Attachment 1 - Draft CTX PWS Ground Ambulance.pdf

Performance Work Statement (PWS)

GROUND AMBULANCE

VISN 17/Station 674 NAICS 621910

36C25727R0002 Attachment 1 - Draft CTX PWS Ambulance Ground 1

1. Purpose: The Central Texas Veterans Health Care Center (hereafter CTVHCS), its associated

Community-Based Outpatient Clinics (CBOCs), and affiliated healthcare clinics require contracted non-emergency ambulance transportation services. The contractor shall provide all vehicles, personnel, management, supplies, equipment, and necessary reporting for the provision of Stretcher Transports for Basic Life Support (BLS), Advanced Life Support (ALS), and Critical Care Transport (CCT) services. The contractor shall make these ambulance services available to the VA as needed, 24 hours a day, seven days a week (24/7), including weekends and holidays.

2. Background: The CTVHCS main campus is located at 1901 Veterans Memorial Drive, Temple, TX 76504, serving over 252,000 veterans, primarily from the Temple, Waco, Austin area and it’s 7 Community-Based Outpatient Clinics. The hospital has 519 inpatient beds and sees approximately 5,390 inpatient admissions and 116,400 outpatient visits a year. Veterans served within this facility lives within the following counties and zip codes.

County County County County County

Bell Llano Milam Blanco Williamson

Hays Fayette Bastrop Travis Lee

San Saba Hamilton Lampasas Mills Coryell

Bosque Hill McLennan Falls Limestone

Leon Robertson Summerville Comanche Erath

Brown Anderson Navarro Freestone Robertson

Brazos Burleson Washington Caldwell

3. Acronyms

ALS – Advanced Life Support AOD – Administrative Officers of the Day BLS – Basic Life Support CCT – Critical Care Transport CCTP – Critical Care Transport Paramedic CCEMTP – Critical Care Emergency Medical Transport CO – Contracting Officer COR – Contracting Officer’s Representative CPR – Cardiopulmonary Resuscitation DOL – Department of Labor EMT – Emergency Medical Technician IAW – In Accordance With OO – Ordering Officer PWS – Performance Work Statement QASP – Quality Assurance Surveillance Plan QC – Quality Control Plan TB – Tuberculosis TJC – The Joint Commission VTS – Veteran Transportation Service

4. Scope/Requirements

4.1. Types of Ambulance Service

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4.1.1. The contractor shall provide urgent, non-emergent Stretcher Transports for Basic Life Support (BLS), Advanced Life Support (ALS), and Critical Care Transport (CCT) Tier 1, 2, and 3 ambulance services on an as-needed basis in accordance with all federal, state, and local regulations.

4.1.2. Occasionally a veteran will need to be transported with VA staff and equipment; the contractor shall return VA Staff and equipment to the original place of pick-up.

4.2. Transport of Miscellaneous Items with the Patient

The Contractor may also be required to transport patient luggage, medical records, medication, and comfort items from pickup points to the destination at no additional cost to the Government. Luggage to be transported will be restricted to suitcase and valise types. When patients are transported to the CTVHCS, the destination is deemed to be the ER, Admissions, the clinic, or service within the hospital, or directly to the ward as instructed by VA Staff.

4.3. Contractor Personnel: Contractor personnel shall be courteous and always conduct themselves in a businesslike manner while providing services under this contract.

4.3.1. Emergency Medical Technicians (EMTs), Critical Care Transport Paramedics (CCTPs) & Other Personnel

4.3.1.1. EMTs, CCTPs and other medical personnel (as applicable) shall at all times meet the qualifications specified in this contract as well as all applicable federal, state, and local government laws, regulations, and standards. EMTs, CCTPs and other medical personnel (as applicable) shall be certified, licensed, or otherwise officially recognized by the local, state, or regional government or public entity where the emergency service is operated or by which it is governed.

4.3.1.2. If the contractor wishes to add or replace personnel throughout the life of the contract, it shall provide evidence of required training, certifications, licensing (i.e., Driver & Transportation-for Hire) and any other qualifications to the Contracting Officer’s Representative (COR) for review.

4.3.1.3. All ambulance drivers shall have a valid driver’s license in accordance with state requirements for their place of operation and the services they perform. If the contractor wishes to add or replace drivers throughout the life of the contract, it shall provide a valid driver’s license to the COR.

4.3.1.4. CCTPs shall have met all state requirements for the tier in which they are performing services in (I, II, III). Proof in the form of a current certificate for the successful completion of such must be provided to the COR upon request.

4.3.1.5. Investigative Requirements for Contract Personnel: Contract personnel will be subject to the same investigative requirements as those for regular VA appointees and employees. The level of investigation commensurate with the level of access to perform the performance work statement is: Special Agreement Checks (SAC). Fingerprinting for contract personnel will be conducted at CTVHCS. Thereafter the contracted employees will be subject annually to the same requirement, with a 90-day window to complete such requirement as provided by CTVHCS. The Workforce Management and Consulting, Human Resource Operation Office, Personnel Security Contracting Team (WMC HROO PerSec Contractor Team) is

36C25727R0002 Attachment 1 - Draft CTX PWS Ambulance Ground 3 responsible for adjudicating all background investigations for contract employees.

4.3.1.6. EMTs, CCTPs, and other contractor personnel as applicable must pass the Contractor’s background check and must not have been convicted of (or have any pending charges for) a felony for the past five years. Personnel (and Contractor) must report any new or additional charges or convictions if they arise during the course of performance under this contract so VA can review them and determine whether the employee in question needs to be discharged of his or her duties until the matter is adjudicated. The contractor, when notified of an unfavorable determination by the Government, shall withdraw the employee from consideration from working under the contract. Failure to comply with the contractor personnel security requirements may result in termination of the contract for cause.

4.3.2. Tuberculosis Exposure Control Policy

4.3.2.1. The contractor shall provide the VA with a policy on tuberculosis (TB) exposure and control, to include TB decontamination.

4.3.2.2. The contractor shall have its personnel tested for TB in accordance with state guidelines and provide written confirmation to the COR that all personnel (current employees and any new hires) performing services under this contract are current in their TB test at the start of each Ordering Period.

4.4 Contractor Equipment, Vehicles, and Inspection

4.4.1. Ambulances shall meet all applicable federal, state, and local regulations and specifications, including but not limited to licensing (i.e., Driver & Transportation-for Hire), registration, and safety standards.

4.4.2. The VA reserves the right to inspect the contractor’s equipment and vehicles or require documentation of compliance with state laws, rules, regulations, and guidelines governing emergency medical transport vehicles (ambulances). VA inspections of contractor equipment do not constitute a warranty or guarantee that the contractor’s vehicles and equipment are properly maintained. The VA reserves the right to restrict the contractor’s use of equipment and vehicles in the performance of this contract which are not in compliance with contract requirements. The restriction of such equipment and vehicles shall not relieve the contractor from performance in accordance with the contract nor necessitate additional cost to the VA.

4.4.3. Vehicles shall be clean and maintained in good repair in accordance with manufacturer’s instructions.

4.4.4. The contractor shall not borrow or exchange supplies, equipment, and/or medications with the

VA. Equipment attached to or in use by the patient at time of pick-up may remain with the patient during transport to ensure continuity of care. Medical Control Authorities are responsible for maintaining and supplying medication during patient transport. All VA equipment and unused medications must be returned to VA during patient drop-off or as promptly as feasible within 24 hours.

4.4.5. The contractor shall furnish all linen required for patient transport at no additional cost. Linen shall not be exchanged with linen belonging to CTVHCS or its CBOCs.

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4.4.6. The contractor must be capable of transporting the drugs and/or equipment as required by the patient as listed in Attachment A Critical Care Transport (CCT) Capabilities Confirmation. The contractor shall have the appropriate medications, including Critical Care Transport, if necessary, based on the EMS region the ambulance provider is functioning in.

4.4.7. The contractor shall furnish qualified personnel as required by contract specifications to accomplish all services under this contract.

4.4.7.1. The contractor personnel performing services for the VA, shall, at all times, conduct themselves in a professional manner, and be identified by having the company name, and employee name affixed to the uniform. The Contractor shall be responsible for furnishing all vehicles, uniforms, nametags and/or badges for performance of services under this contract.

Employee identifications shall be worn in clear view above the waist. The contractor personnel shall not smoke/play loud music originating from any device in vehicles while transporting VA patients.

4.4.7.2. Each driver shall possess a driver’s license that is valid for the class of vehicle driven.

Evidence of a special transportation service vehicle permit, or endorsement issued by the commissioner of public safety.

• Be at least 18 years of age and have not less than one year of experience as a licensed driver; and o For the past three years:

▪ Have not had a driver’s license canceled or suspended.

▪ Have a driving record clear of convictions for operating a motor vehicle or motorcycle without insurance.

▪ Have a driving record clear of convictions for driving a motor vehicle without a valid current license for the class of vehicle driven

▪ Have a driving and criminal record clear of convictions for driving under the influence of alcohol or a controlled substance.

4.4.7.3. The contractor personnel will ensure that the patient is secured to the stretcher/cot and that the stretcher /cot is secure in the back of the ambulance before the vehicle moves.

4.4.7.4. Ambulance drivers shall have a valid driver’s license, in accordance with Federal, State, and local government requirements for their place of operation for the services they perform, be capable of administering oxygen and shall have successfully completed the standard and advanced first aid course of the American Red Cross of U.S. Bureaus of Mines of equivalent and be capable of providing necessary medical assistance to the attending emergency medical technician or paramedic.

4.4.7.5. Emergency Medical Technician (EMT) and Paramedic Qualifications: EMT’s and

Paramedic’s providing services under this contract shall have the following qualifications, in addition to those required by Federal, State, and Local Government:

• Have completed training in accordance with the standards published by the Department of Health and Human Services with a minimum curriculum of 150 hours or equivalent including an in-hospital training period. Such training programs must also be acceptable under the

36C25727R0002 Attachment 1 - Draft CTX PWS Ambulance Ground 5 regulating requirements for local EMS Systems supported by DHHS under PL 93-154, Federal Register 39:24304. (1974).

• Shall be certified, licensed, or otherwise officially recognized by the local, state of regional government or public entity where the emergency ambulance service is operated or by which it is governed.

4.5 Transportation Request

4.5.1 VetRide or VA-approved Transportation Software Utilization:

The contractor agrees to utilize the VetRide Vendor Portal or VA-Approved Transportation Software with every patient transported under this contract.

Department of Veteran Affairs will provide the software and access to the VetRide Vendor Portal or VA-

Approved Transportation Software for the vendor/contractor in this contract. The Contractor will utilize the VetRide Vendor Portal or VA-Approved Transportation Software fully as instructed:

a) Receive and respond to electronic trip requests

b) Receive, use, and ensure the use of the Vendor pass by the driver.

c) Removed.

d) All invoices must be submitted within 30 calendar days of date of service in accordance with 38

CFR 70 to be considered timely submission.

e) Unauthorized charges will be reviewed by the Contracting Officer’s Representative (COR) as to the validity of the charges and as to whether the payment will be made. A final determination will be made within 30 days after notifying the Contractor of the charges that are being suspended.

4.5.1.1. A transportation request is defined as one incident of a request for one-way service (Stretcher Transports for BLS, ALS, CCT). No more than one patient will be transported per order unless approved by an authorized VA staff. Transportation requests will be made through VetRide or VA-Approved Transportation Software Utilization. Contractors must have the capability to receive orders, update ride status, and input trip costs and other required data through this portal. Contractors must have dedicated staff available to monitor this portal 24/7. CTVHCS Travel Program Staff will be available to assist with account setup and training for the Contractor’s Staff. In the event VetRide or other VA-Approved Transportation Software Utilization is down, other methods of communication (i.e., telephone, facsimile) will be used to place Transportation requests.

4.5.1.1.1 CTVHCS Travel Program Staff/or authorized VA employees will work with the

Contractor the following business day to reconcile any transportation requests that were placed outside of VetRide or VA-Approved Transportation Software Utilization.

4.5.1.1.2 “Reconcile" refers to the collaborative process undertaken by VA staff and the contracted vendor to ensure the consistency and completeness of transportation records. This process involves comparing and updating the records to account for any transportation requests that were not initially captured in VetRide or the VA-approved transportation software due to system unavailability. Reconciliation

36C25727R0002 Attachment 1 - Draft CTX PWS Ambulance Ground 6 ensures that all transportation requests are accurately recorded and reflected in the system.

4.5.1.2 Only the following VA staff are authorized to place, cancel, or make changes to transportation requests:

Contracting Officer (CO) Ordering Officers (OO) Administrative Officer of the Day (AOD) Beneficiary Travel Office Staff Contracting Officer’s Representative (COR)

The Contracting Officer will furnish the Contractor with the names of individuals above, who are authorized as Ordering Officers, by separate memorandum upon issuance of the contract. The Contracting Officer will update this list throughout the life of the contract as Ordering Officers change.

Ordering Officers are responsible for issuing and administering orders placed under this contract. Ordering Officers have no authority to modify any term of this basic contract. Any deviation from the terms of the basic contract must be approved in writing by the Contracting Officer responsible for this contract. The Contractor shall accept orders against this contract only from the Contracting Officer and/or authorized ordering officers. Fulfilling orders from persons other than the Contracting Officer or ordering officer may result in loss or delay in payment for supplies/services provided under such orders.

Non-authorized VA employees and private agencies (e.g., nursing homes) are not considered authorized to place transportation requests.

4.5.1.2.1 All patient pick-up(s) and drop-off(s) shall be authorized via “orders” which shall only be issued by the designated Ordering Officers. When placing orders for services, the Ordering Officer shall contact the designated contractor point of contact(s) to provide the following information:

▪ Mode of transportation required

▪ Required time of arrival

▪ Name of the beneficiary

▪ Pick-up and delivery point

▪ Type and number of additional medical care specialists required

▪ Type of equipment required

▪ Last four of the patient's Social Security Number, and

▪ Any other special instructions

4.5.1.3 For ALL Transports – an Audit system will be put in place by the VA to include the COR or designee, Beneficiary Travel Department staff, and clinical staff to ensure appropriateness of the order and timeliness of the response.

4.5.1.4 The type of transportation service (Stretcher Transports for BLS, ALS, CCT) required will be discussed and determined by VA clinical personnel and the contractor. The contractor shall transport the patient per its policies and standard industry practice. If the type of transportation service differs from what was agreed upon by the VA and contractor, the contractor shall submit documentation to the VA explaining its rationale.

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4.5.1.5 The VA may authorize an escort (e.g., spouse, relative, guardian, etc.) to accompany the patient during medical transport if it is practicable and, in the patient’s, best interest. The contractor shall allow the escort to accompany the patient at no additional cost.

4.5.1.6 Removed.

4.5.1.7 Removed.

4.5.1.8 The patient may bring with her or him up to three (3) liters of oxygen. The contractor shall be responsible for providing adequate and safe storage of the oxygen tanks during transport.

4.5.1.9 Response Times*

4.5.1.9.1 Orders that are scheduled by 7pm local time the day before the required services are defined as scheduled in advance. With the exceptions found below, the contractor shall arrive on time for all orders scheduled in advance.

4.5.1.9.2 Urgent Transport (Originating from VA (Only)): The contractor shall be required to provide ground ambulance transportation within thirty (30) minutes of order/patient pick-up call.

4.5.1.9.3 For all add-on transportation requests (not scheduled in advance) with pickup at CTVHCS: The contractor will be allotted up to a sixty (60) minute response time to “accept or deny the trip” from the time of order placement for transportation requests that are not previously scheduled in advance.

a. For an urgent transport request for a critical patient (as deemed by the physician) with pick up at CTVHCS, the contractor will be allotted up to a thirty (30) minute response time.

4.5.1.9.4 For transportation requests which do not have a pick-up at CTVHCS:

a. The contractor may be required, if requested by the VA, to dispatch ambulances on short notice for transportation requests not scheduled in advance; for these transportation requests the contractor shall dispatch ambulances within thirty (30) minutes of receiving the order.

b. Pick-up appointment times shall be agreed upon by the VA and contractor at time of order placement and be reasonable based upon travel distance, speed limits, and weather conditions.

c. Vendor Responsibility for Pick-Up and Drop-Off Times: The vendor is responsible for managing and recording pick-up and drop-off times to ensure timely transportation for Veterans.

1. Management and Entry of Pick-Up Times:

All pick-up times must be managed by the vendor and accurately recorded in the VetRide system.

2. Veteran’s Scheduled Appointment Time:

The Veteran's scheduled appointment time is annotated in the VetRide system to ensure proper coordination.

3. Scheduled Pick-Up Time:

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Pick-up times should be scheduled to ensure the Veteran arrives on time for their appointment.

4. Drop-Off Times:

Drop-off times must occur within a reasonable period after the Veteran's appointment. Veterans should not have to wait more than 1 hour after their appointment to be transported home.

* The contractor shall not be held liable for nonperformance caused by an occurrence beyond the reasonable control of the contractor and without its fault or negligence such as, acts of God or the public enemy, acts of the Government in its sovereign or contractual capacity, fires, floods, epidemics, quarantine restrictions, strikes, and unusually severe weather. The contractor MUST notify the VA with as much advance notice as possible should any of these occur.

4.5.2 Cancellations

4.5.2.1 For trips in which the contractor is notified of cancellation before the vehicle is dispatched, there shall be no charge to the Government.

4.5.2.1.1 A “no show” is defined as a transportation request which is cancelled after the contractor has dispatched a vehicle, the vehicle is enroute, or has arrived at the pick-up location, and there is no longer a requirement for patient transportation. The contractor may request one-way reimbursement for no-shows. No-show reimbursement shall be based upon the base rate for the type of service requested (Stretcher Transports for BLS, ALS, CCT) and the one-way mileage (Stretcher Transports for BLS, ALS, CCT) accrued enroute to the pick-up location at time of cancellation. Mileage for no- show cancellations shall be confirmed by the contractor and reported to the VA as soon as possible from time of cancellation.

4.5.2.2 For transportation requests OUT of CTVHCS ONLY – The contractor will immediately dispatch a vehicle upon receipt of the order (including transportation requests in which the final destination may change prior to pick up due to the critical condition of the patient).

When the contractor is notified of a cancellation prior to arrival at the CTVHCS campus, there shall be no charge to the Government.

4.6 Pick-Up/Drop-Off/Reporting Procedures

4.6.1 Ambulance personnel shall pick-up and deliver patients at specified locations (e.g., front door of

CTVHCS Entrance). These locations will be specified by VA staff when an order is placed and communicated to the transporting personnel.

4.6.2 When applicable, ambulance personnel shall report to the Veteran Transportation Service (VTS)

Dispatcher or Administrative Officer of the Day (AOD) to (1) announce his/her arrival to pick-up and transfer the patient and (2) obtain report of pertinent information regarding the patient’s condition from the primary nurse/physician.

4.6.3 When delivering a patient, ambulance personnel shall give report to the appropriate VA healthcare staff and provide a copy of the run sheet which will be retained by the facility for inclusion to the patient’s medical record.

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4.6.4 In cases where ambulance personnel must divert to a local emergency department while performing a VA authorized transport, the contractor’s dispatcher shall notify the VA Beneficiary Travel Department or Administrative Officer of the Day of the patient’s location and status as soon as this information becomes available.

4.7 Patient Welfare

4.7.1 The contractor shall be responsible for the patient’s welfare during transport. The contractor shall be held responsible for patient and/or VA property during transport. Any damaged or lost wheelchairs, walkers, crutches, or personal belongings shall be replaced at the contractor’s expense.

4.7.2 The VA requires the contractor to exercise extreme caution and care in the handling of patients.

4.7.3 If a VA beneficiary being transported declines to be properly secured or removed the securement devices himself/herself, the driver will notify the Contracting Officer’s Representative (COR) of this fact prior to departure. The contractor is not required to transport any VA beneficiary who refuses to be properly secure while being transported. In the event that the beneficiary refuses to be properly secured, they shall be returned back into the building which they came from.

4.8 Incident Reporting

4.8.1 The contractor shall notify the COR, Requestor, Program Manager, Beneficiary Travel

Department, of any accidents and/or safety problems that occur while the patient is being transported. This notification shall occur within one (1) hour by telephone. A written report of the incident shall be delivered to the COR, Program Manager, or Beneficiary Travel Department, by the close of business of the next working day.

4.8.2 The COR will monitor the service provided. The contractor shall cooperate with the COR in providing information and answering questions in a timely manner. The contractor shall promptly inform the COR of any complaints received directly from patients. If warranted, the VA may conduct incident investigations and require written response from the contractor within 48 hours of request.

4.9 Invoicing

4.9.1 Each transport shall include thirty (30) minutes of wait time; the contractor may invoice for wait times in excess of this initial thirty (30) minutes VA notification/approval. Wait time shall begin only once the contractor has both reached the pick-up address location and the scheduled pick-up time has elapsed. All wait times shall be itemized and invoiced in fifteen (15) minute intervals. For partial fifteen (15) minute intervals, zero (0) to seven (7) minutes shall be rounded down to zero (0) minutes and eight (8) to fifteen (15) minutes rounded up to fifteen (15) minutes.

4.9.2 When invoicing for mileage, the contractor shall round to the nearest mile. Mileage ending in .5 or higher shall be rounded up to the nearest mile. Mileage ending in .4 or lower shall be rounded down to the nearest mile. Payment for mileage to or from the point of care shall be limited to the VA’s calculation according to the VA’s Bing Maps API determination. Bing Maps API is optimized to determine mileage based on the shortest time of travel.

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4.9.3 Long Distance Mileage — Payment for mileage outside the contract miles covered in the base rate, shall be at the mileage rate stated in the price schedule, and shall be based upon the miles from the pick-up point and the specified destination. Any mileage from the place of business and/or location of vehicle and the pick-up point, or from the delivery destination back to the place of business and/or location of next trip are not considered as a separate item of this reimbursement but would be expected to be incorporated into the mileage rate as part of the administrative costs (or costs of doing business). *Base Rate- Base Rate is defined as the rate paid for one-way transportation and handling of a patient, from the designated pick-up point to a designated drop-off point. This rate will be paid for all VA-initiated one-way trips ordered under this contract action up to 25 miles.

4.9.4 Upon notification of the contracting officer, the vendor must receive training and begin implementation of invoices via Vet Ride within 30 days.

Payment by VA under this contract to a provider of ground ambulance transportation services authorized under this contract extinguishes any and all liability on the part of the VA BENEFICIARY for that transportation service. UNDER NO CIRCUMSTANCES ARE VA BENEFICIARIES, THIRD PARTY

INSURANCES, MEDICARE, OR MEDICAID TO BE BILLED FOR THE SERVICES PERFORMED

UNDER THIS CONTRACT.

5 Period & Place of Performance

5.4 This contract’s ordering period shall be effective from Date of Award through 12 months.

5.5 The Place of Performance is variable and may occur within the state of Texas, and the CTVHCS catchment area; ambulance services may be required to or from locations including, but not limited to the following:

5.5.1 CTVHCS to include specific Clinics, Emergency Department, pavilions, or out-buildings on the CTVHCS campus. The CTVHCS address is: 1901 Veterans Memorial Drive, Temple, TX 76504- 7451.

5.5.2 CTVHCS Community-Based Outpatient Clinics (CBOCs):

CBOC Name: Address:

Doris Miller VAMC 4800 Memorial Drive Waco, TX 76711-1329

Austin VA Outpatient Clinic 7901 Metropolis Drive Austin, TX 78744-3111

Bryan/College Station CBOC 1651 Rock Prairie Road, Suite 100 College Station, TX 77845-8652

Brownwood CBOC 2600 Memorial Park Drive Brownwood, TX 76801-5950

Cedar Park CBOC 1401 Medical Parkway, Suite 400, Building C Cedar Park, TX 78613-2216

Copperas Cove CBOC 336 Town Square, Town Square Plaza Copperas Cove, TX 76522-2800

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Killeen CBOC 1001 East Veterans Memorial Boulevard, Midtown Mall, Suite 400 Killeen, TX 76541-7292

Palestine CBOC 300 Willow Creek Parkway, Willow Creek Medical Plaza, Suite 100 Palestine, TX 75801-4433

Lagrange Satellite Clinic 2 Saint Marks Place LaGrange, TX 78945-1251

Temple VA Clinic 4501 South General Bruce Drive, Suite 75 Temple, TX 76502-1466

5.5.3 Other VA Medical Centers, Hospitals, or CBOCs within Veterans Integrated Service Network (VISN) 17 including, but not limited to:

Medical Center Name: Address:

North Texas VA HCS 4500 S. Lancaster Rd.

Dallas, TX 75216

South Texas VA HCS 7400 Merton Minter San Antonio, TX 78229

West Texas VA HCS 300 W. Veterans Blvd.

Big Spring, TX 79720

El Paso VA HCS 5001 N. Piedras St.

El Paso, TX 79930

Valley Coastal Bend VA HCS 2601 Veterans Dr.

Harlingen, TX 78550

Amarillo VA HCS 6010 W. Amarillo Blvd.

Amarillo, TX 79106

5.5.4 Other Non-VA Medical facilities and Community Care facilities as authorized by the VA.

5.5.5 Veteran’s residence.

5.5.6 Local airports including: Killeen Regional Airport, Austin Bergstrom Airport, Waco Regional

Airport, Draughon-Miller Central Texas Regional Airport.

6 Quality Control Plan

6.4 Quality Control

6.4.1 The contractor shall maintain a Quality Control Plan (QCP) that contains, at a minimum, the following:

6.4.1.1 A description of the company’s organizational structure including a description of the roles and responsibilities of management and supervisors.

6.4.1.2 A description of the methods to be used by the contractor for identifying and preventing deficiencies or problems in the quality of service.

6.4.1.3 A description of the specific steps the contractor will take for corrective action if needed if a deficiency or problem in the quality of service occurs.

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6.4.1.4 A description of the company’s records and tracking system used to identify up-to-date background checks, applicable certifications and tests, and training of each employee performing services under this contract.

6.4.1.5 A description of the method used to provide on-time ambulance services to meet the requirements of this contract (24/7 availability for transport in accordance with PWS 4.5.1.7).

6.4.1.6 A description of the methods used to identify and prevent radio communication breakdowns and a detailed procedure for alternative communications in the event of electronic and mechanical breakdown of vehicle two-way radios.

6.4.1.7 CONTENGENCY PLAN: (In case VetRide Vendor Portal is down) A description of the method/system used to log all requests for service. The contractor shall confirm that the log indicates the date and time of service call, actual time of pick-up versus the scheduled time, name of patient requiring services, designated pick-up and delivery points, mileage, and actual waiting time at pick-up and delivery points if waiting charges are claimed. The contractor shall confirm the log will be sent to the COR monthly.

6.4.2 The Government will evaluate the contractor’s performance under this contract to ensure that the contractor’s QCP is adequate, and that quality is achieved through a Quality Assurance Surveillance Plan (QASP).

6.4.3 The Government shall prepare a QASP after contract award derived from the PWS and contractor’s submitted quality control plan. The QASP is a “living document” and the Government may review and revise it at any time. However, the Government shall coordinate changes to the QASP with the contractor.

6.4.4 The QASP will specify the work requiring surveillance and the Government’s method of surveillance.

6.5 Minimum Performance Standards

6.5.1 The contractor shall maintain performance standards in accordance with the standards outlined in the table below. Failure to meet the Acceptable Quality Levels (AQL) may result in termination of the contract.

6.5.2 The QASP will include the standards below as well as others derived from the successful offeror’s quality control plan.

Task PWS Reference

Standard Acceptable Quality Level

Method of Surveillance

Provide on-time ambulance services

Section 4.5.1.8.3

Scheduled patient pick-ups shall not deviate more than 15 minutes past scheduled pick-up time for scheduled orders

97% Customer Feedback

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Incident Reporting

Section 4.8 The contractor shall notify the Program Manager, Beneficiary Travel Department, of any accidents and/or safety problems that occur while the patient is being transported. This notification shall occur within one (1) hour by telephone. A written report of the incident shall be delivered to the Program Manager, Benefits Management, by the close of business of the next working day.

97% Customer Feedback

Invoice Reports

Section 4.9 Provide a monthly invoice including secondary documentation in accordance with Section 4.10 of the

PWS

95% 100% inspection of monthly invoices/reports

7 COVID-19 Or Other Similar Infectious Diseases

7.4 Contractor shall not refuse transports of COVID-19 positive or other similarly infected patients.

7.5 Contractor shall abide by all additional procedures and precautions that may be implemented by the

VA based on VA-issued guidance and/or CDC recommendations. These procedures are subject to change throughout the life of the contract and will be incorporated via attachment (See S03 VTS Patient Transport PPE and Vehicle Cleaning/Disinfection SOP).

7.6 Contractor shall have written policy of steps they will take to prevent the spread of COVID-19 or other similarly infectious diseases by their employees and/or vehicles. This policy shall, at a minimum, include procedures of screening drivers before each shift, deliberate decontamination of their vehicles and all other preventative precautions taken by Contractor employees.

7.7 Contractor shall furnish all required PPE throughout the life of the contract.

8 Conformity To Regulations

8.1 The contractor and his/her operators shall conform to all Federal, State, and local regulations governing the performance of contracted services.

8.2 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, the contractor may be directed to stop work. The contractor is to notify all of his/her employees and/or sub-contractors of this strict enforcement policy.

9 Wage Rates

9.1. Wage Determination(s) as listed in Section D in this solicitation are applicable to any resulting contract.

9.2. The contractor certifies by signature on this offer that the salaries to be paid workers involved in the performance of the contract are equal to or greater than those specified in the attached Wage Determination(s).

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9.3 The Department of Labor has held that contractors must pay their employees the Service Contract Act wage while they are driving both to and from destinations for the VA. The contractor and subcontractors shall abide by the SCA and stay abreast of all its provisions and guidelines at www.dol.gov.

10 Evidence of Coverage

10.1 Before commencing work under the contract, the contractor shall furnish the Contracting Officer with a certification from his/her insurance company indicating that the coverage outlined in this contract has been obtained and that it may not be changed or canceled unless a 30-day advance written notice is provided to the Contracting Officer.

11 Worker’s Compensation

11.1 The Act of June 25, 1936, 42 Stat. 1938 (40 USC 290), authorized 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, Workers’ 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. Upon award of the contract, the contractor shall furnish to the Contracting Officer a certificate from its insurance company indicating that this coverage has been obtained and that such coverage may not be changed or canceled unless a 30-day advance written notice is provided to the Contracting Officer.

12 Contractor Personnel Security Requirements

12.1 The contractor shall agree that all deliverables, associated working papers, and other material deemed relevant by the contractor in the performance of this task order are the property of the United States Government. The contractor shall agree that all individually identifiable health information shall be treated with the strictest confidentiality. Access to records shall be limited to essential personnel only.

Records shall be secured when not in use. At the conclusion of the contract, all copies of individually identifiable health records shall be destroyed or returned to the VA. Any individually identifiable health records shall be deleted from computers not belonging to the VA. The contractor shall comply with the Privacy Act, 38 U.S.C. 5701, 38 U.S.C. 7332, and 5 U.S.C. 552(a) et. Seq. Contractor staff shall sign confidentiality statements before the start date of the contract. The contractor shall comply with all provisions of the Health Information Portability and Accountability Act (HIPAA), including but not limited to privacy, security of electronic health data, and adherence to standards and code sets as required by HIPAA. The contractor shall ensure the confidentiality of all patient and employee information and shall be held liable in the event of breach of confidentiality. Any person who knowingly or willingly discloses confidential information obtained from the VA with non-essential persons, may be subject to fines.

12.1.1 HIPAA COMPLIANCE. HIPAA compliance is required. The contractor must adhere to the provisions of Public Law 104-191, Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the National Standards to Protect the Privacy and Security of Protected Health Information (PHI).

As required by HIPAA, the Department of Health, and Human Services (HHS) has promulgated rules governing the security and use and disclosure of protected health information by covered entities, including the Department of Veterans Affairs (VA). In accordance with HIPAA, the contractor may be required to enter into a Business Associate Agreement (BAA) with VA.

12.1.2 BLOOD BORNE PATHOGENS: The contractor and the employees provided, pursuant to this

36C25727R0002 Attachment 1 - Draft CTX PWS Ambulance Ground 15 contract, shall comply with the effective VAMC Policy (and Occupational Health requirements in accordance with OSHA Blood Borne Pathogens (BBP) Law and the OSHA Tuberculosis Compliance Directive, enforceable under OSHA’s General Duty Clause) governing health care workers infected with a blood borne pathogen. If the contractor obtains information that a health care worker providing care pursuant to this agreement may be infected with a blood borne pathogen, the contractor will advise the Contracting Officer immediately.

13 Medical Liabilities Insurance

13.1 The contractor shall carry required insurance (See VAAR Clause 852.237-70 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE) and vehicle insurance in accordance with the Texas Department of State Health Services.

14 Annual VHA Training

14.1 In accordance with VHA Directive 2003-028 "Compliance and Business Integrity Program", its updates or replacement directives, IG Guidance at 8994, Section II(C); Guidance at 4875, Section III (B)(4) Sentencing Guidelines, Section 8B2.1 (b) (4) (B) annual compliance training is to be provided to all contractors within the scope of their work. The medical center COR’s are to coordinate the annual training with their respective Contracting Officer and Compliance and Business Integrity Officers. A copy of the documentation of the completed annual training is to be provided to the Compliance and Business Integrity Officers for their files.

In accordance with VHA Directive 1605.01 “Privacy and Release of Information”, updates or replacement directives annual VHA Privacy Policy Training is to be provide to all contractors within the scope of their work. A copy of the documentation of the completed annual training is to be provided to the Contracting Officer and the facility Privacy Officer for their files.

In accordance with VA Directive 6500, “Information Security Program”, updates or replacement directives annual VHA Cyber and Security Information Training is to be provided to all contractors within the scope of their work. A copy of the documentation of the completed annual training is to be provided to the Contracting Officer and the facility Information Security Officer for their files.

15 Conformance with Environmental Management Systems

15.1 The contractor shall perform work under this contract consistent with the relevant policy and objectives identified in the agency, organizational, or facility environmental management system (EMS) applicable for your contract. The contractor shall perform work in a manner that conforms to all appropriate Environmental Management Programs and Operational Controls identified by the agency, organizational, or facility EMS, and provide monitoring and measurement information as necessary for the organization to address environmental performance relative to the environmental, energy, and transportation management goals. In the event an environmental nonconformance or noncompliance associated with the contracted services is identified, the contractor shall take corrective and/or preventative actions. In the case of a noncompliance, the contractor shall respond and take corrective action immediately. In the case of a nonconformance, the contractor shall respond and take corrective action based on the time schedule established by the EMS Site Coordinator. In addition, the Contractor shall ensure that their employees are aware of the roles and responsibilities identified by the environmental management system and how these requirements affect their work performed under this contract.

All on-site contractor personnel shall complete yearly EPA sponsored environmental training specified for

36C25727R0002 Attachment 1 - Draft CTX PWS Ambulance Ground 16 the type of work conducted on-site. Upon contract award, the Contracting Officer's Representative will notify the facility-level Environmental Management Systems Coordinator to arrange EMS training for appropriate staff.

16 Contractor Performance Assessment Rating System (CPARS) Required Registration with Contractor Performance Assessment Rating System (CPARS)

16.1 As prescribed in Revolutionary FAR Overhaul (RFO) Federal Acquisition Regulation (FAR) Part 42.11, the Department of Veterans Affairs (VA) evaluates contractor past performance on all contracts that exceed $1,000,000 and shares those evaluations with other Federal Government contract specialists and procurement officials. The FAR requires that the contractor be provided with an opportunity to comment on past performance evaluations prior to each report closing. To fulfill this requirement, VA uses an online database. The CPARS database information is shared with the Past Performance Information Retrieval System (PPIRS) database, which is available to all Federal Agencies.

16.2 Each contractor whose contract award is estimated to exceed $1,000,000 is required to register with the Contractor Performance Assessment Rating System (CPARS) database at the following https://www.cpars.gov/ or by calling (207) 438-1690. Registration should occur no later than thirty days after contract award and must be kept current should there be any change to the contractor’s registered representative.

16.3 For contracts with a period of one year or less, the contracting officer will perform a single evaluation when the contract is complete. For contracts exceeding one year, the contracting officer will evaluate the contractor’s performance annually. Interim reports will be filed each year until the last year of the contract when the final report will be completed. The report shall be assigned in CPARS to the contractor’s designated representative for comment. The contractor representative will have thirty days to submit any comments and re-assign the report to the VA contracting officer.

16.4 Failure to have a current registration in the CPARS database, or to re-assign the report to the VA contracting officer within those thirty days, will result in the Government’s evaluation being placed on file in the database with a statement that the contractor failed to respond.

https://www.cpars.gov/

36C25727R0002 Attachment 1 - Draft CTX PWS Ambulance Ground 17

Surveillance Checklist

(CTVHCS)

Contract: Ground Ambulance

Date/Time of Inspection:

Government POC Primary:

Government POC Alternate:

Organization:

(Facility Name)

Location: Bldg. Post

SS Performance Objective

PWS

Para

Performance Threshold

Method of Surveillance

Met Not Met Remarks

SS 1

The contractor shall provide Ambulance service, 24 hours per day, 365 days per year, as required in accordance with the terms and conditions contained herein.

95%

Compliance

100% Surveillance of each patient pick-up.

SS 2

The objective of Standards for Maintenance is to protect veterans and to cause no harm to all parties. The contractor shall maintain all vehicles in a clean and orderly condition, free from debris and accumulation which may create an accident, injury, or fire hazard.

4.4.3 95%

Compliance 100%

Surveillance

SS3

The contractor shall maintain (and furnish upon request) procedures that outline preventive maintenance and/or repairs on each vehicle in an individual vehicle file and in chronological order, latest service on top. A statement from the Contractor indication compliance of vehicle maintenance files is in place should be submitted at time of offer for

4.4.3 95%

Compliance

36C25727R0002 Attachment 1 - Draft CTX PWS Ambulance Ground 18

SS Performance Objective

PWS

Para

Performance Threshold

Method of Surveillance

Met Not Met Remarks evaluation purposes.

Requested submission and verification of these documentation requirements will be a quality assurance procedure during the contract period.

SS4

The contractor shall furnish qualified personnel as required by contract specifications to accomplish all services under this contract.

4.3.1 100%

Compliance

SS5

Have completed training in accordance with the standards published by the Department of Health and Human Services with a minimum curriculum of 150 hours or equivalent including an in-hospital training period. Such training programs must also be acceptable under the regulating requirements for local EMS Systems supported by DHHS under PL 93- 154, Federal Register 39:24304. (1974).

4.3.1 100%

Compliance

SS6

A licensed MTO shall ensure that sanitation procedures are provided to all personnel in a written document that conforms with current standards as set forth in occupational safety and health administration-blood borne pathogens protocol.

Attach ment B

100% Compliance

36C25727R0002 Attachment 1 - Draft CTX PWS Ambulance Ground 19

Attachment A

Critical Care Transport (CCT) Confirmation

If a transport is classified as a Critical Care Transport (CCT) the offeror must be capable of transporting the drugs and/or equipment as required by the patient (listed below), up to and including Critical Care Transport (CCT), if necessary, based on the EMS region the ambulance provider is functioning in.

Prospective offerors must sign and return this form confirming they can meet these criteria for CCTs ordered under this contract.

Drug Supply List: Equipment List:

Acetylcysteine (Acetadote, Mucomyst) Chest tubes Amiodarone (Cordarone) Portable mechanical vents; including

CPAP

Antibiotics All VADs Blood and Blood Products CVP lines Diltiazem (Cardizem) Swan-Ganz line Dobutamine SmartPump Capability: up to 6 IV drips Dopamine Fentanyl (Sublimaze) Furosemide (Lasix) Heparin Hyperalimentation (TPN and lipids) Insulin Labetalol (Trandate) Lidocaine Lorazepam (Ativan) Magnesium Sulfate Mannitol Midazolam (Versed) Milrinone (Primacor) Nicardipine (Cardene) Nitroglycerin (NitroStat, Nitro-Dur, Nitro-Bid) Norepinephrine (Levophed) Octreotide (Sandostatin) Ondansetron (Zofran) Pantoprazole (Protonix) Phenylephrine (Neo-Synephrine) Potassium Chloride Propofol Sodium Bicarbonate Vasopressin (Pitressin) TPA* (Pending)

I hereby confirm that _______________________________ can meet the criterion for Critical Care Transports.

(Company Name)

Signature of Company Representative Date

*Any pump(s) capable for up to and including 6 infusion lines or IV drips as required by the patient. If the pumps are not compatible with VA supplied IV tubing, the contracted ambulance would need to provide their own tubing and be able to switch the tubing over prior to transport. *

Zoll X Series Critical Care Monitor Capabilities:

Continuous 12-lead EKG monitoring 2-Temperature Monitoring Automatic Blood Pressure Capnography 2 arterial lines monitoring

36C25727R0002 Attachment 1 - Draft CTX PWS Ambulance Ground 20

Attachment B…