Attachment A - PWS Wilkes-Barre.docx

Attachment A PERFORMANCE WORK STATEMENT

1.0 PURPOSE:

The Wilkes-Barre VA Medical Center (VAMC) in Pennsylvania, requires contracted Non-Emergent Ambulance and Wheelchair Transportation Services. This includes Wilkes-Barre VAMC and its seven Community Based Outpatient Clinic (CBOC) locations listed below. Contractor shall provide all vehicles, personnel, and equipment required to provide Basic Life Support (BLS), Advanced Life Support (ALS) Ambulance, and Wheelchair Services 24 hours a day, 7 days a week (24/7), including weekends and holidays, to beneficiaries of Wilkes-Barre VAMC in accordance with the terms, schedule and referenced materials of this agreement.

Allentown CBOC 3110 Hamilton Boulevard Allentown, PA 18103 Wilkes-Barre VAMC 1111 East End Blvd Wilkes-Barre, PA 18711

Bangor CBOC 701 Slate Belt Boulevard Bangor, PA 18013-9341 Williamsport CBOC 1705 Warren Avenue, Werner Building 3rd Floor (Suite 304) Williamsport, PA 17701

Columbia County CBOC 225 Columbia Mall Drive Bloomsburg, PA 17815 Wayne County CBOC 600 Maple Ave. Suite 2 Honesdale, PA 18431

Tobyhanna CBOC Building 220 Tobyhanna, PA 18466 Sayre CBOC 1537 Elmira St Sayre, PA 18840

2.0 BACKGROUND

The Wilkes Barre VA Medical Center is comprised of a Main Campus, where the main hospital, a Community Living Center, and many outbuildings are located; and, in the surrounding counties, the Community Based Outpatient Clinics (CBOCs) where primary care and specialty clinics are available for treating eligible Veterans.

3.0 ACRONYMS:

3.1 ALS – Advanced Life Support

3.2 AOD – Administrator on Duty

3.3 BLS – Basic Life Support

3.4 CC – Critical Care

3.5 CO – Contracting Officer

3.6 COR – Contracting Officer’s Representative

3.7 CPR – Cardiopulmonary Resuscitation

3.8 DOL – Department of Labor

3.9 EMT-B – Emergency Medical Technician-Basic

3.10 EMT-P – Emergency Medical Technician-Paramedic

3.11 VAMC – Veterans Affairs Medical Center

3.12 IAW – In Accordance With

3.13 PWS – Performance Work Statement

3.14 QASP – Quality Assurance Surveillance Plan

3.15 QCP – Quality Control Plan

3.16 TB – Tuberculosis

3.17 TJC – The Joint Commission

4.0 REQUIREMENTS:

The Contractor shall provide the following Ambulance Services on an as-needed basis:

4.1 BASIC LIFE SUPPORT (BLS):

Basic Life Support (BLS) Services is defined as a basic level of pre-hospital and inter-hospital emergency care and non-emergency medical services that includes airway management, cardiopulmonary resuscitation (CPR), control of shock and bleeding and splinting of fractures, as outlined in the Basic Life Support national curriculum of the United States Dept. of Transportation and any modifications to that curriculum specified in rules adopted by the Department.

4.1 a Staffing:

For BLS services, each ambulance shall be staffed by Emergency Medical Technicians with a current Pennsylvania EMT-B license or as required by local, state, or regional Government, or public entity by which the ambulance services are governed.

4.2 ADVANCED LIFE SUPPORT (ALS):

Advanced Life Support (ALS) Services is defined as an advanced level of pre-hospital and inter- hospital emergency care and non-emergency medical services that includes BLS, electrocardiography, cardiac defibrillation, cardiac monitoring, IV therapy, administration of drugs and solutions, use of adjunctive medical devices, trauma care, and other authorized techniques and procedures.

4.2a Staffing:

For ALS service, each ambulance shall be staffed by Advanced Emergency Medical Technician- Paramedics with a current Pennsylvania EMT-P license or as required by local, state, or regional Government, or public entity by which the ambulance services are governed.

4.2 b Typical situations when the Wilkes Barre VAMC would require ALS Services:

i. Patients with running IVs

ii. Patients requiring cardiac monitoring

4.3 CONTRACTOR PERSONNEL:

Contractor employees shall be courteous and conduct themselves in a business-like manner at all times while providing services under this agreement.

4.3a Paramedics and EMTs Paramedics, EMTs and other medical personnel (as applicable), shall at all times meet the qualifications specified in this agreement, as well as all applicable federal, state and local Government laws, regulations, and standards. They shall be certified, licensed, or otherwise officially recognized by local, state, or regional Government or public entity by which the emergency service is governed.

4.3 b Non-Emergency Attendants/Drivers

i. Attendants/drivers shall be capable of administering oxygen and have successfully completed the Standards and Advanced First Aid Courses of the American Red Cross or US Bureau of Mines or equivalent. Proof in the form of a current certificate for the successful completion of such training must be provided upon request.

ii. All ambulance drivers shall have a valid driver’s license in accordance with state requirements for their place of operation and the services they perform.

4.3 c Driver Conduct The following acts are not permissible by drivers which provide services under this agreement or while on Wilkes Barre VAMC premises:

i. Use of intoxicating liquors, narcotics, or controlled substances of any kind (excluding Dr.’s prescriptions which do not impair driving ability), while on duty or reporting for duty.

ii. Gambling in any form.

iii. Smoking and other uses of tobacco while on duty.

iv. Carrying of pistols, firearms, or concealed weapons.

v. Resorting to physical violence to settle a dispute with a fellow employee(s), customer(s), or the general public while on duty.

vi. Spitting, or any other unsanitary, or offensive practice or behavior while on VAMC premises

vii. Use of loud, indecent, or profane language and/or making threatening or obscene gestures towards customers or other employees.

viii. Stopping for personal business, including use of a restroom, while a patient is in the vehicle.

ix. The driver shall not leave the vehicle with the key in the ignition at any time.

x. Engaging a customer in a verbal confrontation in an attempt to settle a disagreement. Should a disagreement arise, the driver is to contact his dispatcher/supervisor via the radio system.

xi. Soliciting or accepting tips from customers, companions, or others at any time.

4.3d Certification/Licensing Requirements Prior to performing any services under this agreement, the Contractor shall provide evidence of required training, certifications, licensing, and any other qualifications of any personnel performing services under this agreement. If the Contractor wishes to add or replace personnel, it shall provide the above requirements to the COR for approval.

4.3 e Tuberculosis (TB) Exposure Control Policy

i. Prior to performance any services under this agreement, he Contractor shall provide Wilkes Barre VAMC their policy on TB exposure and control, to include TB decontamination.

ii. The Contractor shall have its personnel tested for TB and provide each of these test results to the COR.

4.4 DESTINATIONS FOR VETERANS TRANSPORTED TO/FROM WILKES BARRE VAMC INCLUDE:

4.4a A clinic within Wilkes Barre VAMC to another clinic, or to the ER 4.4b From an outbuilding/outlying area on the Wilkes Barre VAMC Campus to the ER, or other appropriate facility as determined by local protocol as part of the on-campus emergency response process 4.4c To and from the veteran’s house to the Wilkes Barre VAMC (requiring an ambulance vs. a wheelchair van) 4.4d To and from the Wilkes Barre VAMC to other local area hospitals

4.4 e To and from the Wilkes Barre VAMC to other VISN-4 medical facilities (i.e., Philadelphia VAMC, Pittsburgh VA MC, Coatesville VAMC, Manhattan VAMC, etc.)

4.5 ADDITIONAL SERVICES:

Contractor shall be required to transport patient luggage, medical records, medication, and comfort items from pickup points to destination at no additional cost to the Government. Luggage to be transported is restricted to a suitcase or travel case type bag when patients are transported to Wilkes Barre VAMC.

5.0 CONTRACTOR VEHICLES, EQUIPMENT, AND INSPECTION:

5.1 AMBULANCES

5.1a The Contractor shall have the capabilities to sufficiently handle simultaneous calls and meet or exceed the minimum time requirements (see section 6.3 under ORDERS).

5.1b Ambulances shall meet all current applicable Federal, State, and local regulations and specifications including, but not limited to, licensing, registration, and safety standards. Appropriate licensing by the State of Illinois is required.

5.1c Vehicles shall be clean and maintained in good repair in accordance with manufacturer’s instructions. At no time will the Contractor leave vehicles on the Wilkes Barre VAMC premises unless a pick-up or delivery is in process.

5.1d Wilkes Barre VAMC reserves the right to inspect Contractor's vehicles or require documentation of compliance with agreement specifications, and State laws, regulations, rules, and guidelines governing emergency medical transport vehicles (ambulances). Wilkes Barre VAMC inspections of Contractor vehicles will not constitute a warranty that the Contractor's vehicles are properly maintained.

5.1 e Wilkes Barre VAMC reserves the right to restrict the Contractor’s use of vehicles which are not in compliance with agreement requirements. The restriction of such vehicles shall not relieve the Contractor from performing in accordance with the agreement, nor necessitate additional costs to VAMC.

5.2 EQUIPMENT

5.2a Wilkes Barre VAMC reserves the right to inspect Contractor's equipment, or require documentation of compliance with agreement specifications, and State laws, rules, regulations, and guidelines governing emergency medical equipment. Wilkes Barre VAMC inspections of Contractor’s equipment will not constitute a warranty that the Contractor's equipment is properly maintained.

5.2b Wilkes Barre VAMC reserves the right to restrict the Contractor’s use of equipment which is not in compliance with agreement requirements. The restriction of such equipment shall not relieve the Contractor from performing in accordance with the agreement, nor impose additional costs to VA.

5.2c The Contractor shall have sufficient equipment within inventory to appropriately respond to any type of call within the PWS at all times while providing services under this agreement (see section 6.3 under ORDERS). Wilkes Barre VAMC reserves the right to inspect and verify that the equipment proposed is on hand.

5.2d The Contractor shall not be permitted to borrow medical equipment, nor at any time, or under any circumstances, exchange supplies, equipment, or medications with Wilkes Barre VAMC.

5.2e Equipment attached to, or in use by, the patient at time of pick-up may remain with the patient during transport to ensure continuity of care. Medical Authorities are responsible for maintaining and supplying medication during patient transport. All Wilkes Barre VAMC equipment and unused medications must be returned to the VAMC during patient drop-off or as promptly as feasible.

6.0 ORDERS:

An order is defined as one incidence of a request for service (BLS or ALS service). But for exceptions approved by authorized VA ordering employees, no more than one patient will be transported per order.

6.1 The type of transportation service required (BLS or ALS) will be discussed and determined by Wilkes Barre VAMC clinical staff and the Contractor. Contractor shall transport the patient per its policies and standard industry practice. If the type of transport differs from what was agreed upon by Wilkes Barre VAMC and the Contractor, the Contractor shall submit documentation to Wilkes Barre VAMC explaining its rationale.

6.2 Wilkes Barre VAMC may authorize an escort (i.e., spouse, relative, guardian, etc.) to accompany the patient during medical transport if it is practicable and, in the patient’s, best interest. The Contractor shall allow the escort to accompany the patient at no additional cost to the Government.

6.3 The Contractor shall have sufficient vehicles and personnel to provide services for up to three (3) simultaneous calls within a calendar day, for any mix of BLS or ALS services. If Wilkes Barre requires ambulance services exceeding three (3) simultaneous calls in a calendar day, the vendor will be offered to provide the services if they have sufficient vehicles/personnel available; but may decline these additional orders if sufficient vehicles/personnel are unavailable.

6.4 If the Wilkes Barre VAMC schedules an ALS level transport, and Wilkes Barre VAMC wishes to send a nurse or other specialized personnel with the ambulance, AND the equipment required from the Contractor does not exceed the scope of ALS level service, the Government shall be charged for an ALS level of service.

6.5 The Contractor shall not be held liable for non-performance caused by an occurrence beyond the rea- sonable control of the Contractor and without its fault or negligence, such as:

6.5a acts of God or the public enemy 6.5b acts of the Government in its sovereign or contractual capacity 6.5c fires 6.5d floods 6.5e epidemics 6.5f strikes 6.5g delays of common carriers 6.5h quarantine restrictions 6.5i unusually severe weather

6.6 RESPONSE TIMES:

6.6a For this agreement, Ambulances Services are split into two (2) levels (BLS and ALS), with time response requirements as noted below in the chart. The response times represent minimally acceptable response time standards. The Contractor is expected to exceed the minimum. The Contractor shall arrive no later than the pre-scheduled time.

6.6 b The Wilkes Barre VA representative authorized to schedule services shall specify the level of service, the required response time, and origin and destination locations. If the Contractor feels the scheduled delivery does not accurately match the minimum service needed, the Contractor shall contact the authorized VA Wilkes Barre representative and request to change the scheduled service level. If the representative agrees and the Contractor must make a second trip, they are entitled to charge the Government for both trips. No additional cost will be paid unless authorized prior to the second trip.

Response Options

Ser vice

6.7 RE: AMBULANCE TRANSPORTATIONSERVICES

6.7a Orders for transport services will be made by telephone.

6.7b Only properly appointed ordering officers or warranted contracting officers are authorized to place orders against this agreement.

6.7c Private agencies (e.g., nursing homes) are not considered authorized to place orders. A list containing the names and phone numbers of the Wilkes Barre VAMC staff who are authorized to place orders will be submitted to the Contractor at time of award.

6.7 d If the Contractor fails to furnish ambulance services within the required response time, after receiving a request for a scheduled trip, Wilkes Barre VAMC may obtain the service from another source.

6.8 RE: AN INTER-HOSPITAL NON-EMERGENCY MEDICAL TRANSPORT

6.8a If a physician from the sending hospital provides EMS personnel with written medical orders, such written orders cannot exceed the scope of care for which the EMS personnel are authorized.

6.8b For an inter-hospital medical transport of a patient who requires medical care beyond the scope of care that the EMS personnel are authorized to render, a qualified physician, respiratory therapist, clinical perfusionist, or nurse familiar with the scope of care needed must accompany the patient and the transferring hospital and physician shall assume medical responsibility for that portion of the medical care.

7.0 PICK UP AND DROP OFF REPORTING PROCEDURES:

7.1 Ambulance personnel shall pick up and deliver patients at specified locations (i.e., Emergency Room, Clinic, Green House Homes, other out-lying areas on the campus, East Campus clinics, etc.). These locations will be designated when contact is made by authorized Wilkes Barre VAMC personnel.

7.2 When responding to a transportation order, ambulance personnel shall report to the Nursing Station to:

7.2a announce his/her arrival to pick-up and transfer the patient and

7.2 b obtains report of pertinent information regarding the patient’s condition from the primary provider.

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

7.4 In cases where the ambulance personnel must divert to a local emergency room while performing a Wilkes Barre VAMC authorized transport, the Contractor’s dispatcher shall notify the VAMC Beneficiary Travel or AOD, of the patient’s location and status as soon as this information becomes available.

8.0 PATIENT WELFARE AND ABUSE:

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

8.2 Wilkes Barre VAMC requires the Contractor to exercise extreme caution and care in the handling of patients. Any abuse of patients will be grounds for default action or immediate termination of the agreement.

8.3 The Contractor shall take into consideration that they will be transporting ill patients. Drivers are required to observe speed limits, sweep vehicles clean, and wash the exteriors periodically. Drivers are to escort patients to and from point of pick-up and destination.

9.0 CANCELLATIONS/NO SHOWS:

9.1 CANCELLATIONS

For trips in which the Contractor is notified of a cancellation before the vehicle is dispatched, there will be no charge to the Government.

9.2 NO-SHOWS

A “no-show” is defined as an order that is cancelled after the Contractor has dispatched a vehicle and the vehicle is enroute or has arrived at the pick-up location, and there is no longer a need for this patient transport. The Contractor may request one-way reimbursement for no-shows, which are based on the base rate for the service (BLS, ALS), and one-way mileage (BLS, ALS) accrued enroute to the pick-up location at time of cancellation. Mileage for no-show cancellations shall be confirmed by the Contractor and reported to the COR or designee as soon as possible from the time of cancellation.

9.3 ADDITIONAL CHARGES

There will be no additional charge for time spent at the site (during, or after the normal hours of coverage) awaiting the arrival of additional Contractor staff and/or delivery of parts.

10.0 INCIDENT REPORTING:

10.1 The Contractor shall be required to notify the Beneficiary Travel Department or AOD of any accidents, and/or safety problems that occur while the patient is being transported. This notification shall occur within one (1) hour by telephone, and if requested by the Wilkes Barre VAMC, a written report of the event shall be delivered to the Wilkes Barre VAMC Official by the close of business the next working day.

10.2 The COR/designee will monitor the service provided. The Contractor shall cooperate with the COR in providing information and answering questions in a timely manner. The Contractor shall promptly inform the COR of any complaints received directly from patients. If warranted, the Wilkes Barre VAMC may conduct incident investigations and require a written response from the Contractor within 48 hours.

11.0 INVOICING PROCEDURES:

With the exception of “no shows” defined in 9.2, the Contractor shall invoice for loaded (patient onboard) services and mileage only. Contractor shall submit an electronic invoice by the tenth day of each month for services that occurred the preceding month. Electronic invoices shall be submitted to the VAFSC; invoices shall not include patient information. Also, a copy of the invoice along with secondary documentation shall be sent to Beneficiary Travel and must include the following information:

11.1 Blanket Purchase Agreement Number

11.2 Date(s) of Service

11.3 Patient’s Name

11.4 Pick-up/drop-off points

11.5 Total amount invoiced

11.6 An itemized list of charges or services rendered

UNDER NO CIRCUMSTANCES ARE VA BENEFICIARIES, THIRD PARTY INSURANCES, MED ICARE OR MEDICAID TO BE BILLED FOR SERVICES PERFORMED UNDER THIS AGREEMENT WHICH ARE AUTHORIZED BY THE WILKES-BARRE VAMC.

12.0 CONTRACTOR’S QUALITY CONTROL PROGRAM:

Contractor shall establish and maintain a complete Quality Control Program (QCP) to ensure the requirements of this agreement are provided as specified. The QCP shall address processes and procedures to ensure services are performed in accordance with all state and local standards and codes. Contractor’s QCP shall include the following at a minimum:

12.1 Incorporation of either active or established internal policy or procedures for updating service protocols that may affect the performance of the agreement.

12.2 The methods for identifying and preventing deficiencies in the quality of service before the level of performance becomes unacceptable; and organizational functions, noting intermediate supervisory responsibilities, and overall management responsibilities for ensuring total acceptable performance.

12.3 On-site records identifying the character (background checks), certifications, applicable tests (e.g., TB Test), and documentation of ongoing training of all staff performing services under this agreement.

12.4 The methods of identifying and preventing radio communication breakdowns. A detailed procedure for alternative communication in the event of mechanical breakdown of vehicle two-way radios.

12.5 A log to account for all requests for service. The log shall indicate date and time of service calls, actual time of pick-up vs. scheduled time, patient's name, designated pick-up and delivery points, mileage, and actual waiting time at pick-up/delivery points, if waiting charges are claimed. Contractor shall send log sheets to the COR monthly.

12.6 On-site records of complaints or problems, with procedures taken to allow for corrections and/or elimination before the effects cause interruption of performance of the agreement. Contractor shall report any complaints to the COR within 48 hours along with any planned corrective action.

13.0 SECURITY AND PRIVACY CONTROL:

The Authorization and Accreditation (A&A) requirements of VHA Handbook 6500.6 do not apply to this requirement, therefore, a Security Accreditation Package is not required. No A&A or MOU/ISA is required. Sensitive information exposure as part of this agreement involves applicable security controls within the facility as part of the Wilkes Barre VAMC/VA Information Security.

If there are any questions related to privacy, please have a member of your staff, or yourself, contact the VA Privacy Service at (202)461-6309. If there are any questions related to the Information Security, contact the Office of Cyber Security at (304)262-7733.

13.1 CONFIDENTIALITY OF PATIENT INFORMATION

13.1a Contractor will not have physical access to any VA computers and/or databases. The Contractor, in providing service, will assist in the provision of health care to patients seeking care through the VAMC. As such, the Contractor may have access to patient medical information to the extent necessary to perform its responsibilities per the agreement; and therefore, shall ensure the confidentiality / security of all patient information and shall be held liable in the event of breach of confidentiality.

13.1b The Contractor shall comply with the provisions of the Privacy Act of 1974 (5 U.S.C. 552a), Confidentiality of Certain Medical Records (38 U.S.C. 7332), Confidential Nature of Claims (38 U.S.C.5701), and Confidentiality of Medical Quality-Assurance Records (38 U.S.C.5705).

13.1c The Contractor shall comply with all laws and regulations pertaining to confidentiality and security statutes. The Contractor shall comply with: Public Law 104-191, C.F.R. Parts 45, 160, 162 and 164 (Health Insurance Portability and Accountability Act). Failure to comply with statutes regarding confidentiality and security of patient health information/Individually identifiable information may result in financial sanctions.

13.1d VA protected health information (PHI) may be disclosed and used for treatment of patients. In accordance with 45 CFR 164.502(e), the Privacy Rule includes exceptions to the Business Associate standard. This agreement and its requirements meet the following exception and do not require a Business Associate agreement in order for Covered Entity to disclose Protected Health Information to a health care provider for treatment. Based on the exception a Business Associate agreement is not required for this agreement. Except for medical emergencies (C.F.R. 42), the Contractor is authorized to release patient medical information to the Wilkes Barre VAMC only.

14.0 THE JOINT COMMISSION (TJC) AND OTHER SPECIAL REQUIREMENTS:

Where the agreement does not require Joint Commission accreditation or other regulatory requirements regarding worker competency, the Contractor must perform the required work in accordance with Joint Commission standards. The Contractor is required to develop and maintain the following for each Contractor employee working on this agreement:

14.1 Credentials and qualifications for the job

14.2 A current competency assessment checklist (including an assessment of knowledge, behaviors, skills, and abilities required to perform a job correctly and skillfully; and knowledge and skills required to provide care for certain patient populations, as appropriate)

14.3 A current performance evaluation supporting the ability of the Contractor employee to successfully perform the work required in this solicitation

14.4 Listing of relevant continuing education for the last two years the Contractor will provide current copies of these records to the COR at time of agreement award and upon completion of the agreement or upon request, for each Contractor employee working on the contract.

15.0 WAGE RATES:

15.2 Contractor is responsible to insure their employees working under this contract receive all pay and benefits due them under the Service Contract Act wage determination, which is part of the contract.

15.3 The DOL has held that transportation Contractors must pay Service Contract Act Wages on a round- trip basis when performing services for the Federal Government. These costs should be considered when pricing the quote.

16.0 TRAINING

16.1 Contractor shall be responsible for supervising the daily services provided under this agreement; and shall provide and document orientation and training programs for all employees regarding safety, equipment management, and patient confidentiality appropriate to the service provided.

16.2 Contractor shall provide orientation to designated staff regarding agency policy and procedures, and any agency processes necessary for cooperative functioning between the agency and the Wilkes Barre VAMC. Up-dates and refreshers shall be provided upon request and when policy or procedures change.

16.3 Contractor may be requested to take part in training in conjunction with the Wilkes Barre VAMC staff to ensure emergency response quality.

17.0 HHS/OIG:

To ensure that the individuals providing services under the agreement have not engaged in fraud or abuse regarding Sections 1128 and 1128A of the Social Security Act regarding federal health care programs, the Contractor is required to check the Health and Human Services - Office of Inspector General (HHS/OIG), List of Excluded Individuals/Entities on the OIG Website (www.hhs.gov/oig) for each person providing services on this agreement. Further, Contractor is required to certify all persons listed in Contractor’s proposal have been compared to the OIG list and are NOT listed. During performance of the agreement, Contractor is prohibited from using any individual or business listed on the List of Excluded Individuals/Entities.

18.0 SECURITY REQUIREMENTS: Access to work areas and performance monitoring will be accomplished by the COR/designee. Smoking is prohibited inside all Wilkes Barre VAMC buildings. Possession of weapons is prohibited. Enclosed containers shall be subject to search. Violations of VA regulations may result in citation answerable in the U.S. (Federal) District Court, not a local, state, or municipal court.

19.0 REQUIRED DOCUMENTATION: Contractor is responsible for the documentation listed below. Failure to provide the documentation when requested, or at the times called for in the PWS may result in unfavorable performance evaluations.

19.1 QUALITY CONTROL PLAN – as outlined under QCP section.

19.2 SERVICE LOG SHEETS

19.3 GENERAL LIABILITY COVERAGE

19.4 SAFETY AND HEALTH PLAN

19.5 TRAINING AND CERTIFICATION – evidence of required training, certifications, licensing, and any other qualifications of any personnel performing services under this agreement.

20.0 SERVICE DELIVERY SUMMARY: Contractor service requirements are summarized into performance standards that relate directly to mission essential items. The maximum deviations briefly describe the acceptable levels of service needed for each requirement, which are critical to mission success. Refer to the Performance Matrix in 23.3d.

21.0 QUALITY ASSURANCE: Contractor shall ensure services are performed in accordance with accepted commercial practices. Wilkes Barre VAMC will evaluate the Contractor’s performance and approve all services per the COR/designee in accordance with the QASP.

22.0 CONTRACTING OFFICER REPRESENTATIVE (COR):

NAME: Jennifer Rafalko PHONE: (570)824-3521 x27456 EMAIL: Jennifer.Rafalko@va.gov

23.0 QUALITY ASSURANCE SURVEILLANCE PLAN (QASP):

23.1 This QASP was developed to evaluate Contractor actions while implementing this PWS. It is designed to provide an effective method of monitoring Contractor performance for each listed objective in the PWS. The QASP provides a systematic method to evaluate the services the Contractor is required to furnish.

23.2 This QASP is based on the premise that the Government desires to maintain a quality standard in the operation of the systems to be serviced under this agreement and to provide the service is the best means of achieving that objective. The Contractor, not the Government, is responsible for management and quality control actions to meet the terms of the agreement. The Government’s role is quality assurance to ensure agreement standards are achieved.

23.3 PERFORMANCE STANDARDS: The Technical Representative (COR) at the Wilkes Barre VAMC will monitor tasks issued under this requirement. Surveillance observations and inspections made by the COR will be recorded in order to document the Contractor’s performance. These documents will become official Government records. Performance criteria to be measured include the following:

23.3 a Customer Complaints: The COR may receive customer complaints about the quality of services. The COR will make a determination if the complaint involves services provided by the Contractor, and if so, will make a determination if the complaint is a minor or major complaint. The COR will notify the Contractor of the nature and severity of the complaint.

Contractor shall have a plan in place for handling patient complaints, including methods for monitoring, correcting, and reporting. Contractor shall report any corrective action taken to the COR within 48 hours of incident. COR will track internal complaints as well as from the Contractor. Contractor shall maintain less than five (5) complaints per quarter.

i. Minor complaints – (i.e., complaints about timeliness, customer service, or vehicle cleanliness. Isolated incidents of minor complaints will be addressed by the COR at the task order level. The COR will be notified of the complaint and the Contractor will work with the COR to ensure the complaint is addressed or resolved.

ii. Minor complaints will be documented if the COR determines there is a pattern of minor complaints or if there is an alarming increase in frequency of minor complaints. If so, the severity level of the complaints would be designated as a major complaint.

iii. Major complaints – (i.e., concerns regarding Contractor’s driving abilities (e.g., driving recklessly or while under the influence), lack of safe vehicle conditions, or emotional or physical abuse by driver/passenger. All of these complaints shall be documented. COR will determine the validity of the complaint, then notify the Contractor. Major complaints left unresolved will be deemed subpar performance and will be sent to the CO.

23.3b Inspections: Periodic quality assurance and safety inspections may occur monthly as predetermined by the COR. The results of periodic inspections may be used as the basis for subpar report documentation. Random inspections may occur at any time and location.

23.3 c Performance: The Contractor shall meet, or be less than, the required response times per level of service ordered and as indicated in section 6.6, at least 95% of the time per quarter. The Contractor shall send a log sheet to include all information listed in paragraph 11.0 prior to submitting an invoice. At least 5 trips will be reviewed by the COR monthly to determine contractor’s response times in order to accurately measure performance; and shall report to the CO trips that are not within the required times.

When performance is deemed unacceptable, the COR will inform the Contractor’s on-site representative, or one of the Contractor’s managers. Disputes should be referred to the COR. The COR will notify the Contracting Officer of subpar performance. If any services do not conform to agreement requirements, the Government may:

i. Require the Contractor to take action necessary to ensure future performance conforms with agreement requirements.

ii. By separate agreement or otherwise, perform the services and charge to the Contractor any cost incurred by the Government that is directly related to the performance of such service.

23.3d Government Roles And Responsibilities: The following personnel shall oversee and coordinate surveillance activities:

i. Contracting Officer (CO) - The CO shall ensure performance of all necessary actions for effective contracting, ensure compliance with the contract terms, and shall safeguard the interests of the United States in the contractual relationship. The CO shall also assure that the Contractor receives impartial, fair, and equitable treatment under this contract. The CO is ultimately responsible for the final determination of the adequacy of the Contractor’s performance.

ii. Contracting Officer’s Representative (COR) - The COR is responsible for technical administration of the contract and shall assure proper Government surveillance of the Contractor’s 23.3e Contractor Representatives: The following employees of the Contractor serve as the Contractor’s program manager for this contract.

i. Program Manager – Government will enter name upon contract award.

ii. Other Contractor Personnel - Government will enter other names upon contract award.

Title: Government will enter titles upon contract award.

Required Services (Tasks)

Ground Ambulance Service Response Reference PWS Paragraph 5 (c)

Favorable Contractor performance evaluation.

Disincentive:

Payment deduction.

Unfavorable:

Contractor performance evaluation.

Certifications and Training Reference PWS Paragraph 7 (b)

Customer Feedback Incentive:

Favorable Contractor performance evaluation.

Disincentive:

2% deduction of monthly payment if 1 or more employees do not have current licenses or > 1 customer complaint on attendant competence.

Unfavorable:

Contractor performance evaluation

Submit Monthly Reports/Trip Tickets Reference PWS Paragraphs 7 (h)

Favorable Contractor performance evaluation.

Disincentive:

1% deduction of monthly payment for deliverables >5 calendars late.

Unfavorable:

Contractor performance evaluation.

Ambulance Maintenance/Safety Reference PWS Paragraph 7 (c)

Favorable Contractor performance evaluation.

Disincentive:

2% deduction from monthly payment with 1 or more findings of unsafe conditions.

Unfavorable:

Contractor performance evaluation.

23.3ePerformance Matrix - Ambulance Service

END OF PERFORMANCE WORK STATEMENT

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.