ATTACHMENT 1 PERFORMANCE WORK STATEMENT - SUB-ACUTE DETOX SERVICES .docx

ATTACHMENT 1: PERFORMANCE WORK STATEMENT

Sub-Acute Residential Detoxification Services In Support of Veterans Affairs Portland Healthcare System (VAPORHCS), Oregon

1.0 General:

1.1. The Department of Veterans Affairs (VA) requires qualified providers to deliver sub-acute residential detoxification services for eligible Veterans. These services are intended to provide medically monitored, safe, effective, and comprehensive detoxification from alcohol and other drugs in a sub-acute residential setting.

1.2. Services Provided: The Contractor shall provide one firm-fixed price in accordance with the Performance Work Statement (PWS) requirements for Sub-Acute Residential Detoxification Services. The all-inclusive unit pricing is based on a VA-referred patient bed per day. It includes 24 hours of nursing coverage, 24-hour availability of an on-call physician, and 24-hour phone availability of the Medical Director for emergencies.

1.3. Estimated quantities depicted in the schedule are based on prior weekly/monthly/annual ordering quantities; a bed is required approximately 331 days.

1.4. Type of Contract: This contract shall be an Indefinite Delivery-Indefinite Quantity (IDIQ) Contract with annual ordering periods. Separate funding Task Orders will be issued on an annual basis.

1.5. Period of Performance: This contract shall be a (1) one-year contract.

1.6. Place of Performance: The contractor shall provide a state-of-the-art civilian medical treatment facility, capable of providing medically monitored detoxification in a sub-acute residential setting.

1.7. Material and Other Direct Costs (ODC): The all-inclusive price includes potential ODCs, such as medical supplies, personal care supplies, food and nutrition, recreational and therapeutic materials, cleaning and maintenance supplies, labor costs, utilities and facilities costs, administrative and office expenses, training and certifications, insurance, food service, marketing and outreach, and regulatory compliance.

1.8. Authority: This contract is established under the authority of Title 38 United States Code (U.S.C.) Section § 8153 permits the Department of Veterans Affairs (VA) to enter into agreements for the sharing of healthcare resources to improve the quality and accessibility of healthcare services, and VA Acquisition Regulation, Part 873, Simplified Procedures for Health-Care Resources (VAAR 873).

1.9. Policy/Directives/Handbooks. The contractor shall be subject to the following policies, including any subsequent updates during the period of performance. The policies listed below can be accessed electronically at the following:

VA Publications VHA Publications

1.9.1 VHA Directive 1003.04: VHA Patient Advocacy

1.9.2 VHA Directive 1605.01: Privacy and Release of Information

1.9.3 VHA Directive 1907.01: VHA Health Information Management & Health Record

1.9.4 Privacy Act of 1974 (5 U.S.C. 552a): The Freedom of Information Act

1.9.5 National Association of Addiction Treatment Provider NAATP

1.9.8 National Board of Certified Counselors NBCC

1.9.9 Association of Social Work Boards ASWB

1.9.10 Board of Licensed Professional Counselors and Therapists Counseling Compact

1.9.11 The Joint Commission (TJC) Joint Trade Commission

1.9.12 Medication-Assisted Treatment (MAT) Certification MAT Certification

1.9.13 Substance Abuse and Mental Health Services Administration (SAMHSA)

1.10 Key Personnel: All licensed providers assigned by the Contractor to perform the services covered by this contract shall have a current license to practice in the state where the outpatient site is located. All licenses held by the personnel working on this contract shall be full and unrestricted. Contract providers who have current, full, and unrestricted licenses in one or more states, but who have, or ever had, a license restricted, suspended, revoked, voluntarily revoked, voluntarily surrendered pending action, or denied upon application, will not be considered for this contract.

2.0 Scope:

2.1 The VA Portland Healthcare System (VAPORHCS) currently has a need for sub-acute residential detoxification services. The Contractor shall furnish all key personnel that are licensed and qualified to provide necessary detox services such as medical evaluations, medication administration and monitoring, treatment plans, dosing supervision, documentation, inventory management, controlled substance logs, and compliance with DEA and State regulations to eligible Veterans of the Department of Veterans Affairs.

2.2 The Contractor shall provide the following Medical Services:

2.2.1 A physical exam conducted by a Registered Nurse (RN) at admission.

2.2.2 Medically monitored detoxification from alcohol and drugs.

2.2.3 Detoxification from opioids utilizing buprenorphine and other agents as needed for symptom relief. Buprenorphine, a partial opioid agonist used in opioid detoxification, can only be prescribed by healthcare providers who have received special waivers (commonly known as the "X-waiver") under the Drug Addiction Treatment Act (DATA 2000). Benzodiazepines may be prescribed for the management of symptoms related to anxiety, seizures, or severe agitation.

2.2.4 Detoxification from alcohol using benzodiazepines and/or other agents as needed for symptom relief.

2.2.5 Monitoring and symptomatic relief from stimulant withdrawal.

2.2.6 Monitoring of chronic medical conditions during withdrawal.

2.2.7 Monitoring for mental health symptoms that emerge during withdrawal.

2.2.8 24-hour Nursing coverage.

2.2.9 Availability of an on-call Physician 24 hours a day; and

2.2.10 Availability of the contract facility Medical Director by phone 24 hours a day for emergencies.

2.2.11 Services will be administered by a Certified Alcohol and Drug Counselor (CADC I, II, or II).

2.2.12 Priority access to residential detox services will be provided each morning, ideally seven days a week, and at a minimum, Monday through Friday.

2.3 The Contractor shall provide the following Urgent Care Clinic services:

2.3.1 Medical management of chronic medical conditions.

2.3.2 Medical management or referral for acute medical conditions.

2.3.3 Medical management of complications of withdrawal.

2.3.4 Urgent medical services will be provided by available medical support at least three times per week, for monitoring, documenting vital signs, and behavior.

2.3.5 Addiction Counselor or Rehabilitation Tech support.

2.4 The Contractor shall provide the following Clinical Services:

2.4.1 Alcohol and drug counseling and services below, by certified alcohol and drug counselors.

2.4.2 Written Biopsychosocial Assessment.

2.4.3 Written Treatment Planning and Discharge Planning.

2.4.4 Individual and/or group supportive counseling.

2.4.5 Patient education on effects of alcohol and drugs, relapse prevention, and community treatment and housing resources.

2.5 The Contractor shall provide the following Support Services:

2.5.1 Separate sleeping and dining facilities for women.

2.5.2 Three meals a day, plus snacks and drinks.

2.5.3 Availability of laundry facilities.

2.5.4 Personal hygiene items as needed.

2.5.5 A second set of clothing, i.e., scrubs, robes, slippers.

2.5.6 A bed, bedding, and towels; and

2.5.7 A secure locker and/or wardrobe space for personal property.

2.6 The Contractor shall provide the following referral services:

2.6.1 The Contractor shall only accept Contract referrals from the VAPORHCS Substance Addiction Treatment Program and will not accept walk-in Veterans without a referral.

2.6.2 The Contractor shall accept same-day referrals as physician staff are available after pre-arranged admission appointments, provided the Veteran has been cleared for sub-acute Medically Monitored Detoxification, up to the funding limits of the contract. The Contractor shall provide no more than 30 days of detoxification services to an individual Veteran in a 12 month period.

2.6.3 If the funded contract treatment episodes are exhausted, the Contractor shall notify the Contracting Officer and VAPORHCS Detox Liaison that the standard non-contract admission procedures will be re-instituted.

2.6.4 The Contractor shall refer Veterans whose medical condition cannot safely be treated in the sub-acute residential level of care to the VAPORHCS Emergency Department (ED) or, in the event of diversion, to the nearest hospital. In a medical or psychiatric emergency or urgent care situation, the Contractor shall notify the VAPORHCS ED prior to returning a patient to the Medical Center.

2.6.5 The Contractor shall refer Veterans who have self-directed discharges, as well as those who complete detoxification, to the most clinically appropriate level of VA Substance Addiction Treatment Program, to include residential or outpatient substance addiction treatment at VAPORHCS or another VA facility.

2.6.6 The Contractor shall notify the VAPORHCS Substance Addiction Treatment Program (SATP) and forward documents to the designated SATP Detox Liaison person before discharge from the Contractor's facility. Documents forwarded at the time of referral will include the Assessment, Active Medications sheet, all Progress Notes pertinent to the transfer, and the Discharge Note or Summary.

3.0 Qualifications/Licenses:

3.1 The Contractor shall adhere to all applicable accreditation and certification standards:

All licenses held by the key personnel working on this contract shall be full and unrestricted licenses. Contractor’s physician(s) who have current, full, and unrestricted licenses in one or more states, but who have, or ever had, a license restricted, suspended, revoked, voluntarily revoked, voluntarily surrendered, pending action, or denied upon application will not be considered for the purposes of this contract.

4.0 Health and Safety:

4.1 The Contractor shall provide for the health and safety of patients and staff:

4.1.1 The Contractor shall notify VAPORHCS immediately and in writing of deficiencies in meeting accreditation, certification, or other Federal, State, or Local standards.

4.1.2 The Contractor’s facility shall conform to the standards of the Life Safety Code (National Fire Protection Association Standard #101) in effect on the date of contract award.

4.1.3 The Contractor shall meet all Federal, State and Local Laws, regulations, and codes pertaining to health and safety.

4.1.4 The Contractor shall assist VAPORHCS personnel to conduct periodic inspections of patient and employee safety, security, and sanitation practices throughout the facility at the discretion of the VA.

4.1.5 The Contractor shall notify VAPORHCS immediately and in writing of deficiencies in meeting Federal, State, or Local standards for health and safety of patients and staff.

4.1.6 The Contractor shall assure that the facility is secure during and after business hours by employing staff observation, locked doors, or cameras.

4.2 The Contractor shall provide for safe storage, administration, and dispensing of medications:

4.2.1 The Contractor shall provide locked storage for the Veteran's medications, to include take home Methadone.

4.2.2 The Contractor shall maintain a system for monitoring and documenting the Veteran's medication compliance.

4.2.3 The Contractor shall notify the VAPORHCS Detox Liaison of prescription discrepancies, unanticipated side effects, adverse medical or psychiatric events, or other medication-related problems and shall seek reconciliation of such problems.

4.2.4 The Contractor shall maintain safe procedures for dispensing, administering, reconciling, and cads of medications. The Contractor shall allow inspection by VAPORHCS personnel of these policies, procedures, and facilities.

5. Quality Assurance Monitoring:

5.1 The Contractor shall provide reports and information for Quality Assurance Monitoring:

5.1.1 The Contractor shall call or submit a list of all admitted Veterans referred by the Detox Liaison with each patient's name, Social Security number, date of birth (DOB), substance requiring withdrawal treatment, outcome of treatment, and referral information from the Contractor to any subsequent program or facility. This shall be submitted to the Detox Liaison daily. The Contractor shall also inform the Detox Liaison of unanticipated or irregular discharges, from detoxification within 24 hours of the event.

5.1.2 The Contractor shall send a report on all VA-referred patients, indicating the number of Veterans who have been referred to Detox, the number admitted, the number of Incomplete or Declined admissions, the number of Medical or Behavioral Discharges, the number of self-directed discharges, and the number of Veterans referred to ongoing treatment at any VA Substance Addiction Treatment Program. This will be submitted to the Detox Liaison quarterly.

5.1.3 The Contractor shall report adverse medical and psychiatric events, such as medication errors, adverse reactions to medication, or sentinel events (loss of life or threat of injury to life or limb) to the Detox Liaison within 24 hours. A summary report of these events will be submitted quarterly to the Detox Liaison or designee.

6.0 Prohibited Discrimination:

6.1 The Contractor shall accept referral of and shall provide all services specified in this contract for any person determined eligible by the Directors, Mental Health Division, VA Portland Health Care System (VAPORHCS), or their designee, regardless of the race, religion, color, gender, national origin, disability, sexual orientation, gender identity, age, education, geographic origin, and skill characteristics of the person for whom such services are ordered. In addition, the Contractor warrants that subcontracting will not be resorted to as a means of circumventing this provision.

6.2 The Contractor shall not maintain nor provide dual or segregated patient facilities, which are segregated based on race, religion, color, gender, national origin, disability, sexual orientation, gender identity, age, education, geographic origin, or skill characteristics. (Note: Services such as sleeping and dining quarters separated by gender are required by this Contract.) The Contractor shall neither require such segregated use by written or oral policies nor tolerate such use by local custom. The term "facilities" shall include, but not be limited to, rooms, wards, sections, drinking fountains, entrances, and other like areas.

7.0 Clinical Records:

7.1 All medical records concerning the Veteran's care in the Contracted program shall be readily accessible to the VA. Upon discharge or death of the patient, the Contractor shall retain medical records for a period of at least three years following termination of care. Patient records shall be maintained in conformance with the Privacy Act of 1974 (5 U.S.C. 552a). A medical record shall be maintained for each patient. All Medical records shall be treated according to the Special Confidentiality/Prohibition of Re-disclosure Regulations of 42CFRPart 2 (and updates) for Substance Addiction Treatment Programs.

7.2 Security of information and IT systems: VAPORHCS has determined that the C&A requirements do not apply, and a Security Accreditation Package is not required.

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

8.0 Supervision of Contract Performance:

8.1 This contract for Medically Monitored Detoxification will be supervised by the Contracting Officer (CO), Contracting Officer Representative (COR), Mental Health Division (MHD) Clinical Consultant, and the Detox Liaisons at the Substance Addiction Treatment Program of VAPORHCS. The Contractor shall adhere to the guidelines of those officials. The Contractor shall provide no more than 30 days of detoxification services to an individual Veteran in a 12 month period. The Veteran shall be provided with detoxification services at the expense of VA for a period not more than that stated in the Authorization received from VA, unless an extension of the authorization is provided in writing by the Substance Addiction Treatment Program of the VAPORHCS. The Detox Liaisons will be given the information necessary to authorize and document the authorization in the Veteran's Electronic Health Record (EHR).

8.2 The Government will have the right to inspect the Contractor’s facility and all appurtenances by authorized VA representative(s) to ensure that acceptable safety, security, sanitation, and quality of environment standards are maintained and that the necessary clinical care to maintain the well-being of the patient is rendered.

8.3 Duly authorized representatives of the Government will provide follow-up supervision visits to Veterans placed to assure the extent, quality, and continuity of care and to determine whether acceptable standards are maintained, and that adequate care is being rendered. These visits do not substitute for nor relieve the Contractor in any way of the responsibility for the agreed-upon plan of care, including the medical, psychiatric, and addiction treatment of the Veteran.

9.0 Reports:

9.1 The Contractor shall submit reports to the Detox Liaison or designee on the utilization of services for VA-referred patients. The Contractor shall send a report on all VA-referred patients, indicating the number of Veterans who have been referred to Detox, the number admitted, the number of Incomplete or Declined admissions, the number of Medical or Behavioral Discharges, the number of self-directed discharges, and the number of Veterans referred to ongoing treatment at any VA Substance Addiction Treatment Program. Utilization of service reports will include average length of stay and drop-out rate, a list of adverse medical/psychiatric events or sentinel events, outcomes of treatment, and performance improvement efforts. These reports shall be submitted quarterly.

9.2 The Contractor shall call or submit a list of all admitted Veterans who have been referred by the Detox Liaison, with each patient's name, Social Security number, DOB, treated substance(s), outcome of treatment, referral information from the Contractor to any subsequent program or facility, and program completion status. This shall be submitted to the Detox Liaison daily. The Contractor shall also inform the Detox Liaison of dropouts from detoxification within 24 hours of the event.

9.3 The Contractor shall inform the Detox Liaison of sentinel events, adverse medical or psychiatric events, medication errors, or other emergencies within 24 hours of the occurrence.

10. Termination of Services:

10.1 The VAPORHCS reserves the right to remove any or all VA patients from the Contractor’s facility at any time, when it is determined to be in the best interest of the VA or the patients.

11. Rate Determination and Payments:

11.1 The Contractor shall provide to the VAPORHCS services to enrolled Veteran patients in accordance with all terms, provisions, general conditions, and requirements as listed herein, and in accordance with the Price/Cost Schedule. Prices are inclusive of all services as may be necessary in the treatment of the patient.

11.2 Payments made by the Department of Veterans Affairs (VA) under this contract shall constitute the total cost of the Contractor’s care. No additional charges shall be billed to Medicare Part B, the beneficiary, or the beneficiary's family by the Contractor or any third-party furnishing services or supplies required for such care. The Contractor shall be prohibited from soliciting contributions, donations, or gifts from patients or their family members.

11.3 The Veterans Health Administration (VHA) is not legally obligated to pay state Medical Assistance Programs (Medicaid) rates, including Oregon Medicaid Assistance Program (OMAP) rates, for contracted substance use disorder (SUD) services.

12. Absence:

12.1 Absence of the patient from the Contractor's Program for longer than 24 hours will not be reimbursable.

13. Contract Administration:

13.1 The Contracting Officer is the only person authorized to approve changes or modify any of the requirements under this contract. The Contractor shall communicate with the Contracting Officer on all matters related to contract administration. Only the Contracting Officer is authorized to make commitments or issue changes that will affect price, quantity, terms, or quality of performance of this contract.

13.2 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 will be made in the contract price to cover any increase in costs incurred as a result thereof.

14. Vendor Electronic Invoice Submission Methods:

14.1 Invoices will be electronically submitted to the Tungsten Automation website at https://www.tungstenautomation.com/. Tungsten Automation's direct vendor support number is 877-489-6135 for VA contracts. The VA-FSC pays all associated transaction fees for VA orders. During implementation (technical set-up), Tungsten Automation will confirm your Taxpayer ID Number with the VA-FSC. This process can take up to 5 business days to complete to ensure your invoice is automatically routed to your certifying official for approval and payment. To successfully submit an invoice to VA-FSC, please review “How to Create an Invoice” within the how-to guides. All invoices submitted through Tungsten Automation to the VA-FSC should mirror the current submission of the invoice. Clarification of additional requirements should be confirmed with your certifying official (your CO or buyer). Payments will only be made for actual services rendered. Payments shall be made monthly, in arrears. The VA-FSC requires specific information in compliance with the Prompt Pay Act and business requirements. The contractor shall be reimbursed upon receipt of a proper invoice. For additional information, please contact:

Tungsten Support Phone: 1-877-489-6135 Website: https://www.tungstenautomation.com/ Department of Veterans Affairs Financial Service Center https://www.fsc.va.gov/einvoice.asp

15. No Employee Status:

15.1 The Contractor shall be responsible for protecting the Contractor’s employee(s) furnishing services. To carry out this responsibility, the Contractor shall provide or certify that the following is provided for all their staff providing services under the resultant contract:

Workers’ compensation Professional liability insurance Health examinations Income tax withholding, and Social security payments.

16. Tort Liability:

16.1 The Federal Tort Claims Act does not cover the Contractor or the Contractor’s employees. If the Contractor or the Contractor’s employees are identified as providers in a tort claim, the Contractor shall be responsible for notifying their legal counsel and/or insurance carrier. Any settlement or judgment arising from actions or omissions by the Contractor or the Contractor’s employees shall be the responsibility of the Contractor and/or their insurance carrier.

17. Performance Standards:

17.1 Measure: Quality of Care

Performance Requirement: Referral to the VA Substance Addiction Treatment Program at discharge.

Standard: VA-funded Veterans will be referred to ongoing substance use disorder treatment.

Acceptable Quality Level: GOAL: 90% of Veterans will be referred to VA Substance Use Disorder (SUD) Programs before discharge.

Surveillance Method: Contractor will report and document quarterly the percentage of VA-funded Veterans who were referred to ongoing Substance Abuse Treatment (SA Tx) at any VA.

Referral to continuing care in substance abuse treatment should always be attempted and documented. This is one measure of the quality of care.

Veterans will be referred to ongoing substance abuse treatment: Contractor will note documentation of a referral to any VA Substance Addiction Treatment Program. This measure applies only to Veterans who complete the detox program. The acceptable level of quality will be 90% of VA-referred Veterans who complete the detox program will be referred to ongoing substance abuse treatment in any VA Program.

17.2. Measure: Quality of Care/Safety

Performance Requirement: Safe completion of detox.

Standard: VA-funded Veterans will complete the detox process.

Acceptable Quality Level: GOAL: 80% of Veterans will complete the detox program.

Surveillance Method: Contractor will document quarterly the percentage of VA-funded Veterans who completed the detox program vs dropouts.

Detoxification is a challenging process; we wish to measure the completion rate as an indicator of the quality of care and patient safety. The contractor will monitor using a tracking document or conduct a chart review of VA-referred Veterans to identify the number who complete the detox treatment (numerator) divided by the number who are admitted for detox (denominator). We expect a completion rate of 80% but will meet with the Contractor if this figure needs revision.

17.3. Measure: Quality/Safety

Performance Requirement: Adverse medical or psychiatric events.

Standard: 100% of Adverse Events on VA-funded Veterans will be reported to VAPORHCS Detox Liaison within 24 hours.

Acceptable Quality Level: GOAL: 90% of adverse events reported within 24 hours.

Surveillance Method: Contractor will report adverse events daily to the Detox Liaison. Contractor will keep data and submit quarterly report on adverse medical or clinical events for VA-funded Vets.

17.4 Adverse events, such as medication errors, adverse medical reactions, and sentinel events, are a constant threat as well as a learning opportunity. The contractor will report the number and type of medication errors, adverse medical reactions, and sentinel events to the PVAMC Detox Liaison within 24 hours. In addition, the Contractor will provide a quarterly report summarizing the number and type of adverse events. The acceptable level of quality is 90% timely reporting for both the daily and quarterly measures.