C03 ELP Home Oxygen.pdf

Period of Performance: 8/7/2023 - 1/30/2024

Reginald D. Hayes 525436 Digitally signed by Reginald D. Hayes 525436 Date: 2023.08.08 10:14:28 -05'00'

08/08/2023

36C25723D0059

Table of Contents

SECTION A ...................................................................................... Error! Bookmark not defined.

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

AND COMMERCIAL SERVICES ...................................... Error! Bookmark not defined.

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

A. EL PASO VA HEALTH CARE SYSTEM (EPVAHCS):

INCLUDES: AVAHCS, WTVAHCS, EPVAHCS ................................ Error! Bookmark not defined.

2.3 ENSURE HOME REQUIREMENTS ARE PRESENT:

2.5 EMERGENCY SERVICES:

2.10 PATIENT TRAVEL:

2.13 DELIVERY AND DISCONTINUATION OF EQUIPMENT AND SUPPLIES: The Contractor

2.15 SERVICE OF EQUIPMENT:

2.18 ASSESSMENT REQUIREMENTS:

2.19 DISCONTINUATION OF SERVICE:

2.21 WARNINGS:

2.32 EMERGENCY PATIENT SAFETY REPORTS:

3. EQUIPMENT REQUIREMENTS:

3.2 OXYGEN CONCENTRATORS:

3.3 FIVE (5) LPM (LITERS PER MINUTE) CONCENTRATOR:

3.4 TEN (10) LPM CONCENTRATOR:

3.5 PNEUMATIC POWERED OXYGEN CONSERVING DEVICES:

3.6 BATTERY-POWERED OXYGEN CONSERVING DEVICES:

3.7 LIQUID OXYGEN SYSTEM:

3.8 LIQUID SYSTEM WITH CONSERVING DEVICE:

3.9 OXYGEN CYLINDER REFILL STATIONS:

3.15 CYLINDERS:

3.16 VENTILATORS:

3.18 HUMIDIFICATION AND MOISTURE EXCHANGE DEVICE:

4. REQUIREMENTS AND STANDARDS:

4.2 QUALIFICATIONS OF OFFERORS:

4.8 INFECTION CONTROL REQUIREMENTS:

5. INFORMATION TECHNOLGY SECURITY REQUIREMENTS SECTION

B.2 PRICE/COST SCHEDULE

ITEM INFORMATION

ACCOUNTING AND APPROPRIATION DATA

B.3 DELIVERY SCHEDULE

SECTION C - CONTRACT CLAUSES

C.1 52.216-18 ORDERING (AUG 2020)

C.2 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.3 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.4 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) ... 71

C.5 52.204-21 BASIC SAFEGUARDING OF COVERED CONTRACTOR

INFORMATION SYSTEMS (NOV 2021)

C.6 52.245-2 GOVERNMENT PROPERTY INSTALLATION OPERATION SERVICES

(APR 2012)

C.7 VAAR 852.239-76 INFORMATION AND COMMUNICATION TECHNOLOGY

ACCESSIBILITY (FEB 2023)

C.8 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.9 VAAR 852.201-70 CONTRACTING OFFICER'S REPRESENTATIVE (DEC 2022)

C.10 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (JUN 2023)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR: Rotech Healthcare Inc.

Dania Vega

407-822-1542

Dania.vega@rotech.com

b. GOVERNMENT: Contracting Officer 36C257

Department Of Veterans Affairs

Network Contracting Office 17

4500 South Lancaster Road

Dallas TX 75216

2. 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

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly []

b. Semi-Annually []

c. Other [X] Weekly

4. 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.

Government Purchase Card (GPC)

1. SCOPE: This Statement of Work (SOW) defines the effort required for the setup, installation, and management of Home Oxygen services and Ventilation, in accordance with Joint Commission (JC) standards, to Veteran beneficiaries serviced by VISN 17. This SOW 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. It is anticipated that one firm-fixed price Indefinite Delivery Indefinite Quantity contract will be awarded in order to ensure coverage to all locations.

1.1 BACKGROUND: The acquisition of Home Oxygen services is being initiated to provide Home Oxygen services to Veteran beneficiaries serviced by VISN 17 for only El Paso VAMC. VISN 17 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.

1.2 LOCATIONS: All services shall be performed in the veteran's place of residence or in a nursing home housing the veteran. The geographic area of service shall be all patients serviced by VISN 17, including catchment areas, regardless of where Patient resides. 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 will 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 VA Health Care System (VAHCS).

For each listed VAHCS, Contractor shall provide setup, installation, and management of Home Oxygen and/or Ventilation services to any Patient that are treated at the main VAHCS Medical Center (VAMC) and all Community Based Outpatient Clinics (CBOCs) and Outpatient Clinics (OCs) supported therein (Clinic of Jurisdiction/Primary Service Area COJ/PSA), regardless of their physical location. The listing of counties in the PSA for each VAHCS does not exclude the provision of services in other counties.

This includes Patients who reside near bordering state’s catchment areas but prefer to be seen by a VISN 17 VAHCS. Some counties are served by more than one VAHCS.

A. EL PASO VA HEALTH CARE SYSTEM (EPVAHCS):

VAMC: 5001 N Piedras, El Paso, TX 79930

COUNTIES IN TEXAS: Culberson, El Paso, Hudspeth, Reeves. COUNTIES IN NEW MEXICO: Dona Ana, Eddy, Grant, Lincoln, Luna, Otero, Sierra.

2. SERVICE SPECIFICATIONS:

2.1 VETERANS SERVED: VISN 17 currently serves an estimated 3,000 oxygen-using Patients. 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 will provide (via encrypted email and 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 and fax) of the request within one (1) working hour of notification. Per Facilities discretion the COR or designee will also provide (via encrypted email and fax) notification if VA owned equipment is to be provided. The COR or designee will also provide notification (via encrypted email and fax) to the contractor of VA initiated discontinuation of service. The discontinuation notifications will be made (via encrypted email and fax) within 24 hours. The written documents will 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 already have a VA authorized oxygen therapy delivery system or ventilator. Two ventilators shall be delivered to each patient home when prescribed.

A. Contractor shall have a policy statement and program in place for Patient evaluation. VA medical staff evaluation is required to ascertain if the Contractor is able to care for each individual patient and determine if that patient is suitable for care in a home setting, immediate a home setting. Evaluations shall occur prior discharge from the hospital. The results of the evaluation will be provided to the local VA Prosthetics Department, who will then notify the COR, Patient, and Contractor.

B. Initial setup(s) for Home Oxygen Patients and Ventilator Patients shall be performed by the Contractor’s certified respiratory therapist (CRT) or registered respiratory therapist (RRT) or Registered Nurse (RN) that is licensed in accordance with the governing standards of where the services are to be provided. A qualified service technician can be substituted for an CRT, RRT or RN for the set-up of Home Oxygen only. Staff performing ventilator setup shall arrive at the home 1 hour from the receipt of evaluation (preferably before the patient arrives) and shall perform ventilator setup immediately upon patient and caregiver arrival. Caregiver education shall be provided by the Contractor on the specific supplies or equipment required by evaluation, and performed prior to discharge and concurrently with setup. Setup of Home Oxygen includes setting up and ensuring the appropriate oxygen system is operational, instruction and training of Patient and/or caregiver, and home environment safety check.

2.3 ONGOING SERVICES: The contractor shall perform the following tasks:

i. Home visits shall be performed monthly by the RRT/CRT/RN for all Patients that utilize the ventilator either continuously, for nocturnal concerns, or for intermittent ventilation.

ii. Home visits shall be performed within 72 hours of setup and quarterly by the RRT/CRT/RN for all Patients that utilize home oxygen services.

iii. Documentation shall be provided (via encrypted email and fax) 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, if necessary.

iv. Documentation shall be provided (via encrypted email and fax) to the ordering facility’s COR for all home visits within five (5) business days of the visit.

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

a) Proper equipment usage

b) Equipment function and operation system

c) Equipment knobs, controls, buttons, outlets, and inlets

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

e) Proper utilization of oxygen with the prescribed ventilator

f) Troubleshooting the equipment and system alarms

g) Equipment and equipment settings that have been prescribed

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

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

j) How to attach the resuscitation bag to the oxygen source

k) How to complete the home ventilator monitor record

l) Emergency Procedures and how to respond to:

1) Power failure

2) Equipment failure

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

m) Practicing regular safety drills helps prepare for emergencies

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

o) Infection control and Patient supply storage

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

1) Cleaning or exchange of the resuscitation bag and supplies

2) Cleaning or exchange of all equipment and accessories

A. 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 Pulmonary or Respiratory Chief/ Director/Supervisor or designee within the Pulmonary/Respiratory Section. Any changes to educational materials will need to be reapproved prior to providing the aforementioned documentation to Patients.

B. The Contractor shall provide a signed document (via encrypted email and fax) to the ordering facility COR verifying the following:

1) Patient has a safe home environment in accordance with Joint Commission standards.

2) Patient received proper education and instructions

3) 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.

C. The Contractor shall ensure all equipment contains an adhesive type 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 time. The Contractor shall provide Patient a document listing toll-free phone number for routine resupply of oxygen cylinders and supplies.

D. 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”.

E. The Contractor shall provide the initial set-up the same day when the prescription is received by 3:00 PM in the local time zone 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 will result there from, if the contractor is unable to meet required response time.

F. The Contractor shall provide initial setup within 24 hours when prescription is received after 3:00 PM in the local time zone to include weekends and holidays.

This shall also apply to service calls.

G. The Contractor shall have a staffed branch office or available resources located within 35 miles of each medical center. Branch offices will stock additional equipment for emergency replacement, as well as maintain staff available to respond to emergency service calls.

H. The Contractor shall bill for mileage required for services on a rate-per-mile basis according to the following criteria:

a. Trip Charge Area A: 0-50 miles from nearest Contractor office

b. Trip Charge Area B: 51-100 miles from nearest Contractor office

c. Trip Charge Area C: 101-200 miles from nearest Contractor office

d. Trip Charge Area D: 200+ miles from nearest Contractor office e.

I. Once the VA places an order for home oxygen services with the Contractor, time is of the essence. The Contractor’s failure to deliver against an order within the required time will result in the VA obtaining home oxygen services from another source. Any costs in excess of contract pricing for services provided will be billed to contractor or credited to next invoice at the discretion of the ordering facility.

J. The Contractor shall coordinate any modifications or preparations required to be made to equipment with patient caregiver and shall make all modifications and preparations before the Patient arrives home from the hospital. Other items that the Contractor shall prepare ahead of time include:

i. Establishing designated Customer Service support phone line for Patients to call for in home assistance

ii. Posting all emergency numbers by each telephone

iii. Marking the circuit breakers and fuses

2.3 ENSURE HOME REQUIREMENTS ARE PRESENT:

1. Upon initial setup the contractor shall ensure the home environment will support all requirements of the equipment being provided including:

a. Proper electrical requirements are present.

b. Appropriate heating and/or air conditioning, if applicable

c. Hot and cold running water

d. Spaces for cleaning and storing equipment

e. General conditions and cleanliness

f. Adequate door size

g. Steps/need for ramps, etc.

h. Availability of ambulance/paramedics and hospital

i. Availability of a telephone

j. Presence of operational smoke detector(s)

k. Presence of operational fire extinguisher(s)

l. Presence of fire evacuation plan

2. The Contractor shall notify 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's electrical system is not sufficient, the Contractor will 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/RN visit the Patient to reassess equipment compliance and educational needs for Home Oxygen Patients at least once every 90 days and once every 30 days for Patients on ventilators

A. The Contractor shall develop a report, signed and dated by the Contractor staff and the Patient/care giver and a copy shall be left with the Patient. The reports shall be legible and attached to the invoice. All reports shall be submitted to the COR or designee in alphabetical order, within five (5) business days of the service. The written report shall include at a minimum the following data:

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

ii. Monitor compliance on prescription (LPM, hours per day)

iii. Type of concentrator and hours on concentrator

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

v. Inspection compliance of filters (exchange or clean by Patient) according to manufacturers guidelines

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

vii. Revised plan of service as needed.

viii. The Contractor shall provide documentation (via encrypted email and fax) of the last visit date, calculated number of expected monthly usage hours and the actual monthly hours of usage based upon the Patient prescription and the Patient last visit to the COR or designee.

B. If the Patient does not receive a reassessment of equipment every 90 days, the Contractor shall provide documentation (via encrypted email and 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).

a) If the Contracting Officer determines that 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.

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

2.5 EMERGENCY SERVICES:

1. 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 Joint Commission standards. This emergency action plan shall address continuity of services for all patients in the affected region. The Contractor and each VAMC shall develop a joint emergency call list for afterhours sentinel event notification.

2. The Contractor shall provide emergency maintenance 24 hours per day/7 days a week. The Contractor shall provide a document listing the emergency telephone number to the Patient at the time of set up.

3. The Patient will 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 one (1) hour of a call. Person receiving the call shall be a certified respiratory therapist (CRT) or registered respiratory therapist (RRT) or relay the call to a CRT or RRT for response.

4. The Contractor shall ensure all Patients have at minimum a non-electrical oxygen supply to last three (3) times the Contractors' response time to a call. The minimum supply shall take into account each Patient's prescription flow-rate and distance from the Contractors location, and so actual supply levels may differ from Patient to Patient, as long as each Patient has oxygen supply to last a minimum of three (3) times the contractors' response time. If the Contractor is unable to respond to an emergency service call within one (1) hour, the Contractor shall be responsible for making arrangements with another supplier, who meets all Joint Commission standards, to provide oxygen at the Contractor's expense. A written explanation (via encrypted email and 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 three-times the Contractor's response time.

5. In the event of disaster, natural or otherwise, the Contractor shall notify the COR or their designee 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. The Contractor shall immediately replace equipment for which there are no replacement parts available or for which there are no certified service technicians available.

The Contractor shall deliver maintenance records monthly, or as extraordinary problems arise, to the COR. Contractor shall provide all documentation with signatures and dates.

2.7 MANUALS: The Contractor shall provide the Operation and Service manual to the Patient or caregiver. The manual shall contain information on operation, maintenance, and trouble shooting for clinicians, users, caregivers and service technicians. Contractor shall provide to the Government, one (1) copy of the Operation and Service manual for each type of equipment.

2.8 DEMURRAGE CHARGES: The Contractor shall provide cylinders without assessing demurrage charges on the Government. The Contractor’s free loan period of cylinders shall not exceed the term of the contract.

2.9 HIGH RISK SMOKERS: The facility will 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 and 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 (i.e. safety precautions, etc). 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:

1. The Contractor shall coordinate all home oxygen and durable medical equipment with incidental services for veterans who travel within the geographical area covered by this contract. 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 will be responsible for coordinating transportation of oxygen/equipment with their respective airlines.

2. Veterans covered within the purview of this contract will be authorized, excluding medically related travel, a maximum of 30 days travel, with a maximum of 2 set-up charges within one calendar year from the latest prescription date. Subsequent to this, any other costs will be the Patient’s responsibility. Those other costs will be negotiated and settled between the Patient and the Contractor.

3. The Contractor shall provide veterans traveling within the regions covered by the contract, as defined by Section 1.2, all oxygen services hereunder at the contract rate utilizing contractor furnished equipment only. The Contractor shall provide equipment setup by the Contractor’s licensed CRT/RRT/RN at designated travel destinations for Veterans receiving care at a covered geographic area within VISN 17.

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

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

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

b. The contractor shall provide the Veteran with up to a 90 day supply of Oxygen/Ventilator Supplies or until such time as the destination VAMC enrolls the patient into the Pulmonary/Home Oxygen Clinic and the destination facility (or contracted vendor) provides their equipment (unless other arrangements/agreements have been made between the two VAMCs), whichever occurs first. The destination VAMC must enroll the Veteran as soon as reasonably possible (e.g. < 30 days in accordance with VA Clinics “Waits and Delays” measure).

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

6. Travel outside the continental United States is not covered under this contract.

Veteran will 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 will be developed by appropriate VA clinical staff at each facility and the Contractor’s Respiratory Care Practitioner (RCP), in accordance with the Plan of Care and the prescription provided by the VA. Prescription changes must be authorized by a VA Provider.

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 promptly schedule appointments with Patients to initiate set ups and deliveries. Deliveries shall not be left unattended at the Patient's home. If the Patient fails to meet two (2) consecutive appointments, the Contractor shall notify (via encrypted email and fax) the COR or their designee within 24 hours of the second missed appointment. The COR or their designee will contact the Patient and a corrective action plan will be implemented.

COR will notify (via encrypted email and fax) the Contractor of any changes. If the Contractor has not documented valid attempts to contact the Patient for set ups 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:

1. The Contractor shall furnish, install and service all equipment and supplies ordered under this contract, including ancillary disposable ventilator-related equipment as determined to be required by evaluation. All disposable supplies shall be new and unused. A label with the Contractor's name and emergency telephone number, where they can be reached 24 hours/day, shall be affixed to all equipment.

2. 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). The Contractor shall provide a home environment safety/emergency contact number 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. The Contractor shall perform maintenance on all equipment according to the equipment manufacturer's guidelines. 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 all maintenance and repairs. The Contractor shall have recall procedures for equipment and supplies.

3. The Contractor shall not change or alter a Patient's oxygen prescription or equipment requirements without a new prescription from the Patient's VA physician.

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 will be made in the cases of emergencies. The Contractor shall schedule the appointments to the Patient's home at least 48 hours prior to the appointment. 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:

1. 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.

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

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

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

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

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

7. Skirts shall be at or below knee length.

2.17 EXCESS DELIVERY: The VA will not authorize payment on the delivery of excess supplies or equipment; excess deliveries are those provided without prior authorization by the VA.

2.18 ASSESSMENT REQUIREMENTS:

1. The Contractor shall perform an assessment of the Patient's home and environment, at least every 90 days (or if required due to Plan of Service changes) in accordance with Joint Commission accreditation standards, and maintain documentation of assessments in the individual Patient file or folder.

2. 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 or Contractor's staff in immediate danger. The Contractor shall contact the COR or designee by phone during the home visit and furnish (via encrypted email and fax) written documentation of the safety hazard to the COR or their designee within five (5) business days of the incident.

3. The Contractor shall document and report (via encrypted email and 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 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.

4. 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. The Contractor shall be liable for any unsafe electrical conditions caused by the Contractor. Any alterations to the veteran's residence will be the responsibility of the veteran. If the COR or their designee decide that the ordered equipment cannot be safely installed, the Contractor shall provide an alternative oxygen delivery system after approval until new prescription can be obtained.

5. 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 and 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:

1. The Government will notify (via encrypted email and fax) the Contractor in the event of an order to discontinue oxygen service to any Patient covered under this contract.

Payment will 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, etc).

Payments will be prorated based on dates of service provided.

2. The Contractor shall remove equipment from the Patient's residence at the earliest possible time but no later than five (5) business days after discontinuation of service 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 funerals.

3. Any and all documentation related to the Patient record during the duration of this contract is the property of the VA and shall be returned by the Contractor to the facility’s COR upon the termination or non- renewal of this contract.

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.

The Contractor shall present all Patient education material, in written form, to the COR within thirty (30) days of contract award. The Contractor, as directed by COR or designee shall implement any new or revised education material. The VA will determine whether the contractor shall use their forms or forms supplied by the VA for documentation of education services provided to patients.

2.21 WARNINGS:

1. The Contractor shall provide educational and 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 the Contractor for medical gas follow-up services shall, at minimum include:

a. No Smoking signs provided and posted

b. Veteran instructed to test all smoke alarms monthly, and smoke alarm sounds when tested and provide how to obtain one. Veteran instructed to remove the cannula, shut off the oxygen supply, move 15 feet from the oxygen source, and wait for the oxygen to dissipate prior to smoking

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

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

2.22 PATIENT RIGHTS & RESPONSIBILITIES: The Contractor shall provide Veterans a copy of VA Patient Rights & Responsibilities and any applicable information concerning advance directives during initial setup. The Contractor shall provide documentation (via encrypted email and fax) that the Patient/care giver is instructed in accordance with Joint Commission standards to include how to contact the Joint Commission.

2.23 FALL PREVENTION: The Contractor shall provide Patient education or re-education on how to prevent falls in the home related to oxygen equipment and supplies (i.e. oxygen tubing is a fall hazard) on initial set up and every 90 days thereafter. The Contractor shall provide documentation (via encrypted email and fax) if it becomes known to the Contractor that the Patient has recently fallen.

2.24 PERIODIC PERFORMANCE REVIEW REPORT: The Contractor shall provide a written, quarterly report addressing all Joint Commission Standards for improving organizational performance (The Joint Commission standards may be accessed at www.JointCommission.org ).The Contractor shall submit their Periodic Performance Review for contracted services to the COR or designee via encrypted email or fax within 90 days of the end of base or option year annually. The Contractor shall assess and score each Joint Commission standard and element of performance that is applicable to the contracted services by entering a self-assessed score. Any noncompliant findings or gaps in service identified on the self-assessment shall require a plan of action to correct as part of the Periodic Performance Review submitted to the COR or designee.

2.25 INCIDENT REPORT: The Contractor shall report special incidents found or occurring during a home visit; to include finding Patients in need of emergency medical assistance, safety hazards that do not fall into the category of presenting immediate life-threatening danger to the Patient or Contractors staff, inability to contact a Patient within a reasonable period of time, and any other incident meeting the Contractors written policy for incident reporting according to Joint Commission accreditation standards. All reports, containing confidential Patient information, shall be provided to the COR via encrypted email using a standard encryption scheme, such as PKI and fax within 24 hours. Life threatening situations (i.e. 911, police, etc.) shall be reported to the proper authorities immediately. The Contractor shall maintain a file containing all incident reports at its place of business.

2.26 CUSTOMER SATISFACTION REPORT: The Contractor shall collect satisfaction data from contracted Patients and their families on a quarterly basis in accordance with Joint Commission standards. A copy of survey results shall be submitted to COR or designee in Quarterly reports via encrypted email and fax. The quarterly report is due to the COR within the 5th working day at the conclusion of the quarter. The reporting quarters are as follows:

October 1st through December 31st, January 1st through March 31st, April 1st through June 30th and July 1st through September 30th.

2.27 INFECTION CONTROL REPORT: The Contractor shall collect, trend, and report on data related to the Contractor’s Infection Control Program to the COR or designee on a quarterly basis for each contract performance period via encrypted email and fax. The quarterly report is due to the COR within the 5th working day at the conclusion of the quarter.

2.28 PERFORMANCE IMPROVEMENT REPORT: The Contractor shall collect, trend, and report on important processes and outcomes data related to Patient care and organizational functions to the COR or designee on a quarterly basis for each contract performance period via encrypted email and fax. The quarterly report is due to the COR within the 5th working day at the conclusion of the quarter.

2.29 CONTRACT USAGE REPORT: Contractor shall provide a monthly electronic report detailing contract usage by each VISN 17 Facility. Contractor shall provide to each VISN 17 Facility’s COR or designee their respective facility’s electronic report NLT the 15th of each month. The electronic report shall include the total units per CLIN and total dollars invoiced by CLIN. Contractor additionally shall submit a composite report of each facility’s usage, by facility, to include the total number of unique Patients, the total number of units used by contract CLIN, and the total dollars invoiced by CLIN number to the VISN COR monthly, NLT the 15th of each month.

2.30 FALL PREVENTION REPORT: The Contractor shall collect data and provide a report on falls and outcomes through conversations with the patient and caregivers on a quarterly basis for each contract performance period. The report shall indicate when the incident occurred, were injuries involved, possible causes of fall (i.e. medication, tripping hazard, etc), as well as corrective action plans, and patient education conducted. This report shall be provided to the COR or designee via encrypted email and fax. The quarterly report is due to the COR within the 5th working day at the conclusion of the quarter.

2.31 HOME VISIT REPORT: Contractor shall provide a report on compliance with the 90 day home visit requirement for Home Oxygen Patients and 30 day home visit requirement for Patients using Ventilators. Report shall be inclusive to all veterans serviced under the contract. Data shall include date of last home visit, due date of next home visit, incomplete home visits including documentation and action plan. Report shall be compiled on a monthly basis and be provided NLT the 15th of each month to the COR or designee of each facility via encrypted email and fax.

2.32 EMERGENCY PATIENT SAFETY REPORTS:

1. The Contractor shall provide the following emergent Patient safety reports throughout the contract period (initial notification shall be within one business day of when the Contractor is aware of the event or issues) with a follow-up official report within 5 business days unless specified below.

2. The Contractor shall inform the COR or their designee of a sentinel event (as defined by Joint Commission) via encrypted email and fax that occurs during the performance of this contract that involves the patients serviced under this contract.

3. All beneficiaries will have the right of refusal of service. In the event a Patient refuses service or orders the equipment to be removed from the home, the Contractor shall notify the COR or designee for authorization. The Contractor shall also report the specifics of the refusal to the COR or designee by telephone while in Patient’s home.

Formal written documentation of this refusal shall be provided to the COR within 5 business days. If the refusal occurs during a home visit, the Contractor's staff shall notify the COR or their designee of the refusal during the home visit.

4. The Contractor shall report suspected incidents of Patient abuse or neglect.

Suspected incidents shall be reported to the COR or their designee, as well as to the adult protective agency. The Contractor shall follow all state and local laws in reporting suspected incidents of abuse or neglect.

5. The Contractor shall report non-compliant behavior with fire safety guidelines set forth in the Patient education and re-assessment material and/or behaviors which pose a risk of self harm or harm to others. Such behavior shall be reported to the COR or their designee during the home visit if the Contractor's staff determines the Patient's non-compliant behavior, within the home environment, is not improving after education on the fire hazard of smoking when on oxygen treatment is provided. Noncompliant behavior and any follow-up actions (i.e. educations) shall be documented.

3. EQUIPMENT REQUIREMENTS:

3.1 SUPPLIES:

1. The Contractor shall be staffed and have sufficient supplies to render satisfactory and courteous service at all times to the Patient as listed below. The Contractor shall be responsible for the acts and omissions of its employees, its Sub-contractors or satellite offices and their employees. The Contractor shall ensure sub-contractors adhere to the requirements of this contract. In accordance with the prescription received from the VAMC, the Contractor shall provide the Patient with the following disposable supplies:

a. Oxygen cannula (including colored cannula/tubing) which is indicated for change at a minimum of every two (2) weeks with a supply in reserve at all times until the contractor’s next scheduled visit.

b. Connectors, swivel connectors, washers, wrenches, oxygen nipple adaptors (Christmas trees) provided as needed.

c. All masks types (when prescribed) for change every two (2) weeks with a 30 day supply in reserve at all times until the contractor’s next scheduled visit.

d. 25-50 ft. of oxygen connecting tubing shall be replaced on a 90 day supply with an equivalent section of tubing in reserve at all times until contractor next scheduled visit.

e. Trachea collar and accessories (i.e. tubing, large volume nebulizer, etc) allowing for change every three (3) days with a supply in reserve at all times until contractors next scheduled visit.

f. Humidifiers (both disposable and reusable) and water traps when deemed necessary. The number of humidifiers shall be sufficient to insure that they are not depleted between re- supply visits. The number of traps shall be based on the Patient’s flow rate.

g. Safety holder(s), storage rack(s), and/or an e-cylinder cart shall be provided for all veterans with a prescription for tanks (cylinders) and for use with the back-up system.

h. FIRESAFE™ Cannula from LifeGas (this item will be provided to the Contractor by the VAMC):

i. The Contractor shall install the FIRESAFE™ Cannula devices during contract start-up and during any initial equipment set-ups.

ii. The Contractor shall replace the FIRESAFE™ Cannula devices annually with prescription renewal (e.g. renew order for home oxygen therapy).

iii. The Contractor shall provide documentation that the Veteran has received and educated on the appropriate use of these devices via encrypted email and fax.

iv. Contractor shall provide documentation that the devices are being used properly and that the Veteran understands their intended use via encrypted email and fax.

v. Contractor shall provide documentation concerning the annual exchanges of these devices as well as any unscheduled exchanges when the device is found missing via encrypted email or fax.

vi. Contractor shall provide two FIRESAFE™ Cannula devices per Veteran only for use on their stationary oxygen system; one at the supply and one at the cannula/mask. No devices are to be used on portable oxygen systems for Veterans using oxygen for migraine headaches only.

3.2 OXYGEN CONCENTRATORS:

1. The oxygen concentrators the Contractor provides shall be Underwriter Laboratory (UL) approved and shall at a minimum meet the following specifications:

a. The oxygen concentrator shall be electrically powered (120 volts)

b. The oxygen concentrator shall contain a battery operated audible alarm to indicate a power failure.

c. The oxygen concentrator shall not perform below the manufacturer's specification

d. The oxygen concentrator shall contain an hour meter and oxygen concentration indicator (OCI)

e. The oxygen concentrator shall be grounded internally or plug into a three-prong wall outlet appropriate for the Patient's home (outlet adaptors are not acceptable).

f. Portable oxygen concentrators shall be Federal Aviation Administration (FAA) approved.

g. The oxygen concentrator shall have 2 fire safety valves.

3.3 FIVE (5) LPM (LITERS PER MINUTE) CONCENTRATOR:

1. Concentrators the Contractor provides shall meet the following requirements:

a. Operate on 120 Volts Alternating Current (VAC), 60 hertz (Hz).

b. Have thermal protector for compressor.

c. Be double insulated and have a three prong plug.

d. Have pressure compensated flow meter.

e. Alarms for the following failures required: Power Failure, 02

Concentration, and Irregular Pressure.

f. Have power failure alarm.

g. Shall meet Food and Drug Administration (FDA) Quality Systems Regulations

h. Be mounted on wheels for easy movement by Patient/caregiver.

i. (QSR) standards.

j. Sound level…