Performance Work Statement HCHV CERS Puget Sound.pdf

A Puget Sound Health Care System

STATEMENT OF WORK

CONTRACT SUPPORTIVE SHELTER SERVICES

A. Purpose

The Department of Veteran Affairs Puget Sound Health Care System (VAPSHCS), 1660

S. Columbian Way, Seattle WA requests contractors to provide a community shelter bed facility for Veterans who are engaged in mental health treatment and/or substance use disorder treatment. The goal is to prioritize Veterans from literal street homelessness or habitation unfit for Veterans, homeless Veterans with co-occurring mental health or substance use (SUDs), and place them in a community-based, residential environment with sufficient supportive services to meet their needs, and ultimately facilitate the improvement of their housing situation.

B. Background

The VAPSHCS Mental Health Service Line (MHS) provides a full range of medical, mental health and therapeutic housing services to Veterans in Seattle and Tacoma. The

MHS provides comprehensive treatment to Veterans who are in need of substance use and/or mental health treatment. Comprehensive treatment includes community shelters for unhoused Veterans. The targeted population is unhoused Veterans who are actively engaged in treatment with MHS who do not require hospital-level care.

This contract is for six beds in a shelter bed facility. These six beds will be available for

VAPSHCS patients and payment will be made by VAPSHCS only when the beds are occupied. A shelter bed facility is defined as a community-based, peer group-oriented residential facility which provides food, lodging and supportive services in a safe environment. These are individuals who, due to their substance use and/or mental health conditions, require a supportive environment, but do not require skilled nursing services such as provided by a skilled nursing facility.

C. Basic Services

The location for the shelter bed facility must be in an area accessible and within walking distance to public transportation and within a 10 mile radius of the Seattle Division of

VAPSHCS. The expectation is that the Veteran will have less than a one hour bus ride between the shelter bed facility and the Seattle Division of VAPSHCS.

The contractor shall furnish services to beneficiaries from whom such care is specifically authorized by the VAPSHCS. It is understood that the type of patients to be cared for under this contract include unhoused Veterans who may have substance abuse and/or mental health concerns. The shelter facility will not be used for detoxification requiring hospital-level treatment. The shelter facility may be used for outpatient detoxification when clinically appropriate.

Docusign Envelope ID: 94B380BB-9AAC-4125-ADD0-EDC1C1C02C98

The contractor shall furnish each Veteran authorized care under this contract with the following basic services:

1. Lodging for up to six Veterans to include a bed, locked storage for medications and belongings, and linens for the beds.

2. Daily intake availability to allow for same-day access to VAPSHCS contract beds.

3. A supervised environment with 24-hour on site staffing.

4. At least two nutritious meals per day served daily. Appetizing, nutritionally adequate meals are provided in a setting, which encourages social interaction and nutritious snacks between meals and bedtime are available for those requiring or desiring additional food, when it is not medically contraindicated.

5. Laundry facilities including laundry detergent or will provide services that launder and clean patient clothing.

6. Hygiene products to include wash cloths, soap, deodorant, toothpaste, and toothbrushes.

7. Supportive social services, in collaboration with the VAPSHCS providers and other contract resources.

8. Case management, discharge planning, and supportive social services which reflect a team assessment of health, vocational, and social needs. These services will be provided in collaboration with the VAPSHCS providers and other contract resources.

9. An identified liaison to facilitate clinical communication between the shelter facility and VAPSHCS providers.

D. Admission Criteria

1. The VAPSHCS client must be enrolled in the VAPSHCS MHS, but may be awaiting inpatient/outpatient treatment and/or may be in active outpatient treatment.

2. The VAPSHCS client will be referred by MHS.

3. The VAPSHCS client must be medically stable, functionally and cognitively able to perform activities of daily living and flee an emergency situation if needed.

4. The VAPSHCS client must not be danger to self, others or property.

E. Admission and Referral Procedures

VAPSHCS staff, as assigned by the MHS Service Line Leader, will have overall responsibility for placement of VAPSHCS Clients at the contract facility. The admission procedure will be developed in collaboration between VAPSHCS staff and the contract facility

The contact facility agrees to accept referral of and to provide all services specified in this contract for any person determined eligible regardless of race, color, religion, sex or national origin of the person for whom such services are ordered.

Before referring any patient, the VAPSHCS shall have provided the contracted agency with a signed Release of Information (ROI).

VAPSHCS personnel authorized to order service shall make requests for service via telephone or encrypted electronic communication.

Orders, requests, or changes in the referral process will only be made by the designated

VAPSHCS staff. No changes in the referral process will be made without agreement between the contract facility and VAPSHCS staff.

F. Discharge Procedures

Veterans may be discharged from the contract facility for violations of the agreed upon facility rules.

The contract facility shall notify the appropriate VAPSHCS staff whenever a client violates facility rules and/or is discharged. Appropriate documentation will be maintained by the contract facility and made available to VAPSHCS staff.

Discharge from the contract facility shall not prevent VAPSHCS client from future shelter placement.

The contact facility shall provide resource referrals to Veterans being discharged.

In the event a beneficiary receiving care under this contract dies, the contract facility shall promptly notify the VAPSHCS staff or after hours Social Worker and immediately assemble, inventory, and safeguard the patient’s personal effects. The funds, deposits, and effects left by Veteran upon the premises of the contract facility shall be delivered by the facility to the person or persons entitled thereto under the laws currently governing the contract facility for making disposition of funds and effects left by Veterans, unless the beneficiary died without leaving a will, heirs, or next of kin capable of inheriting.

When disposition has been made the itemized inventory, with a notation as to the disposition of the funds and effects, shall be immediately forwarded to the VAPSHCS office. Should a deceased Veteran leave no will, heirs, or next of kin, their personal property and funds wherever located vests in and becomes the property of the United

States in trust. In these cases the contract facility shall forward an inventory of any such property and funds in its possession to the appropriate VAPSHCS office and shall hold them (except articles of clothing necessary for proper burial) under safeguard until instructions are received from the VAPSHCS official concerning disposition.

G. Personnel

The contract facility will employ sufficient personnel to professionally carry out the policies, responsibilities, and the program for the facility.

In residential facilities there must be, at a minimum, a full-time administrative staff member or staff designee on duty or residing on the premises who is available for emergencies 24 hours a day, 7 days a week.

The Contractor shall assign to this contract personnel that by education and training (and, when required, certification or licensure) are qualified to provide the Basic Services and

Supplemental Services required by this Statement of Work (SOW).

VAPSHCS Inspection Teams are expected to evaluate the contractor's ability to consistently assure the presence of staff capable of providing those services required under the terms of the contract.

H. Absences

The contractor will notify the authorizing VAPSHCS staff of absences from the facility.

It is understood that the beneficiary may be provided facility care at the expense of

VAPSHCS for a period not to exceed of that stated in the length of treatment plan contracted, unless an extension of the authorization is provided in writing by the

VAPSHCS.

Length of stay at VAPSHCS cost will be initially authorized for up to two months.

Extensions may be authorized by VAPSHCS providers when clinically indicated.

I. Facility/Safety

The facility must conform to the requirements for the "Board and Care" type occupancy in the latest edition of the Life Safety Code, NFPA (National Fire Protection Association)

Standard No.101. In addition, all local and state fire safety requirements and licensing standards must be met for "Board and Care" type occupancies or the occupancy type the facility is designated as by the local fire safety officials.

The Contract Facility warrants that all applicable fire laws (City, State, Federal) are being complied with and there are no recommendations of fire officials which have not been resolved. Fire drills will be conducted monthly with an evening Fire Drill every quarter with documentation of each, along with documentation of new patient fire and safety orientation. Contracted staff will have fire and safety training every two months with documentation.

Handicap and wheelchair accessible per City, State, and Federal guidelines.

Sanitary procedures shall be established and maintained for washing dishes, cleaning equipment and work areas, and for proper waste disposal in accordance with local state and federal guidelines.

The contract facility must have a current occupancy permit by the authority having jurisdiction.

The contract facility shall be equipped with operational air conditioning/heating systems.

The contract facility shall be kept clean free of bed bugs, dirt, grime, mold, or other hazardous substances and damages that noticeably detract from the overall appearance.

The contract facility shall have windows and doors that can be opened and closed in accordance with manufacturer standards.

The contract facility will provide a positive and constructive environment of care for Veterans engaging in recovery from mental health and substance use disorders.

J. Conduct

The facility agrees to accept referral of and to provide all services specified in this contract for any person determined eligible regardless of race, color, religion, sex or national origin of persons for whom such services are ordered. In addition the facility warrants that subcontracting will not be resorted to as a means of circumventing this provision.

The contractor shall comply with the VA Patient's Bill of Rights as set forth in the Code of Federal regulations, Title 38, Section 17.33 (copy is available upon request).

The contractor shall comply with the principles listed in 38 CFR 17.707(b) to provide housing and supportive services in a manner that is free from religious discrimination.

The following acts are not permissible by contractor staff while providing services under this contract or while on facility premises.

1. Use of intoxicating liquors, narcotics or controlled substances of any kind

(excluding doctors’ prescriptions which do not impair ability to perform contract) while on duty or reporting for duty while under the influence of liquors, narcotics or controlled substance of any kind (excluding doctors’ prescriptions which do not impair performance).

2. Gambling in any form.

3. Carrying of pistols, firearms or concealed weapons.

4. Resorting to physical or verbal violence to settle a dispute with a fellow employee, customer(s) or the general public while on duty.

5. Use of loud, indecent or profane language and/or making threatening or obscene gestures toward customers or other employees.

6. Engaging client in a verbal confrontation in an attempt to settle a disagreement.

7. Soliciting or accepting tips from clients or others at any time.

The VA reserves the right to exclude Contractor staff members from providing services to Veterans under this contract based on breaches of conduct, including conduct that jeopardizes patient care 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 conduct resulting in formal complaints by Veterans or other staff members to designated

Government representatives. The Contractor and Contracting Officer’s Representative shall deal with issues raised concerning contractor personnel conduct. The Contracting

Officer shall be the final arbiter on questions of acceptability and in validating complaints.

K. Reports

The contractor shall notify VAPSHCS facility immediately when a medical emergency occurs requiring re-hospitalization of a patient receiving care at VAPSHCS expense. It is agreed that the Veteran will be readmitted to the appropriate facility.

The contract facility shall make a verbal report and forward a written report to the appropriate VAPSHCS staff regarding any critical incident involving a VAPSHCS client.

L. Records

It is agreed that the VAPSHCS readily have access to all records concerning the veteran's care in the facility. Upon discharge or death of the patient, records on all VAPSHCS beneficiaries will be retained by the facility for a period of at least three years following termination of care at VAPSHCS expense.

Before referring any patient, the VAPSHCS shall collect a signed Release of Information

(ROI) providing consent to communicate protected health information to the facility.

The contractor shall make available to VAPSHCS, documentary information deemed necessary by the VAPSHCS to conduct utilization review audits for the mandated national evaluation study as required by the Section 2 of Public Law 100-6; to verify quality of patient care for Veterans, to assure confidentiality of patient record information and to determine the completeness and accuracy of financial records.

The contract facility must comply with the requirements of the "Confidentiality of

Alcohol and Drug Abuse Patient Records" (42CFR, Part II) and the "Confidentiality of

Certain Medical Records (38 USC 4l32). The contractor is a VAPSHCS contractor and shall assist in the provision of health care to patients seeking such care from or through

VAPSHCS. Contractor is considered to be a VAPSHCS contractor for purposes of the

Privacy Act, Title 5 U.S.C. 552a. Further, for the purpose of VAPSHCS records access and patient confidentiality, Contractor is considered to be a VAPSHCS contractor for the following provisions: Title 38 U.S.C. 5701, 5705, and 7362. Therefore, Contractor may have access, as would other appropriate components of VA, to patient medical records including patient treatment records pertaining to drug and alcohol abuse, HIV, and sickle cell anemia, to the extent necessary to perform its contractual responsibilities. However, like other components of the Department, and notwithstanding any other provisions of the contract, the Contractor is restricted from making disclosures of VA records, or information contained in such records, to which it may have access, except to the extent that explicit disclosure authority from VAPSHCS has been received. The Contractor is subject to the same penalties and liabilities for unauthorized disclosures of such records as VAPSHCS.

The records referred to above shall be and remain the property of VAPSHCS and shall not be removed or transferred from VAPSHCS except in accordance with U.S.C.551a

(Privacy Act), 38 U.S.C. 5701 (Confidentiality of claimants records), 5 U.S.C. 552

(FOIA), 38 U.S.C. 5705 (Confidentiality of Medical Quality Assurance Records) 38

U.S.C. 7332 (Confidentiality of certain medical records) and federal laws, rules and regulations. Subject to applicable federal confidentiality or privacy laws, the Contractor, or their designated representatives, and designated representatives of federal regulatory agencies having jurisdiction over Contractor, may have access to VAPSHCS‘s records, at

VAPSHCS’s place of business on request during normal business hours, to inspect and review and make copies of such records.

Periodic administrative and fiscal reports shall be provided to VAPSHCS as required.

M. Inspection

It is agreed that the VA will have right to inspection of the contract facility and all appurtenances by an authorized representative(s) designated by VAPSHCS.

Prior to the award of a contract, a multidisciplinary VAPSHCS team consisting of a social worker, dietitian, registered nurse, police officer, engineering service safety officer or any other staff deemed appropriate by VAPSHCS shall conduct a survey of the facility.

The contractor will be advised of the finding of the inspection team. If deficiencies are noted during any inspection, the facility will be given a reasonable time to take corrective action to notify the Contracting Officer that the corrections have been made. A contract will not be awarded until noted deficiencies have been eliminated.

Inspections may also be carried out at such other times and deemed necessary. The

VAPSHCS shall monitor the contractor's program and inspect the contractor's facility to ensure compliance with this agreement. Any unsatisfactory conditions noted during an inspection of contract facility will be reported in writing to the VAPSHCS Contracting

Officer through the Medical Center Director. If corrections are not made to the satisfaction of VAPSHCS, the Contracting Officer will consult with the appropriate officials so that suitable arrangements can be made to discharge or transfer patients and to terminate the contract.

VAPSHCS inspection teams will evaluate the ability of the Contract Facility to consistently assure the presence of staff capable of providing the services required under the terms of the contract.

N. Supplemental Insurance Coverage

In accordance with FAR 28.307-2 and FAR 52.228-5, the following minimum coverage shall apply to this contract:

(a) Workers' compensation and employers liability: Contractors are required to comply with applicable Federal and State workers' compensation and occupational disease statutes. If occupational diseases are not compensable under those statutes, they shall be covered under the employer's liability section of the insurance policy, except when contract operations are so commingled with a Contractor's commercial operations that it would not be practical to require this coverage. Employer's liability coverage of at least $100,000 is required, except in States with exclusive or monopolistic funds that do not permit workers' compensation to be written by private carriers.

(b) General Liability: $500,000.00 per occurrences.

(c) Automobile liability: $200,000.00 per person; $500,000.00 per occurrence and

$20,000.00 property damage.

(d) The successful bidder must present to the Contracting Officer, prior to award, evidence of general liability insurance without any exclusionary clauses for asbestos that would void the general liability coverage.

O. Billing

Unless specifically excluded in this contract, the per diem rate established will include the services listed in this document and will also include all services or supplies normally provided to other residents by the facility without extra charge. Payments made by the

VA under this contract shall constitute the TOTAL cost of care and housing of the homeless Veterans. Payment is authorized starting from the first day of admission and does not include the day of discharge. Absences of the Veteran from the facility will not be reimbursed after 24 hours but do not have to be discharged unless the absence is unauthorized and there is no expectation that the Veteran will return to the facility. The

Contractor shall be expected to utilize nightly sign in logs and/or visual bed check roster for the purpose of verifying a Veteran’s attendance in the program on a daily basis. These are to be submitted to the VA Liaison monthly, along with invoices to ensure accuracy of billing. All excused and unexcused absences will be clearly documented in the monthly attendance log including reason for any excused absences (e.g. medical needs). Payment will not be received for any unexpected absences over 24 hours nor excused absences over 72 hours however, Veteran does not have to be formally discharged and may remain in the program for up to 14 days.

This contract is for six beds in a shelter bed facility. These six beds will be available for VAPSHCS patients and payment will be made by VAPSHCS only when the beds are occupied. A shelter bed facility is defined as a community-based, peer group-ori...