36C26223R0173_1.docx

Presolicitation Notice Presolicitation Notice

GENERAL INFORMATION

SET-ASIDE

Los Angeles CA

COUNTRY

CONTACT INFORMATION

CONTRACTING OFFICE ADDRESS

Department of Veterans Affairs NCO 22 - Gilbert Network Contracting 335 East Germann Road Gilbert AZ 85297

POINT OF CONTACT*

Sandra Fusco Sandra Fusco sandra.fusco@va.gov 562-766-2226

ADDITIONAL INFORMATION

AGENCY’S URL

URL DESCRIPTION

AGENCY CONTACT’S EMAIL ADDRESS

EMAIL DESCRIPTION

DESCRIPTION

This is not a solicitation announcement. This is a pre-solicitation notice only.

The purpose of this pre-solicitation notice is to announce that the Government has an upcoming requirement for a contractor to provide On-campus Enhanced Use Lease (EUL) Project-Based Voucher (PBV) VA Supportive Housing (VASH) services for VA Greater Los Angeles Healthcare System.

All Offerors who provide goods or services to the United States Federal Government must be registered in the System for Award Management (SAM) database found at https://www.sam.gov at the time of proposal submission and at the time of award.

The contract will be issued as an Indefinite Delivery-Indefinite Quantity contract, with Fixed Unit Prices.

All requirements shall be detailed in the impending solicitation to be issued on or about Nov 10, 2023.

No questions will be answered prior to the solicitation being released.

See below for DRAFT statement of work excerpt.

STATEMENT OF WORK

1. BACKGROUND

1.1. The U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System (VAGLAHS) requires a Contractor with demonstrated experience in Veterans Affairs Supportive Housing (VASH) services to provide On-campus project-based case management and supportive services for Veterans who have Housing and Urban Development (HUD) vouchers and who would benefit from onsite intensive case management due to the complexity and acuity of their needs. Project Based Vouchers (PBVs) are a component of the Public Housing Authorities (PHAs) housing support program. They are associated with existing housing units available for immediate move-in and are facilities dedicated to housing homeless Veterans who already have HUD Vouchers. PBV units are located either in the community or, as required by this contract, on the campus of VAGLAHS in Enhanced-Use Lease (EUL) properties which comprise PBV units.

1.2. VA’s EUL program allows VA to manage underutilized property through leasing arrangements with state or local governments or private sector organizations. Title 38, U.S.C. Sections 8161-8169, EULs of Real Property, as amended, authorizes VA to lease real property under VA’s control or jurisdiction to other public and private entities on a long-term basis (up to 99 years). The statute permits Enhanced-Use Leases (EULs) for supportive housing or for the direct or indirect benefit of Veterans. The VA EUL program will continue to serve as a vehicle for VA to achieve its goal of eliminating Veteran homelessness.

1.3. HUD-VASH is a national program serving Veterans and their families throughout the country. This program continues to expand and has become one of the largest VA interventions to assist homeless Veterans. It represents one of VA’s most significant efforts to achieve the President’s goal of ending homelessness among Veterans. To be eligible for the HUD-VASH program, a Veteran must be eligible for VA health care as determined by the local VA medical center, determined to be “homeless” based on McKinney-Vento Act definitions by the local VA medical center HUD-VASH program with every effort made to identify and serve the most chronically homeless and vulnerable Veterans.

1.4. The target population for this contract includes chronically homeless Veterans who demonstrate the most need/vulnerability and may often have severe mental health, medical, and/or substance use disorders (SUD) issues. Veterans may not be chronically homeless and fall into one of the priority groups: women, women Veterans with children, Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) Veterans, and/or Veterans who have physical health problems and/or SUD issues with frequent emergency room visits, multiple treatment failures, and limited access to other social supports (reference VHA HUD-VASH Directive 1162.05). Other priority groups per HUD Guidelines include homeless persons with a disability with long periods of episodic homelessness and severe service needs, homeless persons with disability with severe service needs, homeless persons with a disability coming from places not meant for human habitation, safe havens, or emergency shelters without severe service needs and/or homeless persons with a disability coming from transitional housing. The The HUD-VASH program is reserved for homeless Veterans with serious medical, SUD, and/or mental health problems with a demonstrated need for case management services to sustain housing. Reference VHA HUD-VASH DIRECTIVE 1162.05(1), attached in section D.1, and VHA HUD-VASH Directive definition of Chronically Homeless. HUD Notice CPD-16-11, Notice on Prioritizing Persons Experiencing Homelessness, at https://files.hudexchange.info/resources/documents/notice-cpd-16-11-prioritizing-persons-experiencing- chronic-homelessness-and-other-vulnerable-homeless-persons-in-psh.pdf.

2. GENERAL CONTRACT REQUIREMENTS

2.1. Contractor shall serve homeless Veterans with complex medical and psychiatric needs who have few resources and require long-term case management to either obtain and/or maintain permanent supportive housing. HUD-VASH follows the definition of “homeless” as authorized in 24 CFR 91.5, 38 U.S.C. 202(1) Reference VHA HUD-VASH Directive 1162.05 and the McKinney-Vento Homeless Assistance Act, as amended by S.896 the HEARTH Act of 2009 at (https://files.hudexchange.info/resources/documents/HomelessAssistanceActAmendedbyHEARTH.pdf).

2.2. Through the HUD-VASH program, the Contractor shall place Veterans into Project Based housing while simultaneously providing case management to assist Veterans in maintaining housing. These Veterans will be placed in project-based housing due to complex medical/mental health needs to enhance accessibility to services. The contractor is expected to engage in frequent care coordination activities with VA and community providers working with the Veteran. The number of Veterans assigned to each EUL PBV site is expected to fluctuate over time and each facility under this contract has a varying number of units. The Contractor agrees to accept and serve Veterans to the facilities awarded at the same price per voucher as shown in the price schedule herein.

2.3. Contractor shall provide case management and supportive services to Veteran beneficiaries of diverse backgrounds. Contractor shall provide all labor, supervision, supplies, materials, and logistics required to perform these services for the duration of the contract. Contractor shall perform services at the EUL PBV site. Contractor shall work traditional work hours, M-F, 7:00 a.m. to 3:30 p.m., 7:30 a.m. to 4:00 p.m., or 8:00 a.m. to 4:30 p.m.

2.4. The Contractor shall submit all deliverables to the VA’s Contracting Officer’s Representative (VA COR) or designee, who will evaluate all deliverables submitted and certify invoices based upon acceptable deliverables. The VA COR or designee will also be the Contractor’s main point of contact for Veteran related issues in conjunction with the VA homeless team. The VA COR will provide clinical oversight but will not provide direct clinical supervision.

2.5. Clinical oversight refers to a working relationship between the VA COR and Contractor. The VA COR monitors compliance with the contract deliverables and quality of care that is provided by the Contractor to Veterans. In providing clinical oversight, VA CORs may also serve as consultants to the Contractor in enhancing safe and effective person-centered care in complex situations to meet the needs of Veterans in conjunction with VA regulations, requirements, and guidelines.

2.6. Contractor shall have the staffing and expertise to execute the tasks and associated deliverables associated with this Statement of Work without reliance on the VA COR or designee to provide support that would reasonably be considered clinical supervision. The Contractor shall provide routine, ongoing clinical supervision to staff performing on this contract.

2.7. Contractor shall have a primary point of contact for the management of this contract who will work directly with the VA COR/designee on contract and invoicing matters. This person shall have full authority to act for the Contractor on all matters relating to the daily operation of this contract. An alternate may be designated should the primary point of contact be unavailable. The Contractor shall identify in writing instances when the alternate shall act as the point of contact. The Contractor shall notify VA COR of planned and unplanned changes in the primary point of contact’s work schedule. The Contractor shall also provide the following information regarding their primary point of contact and update it as necessary:

NAME, TITLE, PHONE NUMBER, FAX NUMBER AND VA EMAIL ADDRESS

2.8. Task Order Ordering Procedures. Task orders shall be issued against this IDIQ contract and shall be competed amongst all IDIQ contract holders by issuing competitive requests for proposals (RFP) to the IDIQ contract holders. Evaluation criteria used to determine the task order awardees and the number of Veteran vouchers issued for each task order will be included in the task order RFP. Price shown in the Schedule of Services and Price for the base IDIQ contract (Section B.2 of this contract) is the maximum price the Contractor may charge for each line item listed and during dates shown in the schedule. The Contractor may propose to provide services at less than the schedule price, however the Contractor shall not propose rates that exceed the schedule price applicable to the task order period of performance.

3. SPECIFIC CONTRACT REQUIREMENTS

3.1. Contractor shall provide case management and supportive services to Veterans who will be housed in the EUL PBV units on the campus of VAGLAHS.

3.2. Contractor shall attend monthly resident town hall meetings and provide supportive services to Veterans, which may include but are not limited to harm reduction/recovery groups, recreational activities, life skills groups, social skills building, community resource linkage, peer support groups, and/or employment support.

3.3. Contractor shall provide case management in accordance with Stages of Case Management, and Minimum Visit Requirements (SOP) and HUD-VASH Case Management SOP, both attached in section D1.

3.4. Contractor shall provide interdisciplinary teams who work collaboratively to provide patient-centered care. Team compositions may consist of addiction treatment professionals, licensed clinical social workers, licensed marital and family therapist, licensed mental health counselors, nurses, psychologists and peer support specialists. At least 50% of clinical providers shall be master’s level.

3.5. Contractor shall comply with HUD-VASH and GLA policy and procedures regarding documentation and evaluation standards for Veterans enrolled in HUD-VASH. Reference HUD-VASH Documentation SOP, attached in section D1.

3.6. Contractor shall provide information to the VA COR at the interval requested to update the PBV registry and PBV tracker.

3.7. Contractor’s staff shall attend the HUD-VASH All Staff monthly meeting.

3.8. Contractor’s staff shall visit Veterans if in an institutionalized setting (hospital, assisted living, skilled nursing facility, etc.). Contractor shall engage in treatment and discharge planning with inpatient providers. If Veterans are incarcerated, staff shall contact Veterans Justice Outreach (VJO) for care coordination. Contract staff shall accompany Veterans to medical appointments, emergency visits, or other appointments as clinically indicated.

3.9. Contractor shall obtain approval from the VA COR/Liaison prior to discharging Veterans from case management services and adhere to VASH Discharge SOP, attached in section D1. Discharge planning may include linkage to alternate case management services and other support as needed.

3.10. Case Management visits to Veterans shall be conducted in accordance with VHA HUD-VASH Directive and HUD-VASH Stages of Case Management and Minimum Visit Requirements SOP, attached in section D1.

3.11. Contractor staff shall ensure that when Veterans have achieved housing stability, the focus of service support changes to community integration and other goals as discussed and agreed upon with Veteran, and their contact with the Veteran does not diminish.

3.12. Contractor staff shall ensure that when Veterans have achieved housing stability, the focus of the service support changes to community integration and other goals as discussed and agreed upon with Veteran, and their contact with the Veteran does not diminish.

3.13. Contractor staff shall participate in continuing education training related to Pathways Housing First model, trauma informed care, motivational interviewing (refer to definitions section of this SOW), relapse prevention, supported employment and supported education. The Contractor shall participate in all VA mandatory trainings for staff. The VA shall also extend an invitation to Contract staff to participate in new trainings as approved throughout the year; if the Contractor chooses to provide their own similar trainings for staff, the contractor shall show that these trainings are performed by a certified trainer.

3.14. The Contractor shall provide full staffing as defined herein within 60 days of the contract award.

3.15. The Contractor shall maintain Basic Life Support (BLS) certification for all staff working on this contract. Certification is required prior to providing direct patient care. Contractor shall remove any staff with expired certification from providing direct patient care on this contract until recertification is obtained. American Heart Association certification is preferred but not required. Contractor shall provide VA COR/Liaisons with a copy of current certifications for each staff performing on this contract.

3.16. Contractor shall encourage Veterans to actively engage in healthcare and when clinically indicated, mental health and or addiction services.

3.17. Contractor shall document changes of status for Veterans to include Veteran level of Care (LOC) and employment as indicated in the Homeless Operations Management and Evaluation System (HOMES). Documentation shall be entered within 3 business days of Veteran encounters. HOMES is a database used by the VHA Homeless Program Office (HPO) to gather homeless Veterans data and statistics for analytical purposes.

3.18. Contractor shall enter Veteran information (e.g., name, SSN), after obtaining a release of information into the Coordinated Entry System and Health Information Management System (HMIS) within 3 business days.

3.19. Contractor shall assess Veterans to determine if criteria is met for enrollment into the HUD-VASH program. The contractor shall complete HOMES, screening/admission, and encounter documentation consistent with the HOMES reporting policy and VA medical documentation, and in compliance with HUD-VASH Documentation Standard Operating Procedure (SOP), attached in section D1. Contractor shall document using the appropriate note template for all progress notes and ensure all encounters are entered within 3 business days or on the same day for emergent issues.

3.19.1. Contractor staff shall document in the electronic health record (EHR) services delivered during a patient encounter using appropriate Current Procedural Terminology (CPT) coding. An encounter is a professional contact between a patient and a provider vested with responsibility for diagnosing, evaluating, and treating the patient’s condition. The reason for the services provided (diagnosis) and the actual services provided to the patient by the provider must be fully and clearly documented and coded using nationally accepted coding schemes. Licensed Independent Providers e.g., Psychologist, Pharmacist, Licensed Clinical Social Worker, are to be listed as the primary provider for any trainees they supervise (e.g., Psychology Intern, Pharmacy Resident) or any other non-licensed independent provider (NLIP) under their supervision. Contractors documenting in CPRS are required to participate in productivity training conducted by VA. Contractors shall generate encounters and use CPT and Diagnostic codes when they have contact with Veterans. Contractor shall make corrections in CPRS by the due date indicated by the VA when documentation and encounter errors occur per VHA Directive 1082 Patient Care Data Capture and VHA Directive 1161 Productivity And Staffing In Clinical Encounters For Mental Health Providers, attached in section D1.

3.19.2. Contractor’s staff are required to attend the HUD-VASH CPT training.

3.20. Contract Program Manager shall participate in a weekly administrative meeting with the VA COR/Liaison to discuss any administrative concerns and contractor performance.

3.21. Contractor shall participate in lease up calls with the EUL property manager.

3.22. The Contractor shall work with Veterans on maintaining PBV housing and developing independent living skills.

3.23. Contractor shall participate in and coordinate with the VA COR/Liaison during huddles regarding updates and changes in the Veteran’s care plans to foster a collaborative relationship with the VA and Contractor in meeting the Veteran’s needs. Huddles may take place in person or by telephonic conference calls as determined by the VA HUD-VASH Coordinator or their designee. All Veterans should be reviewed during huddle once every quarter (no less than every 90 days) or as clinically indicated. All huddles shall be documented in a VA approved spreadsheet for tracking purposes. The Contractor shall include relevant mutual providers to participate in huddles for service coordination as indicated. The contractor shall monitor the huddle schedule to ensure all Veterans have been reviewed quarterly. Contractor shall provide the VA COR/Liaison with Veteran updates and a current copy of the huddle spreadsheet as requested. Reference HUD-VASH Huddle SOP in section D1

3.24. Contractor shall ensure staff working on the contract complete a VA Security/background investigation prior to providing direct patient care via National Agency Check with Written Inquiries (NACI), and a Special Agreement Check (SAC) which includes electronic fingerprinting. Results of investigation must return favorable for staff to perform on the contract. Contractor shall include VA COR in all onboarding correspondence.

3.25. VetPro is necessary for all licensed, registered or certified clinical staff members (e.g. LCSW, LMFT, RN, CASAC.) Contractor shall ensure staff who meet this criterion complete the credentialing process through the VA’s VetPro system. Staff awaiting VetPro clearance may only begin work on the contract prior to receiving credentialing by performing tasks that do not involve Protected Health Information (PHI, Refer to Definitions section of this SOW).

3.26. The Contractor shall make every effort to communicate with the VA regarding this contract through the Network Contracting Office (NCO) 22, via the designated primary VA COR and/or at minimum when reaching out to Contracting office, include the COR in the communication.

3.27. Contractor shall complete the VA’s online Information Security and Privacy Awareness Training Course, the Privacy Policy Awareness Training Course, and Mandatory Training for Transitory, Part-Time and Intermittent Clinical Staff (MTTCS) for staff members providing direct patient care under this contract. All required trainings must be maintained on schedule as required by the VA. Trainings shall be completed by the due date indicated to maintain access to the VA Network.

4. ADMISSIONS/REFERRALS

4.1. Veterans enter the HUD-VASH program by being identified as meeting HUD-VASH admission criteria (Reference VHA Directive 1162.05 HUD-VASH Program). Veterans may be referred by the VA as eligible for the program or through community outreach conducted by the Contractor.

4.1.1. Contractor shall promote project-based housing and share housing resources at respective By Name List (BNL) case conferencing meetings.

4.2. The Contractor shall conduct eligibility screenings, including an interview with the Veteran, review of patient records, and HOMES assessment to determine whether admission criteria has been met. Contractor shall have knowledge of EUL project-based housing eligibility criteria and work collaboratively with property management in reviewing applications. Reference HOMES forms attached in section D1

4.3. The Contractor shall conduct a basic screening for healthcare eligibility that shall include a review of the Veteran’s DD214 by obtaining access to SQUARES (see definition section of SOW). Contractors shall admit Veterans to the HUD-VASH program without VA approval. After completing necessary screening/admission documentation, the Contractor shall notify the VA COR by email within 24-hours of Veteran admissions. Note: Admission is by clinical decision of clinical contract staff, or in more complex situations with consultation of homeless program leadership or other appropriate service providers. Contractors shall maintain a list of Veterans who do not meet eligibility criteria and provide those Veterans with a copy of the HUD VASH Denial letter. Veterans must be informed of their right to file an appeal within 60 days from receipt of the denial letter by following the process outlined in the letter. Veterans shall also be provided referrals for alternate housing resources. Reference Sample Resource Handout, attached in section D1.

4.4. To be eligible for the HUD-VASH program, a Veteran must be determined to be eligible by the VAGLAHS Enrollment and Eligibility based on discharge type (Reference VHA Directive 1162.05 HUD-VASH Program):

4.4.1. Honorable Discharge

4.4.2. General Discharge

4.4.3. Other than Honorable Discharge (in Lieu of court-martial or from a special court-martial)

4.4.4. Bad Conduct Discharge (from a special court-martial) Uncharacterized (Entry Level Separation)

4.4.5. Undesirable (confirm with Eligibility, must be adjudicated).

4.5. If a Veteran was previously screened and denied by the VA, as evidenced by the screening note in their VA Medical record, Contractor shall contact VA COR/Liaison to consult prior to completing their screening and/or admission into the program.

4.6. Contractor shall provide case management services for Veterans under their care.

4.7. Veterans are considered admitted into HUD-VASH when accepted for case management. Admission decisions shall occur within 24 hours or one business day of a completed screening interview with the appropriate documentation in HOMES.

4.8. In the case of a two-Veteran household, the individual identified as head of household with the primary need for case management is the voucher holder. If both Veterans require case management, there shall be two separate entries in HOMES showing that they are case managed although one Veteran has a HUD-VASH Voucher issued.

4.9. Contractor Housing Placement & Stabilization Duties: The Contractor shall perform Housing Placement & Stabilization Duties that include the following:

4.9.1. Identify and enroll Veterans who meet criteria for program admission. To be eligible for the HUD-VASH program, a Veteran must be determined to be homeless based on national HUD-VASH directives with every effort made to identify and serve the most chronically homeless and vulnerable Veterans.

4.9.2. Assist the Veteran in completing and submitting PHA and other Federal, local, and state entitlement program paperwork (e.g. Social Security, food stamps, utility assistance, etc.)

4.9.3. Advocate with property managers at PBV sites on behalf of the Veteran to maintain a lease and advise any potential property managers that the contractor shall be providing case management services to the Veteran to help the Veteran remain successfully housed. Contractor shall assist Veterans with all inspections required for move-in (reference Pre-inspection checklist, attached in section D1). Contractor shall ensure that the Veteran has completed a VA release of information permitting communication between the property manager, Contractor, and VA for housing related support.

4.9.4. Assist with developing a budget and assist the Veteran in securing necessary financial resources for recurrent monthly expenses.

4.9.5. Assist the Veteran in contacting utility providers as necessary ensure the Veteran is paying rent and utility bills in a timely manner and provide budgeting/money management assistance as needed.

4.9.6. Assist Veteran in applying for all eligible benefits, both VA and non-VA, including but not limited to; Veteran’s Benefits Administration (VBA), Employment Development Department (EDD), Social Security Administration (SSA).

4.9.7. Perform site visits of HUD-VASH apartments to ensure Veterans reside in safe residences in accordance with VHA Directive 1162.05 HUD-VASH Program and HUD-VASH Stages of Case management and minimum visit requirements SOP attached in section D1. Veterans in PBV units have been identified as psychiatrically and medically complex and the Contractor shall visit Veterans monthly with the Lead Case Manager making at least quarterly face to face contact with the Veteran.

5. CASE MANAGEMENT DUTIES

5.1. The Contractor shall have procedures in place to ensure Veterans have access to clinical case management services twenty-four (24) hours per day, 365 days per year, which shall include crisis management and referrals (Reference HUD-VASH Case Management attached in section D1).

5.2. The Contractor shall ensure consistency of case management services to enhance staff ability to engage Veterans and provide highly skilled interventions in keeping with the Housing First (HF) model as described below.

5.2.1. Housing First is an approach that centers on rapidly providing homeless individuals with housing and connection with needed services and treatment thereafter. The primary focus of the Housing First approach is to identify individuals and families who have an immediate need for housing and provide services to obtain and sustain permanent housing.

5.2.2. Focus on helping individuals and family’s access and sustain permanent housing as quickly as possible;

5.2.3. A variety of services are delivered primarily following housing placement to promote housing stability and individual well-being.

5.2.4. Time-limited or long-term services depending upon the individual need;

5.2.5. Veteran agreement to participation in case management Services to support housing maintenance. Non-compliance with Case management services may result in a loss of housing and/or voucher;

5.2.6. Contractor staff shall support Veteran’s family members who reside with the Veteran by assisting them in connecting to supportive services /resources as needed. (Refer to the Definitions section of this SOW).

5.2.7. Contractor staff shall address the documented needs of Veterans and make visits in accordance with HUD-VASH Stages of Case management and minimum visit requirements SOP and Mental Health Treatment, which are made part of this contract and incorporated by reference herein.

5.2.8. Contractor shall apply Harm Reduction interventions as clinically indicated.

5.2.9. The Contractor shall have space available at the project-based site allowing privacy for staff to conduct group meetings with Veterans under enrolled on the contract. Contractor shall submit a monthly Veteran tracking sheet (commonly referred to as White Board) with requested fields as approved by the VA COR or designee.

5.2.10. Contractor shall ensure sufficient staff are available to provide services to meet the needs of Veterans and conduct visits consistent with the level of care at which each Veteran is assigned. Contractor shall perform the following work:

5.2.10.1. Create a Mental Health Treatment Plan (MHTP) documenting Veteteran goals, needs, areas of concern, and other relevant information. (Reference Mental Health Treatment Plan and Mental Health Treatment Plan Goals attached in section D1).

5.2.10.2. Review and update the MHTP with the Veteran every six months or when there is a significant change in Veteran’s functioning level, or circumstances that call for a change in treatment planning.

5.2.10.3. Comply with additional documentation and/or data reporting as required by VAGLAHS based on local, regional, or national HUD-VASH requirements.

5.2.10.4. Engage in the HUD-VASH screening process to assess Veterans considered high risk due to medical, mental, and/or addiction history; identify service and treatment needs which may affect housing stability and recovery/community reintegration. (Reference Sample Psychosocial Assessment attached in section D1).

5.2.10.5. Utilize case management strategies aimed toward long term independent housing and community reintegration. Contractor shall reassess Veteran acuity in accordance with local policy for changes in stage of case management. Contractor shall assess each Veteran for suicidal and homicidal risk with each contact. This assessment shall be documented in the VA medical record using appropriate note titles.

5.2.10.6. If the Veteran is a danger to themselves or others, the Contractor shall take immediate steps to provide appropriate intervention per CERS Procedure for Medical and Psychiatric Emergency Response in the Community and CERS Management and Escalation of Health Status Concerns, both attached in section D1.

5.2.10.7. Crisis management shall be coordinated and executed by the contractor and shall be reported to the VA COR/Liaison and other VA staff in accordance with CERS Management and Escalation of Health Status Concerns and CERS Incident-Death Reporting Manual, attached in section D1. Contract case management staff shall immediately consult with Contractor Clinical Supervisors any time emergent Veteran issues/concerns arise and notify the VA COR/Liaison same day. Contractor staff shall use clinical judgement and collaborate with the VA COR/Liaison as appropriate in determining next steps.

5.2.10.8. Contractor shall adhere to the reporting requirements located in the U.S. Department of Housing and Urban Development Public and Indian Housing Notice PIH 2011-53(HA), issued 09/20/2011 and available at https://www.hud.gov/sites/documents/pih2011-53.pdf, which is made part of this contract and is incorporated by reference herein, including any subsequent changes, updates, or revisions to the PIH Notice.

5.2.10.9. Contractor shall facilitate the Veteran’s involvement in supportive employment and other restoration programs when clinically indicated.

5.2.10.10. Contractor shall assess and promote engagement with appropriate healthcare, mental health and addiction care when clinically indicated. Reference the attached CERS Primary Care Engagement SOP.

5.2.10.11. Formulate treatment goals and plans with Veteran that address identified needs, stressors, and areas of concern. Actively involve the Veteran and other relevant parties, based on psychosocial assessments, to develop a treatment plan with the Veteran using their language, ensuring they have a copy of the plan including discharge from case management.

5.3. Contractors shall provide direct mental health and substance abuse counseling within their scope of practice and assist in securing VA and/or community treatment services. Contractor shall integrate housing stabilization planning with relevant VA health and mental health services. The housing stabilization plan shall provide a framework for the Veteran’s sustainability in HUD-VASH and identify the Veteran’s goals with steps to achieve those goals

5.4. Contractor shall visit each Veteran face-to-face at the intervals required by HUD-VASH Directive and Stages of Case Management and Minimum Visit Requirements attached in section D1. Additionally, the Contractor shall adhere to the following:

5.4.1 The designated case management stage and corresponding minimum visit requirement determination shall be determined by the Contract clinical supervisor, based on the documented needs of the Veteran. LOC changes will be effective once the CM completes the Stage of CM note in CPRS (clinical supervisor and contract liaison must be added as additional signers on the note), LOC change is updated in HOMES and Contract Supervisor completes an addendum to the Stage of CM note indicating LOC request was reviewed with CM and approved by clinical supervisor. If Veteran presents with an urgent need for increased contact, the Contractor shall demonstrate diligent efforts to provide services based on the presenting needs prior to review with the VA Liaison. Veterans LOC shall be assessed at a minimum every 90 days. The COR/Liaison will review LOC changes monthly to ensure contractor is incompliance with the HUD-VASH Stages of Case Management and Minimum Visit Requirement SOP. Contractor performance will be based upon compliance with the above-mentioned SOP and reviewed in case conference and administrative meeting.

5.4.2 Contractor shall make every effort to conduct case management visits in PBV units to assess Veteran’s well-being and condition of the home.

5.4.3 Phone contacts, while an acceptable way to communicate with the Veteran, are not considered visits in meeting the minimum visit requirements for any acuity level. VVC may be utilized when there are extenuating circumstance preventing visitation in the home (i.e., inpatient treatment, Veteran travel, etc.) and notification shall be provided to VA COR/Liaison. All staff using VA Video Connection, (VVC) must complete the required training in the VA Talent Management System (TMS) prior to engaging Veterans in VVC. Training on use of VVC will be provided by the VA. In the event the Contractor is unable to locate the Veteran for the required number of visits, the Contractor shall document all attempts demonstrating escalation efforts to contact Veteran including but not limited to telephone calls, in person attempts, welfare checks, or letters sent to the Veteran. This is referred to as “due diligence” and actions should reflect a sense of urgency in outreaching Veterans who cannot be located. Documentation of outreach efforts should include dates and times as verification of services rendered and to show due diligence has been exercised. Note: phone calls and letters only do not qualify as attempts.

6. ENDING CASE MANAGEMENT SERVICES

6.1. Community integration and achieving the highest level of independent housing are two primary goals of the HUD-VASH program. Contract case management team members and the Veteran shall meet to determine if the Veteran has achieved this milestone and to develop a plan for ongoing receipt of needed services.

6.2. The Contractor shall re-assess any Veterans who do not meet the goals and objectives outlined in their treatment plan to determine any barriers to housing stability and service engagement. The Contract case manager shall work with the Veteran to eliminate any barriers and assist with connection to needed services/resources. The case manager is expected to continue efforts to engage the Veteran unless there is a risk to the safety of staff. The Contractor shall consult with the VA COR and collaborate with VA mental health providers, SUD programs, and/or other programs for assistance in determining alternative clinical treatment approaches.

6.3. If Veterans are at risk of eviction or voucher revocation, the Contractor shall immediately notify the VA COR/Liaison. Veterans shall be scheduled for discussion in weekly huddle/case conferences for intervention planning. Contract case managers shall comply with VA HUD-VASH Documentation SOP and discharge procedures as outlined in HUD-VASH Discharge SOP.

6.4. In some instances, discharge from the HUD-VASH Program may be required if the Veteran refuses, despite all efforts to engage in case management. In these instances, the Contractor shall follow the procedures found in the HUD-VASH Discharge SOP. After 30 days of non-engagement by the Veteran, the Contractor shall initiate a huddle with the VA COR/Liaison to discuss an action plan.

6.5. Contract case managers shall document in the EHR and HOMES system within 3 business days of Veteran exit from the program. The VA COR should be notified immediately if an exit occurred without prior notice or case conferencing.

6.6. If a Veteran chooses to relocate to another VAMC, the Contractor shall schedule a meeting with the VAMC in the requested relocation area. The Contractor shall then determine if that new VAMC has HUD-VASH case management and voucher availability. The Contractor shall verify that the receiving VAMC has necessary services available. The Contractor shall continue to provide case management services until exit from the program is complete and comply with VASH discharge policies and procedures.

7. STAFFING QUALIFICATIONS AND REQUIREMENTS

7.1. Contractor staff with a license/certification and performing work under this contract shall maintain an active standing with the licensing boards in their respective profession in accordance with the below qualification requirements

7.2. The Contractor is responsible for the following staffing requirements as described below:

7.2.1. Program Manager: This is a mandatory and a part-time position. The Program Manager shall be a Licensed Clinical Social Worker (LCSW), Licensed Clinical Psychologist, Licensed Marriage Family Therapist (LMFT) or Licensed Mental Health Counselor. The Program Manager shall be assigned to the HUD- VASH contract for overall oversight of staff and contract performance. The Program Manager’s schedule shall allow for 24-hour access to contract staff for the purposes of clinical oversight, documentation, and crisis management. The licensed independent clinical practitioner must be available for huddles and case conferences as requested by the VA. The Program Manager shall act as the point of contact for VA correspondence and is responsible for disseminating information to Contractor staff. The Program Manager shall have an active, current, unrestricted license and a minimum of a master’s degree or doctorate from an accredited institution in Social Work, Counseling, Marriage and Family Therapy, or Psychology.

7.2.2. Clinical Supervisors /Team Supervisors: This is a mandatory position. The Contractor shall have full-time clinical supervisors assigned to this contract. The clinical supervisors shall be Licensed Clinical Social Worker (LCSW), Licensed Clinical Psychologist, Licensed Marriage and Family Therapist (LMFT) or Licensed Mental Health Counselor. The clinical supervisors shall be available for 24-hour supervision of case management personnel for the purposes of clinical oversight, documentation, and crisis management. The clinical supervisors shall participate in team huddles and case conferences as requested by the VA. In addition, the clinical supervisors shall ensure appropriate supervision of any non-clinical/non-licensed Contractor staff providing services to Veterans to ensure quality of care and clinical supervision. All unlicensed staff must have their clinical supervisor added as expected co-signers when documenting in the electronic health record. Clinical supervisors shall have active, current, unrestricted licenses. Clinical Supervisors shall have a minimum of a master’s degree or doctorate from an accredited institution in Social Work, Mental Health Counseling, Marriage and Family Therapy, or Psychology. Clinical supervisors shall have direct oversight over case management staff gathering hours towards clinical licensure. Clinical supervisors shall adhere to the supervision guidelines issued by the state in which the license is being pursued and co-sign progress notes in accordance with the state licensing requirements. The Contractor shall comply with HUD-VASH Documentation SOP.

7.2.3. Lead Case Managers: This is a mandatory position. The Contractor shall have full-time lead case managers assigned to this contract. The lead case managers shall have a minimum of a bachelor’s degree from an accredited institution in the social science or family therapy field and at least 2 years demonstrated case management experience with high needs/ high intensity of service populations. Case managers with a master’s degree are strongly preferred. A master’s degree shall be from an accredited institution in sociology, psychology, social work, mental health counseling, or family therapy. Master’s level Case Manager’s shall have at least 1 year of demonstrated case management experience with high needs/high intensity of service populations. Additionally, lead case managers shall:

7.2.3.1. Collaboratively review Veteran primary care assignment reports, medical/mental health needs of intensive-stage Veterans, and any recent hospitalization reports.

7.2.3.2. Evaluate Veteran treatment plan during team huddles to ensure needs/concerns are addressed, request assistance and consultation from team member as appropriate, coordinate with mutual care providers and initiate needed referrals.

7.2.3.3. Provide care within their scope of practice and as outlined in HUD-VASH Team Roles SOP, attached in section D1.

7.2.3.4. Monitor Veteran engagement with assigned medical and mental health providers and encourage regular participation in treatment services. Utilize the Primary Care Engagement SOP, attached in section D1, for HUD-VASH Veterans for general guidance.

7.2.3.5. Develop treatment plan in collaboration with Veterans primary care team, HUD- VASH team members and other relevant specialty care members/community providers. providers.

7.3. Peer Support Specialist (PSS): The Contractor shall have PSS serving on this contract to provide general service support to Veterans. PSS shall have completed the VA designated Peer Specialist approved certification course. PSS may have a history of mental health, substance misuse, health concerns, justice involvement and/or homelessness and be certified to help others with these concerns, identify and achieve specific life and recovery goals. Visits conducted by the PSS count towards the minimum visit requirement, though at least one visit per month shall be conducted by the Lead Case Manager when the Veteran is in the intensive stage of case management. The Contractor shall comply with VA Peer Specialist Approved Certification Process October 1-2019, and HUD- VASH Stage of Case management and minimum visit requirements SOP attached in section D1.

7.4. Contractor shall maintain a caseload ratio per lead case manager of 25 Veterans:1 Lead Case Manager but may exceed this by no more than a 30:1 ratio. Reference HUD-VASH Stages of Case Management and minimum visit requirements SOP, attached in section D1.

7.5. Contractor shall ensure there is coverage for staff when they are out on planned or unplanned leave and shall notify the VA COR/Liaison of coverage plans.

7.6. Contractor shall provide staffing at a level to ensure all services listed in the contract are met for every Veteran enrolled. The Contractor shall have staff who are trained to provide services as per contract requirements. Contractor shall ensure sufficient staffing for the term of this contract.

7.7. The Contractor will have access to VA subject matter experts for case consultation for any Veteran covered under this contract. Contractors are encouraged to utilize this service at least monthly thru case consultation, team huddles, and/or case conferencing.

8. STANDARD OF CONDUCT

8.1. The Government reserves the right to refuse acceptance of Contractor personnel whose personal or professional conduct jeopardizes Veteran care. Breaches of conduct include but are not limited to intoxication, theft, abuse, dereliction of duties or other conduct resulting in formal sustained complaints by Veterans, VA COR, or staff.

8.2. Contractor staff shall under no circumstances engage in sexual activities or sexual contact with Veterans or their family members, even if such contact is consensual. Contractor shall under no circumstances engage in any monetary transactions with the Veterans. Contractor shall under no circumstances take unfair advantage of any professional relationship or exploit Veterans or their family members to further their personal, religious, political, or business interests. Contractor is responsible for taking steps to protect Veterans and their family members and is responsible for setting clear, appropriate, and culturally sensitive boundaries.

8.3. Contractor shall comply with the Standards of conduct described in VHA Handbook 6500, attached in section D1.

8.4. Complaints concerning Contractor conduct with Government employees or Veteran patients shall be dealt with by the Contractor and VA COR or designee. The Contracting Officer is the final authority on validating complaints. The Government reserves the right to refuse acceptance of services from Contractor personnel and require the Contractor to remove such personnel from performing work under the contract for any reason that the Government determines to jeopardize performance of this contract or create the potential for harm to Veterans or VA staff. This does not preclude refusal in the event of incidents involving physical or verbal abuse. The final arbiter on questions of acceptability is the Contracting Officer. In the event the Government refuses acceptance of services of Contractor personnel, the Contractor shall immediately remove the individual(s) from performing work under the contract and provide replacement personnel that are acceptable to the Contracting Officer. The cost of removing and replacing such personnel shall be borne solely by the Contractor.

8.5. The Contractor shall ensure its personnel respect and maintain the basic rights of patients, demonstrating concern for personal dignity and human relationships.

8.6. Department of Health and Human Services/The Office of Inspector General Requirements: To ensure that the individuals providing services under this contract have not engaged in fraud or abuse regarding Sections 1128 and 1128A of the Social Security Act regarding federal health care programs, the Contractor shall check the Health and Human Services Office of Inspector General (HHS/OIG), List of Excluded Individuals/Entities on the OIG Website annually for each person providing services under this contract. During the performance of this contract, the Contractor is prohibited from using any individual or business listed on the List of Excluded Individuals/Entities.

9. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) PRIVACY RULE

9.1. The Contractor shall ensure its personnel take all reasonable precautions to safeguard patient information from unauthorized access or modification, in both electronic and hard-copy formats. This includes not only electronic security measures such as “strong” user passwords on computer systems, but also physical barriers to prevent unauthorized use of computer workstations; and requires that hard copy Veteran files are stored in secured lockable areas, that files are in lockable cabinets, that the cabinets can in fact be locked (i.e., keys are available, and the locking mechanisms work properly). The Contractor shall also take all reasonable precautions to safeguard patient information when transferring Veteran information via electronic means, such as faxing or system-to-system transmission.

9.2. Subcontractors: All individuals that provide services under this contract and are not employees of the Contractor will be regarded as subcontractors. The Contractor shall be responsible and accountable for the quality of care delivered by all of its subcontractors. The Contractor shall ensure strict compliance with all contract terms and conditions without regard to who provides the service. The parties agree that the Contractor, its employees, agents, and subcontractors shall not be considered VA employees.

9.3. Substitution of Personnel: The Contractors shall replace any contractor or subcontractor employee assigned to work on this contract, if the employee is determined not to possess the experience, education, credentials, or ability required under the contract, or if said employee is for any other reason found to be unsuitable by the Government to perform the work required by the contract. The replacement shall meet the personnel requirements stated in the contract. In the event the Government requires replacement of Contractor or subcontractor personnel, the Contractor shall provide replacement personnel that are acceptable to the VA COR or designee within 10 days. The replacement personnel may be Contractor staff on an interim basis, while pending hiring and/or completion of criminal background checks and VetPro certification. All staff serving on the contract must be onboarded by the VA before working on the contract. The cost of removing and replacing such personnel shall be borne solely by the Contractor.

9.4. Alcohol/Drug Screening: Contractor is responsible for ensuring their employees are not using alcohol or drugs while performing work under this contact and are subject to random alcohol/drug testing performed by the Contractor. Contractor shall perform alcohol/ drug testing when there is a reasonable suspicion that an employee is using or impaired by alcohol or drugs while on duty.