PWS AMBULANCE - Northampton.docx

PERFORMANCE WORK STATEMENT

GENERAL OVERVIEW

The Northampton and Central Western Massachusetts VA Medical Center (Northampton VA) requires a contractor to furnish Basic Life Support (BLS) and Advanced Life Support (ALS) Ambulance Transportation Services to its beneficiaries. The contractor must provide all equipment, personnel, supervision, and support as part of these services. All services will be provided in accordance with the terms and conditions of this contract, applicable federal and state regulations, and industry accepted quality standards highlighted in this Statement of Work. The awarded contract will be for and four addition ordering periods.

Pricing is established on a per trip basis (one-way) with an additional per mile charge for every mile over 25 miles. The estimated number for each type of transport is laid out in the Price/Cost Schedule.

A. SCOPE OF CONTRACT

The Northampton VA system includes the one major medical center and five (5) community- based outpatient clinics (CBOC) as laid out below. Services include patient transport twenty-four (24) hours per day, seven (7) days per week, 365 days per year including all holidays. These trips will originate at one of the VA facilities.

The contractor shall provide twenty- four (24) hour ambulance service (ALS and BLS) to VA beneficiaries receiving care at one or more of the facilities listed below. Upon request by the VA, the contractor shall transport VA beneficiaries from the beneficiaries’ place of origin to the beneficiaries’ place of treatment. All vehicles, personnel, and services rendered shall conform to all Federal, state, and local statutes, rules, and regulations. The contractor shall have the ability to schedule, coordinate, and execute the estimated volume of 2,000 trips per year (estimated 140 BLS and 20 ALS trips per month). Average mileage per transport is approximately 20 miles. The VA experiences seasonal shifts in transportation requests, and the contractor shall adapt to these changes while maintaining performance standards identified in the Quality Assurance Surveillance Plan (QASP)

A.1 VA Medical Facilities The following facilities require transportation of VA beneficiaries. Any and all facilities may order transportation.

Northampton VA Medical Center 421 North Main Street Leeds, MA 01053

Pittsfield CBOC 73 Eagle Street Pittsfield, MA 01201

Fitchburg CBOC 881 Main Street Fitchburg, MA 01420

Springfield CBOC 25 Bond Street Springfield, MA 01104

Greenfield CBOC 143 Munson Street Greenfield, MA 01301

Worcester CBOC 605 Lincoln Street Worcester, MA 01605

Regional Airport Albany Regional Airport 737 Albany Shaker Rd.

Albany, New York 12211

A listing of VA personnel authorized to communicate the arrangement of these transportation services will be forwarded to the Contractor after award of contract. Updated listings shall be provided to the contractor when required during the term of the contract.

The Contractor shall contact the Contracting Officer on all matters pertaining to administration. Only the Contracting Officer is authorized to make commitments to issue changes that shall affect the price, quantity, quality, or delivery terms of this contract.

B. AMBULANCE SERVICES

The contractor shall furnish ambulance service 24 hours per day, 7 days per week, including all holidays for all patients including trips originating at one of the VA facilities.

The contractor shall furnish all linen supplies.

The average number of daily runs ranges from two (2) to four (4). The contractor shall provide as many ambulances as necessary to furnish timely service. Timely service is service that meets the response times indicated in Section 4 “Response Time.” This includes any subcontracted job to another company that meets all the terms and conditions in this contract.

The Contractor’s subcontractor, if any, shall not bill the VA directly and the VA will not pay more than the rates in this contract for all trips performed by the Contractor or their subcontractor. It is the responsibility of the Contractor to pay their subcontractors directly.

The contractor’s business, vehicles and personnel shall be licensed in accordance with the Commonwealth of Massachusetts’s regulation 105 CMR 170.00; Emergency Medical Services System.

Emergency medical technicians (EMT) shall have completed training in accordance with the standards published by the Department of Health and Human Services (DHHS) with a minimum of 81 hours or equivalent training including but not limited to an in-hospital-training period. Emergency Medical Technicians: Basic B and Paramedic P, in full compliance with training, certification, current CPR certification, valid Massachusetts driver’s license and all other applicable provisions of Massachusetts 105 CMR 170.00 shall be supervised by a qualified EMT-A or Paramedic. Such training shall be accepted and consistent with the requirements for local EMS systems supported by DHHS under P.L. 93-154, 39 Federal Regulation 24,304 (1974).

All emergency medical technicians shall be currently certified and/or licensed by local, state and regional authorities as required by law in the area in which service is performed including but not limited to EMT basic Certification, Valid Massachusetts driver’s license.

The emergency medical technician shall be enrolled periodically in “refresher” continuing education and/or advanced training programs as required by state and local laws where service is performed. “Refresher” training shall be at a minimum equivalent to that developed by the Department of Transportation and National Highway Safety Administration. Evidence of successful training shall be provided to the Contracting Office upon request.

The contractor’s ambulances shall meet the minimum vehicle requirements for ALS and BLS services with regard to storage, equipment, and supplies as well as required safety inspections and certifications as specified in 105 CMR 170.000. The VA reserves the right to confirm compliance by viewing the Contractor’s records and/or performing a physical inspection themselves.

Federal HIPPA, state, and local laws shall govern the release of patient information to the contractor. For trips within Massachusetts, upon request and as required by 105 CMR 170.240, the VA shall release relevant patient information, including medical condition at scene. For trips originating outside of Massachusetts, laws of the state in which the trip originates or federal HIPPA law shall govern the release of patient information.

C. RESPONSE TIME

SCHEDULED PICKUPS: It is expected that the contractor will arrive at the prescheduled pickup time for any prescheduled pickups.

UNSCHEDULED PICKUPS: The contractor shall respond to VA requests for ambulance service by arriving at the patient’s place of origin within thirty (30) minutes for unscheduled BLS requests and 30 minutes for unscheduled ALS requests from the time the order/call is placed by VA. Response time will be calculated from the receipt of the telephone request for services.

EMERGENCY SITUATIONS: If at any time, the contractor determines that the patient requires emergency medical service, the Contractor shall immediately call 911 for emergency services and/or proceed to the nearest emergency room.

If, prior to travel or during travel to the beneficiaries’ place of origin, the contractor determines that they cannot comply with the response time, the contractor shall immediately notify the appropriate VA travel office. Notification shall consist of the reason why the contractor cannot comply with the response time. The contractor shall not withhold notification for any reason. This notification by the contractor shall provide the VA with the name of the company that has been subcontracted to fulfill the obligations of this contract.

Failure of the contractor (including subcontracted runs) to respond to calls within the response periods will result in corrective action by the VA. If the failure to perform is not resolved within a reasonable period, the Government may take corrective action pursuant to FAR 52.212-4(m) Termination for Cause. The VA reserves the right to deduct the waiting time fee in 15-minute increments from the Contractor’s next invoice for any late transport.

Upon request, the contractor shall cooperate and furnish to the VA information detailed in the contractor’s dispatch logs, electronic records or equivalent real time recording system, ambulance sheets, or other materials requested.

If available, the Contractor shall sign a “Transport Log” upon arrival at the VA facilities. Contractors may be asked to sign out for items listed but not limited to hospital linens, pillows, and any and all hospital equipment or property moved with a patient for transport.

C. RESPONSE TIME COMPLIANCE RATE

The Contractor shall maintain at a minimum, a 95% compliance rate on responses to pick-up or deliver during the contract year. Failure of the Contractor to perform in accordance with this compliance rating may constitute sufficient cause for termination of the contract for "cause," (see FAR clause 52.212-4(m)).

It is estimated that 90% of all requests for service will be placed by telephone and 10% by fax. Requests for service may also be in writing or oral from an authorized representative of Northampton VAMC, and may be completed by telephone, mail, e-mail, or in person (by giving a written or verbal request). A list of authorized employees will be provided at the time of contract award.

D. CONTRACTOR EMPLOYEES

Contractor employees shall not be considered Government employees for any purpose. Northampton VAMC reserves the right to restrict any contractor employee from performing services under this contract who does not meet the required qualifications for the services he/she is required to perform and who violates Federal regulations or is identified as a potential threat to the security, safety, health and/or operational mission of the VA and its patient population. The restriction of such contractor personnel shall not relieve the Contractor from performing all the required services, in accordance with all terms, conditions, and schedules contained herein.

The Contractor shall furnish qualified personnel as required by contract specifications to accomplish all services under this contract.

Contractor personnel performing services to the Northampton VAMC shall conduct themselves in a professional manner, maintain personal hygiene, wear clean, neat uniforms and be identified by having the company name, and employee name affixed to the uniform. The Contractor shall be responsible for furnishing all vehicles, personnel, equipment and supplies, vehicle fuel, uniforms, nametags and/or badges for performance of services under this contract. Employee identifications (that associate the employee with the Contractor) shall be worn in clear view above the waist. All VA facilities are Smoke-Free facilities. There shall be no smoking within the vehicles by Contractor, patient or any other passenger.

Each patient shall be treated with the utmost of respect and concern, with a professional approach to his/her dignity as an individual and patient. All communication, both verbal and non-verbal, by Contractor's personnel with and in the presence of the patient, will be conducted in a professional manner. The Contractor's personnel shall practice the utmost discretion when discussing the patient's condition with hospital professionals in the presence of the patient, relatives, and/or caregivers.

E. CONTRACTOR PERSONNEL QUALIFICATIONS

All Contractor personnel performing contract services shall meet the qualifications as specified in this contract, as well as any qualifications required by Federal, State, County and local government entities from the place in which they operate. Contractor personnel shall meet these qualifications at all times while performing contract services. Record of each employee as to name, level, and certification to perform the duties of an ambulance driver or attendant shall be maintained and made available for inspection upon request. The VA requires that all contractor personnel receive a physical verification of safe driving record and drivers check every 2 years, and safety training one time per year.

During the contract period of performance, if the Contractor proposes to add on or replace personnel to perform contract services, the Contractor shall submit the required evidence of training, certifications, licensing and any other qualifications to the designated COR. At no time shall the Contractor utilize add-on or replacement personnel to perform contract services who do not meet the qualifications under the terms and conditions of this contract.

Within seven (7) days after receipt of award notification, the Contractor shall provide evidence of required training, certifications, licensing, and any other qualifications of any personnel performing services under this contract. The initial documentation shall be provided to the Contracting Officer.

Emergency Medical Technician-Paramedic (EMT-P) and Emergency Medical Technician-Basic (EMT-B) Qualifications. EMT-P and EMT-B providing services under this contract shall have the following qualifications, in addition to those required by Federal, State, and Local Government:

· Have completed training in accordance with the standards published by the Department of Health and Human Services (HHS). Such training programs must also be acceptable under the regulating requirements for local EMS Systems supported by DHHS under PL 93-154.

· Shall submit evidence of equivalent training program successfully completed to the Contracting Officer.

· Shall be certified, licensed or otherwise officially recognized by the local, state or regional government or public entity where the emergency ambulance service is operated or by which it is governed.

· Shall attend (at the expense of the contractor) all refresher continuing education, or advance training programs as required by the local or state government entity in which service is rendered. In no instance shall this be less frequent than every two (2) years. Such refresher training shall be equivalent to that developed by the Department of Transportation, National Highway Safety Administration.

· http://www.nhtsa.gov/About+NHTSA/Traffic+Techs/current/Emergency+Vehicle+Operators+Course+Revised+for+Ambulances

· The contractor shall provide its employees with certified training for ventilator operation as there may be a need to transport a stable, non-emergent transport for a patient who is on a ventilation system.

Ambulance Driver: Drivers shall have a valid operator's or chauffeur's license in accordance with Federal, State, and local government requirements for their place of operation for the services they perform. Drivers shall have EMT-B certification as a minimum.

Prices quoted in the Schedule include the service of a qualified driver and a qualified level of EMT on any ambulance assignment. All attendants/van drivers on duty must be qualified to administer oxygen and shall have successfully completed the Standard and Advance First Aid Courses of the American Red Cross, U.S. Bureau of Mines, or equivalent. Proof in the form of a current or unexpired certificate that such first aid training has been successfully completed must be available upon request.

F. CONTRACTOR EQUIPMENT, VEHICLES AND INSPECTION

Northampton VAMC reserves the right to inspect contractor's equipment and vehicles or require documentation of compliance with contract specifications, State laws, rules, regulations, and guidelines governing emergency medical transport vehicles (ambulances). Inspections of contractor facilities shall in no way constitute a warranty by Northampton VAMC that the contractor's vehicles and equipment are properly maintained. Northampton VAMC reserves the right to restrict the Contractor's use of equipment and vehicles which are in need of repair, unclean, unsafe, damaged on the interior or exterior body, and are not in compliance with contract requirements. The restriction of such equipment and vehicles shall not relieve the Contractor from performing in accordance with the strict intent and meaning of the contract without additional cost to the government.

Ambulances shall meet all current applicable Federal, State, and local specifications and regulations including, but not limited to, licensing, registration, and safety standards by the respective states of service.

Vehicles shall be clean and maintained in good repair in accordance with manufacturer's instructions and specifications at all times during the performance of this contract and shall contain:

· An emergency safety kit,

· Portable oxygen unit(s),

· Fire suppression equipment

· Appropriate road emergency warning equipment.

· Written emergency procedures.

· Protective clothing required for the protection of contractor employees where patient care is expected, such as - i) gowns, ii) gloves, iii) masks, etc

BLS vehicle shall, in conjunction with the above, also provide on-board EMT-B, perform basic airway management, and provide IV at KVO without additives.

ALS vehicle shall, in conjunction with the above, also provide an on-board EMT-P, perform cardiac monitoring, provide Advanced Cardiac Life Support (ACLS) drugs and procedures, and perform advanced airway management and medication monitoring and administration. Advanced airway management means the ability to intubate a patient and provide appropriate respiratory care, including emergency cricothyroidotomy.

All vehicles are to be equipped in accordance with the laws and regulations promulgated by the respective states of service. Radios shall be adequately powered to provide communication within the regional area as a minimum.

All vehicles must remain locked when not attended by Contractor employees to avoid unauthorized entrance. Vehicles (when not attended) shall NOT remain running, due to exhaust fumes.

The Contractor that is providing ambulance services shall provide oxygen when it is requested by authorized Northampton VAMC facility personnel or required by the patient's medical condition.

With the exception of intravenous administration pumps, the Contractor shall not be permitted to borrow medical equipment from the Northampton VAMC facilities. The Contractor shall provide all medications required while in transport, sheets and blankets, and other equipment and supplies required for use while in transport for direct patient care. An exception will be made for medications which are outside the realm of what is carried in the vehicle and are case-specific to the patient needs. Contractor shall at no time and under any circumstances exchange supplies, equipment and/or medications with Northampton VAMC (with the exception of intravenous administration pumps, as determined by the transporting facility). The prices quoted in the Price/Cost Schedule (Section B.1. of the contract) shall be inclusive of consumables used in transport. All vehicles used for critical patient care (i.e. ALS, BLS), shall include, but not be limited to, monitors, defibrillator with external pacemaker, intubation equipment, intravenous equipment, medications, patient compartment facilities, oxygen and suction system equipment including portable oxygen suction and accessories. Upon approval by the transporting facility, the Contractor will be allowed to transport the intravenous administration pumps that are delivering a fluid or medication to a patient during transfer. The Contractor shall return the pumps to the lending facility within 72 hours of patient delivery.

The Contractor shall submit a letter, electronically, fully describing the make, model, and year of the vehicle(s) which they agree to furnish under this contract along with the location and telephone numbers of their establishment where calls are received and vehicles are dispatched. The Contracting Officer shall be notified, in writing, of any equipment added or deleted after award of contract.

The Northampton VAMC shall be provided with a formal written report regarding the ambulance vehicles utilized by the Contractor. The report shall identify the various ambulance levels, their staffing criteria, stock equipment and medications carried, and procedures.

G. BILLING.

The contractor shall provide all vehicles and manpower necessary to meet the ALS and BLS transport requirements of this contract. The Contractor will be authorized to utilized other ambulance service companies as subcontractor (certified to meet all requirements within this contract) to meet contract requirements. All bills for subcontracted service will be paid directly to the Contractor at the contract rate, and the Contractor shall reimburse the subcontractor at their agreed to rate. Northampton VAMC reserves the right to re-procure services which cannot be performed by the Contractor or its’ subcontractors in accordance with the terms, conditions, and schedule of this contract. The Contractor shall indemnify Northampton VAMC for excess re-procurement cost which result from the Contractor's inability to perform the required service. Payment of re-procurement costs shall not relieve the Contractor from any other provision in this contract covering inspection, acceptance, and deductions from payment. Northampton VAMC shall be the sole judge in determining when services must be re-procured.

H. PATIENT ESCORT

The Northampton VAMC reserves the right to have an escort, such as a relative, or care provider of a beneficiary when it is determined that an escort is in the best interest of the beneficiary. There shall be no additional charge when escorts are authorized to travel with the beneficiary (return trip for VA clinician shall be paid according to the Contract Schedule.)The escort shall ride in the front passenger seat so the proper seat belt restraints can be utilized. At no time shall escorts or other personnel, except a physician, nurse or respiratory therapist treating the patient, be allowed in the patient compartment of the ambulance while the vehicle is in route.

I. SUBSTITUTION OF BENEFICIARY

The Northampton VAMC reserves the right to substitute the beneficiary requiring services at any time during the performance of this contract to prevent delays, cancellations, or dry runs. There shall be no additional charge to Northampton VAMC when such changes occur.

J. NUMBER OF PATIENTS

The Contractor shall transport only one beneficiary per trip, under ambulance services, unless specifically authorized by Northampton Healthcare personnel (authorized employees will be identified per Section 16 of this SOW) to transport more than one, and at no time shall the Contractor transport more than two beneficiaries.

K. STANDARDS OF CARE

The Contractor shall adhere to the highest quality standards of both patient and medical care. Contractor shall adhere to the city, county, and state protocols established for emergency medical care and transportation. However, Northampton VAMC may order specific levels of ambulance service to their campuses or to pick-up patients at other hospitals, nursing homes or patient homes when transporting to Northampton VAMC.

L. ELECTRONIC TRANSMISSIONS

The Contractor shall at all times during the contract period, have on his/her premises a functioning fax machine to communicate requirements with Northampton VAMC (i.e., patient incidents, requests for service, special correspondence, etc.). The Contractor shall indicate if there is e-mail availability for their company to complete communications with Northampton VAMC (use of this communication system shall be mutually agreed upon after award of contract before any communications are completed in this manner).

M. WAITING TIME

For unscheduled trips, waiting charges shall commence 15 minutes from the time the Contractor actually arrives at the designated pick-up and/or delivery points. For scheduled trips, waiting charges shall commence 15 minutes from the scheduled pick-up time or from the time the Contractor actually arrives at the designated pick-up point, whichever is later.

If the designated pick-up and/or delivery points are at other than the VA Medical facilities and waiting beyond the required 15 minute grace period is anticipated, the Contractor shall notify the travel section. This call is only for the purpose of verifying the Contractor's time of arrival at pick-up and or delivery points and is not necessary if the Contractor does not anticipate a delay for which waiting charges will be claimed. The Contractor's failure to notify the travel section when waiting beyond the grace period shall result in nonpayment for waiting time.

Trips shall be scheduled by Contractor so that patients are not held at any point to meet another vehicle for the purposes of carpooling unless authorized by the Northampton VAMC Travel Clerk.

N. AUTHORIZED NORTHAMPTON HEALTHCARE PERSONNEL

Authorized personnel will be full time staff employed by Northampton VAMC. Authorized personnel shall be communicating directly from Government telephones/fax machines/computers from within the facility.

Prior to performance, the Contracting Officer will provide the Contractor with a list of names or position titles and phone numbers of authorized Government personnel who may request services and receive calls from Contractor regarding contract performance. This list will be updated and submitted to the Contractor as changes occur. The Contractor shall ensure that requests for services are received from authorized medical center personnel. Services rendered in response to requests from other than authorized personnel shall be at the risk of the Contractor and any cost related thereto shall be borne by the Contractor.

O. ORDERING PROCEDURES

A. Department of Veteran Affairs will provide the software and access to the VetRide Vendor Portal Software for the vendor/contractor in this contract. The Contractor will utilize the VetRide Vendor Portal as instructed to:

a) Receive and respond to electronic trip requests

b) Receive, use, and ensure the use of the Vendor pass by the driver.

c) Submit claims via the electronic HCFA 1500 in the VetRide Vendor Portal or VA-Approved Transportation Software system.

d) All invoices must be submitted within 30 calendar days of date of service in accordance with 38 CFR 70 to be considered timely submission.

i. The contractor’s invoice must be on the HCFA 1500 to include:

ii. Contract Number

iii. Date of Service (to include Box 24 A-J)

iv. Authorization number(s)

v. Pick-up and drop-off location of the patient

vi. Base Rate

vii. Name (Last, First and Middle Initial (if any)) and Full Social Security number (Box 1a) of patient transported

viii. Date of Birth and Sex

ix. Diagnosis Codes or Nature of Illness or Injury

x. Documentation of circumstances when billing for waiting time

xi. Any miscellaneous charges for which the contractor is expecting reimbursement i.e., Tool charges, waiting time, etc.

xii. VA authorizing official’s name

xiii. Healthcare Procedure Coding System/National Level II (HCPCS)

e) Unauthorized charges will be reviewed by the Contracting Officer Representative (COR) as to the validity of the charges and as to whether the payment will be made. A final determination will be made within 30 days after notifying the Contractor of the charges, which are being suspended.

Each transport shall include thirty (30) minutes of wait time; the contractor may invoice for wait times in excess of this initial thirty (30) minutes. Wait time shall begin only once the contractor has both reached the pick-up address location and the appointment time has elapsed. All wait times shall be itemized and invoiced in fifteen (15) minute intervals. For partial fifteen (15) minute intervals, zero (0) to seven (7) minutes shall be rounded down to zero (0) minutes and eight (8) to fifteen (15) minutes rounded up to fifteen (15) minutes.

When invoicing for mileage, the contractor shall round to the nearest mile. Mileage ending in .5 or higher shall be rounded up to the nearest mile. Mileage ending in .4 or lower shall be rounded down to the nearest mile. Payment for mileage to or from the point of care shall be limited to the VA’s calculation according to the VA’s Bing Maps API determination. Bing Maps API is optimized to determine mileage based on the shortest time of travel.

Long Distance Mileage — Payment for mileage outside the contract miles covered in the base rate, shall be at the mileage rate stated in the price schedule, and shall be based upon the miles from the pick-up point and the specified destination. Any mileage from the place of business and/or location of vehicle and the pick-up point, or from the delivery destination back to the place of business and/or location of next trip are not considered as a separate item of this reimbursement but would be expected to be incorporated into the mileage rate as part of the administrative costs (or costs of doing business).

Upon notification of the contracting officer, the vendor must receive training and begin implementation of invoices via Vet Ride within 30 days versus VA Tungsten Network e-Invoicing network. Invoices must be submitted via the electronic HCFA 1500 in the VetRide Vendor Portal or other VA approved software. These invoices shall not include patient information, but shall include the following:

· Contractor Name

· Contract Number

· Current Purchase Order Number

· Date of service

· Total amount invoiced including a summary of the total number of charges that align with the line items of this contract (i.e., total number of BLS Base Rate, total BLS Mileage incurred, etc.)

· An itemized list of charges or services rendered that align with the line items of this contract (i.e., BLS Base Rate, BLS Mileage incurred, etc.)

Payment by VA under this contract to a provider of ground ambulance transportation services authorized under this contract extinguishes any and all liability on the part of the VA BENEFICIARY for that transportation service. UNDER NO CIRCUMSTANCES ARE VA BENEFICIARIES, THIRD PARTY INSURANCES, MEDICARE, OR MEDICAID TO BE BILLED FOR THE SERVICES PERFORMED UNDER THIS CONTRACT.

P. INVOICES

Payments for services will be monthly, in arrears, on certified invoices, per VAAR clause 852.232-37 Electronic Submission of Payment Requests.

Q. REIMBURSEMENT FOR MILEAGE

Should Northampton VAMC make a determination that a previously scheduled trip may be cancelled, and a vehicle has already been dispatched to the designated pick-up point, Northampton VAMC may notify the Contractor to cancel the order. For orders that are cancelled while the Contractor is already in route to the designated pick-up, the Contractor will be reimbursed at the rate for the trip at the rates provided in the Prices/Cost Schedule. Should the Contractor arrive at the destination before Northampton VAMC cancels the order, or if the Contractor is unable to perform a scheduled pick-up for reasons beyond the Contractor's control, (e.g., incorrect address, patient absence, patient refusal) then the Contractor shall receive 100% of rate for a one-way trip.

The prices listed in the accepted Schedule shall be inclusive of any and all ferry, bridge, tunnel or road toll charges. Contractor shall not bill Northampton VAMC for any such separate charges.

R. PATIENT RIGHTS

Patients may bring a reasonable amount of equipment, such as folding wheelchair, consumable medical supplies and personal suitcase.

Each patient shall be provided with safe and comfortable transportation to and/or from the Northampton VAMC Healthcare System. The Contractor shall assume the total responsibility for the patient's safety and comfort during the entire transfer process, from the time the Contractor's staff reaches the patient, through the loading and unloading of the patient into the vehicle, and until the time the patient is properly delivered to the professional staff of the medical Center or other final destination.

Contractor employees shall conduct themselves in a businesslike manner at all times while on Northampton VAMC premises.

When transporting patients to or from medical facilities, the driver, acting for the Contractor, shall ensure that the patient's luggage, medical records, medications, and prosthetic devices are properly accounted for and delivered with the patient as required.

S. INCIDENT/ACCIDENT REPORTS

IMMEDIATELY upon any incident/accident involving a Northampton VAMC patient being transported or escorted, verbal notification shall be made to the Northampton VAMC COR and/or CO with all the facts as they relate to the incident/accident. A written report with a list of the Contractor staff names (drivers/escorts), patient's name, and pertinent information and witnesses shall be filed within forty-eight (48) HOURS OF THE INCIDENT/ACCIDENT with the COR or CO. The report shall be filed no matter how minor the incident/accident appears to be.

The Contractor shall notify the COR in writing within 24 hours of any complaints made by the beneficiaries with regard to the ambulance service. The Contractor may provide recommendations for improved services along with the patient complaints for Northampton VAMC review. No recommendation shall be construed as being effective until and unless it is provided as a written modification to the contract from the CO.

T. INFECTION CONTROL PROCEDURES

Health Tests: Contractor must submit proof of the following within seven (7) days after contract award: All tests must be current within the past year:

T.1 TUBERCULOSIS TESTING

- Contractor must provide evidence of negative PPD test within fourteen (14) calendar days prior to an employee with direct patient contact beginning service and annually thereafter.

- Contractor must provide medical evidence that employee is disease free for those employees having a positive PPD.

- In no circumstance will an employee or driver be allowed to begin duty without prior submission of the required testing certification.

T.2. HEPATITIS B VACCINATION

- The employer shall make available the Hepatitis B vaccine and vaccination series within ten (10) days of employment to all contract employees who have direct patient contact and follow-up to all contract employees who have an exposure incident.

- Contractor shall bear all costs associated with vaccinations.

- VA Form 10-5549c, Information about Hepatitis B Vaccine (Recombinant), Consent Form, or VA Form 10-5549d. Hepatitis B Vaccine Declination (Mandatory) (Attachment B) shall be submitted to the Contracting Officer within thirty (30) days of waiver, or completion of the first in the series of the Hepatitis B Vaccine, and at completion of the vaccination series. These forms shall be provided to the contractor upon award of the contract.

T.3 COVID-19 INFORMATION AND REQUIREMENTS

Please see Attachment 1: CertificationVaccinationPRAv7 (Certification of Vaccination) and Attachment 2: COVID-19_Safe Federal Workplace Agency Model Safety Principles Revised 20210828.

Pursuant to this policy and effective immediately, onsite contractors must complete the attached Certification of Vaccination Form. The Form must be in their possession while onsite and shown to individuals responsible for enforcement of agency safety protocols. If not fully vaccinated the onsite contractor must also carry documentation demonstrating proof of a negative COVID-19 test within the previous three days.

Failure to follow these procedures may result in denial of entry to the VA facility and administrative action by the contracting officer representative (COR).

The contractor shall delay using drivers and/or attendants who have the cold, flu, chickenpox, measles, or have been around someone who is sick on trips until well or no longer symptomatic. If any ambulance employee has suffered from a communicable disease and has been cleared to return to work, a copy of the clearance documentation must be submitted to the VA contracting office prior to the ambulance employee starting work for this contract.

U. REQUIRED REPORTS AND DOCUMENTS

U.1 Within seven (7) days after contract award the Contractor shall provide a Contractor Personnel Roster. In this document, Contractor shall identify the employee Name, Position, Title and Work Assignment Area. Thereafter, any personnel changes shall be submitted within two (2) business days after the changes occur.

U.2 Contractor shall provide a "Run Sheet" as part of the beneficiary’s permanent record. This Run Sheet shall include a record of the beneficiary’s vital signs, medications used, oxygen use, beneficiary’s attitudes and any changes in the beneficiary's condition. The list stated herein shall not be construed to be as all inclusive; the Contractor shall provide all pertinent information.

U.3 CONTRACTOR AUTHORIZED REPRESENTATIVES: The contractor shall provide a list with the names, addresses, telephone numbers, and facsimile number of authorized Contractor representative(s) who have the binding authority to act on behalf of the Contractor on administrative and/or performance matters pertaining to this contract. The Contractor shall maintain this list and submit any changes thereof to the Contracting Officer as changes occur.

V. CONTRACTOR’S QUALITY CONTROL PLAN (QCP)

The Contractor shall establish and maintain a complete Quality Control Plan to assure the requirements of this contract are provided as specified. A copy of this Quality Control Plan shall be forwarded to the CO along with the requested initial proposal. The Contractor's Quality Control Plan shall include the following or have incorporated into during performance of contract, as a minimum:

· An inspection plan covering all services required by this contract. The inspection plan shall specify the areas to be inspected on either a scheduled or unscheduled basis; how often inspections will be accomplished and documented; and the title of the individual(s) who will perform the inspections.

· On-site records of all inspections conducted by the Contractor noting necessary corrective action taken. The Government reserves the right to request copies of any and/or each inspection.

· Incorporation of both active or established internal policies and procedures for updating medical service protocols that could affect performance of contract.

· The methods for identifying and preventing deficiencies in the quality of service performed, before the level of performance becomes unacceptable.

· On-site records of all vehicle maintenance and repairs performed on vehicles used in the performance of this contract, the methods of preventing vehicle breakdowns, and detailed procedures for alternative transportation of patients in the event of mechanical breakdown of ambulance.

· On-site records identifying the physical capabilities, certifications, and ongoing training of each employee performing services under this contract.

· The methods of identifying and preventing radio communication breakdowns. A detailed procedure for alternative communications in the event of electronic and mechanical breakdown of vehicle communication radios.

· A log to account for all requests for services. The log shall indicate the date and time of service call, name of the beneficiary requiring services, any required Medicare/Medicaid forms with doctor's signatures, type of transportation requested, designated pick-up and delivery points, actual time of arrival at pick-up and delivery points and actual waiting time at pick-up and delivery points, if waiting charges are claimed.

· On-site records of any complaints or problems, with procedures taken to allow for corrections and/or elimination before effects caused interruption of performance of contract.

W. SPECIAL CONTRACT REQUIREMENTS

W.1 Contractor's Responsibilities and Insurance Requirements The Contractor shall obtain all necessary licenses and/or permits required to perform this work. The Contractor shall take all precautions necessary to protect persons and property from injury or damage during the performance of this contract. The Contractor shall be responsible for any injury to themselves, their employees, or others, as well as for any damage to personal or public property that occurs during the performance of this contract that is caused by his or his employees' actions and/or negligence. The Contractor shall maintain personal liability, automobile liability, and property damage insurance, as prescribed by the laws of the states, and in accordance with VAAR 852.228-71 INDEMNIFICATION AND INSURANCE and 852.237-7 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE. Evidence of coverage shall be submitted to the Contracting Officer before commencing work under this contract (copy of Certificate of Insurance), and it shall not be changed or cancelled without thirty (30) calendar days prior written notice to the Contracting Officer.

W.2 Safety Requirements In order to protect the lives and health of all VA employees, patients, guests, and visitors on VA property, the Contractor in the performance of this contract shall take such safety precautions as the Contracting Officer, or his designate, may determine to be reasonably necessary. The Contracting Officer, or his designate, will notify the Contractor of any noncompliance with the foregoing provisions and the action to be taken. The Contractor shall, after receipt of such notice, immediately correct the conditions to which attention has been directed. Such notice, when served on the Contractor or his representative at the site of the work, shall be deemed sufficient for the purpose aforesaid. If the Contractor fails or refuses to comply promptly, the Contracting Officer may issue an order, stopping all or any part of the work, and hold the Contractor in default.

W.3 Interference with Normal Functions The Contractor's personnel shall interrupt their work at any time so as not to interfere with the normal functioning of the Northampton VAMC, including utility services, fire protection systems, and passage of facility veterans, personnel, equipment and emergency and/or service carts. These interruptions should only be occasional. Any interruptions considered to be excessive shall be brought to the attention of the Contracting Officer.

W.4 Disposal of Hazardous Waste The Contractor shall not dispose of any hazardous materials at any location on the Northampton VAMC premises except as specified by the Contracting Officer.

W/5 Sales of Companies or Name Changes The Contractor gaining award of the contract shall notify the Contracting Officer, Department of Veterans Affairs, Contracting Office ( 90C) 940 Belmont St. Brockton MA 02301 in writing immediately upon entering an agreement (either oral or written) to sale or transfer all or part of its stock or other ownership interest to any other party. Contractor shall also contact the Contracting Officer immediately in writing (at the above referenced address) in the event a company name change will happen, with information as to the reasons and/or determinations causing this action.

W.6 Health Insurance Portability and Accountability Act (HIPAA), Privacy Rule, and Security Rule Because the Contractor will have access to Protected Health Information (PHI) and Electronic Protected Health Information (EPHI) and is considered a covered entity, the Contractor is subject to regulations and guidelines issued by the Department of Health and Human Services, as mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 CFR Parts 160 and 164, Subparts A and E, the Standards for Privacy of Individually Identifiable Health Information (“Privacy Rule”), and 45 CFR Parts 160 and 164, Subparts A and C, the Security Standard (“Security Rule”); and whereas, Department of Veterans Affairs Veterans Health Administration is a “Covered Entity” as that term is defined in the HIPAA implementing regulations, 45 CFR 160.103. In accordance with HIPAA, the Contractor will be required to enter into a Business Associate Agreement (BAA) with VHA upon Contract award. (see Attachment 3)

W.7 Patient Privacy and Confidentiality All "patient papers" transported with the patient are confidential in accordance with HIPPA. Contractor's personnel may review these records for assessment and treatment purposes only. Appropriate administrative and medical information will be provided to the Contractor for patient transport. If the medical record is transported with the patient, it may be used as a source of information if the situation warrants (i.e. emergent care while in-route). In all other instances, all documents will remain intact and sealed.

CONTRACT DEFINITIONS AND ACRONYMS

Advanced Life Support (ALS) - ALS shall be provided by ambulance vehicles containing at a minimum, an on-board EMT-P, cardiac monitoring, Advanced Cardiac Life Support (ACLS) drugs and procedures, advanced airway management and medication monitoring and administration. Ambulances for ALS services shall be staffed, certified, and licensed in accordance with current laws and regulations governing the certification and licensure of private ambulances by the respective states of service, and all ALS services shall be in accordance with current laws and regulations by the respective states of service.

Basic Life Support (BLS) - BLS is defined as services required for non-critical patient care in which patient requires an ambulance, which has been staffed, certified, and licensed in accordance with current laws and regulations governing the certification and licensure of private ambulances by the respective states of service. All BLS services shall be in accordance with current laws and regulations by the respective states of service. The ambulance at a minimum shall be staffed with a vehicle operator and an Emergency Medical Technician (EMT) - Basic Ambulance, basic airway management, and IV's at Keep Vein Open (KVO) without additives.

Beneficiary - Veterans and other members determined to be eligible for benefits by the Veterans Administration (VA).

BFR - A Billed For Responses run is defined as a request for service by authorized personnel, whereby the Contractor arrives at the designated pick-up point and no patient is transported due to a change in the medical center needs. The Contractor will be entitled to the applicable rate only when BFR’s are encountered due to no fault or negligence of the Contractor.

Business Hours/Days - Business hours/days are defined as the time of 8:00AM to 4:30PM, Monday through Friday, except Federal holidays. The Federal Government observes the following days as holidays.

*If the date of the holiday falls on a Saturday, the Government holiday is the preceding Friday. If the date of the holiday falls on a Sunday, the Government holiday is the following Monday.

In addition to the days designated as holidays, the Government observes the following days:

· Any other day designated by Federal Statute

· Any other day designated by Executive Order

· Any other day designated by the President’s Proclamation

Off-Business hours/days are defined as the time of 4:31PM to 7:59AM, Monday through Friday, all day Saturday, all day Sunday, and Federal holidays.

Contracting Officer (CO) – Veterans Administration official with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings. Any changes to a resultant contract may only be made through a written modification as prepared and executed by the CO.

Contracting Officer’s Representative (COR) - VA official responsible for providing contract oversight and technical guidance to the Contracting Officer. COR responsibilities will include, but not be limited to: surveillance of services required under this contract, determining the adequacy of Contractor performance according to the specifications of this contract, acting as the Government's representative, ensuring compliance with contract requirements insofar as the work is concerned, certification of invoices, placing orders for service, providing technical guidance, overseeing technical aspects of the contract, and serves as a member on the vehicle inspection team. The COR cannot authorize deviations from the specifications and requirements of this contract. In the event the Contractor deviates without approval from the CO, such deviation shall be at the risk of the Contractor and any cost related thereto shall be borne by the Contractor. The POC will be designated in writing by the CO after contract award.

Contractor - The term "Contractor" as used herein refers to both the prime Contractor, their employees, and any subcontractors and their employees. The Contractor shall be responsible for assuring that their subcontractors comply with the provisions of this contract.

Joint Commission - A national organization dedicated to improving the care, safety and treatment of patients in a health care facility and environment.

Quality Assurance - Those actions taken by the Government to assure services meet the requirements of this contract.

Quality Assurance Surveillance Plan - An organized written document used for quality assurance surveillance. The document contains specific methods for performing surveillance of the Contractor's continuous performance.

Quality Control - Those actions taken by the Contractor to control the production of goods or services so they will meet the requirements of a contract.

Rate - Rate is defined as the rate paid for one-way transportation from a designated pick up point to a designated delivery point. This rate will be paid for all authorized one-way trips ordered under this contract action.

Scheduled Trip(s) - The term "Scheduled Trip" as used in this contract refers to those trips in which the Contractor has been given advance…