S02 36C24526R0037 Draft.pdf

PAGE 1 OF 1. REQUISITION NO.

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NO. 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

a. NAME b. TELEPHONE NO. (No Collect Calls) 8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY CODE 10. THIS ACQUISITION IS UNRESTRICTED OR SET ASIDE: % FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ IFB RFP

15. DELIVER TO CODE 16. ADMINISTERED BY CODE

17a. CONTRACTOR/OFFEROR CODE FACILITY CODE 18a. PAYMENT WILL BE MADE BY CODE

TELEPHONE NO. UEI: EFT:

PHONE: FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19. 20. 21. 22. 23. 24.

ITEM NO. SCHEDULE OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only)

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA ARE ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________ 29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY (BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION (REV. NOV 2021)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

36C24526R0037

Mark Smith 410-642-2411 04-27-2026

3PM EST

Department of Veterans Affairs

VA Maryland Health Care System

Contracting Officer (90C)

P.O. Box 1000, Bldg. 101, Room 26

Perry Point MD 21902

X

621910

$22.5 Million

N/A

X

Department of Veterans Affairs

VA Maryland Health Care System

Contracting Officer (90C)

1540 Spring Valley Dr

Huntington WV 25704

19ACQ

Department of Veterans Affairs

VA Maryland Health Care System

Contracting Officer (19ACQ)

P.O. Box 1000, Bldg. 101C Room 3

PAYMENT WILL BE MADE BY

FSC e-Invoice Payment

Invoice must be submitted electronically http://www.fsc.va.gov/einvoice.asp

Invoice Setup Information 1-877-489-6135

See CONTINUATION Page

Contractor shall provide ambulance services in accordance with the Performance Work Statement for the Huntington VAMC.

Questions shall be submitted by the date listed in Section E of this solicitation. See instructions for offerors in

Section E.

Responses can be sent to Mark Smith | mark.smith25@va.gov

See CONTINUATION Page

X X

X 1

Mark Smith

VA-VHA-RPOE-2024-0087

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 PERFORMANCE WORK STATEMENT

B.3 PRICE/COST SCHEDULE

ITEM INFORMATION

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL PRODUCTS

AND COMMERCIAL SERVICES (OCT 2025)

C.2 52.216-18 ORDERING (AUG 2020)

C.3 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.4 52.216-22 INDEFINITE QUANTITY (NOV 2025) (DEVIATION)

C.5 52.217-8 ORDERING PERIOD TO EXTEND SERVICES (NOV 1999)

C.6 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR

1984)

C.7 52.240-91 SECURITY PROHIBITIONS AND EXCLUSIONS (NOV 2025)

(DEVIATION)

C.8 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV

2018)

C.9 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020) ... 50

C.10 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.11 MANDATORY WRITTEN DISCLOSURES

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 WAGE DETERMINATION

D.2 SURVEILLANCE CHECKLIST

D.3 ATTACHMENT A

D.4 QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (SEP 2023)

E.2 SUPPLEMENTAL INSTRUCTIONS TO OFFERORS

E.3 52.201-1 ACQUISITION 360: VOLUNTARY SURVEY (SEP 2023)

E.4 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

E.5 52.212-2 EVALUATION—COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES (NOV 2021)

E.6 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—

COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (OCT 2025) (DEVIATION

FEB 2025)

E.7 52.216-1 TYPE OF CONTRACT (NOV 2025) (DEVIATION)

E.8 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.9 52.240-90 SECURITY PROHIBITIONS AND EXCLUSIONS REPRESENTATIONS

AND CERTIFICATIONS (NOV 2025) (DEVIATION)

E.10 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

(FEB 1998)

E.11 VAAR 852.252-70 SOLICITATION PROVISIONS OR CLAUSES

INCORPORATED BY REFERENCE (JAN 2008)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR:

b. GOVERNMENT: Contracting Officer 36C245 Mark Smith Department of Veterans Affairs VA Maryland Health Care System Contracting Officer (19ACQ) P.O. Box 1000, Bldg. 101, Room 26

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

[X] 52.232-33, Payment by Electronic Funds Transfer—System For Award Management, or

[] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly []

b. Semi-Annually []

c. Other [X] Monthly In Arrears

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment

Requests.

ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

AMENDMENT NO DATE

B.2 PERFORMANCE WORK STATEMENT

1. Purpose: The Hershel “Woody” Williams VA Medical Center (hereafter HWW VAMC), its associated Community-Based Outpatient Clinics (CBOCs), and affiliated healthcare clinics require contracted ambulance transportation services. The contractor shall provide all vehicles, personnel, management, supplies, equipment, and necessary reporting for the provision of Basic Life Support (BLS), Advanced Life Support (ALS), Specialty Care Transport (SCT) or Critical Care Transport (CCT) services. The contactor shall make these ambulance services available to the VA as specified in the terms of this contract below.

2. Background: H W W VAMC campus is located 1540 Spring Valley Drive Huntington WV 25704, serving over 30.000 Veterans, primarily from Southern Ohio, Eastern KY and Western WV areas and it’s four Community-Based Outpatient Clinics. The hospital has 95 inpatient beds and sees approximately 2,084 inpatient admissions and 390,325 outpatient visits a year. Veterans served within this facility lives within the following counties and zip codes.

CABELL COUNTY: WV

25701 25705 25504 25541 25702 25703 25545 25510 25506 25520

25559 25537 25755 25729 25771 25770 25773 25772 25775 25774

25777 25776 25779 25778 25706 25708 25707 25710 25709 25712

25711 25714 25713 25716 25715 25718 25717 25720 25719 25722

25721 25724 25723 25726 25725 25728 25727

WAYNE COUNTY: WV

25504 25511 25512 25514 25517 25530 25534 25535 25555 25557

25570 25669 25674 25699 2525701 25704

LINCOLN COUNTY, WV:

25003 25003 25501 25505 25506 25510 25521 25523

LAWRENCE COUNTY, OH:

45619 45623 45629 45638 45645 45656 45659 45669

BOYD COUNTY, KY:

41101 41102 41129 41143 41168

CARTER COUNTY, KY:

40351 41132 41141 41143 41146 41164 41168 41179 41180

3. Acronyms ALS – Advanced Life Support AOD – Administrative Officers of the Day BLS – Basic Life Support CCT – Critical Care Transport CCTP – Critical Care Transport Paramedic CCEMTP – Critical Care Emergency Medical Transport CO – Contracting Officer COR – Contracting Officer’s Representative CPR – Cardiopulmonary Resuscitation DOL – Department of Labor EMT – Emergency Medical Technician IAW – In Accordance With OO – Ordering Officer PWS – Performance Work Statement QASP – Quality Assurance Surveillance Plan QC – Quality Control Plan TB – Tuberculosis TJC – The Joint Commission VTS – Veteran Transportation Service

4. Scope/Requirements

4.1. Types of Service

4.1.1. The contractor shall provide scheduled add-ons and emergent transport.

4.1.1.1. Scheduled –HWW VAMC will provide a schedule of all pick-ups by noon the day prior to pick-up. For Monday and Holidays, the schedule will be provided for the last workday prior to the break.

4.1.1.2. Add-on – Appointments that are scheduled after the cut-off time of the day prior. These are for routine appointments, and non-critical transport.

4.1.1.3. Emergent –Requests for advance transport after the cut-off time for patients who cannot wait.

4.1.2. Types of transportation Service

4.1.2.1. Basic Life Support (BLS) - (A0429) Non-Emergency Transport, Basic Life Support BLS ambulances provide transport to patients who do not require extra support or cardiac monitoring. A BLS ambulance is staffed by at least one emergency medical technician (EMTs) or Paramedic and Emergency Medical Vehicle Operator (EMVO) who have training in basic emergency medical care such as basic airway management, use of an automated external defibrillator and basic drug administration.

4.1.2.2. Advanced Life Support (ALS) - (A0426) Advanced Life Support ALS ambulances transport patients who need a higher level of care during transport above those services provided by a BLS ambulance.

The unit is staffed by at least one paramedic and is qualified to render advanced life support to patients such as advanced airway management, drug administration and cardiac monitoring under the direction of a hospital. Vehicle must be operated by an EMVO, EMT, or Paramedic.

4.1.2.3. Critical Care Transport (CCT) – Patient Transportation when medically necessary, for a critically ill or injured patient needing critical care paramedic (CCP) skills between medical care facilities and provided by an authorized ambulance service to provide critical care transport and staffed by one or more critical care paramedic or other health care professional in an appropriate specialty area. Vehicle must be operated by a EMVO, EMT, or Paramedic.

4.1.2.4. Specialty Care Transport (SCT) (A0434) (Upper-Level Care) Specialty Care Transport SCT – A critically injured or ill patient transported by a ground ambulance vehicle that includes the provision of medically necessary supplies and services, at a level of service beyond the scope of the EMT- Paramedic. SCT is necessary when a patient’s condition requires ongoing care that must be furnished by one or more health professionals in an appropriate specialty area.

4.1.3. Costing for each type of trip based on each type of transport.

4.1.3.1. Reoccurring one-way trip is equivalent to one each for the unit of issue. One-way trip is calculated on 40 miles. Over 40 miles will utilize flat mileage rate.

4.1.3.2. Out of catchment area trip requests will be paid on a flat mileage rate.

4.1.3.3. Reoccurring transportation to Chillicothe OH VAMC be based on a flat rate and will be included in the Price/Cost Schedule.

4.1.3.4. Reoccurring transportation to Lexington KY VAMC be based on a flat rate and will be included in the Price/Cost Schedule.

4.1.3.5. Reoccurring transportation to Louisville KY VAMC be based on a flat rate and will be included in the Price/Cost Schedule.

4.1.3.6. Reoccurring transportation to Clarksburg VAMC be based on a flat rate and will be included in the Price/Cost Schedule.

4.1.3.7. Reoccurring transportation to Pittsburgh PA VAMC be based on a flat rate and will be included in the Price/Cost Schedule.

4.1.3.8. Reoccurring transportation to Martinsburg WV VAMC be based on a flat rate and will be included in the Price/Cost Schedule.

4.1.3.9. Reoccurring transportation to Dayton OH VAMC be based on a flat rate and will be included in the Price/Cost Schedule.

4.1.3.10. Reoccurring transportation to Nashville, TN VAMC be based on a flat rate and will be included in the Price/Cost Schedule.

4.1.3.11. One-way return trips outside of 100 miles will utilize flat mileage rate over 100 miles except for reoccurring transportation requests.

4.1.3.12. Waiting Time –For time lost in waiting at either or both ends of a trip due to causes beyond the Contractor's control, the Contractor will be reimbursed per quarter hour as proposed in the schedule for each quarter hour or fraction thereof more than one-'quarter hour for the time reported to the designated Veterans Affairs personnel. If the pick-up point is other than the Veterans Affairs Medical Center; the Contractor will call the Travel Clerk first or Transportation Assistant during administrative hours (8:00AM through 4:30PM, Monday through Friday) or the Administrative Officer of the Day (AOD) on duty during non- administrative hours (during evenings, nights, weekends, and holidays) as soon as it is anticipated that a delay may develop for which the Contractor expects to claim reimbursement. This call is only for the purpose of verifying the arrival time at the pick-up point and is not necessary if the Contractor anticipates no delay for which reimbursement will be claimed. The Contractor's failure to notify the travel section when waiting beyond the grace period shall result in non-payment for waiting time.

4.1.3.13. Respirator – Flat rate for providing transport and personnel to monitor patient with respirator.

4.2. Transportation Requirements

4.2.1. Luggage – The Contractor may also be required to transport patient luggage, medical records, medication, and comfort items from pickup points to destination at no additional cost to the Government. Luggage to be transported will be restricted to suitcase and valise types.

4.2.2. Patient Pickup and Delivery from/to VAMC

4.2.2.1. Ambulance drivers will report and sign-in at the Travel Clerk's or

AOD desk, Monday through Friday, from 8:00 AM through 4:30 PM and at the Admission Office from 4:30 PM to 8:00 AM Monday through Friday and weekends.

4.2.2.2. Ambulance drivers will deliver and pick-up patients at designated locations, i.e., Emergency Room, Special Treatment Room, Clinic Area, Ward (if known). These locations will be designated when designated Veteran Affairs personnel make contact.

4.2.2.3. Ambulance personnel will report to the Nursing Station to (1) announce his/her arrival to pick-up and transfer the patient, and (2) obtain report of pertinent information regarding the patient's condition from the primary nurse/physician.

4.2.2.4. When delivering a patient, the ambulance personnel will give report to appropriate nursing personnel. When requested, a run sheet of that run shall be faxed or sent electronically to the VA Medical Center.

4.2.2.5. In cases which the ambulance's dispatchers prioritize their requests for services as an emergency and a rescue squad is dispatched, the dispatcher will notify the calling party at the VAMC of the patient's location as soon as it becomes available.

4.2.3. Response Times.

4.2.3.1. Scheduled - All scheduled request will arrive on time for all orders.

4.2.3.2. ALS

4.2.3.2.1. Add-on – 2 hours

4.2.3.2.2. Emergent – 20 minutes

4.2.3.3. BLS

4.2.3.3.1. Add-on – 2 hours

4.2.3.3.2. Emergent – 20 minutes

4.2.3.4. Critical – 20 minutes

4.2.3.5. Specialty – 30 minutes

4.2.3.6. Reporting – If response times cannot be met, a phone call will need to be placed immediately to the COR, Program Manager, or Beneficiary Travel Department.

4.2.4. Number of Patients – Only one patient will be transported on a trip unless specifically authorized or requested by the Department of Veterans Affairs.

When, pursuant to the Department of Veterans Affairs authorization, more than one patient is transported concurrently on a trip, reimbursement shall be made only at the rates contained in the schedule of costs for transporting a single patient. Regardless of the number of patients transported concurrently on a single trip, the Contractor shall be reimbursed for only the Base Rate (Item 1} for one trip. An Authorized official of the Department of Veterans Affairs may, when in the best interest of the veteran, allow a relative or caregiver to accompany the veteran, but caregiver/relative will have to provide their own transportation home.

4.2.5. Complete Trip –When ambulance service under the terms of this contract involves pick-up of a patient who is to be brought to this medical center or to another hospital and/or clinic for hospitalization or treatment, the trip will be considered complete when the patient is delivered by ambulance personnel to the admitting/evaluation unit, a specified ward or unit, or to the location specified at the time the trip is requested.

4.2.6. Non-Pickup of Patient - When ambulance service involves a trip to or from this medical center, patient's residence, or patient refusal, but due to unforeseen circumstances the patient is not available for pick-up, the Contractor will collect for the trip at the rates applicable under the schedule portion of this contract. The Department of Veterans Affairs reserves the right to substitute patients in these instances to prevent the "no-load” situation.

4.2.7. Non-Arrival of Patient - When ambulance service involves the pick-up of a patient scheduled to arrive by air and the ambulance driver finds such patient does not arrive as scheduled, the ambulance driver will contact the Travel Clerk, Supervisor, Patient Support Unit, or the AOD and inquire as to the status of the arrival. If appropriate, waiting time may be authorized for time lost in waiting in accordance with the rate applicable under the schedule of costs of this contract. If Contractor reported as scheduled and no patient is transported, Contractor will be reimbursed at the rates applicable under the schedule of costs of this contract.

4.2.8. Patient Custody: The Contractor shall not release the patient from his/her custody, unless custody is released to a charge nurse on duty at the facility patient is being transported to, or to a designated point of contact at the patient's residence. The Contractor shall take every reasonable measure to assure the well-being of the patient at their destination. The ambulance crew shall wait with the patient when transporting for scheduled appointments and provide assistance as needed, unless otherwise released by medical personnel at the location of the appointment.

NOTE: The charge nurse or designated responsible individual must oversee the change in custody.

4.2.9. Rates: Rates will apply twenty-four hours per day seven days a week.

Payment for mileage travel beyond the catchment area will be limited to "One Way Only" for the distance over which the patient is transported. Such mileage costs will be paid in addition to the applicable rate per trip for any trip entirely within the catchment limits. The contractor shall receive the base rate proposed in the schedule for all one-way trips ordered. The base rate shall constitute full compensation for one-way trips which do not exceed the mileage threshold as defined herein.

4.2.10. Mileage – For all trips ordered under this solicitation "Mileage Threshold" is considered to be 40 miles one way. Any trips beyond 40 miles will be subject to a flat rate per mile. If claimed, mileage must be documented on the trip sheet. Mileage is determined using Bing Maps.

4.2.11. Telephone System - The Contractor shall have telephone coverage to accept calls from the HWW VMC seven (7) days a week/24 hour a day, Sunday through Saturday. The contractor shall have sufficient telephone capacity to ensure immediate communication access between the HWW VAMC and the Contractor's facility for the purposes of scheduling and/or canceling trip requests as well as handling other emergencies. If the Contractor's place of business is located beyond the local telephone call zone, the Contractor shall accept telephone orders for service on a collect basis or provide a toll-free number.

4.2.12. Tolls - It is agreed and understood that the prices proposed in the schedule do include any ferry, bridge, tunnel, or road toll charges. If Contractor's place of business is located beyond the local telephone call zone of this medical center, Contractor agrees to provide a toll-free telephone number or will accept telephone orders for service on a collect basis.

4.2.13. Contractor Personnel: Contractor personnel shall be courteous and always conduct themselves in a businesslike manner while providing services under this contract.

4.2.14. Emergency Medical Technicians (EMTs), Critical Care Transport Paramedics (CCTPs) & Other Personnel

4.2.15. EMTs, CCTPs and other medical personnel (as applicable) shall at all times meet the qualifications specified in this contract as well as all applicable federal, state, and local government laws, regulations, and standards. EMTs, CCTPs and other medical personnel (as applicable) shall be certified, licensed, or otherwise officially recognized by the local, state, or regional government or public entity where the emergency service is operated or by which it is governed.

4.2.16. If the contractor wishes to add or replace personnel throughout the life of the contract, it shall provide evidence of required training, certifications, licensing, and any other qualifications to the Contracting Officer’s Representative (COR) for review.

Note: The contractor assumes responsibility for the management and oversight of their employees. Upon request by the VA, the contractor may be required to provide credentials for new employees.

4.2.17. All ambulance drivers shall have a valid driver’s license in accordance with state requirements for their place of operation and the services they perform. If the contractor wishes to add or replace drivers throughout the life of the contract, it shall provide a valid driver’s license to the COR.

Note: The Government does not maintain records of these items. The contractor is responsible for the management and oversight of its employees. Upon request, the contractor shall provide credentials for any new employee.

4.2.18. CCTPs shall have met all state requirements for the tier in which they are performing services in (I, II, III). Proof in the form of a current certificate for the successful completion of such must be provided to the COR upon request.

4.2.19. Investigative Requirements for Contract Personnel: Contract personnel will be subject to the same investigative requirements as those for regular VA appointees and employees. The level of investigation commensurate with the level of access to perform the performance work statement is: Special Agreement Checks (SAC). Fingerprinting for contract personnel will be conducted at (Huntington VAMC). Thereafter the contracted employees will be subject annually to the same requirement, with a 90-day window to complete such requirement as provided by (Huntington VAMC). The Workforce Management and Consulting, Human Resource Operation Office, Personnel Security Contracting Team (WMC HROO PerSec Contracting Team) is responsible for adjudicating all background investigations for contract employees.

NOTE: Contractors are responsible for screening their employees. VA may request verification of screening at any time

4.2.20. EMTs, CCTPs, and other contractor personnel as applicable must pass the Contractor’s background check and must not have been convicted of (or have any pending charges for) a felony for the past five years. Personnel (and Contractor) must report any new or additional charges or convictions if they arise during the course of performance under this contract so VA can review them and determine whether the employee in question needs to be discharged of his or her duties until the matter is adjudicated. The contractor, when notified of an unfavorable determination by the Government, shall withdraw the employee from consideration from working under the contract. Failure to comply with the contractor personnel security requirements may result in termination of the contract or cause.

4.2.21. Tuberculosis Exposure Control Policy

4.2.22. The contractor shall provide the VA with a policy on tuberculosis

(TB) exposure and control, to include TB decontamination.

4.2.23. The contractor shall have its personnel tested for TB in accordance with state guidelines and provide written confirmation to the COR that all personnel (current employees and any new hires) performing services under this contract are current in their TB test by at the start of each Ordering Period.

4.2.24. Training - In addition to formal training for license/certificate, the contractor shall provide 16 hours of orientation training for each employee up to 14 days after his or her initial assignment of duty. Vendor must provide proof of training upon request from the CO or COR

4.2.24.1. All contracted employees who have access to protected health information (PHI) in the performance of their official duties are required to take vendor Privacy and HIPAA focused training and Information Security Awareness Training and Rules of Behavior.

4.3. Contractor Provided Vehicles, Supplies, and Equipment

4.3.1. Infectious Prevention Transmission Based Precautions – Vendor is expected to follow the Center for Disease Control (CDC) for standard and transmission-based precautions for all patients, care givers, and staff.

4.3.2. Vehicles

4.3.2.1. Vehicles shall meet all applicable federal, state, and local regulations and specifications, including but not limited to licensing, registration, and safety standards for the services they are providing.

4.3.2.2. The VA reserves the right to inspect the contractor’s equipment and vehicles or require documentation of compliance with state laws, rules, regulations, and guidelines governing emergency medical transport vehicles. VA inspections of contractor equipment do not constitute a warranty or guarantee that the contractor’s vehicles and equipment are properly maintained. The VA reserves the right to restrict the contractor’s use of equipment and vehicles in the performance of this contract which are not in compliance with state laws, rules, regulations, and guidelines governing emergency medical transport vehicles. The restriction of such equipment and vehicles shall not relieve the contractor from performance in accordance with the contract nor necessitate additional cost to the VA.

4.3.2.3. Vehicles shall be clean and maintained in good repair in accordance with manufacturer’s instructions.

4.3.3. Supplies and Medication

4.3.3.1. The contractor shall not borrow or exchange supplies and/or medications with the VA. All required supplies and medication required for safe patient transport will be provided by the vendor.

Equipment attached to or in use by the patient at time of pick-up may remain with the patient during transport to ensure continuity of care.

Medical Control Authorities are responsible for maintaining and supplying medication during patient transport.

4.3.3.2. All VA equipment and unused medications must be returned to VA during patient drop-off or as promptly as feasible within 24 hours.

4.3.3.3. The contractor must be capable of transporting the drugs, supplies, and/or equipment required by the patient. The contract shall have the appropriate medications, including Specialty Care and Critical Care Transport, if necessary, based on county and state requirements for the region.

4.3.4. Equipment

4.3.4.1. The VA reserves the right to inspect the contractor’s equipment or require documentation of compliance with state laws, rules, regulations, and guidelines governing emergency medical transport vehicles. VA inspections of contractor equipment do not constitute a warranty or guarantee that the contractor’s equipment are properly maintained. The VA reserves the right to restrict the contractor’s use of equipment in the performance of this contract which is not in compliance with contract requirements. The restriction of such equipment shall not relieve the contractor from performance in accordance with the contract nor necessitate additional cost to the VA

4.3.5. Linen - The contractor shall furnish all linen required for patient transport at no additional cost. Linen shall not be exchanged with linen belonging to

HWWVAMC.

4.4. Transportation Request –

4.4.1. The contractor agrees to utilize the VetRide Vendor Portal or VA-

Approved Transportation Software with every patient transported under this contract.

4.4.2. Department of Veteran Affairs will provide the software and access to the VetRide Vendor Portal or VA-Approved Transportation Software for the vendor/contractor in this contract. The Contractor will utilize the VetRide Vendor Portal or VA-Approved Transportation Software fully as instructed.

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.

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

b. Contract Number

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

d. Authorization number(s)

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

f. Base Rate

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

h. Date of Birth and Sex

i. Diagnosis Codes or Nature of Illness or Injury

j. Documentation of circumstances when billing for waiting time

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

l. VA authorizing official’s name

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

4.4.2.1. Unspecified charges, charges not associated with the contract, 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. A transportation request is defined as one incidence of a request for one-way service (Stretcher Transports, BLS, ALS, CCT). No more than one patient will be transported per order unless approved by an authorized VA staff. Transportation requests will be made through VetRide or VA-Approved Transportation Software

Utilization. Contractors must have the capability to receive orders, update ride status, and input trip costs and other required data through this portal. Contractors must have dedicated staff available to monitor this portal 24/7. HWW VAMC Travel Program Staff will be available to assist with account setup and training for the Contractor’s Staff. In the event VetRide or other VA-Approved Transportation Software Utilization is down, other methods of communication (i.e., telephone, facsimile) will be used to place Transportation requests.

4.4.2.1.1. HWW VAMC Travel Program Staff/or authorized VA employees will work with the Contractor the following business day to reconcile any transportation requests that were placed outside of VetRide or VA-Approved Transportation Software Utilization.

4.4.2.1.2. The Contractor must update VetRide or VA-Approved

Transportation Software Utilization with any data and/or notes in real time that deviate from the original order such as invoicing for additional mileage due to a road closure, wait time, reason for no load, etc. HWW VAMC Travel Program Staff/or authorized VA employees may place a “hold” on payment of this order until it has been reconciled.

4.4.2.2. Only the following VA staff are authorized to place, cancel, or make changes to transportation requests:

Contracting Officer (CO) Contracting Officer’s Representative (COR)

4.4.2.3. The Contracting Officer Representative will furnish the Contractor with the names of individuals above, who are authorized as Ordering Officers, by separate memorandum upon issuance of the contract. The Contracting Officer Representative will update this list throughout the life of the contract as Ordering Officers change.

4.4.2.4. Ordering Officers are responsible for issuing and administering orders placed under this contract. Ordering Officers have no authority to modify any term of this basic contract. Any deviation from the terms of the basic contract must be approved in writing by the Contracting Officer responsible for this contract. The Contractor shall accept orders against this contract only from the Contracting Officer and/or authorized ordering officers. Fulfilling orders from persons other than the Contracting Officer or ordering officer may result in loss or delay in payment for supplies/services provided under such orders.

4.4.2.5. Non-authorized VA employees and private agencies (e.g., non-VA medical facility, nursing homes) are not considered authorized to place transportation requests.

4.4.2.5.1. All patient pick-up(s) and drop-off(s) shall be authorized via “orders” which shall only be issued by the designated Ordering Officers. When placing orders for services, the Ordering Officer shall contact the designated contractor point of contact(s) to provide the following information:

▪ Mode of transportation required,

▪ Required time of arrival

▪ Name of the beneficiary,

▪ Pick-up and delivery point,

▪ Type and number of additional medical care specialists required,

▪ Type of equipment required,

▪ Last four of the patient's Social Security Number, and

▪ Any other special instructions

4.4.2.6. An Audit system will be put in place by the VA to include the COR or designee, Beneficiary Travel Department staff, and clinical staff to ensure appropriateness of the order and timeliness of the response.

4.4.2.7. The type of transportation service (BLS, ALS, CCT) required will be discussed and determined by VA clinical personnel and the contractor.

The contractor shall transport the patient per its policies and standard industry practice. If the type of transportation service differs from what was agreed upon by the VA and contractor, the contractor shall submit documentation to the VA explaining its rationale.

4.4.2.8. The VA may authorize an escort (e.g., spouse, relative, guardian, etc.) to accompany the patient during medical transport if it is practicable and, in the patient’s, best interest. The contractor shall allow the escort to accompany the patient at no additional cost.

4.4.2.9. The patient may bring with her or him up to three (3) liters of oxygen.

The contractor shall be responsible for providing adequate and safe storage of the oxygen tanks during transport.

4.4.2.10. The contractor shall have sufficient vehicles and personnel to provide services for up to eight (8) simultaneous transportation requests for BLS transport and three (3) simultaneous transportation requests for ALS. One of these eleven (11) simultaneous transports may require CCT capability up to Tier III. If HWW VAMC requires ambulance services exceeding eight (8) BLS simultaneous transportation requests, or three

(3) ALS simultaneous transportation requests the vendor will be offered to provide the services if they have sufficient vehicles/personnel available; but may decline these additional orders if sufficient vehicles/personnel are unavailable.

4.4.2.11. The number of transports under normal operating conditions will typically range from (10-20) transports each weekday and significantly less on weekends and holidays. The number of actual transports may vary throughout the life of the contract.

4.4.2.12. Response Times

4.4.2.12.1. Orders that are scheduled by 7pm local time the day before the required services are defined as scheduled in advance. With the exceptions found below, the contractor shall arrive on time for all orders scheduled in advance

4.4.2.12.2. Emergent Transport (Originating from VA or CBOCS (Only): The contractor shall be required to provide Ground Ambulance transportation within twenty (20) minutes of order/patient pick up call.

4.4.2.12.3. For all add-ons (not scheduled in advance) transportation requests, with pick up at HWW VAMC, the contractor will be allotted up to a sixty (60) minute response time from time of order placement for transportation requests that are not previously scheduled in advance.

n. For an urgent transport request for a critical patient (as deemed by the physician) with pick up at HWW VAMC, the contractor will be allotted up to a thirty (30) minute response time.

4.4.2.12.4. For transportation requests which do not have a pick-up at HWW

VAMC

a. The contractor may be required, if requested by the VA, to dispatch ambulances on short notice for transportation requests not scheduled in advance; for these transportation requests the contractor shall dispatch ambulances within thirty (30) minutes of receiving the order.

b. Pick-up appointment times shall be agreed upon by the VA and contractor at time of order placement and be reasonable based upon travel distance, speed limits, and weather conditions.

c. The contractor’s patient pick-up time cannot be more than 15 minutes prior to the schedule pickup time nor 15 minutes later than the scheduled pickup time for transportation requests scheduled in advance.

d. The contractor shall not be held liable for nonperformance caused by an occurrence beyond the reasonable control of the contractor and without its fault or negligence such as, acts of God or the public enemy, acts of the Government in its sovereign or contractual capacity, fires, floods, epidemics, quarantine restrictions, strikes, and unusually severe weather.

The contractor MUST notify the VA with as much advance notice as possible should any of these occur.

4.4.3. Cancellations

4.4.3.1. For trips in which the contractor is notified of cancellation before the vehicle is dispatched, there shall be no charge to the Government.

4.4.3.2. A “no show” is defined as a transportation request which is cancelled after the contractor has the vehicle enroute, or has arrived at the pick-up location, and there is no longer a requirement for patient transportation. The contractor may request one-way reimbursement for no-shows. No-show reimbursement shall be based upon the base rate for the type of service requested (Stretcher Transports, BLS, ALS, CCT) and the one-way mileage (Stretcher Transports, BLS, ALS, CCT) accrued enroute to the pick-up location at time of cancellation. Mileage for no- show cancellations shall be confirmed by the contractor and reported to the VA as soon as possible from time of cancellation.

For transportation requests out of HWW VAMC only, the contractor will immediately dispatch a vehicle upon receipt of the order (including transportation requests in which the destination may change prior to pick up due to the critical condition of the patient). When the contractor is notified of a cancellation prior to arrival at the HWW VAMC campus, there shall be no charge to the Government.

4.5. Pick-Up/Drop-Off/Reporting Procedures

4.5.1. Ambulance personnel shall pick up and deliver patients at specified locations. These locations will be specified by VA staff when an order is placed and communicated to the transporting personnel.

4.5.2. When applicable, ambulance personnel shall report to the Veteran Transportation Service (VTS) Dispatcher or Administrative Officer of the Day (AOD) to (1) announce his/her arrival to pick up and transfer the patient and (2) obtain report of pertinent information regarding the patient’s condition from the primary nurse/physician.

4.5.3. When delivering a patient, ambulance personnel shall give reports to the appropriate VA healthcare staff and provide a copy of the run sheet which will be retained by the facility for inclusion to the patient’s medical record.

NOTE: At this time, we do not receive any paper documentation from the contractor. The contractor brings the patient to the designated clinical area, has the Veteran check in directly with staff when possible, and when that is not feasible, the contractor staff relay the check-in information to our staff. We can revise the statement accordingly to reflect this process.

Ordering Period:

When delivering a patient, ambulance personnel shall present patient to the appropriate VA clinic and healthcare staff for check in.

4.5.4. In cases where ambulance personnel must divert to a local emergency department while performing a VA authorized transport, the contractor’s dispatcher shall notify the VA Beneficiary Travel Department or Administrative Officer of the Day of the patient’s location and status as soon as this information becomes available.

4.6. Patient Welfare

4.6.1. The contractor shall be responsible for the patient’s welfare during transport. The contractor shall be held responsible for patient and/or VA property during transport. Any damaged or lost wheelchairs, walkers, crutches, or personal belongings shall be replaced at the contractor’s expense.

4.6.2. The VA requires the contractor to exercise extreme caution and care in the handling of patients.

If a VA beneficiary being transported declines to be properly secured or removed the securement devices himself/herself, the driver will notify the Ordering Officers (OO), Administrative Officer of the Day (AOD) Beneficiary Travel Office Staff, or COR Contracting Officer’s Representative (COR) of this fact prior to departure. The contractor is not required to transport any VA beneficiary who refuses to be properly secured while being transported. In the event a beneficiary refuses to be properly secured, they shall be returned back to the location which they came from.

4.7. Incident Reporting

4.7.1. The contractor shall notify the COR, Requestor, Program Manager, Beneficiary Travel Department, of any accidents and/or safety problems that occur while the patient is being transported. This notification shall occur within one (1) hour by telephone. A written report of the incident shall be delivered to the COR, Program Manager, or Beneficiary Travel Department, by the close of business of the next working day.

4.7.2. The COR and Program Manager will monitor the service provided. The contractor shall cooperate with the COR in providing information and answering questions in a timely manner. The contractor shall promptly inform the COR of any complaints received directly from patients. If warranted, the VA may conduct incident investigations and require written response from the contractor within 48 hours of request.

4.7.3. Invoicing

4.7.4. 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.

4.7.5. 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.

4.7.6. 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).

4.7.7. 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:

4.7.8. - Contractor Name

4.7.9. - Contract Number 4.7.10.- Current Purchase Order Number 4.7.11.- Date of service 4.7.12.- 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.)

4.7.13.- 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.)

4.7.14. 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.

5. Period & Place of Performance

5.1. The Place of Performance is variable and may occur within the states of West Virginia, Pennsylvania, Ohio, Maryland, Kentucky, Washington DC.;

ambulance services may be required to or from locations including, but not limited to the following:

5.1.1. Hershel “Woody” Williams VA Medical Center to include front entrance and emergency department. The HWW VAMC address is: 1540 Spring Valley Drive Huntington, WV 25704.

5.1.2. HWW VAMC Community-Based Outpatient Clinics (CBOC)

CBOC Name Address

Charleston WV CBOC 700 Technology Dr, South Charleston, WV 25309

Prestonsburg KY CBOC 5230 KY Route 321, Suite 8 Prestonsburg, KY 41653

Gallipolis OH CBOC 323A Upper River Road, Gallipolis, OH 45631

Lenore WV CBOC 2867 Route 65, 15 Lenore Business Mall Williamson, WV 25661

5.1.3. Other VA Medical Centers and Hospitals, but not limited to:

Hospital Name Address

St. Mary’s Medical Center 2900 1ST Ave Huntington WV 25702

Cabell Huntington Hospital 1640 Hal Greer Blvd Huntington WV 25701

Cleveland Clinic 9500 Euclid Ave Cleveland OH

Chillicothe OH VAMC 17273 St Rt 104 Chillicothe OH 45601

Dayton OH VAMC 4100 W 3rd St. Dayton OH 45428

Lexington KY VAMC 1101 Veterans Dr. Lexington KY 40502

Louisville KY VAMC 800 Zorn Ave Louisville KY 40206

Beckley VAMC 200 Veterans Ave Beckley WV 25801

Martinsburg VAMC 510 Butler Ave Martinsburg WV 25405

Clarksburg VAMC 1 Medical Center Dr. Clarksburg WV 26301

Washington DC VAMC 50 Irving St NW Washington DC 20422

Baltimore VAMC 10 N Greene St Baltimore MD 21201

Pittsburgh VA Medical Center

University Drive C Pittsburgh 15204

Pittsburgh VA Medical Center

1010 Delafield Rd Pittsburgh 15204

Nashville TN VAMC 1310 24th Ave S Nashville TN 37212

5.1.4. Veteran’s Residence – TBD

5.1.5. Tri-State Airport – 1449 Airport Rd, Huntington, WV 25704

Yeager Airport – 100 Airport Rd, Charleston, WV 25311

6. Quality Control Plan

6.1. Quality Control

6.1.1. The contractor shall maintain a Quality Control Plan (QCP) that contains, at a minimum, the following:

6.1.1.1. A description of the company’s organizational structure including a description of the roles and responsibilities of management and supervisors.

6.1.1.2. A description of the methods to be used by the contractor for identifying and preventing deficiencies or problems in the quality of service.

6.1.1.3. A description of the specific steps the contractor will take for corrective action if needed if a deficiency or problem in the quality of service occurs.

6.1.1.4. A description of the company’s records and tracking system used to identify up-to- date background checks, applicable certifications and tests, and training of each employee performing services under this contract.

6.1.1.5. A description of the method used to provide on-time ambulance services to meet the requirements of this contract (24/7 availability and up to 11 simultaneous transports in accordance with PWS 4.5.2.10)

6.1.1.6. A description of the methods used to identify and prevent radio communication breakdowns and a detailed procedure for alternative communications in the event of electronic and mechanical breakdown of vehicle two-way radios.

6.1.1.7. Contingency Plan for VetRide Vendor Portal is down. A description of the method/system used to log all requests for service. The contractor shall confirm that the log indicates the date and time of service call, actual time of pick-up versus the scheduled time, name of patient requiring services, designated pick-up and delivery points, mileage, and actual waiting time at pick-up and delivery points if waiting charges are claimed. The contractor shall confirm the log will be sent to the COR, Program Manager, or Beneficiary Travel Department monthly.

6.1.2. The Government will evaluate the contractor’s performance under this contract to ensure that the contractor’s QCP is adequate, and that quality is achieved through a Quality Assurance Surveillance Plan

(QASP).

6.1.3. The Government shall prepare a QASP after contract award derived from the PWS and contractor’s submitted quality control plan.