Statement of Work - HCHV CRS Transitional Housing and Supportive Services - VALLHS.pdf

STATEMENT OF WORK

1. BACKGROUND AND OVERVIEW

1.1. In late 2009 the Secretary of the VA announced a Plan to End Homelessness Among Veterans. This plan calls for enhancing the capacity of existing programs as well as developing new programs, partnerships, and initiatives in concert with community and federal partners and stakeholders.

1.2. The Healthcare for Homeless Veterans (HCHV) Program at the VA Loma Linda Healthcare System (VALLHS) was established in 1991. HCHV is an essential and critical part of Veterans Healthcare Administration (VHA), providing housing and wraparound services to Veterans and facilitating their access to a broad range of medical, mental health, and rehabilitative services. HCHV serves as an entry point into VA’s system of care. HCHV Contract Residential Services (CRS) goal is to engage Veterans experiencing homelessness in services and facilitate their placement into safe and secure housing that shall support and promote their rehabilitation goals while they seek permanent housing.

1.3. The intent of this contract is for the HCHV Program at the VALLHS to engage a community provider to offer transitional housing and supportive services to 20 homeless male Veterans at one time in a community-based Contract Emergency Residential Services (CERS) program. The HCHV CERS program exists to provide a means of offering Veterans experiencing homelessness community-based, residential environments with sufficient supportive services to meet their basic needs. Maximum number of beds funded shall not exceed 15 beds for the first six months with up to 20 beds to be requested thereafter x 365 days of care per year. The ultimate goal is to facilitate the improvement of these Veterans’ overall health and functioning while encouraging permanent housing. Lengths of stay in CERS typically range from 30 to 90 days with the option to extend based on clinical need.

1.4. The Contractor shall provide the VALLHS HCHV Program with residential housing and supportive services for Veterans experiencing homelessness in accordance with the HCHV CERS model requirements. “Veteran” and “participant” will be used interchangeably throughout this document to identify the served population. Services are expected to be consistent with supportive and secure housing for Veterans, many of whom may also be dealing with substance use disorders, mental illness, and/or health conditions. The program places an expectation on the Veteran to engage in supportive case management services, and on the Contractor to provide expertise and guidance for improving housing stability to ensure a transition from homelessness to permanent, stable housing. Contractors must comply with all HCHV CERS requirements as identified below.

1.5. The Contractor shall provide all facilities, labor, supervision, materials, and transportation as required in this resulting contract. Government furnished property will not be provided to the Contractor. The Contractor shall be required to provide an on-demand, low-barrier therapeutic and rehabilitative milieu and attendant services targeting the underlying factors contributing to homelessness.

1.6. Place of Performance. The facility where services are to be provided shall be within 25-mile-radius of the immediate urban areas around VALLHS. The Contractor may be required to attend frequent meetings and planning sessions at the VALLHS Medical Center located at 11201 Benton St, Loma Linda, California 92357.

1.7. The period of performance for this contract shall be one (1) base year plus four (4) option years.

1.8. The contract facility and associated onsite services are expected to pass inspection and become fully operational within 90 days from the date of contract award. Failure to meet the 90-day milestone may result in the contract being terminated. Contractor shall demonstrate successful completion of the following tasks, validated by VA inspection, prior to receiving Veteran referrals and invoicing for payment:

Task Timeline Demonstrate site control At the time of proposal submission Complete a post-award inspection of the facility and on-site services conducted by VA clinical staff and safety specialists. Items requiring corrective action will be communicated to the contractor in writing within 1 week after the inspection.

Between 30 and up to 90 days after the contract award.

Complete the abatement of all corrective action items and pass VA inspection

Within 90 days after the post award inspection

Identify all staff required per the Statement of Work and have in place and available to provide the full range of case management and onsite services to Veterans

Between 30 and up to 90 days after the contract award.

2. HCHV CERS PROGRAM DESCRIPTION OVERVIEW

2.1. Targets and prioritizes homeless Veterans who are eligible for VA healthcare and are transitioning from chronic/literal street homelessness, Veterans being discharged from institutions, and Veterans who recently became homeless and require safe and stable living arrangements while they seek permanent housing.

2.2. Seeks to reduce barriers to immediate placement.

2.3. Does not require any length of sobriety or abstinence from alcohol or other drugs as a condition of admission.

2.4. Provides safe, secure housing as well as supportive services.

2.5. Length of stay ranges from 30 to 90 days with the option to extend on a case-by-case basis and based on clinical need.

2.6. Veterans are expected to meaningfully engage with their case managers and available programming.

2.7. Emphasis is placed on achieving placement in permanent housing at the time of program exit and reducing negative exits due to rule violations or other avoidable circumstances.

3. GENERAL SUPPORTIVE SERVICES

3.1. The Contractor shall be expected to provide same-day residential placement into the CERS program for 20 male Veterans.

3.2. Contractor services shall be furnished to beneficiaries for whom such care is specifically authorized by the VA and who are considered literally or chronically homeless. The Contractor shall provide supportive housing services as an alternative to shelter care. It is understood that the type of participant to be cared for under this contract will require care and services above the level of room and board.

3.3. Activities shall be designed to meet the goals and objectives for increased social responsibility, self-motivation, and integration into the larger community. Supportive services shall assist homeless Veterans to access resources to increase income, obtain permanent housing, obtain vocational training and/or employment, obtain treatment for mental health and/or substance use issues, obtain treatment to address medical needs, and coordinate discharge planning.

3.4. The Contractor shall provide residential care, case management, and treatment services that utilize a Recovery Model approach that includes elements of motivational interviewing, harm reduction, and critical time intervention. The Contractor must have written policies and procedures in place that address the following concerns and situations:

3.4.1. The CERS program shall be a low-demand environment with a minimum set of rules designed to engage the Veteran in needed services. Infraction of rules will be used as opportunities for engagement.

3.4.2. Acceptance of treatment cannot be a condition of admission or continued stay.

3.4.3. Substances shall not be permitted on the facility premises. However, continued use of substances shall not be used as a sole condition for denial of admission or discharge from the CERS program. Program rules that address substance use should outline ways that homeless Veterans manage their substance use issues and (mental) health without abstinence from substances being the only measure of success. Abstinence from alcohol or drugs cannot be a condition of treatment or continued stay.

3.4.4. In all cases relating to signs of withdrawal, the Contractor staff shall contact the local emergency response system and follow up with immediate VA notification via email or telephone call to the COR, CRS Liaison, or VA representative.

3.5. The Contractor must provide a safe and sober environment for all residents. The Contractor must have written policies and procedures in place that address the following concerns and situations:

3.5.1. Onsite contraband, including weapons and drug or alcohol-related paraphernalia (e.g., alcohol, drugs, drug “works,” etc.)

3.5.2. Contraband disposal

3.5.3. Room inspections, including method and frequency, as well as requirement of increased room checks with supporting documentation for Veterans determined to be high-risk.

3.5.4. Client abandonment of belongings in the facility, including time frames for disposal.

3.5.5. Process to elicit client satisfaction with the facility and onsite services, including information collection methods and frequency, and process for utilizing information for continual performance improvement purposes.

3.6. The Contractor shall ensure the following:

3.6.1. Participants are monitored 24 hours a day, 7 days a week, to include all national, religious, and federal holidays.

3.6.2. Staffing shall be on-site and available 24 hours a day, 7 days a week, including all national, religious, and federal holidays.

3.6.3. There are sufficient personnel to assure security.

3.6.4. Veterans shall be provided with opportunities to participate in spiritual worship, counseling, treatment, and social skills enhancement.

3.6.5. CERS program participants are not co-located with participants of other programs who may be located in the same facility.

3.6.6. Planning and coordination of all activities associated with providing safe and appropriate residential care.

4. VETERAN CODE OF CONDUCT

4.1. The Contractor shall develop a code of conduct to be followed by program residents while receiving services under this contract or while on facility premises. The code of conduct should be reviewed and approved by the COR, CRS Liaison, or VA representative and provided in writing to program participants upon admission.

Participants must sign the code of conduct upon admission demonstrating agreeance.

At a minimum, the following acts are not permissible:

4.1.1. Acts or threats of violence to self, other participants, staff, or the general public.

4.1.2. The carrying of firearms or weapons.

4.1.3. Gambling in any form.

4.1.4. Use of intoxicating liquors, narcotics, or controlled substances of any kind on facility premises.

4.1.5. No sexual activity between residents.

4.1.6. Honor nightly curfew.

4.1.7. No buying or selling of alcohol or drugs among participants.

4.1.8. Sexual harassment of other participants or staff.

4.1.9. Allowing entry of an unauthorized individual(s) into contract housing.

5. PROGRAM REFERRAL AND ADMISSION

5.1. The Contractor agrees to accept referrals and provide all services outlined in this contract to any person determined to be eligible by the VA regardless of race, color, religion, sex, sexual orientation/identification, or national origin of the person for whom such services are ordered. Additionally, the Contractor shall not use sub-contracting facilities as a means of circumventing this requirement.

5.2. Program eligibility criteria are as follows:

5.2.1. Veteran shall be literally and/or chronically homeless.

5.2.2. Veterans shall be capable of working towards permanent, independent housing.

5.2.3. Veteran shall be eligible for VA healthcare services.

5.2.4. Veterans shall be independent with their ADLs.

5.2.5. Veterans shall not be at high risk for falls.

5.2.6. Veteran shall not present with active danger to self or danger to others.

5.3. The Contractor shall work to reduce barriers to admission by accepting referrals throughout the day, if possible, and practicing flexibility with admission processes.

5.4. The Contractor shall assist residents with admission forms and eligibility determination with VA.

5.5. The Contractor will verify veteran identification immediately upon entry. If veteran does not have a legal form of ID available, one will be obtained to provide proof within two weeks.

5.6. The contractor is the point of contact for referrals and is responsible for initial assessment of whether Veteran is appropriate for admission. The VA is responsible for confirming eligibility of Veterans prior to admission to contract bed for services during normal business hours. The Contractor is expected to work with the identified VA Liaison or other VA designee or representative to confirm eligibility during normal business hours. The contractor is allowed to determine eligibility and admit eligible Veterans after hours and on weekends in support of same day access if VA Liaison or VA designee or representative is not available to determine eligibility. VA Liaison or designee must be informed by next business day of Veteran admission. Liaison or designee must verify Veteran’s eligibility for program participation within one business day from admission. If due diligence is followed by the contractor to determine eligibility and the Veteran is determined by the VA Liaison or VA designee or representative to be ineligible after admission, the contractor may bill for the stay of the Veteran for up to 4 days after receiving VA Liaison or designee approval. VA will pay for 4 days to allow for alternative placement to be identified. Contractor will utilize SQUARES as a form of demonstrating good faith in determining initial eligibility.

5.7. The Contractor is expected to make final placement decisions with prior authorization from the VA Liaison or designee/VA representative during normal business hours.

5.8. The Contractor shall ensure that a signed VA Release of Information (ROI) is obtained for any Veteran being admitted to an HCHV CERS bed and that the signed ROI is placed into the Veteran’s individual case record and submitted to VA Liaison or designee/VA representative.

5.9. Within 24 hours after admission or the next business day, the Contractor shall provide a written report of admission that contains the specific data required by the Northeast Program Evaluation Center (NEPEC) for immediate documentation in the Homeless Operations and Management Evaluation System (HOMES).

5.10. The Contractor shall be responsible for assessing Veterans upon admission and on an ongoing basis. The Contractor shall also be responsible for providing care planning processes that include coordination, supervision, and evaluating care services provided along with discharge planning.

5.11. Orders, requests, or changes in the referral process shall only be made by the VA COR or HCHV Coordinator. In addition, referrals may be coordinated by an authorized party specified by the VA Liaison or the HCHV Coordinator.

5.12. The Contractor shall be responsible for ensuring that a minimally acceptable level of 80% occupancy of HCHV CERS-funded beds is maintained at all times through independent outreach efforts as well as through collaboration with VA.

5.13. Contractors must communicate policies and procedures to Veteran residents both verbally and in writing in a manner that is understandable to each Veteran upon admission to the facility, ideally in the form of a written resident handbook that is verbally reviewed by the assigned case manager with the Veteran. This communication must be documented in the participants record.

6. CASE MANAGEMENT

6.1. Case management services shall be initiated within 1 week of a Veteran’s admission to the program. The written plan of care shall be completed and entered into the individual Veteran case record no later than 14 days after Veteran is admitted to the program.

6.2. A highly Individualized Service Plan (ISP) shall be developed in collaboration with each participant. Supportive services shall be administered by trained program staff and provided as outlined in the plan of care. The ISP shall be reviewed weekly in a clinical meeting with the participant.

6.3. Case management services shall meet the individual needs of each participant and will include, at a minimum, weekly face-to-face meetings with each participant individually to assess, determine, and coordinate housing plans, care needs, and discharge planning.

6.4. Case management shall include services that will assist participants to access resources to increase income, obtain permanent housing, obtain vocational training and/or employment, obtain treatment for mental health and/or substance use and/or psychosocial issues, obtain treatment to address medical needs, and coordinate discharge planning. Contractor shall take primary responsibility for assisting participants in completing housing applications and other benefits paperwork as needed.

Contractor shall assist participants in obtaining the needed documentation required for complete applications, including, but not limited to, birth certificates, DD214, VA Identification, Social Security card, driver’s license, income verification, and any additional information required by housing resources and potential income supports.

6.5. Case management shall provide referrals to agencies that will support participants care needs and facilitate access to benefits for which participants may be eligible. Contractor shall obtain relevant Releases of Information to communicate and coordinate Veterans’ treatment with VA and other community-based service providers. Contractor shall accompany Veterans to housing interviews, medical appointments, and other appointments as clinically indicated while working with participants to foster independence and a sense of self-determination.

6.6. Veteran shall be screened for suicidal and homicidal risk with each contact, at a minimum of weekly during case management sessions. The screening must be documented in regular progress notes in the Contractor’s clinical service records. If the participant is a danger to self or others, the Contractor shall take immediate steps to provide appropriate intervention. Crisis management will be conducted in consultation and coordination with the VA Liaison.

6.7. All services offered and provided to participant shall be documented in the Veteran’s file.

6.8. Case Management shall include coordination with the VA Liaison as necessary to access care at the VA.

7. COORDINATION OF CARE WITH VA

7.1. Contractor shall maintain a daily census. All Veterans shall sign an attendance log, which will be maintained by the Contractor to verify program census on a daily basis.

Contractor will not have participants sign logs for future dates. This information, both census and sign in sheets, is to be provided to the VA Liaison daily or at intervals approved by the COR, CRS Liaison, or VA representative in order to ensure effective monitoring of bed utilization. Contractor shall establish coverage plan to ensure that daily census information is communicated to the COR, CRS Liaison, or VA representative when regularly assigned Contractor staff member is out of the office.

Weekend or holiday sign-in sheets are to be provided to the VA Liaison on the next business day. In the event one or more Veterans refuses to sign the daily sign-in sheets due to documented mental health problems, an alternative method of verification may be developed on a case-by-case basis in collaboration with VALLHS subject to final approval by the COR, CRS Liaison, or VA representative.

7.2. Contractor shall document and report each Veteran’s progress in the areas of housing placement, care plan, and observations at a minimum of once per week, per Veteran.

Case conferencing may be conducted in person, by telephonic conference calls, or by other virtual platform as determined by VA Medical Center. Plan of care shall be developed in conjunction with and monitored by the CRS Liaison, COR, or VA representative.

7.3. Contractor shall document ongoing communications as it pertains to Veteran participation at least on a weekly basis or more as needed.

7.4. Coordination of care provided by VA staff and the Contractor for individual Veterans shall be maintained as such:

7.4.1. Contractor shall participate in team conferences and case consultation with VA staff as needed or requested by the VA.

7.5. All Veterans who are accepted must be eligible to receive medical care by a VA facility/medical center while being provided services authorized by this contract.

Healthcare requirements will follow VA healthcare policy for treatment and reimbursement.

7.6. If hospitalization is required for a CERS program participant, it is agreed that readmission will be evaluated by appropriate COR, CRS Liaison, or VA representative.

7.7. The Contractor is responsible for ensuring that all requests for extension beyond the initially authorized service period are reviewed and approved verbally or in writing by the VA Liaison. Written requests for extension are due a minimum of 2 week prior to the initial targeted exit date when it is anticipated the Veteran will require additional time beyond the initially authorized service period, as well as for any and all subsequent extension authorizations. In the event that a Veteran is not approved for an extension of stay, the Contractor shall retain responsibility for finding suitable transitional or permanent housing in the community at its own expense. Extensions should not occur on a regular basis and will not be approved except on a case-by-case basis as follows:

7.7.1. There are extenuating clinical circumstances beyond the Contractor’s control that are barriers to the Veteran’s placement in housing; and/or

7.7.2. There is documented evidence that the Contractor has exhausted every effort to place the Veteran in housing sooner; and

7.7.3. The VA Liaison has been appropriately advised of these efforts well in advance;

and

7.7.4. The VA Liaison concurs that the Veteran will continue to derive therapeutic benefits from a continued stay at the HCHV Residential Care facility.

8. PREFORMANCE MEASURES

8.1. COR, CRS Liaison, or VA Representative will review with Contractor participant outcomes and verify that the HCHV CRS program is meeting or exceeding the applicable HCHV performance measures. Below are the applicable measures which are determined by National Homeless Programs Office and can change:

8.1.1. Percent Exits to Permanent or Transitional Housing (for Veterans staying at least 8 days or more), 55% or above

8.1.2. Percent Negative Exits, 20% or below

8.1.3. Cumulative Bed Occupancy Rate > 80%

8.1.4. Average Length of Stay of 90 days

8.2. COR, CRS Liaison or VA Representative will review any deficiencies or trends with the contractor and discuss proactive strategies to improve participant outcomes. If indicated, an action plan or performance improvement plan, in consultation with the COR and CO, will be initiated.

9. ABSENCES

9.1. Scheduled and approved absences may be permitted only by VA staff, at the VA’s discretion, solely on a case-by-case basis, and are reimbursable up to 96 consecutive hours. The Contractor will be expected to hold the bed up to 96 hours if approved by the VA in advance. The Contractor may maintain a homeless Veteran within their program beyond the approved 96-hour absence at their discretion, which may not be reimbursable. However, the Veteran must be discharged after a 14-day absence and the appropriate exit form in HOMES must be completed.

9.1.1. Consistent with participants individual service plan (i.e. family reunification, short term medical, substance use disorder SUD or psychiatric treatment).

9.1.2. Not to be used for extended educational or employment circumstances.

9.1.3. Not to be used for a break or vacation from treatment.

9.1.4. Not to be used to create more than 4 consecutive days in absence.

9.2. Inpatient Hospitalization: If a participant requires inpatient medical or psychiatric treatment, VA will reimburse for a period of up to 7 days. The provider may not fill the bed during this time and should maintain contact with the COR, CRS Liaison, or VA representative and the participant if authorized.

9.3. A Veteran who is absent without approval from the contract facility with no expectation of return must be discharged after 24 hours and the appropriate exit form in HOMES must be completed. Contractor must have evidence of active outreach to locate and reengage the participant and document steps take in the participants case file, treatment record, or service plan. If there is some expectation of return, unexcused absences less than 48 consecutive hours will not be a basis for discharge in and of themselves.

Unexcused or AWOL absences in excess of 48 consecutive hours will not be reimbursable. The Contractor may use discretion to hold a bed for a Veteran in excess of 48 hours, if the Veteran has been located. However, the Veteran must be discharged after a 14-day absence and the appropriate exit form in HOMES must be completed.

9.4. The Contractor understands that the decision to hold a bed for a Veteran (beyond the approved consecutive 96-hours or unexcused consecutive 48-hours) shall not hinder bed availability for other Veterans attempting to enter the program, nor will the Contractor be reimbursed for doing so.

9.5. Absences shall be documented on daily sign-in sheets and the Contractor shall submit approved absence passes with monthly billing statements.

10. DISCHARGE

10.1. Veterans may be discharged from HCHV Contracted Emergency Residential Care Programs for positive, negative, or administrative reasons. The date of discharge must be approved by the COR, CRS Liaison, or VA representative for billing purposes. The Contractor shall provide discharge planning and referrals for each Veteran, regardless of character of discharge from the facility to appropriate community resources and services based upon a team assessment of health, social and vocational needs, and the involvement of Veterans’ families as appropriate.

10.1.1. A negative discharge is characterized as follows: Veteran was asked to leave the program due to violation of program rules (excluding exits due to threatened/actual violence to self or others), failure to comply with program requirements, or left the program without consulting staff. It is the Contractor’s responsibility to assist Veteran in identifying and securing a safe housing arrangement upon discharging from program.

10.1.2. Performance expectations regarding discharges shall meet the performance target measures set by the VA National Homeless Programs Office

10.1.2.1. Percent Exits to Permanent or Transitional Housing (for Veterans staying at least 8 days or more), 55% or above

10.1.2.2. Percent Negative Exits, 20% or below

10.1.3. Performance target measures may change annually depending on previous years’ performance and national guidelines. These targets are set for FY27 and future target measures will be provided to the Contractor at the beginning of each fiscal year.

10.2. The VA reserves the right to remove any and/or all Veterans from the facility and/or program at any time without additional cost when it is determined by the VA to be in the best interest of the VA or Veteran participant.

10.3. All discharge planning shall be completed by the Contractor. The Veteran shall be involved in the discharge planning process and will be provided with clear information regarding exit. Arrangements will be made for ongoing medical and mental health needs.

The VA COR shall be included in decisions regarding the setting and frequency of ongoing treatment and community recovery activities. If the Veteran does not exit to permanent housing, the Contractor shall provide information that facilitates arrangements for transitional or temporary housing. It is the Contractor’s responsibility to assist Veteran in identifying and securing a safe housing arrangement upon discharging from program.

10.4. The Contractor is responsible for notifying the identified VA Liaison (or designee) of anticipated discharges before they occur. The Contractor shall notify the VA Liaison (or designee) within 24 hours, or the next business day that a discharge has occurred and provide a written report of discharge that contains the specific data required by the Northeast Program Evaluation Center (NEPEC) for immediate documentation of discharge in the Homeless Operations and Management Evaluation System (HOMES).

10.5. The Contractor is responsible for ascertaining and informing the VA Liaison of the Veteran’s location upon discharge.

10.6. Discharging a Veteran participant to the streets without coordinated services will not be approved by the VA. Efforts to provide safe placements must be considered and coordinated by the Contractor. Contractor must notify VA Liaison of discharge plan prior to discharge. Participants will not be discharged solely for drinking, use of drugs, non-compliance with prescribed medication, or infractions of house rules that do not constitute a risk to their personal safety or the safety of the facility residents or staff.

Contractor shall develop and implement a process for addressing problematic behaviors with opportunities for participants to modify behavior prior to discharge, including use of behavioral contracts. Contractors will implement harm reduction best practices to address problematic behavior.

10.7. Violent Acts will be reviewed, and discharge could be considered for the following:

10.7.1. Acts or threats of violence to self, other program participants or facility residents, staff, or the general public

10.7.2. Carrying of or threatening with any firearms or weapons

10.8. At a minimum of 90 days prior to contract expiration (excluding the renewal of option periods), and preferably sooner, the Contractor shall be responsible for implementing an exit plan, including coordinating services to ensure the remaining program participants are transitioned to a safe housing alternative. The safe housing alternative is expected to be permanent housing. This process should also include coordination with the COR, CRS Liaison, or VA representative.

11. MEDICATION MANAGEMENT

11.1. The Contractor shall have a written policy statement regarding the use of prescribed medications. Such policy shall not necessarily preclude the legal use of prescribed medications. Written policy shall address safe prescription medication storage and handling, including specific provisions for prescribed controlled substances.

11.2. Medications, including controlled substances, shall be properly stored and controlled in a double-locked storage unit. Veterans must be able to carry on their person medications which require urgent administration to be effective (e.g., rescue inhalers, Naloxone, EpiPen).

11.3. All medication shall be self-administered by the Veteran.

11.4. The Veteran shall be expected to provide the Contractor with an updated list of current medications, including dosages and instructions, which is regularly updated or at minimum monthly review.

11.5. Veteran’s current medication information shall be maintained in the Veteran’s file and updated as changes occur.

11.6. Any suspicion or concern of misuse is to be reported to the VA Liaison immediately following incident reporting protocol.

12. DIETARY SERVICES

12.1. The VA will have the right to inspection of the facility, multiple times annually, scheduled and unscheduled, by an authorized representative(s) designated by the VA to determine whether acceptable dietary standards are maintained, and that adequate care is being rendered. The VA has particular concern for the dietary needs of chronically homeless Veterans, many of whom are either undernourished or have developed poor eating habits, or both, because of chronic medical, mental health, or substance use disorders.

12.2. The Contractor shall serve Veterans 3 nutritionally adequate meals a day (breakfast, lunch, and dinner), with no more than a 14-hour time span between the evening and morning meals.

12.3. In between meals, at least 2 nutritious snacks that meet each Veteran’s dietary needs shall be served to all Veterans. Some Veterans may be limited by dietary restrictions prescribed by a medical provider.

12.4. Food preparation, serving and storage shall be in accordance with the California Department of Public Health standards:

https://www.cdph.ca.gov/Programs/CEH/DFDCS/Pages/FDBPrograms/FoodSafetyProgr am.aspx

12.5. Sanitary procedures shall be established and maintained for washing dishes, cleaning equipment and work areas, and for proper waste disposal. Any safety or sanitation deficiency must be addressed immediately.

12.6. The Contractor shall provide all kitchen supplies and utensils required to prepare and consume food and drinks. Contractor will ensure all appliances are adequate to safely store and prepare food and are in good working condition and maintain in sanitary conditions.

12.6.1.1. Contractor shall ensure the refrigerator and all appliance are maintained in good repair and are cleaned regularly to uphold sanitary standards.

12.6.1.2. Thermometers should be used in monitoring temperatures to ensure safe keeping of food items. Temperature logs are properly posted, current, and accurately documenting temperatures within the required ranges.

12.6.1.3. Food must be labeled and expiration dates monitored as required by facility inspection team.

12.6.1.4. Kitchen counters must be kept in sanitary conditions and wiped down at all times.

12.6.1.5. Contractor shall provide appropriate cleaning supplies as needed to https://www.cdph.ca.gov/Programs/CEH/DFDCS/Pages/FDBPrograms/FoodSafetyProgram.aspx https://www.cdph.ca.gov/Programs/CEH/DFDCS/Pages/FDBPrograms/FoodSafetyProgram.aspx maintain a suitable and sanitized area.

12.7. Menus shall be written at least one week in advance and copies of the menus as served shall be dated and kept on file for at least 30 days. These records shall be made available for review by Veterans and/or VA staff. A designated VA staff member will assess printed menus as well as Veterans’ satisfaction with meals and the actual consumption of food offered in determining the Contractor’s success in meeting this requirement during annual facility inspection or any point during the contract period.

12.8. Some Veterans may have medical recommendations for specialized diets (e.g., cardiac, low sodium, or diabetic diets). The Contractor shall accommodate the individualized dietary needs of Veteran residents, as specified by their medical providers.

12.9. The dietary needs of all Veterans shall be met in accordance with sound nutrition consistent with USDA standards: https://www.nal.usda.gov/fnic/dietary-guidelines.

13. TRANSPORTATION SERVICES

13.1. The Contractor shall be required to provide transportation to and from the Loma Linda Medical Center (Main Campus), Ambulatory Care Center (ACC), and Community- Based Outpatient Clinics (CBOCs) for Veterans being served under this contract. The Contractor shall also provide transportation to support linkage to community services and resources as needed. If Veterans prefer, Contractor may provide assistance in accessing other transportation services and/or funding, for example, obtaining reduced bus fare, local subsidized transportation services such as Access, etc.

13.2. Contractor will be a good steward of resources aimed at lowering barriers for veteran’s access to healthcare, by developing a clear and efficient protocol for ride request submissions that is participant friendly. At all times, contractor should facilitate transportation for healthcare services and/or services needed to establish permanent housing.

13.3. The VA shall have the right to inspect any vehicles utilized for the transportation of program participants.

13.4. The VA may designate representative(s) to determine whether safe vehicle operating conditions are being maintained by the Contractor.

13.5. Vehicle operation shall be as follows:

13.5.1. The manufacturer’s rated seating capacity of any vehicle shall not be exceeded.

13.5.2. Motor vehicles shall be maintained in a safe operating condition and fully insured with current vehicle registration.

13.5.3. Only fully insured drivers with valid driver’s licenses for the type of vehicle being operated shall be permitted to transport Veterans.

https://www.nal.usda.gov/fnic/dietary-guidelines

13.5.4. First-aid kits shall be maintained in the vehicle and updated on a quarterly basis. Records of such shall be maintained by the Contractor.

13.5.5. Motor vehicles shall be equipped with appropriate fire extinguishers and road emergency kits.

14. RECORDS AND CONFIDENTIALITY

14.1. The Contractor shall assist in the provision of healthcare to patients seeking such care from or through VHA. As such, the Contractor is considered as being part of the department healthcare activity. The Contractor is considered to be a VHA contractor for purposes of the Privacy Act, Title 5 U.S.C. 552a, further, for the purpose of VHA records access and patient confidentiality. The Contractor is considered to be a VHA contractor for the provisions of Title 38 U.S.C 5701, 5705, and 7362. Therefore, the Contractor will only have access to patient health information, including information pertaining to drug and alcohol abuse, HIV, and sickle cell anemia, to the extent necessary to perform its contractual responsibilities. Contractor will not have access to VA computerized electronic health record systems. Information will be provided following Veteran consent and completion of VA Authorization to Release Information form. No personal identifying/health information shall be shared without an ROI signed by the Veteran.

14.2. The Contractor shall take reasonable measures to ensure Veteran’s privacy and confidentiality. The Contractor shall only release medical information obtained during the course of this contract to VA employees involved in the care and/or treatment of the Veteran. The Contractor personnel shall make sure no Veteran information of any type is given to outside parties, agencies, or organizations of any type without the express written consent of the Veteran and the VA and only in capacities directly related to the provision of the services contracted in this instrument. Lists, names, and/or social security numbers of Veterans shall not be disclosed or revealed in any way, for any use outside the Contractor’s facility or without prior express written permission of the Contracting Officer or the Veteran. The Contractor shall ensure that only the minimum necessary Veteran information is used to provide appropriate services to the correct Veteran. Transcribed reports containing personal identifiers, when not used as an official document, shall be shredded by the Contractor in accordance with the VA policy on destruction of records. Temporary paper records that are collected for destruction shall be kept in a manner that will prevent their content from being read by individuals with no official business need or right to access the data contained in these records. The method of collecting and processing these records shall also prevent the loss or theft of these records until their final destruction.

14.3. The Contractor is subject to the same penalties and liabilities as VHA for unauthorized disclosures of any records. The Contractor and any subcontractors shall adhere to the provisions of Public Law 104-191, Health Insurance Portability and Accountability Act (HIPAA) of 1996. This includes both the HIPAA Privacy and

Security Rules published by the Department of Health and Human Services for the protection of certain health information by covered entities. The Contractor shall be responsible for the following:

14.3.1. The Contractor shall be responsible for the development of any necessary forms.

14.3.2. The Contractor shall maintain an individual case record for each referred Veteran and Veteran files shall be kept behind 2 locks at all times. Case records must be maintained in security and confidence as required by the Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR part II), the Confidentiality of Certain Medical Records (38 USC 7332), and the Heath Insurance Portability and Accountability Act (HIPAA: Pub. Law. 104-191).

14.4. At a minimum, records should contain the following:

14.4.1. ROI signed by participant to allow communication between VA and contractor, relevant correspondence with or regarding VA (including documentation of verbal authorization and eligibility for admission/exit), and any other forms related to coordination of care.

14.4.2. Demographic information sufficient to identify the Veteran participant and to satisfy data collection needs of the program and funding agencies:

14.4.2.1. Veteran identifier (e.g., first and last name, Social Security number)

14.4.2.2. Date of birth

14.4.2.3. Sex

14.4.2.4. Race/ethnic backgrounds

14.4.2.5. Address (if applicable)

14.4.2.6. Telephone number (if applicable)

14.4.2.7. Next of kin or emergency contact (including phone number and ROI)

14.4.2.8. VA to receive verification of homelessness of participant, either verbal, written or documented.

14.4.2.9. Date of admission/readmission

14.4.2.10. Participant Handbook and participant signature verifying receipt.

14.4.2.11. Admission agreement, including rules, policies, and expected conduct of participants, and participant signature verifying receipt.

14.4.2.12. Veteran rights document and participant signature verifying receipt.

14.4.2.13. Grievance procedure, including time frames for responses from Contractor’s program/facility management, and participant signature verifying receipt.

14.4.2.14. Referral source and reason for referral

14.4.2.15. Medical referrals and clearances as needed

14.4.2.16. Individualized Service Plan (ISP), including provisions for Veteran placement into housing within designated time period approved by VA Liaison and provisions for stabilization of biopsychosocial issues and stressors

14.4.2.17. Updated ISP every 30 days from date of initial plan or more as needed, to include any measures of movement towards rehabilitation goals, with particular focus on the attainment of community-based housing

14.4.3. Case management/treatment notes, including the following:

14.4.3.1. Discussions and actions to reengage Veteran for not complying with program rules and requirements

14.4.3.2. Behavior contracts/agreements if applicable

14.4.3.3. Any type of supportive services provided to Veteran, e.g., resources and referrals, additional transportation, clothing assistance, etc.

14.4.3.4. Documentation of Veteran participation in onsite daily structured activities and groups

14.4.4. Relevant Releases of Information to communicate and coordinate Veteran’s treatment with VA and other community-based service providers

14.4.5. Medications should be documented in records and/or incidences of medication non-compliance.

14.4.6. Any incident reports, including follow-up and/or outcomes.

14.4.7. A final summary that includes reason(s) for discharge, the Veteran’s known future plans, follow-up locator information and any beneficial changes realized during the residential period. This summary is due to the VA Liaison, COR, or VA representative within 24 hours of discharge.

14.5. It is agreed that the VA may readily have access to all records concerning the Veteran’s care in the facility.

14.6. Upon discharge or death of a patient, all records on all VA beneficiaries will be retained by the facility for a period of at least 3 years following termination of VA care.

14.7. Periodic reports will be provided to the VA (i.e., Fiscal Accountability) as required.

14.8. Contractor shall comply with all applicable records management laws and regulations, as well as National Archives and Records Administration (NARA) records policies, including but not limited to the Federal Records Act (44 U.S.C. chs. 21, 29, 31, 33), NARA regulations at 36 CFR Chapter XII Subchapter B, and those policies associated with the safeguarding of records covered by the Privacy Act of 1974 (5 U.S.C. 552a).

These policies include the preservation of all records, regardless of form or characteristics, mode of transmission, or state of completion.

14.9. In accordance with 36 CFR 1222.32, all data created for Government use and delivered to, or falling under the legal control of, the Government are Federal records subject to the provisions of 44 U.S.C. chapters 21, 29, 31, and 33, the Freedom of Information Act (FOIA) (5 U.S.C. 552), as amended, and the Privacy Act of 1974 (5 U.S.C. 552a), as amended and must be managed and scheduled for disposition only as permitted by statute or regulation.

14.10. In accordance with 36 CFR 1222.32, Contractor shall maintain all records created for Government use or created in the course of performing the contract and/or delivered to, or under the legal control of the Government and must be managed in accordance with Federal law. Electronic records and associated metadata must be accompanied by sufficient technical documentation to permit understanding and use of the records and data.

14.11. VA Loma Linda Healthcare System and Clinics and its contractors are responsible for preventing the alienation or unauthorized destruction of records, including all forms of mutilation. Records may not be removed from the legal custody of VA Loma Linda Healthcare System and Clinics or destroyed except for in accordance with the provisions of the agency records schedules and with the written concurrence of the Head of the Contracting Activity. Willful and unlawful destruction, damage or alienation of Federal records is subject to the fines and penalties imposed by 18 U.S.C. 2701.

14.12. In the event of any unlawful or accidental removal, defacing, alteration, or destruction of records, Contractor must report to VA Loma Linda Healthcare System and Clinics. The agency must report promptly to NARA in accordance with 36 CFR 1230.

14.13. The Contractor shall immediately notify the appropriate Contracting Officer and COR and CRS Liaison upon discovery of any inadvertent or unauthorized disclosures of information, data, documentary materials, records or equipment. Disclosure of non-public information is limited to authorized personnel with a need-to-know as described in the [contract vehicle]. The Contractor shall ensure that the appropriate personnel, administrative, technical, and physical safeguards are established to ensure the security and confidentiality of this information, data, documentary material, records and/or equipment is properly protected. The Contractor shall not remove material from Government facilities or systems, or facilities or systems operated or maintained on the Government’s behalf, without the express written permission of the Head of the Contracting Activity. When information, data, documentary material, records and/or equipment is no longer required, it shall be returned to VA Loma Linda Healthcare

System and Clinics control, or the Contractor must hold it until otherwise directed. Items returned to the Government shall be hand carried, mailed, emailed, or securely electronically transmitted to the Contracting Officer or address prescribed in the [contract vehicle]. Destruction of records is expressly prohibited unless in accordance with Paragraph (4).

14.14. The Contractor is required to obtain the Contracting Officer's approval prior to engaging in any contractual relationship (sub-contractor) in support of this contract requiring the disclosure of information, documentary material and/or records generated under, or relating to, contracts. The Contractor (and any sub-contractor) is required to abide by Government and VA Loma Linda Healthcare System and Clinics guidance for protecting sensitive, proprietary information, classified, and controlled unclassified information.

14.15. The Contractor shall only use Government IT equipment for purposes specifically tied to or authorized by the contract and in accordance with VA Loma Linda Healthcare System and Clinics policy.

14.16. The Contractor shall not create or maintain any records containing any non-public VA Loma Linda Healthcare System and Clinics information that are not specifically tied to or authorized by the contract.

14.17. The Contractor shall not retain, use, sell, or disseminate copies of any deliverable that contains information covered by the Privacy Act of 1974 or that which is generally protected from public disclosure by an exemption to the Freedom of Information Act.

14.18. The VA Loma Linda Healthcare System and Clinics owns the rights to all data and records produced as part of this contract. All deliverables under the contract are the property of the U.S. Government for which VA Loma Linda Healthcare System and Clinics shall have unlimited rights to use, dispose of, or disclose such data contained therein as it determines to be in the public interest. Any Contractor rights in the data or deliverables must be identified as required by FAR 52.227-11 through FAR 52.227-20.

15. PRIVACY AND CONFIDENTIALITY:

15.1. The Contractor shall comply with the VA patients’ Bill of Rights as set forth in 38 CFR § 17.33 Patients’ Rights. The Contractor is responsible for maintaining Veterans’ privacy and confidentiality and must have systems in place that protect Veteran’s personal identifying information and protected health information. This includes but is not limited to the following:

15.1.1. Having adequate private office space for Veterans to meet in confidence with their case manager.

15.1.2. Having secured paper and electronic filing systems to protect Veterans’ case records and other documentation. Paper filing systems must be maintained behind 2 locks at all times.

15.1.3. Conducting ongoing training of staff about maintaining client privacy and confidentiality in all verbal and written communications and interactions.

15.1.4. Ensuring that non-clinical/non-case management staff have access to Veteran information only as needed in order to meet the service requirements contained in the contract.

15.2. Computer Security: In the performance of official duties, Contractor personnel will have regular access to printed and electronic files containing sensitive data that shall be protected under the provisions…