VA256-17-R-0994-A00007001.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. DUNS: DUNS+4:

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. 2/2012)

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

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

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

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 99

VA256-17-R-0994 09-22-2017

AJ Raiber 479-444-4012 10-20-2017

2:00 PM

36C256 Department of Veterans Affairs Network Contracting Office 16 ATTN: AJ Raiber 2575 Keystone Crossing Fayetteville AR 72703

X 100

X

Y

621610

$15.0 Million

X

N/A

X

36C256

See Performance Work Statement

36C256

Department of Veterans Affairs Network Contracting Office 16 ATTN: AJ Raiber 2575 Keystone Crossing Fayetteville AR 72703

Department of Veterans Affairs Financial Services Center P.O. Box 149971

Austin TX 78714-8972

See CONTINUATION Page

See Price Schedule Attached for item listing

See CONTINUATION Page

X

X 1

AJ Raiber Contracting Officer

VA256-17-R-0994

Table of Contents

SECTION A

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

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 LIMITATIONS ON SUBCONTRACTING-- MONITORING AND COMPLIANCE (JUN

2011)

B.3 PERFORMANCE WORK STATEMENT (PWS)

B.4 IT CONTRACT SECURITY

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS (JAN

2017)

C.2 52.204-4 PRINTED OR COPIED DOUBLE-SIDED ON RECYCLED PAPER (MAY 2011)

C.3 52.204-21 BASIC SAFEGUARDING OF COVERED CONTRACTOR INFORMATION

SYSTEMS (JUN 2016)

C.4 52.216-18 ORDERING (OCT 1995)

C.5 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.6 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.7 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.8 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

C.9 52.224-1 PRIVACY ACT NOTIFICATION (APR 1984)

C.10 52.224-2 PRIVACY ACT (APR 1984)

C.11 52.227-17 RIGHTS IN DATA—SPECIAL WORKS (DEC 2007)

C.12 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984) . 47

C.13 52.237-3 CONTINUITY OF SERVICES (JAN 1991)

C.14 VAAR 852.203-70 COMMERCIAL ADVERTISING (JAN 2008)

C.15 VAAR 852.203-71 DISPLAY OF DEPARTMENT OF VETERAN AFFAIRS HOTLINE

POSTER (DEC 1992)

C.16 VAAR 852.219-10 VA NOTICE OF TOTAL SERVICE-DISABLED VETERAN-OWNED

SMALL BUSINESS SET-ASIDE (JUL 2016) (DEVIATION)

C.17 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV

2012)

C.18 VAAR 852.237-70 CONTRACTOR RESPONSIBILITIES (APR 1984)

C.19 VAAR 852.270-1 REPRESENTATIVES OF CONTRACTING OFFICERS (JAN 2008) . 51

C.20 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.21 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (JAN 2017)

C.22 MANDATORY WRITTEN DISCLOSURES

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

BUSINESS ASSOCIATE AGREEMENT BETWEEN THE DEPARTMENT OF VETERANS

AFFAIRS VETERANS HEALTH ADMINISTRATION, VISN 16, AND

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS (JAN 2017)

E.2 Addendum to Instructions to Offerors

E.3 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (JUL 2013)

E.4 52.216-1 TYPE OF CONTRACT (APR 1984)

E.5 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.6 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION

(JAN 2008)

E.7 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (JAN 1998)

E.8 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998)

E.9 52.212-2 EVALUATION—COMMERCIAL ITEMS (OCT 2014)

E.10 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL

ITEMS (JAN 2017)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

(continuation from Standard Form 1449, block 18A.)

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

a. CONTRACTOR:

b. GOVERNMENT: Contracting Officer AJ Raiber

Department of Veterans Affairs Network Contracting Office 16 2575 Keystone Crossing Fayetteville, AR 72703

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

[X] 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

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.

Department of Veterans Affairs Financial Services Center PO Box 149971 Austin, TX 78714-8972

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

AMENDMENT NO DATE

B.2 LIMITATIONS ON SUBCONTRACTING-- MONITORING AND

COMPLIANCE (JUN 2011)

This solicitation includes VAAR 852.219-10 VA Notice of Total Service- Disabled Veteran-Owned Small Business Set-Aside. Accordingly, any contract resulting from this solicitation will include this clause. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) retained by VA to assist in assessing the contractor's compliance with the limitations on subcontracting or percentage of work performance requirements specified in the clause.

To that end, the support contractor(s) may require access to contractor's offices where the contractor's business records or other proprietary data are retained and to review such business records regarding the contractor's compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor's compliance with the limitations on subcontracting or percentage of work performance requirement.

B.3 PERFORMANCE WORK STATEMENT (PWS)

1. General:

The Department of Veterans Affairs (VA) has a requirement for home oxygen services to VA beneficiaries throughout Veteran Integrated Service Network (VISN) 16 comprising of the states of Arkansas, Louisiana, Mississippi and parts of Alabama, Florida, Missouri, Oklahoma and Texas.

2. Description of Services/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 equipment and services as defined in this Performance Work Statement (PWS). 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 quarterly in home respiratory therapy visits. This includes providing a Quality Control (QC) Plan 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, educate the patient and/or caregiver on proper use of equipment, documenting education and understanding, 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, including the Home Care National Patient Safety Goals. 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.

A (smallest)-E (largest)H and/or M] and replacement parts; portable oxygen concentrator; liquid oxygen; valved fireproof cannula; procurement/distribution of two types of oxygen and backup/spare parts; nasal cannula to include micro nasal cannula, high flow, Oxymizer pendant, nasal cannula with cushion ear piece, soft pronged nasal cannula/masks to include Oxymask, tracheostomy mask, bi-flow nasal mask, aerosol mask and replacement parts, and any interface, adapter or connection to enhance oxygen delivery/masks to include Oxymask, 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 or for primary source for patient mobility); 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. These services include delivery, set-up, education, pick-up, cleaning, preventative maintenance, ongoing RT visits (quarterly) to assess compliance and safety, after-hours support, and storage of equipment.

4. Scope:

This PWS 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 VISN 16. All content contained herein regarding TJC standards shall be interpreted in the following manner. All issuing and follow-up care provided under this contract shall be provided in accordance with all current TJC standards. Contractor’s facility(ies) may be inspected by the VA prior to the contract award. The use of the terms “beneficiary”, “Veteran”, “Patients”, and “patient” are used interchangeably and refer to the recipient of required supplies, equipment, and incidental services required under the contract. Any changes to the PWS will be made via a bilateral modification in accordance with FAR 52.212-4(c)

5. Geographical Boundaries: The geographical boundaries described herein have been determined as the areas of responsibility/jurisdiction for each local VA Medical Center:

a. FAYETTEVILLE, AR VAMC AND CBOC’s: Contractor shall service any patients that are treated at the Fayetteville, AR VAMC, regardless of their physical location. This includes but is not limited to the patients in the catchment area delineated below and patients who reside in or near bordering states catchment areas, (i.e., Muskogee, OK catchment area, but prefer to be seen in Fayetteville), Ft. Smith, AR, Mt. Vernon, MO, and Harrison, AR. The Fayetteville VAMC catchment area includes: 11 counties in Northwest Arkansas (Benton, Boone, Carroll, Crawford, Franklin, Madison, Marion, Newton, Scott, Sebastian, Washington); 11 counties in Southwest Missouri (Barry, Christian, Dade Greene, Jasper, Lawrence, McDonald, Newton, Stone Taney, Webster); 2 counties in Southeast Kansas (Cherokee, Crawford); 2 counties in Northwest Oklahoma (Adair, Delaware).

b. HOUSTON, TX VAMC: Contractor shall service any patients that are treated at the Houston, TX VAMC Clinic of Jurisdiction/Primary Service Area (COJ/PSA) to include, but not limited to, the following counties: Angelina, Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Grimes, Hardin, Harris, Jasper, Jefferson, Liberty, Matagorda, Montgomery, Nacogdoches, Newton, Orange, Polk, Sabine, San Augustine, San Jacinto, Trinity, Tyler, Walker, WaIler, Washington, and Wharton. Patients may also reside in the following parishes in Louisiana:

Beauregard, Calcaieu, and Cameron.

c. ALEXANDRIA, LA MEDVAMC: Contractor shall service any patients that are treated at the Alexandria, LA VAMC, regardless of their physical location. Service area to include, but not limited to, the following counties: Winn, Cheneyville, Grant, Deville, La Salle, Flatwoods Caldwell, Forest Hill, Franklin Lena, Catahoula, Pineville Concordia, Woodworth, Avoyelles Olla, Rapides, Jena Vernon, Jonesville, Natchitoches Harrisonburg, Beauregard Allen, Evangeline, St Landry, Calcasieu Jeff Davis, Cameron, Acadia, St Martin Lafayette, Iberia, Vermilion, Monterey Vidalia, Ball, Boyce

d. LITTLE ROCK, AR MEDVAMC: Contractor shall service any patients that are treated at the CAVHS, regardless of their physical location. This includes, but is not limited to, patients who reside in or near bordering state catchment areas, (i.e., Shreveport’s catchment area, but prefer to be seen in at CAVHS), All counties in Arkansas: Arkansas, Ashley, Baxter, Benton, Boone, Bradley, Calhoun, Carroll, Chicot, Clark, Clay, Cleburne, Cleveland, Columbia, Conway, Craighead, Crawford, Crittenden, Cross, Dallas, Desha, Drew, Faulkner, Franklin, Fulton, Garland, Grant, Greene, Hempstead, Hot Springs, Howard, Independence, Izard, Jackson, Jefferson, Johnson, Lafayette, Lawrence, Lee, Lincoln, Little River, Logan, Lonoke, Madison, Marion, Miller, Mississippi, Monroe, Montgomery, Nevada, Newton, Ouachita, Perry, Phillips, Pike, Poinsett, Polk, Pope, Prairie, Pulaski, Randolph, Saline, Scott, Searcy, Sebastian, Sevier, Sharp, St. Francis, Stone, Union, Van Buren, Washington, White, Woodruff, Yell, COUNTIES IN TEXAS: Bowie, Morris, Franklin, Cass COUNTIES IN OKLAHOMA: McCurtain, Le Flore COUNTIES IN MISSOURI: Ozark

e. NEW ORLEANS, VA MEDVAMC/SLVHCS: Contractor shall service any patients that are treated at the Southeast Louisiana Veterans Health Care System (SLVHCS), regardless of their physical location. This includes, but is not limited to patients in the following parishes and patients who reside in or near bordering state catchment areas, but prefer to be seen at SLVHCS.

PARISHES IN LOUISIANA: Orleans, Plaquemine, St. Charles, St. John, Thibodeaux, Iberville, St. Tammany, Livingston, West Baton Rouge, St. Helena, St. John the Baptist, Terrebonne, St.

Bernard, Jefferson, Lafourche, Assumption, Vermillion, Ascension, Tangipahoa, East Baton Rouge, Pointe Coupe, East Feliciana, West Feliciana, Washington, and St. James

f. BILOXI, MS MEDVAMC: Contractor shall service any patients that are treated at the Biloxi GCVHCS, regardless of their physical location. This includes, but is not limited to, patients in the following counties and patients who reside in or near bordering state catchment areas, (i.e.

outside Biloxi’s catchment area, but prefer to be seen in Biloxi or its Outpatient Clinics).

COUNTIES IN MISSISSIPPI: Pearl River, Stone, Greene, Jackson, Hancock, Harrison and George

COUNTIES IN ALABAMA: Washington, Mobile, Escambia and Baldwin

COUNTIES IN FLORIDA: Escambia, Santa Rosa, Okaloosa and Fort Walton

g. SHREVEPORT, LA MEDVAMC: Contractor shall service any patients that are treated at the Overton Brooks VA Medical Center in Shreveport, LA, regardless of their physical location. This includes, but is not limited to, patients in the following parishes and patients who reside in or near bordering state catchment areas, (i.e. outside Shreveport’s catchment area, but prefer to be seen in Shreveport or its Outpatient Clinics).

PARISHES IN LOUISIANA: Bienville, Bossier, Caddo, Claiborne, Desoto, Jackson, Lincoln, Ouachita, Red River, Sabine, Union, Webster

COUNTIES IN TEXAS: Bowie, Camp, Cass, Gregg, Harrison, Marion, Morris, Nacogdoches, Panola, Rusk, Red River, San Augustine, Shelby, Titus, Upshur

COUNTIES IN ARKANSAS: Columbia, Lafayette, Little River, Miller, Sevier

h. JACKSON, MS MEDVAMC: Contractor shall service any patients that are treated at the G.V.

“Sonny” Montgomery VA Medical Center in Jackson, MS, regardless of their physical location.

This includes, but is not limited to, patients in the following counties and patients who reside in or near bordering state catchment areas, (i.e. outside Jackson’s catchment area, but prefer to be seen in Jackson or its Outpatient Clinics). Mississippi counties under G. V. (Sonny) Montgomery VAMC PSA: Washington, Sunflower, Leflore, Carroll, Montgomery, Webster, Choctaw, Oktibbeha, Lowndes, Issaquena, Sharkey, Humphreys, Holmes, Attalla, Winston, Noxubee, Warren, Yazoo, Madison, Leake, Neshoba, Kemper, Hinds, Rankin, Scott, Newton, Lauderdale, Claiborne, Copiah, Simpson, Smith, Jasper, Clarke, Jefferson, Lincoln, Lawrence, Jefferson

Davis, Covington, Jones, Wayne, Adams, Franklin, Wilkinson, Amite, Pike, Walthall, Marion, Lamar, Forrest, and Perry

PARISHES IN LOUISIANA: Madison, Morehouse, East Carroll, West Carroll, Richland Tensas

6. Work Load Data:

The volumes or amounts shown in the Contract Line Item Numbers (CLINs) are estimates only and impose no obligation on the VA. The contract shall be for the actual requirements of the VA as ordered by the VA during the life of the contract. Below is a list of each location’s estimated oxygen-using Patients per month.

VISN 16 Medical Centers Per

Month Total per year

1 Alexandria VA Medical Center, Alexandria, LA 280 3,360

2 Gulf Shores VA Medical Center, Biloxi, MS 659 7,908

3 Veterans Health Care System of the Ozarks, Fayetteville, AR 1,800 21,600

4 Michael E DeBakey VA Medical Center, Houston, TX 2,041 24,492

5 G.V. “Sonny” Montgomery VA Medical Center, Jackson, MS 640 7,680

6 Central Arkansas Veterans Health Care System, Little Rock, AR 1,063 12,756

Southeast Louisiana Veterans Health Care System, New Orleans, LA 444 5,328

8 Overton Brooks VA Medical Center, Shreveport, LA 675 8,100

7,602 91,224

7. Ordering Process:

The COR or designee shall provide (via encrypted email and/or fax) the Contractor with notification to initiate individual patient service requirements, including the patient's oxygen prescription by authorized Licensed Independent Practitioner (LIP), equipment, supplies and services to be provided including date and place of delivery. The Contractor shall confirm receipt (via encrypted email and/or fax) of the request within one (1) working hour of notification to the ordering facility. The COR or designee shall also provide notification (via encrypted email and/or fax) to the Contractor of VA initiated discontinuation of service. The Contractor shall provide a toll-free telephone number for the purpose of communicating with VA eligible beneficiaries (Veterans) and VA staff. In addition, the Contractor SHALL NOT place collect telephone calls to the VA or to any VA beneficiary, family member or caregiver.

8. Quality Control:

The Contractor shall develop a QC plan to ensure compliance with all applicable/current guidelines put forth by TJC standards and this PWS. The Contractor shall also develop and maintain an organization-wide planning structure and processes that focus on safety and quality to ensure services are performed in accordance with this PWS. The QC plan shall address at a minimum:

a. Patient satisfaction data.

b. Initial Patient Set-Ups within standards listed in paragraph 22(j) and 22(k).

c. Documentation of Patient Set-ups.

d. Emergency Services with 4 hours of notification.

e. Semi-annual TJC compliance self-assessment reports

f. Incident reports within 4 hours.

g. Quarterly Customer satisfaction reports.

h. Quarterly infection control reports.

i. Semi-annual performance improvement reports.

j. Preventative maintenance on equipment.

k. Preventative maintenance reports monthly.

l. Quarterly reassessment of patient after initial set-up/equipment installation and submit reports.

m. Quarterly Respiratory Therapist visits

n. Disaster Preparedness Plan.

o. Plan for prevention and control of infection

9. Patient Education Requirements:

The Contractor shall provide education or re-education to each Veteran and/or caregiver on all equipment which is being used to include travel literature. This information is to be presented written and verbally on equipment, supplies, and services in the preference or learning style based on need.

Education in demonstration and material covered shall be in written form to be left with the patient or care giver. The written material shall be in English as well as the foreign or preferred language of the patient; in the event the patient does not speak English. The Contractor provides information and instructions about infection control issues related to equipment and supplies it provides. The Contractor must evaluate the patient’s and/or caregiver’s understanding of the education and training it provided. Contractor provides education on how to communicate concerns about patient safety issues that occur before, during and after care is received. The Contractor, as directed by CO or COR shall implement any new or revised education material. The VA shall determine whether the Contractor shall use their forms or forms supplied by the VA for documentation of education services provided to Patients. A copy of the signed education forms shall be provided to the COR with-in 24 hours upon request.

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.

11. Reports:

a. Initial Setups: Contractor shall provide to stations a report of all faxes received the prior day no later than (NLT) 1pm each work day. Report shall include all veterans serviced under the contract. Data shall include, at a minimum, date and time fax was received (including time zone if different from sending station), patient first and last name, last 4 of patient social security number, vendor patient identification number, if any, and type of request (initial setup, renewal, travel, etc.). Report will be consolidated weekly to show all initial setup requests and the date and time setup was completed. This weekly report will be provided NLT 1pm the Monday of the following week to the COR or designee of each facility via encrypted email or fax.

b. PM & RT Home Visit Report: Contractor shall provide a report on compliance with the quarterly home visit requirement for Home Oxygen Patients and 30-day home visit requirement for Patients using Ventilators. Report shall include all veterans serviced under the contract. Data shall include date of last home visit performed, due date of next home visit, date visit was actually completed. Report shall be compiled monthly and provided NLT the 15th of each month to the COR or designee of each facility via encrypted email or fax.

c. Travel: Contractor shall provide a report on patient travel arranged each month. Data shall include patient name, last 4 of SSN, date facility requested travel, travel dates, and dates veteran received travel equipment. Report shall be compiled monthly and provided NLT the 15th of the month to the COR or designee of each facility via encrypted email or fax.

d. Incident: Reporting special incidents found or occurring during a home visit, to include finding patients in need of emergency medical assistance, safety hazards that do not fall into the category of presenting immediate life-threatening danger to the patient or Contractors staff, inability to contact a patient within a reasonable period of time, and any other incident meeting the Contractors written policy for incident reporting according to accreditation standards.

e. Customer Satisfaction: In accordance with TJC standards the Contractor shall collect data on service satisfaction from contracted patients and their families from each facility on a quarterly basis. A copy of survey results shall be submitted to each station’s COR or designee in quarterly reports with an aggregate summary report to the VISN Prosthetics Rep or designee.

f. Infection Control/Communicable Diseases: Quarterly Report shall include data related to the

Contractor’s ongoing Infection Control Program.

g. Performance Improvement: The Contractor shall collect data on important processes and outcomes related to patient care and organizational functions on a semi-annual basis.

h. Dispatch Plan: The Contractor shall provide a detailed plan which adequately addresses the dispatch requirements necessary to meet the needs of the requirements of the PWS as part of their proposal and provide an updated copy to the CO and COR when changes occur.

i. Emergency Patient Safety: The Contractor shall provide the following emergency patient safety reports, within five (5) business days of the action, throughout the contract period.

1) Sentinel Events: The Contractor is required to inform the COR or designated person within four (4) hours of a sentinel event (as defined by TJC) that occurs during the performance of this contract that involves VA beneficiaries.

2) Refusal of service: 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, however in addition to a written report; the Contractor shall report the specifics of the refusal to the COR or designee by telephone within one (1) hour (follow up via encrypted email and/or fax, within 24 hours).

The Contractor shall obtain signed Against Medical Advice (AMA) form from veteran and notify COR/designee within 24 hours.

3) Suspected incident: The Contractor shall report suspected incidents of abuse or neglect to the patient by family members or caregivers. Suspected incidents shall be reported immediately (within four (4) hours) to the COR or designee, as well as to the adult protective agency. The Contractor shall follow all state and local laws in reporting suspected incidents of abuse or neglect.

j. Meetings:

1) The Contractor shall meet, or participate in a conference call, with each station COR monthly to discuss the progress of the service being provided to VA beneficiaries. Each station COR will discuss with the Contractor any issues and complaints from the Government, beneficiaries, or the Contractor. All issues and complaints from the prior month will be addressed to ensure that all corrections have been made and a process is in place to help ensure corrections remain in effect. Each station COR will maintain a complaint log to ensure all issues and complaints are addressed.

2) The Contractor shall meet with or participate in a conference call with the Contracting Officer and each of the station CORs on a quarterly basis to discuss the progress of the contract and to address any issues or complaints from the government, beneficiaries or contractor. All issues and complaints from the prior quarter will be addressed to ensure that all corrections have been made and a process is in place to help ensure corrections remain in effect. The COR will submit to the Contracting Officer each quarter a COR Quarterly Report that will address any issues or complaints.

3) Site Visits – Periodic, unscheduled on-site contractor, home oxygen patient, and ventilator patient visits may be made by COR or designee to monitor Contractor’s under this contract.

The Contractor shall make available all records and/or documentation necessary during the monitoring visit to the COR or designee. Other visits may be made by the Joint Commission surveyors and/or the Home Respiratory Care Team for each facility.

12. Infection Control/Communicable Diseases Requirements:

a. Contractor shall have a QC plan for prevention and control of infection. The plan shall meet current TJC standards. Quarterly reports shall be provided to the CORs (see paragraph 11f).

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

c. The COR or designee shall consult with VA infection control staff regarding the need to contact exposed patients and/or complete any needed medical follow-up.

d. The Contractor shall report non-compliant reported or observed behavior with fire safety guidelines set forth in the patient education and re-assessment material and/or behaviors which pose a risk of self-harm or harm to others. Such behavior shall be reported to the COR or their designee during the home visit if the Contractor's staff determines the patient's non-compliant behavior, within the home environment, is not improving after education on the fire hazard of smoking when on oxygen treatment is provided. Noncompliant behavior and any follow-up actions (i.e. educations) shall be documented.

13. Holidays:

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

14. Place of Performance:

Services shall 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 VISN 16, regardless of where patient resides. The equipment needs are subject to change as determined by the prescribing clinician. Contractors shall have sufficient facilities or resources physically located in the geographic area in which they shall provide service to be able to meet the timelines required in this performance work statement. VA Health Care

Systems and Medical Centers which are serviced by the VISN 16 include, but are not limited to those listed in paragraph 5.

15. Special Qualifications:

a. Each branch office or distribution point shall meet or exceed all applicable TJC standards. 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/oxygen concentrators/portable oxygen concentrators/cylinders/liquid oxygen (LOX) upon initiation of the contract and upon request thereafter.

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 each individual 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.

g. The Contractor shall educate, evaluate and document employee education in a manner that meets or exceeds TJC accreditation standards.

h. Only employees that have been properly trained and who have demonstrated competency shall perform equipment deliveries, recoveries, and patient education on the equipment.

i. The contractor shall obtain PKI certification for all branch location managers to ensure secure communications.

16. Key Personnel:

The Contractor shall provide a listing of key personnel required to successfully implement this requirement to include all Certified Respiratory Therapists (CRT) and/or Registered Respiratory Therapist (RRT). Key personnel are the members of the Contractor’s management team including the

Customer Service Manager, Logistics Manager, Billing Manager, Distribution Point Managers and the CRTs and or RRTs. In addition to having key personnel on the contract, the Contractor must also provide and maintain a comprehensive list of employees that are to be used in support of this contract action. Although these positions are not referenced as key personnel, they are integral in maintaining continuity of operations in support of this contract. The Contractor shall provide a quarterly listing of all personnel used in support of this contract. In the event a new contracted employee is brought on to support the contract, the Contractor shall notify the COR or designee immediately. The Contractor shall be responsible for the correct title classification of workers and compliance with all applicable wage and hour laws, reference Department of Labor (DOL) wage rate information.

(http://www.wdol.gov/sca.aspx). Contractor employees shall not be considered Government employees for any purpose under this contract.

17. Registration /Licensure/Accreditation requirements:

Contractor is responsible to comply with all applicable Federal & State laws/regulations in support of the contracted requirements.

a) Registration: National Provider Identification (NPI)

b) Distributor License:

1) Applicable State(s)

2) FDA permits and licenses as applicable

3) The Contractor's Respiratory Care Practitioner (RCP) shall be credentialed with the National

Board for Respiratory Care (NBRC) and hold a current state license where the work shall be performed.

4) All personnel servicing Veterans shall maintain a current valid driver’s license.

c) Evidence of ability to meet or exceed TJC Accreditation Standards.

d) Certified Respiratory Therapists (CRT) or Registered Respiratory Therapist (RRT).

18. Service Transition (Phase In/Phase Out):

a. In the event award(s) are made to other than the incumbent Contractor, the new Contractor(s) shall arrange with the incumbent Contractor for exchange of equipment ensuring that there is no disruption of supplies/services to veteran beneficiaries. The Contractor recognizes that the services under this contract are vital to the Government and must be continued without interruption and that, upon contract expiration, a successor, either the Government or another contractor, may continue them. The Contractor agrees to furnish phase-in training; and exercise its best efforts and cooperation to effect an orderly and efficient transition to a successor. The Contractor shall, upon the Contracting Officer’s written notice, furnish phase-in, phase-out services for up to 90 days after this contract expiration and negotiate in good faith a plan with a successor to determine the nature and extent of phase-in, phase-out services required. The plan shall specify a training program and a date for transferring responsibilities for each division of work described in the plan, and shall be subject to the Contracting Officer’s approval. The Contractor shall provide sufficient experienced personnel during the phase-in, phase-out period to ensure that the services called for by this contract are maintained at the required level of proficiency. Successful Offeror shall provide a detailed contract change over plan that can be utilized upon contract award.

http://www.wdol.gov/sca.aspx

b. This transition period will be designated for the transfer of VA veteran beneficiaries from the incumbent to the successor Contractor. The change shall, at a minimum, include oxygen care and instructions, usage, set up, emergency service, etc. The transition shall be coordinated through the Contracting Officer, and facility COR. Any requirement for an RRT or CRT visit shall be coordinated between the Contractor and COR. The appropriate VA facility shall provide the successful Contractor(s) with an up to date prescription.

c. The Contractor shall provide the facility COR by 12:00 noon each Friday, during the transition period, a detailed listing of all VA beneficiaries contractor owned equipment whose Oxygen Service has been changed over from the incumbent to the successor Contractor. The list shall include the exact date of the change for each beneficiary. Along with this list the successor Contractor shall also provide documentation showing that the incumbent Contractor has been notified to pick-up their equipment.

19. Physical Security:

The Contractor shall be responsible for safeguarding all Government equipment, personal patient information, information and property provided for Contractor use.

20. Government Furnished Property

The Government will not provide any equipment to the contractor for use under this contract unless added through a contract modification.

21. Contractor Furnished Items and Responsibilities:

The Contractor shall furnish all supplies, equipment, facilities and services required to perform work under this contract. All electrically powered equipment used in performance of this contract shall be Underwriters Laboratories (UL) Approved Equipment and in compliance with regulatory standards.

The Contractor shall be responsible for scheduling appointments with Patients to initiate set ups and deliveries. Deliveries shall not be left unattended at the patient's home; physical acceptance of deliveries must take place between the Contractor and either the patient or caregiver. If the patient fails to meet two (2) consecutive appointments, the Contractor shall notify (via encrypted email and/or fax) the COR/Representative within 24 hours of the second missed appointment. The COR shall notify (via encrypted email and/or fax) the Contractor of any changes. If the Contractor has not documented valid attempts to contact the patient for set ups and or deliveries, the Government reserves the right to call in a third party and bill the Contractor. The Contractor shall not be paid for those services during the billing period if services are not rendered.

a) Materials: The Contractor shall provide the Operation and Service manual to the patient and/or caregiver upon delivering any equipment. The manual shall contain information on operation, maintenance, and troubleshooting for clinicians, users, caregivers and service technicians.

Contractor shall provide to the Government, one (1) copy of the Operation and Service manual for each type of equipment with any proposals regarding this contract.

b) Supplies: The Contractor shall be staffed and have sufficient supplies to render satisfactory and courteous service at all times to the patient as listed below. The Contractor shall be responsible for the acts and omissions of their employees. In accordance with the order/consult received from the Government, the Contractor shall provide the patient with the following disposable supplies:

1) Oxygen cannula (including low flow and high flow cannulas, special cannulas as requested by VA clinician and demand flow cannulas) colored extension tubing. The Contractor shall provide the patient or caregiver with enough supplies to change at a minimum of every two (2) weeks with a supply in reserve at all times until the Contractor’s next scheduled visit.

2) Various interfaces and connectors, swivel adapter, oxygen bleed in adapter, to enhance oxygen delivery, washers, wrenches, oxygen nipple adaptors (Christmas trees), provided as needed.

3) All masks types (when prescribed) for change every two (2) weeks with a 30-day supply in reserve at all times until the Contractor’s next scheduled visit.

4) 25-50 feet of oxygen connecting tubing shall be replaced on a 90-day supply with an equivalent section of tubing in reserve at all times until Contractor’s next scheduled visit.

5) Trachea collar or t-piece adapter and accessories (i.e. tubing, large volume nebulizer, drainage bag, oxygen bleed-in adapter when needed and any other supplies/equipment that is needed to carry out clinician orders) allowing for change every three (3) days with a supply in reserve at all times until the Contractors next scheduled visit.

6) Humidifiers (disposable) and water traps as ordered by a VA clinician. The number of humidifiers shall be sufficient to ensure that they are not depleted between re-supply visits.

The number of traps shall be based on the manufacturer’s recommended change rate.

7) Safety holder(s), storage rack(s), and/or an e-cylinder cart shall be provided for all veterans with a prescription for tanks (cylinders) and for use with the back-up system.

8) NO SMOKING OXYGEN IN USE SIGNAGE and one backup. Visible and legible from the street.

9) Valved Fireproof Cannula shall be provided to all oxygen users.

10) The Contractor shall install the Valved Fireproof Cannula devices during contract start-up and during any initial equipment set-ups.

11) The Contractor shall replace the Valved Fireproof Cannula devices semi-annually (every six

(6) months).

c) Equipment: The Contractor shall provide the following equipment to meet the requirements per the PWS. The following equipment is considered stationary and each unit shall have an attached sticker with a correct vendor name and emergency telephone number. The Contractor shall comply with all applicable Federal & State laws/regulations in support of the contracted requirements. The Contractor shall 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, shall be affixed to all equipment.

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

a) Alarms for the following failures required: Power Failure, 02 Concentration, and

Irregular Pressure and Loss of Flow.

b) The oxygen concentrator shall not perform below the manufacturer's specification, at minimum delivers 93±3% or higher concentration of oxygen at flow rates up to 10 liters per minute (LPM).

c) The oxygen concentrator shall contain an hour meter and oxygen concentration indicator (OCI). Should either of these components fail, the OCI must be removed from service and replaced with a working unit. Failed units cannot be put back into service until repairs have been made and the system successfully tested. Contractor shall maintain records of each unit that fails, the repairs done, and the successful testing of the unit.

d) Oxygen sensing devices.

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

f) Be double insulated and have 3 prong plugs.

g) Be mounted on wheels for easy movement by patient/caregiver.

h) Shall meet Food and Drug Administration (FDA) Quality Systems Regulations (QSR) standards.

i) The portable oxygen concentrators shall be Federal Aviation Administration (FAA) approved.

j) The portable oxygen concentrator shall be electrically powered operate on 120 Volts Alternating Current (VAC), 60 hertz (Hz).

2) Types of Stationary Electrical Oxygen Concentrators.

a) Low-flow Concentrator (≤ 5 liter per minute (LPM)):

b) High-flow Concentrator (> 5 liter per minute (LPM)):

c) Low Decibel Concentrator – 40 decibels or less

3) Stationary Oxygen Cylinders. The Contractor shall furnish cylinders in accordance with the Interstate Commerce Commission Regulations. Contractor shall transport cylinders in accordance with the Code of Federal Regulations (CFR) Part 49, U.S. Department of Transportation.

a) Types of cylinders “G”, “H” and “M”.

b) Shall have a safety stand.

c) Regulator flow gauge.

d) Cylinder wrench and consumables.

e) Stationary gas oxygen systems used as backup may only be charged for when backing up

VA owned equipment.

f) Pulse dose regulator as prescribed by VA Clinician

4) Liquid Oxygen Reservoir: Standard reservoir holds 110 pounds of liquid oxygen. The standard reservoir weighs 65 pounds full.

a) Reservoir shall have condensation collection tray.

b) Shall have quick release valve for easy refilling.

c) Flow meter range of 0 to 15 LPM.

d) Shall have electrical or mechanical content indicators.

e) Be mounted on wheels for easy movement by patient/caregiver.

5) Combined Stationary and Portable Units: Home Fill Stations: Concentrator base with compatibility for oxygen cylinder refill that allow a patient to fill their own high pressure cylinders from a concentrator. In addition to the requirements for a standard oxygen concentrator:

a) Oxygen Cylinder Refill Stations shall be a minimum of 5 LPM, fill any size cylinders with capability for continuous or pulse dose.

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

c) Have a minimum four (4) compatible Post Valve Cylinders with integrated conserver

(various sizes).

d) Gas cylinders have integral flow regulator.

e) Appropriate interlocking fill fitting for custom portable oxygen cylinders.

f) Indicator light when cylinder is full.

g) Audible alarm for compressor failure.

h) Carry bag (backpack, shoulder strap, waist pack) or wheeled cart for cylinders.

i) Oxygen provided shall be U.S.P. Oxygen.

6) Portable Oxygen Concentrator (POC): A concentrator that can be powered via AC or DC.

It is similar to a stationary concentrator but is smaller and more mobile.

a) Must be Federal Aviation Administration Approved.

b) Shall be available for delivery within four (4) hours of a request.

c) Minimum continuous flow range of 0.5 LPM to 3 LPM.

d) Minimum pulse dose up to a setting of 6.

e) Minimum of 12 hours battery life or sufficient batteries for 12 hours of use based on patient’s highest usage rate in the prescription.

f) Have continuous and pulse doses (40 ml or greater) flow option.

7) Portable Oxygen Systems.

a) Oxygen cylinders - The Contractor shall furnish aluminum cylinders that are in accordance with the Interstate Commerce Commission Regulations, and transport cylinders in accordance with Code of Federal Regulations (CFR) Part 49, U.S.

Department of Transportation.

b) Types of Cylinders “B”, “C”, “D”, and “E”, “M6”.

c) Shall have a safety stand for storage, Safety stands are provided at no additional charge to the Government.

d) Carrying case, shoulder/waist bag, backpack or cart.

e) Regulator flow gauge.

f) Cylinder wrench and consumables.

g) Patient shall be provided unlimited cylinders per month.

8) Liquid portable systems: The Liquid oxygen system consists of large reservoir and portable unit that is filled from a Liquid Oxygen Reservoir.

a) Shall have carrying case (shoulder/waist bag, backpack or cart) or built in shoulder strap.

b) Easy to read contents gauge/scale.

c) Shall have flow setting of 1-6 for standard units or 1-15 high flow units.

d) Shall have quick release valve for easy refilling.

e) Shall have electrical or mechanical content indicators.

f) May have a built-in Demand Valve Regulator (DVR).

9) Oxygen Regulators: Device which regulates gas flow and pressure from a portable oxygen system.

a) Continuous flow regulator - Flow 0-8 LPM or 0-15 LPM based on prescription.

b) Demand Valve Regulator (DVR): A device that limits the oxygen flow to inspiration only and thereby increases the duration of the oxygen…