S02 - Solicitation Home O2 RFP TVHS Mt Home Memphis VAs FINAL 02.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

Orders paid via Government

Purchase Card (GPC)

36C24923R0026 03-30-2023

Shawn.hendricks@va.gov 615-705-9064

05-01-2023 1PM CDT

CDT

Department of Veterans Affairs

Network Contracting Office 9 (90C)

Shawn Hendricks

1639 Medical Center Parkway, Suite 400

Murfreesboro TN 37129

X 100

X

621610

$19 Million

Net 15

N/A

X

See SOW (Pages 35-37) for Specific Locations

Department of Veterans Affairs

Network Contracting Office 9 (90C)

Shawn Hendricks

1639 Medical Center Parkway, Suite 400

Murfreesboro TN 37129

Government Purchase Card

Period of Performance: 05/12/2023 thru 05/11/2028

This solicitation uses Federal Acquisition Regulation (FAR)

Part 15 Contracting by Negotiation procedures.

Tradeoff Process, FAR 15.101-1

All Offerors shall be active/registered at System for proposal submission, proposal evaluation, and award.

All Service-Disabled Veteran-Owned Small Business (SDVOSB) concerns shall be active/registered at SBA’s website (VetCert) at https://veterans.certify.sba.gov at the time of proposal submission, proposal evaluation, and award.

Home Oxygen services for the patients of the Tennessee Valley

Healthcare System (TVHS), James H. Quillen VA Medical Center

(VAMC) and the Memphis VAMC. See catchment areas on pages 35-

37 37.

Orders to be paid via Government Purchase Card

X X

X 1

Roxie Keese https://veterans.certify.sba.gov/

36C24923R0026

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 REQUIRED REGISTRATION WITH CONTRACTOR PERFORMANCE ASSESSMENT

REPORTING SYSTEM (CPARS)

B.3 STATEMENT OF WORK

B.4 PRICE SCHEDULE

SECTION C - CONTRACT CLAUSES

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

AND COMMERCIAL SERVICES (NOV 2021)

C.2 52.204-21 BASIC SAFEGUARDING OF COVERED CONTRACTOR INFORMATION

SYSTEMS (NOV 2021)

C.3 52.216-18 ORDERING (AUG 2020)

C.4 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.5 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.6 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.7 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

C.8 VAAR 852.212-70 PROVISIONS AND CLAUSES APPLICABLE TO VA

ACQUISITION OF COMMERCIAL ITEMS (APR 2020)

C.9 VAAR 852.212-72 GRAY MARKET AND COUNTERFEIT ITEMS (MAR 2020)

C.10 VAAR 852.219-74 LIMITATIONS ON SUBCONTRACTING—MONITORING AND

COMPLIANCE (JUL 2018)

C.11 VAAR 852.219-77 VA NOTICE OF LIMITATIONS ON SUBCONTRACTING—

CERTIFICATE OF COMPLIANCE FOR SERVICES AND CONSTRUCTION (SEP 2021)

(DEVIATION)

C.12 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020)

C.13 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.14 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (MAY 2022) (JUL 2020) (DEVIATION)

C.15 IT CONTRACT SECURITY

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

ATTACHMENT D.1 – PRICE SCHEDULE

ATTACHMENT D.2 - VHA 1605.05 BUSINESS ASSOCIATE AGREEMENT

ATTACHMENT D.3 – REFERENCE CONTRACT WORKSHEET HOME O2

SECTION E - SOLICITATION PROVISIONS

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

COMMERCIAL SERVICES (NOV 2021)

E.2 ADDENDUM TO INSTRUCTIONS TO OFFERORS

E.3 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (NOV 2021)

E.4 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.5 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

E.6 52.212-2 EVALUATION—COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES (NOV 2021)

E.7 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL

PRODUCTS AND COMMERCIAL SERVICES (MAY 2022) (JUL 2020) (DEVIATION)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

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

a. CONTRACTOR:

b. GOVERNMENT: Contracting Officer 36C249

Department of Veterans Affairs

Network Contracting Office 9 (90C)

Shawn Hendricks

1639 Medical Center Parkway, Suite 400

Murfreesboro TN 37129

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

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

Management, or

[X] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly []

b. Semi-Annually []

c. Other [X] Monthly in arrears, after receipt of an approved invoice

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

AMENDMENT NO DATE

B.2 REQUIRED REGISTRATION WITH CONTRACTOR PERFORMANCE

ASSESSMENT REPORTING SYSTEM (CPARS)

As prescribed in Federal Acquisition Regulation (FAR) Part 42.15, the Department of Veterans

Affairs (VA) evaluates Contractor past performance on all contracts that exceed the simplified acquisition threshold (SAT) as defined in FAR 2.101 and shares those evaluations with other

Federal Government contract specialists and procurement officials. The FAR requires that the

Contractor be provided an opportunity to comment on past performance evaluations prior to each report closing. To fulfill this requirement VA uses an online database, CPARS, which is maintained by the Naval Seal Logistics Center in Portsmouth, New Hampshire. CPARS has connectivity with the Past Performance Information Retrieval System (PPIRS) database, which is available to all Federal agencies. PPIRS is the system used to collect and retrieve performance assessment reports used in source selection determinations and completed CPARS report cards transferred to PPIRS. CPARS also includes access to the federal awardee performance and integrity information system (FAPIIS). FAPIIS is a web-enabled application accessed via

CPARS for Contractor responsibility determination information.

Each Contractor whose contract award is estimated to exceed the SAT is required to register with

CPARS database at the following web address: https://www.cpars.gov/. Help in registering can be obtained by contacting Customer Support Desk @ DSN: 684-1690 or COMM: 207-438-1690.

Registration should occur no later than thirty days after contract award and must be kept current should there be any change to the Contractor’s registered representative.

For contracts with a period of one year or less, the contracting officer will perform a single evaluation when the contract is complete. For contracts exceeding one year, the contracting officer will evaluate the Contractor’s performance annually. Interim reports will be filed each year until the last year of the contract, when the final report will be completed. The report shall be assigned in CPARS to the Contractor’s designated representative for comment. The

Contractor representative will have thirty days to submit any comments and re-assign the report to the VA contracting officer.

Failure to have a current registration with the CPARS database, or to re-assign the report to the

VA contracting officer within those thirty days, will result in the Government’s evaluation being placed on file in the database with a statement that the Contractor failed to respond.

B.3 STATEMENT OF WORK

1. GENERAL: The Department of Veterans Affairs (VA) has a requirement for home oxygen services for VA beneficiaries throughout the Tennessee Valley Healthcare System (TVHS), the

James H. Quillen VA Medical Center (VAMC) and the Memphis VAMC catchment areas (See

16. Catchment Areas:). A single Indefinite-Delivery Indefinite-Quantity (IDIQ) contract with a one-year base year and four one-year option years will be awarded to cover all of the VA locations referenced above.

2. DESCRIPTION OF SERVICE/ INTRODUCTION: The Contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to provide home oxygen as defined in this Statement of Work (SOW); except for those items specified as Government Furnished Property. The services associated with this contract include: all logistical/administrative functions involved with the day-to-day operation of providing the service to the Veteran and their families, including furnishing warehouse space, surplus supplies, and in-home respiratory therapy visits for patients with ventilators. This includes providing a Quality Assurance Surveillance Plan

(QASP) about how the contractor will comply with the requirements of the contract to include coordinating and managing patient care, deliveries consisting of pickup and delivery of supplies, briefing patient on proper use of equipment, documenting use of supplies and inspection of home in relation to home oxygen in accordance with The Joint Commission (TJC) concerning patient use/safety of home oxygen standards. The requirement includes providing in home supplies such as the following: low decibel concentrator (rental) with two broad categories of flow rates and replacement parts; various cylinder sizes (rental) to provide oxygen (ex. E, M6, C, D, M, H)[ex.

A (smallest)-E (largest)H and/or M] and replacement parts; portable oxygen concentrator;

refillable oxygen cylinders/concentrator; valve fireproof cannula; procurement/distribution of two types of oxygen and backup/spare parts; nasal cannula to include micro nasal cannula, high flow, pendant, nasal cannula with cushion ear piece, soft pronged nasal cannula/masks to include tracheostomy mask, bi-flow nasal mask, aerosol mask and replacement parts, and any interface, adapter or connection to enhance oxygen delivery/masks, tracheostomy mask, bi-flow nasal mask, aerosol mask and replacement parts, and any interface, adapter or connection to enhance oxygen delivery; and replacement parts; oxygen bleed in connector, portable oxygen systems (used when a Veteran travels); Contractor is responsible for delivery and associated services related to delivery/proper use of equipment

3. OBJECTIVES: The Contractor shall provide home oxygen services for VA outpatients.

The Contractor shall furnish all labor, supplies, delivery, after-hours support, and storage of equipment, maintenance, and incidentals to provide home oxygen services to all beneficiaries of the TVHS, the James H. Quillen VAMC and the Memphis VAMC. Services include delivery, set-up, education, pick-up, cleaning, and preventative maintenance. Services apply to vendor provided and Government supplied equipment.

4. SCOPE: This SOW defines the effort required for the delivery, setup, education installation, and management of home oxygen services, in accordance with applicable TJC home care standards, to Veteran beneficiaries serviced by the TVHS, James H. Quillen VAMC and the

Memphis VAMC. All issuing and follow-up care provided under this contract shall be provided in accordance with all current TJC standards. Contractor’s facilities may be inspected by the VA prior to the contract award. The use of the term “beneficiary”, “Veteran”, “Patients”, and

“patient” are used interchangeably and refer to the recipient of required supplies, equipment, and incidental services required under the contract.

The Contractor’s comprehensive procedure manual shall be provided to the Contracting

Officer’s Representative (COR) at time of award of contract. The manual shall include, but not limited to, delivery/set-up, infection control, safety, rights and responsibilities, inventory, employee training (to include age specific), competency records, and performance improvement.

The Contractor shall be required to have a Do Not Resuscitate (DNR) policy in accordance with

State Regulations. A copy of the DNR policy shall also be provided to the COR at time of award of contract.

All services shall be performed in the Veteran’s place of residence or in a nursing home or assisted living facility housing the veteran. The area of service shall be all patients serviced by the TVHS, James H. Quillen VAMC and the Memphis VAMC. Should a veteran(s) be located within a zone that is not listed for that VA Hospital, but is within a zone listed through a separate

VA Hospital, the Government reserves the right to purchase the services from the Contractor awarded the contract for the zone that the Veteran resides in. The geographical boundaries have been detailed in Section 16 herein and have been determined as the areas of responsibility/jurisdiction for each local VA Medical Center listed in Section 16.

The Contractor shall furnish, install and service all equipment and supplies ordered under this contract. All disposable supplies shall be new and unused. A label with the Contractor’s name and emergency telephone number, where they can be reached 24 hours/day, seven days a week, including holidays shall be affixed to all equipment. The primary service areas covered by this contract include all counties specified in in the Service Area Section of the SOW. The

Contractor shall provide all services and equipment in accordance with a Home Oxygen prescription (SF Form 513 or electronic facsimile) for each authorized patient. 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.

VA owned equipment may be utilized in some instances when preferred. Such equipment will be delivered and serviced in accordance with these contract specifications but will be reimbursed in accordance with applicable line items stated in the Schedule of Supplies/Services.

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 of all equipment shall be consistent with local Fire and Safety Codes in the respective area of the State and shall conform to National Fire Protection Association (NFPA) 99/l0l (Life Safety Codes)

NFPA (Oxygen Cylinder Requirements). This provision can be located at http://www.nfpa.org/assets/files/PDF/ROP/51-F2001-rop.pdg. The Contractor shall provide a safety/emergency checklist (may be included in the Initial Set-up/Periodic Maintenance Form) to be completed and signed by the veteran or his/her caregiver and retained in the beneficiary account folder. The Contractor shall ensure that all equipment is checked at manufacturer recommended intervals. A Contractor staff member shall conduct a check of the concentrator using a certified oxygen analyzer that is calibrated according to the manufacturer standards. The

Contractor shall perform maintenance on equipment in accordance with manufacturer’s specifications. The Contractor shall change compressor inlet pre-filter and compressor inlet bacteria filter changes according to the manufacturer recommendations as applicable. The

Contractor shall test the alarm at each maintenance check, changed as indicated but at least http://www.nfpa.org/assets/files/PDF/ROP/51-F2001-rop.pdg annually. The Contractor shall be responsible for tracking and documenting maintenance of equipment in accordance with manufacturer specifications and providing these records for review upon request. The Contractor will furnish parts and labor for routine monthly maintenance to include, analyze concentrator, oxygen purity, check audible alarm, check/change filters. All preventive maintenance for Government-owned equipment must be in accordance with manufacturers’ specifications. If any equipment performance issues are identified during routine maintenance checks, prompt action will be taken by the Contractor to ensure the equipment is performing according to manufacturer specifications. All repairs/parts required on

Government owned equipment shall have prior approval of the Contracting Officer’s

Representative (COR).

5. PERIOD OF PERFORMANCE: A single IDIQ contract with a one-year base year and four one-year option years will be awarded.

6. GENERAL INFORMATION:

6.1. Quality Control: The Contractor shall maintain an on-going quality control program to, objectively and systematically monitor and evaluate the quality and appropriateness of care, resolve any identified problems, and pursue any opportunities to improve patient care. The

Contractor shall provide a self-assessment of compliance with this contract. Quality

Assurance/Performance Improvement reports shall be provided quarterly of all findings, corrective actions, improvements and patient outcomes to the Contracting Officer and COR. The competency and Infection log shall be medical center specific and VA patient specific.

The Contractor and/or their representative shall be required to meet with the COR monthly to review performance and quality service to patients. Coordination of the date, time, and location of these meetings shall be coordinated by the Contractor with the

COR.

Monthly Quality Improvement meeting minutes shall be recorded by the Contractor and provided to the Contracting Officer within 10 working days of the meeting. If at any time the COR and Contractor cannot resolve an issue, discussions will cease, and the

Contracting Officer will be notified immediately.

a. The Contractor shall collect data on important processes and outcomes related to patient care and organizational functions at a minimum in the following areas:

1. Patient Focused Functions, Organizational Functions

2. Rights and Ethics (RI), Improving Organizational Performance (PI)

3. Assessment (PE), Leadership (LD), Care, Treatment and Services (TX)

4. Environmental Safety and Equipment Management (EC)

5. Education (PF), Management of Human Resources (HR)

6. Continuum of Care and Services (CC)

7. Management of Information (IM)

8. Surveillance, Prevention and Control of Infection (IC)

b. The following functions shall be monitored by the medical centers: Surveillance, Prevention and Control of Infection, Staff competency, Patient Satisfaction, and

Equipment Quality Control. The Contractor will be monitored pursuant with Quality

Assurance Surveillance Plan (Attachment H-QASP). The Contractor is responsible for collection of the data required and their own internal monitoring for compliance.

The Contractor shall provide a list of names to the COR of all veteran patients exposed to communicable diseases by contracted staff during an identified incubation period. The type of exposure shall also be identified.

Report shall be required for the following areas at the indicated interval:

1. A Quarterly report on Patient Satisfaction. This report shall be for veterans served on this contract only.

2. A Semi-annual report on Staff Competency. This report shall consist of the name of the employee, date of competency assessment and findings of this assessment.

3. A Quarterly report listing the names of patients exposed to communicable diseases by contracted staff. The report shall identify the incubation period and type of exposure. Negative reports shall be required.

c. The Contractor shall conduct Patient Satisfaction Surveys on a minimum of 5% or 30 patients; whichever is greater, of contract patients from each facility on a quarterly basis.

d. The Home Oxygen Coordinator will consult with VA infection control staff regarding the need to contact exposed patients and/or complete any needed medical follow-up.

e. The Contractor shall collect data about patient’s and families’ needs and expectations and collect data on staff views of current performance and opportunities for improvement. The important processes and outcomes will be measured on a continuing basis and the Contractor shall review, assess, and improve requirements.

f. Applicable Form Revisions – If at any time during the life of the contract, a revision of any Contractor developed, VA approved, form is required due to regulatory or patient safety changes, the Contractor shall make those changes and resubmit the revised form to the COR and Contracting Officer for approval.

6.2. New Patient Set-Ups Oxygen Systems:

a. Initial set-ups are to be considered those beneficiaries who do not have a VA authorized oxygen therapy delivery system or ventilator and shall occur within 24 hours or next business day of the time the prescription is written. Orders for supplies and services will be placed by the

COR or designee. Each order will contain the patient’s name, social security number, home address, VA’s plan of care for patient, as well as the physician’s prescription, which will specify the liters per minute each patient is to receive and delivery system. The Contractor shall adjust the regulator per the prescription. The liter flow shall be changed only when furnished a new prescription, however the Contractor shall check the liter flow during the monitoring visits to make sure the liter flow still matches the prescription.

b. The Contractor shall perform an assessment of the beneficiary’s home and environment in accordance with TJC standards or equivalent accredited standards and maintain documentation of assessments in the individual patient file or folder.

c. The Contractor shall notify the COR and prescribing physician 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.

d. The Contractor shall verbally notify and provide written documentation to the COR by the next business day of any unsafe conditions observed in the VA beneficiary’s home and precludes the installation or 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 furnish written documentation of the safety hazard to the COR within five (5) business days of the incident. (Remove)

e. The Contractor shall document and report to the VA Home Oxygen Coordinator and COR any patient who is noncompliant with safety guidelines set forth in the education and orientation material and/or whose behavior poses a risk of self-harm or harm to others (e.g., smoking includes marijuana, tobacco, e-cigarettes, or similar items while on oxygen), despite warnings and ongoing educational interventions.

f. The Contractor shall ensure that electrical outlet is grounded before connecting equipment. If the outlets are not grounded the equipment shall not be set up and the COR and Home Oxygen

Coordinator shall be notified. The Contractor shall furnish written documentation of the safety hazard to the COR within 24 hours.

g. Any alterations to the Veteran’s residence shall be the responsibility of the veteran.

h. The Contractor shall take such safety precautions necessary to protect the lives and health of occupants in the patient’s home. The VA shall notify the Contractor of any non-compliance with the foregoing precautions and the action to be taken. The Contractor shall, after receipt of such notice, immediately (within 24 hours) correct the conditions to which attention has been directed.

The Contractor shall perform an assessment of the beneficiary’s home and environment in accordance with TJC accreditation standards and maintain documentation of assessments in the individual patient’s file or folder and provided to COR.

i. The Contractor shall verify the presence of the smoke alarms and instruct the patient to test all smoke alarms monthly. In any home where smoke alarms are not present, the Contractor will notify the COR for further review and potential action. Question about providing smoke alarms.

j. If the oxygen set-up is performed by a technician only, the visit shall be limited to set-up and instruction, solely focusing on the equipment use and safety and not providing instruction for the purpose of deriving the intended medical benefit. If the set-up visit is performed by a

Respiratory Care Practitioner, in addition to set-up and instruction in the use and safety of equipment, the patient shall receive patient education relevant to his/her medical condition, the prescription, and on the intended medical benefit of the applicable home oxygen treatment.

24-hour or one business day follow-up by RRT

k. The Contractor shall provide to each VA patient a copy of the approved “Patient Instruction

Booklet”. This booklet shall be placed in a durable binder with emergency and routine contact information properly annotated before the booklet is given to the patient. Instructions shall cover the use of all equipment delivered. The contact information for the TJC shall be provided in the booklet. The patient/caregiver and contract representative shall sign the approved

“Documentation of Set up/Periodic Maintenance” and “Patient Training Checklist” acknowledging that the written and oral instructions have been provided. A copy of the signed documents shall be submitted to the COR within five workdays of the initial set up. Instruction shall be in accordance with TJC and CMS standards.

(VA Home O2 booklet)

The Patient Instruction Booklet shall include connection, removal, emergency procedures and toll free or collect phone number of Contractor for emergency repair. The instructions shall be consistent with patient education information provided by VA to the patient. The Contractor must have the patient provide a return demonstration of appropriate use of equipment. The

Contractor shall install “No Smoking, Oxygen in Use” signs in each patient’s residence. The

Contractor shall initially test the smoke alarms to ensure proper function at the time of the initial set-up.

l. Initial Set-up Instructions to Patient and Caregivers: The Contractor shall provide patient or caregiver education that is written and oral and require the patient/caregiver to demonstrate their ability to perform the function(s) prior to leaving the equipment in the patient’s home. Any written material shall be written in English. In the case of the beneficiary not speaking English, the Contractor shall advise the COR. The Contractor shall provide patient or caregiver education that is written and oral at a clearly understandable level of reading and in an easily readable font in the following subject areas:

1. Equipment:

• Infection control, cleaning, handling, and storage

• proper equipment usage

• equipment knobs, controls, buttons, outlets, and inlets

• power source, electric, battery, compressor air, oxygen and UL approved

• troubleshooting the equipment and system alarms

• daily maintenance

• equipment settings as prescribed

• proper equipment exchange/replacement, for example: cannulas or the circuit if patient is on a ventilator

• fire safety valves

• how to attach the resuscitation bag to the oxygen source

• how to complete the home ventilator monitor record if on a ventilator

2. Emergency Procedures and how to respond to:

• Power failure

• Equipment failure

• Ventilator users and their caregivers must be prepared for equipment failure, disconnects, and power outages, especially if using 24-hour ventilation

3. Electrical and fire safety precautions – stress the importance of displaying a “No

Smoking, Oxygen in Use” sign at the entrance or inside the home to alert visitors that oxygen is in use.

4. Practicing regular safety drills helps prepare for emergencies

5. Keeping a manual resuscitator, such as a bag valve mask (Ambu bag).

6. Fire safe cannula

7. Fall prevention at home

8. Do’s/Don’ts information

• Do not smoke or allow others to smoke when using oxygen

• Do not keep equipment and cannulas near heat or flames

• Do not use underground electrical equipment near oxygen unit

• Do not place electrical appliances within 6 feet of oxygen unit

• Do not use extension cords

• Do not use oils, grease, or any type of petroleum products on oxygen equipment

• Do not leave oxygen equip0ment on when you are not using it

• Do not run oxygen tubing under rugs, carpet, or bedding

Do’s

• Do call (vendor phone) if you have any problems with your equipment

• Always use your oxygen in well ventilated areas

• Have functioning smoke detectors

• Always plug oxygen concentrators into grounded (three-pronged type) plug

• Do have and practice emergency exit plan from your home

• Do store oxygen cylinders in approved racks or flat on the floor

• Do notify your local fire department that you are using oxygen in your home

9. Proper use of prescribed oxygen administration device(s), regulator(s), flow meter(s), and fire safe valves.

10. Patient rights and responsibilities

11. Instruct patient to check smoke alarm monthly. Encourage patient to have a functional fire extinguisher and check monthly.

12. Provide written materials on the hazards of smoking at initial set up and every 6 months.

13. Provide continuing education in use as needed or directed by a licensed Department of Veteran Affairs Certified Respiratory Therapist (CRT) or Registered Respiratory

Therapist (RRT). All education material provided by the Contractor shall be initially reviewed and approved by the COR and Veterans Affairs Pulmonary or Respiratory

Chief/ Director/Supervisor or designee within the Pulmonary/Respiratory Section. Any changes to educational materials shall need to be approved through the COR before dissemination to the patients.

m. All beneficiaries have the right to refuse service. In the event a beneficiary refuses service or orders the equipment to be removed from the home, the Contractor shall comply with the beneficiary’s wishes. At the time of the refusal the Contractor shall have the veteran sign a letter of refusal. Any veteran refusing to accept oxygen equipment or supplies prescribed by the VA shall sign the approved Visit Documentation form, noting their refusal (AMA Form). The contracted employee shall also sign the form and shall report the incident to the COR immediately (within 24 hours or one business day). The signed form shall be submitted to the

COR along with the next monthly invoice. No payment will be made for refusal of items.

Payment for monthly rental, service or supplies will not be rendered without this required documentation.be approved by the COR prior to issuance to the patient or caregiver.

6.3. Patient Visits: All patients receiving services under this contract shall be visited by a contract representative on a monthly visit. This applies to VA and/or Contractor owned equipment. In the event a monthly visit will not occur, the COR will be notified and provided with details regarding any attempts to contact the Veteran to schedule services.

The Contractor shall notify the COR or their 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 shall be removed, or in the case of an initial set-up, not placed in the home. Unsafe conditions may include, but are not limited to, fire safety hazards, oxygen safety hazards, Patient abuse, or any instance that places the Patient or Contractor's staff in immediate danger. The Contractor shall contact the COR or designee by phone during the home visit and furnish (via fax or encrypted email) written documentation of the safety hazard to the COR or their designee within five (5) business days of the incident.

The Contractor shall document and report (via fax or encrypted email) to the COR or their designee, within five (5) business days of the service, any Patient who is non-compliant with safety guidelines set forth in the education and orientation material and or whose behavior poses a risk of self-harm or harm to others (i.e. smoking while on oxygen) despite warnings and ongoing educational interventions.

If the COR or their designee decide that the ordered equipment cannot be safely installed, an alternative oxygen delivery system shall be provided after approval until new prescription can be obtained.

Monthly assessment shall be required for all Ventilator Patients by a CRT/RRT. A CRT/RRT is also responsible for quarterly visits to tracheostomy patients with compressors. A CRT/RRT may also be required to perform visits in addition to the above for problems that arise as requested by

COR. The annual and patient problem assessment charges shall be per patient and each patient is to be listed and charged as a separate item on the monthly invoice (no lump sum charges).

6.4. Place of Performance: The work to be performed under this contract will be performed in the Veteran's place of residence, VA Medical or VA authorized Facilities for patients being discharged who require oxygen for travel to their residence. The area of service shall be all patients serviced by the TVHS, James H. Quillen VAMC and the Memphis VAMC, regardless of where patient resides. The equipment needs are subject to change as determined by the prescribing physician. Contractors shall have a facility or resources physically located in the geographic area in which they shall provide service for.

6.5. Hours of Operation: The contractor is responsible for conducting business, between the hours of 8 am through 4:30 pm, in the applicable local time zone, Monday thru Friday except

Federal holidays or when the Government facility is closed due to local or national emergencies, administrative closings, or similar Government directed facility closings. For other than firm fixed price contracts, the contractor will not be reimbursed when the government facility is closed for the above reasons. The Contractor must, at all times, maintain an adequate workforce for the uninterrupted performance of all tasks defined within this SOW when the Government facility is not closed for the above reasons. When hiring personnel, the Contractor shall keep in mind that the stability and continuity of the workforce are essential.

6.6. Recognized Holiday: Recognized Holidays: The Contractor is required to perform services 365 (366 leap year) days a year, to include all holidays.

New Year’s Day Labor Day

Martin Luther King Jr.’s Birthday Columbus Day

President’s Day Veteran’s Day

Memorial Day Thanksgiving Day

Independence Day Christmas Day

Juneteenth

6.7. Special Qualification:

a. Each branch office or distribution point shall meet or exceed all applicable TJC standards. Any and all documentation related to the patient record during the duration of this contract is the property of the VA and shall be turned over to the new Contractor as part of the Phase In/Phase Out upon the termination or non-renewal of this contract.

b. The Contractor shall have written policies and job descriptions that specify staff requirements to the specialized equipment, supplies and services it provides to patients such as; qualifications, experience, applicable certification, registration or license, training requirements and continuing education requirements. Contractor shall provide the CO/COR or designee with documented competency training to deliver prescribed supplies/cylinders/liquid oxygen (LOX) as required to each patient as needed.

c. The Contractor shall adhere to the provision 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).

d. The Contractor shall internally maintain a patient account folder holding all documentation related to the supplies and services provided in compliance with the

Privacy Act and Health Insurance Portability and Accountability Act (HIPAA). All patient files are subject to review by designated VA officials and accreditation surveyors on behalf of the VA during accreditation surveys or consultation. At a minimum the patient folder shall adhere to current TJC standards for patient record keeping.

e. The Contractor shall provide upon request all Contractor personnel files, which shall comport to Federal & State laws/regulations which shall contain information relative to the contract requirements for everyone providing services is support of this contract.

Information should include experience, training records, performance reports and any certifications/licenses.

f. The Contractor shall provide CO/COR or their designee with a list of all employees currently competent to perform delivery/recovery and patient education services at the time the contract is awarded and through the life of the contract whenever there is a change to staffing. COR or their designee shall inspect employee files at the time of the inspection of Contractor premises and vehicles. Employee files shall be maintained at the local contract site.

6.8. Scheduled Appointments: The Contractor shall visit the beneficiary’s residences in performance of this contract at least once every month by appointment only. The

Contractor is responsible for scheduling the appointments to the beneficiary’s home 24-

48 hours prior to the appointment. On each scheduled setup/delivery the Contractor shall reassess the need to instruct the beneficiary on the use and care of the equipment and supplies as necessary. The Contractor shall complete an evaluation and written report and as a minimum shall include the following data:

a. Date of visit

b. Name and social security number (SSN) of beneficiary using the equipment

c. Revised plan of service as needed.

d. Review of prescription, verify % of concentration

e. Record of manufacturer, model, serial number, lot number or asset number and hours on the concentrator or other equipment. All serial numbers on VA owned and rented equipment shall be kept on file in Contractor’s main office.

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

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

h. Inspection compliance of intake filters (exchange or clean by patient)

i. Follow-up education and/or reinforcement of compliance documented including smoking education-posted no smoking signs, and fire safe valves. Contractor should remind patient to test smoke alarm and inquire about presence of fire extinguisher.

Contractor should report any evidence of smoking in the home by Veteran or family members.

j. Recommendations and/or problems relating to the patient’s use of the equipment k Inspection for proper function of all equipment (i.e. internal/external batteries, settings, humidifiers, aspiration machines, filters, temperature probes, and nebulizers

l. Assessment of infection control procedures and the general home environment.

m. A report shall be developed by the Contractor signed and dated by the Contract staff and the

VA beneficiary caregiver. A copy shall be left with the beneficiary. The reports shall be submitted to the COR in alphabetical order with the monthly bills within 10 business days of the month following service.

6.9. Delivery Requirements At no time shall equipment and/or supplies be left outside the patient’s home, left in driveway, carport, garage or doorstep.

Delivery Documentation Requirements: Documentation of monthly oxygen cylinder deliveries and periodic maintenance of oxygen concentrators and ventilators shall be accomplished by submitting evaluation forms signed by the patient and/or authorized patient representative acknowledging receipt of said services. The RRT/CRT or driver will sign the evaluation using his/her title to confirm delivery of equipment. This form shall be maintained in the patient’s record. A copy of the evaluation shall be forwarded to the COR with the invoice. Should the patient refuse the monthly visit by the

Contractor, the Contractor shall document this in their notes on the approved, “Against

Medical Advice” form. The COR is to be notified of patient’s visit refusal by faxing the signed form to the COR within 24 hours.

6.10. Patient Rights and Responsibilities: The Contractor shall provide a copy of VA approved “Patient Rights & Responsibilities” and any applicable information concerning advance directives during initial setup to all patients.

6.11. Discontinuation of Home Oxygen Services and Pick Ups: The Contractor shall pickup all equipment and supplies within 24 hours after being advised by the family of a patient’s death or by the COR of a stop oxygen order. Additional billing will not be honored for any time after the date of the cancellation notice. 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 beneficiary’s or family’s requests to pick-up equipment before or after funerals or family gatherings relative to beneficiary funerals. The Contractor shall treat such requests with the utmost courtesy and give such requests the highest priority. This cancellation may be in the form of a letter, fax, or telephonic communication (confirmed in writing). A Veteran’s home oxygen shall automatically terminate on the date of his/her death. The COR will notify the Contractor as soon as he/she is aware of the patient’s death; likewise, the Contractor shall notify the COR if she/he is first to be aware of the death. Payment for oxygen shall be prorated for final month’s billing. Home oxygen cannot be stopped at any time unless written orders have been received from the COR or Pulmonary Physician of the VAMC.

6.12. Equipment Maintenance/Repair:

a. Contractor shall have written equipment preventive maintenance policies and procedures that will ensure scope, sanitary conditions, and that equipment is in good working conditions as intended for the patient’s home.

b. Contractor shall maintain a system for tracking all equipment preventative maintenance by model and serial number. The safety and working condition of the equipment shall be monitored on an ongoing basis, including maintaining preventative maintenance logs, calibration logs, recalls, logs of oxygen cylinder lot, batch numbers, (to facilitate immediate location identification for possible retrieval) and the results documented by serial number. This documentation shall be maintained for the term of the contract.

c. Only qualified technicians with documented training according to contract – the

Contractor shall educate, evaluate and document employee education in strict accordance with current JC and Center for Medicare Services (CMS) Maccreditation standards, further only employees that have been properly trained and demonstrated competency may perform equipment deliveries, recovers, and patient education on the equipment will provide maintenance/repair to this equipment. The Contractor shall perform a formal preventive Maintenance Inspection (PMI) immediately before stored equipment is issued.

d. The Contractor shall have a written recall plan or system in place for identification of equipment recalls, hazardous or defective equipment, and action taken.

e. All preventive maintenance for Government-owned equipment must be in accordance with manufacturers’ specifications. If any equipment performance issues are identified during routine maintenance checks, prompt action will be taken by the Contractor to ensure the equipment is performing according to manufacturer specifications. All repairs/parts required on Government owned equipment will be required to have prior approval of the COR.

6.13. Ventilators: Full Ventilator Support: The VA provides the patient with two ventilators, each with a backup battery support, spare breathing circuits and a self-inflating resuscitation bag.

The backup system provides continuing equipment function for a minimum of 48 hours backup support capacity.

a. Unit(s) can be Government owned or Contractor owned. Utilize a ll0 VAC or 220 VAC, 50/60 HZ power supply source. A minimum of one hour operation on internal battery;

volume ventilator; brush-less induction; piston l00 to 2200 ml; alarm silence reset; push-button battery test; rotary switch to set ventilator operating mode; High alarm/limit; push to turn knob to set volume; rotary switch to set breathing rate; and delivery of set volume;

push to turn knob to set pressure level for detecting breathing effort; continuously adjustable from –l0 to +l0 cm H20. Port for connection to the proximal pressure line of the patient circuit, 22 mm port for connection to bacteria filter, port for connection to the exhalation valve of the patient circuit. For example, the following equipment is or was used for VISN 9 patients: The main ventilators used are the LP6 volume ventilators, LP10 volume ventilators by Acquitron Medical, and/or PLV-100 and PLV 102 by

Lifecare International or equal. The Contractor shall furnish ventilators as prescribed by a licensed and privileged VA physician/provider. The below ventilator settings will be sent to the Contractor. The monthly ventilator sheet used by the Contractor should be sent to the Respiratory Home Oxygen Coordinator for review.

1. Ventilator settings/mode

2. Ventilator alarms

3. Actual high and low alarm parameters

4. Actual tidal volume and rate Compliance

5. Patient pressure

6. Breath rate – ventilator

7. Breath rate – Patient

8. Tidal volume

9. Breathing effort

10. Inspiratory time

11. Oxygen concentration (fractional inspired oxygen (FiO2) or LPM), if necessary

12. Positive End Expiratory Pressure (PEEP), if applicable

13. Pressure Support, if applicable

b. Before a final decision shall be made regarding the installation of a ventilator system in a

Patient's home, the Contractor's CRT/RRT shall make a visit to assess equipment functionality and the feasibility of supporting mechanical ventilation in the home.

c. The Contractor shall perform an assessment of the Patient's home and environment, at least every 30 days (or if required due to Plan of Service changes) in accordance with

TJC accreditation standards and maintain documentation of assessments in the individual

Patient file or folder.

d. The Contractor shall check the adequacy of the electrical outlets in the Patient's home and report unsafe conditions to the COR or their designee via phone call during the home visit. VA is not responsible or liable for any unsafe electrical conditions caused by the

Contractor. Any alterations to the Veteran’s residence shall be the responsibility of the veteran.

e. The Contractor shall verify the presence of working smoke alarms and instruct the Patient to test all smoke alarms monthly and include this verification in the documentation of assessment. The Contractor shall document (via fax or encrypted email) any home where smoke alarms are not present and fully functional, the Contractor shall provide this notification to the COR or designee within five (5) business days of the service.

f. The Contractor shall provide documentation (via fax or encrypted email) to the ordering facility’s COR showing that they trained the Patient or caregiver on how to check the battery

g. The Contractor shall provide the Patient and/or caregiver with enough supplies to ensure that the ventilator tubing/circuits are changed every seventh (7th) day, or as per manufacturer's guidelines with two (2) in reserve all the time.

h. The Contractor shall provide the Patient and family/care giver with training at the

Medical Center prior to discharge upon the COR or designee’s request.

i. If the VA physician requires an additional assessment the COR will coordinate the assessment. The Contractor shall provide documentation (via encrypted email or fax) to the ordering facility’s COR. Ventilator assessments shall be made to ventilator patients who reside in their homes, nursing homes or other non-VA facilities. (VA or Contractor owned equipment).

j. Ventilator Home Assessments shall include the following:

1. Electrical inspection of the home for ground fault

2. Presence of smoking

3. Presence of smoke detectors

4. Location of ventilator placement, (will the caregiver be able to hear ventilator alarms?)

5. Clean area of where the ventilator will be placed to ensure no cat dander or…