PWS WVAMC HCHV CERS.docx

WILMINGTON VETERANS’ AFFAIRS MEDICAL CENTER (WVAMC)

PERFORMANCE WORK STATEMENT

CONTRACT RESIDENTIAL SERVICES BEDS FY22

1) PURPOSE:

The Wilmington Veterans Affairs Medical Center (WVAMC) in Wilmington Delaware requires Contractors to provide services as part of its Community Based Health Care for Homeless Veterans (HCHV) program. The goal of the HCHV program is to remove homeless Veterans from the street or habitation unfit for Veterans and place them in community-based, residential environments with sufficient supportive services to meet their needs and ultimately facilitate the improvement of their housing situation.

The WVAMC is seeking 24 hours a day / 7 days a week (24/7) community-based early recovery model of supportive housing within the State of Delaware in New Castle County and accessible by public transportation that provides therapeutic and rehabilitative services in a safe environment to homeless eligible Veterans.

The purpose of this solicitation is to obtain offers from contractors who can provide housing, outreach services, case management services, and rehabilitative services within the State of Delaware for Veterans experiencing homelessness and/or chronic homelessness as defined by the Housing and Urban Development (HUD), including Veterans diagnosed with severe mental illness and/or substance use disorders, in community-based residential facilities.

2) BACKGROUND:

The Department of Veteran Affairs (VA) has been providing direct and specialized services for homeless Veterans for nearly 25 years. The Secretary of the VA has set a zero-tolerance policy for homelessness within the Veteran population. As part of the Plan to End Homelessness among Veterans announced in late 2009, the Veterans Health Administration (VHA) has been increasing both capacity of existing programs and services offered to program participants. The plan calls for utilizing new models of care not previously offered by VA. The Health Care for Homeless Veterans (HCHV) program is authorized by 38 U.S.C. 2031, under which VA may provide “care and services under section 1710 of this title to veterans suffering from serious mental illness and to veterans who are homeless.” The duties of, and standards applicable to, non-VA community-based providers is authorized by 38 U.S.C. 501, 2031, part 63.15.

WVAMC is seeking Contractor(s) to assist with the provision of emergency residential housing and supportive services to Homeless Veterans with special needs with or without their families in community-based Contracted Emergency Residential Services (CERS) facilities offering a safe and secure environment that supports their goals for recovery from homelessness. The Contractor will be required to provide a low-barrier therapeutic and rehabilitative milieu and attendant services targeting the underlying factors contributing to homelessness. The Contractor will not be required to provide detoxification or other hospital level treatment.

WVAMC intends to issue one award contract with a max of 15 beds. Priority groups are male veterans, female veterans, veterans with a sex offender status, and sites that can house families. VA is only able to pay for services provided to the veteran themselves. Solicitations from contractors who can service multiple priorities groups will be weighed higher. Contract (s) will not exceed a total of 15 homeless Veterans, who need immediate placement in a safe environment with onsite treatment services. Many of these veterans have co-morbid conditions that include serious mental illnesses, substance abuse disorders, and other medical conditions. The goal of the HCHV Contracted Residential Services (CRS) is to rapidly stabilize Veterans’ medical, mental health, substance abuse and other psychosocial problems in order to place Veterans in other appropriate transitional or permanent housing within 30 to 90 days, but no more than 180 days. Contractor will provide rapid placement of VA-referred Veterans in a safe, residential treatment setting while addressing Veterans’ complex needs through on-site case management and therapeutic support services. This housing must meet the criteria established both by HCHV clinical staff and VA fire and safety officials. Contractors are urged in the strongest terms to carefully review the requirements outlined in the Performance Work Statement to ensure that all facilities fire and safety and treatment services criteria can be met in a timely way.

Definitions:

Chronic Homelessness is defined by HUD in 24 CFR parts 91 and 578 to mean a homeless individual with a disability who lives either in a place not meant for human habitation, a safe haven, or in an emergency shelter, or in an institutional care facility if the individual has been living in the facility for fewer than 90 days and had been living in a place not meant for human habitation, a safe haven, or in an emergency shelter immediately before entering the institutional care facility. In order to meet the “chronically homeless” definition, the individual also must have been living as described above continuously for at least 12 months, or on at least four separate occasions in the last 3 years, where the combined occasions total a length of time of at least 12 months. Each period separating the occasions must include at least 7 nights of living in a situation other than a place not meant for human habitation, in an emergency shelter, or in a safe haven.

Contracted Residential Services (CRS) is a community-based early recovery model of supportive housing that serves hard to reach, hard to engage homeless individuals with severe mental illness and substance use disorders. Many have not been able to comply with traditional program requirements resulting in high use of emergency room and acute care services and more Veterans living on the streets or in shelters. CRS places no treatment participation demands on residents but expects a transition from unsafe and unstable street life to permanent housing and to re-engage with treatment services.

Contracted Emergency Residential Services (CERS) 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 provide low demand time-limited services such as supporting mental health stabilization, Substance Use Disorder (SUD) treatment services, enhancement of independent living skills, vocational training, and employment services. In some cases, VA may complement the CERS program with added treatment services; such as participation in VA outpatient programs. Emphasis is placed on referral and placement in permanent housing or longer term residential programs utilizing VA and/or community resources. Lengths of stay in CERS typically range from 30 to 90 days with the option to extend based on clinical need but not to exceed 180 days.

3) BASIC SERVICES REQUIRED BY THE CONTRACTOR:

a) PROGRAM REQUIREMENTS: The contractor must provide contracted emergency residential services (CERS) to male and female veterans. 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. No funds will be made available for capital improvements under this contract. 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.

The contractor will offer a low-demand environment for CERS with a minimum set of rules designed to re-establish trust and engage the Veteran in needed treatment services as follows:

i) Acceptance of treatment cannot be a condition of admission or continued stay

ii) Abstinence from alcohol or drugs cannot be a condition of admission or continued stay

iii) Repeated admission or past behavior cannot be a condition of admission or continued stay

iv) Demands are kept to a minimum

v) Rules focus on staff and resident safety

vi) Infractions of rules are used as opportunities for engagement

b) ROOM AND BOARD: Room and Board shall be accessible to the Veteran 7 days a week and 24 hours per day. Accommodations will include a private or semi-private room (no more than 4 per room) with a bed and other furnishings such as a dresser, storage locker or designated secured space, and personal linens (towels, pillows, blankets and bed sheets). The environment must be conducive to social interaction, supportive of recovery models and the fullest development of the resident’s rehabilitative potential. Residents must be assisted in maintaining an acceptable level of personal hygiene and grooming. Contractor shall make free items accessible to Veterans such as wash cloths, soap, feminine products, deodorant, toothpaste, and toothbrush. Contractor shall notify VA of any possible exposure to Infectious Diseases and coordinate with their County Department of Public Health, VA Infectious Disease Control, and other governmental agencies as appropriate or instructed. The Contractor will allow Veteran to store personal belongings for at least 72 hours after formal HCHV discharge.

c) MEALS: Meals shall meet 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. At least three nutritious meals, two of which are hot meals, 7 days a week will be provided for the Veteran in a setting that encourages social interaction. In addition, the contractor must provide 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, even when it is not medically indicated. 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 accommodation for Veterans with cultural/religious preferences around food (e.g. Kosher, Sikh, etc.). When given ample notice, the contractor shall provide nutritionally adequate bag meals for participants who work or have appointments off-site during the facility’s posted meal service times. If food is centrally prepared, it shall be prepared, served and stored under sanitary conditions. The contractor shall provide storage space in an onsite refrigerator 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. 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. A VA dietitian will 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 inspections, in response to any complaints, or at any other point during the performance period

d) GENDER SPECIFIC CARE PROVISIONS Special attention needs to be given to meeting the unique treatment needs of homeless women Veterans. These needs often may include assistance with managing sexual trauma, eating disorders, interpersonal violence, and caring for dependents while in treatment. Special emphasis on privacy and security should be noted in mixed-gender facilities. Veteran residents have a right to be treated with dignity in a humane environment that affords them both reasonable protection from harm and appropriate privacy with regard to their personal needs. The living environments of HCHV CRS must include:

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

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

iii) Separate and secure bathroom arrangements to ensure an acceptable level of privacy for personal hygiene and grooming.

e) LAUNDRY FACILITIES: Contractor must provide laundry facilities on-site and necessary detergent free of charge and adequate for residents to do their own laundry or to have laundry done at minimum one time per week. If laundry services cannot be provided on-site, contractor shall be responsible for making other arrangements for laundry services free of charge to veterans.

f) TRANSPORTATION: The Contractor shall assist the Veterans free of charge with local transportation to scheduled meeting and appointments. The Contractor will be expected to help the Veteran arrange and access public transportation, including providing information and instructions necessary to enable Veterans to utilize public transportation. If VA Liaison and/or other appropriate VA staff determines that adequate public transportation is not available or appropriate for a Veteran, the Contractor shall provide alternative transport by car or taxi. Transportation cannot be a barrier to a Veteran receiving services necessary to reach their treatment goals. Thus, if public transportation isn’t appropriate or adequate, then the contractor must have the ability to provide transportation to accommodate scheduled admissions, meetings, housing search, and other appointments in the community and at the local VA facility during business hours and after hours as necessary.

4) ADDITIONAL SERVICES REQUIRED BY CONTRACTOR:

THERAPEUTIC/REHABILITATIVE SERVICES: Each Veteran must have an Individual Service Plan (ISP) completed by the Contractor with input from the Veteran and with consultation by VA Liaison and/or other appropriate VA staff within 3 business days of admission. Therapeutic and, as appropriate, rehabilitative services must be provided by the contractor. Therapeutic and rehabilitative services must be stated in the ISP based on the veteran’s needs. Services which the Contractor must be able to furnish or provide shall be detailed in the QASP and will include:

a) Group Activities: Structured group activities, as appropriate, shall occur at a minimum of two times per month – examples include group therapy, life skills training, social skills training, financial workshops, Alcoholics Anonymous, Narcotics Anonymous, vocational counseling and recreational activities. For the purposes of this contract “House Meetings” and VA Housing Resource Groups may not be counted as a structured group activity. Group Activities should have a therapeutic value and facilitation shall be the responsibility of the Contractor. Should a Veteran have mental health, medical, family and/or employment obligations which directly conflicts with their ability to participate with group activities as stated in their ISP, alternate group activities will be arranged and/or the Contractor will clearly document efforts made to accommodate the Veteran.

b) VA Coordination: Collaboration and coordination with VA program staff, as needed, will include coordination of supportive psychosocial services. In particular, coordinated efforts must be made with the VA Liaison or Designee and/or other appropriate VA staff around medical, mental health, admission and discharge needs.

c) Case Management: Case management means arranging, planning, coordinating, or providing direct services and support; referring and providing linkage to VA and non-VA resources, providing crisis management services and monitoring; and intervening and advocating on behalf of veterans to support transportation, credit, legal, and other needs. Contractor shall conduct high-risk screening, psychosocial assessment and treatment planning, actively involving the Veteran and their family or significant others, in coordination with the team members. Psychosocial assessments will include goals for clinical treatment. Contractor shall coordinate and document clinical case management and psychosocial services and documents the overall effectiveness of the case management services provided A thorough written Individualized Service Plan (ISP) will be developed within 3 business days of admission for each Veteran and updated at least every 30 days. Initial and updated ISP shall be provided to VA liaison within 1 business day. This will include structured individual case management, at minimum, weekly including counseling on self-care skills, adaptive coping skills, financial planning, permanent housing search, written care plan, referral for financial benefits. Additional counseling may include, professional and vocational rehabilitation counseling in collaboration with VA programs and community resources. In addition, special attention will be made to address High Suicide Risk (HSR) Veterans as identified by the VA Liaison, VA Mental Health Staff and/or the contractor’s Case Manager. On a weekly basis the contracted case manager will be required to update the VA Liaison on Veteran progress and/or safety concerns for HSR Veterans. Contracted case manager will review the HSR Safety Plans with the Veteran on a bi-weekly basis. HSR Safety plan reviews and a copy of the Veteran’s Safety Plan will be documented in the chart. If a veteran is deemed to be at risk of self-harm or risk of harm to others then contracted staff will immediately contact 911 or mobile crisis as well as notify VA liaison. All Veterans will be referred for VA Primary Care and Mental Health and Contractors will support Veterans in making initial and subsequent appointments. Particular efforts to access care will be made for Veterans who are identified by VA Liaison to be highly acute. Efforts will be documented in the Veterans ISP and reviewed by the VA Liaison at least monthly. For the purpose of this contract, VA discharge meetings do not count towards the weekly structured individual case management requirements. It is understood that these visits do not substitute nor relieve the contractor in any way or the responsibility for the daily care and treatment of the Veteran. The contractor must also promote community interaction, as demonstrated by scheduled activities or by information about resident involvement with community activities, volunteers, and local consumer activities. Case managers will document all structured activities that support Veteran in applying for employment as appropriate based on needs of Veteran as identified in the assessment. Contractor will provide proper documentation verifying services and case management efforts provided to the resident by all team members including, but not limited to housing, benefit and employment specialists, and program management staff. There will be an expectation that notes are written professionally in a format that utilizes the clear settings of goals and documents progress towards those goals (e.g. SNAP, SOAP, DAP or SMART notes).

d) Community Outreach: The contractor will be responsible to engage in outreach in the community both independently and in collaboration with VA Homeless Programs Designee(s) at least 2 times per month. In addition, clear documentation for outreach activities must be made available to Liaison upon request during the QASP review. Engagement with the Veteran should be goal-directed with consistent staff geared toward building trust and getting the Veteran to accept and remain in the residence. Evidence-based practices, such as motivational interviewing and harm reduction, should be utilized. Contractors will maintain occupancy by engaging in outreach services and will be knowledgeable about outreach best practices generally accepted in the community. The Contractor will participate with HMIS and the Delaware Homeless Alliance.

e) Financial Planning: The contractor will assist the residents in obtaining community resources and assistance such as, but not limited to, and as appropriate: applying for social service benefits, applying for VA benefits, income assistance and financial planning, employment services, housing resources, religious/spiritual services and access to social/recreational opportunities. The contractor case manager will assist Veteran with referrals to and follow up on all potential financial resources the Veteran may be eligible for (e.g. SSI, SSDI, Food Stamps, NSC pension, SC compensation, etc.). Case Managers will document all structured activities that support Veteran in developing a short and long term plan to understand and address their current financial situation and how to improve it. Financial planning efforts may be accomplished in group but preferably through one on one case management services.

f) Employment Services: Referral to all relevant employment opportunities the Veteran is eligible for and interested in, Case managers will document all structured activities that support Veteran in applying for employment as appropriate based on needs of Veteran as identified in the assessment.

g) Permanent Housing Search: Programs are required to provide Veterans with direct and ongoing assistance in achieving permanent housing. 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 3 business days of program admission. Housing Assessments must identify Veterans’ housing history, strengths (i.e. positive prior rental history), and barriers (i.e. Unlawful Detainers). Should Veteran refuse to engage with program staff regarding plans for permanent housing transition, motivational interviewing and other therapeutic techniques will be used to address Veteran ambivalence. All efforts to engage Veteran regarding housing plans, options, and resources shall be clearly documented and include any therapeutic techniques utilized. Contractor staff must provide direct assistance to Veterans in developing permanent housing plans and accessing appropriate housing resources. These services shall be provided weekly through one to one case management. Examples of direct assistance include: 1) assistance obtaining and reviewing Veteran’s free credit report, identifying housing strengths and/or barriers associated with current credit status; 2) Creating a Tenant Portfolio with Veteran that contains all relevant documents required in the rental process, including a completed sample rental application for Veteran, income verification documents, identification, applicable subsidies, etc.; 3) Reviewing affordable housing rental options and Permanent Supportive Housing (PSH) program offerings, and assisting Veterans with making appropriate rental inquiries and submitting completed rental applications; 4) Conducting regular and individualized housing advocacy efforts, including transportation, assistance scheduling, meeting, and communicating with property managers and landlords, and engage in troubleshooting where rental barriers or denials occur in the housing search process 5) exploring housing option in low-rent areas. All housing efforts by Contractor shall be documented clearly and presented to VA Liaison upon request. Mere communication with Veterans regarding housing, without subsequent Contractor staff action and follow-up, shall not on its own meet the above requirements. Veterans with Sex Offender status will have increased focus on discharge to stable or permanent housing placements as evidenced in ITP.

h) Recovery: Support for an alcohol/drug abuse-free lifestyle provided in an environment conducive to social interaction and the fullest development of the resident’s rehabilitative potential. Assistance to gain and to apply knowledge of the recovery process in an environment supportive of recovery models including a focus on Harm Reduction rather than strict abstinence and supportive of a Housing First approach. Pursuant to these principles, drug testing may not be used to admit, discharge or discipline a Veteran but may be used as a clinical intervention to modify behavior.

i) Occupancy: It is expected that Contractor beds will be maintained at an average minimum of 80% occupancy rate but at a preferred rate of 95% as calculated based upon number of bed nights available per quarter. If this rate is not consistently attained a Corrective Action Plan (CAP) will be developed by the Contractor as part of the QASP and/or process improvement plan.

j) Discharge Planning: Securing permanent housing will be the primary discharge goal for every Veteran. All Veterans must have a discharge plan within one week of admission. Veterans must maintain a minimum of two appropriate housing placement applications until permanent housing is obtained. Contractor must provide computer and telephone access for Veterans to assist with discharge planning and case management needs. Case Managers will provide assistance with discharge planning for every Veteran and report all discharges via email within 24 business hours using a secured process (e.g. HOMES ID number). HOMES exit form is required for discharging a Veteran from any HCHV program via fax within 24 business hours from known discharge. Compliance with all VA regulations regarding discharges and timeliness of reporting discharges is required by Contractor. Housing needs will be assessed upon acceptance to the program and resources will be coordinated for discharge to a successful community placement throughout the duration of the Veteran’s stay. A negative discharge for undesirable behavior is a committee decision that must include the VA Liaison prior to discharge. All Veterans scheduled for discharge based on behavior must meet with the treatment team and work with team to determine most therapeutic option for Veteran. This does not include violations for safety reasons or physical abuse. Please note: Profanity does not in and of itself constitute abuse and shall not exclusively be considered grounds for discharge. Any and all actual violence will be grounds for discharge. Veterans may be discharged for safety reasons at any time. All negative discharges will be subject to a full team debriefing, including VA Liaison, to look for opportunities missed to intervene sooner. All discharges are subject to the Contractors grievance procedures and must allow clients the opportunity to be represented by the VA Liaison in the grievance process. Reasonable efforts must be made to coordinate with the VA Liaison in order to schedule an appeal. Discharges shall be characterized as follows:

i) Successful Discharge – a.) the Veteran has been successfully placed as anticipated in transitional or permanent housing, or reunited with family, and has met the goals of his/her Individual Service Plan within 180 days or less; b.) the Veteran has been successfully placed as anticipated in transitional or permanent housing, or reunited with family, and has met the goals of his/her Individual Service Plan in greater than 180 days from the date of admission and the VA Liaison has approved continuation of per diem payment.

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

iii) Unsuccessful Discharge – a.) the Veteran has absconded from the facility and his/her whereabouts are unknown; b.) the Veteran has had an episode of violence or has threatened violence against staff or other residents and must be discharged to maintain the safety of the facility; c.) the Veteran has had more than one episode of onsite drug use at the facility and must be discharged to maintain a safe and sober environment at the facility; d.) the Veteran’s length of stay has exceeded 180 days from the date of admission and the VA Liaison has not approved continuation of per diem payment.

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

v) Veterans will not be discharged for drinking, off site use of drugs, 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 residents or staff. Assertive engagement by the staff with patients regarding these problems is the preferred course of action to deal with these common problems.

5) MEDICATION MANAGEMENT:

Medications and narcotics shall be properly stored, controlled, issued and recorded in compliance with physician’s orders. Contractor shall establish written procedures for ensuring Veterans confidentiality in the storage of and keeping of records concerning medication. Medication Assisted Treatment (MAT) cannot be used to rule out Veterans participation in either of the CRS Programs. This includes prescribed use of Vicodin, morphine, methadone, oxygen, etc. Reasonable accommodation for individuals in MAT is required provided the requested accommodation does not require major financial or administrative commitments that would be considered an “undue burden.” Examples of reasonable accommodations include:

a) Arranging for the individual to take medication at their clinic, physician’s office, or another off-site location – when consistent with the individual’s treatment plan.

b) Storing an individual’s MAT medication in a lock box in the program and having the individual be personally responsible for it.

c) Arranging to have the housing facility keep MAT medications in a locked cabinet (Copies of Inspection Packet requirements relating to medication management are available upon request).

6) CRITICAL INCIDENT REPORTING:

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

a) Falls

b) Assault (to Veteran or Staff)

c) Elderly/Dependent Adult Abuse or Neglect

d) Sexual Assault

e) Fire (Veteran Involved)

f) Medical/Psychiatric Emergency (911 Calls)

g) Hospitalization

h) Suicide or Suicide Attempt

i) Homicide

j) Death

k) Drug/Police Raid

l) Medication Problem

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

n) Active Substance Abuse

o) Observation/ Possession of Weapons

7) DOCUMENTATION:

The Contractor shall provide treatment and discharge planning that reflects a team based assessment of health, social and vocational needs with the involvement of the Veteran, the VA Liaison and appropriate community resources in resolving problems and setting goals via the ISP. Updated ISP every thirty (30) days from the date of the initial plan, to include any measures of movement toward rehabilitation goals, with particular focus on the attainment of community-based housing. An individual case record will be created for each referred Veteran. Case records shall be maintained to ensure the confidentiality of each Veteran. Case records and data normally maintained and included in a medical record as a function of compliance with State or community licensing standards will be made available on a need to know basis to appropriate Department of Veterans Affairs staff members involved with the treatment program of the Veterans concerned. The Contractor shall comply with applicable requirements of the Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR Part II) and the Confidentiality of Certain Medical Records (38 USC 7332). The Contractor shall participate in the Homeless Management Information System (HMIS). HMIS means the information system designated by the Continuum of Care to comply with the HUD's data collection, management, and reporting standards and 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: The files shall include:

a) Reasons for referral, data relevant to the Veteran’s admission and anticipated length of stay.

b) All essential identifying data relevant to the Veteran and his/her family including a socio-cultural assessment, weekly progress reports or notes, and documentation of any case management interventions or Veteran care conferences.

c) Medication Management/Monitoring- Copies of any medical prescriptions issued by physicians, including orders, if any, for medications to be taken. Contractor must be in compliance with HCHV medication inspection requirements.

d) Case management notes written in a professional manner (i.e. SMART, SOAP, SNAP, DAP) will include the following: 1) A written and thorough Housing Needs Assessment, 2) Financial Plan, 3) Individual Service Plan with attendant goals and documented activity indicating Veteran and Case Manager is actively working on identified goals and 4) Discharge Plan.

e) QASP Compliance Tool and all attendant supporting documentation demonstrating Contractor compliance with Contract

f) Final summaries on each resident who leaves the program, regardless of character of discharge, to include a description of beneficial changes realized during the residential period, reasons for leaving, the Veteran’s future plans, after-care referrals and connections, and follow up locator information

g) Extension approval if relevant.

h) Waivers as appropriate.

i) Upon discharge or death of the patient, medical records on all VA beneficiaries will be retained by the residential housing facility for a period of at least three years following termination of care.

The Contractor shall comply with the principles listed in 38 CFR 17.707(b) to provide housing and supportive services in a manner that is free from religious discrimination.

8) REFERRALS, ADMISSIONS AND ELIGIBILITY:

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 being homeless and eligible and registered for VA services (24 CFR 576.2). A formal diagnosis is not required for the Veteran to participate in the program. Contractor must provide housing and services to special Veteran populations, such as but not limited to the following: medically compromised Veterans, Veteran with young children, Veterans with sex offender status, seriously mentally ill Veterans, Veterans who have abused drugs or alcohol for many years, and/or Veterans who have been involved with the legal system.

Contractor must utilize an admission process that includes written eligibility criteria that is fair, objective, and compliant with applicable State and Federal laws. Contractor will provide verbal and written notification that is readily accessible to all individuals, upon request, of reasons for non-acceptance. Notification of reasons for non-acceptance is not required to be given to those denied service/housing because of bed unavailability. The eligibility information must be made available to clients at intake and staff must provide answers to questions about the admission criteria and process. Contractors must have formal appeal procedures through which clients may appeal unfavorable admission or eligibility decisions and a copy of the policy for appeals is to be given to the Veteran at screening or intake.

VA Liaison and Contractor will mutually determine an admission process that includes written eligibility criteria that is fair, objective, and compliant with applicable State and Federal laws. 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. After receipt of a Release of Information (ROI), a written pre-approval from VA Staff 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. If there is an urgent need to admit a Veteran and VA Staff is not available to provide a written approval in a timely manner a verbal approval is acceptable. Any admissions that occur without written/verbal approval must be verified by VA Staff within 24 business hours in order for the Contractor to receive payment for time spent prior to approval (e.g. admission after hours or during the weekend). Written documentation of eligibility verification, signed by an authorized VA Staff, shall be obtained by the Contractor as soon as possible for each Veteran referred for services under the contract for inclusion in the Veterans program file. The needs of special homeless populations including women, OEF/OIF/OND, serious mental illness, and chronically homeless will be prioritized within each subgroup in admission criteria.

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. The Contractor shall be provided an updated list of authorized VA Staff whenever such changes are made.

Veterans who refuse to allow this communication about their treatment needs and ongoing care will need to receive services elsewhere.

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

i) Description of the Contractors services

ii) Rules and Regulations

iii) Grievance Policy

iv) Emergency procedures

v) Veteran rights and Reasonable Accommodation

b) Timeliness of Response- Contractor must have a dedicated phone line for VA inquiries and referrals. Return calls from the contractor are expected within 2 hours during business hours Monday through Friday. This includes calls from VA Liaison or Staff to the program.

c) Admission Criteria:

i) To be eligible for HCHV Contracted Residential Services, a Veteran must meet the requirements of 38 U.S.C. 2031(a) and 38 CFR 63.3.

ii) VA will give priority to veterans, in the following order, who;

(1) Are new to the VA health care system as a result of VA outreach efforts, and to those referred to VA by community agencies that primarily serve the homeless population, such as shelters, homeless day centers, and soup kitchens.

(2) Have service-connected disabilities.

(3) All other veterans.

iii) Contractor must have the ability to accommodate immediate admissions 24/7. All admissions must have authorization of the VA. In reference to eligibility, Contractor shall get registered with SQAURES to perform an eligibility check. Contractor staff can also contact WVAMC 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 newly admitted individual and complete an assessment. If glaring safety issues arise before 72 hour time frame, decision to exit individual based on safety concerns will be deferred to contractor. VA staff cannot approve payments for services provided to unauthorized/ineligible Veterans.

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

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

vi) 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 arrange for provision of care through other VA or community resources.

vii) Contractor must have the ability to accommodate the following if a bed is available:

(1) Veterans with ambulatory difficulties including wheelchairs and other assistive devices in compliance with Americans with Disabilities Act Accessibility Guidelines

(2) Veterans participating in opioid treatment programs

(3) Veterans with medical issues that do not meet criteria for inpatient medical or nursing home services.

(a) Contractor is not expected to provide home health aide or skilled nursing services. However Contractor may not deny admission based on 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)

viii) An extension of the length of stay may be authorized by the VA Liaison, provided that funding is available. All extensions beyond 60 days must be approved in writing by the VA HCHV Liaison or Designee.

9) TIMEFRAMES:

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. The goals of the CRS Programs are to 1) rapidly stabilize Veterans’ medical, mental health, substance abuse and other psychosocial problems by expediting placement of these Veterans into safe, supportive emergency housing, and 2) place Veterans in other appropriate transitional or permanent housing within 60 to 90 days, but no more than 180 days from the date of admission. The initial stay for a Veteran should be no longer than 60 days. Some Veterans may be considered for up to 90 days depending on the needs of the Veteran as mutually determined by the Veteran, the Contractor’s staff, and HCHV Coordinator or Designee. Any extension of the stay after 90 days must be authorized by the VA Homeless Program Coordinator 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 180 days for individual Veterans and these must be authorized by the Homeless Program Supervisor or Designee. There must be documented evidence that the Contractor has exhausted every effort to place the Veteran in housing sooner and have appropriately advised the VA Liaison of these efforts well in advance of the 180 day limit. In the event that a Veteran’s length of stay exceeds 180 days from the date of admission and there is not approval for continued per diem, the Contractor shall retain the responsibility for finding suitable transitional or permanent housing in the community at its own expense.

10) DENIAL OF ADMISSION:

Veterans cannot be denied entry to HCHV CRS 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, transgender orientation, sexual orientation or legal history. This includes a Veterans status of being a victim of Domestic Violence and as such cannot be considered during the screening 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.

11) ABSENCES AND CANCELLATION:

The Contractor shall notify the VA Liaison of unauthorized absences by a referred Veteran from the facility within 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. After 48 hours the Veteran will be discharged from facility. Management of program negative exits as defined by VHA performance measures will be an element of quality assurance review of this program.

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. Excused absence of the Veteran from the facility will not be reimbursed after 72 hours. After 72 hours for an excused absence the veteran does not have to be discharged from facility immediately as long as the contractor is willing to hold the bed without receiving payment at VA request. 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. This includes discharge from facility for ongoing bed bug infestation.

12) MEDICAL EMERGENCIES

The Contractor shall notify the authorizing VA facility immediately when a medical emergency occurs that requires hospitalization of a referred Veteran. It is agreed that the Veteran will be admitted to the appropriate VA facility. When such admission is not feasible because of the nature of the emergency, it is agreed that hospitalization in a non-federal facility is acceptable. If hospitalization of a non-emergent nature is required it is agreed that admission to the appropriate VA facility will be accomplished promptly. The Contractor will make arrangements for admission and support the Veteran with any transportation issues that may arise.

The Contractor shall notify the authorizing VA facility immediately of any incidents involving a referred Veteran. The Contractor shall notify the VA Liaison by telephone during business hours. The Contractor shall notify the Administrator on Duty at the WVAMC by telephone during non-business hours. All incidents that occur during non-business hours, the Contractor should notify the VA Liaison the following business day. The Contractor shall provide the VA Liaison with a copy of the incident report within 24 business hours. The Contractor shall maintain a copy of the incident report in the Veteran’s case record. Please see above in section six for details regarding what constitutes Critical Incident Reporting.

In the event a beneficiary receiving care under this contract dies, the Contractor will promptly notify the WVAMC and immediately assemble, inventory, and safeguard the Veteran’s personal effects. The funds, deposits, and effects left by WVAMC veterans upon the premises of the facility shall be delivered by the Contractor to the person or persons entitled thereto under the laws currently governing the facility for making disposition of funds and effects left by veterans, unless the beneficiary died without leaving a will, heirs, or next of kin capable of inheriting. When disposition has been made, the itemized inventory with a notation as to the disposition of the funds and effects will be immediately forwarded to the WVAMC. Should a deceased patient leave no will, heirs, or next of kin, his/her personal property and funds wherever located vests in and becomes the property of the United States in trust. In these cases the contract facility will forward an inventory of any such property and funds in its possession to WVAMC and will hold them (except articles of clothing necessary for proper burial) under safeguards until instructions are received from the WVAMC concerning disposition.

13) EMERGENCY PROCEDURES:

Contractor will train all staff on emergency procedures and have written protocols that are posted to guide staff response to crises including, but not limited to, manmade or natural disasters, episodes of infectious diseases, physical injury, resident suicide attempts, overdoses, and domestic or other violence. Contractors will have at least one designated paid staff on site at all times who has had training and orientation on emergency procedures. Contractor will promptly and appropriately respond to the medical/psychiatric problems of Veterans and staff. There will be first aid equipment and supplies for medical emergencies available at all times. These supplies must be checked regularly to ensure they are up to date and their location in the facility must be clearly marked. Contractor will have all emergency contact numbers posted.

Universal precaution practices are used by Contractor to prevent transmission of diseases and are implemented under the presumption that blood and body fluids from any source are to be considered potentially infectious. Supplies and space necessary for maintaining universal precautions must be available. Contractor is required to follow all CDC guidance regarding infection control and be able to modify facility policies regarding infection control as guidance is updated or modified which could include limiting the amount of veterans per room or occupancy for safety.

14) RULES, POLICIES AND PROCEDURES:

The Contractor shall have reasonable rules governing day-to-day life and activities in the facility in…