Attachment A - PWS WVAMC CERS FY22 Contract_2Mar 22.docx

Attachment A:

Performance Work Statement Contract Residential Services Beds Wilmington VAMC, Wilmington, DE

1.0 DESCRIPTION:

The Wilmington Veterans Affairs Medical Center (WVAMC) in Wilmington Delaware requires Contractors to provide services as part of its Community Based Health Care for Homeless Veterans (HCHV) program. WVAMC is seeking to award a five-year Indefinite Delivery / Indefinite Quantity (IDIQ) contract. The goal of the HCHV program is to remove homeless Veterans from the street or habitation unfit for Veterans and place them in community-based, residential environments with sufficient supportive services to meet their needs and ultimately facilitate the improvement of their housing situation.

The WVAMC is seeking 24 hours a day / 7 days a week (24/7) community-based early recovery model of supportive housing within the State of Delaware in New Castle County and accessible by public transportation that provides therapeutic and rehabilitative services in a safe environment to homeless eligible Veterans. The purpose of this solicitation is to obtain offers from contractors who can provide housing, outreach services, case management services, and rehabilitative services within the State of Delaware for Veterans experiencing homelessness and/or chronic homelessness as defined by the Housing and Urban Development (HUD), including Veterans diagnosed with severe mental illness and/or substance use disorders, in community-based residential facilities. The Contractor will be required to provide a low-barrier therapeutic and rehabilitative milieu and attendant services targeting the underlying factors contributing to homelessness. The Contractor will not be required to provide detoxification or other hospital level treatment.

WVAMC will issue one contract with a maximum of 15 beds. Priority groups are male veterans, female veterans, veterans with a sex offender status, and sites that can house families. VA is only able to pay for services provided to the veteran themselves. Solicitations from contractors who can service multiple priorities groups will be weighed higher. Some of the Veterans may have co-morbid conditions that include serious mental illnesses, substance abuse disorders, and other medical conditions. The goal of the HCHV Contracted Residential Services (CRS) is to rapidly stabilize Veterans’ medical, mental health, substance abuse and other psychosocial problems with a goal to place Veterans in other appropriate transitional or permanent housing within 30 to 90 days, but no more than 180 days. Contractor will provide rapid placement of VA-referred Veterans in a safe, residential treatment setting while addressing Veterans’ complex needs through on-site case management and therapeutic support services. This housing must meet the criteria established both by HCHV clinical staff and VA fire and safety officials. Contractors are urged in the strongest terms to carefully review the requirements outlined in the Performance Work Statement to ensure that all facilities fire and safety and treatment services criteria can be met in a timely way.

2.0 DEFINITIONS:

2.1 Homeless: A literally homeless individual who lacks a fixed, regular and adequate nighttime residence, meaning:

(i) Has a primary nighttime residence that is a public or private place not meant for human habitation

(ii) is living in a publicly or privately operated safe haven or emergency shelter, or

(iii) in an institutional care facility if the individual has been living in the facility for fewer than 90 days and had been living in a place not meant for human habitation, a safe haven, or in an emergency shelter before entering the institutional care facility.

(For Homeless HUD’s Homeless Definition criteria, see https://files.hudexchange.info/resources/documents/HomelessDefinition_RecordkeepingRequirementsandCriteria.pdf)

2.2 Chronic Homelessness is defined by HUD in 24 CFR parts 91 and 578 to mean a homeless individual with a disability who lives either in a place not meant for human habitation, a safe haven, or in an emergency shelter, or in an institutional care facility if the individual has been living in the facility for fewer than 90 days and had been living in a place not meant for human habitation, a safe haven, or in an emergency shelter immediately before entering the institutional care facility. In order to meet the “chronically homeless” definition, the individual also must have been living as described above continuously for at least 12 months, or on at least four separate occasions in the last 3 years, where the combined occasions total a length of time of at least 12 months. Each period separating the occasions must include at least 7 nights of living in a situation other than a place not meant for human habitation, in an emergency shelter, or in a safe haven. (See https://www.govinfo.gov/content/pkg/FR-2015-12-04/pdf/2015-30473.pdf for additional information)

2.3 Contracted Residential Services (CRS) is a community-based early recovery model of supportive housing that serves hard to reach, hard to engage homeless individuals with severe mental illness and substance use disorders. Many have not been able to comply with traditional program requirements resulting in high use of emergency room and acute care services and more Veterans living on the streets or in shelters. CRS places no treatment participation demands on residents but expects a transition from unsafe and unstable street life to permanent housing and to re-engage with treatment services.

2.4 Contracted Emergency Residential Services (CERS): CERS programs target and prioritize homeless Veterans transitioning from literal street homelessness, Veterans being discharged from institutions, including those in need of medical respite, and Veterans who recently became homeless and require safe and stable living arrangements while they seek permanent housing. CERS Programs provide low demand time-limited services such as supporting mental health stabilization, Substance Use Disorder (SUD) treatment services, enhancement of independent living skills, vocational training, and employment services. In some cases, VA may complement the CERS program with added treatment services, such as participation in VA outpatient programs. Emphasis is placed on referral and placement in permanent housing or longer-term residential programs utilizing VA and/or community resources. Lengths of stay in CERS typically range from 30 to 90 days with the option to extend based on clinical need but not to exceed 180 days.

2.5 Quality Assurance Surveillance Plan (QASP): An organized written document used for quality assurance surveillance. The document contains specific methods for performing surveillance of the Contractor’s continuous performance.

2.6 Contractor Action Request Violation (CARV): A violation which the contractor will need to submit a corrective action plan to remedy.

2.7 HOMES (VA Homeless Operations Management and Evaluation System): A computer system used by VA Homeless staff to coordinate care for homeless Veterans.

2.8 MAT (Medication Assisted Treatment): the use of medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders. Medications used in MAT are approved by the Food and Drug Administration (FDA) and MAT programs are clinically driven and tailored to meet each patient’s needs.

2.9 SQUARES (Status Query and Response Exchange System): A VA web application that provides VA employees and external homeless service organizations with reliable, detailed information about Veteran eligibility.

2.10 Harm reduction approach: A approach for substance abuse treatment that aims to reduce the risky behaviors and negative consequences; it neither condemns nor condones any behavior. It incorporates strategies on a gradual basis beginning with safer drug use, moving on to managed substance abuse, and finally to abstinence.

2.11 COR: Contracting Officer Representative. For purposes of this contract, the VA Liaison is also the COR.

2.11 SMART, SOAP, SNAP, DAP: Professionally written styles of case management notes used in social work practice.

2.12 NFPA (National Fire Protection Association): The leading information and knowledge resource on fire, electrical, and related hazards.

2.13 HUD (Housing and Urban Development): Department of Housing and Urban Development is the federal agency responsible for national policy and programs that address America’s housing needs, that improve and develop the Nation’s communities, and enforce fair housing laws.

2.14 ADA (Americans with Disabilities Act): prohibits discrimination against people with disabilities in several areas, including employment, transportation, public accommodations, communications and access to state and local government program and services.

2.15 Homeless Management Information System (HMIS): a local information technology system used to collect client-level data and data on the provision of housing and services to homeless individuals and families and persons at risk of homelessness. Each Continuum of Care (CoC) is responsible for selecting an HMIS software solution that complies with HUD's data collection, management, and reporting standards.

2.16 Continuum of Care: The Continuum of Care (CoC) Program is designed to promote communitywide commitment to the goal of ending homelessness; provide funding for efforts by nonprofit providers, and State and local governments to quickly rehouse homeless individuals and families while minimizing the trauma and dislocation caused to homeless individuals, families, and communities by homelessness; promote access to and effect utilization of mainstream programs by homeless individuals and families; and optimize self-sufficiency among individuals and families experiencing homelessness.

2.17 High Suicide Risk (HSR): A categorization that a Veteran that has a higher risk of suicide will be designated for particular care and follow up by staff. A HSR Safety Plan will be offered and charted by staff for Veterans identified as benefiting from a plan.

2.18 Individualized Homeless Stabilization Plan (ISP): A plan that is a mutually agreed upon by staff and Veteran of goals that they will be working towards while in the CERS program.

2.19 SSI/SSDI: Supplemental Security Income; Social Security Disability Insurance

2.20 POC: Point of Contact

2.21 NSC Pension: Non-Service-Connected Pension, a pension from the VA based on factors such as age, income, and disability that was not acquired during military service.

2.22 SC Pension: Service-connected pension. A pension from the VA based on a injury sustained during military service.

2.23 PSH: Permanent Supportive Housing

2.24 OEF/OIF/OND: Operation Enduring Freedom; Operation Iraqi Freedom: Operation New Dawn

3.0 PROGRAM REQUIREMENTS:

GUIDELINES FOR SERVICES: The Contractor must provide a safe environment for all Veterans. The Contractor will offer a low-demand environment with a minimum set of rules designed to re-establish trust in the chronically homeless Veteran and engage the Veteran in needed treatment services. Contractor must have written policies and procedures in place that address the following concerns and situations:

a. Acceptance of treatment cannot be a condition of admission or continued stay;

b. Medication adherence or compliance cannot be a condition of admission or continued stay;

c. Abstinence from alcohol or drugs cannot be a condition of admission or continued stay; Infractions of rules should be used as opportunities for engagement;

d. Management of suspected or known drug or alcohol use or relapse by one or more Veterans and interventions including Motivational Interviewing and Harm Reduction;

e. On-site contraband, weapons, drug or alcohol related paraphernalia (i.e., found alcohol, drugs, drug “works”, etc.)

f. Safe prescription medication storage and handling, including specific provisions for prescribed controlled substances;

g. Grievance process to address Veteran complaints with time frames for responses from the Contractor’s program/facility management;

h. Procedure for medical records request by veteran with a specifics regarding re-release of information.

These policies and procedures must be communicated to Veterans both verbally and in writing in a manner that is understandable within 72 business hours of admission to the facility. This communication must be documented in the Veteran’s client record.

Program rules and expectations should be kept to a minimum, be simple, and should focus on safety of the Veterans and staff. Program rules should focus on staff and resident safety. Most Veterans may have had difficulty in the past adhering to settings where strict rules are applied. The rules should reward positive behavior, be enforceable, relate to the living situation, provide for safety of the Veterans, and provide opportunities for engagement.

Veterans will not be discharged for the use of alcohol or drugs. Many of the Veterans that this program will target have failed programs in the past for their inability to stay clean and sober. To provide for the safety of the Veteran(s), the Contractor must have written policies and procedures in place that clearly indicate the following are prohibited:

a. Dealing, buying or use of illicit drugs/alcohol at the facility;

b. Violence or threat of violence toward Veterans or facility staff;

c. Destruction of facility property;

d. Possession of weapons.

Although rules must be kept simple and demands on the Veterans low, it is required that staff at the facility stay continuously engaged with the Veterans. Policies and procedures for staff should reflect the following:

a. Staff is trained in providing flexible, respectful responses to infractions of rules;

b. Homeless Veterans will not be discharged for drinking or use of drugs off property, non-compliance with prescribed medication or infractions of house rules that do not constitute a risk to their personal safety or the safety of the facility Veterans or staff; and

c. Assertive engagement by the staff with patients regarding these problems is the preferred course of action to deal with these common problems of the contracted facility.

The Contractor shall have reasonable rules governing day-to-day life and activities in the facility in accordance with VHA HANDBOOK 1162.09 (VHA Publications (va.gov)). Such rules clearly inform Veterans of the obligations upon which their continued participation in the program depends and the consequences for non-compliance. Veterans and COR / designee will be provided a copy of the rules and regulations at intake, upon Veteran’s request, and upon update / change. In addition, Contractor will post the rules in a location readily accessible to clients and visitors. The rules must include detailed Veteran 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.

The Contractor must communicate policies and procedures to Veterans both verbally and in writing in a manner that is understandable to each Veteran upon admission to the facility, in the form of a written Veteran handbook that is verbally reviewed by the assigned case manager with the Veteran. All updates to any policies and procedures must be reviewed with Veterans within 7 days of revision. This communication must be documented in the Veteran’s client record.

3.1 ROOM AND BOARD: Room and Board shall be accessible to the Veteran 7 days a week and 24 hours per day. Accommodations will include a private or semi-private room (no more than 4 per room) with a bed and other furnishings such as a dresser, storage locker or designated secured space, and personal linens (towels, pillows, blankets, and bed sheets). The environment must be conducive to social interaction, supportive of recovery models and the fullest development of the resident’s rehabilitative potential. Residents must be assisted in maintaining an acceptable level of personal hygiene and grooming. Contractor shall make free items accessible to Veterans such as wash cloths, soap, feminine products, deodorant, toothpaste, and toothbrush. Contractor shall notify VA of any possible exposure to Infectious Diseases and coordinate with their County Department of Public Health, VA Infectious Disease Control, and other governmental agencies as appropriate or instructed. The Contractor will allow Veteran to store personal belongings for at least 72 hours after formal HCHV discharge.

3.2 MEALS: Meals shall meet dietary guidelines set forth by the U.S. Department of Agriculture and U.S. Department of Health and Human Services, including any updates made to the guidelines. Adequate food will be provided for patient to cook and prepare three nutritious meals, two of which are hot meals, 7 days a week will be provided for the Veteran in a setting that encourages social interaction. In addition, the contractor must provide the availability of snacks of nourishing quality (e.g. fruits, vegetables, protein sources, etc.), between meals and bedtime for those requiring or desiring additional food, even when it is not medically indicated. There will not be more than a 14-hour span between evening meal and breakfast of the following day. Contractor will 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/religious preferences around food (e.g. Kosher, vegetarian). Veterans in the program are required be independent with preparing their meals, although they may ask contractor staff for assistance with meal preparation if they require it. The contractor shall provide storage space in an onsite refrigerator for Veterans to store and freely access personal food. The contractor shall establish and maintain sanitary procedures for washing dishes, cleaning equipment and work areas, and disposing of waste. The VA has particular concern for chronically homeless Veterans, many of whom are either undernourished or have developed poor eating habits or both, because of chronic medical, mental health or substance abuse disorders. A VA dietitian will assess the Veterans’ satisfaction with meals and the actual consumption of food offered in determining the Contractor’s success in meeting this requirement during annual facility inspections, in response to any complaints, or at any other point during the performance period.

3.3 GENDER SPECIFIC CARE PROVISIONS: Special attention needs to be given to meeting the unique treatment needs of homeless women Veterans. These needs often may include assistance with managing sexual trauma, eating disorders, interpersonal violence, and caring for dependents while in treatment. Special emphasis on privacy and security should be noted in mixed-gender facilities. Veteran residents have a right to be treated with dignity in a humane environment that affords them both reasonable protection from harm and appropriate privacy with regard to their personal needs. The living environments of HCHV CRS must include:

a. Residential room and board in an environment that promotes a lifestyle free of sexual discrimination.

b. An environment conducive to social interaction, supportive of recovery models and the fullest development of the resident's rehabilitative potential regardless of gender or sexual orientation.

c. Separate and secure bathroom arrangements to ensure an acceptable level of privacy for personal hygiene and grooming.

3.4 LAUNDRY FACILITIES: Contractor must provide laundry facilities on-site and necessary detergent free of charge for residents to do their own laundry at minimum one time per week. If laundry services cannot be provided on-site, contractor shall be responsible for making other arrangements for laundry services free of charge to veterans.

3.5 TRANSPORTATION: The Contractor shall assist the Veterans free of charge with local transportation to scheduled meeting and appointments. The Contractor will be expected to help the Veteran arrange and access public transportation, including providing information and instructions necessary to enable Veterans to utilize public transportation. If VA Liaison and/or other appropriate VA staff determines that adequate public transportation is not available or appropriate for a Veteran, the Contractor shall provide alternative transport by car or taxi. Transportation cannot be a barrier to a Veteran receiving services necessary to reach their treatment goals. Thus, if public transportation isn’t appropriate or adequate, then the contractor must have the ability to provide transportation to accommodate scheduled admissions, meetings, housing search, and other appointments in the community and at the local VA facility during business hours and after hours as necessary. These costs will be considered part of the basic services provided.

VA Liaison and Contractor shall have weekly meetings to discuss Veteran’s appointment schedule. During this meeting, VA Liaison will discuss the weekly faxed or emailed Veteran doctor appointments and any other appointments scheduled by the Contractor on the Veteran’s behalf. These records will be inspected quarterly.

3.6 THERAPEUTIC / REHABILITATIVE SERVICES: Each Veteran must have an Individual Service Plan (ISP) completed by the Contractor with input from the Veteran and with consultation by VA Liaison and/or other appropriate VA staff within 3 business days of admission. Therapeutic and, as appropriate, rehabilitative services must be provided by the contractor. Therapeutic and rehabilitative services must be stated in the ISP based on the veteran’s needs. VA staff will meet with the Veteran and Contractor to verify Veteran’s enrollment and progress weekly as well as a quarterly inspection to review documentation.

a. Group Activities: Structured group activities, as appropriate, shall occur at a minimum of two times per month, examples include group therapy, life skills training, social skills training, financial workshops, Alcoholics Anonymous, Narcotics Anonymous, vocational counseling, and recreational activities. For the purposes of this contract, “House Meetings” and VA Housing Resource Groups may not be counted as a structured group activity. Group Activities should have a therapeutic value and facilitation shall be the responsibility of the Contractor. Should a Veteran have mental health, medical, family and/or employment obligations which directly conflicts with their ability to participate with group activities as stated in their ISP, alternate group activities will be arranged and/or the Contractor will clearly document efforts made to accommodate the Veteran.

b. VA Coordination: Collaboration and coordination with VA program staff, as needed, will include coordination of supportive psychosocial services. Coordinated efforts must be made with the VA Liaison or Designee and/or other appropriate VA staff around medical, mental health, admission, and discharge needs.

c. Case Management: Case management means arranging, planning, coordinating, or providing direct services and support; referring and providing linkage to VA and non-VA resources, providing crisis management services, and monitoring; and intervening and advocating on behalf of veterans to support transportation, credit, legal, and other needs. Contractor shall conduct high-risk screening, psychosocial assessment, and treatment planning, actively involving the Veteran and their family or significant others, in coordination with the team members. Psychosocial assessments will include goals for clinical treatment. Contractor shall coordinate and document clinical case management and psychosocial services and documents the overall effectiveness of the case management services provided. A thorough written Individualized Service Plan (ISP) will be developed within 3 business days of admission for each Veteran and updated at least every 30 days. Initial and updated ISP shall be provided to VA liaison within 1 business day. This will include structured individual case management, at minimum, weekly including counseling on self-care skills, adaptive coping skills, financial planning, permanent housing search, written care plan, referral for financial benefits. Additional counseling may include professional and vocational rehabilitation counseling in collaboration with VA programs and community resources. In addition, special attention will be made to address High Suicide Risk (HSR) Veterans as identified by the VA Liaison, VA Mental Health Staff and/or the contractor’s Case Manager. On a weekly basis, the contracted case manager will be required to update the VA Liaison on Veteran progress and/or safety concerns for HSR Veterans. Contracted case manager will review the HSR Safety Plans with the Veteran on a bi-weekly basis. HSR Safety plan reviews and a copy of the Veteran’s Safety Plan will be documented in the chart. If a veteran is deemed to be at risk of self-harm or risk of harm to others, then contracted staff will immediately contact 911 or mobile crisis as well as notify VA liaison. All Veterans will be referred for VA Primary Care and Mental Health and Contractors will support Veterans in making initial and subsequent appointments. Particular efforts to access care will be made for Veterans who are identified by VA Liaison to be highly acute. Efforts will be documented in the Veterans ISP and reviewed by the VA Liaison at least monthly. For this contract, VA discharge meetings do not count towards the weekly structured individual case management requirements. It is understood that these visits do not substitute nor relieve the contractor in any way or the responsibility for the daily care and treatment of the Veteran. The contractor must also promote community interaction, as demonstrated by scheduled activities or by information about resident involvement with community activities, volunteers, and local consumer activities. Case managers will document all structured activities that support Veteran in applying for employment as appropriate based on needs of Veteran as identified in the assessment. Contractor will provide proper documentation verifying services and case management efforts provided to the resident by all team members including, but not limited to housing, benefit and employment specialists, and program management staff. Notes are required to be written professionally in a format that utilizes the clear settings of goals and documents progress towards those goals (e.g. SNAP, SOAP, DAP or SMART notes).

d. Community Outreach: The contractor will be responsible to engage in outreach in the community both independently and in collaboration with VA Homeless Programs Designee(s) at least 2 times per month. In addition, clear documentation for outreach activities must be made available to Liaison upon request during the QASP review. Engagement with the Veteran should be goal-directed with consistent staff geared toward building trust and getting the Veteran to accept and remain in the residence. Evidence-based practices, such as motivational interviewing and harm reduction, should be utilized. Contractors will maintain occupancy by engaging in outreach services and will be knowledgeable about outreach best practices generally accepted in the community. The Contractor will participate with Homeless Management Information System (HMIS) and the Delaware Homeless Alliance.

e. Financial Planning: The contractor will assist the residents in obtaining community resources and assistance such as, but not limited to, and as appropriate: applying for social service benefits, applying for VA benefits, income assistance and financial planning, employment services, housing resources, religious/spiritual services, and access to social/recreational opportunities. The contractor case manager will assist Veteran with referrals to and follow up on all potential financial resources the Veteran may be eligible for (e.g. SSI, SSDI, Food Stamps, NSC pension, SC compensation, etc.). Case Managers will document all structured activities that support Veteran in developing a short- 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 case management services.

f. Employment Services: Referral to all relevant employment opportunities the Veteran is eligible for and interested in, Case Managers will document all structured activities that support Veteran in applying for employment as appropriate based on needs of Veteran as identified in the assessment.

g. Permanent Housing Search: Programs are required to provide Veterans with direct and ongoing assistance in achieving permanent housing. As a primary goal of the HCHV program, plans for Veterans’ transition to permanent housing placements must be clearly reflected in each ISP 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 3 business days of program admission. Housing Assessments must identify Veterans’ housing history, strengths (i.e. positive prior rental history), and barriers (i.e. Unlawful Detainers). Should Veteran refuse to engage with program staff regarding plans for permanent housing transition, motivational interviewing 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. Contractor staff must provide direct assistance to Veterans in developing permanent housing plans and accessing appropriate housing resources. These services shall be provided weekly through one-to-one case management. Examples of direct assistance include: 1) assistance obtaining and reviewing Veteran’s free credit report, identifying housing strengths and/or barriers associated with current credit status; 2) 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, etc.; 3) Reviewing affordable housing rental options and Permanent Supportive Housing (PSH) program offerings, and assisting Veterans with making appropriate rental inquiries and submitting completed rental applications; 4) Conducting regular and individualized housing advocacy efforts, including transportation, assistance scheduling, meeting, and communicating with property managers and landlords, and engage in troubleshooting where rental barriers or denials occur in the housing search process; 5) exploring housing option in low-rent areas. All housing efforts by Contractor shall be documented clearly and presented to VA Liaison 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. Veterans with Sex Offender status will have increased focus on discharge to stable or permanent housing placements which will be reflected in the ISP.

h. Recovery: Support for an alcohol/drug abuse-free lifestyle provided in an environment conducive to social interaction and the fullest development of the resident’s rehabilitative potential. 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 admit, discharge or discipline a Veteran but may be used as a clinical intervention to modify behavior.

i. Occupancy: It is expected that Contractor beds will be maintained at an average minimum of 80% occupancy rate but at a preferred rate of 95% as calculated based upon number of bed nights available per quarter.

3.7 DISCHARGE PLANNING: Securing permanent housing will be the primary discharge goal for every Veteran. All Veterans must have a discharge plan within one week of admission. Veterans must maintain a minimum of two appropriate housing placement applications until permanent housing is obtained. Contractor must provide computer and telephone access for Veterans to assist with discharge planning and case management needs. Case Managers will provide assistance with discharge planning for every Veteran and report all discharges via email within 24 business hours using a secured process (e.g. HOMES ID number). HOMES exit form is required for discharging a Veteran from any HCHV program via fax within 24 business hours from known discharge. Compliance with all VA regulations regarding discharges and timeliness of reporting discharges is required by Contractor. Housing needs will be assessed upon acceptance to the program and 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 discharge based on behavior must meet with the treatment team and work with team to determine most therapeutic option for Veteran. This does not include violations for safety reasons or physical abuse. Please note: Profanity does not in and of itself constitute abuse and shall not exclusively be considered grounds for discharge. Any actual 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 missed to intervene sooner. All discharges are subject to the Contractors grievance procedures and must allow clients the opportunity to be represented by the VA Liaison in the grievance process. Reasonable efforts must be made to coordinate with the VA Liaison to schedule an appeal. Discharges shall be characterized as follows:

a. Successful Discharge – a.) the Veteran has been successfully placed as anticipated in transitional or permanent housing, or reunited with family, and has met the goals of his/her Individual Service Plan within 180 days or less; b.) the Veteran has been successfully placed as anticipated in transitional or permanent housing, or reunited with family, and has met the goals of his/her Individual Service Plan in greater than 180 days from the date of admission and the VA Liaison has approved continuation of per diem payment.

b. Administrative Discharge – the Veteran has been transferred to an alternate level of care with concurrence from the VA Liaison for medical, mental health, or substance abuse treatment to better meet the Veteran’s clinical needs.

c. Unsuccessful Discharge – a.) the Veteran has absconded from the facility and his/her whereabouts are unknown; b.) the Veteran has had an episode of violence or has threatened violence against staff or other residents and must be discharged to maintain the safety of the facility; c.) the Veteran has had more than one episode of onsite drug use at the facility and must be discharged to maintain a safe and sober environment at the facility; d.) the Veteran’s length of stay has exceeded 180 days from the date of admission and the VA Liaison has not approved continuation of per diem payment.

d. Unacceptable Discharge – a.) the Veteran is discharged to a homeless shelter or drop in setting after a length of stay greater than seven (7) days from the date of admission unless there is concurrence from the VA Liaison that there is no other alternative due to circumstances beyond the Contractor’s control; b.) the Veteran is discharged to the streets at any point in time after the date of admission under any circumstances.

e. Veterans will not be discharged for drinking, off site use of drugs, non-compliance with prescribed medication or infractions of house rules that do not constitute a risk to their personal safety or the safety of the facility residents or staff. Assertive engagement by the staff with patients regarding these problems is the preferred course of action to deal with these common problems.

f. All discharges MUST include: Date of exit, type of exit, Veteran’s perception of exit, and agreement with the exit, status of treatment goals at time of the exit, the aftercare plan, and housing status and contact information given to the Veteran and kept in patient record. VA will be reviewing charts and associated documentation monthly and upon discharge.

3.8 MEDICATION MANAGEMENT:

Medications and narcotics shall be properly stored, controlled, issued, and recorded in compliance with physician’s orders. Contractor shall establish written procedures for ensuring Veteran’s confidentiality in the storage of and keeping of records concerning medication. Medication Assisted Treatment (MAT) cannot be used to rule out Veteran’s participation in either of the CRS Programs. This includes prescribed use of Vicodin, morphine, methadone, oxygen, etc. 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:

a. 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.

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

c. 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).

3.9 CRITICAL INCIDENT REPORTING:

All critical incidents will be reported to the VA liaison or Designee within 24 hours. This includes the following:

a. Falls

b. Assault (to Veteran or Staff)

c. Elderly/Dependent Adult Abuse or Neglect

d. Sexual Assault

e. Fire (Veteran Involved)

f. Medical/Psychiatric Emergency (911 Calls)

g. Hospitalization

h. Suicide or Suicide Attempt

i. Homicide

j. Death

k. Drug/Police Raid

l. Medication Problem

m. Infectious Control (bed bugs, TB, etc.)

n. Active Substance Abuse

o. Observation/ Possession of Weapons

3.10 DOCUMENTATION:

The Contractor shall provide treatment and discharge planning that reflects a team-based assessment of health, social and vocational needs with the involvement of the Veteran, the VA Liaison and appropriate community resources in resolving problems and setting goals via the ISP. Updated ISP every thirty (30) days from the date of the initial plan, to include any measures of movement toward rehabilitation goals, with particular focus on the attainment of community-based housing. An individual case record will be created for each referred Veteran. Case records shall be maintained to ensure the confidentiality of each Veteran. 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 Contractor shall participate in the Homeless Management Information System (HMIS). HMIS means the information system designated by the Continuum of Care to comply with the HUD's data collection, management, and reporting standards and used to collect client-level data and data on the provision of housing and services to homeless individuals and families and persons at-risk of homelessness. The files shall include:

A. Reasons for referral, data relevant to the Veteran’s admission and anticipated length of stay.

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

C. Medication Management/Monitoring- Copies of any medical prescriptions issued by physicians, including orders, if any, for medications to be taken. Contractor must follow HCHV medication inspection requirements.

D. Case management notes written in a professional manner (i.e. SMART, SOAP, SNAP, DAP) will include the following: 1) A written and thorough Housing Needs Assessment, 2) Financial Plan, 3) Individual Service Plan with attendant goals and documented activity indicating Veteran and Case Manager is actively working on identified goals and 4) Discharge Plan.

E. Final summaries on each resident who leaves the program, regardless of character of discharge, to include a description of beneficial changes realized during the residential period, reasons for leaving, the Veteran’s future plans, after-care referrals and connections, and follow up locator information.

F. Extension approval if relevant.

G. Waivers as appropriate.

H. Upon discharge or death of the patient, medical records on all VA beneficiaries will be retained by the residential housing facility for a period of at least three years following termination of care.

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.

3.11 REFERRALS, ADMISSIONS, AND ELIGIBILITY:

It is understood that the type of Veterans to be cared for under this contract will require 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. To be eligible for placement in emergency contract beds, all Veterans must be homeless or at imminent risk of being homeless and eligible and registered for VA services (24 CFR 576.2). A formal diagnosis is not required for the Veteran to participate in the program. Contractor must provide housing and services to special Veteran populations, such as but not limited to the following: medically compromised Veterans, Veteran with young children, 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.

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. Contractor 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. Contractor must have a copy of this procedure available as requested by Veterans and VA Liaison. A copy of the procedure must be posted in public view.

VA Liaison and Contractor will mutually determine an admission process that includes written eligibility criteria that is fair, objective, and compliant with applicable State and Federal laws. The eligibility information must be made available to clients at intake and staff must provide answers to questions about the admission criteria and process. VA Liaison will review the admission records for Veteran’s signature quarterly to ensure the packet has been received.

The VA 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. The needs of special homeless populations including women, OEF/OIF/OND, serious mental illness, and chronically homeless will be prioritized within each subgroup in admission criteria.

A list of authorized VA Staff that can make referrals shall be provided to the Contractor upon award of the contract. VA Staff may be added or deleted from the list during the term of the contract at the discretion of the VA liaison. The Contractor shall be provided an updated list of authorized VA Staff whenever such changes are made.

Veterans who refuse to allow this communication about their treatment needs and ongoing care will need to receive services elsewhere.

A. Intake Packets: All Veterans must receive and sign a receipt for an intake packet within 72 business hours which includes, at minimum, the following information:

1. Description of the Contractors services

2. Rules and Regulations

3. Grievance Policy

4. Emergency procedures

5. Veteran rights and Reasonable Accommodation The intake packets must be available upon request in addition to upon admission.

B. Timeliness of Response- Contractor must have a phone line for VA inquiries and referrals. Return calls from the contractor are expected within 2 hours during business hours Monday through Friday. This includes calls from VA Liaison or Staff to the program.

All Intake Packet documents must be reviewed and approved within 15 days of award. Any updates / changes to these packets must be reviewed and approved prior to presenting to Veterans. Reviews and approvals will be conducted by the COR / designee.

3.12 ADMISSION CRITERIA:

A. To be eligible for HCHV Contracted Residential Services, a Veteran must meet the requirements of 38 U.S.C. 2031(a) and 38 CFR 63.3. VA will give priority to veterans, in the following order, who:

1. Are new to the VA health care system because of VA outreach efforts, and to those referred to VA by community agencies that primarily serve the homeless population, such as shelters, homeless day centers, and soup kitchens.

2. Have service-connected disabilities.

3. All other veterans.

B. Contractor must have the ability to accommodate immediate admissions 24/7. All admissions must have authorization of the VA. In reference to eligibility, Contractor shall get registered with SQUARES to perform an eligibility check. Contractor staff can also contact WVAMC eligibility office to verify Veteran status during non-business hours. If unable to verify during non-business hours, a homeless person should be accepted conditionally. Contractor must notify VA Liaison of admissions that occur outside of non-business hours immediately the next business day. Within 72 hours of the notification, VA clinical staff will meet with newly admitted individual and complete an assessment. If glaring safety issues arise before 72-hour time frame, decision to exit individual based on safety concerns will be deferred to contractor. VA staff cannot approve payments for services provided to unauthorized/ineligible Veterans.

C. If, within 72 hours of admission, homeless individual is found to be ineligible for VA healthcare, Contractor will initiate referrals to alternative placements and transition homeless individual to this placement. If, within 72 hours of admission, the Veteran displays physical evidence of communicable disease and/or tests positive for such, the decision to transition this individual to alternative placement will be deferred to Contractor. If within 72 hours it is determined that the level of care is not appropriate, the Contractor will collaborate with the Veteran and VA to arrange for provision of care through other VA or community resources.

D. COVID-19 test must be completed for the Veteran 48 hours prior to admission to program. Contractor must provide proof of negative test to HCHV liaison prior to admission.

E. Contractor must have the ability to accommodate the following if a bed is available:

1. Veterans with ambulatory difficulties including wheelchairs and other assistive devices in compliance with Americans with Disabilities Act Accessibility Guidelines.

2. Veterans participating in opioid treatment programs.

3. Veterans with medical issues that do not meet criteria for inpatient medical or nursing home services.

4. Contractor is not expected to provide home health aide or skilled nursing services. However, Contractor may not deny admission based on need for in home services if services are provided by VA or another outside agency. Examples include medication, administration, wound care, assistance with activities of daily living (including bowel/bladder incontinence).

5. An extension of the length of stay may be authorized by the VA Liaison, if funding is available. All extensions beyond 60 days must be approved in writing by the VA HCHV Liaison or Designee.

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