36C24820R0069 Home Oxygen Soliciation.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 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 91

573-21-1-1912-0001

36C24820R0069 07-10-2020

Scott Brickey (352) 352-5723 08-03-2020

4:30 PM ET

36C248

Department of Veterans Affairs

Network Contracting Office 8

300 East University Ave # 170

Gainesville FL 32601

X

532283

$15 Million

X

N/A

X

36C573

Department of Veterans Affairs

Malcom Randall VA Medical Center

1601 S.W. Archer Road

Gainesville FL 32608

36C248

Network Contracting Office 8 (NCO 8)

300 East University Ave # 170

Gainesville FL 32601

Financial Services Center

P.O. Box 149971

Austin TX 78714-9971

1-877-353-9791

The Contractor shall provide Home Oxygen to Support the

Malcom Randall VA Medical Center and all Catchment areas specified herein.

X X

X 1

36C24820R0069

Table of Contents

SECTION A

A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 STATEMENT OF NEED

B.3 ESTIMATED PRICE SCHEDULE

SECTION C - CONTRACT CLAUSES

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

2018)

C.2 52.216-18 ORDERING (OCT 1995)

C.3 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.4 52.216-21 REQUIREMENTS (OCT 1995)

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

C.6 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984) 39

C.7 52.245-1 GOVERNMENT PROPERTY (JAN 2017)

C.8 52.245-9 USE AND CHARGES (APR 2012)

C.9 VAAR 852.215-71 EVALUATION FACTOR COMMITMENTS (DEC 2009)

C.10 VAAR 852.219-75 SUBCONTRACTING COMMITMENTS MONITORING AND

COMPLIANCE (JUL 2018)

C.11 VAAR 852.237-70 CONTRACTOR RESPONSIBILITIES (APR 1984)

C.12 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.13 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (MAY 2019)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 CONTRACTOR REQUIRED DOCUMENTS

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS (OCT 2018)

E.2 52.216-1 TYPE OF CONTRACT (APR 1984)

E.3 VAAR 852.215-70 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-

OWNED SMALL BUSINESS EVALUATION FACTORS (JUL 2016)(DEVIATION)

E.4 VAAR 852.219-74 LIMITATIONS ON SUBCONTRACTING—MONITORING AND

COMPLIANCE (JUL 2018)

E.5 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

E.6 52.212-2 EVALUATION—COMMERCIAL ITEMS (OCT 2014)

E.7 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL

ITEMS (OCT 2018)

E.8 52.209-5 CERTIFICATION REGARDING RESPONSIBILITY MATTERS (OCT 2015) 88

E.9 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

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 36C248

Network Contracting Office 8

300 East University Suite 170

Gainesville, FL 32601

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

ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the

Solicitation numbered and dated as follows:

AMENDMENT NO DATE

B.2 STATEMENT OF NEED

A. Scope:

The Department of Veterans Affairs (VA) North Florida/South Georgia VA Healthcare System

(NF/SGVAHS) located at 1601 S.W. Archer Road Gainesville, Florida has a requirement for Home

Oxygen and Medical Equipment Management. The Contractor shall provide supplies, materials, equipment, labor, supervision, equipment management, safety management, infection control, repairs, maintenance and in-service training for patients to include patient education. This shall include but it not limited to; Set-ups, (Initial & Restarts), Switch-outs, Basic & Complex systems that consists of equipment to provide supplemental oxygen up to 4 liters per minute (LPM) via appropriate interface and a Complex system consists of all equipment required supplemental oxygen 4 LPM or more with appropriate interface, to include cough assists, ventilators and other complex systems.

The Contractor shall furnish, provide, install and maintain medical oxygen equipment, high-pressure cylinder, 50 psi air compressors, POCs, concentrators (if VA owned concentrators, POCs not available) and/or liquid systems, portable systems, emergency back-up systems and all required supplies to eligible

VA patients as required by the NF/SGVAHS. The Contractor shall maintain, service, install VA owned equipment; concentrators, POCs, self-fill units and cylinders, cough assists and ventilators and all required supplies to eligible VA patients as required by the NF/SGVAHS. All Government Furnished

Property (GFP) will be labeled as VA Owned. The Contracting Officer’s Representative (COR) or designee will provide the Contractor with notification to initiate individual patient 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 Home Oxygen Clinics (Gainesville, Lake City and Jacksonville) medical respiratory 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.

1. Geographic Area of Coverage:

The Contractor is responsible for deliveries and service to VA patients in the following Florida and South

Georgia counties: MONTHLY AVERAGE: 3,100 estimated patients

North Florida/South Georgia Veterans Healthcare System:

Consists of the Gainesville Division, Lake City Division, Jacksonville Outpatient Clinic (OPC), Jacksonville South Point, Tallahassee HCC, Palatka CBOC, St. Augustine CBOC, Perry CBOC, Marianna CBOC, Lecanto CBOC, Ocala CBOC, Ocala West, The Villages OPC, St. Mary’s CBOC, Valdosta CBOC, Waycross CBOC & Jacksonville Naval Air Station.

The following thirty-two (32) Florida counties are covered; Alachua, Baker, Bradford, Calhoun, Columbia, Citrus, Clay, Dixie, Duval, Flagler, Franklin, Gadsden, Gulf, Gilchrist, Hamilton, Jackson, Jefferson, Lafayette, Lake, Leon, Levy, Liberty, Madison, Marion, Nassau, Putnam, St.

John’s, Sumter, Suwannee, Taylor, Union, & Wakulla.

The following nineteen (19) Georgia counties are covered; Atkinson, Berrien, Brantley, Brooks, Camden, Charlton, Clinch, Colquitt, Cook, Decatur, Echols, Grady, Lanier, Lowndes, Miller, Mitchell, Pierce, Thomas, and Ware.

Further information for the locations may be accessed at website:

http://www.northflorida.va.gov/NORTHFLORIDA/index.asp

Note: Distribution of patients on Home Oxygen may vary from month to month as patients are added and discharged from the program for a variety of reasons.

B. Government Owned Equipment & Definitions/Acronyms: See Attachment(s) 2 & 3

C. Estimated Quantities:

The quantities or dollar threshold listed in the Estimated Price Schedule, effective for the periods stated are estimates only, and are not purchased by this contract. Except as this contract may otherwise provide, if the VA's requirements do not result in orders in the quantities or dollar amount described, that fact shall not constitute the basis for an equitable price adjustment.

D. Evaluation of Options:

Except when it is determined in accordance with FAR 17.206 (b) not to be in the Government’s best interests, the Government will evaluate offers for award purposes by adding the total price for all options to the total price for the basic requirement. This includes options under FAR 52.217-8, Option to Extend

Services, which applies to this solicitation. Evaluation of options under FAR 52.217-8 will be accomplished by using the prices offered for the last option period to determine the price for a six (6) month option period, which will be added to the base and other option years to arrive at the total price. Evaluation of options will not obligate the Government to exercise the option(s).

E. Contractor Qualifications:

The Contractor shall possess all licenses, permits, accreditations, and certificates as required by local, state and federal law. Sub-contractors must meet same requirements as Contractor and adhere to ALL the requirements of this contract. The Contractor shall meet the Home Care part of the Joint Commission

(JC) standards. Therapy in the Home or Alternate Site Health Care Facility-2007 Revision & Update, Association for the Advancement of Medical Instruments (AAMI) the American Association of

Respiratory Care (AARC) Clinical Practice Guideline and the American Society for Testing Materials

(ASTM) minimum standards specification for electrically powered home care portable ventilators and cough assists. The Contractor shall meet or exceed these and The Joint Commission (JC) accreditation for 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

North Florida/South Georgia VA catchment areas. The contractor shall designate a specific service representative to coordinate daily matters with COR. VA beneficiary account folders shall comply with the Privacy Act and health Insurance Portability and Accountability Act (HIPAA). All files are subject to review by designated Veterans Affairs Medical Center (VAMC) officials and accreditation surveyors on behalf of the VAMC during accreditation surveys or consultation.

http://www.northflorida.va.gov/NORTHFLORIDA/index.asp

The Contractor shall have at least five (5) calendar years’ experience in successfully administering basic and complex home oxygen, aerosol therapy, cough assists and ventilator care to adult and geriatric patients and experience in providing Home Oxygen and Medical equipment and supplies for gas Oxygen

(02), liquid 02, portable and stationary concentrators, Continuous Positive Airway Pressure (CPAP)/Bi

(2) Positive Airway Pressures (BIPAP), cough assists and ventilators. The Contractor staff shall include

Licensed Respiratory Therapists (RCP) required for complex setups; i.e. oxygen over 4 LPM, trach, cough assists and ventilators.

The Contractor shall replace all non-VA owned NF/SGVAHS equipment presently located in homes of patients as soon as possible after award, but not to exceed thirty (30) calendar days from the date of contract award without causing a break in service and may not be exceeded without prior approval from the contracting officer. This change shall include delivery, setup, instructions, all required supplies until next scheduled visit (30 -90 days) and shall be accomplished with the least disruption to the VAMC patient as possible. Cost(s) will be prorated upon setup and discontinuance with equipment pickup no more than one billing cycle. Failure to perform the switch-outs as specified will result in a forfeit of payment for every day thereafter until switch-out is complete. Pro-rated payments will be assessed based on each provider’s established rate and prorated based on setup date. No payment will start for any given patient until ALL required equipment is provided for that patient. Payment to previous vendor will not extend more than three (3) days after notification of delivery of ALL equipment by new vendor. Method of notification will be mutually agreed upon during post award meetings by all parties. No additional charges will be applied for switch-outs.

All home oxygen will be performed in the patient’s place of residence or designated location. The equipment needs are subject to change as determined by the prescribing VA physician. The contactor agrees to a short-term rental or loaner of exact match equipment for the NF/SGVAHS veterans/patients home oxygen needs while VA owned equipment is being repaired or replaced.

The Contractor shall provide and maintain the following oxygen equipment to the VA Medical Center

Pulmonary Departments as indicated. A Liquid Oxygen Reservoir with a 2 portable units one Helios and

1 Marathon or equivalent; twelve (12) “E” tanks with cart and regulator flow meter, 3 oxygen conserving devices, two pneumatic and one battery operated with twelve (12) “B” cylinders with at least 2 carry bags provided to the: VAMC Gainesville, VAMC lake City and the Jacksonville OPC. The contractor shall provide and maintain 6 “E” tanks with cart and regulator flow meter to Naval Air Station Jacksonville

Patient Care. Racks for proper storage will be provided by the Contractor. The tanks and reservoirs will be checked and automatically filled not less than two (2) times per month. Separate itemized invoices with supporting documentation for each location shall be submitted no later than the tenth of the month.

F. 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 5:00 pm EST including

Holidays. Exceptions shall include the case of emergencies. The Contractor shall inform the Contracting

Officer Representative (COR) of deaths or inability to service or locate a veteran (i.e. due to change of address). The Contractor is still required to provide monthly and quarterly service, replenishment of cylinders and supplies even if it requires making a special or non- scheduled visit to the patient's home.

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.

G. 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 emergent home oxygen at the patient’s home within a maximum of four (4) hours of call and for patients being discharged on the same day from inpatient care.

The Contractor shall ensure all patients have minimum backup to maintain prescription requirements.

The Contractor shall provide battery backup for cough assists, ventilators up to 24 hours and non-electrical oxygen supply to last three (3) times the Contractor’s response time to a call. The minimum supply for oxygen shall take into account each patient’s prescription flowrate 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 (3) 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 or for contractor convenience of outspreading the time between fills shall be borne by the Contractor. No cylinder size “E” or smaller may be used as back up.

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

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

During a disaster or other emergency, the contractor is responsible to ensure all veterans are contacted at initiation, during and post response of the emergency. Updates on veterans contacted, those not contacted, contingency plans, response effort and other information will be provided to the VAMC on request. A

Post Emergency Plan activation report shall be provided at the end of the response. Additional back-up equipment and supplies will be provided for as long as the emergency lasts to ensure veteran’s prescription needs are met. These excess deliveries will be annotated on the next month’s invoice as

“Disaster Response for; i.e. Hurricane Smith” for appropriate reimbursement. Failure to annotate the invoices accordingly will result in non-payment by the VAMC.

Contractor shall develop Special Equipment Identification Codes to identify North Florida/South Georgia

VA owned equipment and services to veterans from other catchment areas provided as a result; of hurricanes, acts of God and/or emergency situations. Invoice to list veteran, location, equipment, service provided and type of emergent situation.

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

NF/SGVAHS 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. A safety/emergency checklist shall be completed, then signed by the veteran or his/her caregiver and retained in the beneficiary account folder.

H. Veteran/Patient Re-location:

The NF/SGVAHS will be responsible to provide home oxygen for the first ninety (90) days after a patient permanently relocates to another VAMC catchment area. It will be the patient’s responsibility to enroll at the nearest VAMC, make an appointment with their Respiratory/Pulmonary Clinic for home oxygen and receive a new prescription. The contractor shall provide contractor owned equipment for veterans/patients relocating to another VAMC location, unless otherwise approved by the COR for the veteran/patient to utilize VA-owned equipment. The contractor shall inform the veteran/patient, care giver or veteran/patient representative and both parties must agree in writing and sign that the veteran/patient, care giver or veteran/patient representative will be financially responsible for any/all non-returned contractor equipment. Recovery of contractor-owned equipment will be at no cost to the VA.

If applicable, the contractor shall recover all VA- owned equipment from the veteran, care provider or veteran/patient representative and ship directly to the contractor’s warehouse. Contractor will verify operation per manufacture guidelines before placing back into service. Note: Prior to shipping VA-owned equipment, the contractor shall provide the COR with an itemized list of equipment to include the patients name, billing receipt(s), documentation (i.e., FedEx or UPS) estimated charges.

I. Patient Assessment:

The Contractor shall provide an in-home initial patient setup/delivery, restarts, relocation and installation of prescribed equipment within twenty-four (24) hours of notification to include weekends and holidays.

If the contractor is unable to meet the 24-hour response time the contractor must notify the ordering clinic. NF/SGVAHS reserves the right to obtain the service from another source and to charge the contractor.

A setup includes delivery of prescribed Home Medical equipment with applicable disposables and backup equipment. Orientation to the vendor’s services, an equipment assessment, patient education with return demonstration, a home safety review and inspection, scheduling of ongoing deliveries and preventive maintenance inspection (PMI) service appointments. Completion of a treatment plan/care plan by a licensed Respiratory Therapist in 24 hours for all complex setups and 78 hours for basic. For prescription renewals/changes, the contractors licensed RCP shall review all prescription changes with the patient. At home training is required for all prescription equipment changes (i.e. B tank via OCD regulator to E tank via Continuous regulator) or change in complexity (i.e. Basic 3lpm to Complex 4lpm).

Restarts are considered the initiation of service for those beneficiaries who have been provided equipment through the NFSG/VAHS home oxygen program in their residence or SNF, ALF home during the previous sixty (60) days.

Home oxygen services are provided to any patient that is under NFSG/VHS primary care. At time these patients can live outside our actual “Catchment” or Geographic area. The ordering home oxygen clinic will identify these patients as “Out of Area”. The COR will coordinate with the contractor for these veterans/patients. Subcontractors shall adhere to all Joint Commission standards and the requirements of this contract. Home oxygen for these designated patients will be on a case by case basis.

The Delivery Driver/RCP will provide the patient with a Welcome Packet” on the first visit. All patient education material must be presented in written form to the COR for approval prior to the award. The written material shall be in English as well as the foreign language of the beneficiary as applicable. In the case that the beneficiary does not speak English the Contractor is to advise the VAMC of any occurrences so that the VA can obtain adequate instructions. This includes any coordination of instruction/delivery of equipment for those veterans with special needs. i.e. vision impaired may need a blind rehab specialist to be present at time of instruction

This packet will include, but not be limited to, the following:

• NF/SGVAHS Patient’s Rights & Responsibilities, and other general information.

• Information regarding Advance Directives

• Contractor’s Toll-Free Number, Hours of Operation, Location

• Contractor’s Mission, Vision.

• Contractor’s Complaint Process.

• Patient Educational Information – provided initially and at prescription changes/renewals

• Emergency Preparedness Information.

• Emergency Contact Names and Phone Numbers.

• Fall and Fire prevention

• “No Smoking, Oxygen in Use” signs minimally two for front and rear entrance must remain posted. (replace as needed)

• Verification of 2 smoke alarms present, alarm when tested, be tested monthly, if not present contractor is to notify the ordering clinic

• Documentation verifying placement of Thermal Fuses per AL18-01 safety mandate, unless there is a documented clinical contraindication (e.g., patients using heated humidity, patients with flow rates more than 25 liters per minute, patients with behavioral conditions that make use of thermal fuses impractical). This must be documented in the patient’s medical record.

Two thermal fuses must be provided and installed in each home oxygen delivery system (one at the patient end and one at the oxygen source). This shall be done for the patient’s primary oxygen therapy equipment as well as any portable oxygen therapy equipment. Thermal fuses are considered part of the routine oxygen supplies required for setup and will be provided at no additional charge

a. Thermal fuses are not required for portable pulse dose/intermittent oxygen therapy equipment when the equipment does not have a continuous flow setting.

b. Thermal fuses provided must work regardless of their orientation in the oxygen tubing

(bidirectional) or have a design that prevents them from being installed in the wrong orientation

(e.g., source end of the thermal fuse has threads or bayonets that make backwards installation impossible).

At the time of installation, education must be provided to the patient describing the proper use and placement of thermal fuses, including that a thermal fuse does not make it safe to smoke, be near people who are smoking, or be near any source of sparks or flame while using oxygen. It should be emphasized that the thermal fuses will not prevent burns to the face, neck and airways if the ignition occurs at or near the nasal cannula. The thermal fuse does not prevent the start of a fire nor extinguish a fire; it simply limits the flow of oxygen that might continue to feed the fire.

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

The contractor will at least once every three (3) months, perform a quarterly visit to the VA beneficiaries and reassess equipment compliance, educational needs, equipment maintenance. A report as supporting documentation of visit will be submitted with the monthly invoices. Ventilators and cough assists are seen monthly.

Ventilator patient discharges to the home will be arranged Monday – Friday, unless previously agreed to by the contractor and VA. Prior to discharge the Contractor shall perform a Home Inspection of the veteran’s residence. This inspection will include; electrical capacity, physical space and caregiver’s ability to provide for the veteran’s needs upon discharge. The Contractor shall follow JC Homecare standards and AARC Clinical Practice Guidelines for Home Ventilators. If there are any unsafe issues or concerns preventing acceptance into their home ventilator program the Contractor shall notify the ordering Home Oxygen Clinic and COR immediately. The discharge of the ventilator patient to the home may be held pending resolutions to caregiver or home environment safety concerns. The Contractor will receive preliminary ventilator orders and the Contractor’s RCP will provide training to all caregivers and the veteran. At time of discharge a final set of orders will be provided to the contractor with current ventilator settings and well as requests for any additional equipment.

The Contractor’s RCP will assist in getting the ventilator patient settled in their home at time of discharge. Follow up weekly visits minimally for the first month may be required to ensure a smooth transition from hospital to home (at no additional charge) then monthly thereafter. The Contractor’s RCP will perform monthly visits for prescription compliance, supplies and equipment inspection/maintenance.

Noncompliance or other concerns are to be reported immediately to the ordering clinic. Monthly ventilator visit fee is all inclusive: patient assessment for compliance, 30-day month supply of tubing filters, HMEs; ventilator check/maintenance (including backup vent). The VA will review and approve the Contractor’s forms to be used for the ventilator patients, i.e. the home inspection, ventilator checklist and training prior to the contract award.

Cough assists are seen monthly and fee is all inclusive. The Contractor’s RCP will take the cough assist to the home along with sufficient supplies to allow weekly circuit, filter changes. Perform instruction and observe return demonstration, until confident the veteran can use the deice appropriately. A compliance report shall be sent to the ordering VA clinic to include as a minimum current order vs actual usage, interface, cough production/efficacy, hospitalizations since last visit, caregiver/patient comments. Routine preventative maintenance as defined by the manufacturer.

When advantageous for NF/SGVAHS veterans it may become necessary to provide CPAP/BiPAP training in the home by the Contractor’s RCP rather than in the clinical setting. When this occurs, an order will be provided to the contractor with settings and interface type required. The Contractor may on occasion pick up equipment (CPAP/BiPAP), Interface or Modem) at one of the home oxygen clinics and deliver, setup and instruct the veteran. Training should be provided within 24 hours of receiving the order unless otherwise noted on the order.

The Contractor shall complete a Care plan and a Home Oxygen Equipment check per manufacturer’s instructions, and complete a quarterly equipment check at a minimum. An adhesive sticker or service card, depicting the date of inspection/pm and the date of the next required inspection/pm will be annotated using a permanent marker, on said equipment. Documentation shall include analyzation of oxygen and verification of liter flow rate as prescribed. A signed copy shall be left with the patient and/or caregiver. All VA owned equipment will be labeled. Cough assists and ventilators (invasive and non-invasive) require monthly equipment checks and assessments.

The Contractor will assess or reassess Home Oxygen Medical Equipment and the patient’s need(s) whenever there is a change in the prescription or renewal. This will include an in-home assessment, all patient training with return demonstration, treatment care plan, and patient assessment to insure understanding and appropriate use of equipment. Cough assists, and ventilators require monthly equipment checks and assessments. The Contractor shall document the patient receipt of all forms in their patient file, database.

The Contractor’s Delivery Driver, Respiratory Therapist or Contractor designee will immediately contact the NF/SGVAHS COR when one of the following occurs:

• Non-Compliance of prescription

• Veteran Abuse/neglect concerns

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

• Fall - safety concerns

• Oxygen safety or Fire concerns

Per VHA Central Office Patient Safety Alert (AL18-01) All identified oxygen safety concerns or fires must be reported immediately to the COR and ordering VA clinic. For fires the required information is reported as follows.

a. What was the reported cause of the fire (primary ignition source)?

b. Where did the fire originate (e.g.; kitchen, bedroom, vehicle)?

c. What date and time did the fire occur?

d. What was the first item that ignited (e.g.; nasal cannula, clothing)?

e. Describe the extent of injury to the patient, family and others.

f. Describe the extent of property damage.

g. How many thermal fuses were in use and where were they installed in the home oxygen delivery system or tubing?

The COR will inform the Malcom Randall Patient Safety, Home Oxygen Clinic Respiratory Care, Pulmonary, who will alert the clinical staff/provider and communicate appropriate interventions to the

Contractor.

J. Care Planning:

The NF/SGVAHS 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 all provided equipment and home safety requirements reflecting the Joint Commission Standards.

K. Quality Assurance, Coordination, Supervision and Evaluation of Care:

NF/SGVAHS 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 clinical staff will be notified of patient refusal of service (AMA), suspected abuse or neglect.

Contractor will notify the prescribing VA clinic and COR of needed prescription renewals for patients two (2) months prior to the expiration date of the existing prescription

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 the following reports:

Sub-Contractor Notification; Unsafe Condition Report, Impending Disaster, Incident Report, Sentinel

Events, Equipment malfunction/recalls per Federal Drug Administration (FDA) at time of occurrence, certification of required staff training and current license verification.

Weekly a VA-Owned Equipment Inventory Status Report will be submitted to the COR at the beginning of the week for all VA-Owned equipment. Report will include all VA-owned equipment delivered to the contractor for storage, maintenance and issue; identified by make, model and serial number; indicate new or used status (i.e. issued to/returned from name/last 4, defective, replaced with serial#,); sort list by type of item and provide a total for each equipment type. If VA-owned equipment is stored at various locations, the storage location will also be provided. Any disparity between total equipment provided to contractor and total in Report will be promptly resolved between Contractor and the COR. Used as a method to confirm accountability for all VA-owned equipment at any given time.

Monthly service report for each patient visited will be submitted in conjunction with submitting the invoices. The contractor shall provide for each VA site an equipment summary listing all items issued to each patient. and picked up. Equipment will be identified by make, model, serial number, new or used VA equipment. Lists are to be sorted alphabetically by item then by patient’s name. A total will be reflected at the end of each item column to indicate how many of that item are in patient’s homes

(i.e. concentrators, conservers, B-tanks, E-tanks, Lbs. of Liquid Oxygen (LOX), etc.). A

Delivery/Pickup Equipment Report to be submitted by the 10th of each month to assist in updating data into the patients VA Prosthetic’s record. The following reports are provided via email as one Excel

Report with separate worksheets therein. This spreadsheet will list deliveries, pickups of all VA issued equipment. Concentrators, Portable Oxygen Concentrators (POCs), Self-Fill System with cylinders, Oxygen Conserving Devices, Regulators, Cough Assists and Ventilators and include the patient’s name, last 4, identify equipment as new/used, quantity. Defective VA Equipment for repair/replacement or disposal. A Sales Report to include each item issued to patients, the total amount charged o the VA for the item. List will reflect charges for each VA listing the total for each item and a grand total for all items.

On a quarterly basis a Quality Management (QM) Plan to include; Performance Improvement (PI) reports in accordance with Joint Commission for improving organizational performance. Patient Satisfaction, Infection Control/Communicable Diseases, Hand Hygiene Data as required by JC and CDC, Influenza

Vaccine Data.

The Contractor Security Control Assessment shall be submitted annually to the COR.

COR, PSAS RRTs, or Prosthetic Representatives will make unannounced Contractor site visits quarterly for a vendor site audit.

COR, PSAS RRTs will make random patient home visits monthly. COR or PSAS RRTs may request

“ride along” with contractor technician or RCP for observation of service provided. The Contractor will be provided a seven (7) calendar day notification in advanced notice. In addition, the COR may request to take part on a random day delivery schedule to accompany the Delivery Driver or the RCP during their

NF/SGVAHS delivery schedule. On a limited basis, it may be necessary to make an emergent visit which will be coordinated with the Contractor.

NF/SGVAHS Chief of Prosthetics, COR or designee will communicate with the Contracting Officer any high risk, problem-prone, and quality improvement issues.

L. Contractor Performance Standards:

Measure: Timeliness of Service – Delivery made within 24 hours or receipt of order

Numerator and Denominator: Number of VA patients delivered.

Quantity of Surveillance: Randomly pull 5% of files. results quarterly

Acceptable Quality Level: 97%

Method of Surveillance: Random Sampling

Measure: Timeliness of Service – quarterly and monthly visits

Numerator and Denominator: Number of VA patients delivered.

Quantity of Surveillance: Randomly pull 5% of files. results quarterly

Acceptable Quality Level: 97%

Measure: Vendor Audit

Numerator and Denominator: On site review of vendor contract regulatory requirements, on-call response, employee records, warehouse inspection – equipment tracking and management, patient record review and vehicle inspection.

Quantity of Surveillance: Random survey results quarterly.

Acceptable Quality Level: 95%

Measure: Home Visit Findings

Numerator and Denominator: Number of VA patients receiving service, Equipment as ordered, Home

Safety, Prescription compliance

Quantity of Surveillance: Random. home visits by PSAS RRTs results quarterly

Acceptable Quality Level: 95%

Method of Surveillance: Random Sampling

Measure: Falls per JC NPSG

Numerator and Denominator: Number of VA patients who had an incident related to oxygen

Equipment to include; accidents, malfunctions, injuries, deaths, and sentinel events.

Number of VA patients receiving oxygen equipment.

Quantity of Surveillance: Home Visits by RRTS, Contractor, HBPC and Home Oxygen Clinical Staff – identification of at Risk for Falls

Acceptable Quality Level: 0%

Method of Surveillance: Random Sampling reported quarterly

Measure: Fires per JC NPSG

Numerator and Denominator: Number of VA patients who had an incident related to oxygen

Equipment to include; accidents, malfunctions, injuries, deaths, and sentinel events.

Number of VA patients receiving oxygen equipment

Quantity of Surveillance: Home Visits by RRTS, Contractor, HBPC and Home Oxygen Clinical Staff – identification of at Risk for Fire

Acceptable Quality Level: 0%

Method of Surveillance: Random Sampling reported quarterly

M. Scheduling Visits:

The Contractor’s responsibility for the scheduling of equipment installation, assessment, monthly reassessments, quarterly equipment checks, and equipment pickup shall adhere to the contract requirements. When scheduling visits, every effort should be made to accommodate the patient and/or caregiver.

Initial delivery of equipment is to be completed within 24 hours of receipt of the order.

A licensed RCP shall see all basic setups within 78 hours and complex setups within 24 hours for the initial assessment and education. Monthly assessments shall be completed by the RCP for all ventilator and cough assists. Quarterly visits shall reassess equipment compliance, educational needs, equipment maintenance. Equipment pick-ups shall be completed within 3 days of receipt of the order.

N. Discharge Planning:

Discontinuation of any treatment or discharge from a treatment plan will be determined by NF/SGVAHS clinical staff. The Contractor shall not have any role and is relieved of any responsibility for the discharge of patients from the NF/SGVAHS Home Oxygen Program, however, the Contractor is responsible for notifying the COR or his/her designee if a patient requests their equipment be picked up.

All beneficiaries have the right of refusal of equipment. In the event a patient refuses the equipment, the contractor shall comply with the beneficiary’s wishes, after being sure the veteran understands the consequences of not using their oxygen as ordered by the physician. An “Against Medical Advice” form should be signed by the veteran and/or their caregiver at the time of refusal, as testament to their understanding of the risks of refusing treatment. If the refuse to sign the form the equipment can still be picked up and the form documented as “refused to sign”.

The Contractor shall be notified via consult requesting discharge of the Home Oxygen Program. Payment will be pro-rated based upon the notification date of discontinuance of service. The contractor shall notify the government within the next business day of learning of a patient death, or upon finding a patient has moved out of the service area. Payment to the contractor for services provided terminates 3 days after notification from the prescribing VA clinic to discontinue service.

O. Documentation:

The Contractor shall maintain a file of all deliveries, 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 when requested.

P. Government Furnished Property:

The Contractor shall maintain an inventory of Government Furnished Equipment (GFE) that is inventoried and provided by the COR via email on a quarterly basis. Provide Government Furnished

Property (GFP) management plan detailing how GFP will be accounted for. 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 other appropriate Government official. All VA owned equipment will be labeled “Property of VAMC-NFSG”. Equipment needing repair will be approved by the COR prior to repair. The Government shall not be held liable for the estimated or maximum equipment to be repaired nor will the contractor be entitled to an equitable adjustment in price under the Government Property Clause of the executed contract. See Section D for listing of Government

Property

Q. Demurrage Charges: The contractor agrees that the use of cylinders (Ref: SON Para. D) is indefinite but not to exceed the term of the contract.

R. Infection Control:

The Contractor shall comply with JC and NF/SGVAHS 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.

S. 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 NFSGVAHS 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 four (4) hours after discharge from the NF/SGVAHS Facility. 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 shall 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.

Supplies: An amount of supplies provided shall be sufficient until next scheduled visit. The cost for supplies will be at no additional charge and shall be included in the monthly or quarterly visit fee.

Daily: Heat and Moisture exchangers used with artificial airways (31/month)

Weekly: Aerosol system accessories (e.g. trach mask, tubing, large volume nebulizer); EZ-Wrap (or equivalent); Nasal Cannulas, Oxygen masks (e.g. Oxymask)

Monthly: 25 ft. or 50 ft. Green extension tubing with an equivalent section in reserve; Humidifier bottles;

Water traps; cough and ventilator circuits with all connectors (plus additional spare in reserve)

Replace when required: Thermal Fuses – Bidirectional (intended life is 4 years) and to be replaced if actuated or involved in a fire.; Oxygen tubing connection adaptors

The Contractor shall furnish cylinders called for under this contract that are only in accordance with the

Interstate Commerce Commission Regulations and transport cylinders in accordance with Code of

Federal Regulations (CFR) Part 49, U.S. Department of Transportation, including FDA. When more than

Two (2) portable cylinders are in the home a rack/container to secure the cylinders will be provided at no additional charge to the Government. A carry-bag, shoulder or backpack will be provided based on the patient’s physical condition and ability to carry the portable liquid or M6/B tank system with regulator/OCD at no additional charge.

T. Placement of Orders:

Ordering officers (OOs) will be authorized to place orders against this contract. The Contracting Officer

(CO) will furnish the Contractor with the names of individuals authorized as OOs, by separate memorandum upon issuance of the contract. When OOs are added after award, the CO will furnish the

Contractor with the names of individuals authorized as OOs, by memorandum upon OO appointment.

OOs are responsible for issuing and administering orders placed under this contract. OOs have no authority to modify any term of this basic contract. Any deviation from the terms of the basic contract must be approved in writing by the CO responsible for this contract.