S02-RFP-RHJ Oxy-36C24724R0051.docx

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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

Payment via 1358 36C24724R0051 -2024 Thomas Nicholls 8435775011 04- -2024

08:00 AM

EDT

Department of Veterans Affairs Ralph H. Johnson VA Medical Center 109 Bee Street Charleston SC 29403-5799 X X 532283 $41 Million

NET 30

N/A X Department of Veterans Affairs Charleston VA Medical Center 109 Bee Street Charleston, SC 29461 Department of Veterans Affairs Ralph H. Johnson VA Medical Center 109 Bee Street Charleston SC 29403-5799

Department of Veterans Affairs

FMS-VA-2(101)

Financial Services Center PO Box 149971 Austin TX 78714-9971 See CONTINUATION Page Home Oxygen Service for the Department of Veteran Affairs Charleston Veterans Administration Medical Center.

Services as described in the Performance Work Statement for VISN 7 Charleston VAMC Location in South Carolina.

Wage Determination No. : 2015-4427 Revision No. : 25 Date Of Last Revision: 12/26/2023 This is a five-year contract with five one-year pricing periods. Total contract performance:

06/01/2024-05/31/2029 Maximum Contract Limit: $ 19,000 ,000.00 Guaranteed Minimum: $ 00.00 See CONTINUATION Page X X X Thomas Nicholls Contacting Officer Table of Contents2.6

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: TBD

b. GOVERNMENT: Contracting Officer 36C247 Department of Veterans Affairs Ralph H. Johnson VA Medical Center 109 Bee Street Charleston SC 29403-5799

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

3. INVOICES: Invoices shall be submitted 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.

Department of Veterans Affairs-FMS-VA-2(101) Electronic Submission to: http://www.fsc.vs.gov/einvoice.asp ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

36C24724R0051

Page 1 of Page 1 of

B.2 PERFORMANCE WORK STATEMENT(PWS)

HOME OXYGEN

VISN 07-Station 534- Ralph H. Johnson Veterans Affairs Medical Center

1. SCOPE: The Contractor shall provide all equipment, supplies, transportation, and personnel to provide services per the Performance Work Statement (PWS). To include the setup, installation, and management of Home Oxygen services and Ventilation, by Joint Commission (JC) standards for home care to Veteran beneficiaries serviced by VISN 7. This PWS includes program management, human engineering, and logistic support planning requirements. The use of terms “beneficiary”, “Veterans”, “Patients”, and “Patient” are used interchangeably and refer to the recipient of required services, equipment, and supplies under the contract.

1.1 BACKGROUND: Home Oxygen services are being acquired to provide Home Oxygen services to Veteran beneficiaries serviced by Charleston VAMC/VISN 7. VISN 7 cannot provide these services, so a contract has been sought for the provision of home oxygen and all associated products and services.

1.2 VETERANS SERVED: The VA Southeast Network Charleston VAMC/VISN 7 is presently catering to around 830 patients who require oxygen. The contract will be based on the actual needs of the VA, as per the orders placed during the contract's duration.

1.3 LOCATIONS: The Contractor is required to supply Home Oxygen to the patient's residence, or any other specified location mentioned in the Home Oxygen order to include the following counties: Abbeville, Aiken, Allendale, Anderson, Bamberg, Barnwell, Beaufort, Berkeley, Calhoun, Charleston, Chatham, Cherokee, Chester, Chesterfield, Clarendon, Colleton, Darlington, Dillion, Dorchester, Edgefield, Fairfield, Florence, Georgetown, Greenville, Greenwood, Hampton, Horry, Jasper, Kershaw, Lancaster, Laurens, Lee, Lexington, Liberty, Marion, Marlboro, McCormick, Newberry, Oconee, Orangeburg, Pickens, Richland, Saluda, Spartanburg, Sumter, Union, Williamsburg, and York. The area of responsibility/jurisdiction for each VA facility encompasses the counties relevant to the area of responsibility/jurisdiction.

NOTICE: IT IS REQUIRED THAT THE CONTRACTOR HAS A BUSINESS LOCATION THAT IS MAINLY INVOLVED IN CARRYING OUT THE SCOPE OF WORK WITHIN A 50-MILE RADIUS OF THE SUPPORTED MEDICAL CENTER. THIS BUSINESS LOCATION MUST BE MAINTAINED THROUGHOUT THE ENTIRE CONTRACT PERIOD.

1.4 PORTABLE EQUIPMENT AT VA MEDICAL CENTERS: A stock of ten (10) portable cylinders, regulators, and oxygen carriers shall be continuously maintained by the contractor at the VA Medical Center. These cylinders shall be used only to accommodate Home Oxygen beneficiaries who are visiting the VA or being discharged and require a tank of oxygen to go home. This service shall be provided at no additional cost to the Government. VA shall furnish storage space and maintain all security for this equipment. The contractor shall be permitted access to the space and equipment when requested, by telephone, with 24 hours’ notice to the VA Medical Center’s Prosthetics Service. The contractor shall maintain an updated inventory of all equipment every quarter.

2.0 NOTIFICATION AND DELIVERY:

2.1 NOTIFICATION: The Contracting Officer’s representative (COR) or designee shall notify the Contractor via f simile to initiate individual patient service requirements. This shall include the patient’s oxygen prescription, oxygen prescription expiration date, equipment, supplies, and services to be provided including the date and place of delivery. The Contractor shall confirm receipt of the request within two (2) working hours of notification. The contractor shall confirm by secure email to COR or alternate COR for all Home Oxygen initiations, plan of care changes, and discharges. The COR or alternate COR shall also provide notification of VA-initiated discontinuance of service via secure email. All changes to patient care shall be confirmed in writing. The written documents shall include the authorizing official’s signature. The prescription is terminated the day the patient expires.

2.2 NOTIFICATION TO VA REGARDING STATUS OF DELIVERY OF HOME OXYGEN SERVICES:

a. The contractor shall notify the appropriate VA of the initial delivery of home oxygen equipment by emailing a copy of the delivery ticket. The delivery ticket shall be signed and dated by the patient. This notification shall be made within two (2) working days. This notification shall be made when the patient requires changes in medical equipment or equipment switch-outs.

b. The Contractor shall notify the appropriate VA by secure email within one (1) working day if the expected delivery of medical equipment is not completed. This notification shall include the reason why the delivery was unable to be completed within the 24-hour timeframe.

c. The Contractor shall notify the appropriate VA by secure email within one (1) working day if the patient refuses delivery of medical equipment and/or signs the Contractor’s AMA form. A copy of the AMA form signed by the patient shall be included in this notification.

2.3 DELIVERY OF MEDICAL EQUIPMENT:

a. The Contractor shall deliver and set up in the patient’s residence, all equipment and supplies ordered by an authorized VA Physician, COR, or Designee. Contract prices are all-inclusive. The Contractor shall not be reimbursed for costs incurred more than the contract prices in the Schedule of Supplies/Services for services provided in the Schedule of Supplies/Services.

b. Patients shall be notified of expected delivery times by the Contractor. Veterans shall be provided with a four (4) four-hour delivery time window for expected time delivery.

c. Deliveries of medical equipment and supplies shall be made in full, without exception. If the contractor is unable to fulfill the full prescribed medical equipment and supplies list, they may choose to partial delivery. The cost for such delivery shall be considered at no cost to VA and is for the convenience of the Contractor. Payment shall only be issued for full deliveries. In such cases where a partial delivery is made, the remainder of the delivery shall be made within one (1) calendar day. The contractor shall maintain sufficient stock (or have it available) to ensure all deliveries can be made within the contractual timeframes.

d. The Contractor shall deliver portable oxygen equipment to previously established and new patients being discharged to their homes from non-VA Facilities and other facilities as requested by VA Staff per the needs of the Veteran. Equipment shall be delivered within 4 hours of the request.

2.4 EXCESS DELIVERY: The Contractor shall not deliver supplies and/or equipment more than those prescribed, and the Contractor shall not be paid for any excess deliveries.

2.5 NON-SCHEDULED DELIVERIES: The contractor shall provide non-scheduled deliveries in the event the patient requires “an additional” delivery to the routine delivery.

2.6 ORDERING & INVOICES: Per VHA Directive 1173.13(1) Home Oxygen Program. The prescribing provider is responsible for completing the annual prescription for home oxygen after the need is determined. Only credentialed staff are authorized via VA access controls to access and complete the prescriptions via the prosthetic consult module. The prosthetic consult is the order. Prosthetics and Sensory Aids Service (PSAS) and the Contracting Officer’s Representative (COR) or designee shall notify the Contractor via facsimile, email, or VA-approved portal in addition to a phone call to initiate individual patient service requirements. The consult includes the patient’s oxygen prescription, oxygen prescription expiration date, equipment, supplies, and services to be provided including the date and place of delivery. The Contractor shall confirm receipt within two (2) working hours of notification. The Contractor shall confirm by facsimile, secure email, and/or documentation in a VA approved portal to COR or designee for Home Oxygen and Respiratory Service initiations, plan of care changes, and discharges. The COR or designee shall provide notification of VA-initiated discontinuance of service via facsimile or email or through VA approved portal. All changes to patient care shall be confirmed through one of the above mechanisms in writing. The documents shall include the authorizing VA official’s signature. The prescription is terminated the day the patient expires. For additional ordering instructions refer to 52.216-18.

Invoices shall be submitted monthly upon completion of complete delivery/pickup/setup. Invoices shall be submitted using the CLIN structure, i.e., CLIN #, Descriptions, Quantity, Unit Price, Units, and Total Price. Invoices not following the CLIN structure will be rejected.

3.0 SERVICE SPECIFICATIONS:

3.1 PRESCRIPTION CHANGES: The Contractor shall not change or alter a patient’s oxygen prescription or equipment requirements without a new prescription from the patient’s VA physician, COR, or designee.

3.2 HOME VISITS:

a. The Contractor shall visit patients’ residences for regularly scheduled maintenance visits in performance of this contract by appointment only; between the hours of 7:00 a.m. and 7:00 p.m. Exceptions shall be made in the cases of emergencies.

b. The Contractor is responsible for scheduling the appointments at the patient’s home 24-48 hours before the appointment.

c. On each scheduled set-up/delivery the Contractor shall reassess the need to instruct the patient on the use and care of the equipment and supplies as necessary.

d. The contractor shall re-instruct the patient, family, or caregivers as necessary without a formal order from the VA.

3.3 CDC COVID-19 PROCEDURES:

The contractor shall abide by all CDC guidelines regarding social distancing, cleaning of equipment and materials, and personal protection equipment. Updated guidelines can be found on the CDC website: https://www.cdc.gov/coronavirus/2019-ncov/community/index.html.”

3.4 INITIAL SET-UPS:

a. Initial set-ups are services provided to those patients who have not been provided a VA-authorized oxygen therapy delivery system in the residence or nursing home on a previous occasion or have not used such a system continuously for the past 60 days.

b. Set up will be performed 7 days a week within 24-48 hours of receipt of signed VA physician order, COR, or designee. Orders received before noon will be set up same day whenever possible. Emergent requests received will be set up within 4 hours of receipt of a signed VA physician order to allow discharge from the emergency room or inpatient facility. Once the initial set-up has been completed, the Contractor shall develop a regular delivery schedule for home oxygen and supplies to patients. All Initial 50 PSI setups shall include all disposables large bore tubing, large volume nebulizers, drain bags, and masks.

c. Switch-outs are services provided to those patients who are presently using an oxygen delivery system or have used such a system continuously within the past 60 days. The Contractor shall provide equipment switch-outs by staff with documented competency training on the manufacturer’s recommended assembly, use, and maintenance of the equipment used under this contract. Failure to perform the switch-outs as ordered by VA staff shall result in no cost to the government. Payment shall be made once switch-outs are completed as prescribed by VA staff. Payments shall be assessed based on the provider’s established rate and prorated from the set-up date. Medical equipment switch-out requested to increase the patient’s quality of life or due to changes in the patient’s oxygen requirement shall be made at no extra charge to the government.

d. Set-up of Home Oxygen includes setting up and ensuring the appropriate oxygen system is operational, instruction and training of patient, and/or caregiver, and home environment safety check. Failure to deliver within the required time shall result in the VA obtaining oxygen from another source. Any costs more than contract pricing for services provided shall be billed to the contractor or credited to the next invoice at the discretion of the ordering facility.

e. The Contractor is responsible for establishing appointments with patients when initiating set-ups, deliveries, and switch-outs within 24 hours of receipt of a signed VA physician order, COR, or designee.

3.5 ASSESSMENT REQUIREMENTS:

a. The Contractor shall assess the patient’s home and environment by JC accreditation standards for home care and maintain documentation of assessments in the individual patient file or folder.

b. The Contractor shall notify the COR/designee during the home visit if the Contractor’s staff determines that the presence of oxygen in the home presents such a danger that the oxygen must be removed, or in the case of an initial set-up, not placed in the home.

c. The Contractor shall notify the COR or designee by telephone or email within two (2) hours if any unsafe conditions are observed in the patient’s home that preclude the installation of continuance of oxygen service. Unsafe conditions may include but are not limited to, fire safety hazards, oxygen safety hazards, patient abuse by family or caregivers, or any instance that places the patient or Contractor’s staff in immediate danger. The Contractor shall provide written documentation of the safety hazard to the COR or designee within one (1) business day of the incident.

d. The Contractor shall check the adequacy of the electrical outlets in the patient’s home and immediately report unsafe conditions to the COR or designee. VA shall not be responsible or liable for any unsafe electrical conditions caused by the Contractor. Any alterations to the patient’s residence shall be the responsibility of the patient. If ordered equipment cannot be safely installed, the COR or designee shall provide an alternative oxygen delivery system after approval until a new prescription can be obtained. If no alternative is available, the prescribing VA physician shall be notified by the COR or designee.

3.6 PATIENT EDUCATION REQUIREMENTS:

a. The Contractor shall provide initial education to each patient at the time of set-up. The initial setup visit, stated above, will account for said annual check. This information shall be presented verbally, in demonstration and the material covered shall be in written form to be left with the patient/caregiver. The written material shall be in English as well as the foreign language of the patient, should the patient not speak English. In the case of such an occurrence, the Contractor is to advise the VA facility to facilitate adequate instructions. All patient education material must be presented in written form to the COR or designee for approval before distribution to patients. The Contractor shall implement any new or revised education material as directed by the COR or designee. The VA shall determine whether the Contractor shall use his/her forms or forms supplied by the VA for documentation of services provided to patients. Regardless of whether the VA provides a VA Patient Rights & Responsibilities document and/or forms to the Contractor, and/or the Contractor uses his/her VA Patient Rights & Responsibilities and/or forms, the Contractor is responsible for duplication of the documents/forms when copies are needed to give to patients.

b. Patients shall be provided a copy of VA Patient Rights & Responsibilities, Suicide Prevention information, and Advance Directives as appropriate. The Contractor shall document that the patient/caregiver has been instructed by JC Standards for Homecare.

3.7 DISCONTINUATION OF SERVICE:

a. The Government shall notify the Contractor in the event of an order to discontinue oxygen service to any patient covered under this contract as soon as identified (but not earlier than two (2) weeks before expiration). Notification shall be by secure email or telephone. At least two (2) weeks before the scheduled termination of the prescription the Contractor shall notify the COR or designee via telephone or secure e-mail, if removal of home oxygen may be detrimental to the patient. Payment shall be pro-rated based upon the notification date of discontinuance of service. The Contractor shall notify the Government within the next business day of a patient's death, or upon finding a patient has moved out of the service area.

b. The Contractor shall remove equipment from the patient’s residence at the earliest possible time but no later than five (5) business days after notification unless approved by the COR or designee. The date and time of equipment pickup shall be coordinated with the patient and/or next of kin and/or significant other. The Contractor shall make every effort to meet the patient’s or patient’s families’ requests for pickup times. The Contractor shall honor the family’s requests to pick up equipment before or after funerals or family gatherings relative to patient funerals. The Contractor shall treat such requests with the utmost courtesy and give such requests the highest priority. In the event the patient refuses to release the equipment the Contractor shall immediately notify the COR or designee. Billing of services ends at the time of VA-issued notification to discontinue the order or prescribed duration of therapy.

3.8 EMERGENCY SERVICES:

a. The Contractor shall provide emergency services on a 24-hour basis, and the contractor shall provide services at the patient’s home no more than four (4) hours after receiving a call. If the Contractor is unable to respond to an emergency service call within four (4) hours, the Contractor shall be responsible for planning with another supplier to provide oxygen, and the Contractor shall be responsible for any excess cost above the contract reimbursed price. A written explanation of why the Contractor was unable to respond to the emergency must be provided to the COR or designee within one (1) business day.

b. An emergency exists if the COR or designee informs the Contractor that he/she considers the situation an emergency, or if the patient states in a telephone call to the Contractor that an emergency exists regarding the function of the home oxygen equipment or use of the equipment. The Contractor shall provide written details of the patient emergency to the COR or designee within one (1) business day of notification by the patient. This written report shall contain the time of the initial call and time the contractor arrived at the patient’s house, and details of the emergency.

c. The Contractor shall maintain a telephone number for emergency purposes so that the VA and patients who have been authorized to receive home oxygen may contact the Contractor outside of normal business hours. The Contractor shall provide the telephone numbers to the patients and the COR. This emergency telephone number will be operated and answered 24 hours a day, 7 days a week, 365 days a year.

d. The Contractor shall notify the COR or designee immediately in the event of a disaster, natural or otherwise, that may affect the services covered under this contract.

3.9 SIGNAGE: The Contractor shall provide the patient signs for all entrances into the patient’s residence, stating “Warning Oxygen in Use, No Smoking” or other verbiage that No Smoking is allowed due to oxygen being present and document that the Patient/Caregiver is instructed in the safe use of oxygen and equipment per OSHA regulations. The Contractor shall attach patient education and expectations placards to all concentrators and liquid oxygen stationary systems.

3.10 TRAVELING PATIENTS:

a. The Contractor shall be responsible for coordinating all home oxygen for patients who travel both within and outside their respective contracted area of responsibility/jurisdiction unless otherwise indicated. The COR designee, or patient, shall be responsible for notifying the Contractor where/when the patient is traveling and the mode of transportation. The Contractor is responsible for coordinating with the patient when travel has been completed.

b. Traveling patients shall be provided with a Federal Aviation Administration (FAA) approved portable concentrator for travel purposes at the request of the COR or designee. The VA estimates that 30% of patients will travel at some point within each year. These units shall not be standard for long-term use.

c. Invoices for travel patients are to be provided to the VA within seven (7) days of the patient's return from the travel destination.

d. Patients traveling within the Contractor’s area of responsibility/jurisdiction shall be provided all home oxygen under the contract at the contract rate. Patients traveling within contracted areas of responsibility/jurisdiction covered under other VISN 7 contracts for home oxygen, but not within the Contractor’s area of responsibility/jurisdiction, shall be provided all required oxygen services at whatever contract rate that applies to the area the patient is traveling to. The Contractor currently providing home oxygen shall notify and arrange for home oxygen with the contractor whose area the patient is traveling to.

e. For patients traveling outside the areas of responsibility/jurisdiction covered by Charleston VAMC’s contract for home oxygen, and/or temporarily relocating, the Contractor shall arrange for home oxygen.

f. Home oxygen for overseas travel is the responsibility of the patient.

4.0 EQUIPMENT SPECIFICATIONS AND ASSOCIATED REQUIREMENTS:

4.1 EQUIPMENT MAINTENANCE:

a. At least once every 30 days the Contractor shall visit the patient to reassess equipment compliance, and educational needs, and to perform an environmental survey. A written report shall include at a minimum the following data:

1. Name and social security number (SSN) of the patient using the equipment.

2. Monitor compliance on prescription (Liters Per Minute (LPM), hours per day).

3. Type of equipment, hours on concentrator (Serial numbers for the rented equipment shall be the Contractor’s responsibility and kept on file in the Contractor’s main office).

4. Inspection results of liter flow rate in monitoring patient compliance (as compared to prescription).

5. Inspection compliance of intake filters (exchange or clean by the patient); follow-up education and/or reinforcement of compliance documented.

6. Revised plan of service as needed.

7. A delivery report shall be developed by the Contractor, signed, and dated by the contract staff and the patient/caregiver and a copy shall be left with the patient. The reports shall be legible and attached to the invoice. All reports shall be submitted to the COR or designee in alphabetical order, with the monthly invoices by the 10th business day of the month following service. The report must include a patient list and associated scanned delivery/maintenance receipts with the patient’s signatures, patient-signed patient education notes, and clinical notes associated with the plan of care changes. The report shall be submitted by the Contractor in both hard copy and on electronic media (DVD or CD). Format to be approved by VA. Changes to the format shall not constitute a need for a contract modification.

4.2 NECESSARY EQUIPMENT AND SERVICES:

a. By the prescription received from the VA facility, the Contractor shall provide the patient with the following items:

1. Humidifiers and water traps, when the liter flow is equal to or greater than four (4) liters per minute, or if prescribed. The number of humidifiers must be sufficient to ensure that they are not depleted between re-supply visits. The number of traps shall be based on the patient’s flow rate. Humidifiers and water traps are always changed every two weeks with a supply in reserve sufficient to last until the contractor’s next visit.

2. Six (6) disposable oxygen cannulas on hand for a change every two (2) weeks with a supply in reserve always until the Contractor’s next scheduled visit.

3. Six (6) disposable masks for always change/wash every two (2) weeks with a supply in reserve (when masks are prescribed instead of nasal cannulas).

4. 25-50 feet of oxygen connecting tubing shall be always replaced every 30 days with an equivalent section of tubing in reserve (to be included in the initial setup) until the Contractor’s next scheduled visit.

5. Tracheotomy collar and accessories (e.g., tubing, and large volume nebulizer) with a supply on hand allowing for always change every three (3) days and a supply of five (5) each in reserve until the Contractor’s next scheduled visit.

6. Safety holders shall be provided at no charge for all patients with a prescription for four (4) or more cylinders.

7. (2) Oxygen Thermal Fuses per source per patient IAW AL18-01

b. The contractor shall schedule and perform home visits every 30 days for traditional concentrators and every home fill system to educate patients and perform equipment inspection and maintenance according to the manufacturer’s recommendations.

c. The contractor shall maintain, deliver, and pick up VA-owned equipment.

d. One Oxygen-conserving nasal cannula with a pendent reservoir (if prescribed).

e. Airway clearance device (if prescribed)

f. Cough assist device (if prescribed)

4.3 CONTRACTOR OWNED CONCENTRATORS:

a. The Contractor shall furnish, install, and service all oxygen equipment to dispense oxygen and supplies ordered under this contract. All equipment shall be a current, state-of-the-art model, and all supplies are to be new. A label with the Contractor’s name and emergency telephone number where they can be reached 24 hours/day shall be affixed to all equipment.

b. The concentrators must meet the following standards and guidelines:

· The American Society for Testing Materials (ASTM) minimum standards specification for electrically powered home care portable ventilators.

· Association for the Advancement of Medical Instrumentation (AAMI).

· Joint Commission (JC) Standard for Home Care.

Please note: Ventilators, 50 PSI Compressors, and POCs are included in this PWS, as needed.

4.4 CYLINDERS:

a. The Contractor shall furnish cylinders required under this contract that are by the Interstate Commerce Commission Regulations, and transport cylinders by Code of Federal Regulations (CFR) Part 49, U.S. Department of Transportation. ‘H’ or “M” cylinders furnished by the Contractor shall have ‘H’ or “M” safety stand at no additional charge to the Government. This stand shall remain Contractor-owned.

b. Oxygen Cylinders provided must be United States Pharmacopoeia (U.S.P.) oxygen.

4.5 OXYGEN SAFETY VALVES:

a. The Contractor shall furnish oxygen safety valves to each Veteran on home oxygen. These valves shall remain Contractor-owned and will be replaced every (1) year. Two (2) oxygen safety valves will be issued for each Veteran on home oxygen (one (1) each to be placed between the nasal cannula and oxygen tubing, with another one (1) each being placed between the oxygen concentrator (at the flow meter) and oxygen tubing).

b. Oxygen safety valves act like a fuse to automatically isolate the oxygen supply in case of accidental fire, and potentially:

i. Provides an additional level of protection, buying the patient, caregivers, emergency personnel, and others valuable time to evacuate.

ii. Prevents the progression to upstream equipment oxygen concentrator, high-pressure cylinder, or liquid vessel.

iii. Lessens the probability that the fire will spread further, minimizing the overall cost of restoration.

a. Veterans with heated humidity will not be provided with a valve, as this is a contraindication indicated by the manufacturer.

b. Veterans shall be instructed to clean the exterior surfaces of the valves every two (2) weeks with an alcohol or disinfectant wipe.

c. Oxygen safety valves should be provided during a regularly scheduled cylinder delivery or every 30-day equipment maintenance visit. Special visits to deliver oxygen safety valves should not be made.

d. If the patient refuses the oxygen safety valve, documentation of refusal, signed by the patient, must be provided to the VA.

e. If the contractor is unable to contact the patient, notification should be made to the VA requesting updated contact information. If the patient is still unable to be contacted, written documentation of 3 attempts to contact the patient should be provided to the VA.

f. If the delivery of the safety valve coincides with a patient’s extended winter vacation, notification of this should be made to the VA in writing. Valves should be delivered to the patient during the first equipment delivery when the patient returns. Follow-up documentation should be provided to the VA after the valves are delivered.

g. Valves to be used must meet or exceed the below device specifications:

(1) Likely upstream system pressure following activation of the valve; (2) Leak through the valve after activation; (3) Leak from the valve body after activation. Subject to correct installation as per instruction.

The Contractor shall furnish a male-female oxygen swivel connector to each Veteran to be used in conjunction with the oxygen safety valve, as requested by the Veteran or VA staff.

Oxygen swivel adapters shall not be routinely issued like oxygen tubing or filters, but only as requested by the Veteran or VA staff.

(1) Likely upstream system pressure following activation of the valve; (2) Leak through the valve after activation; (3) Leak from the valve body after activation. Subject to correct installation as per instruction.

4.0 MALE-FEMALE OXYGEN SWIVEL CONNECTOR:

a. The Contractor shall furnish a male-female oxygen swivel connector to each Veteran to be used in conjunction with the oxygen safety valve, as requested by the Veteran or VA staff.

· Oxygen swivel adapters shall not be routinely issued like oxygen tubing or filters, but only as requested by the Veteran or VA staff.

· All requests for oxygen swivel connectors, made by either the Veteran or VA staff must be documented on the patient-signed equipment maintenance sheet or patient-signed delivery sheet.

· Delivery of swivel connectors shall be completed during a regularly scheduled delivery/equipment maintenance appointment. Any deliveries made outside this defined time must have prior approval from VA Prosthetics / COR or designee.

b. The swivel connector is designed to help prevent oxygen tubing from twisting, kinking, or becoming tangled.

c. Two (2) swivel connectors will be issued for each Veteran who is receiving VA home oxygen and has an oxygen safety valve, as requested. These swivel connectors shall remain Contractor-owned and will be replaced every (1) year and as needed with prior approval from VA Prosthetics / COR or designee.

d. Male-female oxygen swivel connectors must meet or exceed the following specifications:

4.1 HOME OXYGEN EQUIPMENT:

a. Installation - The installation of all machines and equipment by the Contractor shall be performed by a competent professional familiar with the nature of the equipment involved and fully qualified under the laws of the State in which the services are being rendered. Installation shall be consistent with local Fire and Safety Codes in the respective area of the State and shall conform to the most current National Fire Protection Association (NFPA) Life Safety Codes and NFPA Oxygen Cylinder Requirements. The Contractor shall provide a safety/emergency checklist to be completed, then signed by the patient or his/her caregiver and retained in the beneficiary account folder.

b. Maintenance - The Contractor shall ensure that all equipment is inspected at the manufacturer’s recommended intervals. A Contractor’s staff member shall conduct a check of the concentrator using a certified oxygen analyzer that is calibrated according to the manufacturer’s standards. Equipment shall be maintained per manufacturer’s specifications, and the maintenance shall be completed using the manufacturer’s checklist. It shall include compressor inlet pre-filter changes and compressor inlet bacteria filter changes according to the manufacturer's recommendations. The alarm battery shall be tested at each maintenance check, changed as indicated but at least annually. The Contractor is responsible for tracking and documenting maintenance of equipment by manufacturer specifications and providing these records for review upon request. The contractor shall furnish parts and labor for routine maintenance at no cost to the VA. The Contractor shall have recall procedures for equipment and supplies.

4.2 EQUIPMENT SPECIFICATIONS FOR OXYGEN CONCENTRATORS:

a. The oxygen concentrators shall be Underwriter Laboratory (UL) approved and must at a minimum meet the following specifications:

1) Electrically powered (115 volts).

2) There shall be a battery-operated audible alarm to indicate a power failure.

3) The oxygen concentrator shall not perform below the manufacturer’s specification.

4) Hour meter and OCI indicator.

5) The oxygen concentrator shall be grounded internally or plugged into a three-prong wall outlet appropriate for the patient’s home (outlet adaptors are not acceptable).

b. All electrically powered equipment used in the performance of this contract shall be UL-approved and shall be the most recently developed in the field at the time of use and not more than three (3) years old.

c. Contractor-owned equipment shall be repaired or replaced at no cost to the Government when breakdown or malfunction is due to normal usage or due to the fault of the Contractor.

4.3 FIVE (5) LPM CONCENTRATOR:

1. Concentrators must meet the following specifications:

a. Deliver 92 - 95% oxygen (+ / - 3%) at flow rates up to 5LPM.

b. Operate on 120 VAC, 60 Hz.

c. Irregular pressure alarm

d. Have a power failure alarm.

e. Weigh 60 pounds or less.

f. Be mounted on wheels for easy movement by the patient/caregiver.

g. Must meet Food and Drug Administration (FDA) Quality Systems Regulation (QSR) standards.

h. Minimum of three-year warranty on concentrator and compressor.

i. Sound level of 60db or less.

Concentrators that have oxygen-sensing devices are preferred, but not required.

4.4 TEN (10) LPM CONCENTRATOR:

1. Concentrators must meet the following specifications:

a. Deliver 92 - 95% oxygen at flow rates from 0.5 to 7 LPM.

b. Deliver 90 - 95% oxygen at flow rates from 7 to 10LPM.

c. Alarms for the following failures are required: Power Failure, O2 Concentration (Optional), and Irregular Pressure.

d. No larger than 26.0 H x 14.7 W x 19.1 Deep (in) 28.4 H x 39.4 W x 47.0 deep (cm).

e. No heavier than 60 lbs. (10 LPM unit) 110 volt; 60 cycle.

f. Be mounted on wheels for easy movement by the patient/caregiver.

g. Must meet FDA QSR standards.

h. Minimum of two-year warranty on concentrator and compressor.

i. Sound level of 60 dB or less.

Concentrators that have oxygen-sensing devices are preferred, but not required.

4.5 CONCENTRATOR WITH PORTABLE GASEOUS OXYGEN SYSTEM:

1. Oxygen concentrator with home compressor used to fill portable oxygen cylinders. The home compressor feature may be integrated into the stationary concentrator or may be a separate component. Oxygen concentrator to deliver flow rates of either up to 5 LPM or up to 10 LPM (low flow or high flow concentrator). The system shall include the following accessories:

a. Portable containers.

b. Regulator.

c. Flow meter.

d. Integrated oxygen-conserving device.

e. Humidifier.

f. Nasal cannula or mask.

g. Tubing.

h. Cylinder carrier.

i. Oxygen Thermal Fuse.

j. 5 CY (includes E, B, C, and/or D cylinders)

The contractor shall provide at no cost to the VAMC and Outpatient Clinics a home-fill system so patients can be titrated in actual units before he/she goes home at no cost to the VA. Devices shall then be billed at a monthly rental charge.

4.6 RENTAL DEMAND PULSE CONSERVER DEVICE: The contractor shall provide an oxygen-conserving device when ordered. Devices shall be approved by the VA and furnished to the VA Medical Center and Outpatient Clinics at no charge, so patients can be titrated accordingly. The contractor shall provide at no cost to the VA an oxygen-conserving device so patients can be titrated in the actual unit before he/she goes home. Devices shall then be billed at a monthly rental charge upon delivery of prescribed equipment.

4.7 PNEUMATIC POWERED OXYGEN CONSERVING DEVICES:

Pneumatic units shall meet the following specifications:

a. Flow settings from .5 to 6.

b. Have an easy-to-read content gauge.

c. Have a continuous flow setting.

d. Have at least a 2-year warranty.

e. Weight less than 30 oz.

4.8 ELECTRIC POWERED OXYGEN CONSERVING DEVICES:

Electric units must meet the following specifications:

a. Flow settings from .5 to 6.

b. Have an easy-to-read content gauge.

c. Have an alarm for low oxygen pressure levels.

d. Have an alarm for “no inspiration taken”.

e. Have a continuous flow setting.

f. Have at least a 2-year warranty.

g. Weight less than 30 oz.

4.9 LIQUID OXYGEN SYSTEM:

A liquid oxygen system consists of a large reservoir and a portable unit that is filled from the reservoir. The standard reservoir holds 110 pounds of liquid oxygen, and the portable unit holds 3-5 pounds of liquid oxygen. The standard reservoir weighs 165 pounds full, and the portable unit weighs 6-8 pounds full. The system shall meet the following specifications:

a. Reservoir must have a condensation collection tray.

b. Must have a quick-release valve for easy refilling.

c. Flow meter range of 0.5 to 6 LPM.

d. Portable must come with a shoulder strap.

e. May have electrical or mechanical content indicators.

f. Safety pressure relief valves, primary and secondary.

4.10 LIQUID SYSTEM WITH CONSERVING DEVICE:

This system consists of a large reservoir and a portable unit that is filled from the reservoir. Standard reservoir holds 110 pounds of liquid oxygen and portable unit holds 0.9 pounds of liquid oxygen.

The standard reservoir weighs 165 pounds full, and the portable unit weighs four (4) pounds full. The system shall meet the following specifications:

a. Reservoir must have a condensation collection tray.

b. Must have a quick-release valve for easy refilling.

c. Must have flow settings of one (1) to six (6).

d. Portable must come with shoulder strap and belt loop holder.

e. May have electrical or mechanical content indicators.

The Plan of Service must be developed by the VA or the Contractor’s clinical representative, by the Plan of Care, and by the appropriate clinical staff at each VA facility. No alteration to the prescription shall be permitted without written prior approval of the COR or designee.

4.11 BACKUP SYSTEM:

a. Patients with a prescription for an oxygen concentrator shall be provided with an appropriate backup system. This system shall consist of a compressed gas source and regulator with a stand, humidifiers, and cannulas/masks for use during the event of a power failure or mechanical problem necessitating the use of the backup cylinder. The cost for the above-mentioned backup system would be borne by the Contractor. Any patient refusing to accept oxygen equipment or supplies prescribed by the VA is considered Against Medical Advice (AMA) and must sign the Contractor’s visit documentation or AMA form. The Contractor shall send the signed form and report within one (1) business day to the COR or designee by facsimile or secured email. If a patient refuses to sign the Contractor's visit documentation or AMA form, the Contractor shall notify VA via facsimile or secured email within one (1) business day.

b. The Contractor shall ensure all patients have at minimum a non-electrical oxygen supply to last three (3) times the Contractor’s response time to a call. The minimum supply shall consider each patient’s prescription flow rate and distance from the Contractor’s location, so actual supply levels may differ from patient to patient. The cost of backup systems, backup oxygen, and backup equipment shall be borne by the Contractor. If H tanks are used for backup, the Contractor shall furnish an H tank stand for each H tank at no cost to the Government. Liquid oxygen supply may be considered backup oxygen; however, the oxygen supply must be maintained at the minimum three (3) times the Contractor’s response time, and the cost of any additional equipment such as extra stationary units used solely to maintain the minimum level of backup oxygen shall be borne by the Contractor. The cost of liquid oxygen used solely for backup purposes shall be borne by the Contractor.

4.12 STOCK STORAGE PORTABLE EQUIPMENT AT VAMC:

a. Ten (10) portable cylinders, regulators, and oxygen carriers shall be continuously maintained by the Contractor at the VA Medical Center. These cylinders shall be used only to accommodate home oxygen beneficiaries who are visiting the VA or being discharged and require a tank of oxygen to go home. This shall be provided at no additional cost to the Government for this service.

b. Portable cylinders, regulators, and 02 carriers shall be delivered to the VAMCs within One (1) business day of request to accommodate home oxygen beneficiaries who are visiting the VA or being discharged and require a tank of oxygen to go home, at no additional cost to the Government.

c. The VA shall furnish storage space and maintain all security for the above equipment. The Contractor shall be permitted access to the space and equipment when requested, by telephone, with 24 hours’ notice to the Respiratory Therapy Department. The Contractor shall maintain an updated inventory of all equipment every quarter.

4.13 DEMURRAGE CHARGES: The Contractor agrees to provide cylinders without assessing demurrage charges on the Government. The Contractor further agrees that the free loan period of cylinders is indefinite but shall not exceed the term of the contract.

4.14 LOSS OR DAMAGED EQUIPMENT: The VA will not pay for the Contractor’s lost or…