Attachment A - Performance Work Statement.pdf

Butler VA Medical Center Transportation Services

Performance Work Statement

1. Scope of Work:

The contractor shall provide Transportation Services for Veterans within the Butler VA Homeless, Veteran Justice Outreach (VJO), Vocational, and Rural Access Network for Growth Enhancement (RANGE) programming to support the following efforts within the Butler VA catchment area. Transportation may only be used by an Eligible Veteran who is receiving services within Butler VA’s Homeless, Vocational, and RANGE Programs.

Rides may only be requested by Identified Staff within the Butler VA’s Homeless, Vocational, and RANGE programs.

Transportation shall be provided to:

a. Veterans experiencing homelessness to the nearest facility identified by VA staff that can provide shelter.

b. Veterans attending their housing appointments, so they are not delayed in seeking permanent housing through the VA Hud-Vash program.

c. Veterans, who need to meet with any community provider that would be providing critical support to the Veteran (Supportive Services for Veterans Families (SSVF), Veteran Service Officer, Homeless Veterans’ Reintegration Program (HVRP), and any other federal, state, or municipal funded program).

d. Veterans participating in the VHA Homeless program Veteran Justice Outreach Program (VJO) ensuring they do not miss any court dates or essential meetings determined by VJO staff.

e. Vulnerable Veterans who need essential goods such as food and essential household supplies, to mitigate risks to the Veterans’ and staff’s health.

f. Veterans, who need to get to essential medical appointments but only when no other travel is available to the Veteran or minimize risk to the Veteran by offering alternative transportation to public transportation.

h. Veterans who need to get to and from job interviews and provide transportation up to the first four weeks of employment.

2. Contract Definitions:

2.1 Ambulatory Transport: A form of non-emergency transportation. It is for Eligible Veterans who do not need equipment to travel and who can walk, or only need basic assistance.

2.2 Business Hours/Days - Business hours/days are defined as the time of 8:00AM to 4:30PM, Monday through Friday, except Federal holidays. Federal holidays include New Year’s Day, Martin Luther King Day, President’s Day, Memorial Day, Independence Day, Labor Day, Columbus Day, Veterans’ Day, Thanksgiving Day, Christmas Day and other specifically designated days by the President of the United States to be a federal holiday. Off business hours/days are defined as the time of 4:31PM to 7:59AM, Monday through Friday, all day Saturday and Sunday and Federal holidays.

2.3 Contract – The Contract awarded as a result of this solicitation.

2.4 Contracting Officer (CO) - VA official with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings, and is a member of the vehicle inspection team.

2.5 Contractor - The term “Contractor” as used herein refers to both the prime Contractor and their employees, and any subcontractors and their employees. The Contractor shall be responsible for assuring that his subcontractors comply with the provisions of this Contract. The Government has a contracting relationship with the Prime Contractor only.

2.6 Eligible Veterans - Veterans and other members determined to be eligible for VA Homeless Program, Vocational, and/or RANGE services.

2.7 Escort - Such as a relative of the Eligible Veteran or a BUTLER VA employee accompanying the Eligible Veteran when the Identified Staff has determined such an escort is in the best interest of the beneficiary.

2.8 Excess Cost - The difference between prices charged by another source used and the applicable Contract prices.

2.9 Financial Services Center VA - (FSC) – Payment is made through electronic funds transfer - Department of Veterans Affairs, Financial Services Center, PO Box #149971, Austin, TX 78714-9971; FAX: 512-460-5540 (services).

2.10 Identified Staff- VA Butler staff who are assigned to work with Eligible Veterans that work within the Homeless Program (HCHV, GPD, Hud Vash, VJO), Vocational/Employment and RANGE programs and are authorized to make Ride Share requests for Eligible Veterans.

2.11 The Joint Commission (TJC) – A national organization dedicated to improving the care, safety, and treatment of beneficiaries in a health care facility and environment.

2.12 Mileage Rate – The rate the Contractor shall receive for mileage traveled while transporting a beneficiary. This rate applies to loaded, one-way transportation only. The rate charged shall be the rate set by the Pennsylvania Public Utilities Commission (PA -

PUC).

2.13 Monthly Trip Summary Sheet – A document that specifies the date, Eligible Veteran name and last four digits of Social Security number, time of pickup, destination, time of drop off, mileage if outside the Contract Mileage Threshold, and any notes regarding issues particular to the specific transport or condition, including recording oxygen, cardiac monitoring, and any other items provided. VA staff requests should be submitted 3-business-days prior to requested date/time of ride. Any request submitted with less notice is at discretion of Contractor as to schedule the ride.

2.14 Flat-rate (to include the first 10 miles) – The flat rate the Contractor charges for each authorized trip.

2.15 Point of Contact (POC) – Butler VA official responsible for providing Contract oversight and technical guidance to the CO. Responsibilities include certifying invoices, providing technical guidance, and overseeing technical aspects of the Contract. All contacting authority remains with the CO.

2.16 Protected Health Information (PHI)- individually identifiable health information, held or maintained by a covered entity or its business associates acting for the covered entity, that is transmitted or maintained in any form or medium (including the individually identifiable health information of non-U.S. citizens).

2.17 Quality Assurance - Those actions taken by the Government to assure services meet the requirements of this Contract.

2.18 Quality Assurance Surveillance Plan - An organized written document used for quality assurance surveillance. The document contains specific methods for performing surveillance of the Contractor’s continuous performance.

2.19 Quality Control - Those actions taken by the Contractor to control the production of goods or services, so they will meet the requirements of a contract.

2.20 Scheduled Trip(s) - The term “Scheduled Trip” as used in this Contract refers to those trips in which the Contractor has been given advance notice (advance notice is defined as notice given by 4:30PM the prior business day) of required services and a specific pick-up time.

2.21 Transportation Services- Forms of transportation governed by this Agreement for Eligible Persons as defined herein established and authorized under this contract. The Contractor will have the infrastructure to support providing transportation services to Eligible Veterans that would support the PWS.

2.22 Transport Trip Request Form- – A document that specifies the date, Eligible Veteran’s name and last four digits of Social Security number, time of pickup, destination, time of drop off, and any notes regarding issues particular to the specific transport or condition, including the need for oxygen and/or wheelchair transport.

2.23 Waiting Grace Period - The waiting grace period is defined as fifteen (15) minutes prior to the time waiting charges commence. The base rate for services shall include a fifteen (15) minute waiting grace period at origin and destination.

2.24 Wheelchair Transport: A form of non-emergency transport by a ground vehicle which is designed and equipped with a wheelchair lift to transport individuals who do not require EMT medical assistance during transport.

3. Eligible Veteran Transportation Requirements:

The Contractor shall provide Transportation Services during business days and hours but may be flexible upon the business hours of Contractor (Contractor may run their services earlier and/or later than the Business Hours as defined above and may have some resources to provide rides during non-business hours). The following ten holidays are observed by the Federal Government: New Year’s Day, Martin Luther King’s Birthday, President’s Day, Memorial Day, Independence Day, Labor Day, Columbus Day, Veterans’ Day, Thanksgiving Day, Christmas Day, and any other day specifically declared to be a national holiday by the President of the United States. Most trips will be between 6:00 a.m. and 6:00 p.m. Monday through Friday.

3.1 The Contractor shall provide the Butler VA with the communication method of contacting the Contractor throughout the business day. The Point of Contact (POC) shall notify the Contractor if the proposed method of communication is not acceptable.

3.2 The Contractor shall ensure that Eligible Veteran pick-ups and drop-offs are scheduled so that the total distance traveled will result in the most economical charge to Butler VA. While the required transportation may include trips to parts of Ohio, West Virginia, Maryland, Virginia, Washington DC, New York and New Jersey, the majority of the trips will be confined to Southwestern Pennsylvania, and most beneficiaries will be Eligible Veterans. It may be necessary on occasion for the Contractor to extend a trip beyond normal distances due to extenuating circumstances in order to avoid lengthy Eligible Veteran wait times for alternate transportation.

3.3 The Contractor shall provide Eligible Veteran door to door and/or curb side pick-up/drop-off options for all Eligible Veterans to and from their designated appointments.

Eligible Veterans shall be picked up at Butler Health Care Center (HCC), in their homes, at our Community Outpatient Clinics (CBOC), or at other areas designated by Butler VA Identified Staff and taken to the authorized destination or appointment.

3.4 Assistance in maneuvering stairs and other barriers shall be provided by the driver when necessary. These services may be provided outside the home (i.e., from the door to the vehicle). If an Eligible Veteran needs assistance inside the home, this request will be noted on the Transportation Trip Request Form submitted to Contractor.

3.5 The Contractor’s driver shall observe beneficiaries during transport. Any indication of a significant change in a beneficiary’s condition (i.e., sudden onset of rapid or labored respiration, complaints of chest pains, etc.) shall be diverted to closest Emergency Room for care. All diversions from destination, if authorized, shall be reported to the POC.

3.6 Should the Contractor’s driver encounter any problems when transporting beneficiaries, the driver shall contact the identified POC, from 8:00 AM to 4:30 PM.

This notification is merely for information purposes. It does not replace internal Contractor communications needed to solve the problem.

3.7 Contractor’s driver shall notify the identified POC, of any unusual events, including but not limited to accidents, safety problems, Eligible Veteran complaints and other such incidents that may occur during transport. The POC shall be notified within one business day of occurrence of the incident(s) by telephone or Email and, if requested by the POC, a written report of the incident(s) will be provided by close of business the next business day. This notification is merely for information purposes, and does not replace normal Contractor communications needed to solve issues.

4. Transportation Orders:

4.1 Identified Staff will have access to the Transport Trip Request Form (See Addendum I) and use this form to request a ride for an Eligible Veteran with at least 3-business days prior to date of trip. The Transport Trip Request Form will be emailed to the Contractor and the Contractor will have 24-hours to confirm and/or decline trip. Transport Trip Requests can only be made by Eligible Staff and if made with less than 3-days’ notice it will be up to the discretion of the contractor as to whether or not they can/will accommodate the ride request. In the event that the Contractor does not anticipate being able to meet Butler VA needs the Contractor shall immediately notify the Eligible Staff making the request during normal business hours. If the Contractor accepts the manifest and fails to furnish services the Butler VA reserves the right to re-procure services which cannot be performed by the Contractor, in accordance with the terms, conditions, and schedule of this Contract.

4.2 In case of inclement weather, the decision as to whether or not an Eligible Veteran shall be transported shall be made mutually by Butler VA and the Contractor.

4.3 The Contractor shall notify the Eligible Veteran via phone call about 15-minutes prior to pick-up if Eligible Veteran does not have a phone then the requesting Identified Staff shall be informed that driver is in route. The Contractor shall also notify the POC, by telephone and email, at least one-hour in advance in the event that the Contractor is unable to provide the scheduled ride within the time frame necessary for the Eligible Veteran to make their scheduled appointment time.

4.4 Waiting Time – Butler VA Identified Staff shall make every effort to alert the eligible Veteran to be ready and waiting for the arrival of the vehicle in order to reduce any lost time to the driver. Waiting time shall not apply to the reasonable amount of time required for escorting the Eligible Veteran to the vehicle, loading and securing the Eligible Veteran in the vehicle, or unloading and delivering the Eligible Veteran to the authorized care giver/paramour or specified destination. The Contractor may or may not be eligible for compensation for missed or delayed rides due to Contractors scope of collecting fares for rides that were not completed. The Contractor will notify the POC via email after waiting 15 minutes if the Eligible Veteran no-shows the driver. If an Eligible Veteran no-shows the 1st time he/she will be warned. After the second no-show the Eligible Veteran will no longer be allowed to access Ride Share services.

4.5 If the POC, authorizes the Contractor to transport more than one Eligible Veteran on a trip to the same destination or separate destinations, the ride will be billed per veteran and separate Transport Trip Request Forms shall be submitted.

5. Payments and Billing:

5.1 Payment for mileage traveled shall be limited to “one way only”, which is the distance over which the Eligible Veteran is transported. If the transport is requested for round trip each leg will be billed as two separate trips. Wait time shall be calculated if driver has to wait 15 minutes from time after the Waiting Grace Period. The Transportation Service company will charge based on type of transport with a flat rate for the first 10 miles and then a flat rate for each additional mile.

Laemmerhirt, Cynthia A.

Are they not using VetRide program? They should be as it is should be used for all transportation contracts. If it is not, I do not see the Tungsten instructions.

5.1.1 At no time during these trips should the Transportation Service driver request ANY fees from Eligible Veterans. The Transportation Service company will submit invoices monthly in arrears, based on the Transportation Request Forms submitted and rides confirmed and completed. It is estimated that approximately 250 one-way trips per month will be completed.

The Contractor shall be paid for the milage of the trip with the rate dependent on type of transport needed and not the amount of time it takes to complete trip, unless additional wait time is being billed for trip.

5.1.2 Trip Sheet - The Contractor shall provide a detailed trips report, in Excel format, no later than the 5th day of each month for the previous month’s trips. This report shall be in Excel format and shall emailed to the Program POC. Trip logs must include the following:

• Report header to include Ordering Period, contract number, task order number and purchase order number

• Trip date

• Beneficiary’s name

• Trip number

• Scheduled or Unscheduled trip

• Beneficiary’s DOB

• Beneficiary’s last 4

• Origin address

• Destination address

• Time call received

• Appointment time

• Pick up – arrival time

• Pick up – departure time

• Drop off – arrival time

• Trip mileage

• Individual trip cost

• Total trips cost

Failure to provide the required billing documents on time and in the required format may result in late payment to the Contractor.

Payment to the Contractor shall be made monthly, in arrears, upon receipt of a properly prepared invoice. Payment for services will be at the rates specified in the Price/Cost Schedule. All monthly invoices from the contractor will be electronically submitted through the Tungsten Network within 15 days following the end of the month of services rendered.

Vendor Electronic Invoice Submission Methods: Facsimile, e-mail, and scanned documents are not acceptable forms of submission for payment requests. Electronic form means an automated system transmitting information electronically according to the accepted electronic data transmission methods below.

The information page for the Financial Service Center (FSC) of the Department of Veterans Affairs that includes information regarding electronic invoice submission can be referenced at: http://www.fsc.va.gov/einvoice.asp Department of Veterans Affairs Financial Services Center PO Box 149971 Austin TX 78714-8971 Customer Support Help Desk (877-353-9791)

Invoices must be approved by the Program POC prior to payment release. Invoices without the required information will be rejected.

If the Program POC refuses an invoice due to incorrect billing, subsequent changes or corrections to the monthly invoice shall be resubmitted by the vendor with a corrected invoice. In addition to information required for submission of a “proper” invoice in accordance with FAR 52.212-4 (g), all invoices must include:

• Name and Address of Contractor

• Invoice Date and Invoice Number

• Contract Number and Obligation Number

• Name of Veteran

• Total Price

Failure to comply with all terms and conditions of this contract shall result in invoices/claims submitted for reimbursement during that period to be considered incomplete. Interest penalties imposed under the Prompt Payment Act shall not apply to incomplete invoices or invoices received after the established invoice due date.

Contractor Remittance Address: All payments by the Government to the Contractor will be made by Electronic Funds Transfer (EFT).

The contractor shall be responsible for scheduling rides and settling the accounts with the rideshare services. The Government will pay the contractor in accordance with the Price / Cost Schedule.

5.2 Trip mileage under the contract shall be determined by using Internet web site applications such as Google Maps, Yahoo Maps, Map Quest, or other Internet mileage application.

Disputes concerning mileage discrepancies between the Butler VA and the Contractor shall be resolved by the CO, who will render their decision in writing, subject to provisions of the disputes clause of this contract.

5.3 The Contractor shall maintain a record of all trips (scheduled on the travel log) and provide a printed report that includes the Eligible Veteran’s name, date and time of the trip, mileage. The trip log summary shall be used to create the charges for each billing cycle. The Contractor shall contact the POC with any questions, requests for clarification, or the need for additional information between the hours of 8:00 a.m. to 4:30 p.m.

5.4 The Contractor shall provide a detailed trips report no later than the 5th day of each month for the previous month’s trips. If detours are encountered due to road construction or other obstruction, this information should be included in the trip log. This report shall be in excel format and shall be emailed to the POC and include the following:

a. Date of trip

b. Status of trip (no-show and/or complete)

c. Identified Staff that requested ride’s contact name

d. Scheduled pick-up date and time

e. Total duration of trip

f. Wait time if applicable

g. Distance of trip

h. Total fare amount

i. Type of Transport used/needed

j. Date and time - Load

k. Date and time - Unload

5.4.1 Spreadsheet summary (in MS Excel or comparable format) must include:

a. Date of transport

b. Status of trip (no-show and/or complete)

c. Type of transport

d. Pick-up location

e. Drop-off location

f. Purpose of trip

g. Fare amount

h. Wait time

i. Total fare

j. Irregular charge justification

5.5 Failure to provide the required billing documents on time and in the required format may result in late payment to the Contractor.

6. Contractor Vehicle Operator Requirements:

6.1 The Contractor’s drivers shall be required to wear, in an easily observable area on the employee, a Contractor supplied photo identification badge which includes the driver’s name, and the Contractor’s business name, or a company uniform, which identifies the driver while performing services. Records of each employee as to character (criminal background check performed) and physical capabilities (Health Certificate or statement of health from a private physician) must be maintained and made available to the POC upon request. The Contractor shall be responsible for appropriate driver screening and selection criteria when employing drivers. Such screening shall include but not limited to testing drivers for prohibited drug use and alcohol misuse, and criminal background checks to the maximum extent permitted by law.

6.1.1 Butler VA may authorize a relative, service/guide dog, or other person deemed appropriate to accompany beneficiaries that require assistance at no additional cost to Butler VA.

6.1.2 Butler VA reserves the right to observe Contractor customer service at any time, and to inspect all Contractor vehicles used for the contract as well drivers’ credentials.

Violations may result in poor performance ratings, and/or potential loss of the contract.

6.1.3 The following acts are not permissible by the Contractor that provide services under this contract or while on Butler VA premises:

6.1.4 Use of intoxicating liquors, narcotics or controlled substances of any kind (excluding doctor’s prescriptions which do not impair driver’s driving ability) while on duty. Also includes reporting for duty while under the influence of liquors, narcotics or controlled substances of any kind.

6.1.5 Gambling in any form.

6.1.6 Smoking and other uses of tobacco while on duty. Both Eligible Veterans and Contractor are prohibited from smoking in vehicle.

6.1.7 Carrying of firearms or other types of concealed weapons.

6.1.8 Resorting to physical violence to settle a dispute with a fellow employee, Eligible Veterans, or the general public while on duty.

6.1.9 Use of loud, indecent, or profane language and/or making threatening or obscene gestures toward Eligible Veterans or other employees.

6.1.10 Stopping for personal business, including excessive use of restroom facilities, while the vehicle is occupied by an Eligible Veteran. The driver shall not leave the vehicle with the keys in the vehicle at any time.

6.1.11Engaging Eligible Veterans in a verbal confrontation in an attempt to settle a disagreement. Should a disagreement arise, the driver shall contact his Dispatcher/supervisor.

6.1.12 Soliciting or accepting gratuities from Eligible Veterans, companions, or others at any time.

6.2 All Contractor’s drivers shall maintain a valid operator or chauffeur’s license, required to operate the type of vehicle necessary to perform the service, as required by the State of Pennsylvania. The Contractor shall provide, upon request of the POC, a copy of the valid license of all drivers performing under this contract.

6.2.1 Contractor’s drivers shall not text message while driving. See FAR 52.223-18, Encouraging Contractor Policies to Ban Text Messaging While Driving” which in incorporated into FAR 52.212-5, Commercial Terms and Conditions

7. Vehicles:

7.1 All vehicles used in the performance of this contract shall meet all State and Local Laws, ordinances, codes, rules, and regulations.

7.2 Transport vehicles shall be of model and make to provide Eligible Veterans with the safest and most comfortable service possible. Vehicles and all accessories and systems shall be clean and shall meet all maintenance standards set forth by the manufacturer. All preventive maintenance shall be documented, and records provided upon request by the POC.

Transportation shall be designed so that Eligible Veterans can be restrained by a seat belt at all times when the vehicle is in motion.

7.3 All vehicles shall be equipped to allow for direct communication, at all times, between the drivers and Contractor’s Dispatch. This equipment may be a mobile (cellular) telephone, or radio dispatch device which would allow communication.

7.4 All vehicles shall be equipped with properly functioning heating and air conditioning systems, with adequate capacity to maintain a comfortable cabin temperature level.

7.5 All vehicles shall be clean and well maintained. Vehicles shall be free from physical damage, odor, debris, and accumulation of excess dirt. Each vehicle shall contain a daily maintenance and safety checklist. Checklists shall be maintained by the Contractor and be made available for inspection upon request by the POC.

7.6 All vehicles shall be smoke and vape free.

8. Contractor’s Quality Control Program (QCP):

8.1 The Contractor shall establish and maintain a QCP to ensure all contract requirements are met. The Contractor’s QCP shall include the following at a minimum:

8.2 An inspection plan covering all services required by this contract. The inspection plan must specify the areas to be inspected on either a scheduled or unscheduled basis and how often inspections will be accomplished and documented, and the title of the individual(s) who will perform the inspections.

8.3 On-site records of all inspections conducted by the Contractor noting necessary corrective action taken. The Government reserves the right to request copies of any inspection record.

8.4 The methods for identifying and preventing deficiencies in the quality of service performed before the level of performance becomes unacceptable.

8.5 The Contractor shall maintain on-site records of all vehicle maintenance and repairs performed on vehicles used in the performance of this contract.

8.6 The Contractor shall have a contingency plan in the event of vehicle damage or loss, which will maintain the required level of services.

8.7 The Contractor shall have a contingency plan in the event of a communication system failure.

8.8 The Contractor shall maintain records of all Eligible Veteran complaints. Complaints shall be reported to the POC.

8.9 The Contractor shall participate in quarterly scheduled and/or unscheduled conference calls with the POC to discuss performance and any issues.

8.10 The Contractor shall maintain licenses and driving record information and shall make this information available for review by the POC upon request.

9. Performance Standards:

The contractor must maintain a 95% customer satisfaction rate per 100 trips to be considered as providing acceptable performance. Acceptable performance is considered as having no more than one (1) valid complaint per 100 trips. The validity of the complaint is to be determined by the POC. Performance tracking will be monitored by the POC every quarter.

(See Quality Assurance Surveillance Plan).

10. Contract Administration:

The Contractor shall not deviate from the contract requirements without written approval from the Contracting Officer (CO). Only the CO is authorized to make commitments to issue changes that will affect the price, quantity, quality, or delivery terms of this contract. The POC shall be the primary point of contact for all other matters.

10.1 Evidence of Insurance Coverage - Before award of the contract, the Contractor shall furnish to the CO a Certificate of Insurance that is in compliance with the State requirements for the State of contract performance. Insurance shall contain an endorsement to the effect that cancellation of, or any material change in, the policies which adversely affect the interest of the Government in such insurance, shall not be effective unless a 30-day written notice of cancellation or change is furnished to the CO.

11. Special Contract Requirements:

Reports/Deliverables: The Contractor shall be responsible for complying with all reporting requirements established by the Contract. Contractor shall be responsible for assuring the accuracy and completeness of all reports and other documents as well as the timely submission of each. Contractor shall comply with contract requirements regarding the appropriate reporting formats, instructions, submission timetables, and technical assistance as required.

The following are brief descriptions of required documents that must be submitted by Contractor: monthly; quarterly; annually, etc. identified throughout the PWS and is provided here as a guide for Contractor convenience. If an item is within the PWS and not listed here, the Contractor remains responsible for the delivery of the item.

What Submit as noted Submit To

Para. 5.4 Dispatcher Information Within 5 days of award and any time this information changes.

POC/Designee

Para. 6.2 Contractor Driver’s Licenses and Training Records

Upon request and when new personnel are added to contract.

POC/Designee

Para. 7.4 Inspection report for all vehicles used in this contract.

Annually or Upon request POC/Designee

Para. 3.7 Eligible Veteran Incidents and Complaints - Incident Report

Within 24 hours by telephone and Email and in writing within 24 hours

POC/Designee

Para. 9 Contractor’s Quality Control Program

Upon Request POC/Designee

Service Delivery Summary: The Services Delivery Summary (SDS) represents the most important contract objectives that, when met, will likely indicate contract performance is satisfactory. Although not all PWS requirements are listed in the SDS, the contractor is expected to fully comply with all requirements in the PWS.

Task ID Indicator Standard Acceptable

Quality Level

Method of Surveillance Incentive/Penalty

Initial Pick Up Delivery/ Wait Time

4.2 4.3

Eligible Veteran must be picked up and/or delivered by the Contractor’s employees in accordance with the PWS timelines

Contractor shall be responsible for pick-up and delivery points, actual time of arrival at pick-up and delivery points and actual waiting time at pick-up and delivery points.

95%

Daily observation/review of trips in monthly travel log, Eligible Veterans valid complaints/feedback per surveys

Negative Past Performance Rating for Failure to Comply

Environment of Care

6.0 5.4 5.41

Contractor Personnel

Contractor shall maintain on-site records that document competence/performance level of contractor employees working on this contract in accordance with Joint Commission and other regulatory requirements.

Periodic Inspection of contractor on-site Competency Records for employees

Negative past performance rating and may not continue services.

Environment of Care

6.0 6.2

Vehicles and medical equipment

Contractor shall ensure all vehicles operated and any equipment utilized under the terms of this agreement meet all established requirements defined by this contract.

Periodic review of contractor on-site Vehicle and Equipment Maintenance/Inspection Records validating compliance with all State requirements.

Contractor shall be required to provide annual compliance logs for all vehicles/equipment utilized to provide service to the Butler VA.

Contractor vehicles shall also be subject to physical inspection by the VA at any time during the contract.

Negative Past Performance Rating for failure to comply

12. HIPAA Compliance:

BUSINESS ASSOCIATE AGREEMENT:

A Business Associate Agreement (BAA) is required as defined in Health Insurance Portability and Accountability Act (HIPAA), Public Law 104-191. (See Section D of the RFQ solicitation for completion)

Contractor Personnel Security Requirements:

VA Information and Information System Security/Privacy (Inserts from VA Handbook 6500.6 – Appendix C, Paragraph numbers: 3a, e, f, h, j, k, #6 (all), #7(all) as follows:

VA Information Custodial Language

a. Information made available to the contractor or subcontractor by VA for the performance or administration of this contract or information developed by the contractor/subcontractor in performance or administration of the contract shall be used only for those purposes and shall not be used in any other way without the prior written agreement of the VA. This clause expressly limits the contractor/subcontractor's rights to use data as described in Rights in Data - General, FAR 52.227-14(d) (1).

b. The contractor/subcontractor shall not make copies of VA information except as authorized and necessary to perform the terms of the agreement or to preserve electronic information stored on contractor/subcontractor electronic storage media for restoration in case any electronic equipment or data used by the contractor/subcontractor needs to be restored to an operating state. If copies are made for restoration purposes, after the restoration is complete, the copies must be appropriately destroyed.

c. If VA determines that the Contractor has violated any of the information confidentiality, privacy, and security provisions of the Contract, it shall be

Eligible Veteran Safety

3.6 3.7

Incidents and Eligible Veteran complaints

The Contractor shall notify the POC, within one hour by telephone and in writing within 24 hours of any complaints made by the Eligible Veterans or incidents with regards to transportation services.

100% Customer Feedback Negative past performance rating and may not continue services.

sufficient grounds for VA to withhold payment to the Contractor or third party or terminate the Contract for default or terminate for cause under Federal Acquisition Regulation (FAR) part 12.

The contractor/subcontractor must store, transport, or transmit VA sensitive information in an encrypted form, using VA-approved encryption tools that are, at a minimum, FIPS 140-2 validated. i. The contractor/subcontractor’s firewall and Web services security controls, if applicable, shall meet or exceed VA’s minimum requirements. VA Configuration Guidelines are available upon request.

Except for uses and disclosures of VA information authorized by this contract for performance of the contract, the contractor/subcontractor may use and disclose VA information only in two other situations: (i) in response to a qualifying order of a court of competent jurisdiction, or (ii) with VA’s prior written approval. The contractor/subcontractor must refer all requests for, demands for production of, or inquiries about, VA information and information systems to the VA contracting officer for response.

Notwithstanding the provision above, the contractor/subcontractor shall not release VA records protected by Title 38 U.S.C. 5705, confidentiality of medical quality assurance records and/or Title 38 U.S.C. 7332, confidentiality of certain health records pertaining to drug addiction, sickle cell anemia, alcoholism or alcohol abuse, or infection with human immunodeficiency virus. If the contractor/subcontractor is in receipt of a court order or other requests for the above mentioned information, that contractor/subcontractor shall immediately refer such court orders or other requests to the VA contracting officer for response.

Security Incident Investigation

a. The term “security incident” means an event that has, or could have, resulted in unauthorized access to, loss or damage to VA assets, or sensitive information, or an action that breaches VA security procedures. The contractor/subcontractor shall immediately notify the COTR and simultaneously, the designated ISO and Privacy Officer for the contract of any known or suspected security/privacy incidents, or any unauthorized disclosure of sensitive information, including that contained in system(s) to which the contractor/subcontractor has access.

b. To the extent known by the contractor/subcontractor, the contractor/subcontractor’s notice to VA shall identify the information involved, the circumstances surrounding the incident (including to whom, how, when, and where the VA information or assets were placed at risk or compromised), and any other information that the contractor/subcontractor considers relevant.

c. With respect to unsecured protected health information, the business associate is deemed to have discovered a data breach when the business associate knew or should have known of a breach of such information. Upon discovery, the business associate must notify the covered entity of the breach. Notifications need to be made in accordance with the executed business associate agreement.

d. In instances of theft or break-in or other criminal activity, the contractor/subcontractor must concurrently report the incident to the appropriate law enforcement entity (or entities) of jurisdiction, including the VA OIG and Security and Law Enforcement. The contractor, its employees, and its subcontractors and their employees shall cooperate with VA and any law enforcement authority responsible for the investigation and prosecution of any possible criminal law violation(s) associated with any incident. The contractor/subcontractor shall cooperate with VA in any civil litigation to recover VA information, obtain monetary or other compensation from a third party for damages arising from any incident, or obtain injunctive relief against any third party arising from, or related to, the incident.

Liquidated Damages for Data Breach

a. Consistent with the requirements of 38 U.S.C. §5725, a contract may require access to sensitive personal information. If so, the contractor is liable to VA for liquidated damages in the event of a data breach or privacy incident involving any SPI the contractor/subcontractor processes or maintains under this contract.

b. The contractor/subcontractor shall provide notice to VA of a “security incident” as set forth in the Security Incident Investigation section above. Upon such notification, VA must secure from a non-Department entity or the VA Office of Inspector General an independent risk analysis of the data breach to determine the level of risk associated with the data breach for the potential misuse of any sensitive personal information involved in the data breach. The term 'data breach' means the loss, theft, or other unauthorized access, or any access other than that incidental to the scope of employment, to data containing sensitive personal information, in electronic or printed form, that results in the potential compromise of the confidentiality or integrity of the data. Contractor shall fully cooperate with the entity performing the risk analysis. Failure to cooperate may be deemed a material breach and grounds for contract termination.

c. Each risk analysis shall address all relevant information concerning the data breach, including the following:

(1) Nature of the event (loss, theft, unauthorized access);

(2) Description of the event, including:

(a) date of occurrence;

(b) data elements involved, including any PII, such as full name, social security number, date of birth, home address, account number, disability code;

(3) Number of individuals affected or potentially affected;

(4) Names of individuals or groups affected or potentially affected;

(5) Ease of logical data access to the lost, stolen or improperly accessed data in light of the degree of protection for the data, e.g., unencrypted, plain text;

(6) Amount of time the data has been out of VA control;

(7) The likelihood that the sensitive personal information will or has been compromised (made accessible to and usable by unauthorized persons); MARCH

12, 2010, VA HANDBOOK 6500.6 APPENDIX C C-11

(8) Known misuses of data containing sensitive personal information, if any;

(9) Assessment of the potential harm to the affected individuals;

(10) Data breach analysis as outlined in 6500.2 Handbook, Management of Security and Privacy Incidents, as appropriate; and

(11) Whether credit protection services may assist record subjects in avoiding or mitigating the results of identity theft based on the sensitive personal information that may have been compromised.

d. Based on the determinations of the independent risk analysis; the contractor shall be responsible for paying to the VA liquidated damages in the amount of $37.50 per affected individual to cover the cost of providing credit protection services to affected individuals consisting of the following:

(1) Notification;

(2) One year of credit monitoring services consisting of automatic daily monitoring of at least 3 relevant credit bureau reports;

(3) Data breach analysis;

(4) Fraud resolution services, including writing dispute letters, initiating fraud alerts and credit freezes, to assist affected individuals to bring matters to resolution;

(5) One year of identity theft insurance with $20,000.00 coverage at $0 deductible; and

(6) Necessary legal expenses the subjects may incur to repair falsified or damaged credit records, histories, or financial affairs.

Additional Information:

A Contractor Security Control Assessment (CSCA) is not required since the contractor is not storing VA data on behalf of the VA.

BAA is required, as protected health information is being disclosed to a non-covered entity.

The certification and accreditation requirements do not apply, and a Security Accreditation Package is not required.

All Contractors must receive Privacy training annually using one of the following methods:

• Complete “VA Privacy Training for Personnel without Access to VA Computer Systems or Direct Access to or Use to VA Sensitive Information” training by using VA’s TMS system (https://www.tms.va.gov/).

Contractors may use the TMS Managed Self Enrollment method to complete the training in TMS. The POC must ensure that all contractors are validated in the PIH domain.

• Complete the hard copy version of “VA Privacy Training for Personnel without Access to VA Computer Systems or Direct Access to or Use to VA Sensitive Information”. Signed training documents must be submitted to the POC.

Training must be completed prior to the performance of the contract and annually thereafter. Proof of training completion must be verified and tracked by the POC.

Additional Security Requirement:

https://www.tms.va.gov/

HIPAA-Focused Training" prior to the performance of the contract and annually thereafter. Training must be completed in VA’s Talent Management System (TMS) (https://www.tms.va.gov/). Certification of Completion is required to be provided to COR and CO for each employee working on this contract.

NOTE: The solicitation and subsequent contact include FAR 52.222-41, Service Contract Labor Standards (SCLS). The Offeror and resultant contract awardee, by signing the offer and contract, is acknowledging they have reviewed the clause and will fully comply throughout the contract period. It is the responsibility of the Contractor to determine and pay the appropriate prevailing wage rate and fringe benefits for the location. The Government will not be held responsible for any mistakes in applying the

SCLS.

VA reminds contractors of the Department of Labor Regulations which implement the SCLS, and which read at 29 CFR § 4.115:

Employee coverage does not depend on form of employment contract. The Act, in section 8(b), makes it plain that the coverage of service employees depends on whether their work for the contractor or subcontractor on a covered contract is that of a service employee as defined in section 8(b) and not on any contractual relationship that may be alleged to exist between the contractor or subcontractor and such persons. In other words, any person, except those discussed in §4.156 below, who performs work called for by a contract or that portion of a contract subject to the Act is, per se, a service employee.

Thus, for example, a person's status as an “owner-operator” or an “independent contractor” is immaterial in determining coverage under the Act and all such persons performing the work of service employees must be compensated in accordance with the Act's requirements.

**Any/all subcontractors must meet the same criteria specified in this Statement of Work https://www.tms.va.gov/

Addendum I

VA Rideshare ANR Transport Trip Request Form

1. Patient Name:

Patient Address ((must include zip code and county): Click or tap here to enter text.

2. Nursing Unit / Room #: Click or tap here to enter text.

3. Phone number: Alternate Phone number: Click or tap here to enter text.

4. Round trip ☐ One Way ☐

5. Full Address of Destination (must include zip code, county, & phone number):

Address:

6. Date of Transport:

7. Appointment time:

8. Return time: Click or tap here to enter text.

9. Is patient Wheelchair bound or require a mobility device? YES ☐ Type of mobility device: Click or tap here to enter text.

We cannot accommodate bariatric wheelchair (seat over 20” wide)? YES ☐ *Wheelchair must have leg rests for safe transport

10. Does the patient need Oxygen? YES ☐

11. Does the patient have orders for Isolation? YES ☐ If yes, please give details Click or tap here to enter text.

12. Does client require curb to curb service ☒or door to door service ☐

Purpose of trip: Work at the AARP

Additional Persons Traveling & Relationship: NA

*Must have infant or booster seat to transport children

PLEASE email form to: _________________ and ______________________

Transport dispatch phone:

*Transport is for non-emergent transportation only mailto:_________________