36C26323Q0613.pdf

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. UEI:

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

36C26323Q0613

Matthew Rose 651-293-3010

36C263 Department of Veterans Affairs

NETWORK 23 CONTRACTING OFFICE

316 Robert Street N. STE. 506 St. Paul MN 55101

X 100

X

621340

$12.5 million

X

N/A

X

36C636

Department of Veterans Affairs Nebraska-Western Iowa VA Health Care

4101 Woolworth Avenue Omaha, NE 68105

Y

Department of Veterans Affairs Financial Services Center PO Box 149971

Austin TX 78714-9971

See CONTINUATION Page

This is a small business set-aside solicitation for wheelchair seating rehabilitative and related services for the Nebraska- Western Iowa VA Health Care System. Services will be provided on-site at VA facilities in Lincoln, NE, Grand Island, NE, and Omaha, NE.

Services to begin on 01 August 2023 and last for five years.

See B.2 for schedule, B.3 for performance work statement.

See E.6 for detailed proposal evaluation criteria and proposal submission instructions.

See CONTINUATION Page

X 1

Matthew Rose Contracting Officer

03 May 2023

05 June 2023

8AM CDT

See Block 9

36C26323Q0613

Table of Contents

Section B - Continuation of SF 1449 Blocks

B.1 Contract Administration Data B.2 Schedule of Services B.3 Performance Work Statement (PWS) B.3.1 PWS Addendum: VHA Supplemental Contract Requirements for Combatting COVID-19 B.4 Records Management Obligations (NARA Language)

Section C - Contract Clauses

C.1 52.212-4 Contract Terms and Conditions—Commercial Products and Commercial Services (Dec 2022) C.2 52.204-21 Basic Safeguarding of Covered Contractor Information Systems (Nov 2021) C.3 52.216-18 Ordering (Aug 2020) C.4 52.216-19 Order Limitations (Oct 1995) C.5 52.216-22 Indefinite Quantity (Oct 1995) C.6 52.217-8 Option to Extend Services (Nov 1999) C.7 VAAR 852.237-72 Crime Control Act—Reporting of Child Abuse (Oct 2019) C.8 VAAR 852.204-71 Information and Information Systems Security (Feb 2023) C.9 52.252-2 Clauses Incorporated by Reference (Feb 1998) C.10 52.212-5 Contract Terms and Conditions Required to Implement Statutes or Executive Orders—Commercial Products and Commercial Services (Mar 2023)

Section D - Contract Documents, Exhibits, Or Attachments

Section E - Solicitation Provisions

E.1 52.212-1 Instructions to Offerors—Commercial Products and Commercial Services (Mar 2023) E.2 Proposal Submission Instructions E.3 52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment (Nov 2021) E.4 52.252-1 Solicitation Provisions Incorporated by Reference (Feb 1998) E.5 852.252-7 Evaluation- Health Care Resources (Nov 2021) E.6 Instructions to Offerors E.7 Evaluation of Option to Extend Under FAR 52.217-8 E.8 52.212-3 Offeror Representations and Certifications—Commercial Products and Commercial Services (Dec 2022) .. 59

B.1 Contract Administration Data | NWI Wheelchair Seating Services | 36C26323Q0613

Section B - Continuation of SF 1449 Blocks

B.1 Contract Administration Data Under the authority of 38 USC 8153 and FAR Part 13, the Contractor agrees to provide Health Care Resources in accordance with the terms and conditions stated herein, to furnish to and at the Nebraska-Western Iowa VA Health Care System (NWIVAHCS), the services and prices specified in the Sections B.2 (Schedule) and B.3

(PWS).

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

Contractor: Government:

Contracting Officer:

Matthew Rose, NCO 23 316 N. Robert St. STE 506 St. Paul MN 55101 651-293-3010 Matthew.Rose3@va.gov

2. Contractor and Government points of contact can be changed by written notification to the other party.

Notification will be placed in the Contract file and will not require a modification to the Contract.

3. Contractor Remittance Address: All payments by the Government to the Contractor will be made in accordance with FAR 52.232-33, Payment by Electronic Funds Transfer – System for Award Management, and VAAR 852.232-72, Electronic Submission of Payment Requests.

4. Availability of Funds: The Contractor shall perform no service until funding is provided for the applicable performance period and the Contracting Officer authorizes such services in writing.

5. Invoices: Invoices shall be submitted monthly in arrears. The Contracting Officer’s Representative (COR) will review all invoices submitted. The COR is responsible for certifying invoices for payment for only those services received and deemed acceptable by VA. Once certified by the COR, payment can be made via the Tungsten Network.

6. Billing Instructions: See Performance Work Statement (PWS) Section 7.2 for billing instructions.

7. Amendments: Contractor acknowledges receipt of solicitation amendments listed below:

Amendment Number Date Issued None currently N/A mailto:Matthew.Rose3@va.gov

B.2 Schedule | NWI Wheelchair Seating Services | 36C26323Q0613

B.2 Schedule of Services Place of Performance: Services shall be provided on site at NWI’s sites in Lincoln, Omaha, and Grand Island (See PWS at 1.3.1).

Pricing Instructions: This solicitation covers five Ordering Periods (OP). hours for each OP are estimated.

For each OP: List your proposed hourly rate as well as your proposed total estimated price for all three sites by filling that information in the yellow boxes. Provide a total estimated price for each OP by adding the totals for each site together and filling in the bottom yellow box for that OP.

Finally, provide an estimated grand total below the OP5 schedule.

Note: proposed hourly rate is all-inclusive (transportation, mileage, training, supplies/equipment, any other Contractor expenditures needed to successfully provide the services as described in the B.3 PWS).

Ordering Procedures: The Contracting Officer (CO) will issue a task order at the beginning of each OP.

This will provide funding for the year and list a purchase order number that Contractor will reference when invoicing for that OP.

CO will send a modification to Contractor at the end of each OP to remove any unspent funding at the end of that OP. CO will also add additional funding as needed to OPs as needed and so long is total number of hours on the contract does not exceed the maximum contract value listed under the schedule for OP5.

NWI Wheelchair Seating Services Schedule Ordering Period 1: 01 August 2023 to 31 July 2024

LIN

Sub LIN Description / Location Est.

Qty. Unit Unit Price Total Price

0001 None Wheelchair Seating Services (total of all three Sub-LINs below) 288 Hours DO NOT

PRICE

DO NOT

PRICE

None 0001a

Assistive Technology Professional (ATP) Services

VANWIHCS, Omaha Division

144 Hours

None 0001b

Assistive Technology Professional (ATP) Services

VANWIHCS, Lincoln Division

72 Hours

None 0001c

Assistive Technology Professional (ATP) Services

VANWIHCS, Grand Island Division

72 Hours

Ordering Period 1 Estimated Total 288 Hours

NWI Wheelchair Seating Services Schedule Ordering Period 2: 01 August 2024 to 31 July 2025

LIN

Sub LIN Description / Location Est.

Qty. Unit Unit Price Total Price

1001 None Wheelchair Seating Services (total of all three Sub-LINs below) 288 Hours DO NOT

PRICE

DO NOT

PRICE

None 1001a

Assistive Technology Professional (ATP) Services

VANWIHCS, Omaha Division

144 Hours

None 1001b

Assistive Technology Professional (ATP) Services

VANWIHCS, Lincoln Division

72 Hours

None 1001c

Assistive Technology Professional (ATP) Services

VANWIHCS, Grand Island Division

72 Hours

Ordering Period 2 Estimated Total 288 Hours

NWI Wheelchair Seating Services Schedule Ordering Period 3: 01 August 2025 to 31 July 2026

LIN

Sub LIN Description / Location Est.

Qty. Unit Unit Price Total Price

2001 None Wheelchair Seating Services (total of all three Sub-LINs below) 288 Hours DO NOT

PRICE

DO NOT

PRICE

None 2001a

Assistive Technology Professional (ATP) Services

VANWIHCS, Omaha Division

144 Hours

None 2001b

Assistive Technology Professional (ATP) Services

VANWIHCS, Lincoln Division

72 Hours

None 2001c

Assistive Technology Professional (ATP) Services

VANWIHCS, Grand Island Division

72 Hours

Ordering Period 3 Estimated Total 288 Hours

NWI Wheelchair Seating Services Schedule Ordering Period 4: 01 August 2026 to 31 July 2027

LIN

Sub LIN Description / Location Est.

Qty. Unit Unit Price Total Price

3001 None Wheelchair Seating Services (total of all three Sub-LINs below) 288 Hours DO NOT

PRICE

DO NOT

PRICE

None 3001a

Assistive Technology Professional (ATP) Services

VANWIHCS, Omaha Division

144 Hours

None 3001b

Assistive Technology Professional (ATP) Services

VANWIHCS, Lincoln Division

72 Hours

None 3001c

Assistive Technology Professional (ATP) Services

VANWIHCS, Grand Island Division

72 Hours

Ordering Period 4 Estimated Total 288 Hours

NWI Wheelchair Seating Services Schedule Ordering Period 5: 01 August 2027 to 31 July 2028

LIN

Sub LIN Description / Location Est.

Qty. Unit Unit Price Total Price

4001 None Wheelchair Seating Services (total of all three Sub-LINs below) 288 Hours DO NOT

PRICE

DO NOT

PRICE

None 4001a

Assistive Technology Professional (ATP) Services

VANWIHCS, Omaha Division

144 Hours

None 4001b

Assistive Technology Professional (ATP) Services

VANWIHCS, Lincoln Division

72 Hours

None 4001c

Assistive Technology Professional (ATP) Services

VANWIHCS, Grand Island Division

72 Hours

Ordering Period 5 Estimated Total 288 Hours

Estimated Total for all Ordering Periods: $_____________________

Minimum guarantee: 100 hours Contract maximum value: 1800 hours

B.3 Performance Work Statement | NWI Wheelchair Seating Services | 36C26323Q0613

B.3 Performance Work Statement (PWS)

1. GENERAL

1.1. Services Provided: The Contractor shall provide all necessary equipment, supplies, and professional labor, etc., consisting of a certified Assistive Technology Professional (ATP), or higher, to perform the following Wheelchair Seating requirements for the VA Nebraska- Western Iowa Health Care System (NWIHCS) located in Omaha, Lincoln, and Grand Island, Nebraska. Direct and indirect patient interaction will occur as services are provided to the beneficiaries of the VA NWIHCS See paragraph 3.2 for clinic hours/locations.

1.2. The VA shall provide all wheelchair equipment, motorized or non-motorized, at VA expense.

1.3. Place of Performance: Services to be performed on-site and will be in accordance with the requirements contained in this performance work statement (PWS).

1.3.1. On-Site Locations:

1.3.1.1. VA Nebraska Western Iowa Health Care System – Omaha Division

4101 Woolworth Avenue Omaha, NE 68105

1.3.1.2. VA Nebraska Western Iowa Health Care System – Lincoln Division 301 Centennial Mall South, 4th Floor PO Box 95083 Lincoln, NE 68509-5083

1.3.1.3. VA Nebraska Western Iowa Health Care System – Grand Island Division 2201 North Broadwell Avenue Grand Island, NE 68803

1.4. Definitions/Acronyms - Terms used in this contract shall be interpreted as follows unless the context expressly requires a different construction and/or interpretation. In case of a conflict in language between the Definitions and other sections of this contract, the language in this section shall govern.

1.4.1. ATP: Assistive Technology Professional

1.4.2. Contracting Officer (CO): The person executing this contract on behalf of the

Government with the authority to enter into and administer contracts and make related determinations and findings.

1.4.3. Contracting Officer’s Representative (COR): A person appointed by the CO to take necessary action to ensure the Contractor performs in accordance with and adheres to the specifications contained in the contract and to protect the interest of the Government. The COR shall report to the CO promptly any indication of non-compliance in order that appropriate action can be taken.

1.4.4. COS: Chief of Staff

1.4.5. CPARS: Contractor Performance Assessment Reporting System

1.4.6. HIPAA: Health Insurance Portability and Accountability Act

1.4.7. ISO: Information Security Officer

1.4.8. Non-Contract Personnel: any person, organization, agency, or entity that is not directly or indirectly employed by the Contractor or any of its subcontractors

1.4.9. POP: Period of Performance

1.4.10. PWS: Performance Work Statement

1.4.11. QASP: Quality Assurance Surveillance Plan

1.4.12. Reptrax: Vendor Access System for Vendors

1.4.13. RESNA: Rehabilitation Engineering & Assistive Technology Society of North

America

1.4.14. TJC: The Joint Commission

1.4.15. Veterans’ Health Administration (VHA): The central office for administration of the

VA medical centers through throughout the United States. The VHA is located in Washington, D.C.

1.4.16. Veterans Integrated Services Network (VISN): The regional oversight for the VA medical centers is the VISN office. The VISN office for VA NWIHCS is located in Egan, Minnesota.

1.4.17. Veterans Affairs Medical Center (VAMC): Unless identified with the name of a different VA Medical Center, for purposes of this contract, this term shall mean the VA Nebraska-Western Iowa Health Care System.

1.4.18. Veterans’ Health Care System (VAHCS): Unless identified with the name of a different VA Health Care System, for purposes of this contract, this term shall mean the VA Nebraska-Western Iowa Health Care System.

2. QUALIFICATIONS

2.1. Staff/Facility

2.1.1. Assistive Technology Professional (ATP) or higher

2.1.1.1. The ATP shall be Rehabilitation Engineering and Assistive Technology

Society of North America (RESNA) certified https://www.resna.org. The qualification of personnel shall also be subject to review by the Contracting Officer Representative and approved by the Contracting Officer.

2.1.1.2. The ATP shall have extensive experience in evaluating and fitting of all motorized and non-motorized wheelchairs.

2.1.1.3. The ATP shall serve as a subject matter expert and provide consultative services for multiple product lines of wheelchair and seating systems.

2.1.2. Technical Proficiency: Contractor’s employee(s) shall be technically proficient in the skills necessary to fulfill the government’s requirements, including the ability to speak, understand, read and write English fluently. Contractor shall provide documents upon request of the CO/COR to verify current and ongoing competency, skills, certification and/or licensure related to the provision of care, treatment and/or services performed.

2.1.3. Training: Contractor shall meet all VA educational requirements and mandatory course requirements defined herein; all training must be completed by the contractor employee(s) as required by the VA. Failure to complete the mandatory annual training, within the timeframe required, is grounds for suspension or termination of all physical or electronic access privileges and removal from work on the contract until such time as the training and documents are complete. Additional training requirements may be added at the discretion of the Government. Training requirements may include, but not be limited to, the following:

• VHA Privacy and HIPAA Focused Training

• Reptrax - www.reptrax.com https://www.resna.org/ http://www.reptrax.com/

Training for Assistive Technology Professional (ATP) – Wheel-Chair Seating Services Frequency Annual Hours

VHA Privacy and HIPAA Focused Training Annual - TMS Item #20152 2

Reptrax Annual 2

2.1.3.1. Note: Contractor staff shall not have access to VA Computerized Patient Record System (CPRS) or VA Network.

2.1.4. Standard Personnel Testing (PPD, etc.): Contractor shall provide proof of the following tests for Contract employee(s) within five (5) calendar days after contract award and prior to the first duty shift to the COR and Contracting Officer. Tests shall be current within the past year.

2.1.4.1. TUBERCULOSIS TESTING: Contractor shall provide proof of a negative

Tuberculosis Skin Test (TST) or interferon-gamma release assays (IGRA) for all contract employee(s) upon hire in accordance with CDC guidance. A negative chest radiographic report for active tuberculosis shall be provided in cases of positive TST or IGRA results. The PPD test shall be repeated annually.

2.1.4.2. MEASLES, MUMPS, & RUBELLA TESTING: Contractor shall provide proof of immunization for all contract employee(s) for measles, mumps, rubella or a rubella titer of 1.8 or greater. If the titer is less than 1.8, a rubella immunization shall be administered with follow-up documentation to the

COR.

2.1.4.3. INFLUENZA: Contractors shall provide proof that all Contractor employee(s) have received the annual Influenza vaccine unless it is contraindicated. If the Contractor employee(s) has a medical contraindication to the vaccine, they shall be required to wear a mask during the Influenza season. {This is applicable to all health care workers}.

2.1.4.4. COVID-19: Contractors shall comply with VHA Supplemental Contract

Requirements for Combatting COVID-19 {This is applicable to all health care workers} (Attachment D.2).

2.1.4.5. OSHA REGULATION CONCERNING OCCUPATIONAL EXPOSURE

TO BLOODBORNE PATHOGENS: Contractor shall provide evidence of completing and passing generic self-study blood-borne pathogen training for all Contractor’s employee(s). {This is applicable to all health care workers};

provide their own hepatitis B vaccination series and hepatitis B surface antigen test results following the hepatitis B vaccination series; maintain an exposure determination and control plan; maintain required records; and ensure that proper follow-up evaluation is provided following an exposure incident.

2.1.4.6. The VA NWIHCS shall notify the Contractor of any significant communicable disease exposures as appropriate. Contractor shall adhere to current CDC/HICPAC Guideline for Infection Control in health care personnel as published in American Journal for Infection Control- AJIC 1998; 26:289-354 http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf) for http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf disease control. Contractor shall provide follow up documentation of clearance to return to the workplace prior to their return.

2.1.4.7. Conflict of Interest: The Contractor and all contractor’s employee(s) are responsible for identifying and communicating to the CO and COR conflicts of interest at the time of proposal and during the entirety of contract performance. At the time of proposal, the Contractor shall provide a statement which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided. The Contractor shall also provide statements containing the same information for any identified consultants or subcontractors who shall provide services. The Contractor shall also provide relevant facts that show how it’s organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest. These statements shall be in response to the VAAR provision 852.209-70 Organizational Conflicts of Interest and fully outlined in response to the subject attachment in Section D (Attachment D.3) of the solicitation document.

2.1.5. Citizenship related Requirements

2.1.5.1. The Contractor certifies that the Contractor shall comply with any and all legal provisions contained within the Immigration and Nationality Act of 1952, as amended; its related laws and regulations that are enforced by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor; as these may relate to non-immigrant foreign nationals working under contract or subcontract for the Contractor while providing services to Department of Veterans Affairs patient referrals.

2.1.5.2. While performing services for the Department of Veterans Affairs, the Contractor shall not knowingly employ, contract or subcontract with an illegal alien; foreign national non-immigrant who is in violation of their status, as a result of their failure to maintain or comply with the terms and conditions of their admission into the United States. Additionally, the Contractor is required to comply with all “E-Verify” requirements consistent with “Executive Order 12989” and any related pertinent Amendments, as well as applicable Federal Acquisition Regulations.

2.1.5.3. If the Contractor fails to comply with any requirements outlined in the preceding paragraphs or its Agency regulations, the Department of Veterans Affairs may, at its sole discretion, require that the foreign national who failed to maintain their legal status in the United States or otherwise failed to comply with the requirements of the laws administered by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor, shall be prohibited from working at the Contractor’s place of business that services Department of Veterans Affairs patient referrals; or other place where the Contractor provides services to veterans who have been referred by the Department of Veterans Affairs; and shall form the basis for termination of this contract for breach.

2.1.5.4. This certification as referenced in 2.1.5.1 concerns a matter within the jurisdiction of an agency of the United States and the making of a false, https://acquisition.gov/vaar/852.209-70-organizational-conflicts-interest.

https://acquisition.gov/vaar/852.209-70-organizational-conflicts-interest.

https://www.uscis.gov/laws-and-policy/legislation/immigration-and-nationality-act https://www.uscis.gov/laws-and-policy/legislation/immigration-and-nationality-act https://www.e-verify.gov/ https://www.e-verify.gov/supplemental-guide-for-federal-contractors-10-e-verify-federal-contractor-rule-overview-11/111 fictitious, or fraudulent certification may render the certifier (individual authorized to bind the contractor to subject to prosecution under 18 U.S.C.

1001.

2.1.5.5. The Contractor agrees to obtain a similar certification from its subcontractors. The certification shall be made as part of the offerors response to the RFP using the subject attachment (Attachment D.4) in Section D of the solicitation document.

2.1.6. Annual Office of Inspector General (OIG) Statement: In accordance with HIPAA and the Balanced Budget Act (BBA) of 1977, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has established a list of parties and entities excluded from Federal health care programs. Specifically, the listed parties and entities shall not receive Federal Health Care program payments due to fraud and/or abuse of the Medicare and Medicaid programs.

2.1.6.1. Therefore, Contractor shall review the HHS OIG List of Excluded

Individuals/Entities on the HHS OIG web site at http://oig.hhs.gov/exclusions/index.asp to ensure that the proposed contractor’s employee(s) are not listed. Contractor should note that any excluded individual or entity that submits a claim for reimbursement to a Federal health care program, or causes such a claim to be submitted, may be subject to a Civil Monetary Penalty (CMP) for each item or service furnished during a period that the person was excluded and may also be subject to treble damages for the amount claimed for each item or service. CMP’s may also be imposed against the Contractor that employ or enter into contracts with excluded individuals to provide items or services to Federal program beneficiaries.

2.1.6.2. By submitting their proposal, the Contractor certifies that the HHS OIG List of Excluded Individuals/Entities has been reviewed and that the Contractors or firm is/are not listed as of the date the offer/bid was submitted to the government for consideration.

2.2. Non-Personal Healthcare Services: The parties agree that the Contractor and all contract staff shall not be considered VA employees for any purpose.

2.3. Indemnification: The Contractor shall be liable for, and shall indemnify and hold harmless the Government against, all actions or claims for loss of or damage to property or the injury or death of persons, arising out of or resulting from the fault, negligence, or act or omission of the Contractor, its agents, or employees.

2.4. Inherent Government Functions: Contractor and contract staff shall not perform inherently governmental functions. This includes, but is not limited to, determination of agency policy, determination of Federal program priorities for budget requests, direction and control of government employees (outside a clinical context), selection or non-selection of individuals for Federal Government employment including the interviewing of individuals for employment, approval of position descriptions and performance standards for Federal employees, approving any contractual documents, approval of Federal employees, approving any contractual documents, approval of Federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy.

https://www.federallawyers.com/new-york/18-usc-1001-general-federal-false-statements-statute/#:%7E:text=The%20federal%20law%2018%20USC%201001%20makes%20it,need%20to%20contact%20a%20federal%20defense%20lawyer%20immediately.

https://www.federallawyers.com/new-york/18-usc-1001-general-federal-false-statements-statute/#:%7E:text=The%20federal%20law%2018%20USC%201001%20makes%20it,need%20to%20contact%20a%20federal%20defense%20lawyer%20immediately.

https://www.hhs.gov/hipaa/for-professionals/security/laws-regulations/index.html https://www.fns.usda.gov/snap/leghistory/balanced-budget-act-1977-questions-answers-set-2 http://oig.hhs.gov/exclusions/index.asp

2.5. No Employee status: The Contractor shall be responsible for protecting contract staff furnishing services. To carry out this responsibility, the Contractor shall provide or certify that the following is provided for all their staff providing services under the resultant contract:

2.5.1.1. Workers’ compensation

2.5.1.2. Professional liability insurance

2.5.1.3. Health examinations

2.5.1.4. Income tax withholding, and

2.5.1.5. FICA and Medicare Tax Withholding

2.6. Tort Liability: The Federal Tort Claims Act does not cover Contractor or contractor staff. When a Contractor or contractor staff has been identified as a provider in a tort claim, the Contractor shall be responsible for notifying their legal counsel and/or insurance carrier.

Any settlement or judgment arising from a Contractor’s (or contractor staff) action or non-action shall be the responsibility of the Contractor and/or insurance carrier.

2.7. Key Personnel:

2.7.1. It is essential that continuity of services is maintained to the maximum degree possible, hence, substitution of contractor provided staff shall be limited to urgent/emergent absences of approved, assigned providers. The Contractor shall be responsible for providing coverage to the VA during periods of vacancies of the Contractor’s staff due to sick leave, personal leave, vacations and additional coverage as required. In the event a scheduled contractor employee is unable to complete a clinic shift, the contractor shall provide a replacement employee and notify the Contracting Officer Representative (COR) immediately of the schedule change.

2.7.2. The qualifications of contractor personnel shall be subject to review by the VA NWIHCS Physical Therapy and/or Prosthetic Representatives.

2.8. Personnel Substitutions: During the first ninety (90) calendar days of performance, the Contractor shall make NO substitutions of key personnel unless the substitution is necessitated by illness, death or termination of employment. The Contractor shall notify the CO, in writing, within 15 calendar day(s) after the occurrence of any of these events and provide the information required below. After 90 days, the Contractor shall submit the information required below to the CO at least 25 calendar days prior to making any permanent substitutions. Note: Contractor will not be reimbursed for any services performed by a contractor not identified on the contract.

2.8.1. The Contractor shall provide a detailed explanation of the circumstances necessitating the proposed substitutions, with complete resumes for the proposed substitutes, and any additional information required by the CO. Proposed substitutes shall have comparable qualifications to those of the persons being replaced. The CO will notify the Contractor within 15 calendar days after receipt of all required information of the decision on the proposed substitutes. The contract will be modified to reflect any approved changes of key personnel.

2.8.2. For temporary substitutions where the key person shall not be reporting to work for three (3) consecutive workdays or more, the Contractor shall provide a qualified replacement for the key person. The substitute shall have comparable qualifications to the key person. Any period exceeding two weeks will require the procedure as stated in

2.10.6. When changes are approved, the contract price may be adjusted accordingly to reflect the salary and benefits of the personnel actually providing the services.

https://bphc.hrsa.gov/initiatives/ftca/what-ftca

2.8.3. The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility.

Breaches of conduct include but are not limited to: intoxication or debilitation resulting from any drug use, theft, patient abuse, dereliction, malfeasance or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. Should the VA COS or designee show documented clinical problems or continual unprofessional behavior/actions with any Contractor’s employee(s), s/he may require, without cause, the immediate replacement of said Contractor’s employee(s). The CO and COR shall work with VA NWIHCS leadership regarding any issues raised concerning Contractor’s employee(s) conduct. The final arbiter on questions of acceptability is the

CO.

2.9. Contingency Plan: Because continuity of care is an essential part of VAMC’s medical services, the Contractor shall have a contingency plan in place to be utilized if the Contractor’s employee leaves Contractor’s employment or is unable to continue performance in accordance with the terms and conditions of the resulting contract. A copy of this contingency plan shall be submitted with the proposal and updated throughout the period of performance (POP).

3. VA HOURS OF OPERATION/SCHEDULING:

3.1. VA Business Hours: The VA NWIHCS Physical Therapy Service is open Monday through

Friday, excluding holidays, from 8:00AM to 4:30PM. The services covered by this contract shall be furnished by the Contractor as defined herein. The Contractor shall not be required, except in case of emergency, to furnish such services during off-duty hours as described below:

3.2. Wheelchair Clinic Schedule:

3.2.1. Wheelchair Clinics – the Contractor shall be required to provide a certified Assistive

Technology Professional (ATP), or higher, to attend VA clinics on specified days, times, and locations, as identified below:

LOCATION FREQUENCY DURATION TIME

Omaha Division 4101 Woolworth Avenue Omaha, NE 68105

Three clinics per month (1st and 3rd Tuesdays) (2nd Thursday – after the 2nd Tuesday)

4-6 hours/clinic = 12-18 hours per month

9:00 AM – 1:00 PM

1:30 PM – 3:30 PM

(as needed)

Lincoln Division 600 South 70th Street Lincoln, NE 68510

Two clinics per month (1st and 3rd Wednesdays

– after the 1st Tuesday)

3 hours/clinic = 6 hours per month

9:00 AM – 12:00 PM

Grand Island Division 2201 North Broadwell Avenue Grand Island, NE 68803

Two clinics per month (2nd and 4th Tuesdays)

3 hours/clinic = 6 hours per month

10:00 AM – 1:00 PM

NOTES:

(1) Any change to the current schedule shall be determined by the COR.

(2) Any changes to the current schedule shall be communicated to the Contractor a minimum of 60 days in advance to the proposed date of change.

(3) Exact hours are subject to change based on patient workload and contractor will be reimbursed for only actual hours worked.

3.2.1.1. In the event the Wheelchair Clinic is rescheduled due to an unknown event, the contractor shall be notified at least 24 hours prior to the clinic date. The VA NWIHCS will coordinate with the contractor to establish a new clinic date.

3.2.1.2. In the event the Wheelchair Clinic must be rescheduled due to an untimely event (i.e., facility emergency, hazardous weather closure, unavailability of Physical Therapist/Occupational Therapist, etc.), the VA NWIHCS will notify the contractor as the situation becomes known and coordinate with the contractor to establish a new clinic date.

3.2.1.3. Scheduled clinics that fall on a Government-observed holiday (see paragraph 3.2.2., below) shall be adjusted to a new date within one week of the holiday date.

3.2.2. National Holidays: The following national holidays are observed by the Federal

Government:

• New Year’s Day

• Martin Luther King’s Birthday

• Presidents Day

• Memorial Day

• Juneteenth

• Independence Day

• Labor Day

• Columbus Day

• Veterans Day

• Thanksgiving

• Christmas

• Any other day specified by the President of the United States to be a national holiday.

4. CONTRACTOR RESPONSIBILITIES

4.1. Personnel Required: The Contractor shall provide contractor staff that are competent, qualified per this performance work statement and adequately trained to perform assigned duties.

4.1.1. The contractor shall assign a trained Rehab and Seating Specialist, RESNA-Certified

ATP, to perform the services covered by this contract.

4.1.2. One RESNA-certified ATP shall attend each scheduled Wheelchair Clinic at the VA

NWIHCS.

4.1.3. Contracted staff are responsible for the following:

4.1.3.1. Contractor work directly with the VA NWIHCS Physical Therapist and/or Prosthetic Service Line to perform professional assessment and recommendation for the most appropriate equipment based on a patient’s specific needs.

4.1.3.2. When Vendor has access to requested demo equipment for Veteran, Vendor may bring demo equipment to the Wheelchair clinic for clinical trails only, if requested.

4.1.3.3. The RESNA-Certified ATP shall complete the assessment and specific equipment recommendations for each referred Veteran patient to the respective PM&RS and Prosthetics staff the same day as the respective Wheelchair and Seating Clinic.

4.1.3.4. Adjustments to VA-issued equipment will be made within Wheelchair

Clinic as required to assist the VA Wheelchair team in determining the most appropriate equipment to order

4.1.3.5. Prescription for wheelchair and seating systems shall be provided in collaboration by the Contractor and the VA NWIHCS Physical Therapy, Occupational Therapy, and Prosthetics team members.

4.1.3.6. Maintaining appropriate knowledge, skills, with regards to new products and technology, in the wheelchair and seating field/industry, as well as maintaining knowledge for power mobility evaluations.

4.2. General:

4.2.1. All vendors are required to check in at the VA NWIHCS main hospital information desk’s Reptrax station to obtain a Reptrax vendor ID badge. The vendor will wear the temporary Reptrax badge during their visit. Vendors are responsible for maintaining all documentation and education within the Reptrax system in order to obtain the temporary Reptrax ID badge. If vendors are unable to satisfy the requirements for registration with the Reptrax system, they will not be authorized access to restricted areas. Reference the following VA NWIHCS Policies:

4.2.1.1. POL-003, Security and Law Enforcement Program (Attachment 5).

4.2.1.2. PHARM-004, Policy Governing Pharmaceutical and Medical Industry

Representatives (Attachment 6).

4.2.2. The Contractor's personnel shall wear visible identification at all times while on the premises of the VA Medical Center facilities.

4.2.3. The contractor shall ensure that personnel maintain their valid state-issued drivers’ licenses, vehicle insurance and registration.

4.2.4. It is the responsibility of the contractor to park in the appropriate designated parking areas. Information on parking is available from the VA Police. The VA Medical Center will not invalidate or make reimbursement for parking violations of the contractor under any conditions.

4.2.5. All vehicles shall be locked, and the keys removed while performing service on VA

Medical Center property. This is intended to protect the contractor's property and provide for the safety of the Medical Center's personnel.

4.2.6. Smoking is prohibited inside any buildings of the VA Medical Center. Possession of weapons is prohibited. Enclosed containers, including tool kits, shall be subject to search. Violations of VA regulations may result in citation answerable in the United States (Federal) District Court, not a local district, state, or municipal court.

4.3. REPORTS/DELIVERABLES:

4.3.1. The Rehab and Seating Specialist/ATP shall provide assessments and specific equipment recommendations the same day (or not to exceed 24 hours) as the respective Wheelchair and Seating Clinic.

4.4. PATIENT CARE DOCUMENTATION: Contractor staff shall be responsible for complying with documentation and ensuring that all documentation is completed and signed and shall appropriately documented in accordance with VA standards, equivalent to The Joint Commission (TJC) compliance guidelines, standard commercial practice and guidelines established by VA NWIHCS.

4.5. MEDICAL RECORDS:

4.5.1. Authorities: Contractor staff providing healthcare services to VA patients shall be considered as part of the Department Healthcare Activity and shall comply with the U.S.C.551a (Privacy Act), 38 U.S.C. 5701 (Confidentiality of claimants records), 5 U.S.C. 552 (FOIA), 38 U.S.C. 5705 (Confidentiality of Medical Quality Assurance Records) 38 U.S.C. 7332 (Confidentiality of certain medical records), Title 5 U.S.C. § 522a (Records Maintained on Individuals) as well as 45 C.F.R. Parts 160, 162, and 164

(HIPAA).

4.5.2. This order and its requirements meet the exception in 45 CFR 164.502(e), and do not require a BAA in order for Covered Entity to disclose Protected Health Information to a health care provider for treatment. Based on this exception, a BAA is not required for this contract. Treatment and administrative patient records generated by this contract or provided to the Contractors by the VA are covered by the VA system of records entitled ‘Patient Medical Records-VA’ (24VA19). Contractor generated VA Patient records are the property of the VA and shall not be accessed, released, transferred, or destroyed except in accordance with applicable laws and regulations. Contractor shall ensure that all records pertaining to medical care and services are available for immediate transmission when requested by the VA. Records identified for review, audit, or evaluation by VA representatives and authorized federal and state officials, shall be accessed on-site during normal business hours or mailed by the Contractor at his expense. Contractor shall deliver all final patient records, correspondence, and notes to the VA within twenty-one (21) calendar days after the contract expiration date.

4.5.3. Disclosure: Contractor staff may have access to patient medical records: however, Contractor shall obtain permission from the VA before disclosing any patient information. Subject to applicable federal confidentiality or privacy laws, the Contractor, or their designated representatives, and designated representatives of federal regulatory agencies having jurisdiction over Contractor, may have access to VA ‘s records, at VA’s place of business on request during normal business hours, to inspect and review and make copies of such records. The VA will provide the Contractor with a copy of VHA Handbook 1907.1, Health Information management and Health Records and VHA Handbook 1605.1, Privacy and Release of Information.

The penalties and liabilities for the unauthorized disclosure of VA patient information mandated by the statutes and regulations mentioned above, apply to the Contractor.

http://www.rms.oit.va.gov/SOR_Records/24VA19.asp http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1469 http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1469 http://www1.va.gov/vhapublications/viewpublication.asp?pub_id=1423

4.5.4. Release of Information: The VA shall maintain control of releasing any patient medical information and will follow policies and standards as defined, but not limited to Privacy Act requirements. In the case of the VA authorizing the Contractor to release patient information, the Contractor in compliance with VA regulations, and at his/her own expense, shall use VA Form 3288, Request for and Consent to Release of Information from Individual’s Records, to process “Release of Information Requests.”

In addition, the Contractor shall be responsible for locating and forwarding records not kept at their facility. The VA’s Release of Information Section shall provide the Contractor with assistance in completing forms. Additionally, the Contractor shall use VA Form 10-5345, Request for and Authorization to Release Medical Records or Health Information, when releasing records protected by 38 U.S.C. 7332. Treatment and release records shall include the patient’s consent form. Completed Release of Information requests will be forwarded to the VA Privacy Officer at the following address:

PRIVACY OFFICER CONTACT INFORMATION:

VA, Nebraska-Western Iowa Healthcare System Privacy/FOIA Officer (636/136D) 4101 Woolworth Avenue

402-995-3427

4.6. PERFORMANCE STANDARDS, QUALITY ASSURANCE (QA) AND QUALITY

IMPROVEMENT (QI)

4.6.1. Quality Management/Quality Assurance Surveillance: Contract personnel shall be subject to Quality Management measures, such as patient satisfaction surveys and timely completion of services. Methods of Surveillance: Focused Contractor performance will be monitored by the government using the standards as outlined in this Performance Work Statement (PWS) and methods of surveillance detailed in the Quality Assurance Surveillance Plan (QASP). The QASP shall be attached to the resultant contract and shall define the methods and frequency of surveillance conducted.

4.6.2. Patient Complaints: The CO will resolve complaints concerning Contractor relations with Government employees or patients. The CO is final authority on validating complaints. In the event that The Contractor is involved and named in a validated patient complaint, the Government reserves the right to refuse acceptance of the services of such personnel. This does not preclude refusal in the event of incidents involving physical or verbal abuse.

4.6.3. The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility.

Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. The CO and COR shall deal with issues raised concerning Contractor’s conduct. The final arbiter on questions of acceptability is the

CO.

http://www4.va.gov/vaforms/va/pdf/VA3288.pdf http://www4.va.gov/vaforms/va/pdf/VA3288.pdf http://www4.va.gov/vaforms/medical/pdf/vha-10-5345-fill.pdf http://www4.va.gov/vaforms/medical/pdf/vha-10-5345-fill.pdf

4.6.4. Frequency of Performance Measure Assessment: The COR shall visit/correspond with the contractor either as needed or, at a minimum, on a quarterly basis. In addition, the following performance measure reports will occur:

4.6.4.1. Quarterly Reports are prepared and completed by the COR within 45 days of the end of the reporting period. Contractor will review quarterly performance measure reports and acknowledge receipt of report by returning a signed copy, along with any comments, to the Contracting Officer within 30 days of receipt of the report.

4.6.4.2. Contractor’s Performance Report: At the end of each contract period, the

COR will assess the summary of the contractor’s performance and shall provide a written assessment. This written assessment will be forwarded to the Contracting Officer as documentation of contractor’s performance and/or for a request to exercise option period, renewal of a contract or termination of a contract. This information will be loaded into the Contractor Performance Assessment Reporting System (CPARS) (see paragraph 4.8.).

4.7. PERFORMANCE STANDARDS

4.7.1. Measure: Timely Assessments and Equipment Recommendations Performance Requirement: Timely delivery of reports Standard: 100% of the assessments and specific equipment recommendations are available the same day (or not to exceed 24 hours) as the respective Wheelchair and Seating Clinic Acceptable Quality Level: 95% of the assessments and specific equipment recommendations are available the same day (or not to exceed 24 hours) as the respective Wheelchair and Seating Clinic Surveillance Method: Ongoing and Random Performance Evaluations.

Frequency: Ongoing

4.7.2. Measure: Qualifications of Key Personnel

Performance Requirement: All Rehab and Seating Specialists shall be Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) Assistive Technology Professional (ATP) certified Standard: All 100% of contractor employees must be RESNA ATP certified Acceptable Quality Level: 100%; No deviations accepted.

Surveillance Method: Random Inspection of qualification documents Frequency: Upon contract award and as needed when new staff is added to the contract or contract.

4.7.3. Measure: Contractor Employees Available for Clinics

Performance Requirement: Contractor employees shall be available for clinics

Standard: 100% of the time contractor employees shall be available at the designated clinic start times.

Acceptable Quality Level: 95% of the time contract personnel are available at the designated clinic start times Surveillance Method: Random Inspection/Sign-in Sheets Frequency: Random

4.7.4. Measure: Accuracy of Specs

Performance Requirement: ATP identifies correct specifications for Veteran patient Standard: 100% of the time specifications have been identified correctly Acceptable Quality Level: 95% of the time specifications are correct

Surveillance Method: Ongoing review of the specifications Frequency: Ongoing

4.7.5. Measure: Mandatory Training

Performance Requirement: Contractor completes all mandatory required training per this PWS and VA NWIHCS policy Standard: All 100% of required training is completed on time by Contractor employees Acceptable Quality Level: 100%; no deviations accepted Surveillance Method: Contractor to provide evidence of training required by VA NWIHCS, reports violations per policy.

Frequency: Annually or upon contract Option Period renewal, as required

4.8. Registration with Contractor Performance Assessment Reporting System (CPARS):

4.8.1. As prescribed in Federal Acquisition Regulation FAR Subpart 42.15, the Department of Veterans Affairs (VA) evaluates Contractor past performance on all contracts that exceed the Simplified Acquisition Threshold and shares those evaluations with other Federal Government contract specialists and procurement officials. The FAR requires that the Contractor be provided an opportunity to comment on past performance evaluations prior to each report closing. To fulfill this requirement VA uses an online database, CPARS, which is maintained by the Naval Seal Logistics Center in Portsmouth, New Hampshire.