FY 23 SOW Edit_ 4-21.pdf

PHOENIX VA HEALTH CARE SYSTEM

STATEMENT OF WORK

CONTRACT RESIDENTIAL SERVICES (CRS)

1. PURPOSE.

The Department of Affairs Medical Center in Phoenix, Arizona (Phoenix VA Medical Center) requires Contractors to provide services as part of its community-based Health Care for

Homeless Veterans (HCHV) program. The HCHV program’s Contract Emergency Residential

Services (CRS) programs target and prioritize Veterans experiencing homeless who are transitioning from literal street homelessness, being discharged from institutions, including those in need of medical respite, and who recently became homeless and require safe and stable living arrangements while they seek permanent housing.

2. BACKGROUND.

Through the HCHV program, VA provides supportive services to Veterans and facilitates their access to a broad range of medical, mental health, and rehabilitative services. The goal is to seek quality Medical and Mental Health Recuperative Care and housing services for the most vulnerable and at-risk homeless Veterans and provide a safe, healthy, and secure setting to promote their rehabilitation goals and discharge to permanent housing. Services will be provided to VHA healthcare-eligible Veterans who may be discharging from the VA Medical

Center or preparing for planned medical procedures, requiring stabilization prior to and after hospitalization. The Contractor shall provide a low-barrier therapeutic and rehabilitative milieu and attendant services to address medical rehabilitation, while targeting the underlying factors contributing to homelessness. The Contractor shall not provide detoxification or other acute level treatment.

3. SERVICES TO BE PROVIDED

3.1 GENERAL: The Contractor shall provide sufficient facilities to accommodate 5 homeless Veterans who need medical and mental health recuperative care. The facility shall be staffed 24-hours-a-day, 7-days-a-week and have at a minimum of one administrative staff member or designee on the premises available for emergencies at all times. The Contractor shall provide an on-site Registered Nurse (RN), Mental

Health Provider and Case Manager no less than 10 hours per week. The Contractor’s staff shall provide therapeutic rehabilitative and recovery services, which shall be determined according to the needs of the Veteran through a nursing and biopsychosocial intake assessment. The intake assessment shall include the identification of the Veteran’s biopsychosocial needs that will inform the development of the individualized care plan for the Veteran. Contractor shall be capable of receiving referrals Monday through Friday during business hours of 8am to 4:30pm, excluding

Federal holidays. Absences of any Veteran from the facility in excess of seventy–two

(72) consecutive hours will not be reimbursable except with prior approval of the designated Contracting Officer’s Representative (COR). Negative drug screens shall not be a requirement for admission. The contracted Recuperative Care Program will offer services to male, female, transgender and non-binary Veterans who need medical and mental health recuperative care stabilization due to sickness, injury preparation for and/or recovery from inpatient hospital care. It is understood that Veterans to be served under this contract will need care and services above the level of room and board.

4. CONTRACTOR RESPONSIBILITIES AND QUALIFICATIONS:

The Contractor shall provide homeless Veterans medical and mental health recuperative care in accordance with the plan of care developed by VA referring healthcare providers.

The Contractor shall provide an on-site registered nurse (RN), licensed by the state of

Arizona and in good standing with the Arizona State Board of Nursing (AZBN). The on-site RN shall provide services no less than 10 hours per week only to Veterans enrolled under this contract. Additional hours may be necessary, commensurate with the needs of each Veteran. The RN will be available on-call 24-hours-a-day 7-days-a-week for emergency care. The Contractor shall provide an on-site Master’s Level mental health provider (Social Worker, Professional Mental Health Counselor, Psychologist, Marriage and Family Counselor, etc.) who is licensed and registered, in good standing with the

Arizona Board of Behavioral Health Examiners (AZBBHE). The Master’s Level mental health provider shall provide services no less than 10 hours per week only to Veterans assigned to this contract. Additional hours may be necessary, commensurate with the needs of each Veteran. The Contractor shall provide an on-site Case Manager assigned to

Veteran residents under this contract. The Case Manager shall hold a Bachelor’s degree and have at least 6 months of experience in social services settings. The Case Manager shall provide services no less than 10 hours per week only to Veterans assigned to this contract. Additional hours may be necessary, commensurate with the needs of each

Veteran.

5. RECUPERATIVE MEDICAL CARE: The RN shall be responsible for medication management, monitoring vital signs and coordination of care with VA medical staff. The services to be provided shall include but are not limited to the following:

5.1 The RN shall provide weekly education and assistance with medication management and treatment compliance within the scope of practice for nursing.

5.2 The RN shall support coordination of care with VA providers and the VA Liaison to ensure for continuity of care.

5.3 The RN shall provide Veterans health education in areas such as sleep, nutrition, coping with chronic illnesses and pain management.

5.4 The RN shall monitor vital signs and follow up with VA medical staff as appropriate within the scope of practice for nursing.

5.5 The RN shall assist Veterans with the use of VA telehealth as needed.

5.6 The RN shall oversee and assist with coordination of Veteran participation in in-home health care and outpatient services to address varying recuperative needs (i.e. Physical

Therapy, Occupational Therapy, Wound care, etc.).

5.7 The RN shall provide services no less than 10 hours per week only to Veterans enrolled under this contract.

6. RECUPERATIVE MENTAL HEALTH CARE The Mental Health Provider shall be responsible for providing biopsychosocial mental health assessments, counseling, crisis intervention and coordination of care with VA mental health providers. The services to be provided shall include but are not limited to the following:

6.1 The Mental Health Provider shall be on staff to provide biopsychosocial mental health assessments and referrals for Veterans who have mental health diagnoses and are engaging in VA outpatient mental health treatment.

6.2 The Mental Health Provider shall complete weekly mental status exams with Veterans.

6.3 The Mental Health Provider shall support coordination of care with VA outpatient mental health providers and the VA liaison to ensure continuity of care.

6.4 The Mental Health Provider shall provide group and individual counseling to residents as needed.

6.5 The Mental Health Provider shall provide Veterans mental health education in areas such as problem solving, coping skills, and treatment compliance.

6.6 The Mental Health Provider shall assist Veterans with the use of VA telehealth as needed.

6.7 The Mental Health Provider shall provide special attention to High Suicide Risk

(HSR) Veterans, as identified by VA Medical or Mental Health Staff, including weekly evaluation, crisis intervention, safety planning and care coordination.

6.8 The Mental Health Provider shall provide services no less than 10 hours per week only to Veterans enrolled under this contract.

6.9 The Mental Health Provider is permitted to act in a dual role as Case Manager and

Mental Health Provider, provided that the Mental Health services offered are in addition to the minimum of 10 hours per week of case management services.

7. CASE MANAGEMENT SERVICES: 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 VA staff. Therapeutic and rehabilitative services to be provided shall include but are not limited to the following:

7.1 A thorough written Individualized Care Plan (ICP) shall be developed within 72 business hours of admission for each Veteran. This shall include structured individual case management, at minimum, weekly referral to including counseling on self-care skills, adaptive coping skills, financial planning, long-tern transitional and permanent housing referrals, written care plan, referral for financial benefits. Additional counseling may include, professional and vocational rehabilitation counseling, in collaboration with VA programs and community resources.

7.2 Weekly scheduled visits with each Veteran resident and open office hours to discuss progress toward goals established at intake. Case Managers shall possess the ability to respond to crisis situations with Veteran residents and provide access to emergency care as needed.

7.3 Structured group activities, as appropriate, shall occur two times per month – examples include group therapy, life skills training, social skills training, financial workshops, Alcoholics Anonymous, Narcotics Anonymous, vocational counseling and physical activities as appropriate. For the purposes of this contract “House Meetings” and VA housing resource groups may not be counted as a structured group. Group activity shall have a therapeutic value and facilitation, which may include guest speakers, shall be the responsibility of the Contractor. Should a Veteran have mental health, medical, family and/or employment obligations which directly conflicts with this requirement alternate group activities shall be arranged and/or the Contractor shall clearly document efforts made to accommodate the Veteran.

7.4 All Veterans shall be referred for follow up to VA for Primary Care and Mental Health appointments and Contractor shall support Veterans in making initial and subsequent follow up appointments. Particular efforts shall be made for Veterans who are identified to be highly acute. Efforts will be documented in the Veterans ICP and reviewed in case consultation with the VA Liaison at least monthly.

7.5 Special attention shall be made to address High Suicide Risk (HSR) Veterans, as identified by VA Medical or Mental Health Staff, the contracted Case Manager, and/or the Mental Health provider. On a weekly basis the contracted Case Manager and/or

Mental Health provider shall update the VA Liaison on Veteran progress, changes, and/or safety concerns for HSR Veterans. Contracted Case Manager shall review HSR

Safety Plans with the Veteran on a bi-weekly basis. HSR Safety plan reviews and a copy of the Veteran’s Safety Plan shall be documented in the chart.

7.6 Provision of intensive weekly case management services, including assistance with completing and submission of applications for benefits (both VA and non-VA) obtaining necessary identification and records (i.e. birth certificate , DD 2-14, VA ID, state issued ID, etc.), referrals to transitional housing (both VA-GPD and non-VA transitional housing) and permanent housing resources such as Supportive Services to

Veteran Families (SSVF), Housing and Urban Development-Veterans Affairs

Supportive Housing (HUD-VASH) and non-VA housing resources in the community.

7.7 Instruction in and assistance with health and person hygiene, establishment of income and or financial benefits, and strengthening budgeting skills to increase financial stability.

7.8 Discharge planning to appropriate transitional or permanent housing, including assistance with completing and submission of applications and referrals, as clinically indicated. This includes offer of referrals and linkages to Veterans that are asked to exit the program prior to successful completion, due to rule violation(s).

8. ALL CONTRACTOR STAFF: All Contractor staff shall maintain proper documentation verifying services and case management efforts by all team members including but not limited to housing, benefits, and employment services, Case Manager and RN interactions/interventions, and program management staff. Notes shall be written professionally in a format that utilizes clear goal setting and progress towards those goals

(e.g. SNAP, SOAP, or SMART notes). Upon exit of the program, a discharge plan summarizing services provided during the Veteran’s stay, including Veteran’s engagement and achievement of goals, housing status, discharge placement and location, and aftercare plan will be placed in the Veteran record and available for VA Liaison to review.

9. BASIC SERVICES: The Contractor shall furnish each Veteran resident under this contract with the following basic services:

9.1 ROOM AND BOARD: The Contractor shall provide sufficient facilities to accommodate 5 Veteran residents and shall be accessible to the Veterans 7 days a week and 24 hours per day. Accommodations shall include a bed and other furnishings for clothing and personal properties such as a dresser, storage locker or designated secured space, and personal linens (towels, pillows, blankets and bed sheets, etc.). The

Contractor shall allow Veterans to store personal belongings for at least 72 hours after formal discharge. At least three nutritious meals, 7 days a week shall be provided for the Veteran. In addition, there shall be availability of snacks of nourishing quality (e.g.

fruits, vegetables, protein sources, etc.), between meals and bedtime for those requiring or desiring additional food, even when it is not medically indicated. There shall not be more than a 14-hour span between evening meal and breakfast of the following day.

Contractor shall provide alternative meals for Veterans with dietary restrictions, if medically indicated (e.g. diabetic, renal, and soft mechanical diets) and reasonable accommodation for Veterans with cultural or religious preferences around food (e.g.

Kosher, Sikh, Vegan, etc.). Food shall be prepared, transported, served, and stored under sanitary conditions, in accordance with local, state, and federal guidelines. The facility shall establish and maintain sanitary procedures for washing dishes, cleaning equipment and work areas, and disposing of waste. Sub-contracted food service providers will be subject to the same guidelines.

9.2 LAUNDRY FACILITIES: Laundry facilities and necessary detergent free of charge and adequate for residents to do their own laundry or to have laundry done at minimum one time per week.

9.3 HOUSING SERVICES: Programs shall provide Veterans with direct and ongoing assistance in achieving permanent housing. As a primary goal of the HCHV program, plans for Veterans’ transition to permanent and housing placements must be clearly reflected in each ICP and in weekly case management notes. As part of this plan, Veterans’ housing history and needs must be assessed through a formal and thorough

Housing Assessment completed within 72 business hours of program admission.

Housing Assessments must identify Veterans’ housing history, strengths (i.e. positive prior rental history), and barriers (i.e. Unlawful Detainer, evictions, etc). Should

Veteran refuse to engage with program staff regarding plans for housing transition, motivational interviewing, trauma informed care, and other therapeutic techniques shall be used to address Veteran ambivalence. All efforts to engage Veteran regarding housing plans, options, and resources shall be clearly documented and include any therapeutic techniques utilized. Contractor staff shall provide direct assistance to

Veterans in developing housing plans and accessing appropriate housing resources.

These services shall be provided weekly through one-to-one case management.

Examples of expected housing services include:

9.3.1 Assistance obtaining and reviewing Veteran’s free credit report, identifying housing strengths and/or barriers associated with current credit status

9.3.2 Creating a Tenant Portfolio with Veteran that contains all relevant documents in the rental process, including a completed sample rental application for

Veteran, income verification documents, identification, applicable subsidies, etc.

9.3.3 Reviewing and applying to affordable permanent housing options and

Permanent Supportive Housing (PSH) program offerings, and assisting

Veterans with making appropriate inquiries and submitting completed referrals to permanent housing programs.

9.3.4 Conducting regular and individualized housing advocacy efforts, including transportation, assistance scheduling, meeting, and communicating with transitional housing programs, property managers and landlords, and engage in troubleshooting where referral, rental barriers or denials occur in the housing search process

9.3.5 All housing efforts by Contractor shall be documented in the chart clearly and timely and will be presented to VA Liaison and/or inspection team upon request. Mere communication with Veterans regarding housing, without subsequent Contractor staff action and follow-up, shall not on its own meet the above requirements.

9.4 FINANCIAL PLANNING: Referral to and follow up on all potential financial resources the Veteran may be eligible for (e.g. SSI, SSDI, Food Stamps, VA NSC pension, VA Disability, General Assistance, etc.). Case Managers shall document all structured activities that support Veteran in developing a short- and long-term plan to understand and address their current financial situation and how to improve it. Financial planning efforts may be accomplished in group but preferably through one-on-one case management services as well. Financial planning activities appropriate to the Veterans individual circumstance shall be documented monthly.

9.5 EMPLOYMENT SERVICES: Referral to all relevant employment and training opportunities the Veteran is eligible for and interested in shall occur on a regular basis, as clinically indicated. Case managers shall document all structured activities that support each Veteran in applying for employment or training opportunities, as appropriate, based on needs of the Veteran, as identified in the ICP.

9.6 RECOVERY and TOXICOLOGY SCREENING: Support for an alcohol/drug abuse-free lifestyle shall be provided in an environment conducive to social interaction and the fullest development of the resident’s rehabilitative potential. Assistance to gain and to apply knowledge of the recovery process in an environment supportive of recovery models, including a focus on Harm Reduction, rather than strict abstinence, and supportive of a Housing First approach. Pursuant to these principles, drug testing may not be used to discharge or discipline a Veteran but may be used as a clinical intervention to modify behavior. The Contractor shall ensure that illicit drugs as defined by the federal government, drug paraphernalia, and alcohol are not permitted on the premises.

9.6.1 If urine toxicology screening is needed, the Contractor shall coordinate and pay the fees associated with an outside agency under the following standard certifications to include Centers for Medicare and Medicaid Services (CMS), Clinical Laboratory Improvement Amendments (CLIA) for clinical diagnostics, Drug and Alcohol Testing Industry Association (DATIA) for specimen collections, and Arizona Department of Public Safety for blood alcohol testing.

It shall be the Contractor’s responsibility to facilitate transportation for the

Veteran. If Veteran is acutely intoxicated, contract facility will contact emergency medical services.

9.7 OCCUPANCY: Contractor beds shall be maintained at an average minimum of an

85% occupancy rate but at a preferred rate of 90% as calculated based upon number of bed nights available per quarter. If this rate is not consistently attained a Corrective

Action Plan (CAP) shall be developed by the Contractor as part of the QASP and/or process improvement plan in consultation with the Contracting Officer and VA Liaison.

Adjustments in contract funding may occur through modifications if occupancy is not maintained. Failure to maintain year to date occupancy rate at or above 80% may be grounds for immediate termination for convenience.

9.8 DISCHARGE PLANNING: Permanent housing shall be the primary discharge goal for very Veteran. All Veterans shall have a discharge plan within one week of admission.

Although discharge planning should have primary goals of permanent housing, referrals to lower levels of care may be based on the Veteran’s clinical needs and housing readiness. Transitional housing referrals may include VA GPD housing programs, community transitional housing programs, residential inpatient programs, and/or other

Contracted Residential Services programs. The Contractor shall comply with all VA regulations regarding discharges and timeliness of reporting. Case Manager shall provide assistance with discharge planning for every Veteran and report all discharges via email within 24 business hours using a secured process (e.g. HOMES ID number or

RMS encryption). The Contractor shall provide paperwork for discharging a Veteran from any HCHV program within 24 business hours from known discharge. Resources shall be coordinated for discharge to a successful community placement throughout the duration of the Veteran’s stay. A negative discharge for undesirable behavior is a committee decision that shall include the VA Liaison prior to discharge. All Veterans scheduled for negative discharge based on behavior shall be offered an opportunity to meet with the treatment team and work to determine the most therapeutic alternative temporary housing option for Veteran. This does not include violations for safety reasons. Please note: Profanity does not in and of itself constitute to abuse and shall not exclusively be considered grounds for discharge. Any and all actual or threatened violence shall be grounds for discharge. Veterans may be discharged for safety reasons at any time. All negative discharges shall be subject to a full team debriefing, including

VA Liaison, to look for opportunities for improvement. All discharges are subject to the

Contractor’s grievance procedures and must allow clients the opportunity to be represented by the VA Liaison in the grievance process. Reasonable efforts must be made to coordinate with the Liaison or designee in order to schedule an appeal.

9.9 GRIEVENCE PROCEDURES: Programs shall have an internal grievance process that

Veterans can use to resolve conflicts within the program. Programs shall have written policies and procedures for resolving grievances, including a statement regarding the client’s right to request reasonable accommodation, and shall post them in a place conspicuous and be accessible to clients. In addition, each client shall receive a copy of the grievance policies and procedures, upon intake and upon receiving a warning or discharge notice.

9.10 INTAKE PACKETS: All Veterans shall receive an intake packet within 72 business hours of admission, which includes at minimum, the following information:

9.10.1 Description of the Contractor’s services

9.10.2 Grievance policy

9.10.3 Emergency procedures

9.10.4 Rights and responsibilities

9.10.5 Reasonable accommodation

9.11 EXTENSIONS- All extensions beyond 90 days shall be requested in writing and approved by VA Liaison or designee.

9.12 MEDICATION MANAGEMENT: Medications and narcotics shall be properly stored, controlled, issued and recorded in compliance with physician’s orders. Contractor shall establish procedures for ensuring Veterans’ confidentiality in the storage of and record keeping of medications. Medication Assisted Treatment (MAT) cannot be used to rule out Veterans’ participation in an HCHV Program. This includes prescribed use of

Vicodin, morphine, methadone oxygen, etc. Reasonable accommodation for individuals in MAT shall be provided if the requested accommodation does not cause major financial or administrative commitments that would be considered an “undue burden.”

Examples of reasonable accommodations include:

9.12.1 Arranging for the individual to take medication at their clinic, physician’s office, or another off-site location – when consistent with the individual’s treatment plan.

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

9.12.3 Arranging to have the housing facility keep MAT medications in a locked cabinet (Copies of Inspection Packet requirements relating to medication management are available upon request).

9.13 TIMELINESS OF RESPONSE: Contractor shall have a dedicated phone line for VA inquiries and referrals. Return calls from the program are expected within 4 hours during business hours Monday through Friday. This includes calls from VA Staff or the Liaison to the program.

9.14 CRITICAL INCIDENT REPORTING: All critical incidents shall be reported as soon as possible and no later than 24 hours. This includes the following:

9.14.1 Falls with injury

9.14.2 Assault (to Veteran or Staff)

9.14.3 Elderly/Dependent Adult Abuse or Neglect

9.14.4 Sexual Assault

9.14.5 Fire (Veteran Involved)

9.14.6 Medical/Psychiatric Emergency (911 Calls)

9.14.7 Hospitalization

9.14.8 Suicide or Suicide Attempt

9.14.9 Homicide

9.14.10 Death

9.14.11 Infectious Control (COVID-19, TB, etc.)

9.14.12 Active Substance Abuse

9.14.13 Observation/ Possession of Weapons

9.14.14 On-site arrest of a Veteran by law enforcement

10. DOCUMENTATION: The Contractor shall provide treatment and discharge planning reflecting a team assessment of medical, social and vocational needs and the involvement of the Veteran, VA staff and appropriate community resources in resolving problems and setting goals. An individual case record will be created for each referred

Veteran. Case records shall be maintained in security and confidence as defined by the

Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR part 2) and the

Confidentiality of Certain Medical Records (38 USC 7332). Case records and data normally maintained and included in a medical record as a function of compliance with

State or community licensing standards will be made available on a need-to-know basis to appropriate Department of USC Veterans Affairs staff members involved with the treatment program of the Veterans concerned. The Contractor shall comply with applicable requirements of the Confidentiality of Alcohol and Drug Abuse Patient

Records (42 CFR Part II) and the Confidentiality of Certain Medical Records (38 7332).

The files shall include:

10.1 Reasons for referral

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

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

10.4 Nursing, Case management, and Mental Health notes written in a professional manner (i.e. SMART, SOAP, SNAP) will include the following: 1) A written and comprehensive Assessment, 2) Individual Care Plan 3) Financial Plan, 3)

Discharge Plan, 4) documented progress and activity towards identified goals.

10.5 QASP Compliance Tool and all attendant supporting documentation demonstrating Contractor compliance with contract

10.6 Final discharge summaries on each resident who leaves the program, to include reasons for leaving, the resident’s future plans, and follow-up locator information.

10.7 Extension approval if relevant

10.8 Waivers as appropriate

11. RECORDS AND REPORTS: The Contractor provides their own records placed under this contact accordance to their own business practice which is not part of VA medical records. The Contactor shall safeguard disclosure of protected health information under the provisions of the Health Insurance Portability and Accountability Act (HIPAA), and other regulations as defined by VA, federal and state laws and maintain a Business

Associate Agreement (BAA) with the VA. The contract shall have a signed VA Form 10-

5345 or equivalent Health Insurance Portability and Accountability Act (HIPAA) authorization with “7332” disclosures prior to disclosures of Protect Health Information

(PHI) to Contractor. Records and reports will be made available to appropriate VA staff members involved with the treatment program of the Veterans concerned. The clinical record maintained by the contract facilities shall include:

11.1 Veterans’ admission forms. All essential identifying data relevant to the resident and his/her family, including a socio-cultural vocational assessment.

11.2 Data relevant to the Veteran’s admission to include the targeted goals for constructive changes which are to be attained during the residential rehabilitation episode, and the anticipated length of stay, if known.

11.3 Copies of any medical prescriptions issued by physicians, including orders, if any, for medications to be taken.

11.4 Treatment plan within three days of admission to be completed by assigned case manager.

11.5 Reports of periodic re-evaluation, to include any measures of movement toward rehabilitation goals, with focus on the attainment of self-help skills.

11.6 Final summaries on each resident who leaves the program, to include a description of beneficial changes realized during the residential period, reasons for leaving, the resident’s future plans and follow up locator information.

11.7 The Contractor, their personnel, and their Subcontractors shall be subject to the

Federal laws, regulations, standards, and VA Directives and Handbooks regarding information and information system security as delineated in this contract.

11.8 The Contractor shall make available to the VA, documentary information deemed necessary by the VA to conduct utilization review audits for the mandated national evaluation study as defined in Section 2 of Public Law 100-6; to verify quality of patient care, to assure confidentiality of patient record information, and to determine the completeness and accuracy of financial records.

11.9 The Contractor shall work with the VA Case Manager and/or HCHV coordinator to complete any national reporting requirements.

11.10 The Homeless Management Information System (HMIS) is a web-based software application that has been implemented to monitor and report progress of all

Federal partners and communities in abolishing homelessness among Veterans. It will be used to collect data, report on trends, service utilization and performance being provided to homeless individuals and families. VA currently cannot release patient identifiable data to local Continuum of Care (CoC’s) facilities without a signed patient release. VA is working towards a blanket authority that will allow

VA homeless programs to share the basic information. This will occur, though it may not be in time for this year’s “point-in-time” (PIT) count. A signed at patient release form should acknowledge that information shall be provided to the HMIS database for PIT.

12. RULES, POLICIES AND PROCEDURES: The Contractor shall have reasonable rules governing day-to-day life and activities in the facility. Such rules clearly inform Veterans of the obligations upon which their continued participation in the program depends and the consequences for non-compliance. Veterans shall be provided a copy of the rules at intake or upon Veterans request. In addition, Contractor shall post the rules in a location readily accessible to clients and visitors. These rules shall include detailed Patient Rights and the procedures that the Contractor has in place to protect the Veterans rights and dignity. Veterans shall be permitted to exercise these rights without fear of reprisal. If requested, Contractor shall reasonably accommodate Veterans whose compliance with program rules is limited by the Veterans’ physical or mental disabilities, in accordance with the Americans with Disabilities Act, the Federal Fair Housing Amendments Act, Section 504 of the Rehabilitation Act, including those requirements covering reasonable accommodations for disabilities and the use of assistance animals, and the California Fair

Employment and Housing Act of 1973 and all other applicable State or Federal laws.

Contractor shall equally apply all rules, policies and procedures to Veterans, unless a

Veteran has asked for a reasonable accommodation due to his/her disability.

12.1 PROCEDURES FOR NEGATIVE DISCHARGE OR SANCTION: Contractor must post rules in the Veterans Case Manager’s Office and provide Veteran with the rules which specify the reasons or conditions for which a Veteran may be sanctioned or discharged, including those behaviors which constitute gross misconduct and are grounds for immediate discharge from the program and those which would prompt a written warning if violated and potential discharge if violated repeatedly. Contractor shall describe the formal appeal procedures through which clients may appeal program regulations, sanctions or discharges. This information must be provided to clients in writing upon intake and must be clear and easily understandable by clients. This information will include:

12.1.1 Immediate contact with VA liaison

12.1.2 Timely due process provisions which should include two warning notices for violations which do not result in immediate discharge prior to issuance of a discharge notice and an opportunity for a case conference after warning is issued to the client

12.1.3 Notice of, and access to, formal appeal procedures

12.1.4 Notice of the conditions or process for re-admission to the program.

12.1.5 Reasonable efforts to provide an appropriate referral to another facility or appropriate level of care as needed

12.1.6 This does not apply to Veterans who are discharged for danger to self or others

13. ADDITIONAL CONTRACT REQUIREMENTS

13.1 PERSONNEL: The Contractor shall employ sufficient personnel to carry out the policies, contract responsibilities, and the program for the facility. Case management staff must have appropriate and commensurate coverage for staff using authorized and unauthorized leave (e.g. holidays, sick leave, family care, etc.). There must be, at a minimum, one staff member on duty on the premises or residing at the facility and available for emergencies 24 hours a day, 7 days a week. In addition, there is an expectation that there is an administrative/clinical Designee that will be available for consultation for emergencies 24 hours a day, 7 days a week. The Contractor shall assign personnel that are qualified through education, training, certification or licensure to provide the Basic Services and Supplemental Services outlined in this SOW.

13.2 Staff Training: Contractor shall provide at least one staff person on-site at all times who has had training and orientation on the following topics. Staff shall receive and document—at a minimum—one-time training per year on these subjects.

13.2.1 CPR

13.2.2 First Aid

13.2.3 Crisis intervention

13.2.4 Cultural sensitivity and Diversity, Equity, and Inclusion

13.2.5 Sexual harassment

13.2.6 Sensitivity to wider issues of homelessness

13.2.7 Universal Precautions (disease transmission prevention)

13.2.8 Elder/Dependent Adult abuse reporting laws

13.2.9 Harm Reduction philosophy

13.2.10 Housing First

13.2.11 Suicide assessment and prevention

13.2.12 Medication management (for staff assigned to this duty)

13.2.13 State and Federal Fair Housing Law and ADA Requirements

13.2.14 Conflict resolution

13.2.15 De-escalation and disruptive behavior management techniques

13.2.16 Search and Seizure/Probable Cause in the Shelter Setting

13.2.17 Conservatorship

13.2.18 Grave Disability Criteria

13.2.19 Confidentiality and privacy requirements.

13.3 Contractor shall perform criminal background checks on all staff members. Contractors will agree not to hire staff members who are currently enrolled in a VA Homeless Program.

Contractor shall have a policy prohibiting staff from establishing sexual relationships with program clients.

13.4 The Contractor shall identify each person functioning as “Key Personnel” under this contract and provide to the VA a description of the services to be provided by such person, together with a resume summarizing that person’s relevant skills and experience.

13.5 During the first ninety (90) calendar days of contract performance, the Contractor shall make

NO substitutions of key personnel unless the substitution is necessitated by illness, death, or termination of employment. Within 14 days after substitutions necessitated by situations described above, the Contractor shall provide resumes for the substitute key personnel. For substitutions proposed by the Contractor after the initial 90 calendar day period, the

Contractor shall provide resumes for the substitute personnel, together with any other additional information requested by the Contracting Officer, at least fifteen (15) calendar days before the substitution is to occur. The Contracting Officer shall notify the Contractor within fifteen (15) calendar days after receipt of all requested information if the VA refuses to accept the substitute key personnel. The VA reserves the right to refuse or revoke acceptance of key personnel if personal or professional conduct, or lack of professional skills or experience, jeopardizes patient care or interferes with the regular and ordinary operation of the facility.

13.6 Temporary substitutions of key personnel shall be permitted in accordance with the

Contractor’s contingency plan. The Contractor’s contingency plan to be utilized if personnel leave Contractor’s employment or are unable to continue performance in accordance with the terms and conditions of the resulting contract must be submitted as part of the

Contractor’s offer.

13.7 REFERRALS, ADMISSIONS AND ELIGIBILITY: Contractor shall utilize an admission process that includes written eligibility criteria that is fair, objective, and compliant with applicable State and Federal laws. Contractor shall provide verbal and written notification that is readily accessible to all individuals, upon request, of reasons for non-acceptance. The eligibility information must be made available to clients at intake and staff must provide answers to questions about the admission criteria and process. Contractors shall have formal appeal procedures through which clients may appeal unfavorable admission or eligibility decisions and a copy of the policy for appeals is to be given to the

Veteran at screening or intake.

13.8 The VA is responsible for determining eligibility of Veterans prior to acceptance by the

Contractor for services. After receipt of a Release of Information (ROI), a written pre-approval from VA Staff (hard copy, fax or e-mail are acceptable) shall be provided to the

Contractor for each Veteran referred for services under the contract. If there is an urgent need to admit a Veteran and VA Staff is not available to provide a written approval in a timely manner a verbal approval is acceptable. Any admissions that occur without written/verbal approval must be verified by VA Staff within 24 business hours in order for the Contractor to receive payment for time spent prior to approval (e.g. admission after hours or during the weekend). Written documentation of eligibility verification, signed by an authorized VA Staff, shall be obtained by the Contractor as soon as possible for each Veteran referred for services under the contract for inclusion in the Veterans program file.

13.9 A list of authorized VA Staff for the contract shall be provided to the Contractor upon award of the contract. VA Staff may be added or deleted from the list during the term of the contract at the discretion of VA Contracting Officer. The Contractor shall be provided an updated list of authorized VA Staff whenever such changes are made.

13.10 It is understood that the Contractor will not be paid for care provided to a referred Veteran beyond the period authorized in the referral, unless an extension of the authorization is provided in writing by the VA.

13.11 The initial stay for a Veteran should be no longer than 90 days. Any extension of the stay after 90 days must be authorized by the VA Liaison or designee, provided that there is clear clinical indication and availability of funds. Approvals for extensions must be stored in the

Veteran’s chart.

13.12 It is understood that the type of Veterans to be cared for under this contract will require care and treatment services over and above the level of room and board. It is also understood that Veterans may need more intensive case management than the general population. The level of intensity of services will be part of an ongoing conversation with the VA Liaison.

To be eligible for placement in contract beds, all Veterans must be homeless or at imminent risk of becoming homeless and be eligible and registered for VHA services. Veterans shall be independent in Activities of Daily Living (ADLs) for admission eligibility. CRS services are not a substitute for long-term care or skilled nursing care. Contractors shall provide housing and or services to special Veteran populations, such as but not limited to the following: medically compromised Veterans, seriously mentally ill Veterans, Veterans who have abused drugs or alcohol for many years, and/or Veterans who have been involved with the legal system.

13.13 DENIAL OF SERVICES: Veterans shall not be denied entry to HCHV Contracted

Residential Services based solely upon length of current abstinence from alcohol or non-prescribed controlled substances, the number of previous treatment episodes, the time interval since the last program entry, the use of prescribed controlled substances, disability, income, gender, or legal history. This includes a Veterans status of being a victim of Intimate

Partner Violence (IPV) and as such cannot be considered during the screening process. The screening process must consider each of these special circumstances and determine whether the program can meet the individual Veteran's needs while maintaining the program's safety, security, and integrity. All Contractors shall employ a harm reduction approach.

13.14 ABSENCES AND CANCELLATION: The Contractor shall notify the VA of unauthorized absences by a referred Veteran from the facility within 24 hours of Veterans absence. Should a Veteran absent himself/herself from the Contractor’s facility in an unauthorized manner, payment for services for that Veteran shall be continued for a maximum period of 72 hours, provided there is a documented active outreach attempt on the part of the Contractor’s staff to return the Veteran to the facility and there is a reasonable belief that the Veteran will return. Management of program dropout rate will be an element of quality assurance review of this program.

13.14.1 VA reserves the right to remove any or all Veterans from the facility at any time, without additional cost, when it is determined to be in the best interest of the VA or the Veteran. This includes discharge from facility for ongoing bed bug infestation.

13.14.2 The Contractor shall notify the authorizing VA facility immediately when a medical emergency occurs that requires hospitalization of a referred Veteran. It is agreed that the Veteran will be admitted to the appropriate VA facility. When such admission is not feasible because of the nature of the emergency, it is agreed that hospitalization in a non-federal facility is acceptable. If hospitalization of a non-emergent nature is needed, it is agreed that admission to the appropriate VA facility will be accomplished promptly. The Contractor will make arrangements for admission and support the Veteran with any transportation issues that may arise to address the emergency.

13.14.3 The Contractor shall notify the authorizing VA Liaison or designee immediately of any incidents involving Veterans residing in the Contract Emergency Residential program. The Contractor shall notify the VA Liaison by telephone during the hours of 8:00am and 5:00 pm. For all incidents that occur after normal business hours, the Contractor should notify the VA Liaison the following business day. The

Contractor shall provide the VA Liaison and the COR with a copy of the incident report within 24 business hours. The Contractor shall maintain a copy of the incident report in the Veteran’s case record. Please see above in Basic Services for details regarding what constitutes Critical Incident Reporting.

13.15 CONTRACTOR STAFF CONDUCT/COMPLAINTS HANDLING: Contractor personnel shall be expected to treat referred Veterans with dignity and respect and abides by standards of conduct mirroring those prescribed by current federal personnel regulations. The Contractor shall comply with the VA Patient's Bill of Rights as set forth in 38 CFR 17.34a (copy available upon request). The VA reserves the right to exclude

Contractor staff members from providing services to Veterans under this contract based on breaches of conduct, including conduct that jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by Veterans or other Staff members to designated Government representatives. The Contractor and

Contracting Officer’s Representative shall deal with issues raised concerning Contractor personnel conduct. The Contracting Officer shall be the final arbiter on questions of acceptability and in validating complaints.

13.16 BASIC RIGHTS AND PROTECTION AGAINST DISCRIMINATION: The

Contractor shall comply with the principles listed in 38 CFR 17.707(b) to provide housing and supportive services in a manner that is free from religious discrimination. The

Contractor shall protect the rights and dignity of the individual or family served in all phases of service delivery. At a minimum, providers must afford each Veteran the following rights and protections. Clients must be permitted to exercise these rights without fear of reprisal.

13.16.1 Veterans are entitled to enjoy a safe and healthful environment in the program.

13.16.2 Veterans are entitled to be treated in a manner that respects their dignity, privacy and individuality.

13.16.3 Veterans with disabilities are entitled to reasonable accommodations under fair housing laws when such accommodations are necessary because of their disability.

13.16.4 Veterans are entitled to remain in the program and not be involuntarily removed without reasonable notice, good cause, and just procedures

13.16.5 All program clients are entitled to just and standardized procedures for determining eligibility, admissions, sanctions and discharges, and resolving grievances

13.16.6 Veterans are entitled to reasonable privacy and confidential treatment of personal, social, financial, medical, and behavioral/mental health records, except as necessary to further treatment, information and referral services and in compliance with the resident’s consent to release information

13.16.7 Veterans are entitled to the full exercise of their civil, constitutional, and legal rights

13.16.8 Veterans will have on-going opportunities to voice opinions, to participate in program operation and programming, and to make suggestions regarding programming and rules.

13.16.9 Veterans’ rights shall be protected against all forms of discrimination, including those based on race, religious creed, color, national origin, ancestry, language, disability (physical or mental health), medical condition, marital status, familial status, age, gender expression, sexual orientation, source of income, or political affiliation

13.16.10 Veterans shall receive a written policy indicating that harassment of residents and staff on the basis of race, religious creed, color, national origin, ancestry, language, disability (physical or mental health), medical condition, marital status, familial status, age, gender expression, sexual orientation, source of income, or political affiliation will not be condoned nor tolerated.

13.16.11 Contractors shall develop a written policy for transgender and non-binary clients that provides for safe, secure and dignified case management as well as accommodations for privacy. All Veterans will have access to sleeping accommodations and bathroom facilities based on their gender of identification/expression, regardless of physical characteristics or gender conformity. It is the Contractor’s responsibility to promote a safe environment for transgender and non-binary clients amongst the general population.

13.16.12 Programs must post these policies in a conspicuous place and in appropriate languages. All policies and procedures will be in writing and subject to review by the VA.

13.17 REASONABLE ACCOMODATION: Contractor shall respect and reasonably accommodate personal and cultural differences associated with race, religious creed, color, national origin, ancestry, language, disability (physical or mental health), medical condition, marital status, familial status, age, gender expression, sexual orientation, source of income, or political affiliation. At no point shall program access be denied because of an individual’s disability. Information learned about the client’s disability from the assessment will not be used as grounds for discharge or other punishment and will be used to guide client to appropriate services. Moreover, a program may not apply different rules to individuals because of their disabilities, unless the different rules are a result of granting a reasonable accommodation request made by an individual with a disability. The

Contractor shall not ask questions about a client’s disability, including the nature and severity of the disability or the treatment, symptoms, and medications related to the disability. A Veteran is not obligated to reveal that s/he has a disability prior to admission.

Veterans with disabilities are entitled…