UPDATED PWS 36C26124Q0683.pdf

B.3 PERFORMANCE WORK STATEMENT

MOBILE CRISIS TEAM REQUIREMENTS

1.0 GENERAL

1.1 Service Provided: The contactor must provide licensed independent mental health professionals for on‐call Emergency Department (ED) consultations five days a week (Monday through Friday) from 4:30 p.m. to 8:00 a.m. the following morning, and 24 hours a day on weekends and holidays. Psychiatric Assessments (hereinafter “mental health evaluations”) shall be performed for patients in the VA Northern California Health Care System Emergency Department (ED) at 10535 Hospital Way Bldg. 700, Mather, California 95655.

1.2 Place of Performance: The contractor shall provide licensed independent mental health professionals for VA Northern California Health Care System’s (VANCHCS)

Emergency Department (ED) at Sacramento VA Medical Center at Mather, California.

Located at 10535 Hospital Way, Mather, CA 95655.

1.3 Period of Performance: October 1, 2024 – September 30, 2029

Ordering Period 1: October 1, 2024 – September 30, 2025 Ordering Period 2: October 1, 2025 – September 30, 2026 Ordering Period 3: October 1, 2026 – September 30, 2027 Ordering Period 4: October 1, 2027 – September 30, 2028 Ordering Period 5: October 1, 2028 – September 30, 2029

1.4 Authority: Title 38 USC 8153, Health Care Resources (HCR) sharing Authority.

1.5 Policy/Handbooks‐ the contractor shall be subject to the following policies, including any subsequent updates during the period of performance:

1.5.1 ‐ VA Directive 1663: Health Care Resources Contracting ‐ Buying

1.5.2 ‐ VHA Directive 2006‐041 “Veterans’ Health Care Service Standards” (expired but still in effect pending revision)

2006‐041

1.5.3 ‐ VHA Handbook 1100.17: National Practitioner Data Bank Reports –

1100.17

1.5.4 ‐VHA Handbook 1100.18 Reporting And Responding To State Licensing Boards –

1100.18

1.5.5 ‐ VHA Handbook 1100.19 Credentialing and Privileging –

1000.19

1.5.6 VHA Handbook 1907.01 Health Information Management and Health Records:

1907.01

1.5.7 Privacy Act of 1974 (5 U.S.C. 552a) as amended

http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm

1.6 Definitions/Acronyms‐ Terms used in this contract shall be interpreted as follows unless the context expressly requires a different construction and/or interpretation. In case of a conflict in language between the Definitions and other sections of this contract, the language in this section shall govern.

1.6.1 ABECSW: American Board of Examiners in Clinical Social Work

1.6.2 ACGME: Accreditation Council for Graduate Medical Education

1.6.3 ACLS: Advanced Cardiac Life Support

1.6.4 AOD: Admitting Officer of the Day

1.6.5 BLS: Basic Life Support

1.6.6 CDC: Centers for Disease Control and Prevention

1.6.7 CDR: Contract Discrepancy Report

1.6.8 CEU: Certified Education Unit

1.6.9 CME: Continuing Medical Education

1.6.10 CMS: Centers for Medicare and Medicaid Services

1.6.11 Contracting Officer (CO): The person executing this contract on behalf of the Government with the authority to enter into and administer contracts and make related determinations and findings.

1.6.12 Contracting Officer’s Representative (COR): A person appointed by the CO to take necessary action to ensure the Contractor performs in accordance with and adheres to the specifications contained in the contract and to protect the interest of the Government. The COR shall report to the CO promptly any indication of non‐ compliance in order that appropriate action can be taken.

1.6.13 COS: Chief of Staff

1.6.14 Credentialing: Credentialing is the systematic process of screening and evaluating qualification and other credentials, including licensure, required education, relevant training and experience and current competence and health status.

1.6.15 DEA: Drug Enforcement Agency

1.6.16 ED: Emergency Department

1.6.17 FSMB: Federation of State Medical Boards

1.6.18 HHS: Department of Health and Human Services

1.6.19 HICPAC: Healthcare Infection Control Practices Advisory Committee

1.6.20 HIPAA: Health Insurance Portability and Accountability Act

1.6.21 HR: Human Resources

1.6.22 ISO: Information Security Officer

1.6.23 MHLIP: Mental Health Licensed Independent Practitioner (Licensed Clinical Social Worker, Licensed Marriage and Family Therapist, Licensed Psychologist, or Licensed Mental Health Nurse Practitioner)

1.6.24 Medical Emergency: a sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably result in: Permanently placing a patient's health in jeopardy, causing other serious medical consequences, causing impairments to body functions, or causing serious or permanent dysfunction of any body‐organ or part.

1.6.25 MH: Mental Health

1.6.26 MOD: Medical Officer of the Day

1.6.27 National Provider Identifier (NPI): NPI is a standard, unique 10‐digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA‐standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers).

1.6.28 Non‐Contract Provider: any person, organization, agency, or entity that is not directly or indirectly employed by the Contractor or any of its subcontractors

1.6.29 OIG: Office of Inspector General

1.6.30 OSHA: Occupational Safety and Health Administration

1.6.31 NPPES: National Plan and Provider Enumeration System

1.6.32 POP: Period of Performance

1.6.33 PPD: Purified Protein Derivative

1.6.34 PWS: Performance Work Statement

1.6.35 Privileging (Clinical Privileging): Privileging is the process by which a practitioner, licensed for independent practice; e.g., without supervision, direction, required sponsor, preceptor, mandatory collaboration, etc.; is permitted by law and the facility to practice independently, to provide specific medical or other patient care services within the scope of the individual’s license, based upon the individual’s clinical competence as determined by peer references, professional experience, health status, education, training and licensure. Clinical privileges must be facility‐specific and provider‐specific.

1.6.36 QASP: Quality Assurance Surveillance Plan

1.6.37 VAAR: VA Acquisition Regulation

1.6.38 Veterans Health Administration (VHA): The central office for administration of the VA medical centers through throughout the United States. The VHA is located in Washington, D.C.

1.6.39 Veterans Integrated Services Network (VISN): The regional oversight for VA medical centers.

1.6.40 VetPro: a federal web‐based credentialing program for healthcare providers.

1.6.41 VANCHCS : Unless identified with the name of a different VA medical Center, for purposes of this contract, this term shall mean VA Northern California Health Care System.

2 QUALIFICATIONS:

2.1 Staff/Facility

2.1.1 License: Contract MHLIP(s) assigned by the Contractor to perform the services covered by this contract shall have a current license. All licenses held by the personnel working on this contract shall be full and unrestricted licenses. Contract MHLIP(s) who have current, full and unrestricted licenses in one or more states, but who have, or ever had, a license restricted, suspended, revoked, voluntarily revoked, voluntarily surrendered pending action or denied upon application will not be considered for the purposes of this contract.

2.1.2 Board Certification: All contracts MHLIPs may be board certified by the appropriate, respective Professional Board but are not required to be. All contract MHLIPs must be currently certified in Basic Life Support (BLS).

2.1.3 Credentialing and Privileging: Credentialing and privileging is to be done in accordance with the provisions of VHA Handbook 1100.19 referenced above. The Contractor is responsible to ensure that proposed MHLIP(s) possess the requisite credentials enabling the granting of privileges. No services shall be provided by any contract MHLIP(s) prior to obtaining approval by the VANCHCS Professional Standards Board, Medical Executive Board and Medical Center Director.

2.1.3.1 If a contract MHLIP(s) are not credentialed and privileged or has credentials/privileges suspended or revoked, the Contractor shall furnish an acceptable substitute without any additional cost to the government.

2.1.4 Technical Proficiency: Contract MHLIP(s) shall be technically proficient in the skills necessary to fulfill the government’s requirements, including the ability to speak, understand, read and write English fluently. Contractor shall provide documents upon request of the CO/COR to verify current and ongoing competency, skills, certification and/or licensure related to the provision of care, treatment and/or services performed.

Contractor shall provide verifiable evidence of all educational and training experiences including any gaps in educational history for all contract MHLIP(s) and contract MHLIP(s) shall be responsible for abiding by the Facility's Medical Staff By‐Laws, rules, and regulations (referenced herein) that govern medical staff behavior.

2.1.5 Continuing Medical Education (CME)/ Certified Education Unit (CEU) Requirements:

Contractor shall provide the MH Service’s designated Program Support Assistant with copies of current CMEs as required or requested by the VANCHCS Contract MHLIP(s) registered or certified by national/medical associations shall continue to meet the minimum standards for CME to remain current. Contractor shall report CME hours to the credentialing office for tracking. These documents are required for both privileging and re‐privileging. Failure to provide shall result in loss of privileges for contract MHLIP(s).

2.1.6 Standard Personnel Testing (PPD, etc.): Contractor shall provide proof of the following tests for MHLIPs within five (5) calendar days after contract award and prior to the first duty shift to the MH Service’s designated Program Support Assistant and Contracting Officer. Tests shall be current within the past year.

2.1.6.1 TUBERCULOSIS TESTING: Contractor shall provide proof of a negative reaction to PPD testing for all contract MHLIP(s). A negative chest radiographic report for active tuberculosis shall be provided in cases of positive PPD results. The PPD test shall be repeated annually.

2.1.6.2. RUBELLA TESTING: Contractor shall provide proof of immunization for all contract MHLIP(s) for measles, mumps, rubella or a rubella titer of 1.8 or greater. If the titer is less than 1.8, a rubella immunization shall be administered with follow‐ up documentation to the MH Service’s designated Program Support Assistant.

2.1.6.3. VARICELLA (CHICKEN POX) or, if unknown, results of a varicella antibody test. If non‐immune, must be vaccinated with Varivax (Chicken Pox).

2.1.6.4. OSHA REGULATION CONCERNING OCCUPATIONAL EXPOSURE TO

BLOODBORNE PATHOGENS: Contractor shall provide generic self‐study training for all contract MHLIP(s); provide their own Hepatitis B vaccination series at no cost to the VA if they elect to receive it; maintain an exposure determination and control plan; maintain required records; and ensure that proper follow‐up evaluation is provided following an exposure incident. The VANCHCS shall notify the Contractor of any significant communicable disease exposures as appropriate. Contractor shall adhere to current Center for Disease Control/Healthcare Infection Control Practices Advisory Committee (CDC/HICPAC) Guideline for Infection Control in health care personnel (as published in American Journal for Infection Control‐ AJIC 1998;

26:289‐354 http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf ) for disease control. Contractor shall provide follow up documentation of clearance to return to the workplace prior to their return.

2.1.7. National Provider Identifier (NPI): NPI is a standard, unique 10‐digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA‐standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers). The Contractor shall have or obtain appropriate NPI and if pertinent the Taxonomy Code confirmation notice issued by the Centers for Medicare and Medicaid Services (CMS) National Plan and Provider Enumeration System (NPPES) be provided to the Contracting Officer with the quote.

2.1.8 DEA (as required) ‐ Contractor shall provide copy of current DEA certificate.

2.1.9 Conflict of Interest: The Contractor and all contract MHLIP(s) are responsible for identifying and communicating to the CO and COR conflicts of interest at the time of quote and during the entirety of contract performance.

2.1.10 Citizenship related Requirements:

2.1.10.1 The Contractor agrees that the Contractor and any subcontractors shall comply with any and all legal provisions contained in the Immigration and Nationality Act of 1952, As Amended; its related laws and regulations that are enforced by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor as these may relate to non‐immigrant foreign nationals working under contract or subcontract for the Contractor while providing services to Department of Veterans Affairs patient referrals;

2.1.10.2 While performing services for the Department of Veterans Affairs, the Contractor shall not knowingly employ, contract or subcontract with an illegal alien;

foreign national non‐immigrant who is in violation their status, as a result of their failure to maintain or comply with the terms and conditions of their admission into the United States. Additionally, the Contractor is required to comply with all “E‐ Verify” requirements consistent with “Executive Order 12989” and any related pertinent Amendments, as well as applicable Federal Acquisition Regulations.

2.1.10.3 If the Contractor or subcontractor fails to comply with any requirements outlined in the preceding paragraphs or its Agency regulations, the Department of Veterans Affairs may, at its discretion, require that the foreign national who failed to maintain their legal status in the United States or otherwise failed to comply with the requirements of the laws administered by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor, shall be prohibited from working at the Contractor’s place of business that services Department of Veterans Affairs patient referrals; or other place where the Contractor provides services to veterans who have been referred by the Department of Veterans Affairs; and shall form the basis for termination of this contract for breach.

2.1.11 Annual Office of Inspector General (OIG) Statement: In accordance with HIPAA and the Balanced Budget Act (BBA) of 1977, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has established a list of parties and entities excluded from Federal health care programs. Specifically, the listed parties and entities may not receive Federal Health Care program payments due to fraud and/or abuse of the Medicare and Medicaid programs.

2.1.11.1 Therefore, Contractor shall review the HHS OIG List of Excluded Individuals/Entities on the HHS OIG web site at http://oig.hhs.gov/exclusions/index.asp to ensure that the proposed contract MHLIP(s) are not listed. Contractor should note that any excluded individual or entity that submits a claim for reimbursement to a Federal health care program, or causes such a claim to be submitted, may be subject to a Civil Monetary Penalty (CMP) for each item or service furnished during a period that the person was excluded and may also be subject to treble damages for the amount claimed for each item or service. CMP’s may also be imposed against the Contractor that employ or enter into contracts with excluded individuals to provide items or services to Federal program beneficiaries.

2.1.11.2 By submitting their quote, the Contractor certifies that the HHS OIG List of Excluded Individuals/Entities has been reviewed and that the Contractors are and/or firm is not listed as of the date the offer/bid was signed.

2.2 Clinical/Professional Direction: The qualifications of Contractor personnel are subject to review by VANCHCS Chief of Staff or his/her clinical designee and approval by the VANCHCS Medical Center Director as provided in VHA Handbook 1100.19.

Clinical/Professional direction of all clinical personnel covered by this contract will be provided by the VANCHCS COS and/or the Chief of the Service or his designee. A COR may be appointed, however, only the CO is authorized to consider any contract modification request and/or make changes to the contract during the administration of the resultant contract.

2.3 Non‐Personal Healthcare Services: The parties agree that the Contractor and all contract MHLIP(s) shall not be considered VA employees for any purpose.

2.4 Inherent Government Functions: Contractor and Contract MHLIP(s) shall not perform inherently governmental functions. This includes, but is not limited to, determination of agency policy, determination of Federal program priorities for budget requests, direction and control of government employees (outside a clinical context), selection or non‐ selection of individuals for Federal Government employment including the interviewing of individuals for employment, approval of position descriptions and performance standards for Federal employees, approving any contractual documents, approval of Federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy.

2.5 No Employee status: The Contractor shall be responsible for protecting Contract MHLIP(s) furnishing services. To carry out this responsibility, the Contractor shall provide or certify that the following is provided for all their staff providing services under the resultant contract:

2.5.1 Workers’ compensation

2.5.2 Professional liability insurance

2.5.3 Health examinations

2.5.4 Income tax withholding, and

2.5.5 Social security payments.

2.6 Tort Liability: The Federal Tort Claims Act does not cover Contractor or contract MHLIP(s). When a Contractor or contract MHLIP has been identified as a provider in a tort claim, the Contractor shall be responsible for notifying their legal counsel and/or insurance carrier. Any settlement or judgment arising from a Contractor’s (or contract MHLIP(s) action or non‐action shall be the responsibility of the Contractor and/or insurance carrier.

2.7 Key Personnel:

2.7.1 The VA Full Time Equivalency (FTE) for the services required is 0.25 VA FTE.

FTE is defined by VA as a minimum of 80 hours every two weeks and does not include holidays.

2.8 Emergency Substitutions: During the first ninety (90) calendar days of performance, the Contractor shall make NO substitutions of key personnel unless the substitution is necessitated by illness, death or termination of employment. The Contractor shall notify the CO, in writing, within 15 calendar days after the occurrence of any of these events and provide the information required below. After 90 days, the Contractor shall submit the information required below to the CO at least 15 calendar days prior to making any permanent substitutions.

2.8.1 The Contractor shall provide a detailed explanation of the circumstances necessitating the proposed substitutions, complete resumes for the proposed substitutes, and any additional information requested by the CO. Proposed substitutes shall have comparable qualifications to those of the persons being replaced. The CO will notify the Contractor within 15 calendar days after receipt of all required information of the decision on the proposed substitutes. The contract will be modified to reflect any approved changes of key personnel.

2.8.2 For temporary substitutions where the key person shall not be reporting to work for three (3) consecutive workdays or more, the Contractor shall provide a qualified replacement for the key person. The substitute shall have comparable qualifications to the key person. Any period exceeding two weeks will require the procedure as stated above.

2.8.3 The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. Should the VA COS or designee show documented clinical problems or continual unprofessional behavior/actions with any contract MHLIP(s), they may request, without cause, immediate replacement of said contract MHLIP(s).

2.8.4 The CO and COR shall deal with issues raised concerning Contract MHLIP(s) conduct. The final arbiter on questions of acceptability is the CO.

2.9 Contingency Plan: Because continuity of care is an essential part of VANCHCS’s medical services, The Contractor shall have a contingency plan in place to be utilized if the contract MHLIP leaves Contractor’s employment or is unable to continue performance in accordance with the terms and conditions of the resulting contract.

3.0 HOURS OF OPERATION

3.1 VA Business Hours: Monday through Friday, 8:00am – 4:30pm

3.2 Work Schedule: As needed, Monday through Friday, 4:30 pm – 8:00 am the next morning, and 24 hours a day on weekends and holidays.

3.3 Federal Holidays: The following holidays are observed by the Department of Veterans Affairs:

New Year’s Day

Martin Luther King’s Birthday

Washington’s Birthday

Memorial Day

Juneteenth

Independence Day

Labor Day

Columbus Day

Veterans Day

Thanksgiving

Christmas

Any day specifically declared by the President of the United States to be a national holiday.

3.5 Vacation Leave/Absences: Vacation, leave, or absences shall be paid and responsibility of the contractor. Contract MHLIP(s) shall coordinate leave/absences with the Mental Health (MH) Clinic Manager or designee. VANCHCS will only make payment to contractor during holidays for time spent conducting assessments.

3.5.1 Monitoring Procedures: The established productivity standards used for all VANCHCS MHLIP(s) shall be used to monitor all Contractor employees. A copy of these standards can be obtained from the appropriate MH staff personnel.

3.6. Cancellations: Unless a state of emergency has been declared or clinics are otherwise cancelled by the VANCHCS, the Contractor shall be responsible for providing services.

4.0 CONTRACTOR RESPONSIBILITIES

4.1 Clinical Personnel Required: The Contractor shall provide Mental Health Licensed

Independent Practitioners who are competent, qualified per this performance work statement and adequately trained to perform assigned duties.

4.1.1 Contract MHLIP(s) shall have at least two years experienced (per occupation history and reference checks) of performing mental health evaluations involving

Welfare and Institution Code section 5150 determinations, be trained and currently certified by Sacramento County to perform 5150 evaluations; or if the VA provides re‐certification, they must become appropriately recertified. MHLIP must keep their

5150 certification up‐to‐date through Sacramento County or through the VA, if the

VA provides recertification, every 2 years. MHLIP are subject to quality oversight directly by Mental Health Leadership. Mental Health Leadership may review the mental health evaluations to ensure proper protocols are followed. MHLIPs shall be responsible for signing in and out when in attendance. Time sheets will be used by the COR to confirm hours/day and services provided against the contractor’s invoices.

4.1.2 Contractor employees will maintain a neat personal appearance and maintain professionalism while working at VANCHCS.

4.1.3 The contractor shall provide accurate and reliable contact telephone contact numbers (e.g., single phone number, on‐call roster, etc.) for use by emergency room staff to request consultation.

4.1.4 The contractor will evaluate patients who may be considered by emergency room staff as an immediate danger to themselves or others or gravely disabled within 60 minutes of being called by the ED. The contractor and ED staff will determine the need for the contractor to evaluate the patient in the ED.

4.1.5 The contractor provides written results of the assessment. The contracted provider also completes as needed the Application for 72 Hour Detention for

Evaluation and Treatment (MH 302) which is available in the ED.

4.1.6 If admission to the inpatient unit is necessary and appropriate (admission criteria is available in the Appendix to this Performance Work Statement (PSW)), the contractor will inform the ED, and consult with the Psychiatrist or Resident on‐ call by phone. The ED maintains a rotation schedule and the contact number for the on‐call personnel.

4.1.7 Admission may not be appropriate for all patients and discharge disposition should be presented to the ED. For those patients who the contractor determines are in need of hospitalization, but who have medical conditions that preclude admission to the Inpatient Psychiatry Unit, the ED will transfer the patient to the appropriate medical unit with a 1:1 sitter for observation until a medical clearance is completed. A patient can request voluntary admission after evaluation if deemed appropriate by the contracted provider.

4.1.8 The VA Emergency Department is to provide a safe environment for the evaluation with access to a telephone. The ED will also maintain a current roster for the Psychiatrist or Resident on‐call.

4.1.9 No patients will be billed for services provided under this contract.

4.1.10 Emergency Health Services ‐ VANCHCS will render emergency health services for an incapacitating injury or otherwise serious illness occurring while on duty. All services, to include wages earned during period of initial medical evaluation provided by VANCHCS, will be reimbursed by the Contractor. The Contractor will furnish VANCHCS with the necessary injury/illness form(s) for reporting purposes.

VANCHCS for statistical and/or billing purposes will retain a copy of the complete form(s).

4.1.11 Identification, Parking, Smoking, and VA Regulations ‐ Contractor employees shall wear visible identification provided by VANCHCS at all times while on

VANCHCS premises. It is the responsibility of the Contractor employees to park in the appropriate designated parking areas (non‐patient parking sections).

Information of designated parking areas is available from the Police Station.

VANCHCS will not invalidate or make reimbursement for parking violations of the

Contractor under any conditions. Smoking is prohibited inside any buildings at

VANCHCS. Possession of weapons, illegal drugs or alcohol is prohibited. Enclosed containers, including tool kits, shall be subjected to search. Violations of VANCHCS regulations may result in citation answerable in the United States Federal District

Court, not a local district, state, or municipal court.

4.1.12 Contractor certifies that all Contractor employees assigned to work for

VANCHCS are current in Universal Precautions and are aware of pertinent

Occupational Safety and Health Administration (OSHA) and Universal Precautions

Regulations.

4.1.13 Contract employees will have the use of all required equipment, supplies and forms for performing services required by this contract.

4.1.14 Contractor employees who previously received a favorable adjudication as a result of a Government background investigation may be exempt from this contract requirement provided that they can provide documentation to support the previous adjudication. Proof of previous adjudication must be submitted by the

Contractor to VA SIC through the VA Contracting Officer. Proof of previous adjudication is subject to verification by the VA SIC. Some positions may be subject to periodic re‐investigation.

4.1.15 For those Contractor employees who will work less than six (6) months (180 days) under this contract and does not require access to VA computer systems, a background investigation is not required; however, such employees will be required to initiate a SIC for Fingerprint Only prior to providing services under this contract.

4.1.16 Position Sensitivity: The position sensitivity has been designated as: Low

Risk

4.1.17 Background Investigation: The level of background investigation commensurate with the required level of access is: NACI

4.1.18 Contractor Responsibilities: In order to conduct a background investigation the Contractor shall submit or have their contract personnel submit the following required forms to the MH Administrative Officer. The appropriate Mental Health

(MH) staff personnel will arrange a time for contract personnel to complete fingerprint verification.

4.1.18.1 Standard Form 85, Questionnaire for Non‐Sensitive Positions

4.1.18.2 Standard Form 86A, Continuation Sheet for Questionnaires

4.1.18.3 Optional Form 306, Declaration for Federal Employment

4.1.18.4 Electronic Fingerprint Verification OR FD 258, U.S. Department of

Justice Fingerprint Applicant Chart

4.2 Standards of Care: The contract MHLIP(s) care shall cover the range of Psychiatric services as would be provided in a state‐of‐the‐art civilian medical treatment facility and the standard of care shall be of a quality, meeting or exceeding currently recognized national standards as established by:

4.2.1 American Psychiatric Association Guidelines:

http://www.psych.org/practice/clinical‐practice‐guidelines

4.2.2 VA Standards: VHA Directive 2006‐041 “Veterans’ Health Care Service

Standards” (expired but still in effect pending revision) https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443

4.2.3 The professional standards of the Joint Commission (TJC) http://www.jointcommission.org/standards_information/standards.aspx

4.2.4 The standards of the American Hospital Association (AHA) http://www.hpoe.org/resources?show=100&type=8 and;

4.2.5 The requirements contained in this Performance Work Statement.

4.2.6 The government may evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of services rendered (e.g., professional judgments, diagnosis for specific medical treatment).

4.3 RECORDS/PATIENT INFORMATION

4.3.1 Authorities: Contract MHLIP(s) providing healthcare services to VA patients shall be considered as part of the Department Healthcare Activity and shall comply with the U.S.C.551a (Privacy Act), 38 U.S.C. 5701 (Confidentiality of claimants records), 5 U.S.C. 552 (FOIA), 38 U.S.C. 5705 (Confidentiality of Medical Quality Assurance Records) 38 U.S.C. 7332 (Confidentiality of certain medical records), Title 5 U.S.C. § 522a (Records Maintained on Individuals) as well as 45 C.F.R. Parts 160, 162, and 164 (HIPAA).

4.3.2 HIPAA: This contract and its requirements meet exception in 45 CFR 164.502(e), and do not require a BAA in order for Covered Entity to disclose Protected Health Information to: a health care provider for treatment. Based on this exception, a BAA is not required for this contract. Treatment and administrative patient records generated by this contract or provided to the Contractors by the VA are covered by the VA system of records entitled ‘Patient Medical Records‐VA (24VA10P2). Contractor generated VA Patient records are the property of the VA and shall not be accessed, released, transferred, or destroyed except in accordance with applicable laws and regulations. Contractor shall ensure that all records pertaining to medical care and services are available for immediate transmission when requested by the VA. Records identified for review, audit, or evaluation by VA representatives and authorized federal and state officials, shall be accessed on‐site during normal business hours or mailed by the Contractor at his expense.

Contractor shall deliver all final patient records, correspondence, and notes to the VA within twenty‐one (21) calendar days after the contract expiration date.

4.3.3 Disclosure: Contract MHLIPs shall obtain permission from the VA before disclosing any patient information. Subject to applicable federal confidentiality or privacy laws, the Contractor, will be provided the Contractor with a copy of VHA Handbook 1907.1, Health Information management and Health Records and VHA Handbook 1605.1, Privacy and Release of Information. The penalties and liabilities for the unauthorized disclosure of VA patient information mandated by the statutes and regulations mentioned above, apply to the Contractor.

4.3.4 Professional Standards for Documenting Care: Care shall be appropriately documented in medical records in accordance with standard commercial practice and guidelines established by VHA Handbook 1907.01 Health Information Management and Health Records: 1907.01 and all guidelines provided by the

VANCHCS.

4.3.5 Release of Information: The VA shall maintain control of releasing any patient medical information and will follow policies and standards as defined, but not limited to Privacy Act requirements. In the case of the VA authorizing the Contractor to release patient information, the Contractor in compliance with VA regulations, and at his/her own expense, shall use VA Form 3288, Request for and Consent to Release of Information from Individual’s Records, to process “Release of Information Requests.” In addition, the Contractor shall be responsible for locating and forwarding records not kept at their facility. The VA’s Release of Information Section shall provide the Contractor with assistance in completing forms.

Additionally, the Contractor shall use VA Form 10‐5345a, Individuals’ Request for and Authorization to Release Medical Records or Health Information, this is used when the Veteran is requesting for their records to be sent to a 3rd party, not just for the release of 38 U.S.C. 7332 information. Treatment and release records shall include the patient’s consent form. Completed Release of Information requests will be forwarded to the VA Privacy Officer at the following address: Shannon Caston, VANCHCS (001/PO/FOIA/FF), 103 Bodin Circle, Travis AFB, Fairfield, CA 94535;

Phone (707)437‐1823.

4.4 DIRECT PATIENT CARE: 95% of the time involved in direct patient care.

7.4.1 Per the contract responsibilities section of this PWS, the Contract Mental Health Licensed Independent Practitioner(s) (as appropriate and within scope of practice/privileging) shall be responsible for providing Psychiatric assessments.

4.5 ADMINISTRATIVE: up to 5% of time not involved in direct patient care.

Forms/paperwork associated with patient care (Evaluation, applications, etc.).

4.6 PERFORMANCE STANDARDS, QUALITY ASSURANCE (QA) AND QUALITY

IMPROVEMENT (QI)

4.6.1 Quality Management/Quality Assurance Surveillance: Contractor performance will be monitored by the government using the standards as outlined in this Performance Work Statement (PWS) and methods of surveillance detailed in the Quality Assurance Surveillance Plan (QASP). The QASP shall be attached to the resultant contract and shall define the methods and frequency of surveillance conducted.

4.6.2 Patient Complaints: The CO will resolve complaints concerning Contractor relations with the Government employees or patients. The CO is final authority on validating complaints. In the event that The Contractor is involved and named in a validated patient complaint, the Government reserves the right to refuse acceptance of the services of such personnel. This does not preclude refusal in the event of incidents involving physical or verbal abuse.

4.6.3 The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. The CO and COR shall deal with issues raised concerning Contractor’s conduct. The final arbiter on questions of acceptability is the CO.

4.6.4 Performance Standards:

4.6.4.1 Measure: Legal Forms

Performance Requirement:

Standard: Demonstrates a concerned and positive attitude with workers, patients, and other stakeholders.

Acceptable Quality Level: Satisfactory rating = No more than 2 validated complaints during rating period.

Surveillance Method: 1) Service reports, 2) Supervisor review Frequency: Every six months Incentive: Positive Past Performance Disincentive: Negative Past Performance, (should there be deductions for this standard)

4.6.4.2 Measure: Interpersonal Communication/Customer Service

Standard: Demonstrates a concerned and positive attitude with workers, patients, and other stakeholders.

Acceptable Quality Level: Satisfactory rating = No more than 2 validated complaints during rating period.

Surveillance Method: 1) Service reports, 2) Supervisor review Frequency: Every six months Incentive: Positive Past Performance Disincentive: Negative Past Performance, (should there be deductions for this standard)

4.6.4.3 Measure: Emergency Department Request for Evaluations Performance Requirement:

Standard: Mather Emergency Department (ED) will contact on‐call Licensed Independent Practitioner to complete a psychiatric assessment of a patient that is medically cleared in the Mather ED within 60 minutes.

Acceptable Quality Level: Satisfactory rating = No more than two failures to meet the timeline.

Surveillance Method: 1) Validated Evaluation Form, 2) Contractor meets availability time frames.

Frequency: Every six months Incentive: Positive Past Performance Disincentive: Negative Past Performance, (should there be deductions for this standard)

4.6.4.4 Measure: Professionalism

Performance Requirement: Training is kept current.

Standard: Routinely on‐time for clinical assignments. Completes required CME in specialty area. Maintains active BLS training.

Acceptable Quality Level: Satisfactory rating = 100% during rating period.

Surveillance Method: 1) Timecards, 2) Confirmation of current BLS, 3) Attestation of completed CME.

Frequency: Every six months Incentive: Positive Past Performance Disincentive: Negative Past Performance, (should there be deductions for this standard)

4.6.4.5 Measure: Psychiatric Evaluation

Performance Requirement: Data is accurate and timely.

Standard: Sound Psychiatric principles are applied. The Behavioral Health Inpatient Care Unit (BHICU) psychiatric admission guidelines will be used to determine if the patient meets psychiatric inpatient, medical admission or neither.

Acceptable Quality Level: All (100%) contract MHLIP(s) perform within their scope of practice/privileges 100% of the time. No deviations accepted.

Surveillance Method: Random Inspection of records.

Frequency: Every six months Incentive: Favorable contractor performance evaluation.

Disincentive: Unfavorable contractor performance evaluation. Removal from contract until such time the contract MHLIP(s) meet qualification standard.

Deduction:

4.6.4.6 Measure: Evaluation Forms

Performance Requirement: Data is accurate and timely.

Standard: Written results of the assessments are completed in a timely manner.

The Social Worker will complete the assessment forms and make recommendations to the ED Physician and/or On‐call Psychiatrist. HIPAA Privacy and Security Rules apply at all times.

Acceptable Quality Level: No more than two failures to complete paperwork.

Nor more than two validated complaints or incidents.

Surveillance Method:

Frequency: Every six months Incentive: Favorable contractor performance evaluation.

Disincentive: Unfavorable contractor performance evaluation. Removal from contract until such time the contract MHLIP(s) meet qualification standard.

4.6.4.7 Measure: Patient Access

Performance Requirement: The Contractor shall provide contract MHLIP(s) in accordance with the operating hours and VA clinical schedule outlined in this

PWS.

Standard: All (100%) contract MHLIP(s) are on time and available to perform services.

Acceptable Quality Level: Contract MHLIP is on‐time and available to perform services 100% of the time.

Surveillance Method: Periodic Sampling of Time and Attendance Sheets Frequency: Every three months Incentive: Favorable contactor performance evaluation.

Disincentive: Unfavorable contractor performance evaluation, Deduction:

4.6.4.8 Measure: Maintains licensing and registration

Performance Requirement: Licensing and registration information kept current.

Standard: All (100%) licensing for contract MHLIP(s) shall be provided as they are renewed. Licensing and registration information kept current.

Acceptable Quality Level: All (100%) licensing, registration(s) and certification(s) for contract MHLIP(s) shall be provided as they are renewed. Licensing and registration information kept current. No acceptable deviation.

Surveillance Method: Periodic Sampling and Random Sampling Frequency: Annually

Incentive: Favorable contractor performance evaluation.

Disincentive: Unfavorable contractor performance evaluation, Deduction:

4.6.4.9 Measure: Privacy, Confidentiality and HIPAA

Standard: All (100%) contractor MHLIP(s) comply with all laws, regulations, policies and procedures relating to Privacy, Confidentiality and HIPAA Acceptable Quality Level: 100% compliance; no deviations.

Surveillance Method: Periodic Sampling; Contractor shall provide evidence of annual training required by VANCHCS, reports violations per VA Directive 6500.6.

Frequency: Every six months Incentive: Favorable contractor performance evaluation.

Disincentive: Unfavorable contactor performance evaluation. Immediate removal from contract

5 GOVERNMENT RESPONSIBILITIES

5.1 VA Support Personnel, Services or Equipment:

5.2 Contract Administration/Performance Monitoring: After award of contract, all inquiries and correspondence relative to the administration of the contract shall be addressed to: the appointed COR.

5.2.1 CO RESPONSIBILITIES:

5.2.1.1 The Contracting Officer is the only person authorized to approve changes or modify any of the requirements of this contract. The Contractor shall communicate with the Contracting Officer on all matters pertaining to contract administration. Only the Contracting Officer is authorized to make commitments or issue any modification to include (but not limited to) terms affecting price, quantity or quality of performance of this contract.

5.2.1.2 The Contracting Officer shall resolve complaints concerning Contractor relations with the Government employees or patients. The Contracting Officer is final authority on validating complaints. In the event the Contractor effects any such change at the direction of any person other than the Contracting Officer without authority, no adjustment shall be made in the contract price to cover an increase in costs incurred as a result thereof.

5.2.1.3 In the event that contracted services do not meet quality and/or safety expectations, the best remedy will be implemented, to include but not limited to a targeted and time limited performance improvement plan; increased monitoring of the contracted services; consultation or training for Contractor personnel to be provided by the VA; replacement of the contract personnel and/or renegotiation of the contract terms or termination of the contract.

5.2.2 COR Responsibilities:

The COR for this contract is: the appointed COR.

5.2.2.1. The COR shall be the VA official responsible for verifying contract compliance. After contract award, any incidents of Contractor noncompliance as evidenced by the monitoring procedures shall be forwarded immediately to the Contracting Officer.

5.2.2.2. The COR will be responsible for monitoring the Contractor’s performance to ensure all specifications and requirements are fulfilled. Quality Improvement data that will be collected for ongoing monitoring includes but is not limited to entering data that may be collected.

5.2.2.3. The COR will maintain a record‐keeping system of services. The COR will review this data monthly when invoices are received and certify all invoices for payment by comparing the hours documented on the VA record‐keeping system and those on the invoices. Any evidence of the Contractor's non‐ compliance as evidenced by the monitoring procedures shall be forwarded immediately to the Contracting Officer.

5.2.2.4. The COR will review and certify monthly invoices for payment. If in the event the Contractor fails to provide the services in this contract, payments will be adjusted to compensate the Government for the difference.

5.2.2.5. All contract administration functions will be retained by the VA.

6 SPECIAL CONTRACT REQUIREMENTS

6.1 Reports/Deliverables: The Contractor shall be responsible for complying with all reporting requirements established by the Contract. Contractor shall be responsible for assuring the accuracy and completeness of all reports and other documents as well as the timely submission of each. Contractor shall comply with contract requirements regarding the appropriate reporting formats, instructions, submission timetables, and technical assistance as required.

6.1.1 The following are brief descriptions of required documents that must be submitted by Contractor: upon award; weekly; monthly; quarterly’; annually, etc.

identified throughout the PWS and is provided here as a guide for Contractor convenience. If an item is within the PWS and not listed here, the Contractor remains responsible for the delivery of the item.

What Submit as noted Submit To

Quality Control Plan: Description and reporting reflecting the contractor’s plan for meeting of contract requirements and performance standards

Upon quote and as frequently as indicated in the performance standards.

Contracting Officer

Copies of any and all licenses to include primary source verification of all licensed staff

Upon quote and upon renewal of licenses and upon renewal of option periods or change of key personnel.

Contracting Officer

Certification that staff list have been compared to OIG list

Upon quote and upon new hires.

Contracting Officer

Proof of Indemnification and Medical Liability Insurance

Upon quote and upon renewals.

Contracting Officer

BLS Certification Upon award and every two years after award.

COR

Contingency plan Upon quote and as updated COR

6.2 Billing:

6.2.1 Invoice requirements and supporting documentation: Invoices for care and ancillary services shall be submitted promptly to the authorizing facility by the 15th calendar day following the end of the month in which services were rendered.

Subsequent changes or corrections shall be submitted by separate invoice. In addition to information required for submission of a “proper” invoice in accordance with FAR 52.212‐4 (g), all invoices must include:

6.2.1.1 Name and Address of Contractor.

6.2.1.2 Invoice Date and Invoice Number.

6.2.1.3 Contract Number and Purchase/Task Order Number

6.2.1.4 Patient’s name and full social security number.

6.2.1.5 Date of Service.

6.2.1.6 Contract MHLIP(s).

6.2.1.7 Hourly Rate.

6.2.1.8 Quantity of hours worked.

6.2.1.8 Total price.

6.2.1.9 Failure to include the above information may result in delayed payment.

The current Agency billing cover sheet can be obtained from the VA Fee Basis/Purchased Care Department at (707) 647‐8914.

6.2.1.10 The Contracted Facility will promptly notify the VA Social Work/COR assigned to manage the “On Call Contract” regarding any change in contract employee status, i.e., difficulties in reporting to work, expiration of license.

6.2.1.11 Pre‐approved services billed by CMS procedures or Current Procedural Terminology (CPT) codes: The Contracted Facility will be reimbursed based on local guidelines and VA pricing schedules.

6.3 Vendor Electronic Invoice Submission Methods:

Facsimile, e‐mail, and scanned documents are not acceptable forms of submission for payment requests. Electronic form means an automated system transmitting information electronically according to the accepted electronic data transmission methods below:

6.3.1 VA’s Electronic Invoice Presentment and Payment System – The Federal Supply Classification Code (FSC) uses a third‐party contractor, OB10, to transition vendors from paper to electronic invoice submission. Please go to this website:

http://ob10.com/us/en/veterans‐affairs‐us/ to begin submitting electronic invoices, free of charge. A system that conforms to the X12 electronic data interchange (EDI) formats established by the Accredited Standards Center (ASC) chartered by the American National Standards Institute (ANSI). The X12 EDI website (http://www.x12.org).

6.3.3 The Contract may contact FSC at the phone number or email address listed below with any questions about the e‐invoicing program or OB10:

6.3.3.1. OB10 e‐Invoice Setup Information: 1‐877‐489‐6135

6.3.3.2. OB10 e‐Invoice email: VA.Registration@ob10.com

6.3.3.3. FSC e‐Invoice Contact Information: 1‐877‐353‐9791

6.3.3.4. FSC e‐invoice email: vafsccshd@va.gov

6.3.4 Contactors who bill electronically using the HIPAA‐compliant claims transactions must submit claims through the VA clearinghouse, Emdeon, using payer ID number 12115 for medical claims.

6.3.5 Contractors who are not able to use the HIPAA‐compliant transactions are not required to do so. Supporting information for monthly invoices will be mailed to:

VA Northern California Health Care System Mare Island Outpatient Clinic Fee Basis/Purchased Care (04F/MI) 201 Walnut Avenue Vallejo, CA 94592

6.3.6 Invoice Correction: Corrected invoices must be submitted for additional payment of any ancillary costs or changes to the original billing. All corrected invoices must include all items that are affected by the change and should include the corrected claim form (available from VA Fee Basis/Purchased Care (707) 647‐ 8914).

6.4 Payment…