36C26123Q0651.docx

Sources Sought Notice Sources Sought Notice

GENERAL INFORMATION

SET-ASIDE

VA Sierra Pacific Network (VISN 21) VA Central California Health Care System 855 M Street, Suite 1020 Fresno CA 93721

POINT OF CONTACT*

Maricela Berrones-Gauger Maricela.Berrones-Gauger@va.gov maricela.berrones-gauger@va.gov 559-225-6100

PLACE OF PERFORMANCE

ADDRESS

San Francisco, CA

POSTAL CODE

COUNTRY

ADDITIONAL INFORMATION

AGENCY’S URL

URL DESCRIPTION

AGENCY CONTACT’S EMAIL ADDRESS

EMAIL DESCRIPTION

DESCRIPTION

Sources Sought Synopsis The purpose of this Sources Sought Synopsis is to assist in our decision-making process for a service procurement. This is not a solicitation, nor a request for quotes or proposals. Responses to this sources sought synopsis will be used by the Government to make appropriate acquisition decisions.

The Government is not obligated to, nor will it pay for or reimburse any costs associated with responding to this sources sought synopsis request. This notice shall not be construed as a commitment by the Government to issue a solicitation or ultimately award of a contract, nor does it restrict the Government to a particular acquisition approach. The Department of Veterans Affairs, Network Contracting Office (NCO) 21, is conducting market research to identify potential vendors that can provide HCHV Low Demand Safe Haven Services per the general requirements below.

Sources Sought Synopsis

General Requirements The Contractor shall provide HCHV Low Demand Safe Haven Services. The Safe Haven Program provides short-term 24/7 residential services to eligible Veterans who need immediate housing placement as they seek permanent housing and/or additional care and services. These interim housing services shall be provided in a community-based facility that offers a safe and secure environment and supports the Veterans’ individualized goals for recovery from homelessness in accordance with the HCHV LDSH Model characteristics, core values, and requirements.

Place of Performance:

Services shall be provided off site at the Contractor’s location Period of Performance: The intended period of performance which will approximately begin September 30th, 2023.

Response Method Any inquiries are to be made in writing by email to the point of contact, Maricela Berrones-Gauger, Contract Specialist. Responses to this notice shall be sent by email to Maricela.Berrones-Gauger@va.gov by the due date and time of May 19th, 2023 3pm (Pacific Time). The email’s subject line should be: SAM – HCHV for SFVAHCS Responsible sources are encouraged to submit a response to this sources sought synopsis with a statement of interest on a company letterhead.

At a minimum please provide the following:

1. Company Name and Address

1. GSA Federal Supply Schedule Contract Number (if applicable)

1. Point of Contact Name, Phone, and Email

1. Socio-economic status as it relates to 624221 (Temporary Shelters)

3. Please ensure the System for Award Management (SAM) (sam.gov) indicates this NAICS code if you are interested in the requirement

1. SAM UEI

1. Business Size SMALL or LARGE

1. Description of your firm’s capability in providing HCHV services (Include relevant past performance/ contract number and point of contact for services provided)

Before responding, please carefully read and consider the following:

As this is a service acquisition, the Small Business Administration and the Federal Acquisition Regulation have a Limitations on Subcontracting requirement. For all small businesses, to include SDVOSB and VOSB, “At least 50 percent of the cost of contract performance incurred for personnel shall be expended for employees of the concern.” See FAR 52.219-14 available in full text at https://www.acquisition.gov/far/part-52 Invoices will only be accepted on a monthly basis.

1. Weekly invoices will not be accepted.

1. Please see the attached DRAFT performance work statement for further details.

PRICE/COST SCHEDULE

Ordering Period One: PERIOD OF PERFORMANCE: September 30, 2023 – September 29, 2024

Ordering Period Two: PERIOD OF PERFORMANCE: September 30, 2024 – September 29, 2025

Ordering Period Three PERIOD OF PERFORMANCE: September 30, 2025 – September 29, 2026

Ordering Period Four: PERIOD OF PERFORMANCE: September 30, 2026 – September 29, 2027

Ordering Period Five: PERIOD OF PERFORMANCE: September 30, 2027 – September 29, 2028

TOTAL FOR ALL ORDERING PERIODS: __________________

PERFORMANCE WORK STATEMENT - DRAFT

1. BACKGROUND

0. Ending Veteran homelessness was established as a National priority by former Department of Veterans Affairs (VA) 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 resulted in a period that has decreased Veteran homelessness by more than half with over 960,000 Veterans and their family members becoming permanently housed or prevented from becoming homeless. USICH has since released the Biden-Harris Administration’s own roadmap to reducing homelessness 25% by January 2025, All In: The Federal Strategic Plan to Prevent and End Homelessness. Ending homelessness among Veterans specifically remains a top priority of VA, current VA Secretary Denis R. McDonough, and the Biden-Harris Administration.

0. After VA exceeded its 2022 goal by more than 6% by placing over 40,000 homeless Veterans into permanent housing, VA announced that its 2023 goals for preventing and ending Veteran homelessness include: placing at least 38,000 more Veterans experiencing homelessness into permanent housing, ensuring that at least 95% of those Veterans housed in 2023 do not return to homelessness during the year, ensuring that at least 90% of those who do return to homelessness are rehoused or are on a path to rehousing by the end of 2023, and at least 28,000 unsheltered Veterans are engaged with help to obtain housing and other wraparound services.

0. The Health Care for Homeless Veterans (HCHV) Program is an essential and critical part of VA, 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 interim housing assistance by contracting with community providers. HCHV Contract Residential Services 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 to living successfully in permanent, stable housing.

0. In July 2010, under the leadership and direction of the VA National Center on Homelessness among Veterans, VA Low Demand Safe Haven (LDSH aka “Safe Haven”) Programs were developed and implemented as evidence-based practice that serves as an alternative to more traditional programs for homeless Veterans. Safe Haven Programs are community-based early recovery models of care that incorporate Harm Reduction principles and practices into supportive interim housing for hard-to-reach, hard-to-engage chronically homeless Veterans with severe mental illness and/or substance use disorders. Safe Havens were created to meet the gap in access and availability for those who would otherwise have difficulty succeeding in other VA interim housing programs.

1. PROGRAM DESCRIPTION

1. The HCHV LDSH “Safe Haven” Program provides short-term 24/7 residential services to eligible Veterans who need immediate housing placement as they seek permanent housing and/or additional care and services. These interim housing services shall be provided in a community-based facility that offers a safe and secure environment and supports the Veterans’ individualized goals for recovery from homelessness in accordance with the HCHV LDSH Model characteristics, core values, and requirements. The purpose of this solicitation is to obtain offers from Contractors who can provide the type of wraparound, low barrier, low demand residential services and facility that employs harm reduction strategies to support Veterans in attaining and maintaining housing while seeking to minimize the health impacts and social effects of risky behaviors. This program shall serve hard-to-reach, hard-to-engage chronically homeless Veterans with severe mental illness and/or substance use disorders and/or other comorbid conditions, who have not been successful in traditional programs, and/or who cannot, or will not, be fully compliant with the rules of a traditional homeless program or who cannot, or will not, abstain from alcohol and drug use. The Safe Haven Program shall serve as a means of moving homeless Veterans from the street or other habitation unfit for human habitation and placing them in a community-based, residential environment with sufficient supportive services to meet their basic needs, facilitate improvement of their overall health status, and help end their homelessness.

1. Safe Haven Program shall offer residential programming located within the City and County of San Francisco, CA with easy access by public transportation to San Francisco VA Downtown Clinic (401 3rd Street, San Francisco, CA 94107) and/or San Francisco VA Medical Center (4150 Clement Street, San Francisco, CA 94121).

1. Safe Haven Program shall cover up to a total of five years that includes one 12-month Base Year and four additional 12-month Ordering Periods.

1. Safe Haven Program shall have capacity to serve up to 19 Veterans who identify as men, women, and non-binary adults.

1. Safe Haven Program Characteristics and Core Values

4. Serves Veterans who are eligible for VA health care

4. Serves Veterans who are homeless and who are transitioning from literal street homelessness, who are being discharged from other programs or institutions, and/or who recently became homeless and require safe and stable living arrangements while they seek permanent housing

4. Targets and prioritizes chronically homeless Veterans with severe mental illness and/or substance use problems who are in the early stages of recovery

4. Targets and prioritizes Veterans who have not been successful in traditional programs

4. Targets Veterans who cannot, or will not, be fully compliant with the rules of a traditional homeless program and/or who cannot, or will not, abstain from alcohol or drug use

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

4. Does not require abstinence or compliance with treatment as a condition of admission or continued stay (Core Value)

4. Provides safe, secure housing, supportive services, and a trauma-informed environment of care (Core Value)

4. Environment of care is as non-intrusive as possible; demands are kept to a minimum; low demand is not no demand (Core Values)

4. Engages Veterans in harm reduction strategies with a primary focus of attaining and maintaining housing (Core Value)

4. Based on acceptance that not all mental health and substance use problems can “be fixed” (Core Value)

4. Lengths of Stay are typically up to 180 days with the option to extend based on clinical need

4. Safe Haven Low Barrier Admissions Practices

12. Contractor will work to reduce or eliminate program admission requirements, obstacles and barriers, both on an individual level (e.g., requirements for treatment compliance) and the system level (e.g., delays between screening and admission)

12. Contractor will focus on minimizing “housing readiness” issues for admission to program

12. Contractor will allow trial visits by Veterans to see if the program is a good fit

12. Contractor will assist Veterans with admissions forms and eligibility determination with VA

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

4. Accepting referrals and admissions Monday – Friday, 8AM-4:30PM; and

4. If/when possible, up to 24 hours a day, 7 days a week including weekends and holidays

1.4.12.4.2. Making reasonable efforts to admit Veterans immediately whenever 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

4. 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

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

4. Not denying entry to HCHV LDSH Program based solely upon:

5. Abstinence from alcohol or non-prescribed controlled substances

5. Diagnosis

5. Number of previous treatment episodes

5. Time interval since the last program entry

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

5. Legal history including legal requirement to register as a sex offender

5. Veteran’s total income

5. Veteran’s student or vocational status

4. 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

12. Admissions Criteria

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

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

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

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

4. Safe Haven Low Demand Rules and Expectations

13. Contractor works to reduce or eliminate requirements, obstacles, and barriers to continued stay

13. Rules are simple, easily understood, and kept to a minimum

13. Rules focus on staff and resident safety (Core Value), e.g.,

2. No buying or selling of drugs in the facility

2. No drug use in the facility

2. No sexual activity between the residents

2. No violence or threats of violence

13. Episodes of intoxication, substance use, compliance problems, and rule infractions are to be used as opportunities for engagement, not simply as grounds for discharge or to impose sanctions; punitive responses to infractions are avoided (Core Values)

13. Emphasis is placed on achieving placement in permanent housing at the time of program exit and on reducing negative exits due to simple rule violations or other avoidable circumstances; negative discharges will be monitored as a measure of program quality

13. Minimal demands with High Expectations include:

5. Primary focus on attaining and maintaining stable housing

5. Expectation that Veterans will transition to permanent housing

5. Privacy (e.g., private rooms) for Veterans

5. Expectation that Veterans will engage with their case managers in developing a housing plan; other treatment and programming is optional but encouraged

5. Mental health and substance use treatment are optional but encouraged

5. Engagement in care may look different for each Veteran enrolled in the program

5. Engagement in services and the extent to which assertive engagement is needed may look different from one individual Veteran to another.

5. 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.

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

13. Veterans shall 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.

4. Overview of Types of Services Available to Veterans

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

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

14. Case Management and Care Coordination Services

14. Vocational training and employment services

14. Benefits Services

14. Enhancement of Independent Living Skills such as money management, food preparation and access, or housekeeping/laundry skills

14. Support for housing search

14. Arranging, coordinating, and/or providing direct clinical services including clinical case management and support for mental health stabilization and substance use treatment services using Harm Reduction Model principles

14. Facility-provided programs of general interest such as personal development programs and prosocial community outings

4. Best Practices for Daily Life in Safe Haven Program may include:

15. Safe Rooms/Sober Lounges/Observation Areas as an alternative means of ensuring Veteran and staff safety while managing aggressive or disruptive behavior, emotional dysregulation, intoxication, or drug-induced behavior at the facility that may otherwise lead to police involvement and/or lower program retention rates

15. Amnesty Boxes for contraband management

15. Empowering Veterans through opportunities to participate in program governance and giving Veterans a voice through a Resident Council or community meetings

15. Utilization of peer support and mentorship by senior program participants during orientation of Veterans new to the program; resident orientation is designed to set expectations

15. Incentivization of participation, e.g., for doing daily chores

1. HCHV LDSH CAPABILITY REQUIREMENTS

5. Capable of performing outreach on the streets or otherwise identifying and referring to the contract program hard-to-reach chronically homeless Veterans with severe mental illness and/or substance use disorder and/or other comorbid conditions who are currently living on the streets and have been unable or unwilling to participate successfully in other traditional programs for homeless individuals

5. Capable of admitting a Veteran for placement on the same day of referral when space is available

5. Capable of providing services 24 hours per day for Veteran placements lasting up to 180 days per Veteran; extensions beyond the initial 180 days shall be authorized in writing by VA Safe Haven Liaison, Social Work Service Contract Coordinator, COR, and/or designee

5. Capable of providing secure and private accommodations that include private 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

5. Capable of providing bathroom accommodations that may include private bathrooms or shared bathrooms that are separated by gender and/or include gender neutral accommodations

5. Capable of providing showers and toilets that are kept clean and sanitary 24 hours a day/7 days a week

5. Capable of providing 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; shared kitchen and dining facilities are acceptable

5. Capable of offering a means for Veteran participants to wash their own clothes or otherwise tend to laundry at a minimum of once per week; laundry services and detergent shall be free of charge

5. Capable of providing clinical case management and treatment services that utilize a Harm Reduction Model approach and include elements of Motivational Interviewing, Critical Time Intervention, and Trauma-Informed Care. (Note: The per diem rate established by this contract is all inclusive of services listed in this document as well as all services normally provided to other residents of the facility, if any, without extra charge.)

5. Capable of providing drop-in services as part of engagement activities available in a low demand setting where participants have ready access to needed services but are not required to utilize them

5. Capable of providing 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)

5. Capable of maintaining staff onsite 24 hours a day, 7 days a week with sufficient personnel to maintain the safety and security of the program

5. Capable of facilitating prompt communication between Veteran participants and VA and ensuring reasonably prompt communication (same day or within one business day) between Contractor and VA at all times

1. DIRECT VETERAN CLINICAL SERVICES

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

0. 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 SFVAHCS providers for referrals at least twice monthly to maintain satisfactory occupancy rate when occupancy does not meet minimally acceptable level.

6. 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 at least once every 30 days with the Veteran and the VA Liaison or designee and as needed throughout each individual Veteran’s episode of care. Contractor shall coordinate care with VA Liaison or designee during weekly case conferences to provide an update on case management progress made and shall work cooperatively with VA Liaison or designee to coordinate services and foster a collaborative relationship between the VA and Contractor in meeting Veteran needs. Case conferences may be done in person or by virtual conference calls as agreed upon by VA Safe Haven Liaison and Contractor.

6. Case Management: Contractor shall provide individual clinical case management meetings at least once per week that focus on each Veteran’s individualized needs as identified through the care planning process which shall include a housing plan and may also include at minimum: increasing income through referral to all potential financial resources and entitlements relevant to individual need such as SSI/SSDI, VA pensions, GA, SNAP, Medi-Cal, and/or employment, vocational training, 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/or 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.

6. Mental Health and Substance Use Disorder Treatment: Contractor shall demonstrate flexibility and adaptability by meeting each Veteran where they are. Participation in outpatient mental health and/or substance use disorder treatment is not required but encouraged when indicated. Contractor will be expected to provide individual and group treatment and services using evidence-based practices that support the Veterans in gaining and applying knowledge of the recovery process to his/her/their life and to provide referral for additional treatment and/or aftercare supports as needed to promote and facilitate the individual Veteran’s recovery efforts and successful transition to permanent housing. Treatment may be defined as services which are needed for the specific clinical presentation of each individual Veteran including, but not limited to, VA-based services, community-based care, and/or services provided by Contractor at the program site. Working towards engagement in the types of treatment that meet the individualized needs of each Veteran is integral to the program’s care planning process. Admissions decisions shall not be contingent upon a Veteran’s expressed willingness to engage in treatment at time of referral.

6. Therapeutic and Rehabilitative Services: Contractor shall provide, or assist with linkage to, a variety of daily structured groups, activities and supportive services that promote healthy living skills and social skills building on- and off-site that may include, but are not limited to, 12-step or other recovery meetings, recreation, education, vocational training and job fairs, shopping, prosocial groups and outings, linkage to and coordination with VA and/or other community-based services/resources, social skills training, independent living skills training including health education, safety, and personal hygiene/basic cleanliness skills, self-governing Veteran groups, and discharge planning that begins with an assessment of housing needs upon program entry. Contractor shall provide documentation of all therapeutic and rehabilitative services provided throughout each Veteran’s episode of care.

6. VA Safe Haven Liaison: VA Safe Haven Liaison (“Liaison”) shall be a full-time VA Social Worker who is available to Contractor during VA business hours (8:00AM-4:30PM). The role of Liaison is to advocate for Veterans, ensure they are being linked effectively with VA and community services, and take part in outreach activities with Contractor staff to enroll and retain homeless Veterans in the Safe Haven Program. Liaison will also monitor and assist with implementation of and fidelity to the Safe Haven Model of care and serve as consultant to Contractor staff.

6. Medication Storage and Monitoring: Contractor shall 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.

6. Storage of Personal Belongings: Contractor shall 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 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 of Veteran’s items.

6. Absences and Cancellation

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

0. 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:

0. 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).

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

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

0. Not be for a break or vacation from treatment

0. Not be used for extended educational or employment circumstances

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

0. 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:

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.

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

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

1. Veteran must be discharged from the HCHV LDSH program if not located within 48 hours

0. Inpatient Hospitalization. VA will pay per diem up to a maximum of seven (7) days if a Veteran enrolled in HCHV LDSH requires inpatient medical or psychiatric treatment. To receive payment while a Veteran is hospitalized as an inpatient:

2. Contractor shall notify VA Safe Haven Liaison, COR, or designee immediately or during next available business hours of all hospital admissions.

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

2. Contractor shall maintain contact with the HCHV Safe Haven Liaison and the Veteran if authorized for continued payment.

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

8. Contractor may choose to maintain enrollment of a Veteran without payment beyond the approved absence period 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.

8. 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 bed or medical respite program.

8. 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.

6. Exits to Permanent Housing: 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 Safe Haven Liaison and/or COR to Contractor at the start of each fiscal year.

6. Negative Exits: Contractor is expected to facilitate Veteran completion of the HCHV LDSH 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 Safe Haven Liaison and/or COR to Contractor at the start of each fiscal year.

10. Procedures for Negative Exits

0. 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.

0. The policy/procedure shall include case conference with Program Staff, Veteran, VA Safe Haven Liaison and/or Designee, and other relevant 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.

0. 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.

0. 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.

0. 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 SFVAHCS Hospitals or Clinics for alternative resources and referrals without consulting VA Safe Haven Liaison on day of discharge is not considered an appropriate level of care.

0. The policy/procedure shall be subject to approval by VA Safe Haven Liaison, COR and/or Designee.

1. ADMINISTRATIVE SERVICES

7. Determination of Eligibility, Referrals, and Admissions

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

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

0. 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.

0. 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).

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

0. A list of authorized VA ordering personnel including primary identified VA Safe Haven 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.

0. To be eligible for HCHV Contract 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 SFVAHCS

0. Referral constitutes authorization of an initial service period of up to 180 days unless otherwise specified.

0. Contractor shall be expected to provide same-day residential placement in the LDSH 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 VA Safe Haven Liaison, COR, and/or designee. Admissions process is subject to VA Safe Haven Liaison review and adjustment at any time to ensure program accessibility for Veterans.

0. 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 Safe Haven Liaison. Contractor shall maintain effective communication with VA regarding any issues covered under this agreement.

7. Release of Information: Contractor shall ensure that a signed VA Release of Information (ROI) is obtained for any Veteran being admitted to an HCHV LDSH Bed and placed into individual case record.

7. 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:

2. Reason for referral

2. Pertinent demographic information

2. Verification of Veteran status

2. Family status

2. Employment history

2. Education/marketable skills/licenses/credentials

2. 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.

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

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

2. Authorized absence “pass” requests

2. Critical incident reports

2. Extension approvals when indicated

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

2. 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”)

7. 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.

7. Homeless Management Information System (HMIS) Data Reporting: Veterans served through VA’s HCHV LDSH 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.

7. 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 Safe Haven 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.

7. Incident Reporting

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

0. Falls

0. Elderly/Dependent Adult Abuse or Neglect

0. Sexual Assault

0. Fire

0. Medical or Mental Health Emergency (911 Calls)

0. Hospitalization

0. Suicidal ideation or attempt

0. Homicidal ideation

0. Act of violence by Veteran against other(s)

0. Act of violence by other(s) against Veteran

0. Abusive behavior by Veteran against staff or other(s)

0. Abusive behavior by staff against Veteran

0. Death

0. Infectious Disease Concerns (e.g., Bed Bugs, TB, Scabies, Coronavirus)

0. Active Substance Use that Requires Medical Intervention and/or Involves Overdose and/or Could Result in Discharge from Program

0. Observation/ Possession of Weapons

6. During regular business hours, VA Safe Haven Liaison, HCHV 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 Safe Haven Liaison, HCHV Supervisor and/or COR at the start of the following business day. Should Contractor require immediate afterhours VA support/intervention, Contractor shall notify the SFVAHCS Administrator on Duty (AOD) by calling the local VA facility. A written report to the VA Safe Haven 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.

7. 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 180 days are reviewed in advance and approved in writing by the VA Safe Haven Liaison, COR, or other designee before reaching the Veteran participant’s 180th 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 nine (9) months, and all requests for extension exceeding nine (9) months from date of admission must be approved in writing by VA Liaison and COR or designee.

7. 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.

8. Contractor shall refer grievances received directly from Veterans to the identified VA Safe Haven Liaison, COR or designee within 24 business hours of complaint. All grievances received by the VA Safe Haven 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 Safe Haven 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.

8. VA Safe Haven 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.

7. Satisfaction Surveys: When requested, Contractor will be…