36C25522R0100 10-13-2022.pdf

PAGE 1 OF 1. REQUISITION NO.

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NO. 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

a. NAME b. TELEPHONE NO. (No Collect Calls) 8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY CODE 10. THIS ACQUISITION IS UNRESTRICTED OR SET ASIDE: % FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ IFB RFP

15. DELIVER TO CODE 16. ADMINISTERED BY CODE

17a. CONTRACTOR/OFFEROR CODE FACILITY CODE 18a. PAYMENT WILL BE MADE BY CODE

TELEPHONE NO. 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

36C255-22-AP-0737

10/13/2022 36C25522R0100 10-13-2022

Mike Crader michael.crader@va.gov 913-230-7042 11-14-2022

1300 CDT

36C255 Department of Veterans Affairs Network Contracting Office (NCO) 15 3450 S 4th Street Trafficway

Leavenworth KS 66048

X

621610

$16.5 Million

N/A

X

See Schedule for Details

36C255

Department of Veterans Affairs Network Contracting Office (NCO) 15 3450 S 4th Street Trafficway

36C255

Department of Veterans Affairs Financial Services Center http://www.fsc.va.gov/einvoice.asp

Austin TX

877-353-9791 512-460-5429

See CONTINUATION Page

1. VISN 15 VA Medical Centers Home Oxygen Services.

Vendor shall provide designated experienced personnel, required training, equipment and labor for the setup, installation and management of Home Oxygen and Ventilation services to Veteran beneficiaries serviced by the VISN 15 VA Health Care System. See attached Performance Work Statement

2. It is anticipated the government will award a Fixed Price Indefinite Delivery, Indefinite Quantity (IDIQ) contract.

3. The contract will be for a five-year Period of Performance. Please see attached price spreadsheet. Each task order will be issued with individual obligation numbers referencing each VA Medical Center within the VISN 15 VA Health Care System.

4. Electronic proposal submittal is required. Please see instructions to offerors for details.

See CONTINUATION Page

Funding will be placed on each task order.

X X

X 1

Mike Crader Contracting Officer

36C25522R0100

Table of Contents

SECTION A

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

AND COMMERCIAL SERVICES

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 PERFORMANCE WORK STATEMENT

B.3 PRICE/COST SCHEDULE – See attached Spreadsheet

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL PRODUCTS

AND COMMERCIAL SERVICES (NOV 2021)

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

C.3 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (MAY 2022)

C.4 52.216-18 ORDERING (AUG 2020)

C.5 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.6 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.7 52.217-2 CANCELLATION UNDER MULTI-YEAR CONTRACTS (OCT 1997)

C.8 52.222-43 FAIR LABOR STANDARDS ACT AND SERVICE CONTRACT LABOR

STANDARDS—PRICE ADJUSTMENT (MULTIPLE YEAR AND OPTION CONTRACTS)

(AUG 2018)

C.9 52.222-55 MINIMUM WAGES FOR CONTRACTOR WORKERS UNDER

EXECUTIVE ORDER 14026 (JAN 2022)

C.10 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR

1984)

C.11 52.237-3 CONTINUITY OF SERVICES (JAN 1991)

C.12 VAAR 852.212-70 PROVISIONS AND CLAUSES APPLICABLE TO VA

ACQUISITION OF COMMERCIAL ITEMS (APR 2020)

C.13 VAAR 852.219-10 VA NOTICE OF TOTAL SERVICE-DISABLED VETERAN-

OWNED SMALL BUSINESS SET-ASIDE (JUL 2019) (DEVIATION)

C.14 VAAR 852.219-74 LIMITATIONS ON SUBCONTRACTING—MONITORING AND

COMPLIANCE (JUL 2018)

C.15 VAAR 852.219-77 VA NOTICE OF LIMITATIONS ON SUBCONTRACTING—

CERTIFICATE OF COMPLIANCE FOR SERVICES AND CONSTRUCTION (SEP 2021)

(DEVIATION)

C.16 VAAR 852.219-78 VA NOTICE OF LIMITATIONS ON SUBCONTRACTING—

CERTIFICATE OF COMPLIANCE FOR SUPPLIES AND PRODUCTS (SEP 2021)

(DEVIATION)

C.17 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020) ..72

C.18 SUPPLEMENTAL INSURANCE REQUIREMENTS

C.19 MANDATORY WRITTEN DISCLOSURES

C.20 VA INFORMATION AND INFORMATION SYSTEM SECURITY/PRIVACY

LANGUAGE FOR INCLUSION INTO CONTRACTS, AS APPROPRIATE

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

Quality Assurance Surveillance Plan

WAGE DETERMINATIONS INCORPORATED BY REFERENCE

PWS Supplement – Counties (see attached)

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS (JUN 2020) 88

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

E.3 52.212-2 Addendum – Proposal Instructions

E.4 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—

COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (MAY 2022) (JUL 2020)

(DEVIATION)

E.5 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (NOV 2021)

E.6 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

E.7 52.216-1 TYPE OF CONTRACT (APR 1984)

E.8 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.9 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

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

(a). CONTRACT ADMINISTRATION: All contract administration matters will be handled by the following individuals:

(1). CONTRACTOR: ____________________________________

SAM UEI: ____________________________________

Contact person name: ____________________________________

Contact person email: ____________________________________ Contact person telephone:

(2). GOVERNMENT: DEPT. OF VETERANS AFFAIRS

Veterans’ Health Administration Network Contracting Office (NCO) 15 Contracting Officer: Mike Crader 3450 S 4th St.

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

[X] 52.232-33, Payment by Electronic Funds Transfer—System For Award Management, or

[] 52.232-36, Payment by Third Party

(c). INVOICES: Invoices shall be submitted in arrears:

a. Quarterly []

b. Semi-Annually []

c. Other [X] Monthly.

(d). GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.

Department of Veterans Affairs Financial Services Center http://www.fsc.va.gov/einvoice.asp

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

AMENDMENT NO DATE

(e). GOVERNMENT INVOICE ADDRESS: Invoices will be provided in accordance with the requirements listed in FAR 52.212-4, Commercial Items – Terms and Conditions, (MAY 2014), (g) Invoice; and VAAR 852.232-72 Electronic Submission of Payment Request (NOV 2012); electronically to:

Department of Veterans Affairs Financial Services Center http://www.fsc.va.gov/einvoice.asp

(f). REFERENCE NUMBERS: Please reference both the Task Order number (to be assigned) and the Obligation Number (to be assigned) on all correspondence and invoices.

(g). AUTHORIZATIONS:

(1). The Contracting Officer (CO) named in Section (a) above is responsible for the overall administration of this contract. Only the CO has the authority to make changes which affect:

(A). Contract prices, (B). Quality, (C). Quantities, or (D). Delivery terms and conditions.

(2). Contracting Officer Representatives (COR) and Alternate Contracting Officer’s Representatives (Alt-COR) may be assigned to this contract. The COR and Alt-COR shall be provided specific written delegated authority by the CO, a copy of which will be provided to the Contractor.

(h). CHANGES TO THE CONTRACT: No individual or activity has authority to ADD, DELETE, CHANGE, OR MODIFY this contract of issued orders except by the CO or by written authority specifically delegated by the CO.

(i). CONTRACT TIME PERIOD:

(1). The expected contract period of performance shall commence on or about 01/01/2023 and expires 12/31/2027.

B.2 PERFORMANCE WORK STATEMENT

HOME OXYGEN SERVICES VISN 15

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 National Accreditation standards (i.e. Joint Commission on Accreditation of Healthcare Organizations (JCAHO)) to Veteran beneficiaries serviced by VISN 15. 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 supplies, equipment and incidental services required under the contract.

BACKGROUND: The acquisition of home oxygen services is being initiated to provide Home Oxygen services to Veteran beneficiaries serviced by VISN 15. VISN 15 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. As of January 2022, VISN 15 has approximately 5,300 beneficiaries on home oxygen and 113 on ventilators. The total number of patients fluctuates each month due to patients being added/removed from the program.

Historical data indicates that the overall number of unique patients on home oxygen has minimally fluctuated from January 2020 (5,585) to January 2022 (5,303).

1.1 LOCATIONS: All services shall be performed in the veteran's place of residence. The area of service shall be all patients serviced by VISN 15, including counties of the catchment areas as well as additional counties identified in this contract. The equipment needs are subject to change as determined by the prescribing physician. Contractors shall have a facility or resources physically located in the geographic area in which they shall provide service. Non-territory requests shall be required from time to time and the Contractor shall accept these "non-territory" Veterans at that Contractor’s awarded price. VA reserves the right to assign these patients to any contractor. The geographical boundaries described herein have been determined as the areas of responsibility/jurisdiction for each local VA Medical Center (see VISN 15 Facilities and Counties covered, attached).

Harry S. Truman - Veterans Affairs Medical Center – Columbia, MO. (CO) 800 Hospital Drive Columbia, MO. 65201 Estimated # of patients is 890.

Veterans Affairs Medical Center - Kansas City, MO. (KC) 4801 Linwood Blvd. Kansas City, MO.

64128 Estimated # of patients is 960.

Dwight D. Eisenhower - Veterans Affairs Medical Center – Leavenworth, KS. (LE) 4101 S. 4th St.

Leavenworth, KS.66048 Estimated # of patients is 350.

Veterans Affairs Medical Center – Marion, IL. (MA) 2401 West Main St. Marion, IL. 62959 Estimated # of patients is 820.

John J. Pershing - Veterans Affairs Medical Center – Poplar Bluff, MO. (PB) 1500 N. Westwood Blvd. Poplar Bluff, MO. 63901 Estimated # of patients is 570.

Jefferson Barracks - Veterans Affairs Medical Center – St. Louis, MO. (SL) #1 Jefferson Barracks Dr. St. Louis, MO. 63125 Estimated # of patients is 1,110.

Colmery O’Neil - Veterans Affairs Medical Center – Topeka, KS. (TO) 2200 Gage Blvd.

Topeka, KS. 66622 Estimated # of patients is 350.

Robert J. Doyle - Veterans Affairs Medical Center – Wichita, KS. (WI) 5500 E. Kellogg Drive Wichita, KS. 67218 Estimated # of patients is 350.

2. SERVICE SPECIFICATIONS:

2.1 VETERANS SERVED: VISN 15 currently serves an estimated 5,300 oxygen-using beneficiaries and 113 ventilator beneficiaries. The volumes or amounts shown in the Contract Line-Item Numbers (CLINS) are estimates only and impose no obligation on the VA. The contract shall be for the actual requirements of the VA as ordered by the VA during the life of the contract. The Contracting Officer’s Representative (COR) or designee shall provide (via encrypted email or fax) the contractor with notification to initiate individual patient service requirements, including the patient’s oxygen prescription, equipment, supplies and services to be provided including date and place of delivery. The Contractor shall confirm receipt (via encrypted email or fax) of the request within one (1) working hour of notification. The COR or designee shall provide notification (via encrypted email or fax) to the contractor of VA initiated discontinuation of service. The discontinuation notifications shall be made (via encrypted email or fax) within 24 hours. The written documents shall include the authorizing official's signature, electronic or written.

2.2 INITIAL SETUPS:

Initial set-ups are considered to be those beneficiaries who do not have a VA authorized oxygen therapy delivery system or ventilators.

A. Initial setup(s) for Home Oxygen Patients shall be performed by a certified trained technician familiar with the nature of the equipment involved and fully qualified under the laws of the State in which the services and supplies ordered under this contract or Certified Respiratory Therapist (CRT) or Registered Respiratory Therapist (RRT). The initial set-up will be conducted face-to-face at the place of delivery. If the set-up is performed by a certified technician a CRT or RRT will contact the patient by phone post setup within 72 hours of set up to review and document the plan of care, education and ensure all questions have been answered regarding the supply and service provided. Initial setups of Ventilator Patients shall be performed by a CRT or RRT. All CRTs and RRTs shall be licensed in accordance with the governing standards of where the services are to be provided:

Home visits shall be performed monthly by the RRT/CRT for all patients that utilize the ventilator either continuously, for nocturnal concerns, and/or for intermittent ventilation. A licensed Respiratory Therapist must be available 24 hours per day, 7 days a week.

Each home oxygen patient will be contacted by phone monthly by a qualified person (Certified Technician, CRT, or RRT) to review the plan of care with the patient/caregiver, ensure patient compliance and discuss any issues pertaining to the provision of home oxygen. A report of contact will be forwarded to the referring facility. A follow-up home visit for all home oxygen patients shall be conducted quarterly by a qualified person (Certified Technician, CRT, RRT) (Example: Initial set up completed March 1st, patient must have a followup home visit no later than June 1st). If the patient does not receive a home visit every 3 months, documentation will be provided identifying the reason a home visit was not made. If a home visit is not conducted within 4 months the referring facility will be contacted by the contractor to determine appropriate action, based upon the documentation. Each home oxygen patient will be contacted by phone quarterly by a CRT or RRT to review the plan of care with the patient/caregiver, ensure patient compliance and discuss any issues pertaining to the provision of home oxygen. If any issues are found, the CRT or RRT will make a home visit within 24 hours. If Certified Technician finds that a home oxygen patient is found to be high risk for smoking, home environment or falls, a CRT or RRT will make a home visit within 24 hours and forward their report to the referring facility. If a Certified Technician finds that a patient is not compliant with their RX or not following proper infection control, a CRT or RRT will make contact with the patient by phone to reeducate the patient. A CRT or RRT will make a home visit when it is requested by the VA. A copy of their report will be sent to the referring facility. If the patient is found a second time not in compliance with RX or not following proper infection control, a CRT or RRT will make a home visit within 24 hours and forward their report to the referring facility. Home oxygen patients that have RX changes will be contacted by phone by a CRT or RRT to review their new RX.

Documentation of all contacts by phones and home visits shall be provided to the ordering facility’s COR, documenting a thorough review of the patient’s equipment, to include all equipment records, and any re-education of the patient and/or caregiver with the monthly billing.

When an issue arises, during a set up or home visit, the COR or designee will be notified, when possible, during the setup/visit and followed up by written notification within 5 business days by encrypted e-mail or fax.

Patient or caregiver education shall be performed on the proper utilization for the issued equipment to include the following:

Proper equipment usage

Equipment function and operation system

Equipment knobs, controls, buttons, outlets, and inlets

Equipment power source: electric, battery, compressor air, oxygen, and UL approved

Proper utilization of oxygen with the prescribed ventilator

Troubleshooting the equipment and system alarms

Equipment and equipment settings that have been prescribed

Proper equipment exchange/replacement, for example: ventilator tubing/circuit

Proper utilization of a Passy Muir Valve (PMV) Speaking Valve while in use with the ventilator

How to attach the resuscitation bag to the oxygen source

How to complete the home ventilator monitor record

Emergency Procedures and how to respond to:

Power failure

Equipment failure

Ventilator users and their caregivers must be prepared for equipment failure, disconnects, and power outages, especially if using 24-hour ventilation

Practicing regular safety drills helps prepare for emergencies

Keeping a manual resuscitator, such as a bag valve mask (Ambu bag).

Infection control and patient supply storage

Cleaning or exchanging the oxygen tubing, ventilator tubing/circuits, and humidifier

Cleaning or exchange of the resuscitation bag and supplies

Cleaning or exchange of all equipment and accessories

Provide continuing education in use as needed or directed by a licensed and privileged Department of Veteran Affairs Physician.

All education material provided by the Contractor shall be initially reviewed and approved by the Veteran's Affairs contract evaluation team. Any changes to educational materials shall need to be reapproved prior to providing the aforementioned documentation to patients.

The Contractor shall provide a signed document with the monthly billing, to the ordering facility COR verifying the following:

Patient has a safe home environment in accordance with National Accreditation standards.

Patient received proper education and instructions.

Competency has been accomplished with the patient and caregiver on the proper use of the ventilator, oxygen equipment, and other home medical equipment upon initial set up, and re-verified annually.

B. All equipment shall contain an adhesive type of label containing the vendor’s name and emergency 24-hour toll-free phone number. This label shall be placed on the equipment in an area that is viewable to patients and/or caregivers at all times. Patient shall be given a document listing toll-free phone number for routine resupply of oxygen cylinders and supplies.

C. The Contractor shall provide and post on all entrances into the residence, a sign 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/care giver is instructed in the safe use of oxygen and equipment per OSHA regulations. Specified sign shall be no smaller than 4” X 6”.

D. The Contractor shall provide the initial set-up the same day when the prescription is received by 3:00 PM Central Standard Time to include weekends and holidays; this shall also apply to service calls. The VAMC reserves the right to obtain the supplies and service from another source and to charge the contractor with any excess cost which shall result there from, if the contractor is unable to meet required response time.

E. The Contractor shall be required to provide initial setup within 24 hours when prescription is received after 3:00 PM Central Standard Time to include weekends and holidays.

This shall also apply to service calls. Contractor may be required to do an initial set up on the same day on a prescription is received after 3:00 PM, in which case an emergency set-up fee will be authorized.

F. The Contractor shall have a staffed branch office within 35 miles of each medical center. A staffed branch office shall not be required near the Topeka VAMC, provided there is an office within 35 miles of the Leavenworth VAMC.

G. Setup of Home Oxygen includes setting up and ensuring the appropriate oxygen system is operational, equipment 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 (Reference 52.212-4(d) Disputes).

H. If any modifications or preparations need to be made to equipment, these changes shall be coordinated with patient caregiver and made before the patient arrives home from the hospital. Other items that shall be prepared ahead of time include:

Establishing designated Customer Service support phone line for patients to call for in home assistance

Posting all emergency numbers by each telephone

Marking the circuit breakers and fuses

2.3 ENSURE HOME REQUIREMENTS ARE PRESENT:

1. Upon initial setup the contractor is responsible for ensuring the home and electrical system shall support all requirements of the equipment being provided including:

Proper electrical requirements are present.

Appropriate heating and/or air conditioning, if applicable

Hot and cold running water

Spaces for cleaning and storing equipment

General conditions and cleanliness

Adequate door size

Steps, need for ramps, or other access needs

Availability of ambulance/paramedics and hospital

Availability of a telephone

Presence of operational smoke detector(s)

Presence of operational fire extinguisher(s)

Presence of fire evacuation plan

2. The Contractor shall be responsible for notifying the COR or their designee by telephone while in the patient’s home, if any alteration to the patient’s home is necessary to accommodate the oxygen equipment, including electrical work. If the patient’s home electrical system is not sufficient, the Contractor shall facilitate alternative oxygen system, if deemed appropriate by the COR or their designee. Any alteration to the Veteran’s residence shall be the responsibility of the Veteran.

2.4 PERIODIC EQUIPMENT EVALUATION:

The Contractor shall have a CRT/RRT visit the patient to reassess equipment compliance, educational needs, and other patient needs for home oxygen patients at least annually and once every 30 days for patients on ventilators. All home oxygen patients will receive a monthly phone follow-up by a qualified individual (therapist, certified technician, etc.) and a home visit every 90 days by a (therapist, certified technician, etc.)

A report shall be developed, signed and dated by the contractor staff and the VA patient/care giver and a copy shall be left with the patient. The reports shall be legible and attached to the monthly invoice. The written report shall include at a minimum the following data:

Name and Patient ID to be assigned by facility of patient using the equipment.

Monitor compliance on prescription (LPM, hours per day)

Type of concentrator and hours on concentrator

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

Inspection compliance of filters (exchange or clean by patient) according to manufacturer’s guidelines

Follow-up education and/or reinforcement of compliance documented.

Revised plan of service as needed.

Calculated number of expected usage hours and the actual usage hours.

B. If the patient does not receive a reassessment of equipment every 90 days, documentation shall be provided (via encrypted email or fax) to the COR or designee identifying the reason a home visit was not made (Example: Initial set up completed March 1st, patient shall have a follow-up home visit no later than June 1st).

If, in the Government’s discretion, the Contractor has not made valid and documented attempts to contact the patient for set up and/or deliveries, the Government reserves the right to call in third party to provide said setups and/or deliveries in the Contractor’s place, and shall bill the Contractor all excess costs for covering the missed requirement, if the contractor fails to perform for any due month (reference FAR 52.212-4(d) Disputes).

C. Serial Numbers for the rented equipment shall be the vendor's responsibility and kept on file in contractor's office.

2.5 EMERGENCY SERVICES:

Emergency services are for medical equipment provided to patients when an equipment malfunction or natural disaster may threaten a patient’s health. The Contractor shall provide to the Contracting Officer a written emergency management plan, in compliance with National Accreditation standards. This emergency action plan shall address continuity of services for all patients in the affected region.

The Contractor shall provide emergency maintenance 24 hours/7 days a week. A document listing the emergency telephone number shall be provided to the patient at the time of set up.

The patient shall first call the Contractor in an emergency equipment situation as described in the previous sentence. 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 two (2) hours of a call, but in no case to exceed six (6) hours of a call.

The Contractor shall ensure all patients have at minimum a non-electrical oxygen supply to last twenty-four 24 hours. The minimum supply shall take into account each patient’s prescription flowrate and distance from the Contractors location, actual supply levels may differ from patient to patient, as long as each patient has oxygen supply to last a minimum of 24 hours. If the Contractor is unable to respond to an emergency service call within six (6) hours, the Contractor shall be responsible for making arrangements with another supplier, who meets all National Accreditation standards, to provide oxygen at the Contractor's expense. A written explanation (via encrypted email or fax) of why the Contractor was unable to respond to the emergency shall be provided to the COR or designee within two (2) business days. The cost of backup systems, backup oxygen, and backup equipment shall be borne by the Contractor. If H or M size oxygen cylinder is used for backup, the Contractor shall furnish an H or M size oxygen cylinder stand for each H or M size oxygen cylinder. Liquid oxygen supply shall be considered backup oxygen;

however, the oxygen supply shall be maintained at the minimum of 24 hours.

In the event of disaster, natural or otherwise, the Contractor shall notify the COR or their designee (encrypted e-mail and fax) within 24 hours if services covered under this contract may be affected.

2.6 PREVENTIVE MAINTENANCE:

Contractor shall provide service and preventive maintenance on all equipment as recommended by the manufacturer. Preventive maintenance shall only be performed by a certified service technician that has received the approved training.

2.7 MANUALS:

The Contractor shall provide the Operation and Service manual to the patient and/or caregiver upon delivering any equipment. The manual shall contain information on operation, maintenance and troubleshooting for clinicians, users, caregivers and service technicians. Contractor shall provide to each facility COR, one (1) copy of the Provider Information and Resource Manual which will include, at a minimum, the following information:

A copy of all patient educational materials.

Copies of all documents that will be utilized in performance of the contract.

Office locations, including address, phone, and fax numbers.

National Provider Identifier numbers for each location.

Certificates of National Accreditation

FDA approval

Board of Pharmacy License for each state cover under this contract.

Copy of local and state operating licenses.

Copy of Employees licenses (required for all RRT/CRT) and training records, for each employee performing under this contract.

A manual for each type of equipment provided under this contract.

2.8 STORAGE CHARGES:

The Contractor shall provide cylinders to store at each facility without charging the Government.

These cylinders shall be used for unusual circumstances (i.e. emergency services or short notice discharges). The Contractor’s free loan period of cylinders shall not exceed the term of the contract.

2.9 HIGH RISK SMOKERS:

The facility shall notify the Contractor of all identified High Risk Smokers. The Contractor shall notify the COR or designee of High-Risk Smokers that they identify in the home via encrypted email or fax within one (1) day of the home visit. Contractor notification to each COR or designee shall consist of contractor’s written report/form and shall contain at a minimum Veteran’s name and last four (4) numbers of their social security number shall be clearly documented, and what precautions were provided to the patient. High-risk patients are patients who exhibit unsafe clinical or behavioral traits involving oxygen and smoking, such as;

attempting to hide their smoking materials or activities from staff, having a history of non-compliance with smoking rules; or smoking in a patient sleeping room or other areas designated as non-smoking areas.

2.10 PATIENT TRAVEL:

The Contractor shall be responsible for coordinating all services for Veterans who travel within the geographical area covered by this contract. Travel is defined as those occurrences in which the beneficiary stays away from their residence overnight. Patients shall be instructed by the Contractor and VA staff to notify the Contractor and the VA resident facility at least two (2) weeks before intent to travel and four (4) weeks if they are permanently relocating. Patient shall be responsible for coordinating transportation of oxygen/equipment with their respective airlines.

The Contractor shall provide Veterans traveling within the geographical area covered by the contract all oxygen services hereunder at the contract rate utilizing contractor furnished equipment only. The Contractor shall provide equipment setup by licensed CRT/RRT at designated travel destinations for Veterans receiving care at a covered geographic area within VISN 15. The Contractor shall invoice the resident Facility monthly for the services rendered under this contract.

When the Veteran is temporarily traveling/relocating, outside of the contracted area, the contractor shall coordinate oxygen requirements if that contractor has a subsidiary office located at the temporary destination. If not, the resident VA facility shall coordinate with the VAMC nearest the veteran’s destination to make these arrangements.

When the Veteran is permanently relocating to any area not covered under this contract, the Contractor shall:

Instruct the patient that they are responsible for notifying the current resident facility 30 days prior to the permanent relocation.

Provide the Veteran with up to a 30-day supply (may be extended by the resident facility upon approval by the COR or their designee) of Oxygen/Ventilator equipment and supplies.

Upon arrival at the destination VAMC, any equipment that came with the patient and that is owned by the contractor shall be returned. Any cost incurred in the shipping/handling is the responsibility of the Contractor.

Travel outside the continental United States is not covered under this contract. Veteran shall be responsible for all travel arrangements and for obtaining oxygen services when traveling outside the United States.

2.11 PLAN OF SERVICE:

The Plan of Service shall be developed by appropriate VA clinical staff at each facility and the Contractor’s Respiratory Care Practitioner (RCP) (RCP must be an RRT or CRT) in accordance with the Plan of Care and the prescription provided by the VA. Prescription changes must be authorized in writing by the VA.

HOME OXYGEN & VENTILATOR CONTRACT ROLES AND RESPONSIBILITIES

Scope/Type of Service VAMC Contracted Provider

1. Role and responsibilities of the organization and the contracted provider in:

a. Patient Admission Process Clinical coordinator or designee reviews, verifies medical need, obtains physician order which is submitted to Prosthetics. VA authorized personnel contacts the contracted oxygen provider.

Contractor will furnish oxygen supplies, equipment, and services to VA beneficiaries for the VA Medical Centers during the period of the contract.

b. Patient Assessment Process, initial and ongoing

Service provided solely by VA staff, Pulmonary/respiratory.

Contractor, as part of the initial delivery protocol, completes the initial equipment assessment and provides education on equipment use and care, safety, VA Patient rights and responsibilities, etc. At the request of the VA Contractor CRT or RRT will consult with VA staff at the medical center for ventilator patients. Ongoing assessment related to equipment use, condition, education, and contractor will report maintenance every 3 months.

c. Plan of Care, development, review and revision

Service provided solely VA staff, pulmonary/respiratory for Home Oxygen Patients.

Contractor, at the request of the VA Staff, will participate in the development for Home Ventilator patients.

d. Plan of Service, equipment, maintenance, refills

Service provided solely by contractor.

The Contractor is responsible for developing, reviewing, and revising the patient’s plan of service. The Plan of service will be maintained at the Contractor’s local office providing service to the VA beneficiary and will be developed, reviewed, and revised per contract.

e. Scheduling care or services Home Oxygen Coordinator HOC and/or COR will schedule home visits with the patient in keeping with the most current regulations on Home Oxygen Therapy.

The Contractor is responsible for scheduling services with VA beneficiaries.

f. Discharge Planning Discontinuing therapy

HOC or designee, either by direct notification from physician, death of the beneficiary, or reassessment no longer qualifies patient for therapy, will contact the contracted provider to discontinue therapy.

The Contractor will notify patient/family and arrange time for pick-up of equipment.

g) Travel outside usual service area

The VA will arrange for services for VA beneficiaries during travel status and use a non-contract source. Veteran is responsible for contacting the airlines to arrange for oxygen while on the airplane, if traveling by other public transportation, the patient is responsible for contacting and determining the policies of the transportation provider and conveying this information to the P&SAS. The supplying of oxygen by the VA will be determined dependent upon the transportation provider’s policy. It is possible that some forms of public transportation may not be available for patients traveling with oxygen. If travel is by personal vehicle, the patient is responsible for working with the VA to determine the best approach to providing oxygen while traveling.

Will assist the VA in meeting the needs of the patients as requested, once it is determined the best method to be used for travel.

h) Patient Privacy and IT Security VA will abide by local policy related to patient privacy and record security

The Contractor shall maintain a VA beneficiary account folder in compliance with the Privacy Act and Health Insurance Portability and Accountability Act (HIPAA).

All beneficiary files are subject to review by designated VAMC officials and accreditation surveyors on behalf of the VAMC during accreditation surveys or consultations. At a minimum the VA beneficiary folder will adhere to current The National Accreditation standards for patient record keeping regarding DME and home oxygen.

2. Documentation requirements and time frames

Service provided solely by the contractor

The Contractor will maintain a complete record of services provided to VA beneficiaries to meet current The National

Accreditation Standards and as stipulated in the contract. The contractor will maintain this documentation in the VA beneficiary’s folder.

3. Monitoring, evaluating, and auditing of contracted care and/or services.

The HOC and/or the COR or designee will make unscheduled on-site contractor and home patient visits on at least a quarterly basis, to monitor the contracted provider's performance under this contract.

The Contractor agrees to make available all records and documentation necessary to perform these reviews.

4. Responsibility of contracted provider to comply with applicable organization policies and personnel qualifications

Policies: the HOC and/or COR will review the Contractor’s policies/procedures for compliance with VA policies/procedures and National Accreditation standards.

The Contractor agrees to make available all records and documents necessary per the Contract.

The Contractor shall be responsible for policy and personnel compliance with current National Accreditation standards.

5. Procedures for determining charges and reimbursement

COR or designee reviews monthly bills from the contracted provider for appropriate charges.

The Contractor will submit billing reports monthly as stipulated in this contract.

2.12 COMMUNITY NUMBERS:

The Contractor shall provide the local Power Company, Telephone Company, and Fire Department a letter for special consideration within 24 hours of the initial setup and delivery of Home Oxygen Services. This letter shall request that this patient be placed on the priority list to restore or respond in the event of an emergency or failure of any source. The Contractor shall provide this letter to the COR or designee for approval within 30 days of this contract award date. The Contractor shall also provide a magnet no smaller than 3 ½”X 4” with emergency numbers which include police department, fire department, ambulance, doctor and VAMC number to all patients.

2.13 DELIVERY AND DISCONTINUATION OF EQUIPMENT AND SUPPLIES:

The Contractor shall be responsible for scheduling appointments with patients within the time requirements listed in section 2.2 to initiate set ups and deliveries. Deliveries shall not be left unattended at the patient’s home; physical acceptance of deliveries must take place between the Contractor and either the patient or caregiver. If the patient fails to meet two (2) consecutive appointments, the Contractor shall notify (via phone followed by encrypted email or fax) the COR or their designee within 24 hours of the second missed appointment. The COR or their designee shall contact the patient and a corrective action plan shall be implemented. COR or their designee shall notify (via phone followed by encrypted email or fax) the Contractor of any changes. If the Contractor has not documented valid attempts to contact the patient for set ups and or deliveries, the Government reserves the right to call in a third party and bill the Contractor. The Contractor shall not be paid for those services during the billing period if services are not rendered.

2.14 DELIVERY SCHEDULE:

Contractor shall develop a delivery schedule for service, equipment, and supplies with each patient following receipt of the facility order.

2.15 SERVICE OF EQUIPMENT:

The Contractor shall furnish, install and service all equipment and supplies ordered under this contract. All disposable supplies shall be new and unused. A label with the Contractor's name and emergency toll free telephone number, where they can be reached 24 hours/7 days a week, shall be affixed to all equipment.

The repair/maintenance of all equipment by the Contractor shall be performed by a competent professional familiar with nature of the equipment involved and fully qualified under the laws of the State in which the services are being rendered. Provision of all equipment shall be consistent with local Fire and Safety Codes in the respective area of the State, and shall conform to National Fire Protection Association (NFPA) 99/101 (Standard for Health Care Facilities/Life Safety Code) NFPA (Oxygen Cylinder Requirements found at http://www.nfpa.org/assets/files/PDF/ROP/51-F2001-rop.pdf. The Contractor shall provide a safety/emergency checklist to be completed, then signed by the veteran or his/her caregiver and retained in the patient account folder. The Contractor shall service all equipment at the manufacturer recommended intervals. The Contractor shall conduct a check of the concentrator using a certified oxygen analyzer that is calibrated according to the manufacturer standards.

http://www.nfpa.org/assets/files/PDF/ROP/51-F2001-rop.pdf

The Contractor shall change compressor inlet pre-filters and compressor inlet bacteria filters according to the manufacturer recommendations. The Contractor shall test the alarm battery at each maintenance check, change as indicated but at least annually. The Contractor shall track and document maintenance of equipment in accordance with manufacturer specifications and provide these records for review upon request. Contractor shall furnish parts and labor for routine maintenance. The Contractor shall have recall procedures for equipment and supplies.

The Contractor shall not change or alter a patient’s oxygen prescription or equipment requirements without a new prescription from the patient’s VA provider.

2.16 CONTRACTOR VISITS:

The Contractor shall visit beneficiaries' residences in performance of this contract by appointment only between the hours of 8:00 AM and 8:00 PM, seven days per week, exceptions shall be made in the cases of emergencies. The Contractor shall be responsible for scheduling appointments for routine deliveries and follow-up, to the patient’s home, at least 48 hours prior in advance. On each scheduled setup/delivery the Contractor shall retrain the patient on the use and care of the equipment and supplies. When conducting home visits, the Contractor’s representatives shall present a professional appearance and adhere to the following as a minimum:

An ID badge shall be affixed to clothing above the waist with the Company name, employee name, and photograph to the front and clearly visible.

Shoes shall be clean and in good condition (open toe shoes are not acceptable).

Shirts and/or blouses shall be uniform and contain the companies name and/or logo.

Slacks or khakis shall be worn. Blue jeans are not allowed.

Mid-calf dress slacks or trousers shall not be denim, revealing, provocative, spandex or similar tight-fitting fabrics

Socks, stockings, or hosiery shall be worn at all times.

Skirts shall be at or below knee length.

Adhering to the CDC’s COVID requirements throughout the pandemic

2.17 EXCESS DELIVERY:

The VA shall not authorize payment on the delivery of excess supplies or equipment. Patient using portable oxygen are limited on the number of tanks authorized per month, patients will be delivered tanks only to the extent they can be safely stored in accordance with national accreditation standards but not to exceed a 30-day supply. Excess deliveries are those provided without prior authorization by the VA.

2.18 ASSESSMENT REQUIREMENTS:

The Contractor shall perform an assessment of the patient’s home and environment, to include fire safety, at least every 90 days (or if required due to Plan of Service changes) in accordance with National accreditation standards and maintain documentation of assessments in the individual patient file or folder.

The Contractor shall notify the COR or their designee 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 should be removed, or in the case of an initial set-up, not placed in the home. Unsafe conditions may include, but are not limited to, fire safety hazards, oxygen safety hazards, patient abuse, or any instance that places the patient, Contractor's staff or others, in immediate danger. The Contractor shall contact the COR or designee by phone during the home visit and furnish (via encrypted email or fax) written documentation of the safety hazard to the COR or their designee within five (5) business days of the incident.

The Contractor shall document and report (via encrypted email or fax) to the COR or their designee, within five (5) business days of the service, any patient who is non-compliant with safety guidelines set forth in the education and orientation material and or whose behavior poses a risk of self-harm or harm to others (i.e. smoking while on oxygen) despite warnings and ongoing educational interventions.

The Contractor shall check the adequacy of the electrical outlets in the patient’s home and report unsafe conditions to the COR or their designee via phone call during the home visit. VA is not responsible or liable for any unsafe electrical conditions caused by the Contractor. Any alterations to the veteran's residence shall be the responsibility of the veteran. If the COR or their designee decide that the ordered equipment cannot be safely installed, an alternative oxygen delivery system shall be provided after approval until new prescription can be obtained.

The Contractor shall verify the presence of working smoke alarms and instruct the patient to test all smoke alarms on a monthly basis and include this verification in the documentation of assessment. The

Contractor shall document (via encrypted email or fax) any home where smoke alarms are not present and fully functional, the Contractor shall provide this notification to the COR or designee within five (5) business days of the service.

2.19 DISCONTINUATION OF SERVICE:

The Government shall notify (via encrypted email or fax) the Contractor in the event of an order to discontinue oxygen service to any patient covered under this contract. Payment shall be pro-rated based upon the notification date of discontinuance of service. The Contractor shall notify the COR or designee within next business day upon discovering a patient is no longer available for services (i.e. deceased, moved out of the service or contract coverage area, and any other situation that the patient would no longer be available for services). Payments shall be prorated based on dates of service provided.

The Contractor shall remove equipment from the patient’s residence at the earliest possible time but no later than two (2) business days after notification unless approved by COR or designee.

The date and time of equipment pickup shall be coordinated with the patient (if relocated) and/or next of kin and/or significant other. The Contractor shall honor patient’s or family's requests to pick-up equipment before or after funerals or family gatherings relative to patient’s funeral.

2.20 PATIENT EDUCATION REQUIREMENTS:

The Contractor shall provide education to each veteran at the time of set-up and assess the need for reinforcement during visits. This information is to be presented verbally, in demonstration and material covered shall be in written form to be left with the patient/care giver.

The written material shall be in English as well as the foreign language of the patient, in the event the patient does not speak English. All patient education material and documents used in performance of this contract shall be presented in written form with the proposal. The Contractor, as directed by COR shall implement any new or revised educational materials.

2.21 WARNINGS:

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 warning materials shall be provided upon initial delivery and every 90 days thereafter. The checklist used by vendors for follow-up services shall, at minimum, include:

No Smoking signs provided and posted

Smoke alarm present, veteran instructed to test all smoke alarms monthly, and smoke alarm sounds when tested and provide how to obtain one.

Veteran has been instructed to remove the cannula, shut off the oxygen supply, and wait for the oxygen to dissipate prior to smoking

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

Contractor shall check for fire extinguishers and/or provide guidance on how to obtain one.

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