2 VA Liaison Overview Template.docx
DOCX document 19 KB Posted
- Attached to
- HCHV Federal contract opportunity
- Solicitation number
- 36C26123Q0196
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|---|---|---|
| S02 36C26123Q0196 0004.pdf | ||
| S02 36C26123Q0196 0003.pdf | ||
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| 3 Facilities Managment Template.docx | DOCX document | |
| ZIP CODE CATCHMENT LIST - EXCEL VERSION.xlsx | XLSX spreadsheet | |
| S02 36C26123Q0196 0002.pdf | ||
| S02 36C26123Q0196 0001.pdf | ||
| PERFORMANCE WORK STATEMENT.pdf | ||
| Attachment 1 - Wage Determination 1995-0573 Rev 52 12.27.22.pdf | ||
| S02 36C26123Q0196.pdf |
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Text version
VA LIAISON – OVERVIEW & RECOMMENDATION
HOMES PROJECT CODE:
SITE ADDRESS:
HCHV LIAISON SHOULD COMPLETE THIS SECTION
ATTACHING ANY OTHER DOCUMENTATION, AS NECESSARY
| YES |
| NO |
| N/A |
| 1 |
| THE FOLLOWING POPULATIONS ARE CLINICALLY APPROPRIATE TO HOUSE WITHIN THE SITES COVERED UNDER THIS PROGRAM NUMBER: |
A. MEN
B. WOMEN
C. CHILDREN
| 2 |
| PROGRAM OPERATES IN ACCORDANCE WITH HCHV PROGRAM REGULATIONS, 38 CFR 63 |
| 3 |
| PROGRAM MEETS ALL APPLICABLE STATE AND LOCAL LICENSING AND |
OTHER REQUIREMENTS FOR THE OPERATION OF THE PROGRAM IN THE
JURISDICTION WHERE THE PROGRAM IS LOCATED
| 4 |
| CONTRACT PROVIDER HAS DEMONSTRATED ADEQUATE STAFFING AND AN |
APPROPRIATE SCOPE OF SERVICES TO CARRY OUT THIS PROGRAM AS
OUTLINED IN THE ORIGINAL SOW/PWS OR SUBSEQUENT APPROVED CHANGE / CONTRACT MODIFICATION
| 5 |
| CONTRACT PROVIDER SERVES/CAN SERVE THE POPULATION(S) AS DESCRIBED IN THEIR CONTRACT / SOW/PWS. |
| 6 |
| THE CONTRACT PROVIDER SUBMITS ACCURATE BILLING ON A MONTHLY BASIS AND MAINTAINS DOCUMENTATION TO SUPPORT MONTHLY BILLING. |
*If initial inspection this section can be left blank
| 7 |
| CONTRACT PROVIDER MAINTAINS SYSTEMATIC PARTICIPANT ENROLLMENT AND TRACKING INFORMATION FOR SAFETY AND BILLING PURPOSES. *If initial inspection this section can be left blank |
| 8 |
| THE RESULTS OF THE CONTRACT PROVIDER'S PERFORMANCE ON THE |
APPLICABLE VA METRICS HAVE BEEN DISCUSSED AT LEAST QUARTERLY WITH THE CONTRACT PROVIDER (RE-INSPECTIONS ONLY)
| 9 |
| THE PHYSICAL STRUCTURE OF THE FACILITY, PROGRAM POLICIES AND |
PROCEDURES ARE APPROPRIATE TO ENSURE THE SAFETY, SECURITY, AND PRIVACY OF ALL INDIVIDUALS IN THE FACILITY
| 10 |
| CONTRACT PROVIDER UTILIZES HMIS FOR PROGRAM PARTICIPANTS |
| 11 |
| THE CRS PROVIDER MEETS OR EXCEEDS THE MOST CURRENT (YEARLY OR |
QUARTERLY) PERFORMANCE DATA BELOW AND IF NOT, THE HCHV LIASION WORKS WITH THE PROVIDER TO PUT A PLAN IN PLACE FOR IMPROVEMENT (*If initial inspection this section can be left blank):
| MEETS TARGET |
| DOES |
NOT
MEET
TARGET
PIP IN
PLACE /
REQUIR ED
A. EXITS TO PERMANENT HOUSING
B. NEGATIVE EXITS
| YES |
| NO |
| N/A |
| 12 |
| THIS INSPECTION INVOLVED INVERVIEWS BY THE INSPECTION TEAM |
MEMBERS WITH VETERANS PARTICIPATING IN THIS PROGRAM; ANY
COMPLAINTS OR ALLEGATIONS MADE BY VETERANS REGARDING DEFICENCIES IN THE PROGRAM HAVE BEEN EITHER FULLY RESOLVED OR INVESTIGATED AND DETERMINED TO BE UNFOUNDED.
| 13 |
| ANNUAL REVIEW OF SERVICES: LIST THE CORE SERVICES INDEPENDENTLY PERFORMED BY THE CONTRACT PROVIDER AS STATED IN THE SOW/PWS. |
PLEASE INDICATE IF THE SERVICE IS CURRENTLY PROVIDED.
A. Seeks to reduce barriers to immediate placement of Veterans.
B. Provides safe and secure housing as well as supportive services.
C. Lengths of Stay typically range from 30 to 90 days with the option to extend.
D. Veterans are expected to meaningfully engage their case managers.
E. Emphasis is placed on achieving placement in permanent housing.
F. Reducing negative exits due to rule violations or other avoidable events.
| 14 |
| THE CONTRACT PROVIDER IS CURRENTLY PROVIDING ALL SERVICES AS STATED IN THE CONTRACT / SOW/PWS . *If initial inspection this section can be left blank |
ALL APPROPRIATE CHECKLIST ITEMS HAVE BEEN ADDRESSED AND FACILITY IS APPROVED FOR PLACEMENT OF VETERANS:
HCHV LIAISON SIGNATURE
| HCHV LIAISON NAME (PRINT) |
| DATE |
I, AS THE HCHV LIAISONS SUPERVISOR HAVE REVIEWED THIS INSPECTION PACKET AND DISCUSSED THE FINDINGS WITH THE HCHV LIAISON. I CONCUR WITH THE LIAISONS FINDINGS AND AFFIRM THAT TO THE BEST OF MY KNOWLEDGE THAT THIS HCHV PROGRAM OPERATES IN ACCORDANCE WITH HCHV PROGRAM REGULATIONS AND IS CURRENTLY PROVIDING ALL SERVICES AS STATED IN THE ORIGINAL SOW/PWSOR SUBSEQUENTLY APPROVED CHANGE OF SCOPE.
DATE
HCHV LIAISON SUPERVISOR'S SIGNATURE
HCHV LIAISON SUPERVISOR'S NAME (PRINT)
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