36C25719Q0589-002.pdf

Performance Work Statement

1. PURPOSE: The South Texas Veterans Health Care System (STVHCS) has requirements for paramedic life support transportation. This includes Basic Life Support (BLS) and Advanced Life Support (ALS) Services. STVHCS averages around 81 special mode transports a day that include wheel chair vans, BLS, ALS, and Mobile Intensive Care Unit (MICU) that cover the STVHCS catchment area.

NOTE: This contract is not for emergency medical services.

2. GENERAL REQUIREMENT: The contractor shall provide special mode transportation within various counties within the State of Texas for eligible beneficiaries of the Department of Veterans Affairs, STVHCS. Special mode for the purposes of this requirement is defined as ambulance and wheelchair vans. The contractor shall be responsible for providing all vehicles and manpower necessary to meet all MICU, ALS, and BLS transport requirements.

Services provided under this contract shall strictly adhere to all current laws and regulations applicable to the state of Texas unless supplemented to exceed those requirements as specified herein. In no circumstances, will any section or clause of this contract authorize the contractor to provide care and/or equipment below established OSHA guidelines.

The contractor will furnish bariatric stretcher. Patients transported by stretcher will be dropped off at the designated clinic location and provide warm hand-off to VA staff. If appointment is less than 30 minutes the contractor will stay with patient and if greater than 30 minutes, transfer patient to VA stretcher. Patients transported by wheelchair requiring assistance will be dropped off at the designated Transportation front-desk and provide warm hand-off at the Audie Murphy VA Medical Center.

Transportation at other VA authorized medical clinics will be dropped off at the designated clinic location and provide warm hand-off to staff. Those patients that are self-sufficient with power mobility devices do not require a warm hand-off to VA staff and can transport themselves.

The quantities listed in the schedule are estimates for a six-month term. The estimated quantities shown in the table below are for planning purposes only and are based on historical data.

Item Estimated Quantity Unit

HCPCS Code: A0433 - ADVANCED LIFE SUPPORT, LEVEL 2 (ALS 2) (Mobile Intensive Care Unit (MICU), base rate to include first 35 miles) one-way trip is equivalent to one each for unit of issue.

250 1 Way Trip

HCPCS Code: A0426 - AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, NON-EMERGENCY

TRANSPORT, LEVEL 1 (ALS 1) (base rate to include first 35 miles) one-way trip is equivalent to one each for unit of issue.

250 1 Way Trip

HCPCS Code: A0427 – ADVANCED LIFE SUPPORT, Emergency Transport, Level 1 (ALS 1) (Base rate to include first 35 miles) one-way trip is equivalent to one each for unit of issue.

441 1 Way Trip

Solicitation 36C25719Q0589 Attachment 1 - Performance Work Statement 04/19/2019

VHASTXLeyteJ Highlight

HCPCS Code: A0428 - AMBULANCE SERVICE, BASIC LIFE SUPPORT, NON-EMERGENCY TRANSPORT, (base rate, to include first 35 miles) one-way trip is equivalent to one each for unit of issue.

824 1 Way Trip

HCPCS Code: A0429 - AMBULANCE SERVICE, BASIC LIFE SUPPORT, EMERGENCY TRANSPORT, (base rate, to include first 35 miles) one-way trip is equivalent to one each for unit of issue.

442 1 Way Trip

Wheel Chair Van or Power Wheel Chair Van (Base rate, to include first 35 miles) one-way trip is equivalent to one each for unit of issue.

13,450 1 Way Trip

HCPCS Code: A0425 GROUND MILEAGE, WHEEL CHAIR/VAN PER STATUTE MILE, per mile, one way, loaded miles only, beyond first 35 miles. One-way trip is equivalent to one each for unit of issue.

25,000 1 Mile

HCPCS Code: A0425 GROUND MILEAGE, AMBULANCE, per mile, one way, loaded miles only, beyond first 35 miles. One-way trip is equivalent to one each for unit of issue.

2,500 1 Mile

Waiting Charges beyond 15 minutes. Each unit is a 15-minute block of time.

2,500 -

Table 1: Contract Quantity Estimates

3. PLACE OF PERFORMANCE: The STVHCS facilities are located at 7400 Merton Minter Blvd., San Antonio, Texas 78229. Kerrville Memorial Veterans Hospital, located at 3600 Memorial Blvd, Kerrville, TX 78028 and at the various counties within the state of Texas as shown in the table under paragraph 7, page 5.

NOTE: If at any point performance occurs outside of the stated catchment area, the contractor shall immediately notify the Contracting Officer for inclusion of the applicable Department of Labor Wage Determination into the contract.

4. PERIOD OF PERFORMANCE: The period of performance is for a six-months.

5. SPECIAL CONSIDERATIONS: The VA reserves the right to restrict any contractor employee from performing services under this contract who do not meet the required qualifications for the services they are required to perform, and who violates Federal regulations and are identified as a potential threat to the security, safety, health and/or operational mission of the VA and its Veteran population.

The restriction of such contractor personnel shall not relieve the contractor from performing all the required services, in accordance with all terms, conditions, and schedules contained in the contract to include referenced attachments. The contractor, it’s employees, agents or subcontractors shall not be considered VA employees for any purpose.

a. The contractor shall furnish qualified personnel as required by contract specifications to accomplish all services under this contract.

b. Contractor personnel shall always conduct themselves in a professional manner, to include good personal hygiene, wear clean and neat uniforms, and be identified by having the company and employee name affixed to the uniform. The contractor shall be responsible for furnishing

Solicitation 36C25719Q0589 Attachment 1 - Performance Work Statement 04/19/2019 all vehicle fuel, uniforms, nametags and/or badges for performance of services under this contract. Employee identifications shall be worn in clear view above the waist. Contractor personnel are prohibited and shall refrain from smoking while performing transportation duties, shall not smoke in vehicles while transporting patients and shall only smoke within clearly marked and approved VA facility designated smoking areas.

c. At no time shall the contractor leave vehicles on VA premises unless a pick-up delivery is in progress.

6. CONTRACTOR PERSONNEL:

a. General:

i. A record of each employee as to license, certifications, other required qualifications, character and physical capabilities of performing the duties of their position must be maintained and made available to the Contracting Officer (CO) and/or Contracting Officer Representative (COR) for inspection upon written request. No less than (5) days after each quarter, the contractor shall forward a list of contractor employees directly supporting this contract. This list shall provide the contractor the employees’ name, position(s), and licenses and/or certifications (Emergency Medical Technician-EMT, Paramedic, etc.) held and shall include their current certification number.

ii. The company name and the employee’s name must appear on the driver’s, EMT, Paramedic, and/or attendants’ attire. This can be a legend on a uniform or uniform jacket or by means of a name pin or combination of both. This identification shall be worn at all times while performing work under this contract. It is the responsibility of the contractor to provide appropriate uniform, jacket, and name pin for personnel.

iii. Contractor personnel restricted from supporting this contract for cause shall not relieve the contractor from providing all the required services as described herein.

The VA reserves the right to investigate contractor personnel as to character and physical capabilities for performing the duties under this contract.

iv. The contractor shall provide all personal protective clothing required for the protection of their employees; i.e. gowns, gloves, masks, etc. The provision of protective clothing will be at no additional cost to the VA.

b. Qualifications:

i. All contractor personnel performing contract services shall meet the qualifications as specified in this contract, as well as any qualifications required by Federal, State, County and local government entities from the place in which they operate.

Contractor personnel shall meet these qualifications always while performing contract services (Ref: Texas Administrative Code, Title 25, Part 1, Chapter 157; and Chapter 773 Texas Health and Safety code for Emergency Medical Services).

ii. During the contract period of performance, if the contractor proposes to add or replace personnel, the contractor shall notify the Contracting Officer’s Representative (COR) and the Contracting Officer (CO) of the proposed changes and submit the required evidence of training, certifications, licensing and any other qualifications to the designated COR prior to the employee’s commencement of

Solicitation 36C25719Q0589 work. At no time, shall the contractor add or replace personnel on this contract without prior written approval from the CO.

iii. Within seven (7) business days after receipt of award notification and/or upon written request from CO, the contractor shall provide evidence of required training, certifications, licensing and any other qualifications of any personnel performing services under this contract. Failure to adhere will result in a 2% deduction of monthly payment if one or more employees do not have current licenses.

iv. Emergency Medical Technician (EMT) Qualifications: EMT-Basics, EMT- Intermediates, and EMT-Paramedics providing services under this contract shall have the following qualifications, in addition to those required by Federal, State, and Local Government (Ref. www.nremt.org)

a. Contractor shall complete training in accordance with the standards published by the Department of Health and Human Services with a minimum curriculum of 150-hours or equivalent including an in-hospital training period.

Such training programs must also be acceptable under the regulating requirements for local Emergency Medical Services (EMS) supported under Public Law 93-154, Federal Register 39:24304 (1974).

b. The contractor shall submit evidence of equivalent training program successfully completed to the COR with seven (7) business days.

v. The contractor shall be certified, licensed or otherwise officially recognized by the local, state or regional government or public entity where the emergency ambulance service is operated or by which it is governed.

vi. The contractor shall attend all refresher continuing education, or advance training programs as required by the local or State government entity in which service is rendered. In no instance, shall this be less frequent than every two (2) years. Such refresher training shall be equivalent to that developed by the Department of Transportation, National Highway Safety Administration at no additional cost to the Government. Contractor shall provide documentation of all refresher training seven

(7) days after completion. Failure to adhere will result in a 2% deduction of monthly payment if one or more employees do not have current licenses.

vii. Registered Nurse (RN): Personnel assigned by the contractor to perform the services covered by this contract shall be Licensed Registered Nurses in a State, Territory, or Commonwealth of the United States or the District of Columbia, the qualifications of such personnel shall also be subject to review by the VA Chief of Staff and approval by the VA facility Director.

viii. Emergency Vehicle Operator for BLS, ALS, and MICU: Drivers shall have a valid operator’s license in accordance with Federal, State and local government requirements for their place of operation.

ix. Wheel Chair and Power Wheel Chair Vehicle Operator: Drivers shall have a valid operator’s license in accordance with Federal, State and local government requirements for their place of operation and be trained in Cardio Pulmonary Resuscitation (CPR) in accordance with standards of the American Heart Association or the American Red Cross.

Solicitation 36C25719Q0589 http://www.nremt.org/

7. AREAS OF COVERAGE:

The STVHCS and surrounding VA facilities, utilize special mode ambulance services approximately 29,565 times annually. The contractors will provide coverage in the following counties listed and outside of the catchment area for patients of the greater Texas area as follows:

Atascosa Bandera Bee Bexar Calhoun

Comal Crockett De Witt Edwards Frio Gillespie Goliad Gonzales Guadalupe Jackson Karnes Kendall Kerr Kimble Kinney Lavaca Live Oak Llano Mason McMullen Medina Menard Real Schleicher Sutton Terrell Uvalde Val Verde Victoria Wilson

Table 2: - STVHCS Catchment Area by County

8. CONTRACTOR EQUIPMENT, VEHICLES AND INSPECTIONS:

a. The VA reserves the right to inspect contractor’s equipment and vehicles or require documentation of compliance with contract specifications, and State laws, rules, regulations and guidelines governing emergency medical transport vehicles (ambulances) per OSHA Title 29 CFR

1910.120 (q)(6). VA inspections of contractor facilities shall in no way constitute a warranty by the VA that the contractor’s vehicles and equipment are properly maintained. The VA reserves the right to restrict the contractor’s use of equipment and vehicles which need repair, unclean, unsafe, damaged on the interior or exterior body, and are not in compliance with contract requirements. The restriction of such equipment and vehicles shall not relieve the contractor from performing in accordance with the strict intent and meaning of the contract without additional cost to the VA.

b. Ambulances shall meet all current applicable Federal, State and local specifications and regulations including licensing, registration, and safety standards. Appropriate licensing by the State of Texas is required (Ref: Texas Administrative Code, Title 25, Part 1, Chapter 157).

c. Ambulances shall be clean and maintained in good proper condition in accordance with manufacturer’s instructions and specifications and fit for patient and public safety always during the performance of this contract, and shall contain all required equipment in compliance with the Texas Administrative Code Title 25 Health Services Part 1, Texas Department of Health Chapter 157 Emergency Medical Care, Rule 157.11.

http://www.nasemso.org/legislation/Texas/txc157.11.html

i. Oxygen unit(s) for ambulances

ii. Oropharyngeal airways

iii. Portable and vehicle mounted suction

iv. Bag valve mask units, oxygen capable

v. Portable and vehicle mounted oxygen

vi. Oxygen delivery devices

vii. Dressing and bandaging materials

viii. Ridged cervical immobilization devices

Solicitation 36C25719Q0589 Attachment 1 - Performance Work Statement 04/19/2019 http://www.nasemso.org/legislation/Texas/txc157.11.html

ix. Spinal immobilization devices

x. Extremity splints

xi. Equipment to meet special needs patients

xii. Equipment for determining and monitoring patient vital signs, condition, or response to treatment

xiii. Pharmaceuticals as directed by medical director protocols

xiv. Portable External cardiac defibrillator appropriate to staffing level

xv. Patient transport device capable of being secured to the vehicle

xvi. Epinephrine auto-injector or similar device capable of treating anaphylaxis

xvii. Fire Suppression equipment

xviii. Emergency Safety kit

xix. Appropriate road emergency warning equipment

xx. Written emergency procedures

xxi. Protective clothing required for the protection of contractor employees where patient care is expected, such as gowns, gloves, masks, sharps container, bio-hazard bags, portable battery-powered flashlight, etc.

d. MEDICAL EQUIPMENT: Each EMS vehicle used in the performance of this contract shall be appropriately equipped with medical equipment as required by Federal, State, and local laws, rules and regulations. Such equipment includes but is not limited to oxygen (on-board and portable), suction and airway equipment, etc.

e. In addition to the general medical equipment listed in paragraph 8c, ALS vehicles shall be equipped with advanced life support equipment for critical patient care and meet all applicable requirements including Federal, State, and local laws, ordinances, rules, regulations, and approved protocols. The ALS vehicles shall have available, at a minimum, one (1) IV pump available for use on STVHCS transports at any given time. Although it is not necessary for the IV pumps to match those in use by the STVHCS facility, the contractor will be required to change out all required tubing, at no additional expense to the Government if the tubing is not compatible with the tubing on government owned equipment. At a minimum, two ventilator(s) will be available for those transports scheduled by STVHCS.

f. The contractor shall have available, upon request, at a minimum, one (1) EMS/Ambulance bariatric stretcher specifically rated to hold patients weighing up to 500 pounds. This stretcher shall be available upon request for use on either ALS or BLS transports ordered.

g. BLS vehicles shall, in conjunction with section 8c also provide two (2) on-board EMT-Basics.

h. ALS vehicles shall, in conjunction with the section 8c, also provide one (1) on-board EMT- Intermediate and at minimum one (1) EMT-Basic, and the following advanced equipment:

i. Advanced airway equipment

ii. IV administration equipment and supplies

i. MICU vehicles shall, in conjunction with section 8c, also provide one (1) on board EMT- Paramedic and at minimum one (1) EMT-Basic, and the following advanced equipment:

i. Advanced airway equipment

ii. IV administration equipment and supplies

iii. Cardiac monitor/defibrillator

Solicitation 36C25719Q0589

j. Wheel Chair and power wheel chair vehicles shall be clean and maintained in good operating condition in accordance with manufacturer’s instructions and specifications and fit for patient and public safety during the performance of this contract at all times. All vehicles used to provide wheel chair and/or power wheel chair transportation services on this contract shall meet the following requirements:

i. Have functioning mechanisms which ensure that all access doors are capable of being opened from the inside and remain closed and secure during travel.

ii. Be equipped with operational air conditioning and heating systems.

iii. Meet all safety and mechanical standards established by Local, State and Federal statutes and regulations.

iv. Shall be appropriately equipped with medical equipment as required by Federal, State, and local laws, rules and regulations. Such equipment includes but is not limited to portable oxygen at no additional expense to the Government.

v. Be equipped with an operable two-way radio and/or cellular telephone communication system, which afford contact with the vehicle during all hours of operation. Beepers are not an acceptable substitute.

vi. Be equipped with wheel chair tie down straps and effective securement devices to secure both wheel chair and wheel chair beneficiaries.

vii. Be equipped with secured harness for portable oxygen transport and ensure oxygen is secured before vehicle is driven.

viii. The lift shall incorporate an emergency method of deploying, lowering to ground level with a lift occupant, and raising and stowing the empty lift if the power to the lift fails and have a backup for all lift capacity.

ix. A fixed seat position or a fixed secured floor or sidewall wheel chair lock must be approved for each ambulatory or wheel chair restricted passenger being transported, per the passenger’s needs.

x. Driver shall ensure wheel chair/power wheel chair locks are secured and seat belts and shoulder harnesses are in place before the vehicle is driven.

xi. Driver shall ensure that at no time, will the beneficiary be transported while sitting in a scooter while in transport. Driver will transfer patient to wheel chair for proper transport and secure scooter before vehicle is driven.

k. The contractor shall provide oxygen when authorized by medical facility personnel or when required by the patient’s medical condition or as becomes necessary during transport on any ALS or BLS transport at no additional cost to the Government.

l. The contractor shall not be permitted to borrow medical equipment from the VA medical facilities. The contractor shall provide all medications required while in transport, sheets and blankets and other equipment and supplies required for use while in transport, for direct patient care. Contractor shall at no time and under no circumstances exchange supplies, equipment and/or medications with VA. The prices quoted in Schedule shall be inclusive of consumables used in transport.

9. CONTRACTOR NOTIFICATION:

a. The contractor shall be responsible for providing all wheel chair vans, ambulances, and manpower, necessary to meet all MICU, ALS, BLS, and wheel chair transport requirements of this contract.

b. Should the VA determine that immediate transportation is essential to prevent loss of life or serious bodily harm, as in calling 911, emergency transportation services may be procured without referral to the ambulance contractor.

10. ESCORT: The VA reserves the right to have an escort, such as a relative, or care provider of beneficiary of VA staff accompany beneficiary when the VA determines that such an escort is in the best interest of the beneficiary. The VA will also be the sole judge in determining when an escort is required. There shall be no additional charge to the VA when escorts are authorized by authorized medical center personnel to travel with beneficiary. Contractor shall only be required to transport escort with patient and shall not be required to return the escort back to point of origin.

11. HOURS OF PERFORMANCE AND RESPONSE TIMES:

a. Hours of Performance: Contractor shall provide ambulance and wheel chair services for Veteran beneficiaries as requested 24 hours a day, 365/366 days a year.

b. Response Time: The contractor shall respond to all calls for ambulance and wheel chair transports by being on-site at the designated point of pick-up within 45-minutes of notification.

Scheduled patients need to be at their appointments no more than 45-minutes prior to the appointment and no later than 15 minutes of the appointment time. Pick up for these patients need to be no more than 45-minutes after the Contractor has been notified of completion of the patient appointment. In addition, the contractor shall provide non-critical transport services within 45-minutes of being notified of an unscheduled transport (e.g., discharges, transport to nursing homes, ED, or Texas State Veteran Home). (Exceptions are critical transports: Dialysis patients within 20 minutes of the requested pick-up time. Hematology/Oncology patients within 20 minutes of the requested pick-up time. Radiation patients within 20 minutes of the requested pick-up time. Oxygen patients within 20 minutes of the requested pick-up time.)

c. If the period for pick up, stated herein, is physically impossible due to location of Veteran beneficiary, the contractor shall contact the VA travel coordinator and inform him/her of the anticipated time required for pick-up and delivery of said patient. The VA reserves the right to verify standard response times with local reviews (e.g. Run Sheets).

d. Electronic transmissions: The contractor shall, always during the contract period, have on his/her premises a functioning fax machine, phone, and email access to communicate requirements with the VA (i.e., patient incidents, requests for service, special correspondence, etc.).

12. REQUESTS FOR SERVICE:

a. Orders:

i. Requests for individual transports may be in writing, telephone, or facsimile.

ii. Contractor will accept and initiate transports only from authorized personnel of the VA. Upon award of contract, the contractor will be provided with a list of authorized personnel and appropriate contact phone numbers.

iii. Providing transport upon the request from other than authorized personnel may result in non-payment of transport by the Government.

b. Request for services will be requested by the Beneficiary Travel section at STVHCS during weekday hours and by the Administrative Officer of the Day (AOD) during nights, weekends, and

Solicitation 36C25719Q0589 federal holidays. All requests shall be placed against scheduled transport on a unit price basis, and will be verified against invoices. When ordering services, the VA medical facility will provide the contractor with the following type of information:

i. Mode of transportation required

ii. Required date and time of arrival

iii. Name of beneficiary

iv. Pick-up and delivery points

v. Social Security Number

vi. Any other special instructions

c. Only requests for transport services is authorized and any costs incurred for unauthorized travel, top-offs, unauthorized waiting times, etc. will be the responsibility of the contractor. The contractor is cautioned that performance of a trip or substitution of type of vehicle at the request of others, without approval of appropriate authorized VA personnel, may be deemed as unauthorized travel for which the contractor may bear the risk of non-reimbursement.

13. REQUESTS FOR SERVICES OF TRANSPLANT RECIPIENTS:

a. Hours of Performance: Contractor shall provide ambulance and wheel chair services for Veteran beneficiaries as requested 24 hours a day, 365/366 days a year.

b. Response Time: The contractor shall respond to all calls for ambulance and wheel chair transports by being on-site at the designated point of pick-up within 30 minutes of notification and arriving to specified location within 4 to 5 hours of notification.

c. If the period for pick up, stated herein, is physically impossible due to location of Veteran beneficiary, the contractor shall contact the VA travel coordinator and inform him/her of the anticipated time required for pick-up and delivery of said patient. The VA reserves the right to verify standard response times with local reviews (e.g. Run Sheets).

d. Electronic transmissions: The contractor shall, always during the contract period, have on his/her premises a functioning fax machine, phone, and email access to communicate requirements with the VA (i.e., patient incidents, requests for service, special correspondence, etc.). Request for transport of Transplant patients will follow the same protocol in Section 13.

14. SERVICE REQUEST CANCELLATIONS: In the event the VA decides that a previously scheduled trip may be cancelled, and a vehicle has already been dispatched to the designated pick-up point, VA may notify the contractor to cancel the order. For orders that are cancelled while the contractor is already in route to the designated pick-up, the contractor shall be entitled to receive 50% of the base rate for the trip. This charge shall not include any mileage charge. Should the contractor arrive at the destination before VA cancels the order, or if the contractor is unable to perform a scheduled pick-up for reasons beyond the contractor’s control, e.g., incorrect address, or patient absence, or patient refusal, then the contractor shall receive 100% of base rate for a one-way trip.

15. INFECTION CONTROL PROCEDURES: When ambulance and wheel chair services are required, the contractor shall use universal precautionary measures for the prevention and control of the spread of infectious agents to all person in accordance with Occupational Safety and Health Administration

Solicitation 36C25719Q0589

(OSHA) Standards 29 CFR, 1910.1030.

https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=10051&p_table=STANDARDS

16. REQUIRED REPORTS AND DOCUMENTS: Contractor shall provide a “Run Sheet” as part of the patient’s permanent record. This run sheet shall include a record of the patient’s vital signs, medications used, oxygen use, patient attitudes and any changes in the patient’s condition from time of pick up to time of drop off. The list stated here shall not be construed to be as all inclusive; the contractor shall provide all pertinent information. This information is provided with all invoices submitted. Additional documents requested, for this contract, will be submitted within five calendar days of due date.

17. DISPOSAL OF HAZARDOUS WASTE: The contractor shall not dispose of any hazardous materials at any location on the VA medical facility premises except as specified by the COR.

18. NUMBER OF BENEFICIARIES FOR TRANSPORTS: It is understood and agreed that only ONE (1) beneficiary will be transported on a trip unless specifically authorized by the VA. The VA will be solely responsible for determining who will be transported, and how many may be transported on each specific trip. When more than one is transported on a trip, reimbursement will be made at the rate not exceeding the cost of transporting a single patient; however, when travel beyond the county limits is involved, the longest distance over which a beneficiary is transported may be claimed when more than one beneficiary is transported in an ambulance or wheel chair van concurrently.

a. In no instance, will the contractor be permitted to refuse multiple loads.

b. The VA reserves the right to substitute the beneficiary requiring services at any time during the performance of this contract, to prevent delays, cancellations, or dry runs. There shall be no additional charge to the VA when such changes occur.

c. At no time, will the Government require or demand that the contractor transport multiple loads that is more than those allowed under any other federal, state, local law or ordinance.

19. SERVICE ANIMALS: A service animal may accompany the beneficiary with a disability whereas the presence of the animal would not compromise patient care, safety or infection prevention and control standards. The driver may remove the service animal if it is not under the proper control of the handler, is not house broken, behaves in an aggressive way (e.g. snapping, biting, growling baring teeth or lunging), or if it exhibits external signs or parasites, disease, or bad health.

20. MEDICAL RECORDS AND PERSONAL EFFECTS: When applicable, the contractor will be required to transport with the beneficiary, medical records, lab specimens, x-rays and a reasonable amount of personal effects during pick up and/or delivery. This will be accomplished with the priority being on the safety of the beneficiary and safe completion of the transport. In no instance, will the contractor be required, without compensation, to transport these items by separate vehicle (i.e. transport of oversize wheel chair that can’t be safely secured in an ambulance or wheel chair van.

21. VEHICLES:

a. MICU, ALS, BLS vehicles

i. All newly purchased EMS Vehicles (Paramedic, Intermediate, and Basic Life Support) used under the terms of this contract will meet the minimum vehicle requirements

Solicitation 36C25719Q0589 Attachment 1 - Performance Work Statement 04/19/2019 https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=10051&p_table=STANDARDS as mandated by Federal Specification KKK-A-1822F or newer and the Texas State Department of Transportation. Vehicles used in the performance of this contract must be capable of high quality medical transportation and, of providing basic life support and/or advanced life support measures, as appropriate. All vehicles and equipment shall be maintained to ensure mechanical fitness and cleanliness to provide for adequate infection control. All vehicles shall have sufficient headroom to accommodate patients in the Fowler position and must provide adequate heat and air conditioning for the comfort of the beneficiary. All vehicles shall be equipped with suitable warning lights, siren and markings to operate as an ambulance vehicle in various counties, cities, and towns in the State of Texas. All vehicles must be licensed and/or certified as required by the laws and rules of the State of Texas.

Provision of extrication equipment is not required under this contract.

https://www.nasemso.org/Projects/AgencyAndVehicleLicensure/documents/KKK-A- 1822F-08.01.2007_000.pdf

ii. As required by the aforementioned Federal specification, the successful offeror is required to certify to the Government that all vehicles bearing the “Star of Life”, its components, and equipment meet or exceed all the requirements and tests set forth in the specification and to provide an authenticated certification and label which certifies a “Star of Life” vehicle.

iii. All vehicles will have, at a minimum, the following:

1. One (1) five-pound Standard ABC fire extinguisher in operating condition with a current inspection tag.

2. Adequate straps, tie downs, latches, etc. to secure stretchers, cots, wheel chairs, etc. to the specific vehicle used in performing work under this contract.

3. Adequate straps to secure beneficiaries safely to any seat, stretcher, cot, and/or collapsible stretcher appropriate to the vehicle used in performing work under this contract.

4. Adequate supply of sanitary and/or disposable sheets, pillow cases and blankets for transport of ALS or BLS transports (NOTE: Linens will not be exchanged. Contractor will be responsible for their own linen.)

iv. The VA reserves the right to thoroughly inspect all vehicles and equipment proposed to be used and/or used in the performance of the contract requirements. Inspection and/or observation of vehicles and equipment and premises may occur at any time prior to or during the performance period of the contract. Visits may be either scheduled or unscheduled. If any vehicle and/or equipment are added after award of contract, the CO shall be notified, and an inspection performed prior to use.

22. MAINTENANCE:

a. Vehicles shall undergo continual preventive maintenance.

b. Contractor shall maintain and make available, upon the request of the CO, individual maintenance records for each vehicle used in the performance of this contract. Documentation reports which results in a failure will result in a 5% deduction from monthly payment with one or more findings of unsafe conditions.

https://www.nasemso.org/Projects/AgencyAndVehicleLicensure/documents/KKK-A-1822F-08.01.2007_000.pdf https://www.nasemso.org/Projects/AgencyAndVehicleLicensure/documents/KKK-A-1822F-08.01.2007_000.pdf

23. CONTRACTOR PERSONNEL SECURITY REQUIREMENTS:

a. All contractor determinations within the VA will be conducted by the Security Investigation Center (SIC). Contractor fitness determinations will be performed in the same manner as employee determinations, using the suitability criteria of 5 CF 731. VA reserves the right to restrict access to VA facilities, sensitive information, or resources for any contractor.

b. Position Sensitivity – This contract has been designated as Low Risk for background investigation. The level of background investigation commensurate with the required level of access is National Agency with Written Inquiries (NACI).

c. The contractor must submit the names of all employees assigned that will perform ambulance service duties under this contract. The cost of the background investigation (BI) is borne by the contractor at a rate of $381 in accordance with SIC product prices.

https://www.va.gov/SECURITYINVESTIGATIONSCENTER/docs/FY17%20Product%20Prices%20Ve r%201.1.pdf

d. The Contractor shall bear the expense of obtaining background investigations. If the Office of Personnel Management (OPM) conducts the investigation, the contractor shall reimburse the Veterans Health Care Administration Service Center (VCS) within 30 days.

e. Contractors and subcontractors working with sensitive VA information are subject to the same investigative requirement s as those of regular VA appointees or employees who have access to the same type of data or information.

f. The CO will submit a request to the SIC through the Contractor Request Database (CRD).

Before the background investigation can be requested, the contractor employee will need to complete the background investigation request worksheet and submit to the CO. Upon receipt of the request, the Contractor’s point of contact will automatically receive an email notification identifying the web site link https://nbib.opm.gov/e-qip-background-investigations/ for the contractor employee to initiate the Electronic Questionnaires for Investigation Process (e-QIP).

This notification provides detailed instructions regarding completion of the application process.

This process must be complete within 14 days.

g. If the e-QIP application remains “Initiated Untouched by Applicant”, it will be automatically cancelled by the Office of Personnel Management (OPM). Additionally, the Contracting Agency point of contact and the VA CO will be notified that the requirements of Executive Order (EO) 12968 or EO 10450 and VA Directives have not been met. If cancelled, a new request for background investigation must be submitted prior to re-initiation into e-QIP.

h. After the e-QIP application is successfully accepted, the contractor’s point of contact will receive an email notification confirming that the required documents have been reviewed and released to OPM. At this point SIC considers the background investigation process is initiated and the contractor employee may begin, excluding any local requirements and/or restrictions, pending the results of the investigation. Once adjudicated, the certificate of eligibility will be provided to the requesting VA official. If the results are determined unfavorable, the contractor shall withdraw the employee for consideration to work under the contract.

https://www.va.gov/SECURITYINVESTIGATIONSCENTER/docs/FY17%20Product%20Prices%20Ver%201.1.pdf https://www.va.gov/SECURITYINVESTIGATIONSCENTER/docs/FY17%20Product%20Prices%20Ver%201.1.pdf https://nbib.opm.gov/e-qip-background-investigations/

i. If the contractor hires staff that previously worked in VA facilities as a contractor-employee and had a background investigation adjudicated favorably within 24 months as of date of award of this contract, the former contractor-employees’ background investigation is still valid.

j. Failure to comply with the contractor personnel security requirements may result in termination of the contract for default.

24. FAILURE TO PROVIDE SERVICE AS ORDERED:

a. If at any time a transport is cancelled by the facility due to the contractor’s failure to arrive to pick-up the beneficiary in ample time to make the designated appointment, this cancellation shall be considered as a failure to meet the requirement of the contract as it pertains to response times. At no time, shall this failure to complete the transport as scheduled result in reimbursement for a “Dry Run”. Repeated failures of this nature may result in termination of the contract for cause.

b. If at any time a transport is ordered and the contractor does not meet response times and completes a transport but fails to do so in time for the patient to meet their scheduled appointment time, that transport will be invoiced and paid at one-half (1/2) the contracted rate (base mileage, mileage, etc.) The condition claimed to be within the control of the contractor and shall be fully documented and submitted with the invoice.

c. If the contractor refuses to accept an order or fails to furnish service within the specified time frames, it shall be considered as a failure to meet the requirement of the contract.

d. QUALITY ASSURANCE/IMPROVEMENT PROGRAM: The contractor will have an on-going quality assurance and/or quality improvement program designed to objectively and systematically measure, assess, and improve performance to enhance patient care and all patient care services. This shall be provided to the COR within 10 days of contract award. Any revisions thereafter shall be submitted to the COR within seven days.

25. PROVISION OF SUPPLIES OR SERVICES NOT SPECIFICALLY AUTHORIZED:

a. The contractor shall not provide unauthorized supplies or services to any beneficiary of the

VA.

b. In the event the beneficiary’s condition warrants the use of on-board supplies or medications, every attempt will be made to contact the VA for appropriate guidance.

c. Any charge for items and/or services not provided for under this contract shall be invoiced as a separate itemized invoice listing description, quantity and unit price and shall be supported with justification/explanation.

d. Invoices submitted by the contractor for services furnished in accordance with the terms and conditions of any resulting contract(s) or transports placed under any resulting contract(s) shall be in full, and the beneficiary nor any person, party, estate, etc. will be required to bear the burden of additional payment, surcharges, tips, or any other gratuity. Any attempt by the contractor to assess such charges will be in direct violation of this contract and may be reason and/or cause for Termination for Cause.

26. EVIDENCE OF INSURANCE/WORKER’S COMPENSATION COVERAGE:

a. Written proof of Insurance coverage as required prior to award of any contract period.

Coverage must be maintained continually through the life of the contract.

b. The contractor shall furnish to the CO a certificate of insurance which shall contain an endorsement to the effect that cancellation of, or any material change in, the policies which adversely affect the interests of the Government in such insurance shall not be effective unless a 30-day advance written notice of cancellation or change is furnished to the CO.

c. The contractor shall furnish to the CO a copy of the contractor current and valid Worker’s Compensation certificate.

27. COMMENCEMENT OF SERVICES: Services are to commence upon official notice of award.

28. Invoices: All invoices will be submitted on Form CMS-1500 (Health Insurance Claim Form) and shall be submitted weekly to the VA Financial Services Center (VAFSC); no later than 30 days from date of service. The contractor will be reimbursed for payment on a weekly basis at a NET 30 rate. A proper invoice will consist of the following items:

a. Vendor Name, Invoice Number and Date

b. Remittance Address

c. Complete Purchase Order/contract number assigned by the VA facility

d. Itemized description of services to include the following: Corresponding line item number from Price/Cost Schedule, quantity, unit of measure, and unit price (to include breakdown showing costs/mileage)

e. Patient’s Name and Last Four of Social Security Number

f. Trip date, PICK UP location and time, Drop-off location and time

g. VA Official who authorized the trip

h. Total Dollar Amount of Invoice

i. Must be typed rather than handwritten

29. PERFORMANCE STANDARD AND MONITORING:

a. Contractor must achieve and sustain the level of performance outlined herein, throughout the life of the contract. Monitoring of contractor performance will be achieved by verification of documentation, visual inspections, investigation of complaints, etc.

b. Every effort shall be made by the Contractor to prevent errors, falls and patient injury caused by acts of commissions or omission in the delivery of care.

c. Any adverse event related to patient injury or other patient safety issues will be reported orally to the COR and Contracting Officer within thirty (30) minutes following the completion of the event and then followed by written notification (incident report) within 24-hours. A fact finding will be conducted by the Contractor to determine what happened, why it happened and what has been done to prevent recurrence.

Solicitation 36C25719Q0589

d. If the ambulance is involved in an automobile accident, a copy of the police report must be provided to the COR and Contracting Officer within five business days of the accident. Failure to report timely and provide documentation as outlined above may result in negative past performance.

30. REFERENCES:

a. Texas Health and Safety Code – Chapter 773 Emergency Health Care Act.

i.http://www.statutes.legis.state.tx.us/Docs/HS/htm/HS.773.htm

b. Texas Administrative Code – title 25, Part 1, Chapter 157 Emergency Medical Care.

i.http://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=4&ti=25&pt=1&ch= ii.http://www.nasemso.org/legislation/Texas/txc157.11.html

31. INFORMATION SYSTEMS OFFICER, INFORMATION PROTECTION: The contractor will not have access to VA Desktop computers and will not have limited access to online resources belonging to the Government while conducting official Government business. The certification and accreditation requirements do not apply to this requirement and individual security accreditation packages will not be required by contracted employees.

32. PRIVACY OFFICER: The contractor will have limited access to Patient Health Information (PHI), and will have the capability of accessing patient information such as inpatient status during the services provided to the VA. VA Privacy and Information Security Awareness, and Rules of Behavior training will be required.

a. SECURITY INCIDENT INVESTIGATION:

i. The term “security incident” means an event that has, or could have, resulted in unauthorized access to, loss or damage to VA assets, or sensitive information, or an action that breaches VA security procedures. The contractor/subcontractor shall immediately notify the COR and simultaneously, the designated ISO and Privacy Officer for the contract of any known or suspected security/privacy incidents, or any unauthorized disclosure of sensitive information, including that contained in system(s) to which the contractor/subcontractor has access.

ii. To the extent known by the contractor/subcontractor, the contractor/subcontractor’s notice to VA shall identify the information involved, the circumstances surrounding the incident (including to whom, how, when, and where the VA information or assets were placed at risk or compromised), and any other information that the contractor/subcontractor considers relevant.

iii. With respect to unsecured protected health information, the business associate is deemed to have discovered a data breach when the business associate knew or should have known of a breach of such information. Upon discovery, the business associate must notify the covered entity of the breach. Notifications need to be made in accordance with the executed business associate agreement.

iv. In instances of theft or break-in or other criminal activity, the contractor/subcontractor must concurrently report the incident to the appropriate

Solicitation 36C25719Q0589 Attachment 1 - Performance Work Statement 04/19/2019 http://www.statutes.legis.state.tx.us/Docs/HS/htm/HS.773.htm http://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=4&ti=25&pt=1&ch=157 http://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=4&ti=25&pt=1&ch=157 http://www.nasemso.org/legislation/Texas/txc157.11.html law enforcement entity (or entities) of jurisdiction, including the VA OIG and Security and Law Enforcement. The contractor, its employees, and its subcontractors and their employees shall cooperate with VA and any law enforcement authority responsible for the investigation and prosecution of any possible criminal law violation(s) associated with any incident. The contractor/subcontractor shall cooperate with VA in any civil litigation to recover VA information, obtain monetary or other compensation from a third party for damages arising from any incident, or obtain injunctive relief against any third party arising from, or related to, the incident.

b. LIQUIDATED DAMAGES:

i. Consistent with the requirements of 38 U.S.C. §5725, a contract may require access to sensitive personal information. If so, the contractor is liable to VA for liquidated damages in the event of a data breach or privacy incident involving any PHI the contractor/subcontractor processes or maintains under this contract.

ii. The contractor/subcontractor shall provide notice to VA of a “security incident” as set forth in the Security Incident Investigation section above. Upon such notification, VA must secure from a non-Department entity or the VA Office of Inspector General an independent risk analysis of the data breach to determine the level of risk associated with the data breach for the potential misuse of any sensitive personal information involved in the data breach. The term 'data breach' means the loss, theft, or other unauthorized access, or any access other than that incidental to the scope of employment, to data containing sensitive personal information, in electronic or printed form, that results in the potential compromise of the confidentiality or integrity of the data. Contractor shall fully cooperate with the entity performing the risk analysis. Failure to cooperate may be deemed a material breach and grounds for contract termination.

iii. Each risk analysis shall address all relevant information concerning the data breach, including the following:

1. Nature of the event (loss, theft, unauthorized access).

2. Description of the event, including:

a. Date of occurrence

b. Data elements involved, including any PII, such as full name, social security number date of birth, home address, account number, disability code.

3. Number of individuals affected or potentially affected.

4. Names of individuals or groups affected or potentially affected.

5. Ease of logical data access to the lost, stolen or improperly accessed data considering the degree of protection for the data, e.g., unencrypted, plain text.

6. Amount of time the data has been out of VA control.

7. The likelihood that the sensitive personal information will or has been compromised (made accessible to and usable by unauthorized persons).

8. Known misuses of data containing sensitive personal information, if any.

9. Assessment of the potential harm to the affected individuals.

10. Data breach analysis as outlined in 6500.2 Handbook, Management of Security and Privacy Incidents, as appropriate; and, whether credit protection services may assist record subjects in avoiding or mitigating the results of

Solicitation 36C25719Q0589 identity theft based on the sensitive personal information that may have been compromised.

iv.