36C26120Q0102-002.pdf

Performance work statement

1. General Specifications

a. Purpose: The contractor will provide ambulance services as needed for beneficiaries of the San Francisco Veterans Affairs Health Care System (SFVAHCS). These services are to assure appropriate and safe transportation for authorized beneficiaries between

SFVAHCS and UCSF, requiring mechanical circulatory support (MCS) or extracorporeal membrane oxygenation (ECMO) ambulance transportation. The contractor will provide ambulance services, to include staff, equipment, supplies that might be required.

2. Performance Criteria

a. The contractor shall provide ambulance services that meet the following criteria:

i. Response time:

1. Response time is calculated from the receipt of the telephonic request for service.

2. At the time of the request, contractor shall acknowledge and communicate their ability to provide the service within the requested response time. If the contractor is unable to meet the request, contractor must identify and coordinate transportation with a sub-contractor, who would be required to meet the same performance work statement and criteria.

3. The contractor shall respond to all requests within 1 hour of telephonic request.

ii. Equipment: Contractor must have the following equipment available and ready:

1. Extracorporeal membrane oxygenation (ECMO),

2. Intra-aortic balloon pump (IAPB),

3. Left ventricular assist devices (LVADs),

4. External pacemakers,

5. ECMO disposables, i.e. oxygenator, arterial/venous canula,

6. And knowledge to manage impella devices.

iii. Staff: Contractor must have the following staff available and ready:

1. Physician,

2. Mechanical circulatory support specialist,

3. Critical care transport registered nurse, and

4. Critical care transport emergency medical technician.

iv. Conversion: When necessary, Contractor must be able to cannulate patients.

Contractor will convert patients from VA ECMO, IABP, mechanical ventilator and external LVAD support system to their transport versions, at bedside at the patient.

v. Trip documentation: The contractor shall document each transport with an appropriate document that specifies the date, patient name, social security number, time of pick-up, destination, time of drop-off, and any notes about issues particular to the specific transport, including recording oxygen, cardiac monitoring, and other services provided. The contractor shall leave a copy of this form with the authorized VA staff (or a copy will be mailed to the specified

VA location). These forms will serve as documentation of the transport and will be a source document for reconciliation of the contractor’s filed claims for VA payment.

vi. Ordering procedures: Authorized VA staff will telephonically notify the contractor of a request for service. The contractor must not transport any patient without first having VA authorization. (The contractor may propose the use of alternative ordering procedures/systems such as electronic notification.

The VA may accept such procedures after consideration and the specific processes will be so documented if accepted.) Authorized VA staff may place orders at any time during the day or night. The contractor must be prepared to accept orders and to provide service 24 hours a day, 7 days per week. When placing orders, VA staff must specify any special services needed, such as oxygen, cardiac monitoring, etc.

vii. Origin and Destination: Patients may be transported to or from any designated location within the defined service area. Most transports will be between VA facilities or between a VA facility and a community health resource. The VA staff will specify the points of origin and the destination of every trip.

viii. Emergency diverts: The contractor may determine that a patient requires an emergency divert from a planned transport due to a medical emergency with the patient being transported. Such diversions are allowed as necessary, however, the contractor must notify the VA as soon as possible.

3. Vehicle Standards:

a. The contractor will provide services utilizing ambulances that are licensed and meet the minimum vehicle requirements mandated by the State of California, the California Highway

Patrol Ambulance Service criteria, and any mandated local codes or industry standards.

b. The VA reserves the right to inspect the contractor’s equipment and vehicles or require documentation of compliance with contract specifications and State laws, rules, regulations, and guidelines governing medical transport vehicles (ambulances). VA inspections of contractor facilities shall in no way constitute a warranty by the VA that the contractor’s vehicles and equipment are properly maintained. The VA reserves the right to restrict the

Contractor’s use of equipment and vehicles which are in need of repair, unclean, unsafe, damaged on the interior or exterior body, and are not in compliance with contract requirements. The restriction of such equipment and vehicles shall not relieve the contractor from performing in accordance with the strict intent and meaning of the contract without additional cost to the Government.

c. The Ambulance will comply with GSA Specifications KKK-A-1822.

i. The Contractor that is providing ambulance services shall provide oxygen when it is requested by authorized VA personnel or required by the patient’s medical condition. Oxygen required for ambulance services shall be at the rate and price shown in the Schedule B of Services and Prices.

d. The Contractor shall not be permitted to borrow medical equipment from any medical facility.

e. The Contractor shall provide all medications required while in transport, sheets and blankets and other equipment and supplies required for use while in transport, for direct patient care. Contractor shall at no time and under any circumstances exchange supplies, equipment and/or medication with the VA. All vehicles used for care and transport, shall include all equipment in paragraph 2ii.

4. Contractor Personnel Qualifications:

a. All Contractor personnel performing contract services shall meet the qualifications as specified in this contract, as well as any qualifications by Federal, State, County, and local government entities from the place in which they operate. Contractor personnel shall meet these qualifications at all times while performing contract services.

b. The contractor shall not employ any persons for work on this contract if such employee is considered by the VA Contracting Officer (CO) to be a potential threat to the health, safety, security, or operations of the VA, its facilities or its staff.

c. Contractor’s employees shall understand, speak, read, and write the English language at a level, which promotes effective communication.

d. All contractor employees must have current and valid licenses/certifications before they can begin work on this contract. A copy of all certifications and/or other credentials shall be provided to the VA upon request by the CO or Contracting Officer Representative

(COR).

e. No employee of the contractor can be a Federal employee, nor can they have any conflict of interest either real or perceived.

f. Identification badges: All contractor employees shall wear appropriate identification that can clearly identify them by name, title, and by job performed.

g. Training: All contractor personnel will have ongoing documented training to maintain their appropriate levels of competency. Records and certifications shall be maintained by the contractor and available for VA inspection upon request. All attendants on the ambulances must have current CPR certification and basic first aid training along with their required certifications. Contractor employees must be trained on the appropriate handling of Mental Health patients and those patients that are developmentally disabled.

h. During the period of performance, if the Contractor proposes to add-on or replace personnel to perform contract services, the Contractor shall submit the required evidence of training, certifications, licensing, and any other qualifications to the

Contracting Officer.

i. Critical Care Transport Emergency Medical Technician (CCTEMT) and Paramedic

Qualifications: EMT’s and Paramedic’s providing service under this contract shall hold a valid and current California EMT certificate. EMT’s shall comply with all re-certification and continuing education required under California Code of Regulations §100080 and any applicable local rules or ordinances.

j. Critical Care Transport Registered Nurse (CCTRN): Personnel assigned by the Contractor to perform services by this contract shall be Licensed Registered Nurses in the State of

California.

k. Ambulance Driver: All drivers shall have a valid State of California operator’s license to perform the services they perform, be capable of administering oxygen and have successfully completed the Standard and Advance First Aid Course of the American Red

Cross or equivalent and be capable of providing necessary medical assistance to the attending medical care specialist.

5. Patient’s Rights:

a. The Contractor shall be courteous to VA beneficiaries and shall not smoke while transporting patients.

b. The Contractor shall immediately notify the VA of any incidents involving injury to VA patients during transport.

c. The Contractor shall notify the COR, in writing within 24 hours of any complaint made by the patients or staff with regards to the ambulance service. The COR will report to the

Contracting Officer. The Contracting Officer may request an investigation by the

Contractor and a Plan of Correction.

d. The contractor shall be held responsible for patient welfare during transport. The contractor shall be held responsible for patient and/or Government property during transport. Any damaged or lost wheelchairs, walkers, crutches or personal belongings will be replaced by the contractor at no additional cost to the Government or beneficiary.

e. The Government requires the contractor to exercise extreme caution and care in the handling of patients. Any abuse of patients will be grounds for default action or

Termination of the contract.

f. In the event a patient's condition worsens during transport, the Contractor shall transport the patient to the closest facility appropriate for the required care. In the event a patient should expire during transport the Contractor shall return with the patient back to the origin point.

6. Infection control requirements.

a. Health tests. Contractor attests that assigned personnel have fulfilled all testing and screening requirements as described below prior to first duty shift. Evaluations and tests shall be current within the past year, except as noted. At the VA’s request, Contractor shall provide proof that all requirements are current and fully met as described within 2 business days of request.

b. Tuberculosis Screening and Testing.

i. For those with previous documented positive Purified Protein Derivative (PPD) test results: All Contractor personnel shall provide a note from their physician, dated within the past three months stating they are free of any signs and symptoms of tuberculosis. This evaluation will be renewed annually.

ii. For those with previously negative PPD skin test results: All Contractor personnel shall provide proof of a negative reaction to PPD testing, performed in accordance with the latest CDC standards and CDHC/California Tuberculosis

Controllers Association guidelines, within the past 6 months. This test shall be renewed annually.

iii. For PPD skin converters (a change from a previously negative skin test to positive; defined as an increase in duration of 10mm or more with 2 years): An evaluation from their physician within 30 days of the positive test stating they are free from signs/symptoms of TB and indicating whether prophylactic treatment is indicated. If treatment is indicated, a note from the physician stating it was satisfactorily completed.

c. Rubella Testing. All Contractor personnel shall provide proof of immunization 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 a follow-up documentation provided to the COR.

d. Varicella (Chicken Pox) Testing. Provide a history of varicella or, if unknown, results.

7. SPECIAL REQUIREMENTS

a. Ambulance Medical Equipment: Each ambulance shall have patient compartment facilities, oxygen, and suction systems and environmental climatic supplies as required by the Federal Specification for Ambulances, KKK-A-1822.

b. Licenses and other Certifications: The Contractor SHALL have all necessary license(s) and certifications for the service area.

c. Offerors for services in San Francisco shall comply with the requirements in San

Francisco Health Code 903. For information contact the City and County of San

Francisco, Emergency Medical Service Section, 68 12th Street, Suite 220, San Francisco, CA 94103, 415/ 355-2600.

8. Patient Information - Patient information, no matter how developed shall be treated as privileged information under the privacy act and applicable release of information guidelines.

Lists and/or names of patients shall not be disclosed to or revealed in any way for any use outside the VA San Francisco without prior written permission by the Chief of Medical Staff.

9. Release of Medical Information - The paramedics shall only release medical information obtained during the course of this contract to other VA or medical treatment facility staff involved in the care and treatment of that individual patient.

10. Patient Sensitivity - Contract paramedics shall respect and maintain the basic rights of patients, demonstrating concern for personal dignity and human relationships. Paramedics receiving complaints validated by the COR and Chief of the Medical Staff shall be subject to counseling and, depending on the nature and severity of the complaint, separation from performing services under this contract.

11. Orientation Period

a. Contractor(s) Phase In: To ensure a smooth changeover from a current contract to a new contractor, a sixty (60) calendar day phase in period is required. The current contractor(s) shall be cooperative to ensure a smooth changeover is accomplished during the phase-in and phase-out periods. The contractor(s) shall ensure that all training requirements for the newly hired employee(s) are completed before contract start date.

b. Contractor(s) Phase-out Requirements: During the phase-out period, the incumbent contractor(s) shall be fully responsible for all work performed under this Performance

Work Statement (PWS). A sixty (60) calendar day phase out period is required. The incumbent contractor(s) shall cooperate fully to permit an orderly changeover of workload. The incumbent contractor shall allow the new contractor and government personnel access on a non-interference basis, to observe the day-to-day operations and to become familiar with the work requirements and procedures.

c. Ambulance service provider must have a license to provide ambulance services from the

California State Department of Health, EMS Division and the applicable County(ies) and zones in which award was made.

d. Access government facilities in order to familiarize supervisors, key personnel, and staff with equipment, reporting, work schedules and procedures. However, such access will not interfere with the production efforts of current work force. To preclude such interference, arrangements for access to government facilities will be made with the CO or COR.

e. Provide EMT-Paramedic, State of California license, etc. within 5 business days before period of performance begins.

12. Quality Control (QC)

a. The contractor shall develop, submit for contracting office acceptance, and maintain a quality control program to ensure the requirements of this contract are performed in accordance with established standards. The contractor shall develop and implement procedures to identify, prevent and ensure nonrecurrence of defective services. As a minimum the contractor shall develop quality control procedures (QCP) addressing the areas identified in the service summary. The contractor shall make appropriate modifications (at no additional costs to the government) and obtain acceptance of the plan by the CO. The VA shall reserve the right to determine contractor QCPs unacceptable at any time during contract performance. If a QCP is found to be unacceptable, the contractor shall be notified and the CO will take action to enforce the inspection of services clause requiring an inspection system acceptable to the government.

13. Quality Assurance

a. According to the contract’s inspection clause, the government will evaluate the contractor’s performance under this contract. The COR is a representative of the CO and will participate in the administration of this contract. Any matter concerning a change to the scope, prices, terms, or conditions of this contract shall be referred to the CO. All services to be performed by the contractor during the period of this contract will be subject to review by the CO or COR.

b. Contractor Response Time: The contractor shall provide written response addressing the root cause, corrective action and preventive action(s). The contractor will be given up to

48 hours to answer a customer complaint.

Performance Objective PWS Para Acceptable Quality

Level

Service: Provide 24 hour certified paramedic personnel and ambulances services required for patient transport in support of Veteran beneficiaries.

100%

Ambulance Response: Response time to

Urgent calls within 1 hour response time.

Response time to Standard calls within 2 hour response time.

No more than 1 late response in a contract period of performance.

Certification Requirements: Current BLS, ACLS and NREMT Paramedic certification on file for contract personnel

100% of staff must meet

Health Requirements: Physical examinations and required immunizations current and on file for contract personnel.

100% of staff must meet

Quality Control Plan: Contractor shall maintain quality program to ensure

90% requirements to meet established standards.

Conversion: Contractor must be able to convert patients from VA ECMO, IABP, mechanical ventilator and external LVAD support system to their transport versions, at bedside at the patient.

100%