HCHV Statement of Work-Lincoln FY27.docx

VA Nebraska- Western Iowa Health Care

STATEMENT OF WORK

HEALTH CARE FOR HOMELESS VETERANS

CONTRACT EMERGENCY RESIDENTIAL SERVICES BEDS: GENERAL POPULATIONS

A. PURPOSE.

The core mission of the HCHV program is to reduce homelessness among Veterans by conducting outreach to those who are the most vulnerable and who are not currently receiving VA services and then engaging them in treatment and rehabilitation via VA programs and non-VA community programs that provide prevention and support services. The Nebraska-Western Iowa Medical Center requires Contractors to provide 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 HCHV Contract Emergency Residential Services program is outlined in VHA Directive 1162.04.

B. 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 purpose of this solicitation is to obtain offers from Contractors in (20 mile radius) Lincoln NE, who can provide housing and supportive services to Homeless Veterans in community-based Contracted Emergency Residential Services (CERS) facilities offering a safe and secure environment that supports their goals for recovery from homelessness. The Contractor will be required to provide a low- barrier therapeutic and rehabilitative milieu and attendant services targeting the underlying factors contributing to homelessness. The Contractor will not be required to provide detoxification or other hospital level treatment.

C. SERVICES TO BE PROVIDED

I. BASIC SERVICES: The Contractor shall furnish each Veteran who has been approved as eligible by the VA and admitted for care under this contract with the following basic services:

a. ROOM AND BOARD: Room and Board shall be accessible to the Veteran 7 days a week and 24 hours per day. Accommodation will include a bed and other furnishings such as a dresser, storage locker or designated secured space, and personal linens (towels, pillows, blankets and bed sheets, etc.). The Contractor will allow Veteran to store personal belongings for at least 72 hours after formal HCHV discharge. At least three nutritious meals, 7 days a week will be provided for the Veteran. In addition, there will 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 will not be more than a 14-hour span between evening meal and breakfast of the following day. Contractor will 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/religious preferences around food (e.g. Kosher, Sikh, etc.). Food shall be prepared, served and stored under sanitary conditions. The facility shall provide storage space in an onsite refrigerator for Veterans to store and freely access personal food. The facility shall establish and maintain sanitary procedures for washing dishes, cleaning equipment and work areas, and disposing of waste.

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

c. THERAPEUTIC AND REHABILITATIVE SERVICES: Each Veteran will have an Individual Service Plan (ISP) completed by the Contractor with input from the Veteran and the VA HCHV Liaison (or Designee). Therapeutic and rehabilitative services will be stated in the plan of care. Services which the Contractor must be able to furnish or provide will include:

(1) Group Activities: Structured group activities, as appropriate, shall occur 3 times per day 7 days per week – examples include group therapy, life skills training, social skills training, financial workshops, Alcoholics Anonymous, Narcotics Anonymous, vocational counseling and physical activities as appropriate. Group activities should have a therapeutic value, and facilitation shall be the responsibility of the Contractor. Should a Veteran have mental health, medical, family and/or employment obligations which directly conflict with this requirement the Contractor will clearly document efforts made to accommodate the Veteran.

(2) VA Coordination: Collaboration and coordination with VA program staff, as needed, will include coordination of supportive psychosocial services. In particular, coordinated efforts must be made with the Liaison around medical, mental health, admission and discharge needs.

(3) Case Management: A thorough written Individualized Service Plan (ISP) will be developed within 2 weeks of program admission for each Veteran. This will include structured individual case management, at minimum, weekly focusing on skills to obtain and maintain permanent housing such as self-care skills, adaptive coping skills, financial planning/financial benefits, vocational skills, permanent housing search. In addition, case management will focus on referral to programs to meet the identified needs of Veteran. In addition, special attention will be made to address High Suicide Risk (HSR) Veterans as identified by the VA Liaison. On a weekly basis the contracted case manager will be required to update the VA Liaison on Veteran progress and/or safety concerns for HSR Veterans. Contracted case manager will review the HSR Safety Plans with the Veteran on a bi-weekly basis. HSR Safety plan reviews and a copy of the Veteran’s Safety Plan will be documented in the chart. Veterans will be referred to VA or community for Primary Care, Mental Health and/or Substance Use services as indicated by assessment. Contractors will support Veterans in making initial and subsequent appointments. Efforts will be documented in the Veterans ISP and reviewed by the HCHV Liaison at least monthly. Contractor will document case management efforts in client chart. There will be an expectation that notes are 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). The contractor will act as primary in providing case management services. VA Liaison serves as secondary working in collaboration with Contractor.

(4) Staffing Ratio: Contractor will maintain a minimum staffing requirement ratio of 1:10. Staff are defined as paid professional or para-professional and do not include interns. Contractor will provide services to cover a capacity of 10 Veterans.

(5) Permanent Housing Search: Programs are required to 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 housing placements must be clearly reflected in each Individual Service Plan (ISP) and in weekly case management notes. As part of this plan, Veterans’ housing history and needs must be assessed within 2 weeks of program admission. Housing Assessments must identify Veterans’ housing history, strengths (i.e. positive prior rental history), and barriers (i.e. Unlawful Detainers). Should Veteran refuse to engage with program staff regarding plans for permanent housing transition, motivational interviewing and other therapeutic techniques will 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 must provide direct assistance to Veterans in developing permanent housing plans and accessing appropriate housing resources. All housing efforts by Contractor shall be documented clearly and presented to HCHV Liaison 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.

(6) Financial Planning: Referral to and follow up on all potential financial resources the Veteran may be eligible for (e.g. SSI, SSDI, Food Stamps, NSC pension, GA, etc.). Case Managers will 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.

(7) Employment Services: Referral to all relevant employment opportunities the Veteran is eligible for and interested in, Case managers will document all structured activities that support Veteran in applying for employment as appropriate based on needs of Veteran as identified in the assessment.

(8) Recovery: Support for an alcohol/drug abuse-free lifestyle 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 supportive of a Harm Reduction approach.

(9) Occupancy: It is expected that Contractor beds will be maintained at an average minimum of an 80% occupancy rate but at a preferred rate of 100% as calculated based upon number of bed nights available per quarter.

(10) Outreach: Contractor will be responsible for engaging in outreach in the community monthly. In addition, clear documentation for outreach activities must be made available to Liaison upon request. Contractors will maintain occupancy by engaging in outreach services and will be knowledgeable about outreach best practices generally accepted in the community.

(11) Discharge Planning: Securing permanent housing will be the primary discharge goal for every Veteran. All Veterans must have a documented discharge plan within 4 weeks of admission which integrates items included in Paragraph 5 above. Discharge plan will be documented and reviewed with Veteran by Contractor at minimum monthly. Compliance with all VA regulations regarding discharges and timeliness of reporting discharges is required by Contractor. Paperwork required for discharging a Veteran is required to be provided to VA Liaison within 24 business hours from known discharge. Housing needs will be assessed upon acceptance to the program and resources will be coordinated for discharge to a successful community placement throughout the duration of the Veteran’s stay. Any and all actual or threatened violence will be grounds for discharge. Veterans may be discharged for safety reasons at any time. 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 the Contractors grievance procedures. HCHV performance measures and requirements set forward in this solicitation must be met in order to receive the highest past performance rating. These include the following:

HCHV1: 55% Exits to Permanent Housing HCHV2: Below 20% of Negative exits

Bed Occupancy: 80%

Length of Stay: 90 days

(12) Grievance Procedures: Programs must have an internal grievance process that Veterans can use to resolve conflicts within the program. Programs must have written policies and procedures for resolving grievances, including a statement regarding the client’s right to request reasonable accommodation, and must 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.

(13) Intake Packets: All Veterans must receive an intake packet within 72 business hours which includes, at minimum, the following information:

1. Description of the Contractors services

2. Grievance Policy

3. Emergency procedures

4. Patient rights and Reasonable Accommodation

(14) Extensions- All extensions beyond 180 days must be approved in writing by HCHV Liaison or Designee.

(15) Medication Management: Medications and narcotics shall be properly stored, controlled, issued and recorded in compliance with physician orders. Contractor will maintain an up-to-date individual record of all medications, including prescription and non-prescription medications, used by Veterans enrolled in program.

1. The contractor will have written procedures that address storage and handling of medications, safe disposal, and documentation of medication use.

2. All medications are stored in a secure locked area, except when under the direct supervision of appropriate staff.

3. Keys or combinations to locks for the medication area are under the control of authorized staff.

4. All medications are periodically checked for expiration dates or deterioration.

5. All medications are stored according to manufacturer’s recommendations.

6. Program staff responsible for monitoring are familiar with all medications stocked. Staff have knowledge and/or access to information(e.g. current physicians’ desk reference or other resource) that includes indications, side effects, toxic effects, interactions and potential allergic reactions.

7. Program staff responsible for monitoring provide orientation, continuing education and training as appropriate.

(16) Timeliness of Response- Contractor is expected to have a dedicated phone line for VA inquiries and referrals. Return calls from the program are expected to be within 4 hours during business hours Monday through Friday. This includes calls from VA Staff or the Liaison to the program.

· Falls

· Assault (to Veteran or Staff)

· Elderly/Dependent Adult Abuse or Neglect

· Sexual Assault

· Fire (Veteran Involved)

· Medical/Psychiatric Emergency (911 Calls)

· Hospitalization

· Suicide or Suicide Attempt

· Homicide

· Death

· Infectious Control (TB, etc.)

· Active Substance Abuse

· Observation/ Possession of Weapons

(17) Critical Incident Reporting- All critical incidents will be reported within 24 hours. This includes the following:

II. DOCUMENTATION: Site visits by VA Liaison will periodically include spot check of records to ensure accurate documentation. The Contractor will be responsible for the following onsite records and reports:

A. Daily sign-in sheets signed by program Veterans, to document and verify Veteran’s presence at the facility for billing purposes. Daily sign-in sheets must be completed clearly, accurately and thoroughly with full signatures and monitored so as to provide a full accounting of Veteran’s stay and services received for billing and audit purposes. These sign-in sheets will be hand delivered and/or faxed a minimum of weekly to HCHV Program Coordinator or designee for review. In the event one or more Veterans refuse to sign the daily sign-in sheets due to documented mental health problems, an alternative method of verification may be developed on a case-by-case basis in collaboration with the HCHV Program Coordinator or designee, subject to final approval by the VA COR.

B. Contractor shall maintain an individual clinical record on each Veteran outplaced under this contract. The Contractor must adhere to the Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR part 2) and the Confidentiality of Certain Medical Records (38 USC 7332). All case records will be maintained with security and confidentiality and will be made available on a need-to-know basis to appropriate staff members involved with the treatment program of the Veterans concerned. Individual clinical records will contain the following:

1. An initial biopsychosocial assessment completed within two (2) weeks of program admission. The assessment and plan will include but not be limited to: verification of Veteran status, all identifying data relevant to the Veteran and his/her family, including medical problems and medications, mental health problems and medications, substance use history, housing history and preferences, income supports or benefits, education , marketable skills and licenses, employment history/vocational issues, information relating to the Veteran’s admission including reason for referral, the targeted goals for constructive changes which are to be attained during the residential rehabilitation episode and the anticipated length of stay, if known.

2. An initial Individual Service Plan completed within two (2) weeks of program admission signed by the Veteran. The Individual Service Plan must contain the following assessment of: barriers, service needs, strengths, specific services provided including duration and outcomes, documentation of referrals, and benefits to be achieved due to program participation. The plan must specifically include but will not be limited to:

a. Provisions for Veteran placement into an appropriate transitional or permanent housing placement within 60-90 days of admission to the HCHV Contract Residential Care facility, but no more than 180 days. The housing placement planning must consider all appropriate and available community-based housing options as well as the Veteran’s preferences regarding location and housing type.

b. Provisions for the stabilization and/or treatment of biopsychosocial issues and stressors. This may include provisions of care within the contracted facility, connections to VA medical and mental health care, and/or referrals and connections to community-based resources.

3. Relevant Releases of Information to communicate and coordinate Veteran’s treatment with VA and other community-based service providers.

4. Progress notes for each case management encounter include information regarding progress toward meeting the Individual Service Plan goals.

5. Documentation of Veteran participation in onsite daily structured activities and groups.

6. Updated Individual Service Plans every thirty (30) days from the date of the initial plan, to include any measures of movement toward rehabilitation goals, with particular focus on the attainment of community-based housing.

7. A final discharge summary on each Veteran who leaves the program regardless of character of discharge, to include a description of beneficial changes realized during the residential period, reasons for leaving, the Veteran’s future plans, after-care referrals and connections, and follow up locator information.

C. Contractors will have written policies and procedures in place to address how intoxicated or impaired participants will be identified and managed. Contractors will have written process of how staff are educated on the policies and procedures addressing intoxicated or impaired participants.

D. Contractors will be expected to enter data into a Homeless Management Information System (HMIS) web-based software application and bed totals in the Homeless Inventory Count.

E. The Contractor will be expected to participate in the Lincoln Continuum of Care for the Homeless via entering data as stated above and any other activities focused on meeting the needs of Veterans.

F. During the duration of the contract the contract provider representative or designee and VA Liaison or designee will meet quarterly to review contracted provider’s performance on the applicable VA metrics.

III. 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 will be provided with a copy of the rules at intake or upon Veterans request. In addition, Contractor will post the rules in a location readily accessible to clients and visitors. These rules must include detailed Patient Rights and the procedures that the Contractor has in place to protect the Veterans’ rights and dignity. Veterans must be permitted to exercise these rights without fear of reprisal. If requested, Contractors 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 animals, and all other applicable State or Federal laws. Contractor must equally apply all rules, policies and procedures to Veterans, unless a Veteran has asked for reasonable accommodation due to his/her disability.

IV. 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 will describe the formal appeal procedures through which clients may appeal to 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:

· Contact with VA liaison

· 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

· 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

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

D. ADDITIONAL CONTRACT REQUIREMENTS

The C&A requirements do not apply, and a Security Accreditation Package is not required.

I. PERSONNEL: The Contractor will 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.). 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 by education, training and when required, certification or licensure qualified to provide the Basic Services and Supplemental Services required by this SOW.

Staff Training: Contractor will 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.

· CPR

· First Aid

· Crisis intervention

· Cultural sensitivity

· Sexual harassment

· Sensitivity to wider issues of homelessness

· Universal Precautions (disease transmission prevention)

· Adult abuse/neglect reporting laws

· Harm Reduction philosophy

· Suicide Prevention

· Medication management

· State and Federal Fair Housing Law and ADA Requirements

· Conflict resolution

· Professional Boundaries

· Motivational Interviewing

· De-escalation techniques

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

The 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.

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 15 days before the substitution is to occur. The Contracting Officer shall notify the Contractor within fifteen (15) calendar days after receipt of all required 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 required skills or experience, jeopardizes patient care or interferes with the regular and ordinary operation of the facility.

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.

II. REFERRALS, ADMISSIONS AND ELIGIBILITY: Contractor must utilize an admission process that includes written eligibility criteria that is fair, objective, and compliant with applicable State and Federal laws. This process must include clear procedures for managing waitlists, including how Veterans are added, prioritized, and notified when a bed becomes available. The eligibility information must be made available to clients at intake and staff must provide answers to questions about the admission criteria and process.

Contractor will provide verbal and written notification that is readily accessible to all individuals, upon request, of reasons for non-acceptance. Notification of reasons for non-acceptance is not required to be given to those denied service/housing because of bed unavailability. Contractors must 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.

Contractors are expected to accept and admit Veterans on the same day whenever feasible and must utilize SQUARES to assist in verifying program eligibility. When a referral does not originate from the VA, the Contractor is required to notify the VA Liaison within 24 business hours of the Veteran’s admission to allow the VA to confirm eligibility. The VA is responsible for determining eligibility prior to acceptance whenever feasible and following receipt of Release of Information (ROI), written approval from VA staff—submitted via hard copy, fax, or email—is required for each Veteran referred under the contract. In urgent circumstances where written approval cannot be obtained in a timely manner, verbal approval is acceptable; however, any admission occurring without written or verbal approval must be verified by VA staff within 24 business hours for the Contractor to receive payment for services rendered prior to confirmation, such as admissions occurring after hours or on weekends. The Contractor must obtain written eligibility verification, signed by authorized VA staff, as soon as possible for inclusion in the Veteran’s program file.

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.

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.

The initial stay for a Veteran should be no longer than 90 days. Some Veterans may be considered for up to 180 days depending on the needs of the Veteran as mutually determined by the Veteran, the Contractor’s staff, and HCHV Coordinator or Designee. Any extension of the stay after 180 days must be authorized by the VA Homeless Program Coordinator or Designee, provided that there are clear clinical indication and availability of funds. Only extraordinary circumstances will be considered in order to extend Service periods to excess of 6 months for individual Veterans.

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. To be eligible for placement in emergency contract beds, all Veterans must be homeless or at imminent risk of becoming homeless and be eligible and registered for VA services. Contractors are encouraged to provide housing and or services to special Veteran populations, such as but not limited to the following: medically compromised Veterans, Veterans with sex offender status, 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.

III. Denial of Services: Veterans cannot 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 Domestic Violence 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.

IV. ABSENCES AND CANCELLATION: The Contractor shall notify the VA of unauthorized absences by a referred Veteran from the facility within 24 hrs. 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 48 consecutive hours, provided there is evidence of 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. The provider may not fill the bed. The Veteran must be discharged from the HCHV CRS program if not located within 48 hours. Management of program dropout rate will be an element of quality assurance review of this program. The HCHV Liaison may authorize payment for excused absences up to 96 hours if there is a compelling medical, mental health or programmatic need and the excused absence is verified.

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.

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 required, it is agreed that admission to the appropriate VA facility will be accomplished promptly. The Contractor will plan for admission and support the Veteran with any transportation issues that may arise.

The Contractor shall notify the authorizing VA facility immediately of any incidents involving Veterans residing in the Contract Emergency Residential program. The Contractor shall notify the VA case manager by telephone during the hours of 8:00am and 4:30pm. For all incidents that occur after normal business hours, the Contractor should notify the Administrator on Duty (AOD) and notify the VA Liaison the following business day. The Contractor shall provide the VA Liaison 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.

V. CONTRACTOR STAFF CONDUCT/COMPLAINTS HANDLING: Contractor personnel shall be expected to treat referred Veterans with dignity and respect and abide 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 validating complaints.

VI. BASIC RIGHTS AND PROTECTION AGAINST DISCRIMINATION: Contractors must 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.

· Veterans are entitled to enjoy a safe and healthy environment in the program.

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

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

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

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

· 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 resident’s consent to release information

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

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

· 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

· 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

· 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

VII. REASONABLE ACCOMODATION: 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. 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 to reasonable accommodation. If a 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. The 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 the 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.

VIII. TRANSPORTATION: The Contractor shall assist the Veterans with local transportation to scheduled meetings and appointments. The Contractor will be expected to help the Veteran access public transportation, including providing information and instructions necessary to enable Veterans to utilize public transportation. If assessment by Contract and/or VA Liaison determines that adequate public transportation is not available or appropriate for a Veteran, the Contractor shall arrange for alternative transport by car. Since Veterans without income cannot be responsible for the cost of transportation, the Contractor will be responsible for providing transportation by linking Veteran to transportation/and/or providing transportation for activities needed to achieve goals in the Individual Service Plan.

IX. FACILITY: It is the responsibility of the Contractor to properly maintain its facilities and the VA shall have no responsibility for paying or reimbursing the Contractor for such expenses.

The contract facility must:

· Pass VA NFPA inspection within 60 days of the award of this contract if they have not been previously awarded a contract. Contract will be terminated for convenience if facility does not pass NFPA inspection within 60 days.

· Have a current occupancy permit issued by the local and state governments in the jurisdiction where the facility is located.

· Be in compliance with existing standards of the National Fire Protection Act (NFPA), State and local safety codes, and/or State health and sanitation codes.

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

· Where applicable, be accredited by the State.

· Be equipped with operational air conditioning /heating systems

· Be kept clean free of dirt, grime, mold, or other hazardous substances and damaged noticeably detract from the overall appearance.

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

· Have windows and doors that can be opened and closed in accordance with manufacturers’ standards.

· Have an aggressive on-going plan to address bed bug infestation. This policy must be a part of your written response to this solicitation. On-going bed bug infestation will be grounds for immediate discharge of Veterans from the facility

a. The Contractor facility must meet fire safety requirements, as follows:

· The building must meet the requirements of the applicable residential occupancy chapters of the current version of NFPA 101, National Fire Protection Association's Life Safety Code. Any equivalencies or variances must be approved by VAPAHCS Director

· All residents in the facility must be mentally and physically capable of leaving the building unaided, in the event of an emergency

· Fire exit drills must be held at least quarterly. Residents must be instructed in evacuation procedures. A written fire plan for evacuation in the event of fire shall be developed and reviewed annually. The plan shall outline the duties, responsibilities and actions to be taken by the staff and residents in the event of a fire emergency. Plan should be implemented during fire exit drills.

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

· NFPA 10 Portable fire extinguishers shall be installed at the facility and NFPA will be used as guidance in selection and location requirements of fire extinguishers.

· Requirements for fire protection equipment and systems shall be in accordance with NFPA 101. All fire protection systems and equipment, such as the fire alarm system, smoke detectors, and portable extinguishers, shall be inspected, tested and maintained in accordance with the applicable NFPA fire codes and the results documented.

· The annual inspection by a VA team required by paragraph 7 shall include a fire and safety inspection conducted at the facility unless a review of past Department of Veterans Affairs inspections or inspections made by the local authorities indicates that a fire and safety inspection would not be necessary, in which case the fire and safety inspection may be waived by the VA.

X. INSPECTION OF FACILITY AND PROGRAM: Prior to the award of a contract and annually during the contract term, a multidisciplinary VA team consisting of a social worker, dietitian, a representative of the VA Police, and a Facilities Management Safety Officer, Nursing and/or other subject matter experts as determined necessary by the medical center director or HCHV Coordinator shall conduct a survey of the Contractor’s facilities to be used to provide Veterans food, shelter, and therapeutic services to assure the facility provides quality care in a safe environment. Inspections may also be carried out at such other times as deemed necessary by the Department of Veterans Affairs.

· The Contractor will be advised of the findings of the inspection team. If deficiencies are noted during any inspection, the Contractor will be given a reasonable time (90 days) to take corrective action and to notify the Contracting Officer that the corrections have been made. A contract will not be awarded until noted deficiencies have been eliminated. Failure by the Contractor to take corrective action within a reasonable time (90 days) will be reported to the VA Contracting Officer. If corrections are not made to the satisfaction of the VA, the Contracting Officer will consult with the appropriate officials so that suitable arrangements can be made to discontinue plans to award a contract, or to discharge or transfer patients and to terminate the existing contract, as appropriate.

· The inspection of the Contractor facilities will include inspection for conformity to the current Life Safety Code and will also include the following:

· General observation of residents to determine if they maintain an acceptable level of personal hygiene and grooming.

· Assessment of whether the facility meets applicable fire, safety and sanitation standards.

· Determining whether the facility is in attractive surroundings conducive to social interaction and the fullest development of the resident's rehabilitative potential.

· Observation of facility operations to see if appropriate organized activity programs are available during waking hours (including evenings) and to the degree to which a high level of activity is observed in the facility, such as individual professional counseling, physical activities, assistance with health and personal hygiene.

· Seeking evidence of facility-community interaction, demonstrated by the nature of scheduled activities or by information about resident flow out of the facility, e.g., community activities, volunteers, local consumer services, etc.

· Observation of staff behavior and interaction with residents to determine if they convey an attitude of genuine concern and caring.

· Inspecting the types of meals and other nutrition provided to residents to see if appetizing, nutritionally adequate meals are provided in a setting, which encourages social interaction and if nutritious snacks between meals and bedtime are available for those requiring or desiring additional food, when it is not medically contraindicated.

· Making a spot check of Veterans’ records to ensure accuracy with respect to Veterans’ length of stay and services provided to the Veterans.

· All Department of Veterans Affairs reports of inspection of residential facilities furnishing treatment and rehabilitation services to eligible Veterans shall, to the extent possible, be made available to all government agencies charged with the responsibility of licensing or otherwise regulating or inspecting such institutions.

XI. EMERGENCY PROCEDURES: Contractor will train all staff on emergency procedures and have written protocols that are posted to guide staff response to crises including, but not limited to, manmade and natural disasters, episodes of infectious diseases, physical injury, resident suicide and suicide attempts, overdoses, and domestic or other violence. All contractors’ staff will be trained in emergency procedures and crises including, but not limited to, physical injury, resident suicide attempts, overdoses, and domestic or other violence. Contractor will have staff on site who have had training and orientation in emergency procedures. Contractor will promptly and appropriately respond to the medical/psychiatric problems of clients and staff. There will be first aid equipment and supplies for medical emergencies available at all times. These supplies must be checked regularly to ensure they are up to date and their location in the facility must be clearly marked. Contractor will have all emergency contact numbers posted.

Universal precaution practices are used by Contractor to prevent transmission of diseases and are implemented under the presumption that blood and body fluids from any source are to be considered potentially infectious. Supplies necessary for maintaining universal precautions, such as sharps containers, must be available.

XII. BILLING: Unless specifically excluded in this contract, the per-dem rate established will include the services listed in this document and will also include all services or supplies normally provided to other residents by the facility without extra charge. Payments made by the VA under this contract shall constitute the TOTAL cost of care and housing of the homeless Veterans. Payment is authorized starting from the first day of admission and does not include the day of discharge. Absences of the patient from the facility will not be reimbursed after 24 hours but do not have to be discharged unless the absence is unauthorized and there is no expectation that the Veteran will return to the facility. When a Veteran is admitted to a HCHV CRS program and found to be ineligible for HCHV CRS, VA will pay for a maximum of 4 days from the day of admission to allow the provider and HCHV CRS Liaison time to locate and arrange alternative placement. Failure to make timely invoice submissions will be cause for a request for corrective action and if invoice issues continue to arise it will be grounds for termination for convenience.

Invoices will be electronically submitted to the Tungsten website at https://www.tungstenautomation.com. Tungsten Automation direct vendor support number is 877-489-6135 for VA contracts. The VA-FSC pays all associated transaction fees for VA orders. During Implementation (technical set-up) Tungsten Automation will confirm your Taxpayer ID Number with the VA-FSC. This process can take up to 5 business days to complete to ensure your invoice is automatically routed to your Certifying Official for approval and payment. To successfully submit an invoice to VA-FSC please review “How to Create an Invoice” within the how to guides. All invoices submitted through Tungsten Automation to the VA-FSC should mirror the current submission of Invoice. Clarification of additional requirements should be confirmed with your Certifying Official (your CO or buyer). Payment will only be made for actual services rendered. Payments shall be made monthly in arrears.