Amendment 1 36C26124Q0256 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 35

2-14-2024

None

612MCP

Department of Veterans Affairs Network Contracting Office (NCO) 21

3237 Peacekeeper Way, Bldg 200 Suite 204 McClellan Park CA 95652

612MCP

Department of Veterans Affairs Network Contracting Office (NCO) 21

3237 Peacekeeper Way, Bldg 200 Suite 204 McClellan CA 95652

To all Offerors/Bidders 36C26124Q0256

2-07-2024 X

X

X 1

The purpose of this amendment is to include the Question and Answer (QA) response and updates the PWS based on response to question 10. The QA response and updated PWS are located below.

All other terms and conditions remain unchanged.

Tim Smith Contracting Officer

Question and Answer Response

1. Addendum to 52.212‐1 INSTRUCTIONS TO OFFERORS‐COMMERCIAL ITEMS Volume 1 ‐

Technical Submission located on page 67 of the solicitation discusses providing the resume and license for a LVN or higher. What if a LVN or higher is not employed by our company at the present time. Should we just send the plan for the staff?

VA Response ‐ Yes, please provide a staffing plan if the current staff is not currently on board.

You will need to have someone onboarded within 90 days of contract start. Payment for beds and admissions cannot begin until a staff is hired.

2. Section 3.1.4.18 of the PWS talks about 60 day stays and no payments after 60 days. What are the procedures for discharging an individual if no permanent housing is established or the veteran refuses to relocate? The liability falls onto the contractor that will still occur room and board, meals, cleaning, and operation expenses without payment. If veteran refuses to leave the program, contractor would be forced to file for eviction and enter a 6‐12 month long eviction process. Does the VA have a plan to address this scenario?

VA Response – There is additional verbiage in the contract about waivers and extensions.

Specifically, waivers and extensions may be granted by the VA on a case‐by‐case basis depending on the progress being made. Particularly with specialty contracts, enough time is allowed for a successful discharge if progress is being demonstrated. There is an expectation that if a Veteran is willfully not working towards housing that an alternate housing plan will be initiated. The expectation is for a Veteran to be in the program between 60 days to 6 months with exceptions if a permanent housing plan is in place. A consideration may be to have a document on intake signed by the Veteran which outlines the timelines of the program (ie, this is a month‐to‐month program where Veteran will be expected to be assisted with placement into longer term permanent housing between 60 days to 6 months.) Payments will continue if extensions are granted.

3. According to Section 3.1.9.2, the VA expects contractor to have RCFE certification. This certification is designed to work with aging seniors needing 24 hour care and support services.

The RCFE administrator/certification is NOT trained or licensed to care for individuals with SMI or substance use disorders. The question is, does the VA expect the contractor to be trained and licensed to care for an all inclusive population or more specifically for RCFE populations?

VA Response – The training we require is RCFE Administrator training. The VA does not require an RCFE certified facility for this contract. We do require the agency to have familiarity and be able to work with Veterans who may have a diagnosis of SMI or co‐occuring disorders which may include substance use disorders and we ask that staff are educated through onsite trainings around substance use, harm reduction, etc. We do not expect the contractor to be licensed in all issues related to the homeless population (i.e. CADC for substance use, an LIP for mental health, etc) These trainings can also be provided by the VA. We ask for the RCFE

Administrator certification so there is 1. A deeper background in geriatric resources 2. Better knowledge of optimal environment of care 3. What is and is NOT allowed in a unlicensed program 4. Deeper knowledge of cognitive disorders and how to work with them. As this is a complicated population, these geriatric issues often occur with mental health and substance use issues. That being said, if behaviors are such that they are posing a danger to the community we would support a transfer to another program or to the hospital.

4. From direct experience, a senior individual needing care and support services for activities of daily living ADL's or who might suffer from MCI or dementia will need long term care and 24 hour staff support. This individual would not be able to live and function on their own outside an RCFE type environment. An individual in this scenario would be able to find long term care placement under the Medi‐Cal program Assisted Living Waiver Program but current 2024 wait lists can be up to 12 months to be qualified. What's the VA process if a licensed RCFE administrator reports that an individual needs 24/7 long term care vs independent housing with no 24/7 support.

VA Response – VA Staff are accustomed to screening for the ability to perform basic ADL’s or to at least follow prompts for these activities. Depending on what is needed there are some resources such as home health through the VA to help with some of these needs. If a Veteran is placed and needs this care, the goal is to work with the Veteran to try to find housing placement to an RCFE or other higher level of care, we understand that this often takes time as the Veteran will not have a Medi-Cal application placed nor Aid and Attendance. These cases are often reviewed and supported on a case-by-case basis depending on what the Veteran needs. This program is intended to be the much-needed bridge to assist the veteran with finding stable permanent residency with the appropriate level of care.

5. Section of 3.1.9.2 states it is expected that the contractor will assist with light self‐care including, but not limited to, offering adult briefs, and providing daily cues for hygiene, self‐ care, medication, and eating. It will be understood that the target population in this contract are going to need intense assistance in getting completing activities of daily living. In the above bold text of it seems to contradict one another. As an RCFE licensed administrator and licensed 65 bed facility RCFE owner, this description of care and services could be seen as someone needing assisted living care and support which falls under long term care with 24/7 staff. Additionally, if an individual requires adult briefs, is the contractor expected to change the briefs for the individual? If so, this would fall under "intense assistance of ADL's".

VA Response – To clarify, this contract is for Veterans who are able to live independently with some assistance. It is not expected for the provider to care for Veterans who need a higher level of care such as 24/7 nursing. The contracted expectation is to provide light assistance with

ADL’s which consist of prompting, monitoring, and one person assist. The description “intense assistance” differentiates and defines the expectation which is considered above what is provided in a general population homeless services contract. That being said, general population contracts must still provide staff 24/7 in case of emergencies and supervision. To reiterate, this contract is a specialty contract that differs from our general population contracts and requires much more assistance including additional nursing/medical oversight.

6. Section 4.3.5 of the PWS states “"Contractors will be expected to provide housing and or services to other special Veteran populations, such as but not limited to the following:

medically compromised Veterans, Veterans with Cognitive disorders, Veterans with sex offender status, seriously mentally ill Veterans, Veterans who have abused drugs or alcohol for many years, and/or Veterans who have been involved with the legal system." I own a licensed

RCFE facility and fall under Department of Social Services regulations for admission of residents. As an applicant for this solicitation I would not be able to accept veterans under 60 years of age or those that fall into the category of "Veterans with sex offender status, seriously mentally ill Veterans, and/or Veterans who have been involved with the legal system."

VA Response – Please note that anyone who registers with the sex offender registry but not on parole or probation does not have any housing restrictions and no longer considered a threat to public safety.

The homeless population often ages sooner than the housed population, therefore there would need to be a waiver or an exception if there is a Veteran under 60 (often in their mid to late

50s) who are impaired beyond the means of a regular homeless program. It is our understanding that this is also currently allowed under the RCFE Manual of Policies and

Procedures on page 124 it states the following:

“Persons who are under 60 years of age whose needs are compatible with other residents in care, if they require the same amount of care and supervision as do the other residents in the facility”

Such admissions into our program would similarly be based off the acuity of the client would have comparable needs as the other residents in the community.

Veterans who are homeless often have mental illness and substance use issues. It is a part of the contractual agreement that the provider will take a harm reduction approach for this homeless population. If there is a safety concern, we will support in transferring the Veteran to another agency or to the hospital. Such instances would be based off non redirectable behavioral issues as may also happen with other clients with in an RCFE due to cognitive decline.

7. Can the VA clarify the term "medically compromised Veterans"?

VA Response – This means the acuity of the Veteran is higher than those of a regular homeless program. Veterans in this program will require additional assistance due to medical issues that a regular homeless program does not and/or is not expected to provide.

8. Are funds available to acquire a location to help a contractor expand its current business to support all veteran categories under this contract?

VA Response – The VA does not have facilities or locations to provide to contractors, however we can provide leads if we receive them and, if the occupancy demonstrates the need, more funding can be requested and we can request a contract modification to increase bed capacity

9. Section 7.1.11.2 states "All residents in the facility must be mentally and physically capable of leaving the building, unaided, in the event of an emergency." This paragraph above conflicts with paragraph 3.1.9.2. If a veteran needs "intense assistance with ADL's" or needs cues to eat and self care, a staff member will be required to assist the veteran fully in case of an emergency.

VA Response – Section 7.1.11.2 of the PWS is a description of the facility and to ensure that there are no barriers from the facility that would impede escape in case of a fire (i.e. stairs, locked doors, blocked exits, etc). It does not speak to the mobility concerns of the Veteran.

As explained earlier, “intense assistance” with ADL’s involved prompts and monitoring. Not providing skilled level care as this would be beyond the scope of this contract. The assistance that would be required from staff would vary case by case, but there is an assumption that the contractor would have a plan in place based off acuity.

10. Page 36 of the solicitation (PWS) states, “The contractor is responsible for the daily professional cleaning of all bedrooms and common areas, including the deep cleaning of all carpets and floors." My current cleaning schedule is deep clean bedrooms once per week and light cleaning in common areas daily. Will the VA require me to adhere to the contract terms of "daily professional cleaning of all bedrooms"?

VA Response – This will be taken out. However, liaisons conduct environmental rounds in order to ensure the cleanliness of the facility. If your agencies current cleaning schedule maintains cleanliness, it would not need to be modified. Updated PWS below.

11. Does the VA expect the contractor to occur out‐of‐pocket expenses by purchasing all bedroom furniture, supplies, and toiletries to house and care for the veteran before receiving any payments?

VA Response – It is the expectation that the contractor will provide room and board to the Veteran in a furnished room. The services outlined in the contract must be delivered before payment for these services are delivered. As the target population is homeless, they will nearly never have furnishings, supplies or toiletries.

12. Can the Veterans be housed in a hotel for this requirement?

VA Response – A use of a hotel is acceptable as long as it passes inspection.

36C26124Q0256

B.3 PERFORMANCE WORK STATEMENT

PERFORMANCE WORK STATEMENT

CONTRACT EMERGENCY RESIDENTIAL SERVICES BEDS

1. PURPOSE

1.1. The Department of Veterans Affairs Palo Alto Health Care System

(VAPAHCS) located at 795 Willow Rd. Menlo Park, CA 94025 requires a contractor to provide services as part of its Community Based Health Care for Homeless Veterans (HCHV) program. The goal of the HCHV program is to remove homeless Veterans from the street or habitation unfit for Veterans and place them in community-based, residential environments with sufficient supportive services to meet their needs and ultimately facilitate the improvement of their housing situation. This contract represents a Firm Fixed-Priced, Indefinite Delivery-Indefinite Quantity contract. Costs not incorporated into the Contractor’s price will NOT be reimbursed by the Government. This contract is specifically for the geriatric population which has additional requirements as outlined below.

2. BACKGROUND

2.1. Through the HCHV program, VA provides supportive services to Veterans and facilitates their access to a broad range of medical, mental health, and rehabilitative services. The purpose of this solicitation is to obtain offers from Contractors in Santa Cruz and Monterey County who can provide housing, and supportive services to geriatric Homeless Veterans that, in addition to community-based, the Contracted Emergency Residential Services (CERS) facilities will be stand-alone and have a home like environment. Geriatric is defined as a veteran who is 50 years of age or older. However, exceptions to this age requirement of admission can be made on a case-by-case basis.

These facilities will offer a safe and secure environment that supports the goal of recovery from homelessness. The Contractor will be required to provide a low-barrier therapeutic and rehabilitative milieu and attendant services targeting the underlying factors contributing to homelessness within the geriatric population. The Contractor will not be required to provide detoxification or other hospital level or licensed care treatment.

3. SERVICES TO BE PROVIDED

3.1. The Contractor shall provide all labor, supervision, housing, material and supplies necessary to provide emergency residential treatment, rehabilitative and supportive services. Services will be provided on-site at the Contractor’s facility, in accordance with all terms and conditions, provisions and requirements listed herein. The prices provided in the Price Schedule shall be inclusive of all “basic services” as may be necessary in the treatment of the Veteran. “Basic Services” shall be defined in the Performance Work Statement.

3.1.1. Residential Room and Board: Room and Board shall be accessible to the Veteran 7 days a week and 24 hours per day.

3.1.1.1. One single bed and personal linens (towels, pillows, blankets, and bed sheets, etc.)

3.1.1.2. Furnishings such as a dresser, storage locker and lock or designated locked secured space. Storage space will accommodate two bags of belongings and all prescribed medical equipment. The Contractor will allow Veteran to store personal belongings for at least 72 hours after formal HCHV discharge. Should a Veteran abandon his/her belongings, the contractor will make three documented attempts to contact the Veteran before disposing Veterans items. At least three nutritious meals, 7 days a week will be provided for the Veteran. At least 50% of the beds will be wheelchair accessible and will have access to ADA accessible entryways and restrooms.

3.1.2. Dietetic Services: Three meals a day and snacks of nourishing quality (e.g., fruits, vegetables, protein sources, etc.), between meals and bedtime for those requiring or desiring additional food, even when it is not medically indicated. There will not be more than a 14-hour span between evening meal and breakfast of the following day. Contractor will provide alternative meals for Veterans with dietary restrictions if medically indicated (e.g., diabetic, renal, and soft mechanical diets) and reasonable accommodation for Veterans with cultural/religious preferences around food (e.g., Kosher, Halal, etc.). Food shall be prepared, served, and stored under sanitary conditions. The facility shall provide storage space in an onsite refrigerator for Veterans to store and freely access personal food. The facility shall establish and maintain sanitary procedures for washing dishes, cleaning equipment and work areas, and disposing of waste. In addition, for locations where food is provided via food pantry, Veterans will have access to the pantry at least three times a day to access foods. All foods shall be stored and maintained in sanitary conditions following all health and safety regulations. Veterans will be offered food of nourishing quality and variety (fresh fruits, vegetables, grains, breads, and proteins).

3.1.3. Laundry Facilities: Laundry facilities and necessary detergent free of charge shall be available for residents to do their own laundry or to have laundry done at minimum one time per week. Should a Veteran have difficulty doing his or her own laundry, the facility will provide guidance.

Should a Veteran refuse to wash his or her clothes, this will not be grounds for discharge but rather be addressed as a therapeutic opportunity.

3.1.4. Case Management Services: This contract requires that the Contractor will maintain a minimum staffing ratio of one dedicated, full time, on-site medical case manager per 12 Veterans. (For further information on staffing requirements please see Section 6: Personnel) Exceptions may be granted in writing by the VA. Staff is defined as a paid professional and does not include interns. The VA requires that case managers working with Veterans do not engage in any outside duties that do not pertain to the HCHV program which includes, case management of or group facilitation of non-Veteran populations unless a waiver has been granted by the VA Liaison (or Designee). Each VA Liaison (or Designee) will have no more than two POC’s per program. Additionally, the Case Manager shall provide the following:

3.1.4.1. Intake Packets: All Veterans must receive an intake packet within 72 business hours which includes, at minimum, the following information:

1. Description of the Contractors services

2. Grievance Policy

3. Emergency procedures

4. Patient rights and Reasonable Accommodation

3.1.4.2. A thorough assessment of Veteran’s psychosocial needs and written Individualized Care Plan (ICP) will be developed within 72 business hours of admission for each Veteran. Information from the assessment will be integrated into the Veterans’ Individual Care Plan. Care Plans will also include an assessment of possible crisis for the Veteran such as harm to self, verbal abuse or acts of violence or any other medical or psychiatric crisis. Staff will take proactive measures to prevent these instances to avert crisis to keep these incidents at a minimum.

Contractors will be proactive to ensure staff are trained in de-escalation techniques.

3.1.4.3. Case Manager will provide structured individual case management, at minimum, weekly including counseling on self-care skills, adaptive coping skills, financial planning, permanent housing search, written care plan, referral for financial benefits.

3.1.4.4. Collaboration and coordination with VA program staff, as needed, will include coordination of supportive psychosocial services.

Coordinated efforts must be made with the Liaison around medical, mental health, admission and discharge needs. Contractor is expected to coordinate all appointments including, but not limited to chemotherapy appointments, dialysis appointments, and wound care appointments. Contractors will be expected to accompany

Veterans to their appointments when medically, cognitively, or psychiatrically indicated per the liaison and/or the contractor’s clinical judgement. Contractor staff will make active effort to establish relationships with key stakeholders, providers, and partners in the VA Health Care and Benefits Administration Systems to work closely and collaboratively with the interdisciplinary treatment team.

3.1.4.5. Ongoing Care Plan Coordination will be expected between the Case Manager and VA Liaison (or Designee). The Case Manager will be expected to coordinate with the VA Liaison (or Designee) to ensure Veterans’ goals, as expressed in both the agency and VA Liaison’s (or Designee’s) intake, are reflected in the ICP’s.

3.1.4.6. Every 60 Days the Case Managers will also coordinate a meeting with the Veteran and the VA Liaison (or Designee) for bi-monthly ICP update meetings. The Care Plan meeting may be used by the Liaison (or Designee) as the main factor to determine if any Veteran extension requests may be approved or denied.

3.1.4.7. Meet with the VA Liaison (or Designee) for case management update meetings every 30 days. All Contractors will provide proper documentation verifying services and case management efforts by all team members including, but not limited to housing, benefit and employment specialists, and program management staff. There will be an expectation that notes are written professionally in a format that utilizes the clear settings of goals and documents progress towards those goals (e.g., SNAP, SOAP, or SMART notes).

3.1.4.8. Special attention will be made to address High Suicide Risk (HSR) Veterans as identified by the VA Liaison (or Designee), VA Mental Health Staff and/or the contracted Case Manager. Contractor will avail themselves to be contacted by the suicide prevention coordinator immediately should a Veteran miss an appointment and his/her safety must be verified. On a weekly basis the contracted case manager will be required to update the VA Liaison (or Designee) on Veteran progress and/or safety concerns for HSR Veterans. Contracted case manager will review the HSR Safety Plans with the Veteran on a bi-weekly basis. HSR Safety plan reviews and a copy of the Veteran’s Safety Plan will be documented in the chart. All Veterans will be referred to VA for Primary Care and Mental Health appointments and Contractors will support Veterans in making initial and subsequent appointments. Efforts will be made for Veterans who are identified by Liaison to be highly acute. Efforts will be documented in the Veterans ICP and reviewed by the VA Liaison (or Designee), at least monthly.

3.1.4.9. If the Contractor determines a Veteran who has not been identified as an HSR Veteran to have expressed suicidal ideation, the Contractor will be expected to follow their agency and VA incident and safety protocols. If the identified Veteran does not have a safety plan, the agency will create an agency safety plan with the Veteran and make increased efforts to connect the Veteran to mental health services. The agency safety plan will be forwarded to the VA Liaison (or Designee) as well as information on all efforts to connect Veteran to mental health services. As above, all procedures applied to HSR Veterans will then be followed for the non-flagged HSR Veteran until the Veteran can be evaluated by a MH provider and/or Suicide Prevention Coordinator.

3.1.4.10. Contractors must be in close communication with the liaison for any missing Veterans due to the high acuity of the target population.

The contractor must file missing person’s report should the Veteran be considered at risk.

3.1.4.11. Contractor staff will treat liaisons with respect and will work with assigned liaisons to resolve issues around quality of care and contract compliance with respect.

3.1.4.12. Medical Case Management Services: Provides support to patients in maintaining health and wellness in the Geriatric program.

Assists veterans with scheduling medical and mental health appointments, provides customized education for medical diagnosis and medication management, and arranges appropriate transportation to and from all appointments. Makes referrals to community-based organizations when health and/or psychosocial condition(s) indicate need for appropriate referral(s) and make sure all medications prescribed are reconciled to prevent duplication of orders among providers. Promotes clear communication amongst treating providers by ensuring awareness regarding veteran’s medical needs and prescribed medication. Provides coordination of care by meeting with veterans and medical staff to determine goals and recovery targets for identified conditions. Assist veterans with medication management by monitoring Veterans’ compliance issues and providing extensive medication education to improve compliance. Teaches appropriate medical interventions regarding wound care, self-care, and management of medical diagnosis.

Contractor is expected to offer cues to Veterans to facilitate self-care. Staff giving this education will be qualified professionals to offer this service and education to Veterans.

3.1.4.13. Permanent Housing Search: Programs are required to provide Veterans with direct and ongoing assistance in achieving permanent housing. Plans for Veterans’ transition to permanent housing placements must be clearly reflected in each ICP and in weekly case management notes. As part of this plan, Veterans’ housing history and needs must be assessed through a formal and thorough Housing Assessment completed within 72 business hours of program admission. Housing Assessments must identify Veterans’ housing history, strengths (i.e., positive prior rental history), and barriers (i.e., Unlawful Detainers). Should Veteran refuse to engage with program staff regarding plans for permanent housing transition, motivational interviewing and other therapeutic techniques will be used to address Veteran ambivalence. All efforts to engage Veteran regarding housing plans, options, and resources shall be clearly documented and include any therapeutic techniques utilized.

Contractor staff must provide direct assistance to Veterans in developing permanent housing plans and accessing appropriate housing resources. These services shall be provided weekly through one-to-one case management. Examples of expected housing services include: 1) assistance obtaining and reviewing Veteran’s free credit report, identifying housing strengths and/or barriers associated with current credit status; 2) Creating a Tenant Portfolio with Veteran that contains all relevant documents required in the rental process, including a completed sample rental application for Veteran, income verification documents, identification, applicable subsidies, etc.; 3) Reviewing affordable housing rental options and Permanent Supportive Housing (PSH) program offerings, and assisting Veterans with making appropriate rental inquiries and submitting completed rental applications; 4) Conducting regular and individualized housing advocacy efforts, including transportation, assistance scheduling, meeting, and communicating with property managers and landlords, and engage in troubleshooting where rental barriers or denials occur in the housing search process 5) exploring housing option in low-rent areas 6) exploring appropriate level senior care facilities. All housing efforts by Contractor shall be documented clearly in case notes and presented to VA Liaison (or Designee) upon request.

Mere communication with Veterans regarding housing, without subsequent Contractor staff action and follow-up, shall not on its own meet the above requirements. If housing placements or inpatient residential treatments have been approved and acquired, the support and case management around maintaining housing, future housing options, connecting to local resources, discussions on how to maintain/pay for housing over long term, adult day health referrals and other community long-term supports may be counted as a housing resource.

3.1.4.14. Financial Planning and Employment: Referral to and follow up on all potential financial resources the Veteran may be eligible for (e.g., SSI, SSDI, Food Stamps, NSC pension, GA, Medi-Cal, etc.). Case Managers will document in the case notes all structured activities that support Veteran in developing a short and long-term plan to understand and address their current financial situation and how to improve it. At minimum two financial planning activities appropriate to the Veterans individual circumstance must be documented monthly. All Veterans will be assessed for employment within 72 hours of admission. Veterans who report a desire to work will be provided referrals to all relevant employment opportunities the Veteran is eligible for and interested in and/or structured activities that support Veteran in applying for employment as appropriate based on needs of Veteran as identified in the assessment.

Employment referrals and activities may be counted as a financial resource. The Case managers will document the assessment and all referrals and supportive activities in the case notes. Each Veteran must apply for Medi-Cal and Medi-Care if they do not have this benefit.

3.1.4.15. Group Activities: Structured group activities, as appropriate, shall occur two times per month – examples include group therapy, life skills training, social skills training, financial workshops, Alcoholics Anonymous, Narcotics Anonymous, vocational counseling, and physical activities as appropriate. For the purposes of this contract “House Meetings” and VA Housing Resource Groups may not be counted as a structured group activity should have a therapeutic value and facilitation shall be the responsibility of the Contractor.

Should a Veteran have mental health, medical, family and/or employment obligations which directly conflicts with this requirement alternate group activates will be arranged and/or the Contractor will clearly document in their case notes their efforts to accommodate the Veteran. Unwillingness to participate in these groups will not be considered grounds for program discharge.

3.1.4.16. Case manager will make referral to all relevant legal services which would further the Veteran’s efforts to get housed. Case managers will document all activities and education that support a Veteran’s legal needs.

3.1.4.17. Discharge Planning: Securing permanent housing will be the primary discharge goal for every Veteran, and resources will be coordinated for discharge to a successful community placement throughout the duration of the Veteran’s stay.

3.1.4.16.1. All Veterans must have a discharge plan within one week of admission which integrates items included in earlier sections of this document.

3.1.4.16.2. Veterans must also b e i n a c t i v e s e a r c h a n d / o r apply for independent housing within the first month of admission.

Compliance with all VA regulations regarding discharges and timeliness of reporting discharges is required by Contractor.

Paperwork required for discharging a Veteran from any HCHV program is required via fax or secure email within 24 business hours from known discharge.

3.1.4.16.3. A negative discharge for undesirable behavior is a committee decision that must include the VA Liaison prior to discharge.

All Veterans scheduled for discharge based on behavior must meet with the treatment team and work with team to determine most therapeutic option for Veteran. This does not include violations for safety reasons. Please note: Profanity does not in and of itself constitute abuse and shall not exclusively be considered grounds for discharge. All actual or threatened violence will be grounds for discharge. Veterans may be discharged for safety reasons at any time. Safety concerns must be clear and obvious to both contractor and liaison. Parameters around safety violations and/ what constitutes reasonable threat must be established with liaison. All negative discharges will be subject to a full team debriefing, including VA Liaison, to look for opportunities missed to intervene sooner. All discharges are subject to the Contractors grievance procedures and must allow clients the opportunity to be represented by the VA Liaison in the grievance process. Reasonable efforts must be made to coordinate with the Liaison to schedule an appeal. In the case of no reasonable alternative housing arrangement, a target discharge date may be established by agency, no less than 7 calendar days of decision to discharge, to afford Veteran an opportunity to utilize VA Liaison advocacy.

3.1.4.16.4. Lastly, all TQI measures must be met to receive the highest past performance rating. These include the following:

• HCHV1 (DC to Ind. Housing) - > 55%

• HCHV2 (DC w/ Neg. Exits) - 20%

• Bed Occupancy > 85%

3.1.4.18. Extensions- It is understood that the Contractor will not be paid for care provided to a referred Veteran beyond the period authorized, unless an extension of the authorization is provided in writing by the VA. The initial stay for a Veteran is expected to be no longer than 60 days. Any extension of the stay after 60 days must be authorized by the VA Homeless Program Coordinator or Designee, if there is clear clinical indication and availability of funds. Only extraordinary circumstances will be considered to extend service periods up to and more than 6 months for individual Veterans and these must be authorized by the Medical Center Director or Designee.

3.1.5. Medication Management: Medications and narcotics shall be properly stored, controlled, issued, and recorded in compliance with physician’s orders. For Geriatric Contracts it is recommended that facilities utilize a Medication Management system for Veteran medications. (Copies of Inspection Packet requirements relating to medication management are available upon request).

3.1.5.1. Contractor shall establish procedures for insuring Veteran’s confidentiality in the storage of and keeping of records concerning medication.

3.1.5.2. Medication Assisted Treatment (MAT) cannot be used to rule out Veteran’s participation in an HCHV Program. This includes prescribed use of Vicodin, morphine, methadone, oxygen, etc.

3.1.5.3. Reasonable accommodation for individuals in MAT is required provided the requested accommodation does not require major financial or administrative commitments that would be considered an “undue burden.” Examples of reasonable accommodations include:

1. Arranging for the individual to take medication at their clinic, physician’s office, or another off-site location – when consistent with the individual’s treatment plan.

2. Storing an individual’s MAT medication in a lock box in the program and having the individual be personally responsible for it.

3. Arranging to have the housing facility keep MAT medications in a locked cabinet For Facilities that are providing Medication Management, there must also be staff identified for after hours and on weekends who are trained in medication management protocol who can provide medication to the Veterans as needed when the medical case manager is not on duty. This coverage must be and the certificate(s) of medication management training and the times/days and hours of the person(s) covering will be provided to the VA Liaison to keep on file. (Copies of Inspection Packet requirements relating to medication management are available upon request).

4. Arranging to have refrigerated medications stored in appropriate locked location which is only accessible to the Veteran or trained designee. (Copies of Inspection Packet requirements relating to medication management are available upon request).

3.1.6. Grievance Procedures: Programs must have an internal grievance process that Veterans can use to resolve conflicts within the program.

Programs 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 place conspicuous and be accessible to clients. In addition, each client shall receive a copy of the grievance policies and procedures, upon intake and upon receiving a warning or discharge notice.

3.1.7. Timeliness of Response: Contractor is expected to have a dedicated phone line for VA inquiries and Veteran self-referrals. Return calls from the program are expected within 4 hours during business hours Monday through Friday. Calls, referrals, emails, or other correspondence from, community agencies, VA staff, Veterans or VA Liaisons (or Designees), are also expected to be addressed within 4 business hours Monday through Friday. Admission determinations must be made within 24 hours of referral.

3.1.8. Critical Incident Reporting: All critical incidents will be reported within 24 hours. This includes the following:

o Falls o Assault (to Veteran or Staff) o Elderly/Dependent Adult Abuse or Neglect o Sexual Assault o Fire (Veteran Involved) o Medical/Psychiatric Emergency (911 Calls) o Hospitalization o Suicide or Suicide Attempt o Homicide o Death o Infectious Control (TB COVID, etc.)

o Active Substance Abuse on contractor property o Observation/ Possession of Weapons o Use of “cooling off” option within facility o Grave Disability

3.1.9. Therapeutic and Rehabilitative Services:

3.1.9.1. Milieu: The agency will cultivate a milieu of trust and safety.

This includes a tolerance for relapses, regression, and personal unpredictability. In cases of documented verbal escalation with other program participants and/or Contractor staff, Contractor is permitted to request Veteran voluntarily relocate to “cooling off” area, as long as the area is within the physical boundaries of the Contractor’s HCHV facility. Veteran will be monitored in a clinically appropriate manner by Contractor’s staff, during any time within the aforementioned area. As a part of the engagement strategy, Veterans will be invited to participate in the activities of everyday life, including meals, chores, recreation activities, and socializing.

These activities must maintain a therapeutic significance. Such opportunities will be offered, not required nor demanded and modeled by staff. Veteran’s resistance to participate in these activities will not be grounds for discharge. A Harm Reduction Model will be utilized. Fidelity to this model may be assessed at any time by the liaison.

3.1.9.2. For the Geriatric contract, it is expected that the contractor will assist with light self-care including, but not limited to, offering adult briefs, and providing daily cues for hygiene, self-care, medication, and eating. It will be understood that the target population in this contract are going to need intense assistance in getting completing activities of daily living. The contractor will also be expected to accommodate Geriatric Veterans with mild cognitive impairment, severe mental illness and substance use disorders. The contractor and may need to facilitate daily case management meetings, coordination with family, ombudsman and board and care facilitators, hospitals, substance use treatment facilities, medical provider, applying for HHA and IHSS etc. They will be expected to have increased understanding of aging and dementia needs. While the contractor is not expected to offer licensed level care, the contractor will support Veterans who show a decline in daily functioning. As such, the administrator for this agency must have a Residential Care Facility for Elderly and Adult (RCFE) Administrator certification. The facility does not need to be RCFE certified. The Administrator Certification must be completed within three months of contract award.

3.1.9.3. Recovery: Support for a healthy lifestyle provided in an environment conducive to social interaction and the fullest development of the resident’s rehabilitative potential. Assistance to gain and to apply knowledge of the recovery process in an environment supportive of recovery models including a focus on Harm Reduction rather than strict abstinence and supportive of a Housing First approach.

Pursuant to these principles, drug testing may not be used to discharge or discipline a Veteran but may be used as a clinical intervention to modify behavior or assess behavioral issues.

3.1.10. Transportation: The Contractor shall assist the Veterans with round trip transportation to scheduled meetings, medical appointments, and hospital visits within normal business hours.

3.1.10.1. The Contractor will be expected to help the Veteran access public transportation, including providing information and instructions necessary to enable Veterans to utilize public transportation.

3.1.10.2. If VA staff determines that adequate public transportation is not available or appropriate for a Veteran, the Contractor shall arrange for alternative transport by car or taxi.

3.1.10.3. Contractor will also be expected to accompany Veteran to appointment to ensure the Veteran meets the provider should the Veteran need this added assistance.

3.1.11. Occupancy: It is expected that Contractor beds will be maintained at an average minimum of an 85% occupancy rate but at a preferred rate of 90% as calculated based upon number of bed nights available per quarter. After hours and weekend admission will be expected. If this rate is not consistently attained a Corrective Action Plan (CAP) will be developed by the Contractor as part of the QASP and/or process improvement plan. Adjustments in contract funding may occur through modifications if occupancy is not maintained. Failure to maintain year to date occupancy rate at or above 85% may be grounds for immediate termination for convenience. Contractors must develop relationship with key referral sources in order to maintain referrals. All beds must be filled within 24 hours if there is a waiting list.

3.1.12. Outreach: Contractor will be responsible to engage in outreach in the community at least two times per month. Outreach activities may also include collaboration with the VAPAHCS providers for referrals. In addition, clear documentation for outreach activities must be made available to Liaison upon request during the QASP review. Contractors will maintain occupancy by engaging in outreach services and will be knowledgeable about outreach best practices generally accepted in the community.

3.1.13. Documentation: The Contractor shall provide treatment and discharge planning reflecting a team assessment of health, social and vocational needs and the involvement of the Veteran, the VA staff and appropriate community resources in resolving problems and setting goals. An individual case record will be created for each referred Veteran. Case records shall be maintained in security and confidence as required by the Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR part 2) and the Confidentiality of Certain Medical Records (38 USC 7332). Case records and data normally maintained and included in a medical record as a function of compliance with State or community licensing standards will be made available on a need-to-know basis to appropriate Department of Veterans Affairs staff members involved with the treatment program of the Veterans concerned. The Contractor shall comply with applicable requirements of the Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR Part II) and the Confidentiality of Certain Medical Records (38 USC 7332).

The files shall include:

Reasons for referral All essential identifying data relevant to the resident and his/her family including a socio-cultural assessment, weekly progress reports or notes, and documentation of any case management interventions or patient care conferences

For sites who implement Medication Management/Monitoring- Copies of any medical prescriptions issued by physicians, including orders, if any, for medications to be taken. Contractor must be in compliance with HCHV inspection requirements

Case management notes written in a professional manner (i.e., SMART, SOAP, SNAP) will include the following: A written and thorough Housing Needs Assessment, A written, standardized Employability Assessment, A Financial Plan, A Discharge Plan, and an Individual Care Plan with attendant goals and documented activity indicating Veteran and Case Manager is actively working on identified goals.

QASP Compliance Tool and all attendant supporting documentation demonstrating Contractor compliance with Contract

Final summaries on each resident who leaves the program, to include reasons for leaving, the resident’s future plans, and follow-up locator information.

Extension approval if relevant Waivers as appropriate

The 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.

3.1.14. In addition to standard documentation, the case manager(s) will also be expected to update HMIS on all admissions, discharges and enter at least one transaction in HMIS at per month.

3.1.15. Rules, Policies and Procedures: The Contractor shall have reasonable rules governing day-to-day life and activities in the facility.

The purpose of these rules is to promote transition, safety, cleanliness, and dignity. Rules should not set up residents for failure and should be presented in a manner that is least intrusive and punitive. Infraction of rules are to be seen as a therapeutic opportunity, not responded to punitively. Should any rule prove to be a barrier to service, then the rule must be reviewed with the liaison and possibly changed to ensure continuous engagement and accessibility to the program. Response to rule infractions should be approached with leniency and engagement with further enforcement of rules as appropriate to the Veteran’s engagement in the program. The focus of the rules is to be around the safety of Veterans residing at the facility. Rules regarding entry and exit of the facility, rules of substance use, chores, engagement in treatment, and general rule compliance, shall be as flexible as is necessary to carry out the functions of this contract and to maximize Veteran engagement.

Rules traditionally applied in the shelter and transitional housing contexts may not be appropriate to the objectives stated here. Any rule or policy that proves problematic to the active, effective, and ongoing engagement of the Veteran shall be addressed by the VA and program management team, subject to…