36C25720Q0225-001.doc

DRAFT - Performance Work Statement (PWS) (This PWS is a DRAFT and may be updated and edited)

1. BACKGROUND

The Office of Rural Health (ORH) was established to improve the access and quality of care for Veterans in geographically isolated areas, typically in rural locations. The ORH supports policies, programs and studies and evaluations across several areas of focus, to include access, quality, technology, workforce education and collaboration strategies.

Public Law 110-329 authorizes new initiatives to include: (i) increasing the number of mobile clinics, establishing new outpatient clinics and expanding fee-based care; (ii) exploring collaborations with Federal/community partners; (iii) accelerating telemedicine deployment; and (iv) funding innovative pilot and demonstration programs.

Public Law 110-387 mandates rural health pilot programs for collaborations with public and private entities for the delivery of health care including mental health. ORH is providing funding for the contract with Mental Health Mental Retardation Centers to continue providing Mental Health services via Clinical Video Technology (CVT) to Veterans in rural areas with a few modifications.

2. SCOPE

CVT Mental Health Services will be provided to eligible Veterans in selected rural areas of VISN 17. Services are to be performed at times determined by the VISN Mental Health staff. The Mental Health care services will be performed by Veteran Affairs (VA) Mental Health providers utilizing secure clinical video conferencing equipment.

Each Center will designate a day or more in a week for use of their telemedicine equipment, room and staff (this will vary between Centers due to current utilization).

The VA will reserve the appointments with the Center for 1-hour block of service on that day providing 48-hour notification.

The VA will notify the Veteran of the date, time, and location of the session. If the Veteran fails to appear, the VA will be billed by the rate agreed upon. However, if the VA provides a 24-hour notice of any cancellation and the VA will not be billed

Several rural health facilities will be selected to conveniently serve the following areas in Texas (the facility selected should be located among the counties listed)

3. COVERAGE AREAS

Area 1: South Texas Counties: Kinney, Edwards, Atascosa, Frio, Wilson, Val Verde, Live Oak, Bee, Crockett, Terrell, Uvalde, Sutton, Schleicher, Menard, Kimble, Kerr, Mason, Llano, Gillespie, Bandera, Kendall, Medina, McMullen, Bexar, Comal, Guadalupe, Gonzales, Kames, Dewitt, Lavaca, Jackson, Victoria, Goliad, and Calhoun

Patients seen more than one hour will be paid in increments of 30 minutes after the first hour of visit.

If contractor provided CVT equipment failure occurs, then the mental health service/therapy will be completed by telephone in the room where the CVT is located and the VA patient will use the non-VA facility phone. Cost for this type of service will reduced by 20 percent of contract cost.

If a VA equipment failure occurs, then the mental health service/therapy will be completed by telephone in the room where the CVT is located and the VA patient will use the non-VA facility phone. There will be no change in contract costs

4. STANDARDS

The Contractor shall adhere to the applicable Federal and/or Military Standard guidelines when performing work for the Government unless otherwise specified in the Government issued work order.

The Contractor is responsible for maintaining and making available personnel who are competent and versatile in performing the capacity planning services on both an emergency and routine basis throughout the established contract period.

The term Contractor used herein shall refer to both the prime Contractor and any subcontractors. The prime Contractor shall ensure that his subcontractors comply with the provisions of any resultant contract.

5. REQUIREMENTS AND DELIVERABLES

Facilities’ appropriate staff will escort scheduled veterans to a private exam room equipped with the Clinical Video Teleconferencing (CVT) equipment. Facility staff ensure patient feel safe and comfortable before entering the Telehealth suite. They will also ensure the equipment is fully operational and secure connectivity has been established at least 5 to 10 minutes prior to appointment. Facility staff should introduce themselves to the Mental Health provider in case of an emergency. Facility staff will ensure that the sessions are not abruptly ended if the clinician goes beyond the designated time. The VA will exchange points of contact for Appointment information and IT issues. For medial/psychiatric medication visits, if requested by the VA Telemental Health provider, the Veterans’ vital signs will be collected by appropriately licensed nurses/nurses aids at the facility who will verbally report the results to the VA provider at the beginning of the telemental health session.

Facility staff will ensure a steady patient flow throughout the clinic exam room equipped with the CVT equipment. VA Information Technology and Security staff will work with the selected facilities to ensure equipment meets security requirements prior to seeing Veterans at the facility. Facility staff will provide headphones when Veterans cannot hear or understand what the VA provider is saying. Additionally, facility staff will provide Kleenex® or similar type of facial tissue in the Veteran’s room. The VA will furnish all documentation that the Veteran will require for their treatment via email. The handouts are to be ready for the Veteran prior to appointment as to not disrupt scheduled appointments. However, there might be times when the Contractor might need to make a copy of paperwork and fax it to the VA Mental Health provider.

Facility staff will assist VA Telemental health providers in managing any medical/mental health emergencies which may arise during the Telemental health visits. They will explain alternate means of communication within the facility if the CVT should fail during the visit. The VA Telemental

Health providers must have a telephone number to contact the facility staff immediately to notify them of the emergency. These emergencies are defined as medical or mental health a crisis which in the opinion of the VA Telemental Health provider requires immediate transportation by ambulance to a VA or other authorized medical/psychiatric hospital. VA will assume the financial responsibility for emergence transportation care under these circumstances. If directed to do so by the VA Telemental Health provider, facility staff must provide one-to-one observation and support until the patient is safely transferred to the care of the ambulance technicians. In the case that an unstable Veteran elopes from the facility while waiting for emergency transportation, facility staff will work with the VA provider to contact local law enforcement officials.

The services specified in the Sections entitled Schedule of Supplies or Services and Price/Cost, Description/Specifications/Work Statement and Special Contract Requirements may be changed by written modification to this contract. The modification will be prepared by the VA Contracting Officer and, prior to becoming effective, shall be approved by the VA Under Secretary for Health or his/her designee.

Other necessary personnel for the operation of the services contracted for at the VA will be provided by the VA at levels mutually agreed upon which are compatible with the safety of the patient and personnel and with quality medical care programming.

The services to be performed by the contractor will be performed in accordance with VA policies and procedures and the regulations of the medical staff by laws of the VA facility.

The services to be performed by the contractor will be under the direction of the VISN 17 Mental Health Office, and the Chief of the Service delegated by the Chief of Staff for the responsibility of this action. Contractor employee shall act in a thoroughly professional manner at all times.

Employee(s) shall work in harmony with other members of the professional and technical staff in keeping with established patterns of professional interaction. Tact and courtesy are mandatory when interfacing with patients and staff.

Contractor will provide service for the times and dates specified in the Statement of Work. Contractor will notify the VISN 17 Mental Health Office of closure dates a week in advance. This will let the VISN 17 Mental Health staff know not to make appointments on the date the contractor clinic is closed.

Each staff assigned to work under this contract shall be appropriately licensed and shall be in good standing and practice within the standards of nursing care within the medical community. Information provided with the initial proposal must be updated annually after contract award.

The services covered by this contract shall be furnished by the contractor as defined herein. The contractor will not be required, except in case of emergency, to furnish such services during off-duty hours as described below

The following terms have the following meanings:

Duty hours: Monday through Friday, 8 a.m. to 5:00 p.m. Every effort will be made to schedule patients early. Days of service will be determined by mutual agreement of both parties.

Off duty hours: Saturdays, Sundays, National Holidays and Monday through Friday 5:01 p.m. to 7:59 a.m. Other dates may be blocked with 30 days notice and the consent of both parties.

National Holidays: The 10 holidays observed by the Federal Government: New Year’s Day, Martin Luther King’s Birthday, Washington’s Birthday, Memorial Day, Independence Day, Labor Day, Columbus Day, Veteran’s Day, Christmas Day and any other day declared by the President of the United States as a National Holiday.

If the contractor has closures different than those identified above, the contractor will notify the VISN 17 Mental Health staff a week in advance so appointments can be rescheduled.

6. PERSONNEL POLICY

The contractor shall be responsible for protecting the non-VA personnel furnishing services under this contract. To carry out this responsibility, the contractor shall provide the following for these personnel:

- workers’ compensation

- professional liability insurance

- health examinations

- income tax withholding and

- social security payments

The parties agree that the contractor, its employees, agents and subcontractors shall not be considered VA employees for any purpose.

7. CONTRACT PERFORMANCE MONITORING

Monitoring of contractors time shall be demonstrated through a CVT Mental Health monthly workload report. The contractor shall be required to keep an appointment log upon the patient reporting to clinic/center and the VA official will be responsible for verifying contract compliance. After contract award, any incidents of contractor noncompliance as evidenced by the monitoring procedures shall be forwarded immediately to the Contracting Officer. Documentation deficiencies will be referred to the appropriate VA or facility leadership for correction.

8. MEDICAL RECORDS AND PATIENT INFORMATION

The contractor will not maintain patient information and medical records, including results of test, and will follow appropriate procedures to ensure that patient confidentiality rights are not abridged in accordance with applicable state and federal confidentiality laws. The contract shall be subject to the Privacy Act of 1974. Federal Acquisition Regulation (FAR) 52.224-1 Privacy Act Notification and 52.224-2 Privacy Act apply.

9. COMPUTER SECURITY REQUIREMENT

Contract personnel performing work under this contract shall satisfy all requirements for appropriate security eligibility in dealing with access to sensitive information belonging to or being used on behalf of the Department of Veterans Affairs. The cost of the background investigations is borne by the Contractor. To satisfy the requirements of the Department of Veterans Affairs a Minimum Background Investigation shall be conducted prior to performing work under this contract. The level of access and the individual’s capability to perform work under this contract will be the determining factor in deciding if a higher investigative requirement is needed. The contractor shall ensure that those requirements are fully satisfied within thirty (30) days of initiation of such investigations. The investigative history of contract personnel working under this contract must be maintained in the databases of either the Office of Personnel Management (OPM) or the Defense Industrial Security Clearance Organization (DISCO). Should the contractor use a vendor other than OPM or Defense Security Service (DSS) to conduct investigations, the investigative company must be certified by OPM/DSS to conduct contractor investigations.

10. RECORDS

Contract personnel will not obtain access to hardware or media which may manipulate or store any sensitive information protected under 38 USC 4132 or 3305, as defined by the Department of Veterans Affairs. Disclosure of any sensitive data obtained during the performance of the particular contractual duty is prohibited. Violation of these statutory provisions my involve imposition of criminal penalties.

11. CONTRACTOR RESPONSIBILITIES

The contractor shall designate an individual who shall facilitate scheduling, problem solving and other communication needs related to this contract. The name(s) shall be provided prior to award of the contract.

On a monthly basis, the contractor shall provide the VA with a log of VA Beneficiaries treated under this contract. Individual patient data shall be required more frequently as needed.

12. INVOICE AND PAYMENT

Payment is to be made in arrears. Contractor shall submit invoices monthly in arrears electronically to the COR for review and verification of charges. After COR certifies invoices they will be submitted for payment electronically using the Tungsten Network systems.

Electronic Invoicing Information – VSC FSC Mandatory Electronic Invoice Submission The Department of Veterans Affairs published a final rule in the Federal Register on November 27, 2012 to require contractors to submit payment requests in electronic form in order to enhance customer service, departmental productivity, and adoption of innovative information technology, including the appropriate use of commercial best practices. The rule is effective December 27, 2012. Vendor Electronic Invoice Submission Methods Facsimile, e-mail, and scanned documents are not acceptable forms of submission for payment requests. Electronic form means an automated system transmitting information electronically according to the accepted electronic data transmission methods below: 1. VA’s Electronic Invoice Presentment and Payment System – The FSC uses a third-party contractor, OB10, to transition vendors from paper to electronic invoice submission. Please go tothis website: http://ob10.com/us/en/veterans-affairs-us/ to begin submitting electronic invoices, free of charge. 2. A system that conforms to the X12 electronic data interchange (EDI) formats established by the Accredited Standards Center (ASC) chartered by the American National Standards Institute (ANSI). The X12 EDI Web site (http://www.x12.org).