Performance Work Statement v4.0 HCHV.docx

PERFORMANCE WORK STATEMENT

HEALTHCARE FOR HOMELESS VETERANS (HCHV) SERVICES

Coatesville Veterans Affairs Medical Center (CVAMC) 1400 Blackhorse Road, Coatesville, Pennsylvania, 19320

1.0 Description:

This is an Indefinite Delivery Indefinite Quantity (IDIQ) contract for the Healthcare for Homeless Veterans (HCHV) Program services. The contract will support the Coatesville VAMC in the specified catchment area. This contract requires the Contractor to provide a 24-hours a day / 7 days a week (24/7) community-based early recovery model that serves homeless Veterans, including those with serious mental illness, physical disabilities, and substance use disorders.

The Contractor will provide emergency residential placement and treatment services through the Health Care for Homeless Veterans (HCHV) program for a total of 45 homeless Veterans. The target population for this HCHV Contracted Residential Services is chronically homeless, chronically mentally ill Veterans, Veterans with chronic substance abuse disorders and complex needs. The goal of the HCHV Contracted Residential Services is to remove homeless Veterans from the street or habitation unfit for Veterans, rapidly stabilize Veterans’ medical, mental health, substance abuse, and other psychosocial problems to place Veterans in other appropriate transitional or permanent housing. The Contractor will provide rapid placement of VA-referred Veterans in a safe, residential treatment setting while addressing Veterans’ complex needs through on-site treatment case management services.

A VA Liaison to the Contractor will be identified by Homeless Program leadership for each facility. These individuals will act as the clinical liaisons for all client related issues between the Contractor and VA by providing clinical oversight. The VA Liaisons will not provide direct clinical supervision. The VA Liaisons will also consult with and provide input for the Contractor as needed.

The Contractor shall provide all labor, supervision, transportation, housing, material and supplies necessary to provide emergency residential placement, treatment, and supportive services to Veterans on-site at the Contractor’s facility, in accordance with all terms, conditions, provisions and requirements listed herein.

2.0 Contract Definitions:

2.1 Homeless: An individual who lacks a fixed, regular, and adequate night-time residence, meaning:

(i) Has a primary night-time residence that is a public or private place not meant for human habitation

(ii) is living in a publicly or privately operated safe haven or emergency shelter, or

(iii) in an institutional care facility if the individual has been living in the facility for fewer than 90 days and has been living in a place not meant for human habitation, a safe haven, or in an emergency shelter before entering the institutional care facility. (For Homeless HUD’s Homeless Definition criteria, see https://files.hudexchange.info/resources/documents/HomelessDefinition_RecordkeepingRequirementsandCriteria.pdf)

2.6 N/A

2.7 Contracted Emergency Residential Services (CERS) program: 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 employments services. Emphases are placed on referral and placement in permanent housing or longer-term residential programs utilizing VA and/or community resources. The length of stay in CERS typically ranges from 30- to 90 days with the option to extend based on clinical need.

2.8 Quality Assurance Surveillance Plan (QASP): An organized written document used for quality assurance surveillance. The document contains specific methods for performing surveillance of the Contractor’s continuous performance.

2.9 Commission on Accreditation of Rehabilitative Facilities (CARF): A non-profit accreditor of health and human services to approve policies regarding standards development and the accreditation process and fiscal matters governing the operation of CARF.

2.10 VA Homeless Operations Management and Evaluation System (HOMES): A computer system used by VA Homeless staff to coordinate care for homeless Veterans

2.11 Contracting Officer Representative (COR): For purposes of this contract, the VA Liaison is also the COR.

2.12 SMART, SOAP, SNAP, DAP: Professionally written styles of case management notes used in social work practice.

2.13 National Fire Protection Association (NFPA): The leading information and knowledge resources on fire, electrical and related hazards.

2.14 Housing and Urban Development (HUD): Department of Housing and Urban Development is the federal agency responsible for national policy and programs that address America’s housing needs, that improve and develop the Nation’s communities and enforce fair housing laws.

2.15 Americans with Disabilities Act (ADA): Prohibits discrimination against people with disabilities in several areas, including employment, transportation, public accommodations, communications and access to state and local government program and services.

2.16 Homeless Management Information System (HMIS): A local information technology system used to collect client-level data and data on the provision of housing and services to homeless individuals and families and persons at risk of homelessness. Each Continuum of Care (CoC) is responsible for selecting an HMIS software solution that complies with HUD’s data collection, management and reporting standards.

2.17 Continuum of Care (CoC): Program designed to promote community wide commitment to the goal of ending homelessness, provide funding for efforts by nonprofit providers, and State and local governments to quickly rehouse homeless individuals and families while minimizing the trauma and dislocation caused to homeless individuals, families, and communities by homelessness. CoC also promotes access to and effective utilization of mainstream programs in order to optimize self-sufficiency among homeless individuals and families experiencing homelessness.

2.18 High Suicide Risk (HSR): A categorization that a Veteran that has a higher risk of suicide will be designated for particular care and follow up by staff. A HSR Safety Plan will be offered and charted by staff for Veterans identified as benefiting from a plan.

2.19 Individualized Homeless Stabilization Plan (ISP): A plan that is a mutually agreed upon by staff and Veteran of goals that they will be working towards while in the CERS program.

2.20 OEF/OIF/OND: Operation Enduring Freedom / Operation Iraqi Freedom / Operation New Dawn

3.0 Performance Requirements:

3.1 FACILITY: It is the responsibility of the Contractor to properly maintain the facility and the VA shall have no responsibility for paying or reimbursing the Contractor for such expenses. The facility must:

a. Pass VA NFPA inspection as required by all guidelines and additional requirements if provided by the VA.

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

c. Maintain proper insurance policy and coverage

d. Comply with State and local safety codes, and/or State health and sanitation codes.

e. Be licensed under the State and/or local authority.

f. Where applicable, be accredited by the State.

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

h. Be equipped with first aid equipment, evacuation, and emergency management plan, in case of emergency.

i. Have an aggressive on-going plan to address bed bug infestation.

j. Contractor must be able to provide on-site office space for VA Liaison or other VA clinical staff as needed.

3.2 INSPECTION OF FACILITY AND PROGRAM: Annual and random unscheduled inspections will be conducted during contract term, a multidisciplinary VA team consisting of social workers, dietitian, a representative of the VA Police and a Facilities Management Safety Officer, Nursing and/or other subject matter experts as determined necessary by the medical center director or HCHV Coordinator shall conduct a survey of the facilities to be used to provide Veterans food, shelter, and therapeutic services to assure the facility provides quality care in a safe environment. Inspections may also be carried out at such other times (scheduled and unscheduled) as deemed necessary by the Department of Veterans Affairs. Contractor will allow VA staff to inspect the facility and/or review Veteran participant treatment protocols at any time without prior written notice to the Contractor.

The Contractor will be advised of the findings of the inspection team. If deficiencies are noted during any inspection, the Contractor will be given 15 days to take corrective action and to notify the COR that the corrections have been made. A contract will not be awarded until noted deficiencies have been eliminated. Failure by the Contractor to take corrective action within 15 days, this failure will be reported to the VA Contracting Officer. If corrections are not made to the satisfaction of the VA, the Contracting Officer will consult with the appropriate officials so that suitable arrangements can be made to discharge or transfer Veterans and to terminate the existing contract, as appropriate.

The inspection of the facilities will include inspection for conformity to the current Life Safety Code as described, and will also include the following:

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

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

c. Determining whether the facility is in attractive surrounding conducive to social interaction and the fullest development of the resident’s rehabilitative potential.

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

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

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

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

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

i. Local, on-site supervisor(s) are accessible to facility staff and veterans 24 hours a day, seven days a week for anticipating and problem-solving veteran's needs (i.e. HSR) or administrative concerns (staffing ratio, facility maintenance) in real time. At all times the Contractor must have a designee or supervisor available to communicate and respond to the VA Liaison in real time.

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

3.3 GUIDELINES FOR SERVICES: The Contractor must provide a safe environment for all Veterans consistent with the Safe Haven model of housing and services. The Contractor will offer a low-demand environment with a minimum set of rules designed to re-establish trust in the chronically homeless Veteran and engage the Veteran in needed treatment services. Contractors must have written policies and procedures in place that address the following concerns and situations:

a. Acceptance of treatment cannot be a condition of admission or continued stay.

b. Medication adherence or compliance cannot be a condition of admission or continued stay.

c. Abstinence from alcohol or drugs cannot be a condition of admission or continued stay; Infractions of rules should be used as opportunities for engagement.

d. Management of suspected or known drug or alcohol use or relapse by one or more Veterans and interventions based on the Safe Haven model including Motivational Interviewing and Harm Reduction.

e. On-site contraband, weapons, drug or alcohol related paraphernalia (i.e., found alcohol, drugs, drug “works”, etc.) and utilize interventions based on the Safe Haven model.

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

g. Room inspections and searches, including approval, methods and frequency to be tracked in a log and available for review by VA staff upon request.

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

i. Client abandonment of belongings in the facility, including time frames and procedures for disposal.

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

k. Procedure for medical records request by veteran with specifics regarding re-release of information.

l. Designated area for use as a “safe room,” “sober lounge” or “respite room” that is separate from the community and allows for privacy and staff observation These policies and procedures must be communicated to Veterans both verbally and in writing in a manner that is understandable within 72 business hours of admission to the facility. This communication must be documented in the Veteran’s client record.

Program rules and expectations should be kept to a minimum, be simple, and should focus on the safety of the Veterans and staff. Program rules should focus on staff and resident safety. Most Veterans may have had difficulty in the past adhering to settings where strict rules are applied. The rules should reward positive behavior, be enforceable, relate to the living situation, provide for safety of the Veterans, and provide opportunities for engagement. Veterans will not be discharged for the use of alcohol or drugs. Many of the Veterans that this program will target have failed programs in the past for their inability to stay clean and sober. To provide for the safety of the Veteran(s), the Contractor must have written policies and procedures in place that clearly indicate the following are prohibited:

a. Dealing or use of illicit drugs/alcohol at the facility.

b. Buying or selling of alcohol or drugs in the facility.

c. Sexual activity between Veterans (including kissing and holding hands).

d. Violence or threat of violence toward Veterans or facility staff.

e. Destruction of facility property.

f. Possession of weapons.

Although rules must be kept simple and demands on the Veterans is low, it is required that staff at the facility stay continuously engaged with the Veterans. Policies and procedures for staff should reflect the following:

a. Regular room checks should occur with a strong focus on maintaining a safe environment that promotes the well-being of all Veterans.

b. Staff are trained in providing flexible, respectful responses to infractions of rules.

c. Homeless Veterans will not be discharged for drinking or use of drugs off property, non-compliance with prescribed medication or infractions of house rules that do not constitute a risk to their personal safety or the safety of the facility Veterans or staff; and

d. Assertive engagement by the staff with patients regarding these problems is the preferred course of action to deal with these common problems of the Safe Haven facility.

The Contractor shall have reasonable rules governing day-to-day life and activities in the facility in accordance with VHA HANDBOOK 1162.09. Such rules clearly inform Veterans of the obligations upon which their continued participation in the program depends and the consequences for non-compliance. Veterans will be provided with a copy of the rules and regulations at intake and upon Veteran’s request, and when changed/updated. In addition, Contractor will post the rules in a location readily accessible to clients and visitors. The rules must include detailed Veteran Rights and the procedures that the Contractor has in place to protect the Veterans rights and dignity. Veterans must be permitted to exercise these rights without fear of reprisal.

The Contractor must communicate policies and procedures to Veterans both verbally and in writing in a manner that is understandable to each Veteran upon admission to the facility, in the form of a written Veteran handbook that is verbally reviewed by the assigned case manager with the Veteran. All policies and procedures must be reviewed and approved within 15 days after the contract award. Any updates/changes to these policies and procedures must be reviewed and approved prior to being presented to Veterans. All updates to any policies and procedures must be reviewed with Veterans within 7 days of revision. This communication must be documented in the Veteran’s client record.

Contractor must have an internal grievance process that Veterans can use to resolve conflicts within the program. Contractor must have written policies and procedures for resolving grievances, including a statement regarding the client’s right to request reasonable accommodation, and must post them in a place conspicuous and be accessible to clients. In addition, each Veteran shall receive a copy of the grievance policies and procedures upon intake and upon sanction or discharge notice.

3.4 BASIC RIGHTS AND PROTECTION AGAINST DISCRIMINATION: Contractor must protect the rights and dignity of the individual served in all phases of service delivery. At minimum, Contractor must afford each Veteran the following rights and protections. Veterans must be permitted to exercise these rights without fear of reprisal.

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

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

c. Veterans whose compliance with program rules is limited by their physical and/or mental health disabilities are entitled to reasonable accommodations, in accordance with the Americans with Disabilities Act, the Federal Fair Housing Amendments Act, Section 504 of the Rehabilitation Act, including those requirements covering reasonable accommodations for the disabilities and the use of assistance animals, and all other applicable State or Federal Laws. Contractor must equally apply rules, policies, and procedures to Veterans, unless a Veteran has asked for a reasonable accommodation due to his/her disability.

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

e. All Veterans are entitled to just and standardized procedures for determining eligibility, admissions, sanctions, and discharges, and resolving grievances.

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

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

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

i. Veterans’ rights must be protected against all forms of discrimination, including those based on race, religious creed, color, national origin, ancestry, language, disability (physical or mental health), medical condition, marital status, familial status, age, sex, source of income or political affiliation.

j. Veterans will receive a written policy indicating that harassment of clients and staff on the basis of race, religious creed, color, national origin, ancestry, language, disability (physical or mental health), medical condition, marital status, familial status, age, sex, source of income, or political affiliation will not be condoned nor tolerated.

k. All Veterans are entitled to a safe and secure environment and dignified case management.

l. Contractor must post basic rights and protection against discrimination policies in a conspicuous place and in appropriate languages.

m. All policies and procedures will be in writing and subject to review by the VA upon request.

3.5 REASONABLE ACCOMMODATION: Contractor must respect and reasonably accommodate personal and cultural differences associated with race, religious creed, color, national origin, ancestry, language, disability (physical or mental health), medical condition, marital status, familial status, age, gender, sexual preference, source of income, or political affiliation. At no point shall program access be denied because of an individual disability. Information learned about the Veteran’s disability from the assessment will not be used as grounds for discharge or other punishment and will be used to guide Veteran to appropriate services. Moreover, a program may apply different rules to Veterans because of their disabilities, unless the different rules are a result of granting a reasonable accommodation request made by a Veteran with a disability. The Contractor shall not ask questions about a Veteran’s disability, including the nature and severity of the disability or the treatment, symptoms, and medications related to the disability. A Veteran is not obligated to reveal that s/he has a disability prior to admission. Veterans with disabilities are entitled to reasonable accommodations. If a Veteran requests a change in a program’s policy or procedure as an accommodation of his/her disability, the program should grant the accommodation when the accommodation is both reasonable and necessary because of the Veterans disability. Such an accommodation request must be considered during any stage in the provision of a program, including at intake, during services, and during discharge proceedings. When a reasonable accommodation request is made, the program supervisor may request verification of the individual’s disability. The Contractor is required to develop a written policy for their process for reasonable accommodations with VA approval. This will include: 1) All requests for reasonable accommodation, 2) details of all steps taken to accommodate a Veteran’s request for reasonable accommodation, and 3) any explanation for denial of services and/or accommodation, and 4) any appropriate referrals to Veterans who are denied accommodation. All explanations are to be written on formal letterhead from program management to the Veteran and VA Liaison at the time of denial for services or accommodation. Contractor will be aware that violation of the ADA< Section 504 of the Rehabilitation Act and Fair Housing Laws may result in stopping admissions and/or termination of contract for cause.

3.6 PROGRAM REQUIREMENTS: The facility shall have 45 beds for CERS. No funds will be made available for capital improvements under this contract.

3.7 ROOM AND BOARD: Room and Board shall be accessible to the Veteran 7 days a week and 24 hours per day. Accommodation will include a private or semi-private room, with no more than three Veterans having access per room. Community bathrooms shall not require going through a Veteran's bedroom for access. If applicable, the kitchen area should be separate from the sleeping quarters. Rooms shall include a bed and other furnishings such as a dresser, storage, and personal linens (towels and bed sheets). The bed must be designated for use exclusively by the individual Veteran from the time of admission to the time of discharge. The bed must be situated in a room that affords the Veteran safety, privacy, and security. Each Veteran must have a safe and secure place to store their belongings that is readily accessible to the Veteran (such as a locking closet, a locking armoire, a locker, etc.). The Contractor will allow Veterans to store personal belongings for at least 72 hours after formal HCHV discharge.

Contractor is required to ensure that the facility used for this contract meets the Americans with Disabilities Act (ADA) guidelines for accessible accommodations for Veterans with physical limitations or impairments. At least 50% of a facility’s Contracted Residential Care CERS rooms must be wheelchair accessible, to include all entrances/exits, bathroom facilities, common areas, Liaison office, case management offices and group rooms. Veterans must not be segregated from the rest of the facility due to physical disability; they must have the same access to the physical plant as well as the treatment services and supports at the facility as any other resident.

3.8 MEALS: 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 chronic medical, mental health or substance abuse disorders. Meals shall meet current dietary guidelines, set forth by the U.S. Department of Agriculture and U.S. Department of Health and Human Services, including any updates made to the guidelines. There will be a minimum of three (3) nutritionally adequate meals a day, 7 days a week and the availability of snacks of nourishing quality (e.g. fruits, vegetables, protein sources, etc.) between meals and bedtime for those requiring or desiring additional food, when it is not medically contraindicated. There will not be more than a 14-hour span between evening meal and breakfast of the following day. Contractor will provide alternative meals for Veterans with dietary restrictions, if medically indicated (e.g. diabetic, renal, and soft mechanical diets) and reasonable accommodations for Veterans with cultural/religious preferences around food (e.g. Kosher, Sikh, Ramadan, etc.). Food shall be prepared, served, and stored under sanitary conditions. The Contractor shall provide storage space in an on-site refrigerator and/or freezer for Veterans to store and freely access personal food. The Contractor shall establish and maintain sanitary procedures for washing dishes, cleaning equipment and work areas and disposing of waste. A VA dietitian may assess printed menus as well as Veterans’ satisfaction with meals and the actual consumption of food offered in determining the Contractor’s success in meeting this requirement during annual facility inspection or at any point during the contract period.

3.9 LAUNDRY FACILITIES: Contractor must provide on-site laundry facilities and supplies (detergent) free of charge for Veterans to do their own laundry or to have laundry done.

3.10 SAFE ROOM: Contractor shall provide a “safe room” where veterans returning to the facility under the influence can relax until they are ready to return to their rooms. This room shall offer a bed and/or chair. A minimum of 30-minute checks will be performed by staff on duty while a Veteran is in the “safe room” or a security camera to monitor Veteran.

3.11 INTERNET, COMPUTER AND PHONE ACCESS: Internet and phone access shall be available to Veterans residing at the facility. Access shall consist of a service/speed rating of at least 10 Megabytes per Second (Mbps) Download, 1Mbps Upload or better. Wireless or other access shall be provided so that it is possible for three (3) or more users to access internet services simultaneously. Facility shall provide hardware (computer(s), printer, etc.) to be utilized. Veterans enrolled at the local community college or taking online courses should be given priority of usage. The Contractor will be responsible for establishing hours of usage as well as setting any “parental controls” they deem essential.

3.12 ENVIRONMENT OF CARE SERVICES: The Contractor must provide a clean and comfortable care environment that is structurally sound facility; does not pose any threat to the health and safety of the occupants and protects them from the elements. The facility entries and exit locations are capable of being utilized without unauthorized use and provide alternate means of egress in case of fire; every room or space will have natural or mechanical ventilation; be free of pollutants in the air at levels that threaten the health of Veterans; provide a water supply free from contamination; has sufficient sanitary facilities in proper operational condition, allowed to be used in privacy, and are adequate for personal cleanliness and the disposal of human waste. Facility must have adequate heating and or cooling mechanisms that are in proper operating condition; adequate natural or artificial illumination to permit normal indoor activities and to support the health and safety of Veterans; provides sufficient electrical sources to permit use of essential electrical appliances while assuring safety from fire. All housing and equipment will be maintained in a sanitary manner free from pests, insects, and vermin and will provide a warm, welcoming, and respectful atmosphere through lighting and décor. Contractor ensures that the furniture is well maintained and comfortable. It is the Contractor’s responsibility to maintain a clean and comfortable environment that meets these conditions. It is the Contractor’s responsibility to anticipate problems and be proactive and assertive in their resolution to reduce the likelihood of reoccurrence. For example, the Contractor would be responsible for alleviating a bed bug infestation by hiring an exterminator at its own expense.

3.13 ON-SITE OFFICE SPACE FOR VA LIAISON: The Contractor must provide private onsite furnished office space to a Liaison from VA. The office space must afford the VA Liaison and Veterans privacy and confidentiality when meeting. The VA Liaison is expected to be onsite at the Contractor facility two to five days per week in keeping with VA model development program expectations.

3.14 TRANSPORTATION: The Contractor shall provide Veterans with local round-trip transportation to accommodate scheduled admissions, to attend medical/mental health appointments in the community and at the local VA facility, search for transitional or permanent housing, benefits agencies, meetings with landlords/property managers and address other care needs during business hours and after hours as necessary. Contractor shall help Veteran’s access public transportation, including providing information and instructions necessary to enable Veterans to utilize public transportation. This can be done through the provision of bus passes, if available. If VA Liaison and/or other appropriate VA staff determines that adequate public transportation is not available or appropriate for Veteran, the Contractor shall provide alternative transport by car or taxi 24/7. These costs will be considered part of the basic services provided.

3.15 ADMISSIONS: The goal of this contract is to rapidly stabilize Veterans’ medical, mental health, substance abuse and other psychosocial problems by expediting placement of these Veterans into safe, supportive, emergency housing. It is understood that the type of Veterans to be cared for under this contract will require care and treatment services over and above the level of room and board. It is also understood that Veterans may need more intensive case management than the general population. To be eligible for placement in emergency contract beds, all Veterans must be homeless or at imminent risk of becoming homeless and be eligible and registered for VA services. A formal diagnosis is not required for the Veteran to participate in the program. Contractor must provide housing and services to Veterans, including medically compromised Veterans, Veterans with sex offender status, seriously mentally ill Veterans, Veterans who have abused or are actively using drugs or alcohol, and/or Veterans who have been involved with the legal system.

VA Liaison and Contractor will mutually determine an admission process that includes written eligibility criteria that are fair, objective, and compliant with applicable State and Federal laws. VA maintains final approval authority. The eligibility information must be made available to clients at intake and staff must provide answers to questions about the admission criteria and process.

The VA is responsible for determining eligibility of Veterans prior to acceptance by the Contractor for services. A Release of Information (ROI) is required (hard copy, fax or e-mail are acceptable) and shall be provided to the Contractor for each Veteran referred for services under the contract. The needs of special populations including women, OEF/OIF/OND, senior mental illness and chronically homeless will be prioritized. Veterans who decline or refuse to allow this communication about their treatment needs and ongoing care through an ROI will need to receive services elsewhere.

3.16 INTAKE AND REFERRALS: A list of authorized VA Staff that can make referrals shall be provided to the Contractor upon award of the contract. VA staff may be added or deleted from the list during the term of the contract at the discretion of the VA liaison.

All Veterans must receive and sign a receipt for an intake packet within 72 business hours, which includes, at minimum, the following information:

a. Description of the Contractor’s services

b. Rules and Regulations

c. Grievance Policy

d. Emergency Procedures

e. Veteran Rights and Responsibilities

f. Reasonable Accommodation

g. Medication Management

h. Veteran Handbook

The Contractor must have a phone line for VA inquiries and referrals. Return calls from the Contractor are expected within two (2) hours during business hours Mondays through Fridays. This includes calls from VA Liaison or Staff to the Program.

3.17 ADMISSION CRITERIA: To be eligible for HCHV Contracted Residential Services,

a. Veterans must meet the requirements of 38 U.S.C. 2031 (a) and 38 CFR 63.3.

b. Veterans will be screened and referred to the Contractor by the VA Liaison.

c. CERS will target individuals experiencing brief and non-recurring episodes of homelessness but may accept individuals experiencing chronic homelessness.

d. Contractor must have the ability to accommodate immediate admissions 24/7. All admissions must have authorization of the VA. In reference to eligibility during non-business hours, contracted staff should contact CMCVAMC eligibility office to verify Veteran status during non-business hours. If unable to verify during non-business hours, a homeless person should be accepted conditionally. Contractor must notify VA Liaison of admissions that occur outside of non-business hours immediately the next business day. Within 72 hours of the notification, VA clinical staff will meet with the newly admitted individual and complete an assessment. If evident safety concerns/issues arise before the 72-hour time frame, the decision to exit individual based on safety concerns will be deferred to the Contractor. VA staff cannot approve payments for services provided to unauthorized/ineligible Veterans.

e. If, within 72 hours of admission, a homeless individual is found to be ineligible for VA healthcare, Contractor will initiate referrals to alternative placements and transition the homeless individual to this placement.

f. If, within 72 hours of admission, Veteran displays physical evidence of a communicable disease and/or tests positive for such, the decision to transition this individual to alternative placement will be deferred to the Contractor.

g. If, within 72 hours, it is determined that the level of care is not appropriate, the Contractor will collaborate with the Veteran and VA to initiate referrals and arrange for provision of care through other VA or community resources.

h. Contractor must have the ability to accommodate the following:

· Veterans with ambulatory difficulties, including wheelchairs, rollators, and other assistive devices in compliance with Americans with Disabilities Act Accessibility Guidelines

· Veterans with sex offender designations, including Megan’s Law in coordination with individual reporting requirements on a case-by-case basis

· Veterans participating in opioid treatment programs

· Veterans with medical issues that do not meet criteria for inpatient medical or nursing home services. Contractor is not expected to provide home health aide or skilled nursing services. However, Contractor may not deny admission based on the need for in-home services, if services are provided by VA or another outside agency. Examples include medication administration, wound care, assistance with activities of daily living (including bowel/bladder incontinence)

3.18 TIME FRAME/LENGTH OF STAY: The initial stay for a Veteran in Contracted Residential Services is determined by the need of each individual Veteran. There shall be no minimum stay criteria for admissions. It is understood that the Contractor will not be paid for care provided to a referred Veteran beyond the period authorized in the referral, unless an extension of the authorization is provided in writing by the VA.

CERS: The initial length of stay for a Veteran in CERS should be no longer than 90 days depending on the needs of the Veteran as mutually determined by the Veteran, Contractor, and VA Liaison. Any extension of the stay after 90 days must be authorized by the VA Liaison or Designee, provided that there is clear clinical indication and availability of funds. Only extraordinary circumstances will be considered in order to extend service periods in excess of 90 days for individual Veterans, and these must be authorized by the VA Liaison or Designee. The Contractor shall develop a procedure for requests and approvals of per diem extension within 15 days from award with VA approval.

3.19 DENIAL OF ADMISSION: Veteran cannot be denied entry to HCHV Contracted Residential Services based solely upon length of current abstinence from alcohol or non-prescribed controlled substances, the number of previous treatment episodes, the time interval since the last program entry, the use of prescribed controlled substances, disability, income, sex, or legal history. This includes a Veteran status of being a victim of Domestic Violence and as such cannot be considered during the screen process. The screening process must consider each of these special circumstances and determine whether the program can meet the individual Veteran’s needs while maintaining the program’s safety, security, and integrity. All Contractors must employ a harm reduction approach. Additionally, Contractor cannot limit re-entry (i.e. if a Veteran discharges for negative reasons, Contractor cannot require the Veteran to wait a number of days for program re-entry).

3.20 ABSENCES AND CANCELLATION: The Contractor shall notify the VA Liaison of unauthorized absences by a referred Veteran from the facility within two (2) hours during business hours or immediately the next business day if absence occurs during non-business hours. Should a Veteran absent himself/herself from the Contractor’s facility in an unauthorized manner, payment for services for that Veteran shall be continued for a maximum period of 48 hours, provided there is a concurrent documented active outreach attempt on the part of the Contractor’s staff to return the Veteran to the facility and there is a reasonable belief that the Veteran will return. Excused and unexcused absences of the Veteran from the facility will not be reimbursed after 48 hours but do not have to be discharged unless the absence is unauthorized and there is no expectation that the Veteran will return to the facility as determined by the VA liaison.

The VA Liaison may authorize payment for excused absences if there is a compelling medical or mental health need and the excused absence is verified in advance for a maximum period of 7 days for Veterans who are confirmed admitted to a VA Medical Center and/or community hospital for medical and/or mental health needs.

The Contractor shall develop a policy for notification, confirmation, and authorization of payment for Veterans who are excused and/or Veterans admitted into a hospital/mental health facility for no more than 7 days. VA reserves the right to remove any or all Veterans from the facility at any time, without additional cost, when it is determined to be in the best interest of the VA or the Veteran. This includes discharge from facility for ongoing bed bug infestation.

3.21 DISCHARGES: 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 VA Liaison 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. Two performance measures have been defined by VHA performance measures in VA Homeless Operations Management and Evaluation Systems (HOMES). The following performance measures are defined elements in the quality assurance review (QASP) of this program which include:

· HCHV1: Discharges to Permanent Housing

· HCHV2: Negative Discharges

3.22 PROCEDURES FOR NEGATIVE DISCHARGE: Contractor must post rules in the Veterans Case Manager’s Office and provide Veteran with the rules which specify the reasons or conditions for which a Veteran may be sanctioned or discharged, including those behaviors which constitute gross misconduct and are grounds for immediate discharge from the program and those which would prompt a written warning if violated and potential discharge if violated repeatedly. Timely due process provisions will include two warning notices for violations which do not result in immediate discharge prior to issuance of a discharge notice and an opportunity for case conference after warning is issued to the client.

All negative discharges will require immediate contact with the VA Liaison. The Contractor will describe the formal appeal procedures through which clients may appeal program regulations, sanctions, or discharges. This information must be provided to Veterans in writing upon intake via rules and regulations and grievance policy and must be clear and easily understandable by Veterans. Notice of, and access to, formal appeal procedures and conditions or process for re-admission to the program must be posted and provided to Veterans. Reasonable efforts to provide an appropriate referral to another facility or appropriate level of care must be made. This does not apply to Veterans who are discharged for danger to self or others.

3.23 CASE MANAGEMENT REQUIREMENTS: The Contractor shall comply with the VA patient’s Bill of Rights as set forth in Section 17.34a, Title 38, Code of Federal Regulations. The Contractor is responsible for maintaining Veterans’ privacy and confidentiality and must have systems in place that protect Veteran’s personal identifying information and protected health information. This includes but is not limited to the following: having adequate private office space for Veterans to meet in confidence with their case manager; having secured paper and electronic filing systems to protect clients’ case records and other documentation; conducting ongoing training of staff about maintaining client privacy and confidentiality in all verbal and written communications and interactions; ensuring that non-clinical/non-case management facility staff have access to Veteran information only as needed in order to meet the service requirements contained in the contract.

Upon Veteran program entry/admission, the Contractor shall:

a. Conduct a high-risk screening, psychosocial assessment, and treatment planning, actively involving the Veteran. Psychosocial assessments will include establishing goals of identified treatment needs which affect the Veterans’ adjustment to their environment.

b. Obtain relevant Releases of Information to communicate and coordinate Veterans’ treatment with VA and other community-based service providers.

c. Develop a highly Individualized Service Plan (ISP) with the Veteran consistent with low demand program goals within 72 hours of program admission; the plan must specifically include provisions for Veteran placement into an appropriate transitional or permanent housing placement dependent on the length of stay from their admission to the HCHV Contract Residential Care facility, which is 30-90 days of CERS admission. ISP must be signed by the Contractor, the Veteran, and the VA Liaison.

d. As a primary goal of the HCHV program, plans for Veterans’ transition to permanent housing placements must be clearly reflected in each ISP and in weekly case management notes. As part of this plan, Veterans’ housing history and needs must be assessed through a formal and thorough Housing Assessment completed within 72 business hours of program admission. Housing Assessments must identify Veterans’ housing history, strengths (i.e. positive prior rental history), and barriers (i.e. Unlawful Detainers). The housing placement planning must take into account all the appropriate and available community-based housing options as well as the Veteran’s preferences regarding location and housing type.

e. The plan should also be focused on encouraging the Veteran(s) to reconnect or maintain services, especially mental health and substance use services that will allow attainment of transitional or permanent housing. Acceptance of the services offered should not be a condition of continued stay in Safe Haven. However, engagement and service delivery should retain the expectation that the Veteran will advance to permanent housing with support, recognizing that it will often be at his or her own pace.

f. All Veterans will be referred to the VA for Primary Care and Mental Health appointments and the Contractor will support Veterans in making initial and subsequent appointments. Particular efforts will be made for Veterans who are identified by VA Liaison to be highly acute.