P01 Performance Work Statement - Medical Respite Preliminary.docx

PERFORMANCE WORK STATEMENT (PWS)

Health Care for Homeless Veterans Program

1. General Information

1.1. GENERAL: The VA North Texas Health Care System (VANTXHCS) located at 4500 S. Lancaster, Dallas, Texas 75216 has a requirement for a non-personnel services contract to provide care, treatment, and rehabilitative services, including case management services; and Medical Respite Services for the Health Care for Homeless Veterans Programs (HCHV) for up to 6 veterans (male and female per day. The Government shall not exercise any supervision or control over the contract service providers performing the services herein. Such contract service providers shall be accountable solely to the Contractor who, in turn is responsible to the Government.

1.2. Description of Services/Introduction: The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and services necessary to perform Health Care for Homeless Veterans as defined in this Performance Work Statement except for those items specified as Government furnished property and services. The contractor shall perform to the standards in this contract. Note: Under section 38 USC 2031, VA can contract for care, treatment, and rehabilitative services (for eligible veterans) with community-based treatment facilities. VA does not have the authority under 2031 to contract for housing alone; even if VA is also providing care and services to the veterans residing at the contractor’s facility, the contractor must furnish care, treatment and rehabilitative services.

1.3. Background: Through the HCHV program, VA provides supportive services to Veterans experiencing homelessness and facilitates their access to a broad range of medical, mental health, and rehabilitative services. The purpose of this market research is to obtain capability information from interested vendors in surrounding areas within 20 miles of the VA North Texas Health Care System that can provide temporary housing and supportive services in a community-based setting to Veterans with special needs who are experiencing homelessness.

This notice is for market research purposes for quality Medical Respite Care and housing services for the most vulnerable and at-risk homeless Veterans to provides a safe, healthy, and secure setting to promote their rehabilitation goals and discharge to permanent or transitional housing. Services will be provided to VHA healthcare-eligible Veterans who are experiencing homelessness and may be discharging from the VANTXHCS, another medical facility, living on the streets or preparing for planned medical procedures, requiring stabilization prior to and after hospitalization. The contractor will be required to provide a low-barrier therapeutic and rehabilitative social environment and attendant services to address medical rehabilitation, while targeting the underlying factors contributing to homelessness. The contractor will not be required to provide detoxification or other acute level treatment.

1.4. Objectives:

· Clinical Assessment to provide determination of strengths, needs abilities and preference of each Veteran

· Initiation of case management to plan and coordinate the homeless Veteran’s care

1.5. Scope: HCHV Services address the cause and effects of homelessness in a community-based setting that provides direct services in a safe environment that supports recovery and meets the needs of homeless Veterans. Services include short-term residential treatment and recuperative medical and mental healthcare to Veterans (including those who must register as sex offenders) who need an immediate housing placement as they seek permanent housing and/or additional care and services. HCHV services may be responsible for the direct provision of case management and additional care and services. Additional care and services may include, but are not limited to, personal care, benefits acquisition, vocational training and skills development, mental health and/or substance use disorder (SUD) counseling, and assistance with permanent housing placement.

1.6. Period of Performance: The period of performance of this any resultant contract shall be for one base year of 12 months and four 12-month option periods.

1.7. Quality Control: The contractor shall develop and maintain an effective quality control program to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The contractor’s quality control program is the means by which he assures himself that his work complies with the requirement of the contract. As a minimum, the contractor shall develop QC procedures addressing the areas identified in Technical Exhibit -ATTACHMENT TBD, “Performance Requirements Summary.” Within 30 days after contract award, Contractor shall submit electronic copies (compatible with Microsoft Word or PDF) of a comprehensive written QCP to the Contracting Officer (CO) and COR. Contractor shall submit copies of revisions to the QCP to the CO and COR within five working days when changes are made thereafter. After acceptance of the quality control plan the contractor shall receive the CO’s acceptance in writing of any proposed change to his QC system.

1.8. Quality Assurance: The Government will periodically evaluate the contractor’s performance under this contract. Contractor shall provide the Government unrestricted access to facilities and records required to evaluate Contractor’s performance under this contract.

1.9. Recognized Holidays: Contractor shall perform residential services on the following holidays. Contractor shall bear the cost of any overtime and/or holiday pay to which its personnel may be entitled as a result of performing work under this contract. These costs shall not be billed to nor reimbursed by the Government.

Juneteenth

1.10. Hours of Operation: The Contractor shall conduct business at the residential facility 24 hours per day. Admissions will occur at any time as clinically needed from VA HCHV Staff with collaboration from the COR. The Contractor shall at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS. When hiring personnel, the Contractor shall keep in mind that the stability and continuity of the workforce are essential.

1.11. Place of Performance: The work to be performed under this contract shall be performed at the contractor facility within 20 miles of the VA North Texas Health Care System (VANTXHCS), 4500 S. Lancaster, Dallas, Texas 75216.

1.12. Evidence of Insurance Coverage: Before commencing work under this contract, the Contractor shall furnish certification to the CO that the coverage required (General & Professional Liability as well as Workers Comp) has been obtained and such policy shall state, “This policy may not be changed or cancelled without written notice to the VA CO, Network Contracting Office 17 at the CO’s email listed on the contract. Said policy must bear an appropriate “loss payable clause’’ to the United States as its interest may appear. Such evidence of insurance will not be waived.

See VAAR Clause 852.237-7 for amounts.

1.13. Security Requirements: The contractor, its personnel, and its subcontractors shall be subject to the Federal laws, regulations, standards, and VA Directives and Handbooks regarding information and information system security as delineated in this contract.

1.14. Physical Security: The contractor shall safeguard all Government equipment, information, and property provided for contractor use.

1.15. Post Award Conference/Periodic Progress Meetings/Weekly Treatment Group Meetings: The Contractor shall attend any post award conference convened by the contracting activity or contract administration office. The CO, Contracting Officers Representative (COR), Alternate Contracting Officer's Representative (ACOR), and other Government personnel, as appropriate, may meet periodically with the contractor to review the contractor's performance. At these meetings the CO will apprise the contractor of how the Government views the contractor's performance and the contractor will apprise the Government of problems, if any, being experienced. Appropriate action shall be taken to resolve outstanding issues. Contractor shall attend weekly treatment group meetings with the VA COR. All meetings described herein shall be at no additional cost to the Government.

1.16. Contracting Officer Representative (COR): The COR (and if applicable Alternate COR (ACOR)) will be identified by separate letter. The COR monitors all technical aspects of the contract and assists in contract administration. The COR is authorized to perform the following functions: monitor Contractor’s performance of the technical requirements of the contract: perform inspections necessary in connection with contract performance: maintain written and oral communications with the Contractor concerning technical aspects of the contract: issue written interpretations of technical requirements, including Government specifications: monitor Contractor's performance and notifies both the CO and Contractor of any deficiencies; coordinate availability of Government furnished property, and provide site entry of Contractor personnel. The COR is not authorized to change any of the terms and conditions of this contract.

1.17. Key Personnel: The Contractor shall utilize the minimum key personnel named in Section 1.18 to perform the services required under this contract. In the event that any of the personnel named in the proposal are unable to perform the duties of this contract, for any reason such as death, illness, or resignation from the Contractor’s employ, the Contractor shall promptly submit to the CO and COR, in writing, a detailed explanation of the circumstances necessitating the substitution within one business day of the personnel change event. See Attachment D1.

a. The Contractor shall submit to the CO and COR, in writing, a plan for acting/interim coverage of the absent personnel within two business days after the start of an absence expected to last more than three days. This plan shall adequately address maintaining safety, security and service delivery within the program.

b. The Contractor shall email notice of proposed changes of personnel to the COR and include a resume for the proposed substitute, and any other information that may be needed to approve or disapprove the proposed substitution to the CO and COR within 15 business days of the personnel change event. Contractor shall bear the expense of any replacement of personnel it makes. Any substitution of personnel shall be without any increase to the contract price and without delay in the performance or delivery of services to the Government.

c. The Government shall have the right to request replacement of any Contractor or subcontractor employee assigned to work on this contract, if the Contracting Officer determines that the employee does not possess the experience or ability required under the contract, or if said employee is for any other reason found to be unsuitable to perform the work required by the contract. The replacement must meet the Special Qualifications requirements stated in the 1.18. Contractor shall bear the expense of any replacement of personnel directed by the Government. Any substitution of personnel shall be without any increase to the contract price and without delay in the performance or delivery of services to the Government.

1.18. Special Qualifications: The contractor shall ensure all employees possess and maintain current professional certification as described below during the execution of this contract. Contractor shall ensure the following staff performing services under this contract have the following qualifications and meet the following minimum staffing ratios: 1:20.

a. Program Manager – High School Graduation or G.E.D. with a minimum of one year experience providing administrative services in an organization serving clients with social service needs.

b. Clinical Supervisor - licensed in the State of Texas with one of the following: Licensed Professional Counselor, Licensed Marriage and Family Therapist, Licensed Independent Substance Abuse Counselor, Licensed Master of Social Worker or Licensed Clinical Social Worker.

c. Case Manager – Part or full-time onsite case manager with a bachelor’s degree in social services or related field; and a minimum 1-year experience working with individuals that have chronic medical conditions, mental illness, substance use, and/or homelessness.

d. Onsite LVN or Certified Medication/Nurse Aid for 24 hours a day under the supervision of a RN.

e. Registered Nurse (RN) – Onsite as needed and available on call 24 hours a day/7 days a week as needed.

2. DEFINITIONS AND ACRONYMS:

2.1. DEFINITIONS:

2.1.1. ADMINISTRATIVE DISCHARGE. When the Veteran has been transferred to an alternate level of care with concurrence from the COR for medical, mental health, or substance abuse treatment to better meet the Veteran’s clinical needs.

2.1.2. BI-WEEKLY MEETINGS. Taking place every two weeks.

2.1.3. CONTRACTED EMERGENCY RESIDENTIAL SERVICES (CERS). Target and prioritize homeless Veterans transitioning from literal street homelessness, Veterans being discharged from institutions, including those in need of medical respite, and Veterans who recently became homeless and require safe and stable living arrangements while they seek permanent housing. CERS Programs, either directly or through linkage with community and other VA services, provide time-limited services such as supporting mental health stabilization, SUD treatment services, and enhancement of independent living skills, vocational training, and employment services. Emphasis is placed on referral and placement in permanent housing or longer-term residential programs utilizing VA and/or community resources. Lengths of stay in CERS typically range from 30 to 90 days with the option to extend based on clinical need. NOTE: CERS programs represent a consolidation of existing HCHV contract residential programs, previously designated as either residential treatment (RT) or emergency housing (EH). Since varying levels of supportive services have been present in both, as noted above, this consolidation reflects the range and flexibility of these services as currently constituted.

2.1.4. CONTRACTOR. A supplier or vendor awarded a contract to provide specific supplies or service to the government. The term used in this contract refers to the prime contractor.

2.1.5. CONTRACTING OFFICER (CO). A person with authority to enter into, administer, and or terminate contracts, and make related determinations and findings on behalf of the government. Note: The only individual who can legally bind the government.

2.1.6. CONTRACTING OFFICER'S REPRESENTATIVE (COR). An employee of the U.S. Government appointed by the contracting officer to assist with administering the contract. Such appointment shall be in writing and shall state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the contract.

2.1.7. COMMUNITY INTEGRATION. Community integration (CI) refers to a person’s belonging and full participation in society. CI traditionally has been defined by three main areas: employment or other productive activity, independent living, and social activity.

2.1.8. CHRONICALLY HOMELESS. The HCHV program follows the Federal definition of the term “chronically homeless” from section 401 of the McKinney-Vento Homeless Assistance Act, 42 U.S.C. 11360

2.1.9. DEFECTIVE SERVICE. A service output that does not meet the standard of performance associated with the Performance Work Statement.

2.1.10. DELIVERABLES SCHEDULE. A schedule of deliverables associated with the PWS. See ATTACHMENT TBD.

2.1.11. HEALTH CARE FOR HOMELESS VETERANS PROGRAM. The Health Care for Homeless Veterans (HCHV) program is an essential and critical part of VHA, providing a gateway to VA and community-based supportive services for eligible Veterans who are homeless. HCHV programs provide outreach services; care, treatment, and rehabilitative services, including case management services; and therapeutic transitional housing assistance under 38 U.S.C. 2032 in conjunction with Work Therapy under 38 U.S.C. 1718. The program uses Contracted Residential Services (see paragraph 5.d.) in community locations to engage homeless Veterans who have been underserved. Many of these Veterans would benefit from mental health and Substance Use Disorder (SUD) treatment but will not avail themselves of these services without the encouragement of outreach workers.

2.1.12. HOMELESS. The HCHV Program follows the definition of “homeless” in 38 U.S.C. 2002(1) and section 103(a) of the McKinney-Vento Homeless Assistance Act, 42 U.S.C. 11302 (a). NOTE: the term “homeless” or “homeless individual” does not include any individual imprisoned or otherwise detained pursuant to an Act of Congress or state law.

2.1.13. HOMELESS OPERATIONS MANAGEMENT AND EVALUATION SYSTEM. The Homeless Operations Management and Evaluations System (HOMES) is an online data collection system that tracks homeless Veterans as they move through VA’s Homeless Programs. The system streamlines data collection processes and facilitates communication between VA homeless program staff and leadership on the local, regional, and national levels. By providing a centralized data collection system, HOMES enables VA to efficiently and effectively collect and manage access homeless Veteran data. Historically, when a Veteran entered a new VA homeless program or episode of care, homeless program staff would re-enter Veteran data into a program-specific system resulting in duplicated data across separate homeless program systems. Further, these systems did not share information about the Veteran and the care received. The HOMES system allows for single entry of Veteran data and satisfies program operations, management, and evaluation requirements. Any entry into the system is available to all homeless staff across all Veteran Integrated Service Networks (VISN). HOMES is designed so that critical data elements are compatible with HUD’s Homeless Management Information System (HMIS), allowing VA and HUD to meet the goals of integrating community and VA data into a single Registry.

2.1.14. HOMELESS MANAGEMENT INFORMATION SYSTEM. The Homeless Management Information System (HMIS) is a computerized data collection tool specifically designed to capture client level information over time on the characteristics and service needs of men, women, and children experiencing homelessness and the services provided to them. HMIS implementations can encompass geographic areas ranging from a single county to an entire state and are administered locally within the community (Continuum of Care) by one lead agency that is responsible for standards and privacy compliance, as well as HUD reporting and other funder required aggregate reporting.

2.1.15. KEY PERSONNEL. Contractor personnel that are evaluated in a source selection process and that may be required to be used in the performance of a contract by the Key Personnel listed in the PWS.

2.1.16. LOW DEMAND SAFE HAVENS (LDSH) are 24-hour staffed transitional residences with private or semi-private accommodations, that target the population of hard-to-reach, chronically homeless Veterans with mental illness and/or substance use problems who require a low-demand environment. The low-demand or non-intrusive environment is designed to re-establish trust and motivate the homeless Veteran to seek needed treatment services and transitional and permanent housing options. Lengths of stay in LDSH programs are typically 6 months with the option to extend based on clinical need.

2.1.17. MEDICAL RESPITE. Medical respite refers to acute and post-acute medical care provided for homeless persons who are too ill or frail to recover from a physical illness or injury independently, but who are not ill enough to be in a hospital. Unlike “respite” for caregivers, “medical respite” is short-term residential care that allows homeless individuals the opportunity to rest in a safe environment while accessing medical care and other supportive services. Medical respite care can be offered in a variety of settings including freestanding facilities, homeless shelters, nursing homes, and transitional housing. The care can be provided through any one of a number of different models, including a visiting care team (e.g., visiting nurses, rotating teams), an in-house clinical team, and/or in direct consultation with an established care team at a medical facility in such a way that therapeutic care can be provided, and a treatment plan can be carried out at the respite facility.

2.1.18. NEGATIVE DISCHARGE. a.) the Veteran left the program by his/her own decision, without consulting staff; b.) the Veteran was asked to leave because of violation of program rules or failure to comply with program requirements (not including those who were asked to leave due to threatened/actual violence to self or others). This measure is set by VHA Homeless Program and can change yearly.

2.1.19. PERFORMANCE REQUIREMENTS SUMMARY. The contractor service requirements are summarized into performance objectives that relate directly to mission essential items. The performance threshold briefly describes the minimum acceptable levels of service required for each requirement. These thresholds are critical to mission success. See ATTACHMENT TBD

2.1.20. PHYSICAL SECURITY. Actions that prevent the loss or damage of Government property.

2.1.21. POSITIVE DISCHARGE. The Veteran has been successfully placed as anticipated in permanent housing (housing owned or rented by Veteran, with or without subsidy, and those who move in with friends or family on a permanent basis). This measure is set by VHA Homeless Program and can change yearly.

2.1.22. QUALITY ASSURANCE. The Government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

2.1.23. QUALITY ASSURANCE Surveillance Plan (QASP). An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

2.1.24. QUALITY CONTROL. All necessary measures taken by the Contractor to assure that the quality of an end product or service shall meet contract requirements.

2.1.25. RECOVERY MODEL. The recovery model is centered on the belief that it is possible for homeless Veterans with mental health conditions to re-establish normal roles in the community. The recovery model fully supports community integration and improved quality of life for Veterans who have been diagnosed with a serious mental health condition that impairs their ability to lead meaningful lives. Within this model, psychiatric rehabilitation services are collaborative and encourage the Veteran’s self-determination.

2.1.26. SUBCONTRACTOR. One that enters into a contract with a prime contractor. The Government does not have privity of contract with the subcontractor.

2.1.27. SUPPORTIVE HOUSING. Supportive Housing is a combination of housing and services intended as a cost-effective way to help people live more stable, productive lives. Supportive housing is widely believed to work well for those who face the most complex challenges—individuals and families confronted with homelessness and who also have very low incomes and/or serious, persistent health issues. Supportive housing can be coupled with social services such as job training, life skills training, alcohol and drug abuse programs, community support services, and case management. Supportive housing is intended to be an efficient, pragmatic solution that improves quality of life and, to the extent feasible, reduces the overall cost of care.

2.1.28. SUPPORTIVE SERVICES. Supportive Services encompass a range of services that assist an individual in the transition from the streets or shelters into permanent or permanent supportive housing and that assist persons with living successfully in housing. Examples of supportive services include but are not limited to: assistance in securing permanent housing; vocational assistance, including mentoring and coaching as well as job placement; income assistance and financial planning; relapse prevention; and social and recreational activities.

2.1.29. TREATMENT TEAM. Treatment team includes: VA HCHV Social Worker, VA HCHV Program Manager/Supervisor, HCHV Advanced Practice Registered Nurse, Contractor Program Manager, and Contractor Case Manager.

2.1.30. UNACCEPTABLE DISCHARGE. When: a.) the Veteran is discharged to a homeless shelter or drop in setting after a length of stay greater than seven (7) days from the date of admission unless there is concurrence from the COR that there is no other alternative due to circumstances beyond the Contractor’s control; b.) the Veteran is discharged to the streets at any point in time after the date of admission under any circumstances.

2.1.31. VETERAN. A Veteran, for the purpose of HCHV programs, is a person who served in the active military, naval, or air service, and who was discharged or released under conditions other than dishonorable and is enrolled or eligible for VA health care under 38 CFR 17.36 or 17.37. An eligible veteran must meet the criteria specified in 38 CFR 63.3 to qualify for benefits under the HCHV program.

2.1.32. WORK DAY. The number of hours per day the Contractor provides services in accordance with the contract.

2.1.33. WORK WEEK. Monday through Friday, unless specified otherwise.

2.2. ACRONYMS:

3. GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND SERVICES

3.1 Veterans will be screened for entry to HCHV Contracted Residential Services Level 1 Medical Respite to determine medical and psychiatric stability and their suitability for entry to the program by VA HCHV Staff.

3.2 Services: The Government will provide a VA Case Manager who will be delegated as the primary COR to ensure psychosocial needs are met and to facilitate assistance with an appropriate Contracted housing placement. The COR will meet with Contractor weekly or bi-weekly for treatment group meetings to review Veteran treatment plans.

a. The VA will obtain an initial Release of Information (ROI) from each Veteran for any information requested by outside parties during the Veteran’s participation in the program.

b. Appropriate VA services must be coordinated by the VA HCHV program staff, as indicated, for aftercare or re-engagement regardless of exit circumstances.

3.3 Materials: VA Assessment and Treatment forms and documentation training (estimate of one hour), initial assessment, initial and recurrent treatment plan, and ongoing consultation regarding evidence-based therapies approved by the VA.

3.4 The VA will provide a Housing Liaison with LCSW credentials and NP/PA.

3.5 The VA will have an assigned nurse practitioner or physician assistant to conduct the initial veteran assessment and follow up with veterans and contractor personnel as needed for veterans’ care.

4. CONTRACTOR FURNISHED ITEMS AND RESPONSIBILITIES:

4.1 General: The Contractor shall furnish all supplies, equipment, facilities and services required to perform work under this contract that are not listed under Section 3 of this PWS.

4.2 Provide Treatment Services and Documentation of Services. Contractor shall provide the Medical Respite Services described in the Performance Work Statement as outlined below.

4.3 Residential Care Facilities: The Contractor shall have site control of the residential care facility through ownership or valid lease. VA will conduct an inspection that Contractor sites must pass prior to contract award and annually 60 days prior to an option period being exercised. VA reserves the right to inspect any facility and associated services at any time under the terms of this contract.

a. Contractor shall ensure its facilities are licensed as required for the particular setting and meet all applicable local, state, and Federal requirements concerning licensing and health codes. Contractor shall provide copies of valid licenses to the VA at the time of pre-inspection and during annual inspection reviews. Where applicable, the facility must have a current occupancy permit issued by the authority having jurisdiction.

b. Contractor shall meet all the standards referenced in the Health Care for Homeless Veteran (HCHV) Contracted Provider Inspection Form provided by the VA.

c. Contractor shall provide space for Veteran to engage in any home health, physical therapy, speech, and occupational therapy services.

d. Contractor shall ensure its facilities meet the following standards:

i. NFPA 101: Life Safety Code. This code can be located at http://www.nfpa.org/aboutthecodes/AboutTheCodes.asp?DocNum=101# or within the published NFPA 101: Life Safety Code, 2012 edition

ii. Americans with Disabilities Act (ADA) to include facility safety and accessibility requirements of the disabled, see www.ada.gov. This also includes meeting standards for certified service dogs in the facility, see current standards at www.ada.gov/service_animals_2010.htm. Service Dog owner is responsible for supervision, care and feeding of animal.

e. Contractors shall provide the following to each Veteran referred and admitted to the Contract Residential Care facility:

i. Sleeping accommodations that are safe and accessible to Homeless Veterans, particularly of vulnerable target populations such as the geriatric community that may have issues with things such as climbing stairs and ladders, along with a designated single standing bed with a mattress that is used exclusively by the individual Veteran from the time of admission to the time of discharge. This bed must be situated in a private or semi-private room that affords the Veteran safety, privacy and security. Appropriate linens/bedding for the bed including a pillow.

ii. A nightstand for personal effects.

iii. Closet space sufficient to hang clothing.

iv. A Chest of Drawers with sufficient drawer space to hold Veteran clothing/personal effects.

v. A safe and securely locked place for each Veteran to store his/her belongings that is readily accessible to the Veteran (such as a locking closet, a locking armoire, a locker, etc.). This securely locked space must be of sufficient size to contain a 17” laptop and/or other valuables/ medications. The locked space must also be permanently mounted in the facility so as not be easily removed from the facility.

vi. Laundry facilities (including detergent and dryer sheets/fabric softener) for Veterans to do their own laundry or laundry services provided as part of the Veteran’s stay in the residential care program (at no cost to the Veteran).

f. Contractor shall provide appropriate safety and security in all common areas, such as lounges, laundry rooms, shared kitchens, group rooms, entrances and exits, and hallways, through active monitoring. Monitoring may be done through video surveillance or frequent security staff observation (1–2-hour checks for staff observation). No video surveillance in private areas such as bathrooms or sleeping areas.

g. Sanitary procedures shall be established by the Contractor. Veterans are to be taught such procedures and encouraged to follow them. Many Homeless Veterans need to be taught how to successfully keep their own residence clean after successful transition to stable housing. Contractor shall encourage Veterans to engage in the cleaning and upkeep of the facility. Such encouragement should be limited to Veteran’s clinical abilities. The Contractors staff is responsible for ensuring a clean and sanitary living environment. The VA COR may perform random checks to ensure cleanliness.

h. Contractors shall provide a safe environment for all Veterans. These policies and procedures must be communicated to Veterans both verbally and in writing in a manner that is understandable to them upon admission to the facility. This communication must be documented in the Veteran’s record by the Contractor. The following situations are to be enforced and addressed with the Veteran:

i. Suspected or known drug or alcohol use or relapse by one or more Veterans;

ii. On-site contraband, weapons (including props or souvenirs that appear to be weapons), drugs, alcohol, or related paraphernalia;

iii. On-site drug or alcohol testing methods (i.e., urine drug screens, breathalyzers, etc.) and frequency;

iv. Safe prescription medication storage and handling, including specific provisions for prescribed controlled substances;

v. Safe prescription medication access, including specific provisions for safe disposal of medications and syringes;

vi. Assertive monitoring of controlled substances, including but not limited to signing in medications after receipt from pharmacy with an observed pill count by Contractor staff when clinically warranted; staff observation and recording of taking of controlled substances and other medications by Veterans when clinically warranted;

vii. Room inspections and daily bed checks of Veterans residing in the program, including methods and frequency. Daily tracking and documentation of Veteran’s presence in the program at least once daily. If a Veteran has not been confirmed present in any one 24 hour period, the Contractor shall notify the COR immediately;

viii. Grievance process to address Veteran complaints with time frames for responses from the Contractor’s program/facility management;

ix. Veteran abandonment of belongings in the facility, including time frames and procedures for disposal

x. Process to elicit Veteran satisfaction with the facility and onsite services, including information collection methods and frequency, and process for utilizing the information for continual performance improvement purposes.

i. The HCHV CRS contract provider is responsible for providing a sanitary food preparation area, supply food sufficient for at least three nutritious meals 7 days a week, and snacks of nourishing quality (e.g., fruits, vegetables, protein sources), between meals and bedtime. This is to include alternative meals or food supplies 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). Contractors shall ensure that all food, whether purchased by Veterans or provided by Contractor, is stored, handled and served in a safe and sanitary manner that meets accepted industry standards and guidelines.

The VA has particular concern for chronically homeless Veterans, many of whom are either undernourished or have developed poor eating habits or both, because of extended homelessness, chronic medical, mental health or substance abuse disorders. The Contractor shall ensure such Veterans are getting adequate nutrition.

0. Contractor shall maintain a printed menu or list of food items provided weekly. Contractor shall provide a VA dietitian or the COR access to these menus at any time.

1.The Contractor shall develop a process to elicit Veteran feedback for the snacks and meals provided by the Contractor. The process will include information collection methods and frequency, and a process for utilizing the information for continual performance improvement purposes.

2. The VA dietitian or the COR may assess Veterans’ feedback with Contractor provided meals and snacks to determine the Contractor’s success in meeting the requirement to provide satisfying and nutritious meals during annual facility inspection or at any point during the contract period.

4.4 Contractor shall document all clinical information in accordance with CARF Standards as outlined in 5.2 Treatment Services and Documentation of Services.

4.5 Veterans will be screened and referred to the contractor by the HCHV Clinic and Homeless Mobile Medical/Mental Health Vehicle (HMMMV)Team. Excepting lack of available beds, the contractor will be expected to provide admission to the residential care facility, 24 hours per day, 7 days per week, and associated treatment services to these Veterans. The date of admission must be approved by the COR for billing purposes. Engagement of homeless Veterans in the provision of case management, housing placement planning, and psychosocial treatment services is a key element of the program. Therefore, management of program dropout will be an element of the quality assurance review of this program.

4.6 Veterans in the HCHV program will ideally be placed in other transitional or permanent housing suitable for the Veteran within 60 to 90 days from the date of admission, but not more than 180 days from the date of admission. Contractors may not bill a fixed daily charge for Veterans whose length of stay exceeds 180 days from the date of admission without prior written approval from the COR. The COR will not approve fixed daily charges for lengths of stay exceeding 180 days from the date of admission unless:

a. There are extenuating clinical circumstances beyond the contractor’s control that are barriers to the Veteran’s placement in housing; and/or

b. There is documented evidence that the contractor has exhausted every effort to place the Veteran in housing sooner; and

c. The COR has been appropriately advised of these efforts well in advance of the 180-day limit; and

d. The COR concurs that the Veteran will continue to derive therapeutic benefits from a continued stay at the HCHV Contracted Residential Care facility.

4.7. In the event that a Veteran’s length of stay exceeds 180 days from the date of admission and there is not approval from the COR for continued treatment, the contractor will retain the responsibility for finding suitable transitional or permanent housing in the community at its own expense and the veteran will be discharge from the VA program.

4.8. Veterans may be discharged from HCHV Contract Residential Care programs for positive, negative or administrative reasons. The date of discharge must be approved by the COR for billing purposes. The Contractor shall provide discharge planning and referrals for each Veteran, regardless of character of discharge from the facility to appropriate community resources and services based upon a team assessment of health, social and vocational needs and the involvement of Veterans’ families as appropriate. Discharges will be accomplished in collaboration with the COR to ensure appropriate resources are offered to Veteran. Veterans who engage in an episode of violence or threaten violence against staff or other Veterans must be discharged immediately to maintain the safety of the facility.

Discharges will be characterized as follows:

a. Positive Discharge – the Veteran has been successfully placed as anticipated in permanent housing (housing owned or rented by Veteran, with or without subsidy, and those who move in with friends or family on a permanent basis). This measure is set by VHA Homeless Program and can change yearly.

b. Administrative Discharge – the Veteran has been transferred to an alternate level of care with concurrence from the COR for medical, mental health, or substance abuse treatment to better meet the Veteran’s clinical needs.

c. Negative Discharge – a.) the Veteran left the program by his/her own decision, without consulting staff; b.) the Veteran was asked to leave because of violation of program rules or failure to comply with program requirements (not including those who were asked to leave due to threatened/actual violence to self or others). Please note: This measure is set by VHA Homeless Program and can change yearly.

d. Unacceptable Discharge – a.) the Veteran is discharged to a homeless shelter or drop in setting after a length of stay greater than seven (7) days from the date of admission unless there is concurrence from the COR that there is no other alternative due to circumstances beyond the Contractor’s control; b.) the Veteran is discharged to the streets at any point in time after the date of admission under any circumstances. The performance goal is zero (0) occurrences.

4.9 Special Care Provisions for Female Veterans: Contractor shall give special attention to meeting the unique treatment needs of homeless women Veterans. These needs often may include assistance with managing sexual trauma, eating disorders, interpersonal violence, and caring for dependents while in treatment.

a. Contractor shall ensure that women Veterans have access to female clinical staff (whether from the Contractor, VA or other community partner) for additional gender-specific treatment and/or supportive services as needed.

b. Contractor shall maintain and adjust environments to support the safety, security, privacy and services for women Veterans. Contractor shall place special emphasis on privacy and security in mixed-gender facilities. Veteran residents have a right to be treated with dignity in a humane environment that affords them both reasonable protections from harm and appropriate privacy with regard to their personal needs. The Contractor shall ensure that the living environments include:

i. Residential room and board in an environment that promotes a lifestyle free of sexual discrimination.

ii. An environment conducive to social interaction, supportive of recovery models and the fullest development of the resident's rehabilitative potential regardless of gender or sexual orientation.

iii. If housed with males provide separate and secure bathroom arrangements to ensure an acceptable level of privacy for personal hygiene and grooming.

4.10 Medication Storage and Monitoring: Contractor shall provide appropriate space and security for the storage of medications. Contractor shall ensure there are appropriate policies and procedures that support the safe storage of medications for Veteran residents. This storage can be provided to the Veteran to secure his or her medications, or central storage can be provided by the Contractor.

a. Contractor shall have written procedures that address storage while providing access to medications and safe disposal of medications and syringes. Contractor shall ensure that Veterans residing in the program are educated about these procedures and the importance of safely storing their medications.

4.11 Personal Care Services: Contractor shall provide personal care services to those Veterans identified as needing minimal/short term assistance with ADLs and IADLs and include the service as part of the Veteran’s treatment plan.

5. SPECIFIC TASKS: Contractor shall perform the following tasks:

5.1 Obtain a Release of Information (ROI) from Veteran for any information requested by outside parties during the Veterans participation in the program if applicable.

5.2 Ensure all documentation is in accordance with the current CARF standards.

5.3 Inform COR in writing within 24 hours of Veteran’s admission to the program.

5.4 Provide Clinical Assessments within seven days of admission to determine strengths, needs, abilities and preferences of each Veteran and/or services to include:

a. History of homelessness

b. Mental health history

c. Physical health history

d. Substance use history

e. Social history

f. Education, vocation, and income history

g. Legal history

h. Strengths and Needs

i. Abilities and Preferences

j. Barriers/Vulnerabilities

k. Military History

l. Trauma History

m. Suicide Risk Assessment

5.5 Provide on-site drug or alcohol testing methods (i.e., urine drug screens, breathalyzers), when clinically appropriate or when requested by the COR.

5.6 Provide Case Management to plan and coordinate the homeless Veteran’s care. At a minimum Case Management Services will include the following:

a. Working toward the rapid placement of the Veteran in a safe setting, with an emphasis on utilizing “housing first” approaches wherever possible.

b. Arranging, coordinating, and/or providing direct clinical services (enrollment, assessment, treatment plan, reassessment) and support.

c. Using Recovery Model principles.

5.7 Assistance with ADLs (bathing, grooming, eating, dressing, toileting, mobility and transfers) and IADLs (meal preparation, laundry, money management, housekeeping, shopping, transportation, medication management) as needed by the Veteran.

5.8 Provide the following brief therapeutic interventions in an individual or group setting as clinically indicated: Trauma Informed Care, Motivational Interviewing, psychosocial education, life skills, sober living skills, psychotropic medication education, or other clinically relevant interventions to assist Veterans in managing negative mental health symptoms. Coordinate outpatient mental health services with VA and community providers, ensuring transportation to appointments and monitoring treatment compliance. Identify and assess mental health crisis and implement appropriate therapeutic interventions to include collaborating with emergency services, local hospitals, VA mental health providers, community mental health agencies, Veterans Crisis Line, and notifying the VA Housing Liaison. The goal in utilizing the above skills/interventions is to provide an environment in which Veterans can successfully transition into stable permanent housing after the Veteran has reduced the impact of negative mental health symptoms and improved their ability to successfully live independently.

5.9 Contractor will take primary responsibility for assisting Veterans in completing housing applications and benefits paperwork as needed. Including benefits to pay for a higher level of care if Veteran is unable to live independently. Contractor will assist Veterans in obtaining the needed documentation required for complete housing and benefits applications including but not limited to, birth certificates, driver’s license, income verification and any additional information required by housing resources and potential income supports.

5.10 If needed, Contractor will accompany Veterans to housing interviews, medical appointments, and other appointments as needed while working with Veterans to foster independence and a sense of self-determination. Also, Contractor will assist Veterans in obtaining transportation to attend appointments at the VA, potential housing placements, benefits agencies, meetings with landlords, etc. This assistance may include providing transportation, helping Veterans to obtain bus fare, or local subsidized transportation services as a part of the case management process.

5.11 Provide Treatment Services and Documentation of Services provided in Veteran’s record: Address the needs of special populations which may include women, EF/OIF/OND, SMI, and chronically homeless.

5.12 Provide routine updates to the Initial Treatment Plan developed in conjunction with the VANTX HCHV and HMMMV Teams. Individual treatment plan shall include specific goals, measurable objectives, targeted dates for completion, a designated responsible individual for addressing each goal. Plans may include goals that:

a. Improve the Veteran’s safety.

b. Assist the Veteran’s overall physical and mental status and promote a healthy lifestyle

c. Instill hope

d. Increase employability or increase income, or improve income management

e. Improve the Veteran’s overall quality of life

f. Improve the Veteran’s self-esteem, self-efficacy, and independence

g. Assist the Veteran in achieving an optimal level of psychosocial functioning

h. Provide support services aimed at the prevention of homelessness

5.13 Provide progress notes that document the following:

a. Progress toward the Veteran’s goals

b. Veteran’s participation in treatment

c. Services provided

d. Changes to treatment or service plan

e. Suicide Risk assessment

5.14 Provide program exit summary to COR, in writing, within 24 hours of termination from the program for each episode of care. Medical care and services provided, and recommendations for follow-up care, shall be documented in this exit summary, which shall include at minimum:

a. Date of Exit

b. Type of Exit

c. Veteran’s perception of exit and agreement with exit

d. Status of Treatment goals at…