Sources Sought Home Oxygen SOW.doc

STATEMENT OF WORK (SOW)

HOME OXYGEN

Veterans Integrated Service Network 20 (VISN 20) Schedule of Services/Supplies ORDERING & INVOICES: Per VHA Directive 1173.13(1) Home Oxygen Program 5.o., the prescribing provider is responsible for completing the annual prescription for home oxygen after the need is determined. Only credentialed staff are authorized via VA access controls to access and complete the prescriptions via the prosthetic consult module. The prosthetic consult is the order. Prosthetics and Sensory Aids Service (PSAS) and the Home Oxygen Clinical Coordinator/Respiratory Therapist (HOC) or designee shall provide the Contractor with notification via facsimile, email or VA approved portal in addition to a phone call to initiate individual patient service requirements. The consult includes the patient’s oxygen prescription, oxygen prescription expiration date, equipment, supplies and services to be provided including the date and place of delivery. The Contractor shall confirm receipt within two (2) working hours of notification. The Contractor shall confirm by facsimile, secure email or documentation in VA approved portal to HOC or designee for Home Oxygen and Respiratory Service initiations, plan of care changes and discharges. The HOC or designee shall provide notification of VA initiated discontinuance of service via facsimile or email or through VA approved portal. All changes to patient care shall be confirmed through one of the above mechanisms in writing. The documents shall include the authorizing VA official’s signature. The prescription is terminated the day the patient expires. For additional ordering instructions refer to 52.216-18.

Invoices shall be submitted monthly upon completion of complete delivery/pickup/setup. Invoices shall be submitted using the CLIN structure, i.e. CLIN #, Descriptions, Quantity, Unit Price, Units and Total Price. Invoices not following the CLIN structure will be rejected. Send invoices with proper documentation to the appropriate VA Medical Center listed below:

Alaska VA Health Care System

1. SCOPE: This Statement of Work (SOW) defines the effort required for the setup, installation, and management of Home Oxygen and Ventilation, in accordance with Joint Commission (JC) standards for Homecare, to Veteran beneficiaries serviced by VISN 20. 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 services required under the contract.

1.1 Background: The acquisition of Home Oxygen is being initiated to provide Home Oxygen to Veteran beneficiaries serviced by VISN 20. VISN 20 does not have the capacity to provide these supplies, so a contract has been sought for the provision of home oxygen and all associated products and services.

1.2 VETERANS SERVED: The Department of Veterans Affairs Medical Centers (VAMC) at: Anchorage Alaska currently serves an estimated (300 patients) oxygen-using patients. The volumes or amounts shown in the solicitation 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 Home Oxygen Clinical Coordinator/Respiratory Therapist (HOC) or designee shall provide (via encrypted email, fax, or VA approved portal) the contractor with notification to initiate individual Patient delivery requirements, including the Patient's oxygen prescription, equipment, supplies and incidental services to be provided including date and place of delivery. The Contractor shall confirm receipt (via encrypted email, fax or through VA approved portal) of the request within one (2) working hour of notification; Per Facilities discretion the HOC or designee shall also provide (via encrypted email, or fax or through VA approved portal) notification if VA owned equipment is to be provided; the HOC or designee shall also provide notification (via encrypted email, or fax, or VA approved portal) to the contractor of VA initiated discontinuation of service. The discontinuation notifications shall be made (via encrypted email, or fax or VA approved portal) within 24 hours. The written documents shall include the authorizing official's signature, electronic or written.

1.3 Locations: The Contractor shall provide Home Oxygen within a defined area of responsibility/jurisdiction to the patients’ residence, or other location as indicated on the order for Home Oxygen. Area of responsibility/jurisdiction for each VA facility includes the counties identified as applicable to the area of responsibility/jurisdiction.

A. ALASKA VA HEALTH CARE SYSTEM – (ANCHORAGE VETERANS AFFAIRS MEDICAL CENTER (VAMC) LOCATED IN ANCHORAGE, ALASKA AND CBOC’S SODOTNA, MAT-SU, JUNEAU, HOMER,FAIRBANKS, AND ELMENDORF-RICHARDSON): Contractor shall provide delivery, setup, installation, and management of Home Oxygen services to any Patients that are treated at the Anchorage VA Medical Center and all Community Based Outpatient Centers (CBOC’s) supported therein (Clinic of Jurisdiction/Primary Service Area COJ/PSA), regardless of their physical location. Portable cylinders, regulators, regulator keys and 02 carriers shall be delivered to the Anchorage VAMC within one (1) business day of request to accommodate Home Oxygen beneficiaries who are visiting the VA or being discharged and require a tank of oxygen to go home. This shall be provided at no additional charge.

2. ORDERS, NOTIFICATION AND DELIVERY:

2.1 ORDERS: The Home Oxygen Clinical Coordinator/Respiratory Therapist (HOC) or VA designee shall provide the Contractor with the orders/prosthetic consult, via facsimile, secured email or through VA approved portal in addition to phone contact to initiate individual patient service requirements. This shall include patient’s oxygen prescription, oxygen prescription expiration date, equipment, supplies, and services to be provided including the date and place of delivery. The Contractor shall confirm receipt of the request within two (2) working hours of notification. Contractor shall confirm by facsimile, secure email or documentation in VA approved portal to VA designee/designated staff for all Home Oxygen initiations, plan of care changes, and discharges. The VA designee shall also provide notification of VA initiated discontinuance of service via facsimile, secured email, or entry in VA approved portal.. All changes to patient care shall be confirmed in one of the above mechanisms. The prescription is terminated the day the patient expires.

2.2 NOTIFICATION TO VA REGARDING STATUS OF DELIVERY OF HOME OXYGEN

SERVICES:

a. The contractor shall notify the appropriate VA designee and/or HOC monthly of initial delivery of home oxygen equipment by sending copies of individual delivery tickets via FEDEX/UPS/USPS or similar. The delivery ticket shall be signed and dated by the patient or their designated representative. This notification shall be made when patient requires changes in medical equipment or equipment switch-outs.

b. The Contractor shall notify the appropriate VA designee and/or HOC by secure email or facsimile within one (1) working day if expected delivery of medical equipment is not completed. This notification shall include reason/explanation as to why the delivery was not able to be completed; and a plan of action to resolve delivery failure.

c. The Contractor shall notify the appropriate VA designee and/or HOC by secure email or facsimile or documentation in VA approved portal within one (1) working day if the patient refuses delivery of medical equipment and/or signs the Contractor’s AMA form. Copy of the AMA form signed by patient shall be included in this notification.

2.3 DELIVERY OF MEDICAL EQUIPMENT:

a. The Contractor shall deliver and set up in the patient’s residence all equipment and supplies ordered. This contract is a full-service contract. Set-up shall include establishment of operational parameters of equipment to VA prescription, ensures purity of O2, Veteran training on system operations, review of safety checks and discussion of home safety issues. Services are required to be provided 24 hours a day, seven (7) days a week, including holidays, including all emergency service calls. Contract prices are all-inclusive. The Contractor shall not be reimbursed for costs incurred in excess of the contract prices in the Schedule of Supplies/Services for services provided in accordance with the Schedule of Supplies/Services.

b. Patients shall be notified of expected delivery times by the Contractor. Veterans shall be provided with a four (4) hour delivery time window for expected time of delivery.

c. Deliveries of medical equipment and supplies shall be made in full. If the contractor is unable to fulfill the full prescribed medical equipment and supplies list, they may choose partial delivery. Contractor shall notify the VA Designee and/or HOC via secured email or facsimile or entry in VA approved portal within one (1) calendar day in the event of a partial delivery. In such cases where a partial delivery is made, the remainder of the delivery will be made within one (1) calendar day. Payment shall only be issued for full deliveries. Contractor shall maintain sufficient stock (or have available) to ensure all deliveries can be made within the contractual timeframes. The cost for additional deliveries to complete the order shall be at no additional cost to VA.

d. The Contractor shall deliver portable oxygen equipment to previously established and new patients being discharged to their home from non-VA Facilities and other facilities as requested by VA Staff per the needs of the Veteran. Equipment shall be delivered within four (4) hours of the request.

2.4 EXCESS DELIVERY: The Contractor shall not deliver supplies and/or equipment in excess of those prescribed, and the Contractor shall not be paid for any excess deliveries.

3. SERVICE SPECIFICATIONS:

3.1 PRESCRIPTION CHANGES: 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. A request to change tank size does not require a Physician’s signature, as long as liter flow rate is not altered.

3.2 HOME VISITS:

a. The Contractor shall visit patients’ residences for regularly scheduled maintenance visits in performance of this contract by appointment only; between the hours of 7:00 a.m. and 7:00 p.m. Exceptions shall be made in the cases of emergencies.

b. The Contractor is responsible for scheduling the appointments to the patient’s home 24-48 hours prior to the appointment.

c. On each scheduled set-up/delivery the Contractor shall reassess the need to instruct the patient on the use and care of the equipment and supplies as necessary. The Contractor shall perform and document a home safety assessment that will include assessing for fall risk, evidence of smoking around oxygen equipment, working smoke detectors, posted “No Smoking” signs in addition to all other JC requirements for home safety assessments.

d. Contractor shall re-instruct patient, family or caregivers as necessary without formal order from the VA.

3.3 INITIAL SET-UPS: Initial set-ups are services provided to those patients who have not been provided a VA authorized oxygen therapy delivery system to their place of residence on a previous occasion or have not used such a system continuously for the past 60 days. Once initial set-up has been completed, the Contractor shall develop a regular delivery schedule for home oxygen and supplies to patients. All Initial 50 PSI setups shall include all disposables, large bore tubing, large volume nebulizers, drain bags and masks.

a. Initial set-ups shall be completed within eight (8) hours of request. Failure to deliver within the required time shall result in the VA obtaining oxygen from another source. Any costs in excess of contract pricing for services provided shall be billed to contractor or credited to next invoice at the discretion of the ordering facility. The Contractor shall notify the appropriate VA designee and/or HOC via secured email, facsimile or documentation in within one (1) calendar day if expected delivery is not completed. This notification shall include reason why delivery was unable to be completed.

b. Switch-outs are services provided to those patients who are presently using an oxygen delivery system or have used such a system continuously within the past 60 days. The Contractor shall provide equipment switch-outs by staff with documented competency training on the manufacturer’s recommended assembly, use, and maintenance of the equipment used under this contract.

c. Switch outs are to be completed within two (2) calendar days. Failure to complete switch out within the required time shall result in the VA obtaining oxygen from another source. Any costs in excess of contract pricing for services provided shall be billed to contractor or credited to next invoice at the discretion of the ordering facility.

d. Failure to perform the switch-outs as prescribed by VA prescription shall result in no cost to the government. Payment shall be made once switch-outs are completed as prescribed. Payments shall be assessed based on the provider’s established rate and pro-rated from set-up date. Medical equipment switch-out requested to increase the patient’s quality of life or due to changes in the patient’s oxygen requirement shall be made at no additional charge to the government.

e. Set-up 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. Failure to deliver within the required time shall result in the VA obtaining oxygen from another source. Any costs in excess of contract pricing for services provided shall be billed to contractor or credited to next invoice at the discretion of the ordering facility.

f. The Contractor is responsible for establishing appointments with patients when initiating set-ups, switch-outs, and deliveries.

3.4 ASSESSMENT REQUIREMENTS:

a. The Contractor shall perform an assessment of the patient’s home and environment in accordance with Joint Commission (JC) accreditation standards for Homecare and maintain documentation of assessments in the individual patient file or folder.

b. The Contractor shall notify the VA designee and/or HOC 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 must be removed, or in the case of an initial set-up, not placed in the home.

c. The Contractor shall notify the VA designee and/or HOC by telephone or email within two (2) hours if any unsafe conditions are observed in the patient’s home that preclude the installation or continuance of oxygen service. Unsafe conditions shall include fire safety hazards, oxygen safety hazards, patient abuse by family or caregivers, or any instance that places the patient or Contractor’s staff in immediate danger. The Contractor shall provide written documentation of the safety hazard to the VA designee and/or HOC within one (1) business day of incident.

d. The Contractor shall check the adequacy of the electrical outlets in the patient’s home and while still in the patient’s residence, report any unsafe conditions to the VA designee and/or HOC during the initial assessment. VA shall not be responsible or liable for any unsafe electrical conditions caused by the Contractor. Any alterations to the patient’s residence shall be the responsibility of the patient. If ordered equipment cannot be safely installed, the VA designee and/or HOC shall provide an alternative oxygen delivery system after VA physician’s approval until new prescription can be obtained. If no alternative is available, the prescribing VA physician shall be notified by the VA designee and/or HOC.

3.5 PATIENT EDUCATION REQUIREMENTS:

a. The Contractor shall provide education to each patient at the time of set-up, and every six (6) months thereafter, and assess the need for reinforcement during visits. This information shall be presented verbally, in demonstration and material covered shall be in written form to be left with the patient/caregiver. The written material shall be in English as well as the foreign language of the patient, should the patient not speak English. In the case of such an occurrence the Contractor is to advise the VA facility to facilitate adequate instructions. All patient education material must be presented in written form to VA designee and/or HOC for approval prior to distribution to patients. The Contractor shall implement any new or revised education material as directed by the VA designee and/or HOC. The VA shall determine whether the Contractor shall use his/her forms or forms supplied by the VA for documentation of services provided to patients. Regardless of whether the VA provides a VA Patient Rights & Responsibilities document and/or forms to the Contractor, and/or the Contractor uses his/her VA Patient Rights & Responsibilities and/or forms, the Contractor is responsible for duplication of the documents/forms when copies are needed to give to patients.

b. Patients shall be provided a copy of VA Patient Rights & Responsibilities, and Advance Directives as appropriate. The Contractor shall document that the patient/caregiver has been instructed in accordance with JC Standards for Homecare.

3.6 DISCONTINUATION OF SERVICE:

a.

The Government shall notify the Contractor in the event of an order to discontinue oxygen service to any patient covered under this contract as soon as identified. Notification shall be by via secured email or facsimile. At least two (2) weeks prior to the scheduled termination of prescription the Contractor shall notify the VA designee and/or HOC via secured email or facsimile, if removal of home oxygen may be detrimental to the patient. Payment shall be pro-rated based upon the notification date of discontinuance of service. In the event that the contractor is notified that a patient has moved out of the service area, or is deceased, the Contractor shall notify the VA designee and/or HOC within one (1) business day of this discovery.

b.

The Contractor shall remove equipment from the patient’s residence at the earliest possible time but no later than five (5) business days after notification of Discontinuation of Service (DC) unless approved by the VA Designee and/or HOC. The date and time of equipment pickup shall be coordinated with the patient and/or next of kin and/or significant other. The Contractor shall make every effort to meet the patient’s or patient’s families’ requests for pickup times. The Contractor shall honor family’s requests pickup equipment before or after funerals or family gatherings relative to patient funerals. The Contractor shall treat such requests with the utmost courtesy and give such requests the highest priority. In the event the patient refuses to release the equipment the Contractor shall immediately notify the VA designee and/or HOC. Billing of services ends at time of VA-issued notification to discontinue order and/or date of patient’s death.

3.7 EMERGENCY SERVICES:

a. The Contractor shall provide emergency services on a 24-hour basis, and the contractor shall provide services at the patient’s home no more than four (4) hours of receiving a call. If the Contractor is unable to respond to an emergency service call within four (4) hours, the Contractor shall be responsible for making arrangements with another supplier to provide oxygen, and the Contractor shall be responsible for any excess cost above the contract reimbursed price. A written explanation of why the Contractor was unable to respond to the emergency must be provided to the VA Designee and/or HOC within one (1) business day.

b. An emergency exists if the VA Designee and/or HOC informs the Contractor that he/she considers the situation an emergency, or if the patient states in a telephone call to the Contractor that an emergency exists in regard to the function of the home oxygen equipment or use of the equipment. The Contractor shall provide written details of the patient emergency to the VA Designee and/or HOC within one (1) business day of notification by the patient. This written report shall contain time of initial call and time contractor arrived at the patient’s house.

c. The Contractor shall maintain a telephone number for emergency purposes so that the VA and patients who have been authorized to receive home oxygen may contact the Contractor outside of normal business hours. The Contractor shall provide the telephone number to the patients.

d. The Contractor shall notify the VA designee and/or HOC immediately in the event of a disaster, natural or otherwise, that may affect the services covered under this contract.

e. The Contractor shall be prepared to provide services on an emergency basis. Contractor shall provide initial setups and emergency service seven (7) days a week, twenty-four (24) hours a day, this includes holidays. Patient discharges requiring initial setups after 7:00 pm shall be completed that same day.

3.8 SIGNAGE: The Contractor shall provide the patient signs for all entrances into the patient’s residence, 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/Caregiver is instructed in the safe use of oxygen and equipment per OSHA regulations. The Contractor shall attach patient education and expectations placard to all concentrators and liquid oxygen stationary systems. In the event the Veteran refuses the signage, the contractor shall notify the VA Designee and/or HOC immediately after the visit, for documentation purposes by the VA.

3.9 TRAVELING PATIENTS:

a. The Contractor shall be responsible for coordinating all home oxygen for patients who travel both within and outside their respective contracted area of responsibility/jurisdiction, unless otherwise indicated. The VA designee and/or HOC shall be responsible for notifying the Contractor where/when the patient is traveling to and the mode of transportation. The Contractor is responsible for coordinating with the patient when travel has been completed.

b. Traveling patients shall be provided with a Federal Aviation Administration (FAA) approved portable concentrator for travel purposes at the request of the VA designee and/or HOC. These units shall not be standard for long term use.

c. Invoices for travel patients shall be provided to the VA with the next monthly invoice.

d. Patients traveling within the Contractor’s area of responsibility/jurisdiction shall be provided all home oxygen under the contract at the contract rate. Patients traveling within contracted areas of responsibility/jurisdiction covered under other VA contracts for home oxygen, but not within the Contractor’s area of responsibility/jurisdiction, shall be provided all required oxygen services at whatever contract rate that applies to the area the patient is traveling. The Contractor currently providing home oxygen shall work with the VA designee and/or, the Home Oxygen Coordinator, and the Prosthetic Representative to notify and arrange for home oxygen with the contractor whose area the patient is traveling.

e. For patients traveling outside the areas of responsibility/jurisdiction covered by other VA contracts for home oxygen, and/or temporarily relocating, the Contractor shall arrange for home oxygen from an area provider. The Contractor shall obtain pre-approval from the Contracting Officer or designee on pricing if it is above the contract price on the Contractor’s contract. If approved, the Contractor shall be reimbursed the contract rate plus the additional cost incurred for providing appropriate home oxygen. The Contractor shall provide the VA designee and/or HOC evidence of any additional costs involved in providing the services outside the areas of responsibility / jurisdiction covered by other VA contracts for home oxygen.

f. Home oxygen for travel outside of the continental USA, overseas travel, and cruises are the responsibility of the patient.

g. Patients not travelling but are permanently relocating outside of established contracted area of coverage will be provided up to 90 days of continuation of services.

4 EQUIPMENT SPECIFICATIONS AND ASSOCIATED REQUIREMENTS:

4.1 EQUIPMENT MAINTENANCE:

a.

Twice annually or as recommended by the equipment manufacturer, whichever occurs most often, the Contractor shall visit the patient to inspect equipment, checking for proper functioning and prompting patients to replace disposables, such as filters, tubing and nasal cannula as needed. During the visit the Contractor shall also reassess equipment compliance, provide educational needs, perform equipment inspection and maintenance in accordance with manufacturer’s recommendations and perform an environmental survey. All equipment ordered shall be inspected. A written report shall include at minimum the following data:

1. Name and last four digits of social security number (SSN) of patient using the equipment.

2. Monitor compliance on prescription (Liters Per Minute (LPM), hours per day). Report will reflect hours of all equipment ordered.

3. Type of equipment, hours on concentrator (Serial numbers for the rented equipment shall be the Contractor’s responsibility and kept on file in the Contractor’s main office).

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

5. Inspection compliance of intake filters (exchange or clean by patient); follow-up education and/or reinforcement of compliance documented.

6. Revised plan of service as needed.

7. A delivery report shall be developed by the Contractor, signed and dated by the contract 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 VA designee and/or HOC in alphabetical order, with the monthly invoices by the 10th business day of the month following service. The report must include a patient list and associated scanned delivery/maintenance receipts with patient’s signatures, patient signed patient education notes and clinical notes associated with plan of care changes. The report shall be submitted by the Contractor in both hard copy and on electronic media (DVD or CD). Format to be approved by VA. Changes to the format shall not constitute a need for a contract modification.

4.2 NECESSARY EQUIPMENT AND SERVICES:

a.

In accordance with the prescription received from the VA facility, the Contractor shall provide the patient with the following items:

1. Humidifiers and water traps, when the liter flow is equal to or greater than four (4) liters per minute, or if prescribed. The number of humidifiers must be sufficient to ensure that they are not depleted between re-supply visits. The number of traps shall be based on the patient’s flow rate. Humidifiers and water traps are changed every two-weeks with a supply in reserve at all times sufficient to last until the contractor’s next visit.

2. Twelve (12) disposable oxygen cannulas on hand for a change every two (2) weeks with a supply in reserve at all times until the Contractor’s next scheduled visit.

3. Twelve (12) disposable masks for change/wash every two (2) weeks with a supply in reserve at all times (when masks are prescribed in lieu of nasal cannulas).

4. 25-50 feet of oxygen connecting tubing shall be replaced every 30 days with an equivalent section of tubing in reserve at all times (to be included in initial setup) until the Contractor’s next scheduled visit.

5. Safety holders shall be provided at no charge for all patients with a prescription for cylinders.

4.3 CONTRACTOR OWNED CONCENTRATORS:

a.

The Contractor shall furnish, install and service all oxygen equipment to dispense oxygen and supplies ordered under this contract. All equipment shall be the most current model and all supplies are to be new. 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.

b.

The concentrators must meet the following standards and guidelines:

• The American Association for Respiratory Care for Respiratory Equipment Used in the Home. http://www.rcjournal.com/cpgs/pdf/08.07.1063.pdf

• Association for the Advancement of Medical Instrumentation (AAMI).

https://my.aami.org/aamiresources/previewfiles/HA6060101011_1508_preview.pdf

• Joint Commission (JC) Standard for Home Care.

http://www.jointcommission.org/accreditation/home_care.aspx

4.4 CYLINDERS:

a. The Contractor shall furnish cylinders required under this contract that are in accordance with the Interstate Commerce Commission Regulations, and transport cylinders in accordance with Code of Federal Regulations (CFR) Part 49, U.S. Department of Transportation. ‘H’ or “M” cylinders furnished by the Contractor shall have ‘H’ or “M” safety stand(s) at no additional charge to the Government. This stand shall remain Contractor-owned.

b. Oxygen Cylinders provided must be United States Pharmacopoeia (U.S.P.) oxygen.

4.5 VENTILATORS:

a.

Contractor shall track ventilators for preventive maintenance in accordance with manufactures' specifications.

b.

If there are no manufacturer’s instructions then the VA designee and/or HOC & Contractor shall determine maintenance schedule.

c.

If a ventilator needs maintenance, either scheduled or unscheduled, the contractor shall pick up the ventilator from the patient’s home and replace with another Contractor owned ventilator.

d.

The patient shall always have two (2) ventilators on hand. In cases of a multi-function ventilator being utilized, a standard ventilator, i.e. Trilogy, may be used as a secondary ventilator.

e.

The Contractor shall always keep one (1) or more ventilators in stock for replacement purposes for each patient on a rental ventilator. All related supplies shall be provided by the Contractor.

f.

Contractor shall provide each site a quarterly report due on the 10th day following the end of the quarter containing the following:

1.

Name and last four (4) digits of the social security number of the beneficiary.

2.

Serial number of the ventilator.

3.

Date of last preventive maintenance.

4.

Date of next scheduled preventive maintenance.

g.

Patients may be on continuous or intermittent mechanical ventilation.

h.

Contractor responsibility for ventilator usage is as follows:

1.

Perform home visits (continuous patients shall be visited monthly and nocturnal/intermittent ventilation patients visited quarterly). This visit is to include ventilator respiratory assessment by a Registered Respiratory Therapist.

2.

Provide documentation of all home visits to the VA Home Oxygen Coordinator or designee within two (2) weeks of visit.

3.

Provide thorough education to patient and caregiver in proper ventilator usage, ventilator function and operation including control knobs, power sources, adding oxygen, troubleshooting the ventilator and alarms, the remote alarm, checking tidal volume, ventilator tubing change, talking devices, cleaning of tubing and humidifier, back pressure with Jackson trach tube (if applicable), ventilate with AMBU bag, and supplies. When clinical respiratory services are provided to ventilator patients, education on trach changes, airway care and suctioning shall also be provided.

4.

Provide continuing education in ventilator use as needed. All education provided by Contractor’s therapist shall be approved by the VA designee and/or HOC upon consultation with Respiratory Care.

5.

Contractor shall assess the home environment for safety and suitability for ventilator use.

6.

Verify and document safe and proper use of the ventilator.

7.

Contractor cannot adjust the ventilator prescription without an approved VA order. i.e. it cannot be adjusted at patient request.

i.

Contractor Registered Respiratory Therapist Responsibilities/Competency shall include the following:

1.

Home Ventilator Management and assessment.

2.

Competency assessments shall be completed annually for each type of mechanical ventilator managed by contractor respiratory therapist.

3.

Oxygen delivery.

4.

Aerosol equipment.

5.

Tracheotomies.

6.

Airway care.

7.

Suction machines.

8.

CPR.

9.

Cough Stimulating Device j.

Competency assessment of the contractor’s Registered Respiratory Therapists shall remain the responsibility of the Contractor

4.5.1 VENTILATOR EQUIPMENT AND SUPPLIES:

Equipment, disposables, and supplies shall be provided to patients receiving home ventilator service as described in Table 1 below. These items are to be provided to ventilator patients only

Table1:

Ventilator Equipment and Supply Delivery Schedule

Options when medically necessary

4.5.2 CLOSED SUCTION CATHETERS:

Contractor shall provide four (4) closed suction catheters to each ventilator patient each month. Patients shall have a replacement catheter each week. Catheters shall be replaced as needed during monthly visit by contractor RT. This item is to be provided to ventilator patients only.

4.5.3 INLINE HME:

The Contractor shall provide an inline heated moisture exchanger (HME) to Veterans receiving non-invasive mechanical ventilation in order to provide optimal levels of heat and moisture to the patient’s airway. This item is to be provided to ventilator patients only.

4.5.4 FULL FACE PAP MASK:

The Contractor shall provide a full-face mask to Veterans receiving non-invasive mechanical ventilation. This item is to be provided to ventilator patients only.

4.5.5 HEATED HUMIDIFIER:

The Contractor shall provide a heated humidifier to Veterans receiving mechanical ventilation to provide optimal levels of heat and moisture to the patient’s airway. This item is to be provided to ventilator patients only.

a. Supplies and disposables shall be replaced according to infection control policy of the VAMC.

b. Contractor shall perform equipment maintenance check on 50 psi air compressors and suction machines in accordance with manufacturer guidelines or as determined by COR and Contractor.

4.6 PORTABLE OXYGEN CONCENTRATORS: Portable oxygen concentrators shall include a suitable carrying device, such as a handcart or carrying pouch, to be determined by the size and weight of the portable oxygen concentrator along with the patient’s physical ability.

a. Portable Oxygen Concentrator (Pulse Dose Only) weight </= 6 lbs.

1. Contractor shall provide FAA approved portable concentrators to beneficiaries. Portable concentrators shall be suitable for airline travel and extended and / or multi-destination land travel.

2. Provide 2 batteries, wall and car charger

3. Deliver portable oxygen concentrator (POC) in accordance with prescription

4. Should malfunctioning occur during beneficiaries’ travel, Contractor is responsible to make arrangements for replacement portable concentrator at beneficiaries’ place of travel.

b.

Portable Oxygen Concentrator System (Continuous up to 2 (LPM) with pulse dose settings) weight </= 10 lbs.

1. Contractor shall provide FAA approved portable concentrators to beneficiaries. Portable concentrators shall be suitable for airline travel and extended and / or multi-destination land travel.

2. Must have pulse dose and continuous flow capabilities

3. Provide 2 batteries, wall and car charger

4. Deliver portable oxygen concentrator (POC) in accordance with prescription

5. Should malfunctioning occur during beneficiaries’ travel, Contractor is responsible to make arrangements for replacement portable concentrator at beneficiaries’ place of travel.

c.

Portable Oxygen Concentrator System (Continuous up to 3 (LPM) with Pulse dose settings) weight < or = 25 lbs.

1.

Contractor shall provide FAA approved portable concentrators to beneficiaries. Portable concentrators shall be suitable for airline travel and extended and / or multi-destination land travel.

2. Must have pulse dose and continuous flow capabilities

3. Provide 2 batteries, wall and car charger

4. Deliver portable oxygen concentrator (POC) in accordance with prescription

5. Should malfunctioning occur during beneficiaries’ travel, Contractor is responsible to make arrangements for replacement portable concentrator at beneficiaries’ place of travel.

Contractor shall provide at no additional cost to the VAMC and Outpatient Clinics a portable oxygen concentrator, so patients can be titrated on actual unit before he/she goes home. Devices shall then be billed at monthly rental charge.

4.7 POSITIVE AIRWAY PRESSURE (PAP) MASKS: The Contractor shall deliver a PAP Mask to Veterans receiving noninvasive ventilation, as ordered by the VAMC. The Contractor shall provide instruction on use of mask, with return demonstration by caregiver, along with applicable patient education, cleaning and equipment maintenance training. The contractor shall develop a regular delivery schedule for all disposable and/or consumable supplies.

a. Full Face PAP Mask

b. Nasal PAP Mask

c. Nasal Pillow PAP Mask

MASKS SHALL BE PROVIDED TO NON-INVASIVE VENT PATIENTS ONLY

4.8 POSITIVE AIRWAY PRESSURE (PAP) VALVE:

a.

The Contractor shall furnish a PAP Valve to each Veteran on nocturnal oxygen bled into a PAP device when ordered by the VAMC. These valves shall remain Contractor owned and shall be replaced as ordered by the VAMC. One pressure valve shall be issued for each Veteran as ordered which shall be placed on the outlet port of the PAP system.

b.

The Pressure Valve helps prevent the backflow of oxygen from the patient circuit into the PAP system when the unit is turned off. Any backflow passes out of the circuit through the vents. When the system is operating, the valve allows air to flow through the patient circuit. The vents are sealed to prevent flow out of the circuit.

c.

Veterans shall be instructed to clean the PAP valve weekly with a solution of warm water and mild detergent. Veterans shall be instructed that they should not clean the pressure valve with alcohol, cleaning solutions containing alcohol or any strong household cleaners.

d.

Pressure Valves used are described below:

1. The inlet side of the valve is a 22mm connector that fits on the outlet port of the PAP system.

2. The outlet side of the valve fits a 22mm connector on a bacteria filter or smooth inner lumen tubing.

3. The minimum operating pressure is a 2cm H2O

4. The pressure valve is not an exhalation port and does not vent exhaust gas during operation.

e.

Veterans shall be setup with a Positive Airway Pressure Valve when ordered by VA Staff

1. Pressure valve shall be provided during a regularly scheduled cylinder delivery or twice-yearly equipment maintenance visit. Special visits to deliver pressure valve shall not be made.

2. If patient refuses a pressure valve, documentation of refusal, signed by the patient, must be provided to the VA.

3. If contractor is unable to contact patient, notification shall be made to the VA requesting updated contact information. If patient is still unable to be contacted, written documentation of 3 attempts to contact patient shall be provided to the VA.

4. If patient is a “snowbird” and delivery of pressure valve coincides with the patients extended winter vacation, notification of this shall be made to the VA in writing. Valve shall be delivered to patient during first equipment delivery when patient returns. Follow up documentation shall be provided to the VA after valve delivered.

4.9 OXYGEN SAFETY VALVES:

a.

The Contractor shall furnish bi-directional oxygen safety valves (fire safety valves) to each Veteran on home oxygen. These valves shall remain Contractor-owned and shall be replaced according to the manufacturer recommendations. Two (2) each bi-directional oxygen safety valves shall be issued for each Veteran, on stationary units and on all portable oxygen units/equipment, unless there is a documented clinical contraindication (i.e. patients using heated humidity, flow rates that exceed 25 liters per minute, patients with behavioral conditions that make use of oxygen safety valves impractical and/or patients using single lumen or dual lumen conservers.) If oxygen safety valves are not provided due to a clinical contraindication, this must be documented in the patient’s medical record.

1. One (1) bi-directional oxygen safety valve shall be placed between the nasal cannula and oxygen tubing (proximal to the patient)

2. The second bi-directional oxygen safety valve shall be placed between the oxygen source (at the flow meter) and oxygen tubing.

3. Contractor shall ensure that bi-directional oxygen safety valves are installed on all home oxygen systems (stationary and/or portable equipment) at the next scheduled home visit.

b.

Oxygen safety valves act like a fuse to automatically isolate the oxygen supply in case of accidental fire, and potentially:

1.

Provides an additional level of protection, buying the patient, caregivers, emergency personnel and others valuable time to evacuate.

2.

Prevents the progression to upstream equipment oxygen concentrator, high pressure cylinder or liquid vessel.

3.

Lessens the probability that the fire will spread further, minimizing the overall cost of restoration.

c.

Veterans with heated humidity shall not be provided with a bi-directional oxygen safety valve, as this is a contraindication indicated by the manufacturer.

d.

Veterans shall be instructed to clean exterior surfaces of the bi-directional oxygen safety valves every two (2) weeks with an alcohol or disinfectant wipe.

e.

Bi-directional oxygen safety valves shall be provided during a regularly scheduled delivery or equipment maintenance visit. Special visits to deliver oxygen safety valves shall not be made. Broken and/or destroyed Bi-Directional valves, at the fault of the patient, will be replaced and charged to the Government.

f.

If patient refuses a bi-directional oxygen safety valve, documentation of refusal, signed by the patient, must be provided to the VA.

g.

If contractor is unable to contact patient, notification shall be made to the VA requesting updated contact information. If patient is still unable to be contacted, written documentation of three (3) attempts to contact patient shall be provided to the VA.

h.

If the delivery of a bi-directional oxygen safety valve coincides with a patient’s extended winter vacation, notification of this shall be made to the VA in writing. Valves shall be delivered to patient during first equipment delivery when patient returns. Follow up documentation shall be provided to the VA after valves are delivered.

i.

Valves to be used must meet or exceed the below device specifications:

(1) Likely upstream system pressure following activation of the valve; (2) Leak through the valve after activation, (3) Leak from the valve body after activation. Subject to correct installation as per instruction.

4.10 MALE-FEMALE OXYGEN SWIVEL CONNECTOR:

a.

The Contractor shall furnish a male-female oxygen swivel connector to each Veteran to be used in conjunction with the bi-directional oxygen safety valve, as requested by the Veteran or VA staff.

1.

Oxygen swivel adapters shall not be routinely issued like oxygen tubing or filters, but only as requested by the Veteran or VA staff.

2.

All requests for oxygen swivel connectors, made by either the Veteran or VA staff must be documented on the patient signed equipment maintenance sheet or patient signed delivery sheet.

3.

Delivery of swivel connectors shall be completed during a regularly scheduled delivery and/or equipment maintenance appointment. Any deliveries made outside this defined time must have prior approval from VA designee, and/or COR.

b.

The swivel connector is designed to help prevent oxygen tubing from twisting, kinking or becoming tangled.

c.

Two (2) each swivel connectors shall be issued for each Veteran who is receiving VA home oxygen and has an oxygen safety valve, as requested. These swivel connectors shall remain Contractor-owned and shall be replaced every - one (1) year and as needed with prior approval from VA designee and/or COR.

d.

Male-female oxygen swivel connectors must meet or exceed the following specifications:

Connections

4.11 HOME OXYGEN EQUIPMENT:

a.

Installation - The installation of all machines and equipment by the Contractor shall be performed by a competent professional familiar with the nature of the equipment involved and fully qualified under the laws of the State in which the services are being rendered. Installation shall be consistent with local Fire and Safety Codes in the respective area of the State and shall conform to the most current National Fire Protection Association (NFPA) Life Safety Codes and NFPA Oxygen Cylinder Requirements. The Contractor shall provide a safety/emergency checklist to be completed, then signed by the patient or his/her caregiver and retained in the beneficiary account folder.

b.

Maintenance - The Contractor shall ensure that all equipment is inspected at manufacturer’s recommended intervals. A Contractor’s staff member shall conduct a check of the concentrator using a certified oxygen analyzer that is calibrated according to the manufacturer’s standards. Equipment shall be maintained per manufacturer’s specifications, and the maintenance shall be completed using the manufacturer’s checklist, which shall include compressor inlet pre-filter changes and compressor inlet bacteria filter changes according to the manufacturer recommendations. The alarm battery shall be tested at each maintenance check, changed as indicated, but not less than annually. The Contractor is responsible for tracking and documenting maintenance of equipment in accordance with manufacturer specifications and providing these records for review upon request. Contractor shall furnish parts and labor for routine maintenance at no additional cost to the VA. The Contractor shall have recall procedures for equipment and supplies.

4.12 EQUIPMENT SPECIFICATIONS FOR OXYGEN CONCENTRATORS:

a.

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

1) Electrically powered (115 volts).

2) There shall be a battery-operated audible alarm to indicate a power failure.

3) The oxygen concentrator shall not perform below the manufacturer’s specification.

4) Hour meter and OCI indicator.

5) The oxygen concentrator shall be grounded internally or plugged into a three-prong wall outlet appropriate for the patient’s home (outlet adaptors are not acceptable).

b.

All electrically powered equipment used in performance of this contract shall be UL approved and shall be the most recently developed in the field at the time of use.

c.

Contractor-owned equipment shall be repaired or replaced at no additional cost to the Government when breakdown or malfunction is due to normal usage or due to the fault of the Contractor.

4.13 FIVE (5) LPM CONCENTRATOR:

a. Concentrators must meet the following specifications:

1.

Deliver 92 - 95% oxygen (+ / - 3%) at flow rates up to 5LPM.

2.

Operate on 120 VAC, 60 Hz.

3.

Irregular pressure alarm

4.

Have power failure alarm.

5.

Weigh 60 pounds or less.

6.

Be mounted on wheels for easy movement by patient/caregiver.

7.

Must meet Food and Drug Administration (FDA) Quality Systems Regulation (QSR) standards.

8.

Minimum of three-year warranty on concentrator and compressor.

9.

Sound level of 60 dB or less.

Concentrators that have oxygen sensing devices are preferred, but not required.

4.14 TEN (10) LPM CONCENTRATOR:

a. Concentrators must meet the following specifications:

1.

Deliver 92 - 95% oxygen at flow rates from 0.5 to 7 LPM.

2.

Deliver 90 - 95% oxygen at flow rates from to 7 to 10LPM.

3.

Alarms for the following failures required: Power Failure, O2 Concentration (Optional), and Irregular Pressure.

4.

No larger than 26.0 H x 14.7 W x 19.1 Deep (in) 28.4 H x 39.4 W x 47.0 deep (cm).

5.

No heavier than 60 lbs. (10 LPM unit) 110 volt; 60 cycle.

6.

Have power failure alarm.

7.

Be mounted on wheels for easy movement by patient/caregiver.

8.

Must meet FDA QSR standards.

9.

Minimum of two-year warranty on concentrator and compressor.

10.

Sound level of 60 dB or less.

Concentrators that have oxygen sensing devices are preferred, but not required.

4.15 CONCENTRATOR WITH PORTABLE GASEOUS OXYGEN SYSTEM:

a.

Oxygen concentrator with home compressor used to fill portable oxygen cylinders. Home compressor feature may be integrated into the stationary concentrator or may be a separate component. Oxygen concentrator to deliver flow rates of either up to 5 LPM or up to 10 LPM (low flow or high flow concentrator). System shall include the following accessories:

1. Portable containers.

2. Regulator.

3. Flow meter.

4. oxygen conserving device.

5. Humidifier.

6. Nasal cannula or mask.

7. Tubing.

8. Cylinder carrier.

Contractor shall provide at no additional cost to the VAMC and Outpatient Clinics a home-fill system so patients can be titrated on actual unit before he/she goes home.