36C26123Q0567 0001.pdf

5. PROJECT NUMBER (if applicable)

CODE 7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER 3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO. 1. CONTRACT ID CODE

FACILITY CODE CODE

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office. is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER 16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30 PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243

(Type or print) (Type or print)

(Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code)

(If other than Item 6)

(Specify type of modification and authority)

(such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer)

1 32

612MCP

Department of Veterans Affairs VA Sierra Pacific Network (VISN 21) Network Contracting Office (NCO) 21 3237 Peacekeeper Way, Bldg 200 Suite 204 McClellan Park CA 95652

612MCP

Department of Veterans Affairs VA Sierra Pacific Network (VISN 21) Network Contracting Office (NCO) 21 3237 Peacekeeper Way, Bldg 200 Suite 204 McClellan CA 95652

To all Offerors/Bidders

36C26123Q0567

07-17-2023

X

X X

08/02/2023 15:00 PDT

See CONTINUATION Page

a. The purpose of this Amendment 0001 is to update the Performance Work Statement (PWS), Schedule, and Addendum to

FAR 52.212-1.

b. Section 2 of the PWS has been updated.

c. The schedule has been updated to reflect the changes in the PWS.

d. Section 1 and 2 of the Addendum to FAR 52.212-1 have been modified to reflect PWS changes.

e. Changes are reflected in highlighted sections throughout the Continuation Pages of this document.

Larry Facio

CONTRACTING OFFICER

CONTINUATION PAGES

A.1 PERFORMANCE WORK STATEMENT

1. BACKGROUND

1.1. Ending homelessness among Veterans by 2015 was established as a national priority by the Department of Veterans Affairs Secretary, Eric Shinseki, in November 2009 at the National Summit on Ending Veterans Homelessness. In June 2010, the U.S. Interagency Council on Homelessness (USICH) released Opening Doors: Federal Strategic Plan to Prevent and End Homelessness, which is fully aligned with this goal. Ending Veteran Homelessness continues to be a Strategic Objective Performance Goal of VA’s FY 2018- 2024 Strategic Plan.

1.2. The Health Care for Homeless Veterans (HCHV) Program is an essential and critical part of VHA, providing a gateway to VA and community-based supportive services for eligible Veterans who are homeless. The central goal of HCHV programs is to reduce homelessness among Veterans by conducting street outreach to Veterans who are homeless or experiencing housing instability and need case management assistance to end their homelessness and connect to community-based and VA-supported housing services, VA health care, and other supportive services. In addition to outreach services, HCHV programs provide care, treatment, and rehabilitative services, including case management and therapeutic transitional housing assistance by contracting with community providers. HCHV Contract Emergency Residential Services (HCHV CERS) programs promote an environment that maintains the wellbeing and safety of enrolled Veterans and offers Veterans supportive services that assist them with transitioning from the streets or shelters and living successfully in housing.

2. PROGRAM DESCRIPTION

The HCHV CERS Program provides short-term residential care and treatment to eligible Veterans who need immediate housing placement as they seek permanent housing and/or additional care and services. The purpose of this solicitation is to obtain offers from Contractors who can provide a means of removing homeless Veterans from the street or other habitation unfit for humans and placing them in community-based, residential environments with sufficient supportive services to meet their basic needs and ultimately facilitate improvement of their overall health status and housing situation.

The National Institute for Medical Respite Care has described Medical Respite Care as acute and post-acute care for people experiencing homelessness who are too ill or frail to recover from an illness or injury on the streets or in a shelter, but who do not require hospital-level care. Unlike “respite” for caregivers, “medical respite” is short-term residential care that allows individuals experiencing homelessness the opportunity to rest, recover, and heal in a safe environment while accessing medical care and other supportive services. Medical respite care is offered in a variety of settings including freestanding facilities, homeless shelters, motels, and transitional housing.

In order to provide high quality clinical care, the contractor shall communicate regularly (minimum of weekly) with the HCHV Homeless Patient Aligned Care Team (HPACT) and/or other identified medical staff.

2.1. HCHV CERS Program Characteristics:

2.1.1. Offers residential programming located within the Northern Nevada with easy access by public transportation to Reno VA Health Care for Homeless Veterans Clinic (350 Capitol Hill, Reno, NV 89502) and/or Reno VA Medical Center (975 Kirman Ave, Reno, NV 89502)

2.1.2. Targets and prioritizes homeless Veterans who are eligible for VA health care and are transitioning from literal street homelessness, Veterans being discharged from institutions who are homeless, including those in need of medical respite or recuperative care, and Veterans who recently became homeless and require safe and stable living arrangements while they seek permanent housing

2.1.3. Has capacity to serve up to five (5) Veterans, at any time throughout the period of performance, identifying as men, women, and/or non-binary.

2.1.4. Lengths of Stay typically range from 30 to 90 days with the option to extend based on clinical need

2.1.5. Seeks to reduce barriers to immediate placement and accommodates same day admissions

2.1.6. Does not deny entry to HCHV CERS Program based solely upon:

2.1.6.1. Length of current abstinence from alcohol or non-prescribed controlled substances

2.1.6.2. Diagnosis

2.1.6.3. Number of previous treatment episodes

2.1.6.4. Time interval since the last program entry

2.1.6.5. Use of prescribed controlled substances including but not limited to prescribed FDA-approved medications such as methadone or buprenorphine for SUD treatment

2.1.6.6. Legal history

2.1.7. Considers each of the special circumstances above during the screening process and makes an admissions determination based on whether the individual Veteran’s needs can be met while maintaining the program’s safety, security, and integrity

2.1.8. Provides safe, secure housing as well as supportive services including but not limited to assistance in securing permanent housing, vocational assistance, including mentoring and coaching as well as job placement, income assistance and financial planning, linkage to health care, moderation of substance use, and social and recreational activities

2.1.9. Veterans are expected to meaningfully engage with their case managers and in available programming. Contractor is expected to actively engage Veterans in services from time of admission to time of discharge through outreach efforts, rapport-building, and Veteran-centered SMART goals. Engagement in services and the extent to which engagement is needed may look different from one individual Veteran to another.

2.1.10. Emphasis is placed on achieving placement in permanent housing at the time of program exit and on reducing negative exits due to rule violations or other avoidable circumstances

2.2. House Rules and Expectations

2.2.1. Rules focus on staff and resident safety:

2.2.1.1. No buying or selling of alcohol or drugs in the facility

2.2.1.2. No dealing or use of illicit drugs in the facility

2.2.1.3. No sexual activity between residents

2.2.1.4. No violence or threats of violence

2.2.1.5. Honor nightly curfew

2.2.2. When possible, infractions are to be used to engage residents, not simply as grounds for service termination. Negative discharges will be monitored as a measure of program quality.

2.2.3. Veterans are expected to engage in programming and maintain communication with case managers at all times around matters relating to admission, stay, and treatment.

2.2.4. It is essential that Veterans permit communication between VA and Contractor through an appropriate Release of Information (ROI) to ensure safe and effective treatment of each Veteran. Veterans who refuse to allow this communication about their treatment needs and ongoing care will need to receive services elsewhere.

2.3. Admission Practices

2.3.1. Contractor will assist Veterans with admission forms and eligibility determination with VA.

2.3.2. Contractor works to reduce barriers to admission and demonstrate flexibility with admission processes by:

2.3.2.1. Accepting referrals and admissions Monday – Friday, 8AM-4PM and, whenever possible, up to 24 hours a day, 7 days a week including weekends and holidays.

2.3.2.2. Making reasonable efforts to admit Veterans immediately when there is a vacancy in the program especially prior to a weekend or holiday if/when there is no option to admit over the weekend or holiday and Veteran has no alternative to staying on the streets.

2.3.2.3. Accommodating same-day admissions when there are vacancies in the program. If Contractor is unable to accommodate a same-day admission when there is a vacancy in the program, Contractor will provide written explanation with reason for delay to VA Liaison, COR, and/or designee.

2.3.2.4. Supporting Veterans in follow through with obtaining tuberculosis (TB) clearance within 10 working days of admission if TB clearance results are not available at the time of referral. Veterans shall be screened for TB via PPD or QuantiFERON or chest x-ray and shall not be admitted if exhibiting any signs or symptoms of active TB.

2.4. Admission Criteria

2.4.1. To be eligible for HCHV Contracted Residential Services, a Veteran must meet the requirements of 38 U.S.C. 2031(a) and 38 CFR 63.3.

2.4.1.1. Veteran is enrolled in the VA health care system, or eligible for VA health care under 38 CFR 17.36 or 17.37; and

2.4.1.2. Veteran is homeless as defined in 38 U.S.C. §§ 2002(1) and 103(a) of the McKinney-Vento Homeless Assistance Act, 42 U.S.C. § 11302(a) and 24 CFR 576.2 including:

2.4.1.2.1. Veteran who lacks a fixed, regular, and adequate nighttime residence; or

2.4.1.2.2. Veteran who will imminently lose their primary nighttime residence within 14 days of the date of application for homeless assistance.

2.5. Overview of Types of Services Available to Residents

2.5.1. Safe, Secure housing that includes laundry and restroom facilities

2.5.2. Ensuring access to three nutritious meals per day, seven days per week, as well as nutritious snacks between meals and before bedtime

2.5.3. Case Management and Care Coordination Services

2.5.4. Vocational training and employment services

2.5.5. Benefits Services

2.5.6. Enhancement of Independent Living Skills

https://www.law.cornell.edu/cfr/text/38 https://www.law.cornell.edu/cfr/text/38/17.36 https://www.law.cornell.edu/cfr/text/38/17.37

2.5.7. Permanent/ Transitional housing search support

2.5.8. Arranging, coordinating, and/or providing direct clinical services and support for mental health stabilization and substance use treatment services using Recovery Model principles.

3. OBJECTIVE

3.1. Contractor shall provide emergency housing and supportive services for homeless Veterans in community based HCHV CERS facilities that offer a safe and secure environment that support their goals for recovery from homelessness in accordance with the HCHV CERS model requirements. Services are expected to consist of 24-hours-a-day/7-days-a-week housing and supportive services for homeless Veterans, many of whom may be dealing with mental illness and/or substance use disorders and/or other comorbid conditions. The program places an expectation on the Veteran to engage in supportive case management services, and also on the Contractor to provide supportive services, expertise, and guidance that focuses on improving housing stability to ensure a transition from homelessness to permanent, stable housing and ongoing engagement with aftercare services upon discharge. Contractors must comply with all HCHV CERS requirements as identified below.

3.2. HCHV CERS PROVIDER QUALIFICATIONS & CAPABILITY REQUIREMENTS

3.2.1. Shall perform outreach or otherwise identifying and referring to the contract program homeless Veterans who may have mental illness and/or substance use disorders

3.2.2. Shall provide secure housing and bathroom accommodations; shared use of kitchen facilities and dining rooms is acceptable

3.2.3. Shall provide services twenty-four (24) hours a day for Veteran placements lasting up to ninety (90) days per Veteran. Extensions beyond initial ninety (90) days shall be authorized in writing by VA Liaison; extensions beyond six (6) months must be prior- approved by the Social Work Service Contract Coordinator/ COR/designee

3.2.4. Shall provide a sanitary food preparation area and ensuring access to three daily nutritious meals, nutritious snacks for those requiring or desiring additional food between meals even when not medically indicated, and reasonable accommodation for special dietary needs, e.g., diabetic, renal or soft mechanical diets, and/or cultural/religious preferences around food, e.g., Kosher, Halal, vegetarian

3.2.5. Shall offer means for Veteran participants to wash their own clothes or otherwise tend to laundry at a minimum of once per week; detergent shall be free of charge

3.2.6. Shall of provide accommodations that include semiprivate (private preferred) sleeping units with a bed and other furnishings such as a dresser, storage locker and lock or designated locked secured space, and personal linens (i.e., towels, pillows, blankets, bed sheets); storage space shall accommodate two bags of personal belongings and all prescribed medications and other medical equipment

3.2.7. Shall provide an isolation area or quiet space/safe room for Veteran participant(s) who may require closer short-term monitoring by staff for the health and safety of the community (e.g., management of acute intoxication or emotional dysregulation or prevention of disease transmission)

3.2.8. Shall store personal belongings for at least 72 hours after formal HCHV discharge

3.2.9. Shall provide quality case management and treatment services that utilize a

Recovery Model approach and include elements of Motivational Interviewing, Harm Reduction, and Critical Time Intervention

3.2.10. Shall maintain a minimum of one staff member on duty on the premises or a resident manager who resides at the facility and always has access to an on-call administrator in case of emergency to ensure appropriate response to matters involving Veteran safety

3.2.11. Shall facilitate prompt communication between Veteran participants and VA and always ensuring reasonably prompt communication (same day or within one business day) between Contractor and VA

3.3. DIRECT VETERAN CLINICAL SERVICES

3.3.1. Occupancy: Contractor will be responsible for ensuring that a minimally acceptable level of 80% occupancy (90-100% preferred) of HCHV CERS funded beds is maintained at all times through independent outreach efforts as well as through collaboration with VA.

3.3.1.1. Contractor will be knowledgeable about outreach best practices generally accepted in the community and will be responsible for engaging in outreach in the community including collaboration with VASNHCS providers for referrals at least twice monthly to maintain satisfactory occupancy rate when occupancy does not meet minimally acceptable level.

3.3.2. Therapeutic and Rehabilitative Services: These may include, but are not limited to, clinical case management, individual and group counseling, structured group activities such as 12-step meetings, vocational training, and/or prosocial outings, linkage to and coordination with VA and/or other community-based services/resources, independent living skills, and discharge planning that begins with an assessment of housing needs upon program entry.

3.3.3. Care Planning: Contractor will engage the Veteran in a collaborative assessment of service needs with input from the Veteran and the VA Liaison or designee and create an initial service plan of care to address those needs within 14 days of admission. Care plans must include goals and objectives for achieving stable housing. Care plan will include an assessment of strengths and barriers to stable housing, specific services to be provided including duration and outcomes, documentation of referrals and benefits to be achieved as a result of program participation. This plan is to be reviewed and updated every 30 days with the Veteran and the VA Liaison or designee and as needed throughout each individual Veteran’s episode of care. Contractor case manager shall meet with VA Liaison or designee at least once every 30 days to provide an update on case management progress made and must work cooperatively with VA Liaison or designee to coordinate services.

3.3.4. Case Management: Contractor will provide individual case management meetings at least once per week that focus, at a minimum, on: permanent housing search and stabilization, increasing income through referral to all potential financial resources such as SSI/SSDI, VA pensions, GA, SNAP, Medicaid, vocational training when indicated, self-care skills, adaptive coping skills, any necessary coordination of care provided by VA and community-based medical, mental health, and/or substance use treatment providers, and ongoing discharge planning that includes linkage to community resources for long-term housing success such as IHSS, Meals on Wheels, or Adult Day Health. Progress made in Veterans’ transition to stable housing must be clearly reflected in weekly case management notes.

3.3.5. Medication Storage and Monitoring: Contractor is expected to provide a means of securely and properly storing all medications brought into the program for Veteran use. Contractor shall ensure there are appropriate policies and procedures that support the safe storage of medications for Veteran participants. This storage can be provided to the Veteran to secure his or her medications, or central storage may be provided by the Contractor. Veterans may self-administer medications, but storage should ensure that no other program participants are able to access an individual Veteran’s medications. Any suspicion or concern for misuse is to be reported to VA Liaison and/or COR immediately by following incident reporting protocol.

3.3.6. Storage of Personal Belongings: Contractor will provide storage space such as a dresser, storage locker and lock, or designated locked secured space that will hold up to two bags of personal belongings and all prescribed medical equipment.

Contractor will allow Veteran to store personal belongings for at least 72 business hours after formal HCHV exit from program. If a Veteran abandons his/her belongings, Contractor will make three documented attempts to contact the Veteran and/or VA Liaison before disposing Veteran’s items.

3.3.7. Absences and Cancellation

3.3.7.1. The Department of Veterans Affairs (VA) allows payment to a provider for an absent Veteran under the circumstances outlined below.

3.3.7.1.1. Scheduled Absences. VA will pay per diem up to a maximum of

96 consecutive hours for the scheduled absence of a Veteran.

Contractor shall notify VA Liaison, COR or designee in writing of all Veteran requests for scheduled absences or “passes” prior to the start of any absence from program authorized by Contractor (preferably 24-48 hours) and include reason for pass and contact/location information for Veteran while absent. To receive payment, the absence must:

3.3.7.1.1.1. Be pre-planned, consistent with and support the

Veteran’s individual service plan (e.g., family reunification, short-term medical, substance use disorder or psychiatric treatment).

3.3.7.1.1.2. Have the reason documented in the individual Veteran’s case file, treatment record or service plan

3.3.7.1.1.3. Not result in the bed being filled by the provider

3.3.7.1.1.4. Not be for a break or vacation from treatment

3.3.7.1.1.5. Not be used for extended educational or employment circumstances

3.3.7.1.1.6. Not be used to create more than four consecutive days of absence

3.3.7.1.2. Unscheduled Absences. VA will pay per diem up to a maximum of 48 consecutive hours for the unscheduled absence. To receive payment for an unscheduled absence:

3.3.7.1.2.1. Contractor must have evidence of active outreach to locate and reengage the Veteran and document the steps taken in the Veterans individual case file, treatment record, or service plan.

3.3.7.1.2.2. Contractor shall notify VA Liaison, COR or designee immediately or during next available business hours of all unscheduled Veteran absences .

3.3.7.1.2.3. Contractor may not fill the bed during this time.

3.3.7.1.2.4. Veteran must be discharged from the HCHV CERS

program if not located within 48 hours

3.3.7.1.3. Ineligible Veteran. When a Veteran is admitted to an HCHV CERS program and found to be ineligible for HCHV CERS, VA will pay for a maximum of four (4) days from the date of admission to allow Contractor and HCHV CERS Liaison time to locate and arrange alternate placement.

3.3.7.2. Contractor may choose to maintain enrollment of a Veteran without payment beyond the approved 96-hour scheduled/48-hour unscheduled absence at Contractor’s discretion and in consultation with VA Liaison, COR or designee. However, the Veteran must be discharged if absent for more than 14 days.

3.3.7.3. Contractor cannot receive payment of per diem if/when an enrolled Veteran is temporarily placed in another VA Homeless Programs-funded bed such as HCHV CRS-contracted detox beds or medical respite programs.

3.3.7.4. VA reserves the right to remove any or all Veterans from the facility at any time without additional cost when it is determined to be in the best interest of the Veteran or VA.

3.3.8. Exits to Permanent Housing: The Contractor is expected to promote a focus on achieving stable, independent housing for all Veterans referred for care; exits to permanent, independent housing will be monitored as an indicator of overall program quality utilizing data provided by the VHA Support Service Center’s Homeless Services Scorecard. The target values for exits to this type of housing are established by VHA Homeless Program Office on an annual basis at the start of each fiscal year (e.g., FY23 target value for Exits to Permanent Housing is 55% or more) and can vary from year to year. Target values for Exits to Permanent Housing will be communicated by VA HCHV Liaison and/or COR to Contractor at the start of each fiscal year.

3.3.9. Negative Exits: The Contractor is expected to facilitate Veteran completion of the HCHV CERS Program to the maximum extent possible while still maintaining program integrity and safety. Negative Exits shall be defined as exits from the program in which the Veteran was asked to leave due to violation of program rules (excluding exits due to threatened/actual violence to self or others), failure to comply with program requirements, or leaving the program without consulting staff.

Negative Exits shall be monitored on a continuous basis utilizing data provided by the VHA Support Service Center’s Homeless Services Scorecard. The target values for Negative Exits are established by VHA Homeless Program Office on an annual basis at the start of each fiscal year (e.g., FY23 target value for Negative Exits is 20% or less) and can vary from year to year. Target values for Negative Exits will be communicated by VA HCHV Liaison and/or COR to Contractor at the start of each fiscal year.

3.3.9.1. Procedures for Negative Exits

3.3.9.1.1. For all negative exits other than exits for threatened/actual violence to self or others, Contractor shall develop a written progressive warning policy/procedure that includes issuance of at least two formal warnings prior to proceeding with a negative discharge.

3.3.9.1.1.1. The policy/procedure shall include case conference with Program Staff, Veteran, VA Liaison and/or Designee, and other clinical providers involved in the Veteran’s care, e.g., HUD-VASH Social Worker or

Mental Health/Substance Use Disorder staff, no later than issuance of the final warning.

3.3.9.1.1.2. Information on the policy/procedure shall be provided to the Veteran upon admission to the program including a formal appeals process through which Veteran may appeal program regulations, sanctions or discharges.

3.3.9.1.1.3. There shall be no permanent bans from the

program/facility. Veterans exited under negative circumstances shall be notified upon request of conditions or process for re-admission.

3.3.9.1.1.4. Contractor shall be expected to make reasonable

efforts to facilitate referral to another facility or appropriate level of care if negative discharge is indicated. Direct discharge to VASNHCS Hospitals or Clinics for alternative resources and referrals without consulting HCHV Liaison on day of discharge is not considered an appropriate level of care.

3.3.9.1.1.5. The policy/procedure shall be subject to approval by

VA Liaison, COR and/or Designee.

3.4. ADMINISTRATIVE SERVICES

3.4.1. Determination of Eligibility, Referrals, and Admissions

3.4.1.1. VA is responsible for determining Veteran eligibility for placement in program prior to admission by Contractor for services.

3.4.1.2. Contractor is responsible for obtaining confirmation of Veteran eligibility for placement into program prior to admission of each Veteran referred under this contract.

3.4.1.3. If there is an urgent need to admit a Veteran and designated VA staff is unavailable to provide written verification of eligibility prior to admission, then verbal approval by VA is acceptable pending receipt of written verification.

3.4.1.4. Any admissions that occur without written/verbal approval must be verified by VA staff within 24 business hours in order for Contractor to receive payment for day(s) admitted prior to formal approval (e.g., admission occurs after hours or over the weekend).

3.4.1.5. Failure to establish eligibility prior to admission may result in denial of payment for services provided.

3.4.1.6. A list of authorized VA ordering personnel including primary identified VA

Liaison shall be made available to Contractor upon award of the contract.

VA employees may be added or deleted from this list during the term of the contract at the discretion of VA. Contractor shall not deviate from the list of individuals authorized to approve admissions without an updated list.

3.4.1.7. To be eligible for HCHV Contracted Residential Services, all Veterans must meet the requirements of 38 U.S.C. 2031(a) and 38 CRF 63.3, i.e., Veterans in this program must be homeless or at imminent risk of homelessness within 14 days of application for services and be eligible and registered for VA health care at VASNHCS

3.4.1.8. Referral constitutes authorization of an initial service period of up to 90 days unless otherwise specified.

3.4.1.9. Contractor shall be expected to provide same-day residential placement in the CERS program whenever possible. Contractor shall work to reduce barriers to admission by accepting referrals throughout the day and practicing flexibility with admissions processes. Admissions decisions shall be made on the same day of referral for admission when there is a program vacancy and no later than 24 hours after receipt of referral if the program does not have any immediate openings. Notification of all admissions decisions, any delay in admissions decisions beyond 24 hours, and reasons for denial of any admission shall be provided in writing to HCHV Liaison, COR, and/or designee. Admissions process is subject to VA Liaison review and adjustment at any time to ensure program accessibility for Veterans.

3.4.1.10. Contractor shall display a willingness to accept referred Veterans. VA referral to program shall include a verbal and/or written description of the referred Veteran’s current clinical presentation, current psychosocial circumstances, and risk assessment. Admissions decisions are not contingent upon Contractor receipt of SWS psychosocial assessment or Veteran’s intent to enroll in treatment at time of referral. It is understood that Veterans to be cared for under this contract will require care and services beyond room and board and may need more intensive case management than the general population. Level of intensity of services will be part of an ongoing discussion with VA Liaison. Contractor shall maintain effective communication with VA regarding any issues covered under this agreement.

3.4.2. Release of Information: Contractor shall ensure that a signed VA Release of

Information (ROI) is obtained for any Veteran being admitted to an HCHV CERS Bed and placed into individual case record.

3.4.3. Individual Case Records: Contractor will maintain an individual case record for each referred Veteran. Case records must be maintained in security and confidence as required by the Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR part II) and the Confidentiality of Certain Medical Records (38 USC 7332), and in accordance with the Health Insurance Portability and Accountability Act (HIPAA:

Pub. Law. 104–191). Records should contain at a minimum:

3.4.3.1. Reason for referral

3.4.3.2. Pertinent demographic information

3.4.3.3. Verification of Veteran status

3.4.3.4. Family status

3.4.3.5. Employment history

3.4.3.6. Education/marketable skills/licenses/credentials

3.4.3.7. Copies of any medical prescriptions/orders issued by physicians for any contract program that implements medication management/monitoring.

Contractor must comply with HCHV inspection requirements.

3.4.3.8. Individual service plan as described in Section C.3.3. Care Planning.

3.4.3.9. Weekly case management/treatment notes and documentation of any case management interventions or Veteran case conferences

3.4.3.10. Authorized absence “pass” requests

3.4.3.11. Critical incident reports

3.4.3.12. Extension approvals when indicated

3.4.3.13. Final summary that includes reason(s) for leaving, Veteran’s known future plans, and follow-up locator information if available

3.4.3.14. Any and all information needed to meet clinical requirements of annual

HCHV Residential Services Programs inspection (see sample attached, “Health Care for Homeless Veterans Contracted Residential Services Programs Inspection Packet – Clinical Review”)

3.4.4. Computer Security: In the performance of official duties under this contract, Contractor may have regular access to printed and electronic files containing sensitive data. This data shall be protected under the provisions of the Privacy Act of 1974 and other confidentiality laws, and agency policy. Contractor shall ensure its personnel protect the data from unauthorized release or from loss, alteration, or unauthorized deletion. Contractor shall ensure its personnel take all reasonable precautions to safeguard patient information from unauthorized access or modification, in both electronic and hard-copy formats. This includes not only electronic security measures such as “strong” user passwords on computer systems, but also physical barriers to prevent unauthorized use of computer work-stations; and also requires that hard copy Veteran files are stored in secured lockable areas, that files are in lockable cabinets, that the cabinets can in fact be locked (i.e., keys are available, and the locking mechanisms work properly). If Contractor uses computer laptops, Contractor shall store computer laptops in a safe, secure locked bag or cabinet when not in use, and store in locked, secure location (i.e., trunk of car) when transporting computer laptop in the field. Contractor shall also take all reasonable precautions to safeguard patient information when transferring Veteran information via electronic means, such as faxing or system-to-system transmission. Contractor shall not use personal flash drives to store or retain any personal health information (PHI) or Veteran information. Contractor shall not transmit any PHI via email without use of encryption software that uses VA-approved authentication mechanisms. While the first initial of the last name of a Veteran and the last four of their social security number by itself is not considered individually identifiable, any other PHI that has not been de-identified in accordance with VHA Directive 1605.01 coupled with the last initial/last four may not be transmitted together without encryption.

3.4.5. Homeless Management Information System (HMIS) Data Reporting: Veterans served through VA’s HCHV CERS program must have client level data entered into the local Community Continuum of Care’s (CoC) HMIS. Data entered must include, at a minimum, the Universal Data Elements from the 2010 HMIS Data Standards.

Contractor is responsible for registering with local HMIS system to obtain access roles and manage agency data within the system.

3.4.6. Daily Census Sign-In Sheet: Contractor is responsible for collecting Veteran participant signatures on a daily census sign-in sheet to verify attendance in the program. This information is to be provided to the VA Liaison, COR, or other designee at a frequency to be designated by VA that is no less than once weekly and up to daily with weekend or holiday sign-in sheets to be provided on the next business day in order to ensure effective monitoring of bed utilization.

3.4.7. Incident Reporting

3.4.7.1. Contractor shall notify the VA immediately when any adverse critical incident involving a Veteran admitted to the program occurs. Critical Incidents shall include:

3.4.7.1.1. Falls

3.4.7.1.2. Elderly/Dependent Adult Abuse or Neglect

3.4.7.1.3. Sexual Assault

3.4.7.1.4. Fire (Veteran Involved)

3.4.7.1.5. Medical or Mental Health Emergency (911 Calls)

3.4.7.1.6. Hospitalization

3.4.7.1.7. Suicidal ideation or attempt

3.4.7.1.8. Homicidal ideation

3.4.7.1.9. Assault (of other residents or Staff)

3.4.7.1.10. Death

3.4.7.1.11. Infectious Control Concerns (e.g., Bed Bugs, TB, Scabies, Coronavirus)

3.4.7.1.12. Active Substance Use

3.4.7.1.13. Observation/ Possession of Weapons

3.4.7.2. During regular business hours, VA Liaison, HCHV Coordinator/Supervisor and/or COR shall be contacted immediately by phone to report such an incident; if the incident occurs outside of regular business hours (Monday- Friday 8:00AM-4:30PM), Contractor shall notify VA Liaison, HCHV

Coordinator/Supervisor and/or COR at the start of the following business day. Should Contractor require immediate afterhours VA support/intervention, Contractor shall notify the VASNHCS Administrator on Duty (AOD) by calling the local VA facility. A written report to the VA Liaison and/or COR should follow the initial VA notification within 24 business hours. The report should list known precipitating factors or triggers. Contractor shall maintain a copy of all critical incident reports in the involved Veteran’s individual case record.

3.4.8. Extension Requests: It is understood that Contractor will not be paid for care provided to a Veteran participant beyond the initial authorized period unless an extension of authorization is provided in writing by the VA. Contractor is responsible for ensuring that all requests for extension of services beyond the initially authorized service period of 90 days are reviewed in advance and approved in writing by the VA Liaison, COR, or other designee before reaching the Veteran participant’s 90th day. Extension requests must include clinical reasoning and a targeted housing plan to justify approval; extension requests will be individualized to Veteran needs and approved, in writing, in increments of no more than 30 days at a time. Only extraordinary circumstances will be considered in order to extend service periods in excess of six (6) months, and all requests for extension exceeding six (6) months from date of admission must be approved in writing by VA Liaison and COR or designee.

3.4.9. Grievance Procedures: Contractor must have an internal grievance process that

Veterans can use to resolve conflicts within the program. Contractor must have written policies and procedures for resolving grievances including a statement regarding the client’s right to request reasonable accommodation and must post them in a conspicuous place that is accessible to program participants. Each Veteran shall receive a copy of the grievance policies and procedures upon intake and upon receiving a warning or notice of discharge.

3.4.9.1. Contractor shall refer grievances received directly from Veterans to the identified VA Liaison, COR or designee within 24 business hours of complaint. All grievances received by the VA Liaison, COR or designee will be forwarded to the Contractor within 24 business hours and shall be investigated promptly. After investigation and clarification of disposition, Contractor shall respond to the VA Liaison or COR within five (5) business days or less with proposed resolution or plan for corrective action. The Contracting Officer (CO) shall be notified in instances where the proposed course of action or response does not appear sufficient to resolve any given complaint.

3.4.9.2. VA Liaison, COR or designee will monitor the services being provided in this contract program. Contractor is expected to cooperate with VA Staff and COR by providing information and answering questions in a timely manner when requested. Contractor will be subject to a Contract Discrepancy Report (CDR) anytime unacceptable contract performance is determined to be critical in nature and requires formal corrective action through report of contract discrepancy to CO. Failure to perform duties herein will have Contractor be subject to contract termination.

3.4.10. Satisfaction Surveys: When requested, Contractor will be responsible for administering, collecting, and delivering to VA Liaison a survey of the Veterans’ experience in the program.

3.4.11. Admission and Discharge Reporting: Contractor is responsible for notifying the identified VA Liaison, COR, and/or designee within 24 business hours that an admission or discharge has occurred and for providing a written report of admission or discharge within 48 business hours that contains the specific data required by the Northeast Program Evaluation Center (NEPEC) for documentation in the Homeless Operations and Management Evaluation System (HOMES). The written report of discharge shall also contain a brief discharge summary that includes but is not limited to: date of exit, type of exit (positive vs. negative vs. neutral), Veteran’s perception of exit in instances where a Veteran was terminated from the program, status of treatment goals at the time of exit, sentinel events occurring during the episode of care, established aftercare plan, housing status at exit and future contact information.

4. CONDUCT

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

4.2. Local law enforcement and/or fire departments should be contacted for assistance and intervention as appropriate and indicated by any given circumstances.

4.3. Contractor shall also notify the VA Liaison, AOD, or COR immediately of any high-risk situations involving Veterans with suicidal and/or homicidal threats or ideation, episodes of physical or sexual violence, sexual activities, safety concerns, or activities involving illegal substances so that appropriate response may be coordinated.

4.4. In the event of a medical or psychiatric emergency, it is agreed that every effort will be made to facilitate Veteran access to local VA Medical Center for care. If a VA Medical Center is not available in the vicinity or is otherwise inconveniently located, Contractor will advise the VA Liaison or AOD of the facility to which the Veteran has been admitted.

Contractor will also be expected to assist Veterans requiring non-urgent services with accessing appropriate care from a VA or community facility, as appropriate.

5. TRAVEL

5.1. Contractor is expected to assist Veterans with arranging local transportation to scheduled meetings and appointments. Contractor is expected to help Veterans understand and learn how to use public transportation. This includes providing education, information and clarifying instructions necessary to effectively utilize public transit systems. If

Contractor and/or VA staff determine that public transportation is not available, adequate, or appropriate for any Veteran, Contractor will be expected to assist the Veteran with identifying alternative modes of transport. Contractor is not required to provide transportation to a Veteran directly.

6. FACILITIES

6.1. General Requirements: It is the responsibility of Contractor to properly maintain its facilities and the VA shall have no responsibility for paying or reimbursing the Contractor for such expenses. The contract facility must:

6.1.1. Have a current occupancy permit issued by the local and state governments, where applicable, in the jurisdiction where the facility is located.

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

6.1.3. Meet the requirements of the Americans with Disabilities Act (ADA) (Public Law 100- 336, 42 USC 12101-12213) pertaining to handicapped accessibility in effect on the date of contract award.

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

6.1.5. Where applicable, be accredited by the State.

6.1.6. Be equipped with operational air conditioning/heating systems if needed to maintain acceptable temperature

6.1.7. Be kept clean free of dirt, grime, mold, or other hazardous substances and damaged noticeably detract from the overall appearance.

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

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

6.1.10. Have an aggressive ongoing plan to address bed bug infestation. Ongoing bed bug infestation will be grounds for immediate discharge of Veterans from the facility.

6.1.11. Have emergency and disaster plans with written protocols that are posted to guide staff response to crises including, but not limited to, manmade and natural disasters, episodes of infectious diseases, physical injury, program participant suicide or suicide attempts, overdoses, and domestic or other violence. All Contractor staff shall be trained on emergency procedures and protocols.

6.2. Fire Safety Requirements:

6.2.1. The building must meet the requirements of the applicable residential occupancy chapters of the current version of NFPA 101, National Fire Protection Association's Life Safety Code. Any equivalencies or variances must be approved by VASNHCS Director.

6.2.2. Fire exit drills must be held at least quarterly. Program participants must be instructed in evacuation procedures when the primary and/or secondary exits are blocked. A written fire plan for evacuation in the event of fire shall be developed and reviewed annually. The plan shall outline the duties, responsibilities and actions to be taken by the staff and residents in the event of a fire emergency. This plan shall be implemented during fire exit drills. A written policy regarding tobacco smoking in the facility shall be established and enforced.

6.2.3. Portable fire extinguishers shall be installed at the facility. Use NFPA 10, Portable

Fire Extinguishers, as guidance in selection and location requirements of extinguishers. Requirements for fire protection equipment and systems shall be in accordance with NFPA 101. All fire protection systems and equipment, such as the fire alarm system, smoke detectors, and portable extinguishers, shall be inspected, tested and maintained in accordance with the applicable NFPA fire codes and the results documented.

6.3. Inspection

6.3.1. Prior to the award of any contract and annually thereafter during any subsequent contracted performance periods, a multidisciplinary VA team consisting of a social worker, dietitian or nutrition and food service professional, nursing staff, VA Police, and a Safety and Occupational Health Specialist, as well as any other subject matter experts determined necessary by the medical center director, COR, HCHV Coordinator, or VA Liaison, shall conduct a survey of the Contractor’s facilities to be used to provide Veterans food, shelter, and clinical services to assure the facility provides acceptable level quality care in a safe environment. Additional inspections may also be carried out, announced or unannounced, at any other time as deemed necessary by VA.

6.3.2. Contractor will be advised of the findings of the annual inspection team. If deficiencies are noted during any inspection, Contractor will be given a reasonable amount of time (typically 30 days) to take corrective action and to notify the Contracting Officer, Contracting Officer’s Representative, or other VA designee that the corrections have been made. A contract will not be awarded until noted deficiencies have been eliminated. Failure by Contractor to take corrective action within the reasonable time provided will be reported to the VA Contracting Officer.

If corrections are not made to the satisfaction of the VA, the Contracting Officer will be notified, and shall be the final arbiter on the necessary resulting consequences and action.

6.3.3. Annual reinspections shall be unannounced whenever possible. When an unannounced annual inspection is not possible due to privacy or other concerns, no less than four unannounced site visits by HCHV Liaison or other VA designee shall be made annually in addition to annual reinspection and shall include:

6.3.3.1. A visual safety and sanitation inspection of the facility including meal preparation areas, fire exits, sleeping areas and medication storage. Any safety or sanitation deficiency must be addressed immediately.

6.3.3.2. Review of Contractor’s emergency and disaster plans to ensure they are up to date and that staff are trained in the procedures outlined in the plans.

6.3.3.3. An audit of Veteran’s clinical records selected randomly to ensure documentation of case management services and that other services are being provided as required by the contract terms.

6.3.3.4. Review of any Veteran complaints to ensure that these have been resolved in a fair, impartial and consistent manner.

6.3.3.5. The results of the unannounced site visits are to be documented and shared with the COR and the Contracting Officer. The report and any issues that were found along with the resolution must be kept in the COR Administrative File for that program.

6.3.4. The inspection of the Contractor facilities will include inspection for conformity to the current Life Safety Code as described in Section 6.2, and will also include the following:

6.3.4.1. General observation of residents to determine if they maintain an acceptable level of personal hygiene and grooming.

6.3.4.2. Assessment of whether the facility meets applicable fire, safety and sanitation standards.

6.3.4.3. Determining whether the facility is in attractive surroundings conducive to social interaction and the fullest development of the resident's rehabilitative potential.

6.3.4.4. Observation of facility operations to see if appropriate organized activity programs are available during waking hours (including evenings) and degree to which a high level of activity is observed in the facility, such as individual professional counseling, physical activities, assistance with…