36C26119Q0245-001.docx

36C26119Q0245

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1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

DUNS:

DUNS+4:

PHONE:

FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

612-19-1-293-0005 36C26119Q0245 01-30-2019 Tracy Worrell 775-785-7158 02-27-2019

1:00 PM

Department of Veterans Affairs VA Sierra Pacific Network (VISN 21) VA Sierra Nevada Health Care System 975 Kirman Avenue Reno NV 89502-2597 X X 561320 $27.5 Million X N/A X Department of Veterans Affairs VA Northern California HealthCare System Mental Health Services 10535 Hospital Way Mather CA 95655 Department of Veterans Affairs VA Sierra Pacific Network (VISN 21) VA Sierra Nevada Health Care System 975 Kirman Avenue Reno NV 89502-2597

Department of Veteran Affairs FMS-VA-2(101) Financial Services Center PO Box 149971 Austin TX 78714-9971 X See CONTINUATION Page The VA Northern California Health Care System has a requirement for on-call Mobile Crisis/Rapid Response Team to conduct Mental Health crisis evaluations for voluntary and/ or involuntary admission to inpatient psychiatry for VA patients.

See CONTINUATION Page X X Tracy Worrell Contracting Officer Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

36C26119Q0245

Page 1 of Page 1 of

B.1 CONTRACT ADMINISTRATION DATA

(continuation from Standard Form 1449, block 18A.)

1. CONTRACT ADMINISTRATION: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR:

VA Sierra Nevada HealthCare System 975 Kirman Ave (90/CCA) Reno, NV 89502 775-785-7158/tracy.worrell@va.gov

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3. INVOICES: Invoices shall be submitted in arrears:

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests. Invoices shall be in accordance with the requirements of The Department of Veterans Affairs (VA) Financial Services Center (VAFSC). The latest information shall be used for invoicing and payments and may be changed during the Period of Performance of this acquisition. Current invoicing information is located at https://www.fsc.va.gov/einvoice.asp Vendor e-Invoice Set-Up Information:

Please contact Tungsten at the phone number or email address listed below to begin submitting your electronic invoices to the VA Financial Services Center for payment processing, free of charge. If you have question about the e-invoicing program or Tungsten, please contact the FSC at the phone number or email address listed below:

· Tungsten e-Invoice Setup Information: 1-877-489-6135

· Tungsten e-Invoice email: VA.Registration@Tungsten-Network.com

· FSC e-Invoice Contact Information: 1-877-353-9791

· FSC e-invoice email: vafsccshd@va.gov ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

AMENDMENT NO DATE

B.2 PRICE/COST SCHEDULE

Please provide your most favored customer/preferred rates.

Contractor shall provide Mobile Crisis Team services in accordance with the attached performance work statement.

Note: Indefinite Delivery, Indefinite Quantity Contract is being used because it is impossible to determine with any certainty the exact amount of services that will be required under this contract.

It is anticipated that a Firm fixed price, Single Award, Indefinite Delivery/Indefinite Quantity contract, shall be awarded as a result of this solicitation.

The guaranteed minimum, is $500.00. The maximum of the contract, inclusive of the base period and all options exercised, shall not exceed $2,000,000. The Government does not guarantee that it will place any orders under this contract in excess of the guaranteed minimum award amount

ITEM INFORMATION

Contract Period:

POP Begin: 4-01-2019 POP End: 03-31-2020

EA

Contract Period:

POP Begin: 4-01-2020 POP End: 03-31-2021

EA

Contract Period:

POP Begin: 4-01-2021 POP End: 03-31-2022

EA

Contract Period:

POP Begin: 04-01-2022 POP End: 03-31-2023

EA

Contract Period:

POP Begin: 04-01-2023 POP End: 03-31-2024

EA

B.3 PERFORMANCE WORK STATEMENT

MOBILE CRISIS TEAM REQUIREMENTS

1.0 GENERAL

1.1 Service Provided: The Contractor shall provide a mobile crisis team to be available on an as-needed basis. This team will consist of Mental Health Licensed Independent Professionals (MH LIPs) that must be skilled in conducting Mental Health crisis evaluations for voluntary and/or involuntary admission to Designated 5150 Facility for VA patients in accordance with all terms, conditions, provisions, schedules and specifications herein.

1.2 Place of Performance: The contractor shall provide MH LIPs for VA Northern California Health Care System’s (VANCHCS) Emergency Department (ED) at Sacramento VA Medical Center at Mather, California. Located at 10535 Hospital Way, Mather, CA 95655.

1.4 Period of Performance:

Option Year 2: April 1, 2021 – March 31, 2022 Option Year 3: April 1, 2022 – March 31, 2023 Option Year 4: April 1, 2023 – March 31, 2024

1.5 Authority: Title 38 USC 8153, Health Care Resources (HCR) sharing Authority.

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

1.6.1 - VA Directive 1663: Health Care Resources Contracting - Buying http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=347

1.6.2 - VHA Directive 2006-041 “Veterans’ Health Care Service Standards” (expired but still in effect pending revision) https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443

1.6.3 - VHA Handbook 1100.17: National Practitioner Data Bank Reports - http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135

1.6.4 -VHA Handbook 1100.18 Reporting And Responding To State Licensing Boards - http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364

1.6.5 - VHA Handbook 1100.19 Credentialing and Privileging - http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910

1.6.6 VHA Handbook 1907.01 Health Information Management and Health Records: http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2791

1.6.7 Privacy Act of 1974 (5 U.S.C. 552a) as amended http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm

1.7 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.

1.7.1 ABECSW: American Board of Examiners in Clinical Social Work

1.7.2 ACGME: Accreditation Council for Graduate Medical Education

1.7.3 ACLS: Advanced Cardiac Life Support

1.7.4 AOD: Admitting Officer of the Day

1.7.5 BLS: Basic Life Support

1.7.6 CDC: Centers for Disease Control and Prevention

1.7.7 CDR: Contract Discrepancy Report

1.7.8 CEU: Certified Education Unit

1.7.9 CME: Continuing Medical Education

1.7.10 CMS: Centers for Medicare and Medicaid Services

1.7.11 Contracting Officer (CO): The person executing this contract on behalf of the Government with the authority to enter into and administer contracts and make related determinations and findings.

1.7.12 Contracting Officer’s Representative (COR): A person appointed by the CO to take necessary action to ensure the Contractor performs in accordance with and adheres to the specifications contained in the contract and to protect the interest of the Government. The COR shall report to the CO promptly any indication of non-compliance in order that appropriate action can be taken.

1.7.13 COS: Chief of Staff

1.7.14 Credentialing: Credentialing is the systematic process of screening and evaluating qualification and other credentials, including licensure, required education, relevant training and experience and current competence and health status.

1.7.15 DEA: Drug Enforcement Agency

1.7.16 ED: Emergency Department

1.7.17 FSMB: Federation of State Medical Boards

1.7.18 HHS: Department of Health and Human Services

1.7.19 HICPAC: Healthcare Infection Control Practices Advisory Committee

1.7.20 HIPAA: Health Insurance Portability and Accountability Act

1.7.21 HR: Human Resources

1.7.22 ISO: Information Security Officer

1.7.23 MH LIP: Licensed Clinical Social Worker, Licensed Marriage and Family Therapist, Licensed Psychologist, Licensed Mental Health Nurse Practitioner

1.7.24 Medical Emergency: a sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably result in: Permanently placing a patient's health in jeopardy, causing other serious medical consequences, causing impairments to body functions, or causing serious or permanent dysfunction of any body-organ or part.

1.7.25 MH: Mental Health

1.7.26 MOD: Medical Officer of the Day

1.7.27 National Provider Identifier (NPI): NPI is a standard, unique 10-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers).

1.7.28 Non-Contract Provider: any person, organization, agency, or entity that is not directly or indirectly employed by the Contractor or any of its subcontractors

1.7.29 OIG: Office of Inspector General

1.7.30 OSHA: Occupational Safety and Health Administration

1.7.31 NPPES: National Plan and Provider Enumeration System

1.7.32 POP: Period of Performance

1.7.33 PPD: Purified Protein Derivative

1.7.34 PWS: Performance Work Statement

1.7.35 Privileging (Clinical Privileging): Privileging is the process by which a practitioner, licensed for independent practice; e.g., without supervision, direction, required sponsor, preceptor, mandatory collaboration, etc.; is permitted by law and the facility to practice independently, to provide specific medical or other patient care services within the scope of the individual’s license, based upon the individual’s clinical competence as determined by peer references, professional experience, health status, education, training and licensure. Clinical privileges must be facility-specific and provider-specific.

1.7.36 QASP: Quality Assurance Surveillance Plan

1.7.37 VAAR: VA Acquisition Regulation

1.7.38 Veterans Health Administration (VHA): The central office for administration of the VA medical centers through throughout the United States. The VHA is located in Washington, D.C.

1.7.39 Veterans Integrated Services Network (VISN): The regional oversight for VA medical centers.

1.7.40 VetPro: a federal web-based credentialing program for healthcare providers.

1.7.41 VANCHCS : Unless identified with the name of a different VA medical Center, for purposes of this contract, this term shall mean VA Northern California Health Care System.

2 QUALIFICATIONS:

2.1 Staff/Facility

2.1.1 License: Contract MH LIP(s) assigned by the Contractor to perform the services covered by this contract shall have a current license. All licenses held by the personnel working on this contract shall be full and unrestricted licenses. Contract MH LIPs who have current, full and unrestricted licenses in one or more states, but who have, or ever had, a license restricted, suspended, revoked, voluntarily revoked, voluntarily surrendered pending action or denied upon application will not be considered for the purposes of this contract.

2.1.2 Board Certification: All contracted MH LIPs may be board certified by the appropriate, respective Professional Board but are not required to be. All contracted MH LIPs must be currently certified in Basic Life Support (BLS).

2.1.3 Credentialing and Privileging: Credentialing and privileging is to be done in accordance with the provisions of VHA Handbook 1100.19 referenced above. The Contractor is responsible to ensure that proposed MH LIP(s) possess the requisite credentials enabling the granting of privileges. No services shall be provided by any contract MH LIP(s) prior to obtaining approval by the VANCHCS Professional Standards Board, Medical Executive Board and Medical Center Director.

2.1.3.1 If a contract MH LIP(s) are not credentialed and privileged or has credentials/privileges suspended or revoked, the Contractor shall furnish an acceptable substitute without any additional cost to the government.

2.1.4 Technical Proficiency: Contract MH LIP(s) shall be technically proficient in the skills necessary to fulfill the government’s requirements, including the ability to speak, understand, read and write English fluently. Contractor shall provide documents upon request of the CO/COR to verify current and ongoing competency, skills, certification and/or licensure related to the provision of care, treatment and/or services performed. Contractor shall provide verifiable evidence of all educational and training experiences including any gaps in educational history for all contract MH LIP(s) and contract MH LIP(s) shall be responsible for abiding by the Facility's Medical Staff By-Laws, rules, and regulations (referenced herein) that govern medical staff behavior.

2.1.5 Continuing Medical Education (CME)/ Certified Education Unit (CEU) Requirements: Contractor shall provide the MH Service’s designated Program Support Assistant with copies of current CMEs as required or requested by the VANCHCS Contract MH LIP(s) registered or certified by national/medical associations shall continue to meet the minimum standards for CME to remain current. Contractor shall report CME hours to the credentials office for tracking. These documents are required for both privileging and re-privileging. Failure to provide shall result in loss of privileges for contract MH LIP(s).

2.1.6 Standard Personnel Testing (PPD, etc.): Contractor shall provide proof of the following tests for MH LIPs within five (5) calendar days after contract award and prior to the first duty shift to the MH Service’s designated Program Support Assistant and Contracting Officer. Tests shall be current within the past year.

2.1.6.1 TUBERCULOSIS TESTING: Contractor shall provide proof of a negative reaction to PPD testing for all contract MH LIP(s). A negative chest radiographic report for active tuberculosis shall be provided in cases of positive PPD results. The PPD test shall be repeated annually.

2.1.6.2. RUBELLA TESTING: Contractor shall provide proof of immunization for all contract MH LIP(s) for measles, mumps, rubella or a rubella titer of 1.8 or greater. If the titer is less than 1.8, a rubella immunization shall be administered with follow-up documentation to the MH Service’s designated Program Support Assistant.

2.1.6.3. VARICELLA (CHICKEN POX) or, if unknown, results of a varicella antibody test. If non-immune, must be vaccinated with Varivax (Chicken Pox).

2.1.6.4. OSHA REGULATION CONCERNING OCCUPATIONAL EXPOSURE TO BLOODBORNE PATHOGENS: Contractor shall provide generic self-study training for all contract MH LIP(s); provide their own Hepatitis B vaccination series at no cost to the VA if they elect to receive it; maintain an exposure determination and control plan; maintain required records; and ensure that proper follow-up evaluation is provided following an exposure incident. The VANCHCS shall notify the Contractor of any significant communicable disease exposures as appropriate. Contractor shall adhere to current Center for Disease Control/Healthcare Infection Control Practices Advisory Committee (CDC/HICPAC) Guideline for Infection Control in health care personnel (as published in American Journal for Infection Control- AJIC 1998; 26:289-354 http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf ) for disease control. Contractor shall provide follow up documentation of clearance to return to the workplace prior to their return.

2.1.7. National Provider Identifier (NPI): NPI is a standard, unique 10-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers). The Contractor shall have or obtain appropriate NPI and if pertinent the Taxonomy Code confirmation notice issued by the Centers for Medicare and Medicaid Services (CMS) National Plan and Provider Enumeration System (NPPES) be provided to the Contracting Officer with the proposal.

2.1.8 DEA (as required) - Contractor shall provide copy of current DEA certificate.

2.1.9 Conflict of Interest: The Contractor and all contract MH LIP(s) are responsible for identifying and communicating to the CO and COR conflicts of interest at the time of proposal and during the entirety of contract performance. At the time of proposal, the Contractor shall provide a statement which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided. The Contractor shall also provide statements containing the same information for any identified consultants or subcontractors who shall provide services. The Contractor must also provide relevant facts that show how it’s organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest. These statements shall be in response to the VA Acquisition Regulation (VAAR) provision 852.209-70 Organizational Conflicts of Interest (Jan 2008) and fully outlined in response to the subject attachment in Section D of the solicitation document.

2.1.10 Citizenship related Requirements:

2.1.10.1 The Contractor certifies that the Contractor shall comply with any and all legal provisions contained in the Immigration and Nationality Act of 1952, As Amended; its related laws and regulations that are enforced by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor as these may relate to non-immigrant foreign nationals working under contract or subcontract for the Contractor while providing services to Department of Veterans Affairs patient referrals;

2.1.10.2 While performing services for the Department of Veterans Affairs, the Contractor shall not knowingly employ, contract or subcontract with an illegal alien; foreign national non-immigrant who is in violation their status, as a result of their failure to maintain or comply with the terms and conditions of their admission into the United States. Additionally, the Contractor is required to comply with all “E-Verify” requirements consistent with “Executive Order 12989” and any related pertinent Amendments, as well as applicable Federal Acquisition Regulations.

2.1.10.3 If the Contractor fails to comply with any requirements outlined in the preceding paragraphs or its Agency regulations, the Department of Veterans Affairs may, at its discretion, require that the foreign national who failed to maintain their legal status in the United States or otherwise failed to comply with the requirements of the laws administered by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor, shall be prohibited from working at the Contractor’s place of business that services Department of Veterans Affairs patient referrals; or other place where the Contractor provides services to veterans who have been referred by the Department of Veterans Affairs; and shall form the basis for termination of this contract for breach.

2.1.10.4 This certification concerns a matter within the jurisdiction of an agency of the United States and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under 18 U.S.C. 1001.

2.1.10.5 The Contractor agrees to obtain a similar certification from its subcontractors. The certification shall be made as part of the offerors response to the Request for Proposal (RFP) using the subject attachment in Section D of the solicitation document.

2.1.11 Annual Office of Inspector General (OIG) Statement: In accordance with HIPAA and the Balanced Budget Act (BBA) of 1977, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has established a list of parties and entities excluded from Federal health care programs. Specifically, the listed parties and entities may not receive Federal Health Care program payments due to fraud and/or abuse of the Medicare and Medicaid programs.

2.1.11.1 Therefore, Contractor shall review the HHS OIG List of Excluded Individuals/Entities on the HHS OIG web site at http://oig.hhs.gov/exclusions/index.asp to ensure that the proposed contract MH LIP(s) are not listed. Contractor should note that any excluded individual or entity that submits a claim for reimbursement to a Federal health care program, or causes such a claim to be submitted, may be subject to a Civil Monetary Penalty (CMP) for each item or service furnished during a period that the person was excluded and may also be subject to treble damages for the amount claimed for each item or service. CMP’s may also be imposed against the Contractor that employ or enter into contracts with excluded individuals to provide items or services to Federal program beneficiaries.

2.1.11.2 By submitting their proposal, the Contractor certifies that the HHS OIG List of Excluded Individuals/Entities has been reviewed and that the Contractors are and/or firm is not listed as of the date the offer/bid was signed.

2.2 Clinical/Professional Direction: The qualifications of Contractor personnel are subject to review by VANCHCS Chief of Staff or his/her clinical designee and approval by the VANCHCS Medical Center Director as provided in VHA Handbook 1100.19. Clinical/Professional direction of all clinical personnel covered by this contract will be provided by the VANCHCS COS and/or the Chief of the Service or his designee. A COR may be appointed, however, only the CO is authorized to consider any contract modification request and/or make changes to the contract during the administration of the resultant contract.

2.3 Non Personal Healthcare Services: The parties agree that the Contractor and all contract MH LIP(s) shall not be considered VA employees for any purpose.

2.4 Inherent Government Functions: Contractor and Contract MH LIP(s) shall not perform inherently governmental functions. This includes, but is not limited to, determination of agency policy, determination of Federal program priorities for budget requests, direction and control of government employees (outside a clinical context), selection or non-selection of individuals for Federal Government employment including the interviewing of individuals for employment, approval of position descriptions and performance standards for Federal employees, approving any contractual documents, approval of Federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy.

2.5 No Employee status: The Contractor shall be responsible for protecting Contract MH LIP(s) furnishing services. To carry out this responsibility, the Contractor shall provide or certify that the following is provided for all their staff providing services under the resultant contract:

2.5.1 Workers’ compensation

2.5.2 Professional liability insurance

2.5.3 Health examinations

2.5.4 Income tax withholding, and

2.5.5 Social security payments.

2.6 Tort Liability: The Federal Tort Claims Act does not cover Contractor or contract MH LIP(s). When a Contractor or contract MH LIP has been identified as a provider in a tort claim, the Contractor shall be responsible for notifying their legal counsel and/or insurance carrier. Any settlement or judgment arising from a Contractor’s (or contract MH LIP(s)) action or non-action shall be the responsibility of the Contractor and/or insurance carrier.

2.7 Key Personnel:

2.7.1 The VA Full Time Equivalency (FTE) for the services required is 0.25 VA FTE. FTE is defined by VA as a minimum of 80 hours every two weeks and does not include holidays.

2.8 Emergency Substitutions: During the first ninety (90) calendar days of performance, the Contractor shall make NO substitutions of key personnel unless the substitution is necessitated by illness, death or termination of employment. The Contractor shall notify the CO, in writing, within 15 calendar days after the occurrence of any of these events and provide the information required below. After 90 days, the Contractor shall submit the information required below to the CO at least 15 calendar days prior to making any permanent substitutions.

2.8.1 The Contractor shall provide a detailed explanation of the circumstances necessitating the proposed substitutions, complete resumes for the proposed substitutes, and any additional information requested by the CO. Proposed substitutes shall have comparable qualifications to those of the persons being replaced. The CO will notify the Contractor within 15 calendar days after receipt of all required information of the decision on the proposed substitutes. The contract will be modified to reflect any approved changes of key personnel.

2.8.2 For temporary substitutions where the key person shall not be reporting to work for three (3) consecutive work days or more, the Contractor shall provide a qualified replacement for the key person. The substitute shall have comparable qualifications to the key person. Any period exceeding two weeks will require the procedure as stated above.

2.8.3 The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct 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 patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. Should the VA COS or designee show documented clinical problems or continual unprofessional behavior/actions with any contract MH LIP (s), s/he may request, without cause, immediate replacement of said contract MH LIP(s).

2.8.4 The CO and COR shall deal with issues raised concerning Contract MH LIP(s) conduct. The final arbiter on questions of acceptability is the CO.

2.9 Contingency Plan: Because continuity of care is an essential part of VANCHCS’s medical services, The Contractor shall have a contingency plan in place to be utilized if the contract MH LIP leaves Contractor’s employment or is unable to continue performance in accordance with the terms and conditions of the resulting contract.

3.0 HOURS OF OPERATION

3.1 VA Business Hours: Monday through Friday, 0800-4:30pm

3.2 Work Schedule: Contractor must be available to provide Mental Health Crisis evaluations Monday through Friday, 4:30 pm – 8:00 am the next morning, and 24 hours a day on weekends and holidays.

3.3 Federal Holidays: The following holidays are observed by the Department of Veterans Affairs:

3.5 Vacation Leave/Absences: Vacation, leave, or absences shall be paid and responsibility of the contractor. Contract MH LIP(s) shall coordinate leave/absences with the Mental Health (MH) Clinic Manager or designee. VANCHCS will only make payment to contractor during holidays for time spent conducting assessments.

3.5.1 Monitoring Procedures: The established productivity standards used for all VANCHCS MH LIP(s) shall be used to monitor all Contractor employees. A copy of these standards can be obtained from the appropriate MH staff personnel.

3.6. Cancellations: Unless a state of emergency has been declared or clinics are otherwise cancelled by the VANCHCS, the Contractor shall be responsible for providing services.

4.0 CONTRACTOR RESPONSIBILITIES

4.1 Clinical Personnel Required: The Contractor shall provide MH LIP(s) who are competent, qualified per this performance work statement and adequately trained to perform assigned duties.

4.1.1 Contract MH LIP(s) shall be responsible for signing in and out when in attendance. Time sheets will be used by the COR to confirm hours/day and services provided against the contractor’s invoices.

4.1.2 Contractor employees will maintain a neat personal appearance and maintain professionalism while working at VANCHCS.

4.1.3 The contractor shall provide accurate and reliable contact telephone contact numbers (e.g., single phone number, on-call roster, etc.) for use by emergency room staff to request consultation.

4.1.4 The contractor will evaluate patients who may be considered by emergency room staff as an immediate danger to themselves or others or gravely disabled within 60 minutes of being called by the ED. The contractor and ED staff will determine the need for the contractor to evaluate the patient in the ED. Telephone consults with the contractor may suffice.

4.1.5 The contractor provides written results of the assessment. The contracted provider also completes as needed the Application for 72 Hour Detention for Evaluation and Treatment (MH 302) which is available in the ED.

4.1.6 If admission to the inpatient unit is necessary and appropriate (admission criteria is available in the Appendix to this Performance Work Statement (PSW)), the contractor will inform the ED, and consult with the Psychiatrist or Resident on-call by phone. The ED maintains a rotation schedule and the contact number for the on-call personnel.

4.1.7 Admission may not be appropriate for all patients and discharge disposition should be presented to the ED. For those patients who the contractor determines are in need of hospitalization, but who have medical conditions that preclude admission to a psychiatric unit, the ED will transfer the patient to the appropriate medical unit with a 1:1 sitter for observation until a medical clearance is completed. A patient can request voluntary admission after evaluation if deemed appropriate by the contracted provider.

4.1.8 The VA Emergency Department is to provide a safe environment for the evaluation with access to a telephone. The ED will also maintain a current roster for the Psychiatrist or Resident on-call.

4.1.9 No patients will be billed for services provided under this contract.

4.1.10 Emergency Health Services - VANCHCS will render emergency health services for an incapacitating injury or otherwise serious illness occurring while on duty. All services, to include wages earned during period of initial medical evaluation provided by VANCHCS, will be reimbursed by the Contractor. The Contractor will furnish VANCHCS with the necessary injury/illness form(s) for reporting purposes. VANCHCS for statistical and/or billing purposes will retain a copy of the complete form(s).

4.1.11 Identification, Parking, Smoking, and VA Regulations - Contractor employees shall wear visible identification provided by VANCHCS at all times while on VANCHCS premises. It is the responsibility of the Contractor employees to park in the appropriate designated parking areas (non-patient parking sections). Information of designated parking areas is available from the Police Station. VANCHCS will not invalidate or make reimbursement for parking violations of the Contractor under any conditions. Smoking is prohibited inside any buildings at VANCHCS. Possession of weapons, illegal drugs or alcohol is prohibited. Enclosed containers, including tool kits, shall be subjected to search. Violations of VANCHCS regulations may result in citation answerable in the United States Federal District Court, not a local district, state, or municipal court.

4.1.12 Contractor certifies that all Contractor employees assigned to work for VANCHCS are current in Universal Precautions and are aware of pertinent Occupational Safety and Health Administration (OSHA) and Universal Precautions Regulations.

4.1.13 Contract employees will have the use of all required equipment, supplies and forms for performing services required by this contract.

4.1.14 Contractor employees who previously received a favorable adjudication as a result of a Government background investigation may be exempt from this contract requirement provided that they can provide documentation to support the previous adjudication. Proof of previous adjudication must be submitted by the Contractor to VA SIC through the VA Contracting Officer. Proof of previous adjudication is subject to verification by the VA SIC. Some positions may be subject to periodic re-investigation

4.1.15 For those Contractor employees who will work less than six (6) months (180 days) under this contract and does not require access to VA computer systems, a background investigation is not required; however, such employees will be required to initiate a SIC for Fingerprint Only prior to providing services under this contract

4.1.16 Position Sensitivity: The position sensitivity has been designated as: Low Risk

4.1.17 Background Investigation: The level of background investigation commensurate with the required level of access is: NACI

4.1.18 Contractor Responsibilities: In order to conduct a background investigation the Contractor shall submit or have their contract personnel submit the following required forms to the MH Administrative Officer. The appropriate Mental Health (MH) staff personnel will arrange a time for contract personnel to complete fingerprint verification.

4.1.18.1 Standard Form 85, Questionnaire for Non-Sensitive Positions

4.1.18.2 Standard Form 86A, Continuation Sheet for Questionnaires

4.1.18.3 Optional Form 306, Declaration for Federal Employment

4.1.18.4 Electronic Fingerprint Verification OR FD 258, U.S. Department of Justice Fingerprint Applicant Chart

4.2 Standards of Care: The contract MH LIP(s) care shall cover the range of mental health services as would be provided in a state-of-the-art civilian medical treatment facility and the standard of care shall be of a quality, meeting or exceeding currently recognized national standards as established by:

4.2.1 American Psychiatric Association Guidelines: http://www.psych.org/practice/clinical-practice-guidelines

4.2.2 VA Standards: VHA Directive 2006-041 “Veterans’ Health Care Service Standards” (expired but still in effect pending revision) https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443

4.2.3 The professional standards of the Joint Commission (TJC) http://www.jointcommission.org/standards_information/standards.aspx

4.2.4 The standards of the American Hospital Association (AHA) http://www.hpoe.org/resources?show=100&type=8 and;

4.2.5 The requirements contained in this Performance Work Statement.

4.2.6 The government may evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of services rendered (e.g., professional judgments, diagnosis for specific medical treatment).

4.3 RECORDS/PATIENT INFORMATION

4.3.1 Authorities: Contract MH LIP (s) providing healthcare services to VA patients shall be considered as part of the Department Healthcare Activity and shall comply with the 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), Title 5 U.S.C. § 522a (Records Maintained on Individuals) as well as 45 C.F.R. Parts 160, 162, and 164 (HIPAA).

4.3.2 HIPAA: This contract and its requirements meet exception in 45 CFR 164.502(e), and do not require a BAA in order for Covered Entity to disclose Protected Health Information to: a health care provider for treatment. Based on this exception, a BAA is not required for this contract. Treatment and administrative patient records generated by this contract or provided to the Contractors by the VA are covered by the VA system of records entitled ‘Patient Medical Records-VA (24VA10P2). Contractor generated VA Patient records are the property of the VA and shall not be accessed, released, transferred, or destroyed except in accordance with applicable laws and regulations. Contractor shall ensure that all records pertaining to medical care and services are available for immediate transmission when requested by the VA. Records identified for review, audit, or evaluation by VA representatives and authorized federal and state officials, shall be accessed on-site during normal business hours or mailed by the Contractor at his expense. Contractor shall deliver all final patient records, correspondence, and notes to the VA within twenty-one (21) calendar days after the contract expiration date.

4.3.3 Disclosure: Contract MH LIPs shall obtain permission from the VA before disclosing any patient information. Subject to applicable federal confidentiality or privacy laws, the Contractor, will be provided the Contractor with a copy of VHA Handbook 1907.1, Health Information management and Health Records and VHA Handbook 1605.1, Privacy and Release of Information. The penalties and liabilities for the unauthorized disclosure of VA patient information mandated by the statutes and regulations mentioned above, apply to the Contractor.

4.3.4 Professional Standards for Documenting Care: Care shall be appropriately documented in medical records in accordance with standard commercial practice and guidelines established by VHA Handbook 1907.01 Health Information Management and Health Records: http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2791 and all guidelines provided by the VANCHCS.

4.3.5 Release of Information: The VA shall maintain control of releasing any patient medical information and will follow policies and standards as defined, but not limited to Privacy Act requirements. In the case of the VA authorizing the Contractor to release patient information, the Contractor in compliance with VA regulations, and at his/her own expense, shall use VA Form 3288, Request for and Consent to Release of Information from Individual’s Records, to process “Release of Information Requests.” In addition, the Contractor shall be responsible for locating and forwarding records not kept at their facility. The VA’s Release of Information Section shall provide the Contractor with assistance in completing forms. Additionally, the Contractor shall use VA Form 10-5345a, Individuals’ Request for and Authorization to Release Medical Records or Health Information, this is used when the Veteran is requesting for their records to be sent to a 3rd party, not just for the release of 38 U.S.C. 7332 information. Treatment and release records shall include the patient’s consent form. Completed Release of Information requests will be forwarded to the VA Privacy Officer at the following address: Shannon Caston, VANCHCS (001/PO/FOIA/FF), 103 Bodin Circle, Travis AFB, Fairfield, CA 94535; Phone (707)437-1823.

4.4 DIRECT PATIENT CARE: 95% of the time involved in direct patient care.

7.4.1 Per the contract responsibilities section of this PWS, the Contract Mental Health Licensed Independent Professional(s) (as appropriate and within scope of practice/privileging) shall be responsible for providing Mental Health assessments.

4.5 ADMINISTRATIVE: up to 5% of time not involved in direct patient care. Forms/paperwork associated with patient care (Evaluation, applications, etc.).

4.6 PERFORMANCE STANDARDS, QUALITY ASSURANCE (QA) AND QUALITY IMPROVEMENT (QI)

4.6.1 Quality Management/Quality Assurance Surveillance: Contractor performance will be monitored by the government using the standards as outlined in this Performance Work Statement (PWS) and methods of surveillance detailed in the Quality Assurance Surveillance Plan (QASP). The QASP shall be attached to the resultant contract and shall define the methods and frequency of surveillance conducted.

4.6.2 Patient Complaints: The CO will resolve complaints concerning Contractor relations with the Government employees or patients. The CO is final authority on validating complaints. In the event that The Contractor is involved and named in a validated patient 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.

4.6.3 The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct 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 patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. The CO and COR shall deal with issues raised concerning Contractor’s conduct. The final arbiter on questions of acceptability is the CO.

4.6.4 Performance Standards:

4.6.4.1 Measure: Legal Forms

Performance Requirement:

Standard: Demonstrates knowledge of California Welfare & Institution codes when completing legal forms.

Acceptable Quality Level: All legal forms will be accurate, complete, legible and timely. Surveillance Method: 1) Service reports, 2) Review Frequency: Every six months

4.6.4.2 Measure: Interpersonal Communication/Customer Service Performance Requirement: Handles administrative issues professionally with ED staff, other on-call staff, patient, patient’s family, and Administrative Officer of the Day (AOD) when called in for assessment or during phone conversations. The upcoming month’s on-call schedule will be provided prior to the end of the current month.

Faxes all assessment forms completed by contractor to the BHICU whether the patient is admitted or not.

Standard: Maintains a courteous and helpful attitude when dealing with external and internal customers Acceptable Quality Level:

Surveillance Method: 1) Validated commendations, complaints, customer surveys or feedback Frequency: Every six months

4.6.4.3 Measure: Emergency Department Request for Evaluations Performance Requirement:

Standard: Mather Emergency Department (ED) will contact on-call MH LIP to complete a mental health assessment of a patient that is medically cleared in the Mather ED within 60 minutes.

Acceptable Quality Level: Satisfactory rating = No more than two failures to meet the timeline.

Surveillance Method: 1) Validated Evaluation Form, 2) Contractor meets availability time frames Frequency: Every six months

4.6.4.4 Measure: Professionalism

Performance Requirement: Training is kept current Standard: Routinely on-time for clinical assignments. Completes required CME in specialty area. Maintains active BLS training.

Acceptable Quality Level: Satisfactory rating = 100% during rating period.

Surveillance Method: 1) Timecards, 2) Confirmation of current BLS, 3) Attestation of completed CME Frequency: Every six months

4.6.4.5 Measure: Mental Health Evaluation

Performance Requirement: Data is accurate and timely.

Standard: Sound mental health assessment and services principles are applied. The Behavioral Health Inpatient Care Unit (BHICU) psychiatric admission guidelines will be used to determine if the patient meets psychiatric inpatient, medical admission or neither.

Acceptable Quality Level: All (100%) contract MH LIP(s) perform within their scope of practice/privileges 100% of the time. No deviations accepted.

Surveillance Method: Random Inspection of records.

Frequency: Every six months

4.6.4.6 Measure: Evaluation Forms

Performance Requirement: Data is accurate and timely.

Standard: Written results of the assessments are completed in a timely manner. The MH LIP will complete the assessment forms and make recommendations to the ED Physician and/or On-call Psychiatrist. HIPAA Privacy and Security Rules apply at all times.

Acceptable Quality Level: No more than two failures to complete paperwork. Nor more than two validated complaints or incidents.

Surveillance Method: Validated commendations, complaints, customer surveys or feedback Frequency: Every six months

4.6.4.7…