36C26121Q0791.docx

36C26121Q0791

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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

36C26121Q0791 06-15-2021 Maricela Berrones-Gauger 559-225-6100 x6792 06-29-2021

11:59 PM

PDT

Department of Veterans Affairs VA Sierra Pacific Network (VISN 21) Network Contracting Office (NCO 21) 855 M Street, Suite 1020 Fresno CA 93721 X 623220 $16.5 Million N/A X ** See Performance Work Statement **

Department of Veterans Affairs VA Sierra Pacific Network (VISN 21) Network Contracting Office (NCO 21) 855 M Street, Suite 1020 Fresno CA 93721

Department of Veterans Affairs FMS-VA-2(101) Financial Services Center

PO BOX 149971

Austin TX 78714-9971 See CONTINUATION Page The Contractor shall provide Medical Respite Services for Homeless Veterans of the VA Pacific Islands Health Care System (VAPIHCS).

All performances shall be in accordance with the Performance Work Statement contained herein.

See Schedule of Services in Section B.2 Period of Performance: 08/02/2021 - 08/01/2026 Ordering Period One: 08/02/2021 - 08/01/2022 Ordering Period Two: 08/02/2022 - 08/01/2023 Ordering Period Three: 08/02/2023 - 08/01/2024 Ordering Period Four: 08/02/2024 - 08/01/2025 Ordering Period Five: 08/02/2025 - 08/01/2026 Point of Contact: Maricela Berrones-Gauger Maricela.Berrones-Gauger@va.gov See CONTINUATION Page X Latasha Winston Contracting Officer Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR:

b. GOVERNMENT: Contracting Officer: Latasha Winston Department of Veterans Affairs Network Contracting Office (NCO) 21 5342 Dudley Blvd., Bldg. 209 McClellan, CA 95652

Contract Specialist: Maricela Berrones-Gauger Department of Veterans Affairs Network Contracting Office (NCO) 21 855 M Street, Suite 1020 Fresno, CA 93721

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

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.

Department of Veterans Affairs FMS-VA-2(101) Financial Services Center

PO BOX 149971

Austin TX 78714-9971

B.2 PRICE/COST SCHEDULE

The Contractor shall provide emergency housing and supportive services for homeless Veterans in community based HCHV Medical Respite facilities in accordance with the specifications listed herein.

The guaranteed minimum award amount for this contract is $1,000. The maximum aggregate value of orders that can be placed under this contract is $4,000,000.00. The Government does not guarantee that it will place any orders under this contract in excess of the guaranteed minimum award amount.

ITEM INFORMATION

Provide 5 beds per day to Homeless Veterans on a per diem basis in accordance with the PWS in Island of Oahu. (5 Beds x 365 Day = 1,825) Period of Performance: 08/02/2021 - 08/01/2022

Provide 5 beds per day to Homeless Veterans on a per diem basis in accordance with the PWS in Island of Oahu. (5 Beds x 365 Day = 1,825) Period of Performance: 08/02/2022 - 08/01/2023

Provide 5 beds per day to Homeless Veterans on a per diem basis in accordance with the PWS in Island of Oahu. (5 Beds x 365 Day = 1,825)Period of Performance: 08/02/2023 - 08/01/2024

Provide 5 beds per day to Homeless Veterans on a per diem basis in accordance with the PWS in Island of Oahu. (5 Beds x 365 Day = 1,825) Period of Performance: 08/02/2024 - 08/01/2025

Provide 5 beds per day to Homeless Veterans on a per diem basis in accordance with the PWS in Island of Oahu. (5 Beds x 365 Day = 1,825) Period of Performance: 08/02/2025 - 08/01/2026

36C26121Q0791

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B.3 PERFORMANCE WORK STATEMENT

VA Pacific Islands Health Care System (VAPIHCS) Health Care for Homeless Veterans

HCHV EMERGENCY CONTRACT HOUSING

Medical Respite Services

A .GENERAL

1.1. Services Required: The Department of Veteran Affairs Pacific Health Care System (VAPIHCS) through the Health Care for Homeless Veterans (HCHV) Emergency Contract Housing program provides care, treatment and rehabilitative services to homeless veterans in the Pacific Region. The services provided to eligible homeless veterans include outreach, case management and housing services. It is the purpose of this program to provide these veterans a safe residential setting for a temporary period while addressing their immediate and long term needs by accessing appropriate resources and supports with the goal to obtain permanent housing and end their homelessness.

To provide the care, treatment and rehabilitative services required the VA- HCHV program to contract with agencies and/or organizations (Contractors) to stabilize the veterans’ needed medical, mental health, substance abuse and other psychosocial problems so the veteran is able to transition into other appropriate transitional or permanent housing. Since these veterans may have co-morbid conditions which may include serious mental illnesses, substance abuse disorders, and other serious medical conditions the Contractor is required to possess an understanding of these challenges and general skills to support the veterans to address these issues.

1.2. Authority: The Department of Veterans Affairs established Health Care for Homeless Veterans (HCHV), in accordance with 38 USC 1720A and Public Law 101-237. The Department of Veterans Affairs is implementing programs to end homelessness for veterans and this program’s purpose is consistent with that effort through the provision of immediate short term housing for homeless veterans.

1.3. Definitions:

1.3.1. McKinney-Vento Act Definition of Homelessness: It is the responsibility of the VA HCHV program to determine homeless status of program applicants. The HCHV Program follows the definition of “homeless” as authorized in 38 U.S.C. 2002(1) and The McKinney-Vento Homeless Assistance Act, as amended by S. 896 The Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act of 2009.

NOTE: See http://www.hudhre.info/hearth/

1.3.2. Veteran: A Veteran is, for the purpose of HCHV Emergency Contract Housing, a person who served in the active military, naval, or air service, and who was discharged or released under conditions other than dishonorable and is eligible for VA health care as determined by the local VA medical center. To be eligibility for Emergency Contract Housing requires that the veteran not be convicted of a Sexual Offense or Arson.

1.3.3. Contracting Officer (CO): The CO is a VA employee who is assigned responsibility for the VA contract. The CO role is to ensure performance of all necessary actions for effective contracting, ensure compliance with the contract terms, and shall safeguard the interests of the United States in the contractual relationship. The CO is the only person authorized to approve changes or modify any of the requirements of this contract. The Contractor shall communicate with the Contracting Officer on all matters pertaining to contract administration as only the Contracting Officer is authorized to make commitments or issue changes that shall affect price, quantity or quality of performance of this contract. The CO shall also assure that the contractor receives impartial, fair, and equitable treatment under this contract. The CO is ultimately responsible for the final determination of the adequacy of the contractor’s performance.

1.3.4. Contracting Officer’s Technical Representative (COR): The COR is responsible for technical administration of the contract as outlined in the COR Delegation of Authority issued by the CO. The COR shall assure proper Government surveillance of the contractor’s performance and keep the CO informed of such. The COR shall keep a quality assurance file. The COR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government’s behalf.

VA Contracted Housing Representative: The Representative is the HCHV staff assigned responsibility for program eligibility determination and admission authorization for homeless veteran’s entry into the contracted program. The representative is the primary contact for the program regarding the veterans served and provides general oversight and program assistance as needed.

1.3.6 Quality Assurance Surveillance Plan (QASP): The QASP is part of the contract and identifies the specific performance indicators and standards to be achieved by the contractor as outlined in the Performance Work Statement (PWS). The QASP review will be completed periodically by the COR and contractor’s performance reported to the CO.

1.3.7 Key Personnel: Employees of the contractor that are considered to be essential to the work being performed under this contract.

1.3.8 Activities of Daily Living (ADL’s): Activities of daily living are routine activities people do every day without assistance. There are six basic ADLs: eating, bathing, getting dressed, toileting, transferring and continence.

1.3.9 Instrumental Activities of Daily Living (iADL’s): Instrumental ADLs (iADLs) are things involved in independent daily life at home and in the community including such activities as housework, money management, preparing meals, shopping and work.

2. CONTRACTOR RESPONSIBILITIES: The U.S. Department of Veterans Affairs (VA) requires a Contractor to provide emergency residential placement and case management services through the Health Care for Homeless Veterans (HCHV) program. This contract is designed to serve homeless Veterans in need of immediate placement in a safe environment with onsite support service. The contractor is not to provide any medical services including attendant or personal care but facilitate the acquisition and coordination of these services to veterans requiring this support from VA homecare or homecare provided through a community agency.

2.1 Population to be Served

VA Eligible, Locally Registered, and Approved to enter program services: Individuals who served in the US Military must be determined eligible for VA benefits and services and registered at the local VA serving the local catchment area. All eligible veterans must be approved by the VA Representative per the identified process prior to program admittance. While all other Emergency Housing Services require that veterans be independent in their Activities of Daily Living (ADL) and be able to demonstrate Instrumental Activities of Daily Living (IADL) this is not a requirement under this contract for veterans either at the time of entry or upon medical recovery. The veteran’s skills in these areas will be evaluate and program eligibility will be determined on a case by case basis by the contractor and the VA representative.

Consideration of program acceptance will be made on a case by case basis for homeless veterans who have been convicted of a sex offense. This consideration will include but not be limited to the nature of the offense, the composition of the house including vulnerability, the community at large, the Contractor’s policy of acceptance of individuals with this conviction and the post discharge permanent housing plan for the veteran. Veteran would be required to register their location per Megan’s Law. Veterans convicted of an arson offense are not eligible.

2.1.1 Veterans will not be served if at the discretion of the VA representative in collaboration with the contractor it is determined that a veteran’s current and past behavior may have a negative impact on the program and other residents.

2.1.2 Location of Services: Island of Oahu The site must be accessible by local public or contractor provided transportation to the local VA facility and community resources and services. Performance will occur at the Contractor’s VA approved location.

2.1.3 Homeless : To be eligible for Emergency Housing services under this contract the veteran must be homeless prior to their hospitalization or needed medical recovery . A required initial homeless clinical assessment completed by a VA representative or in certain circumstances due to distance an initial prescreen submitted by the contractor, reviewed and approved by the VA Representative who will follow up with a clinical review will serve as verification of homelessness or at risk.

2.1.4 Primary target populations: Homeless veterans who are homeless or chronically homeless and may have mental health support needs, substance abuse disorders and in need of a short term medical recovery. Veterans considered may have been discharged directly from hospital/rehabilitation programs and require home-care to complete a recovery or homeless veterans who may not meet acute care criteria for being hospitalized but present with vulnerable conditions that require temporary healthcare.

2.1.5 Number to veterans to be service under this contract: 5 male or female homeless veterans.

2.1.6 Length of Stay: The duration of a Veteran’s stay are targeted to be no longer that 90 days unless specifically authorized by the VA Emergency Housing Representative for an extension (See 2.3.3.11 regarding extensions criteria). Extensions will be provided in the event the medical recovery period requires a continued stay or if circumstances require a continued stay due to the need to secure long term care for the veteran.

2.1.7 Hours of Service to be Provided: On site supervision shall be provided 24 hours/7 days/ 365-366 days per year including State, Territory and Federal Holidays.

2.1.8 Service Outcome: The service outcome of the emergency housing medical respite services is to stabilize the homeless veteran, secure appropriate resources and supports to assist in their medical recovery, and secure transitional or permanent housing including long term care for their future. Permanent housing is the primary desired residential outcome for all veterans participating in this program.

2.1.9 Care, Treatment and Rehabilitative Services: The Contractor must furnish care, treatment and rehabilitative services.

2.2 Facility

2.2.1 Type of Housing to be provided: It is preferred that the housing unit be in single family detached houses within the community although other housing types are considered such as apartments or units within a facility. The Contractor may utilize more than one VA approved site given specialty of care to address the requirements of this contract. Environments should provide for adequate bedroom, dining, and a common area equipped with adequate seating and entertainment options. An outside common seated area for residents is desired but not required.

2.2.2 Accessibility: It is preferred that the housing sites Housing shall be accessible from the street and wheelchair accessible or where needed ramped for home access. Doorways shall be of sufficient width to accommodate wheelchairs and at least one bathroom will be wheelchair accessible with toilets and showers compliant to handicap accessibility. Bathroom equipment needed may include shower grab bars and shower chairs.

2.2.3 Bedrooms must be appropriate and be of sufficient size to accommodate wheelchairs and bed transfers. Bedrooms shall accommodate no more than 2 beneficiaries, unless specifically authorized by VHA.

2.2.4 New Contracts/Site Relocations – For new contracts the Contractor shall secure an appropriate site for the performance of the contract, promptly comply with VA site and other inspection requirements and be operational to accept veteran residents within 90 days from the date of the contract. This 90 day operational requirement also applies to sites which have had to relocate during the term of the contract.

2.2.5 Contractors must have site control of the residential care facility through ownership or a valid property lease.

2.2.6 The Contractor’s identified site(s) of service approved by VA will be the location for the services to be provided to veterans under this contract. Any additional sites will require a VA pre-inspection and authorization.

2.2.7 It is the responsibility of the Contractor to properly develop and/or maintain its facilities and the VA shall have no responsibility for paying or reimbursing the Contractor for such expenses.

2.2.8 The contract facility must have a current occupancy permit, if new, issued by the local and State governments in the jurisdiction where the facility is located or a statement from the appropriate city or state office, stating there is not a need for an occupancy Permit.

2.2.9 Be in compliance with existing standards of State safety codes and local, and/or State Health and sanitation codes.

2.2.10 Where applicable, be licensed under State or local authority.

2.2.11 Where applicable, be accredited by the State.

2.2.12 Be equipped with operational air conditioning /heating systems if required for habitation at the discretion of the VA facilities inspector at the site’s pre-inspection.

2.2.13 Be kept clean free of insects including bedbugs and rodents, free of dirt, grime, mold, or other hazardous substances and damaged noticeably detract from the overall appearance.

2.2.14 Showers and toilets will be maintained clean and sanitary.

2.2.15 Be equipped with first aid equipment and an evacuation plan in case of emergency.

2.2.16 Have windows and doors that can be opened and closed in accordance with manufacturer standards.

2.3 Environment Supports: In the housing environment the following must be provided:

2.3.1 Each resident shall be provided with a single bed and frame and bed linens, including blankets as needed. Specially designed zippered bed bug mattress covers which enclose the mattress and box springs must be in place to reduce the infestation of bed bugs. If the bug mattress covers is torn or if zipper is not closing properly the cover must be replaced.

2.3.2 Hygiene products to include towels, wash cloths, soap, deodorant, toothpaste, and toothbrushes, as needed.

2.3.3 Bathrooms (toilets, basins and showers and bathroom hygiene supplies) will be located within a reasonable distance on the same floor of the living space.

2.3.4 A space for personal belongings off the floor such as closets, dressers or wardrobes for clothing and effects shall be provided.

2.3.5 A place for the resident to secure (lock) valuable personal items and medications (if independent in their medication management) which cannot be removed by other quest.

2.3.6 Privacy shall be provided to the resident.

2.3.7 Rooms shall be accessible to the Veteran 7 days a week and 24 hours per day. Veterans will have access to their assigned bed during this time except, where necessary, a specific defined period of no more than two hours daily for staff to clean the room or bed area.

2.3.8 Veteran sleeping environment shall be maintain in a preventative manner to assure that it is in good repair, clean, free of noise during normal night time sleep hours, and free of insects and/or rodents. Program will have in place and be able to follow in a timely manner a written plan to rid the environment of insects and/or rodents if an infestation is identified.

2.4 Meals: The contractor shall provide nutritious meals. Food shall be prepared, served and stored under sanitary conditions. The following shall be provided:

2.4.1 Unless deemed inappropriate for the facility by VA the facility shall provide storage space in an onsite refrigerator for Veterans to store personal food if refrigeration is required.

2.4.2 The facility shall establish and maintain sanitary procedures for washing dishes, cleaning equipment and work areas, and disposing of waste.

2.4.3 At least three (3) nutritious meals or their equivalent shall be served daily at regular times. These meals will follow a weekly posted menu and substitutions of menu items will be at a minimum. In addition, nutritious snacks of nourishing quality should be available between meals and before bedtime for those requiring or desiring additional food when it is not medically contraindicated. There will not be more than a 14 hour span between evening meal and breakfast of the following day.

2.4.4 Contractor will provide alternative meals to veterans with dietary restrictions if medically indicated (e.g. diabetic, renal and soft mechanical diets) and reasonable accommodation for veterans with cultural/religious preferences around food.

2.5 Laundry: Laundry services including a functioning washer and dryer shall be provided by the facility at no cost to the resident.

2.6 Transportation: The contractor shall assist the Veteran to their scheduled meetings and appointments through the provision of transportation or secure public transportation for the program veterans through the provision of bus passes and taxi vouchers. If reliable public transportation is not available within a reasonable distance (1/4 mile) the agency shall also establish a schedule to transport residents to local community services such as food markets, retail or dining services in addition to medical appointments. In the event the veteran has ambulation difficulties and unable to access public transportation then the contractor shall assist veteran to appointments and community access through securing the veteran’s acquisition of community transportation services for the disabled such as Handi-van.

2.7 Program Service

The following outlines the services required of the Contractor to address the care, treatment and rehabilitative services expectation under this contract. Additional Contractor developed and implemented supports to address these expectations must be in place. VA may complement the non-VA community-based provider’s program with added treatment services such as VA outpatient programs.

2.7.1 Outreach: The contractor shall accept referrals of homeless veterans directly from the VA Emergency Housing Representative and engage in community outreach to identify homeless veterans who may be eligible and in need of contracted emergency housing services. This outreach activity may include referrals from local hospitals, rehabilitation programs or community clinics where eligible homeless veterans in need of medical respite are identified. If the Contractor identifies through their outreach a veteran who may qualify for a contracted medical respite bed the contractor will utilize and follow the VA referral process for VA’s Representative’s acceptance of the veteran into the program. This process identifies specific non acceptance issues and/or behaviors which may place the veteran or others at risk. In all situations the VA representative or their assigned has the sole determination if a veteran is accepted into a contracted bed at the site. It is expected that the Contractor actively engage in outreach so the occupancy of contracted beds be maintained at a minimum rate of 80% or higher as determined by VA during the course of any given quarter (Contractor Performance Standard #1). If an increase in the percentage of occupancy is required by VA Central Office the revised expectation will be conveyed to the contractor by the COR. Occupancy will be reviewed quarterly as part of ongoing Quality Assurance Surveillance Plan (QASP) efforts. If this rate is not consistently achieved a corrective action plan may be required depending on factors affecting the occupancy shortfall.

2.7.2 Entry Referral: Homeless Veteran’s eligible for the medical respite program must require home-care to complete their medical recovery or be a homeless veterans who does not meet acute care criteria for hospitalization but presents with vulnerable conditions and requires temporary healthcare. Entry into services can be either through the direct referral from the Emergency Housing Representative or through the outreach efforts of the contractor. If the contractor identifies a homeless individual as potentially qualified to receive services the Contractor shall obtain from the veteran a VA Release of Information (ROI) and follow the identified process to request the veteran’s VA eligibility with the VA Representative or their assigned to assure the veteran is registered for VA benefits and services (Contractor Performance Standard #2).

2.7.3. Level of Support Assessment: Since the contractor is not authorized to provide medical services including attendant or personal care it is critical that an assessment for respite eligibility review the degree of physical and medical support required by the referred veteran. Specifically this assessment should determine whether the veteran’s needs can be adequately served at the site even with support from VA Home Based Care or individually contracted care from a community homecare provider. This determination will require the use of a collaborative assessment document and process between the VA representative and the Contractor prior to eligibility determination. Likewise, consideration should be based on a veteran’s history and condition to determine, if possible, whether the veteran will demonstrate medical recovery and increased independence in ADL’s and IADLs within the projected 90 day timeline. In addition strong consideration should include a prognosis on the veteran’s medical recovery and stability and the feasibility of securing long term care or other post respite housing. Due to the veteran’s possible need for medical or attendant support any consideration of eligibility requires that if these direct services are required for the veteran they are confirmed to be available at the time of admission and to be coordinated by the identified service provider’s physician/nursing case management program. If in collaboration the VA representative and the Contractor determine the veteran is not appropriate for this service due to the need for a higher level of care the referring source will be informed of that decision. In all referral situations the VA representative will make the final determination on the veteran’s program eligibility.

2.7.4 Admission: The VA Representative is responsible for determining VA eligibility of Veterans prior to admission to contractor’s bed. A list of VA staff authorized to approve admissions under the contract shall be provided to the contractor. Acceptance of billing is conditional upon the eligibility and admission approval of the VA representative. In addition the contractor shall follow the current HCHV identified process for eligibility determination which may include the submission of a completed VA Homeless Prescreen Questionnaire (unless the VA Representative completes a clinical assessment), Participation Agreement, and VA Rights submitted by fax/secure email to the VA representative. If the veteran is denied eligibility/admission to the program the Veteran must be explained in writing with copies maintain in a file by the contractor. If the contractor’s referral is accepted into the program the VA Representative shall fax or send by secure email a completed VA Eligibility and Enrollment into Emergency Housing Services to the contractor acknowledging the veterans acceptance. The contractor shall maintain these documents in a secure file (Contractor Performance Standard #3). The contractor may also utilize admission and other forms specific to their agency requirements.

Training and updates on the processes and all referenced VA forms will be provided to the Contractor by the VA Emergency Housing Representative.

2.7.5 Case Management: The contractor shall assign a case manager as the primary contact for the Veteran and this role shall not conflict with other duties such as also being the primary residence rules and compliance staff person. This case manager will, in conjunction with the program participant based on their Inventory of Needs develop a Housing Support Plan (HSP) which outlines the general services and supports needed and prioritized. This document will also identify the veteran’s Resource Acquisition (financial plan) and their Discharge Plan upon leaving the program. This plan will be created, implemented and submitted to VA within 7 days of admission (Contractor Performance Standard #4). The HSP should identify the shared responsibility of the case manager and the veteran in achieving the goals identified. The level of achieving the identified goals depend greatly on the veteran’s desires, wishes, priorities and their motivation. This case manager shall have sufficient time to meet with veterans and will meet with the veteran and document a minimum of 3 or more time per month to review progress. (Contractor Performance Standard #5).

The case management provided should include but not be limited to the following:

2.7.5.1 Housing Assistance: Provide direct and ongoing assistance to support the Veteran’s access to permanent housing including long term care where appropriate. All efforts to engage veteran regarding housing plans, options and resources shall be clearly documented. Mere communication with veteran regarding housing without subsequent contractor staff action and follow-up, shall not on its own meet the above requirement.

2.7.5.2 Resource Acquisition: Provide direct and ongoing assistance to support the Veteran’s accessing eligible financial and supportive programs i.e. SS, SSDI, General Assistance, Food Stamps, VA service connected benefits, SSVF, employment, etc. and assist application preparation and/or transportation to benefit site. Veteran must also be screened for Medicaid eligibility and application submitted even though veteran’s health care is provided by VA . Documentation of all referrals and outcomes must be noted in the veterans progress note. (Contractor Performance Standard #6). As part of the Housing Support Plan the case manager shall develop with the veteran a Financial Plan and Budget which reflects employment and non-employment resources and income and what is needed to secure housing. (Contractor Performance Standard #7).

For veterans eligible for the VA HUD-VASH program, contractor staff, as the secondary case managers, shall develop a Collaboration Plan with the veteran and the VA HUD-VASH social worker to identify and support the efforts to secure needed documents and other resource to facilitate and expedite the veteran’s move into permanent housing. This Plan will be consistent with the HUD-VASH Housing Plan, a copy of which will be maintained in the Contractor’s file. This Collaboration Plan shall be updated and submitted monthly as part of the progress note for the veteran to the HCHV Social Worker.

2.7.5.3 Guardianship/Fiduciary/Representative Payee Assistance: For the benefit of the veteran and in collaboration with the VA representative the contractor will, where appropriate, initiate a referral for guardianship, a financial fiduciary or a representative payee for benefits.

2.7.5.4 Medical and Mental Health Assistance: Support the Veteran’s attendance at medical and mental health programs at VA and scheduling or providing transportation as needed. Medication management is not required by the contractor unless it is policy for the facility. The veteran may manage their physician non-narcotic prescribed and over the counter medication but they must be properly stored and secured. If not in conflict with a general facilities ban on the use of all narcotics including those prescribed by their physician, the facility must have a specific policy for physician prescribed narcotics to assure that their use is in compliance with physician orders.

2.7.3.5 Relationship Assistance: Where appropriate support the Veteran to connect with peers and their family.

2.7.3.6 Onsite and Community Support Services: The contractor will provide or when possible refer the veteran to any appropriate community service provider for the provision of individual or group services. This support may be in the areas of financial planning, life skills, social skills training, Alcoholics Anonymous, Narcotics Anonymous, mental health services, vocational counseling and permanent housing search groups or other supports deemed appropriate as determined by the veteran.

2.7.3.7 VA Coordination and Veteran’s status: Communicate with the VA representative through regular scheduled contacts which address the Veteran’s progress of the Housing Support Plan or on issues that may arise. The Program will submit a monthly summary of the case management activities and veteran’s progress toward the goals outlined in the HSP. In addition if a veteran is or has been identified as HUD-VASH eligible the Collaboration Plan is to be updated and submitted as the veteran’s progress note. (Contractor Performance Standard #8).

2.7.3.8 Discharge Planning: Develop with the veteran a Discharge Plan to identify the type of housing the veteran will transition to at the time of their discharge. This Discharge Plan shall be prepared no later than 7 days after admission. In addition the program will inform the VA representative within 24 business hours of the veteran’s discharge whether planned or unplanned. The contractor shall also submit a final progress summary note including reasons for resident leaving, their future plans and their progress to achieving their established goals along with the Exit Summary for Contracted Housing to the VA representative within 48 business hours of discharge.

Discharges will be characterized as follows:

a. Positive Discharge: A positive discharge is when the Veteran has been successfully placed in permanent housing either individually or with family or friends. The contractor will work to target that 50% or more of veteran discharges are positive with the veterans moving into permanent housing. (Contractor Performance Standard #9) If a revision (increase) in the target percentage expectation is identified by VA Central Office, this revised expectation will be conveyed to the contractor by the COR. The percentage of Positive Discharges will be reviewed quarterly as part of ongoing Quality Assurance Surveillance Plan (QASP) efforts. If this rate is not consistently achieved, a corrective action plan may be required depending on factors affecting the positive discharge shortfall.

b. Administrative /Neutral Discharge: the Veteran has been transferred to an alternate level of care with concurrence from the VA Representative for medical, mental health, or substance abuse treatment to better meet the Veteran’s clinical needs.

c. Negative Discharge: A negative discharges is when a.) the Veteran is absent from the program site and his whereabouts are unknown and or unwilling to return; b.) the Veteran has had an episode of violence or has threatened violence against staff or other residents and must be discharged to maintain the safety of the facility; c.) the Veteran has had more than one episode of drug use at the facility, d.) the Veteran’s length of stay has exceeded 90 days from the date of admission and the VA Representative has not approved continuation.

The target for negative discharges of veterans is 20% or less (Contractor Performance Standard #10) and the contractor will work to achieve this target. If a revision (decrease) in the target percentage expectation is identified by VA Central Office, this revised expectation will be conveyed to the contractor by the COR. The percentage of Negative Discharges will be reviewed quarterly as part of ongoing Quality Assurance Surveillance Plan (QASP) efforts. If this rate is not consistently achieved, a corrective action plan may be required depending on factors affecting the negative discharges.

2.7.3.9 Customer Satisfaction: Veterans served in Emergency Housing shall complete a VA Customer Satisfaction Questionnaire (uSPEQ) regarding the services received at the site. The questionnaires will be provided by VA and distributed by the program case manager to veterans who have resided at the program for 14 days or longer. The veteran’s response is to remain confidential and veterans are to be strongly encouraged to complete the questionnaire and mail in the attached stamped envelope to the VA Contract Housing Coordinator. The veteran may complete this questionnaire only once per year. At minimum programs should demonstrate a 25% rate of return of completed and returned questionnaires of eligible program participants. The cumulative results shared with the contractor at the end of end quarter. (Contractor Performance Standard #11)

2.7.3.10 Incident Reporting: The Program shall notify the authorizing VA representative within 12 business hours of any critical incident involving the death, suicide/suicide attempt, fire (veteran involved) or sexual or physical assault of a Veteran residing in the residential program. The contractor shall provide the VA representative with a copy of the incident report within 24 business hours.

For all other incidents program shall submit to VA staff an incident report within 48 business hours. These include falls, abuse or neglect, hospitalization, infection control (Bed Bugs, TB, etc.) active substance abuse and possession of weapons

2.3.3.11 Length of Stay: Case managers are to assist veterans to demonstrate progress toward their goals outlined in the Housing Support Plan. Veteran’s stays are reviewed Emergency Housing Representative and the case manager for progress after 14 days and continued stays are limited to 90 days unless specifically authorized by the VA Emergency Housing Representative for an extension.(Contractor Performance Standard #12) Any extension of this time may not occur without written prior approval from the VA Emergency Housing representative. The VA Representative will not approve per diem for lengths of stay exceeding 90 days from the date of admission unless:

I. The veteran has demonstrated reasonable progress and there are circumstances that are barriers to the Veteran’s placement in housing; and/or Ii. There is documented evidence that the contractor has exhausted every effort to place the Veteran in housing sooner; and Iii. The VA Representative has been appropriately advised of these efforts well in advance of the 90 day limit; and

iv. The VA representative concurs that the Veteran will continue to derive benefits from a continued stay at the contracted site.

2.3.3.12 Occupancy: It is expected that the contractor beds will be maintained at an average minimum of 75% occupancy rate but at a preferred rate of 80% as calculated based upon number of bed nights available per quarter. If a revision (increase) in the target percentage expectation is identified by VA Central Office, this revised expectation will be conveyed to the contractor by the COR. The Occupancy percentage will be reviewed quarterly as part of ongoing Quality Assurance Surveillance Plan (QASP) efforts. If this rate is not consistently achieved, a corrective action plan may be required depending on factors affecting the negative discharges.

3.0 Contractor Staff Requirements

3.1 License: The Contractor shall assign to this contract, personnel that by education and training and, when required, certification or licensure, are qualified to provide the Services required by this Performance Work Statement (PWS).

3.2 Ratios: The contractor needs to provide a sufficient number of staff to carry the policies, responsibilities and services of the program. This should include:

3.2.1 That each Veteran has an assigned case manager responsible for coordinating services specified in the contract. The ideal case manager to Veteran ratio is 1:20 or fewer cases per case manager; however consideration will be given by the VA to the staffing characteristics of each facility.

3.3 On-site Staffing

3.3.1 A qualified designated staff person will be on duty at the approved site 24hrs. a day 7 days per week. (Contractor Performance Standard #13). The role and authority of this person must be identified and consistent with the site specific policies and procedures to address emergencies as they arise.

3.3.2 There must be at least one administrative staff member identified and able to be contacted within one hour of any emergency or situation occurring with the authority to make decisions regarding the facility and residents. The name and contact number of this administrative staff person and a sequence of other administrative contacts must be posted on site and available to the on-site staff and residents.

3.3.3 Contractor shall provide prior to initiating services an initial Emergency Plans with periodic updates if the plan changes which identifies what actions will be taken if an emergency/crisis occurs which impacts the on-site staffing and case management expectation. This plan must also address what actions will be taken in the event on-site staff is unavailable. This requires an attached Memorandum of Agreement with an identify agency to provide emergency on-site coverage. The plan must also include a statement that if no on-site coverage can be identified where the veterans in the residents will be safely housed off – site during this time.

3.3.4 That a sufficient number of trained staff are present to ensure that the veterans are provided a safe, secure, confidential and structured environment that address their needs.

3.3.5 That when a VA inspection team evaluates the Contracted Facility the team is consistently assured that staff is capable of providing the services required under the terms of the contract.

3.4 Training: The Contractor shall assign to this contract personnel who will receive initial and periodic training as required in the following areas. An annual training report will be submitted to the COR upon request. (Contractor Performance Standard #14)

3.4.1 Possess current certification in Basic Life Safety (BLS for Healthcare Providers including CPR and AED).

3.4.2 Have received training on alcohol and substance use and familiarity with current treatment programs.

3.4.3 Have received training related to Military Sexual Trauma and PTSD, the characteristics of the disorders and triggers, and awareness of treatment approaches.

3.4.4 Have received training related to general mental health disorders, their characteristics, use of medications, and awareness of treatment approaches.

3.4.5 Have received training in maintaining client privacy and confidentiality in all verbal and written communications and interactions.

3.4.6 Adhere to the provisions of Public Law 104-191, Health Insurance Portability and Accountability Act (HIPPA) of 1996. This includes both the Privacy and Security Rules published by the Department of Health and Human Services (HHS) regarding the use and disclosure of protected health information. Privacy training shall be completed annually.

3.4.7 Have training on Bloodborne Pathogen/Infection Control Procedures.

3.4.8 Employees involved in patient care shall complete the VA Privacy and Security Training in TMS at https://www.tms.va.gov/learning/user/SelfRegistrationUserSelection.do

3.4.9 Have training on Crisis Prevention/ Intervention Training.

3.4.10 Have training on Emergency Disaster Preparedness and Policy Reviews

3.4.11 Have training on Suicide Prevention and action plan.

3.4 Infection Control

3.4.1 Tuberculosis Testing - All contractor personnel shall provide documentation of a Purified Protein Derivative (PPD) test performed within the past year. In case of a past positive PPD test, a negative chest radiographic report to rule out active tuberculosis shall be provided. The PPD test shall be repeated annually.

3.4.2 OSHA Regulation Concerning Occupational Exposure to Blood borne Pathogens - The contractor shall provide training or a self-study training module, as indicated above, to its personnel; provide Hepatitis B vaccination series at no cost to its personnel who elect to receive it; maintain and distribute an exposure determination and control plan to its personnel; maintain required records; and ensure that proper follow-up evaluation is provided following an exposure incident. Contractor shall provide documentation that the employee(s) have received the Hepatitis B vaccination series or that the employee(s) declined to receive the series.

If the employees of the contracting agency suffer a communicable disease, the Contractor shall provide follow up documentation of employee’s clearance to return to the workplace prior to their return.

3.5 Conduct: Under this contract the following acts are not permissible by staff or veteran resident when while on facility premises and should be outlined in at employee policy handbook and resident handbook:

3.5.1 Use of intoxicating liquors, narcotics or controlled substances of any kind (excluding doctors’ prescriptions which do not impair ability to perform contract) while in residence, on duty or reporting for duty.

3.5.2 Gambling in any form.

3.5.3 Carrying of weapons of any kind whether in the open or concealed.

3.5.4 Smoking and other uses of tobacco only in designated site approve areas.

3.5.5 Resorting to physical violence to settle a dispute with a fellow resident, employee,…