36C25820Q0121 0001.pdf

5. PROJECT NUMBER (if applicable)

CODE 7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER 3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO. 1. CONTRACT ID CODE

FACILITY CODE CODE

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office. is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER 16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30 PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243

(Type or print) (Type or print)

(Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code)

(If other than Item 6)

(Specify type of modification and authority)

(such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer)

1 10

0001 06-08-2020

N/A

Department of Veterans Affairs NCO22-Gilbert Network Contracting 3601 S. 6th Avenue Tucson AZ 85723

Department of Veterans Affairs NCO22-Gilbert Network Contracting 3601 S. 6th Avenue Tucson AZ 85723

To all Offerors/Bidders

36C25820Q0121

04-09-2020

X

X X

X 1

The purpose of this solicitation amendment is to include language to the PWS found in Section B.2 Performance Work Statement. Section 6.0 VA Procedures and 7.0 Contractor Procedures has been added.

No other changes have been made.

Nonya Montano Contracting Officer

B.2 PERFORMANCE WORK STATEMENT

1. GENERAL INFORMATION:

1.1. Description of Services/Introduction: The Contractor shall provide non-personal

Companion Care Services to eligible beneficiaries for whom such care is specifically authorized by the Phoenix VA Health Care System (PVAHCS). The Contractor shall provide all necessary personnel, equipment, transportation, and supplies associated with the full range of Companion Care Services in performing the requirements of this agreement.

VA beneficiaries to be cared for under this agreement, as referred by the PVAHCS, shall receive the Companion Care Services post procedure. These services are for beneficiaries no longer requiring medical supervision. The purpose of providing Companion Care Services is to:

1.1.1. Provide experienced caregivers to supervise non-medical, private duty home care assistance and transportation from medical facility post procedures.

1.1.2. Services include transportation, personal hygiene, bathing (if needed) medication reminder (no dispensing of medications), personal care, ambulation assistance, meal preparation, and overnight stay if needed.

1.2. Place of Performance: The work to be performed under this agreement shall be performed at the Phoenix VA Health Care System, 650 E. Indian School Rd. Phoenix, AZ 85012 and the beneficiary’s residence in any of the following State of Arizona Counties: Maricopa, Gila, and Navajo.

1.3. Term of Agreement: This agreement is for a period of five years from the effective date.

1.3.1. Termination of Agreement: either party may terminate this agreement with 30 days written notice.

1.3.2. Termination of beneficiary services: The VA reserves the right to remove any or all VA beneficiaries from the Companion Care Program at any time, when it is determined to be in the best interest of the VA or the beneficiary.

1.4. Policy/Handbooks: The contractor shall be subject to the following policies, including any subsequent updates during the period of performance:

1.4.1 VA Directive 1663, “Health Care Resources Contracting – Buying” https://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=969&FType=2

1.4.2 Freedom of Information Act (5 U.S.C. 552) as amended:

http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm

1.4.3 Privacy Act of 1974 5 U.S.C. § 552a https://www.justice.gov/opcl/privacy-act-1974

1.5. Definitions/Acronyms: Terms used in this contract shall be interpreted as follows unless the context expressly requires a different construction and/or interpretation. In case of a conflict in language between the Definitions and other sections of this contract, the language in this section shall govern.

https://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=969&FType=2 http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm http://www.gpo.gov/fdsys/pkg/USCODE-2012-title5/pdf/USCODE-2012-title5-partI-chap5-subchapII-sec552a.pdf https://www.justice.gov/opcl/privacy-act-1974 https://www.justice.gov/opcl/privacy-act-1974

1.5.1 DEFINITIONS:

1.5.1.1 BLANKET PURCHASE AGREEMENT (BPA): A BPA is a simplified method of filling anticipated repetitive needs for services by establishing “charge accounts” with qualified sources of supply.

1.5.1.2 BPA ORDER CREATION: An order/contract is formed, in accordance with the terms and conditions of this agreement, when the VA contacts the CCC and the CCC agrees to accept the VA Beneficiary. Upon acceptance by CCC of VA Beneficiary all terms and conditions of this agreement shall apply during such time specified by the VA at the expense of VA.

Upon acceptance of a VA Beneficiary by the CCC, if and when requested by the Contracting Officer or authorized representative, the CCC shall furnish all services herein described, at the rates specified. VA is obligated only to the extent authorized placements of patients are made under this agreement.

1.5.1.3 CONTRACTOR. A supplier or vendor awarded a contract to provide specific supplies or service to the government. The term used in this contract refers to the prime.

1.5.1.4 CONTRACTING OFFICER (CO). A person with authority to enter into, administer, and or terminate contracts, and make related determinations and findings on behalf of the government. Note: The only individual who can legally bind the government.

1.5.1.5 CONTRACTING OFFICER'S REPRESENTATIVE (COR). An

employee of the U.S. Government appointed by the contracting officer to administer the contract. Such appointment shall be in writing and shall state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the contract.

1.5.1.6 DELIVERABLE. Anything that can be physically delivered but may include non-manufactured things such as meeting minutes or reports.

1.5.1.7 KEY PERSONNEL. Contractor personnel that are evaluated in a source selection process and that may be required to be used in the performance of a contract by the Key Personnel listed in the PWS. When key personnel are used as an evaluation factor in best value procurement, an offer can be rejected if it does not have a firm commitment from the persons that are listed in the proposal.

1.5.1.8 QUALITY ASSURANCE. The government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

1.5.1.9 QUALITY ASSURANCE Surveillance Plan (QASP). An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

1.5.1.10 QUALITY CONTROL. All necessary measures taken by the Contractor to assure that the quality of an end product or service shall meet contract requirements.

1.5.1.11 SUBCONTRACTOR. One that enters into a contract with a prime contractor. The Government does not have privity of contract with the subcontractor.

1.5.1.12 WORKDAY. The number of hours per day the Contractor provides services in accordance with the contract.

1.5.1.13 WORK WEEK. Monday through Friday, unless specified otherwise

1.5.2 ACRONYMS:

ACOR Alternate Contracting Officer's Representative BPA Blanket Purchase Agreement CCC Companion Care Contractor CFR Code of Federal Regulations CO Contracting Officer CONUS Continental United States (excludes Alaska and Hawaii) COR Contracting Officer Representative DVA Department of Veteran Affairs FAR Federal Acquisition Regulation GEMS Green Environmental Management System HHS Health and Human Services HIPAA Health Insurance Portability and Accountability Act of 1996 OCI Organizational Conflict of Interest OCONUS Outside Continental United States (includes Alaska and Hawaii) ODC Other Direct Costs OIG Office of Inspector General POC Point of Contact PRS Performance Requirements Summary PWS Performance Work Statement PVAHCS Phoenix VA Health Care System QA Quality Assurance QAP Quality Assurance Program QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Program TE Technical Exhibit VAMC VA Medical Center VHA Veterans Health Administration WD Wage Determinations

2.0 QUALIFICATIONS:

2.1 Staff: Contractor and employees must maintain the following criteria:

2.1.1 Company must be licensed and bonded for all services they are providing, and

2.1.2 Contractor must have and maintain for the life of the agreement, background checks to include fingerprint card verification, and

2.1.3 Caregiver skills training provided by contracted company or other documented training, and

2.1.4 Received orientation covering Health Insurance Portability and

Accountability Act (HIPAA), ethics, integrity, respect and safety techniques (to include safe ambulation assistance protocols), and

2.1.5 Caregiver will have documented illegal drug screening tests completed a maximum of one month prior to hiring, and

2.1.6 Caregiver will have a valid Arizona Driver’s license and meet state of Arizona Insurance requirements.

2.1.7 Contractor must maintain liability insurance coverage for all contracted services at a minimum of $1,000,000.

2.1.8 Contractor Liaison. The contractor shall designate one (1) employee who shall be responsible for the performance of the work under the resulting agreement(s) and orders. The liaison shall have full authority to act for the Contractor on all matters relating to the daily performance of the contractor’s staff.

2.2 Employment Eligibility:

2.2.1 Employee must be authorized to work in the United States and Arizona and must provide verification.

2.2.2 Employee must have valid non-restricted Arizona Driver’s License

2.2.3 Documented drug screening test (negative result) within a maximum of one month prior to providing services.

2.2.4 Completed Contractor orientation and required training as reflected under required qualifications: HIPAA, ethics, integrity, respect, mandatory companion service confidentiality and safety.

2.2.5 Proof of current Basic Life Support certification from the American Heart Association.

2.2.6 Required immunization and testing:

2.2.6.1 Measles Vaccine, Mumps, and Rubella Vaccine (evidence of 2 doses or individual titers of each of these sub items)

2.2.6.2 Varicella Vaccination (2 doses) or positive Varicella Titer

2.2.6.3 Current negative Tuberculin Skin Test (if test is previously positive, then must provide copy of negative chest X-Ray after the test)

2.2.6.4 Current Flu vaccine

2.2.7 Copy of Valid, Current Fingerprint Card from the State of Arizona (must be valid throughout the duration of companion care).

2.2.8 Valid Work Permit for the United States and the State of Arizona

2.2.9 I-9 Form, Employment Eligibility Verification Form and corresponding documentation to establish identity and employment eligibility.

2.2.10 HHS/OIG Requirements. To ensure that the contract staff performing under the resulting contract(s) have not engaged in fraud or abuse regarding Sections 1128 and 1128A of the Social Security Act regarding federal health care programs, the contractor is required to check the Health and Human Services - Office of Inspector General (HHS/OIG), List of Excluded Individuals/Entities on the OIG Website (www.hhs.gov/oig) for each person providing services. Further, the contractor is required to certify in its offer that all persons listed in the contractor’s offer have been compared against the OIG list and are NOT listed. During the performance of the resulting contract, the contractor is prohibited from using any individual or business listed on the List of Excluded Individuals/Entities.

2.3 Standards of Conduct

2.3.1 The Government reserves the right to refuse acceptance of contract employee whose personal or professional conduct jeopardizes or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other abuse, or other conduct resulting in formal complaints by patients or other staff members to designated Government Representatives.

2.3.2 Complaints concerning contract staff’s conduct with Veteran Beneficiary will be dealt with by the contractor and the COR. The Contracting Officer is the final authority on validating complaints. In the event that contract staff are involved and named in a validated complaint, the Government reserves the right to refuse acceptance of the services of such personnel.

This does not preclude refusal in the event of incidents involving physical or verbal abuse. The final arbiter on questions of acceptability is the Contracting Officer.

2.4 Transport

2.4.1 The contractor shall certify all vehicles used for the performance of this service are maintained in safe operating conditions during operations and shall be monitored for cleanliness and sanitizing.

2.4.2 Items found in Companions vehicle is the responsibility of the Contractor to ensure that all extraneous items, except trash, found in areas under the jurisdiction of the Contractor (i.e., medical instruments and personal items) are turned in to the COR daily (M - F). A note will accompany the articles returned identifying the area or origination/facility, and the type of item that was found.

2.5 Contingency Plan

2.5.1 Because continuity of care is an essential part of VAMC’s medical services, The Contractor shall have a contingency plan in place to be utilized if the contract personnel (s) leaves Contractor’s employment or is unable to continue performance in accordance with the terms and conditions of the resulting contract.

2.5.2 The contractor shall be responsible to provide a contingency plan indicating how services will be continued, uninterrupted in the event of vehicle breakdowns, accidents, inclement weather, and/or staffing failures.

This plan shall be provided with the contractor’s offer.

3.0 CONTRACTOR RESPONSIBILITIES: Contractor shall provide Companion Care

Services as described in the Performance Work Statement as outlined below.

3.1 VA Beneficiary will be screened by VA providers prior to release from the hospital to the Companion Care contractor to verify patient no longer requires medical supervision.

3.2 The contractor shall accept referral of and shall provide all services specified in this contract for any person determined eligible by the VA, regardless of the race, color, religion, sex or national origin of the person for whom such services are ordered.

The contractor shall not use subcontracting as a means of circumventing this provision.

3.3 Contractor shall provide experienced caregivers to provide non-medical, private duty home care assistance and transportation from medical facility post procedure.

Services to include reliable transportation, , personal hygiene, bathing (if needed) medication reminder (no dispensing of medications), personal care, ambulation assistance, meal preparation, and overnight stay if needed.

3.4 Contract employees providing companion care services must have an active cell phone that has coverage for areas contracted to support. This phone must be capable of being used to call 911 in the event of an emergency.

3.5 The Contractor shall report all patient safety incidents to the authorizing VAMC and

COR within 24 hours of incident.

3.6 Contractor is responsible for vetting the identity documentations of their employees providing services to the VA Beneficiaries.

3.7 Contractor is to ensure all employee providing services will maintain the Veterans privacy in accordance with Health Insurance Portability and Accountability Act (HIPAA) and the Balanced Budget and Privacy Act of 1974 (5 U.S.C. 552a).

3.8 Contractor is responsible to ensure the following Core Professional Competencies

(non-clinical).

3.8.1 Veteran Safety: Ensure the safety of the veteran at all times to include transportation and companion services in the home.

3.8.2 Interpersonal Effectiveness: Provide compassionate care and non-medical support to the client.

3.8.3 Service: Provide safe and effective transportation, sitter support and companion care to the client.

3.8.4 Systems Thinking: Actively demonstrates the ability to understand the complexity the nonmedical needs of the client and provides companion support as needed.

3.8.5 Flexibility/Adaptability: Demonstrates ability to manage multiple task/priorities.

3.8.6 Technical: Demonstrates the skills necessary to perform assigned work.

Evidenced by reported client incidence and proof of training/orientation to companion care.

3.8.7 General: Ensure compliance with mandatory training as reflected above in the “Qualifications” section 1.11.

3.8.8 HIPAA and Confidentiality understanding and annually signed confidentiality statement

3.8.9 GEMS:

Utilize sustainable practices to eliminate, minimize, or mitigate adverse environmental impacts. Contractor shall be a good steward of the environment by preventing pollution, minimizing waste, and continually improving environmental programs.

4.0 SPECIFIC TASKS:

4.1 Contractor shall provide services for the Companion Care Services which includes the following tasks:

4.1.1 Provide a responsible adult who meets or exceed the criteria in paragraph 2 who shall:

4.1.1.1 Transportation to beneficiary’s home

4.1.1.1.1 Transportation will be calculated utilizing a per mile charge from 650 E. Indian School Rd., Phoenix, AZ 85012, utilizing the most direct route to beneficiaries’ home.

4.1.1.2 Provide companion care services up to 24 hours post-

surgery/procedure.

4.1.1.3 Companion Care Services includes:

4.1.1.3.1.1 Personal hygiene and

4.1.1.3.1.2 Bathing (if needed) and

4.1.1.3.1.3 Medication reminder (no dispensing of

medications) and

4.1.1.3.1.4 Personal care and

4.1.1.3.1.5 Ambulation assistance and

4.1.1.3.1.6 Meal preparation and

4.1.1.3.1.7 Overnight stay if needed.

4.1.2 Call 911 in case of an emergency. (The caregiver must have an active cellphone that has coverage for the serviced counties).

5.0 QUALITY CONTROL:

5.1 Post Award Conference/Periodic Progress Meetings: The Contractor shall attend any post award conference convened by the contracting activity or contract administration office. The CO, Contracting Officers Representative (COR), Alternate Contracting Officer's Representative (ACOR), and other Government personnel, as appropriate, may meet periodically with the contractor to review the contractor's performance. At these meetings the CO will apprise the contractor of how the Government views the contractor's performance and the contractor will apprise the Government of problems, if any, being experienced. Appropriate action shall be taken to resolve outstanding issues. All meetings described herein shall be at no additional cost to the Government.

5.2 Quality Control: The contractor shall develop and maintain an effective quality control program to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The contractor’s quality control program is the means by which he assures himself that his work complies with the requirement of the contract. As a minimum, the contractor shall develop quality control procedures addressing the areas identified in Technical Exhibit 1, “Performance Requirements Summary.” Within 30 days after contract award, Contractor shall submit electronic copies (compatible with Microsoft Word or PDF) of a comprehensive written Quality Control Plan (QCP) to the Contracting Officer (CO) and COR. Contractor shall submit copies of revisions to the QCP to the CO and COR within five working days when changes are made thereafter. After acceptance of the quality control plan the contractor shall receive the CO’s acceptance in writing of any proposed change to his QC system.

5.3 Quality Assurance Surveillance: The Government will periodically evaluate the contractor’s performance under this contract. Contractor shall provide the Government unrestricted access to facilities and records required to evaluate Contractor’s performance under this contract.

5.4 Performance Standards: The Contractor service requirements are summarized into performance standards that relate directly to mission essential items and the overarching objectives. The performance standards listed in the table below set thresholds for the minimum acceptable levels of service required for acceptable work under this PWS identifies systematic methods to be used to monitor performance and reporting/documentation required to support the process. These thresholds are critical to mission success. The Performance standards serves as a basis for the Government’s evaluation criteria, providing the means for evaluating how well the Contractor is doing in meeting the PWS requirements. The Government may increase the frequency of surveillance in areas where substandard performance occurs.

A “results” focus provides the Contractor flexibility to continuously improve over the course of performance as long as objectives are being achieved and performance levels are being met. This approach migrates away from scrutinizing a contractor’s compliance with the processes/practices used to achieve the outcome. Exceptions to process reviews are those required by law (federal, state, and local) and compelling situations such as information assurance, IT security, safety, or health.

6.0 VA PROCEDURES:

6.1 Before Veteran receives procedure, the Veteran will self-quarantine for 5 days, and be tested for COVID-19 5-7 days prior to procedure. No procedure will be provided to Veteran if they have indicators for COVID-19. VA will notify Vendor as soon as possible when procedures have been cancelled due to COVID results. Cancellations on day of procedure may be subject to time and trouble CLIN.

7.0 CONTRACTOR PROCEDURES:

7.1 Before pick-up at a VA, provider will ensure vehicle is cleaned and disinfected per CDC Guidelines, https://www.cdc.gov/coronavirus/2019-ncov/community/disinfecting-building-facility.html https://www.cdc.gov/coronavirus/2019-ncov/community/disinfecting-building-facility.html https://www.cdc.gov/coronavirus/2019-ncov/community/disinfecting-building-facility.html

7.2 Vendor will wear at minimum a cloth mask while on VA Campus and during the time with the Veteran.

TECHNICAL EXHIBIT 1

Performance Standards Summary

Performance

Objective

Standard PWS Reference

Acceptable Quality Level

Method of Surveillance

The Contractor shall provide qualified staff.

The Contractor provided staff with the proper training, validations, and vaccines as required.

PWS 2.0 No deviation from requirement permissible.

Random Inspection

Contract Employee shall call 911 in case of an emergency

Contract employees providing companion care services must have an active cellphone that has coverage for areas contracted to support. This phone must be capable of being used to call 911 in the event of an emergency.

PWS 4.1.2 No deviation from requirement permissible.

Random Inspection

5.5 Methods of Surveillance: In an effort to minimize the performance management burden, simplified surveillance methods shall be used by the government to evaluate contractor performance when appropriate. The primary methods of surveillance are:

a. Random Inspection – Five (5) randomly selected patient files will be reviewed per quarter. All reviews and reports will be conducted in compliance with VA Privacy and Information security standards.

INSPECTION NOTE: The COR shall record results of inspection, noting the date & time of inspection.

If inspection indicates unacceptable performance, the government evaluator shall notify the CO of the deficiencies and have contractor correct those deficiencies. Contractor shall be given notification to correct the deficiencies within a reasonable amount of time, on a case-by-case basis. The CO shall have the final authority on the amount of time the contractor has to correct the deficiency. The evaluator shall not issue a receiving report accepting the services for the month in question until all deficiencies have been corrected.

B.2 PERFORMANCE WORK STATEMENT