Attachment A - PWS.docx

Performance Work Statement

CMCVAMC MEDICAL RESPITE PILOT PROGRAM

SOCIAL WORK SERVICE DEPARTMENT

3900 WOODLAND AVE,

PHILADELPHIA, PA 19119

PURPOSE: The Corporal Michael J. Crescenz VA Medical Center (CMCVAMC) Social Work Service Department has a requirement to contract medical respite services for homeless Veterans within one of the five (5) counties supported by the CMCVAMC – Philadelphia County, Bucks County, Camden County, Gloucester County, and Burlington County. Medical respite is short-term housing placement for homeless men or women, who would benefit from post-acute care, respite or recuperative medical services. The CMCVAMC’s Medical Respite Program is offered to homeless Veterans who are healthcare eligible by law, and too ill or frail to recover from a physical illness, surgery, or injury in a non-medical homeless shelter or housing program setting.

BACKGROUND: Through the Veteran Health Administration’s national initiative entitled Heath Care for Homeless Veterans (HCHV) program, the VA is accountable for providing supportive services to homeless Veterans and facilitating their access to a broad range of medical, mental health, and rehabilitative services. The Contractor shall be able to provide temporary housing, medical, and mental health services in a community-based setting to healthcare eligible Veterans with medical needs who are experiencing homelessness. The intent of the Medical Respite Program is to make medical respite and recuperative services available to Veterans who have a pending hospital discharge and/or Veterans who are unable to function in other local programs or housing shelters due to the need for medical services, including but not limited to, wound care, medication management, and the need for oxygen.

The Contractor shall provide a low-barrier therapeutic and rehabilitative environment and attendant services to address medical rehabilitation, while targeting the underlying factors contributing to the Veteran’s homelessness. The Contractor is required to provide detoxification or other acute level treatment.

PERIOD OF PERFORMANCE:

For this awarded medical respite contract, the Contractor shall be responsible for performing all actions outlined within this PWS no later than thirty (30) calendar days after the contract award. The ordering period shall not exceed twelve (12) consecutive months from the date the government places an order.

The Contractor shall be responsible for conducting administrative business, between the hours of 8:00 A.M. EST through 4:30 P.M. EST, Monday thru Friday except Federal holidays. The Contractor must at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS when the Government facility is not closed for the above reasons. When hiring personnel, the Contractor shall keep in mind that the stability and continuity of the workforce is essential.

SCOPE OF WORK:

I. GENERAL RESPONSIBILITIES: Contractor shall provide non-smoking accommodations to facilitate a quantity of five (5) Veterans with temporary residential placement which shall include the following:

a. On-site recuperative medical care and medication management by a Licensed Practical Nurse (LPN) or Registered Nurse (RN). Medication management shall be available twenty-four (24) hours per day/seven (7) days per week.

b. On-site case management services by a Human Services Professional.

c. On-site mental health services by a Mental Health Provider.

d. On-site residential staffing twenty-four (24) hours per day/seven (7) days per week. The Contractor shall, at all times, maintain an adequate workforce for the uninterrupted performance of all tasks defined in this Performance Work Statement. When hiring personnel, Contractor shall keep in mind that the stability and continuity of the workforce is essential.

The Contractor shall offer services to all healthcare eligible Veterans who require recuperative medical care stabilization due to either sickness, injury, and/or recovery from inpatient care. Veterans eligible to participate in the CMCVAMC’s Medical Respite Program shall be independent with the activity of daily living (ADL’s); meaning that Veterans eligible to participate in this program must be able to conduct fundamental skills required to care for oneself, such as bathing, walking, dressing, toileting, and etcetera. The Veteran must also be independent with medicine administration.

The Contractor shall be responsible for providing therapeutic rehabilitative and recovery services, which shall be determined according to the needs of the Veteran through a nursing and biopsychosocial intake assessment. The intake assessment shall include the identification of the Veteran’s biopsychosocial needs, which will inform the Contractor of the individualized care plan for the Veteran. Contractor shall be notified of Veterans being admitted after approved by VA Liaison upon decision from VA providers of Veteran meeting eligibility for program.

The Contractor shall be capable of receiving Veteran referrals, Monday through Friday during the business hours of 8:00 a.m. to 4:30 p.m. Eastern Standard Time (EST), excluding Federal holidays. The unexcused absence of any healthcare eligible Veteran from the Medical Respite facility in excess of seventy–two (72) consecutive hours shall not be authorized under this contractual agreement, and shall be considered cause for contract termination. Contractor shall ensure the Veteran has prior formal approval from the delegated VA Liaison for each instance of excused absence. Negative drug screens and test results shall not omit or discourage a healthcare eligible Veteran from participating in the CMCVAMC’s Medical Respite Program. However, the Contractor shall enforce that enrolled Veterans cannot be found using any non-prescribed drugs or controlled substances on the Contractor’s premises or grounds of the Contractor’s premises. The Contractor shall permit the Veteran to take their prescribed medications, to include Medication Assisted Treatments such as Suboxone or Methadone.

I. RECUPERATIVE MEDICAL CARE: The Contractor shall provide Veterans with respite and recuperative medical and mental healthcare in accordance with the plan of care developed by VA referring healthcare providers. The Contractor shall provide an on-site contracted LPN or LPN OR RN, licensed by the state of facility location (PA or NJ) and in good standing with their licensing board. The LPN or RN shall be scheduled to work no less than forty (40) hours per calendar week and available on call twenty-four (24) hours each day/seven (7) days per week. The LPN or RN shall be responsible for providing services only to Veterans enrolled in the Medical Respite Program. Additional hours may be necessary, commensurate with the needs of each Veteran.

a. The LPN or RN shall provide patient education, assistance with medication management, and treatment compliance within the scope of practice for nursing. The LPN or RN shall support the coordination of each Veteran’s care with VA healthcare providers and the VA Liaison to ensure for continuity of care. Veterans will also receive health education in areas such as sleep, nutrition, coping with chronic illnesses, and pain management. The LPN or RN will monitor the Veteran‘s vital signs and follow up with VA medical staff as appropriate. The LPN or RN shall be responsible for assisting the Veterans with the use of VA telehealth as needed. The LPN or RN shall oversee and assist with coordination of Veteran participation in in-home health care and outpatient services to address varying recuperative needs (i.e. Physical Therapy, Occupational Therapy, Wound care, etcetera). Each Veteran’s prescribed medication shall be safe guarded, properly documented, accounted for, and issued to the Veteran as prescribed by the recommending physician as monitored and managed by LPN or RN.

II. Case Management Services: The Contractor shall assign a representative to be a case manager to Veteran residents. The Case Manager shall be on-site at the medical respite facility at least twenty (20) hours per calendar week. Additional hours may be necessary to commensurate with the needs of each Veteran. The Case Manager shall hold a minimum of a Bachelor’s degree in Human Services and at least six (6) months of experience in social service settings. The Case Manager shall be responsible for providing the intake assessment to each Veteran resident and develop a plan of care with consultation of the Veteran and VA staff. The Case Manager shall be responsible for providing each Veteran an admissions packet that specifies a description of services offered in the Medical Respite Program during the Veteran’s length of stay. Therapeutic and rehabilitative services that shall be offered in the Medical Respite Program include, but are not limited to the following:

a. A thorough written Individualized Care Plan (ICP) shall be developed within seventy-two (72) business hours of admission for each Veteran patient. The ICP shall include individual case management services, such as weekly medical and mental health referrals, counseling on self-care skills, adaptive coping skills, financial planning, long-term transitional and permanent housing referrals, written care plan, and referrals for financial benefits. Additional counseling may include, professional and vocational rehabilitation counseling, in collaboration with VA programs and community resources.

b. The Case Manager shall be responsible for conducting weekly scheduled visits with each Veteran resident. The case manager shall be responsible for establishing open office hours to discuss progress toward goals established during the Veteran’s intake assessment. The Case Manager assigned shall possess the training and certifications necessary to respond to crisis situations with Veteran residents and provide access to emergency care as needed.

c. Coordinating structured group activities, at least offered weekly – examples include group therapy, life skills training, social skills training, financial workshops, Alcoholics Anonymous, Narcotics Anonymous, vocational counseling, and physical activities as appropriate. For the purposes of this contract, “House Meetings” and other informal group gatherings may not be counted as a structured group activity. Group activities should hold therapeutic value and facilitation, which may include guest speakers and shall be the responsibility of the Contractor. Should a Veteran have mental health, medical, family and/or employment obligations which directly conflicts with group involvement of the Veteran’s interest, alternate group activities shall be arranged and/or the Contractor will clearly document efforts made to accommodate the Veteran.

d. Each Veteran resident shall be referred to the Veterans Health Administration (VHA) for follow-up primary care and mental health appointments. The Contractor shall provide sufficient resources, transportation, and support to Veterans who are making their initial and/or subsequent follow up appointments. Special attention and efforts shall be made for Veterans who are identified as highly acute; meaning the Veteran has an illness that is of short duration, rapidly progressive, and in need of urgent care. Any special attention and efforts made for highly acute Veterans shall be documented in the Veteran’s ICP and reviewed during case consultation with the VA Liaison at least once a month.

e. Immediate care and attention shall be made to address the needs and concern of High Suicide Risk (HSR) Veterans. On a weekly basis, the Case Manager and/or Mental Health provider shall be required to update the VA Liaison on the Veteran’s progress, changes, and/or safety concern. The case manager will review HSR Safety Plans with the Veteran on a bi-weekly basis. A copy of the Veteran’s Safety Plan will be provided to the VA Liaison within seventy-two (72) hours of completion and the VA Liaison will input the documentation into the Veteran’s VA medical record.

f. Provisioning of intensive weekly case management services, including assisting the Veteran with completing and submitting applications for benefits (both VA and non-VA). obtaining necessary identification and records (i.e., birth certificate, DD 2-14, VA ID, state issued ID, etcetera), referrals to transitional housing (both VA-Grant Per Diem (GPD) and non-VA transitional housing) and permanent housing resources such as Supportive Services to Veteran Families (SSVF), Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) and non-VA housing resources in the community. Contractor will be required to keep Veteran files for minimum of 3 years post discharge from program for auditing purposes.

g. Providing instruction in and assistance with personal health and personal hygiene, establishment of income and or financial benefits, and strengthening budgeting skills to increase financial stability.

h. Discharge planning and coordination to appropriate transitional or permanent housing should also be offered to all Veterans upon discharge regardless of reason or type of discharge, including negative discharges. Discharge resources should include assistance with completing and submitting of housing applications, referrals, and community linkages.

i. The Contractor shall maintain proper documentation verifying services and case management efforts made by all team members involved including but not limited to housing staff, benefits staff, employment services staff, case manager, LPN or RN, and program management staff. There will be an expectation that notes are written in a clinically professional format that utilizes clear goal setting and progress towards those goals (e.g. DAP, SOAP, or SMART notes). Upon exit of the Medical Respite Program, a discharge plan summarizing services provided during the Veteran’s stay, including Veteran’s engagement and achievement of goals, housing status, discharge placement and location, and aftercare plan shall be placed in the Veteran record and available for VA Liaison to review and use for assistance in documentation purposes for discharge note submission within Veteran’s VA medical record.

j. Submission of the following required VA documentation to the VA Liaison will be provided by the Contractor in accordance with VA request within seventy-two (72) hours: individual VA Homeless Operations Management and Evaluation System (HOMES) forms, individual treatment plans, individual discharge summary, incident reports if appropriate, and monthly technical reports, at minimum.

III. MENTAL HEALTH SERVICES:

a. A Master’s Degree level mental health provider (Social Worker, Professional Mental Health Counselor, Psychologist, Marriage, and Family Counselor, etcetera) who is licensed or licensed-eligible and registered in good standing with their respective state of the facility location (PA or NJ) shall be on-site at minimum of twenty (20) hours/week and on-call twenty-four (24) hours per day/seven (7) days per week at the medical respite facility. The Mental Health provider shall provide mental health assessments, provision of interventions and treatments, monitoring mental health conditions, and referrals for Veterans who have mental health diagnoses that require assessment and treatment, as clinically indicated. If unlicensed, the Mental Health provider will be under the professional clinical supervision of an individual who is licensed at the highest level of state licensure for their respective mental health profession. Hours per week may vary, depending upon the level of clinical services needed.

b. The Mental Health provider may be permitted to act in a dual role as the Case Manager provided that the Mental Health services offered are in addition to the minimum number of hours of case management services required of a Case Manager.

IV. BASIC SERVICES: The Contractor shall provide each Veteran resident under this contract with the following basic services:

a. ROOM AND BOARD: Contractor is required to provide sufficient non-smoking facilities to accommodate a quantity of five (5) Veteran residents and shall be accessible to the Veterans twenty-four (24) hours per day/seven (7) days per week. Accommodations shall include a bed, and other furnishings for clothing and personal properties such as a dresser, storage locker or designated secured space, and personal linens (towels, pillows, blankets, and bed sheets, etc.). Contractor will allow Veterans to store personal belongings for at least seventy-two (72) hours after formal discharge on-site. A minimum of three (3) balanced and nutritious meals shall be offered to each Veteran resident per day; seven (7) days per week. In addition, there will be availability of snacks of nourishing quality (e.g., fruits, vegetables, protein sources, and etcetera), between meals and bedtime for Veterans requiring or desiring additional food, even when it is not medically indicated. Contractor shall be responsible for ensuring that not more than a fourteen (14) hour time span elapses between evening’s dinner meal and morning’s breakfast of the following day. The Contractor shall provide alternative meals for Veterans with dietary restrictions, if medically indicated (e.g. diabetic, renal, and soft mechanical diets) and reasonable accommodation for Veterans with cultural or religious preferences around food (e.g. Halal, Kosher, Sikh, Vegan, etc.). Food shall be prepared, transported, served, and stored under sanitary conditions, in accordance with local, state, and federal guidelines. Contractor shall establish and maintain sanitary procedures for washing dishes, cleaning equipment, work areas, and disposing of waste. Sub-contracted food service providers will be subject to the same guidelines.

b. LAUNDRY FACILITIES: The Contractor shall be responsible for possessing a fully functioning laundry facility, for the Veteran resident to wash their clothes. The Contractor shall provide the laundry detergent and other cleaning materials adequate for residents to do their own laundry, or to have laundry done a minimum of one time per week. The site staff should assist Veterans as medically needed with their laundry.

c. HOUSING SERVICES: A secondary goal of the Medical Respite Program is to provide Veterans with direct and ongoing assistance in achieving permanent housing. Plans for the Veterans’ transition to permanent and housing placements must be clearly reflected in each ICP and in weekly case management notes. As part of this plan, Veterans’ housing history and needs must be assessed through a formal and thorough Housing Assessment completed within seventy-two (72) business hours of program admission. Housing Assessments must identify Veterans’ housing history, strengths (i.e., positive prior rental history), and barriers (i.e., Unlawful Detainer, evictions, etcetera). Should a Veteran refuse to engage with program staff regarding plans for housing transition, motivational interviewing, trauma informed care, and other therapeutic techniques will be used to address Veteran ambivalence. All efforts to engage Veteran regarding housing plans, options, and resources shall be clearly documented and include any therapeutic techniques utilized. The Contractor shall provide direct assistance to Veterans in developing housing plans and accessing appropriate housing resources. These services shall be provided weekly through one-to-one case management. Examples of expected housing services include:

· Assistance obtaining and reviewing Veteran’s free credit report, identifying housing strengths and/or barriers associated with current credit status.

· Creating a Tenant Portfolio with Veteran that contains all relevant documents required in the rental process, including a completed sample rental application for Veteran, income verification documents, identification, applicable subsidies, and etcetera.

· Reviewing and applying to affordable permanent housing options and Permanent Supportive Housing (PSH) program offerings, and assisting Veterans with making appropriate inquiries and submitting completed referrals to permanent housing programs

· Conducting regular and individualized, housing advocacy efforts, including transportation, assistance scheduling, meeting, and communicating with transitional housing programs, property managers and landlords, and engage in troubleshooting where referral, rental barriers or denials occur in the housing search process all housing efforts by the Contractor shall be entered timely and clearly documented in the Veteran file, which will be presented to VA Liaison and/or VA inspection team upon request. Mere communication with Veterans regarding housing, without subsequent Contractor staff action and follow-up, shall not on its own meet the above requirements.

d. FINANCIAL PLANNING: Referral to and follow up on all potential financial resources the Veteran may be eligible for (e.g. SSI, SSDI, Food Stamps, VA NSC pension, VA Disability, General Assistance, and etcetera). Case Managers will document all structured activities that support the Veteran in developing a short-term and long-term plan to understand and address their current financial situation and how to improve it. Financial planning efforts may be accomplished in group but preferably through one-on-one sessions with the case manager. Financial planning activities appropriate to the Veterans’ individual circumstance must be documented and provided to VA Coordinator or Liaison monthly.

e. EMPLOYMENT SERVICES: Referral to all relevant employment and training opportunities the Veteran is eligible for and interested in will occur on a as clinically indicated and at minimum monthly. The Case manager will document all structured activities that support each Veteran in applying for employment or training opportunities, as appropriate, based on needs of the Veteran, as identified in the treatment plan.

f. RECOVERY: Support for an alcohol/drug abuse-free lifestyle should be provided in an environment conducive to social interaction and in accordance with the Veteran’s treatment goals. Assistance to gain and to apply knowledge of the recovery process in an environment supportive of recovery models, including a focus on Harm Reduction, rather than strict abstinence, and supportive of a Housing First approach. Pursuant to these principles, drug testing may not be used to discharge or discipline a Veteran but may be used as a clinical intervention to modify behavior. The Contractor will ensure that illicit drugs as defined by the federal government, drug paraphernal, and alcohol are not permitted on the premises.

g. OUTREACH: The Contractor will be responsible to engage in outreach in the community independently and/or in collaboration with VA Liaison at least two times per month in order to provide Veterans with community resource options. In addition, clear documentation for outreach activities must be made available to VA Liaison upon request during the QASP review. Contractors will maintain occupancy by engaging in outreach services and will be knowledgeable about outreach best practices generally accepted in the community.

h. DISCHARGE PLANNING: Discharge requirements: The Veteran will be discharged with housing options; with minimally a 5-day supply of medications; medically cleared for lower level of care; follow up medical appointments will be scheduled as deemed necessary.

Additional discharge requirements include ensuring follow-up appointments are scheduled prior to discharge and if/when needed permanent housing will be the primary discharge goal for every Veteran. All Veterans must have a discharge plan within one week of admission. Although discharge planning should have primary goals of permanent housing, referrals to lower levels of care may be required, based on the Veteran’s clinical needs and housing readiness. Transitional housing referrals may include VA GPD housing programs, community transitional housing programs, residential inpatient programs, and/or other Contracted Residential Service programs. Compliance with all VA regulations regarding discharges and timeliness of reporting is required of the Contractor. The Contractor will provide assistance with discharge planning for every Veteran and report all discharges via email within twenty-four (24) business hours using a secured process (e.g. HOMES ID number or VA approved encryption method) to the VA Liaison. Paperwork required for discharging a Veteran from any HCHV program is also due within twenty-four (24) business hours from known discharge. Resources will be coordinated for discharge to a successful community placement throughout the duration of the Veteran’s stay.

A negative discharge for undesirable behavior is a committee decision that must include the VA Liaison prior to discharge. All Veterans scheduled for negative discharge based on behavior must be offered an opportunity to meet with the treatment team and work to determine the most therapeutic alternative temporary housing option for Veteran. This does not include violations for safety reasons. Please note: Profanity does not in and of itself constitute to abuse and shall not exclusively be considered grounds for discharge. Any and all actual or threatened violence will be grounds for discharge. Veterans may be discharged for safety reasons at any time. All negative discharges will be subject to a full team debriefing, including VA Liaison, to look for opportunities for process improvement.

The Contractor shall have a clearly posted grievance process. All discharges are subject to the Contractor’s grievance procedures and must allow Veterans the opportunity to be represented by the VA Liaison in the grievance process.

i. GRIEVENCE PROCEDURES: The Contractor must have an internal grievance process that Veterans can use to resolve conflicts within the Medical Respite Program. The Contractor must have written policies and procedures for resolving grievances, including a statement regarding the Veteran’s right to request reasonable accommodation, and must post them in a place conspicuous and accessible to Veterans. In addition, each Veteran shall receive a copy of the grievance policies and procedures upon intake and upon receiving a warning or discharge notice. Veterans are also able to share grievances directly to VA Liaison. Reasonable efforts must be made to coordinate with the VA Liaison or designee in order to schedule an appeal.

j. INTAKE PACKETS: All Veterans must receive an intake packet within seventy-two (72) business hours of admission, which includes at minimum, the following information:

· Description of the Contractor’s services

· Grievance policy

· Emergency procedures

· Rights and responsibilities

· Reasonable accommodation

k. EXTENSIONS- All extensions beyond ninety (90) days must be requested in writing and approved by VA Liaison or designee.

l. MEDICATION MANAGEMENT: Medications and narcotics shall be properly stored, controlled, issued, and recorded in compliance with physician’s orders. The Contractor shall establish procedures for ensuring Veterans’ confidentiality in the storage of and record keeping of medications. Medication Assisted Treatment (MAT) cannot be used to rule out Veterans’ participation in an HCHV Program. This includes prescribed use of Vicodin, Morphine, Methadone, Oxygen, etcetera. Reasonable accommodation for individuals in MAT is required, provided the requested accommodation does not require major financial or administrative commitments that would be considered an “undue burden.” Examples of reasonable accommodations include:

· Arranging for the individual to take medication at their clinic, physician’s office, or another off-site location – when consistent with the individual’s treatment plan.

· Storing an individual’s MAT medication in a lock box in the program and having the individual be personally responsible for it.

· Arranging to have the housing facility keep MAT medications in a locked cabinet (Copies of Inspection Packet requirements relating to medication management are available upon request).

m. TIMELINESS OF RESPONSE: The Contractor is expected to have a dedicated phone line for VA inquiries and referrals. Return calls from the program are expected within 4 hours during business hours Monday through Friday. This includes calls from VA Staff or the Liaison to the program.

n. CRITICAL INCIDENT REPORTING: All critical incidents will be reported as soon as possible and no later than twenty-four (24) hours after the incident’s occurrence. This includes the following:

i. Falls with injury

ii. Assault (to Veteran or Staff)

iii. Elderly/Dependent Adult Abuse or Neglect

iv. Sexual Assault

v. Fire (Veteran Involved)

vi. Medical/Psychiatric Emergency (911 Calls)

vii. Hospitalization

viii. Suicide or Suicide Attempt

ix. Homicide

x. Death

xi. Infectious Control (COVID-19, TB, etcetera)

xii. Active Substance Abuse

xiii. Observation/ Possession of Weapons

xiv. On-site arrest of a Veteran by law enforcement

V. DOCUMENTATION: The Contractor shall provide treatment and discharge planning reflecting a team assessment of medical, social and vocational needs and the involvement of the Veteran, VA staff and appropriate community resources in resolving problems and setting goals. An individual case record will be created for each referred Veteran. Case records shall be maintained in security and confidence as required by the Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR part 2) and the Confidentiality of Certain Medical Records (38 USC 7332). Case records and data normally maintained and included in a medical record as a function of compliance with State or community licensing standards will be made available on a need-to-know basis to appropriate Department of Veterans Affairs staff members involved with the treatment program of the Veterans concerned. The Contractor shall comply with applicable requirements of the Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR Part II) and the Confidentiality of Certain Medical Records (38 USC 7332). The files shall include:

i. Reasons for referral.

ii. All essential identifying data relevant to the resident and his/her family including a socio-cultural assessment, weekly progress reports or notes, and documentation of any case management interventions or patient care conferences.

iii. Medication Management/Monitoring- Copies of any medical prescriptions issued by physicians, including orders, if any, for medications to be taken. The Contractor must be in compliance with HCHV inspection requirements.

iv. Nursing, Case management, and Mental Health notes written in a professional manner (i.e., SMART, SOAP, DAP) will include the following: 1) A written and comprehensive Assessment, 2) Individual Care Plan 3) Financial Plan, 3) Discharge Plan, 4) documented progress and activity towards identified goals.

v. QASP Compliance Tool and all attendant supporting documentation demonstrating Contractor compliance with contract.

vi. Final discharge summaries on each resident who leaves the program, to include reasons for leaving, the resident’s future plans, and follow-up locator information.

vii. Extension approval if relevant.

viii. Waivers as appropriate.

VI. RULES, POLICIES AND PROCEDURES: The Contractor shall have reasonable rules governing day-to-day life and activities in the facility. Such rules clearly inform Veterans of the obligations upon which their continued participation in the program depends and the consequences for non-compliance. Veterans will be provided a copy of the rules at intake or upon Veterans request. In addition, the Contractor will post the rules in a location readily accessible to clients and visitors. These rules must include detailed Patient Rights and the procedures that the Contractor has in place to protect the Veterans rights and dignity. Veterans must be permitted to exercise these rights without fear of reprisal. If requested, the Contractor must reasonably accommodate Veterans whose compliance with program rules is limited by the Veterans’ physical or mental disabilities, in accordance with the Americans with Disabilities Act, the Federal Fair Housing Amendments Act, Section 504 of the Rehabilitation Act, including those requirements covering reasonable accommodations for disabilities and the use of assistance animals, and the Pennsylvania Fair Employment and Housing Act of 1973 and all other applicable State or Federal laws. Contractor must equally apply all rules, policies, and procedures to Veterans, unless a Veteran has asked for a reasonable accommodation due to his/her disability.

a. PROCEDURES FOR NEGATIVE DISCHARGE OR SANCTION: The Contractor must post rules in the Case Manager’s Office and provide Veteran with the rules which specify the reasons or conditions for which a Veteran may be sanctioned or discharged, including those behaviors which constitute gross misconduct and are grounds for immediate discharge from the program and those which would prompt a written warning if violated and potential discharge if violated repeatedly. The Contractor will describe the formal appeal procedures through which clients may appeal program regulations, sanctions or discharges. This information must be provided to clients in writing upon intake and must be clear and easily understandable by clients. This information will include:

i. Immediate contact with VA liaison.

ii. Timely due process provisions which should include two warning notices for violations which do not result in immediate discharge prior to issuance of a discharge notice and an opportunity for a case conference after warning is issued to the client.

iii. Notice of, and access to, formal appeal procedures.

iv. Notice of the conditions or process for re-admission to the program.

v. Reasonable efforts to provide an appropriate referral to another facility or appropriate level of care as needed.

vi. This does not apply to Veterans who are discharged for danger to self or others

A. ADDITIONAL CONTRACT REQUIREMENTS

I. PERSONNEL: The Contractor shall be responsible for ensuring the continuity and stability of the workforce to carry out the policies, contract responsibilities, and the program for the facility. Case management staff must have appropriate and commensurate coverage for staff using authorized and unauthorized leave (e.g., holidays, sick leave, family care, etcetera). There must be, at a minimum, one staff member on duty on the premises or residing at the facility and available for emergencies twenty-four (24) hours a day/ seven (7) days a week. In addition, there is an expectation that there is an administrative/clinical Designee that will be available for consultation for emergencies twenty-four (24) hours a day/ seven (7) days a week. The Contractor shall assign required personnel that by education, training and when required, certification or licensure qualified to provide the Basic Services and Supplemental Services required by this PWS.

a. Staff Training: The Contractor will provide clinical staff personnel on-site, at all times, who have current training and orientation on the following topics. Staff shall receive and document—at a minimum—one-time training per year on these subjects.

i. CPR

ii. First Aid (including Nasal Naloxone use)

iii. Crisis intervention

iv. Cultural sensitivity and Diversity, Equity, and Inclusion

v. Sexual harassment

vi. Sensitivity to wider issues of homelessness

vii. Universal Precautions (disease transmission prevention)

viii. Elder/Dependent Adult abuse reporting laws

ix. Harm Reduction philosophy

x. Housing First

xi. Suicide assessment and prevention

xii. Medication management (for staff assigned to this duty)

xiii. State and Federal Fair Housing Law and ADA Requirements

xiv. Conflict resolution

xv. De-escalation and disruptive behavior management techniques

xvi. Search and Seizure/Probable Cause in the Shelter Setting

xvii. Conservatorship

xviii. Grave Disability Criteria

xix. Confidentiality and privacy requirements

Contractor will perform criminal background checks on all staff members. Contractor must have a policy prohibiting staff from establishing sexual relationships with program Veterans.

Contractors will agree not to hire staff members who are currently enrolled in a VA Homeless Program or who have ended participation in a VA Homeless Program within the past two years.

Contractor must identify each person functioning as “Key Personnel” under this contract and provide to the VA a description of the services to be provided by such person, together with a resume summarizing that person’s relevant skills and experience.

II. REFERRALS, ADMISSIONS AND ELIGIBILITY: The Contractor must utilize an admission process that includes written eligibility criteria that is fair, objective, and compliant with applicable State and Federal laws. Contractor will provide verbal and written notification that is readily accessible to all individuals, upon request, of reasons for non-acceptance. Notification of reasons for non-acceptance is not required to be given to those denied service/housing because of bed unavailability. The eligibility information must be made available to clients at intake and staff must provide answers to questions about the admission criteria and process. Contractors must have formal appeal procedures through which clients may appeal unfavorable admission or eligibility decisions and a copy of the policy for appeals is to be given to the Veteran at screening or intake.

The VA Liaison or designee is responsible for determining eligibility of Veterans prior to acceptance by the Contractor for services. After receipt of a Release of Information (ROI), a written pre-approval from VA Staff is required (hard copy, fax or e-mail are acceptable) and shall be provided to the Contractor for each Veteran referred for services under the contract. If there is an urgent need to admit a Veteran and VA Staff is not available to provide a written approval in a timely manner a verbal approval is acceptable. Any admissions that occur without written/verbal approval must be verified by VA Staff within 24 business hours in order for the Contractor to receive payment for time spent prior to approval (e.g. admission after hours or during the weekend). Written documentation of eligibility verification, signed by an authorized VA Staff, shall be obtained by the Contractor as soon as possible for each Veteran referred for services under the contract for inclusion in the Veterans program file.

A list of authorized VA Staff for the contract shall be provided to the Contractor upon award of the contract as updated as needed. The Contractor will be provided an updated list of authorized VA Staff whenever such changes are made.

It is understood that the Contractor will not be paid for care provided to a referred Veteran beyond the period authorized in the referral, unless an extension of the authorization is provided in writing by the VA.

The initial stay for a Veteran should be no longer than 90 days. Any extension of the stay after ninety (90) days must be authorized by the VA Liaison or designee, provided that there is clear clinical indication and availability of funds. Approvals for extensions must be stored in the Veteran’s file.

It is understood that the eligibility of Veterans to be cared for under this contract will require medical care and treatment services over and above the level of room and board. It is also understood that Veterans may need more intensive case management than the general population. The level of intensity of services required will be part of an ongoing conversation with the VA Liaison. To be eligible for placement in HCHV contract beds, all Veterans must be homeless or at imminent risk of becoming homeless and be eligible and registered for VHA services. While special population contracts are intended for Veterans with special needs, a formal diagnosis is not required for the Veteran to participate in the program. Veterans should be independent in ADLs as an eligibility requirement. Medical Respite services are not a substitute for long-term care or skilled nursing care. The Contractor is encouraged to provide housing and or services to special Veteran populations, such as but not limited to the following: medically compromised Veterans, Veterans with sex offender status, seriously mentally ill Veterans, Veterans who have abused drugs or alcohol for many years, and/or Veterans who have been involved with the legal system.

III. DENIAL OF SERVICES: Veterans cannot be denied entry to HCHV Medical Respite beds based solely upon length of current abstinence from alcohol or non-prescribed controlled substances, the number of previous treatment episodes, the time interval since the last program entry, the use of prescribed controlled substances, disability, income, gender, or legal history. This includes a Veterans status of being a victim of Intimate Partner Violence (IPV) and as such cannot be considered during the screening process. The screening process must consider each of these special circumstances and determine whether the program can meet the individual Veteran's needs while maintaining the program's safety, security, and integrity. Contractor must employ a harm reduction approach.

IV. ABSENCES AND CANCELLATION: The Contractor shall notify the VA of unauthorized absences of a referred Veteran from the facility within twenty-four (24) hours of the Veteran’s absence. Should a Veteran become absence without leave (AWOL) from the Contractor’s facility in an unauthorized manner, payment for services for that Veteran shall be continued for a maximum of forty-eight (48) hours timeframe, provided there is documented active outreach attempt to the Veteran on the part of the Contractor for the Veteran’s return to the facility.

VA reserves the right to remove any or all Veterans from the facility at any time, without additional cost, when it is determined to be in the best interest of the Veteran and/or the VA. This includes discharge from facility for ongoing bed bug infestation without plan to avoid.

The Contractor shall notify the authorizing VA facility immediately when a medical emergency occurs that requires hospitalization of a referred Veteran. It is agreed that the Veteran will be admitted to the appropriate VA facility. When such admission is not feasible because of the nature of the emergency, it is agreed that hospitalization in a non-VA facility is acceptable. If hospitalization of a non-emergent nature is required, it is agreed that admission to the appropriate VA facility will be accomplished promptly. The Contractor will make arrangements for admission and support the Veteran with any transportation issues that may arise to address the emergency.

The Contractor shall notify the authorizing VA Liaison or designee immediately of any incidents involving Veterans residing in the HCHV Medical Respite program. The Contractor shall notify the VA Liaison by telephone or email during normal business hours of 8:00 am and 4:30 pm, Monday thru Friday. For all incidents that occur after normal business hours, the Contractor should notify the VA Liaison the following business day. The Contractor shall provide the VA Liaison with a copy of the incident report within twenty-four (24) business hours. The Contractor shall maintain a copy of the incident report in the Veteran’s case record. Please see above in Basic Services for details regarding what constitutes Critical Incident Reporting.

V. CONTRACTOR STAFF CONDUCT/COMPLAINTS HANDLING: Contractor personnel shall be expected to treat referred Veterans with dignity and respect and abides by standards of conduct mirroring those prescribed by current federal personnel regulations. The Contractor shall comply with the VA Patient's Bill of Rights as set forth in 38 CFR 17.34a (copy available upon request).

The VA reserves the right to exclude Contractor staff members from providing services to Veterans under this contract based on breaches of conduct, including conduct that jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction, or negligence in performing directed tasks, or other conduct resulting in formal complaints by Veterans or other Staff members to designated Government representatives. The Contractor and Contracting Office shall deal with issues raised concerning Contractor personnel conduct. The Contracting Officer shall be the final arbiter on questions of acceptability and in validating complaints.

VI. BASIC RIGHTS AND PROTECTION AGAINST DISCRIMINATION: The Contractor shall comply with the principles listed in 38 CFR 17.707(b) to provide housing and supportive services in a manner that is free from religious discrimination. The Contractor must protect the rights and dignity of the individual or family served in all phases of service delivery. At a minimum, providers must afford each Veteran the following rights and protections. Clients must be permitted to exercise these rights without fear of reprisal.

Veterans are entitled to enjoy a safe and healthful environment in the program.

Veterans are entitled to be treated in a manner that respects their dignity, privacy, and individuality.

Veterans with disabilities are entitled to reasonable accommodations under fair housing laws when such accommodations are necessary because of their disability.

Veterans are entitled to remain in the program and not be involuntarily removed without reasonable notice, good cause, and just procedures.

All program clients are entitled to just and standardized procedures for determining eligibility, admissions, sanctions, and discharges, and resolving grievances.

Veterans are entitled to reasonable privacy and confidential treatment of personal, social, financial, medical, and behavioral/mental health records, except as necessary to further treatment, information, and referral services and in compliance with the resident’s consent to release information.

Veterans are entitled to the full exercise of their civil, constitutional, and legal rights.

Veterans will have on-going opportunities to voice opinions, to participate in program operation and programming, and to make suggestions regarding programming and rules.

Veterans’ rights must be protected against all forms of discrimination, including those based on race, religious creed, color, national origin, ancestry, language, disability (physical or mental health), medical condition, marital status, familial status, age, gender expression, sexual orientation, source of income, or political affiliation. Veterans will be free from retaliation.

Veterans will receive a written policy indicating that harassment of residents and staff on the basis of race, religious creed, color, national origin, ancestry, language, disability (physical or mental health), medical condition, marital status, familial status, age, gender expression, sexual orientation, source of income, or political affiliation will not be condoned nor tolerated.

Contractors will develop a written policy for transgender and non-binary Veterans that provides for safe, secure, and dignified case management as well as accommodate the special requirements needed for privacy. All Veterans will have access to sleeping accommodations and bathroom facilities based on their gender of identification/expression, regardless of physical characteristics or gender conformity. People who do not clearly identify as male or female should have access to whichever sleeping and/or bathroom accommodation helps them feel safest. Where there are single-use showers and bathrooms in the facility designated for Veterans, transgender Veterans will be informed about them and welcomed, but not required to use them in lieu of shared facilities. It is the Contractors responsibility to promote a safe environment for transgender and non-binary clients amongst the general population.

Programs must post these policies in a conspicuous place and in appropriate languages of the Veteran population. All policies and procedures will be in writing and subject to review by the VA

VII. REASONABLE ACCOMODATION: The Contractor must respect and reasonably accommodate personal and cultural differences associated with race, religious creed, color, national origin, ancestry, language, disability (physical or mental health), medical condition, marital status, familial status, age, gender expression, sexual orientation, source of income, or political affiliation. At no point shall program access be denied because of an individual’s disability. Information learned about the client’s disability from the assessment will not be used as grounds for discharge or other punishment and will be used to guide client to appropriate services. Moreover, a program may not apply different rules to individuals because of their disabilities, unless the different rules are a result of granting a reasonable accommodation request made by an individual with a disability. The Contractor shall not ask questions about a client’s disability, including the nature and severity of the disability or the treatment, symptoms, and medications related to the disability. A Veteran is not obligated to reveal that they have a disability prior to admission. Veterans with disabilities are entitled to reasonable accommodations. If a Veteran requests a change in a program’s policy or procedure as an accommodation of his/her disability, the program should grant the accommodation when the accommodation is both reasonable and necessary because of the individual’s disability. Such an accommodation request must be considered during any stage in the provision of a program, including at intake, during services, and during discharge proceedings.