P09_PWS_CERS_Lebanon_DRAFT.docx

Performance Work Statement (PWS) Contracted Emergency Residential Services (CERS) for Homeless Veterans

1.0 Description:

The Department of Veteran Affairs Medical Center, 1700 South Lincoln Ave, Lebanon, PA 17042, (Lebanon VAMC) requires contractors to provide services as part of its Community Based Health Care for Homeless Veterans (HCHV) program, in accordance with VHA Handbook 1162.09. 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 therapeutic services to meet the needs of those Veterans. Lebanon VAMC is seeking to award a five-year Indefinite Delivery / Indefinite Quantity (IDIQ) contract.

Contracted Emergency Residential Services (CERS) programs 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 low demand time-limited services such as supporting mental health stabilization, Substance Use Disorder (SUD) treatment services, 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 90 to 180 days with the option to extend based on clinical need.

2.0 Contract Definitions: (Please put the definitions in alpha order)

3.0 Program Requirements:

The contractor shall provide services to Veterans for whom such care is specifically authorized by the VA. The contractor shall provide residential placement and supportive services sufficient to place up to 10 Veterans under the Health Care for Homeless Veterans (HCHV) program, for the period of December 01, 2022 through November 30, 2027, in accordance with all terms and conditions, provisions and requirements listed herein for the all-inclusive rate. This rate is inclusive of all services as may be necessary in the treatment of the Veteran to include transportation to healthcare appointments and meetings. Unless specifically excluded in this contract, the per diem rate established will include the services listed in this document and will also include all services normally provided other residents by the facility without extra charge. The contractor facility will not be used for detoxification or other hospital level treatment. The contractor facility shall be located within our nine-county catchment and within a 60-mile radius of the Lebanon VA Medical Center.

3.1 The contractor shall furnish services to Veterans for whom such care is specifically authorized by the VA. It is understood that the type of residents to be cared for under this contract will normally require care and services over and above the level of room and board. Many of these Veterans who are homeless or who are at risk for homelessness have co-morbid conditions that include mental illnesses, substance abuse disorders, and/or medical conditions. This contract is designed to serve homeless Veterans in need of immediate placement and/or emergency housing in a safe environment.

3.2 The contractor shall furnish each Veteran authorized care under this contract with the following basic services:

a. Room and Board, including menus listing three (3) nutritionally adequate meals a day, seven (7) days a week and the availability of nutritious snacks between meals and at bedtime for those requiring or desiring additional food, when it is not medically contraindicated. Supplemental menus shall be provided for those with dietary restrictions.

b. Laundry facilities for Veterans to do their own laundry or to have laundry done.

c. Therapeutic and Rehabilitative Services determined to be needed by the individual Veteran in a plan developed by the contractor with input from the Veteran and the Lebanon VAMC-HCHV case manager. Services, which the contractor must be able to furnish, include:

(1) Structured group activities, including physical activities as appropriate.

(2) Instruction in and assistance with health and personal hygiene

(3) Provision of locked drawers for storage of medication.

(4) Supportive social services, in collaboration with the Lebanon VAMC-HCHV case managers, or other contract resources.

(5) Individual professional counseling, by a properly qualified individual who possesses a degree, license, or certification, including counseling on self-care skills and adaptive coping skills.

(6) Assistance in learning and development of responsible living patterns to achieve a more adaptive level of psychosocial functioning, upgraded social skills, and improved personal relationships.

(7) Support for an alcohol/drug abuse free lifestyle by maintaining a drug and alcohol-free environment.

(8) Assistance in learning, testing and internalizing knowledge of the illness/recovery process for homelessness. Assistance to gain and to apply knowledge of the illness/recovery process in an environment supportive of recovery models.

(9) Assistance with provision of transportation to health care at the Lebanon VAMC and other medical appointments.

3.3 The contract facility must have a current occupancy permit or license required by the authority having jurisdiction.

3.4 Unless specifically excluded in this contract, the per diem 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. Payment is authorized starting from the first day of admission and does not include the day of discharge. The Contractor will submit billing to Austin Payment Center by the 10th business day of every month. The sign-in logs must be submitted monthly with the invoice. Failure to make timely invoice submissions will be cause for a request for a corrective action.

3.5 The contractor shall employ sufficient personnel to carry out the policies, responsibilities, and the program for the facility. The CERS must have an administrative staff member or designee of equivalent professional capability on duty on the premises or residing at the house and available for emergencies 24 hours a day, seven (7) days a week. Multiple residential buildings will require additional on-site personnel to ensure each building has 24 hours a day supervision. In those instances where a supervised residential setting is linked to a geographically distinct rehabilitation and/or socialization day program, sufficient professional counseling personnel must be identified to provide the necessary therapeutic activities and to ensure a meaningful integration of these efforts with those provided in the residential setting. Any professional counseling provided by the contractor shall be performed by a properly qualified individual who has a degree, license, or certification in this skill.

3.6 All critical incidents will be reported to the VA liaison or Designee within 24 hours. This includes the following:

a) Falls

b) Assault (to Veteran or Staff)

c) Elderly/Dependent Adult Abuse or Neglect

d) Sexual Assault

e) Fire (Veteran Involved)

f) Medical/Psychiatric Emergency (911 Calls)

g) Hospitalization

h) Suicide or Suicide Attempt

i) Homicide

j) Death

k) Drug/Police Raid

l) Medication Problem

m) Infectious Control (bed bugs, TB, etc.)

n) Active Substance Abuse

o) Observation/ Possession of Weapons

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 make arrangements 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 a referred Veteran. The Contractor shall notify the VA Liaison by telephone during business hours. For all incidents that occur during non-business hours, the Contractor must 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.

3.7 The contractor shall make available to the Lebanon VAMC-HCHV staff, documentary information deemed necessary by the Lebanon VAMC to conduct utilization review audits for the mandated national evaluation study as required by the Section 2 of Public Law 100-6; to verify quality of resident care for Veterans, to assure confidentiality of resident record information and to determine the completeness and accuracy of financial records.

3.8 The contractor shall conduct treatment and discharge planning reflecting a team assessment of health, social, vocational needs, involvement of the Veteran, Lebanon VAMC-HCHV staff, and appropriate community resources in resolving problems and setting goals.

3.9 Absences shall be managed using the following guidance:

a. Scheduled/Approved Absences: If the Veteran is on scheduled/approved and/or deemed in-line with treatment goals, the contractor can only bill for the first 72 hours of the absence.

b. Unscheduled/Not Approved: If the Veteran is on unscheduled/not and/or deemed in-line with treatment goals, the Veteran must be discharged after 24 hours and is considered AWOL (absent without leave). The contractor can bill for the 24-hour period that they held the bed in good faith anticipating the Veteran’s return. Notification must be made to Lebanon VAMC within one business day.

3.10 The facility agrees and warrants that it does not maintain nor provide dual or segregated patient facilities, which are segregated on the basis of race, creed, color, or national origin. The facility may neither require such segregated use by written or oral policies nor tolerate such use by local custom. The term "facilities" shall include but not limited to rooms, wards, sections, eating areas, drinking fountains, entrances, etc.

3.11 The facility agrees to accept referral of and to provide all services specified in this contract for any Veteran regardless of race, color, religion, sex, or national origin determined eligible by the Lebanon VAMC-HCHV designee for whom such services are required. In addition, the Lebanon VAMC warrants that subcontracting will not be resorted to as a means of circumventing this provision. The contractor agrees to accept referrals and provide services 24 hours per day, seven days per week. The contractor will make available at least one housing unit for females, assuring their privacy and safety, and at least one unit and all common living areas should be handicapped accessible.

3.12 It is agreed that the Lebanon VAMC-HCHV staff will have complete access to all records concerning the Veteran's care in the facility. It is agreed that duly authorized representatives of the Lebanon VAMC will provide follow-up supervision visits to Veterans placed to assure the continuity of care and to assist in the Veteran's transition back into the community. It is understood that these visits do not substitute nor relieve the contractor in any way of the responsibility for the daily care and treatment of the Veteran.

3.13 It is understood that the Veteran may be provided facility care at the expense of the Lebanon VAMC for a period not to exceed that stated in the length of treatment plan contracted unless an extension of the authorization is provided in writing by the Lebanon VAMC-HCHV staff.

3.14 The contractor facility shall provide the Veterans with transportation to scheduled meetings and appointments at medical facilities including but not limited to the Lebanon VAMC, and/or the local Community Based Outpatient Clinics (CBOC) at Mechanicsburg, Lancaster, Berks, York, and Schuylkill, and assistance with information and instructions to Veterans so they can utilize public transportation if that is their preference.

3.15 The contractor facility shall not accept food stamps or welfare from Veterans.

3.16 The contractor facility warrants that all applicable fire laws are being complied with and there are no recommendations by fire officials, which have not been resolved.

3.17 The Lebanon VAMC reserves the right to remove any or all Veteran residents from the facility at any time without additional cost, when it is determined to be in the best interest of the Lebanon VAMC or the Veteran(s).

3.18 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 17.33.

3.19 It will be the responsibility of the Lebanon VAMC-HCHV case manager to refer all homeless Veterans to the contractor(s). The Veteran’s status will be homeless or at risk for homelessness and he/she may have co-morbid conditions that include mental illnesses, substance abuse disorders, and/or medical conditions.

3.20 Before referring any Veteran, the Lebanon VAMC-HCHV case manager shall have provided the patient with a clinical assessment to include a physical, laboratory studies, and confirmation of co-morbid conditions by Lebanon VAMC clinical staff.

3.21 All Veterans shall be capable of self-preservation, and in an emergency, will have sufficient capacity to recognize physical danger, sufficient judgment to recognize when such danger requires immediate egress from the group residence, sufficient capacity to follow a prescribed route of egress, and sufficient physical mobility to accomplish such egress.

3.22 Length of stay at Lebanon VAMC cost will be initially authorized for up to six (6) months (authorization will not exceed contract performance period), depending upon the needs of the Veteran, as mutually determined by the Veteran, the contractor’s residential treatment staff, and VAMC-HCHV case manager.

3.23 INSPECTION AND ACCEPTANCE

a. It is agreed that the Lebanon VAMC will have the right to inspection of the CERS and all appurtenances by authorized representative(s) designated by the Lebanon VAMC. The contractor will be advised of the finding of the inspection team. If deficiencies are noted during any inspection, the contractor will be given 30 days to take corrective action to notify the Contracting Officer that the corrections have been made. A contract will not be awarded until noted deficiencies have been eliminated.

b. Prior to the award of a contract, a multidisciplinary Lebanon VAMC team consisting of a social worker, dietitian, and an engineering service safety officer shall conduct a survey of the contractor’s emergency residential center. Contracted Emergency Residential Service centers to be utilized will be restricted to community-based facilities that provide food, shelter, and therapeutic services in a supportive environment.

c. In the cases of complexes of non-VA community facilities, it is imperative that all components of the program be inspected by the Lebanon VAMC team prior to award of the contract as is required for an integrated primary site. Each of the community facilities identified in the complex as contract recipients will also be subject to the requirement for contracting, safety, and record keeping described in other parts of this document as applying to the CERS.

d. The Lebanon VAMC Safety Officer will inspect the facility for conformity to the current National Fire Protection Association Life Safety Code and submit findings to the chairperson of the Lebanon VAMC team. The other team members will focus on an assessment of the quality of life within the CERS, giving particular attention to the following factors:

(1) General observation of residents indicates that they maintain an acceptable level of personal hygiene and grooming.

(2) The facility meets applicable fire, safety, and sanitation standards in attractive surroundings conducive to social interaction and the fullest development of the resident's rehabilitative potential.

(3) The facility should be in a central location, near public transportation, and near areas which provide employment.

(4) Appropriate organized activity programs during waking hours (including evenings) reflecting a high level of activity in the facility or in the linked facilities, for example individual professional counseling, physical activities, assistance with health and personal hygiene.

(5) There is evidence of facility-community interaction. This may be 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.

(6) Staff behavior and interaction with Veterans convey an attitude of genuine concern and caring.

(7) Appetizing, nutritionally adequate meals are provided in a setting, which encourages social interaction and nutritious snacks between meals and bedtime are available for those requiring or desiring additional food, when it is not medically contraindicated. The addition of nutritious snacks to the requirements for room and board is particularly indicated for homeless Veterans. Many of these Veterans are either undernourished or have developed poor eating habits or both, because of their chronic psychiatric disorder, including alcohol/drug abuse behaviors. The local VA Medical Center dietitian may consult with the initial inspection team and the team making subsequent assessments, in evaluating not only the printed menus but also the Veterans’ satisfaction with meals and the actual consumption of food offered.

e. The VA shall monitor the contractor's program and inspect the contractor's facility to ensure compliance with this agreement. Any unsatisfactory conditions noted during an inspection of contract facility will be reported in writing 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 discharge or transfer Veteran and to terminate the contract.

f. Subsequent inspections of the CERS must be made yearly by a multidisciplinary team including such VA Medical Center personnel necessary to assure the facility provides quality care in a safe environment. As the VA program personnel accomplish site visits, attention will be directed to the adequacy of Veterans' records. Site visits will also include a spot check of records to ensure contractor invoices accurately reflect the Veteran's length of stay.

3.24 Invoicing Instructions:

Payment to the Contractor shall be made monthly, in arrears, upon receipt of a properly prepared invoice. Payment for services will be at the rates specified in the Price/Cost Schedule. All monthly invoices from the contractor will be electronically submitted through the Tungsten Network within 15 days following the end of the month of services rendered.

Vendor Electronic Invoice Submission Methods: Facsimile, e-mail, and scanned documents are not acceptable forms of submission for payment requests. Electronic form means an automated system transmitting information electronically according to the accepted electronic data transmission methods below.

The information page for the Financial Service Center (FSC) of the Department of Veterans Affairs that includes information regarding electronic invoice submission can be referenced at:

http://www.fsc.va.gov/einvoice.asp Department of Veterans Affairs Financial Services Center PO Box 149971 Austin TX 78714-8971 Customer Support Help Desk (877-353-9791)

Invoices must be approved by the COR prior to payment release. Invoices without the required information will be rejected.

If the COR refuses an invoice due to incorrect billing, subsequent changes or corrections to the monthly invoice shall be resubmitted by the vendor with a corrected invoice. In addition to information required for submission of a “proper” invoice in accordance with FAR 52.212-4 (g), all invoices must include:

● Name and Address of Contractor

● Invoice Date and Invoice Number

● Contract Number and Obligation Number

● Name, title, and phone number of person to notify in event of defective invoice

● Total Price

Failure to comply with all terms and conditions of this contract shall result in invoices/claims submitted for reimbursement during that period to be considered incomplete. Interest penalties imposed under the Prompt Payment Act shall not apply to incomplete invoices or invoices received after the established invoice due date.

Contractor Remittance Address: All payments by the Government to the Contractor will be made by Electronic Funds Transfer (EFT)

3.25 COVID-19 PANDEMIC:

The contractor will implement processes to enhance safety in response to the COVID-19 pandemic. These processes include:

a. The contractor is responsible for ensuring adherence to VA facility-implemented visitation and screening processes or policies related to COVID-19

b. The contractor must follow guidelines from Federal and Local Health offices, including the Centers for Disease Control (CDC) and Pennsylvania State Department of Health (PADoH) related to providing homeless support, congregate living space, and infection control procedures. Sample guidelines include but are not limited to the following sources:

i. CDC Interim Guidance for Homeless Service Providers to Plan and Respond to Coronavirus Disease 2019 (COVID-19): https://www.cdc.gov/coronavirus/2019-ncov/community/homeless-shelters/planprepare-respond.html

ii. CDC COVID-19 Guidance for Shared or Congregate Housing: https://www.cdc.gov/coronavirus/2019-ncov/community/shared-congregatehouse/guidance-shared-congregate-housing.html#accepting-new-residents

iii. CDC Living in Shared Housing: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/sharedhousing/index.html

c. The contractor shall make available to the VA documentation deemed necessary by the VA related to infection control protocols or other procedures put in place to address the COVID-19 pandemic, to verify quality of patient care.

d. Services and supplies associated with COVID-19 related safety and infection control will not be included in the per diem bed day rate established in this contract. These services and supplies will adhere to CDC cleaning guidelines as related to the COVID-19 pandemic, and to CDC and/or PADoH guidelines related to source control, infection prevention, quarantine, or isolation protocols. Services or supplies include:

i. Cleaning agents or cleaning services that are EPA-approved for use against the virus that causes COVID-19, to be used according to the manufacturer’s recommended and Safety Data Sheets. Cleaning protocols and schedules will be consistent with CDC recommendations.

ii. Personal Protective Equipment including gloves, face coverings and face shields, gowns, shoe or leg coverings, as appropriate consistent with CDC guidance, to address COVID-19 risk, exposure, or infection.

VHA SUPPLEMENTAL CONTRACT REQUIREMENTS FOR COMBATTING COVID-19: Contractor employees who work in or travel to VHA locations must comply with the following:

a. Documentation requirements:

i. If fully vaccinated, contractors shall show proof of vaccination.

ii. NOTE: Acceptable proof of vaccination includes a signed record of immunization from a health care provider or pharmacy, a copy of the COVID-19 Vaccination Record Card (CDC Form MLS-319813_r, published on September 3, 2020), or a copy of medical records documenting the vaccination. If unvaccinated, contractors shall show negative COVID-19 test results dated within three calendar days prior to desired entry date. Test must be approved by the Food and Drug Administration (FDA) for emergency use or full approval. This includes tests available by a doctor’s order or an FDA approved over-the-counter test that includes an affiliated telehealth service.

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

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

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

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

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

d. For indefinite delivery contracts: Contractor agrees to comply with VHA Supplemental Contract Requirements for any task or delivery orders issued prior to this modification when performance has already commenced.

Please add a section 4.0 Special Contract Requirements and 5.0 Service Delivery Summary.