SOW HCHV Emergency Housing 1.doc

SCOPE OF WORK STATEMENT 2/21/22

VA Pacific Islands Health Care System (VAPIHCS) Health Care for Homeless Veterans

HCHV EMERGENCY CONTRACT HOUSING

A. GENERAL

1.1. Services Required: The Department of Veteran Affairs Pacific Health Care System (VAPIHCS) through the Health Care for Homeless Veterans (HCHV) Emergency Contract Housing program provides care, treatment and rehabilitative services to homeless veterans in the Pacific Region. The services provided to eligible homeless veterans include outreach, case management and housing services. It is the purpose of this program to provide these veterans a safe residential setting for a temporary period while addressing their immediate needs by accessing appropriate resources and supports with the goal to obtain permanent housing and end their homelessness.

To provide the care, treatment and rehabilitative services required the VA- HCHV program to contract with agencies and/or organizations (Contractors) to stabilize the veterans’ needed medical, mental health, substance abuse and other psychosocial problems in the short term so the veteran can transition into other appropriate transitional or permanent housing. Since these veterans may have co-morbid conditions which may include serious mental illnesses, substance abuse disorders, and other serious medical conditions the Contractor is required to possess an understanding of these challenges and general skills to support the veterans to address these issues.

1.2. Authority: The Department of Veterans Affairs established Health Care for Homeless Veterans (HCHV), in accordance with 38 U.S.C. 501, and 2031. The Department of Veterans Affairs is implementing programs to end homelessness for veterans and this program’s purpose is consistent with that effort through the provision of immediate short term housing for homeless veterans.

1.3. Definitions:

1.3.1. Definition of Homelessness: It is the responsibility of the VA HCHV program to determine homeless status of program applicants. The HCHV Program follows the definition of “homeless” as authorized in 24 U.S.C. 576.2

1.3.2. Veteran: A Veteran is, for the purpose of HCHV Emergency Contract Housing, a person who served in the active military, naval, or air service, and who was discharged or released under conditions other than dishonorable and is eligible for VA health care as determined by the local VA medical center.

1.3.3. Contracting Officer (CO): The CO is a VA employee who is assigned responsibility for the VA contract. The CO role is to ensure performance of all necessary actions for effective contracting, ensure compliance with the contract terms, and shall safeguard the interests of the United States in the contractual relationship. The CO is the only person authorized to approve changes or modify any of the requirements of this contract. The Contractor shall communicate with the Contracting Officer on all matters pertaining to contract administration as only the Contracting Officer is authorized to make commitments or issue changes that shall affect price, quantity or quality of performance of this contract. The CO shall also assure that the contractor receives impartial, fair, and equitable treatment under this contract. The CO is ultimately responsible for the final determination of the adequacy of the contractor’s performance.

Assigned CO: Network Contracting Office (NCO) 21 Contracting Officers

Organization or Agency: Department of Veterans Affairs, VISN 21 Contracting

1.3.4. Contracting Officer’s Technical Representative (COR): The COR is responsible for technical administration of the contract as outlined in the COR Delegation of Authority issued by the CO. The COR shall assure proper Government surveillance of the contractor’s performance and keep the CO informed of such. The COR shall keep a quality assurance file. The COR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government’s behalf.

1.3.5. VA Contracted Housing Representative (Liaisons): The Representative is the HCHV staff assigned responsibility for program eligibility determination and admission authorization for homeless veteran’s entry into the contracted program. The representative is the primary contact for the program regarding the veterans served and provides general oversight and program assistance as needed.

1.3.6 Quality Assurance Surveillance Plan (QASP): The QASP is part of the contract and identifies the specific performance indicators and standards to be achieved by the contractor as outlined in the Performance Work Statement (SOW). The QASP review will be completed periodically by the COR and contractor’s performance reported to the CO.

1.3.7 The QASP monitors the specific performance indicators and will be completed through an onsite visits, announced or unannounced, or through other means available to the COR. Any issues identified will be forwarded to the contractor for correction.

1.3.8 General Monitoring – Announced or unannounced on-site monitoring will also occur by Emergency Housing representatives (Liaisons) and will include review of general service performance and the environment for health and safety. Any issues identified will also be forwarded to the contractor for correction.

1.3.9 Key Personnel: Employees of the contractor that are essential to the work being performed under this contract.

2. CONTRACTOR RESPONSIBILITIES: The U.S. Department of Veterans Affairs (VA) requires a Contractor to provide emergency residential and case management services through the Health Care for Homeless Veterans (HCHV) program. This contract is designed to serve homeless Veterans in need of immediate placement in a safe environment with onsite support service.

2.1 Population to be Served

VA Eligible, Locally Registered, and Approved to entry program services: This site will serve veterans who served in the US Military and determined eligible for VA benefits and services and registered at the local VA serving the local catchment area. All eligible veterans must be approved by the VA Representative per the identified process prior to program admittance. Veterans must also be independent in their Activities of Daily Living (ADLs) and Independent Daily Living skills (IDLs). Consideration of program acceptance will be made on a case by case basis for homeless veterans who have been convicted of a sexual offense. This consideration will include but not be limited to the nature of the offense, the composition of the house including vulnerability, the community at large, the Contractor’s policy of acceptance of individuals with this conviction and the post discharge permanent housing plan for the veteran. Veteran would be required to register their location per Megan’s Law.

Veterans who have been convicted of an Arson offense will not be approved for program entry. In addition, veterans will not be served if at the discretion of the VA representative in collaboration with the contractor it is determined that a veteran’s current and past behavior may have a negative impact on the program and other residents.

2.1.1 Location of Services: The sites will be identified on the Island of Oahu. The site must be accessible by local public or contractor provided transportation to the local VA facility and community resources and services. Performance will occur at the Contractor’s VA approved location.

2.1.2 Homeless or at Risk: To be eligible for Emergency Housing services under this contract the veteran must be homeless or at imminent risk of becoming homeless. A required initial homeless clinical assessment completed by a VA representative or in certain circumstances due to distance an initial prescreen submitted by the contractor, reviewed and approved by the VA Representative who will follow up with a clinical review will serve as verification of homelessness or at risk.

2.1.3 Primary target populations: Homeless veterans who are homeless or chronically homeless and may have mental health support needs, substance abuse disorders and/or in need of a short-term medical recovery.

2.1.4 Number to be service under this contract: The number of veterans served will be determined by site characteristic but will be limited to no more than 10 veterans at one time at this Oahu, Hawaii site. If contractor’s environment allows and if there under utilized funds in the contract as a result of bed vacancies, authorization may be given to over serve this 10 limit. Served will be male veterans or a combination of male and female veterans depending on the environment proposed and approved.

2.1.5 Length of Stay: The duration of a Veteran’s stay is targeted to be no longer that 90 days unless specifically authorized by the VA Emergency Housing Representative for an extension.

2.1.6 Hours of Service to be Provided: 24 hours/7 days/ 365 (Leap Year 366 days) per year including State, Territory and Federal Holidays.

2.1.7 Service Outcome: The service outcome of emergency contracted housing services is to stabilize the homeless veteran, secure appropriate resources and supports, and secure transitional or permanent housing for their future. Permanent housing is the primary desired residential outcome for all veterans participating in this program.

2.1.8 Care, Treatment and Rehabilitative Services: The Contractor shall furnish care, treatment and rehabilitative services in accordance with Section 2.7 Program Service of this Scope of Work (SOW).

2.2 Facility

2.2.1 Type of Housing to be provided: It is preferred that if the number of beds allow that the housing unit be in single family detached houses within the community. However other housing types are acceptable such as apartments or units within a facility. Environment should provide for adequate bedroom, dining, and a common area equipped with adequate seating and entertainment options. An outside common seating area for residents is desired but not required.

2.2.2 Accessibility: Housing shall be accessible from the street and where possible wheelchair accessible or ramped for home access. If possible, doorways shall be of enough width to accommodate wheelchairs or at minimum walkers. An ADA compliant environment is preferred but not required.

2.2.3 Bedroom and bathroom space must be appropriate and be of enough size as determined by VHA. Single bedrooms of adequate size shall accommodate no more than 2 beneficiaries, unless specifically authorized by VHA

2.2.4 New Contracts/Site Relocations – For new contracts the Contractor shall secure an appropriate site for the performance of the contract, promptly comply with VA site and other inspection requirements and be operational to accept veteran residents within 90 days from the date of the contract. This 90-day operational requirement also applies to sites which have had to relocate during the term of the contract. If a new location and/or Contractor is bidding seeking a site to fulfill the requirements of the solicitation, the disclosure of this must be identified in BOLD print on the Solicitation response.

2.2.5 Sub- Contracting – If the Contractor will be subcontracting any part of their proposed contractor such as site utilization and/or services including case management, a fully executed Memorandum of Understanding (MOU) or sub-contract agreement with that entity must be submitted with the Solicitation response.

2.2.6 Contractors must have site control of the residential care facility through ownership or a valid property lease which must be provided with the Solicitation response.

2.2.7 The Contractor’s identified site of service approved by VA will be the location for services to be provided to veterans under this contract. Any additional sites will require a VA pre-inspection and authorization prior to the provision of services.

2.2.8 It is the responsibility of the Contractor to properly develop and/or maintain its facilities and the VA shall have no responsibility for paying or reimbursing the Contractor for such expenses.

2.2.9 The contract facility must have a current occupancy permit, if new, issued by the local and State governments in the jurisdiction where the facility is located or a statement from the appropriate city or state office stating there is not a need for an occupancy Permit.

2.2.10 Follow existing standards of State safety codes and local, and/or State Health and sanitation codes.

2.2.11 Where applicable, be licensed under State or local authority.

2.2.12 Where applicable, be accredited by the State.

2.2.13 Be equipped with operational air conditioning /heating systems if required for habitation at the discretion of the VA facilities inspector at the site’s pre-inspection.

2.2.14 Be kept clean free of insects including bedbugs and rodents, free of dirt, grime, mold, or other hazardous substances and damaged noticeably detract from the overall appearance.

2.2.15 Showers and toilets will be maintained clean and sanitary.

2.2.16 Be equipped with first aid equipment and an evacuation plan in case of emergency.

2.2.17 Have windows and doors that can be opened and closed in accordance with manufacturer standards.

2.3 Environment Supports: In the housing environment the following must be provided:

2.3.1 Each resident shall be provided with a single bed and frame and bed linens, including blankets as needed. Specially designed zippered bed bug mattress covers which enclose the mattress and box springs must be in place to reduce the infestation of bed bugs. If the bug mattress covers are torn or if zipper is not closing properly the cover must be replaced.

2.3.2 Hygiene products to include towels, wash cloths, soap, deodorant, toothpaste, and toothbrushes, as needed.

2.3.3 Bathrooms (toilets, basins and showers and bathroom hygiene supplies) will be located within a reasonable distance on the same floor of the living space.

2.3.4 A space for personal belongings off the floor such as closets, dressers or wardrobes for clothing and effects shall be provided in the resident’s room.

2.3.5 A place for the resident to secure (lock) valuable personal items and medications which cannot be removed by other quest.

2.3.6 Privacy shall be provided to the resident.

2.3.7 Rooms shall be accessible to the Veteran 7 days a week and 24 hours per day. Veterans will have access to their assigned bed during this time except, where necessary, a specific defined period of no more than two hours daily for staff to clean the room or bed area.

2.3.8 Veteran sleeping environment shall be maintained in a preventative manner to assure that it is in good repair, clean, free of noise during normal nighttime sleep hours, and free of insects and/or rodents. Program will have in place and be able to follow in a timely manner a written plan to rid the environment of insects and/or rodents if an infestation is identified.

2.4 Meals: The contractor shall provide nutritious meals. Food shall be prepared, served and stored under sanitary conditions. The following shall be provided:

2.4.1 Unless deemed inappropriate for the facility by VA the facility shall provide storage space in an onsite refrigerator for Veterans to store personal food if refrigeration is required.

2.4.2 The facility shall establish and maintain sanitary procedures for washing dishes, cleaning equipment and work areas and disposing of waste.

2.4.3 At least three (3) nutritious meals or their equivalent shall be served daily at regular times. These meals will follow a weekly posted menu and substitutions of menu items will be at a minimum. A dairy item must be available or upon request for the veterans for each meal and noted on the on the menu.

2.4.4 Contractor will provide alternative meals veterans with dietary restrictions if medically indicated (e.g. diabetic, renal and soft mechanical diets) and reasonable accommodation for veterans with cultural/religious preferences around food.

2.5 Laundry: Laundry facilities shall be available on site for residents to do their wash and dry laundry at no charge.

2.6 Transportation: The contractor shall assist the Veteran to their scheduled meetings and appointments through the provision of transportation or secure public transportation for the program veterans through the provision of bus passes or taxi vouchers. If reliable public transportation is not available within a reasonable distance (1/4 mile) the agency shall also establish a schedule to transport residents to local community services such as food markets, retail or dining services in addition to medical appointments. In the event the veteran has ambulation difficulties and unable to access public transportation then the contractor shall assist veteran to appointments and community access through acquisition of community transportation services for the disabled.

2.7 Program Service

The following outlines the services required of the Contractor to address the care, treatment and rehabilitative services expectation under this contract. Additional Contractor developed and implemented supports to address these expectations must be in place. VA may complement the non-VA community-based provider’s program with added treatment services through VA outpatient programs.

2.7.1 Outreach: The contractor shall accept referrals of homeless veterans directly from the VA Emergency Housing Representative and must also engage in community outreach to identify homeless veterans who may be eligible and in need of contracted emergency housing services. If the Contractor identifies through their outreach a veteran who may qualify for the contracted bed the contractor will utilize and follow the VA referral process for VA’s Representative’s acceptance of the veteran into the program. This process identifies specific non acceptance issues and/or behaviors which may place the veteran or others at risk. In all situations the VA representative or their assigned has the sole determination if a veteran is accepted into a contracted bed at the site. It is expected that the Contractor actively engage in outreach so the occupancy of contracted beds be maintained at a minimum rate of 80% or higher as determined by VA during any given quarter.

Objective #1 – Contractor will maintain minimum acceptable level of occupancy through collaboration with VA and independent outreach efforts. See QASP- Contractor Performance Standard #1. If an increase in the percentage of occupancy is required by VA Central Office, the revised expectation will be conveyed to the contractor by the COR. Occupancy will be reviewed quarterly as part of ongoing Quality Assurance Surveillance Plan (QASP) efforts. If this rate is not consistently achieved a corrective action plan may be required depending on factors affecting the occupancy shortfall.

2.7.2 Entry Assessment and Admission: Entry into services can be either through the direct referral from the Emergency Housing Representative or through the outreach efforts of the contractor. If the contractor identifies a homeless individual as potentially qualified to receive services, the Contractor shall obtain from the veteran a VA Release of Information (ROI) and follow the identified process to request the veteran’s VA eligibility with the VA Representative or their assigned to assure the veteran is registered for VA benefits and services.

Objective #2 -Contractor will follow established VA protocol for submitting documentation for eligibility determination for HCHV Emergency Housing Service. See QASP -Contractor Performance Standard #2. The VA Representative is responsible for determining eligibility of Veterans prior to admission to contractor’s bed. A list of VA staff authorized to approve admissions under the contract shall be provided to the contractor. Acceptance of billing is conditional upon the eligibility and admission approval of the VA representative. In addition, the contractor shall follow the current HCHV identified process for eligibility determination which may include the submission of a completed VA Homeless Prescreen Questionnaire (unless the VA Representative completes a clinical assessment), Participation Agreement, and VA Rights submitted by fax/secure email to the VA representative. If the veteran is denied eligibility/admission to the program the Veteran must be explained in writing with copies maintain in a file by the contractor. If the contractor’s referral is accepted into the program the VA Representative shall fax or send by secure email a completed VA Eligibility and Enrollment into Emergency Housing Services to the contractor acknowledging the veteran’s acceptance. The contractor shall maintain these documents in a secure case management file.

Objective #3- Contractor will maintain a comprehensive case management file. See QASP - Contractor Performance Standard #3. The contractor may also utilize admission and other forms specific to their agency requirements.

Training and updates on the processes and all referenced VA forms will be provided to the Contractor by the VA Emergency Housing Representative.

2.7.3 Case Management: The contractor shall assign a case manager as the primary contact for the Veteran and this role shall not conflict with other duties such as also being the primary residence rules and compliance staff person. This case manager will, in conjunction with the program participant based on their Inventory of Needs develop a Housing Support Plan (HSP) which outlines the general services and supports needed and prioritized. This document will also identify the veteran’s Resource Acquisition and their Discharge Plan upon leaving the program. This plan will be created, implemented and submitted to VA within 7 days of admission. The HSP should identify the shared responsibility of the case manager and the veteran in achieving the goals identified. The level of achieving the identified goals depend greatly on the veteran’s desires, wishes, priorities and their motivation.

For veterans eligible for the VA HUD-VASH program, contractor staff, as the secondary case managers, shall develop a Collaboration Plan with the veteran and the VA HUD-VASH social worker to identify and support the efforts to secure needed documents and other resource to facilitate and expedite the veteran’s move into permanent housing. This Plan will be consistent with the HUD-VASH Housing Plan, a copy of which will be maintained in the Contractor’s file. This Collaboration Plan shall be updated and submitted monthly as part of the progress note for the veteran to the HCHV Social Worker.

Objective #4- Contractor will complete a comprehensive assessment of the veteran’s needs and with the veteran develop a Housing Support Plan to be submitted to VA with 7 days of admission. See QASP - Contractor Performance Standard #4. This case manager shall meet with the veteran and document a minimum of 3 or more time per month to review progress and where needed modify the HSP.

Objective #5 – Contractor will document meeting with the veteran 3 or more times per month to assist veteran in achieve the goals identified in their Housing Support Plan. See QASP - Contractor Performance Standard #5.

Communication with VA on the status of the veteran in achieving their identified goals in the HSP is essential. This provides an opportunity for VA staff to assist as needed in resolving barriers, challenges, or issues which may interfere with the veteran’s successful move into permanent housing. While informal contact will be maintained between VA and site case managers, formal communication will be submitted by the case manager through end of the month summaries (progress notes) of the efforts of both the veteran and the site case manager with the identified HSP goals.

The case management provided should include but not be limited to the following:

2.7.3.1 Housing Assistance: Provide direct and ongoing assistance to support the Veteran’s access to permanent housing. All efforts to engage veteran regarding housing plans, options and resources shall be clearly documented. Mere communication with veteran regarding housing without subsequent contractor staff action and follow-up, shall not on its own meet the above requirement. Contractor shall meet the current Permanent Housing Metrics established by VA Central Office (VACO). This metric shall be communicated by the COR as revisions to the required % of veterans who enter Permanent Housing is established by VACO.

2.7.3.2 Resource Acquisition: Provide direct and ongoing assistance to support the Veteran’s accessing eligible financial and supportive programs i.e. SS, SSDI, General Assistance, Food Stamps, VA service-connected benefits, SSVF, employment, etc. and assist application preparation and/or transportation to benefit site. Veteran must also be screened for Medicaid eligibility and an application submitted even though veteran’s health care is provided by VA. Documentation of all referrals and outcomes must be noted in the veteran’s monthly progress note. Eligible veterans should be encouraged to seek employment services by having veteran contact VA or Community resources. As part of the Housing Support Plan the case manager shall develop with the veteran a Financial Plan and Budget which reflects employment and non-employment resources and income and what is needed to secure housing.

Objective #6 – Contractor will provide veterans direct and ongoing assistance to support the veteran’s access of financial and supportive programs such as SS, SSDI, General Assistance, Medicaid, etc.… and document this activity in the Monthly Summary submitted to VA. See QASP -Contractor Performance Standard #6.

2.7.3.3 Recovery Assistance: Provide referral, support and encouragement for the Veteran’s attendance at PTSD and substance programs provided by contractor, VA or at other programs.

2.7.3.4 Medical and Mental Health Assistance: Support the Veteran’s attendance at medical and mental health programs at VA and scheduling or providing transportation as needed. Medication management is not required by the contractor unless it is policy for the facility. The veteran may manage their physician non-narcotic prescribed and over the counter medication, but they must be properly stored and secured. If not in conflict with a general facility ban on the use of all narcotics including those prescribed by their physician, the facility must have a specific policy for physician prescribed narcotics to assure that their use follows physician orders.

2.7.3.5 Relationship Assistance: Where appropriate support the Veteran to connect with peers and their family.

2.7.3.6 Onsite and Community Support Services: The contractor will provide or when possible, refer the veteran to any appropriate community service provider for the provision of individual or group services. This support may be in the areas of financial planning, life skills, social skills training, Alcoholics Anonymous, Narcotics Anonymous, mental health services, vocational counseling and permanent housing search groups or other supports deemed appropriate as determined by the veteran.

2.7.3.7 VA Coordination and Veteran’s status: Communicate with the VA representative through regular scheduled contacts which address the Veteran’s progress in the goals identified in the Housing Support Plan or on issues that may arise. The Program will submit a monthly summary of the case management activities and veteran’s progress toward the goals outlined in the HSP. In addition, if a veteran is or has been identified as HUD-VASH eligible the Collaboration Plan is to be updated and submitted as the veteran’s progress note.

Objective #7 – Contractor will submit to VA a monthly summary which describes the activities and status of the efforts of both the veteran and the site case manager in achieving the veteran’s goals identified in the Housing Support Plan. See QASP – Contractor Performance Standard #7.

2.7.3.8 Discharge Planning: Develop with the veteran a Discharge Plan to identify the type of housing the veteran will transition to at the time of their discharge. This Discharge Plan shall be prepared no later than 7 days after admission. In addition, the program will inform the VA representative within 24 business hours of the veteran’s discharge whether planned or unplanned. The contractor shall also submit a final progress summary note including reasons for resident leaving, their future and their progress to achieving their established goals along with the Exit Summary for Contracted Housing to the VA representative within 36 business hours of discharge.

Objective #8 – Contractor will submit to VA a completed Exit Summary for Contracted Housing within 36 business hours of the veteran’s departure or discharge from Emergency Housing. See QASP – Contractor Performance Standard #8.

Discharges will be characterized as follows:

a. Positive Discharge: A positive discharge is when the Veteran has been successfully placed in permanent housing either individually or with family or friends. The contractor will work to target that 50% or more of veteran discharges are positive with the veterans moving into permanent housing.

Objective #9 – Contractor will achieve the VA Central Office (VACO) metric which requires that 50%* or more veterans are discharged to permanent housing. *Percentage may be revised by VA Central Office. See QASP -Contractor Performance Standard #9) If a revision (increase) in the target percentage expectation is identified by VA Central Office, this revised expectation will be conveyed to the contractor by the COR. The percentage of Positive Discharges will be reviewed quarterly as part of ongoing Quality Assurance Surveillance Plan (QASP) efforts. If this rate is not consistently achieved, a corrective action plan may be required depending on factors affecting the positive discharge shortfall.

b. Administrative /Neutral Discharge: The Veteran has been transferred to an alternate level of care with concurrence from the VA Representative for medical, mental health, or substance abuse treatment to better meet the Veteran’s clinical needs.

c. Negative Discharge: A negative discharges is when a.) the Veteran is absent from the program site and his whereabouts are unknown and or unwilling to return; b.) the Veteran has had an episode of violence or has threatened violence against staff or other residents and must be discharged to maintain the safety of the facility; c.) the Veteran has had more than one episode of drug use at the facility, d.) the Veteran’s length of stay has exceeded 90 days from the date of admission and the VA Representative has not approved continuation. The target for negative discharges of veterans is 20% or less and the contractor will work to achieve this target.

Objective #10 – Contractor will achieve the VA Central Office (VACO) metric which requires that 20%* or less of veterans leave services through a negative discharge. *Percentage may be revised by VA Central Office. See QASP -Contractor Performance Standard #10. If a revision (decrease) in the target percentage expectation is identified by VA Central Office, this revised expectation will be conveyed to the contractor by the COR. The percentage of Negative Discharges will be reviewed quarterly as part of ongoing Quality Assurance Surveillance Plan (QASP) efforts. If this rate is not consistently achieved, a corrective action plan may be required depending on factors affecting the negative discharges.

2.7.3.9 Customer Satisfaction: Veterans served in Emergency Housing shall complete a VA Customer Satisfaction Questionnaire (uSPEQ) regarding the services received at the site. The questionnaires will be provided by VA and distributed by the program case manager to veterans who have resided at the program for 14 days or longer. The veteran’s response is voluntary and confidential and are to be strongly encouraged to complete the questionnaire and mail in the attached stamped envelope to the VA Contract Housing Coordinator. The veteran may complete this questionnaire only once per year. At minimum programs should demonstrate a 25% rate of return of completed and returned questionnaires of eligible program participants. The cumulative results of the responses of veterans in their services is shared with the contractor at the end of each quarter.

Objective #11 – Contractor will distribute and encourage the completion of the Consumer Satisfaction questionnaire (uSPEQ) or other VA service satisfaction tools requested at a response rate of 25% of eligible respondents. See QASP - Contractor Performance Standard #11)

2.7.3.10 Incident Reporting: The Program shall notify the authorizing VA representative within 12 business hours of any critical incident involving the death, suicide/suicide attempt, fire (veteran involved) or sexual or physical assault of a Veteran residing in the residential program. The contractor shall provide the VA representative with a copy of the incident report within 24 business hours.

For all other incidents program shall submit to VA staff an incident report within 48 business hours. These include falls, abuse or neglect, hospitalization, infection control (Bed Bugs, TB, etc.) active substance abuse and possession of weapons

2.3.3.11 Length of Stay: Case managers are to assist veterans to demonstrate progress toward their goals outlined in the Housing Support Plan. Veteran’s stays are reviewed by the Emergency Housing Representative and the case manager for progress after 14 days and continued stays are limited to 90 days unless specifically authorized by the VA Emergency Housing Representative for an extension.

Any extension of this time may not occur without written prior approval from the VA Emergency Housing representative. The VA Representative will not approve per diem for lengths of stay exceeding 90 days from the date of admission unless:

I. The veteran has demonstrated reasonable progress and there are circumstances that are barriers to the Veteran’s placement in housing; and/or II. There is documented evidence that the contractor has exhausted every effort to place the Veteran in housing sooner; and III. The VA Representative has been appropriately advised of these efforts well in advance of the 90-day limit; and IV. The VA representative concurs that the Veteran will continue to derive benefits from a continued stay at the contracted site.

Objective #12 – Contractor will limit the veteran’s stay in Emergency Housing to 90 days unless authorized in writing by a VA Emergency Housing representative. See QASP -Contractor Performance Standard #12.

2.3.3.12 Occupancy: It is expected that the contractor beds will be maintained at an average minimum of 75% occupancy rate but at a preferred rate of 80% as calculated based upon number of bed nights available per quarter. If a revision (increase) in the target percentage expectation is identified by VA Central Office, this revised expectation will be conveyed to the contractor by the COR. The Occupancy percentage will be reviewed quarterly as part of ongoing Quality Assurance Surveillance Plan (QASP) efforts. If this rate is not consistently achieved, a corrective action plan may be required depending on factors affecting the negative discharges.

3.0 Contractor Staff Requirements

3.1 License: The Contractor shall assign to this contract, personnel that by education and training and, when required, certification or licensure, are qualified to provide the Services required by this

Scope of Work (SOW).

3.2 Ratios: The contractor needs to provide sufficient number of staffs to carry the policies, responsibilities and services of the program. This should include:

3.2.1 That each Veteran has an assigned primary case manager responsible for coordinating services specified in the contract. The ideal case manager to Veteran ratio is 1:20 or fewer cases; however consideration will be given by the VA to the staffing characteristics of each facility. This case manager should not be assigned other duties in addition to this primary role.

3.3 On-site Staffing

3.3.1 A qualified designated staff person will be on duty at the approved site 24hrs. a day 7 days per week. The role and authority of this person must be identified and consistent with the site-specific policies and procedures to address emergencies as they arise.

Objective #13 – Contractor will have qualified designated staff person on duty at the approved site 24 hours per day, 7 days a week. See QASP – Contractor Performance Standard #13

3.3.2 There must be at least one administrative staff member identified and able to be contacted within one hour of any emergency or situation occurring with the authority to make decisions regarding the facility and residents. The name and contact number of this administrative staff person and a sequence of other administrative contacts must be posted on site and available to the on-site staff and residents.

3.3.3 Contractor shall provide prior to initiating services an initial Emergency Plans with periodic updates if the plan changes which identifies what actions will be taken if an emergency/crisis occurs which impacts the on-site staffing and case management expectation. This plan must also address what actions will be taken in the event on-site staff is unavailable. This requires an attached Memorandum of Agreement with an identify agency to provide emergency on-site coverage. The plan must also include a statement that if no on-site coverage can be identified where the veterans in the residents will be safely housed off – site during this time.

3.3.4 That a sufficient number of trained staffs are present to ensure that the veterans are provided a safe, secure, confidential and structured environment that address their needs.

3.3.5 That when a VA inspection team evaluates the Contracted Facility the team is consistently assured that staff can provide the services required under the terms of the contract.

3.4 Training: The Contractor shall assign to this contract personnel who will receive initial and periodic training as required in the following areas. An annual training report will be submitted to the COR upon request.

3.4.1 Possess current certification in Basic Life Safety (BLS for Healthcare Providers including CPR and AED). Frequency per BLS Safety requirements

3.4.2 Have received training on alcohol and substance use and familiarity with current treatment programs.

3.4.3 Have received training related to Military Sexual Trauma and PTSD, the characteristics of the disorders and triggers, and awareness of treatment approaches.

3.4.4 Have received training related to general mental health disorders, their characteristics, use of medications, and awareness of treatment approaches.

3.4.5 Have received training in maintaining client privacy and confidentiality in all verbal and written communications and interactions.

3.4.6 Adhere to the provisions of Public Law 104-191, Health Insurance Portability and Accountability Act (HIPPA) of 1996. This includes both the Privacy and Security Rules published by the Department of Health and Human Services (HHS) regarding the use and disclosure of protected health information. Privacy training shall be completed annually.

3.4.7 Have training on Bloodborne Pathogen/Infection Control Procedures.

3.4.8 Employees involved in patient care shall complete the VA Privacy and Security Training in TMS at https://www.tms.va.gov/learning/user/SelfRegistrationUserSelection.do

3.4.9 Have training on Crisis Prevention/ Intervention Training.

3.4.10 Have training on Emergency Disaster Preparedness and Policy Reviews

3.4.11 Have training on Suicide Prevention and plan of action to address.

Objective #14 – Contractor will assure that staff persons assigned to provide services to veterans in the EH program have completed initial and ongoing training as required and submit to the COR upon request the staff names, when training was received or if scheduled. See QASP – Contractor Performance Standard #14.

3.4 Infection Control

3.4.1 Tuberculosis Testing - All contractor personnel shall provide documentation of a Purified Protein Derivative (PPD) test performed within the past year. In case of a past positive PPD test, a negative chest radiographic report to rule out active tuberculosis shall be provided. The PPD test shall be repeated annually.

3.4.2 OSHA Regulation Concerning Occupational Exposure to Blood borne Pathogens - The contractor shall provide training or a self-study training module, as indicated above, to its personnel; provide Hepatitis B vaccination series at no cost to its personnel who elect to receive it; maintain and distribute an exposure determination and control plan to its personnel; maintain required records; and ensure that proper follow-up evaluation is provided following an exposure incident. Contractor shall provide documentation that the employee(s) have received the Hepatitis B vaccination series or that the employee(s) declined to receive the series. If the employees of the contracting agency suffer a communicable disease, the Contractor shall provide follow up documentation of employee’s clearance to return to the workplace prior to their return.

3.5 Conduct: Under this contract the following acts are not permissible by staff or veteran resident when while on facility premises and should be outlined in at employee policy handbook and resident handbook:

3.5.1 Use of intoxicating liquors, narcotics or controlled substances of any kind (excluding doctors’ prescriptions which do not impair ability to perform contract) while in residence, on duty or reporting for duty.

3.5.2 Gambling in any form.

3.5.3 Carrying of weapons of any kind whether in the open or concealed.

3.5.4 Smoking and other uses of tobacco only in designated site approve areas.

3.5.5 Resorting to physical violence to settle a dispute with a fellow resident, employee, customer(s) or the general public.

3.5.6 Aggressive actions such as spitting, threating or any other unsanitary, offensive or insensitive practices or behavior display for the purpose of threatening.

3.5.7 Use of loud, indecent or profane language and/or making threatening or obscene gestures toward other residents, staff or other employees.

3.5.8 Engaging a customer in a verbal confrontation to settle a disagreement.

3.5.9 Soliciting or accepting tips from customer, companions or others at any time.

3.5.10 Use the residence as a place to entertain non-staff or non-resident visitors whose purpose is at the site is not approved by the contractor.

3.6 Background Screening:

3.6.1 Staff of the contractor providing services to Veterans under this contract must have an appropriate background security check and determined acceptable by the Contractor before their contact with a veteran resident. The Contractor shall ensure all appropriate security documentation is submitted through the local law enforcement agency and that security and/or background documentation is available for review in the personnel file.

3.6.2 The records of contractor personnel shall be subject to review by the VA Chief of Staff or his/her designated COR and HCHV Coordinator.

3.7 Chain of Command

3.7.1 The Contractor shall present to VA, upon request, a “chain of command” for decision making and communication. This included for the organization as well as those persons identified in carrying out the terms of this contract. This document should all identify who will be sharing or responding to any concerns or issues that might arise from either veteran being served or by the VA Representative. A formal process to resolve concerns or issues is required. Outcomes of issues arising with veterans under this process will be shared with the VA Representative.

3.8 Professional Boundaries and Respect

3.8.1 Contractor staff must always maintain professional boundaries with the Veteran while conveying an attitude of genuine concern, respect and caring.

3.8.2 Contractor staff should under no circumstances engage in sexual activities or sexual contact with Veterans or their family members, whether such contact is consensual or forced. Contractor staff should under no circumstances take unfair advantage of any professional relationship or exploit Veteran clients or their family members to further their personal, religious, political, or business interests. Contractor staff should not engage in dual or multiple relationships with Veterans or their family members in which there is a risk of exploitation or potential harm to the Veteran or Veteran family. Contractor is responsible for taking steps to protect Veterans and their family members and is responsible for setting clear, appropriate, and culturally sensitive boundaries.

3.8.3 The contractor shall comply with the VA patient’s Bill of Rights and post it in public view as set forth in Section 17.34a, Title 38, Code of Federal Regulations. The contractor is responsible for maintaining Veterans’ privacy and confidentiality and must have systems in place that protect Veteran’s personal identifying information and protected health information. This includes but is not limited to:

3.8.3.1 Having adequate private office space for Veterans to meet in confidence with them case manager.

3.8.3.2 Having secured paper and electronic filing systems to protect clients’ case records and other documentation.

3.8.3.3 Ensuring that non-clinical/non-case management facility staff have access to Veteran information only as needed in order to meet the service requirements contained in the contract.

3.9 Conflict of Interest: The Contractor and Contractor staff are responsible for identifying and communicating to the Contracting Officer (CO) and Contracting Officer Technical Representative (COR) conflicts of interest at the time of proposal and during the entirety of contract performance.

4 ADMINISTRATIVE REQUIREMENTS

4.1 Administrative Presence: The contractor shall have an administrative unit per location site identified in Addendum where the site for services is located or a Memorandum of Agreement with an agency on the Island to fulfill this function if the contractor is not located there. This shall include at minimum management personnel to supervise the operations, assure that services delivered by staff are consistent with the responsibilities of this contract and be able to address issues and emergencies as they arise. There shall be clearly defined roles which identifies the management and supervisory responsibility of this staff.

4.2 On site rules and regulations: The contractor shall provide residents at the time of admission the site-specific rules and regulations for program participants. The rules and regulations shall include at minimum the admissions process, rights and responsibilities, response to rule infractions, VA Bill of Rights, discharge criteria, process for complaints and other program expectations. The VA representative shall be provided with a copy of these rules and regulations.

4.3 Policies: Contractors must have site specific written Agency Policies/Standards of Practice and procedures in place. These must address at minimum the following concerns and situations:

4.3.1 Suspected or known drug or alcohol use or relapse by one or more residents

4.3.2 On-site contraband, weapons (including props or souvenirs that appear to be weapons), drug or alcohol related paraphernalia (i.e., found alcohol, drugs, drug “works”, etc.)

4.3.3 On-site drug or alcohol testing methods (i.e., urine drug screens, Breathalyzer, etc.) and frequency

4.3.4 Safe prescription medication storage and handling, including specific provisions for prescribed controlled substances

4.3.5 Safe prescription medication access, including specific provisions for safe disposal of medications and syringes

4.3.6 Assertive monitoring of controlled substances, including but not limited to: signing in medications after receipt from pharmacy with an observed pill count by contractor staff; staff observation and recording of taking of controlled substances and other medications by Veterans

4.3.7 Room inspections and daily bed checks of Veterans residing in the program, including methods and frequency

4.3.8 Grievance process to address resident complaints with time frames for responses from the contractor’s program/facility management

4.3.9 Client abandonment of belongings in the facility, including time frames and procedures for disposal

4.3.10 Process to elicit client satisfaction with the facility and onsite services, including information collection methods and frequency, and process for utilizing the information for continual performance improvement purposes.

4.3.11 Processes to address emergency situations including but not limited to staffing issues, natural disasters, relocation due to the environment being non inhabitable, and behavior conflict with residents/staff.

4.3.12 Statement which authorizes the veteran to communicate with the VA Emergency Representative at any time for any reason without fear of retaliation or retribution.

4.3.13 Statement which authorizes a VA Representative to visit the site and meet with residents at any reasonable time if it is deemed appropriate for the support of a veteran and this action is supported by the HCHV Coordinator. Every effort will be made to plan visits during normal business hours during the work week.

These policies and procedures must be communicated to Veteran residents both verbally and in writing in a manner that is understandable to them upon admission to the facility. This communication must be documented in the Veteran’s client record and filed with Case manager.

4.4 Communication: Contractor is expected to have a reliable working phone line and fax capabilities. Messages left for the program by VA staff are expected to be returned as soon as possible during normal business hours. Written correspondence, such as eligibility authorizations, extension request, incident reports, and discharge reports shall be submitted to the designated VA representative.

4.5 Complaints: The COR shall monitor the service provided. Contractor shall cooperate with the Contractor shall refer documented complaints received directly from the veteran(s) to…