36C26219R0026-0004000.docx

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 NUMBERE

D 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 amendmen t, 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) 09-20-2019 None 00262 Department of Veterans Affairs Network Contracting Office 22 4811 Airport Plaza Drive Suite 600 Long Beach CA 90815 00262 Department of Veterans Affairs Network Contracting Office 22 4811 Airport Plaza Drive Suite 600 Long Beach CA 90815 To all Offerors/Bidders

36C26219R0026 08-02-2019

X x x ** HOUR & DATE for Receipt of Offers is EXTENDED to: 10/15/2019- 4:00pm (PST) x Amendment 0004 is hereby issued to publish additional amendments to the RFP.

The due date for receipt of offers has been extended to 10/15/2019 4:00pm (PST)

CHELSEA BLACK

CONTRACTING OFFICER

CONTINUATION PAGE

Amendment 0004- Section F- VA SPACE REQUIREMENT -REAL PROPERTY LEASE

1. The following language is being added to Section F- VA SPACE REQUIREMENT – REAL PROPERTY LEASE

1.8 LABOR STANDARDS The following Labor Standards shall apply to each of the five (5) leases:

LABOR STANDARDS (OCT 2016)

Davis-Bacon Act of 1931 shall apply when the cost of construction, alteration, or repair of VA occupied space is anticipated to be $2,000 or more. The following FAR clauses shall apply to all work performed prior to the Government's acceptance of space as substantially complete. Full text versions of these clauses are available upon request from the LCO. Full text versions are also available at https://www.acquisition.gov/?q=browsefar.

52.2224 Contract Work Hours and Safety Standards Act—Overtime Compensation

52.2225 Construction Wage Rate Requirements - Secondary Site of the Work

52.2226 Construction Wage Rate Requirements

52.2227 Withholding of Funds

52.2228 Payrolls and Basic Records

52.2229 Apprentices and Trainees

52.22210 Compliance with Copeland Act Requirements

52.22211 Subcontracts (Labor Standards)

52.22212 Contract Termination–Debarment

52.22213 Compliance with Construction Wage Rate Requirements and Related Regulations

52.22214 Disputes Concerning Labor Standards

52.22215 Certification of Eligibility

Section D -Contract Documents, Exhibits or Attachments:

2. D21-Section F Lease – Murrieta- Request for Lease Proposals Page 4- SECTION 1 is deleted in its entirety and is replaced with the following:

SECTION 1

3. D22-Section F Lease – Palm Desert- Request for Lease Proposals Page 4- SECTION 1 is deleted in its entirety and is replaced with the following:

SECTION 1

4. D5- Patients Rights Responsibilities and Conduct HSP 003-04

D5 is deleted in its entirety and is replaced with the following:

VA Loma Linda Healthcare System Healthcare System (HCS) Policy 00-38 Loma Linda, CA December 11, 2015

PATIENTS’ RIGHTS AND RESPONSIBILITIES

I. POLICY: To ensure that all employees and volunteers understand patient/Veteran rights at the Healthcare System (HCS) including the right to state-of-the-art health care services and outcomes, personalized, patient-driven, compassionate, respect, dignity, autonomy, positive self-regard, civil rights and care that includes the Veteran and his/her family input into the Veteran’s treatment, and service decisions with the Veteran’s permission.

II. RESPONSIBILITIES:

A. The Executive Leadership Team are responsible for promoting a culture that emphasizes the HCS’ concern for the Veterans’ welfare and personal dignity by providing for the protection of each patient’s rights.

B. The Service Chiefs are responsible for ensuring that their staff are knowledgeable about the Patient Rights and Responsibilities policy.

C. The Admission’s Department staff are responsible for distributing the Patient and Nursing Home Resident Rights and Responsibilities and Patient Service and Information Guide to each patient upon admission that delineates their rights and responsibilities.

D. The Patient Advocates are responsible for taking and resolving written or verbal complaints at the facility level. Additionally, they act as an advocate for each facility patient, ensuring that their rights are honored.

E. The Patient Advocate Liaisons (PALs) are responsible for taking and resolving written or verbal complaints at the service or program level. Additionally, he/she acts as an advocate for each patient at the service/program level, ensuring that the patient’s rights are honored.

F. Staff and Volunteers are responsible for ensuring that the rights of each patient are respected, assuring that treatment decisions include the patient and the families in the decisions about their care and assuring the rights of each patient are honored through the care, treatment and service that is provided.

III. PROCEDURES:

A. Patient Rights:

1. The Medical Center respects the rights of patients.

a. Patients have the right to care, treatment, and services within the Medical Center’s capability and mission and in compliance with law and regulation.

b. Patients have the right of respect to their cultural, psychosocial, spiritual, and personal values, beliefs, and preferences, including age, race, ethnicity, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation, or gender identity or expression.

c. Patients have the right to personal dignity.

d. Patients have the right to pastoral and other spiritual services.

2. Patients receive information about their rights from staff as delineated in:

a. HCS Policy 11-44 Advance Directives for Medical Care

b. HCS Policy 00-36 Privacy and Release of Information

c. Information on patients’ rights is provided to each patient. Upon admission, new patients are provided a copy of the Patient and Nursing Home Resident Rights and Responsibilities and the Patient Services and Information Guide.

d. Information on the extent to which the Medical Center is able, unable, or unwilling to honor Advance Directives is given upon admission if the patient has an Advance Directive.

e. The patient has the right to access, request amendment to, and receive an accounting of disclosures regarding his or her own health information as permitted under applicable law.

3. Patients are involved in decisions about their care, treatment and services as defined in:

a. HCS Policy 11-52 Withdrawing of Life Sustaining Therapy

b. HCS Policy 11-24 Do Not Resuscitate Orders

c. HCS Policy 11-44 Advance Directives for Medical Care

d. HCS Policy 11-49 Palliative Care and Hospice Planning

e. Patients are involved in resolving dilemmas about their care, treatment, and health care service decisions.

f. A surrogate decision-maker, as allowed by law, is identified when a patient cannot make decisions about his/her care, treatment, and service.

g. The Veteran’s legally responsible representative approves care, treatment, and service decisions.

h. The family, as appropriate and as allowed by law, with permission of the patient or surrogate decision-maker is involved in care, treatment, and service decisions.

(1) Procedures or care, treatment, and services required through an Informed Consent.

(2) The process used to obtain an Informed Consent.

(3) The process to document an Informed Consent in the medical record.

(4) The process when a surrogate decision-maker, rather than the patient, may give an Informed Consent.

(5) The procedures or care, treatment, and services normally requiring an Informed Consent which may be given without an Informed Consent.

(6) The patient’s right to revoke the Informed Consent, which must be obtained in writing.

b. An Informed Consent is obtained and documented in accordance with the Informed Consent policy.

c. A complete Informed Consent process includes a discussion of the following elements:

(1) The nature of the proposed care, treatment, services, medications, interventions, or procedures.

(2) The potential benefits, risks, or side effects, including potential problems related to recuperation.

(3) The likelihood of achieving care, treatment, and service goals.

(4) The relevant risks, benefits, and side effects related to alternatives, including the possible results of not receiving care, treatment, and service.

(5) When indicated, any limitations on the confidentiality of information learned from or about the patient.

5. Consent is obtained for recording or filming made for purposes other than the identification, diagnosis, or treatment of the patient as defined in:

a. HCS Policy 11-63 Consent.

b. VHA HB 1907.1 Health Information Management and Health Records.

c. HCS Policy 00-36 Privacy Policy.

d. VHA HB 1605.1 Privacy and Release of Information.

e. HIPAA and Privacy Reference Do’s and Don’ts Handout.

f. HIPAA & Privacy Reference Guide.

g. Per VHA Directive 1078, when recording or filming are to be used only for internal organizational purposes (for example, performance improvement and education), there is documentation of consent (VA FORM 10-3203, Consent for Production and Use of verbal or written Statements, Photographs…), which may be obtained as part of general consent to treatment or another form, if a statement is included in the form regarding the use of recordings or filming for such internal purposes

h. Per VHA Handbook 1605.1, when recording or films are made for external purposes that will be heard or seen by the public (for example, commercial filming, television programs, marketing), there is documentation of a specific, separate consent (VA FORM 10-3203, Consent for Production and Use of Verbal or Written Statements, Photographs…) that includes the circumstances for the use of the recording or film.

i. Except for the circumstances set forth in paragraph 4, there is documentation of consent before recording or filming.

j. The following occurs in situations in which the patient is unable to give an Informed Consent before recording or filming:

(1) The recording or filming may occur before consent, provided it is within the established Informed Consent policy that has been developed with the input of the appropriate ethical mechanism.

(2) The recording or film remains in the possession of the organization and is not used for any purpose until and unless consent is obtained.

(3) If consent for use cannot subsequently be obtained, the recording or film is either destroyed or the non-consenting patient must be removed from the recording or film.

6. Patients receive adequate information about the person(s) responsible for the delivery of their care, treatment, and services.

a. The information provided includes the following:

(1) The name of the physician or other practitioner primarily responsible for their care, treatment, and services.

(2) The name of the physician or other practitioner, who will provide the care, treatment, and services.

b. The information is given to the patient on a timely basis.

c. All individuals who interact with patients shall identify themselves by name and title.

7. Patients have the right to refuse care, treatment, and services in accordance with laws and regulations. When the patient is not legally responsible, the surrogate decision-maker, as allowed by law, has the right to refuse care, treatment, and services on the patient’s behalf (HCS Policy 11-44 Advance Directives for Medical Care).

8. A patient’s wishes regarding end-of-life decisions are addressed in the following policies:

a. HCS Policy 11-52 Withdrawing of Life Sustaining Therapy.

b. HCS Policy 11-24 Do Not Resuscitate Orders.

c. HCS Policy 11-44 Advance Directives for Medical Care.

d. HCS Policy 11-49 Palliative Care and Hospice Planning.

e. HCS Policy 11-43 Organ and Tissue Donation.

f. Policies, in accordance with laws and regulations which address Advance Directives and the framework for foregoing or withdrawing life-sustaining treatment and withholding resuscitative services.

g. Patients are given written information about their right to accept or refuse medical or surgical treatment, including foregoing or withdrawing life-sustaining treatment or withholding resuscitative services.

h. The existence or lack of an Advance Directive does not determine an individual’s access to care, treatment, and services.

i. Documentation indicates whether or not the patient has signed an Advance Directive.

j. The patient has the option to review and revise Advance Directives.

k. Appropriate staff are aware of the Advance Directive, if one exists.

l. Upon request, patients are helped or referred for assistance in formulating Advance Directives.

m. Advance Directives are honored within the limits of the law and the facility’s capabilities.

n. The patient’s wishes are documented and honored regarding organ donation within the limits of the law and facility capacity.

9. Patients, and when appropriate, their families are informed about the outcomes of care, treatment and services that have been provided including unanticipated outcomes (HCS Policy 00-08 Disclosure of Unanticipated Outcomes).

a. Outcomes of care, treatment, and services that have been provided that the patient (or family) must be knowledgeable about to participate in current and future decisions affecting the patient’s care, treatment, and services.

b. Unanticipated outcomes of care, treatment, and services that relate to sentinel events considered reviewable by the Joint Commission.

c. The responsible licensed independent practitioner or his/her designee informs the patient (and when appropriate, his/her family) about unanticipated outcomes of care, treatment and services.

10. The patient’s right to and need for effective communication is respected.

a. Written information provided is appropriate to the age, understanding, and as appropriate to the population served and the language of the patient.

b. Provision of interpretation (including non-English and sign language translation services) are facilitated.

c. The needs of those patients who are vision, speech, hearing, language, and/or cognitively impaired are addressed.

d. Telephone and mail service are offered as appropriate to the setting and population.

e. When there are restrictions placed on a patient’s visitors, mail, telephone calls, or other forms of communication, the restrictions are:

(1) Determined with the patient’s participation and when appropriate with the family’s involvement.

(2) Documented along with justification in the clinical or case record.

(3) Evaluated for therapeutic effectiveness.

11. The organization addresses the resolution of complaints from patients and his /her families and the organization informs patients, families, and staff about the complaint’s resolution process through various mechanisms:

a. Patient Rights and Responsibilities Pamphlet.

b. Patient Services and Information Guide.

c. Family Member Rights and Responsibilities Pamphlet.

d. LLVA Website for My HealtheVet.

e. Network 2002-07 Clinical Appeals.

f. HCS Policy 00-18 Patients Complaints/Concerns Program.

g. The Medical Center receives, reviews, and when possible, resolves complaints from patients and their families.

h. The Medical Center responds to individuals making a significant or recurring complaint.

i. The Medical Center informs patients about their right to file a complaint with the state authority.

j. Patients can freely voice complaints and recommend changes without being subject to coercion, discrimination, reprisal, or unreasonable interruption of care, treatment, and service.

12. The Medical Center respects the needs of patients for confidentiality, privacy, and security.

a. VHA Handbook (HB) 1907.1 Health Information Management & Health Records

b. HCS Policy 00-36 Privacy and Release of Information

c. VHA HB 1605.1 Privacy and Release of Information

d. HIPAA and Privacy Reference Do’s & Don’ts Handout

e. VHA 2013-003 Providing Health Care for Transgender and Intersex Veterans

f. HIPAA & Privacy Reference Guide

g. HCS 07B-01 Security Management Program

h. HCS 07B-02 Police Security and Law Enforcement

i. The Medical Center protects confidentiality of information about patients.

j. The Medical Center respects the privacy of patients.

k. Patients who desire private telephone conversations have access provided.

l. The Medical Center provides for the safety and security of the patients and their property. The number of patients in a room is appropriate to the Medical Center’s goals and the patients’ ages, developmental levels, clinical conditions, or diagnosis needs.

13. Patients have the right to an environment that preserves dignity and contributes to a positive self-image.

a. The environment of care supports the positive self-image of patients and preserves their human dignity.

b. The Medical Center provides sufficient storage space to meet the personal needs of the patients.

c. The Medical Center allows patients to keep and use personal clothing and possessions unless this infringes on others’ rights or is medically or therapeutically contraindicated (as appropriate to the setting or service).

14. Patients have the right to be free from mental, physical, sexual, and verbal abuse, neglect, and exploitation as indicated in the below references:

d. The Medical Center’s policies address how it will, to the best of its ability, protect patients from real or perceived abuse, neglect, or exploitation from anyone, including staff, students, volunteers, other patients’, visitors, or family members.

e. All allegations, observations, or suspected cases of abuse, neglect or exploitation that occur in the hospital is investigated by the appointed Medical Center staff.

c. The Medical Center plans, supports, and coordinates activities and resources to ensure that pain is recognized and addressed appropriately, and in accordance with the care, treatment, and services provided including the following:

(3) Educating patients and families, when appropriate, about their roles in managing pain and the potential limitations and side effects of pain treatments.

16. Patients have the right to access protective and advocacy services.

a. The Medical Center serves a population of patients who often need protective services, guardianship and advocacy services, conservatorship and adult protective services. The Medical Center provides resources to help the family and the courts determine the patients’ needs for such services.

b. The Medical Center maintains a list of names, addresses, and telephone numbers of pertinent state client advocacy groups such as the state authority and the protection and advocacy network. The list is given to patients when requested.

c. The Medical Center develops and implements policies and procedures for the above requirements.

17. The Medical Center protects research subjects and respects their rights during research, investigation, and clinical trials involving human subjects.

a. HCS Policy 151-06 Internal Regulatory Compliance Auditing of Research Projects.

b. The Medical Center reviews all research protocols in relation to its mission, values, and other guidelines and weighs the relative risks and benefits to the research subjects.

c. The Medical Center provides patients who are potential subjects with research investigations and clinical trials with adequate information to participate or refuse to participate in research.

d. Patients are informed that refusing to participate or discontinuing participation at any time will not compromise their access to care, treatment, and services not related to the research.

e. Consent forms address the above elements of performance, indicate the name of the person who provided the information and the date the form was signed; and address the participant’s right to privacy, confidentiality, and safety.

f. Subjects are told the extent to which their personally identifiable private information will be held in confidence.

g. All information given to subjects is in the medical record or research file along with the consent forms.

h. If a research-related injury, physical, psychological, social, financial or otherwise occurs, the principal investigator attempts to address any harmful consequences the subject may have experienced as a result of research procedures.

18. The Medical Center provides opportunities for work (Compensated Work Therapy (CWT) Program) for Veterans as defined in policies and situations in which patients work.

19. The Medical Center is committed to assisting Veterans with exercising their constitutional right to vote, and it is the facility’s policy to help patients who need assistance in registering to vote, or voting using an absentee ballot. Voter registration drives, however, are not permitted. Guidelines are as follows:

a. Patients are granted medical absence for such periods of time as is necessary to register and to vote, subject to the opinions of their healthcare providers.

b. If patients are unable to leave the facility, assistance is provided for registering and for voting by absentee ballot through Voluntary Service.

c. Information on the voting assistance program is posted on inpatient wards and the nursing home by the Voluntary Service Officer or designee. This individual is also responsible for:

(1) Informing all inpatients or residents of the opportunity to receive voting assistance information.

(2) Ensuring all VA Voluntary Service (VAVS) personnel (including volunteers), prior to providing any information or assistance to VA patients who seek to register to vote or vote, annually review and sign the “Political Activities Fact Sheet and Certification”

(VA Form 10-0462) and maintain the completed form in the volunteer’s file.

(3) Obtaining and maintaining all materials used to assist with voter registration.

(4) Following all regulations, including Title 38 CFR § 17.33, Title 38 CFR §1.218(a) 14 and VHA Directive1060.

B. Patient Responsibilities:

1. Patients are provided information on their responsibilities while receiving care, treatment, and services.

a. Patients have the responsibility of asking questions, following instructions, accepting consequences, following rules and regulations, showing respect and consideration and meeting financial commitments.

IV. SUPPLEMENTAL INFORMATION:

A. Definitions:

B. References: a. HCS Policy 11-44 Advance Directives for Medical Care; HCS Policy 00-36 Privacy Policy; HCS Policy 11-52 Withdrawing of Life Sustaining Therapy; HCS Policy 11-24 Do Not Resuscitate Orders; HCS Policy 11-44 Advance Directives for Medical Care; HCS Policy 11-49 Palliative Care and Hospice Planning; HCS Policy 11-63 Consent; VHA HB 1907.1 Health Information Management and Health Records; VHA HB 1605.1 Privacy and Release of Information; HIPAA and Privacy Reference Do’s and Don’ts Handout; HIPAA & Privacy Reference Guide; VHA Directive 1078; Network Policy 2002-07 Clinical Appeals; VHA HB 1907.1 Health Information Management & Health Records; The Joint Commission CAMH, CAMAC, CAMLTC, CABHC; Title 38 CFR § 17.33 and Title 38 CFR § 1.218(a) 14; HCS Policy 11-43 Organ and Tissue Donation; HCS Policy 151-06 Internal Regulatory Compliance Auditing of Research Projects; VHA Directive 1060; HCS Policy 11-58 Pain Management; HCS Policy 116A-05 Patient Abuse Assessment and Reporting; HCS Policy 00-54 Violent Behavior Prevention Program; HCS Policy 05-23 Employee Responsibilities and Conduct; HCS 07B-01 Security Management Program; HCS 07B-02 Police Security and Law Enforcement.

C. Attachments: None

V. COLLABORATED WITH: Chief of Health Administration Service and the Privacy Officer.

VI. RESCISSION: HCS Policy 00-38 dated August 23, 2011

VII. REVIEW & REISSUE DATE: December 11, 2018

VIII. FOLLOW-UP RESPONSIBILITY: Veterans Experience Officer

//Original Signed//

BARBARA FALLEN, FACHE, DIRECTOR

Chair, Executive Leadership