36C26321R0005.docx

PAGE 1 OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

DUNS:

DUNS+4:

PHONE:

FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

N/A; orders to be paid via Govt. Purchase Card 36C26321R0005 03-01-2021 Doug Reed douglas.reed3@va.gov

(605) 336-3230 x 7844 04-01-2021 11:59pm CST

CST

Sioux Falls Services Team Department of Veterans Affairs

NETWORK 23 CONTRACTING OFFICE

2501 W. 22nd St.

Sioux Falls SD 57105 X X 532283 $35 Million N/A X Department of Veterans Affairs Veterans Integrated Service Network

(VISN) 23

2805 Dodd Road, Suite 250 Eagan MN 55121 Sioux Falls Services Team Department of Veterans Affairs

NETWORK 23 CONTRACTING OFFICE

2501 W. 22nd St.

Sioux Falls SD 57105

Via Government Purchase Card Orders /www.fsc.va.gov/einvoice.asp See CONTINUATION Page Home Oxygen Services to support VISN 23 Period of Performance: 06-01-2021 to 05-31-2026 This solicitation uses Federal Acquisition Regulation (FAR) Part 15 (Contracting by Negotiation) Procedures.

All offerors shall be active and registered at System for Award Management (SAM) at https://www.sam.gov at time of proposal submittal to the Government.

All Service-Disabled Veteran Owned Small Business (SDVOSB) and Veteran Owned Small Business (VOSB) offerors shall be registered and active at Vendor Information Pages (VIP) at https://www.vetbiz.va.gov at time of proposal submittal to the Government.

This solicitation is being issued as a tiered evaluation for Service-Disabled Veteran Owned Small Business (SDVOSB) concerns, or in the alternative, a tiered evaluation for Veteran-Owned Small Business (VOSB) concerns, or in the alternative, a set-aside for other small business (SB) concerns with HUBZone small business concerns and 8(a) participants having priority. If award cannot be made, the solicitation will be cancelled and requirement resolicited.

See CONTINUATION Page Not Applicable; orders to be paid via Government Purchase Card.

X X X Travis Johnson Contracting Officer Table of Contents

Attachment 1: VISN 23 Home Oxygen Roles and Responsibilities (2 pages) Attachment 2: Business Associate Agreement Template (8 pages) Attachment 3: USDOL Wage Determinations (90 pages) Attachment 4: Quality Assurance Surveillance Plan (15 pages)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR: TBD

b. GOVERNMENT: Contracting Officer 36C263 Travis Johnson, travis.johnson2@va.gov Sioux Falls Services Team Department of Veterans Affairs

NETWORK 23 CONTRACTING OFFICE

2501 W. 22nd St.

Sioux Falls SD 57105

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with “Invoicing Submissions” in Section B.3 (Performance Work Statement):

3. INVOICES: Invoices shall be submitted in arrears:

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with “Invoicing Submission” in Section B.3 (Performance Work Statement).

5. ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

B.2 PRICE/COST SCHEDULE

NOTE: THE PRICE FOR ITEMS LISTED INCLUDES DELIVERY, SET-UP, INITIAL EDUCATION, AND PREVENTIVE MAINTENANCE INSPECTIONS AS SPECIFIED BY THE MANUFACTURER, TO INCLUDE ALL DISPOSABLE SUPPLIES AS LISTED.

Orders will be placed by VA prosthetists at each individual VA location.

Services are not a line item but are included in the overall charges for supplies and equipment rental. Services are an ongoing requirement for the five-year ordering period. Services are outlined in detail in Section B.3 (Performance Work Statement) and Attachment 1 (Home Oxygen Contract Roles and Responsibilities). The services include but are not limited to: delivery and set-up for new starts, patient assessment and reassessment, implementation of patient safety goals (e.g. fire safety, fall prevention, etc), education and re-education, development of Veteran/caregiver education handouts, routine safety inspections (e.g. equipment, home environment, delivery vehicles), development and implementation of quality assurance plan including infection control policy, implementation of delivery staff screening, orientation, and ongoing training plan, durable medical equipment preventative maintenance, 24-hour emergency services, data collection and collation with reports to the VA, development/review/revision of care plan on each VA beneficiary, ongoing communication with VA, arrangement of service for traveling patients, maintenance of Veteran’s service record, and related expenses such as regulatory compliances.

Contract guaranteed minimum is $54,000 for the initial Year of contract award via individual purchase card orders.

Contract maximum is $54,000,000 for lifetime of the contract.

Quantities listed are estimates only based on historical data. Actual quantities on individual purchase card orders can be less than or greater than estimated quantities listed based on VISN 23 needs.

Only authorized VA Purchase Card holders with appropriate dollar amount authority can place individual purchase card orders against this contract.

The unit “Each” represents Monthly Rental of Item for all Item Numbers except 1016 and 1019; for 1016 “Each” refers to once as needed.

ITEM INFORMATION

0.00

VISN 23

Rental of 5 LPM Concentrator with Backup System Consists of Compressed Gas Source, Regulator, Stand (Nasal Cannula or Mask/Humidifier When Specified) HCPCS Code: E1390

1001A

Year 1: 06-01-2021 to 05-31-2022

1001B

Year 2: 06-01-2022 to 05-31-2023

1001C

Year 3: 06-01-2023 to 05-31-2024

1001D

Year 4: 06-01-2024 to 05-31-2025

1001E

Year 5: 06-01-2025 to 05-31-2026

0.00

VISN 23

Rental of 10 LPM Concentrator with Backup System Consists of Compressed Gas Source, Regulator, Stand (Nasal Cannula or Mask/Humidifier When Specified)

1002A

Year 1: 06-01-2021 to 05-31-2022

1002B

Year 2: 06-01-2022 to 05-31-2023

1002C

Year 3: 06-01-2023 to 05-31-2024

1002D

Year 4: 06-01-2024 to 05-31-2025

1002E

Year 5: 06-01-2025 to 05-31-2026

0.00

VISN 23

Set-Up of Size M or H Cylinder Consists of Regulator, Flow Meter, Safety Stand, Humidifier and Disposable Supplies (Primary or Emergency Backup System)

1003A

Year 1: 06-01-2021 to 05-31-2022

1003B

Year 2: 06-01-2022 to 05-31-2023

1003C

Year 3: 06-01-2023 to 05-31-2024

1003D

Year 4: 06-01-2024 to 05-31-2025

1003E

Year 5: 06-01-2025 to 05-31-2026

0.00

VISN 23

Cylinder Size M or H Refill (Primary or Emergency Backup System) HCPCS Code: E0431

1004A

Year 1: 06-01-2021 to 05-31-2022

1004B

Year 2: 06-01-2022 to 05-31-2023

1004C

Year 3: 06-01-2023 to 05-31-2024

1004D

Year 4: 06-01-2024 to 05-31-2025

1004E

Year 5: 06-01-2025 to 05-31-2026

0.00

VISN 23

Portable System for New Set-Ups, Consisting of Size E, D, C (M9), or B (M6) Size Cylinder with Regulator, Flow Meter, Handcart, Pouch, and Disposable Supplies HCPCS Code: N/A

1005A

Year 1: 06-01-2021 to 05-31-2022

1005B

Year 2: 06-01-2022 to 05-31-2023

1005C

Year 3: 06-01-2023 to 05-31-2024

1005D

Year 4: 06-01-2024 to 05-31-2025

1005E

Year 5: 06-01-2025 to 05-31-2026

0.00

VISN 23

Cylinder Size E Refill - Aluminum or Metal of Equivalent Weight Tank Required - For Item 1005 Above

1006A

Year 1: 06-01-2021 to 05-31-2022

1006B

Year 2: 06-01-2022 to 05-31-2023

1006C

Year 3: 06-01-2023 to 05-31-2024

1006D

Year 4: 06-01-2024 to 05-31-2025

1006E

Year 5: 06-01-2025 to 05-31-2026

0.00

VISN 23

Cylinder Size D Refill - Aluminum or Metal of Equivalent Weight Tank Required - For Item 1005 Above

1007A

Year 1: 06-01-2021 to 05-31-2022

1007B

Year 2: 06-01-2022 to 05-31-2023

1007C

Year 3: 06-01-2023 to 05-31-2024

1007D

Year 4: 06-01-2024 to 05-31-2025

1007E

Year 5: 06-01-2025 to 05-31-2026

0.00

VISN 23

Cylinder Size C Refill - Aluminum or Metal of Equivalent Weight Tank Required - For Item 1005 Above

1008A

Year 1: 06-01-2021 to 05-31-2022

1008B

Year 2: 06-01-2022 to 05-31-2023

1008C

Year 3: 06-01-2023 to 05-31-2024

1008D

Year 4: 06-01-2024 to 05-31-2025

1008E

Year 5: 06-01-2025 to 05-31-2026

0.00

VISN 23

Cylinder Size B (M6) Refill - Aluminum or Metal of Equivalent Weight Tank Required - For Item 1005 Above

1009A

Year 1: 06-01-2021 to 05-31-2022

1009B

Year 2: 06-01-2022 to 05-31-2023

1009C

Year 3: 06-01-2023 to 05-31-2024

1009D

Year 4: 06-01-2024 to 05-31-2025

1009E

Year 5: 06-01-2025 to 05-31-2026

0.00

VISN 23

Demand Nasal Cannula (e.g, Oximyzer) Reservoir or Pendant/Equivalent VA Code: VA111

1010A

Year 1: 06-01-2021 to 05-31-2022

1010B

Year 2: 06-01-2022 to 05-31-2023

1010C

Year 3: 06-01-2023 to 05-31-2024

1010D

Year 4: 06-01-2024 to 05-31-2025

1010E

Year 5: 06-01-2025 to 05-31-2026

0.00

VISN 23

Rental of Demand Pulse Conserver Device (No Less Than 5:1 Ratio or 60 ML/Pulse) VA Code: VA111

1011A

Year 1: 06-01-2021 to 05-31-2022

1011B

Year 2: 06-01-2022 to 05-31-2023

1011C

Year 3: 06-01-2023 to 05-31-2024

1011D

Year 4: 06-01-2024 to 05-31-2025

1011E

Year 5: 06-01-2025 to 05-31-2026

0.00

VISN 23

Rental of Size E Cylinder (Aluminum or Equivalent Weight Metal) Complete Portable System (Including Tank/Regulator) for Facility to Issue to VA Beneficiaries Who Deplete Portable Units During Appointments or To Send Home with New Start-Up (e.g, Discharged From Inpatient) VA Code: N/A

1012A

Year 1: 06-01-2021 to 05-31-2022

1012B

Year 2: 06-01-2022 to 05-31-2023

1012C

Year 3: 06-01-2023 to 05-31-2024

1012D

Year 4: 06-01-2024 to 05-31-2025

1012E

Year 5: 06-01-2025 to 05-31-2026

0.00

VISN 23

Rental of Liquid Oxygen System (90-100 lbs) With Stationary Reservoir Per Beneficiary HCPCS Code: E0439

1013A

Year 1: 06-01-2021 to 05-31-2022

1013B

Year 2: 06-01-2022 to 05-31-2023

1013C

Year 3: 06-01-2023 to 05-31-2024

1013D

Year 4: 06-01-2024 to 05-31-2025

1013E

Year 5: 06-01-2025 to 05-31-2026

0.00

VISN 23

Rental of PORTABLE Liquid Oxygen System Per Beneficiary HCPCS Code: E0434

1014A

Year 1: 06-01-2021 to 05-31-2022

1014B

Year 2: 06-01-2022 to 05-31-2023

1014C

Year 3: 06-01-2023 to 05-31-2024

1014D

Year 4: 06-01-2024 to 05-31-2025

1014E

Year 5: 06-01-2025 to 05-31-2026

0.00

VISN 23

Liquid Oxygen Per Pound for Item 1013 HCPCS Code: E0442

1015A

Year 1: 06-01-2021 to 05-31-2022

1015B

Year 2: 06-01-2022 to 05-31-2023

1015C

Year 3: 06-01-2023 to 05-31-2024

1015D

Year 4: 06-01-2024 to 05-31-2025

1015E

Year 5: 06-01-2025 to 05-31-2026

0.00

VISN 23

Delivery for Re-Supply And/Or Relocation of Equipment Due to Change in Beneficiary's Residence

1016A

Year 1: 06-01-2021 to 05-31-2022

1016B

Year 2: 06-01-2022 to 05-31-2023

1016C

Year 3: 06-01-2023 to 05-31-2024

1016D

Year 4: 06-01-2024 to 05-31-2025

1016E

Year 5: 06-01-2025 to 05-31-2026

0.00

VISN 23

Provide Portable, Lightweight (Weights Less Than 10 LBS) "Travel" Concentrator That Meets FAA Standards and Includes 6 Hour Battery Mininum (Will Include Two Batteries), Continuous or Pulse Dose (40 ML) Flow Option, Pulse Mode 1-5, 5LPM, and AC/DC Capacity for Short-Term Traveling Patients When Authorized by COR

1017A

Year 1: 06-01-2021 to 05-31-2022

1017B

Year 2: 06-01-2022 to 05-31-2023

1017C

Year 3: 06-01-2023 to 05-31-2024

1017D

Year 4: 06-01-2024 to 05-31-2025

1017E

Year 5: 06-01-2025 to 05-31-2026

0.00

VISN 23

Provide Portable (Weights Less Than 20 LBS) "Travel" Concentrator (Meets FAA Standards), 6 Hour Battery Minimum (Will Include Two Batteries), Continuous or Pulse Dose (40 ML) flow option, 5 LPM, AC/DC Capability, For Short Term Traveling Patients When Authorized by COR

1018A

Year 1: 06-01-2021 to 05-31-2022

1018B

Year 2: 06-01-2022 to 05-31-2023

1018C

Year 3: 06-01-2023 to 05-31-2024

1018D

Year 4: 06-01-2024 to 05-31-2025

1018E

Year 5: 06-01-2025 to 05-31-2026

0.00

VISN 23

Provide Additional Batteries As Needed for Portable "Travel" Concentrators For Items 1016 and 1017 Above HCPCS Code: E1356

1019A

Year 1: 06-01-2021 to 05-31-2022

1019B

Year 2: 06-01-2022 to 05-31-2023

1019C

Year 3: 06-01-2023 to 05-31-2024

1019D

Year 4: 06-01-2024 to 05-31-2025

1019E

Year 5: 06-01-2025 to 05-31-2026

0.00

VISN 23

Oxygen Cylinder Refill System (Meets FDA Standards), 5LPM, With Four Cylinders (Any Size), With Continuous Flow or Pulse Dose Capability HCPCS Code: K0738

1020A

Year 1: 06-01-2021 to 05-31-2022

1020B

Year 2: 06-01-2022 to 05-31-2023

1020C

Year 3: 06-01-2023 to 05-31-2024

1020D

Year 4: 06-01-2024 to 05-31-2025

1020E

Year 5: 06-01-2025 to 05-31-2026

0.00

VISN 23

Liquid Oxygen Portable Helio System

1021A

Year 1: 06-01-2021 to 05-31-2022

1021B

Year 2: 06-01-2022 to 05-31-2023

1021C

Year 3: 06-01-2023 to 05-31-2024

1021D

Year 4: 06-01-2024 to 05-31-2025

1021E

Year 5: 06-01-2025 to 05-31-2026

0.00

VISN 23

Replacement of One Fire Safety Valve and Tubing VA Code: VA186

1022A

Year 1: 06-01-2021 to 05-31-2022

1022B

Year 2: 06-01-2022 to 05-31-2023

1022C

Year 3: 06-01-2023 to 05-31-2024

1022D

Year 4: 06-01-2024 to 05-31-2025

1022E

Year 5: 06-01-2025 to 05-31-2026

ESTIMATED GRAND TOTAL

(ALL LINE ITEMS)

36C26321R0005

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B.3 PERFORMANCE WORK STATEMENT (PWS)

TITLE

Home Oxygen Services to support Veterans Integrated Service Network 23 (VISN 23)

GENERAL OVERVIEW

VISN 23 currently serves an estimated 5,000 oxygen-using VA beneficiaries. The contract shall be for the actual requirements of the Department of Veterans Affairs (VA) as ordered by the VA during the life of the contract. The Contracting Officer Representative (COR) or COR designee will provide the contractor with notification to initiate individual beneficiary service requirements, including the beneficiary’s oxygen prescription, equipment, supplies and services to be provided including date and place of delivery. The contractor shall confirm receipt of the request within two working hours of notification; the COR or COR designee shall also provide notification if VA owned equipment is provided; the COR or COR designee will also provide notification of VA initiated discontinuance of service. The notification may be made orally, but will be confirmed in writing within three working days. The written documents shall include the authorizing official’s signature.

Veterans with a prescription for an oxygen concentrator shall be provided with an appropriate backup system consisting of a compressed gas source and regulator with stand and/or wheeled cart, humidifiers, fire safe valves, cannulas/mask for use during the event of a power failure or mechanical problem and necessitating the use of the backup cylinder. The cost for the above-mentioned backup system shall be borne by the Contractor. The cost of replacement of equipment damaged, lost or misplaced not through beneficiary’s negligence shall be borne by the Contractor. Documentation is required if the VA beneficiary declines the oxygen back-up system.

Definitions

· “Annually” refers to once per year

· The term “Beneficiary” and “Patient” are used interchangeably through this PWS and means Veteran being serviced home oxygen at their residence within the VISN 23 service areas.

· “Biannually” refers to two times a calendar year

· “Business Day” refers to days during workweek (Mondays to Fridays, excluding weekends and Federal holidays)

· “Calendar Day” refers to days including weekends and Federal Holidays (Monday to Sunday)

· “Healthcare Common Procedure Coding System (HCPCS)” is a standardized code system necessary for medical providers to submit healthcare claims to Medicare and other health insurances in a consistent and orderly manner. Home Oxygen is typically billed to Medicare first before VA pays full or remaining amount for each VA beneficiary.

· “Quarterly” refer to every three months

· “Weekly” refers to every 7 days

Applicable Documents

Copies of Joint Commission, VA Directives, and National Fire Protection Association standards mentioned throughout PWS are available to Contractor upon request to COR or COR designee. Offerors may requests copies of these documents prior to submitting an offer by requesting this from the CO.

PLACE OF PERFORMANCE

Place of performance is defined as residence of Veteran beneficiaries located within the service areas of the following VISN 23 facilities:

Fargo, ND 58102

Iowa City, IA 52246-2208

Minneapolis, MN 55417

Sioux Falls, SD 57117

Saint Cloud, MN 56303

Fort Meade, SD 57741

Hot Springs, SD 57747

Des Moines, IA 50310

Omaha, NE 68105

PERIOD OF PERFORMANCE

A single award Indefinite Delivery, Indefinite Quantity (IDIQ) contract will be awarded for period of performance of 06-01-2021 to 05-31-2026.

Services will be contracted through the issuance of individual purchase card orders against IDIQ Contract each year of the ordering period:

Issuance of individual purchase card orders during ordering period will be made at Government’s discretion based on continued need for services, Contractor performance, and availability of funds in a given fiscal year.

SCOPE OF WORK

1. In accordance with the prescription received from the VA health care system (HCS), the contractor shall provide the beneficiary with the following items:

a. Humidifiers and water traps when deemed necessary. The amount of humidifier and supplies shall be sufficient to ensure that they are not depleted between re-supply visits. The number of traps shall be based on the patient’s flow rate.

b. Disposable oxygen cannulas on hand for a change every week with a supply in reserve at all times until the contractors next scheduled visit.

c. Disposable oxygen masks for change/wash every week with a supply in reserve at all times (when masks are prescribed in lieu of nasal cannulas).

d. Oxygen connecting tubing shall be replaced every three months with an equivalent section of tubing in reserve at all times (to be included in initial setup) until the contractors next scheduled visit.

e. Trach Collar and accessories (e.g. tubing and large volume nebulizer) with a supply on hand allowing for change every three days and a supply in reserve at all times until the contractors next scheduled visit.

f. Safety holders/cylinder racks shall be provided at no charge for all Veterans with cylinders. The safety holder/cylinder racks must have sufficient space to hold all spare cylinders.

g. Two fire safety valves and cannula tubing shall be provided with each concentrator set up and replaced annually. Two fire safe valves shall be provided for backup systems and/or portable tanks provided to VA beneficiaries.

h. Oxy ears or similar ear protection shall be provided to VA beneficiaries upon request.

i. Two continuous flow regulator will be provided for each patient, one primary and one backup.

j. Home oxygen and home oxygen tank being prescribed.

2. Initial set-ups are considered as those beneficiaries who have not been provided an oxygen therapy delivery system in the residence on a previous occasion or have not used such a system continuously for the past 60 days. Initial set-up includes delivery, set-up, and initial education of equipment to the Veteran beneficiary. Switch-outs are considered those beneficiaries who are presently using an oxygen delivery system or have used such a system continuously within the past 60 days.

3. North Dakota Requirement for Initial Set-Ups: State of North Dakota law requires initial setup(s) to be established by a licensed respiratory therapist. Contractor shall comply with this requirement.

4. The Contractor shall provide the initial set-up within 24 hours of request from the COR or designee, to include weekends and holidays; this shall also apply to service calls. If the Contractor is unable to meet the 24-hour response time, the VA reserves the right to obtain the service from another source and to charge the contractor with any excess cost which may result therefrom.

5. The Contractor shall provide switch-outs by staff with documented competency training on the manufacturers recommended assembly, use, and maintenance of the equipment used under this contract. “Switch outs” refer to exchanging equipment.

6. Emergency Services

a. Emergency services are for medical equipment provided to VA beneficiaries when an equipment malfunction or natural disaster may threaten a patient’s health. The contractor shall have a well-established communication system as well as a disaster and emergency preparedness plan, providing 24-hour emergency services and the ability to provide services at the VA beneficiary’s home within a maximum of 2 hours of a call.

b. The Contractor shall ensure all VA beneficiaries have a minimum oxygen supply. The minimum supply will take into account each patient’s prescription flowrate and distance from the contractor’s location, and so actual supply levels may differ from patient to patient, as long as each patient has oxygen supply to last a minimum of three times the contractors’ response time. If the Contractor is unable to respond to an emergency service call within 2 hours, the Contractor is responsible for making arrangements with another supplier to provide oxygen at the Contractor’s expense. A verbal notification to COR or COR designee shall be provided on same business day of this. A written explanation of why the Contractor was unable to respond to the emergency must be provided to the COR or designee within 2 business days. The cost of backup systems, backup oxygen, and backup equipment shall be borne by the Contractor. If H/M tanks are used for backup, the Contractor shall furnish an H/M tank stand for each H/M tank at no cost to the government. Liquid oxygen supply may be considered backup oxygen; however the oxygen supply must be maintained at the minimum three-times the Contractor’s response time, and the cost of any additional equipment such as extra stationary units used solely to maintain the minimum level of backup oxygen shall be borne by the Contractor. The cost of liquid oxygen used solely for backup purposes shall be borne by the Contractor.

c. The Contractor must notify the COR or designee immediately in the event of a disaster, natural or otherwise, that may affect the services covered under this contract.

7. The Contractor shall provide and post on all entrances into the residence, a sign stating "Warning Oxygen in Use, No Smoking" or other verbiage that NO Smoking is allowed due to oxygen being present and document that the beneficiary/care giver is instructed in the safe use of oxygen and equipment per U.S. Occupational Safety & Health Administration (OSHA). VA beneficiaries shall sign a statement about the safe use of oxygen and equipment during their use of the equipment. Re-education on oxygen safety rules, and proper use of oxygen equipment shall be completed and documented during each quarterly follow-up visit by the contractor.

8. Reports

The Contractor shall provide a written, quarterly report (Periodic Performance Review) meeting all Joint Commission standards for improving organizational performance (The Joint Commission standards may be accessed at www.Joint Commission.org). Annually, contractor will submit to the COR their Periodic Performance Review for contracted services within 90 days of the end of each Year. Contractor shall assess and score each Joint Commission standard and element of performance that is applicable to the contracted services by entering a self-assessed score. Any noncompliant findings or gaps in service identified on the self-assessment shall require a plan of action to correct as part of the Periodic Performance Review submitted to the COR. Periodic Performance Review for home care is based upon Joint Commission’s home care standards that can be accessed at www.Joint Commission.org. This can also be made available by COR upon Contractor’s request.

Such report shall include:

a. Incident Report – Reporting special incidents found or occurring during a home visit, to include finding patients in need of emergency medical assistance, evidence of home oxygen fires or fires unrelated to the VA beneficiaries oxygen delivery system, safety hazards that do not fall into the category of presenting immediate life-threatening danger to the patient or Contractors staff, inability to contact a patient within a reasonable period of time, and any other incident meeting the Contractors written policy for incident reporting according to accreditation standards.

b. Customer Satisfaction - In accordance with Joint Commission standards the contractor shall collect data on service satisfaction from contracted patients and their families from each facility on a quarterly basis. A copy of survey results shall be submitted to COR’s or designee in Quarterly reports.

c. Infection Control/Communicable Diseases/Hand Hygiene Monitoring – Report will include data related to the Contractor’s ongoing Infection Control Program.

d. Delivery Ticket/Billing Audit Report – The contractor shall provide a report providing information auditing the VA order with the delivery ticket and home O2 billing. This report will be provided to the VA on a quarterly basis.

e. Performance improvement – The contractor shall collect data on performance improvement projects and important processes and outcomes related to patient care and organizational functions. These reports/projects shall be provided to the VA on a quarterly basis.

9. The Contractor shall provide the following emergent patient safety reports throughout the contract period, initial notification will be within one business day of when the contractor is aware of the event or issues, with follow-up official report via e-mail to COR or COR designee within 5 business days unless specified below:

a. Sentinel Events - The contractor is required to inform the Home Oxygen personnel of a sentinel event (as defined by Joint Commission as being patient safety event that results in death, permanent harm, or severe temporary harm) that occurs during the performance of this contract that involves VA beneficiaries.

b. Refusal of service - All beneficiaries have the right of refusal of service. In the event a beneficiary refuses service or orders the equipment to be removed from the home, the Contractor shall comply with the beneficiary’s wishes. If the refusal occurs during a home visit, the Contractor’s staff shall make an attempt to notify the COR or COR designee of the refusal during the home visit. If a VA beneficiary refuses services, the contractor shall be required to obtain a client refusal of service or AMA form.

c. The contractor shall report suspected incidents of abuse or neglect to the patient by family members or caregivers. Suspected incidents shall be reported to the COR or COR designee, as well as to the adult protective agency. The contractor shall follow all state, federal and local laws in reporting suspected incidents of abuse or neglect.

d. The contractor shall report non-compliant behavior with fire safety guidelines set forth in the patient education and re-assessment material and/or behaviors which pose a risk of self-harm or harm to others to the Home Oxygen Coordinator or designee during the home visit if the contractor’s staff determines the beneficiary’s non-compliant behavior, within the home environment, is not improving after education on the fire hazard of smoking or other hazardous activities when oxygen is in use. Noncompliant behavior and any follow-up actions (e.g. educations) will be documented and reported to the applicable VA Medical Center (VAMC) in the Veteran beneficiaries’ service area.

10. The Contractor is responsible for notifying the COR or COR designee by telephone at the time of set–up if any alteration to the VA beneficiary’s home is necessary to accommodate the oxygen equipment, including electrical work. If the VA beneficiary’s home electrical system is not sufficient, the Contractor and COR or their designee will facilitate an alternative oxygen system.

11. The Contractor makes every effort to establish appointments with VA beneficiaries when initiating set ups and deliveries. Deliveries will not be left unattended at the beneficiary’s home unless other arrangements have been made. If the VA beneficiary chronically fails to meet appointments, the Contractor is to notify the COR or COR designee. The COR or COR designee shall contact the VA beneficiary and a corrective action plan will be implemented; the COR will notify the Contractor of any changes. If the Contractor has not made valid and documented attempts to contact the VA beneficiaries for set ups and or deliveries the Government reserves the right to call in a third party and bill the Contractor if the Contractor fails to perform for any due month.

12. Infection Control/Communicable Diseases Requirements

a. Contractor must have a current plan for surveillance, prevention and control of infection. The plan must meet current Joint Commission standards. This plan should also include special infection control procedures for pandemics such as COVID-19 and also discuss cleaning protocols for equipment, and wearing of personal protective equipment by Contractors when entering Veteran residences.

b. The contractor shall have a well-defined system for tracking and reporting appropriate hand hygiene practices by their staff when entering the home.

c. Contractor shall provide a list of names to the Home Oxygen Coordinator or designee of all veteran patients exposed to communicable diseases by contracted staff during an identified incubation period. The type of exposure will also be identified.

d. The Home Oxygen Coordinator or designee will consult with VA infection control staff regarding the need to contact exposed patients and/or complete any needed medical follow-up and appropriate disclosures.

13. Assessment Requirements

The Contractor shall perform an assessment of the beneficiary’s home and environment in accordance with Joint Commission accreditation standards and maintain documentation of assessments in the individual patient file or folder.

a. The Contractor shall notify the COR or COR designee or prescribing physician during the home visit if the Contractor’s staff determines that the presence of oxygen in the home presents such a danger that the oxygen must be removed, or in the case of an initial set-up, not placed in the home. Unsafe conditions may include, but are not limited to, fire safety hazards, oxygen safety hazards, patient abuse by family or caregivers, or any instance that places the patient or Contractor’s staff in immediate danger. The Contractor shall provide verbal communication within 24 hours of the incident and provide a written report within three business days.

b. The Contractor shall document and report, verbal communication within 24 hours of the incident and provide a written report within three (3) business days, to the VA Home Oxygen Coordinator or COR any patient who is non-compliant with safety guidelines set forth in the education and orientation material and/or whose behavior poses a risk of self-harm or harm to others (e.g. smoking while on oxygen) despite warnings and ongoing educational interventions.

c. The Contractor shall check the adequacy of the electrical outlets in the patient’s home and immediately report unsafe conditions to the COR or COR designee. VA shall not be responsible or liable for any unsafe electrical conditions caused by the Contractor. Any alterations to the veteran’s residence will be the responsibility of the veteran. If ordered equipment cannot be safely installed, the COR or COR designee may provide an alternative oxygen delivery system after approval until new prescription can be obtained. If no alternative is available, the prescribing VA physician will be notified.

d. The Contractor shall verify the presence of smoke alarms and encourage the patient to test all smoke alarms on a monthly basis. In any home where smoke alarms are not present, the contractor will encourage the patient to obtain a smoke alarm and notify the appropriate VA clinical staff (e.g. VA Home Oxygen Coordinator) for further review and potential action. The contractor shall document a smoke alarm is not present and provide the documentation to the VAMC within three business days.

14. Discontinuation of Service

a. The COR or COR designee shall notify the Contractor in the event of an order to discontinue oxygen service to any beneficiary covered under this contract. Notification shall be by telephone, e-mail, or fax. Payment shall be pro-rated based upon the notification date of discontinuance of service. The Contractor shall notify the COR or COR designee by the next business day of a patient death, or upon finding a patient has moved out of the service area.

b. The Contractor shall remove equipment from the beneficiary’s residence at the earliest possible time but no later than five business days, unless longer period is pre-approved by the COR or COR designee. The date and time of equipment pickup shall be coordinated with the patient and/or next of kin and/or significant other. The Contractor shall make every effort to meet the beneficiary’s or beneficiary’s families’ requests for pickup times. The Contractor shall honor beneficiary’s or family’s requests to pickup equipment before or after funerals or family gatherings relative to beneficiary funerals. The Contractor shall treat such requests with the utmost courtesy, and give such requests the highest priority.

15. Employee Certification

a. The Contractor shall develop, maintain, and make available for review, personnel files on all employees performing under this contract.

b. Contractor shall provide and document employee orientation, ongoing employee education, and ongoing assessment of employee competency for all employees involved with the delivery/recovery of equipment covered under this contract according to Joint Commission standards.

c. The Contractor shall provide COR or COR designee with a list of all employees currently competent to perform delivery/recovery and patient education services at the time the contract is awarded. COR or COR designee will inspect employee files at the time of the inspection of Contractor premises and vehicles. The contractor shall also provide any applicable state licensure or credentials for respiratory therapists providing service under this contract.

d. The Contractor shall educate, evaluate and document employee education in strict accordance with current Joint Commission accreditation standards.

e. Only employees that have been properly trained and who have demonstrated competency may perform equipment deliveries, recoveries, and patient education on the equipment, and oxygen safety.

f. The Contractor shall be staffed and have sufficient supplies to render satisfactory and courteous service at all times to the beneficiary. The contractor shall be responsible for the acts and omissions of his/her employees, his/her subcontractors or satellite offices and their employees. Subcontractors are required to adhere to all requirements of this contract.

16. Contractor-Owned Concentrators: The Contractor shall furnish, install and service all oxygen equipment to dispense oxygen and supplies ordered under this contract. All equipment is to be current state-of-art model and all supplies are to be new. A label with the contractor’s name and emergency telephone number where they can be reached 24 hours/day shall be affixed to all equipment.

Standards and guidelines are as follows; copies of these standards and guidelines are available from COR or COR designee at Contractor request:

· The American Respiratory Care Foundations for Respiratory Equipment Used in the Home.

· Association for the Advancement of Medical Instrumentation (AAMI).

· Joint Commission Standard for Home Care, current year standard.

17. The installation of all machines and equipment by the Contractor shall be performed by their competent employee familiar with the nature of the equipment involved and fully qualified under the laws of the State in which the services are being rendered. Installation shall be consistent with local Fire and Safety Codes in the respective area of the State and shall conform to National Fire Protection Association (NFPA) 99 (Life Safety Codes)/101(Oxygen Cylinder Requirements). The Contractor shall provide a safety/emergency checklist to be completed, then signed by the veteran beneficiary or his/her caregiver and retained in the beneficiary account folder. The Contractor shall ensure that all equipment is checked at manufacturer recommended intervals. A Contractor’s staff member will conduct a check of the concentrator using a certified oxygen analyzer that is calibrated according to the manufacturer standards. Maintenance on equipment shall be done by a manufacturer’s checklist. It shall include compressor inlet pre-filter changes and compressor inlet bacteria filter changes according to the manufacturer recommendations. The alarm battery shall be tested at each maintenance check, changed as indicated but at least annually. The Contractor is responsible for tracking and documenting maintenance of equipment in accordance with manufacturer specifications and providing these records for review upon request. Contractor shall furnish parts and labor for routine maintenance. The Contractor shall have recall procedures and serial number tracking for equipment and supplies.

18. The Contractor shall not change or alter a VA beneficiary’s oxygen prescription or equipment requirements without a new prescription from the beneficiary’s VA provider.

19. Transition Period: At the end of the contract period of performance, a transition period shall be required during which incumbent contractor will continue to provide services at the contract prices while the incoming Contractor is assuming services.

The incumbent contractor agrees to

(1) Furnish phase-in training; and

(2) Exercise its best efforts and cooperation to effect an orderly and efficient transition to a successor.

Incumbent contractor shall, upon the Contracting Officer’s written notice, furnish phase-in/phase-out services for up to 90 days after this contract expires and negotiate in good faith a plan with a successor to determine the nature and extent of phase-in, phase-out services required.

The plan shall specify a training program and a date for transferring responsibilities for each division of work described in the plan and shall be subject to the Contracting Officer’s approval.

Incumbent contractor shall provide sufficient experienced personnel during the phase-in, phase-out period to ensure that the services called for by this contract are maintained at the required level of proficiency.

Incumbent contractor shall allow as many personnel as practicable to remain on the job to help the successor maintain the continuity and consistency of the services required by this contract. The Contractor also shall disclose necessary personnel records and allow the successor to conduct on-site interviews with these employees. If selected employees are agreeable to the change, the Contractor shall release them at a mutually agreeable date and negotiate transfer of their earned fringe benefits to the successor.

20. Equipment Specifications The oxygen concentrators shall be Underwriter Laboratory (UL) approved and must at a minimum meet the following specifications:

a. Electrically powered (115 volts).

b. There shall be a battery-operated audible alarm to indicate a power failure.

c. The oxygen concentrator shall not perform below the manufacturer’s specification.

d. Hour meter and OCI indicator must be present and…