P09_2023 HCHV Contract Emergency Residential Services PWS with security and transportation language_PG.docx

B3. DESCRIPTION/SPECIFICATIONS/Performance Work Statement

1. OVERVIEW: The Department of Veterans Affairs Medical Center in Columbia, Missouri hereafter referred to as Truman VA Hospital located at 800 Hospital Drive, Columbia, MO 65201, requires Contractor to provide homeless Veteran services through a Contracted Emergency Residential Services (CERS) model of residential care at a facility located within 25 miles of the above VA Medical Center. These services, 45 Bed Days of Care (BDOC) not to exceed 16,425 BDOC annually, are to be provided to homeless Veterans as defined in the Performance Work Statement (PWS). The VA National Center on Homelessness among Veterans (“the Center”) will provide ongoing training for program development for both contract providers and VA staff. Contractor will be evaluated based on the Center’s established evaluation protocol and program fidelity measures.

Contracted Emergency Residential Services (CERS) programs target and prioritize homeless Veterans transitioning from literal street homelessness, Veterans being discharged from institutions, and Veterans who recently became homeless and require safe and stable living arrangements while they seek permanent housing. CERS Programs, either directly or through linkage with community and other VA services, provide time-limited services such as supporting mental health stabilization, SUD treatment services, enhancement of independent living skills, vocational training, and employment services. Emphasis is placed on referral and placement in permanent housing or longer-term residential programs utilizing VA and/or community resources. Lengths of stay in CERS typically range from 30 to 90 days with the option to extend based on clinical need. Eligibility will be determined by the VA, based on Veteran status; meeting the McKinney-Vento Homeless Assistance Act definition of homelessness (see http://www.hudhre.info/hearth/ for additional information); and an assessment by the VA Health Care for Homeless Veterans (HCHV) program resulting in a determination of designating the Veteran highly vulnerable and requiring CERS services. This is an indefinite delivery/indefinite quantity contract for the period August 1, 2023, to July 31, 2028, in accordance with FAR 16.5.

2. BACKGROUND AND OVERVIEW: The Department of Veteran Affairs (VA) has been providing direct and specialized services for homeless Veterans for nearly 25 years. The Secretary of the VA has set a zero-tolerance policy for homelessness within the Veteran population. As part of the Plan to End Homelessness among Veterans announced in late 2009, the Veterans Health Administration has been increasing both capacity of existing programs and services offered to program participants. The plan calls for utilizing new models of care not previously offered by VA.

The VA’s Plan to End Veteran Homelessness calls for enhancing current homeless service capacity as well as developing new programs and initiatives in concert with community and federal partners. This contract will enable a community provider to offer homeless Veterans services through a CERS model of residential care. This model will offer services to homeless Veterans under the HCHV CERS program enhanced by the services as defined in the PWS. Rapid stabilization of the Veterans’ medical, mental health, substance abuse and other psychosocial problems to place Veterans in other appropriate transitional or permanent housing within 30 to 60 days, with no more than 120 days, without a planned reason for the extension approved by the VA Liaison, is an expected outcome of this Contract.

The community-based Contractor should have a minimum of 24 months experience as a CERS provider or 24 months experience with other Emergency Shelter models or experience with direct service to the homeless, or a combination of the above documented in its proposal.

This contract will be awarded to a Contractor or Contractors having an acceptable facility within 25 miles of Truman VA Hospital. If no facilities are available within this area, consideration will be given to the Contractor(s) whose facility meets all the stated requirements and is closest to the Medical Center. A VA Liaison to the Contractor will be identified by the Homeless Program leadership at Truman VA Hospital. This individual will act as the coordinator of the CERS program for administrative issues and as the clinical liaison for all client-related issues between the Contractor(s) and Truman VA Hospital by providing clinical oversight. The VA Liaison will not provide direct clinical supervision to Contractor(s) staff. The VA Liaison will also consult with and provide input to the Contractor(s) as needed.

The Contractor shall provide all labor, supervision, housing, material and supplies necessary to provide emergency residential placement, treatment, and supportive services through the HCHV program CERS Model. Services will be provided on-site at the Contractor’s facility, in accordance with all terms, conditions, provisions and requirements listed herein. The prices provided in the Price Schedule shall be inclusive of all “basic services” as may be necessary in the treatment of the Veteran. “Basic services” shall be as defined in the Performance Work Statement.

(1) When an unannounced inspection is not possible due to privacy or other concerns, the HCHV CRS Liaison must still ensure that at a minimum four unannounced site visits are made annually. These unannounced site visits must include:

(2) A visual safety and sanitation inspection of the facility including meal preparation areas, fire exits, sleeping areas and medication storage. Any safety or sanitation deficiency must be addressed immediately. The Nutrition and Food Service checklist is at D.10, Attachment 10.

(3) Review of the contract provider’s emergency and disaster plans to ensure they are up to date, and that staff are trained in the procedures outlined in the plans.

(4) An audit of Veteran’s clinical records selected randomly to ensure documentation of case management services and that other services are being provided as required by the contract terms.

(5) Review of any Veteran complaints to ensure that these have been resolved in a fair, impartial and consistent manner.

b. Cursory Environment Review:

(1) When VA medical facility staff is at a HCHV CRS site, a cursory environmental review must be conducted using D.9, Attachment 9.

(2) If a hazardous condition or deficiency is noted, the HCHV CRS Liaison or other VA medical facility staff must act to ensure that immediate appropriate actions are taken by the HCHV CRS provider to ensure the safety and well-being of the Veterans and then make appropriate notification to VA medical facility staff to include the CO and COR for inspection, guidance and follow-up.

(3) Any hazards or deficiencies noted must be documented in the COR Administrative File for that HCHV CRS program along with the resolution.

c. The Contractor must provide a safe environment for all Veterans consistent with the CERS model of housing and services. The Contractor will offer a safe and stable time-limited living environment along with supportive services necessary to complete an individualized treatment plan to obtain permanent housing. Veterans cannot be denied entry to CERS based solely upon length of current abstinence from alcohol or non-prescribed controlled substances, the number of previous treatment episodes, the time interval since the last program entry, the use of prescribed controlled substances, or legal history. The screening process must consider each of these special circumstances and determine whether the program can meet the individual Veteran's needs while maintaining the program's safety, security, and integrity.

(1) Priority of transportation is as follows: Public transportation

a. Cab services coordinated through the contractor

b. Coordination with HCHV personnel for VA Funded Authorized Program Travel

c. Coordination with VA Travel programs (VTP/DAV)

d. Coordination with HCHV Coordinator for authorization to use Contractor transportation

(2) Contractor owned vehicles may be used to provide transportation on a case-by-case basis with prior HCHV Coordinator or designee approval. When the contractor owned vehicle is used for Veteran transportation, the contractor must maintain a log of all transportation milage for HCHV enrolled veterans. Point to point transportation, not to exceed fifty-two (52) episodes of transportation per HCHV enrolled veteran per calendar year. Every effort is to be made to transport as many veterans per trip as safely possible, reimbursement is by trip not by veteran. Mileage must be tracked on a daily trip log and submitted with the monthly invoices. The Mileage Log is located at Section D, Attachment 6.

(3) Reimbursed mileage shall be dictated by the Joint Travel Regulations. It is the Government’s policy to not allow a charge of profit or fee on reimbursable items and to only reimburse actual costs consistent with the Federal Travel Regulation.

https://www.gsa.gov/travel/plan-book/transportation-airfare-pov-etc/privately-owned-vehicle-pov-mileage-reimbursement-rates

(4) In accordance with the Federal Travel Regulation, subpart D, §301-10.302, mileage shall be captured between the origin and destination as shown in paper or electronic standard highway mileage guide or actual miles driven as determined from odometer readings. Only one method of tracking mileage shall be used. If odometer readings are submitted, an electronic standard highway mileage may be used for comparison of odometer readings as part of VA’s due diligence process.

https://www.gsa.gov/policy-regulations/regulations/federal-travel-regulation-ftr/i1206091#d25e5203

h. OUTREACH: Outreach will be conducted by the CERS provider and VA homeless outreach staff in conjunction with street outreach teams within VA catchment area. Engagement with the Veteran should be goal-directed with consistent staff geared toward building trust and getting the Veteran to accept CERS admission.

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

a. BASIC RIGHTS AND PROTECTION AGAINST DISCRIMINATION: Contractors must protect the rights and dignity of the individual or family served in all phases of service delivery. At a minimum, providers must afford each Veteran the following rights and protections. Clients must be permitted to exercise these rights without fear of reprisal.

7. REASONABLE ACCOMMODATION:

a. Contractor must respect and reasonably accommodate personal and cultural differences associated with race, religious creed, color, national origin, ancestry, language, disability (physical or mental health), medical condition, marital status, familial status, age, gender and gender identity, sex and sexual orientation, source of income, or political affiliation.

b. At no point shall program access be denied because of an individual’s disability.

c. Information learned about the client’s disability from the assessment will not be used as grounds for discharge or other punishment and will be used to guide client to appropriate services. Moreover, a program may not apply different rules to individuals because of their disabilities, unless the different rules are a result of granting a reasonable accommodation request made by an individual with a disability.

d. The Contractor shall not ask questions about a client’s disability, including the nature and severity of the disability or the treatment, symptoms, and medications related to the disability. A Veteran is not obligated to reveal that s/he has a disability prior to admission.

e. Veterans with disabilities are entitled to reasonable accommodations. If a Veteran requests a change in a program’s policy or procedure as an accommodation of his/her disability, the program should grant the accommodation when the accommodation is both reasonable and necessary because of the individual’s disability. Such an accommodation request must be considered during any stage in the provision of a program, including at intake, during services, and during discharge proceedings. When a reasonable accommodation request is made, the program supervisor may request verification of the individual’s disability.

f. The Contractor is required to develop a written policy for their process for reasonable accommodations within 30 days of the award of this contract. This will include:

All explanations are to be written on formal letterhead from program management to the Veteran and Liaison at the time of denial for services or accommodation. Contractor will be aware that violation of the ADA, Section 504 of the Rehabilitation Act and Fair Housing Laws may result in stopping admissions and/or termination of contract for convenience.

6. ADDITIONAL CONTRACT REQUIREMENTS:

(1) Engagement of the Veteran in the service planning process. Contractor will carry responsibility for interviewing, counseling and case managing identified Veterans by conducting psychosocial assessments to identify treatment needs which affect the Veterans’ adjustment to their environment.

(2) Contractor will assess the psychosocial and environmental needs or dysfunction secondary to or exacerbating the social, substance or psychiatric problems, which might contribute to Veterans’ readjustment challenges in the community. Contractor establishes and maintains an intensive therapeutic relationship with the Veteran, staff, and community programs/agencies, and is responsible for formulating case-management treatment goals with the primary goal being to obtain stable housing and plans that address identified needs, stressors and problems.

(3) Contractor will conduct high-risk screening, psychosocial assessment, and treatment planning, actively involving the Veteran and their family or significant others, in coordination with the team members. Psychosocial assessments will include goals for clinical treatment. Contractor coordinates and documents clinical case management and psychosocial services and documents the overall effectiveness of the case management services provided. Specifically, Contractor will:

(4) Develop a highly Individualized Service Plan (ISP) with the Veteran consistent with low demand program goals; the plan must specifically include provisions for Veteran placement into an appropriate transitional or permanent housing placement within 30-60 days of admission to the HCHV Contract Residential Care facility with no more than 120 days without a planned reason for extension. The housing placement planning must consider all appropriate and available community-based housing options as well as the Veteran’s preferences regarding location and housing type. The plan should also be focused on getting the Veteran(s) to accept services, especially mental health and substance use services that will allow attainment of transitional or permanent housing. Acceptance of the services offered should not be a condition of continued stay in CERS.

(5) Complete a written ISP within the first two 7 days of program admission and signed by the Contractor, the Veteran, and the VA Liaison.

(6) Review ISP a minimum every thirty (30) days thereafter in a clinical meeting with the Veteran. Updated plans must by communicated to the VA Liaison within 3 business days.

(7) Make changes in plans in consultation with the Veteran at weekly case management meetings. Weekly case management meetings with Veterans will focus on the objectives and tasks in the ISP. Contracted case manager will provide Veteran with a written copy of their weekly tasks.

(8) Screen each Veteran for suicidal and homicidal risk with each contact. This screening must be documented in regular progress notes in the Contractor’s clinical service records. If the Veteran is a danger to him/herself or others Contractor will take immediate steps to provide appropriate intervention. Contractor will notify the VA same day or next business day (if after hours) of any Veteran suicidal or homicidal risk.

(9) Contractor will conduct weekly case conferencing with Contractor clinical Director, Contractor Case Managers, and VA Liaison, and with other VA Homeless and Contractor staff as necessary. Contractor will coordinate with VA Liaison during weekly case conferences regarding updates and changes in Veterans’ care plans to foster a collaborative relationship with the VAMC and Contractor in meeting Veterans’ needs. Case conferencing may be done in person, by telephone, or through video conference calls as determined by VA staff.

(10) Contractor will obtain relevant Releases of Information to communicate and coordinate Veterans’ treatment with VA and other community-based service providers.

(11) Contractor will work in close collaboration with the VA Liaison to ensure Veterans’ connections to needed VA medical, mental health, and substance abuse treatment and care.

(12) Contractor will take primary responsibility for assisting Veterans in completing housing applications and other benefits paperwork as needed. Contractor will assist Veterans in obtaining the needed documentation required for complete applications including but not limited to, birth certificates, state ID, income verification, and any additional information required by housing resources and potential income supports.

(13) Contractor will provide transportation for Veterans to attend appointments at the VA, potential housing placements, benefits agencies, meetings with landlords, etc. Contractor will attend meetings with Veterans when appropriate according to Veteran’s needs.

(14) The Contractor will provide the following onsite therapeutic and rehabilitative services including: Daily structured groups and activities to promote social skills building and healthy lifestyles; groups will be offered but are not mandatory; Health and personal hygiene maintenance; Monitoring of medications; Supportive social services, in collaboration with the case managers, VA or other community resources; Professional counseling as required, including emphasis on self-care skills, adaptive coping skills, vocational counseling, in collaboration with the VA Liaison or community resources as appropriate; Opportunities for immediate learning and/or development of responsible living with a goal of achieving a more adaptive level of psychosocial functioning; Support for an alcohol and/or drug-free lifestyle; Opportunities for learning, and internalizing knowledge of the illness and/or recovery process; improving social skills; and improving personal relationships; and Opportunities for client participation in community activities, volunteer opportunities, local consumer services, etc.

The Contractor will support an alcohol and/or drug-free lifestyle by training its staff in appropriate harm reduction techniques and to be aware of the signs and symptoms of substance use.

(15) The Contractor shall adapt therapeutic and rehabilitative services to include onsite, VA, or community service and will provide transportation for Veterans to receive services such as: structured groups and activities to promote social skills building and healthy lifestyles. Groups may include emphasis on self-care skills, adaptive coping skills, vocational counseling, in collaboration with the VA Liaison or community resources as appropriate to support the goal of obtaining and maintaining permanent housing.

e. Contractor will notify VA through the VA Liaison at Truman VA Hospital of any critical incident occurring with a Veteran within 24 hours of being informed or made aware of the incident, if not sooner. The Contractor will investigate, confirm, and resolve all incident reports. Contractor will complete a written incident report within 48 hours of notification. Incidents include but are not limited to: death; fire; drug/police raid; suicide/suicide attempt; 911 call (police/fire dept./paramedics/other); drug overdose; severe medical illness / emergency; severe psychiatric illness / emergency; sexual assault; act of violence or abusive behavior by Veteran against other(s); abusive behavior by Veteran against staff; act of violence or abusive behavior by other(s) against Veteran; abusive behavior by staff against Veteran; falls, accident; medication problems or adverse drug reactions; or other untoward events. [See D.11, Attachment 11, Incident Report Form.]

f. In the event a Veteran residing in HCHV CERS housing under this contract dies, the Contractor will promptly notify the VA Liaison authorizing admission and immediately assemble, inventory using established protocol, and safeguard the Veteran’s personal effects. The funds, deposits, and effects left by Veterans upon the premises of the facility shall be delivered by the director or manager of the facility to the person or persons entitled thereto under the laws currently governing the facility for making disposition of funds and effects left by Veterans unless the beneficiary died without leaving a will, heirs, or next of kin capable of inheriting. When disposition has been made, the itemized inventory with a notation as to the disposition has been made, they will be immediately forwarded to the VA Liaison. Property and funds wherever located vests in and becomes property of the United States in trust. In these cases, the facility will forward an inventory of any such property and funds in its possession to the appropriate VA office and will hold them (except articles of clothing necessary for proper burial) under safeguard until instructions are received from the VA concerning disposition.

7. STAFFING AND TRAINING: The Contractor shall employ sufficient personnel to carry out the policies, responsibilities, and programs of the facility. There must be, as a minimum, at least one (1) administrative staff member or designee of equivalent professional capability, on duty on the premises or residing at the house and available for emergencies 24 hours a day, seven (7) days a week. The Contractor shall assign to this contract personnel that, by education and training, and when required, certification or licensure, are qualified to provide the services required by this PWS. The Contractor must identify each person functioning as “Key Personnel” under this contract and provide Truman VA Hospital a description of the services to be provided by such a person, together with a resumé summarizing the person’s relevant skills and experience. During the first 90 calendar days of contract performance, the Contractor shall make NO substitutions of key personnel unless the substitution is necessitated by illness, death, or termination of employment. Within 14 calendar days after substitutions necessitated by situations described above, the Contractor shall provide resumés for the substitute key personnel. For substitutions proposed by the Contractor after the initial 90 calendar day period, the Contractor shall provide resumés for the substitute personnel, together with any other additional information requested by the Contracting Officer at least 15 calendar days before the substitution is to occur. As a minimum, the Contractor shall have:

a. One (1) full-time clinical director with a minimum of a Master’s degree in Social Work or a related discipline. This position will be responsible for the overall functioning of the program including documentation, ethical standards, and assurance that all policies and procedures are being followed, clinical supervision of provider staff, and coordination of weekly staff meetings, management of CERS provider staff and be available by phone 24 hours daily, seven (7) days a week. This position can be full-time or part-time and will work in a clinical consulting role with staff of the Contractor.

b. One (1) full-time staff member who is the primary contact for Truman VA Hospital staff, managing new referrals, discharges, incident reports, and all administrative issues, and management of Contractor staff. This staff member shall be available by phone 24 hours daily, seven (7) day a week.

c. At least two (2) full-time case managers with a minimum of a Bachelor level education in social work or other human services related field with experience working with individuals with chronic substance use disorder as well as mental and medical health related conditions. Each case manager will to carry a maximum caseload of 13 Veterans each. providing direct case management services to Veterans as described in this PWS. Those with certifications in substance use disorders should be given preference.

d. A minimum of one (1) behavioral health technician or certified nursing aide, or certified medication technician/aide, or administrative staff member at the facility. Staff on duty must remain awake and available to interact with Veterans during their work tour, whether during the day or at night. Certified nursing aides and certified medication aides may be used in lieu of a behavioral health technician, but there should always be one (1) staff member, as a minimum, on duty at any time. Staff on duty must remain awake and available to interact with Veterans during their work tour, whether during the day or at night.