36C25020Q0505-015.docx

36C25020Q0505

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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 ATTA

CHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNAT

URE OF OFFEROR/CONTRACTOR

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. 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

36C25020Q0505 04-22-2020 Karen Williams 614-257-5220 05-13-2020 2:00pm EST 36C250757 Department of Veterans Affairs Network Contracting Office (NCO) 10 Chalmers P. Wylie Ambulatory Care Center 420 North James Road Columbus OH 43219-1834 X 624221 $12 Million N/A X 36C655 Department of Veterans Affairs Aleda E. Lutz VA Medicl Center 1500 Weiss Street Saginaw MI 48602-5251 36c250757 Department of Veterans Affairs Network Contracting Office (NCO) 10 Chalmers P. Wylie Outpatient Clinic 420 North James Road Columbus OH 43219-1834

36C250 Department of Veterans Affairs Financial Services Center Invoices to be Submitted Electronically www.ob10.com/us/en/veterans-affairs// e-Invoice Setup Info Phone 877-489-6135 877-353-9791 512-460-5429 See CONTINUATION Page Health Care for Homeless Veterans (HCHV) Emergency Shelter Services See page 6 for the Price Schedule and page 7 for the Performance Work Statement This acquisition will be conducted using the procedures in FAR Part 12, Acquisition of Commercial Items, and adhering to FAR Part 13, Simplified Acquisition Procedures.

See CONTINUATION Page X Karen M. Williams Table of Contents

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’S NAME/ADDRESS/CITY/STATE-ZIP (Please print or type):

b. GOVERNMENT:

Karen Williams, Contract Specialist Department of Veterans Affairs Network Contracting Office (NCO) 10

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with FAR 52.232-33, Payment by Electronic Funds Transfer – System for Award Management.

3. INVOICES: Invoices shall be submitted in arrears: 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. Invoicing shall be in accordance with The Department of Veterans Affairs (VA) Financial Services Center (VAFSC). The latest information shall be used for invoicing and payments and may change during the Period of Performance of this acquisition. Current Invoicing information is located at http://www.fsc.va.gov/einvoice.asp.

Department of Veterans Affairs

FMS-VA-2(101)

Financial Services Center PO Box 149971 Austin TX 78714-9971

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

5. POST AWARD ORIENTATION (Contract Awards Exceeding $1M): The Contracting Officer will schedule a post-award orientation conference for contract orientation purposes as required by Information Letter (IL) 003A3-12-04 (https://www.va.gov/oal/docs/library/ils/il12-04.pdf).

6. SECURE FAX: In accordance with VA Handbook 6500, the following statement is required on all fax cover sheets; if it is determined the ordering process will include a fax: “This fax is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential or protected by law. All others are hereby notified that the receipt of this fax does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution or copying of this communication is prohibited. If you have received this fax in error, please notify this office immediately at the telephone number listed above.

7. The Contracting Officer will be the only person authorized to approve changes or modify any of the requirements under this resultant contract. The Contractor shall communicate with the Contracting Officer on all matters pertaining to contract administration. Only the Contracting Officer will be authorized to make commitments or issue changes that affect price, quantity, delivery or quality of performance of this resultant contract. In the event the Contractor effects any such change at the direction of any person other than the Contracting Officer, the change shall be considered unauthorized by the local VAMC and no adjustment will be made to the contract price to cover any increase in cost incurred as a result thereof.

8. The Contracting Officer’s Representative (COR) will be responsible for the overall technical administration of this contract as outlined in the COR Delegation of Authority.

36C25020Q0505

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B.2 PRICE SCHEDULE

The Contractor shall furnish four (4) to six (6) beds per night for eligible beneficiaries of the Department of Veterans Affairs Aleda E. Lutz Medical Center, Saginaw, MI, under the Health Care for Homeless Veterans (HCHV) rehabilitative services program..

In accordance with FAR 52.216-22, Indefinite Quantity, guaranteed minimum that the Government agrees to order during the period of this contract is 120 Beds. The contract maximum, inclusive of all options exercised, shall not exceed 12,045 Beds.

Reimbursement will be made to the contractor by issuance of individual task orders for the base year and each option year, if exercised. Only the Contracting Officer is authorized to place annual task orders against this contract for the estimated amount of services for the specific timeframe.

Base Year: October 1, 2020 through September 30, 2021

Option Year 1: October 1, 2021 through September 30, 2022

Option Year 2: October 1, 2022 through September 30, 2023

Option Year 3: October 1, 2023 through September 30, 2024

Option Year 4: October 1, 2024 through September 30, 2025

Aggregate Total to include base and all option years: $_____________________

B.3 PERFORMANCE WORK STATEMENT

Healthcare for Homeless Veterans (HCHV) Emergency Shelter Services

The Veterans Affairs Aleda E. Lutz Medical Center in Saginaw, Michigan has a requirement for emergency shelter services for homeless Veterans, and place them in community-based, residential environments with sufficient services to support their rehabilitation goals.

PART I: GENERAL INFORMATION

A. Background

Through the HCHV program, VA provides case management services to Veterans and facilitates their access to a broad range of medical, mental health, and rehabilitative services. These Veterans have a difficult time finding shelter and need a safe and secure environment that supports their rehabilitation goals. The Contractor will be required to provide therapeutic case management services, but will not be required to provide detoxification or other hospital level treatment – those services will be provided by the VA at VA facilities.

B. Services to be Provided

All Veterans placed at the Contractor’s facility by the VA staff will be Veterans eligible for VA healthcare, as defined by Department of Veterans Affairs guidelines. All Veterans referred shall be capable of independent living and performance of all Activities of Daily Living (ADL’s) independently. In the event of an emergency, the referred Veterans shall have the mental and physical capacity and judgement needed to recognize the emergency, follow appropriate procedures for addressing the emergency, and carrying out such procedures.

Four (4) to six (6) HCHV emergency shelter beds shall be located in Traverse City, Michigan for Veterans in the Aleda E. Lutz VA Medical Center's catchment area. One bed will be reserved for female Veterans. The facility will also have a family room available for Veterans who have minor children. The catchment area of the Aleda E. Lutz VA Medical Center includes the following counties: Emmet, Cheboygan, Presque Isle, Charlevoix, Antrim, Otsego, Montmorency, Alpena, Leelanau, Benzie, Grand Traverse, Kalkaska, Crawford, Oscoda, Roscommon, Ogemaw, Alcona, Iosco, Osceola, Clare, Gladwin, Arenac, Bay, Midland, Isabella, Gratiot, Saginaw, Genesee, Lapeer, Tuscola, Huron, Shiawassee, Wexford, Manistee, Missaukee.

C. Applicable Documents

· VHA Handbook 1162.09 Health Care for Homeless Veterans (HCHV) Program (http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3006)

· VA patient’s Bill of Rights, 38 U.S. C 17.34a (http://www.va.gov/health/rights/patientrights.asp)

· Life Safety Code of the National Fire Protection Agency: NFPA #101 (www.nfpa.org)

· Confidentiality of Medical Quality Assurance Records: 38 U.S.C. 5701 (http://www.gpo.gov/fdsys/granule/USCODE-2010-title38/USCODE-2010-title38-partIV-chap57-subchapI-sec5701/content-detail.html); and 38 U.S.C. 7332 (http://www.gpo.gov/fdsys/granule/USCODE-2011-title38/USCODE-2011-title38-partV-chap73-subchapIII-sec7332/content-detail.html)

· Disclosure of Patient Records: Records protected by 38 U.S.C. 5705; its implementing regulations at 38 U.S.C. 17.500-511; VHA Directive 98-016, 4b. (1) (d), 4.6(2)(c) and 4.6(4). These records may be disclosed only as authorized by 38 U.S.C. 5705 and the VA regulations. Disclosure of these records in violation of 5705 is a criminal offense under 38 U.S.C. 5705(e): (http://www.gpo.gov/fdsys/pkg/USCODE-2013-title38/pdf/USCODE-2013-title38-partIV-chap57-subchapI-sec5705.pdf)

PART II: WORK REQUIREMENTS

A. Services to be Provided:

1. The contractor shall furnish each Veteran referred for care under this contract with the following basic services:

a. Contractor shall have a facility obtained (either leased/rented/owned) and made fully operational prior to the effective date of this contract. The facility must pass the life safety inspection prior to any services rendered.

b. The contractor will employ sufficient personnel to carry out the policies, responsibilities, and the program for the facility. There must be, as a minimum, at least one administrative staff member, or designee of equivalent professional capability, on duty on the premises or residing at the house and available for emergencies 24 hours a day, 7 days a week.

c. Veterans may be on physician ordered special diets. Veterans shall have appetizing, nutritional meals provided in a setting that encourages social interaction. Meals shall include three (3) nutritionally adequate meals a day, 7 days a week and availability of nutritious snacks between meals and bedtime for those requiring or desiring additional food, when it is not medically contraindicated. Refrigeration and dry food storage areas are appropriately maintained and monitored. All food areas are clean and free of litter. Current licensures are maintained, if required. If facility is not set up to provide meals 7 days a week, nutritional food must be provided or available at no cost to the Veteran. (This could mean Veterans have access to a food pantry, local food bank, are receiving supplemental nutritional assistance program (SNAP), or the contractor provides the food). For individually prepared meals: Appliances must be adequate to safely store and prepare food and are in good working condition (i.e.: stove, refrigerator, dishwasher, etc.) for individually prepared meals. This would also include ensuring that all food preparation areas contain suitable space and equipment to store, prepare, and serve food in a sanitary manner. Cleaning supplies shall be provided to maintain a clean kitchen area. These would include broom, mop, vacuum, cleaning products, dish soap, trash can, trash bags, etc.) Resource information is available to educate veterans with special dietary needs (i.e.: Diabetic, allergies, medically indicated.) This may be accomplished through nutritional education provided directly by the agency or a referral resource within the community. Many veterans are either undernourished or have poor eating habits because of their chronic psychiatric disorders, which could be alcohol/drug abuse related behaviors.

d. Laundry facilities for residents to do their own laundry with no cost to the veterans. Machines shall be maintained and in good condition to ensure availability of service.

e. Dining areas must be comfortable and adequate size to seat the maximum number of residents in the facility.

f. Common living areas must be comfortable and adequate in size to accommodate the maximum number of residents in the facility.

g. The facility shall maintain one functional lavatory (bathing and/or shower facility) for every six people living in the facility.

h. Bedrooms shall measure at least 100 square feet for a single room, or an additional 25 square feet for each resident double occupancy room (or in a multi-resident room). Male and female residents shall have secure separate sleeping quarters. Bedrooms shall contain no more than four beds. Floor plan of facility/units shall be available for review and approval prior to award. NOTE: The complex nature of certain residents may dictate the need for single occupancy in a bedroom. Bedrooms shall contain a suitable bed furnished by the facility with, mattress, pillow, sheets/blankets and towels. The facility shall be responsible for laundering the linens and towels at least weekly and keeping them in good condition. Mattresses must be kept in good condition and replaced as needed.

i. The Contractor will offer a “low-demand environment” meaning Veterans will be offered mental health and substance abuse services but, their participation in these services will not be contingent on their acceptance or continued stay in the facility.

j. A locked cabinet or secured lock box (that cannot be easily removed from the premises) shall be provided for medication and valuables storage.

k. Facility shall have safe and functioning systems for: Heating and cooling, hot and cold water, electricity, plumbing, sewage, food preparation (unless food is prepared off site), laundry, artificial and natural light, and ventilation. The residence shall be climate controlled to be heated not below 65 degrees Fahrenheit in the winter and cooled not above 75 degrees Fahrenheit in the summer.

l. All facility areas shall be kept clean and sanitized weekly. Chores may be assigned to veterans, but facility staff must ensure areas are cleaned to sanitary standards.

m. Pest Prevention: There shall be a Pest Preventative Treatment plan in place; pest preventative treatment plans shall include prevention and remedy methods for the treatment of pests, such as bed bugs, rodents; and shall render prevention/treatment of such pests with pest control industry standard practices. The COR shall monitor the Contractor’s facility to ensure compliance with this protocol and successful results. Contractor shall maintain an emergency housing contingency plan in the event of an infestation that renders the facility unfit for habitation.

n. Therapeutic, Rehabilitative, and Recovery Services shall be determined by the individual resident in conjunction with the contracted facility staff and in consultation with the Homeless Program Coordinator or designee. The Contractor shall develop a service plan with the veteran and include the Homeless Program Coordinator or designee. Such plans shall be developed based on a psychosocial assessment, completed by contracted facility staff and shall be in compliance with Commission of Accreditation for Rehabilitation Facilities (CARF) standards located at http://www.carf.org/home/

2. Services which the contractor must be able to furnish shall include:

a. Structured group activities as appropriate – examples include: Group therapy, social skills training, Alcoholics Anonymous, Narcotics Anonymous, vocational counseling and physical activities as appropriate.

b. Collaboration with the VA program staff, which will provide supportive psychosocial services.

c. Case Management, including counseling on self-care skills, adaptive coping skills, enrollment in State benefits programs, establish residency, documents needed for housing applications, housing programs, day care services, enrollment in school for minor children or any other services deemed necessary to engage the veteran family in housing, in collaboration with VA program and community resources.

d. Assistance to develop responsible living patterns, to maintain an acceptable level of personal hygiene and grooming, and to achieve a more adaptive level of psychosocial functioning, upgraded social skills, and improved personal relationships.

e. Support for an alcohol/drug abuse-free lifestyle provided in an environment conducive to social interaction and the fullest development of the resident’s rehabilitative potential.

f. Assistance to gain and to apply knowledge of the illness/recovery process in an environment supportive of recovery models.

g. A program that promotes community interaction.

h. A safe and secure environment to foster growth and development, and pursuance of individually identified goals.

i. Track veteran outcomes upon discharge from services for six consecutive months.

j. Provide treatment and discharge planning reflecting a team assessment of health, social and vocational needs and the involvement of the Veteran, the VA Homeless Program staff and appropriate community resources in resolving problems and setting goals.

B. Responsibility and Obligations

1. An individual case record will be created for each referred Veteran. Case records shall be maintained in secure and confidential areas as required by the Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR part 2) and the Confidentiality of Certain Medical Records (38 USC 7332). Case records and data normally maintained and included in a medical record as a function of compliance with State or community licensing standards will be made available on a need to know basis to appropriate U.S. Department of Veteran Affairs staff members involved with the treatment program of the Veterans concerned.

2. The contractor shall comply with applicable requirements of the Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR Part II) and the Confidentiality of Certain Medical Records (38 USC 7332).

3. The contractor shall comply with the principles listed in 38 CFR 17.707(b) to provide housing and supportive services in a manner that is free from religious discrimination.

4. The contractor will enter all veteran data into the HUD Homeless Management Information System (HMIS). Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR part 2) and the Confidentiality of Certain Medical Records (38 USC 7332).

C. Residential Standards

1. Residential settings shall meet the following:

a. The standards of the Life Safety Code (National Fire Protection Association (NFPA #101)

b. The fire and safety code imposed by the State law

c. City, State, and Federal requirements concerning licensing and health codes, including construction, fire, maintenance, and sanitation regulations

d. All residential program settings shall meet ADA (Americans with Disabilities Act) requirements (www.ada.gov)

e. All residential program settings must be licensed as required for the particular setting under State or Federal authority

f. Be equipped with operational air conditioning /heating systems

g. Be kept clean free of dirt, grime, mold, or other hazardous substances and damaged noticeably detract from the overall appearance.

h. Be equipped with first aid equipment and an evacuation plan in case of emergency.

i. Have windows and doors that can be opened and closed in accordance with manufacturer standards.

j. Must have a water supply that is free from contamination.

k. Written policies and procedures regarding safety, security, and privacy in which are regularly communicated to participants and staff and routinely enforced.

l. If applicable, this would include separate facility (bathrooms/showers) access for privacy and security given the population served.

m. Has installed staff offices, treatment, group, participant rooms, dorms, shower, and restrooms have locks appropriate for the setting and gender mix.

n. If applicable, separate male and female bathrooms.

o. Has established a procedure for ongoing law enforcement monitoring.

p. Ensures residential supervision with sufficient knowledge of the position is on duty 24 hours a day, 7 days a week; If this supervision is provided by a volunteer or senior resident, a paid staff member is on call for emergencies 24 hours a day, 7 days a week.

q. Ensures documentation of residential supervision training.

r. Ensures emergency contacts for medical, law enforcement, fire department, and agency are prominently posted in the facility.

s. Has a system to identify participants who are subject to residency restrictions (e.g., Those are required to register following conviction for a sexual offense) and when appropriate, to communicate with parole or probation authorities to confirm that the placement meets any court-imposed requirements

t. Ensures the facility is safe and secure based on location, population(s) served, and facility structure (This includes ensuring locks are in working order where appropriate) (Note adequate consideration should be given to separation and safety in facilities where multiple genders and/or children are served).

u. Program has adequate policies and procedures which are communicated and enforced to ensure safety, security, and privacy based on location, population(s) served, and facility structure.

v. Ensure interior and exterior locks are in good working order; appropriately located; adequate for the area that is being secured and populations served within the facility.

w. Provides adequate natural or artificial illumination to permit normal indoor activities and to support health and safety of residents. Must also ensure there is sufficient lighting on the perimeter of the facility based on the housing setting (e.g.; rural, industrial, or residential settings).

i. Both interior and exterior lights must be checked regularly to make sure they are operating effectively

ii. Interior and exterior lights must be in good working order and adequate for the area that is being secured and populations served within the facility

iii. Common areas (e.g., laundry, computer labs, break rooms) are appropriately secured, monitored, and lit.

x. Contractor has a written disaster plan that has been coordinated with the emergency management entity responsible for the locality in which the project resides. The disaster plan encompasses natural and manmade disasters

D. Accreditation and Licensing

Accreditation by the Commission on Accreditation of Rehabilitation Facilities (CARF) is desirable, but not required. The Contractor’s facility shall have a current occupancy permit issued by the authority having such jurisdiction.

E. Personnel

1. The contractor will employ sufficient personnel to carry out the policies, responsibilities, and the program for the facility. There must be, as a minimum, at least one administrative staff member, or designee of equivalent professional capability, on duty on the premises or residing at the house and available for emergencies 24 hours a day, 7 days a week.

2. The Contractor shall assign to this contract personnel that by education and training (and, when required, certification or licensure) are qualified to provide the Basic Services and Supplemental Services required by this PWS.

3. The Contractor must identify each person functioning as “Key Personnel” under this contract, and provide to the VA a description of the services to be provided by such person, together with a resume summarizing that person’s relevant skills and experience.

4. During the first ninety (90) calendar days of contract performance, the Contractor shall make NO substitutions of key personnel unless the substitution is necessitated by illness, death, or termination of employment. Within 14 days after substitutions necessitated by situations described above, the Contractor shall provide resumes for the substitute key personnel. For substitutions proposed by the Contractor after the initial 90 calendar day period, the Contractor shall provide resumes for the substitute personnel, together with any other additional information requested by the Contracting Officer, at least 15 days before the substitution is to occur. The Contracting Officer shall notify the Contractor within fifteen (15) calendar days after receipt of all required information if the VA refuses to accept the substitute key personnel. The VA reserves the right to refuse or revoke acceptance of key personnel if personal or professional conduct, or lack of required skills or experience, jeopardizes patient care or interferes with the regular and ordinary operation of the facility.

5. Temporary substitutions of key personnel shall be permitted in accordance with the Contractor’s contingency plan. The Contractor’s contingency plan to be utilized if personnel leave Contractor’s employment or are unable to continue performance in accordance with the terms and conditions of the resulting contract must be submitted as part of the Contractor’s offer. The Contracting Officer (CO) or Contracting Officer Representative (COR) shall be notified of temporary substitutions within one (1) business day.

F. Referrals

1. The VA is responsible for determining eligibility of Veterans prior to referral to the Contractor for treatment. A written referral (hard copy, fax or e-mail are acceptable) signed by an authorized VA ordering officer shall be provided to the Contractor for each Veteran referred for services under the contract.

2. The facility (Aleda E. Lutz VAMC) providing authorization for HCHV residential treatment services is responsible for payment to the Contractor.

3. It is understood that the Contractor will not be paid for care provided to a referred Veteran beyond the period authorized in the referral, unless an extension of the authorization is provided in writing by the VA.

4. The Contracting Officer (CO) is the only individual with authority to approve any changes or modifications to the requirements of the contract. The Contractor shall communicate with the CO on all matters pertaining to administration of the contract. The CO is the only individual with authority to make commitments or issue changes that will affect the price, quantity or quality of performance of this contract.

5. The initial referral period for a Veteran may be up to 120 days, depending upon the needs of the Veteran as mutually determined by the Veteran, the Contractor’s staff, and VA Homeless Program Coordinator or designee. An extension of the referral period up to a total of 60 days may be authorized by the VA Homeless Program Coordinator or designee, provided that funding is available. Treatment periods in excess of this time for individual Veterans must be authorized by the Medical Center Director or designee.

6. The Contractor shall be equipped to provide housing and/or therapeutic services to special Veteran populations (medically compromised Veterans, Veterans with a serious mental illness, Veterans with a current or past substance use disorder, and/or Veterans with involvement with the legal system).

7. The Contractor will be responsible for entering all data for authorized Veterans into the HUD Homeless Management Information System (HMIS) per Continuum of Care (CoC) guidance.

G. Absences and Cancellation

1. The Contractor shall notify the VA of unauthorized absences by a referred Veteran from the facility. Should a Veteran absent himself/herself from the Contractor’s facility in an unauthorized manner, payment for services for that Veteran shall be continued for a maximum period of two days, provided there is an active outreach attempt on the part of the Contractor’s staff to return the Veteran to the facility and there is a reasonable belief that the Veteran will return. Management of program dropout will be an element of quality assurance review of this program. Absences of the Veteran from the facility in excess of two days will not be reimbursable unless authorized in advance by the VA Homeless Program Coordinator.

2. The VA reserves the right to remove any or all Veterans from the facility at any time, without additional cost, when it is determined to be in the best interest of the VA or the Veteran.

3. The Contractor shall notify the authorizing VA facility immediately when a medical emergency occurs that requires hospitalization of a referred Veteran. It is agreed that the Veteran will be admitted to the appropriate VA facility. When such admission is not feasible because of the nature of the emergency, it is agreed that hospitalization in a non-federal hospital may be accomplished provided that VA authorization is obtained. If hospitalization of a non-emergency nature is required it is agreed that admission to the appropriate VA facility will be accomplished promptly.

4. The Contractor shall notify the authorizing VA facility immediately when a Veteran receiving services from the Contractor’s facility dies. The Contractor will immediately take an inventory of the Veteran’s belongings and appropriately safeguard them. The Contractor shall adhere to applicable laws regarding disposition of funds and belongings left by Veterans; unless the Veteran dies without leaving a will or next of kin capable or inheriting the items. Once this disposition is made, the Contractor shall send an itemized inventory with a notation identifying the beneficiary of the belongings to the Homeless Program Coordinator immediately. In the event the Veteran does not have an identified beneficiary of his/her belongings, the belongings will become the property of the United States in trust. The Contractor shall forward any belongings in their possession to the Aleda E. Lutz VAMC office, and hold them (except articles of clothing necessary for proper burial) under safeguard until instructions are provided by the VA.

5. The contractor shall notify the authorizing VA facility immediately of any incidents involving veterans residing in the residential program. The contractor shall notify the VA Homeless Program Coordinator, Carly Huffman by telephone at 989-497-500 ext. 11694 during the hours of 8:00am and 4:30pm; or by e-mail at Carly.Huffman@va.gov . The contractor shall provide the Homeless Program Coordinator/COR with a copy of the incident report within 24 hours. The contractor shall maintain a copy of the incident report in the Veteran’s case record.

H. Census Reporting and Payment

DAILY CENSUS: A Daily Veteran Census log sheet broken down by category of bed(s) shall be sent to the COR via e-mail Carly.Huffman@va.gov or fax at 989-321-4985 at the conclusion of each month; prior to invoices for payment being submitted.

PAYMENTS: It is understood that payment made by the VA under this contract shall constitute the total cost of the care provided at the facility. The facility agrees that no additional charges shall be billed to the Veteran or his/her family; either by the facility or any third-party providing services or supplies required for the provision of care- unless and until specific prior written authorization is obtained from the Aleda E. Lutz VAMC for an item. A day is defined as up to the twenty-four (24) hour period after the Veteran is admitted and/or spends the night at the facility; the date of discharge is not counted.

I. Billing

Unless specifically excluded in this contract, the per diem rate established shall include the services listed in the Performance Work Statement (PWS) and shall also include all services or supplies normally provided other residents by the facility without an extra charge. Payments made by the Aleda E. Lutz VAMC under this contract shall constitute the TOTAL cost of care and housing of homeless Veterans. If a Veteran is admitted to and discharged from the facility on the same calendar day, payment shall not be authorized. Absences of the Veteran from the facility for greater than two days shall not be reimbursed. The Contractor shall submit electronic invoices by the tenth (10th) of every month into the Tungsten System.

FSC e-invoice program http://www.fsc.va.gov/einvoice.asp OB10 electronic invoicing system http://www.tungsten-network.com/customer-campaigns/veterans-affairs/ OB10 e-Invoice Setup Information: 1-877-489-6135 OB10 e-Invoice email: VA.Registration@ob10.com FSC e-Invoice Contact Information: 1-877-353-9791 FSC e-invoice email: vafsccshd@va.gov

J. Records and Confidentiality

1. Contractor shall maintain an individual clinical record on each Veteran placed under this contract. The Contractor shall comply with the requirements of the “Confidentiality” of certain medical records (38 USC 7332), and (42 CFR, Part II). All case records shall be maintained with such security and confidentiality as required and shall be made available on a need-to-know basis to appropriate staff members involved with the service program of the veterans concerned. In addition to reasons for referral, the clinical record maintained by the contract facility shall include:

a. All essential identifying data relevant to the resident and his/her family, including a psychosocial assessment, completed by facility staff.

b. Service plans shall be completed by facility staff, in collaboration with VA outreach and the HCHV Program Coordinator, and shall include data relating to the resident’s admission, anticipated length of stay, targeted goals and objectives for constructive changes and discharge planning. Service plans must meet CARF regulations whether or not the facility is CARF accredited.

c. Release of Information (ROI) shall be filled out and signed by the Veteran and placed in the file.

d. A summary of all medical prescriptions issued by physicians, including orders, and if any medications need to be taken.

e. Reports of periodic reevaluations by program staff, to include any measures of movement toward goals, with particular focus on the attainment of self-determination.

f. Final summaries on each Veteran who leaves the program, which includes a description of beneficial changes found during the residential period, reasons for leaving, the Veteran’s future plans, and follow up locator information. Contractor shall provide a copy of final summary to HCHV Program Coordinator and Veteran within one month of the Veteran leaving the facility.

g. Upon discharge or death of the Veteran, medical records on all Veterans shall be retained by the residential program for a period of at least three (3) years following termination of care.

2. In performance of this contract, the Contractor shall not be considered to be part of the VA for purposes of 5 U.S.C. 552a, 38 U.S.C. 5701 and 7332.

a. Contractor shall obtain needed records from VA only with signed consent by veteran.

b. Records created by Contractor in the course of performing this contract are the property of VA, and shall not be accessed, released, transferred, or destroyed except in accordance with federal law, regulations, and policy. Access to data shall be limited to the minimum necessary for performance of the contract. Contractor shall take steps to ensure that access is limited to those employees who need access to the data to perform the contract. Contractor shall not copy information contained in the system, either by printing to paper or by copying to another digital format, without the express permission of Aleda E. Lutz VAMC Release of Information Office, except as is necessary to make single copies in the ordinary course of providing Veteran care. Contractor shall not comingle the data from the system with information from other sources. Contractor shall report any unauthorized disclosure of VA information to the Aleda E. Lutz VAMC Privacy Officer.

c. If this contract is terminated for any reason, Contractor shall provide the VA with all individually identified VA veteran services records or other information in its possession, as well as any copies made pursuant to paragraph (2), above within seven (7) days of the termination of the contract.

d. Certain information available from the database and other records created by the Contractor under this Contract are medical quality assurance records protected by 38 U.S.C. 5705; its implementing regulations at 38 U.S.C. 17.500-511; VHA Directive 98-016, 4b. (1) (d), 4.6(2)(c) and 4.6(4). These records may be disclosed only as authorized by 38 U.S.C. 5705 and the VA regulations. Disclosure of these records in violation of 5705 is a criminal offense under 38 U.S.C. 5705(e).

e. Contractor shall follow all VA policies regarding the retention of records. In the alternative, Contractor may deliver the records to VA for retention.

f. Any changes in the law or regulations governing the information covered by this contract during the term of this contract shall be deemed to be incorporated into this contract. The Contractor shall educate its employees and Subcontractors of the requirements of this section and shall advise its employees and Subcontractors of any changes as they occur. On the Contractor’s request, the VA shall provide trainers who can education the Contractor’s employees and Subcontractors, of their obligations under this section.

g. The Contractor shall make its internal policies and practices regarding the safeguarding of medical and/or electronic information available to federal agencies with enforcement authority over the maintenance of those records upon request.

K. Contractor Staff Conduct/Complaints Handling

1. Contractor personnel shall be expected to treat referred Veterans with dignity and respect and abide by standards of conduct mirroring those prescribed by current federal personnel regulations. The Contractor shall comply with the VA Patient's Bill of Rights as set forth in 38 CFR 17.34a (copy available upon request).

2. The VA reserves the right to exclude Contractor staff members from providing services to Veterans under this contract based on breaches of conduct, including conduct that jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by Veterans or other staff members to designated Government representatives. The Contractor and Contracting Officer’s Representative will respond to identified concerns pertaining to contractor personnel conduct. The Contracting Officer shall be the final arbiter on questions of acceptability and in validating complaints.

L. Transportation

The Contractor shall assist the Veterans with local transportation to scheduled meetings and appointments. The Contractor will be expected to help the Veteran access public transportation, including providing information and instructions necessary to enable Veterans to utilize public transportation. If VA staff determines that adequate public transportation is not available or appropriate for a Veteran, the Contractor shall arrange for alternative transport by contractor agency vehicle.

PART III: FACILITY INSPECTION AND ACCEPTANCE

A It is the responsibility of the Contractor to properly maintain its facilities and the VA shall have no responsibility for paying or reimbursing the Contractor for such expenses. The contract facility must:

1. Have a current occupancy permit issued by the local and state governments in the jurisdiction where the facility is located.

2. Be in compliance with existing standards of State safety codes and local, and/or State health and sanitation codes.

3. Be licensed under State or local authority.

4. Where applicable, be accredited by the State.

5. Be equipped with operational air conditioning /heating systems

6. Be kept clean free of dirt, grime, mold, or other hazardous substances and damaged noticeably detract from the overall appearance.

7. Be equipped with first aid equipment and an evacuation plan in case of emergency.

8. Have windows and doors that can be opened and closed in accordance with manufacturer standards.

B. The contractor facility must meet fire safety requirements, as follows:

1. The building must meet the requirements of the applicable residential occupancy chapters of the current version of NFPA 101, National Fire Protection Association's Life Safety Code. Any equivalencies or variances must be approved by the appropriate Veterans Health Administration Veterans Integrated Service Network (VISN) Director.

2. All residents in the facility must be mentally and physically capable of leaving the building, unaided, in the event of an emergency

3. Fire exit drills must be held at least quarterly. Residents must be instructed in evacuation procedures when the primary and/or secondary exits are blocked. A written fire plan for evacuation in the event of fire shall be developed and reviewed annually. The plan shall outline the duties, responsibilities and actions to be taken by the staff and residents in the event of a fire emergency. This plan shall be implemented during fire exit drills.

4. A written policy regarding tobacco smoking in the facility shall be established and enforced.

5. Portable fire extinguishers shall be installed at the facility. Use NFPA 10, Portable Fire Extinguishers, as guidance in selection and location requirements of extinguishers.

6. Requirements for fire protection equipment and systems shall be in accordance with NFPA 101. All fire protection systems and equipment, such as the fire alarm system, smoke detectors, and portable extinguishers, shall be inspected, tested and maintained in accordance with the applicable NFPA fire codes and the results documented.

7. The annual inspection by a VA team required by paragraph 7 shall include a fire and safety inspection conducted at the facility unless a review of past Department of Veterans Affairs inspections or inspections made by the local authorities indicates that a fire and safety inspection would not be necessary, in which case the fire and safety inspection may be waived by the VA.

2. Prior to the award of a contract and annually during the contract term, a multidisciplinary VA team consisting of a social worker, dietitian, registered nurse, a representative of the VA Police, and a Facilities Management Safety Officer, and other subject matter experts as determined necessary by the medical center Director or HCHV Coordinator shall conduct a survey of the Contractor’s facilities to be used to provide Veterans food, shelter, and therapeutic services to assure the facility provides quality care in a safe environment. Inspections may also be carried out at such other times as deemed necessary by the Department of Veterans Affairs.

3. The contractor will be advised of the findings of the inspection team. If deficiencies are noted during any inspection, the contractor will be given a reasonable time to take corrective action and to notify the Contracting Officer that the corrections have been made. A contract will not be awarded until noted deficiencies have been eliminated. Failure by the Contractor to take corrective action within a reasonable time will be reported to the VA Contracting Officer. If corrections are not made to the satisfaction of the VA, the Contracting Officer will consult with the appropriate officials so that suitable arrangements can be made to discontinue plans to award a contract, or to discharge or transfer patients and to terminate the existing contract, as appropriate.

4. The inspection of the Contractor facilities will include inspection for conformity to the current Life Safety Code as described in paragraph 6, and will also include the following:

a. General observation of residents to determine if they maintain an acceptable level of personal hygiene and grooming.

b. Assessment of whether the facility meets applicable fire, safety and sanitation standards.

c. Determining whether the facility is in attractive surroundings conducive to social interaction and the fullest development of the resident's rehabilitative potential.

d. Observation of facility operations to see if appropriate organized activity programs are available during waking hours (including evenings) and degree to which a high level of activity is observed in the facility, such as individual professional counseling, physical activities, assistance with health and personal hygiene.

e. Seeking evidence of facility-community interaction, demonstrated by the nature of scheduled activities or by information about resident flow out of the facility, e.g., community activities, volunteers, local consumer services, etc.

f. Observation of staff behavior and interaction with Veterans to determine if they convey an attitude of…