G004--Central Western MA HCS HCHV Medical Respite Care services

Veterans Health Administration (VHA)Sources Sought Notice to Obtain a qualified vendor to provide HEALTH CARE FOR HOMELESS VETERANS (HCHV) for MEDICAL RESPITE CARE FOR HOMELESS VETERANS at the Central Western MA HCS

This is a Sources Sought notice and not a request for quotes. This request is solely for the purpose of conducting market research to enhance VHA s understanding of your company s offered services and capabilities. The Government will not pay any costs for responses submitted in response to this Source Sought Notice.

This Sources Sought notice provides an opportunity for respondents to submit their capability and availability to provide the requirement described below. Vendors are being invited to submit information relative to their potential to fulfill this requirement, in the form of a capability response that addresses the specific requirement identified in this Sources Sought.

The Veterans Health Administration (VHA) is seeking to obtain a qualified vendor to provide HEALTH CARE FOR HOMELESS VETERANS (HCHV) MEDICAL RESPITE CARE FOR HOMELESS VETERANS at the Central Western MA HCS per the general requirements below. The standard shall be of quality; meeting or exceeding those outlined in the general statement of work as described below.

Refer to the Performance Work Statement section below for the requested requirement description. This Sources Sought is to facilitate the Contracting Officer s review of the market base, for acquisition planning, size determination, and procurement strategy.

Please provide:

QUALIFICATION INFORMATION:

Company / Institute Name:

Point of Contact:

Address:

Phone Number:

E-mail Address:

Unique Entity Identifier (UEI) #:

CAGE Code:

A statement as to whether your company is large or small business under the applicable NAICS code according to the appropriate size standard. Also indicate if you are: a non-profit entity, small, disadvantaged business, Section 8(a) small business, woman-owned small business, service-disabled veteran-owned small business, or a HUBZone small business.

PERFORMANCE WORK STATEMENT

HEALTH CARE FOR HOMELESS VETERANS (HCHV)

CONTRACTED RESIDENTIAL SERVICES (CRS)

MEDICAL RESPITE CARE FOR HOMELESS VETERANS

BACKGROUND & PROGRAM DESCRIPTION

The Health Care for Homeless Veterans (HCHV) program is an essential and critical part of VHA. It provides a gateway to the VA and community-based supportive services for homeless Veterans. The program utilizes Contracted Residential Services (CRS) in community locations to engage homeless Veterans. HCHV CRSs exists to provide a means of helping homeless Veterans get off the streets and find more suitable habitation. CRS programs work to help Veterans get into residential environments with sufficient supportive services to meet their biopsychosocial health and housing needs. CRSs operates in accordance with HCHV Program Federal Regulations 38 CFR 63 and are partners with the VA in the mission of ending homelessness among Veterans.

According to the National Institute for Medical Respite Care, Medical Respite Care (MRC) provides post acute medical care for people who are homeless and too ill to be on the street but not ill enough for hospital level of care. MRC is short-term and operates where homeless individuals can receive support, education, and assistance in recovering from illness and injury and/or restoring and managing medical and functional health in a safe environment. The objective of the CRS MRC is to supply Veterans with such service and help them to move into permanent housing, living as independently as possible, and ensuring that interventions will be in place to help in maintaining permanent housing.

It is understood that the type of Veterans to be cared for under this contract will require care and treatment services over and above the level of room and board and general. It is also understood that Veterans in CRS MRC may need more intensive case management than the general population. Intensity of services required are to be assessed on an ongoing basis.

CRS MRC is not a substitute or alternate for long-term care or skilled nursing care settings.

B. FOUNDATIONAL RULES & EXPECTATIONS

B.1. Admission Criteria

B.1.1. Veteran is homeless, as defined in the VHA Directive 1162.04 Section 3.E., or at

imminent risk of homelessness.

B.1.2. Veteran is eligible for VA Health Care. (The VA Eligibility Office and VA Liaison

can assist in obtaining a Veteran s status.)

B.1.3. Veteran is discharging from a hospital and in need of recuperative care or

is with marked functional limitations, requiring additional supports such as that of an aide

or nurse, not often found in a traditional shelter or transitional housing setting for

homeless individuals.

B.1.4 MRC candidates may be, but are not limited to:

transitioning from chronic street homelessness.

discharging from institutions other than hospitals (rehabilitation facilities, substance abuse treatment facilities, residential recovery programs, jails, etc.)

recently homeless due to fleeing domestic violence, abuse, or exploitation, being in a place not meant for human habitation, such as an abandoned building, a vehicle, or a residence that is no longer meeting inspection and code or facing condemnation according to a governmental entity.

facing eviction or foreclosure of their residence. Every attempt will be made by the contractor, Veteran, and/or referrer to secure documentation of such as part of referral process to assess acuity or alternates to losing housing.

B.2. Admission Practices

B.2.1. Collaboration with the VA Liaison is amply available and highly encouraged to ensure

appropriateness and eligibility for Veteran to be in CRS. VA Primary Care team members will be

consulted with as needed to determine eligibility. It is understood that payment for Veterans admitted

without an initial determination of eligibility may not be authorized if the Veteran is found to be

ineligible.

B.2.1.i. Staff will ensure that a case manager has met with a Veteran within 72 hours of

Admission for intake and service planning.

B.2.1.ii. Staff will ensure that a Veteran is routed to VA Liaison for an intake within 72

hours of admission, so that HCHV intake by VA Liaison can take place within 7

days of admission .

B.2.1.iii. Veteran will receive a nursing assessment within 48 hours of admission.

B.2.2. Contractor works to reduce barriers to admission:

At a minimum, accept referrals Monday through Friday during business hours.

Respond to referrers with acceptance or decline of Veteran referred within 96 hours from receiving the referral form. Notification of acceptance or decline of Veteran within 72 hours is preferred.

Admit Veterans outside of business hours when and if feasible.

There will not be a certain timeframe prior to admission that a Veteran must be free of drugs or alcohol so long as a Veteran is medically stable to be in MRC. Detoxification services are not expected of the MRC. In cases of unsuitability for MRC environment due to previous episodes in similar settings whereas the Vet infracted upon drug and alcohol policies repeatedly, the contractor reserves the right to decline admission with recommendations to the Veteran and/or referrer for what interventions would be needed to establish an episode of stay.

Contractor is encouraged to accept Veterans, even if they have a sex offense status or otherwise been involved with the legal system.

A Veteran is not obligated to reveal that they have a disability prior to admission.

Accept Veterans into MRC regardless of what geographical location they may come

from: Central or Western MA. Veterans from other geographical locations may also be considered, but with emphasis and priority being on those from the CWM VA HCS catch man area.

B.2.3. Priority and Expedition. For those Veterans referred or who are on the street, in places not

meant for habitation, or staying in vehicles, the admissions and intake committee will

coordinate with others and the Veteran about logistics and pragmatics of getting to the MRC

site as quickly as possible.

B.2.4. The CRS Program admissions and intake staff reserve the right to decline admission to a

Veteran who is found to be inappropriate for MRC. However, every attempt should

be made to accommodate the Veteran. It is the expectation of the VA that if a Veteran is denied

admission to MRC, the admission and intake staff will provide the Veteran and referral source

with alternate resources and services.

B.2.5. The admitted Veteran will be provided with a copy of the Resident Handbook or other

documentation that outlines at a minimum rules, regulations, responsibilities, and expectations

of the Veteran and the Contractor. Veterans are expected to engage programming and maintain

communication with Case Managers, Residential Staff, and Nursing Staff.

B.2.6. While recidivism is discouraged, there is no limitation to the number of times that a Veteran can

be accepted into the CRS Program after leaving the program. Veterans who are former

participants can be rereferred and readmitted so long as they are otherwise meeting eligibility

criteria. Every attempt to address what will be different during additional episodes of stay will

be taken with the Veteran to secure permanent housing and minimize length of stay at the CRS

Program. Case management staff and VA Liaison will monitor and coordinate efforts in helping

recidivistic Veterans on a regularly scheduled basis (i.e. monthly) to decrease barriers to and

successfully establish permanent housing.

B.2.7. Keeping with the objective of the CRS MRC, admission will be made for Veterans who can t

complete instrumental activities of daily living on account of functional impairment - acute,

chronic, or yet to be determined, psychiatric, cognitive, or physical in nature. Veterans cannot

be denied admission if they don t yet have a diagnosis associated with such impairment.

Contractor and/or VA assessment, medical documentation, referrer s knowledge of the Veteran

are all pieces of collateral evidence to consider when making determination for admission.

B.2.8. Rules focus on staff and resident safety. Veterans are expected to adhere to the following:

No buying or selling of alcohol or drugs in the facility

No dealing or use of illicit drugs in the facility

No sexual activity between residents

No violence or threats of violence

Honor nightly curfew

Any others as set forth in a Contractor s Resident Handbook or other policy manual the Veteran would procure at the time of admission.

B.2.9. When possible, infractions are to be used to engage residents, not simply as grounds for

service termination. Profanity does not in and of itself constitute abuse and shall not

exclusively be considered grounds for discharge. Any actual or threatened violence

may be grounds for discharge. Any discharge, for whatever reason, requires that

Contractor staff assist Veterans with finding alternative living arrangements.

B.3. Types of Services Provided by Contractors Case Managers

B.3.1. Screenings or Referrals for Benefits. Vets with limited or no income will have challenges to

obtaining permanent housing. Case managers assess for and refer Veterans to appropriate

agencies or directly assist Veterans with obtaining:

military service-connected compensable conditions

disability insurance or supplemental security income

retirement pensions

Veterans-specific or public cash assistance programs

SNAP benefits

health insurance

one-time-only financial assistance from programs that would provide Veterans with first and/or last month s rent, security deposits, moving expenses coverage, payment of fees and/or fines

B.3.2. Enhancement of independent living and social skills via regularly scheduled programming

and amenities (this list is not all-inclusive of possibilities):

12-step program groups

computer and literacy classes

social and life skills trainings

financial aid and budgeting workshops

vocational and/or credit counseling

justice outreach services

legal services to address identity fraud, child support, and/or benefits & entitlements, etc.

peer and mentor support

access to health fairs and local community events

recreational and leisure activity opportunities

House Meetings

physical activity opportunities via gym equipment

lounge areas with opportunities for reading and socialization

B.3.3. Permanent or transitional housing search support, which may include:

providing Veterans with contact information for such places they wish to pursue for relocation purposes or permanent residence

conducting housing readiness evaluation to determine gaps in being able to complete housing applications

hands-on coordination with agencies and providers to assist Vet in exiting the CRS to another location.

assessing for whether a Veteran needs referral to retirement or rest homes, assisted living facilities, etc.

applying for other transitional housing programs. Veterans who need longer periods of support than what the CRS Program can accommodate may need referrals to other transitional or temporary housing arrangements.

B.4. Expectations of Case Management Staff.

B.4.1. Full-time case managers utilize the following approaches to engaging Veterans:

recovery-oriented and harm reduction

motivational interviewing, and/or

critical time intervention.

B.4.2. Case management staff will have weekly contact with Veterans to engage with them about

completion of goal-oriented tasks related to meeting basic and health needs and addressing

barriers to obtaining permanent housing. The expectation is that, based upon the collaboration

with the nursing staff, determination of the most appropriate permanent housing setting will be

determined swiftly and obtaining said permanent housing besides applying for other

possibilities will ensue as soon as possible. Case Managers will assist Veterans with

rides to view apartments, attend open houses, etc.

making resume enhancements

submitting applications to property managers

running credit reports

tracking down credit and personal reference contact information

other activities to address barriers to getting housing

Case managers and nursing staff may also do the following to help Veterans:

coordinate care with VA and non-VA providers, which may mean picking up prescriptions or phoning for health education purposes

arrange transportation to health care appointments

complete and submit paratransit forms to transportation authorities

discuss and facilitate the execution of advance directives

B.4.3. Case managers should have some experience working in social service or health care fields.

Work history with people who have chronic medical, mental health and substance abuse

problems is highly desirable. This list is not all-inclusive of offerings and opportunities to be

considered by contractor for training purposes, but contractor should have the capacity to direct

case management staff to trainings:

crisis intervention

cultural sensitivity

sexual harassment

sensitivity to wider issues of homelessness

harm reduction philosophy

laws regarding the ADA, fair housing, mandated reporting

de-escalation techniques

first-aid

trauma-informed care

B.4.4. Case managers will ensure that Veterans are safe and healthy. Case managers should be

able to assess, anticipate, and effectively refer Veterans experiencing crises for additional

support as appropriate. They will refer Veterans to mental and medical health providers as

necessary. If a Veteran is suicidal, homicidal, an altered mental status, or otherwise in

crises, the case manager will summon the appropriate staff to address or arrange for

Veteran to get to a hospital s emergency room.

B.4.5. Wherever Veterans in MRC are domiciling, those case managers, nursing staff,

resident staff, and other contractor-designated staff serving Veterans in that location, will

maintain BLS/CPR certification. First-Aid certification is highly encouraged.

B.4.6. Case managers will possess an educational level of at least a B.A. or B.S. degree,

preferably in a social science. Education level of case managers being at the M.A. or M.S.

level are preferred. Case managers will maintain whatever applicable licensures they possess.

B.5. Expectations and Role of Nursing Staff.

B.5.1. Registered Nurse(s) will be employed for at least 12 hours per week to do direct and administrative work with and related to MRC enrollees. At a minimum, RNs will have

current CPR and First Aid training and certification

state-required licensure to practice

be in good standing with their licensing board

a minimum of 2 years experience, preferably working with older adults

availability to work irregular hours, including weekends and holidays, as needed

B.5.2. The Nurse shall possess

a sound, working knowledge base about assisted living facilities, rest homes, & other appropriate housing for the disabled and elderly, especially amongst the geographic region

ability to create a comprehensive assessment to identify

the need for durable medical equipment,

the need for health education,

the health monitoring practices the nurse will engage the Veteran in

the need for medication management assistance

functional limitations and appropriate interventions

what communications with VA and other health care providers are needed

barriers and challenges to functioning independently and housing

the nurse s observations, impressions, prognosis for recovery, and any other applicable information.

an understanding of how to write SMART goals or otherwise document measurable, time-sensitive, and specific treatment plans

contribute to the housing-related disposition and case managers service plans

attend and contribute to case manager/VA Liaison/Veteran meetings, as applicable

B.5.3. The Nurse s role will consist of, but is not limited to, the following:

- Education and assistance with medication management and compliance

- Patient health education in areas such as sleep, nutrition, coping with chronic illnesses,

pain management, rehabilitation and recovery processes, age-related processes

- Vital signs monitoring

- Assistance with the use of VA Tele-Health as needed.

- Assistance with adaptive exercise, such as chair exercises

- Education to Case Managers, Residential Staff, and any other appropriate Contractor

desginees about interventions, means of communication, and recovery processes

concerning Veterans

following up with any and all VA or non-VA providers about any of the abovementioned for the sake of care collaboration, coordination, and continuity

HCHV CRS PROVIDER QUALIFICATIONS & CAPABILITY REQUIREMENTS

Contractor must comply with all HCHV CRS Program requirements as identified below.

C.1. VETERANS ENVIRONMENT AND SERVICES

C.1.1. Capacity for performing outreach or otherwise identifying and referring

homeless Veterans to MRC. Maintain sites within the catchment area of CWM VA HCS:

Franklin, Hampden, Hampshire, Berkshire, and/or Worcester Counties. The contractor

will have strong, ongoing partnerships with other social and health service providers,

such as Supportive Services for Veterans & Families (SSVF) programs, so that MRC

candidates can be identified.

C.1.1.i. The contractor will maintain an outreach log, documenting staff s

activity in referring Veterans to the CRS Program and the outcome of

those referrals. This log will include dates in which referrals were made

and be accessible to the Liaison upon request.

C.1.2.ii. Outreach to acute care and psychiatric hospitals and short-term rehab

nursing centers is encouraged.

C.1.2. Capable of providing ADA-compliant facilities, including sleeping quarters and

bathrooms. Doorways, hallways, and entrances to and from the buildings must be passable

for those in wheelchairs, with crutches, walkers, or other ambulation apparatuses, or

personal motorized scooters.

C.1.3. Capable of routing, referring, or summoning assistance for Veterans to get to emergency

and/or urgent care services per a stated policy that is accessible to Contractor designees or

staff who may be point persons for when emergencies or urgencies arise at Contractors

locations. At least one designated paid and trained staff member will always be on

site.

C.1.3.i. information on how to access designees for emergencies or urgencies

will be posted in common spaces for all CRS participants to be aware of

if need arises

C.1.3.ii. during intake process, attention will be made to ensure that Veterans are

aware of emergency and urgency reporting procedures and where to

access help with emergent or urgent situations

C.1.3.iii. In the event of an evacuation, lock-down, or shelter-in-place order,

contractor must track the location of each Veteran and report to the VA

Liaison the location and status of each Veteran as soon as possible and

no later than 24 hours.

C.1.4. Capable of ensuring that Veterans basic needs are met:

provide three daily nutritiously balanced meals and an evening snack and reasonable accommodation for special dietary needs (gluten or lactose intolerance, diabetic) in a setting that encourages socialization and possesses waste disposal and sanitization systems

offer a means for Veterans to wash clothes or otherwise tend to laundry, providing cleaning products if needed

provide secure, appropriate storage for both Veterans belongings and medication. Storage should be secure so that no other residents are able to access an individual Veterans medications

maintain a food pantry or shelf so that Veterans with food insecurity have readily available non-perishable options. Keep set times and days for when food pantry or shelf is accessible to Veterans.

maintain a clothing shelf operation or provide access to one off-site so that Veterans with cold weather clothing needs can receive provisions as needed

clean, sanitary, and safe common and sleeping spaces to include desk chairs, beds, dressers, etc.

provide linens, bedding, and toiletries as needed

for those Veterans who vacate the premises, retaining belongings for a minimum of 72 hours, if the Veteran returns to retrieve them.

Provide access to a working phone line for the Veteran to be able to conduct communications until an independent mobile device is secured for the Veteran or for those Veterans unable to utilize a mobile/cellular phone

provide monitoring, assessment, and guidance for Veterans who are high risk for suicide or have history of homicidal, violent, or suicidal ideation. Should staff at any time observe a Veteran express homicidal or suicidal ideation, appropriate referrals to mental health providers will be made for evaluation. VA HCHV Liaison will be notified just as VA-determined High-Risk Flagged Veterans admitted to the Contractor s facility will be identified to the Case Management Staff by the VA Liaison. Completion of any safety plans either by VA or Contractor personnel with the Veteran will be part of Contractor s clinical documentation. Veterans with violent and/or homicidal ideation or actions may be discharged from CRS for safety reasons at any time but must receive triaging and referring to appropriate VA and community providers from the Contractor.

C.1.5. Capable of providing transportation services to

assist Veterans with arranging local transportation to scheduled meetings and appointments.

help Veterans understand and learn how to utilize public transportation, including access to information and clarifying instructions necessary to effectively utilize public transit systems.

assist Veterans with identifying potential alternative modes of transport if public transportation is not available, adequate, or appropriate for a Veteran.

have designees with valid driver s licenses to complete transportation of Veterans and a formal process that Veterans can be educated about to initiate scheduling of such transportation.

C.1.6. Capable of minimizing risk of exposure to toxins, disease, etc. for Veterans. Universal

precaution practices are used by Contractor to prevent transmission of diseases and are

implemented under the presumption that blood and bodily fluids from any source are to be

considered potentially infectious. Supplies necessary for maintaining universal

precautions, such as sharps containers, must be available. Hand sanitizer shall be

available in common spaces and/or at doorways to encourage and promote infection

control and disease prevention.

C.2. STAFFING & PERSONNEL

The Contractor will employ sufficient personnel to carry out the MRC policies,

expectations, and programming. Case Management and Nursing personnel must have appropriate

and commensurate coverage for staff using authorized and unauthorized leave (e.g. holidays,

sick, family care leave, etc.) The Contractor shall assign personnel education and training when

required and maintain documentation of training completion and licensures. Contractors will

ensure that criminal background checks are completed on staff members. Contractors must have a

policy prohibiting staff from establishing sexual relationships with Contract enrollees.

During the first 90 days of contract performance, the contractor shall make NO substitutions of

key personnel unless the substitution is necessitated by illness, death, or termination of

employment. Within 14 days after substitutions necessitated by situations described above, the

Contractor shall provide resumes for the substitute key personnel to the Contracting Officer. The

Contracting Officer will notify the Contractor within 15 days of receipt of these documents

whether VA accepts the substitute CRS MRC key personnel. The VA reserves the right to refuse

or revoke acceptance of key personnel if personal or professional conduct, or lack of required

skills or experience, jeopardizes patient care or interferes with the regular and Ordinator operation

of the facility.

A list of authorized VA staff for the Contract shall be provided to the Contractor upon award of

the Contract. VA staff may be added or deleted from the list during the terms of the Contract at

the discretion of the VA Contracting Officer. The Contractor shall be provided an updated list of

authorized VA staff whenever such changes are made.

C.2.1. Capacity for case managers to be hired as full-time employees.

C.2.2. Capacity for nursing staff to be hired at least 12 hours per week to include being

able to manage on-call communications from other staff in the case of urgent

matters concerning Veterans outside of business hours.

C.2.3. Capacity for having at least 1 staff person, who is trained in

emergency management per the Contractor s policy/emergency management plan

and CPR, where there are MRC enrollees at Contractor sites.

C.2.4. Capacity for having at least 1 awake staff person on site 24/7/365 who can

respond to urgent matters and critical incidents. It is highly encouraged that these

support persons to be trained in CPR.

D. HCHV CRS PROVIDER ADMINISTRATIVE ROLES, RESPONSIBILITIES, & DUTIES

D.1.1. Occupancy: The contractor will be responsible for ensuring a minimally acceptable level

occupancy as defined in the Quality Assurance Surveillance Plan (QASP). VA Liaison and

Contractor will monitor how outreach efforts may relate to occupancy rates, if necessary, and

utilize Quarterly Meetings to trouble shoot and problem solve about low occupancy, if

applicable. The Contractor and VA will utilize Quarterly Meetings to debrief on how to

address other performance measures identified below.

D.1.2. Exits to Permanent Housing: The contractor is expected to promote a focus on achieving

stable housing for all MRC enrollees; exits to permanent housing will be monitored as an

indicator of overall program quality utilizing data provided by the VHA Support Service

Center s Homeless Service Scorecard the target rate for exits to this type of housing will be

50% or higher.

D.1.3. Negative Exits: Negative Exits are defined as discharges involving Veterans being asked

to leave the program due to rule violation or otherwise leaving the program without consulting

program staff in any way. Negative exits will be monitored on a continuous basis utilizing data

provided by the VHA Support Service Center s Homeless Service Scorecard the target rate

for these types of exits will be 20% or less.

D.1.4. Release of Information: The contractor shall ensure that a signed VA Release of Information

(ROI) is obtained for any Veteran being admitted to MR and that it is placed into the

individual case record so that it s also available to VA Liaison.

D.1.5. Individual Case Records: The contractor will maintain an individual case record for each

referred Veteran. Case records must be maintained in security and confidence as required by

the Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR part II) and the

Confidentiality of Certain Medical Records (38 USC 7332), and in accordance with the Health

Insurance Portability and Accountability Act (HIPAA: Pub. Law. 104 191). Records should

contain at a minimum:

reason for referral

pertinent demographic information (Veteran, family, employment, and education status)

copies of any medical prescriptions/orders issued by physicians

case management and progress notes that include specific service duration and outcome as well as referrals

any critical incident reports

a final summary (Exit Form or Discharge Note) that includes reason(s) for leaving,

the Veteran s known after care plans, and location upon exiting.

D.1.5.i. Case Notes should be titled according to content and relate to the Veterans goals as

identified in their service plans. Intake Notes should indicate the Veterans

strengths,

needs,

abilities, and

preferences

D.1.5.ii.: Individual Service Plans. an initial written plan shall be completed and entered in

the case record no later than 3 days after program admission and should be updated

monthly. The individual service plan should include goals that address:

Establishing permanent housing

Increasing income or skill level

Supporting self-determination and -preferences

Goals identified in the individual service plans are to be

Time-specific

Measurable

Behavioral

D.1.5.iii. Frequency. Progress notes should be completed ONCE WEEKLY. Case

managers should document attempts to engage Veteran, even if unsuccessful in doing

so. Service plans should be updated ONCE MONTHLY.

D.1.5..iv. Nursing/Medical Staff Documentation.

Just like the case managers, the nurse or medical staff should document all efforts and interactions related to and with the Veteran. Progress notes should be completed ONCE WEEKLY and service plans should be completed within 72 HOURS and updated ONCE MONTHLY. Nurse/medical staff documentation should include:

comprehensive nursing/medical assessment to include:

durable medical equipment needs

identification of daily living activity impairments

referrer and reason for referral

prognosis for housing type and timeframe for obtaining

The assessment will inform the service plan. (It is permittable for an all-encompassing service plan to be completed jointly with the case manager or be a separate nursing staff s stand-alone document.)

telephonic or electronic communications with non-VA and VA health care providers

interdisciplinary team meeting content, whether the meeting included the Veteran

medication administration, reconciliation, education, and/or monitoring matters

an Exit Form or Discharge Note that includes information on

follow-up services and after care and who they will be completed by

a summary of what was accomplished while with the Contractor

the location at discharge

(It is permittable for an Exit Form or Discharge Note to be completed jointly with the case manager or be a separate nursing staff s stand-alone document.)

D.1.6. Daily Census: The contractor is responsible for knowing Veterans status with the Program.

Rosters or census documents as to which Veterans are in the Program are to be given to the

VA Liaison daily Monday through Friday to ensure effective monitoring of bed utilization.

D.1.7. Incident Reporting: The contractor shall notify the VA immediately when any adverse

critical incident involving a Veteran admitted to the program occurs or when any staff becomes

aware of a critical incident having occurred. VA Liaison has operable cellular and office phone

where messages can be left as well as email capacity. Critical incidents are often those that

necessitate 9-1-1 calls or the summoning of police and may also involve Contractor staff.

Critical Incidents include:

Elderly/Dependent Adult Abuse or Neglect

Sexual Assault

Fire (Veteran Involved)

Medical or Mental Health Emergency

Suicidal ideation or attempt

Homicidal ideation or attempt

Physical Assault that results in significant injury

Significant Property Damage due to a Violent Act

Death

Significant Infectious Control Concerns (TB, etc.)

Observation/Possession of Weapons

Illegal Activity (prostitution, etc.)

Medication-related incident (stealing, selling, etc.)

If an incident occurs after hours, the local VA Facility Administrator on Duty (AOD) is to

be notified by telephone. VA or local police and/or EMTs are to be called as warranted

by the provider to ensure the safety and health of any parties involved with a critical incident.

Residential staff should follow emergency plan protocol as established by the Contractor.

D.1.8.i. Documentation. the critical incident should be documented via the Contractor s

incident report form within 24 hours of the critical incident occurring so that it is

available for viewing by the VA Liaison within 24 hours. Contractor shall

maintain a copy of all critical incident reports in the involved Veteran s

individual case record.

D.1.8. Length of Stay & Extension Requests: Generally speaking, Veterans remain under HCHV

CRS MRC for a total of 120 days. The contractor is responsible for coordinating with the VA

Liaison about Veterans in need of extensions under contract beyond the initially authorized

service period. This coordination will include discussion about justifications and lengths of

extension. VA Liaison will document justification of extension granted in the chart. Quarterly

Meetings will be a stage in which Contractor and VA can address length of stay issues should

they arise and whether or not particular MRC enrollees need extensions.

D.1.9. Discharge Reporting: The contractor is responsible for notifying the VA Liaison

within 24 business hrs. via the daily census of Veterans exits and for providing a written

exit form that contains the specific data required by the Northeast Program

Evaluation Center (NEPEC) for documentation of discharge in the Homeless Operations and

Management Evaluation System (HOMES). The Exit Form should be available to Liaisons

within 3 business days of the Veteran s discharge from the HCHV CRS.

DELIVERABLES

E.1. QUALITY CONTROL BUSINESS PLAN: The contractor shall submit a Quality Control

Business Plan that supports the program objectives and associated tasks. The CO shall review

and comment as necessary to ensure that contract goals are met.

E.2. STAFFING PLAN: The contractor shall provide a detailed staffing plan. Plan should

demonstrate that enough professional personnel are employed to carry out the policies,

responsibilities, and services required under this contract. The Contractor must supply key

personnel s

position description

licensures and/or certificates held

resumes

MRC key personnel include those in leadership roles, Resident Staff, Case Managers, and

Nurses. There are to be at a minimum the following:

contact information for an offsite administrator who can make decisions and take action pertaining to the MRC enrollees and sites in case of emergency available 24/7/365

contact information for residential staff and/or other designees for Veterans to access in the event of urgent or emergent concerns and events 24/7/365

designated staff having training in

blood borne pathogens and infection prevention and

medication monitoring or administration (whichever is applicable)

CPR

E.3. ADMINISTRATIVE DOCUMENTATION REQUIREMENTS INVOICES: The monthly

invoice is computed at the daily rate multiplied by the total number of beds occupied by Veterans

at midnight each night of the given month. Invoices should first be submitted to the VA Liaison

for approval and signature by the 5th of the month immediately following the billing period in

question. Once approved, invoices are to be submitted through the Tungsten Network (Electronic

Invoicing System) by the 10th of the month immediately following the billing period in question.

All electronic invoices submitted should be accompanied by invoice bearing VA Liaison signature

for reference of certifying official. (For additional information, Reference: VAAR 852.273-72

Electronic Submission of Payments pg. 23. and FAR 52.232-33 Payments by Electronic Funds

Transfer System for Award Management pg.27.).

F. ABSENCES AND CANCELLATION

F.1. The Contractor shall notify VAMC of any absences from the facility. Absences of the patient

from the facility over 48 hours will not be reimbursable. Should a patient leave in an

unauthorized manner, payment for services for that Veteran to the contract facility would be

continued for a maximum period of 48 hours provided there is an active outreach attempt on the

part of the contractor facility staff to return the Veteran to the residential treatment program and

a strong likelihood that the patient will return. Management of Negative Exits will be an

element of quality assurance review of this program.

F.2. The contractor may consider providing an authorized, pre-planned absence (or pass ) for UP

TO 4 DAYS/96 HOURS for family reunification (child/dependent visitation, e.g.) purposes.

F.3. The Contractor will be able to receive per diem payment when a Veteran absents the CRS for

any of the following reasons:

short term hospitalization for medical reasons

short term rehabilitation facility placement

detox

psychiatric or substance abuse residential or subacute unit treatment

All requests, reasons, and timeframes for passes must be documented in writing in the Veterans

individual case record.

F.4. VA reserves the right to remove any or all Veterans from the facility at any time without

additional cost, when it is determined to be in the best interest of the Veteran or VA.

F.5. When a Veteran is admitted to the MRC and found to be ineligible for the MRC, alternate

arrangements are to be made as soon as possible. VA reserves the right to not pay for someone

not appropriate and meeting criteria of MRC, even if Veteran is already present at the site.

G. CONDUCT

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).

The VA reserves the right to exclude Contractor staff members from providing services to Veterans under this contract based on breaches of conduct, including conduct that jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction, or negligence in performing directed tasks, or other conduct resulting in formal complaints by Veterans or other Staff members to designated Government representatives. The Contractor shall deal with issues raised concerning Contractor personnel conduct. The Contracting Officer shall be the final arbiter on questions of acceptability and in validating complaints.

Contractor must protect the rights and dignity of the individual or family served in all phases of service delivery. At a minimum, providers must afford each Veteran the following rights and protections. Clients must be permitted to exercise these rights without fear of reprisal.

Veterans are entitled to enjoy a safe and healthful environment in the program.

Veterans are entitled to be treated in a manner that respects their dignity, privacy and individuality.

Veterans with disabilities are entitled to reasonable accommodations under fair housing laws when such accommodations are necessary because of their disability. At no point shall program access be denied because of an individual s disability unless disability results in not meeting criteria for CRS MRC and is beyond the level of care that the Contractor can provide. Information learned about the Veteran s disability from any assessments will not be used as grounds for discharge or other punishment; it will be used to guide Veteran to appropriate services. Moreover, a program may not apply different rules to individuals because of their disabilities, unless the rules are a result of granting a reasonable accommodation request made by an individual with a disability. The Contractor shall not ask questions about a client s disability, including the nature and severity of the disability or the treatment, symptoms, and medications related to the disability unless there is a signed Release of Information to do so in place.

Veterans are entitled to remain in the program and not be involuntarily removed without reasonable notice, good cause, and just procedures.

All program clients are entitled to just and standardized procedures for determining eligibility, admissions, sanctions, discharges, and resolving grievances.

Veterans are entitled to reasonable privacy and confidential treatment of personal, social, financial, medical, mental, and behavioral health records, except as necessary to further treatment, information and referral services and in compliance with the resident s consent to release information, however bed/room checks policy should also be in place with Veteran s fully aware of what those entail.

Veterans are entitled to the full exercise of their civil, constitutional, and legal rights.

Veterans will have on-going opportunities to voice opinions, to participate in program operation and programming, and to make suggestions regarding programming and rules.

Veterans rights must be protected against all forms of discrimination, including those based on race, religious creed, color, national origin, ancestry, language, disability (physical or mental health), medical condition, marital status, familial status, age, gender, sexual preference, source of income, or political affiliation.

A written policy indicating that harassment of clients and staff on the basis of race, religious creed, color, national origin, ancestry, language, disability (physical or mental health), medical condition, marital status, familial status, age, gender, sexual preference, source of income, or political affiliation will not be condoned nor tolerated should be part of the Resident Handbook that the Veteran receives.

Contractors will develop a written policy for transgender clients that provides for safe, secure, and dignified case management as well as accommodate the special requirements needed for privacy. People who do not clearly identify as male or female should have access to whichever sleeping and/or bathroom accommodation helps them feel safest. Where there are single-use showers and bathrooms in the facility designated for residents, transgender residents will be told about them and welcome to, but not required to, use them. It is the Contractor s responsibility to promote a safe environment for transgender clients amongst the general population. Contractor s policy will not contradict VHA Directive 1341(2), Providing Health Care for Transgender and Intersex Veterans dated May 23, 2018.

H. COMPLAINTS

The identified VA Liaison will monitor the services being provided in all HCHV CRS Facilities. The contractor is expected to cooperate with VA Staff and COR by providing information and answering questions in a timely manner when requested. Contractor shall refer complaints received directly from Veterans to the identified VA Liaison within 48 hours of complaint. All complaints received by the VA Liaison that of a life-threatening manner to a Veteran, will be immediately forwarded to the contractor and shall be investigated promptly. After investigation and clarification of disposition, the contractor shall respond to the VA Liaison within five (5) working days or less with proposed resolution or plan for corrective action. The CO shall be notified in instances where the proposed course of action or response does not appear sufficient to resolve any given complaint.

The resident handbook, given at the time of intake/admission, will include a grievance policy so that Veterans may know how to address in a step-by-step process format - concerns and complaints concerning the CRS Program and their stay at the shelter. Grievance process to address Veteran complaints must include timeframes for response, per VHA Directive 1162.04 6.b.3.

FACILITIES

The residential locations must be within the counties of Worcester, Franklin, Berkshire,

Hampden and/or Hampshire. The Contractor may have more than one physical plant in

which Veterans will domicile while participating in the CRS.

It is the responsibility of the Contractor to properly maintain its facilities and the VA

shall have no responsibility for paying or reimbursing the Contractor for such expenses.

The work environment may require a combination of settings from personnel s personal sedentary office to shared space in the residential care setting. The work is typically preformed in an adequately lighted and climate-controlled facility. Work may require occasional travel for transport assistance, case management activities, and/or treatment consultation.

I.1. General requirements: It is the responsibility of the Contractor to properly maintain its facilities and the VA shall have no responsibility for paying or reimbursing the Contractor for such expenses. The contract facility must:

I.1.1. Have a current occupancy permit issued by the local and state governments in the

jurisdiction where the facility is located.

I.1.2. comply with existing standards of State safety codes and local, and/or State health

and sanitation codes.

I.1.3. Meet the requirements of the Americans with Disabilities Act (ADA) (Public Law 100-336,

42 USC 12101-12213) pertaining to handicapped accessibility in effect on the date of

contract award.

I.1.4. Where applicable, be licensed under State or local authority.

I.1.5. Where applicable, be accredited by the State.

I.1.6. Be equipped with operational air conditioning/heating systems

I.1.7. Be kept clean free of dirt, grime, mold, or other hazardous substances and damaged

noticeably detract from the overall appearance.

I.1.8. Be equipped with first aid equipment and an evacuation plan in case of emergency.

I.1.9. Have windows and doors that can be opened and closed in accordance with manufacturer

standards. It is strongly recommended that windows on non-ground floors not be openable

beyond 3 inches.

I.1.10. Be able to accommodate for the storage of wheelchairs and other mobility devices. Be

able to accommodate for durable medical equipment storage, implementation, and usage

by Veterans (i.e. grab bars, shower chair, CPAP machine, wound care supplies, etc) and

maintain their condition and operability in the facility

I.1.11. Possess an adjustable wheelchair for facility use. Maintain a first aid kit in a readily

available common area of the facility.

I.2.1. Fire Safety Requirements:

The building must meet the requirements of the applicable residential occupancy chapters of the current version of NFPA 101, National Fire Protection Association's Life Safety Code. Any equivalencies or variances must be approved by VANCHCS Director.

Fire drills must be held 6 times a year. Residents must be instructed in evacuation procedures when the primary and/or secondary exits are blocked. A written fire evacuation plan for evacuation in the event of fire shall be developed and reviewed annually. The plan shall outline the duties, responsibilities and actions to be taken by the staff and residents in the event of a fire emergency. This plan shall be implemented during fire exit drills. A written policy regarding tobacco smoking in the facility shall be established and enforced.

Portable fire extinguishers shall be installed at the facility. Use NFPA 10, Portable Fire Extinguishers, as guidance in selection and location requirements of extinguishers. Requirements for fire protection equipment and systems shall be in accordance with NFPA 101. All fire protection systems and equipment, such as the fire alarm system, smoke detectors, and portable extinguishers, shall be inspected, tested and maintained in accordance with the applicable NFPA fire codes and the results documented.

J. INSPECTIONS

J.1. Annual Inspections.

Prior to the award of any contract and annually thereafter during any

subsequent contracted performance periods, a multidisciplinary VA team consisting of

a social worker or mental health clinician for clinical review purposes,

dietitian or nutrition and food service professional, who will also conduct twice annual

unannounced inspections

nursing or pharmacy staff,

VA Police,

a Safety and Occupational Health Specialist and

any other subject matter experts the VA medical center director deems necessary

Inspectors will survey the contractor s facilities to be used to provide Veterans food, shelter, and clinical services to assure the facility provides acceptable level quality care in a safe environment. Additional inspections may also be carried out, announced or unannounced at any other time as deemed necessary by VA.

The contractor will be advised of the findings of the inspection team. If deficiencies are noted during any inspection, the contractor will be given a reasonable amount of time (typically 30 days) to take corrective action and to notify the Contracting Officer that the corrections have been made. A contract will not be awarded until noted deficiencies have been eliminated. Failure by the Contractor to take corrective action within the reasonable time provided will be reported to the VA Contracting Officer. If corrections are not made to the satisfaction of the VA, the Contracting Officer will be notified, and shall be the final arbiter on the necessary resulting consequences and action.

Cursory environmental reviews will be conducted and based upon observations by VA Liaison(s).

These reviews will be recorded. Any grossly apparent infractions will be addressed with subject matter experts and the Contractor.

A VA CRS Inspection Form template is available from the VA Liaison upon the Contractor s request.

J.1.1. Life Safety Code. The inspection of the Contractor facilities will include inspection for conformity to the current Life Safety Code as described in paragraph 5, and will also include the following:

J.1.2. General observation of residents to determine if they maintain an acceptable level of personal hygiene and grooming.

J.1.3. Assessment of whether the facility meets applicable fire, safety and sanitation standards.

J.1.4. Determining whether the facility is in attractive surroundings conducive to social interaction and the fullest development of the resident's rehabilitative potential.

J.1.5. Observation of facility operations to see if appropriate organized activity programs are available during waking hours (including evenings) and degree to which a high level of activity is observed in the facility, such as individual professional counseling, physical activities, assistance with health and personal hygiene.

J.1.6. Seeking evidence of facility-community interaction, demonstrated by the nature of scheduled activities or by information about resident flow out of the facility, e.g., community activities, volunteers, local consumer services, etc.

J.1.7. Observation of staff behavior and interaction with residents for appropriateness and effectiveness. Observation of staff s ability to share their knowledge base about the residential facility programming and their roles and responsibilities.

J.1.8. Inspecting the types of meals and other nutrition provided to residents to see if appetizing, nutritionally adequate meals are provided in a setting, which encourages social interaction and if nutritious snacks between meals and bedtime are available for those requiring or desiring additional food, when it is not medically contraindicated.

J.1.9. A clinical review of Veterans records to ensure accuracy with respect to services provided to the Veterans.

J.1.9. It is highly recommended that all Contractor policy and procedural document is reviewed for accuracy and updated annually.

All Department of Veterans Affairs inspection findings for residential facilities furnishing treatment and rehabilitative services to eligible Veterans shall, to the extent necessary, be made available to all government agencies charged with the responsibility of licensing or otherwise regulating or inspecting such institutions as well as the VA Integrated Services Network (VISN)

J.2. Unannounced Quarterly Inspections.

J.2.1. Unannounced visits by the Liaison occur quarterly and will monitor the following:

visual safety and sanitation inspection, including meal preparation areas, fire exits, sleeping quarters, and medication storage.

Emergency and disaster plans: contractor staff trainings and drill logs on such, and information about such in common spaces accessible to any Veteran or staff person

Contractor s chart records on Veterans per random selection

Veterans complaints to ensure that these have been resolved in a fair, impartial and consistent manner.

J.2.2. Cursory environmental reviews will occur when the VA Liaison is on site at the facility.

The cursory environmental review is a notation in a log following a visit of any area of

improvement observed was addressed with staff, that any hazardous situation or glaring

infraction on inspection compliance was brought to the immediate attention of Contractor

administration, and/or that there were no remarkable issues to note. Environmental cursory

reviews may include observed incidents of compliance and adherence to expectations laid

out in this Performance work statement.

J.2.3. Although subjected to change at the discretion of the VA Liaison, Contractor designee will

be notified the morning of or day before an unannounced inspection occurs to ensure that

appropriate staff are available to facilitate the accessibility of the site by the VA Liaison.

J.2.4. Unannounced nutrition inspections will occur bi-annually and will be facilitated by the

dietitian/nutritionist.

K. QUARTERLY MEETINGS

Quarterly Meetings are collaborative in nature. They are opportunities for Contractor and VA to

review Contractor performance and address issues or concerns. They are meant to be supportive

and strengthening of the partnership between VA and Contractor. Quarterly Meetings have set

agendas and are times of updating one another with new information.

During Quarterly Meeting with Contractor staff, the VA Liaison shall provide the contractor with

a written report detailing program data and activities on a quarterly basis. The report will contain,

at minimum, the following information:

Occupancy rate

Percent of Veterans discharged to permanent housing

Percent of negative discharges.

This information will be reviewed with the contractor. A detailed action plan concerning steps to be taken to address performance measures will be determined between Contractor and Liaison. During this meeting, results of the unannounced inspections will be discussed. Liaison and Contractor will review areas for improvement, challenges to maintaining compliance, success stories, issues of concern pertaining to Veterans, and any other matters related to the Contractor-VA partnership. It is understood that quarterly inspections and reports are forwarded to VA leadership as indicated.

DELIVERABLES TIMETABLE

QUALITY CONTROL BUSINESS PLAN

Current professional liability insurance documentation

with response to solicitation

(IF PREVIOUSLY AWARDED CONTRACTS BY VA) MOST RECENT DOCUMENT OF INSPECTION RESULTS

with response to solicitation

DOCUMENTATION OF SUPPORTIVE SERVICES:

- operational manual, to include (unless a separate document is provided):

bed bug policy

fire drill policy

service to transgender persons policy (See Performance work statement Section G)

employee & residential staff education &/or training policy (i.e. how soon will what training or orientation take place)

- residential handbook(s)

- if not noted in the residential handbook(s), the following:

tobacco use policy

non-discrimination policy

grievance &/or complaint policy

medication-related policy

- Contractor group and class offerings, ongoing recreational opportunities, and other programming material

with response to solicitation

position descriptions of

nursing staff

case managers

leadership

resident/support staff

with response to solicitation

within 15 days of change in staff

Trainings, Licenses, and/or Certifications belonging to

nursing staff

case managers

leadership

resident/support staff

with response to solicitation

within 15 days of change in staff

resumes for

nursing staff

case managers

leadership staff

resident/support staff

with response to solicitation

within 15 days of change in staff

Employee Handbook

with response to solicitation

CPR and Blood Born Pathogens Certificates for designated employees

with response to solicitation

within 15 days of change in staff who are to have this training/certification

(drafted or proposed) referral form for admission

with response to solicitation

Certificate of Occupancy

with response to solicitation

documented evidence of sites meeting ADA building requirements/standards (see Performance work statement Section I.1.3.)

documentation of sites meeting NFPA 101 (see Performance work statement Section I.2.1.)

with response to solicitation

signing of invoices

by the fifth of every month

submission of invoices into electronic invoicing system

by the tenth of every month

Emergency Management Plan to include responses to and protocol for fire, pandemic, natural disaster, mechanical crises, etc.

with response to solicitation

Staffing Plan (i.e. contingency planning, staff to Veteran ratio) (see Section E.2. of Performance work statement)

with response to solicitation

critical incident reports

within 24 hours of occurrence

documentation of Veterans signed authorization to release of information using VA Form 10-5345 (September 2022 edition) between VA and MRC CRS

within 24 hours of site entry

documentation of nursing assessments

within 48 hours of site entry

documentation of referral for admission

within 48 hours of receipt from referrer

documentation of initial individual service plans

within 72 hours of admission

documentation of weekly interactions with Veterans by case managers and nursing/medical staff

within 72 hours of interaction

documentation of updated individual service plans

within 30 days of the previous individual service plan

an exit/discharge note for each Veteran who leaves the site

within 72 hours of Veteran discharging/exiting

census/rosters of those under Contract (see Performance work statement Section E.3.

daily, during business hours