STATEMENT OF WORK.pdf

STATEMENT OF WORK

HEALTH CARE FOR HOMELESS VETERANS

CONTRACT EMERGENCY RESIDENTIAL SERVICES BEDS

A. PURPOSE

The St. Cloud VAHCS requires Contractors to provide services as part of its Community Based Health Care for Homeless Veterans (HCHV) program. The goal of the HCHV program is to remove homeless Veterans from the street or habitation unfit for Veterans and place them in community-based, residential environments with sufficient supportive services to meet their needs and ultimately facilitate the improvement of their housing situation.

B. BACKGROUND

Through the HCHV program, VA provides supportive services to Veterans and facilitates their access to a broad range of medical, mental health, and rehabilitative services. The purpose of this solicitation is to obtain offers from Contractors in St. Cloud who can provide housing, and supportive services to Homeless Veterans and/or their families in community-based Contracted Emergency Residential Services (CERS) facilities offering a safe and secure environment that supports their goals for recovery from homelessness. The Contractor will be required to provide a low- barrier therapeutic and rehabilitative milieu and attendant services targeting the underlying factors contributing to homelessness. The Contractor will not be required to provide detoxification or other hospital level treatment.

C. SERVICES TO BE PROVIDED

1. BASIC SERVICES: The Contractor shall furnish each Veteran who has been approved as eligible by the VA and admitted for care under this contract with the following basic services:

a) ROOM and BOARD: Room and Board shall be accessible to the Veteran 7 days a week and 24 hours per day. Accommodations will include a bed and other furnishings such as a dresser, storage, and personal linens (towels and bed sheets, etc.). The bed must be designated for use exclusively by the individual Veteran from the time of admission to the time of discharge. The bed must be situated in a room that affords the Veteran safety, privacy and security. Each Veteran must have a safe and secure place to store their belongings that is readily accessible to the Veteran (such as a locking closet, a locking armoire, a locker, etc.)

b) NUTRITION: meals to include at least three (3) nutritionally adequate meals a day, 7 days a week and availability of nutritious snacks between meals and bedtime for those requiring or desiring additional food, even when it is not medically indicated. VA dietitian may assess printed menus as well as Veterans’ satisfaction with meals and the actual consumption of food offered in determining the Contractor’s success in meeting this requirement during annual facility inspection or at any point during the contract period. Note a diabetic diet may also be indicated in the event it is necessary depending on a Veteran’s health status.

c) LAUNDRY FACILITIES: Laundry facilities and necessary detergent free of charge and adequate for residents to do their own laundry or to have laundry done at minimum one time per week.

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2. CASE MANAGEMENT SERVICES: The Contractor shall provide, at minimum, the following case management services to Veterans in the program:

a) Contractor will assess the psychosocial and environmental needs or dysfunction secondary to or exacerbating the social, substance or psychiatric problems, which might contribute to Veterans’ readjustment challenges in the community. Contractor establishes and maintains a therapeutic relationship with the Veteran, staff, and community programs/agencies, and is responsible for formulating case-management treatment goals and plans that address identified needs, stressors and problems.

b) Contractor will conduct high-risk screening, psychosocial assessment and treatment planning, actively involving the Veteran and their family or significant others, in coordination with the team members. Psychosocial assessments will include goals for clinical treatment. Contractor coordinates and documents clinical case management and psychosocial services and documents the overall effectiveness of the case management services provided. Specifically, Contractor will:

(1) Develop an Individualized Service Plan (ISP) with the Veteran consistent with program goals; the plan must specifically include provisions for Veteran placement into an appropriate transitional or permanent housing placement within 6 months of admission to the HCHV Contract Residential Program with no more than 6 months without a planned reason for extension. The housing placement planning must take into account all appropriate and available community-based housing options as well as the Veteran’s preferences regarding location and housing type. The plan should also be focused on getting the Veteran(s) to accept services, especially mental health and substance use services that will allow attainment of transitional or permanent housing.

Acceptance of the services offered should not be a condition of continued stay in Health Care for Homeless Veterans Contract Residential Program programming. However, engagement and service delivery should retain the expectation that the Veteran will advance to permanent housing with support, recognizing that it will often be at his or her own pace.

(2) Complete a written ISP within the first two (2) weeks of program admission and signed by the Contractor, the Veteran, and the Contract Residential Liaison.

(3) Review ISP a minimum every thirty (30) days thereafter in a clinical meeting with the Veteran. Updated plans must be promptly communicated to the Contract Residential Liaison.

(4) Make changes in plans in consultation with the Veteran.

(5) Coordinate with Contract Residential Liaison during weekly case conferences regarding updates and changes in Veterans’ care plans to foster a collaborative relationship with the St. Cloud VAHCS and Contractor in meeting Veterans’ needs. Case conferencing may be done in person or by telephonic conference calls as determined by St. Cloud VAHCS staff.

(6) Obtain relevant Releases of Information to communicate and coordinate Veterans’ treatment with VA and other community-based service providers.

(7) Work in close collaboration with the Contract Residential Liaison to ensure Veterans’ connections to needed VA medical, mental health, and substance abuse treatment and care.

(8) Contractor will take primary responsibility for assisting Veterans in completing housing applications and other benefits paperwork as needed.

Contractor will assist Veterans in obtaining the needed documentation required for complete applications including but not limited to, birth certificates, driver’s license/State issued ID, income verification and any additional information required by housing resources and potential income supports.

(9) Case management to assist obtaining employment for those who are able to be employed.

3. THERAPEUTIC AND SUPPORTIVE SERVICES:

a) Therapeutic, Rehabilitative, and Recovery Services determined to be needed by the individual resident in a plan developed by the contractor with consultation by the Veteran and the VA case manager and/or other appropriate VA staff. Services which the contractor must be able to furnish include:

(1) Structured group activities as required of the need of the Veteran served -examples include group therapy, social skills training, Alcoholics Anonymous, Narcotics Anonymous, vocational counseling, and physical activities as appropriate.

(2) Contractor shall collaborate with Contract Residential Coordinator, VA program and community resources to provide Veteran individual professional counseling, including counseling on self-care skills, adaptive coping skills and vocational rehabilitation counseling.

(3) Assistance to develop responsible living patterns and to achieve a more adaptive level of psychosocial functioning, upgraded social skills, and improved personal relationships.

(4) Support for an alcohol/drug abuse-free lifestyle.

(5) Assistance to gain and to apply knowledge of the illness/recovery process.

b) In the event a Veteran residing in HCHV Contract Residential Program under this contract dies, the Contractor will promptly notify the Contract Residential Liaison authorizing admission and immediately assemble, inventory using established protocol, and safeguard the Veteran’s personal effects.

c) Collaboration: collaboration with Contract Residential Liaison including but not limited to admission, treatment, and discharge.

d) Transportation: The Contractor shall assist the Veterans with local transportation to scheduled meetings and appointments. The Contractor will be expected to help the Veteran access public transportation, including providing information and instructions necessary to enable Veterans to utilize public transportation. If VA staff determines that adequate public transportation is not available or appropriate for a Veteran, the Contractor shall arrange for alternative transport by car or taxi.

e) Internal Grievance: Programs must have an internal grievance process that Veterans can use to resolve conflicts within the program. Programs must have written policies and procedures for resolving grievances, including a statement regarding the client’s right to request reasonable accommodation, and must post them in a place conspicuous and be accessible to clients. In addition, each client shall receive a copy of the grievance policies and procedures, upon intake and upon receiving a warning or discharge notice.

f) Intake: All Veterans must receive an intake packet within 72 business hours which includes, at minimum, the following information:

(1) Description of the Contractor’s services

(2) Grievance Policy

(3) Emergency procedures

(4) Patient rights and Reasonable Accommodation

g) Extensions: All extensions beyond 6 months must be approved in writing by HCHV Contract Residential Liaison or Designee.

h) Medications: medications and narcotics shall be properly stored, controlled, issued and recorded in compliance with physician’s orders. Contractor shall establish procedures for insuring Veterans confidentiality in the storage of and keeping of records concerning medication. Veterans will self-administer prescribed medications.

i) Critical Incident Reporting: All critical incidents will be reported within 24 hours.

This includes the following:

(1) Falls

(2) Assault (to Veteran or Staff)

(3) Elderly/Dependent Adult Abuse or Neglect

(4) Sexual Assault

(5) Fire (Veteran Involved)

(6) Medical/Psychiatric Emergency (911 calls)

(7) Hospitalization

(8) Suicide or Suicide Attempt

(9) Homicide

(10) Death

(11) Infectious Control (TB, etc.)

j) Case Record: An individual case record will be created for each referred Veteran.

Case records shall be maintained to ensure the confidentiality of each Veteran. Case records and data normally maintained and included in a medical record as a function of compliance with State or community licensing standards will be made available on a need-to-know basis to appropriate Department of Veterans Affairs staff members involved with the treatment program of the Veterans concerned. The Contractor shall comply with applicable requirements of the Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR Part II) and the Confidentiality of Certain Medical Records (38 USC 7332). The files shall include:

(1) Reasons for referral

(2) All essential identifying data relevant to the resident and his/her family including a socio-cultural assessment, weekly progress reports or notes, and documentation of any case management interventions or patient care conferences

(3) For sites who implement Medication Management/Monitoring. Contractor must be in compliance with HCHV inspection requirements.

(4) Case management notes written in a clearly and may include the following:

1) A written housing needs assessment, 2) Financial plan, 3) Discharge plan, and Individual Care Plan with attendant goals and documented activity indicating Veteran and Case Manager is actively working on identified goals

(5) QASP Compliance Tool and all attendant supporting documentation demonstrating Contractor compliance with Contract

(6) Final summaries on each resident who leaves the program, to include reasons for leaving, the resident’s future plans, and follow-up locator information

(7) Extension approval if applicable

(8) Waivers as appropriate

k) Rules: The Contractor shall have reasonable rules governing day-to-day life and activities in the facility. Such rules clearly inform Veterans of the obligations upon which their continued participation in the program depends and the consequences for non-compliance. Veterans will be provided a copy of the rules at intake or upon Veterans request. In addition, Contractor will post the rules in a location readily accessible to clients and visitors. These rules must include detailed Patient Rights and the procedures that the Contractor has in place to protect the Veteran’s rights and dignity. Veterans must be permitted to exercise these rights without fear of reprisal. If requested, Contractors must reasonably accommodate Veterans whose compliance with program rules is limited by the Veterans’ physical or mental disabilities, in accordance with the Americans with Disabilities Act, the Federal Fair Housing Amendments Act, Section 504 of the Rehabilitation Act, including those requirements covering reasonable accommodations for disabilities and the use of assistance animals, and all other applicable State or Federal laws. Contractor must equally apply all rules, policies and procedures to Veterans, unless a Veteran has asked for a reasonable accommodation due to his/her disability.

l) Procedures for negative discharge or sanction: Contractor must post rules and provide Veteran with the rules which specify the reasons or conditions for which a Veteran may be sanctioned or discharged, including those behaviors which constitute gross misconduct and are grounds for immediate discharge from the program and those which would prompt a written warning if violated and potential discharge if violated repeatedly. Contractor will describe the formal appeal procedures through which clients may appeal program regulations, sanctions or discharges. This information must be provided to clients in writing upon intake and must be clear and easily understandable by clients. This information will include:

(1) Immediate contact with VA liaison

(2) Timely due process provisions

(3) Notice of, and access to, formal appeal procedures

(4) Notice of the conditions or process for re-admission to the program

(5) Reasonable efforts to provide an appropriate referral to another facility or appropriate level of care as needed

(6) This does not apply to Veterans who are discharged for danger to self or others

4. ADDITIONAL CONTRACT REQUIREMENTS:

a) Contractor location. The contractor’s facility shall be no further than fifteen (15) miles from the St Cloud MN VA hospital located at 4801 Veterans Drive, St Cloud MN 56303-2015. Google driving distance (the shortest distance as google may provide alternate routes) will be used when calculating the distance between the St Cloud MN VA Hospital and the contractor’s facility. https://www.google.com/maps/

b) Staffing: Contractor will employ sufficient professional staff to carry out the policies, responsibilities, and programs of the facility. In a residential living facility, there must be a fulltime administrative staff member or designee of equivalent professional capability on duty, on the premises (in the building where Veterans reside) or residing in facility and available for emergencies 24 hours a day, 7 days a week. Staff is defined as a paid professional or para-professional and does not include interns.

c) Staff Training: Contractor will provide at least one staff person on-site at all times who has had training and orientation on the following topics. Staff shall receive and document—at a minimum—one-time training per year on these subjects. Proof of training certificates will be provided to the COR/Contract Residential Liaison.

(1) CPR

(2) First Aid

(3) Crisis intervention

(4) Cultural sensitivity

(4) Sexual harassment

(6) Sensitivity to wider issues of homelessness

(7) Universal Precautions (disease transmission prevention)

(8) Child abuse/neglect reporting laws (if shelter provides services to children)

(9) Adult abuse/neglect reporting laws

(10) Harm Reduction philosophy

(11) Suicide Prevention

(12) Medication management

(13) State and Federal Fair Housing Law and ADA Requirements

(14) Conflict resolution

(15) De-escalation techniques

(16) Search and Seizure/Probable Cause in the Shelter Setting

d) Contractor must have a policy prohibiting staff from establishing sexual relationships with program clients.

e) Veterans cannot be denied entry to HCHV Contracted Residential Services based solely upon length of current abstinence from alcohol or non-prescribed controlled substances, the number of previous treatment episodes, the time interval since the last https://www.google.com/maps/ program entry, the use of prescribed controlled substances, marital status, disability, income, gender or legal history, unless legal history includes charges of arson, sexual crime, or crime with a weapon. This includes a Veterans status of being a victim of Domestic Violence and as such cannot be considered during the screening process. It is expected the program will serve those of all gender identities. The screening process must consider each of these special circumstances and determine whether the program can meet the individual Veteran's needs while maintaining the program's safety, security, and integrity. All Contractors must employ a harm reduction approach.

f) Contractor personnel shall be expected to treat referred Veterans with dignity and respect and abides by standards of conduct mirroring those prescribed by current federal personnel regulations. The Contractor shall comply with the VA Patient's Bill of Rights as set forth in 38 CFR 17.34a (copy available upon request).

g) Unless specifically excluded in this contract, the per diem rate established will include the services listed in this document and will also include all services or supplies normally provided other residents by the facility without extra charge. Payments made by the VA under this contract shall constitute the TOTAL cost of care and housing of the homeless Veterans. Payment is authorized starting from the first day of admission and does not include the day of discharge. Absences of the patient from the facility will not be reimbursed after 24 hours but do not have to be discharged unless the absence is unauthorized and there is no expectation that the Veteran will return to the facility. The Contractor will submit billing to Austin Payment Center by the 15th of every month.

Failure to make timely invoice submissions will be cause for a request for a corrective action and if invoicing issues continue to arise it will be grounds for termination for convenience.

(1) The Contractor shall be expected to utilize and secure nightly sign in logs for the purpose of verifying a Veteran’s attendance in the program on a daily basis.

These logs are to be submitted to the VA Liaison monthly, along with invoices, to ensure accuracy of billing.

(2) All excused and unexcused absences will be clearly documented on the monthly attendance log including reason for any excused absence (e.g. medical needs). Payment will not be received for any unexcused absences over 48 hours nor excused absences over 72 hours. No payment will be made without the daily sign-in logs to be verified by VA Staff.

h) The Contractor shall provide the Liaison with a written report of program activities on a Quarterly basis in accordance with the QASP. These reports shall be maintained by the Liaison in the contract administrative file, and necessary reports shall be submitted as a part of the annual inspection package. The report should contain, at minimum, the following information:

(1) Total Number of Veterans Served

(2) Data from QASP compliance tool

(3) Program Completion Rates

(4) Outcomes (e.g. # or % of veterans discharged to independent housing, increased income/benefits, occupancy, etc.)

(5) Other pertinent information, such as: quality improvement projects, changes in staffing or business practices, systems or resource concerns, etc.

i) HCHV performance measures and requirements set forward in this solicitation must be met in order to receive the highest past performance rating. These include the following:

(1) HCHV1: Exits to Permanent Housing (Target = 55%)

(2) HCHV2: Negative Exits (Target = 20%)

5. BUILDING REQUIREMENTS:

a) Fire Safety:

(1) Buildings in which space is offered shall be evaluated in accordance with latest editions of the NFPA 101, LIFE SAFETY CODE http://www.nfpa.org/codes-and-standards/document-information-pages?mode=code&code=101 and AMERICANS WITH DISABILITIES ACT (ADA) http://www.ada.gov/

(2) Equipment, services, or utilities furnished and activities of other occupants shall be free of safety, health, and fire hazards. When hazards are detected, the contractor shall promptly correct hazards.

(3) Maintenance of contractor-owned fire extinguishers shall be provided by the contractor in accordance with NFPA Standard No. 101. As required by code, smoke detectors/alarms shall be installed in each room, office, storage area, hallways, and other common areas. Required testing shall be performed, documented, and a copy of the inspection report shall be provided to the VA

COR.

b) Wheelchair Accessibility. Rooms shall be wheelchair accessible. Common areas such as hallways shall provide for accessible path of travel for wheelchairs.

c) Elevators: If elevators are a part of the room complex, they shall conform to the latest requirements of the American National Standard A171 and A171a Safety Code for Elevators https://law.resource.org/pub/us/code/ibr/asme.a17.3.2008.pdf except for elevator emergency recall and shall be inspected and maintained in accordance with American National Standard A17.l, Inspector's Manual for Elevators or equivalent local code. The elevators shall also comply with local codes, and ordinances. A copy of current inspection report shall be furnished to the VA COR.

d) No activity to the building and/or grounds that would cause an increase in dust, dirt, or spores to be airborne (i.e., renovation to the building, movement of earth on the grounds) shall take place without the contractor's written notification to the VA at least seven calendar days in advance of the event.

e) Prior to the award of a contract and annually during the contract term, a multidisciplinary VA team consisting of a social worker, dietitian, a representative of the VA Police, and a Facilities Management Safety Officer, Nursing and/or other subject matter experts as determined necessary by the medical center director or HCHV Coordinator shall conduct a survey of the Contractor’s facilities to be used to provide Veterans food, shelter, and therapeutic services to assure the facility provides quality care in a safe environment. The Government reserves the right, at any time before and

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http://www.nfpa.org/codes-and-standards/document-information-pages?mode=code&code=101 http://www.nfpa.org/codes-and-standards/document-information-pages?mode=code&code=101 http://www.ada.gov/ https://law.resource.org/pub/us/code/ibr/asme.a17.3.2008.pdf after contract award, and during the term of the contract, to inspect the rooms and all other areas of the complex access to which is necessary to ensure a safe and healthy environment for the VA referred occupants.