36C25025R0061.docx

36C25025R0061

PAGE 1 OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

UEI:

EFT:

PHONE:

FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED

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

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

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

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

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. 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. NOV 2021)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

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

36C25025R0061 09-26-2025 Kristina L. Peart 734-845-3444 10-27-2025 13:00

EDT

Department of Veterans Affairs Network Contracting Office 10 24 Frank Lloyd Wright Drive Lobby M, Suite M2200 Ann Arbor, MI 48105 X X 621610 $19 Million N/A X Department of Veterans Affairs

VISN 10

Richard L. Roudebush VAMC 1481 West Tenth Street Indianapolis IN 46202 Department of Veterans Affairs Network Contracting Office 10 24 Frank Lloyd Wright Drive Lobby M, Suite M2200 Ann Arbor, MI 48105

Department of Veterans Affairs See Section B.1 Invoicing.

512-242-7300 N/A X See CONTINUATION Page See Price Schedule in Section B.

Contractor shall ensure 852.219-75 is completed, signed and retuned with offer.

Do not alter this clause in any way.

See Instructions to offerors proposal submission in Section E in the Addendum to FAR 52.212-1.

Contractor shall provide all labor and material to provide Home Oxygen to an estimated 5,0000 beneficiaries.

Questions are due in writing no later than 15 days calendar days before the RFP close date in Box 8.

The Government will award this procurement in accordance with FAR 12 and 15 - See Instruction to offerors in section E.2 for specific award criteria.

See CONTINUATION Page X X One(1) Toni Waggoner-Boykin Contracting Officer 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:

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

3. INVOICES: Invoices shall be submitted in arrears:

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests. Tungsten Network: https://www.tungsten-network.com/customer-campaigns/veteransaffairs

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

AMENDMENT NO DATE

B.2 ELECTRONIC INVOICE SUBMISSION AND INVOICING

VENDOR ELECTRONIC INVOICE SUBMISSION REQUIREMENTS AND METHODS

E-mail, and scanned documents are not acceptable forms of submission for payment requests. Electronic form means an automated system transmitting information electronically according to the accepted electronic data transmission methods below:

1. VA’s Electronic Invoice Presentment and Payment System – the FSC uses a third-party contractor, Tungsten Network (referred to OB10), to transition vendors from paper to electronic invoice submission. Please go to website: https://www.tungsten-network.com/customer-campaigns/veteransaffairs to enroll in the program and begin submitting the electronic invoices, free of charge.

1. A system that conforms to the X12 electronic data interchange (EDI) formats established by the Accredited Standards Center (ASC) chartered by the American National Standards Institute (ANSI). The X12 EDI website is: http://www.x12.org

1. Please contact Tungsten at the phone number or email address listed below to begin submitting your electronic invoices to the VA Financial Services Center for payment processing, free of charge. If you have questions about the e-invoicing program or Tungsten, please contact the FSC at the phone number or email address listed below:

2. Tungsten e-Invoice Setup Information: 1-877-489-6135

2. Tungsten e-Invoice email: VA.Registration@Tungsten-Network.com

2. FSC e-Invoice Contact Information: 1-877-353-9791

2. FSC e-Invoice email: vafsccshd@va.gov

BILLING AND INVOICING

1. In accordance with this contract, all services shall be billed in arrears monthly.

2. Contractor shall only bill for services and for line-items delivered.

3. A proper invoice that is submitted for payment; shall be accepted and certified for payment if:

i. Monthly invoice is submitted in arrears, no later than the 20th business day of the following month that services were rendered.

ii. Invoice contains in addition to the information required for submission of a ‘proper’ invoice in accordance with FAR 52.212-4(g) the following information:

a. Name and Address of the Contractor

b. Invoice Date and Invoice Number

c. Contract Number

d. Contract Order Number

e. Purchase Order Number

f. Date Range of Services Provided

g. Description of Services Provided

h. Line/Sub-Line Item number(s) of services provided

i. Quantity of each Line/Sub-Line Item

j. Unit Rate for each Line/Sub-Line Item

k. Total Cost for each Line/Sub-Line Item

l. Total Invoice Cost

4. The Certifying Official will compare the information in the submitted invoice to the contract and invoice to ensure it is correct and valid.

i. If the invoice submitted is not a proper invoice, the certifying official shall refuse the invoice with a detailed statement as to why the invoice was refused.

ii. Contractor shall make corrections and resubmit using a separate invoice number, notating the invoice number it is replacing.

B.3 CONTRACTOR PERFORMANCE ASSESSMENT REPORTING SYSTEM (CPARS)

As prescribed in FAR Part 42.15, the Department of Veterans Affairs (VA) evaluates contractor past performance on all contracts and contracts that exceed $250,000.00 and shares those FFAR requires that the contractor be provided an opportunity to comment on past performance evaluations prior to each report closing. To fulfill this requirement VA uses an online database, CPARS, which is maintained by the Naval Sea Logistics Center in Portsmouth, New Hampshire. CPARS has connectivity with the CPARS database, which is available to all federal agencies. CPARS is the system used to collect and retrieve performance assessment reports used in source selection determinations and completed CPARS report cards transferred to CPARS. CPARS also includes access to Federal Awardee Performance and Integrity Information System (FAPIIS). FAPIIS is a web-enabled application accessed via CPARS for contractor responsibility determination information.

Each contractor whose contract award is estimated to exceed $250,000.00 requires a CPARs evaluation. A government Focal Point will register your contract within 30 days after award and, at that time, you will receive and email message with a User ID (to be used when reviewing evaluations). Additional information regarding the evaluation process can be found at www.cpars.gov or if you have any questions, you may contact the Customer Support Desk at DSN: 684-1690 or COMM: 207-438-1690.

For contracts with a period of one year or less, the contracting officer will perform a single evaluation when the contract is complete. For contracts exceeding one year, the contracting officer will evaluate the contractor’s performance annually. Interim reports will be filed each year until the last year of the contract, when the final report will be completed. The report shall be assigned in CPARS to the contractor’s designated representative for comment. The contractor representative will have 60 days to submit any comments and re-assign the report to the CO.

Failure for the contractor’s representative to respond to the evaluation within those 60 days will result in the governments evaluation being placed on file in the database with a statement that the contractor failed to respond. The Contractor’s representative will be locked out of the evaluation and may no longer send comments.

B.4 PRICE/COST SCHEDULE INFORMATION

Contractor shall provide all necessary labor, management, equipment, deliverables, and support to provide Home Oxygen services in accordance with the Performance Work Statement.

FAR Clause 52.217-8 Option to Extend Services: If FAR 52.217-8 is utilized at the end of the contract, prices for the extension or extensions will be the awarded pricing for the most currently awarded period pricing. FAR 52.217-8 can be exercised at any time and can be exercised increments of one (1) to six (6) months, but not for more than a total of six (6) months during the life of the contract. The Government is not obligated to utilize FAR 52.217-8.

Estimated Quantities: The Government has provided their best estimate as to the number of items/units that will be required. The need for services may change due to needs of the medical center. There is no guarantee that the exact number of items/units listed in the price schedule will be always needed. The Government is only obligated for the minimum guarantee amount as stated under “Minimum Guarantee”.

Minimum Guarantee: The minimum guarantee for this contract is $1,000.00 over the life of the contract.

Maximum Contract Value: The maximum value of this contract shall be no more than $45,000,000.00 over the life of the contract.

· All payments for services rendered shall be paid for via 1358 Purchase Order Number.

· If the minimum guarantee is not met, see Section B.2 for instructions on invoice submission requirements.

See attached document: SCHEDULE.

Ordering Period One (1):

Ordering Period Two (2)

Ordering Period Three (3)

Ordering Period Four (4)

Ordering Period Five (5)

Aggregate Total (All Ordering Periods)

B.5. PERFORMANCE WORK STATEMENT

VISN 10 HOME OXYGEN SERVICES FOR VA MEDICAL CENTERS LOCATED IN ANN ARBOR MI, BATTLE CREEK MI, DETROIT MI, FORT WAYNE IN, MARION IN, INDIANAPOLIS IN and SAGINAW MI

1. SCOPE: This Performance Work Statement (PWS) defines the effort required for the setup, installation, and management of Home Oxygen services and Ventilation, in accordance with Joint Commission (JC) standards for Homecare, to Veteran beneficiaries serviced by Veterans Integrated Service Network (VISN) 10. This PWS includes the associated program management, human engineering, and logistic support planning requirements. The use of the terms “beneficiary”, “Veterans”, “Patients”, and “Patient” are used interchangeably and refer to the recipient of required services, equipment, and supplies required under the contract.

1.1 BACKGROUND: The acquisition of Home Oxygen services is being initiated to provide Home Oxygen services to Veteran beneficiaries serviced by VISN 10. VISN 10 does not have the capacity to provide these services so a contract has been sought for the provision of home oxygen and all associated products and services.

1.2 VETERANS SERVED: The Department of Veterans Affairs (VA) Medical Centers at: Ann Arbor MI, Battle Creek MI, Detroit MI, Northern Indiana Health Care Systems NIHCS (Fort Wayne IN, Marion IN), Indianapolis IN and Saginaw MI currently serves an estimated 5,000 oxygen-using patients. The volumes or amounts are estimates only.

1.3 LOCATIONS: The Contractor shall provide Home Oxygen within a defined area of responsibility/jurisdiction to the patients’ residence, or other location as indicated on the order for Home Oxygen. Area of responsibility/jurisdiction for each VA facility includes the counties identified (See A-G below within this section for specific counties covered by each facility) as applicable to the area of responsibility/jurisdiction.

NOTE: The Government reserves the right to purchase the services from the Contractor awarded a contract whose area of responsibility/jurisdiction includes the location of the patient’s place of residence.

A. VA ANN ARBOR HEALTH CARE SYSTEM, LOCATED IN ANN ARBOR, MICHIGAN, AND COMMUNITY BASED OUTPATIENT CLINICS (CBOCs): Contractor shall provide delivery, setup, installation, and management of Home Oxygen services to any Patients that are treated at the Ann Arbor VA Medical Center and all Community Based Outpatient Clinics (CBOCs) supported therein (Clinic of Jurisdiction/Primary Service Area COJ/PSA), regardless of their physical location. The listing of these counties does not exclude other counties. This includes Patients who reside near bordering states catchment areas but prefer to be seen in Ann Arbor VAMC. Portable cylinders, regulators, regulator keys and O2 carriers shall be delivered to the Ann Arbor VAMC within one (1) business day of request to accommodate Home Oxygen beneficiaries who are visiting the VA or being discharged and require a tank of oxygen to go home. This shall be provided at no additional charge.

COUNTIES IN ANN ARBOR JURISDICTION (OHIO INCLUDED): MICHIGAN: Hillsdale, Ingham, Jackson, Lenawee, Livingston, Monroe, Washtenaw. OHIO: Allen, Fulton, Hancock, Hardin, Henry, Lucas, Marion, Ottawa, Sandusky, Seneca, Williams, Wood.

B. BATTLE CREEK VA MEDICAL CENTER, LOCATED IN BATTLE CREEK, MICHIGAN AND CBOCs: Contractor shall provide delivery, setup, installation, and management of Home Oxygen services to any Patients that are treated at the Battle Creek VA and all CBOCs supported therein (Clinic of Jurisdiction/Primary Service Area (COJ/PSA)), regardless of the patient’s physical location. The listing of these counties does not exclude other counties. This includes Patients who reside near bordering state’s catchment areas but prefer to be seen in Battle Creek VA. Portable cylinders, regulators, regulator keys and O2 carriers shall be delivered to the Battle Creek VAMC within one (1) business day of request to accommodate Home Oxygen beneficiaries who are visiting the VA or being discharged and require a tank of oxygen to go home. This shall be provided at no additional charge.

COUNTIES IN BATTLE CREEK VA JURISDICTION: Allegan, Barry, Berrien, Branch, Calhoun, Cass, Clinton, Eaton, Genesee, Ingham, Ionia, Isabella, Jackson, Kalamazoo, Kent, Lake, Manistee, Mason, Mecosta, Montcalm, Muskegon, Newaygo, Oceana, Osceola, Ottawa, Shiawassee, St Joseph, Van Buren, and Washtenaw.

C. JOHN D. DINGELL VA MEDICAL CENTER, LOCATED IN DETROIT, MICHIGAN AND CBOCs: Contractor shall provide delivery, setup, installation, and management of Home Oxygen services to any Patient(s) that are treated at the Detroit VA Medical Center and all Community Based Outpatient Clinics (CBOCs) supported therein (Clinic of Jurisdiction/Primary Service Area COJ/PSA), regardless of their physical location. The listing of these counties does not exclude other counties. This includes Patients who reside near bordering states catchment areas but prefer to be seen at Detroit VA Medical Center. Portable cylinders, regulators, regulator keys and O2 carriers shall be delivered to the Detroit VAMC within one (1) business day of request to accommodate Home Oxygen beneficiaries who are visiting the VA or being discharged and require a tank of oxygen to go home. This shall be provided at no additional charge.

COUNTIES IN DETROIT JURISDICTION: Macomb, Oakland, St. Clair, Wayne

D. VA NORTHERN INDIANA HEALTH CARE SYSTEM- FORT WAYNE, INDIANA AND CBOCs: Contractor shall provide delivery, setup, installation, and management of Home Oxygen services to any Patient(s) that are treated at the Fort Wayne VA Medical Center and all Community Based Outpatient Clinics (CBOCs) supported therein (Clinic of Jurisdiction/Primary Service Area COJ/PSA), regardless of their physical location. The listing of these counties does not exclude other counties. This includes Patients who reside near bordering states catchment areas but prefer to be seen at Fort Wayne IN VA Medical Center. Portable cylinders, regulators, regulator keys and O2 carriers shall be delivered to the Fort Wayne VAMC within one (1) business day of request to accommodate Home Oxygen beneficiaries who are visiting the VA or being discharged and require a tank of oxygen to go home. This shall be provided at no additional charge.

COUNTIES IN FORT WAYNE AND MARION JURISDICTION: INDIANA: Adams, Allen, Blackford, De Kalb, Delaware, Elkhart, Fulton, Grant, Howard, Huntington, Jasper, Jay, Kosciusko, Lagrange, Lake, La Porte, Madison, Marshall, Miami, Noble, Porter, Pulaski, Randolph, Starke, Steuben, St. Joseph, Tipton, Wabash, Wells, Whitley. OHIO: Auglaize, Darke, Defiance, Mercer, Paulding, Preble, Putnam, Van Wert

E. VA NORTHERN INDIANA HEALTH CARE SYSTEM- MARION, INDIANA AND CBOCs: Contractor shall provide delivery, setup, installation, and management of Home Oxygen services to any Patient(s) that are treated at the Marion VA Medical Center and all Community Based Outpatient Clinics (CBOCs) supported therein (Clinic of Jurisdiction/Primary Service Area COJ/PSA), regardless of their physical location. The listing of these counties does not exclude other counties. This includes Patients who reside near bordering states catchment areas but prefer to be seen at the Marion VA Medical Center. Portable cylinders, regulators, regulator keys and O2 carriers shall be delivered to the Marion VAMC within one (1) business day of request to accommodate Home Oxygen beneficiaries who are visiting the VA or being discharged and require a tank of oxygen to go home. This shall be provided at no additional charge.

NOTE: COUNTIES IN MARION JURISDICTION ARE COMBINED WITH FORT WAYNE.

F. RICHARD L. ROUDEBUSH VA MEDICAL CENTER, LOCATED IN INDIANAPOLIS, INDIANA AND CBOCs: Contractor shall provide delivery, setup, installation, and management of Home Oxygen services to any Patient(s) that are treated at the Indianapolis VA Medical Center and all Community Based Outpatient Clinics (CBOCs) supported therein (Clinic of Jurisdiction/Primary Service Area COJ/PSA), regardless of their physical location. The listing of these counties does not exclude other counties. This includes Patients who reside near bordering states catchment areas but prefer to be seen at the Indianapolis VA Medical Center. Portable cylinders, regulators, regulator keys and O2 carriers shall be delivered to the Indianapolis VAMC within one (1) business day of request to accommodate Home Oxygen beneficiaries who are visiting the VA or being discharged and require a tank of oxygen to go home. This shall be provided at no additional charge.

COUNTIES IN INDIANAPOLIS JURISDICTION: Bartholomew, Boone, Brown, Carroll, Cass, Clark, Clay, Clinton, Crawford, Daviess, Dearborn, Decatur, Dubois, Fayette, Floyd, Franklin, Gibson, Greene, Hamilton, Hancock, Harrison, Hendricks, Henry, Jackson, Jefferson, Jennings, Johnson, Knox, Lawrence, Marion, Martin, Monroe, Morgan, Ohio, Orange, Owen, Parke, Perry, Pike, Posey, Putnam, Ripley, Rush, Scott, Shelby, Spencer, Sullivan, Switzerland, Union, Vanderburgh, Vigo, Warrick, Washington, Wayne, White

G. ALEDA E. LUTZ VA MEDICAL CENTER, LOCATED IN SAGINAW, MICHIGAN AND CBOCs: Contractor shall provide delivery, setup, installation, and management of Home Oxygen services to any Patient(s) that are treated at the Saginaw VA and CBOCs supported therein (Clinic of Jurisdiction/Primary Service Area COJ/PSA), regardless of the patient’s physical location. The listing of these counties does not exclude other counties. This includes Patients who reside near bordering state’s catchment areas but prefer to be seen at Saginaw VA. Portable cylinders, regulators, regulator keys and O2 carriers shall be delivered to the Saginaw VAMC within one (1) business day of request to accommodate Home Oxygen beneficiaries who are visiting the VA or being discharged and require a tank of oxygen to go home. This shall be provided at no additional charge.

COUNTIES IN SAGINAW VA JURISDICTION: Alcona, Alpena, Antrim, Arenac, Bay, Benzie, Charlevoix, Cheboygan, Chippewa (UP), Clare, Clinton, Crawford, Emmet, Genesee, Gladwin, Grand Traverse, Gratiot, Huron, Iosco, Isabella, Kalkaska, Lapeer, Leelanau, Luce (Upper Peninsula), Macomb, Manistee, Mason, Mecasto, Midland, Missaukee, Montmorency, Ogemaw, Osceola, Oscoda, Otsego, Presque Isle, Roscommon, Saginaw, Sanilac, Shiawassee, Tuscola, and Wexford.

1.4 PORTABLE EQUIPMENT AT VA MEDICAL CENTERS: Ten (10) portable cylinders, regulators, regulator keys, nasal cannulas, fire safety valves (two (2) per tank), and O2 carriers shall be continuously maintained by the Contractor at the VA Medical Centers located in Ann Arbor MI, Battle Creek MI, Detroit MI, Fort Wayne IN, Marion IN, Indianapolis IN and Saginaw MI. These cylinders shall be used only to accommodate Home Oxygen beneficiaries who are visiting VA or being discharged and require a tank of oxygen to go home. This service shall be provided at no additional cost to the Government. VA shall furnish storage space and maintain all security for this equipment. Contractor shall be permitted access to the space and equipment when requested, by telephone, with 24 hours’ notice to the VA Medical Center’s Respiratory Therapy Department. Contractor shall maintain an updated inventory of all equipment on a quarterly basis.

NOTIFICATION AND DELIVERY:

2.0 NOTIFICATION: The Contracting Officer Representative (COR) or VA designee shall provide the Contractor with notification via facsimile or secured email to initiate individual patient service requirements. This shall include patient’s oxygen prescription, oxygen prescription expiration date, equipment, supplies, and services to be provided including the date and place of delivery. The Contractor shall confirm receipt of the request by the end of the working day or as frequently as every two (2) working hours of notification. Contractor shall confirm by facsimile or secure email to COR or VA designee/designated staff for all Home Oxygen initiations, plan of care changes, and discharges. The COR or VA designee shall also provide notification of VA initiated discontinuance of service via facsimile or secured email. All changes to patient care shall be confirmed in writing. The written documents shall include authorizing the official’s signature. The prescription is terminated the day the patient expires.

2.1 NOTIFICATION TO VA REGARDING STATUS OF DELIVERY OF HOME OXYGEN SERVICES:

a. The contractor shall notify the appropriate VA designee and/or COR monthly of initial delivery of home oxygen equipment by PII protected SharePoint delivery. The delivery ticket shall be signed and dated by the patient or their designated representative. This notification shall be made when patient requires changes in medical equipment or equipment switch-outs.

b. The Contractor shall notify the appropriate VA designee and/or COR by secure email or facsimile within one (1) working day if expected delivery of medical equipment is not completed. This notification shall include reason/explanation as to why the delivery was not able to be completed; and a plan of action to resolve delivery failure.

c. The Contractor shall notify the appropriate VA designee and/or COR by secure email or facsimile within one (1) working day if the patient refuses delivery of medical equipment and/or signs the Contractor’s AMA form. Copy of the AMA form signed by patient shall be included in this notification.

d. If the Contractor is unable to contact the patient/caregiver within two (2) contact attempts, the contractor shall:

2.2 DELIVERY OF MEDICAL EQUIPMENT:

a. The Contractor shall deliver and set up in the patient’s residence all equipment and supplies ordered. This contract is a full-service contract. Set-up shall include establishment of operational parameters of equipment to VA prescription, ensures purity of O2, Veteran training on system operations, review of safety checks and discussion of home safety issues. Services are required to be provided 24 hours a day, seven (7) days a week, including holidays, and all emergency service calls. Contract prices are all-inclusive. The Contractor shall not be reimbursed for costs incurred in excess of the contract prices in the Schedule of Supplies/Services for services provided in accordance with the Schedule of Supplies/Services.

b. Patients shall be notified of expected delivery times by the Contractor. Veterans shall be provided with a four (4) hour delivery time window for expected time of delivery.

c. Deliveries of medical equipment and supplies shall be made in full. If the contractor is unable to fulfill the full prescribed medical equipment and supplies list, they may choose partial delivery. Contractor shall notify the VA Designee and/or COR via secured email or facsimile within one (1) calendar day in the event of a partial delivery. In such cases where a partial delivery is made, the remainder of the delivery will be made within one (1) calendar day. Payment shall only be issued for full deliveries. Contractor shall maintain sufficient stock (or have available) to ensure all deliveries can be made within the contractual timeframes. The cost for additional deliveries to complete the order shall be at no additional cost to VA.

d. The Contractor shall deliver portable oxygen equipment to previously established and new patients being discharged to their home from non-VA Facilities and other facilities as requested by VA Staff per the needs of the Veteran. Equipment shall be delivered within four (4) hours of the request.

e. The contractor shall be responsible for replacing any broken or malfunctioning equipment within forty-eight (48) hours from time the issue is reported to the contractor, unless otherwise indicated under the specific equipment section of this contract.

2.3 EXCESS DELIVERY: The Contractor shall not deliver supplies and/or equipment in excess of those prescribed, and the Contractor shall not be paid for any excess deliveries.

SERVICE SPECIFICATIONS:

3.0 PRESCRIPTION CHANGES: The Contractor shall not change or alter a patient’s oxygen prescription or equipment requirements without a new prescription from the patient’s VA physician. A request to change tank size does not require a Physician’s signature, as long as liter flow rate is not altered.

3.1 HOME VISITS:

a. The Contractor shall visit patients’ residences for regularly scheduled maintenance visits in performance of this contract by appointment only; between the hours of 7:00 a.m. and 7:00 p.m. Exceptions shall be made in the cases of emergencies.

b. The Contractor is responsible for scheduling the appointments to the patient’s home 24-48 hours prior to the appointment.

c. On each scheduled set-up/delivery the Contractor shall reassess the need to instruct the patient on the use and care of the equipment and supplies as necessary. The Contractor shall perform and document a home safety assessment that will include assessing for fall risk, evidence of smoking around oxygen equipment, working smoke detectors, posted “No Smoking” signs in addition to all other JC requirements for home safety assessments.

d. Contractor shall re-instruct patient, family or caregivers as necessary without formal order from the VA.

3.2 INITIAL SET-UPS: Initial set-ups are services provided to those patients who have not been provided a VA authorized oxygen therapy delivery system to their place of residence on a previous occasion or have not used such a system continuously for the past 60 days. Once initial set-up has been completed, the Contractor shall develop a regular delivery schedule for home oxygen and supplies to patients. All Initial 50 PSI setups shall include all disposables, large bore tubing, large volume nebulizers, drain bags and masks.

a. Initial set-ups shall be completed within eight (8) hours of request. Failure to deliver within the required time shall result in the VA obtaining oxygen from another source. Any costs in excess of contract pricing for services provided shall be billed to the contractor or credited to next invoice at the discretion of the ordering facility. The Contractor shall notify the appropriate VA designee and/or COR via secured email or facsimile within one (1) calendar day if expected delivery is not completed. This notification shall include reason why delivery was unable to be completed.

b. Switch-outs are services provided to those patients who are presently using an oxygen delivery system or have used such a system continuously within the past 60 days. The Contractor shall provide equipment switch-outs by staff with documented competency training on the manufacturer’s recommended assembly, use, and maintenance of the equipment used under this contract.

c. Switch outs are to be completed within two (2) calendar days. Failure to complete switch out within the required time shall result in the VA obtaining oxygen from another source. Any costs in excess of contract pricing for services provided shall be billed to contractor or credited to next invoice at the discretion of the ordering facility.

d. Failure to perform the switch-outs as prescribed by VA prescription shall result in no cost to the government. Payment shall be made once switch-outs are completed as prescribed. Payments shall be assessed based on the provider’s established rate and pro-rated from set-up date. Medical equipment switch-out requested to increase the patient’s quality of life or due to changes in the patient’s oxygen requirement shall be made at no additional charge to the government.

e. Set-up of Home Oxygen includes setting up and ensuring the appropriate oxygen system is operational, instruction and training of Patient, and/or caregiver and home environment safety check. Failure to deliver within the required time shall result in the VA obtaining oxygen from another source. Any costs in excess of contract pricing for services provided shall be billed to contractor or credited to next invoice at the discretion of the ordering facility.

f. The Contractor is responsible for establishing appointments with patients when initiating set-ups, switch-outs, and deliveries.

3.3 ASSESSMENT REQUIREMENTS:

a. The Contractor shall perform an assessment of the patient’s home and environment in accordance with Joint Commission (JC) accreditation standards for Homecare and maintain documentation of assessments in the individual patient file or folder.

b. The Contractor shall notify the VA designee and/or COR during the home visit if the Contractor’s staff determines that the presence of oxygen in the home presents such a danger that the oxygen must be removed, or in the case of an initial set-up, not placed in the home.

c. The Contractor shall notify the VA designee and/or COR by telephone or email within two (2) hours if any unsafe conditions are observed in the patient’s home that preclude the installation or continuance of oxygen service. Unsafe conditions shall include fire safety hazards, oxygen safety hazards, patient abuse by family or caregivers, or any instance that places the patient or Contractor’s staff in immediate danger. The Contractor shall provide written documentation of the safety hazard to the VA designee and/or COR within one (1) business day of incident.

d. The Contractor shall check the adequacy of the electrical outlets in the patient’s home and while still in the patient’s residence, report any unsafe conditions to the VA designee and/or COR during the initial assessment. VA shall not be responsible or liable for any unsafe electrical conditions caused by the Contractor. Any alterations to the patient’s residence shall be the responsibility of the patient. If ordered equipment cannot be safely installed, the VA designee and/or COR shall provide an alternative oxygen delivery system after VA physician’s approval until new prescription can be obtained. If no alternative is available, the prescribing VA physician shall be notified by the VA designee and/or COR.

3.4 PATIENT EDUCATION REQUIREMENTS:

a. The Contractor shall provide education to each patient at the time of set-up, and twice yearly thereafter, and assess the need for reinforcement during visits. This information shall be presented verbally, in demonstration and material covered shall be in written form to be left with the patient/caregiver. The written material shall be in English as well as the foreign language of the patient, should the patient not speak English. In the case of such an occurrence the Contractor is to advise the VA facility to facilitate adequate instructions. All patient education material must be presented in written form to VA designee and/or COR for approval prior to distribution to patients. The Contractor shall implement any new or revised education material as directed by the VA designee and/or COR. The VA shall determine whether the Contractor shall use his/her forms or forms supplied by the VA for documentation of services provided to patients. Regardless of whether the VA provides a VA Patient Rights & Responsibilities document and/or forms to the Contractor, and/or the Contractor uses his/her VA Patient Rights & Responsibilities and/or forms, the Contractor is responsible for duplication of the documents/forms when copies are needed to give to patients.

b. Patients shall be provided a copy of VA Patient Rights & Responsibilities, and Advance Directives as appropriate. The Contractor shall document that the patient/caregiver has been instructed in accordance with JC Standards for Homecare.

3.5 DISCONTINUATION OF SERVICE:

a. The Government shall notify the Contractor in the event of an order to discontinue oxygen service to any patient covered under this contract as soon as identified. Notification shall be by via secured email or facsimile. At least two (2) weeks prior to the scheduled termination of prescription the Contractor shall notify the VA designee and/or COR via secured email or facsimile, if removal of home oxygen may be detrimental to the patient. Payment shall be pro-rated based upon the notification date of discontinuance of service. In the event that the contractor is notified that a patient has moved out of the service area, or is deceased, the Contractor shall notify the VA designee and/or COR within one (1) business day of this discovery.

b. The Contractor shall remove equipment from the patient’s residence at the earliest possible time but no later than five (5) business days after notification of Discontinuation of Service (DC) unless approved by the VA Designee and/or COR. The date and time of equipment pickup shall be coordinated with the patient and/or next of kin and/or significant other. The Contractor shall make every effort to meet the patient’s or patient’s families’ requests for pickup times. The Contractor shall honor family’s requests to pick up equipment before or after funerals or family gatherings relative to patient funerals. The Contractor shall treat such requests with the utmost courtesy and give such requests the highest priority. In the event the patient refuses to release the equipment, the Contractor shall immediately notify the VA designee and/or COR. Billing of services ends at time of VA-issued notification to discontinue order and/or date of patient’s death.

3.6 EMERGENCY SERVICES:

a. The Contractor shall provide emergency services on a 24-hour basis, and the contractor shall provide services at the patient’s home no more than four (4) hours of receiving a call. If the Contractor is unable to respond to an emergency service call within four (4) hours, the Contractor shall be responsible for making arrangements with another supplier to provide oxygen, and the Contractor shall be responsible for any excess cost above the contract reimbursed price. A written explanation of why the Contractor was unable to respond to the emergency must be provided to the VA Designee and/or COR within one (1) business day.

b. An emergency exists if the VA Designee and/or COR informs the Contractor that he/she considers the situation an emergency, or if the patient states in a telephone call to the Contractor that an emergency exists in regard to the function of the home oxygen equipment or use of the equipment. The Contractor shall provide written details of the patient emergency to the VA Designee and/or COR within one (1) business day of notification by the patient. This written report shall contain time of initial call and time contractor arrived at the patient’s house.

c. The Contractor shall maintain a telephone number for emergency purposes so that the VA and patients who have been authorized to receive home oxygen may contact the Contractor outside of normal business hours. The Contractor shall provide the telephone number to the patients.

d. The Contractor shall notify the VA designee and/or COR immediately in the event of a disaster, natural or otherwise, that may affect the services covered under this contract.

e. The Contractor shall be prepared to provide services on an emergency basis. Contractor shall provide initial setups and emergency service seven (7) days a week, twenty-four (24) hours a day, this includes holidays. Patient discharges requiring initial setups after 7:00 pm shall be completed that same day.

3.7 SIGNAGE: The Contractor shall provide the patient signs for all entrances into the patient’s residence, stating “Warning Oxygen in Use, No Smoking” or other verbiage that No Smoking is allowed due to oxygen being present and document that the Patient/Caregiver is instructed in the safe use of oxygen and equipment per OSHA regulations. The Contractor shall attach patient education and expectations placard to all concentrators and liquid oxygen stationary systems. In the event the Veteran refuses the signage, the contractor shall notify the VA Designee and/or COR immediately after the visit, for documentation purposes by the VA.

3.8 TRAVELING PATIENTS:

a. The Contractor shall be responsible for coordinating all home oxygen for patients who travel both within and outside their respective contracted area of responsibility/jurisdiction, unless otherwise indicated. The VA designee and/or COR shall be responsible for notifying the Contractor where/when the patient is traveling to and the mode of transportation. The Contractor is responsible for coordinating with the patient when travel has been completed.

b. Traveling patients shall be provided with a Federal Aviation Administration (FAA) approved portable concentrator for travel purposes at the request of the VA designee and/or COR. These units shall not be standard for long term use.

c. Invoices for travel patients shall be provided to the VA with the next monthly invoice.

d. Patients traveling within the Contractor’s area of responsibility/jurisdiction shall be provided all home oxygen under the contract at the contract rate. Patients traveling within contracted areas of responsibility/jurisdiction covered under other VA contracts for home oxygen, but not within the Contractor’s area of responsibility/jurisdiction, shall be provided all required oxygen services at whatever contract rate that applies to the area the patient is traveling. The Contractor currently providing home oxygen shall work with the VA designee and/or COR, the Home Oxygen Coordinator, and the Prosthetic Representative to notify and arrange for home oxygen with the contractor whose area the patient is traveling.

e. For patients traveling outside the areas of responsibility/jurisdiction covered by other VA contracts for home oxygen, and/or temporarily relocating, the Contractor shall arrange for home oxygen from an area provider. The Contractor shall obtain pre-approval from the Contracting Officer or designee on pricing if it is above the contract price on the Contractor’s contract. If approved, the Contractor shall be reimbursed the contract rate plus the additional cost incurred for providing appropriate home oxygen. The Contractor shall provide the VA designee and/or COR evidence of any additional costs involved in providing the services outside the areas of responsibility / jurisdiction covered by other VA contracts for home oxygen.

f. Home oxygen for travel outside of the continental USA, overseas travel, and cruises are the responsibility of the patient.

g. Patients not travelling but are permanently relocating outside of established contracted area of coverage will be provided up to 30 days of continuation of services.

EQUIPMENT SPECIFICATIONS AND ASSOCIATED REQUIREMENTS:

4.0 EQUIPMENT MAINTENANCE:

a. Twice yearly or as recommended by the equipment manufacturer, whichever occurs most often, the Contractor shall visit the patient to inspect equipment, checking for proper functioning and prompting patients to replace disposables, such as filters, tubing and nasal cannula as needed. During the visit the Contractor shall also reassess equipment compliance, provide educational needs, perform equipment inspection and maintenance in accordance with manufacturer’s recommendations and perform an environmental survey.

b. All equipment ordered shall be inspected. A written report shall include at minimum the following data:

1. Name and last four digits of social security number (SSN) of patient using the equipment.

2. Monitor compliance on prescription (Liters Per Minute (LPM), hours per day). Report will reflect hours of all equipment ordered.

3. Type of equipment, hours on concentrator (Serial numbers for the rented equipment shall be the Contractor’s responsibility and kept on file in the Contractor’s main office).

4. Inspection results of liter flow rate in monitoring patient compliance (as compared to prescription).

5. Inspection compliance of intake filters (exchange or clean by patient); follow-up education and/or reinforcement of compliance documented.

6. Revised plan of service as needed.

7. A delivery report shall be developed by the Contractor, signed and dated by the contract staff and the patient/care giver and a copy shall be left with the patient. The reports shall be legible and attached to the invoice. All reports shall be submitted to the VA designee and/or COR in alphabetical order, with the monthly invoices by the 10th business day of the month following service. The report must include a patient list and associated scanned delivery/maintenance receipts with patient’s signatures, patient signed patient education notes and clinical notes associated with plan of care changes. The report shall be submitted by the Contractor in both hard copy and on electronic media (DVD or CD). Format to be approved by VA. Changes to the format shall not constitute a need for a contract modification.

1. Humidifiers and water traps, when the liter flow is equal to or greater than four (4) liters per minute, or if prescribed. The number of humidifiers must be sufficient to ensure that they are not depleted between re-supply visits. The number of traps shall be based on the patient’s flow rate. Humidifiers and water traps are changed every two-weeks with a supply in reserve at all times sufficient to last until the contractor’s next visit.

2. Twelve (12) disposable oxygen cannulas on hand for a change every two (2) weeks with a supply in reserve at all times until the Contractor’s next scheduled visit.

3. Twelve (12) disposable masks for change/wash every two (2) weeks with a supply in reserve at all times (when masks are prescribed in lieu of nasal cannulas).

4. 25-50 feet of oxygen connecting tubing shall be replaced every 30 days with an equivalent section of tubing in reserve at all times (to be included in initial setup) until the Contractor’s next scheduled visit.

5. Tracheotomy collar and accessories (e.g., tubing and large volume nebulizer, drain bag) with a supply on hand allowing for change every three (3) days and a supply of five (5) each in reserve at all times until the Contractor’s next scheduled visit.

6. Safety holders shall be provided at no charge for all patients with a prescription for cylinders.

4.2 CONTRACTOR OWNED CONCENTRATORS:

a. The Contractor shall furnish, install and service all oxygen…