HCHV Enhanced Geriatric Services Only PWS - DRAFT.pdf

VAPAHCS

PERFORMANCE WORK STATEMENT

CONTRACT EMERGENCY RESIDENTIAL SERVICES BEDS

1. PURPOSE

1.1. The Department of Veterans Affairs Palo Alto Health Care System (VAPAHCS) located at 795

Willow Rd. Menlo Park, CA 94025 requires a contractor to provide geriatric services as part of its Community Based Health Care for Homeless Veterans (HCHV) program. The goal of the

HCHV program is to remove homeless Veterans from the street or habitation unfit for Veterans and place them in community-based, residential environments with sufficient supportive services to meet their needs and ultimately facilitate the improvement of their housing situation. The period of performance of the resulting contract will be for a one year and no option periods. This contract represents a Firm Fixed-Priced, Indefinite Delivery-Indefinite Quantity contract. Costs not incorporated into the Contractor’s price will NOT be reimbursed by the Government. This contract is specifically for the geriatric population.

2. BACKGROUND

2.1. Through this HCHV Enhanced Geriatric Services Contract the VA will provide supportive services to Veterans and facilitate their access to a broad range of medical, mental health, and rehabilitative services. The purpose of this solicitation is to obtain offers from contractors in Santa

Clara, Santa Cruz or Monterey County who can provide supportive medical, mental health and rehabilitative case management services to high needs geriatric homeless Veterans. Contractor will be required to provide a low-barrier therapeutic and rehabilitative milieu and attendant services targeting the underlying factors contributing to housing instability. Contractor will be expected to enroll and serve homeless Veterans who have little to no income and may fall below the 30% AMI for their county. Contractor will not be required to provide detoxification or other hospital level or licensed care treatment.

3. SERVICES TO BE PROVIDED

3.1. Contractor shall provide all labor, supervision, material and supplies necessary to provide rehabilitative, medical, therapeutic, mental health and supportive services to homeless Veterans.

Services will be provided on-site at the location where the Veteran resides in accordance with all terms and conditions, provisions, and requirements listed herein. Prices provided in the Price

Schedule shall be inclusive of all services listed in this section; prices do not include room and board.

3.1.1. Facilitate Room and Board: This is a service only contract. Prices do not include room and board. Contractor will be expected to enroll and provide services to low and/or no income. Contractor will work with involved agencies (i.e. Public Housing Authority, Office of Supportive Housing, etc.) to facilitate timely access to housing for Veterans enrolled in this program.

3.1.2. Dietetic Services: Contractor will facilitate access to food for Veterans. This can include grocery shopping, Meals on Wheels, food kitchens, food stamps, facility provided meal service, or any other relevant resources related to nutrition for the Veteran. If medically indicated, Contractor will ensure Veterans with dietary restrictions requiring alternative meals (e.g., diabetic, renal, and soft mechanical diets) will have access to required food options.

3.1.3. Laundry Facilities: Contractor will ensure Veteran has access to laundry facilities. If no laundry facilities are on site, Contractor will provide assistance to Veterans on accessing laundry facilities. Should a Veteran have difficulty doing their own laundry, Contractor will provide guidance and support for Veteran to have laundry done at minimum one time per week. Should a Veteran refuse to wash his or her clothes, this will be addressed as a therapeutic opportunity.

3.1.4. Case Management Services: This contract requires that Contractor maintain a minimum staffing ratio of one dedicated, full time, on-site primary daytime medical and/or nursing case manager per a maximum of 12 Veterans. Written requests for exceptions may be granted by the VA Liaison. There will also be secondary medical case management staff coverage for all remaining day, night, and weekend hours. At a minimum, the primary daytime medical case manager must be an LVN level of care or higher and be required to work normal business hours Monday through Friday. For all secondary day, night and weekend staff, they must have qualifications of, at minimum, an experienced caregiver with

5 or more years of caregiver experience and/or CNA level of care or higher. (See “personnel

5.1 for more details on specific requirements for staffing).

3.1.4.1. Check Ins: The primary medical case manager will provide structured individual case management, including counseling on self-care skills, adaptive coping skills, financial planning, permanent housing maintenance, written care plan, referral for financial benefits, socialization, managing medical issues and all other needs as applicable. The primary medical case manager will be required to have daily check ins during their normal tour of duty times. The secondary daytime and night and weekend medical case managers will ensure Veteran basic needs are being met and continuity of care through daily check ins, medication oversight and documented case management follow up as outlined by the primary case manager. For High-Risk

Veterans (Veterans with high cognitive deficits and/or high safety concerns), all medical case managers may be required to have more frequent check ins which will include, at minimum, once during the day shifts and once during the evening shifts

(e.g 8 am and 6pm daily).All staff shall log after each shift any incidents, concerns and follow up needed for the next case manager to refer to as they begin their shift.

The primary case manager is responsible for ensuring any pending items over the night and weekend are resolved or followed up on at beginning of their scheduled shift. Additionally, the primary medical case manager shall provide the following:

3.1.4.2. Informational Packets: All Veterans must receive an informational packet within 72 business hours which includes, at minimum, the following information:

1. Description of services

2. Grievance Policy

3. Emergency procedures

4. Patient rights and Reasonable Accommodation

5. Ombudsmen and/or Patient Advocate contact information in accordance with state regulation.

3.1.4.3. A thorough assessment of Veteran’s psychosocial needs and written individualized care plan (ICP) will be developed within seven business days of admission for each

Veteran. Information from the assessment will be integrated into the Veteran’s

ICP. ICPs will also include an assessment of Veteran ADL and IADL’s and possible crisis situations for the Veteran, such as elder abuse, harm to self, verbal abuse or acts of violence or any other medical or psychiatric crisis. Contracted staff will take proactive measures to address any issues in the ICPs and work to prevent these instances to avert crisis to keep these incidents at a minimum. Contractors will be proactive to ensure staff are trained in de-escalation techniques and mandated reporting laws within 60 days of hire. Contractor will be a mandated reporter.

3.1.4.4. Collaboration and coordination with VA program staff will include coordination of supportive psychosocial services as needed. Coordinated efforts must be made with the Liaison around medical, mental health, admission, and housing support needs.

Contractor is expected to coordinate all appointments including, but not limited to, chemotherapy appointments, dialysis appointments, and wound care appointments.

Contractor will be expected to accompany Veterans to their appointments when medically, cognitively, or psychiatrically indicated per the liaison and/or Contractor’s clinical judgement. Contractor’s staff will make active efforts to establish relationships with key stakeholders, providers, and partners in the VA Health Care and Benefits

Administration Systems to work closely and collaboratively with the interdisciplinary treatment team. Contractor will be required to work on longer term housing goals as needed. Examples of this include Cal Vet Homes, Skilled Nursing Facilities, Memory

Care, Assisted Living and/or Coordination with family and Caregivers for long term care support.

3.1.4.5. Ongoing ICP coordination will be expected between the Case Manager(s) and VA

Liaison (or Designee). The Case Manager(s) will be expected to coordinate with the

VA Liaison (or Designee) to ensure Veteran’s goals, as expressed in both the agency and VA Liaison’s (or Designee’s) intake, are reflected in the ICPs.

3.1.4.6. Every 60 days, the primary case manager will also coordinate a meeting with the

Veteran and the VA Liaison (or Designee) for bi-monthly ICP update meetings for the first six months after admission. If stabilization is evident, meetings may be every 180 days as stabilization continues. These meetings may need to be more frequent than 60 days or may revert to 60 days if the Veteran de-stabilizes.

3.1.4.7. The primary case manager is expected to meet with the VA Liaison (or Designee) for case management update meetings every 30 days. If the Veteran de-stabilizes, meetings may need to be more frequent than 30 days. Contractor will provide proper documentation verifying services and case management efforts by all team members including, but not limited to nursing staff, case management staff, benefit specialists, and program management staff. Notes must be written professionally in a format that utilizes the clear settings of goals and documents progress towards those goals (e.g.

SNAP, SOAP, or SMART notes).

3.1.4.8. Special attention will be made to address High Suicide Risk (HSR) Veterans as identified by the VA Liaison (or Designee), VA Mental Health Staff and/or the contracted Case Manager. Contractor will avail themselves to be contacted by the suicide prevention coordinator immediately should a Veteran miss an appointment and his/her safety must be verified. On a weekly basis, the contracted case manager will be required to update the VA Liaison (or Designee) on Veteran safety concerns for

HSR Veterans. The contracted case manager will review the HSR Safety Plans with the Veteran on a bi-weekly basis and/or until clinically indicated (this can include until the HSR flag is removed by the VA). HSR Safety Plan reviews and a copy of the Veteran’s Safety Plan will be documented in the chart. All Veterans will be referred to the VA for Primary Care and Mental Health appointments and Contractor will support Veterans in making initial and subsequent appointments. Particular efforts will be made for Veterans who are identified by Liaison to be highly acute. Efforts will be documented in the Veterans ICP and reviewed by the VA Liaison (or

Designee), at least monthly or as clinically indicated.

3.1.4.9. If Contractor determines a Veteran who has not been identified as an HSR Veteran to have expressed suicidal ideation, Contractor must follow their agency and VA incident and safety protocols. If the identified Veteran does not have a safety plan, Contractor will create an agency safety plan with the Veteran and make increased efforts to connect the Veteran to mental health services. Contractor safety plan will be forwarded to the VA Liaison (or Designee), as well as information on all efforts to connect the Veteran to mental health services. All procedures applied to HSR Veterans must be followed for the non-flagged HSR Veteran until the Veteran can be evaluated by a MH provider and/or Suicide Prevention Coordinator.

3.1.4.10. Contractor must be in close communication with the liaison for any missing

Veterans due to the high acuity of the target population. Contractor must file missing person’s report should the Veteran be considered at risk.

3.1.4.11. Contractor’s staff will maintain a professional relationship with internal and external partners. As such, Contractor must work together with the VA Liaison and other VA staff to resolve issues around quality of care with respect and professionalism.

3.1.4.12. Medical Case Management Services: Contractor will assist Veterans with the following: scheduling medical and mental health appointments, providing customized education for medical diagnosis and medication management, memory cues, and arranging appropriate transportation to and from all appointments. Contractor will make referrals to community-based organizations when health and/or psychosocial condition(s) indicate need for appropriate referral(s) and make sure all medications prescribed are reconciled to prevent duplication of orders among providers. Contractor will promote clear communication among treatment providers by ensuring awareness regarding Veteran’s medical needs and prescribed medication. Contractor will provide coordination of care by meeting with Veterans and medical staff to determine goals and recovery targets for identified conditions. Contractor will assist Veterans with medication management by monitoring Veterans’ compliance issues and providing extensive medication education to improve compliance. Contractor will teach appropriate medical interventions regarding wound care, self-care, and management of medical diagnosis. Contractor will offer cues to Veterans to facilitate self-care. Staff providing this education must be qualified professionals to offer this service and education to Veterans. Contractor will facilitate connections to non-VA entities and coordinate care and transportation for Adult Day Health Centers and other Geriatric

Services. Contractor will provide housing support and coordination to a higher level of care if needed and will facilitate applications and all medical documentation.

Contractor will be expected to assist in researching and filing applications for VA and

Non-VA medical benefits that the Veteran may be eligible for, which can include

HHA/IHSS/Medi-Cal/Medi-Care/Senior Advantage and other services. Contractor may be required to provide light ADL assistance and operate within their scope.

3.1.4.13. Permanent Housing Search: As applicable, Contractor will aid Veteran on pre-housing paperwork for available units to Veterans who qualify under this contract for the Enhanced Geriatric Services. If higher level of care housing placements or inpatient residential treatments are clinically indicated, case management around obtaining higher level housing options will be required. Examples of this may be researching future housing options, connecting to local resources, discussing how to maintain/pay for housing over long term, adult day health referrals Cal Vet homes, skilled nursing, and licensed assisted living facilities and/or other community long-term supports.

3.1.4.14. Financial Planning: Contractor will refer Veteran to and follow up on all potential financial resources that the Veteran may be eligible for (e.g. SSI, SSDI, Food Stamps, NSC pension, GA, Aid and Attendance, Medi-Cal, etc.). Case Managers will document all structured activities that support Veterans in developing a short and long-term plan to understand and address their current financial situation and how to improve it. Each

Veteran must apply for Medi-Cal, Medi-Care, and aid and attendance (if eligible) if they do not have this benefit. Financial benefits must be applied for within 60 days of housing stability.

3.1.4.15. If applicable, Case Manager will refer Veteran to all relevant legal services which would benefit the Veteran’s housing stability. Case Managers will document all activities and education that support a Veteran’s legal needs.

3.1.4.16. Discharge Planning: If applicable, Contractor will research and apply for higher level of care and facilitate safe transfer and discharge from the Enhanced Services Geriatric contract.

3.1.4.16.1. If a Veteran has an approved discharge from the program, it is Contractor’s responsibility to confirm and/or find alternate housing placement prior to discharge.

3.1.4.16.2. Case management services must be provided to evaluate and increase a Veteran’s income to provide the most opportunities for success. Contractor will assist

Veteran in negotiating landlord disputes.

3.1.4.16.3. Services under this contract may be provided to Veterans below 30% AMI. As applicable, if a Veteran refuses to pay/unable to pay rent or has an income that may be lower than the expected rental requirement and is at risk of being discharged or denied entry into a program, the Contractor will be responsible for assisting Veteran in advocating for acceptance/extensions with the program.

Contractor will assist Veteran in determining if there is a possibility for income in the future. Contractor is expected to work with the current landlord on payment options or other financial assistance programs to increase Veteran income prior to any decision on discharge or acceptance is made.

3.1.4.16.4. Safety concerns must be clear and obvious to both Contractor and Liaison.

Parameters around safety violations and/ what constitutes a reasonable threat must be established with Liaison. All negative discharges will be subject to a full team debriefing, including VA Liaison, to look for opportunities missed to intervene sooner. All discharges are subject to Contractor’s grievance procedures and must allow Veteran the opportunity to be represented by VA Liaison in the grievance process. Reasonable efforts must be made to coordinate with Liaison to schedule an appeal. In the case of no reasonable alternative housing arrangement, a target discharge date may be established by Contractor, no less than 7 calendar days of decision to discharge, to afford Veteran an opportunity to utilize VA Liaison advocacy. Contractor will work closely with the VA Liaison and landlord on lease requirements and any other tenant landlord issues that may arise as a result of discontinuation of services to Veteran.

3.1.5. Medication Monitoring: Contractor will provide Veteran with medication reminders, prompting, medication education, and assistance with organizing medication as therapeutically indicated. Education will include best practice for storage from manufacturer and comply with physician’s orders.

3.1.5.1. All primary and secondary medical case management staff providing

Veteran care will be required to, at minimum, have received the required medication training if not already included in the staff member’s license.

As a result of this training, all staff should be able to provide medication education and prompts to the Veterans as needed when the primary medical case manager is not on duty. This training will need to be completed within

90 days after contract award. The certificate(s) of the medication training and the times/days and hours of the person(s) covering will be provided to the VA Liaison to keep on file. A list of these staff members and their schedules will be requested at start of contract.

3.1.6. Grievance Procedures: Contractor must have an internal grievance process that Veterans can use to resolve conflicts within the program. Contractor must have written policies and procedures for resolving grievances, including a statement regarding the Veteran’s right to request reasonable accommodation, and must post them in a conspicuous place and be accessible to Veteran. In addition, each Veteran receiving services shall receive a copy of the grievance policies and procedures at intake and prior to any discharge decisions.

3.1.7. Timeliness of Response: Contractor must have a dedicated phone line for VA inquiries and

Veteran self-referrals. Return calls from Contractor are expected within 4 hours during business hours Monday through Friday. Calls, referrals, emails, or other correspondence from community agencies, VA staff, Veterans or VA Liaisons (or Designees), are also expected to be addressed within 4 business hours Monday through Friday.

3.1.8. Critical Incident Reporting: All critical incidents will be reported within 24 hours.

This includes the following:

o Falls o Assault (to Veteran or Staff) o Elderly/dependent adult abuse or neglect o Sexual assault o Fire (Veteran involved) o Medical/psychiatric emergency (911 Calls) o Hospitalization o Suicide or suicide attempt o Homicide o Significant change in mental status o Death o Infectious control (TB, COVID, etc.)

o Active substance abuse on Contractor property o Observation/ possession of weapons o Grave disability

3.1.8.1. Critical Incidents: Contractor shall notify the authorizing VA facility immediately of any incidents involving Veterans in the Enhanced

Geriatric Service contract. Contractor shall notify the VA liaison by telephone or email during the hours of 8:00am and 4:30pm. For all incidents that occur after normal business hours, Contractor should notify the HCHV Staff the following business day. Contractor shall provide the

HCHV liaison and the COR with a copy of the incident report within 24 business hours. Contractor shall maintain a copy of the incident report in the Veteran’s case record.

3.1.8.2. Medical Emergencies: For emergency hospitalizations, if possible, a request for Veteran to be transported to the nearest VA facility is expected; however, if 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 required, it is agreed that admission to the appropriate VA facility will be accomplished promptly. Contractor will arrange for admission and support the Veteran with any transportation issues that may arise.

3.1.9. Therapeutic and Rehabilitative Services:

3.1.9.1. Milieu: Contractor will cultivate a milieu of trust and safety. This includes a tolerance for relapses, regression, and personal unpredictability. As a part of the engagement strategy, Veterans will be connected to and invited to participate in activities of everyday life, including recreation activities and socializing. Such opportunities will be offered, not required nor demanded. A Harm Reduction Model will be utilized. Adherence to this model may be assessed at any time by the liaison.

It is expected that Contractor will assist with self-care including, but not limited to, offering adult briefs and providing cues for hygiene, medication, and eating. It will be understood that the target population in this contract is going to need intense assistance in getting completing activities of daily living. While Contractor is not expected to offer licensed level care, Contractor will support Veterans who show a decline in daily functioning. As such, the administrator for this contract must be RCFE administrator certified.

3.1.9.2. Recovery: This contract uses a Housing First approach with a focus on Harm

Reduction. Support for a healthy lifestyle needs to be provided in an environment conducive to social interaction and to the fullest development of the resident’s rehabilitative potential. Pursuant to these principles, abstinence only policies and drug testing may not be used to discharge or discipline a Veteran. Drug testing may only be used as a clinical intervention to modify behavior or assess behavioral issues in agreement with the Veteran’s treatment goals.

3.1.10. Transportation: Contractor shall assist and/or provide Veteran with round trip transportation to scheduled meetings, medical appointments, and hospital visits as needed. Should the Veteran need added assistance for his appointments, Contractor will be expected to accompany Veteran to the appointment to ensure Veteran meets with the provider. For this contract, some Veterans may need use of a wheelchair van/lift. Contractor will be responsible for accommodating these Veterans.

3.1.11. Occupancy: Admission decisions are a joint decision between Contractor and VA. Final decision on admission and discharge is determined by the VA Liaison.

3.1.12. Documentation: An individual case record will be created for each referred Veteran.

Contractor shall document treatment and, if applicable, discharge planning, reflecting the

Veteran’s health, social, cognitive, and mental health needs. Documentation should also include any involvement of the Veteran, the VA staff, and appropriate community resources in resolving problems and setting goals. Case records shall be maintained in a secure and confidential manner as required 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 the appropriate Department of Veterans Affairs staff members. 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

USC 7332). The files shall include:

▪ Reasons for referral

▪ All essential identifying data relevant to Veteran 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.

▪ Copies of any medical prescriptions issued by physicians, including orders, if any, for medications to be taken. Contractor must comply with HCHV inspection requirements.

▪ Case management notes written in a professional manner (i.e. SMART, SOAP, SNAP) and will include the following: 1) a written and thorough Housing

Maintenance Assessment, 2) a written, standardized Socialization Assessment, 3) a

Financial Plan, 4) a Discharge Plan, and 5) an Individual Care Plan with attendant goals and documented activity indicating Veteran and Case Manager are actively working on identified goals.

▪ Daily sign in and administrative logs for the purpose of verifying Veteran’s participation in the program, safety checks, absences and Contractor services.

These logs must be submitted to the VA Liaison monthly.

▪ QASP Compliance Tool and all attendant supporting documentation demonstrating

Contractor compliance with Contract.

▪ Final summaries on each resident who leaves the program, which includes reasons for leaving, the Veteran’s future plans, and follow-up locator information.

▪ Waivers, Corrective Action and Incident Reports as appropriate.

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.

4. Rules, Policies And Procedures: Contractor shall have reasonable rules governing day-to-day life and activities. The purpose of these rules is to promote stability, safety, cleanliness, and dignity.

Rules should not set up Veteran for failure and should be presented in a manner that is the least intrusive and punitive. Infraction of rules will be seen as a therapeutic opportunity, not responded to punitively. Contractors will include in their standard policies and procedures a room entry agreement that the Veteran will have reviewed with the contract and signed with including permission to access the Veteran unit in case of emergency and welfare check. In addition, there will be policies and agreements around medication monitoring (as applicable) for those Veterans that will need this additional support. Should any rule prove to be a barrier to service, then the rule must be reviewed with the Liaison and possibly changed to ensure continuous engagement and accessibility to the program. Response to rule infractions should be approached with leniency and further engagement as appropriate to the Veteran’s participation in the program. The focus of the rules should be around the safety of Veteran residing at the facility. Rules regarding entry and exit, rules of substance use, chores, engagement in treatment, and general rule compliance, shall be as flexible as is necessary to carry out the functions of this contract and to maximize Veteran engagement. Contractor policies will be reviewed with Veteran on admission to ensure Veteran understanding of rules and regulations of the program. Any rule or policy that proves problematic to the active, effective, and ongoing engagement of Veteran shall be addressed by the VA and program management team, subject to immediate review and repeal upon the request of the VA Liaison. Examples of rules that may not be appropriate to this setting are: mandatory breathalyzing, mandatory sobriety, and mandatory meetings (e.g. house meetings, AA, NA, SUD treatment meetings). Veteran will be provided a copy of the rules at intake and/or upon Veteran’s request. In addition, Contractor will post the rules in a location readily visible to Veterans and visitors. These rules must include detailed Patient Rights and the procedures that Contractor has in place to protect the Veteran’s rights and dignity. Veteran must be permitted to exercise these rights without fear of reprisal. If requested, Contractor must 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 and companion animals, and the California Fair Employment and Housing Act of 1973, and all other applicable

State or Federal laws. Contractor must equally apply all rules, policies, and procedures to Veteran, unless Veteran has asked for a reasonable accommodation due to his/her disability.

5. REFERRALS, ADMISSIONS, ELIGIBILITY, AND DISCHARGE

5.1. Referrals and Admissions: Prioritization of Veterans into this program will be based on the acuity of the Veteran’s abilities (or lack thereof) to live independently.

Indicators may include:

• Failure to thrive in HUD-VASH or other permanent supportive housing program

• Frequency of hospitalizations

• Frequency of emergency department visits

• Level of ability to perform basic activities of daily living (ADLs)

• Continuous need for reminders for important tasks, such as managing medications, appointments, meals, and bathing

• Mental status.

5.1.1. Liaisons will have the final decision for admissions and discharges to the program, including denials based on lack of acuity.

5.1.2. Contractor will provide verbal and written notification that is readily accessible to all individuals including the VA liaison, upon request, of reasons for non- acceptance.

5.1.3. Contractor must have formal appeal procedures through which Veteran may appeal unfavorable admission or eligibility decisions and a copy of the policy for appeals is to be given to Veteran at screening or intake. For highly symptomatic Veterans, a waiver for admission and intake procedures can be requested through the VA Liaison (or Designee).

5.1.4. Arranging the meeting between the Liaison and the Veteran is Contractor’s responsibility.

5.2. Eligibility: The VA is responsible for determining eligibility and appropriateness of Veterans prior to acceptance by Contractor for services. The VA is responsible for identification of

Veterans for units and the VA makes the final decision of Veterans who are served by the

Enhanced Geriatric Services Contract. Veterans must be healthcare eligible. If there is an interest list for this program, this list needs to be reviewed jointly by the VA and Contractor to determine best fit for the program.

5.2.1. Written documentation of eligibility verification, signed by an authorized VA Staff, shall be obtained by Contractor as soon as possible for each Veteran referred for services under the contract for inclusion in the Veteran’s program file.

5.2.2. A list of authorized VA Staff for the contract shall be provided to 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. Contractor shall be provided an updated list of authorized VA Staff whenever such changes are made.

5.2.3. 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 basic 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 required will be part of an ongoing conversation with Liaison.

To be eligible for admission to the Enhanced Geriatric Services contract, all Veterans must be homeless and be eligible and registered for VA healthcare services. While the contract is intended for Veterans over age 50, Liaison may grant admission to Veterans under the age of

50 based on needs and acuity. Contractor may provide services to Veteran populations, such as but not limited to the following: medically compromised Veterans, Veterans with cognitive disorders, geriatric Veterans, Veterans with sex offender status, Veterans who may have a mental illness, Veterans who have abused drugs or alcohol for many years, and/or Veterans who have been involved with the legal system.

5.3. Denial of Services: Unless determined clinically appropriate by VA liaison, Veterans cannot be denied based solely upon length of current abstinence from alcohol or non-prescribed controlled substances, active use, 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. 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. Contractor must employ a harm reduction approach. Contractor will provide verbal and written notification that is readily accessible to all individuals including

VA liaison, upon request, of reasons for non-acceptance.

5.4. Absences and Missing Persons: Contractor shall notify the VA of unauthorized/unscheduled absences and/or scheduled absences within 24 hrs. of Veteran’s absence. All scheduled and unscheduled absences will be clearly documented on the daily sign in log, including reason for any scheduled absence (e.g. medical needs).

5.4.1. Absences: The VA may authorize scheduled absences provided the absence is logged on the attendance log and the following conditions are met: (a) be pre-planned, consistent with and support the Veteran’s individual service plan (e.g., family reunification, short term medical, substance use disorder (SUD) or psychiatric treatment), (b) have the reason documented in the individual Veteran’s case file, treatment record, or service plan.

5.4.2. Should a Veteran be absent in an unscheduled manner, services for that Veteran shall be continued provided the absence is logged on the attendance log and the following conditions are met: (a) Contractor must have evidence of notifying the VA liaison and active outreach to locate and reengage the Veteran and document the steps taken in the Veteran’s individual case file, treatment record, or service plan, (b) there is reason to believe the Veteran will return to their home and/or (c) the VA liaison has been notified of the absences and the VA Liaison has approved for prolonged unscheduled absences.

5.4.3. During intake, the emergency contact information must be acquired from Veteran and a discussion of whom Veteran will go to if they leave their unit without notifying staff. This information needs to be documented in Veteran’s file for reference in case of emergency or missing persons. Contractor is required to do daily check ins. During check in, Contractor shall notify VA Liaison of any Veteran unplanned absences within 24 hours or at next check

in. For High-Risk Veterans (Veterans which high cognitive deficits and/or high safety concerns), if the Veteran is absent after 4 hours (and/or as clinically determined by discussion with VA liaison), a missing person’s report will need to be filed and VA liaison notified.

5.4.3.1. Missing Persons: For Veterans determined to be High Risk, if Veteran has an unplanned absence for over 4 hours from last check in (and/or as clinically determined by discussion with VA liaison) and all efforts to locate Veteran are unsuccessful, Contractor must file a missing person’s report immediately and then notify the VA Liaison. For all other instances, with absences over 24 hours, efforts should be made by Contractor to locate Veteran. Efforts will include contacting Veteran and the Veteran emergency contact, VA Liaison, calling local jails, and contacting local hospitals. If every effort to locate

Veteran has been unsuccessful, a missing person’s report is expected to be filed. Contractor is expected to attempt and document at least 3 attempts to locate Veteran over the next 72 hours.

5.4.4. Contractor shall notify the authorizing VA facility immediately of any Critical Incidents involving Veterans participating in the Enhanced Geriatric Services program. Contractor shall notify VA liaison by telephone or email during the hours of 8:00am and 4:30pm. For all Critical Incidents that occur after normal business hours, Contractor should notify the

HCHV Staff the following business day. Contractor shall provide the HCHV case manager and the COR with a copy of the Critical Incident report within 24 business hours after incident. Contractor shall maintain a copy of the Critical Incident report in Veteran’s case record. Please see Case Management Services for details regarding what constitutes Critical

Incident reporting. Contractor will support Veteran with any admission documentation, referral and transportation issues that may arise.

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

Veteran.

5.5. Basic Rights and Protection Against Discrimination: Contractor must protect the rights and dignity of Veteran in all phases of service delivery. At a minimum, Contractor must afford each

Veteran the following rights and protections. Veterans must be permitted to exercise these rights without fear of reprisal.

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

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

5.5.3. Veterans with disabilities are entitled to reasonable accommodations under Fair Housing laws when such accommodations are necessary because of their disability.

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

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

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

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

5.5.8. Veterans’ rights must 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, sexual preference, source of income, or political affiliation.

5.5.9. Veterans will receive a written policy indicating that harassment of clients 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, sexual preference, source of income, or political affiliation will not be condoned nor tolerated.

5.5.10. Contractors will develop a written policy for transgender clients that provides for safe, secure, and dignified case management.

5.5.11. All policies and procedures will be in writing and subject to review by the VA.

5.6. Reasonable Accommodation: Contractor must 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, sexual preference, 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.

Veterans with disabilities are entitled to reasonable accommodations. If Veteran requests a change in a program’s policy or procedure as an accommodation of his/her disability, the program should grant the accommodation when the accommodation is both reasonable and necessary because of the individual’s disability. Such an accommodation request must be considered during any stage in the provision of a program, including at intake, during services, and during discharge proceedings. When a reasonable accommodation request is made, the program supervisor may request verification of the individual’s disability. Contractor is required to develop a written policy for their process for reasonable accommodations within 30 days of the award of this contract. This will include: 1) All requests for reasonable accommodation, 2) details of all steps taken to accommodate a Veteran’s request for reasonable accommodation, and 3) any explanation for denial of services and/or accommodation, and 4) any appropriate referrals to Veterans who are denied accommodation. All explanations are to be written on formal letterhead from program management to Veteran and Liaison at the time of denial for services or accommodation.

Contractor will be aware that violation of the ADA, Section 504 of the Rehabilitation Act and

Fair Housing Laws may result in stopping admissions and/or termination of contract for convenience. Reasonable accommodation will also include ensuring Veterans who require

Caregiver support are also given consideration. Contractor must follow Fair Housing law as applicable to federal and local laws and regulations as applicable.

5.7. Procedures For Negative Discharge Or Sanction: Contractor must clarify rules in which behaviors constitute gross misconduct and which would prompt a written warning if violated and potential discharge or possible eviction, if violated repeatedly. Contractor will describe the formal appeal procedures through which clients may appeal program regulations, sanctions or discharges and information on eviction proceedings. This information must be provided to Veterans in writing upon intake and must be clear and easily understandable by Veterans.

This will include:

▪ Immediate notification by Contractor of incident to VA Liaison

▪ Two warning notices for violations that do not result in immediate discharge prior to issuance of a discharge notice and an opportunity for a case conference after appropriate warning is issued to the Veteran

▪ Notice of and access to formal appeal procedures

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

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

▪ Information on eviction processes

This appeal process does not apply to Veterans who are an immediate danger to others.

6. RELEASE OF MEDICAL INFORMATION: Contractor shall take reasonable measures to ensure Veteran’s privacy and confidentiality. Contractor must obtain a signed ROI within 24 hours of admission. Veteran’s demographics shall be treated as privileged information. Contractor shall only release medical information obtained during the course of this contract to VA employees involved in the care and/or treatment of Veteran. Contractor’s personnel shall make sure no Veteran information of any type is given to outside parties, agencies or organizations without the expressed written consent of Veteran and the VA, and only in capacities directly related to the provision of the services contracted in this instrument. Lists, names, and/or social security numbers of Veterans shall not be disclosed or revealed in any way, for any use without prior express written permission of the Contracting Officer or Veteran.

Transcribed reports containing personal identifiers, when not used as an official document, must be shredded by Contractor. Contractor is subject to the same penalties and liabilities for unauthorized disclosures of such records as VA personnel as prescribed in VAAR Clause 852.273-75 listed in Section

C of this document with attention given to VA Handbook 6500.6, Contract Security Requirements for

Unclassified Information Technology Resources, found at the link in the clause at http://www.iprm.oit.va.gov/Security_and_Privacy_Requirements_for_Contractors.asp

7. STAFF/QUALIFICATIONS/ACCREDITATION/LICENSING

7.1. Personnel: Contractor shall assign personnel qualified to provide the Case Management Services and Supplemental Services required by this contract with requisite education, training, and when required, certification or licensure. Contractor will employ sufficient personnel to carry out the policies, contract responsibilities, and the program for the facility.

7.1.1. This contract will require medical case managers with credentials, such as a caregiver with extensive caregiving experience (e.g. 5+ more years of caregiver experience and references must verify caregiver experience and expertise) or CNA, LVN, RN, and/or BSN for all night and weekend shifts, at least one dedicated full-time LVN, RN and/or BSN for M-F normal business hours, and on call LVN, RN and/or BSN staff members for after hour care as clinically appropriate. Staff must have experience working with geriatric populations and a strong understanding of mental health and substance use disorders. Staffing will be required onsite for 24 hours a day, 7 days a week. All staff members will be expected to be made aware of their coverage duties and trained in appropriate Contractor emergency protocols, CPR/First Aid, and basic de-escalation. If Veterans need additional care from licensed LVN or higher on nights and weekends, Contractor must provide appropriate level care as clinically indicated through an on-call LVN. The on-call LVN or higher must be able to come to the facility within 30 minutes driving to provide higher level of care when required.

7.1.2. Case management staff must have appropriate and commensurate coverage for staff using authorized and unauthorized leave (e.g. holidays, sick leave, family care, etc.). Staff identified by Contractor to provide temporary leave will be expected to cover the same schedule as the primary medical case manager and also have the same credentials. VA

Liaison (or Designee) is expected to be notified of cross coverage if Contractor’s primary medical case manager is absent prior to the leave, and/or within 24 hours of unexpected absences. Staff absences/shift changes and coverage should be reflected on shift schedule provided to VA Liaison for billing purposes.

7.1.3. For this contract, staff is defined as a paid professional and does not include interns. Each

VA Liaison (or Designee) should have no more than two POCs per program.

7.1.4. Veterans will be provided the staff member information on intake and informed whom to call in case of emergencies.

7.1.5. There is an expectation that there will be an administrative/clinical Designee that will be available for consultation for emergencies 24 hours a day, 7 days a week.

7.1.6. Contractor will not assign or hire staff to perform the clinical and medical duties outlined in this contract who are currently enrolled in a VA Homeless Program or who have ended participation in a VA Homeless Program within the past two years.

7.1.7. Contractor must have a policy prohibiting staff from establishing sexual relationships with

Veterans in its program.

7.1.8. Contractor must 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. For this contract, Key

Personnel will be the program manager and the medical case managers covering each shift for the 24/7 required schedule.

7.1.9. During the first ninety (90) calendar days of contract performance, 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 the situations described above, Contractor shall provide resumes for substitute Key Personnel.

For substitutions proposed by Contractor after the initial 90 calendar day period, Contractor shall provide resumes for the substitute personnel, together with any other additional information requested by the Contracting Officer, at least 15 days before the substitution is to occur. At this point, the VA shall review and give feedback on the proposed substitute

Key Personnel. The Contracting Officer shall notify Contractor within fifteen (15) calendar days after receipt of all required information if the VA refuses to accept the substitute http://www.iprm.oit.va.gov/Security_and_Privacy_Requirements_for_Contractors.asp

Key Personnel. The VA reserves the right to refuse or revoke acceptance of Key Personnel if…