S02 - Solicitation 36C24924Q0415 Ambulance Services - Lexington VA Healthcare System.pdf

PAGE 1 OF 1. REQUISITION NO.

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

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

TIME

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

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ IFB RFP

15. DELIVER TO CODE 16. ADMINISTERED BY CODE

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

TELEPHONE NO. UEI: EFT:

PHONE: FAX:

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

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

SEE ADDENDUM

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

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

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

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

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

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

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

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

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

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

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

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

AUTHORIZED FOR LOCAL REPRODUCTION (REV. NOV 2021)

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

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

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

36C24924Q0415 09-05-2024

Shawn Hendricks 615-225-6409 09-16-2024

2PM CDT

Department of Veterans Affairs

Network Contracting Office 9 (90C)

1639 Medical Center Parkway, Suite 204

Murfreesboro TN 37129

X

621910

$22.5 Million

N/A

Department of Veterans Affairs

Lexington VA Healthcare System

1101 Veterans Dr

Lexington KY 40502

90C

Network Contracting Office 9

Department of Veterans Affairs

Network Contracting Office (90C)

1639 Medical Center Parkway Suite 204

Murfreesboro TN 37129

90C

FSC e-Invoicing Payment http://www.fsc.va.gov/fsc/einvoice.asp

Invoice Setup Information 1-877-489-6135

Invoice must be submitted electronically

Setup 1-877-489-6135

See CONTINUATION Page

Ground ambulance services for the Lexington VA Heathcare

System and all associated Community Based Outpatient

Clinics (CBOCs), Request for Quote IAW FAR Part 13.5.

This RFQ will result in a Blanket Purchase Agreement (BPA) with a period of performance of 10/01/2024 thru 09/30/2029.

The BPA will consist of five (5) one-year ordering periods which will allow for price escalation each year.

Service Contract Labor Standards Wage Determinations, by

State/County. Utilize the following link for the most current versions:

https://sam.gov/content/wage-determinations

See CONTINUATION Page

Shawn M. Hendricks

NCO915L2-4043

36C24924Q0415

Table of Contents

SECTION A

A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS

AND COMMERCIAL SERVICES

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 PERFORMANCE WORK STATEMENT

B.2 PRICE/COST SCHEDULE

ITEM INFORMATION

B.3 BPA TERMS & CONDITIONS

SECTION C - CONTRACT CLAUSES

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

AND COMMERCIAL SERVICES (NOV 2023)

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

C.3 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV

2018)

C.4 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (MAY 2024)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

SECTION E - SOLICITATION PROVISIONS

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

COMMERCIAL SERVICES (SEP 2023)

E.2 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (NOV 2021)

E.3 52.204-29 FEDERAL ACQUISITION SUPPLY CHAIN SECURITY ACT

ORDERS—REPRESENTATION AND DISCLOSURES (DEC 2023)

E.4 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

E.5 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

E.6 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984)

E.7 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—

COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (MAY 2024)

E.8 EVALUATION OF QUOTES

Performance Work Statement (PWS)

GROUND AMBULANCE

VISN 09/596 NAICS 621910

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 PERFORMANCE WORK STATEMENT

Purpose: The Lexington, KY VA Health Care System (hereafter Lexington VAHCS), its associated Community-Based Outpatient Clinics (CBOCs), and affiliated healthcare clinics require contracted non-emergency ambulance transportation services. The contractor shall provide all vehicles, personnel, management, supplies, equipment, and necessary reporting for the provision of Stretcher Transports, Basic Life Support (BLS), Advanced Life Support (ALS), Critical Care Transport (CCT) services. The contactor shall make these ambulance services available to the VA as needed, 24 hours a day, seven days a week (24/7), including weekends and holidays.

Background: The (Lexington VAHCS) main campus is located 1101 Veterans Drive and 2250

Leestown Rd. 40511, serving over 400,000 veterans, primarily from the Lexington and the surrounding area and it’s 4 Community-Based Outpatient Clinics. The hospital has 200 inpatient beds and sees approximately 5000 -inpatient admissions and more than 400,000 outpatient visits a year. Veterans served within this facility lives within the following counties and zip codes.

County/Zip Code County/Zip Code County/Zip

Code

County/Zip

Code

County/Zip Code

Fayette Co. 40502, 40503, 40504, 40505, 40507, 40508, 40509, 40510, 40511, 40513, 40515, 40516, 40517

Bell Co. 40813, 40840, 40845, 40856, 40902, 40913, 40935, 40939, 40940, 40958, 40965, 40977, 40988

Menifee Co.

40316, 40322, 40346, 40371, 40387

Jessamine Co.

40356, 40383, 40390, 40515

Clark Co. 40353, 40391, 40509, 40515

Franklin Co. 40601 Knox Co. 40701, 40734, 40744, 40759, 40771, 40903, 40906, 40915, 40921, 40923, 40935, 40943, 40946, 40949, 40953, 40982, 40995, 40997

Mercer Co.

40330, 40372, 40468

Rowan Co.

40313, 40351, 41472

Jackson, Co. 40336, 40402,40403, 40447, 40481, 40486

Anderson Co. 40012, 40046, 40076, 40342, 40372

Laurel Co. 40445, 40701, 40729, 40734, 40737, 40740, 40741, Russell Co.

42528, 42544, 42629, Flemming Co.

40351, 41309, 41041, 41049, 41055, 41093

Morgan Co.

40387,41301,41332,41352, 41408, 41421, 41425, 41465, 41472

VISN 09/596 NAICS 621910

40744 42642

Woodford Co.

40347, 40383, 40390

Rockcastle Co.

40403, 40409, 40419, 40445, 40456, 40460

Owen Co.

40355, 40359, 40379, 40601, 41010, 41046, 41052, 41083, 41086, 41098

Lewis Co.

41056, 41093, 41135, 41141, 41164, 41166, 41174, 41179, 41189

Casey Co. 40009, 40328, 40437, 40442, 40464, 40484, 40489, 42516, 42528, 42539, 42541, 42544, 42553, 42565, 42566, 42642, 42728, 42733

Perry Co. 40972, 41367, 41701, 41712, 41719, 41721, 41722, 41723, 41727, 41729, 41731, 41735, 41745, 41746, 41751, 41754, 41760, 41763, 41773, 41774, 41819

Garrard Co. 40403, 40419, 40444, 40461, 40484

Laurel Co.

40445, 40701, 40729, 40734, 40737, 40740, 40741, 40744, Leslie Co.

40808, 40810, 40816, 40827, 40840, 40858, 40868, 40874,40974, 40979, 41714, 41723, 41749, 41762, 41764, 41766, 41775, 41776, 41777

Pendleton Co. 41003, 41006, 41007, 41030, 41033, 41040, 41043, 41097

Lee Co. 40336, 41301, 41311, 41339

Lincoln Co. 40409, 40419, 40422, 40437, 40442, 40444, 40484, 40489, 42567

Estill Co.

40336, 40380, 40472

Elliot Co.

40351, 41149, 41164, 41171, 41180, 41472

Scott Co. 40324, 40347, 40370, 40379, 40511, 41010

Pulaski Co. 40419, 42053, 42501, 42503, 42518, 42519, 42533, 42544, 42553, 42567, 42642

Nicholas Co.

40311, 40350, 40361, 40374, 41031, 41039

Clay Co.

40402, 40914, 40962, 40972, 40983

Bell Co. 40813, 40840, 40845, 40856, 40902, 40913, 40935, 40939, 40940, 40958, 40965, 40977, 40988

Madison Co. 40385, 40403, 40404, 40461, 40475

Breathitt Co. 41301, 41310, 41311, 41314, 41317, 41339, 41348, 41366, 41385, 41390, 41721

Boyle Co. 40328, 40330, 40422, 40440, 40464, 40468

Mason Co.

41002, 41034, 41039, 41044, 41055, 41056

Montgomery

Co. 40337, 40346, 40353, 40360

Owsley Co. 40972, 41314, 41351, 41364, 41386

VISN 09/596 NAICS 621910

Wolfe Co. 41301, 41311, 41332, 41360, 41365

Wayne Co. 41129, 42518, 42544, 42603, 42633

Powell Co.

40380, 40376, 40312

Grant Co.

40359, 41003, 41010, 41030, 41035, 41046, 41052, 41097

Robertson Co. 41004, 41044, 41055, 41064

Bath Co. 40311, 40334, 40346, 40358, 40360, 40371, 40374, 41049

Bourbon Co.

40311, 40324, 40361, 40374, 41031

Harrison Co.

41031, 41010, 41003, 40370

Grant Co.

40359, 41003, 41010, 41030, 41035, 41046, 41052, 41097

Adair Co. 42129, 42528, 42642, 42715, 42728, 42733, 42741, 42742, 42743, 42753

Knott Co. 41339, 41630, 41640, 41701, 41722, 41740, 41759, 41722, 41773, 41817, 41822, 41828, 41831, 41834, 41836, 41839, 41843, 41844, 41847, 41859, 41861, 41862

Marion Co. 40009, 40333, 40037, 40052, 40060, 40062, 40063, 40069, 40328, 42718

Acronyms

ALS – Advanced Life Support

AOD – Administrative Officers of the Day

BLS – Basic Life Support

CCT – Critical Care Transport

CCTP – Critical Care Transport Paramedic

CCEMTP – Critical Care Emergency Medical Transport

CO – Contracting Officer

COR – Contracting Officer’s Representative

CPR – Cardiopulmonary Resuscitation

VISN 09/596 NAICS 621910

DOL – Department of Labor

EMT – Emergency Medical Technician

IAW – In Accordance With

OO – Ordering Officer

PWS – Performance Work Statement

QASP – Quality Assurance Surveillance Plan

QC – Quality Control Plan

TB – Tuberculosis

TJC – The Joint Commission

VTS – Veteran Transportation Service

Scope/Requirements

Types of Ambulance Service

The contractor shall provide Emergent, non-emergent Stretcher Transports, Basic Life Support

(BLS), Advanced Life Support (ALS), and Critical Care Transport (CCT) Tier 1, 2, and 3 ambulance services on an as-needed basis in accordance with all federal, state, and local regulations. Additionally, the contractor shall have a Kentucky Board of Emergency

Medical Services (KYBEMS) issued Certificate of Need (CON) to operate ambulances within the state of Kentucky so as to be lawful in transporting non-VA eligible patients when such "humanitarian" transports arise.

Occasionally a veteran will need to be transported with VA staff and equipment; the contractor shall return VA Staff and equipment to the original place of pick-up.

Transport of Miscellaneous Items with the Patient:

The Contractor may also be required to transport patient luggage, medical records, medication, and comfort items from pickup points to destination at no additional cost to the Government.

Luggage to be transported will be restricted to suitcase and valise types. When patients are transported to the Lexington VAHCS, destination is deemed to be the ER, Admissions, the clinic, or service within the hospital, or directly to the ward as instructed by VA Staff.

VISN 09/596 NAICS 621910

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

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

Personnel

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

If the contractor wishes to add or replace personnel throughout the life of the contract, it shall provide evidence of required training, certifications, licensing, and any other qualifications to the

Contracting Officer’s Representative (COR) for review.

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

COR.

CCTPs shall have met all state requirements for the tier in which they are performing services in

(I, II, III). Proof in the form of a current certificate for the successful completion of such must be provided to the COR upon request.

Investigative Requirements for Contract Personnel: Contract personnel will be subject to the same investigative requirements as those for regular VA appointees and employees. The level of investigation commensurate with the level of access to perform the performance work statement is: Special Agreement Checks (SAC). Fingerprinting for contract personnel will be conducted at

Lexington VAHCS. Thereafter the contracted employees will be subject annually to the same requirement, with a 90-day window to complete such requirement as provided by Lexington

VAHCS The VA Security and Investigation Center (SIC) is responsible for adjudicating all background investigations for contract employees.

EMTs, CCTPs, and other contractor personnel as applicable must pass the Contractor’s background check and must not have been convicted of (or have any pending charges for) a felony for the past five years. Personnel (and Contractor) must report any new or additional charges or convictions if they arise during the course of performance under this contract so VA can review them and determine whether the employee in question needs to be discharged of his or her duties until the matter is adjudicated.

VISN 09/596 NAICS 621910

Tuberculosis Exposure Control Policy

The contractor shall provide the VA with a policy on tuberculosis (TB) exposure and control, to include TB decontamination.

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

Ordering Period.

Contractor Equipment, Vehicles, and Inspection

Ambulances shall meet all applicable federal, state, and local regulations and specifications, including but not limited to licensing, registration, and safety standards.

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

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

The contractor shall not borrow or exchange supplies, equipment, and/or medications with the

VA. Equipment attached to or in use by the patient at time of pick-up may remain with the patient during transport to ensure continuity of care. Medical Control Authorities are responsible for maintaining and supplying medication during patient transport. All VA equipment and unused medications must be returned to VA during patient drop-off or as promptly as feasible within 24 hours.

The contractor shall furnish all linen required for patient transport at no additional cost. Linen shall not be exchanged with linen belonging to Lexington VAHCS or its CBOCs/Hazard, Berea, Somerset, and Morehead.

The contractor must be capable of transporting the drugs and/or equipment as required by the patient as listed in Attachment A Critical Care Transport Capabilities Confirmation. The contractor shall have the appropriate medications, up to and including CCT Tier III if necessary, based on the EMS region the ambulance provider is functioning in.

VISN 09/596 NAICS 621910

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

The contractor personnel performing services for the VA, shall, at all times, conduct themselves in a professional manner, and be identified by having the company name, and employee name affixed to the uniform. The Contractor shall be responsible for furnishing all vehicles, uniforms, nametags and/or badges for performance of services under this contract. Employee identifications shall be worn in clear view above the waist. The contractor personnel shall not smoke/play loud music originating from any device in vehicles while transporting VA patients.

Each driver shall possess a driver’s license that is valid for the class of vehicle driven. Evidence of a special transportation service vehicle permit, or endorsement issued by the commissioner of public safety.

Be at least 18 years of age and have not less than one year of experience as a licensed driver; and

For the past three years:

Have not had a driver’s license canceled or suspended.

Have a driving record clear of convictions for operating a motor vehicle or motorcycle without insurance.

Have a driving record clear of convictions for driving a motor vehicle without a valid current license for the class of vehicle driven.

Have a driving and criminal record clear of convictions for driving under the influence of alcohol or a controlled substance.

The contractor personnel will ensure that the patient is secured to the stretcher/cot and that the stretcher /cot is secure in the back of the ambulance before the vehicle moves.

Ambulance drivers shall have a valid driver’s license, in accordance with Federal, State, and local government requirements for their place of operation for the services they perform, be capable of administering oxygen and shall have successfully completed the standard and advanced first aid course of the American Red Cross of U.S. Bureaus of Mines of equivalent and be capable of providing necessary medical assistance to the attending emergency medical technician or paramedic.

Emergency Medical Technician (EMT) and Paramedic Qualifications: EMT’s and Paramedic’s providing services under this contract shall have the following qualifications, in additions to those required by Federal, State, and Local Government:

VISN 09/596 NAICS 621910

Have completed training in accordance with the standards published by the Department of

Health and Human Services with a minimum curriculum of 150 hours or equivalent including an in-hospital training period. Such training programs must also be acceptable under the regulating requirements for local EMS Systems supported by DHHS under PL 93-154, Federal Register

39:24304. (1974).

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

Transportation Request

4.5.1 VetRide or VA-Approved Transportation Software Utilization:

The contractor agrees to utilize the VetRide Vendor Portal or VA-Approved Transportation

Software with every patient transported under this contract.

Department of Veteran Affairs will provide the software and access to the VetRide Vendor

Portal or VA-Approved Transportation Software for the vendor/contractor in this contract. The

Contractor will utilize the VetRide Vendor Portal or VA-Approved Transportation Software fully as instructed:

Receive and respond to electronic trip requests

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

Submit claims via the electronic HCFA 1500 in the VetRide Vendor Portal or VA-Approved

Transportation Software system.

All invoices must be submitted within 30 calendar days of date of service in accordance with 38

CFR 70 to be considered timely submission.

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

Contract Number

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

Authorization number(s)

Pick-up and drop-off location of the patient

Base Rate

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

Date of Birth and Sex

VISN 09/596 NAICS 621910

Diagnosis Codes or Nature of Illness or Injury

Documentation of circumstances when billing for waiting time

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

VA authorizing official’s name

Healthcare Procedure Coding System/National Level II (HCPCS)

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

A transportation request is defined as one incidence of a request for one-way service (Stretcher

Transports, BLS, ALS, CCT). No more than one patient will be transported per order unless approved by an authorized VA staff. Transportation requests will be made through VetRide or

VA-Approved Transportation Software Utilization. Contractors must have the capability to receive orders, update ride status, and input trip costs and other required data through this portal.

Contractors must have dedicated staff available to monitor this portal 24/7. Lexington VAHCS

Travel Program Staff will be available to assist with account setup and training for the

Contractor’s Staff. In the event VetRide or other VA-Approved Transportation Software

Utilization is down, other methods of communication (i.e., telephone, facsimile) will be used to place transportation requests.

Lexington VAHCS Travel Program Staff/or authorized VA employees will work with the

Contractor the following business day to reconcile any transportation requests that were placed outside of VetRide or VA-Approved Transportation Software Utilization.

The Contractor must update VetRide or VA-Approved Transportation Software Utilization with any data and/or notes in real time that deviate from the original order such as invoicing for additional mileage due to a road closure, wait time, reason for no load, etc. Lexington VAHCS

Travel Program Staff/or authorized VA employees may place a “hold” on payment of this order until it has been reconciled.

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

Contracting Officer (CO) Ordering Officers (OO)

Administrative Officer of the Day (AOD) Beneficiary Travel Office Staff

Contracting Officer’s Representative (COR)

VISN 09/596 NAICS 621910

The Contracting Officer will furnish the Contractor with the names of individuals above, who are authorized as Ordering Officers, by separate memorandum upon issuance of the contract. The

Contracting Officer will update this list throughout the life of the contract as Ordering Officers change.

Ordering Officers are responsible for issuing and administering orders placed under this contract.

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

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

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

Mode of transportation required, Required time of arrival

Name of the beneficiary, Pick-up and delivery point, Type and number of additional medical care specialists required, Type of equipment required, Last four of the patient's Social Security Number, and

Any other special instructions

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

The type of transportation service (Stretcher Transports, BLS, ALS, CCT) required will be discussed and determined by VA clinical personnel and the contractor. The contractor shall transport the patient per its policies and standard industry practice. If the type of transportation service differs from what was agreed upon by the VA and contractor, the contractor shall submit documentation to the VA explaining its rationale.

VISN 09/596 NAICS 621910

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

The contractor shall have sufficient vehicles and personnel to provide services for up to four (4) simultaneous transportation requests. Transports required may be for any mix of Stretcher

Transports, BLS, ALS transports. One of these four simultaneous transports may require CCT capability up to Tier III. If Lexington VAHCS requires ambulance services exceeding four (4) simultaneous transportation requests, the vendor will be offered to provide the services if they have sufficient vehicles/personnel available; but may decline these additional orders if sufficient vehicles/personnel are unavailable.

The number of transports under normal operating conditions will typically range from 0-

10transports each weekday and significantly less on weekends and holidays. The number of actual transports may vary throughout the life of the contract.

The patient may bring with her or him up to three (3) liters of oxygen. The contractor shall be responsible for providing adequate and safe storage of the oxygen tanks during transport.

Response Times*

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

Emergent Transport (Originating from VA (Only): The contractor shall be required to provide

Ground Ambulance arrangements within thirty (30) minutes of order/patient pick up call.

For all add-ons (not scheduled in advance) transportation requests, with pick up at Lexington

VAHCS The contractor will be allotted up to a sixty (60) minute response time from time of order placement for transportation requests that are not previously scheduled in advance.

For an urgent transport request for a critical patient (as deemed by the physician) with pick up at

Lexington VAHCS the contractor will be allotted up to a thirty (30) minute

For transportation requests which do not have a pick-up at Lexington VAHCS.

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

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

VISN 09/596 NAICS 621910

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

* The contractor shall not be held liable for nonperformance caused by an occurrence beyond the reasonable control of the contractor and without its fault or negligence such as, acts of God or the public enemy, acts of the Government in its sovereign or contractual capacity, fires, floods, epidemics, quarantine restrictions, strikes, and unusually severe weather. The contractor MUST notify the VA with as much advance notice as possible should any of these occur.

Cancellations

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

A “no show” is defined as a transportation request which is cancelled after the contractor has dispatched a vehicle, the vehicle is enroute, or has arrived at the pick-up location, and there is no longer a requirement for patient transportation. The contractor may request one-way reimbursement for no-shows. No-show reimbursement shall be based upon the base rate for the type of service requested (Stretcher

Transports, BLS, ALS, CCT) and the one-way mileage (Stretcher Transports, BLS, ALS, CCT) accrued enroute to the pick-up location at time of cancellation. Mileage for no- show cancellations shall be confirmed by the contractor and reported to the VA as soon as possible from time of cancellation.

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

Pick-Up/Drop-Off/Reporting Procedures

Ambulance personnel shall pick-up and deliver patients at specified locations (e.g., front door of

Main/Tower Entrances. These locations will be specified by VA staff when an order is placed and communicated to the transporting personnel.

When applicable, ambulance personnel shall report to the Veteran Transportation Service (VTS)

Dispatcher or Administrative Officer of the Day (AOD) to (1) announce his/her arrival to pick-up and transfer the patient and (2) obtain report of pertinent information regarding the patient’s condition from the primary nurse/physician.

VISN 09/596 NAICS 621910

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

In cases where ambulance personnel must divert to a local emergency department while performing a VA authorized transport, the contractor’s dispatcher shall notify the VA

Beneficiary Travel Department or Administrative Officer of the Day of the patient’s location and status as soon as this information becomes available.

Patient Welfare

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

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

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

Incident Reporting

The contractor shall notify the COR, Requestor, Program Manager, Beneficiary Travel

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

The COR will monitor the service provided. The contractor shall cooperate with the COR in providing information and answering questions in a timely manner. The contractor shall promptly inform the COR of any complaints received directly from patients. If warranted, the

VA may conduct incident investigations and require written response from the contractor within

48 hours of request.

Invoicing

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

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

If unloaded mileage exceeds loaded mileage, the contractor may invoice for a flat fee only if the following also occur:

Unloaded mileage exceeds 75 miles

The contractor does not deviate from a route to intentionally make unloaded mileage exceed loaded mileage.

Except for no shows and trips when unloaded mileage exceeds loaded mileage in accordance with 4.9.3, the contractor shall invoice for loaded (patient onboard) services and mileage only.

Upon notification of the contracting officer, the vendor must receive training and begin implementation of invoices via Vet Ride within 30 days versus VA Tungsten Network e-

Invoicing network. Invoices must be submitted via the electronic HCFA 1500 in the VetRide

Vendor Portal or other VA approved software. These invoices shall not include patient information, but shall include the following:

Contractor Name

Contract Number

Current Purchase Order Number

Date of service

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

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

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

SERVICES PERFORMED UNDER THIS CONTRACT.

VISN 09/596 NAICS 621910

Period & Place of Performance

This contract’s ordering period shall be effective from Date of Award through Date.

The Place of Performance is variable and may occur within the states of Kentucky; ambulance services may be required to or from locations including, but not limited to the following:

Lexington VAHCS Medical Center to include specific Atrium Clinics, Emergency Department, pavilions, or out-buildings on the Franklin R. Sousley and Troy Bowling campus. The Lexington

VAHCS address is:

2250 Leestown Rd. Lexington, KY 40511 and 1101 Veterans Drive Lexington, KY 40502

Community-Based Outpatient Clinics (CBOCs):

CBOC Name Address

Morehead CBOC 333 Beacon Hill Rd. Ste. 100

Morehead, KY 40351

Hazard CBOC 210 Black Gold Blvd. Ste. 107

Hazard, KY 41701

Somerset CBOC Medpark Dr. Somerset, KY

42503

Berea CBOC 209 Pauline Dr. Berea, KY

40403

Other VA Medical Centers, Hospitals, or CBOCs within Veterans Integrated Service Network

(VISN) 9 including, but not limited to:

Medical Center Name: Address:

VA Tennessee Valley Healthcare 1310 24th Ave. south, Naqshville, TN 37212

Robley Rex VAMC 800 Zorn Ave., Louisville, KY

40206

Hershel “Woody” Williams

VAMC

1540 Spring Vallley Dr., Huntington, WV 25704

James H. Quillen VAMC 99 Sidney St., Mountain

Home, TN 37684

VISN 09/596 NAICS 621910

Cincinnati VAMC 3200 Vine St., Cincinnati, OH

45220

St. Louis VAMC 915 N. Grand Blvd., St. Louis, MO 63106

Richmond VAMC 1201 Broad Rock Blvd., Richmond, VA 23249

Other Non-VA Medical facilities and Community Care facilities as authorized by the VA.

Veteran’s residence.

Local airports including: Bluegrass Airport, Louisville Muhammad Ali International Airport, Huntington Tri-State airport, Bluegrass field.

Quality Control Plan

Quality Control

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

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

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

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

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

A description of the method used to provide on-time ambulance services to meet the requirements of this contract (24/7 availability and up to 4 simultaneous transports in accordance with PWS 4.5.1.7).

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

VISN 09/596 NAICS 621910

CONTENGENCY PLAN: (In case VetRide Vendor Portal is down) A description of the method/system used to log all requests for service. The contractor shall confirm that the log indicates the date and time of service call, actual time of pick-up versus the scheduled time, name of patient requiring services, designated pick-up and delivery points, mileage, and actual waiting time at pick-up and delivery points if waiting charges are claimed. The contractor shall confirm the log will be sent to the COR monthly.

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

Surveillance Plan (QASP).

The Government shall prepare a QASP after contract award derived from the PWS and contractor’s submitted quality control plan. The QASP is a “living document” and the

Government may review and revise it at any time. However, the Government shall coordinate changes to the QASP with the contractor.

The QASP will specify the work requiring surveillance and the Government’s method of surveillance.

Minimum Performance Standards

The contractor shall maintain performance standards in accordance with the standards outlined in the table below. Failure to meet the Acceptable Quality Levels (AQL) may result in termination of the contract.

The QASP will include the standards below as well as others derived from the successful offeror’s quality control plan.

VISN 09/596 NAICS 621910

Task PWS

Reference

Standard Acceptable

Quality Level

Method of

Surveillance

Provide on-time ambulance services

Section

4.5.1.8.3

Scheduled patient pick-ups shall not deviate more than 15 minutes past scheduled pick-up time for scheduled orders

97% Customer

Feedback

Incident

Reporting

Section 4.8 The contractor shall notify the Program

Manager, Beneficiary Travel

Department, of any accidents and/or safety problems that occur while the patient is being transported. This notification shall occur within one (1) hour by telephone. A written report of the incident shall be delivered to the

Program Manager, Benefits

Management, by the close of business of the next working day.

97% Customer

Feedback

Invoice

Reports

Section 4.9 Provide a monthly invoice including secondary documentation in accordance with Section 4.10 of the

PWS

95% 100% inspection of monthly invoices/reports

COVID-19 Or Other Similar Infectious Diseases

Contractor shall not refuse transports of COVID-19 positive or other similarly infected patients.

Contractor shall abide by all additional procedures and precautions that may be implemented by the VA based on VA-issued guidance and/or CDC recommendations. These procedures are subject to change throughout the life of the contract and will be incorporated via attachment (See

S03 VTS Patient Transport PPE and Vehicle Cleaning/Disinfection SOP).

Contractor shall have written policy of steps they will take to prevent the spread of COVID-19 or other similarly infectious diseases by their employees and/or vehicles. This policy shall, at a

VISN 09/596 NAICS 621910

minimum, include procedures of screening drivers before each shift, deliberate decontamination of their vehicles and all other preventative precautions taken by Contractor employees.

Contractor shall furnish all required PPE throughout the life of the contract.

Conformity To Regulations

8.1 The contractor and his/her operators shall conform to all Federal, State, and local regulations governing the performance of contracted services.

8.2 VAMC facilities have been designated NO SMOKING areas in their entirety. Individuals found in violation of this no smoking policy may be subject to a $50.00 federal citation for disregarding posted safety rules and regulations. Furthermore, the contractor may be directed to stop work. The contractor is to notify all of his/her employees and/or sub-contractors of this strict enforcement policy.

Wage Rates

9.1. Wage Determination(s) as listed in Section D in this solicitation are applicable to any resulting contract.

9.2. The contractor certifies by signature on this offer that the salaries to be paid workers involved in the performance of the contract are equal to or greater than those specified in the attached

Wage Determination(s).

9.3 The Department of Labor has held that contractors must pay their employees the Service

Contract Act waged while they are driving both to and from destinations for the VA. The Wage

Determination is attached in Section D.

Evidence of Coverage

10.1 Before commencing work under the contract, the contractor shall furnish the Contracting

Officer with a certification from his/her insurance company indication that the coverage outlined in this contract has been obtained and that it may not be changed of canceled during the term of the contract.

Worker’s Compensation

11.1 The Act of June 25, 1936, 42 Stat. 1938 (40 USC 290), authorized the constituted authority of the several states to apply their workmen’s compensation laws to all lands and premises owned or held by the United States. The contractor agrees to procure and maintain while the contract is in effect, Worker’s Compensation and Employers Public Liability insurance. The policy shall provide coverage for Public Liability Limits of not less than the statutory limitations for any one accident, and at least meet the statutory limitations if more than one person is involved. , Upon award of the contract, the contractor shall furnish to the Contracting

Officer a certificate from its insurance company indicating that this coverage has been obtained and that such coverage may not be changed or canceled unless 30 day advance written notice is provided to the Contracting Officer.

Contractor Personnel Security Requirements

12.1 All contractor employees who require access to the Department of Veterans Affair's computer systems or who come into contact with veteran/beneficiaries shall be the subject of a background investigation and must receive a favorable adjudication from the VA Office of

Security and Law Enforcement prior to contract performance. This requirement is applicable to all subcontractor personnel requiring the same access. If the investigation is not completed prior to the start date of the contract, the contractor will be responsible for the actions of those individuals they provide to perform work for the VA.

VISN 09/596 NAICS 621910

Position Sensitivity - The position sensitivity for this contract has been designated as LOW

RISK.

Background Investigation - The level of background investigation commensurate with the required level of access for this contract is National Agency Check with Written Inquiries.

Contractor Responsibilities:

• The contractor shall pre-screen all personnel requiring VA access to ensure they maintain a

U.S. citizenship and are able to read, write, speak, and understand the English language.

• The contractor shall submit or have their employees submit the following required forms requested by Department of Veterans Affairs, Office of Security and Law Enforcement, Security and Investigations Center, 2200 Fort Roots Drive Bldg. 104, North Little Rock, AR 72114 within

30 days of receipt:

• All documents completed and submitted at the following website:

http://www.va.gov/SECURITYINVESTIGATIONSCENTER/

• The contractor, when notified of an unfavorable determination by the Government, shall withdraw the employee from consideration from working under the contract. Failure to comply with the contractor personnel security requirements may result in termination of the contract or cause.

The contractor shall agree that all deliverables, associated working papers, and other material deemed relevant by the contractor in the performance of this task order are the property of the

United States Government. The contractor shall agree that all individually identifiable health information shall be treated with the strictest confidentiality. Access to records shall be limited to essential personnel only. Records shall be secured when not in use. At the conclusion of the contract, all copies of individually identifiable health records shall be destroyed or returned to the VA. Any individually identifiable health records shall be deleted from computers not belonging to the VA. The contractor shall comply with the Privacy Act, 38 U.S.C. 5701, 38 http://www.va.gov/SECURITYINVESTIGATIONSCENTER/

VISN 09/596 NAICS 621910

U.S.C. 7332, and 5 U.S.C. 552(a) et. Seq. Contractor staff shall sign confidentiality statements before the start date of the contract. The contractor shall comply with all provisions of the Health

Information Portability and Accountability Act (HIPAA), including but not limited to privacy, security of electronic health data, and adherence to standards and code sets as required by

HIPAA. The contractor shall ensure the confidentiality of all patient and employee information and shall be held liable in the event of breach of confidentiality. Any person, who knowingly or willingly discloses confidential information obtained from the VA with non-essential persons, may be subject to fines.

12.1.1 HIPAA COMPLIANCE. HIPAA compliance is required. The contractor must adhere to the provisions of Public Law 104-191, Health Insurance Portability and Accountability Act

(HIPAA) of 1996 and the National Standards to Protect the Privacy and Security of Protected

Health Information (PHI). As required by HIPAA, the Department of Health, and Human

Services (HHS) has promulgated rules governing the security and use and disclosure of protected health information by covered entities, including the Department of Veterans Affairs (VA). In accordance with HIPAA, the contractor may be required to enter into a Business Associate

Agreement (BAA) with VA.

12.1.2 BLOOD BORNE PATHOGENS: The contractor and the employees provided, pursuant to this contract, shall comply with the effective VAMC Policy (and Occupational Health requirements in accordance with OSHA Blood Borne Pathogens (BBP) Law and the OSHA

Tuberculosis Compliance Directive, enforceable under OSHA’s General Duty Clause) governing health care workers infected with a blood borne pathogen. If the contractor obtains information that a health care worker providing care pursuant to this agreement may be infected with a blood borne pathogen, the contractor will advise the Contracting Officer immediately.

Medical Liabilities Insurance

13.1 The contractor shall carry required insurance (See VAAR Clause 852.237-7

INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE) and vehicle insurance in accordance with the Kentucky Department of State Health Services.

Annual VHA Training

VISN 09/596 NAICS 621910

14.1 In accordance with VHA Directive 2003-028 "Compliance and Business Integrity

Program", its updates or replacement directives, IG Guidance at 8994, Section II(C); Guidance at

4875, Section III (B)(4) Sentencing Guidelines, Section 8B2.1 (b) (4) (B) annual compliance training is to be provided to all contractors within the scope of their work. The medical center

COTR’s are to coordinate the annual training with their respective Contracting Officer and

Complianc…