36C26126Q0444 0001.pdf

PDF 1008 KB Posted Apr 3, 2026

Attached to: Home Oxygen Services and Ventilation - VA Central California Healthcare System (VACCHCS)
Solicitation number: 36C26126Q0444
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21

About this file

Written by GovTribe AI · Apr 3, 2026

This is a Performance Work Statement (PWS) for home oxygen and ventilator equipment rental services to be provided to Veteran beneficiaries served by VA Central California Healthcare System (VACCHCS), which encompasses Fresno, Kings, Madera, Mariposa, Merced, Tulare, Kern, and San Luis Obispo counties in California. The contract, solicitation number 36C26126Q0444, is an Indefinite Delivery Indefinite Quantity (IDIQ) contract with a guaranteed minimum of $5,000.00 and maximum ceiling of $1,500,000.00 for the VACCHCS service area. The contract includes five one-year ordering periods from October 1, 2026 through September 30, 2031, with the ordering period beginning October 1, 2026 and ending September 30, 2027 as the base period.

The contractor must provide complete home oxygen services including portable and stationary concentrators, liquid oxygen systems, portable gaseous oxygen systems, oxygen cylinders with refills, ventilators with backup systems, suction pumps, air compressors, and all associated supplies such as cannulas, masks, tubing, humidifiers, and equipment maintenance. Service includes initial setup by certified respiratory therapists (CRT/RRT), patient education, emergency 24/7 response within two hours (not exceeding six hours), equipment maintenance per manufacturer specifications, and reassessment visits at minimum every 90 days for oxygen patients and every 30 days for ventilator patients. The contractor must maintain a staffed branch office or available resources within 50 miles of each medical center, meet The Joint Commission (TJC) or equivalent accreditation standards, provide monthly usage reports and quarterly performance reports addressing infection control, customer satisfaction, performance improvement, fall prevention, and home visit compliance. Contractor must acknowledge orders within one hour, provide initial setup same day for orders received by 3:00 PM local time, possess general liability insurance of at least $500,000 per occurrence, and comply with all applicable federal, state, and local regulations regarding information security, HIPAA, Privacy Act, and personnel qualifications.

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Other files

File	Type	Posted
36C26126Q0444 0002 CANX.pdf	PDF	Jul 22, 2026
36C26126Q0444 Questions and Responses.pdf	PDF	Apr 7, 2026
Quality Assurance Surveillance Plan 4-3-2026.pdf	PDF	Apr 3, 2026
PP Questionnaire.docx	DOCX document	Apr 3, 2026
36C26126Q0444 CLINS Price Per Unit.xlsx	XLSX spreadsheet	Apr 3, 2026
Quality Assurance Surveillance Plan - VA Fresno.pdf	PDF	Mar 23, 2026
PP Questionnaire.docx	DOCX document	Mar 23, 2026
36C26126Q0444.pdf	PDF	Mar 23, 2026

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5. PROJECT NUMBER (if applicable)

CODE 7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

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

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO. 1. CONTRACT ID CODE

FACILITY CODE CODE

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

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

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR

ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

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

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES

SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

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

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

D. OTHER

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

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

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

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30 PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243

(Type or print) (Type or print)

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

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

(If other than Item 6)

(Specify type of modification and authority)

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

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

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

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

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

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

1 85

0001 04-03-2026

None

612MCP

Department of Veterans Affairs

VA Sierra Pacific Network (VISN 21)

Network Contracting Office (NCO) 21

3237 Peacekeeper Way, Bldg 209

McClellan Park CA 95652

612MCP

Department of Veterans Affairs

Network Contracting Office (NCO) 21

3237 Peacekeeper Way, Bldg 209

McClellan CA 95652

To all Offerors/Bidders

36C26126Q0444

03-23-2026

X X

See CONTINUATION Page

X 1

This amendment is to provide responses to the submitted questions regarding this solicitation. Also, a revised

Performance Work Statement (changes are highlighted), revised QASP, revised Past Performance Questionnaire and a line item spreadsheet for input of price per unit only are attached. No other changes are authorized to the spreadsheet. No further questions and/or clarifications will be received/accepted.

David J. Alvarez

Contracting Officer

CONTINUATION PAGE

A.1 PRICE/COST SCHEDULE

ITEM INFORMATION

ITEM

NUMBE

DESCRIPTION OF

SUPPLIES/SERVI

CES

QUANTI

UNI

T UNIT PRICE AMOUNT

5,000.00 MO _______________

Rental of Contractor Owned Portable Concentrator System Priced Per Month. HCPCS CODE E1390. Concentrator, Colored Tubing, Adapter Humidifier (when required), Cannulas or Masks and other required supplies and equipment, including back up systems. Perform Equipment Maintenance in accordance with manufacturer standards. At a minimum of once every 90 calendar days, visit and assess patient to assure equipment compliance, change filters and provide disposable supplies.

Ordering Period: 1 POP Begin: 10-01-2026 POP End: 09-30-2027 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and Supplies

MANUFACTURER PART NUMBER (MPN): N/A

3,000.00 MO _______________

Rental of Contractor Owned Portable O2 Gaseous System for use with or without Stationary System Priced Per Month.

HCPCS CODE E0431. Portable System, Regulator, Flowmeter, Humidifier, Cannulas, or Masks, Tubing, Conserving Device and O2 Tank Cylinder Stands capable of holding 12 cylinders, sizes E, D, C & M-6.

0.00 MO _______________

Rental of Contractor Owned Stationary Liquid O2 System Priced Per Month. HCPCS CODE E0439. Reservoir, Regulator, Flowmeter, Humidifier, Cannulas or Masks, and Colored Tubing.

Rental of Contractor Owned Portable Liquid O2 System Priced Per Month. HCPCS CODE E0434. Portable Container, Refill Adapter Flowmeter, Cannulas or Masks, and Colored Tubing. Reservoir will be provided if another Stationary System (e.g. Concentrator) is rented.

100.00 EA _______________

Suction Pump Priced Per Each. HCPCS CODE E0600.

Purchase, Delivery, Set-up and Training of Contractor Home Model Respiratory Suction Pump, portable or stationary electric to include all supplies.

0.00 EA _______________

Suction Pump Rental Priced Per Each. HCPCS CODE E0600. Purchase, Delivery, Set-up and Training of Contractor Home Model Respiratory Suction Pump, portable or stationary electric to include all supplies.

80.00 MO _______________

Rental of Contractor Owned Volume Ventilator Priced Per Month. HCPCS CODE E0465. Delivery, Set-up, Training, and Maintenance of Contractor Owned Stationary or Portable Ventilator, to include back up Ventilator and all supplies.

Government Owned Ventilator Set-up Priced Per Each.

HCPCS CODE E0465. Delivery, Set-up, and Training of a Government Owned Ventilator to include all necessary supplies.

2.00 MO _______________

REACT V+C ventilator Priced Per Month. HCPCS CODE E0468. Maintenance of Government Owned Ventilator Systems, to include all necessary supplies.

Ordering Period: 1 POP Begin: 10-01-2026 POP End: 09-30-2027 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental

PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

Air Compressor Priced Per Month. HCPCS CODE E0465.

Rental of Contractor Owned and Maintained continuous or intermittent air compressor for use with equipment not self contained or cylinder driven, to include all associated supplies.

50.00 MO _______________

Priced Per Month. E0565. Rental of Contractor Owned and Maintained continuous or intermittent air compressor for use with equipment not self contained or cylinder driven, to include all associated supplies Ordering Period: 1 POP Begin: 10-01-2026 POP End: 09-30-2027 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

Delivery Charge Priced Per Each. HCPCS CODE A9901.

Deliveries not made under all other line items.

Respiratory Therapist Visit Priced Per Each. HCPCS CODE VA120. Government requested Respiratory Therapist visit not covered by other Line Items.

Ordering Period: 2 POP Begin: 10-01-2027 POP End: 09-30-2028 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

Rental of Contractor Owned Portable O2 Gaseous System for use with or without Stationary System Priced Per Month.

HCPCS CODE E0431. Portable System, Regulator, Flowmeter, Humidifier, Cannulas, or Masks, Tubing, Conserving Device and O2 Tank Cylinder Stands capable of holding 12 cylinders, sizes E, D, C & M-6.

Rental of Contractor Owned Stationary Liquid O2 System Priced Per Month. HCPCS CODE E0439. Reservoir, Regulator, Flowmeter, Humidifier, Cannulas or Masks, and Colored Tubing.

Suction Pump Priced Per Each. HCPCS CODE E0600.

Purchase, Delivery, Set-up and Training of Contractor Home Model Respiratory Suction Pump, portable or stationary electric to include all supplies.

Suction Pump Rental Priced Per Each. HCPCS CODE E0600. Purchase, Delivery, Set-up and Training of

Contractor Home Model Respiratory Suction Pump, portable or stationary electric to include all supplies.

Rental of Contractor Owned Volume Ventilator Priced Per Month. HCPCS CODE E0465 & E0466. Delivery, Set-up, Training, and Maintenance of Contractor Owned Stationary or Portable Ventilator, to include back up Ventilator and all supplies.

Government Owned Ventilator Set-up Priced Per Each.

HCPCS CODE E0465 & E0466. Delivery, Set-up, and Training of a Government Owned Ventilator to include all necessary supplies.

Ventilator Maintenance Priced Per Month. HCPCS CODE E0465 & E0466. Maintenance of Government Owned Ventilator Systems, to include all supplies.

Ordering Period: 2 POP Begin: 10-01-2027 POP End: 09-30-2028

PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

Air Compressor Priced Per Month. HCPCS CODE E0565.

Rental of Contractor Owned and Maintained continuous or intermittent air compressor for use with equipment not self contained or cylinder driven, to include all associated supplies.

Priced Per Month. E0565. Rental of Contractor Owned and Maintained continuous or intermittent air compressor for use with equipment not self contained or cylinder driven, to include all associated supplies Ordering Period: 2 POP Begin: 10-01-2027 POP End: 09-30-2028 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

Delivery Charge Priced Per Each. HCPCS CODE A9901.

Deliveries not made under all other line items.

Ordering Period: 2 POP Begin: 10-01-2027 POP End: 09-30-2028 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of

Respiratory Therapist Visit Priced Per Each. HCPCS CODE VA120. Government requested Respiratory Therapist visit not covered by other Line Items.

Ordering Period: 3 POP Begin: 10-01-2028 POP End: 09-30-2029 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

Rental of Contractor Owned Portable O2 Gaseous System for use with or without Stationary System Priced Per Month.

HCPCS CODE E0431. Portable System, Regulator, Flowmeter, Humidifier, Cannulas, or Masks, Tubing, Conserving Device and O2 Tank Cylinder Stands capable of holding 12 cylinders, sizes E, D, C & M-6.

Ordering Period: 3 POP Begin: 10-01-2028 POP End: 09-30-2029 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental

Rental of Contractor Owned Stationary Liquid O2 System Priced Per Month. HCPCS CODE E0439. Reservoir, Regulator, Flowmeter, Humidifier, Cannulas or Masks, and Colored Tubing.

Suction Pump Priced Per Each. HCPCS CODE E0600.

Purchase, Delivery, Set-up and Training of Contractor Home Model Respiratory Suction Pump, portable or stationary electric to include all supplies.

Government Owned Ventilator Set-up Priced Per Each.

HCPCS CODE E0465 & E0466. Delivery, Set-up, and Training of a Government Owned Ventilator to include all necessary supplies.

Ventilator Maintenance Priced Per Month. HCPCS CODE E0465 & E0466. Maintenance of Government Owned

Ventilator Systems, to include all supplies.

Air Compressor Priced Per Month. HCPCS CODE E0565.

Rental of Contractor Owned and Maintained continuous or intermittent air compressor for use with equipment not self contained or cylinder driven, to include all associated supplies.

Priced Per Month. E0565. Rental of Contractor Owned and Maintained continuous or intermittent air compressor for use with equipment not self contained or cylinder driven, to include all associated supplies Ordering Period: 3 POP Begin: 10-01-2028 POP End: 09-30-2029 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

Delivery Charge Priced Per Each. HCPCS CODE A9901.

Deliveries not made under all other line items.

Ordering Period: 3 POP Begin: 10-01-2028 POP End: 09-30-2029

Respiratory Therapist Visit Priced Per Each. HCPCS CODE VA120. Government requested Respiratory Therapist visit not covered by other Line Items.

Ordering Period: 4 POP Begin: 10-01-2029 POP End: 09-30-2030 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

Rental of Contractor Owned Portable O2 Gaseous System for use with or without Stationary System Priced Per Month.

HCPCS CODE E0431. Portable System, Regulator, Flowmeter, Humidifier, Cannulas, or Masks, Tubing, Conserving Device and O2 Tank Cylinder Stands capable of holding 12 cylinders, sizes E, D, C & M-6.

Ordering Period: 4 POP Begin: 10-01-2029 POP End: 09-30-2030

Equipment - Medical, Dental, and Veterinary Equipment and

Rental of Contractor Owned Stationary Liquid O2 System Priced Per Month. HCPCS CODE E0439. Reservoir, Regulator, Flowmeter, Humidifier, Cannulas or Masks, and Colored Tubing.

Suction Pump Priced Per Each. HCPCS CODE E0600.

Purchase, Delivery, Set-up and Training of Contractor Home Model Respiratory Suction Pump, portable or stationary electric to include all supplies.

Ordering Period: 4 POP Begin: 10-01-2029 POP End: 09-30-2030 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of

Government Owned Ventilator Set-up Priced Per Each.

HCPCS CODE E0465 & E0466. Delivery, Set-up, and Training of a Government Owned Ventilator to include all necessary supplies.

Ventilator Maintenance Priced Per Month. HCPCS CODE E0465 & E0466. Maintenance of Government Owned Ventilator Systems, to include all supplies.

Air Compressor Priced Per Month. HCPCS CODE E0565.

Rental of Contractor Owned and Maintained continuous or intermittent air compressor for use with equipment not self contained or cylinder driven, to include all associated supplies.

Priced Per Month. E0565. Rental of Contractor Owned and Maintained continuous or intermittent air compressor for use with equipment not self contained or cylinder driven, to include all associated supplies Ordering Period: 4 POP Begin: 10-01-2029 POP End: 09-30-2030 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

Delivery Charge Priced Per Each. HCPCS CODE A9901.

Deliveries not made under all other line items.

Ordering Period: 4 POP Begin: 10-01-2029 POP End: 09-30-2030

PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

Respiratory Therapist Visit Priced Per Each. HCPCS CODE VA120. Government requested Respiratory Therapist visit not covered by other Line Items.

Ordering Period: 5 POP Begin: 10-01-2030 POP End: 09-30-2031 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

Rental of Contractor Owned Portable O2 Gaseous System for use with or without Stationary System Priced Per Month.

HCPCS CODE E0431. Portable System, Regulator, Flowmeter, Humidifier, Cannulas, or Masks, Tubing, Conserving Device and O2 Tank Cylinder Stands capable of holding 12 cylinders, sizes E, D, C & M-6.

Ordering Period: 5 POP Begin: 10-01-2030

POP End: 09-30-2031

Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

Rental of Contractor Owned Stationary Liquid O2 System Priced Per Month. HCPCS CODE E0439. Reservoir, Regulator, Flowmeter, Humidifier, Cannulas or Masks, and Colored Tubing.

Suction Pump Priced Per Each. HCPCS CODE E0600.

Purchase, Delivery, Set-up and Training of Contractor Home Model Respiratory Suction Pump, portable or stationary electric to include all supplies.

Ordering Period: 5 POP Begin: 10-01-2030 POP End: 09-30-2031 PRINCIPAL NAICS CODE: 532283 - Home Health

Government Owned Ventilator Set-up Priced Per Each.

HCPCS CODE E0465 & E0466. Delivery, Set-up, and Training of a Government Owned Ventilator to include all necessary supplies.

Ventilator Maintenance Priced Per Month. HCPCS CODE E0465 & E0466. Maintenance of Government Owned Ventilator Systems, to include all supplies.

Air Compressor Priced Per Month. HCPCS CODE E0565.

Rental of Contractor Owned and Maintained continuous or intermittent air compressor for use with equipment not self contained or cylinder driven, to include all associated supplies.

Priced Per Month. E0565. Rental of Contractor Owned and Maintained continuous or intermittent air compressor for use with equipment not self contained or cylinder driven, to include all associated supplies Ordering Period: 5 POP Begin: 10-01-2030 POP End: 09-30-2031 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

Delivery Charge Priced Per Each. HCPCS CODE A9901.

Deliveries not made under all other line items.

POP Begin: 10-01-2030 POP End: 09-30-2031 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

Respiratory Therapist Visit Priced Per Each. HCPCS CODE VA120. Government requested Respiratory Therapist visit not covered by other Line Items.

0001a

1.00 MO _______________

Rental of Contractor Owned Low Decibel Concentrator System. HCPCS CODE E1390. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1.

0001b

Rental of Contractor Owned Home Fill Oxygen System.

HCPCS CODE K0738. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1.

Ordering Period: 1 POP Begin: 10-01-2026 POP End: 09-30-2027 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental

0001c

Rental of Contractor Owned Hi Flow Concentrator System.

HCPCS CODE E1390. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1.

00R1

6,000.00 CY _______________

E Cylinder Refill. HCPCS CODE E0443 Ordering Period: 1 POP Begin: 10-01-2026 POP End: 09-30-2027 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

00R2

20.00 CY _______________

D Cylinder Refill. HCPCS CODE E0443 Ordering Period: 1 POP Begin: 10-01-2026 POP End: 09-30-2027 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

00R3

C Cylinder Refill. HCPCS CODE E0443 Ordering Period: 1 POP Begin: 10-01-2026 POP End: 09-30-2027

00R4

1,000.00 CY _______________

M-6 Cylinder Refill. HCPCS CODE E0443 Ordering Period: 1 POP Begin: 10-01-2026 POP End: 09-30-2027 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

00R5

0.00 CY _______________

H Tank Refill. HCPCS CODE E0443 Ordering Period: 1 POP Begin: 10-01-2026 POP End: 09-30-2027 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

00R6

0.00 LB _______________

Liquid Oxygen Refill. HCPCS CODE E0444 Ordering Period: 1 POP Begin: 10-01-2026 POP End: 09-30-2027 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

1001a

Rental of Contractor Owned Low Decibel Concentrator System. HCPCS CODE E1390. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1.

Ordering Period: 2 POP Begin: 10-01-2027 POP End: 09-30-2028

PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

1001b

Rental of Contractor Owned Home Fill Oxygen System.

HCPCS CODE K0738. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1.

1001c

Rental of Contractor Owned Hi Flow Concentrator System.

HCPCS CODE E1390. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1.

10R1

E Cylinder Refill. HCPCS CODE E0443 Ordering Period: 2 POP Begin: 10-01-2027 POP End: 09-30-2028 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

10R2

D Cylinder Refill. HCPCS CODE E0443 Ordering Period: 2 POP Begin: 10-01-2027 POP End: 09-30-2028 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

10R3

C Cylinder Refill. HCPCS CODE E0443 Ordering Period: 2 POP Begin: 10-01-2027 POP End: 09-30-2028 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

10R4

M-6 Cylinder Refill. HCPCS CODE E0443 Ordering Period: 2 POP Begin: 10-01-2027 POP End: 09-30-2028 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

10R5

H Tank Refill. HCPCS CODE E0443 Ordering Period: 2 POP Begin: 10-01-2027 POP End: 09-30-2028 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

10R6

Liquid Oxygen Refill. HCPCS CODE E0444 Ordering Period: 2 POP Begin: 10-01-2027 POP End: 09-30-2028 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

2001a

Rental of Contractor Owned Low Decibel Concentrator System. HCPCS CODE E1390. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1.

2001b

Rental of Contractor Owned Home Fill Oxygen System.

HCPCS CODE K0738. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1.

2001c

Rental of Contractor Owned Hi Flow Concentrator System.

HCPCS CODE E1390. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1.

Ordering Period: 3 POP Begin: 10-01-2028

POP End: 09-30-2029

Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

20R1

E Cylinder Refill. HCPCS CODE E0443 Ordering Period: 3 POP Begin: 10-01-2028 POP End: 09-30-2029 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

20R2

D Cylinder Refill. HCPCS CODE E0443 Ordering Period: 3 POP Begin: 10-01-2028 POP End: 09-30-2029 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

20R3

C Cylinder Refill. HCPCS CODE E0443 Ordering Period: 3 POP Begin: 10-01-2028 POP End: 09-30-2029 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

20R4

M-6 Cylinder Refill. HCPCS CODE E0443 Ordering Period: 3 POP Begin: 10-01-2028 POP End: 09-30-2029

PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

20R5

H Tank Refill. HCPCS CODE E0443 Ordering Period: 3 POP Begin: 10-01-2028 POP End: 09-30-2029 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

20R6

Liquid Oxygen Refill. HCPCS CODE E0444 Ordering Period: 3 POP Begin: 10-01-2028 POP End: 09-30-2029 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

3001a

Rental of Contractor Owned Low Decibel Concentrator System. HCPCS CODE E1390. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1.

3001b

Rental of Contractor Owned Home Fill Oxygen System.

HCPCS CODE K0738. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1.

3001c

Rental of Contractor Owned Hi Flow Concentrator System.

HCPCS CODE E1390. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1.

30R1

E Cylinder Refill. HCPCS CODE E0443 Ordering Period: 4 POP Begin: 10-01-2029 POP End: 09-30-2030 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

30R2

D Cylinder Refill. HCPCS CODE E0443 Ordering Period: 4 POP Begin: 10-01-2029 POP End: 09-30-2030 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of

30R3

C Cylinder Refill. HCPCS CODE E0443 Ordering Period: 4 POP Begin: 10-01-2029 POP End: 09-30-2030 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

30R4

M-6 Cylinder Refill. HCPCS CODE E0443 Ordering Period: 4 POP Begin: 10-01-2029 POP End: 09-30-2030 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

30R5

H Tank Refill. HCPCS CODE E0443 Ordering Period: 4 POP Begin: 10-01-2029 POP End: 09-30-2030 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

30R6

Liquid Oxygen Refill. HCPCS CODE E0444 Ordering Period: 4 POP Begin: 10-01-2029 POP End: 09-30-2030 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of

4001a

Rental of Contractor Owned Low Decibel Concentrator System. HCPCS CODE E1390. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1.

4001b

Rental of Contractor Owned Home Fill Oxygen System.

HCPCS CODE K0738. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1.

4001c

Rental of Contractor Owned Hi Flow Concentrator System.

HCPCS CODE E1390. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1.

40R1

E Cylinder Refill. HCPCS CODE E0443

40R2

D Cylinder Refill. HCPCS CODE E0443 Ordering Period: 5 POP Begin: 10-01-2030 POP End: 09-30-2031 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

40R3

C Cylinder Refill. HCPCS CODE E0443 Ordering Period: 5 POP Begin: 10-01-2030 POP End: 09-30-2031 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

40R4

M-6 Cylinder Refill. HCPCS CODE E0443 Ordering Period: 5 POP Begin: 10-01-2030 POP End: 09-30-2031 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

40R5

H Tank Refill. HCPCS CODE E0443

40R6

Liquid Oxygen Refill. HCPCS CODE E0444 Ordering Period: 5 POP Begin: 10-01-2030 POP End: 09-30-2031 PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: W065 - Lease or Rental of Equipment - Medical, Dental, and Veterinary Equipment and

GRAND TOTAL _______________

A.2 PERFORMANCE WORK STATEMENT

PERFORMANCE WORK STATEMENT - HOME OXYGEN SERVICES

SECTION 1 – SCOPE

1. Scope:

This Performance Work Statement (PWS) defines the effort required for the setup, installation, and management of Home Oxygen services and Ventilation, in accordance with The Joint Commission

(TJC) o r e q u i v a l e n t standards, to Veteran Beneficiaries serviced by VA Central California

Healthcare System (VACCHCS). This PWS includes the associated program management, human engineering, and logistic support planning requirements. The use of the terms “Beneficiary”, “Veterans”, “Patients”, and “Patient” are used interchangeably and refer to the recipient of required supplies, equipment, and incidental services required under the contract.

1.1 Background:

The acquisition of Home Oxygen services is being initiated to provide Home Oxygen services to

Veteran Beneficiaries serviced by VA Central California Healthcare System (VACCHCS.). VA

Central California Healthcare System (VACCHCS.) does not have the capacity to provide these services so a contract has been sought for the provision of home oxygen and all associated products and services.

1.2 Locations:

All services shall be performed in the Veteran's place of residence or in a nursing home housing the Veteran. The area of service shall be all Patients serviced by VA Central California Healthcare

System (VACCHCS), including catchment areas, regardless of where Patient resides. The equipment needs are subject to change as determined by the prescribing physician. Contractors shall have a facility or resources physically located in the geographic area in which they shall provide service. Non-territory requests shall be required from time to time and the Contractor shall accept these "non-territory" Veterans at that Contractor’s awarded price. VA reserves the right to assign these Patients to any Contractor. The geographical boundaries described herein have been determined as the areas of responsibility/jurisdiction for each local VA Medical Centers (see next page for VISN 21 map).

• VA Central California Healthcare System (VACCHCS) serves the counties of: Fresno, Kings, Madera, Mariposa, Merced, Tulare, Kern, and San Luis Obispo California. The main VA facility is located in Fresno California.

1.3 Estimated Dollar Value / Guaranteed Minimum/Maximum

The following table includes the guaranteed minimum amounts per geographical area and the maximum ceiling amounts per geographical area. The minimum guarantee is applicable to the base year only and will be included in the first funded task order awarded against the

IDIQ contract for each respective geographical area of the Indefinite Delivery Indefinite

Quantity (IDIQ) contract. Also, the maximum ceiling amounts stated below for each geographical area apply to the IDIQ contract in its entirety, not to individual task/delivery orders.

Guaranteed Maximum

Geographical Area Minimum Ceiling

VA Central California Health Care System $5,000.00 $1,500,000.00

1.4 Roles and Responsibilities:

A. Clinician orders for providing Home Oxygen Healthcare Services, which includes the use of home oxygen, home based life support systems (i.e. ventilators) and related respiratory equipment (C-PAP/Bi- Level nebulizers, compressors, etc.) are processed through the

Prosthetic and Sensory Aid Services (P&SAS) at the VA Medical Centers, and VA

Healthcare Systems. Initiation of treatment, delivery and pick up of equipment and, resolutions of problems related to equipment or Patients care are under the direction of P&SAS and/or the Contracting Officer's Technical Representative (COR).

B. VA Clinicians have the exclusive responsibility for determining eligibility and necessity for admission to the Home Oxygen Program and for providing orders for admission. The

Contractor shall provide the services, supplies and equipment as ordered, under the timelines specified.

C. VA Clinicians will complete initial and ongoing Patients assessments.

D. The Contractor is responsible for coordinating, supervising, monitoring, and evaluating the care and service provided and must assure that the contracted services are…

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