Attachment A STATEMENT OF WORK REV.pdf

STATEMENT OF WORK

I: General Information

Description: The contractor shall provide one (1) One-site Advance Life Support (ALS) Ambulance, personnel, management, supplies, transportation, equipment, materials, and reports necessary to furnish 7 hours per day; providing Ground Transportation Services from/ to the VA Caribbean Healthcare System (VACHS) and the approved Non-VA facility accepting the patient. VACHS may require that ambulance service perform some transportations in the metropolitan area for discharged patients when cardiovascular transfers are not scheduled. The main Facility/Hospital is located at 10 Casia Street-Bo. Monacillos, San Juan, Puerto Rico.

Period of Performance:

Base Period: 260 days (Monday thru Friday Staring 6am to 1:00pm – Workdays- Excluding Holidays)

Option Period – 130 days (Monday thru Friday Staring 6am to 1:00pm – Workdays- Excluding Holidays)

Changes to the contract shall only be made by written modification formally executed by the Contracting Officer and Contractor; duly signed by both parties.

II: Work Requirements

1. Contractor shall provide all vehicles, personnel, management, supplies, transportation, equipment, materials, and necessary reports as previously mentioned, in providing ambulance services.

2. Transportation required, but different to that on the Schedule of Services, shall be previously notified to the COR, and approved by the CO.

3. Contractor shall make available a bariatric stretcher when requested to accommodate patients weighting in excess of 300 pounds.

4. Only one (1) patient shall be transported on a trip unless specifically authorized by VA. When more than one patient is transported on a trip, reimbursement shall not exceed the cost of transporting a single patient. However, if transportation is out of the covered area by the contract, the longest distance over which the patient is transported may be claimed when more than one (1) patient is transported in a single ambulance at the same time. The ordering officer – COR/ CO/Medical Administrative Assistant or an appointed Government representative for this contract, may, if in the best interest of the patient, allow a relative to accompany him/her. Contractor shall ensure that pick-ups and drop-offs are scheduled so that the total distance traveled will result in the most economical charge to the Government.

5. Request for services will be made by telephone, written and/or in person by the designated representative during regular working hours, nights and/or weekends.

The COR, Health Administration Service Representative, Medical Administrative Assistant (AOD), CO, and/or Beneficiary Travel, or any other Government designee shall be considered ordering officers. The Government, whenever possible, will provide the name of the employees on these positions to each of the contractors.

6. If the contractor fails to furnish services within the required time frame stated above, VA reserves the right to obtain such services from another source and to charge the Contractor with any excess costs above the contract price associated with obtaining the services from the alternate source. VA retains the sole authority to determine when to order services from another source.

7. Acceptance of the trip shall obligate the contractor’s ambulance crew to arrive within the required period and/or to assume payment of the difference in billing rate if they fail to meet this deadline and the VA subsequently goes off contract to secure transport on the open market. Contractor shall be responsible for costs incurred for services obtained from an alternate source for any orders not accepted by the contractor that are within the ordering requirements.

8. The Contractor shall notify the COR as soon as possible of those instances in which the Contractor knows that he will be unable to provide the additional ambulance(s) within one (1) hour of the request, and if the Contractor fails to notify the VA ordering officer of this inability to so provide, the Contractor shall be required to pay any difference in costs. Failure to notify the VA of any instance of inability to provide an ambulance may reflect upon the Contractor’s ability to perform under this contract, and will be documented in the evaluation of contractor’s performance (CPARS) and/or may constitute sufficient cause for termination of the existing contract.

III: Personnel Requirements

A. Minimum of two (2) years’ experience

B. Minimum Qualifications Standards

i. Contractor Education/Experience: Possess a high school education or equivalency, and have two (2) years of experience demonstrating the ability to meet and deal with the general public, to read, understand and apply printed rules, detailed orders, instructions, and training materials; to maintain pose and self-control under stress; and to construct and write clear, concise, accurate and detailed reports as determined by successful, high level of performance with other customers. Any type of military service may be credited toward meeting the requirements. In lieu of the above, each employee shall have two years of relevant education at a residency school above the high school level, or any combination of relevant education above the high school level and relevant experience totaling two (2) years.

ii. Drivers:

1. Education/Experience: Possess a high school education or equivalency, and have two (2) years of experience demonstrating the ability: to meet and deal with the general public; to read, understand and apply printed rules, detailed orders, instructions, and training materials: to maintain pose and self-control under stress; and to construct and write clear, concise, accurate and detailed reports as determined by successful, high level of performance with other clientele.

2. Possesses a valid operator's license issued by the Commonwealth of Puerto Rico, has not, within the last three years, been convicted of reckless driving or driving under the influence of alcohol or controlled substances and has not had a driver’s license suspended under the point system issued by the state. Possess a valid American Red Cross standard first aid and personal safety course card or its equivalent. Drivers must provide full name, date of birth, and social security number to VA prior to operating vehicles with VA beneficiaries. Proof in the form of a current certificate that such first aid training has been successfully completed must be available upon request.

3. Possess a working knowledge of route specific to the area, and knowledge of the geographical areas covered by this contract, and knowledge of the nearest hospital available.

4. Contractor must provide an annual statement that drivers are screened, trained and competent to safely transport patients.

This annual statement of driver competency must include any advanced certifications, such as Advanced Cardiac Life Support or specialized training to assist and secure patients by stretcher or wheelchair.

iii. Attendants-Emergency Medical Technician (EMT) and Paramedics Prices quoted in the schedule shall include the services of a minimum of two (2) Emergency- Medical Technicians (EMTs) for BCLS and a minimum of one EMT and one Paramedic for every ACLS Service. In the event the VA Medical Center determines it necessary for the patient to have more than one ACLS attendant at bed side during transport, the Contractor must provide the additional attendant. In the event that the patient being transported requires mechanical ventilation, and the Contractor is responsible for his or her own mechanical ventilator and the care of the patient during transport. In the event that the patient being transported requires accompaniment by an RN, and the Contractor does not supply the RN, an RN will accompany the patient during transport.

The RN's responsibilities during transport will be clearly outlined in written physician orders. In the event of emergency the care of the patient in transport will be the responsibility of the EMT/Paramedic.

Paramedics, in addition to above, will be licensed in advanced and basic life support and having completed an appropriate training course in the last two years. Attendant should have a minimum of four hours of training in crisis intervention (documented), since some of the patients requiring an attendant will be a psychiatric patient. EMT's, in addition to above requirements, must be licensed in basic life support and having completed an appropriate training course in the last two years. Attendant should have a minimum of four hours of training in crisis intervention (documented), since some of the patients requiring an attendant will be psychiatric patients. An Attendant will always be required for stretcher patients strictly for their safety during the trip and help during transfer to and from ambulance. Contractor shall assure that EMT/Paramedics comply with 'refresher" continuing education, or advanced training programs as required by the Puerto Rico Department of Health, “Comisión de Servicio Público” and the Commonwealth of Puerto Rico. Such "refresher" training must be equivalent to that developed by the Commonwealth of Puerto Rico agencies. Evidence of successful completion for "refresher" training must be provided to the Contracting Officer for inspection.

EMT’s shall have completed satisfactorily a course as Medical Emergency Technician in accordance with the Commonwealth of Puerto Rico Health Secretary, as established by the Federal Transportation Department (DOT) and duly approved the Health

Department of PR; which is taught by an institution credited by the General Education or Superior Education Counsel in PR.

These employees, among their duties may transport any of the following under control of the provider organization’s medical director.

o PCA pump with any medication or fluid infusing through a peripheral IV o Medication infusing through a peripheral IV or continuous subcutaneous catheter via a closed, locked system o A central catheter that is clamped off (subclavian, Hickman, PICC, and

Passport) o A patient with a feeding tube that is clamped off o A patient with a Holter monitor o A patient with a peripheral IV infusing vitamins o IV fluids infusing through a peripheral IV via gravity or an infusing system that allows the technician to change the rate of infusion are limited to D5W, Lactated Ringers, Sodium Chloride (0.9% or less), Potassium chloride (20mEq or less for EMTs, 40mEq or less for Advanced EMTs) o Medication infusing through a peripheral or central IV or fluid infusing through a central IV via gravity or a infusing system that allows the operator or assistant to change the rate of infusion o A patient with a chest tube o A patient with a continuous feeding tube o A vent dependent patient

Most of their routine duties include, but not limited to:

o Determine blood glucose levels o Oxygen & pulse oximetry o Cardiac Monitoring o Administer standard intravenous (IV) solutions of NS & LR o Insert nasogastric tubes for administration of Activated Charcoal o Insert Esophageal Tracheal Combi Tube o Perform Needle Cricotyrotomy o Oral Endotracheal intubation o Nasal Endotracheal intubation o Endotracheal suction o Administer drugs through the following routes:

Sublingual Subcutaneous Intramuscular Intravenous Endotracheal Perform needle thoracotomy to relieve tension pneumothorax Application of splints Order trauma alert (and request aero medical helicopters for serious trauma patient with significant mechanisms of injury or a grade or less than 12 on the Glasco Coma scale

BLS in accordance with current Cardio-Pulmonary Resuscitation standards

ALS in accordance with ACLS protocols, to include defibrillation, cardioversion, and external pacing if the RPM has current documentation of successful ALS course completion

Treatment of acute respiratory failure PCA pump with any medication or fluid infusing through a peripheral IV

iv. Age: Contractor and employees performing work under this contract shall be a minimum of eighteen (18) years of age or as required by local laws.

v. Health and Physical Fitness Requirements:

1. All employees assigned by the Contractor to work under this contract shall be physically able to perform all general duties, functions and activities. Contractor shall certify that personnel performing under this contract do not have current medical condition(s) which interfere with the ability to drive safely or perform their assigned duties. This includes, but not limited to: vision, hearing, mental capacity, and any other condition that may restrict the ability to operate transport service vehicle or/and provide the required assistance and services to the transported patient. Physical examination report to describe above requirements for each driver shall be provided upon request.

2. All employees shall be literate and able to communicate (speak) with clients in English and Spanish to the extent of reading and understanding printed regulations, detailed written orders, training instructions and material, and shall be able to compose reports which convey complete information.

The Contractor is to certify the ability of all employees designated to provide service for this contract. When a patient is transported with any VA owned equipment the equipment shall be returned to the respective VA Medical Center within 24 hours in the same condition as it was released at no addition cost to the Government.

IV. Safety Requirements

Contractor shall take such safety precautions as the CO and/or the COR may determine to be reasonably necessary to protect the lives and health of patients, and occupancy of the buildings and/or facilities. The CO/COR shall notify the contractor of any noncompliance with the foregoing provision and the action to be taken. The Contractor shall correct the situation within one (1) hour to which attention has been directed. If the Contractor fails to promptly comply, the CO may issue an order stopping all or any part of the work and hold the contractor in default.

V. Insurance Certification

Contractor shall have Certificate of Insurance which shall contain an endorsement to the effect that cancellation of, or any material change in the policies which adversely affect the interest of the Government in such insurance shall not be effective unless thirty (30) days written notice of cancellation or change is furnished to the CO.

VI. Training in Psychiatric Behavior

All contractor personnel shall be trained in the prevention and management of disturbed behavior as well as suicide prevention techniques. Documentation/certification must be submitted to the CO within thirty (30) days of contract award. If no prior training has been received on this subject, contractor personnel shall be required to complete VA provided training.

VII. Minimum Quality Considerations

a) The contractor shall continuously meet or exceed all The Joint Commission (TJC) standards. All applicable VACHS policies and procedures shall be followed by the contractor. Contract personnel shall provide compassionate care with respect for the special needs of the veteran population served. Care delivered shall reflect the VACHS Medical Center’s mission, vision, and values.

(http://www.jointcommission.org/standards_information/standards.aspx)

b) The contractor shall maintain records that document competence/performance level of contractor employees working on this contract in accordance with TJC and other regulatory body requirements.

c) Contractor shall provide and document a general orientation for all contractor(s) employees who are providing work on this contract prior to performance.

Documentation of the orientation shall be maintained by the contractor and made available to the Government upon request. This orientation, at minimum, shall include the following topics:

i. Fire and safety policy and procedure

ii. Infection control policy and procedure

iii. Emergency Preparedness /Disaster policy and procedure

iv. Performance requirements according to the contract PWS

d) The Government will monitor contractor(s) performance using the Quality Assurance Surveillance Plan (QASP), and reserves the right to conduct unannounced visits for the purpose of inspecting and/or verifying contract compliance.

http://www.jointcommission.org/standards_information/standards.aspx

e) The contractor(s) shall have a written Quality Control Plan (QCP). It shall specify the areas to be inspected either on a scheduled or an unscheduled basis, how often inspections shall occur, and the title of the individual(s) who shall perform the inspection. At a minimum, the QCP shall include the following:

i. An inspection system covering work performance of the contract.

This system shall specify items to be inspected on both: scheduled and unscheduled basis.

ii. Method of identifying deficiencies in the quality of services performed before the level of performance becomes unacceptable.

iii. A file of all inspections conducted by the contractor and corrective action taken.

VIII. Patient Rights

The contractor(s) shall respect the patients’ beliefs, values, and cultural diversity.

Protection of all patient rights is of highest priority. Patient privacy and confidentiality shall be maintained at all times.

The Contractor shall be courteous to VA beneficiaries, and shall not smoke or text while transporting patients. Patients may bring a reasonable amount of belongings such as a personal suitcase. Texting while driving is a federal violation, and it is prohibited by Commonwealth of Puerto Rico laws too.

IX. Patient Safety and Welfare

Patient safety shall be a primary focus of the contractor. Every effort shall be made by the contractor to prevent medication errors, falls, and patient injury caused by acts of commission or omission in the delivery of care. All events related to patient injury, medication errors, and other breaches of patient safety shall be reported to the COR utilizing and Incident Report, and shall be notified in no more than 24 hours of event.

The contractor shall be held responsible for patient welfare during transport. The contractor shall be held responsible for patient and/or Government property during transport. Any damaged or lost wheelchairs, walkers, crutches or personal belongings will be replaced by the contractor at no additional cost to the Government or beneficiary.

The Government 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 Termination of the contract.

In the event a patient's condition worsens during transport, the Contractor shall transport the patient to the closest facility appropriate for the required care. In the event a patient should expire during transport the Contractor shall return to the VA Medical Center.

X. Sensitive Information

VA sensitive information is considered all data, on any storage media or in any form or format, which requires protection due to risk of harm that could result from inadvertent or deliberate disclosure, alternation n, or destruction of the information. The term includes information whose improper use or disclosure could adversely affect the ability of an agency to accomplish its mission, proprietary information, records about individuals requiring protection under various confidentiality provisions such as the Privacy Act and the HIPAA Privacy rule, and information that can be withheld under the Freedom of Information Act. Examples of VA sensitive information include the following: individually-identifiable medical, benefits and personnel information; financial budgetary, research, quality assurance; confidential commercial, critical infrastructure, investigatory, and law enforcement information; information that is confidential and privileged in litigation such as information protected by the deliberative process privilege, attorney work-product privilege, and the attorney client privilege; and other information which, if released, could result in violation of law or harm or unfairness to any individual or group, or could adversely affect the national interest or the conduct of federal programs.

XI. HIPAA Compliance, Privacy and Confidentiality

Contractor shall comply with the provision of Public Law 104-191, Health Insurance Portability and Accountability Act (HIPAA of 1996 and the National Standards to Protect the Privacy and Security of Protected Health Information (PHI). Contractor shall comply with applicable confidentiality statutes, including 38 U.S.C. 5701, 38 U.S.C. 7332, and 5 U.S.C. 552a (Privacy Act), as well as 45 C.F.R. Parts 160, 162, and 164 (Health Insurance Portability and Accountability Act).

XII. Security Incident Investigation

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

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

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

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

XIII. Security Incident Investigation

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

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

C. With respect to unsecured protected health information, the business associate is deemed to have discovered a data breach when the business associate knew or should have known of a breach of such information. Upon discovery, the business associate must notify the covered entity of the breach.

Notifications need to be made in accordance with the executed business associate agreement.

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

XIV. Liquidated Damages for Data Breach

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

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

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

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

(2) Description of the event, including:

(a) date of occurrence;

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

(3) Number of individuals affected or potentially affected;

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

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

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

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

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

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

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

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

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

Notification;

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

(2) Data breach analysis;

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

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

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

XV. Security Controls Compliance Testing:

On a periodic basis, VA, including the Office of Inspector General, reserves the right to evaluate any or all of the security controls and privacy practices implemented by the contractor under the clauses contained within the contract. With 10 working-day’s notice, at the request of the government, the contractor must fully cooperate and assist in a government-sponsored security controls assessment at each location wherein VA information is processed or stored, or information systems are developed, operated, maintained, or used on behalf of VA, including those initiated by the Office of Inspector General. The government may conduct a security control assessment on shorter notice (to include unannounced assessments) as determined by VA in the event of a security incident or at any other time.

XVI. Recognized Holidays

In accordance with 5 U.S.C. 6103, Executive Order 11582 and Public Law 94-97 the following national holidays are observed and for the purpose of this contract is defined as “Legal Federal official holidays” as follows:

Eleven (11) holidays are observed as prescribed in the Wage Determinations revision applicable to the Commonwealth of Puerto Rico statewide areas as follows:

New Year’s Day January 1 Martin Luther King Day Third Monday in January Presidents’ Day Third Monday in February Good Friday Authorized by Wage Determination Revision Memorial Day Last Monday in May Independence Day July 4 Labor Day First Monday in September Columbus Day Second Monday in October Veterans Day November 11 Thanksgiving Day Fourth Thursday in November Christmas Day December 25

XVII. Ordering Service

Personnel authorized by the Contracting Officer shall make requests for service by telephone. Request for services will be made to the telephone number specified by the Contractor or to one back-up number in the event of no answer at the primary number specified. All contacts from the Contractor will be with the Travel Clerk at (787)641-

7582 ext 131234/131235/131233, Supervisor, Beneficiary Travel Section at (787)641- 7582 ext 131517 or the Administrative Officer of the Day (AOD) at (787)641-7582 ext 131119, 131105 or 131117 during non-administrative hours.

If the VA is unable to establish telephone contact with the Contractor for BLS ambulance service within five (5) minutes or if the Contractor fails to furnish within a reasonable time, 45 minutes after receiving a request or within 45 minutes of the scheduled pick-up time, the VA reserves the right to obtain the service from another source and to charge the Contractor with any excess costs which may result there from.

The VA will be the sole judge in determining when to order service from another source.

The Contractor will furnish qualified Advanced Cardiac Life Support (ACLS) personnel who are competent to perform ACLS protocols.

All ambulances shall be licensed and meet the minimum vehicle requirements as mandated by Commonwealth of Puerto Rico and federal laws such as specification KKK-A-1822E, but not limited to. Each vehicle shall, at least, include the required equipment in strict compliance with the federal, local laws, ordinances, codes, rules or regulations and shall have a minimum of:

a. Air conditioning and/or ventilation for patient comfort

b. Communication devices to be used in case of an emergency, i.e., CB radio, cellular phone

c. Be equipped with an American Red Cross Type 24 Unit first aid kit or equivalent

d. Vehicles shall be kept in a sanitary condition, both inside and outside

e. Vehicles involved in an accident, no matter how insignificant, shall be taken out of operation until the contractor has provided written repair report or documentation to the COR

f. Vehicles involved in an accident while transporting a VA patient, shall contact the VACHS Mobility Manager office within two (2) hours following the incident.

Each ambulance shall have patient compartment facilities, oxygen and suction system equipment, environmental climatic equipment, and additional systems equipment, accessories, and supplies as required by the Commonwealth of Puerto Rico laws and regulations, specification KKK-A-1822F governing the certification and licensure of private ambulances located in websites:

http://www.pr.gov/NR/rdonlyres/055A7CED-E614-432A-BB04- 275BAFEB1028/0/Ley_Num_225.pdf http://www2.pr.gov/agencias/csp/ServiciosyProgramas/secretaria/Documents/Reg lamentos/Carga/Reglamento%206737.pdf http://www.pr.gov/NR/rdonlyres/055A7CED-E614-432A-BB04-275BAFEB1028/0/Ley_Num_225.pdf http://www.pr.gov/NR/rdonlyres/055A7CED-E614-432A-BB04-275BAFEB1028/0/Ley_Num_225.pdf http://www2.pr.gov/agencias/csp/ServiciosyProgramas/secretaria/Documents/Reglamentos/Carga/Reglamento%206737.pdf http://www2.pr.gov/agencias/csp/ServiciosyProgramas/secretaria/Documents/Reglamentos/Carga/Reglamento%206737.pdf

These regulations in addition to federal laws and regulation as: Federal Specification for the Star-of-Life Ambulance KKK-A-1822F, date July 2015, but not limited to. ALS transport units are required to have portable ventilator equipment.

XVIII. Government owned equipment or supplies

Any and all government equipment, linens, etc., taken with patients must be returned.

The Contractor shall furnish all linens, blankets, and supplies. The VA Medical Center will not participate in a linen exchange program or any supply exchange program. The Contractor shall not be permitted to borrow medical equipment from the Medical facilities. The Contractor shall provide all medications required while in transport, sheets, and blankets and other equipment and supplies required for use while in transport, for direct patient care. Contractor shall at no time and under any circumstances exchange supplies, equipment, and/or medications with the VA.

XIX. Records

At the option of the Government, the Contractor may be required to transport records with patients from VA facility to Non-VA facility.

XX. Incident Reports

If an incident and/or accident that involve the welfare of a beneficiary occur, the Contractor shall immediately notify the Travel Clerk, Supervisor, Patient Support Unit, or the Administrative Officer (AOD) during evenings, nights, weekends, and holidays. This notification will be made by telephone within one (1) hour. A written report of the incident shall be filed with the Travel Clerk or the Contracting Officer’s Representative by the close of business the next business day.

XXI. Joint Commission Standards

A. The Contractor shall perform required services in accordance with the standards of the Joint Commission on the Accreditation of Healthcare Organization and the established principles and ethics of the medical profession established by the American Medical Association (AMA) and American College of Emergency Physicians (ACEP). The Contractor shall adhere to the Department of Veteran Affairs regulations and the policies, procedures, and regulations of Medical Staff bylaws of the VA Caribbean Healthcare System. The regulation that governs the Beneficiary Travel Program is Title 38 Code of Federal Regulations (CFR) Section 70.

B. The Contractor shall comply with the provisions of the Privacy Act of 1974, the Health Insurance. Portability and Accountability Act (HIPAA) of 1996, as well as all VA Directive and Handbook 0710. The Contractor shall not maintain and/or share sensitive or patient identifiable information in any form or for any purpose, other than what is needed to perform its obligation under the established Business Associate Agreement (BAA).

XXII. Vehicle and Insurance Requirements

A. The Contractor shall obtain all necessary licenses and/or permits required to perform this work. Contractor shall take all precautions necessary to protect persons and property from injury or damage during the performance of this contract. Contractor shall be responsible for any injury to himself, his employees, or others, as well as for any damage to personal or public property that occurs during the performance of this contract that is caused by his or her employees' fault or negligence.

B. The Contractor shall maintain personal liability, automobile liability, and property damage insurance, as prescribed by the laws of the Commonwealth of Puerto Rico and in accordance with VAAR 852.237-7.

Evidence of coverage is required before commencing work under this contract (copy of Certificate of Insurance), and it may not be changed or cancelled without thirty calendar days prior written notice to the Contracting Officer.

C. The VA reserves the right to inspect the Contractor Team equipment and vehicles or require documentation of compliance with contract specifications, and State laws, rules, regulations and guidelines governing transportation vehicles. The VA reserves the right to restrict the contractor use of equipment and vehicles that are not in compliance with contract requirements. The restriction of such equipment and vehicles shall not relieve the contractor from performing in accordance with the strict intent and meaning of the contract and without additional cost to the

VA.

D. VA inspections of Contractor equipment shall not constitute a warranty that the Contractor’s vehicles and equipment are properly maintained.

E. Vehicles shall meet all current applicable Federal, State and local specifications and regulations including, but not limited to, licensing, registration, safety standards, and permissions of the Commonwealth of Puerto Rico.

F. Vehicles shall be clean (no blood, saliva, urine, any patient discharges) and maintained in good repair in accordance with manufacturer's instructions and specifications, at all times during the performance of this contract.

G. The Government reserves the right to restrict the Contractor's use of equipment and vehicles which are in need of repair, unclean, unsafe, damaged on the interior or exterior body, and are not in compliance with contract requirements. The restriction of such equipment and vehicles shall not relieve the contractor from performing in accordance with the strict intent and meaning of the contract without additional cost to the Government.

H. All new ambulance vehicles shall conform to current Federal

Specifications as published by the General Services Administration, Specification Section. Ambulances that were constructed prior to the implementation of the current Federal Specifications shall conform to the applicable Federal Specifications that were in effect at the time of original construction. Federal Specifications may be reviewed at:

http://vehiclestd.fas.gsa.gov/CommentCollector/Home

I. All medical transportation vehicles (ambulance) shall have patient compartment facilities, oxygen and suction systems and equipment, environment climatic equipment, communications and additional systems, equipment, accessories and supplies as required by the applicable Federal Specifications. The current Federal Specifications may be reviewed at: https://apps.fas.gsa.gov/vehiclestandards/

J. Contractor shall be responsible for using appropriate driver screening and selection criteria when employing drivers. Such screening shall include but not be limited to testing drivers for prohibited drug use and alcohol misuse;

a criminal background check, to the maximum extent permitted by Commonwealth of Puerto Rico law, and, their motor vehicle drivers/operators’ license history and driving skills.

XXIII. Ambulance Medical Equipment

A. All ambulance medical care vehicle will have patient compartment facilities, oxygen and suction systems and equipment, environmental climate equipment, communications equipment, and any additional systems, equipment, accessories, and supplies as required by the Puerto Rico Department of Health, “Comisión de Servicio Público” and the Commonwealth of Puerto Rico.

B. Each advanced life support (ALS) vehicle will have certified paramedics, patient compartment facilities, oxygen, heart monitor, suction systems, and intravenous IV equipment, environmental climate equipment, communications equipment, and any additional systems, equipment, accessories, and supplies as required by the Puerto Rico Department of Health, “Comisión de Servicio Público” and the Commonwealth of Puerto Rico.

http://vehiclestd.fas.gsa.gov/CommentCollector/Home https://apps.fas.gsa.gov/vehiclestandards/

XXIV. Miscellaneous

A. Contractor employees shall conduct themselves in a business-like manner at all times while on VA premises and while transporting patients.

B. When transporting patients to or from Medical facilities, the driver, acting for the Contractor will ensure that the patient’s luggage, medical records, medications, and prosthetic devices are properly accounted for and delivered with the patient as required.

C. Contractor shall provide a “Run Sheet” as part of the patient’s permanent record. This Run Sheet shall include a record of the patient’s vital signs, medications used, oxygen use, patient’s emotional attitude, and any changes in the patient’s condition. The list stated here shall not be construed to be as all-inclusive; the Contractor shall provide all pertinent information.

XXV. Confidentiality

A. Protects printed and sensitive data in accordance with the provisions of the Privacy Act of 1974 and other applicable laws. Protects the data from unauthorized release or from loss and alterations.

STATEMENT OF WORK