup and assess the need for reinforcement during visits. This information is to be presented verbally, demonstrated and the material covered shall be in written form and left with the patient/caregiver and copies shall be kept at the Contractor’s facility.

18.0 - Safety:

At the time of initial setup and during home visits, the Contractor shall perform an assessment of the patient’s home and environment, including a Fall Risk Assessment, in accordance with JC Standards, and maintain documentation of assessments in the individual patient’s file or folder. At the time of setup and during home visits, the Contractor shall ensure smoke alarms are present and instruct the patient to test smoke alarms monthly. In the event the Contractor finds no smoke alarms present in the home, the Contractor shall contact the COR or designee, in writing, so appropriate action can be taken.

The Contractor shall notify the COR or designee during any 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, on in the initial case of setup, not placed in the residence.

The Contractor shall verbally notify the COR or designee by the next business day of any unsafe conditions observed in the VA patient’s home that preclude the installation or continuance of oxygen.

Unsafe conditions may include, but are not limited to, fire safety hazards, oxygen safety hazards, patient abuse by family and caregivers, or any instance that places the patient or Contractor’s staff in immediate danger. The Contractor shall furnish written documentation of the safety hazard to the COR or designee within one (1) business day of the incident.

The Contractor shall check the adequacy of the electrical outlets where any electrically powered oxygen equipment is plugged into in the patient’s residence and immediately report unsafe conditions to the COR or designee. It is the patient’s responsibility to have the appropriate electrical system in their residence.

The BPVAHS shall not be responsible or liable for any unsafe electrical conditions caused by the patient or the Contractor. Any alterations to the patient’s residence will be the responsibility of the patient/caregiver. If ordered equipment cannot be safely installed, the prescribing BPVAHS physician will be notified by COR after notification from the Contractor.

The Contractor shall conduct a Fire Risk Assessment of all new patients who smoke. A reassessment is to be conducted when renewing an oxygen prescription, or at any time there is a change in the patient’s oxygen prescription or equipment. The Government will alert the Contractor to those patients who are at high-risk for smoking while using oxygen. Checklists used by vendors for medical gas follow-up must, at minimum, cover the following items:

“No Smoking, Oxygen in Use” signs are provided and posted

Smoke alarm is present and alarm sounds when tested

Patient has been instructed to shut off oxygen supply, remove cannula and wait for oxygen to dissipate from clothing, then go outside and smoke.

Verification that the patient has been instructed to test all smoke detectors monthly

Patient and family or cohabitants are given educational materials regarding the hazards of smoking and using an open flame near oxygen.

19.0 - Maintenance and Back-Up Equipment:

The Contractor is responsible for the inspection and maintenance of all equipment and supplies located in the patient’s home. The Contractor shall comply with appropriate universal precautions in the cleaning and storage of oxygen systems and related equipment as required in the delivery, recovery and storage process.

Upon request the Contractor shall maintain a system for documenting the preventative maintenance, inspection, repair history of all equipment utilized for the provision of oxygen therapy. The Contractor must provide, at no extra cost, a backup manual oxygen system, such as an “H” or “K” tank, for patient’s prescribed home oxygen to provide a source of oxygen during electrical power failure.

20.0 - Invoice Submission:

Bills for home oxygen provided will be submitted monthly. The billing period will be from the first day of each month through the last day of the month. Invoices shall be submitted promptly to the BPVAHS PSAS no later than the fifth (5th) calendar day of the month following the month in which the home oxygen was provided. All invoices shall include the contract number, name of patient, last four of the patient’s social security number, itemized items provided to include each item provided with quantities and service date. As well as itemized signed delivery tickets by a patient or patient representative for receipt of oxygen equipment.

Invoices for oxygen ordered by the BPVAHS preferably will be provided on CD-ROM disc, mailed or hand carried to the following address:

Bay Pines VA Healthcare System

Prosthetics & Sensory Aids Service (121)

10000 Bay Pines Blvd

Bay Pines, FL 33744

No charge will be made by the Contractor after the effective date of expiration of the contract. If a change in vendors occurs, the Contractor shall have fifteen (15) calendar days to pick up their equipment.

The fifteen (15) days will begin upon notification by the BPVAHS’ COR.

The Contractor shall not deliver or bill patients for oxygen use above what has been authorized. The Contractor is to notify the VA within two (2) business days if a noticeable change in the patient’s oxygen needs occurs. Changes will not be provided without prior authorization by phone, fax or email with updated authorization.

Failure to make an oxygen delivery due to inability to access the patient’s residence because of missed appointment date/time will not result in added trip cost.

Prices quoted shall be all inclusive of deliveries and transportation within the (12) county catchment areas, and equipment, safety inspections, repairs, maintenance, and in-service training for patients to include patient education.

21.0 - Contractor Security Requirements:

Since access to the VA computer system is not required for the Contractor’s staff, there is no mandate for security/background investigations for this purpose. Nevertheless, the Contractor shall carry out sufficient investigation of their staff members, and subcontractors to reduce the risk of hidden criminal background, or substantiated incidents of patient abuse/security/ethics/substance abuse, of their duties.

Patients must not be placed at any such potential risk, which could impact on the safety of patients and the peace of mind of their families.

The Contractor shall be required to install public-key infrastructure (PKI) on their computer systems for encrypted messaging. The Contractor will be assisted by the BPVAHS’ Information Security Officer (ISO) and PKI will be required for any email correspondence involving patient information.

The contract shall be subject to the regulations issued by the Department of Health and Human Services, as mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Privacy Act of 1974. Federal Acquisition Regulations 52.224-1 Privacy Act Notification and 52.224-2 Privacy Act are provided in full text in the Addendum to FAR clause 52.212-4. The Contractor is not authorized to release any medical record information. In accordance with HIPAA, the Contractor will be required to enter into a Business Associate Agreement (BAA) with VHA. The VA is the sole entity authorized to release this information upon written request from the patient.

Business Associates must follow VHA privacy policies and practices. All Contractors and business associates must receive privacy training annually. For Contractors and business associates who do not have access to VHA computer systems, this requirement is met by completing the VHA National Policy Training, other VHA approved privacy training or Contractor furnished training that meets the requirement of the HHS Standards for Privacy of Individual Identifiable Health Information as determined by VHA. For Contractors and business associates who are granted access to VHA computer systems, this requirement is met by completing VHA Privacy Policy training. Proof of training is required. Contractors shall require its employees who have access to patient information to take annual privacy training at the Dept. of Veterans Affairs web site. The web site is available at https://www.tms.va.gov/plateau/user/login.jsp

All Contractors and Contractor personnel shall be subject to the same Federal laws, regulations, standards and VA policies as VA, and VA personnel, regarding information and information system security.

Contractor must follow policies and procedures outlined in VA Directive 6500, Information Security Program and its handbooks to ensure appropriate security controls are in place. The procedures, responsibilities, and processes for implementing security per VA Handbook 6500.6 shall be followed and contractor will be required to sign attached Contractor Rules of Behavior appendix D.

CONTRACTOR SECURITY REQUIREMENTS (VA HANDBOOK 6500.6)

1. INFORMATION AND INFORMATION TECHNOLOGY SECURITY REQUIREMENTS

a. Due to the threat of data breach, compromise or loss of information that resides on either VA-owned or Contractor-owned systems, and to comply with Federal laws and regulations, VA has developed an Information and Information Technology Security clause to be used when VA sensitive information is accessed, used, stored, generated, transmitted, or

b. exchanged by and between VA and a Contractor, subcontractor or a third party in any format (e.g., paper, microfiche, electronic or magnetic portable media).

c. In solicitations and contracts where VA Sensitive Information or Information Technology will be accessed or utilized, the CO shall insert the clause found at 852.273-75, Security Requirements for Unclassified Information Technology Resources.

2. SECURITY REQUIREMENTS FOR UNCLASSIFIED INFORMATION TECHNOLOGY

RESOURCES

The Contractor, their personnel, and their subcontractors shall be subject to the Federal laws, regulations, standards, and VA Directives and Handbooks regarding information and information system security as delineated in this contract

1. GENERAL

Contractors, Contractor personnel, subcontractors, and subcontractor personnel shall be subject to the same Federal laws, regulations, standards, and VA Directives and Handbooks as VA and VA personnel regarding information and information system security.

2. ACCESS TO VA INFORMATION AND VA INFORMATION SYSTEMS

a. A Contractor/subcontractor shall request logical (technical) or physical access to VA information and VA information systems for their employees, subcontractors, and affiliates only to the extent necessary to perform the services specified in the contract, agreement, or task order.

b. All contractors, subcontractors, and third-party servicers and associates working with VA information are subject to the same investigative requirements as those of VA appointees or employees who have access to the same types of information. The level and process of background security investigations for contractors must be in accordance with VA Directive and Handbook 0710, Personnel Suitability and Security Program. The Office for Operations, Security, and Preparedness is responsible for these policies and procedures.

c. Contract personnel who require access to national security programs must have a valid security clearance. National Industrial Security Program (NISP) was established by Executive Order 12829 to ensure that cleared U.S. defense industry contract personnel safeguard the classified information in their possession while performing work on contracts, programs, bids, or research and development efforts. The Department of Veterans Affairs does not have a Memorandum of Agreement with Defense Security Service (DSS). Verification of a Security Clearance must be processed through the Special Security Officer located in the Planning and National Security Service within the Office of Operations, Security, and Preparedness.

d. Custom software development and outsourced operations must be located in the U.S. to the maximum extent practical. If such services are proposed to be performed abroad and are not disallowed by other VA policy or mandates, the Contractor/subcontractor must state where all non-U.S. services are provided and detail a security plan, deemed to be acceptable by VA, specifically to address mitigation of the resulting problems of communication, control, data protection, and so forth. Location within the U.S. may be an evaluation factor.

e. The Contractor or subcontractor must notify the Contracting Officer immediately when an employee working on a VA system or with access to VA information is reassigned or leaves the Contractor or subcontractor’s employ.