36C25218R1040-002.docx

36C25218R1040

PAGE 1 OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

DUNS:

DUNS+4:

PHONE:

FAX:

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

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

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

25. ACCOUNTING AND APPROPRIATION DATA

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

ARE

ARE NOT ATTACHED.

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

ARE

ARE NOT ATTACHED

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

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

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

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

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

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

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

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

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

See continuation pages for funding information 36C25218R1040 10-23-2018 McMillin, Ryan 414-844-4839 11-23-2018 1600 Local 36C252 Department of Veterans Affairs Great Lakes Acquisition Center (GLAC) 115 S 84th Street, Suite 101 Milwaukee WI 53214-1476 X Y 621610 $15 Million N/A X Shipping and delivery instructions are included in the SOW 53214-1476 36C252 Department of Veterans Affairs Great Lakes Acquisition Center (GLAC) 115 S 84th Street, Suite 101 Milwaukee WI 53214-1476

Department of Veterans Affairs Financial Services Center PO Box 149971 Austin TX 78714-9971 877-353-9791 512-460-5540 See continuation pages for CLINs VISN-Wide Requirements contract for Home Respiratory and DME Services It is anticipated that this RFP's period of performance will begin on 01/01/2019 The contract resulting from this solicitation will have a one year base period and four option years to extend.

X X X

SCOTT IVY

CONTRACTING OFFICER

B.1 CONTRACT ADMINISTRATION DATA (continuation from Standard Form 1449, block 18A.)

CONTRACT ADMINISTRATION: All contract administration matters will be handled by the following individuals:

______________________________________ (City-State-Zip) ______________________________________ (Point of Contact/Title)

GOVERNMENT: RYAN MCMILLIN, CONTRACT SPECIALIST

DEPARTMENT OF VETERANS AFFAIRS

GREAT LAKES ACQUISITION CENTER

115 S. 84TH ST., STE 100

MILWAUKEE WI 53214

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

a. 52.232-34 Payment by Electronic Funds Transfer--Other Than System for Award Management

INVOICES: Invoices shall be submitted monthly in arrears in accordance with:

[X] Monthly

Patient invoices shall be submitted monthly in arrears to each VA Chief, Prosthetics and Sensory Aids Service originating the authorization orders by the 10th working day of the subsequent month. The contractor’s invoices and associated paperwork for equipment rentals or services provided shall be sorted alphabetically and accompanied by an alphabetically arranged consolidated listing of all veterans receiving services during the billing period and shall contain the following information:

a. Veteran’s name and last four of SSN

b. Description of equipment (with serial #'s as applicable), supplies, and/or services including corresponding Healthcare Common Procedure Codes (HCPC);

c. Quantities, and lot # information if tanks or liquid oxygen were provided

d. Unit Prices.

e. Total cost in accordance with patient/month

f. Total balance owed Third-Party Billing: This contract represents an “all inclusive” reimbursement rate for all services provided by the medical facility to the veteran beneficiary. Contractor is not allowed third-party or direct patient billing for any services provided under this contract. Contractor shall not submit bills to any other State, Federal, or third-party agency for reimbursement during the period the beneficiary is covered under this contract.

Purchase Cards are the method of payment. The Contractor is required to have VISA Level II capacity.

Contractor shall pro-rate all rentals and service charges during the first month from the date of setup to the end of the month. The contractor shall also prorate the monthly charges in accordance with the date of discontinuance of equipment/service or upon notification of death of patient.

OFFERORS MUST COMPLETE AND RETURN ALL INFORMATION DESIGNATED HEREIN PRIOR TO THE TIME SPECIFIED IN BLOCK 8 OF SF 1449 IN ORDER TO BE CONSIDERED FOR AWARD.

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

SPECIAL NOTES:

In order to maintain integrity of this solicitation and subsequent award date, all offerors are advised that any question and answer requests must be submitted in a written form via e-mail to the Contract Specialist Ryan.McMillin@va.gov no later than FRIDAY NOVEMBER 2, AT 1600 CENTRAL.

The Contracting Officer is the only person authorized to approve changes or modify any of the requirements under this contract. The Contractor shall communicate with the Contracting Officer on all matters pertaining to contract administration. Only the Contracting Officer is authorized to make commitment or issue changes that will affect price, quantity or quality of performance of this 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 to have been made without authority and no adjustment will be made in the contract price to cover any increase in cost incurred thereof.

FOR INFORMATION ONLY - THE FOLLOWING ARE LOCAL PROSTHETICS ADDRESSES AND PRIMARY POINTS OF CONTACT AT EACH OF THE FACILITIES.

Iron Mountain VA Medical Center (585) Attn: Prosthetics Home O2/DME (121) 325 East "H" Street Iron Mountain, MI 49801 Phone: 906-774-3300 Prosthetics Supervisor-Ext 32611 Homecare Coordinator –Ext. 32618 Fax: 906-779-3986 Jesse Brown VA Medical Center (537) Attn: Prosthetic Service Home O2/DME (121) 820 S. Damen Chicago, IL 60612 Phone: 312-569-8387 Prosthetics Supervisor -Ext. 57117 Homecare Coordinator Ext. 57649 Fax : 312-569-8097

Wm S. Middleton Memorial Veterans Hospital (607) Attention: Prosthetics Home O2/DME (121) 2500 Overlook Terrace Madison, WI 53705 Phone: 608-256-1901 Prosthetics Supervisor - Ext. 11893 Homecare Coordinator - Ext. 17497 Fax: 608-280-2097 FHCC Lovell VA Medical Center (556) Attn: Prosthetics Home O2/DME (121) 3001 Green Bay Road North Chicago, IL 60064 Phone: 846-688-1900 Prosthetics Supervisor - Ext. 85549 Homecare Coordinator –Ext. 84229 Fax: 224-610-3862

Tomah VA Medical Center (676) Attn: Prosthetics Home O2/DME (121) 500 E Veterans St Tomah, WI 54660 Phone: 608-372-3971 Prosthetics Supervisor - Ext. 61767 Homecare Coordinator - 67735 Fax: 608-372-1724 Edward Hines Jr. VA Hospital (578) Attn: Prosthetics Home O2/DME (121) 5000 S. 5th Avenue Hines, Il. 60141 Phone: 708-202-8387 Prosthetics Supervisor- Ext. 22007 Homecare Coordinator – Phone- 708-202-8387 Ext. 22638 Fax: 708-202-2008

Zablocki VA Medical Center (695) Phone: 414-384-2000 Prosthetics Supervisor - Ext. 42542 Homecare Coordinator – Ext. 46885 Fax: 414-382-5331

*Illiana Health Care System – Danville (550) Attn: Prosthetics Home O2/DME (121) 1900 E. Main Street Danville, IL 61832 Prosthetics Supervisor – 217-554-4211 Home Care Coordinator – TBD

VISN 12 Prosthetics Supervisor/Contract COR Phone: 414-384-2000 Ext. 42696 VISN 12 Prosthetics Program Assistant- Ext. 46886 Fax # for all VISN 12 Prosthetics personnel 414-382-5216 VISN 12 Prosthetics (VPR) VISN 12 Prosthetics Representative – Phone: 414-384-2000 Ext. 22007

ORDERING PROCEDURES:

Orders can be placed via email, phone, or fax and issued an order by the applicable VA site’s Pulmonary and Prosthetics Departments or the Officer of the Day. Specific ordering officers will be identified after contract award. Orders will include the item(s) to be delivered/provided, patient information, prescription (if applicable) and a location anywhere within the VISN 12 catchment area plus 75 miles in which the item(s) must be delivered.

B.2 PRICE/COST SCHEDULE

ITEM INFORMATION

UNIT PRICE

1.00

MO

Contract Period: Base POP Begin: 01-01-2019 POP End: 12-31-2019

EA

END OF BASE YEAR PRICING

Contract Period: Option Year 1 POP Begin: 01-01-2020 POP End: 12-31-2020

Contract Period: Year 2

END OF OPTION YEAR 1 PRICING

Contract Period: Option Year 2 POP Begin: 01-01-2021 POP End: 12-31-2021

END OF OPTION YEAR 2 PRICING

Contract Period: Option Year 3 POP Begin: 01-01-2022 POP End: 12-31-2022

END OF OPTION YEAR 3 PRICING

Contract Period: Option Year 4 POP Begin: 01-01-2023 POP End: 12-31-2023

Monthly Portable Oxygen Tank System Rental

Monthly Liquid Oxygen Portable Device Rental

POP End: 12-31-2023

END OF OPTION YEAR 4 PRICING

STATEMENT OF WORK

SECTION 1

VISN 12 HOME RESPIRATORY SERVICES AND HOME MEDICAL EQUIPMENT

INTRODUCTION: This Statement of Work (SOW) defines the effort required for the setup, installation, provision of supplies, services and management of VISN 12 Home Respiratory Services and DME. This SOW includes the associated program management, human engineering, and logistic support planning requirements to provide for an effective home respiratory and DME program. The Government will be providing DME, supplies and Respiratory equipment for issuance to patients in accordance with orders/prescriptions.

AREA OF RESPONSIBILITY/JURISDICTION UNDER VISN 12

a. The area of service shall be inclusive of the following VISN 12 Medical Centers and their catchment areas, (A) Milwaukee, WI VAMC (B) Madison, WI VAMC (C) Tomah, WI VAMC (D) Iron Mountain, MI VAMC (E) North Chicago, IL VAMC, (F) Hines, IL VAMC (G) Jesse Brown, IL VAMC, *(H) Danville VAMC, IL (To be tentatively started Option year (1) of this contract).

Non-territory" means the patient is not in the designated area of responsibility/jurisdiction of VISN 12 or is outside of the responsibility/jurisdiction awarded to a contractor. These requests will be required from time to time for patients outside the catchment area and if the contractor has alternate sites for coverage, services shall be provided in accordance with the contract. For all other locations outside of the service area, the contract shall arrange equipment, supplies, and services to be provided by a 3rd party vendor. Contractor shall request authorization by the VA before incurring any costs through this arrangement. If approved the VA will issue an order. Geographical boundaries (see Attachment A) are the areas of responsibility for each local VA Medical Center in VISN 12.

1. GOVERNMENT FURNISHED EQUIPMENT, SERVICE AND SUPPLIES

A. The contractor shall transfer all government equipment and supplies within seven calendar days of award from outgoing contractor’s sites to their facilities. The equipment and supplies must be maintained and separated by VA site at the contractor’s location and stored at the location in a readiness state (cleaned and disinfected, bagged).

B. The Contractor shall pick up all VA owned concentrators from Building 37 on the Hines, IL VA Campus.

C. Upon receipt of VA owned concentrators, the contractor shall:

· Unpack and inspect each unit and notify COR if any unit is damaged

· Mark units “VA” on back of machine with wide black marker (Approximately 4 inch block letters)

· Record model and serial number of unit (spreadsheet of concentrator inventory will be provided to contractor)

· Test/Analyze function of concentrator

· Store units appropriately

· Maintain five concentrator boxes (including intact Styrofoam/Packing material) at each contractor’s site for warranty replacements All other packing materials can be discarded.

D. VA Concentrator Management

The contractor shall:

· Maintain an inventory of all VA owned concentrators on a spreadsheet and shall provide that spreadsheet to applicable VA site monthly. The spreadsheet must include the following information: model number, serial number, location, (e.g., warehouse, patient (identified by patient initials and last 4 SSN), out for service or deleted from inventory)

· Provide all maintenance and upkeep of VA owned concentrators, including battery replacement, testing, filter replacement, and any manufacturer’s recommendations

· Maintain preventive maintenance (PM) sheets and binders for VA owned concentrators which shall include Date Received in inventory, Date PM due, Date PM performed, servicing information in accordance with manufacturer’s recommendations (e.g., filter replacement, usage hours recorded from latest visit, batteries replaced, etc.). These records shall be made available for review during periodic scheduled or unscheduled site visits.

· Notify applicable VA Home Respiratory Coordinator (HRC) whenever contractor is unable to retrieve or locate government owned concentrators.

· Provide and affix preventive maintenance stickers to record PMI visit date and concentrator hours at all visits

· Accept drop shipments of concentrators

· Ship malfunctioning, warranted, concentrators in a concentrator box to the manufacturer for repair or replacement after notifying VA COR to obtain RMA # from manufacturer. The cost of shipping will be covered by VA or manufacturer.

2. STORAGE AND MANAGEMENT OF VA EQUIPMENT AND SUPPLIES

The contractor shall:

· Be responsible for accepting drop shipments of equipment and supplies from any VISN 12 site.

· Inspect equipment prior to accepting delivery and immediately notify the applicable Prosthetics section if equipment is damaged or inventory does not reflect an accurate accounting of item(s) according to the packing list.

· Fax/scan a clear copy of the packing list to local Prosthetics on the day accepted within 2 hours of receipt.

· Store equipment and supplies in a clean area, covered/bagged and separated by VA site in a patient ready condition.

· Provide storage for reclaimed DME that can be utilized for other future orders. This equipment shall be cleaned/disinfected, inspected, tested for operation, bagged/ covered and tagged with nomenclature, model or part number and stored in a patient ready condition.

· Provide delivery of VA inventory to and from VISN 12 sites if requested at no cost and will be cleaned, disinfected, bagged and tagged (if applicable) with patient’s name/last four retrieved from, date picked -up and issue with machine/equipment.

· Manage all government furnished equipment in accordance with FAR 52.245-1.

· Provide bi-monthly individualized VA site inventory reports in a spreadsheet format (e.g., Tomah VA’s inventory report will list all Tomah equipment stored at any/all contractor’s facilities). The spreadsheet must include the following items: nomenclature, model/part numbers and quantities.

· Notify the local Prosthetics Supervisor if inventory levels for any equipment or supplies is below 5 each.

· Provide storage of Government supplies, new and re-claimed DME, in accordance with the VA site estimates below

· Provide notification to applicable site’s Prosthetics section when reclaimed equipment is not serviceable and dispose of equipment if directed

3. DROP SHIPMENT OF DME: The contractor shall be capable of accepting drop shipments of DME and supplies at his/her facility for storage. The contractor shall remove all DME from their packing/shipping cartons upon delivery and promptly inspect shipped DME goods for damages. The contractor shall dispose of the appropriate packing/shipping materials. Contractor shall note the damages on the delivering carrier’s bill of lading prior to acceptance and notify the applicable Prosthetics section of any damaged items within an hour. If the VA is unable to pursue a claim submission because of untimely inspection and notification of a damaged item, the contractor shall be held liable for the repair cost or full replacement cost of the damaged item.

a. The storage area must be adequately equipped with shelves, bins, etc., to properly accommodate the items being stored. The storage area shall be well secured, well ventilated, and free of dampness and humidity that contributes to deterioration of cartons or rusting of metal equipment. The storage facility shall have sufficient electrical outlets to test powered equipment before issue to VA beneficiaries. The contractor shall make the storage area and its contents available for inspection by VA personnel during the contractor’s normal business hours. Inspection may be with or without advance notice. The storage space shall be sufficiently insured against loss or damage equal to the value of the stored equipment. Proof of the insurance coverage will be provided to the Contracting Officer within 10 days of the effective date of the Notice to Proceed. Updates will be provided annually or whenever coverage is discontinued.

b. The contractor shall be held responsible for the proper placement and security of all Government-owned DME to insure against loss or damage while the DME is located at the contractor's facility. Storage shall be provided separate and apart, by VA facility, from all other contractor owned equipment and supplies. The contractor shall identify Government Furnished Property (GFP) by marking or tagging and segregating in such a manner to clearly indicate Government ownership by site at all locations.

4. INVENTORY CONTROL

a. The contractor shall have an adequate inventory control system for maintaining accountability of the DME, and shall maintain a detailed running inventory of daily activities for all items in storage, VA-owned or contractor-owned. The listing shall contain pertinent information as to condition, disposition, make, model, serial number, PM information and any modification incorporated therein.

b. Contractor shall maintain a perpetual inventory and furnish the appropriate PSAS semi-monthly inventory reports of all VA-owned equipment or supplies stored by the contractor.

c. The semi-monthly inventory reports shall indicate receipts, issues and balances and be submitted to each facility via fax on the 1st and 15th of each month or the next business day following the 1st and 15th. Government property shall be used only for performance of this contract.

d. Contractor shall have inspection procedures to assure stored new/reclaimed equipment is in working order and powered equipment tested prior to delivery. All equipment shall be labeled, tagged and dated to document such procedures. Only one (1) payment will be made for the delivery of equipment. If DME failures are within the control of the Contractor, additional trips shall be at contractor’s expense.

e. Equipment shall be protected from the elements during storage and delivery. All clean equipment shall be covered. Clean and dirty equipment shall be separated at all times and shall have protective covering during transport.

5. INFECTION CONTROL

a. The contractor shall have a current plan for surveillance, prevention, and infection control that meets current Joint Commission standards. The contractor shall practice infection control “universal precaution technique” when delivering, picking up, storing or cleaning equipment. When picking up equipment, this equipment is not considered clean and shall be decontaminated when returned to the contractor’s warehouse. Standard precautions shall be used to prevent exposure to blood borne diseases when handling all contaminated equipment/items. Hands shall be washed before and after visiting each Veteran’s place of residence. Contaminated DME shall be separated from clean DME. The contractor’s warehouse shall have clear demarcation between contaminated and clean storage areas. Delivery vehicles, if dirty and clean equipment is transported in the same vehicle, will have a clearly demarcated area for clean and dirty items.

6. HOME RESPIRATORY EQUIPMENT, SUPPLIES AND SERVICES:

A. INITIAL SETUPS FOR NEW STARTS (OXYGEN PATIENTS): The contractor shall furnish oxygen in accordance with the prescription from the patient’s VA provider. The contractor shall have clinical as well as administrative personnel at intake familiar with all modalities of care and how to interpret prescriptions. If at any point there are questions related to the clarity of the order, the vendor shall immediately notify the sending site’s Home Respiratory Coordinator or originator of prescription to clarify and submit, if necessary, another prescription/order to perform what was requested. Initial setups will primarily be in the patient’s residence but may be at the VA facility, civilian healthcare facility or other delivery locations as requested verbally by the ordering site according to the prescription. Contractor shall deliver and set-up oxygen within 24 hours of receipt of prescription/order. Contractor shall accommodate earlier timeframes for delivery as stated on the prescription/order. Contractor to follow AARC guidelines for all respiratory related set-ups, follow-ups, education and provision of supplies.

B. SERVICES, EQUIPMENT AND SUPPLIES

The contractor shall provide:

· Initial home/fall/fire risk assessments per Joint Commission, equipment delivery, set-up, education and follow-up per orders or statement of work.

· Ongoing RT visits to create plan of care/treatment with new oxygen patients within 7 calendar days of initial oxygen set-up. Training, education, review of medications, reinforcement home/fire/fall safety assessment.

· Cannulas/ oxygen interfaces to accommodate weekly change out schedule with 2 in reserve at all times. The contractor shall provide interface options for patient comfort. Contractor shall provide oxygen patients short cannulas to be utilized with Bi-directional thermal fuses (see Attachment B).

· Oxygen extension tubing in accordance with residence/activities of daily living (ADLs) to accommodate monthly change out schedule with reserve tubing on hand always.

· Swivel tubing connectors as needed to prevent coiled tubing if requested by patient/VA

· Ear cushions as requested by patient/VA

· Pre-filled humidifiers as requested by patient/ VA and replenishment as needed for supply at all times

· Pressure valves and inline oxygen enrichment ports for bleed-in PAP (Positive Airway Pressure) devices (if applicable) when oxygen is ordered in conjunction with PAP therapy, which must be replaced as needed if requested by patient/VA

· Back-up M/H tank system, regulator, stand, cannulas for all oxygen patients (this is not an option but required). If a back-up system is refused after educating veteran of dangers, an AMA (see Attachment C) must be signed by the patient and contractor staff to reflect this system was offered but refused.

· Annual follow up visits to “standard fire risk” oxygen patients and semi-annual visits to “high fire risk” oxygen patients by delivery personnel to provide fire/home/fall safety and equipment/supply re-education to the patient. During this visit the contractor shall perform preventive maintenance of contractor-owned or VA-owned equipment in accordance with manufacturers recommendation. Contractor shall perform Concentrator Preventive Maintenance duties described above in section 1. C. and 1. D. and shall complete the PMI Home Safety and Equipment Check Form (see Attachment D).

· Education to patients to communicate to HRC/VA any travel plans a minimum of 2 weeks in advance, inside or outside service area so arrangement can be made for continuity of care.

· VA site specific magnets (see Attachment E) to all existing and new oxygen patients. The magnets shall be ordered upon award and one provided to each patient’s home for reference. The magnets will be no smaller than 3.81" x 5.81"

· Bi-directional thermal fuses for ALL oxygen patients to maximize patient safety (see Attachment B). Initial issue dates will be provided by the VA and must be tracked and valves replaced in accordance with manufacturer’s recommendations or as needed to ensure all oxygen patients have them at all times in-line with their delivery device. If the patient or caregiver(s) dispose of valve(s) accidentally, replacements will be provided at no cost by the contractor. This will be checked/verified and documented at each preventive maintenance inspection interval and replaced at the interval recommended by the manufacturer.

· 24/7/365 coverage to address new set-ups orders, triage emergent equipment issues, resupply to ensure patients are provided appropriate care, education follow-up and supplies to meet their prescriptive requirements or requests for visits to maintain equipment or supplies.

· Ongoing oversight and management of equipment to maintain in accordance with manufacturer’s recommendations

· Red folders (Smead or similar- Poly envelope with string tie closure) – Provided by contractor to store Preventing Slips and Falls literature, Patient Home and Fire Safety literature, VISN 12 Home Oxygen Therapy Information Guide along with copies of any visits/delivery documentation that is readily available for patients to reference

7. PRIMARY STATIONARY OXYGEN DELIVERY DEVICES (Monthly Rental from Contractor):

7.1 CONCENTRATOR -must meet or exceed patient’s liter flow requirements (5 or 10 LPM) machines) (E1390) (Higher liter flows>10 (LPM) at the discretion of the facility in collaboration with contractor) Contractor shall provide services, supplies and equipment in accordance with

6. B.

7.2 LIQUID OXYGEN STATIONARY (LOX) (E0439)

Contractor shall provide:

· Stationary lox units, liquid oxygen and refills that meet or exceed the patient’s monthly needs in accordance with prescription and ADLs.

· Services, supplies and equipment in accordance with 6. B.

7.3 H OR M TANK (E0424) for stationary usage only (not back-up tank) Contractor shall provide:

· Stationary tank(s), stand, regulator, tubing and cannulas/interfaces in the home in accordance with patient’s prescription – Primarily for cluster headache patients

· Replacement tank(s) as necessary when notified by patient or VA

· Services, supplies and equipment in accordance with 6. B.

· Regulator and pulse dose conserving device with continuous flow back-up option in accordance with prescription. If patient has current conserving device from the VA, contractor shall provide a conserving device if/when unit fails at the request of the VA or patient that meets prescriptive requirements

· Handcart, backpack style carrying case, over the shoulder pouch or tank carrying system appropriate to meet patient’s activities of daily living needs

· Batteries (AA or AAA) for VA-owned or contractor conserving devices. These shall be replaced if requested by patient when in the home.

· All patients with tank holders/racks to accommodate safe storage of the size and quantity of tanks within their residence.

· Services, supplies and equipment in accordance with 6. B.

· Liquid Oxygen Portable Unit(s) Continuous or Pulse Dose to meet patient’s exertional needs for desired (LPM) or saturation level in accordance with prescription and ADL’s. (Note: some higher liter flow patient portable lox units are required)

· Carrying Case or stroller for ease of use during activities

· Services, supplies and equipment in accordance with 6. B.

· Utilize an RT to perform all initial deliveries and education of POCs.

· Deliver portable oxygen concentrator (POC) in accordance with prescription

· Provide 2 batteries, wall, car and desktop charger

· Provide replacement POCs and batteries if machine or batteries malfunction

· Provide units that are FAA Approved

· Provide services, supplies and equipment in accordance with 6. B.

· Complete against medical advice (AMA) form if POC does not meet prescriptive requirements.

8.4 Portable Oxygen Concentrator System (Continuous up to 3 (LPM) continuous with Pulse dose settings) weight < 19 lbs. (E1392) to include:

The contractor shall:

· Utilize an RT to perform all initial deliveries of POCs.

· Deliver and instruct portable oxygen concentrator (POC) in accordance with prescription

· Provide 2 batteries, wall, car and desktop charger

· Provide replacement POCs and batteries if machine or batteries malfunction

· Provide unit that is FAA Approved

· Provide Services, supplies and equipment in accordance with 6. B.

· Complete against medical advice (AMA) form if POC does not meet prescriptive requirements.

· Provide shipping of unit to and from traveling destination if malfunction occurs

· A total of four each or combination of cylinders sizes (per below pic) that meet the patient ADLs that are compatible with the compressor /model

· Home compressor tank filling system compatible with VA owned/provided Invacare concentrators (Perfecto 2V w/Sensor 91 (5LPM) and Platinum 10 with Sensor O2 (10 LPM))

· Regulator compatible with transfill cylinder posts, VA owned or contractor owned conserving device to provide longer tank duration for portability

· Handcart, backpack style carrying case, over the shoulder pouch or tank carrying system appropriate to meet patient’s activities of daily living needs

· Replacement batteries for VA owned or contractor owned conserving devices as requested by patient or VA

· Services, supplies and equipment in accordance with 6. B.

9. Monthly Air Compressor Rental (E0565):

Contractor shall provide:

· RT to perform delivery, set-up within 7 calendar days or as specified on order, education and follow-up monthly

· Replenishment of disposable supplies to meet prescription requirements for infection control purposes

· Distilled water as needed

· VA Suction machine (if ordered)

· Suction supplies (yankauers, appropriate suction catheters as ordered, suction tubing, suction kits which are not provided on a routine basis by the VA pharmacy)

· Monthly visits by an RT with corresponding documentation to ensure disposable supplies are adequately stocked for weekly change out schedule

· Patient’s and caregiver’s education on the use of the device and accessories with a priority on infection control education.

· Manual resuscitator bag (if applicable)

· Ventilator delivery by an RT, set up in accordance with prescription and timelines specified on order

· Patient and caregivers initial and ongoing monthly education on all equipment, accessories and supplies that will meet the prescription. (Currently VA is utilizing Trilogy ventilators)

· Back up ventilator (if requested) that meets the patient’s prescription.

· Monthly Patient Ventilator Management and System Checks in accordance with AARC guidelines https://www.aarc.org/wp-content/uploads/2014/08/08.07.1056.pdf

· Assessment and replenishment of disposable supply inventory to ensure the patient has enough until next visit

· 24/7/365 emergency service and response to issues conveyed by the patient/caregivers or the VA Contractor shall provide:

· Filters (disposable)

· Hose/Circuit

· Exhalation valve

· Trach adapter

· Tracheostomy tie

· Tracheostomy tube in accordance with prescription to ensure one patient has emergency replacement at all times and trach cleaning supplies as requested

· Disposable inner cannulas as specified

· VA suction machine

· Oxygen inlet ports

· Artificial Noses (HME) for change out daily with ample supply in stock at all times

· Supplies (yankauers, appropriate suction catheters as ordered, suction tubing, suction kits which are not provided on a routine basis by the VA pharmacy)

· Humidification systems (as specified on equipment order)

· Ventilator Stands

· Distilled/sterile water (if applicable)

· Manual resuscitator bag with tubing to facilitate pre-oxygenating prior to suctioning

The contractor shall provide:

· Delivery of VA-owned non-invasive CPAP/AutoPap/Bi-Level/AVAPS devices from VA inventory within 7 calendar days or as requested on order.

· Equipment or interface triage, education and correspondence/communication with the sending sites Sleep Dept/HRC to resolve issues identified on orders.

· Documentation of equipment and accessory information shall include PAP device number (DN), serial number (SN), mask size, type and model number with documentation of training, assessment of interface and care/education provided during visits. This information must be faxed or conveyed via email to the HRC within 24 hours of set-up or conveyed by the timeframe specified on order.

· Ongoing annual training and competencies which enables contractor’s Respiratory Therapists to be familiar with all makes and models of VA provided PAP and Bi-Level equipment (ResMed, Respironics) and arrange for in-services as necessary with the devices, applicable interfaces and humidifiers associated with those manufacturers.

· Respiratory Therapists in their employ with extensive training on mask fitting for patients, troubleshooting interface issues or equipment issues.

· Thorough evaluation of PAP devices and error codes prior to recommending replacement to ensure all steps are taken to correct the situation before requesting replacement of device.

· Delivery and education for PAP devices and interface according to AARC guidelines to ensure patient has a clear understanding of diagnosis, usage, accessories and cleaning/disinfection schedule with documentation detailed for each and every veteran in accordance with the equipment settings and supplies.

· A re-visit to the patient’s location if the patient did not understand or comprehend training at no charge to the VA if notified by patient or VA within seven calendar days of initial set-up.

· Delivery of VA ventilator, back-up ventilator (if applicable), accessories and supplies in accordance with prescription and timelines specified on order

· Monthly Patient Ventilator Management and System Checks by an RT in accordance with AARC guidelines https://www.aarc.org/wp-content/uploads/2014/08/08.07.1056.pdf (Currently VA is utilizing Trilogy ventilators)

· Monthly RT visit to provide patient and caregiver education, equipment and supply assessment and replenishment of disposable supplies to ensure the patient has enough until next visit

· 24/7/365 emergency service and response to issues conveyed by the patient/caregivers or the VA Contractor shall provide:

· Filters (disposable)

· Hose/Circuit

· Exhalation valve

· Trach adapter

· Tracheostomy tie

· Tracheostomy tube in accordance with prescription to ensure one patient has emergency replacement at all times and trach cleaning supplies as requested

· Disposable inner cannulas as specified

· VA suction machine

· Oxygen inlet ports

· Artificial Noses (HME) for change out daily with ample supply in stock at all times

· Supplies (yankauers, appropriate suction catheters as ordered, suction tubing, suction kits)

· Humidification systems (as specified on equipment order)

· Ventilator Stands

· Distilled or sterile water (if applicable)

· Manual resuscitator bag with tubing to facilitate pre-oxygenating prior to suctioning

11.3 RESPIRATORY THERAPIST VISITS (VA120)

The contractor shall provide various respiratory equipment set-ups, patient assessments or triage issues in accordance with prescription/orders. This will include:

· Nebulizer Compressors/Supplies

· Cough Assist Devices

· OPEP (Oscillating Positive Expiratory Pressure) devices

· Special ventilator visits other than monthly visits (emergent triage requests)

· Suction Machine/Supplies

· Chest percussive vests

· High Volume Air Compressor triage other than monthly visit

· Tasks, set-ups, services and follow-up that are routinely required of respiratory therapists in the outpatient home medical equipment arena.

12. HOME ASSESSMENT REQUIREMENTS:

12.1 The Contractor shall perform home/fire/fall safety assessments in accordance with Joint Commission (JC) and National Patient Safety Goals (NPSGs). Contractor shall perform ongoing assessments whenever in the home with corresponding documentation of assessments/education provided.

12.2 The contractor shall create a tracking system to ensure standard fire risk patients are visited annually and high fire risk patients are visited semi-annually. The contractor is responsible for tracking progress up to full completion and a formal action plan will be required if not meeting the requirement.

12.3 The Contractor shall notify the applicable site’s Prosthetics HRC during the home visit if the Contractor's staff determines they cannot safely provide oxygen or respiratory equipment as ordered, or in the case of an initial set-up, not placed in the home. The Contractor shall contact the Prosthetics HRC or designee (by phone during the home visit and furnish (via encrypted email and/or fax) written documentation of the safety hazard within 24 hours via Priority Patient Concern form (see Attachment F) The Contractor shall complete a PPC form for any patient identified as non-compliant to fire safety education whose behavior poses a risk of self-harm or harm to others (i.e. indications that patient smoking while on oxygen, burns to face or nares) The Contractor shall verify the presence of working smoke alarms and fire extinguishers and instruct the patient to test all smoke alarms on a monthly basis and replace batteries at daylight savings time.

12.4 The Contractor shall complete VISN 12 Acknowledgement form on all new oxygen patients (see Attachment G). If oxygen patients do not have smoke alarms or fire extinguishers, the patient shall be instructed to obtain one or both and documentation shall reflect the recommendation.

12.5 The Contractor shall check the adequacy of electrical outlets with an outlet tester used to verify that an AC wall outlet is wired properly. If the contractor is unable to provide equipment as ordered, immediate notification shall be made to the corresponding Prosthetics HRC to provide updated orders for an alternate oxygen system.

12.6 The contractor shall not engage the patient with offerings or suggestions for therapy devices or services provided by the contractor other than what is prescribed. The contractor shall convey any questions about equipment desired to the local HRC and document such in the educational or assessment paperwork or instruct the patient to address with the VA.

13. PATIENT EDUCATION

13.1 The Contractor’s staff shall provide patient equipment and supply, home, fall and fire safety education at the time of set-up and assess the need for reinforcement during RT follow-up visits. The Plan of care created by the RT will include all aspects of care or treatment in relation to the equipment or service provided, including: explaining the diagnosis, equipment function, timeframes for service/follow-up, periodicity of oxygen or equipment usage, infection control, medications and portability to meet ADLs. This information is to be presented verbally, in demonstration and material covered shall be in written form and a copy left with the beneficiary/care giver. The written material shall be in English as well as the foreign language of the beneficiary if available, if the beneficiary does not speak English. All patient education material, forms and documents utilized in the performance of the contract must be presented in written form to the COR for approval prior to being provided patients. The contractor as directed by COR or designee will implement any new or revised education material or forms if necessary. The VA will determine whether the contractor shall use their forms or forms supplied by the VA for documentation of services/education provided to VA beneficiaries.

13.2 The contractor shall provide educational and/or warning information for patients, their families, or caregivers on the hazards of smoking while oxygen is in use. The educational materials must be provided upon initial delivery and reviewed with patients annually for “standard fire risk” and every 6 months for those categorized as “high fire risk” thereafter with corresponding documentation. (See Attachment D). The checklist used by contractors for oxygen follow-up services shall include:

· No Smoking signs provided and posted

· Ensure thermal fuses are provided and replaced per manufacturer’s recommendations

· Smoke alarm present, veteran instructed to test all smoke alarms monthly, and smoke alarm sounds when tested

· Veteran has been instructed to remove the cannula, shut off the oxygen supply, and wait for the oxygen to dissipate prior to being close to an open flame or ignition source. Recommend patient remove oxygen and go outside of residence if they wish to smoke.

· Veteran, family or cohabitants given educational material regarding the hazards of smoking and using an open flame near oxygen.

· All follow up visits will include the safety education above when performing preventive maintenance inspection (PMI) visits annually or semi-annually.

· Conduct home oxygen safety risk assessment before starting home oxygen therapy and when home care services are initiated that address whether there are smoking materials in the home and whether there are other fire safety risks in patient’s home, such as potential for open flames. The contractor shall document the performance of the fire risk assessment whenever in the home using a PMI form.

· Inform and educate the patient, and family/, and/or caregiver including documentation of the following:

· The findings of the safety risk assessment, the causes of fire, fire risks for neighboring residences & buildings, precautions that can prevent fire related injuries, and recommendations to address the specific identified risk(s).

· Assess the patient’s, family’s, and/or caregiver’s level of comprehension of and compliance with identified risks and compliance with suggested interventions during home visits.

· Implement (& document) strategies to improve patient and/or family compliance with oxygen safety precautions when unsafe practices are observed in the home. This includes notifying the VA HRC with the PPC document.

14. FALL PREVENTION:

The Contractor shall provide Patient education and re-education on how to prevent slips/trips/falls in the home related to home environment, patient condition, oxygen equipment and supplies (i.e. oxygen tubing is a fall hazard, throw rugs) on initial set up and during their scheduled annual or semi-annual visits. The Contractor shall provide notification to the VA HRC if the patient communicates they have fallen and injured themselves without seeking medical attention.

15. HIGH FIRE RISK OXYGEN PATIENTS

The VA facility shall identify fire risk level on all oxygen prescriptions sent to the Contractor. If this designation is not on a prescription, the Contractor shall notify the Home Respiratory Coordinator (HRC) at the applicable VA facility must be notified immediately upon receipt of the prescription. As part of the initial set-up, the contractor shall provide:

· Education with corresponding documentation on the safe usage of oxygen and the dangers to surrounding buildings/residences

· An evacuation route/plan for patient residence

· Discussions with patient and caregivers about creating a safe smoking plan if the patient does not wish to quit or be enrolled in a smoking cessation program

· Ongoing safety assessments during visits and identify presence of smoke detectors and fire extinguisher

· Ensure No smoking signs are placed at entrances to the home

16. EMERGENCY SERVICES:

16.1 Emergency services are for medical equipment provided to patients when an equipment malfunction, power outages occur or natural disaster may threaten a patient's health. The contractor shall provide a written emergency management plan in compliance with Joint Commission standards. This emergency action plan shall address continuity of services for all patients in the affected region.

16.2 The Patient shall first call the contractor in an emergency equipment situation as described in 16.1 above. The contractor shall have a well-established communication system, providing 24-hour emergency services and the ability to provide services at the Patient's home within 3 hours of a call.

16.3 The contractor shall ensure all Patients have at minimum a non-electrical oxygen supply to last three times the response time in any given location.