ATTACHMENT 02 36C261-22-Q-0224 Southern Nevada VA Healthcare System (VASNHCS) Performance Work Statement .pdf

SOUTHERN NEVADA HEALTHCARE SYSTEM

HOME OXYGEN SERVICES PROGRAM

PERFORMANCE WORK STATEMENT

1. From time-to-time, the number of Veterans being served by this agreement will change. The volumes or amounts shown in the solicitation are estimates only and impose no obligation on the VA either minimum or maximum. The contract shall be for the actual requirements of the VA as ordered by the VA during the life of the contract.

The Contracting Officers Technical Representative (COR) or designee will provide the contractor with notification to initiate individual beneficiary service requirements, including the beneficiary’s oxygen prescription, equipment, supplies and services to be provided including date and place of delivery, the contractor will confirm receipt of request within two working hours of notification; the COR or designee will also provide notification if VA owned equipment is provided; the COR or designee will also provide notification of VA initiated discontinuance of service. The notification may be made orally but will be confirmed in writing within one (1) working day. The written documents will include the authorizing official’s signature.

2. Veterans with a prescription for an oxygen concentrator shall be provided with an appropriate backup system consisting of a compressed gas source and regulator with stand, humidifiers, cannulas/mask for use during the event of a power failure or mechanical problem and necessitating the use of the backup cylinder. The cost for the above-mentioned backup system would be borne by the contractor.

The cost of replacement of equipment damaged, lost or misplaced not through the beneficiary’s negligence shall be borne by the contractor. Documentation is required if the patient declines the oxygen backup system.

3. The contractor shall replace all appropriate VISN 22 authorized equipment (contractor-owned) presently located in the homes of beneficiaries with his/her own equipment, and in accordance with the timeframe established in the contract. The contractor shall also replace all appropriate VISN22 authorized equipment (Government-owned), with Government-owned equipment. In the event that the Government-owned equipment is non-operational the contractor shall replace with Government owned equipment. The change shall include delivery, setup instructions, and shall be accomplished with the least disruption in service to the VISN22 beneficiary as possible. The cost will be prorated upon setup and discontinuance with equipment pickup no more than one (1) billing cycle. The contractor is required to issue Government-owned equipment prior to issuing contractor-owned equipment.

4. All services will be performed in the Veteran’s place of residence or in a nursing home housing the Veteran. The area of service shall be (see Attachment 1). The equipment needs are subject to change as determined by the prescribing physician. The contractors’ submitting offers in response to this request for proposal must have a facility physically located in the geographical area in which they will provide service. The contractor’s office location shall include the service office, warehouse, dispatch of vehicles and other functions related to the performance of services of this contract within a fifty (50) mile radius of the VA facilities in VISN 22 to facilitate periodic inspections by VA and/or other accrediting agencies.

5. “Non-territory” meaning the patient is not in the designated area of responsibility/jurisdiction of VISN

22 (rural area sitting outside the designated area). The contractor will accept the Veterans under the resulting contract, at the same costs as other patient services, at the Government’s request. These requests will be required from time to time and may be negotiated on an individual basis. The awardee will be responsible on occasion or on cases by case basis for non-territory patients under terms and conditions of this contract.

6. The geographical boundaries described herein (See Attachment 1) have been determined as the areas of responsibility/jurisdiction for each local VA Healthcare System. The contractors will indicate specific areas or areas of interest by submitting an offer under the Schedule of Items as listed above. The contractor under this solicitation cannot separate facilities incorporated under a healthcare system.

7. In accordance with the prescription received from the VA, the contractor shall provide the beneficiary with the following items:

a. Humidifiers and water traps when deemed necessary. The number of humidifiers must be sufficient to insure that they are not depleted between re-supply visits. The number of traps will be based on the patient’s flow rate.

b. Disposable oxygen cannulas on hand for a change every two (2) weeks with a supply in reserve at all times until the Contractors next scheduled visit.

c. Disposable masks for change/wash every two (2) weeks with a supply in reserve at all times when masks are prescribed in lieu of nasal cannulas.

d. Twenty-five (25) to fifty (50) feet of oxygen connection tubing shall be replaced every six (6) months with an equivalent section of tubing in reserve at all times (to be included in initial set-up) until the contractors next visit.

e. Trach Collar and accessories (e.g. tubing and large volume nebulizer) with a supply on hand allowing for three (3) changes and a supply in reserve at all times until the contractors next scheduled visit.

f. Safety holders shall be provided at no cost for all veterans with a prescription for four

(4) or more cylinders.

8. Initial set-ups are defined as those beneficiaries who have not been provided oxygen therapy delivery system in the resident or nursing home on a previous occasion, or have not used such a system continuously for the past six (60) days. Switch-outs are defined those beneficiaries who are presently using an oxygen delivery system or have used such a system continuously within the past sixty (60) days.

9. The contractor shall provide the initial set-up within 24 hours of request from the COR or designee, to include weekends and holidays; this shall also apply to service calls. Initial setups may be provided by the contractor’s Patient Service Technician; does not have to be a Respiratory Therapist. The VISN 22 facilities reserves the right to obtain the service from another source and to charge the contractor with any excess cost which may result there from, if the contractor is unable to meet the 24-hour response time.

10. The contractor shall provide switch-outs by staff with documented competency training on the manufactures recommended assembly, use, and maintenance of the equipment used under this contract.

All beneficiary switch-outs shall be accomplished as soon as possible after award, but shall not exceed forty-five (45) days after contract award. Failure to perform the switch-outs as specified shall result in a forfeit of payment to the provider currently used for every day thereafter until switch out is complete.

Payments will be assessed based on that provider’s established rate and prorated from setup day.

11. Emergency Services

a. The contractor shall have a well-established communication system, providing 24-hour emergency services and the ability to provide services at the beneficiary’s place of residence with a maximum of 6 hours after a call. Emergency services shall be provided within two (2) hours of a call.

b. The Contractor shall ensure all patients have a minimum of non-electrical oxygen supply to last three (3) times the Contractor’s response time to a call. The minimum supply shall take into account each patient’s prescription flow-rate and distance from the Contractor’s location; actual supply levels any differ from the patient to patient, as long as each patient has oxygen supply to last a minimum of three (3) times the Contractor’s response time. If the Contractor is unable to respond to an emergency service call with six (6) hours, the contractor is responsible for making arrangements with another supplier to provide oxygen at the contractor’s expense. A written explanation of Contractor’s inability to provide emergency service shall be provided to the COR or authorized personnel within two (2) business days. The cost of backup oxygen systems, backup oxygen, and backup equipment shall be borne by the contractor. If H or M tanks are used for backup, the contractor shall furnish an H or M tank stand for each tank at no cost to the Government.

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

d. The contractor shall submit an Emergency Contingency Plan for natural disaster with its proposal and an updated Emergency Contingency Plan shall be provided annually to the COR.

The Contractor shall provide name and contact information for suppliers that will provide service in the event of any disaster where the Contractor cannot meet the needs of VA patients.

The Contractor shall have at least two (2) mobile phone numbers that will be available to the VA during any emergency. The Contractor shall provide phone numbers of supervisory staff that can be accessed twenty-four (24) hours a day, seven (7) days a week, during emergencies. Any changes to the emergency points of contacts or their contact information shall be communicated to VA within 3 business days.

12. No Smoking

a. The Contractor shall provide to the veteran warning signs to post on all entrances into the residence. Signs shall state, “Warning Oxygen in Use - No Smoking” or similar verbiage that clearly states smoking is not permitted due to oxygen being present. The contractor shall document that the beneficiary/care giver is instructed in the safe use of oxygen and equipment.

b. The Contractor shall provide educational and/or warning information for patients, their families, or caregivers on the hazard of smoking while oxygen is in use. The education materials must be provided upon initial delivery and every six (6) month thereafter. Education materials shall instruct Veterans on oxygen that smoke to remove the cannula, shut-off the oxygen supply, stand a minimum of 25 feet away and wait for oxygen to dissipate prior to smoking.

c. The contractor shall check if smoke alarm/detector is present at the Veteran’s place of residence. If the beneficiary’s home does not have a smoke alarm/detector, the contractor will advise the beneficiary to obtain one. The contractor shall notify the VA home oxygen coordinator within 24 hours, if the beneficiary does not have a smoke alarm/detector. The contractor shall instruct the VA beneficiary and/or caregiver to test all smoke alarms/detectors regularly.

d. Incidents where patients are reported as non-compliant with the guidelines set forth in the education and orientation material and/or whose behavior poses a risk of self harm or harm to others shall be documented by the contractor and reported to the Home Oxygen Coordinator and/or the COR.

13. Reports

The Contractor will provide a written, quarterly report meeting all The Joint Commission Standards for improving organizational performance (The Joint Commission standards may be accessed at www.jointcommission.org).

a. 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 contractor staff.

- Contractor staff’s inability to contact a patient within a reasonable period of time.

- Any other incident meeting the Contractor’s written policy for incident reporting according to accreditation standards.

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

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

d. Performance improvement – The contractor will collect data on important processes and outcomes related to patient care and organizational functions.

14. The Contractor shall provide the following emergent patient safety reports, within one (1) business day of the action, throughout the contract period.

a. Sentinel Events - The contractor is required to inform the Home Oxygen Coordinator and/or COR within one (1) business day of a sentinel event (as defined by TJC) that occurs during the performance of this contract that involves VISN22 beneficiaries. The Joint Commission defines a sentinel event as "an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof."

b. Refusal of service - All beneficiaries have the right of refusal of service. In the event a beneficiary refuses service or orders the equipment to be removed from the home, the Contractor shall comply with the beneficiary’s wishes, however in addition to a written report;

the Contractor shall report the specifics of the refusal to the COR by telephone within one (1) hour. If the refusal occurs during a home visit, the Contractor’s staff shall make an attempt to notify the COR or designee of the refusal during the home visit.

c. The contractor shall report suspected incidents of abuse or neglect to the patient by family members or caregivers. Suspected incidents shall be reported immediately (within 24 hours during business hours) to the COR or designee, as well as to the adult protective agency. The contractor will follow all state and local laws in reporting suspected incidents of abuse or neglect.

15. The Contractor shall be responsible for notifying the COR or designee by telephone at time of set- up if any alteration to the beneficiary's home is necessary to accommodate the oxygen equipment, including electrical work.

a. The Contractor is responsible for making every effort to establish appointments with VA beneficiaries when initiating set ups and deliveries. Deliveries will not be left unattended at the beneficiary’s home. If the VA beneficiary chronically fails to meet appointments, the Contractor is to notify the COR or designee. The COR or designee will contact the VA beneficiary and a corrective action plan will be implemented. The COR will notify the Contractor of any changes.

If the Contractor has not made valid and documented attempts to contact the VA beneficiaries for set ups and or deliveries the Government reserves the right to call in a third party and bill the Contractor if the Contractor fails to perform for any due month.

16. Infection Control/Communicable Diseases Requirements

a. Contractor must have a current plan for surveillance, prevention and control of infection. The plan must meet current The Joint Commission standards.

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

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

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

a. The Contractor shall notify the COR/designee or prescribing physician during the home visit if the Contractor’s staff determines that the presence of oxygen in the home presents such a danger that the oxygen must be removed, or in the case of an initial set-up, not placed in the home.

b. The Contractor shall verbally notify the COR or authorized personnel by the next business day of any unsafe conditions observed in the VA beneficiary’s home and preclude 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 or authorized personnel within one (1) business days of the incident.

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

18. Discontinuance of Service

a. The government shall notify the Contractor in the event of an order to discontinue oxygen service to any beneficiary covered under this contract. Notification shall be by telephone, facsimile and/or email. Payment will be pro-rated and terminated five (5) business days after notification to the Contractor to discontinuance service. The Contractor shall notify the COR or authorized personnel within next business day of a patient death, or upon finding a patient has moved out of the service area.

b. After notification to discontinue service, the Contractor shall remove equipment from the beneficiary’s residence at the earliest possible time but no later than 5 business days unless approved by COR or designee. The date and time of equipment pickup shall be coordinated with the patient and/or next of kin and/or significant other. The Contractor shall make every effort to meet the beneficiary’s or beneficiary’s families’ requests for pickup times. The Contractor shall honor beneficiary’s or family’s requests to pick up equipment before or after funerals or family gatherings relative to beneficiary funerals. The Contractor shall treat such requests with the utmost courtesy, and give such requests the highest priority.

19. Contractor Personnel Requirements

a. The Contractor shall develop, maintain, and make available for review upon request of the Contracting Office or COR, personnel folders for all employees providing services under this contract.

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

c. The Contractor shall provide the COR or authorized personnel with a list of all employees currently qualified to perform delivery/recovery and patient education services no more than five (5) days after contract award. The COR or designee will inspect employee files at the time of the inspection of Contract premises and vehicles.

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

e. Only Contractor employees that have been properly trained and who have demonstrated competency may perform equipment deliveries, recoveries, and patient education on the equipment. Certification of competency documents will be provided to the COR within 30 days of completion.

f. The Contractor shall have sufficient staff and have sufficient supplies to render satisfactory and courteous service at all times to beneficiaries. The Contractor shall be responsible for the acts and omissions of its employees, its sub-contractors or satellite office and their employees.

Subcontractors are required to adhere to the requirements of this contract.

g. The Contractor shall provide its employees with appropriate work attire (uniform) and require that employees present and maintain a professional appearance during the performance of this contract.

20. Contractor-Owned Concentrators

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

Standards and guidelines are as follows:

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

b. American Society for Testing Materials (ASTM) minimum standards specification for electrically

c. powered home care portable ventilators.

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

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

21. Equipment

The installation of all machines and equipment by the Contractor shall be performed by a competent professional familiar with nature of the equipment involved and fully qualified under the laws of the State in which the services are being rendered. Installation shall be consistent with local Fire and Safety Codes in the respective area of the State, and shall conform to NFPA 99/101 (Life Safety Codes) NFPA (Oxygen Cylinder Requirements).

a. The Contractor shall provide a safety/emergency checklist to be completed, then signed by the veteran or his/her caregiver and retained in the beneficiary account folder.

b. The Contractor shall ensure that all equipment is checked at manufacturer recommended intervals. A Contractor’s staff member will conduct a check of the concentrator using a certified oxygen analyzer that is calibrated according to the manufacturer standards.

c. Maintenance on equipment shall be done by a manufacturer’s checklist. It shall include compressor inlet pre-filter changes and compressor inlet bacteria filter changes according to the manufacturer recommendations. The alarm battery shall be tested at each maintenance check, changed as indicated but at least annually.

d. The Contractor is responsible for tracking and documenting maintenance of equipment in accordance with manufacturer specifications and providing these records for review upon request. Contractor shall furnish parts and labor for routine maintenance. The Contractor shall have recall procedures for equipment and supplies.

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

23. Transition Period: At the end of the contract period a transition period will be required during which incumbent Contractor will continue to provide services at the contract prices while the incoming Contractor is taking over.

24. Equipment Specifications

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

- Electrically powered (115 volts)

- Shall include a battery operated audible alarm to indicate a power failure

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

- Hour meter and OCI indicator

b. The oxygen concentrator shall be grounded internally or plug into a three-prong wall outlet appropriate for the VA beneficiary’s home (outlet adaptors are not acceptable).

25. All electrical powered equipment used in performance of this contract shall be UL approved and shall be the most recently developed in the field at the time of use.

26. Oxygen provided shall be United States Pharmacopoeia (USP) oxygen.

27. Contractor-furnished equipment and government-owned equipment shall be maintained per manufacture’s specifications. Contractor-furnish equipment shall be repaired or replaced at no cost to the Government with breakdown or malfunction is due to normal usage or due to the fault or negligence of the Contractor.

28. The contractor shall furnish under this contract only those cylinders which are in accordance with the Interstate Commerce Commission Regulations. Transportation of cylinder shall be in accordance with Code of Federal Regulation (CFR) Part 49, U.S. Department of Transportation. All “H” or “M” cylinders or any other cylinder that require a stand furnished by the Contractor shall have a stand at no additional charge to the Government. The stands will remain contractor-owned. Cylinders shall be clean (free of dust, insects, rodent residue or other soil) when delivered to VA beneficiary’s residence.

29. Site Visits Periodic, unscheduled on-site contractor and home oxygen patient visits will be made by the COR or designee to monitor the Contractor’s performance under this contract. The contractor shall make available all records and documentation necessary during the monitoring visits.

30. The Contractor shall have at least three (3) years of experience in successfully administering basic home oxygen and aerosol therapy to adult and geriatric patients. The Contractor shall coordinate, supervise and evaluate the services provided.

31. The contractor must provide staff with documented competency training to deliver prescribed supplies/cylinders/liquid oxygen (LOX) as required to each beneficiary as needed.

32. Approximately every six (6) months the Contractor will visit all VA beneficiaries on concentrators to reassess equipment compliance, educational needs, etc. Patient Service Technician (Non-RT) may perform this service. A written report will include at a minimum the following data:

a. name and social security number (SSN) of beneficiary using the equipment.

b. monitor compliance on prescription (LPM, hours per day).

c. type, hours on concentrator *Serial Numbers kept on file should be for VA owned equipment only.

d. routine maintenance, which consist of inspect internal filter, inspect condition of outside filters and change if necessary, liter flow, and oxygen concentration.

e. serial Numbers for the rented equipment shall be the vendor’s responsibility and kept on file in vendor’s main office.

f. inspection results of liter flow rate in monitoring patient compliance (as compared to prescription).

g. inspection compliance of intake filters (exchange or clean by patient).

h. follow-up education and/or reinforcement of compliance documented.

i. A report shall be developed by the Contractor, signed and dated by the contract staff and the VA beneficiary/care giver and a copy shall be left with the beneficiary. The reports shall be legible and attached to the invoice. All reports shall be submitted to the COR or designee in alphabetical order, with the monthly bills by the 10th business day of the month following service.

33. The Contractor shall develop and maintain a VA beneficiary account folder or digital file no more than five (5) days after the initial oxygen set-up, and maintain it in compliance with the Privacy Act and Health Insurance Portability and Accountability (HIPPA). All beneficiaries’ folder/files are subject to review by designated VISN22 officials and accreditation surveyors on the behalf of VISN22 during accreditation surveys or consultation. These folders/files shall include prescription, plan of care, patient education documentation, reports of infections, safety inspection, initial setup with safety check, invoices/delivery slips, equipment list w/serial numbers, changes in beneficiary care and family support system and any other documentation require by Joint Commission. Specific format of the beneficiary folder/files will be approved by the COR after contract award. All signed deliveries and or maintenance documentation shall be filed in the beneficiary’s folder/file.

34. The Contractor shall provide a written emergency management plan in compliance with Joint Commission standards. At the time of setup of equipment, the Contractor shall provide beneficiaries with a telephone number to contact with any questions or if additional information is required. The Contractor shall also provide patients with written instructions about what to do in case of a natural disaster or other emergency.

35. Standard precautions shall be used to prevent exposure to blood borne diseases when handling all contaminated equipment/items. Gloves shall be worn when handling items soiled with blood and/or body fluid. Hands shall be washed before and after visiting each patient and when gloves are removed.

Contaminated equipment shall be kept separated from clean equipment. The contractor’s warehouse shall have clean demarcation between contaminated and clean storage areas. If contaminated and clean items are transported in the same vehicles, the vehicles shall have clearly demarcated areas for contaminated and clean items. The contractor’s procedure for handling the pick-up of contaminated equipment shall meet Joint Commission Standards.

36. Patient Education Requirements 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/care giver. The written material shall be in English as well as the foreign language of the beneficiary, should the beneficiary not speak English. In the case of such an occurrence the Contractor is to advise the VAHCS to facilitate adequate instructions.

All patient education material must be presented in written form to the COR for approval prior to the award. The contractor as directed by COR or designee will implement any new or revised education material. The VA will determine whether the contractor shall use their forms or forms supplied by the VA for documentation of services provided to VA beneficiaries.

37. Veterans will be provided a copy of VA Patient Rights & Responsibilities, and any advance information concerning directives. The Contractor shall document that the beneficiary/care giver is instructed in accordance with The Joint Commission Standards.

38. The Contractor shall visit beneficiaries' residences in performance of this contract by appointment only, between the hours of 8:00 a.m. and 8:00 p.m., Monday through Friday exceptions will be made in the cases of emergencies. The Contractor is responsible for scheduling the appointments to the beneficiary’s home 24-48 hours prior to the appointment. On each scheduled setup/delivery the Contractor shall reassess the need to instruct the beneficiary on the use and care of the equipment and supplies as necessary.

39. Demurrage Charges The Contractor agrees to provide cylinders without assessing demurrage charges on the Government.

The Contractor further agrees that a free loan period of cylinders is indefinite, but shall not exceed the term of the contract.

40. The VISN22 facilities will not pay for the Contractor’s lost or damaged equipment provided under this contract unless circumstances as reviewed by the Contracting Officer are concluded to be the results of willful negligence on behalf of patients or VAHCS employees. Accordingly, this is considered to be the cost of doing business, and is the requirement of the Contractor to pay for this type of equipment. Contractor may request payment by submitting a written summary of the circumstances of lost or damaged equipment to the contracting officer within 30 calendar days of the occurrence of the incident in question. The Contracting Officer will review the summary, and a written determination will be made to the Contractor as to the liability. The VISN22 facilities will not pay for rental on equipment not being used by an authorized veteran during the performance of this contract or for equipment that cannot be found.

41. Excess Delivery The VISN 22 facilities will not pay for delivery of supplies or equipment in excess of those prescribed without prior authorization by VA.

42. Travel The Contractor shall responsible for coordinating all services for veterans who travel both within and outside the geographical area covered by this contract. Patients will be instructed by the Contractor and VA staff to notify the Contractor at least two (2) weeks before intent to travel and earlier if they are relocating.

a. Veteran covered within the purview of this contract are authorized a maximum of thirty (30) days travel, with a maximum of two (2) set-up charges within a one (1) year period from the latest home Prescription Date. Subsequent to this any other oxygen costs may be the patient’s responsibility.

b. The Contractor shall provide veteran traveling within the geographical area covered by the contract all oxygen service hereunder at the contract rate utilizing Contractor furnished equipment only. The Contractor shall invoice the appropriate VA facility as established herein.

c. The Contractor shall arrange for oxygen services for veteran traveling outside the contract area covered by the contract, including those temporarily relocating or moving out of the area. The Contractor shall be paid in accordance with established pre-travel arrangement agreement made between the Contractor and the providing vendor, and approved by the COR.

d. When making arrangements for oxygen service for travel patients, the Contractor shall utilize VA home oxygen providers and VA contracted rates to the greatest extent possible.

43. Representative of Contracting Officer The contracting Officer reserves the right to designate a representative to act for him/her in furnishing technical guidance and advice to generally supervise the work to be performed under this contract. Such designation will be in writing and will define the scope and limitation of the designee’s authority. A copy of the designation will be furnished to the Contractor no more than five (5) days after notice of award.

44. Qualifications of Offerors

a. Each branch office or distribution point must be nationally accredited by The Joint Commission or meet or exceed The Joint Commission standards. Proof of such accreditation or proof that TJC standards are met or exceeded must be submitted to the local VISN 22 facility initially and on an annual basis to provide home oxygen services. Contractor may use an accreditation body other than Joint Commission but will still be required to maintain Joint Commission standards throughout the life of this contract.

b. Contractor must maintain their accreditation throughout the duration of the contract. All prospective Contractors must include with their proposal documentation on how they have met The Joint Commission Standards.

c. Contractor will notify VA of any change in their accreditation status.

d. Any and all documentation related to the patient record during the duration of this contract is the property of the VA and will be returned to VA by the contractor upon the termination or nonrenewal of this contract.

e. Contractor will have on file a current criminal background check for each employee assigned to VA’s contract.

f. Offers will be considered only from Offerors who are regularly established in the business called for and who, in the judgment of the Contracting Officer, are financially responsible and able to show evidence of their responsibility, ability, experience, equipment, facilities, and personnel directly employed or supervised by them to render prompt and satisfactory service in the volume required for all items under this contract By the signing of this offer, Offeror is certifying that he/she shall meet all requirements of Federal, State, or local laws, codes, and/or regulations regarding the operation of this type of service.

45. Safety Requirements In the performance of this contract, the Contractor shall take such safety precautions as the Contracting Officer or the COR may determine to be reasonably necessary to protect the lives and health of all persons affected by this contract. The Contracting Officer or COR will notify the Contractor of any noncompliance with the foregoing provisions and the action to be taken. The Contractor shall, after receipt of such notice immediately correct the conditions to which attention has been directed. Such notice, when served on the Contractor or his/her representative at the site of the work, shall be deemed sufficient for the purposes aforesaid. If the Contractor fails or refuses to comply promptly, the Contracting Officer may issue an order stopping all or any part of the work and hold the Contractor in default.

46. Conformity to Regulations The Contractor and his/her employees shall conform to all regulations, Federal, State and local, governing the performance of contracted services in each state in which performance occurs.

VAMC facilities have been designated NO SMOKING areas in their entirety. Individuals found in violation of this no smoking policy may be subject to a $50.00 federal citation for disregarding posted safety rules and regulations. Furthermore, Contractor may be directed to stop work. Contractor is to notify all of his/her employees and/or sub-contractors of this strict enforcement policy.

47. Vehicles: The vehicles used in the performance of this contract must be licensed and meet the minimum requirements as mandated by each state/county/city in which performance occurs. All vehicles shall have company name and phone number on the outside.

48. Evidence of Coverage Before commencing work under the contract, the Contractor shall furnish the Contracting Officer with a certification from his/her insurance companies indicating the coverage’s for this contract have been obtained and that it may not be changed or canceled without written notice within thirty (30) days to the Contracting Officer. The coverage’s are outlined below:

a. In accordance with FAR 52.307-2(2), special circumstances apply to this contract requiring the contractor to obtain and maintenance liability insurance. Contractors are required to perform work at VA beneficiary’s place of residence. Thereby special circumstances apply.

b. Property Damage Liability. Contractors are required to have Property Damage Liability insurance coverage of at least $500,000.

49. Workmen’s Compensation Contractors are required to comply with applicable Federal and State Worker Compensation and occupational disease statutes. The Act of June 25, 1936, 42 Stat. 1938 (40 USC 290), authorizes the constituted authority of the several States to apply their workmen’s compensation laws to all lands and premises owned or held by the United States. The Contractor agrees to procure and maintain while the contract is in effect, Workmen’s Compensation and Employers Public Liability Insurance. The policy shall provide coverage for Public Liability limits of not less than the statutory limitations for any one accident, and at least meet the statutory limitations if more than one person is involved.

50. Clinical Respiratory Therapist (RT) Services A Certified / Registered Respiratory Therapist (RT) must be on staff to make home visits to VA beneficiaries on oxygen therapy to perform clinical respiratory therapist services as indicated in this paragraph. The Certified/Registered RT must be licensed and/or have practicing privileges in the state where services are to be rendered. The RT shall prepare beneficiary status reports and care plans when ordered and submit to the VA. Clinical RT Services shall be completed within 72 hours of VA’s request.

Minimum documentation shall include:

Pulse oximetry readings while on oxygen. NOTE: FOR NEW BENEFICIARIES ON THEIR FIRST

VISIT - PULSE OXIMETRY READING ON ROOM AIR ALSO MUST BE DONE IF BENEFICIARY

CAN TOLERATE IT, as applicable.

Documentation of a beneficiary’s intolerance to this procedure must include physiological symptoms.

1) Care Plan includes overall assessment, pain, nutrition, etc., as indicated;

2) Medication Profile documenting all pulmonary medications, as indicated;

3) Respiratory Discharge Summary, as indicated; and

4) Home Oxygen Communication/Progress Notes, as indicated.

51. Subcontracting plan If contract awarded to other than a small business for over $550,000, a subcontracting plan is required in accordance with FAR 19.704 and the informational subcontracting goals to be used are:

23% Small Business 05% Women-Owned Small Business 05% Small Disadvantaged Business 03% HUB Zone Small Business 03% Service Disabled Veteran-Owned Small Business

07% Veteran-Owned Small Business

52. Concentrators

1. 5 LPM Concentrator- electrical device that employs sieves and physical separation to deliver 90% or higher concentration of oxygen at flow rates up to 5 LPM.

Concentrators must meet the following specifications:

A) Deliver 90% oxygen at flow rates up to 5LPM.

B) Operate on 120 VAC, 60 Hz.

C) Have thermal protector for compressor.

D) Be double insulated and have two prong plug.

E) Have pressure compensated flow meter.

F) Have high-low pressure alarm.

G) Have power failure alarm.

H) Weight 60 pounds or less.

I) Be mounted on wheels for easy movement by patient/caregiver.

J) Must meet FDA QSR standards.

K) Minimum of three year warranty on concentrator and compressor.

L) Sound level of 60db or less.

Note: Concentrators that have oxygen sensing devices are preferred.

2. 10 LPM Concentrator - electrical device that employs sieves and physical separation to deliver 90% or higher concentration of oxygen at flow rates up to 10 LPM.

Concentrators must meet the following specifications:

A) Deliver Oxygen flow rates: (I) 95% to 92% @ 1/2 - 7 LPM flow (II) 95% to 90% @ 7-10 LPM flow (O2 Pressure: 7 PSIG (48 KPA) normal) B) Alarms for the following failures required: Power Failure,O2 Concentration (Optional), and Irregular Pressure C) Size: 26.0 H x 14.7 W x 19.1 Deep (in)

28.4 H x 39.4 W x 47.0 Deep (cm)

D) Weight: 57 lbs (26kg) (10 LPM unit) 110 volt; 60 cycle E) Be double insulated and have two prong plug F) Have power failure alarm.

G) Be mounted on wheels for easy movement by patient/caregiver.

H) Must meet FDA QSR standards.

I) Minimum of two year warranty on concentrator and compressor.

J) Sound level of 60 db or less.

Note: Concentrators that have oxygen sensing devices are preferred.

53. Oxygen Conserving device An electric or pneumatic powered device that limits oxygen flow to inspiration only and thereby increase the duration of the supply (all tank sizes outlined in the contract).

1. Pneumatic units - must meet the following specifications:

A) Flow settings from .25 to 6.

B) Have easy to read content gauge.

C) Conservation ratio of 3:1 or higher.

D) No pneumatic conserver has an alarm and not all have continuous setting E) Have at least 2 year warranty.

F) Weight less than 30 oz.

Notes:

1) Pneumatic conservers may use double lumen cannula. (higher cost, additional inventory item)

2) Conserving ratios are based on a breathe rate of 20 bpm.

3) Danger of patient desaturating on exertion due to decreased size of bolus at higher bpm.

2. Electric units - must meet the following specifications:

A) Flow settings from .5 to 6.

B) Have easy to read content gauge.

C) Conservation ratio of 5:1 or higher.

D) Bolus delivered per breath of at least 10cc per setting.

E) Have alarm for low oxygen pressure level.

F) Have alarm for “no inspiration taken”.

G) Have continuous flow setting.

H) Have at least 2 year warranty.

I) Weight less than 30 oz.

54. Liquid Oxygen System Liquid oxygen consists of large reservoir and portable unit that is filled from the reservoir. Standard reservoir holds 110 pounds of liquid oxygen and portable unit holds 3-5 pounds of liquid oxygen. The standard reservoir weighs 65 pounds full and the portable unit weighs 6-8 pounds full.

A) Reservoir must have condensation collection tray.

B) Must have quick release valve for easy refilling.

C) Flow meter range of ¼ to 6 LPM.

D) Portable must come with shoulder strap.

E) May have electrical or mechanical content indicators.

55. Liquid Oxygen System with Conserving Device Liquid system with conserving device - consists of large reservoir and portable unit that is filled from the reservoir. Standard reservoir holds 110 pounds of liquid oxygen and portable unit holds 0.9 pounds of liquid oxygen. The standard reservoir weighs 165 pounds full and the portable unit weighs 4 pounds full.

A) Reservoir must have condensation collection tray.

B) Must have quick release valve for easy refilling.

C) Must have flow settings of 1-6.

D) Portable must come with shoulder strap and belt loop holder.

E) May have electrical or mechanical content indicators.

Provide firm fixed pricing for the equipment, supplies and services per patient per month for each of the VAHCS(s) in VISN 22 by the designated Government activities stated in Attachment 1. Set up is defined as delivery of prescribed Home Medical Equipment (HME), orientation of vendor’s services, equipment assessment, patient education, basic home safety review and scheduling of ongoing deliveries and preventive maintenance inspection’s (PMI) service appointments.

The Plan of Service must be developed by VA or the contractor’s Respiratory Care Practitioner (RCP), in accordance with the Plan of Care and the appropriate clinical staff at each VA. No alteration to the prescription will be permitted without written prior approval of the Contracting Officer’s Technical Representative (COR) or the COR’s designated representative. NOTE: THE RENTAL PRICE FOR ITEMS LISTED INCLUDES, DELIVERY, SET-UP, INITIAL, AND PATIENT SERVICES TECHNICIAN VISITS (See Item #32), EDUCATION, PREVENTIVE MAINTENANCE INSPECTIONS AS SPECIFIED BY THE MANUFACTURER, TO INCLUDE ALL DISPOSABLE SUPPLIES AS LISTED:

1. Disposable supplies as outlined in contract shall be provided as follows:

a. Oxygen cannulas for change every two weeks with a supply in reserve.

b. All masks types (when prescribed) for change every two weeks with a supply in reserve at times.

c. 25-50 ft. of oxygen connecting tubing shall be replaced on a six (6) month basis with an equivalent section of tubing in reserve at all times.

d. Trach Collar and accessories (e.g. tubing, etc) allowing for change every three (3) days with a supply in reserve at all times.

2. Safety holders shall be provided at no charge for all veterans with a prescription for 4 or more tanks (cylinders).

SPECIAL CONTRACT REQUIREMENTS

1. Cost Savings Report Contractor shall provide the Government Contracting Officer Cost Savings Reports (TBD) for the Government facility participating in this contract. This report shall be received by the Government Contracting Officer not later than the 15th day of each month following the end of each quarter of the Government Fiscal Year (October 15th, January 15th, April 15th, and July 15th). It is the contractor’s responsibility to insure these reports are received on a timely basis. Contractors not submitting the report by the required date are subject to contract termination.

2. Contract Administration Data The Contracting Officer is the only person authorized to approve changes or modify any of the requirements under this contract. Only the Contracting Officer is authorized to make commitments or issue changes which shall affect price, quantity, or quality of performance of this contract. In the event the Contractor effects any such change at the direction of any person other than the Contracting Officer, the change shall be considered to have been made without authority and no adjustment shall be made in the contract price to cover any increase in costs incurred as a result thereof.

3. The Joint Commission, VHA (Veterans Health Administration) and Other Standards

a. The contractor must perform the required work in accordance with The Joint Commission (TJC) standards. The contractor must comply with all annual updates as issued.

b. The contractor shall meet all Federal, State, and local fire and life safety codes.

c. Contractor agrees to maintain the minimum acceptable service, reporting systems and quality control as specified herein. Failure to comply with the specified terms and conditions and/or adverse reports from external monitoring agencies that indicate poor quality of care may be grounds for termination of the contract. Immediate (within 24 hours) notification must be given to the VA COR regarding adverse action by a regulatory agency.

d. The services specified in the Schedule of Services may be changed by written modification to this contract with mutual written consent of both parties. VA Contracting Officer will prepare the modification.

e. The contractor shall furnish the services specified in the Schedule of Services to this contract to VA when authorized by VA Medical Center Director or designee.

4. Administrative Requirements For Contractor Employee Competencies

a. The Contractor will be responsible to ensure that Contractor employees providing work on this contract are fully trained and completely competent to perform the required work.

b. The Contractor is required to maintain records that document competence/performance level of Contractor employees working on this contract in accordance with JCAHO and other regulatory body requirements.

c. Notwithstanding other contract requirements, upon request of the Contracting Officer, the Contractor will remove from the work site, any Contractor employee who does not comply with orientation requirements or meet competency requirements for the work being performed.

d. When changes in Contractor personnel occur, the Contractor must provide evidence of orientation, the current competence assessment, and current performance evaluation.

5. Personnel Policy The Contractor shall assume full responsibility for the protection of its personnel furnishing services under this contract, in accordance with the personnel policy of the Contractor, such as providing worker’s compensation, professional liability insurance, health examinations, income tax withholding, and social security payments.