DRAFT PWS Wheelchair Van Services - VAPHS.docx

VA Pittsburgh Healthcare System Wheelchair Van Services Performance Work Statement

Scope:

1. The VA Pittsburgh Healthcare System (VAPHS) is seeking a five year Indefinitely Delivery- Indefinitely Quantity (IDIQ) contract for Wheelchair Van Services to transport patients including physically and mentally handicapped individuals in wheelchairs, and aged and infirm persons, their attendants and personal belongings throughout the Pennsylvania, Ohio and West Virginia tri-state area. The Contractor agrees to furnish non-emergent, wheelchair van services, 24-hours per day, seven days per week, (to include all federal holidays) for all patients of VAPHS located at University Drive, Pittsburgh, PA 15240, 1010 Delafield Road, Aspinwall, PA 15215, and their Community Based Outpatient Clinics (CBOCs) in Beaver, Fayette, Washington, and Westmoreland Counties in PA and Belmont County, OH. Care provided during transfer of a patient shall be according to the orders of the attending physician.

Passenger Transportation:

1. Contractor shall provide medical transportation services seven (7) days per week (including holidays), twenty-four (24) hours per day, three hundred sixty-five (365) days per year, for the term of this contract, including Federal Holidays. The majority of requests for service will be between the hours of 6:00 a.m. and 6:00 p.m. Monday through Friday. The Contractor shall provide the VAPHS with the communication method of contacting the Contractor on a twenty-four (24) hour per day basis. The Contracting Officer’s Representative (COR) shall notify the Contractor if the proposed method of communication is not acceptable.

2. If a patient being transported declines to be properly belted; he/she shall not be transported. The Contractor Officer Representative (COR) shall be notified promptly. If the patient removes the securing devices during the trip, the driver shall notify the COR of this upon arrival at destination. The Contractor is not required to transport any VA patient who refuses to be properly secured while being transported.

3. The Contractor shall ensure proper loading/unloading techniques are followed at all times. Patients in wheelchairs shall be loaded onto ramps, ensuring all safety systems are working properly, e.g. roll back stops, and the driver must ride the lift with the patient during loading/unloading. Patients in motorized scooters must transport to a vehicle seat. No patient shall be allowed to ride a motorized cart (scooter) on the vehicle lift at any time. The Contractor shall ensure that drivers receive appropriate safety training on loading/unloading techniques and such training shall be documented and provided to the COR annually.

4. The Contractor shall provide patient hand-off service for all patients to and from their designated appointments. Contractor is to transfer or “hand-off” the patient to the next person responsible for their care. Patients shall be picked up on the ward, in their homes, in the clinics, or at other areas designated by VAPHS and taken to the authorized destination or appointment. The Contractor shall ensure that the patient is attended by an authorized responsible party at all times. The authorized responsible party may be the Contractor, VAPHS employee, or family member depending on the stage of the trip (pre-appointment, appointment, or post-appointment). At no time shall the contractor leave patients unattended.

5. Assistance in maneuvering stairs and other barriers shall be provided by the driver and/or authorized attendant when necessary. These services may be provided outside the home (i.e., from the door to the vehicle). If a patient needs assistance inside the home, the Transportation Coordinator/Dispatcher shall contact Home-based Primary Care or Geriatrics and Extended to refer the patient to home health aide. When the patient is delivered to a destination (i.e., a clinic or other appointment), an authorized care giver or medical staff at the destination must be informed of the patient’s arrival by the Contractor’s driver or authorized attendant.

6. The use of an attendant shall be required only when requested and authorized by VAPHS. Use of an attendant will be required to assist the driver with loading and unloading patients whose physical characteristics (weigh, height, ability to assist, etc.) necessitate a need for additional assistance. The location of their home (above or below ground level apartment) may also justify the need for an attendant. An Attendant may be required to accompany patients with dementia, etc. Dementia patients not accompanied by a family member or caregiver shall not be left unattended under any circumstances. Attendant services may need to be provided within or outside the home (i.e., from the door to the vehicle). When the patient is delivered to a destination (i.e., a clinic or other appointment), an authorized care giver or medical staff at the destination must be informed of the patient’s arrival by the Contractor’s driver or authorized attendant.

7. The Contractor’s driver (or authorized attendant) shall observe the patient during transport. Any indication of a significant change in the patient’s condition (i.e., sudden onset of rapid or labored respiration, complaints or chest pains, etc.) shall be communicated immediately to the VAPHS Emergency Room staff. Diversion from destination shall only be authorized by the COR, VAPHS Emergency Room staff, or the Administrative Officer of the Day (AOD). All diversions from destination, if authorized, shall be reported to the COR.

8. Should the Contractor’s driver encounter any problems with transporting of patients, the driver shall contact the COR, from 7:30 a.m. to 4:00 p.m. During irregular tour of duty (4:00 p.m. to 7:30 a.m.), weekends or holidays, the driver shall contact the AOD at the admissions desk. VAPHS will provide a list of individuals (other than the COR) authorized to contact the Contractor. This notification is merely for information purposes. It does not replace internal contractor communications needed to solve issues.

9. The Contractor’s driver shall notify the COR of any unusual events, including but not limited to accidents, safety problems, patients unbolting themselves and other such incidents that occur, which involve any VAPHS patient being transported under this contract. The COR shall be notified within one (1) hour of the occurrence of the incident(s) by telephone and, if requested by the COR and/or CO, a written report of the incident(s) will be delivered to the COR by close of business the next working day. This notification is merely for information purposes. It does not replace internal contractor communications needed to solve an issue.

10. When there is a need to transport medical records with the patient; the Contractor’s driver shall assure that the locked carrying pouch containing the records is secure and delivered with the patient to the destination.

11. RESTRICTIONS: The Contractor may not transport non-VAPHS contract beneficiaries or private-pay patients with VAPHS patients under this contract. No patient in-route in any transport shall be transferred from the original vehicle to another vehicle at a location other than the destination address supplied by the VAPHS, unless extraordinary, urgent need situations arise. All such events must be reported to the COR. Drivers shall not make non-emergent stops for any reason during any patient transport under this contract.

12. While transporting VAPHS patients under this contract, only authorized drivers or attendants, or patient’s family member or representative shall be allowed in the vehicle. The number of riders in any vehicle shall not exceed the number of approved safety restraints available in the vehicle.

13. The Contractor shall have a contingency/backup plan in the event the Contractor is unable to perform services or have services performed as required. The Contractor shall immediately notify the COR and provide justification for non-performance and initiate the contingency/backup plan.

14. It is understood and agreed that no vehicle will transport more individuals than the number of approved safety restraint devices installed in that vehicle. When more than one patient is transported on a trip, whether it is to the same destination or to separate destinations, reimbursement will be made at the rate not exceeding the cost of transporting a single patient. However, the longest distance over which a patient is transported may be claimed when more than one patient is transported concurrently. The Contractor must ensure that the pick-ups and drop-offs are scheduled so that the total distance traveled will result in the most economical cost to VAPHS.

Driver and Authorized Attendant:

1. All Contractor’s drivers and attendants shall be required to wear, in a readily observable area on the employee, a Contractor supplied photo identification badge containing the name of the driver or attendant, and the Contractor’s business name, or company uniform, that is acceptable to the COR, which identifies the drivers and attendants while performing all aspects of service. Records of each employee as to character (criminal background check performed) and physical capabilities (Health Certificate or statement of health from a private physician) must be maintained and made available to the COR upon request. The Contractor shall be responsible for appropriate driver screening and selection criteria when employing drivers that will be used to perform services under this contract. Such screening shall include but not be limited to testing drivers for prohibited drug and alcohol use, and a criminal background check to the extent permitted by law.

2. All Contractor’s drivers and attendants shall have passed the American Red Cross First Aid Course and have on file a current certificate (renewable every two years) to be made available to the COR upon request.

3. All Contractor’s drivers and attendants shall have passed the American Red Cross Adult CPR course and have on file a current certificate (renewed every two years) to be made available to the CO upon request.

4. All Contractor’s drivers and attendants shall have the physical capabilities necessary to aid patients during transport to the medical centers and clinics, private residences, nursing homes, and other destinations. The COR reserves the right to prohibit specific drivers from participating in the loading, transporting, and unloading of patients should it be determined the driver has engaged in unsafe practices. The Contractor shall promptly replace any personnel removed from the performance of services under this contract. This determination will be at the sole discretion of the COR and will be based upon documented evidence.

5. The following acts are not permissible by the Contractor providing services under this contract or while on VAPHS premises:

a. Use of intoxicating liquors, narcotics or controlled substances of any kind (excluding doctor’s prescriptions which do not impair the driver’s ability) while on duty. This also includes reporting for duty while under the influence of liquors, narcotics or controlled substance of any kind.

b. Gambling in any form.

c. Smoking, vaping and other uses of tobacco while on duty. Both Patients and Contractor are prohibited from smoking or vaping in vehicles.

d. Carrying of pistols, firearms or concealed weapons.

e. Resorting to physical violence to settle a dispute with a fellow employee, patients, or the general public while on duty.

f. Spitting in prohibited places or any other unsanitary, offensive, or insensitive practices or behavior.

g. Use of loud, indecent, or profane language and/or making threatening or obscene gestures toward patients or other employees.

h. Stopping for personal business, including excessive use of restroom facilities, while vehicle is occupied by a passenger. The driver shall not leave the vehicle with the key in the ignition at any time.

i. Engaging patients in a verbal confrontation in an attempt to settle a disagreement. Should a disagreement arise, the driver shall contact his dispatcher/supervisor for assistance.

j. Soliciting or accepting tips from patients, companions, or others at any time.

VAPHS reserves the right to remove any driver from transporting VAPHS patients at any time.

6. All Contractor’s drivers shall maintain a valid operator or chauffeur’s license required to operate the type of vehicle necessary to perform the service, as required by the State of Pennsylvania. The Contractor shall provide, upon request of the COR, copies of valid licenses of all drivers performing services under this contract.

7. Contractor’s drivers shall not text message while driving. See FAR 52.223-18, Encouraging Contractor Policies to Ban Text Messaging While Driving” which in incorporated into FAR 52.212-5, Commercial Terms and Conditions.

Contractor Conduct:

1. VAPHS places the highest priority on the treatment of its patients. The Contractor, Contractor’s employees, and Contractor’s representatives shall treat each patient with respect, concern and a professional approach to the patient’s dignity as an individual and as a patient. All communication, both verbal and non-verbal, by the Contractor’s personnel, with and in the presence of the patient, shall be conducted in a professional manner.

2. The Contractor shall conduct themselves in a professional manner while performing all aspects of service. All VAPHS rules and regulations shall be adhered to by the Contractor while on VAPHS property.

Orders:

1. Requests for services shall be recorded on the daily travel manifest and furnished to the Contractor via facsimile, electronically (e-mail) and/or telephone, by the COR no later than 4:00 PM. prior to the day the transportation is needed. The Contractor shall respond the same day by providing VAPHS with a confirmation number for each trip on the manifest. The following information shall be provided by VAPHS to the Contractor:

a. Patient name (first and last)

b. Pick up point (include address, telephone #, city, state, bldg. and/or room number if applicable)

c. Destination

d. Time of pick up

e. Support required or items to accompany (oxygen, IV heplocks, escort, other items)

f. Wheelchair size

g. Any specific physician instructions

2. The Contractor shall provide email confirmation to VAPHS Transportation within 10 minutes after the end of each trip. Confirmation notification shall list the trip confirmation number in the subject line, and will be recorded by VAPHS Transportation to determine if the Contractor is meeting the scheduled pick-up and delivery requirements. No other method of delivery confirmation shall be accepted.

3. In the event that a patient misses his/her scheduled appointment due to a pick-up delay, VAPHS shall reschedule the trip at no cost to VAPHS. If additional charges are incurred by VAPHS for a rescheduled trip, the additional charges shall be the responsibility of the Contractor. VAPHS shall notify the Contractor when these types of incidents are identified.

4. Any transportation service performed by the Contractor, without a request from VAPHS, will be the responsibility of the Contractor.

5. The Contractor shall maintain a record of all trips (scheduled and add-on) and provide a printed report that includes the patient’s name, date and time of each trip, mileage, and/or any authorized additional charges. The printed report shall accompany the invoice for each billing cycle. The Contractor shall contact the COR with any questions, requests for clarification, or the need for additional information during the hours of 7:30 a.m. to 4:00 p.m. During irregular tour of duty (4:00 p.m. to 7:30 a.m.), the Contractor shall contact the AOD. The Contractor shall provide a breakdown no later than the 5th day of each month with the prior month’s trips and associated costs (mileage, pick up time, drop off time) for each patient. This report shall be in excel format and emailed to the COR.

6. Requests for add-on trips (orders placed for same day service) not initially recorded on the travel log will be by telephone from the Dispatcher or AOD. If the Contractor fails to furnish services within a reasonable time (established as 45 minutes) after receiving an add-on request for an order, the VAPHS reserves the right to obtain the services from another source and charge the Contractor with any excess cost which may result. In instances of add-on trips that are over 100 miles, the COR shall allow some flexibility in the 45-minute response time. VAPHS shall determine when to order service from another source.

7. In case of inclement weather, the decision as to whether or not a VAPHS patient will be transported shall be made mutually by the COR and the Contractor.

8. The Contractor shall notify VAPHS of the estimated time of arrival for any vehicle in-route to pick-up a VAPHS patient or any loaded vehicle en route to a specific destination. The Contractor shall also notify COR, by telephone, at least one-hour in advance in the event that the Contractor is unable to provide the scheduled or add-on trips within the time frame necessary for the patient to meet their scheduled appointment time.

9. WAIT TIME - VAPHS shall make every effort to alert the beneficiary to be ready and waiting for the arrival of the vehicle in order to reduce wait time. Wait time shall not apply to the reasonable amount of time required for escorting the patient to the vehicle, loading and securing patients in vehicles, or unloading and delivering patients to the authorized care giver or specified destination area. For time lost waiting at either end of a trip, due to causes beyond the control of the driver, the Contractor shall be reimbursed at 15 minute increments per the specified contract rate. The Contractor shall call the VAPHS Dispatcher or AOD and leave a voicemail after waiting 15 minutes to be reimbursed for the wait. The Contractor shall not be reimbursed if they do not notify the Dispatcher or AOD.

Patient Privacy and Confidentiality:

1. Contractor shall maintain the confidentiality of all patient information and records associated with the performance of this contract and adhere to all applicable laws related to patient privacy and confidentiality.

Vehicles:

THE CONTRACTOR’S FAILURE TO MAINTAIN VEHICLE COMPLIANCE PRECRIBED IN THIS SECTION MAY BE CONSIDERED GROUNDS FOR TERMINATION OF THE CONTRACT.

1. Vehicles shall be equipped at all times when transporting VAPHS patients with equipment as prescribed in Federal CFR 49, Parts 27, 37 and 38, Transportation for Individuals with Disabilities (most current volume), State and Local Laws, ordinances, codes, rules and regulations and shall meet the following requirements:

a. Shall be of model and make to insure safe and comfortable transportation of wheelchair bound patients. Each vehicle shall hold a minimum of two (2) passengers in wheelchairs.

b. Shall provide seat belts for all seated patients.

c. Shall be equipped with a minimum of four point restraints for all wheelchair positions, and all positions shall face the front on front mounted seats and rear on rear mounted seats of the vehicle. No patients may be transported on side mounted seats.

d. Shall contain tie-downs for wheelchairs that consist of a leverage lock with a safety catch that requires physical unlatching. Locks shall be affixed to the vehicle frame. Many types and styles of locks are acceptable as long as they prevent motion of the wheelchair.

e. Shall be clean and maintained in accordance with manufacturer’s recommended preventative maintenance/service schedules. Preventive maintenance shall be documented, and records provided upon request to the COR.

f. Shall be licensed and meet the State of Pennsylvania requirements.

g. Shall include a maintenance/safety checklist. Checklists shall be completed by the Contractor and made available for inspection upon request by the COR.

h. Shall have portable oxygen tank holders installed to transport portable oxygen cylinders safely.

i. Shall be equipped with functioning cabin heating and air conditioning systems.

j. Shall be equipped with secured fire extinguishers, first aid kits, two (2) flashlights and (2) sanitary blankets.

2. Vehicles equipped with a wheelchair lift shall meet the following requirements:

a. Include a safety bar and wheel catch (e.g. rollback stop) secured to the outside perimeter to prevent the wheelchair from rolling off.

b. The controls shall be located in such a position that the operator can work the controls while keeping one hand on the wheelchair at all times and ride the lift with the patient during loading and unloading.

c. Operates in such a manner that when going up or down it remains parallel with the ground.

d. Be located as to receive the wheelchair from the rear or passenger side of the vehicle.

e. Include slip-proof surface.

f. Shall be a minimum of 28 inches wide.

3. Vehicles shall be equipped with a communications system which provides direct communication between drivers and VAPHS. The system may be a mobile telephone, cellular telephone, or radio frequency system which provides a link to VAPHS by telephone. The Contractor shall provide all telephone numbers or access codes or devices to VAPHS.

4. The Contractor shall be required to transport bariatric patients that may require more than one person to lift.

5. VAPHS reserves the right to inspect the Contractor’s vehicles and reject the use of specific vehicles from being used to perform services.

Contractor’s Quality Control Program (QCP):

1. The Contractor shall establish and maintain a QCP to ensure all contract requirements are met. The Contractor’s QCP shall include the following:

a. An inspection plan which addresses all components of service (employee certifications, vehicle maintenance records, administrative documentation, etc.) The plan shall specify the frequency of inspections, who will perform them, and if they will occur on a scheduled or unscheduled basis.

b. Methods to be used for identifying potential deficiencies before they have a negative impact on services.

c. A file plan which maintains inspection records for the life of the contract. Records shall be made available to the COR upon request.

d. Records of all vehicle maintenance and repairs performed on vehicles used in the performance of this contract. The Contractor shall perform preventative maintenance on vehicles to reduce the number of vehicle breakdowns

e. A contingency plan that includes an alternative means to transport patients in the event of a loss of vehicles due to accidents or mechanical failure.

f. Records of performance, certifications, vehicle operator licenses, driving history and training of each employee performing services under this contract.

g. A customer complaint log. (Complaints shall be reported to the COR)

2. The Contractor’s management team shall participate in quarterly meetings or conference calls with the COR to discuss Contractor performance and address issues. Unscheduled meetings may be requested at VAPHS discretion.

Contract Administration:

1. The Contractor shall contact the CO on any changes to this contract. Only the CO is authorized to make commitments to issue changes that will affect the price, quantity, quality, or delivery terms of this contract. The CO is Nancy Porter Nancy.Porter@va.gov. The CO Representative (COR) shall be the primary point of contact for all other matters.

2. Evidence of Insurance Coverage - Before award of the contract, the Contractor shall furnish to the CO a Certificate of Insurance that is in compliance with the State requirements for the State of contract performance. Insurance shall contain an endorsement to the effect that cancellation of, or any material change in, the policies which adversely affect the interest of the Government in such insurance, shall not be effective unless a 30-day written notice of cancellation or change is furnished the CO.

3. Invoicing - The Contractor shall coordinate billing arrangements with the COR bi-monthly on the 1st and 15th. Billing documents shall include a printed report that shall contain the contract number, date, time, patient’s name and address, mileage, etc. The COR will forward the certified invoices to the Manager, Financial Services, for transmittal to the Austin Payment Center, Austin, Texas. Invoices shall be submitted monthly. The Contractor shall maintain a log, which will show pickup point, destination, and departure/arrival times if waiting time is claimed. If detours are encountered due to road construction or other obstruction, invoice shall be so noted. The Contractor shall provide a breakdown no later than the 5th of each month with the prior month’s trips and associated costs (mileage, pick up time, drop off time) per patient. This report shall be in Excel format and emailed to the COR.

HIPAA Compliance:

1. As a covered entity, the Department of Veterans Affairs (VA) is required by law to obtain satisfactory assurance of a Business Associate and that the Business Associate appropriately safeguards protected health information it receives or creates on behalf of the covered entity. Contractors and any subcontracts must adhere to the provisions of Public Law 104-191, Health Insurance Portability and Accountability Act (HIPAA) of 1996 to include the Administrative Simplification Provisions of the law and associated rules and regulations published by the Department of Health and Human Services (HHS). The Contractor shall comply with all HIPAA-related rules and regulations to include Electronic Transactions, the Standards for Privacy of Individually Identifiable Health Information, and the Security Standards. This includes both the Privacy and Security Rules published by the Department of Health and Human Services (HHS). As required by HIPAA, HHS has promulgated rules governing the use and disclosure of protected health information by covered entities. The covered entity component of the Department Veterans Affairs is the Veterans Health Administration (VHA). In accordance with HIPAA, the Contractor will be required to enter into a Business Associate Agreement (BAA) with VHA.

2. Business associates must follow VHA privacy policies and practices. All Contractors and business associates must receive privacy training annually. For Contractors and business associates who do not have access to VHA computer systems, this requirement is met by completing VHA National Privacy Policy training, other VHA approved privacy training or Contractor furnished training that meets the requirements of HHS Standards for Privacy of Individually Identifiable Health information as determined by VHA. For Contractors and business associates who are granted access to VHA computer systems, this requirement is met by completing VHA National Privacy Policy training or other VHA approved privacy training. Proof of training is required.

3. Any violation of HIPAA will be reported to the CO in writing within twenty-four (24) hours of the Contractor’s discovery of an occurrence. Included in the report will be a description of the occurrence, patient names (if known), location, date and time. A copy of any filed police report will be provided by the Contractor to the CO within twenty-four (24) hours of completion.

Contractor Personnel Security Requirements:

VA Information and Information System Security/Privacy (Inserts from VA Handbook 6500.6 – Appendix C, Paragraphs: #3a, e, f, h, j, k, #6 (all), #7(all).

Required Documentation:

CONTRACTOR RULES OF BEHAVIOR

This User Agreement contains rights and authorizations regarding my access to and use of any information assets or resources associated with my performance of services under the contract terms with the Department of Veterans Affairs (VA). This User Agreement covers my access to all VA data whether electronic or hard copy ("Data"), VA information systems and resources ("Systems"), and VA sites ("Sites"). This User Agreement incorporates Rules of Behavior for using VA, and other information systems and resources under the contract.

1. GENERAL TERMS AND CONDITIONS FOR ALL ACTIONS AND ACTIVITIES UNDER THE CONTRACT:

a. I understand and agree that I have no reasonable expectation of privacy in accessing or using any VA, or other Federal Government information systems.

b. I consent to reviews and actions by the Office of Information & Technology (OI&T) staff designated and authorized by the VA Chief Information Officer (CIO) and to the VA OIG regarding my access to and use of any information assets or resources associated with my performance of services under the contract terms with the VA. These actions may include monitoring, recording, copying, inspecting, restricting access, blocking, tracking, and disclosing to all authorized OI&T, VA, and law enforcement personnel as directed by the VA CIO without my prior consent or notification.

c. I consent to reviews and actions by authorized VA systems administrators and Information Security Officers solely for protection of the VA infrastructure, including, but not limited to monitoring, recording, auditing, inspecting, investigating, restricting access, blocking, tracking, disclosing to authorized personnel, or any other authorized actions by all authorized OI&T, VA, and law enforcement personnel.

d. I understand and accept that unauthorized attempts or acts to access, upload, change, or delete information on Federal Government systems; modify Federal government systems; deny access to Federal government systems; accrue resources for unauthorized use on Federal government systems; or otherwise misuse Federal government systems or resources are prohibited.

e. I understand that such unauthorized attempts or acts are subject to action that may result in criminal, civil, or administrative penalties. This includes penalties for violations of Federal laws including, but not limited to, 18 U.S.C. §1030 (fraud and related activity in connection with computers) and 18 U.S.C. §2701 (unlawful access to stored communications).

f. I agree that OI&T staff, in the course of obtaining access to information or systems on my behalf for performance under the contract, may provide information about me including, but not limited to, appropriate unique personal identifiers such as date of birth and social security number to other system administrators, Information Security Officers (ISOs), or other authorized staff without further notifying me or obtaining additional written or verbal permission from me

g. I understand I must comply with VA’s security and data privacy directives and handbooks. I understand that copies of those directives and handbooks can be obtained from the COR. If the Contractor believes the policies and guidance provided by the COR is a material unilateral change to the contract, the Contractor must elevate such concerns to the CO for resolution.

h. I will report suspected or identified information security/privacy incidents to the COR and to the local ISO or Privacy Officer as appropriate.

1. GENERAL RULES OF BEHAVIOR

a. Rules of Behavior are part of a comprehensive program to provide complete information security. These rules establish standards of behavior in recognition of the fact that knowledgeable users are the foundation of a successful security program. Users must understand that taking personal responsibility for the security of their computer and the information it contains is an essential part of their job.

b. The following rules apply to all VA Contractors. I agree to:

(1) Follow established procedures for requesting, accessing, and closing user accounts and access. I will not request or obtain access beyond what is normally granted to users or by what is outlined in the contract.

(2) Use only systems, software, databases, and data which I am authorized to use, including any copyright restrictions.

(3) I will not use other equipment (OE) (non-Contractor owned) for the storage, transfer, or processing of VA sensitive information without a VA CIO approved waiver, unless it has been reviewed and approved by local management and is included in the language of the contract. If authorized to use OE IT equipment, I must ensure that the system meets all applicable 6500 Handbook requirements for OE.

(4) Not use my position of trust and access rights to exploit system controls or access information for any reason other than in the performance of the contract.

(5) Not attempt to override or disable security, technical, or management controls unless expressly permitted to do so as an explicit requirement under the contract or at the direction of the COR or ISO. If I am allowed or required to have a local administrator account on a government-owned computer, that local administrative account does not confer me unrestricted access or use, nor the authority to bypass security or other controls except as expressly permitted by the VA CIO or CIO's designee.

(6) Contractors’ use of systems, information, or sites is strictly limited to fulfill the terms of the contract. I understand no personal use is authorized. I will only use other Federal government information systems as expressly authorized by the terms of those systems. I accept that the restrictions under ethics regulations and criminal law still apply.

(7) Grant access to systems and information only to those who have an official need to know.

(8) Protect passwords from access by other individuals.

(9) Create and change passwords in accordance with VA Handbook 6500 on systems and any devices protecting VA information as well as the rules of behavior and security settings for the particular system in question.

(10) Protect information and systems from unauthorized disclosure, use, modification, or destruction. I will only use encryption that is FIPS 140-2 validated to safeguard VA sensitive information, both safeguarding VA sensitive information in storage and in transit regarding my access to and use of any information assets or resources associated with my performance of services under the contract terms with the VA.

(11) Follow VA Handbook 6500.1, Electronic Media Sanitization to protect VA information. I will contact the COR for policies and guidance on complying with this requirement and will follow the COR's orders.

(12) Ensure that the COR has previously approved VA information for public dissemination, including e-mail communications outside of the VA as appropriate. I will not make any unauthorized disclosure of any VA sensitive information through the use of any means of communication including but not limited to e-mail, instant messaging, online chat, and web bulletin boards or logs.

(13) Not host, set up, administer, or run an Internet server related to my access to any use of any information assets or resources associated with my performance of services under the contract terms with the VA unless explicitly authorized under the contract or in writing by the COR.

(14) Protect government property from theft, destruction, or misuse. I will follow VA directives and handbooks on handling Federal government IT equipment, information, and systems. I will not take VA sensitive information from the workplace without authorization from the COR.

(15) Only use anti-virus software, antispyware, and firewall/intrusion detection software authorized by VA. I will contact the COR for policies and guidance on complying with this requirement and will follow the COR's orders regarding my access to and use of any information assets or resources associated with my performance of services under the contract terms with VA.

(16) Not disable or degrade the standard anti-virus software, antispyware, and/or firewall/intrusion detection software on the computer I use to access and use information assets or resources associated with my performance of services under the contract terms with VA. I will report anti-virus, antispyware, firewall or intrusion detection software errors, or significant alert messages to the COR.

(17) Understand that restoration of service of any VA system is a concern of all users of the system.

(18) Complete required information security and privacy training, and complete required training for the particular systems to which I require access.

3. ADDITIONAL CONDITIONS FOR USE OF NON- VA INFORMATION TECHNOLOGY RESOURCES

a. When required to complete work under the contract, I will directly connect to the VA network whenever possible. If a direct connection to the VA network is not possible, then I will use VA approved remote access software and services.

b. Remote access to non-public VA information technology resources is prohibited from publicly-available IT computers, such as remotely connecting to the internal VA network from computers in a public library.

c. I will not have both a VA network line and any kind of non-VA network line including a wireless network card, modem with phone line, or other network device physically connected to my computer at the same time, unless the dual connection is explicitly authorized by the COR.

d. I understand that I may not obviate or evade my responsibility to adhere to VA security requirements by subcontracting any work under any given contract or agreement with VA, and that any subcontract(s) I engage shall likewise be bound by the same security requirements and penalties for violating the same.

4. STATEMENT ON LITIGATION

This User Agreement does not and should not be relied upon to create any other right or benefit, substantive or procedural, enforceable by law, by a party to litigation with the United States Government.

5. ACKNOWLEDGEMENT AND ACCEPTANCE

I acknowledge receipt of this User Agreement. I understand and accept all terms and conditions of this User Agreement, and I will comply with the terms and conditions of this agreement and any additional VA warning banners, directives, handbooks, notices, or directions regarding access to or use of information systems or information. The terms and conditions of this document do not supersede the terms and conditions of the signatory’s employer and VA.

Print or type your full name Signature

Last 4 digits of SSN Date

Office Phone Position Title

__________________________________ Please complete and return the original signed Contractor’s Company Name document to the COR within the timeframe stated in the terms of the contract.

Additional Security Requirement:

HIPAA-Focused Training" prior to the performance of the contract and annually thereafter. Training must be completed in VA’s Talent Management System (TMS) (https://www.tms.va.gov/). Certification of Completion is required to be provided to COR and CO for each employee working on this contract.

Section N - Rates:

Payment for mileage traveled will be limited to “one way only”, the distance over which the patient is transported. The actual distance of the authorized trip from the specified point of origin (pick-up point) to the specified final destination (drop-off point), including applicable waiting time shall determine total cost per trip.

Any trip entirely within a 15 mile radius of the VAPHS, University Drive, Pittsburgh, PA or VAPHS, Delafield Road, Aspinwall, PA is considered local base rate travel.

Payments for trips beyond the 15 mile radius limit will be made under “rate per miles” and will include the base rate and the rate per mile for distance traveled beyond the 15 mile local base travel radius.

Any trip with both the pick-up and drop-off locations outside of the 15 miles local base travel radius shall use the VAPHS, University Drive, Pittsburgh, PA as the destination for the purposes of calculating mileage.

VHA Healthcare Directives

1. The Contractor shall comply with the requirements of the following VA Healthcare Directives:

a. Tuberculosis Screening- VHA Directive 2011-036, Safety and Health During Construction. Contractor must certify annually to the COR(s) that all Contractor employees working at VAPHS facilities have a documented screening for latent Tuberculosis within the last 12 months. If screening for latent Tuberculosis is positive, clearance from a physician is required prior to working at VAPHS.

b. Seasonal Influenza Vaccination - VHA Directive 1192, Seasonal Influenza Prevention Program for VHA Health Care Personnel. Contractor shall certify annually to the COR(s) that all employees working at VAPHS facilities have received a seasonal influenza vaccination.

2. Contractor employees that fail to meet these requirements shall not be permitted to work at VAPHS facilities.

VHA Supplemental Contract Requirements for Combatting COVID-19

1. Contractor employees who work in or travel to VHA locations must comply with the following:

a. Documentation requirements:

1) If fully vaccinated, contractors shall show proof of vaccination.

i. NOTE: Acceptable proof of vaccination includes a signed record of immunization from a health care provider or pharmacy, a copy of the COVID-19 Vaccination Record Card (CDC Form MLS-319813_r, published on September 3, 2020), or a copy of medical records documenting the vaccination.

2) If unvaccinated, contractors shall show negative COVID-19 test results dated within three calendar days prior to desired entry date. Test must be approved by the Food and Drug Administration (FDA) for emergency use or full approval. This includes tests available by a doctor’s order or an FDA approved over-the-counter test that includes an affiliated telehealth service.

3) Documentation cited in this section shall be digitally or physically maintained on each contractor employee while in a VA facility and is subject to inspection prior to entry to VA facilities and after entry for spot inspections by Contracting Officer Representatives (CORs) or other hospital personnel.

4) Documentation will not be collected by the VA; contractors shall, at all times, adhere to and ensure compliance with federal laws designed to protect contractor employee health information and personally identifiable information.

2. Contractor employees are subject to daily screening for COVID-19 and may be denied entry to VA facilities if they fail to pass screening protocols. As part of the screening process contractors may be asked screening questions found on the COVID-19 Screening Tool. Check regularly for updates.

a. Contractor employees who work away from VA locations, but who will have direct contact with VA patients shall self-screen utilizing the COVID-19 Screening Tool, in advance, each day that they will have direct patient contact and in accordance with their person or persons who coordinate COVID-19 workplace safety efforts at covered contractor workplaces. Contractors shall, at all times, adhere to and ensure compliance with federal laws designed to protect contractor employee health information and personally identifiable information.

3. Contractor must immediately notify their COR or Contracting Officer if contract performance is jeopardized due to contractor employees being denied entry into VA Facilities.

1. For indefinite delivery contracts: Contractor agrees to comply with VHA Supplemental Contract Requirements for any task or delivery orders issued (including Modifications) during the life of this contract.

a.

Quality Assurance Surveillance Plan (QASP):

1. PURPOSE

This QASP provides a systematic method to evaluate performance for the stated contract. This QASP explains the following:

0. What will be monitored

0. How monitoring will take place

0. Who will conduct the monitoring

0. How monitoring efforts and results will be documented

This QASP does not detail how the Contractor accomplishes the work. Rather, the QASP is created with the premise that the Contractor is responsible for management and quality control actions to meet the terms of the contract. It is the Government’s responsibility to be objective, fair, and consistent in evaluating performance.

This QASP is a “living document” and the Government may review and revise it on a regular basis. However, the Government shall coordinate changes with the Contractor. Copies of the original QASP and revisions shall be provided to the Contractor and Government officials implementing surveillance activities.

1. GOVERNMENT ROLES AND RESPONSIBILITIES

The following personnel shall oversee and coordinate surveillance activities:

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

1. The COR is responsible for technical administration of the contract and shall assure proper Government surveillance of the Contractor’s performance. The COR shall keep a quality assurance file. The COR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government’s behalf.

1. CONTRACTOR REPRESENTATIVES

The following employees of the Contractor serve as the Contractor’s program manager for this contract.

1. Program Manager ___________________________________.

1. Other Contractor Personnel ______________________________________________.

Quality Assurance Surveillance Plan (QASP)

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