DRAFT PWS_Recuperative Care Services.docx

PERFORMANCE WORK STATEMENT (PWS)

The Veterans Affairs (VA) San Diego Healthcare System (VASDHS), Healthcare for Homeless Veterans (HCHV) program, 3350 La Jolla Village Drive San Diego, CA 92161 has a requirement to provide homeless Veteran beneficiaries with HCHV Recuperative Care Program, which shall consist of community-based residential care and treatment in accordance with the specifications contained herein. The period of performance of the resulting Contract will be for a base year and four (4) one-year option periods. This contract represents a Firm-Fixed-Priced, Indefinite Delivery, Indefinite Quantity (IDIQ) contract.

Contractor should thoroughly review the specifications and become familiar with the areas of coverage to become fully aware of the scope of requirements. Failure to understand the contract requirements shall not relieve the Contractor from performing in accordance with the meaning and intent of the requirements.

DESCRIPTION/SPECS/WORK STATEMENT

1. BACKGROUND. The HCHV Program is an essential and critical part of the Veterans Health Administration (VHA). It provides a gateway to VA services and community resources for Veterans who are homeless. Through the HCHV Program, the VA provides case management services to Veterans and facilitates their access to a broad range of medical, mental health, and rehabilitative services. The HCHV Program’s aim is to engage homeless Veterans in treatment and aid them with placement in a safe, secure environment that shall continue to promote their rehabilitation goals. The Contract Residential Treatment Program (a.k.a. Recuperative Care Program) is a vital component of the HCHV Program’s mission to end homelessness among Veterans. The HCHV Recuperative Care Program (RCP) is designated to provide quality emergency housing and services to the most vulnerable and at-risk Veterans; those who are homeless with serious mental illness and/or medical issues. Services shall be furnished to Veteran beneficiaries for whom such care is specifically authorized by the VA, and may be discharging from the VA Medical Center or other non-VA medical Centers after a period of acute inpatient care.

2. GENERAL RESPONSIBILITIES. The Veterans Affairs (VA) San Diego Healthcare System (VASDHS), Healthcare for Homeless Veterans (HCHV) program has a requirement for HCHV Recuperative Care Transitional Housing Services to Veterans in community-based facilities. The Contractor shall provide sufficient facilities to accommodate up to 30 Veteran residents. The priority service location shall be performed at the contractor’s facility within 40 miles from the VASDHS located at 3350 La Jolla Village Drive San Diego, CA 92161.

This shall involve:

a. Same-day residential placement

b. Registered Nurse for no less than 40 hours per week; and

c. Licensed vocational nurse no less than 40 hours per week

d. Case management services for 40 hours per week

e. Medication management staff 24 hours a day for seven days of the week

f. Clinical services for 20 hours per week; and

The HCHV Recuperative Care Transitional Housing Services to Veterans in community-based facilities shall be available to both male and female Veterans who require recuperative medical care and/or stabilization due to sickness, injury or recovery after inpatient care provided by the VASDHS, other local community hospital, or skilled nursing facility. Veterans may also be suffering from substance abuse or other mental health issues. It is understood that the Veterans (referred to hereafter as Veteran residents) to be cared for under this contract will require care and services above the level of room and board. The Contractor’s personnel shall provide therapeutic, rehabilitative, and recovery services which shall be determined according to the needs of the Veteran resident through an intake assessment. The intake assessment shall include the identification of biopsychosocial needs that will aid in the development of the individualized care plan for the Veteran resident, along with consultation with the Veteran resident and the VA Liaison and/or appropriate VA staff. The Contractor shall provide same-day residential placement that enhances the stability of Veterans served by HCHV Recuperative Care Transitional Housing Services to Veterans in community-based facilities. Contractor shall be capable of receiving referrals 24 hours per day, 7 days per week, including holidays. Absences of any Veteran resident from the facility in excess of seventy-two (72) hours will not be reimbursable except with prior approval of the designated Contracting Officer’s Representative (COR). For per diem payments to be approved in the case of absences, the bed that the Veteran was occupying, shall remain open for them to return, and cannot be filled by another individual. Negative drug screens shall not be a requirement for admission. Basic services provided shall include, but not be limited to:

a. Recuperative Medical and/or Mental Health Care. Contractor shall provide Veterans with recuperative medical and/or mental healthcare in accordance with a plan of care developed by a VA/referring licensed health care professional. Medical Staffing shall include:

· A registered nurse (RN) licensed by the State of California and in good standing with his/her licensing board shall be on-site or available 40 hours per week

· A Licensed Vocational Nurse (LVN) licensed by the State of California and in good standing with his/her licensing board shall be on-site or available 40 hours per week

· At any time, any of the above medical professionals should be available to assist Veterans as medically or clinically indicated with medication management and program compliance. Medical tasks supported include, but are not limited to:

1. Education and assistance with medication management and compliance.

2. RN or designee shall also support coordination of care with VA providers in the event of ongoing medication non-compliance and/or medical need.

3. Veteran residents will also receive health education in areas such as sleep, nutrition, coping with chronic illnesses, and pain management.

4. RN or designee shall monitor vital signs, with follow-up with VA medical staff as appropriate

5. Veteran residents will be assisted with use of VA telehealth as needed.

6. RN or designee shall oversee Veteran resident’s receipt of and participation in in-home services to address varying recuperative needs (i.e., Physical Therapy, Occupational Therapy, Wound Care, etc.

7. RN, LVN, or designee shall conduct weekly nursing appointments with each veteran and/or more if clinically indicated.

8. The program shall establish leave coverage policies. In the absence of the assigned RN or LVN for scheduled or unscheduled leave the program must provide sufficient nursing coverage to ensure there is no interruption in nursing services and communicate coverage plans with the COR.

b. Case Management Services. Contractor shall have a Case Manager, with a ratio of 2 Case Managers to a maximum of 15Veterans each on-site at least 40 hours per week during hours that best suit the Veteran’s needs and the needs of the VA San Diego Healthcare System. The Case Manager(s) shall not hold a caseload of other clients in any other program while working with the Veterans in this program. The Contract Case Manager shall be at minimum an Associate Social Worker (ASW) or Associate Marriage and Family Therapist (AMFT), Associate Professional Clinical Counselor (APCC) who is registered, and in good standing with his/her respective State of California licensing board(s). The Contract Case Manager shall be responsible for the intake assessment of Veteran residents to develop a plan of care with consultation of the Veteran and HCHV staff. Therapeutic and rehabilitative services to be provided include but are not limited to the following:

(3) Provision of intensive weekly case management services, including assistance with submission of application for benefits (both VA and non-VA), obtaining necessary identification and records (i.e., birth certificate, DD214, VA ID, etc.) and enrollment of eligible Veteran residents in HUD-VASH.

(4) Instruction in and assistance with health and personal hygiene, establishment of income, and strengthening budgeting skills to increase financial stability. Instruction will begin with a psychosocial assessment to be completed within 7 business days of admission to program. A treatment plan must be completed within 14 business days of admission, and discharge planning must occur in weekly case management sessions.

(5) Scheduled weekly visits with each Veteran resident and open office hours to discuss progress towards long term goals established at intake. Case Managers should also possess the ability to respond to crisis situations with Veteran residents and provide access to emergency care as needed.

(6) Discharge planning, after consultation with the HCHV staff, to appropriate long-term transitional or permanent housing units, including assistance with referrals and applications. This includes offers of referrals and linkages to Veterans that are asked to exit the program prior to successful completion, due to rule violation(s).

(7) The program shall establish leave coverage policies. In the absence of the assigned Case Manager for scheduled or unscheduled leave the program must provide sufficient Case Management coverage to ensure there is no interruption in case management services and communicate coverage plans with the COR

c. Clinical/Mental Health Services. The contractor shall provide the following clinical services on site at least 20 hours per week to veterans willing and engaged to participate: (1) Contractor shall establish policies and procedures to ensure a clinical intake assessment is completed for every veteran in the program. If a veteran is declining to complete an intake assessment clinician shall make diligent efforts to engage the veteran. Each veteran should be offered weekly therapy services as part of their treatment. Each veteran can choose to participate or not in clinical services with no impact to enrollment in the program.

(2) Contractor shall offer and provide psychotherapy (trauma-informed care and SUD focused treatment/ relapse prevention as indicated) weekly.

(3) Structured clinical group activities focusing on topics of: crisis intervention, relapse prevention, PTSD/trauma, general process groups, independent living skills, social skills groups and other assessed needs as appropriate. General treatment groups can include various approaches such as Motivational Interviewing, CBT, DBT, Social Skills training for Schizophrenia

(4) Contractor shall provide 1-3 groups per week facilitated by a combination of Clinical, Nursing or Case Management staff focusing on the above topics or skills.

d.Supportive Services. The Contractor shall provide the following supportive services:

(1) Transportation for Veterans to and from VA medical and dental appointments.

(2) Locked storage and monitoring of prescription medications

(3) Required social services, in collaboration with VA staff and/or other community resources, such as assistance in obtaining a driver’s license, a DD Form 214, or completing applications for public assistance/ services.

(4) Opportunities to participate in spiritual worship.

(5) A written process that outlines a grievance process to address Veteran complaints in 24-72 business hours of the complaint. VA liaison/COR shall be notified of all complaints, and they can be involved in assisting to address complaints as is clinically indicated.

d. Residential Room and Board. The Contractor shall be required to provide sufficient facilities to accommodate up to 30 Veteran residents. Residents shall be provided private or semi-private rooms where Veterans are the only occupant or there is one other occupant who is also engaged in recuperative care services. There should be no one with no more than 2 individuals per room. All Veteran residents shall be provided (free of charge) clean and sanitary housing to include:

(1) One single bed per occupant with proper bedding (i.e., fitted sheets, blankets, pillows, etc.)

(2) Adequate storage space for clothing and personal properties (i.e., nightstand, one dresser with at least 2 drawers, closet with hangers, etc.) with a locked storage space.

(3) Efficient lighting (i.e., table lamp, floor lamp, overhead lighting, etc.)

(4) Toiletries and bath linens (i.e., linen, bath soap, toothbrush, toothpaste, towels, washcloths, toilet paper, sanitary napkins, shampoo/conditioner, shaving utensils, facial tissue, comb, brush, etc.).

(5) Indoor recreation/lounging areas equipped with chairs, reading materials (i.e., books, magazines, newspapers, etc.), and any other type of entertainment activities and/or games that may be deemed by the COR to be appropriate. Opportunities for physical activity should also be provided (i.e., safe walking areas, gym equipment, etc.). Designated smoking areas shall be provided within the laws of the city and state of California.

(6) Restrooms and showers shall be properly designated with signage indicating separate men and women facilities. Faucets used by Veteran residents for personal care (i.e., shaving, grooming, etc.) will provide hot water capability. All toilets, hand washing, and bathing facilities shall be maintained in safe and sanitary operating condition. Additional equipment, aids, and/or conveniences shall be provided in facilities for accommodating Americans with Disabilities Act (ADA) standards. Solid waste shall be stored, located, and disposed of in a manner that will prevent transmission of communicable diseases or odors, create a nuisance, or provide a breeding place or food source for insects/rodents.

(7) On-site laundry facilities and adequate amounts of needed supplies (i.e., tokens, coins, laundry detergent, hypo-allergenic detergent as prescribed, etc.) for Veteran residents to do their own laundry. Laundry will be done by Veteran residents.

(8) Access to mail and telephone services while a Veteran is a resident of the program.

(9) Rooms shall be organized by Veteran gender, i.e., men shall share rooms with men, and women with women, and each shall have separate restrooms/shower facilities. There shall be no more than 4 beds per room.

e. Referral Process.

The Contractor agrees to accept referrals of and to provide all services in this contract, for any person determined eligible by his/her designees, regardless of the race, color, religion, sex, or national origin of the person for whom such services are ordered. In addition, the facility warrants that subcontracting shall not be resorted to as a means of circumventing this position.

(1) The Contractor shall be responsible for coordinating and screening referrals within 1 business day and initial screening of veteran administrative eligibility. Contractor shall be responsible for establishing and maintaining Squares access to utilize Squares to initially verify administrative VA Healthcare eligibility. Contractor shall notify Contracting Officer’s Representative (COR) of referral. In addition, a negative TB screen within the last 6 months will be required at time of referral.

(2) Once notified by Contractor, COR in collaboration with the existing community homeless program staff shall verify administrative eligibility within 1 business day for mentally ill and/or medically frail Veterans to the Contractor.

(3) The COR shall arrange admission of the Veteran residents with the Contractor, which will often be same-day placements. The Contractor shall record the date and time of admission in the Veteran resident’s file and include that information on the first monthly invoice.

(4) The COR shall complete an intake psychosocial clinical assessment within 14 days of program entry

(5 VA arranged admissions of Veterans shall not include treatment and/or residence of Veterans beyond 90 calendar days, unless the COR has specifically signed a stay/treatment authorization.

(6) VA reserves the right to remove Veteran residents from the facility at any time without additional cost, when it is determined to be in the best interest of the VA and/or the Veteran resident(s).

f. Records and Reports. Contractor shall maintain an individual client record for each Veteran resident referred. Records shall contain reasons for referral and documentation of Veterans’ progress within the program. Contractor should maintain documentation demonstrating that placement and support service objectives are being met throughout the contracted period, including paperwork required as a part of the VA’s performance monitoring efforts for review. This should also include sign-in sheets whenever attendance is required. When requested, the Contractor shall provide to the VA:

(1) All essential identifying data relevant to the Veteran resident including a socio-cultural assessment.

(2) The intake assessment (to be completed within 7 business days of admission) and continuing care plan otherwise known as a treatment plan (to be completed within 14 days of admission, with preliminary discharge goals, developed in consultation with the Veteran resident and HCHV staff.

(3) Reports of any major incidents involving Veteran residents (e.g., arrest, relapse, fighting, injury, contraband on-site) immediately after occurrence, via telephone or encrypted e-mail. A written incident report shall be provided by the Contractor to the COR within 24-business hours of the incident as well via fax or encrypted e-mail. The contractor should investigate and resolve all Veteran Resident Safety Incidents, and report any additional findings to the COR as clinically indicated.

(4) Copies of any medical prescriptions or instructions issued by VA physicians, including orders, if any, for medications to be taken.

(5) Reports of periodic re-evaluation by program staff to include any measures of movement toward rehabilitation goals, with particular focus on the attainment of self-help skills.

(6) Notification to the COR within 24 hours of Veteran resident discharge by phone or email and discharge documentation must be provided to COR within 3 business days of Veteran exiting the program.

(7) Homeless Operations Management and Evaluation Systems (HOMES) Exit Form and discharge summaries on each Veteran resident who leaves the program, to include reason for leaving, the Veteran resident’s future plans, and follow-up locator information, shall be provided to the COR within 3 business days of discharge from the program.

(8) Individual case records will be maintained in confidence as required by U.S.C. Title 42, Chapter I, Part II, “Confidentiality of Alcohol and Drug Abuse Patient Records” found at https://www.gpo.gov/fdsys/pkg/CFR-2016-title42-vol1/xml/CFR-2016-title42-vol1-part2.xml#seqnum2.1 Records will be accessible to the evaluation study required by Congress.

(9) Periodic Reports (e.g., Fiscal Accountability) as required and/or requested. The VA intends to conduct both periodic fiscal and performance reviews of the Contractor and will have at least quarterly inspections of the facility and records of Veterans served in the RCP.

(10) Medical records in the Contractor’s facility regarding a Veteran resident’s care under this contract at any time.

(11) Extensions beyond the initial authorized period of care (which is 90 days) shall be requested in writing by the Contractor with justification of the Veteran need in accordance with treatment plan needs and goals. Approvals shall be authorized by the COR and organized in the Veterans chart.

g. Dietary Services. Contractor shall meet Veteran residents’ dietary needs in accordance with sound medical practice and will include the following:

(1) Provide at least three (3) nutritious meals served daily at regular times with not more than a 14-hour span between evening meal and breakfast of the following day.

(2) Between-meal or bedtime snacks of nourishing quality, unless limited by Veteran resident dietary restrictions prescribed by a medical provider.

(3) Establish and maintain sanitary procedures for food preparation, serving, storage, washing dishes, and cleaning equipment, and properly disposing of waste materials. Cleaning materials shall be kept separated from all food products including those stored in cabinets, closets, and drawers.

(4) All food shall be protected against contamination. Contaminated and/or expired food shall be discarded immediately.

(5) The Contractor shall accommodate the individualized dietary needs (i.e., cardiac, low sodium, or diabetic diets) of Veteran residents, as specified by their medical providers.

(6) Menus shall be written at least one week in advance and copies of the menus as served shall be dated and kept on file and made available upon request for no less than 30 days. Menus shall be clearly posted and displayed. If the menu changes, the menu should be modified immediately to reflect the changes. Menu changes shall be acknowledged and initialed by the Program Manager. Menus shall also be made available for review by the Veteran residents and/or VA staff as requested.

(7) Provide for the dietary needs of all Veteran residents by maintaining compliance with USDA nutrition standards and dietary guidelines found at:

https://www.cnpp.usda.gov/dietary-guidelines

h. Medications Including Controlled Substances.

(1) The Contractor shall have staff members capable of medication management and available to respond to emergencies, practicing within the scope of their respective State licenses, on-site 24 hours per day, 7 days per week, to manage Veteran residents’ medications and provide education or emergency response, as needed.

(2) Medications shall be stored in a locked box, allowing access only to the Veteran resident prescribed the medication and medication management staff. Medications requiring additional care (i.e., refrigeration) shall be stored in a locked refrigerated unit and accessible only to medication management staff, as needed.

(3) Medications shall be dispensed by Veteran residents according to physician’s orders.

i. Transportation.

(1) Contractor shall provide Veteran residents transportation to medical, dental, or mental health appointments at VA medical facilities as related to their recuperative need(s). Transportation vehicles shall be wheelchair accessible and meet the guidelines of the Americans with Disabilities Act.

(2) The manufacturer's rated seating capacity of the vehicles shall not be exceeded.

(3) Motor vehicles used to transport clients shall be maintained in a safe operating condition.

(4) Only drivers licensed and insured for the type of vehicle operated shall be permitted to transport Veteran residents.

3. QUALIFICATIONS/ACCREDITATION/LICENSING/STAFF.

a. Accreditation and Licensing.

(1) Contractor health care personnel shall maintain active standing with the State licensing boards in their respective professions in accordance with the below requirements:

(a) Registered Nurse shall be licensed by the State of California Board of Registered Nursing and in good standing; mental health experience preferred but not required.

(b) Case Manager shall be at minimum an Associate Social Worker (ASW) or Associate Marriage and Family Therapist (AMFT), Associate Professional Clinical Counselor (APCC) who is registered, and in good standing with his/her respective State of California licensing board(s) and hold a Master’s Degree in Social Work or Marriage and Family Therapy or Professional Counseling from an accredited university.

(c) Licensed Vocational Nurses and Psychiatric Technicians, shall have an active license in good standing with the California Board of Vocational Nursing and Psychiatric Technicians

(d) Certified Nurse Assistants shall have an active license in good standing with the California Department of Public Health.

(2) All technical and professional, including drivers, staff shall be certified in Basic Life Support (BLS); (American Heart Association preferred).

(3) Contractor shall have a certificate of liability for all services provided at their facility.

b. Staffing. Contractor shall provide sufficient staff in number and position and with the qualifications necessary to carry out the policies, responsibilities, and programs of the facility. Proof of knowledge is required to provide care for certain patient populations as appropriate.

c. At a minimum, there shall be a staff member capable of medication management and available to respond to emergencies on duty on the premises, 24 hours per day, 7 days per week including all holidays.

4. DESCRIPTION AND STANDARDS OF FACILITIES.

a. The Contractor facility shall conform to the Life Safety Code, National Fire Protection Association (NFPA) #101 standards, reference: http://www.nfpa.org/aboutthecodes/AboutTheCodes.asp?DocNum=101&cookie%5Ftest=1.

b. The Facility shall meet all city, state, and federal requirements concerning licensing and health codes.

c. The Contractor’s facility shall meet the applicable requirements or the equivalent of the Joint Commission on Accreditation of Hospitals and demonstrate full compliance.

d. Contractor facility shall have a current Certificate of Occupancy permit or license as required by the authority that has jurisdiction to issue and shall adhere to all applicable local, state, and federal laws.

e. Contractor shall have Certificate of Liability insurance for services provided.

f. Contractor shall have a current occupancy permit or license as required by the authority that has jurisdiction to issue and shall adhere to all applicable local, state, and federal laws.

g. The facility shall be wheelchair accessible and meet Americans with Disabilities Act guidelines for buildings and facilities found at:

https://www.ada.gov/regs2010/2010ADAStandards/2010ADAstandards.htm#medicalfacilities .

h. Contractor’s facility shall have nearby access to public transportation.

i. The Contractor shall take full responsibility for Veteran resident’s well-being and safety once Veteran residents enter their facility. All identified safety issues resulting from an inspection and/or Veteran resident observation shall be investigated immediately and corrected in a timely manner appropriate to the incident.

j. The facility shall be equipped with first aid supplies and fire extinguishers that are fully charged and non-expired, fire and carbon monoxide alarms, and evacuation plans in the case of an emergency.

k. A change of facility or services affecting this contract shall be promptly reported to the VA Contracting Officer.

l. Contractor’s facility shall be within 40 miles from the VASDHS located at 3350 La Jolla Village Drive San Diego, CA 92161.

5. SUBSTITUTION OF PERSONNEL

a. The Contractor shall utilize the personnel named in its quotation to perform the services required under this contract. In the event that any of the personnel named in the quotation are unable to perform the duties of this task order, for any reason such as death, illness, or resignation from the Contractor’s employ, the Contractor shall promptly submit to the Contracting Officer and COR, in writing, a detailed explanation of the circumstances necessitating the substitution within 24 business hours. The Contractor shall submit a completed Contractor Change email to the COR and HCHV Liaison to include: the reason for the request, a resume for the proposed substitute, and any other information that may be needed to approve or disapprove the proposed substitution. Any substitution of personnel shall occur without any increase to the contract price and without delay in the performance or delivery of services to the Government.

b. The Government shall have the right to require replacement of any Contractor or subcontractor employee assigned to work on this contract, if the employee is determined not to possess the experience or ability required under the contract, or if said employee is for any other reason found to be unsuitable to perform the work required by the contract. The replacement shall meet the Support Personnel requirements stated in the Request for Price (RFP). Any substitution of personnel shall occur without any increase to the contract price and without delay in the performance or delivery of services to the Government.

6. SITE INSPECTION AND INSPECTION STANDARDS. The contract facility and associated onsite services are expected to pass inspection and become fully operational within 120 days from the date of contract award. Failure to meet the 120-day milestone may result in the contract being terminated.

Contractor shall demonstrate successful completion of the following tasks, validated by VA inspection, prior to receiving Veteran referrals and invoicing for payment:

Complete a pre-award inspection of the facility and on-site services conducted by HCHV clinical staff and VA fire and safety officials. Items requiring corrective action shall be communicated to the contractor in writing within 1 week after the inspection.

Within 90 days of proposal submission

Identify all staff required per the Performance Work Statement (PWS) and have in place and available to provide the full range of case management and onsite services to Veterans

Within 120 days after the contract award.

The VASDHS shall conduct an inspection of prospective facilities prior to contract award. Additionally, the Contractor shall permit on-site visits by the VA to ensure compliance with the contract requirements at the start of each fiscal year, quarterly during the period of performance, or at any other interval requested by the CO or COR. Contractor shall make all records accessible for a review. Site inspections may be announced or unannounced. Please refer to the Health Care for Homeless Veterans Contracted Residential Services Programs Inspection Packet (VA Form 10-10115a), Quality Assurance Surveillance Plan (QASP), and Health Care For Homeless Veterans Contract Residential Services Program VHA Directive 1162.04 for all standards for inspection. VASDHS reserves the right to update these at any time, based on directives from VA National Home Program Office.

Contractor shall be expected to meet HCHV performance metrics as set by the National Home Program Office. Data definitions shall be provided on yearly basis and focus on Exits to Permanent Housing, which aims to be at or above 55%, and Negative Exits, which aim to be at or below 20%. These percentages change based on national guidelines, and if they are not meet, Contractor shall be expected to provide plan for improving performance within one week post notification.

7. ORDERING ACTIVITIES AND OFFICES.

a. The VA shall designate a Contracting Officer Representative (COR) to monitor the contract performance and assist in contract administration. A delegation of authority letter delineating the responsibilities and limitations of the COR shall be provided to the Contractor. Any commitments of changes, which affect the price, quantity, authority to amend or render a decision on questions of the fact in dispute, and related contract administration problems are duties of the Contracting Officer and cannot be delegated to the COR.

b. The Contractor shall not accept any instructions issued by any person(s) other than the Contracting Officer or the COR acting within the limits of his/her authority. Only those services specified herein are authorized. Before performing any service of a non-contract nature, the Contractor shall advise the Contracting Officer of the reasons for additional work. Changes to the contract may be made only in writing by the Contracting Officer.

8. EMERGENCY AND DISASTER PLANNING:

a. In the event of a Veteran or non-Veteran emergency, the Contractor shall notify the VA Liaison/COR as soon as it is safe to do so, and in writing within 24 hours. Veteran emergencies are outlined as a medical, mental health, suicide attempts or gestures or any other emergency event, non-Veteran emergencies include, but are not limited to natural or manmade disasters, episodes of infectious diseases, physical injury of program participants, the finding of illicit substances on property, domestic or other violence. As clinically indicated, the Contractor’s staff shall contact emergency services (9-1-1) and request emergency transport to the VA medical center, whenever possible. If the Veteran resident is in need of immediate admission to the nearest available hospital, the Contractor is to inform the admitting hospital that the individual is a Veteran and is eligible for VA healthcare, in order to facilitate a transfer to the VA medical center after stabilization.

b. In the event a Veteran resident under this contract dies, the facility shall promptly notify the VA Liaison/COR and immediately assemble, inventory, and safeguard the Veteran resident’s personal effects. Any fund deposits and personal effects left by the Veteran resident upon the premises of the Contractor facility shall be delivered by the Contractor to the person or persons entitled thereto under the laws currently governing the facility for making disposition of funds and effects left by the Veteran resident, unless the beneficiary died without leaving a will, heirs, or next of kin capable of inheriting.

c. When disposition has been made of the itemized inventory of the funds and effects, the Contractor shall notify the VA Liaison/COR. Should a deceased Veteran resident leave no will, heirs or next of kin, his/her personal property and funds, wherever located, vests in and becomes the property of the United States in trust. In these cases, the facility shall forward an inventory of any such property and funds in its possession to the appropriate VA office and shall hold them (except articles of clothing necessary for proper burial) under safeguard until instructions are received from the COR.

d. The contractor shall 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 participants suicide or suicide attempts, overdoses, and domestic or other violence. All contractor staff are trained on emergency procedures and protocols.

9. CONFLICT OF INTEREST.

a. The Contractor shall not employ any person who is an employee of the United States Government if the employment of that person would create a conflict of interest. The Contractor shall not employ any person who is an employee of the VA, unless such person seeks and receives approval in accordance with VA Regulations. Nor shall the Contractor employ any person who, as a member the Contractor staff, would create a conflict of interest or the appearance of a conflict of interest, particularly with regard to influencing the contract negotiations or terms of the contract. In any such case, VA shall review the matter and give its approval in accordance with agency ethics rules.

b. Contractor shall not act as Fiduciary or Guardian for any Veteran resident nor provide any assistance to Veteran residents outside the scope identified in the PWS without written prior approval from the Chief, Social Work Service, VASDHS.

10. CONTRACTOR LIAISON. The Contractor shall designate one (1) employee who shall be responsible for the performance of the work under this contract. The Liaison shall have full authority to act for the Contractor on all matters relating to the daily operation of this contract. The Liaison may be one of the personnel performing under this contract. An alternate may be designated, but the Contractor shall identify, in writing, those times when the alternate shall act as the liaison.

11. STANDARD OF CONDUCT.

a. The Government reserves the right to refuse acceptance of contract personnel whose personal or professional conduct jeopardizes Veteran resident care. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, abuse, dereliction, or negligence in performing directed tasks, or other abuse, or other conduct resulting in formal complaints by the Veteran resident, COR, or VA HCHV staff.

b. Complaints concerning contract personnel’s conduct with Government employees or patients shall be dealt with by the Contractor and COR. The Contracting Officer is the final authority on validating complaints. In the event that Contractor personnel are involved and named in a validated complaint, the Government reserves the right to refuse acceptance of the services of such personnel. This does not preclude refusal in the event of incidents involving physical or verbal abuse. The final arbiter on questions of acceptability is the Contracting Officer. Providers and staff must be familiar with the contractor’s grievance procedures and patients’ rights.

12. DRUG SCREENING. The Contractor shall be responsible for ensuring their employees are not using illegal drugs and shall conduct random drug testing to ensure a drug-free environment. Contractor personnel are also subject to drug testing when there is a reasonable suspicion that they use or are impaired by illegal drugs while on duty. Reasonable suspicion of drug use or impairment includes, but is not limited to, the following:

a. Observable phenomena, such as direct observation of drug use, possession, or the physical symptoms of being under the influence of a drug.

b. A pattern of abnormal conduct or erratic behavior.

c. Arrest or conviction for a drug-related offense or the identification of a Contractor physician as the focus of a criminal investigation into illegal drug possession, use, or trafficking.

d. Information provided either by reliable and credible sources or independently corroborated; or newly discovered evidence that the Contractor personnel has tampered with a previous drug test.

13. PATIENT SENSITIVITY. Contractor health care providers shall respect and maintain the basic rights of patients, demonstrating concern for personal dignity and human relationships.

14. HEALTH REQUIREMENTS.

a. The Contractor shall certify that his/her employees have received the following testing/immunizations within the past year and shall maintain coverage during the contract period:

(1) Tuberculosis Testing – the PPD test of radiological exam shall be repeated annually.

(2) Immunizations – for purposes of infection control, all Contractor personnel shall take required immunizations and any health action required by generally accepted public health standards and any immunizations necessitated by any outbreaks in the area/community. Contractor personnel shall not be allowed to perform duty until immunization documentation is provided to the COR.

(3) Health Restrictions – Contractor personnel shall have no health or physical disability restrictions which shall interfere with the performance of their duties.

b. As a condition of employment, the Occupational Safety and Health Administration (OSHA) requires that all Contractor personnel who shall have occupational exposure to blood, other body fluids, or other potentially infectious materials, shall receive Hepatitis B vaccine, sign a voluntary declination, or have documented proof of immunity to Hepatitis B infection. The immunization shall be the responsibility of the Contractor at no cost to the Government.

c. The Contractor’s personnel having patient contact or exposure to biological or pathological specimens shall be immunized against, be granted an immunization waiver for, or have documented proof of immunity to: rubella, mumps, polio, and Hepatitis B. In addition, Contractor’s personnel shall be free of infectious diseases (to include but not limited to active Tuberculosis and Viral Hepatitis) that might reasonably be expected to place other workers, patients, or the public at risk.

d. The Contractor shall provide the Government with all the information necessary to ensure that Government records are maintained correctly and in compliance with TJC, OSHA and the Center for Disease Control health records requirements, for each individual Contractor employee.

15. MEDICAL RECORDS. Clinical or other medical records of Veteran residents treated by Contractor personnel under this contract are considered VA records and shall be forwarded to the VA upon request. Contractor personnel who obtain access to hardware or media which may manipulate or store drug or alcohol abuse data, sickle cell anemia treatment records, records, test, or treatment for or infection with HIV, medical quality assurance records, or any other sensitive information as defined by the VA, shall not have access to the records unless absolutely necessary to perform their contractual duties. Any individual who has access to these data shall disclose them to no one, including other employees of the Contractor not involved in the performance of the particular contractual duty for which access was obtained.

16. RELEASE OF MEDICAL INFORMATION.

The Contractor shall take reasonable measures to ensure Veteran residents’ privacy and confidentiality.

Veteran resident’s demographics shall be treated as privileged information. The Contractor shall only release medical information obtained during the course of this contract to VA employees involved in the care and/or treatment of the Veteran residents. The Contractor personnel shall make sure no Veteran resident information of any type is given to outside parties, agencies, or organizations of any type without the expressed written consent of the Veteran resident and the VA and only in capacities directly related to the provision of the services contracted in this instrument. Lists, names, and/or social security numbers of Veteran residents shall not be disclosed or revealed in any way, for any use outside the Contractor’s facility or without prior express written permission of the Contracting Officer or the Veteran resident. That only the minimum necessary Veteran resident information is used to provide appropriate service to the correct Veteran resident. Transcribed reports containing personal identifiers, when not used as an official document, shall be shredded by the Contractor.

17. COMPUTER SECURITY. In the performance of official duties, if the Contractor personnel have regular access to printed and electronic files containing sensitive data, that information shall be protected under the provisions of the Privacy Act of 1974 and other applicable laws, federal regulations, VA statutes and policy, and VHA policy. The Contractor is responsible for protecting the data from unauthorized release or from loss, alteration, or unauthorized deletion and for following applicable regulations and instructions regarding access to computerized files, release of access codes, etc., as set out in the access agreement which the Contractor personnel signs.

18. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA).

a. Contractor shall take reasonable measures to ensure each Veteran resident’s privacy and confidentiality. The Contractor personnel herein agree to take all reasonable precautions to safeguard patient information from unauthorized disclosure, access, or modification, in both electronic and hard-copy formats. 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 workstations. Contractor personnel shall ensure that hard copy Veteran residents 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. This precaution also includes the proper transfer of Veteran resident information via electronic means, such as faxing or system-to-system transmission.

b. Contractor personnel shall make sure no Veteran resident information of any type is given to outside parties, agencies or organizations of any type without the expressed written consent of the Veteran resident and the VA and only in capacities directly related to the provision of the services contracted in this instrument. Contractor shall also ensure that only the minimum necessary Veteran resident information is used to provide appropriate service to the correct Veteran resident. The Contractor is subject to the same penalties and liabilities for unauthorized disclosures of such records as VA personnel.

That the undersigned understands that all parties are bound by the requirements of the “Health Insurance Portability and Accountability Act of 1996” which provide guidance on the protection of patient privacy and confidentiality. This Act mandates that all government agencies and those bodies with whom they contract shall be in compliance with the directives of the Act. Details of the Act are still under development by the Congress of the United States. Once these detailed directives are released, this current contract may require a modification to be in compliance depending on the effective date of the Act as decided by the Congress and President of the United States.

19. QUALITY ASSURANCE AND PERFORMANCE MONITORING. Contractor shall be held to the same standard as VA personnel through quality assurance and performance monitoring to ensure compliance under this contract. These procedures shall include time and attendance logs verification, monitoring of the Computerized Patient Record System (CPRS) records or other appropriated records called for under this contract received by the VA. The Quality Assurance and Performance Monitoring shall be governed by the appointed COR who shall be responsible for verifying compliance with the terms and conditions of the contract. After the contract is awarded, any incidents as evidenced by the monitoring procedures shall be forwarded immediately to the Contracting Officer. In addition, the COR shall forward the summary evaluation of the Contractor performance to the Contracting Officer once performance ends.

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

21. CONTINUING MEDICAL EDUCATION (CME) REQUIREMENTS. Contractor personnel registered by national associations shall continue to meet the minimum standards for CME and VA San Diego Healthcare System Bylaws and Rules to remain current as prescribed by legal requirements. CME is the sole responsibility of the Contractor, shall be obtained at no additional cost to the Government, and shall be reported to the COR annually on the first normal duty day in January for the previous calendar year. Periodic CME may be conducted at the VA and may be available, at no cost, to any Contractor health care provider.

22. EVIDENCE OF INSURANCE COVERAGE. Before commencing work under this contract, the Contractor shall furnish certification to the Contracting Officer that the coverage required (General & Professional Liability as well as Workers Comp) has been obtained and such policy shall state, “This policy may not be changed or cancelled without written notice to the VA Contracting Officer, VA Network 22 Contracting Office 4811 Airport Plaza Drive, Suite 600, Long Beach, CA 90815. Said policy shall bear an appropriate “loss payable clause’’ to the United States as its interest may appear. Such evidence of insurance shall not be waived.

23. PERSONNEL POLICY.

a. General: The Contractor shall assume full responsibility for the protection of its personnel furnishing services under this contract. To carry out this responsibility, the Contractor shall provide the following to its personnel:

(1) Worker’s compensation

(2) Professional liability insurance

(3) Health examinations

(4) Income tax withholdings

(5) Social Security withholdings

b. Payment for any leave, including sick leave or vacation time is considered the sole responsibility of the Contractor. The Contractor shall comply with all existing local, state, federal and/or union laws, regulations relevant to fringe benefits, and premium pay for their employees. Such personnel shall not be considered VA San Diego Healthcare System employees for any purpose and shall be considered employees of the Contractor. There is no employer-employee relationship between the VA and the Contractor or the Contractor’s employee(s).

24. FACILITY HOURS. The Contractor’s HCHV Recuperative Care Transitional Housing Services to Veterans in community-based facilities Program hours of operation shall be twenty-four (24) hours per day, seven (7) days per week, and three-hundred-sixty-five (365) days per year, including holidays.

25. OVERTIME AND HOLIDAY PAY. Any overtime and/or holiday pay that may be entitled to…