S02 36C25020Q1052 HCHV Social Work.docx

36C25020Q1052

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.

DUNS:

DUNS+4:

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. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

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

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

36C25020Q1052 09-08-2020 Karen M. Williams 614-257-5220 09-15-2020 36C250 Department of Veterans Affairs Network Contracting Office (NCO) 10 Chalmers P. Wylie Ambulatory Care Center 420 North James Road Columbus OH 43219

X

624229 $16.5 Million

N/A

36C610 See Delivery Schedule

36C250 Department of Veterans Affairs Network Contracting Office (NCO) 10 Chalmers P. Wylie Ambulatory Care Center 420 North James Road Columbus OH 43219

Department of Veterans Affairs

FMS-VA-2(101)

Financial Services Center PO Box 149971 Austin TX 78714-9971

See CONTINUATION Page Solicitation for Health Care for Homeless Veterans (HCHV) Treatment and Rehabilitative Services for the Northern Indiana Healthcare System (NIHCS). This contract will be a Firm Fixed Price (FFP) Indefinite Delivery Indefinite Quantity (IDIQ) with five (5) one-year ordering periods.

See Performance Work Statement and Price Schedule.

See CONTINUATION Page x

Karen M. Williams Contracting Officer

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

(continuation from Standard Form 1449, block 18A.)

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

a. CONTRACTOR: Name: _____________________________________________ Address:___________________________________________ City, ST Zip:_______________________________________ Telephone Number:__________________________________ Fax Number:_______________________________________ E-mail:____________________________________________

b. GOVERNMENT: Karen M. Williams, Contracting Officer

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with FAR 52.232-33, Payment by Electronic Funds Transfer – System for Award Management.

3. INVOICES: Invoices shall be submitted in arrears: Monthly

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. Invoicing shall be in accordance with The Department of Veterans Affairs (VA) Financial Services Center (VAFSC). The latest information shall be used for invoicing and payments and may change during the Period of Performance of this acquisition. Current Invoicing information is located at http://www.fsc.va.gov/einvoice.asp.

Department of Veterans Affairs

FMS-VA-2(101)

Financial Services Center PO Box 149971 Austin TX 78714-9971

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

5. POST AWARD ORIENTATION (Contract Awards Exceeding $1M): The Contracting Officer will schedule a post-award orientation conference for contract orientation purposes as required by Procurement Policy Memorandum (PPM) 2019- 01 https://www.va.gov/oal/docs/business/pps/ppm201901.pdf.

6. SECURE FAX: In accordance with VA Handbook 6500, the following statement is required on all fax cover sheets; if it is determined the ordering process will include a fax: “This fax is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential or protected by law. All others are hereby notified that the receipt of this fax does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution or copying of this communication is prohibited. If you have received this fax in error, please notify this office immediately at the telephone number listed above.

7. The Contracting Officer will be the only person authorized to approve changes or modify any of the requirements under this resultant contract. The Contractor shall communicate with the Contracting Officer on all matters pertaining to contract administration. Only the Contracting Officer will be authorized to make commitments or issue changes that affect price, quantity, delivery or quality of performance of this resultant contract. In the event the Contractor effects any such change at the direction of any person other than the Contracting Officer, the change shall be considered unauthorized by the local VAMC and no adjustment will be made to the contract price to cover any increase in cost incurred as a result thereof.

8. The Contracting Officer’s Representative (COR) will be responsible for the overall technical administration of this contract as outlined in the COR Delegation of Authority.

B.2 PRICE SCHEDULE

Contractor shall provide Healthcare for Homeless Veterans (HCHV) Treatment and Rehabilitative Services for up to ten (10) homeless veterans per day.

Period of Performance: September 30, 2020 (or date of award) through September 29, 2025.

The guaranteed minimum only applies to the first ordering period after award. The total minimum amount, or guaranteed minimum, for the initial year in which this contract is awarded is 10 days. The total maximum number of days, inclusive of all ordering periods shall not exceed 22,075.

Reimbursement will be made to the contractor by issuance of individual task orders during the life of the contract. Only the Contracting Officer is authorized to place task orders against this contract; which will be issued annually for each ordering period.

Ordering Period 1: 9/30/20 – 9/29/21

3,650

DY

Ordering Period 2: 9/30/21 – 9/29/22

Ordering Period 3: 9/30/22 – 9/29/23

Ordering Period 4: 9/30/23 – 9/29/24

Ordering Period 5: 9/30/24 – 9/29/25

Grand Total

B.3 PERFORMANCE WORK STATEMENT – Healthcare for Homeless Veterans Services

The VA Northern Indiana Health Care Systems (VANIHCS) has a requirement for a community-based residential care center for homeless veterans. Contractor(s) shall provide Healthcare for Homeless Veterans (HCHV) Treatment and Rehabilitative Services for up to ten (10) homeless veterans with mental illness and/or substance use disorders in a residential care center located within a 12 mile radius from the St. Joseph County CBOC (located at 1540 Trinity Place, Mishawaka, IN 46545). The contract minimum is one (1) bed, with a contract maximum of 3,650 beds annually. The new contract for this requirement will be a Firm Fixed Price, Indefinite Delivery, Indefinite Quantity (IDIQ) Contract with five (5), one-year ordering periods.

PART I: GENERAL INFORMATION

1. Background Through the HCHV Program, VA provides Veterans case management services and facilitates their access to a broad range of medical, mental health, and rehabilitative services. The Contractor shall provide care, treatment and rehabilitative services to Homeless Veterans in community-based treatment facilities offering a safe and secure environment that supports their rehabilitation goals. The Contractor shall be required to provide a safe, therapeutic and rehabilitative milieu and attendant services.

The term residential care center may refer to a variety of housing options including, apartment style housing, group home, or institutional setting. 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.

1. Services to be Provided All veterans placed by VA staff in the facility must be eligible veterans for VA health care as described by the Department of Veterans Affairs guidelines. All veteran residents shall be capable of self-preservation and performance of all ADLs (Activities of Daily Living). In an emergency situation, veteran residents shall have sufficient capacity to recognize physical danger, the judgment that requires to immediate egress from the group residence, the capacity to follow a prescribed route of egress, and have the physical ability to accomplish such egress.

Contractor shall provide community-based residential care, treatment and rehabilitative services for up to ten (10) homeless veterans, who may have a mental illness and/or substance use disorder diagnosis, in a residential care center.

1. Applicable Documents

· VHA Handbook 1162.09 Health Care for Homeless Veterans (HCHV) Program (http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3006)

· VA patient’s Bill of Rights, 38 U.S. C 17.34a (http://www.va.gov/health/rights/patientrights.asp)

· Life Safety Code of the National Fire Protection Agency: NFPA #101 (www.nfpa.org)

· Confidentiality of Medical Quality Assurance Records: 38 U.S.C. 5701 (http://www.gpo.gov/fdsys/granule/USCODE-2010-title38/USCODE-2010-title38-partIV-chap57-subchapI-sec5701/content-detail.html); and 38 U.S.C. 7332 (http://www.gpo.gov/fdsys/granule/USCODE-2011-title38/USCODE-2011-title38-partV-chap73-subchapIII-sec7332/content-detail.html)

· Disclosure of Patient Records: Records protected by 38 U.S.C. 5705; its implementing regulations at 38 U.S.C. 17.500-511; VHA Directive 98-016, 4b. (1) (d), 4.6(2)(c) and 4.6(4). These records may be disclosed only as authorized by 38 U.S.C. 5705 and the VA regulations. Disclosure of these records in violation of 5705 is a criminal offense under 38 U.S.C. 5705(e): (http://www.gpo.gov/fdsys/pkg/USCODE-2013-title38/pdf/USCODE-2013-title38-partIV-chap57-subchapI-sec5705.pdf)

PART II: WORK REQUIREMENTS

1. Technical Requirement

1. Contractor shall furnish each veteran authorized care under this contract with the following basic services:

0. Contractor shall have a facility obtained (either leased/rented/owned) and made fully operational prior to the effective date of this contract (September 30, 2020). The facility must pass the life safety inspection prior to any services rendered.

b. Facility shall be staffed 24 hours per day, 7 days a week; and have the ability to place Veteran same day as referral from HCHV VA staff.

c. Veterans may be on physician ordered special diets. Veterans shall have appetizing, nutritional meals provided in a setting that encourages social interaction. Nutritious snacks between meals and bedtime are also available for those requiring or desiring additional food, when it is not medically contraindicated. Veterans shall have at least one hot meal other than breakfast. The Contractor shall maintain a written monthly meal plan. This plan shall be posted in a common area one week prior and during the month of which it applies. Many veterans are either undernourished, or have poor eating habits because of their chronic psychiatric disorders, which could be alcohol/drug abuse related behaviors.

d. Laundry facilities for residents to do their own laundry with no cost to the veterans. Machines shall be maintained and in good condition to ensure availability of service.

e. Dining areas must be comfortable and adequate size to seat the maximum number of residents in the facility.

f. Common living areas must be comfortable and adequate in size to accommodate the maximum number of residents in the facility.

g. The facility shall maintain one functional lavatory (bathing and/or shower facility) for every six people living in the facility.

h. Bedrooms shall measure at least 100 square feet for a single room, or 25 square feet additional for each resident double occupancy room (or in a multi-resident room). Male and female residents shall have secure separate sleeping quarters. Bedrooms shall contain no more than four beds. Floor plan of facility/units shall be available for review and approval prior to award. NOTE: The complex nature of certain residents may dictate the need for single occupancy in a bedroom. Bedrooms shall contain a suitable bed furnished by the facility with, mattress, pillow, sheets/blankets and towels. The facility shall be responsible for laundering the linens and towels at least weekly and keeping them in good condition. Mattresses must be kept in good condition and replaced as needed.

i. The Contractor will offer a “low-demand environment” meaning Veterans will be offered mental health and substance abuse services but their participation in these services will not be contingent on their acceptance or continued stay in the facility.

j. Narcotic medication shall be kept in a secured locked location within a supervised area.

k. Facility shall have safe and functioning systems for: heating and cooling, hot and cold water, electricity, plumbing, sewage, food preparation (unless food is prepared off site), laundry, artificial and natural light, and ventilation. The residence shall be climate controlled to be heated not below 65 degrees Fahrenheit in the winter and cooled not above 75 degrees Fahrenheit in the summer.

l. All facility areas shall be kept clean and sanitized weekly. Chores may be assigned to veterans, but facility staff must ensure areas are cleaned to sanitary standards.

m. A storage locker or designated secured space must be provided to each veteran.

n. Contractor must allow veteran to store personal belongings up to 72 hours after formal HCHV discharge.

o. Therapeutic, Rehabilitative, and Recovery Services shall be determined by the individual resident in conjunction with the contracted facility staff and in consultation with the VA Liaison. The Contractor shall develop an individualized Care Plan (ICP) with the veteran, and include the VA Liaison. Such plans shall be developed based on a psychosocial assessment, completed by contracted facility staff and shall be in compliance with Commission of Accreditation for Rehabilitation Facilities (CARF) standards. Services which the Contractor shall be able to furnish include:

i. Case management and professional counseling services shall address self-care skills, adaptive coping skills mental health/substance abuse treatment needs, vocational rehabilitation counseling, in collaboration with VA program or contracted community resources. A through written Individualized Care Plan (ICP) will be developed within 2 weeks of admission for each veteran. 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 contracted 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 Veterans on a bi-weekly basis. HSR Safety Plan reviews and a copy of the Veteran’s Safety Plan will be documented in the Chart. All Veteran’s will be referred to VA for Primary Care and Mental health appointments and Contractor will support in making initial and subsequent appointments. Efforts will be documented in the Veterans chart and reviewed by the VA Liaison at least monthly. There will be an expectation that notes will be written professionally in a format that utilizes the clear setting of goals and documents progress towards those goals (e.g. SNAP, SOAP, or SMART notes). Examples of case management include but are not limited to assisting veterans with resources/agencies in the community, housing assistance, employment assistance, obtaining identification documents, applying for food stamps. Case management services shall be provided during the day shift hours, Monday through Friday.

ii. Outreach activities shall be used to identify homeless veterans that need HCHV Contract Residential Services. These locations can be at local homeless shelters, missions, soup kitchens, street locations, halfway houses, rehab centers, treatment facilities, or other places (i.e. parks, outdoor areas). Case management and outreach shall be provided by a trained professional holding a minimum bachelor’s degree in human services, social work, or a related field of study. Outreach services will be provided both day and evening shift hours at a minimum of 8 hours per week. A weekly log documenting the places and times that outreach occurred will be submitted to VA liaison weekly.

iii. 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 ICP 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 2 weeks of program admission. Housing Assessment must identify Veteran’s housing history, strengths (i.e. positive prior rental history), and barriers (i.e. unlawful detainers/evictions). 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. These services shall be provided weekly through one to one case management. Examples of expected housing service include: 1.) assistance obtaining and reviewing Veteran’s free credit report, identifying housing strengths and barriers associated with current credit status; 2.) Reviewing affordable housing rental options and making appropriate rental inquiries; 3.) assisting in completing rental applications; 4.) Assisting in contacting property managers and scheduling meetings. A tenant portfolio for each program participant will be required. At minimum it will contain a completed sample rental application for Veteran, income verification documents, photo identification, social security card, DD214 and or birth certificate, and free credit report. The Tenant Portfolio will be completed within 30 days of admission. All housing efforts by Contractor shall be documented clearly and presented to HCHV 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.

iv. Financial Planning: referral and follow up on all potential financial resources the Veteran may be eligible for (e.g. Social Security, SSI, SSDI, Food Stamps, NSC pension etc.) Case Manager 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 preferable thorough one on one case management services. At minimum two financial planning activities appropriate to the Veteran’s individual circumstance must be documented monthly. A budget sheet identifying veterans’ income and debts will be completed monthly with each veteran and given to VA Liaison upon request.

v. Recovery: Support for an alcohol/drug abuse free lifestyle provided in an environment conductive to social interaction and the fullest development of the resident’s rehabilitative potential. Pursuant to these principles drug testing may not be used to discharge or discipline a Veteran but may be used as a clinical intervention to modify behavior.

vi. Professional counseling services shall be provided by a Licensed Clinical Social Worker, Licensed Psychologist, or similar licensure as approved by the VA Contracting Officer Representative. Counseling services, including individual and group sessions, shall be provided for a minimum of twenty hours each week, based upon the individual needs of the residents.

vii. Structured group activities: Shall be conducted twice per month. These may include physical activities when appropriate. Activities of structured groups may consist of group therapy, social skills training, vocational counseling, and physical activities as appropriate. VA Resource groups and “House Meetings” do not meet this requirement. Contractor will submit sign in sheets to the VA Liaison for each group activity along with the description of the group activity.

viii. With the Collaboration with the VA program staff, shall provide supportive psychosocial services.

ix. Supportive social services, in collaboration with the VA case managers, or other community contract resources.

x. Instruction and assistance with health and personal hygiene maintenance.

xi. Monitoring of medications, if instructed and is necessary.

xii. Assistance in learning and development of responsible living patterns to achieve a more adaptive level of psychosocial functioning, upgraded social skills, and improved personal relationships.

xiii. Support for an alcohol/drug abuse free lifestyle may include participation of Alcoholic Anonymous and Narcotic Anonymous meetings.

1. The contract facility shall have a current occupancy permit or license required by the authority having jurisdiction.

1. Contractor shall conduct treatment and discharge planning for the veteran. To resolve any problems and to set goals, a team assessment shall be used to reflect the health, psychosocial, vocational needs, and as appropriate the involvement of residents’ families and community resources. This shall be done in coordination with VA Health Care for Homeless Veterans (HCHV) Contract Residential Liaison.

1. Contractor shall provide and arrange transportation to VA appointments and other appointments in the community for the veteran. If VA staff determines that adequate public transportation is not available or appropriate for a Veteran, the Contractor shall arrange for alternative transport by car or taxi. The contractor shall incur the cost of the transportation for the Veteran. The facility shall be located on a bus line and have access to areas that provide employment opportunities for those Veterans who are able to be employed. The Contractor shall be expected to help the Veteran access public transportation, including providing information and instructions necessary to enable Veterans to utilize public transportation.

1. Contractor must provide designated onsite office space to VA contract approved personnel such as the Contracting Officer Representative (COR), and/or VA clinical personnel. The office space must afford the VA representative and Veteran(s) privacy and confidentiality when meeting.

1. The office must include a desk, desk chair, at least one office chair for the client to sit in, locking file cabinet, noise/sound control capabilities (i.e.: sound machine, music player), a desk top telephone to make local as well as long distance calls, and the office must have internet access capability. The VA representative (COR or otherwise) is expected to be onsite at the Contractor facility two (2) to five (5) days per week.

1. Special Care Requirements

1. “Imperative” Levels of Care

0. A program of therapeutic and rehabilitative mental health services shall be designed to promote a more adaptive level of psychosocial functioning, and to assist VA staff in transitioning veterans into independent housing.

0. Contractor shall include supportive health care that shall include the instruction and/or information related to personal hygiene to all veterans that may be in need of care.

0. Individual adjustment services including social diversion, recovery focused, recreational and spiritual opportunities.

0. Full attention shall be given to motivation and education of veterans to achieve and maintain independence in the activities of daily living and self-care.

0. Pest Prevention

4. There shall be a Pest Preventative Treatment plan in place; pest preventative treatment plans shall include prevention and remedy methods for the treatment of pests, such as bed bugs, rodents; and shall render prevention/treatment of such pests with pest control industry standard practices. The COR shall monitor the Contractor’s facility to ensure compliance with this protocol and successful results. Contractor shall maintain an emergency housing contingency plan in the event of an infestation that renders the facility unfit for habitation.

1. Responsibility and Legal Obligations

1. Contractor and facility staff shall conform to all regulations, Federal, State and local governing the performance of contracted services.

1. The Contractor shall employ sufficient personnel to carry out the policies, responsibilities, and programs of the facility. In residential treatment facilities/group homes, there must be an administrative staff member or designee of equivalent professional capability on the premises, or resides at the house 24-hours a day, seven (7) days a week. When a supervised residential setting is linked to a geographically distinct rehabilitation and/or socialization day program, sufficient professional healthcare personnel must be identified to provide the necessary therapeutic activities and to ensure a meaningful integration. Contractor shall make available to the VA, documentation/information deemed necessary by the VA to conduct utilization review audits for the mandated national evaluation study as required by section 2 of Public Law 110-6; to verify quality of patient care for veterans, to accuracy of financial records.

1. Contractor shall comply with the VA patient’s Bill of Rights as set forth in section 17.34a, Title 38, Code of Federal Regulations.

1. Contractor under this program must meet the following VA standards, based on regulations promulgated by Title 38 Code of Federal Regulations (CFR) Section 17.53b

1. Residential Standards

1. Both residential and ambulatory care settings shall meet the following:

0. The standards of the Life Safety Code (National Fire Protection Association (NFPA #101)

0. The fire and safety code imposed by the State law

0. City, State, and Federal requirements concerning licensing and health codes, including construction, fire, maintenance, and sanitation regulations

0. All residential treatment settings shall meet ADA (Americans with Disability Act) requirements (www.ada.gov)

0. All residential treatment settings must be licensed as required for the particular setting under State or Federal authority

1. In the performance of this contract, the Contractor shall take safety precautions involving the Contracting Officer and the Contracting Officer Representative. This is necessary to protect the lives and health of the occupants in the buildings. The Contracting Officer or his/her designee shall notify the Contractor of any noncompliance with the foregoing provisions and the action to be taken. Once the Contractor shows the receipt of notice, they shall immediately correct the conditions to which attention has been directed. Such notice, when served on the Contractor or his/her representative at the site of the work, shall be deemed sufficient for the purposes aforesaid. If the Contractor fails or refuses to comply promptly, the Contracting Officer may issue an order stopping all or any part of the work and hold the Contractor in default.

1. Accreditation and Licensing Accreditation by the Commission on Accreditation of Rehabilitation Facilities (CARF) is desirable, but not required. Where applicable, the residential treatment center shall have a current occupancy permit issued by the authority having jurisdiction.

1. Personnel

1. Contractor shall employ Licensed Clinical Social Workers (LCSW) and sufficient personnel to carry out the policies, responsibilities, and operate the Program for the facility. There must be, at a minimum, at least one administrative staff member, or designee of equivalent professional capability, on duty on the premises or residing at the facility and available for emergencies 24 hours a day, 7 days a week.

1. Contractor shall assign to this contract personnel that by education and training (and, when required, certification or licensure) are qualified to provide the Basic Services and Supplemental Services required by this Performance Work Statement (PWS).

1. Key personnel are defined as “professional staff,” such as: LCSW and/or facility Director. During the first ninety (90) calendar days of contract performance, the Contractor shall make NO substitutions of key personnel unless the substitution is necessitated by illness, death, or termination of employment. Within fourteen (14) days after substitutions necessitated by situations described above, the Contractor shall provide resumes for the substitute key personnel to the Contracting Officer Representative (COR).

1. For substitutions proposed by the Contractor after the initial ninety (90) calendar day period, the Contractor shall provide resumes for the substitute personnel, together with any other additional information requested by the Contracting Officer (CO) and or Contracting Officer Representative (COR), at least fifteen (15) days before the substitution is to occur. The Contracting Officer or Contracting Officer Representative (COR) shall notify the Contractor within fifteen (15) calendar days after receipt of all required information if the VA refuses to accept the substitute key personnel.

1. Temporary substitutions of key personnel shall be permitted in accordance with the Contractor’s Contingency Plan. The Contingency Plan shall include, at minimum, an outline of how the Contractor shall maintain the full day-to-day operations of the program and provide ongoing clinical care to Veterans during periods when temporary substitutions are required and or there are inadequate staffing levels. The Contractor’s Contingency Plan to be utilized if personnel leave Contractor’s employment or is unable to continue performance in accordance with the terms and conditions of the resulting contract must be submitted as part of the Contractor’s offer. The Contracting Officer (CO) or Contracting Officer Representative (COR) shall be notified of any temporary substitutions within one (1) business day.

1. Referrals

1. Contractor is responsible for verifying the Veteran's eligibility for VA healthcare services. NIHCS is responsible for determining eligibility of Veterans prior to referral to the Contractor for treatment. A written or verbal referral (hard copy, fax or e-mail are acceptable) from the COR shall be provided to the Contractor for each Veteran referred under the contract.

1. It is understood that the Contractor shall 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.

1. The initial referral period for a Veteran may be up to 180 days (6 months), depending upon the needs of the Veteran as mutually determined by the Veteran, the Contractor’s staff, and Contracting Officer Representative (COR). An extension of the referral period up to a total of nine (9) months may be authorized by the COR, based on clinical assessment and provided that funding is available. Treatment periods in excess of 9 months for individual Veterans must be authorized by the Chief of Social Work through the COR.

1. It is understood that the type of Veterans to be cared for under this contract shall require care and treatment services over and above the level of room and board. To be eligible for placement in Contract Residential beds, all Veterans must be homeless or at imminent risk of becoming homeless and be eligible for VA healthcare services.

1. Contractor shall provide housing and/or services to special Veteran populations (e.g.: medically compromised Veterans, 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).

1. Evidence of Insurance Coverage Before commencing work under the contract, the Contractor shall furnish the Contracting Officer a certification within 30 days indicating that the coverage outlined in this contract has been obtained, and that it may not be changed or cancelled without written notice.

1. Records and Reporting

1. The Contractor shall notify the authorizing VA hospital and VA program liaison immediately when a medical emergency may occur, thus requiring the hospitalization of any resident receiving care at VA expense. It is agreed that the veterans shall be admitted to VA Northern Indiana Health Care System facility when feasible. If hospitalization of a non-emergency nature is required, it is agreed that admission to the VA hospital shall be accomplished consistent with eligibility criteria, as determined by VA. Contractor shall notify Health Care for Homeless Veterans (HCHV) Contract Residential Liaison immediately in the event of a veteran’s illness or injury requiring medical care and/or hospitalization. Contractor shall also provide a daily occupancy report to HCHV Contract Residential Liaison.

1. In the event of a beneficiary receiving residential treatment dies, the residential treatment center shall promptly notify the Department of Veterans Affairs office and VA program Liaison, authorizing admission and immediately assemble, inventory, and safeguard the veteran’s personal effects. The funds, deposits, and effects left by the deceased veteran at the residential treatment center, shall be delivered by the residential treatment center to the person or persons entitled. The Contractor shall adhere to the laws currently governing the residential treatment center for making disposition of funds and effects left by veterans, unless the beneficiary dies without leaving a will, heirs, or next of kin capable of inheriting. When disposition has been made, the itemized inventory with a notation identifying the recipient of the belongings shall be immediately forwarded to the VA office. In the event that no such person is identified, the property and funds shall become the property of the United States in trust. In these cases, the residential treatment center shall forward any property and funds in its possession to the appropriate VA office, and hold them (except articles of clothing necessary for proper burial) under safeguard until instructions are received from the VA concerning disposition.

1. Absences of the patient from the residential treatment center in excess of 72 hours will be not reimbursable except with the prior approval of the COR. The COR shall determine if the absence is unauthorized. If a patient referred under this contract is found to be absent in an unauthorized manner, the payment for veteran services would be continued at that contract facility for a maximum period of three (3) days. There should be an active outreach attempt of the facility staff to return the veteran to the residential care center, and a strong likelihood that the patient will return. Management of program dropouts will be an element of the quality assurance review of this program.

1. Contractor shall maintain an individual clinical record on each veteran placed under this contract. The Contractor shall comply with the requirements of the “Confidentiality” of certain medical records (38 USC 7332), and (42 CFR, Part II). All case records shall be maintained with such security and confidentiality as required, and shall be made available on a need-to-know basis to appropriate staff members involved with the treatment program of the veterans concerned. In addition to reasons for referral, the clinical record maintained by the contract facility shall include:

3. All essential identifying data relevant to the resident and his/her family, including a psychosocial assessment, completed by facility staff.

3. Treatment plans/ICP shall be completed by facility staff, in collaboration with VA Contract Residential Liaison, and shall include data relating to the resident’s admission, anticipated length of stay, targeted goals and objectives for constructive changes and discharge planning. Treatment Plans must meet CARF regulations whether or not the facility is CARF accredited.

3. A summary of all medical prescriptions issued by physicians, including orders, and if any medications need to be taken.

3. Reports of periodic reevaluations by program staff, to include any measures of movement toward rehabilitation goals, with particular focus on the attainment of self-help skills.

3. Final summaries on each resident who leaves the program, which includes a description of beneficial changes found during the residential period, reasons for leaving, the resident’s future plans, and follow up locator information. Contractor shall provide a copy of final summary to HCHV Contract Residential Liaison and veteran within one week of the veteran leaving the Residential Treatment Center.

3. Upon discharge or death of the resident, medical records on all beneficiaries shall be retained by the Residential Treatment Center for a period of at least three (3) years following termination of care.

1. Confidentiality of Patient Records

1. In performance of this contract, Contractor shall not be considered to be a part of VA for purposes of 5 U.S.C. 552a, 38 U.S.C. 5701 and 7332. Contractor shall obtain needed records from VA only with signed consent by veteran.

1. Records created by Contractor in the course of performing this contract are the property of VA, and shall not be accessed, released, transferred, or destroyed except in accordance with federal law, regulations, and policy. Access to data shall be limited to the minimum necessary for performance of the contract. Contractor shall take steps to ensure that access is limited to those employees who need access to the data to perform the contract. Contractor shall not copy information contained in the system, either by printing to paper or by copying to another digital format, without the express permission of VANIHCS Release of Information Office, except as is necessary to make single copies in the ordinary course of providing patient care. Contractor shall not comingle the data from the system with information from other sources. Contractor shall report any unauthorized disclosure of VA information to the VANIHCS Privacy Officer.

1. If this contract is terminated for any reason, Contractor shall provide the VA with all individually identified VA patient treatment records or other information in its possession, as well as any copies made pursuant to paragraph (2), above within seven (7) days of the termination of the contract.

1. Certain information available from the database and other records created by the Contractor under this Contract are medical quality assurance records protected by 38 U.S.C. 5705; its implementing regulations at 38 U.S.C. 17.500-511; VHA Directive 98-016, 4b. (1) (d), 4.6(2)(c) and 4.6(4). These records may be disclosed only as authorized by 38 U.S.C. 5705 and the VA regulations. Disclosure of these records in violation of 5705 is a criminal offense under 38 U.S.C. 5705(e).

1. Contractor shall follow all VA policies regarding the retention of records. In the alternative, Contractor may deliver the records to VA for retention.

1. Any changes in the law or regulations governing the information covered by this contract during the term of this contract shall be deemed to be incorporated into this contract. The Contractor shall educate its employees and Subcontractors of the requirements of this section, and shall advise its employees and Subcontractors of any changes as they occur. On the Contractor’s request, the VA shall provide trainers who can education the Contractor’s employees and Subcontractors, of their obligations under this section.

1. The Contractor shall make its internal policies and practices regarding the safeguarding of medical and/or electronic information available to federal agencies with enforcement authority over the maintenance of those records upon request.

1. Inspection and Acceptance

1. It is agreed that the Department of Veteran Affairs shall have the right to inspect the residential treatment center and all appurtenances by an authorized representative(s) designated by the Department of Veterans Affairs.

1. A multi-disciplinary team consisting of a social worker, dietitian, nurse, and an engineering service safety officer, shall conduct an initial inspection of the residential treatment center and all appurtenances. Other inspection team members may be included, as needed. Residential treatment centers shall be restricted to community-based facilities that provide food, shelter, and therapeutic services in a support environment. Subsequent inspections of the residential treatment center shall be made yearly by a multidisciplinary team including hospital personnel (appointed by the director), to assure that the facility is providing quality care within a safe environment. As VA program personnel accomplish site visits, attention shall be directed to the adequacy of veteran’s records. Site visits shall also include a spot check of records to ensure the Contractor invoices accurately reflect the veteran’s length of stay.

1. The local Department of Veterans Affairs Medical Center dietitian (member of the inspection team), shall evaluate not only the printed menus, but the veteran’s satisfaction with meals, and the actual consumption of food. Three sufficient balanced meals shall be provided by the Contractor where the veteran resides. Government food assistance programs such as food stamps shall not be used for this purpose. Meals must be prepared and served following the Indiana State Board of Health, Food, Safety and Sanitation Guidelines. Meals shall be prepared that are nutritionally balanced following USDA guidelines.

1. Contractor shall be advised of the findings of the inspection team. If deficiencies are noted during any inspection, the facility shall be given a reasonable time to take corrective action and to notify the Contracting Officer that the corrections have been made. Facilities must also be made available for random inspections, as applicable.

1. The Department of Veteran Affairs, through the designated Contracting Officer Representative, shall monitor the Contractor’s facility to ensure compliance with this contract. Any unsatisfactory conditions noted during an inspection shall be reported in writing to the Department of Veterans Affairs Contracting Officer through the Medical Center Director. If corrections are not made to the satisfaction of the Department of Veterans Affairs, the Contracting Officer shall consult with the appropriate officials to make suitable arrangements to discharge or transfer patients and terminate the contract.

1. The Safety Officer shall inspect the facility for conformity to the current Life Safety Code, and submit the findings to the chairperson or liaison of the team. Other members of the team shall focus on an assessment of the quality of life within the residential treatment facility, giving particular attention to the following indicators:

5. General observation of residents indicates that they maintain an acceptable level of personal hygiene and grooming.

5. The facility meets applicable fire, safety, and sanitation standards, in attractive surroundings conducive to social interacting, and the fullest development of the resident’s rehabilitative potential.

5. There shall be appropriate organized activity programs during waking hours, including evenings. Examples include individual professional counseling, physical activities, and assistance with health, personal hygiene, employment, and training programs.

5. There is evidence of facility-community interaction. This may be demonstrated by the nature of scheduled activities, or by gathered information about resident flow out of the facility (i.e. community activities, volunteers, local consumer services).

5. Staff behavior and interaction with residents convey an attitude of genuine concern and caring.

PART III: SUPPORTING INFORMATION

1. Security In the performance of this contract, the Contractor shall take such safety precautions with the Contracting Officer Representative, or his/her designee may determine to be reasonably necessary to protect the lives and health of the occupants of the buildings. The Contracting Officer or his/her designee shall notify the Contractor of any noncompliance with the foregoing provisions and the action to be taken.

1. Performance Monitoring/Performance Standards Quality Management/Quality Assurance Surveillance: Contractor (s) shall be subject to Quality Management measures, such as patient satisfaction surveys, staffing and supportive services, timely completion of records and reports, and Social Work Reviews. Methods of Surveillance: Direct observation shall be performed periodically or through 100% surveillance. There will be periodic inspections to evaluate outcomes on a periodic basis.