503 - Home O2 PWS.pdf

B.3 PERFORMANCE WORK STATEMENT

SECTION 1. INTRODUCTION / BACKGROUND INFORMATION

James E Van Zandt VA Medical Center provides Home Oxygen delivery and set-up to Veteran beneficiaries in Pennsylvania. A list of the Altoona VAMC geographical areas covered under this requirement is provided at Attachment D. The Contractor shall arrange for Home Oxygen for veterans traveling and temporarily relocating . The Contractor shall be responsible for providing Home Oxygen supply to Veteran beneficiaries serviced by VISN 4 Prosthetics and Sensory Aid Service (P&SAS). Due to the monthly fluctuation of patients, task orders will be issued by each facility on a monthly basis. The contractor shall provide all supplies, materials, equipment, transportation of equipment, set-up, labor, supervision, patient education, safety management, and infection control, as necessary, for patients on home respiratory care therapy, as specified herein and authorized by the COR/ACOR. These services shall be required 24 hours a day, seven (7) days a week, including holidays. The contractor shall be staffed and stocked to render Home Oxygen delivery and set-up provided in accordance with all contract terms and conditions for the duration of the performance period. It is the Offerors/Contractors responsibility to thoroughly review the specifications and become familiar with the area of coverage in order to be fully aware of the Home Oxygen delivery and set-up requirements. Lack of understanding will not relieve the offeror from performing in accordance with the strict intent and meaning of the specifications and will not authorize additional cost to the Government.

SECTION 2. SCOPE / PERFORMANCE REQUIREMENTS: SPECIFIC TASKS

All initial and follow-up care provided under this contract shall be provided in accordance with all current Joint Commission (JC) standards or equivalent accredited standards related to home oxygen therapy.

Contractor must be JC accredited for Home Care or equivalent accredited standard and must maintain the certification or equivalent accredited standard for the duration of the contract. If the contractor is re-surveyed by The JC or equivalent accredited standard during the contract term, the contractor shall notify the Contracting Officer (CO) of survey dates, the outcome of the survey, and provide copies of new certificates as issued. Contractor facilities may be inspected by the respective Medical Center prior to the contract award. Any and all subcontractor’s must follow The JC standards or equivalent accredited standards and shall be monitored by the contractor for compliance. Contracting Officer’s Representative (COR) or Alternate Contracting Officer’s Representative (ACOR) shall be notified if a subcontractor is utilized. The contractor’s comprehensive procedure manual shall become part of this contract. The manual shall include, but not limited to: delivery/set-up, infection control, safety, rights and responsibilities, inventory, employee training (to include age specific), competency records, and performance improvement. The contractor shall be required to have a DO NOT RESUCITATE (DNR) policy in accordance with State Regulations. A copy of the DNR policy shall also become part of this contract.

Task 2.1 Performance Requirement: New Patient Set-ups-Oxygen Systems Upon receipt of a Department of Veterans Affairs (VA) prescription, the Contractor shall deliver and set-up in the veteran’s residence all equipment and supplies ordered. New set-ups shall be performed as described:

a. All orders for new patient set-ups, placed by the VA and received by the Contractor shall be delivered within 24 hours.

b. In the event the Contractor is unable to meet those delivery times, the Contractor must notify the

VA immediately. The VA reserves the right to obtain the service from another source and to charge the Contractor with any excess cost which may result there from.

c. Contractor shall notify the ordering facility COR or P&SAS if the contractor is unable to contact the patient or caregiver, no later than 4 hours after receipt of the delivery order.

d. Patients who are being released and discharged from hospital stay who require oxygen for travel to home, the contract will require to have a tank deliver for his trip home. Therefore the contract will set up a process for this delivery system for patients here at the Altoona VA hospital and any outside non-VA hospitals within the catchment area.

Task 2.2 Performance Requirement: Initial Set-ups - Oxygen Systems

a. Set-ups shall be performed by a contractor trained and qualified technician, Registered

Respiratory Therapist, or Certified Respiratory Therapist.

b. Contractor shall provide UP TO 15 tanks with initial set-up when portable is ordered. If a patient requires more than 15 tanks after the initial set-up, the COR will issue an order for any additional tanks. The government will determine the size of tanks upon set-up based on the written prescription by the provider.

c. The Contractor shall perform an assessment of the beneficiary’s home and environment in accordance with the JC standards or equivalent accredited standards, and maintain documentation of assessments in the individual patient file or folder.

d. The Contractor shall notify the COR 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.

e. The Contractor shall verbally notify the COR by the next business day of any unsafe conditions observed in the VA beneficiary’s home and precludes the installation or continuance of oxygen service. 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 furnish written documentation of the safety hazard to the COR within five (5) business days of the incident.

f. The Contractor shall document and report to the VA Home Oxygen Coordinator or COR any patient who is noncompliant 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.

g. The Contractor shall check the adequacy of the electrical outlets in the patient’s home and immediately report unsafe conditions to the COR. 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 may provide an alternative oxygen delivery system after approval by the COR, until a new prescription can be obtained. If no alternative is available, the prescribing VA physician will be notified.

h. The Contractor shall verify the presence of the smoke alarms and instruct the patient to test all smoke alarms on a monthly basis. In any home where smoke alarms are not present, the contractor will notify the COR for further review and potential action.

i. If the oxygen set-up is performed by a technician only, the visit shall be limited to set-up and instruction, solely focusing on the equipment use and safety and not providing instruction for the purpose of deriving the intended medical benefit. If the set-up visit is performed by a Respiratory Care Practitioner, in addition to set-up and instruction in the use and safety of equipment, the patient shall receive patient education relevant to his/her medical condition, the prescription, and on the intended medical benefit of the applicable home oxygen treatment.

j. Contractor shall provide documentation to the COR with:

• Name of the contractor’s branch/division servicing the patient

• Date of visit

• Recommendations and/or problems relating to the beneficiaries use of the oxygen equipment

• Proper name, social security number and phone number

• Review of prescription, verify percent of oxygen concentration

• Manufacturer’s model and serial number for Government Owned Equipment

k. In addition to the above list, the contractor shall also provide review of on-site environmental conditions that includes a check of electrical sockets if powered equipment is provided and make all appropriate site preparations (e.g., uncluttered area for storage of standing tanks, fire safety notation of observable safety hazards, etc.) before placing oxygen equipment in the home.

l. The contractor and the employees shall not indirectly make recommendations/comments to patients with respect to the services being provided to the Altoona VAMC under this contract.

The contractor shall refrain from discussing repair/replace items of equipment or any services not specifically delineated in this contract to patients. Any concerns raised by the patient/caregiver outside the scope of this contract regarding services provided shall be addressed to the COR, as appropriate, for solution. The contractor shall not solicit or deal directly with the veteran except as stated in this Scope of Work.

Task 2.3 Performance Requirement: Initial Oxygen Follow Up Visit - Required when initial set-up is performed by a contractor qualified technician

a. Follow-up visits shall be performed by a Respiratory Care Practitioner only, within 72 hours after initial set-up by a qualified technician.

b. Contractor shall provide proof of initial set-up, patient Plan of Care and Education.

c. Contractor shall submit the required documentation to the facility COR with the following monthly invoice.

d. A Respiratory Care Practitioner shall follow up within 72 hours to perform the required patient education and develop a Plan of Care. Documentation of patient education, Plan of Care, and all visits shall be in compliance with the current JC Home Medical Equipment (HME) Standards or equivalent accredited standards and shall be provided to the respective facility COR with the next monthly invoice. Failure to provide the required documentation by the 7th calendar day of each month may result in a 2% reduction applied to the entire monthly billing invoice for the respective facility.

Task 2.4 Performance Requirement: Initial Set-Up-CPAP/BiPAP

a. Initial set-up for Continuous Positive Airway Pressure (CPAP)/Bilevel Positive Airway Pressure (BiPAP) shall be performed by a Respiratory Care Practitioner only. The Contractor shall submit proof of initial set-up and patient Plan of Care and Education.

b. Contractor shall submit the required documentation to facility COR with the following monthly invoice.

c. All VA issued CPAP/BiPAP shall be delivered and set-up by a Respiratory Care Practitioner within 72 hours of normal business days of the VA prescription, unless otherwise notified by the ordering facility. Set-up shall include the pressure setting(s), instructions, mask fitting, safety, and any other necessary instruction. VA will provide sufficient supplies to last between maintenance visits.

d. Oxygen orders with CPAP and BiPAP units shall be delivered within 24 hours in accordance with Task 2.1.

Task 2.5 Performance Requirement: Setup –Air Compressors, and Suction

Machine/Maintenance Visit Requirements and Time Frames

a. All air compressors, and/or suction pumps will be delivered and setup within 24 hours of contact by the Altoona VAMC Prosthetic Service. All deliveries will be done by Respiratory Therapist (RT), or other qualified personnel. The air compressors, and/or suction pump Plan of Care will in the form of the Prosthetics Electronics Request/Consult. This initial request/consult will be generated from the Altoona VAMC Physician including all equipment requirements and settings and sent electronically to the Altoona VAMC Prosthetic Service who will then fax to the contractor. A purchase order will then be sent back to the contractor with the purchase order number and credit card number to confirm the order. The Plan of Service will then be created at the time of delivery by the Contractor’s RT and will include any problems in the patient’s health status and/or compliance with the Plan of Care, and will ensure equipment and treatment is appropriate for the patient’s use in the home environment. Copies of the Plan of Care and Plan of Service shall be furnished to the Prosthetics Service via encrypted email within 5 working days of the Contractor delivery and set up. These records shall also be maintained by the contractor in the Veteran Patient Account Folder

Task 2.6 Performance Requirement: Equipment Monitoring/Maintenance Visit Requirements and Time Frames

a. As part of the equipment monitoring visit, the contractor shall ensure the patient has adequate supplies (mask supplies, colored tubing, filters, water for humidification) to last between visits.

b. The Contractor shall provide and deliver prescribed equipment and supplies to each beneficiary on an as needed basis. The Contractor shall visit beneficiaries' residences in performance of this contract by appointment only, between the hours of 8 a.m. and 8 p.m., Monday through Friday , exceptions will be made in the cases of emergencies.

c. During the bi annual clinical visit, the Contractor shall be responsible for carrying out the plan of care by monitoring issues of patient compliance, completion of a home safety assessment, verification of the patients’ ability to operate equipment, cleaning and maintenance and patient re-education as indicated. Documentation of each visit will be provided to the COR with the monthly billing. Coordination and accomplishment of the mandatory bi-annual visit with the patient is the responsibility of the contractor.

d. All beneficiaries have the right to refuse 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. At the time of the refusal the contractor shall have the veteran sign a letter of refusal. If the refusal occurs during a home visit, the Contractor’s staff shall make an attempt to notify the COR of the refusal during the home visit. In any case, the Contractor shall report the specifics of the refusal to the COR by telephone within one (1) hour and shall follow-up with a written report in the Daily Incident Report. Visit refusals or failure to keep a scheduled appointment shall be faxed or emailed daily to each COR for action. No less than three (3) attempts should be made to visit the beneficiary. Payment for monthly rental, service or supplies will not be rendered without this required documentation.

e. In the event that a monthly visit will not occur, the COR will be notified and provided with details regarding attempts to make contact with the veteran for service.

f. Contractor shall document all prescription renewals in the patient’s file.

g. The Contractor shall not change or alter a VA beneficiary’s equipment settings to deviate from the current prescription without obtaining a new oxygen prescription from the beneficiary’s VA physician.

Task 2.6 Performance Requirement: Emergency Protocol

a. The contractor shall have a well-established communication system providing 24-hour emergency Home Oxygen delivery and set-up and the ability to provide those services at the beneficiary’s home within a maximum of four (4) hours of a call. An emergency exists if the appropriate P&SAS staff or COR informs the Contractor that he/she considers the situation an emergency, or if the VA beneficiary states in a telephone call to the Contractor that an emergency exists in regard to the function or use of the respiratory related equipment or use of the equipment.

b. In emergent situations, the Contractor shall provide service to the beneficiary within four (4) hours; in the event the Contractor is unable to meet the appropriate response times, the Contractor is responsible for making arrangements with another supplier to provide oxygen at the Contractor’s expense. A mandatory written justification detailing why emergency service was not available shall be provided by the Contractor to the facility COR and the Contracting Officer within 12 hours from the original time the Contractor was called to provide the service.

c. The Contractor shall provide a written Emergency Contingency Plan for natural disasters, which provides for continued uninterrupted care and support, in the event of an emergency resulting in an interruption of service. At a minimum, the plan shall address such items as severe weather, power outages, loss of personnel, damage to the Contractor’s site, and communications. A copy of this plan shall be provided in the proposal.

d. The Contractor shall ensure all patients have, at a minimum, a non-electrical oxygen supply to last at least 24 hours. The minimum supply shall take into account each patient’s prescription flow-rate and distance from the contractor’s location, so actual supply levels may differ from patient to patient.

e. The cost of backup systems, backup oxygen, and backup equipment shall be borne by the

Contractor. If H tanks are used for backup, the Contractor shall furnish an H tank stand for each H tank at no cost to the government. Liquid oxygen supply may be considered backup oxygen, however, the oxygen supply must be at a prescribed rate of flow for 24 hours, 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.

Task 2.7 Performance Requirement: Discontinuation of Home Oxygen Delivery and Set-Up

a. Upon termination of Home Oxygen delivery to the beneficiary, either by physician’s prescription or the death of a beneficiary, the Contractor shall pick up all oxygen equipment and supplies at the earliest possible time, but no later than five (5) business days after receipt of notification from the appropriate P&SAS staff or COR. Payment for Home Oxygen shall cease upon this notification. The final invoice shall be prorated from the date of notification. Final services shall be billed with the next scheduled invoice.

b. In the event the contractor gains knowledge of the patient’s death prior to the servicing VA, the contractor shall immediately notify the COR of the patient’s death and the date the contractor was made aware of the death. Billing shall cease on the day the contractor becomes aware of the patient’s death. The final invoice shall be prorated from the date of notification.

Task 2.8 Performance Requirement: Service Transition

a. In the event award is made to other than the incumbent contractor, the new contractor shall arrange with the incumbent Contractor for exchange of equipment, ensuring that there is a continuity of services and no disruption of supplies/services to veteran beneficiaries. Transition to the new contractor shall be complete as soon as possible, but no later than 90 calendar days from the date of award of a new contract. Failure to accomplish this task in 90 days will result in a 10% reduction of the contractor’s overall monthly invoice for the Altoona VAMC until the phase-in is complete. Additionally, if the contractor fails to accomplish the phase-in, the contractor shall be responsible for any duplicate costs the VA may have to pay the incumbent contractor beyond 30 days. In the event the delay is due to the ex-incumbent Contractor’s lack of cooperation during the phase-in process, the incumbent Contractor will not be held liable for this delay

b. This period will be designated as the period for the transfer of VA veteran beneficiaries from the incumbent to the successor contractor. The change shall, at a minimum, include oxygen care and instructions, usage, set-up, emergency service. Contractor shall coordinate, through the Contracting Officer, the schedule of initial patient visits with the Prosthetics COR for the Altoona VAMC. The transition shall be coordinated through the Contracting Officer and facility

COR.

c. The successor Contractor shall provide the facility COR, by 12:00 p.m. each Friday during the transition period, a detailed listing of the VA beneficiaries whose oxygen service has been changed over from the incumbent to the successor Contractor. The list shall include the exact date of the change for each beneficiary. Along with this list, the successor Contractor shall also provide documentation showing that the incumbent Contractor has been notified to pick up their equipment.

d. Payment to the incumbent contractor shall be made up to the day supplies/equipment were transferred to the successor contractor. Payment shall be pro-rated based upon the unit prices in affect during the most recent contract year. Coordination during the transition period shall be accomplished at no additional expense to the Government.

e. Transition Period: At the end of the contract period, up to a 90 day transition period may be required during which the incumbent Contractor will continue to provide Home Oxygen delivery and set-up at the contract prices, while the incoming Contractor is transitioning in by replacing all incumbent equipment with their equipment.”

f. After award of the contract, the contractor, at no additional cost to the VA, shall be responsible for picking up existing inventory from the incumbent contractor’s storage facility within 15 calendar days after the effective date of the Notice to Proceed.

Task 2.9 Performance Requirement: Equipment Maintenance/Repair

a. Contractor shall have written equipment preventive maintenance policies and procedures and shall maintain a system for tracking all equipment preventative maintenance by model and serial number. The safety and working condition of the equipment shall be monitored on an ongoing basis, including maintaining preventative maintenance logs, calibration logs, recalls, logs of oxygen cylinder lot, batch numbers, and the results documented by serial number. This documentation shall be maintained for the term of the contract.

b. All current documentation shall be forwarded to the appropriate COR on a monthly basis. Only qualified technicians with documented training will provide maintenance/repair to this equipment. The contractor shall perform a formal preventive maintenance inspection (PMI) immediately before stored equipment is issued.

c. The Contractor shall have a written recall plan or system in place for identification of equipment recalls, hazardous or defective equipment, and action taken.

d. The Contractor is responsible for repairing VA owned equipment under this contract, when specified by the COR . If the COR requires the Contractor to repair VA owned equipment, the VA reserves the right to furnish replacement parts or obtain maintenance/repair to any item, if, in the opinion of the COR , the contractor's cost for such maintenance/repair is deemed to be excessive and the matter cannot be mutually resolved. The Contractor shall provide loaner equipment equal to or exceeding existing equipment while repairs are being made to patient's equipment. VA owned equipment repairs estimated to cost more than $75.00 must be pre-approved by the COR before the Contractor begins work/repair.

Task 2.10 Performance Requirement: Reserve Supply

a. An adequate supply of liquid tanks, aluminum/composite compressed O2 tanks, with regulator, and E-tank stands shall be provided and stored at each facility as directed by the COR.

Quantities and sizes of tank will vary and shall be agreed upon by the Contractor and facility

COR.

b. The reserve supply shall accommodate home oxygen patients who are either being discharged from the hospital or visiting (appointments) and require a supply of oxygen to enable the VA beneficiary to reach home. Adequate inventory shall be maintained by the Contractor.

Task 2.11 Performance Requirement: VA Beneficiary Records

a. An individual beneficiary account record shall be maintained by the Contractor in compliance with the Privacy Act and maintain the Health Insurance Portability and Accountability Act of 1996 (HIPPA) compliance. Copies of these beneficiary records may be maintained on a computer or via paper files and shall be provided to the COR upon request or when a patient is discharged from the Home Oxygen Healthcare program or upon death. The individual patient medical records shall be maintained and housed at the Contractor’s individual branch providing the oxygen service. At a minimum, the record shall include the following:

• Beneficiary identifying information (full name, complete SSN, home address, phone number of beneficiary caregiver, serial number, and type of VA owned equipment)

• Emergency contact phone number at a separate residence other than the beneficiary

• Copy of physician’s prescription (original or renewal)

• Plan of Care as developed by Contractor

• Documentation of the initial and monthly visits, assessments, and Home Oxygen supplied

• Initial and continuing verbal and written instructions to the beneficiary and/or care giver

(to include, but not limited to basic home safety, safe and appropriate use of equipment, handling, cleaning, precautions on smoking, and storage-universal precautions)

• Patient complaints, accidents, injuries, and safety hazards identified and corrective actions taken

• Documentation of all beneficiary education, to include, course of action in emergency situations

• Infection control- Contractor will comply with standard precautions in the handling, storing, cleaning, delivery of home oxygen equipment, and shall maintain a system for reporting, documenting, and evaluating records of infection among beneficiaries and contractor staff

Task 2.12 Performance Requirement: Plan of Care

a. An initial Plan of Care shall be developed and implemented by a Respiratory Care Practitioner during the initial setup by the Contractor for each VA beneficiary and a copy shall be forwarded to the respective facility COR with the monthly invoice. At a minimum, the plan shall include the following:

• A statement of the patient’s needs and problems

• Measurable beneficiary goals

• Notation of the Home Oxygen delivery recorded and any additional actions taken

b. The Plan of Care shall be signed by the visiting Respiratory Care Practitioner and VA beneficiary or care giver. The beneficiary shall retain the original. The Contractor shall retain one (1) copy and forward one (1) copy to the COR.

c. The contractor shall maintain records of all visits for the term of the contract.

d. The Plan of Care for CPAPs and BiPAPs shall be requested at the direction of the COR. At a minimum, the assessment shall include the beneficiaries’ tolerance and compliance to equipment and mask fitting.

Task 2.13 Performance Requirement: Education/Instruction

a. Education regarding all equipment, supplies, and smoking shall be provided to the beneficiary/caregiver by the contractor in accordance with The JC standards or equivalent accredited standards. At a minimum, the Contractor shall document and provide instruction to the patient/caregiver on the safe and appropriate use of the medical equipment, including basic home safety, storage, handling, required maintenance, electrical safety, equipment hazards and malfunctions, infection control, emergency preparedness, and the beneficiary’s responsibilities in the care and use of all equipment.

b. The Contractor shall provide, as a part of the technical proposal, all patient education materials to be used during the course of the contract. Updates and changes to the education materials must be submitted to the COR prior to making any changes.

c. The Contractor shall provide education to each veteran at the time of set-up, and assess the need for reinforcement during visits. This information is to be presented verbally in demonstration and material covered shall be in written form, to be left with the beneficiary/caregiver. The contractor, as directed by COR shall implement any new or revised education material. The VA will determine whether the contractor shall use their forms or the forms supplied by the VA for documentation of Home Oxygen provided to VA beneficiaries.

d. The Contractor shall document that the beneficiary/caregiver is instructed in accordance with

The JC standards or equivalent accredited standards. The contractor shall provide educational and/or warning information for patients, their families, or caregivers on the hazards of smoking and using an open flame near oxygen while in use. The educational materials must be provided upon initial delivery and minimally every six (6) months thereafter.

e. On each scheduled set-up/delivery, the Contractor shall reassess the need to instruct the beneficiary on the use and care of the equipment and supplies as necessary.

Task 2.14 Performance Requirement: Traveling, Temporary Relocation and Support for Service Outside the Altoona VAMC Designated Areas

• The contractor shall be responsible for arranging and coordinating all Home Oxygen for veterans who travel both within and outside their respective contracted jurisdiction, unless otherwise indicated. The veteran and/or respective VA facility will be responsible for notifying the contractor where the veteran is traveling to and the mode of transportation. Arranging and coordinating oxygen for travel shall be provided at no additional cost to the VA. Coordination of oxygen needed for air transportation is the responsibility of the veteran.

• The contractor shall arrange for Home Oxygen for veterans traveling outside the areas covered by the Altoona VAMC and/or temporarily relocating. All maintenance requirements, as described in this Performance Work Statement, are applicable. All set-up and maintenance forms shall be sent to the facility COR.

• Additional costs incurred as a result of subcontracted Home Oxygen support for veteran travel or temporary relocation which would be outside the normal geographical areas listed at Attachment D shall be individually negotiated and added to the contract via Task Order.

Task 2.15 Performance Requirement: Equipment Specifications

a. Oxygen concentrator systems: Contractor shall provide Underwriters Laboratories (UL) approved concentrators, complete with standard hour meter and must meet the following requirements: Oxygen concentrations must provide at a minimum the following flow rates of oxygen:

• >/= 95% FIO2 at </= 2L/minute

• >/= 92% FIO2 at 3-5L/minute

• >/= 90% FIO2 at > 5L/minute

b. Each system shall have an operating pressure not to exceed 15 PSI with power requirements prescribed at 115 /VAC, 60 Hertz and will operate at a sound level not to exceed 53 dB@ 1 meter. Each system shall have a battery powered built-in audible alarm “ALERT SYSTEM” to alert patient in the event of equipment or electrical power failure. This system shall self-test each time the unit is turned on. During normal operation, the unit will alert the user that it may be necessary to switch to another alternate source of oxygen supply. Concentrator unit will supply the user with the prescribed oxygen flow through connecting tubing of up to 50 feet in length.

c. Each CONCENTRATOR SET-UP shall include disposable humidifiers, tubing connectors, extension tubing (up to 50 feet in length with sufficient diameter to deliver the prescribed flow of oxygen), nasal cannulas, and a back-up system with the capacity to provide continuous, uninterrupted delivery of oxygen at the prescribed rate of flow for 24 hours.

d. The BACK-UP SYSTEM contingency plan shall consist of compressed gas cylinders (H or M type) with a tank stand(s), regulator-flow meter, tubing, connectors, nasal cannulas, and expendable supplies as required for use during the event of a power failure or mechanical problem. The contractor will provide a 24 hour emergency backup system in the event of a power failure or when it is necessary to shut down the concentrator. Each unit shall have an attached sticker with the correct vendor name and emergency telephone number, date with the serial number, and date including the Hobb meter hours when last serviced.

e. The cost of backup systems, backup oxygen, and backup equipment shall be borne by the

Contractor. If H tanks are used for backup, the Contractor shall furnish an H tank stand for each H tank, at no cost to the government. Liquid oxygen supply may be considered backup oxygen, however, the oxygen supply must be maintained at the prescribed rate of flow for 24 hours 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.

f. 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-the-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.

g. Portable System: The Contractor shall provide, as part of the monthly concentrator rental fee, a “system” of Portable Oxygen Cylinders for patient ambulatory use outside the home. Refills are billed according to the schedule page. Safety holders shall be provided, at no charge, for all veterans with a prescription for four (4) or more cylinders.

h. Oxygen Cylinders: All oxygen cylinders provided by the contractor shall be limited to the size and quantity authorized by the prescription. Adequate storage racks will be provided to accommodate each tank/cylinder placed in the home or place of residence. Oxygen cylinders shall be maintained, filled, marked, labeled, and shipped in compliance with all current regulations. Each cylinder furnished under this contract shall be color-coded according to the trade practices for that type of gas.

• "E" cylinder orders shall include lightweight, aluminum oxygen tank/cylinder, storage rack, one (1) "E" handcart (wheeled) per patient, one (1) regulator-flow meter, and all expendable supplies as required. The contractor shall provide the number of tanks as prescribed. Any change to the number of tanks will require a prescription revision.

• "D" cylinder (minimum 240 liters capacity) orders shall include lightweight, aluminum oxygen tank/cylinder, storage rack, one(1) carrying bag per patient, one (1) regulator-flow meter, and all expendable supplies as required.

• "B" / “M6” cylinder orders shall include lightweight, aluminum oxygen tank/cylinder, storage rack, one (1) carrying bag per patient, one (1) regulator-flow meter, and all expendable supplies as required.

• "H or M" cylinder orders shall include oxygen tank/cylinder, storage rack, one (1) regulator-flow meter, and all expendable supplies as required.

i. Liquid System: Standard setup includes stationary reservoir, portable device, transfilling equipment, regulator, and all expendable supplies as required. Each liquid oxygen setup shall also include an emergency back-up system with the capacity to provide continuous, uninterrupted delivery of oxygen, at the prescribed rate of flow for 24 hours. The back-up system will consist of compressed gas cylinders ("H" or "M" type), stand(s), regulator-flow meter, tubing, connectors, nasal cannulas/mask, as ordered, storage rack, and expendable supplies as required for use during the event of a power failure or mechanical problem necessitating the use of the back-up system cylinder. The cost of necessary expendable supplies, as required for use, shall be included in the monthly rental/service cost.

j. Ventilators: Rental equipment shall be a PLV 102 brand or equal to remain consistent with VA owned equipment. The setup of a ventilator system shall include per patient: Initial set-up, necessary supplies as ordered, home assessment, patient training and education, preventative maintenance, RRT monthly visits, evaluation of patient/equipment in home environment as per physician prescription and plan of care. Set-up shall include an emergency back-up system placed in the home with the capacity to provide continuous uninterrupted delivery of care. Monthly charge includes up to six (6) ventilator circuits per month. *NOTE: The intent of the contract regarding ventilators is for the contractor to set-up VA Owned equipment, see Item below. The standard procedure for the contractor is to deliver VA owned ventilators and other VA owned equipment to VA beneficiaries as first priority and rental equipment when VA equipment is not available.

k. VA Owned Ventilators: Includes initial set-up, supplies as ordered, home safety assessment, RRT monthly visits, patient education and training, evaluation of patient/equipment in home environment as per physician prescription and plan of care. Contractor shall provide complete preventative maintenance service on VA owned equipment as required by the manufacturers’ specifications. Includes up to six (6) ventilator circuits per month.

l. The Contractor shall maintain the serial number of all equipment provided and be able to track equipment to each individual patient. All equipment shall be checked to ensure that it is working properly according to manufacturer’s guidelines, documented on a tag or label affixed to the equipment, dated, and signed. Failure to check or clean equipment prior to delivery shall result in non-payment for delivery. This includes equipment delivered to the VA Medical Center. All reissued oxygen equipment delivered shall be cleaned/sanitized/disinfected by approved methods and be in first-class operating condition, in accordance with the manufacturer’s recommendations. In the event that a piece of faulty oxygen equipment is delivered or the delivery is incomplete, as determined by the COR, subsequent trips shall be made without additional cost to the veteran.

Task 2.16 Equipment Management/Handling/Transportation

a. Recovered equipment shall be separated from new and cleaned equipment during transport, in accordance with The JC Standards or equivalent accredited standards.

b. The delivery truck shall be kept in a sanitary condition, so that contamination of the equipment will not occur during transport.

c. The contractor shall have all vehicles used in the performance of Home Oxygen delivery and set-up under the contract clearly marked with company identification.

d. The contractor shall provide a designated secure holding area for equipment awaiting cleaning, disinfecting, servicing, or refurbishing. The holding area shall be separated from the clean equipment storage area to prevent the possibility of contamination of clean equipment per The JC Standards or equivalent accredited standards.

e. Contractor shall have written policies and procedures relating to the cleaning and storage of recovered/dirty /reusable equipment.

f. Prior to being placed in the clean equipment storage area, all recovered equipment shall be cleaned/disinfected using an appropriate cleaning solution according to manufacturer’s instructions, checked for proper operation, safety, serviceability, and covered with plastic for protection..

Task 2.17 Equipment Inventory – VA Owned

a. The contractor shall provide the COR with a complete inventory of all VA owned equipment and supplies on hand at the end of each month. The listing shall include, but not limited to, issuable, non-issuable (scrap), broken, serial numbers, manufacturer’s name, and model. This information shall be included on the listing. Discrepancies noted will be reconciled between both parties before the next monthly invoice is due. Failure to forward the listing shall result in delayed payment of the Contractor’s invoice.

b. The Contractor bears sole responsibility to notify the COR when he/she questions the serviceability of VA owned equipment and/or supplies that are required for this contract. The COR retains the sole right to condemn equipment and will notify the Contractor of arrangements for disposition of VA owned equipment. Under no circumstances should any VA equipment be disposed of without the COR’s authority. When available, recovered equipment that has been repaired for re-issuance under the terms of this contract shall be delivered to beneficiaries first.

c. The Contractor shall notify the COR via telephone, fax, or email when experiencing repeated problems and/or breakdowns with equipment/supplies furnished, to assist the COR in the submission of Quality Improvement Reports.

d. Labeling of VA Equipment: The contractor shall provide a roll of labels to be placed on VA owned equipment. The labels shall provide the Contractor’s emergency contact information in the event the equipment fails and needs to be replaced. The Contractor must ensure the labels are attached to all VA owned equipment already in the field and any new equipment issued to VA patients. The COR will arrange with the Contractor for pickup of equipment ordered and received by the VAMC and marked as belonging to the VAMC. The Contractor shall return equipment picked up during monthly maintenance to the location specified by the COR. VA owned equipment, shall be cleaned, sanitized, tagged, and stored or returned to the designated VAMC within seven (7) working days. In the case of emergencies, the contractor shall provide back-up equipment. The contractor shall communicate-by telephone or fax this change of equipment within 24 hours to the COR.

SECTION 3. PERFORMANCE STANDARDS:

Performance Objective Acceptable Quality Level

Method of Performance Assessment and Frequency

Incentive / Disincentive

Task 2.1 Performance Requirement: New Patient Set-ups-Oxygen Systems

Performance criteria met in 98% or greater of cases

Patient home inspection, patient satisfaction / complaints, monthly review of invoices for accuracy, timeliness of equipment delivery, accuracy of required documentation submitted, and adherence to Joint Commission Standards.

When AQL is not met:

1st offense is written notice to the contractor to correct the deficiency.

2nd offense is 1% deduction to the monthly invoice.

Task 2.2 Performance Requirement: Initial Set-ups- Oxygen Systems

Performance criteria met in review of invoices for accuracy, timeliness of equipment delivery, accuracy of required documentation submitted, and adherence to Joint Commission Standards.

When AQL is not met:

1st offense is written notice to the contractor to correct the deficiency.

2nd offense is 1% deduction to the monthly invoice.

Task 2.3 Performance Requirement Initial Oxygen Follow Up Visit- Required when initial set-

Performance criteria met in 98% or greater of cases

Patient satisfaction / complaints, monthly review of invoices for accuracy, accuracy of required documentation submitted, and

When AQL is not met:

1st offense is written notice to the contractor to correct the deficiency.

up is performed by a contractor qualified technician adherence to Joint Commission Standards.

2nd offense is 1% deduction to the monthly invoice.

Task 2.4 Performance Requirement: Initial Set- Up-CPAP/BiPap

Performance criteria met in review of invoices for accuracy, timeliness of equipment delivery, accuracy of required documentation submitted, and adherence to Joint Commission Standards.

When AQL is not met:

1st offense is written notice to the contractor to correct the deficiency.

2nd offense is 1% deduction to the monthly invoice.

Task 2.5 Performance Requirement: Equipment Monitoring/Maintenance Visit Requirements and Time Frames

Performance criteria met in

Site inspection, patient home inspection, record check, monthly review of invoices for accuracy, timeliness of maintenance visits, accuracy of required documentation submitted, and adherence to Joint Commission Standards.

When AQL is not met:

1st offense is written notice to the contractor to correct the deficiency.

2nd offense is 1% deduction to the monthly invoice.

Task 2.6 Performance Requirement: Emergency Protocol

Performance criteria met in

Site inspection, record check, accuracy of required documentation submitted, and adherence to Joint Commission Standards, monthly as well as quarterly.

Meeting the standard with no more than 1 deviation per month will result in a satisfactory contractor performance evaluation.

Task 2.7 Performance Requirement:

Discontinuation of Oxygen Services

Performance criteria met in

Patient home inspection, record check, patient satisfaction / complaints, monthly review of invoices for accuracy, accuracy of required documentation submitted, and adherence to Joint Commission Standards.

Meeting the standard with no more than 1 deviation per month will result in a satisfactory contractor performance evaluation.

Task 2.8 Performance Requirement: Service Transition

Performance criteria met in inspection, record check, patient satisfaction / complaints, monthly review of invoices for accuracy, timeliness of equipment delivery, accuracy of required documentation submitted, and adherence to Joint Commission Standards.

Meeting the standard with no more than 1 deviation per month will result in a satisfactory contractor performance evaluation.

Task 2.9 Performance Requirement: Equipment Maintenance/Repair

Performance criteria met in inspection, record check, timeliness of maintenance visits, accuracy of required documentation submitted, and adherence to Joint Commission Standards monthly and/or quarterly.

When AQL is not met:

1st offense is written notice to the contractor to correct the deficiency.

2nd offense is 1% deduction to the monthly

Task 2.10 Performance Requirement: Reserve Supply

Performance criteria met in check, accuracy of required documentation submitted, and adherence to Joint Commission Standards monthly and/or quarterly.

Meeting the standard with no more than 1 deviation per month will result in a satisfactory contractor performance evaluation.

Task 2.11 Performance Requirement: VA Beneficiary Records

Performance criteria met in inspection, record check, accuracy of required documentation submitted, and adherence to Joint Commission Standards monthly and/or quarterly.

When AQL is not met:

1st offense is written notice to the contractor to correct the deficiency.

2nd offense is 1% deduction to the monthly invoice.

Task 2.12 Performance Requirement: Plan of Care

Performance criteria met in inspection, record check, accuracy of required documentation submitted, and adherence to Joint Commission Standards monthly and/or quarterly.

Meeting the standard with no more than 1 deviation per month will result in a satisfactory contractor performance evaluation.

Task 2.13 Performance Requirement:

Education/Instruction

Performance criteria met in inspection, record check, patient satisfaction / complaints, accuracy of required documentation submitted, and adherence to Joint Commission Standards monthly and/or quarterly.

Meeting the standard with no more than 1 deviation per month will result in a satisfactory contractor performance evaluation.

Task 2.14 Performance Requirement: Traveling Beneficiaries

Performance criteria met in check, monthly review of invoices for accuracy, timeliness of equipment delivery, accuracy of required documentation submitted, and adherence to Joint Commission Standards monthly and/or quarterly.

Meeting the standard with no more than 1 deviation per month will result in a satisfactory contractor performance evaluation.

Task 2.15 Performance Requirement: Equipment Specifications

Performance criteria met in inspection, record check, monthly review of invoices for accuracy, accuracy of required documentation submitted, and adherence to Joint Commission Standards.

When AQL is not met:

1st offense is written notice to the contractor to correct the deficiency.

2nd offense is 1% deduction to the monthly invoice.

Task 16 Equipment Management/Handling & Transportation

Performance criteria met in documentation submitted, and adherence to Joint Commission Standards monthly and/or quarterly.

When AQL is not met:

1st offense is written notice to the contractor to correct the deficiency.

2nd offense is 1%

Task 17 Equipment Inventory – VA Owned

Performance criteria met in documentation submitted, and adherence to Joint Commission Standards monthly and/or quarterly.

When AQL is not met:

1st offense is written notice to the contractor to correct the deficiency.

2nd offense is 1%

SECTION 4. REPORTS AND NOTIFICATIONS:

Where a report, positive or negative, is established herein and is required to be submitted by the Contractor, reports will be VAMC-Specific. The definitions below outline the timeframe for submission of reports to the COR:

1) Daily* – no later than 24 hours after notification of event

2) Monthly – due to the COR no later than the 10th of the month following the previous month

3) Quarterly – due to the COR no later than the 15th of the month following the reporting quarter – reporting quarters are based on our fiscal year, October to December, January to March, therefore reports are due by January 15th, April 15th, etc.

4) Annual – due to the COR no later than the 1st of October each year.

* While these are labeled as “daily”, they are only reported when applicable. If an incident occurs and the contractor has 48 hours to report, then this would be reported on the daily report in which the 48 hours falls.

DAILY REPORTS (As Required) Report Description Distribution Sub-Contractor Notification COR Unsafe Condition Report COR Impending Disaster COR Incident Report Reporting special incidents found or occurring during a home visit, to include finding patients in need of emergency medical assistance, 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.

COR

Report of accidents, malfunctions, injuries, deaths, and equipment recalls.

A…