36C26126Q0430.docx

SUBJECT*

HCHV CERS Geriatric Services in San Mateo, Santa Clara or Southern Alameda County.

GENERAL INFORMATION

SET-ASIDE

Network Contracting Office (NCO) 21

POINT OF CONTACT*

Contract Specialist Lacy Morgan Lacy.Morgan@va.gov

PLACE OF PERFORMANCE

POSTAL CODE

COUNTRY

ADDITIONAL INFORMATION

AGENCY’S URL

URL DESCRIPTION

AGENCY CONTACT’S EMAIL ADDRESS

EMAIL DESCRIPTION

DESCRIPTION

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

The Government is not obligated to nor will it pay for or reimburse any costs associated with responding to this sources sought synopsis request. This notice shall not be construed as a commitment by the Government to issue a solicitation or ultimately award of a contract, nor does it restrict the Government to a particular acquisition approach.

The Department of Veterans Affairs, Network Contracting Office (NCO) 21, is conducting market research to identify potential vendors that can provide the general requirements below.

General Requirements The Department of Veterans Affairs, Network Contracting Office (NCO) 21, has a requirement for Health Care for Homeless Veterans (HCHV) Contracted Emergency Residential Services (CERS) for Homeless Geriatric Veterans in San Mateo, Santa Clara, or Southern Alameda County for VA Palo Alto Health Care System (VAPAHCS).

The Department of Veterans Affairs Palo Alto Health Care System (VAPAHCS) requires Health Care for Homeless Veterans (HCHV) Contracted Emergency Residential Services (CERS) for Homeless Geriatric Veterans in San Mateo, Santa Clara, or Southern Alameda County. Contractor shall primarily focus on providing emergency housing and supportive services for homeless geriatric Veterans in accordance with the HCHV CERS model requirements. Contractor should have a facility located in San Mateo, Santa Clara, or Southern Alameda County. Please review the draft performance statement for full description of requirements.

Place of Performance: VA Palo Alto Healthcare System: San Mateo, Santa Clara, or Southern Alameda County.

Period of Performance: The intended period of performance will be for 5 years, which may approximately begin around August 1, 2026.

Response Method: Please complete attached Sources Sought Notice Responsible vendors are encouraged to submit a response to this sources sought synopsis.

Any inquiries are to be made in writing to the point of contact, Lacy Morgan, Contract Specialist.

Responses shall be sent to the below email by the specified due date and time.

· Email: lacy.morgan@va.gov

· Response Due Date: March 13, 2026 12:00pm PST

· Email Subject Line: SAM – HCHV CERS Geriatric Services – VA Palo Alto Healthcare System

In response to this sources sought synopsis, please complete the information below.

1. Company Information Company Name

Company Address

Point of Contact Name

Phone Number

Email Address

Unique Entity Identifier (UEI)

☐ Small Business ☐ Emerging Small Business ☐ Small Disadvantaged Business ☐ Certified under Section 8(a) of the Small Business Act ☐ HubZone ☐ Woman Owned ☐ Certified Service-Disabled Veteran Owned Small in Vetbiz.gov ☐ Certified Veteran Owned Small Business in Vetbiz.gov ☐ Large Business ☐ Other:____________

1. Describe experience in providing residential services for a 30-90 day stay or longer for geriatric homeless individuals, providing case management support for improving income, and identifying long-term housing services and indicate the facility location.

1. Has the facility been in San Mateo, Santa Clara, or Southern Alameda County for at least one year?

a. If yes, please provide address:

1. Location/Transportation: Is the residential facility close to public transportation or would arrangements be made to help the Veteran access public transportation?

1. Does your facility have staff and patients currently?

1. What is the desired or typical length of stay?

1. Do you provide 3 meals a day?

1. Do you provide case management services that include helping residents get income, identification paperwork, housing applications, assistance getting them access to their accounts, and discharge planning?

1. How do manage behavioral issues or people that have drug and alcohol use?

1. What is your criteria for admission?

1. Do you have experience serving Veterans and coordinating with the VA?

1. Are your staff on-site 24 hours a day?

1. Do you have the capacity to admit 4 Veterans under a VA contract?

a. How many beds are available?

1. Is the facility wheelchair accessible?

1. Do you support homeless individuals with co-occurring disorders?

1. Do you have any plans for remodeling or pausing operations after August 1st, 2026?

1. To meet the requirement, does the company plan on subcontracting?

15. If yes, please indicate what actions the subcontractor will perform.

1. Identify the estimate pricing for HCHV CERS Geriatric Services. This is not a request for quote. This is a request for pricing information for market research purposes only.

Ordering Period 1 08/01/26-07/31/27

Ordering Period 2 08/01/27-07/31/28

Ordering Period 3 08/01/28-07/31/29

Ordering Period 4 08/01/29-07/31/30

Ordering Period 5 08/01/30-07/31/31

1. Additional comments regarding performance work statement, industry practices, etc.

Before responding, please carefully read and consider the following:

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

1. The Service Contract Act will apply.

1. Invoices will only be accepted on a monthly basis. Weekly invoices will not be accepted.

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

Sources Sought Notice Sources Sought Notice

Sources Sought Notice

VAPAHCS

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 San Mateo, Santa Clara, and Southern Alameda Counties 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. 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 American Disabilities Act 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 points of contact 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. For Santa Clara County locations, in addition to their standard documentation, the case manager(s) will also be expected to update Homeless Management Information System (HMIS) on all admissions, discharges and enter at least one transaction in HMIS per month.

3.1.4.5. 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.

3.1.4.6. 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.

3.1.4.7. 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.

3.1.4.8. 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).

3.1.4.9. 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.

3.1.4.10. 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 Mental Health provider and/or Suicide Prevention Coordinator.

3.1.4.11. 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.

3.1.4.12. 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.

3.1.4.13. 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.

3.1.4.14. 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.

3.1.4.15. 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.

3.1.4.16. 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.

3.1.4.17. 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.

3.1.4.18. 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.

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

3.1.4.18.2. Veterans must also be in active search and/or 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.

3.1.4.18.3 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.

3.1.14.18.4 Lastly, all Total Quality Indicators measures must be met to receive the highest past performance rating. These include the following:

· HCHV1 (Discharge to Permanent Housing) - > 55%

· HCHV2 (DC w/ Neg. Exits) - 20%

· Bed Occupancy > 85%

3.1.4.19. 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:

· Falls

· Assault (to Veteran or Staff)

· Elderly/Dependent Adult Abuse or Neglect

· Sexual Assault

· Fire (Veteran Involved)

· Medical/Psychiatric Emergency (911 Calls)

· Hospitalization

· Suicide or Suicide Attempt

· Homicide

· Death

· Infectious Control (TB, COVID, etc.)

· Active Substance Abuse on contractor property

· Observation/ Possession of Weapons

· Use of “cooling off” option within facility

· 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 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 VA Home Health Aide (HHA) and In Home Supportive Services (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 be Residential Care Facility for the Elderly (RCFE) administrator certified.

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 Quality Assurance Surveillance Plan (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: 1) A written and thorough Housing Needs Assessment, 3) A written, standardized Employability Assessment 4) Financial Plan, 5) Discharge Plan, and 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. 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 immediate review and repeal upon the request of the VA Liaison. Examples of rules that may not be appropriate to this setting are breathalyzing upon intake, enforcing chores as mandatory, mandatory sobriety, mandatory meetings (house meetings, Alcoholics Anonymous, Narcotics Anonymous, Substance Use Disorder treatment meetings). Veterans will be provided a copy of the rules at intake and/or upon Veterans’ request. In addition, Contractor will post the rules in a location readily accessible to clients and visitors. These rules must include detailed Patient Rights and the procedures that the Contractor has in place to protect the Veterans rights and dignity. Veterans must be permitted to exercise these rights without fear of reprisal. If requested, Contractors must reasonably accommodate Veterans whose compliance with program rules is limited by the Veterans’ physical or mental disabilities, in accordance with the Americans with Disabilities Act, the Federal Fair Housing Amendments Act, Section 504 of the Rehabilitation Act, including those requirements covering reasonable accommodations for disabilities and the use of assistance and companion animals, and the California Fair Employment and Housing Act of 1973 and all other applicable State or Federal laws. Contractor must equally apply all rules, policies, and procedures to Veterans, unless a Veteran has asked for a reasonable accommodation due to his/her disability.

4. REFERRALS, ADMISSIONS, ELIGIBILITY, AND DISCHARGE

4.1. Referrals and Admissions: Contractor is not permitted to require written applications and in person interviews from referral sources and/or Veteran as condition of admission to the program unless pre-approval has been obtained from the VA Liaison for special populations. For the Medical Respite and Geriatric programs, if there is an approved written application and this application is causing a delay in admission, the contractor is expected to reach out via phone to the referring party and/or Veteran and allow for any pending needed information to be relayed over the phone. Contractor may verify this information with the VA Liaison. Admission determinations must be made within 24 hours of referral.

4.2. Liaisons may disapprove an admission based on lack of acuity for a Veteran at any time.

4.2.1. HCHV contracts must have their own, separate interest list that cannot be combined with any other programs. Contractor must utilize a transparent admission process that includes written eligibility criteria that is fair, objective, and compliant with applicable State and Federal laws.

4.2.2. The contractor must be able to accept potential admissions from select VA POCs after hours. These POCs will be clarified with the VA liaison.

4.2.3. Contractor will provide verbal and written notification that is readily accessible to all individuals including the VA liaison, upon request, of reasons for non- acceptance. Notification of reasons for non-acceptance is not required to be given to those denied service/housing because of bed unavailability. The eligibility information must be made available to clients at intake and staff must provide answers to questions about the admission criteria and process.

4.2.4. Contractors must have formal appeal procedures through which clients may appeal unfavorable admission or eligibility decisions and a copy of the policy for appeals is to be given to the Veteran at screening or intake. For highly symptomatic Veterans, a waiver for admission and intake procedures can be requested VA Liaison (or Designee). Contractor cannot ban VA staff from the shelters if they are providing coordination, case management or care for Veterans who are enrolled in the VA programs. If there are conflicts with VA staff. Agencies must bring any issues with VA staff to the supervisor. The VA will make all efforts to work with agency staff on coming to a mutual agreement which will respect the agency and minimize care coordination with the Veteran. Admission process is subject to liaison review and adjustment at any time to ensure accessibility for Veterans.

4.3. Eligibility: The VA is responsible for determining eligibility of Veterans prior to acceptance by the Contractor for services.

4.3.1. The Contractor is responsible for requesting eligibility and written pre-approval verification from the VA Liaison (or Designee) (hard copy, fax or secure e-mail are acceptable) prior to admission and/or billing for services for each Veteran referred under this contract. If there is an urgent need to admit a Veteran and VA Staff is not available to provide a written approval in a timely manner a verbal approval is acceptable. Any admissions that occur without written/verbal approval must be verified by VA Staff in order for the Contractor to receive payment for time spent prior to approval (e.g., admission after hours or during the weekend). Written documentation of eligibility verification, signed by an authorized VA Staff, shall be obtained by the Contractor as soon as possible for each Veteran referred for services under the contract for inclusion in the Veterans program file.

4.3.2. A list of authorized VA Staff for the contract shall be provided to the Contractor upon award of the contract. VA Staff may be added or deleted from the list during the term of the contract at the discretion of VA Contracting Officer. The Contractor shall be provided an updated list of authorized VA Staff whenever such changes are made.

4.3.3. 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.

4.3.4. It is understood that the type of Veterans to be cared for under this contract will require care and treatment services over and above the level of basic room and board. It is also understood that Veterans may need more intensive case management than the general population. The level of intensity of services required will be part of an ongoing conversation with the Liaison.

4.3.5. To be eligible for placement in emergency contract beds, all Veterans must be homeless and be eligible and registered for VA healthcare services. Special population contracts are intended for Veterans with special needs. The Geriatric contract is intended for Veterans over 50 however the liaison may grant admission to Veterans under 50 based off needs and acuity. 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.

Denial of Services: Unless determined clinically appropriate by the VA liaison, Veterans cannot be banned or denied entry to HCHV Contracted Residential Services based solely upon length of current abstinence from alcohol or non-prescribed controlled substances, active use, the number of previous treatment episodes, the time interval since the last program entry, the use of prescribed controlled substances, disability, income, gender, or legal history. This includes a Veterans status of being a victim of Domestic Violence and as such cannot be considered during the screening process. The screening process must consider each of these special circumstances and determine whether the program can meet the individual Veteran's needs while maintaining the program's safety, security, and integrity. Any previous behaviors or events which have limited the Veterans ability to be approved for entry to the HCHV program must have clearly defined parameters of how the Veteran can be re-considered for admission. These parameters must be determined clinically appropriate by the VA Liaison. All Contractors must employ a harm reduction approach. Contractor will provide verbal and written notification that is readily accessible to all individuals including the VA liaison, upon request, of reasons for non-acceptance.

4.4. Absences and Cancellation: The Contractor shall notify the VA of unauthorized absences by a referred Veteran from the facility within 24 hours of Veterans absence. Should a Veteran absent himself/herself from the Contractor’s facility in an unscheduled manner, payment for services for that Veteran shall be continued for a maximum period of 48 hours, provided the following conditions: (a) The provider must have evidence of active outreach to locate and reengage the Veteran and document the steps taken in the Veterans individual case file, treatment record, or service plan. (b) The provider may not fill the bed. (c) The Veteran must be discharged from the HCHV CERS program if not located within 48 hours. (d) The Veteran cannot be enrolled in another HCHV or Grant and Per Diem (GPD) program during this time. Management of program dropout rate will be an element of quality assurance review of this program.