Performance Work Statement.docx

PERFORMANCE WORK STATEMENT - HOME OXYGEN SERVICES

SECTION 1 – SCOPE

1. Scope:

This Performance Work Statement (PWS) defines the effort required for the setup, installation, and management of Home Oxygen services and Ventilation, in accordance with The Joint Commission (TJC) or equivalent standards, to Veteran Beneficiaries serviced by VA Palo Alto Healthcare System (VAPAHCS). This PWS includes the associated program management, human engineering, and logistic support planning requirements. The use of the terms “Beneficiary”, “Veterans”, “Patients”, and “Patient” are used interchangeably and refer to the recipient of required supplies, equipment, and incidental services required under the contract.

1.1 Background:

The acquisition of Home Oxygen services is being initiated to provide Home Oxygen services to Veteran Beneficiaries serviced by VAPAHCS. VAPAHCS does not have the capacity to provide these services, so a contract has been sought for the provision of home oxygen and all associated products and services.

1.2 Locations:

All services shall be performed in the Veteran's place of residence or in a nursing home housing the Veteran. The area of service shall be all Patients serviced by VAPAHCS, including catchment areas, regardless of where Patient resides. The equipment needs are subject to change as determined by the prescribing physician. Contractors shall have a facility or resources physically located in the geographic area in which they shall provide service. Non-territory requests shall be required from time to time, and the Contractor shall accept these "non-territory" Veterans at that Contractor’s awarded price. VA reserves the right to assign these Patients to any Contractor. The geographical boundaries described herein have been determined as the areas of responsibility/jurisdiction for each local VA Medical Centers (see next page for VISN 21 map).

· VA Palo Alto Healthcare System serves the counties of: Alameda, Calaveras, Monterey, San Benito, San Joaquin, San Mateo, Santa Clara, Santa Cruz, Stanislaus and Tuolumne, California. The main VA facility is located in Palo Alto California.

1.3 Estimated Dollar Value / Guaranteed Minimum/Maximum

The following table includes the guaranteed minimum amounts per geographical area and the maximum ceiling amounts per geographical area. The minimum guarantee is applicable to the base year only and will be included in the first funded task order awarded against the IDIQ contract for each respective geographical area of the Indefinite Delivery Indefinite Quantity (IDIQ) contract. Also, the maximum ceiling amounts stated below for each geographical area apply to the IDIQ contract in its entirety, not to individual task/delivery orders.

1.4 Roles and Responsibilities:

A. Clinician orders for providing Home Oxygen Healthcare Services, which includes the use of home oxygen, home based life support systems (i.e. ventilators) and related respiratory equipment (C-PAP/Bi- Level nebulizers, compressors, etc.) are processed through the Prosthetic and Sensory Aid Services (P&SAS) at the VA Medical Centers, and VA Healthcare Systems. Initiation of treatment, delivery and pick up of equipment and, resolutions of problems related to equipment or Patients care are under the direction of P&SAS and/or the Contracting Officer's Technical Representative (COR).

B. VA Clinicians have the exclusive responsibility for determining eligibility and necessity for admission to the Home Oxygen Program and for providing orders for admission. The Contractor shall provide the services, supplies and equipment as ordered, under the timelines specified.

C. VA Clinicians will complete initial and ongoing Patients assessments.

D. The Contractor is responsible for coordinating, supervising, monitoring, and evaluating the care and service provided and must assure that the contracted services are performed according to the terms of the contract. The Contractor must also assure that its personnel meet the requirements of the contract and are competent to do the jobs assigned them. The VA may but is not limited to monitoring the Contractor's performance through Contractor site visits, Patient home visits, record checks, and Patient satisfaction/complaints. The VA will conduct monthly review of invoices for accuracy. Monitors will focus on timeliness of equipment delivery; timeliness of maintenance visits; accuracy of required paperwork, and adherence to The Joint Commission (TJC) or equivalent standards.

E. The VA sets timelines for the provision of services and the Contractor must meet those timelines. It is the Contractors responsibility to schedule the times and dates for the delivery of services within the timelines established. Deliveries shall not be left unattended at the Patient's home, unless prior arrangements are made with the Patient. (See section 5 of the Performance Work Statement (PWS)) F. VA providers determine the discharge plan from the Home Oxygen Program based on clinical assessment that may also include data submitted by the Contractor.

G. Contractor shall notify Contracting Officer’s Representative (COR) for review and approval of any changes to the treatment plan and/or prescription that is sent to Contractor by VA medical provider. COR shall contact VA medical provider for his or her review and approval or disapproval.

H. In the event of damage to and/or theft of Contractor's equipment due to Patient negligence, Contractor shall, within 10 calendar days of having knowledge of damage and/or theft of any Contractor issued equipment under this contract, notify the respective facility COR, in writing, describing the damage and/or theft. Facility COR will notify the Contracting Officer to discuss a resolution to the issue.

1.5 Accreditation:

The Contractor shall meet or exceed all The Joint Commission (TJC) standards (previously known as the Joint Commission on Accreditation of Healthcare Organizations, or JCAHO) or equivalent accrediting standards for all services provided herein. Contractor shall submit proof of meeting or exceeding all TJC standards as part of its technical proposal. The TJC or equivalent standards may be accessed at www.jointcommission.orq. Contractor shall be accredited by a nationally recognized organization and shall maintain that accreditation throughout the term of the contract.

1.6 Site Visits:

A. On-site Contractor and VA Patient visits will be made on a scheduled and unscheduled basis. The Contracting Officer and/or the COR and, other VA employees as necessary, will conduct Contractor site visits. The purpose of these visits is to monitor the Contractor's performance as it relates to the contract and commercial practices. The Contractor agrees to make available all records and documentation necessary during such visits.

B. In addition, the Contractor agrees to visits by any accrediting body (or other Government representative) accompanied by the Contracting Officer, COR or designee necessary to review the contract services. These visits shall be allowed at no additional cost to the Government.

1.7 Ordering:

A. Authorized VA representatives of Prosthetics and Sensory Aids Service (P&SAS) or appointed CORs at VISN 21 locations will issue orders for home oxygen services. Such individuals will be identified at time of award. Each order will contain the Veteran’s name, last 4 of social security number, and home address, as well as the type of supplies, services or oxygen system prescribed.

B. Orders may be placed by telephone, fax, Public Key Infrastructure (PKI) secured E-mail, or through a Contractor owned and maintained secure website and as necessary, will be confirmed in writing and accompanied by the Home Oxygen Prescription. If a delivery order is placed verbally, a written copy of the verbal delivery order will be transmitted to the Contractor within 48 hours of placing the order. Confirmations shall be required for any order placed. Contractor shall have a direct local number with an employee on duty for after-hours orders and not be referred to a call center.

1.8 Emergency Service:

A. The Contractor shall have twenty-four (24) hour, seven (7) day a week, and 365 days per year emergency service capability. At a minimum, the Contractor shall have a company employee on duty or a twenty-four hour answering service or, an employee within paging range to respond to emergency calls. Contractor shall respond within thirty (30) minutes by telephone upon receipt of an emergency call and advise Patient of the specific emergency procedure to be implemented. Contractor shall have a backup procedure in the event they are unable to reach the Patient by phone.

B. The back-up procedure stated in 1.7.A. above shall be specific to the geography and conditions of the area being serviced with a copy provided to the appropriate COR at the time of award. If the procedure is updated a copy shall be sent to the COR within three (3) business days.

1.9 Documentation:

The Contractor shall maintain documentation of all orientation programs and background checks for all employees involved in delivery/recovery of home oxygen equipment. As a minimum, topics should include safety and equipment management, such as: electrical requirement, back-up systems, equipment safety checks, troubleshooting, equipment set-up, infection control procedures, Patient confidentiality and handling procedures. Annual competencies are required. Documentation shall be made available upon written request of the Contracting Officer or facility COR.

1.10 Solicitation of Patients:

Contractor shall deal directly with the Contracting Officer, the facility COR, or the appropriate facility P&SAS representative relative to any aspect of the contract. Contractor agrees he/she shall not directly or through his/her dealers solicit the Patients of the Department of Veterans Affairs. Contractor is to contact the Patient or Caregiver only to make arrangements for rendering services or supplies authorized by VA.

1.11 Demurrage Charges:

Contractor agrees to provide cylinders without assessing demurrage charges to the Government. The Contractors further agrees that the free loan period of cylinders is indefinite but shall not exceed the term of the contract.

1.12 Product Substitutions:

The Contractor shall not substitute any product without prior approval of the treating facilities COR.

1.13 Definitions / Acronyms:

· Bi-Level: A device used for the treatment of obstructive sleep apnea/hypoventilation syndrome while sleeping that has two pressure settings

· CBOC: VA Community Based Outpatient Clinic

· CPAP: Stands for “Continuous Positive Airway Pressure” and is a device primarily used for the treatment of obstructive sleep apnea; has single pressure setting

· Concentrator: An electrical device used to deliver oxygen therapy in the home.

· Contracting Officer: A warranted VA official with the authority to legally enter into a contract, administer a contact, and/or terminate contracts on behalf of Department of Veteran Affairs

· Contracting Officer's Technical Representative (COR): VA official who is responsible for providing contract oversight and technical guidance to the Contracting Officer. Responsibilities include certification of invoices, placing orders for services, and technical guidance

· FAR: Federal Acquisition Regulations

· HCPCS: Health Care Procedure Coding System

· IPV: Intrapulmonary Percussive Ventilation use for airway clearance therapy

· The Joint Commission (TJC) — A national organization dedicated to improving the care, safety and treatment of patients in a health care facility and environment

· Liquid Stationary System: A device used to store and dispense liquid oxygen

· Liquid Oxygen: Oxygen in a liquefied state

· Nebulizer: A device used to dispense inhaled medication

· Oxygen Tanks: Cylinders made of steel, light steel, and aluminum used to store oxygen in a compressed state

· P&SAS: Prosthetics & Sensory Aids Service

· Suction Machine: A device used to remove secretions from a Patient's mouth or airways

· VA: Department of Veterans Affairs Medical Center, or Healthcare System

· VISN: Veterans Integrated Service Network

· Plan of Care: Medical care plan is a Patient assessment initiated on each Patient by VA clinician

· Plan of Service: Form initiated by Contractor that depicts Patient's home environment, problems/needs, goals, and action

· CRT: Certified Respiratory Therapist

· RRT: Registered Respiratory Therapist

· RN: Registered Nurse

SECTION 2 – GOVERNMENT-FURNISHED PROPERTY

Some VISN 21 locations authorize Contractor to provide government-furnished equipment to patients in the performance of the contract. In such cases, all government-furnished property provided under the contract shall remain the property of the VA:

· All CPAP Devices, which may include masks, non-heated humidifiers and heated humidifiers

· All BiPAP Devices

· Nebulizers (to include battery powered) Suction Pumps

· Air Compressors

· Intrapulmonary Percussive Ventilation System (IPV) Ventilators

· FIRESAFE Cannula from LifeGas (see Paragraph 4.1.viii.)

At other sites where the VA does not authorize Contractor to provide government-furnished equipment to Patients, the Contractor shall be required to provide such equipment and shall submit a price quote for providing any item listed in the schedule, regardless of the above list. Additional equipment or supplies may be added throughout the life of the contract by contract modification executed by the Contracting Officer (CO).

SECTION 3 – CONTRACTOR-FURNISHED PROPERTY

The Contractor shall furnish the following list of equipment:

· Concentrator Systems

· Liquid Oxygen Systems

· Portable Gaseous Systems

· Portable Gaseous Oxygen Systems

· Portable Liquid Oxygen Systems

· Ventilators and all appropriate prescribed equipment

· Air Compressors

· Aluminum Oxygen Tanks

· Steel Oxygen Tanks (Optional)

· Supplies (e.g., tubing, cannulas, masks, etc.)

In addition to the above list, the Contractor shall furnish all equipment necessary to comply with the requirements of the contract. Equipment furnished by the Contractor shall remain property of the Contractor unless purchased by the VA.

3.1. This paragraph has been removed from PWS.

3.2 Veterans Served:

VISN 21 currently serves an estimated 397,300 covered Veterans with an average growth rate of 2.7%. The volumes or amounts shown in the Contract Line Item Numbers (CLINS) are estimates only and impose no obligation on the VA. The contract shall be for the actual requirements of the VA as ordered by the VA during the life of the contract. The Contracting Officer’s Representative (COR) or designee shall provide (via encrypted email and fax) the Contractor with notification to initiate individual Patient service requirements, including the Patient's oxygen prescription, equipment, supplies and services to be provided including date and place of delivery. The Contractor shall confirm receipt (via encrypted email and fax) of the request within one (1) working hour of notification. Per Facilities discretion, the COR or designee shall also provide (via encrypted email and fax) notification if VA owned equipment is to be provided. The COR or designee shall also provide notification (via encrypted email and fax) to the Contractor of VA initiated discontinuation of service. The discontinuation notifications shall be made (via encrypted email and fax) within 24 hours. The written documents shall include the authorizing official's signature, electronic or written.

3.3 Initial Set-Ups:

Initial set-ups are considered to be those Beneficiaries who do not have a VA authorized oxygen therapy delivery system or ventilators.

A. Initial setup(s) for Home Oxygen Patients and Ventilator Patients shall be performed by a certified respiratory therapist (CRT) or registered respiratory therapist (RRT), that is licensed in accordance with the governing standards of where the services are to be provided, who shall perform the following:

i. Home visits shall be performed monthly by the RRT/CRT for all Patients that utilize the ventilator either continuously, for nocturnal concerns, and/or for intermittent ventilation.

ii. Home visits shall be performed every ninety (90) days by the RRT/CRT for all Patients that utilize home oxygen services.

iii. Documentation shall be provided (via encrypted email and fax) to the ordering facility’s COR documenting a thorough review of the Patient's equipment, to include all equipment records, and any re-education of the Patient and/or Caregiver, if necessary.

iv. Documentation shall be provided (via encrypted email and fax) to the ordering facility’s COR for all home visits within five (5) business days of the visit.

v. Patient or Caregiver education shall be performed on the proper utilization for the issued equipment to include the following:

a) Proper equipment usage

b) Equipment function and operation system

c) Equipment knobs, controls, buttons, outlets, and inlets

d) Equipment power source: electric, battery, compressor air, oxygen, and UL approved

e) Proper utilization of oxygen with the prescribed ventilator

f) Troubleshooting the equipment and system alarms

g) Equipment and equipment settings that have been prescribed

h) Proper equipment exchange/replacement, for example: ventilator tubing/circuit

i) Proper utilization of a Passy Muir Valve (PMV) Speaking Valve while in use with the ventilator

j) How to attach the resuscitation bag to the oxygen source

k) How to complete the home ventilator monitor record

l) Emergency Procedures and how to respond to:

1) Power failure

2) Equipment failure

3) Ventilator users and their Caregivers must be prepared for equipment failure, disconnects, and power outages, especially if using 24 hour ventilation

m) Practicing regular safety drills helps prepare for emergencies

n) Keeping a manual resuscitator, such as a bag valve mask (Ambu bag).

o) Infection control and Patient supply storage

p) Cleaning or exchanging the oxygen tubing, ventilator tubing/circuits, and humidifier

1) Cleaning or exchange of the resuscitation bag and supplies

2) Cleaning or exchange of all equipment and accessories

q) Provide continuing education in use as needed or directed by a licensed and privileged Department of Veteran Affairs Physician.

r) All education material provided by the Contractor shall be initially reviewed and approved by the Veteran's Affairs Pulmonary or Respiratory Chief/ Director/Supervisor or designee within the Pulmonary/Respiratory Section. Any changes to educational materials shall need to be reapproved prior to providing the aforementioned documentation to patients.

s) The Contractor shall provide a signed document (via encrypted email and fax) to the ordering facility COR verifying the following:

1) Patient has a safe home environment in accordance with The Joint Commission or equivalent accrediting standards.

2) Patient received proper education and instructions

3) Competency has been accomplished with the Patient and Caregiver on the proper use of the ventilator, oxygen equipment, and other home medical equipment upon initial set up, and re-verified annually.

B. All equipment shall contain an adhesive type label containing the vendor’s name and emergency 24 hour toll-free phone number. This label shall be placed on the equipment in an area that is viewable to patients and/or Caregivers at all time. Patient shall be given a document listing toll-free phone number for routine resupply of oxygen cylinders and supplies.

C. The Contractor shall provide and post on all entrances into the residence, a sign stating "Warning Oxygen in Use, No Smoking" or other verbiage that No Smoking is allowed due to oxygen being present and document that the Patient/care giver is instructed in the safe use of oxygen and equipment per OSHA regulations. Specified sign shall be no smaller than 4” X 6”.

D. The Contractor shall provide the initial set-up the same day when the prescription is received by 3:00 PM local time, to include weekends and holidays; this shall also apply to service calls. The VAMC reserves the right to obtain the supplies and service from another source and to charge the Contractor with any excess cost which shall result there from, if the Contractor is unable to meet required response time.

E. The Contractor shall be required to provide initial setup within 24 hours when prescription is received after 3:00 PM Central Standard Time to include weekends and holidays. This shall also apply to service calls.

F. The Contractor shall have a staffed branch office or available resources located within 50 miles of each medical center.

G. Setup of Home Oxygen includes setting up and ensuring the appropriate oxygen system is operational, instruction and training of patient, and/or Caregiver and home environment safety check. Failure to deliver within the required time shall result in the VA obtaining oxygen from another source. Any costs in excess of contract pricing for services provided shall be billed to Contractor or credited to next invoice at the discretion of the ordering facility (Reference 52.212-4(d) Disputes).

H. If any modifications or preparations need to be made to equipment, these changes shall be coordinated with Patient’s Caregiver and made before the Patient arrives home from the hospital. Other items that shall be prepared ahead of time include:

i. Establishing designated Customer Service support phone line for patients to call for in home assistance

ii. Posting all emergency numbers by each telephone

iii. Marking the circuit breakers and fuses

3.4 Ensure Home Requirements are Present:

A. Upon initial setup the Contractor is responsible for ensuring the home and electrical system shall support all requirements of the equipment being provided including:

i. Proper electrical requirements are present.

ii. Appropriate heating and/or air conditioning, if applicable

iii. Hot and cold running water

iv. Spaces for cleaning and storing equipment

v. General conditions and cleanliness

vi. Adequate door size

vii. Steps, need for ramps, or other access needs

viii. Availability of ambulance/paramedics and hospital

ix. Availability of a telephone

x. Presence of operational smoke detector(s)

xi. Presence of operational fire extinguisher(s)

xii. Presence of fire evacuation plan B. The Contractor shall be responsible for notifying the COR or their designee by telephone while in the Patient’s home, if any alteration to the Patient's home is necessary to accommodate the oxygen equipment, including electrical work.

If the Patient's home's electrical system is not sufficient, the Contractor shall facilitate alternative oxygen system, if deemed appropriate by the COR or their designee. Any alteration to the Veteran’s residence shall be the responsibility of the Veteran.

3.5 Period Equipment Evaluation:

The Contractor shall have a CRT/RRT visit the Patient to reassess equipment compliance, educational needs, and other Patient needs for Home Oxygen Patients, at least once every ninety (90) days; and for patients on ventilators, once every thirty (30) days. Individual 30 and 90 day checks per patient and a worksheet monthly with a list of patients serviced.

A. A report shall be developed, signed and dated by the Contractor staff and the VA Patient/care giver and a copy shall be left with the Patient. The reports shall be legible and attached to the invoice. All reports shall be submitted to the COR or designee in alphabetical order, within five (5) business days of the service. The written report shall include at a minimum the following data:

i. Name and Patient ID to be assigned by facility of patient using the equipment.

ii. Monitor compliance on prescription (LPM, hours per day)

iii. Type of concentrator and hours on concentrator

iv. Inspection results of liter flow rate in monitoring Patient compliance (as compared to prescription).

v. Inspection compliance of filters (exchange or clean by patient) according to manufacturer’s guidelines

vi. Follow-up education and/or reinforcement of compliance documented.

vii. Revised plan of service as needed.

viii. The Contractor shall provide documentation (via encrypted email and fax) of the last visit date, calculated number of expected usage hours and the actual hours of usage based upon the Patient prescription and the Patient last visit to the COR or designee.

B. If the Patient does not receive a reassessment of equipment every 90 days, documentation shall be provided (via encrypted email and fax) to the COR or designee identifying the reason a home visit was not made (Example: Initial set up completed March 1st, Patient shall have a follow-up home visit no later than June 1st).

If, in the Government’s discretion, the Contractor has not made valid and documented attempts to contact the Patient for set up and/or deliveries, the Government reserves the right to call in third party to provide said setups and/or deliveries in the Contractor’s place, and shall bill the Contractor all excess costs for covering the missed requirement, if the Contractor fails to perform for any due month (reference FAR 52.212-4(d) Disputes).

C. Serial Numbers for the rented equipment shall be the vendor's responsibility and kept on file in Contractor's main office.

3.6 Emergency Services:

A. Emergency services are for medical equipment provided to patients when an equipment malfunction or natural disaster may threaten a Patient's health. The Contractor shall provide to the Contracting Officer a written emergency management plan, in compliance with The Joint Commission or equivalent standards. This emergency action plan shall addresses continuity of services for all Patients in the affected region.

B. The Contractor shall provide emergency maintenance 24 hours/7 days a week, including weekends and holidays. A document listing the emergency telephone number shall be provided to the Patient at the time of set up.

C. The Patient shall first call the Contractor in an emergency equipment situation as described in the previous sentence. The Contractor shall have a well-established communication system, providing 24 hour emergency services and the ability to provide services at the Patient's home within two (2) hours of a call, but in no case to exceed six (6) hours of a call.

D. The Contractor shall ensure all Patients have at minimum a non-electrical oxygen supply to last eighteen (18) hours. The minimum supply shall take into account each Patient's prescription flow-rate and distance from the Contractors location, and so actual supply levels may differ from Patient to Patient, as long as each Patient has oxygen supply to last a minimum of eighteen (18) hours.

i. If the Contractor is unable to respond to an emergency service call within six (6) hours, the Contractor shall be responsible for making arrangements with another supplier, who meets all Joint Commission or equivalent standards, to provide oxygen at the Contractor's expense.

ii. A written explanation (via encrypted email and fax) of why the Contractor was unable to respond to the emergency shall be provided to the COR or designee within two (2) business days. The cost of backup systems, backup oxygen, and backup equipment shall be borne by the Contractor. If H or M size oxygen cylinder is used for backup, the Contractor shall furnish an H or M size oxygen cylinder stand for each H or M size oxygen cylinder. Liquid oxygen supply shall be considered backup oxygen; however, the oxygen supply shall be maintained at the minimum of eighteen (18) hours.

E. In the event of disaster, natural or otherwise, the Contractor shall notify the COR or their designee within 24 hours if services covered under this contract may be affected.

3.7 Preventive Maintenance:

Contractor shall provide service and preventive maintenance on all equipment as recommended by the manufacturer. Preventive maintenance shall only be performed by a certified service technician that has received the approved training. Contractor shall provide all documentation to the COR with signatures and dates on the contract inception date and upon the COR’s request and during quarterly site inspections. The maintenance report shall include but not limited to make/model, serial number, maintenance performed, date of maintenance, printed name and signature of technician.

3.8 Manuals:

The Contractor shall provide the Operation and Service manual to the Patient and/or Caregiver upon delivering any equipment. The manual shall contain information on operation, maintenance, and trouble- shooting for clinicians, users, Caregivers and service technicians. Contractor shall provide to the Government, one (1) copy of the Operation and Service manual for each type of equipment with any proposals regarding this contract.

3.9 Storage Charges:

The Contractor shall provide cylinders to store at each facility without charging the Government. These cylinders shall be used for special circumstances (i.e. emergency services or short notice discharges). The Contractor’s free loan period of cylinders shall not exceed the term of the contract.

3.10 High Risk Smokers:

The facility shall notify the Contractor of all identified High Risk Smokers. The Contractor shall notify the COR or designee of High Risk Smokers that they identify in the home via encrypted email and fax within one (1) day of the home visit. Contractor notification to each COR or designee shall consist of Contractor’s written report/form and shall contain at a minimum Veteran’s name and last four (4) numbers of their social security number shall be clearly documented, and what precautions were provided to the Patient. High-risk Patients are Patients who exhibit unsafe clinical or behavioral traits involving oxygen and smoking, such as: attempting to hide their smoking materials or activities from staff, having a history of non-compliance with smoking rules; or smoking in a Patient sleeping room or other areas designated as non-smoking areas.

3.11 Patient Travel:

A. The Contractor shall be responsible for coordinating all services for Veterans who travel within the geographical area covered by this contract. Travel is defined as those occurrences in which the Beneficiary stays away from their domicile overnight. Patients shall be instructed by the Contractor and VA staff to notify the Contractor and the VA resident facility at least two (2) weeks before intent to travel and four (4) weeks if they are permanently relocating. Patient shall be responsible for coordinating transportation of oxygen/equipment with their respective airlines.

B. Veterans covered within the purview of this contract shall be authorized, excluding medically related travel, a maximum of 30 days travel, with a maximum of two (2) set-up charges within one calendar year from the latest prescription date. Subsequent to this, any other costs shall be the Patient’s responsibility.

C. The Contractor shall provide Veterans traveling within the geographical area covered by the contract all oxygen services hereunder at the contract rate utilizing Contractor furnished equipment only. The Contractor shall provide equipment setup by licensed CRT/RRT at designated travel destinations for Veterans receiving care at a covered geographic area within VISN 21. The Contractor shall invoice the resident Facility on a monthly basis for the services rendered under this contract.

D. When the Veteran is temporarily traveling / relocating, outside of the contracted area, the Contractor shall coordinate oxygen requirements if that Contractor has a subsidiary office located at the temporary destination. If not, the resident VA facility shall coordinate with the VAMC nearest the Veteran’s destination to make these arrangements.

E. When the Veteran is permanently relocating to any area not covered under this contract, the Contractor shall:

i. Instruct the Patient that they are responsible for notifying the current resident facility 30 days prior the permanent relocation

ii. Provide the Veteran with up to a ninety-(90) day supply of Oxygen/Ventilator Supplies or until the Veteran has setup service in the new location

iii. The Contractor is responsible for providing oxygen equipment and supplies until such time as the destination VAMC enrolls the Patient into the Pulmonary/Home Oxygen Clinic and the destination facility (or contracted vendor) provides their equipment, unless other arrangements or agreements have been made between the two VAMCs. The destination VAMC must enroll the Veteran as soon as reasonably possible (e.g. < 30 days in accordance with VA Clinics “Waits and Delays” measure).

iv. Upon arrival at the destination VAMC, any equipment that came with the Patient and that is owned by the resident facility or Contractor shall be returned. Any cost incurred in the shipping/handling is the responsibility of the resident VAMC.

F. Travel outside the continental United States is not covered under this contract. Veteran shall be responsible for all travel arrangements and for obtaining oxygen services when traveling outside the United States.

3.12 Plan Of Service:

The Plan of Service shall be developed by appropriate VA clinical staff at each facility and the Contractor’s Respiratory Care Practitioner (RCP), in accordance with the Plan of Care and the prescription provided by the VA. Prescription changes must be authorized by a VA Provider.

3.13 Community Numbers:

The Contractor shall provide the local power company, telephone company, and fire department a letter for special consideration within 24 hours of the initial setup and delivery of Home Oxygen Services. This letter shall request that this Patient be placed on the priority list to restore or respond in the event of an emergency or failure of any source. The Contractor shall provide this letter to the COR or designee for approval within 30 days of this contract award date. The Contractor shall also provide a magnet no smaller than 3 ½”X 4” with emergency numbers which include police department, fire department, ambulance, doctor, and VAMC number to all Patients.

3.14 Delivery and Discontinuation of Equipment and Suppliers:

A. The Contractor shall be responsible for scheduling appointments with patients within the time requirements listed in section 2.1 to initiate set ups and deliveries. Deliveries shall not be left unattended at the Patient's home. Physical acceptance of deliveries must take place between the Contractor and either the Patient or Caregiver.

B. If the Patient fails to meet two (2) consecutive appointments, the Contractor shall notify (via encrypted email and fax) the COR or their designee within 24 hours of the second missed appointment. The COR or their designee shall contact the patient, and a corrective action plan shall be implemented. COR shall notify (via encrypted email and fax) the Contractor of any changes.

C. If the Contractor has not documented valid attempts to contact the Patient for set ups and or deliveries, the Government reserves the right to call in a third party and bill the Contractor. The Contractor shall not be paid for those services during the billing period if services are not rendered.

3.15 Delivery Schedule:

Contractor shall develop a delivery schedule for service, equipment, and supplies with each Patient following receipt of the facility order.

3.16 Service of Equipment:

A. The Contractor shall furnish, install and service all equipment and supplies ordered under this contract. All disposable supplies shall be new and unused. A label with the Contractor's name and emergency telephone number, where they can be reached 24 hours/day, shall be affixed to all equipment. The repair/maintenance of all equipment by the Contractor shall be performed by a competent professional familiar with nature of the equipment involved and fully qualified under the laws of the State in which the services are being rendered.

i. Provision of all equipment shall be consistent with local Fire and Safety Codes in the respective area of the state,

ii. The Contractor shall provide a safety/emergency checklist to be completed, then signed by the Veteran or his/her Caregiver and retained in the Patient account folder. The Contractor shall service all equipment at the manufacturer recommended intervals. The Contractor shall conduct a check of the concentrator using a certified oxygen analyzer that is calibrated according to the manufacturer standards.

iii. The Contractor shall perform maintenance on all equipment according to the equipment manufacturer's guidelines. The Contractor shall change compressor inlet pre-filters and compressor inlet bacteria filters according to the manufacturer recommendations.

a. The Contractor shall test the alarm battery at each maintenance check, changed as indicated but at least annually.

b. The Contractor shall track and document maintenance of equipment in accordance with manufacturer specifications and provide these records for review upon request. Contractor shall furnish parts and labor for routine maintenance. The Contractor shall have recall procedures for equipment and supplies.

B. The Contractor shall not change or alter a Patient's oxygen prescription or equipment requirements without a new prescription from the Patient's VA physician.

3.17 Contractor Visits:

A. The Contractor shall visit Beneficiaries' residences in performance of this contract by appointment only between the hours of 8:00 AM and 8:00 PM, seven days per week, exceptions shall be made in the cases of emergencies.

B. The Contractor shall be responsible for scheduling the appointments to the Patient's home at least 48 hours prior to the appointment. On each scheduled setup/delivery the Contractor shall retrain the Patient on the use and care of the equipment and supplies. When conducting home visits the Contractor’s representatives shall present a professional appearance and adhere to the following as a minimum:

i. An ID badge shall be affixed to clothing above the waist with the Company name, employee name, and photograph to the front and clearly visible.

ii. Shoes shall be clean and in good condition (open toe shoes are not acceptable).

iii. Shirts and/or blouses shall be uniform and contain the company’s name and/or logo.

iv. Slacks or khakis shall be worn. Blue jeans are not allowed.

v. Mid-calf dress slacks or trousers shall not be denim, revealing, provocative, spandex or similar tight fitting fabrics

vi. Socks, stockings, or hosiery shall be worn at all times.

vii. Skirts shall be at or below knee length.

3.18 Excess Delivery:

The VA shall not authorize payment on the delivery of excess supplies or equipment. Excess deliveries are those provided without prior authorization by the VA.

3.19 Assessment Requirements:

A. The Contractor shall perform an assessment of the Patient's home and environment, at least every 90 days (or if required due to Plan of Service changes) in accordance with The Joint Commission or equivalent accrediting standards, and maintain documentation of assessments in the individual Patient file or folder.

B. The Contractor shall notify the COR or their designee during the home visit if the Contractor's staff determines that the presence of oxygen in the home presents such a danger that the oxygen shall be removed, or in the case of an initial set-up, not placed in the home. Unsafe conditions may include, but are not limited to, fire safety hazards, oxygen safety hazards, Patient abuse, or any instance that places the Patient or Contractor's staff in immediate danger. The Contractor shall contact the COR or designee by phone during the home visit and furnish (via encrypted email and fax) written documentation of the safety hazard to the COR or their designee within five (5) business days of the incident.

C. The Contractor shall document and report (via encrypted email and fax) to the COR or their designee, within five (5) business days of the service, any Patient who is non-compliant with safety guidelines set forth in the education and orientation material and or whose behavior poses a risk of self harm or harm to others (i.e. smoking while on oxygen) despite warnings and ongoing educational interventions.

D. The Contractor shall check the adequacy of the electrical outlets in the Patient's home and report unsafe conditions to the COR or their designee via phone call during the home visit. VA is not responsible or liable for any unsafe electrical conditions caused by the Contractor. Any alterations to the Veteran's residence shall be the responsibility of the Veteran. If the COR or their designee decide that the ordered equipment cannot be safely installed, an alternative oxygen delivery system shall be provided after approval until new prescription can be obtained.

E. The Contractor shall verify the presence of working smoke alarms and instruct the Patient to test all smoke alarms on a monthly basis and include this verification in the documentation of assessment. The Contractor shall document (via encrypted email and fax) any home where smoke alarms are not present and fully functional, the Contractor shall provide this notification to the COR or designee within five (5) business days of the service.

3.20 Discontinuation of Service:

A. The Government shall notify (via encrypted email and fax) the Contractor in the event of an order to discontinue oxygen service to any Patient covered under this contract. Payment shall be pro-rated based upon the notification date of discontinuance of service. The Contractor shall notify the COR or designee within next business day upon discovering a Patient is no longer available for services (i.e. deceased, moved out of the service or contract coverage area, and any other situation that the Patient would no longer be available for services). Payments shall be prorated based on dates of service provided.

B. The Contractor shall remove equipment from the Patient's residence at the earliest possible time but no later than five (5) business days unless approved by COR or designee. The date and time of equipment pickup shall be coordinated with the Patient (if relocated) and/or next of kin and/or significant other. The Contractor shall honor Patient's or family's requests to pick-up equipment before or after funerals or family gatherings relative to patient funerals.

3.21 Patient Education Requirements:

The Contractor shall provide education to each Veteran at the time of set-up and assess the need for reinforcement during visits. This information is to be presented verbally in demonstration and material covered shall be in written form to be left with the Patient/care giver. The written material shall be in English as well as the foreign language of the Patient, in the event the Patient does not speak English. All Patient education material shall be presented in written form to the COR within thirty (30) days of contract award. The Contractor, as directed by COR or designee shall implement any new or revised education material. The VA shall determine whether the Contractor shall use their forms or forms supplied by the VA for documentation of education services provided to patients.

3.22 Warnings - Fire Safety

The Contractor shall provide educational and/or warning information for patients, their families, or Caregivers on the hazards of smoking while oxygen is in use. The warning materials shall be provided upon initial delivery and every 90 days thereafter. The checklist used by vendors for medical gas follow-up services shall, at minimum include:

A. No Smoking signs provided and posted B. Smoke alarm present, Veteran instructed to test all smoke alarms monthly, and smoke alarm sounds when tested and provide how to obtain one. if smoke alarms are not present, Veteran has been instructed to remove the cannula, shut off the oxygen supply, and wait for the oxygen to dissipate prior to smoking C. Veteran, family or cohabitants given educational material regarding the hazards of smoking and using an open flame near oxygen.

D. Contractor shall check for fire extinguishers and/or provide guidance on how to obtain one.

3.23 Patient Rights and Responsibilities:

Veterans shall be provided a copy of VA Patient Rights & Responsibilities and any applicable information concerning advance directives during initial setup. The Contractor shall provide documentation (via encrypted email and fax) that the Patient/care giver is instructed in accordance with The Joint Commission or equivalent standards, to include how to contact The Joint Commission or equivalent accrediting organization.

3.24 Fall Prevention:

The Contractor shall provide Patient education or re-education on how to prevent falls in the home related to oxygen equipment and supplies (i.e. oxygen tubing is a fall hazard) on initial set up and every 90 days thereafter. The Contractor shall provide documentation (via encrypted email and fax) if it becomes known to the Contractor that the Patient has recently fallen.

3.25 Periodic Performance Review Report:

A. The Contractor shall provide a written, quarterly report addressing all Joint Commission Standards (or equivalent accrediting body) for improving organizational performance (The Joint Commission standards may be accessed at www.JointCommission.org ).

B. The Contractor shall submit their Periodic Performance Review for contracted services to the COR or designee via encrypted email or fax within 90 days of the end of base or option year annually. The Contractor shall assess and score each Joint Commission or equivalent standard and element of performance that is applicable to the contracted services by entering a self-assessed score.

C. Any noncompliant findings or gaps in service identified on the self-assessment shall require a plan of action to correct as part of the Periodic Performance Review submitted to the COR or designee.

3.26 Incident Report:

The Contractor shall report special incidents found or occurring during a home visit; to include finding Patients in need of emergency medical assistance, safety hazards that do not fall into the category of presenting immediate life-threatening danger to the Patient or Contractors staff, inability to contact a Patient within a reasonable period of time, and any other incident meeting the Contractors written policy for incident reporting according to The Joint Commission or equivalent accreditation standards. All reports, containing confidential Patient information, shall be provided to the COR via encrypted email using a standard encryption scheme, such as PKI and fax within 24 hours. Life threatening situations (i.e. 911, police, and any other emergency) shall be reported to the proper authorities immediately. The Contractor shall maintain a file containing all incident reports at its place of business.

3.27 Customer Satisfaction Report:

The Contractor shall collect satisfaction data from contracted Patients and their families on a quarterly basis in accordance with The Joint Commission or equivalent standards. A copy of survey results shall be submitted to COR or designee in Quarterly reports via encrypted email and fax. The quarterly report is due to the COR by the 5th working day at the conclusion of the quarter. The reporting quarters are as follows: October 1st through December 31st, January 1st through March 31st, April 1st through June 30th and July 1st through September 30th. This report will encompass areas of Communication, Customer Effort, Meeting Expectations, Financial Responsibility, Staff Knowledge, Quality of Equipment, Ease of Delivery, and Ease of Equipment Recovery.

3.28 Infection Control Report:

The Contractor shall collect, trend, and report on data related to the Contractor’s Infection Control Program to the COR or designee on a quarterly basis for each contract performance period via encrypted email and fax. The quarterly report is due to the COR within the 5th working day at the conclusion of the quarter. This report will include documentation of TJC accreditation and infection control standards. Upon receipt, COR will forward Infection Control Report to VA Infection Control.

3.29 Performance Improvement Report:

The Contractor shall collect, trend, and report on important processes and outcomes data related to patient care and organizational functions to the COR or designee on a quarterly basis for each contract performance period via encrypted email and fax. The quarterly report is due to the COR within the 5th working day at the conclusion of the quarter. This report shall contain but not limited to, dates of process improvement training by staff. Detailed information on processes to improve service to veteran population. Detailed documentation of customer service outcomes, delayed events/services, and any staff training that will improve patient experience.

3.30 Contract Usage Report:

Contractor shall provide a monthly electronic report detailing contract usage by each VISN 21 Facility. Contractor shall provide to each VISN 21 Facility’s COR or designee their respective facility’s electronic report NLT the 15th of each month. The electronic report shall include the total units per CLIN and total dollars invoiced by CLIN. Contractor additionally shall submit a composite report of each facility’s usage, by facility, to include the total number of unique Patients, the total number of units used by contract CLIN, and the total dollars invoiced by CLIN number to the VISN COR monthly, NLT the 15th of each month.

3.31 Fall Prevention Report:

The Contractor shall collect data on falls and outcomes through conversations with the Patient and Caregivers on a quarterly basis for each contract performance period. The report shall indicate when the incident occurred, were injuries involved, possible causes of fall (i.e. medication, tripping hazard, and/or other situations), as well as corrective action plans, and Patient education conducted. This report should be provided to the COR or designee via encrypted email and fax. The quarterly report is due to the COR within the 5th working day at the conclusion of the quarter.