PERFORMANCE WORK STATEMENT

1. PURPOSE

1.1. San Francisco Veterans Affairs Health Care System is seeking a Contractor to provide residential programming and services as part of its Health Care for Homeless Veterans

(HCHV) Low Demand Safe Haven Program. The Contractor shall offer community-based, short-term residential services to eligible Veterans who need immediate housing placement in conjunction with sufficient supportive services to support stabilization in the community and transition to permanent housing. This residential programming shall be offered in the City and County of San Francisco. This contract shall cover up to a total of five years, which includes one 12-month Base Year and four additional 12-month Ordering

Periods.

2. BACKGROUND

2.1. Health Care for Homeless Veterans is an essential and critical part of Veterans Health

Administration (VHA), providing a gateway to VHA and community-based supportive services for eligible Veterans who are homeless. HCHV programs were developed from the original Homeless Chronically Mentally Ill (HCMI) Program, a 6-month pilot project, established on February 12, 1987. The central goal of HCHV programs is to reduce homelessness among Veterans by conducting street outreach to Veterans who are homeless or experiencing housing instability and need case management assistance to end their homelessness and connect to community-based and Veterans Affairs (VA)-supported housing services, VA health care and other supportive services. In addition to outreach services, HCHV programs provide care, treatment, and rehabilitative services, including case management and therapeutic transitional housing assistance by contracting with community providers.

2.2. HCHV programs typically are the first to contact homeless Veterans, and they frequently serve as the entry point into VA’s system of care. Therefore, these programs provide an outreach opportunity to assist and offer homeless Veterans an “Open Door” to prevention and supportive services.

2.3. Federal law provides that VA medical facilities may establish contracts with community agencies to provide residential care to include therapeutic services and treatment to eligible Veterans. The Veteran must be enrolled in the VA health care system or eligible for VA health care to be eligible for services. Since its inception, the number of HCHV

Contract Residential Services programs has increased dramatically, requiring uniform inspection and oversight policies to ensure that these programs offer robust services and promote an environment that maintains the wellbeing and safety of the Veterans enrolled.

2.4. In July 2010, under the leadership and direction of the VA National Center on

Homelessness among Veterans, VA Low Demand Safe Haven (LDSH aka “Safe Haven”)

Programs were developed and implemented as evidence-based practice that serves as an alternative to more traditional programs for homeless Veterans. Safe Haven Programs are community-based early recovery models of care that incorporate Harm Reduction principles and practices into supportive interim housing for hard-to-reach, hard-to-engage chronically homeless Veterans with severe mental illness and/or substance use disorders. Safe Havens were created to meet the gap in access and availability for those who would otherwise have difficulty succeeding in other VA interim housing programs.

3. PROGRAM DESCRIPTION

3.1. HCHV Low Demand Safe Haven (LDSH) programs are 24-hour staffed short-term residences with private or semi-private accommodations that target the population of hard-to-reach, chronically homeless Veterans with mental illness, with substance use disorder (SUD), and/or when traditional residential treatment programs do not meet a

Veteran’s needs. The low-demand or non-intrusive environment is designed to establish trust and motivate homeless Veterans to seek needed treatment services and transitional and permanent housing options. Lengths of stay in LDSH programs typically range between 4 to 6 months with the option to extend based on clinical need.

4. HCHV LDSH PROGRAM CHARACTERISTICS AND CAPABILITY REQUIREMENTS

4.1. Offers emergency housing and supportive services within a community-based facility located within the City and County of San Francisco, CA with easy access by public transportation to San Francisco VA Downtown Clinic (401 3rd Street, San Francisco, CA

94107) and/or San Francisco VA Medical Center (4150 Clement Street, San Francisco, CA

94121).

4.2. Covers up to a total of five years, that includes one 12-month Base Year and four additional 12-month Ordering Periods.

4.3. Has capacity to serve up to 22 Veterans.

4.4. Targets and prioritizes:

4.4.1. Chronically homeless Veterans with severe mental illness and/or substance use problems who are in the early stages of recovery.

4.4.2. Veterans who have not been successful in traditional housing or treatment programs.

4.4.3. Veterans who cannot, or will not, adhere to the rules of a traditional homeless services program and/or who cannot, or will not, abstain from alcohol or drug use.

4.5. Reduces barriers to immediate placement and accommodates same day admissions when there is a vacancy in the program.

4.6. Does not deny entry to HCHV LDSH Program based solely upon:

4.6.1. Length of abstinence from alcohol or other non-prescribed substances

4.6.2. Number of previous treatment episodes

4.6.3. Time interval since the last HCHV LDSH program entry

4.6.4. Use of prescribed controlled substances including, but not limited to, prescribed

FDA-approved medications such as methadone or buprenorphine

4.6.5. Legal history including legal requirement to register as a sex offender

4.6.6. Veteran’s total income

4.6.7. Veteran’s student or vocational status

4.6.8. Pre-existing diagnosis of mental illness, substance use disorder or other comorbid conditions

4.6.9. Veteran’s willingness to engage in specific treatment(s) at time of referral

4.6.10. Veterans having a Patient Record Flag (PRF)

4.7. Considers each of the special circumstances above during the screening process and makes an admissions determination based on whether the individual Veteran’s needs can be met while maintaining the program’s safety, security, and integrity.

4.8. Provides safe and secure housing that is available to enrolled Veterans 24 hours per day, seven (7) days per week and includes:

4.8.1. One bed for each enrolled Veteran.

4.8.1.1. Private or semi-private accommodations are required.

4.8.2. Access to shared or private toileting and bathing facilities.

4.8.3. Personal storage space such as a dresser, storage locker, or designated locked and secure space that shall accommodate two bags of personal belongings.

4.8.3.1. Contractor shall allow Veteran to store personal belongings for at least 72 business hours after formal HCHV exit from program.

4.8.3.2. If a Veteran abandons their belongings at the program site, Contractor shall make at least three documented attempts to contact the

Veteran and VA Liaison or Designee before disposing of Veteran’s belongings.

4.8.4. A means for securely and properly storing all medications and other medical equipment brought into the program for Veteran use.

4.8.4.1. Contractor shall ensure that there are appropriate policies and procedures that support the safe storage of medications for enrolled

Veterans.

4.8.4.2. Individual medication storage may be provided to the Veteran to secure their own medications, e.g., within their locked personal storage space, a lockbox or a locker, and/or central storage may be provided by the

Contractor.

4.8.4.3. Veterans may self-administer medications, but secure storage shall ensure that no other program participants are able to access an individual

Veteran’s medications including medication which requires refrigeration.

4.8.4.4. Any suspicion or concern for misuse of medications is to be reported to VA Liaison, COR, and/or designee immediately by following incident reporting protocol.

4.8.5. Access to laundry facilities or other personal laundering services at least once per week.

4.8.5.1. Laundry and detergent shall be free of charge to enrolled Veterans.

4.8.6. Personal linens, i.e., towels, pillows, blankets, and bed sheets.

4.8.7. Personal hygiene kits.

4.8.8. A safe room or sobering lounge easily accessed and monitored by 24-hour staffing for enrolled Veterans who return to the program site intoxicated or are impaired by substances but are not impaired to a level requiring detoxification or hospitalization, or who are experiencing severe emotional dysregulation. Use of a safe room or sobering lounge allows for closer short-term monitoring by staff while Veterans sober up and/or regain their composure following an acute exacerbation of mental health symptoms.

4.8.8.1. Key reasons for using these rooms include:

4.8.8.1.1. To ensure Veteran and community safety

4.8.8.1.2. To monitor Veteran health and behavior

4.8.8.1.3. To provide a private area for recovery from substance use, medication effects or unmanageable emotional distress

4.8.8.1.4. To provide a private space for any Veteran who needs it

4.8.9. Telephone access with privacy for Veterans to facilitate prompt communication between enrolled Veterans and VA providers and/or emergency services, e.g., 911/988/Veteran’s Crisis Line.

4.9. Access to prepared meals and/or a sanitary food preparation area and food supply that:

4.9.1. Is sufficient for at least three nutritious meals seven days per week and snacks of nourishing quality, even if not medically indicated, e.g., fruits, vegetables, protein sources, between meals and at bedtime.

4.9.2. Includes alternative meals or food supplies for Veterans with dietary restrictions if medically indicated, e.g., diabetic, renal, and soft mechanical diets, and reasonable accommodations for Veterans with cultural/religious preferences around food, e.g., Kosher, Sikh, vegetarian.

4.9.3. Shared use of kitchen facilities and dining rooms is acceptable.

4.10. Provides wraparound case management, care coordination, and supportive services individualized to each enrolled Veteran’s needs including, but not limited to:

4.10.1. Assistance with attaining permanent housing.

4.10.2. Linkage to health care.

4.10.3. Support for mental health stabilization and moderation of substance misuse.

4.10.4. Vocational assistance including mentoring, coaching, linkage to job training and job placement

4.10.5. Assistance with increasing income, linkage to entitlements and budgeting.

4.10.6. Independent living skills to maintain permanent housing.

4.10.7. Social and recreational activities.

5. LOW DEMAND SAFE HAVEN CORE VALUES

5.1. The Low Demand Safe Haven environment of care:

5.1.1. Does not require abstinence or compliance with treatment as a condition of admission or continued stay.

5.1.2. Provides safe and secure housing and supportive services within a trauma-informed environment of care.

5.1.3. Is as non-intrusive as possible, i.e., demands are kept to a minimum.

5.1.3.1. However, low demand is not no demand but rather minimal demands with high expectations which include:

5.1.3.1.1. Privacy for the enrolled Veterans.

5.1.3.1.2. Expectation that Veterans will transition to permanent housing.

5.1.3.1.3. Expectation that Veterans will engage with their case managers in developing a housing plan.

5.1.3.1.4. Other treatment and programming, including mental health and substance use treatment, is optional but highly encouraged based on individual need and interest.

5.1.3.1.5. Engagement in care may look different for each Veteran enrolled in the program (see 9.5.4. for more detail).

5.1.4. Engages Veterans using harm reduction strategies with a primary focus on attaining and maintaining housing.

5.1.5. Is based on acceptance that not all mental health and substance use problems can

“be fixed”.

5.1.6. Uses harm reduction strategies that support Veterans in minimizing the health impacts and social effects of risky behaviors.

5.1.7. Has house rules that are simple, easily understood, kept to a minimum, and focus on staff and resident safety, such as:

5.1.7.1. No violence or threats of violence

5.1.7.2. No buying or selling of alcohol or drugs in the facility

5.1.7.3. No drug or alcohol use within the facility

5.1.7.4. No sexual activity between residents of the facility

5.1.7.5. Honor nightly curfew

5.1.8. Episodes of intoxication, substance use, treatment compliance problems, and infractions of program rules are to be used as opportunities for engagement, not simply as grounds for discharge or to impose sanctions. Punitive responses to infractions are to be avoided.

5.1.9. Emphasis is placed on achieving placement in permanent housing at the time of program exit and on reducing negative exits due to simple rule violations or other avoidable circumstances. Negative discharges will be monitored as a measure of program quality.

6. ELIGIBILITY CRITERIA

6.1. To be eligible for HCHV Contract Residential Services, a Veteran must meet the requirements of 38 U.S.C. 2031(a) and 38 CFR 63.3.

6.1.1. Veteran is enrolled in the VA health care system, or eligible for VA health care under CFR 17.36 or 17.37; and

6.1.2. Veteran is homeless as defined in 38 U.S.C. §§ 2002(1) and 103(a) of the McKinney- Vento Homeless Assistance Act, 42 U.S.C. § 11302(a) including:

6.1.2.1. Veteran who lacks a fixed, regular, and adequate nighttime residence; or

6.1.2.2. Veteran who will imminently lose their primary nighttime residence within 14 days of the date of application for homeless assistance.

7. DETERMINATION OF ELIGIBLITY

7.1. VA is responsible for determining Veteran eligibility for placement in the program prior to admission by Contractor for services.

7.2. Contractor is responsible for obtaining confirmation of Veteran eligibility for placement into the program prior to the admission of each Veteran referred under this contract.

7.3. If there is an urgent need to admit a Veteran and designated VA staff is unavailable to provide written verification of eligibility prior to admission, then verbal approval by VA is acceptable pending receipt of written verification.

7.4. Any admissions that occur without prior verbal or written confirmation of eligibility must be verified by VA staff within one business day for Contractor to receive payment for days(s) admitted prior to formal determination of eligibility.

7.4.1. See Section 8.6.1.3. Ineligible Veteran for payment procedures if a Veteran is admitted to the contract program and subsequently found to be ineligible for HCHV services.

7.5. Failure to establish eligibility prior to admission and/or within 24 business hours if/when VA staff are unavailable to provide verification may result in denial of payment for services provided.

7.6. A list of authorized VA ordering personnel including primary identified VA Liaison shall be made available to Contractor upon award of the contract.

7.6.1. VA employees may be added or deleted from this list during the term of the contract at the discretion of VA.

7.6.2. Contractor shall not deviate from the list of individuals authorized to approve admissions without an updated list.

8. LOW DEMAND SAFE HAVEN ADMISSIONS PRACTICES

8.1. Contractor shall work to reduce barriers to admission and demonstrate flexibility with admission processes by:

8.1.1. Actively reducing or eliminating individual level barriers such as requirements for treatment compliance.

8.1.2. Actively reducing or eliminating system level barriers such as unnecessary delays between screening and admission and “housing readiness” requirements.

8.1.3. Allowing trial visits by Veterans to allow Veteran to determine if the program is a good fit.

8.1.4. Assisting Veterans with admission forms and VA program eligibility determination when needed.

8.1.5. Accepting referrals and admissions throughout the day and, at a minimum, between Monday-Friday, 8AM-8PM, when there is a vacant bed available.

8.1.5.1. Ability to accept admissions up to 24 hours per day, seven (7) days per week, including weekends and holidays, is highly preferred.

8.1.6. Accommodating same-day admissions when there are vacancies in the program.

8.1.6.1. Admissions decisions shall be made on the same day of referral for admission when there is a program vacancy and no later than 24 hours after receipt of referral if the program does not have any immediate openings.

8.1.6.1.1. Notification of all admissions decisions, any delay in admissions decisions as described in 8.1.6.1., and reasons for denial of any referral shall be provided in writing to VA Liaison, COR, and/or designee.

8.1.6.2. Contractor shall make reasonable efforts to admit a Veteran immediately when there is a vacancy in the program, especially prior to a weekend or holiday if/when there is no option to admit over the weekend or holiday and Veteran has no alternative to staying on the streets.

8.1.6.2.1. Vacant units within program shall be turned over and made available for new admissions immediately.

8.1.6.2.2. If Contractor is unable to accommodate a same-day

admission when there is a vacancy in the program, then Contractor shall provide written explanation with reason for delay to VA

Liaison, COR, and/or Designee.

8.1.7. Accepting program referrals from VA, other community partners, and/or self-referral by Veterans that include a verbal and/or written description of the referred

Veteran’s current clinical presentation, current psychosocial circumstances including living situation, and risk assessment.

8.1.7.1. Admissions decisions are not contingent upon Contractor receipt of a comprehensive psychosocial assessment or Veteran’s intent to enroll in specific treatment(s) at time of referral.

8.1.7.2. It is understood that Veterans to be cared for under this contract will require care and services beyond room and board and may need more intensive case management than the general population.

8.1.7.3. Level of intensity of services will be part of an ongoing discussion with VA Liaison.

8.1.7.4. Contractor shall maintain effective communication with VA regarding any issues covered under this agreement.

8.1.7.5. Admissions process is subject to VA Liaison review and adjustment at any time to ensure program accessibility for Veterans.

8.1.8. Supporting Veterans in follow through with obtaining tuberculosis (TB) clearance within 10 business days of admission if TB clearance results are not available at time of referral.

8.1.8.1. Veterans shall be screened for TB via PPD or QuantiFERON or chest x-ray or other medically acceptable means of screening for TB.

8.1.8.2. While results may not be immediately available, Veterans shall be admitted while results are pending unless they are exhibiting any signs or symptoms of active TB.

9. VETERAN CLINICAL SERVICES

9.1. OCCUPANCY

9.1.1. Contractor shall be responsible for ensuring that a minimally acceptable level of

80% occupancy (90-100% preferred) of HCHV LDSH-funded beds is maintained through independent outreach efforts and through collaboration with VA.

9.1.2. Contractor shall be knowledgeable about best practices for outreach generally accepted in the community and shall be responsible for engaging in outreach in the community, including collaboration with SFVAHCS providers, for referrals at least twice monthly, to achieve a satisfactory occupancy rate when occupancy does not meet the minimally acceptable level.

9.1.3. Rate of occupancy may result in increase or decrease in program size in subsequent Ordering Periods depending on Government need and funding availability.

9.2. ACHIEVING PERMANENT HOUSING is a primary goal of the HCHV LDSH program and plans for transition from HCHV LDSH to permanent housing placements which may include transition to other residential treatment and/or transitional housing as an interim step for some Veterans, must be clearly reflected in each Veteran’s Individualized

Service Plan and in weekly case management notes.

9.2.1. Should a Veteran refuse to engage with Contractor staff regarding plans for permanent housing transition, motivational interviewing and other therapeutic techniques shall be used to address Veteran ambivalence.

9.2.2. All efforts to engage Veterans regarding housing plans, options, and resources shall be clearly documented.

9.2.3. Contractor staff must provide direct and ongoing assistance to Veterans in developing permanent housing plans and accessing housing resources and may include, but is not limited to:

9.2.3.1. Assistance with obtaining and reviewing free credit reports.

9.2.3.2. Identifying housing strengths and barriers.

9.2.3.3. Assistance with creating a Tenant Portfolio that includes gathering all relevant documents required for the rental process such as sample rental application, income verification documents, identification (e.g., birth certificate, state ID, social security card, DD214) and subsidy applications.

9.2.3.4. Reviewing/searching for affordable housing options together.

9.2.3.5. Assisting with completion of rental applications.

9.2.3.6. Direct communication and advocacy with prospective landlords, housing agencies, and HUD-VASH staff.

9.2.4. Contractor staff are expected to participate actively in Veteran’s search for housing and to document those efforts and progress made in weekly case management notes.

9.3. CARE PLANNING

9.3.1. Contractor shall engage the Veteran in a collaborative assessment of service needs with input from the Veteran and the VA Liaison or designee and create an initial

Individualized Service Plan (ISP) to address those needs within 14 days of admission.

9.3.2. ISPs must include goals and objectives for achieving stable housing.

9.3.3. ISPs shall include an assessment of strengths and barriers to stable housing, specific services to be provided including duration and outcomes, documentation of referrals and benefits to be achieved as a result of program participation.

9.3.4. ISPs shall be reviewed and updated within 60 days of admission with the Veteran and the VA Liaison or designee and more frequently as needed throughout each individual Veteran’s episode of care.

9.3.5. Contractor staff shall meet with VA Liaison or designee at least once every 30 days to provide an update on case management progress made and must work cooperatively with VA Liaison or designee to coordinate services.

9.4. CASE MANAGEMENT

9.4.1. Contractor shall provide individual case management meetings at least once per week that focus on each Veteran’s individualized needs as identified through the care planning process which may include, but is not limited to:

9.4.1.1. Permanent housing search (refer to Section 9.2.).

9.4.1.2. Increasing income through referral to all potential financial resources relevant to individual needs such as:

9.4.1.2.1. SSI/SSDI

9.4.1.2.2. VA pensions and service-connected compensation claims.

9.4.1.2.3. General Assistance

9.4.1.2.4. Supplemental Nutrition Assistance Program (SNAP)

9.4.1.2.5. Medi-Cal or Medicare

9.4.1.2.6. Employment and vocational training

9.4.1.2.7. Self-care skills, independent living skills, adaptive coping skills.

9.4.1.2.8. Any necessary coordination of care provided by VA and community-based medical, mental health, and/or substance use treatment providers.

9.4.1.2.9. Ongoing discharge planning that includes linkage to community resources for long-term housing success such as In-

Home Supportive Services, Meals on Wheels, or Adult Day Health

Care.

9.5. THERAPEUTIC AND REHABILITATIVE SERVICES INCLUDING MENTAL HEALTH AND

SUBSTANCE USE DISORDER TREATMENT

9.5.1. Contractor shall be expected to provide treatment and services using evidence-based practices that support Veterans in gaining and applying knowledge of the recovery process to their lives and to provide referrals for additional treatment and aftercare supports as needed to promote and facilitate each Veteran’s recovery efforts and successful transition to permanent housing.

9.5.2. Treatment shall be defined as services which are needed for the specific clinical presentation of each enrolled Veteran including, but not limited to:

9.5.2.1. VA-based services, and/or

9.5.2.2. Community-based care, and/or

9.5.2.3. Services provided by Contractor at the program site.

9.5.3. Services may include, but are not limited to:

9.5.3.1. Clinical case management.

9.5.3.2. Individual and group counseling.

9.5.3.3. Structured group activities such as 12-step meetings, vocational training, independent living skills such as budgeting, cooking or hygiene, and prosocial outings and activities.

9.5.3.4. Regularly scheduled (daily or weekly) community meetings that offer a forum for enrolled Veterans to discuss problems between members of the community, air grievances about the program, and resolve any issues before they escalate into more serious conflicts.

9.5.4. Working towards engagement in the types of treatment and services that meet the individualized needs of each enrolled Veteran shall be integral to the program’s care planning process.

9.5.4.1. Engagement in services and the extent to which assertive engagement is needed may look different from one Veteran to another.

9.5.4.2. Veterans are expected to develop a housing plan and to maintain communication with their case managers around matters relating to their admission, stay, and treatment.

9.5.4.3. Veterans are encouraged, but not required, to engage meaningfully in the relevant programming available to them.

9.5.4.4. Contractor staff are expected to actively engage Veterans in services from time of admission to time of discharge through outreach efforts, rapport-building, motivational interviewing, and Veteran-centered

SMART (Specific, Measurable, Achievable, Relevant, and Time-Bound) goals.

9.5.5. Contractor shall ensure that a completed and signed VA Form 10-5345 Request for and Authorization to Release Health Information (ROI) is obtained for every

Veteran admitted to the HCHV LDSH program.

9.5.5.1. A copy of the ROI shall be placed into each individual case record.

9.5.5.2. It is essential that enrolled Veterans permit communication between VA and Contractor by Release of Information to ensure safe and effective treatment of each Veteran.

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

9.6. ABSENCES AND CANCELLATIONS

9.6.1. Per VHA Directive 1162.04(1), HCHV CRS program allows payment to a Contractor for an absent Veteran under the following conditions:

9.6.1.1. Scheduled Absences

9.6.1.1.1. VA will pay per diem up to a maximum of 96 hours per month for the scheduled absence(s) of a Veteran.

9.6.1.1.2. Contractor shall notify VA Liaison, COR, or designee in writing of all Veteran requests for scheduled absences or “passes” prior to the start of any absence from the program authorized by Contractor, preferably 24-48 hours in advance, and include reason for pass and contact/location information for Veteran while absent. To receive payment, the absence must:

9.6.1.1.2.1. Be pre-planned, consistent with and support the

Veteran’s individual service plan (e.g., family reunification, short-term medical, substance use disorder or psychiatric treatment).

9.6.1.1.2.2. Have the reason documented in the individual

Veteran’s case file, treatment record or service plan.

9.6.1.1.2.3. Not result in the bed being filled by the provider.

9.6.1.1.2.4. Not be for a break or vacation from treatment.

9.6.1.1.2.5. Not be used for extended educational or

employment circumstances.

9.6.1.1.2.6. Not be used to create more than four (4)

consecutive days of absence.

9.6.1.2. Unscheduled Absences

9.6.1.2.1. VA will pay per diem up to a maximum of 48 consecutive hours for the unscheduled absence. To receive payment for an unscheduled absence:

9.6.1.2.1.1. Contractor must have evidence of active outreach to locate and reengage the Veteran and document the steps taken in the Veterans individual case file, treatment record, or service plan.

9.6.1.2.1.2. Contractor shall notify VA Liaison, COR or Designee immediately or during next available business hours of all unscheduled Veteran absences.

9.6.1.2.1.3. Contractor shall not fill the bed during this time.

9.6.1.2.1.4. A Veteran who is absent without Contractor

approval must be discharged from the HCHV CRS program if not located within 48 hours.

9.6.1.3. Inpatient Hospitalization

9.6.1.3.1. VA will pay per diem up to a maximum of seven (7) days if a

Veteran enrolled in HCHV LDSH requires inpatient medical or psychiatric treatment. To receive payment while a Veteran is hospitalized as an inpatient:

9.6.1.3.1.1. Contractor shall notify VA Safe Haven Liaison, COR, or Designee immediately or during next available business hours of all hospital admissions.

9.6.1.3.1.2. Contractor shall not fill the bed during this time.

9.6.1.3.1.3. Contractor shall maintain contact with the HCHV

Safe Haven Liaison and the Veteran if authorized for continued payment.

9.6.1.4. Ineligible Veteran

9.6.1.4.1. When a Veteran is admitted to an HCHV LDSH program and found to be ineligible for HCHV LDSH services, VA will pay for a maximum of four (4) days from the date of admission to allow

Contractor and HCHV Safe Haven Liaison or Designee time to locate and arrange alternate placement.

9.6.1.5. Contractor may choose to maintain enrollment of a Veteran without payment beyond the approved absence period at Contractor’s discretion and in consultation with VA Liaison, COR or Designee. However, the Veteran must be discharged from the HCHV LDSH program under the following conditions:

9.6.1.5.1. If the Veteran has not returned within two additional days of the total absence period approved for payment.

9.6.1.5.2. If another Veteran is seeking placement and the program is otherwise full.

9.6.1.6. Contractor cannot receive payment of per diem if/when an enrolled

Veteran is temporarily placed in another VA Homeless Programs-funded bed such as HCHV CRS-contracted detox bed or medical respite program.

9.6.1.7. VA reserves the right to remove any or all Veterans from the program at any time without additional cost when it is determined to be in the best interest of the Veteran or VA.

9.7. EXITS TO PERMANENT HOUSING

9.7.1. Contractor shall promote a focus on achieving stable, independent housing for all Veterans enrolled in the HCHV LDSH program.

9.7.2. Exits to permanent, independent housing will be monitored as an indicator of overall program quality utilizing data provided by the VHA Support Service Center’s Homeless Services Scorecard.

9.7.3. The target values for exits to this type of housing are established by VHA Homeless

Program Office on an annual basis at the start of each fiscal year (e.g., FY26 target value for Exits to Permanent Housing is 55% or more) and can vary from year to year.

9.7.4. Target values for Exits to Permanent Housing will be communicated by VA Safe

Haven Liaison and/or COR to Contractor at the start of each fiscal year.

9.7.5. If it is determined that a Veteran is not appropriate for independent living while enrolled in the program, Contractor will assist with identifying and securing alternative options for housing such as Board and Care, Veterans Homes, Sober

Living Environment or linking to appropriate higher level of care.

9.8. NEGATIVE EXITS

9.8.1. Contractor shall facilitate Veteran completion of the HCHV LDSH program to the maximum extent possible while still maintaining program integrity and safety.

9.8.2. Negative Exits are defined as exits from the program in which:

9.8.2.1. A Veteran was asked to leave due to violation of program rules

(excluding exits due to threatened/actual violence to self or others),

9.8.2.2. A Veteran was asked to leave due to failure to comply with program requirements, or

9.8.2.3. A Veteran leaves the program without consulting staff.

9.8.3. Negative Exits shall be monitored on a continuous basis utilizing data provided by the VHA Support Service Center’s Homeless Services Scorecard.

9.8.4. The target values for Negative Exits are established by VHA Homeless Program

Office on an annual basis at the start of each fiscal year (e.g., FY26 target value for

Negative Exits is 20% or less) and can vary from year to year.

9.8.5. Target values for Negative Exits will be communicated by VA Safe Haven Liaison and/or COR to Contractor at the start of each fiscal year.

9.9. PROCEDURES FOR NEGATIVE EXITS

9.9.1. For all negative exits other than exits for threatened/actual violence to self or others, Contractor shall develop a written progressive warning policy/procedure that includes issuance of at least two formal warnings prior to proceeding with a negative discharge.

9.9.2. The policy/procedure shall include case conference with Program Staff, Veteran, and VA Safe Haven Liaison or Designee, and/or other relevant clinical providers involved in the Veteran’s care when indicated, e.g., HUD-VASH Social Worker or

Mental Health/Substance Use Disorder staff, no later than issuance of the final warning.

9.9.3. Information on the policy/procedure shall be provided to the Veteran upon admission to the program including a formal appeals process through which Veteran may appeal program regulations, sanctions or discharges.

9.9.4. There shall be no permanent bans from the program/facility.

9.9.5. Veterans exited under negative circumstances shall be notified upon request of conditions or process for re-admission.

9.9.6. Contractor shall be expected to make reasonable efforts to facilitate referral to another facility or appropriate level of care if negative discharge is indicated.

9.9.6.1. Direct discharge to SFVAHCS Hospitals or Clinics for alternative resources and referrals without consulting HCHV Liaison on day of discharge is not considered an appropriate level of care.

9.9.7. The policy/procedure for negative exits shall be subject to approval by VA Liaison, COR and/or Designee.

9.10. INDIVIDUAL CASE RECORDS

9.10.1. Contractor shall maintain an individual case record for each enrolled

Veteran.

9.10.2. Case records shall be maintained in compliance with the requirements of the “Confidentiality of Alcohol and Drug Abuse Patient Records” (42 CFR part II) and the “Confidentiality of Certain Medical Records” (38 U.S.C. 7332), and in accordance with the Health Insurance Portability and Accountability Act (HIPAA:

Pub. Law. 104–191).

9.10.3. Case records should contain at a minimum:

9.10.3.1. Reason for referral

9.10.3.2. Pertinent demographic information

9.10.3.3. Verification of Veteran status

9.10.3.4. Sociocultural assessment including:

9.10.3.4.1. Housing History and Needs Assessment

9.10.3.4.2. Family status

9.10.3.4.3. Employment history

9.10.3.4.4. Education/marketable skills/licenses/credentials

9.10.3.4.5. Other relevant psychosocial circumstances

9.10.3.5. Copies of any medical prescriptions/orders issued by physicians for any contract program that implements medication management or monitoring.

9.10.3.6. Individualized service plan as described in Section 8.3. Care Planning

9.10.3.7. Weekly case management/treatment notes and documentation of case management interventions and Veteran case conferences

9.10.3.8. Authorized absence (“pass”) requests

9.10.3.9. Critical incident reports

9.10.3.10. Extension approvals when indicated

9.10.3.11. Final summary that includes reason(s) for leaving, Veteran’s known future plans, and follow-up locator information if available

9.10.3.12. Any and all information needed to meet clinical requirements of annual HCHV CRS Programs Inspection (see sample attached, “Health

Care for Homeless Veterans CRS Programs Inspection Packet – Clinical

Review”)

9.11. COMPUTER SECURITY

9.11.1. In the performance of official duties under this contract, Contractor may have regular access to printed and electronic files containing sensitive data. This data shall be protected under the provisions of the Privacy Act of 1974 and other confidentiality laws, and agency policy.

9.11.2. Contractor shall ensure its personnel protect the data from unauthorized release or from loss, alteration, or unauthorized deletion.

9.11.3. Contractor shall ensure its personnel take all reasonable precautions to safeguard patient information from unauthorized access or modification, in both electronic and hard-copy formats.

9.11.3.1. This includes not only electronic security measures such as “strong” user passwords on computer systems, but also physical barriers to prevent unauthorized use of computer work-stations; and also requires that hard copy Veteran files are stored in secured lockable areas, that files are in lockable cabinets, that the cabinets can in fact be locked (i.e., keys are available, and the locking mechanisms work properly).

9.11.3.2. If Contractor uses computer laptops, Contractor shall store computer laptops in a safe, secure locked bag or cabinet when not in use, and store in locked, secure location (i.e., trunk of car) when transporting computer laptop in the field.

9.11.4. Contractor shall take all reasonable precautions to safeguard patient information when transferring Veteran information via electronic means, such as faxing or system-to-system transmission.

9.11.5. Contractor shall not use personal flash drives to store or retain any personal health information (PHI) or Veteran information.

9.11.6. Contractor shall not transmit any PHI via email without use of encryption software that uses VA-approved authentication mechanisms.

9.11.6.1. While the first initial of the last name of a Veteran and the last four of their Social Security Number by itself is not considered individually identifiable, any other PHI that has not been de-identified in accordance with VHA Directive 1605.04 coupled with the last initial/last four may not be transmitted together without encryption.

9.12. HOMELESS MANAGEMENT INFORMATION SYSTEMS (HMIS) DATA REPORTING

9.12.1. Veterans served through VA’s HCHV LDSH program shall have client level data entered into the local Community Continuum of Care’s (CoC) HMIS.

9.12.2. Data entered must include, at a minimum, the Universal Data Elements from the 2026 HMIS Data Standards.

9.12.3. Contractor is responsible for registering with local HMIS system to obtain access roles and manage agency data within the system.

9.13. DAILY CENSUS SIGN-IN SHEET

9.13.1. Contractor shall collect Veteran participant signatures on a daily census sign-in sheet to verify attendance in the program.

9.13.2. This information is to be provided to the VA Liaison, COR, or other designee at a frequency to be designated by VA that is no less than once weekly, and up to daily, with weekend or holiday sign-in sheets to be provided on the next business day in order to ensure effective monitoring of bed utilization.

9.13.2.1. INCIDENT REPORTING

9.13.2.2. Contractor shall notify the VA immediately when any adverse critical incident involving a Veteran admitted to the program occurs. Critical Incidents shall include, but are not limited to:

9.13.2.2.1. Falls

9.13.2.2.2. Elderly/Dependent Adult Abuse or Neglect

9.13.2.2.3. Sexual Assault

9.13.2.2.4. Fire (Veteran Involved)

9.13.2.2.5. Medical or Mental Health Emergency (911/988) Calls

9.13.2.2.6. Hospitalization

9.13.2.2.7. Suicidal ideation or attempt

9.13.2.2.8. Homicidal ideation

9.13.2.2.9. Assault or other act of violence by Veteran against other(s) or by other(s) against Veteran

9.13.2.2.10. Abusive behavior by Veteran against staff or other(s) or by staff or other(s) against Veteran

9.13.2.2.11. Death

9.13.2.2.12. Infectious Control Concerns (e.g., Bed Bugs, TB, Scabies, Coronavirus)

9.13.2.2.13. Active Substance Use that Requires Medical Intervention, Results in Overdose, and/or Could Result in Discharge from Program

9.13.2.2.14. Observation/ Possession of Weapons

9.13.2.3. During regular business hours, VA Safe Haven Liaison, HCHV Supervisor and/or COR or Designee shall be contacted immediately by phone to report such an incident.

9.13.2.4. If the incident occurs outside of regular business hours (Monday-Friday 8:00AM-4:30PM), Contractor shall notify VA Safe Haven Liaison, HCHV Supervisor and/or COR or Designee at the start of the following business day.

9.13.2.5. Should Contractor require immediate afterhours VA support or intervention, Contractor shall notify the SFVAHCS Administrator on Duty (AOD) by calling the local VA facility and asking to speak with the AOD.

9.13.2.6. A written report to the VA Safe Haven Liaison and/or COR should follow the initial VA notification within 24 business hours.

9.13.2.6.1.1. The report should list known precipitating factors or triggers, intervention, and outcomes of the incidents.

9.13.2.6.1.2. Contractor shall maintain a copy of all critical incident reports in the involved Veteran’s individual case record.

9.14. INITIAL AUTHORIZATION PERIOD AND REQUEST FOR EXTENSION

9.14.1. Program referral from VA of an eligible Veteran constitutes authorization of an initial service period of up to 90 days unless otherwise specified.

9.14.1.1. Contractor shall not be paid for care provided to an enrolled

Veteran beyond the initial authorized period unless an extension of authorization to continue treatment is provided in writing by the VA.

9.14.1.2. Contractor is responsible for ensuring that all requests for extension of services beyond the initially authorized service period of 90 days are reviewed in advance and approved in writing by VA Liaison, COR, and/or other designee before reaching the enrolled Veteran’s 90th day.

9.14.1.3. Extension requests shall include clinical reasoning and a targeted housing plan to justify approval.

9.14.1.4. Extension requests shall be individualized to Veteran needs and approved, in writing, in increments of no more than 30 days at a time, unless at the discretion of the COR.

9.14.1.5. Only extraordinary circumstances shall be considered in order to extend service periods in excess of six (6) months, and all requests for extension exceeding six (6) months from date of admission shall be approved in writing by VA Liaison and COR or designee.

9.15. GRIEVANCE PROCEDURES

9.15.1. Contractor shall have an internal grievance process that Veterans can use to resolve conflicts within the program.

9.15.1.1. Contractor shall have written policies and procedures for resolving grievances including a statement regarding the client’s right to request reasonable accommodation.

9.15.1.2. Contractor shall post the grievance procedure in a conspicuous place that is accessible to enrolled Veterans.

9.15.1.3. Each Veteran shall receive a copy of the grievance policies and procedures upon intake and upon receiving a warning or notice of discharge.

9.15.2. Contractor shall refer grievances received directly from Veterans to the identified VA Liaison, COR or designee within 24 business hours of complaint.

9.15.3. All grievances received by the VA Liaison, COR or designee will be forwarded to the Contractor within 24 business hours.

9.15.4. Contractor shall conduct an investigation of the grievance and respond to the VA Liaison or COR within five (5) business days or less with proposed resolution or plan for corrective action.

9.15.5. The Contracting Officer (CO) shall be notified in instances where the proposed course of action or response does not appear sufficient to resolve the grievance.

9.15.6. VA Liaison, COR or designee will monitor the services being provided in this contract program.

9.15.7. Contractor shall cooperate and collaborate with VA Staff and COR by providing information and answering questions in a timely manner when requested.

9.15.8. Contractor will be subject to a Contract Discrepancy Report (CDR) anytime unacceptable contract performance is determined to be critical in nature and requires formal corrective action through report of contract discrepancy to CO.

9.15.9. Failure to perform duties herein will have Contractor be subject to contract termination.

9.16. SATISFACTION SURVEYS

9.16.1. When requested, Contractor shall administer, collect, and deliver to VA Liaison or Designee a survey of the Veterans’ experience in the program.

9.17. ADMISSION AND DISCHARGE REPORTING

9.17.1. Contractor shall notify the identified VA Liaison, COR, and/or Designee within 24 business hours that an admission or discharge has occurred.

9.17.2. Contractor shall provide a written report of admission or discharge within

48 business hours that contains the specific data required for the Homeless

Operations and Management Evaluation System (HOMES), VA’s primary platform for collecting intake, progress, and outcome information for homeless Veterans as they move through VA’s system of care.

9.17.3. The written report of discharge shall also contain a brief discharge summary that includes but is not limited to:

9.17.3.1. Date of exit

9.17.3.2. Type of exit (positive vs. negative vs. neutral)

9.17.3.3. Veteran’s perception of exit in instances where a Veteran was terminated from the program

9.17.3.4. Status of treatment goals at the time of exit

9.17.3.5. Sentinel events occurring during the episode of care

9.17.3.6. Established aftercare plan

9.17.3.7. Housing status at exit

9.17.3.8. Future contact information

9.18. CONDUCT

9.18.1. Contractor shall provide housing and supportive services in a manner that is free from religious discrimination.

9.18.2. Local law enforcement and/or fire departments should be contacted for assistance and intervention as appropriate and indicated by any given circumstances.

9.18.3. In the event of a medical or psychiatric emergency, it is agreed that every effort will be made to facilitate Veteran access to local VA Medical Center for care.

9.18.3.1. If a VA Medical Center is not available in the vicinity, or is otherwise inconveniently located, Contractor will advise the VA Liaison, COR or AOD of the facility to which the Veteran has been transported and/or admitted.

9.18.3.2. Contractor will also be expected to assist Veterans requiring non-urgent services with accessing appropriate care from a VA or community facility, as appropriate.

9.19. TRAVEL

9.19.1. Contractor shall assist Veterans with arranging local transportation to scheduled meetings and appointments.

9.19.2. Contractor shall help Veterans understand and learn how to use public transportation.

9.19.2.1. This includes providing education, information and clarifying instructions necessary to effectively utilize public transit systems.

9.19.3. If Contractor and/or VA staff determine that public transportation is not available, adequate, or appropriate for any Veteran, Contractor will be expected to assist the Veteran with identifying alternative modes of transport.

9.19.4. Contractor shall be expected to accompany Veteran to appointments to ensure Veteran linkage with provider should any enrolled Veteran need this additional assistance.

9.19.5. Contractor is not required to provide transportation to a Veteran directly.

9.20. FACILITIES

9.20.1. GENERAL REQUIREMENTS: It is the responsibility of Contractor to properly maintain its facilities and the VA shall have no responsibility for paying or reimbursing the Contractor for such expenses. The contract facility shall:

9.20.1.1. Where applicable, have a current occupancy permit issued by the local and state governments in the jurisdiction where the facility is located.

9.20.1.2. Be in compliance with existing standards of State safety codes and local, and/or State health and sanitation codes.

9.20.1.3. Meet the requirements of the Americans with Disabilities Act (ADA)

(Public Law 100-336, 42 USC 12101-12213) pertaining to handicapped accessibility in effect on the date of contract award.

9.20.1.4. Where applicable, be licensed under State or local authority.

9.20.1.5. Where applicable, be accredited by the State.

9.20.1.6. Be equipped with operational air conditioning/heating systems if needed to maintain acceptable temperature.

9.20.1.7. Be kept clean, free of dirt, grime, mold, or other hazardous substances and damage that noticeably detracts from the overall appearance.

9.20.1.8. Be equipped with first aid equipment and an evacuation plan in case of emergency.

9.20.1.9. Have windows and doors that can be opened and closed in accordance with manufacturer’s standards.

9.20.1.10. Have an aggressive ongoing plan to address bed bug infestation.

9.20.1.10.1. Ongoing bed bug infestation will be grounds for immediate discharge of Veterans from the facility.

9.20.1.11. Have emergency and disaster plans with written protocols that are posted to guide staff response to crises including, but not limited to, manmade and natural disasters, episodes of infectious diseases, physical injury, program participant suicide or suicide attempts, overdoses, and domestic or other violence.

9.20.1.11.1. All Contractor staff shall be trained on emergency procedures and protocols.

9.21. FIRE SAFETY REQUIREMENTS

9.21.1. The building must meet the requirements in the applicable provisions of NFPA 101 and the other publications referenced in those provisions. Any equivalencies or variances to VA requirements must be approved by the appropriate Veterans Health Administration Veterans Integrated Service Network (VISN) Director or Designee.

9.21.1.1. A written fire plan for evacuation in the event of fire shall be developed and reviewed annually.

9.21.1.1.1. The plan shall outline the duties, responsibilities, and actions to be taken by the staff and residents in the event of a fire emergency.

9.21.1.1.2. This plan shall be implemented during fire drills.

9.21.2. Fire drills shall be conducted at least quarterly (monthly preferred due to frequency in change in program participants and in staffing across 24/7 staffed shifts).

9.21.2.1. Program participants shall be instructed in evacuation procedures when the primary and/or secondary exits are blocked.

9.21.2.2. A written policy regarding tobacco smoking in the facility shall be established and enforced.

9.21.3. Portable fire extinguishers shall be installed at the facility.

9.21.3.1. Contractor shall use NFPA 101, Portable Fire Extinguishers, as guidance in selection and location requirements of extinguishers.

9.21.3.2. Requirements for fire protection equipment and systems shall be in accordance with NFPA 101.

9.21.3.3. All fire protection systems and equipment, such as the fire alarm system, smoke detectors, and portable extinguishers, shall be inspected, tested and maintained in accordance with the applicable NFPA fire codes and the results documented.

9.22.…