V225--5-year Ambulance Service Memphis VA Medical Center and associated CBOCx/Clinics

Performance Work Statement (PWS)

GROUND AMBULANCE

VISN 09/Station 614

Purpose: The Lt Col. Luke Weathers, Jr. VA Medical Center (hereafter Memphis VA Medical Center), its associated Community-Based Outpatient Clinics (CBOCs), and affiliated healthcare clinics require contracted non-emergency ambulance transportation services. The contractor shall provide all vehicles, personnel, management, supplies, equipment, and necessary reporting for the provision of Stretcher Transports, Basic Life Support (BLS), Advanced Life Support (ALS), Critical Care Transport (CCT) services. The contactor shall make these ambulance services available to the VA as needed, 24 hours a day, seven days a week (24/7), including weekends and holidays.

Background: The Lt. Col. Luke Weathers, Jr. VA Medical Center main campus is located 116 N Pauline St, Memphis, TN, 38105, serving over 196,000 veterans, primarily from the Memphis area and it s eight (8) Community-Based Outpatient Clinics. The hospital has 236 inpatient beds and the facility servers Veterans that live within the 53 counties from Memphis, TN, Arkansas, and Mississippi.

County/Zip Code

County/Zip Code

County/Zip Code

County/Zip Code

County/Zip Code

Craighead/72437

Crittenden/72364

Lauderdale/38063

Chester/38340

Desoto/38641

Poinsett/72342

Obion/38261

Crockett/38001

Shelby/38105

Tate/38668

Cross/72396

Weakley/38225

Tipton/38015

Fayette/38068

Marshall/38635

St Francis/72335

Henry/38242

Haywood/38012

Hardeman/38008

Benton/38603

Lee/72360

Dyer/38024

Madison/38301

McNairy/38375

Tippah/38663

Phillips/72342

Gibson/38382

Henderson/38351

Hardin/38372

Alcorn/38834

Mississippi/72370

Carroll/38344

Decatur/38329

Tunica/38376

Prentiss/38829

Tishomingo/38852

Quitman/38646

Panola/38606

Lafayette/38655

Union/38652

Coahoma/38614

Pontotoc/38863

Lee/38804

Itawamba/38843

Bolivar/38372

Tallahatchie/38921

Yalobusha/38965

Grenada/38901

Calhoun/38951

Chickasaw/38851

Monroe/39730

Clay/39773

Lake/38079

Acronyms

ALS Advanced Life Support

AOD Administrative Officers of the Day

BLS Basic Life Support

CCT Critical Care Transport

CCTP Critical Care Transport Paramedic

CCEMTP Critical Care Emergency Medical Transport

CO Contracting Officer

COR Contracting Officer s Representative

CPR Cardiopulmonary Resuscitation

DOL Department of Labor

EMT Emergency Medical Technician

IAW In Accordance With

OO Ordering Officer

PWS Performance Work Statement

QASP Quality Assurance Surveillance Plan

QC Quality Control Plan

TB Tuberculosis

TJC The Joint Commission

VTS Veteran Transportation Service

Scope/Requirements

Types of Ambulance Service

The contractor shall provide Emergent, non-emergent Stretcher Transports, Basic Life Support (BLS), Advanced Life Support (ALS), and Critical Care Transport (CCT) Tier 1, 2, and 3 ambulance services on an

as-needed basis in accordance with all federal, state, and local regulations.

Occasionally a veteran will need to be transported with VA staff and equipment; the contractor shall return VA Staff and equipment to the original place of pick-up.

Transport of Miscellaneous Items with the Patient

The Contractor may also be required to transport patient luggage, medical records, medication, and comfort items from pickup points to destination at no additional cost to the Government. Luggage to be transported will be

restricted to suitcase and valise types. When patients are transported to the VA Memphis VA Medical Center, destination is deemed to be the ER, Admissions, the clinic, or service within the hospital, or directly to the ward as instructed by VA Staff.

Contractor Personnel: Contractor personnel shall be courteous and always conduct themselves in a businesslike manner while providing services under this contract.

Emergency Medical Technicians (EMTs), Critical Care Transport Paramedics (CCTPs) & Other Personnel

EMTs, CCTPs and other medical personnel (as applicable) shall at all times meet the qualifications specified in this contract as well as all applicable federal, state, and local government laws, regulations, and standards. EMTs, CCTPs and other medical personnel (as applicable) shall be certified, licensed, or otherwise officially recognized by the local, state, or regional government or public entity where the emergency service is operated or by which it is governed.

If the contractor wishes to add or replace personnel throughout the life of the contract, it shall provide evidence of required training, certifications, licensing, and any other qualifications to the Contracting Officer s Representative (COR) for review.

All ambulance drivers shall have a valid driver s license in accordance with state requirements for their place of operation and the services they perform. If the contractor wishes to add or replace drivers throughout the life of the contract, it shall provide a valid driver s license to the COR.

CCTPs shall have met all state requirements for the tier in which they are performing services in (I, II, III). Proof in the form of a current certificate for the successful completion of such must be provided to the COR upon request.

Investigative Requirements for Contract Personnel: Contract personnel will be subject to the same investigative requirements as those for regular VA appointees and employees. The level of investigation commensurate with the level of access to perform the performance work statement is: Special Agreement Checks (SAC). Fingerprinting for contract personnel will be conducted at the Memphis VA Medical Center. Thereafter the contracted employees will be subject annually to the same requirement, with a 90-day window to complete such requirement as provided by the Memphis VA Medical Center. The VA Security and Investigation Center (SIC) is responsible for adjudicating all background investigations for contract employees.

EMTs, CCTPs, and other contractor personnel as applicable must pass the Contractor s background check and must not have been convicted of (or have any pending charges for) a felony for the past

five years. Personnel (and Contractor) must report any new or additional charges or convictions if

they arise during the course of performance under this contract so VA can review them and determine whether the employee in question needs to be discharged of his or her duties until the matter is adjudicated.

Tuberculosis Exposure Control Policy

The contractor shall provide the VA with a policy on tuberculosis (TB) exposure and control, to include TB decontamination.

The contractor shall have its personnel tested for TB in accordance with state guidelines and provide written confirmation to the COR that all personnel (current employees and any new hires) performing services under this contract are current in their TB test by at the start of each Ordering Period.

Contractor Equipment, Vehicles, and Inspection

Ambulances shall meet all applicable federal, state, and local regulations and specifications, including but not limited to licensing, registration, and safety standards.

The VA reserves the right to inspect the contractor s equipment and vehicles or require documentation of compliance with state laws, rules, regulations, and guidelines governing emergency medical transport vehicles (ambulances). VA inspections of contractor equipment do not constitute a warranty or guarantee that the contractor s vehicles and equipment are properly maintained. The VA reserves the right to restrict the contractor s use of equipment and vehicles in the performance of this contract which are not in compliance with contract requirements. The restriction of such equipment and vehicles shall not relieve the contractor from performance in accordance with the contract nor necessitate additional cost to the VA.

Vehicles shall be clean and maintained in good repair in accordance with manufacturer s instructions.

The contractor shall not borrow or exchange supplies, equipment, and/or medications with the VA. Equipment attached to or in use by the patient at time of pick-up may remain with the patient during transport to ensure continuity of care. Medical Control Authorities are responsible for maintaining and supplying medication during patient transport. All VA equipment and unused medications must be returned to VA during patient drop-off or as promptly as feasible within 24 hours.

The contractor shall furnish all linen required for patient transport at no additional cost. Linen shall not be exchanged with linen belonging to Memphis VA Medical Center or its CBOCs.

The contractor must be capable of transporting the drugs and/or equipment as required by the patient as listed in Attachment A Critical Care Transport Capabilities Confirmation. The contractor shall have the appropriate medications, up to and including CCT Tier III if necessary, based on the EMS region the ambulance provider is functioning in.

The contractor shall furnish qualified personnel as required by contract specifications to accomplish all services under this contract.

The contractor personnel performing services for the VA, shall, at all times, conduct themselves in a professional manner, and be identified by having the company name, and employee name affixed to

the uniform. The Contractor shall be responsible for furnishing all vehicles, uniforms, nametags and/or badges for performance of services under this contract. Employee identifications shall be worn in clear view above the waist. The contractor personnel shall not smoke/play loud music originating from any device in vehicles while transporting VA patients.

Each driver shall possess a driver s license that is valid for the class of vehicle driven. Evidence of a special transportation service vehicle permit, or endorsement issued by the commissioner of public safety.

Be at least 18 years of age and have not less than one year of experience as a licensed driver; and

For the past three years:

Have not had a driver s license canceled or suspended.

Have a driving record clear of convictions for operating a motor vehicle or motorcycle without insurance.

Have a driving record clear of convictions for driving a motor vehicle without a valid current license for the class of vehicle driven

Have a driving and criminal record clear of convictions for driving under the influence of alcohol or a controlled substance.

The contractor personnel will ensure that the patient is secured to the stretcher/cot and that the stretcher /cot is secure in the back of the ambulance before the vehicle moves.

Ambulance drivers shall have a valid driver s license, in accordance with Federal, State, and local government requirements for their place of operation for the services they perform, be capable of administering oxygen and shall have successfully completed the standard and advanced first aid course of the American Red Cross of U.S. Bureaus of Mines of equivalent and be capable of providing necessary medical assistance to the attending emergency medical technician or paramedic.

Emergency Medical Technician (EMT) and Paramedic Qualifications: EMT s and Paramedic s providing services under this contract shall have the following qualifications, in additions to those required by Federal, State, and Local Government:

Have completed training in accordance with the standards published by the Department of Health and Human Services with a minimum curriculum of 150 hours or equivalent including an in-hospital training period. Such training programs must also be acceptable under the regulating requirements for local EMS Systems supported by DHHS under PL 93-154, Federal Register 39:24304. (1974).

Shall be certified, licensed, or otherwise officially recognized by the local, state of regional government or public entity where the emergency ambulance service is operated or by which it is governed.

Transportation Request

4.5.1 VetRide or VA-Approved Transportation Software Utilization:

The contractor agrees to utilize the VetRide Vendor Portal or VA-Approved Transportation Software with every patient transported under this contract.

Department of Veteran Affairs will provide the software and access to the VetRide Vendor Portal or VA-Approved Transportation Software for the vendor/contractor in this contract. The Contractor will utilize the VetRide Vendor Portal or VA-Approved Transportation Software fully as instructed:

Receive and respond to electronic trip requests.

Receive, use, and ensure the use of the Vendor pass by the driver.

Submit claims via the electronic HCFA 1500 in the VetRide Vendor Portal or VA-Approved Transportation Software system.

All invoices must be submitted within 30 calendar days of date of service in accordance with 38 CFR 70 to be considered timely submission.

The contractor s invoice must be on the HCFA 1500 to include:

Contract Number

Date of Service (to include Box 24 A-J)

Authorization number(s)

Pick-up and drop-off location of the patient

Base Rate

Name (Last, First and Middle Initial (if any)) and Full Social Security number (Box 1a) of patient transported

Date of Birth and Sex

Diagnosis Codes or Nature of Illness or Injury

Documentation of circumstances when billing for waiting time

Any miscellaneous charges for which the contractor is expecting reimbursement i.e., Tool charges, waiting time, etc.

VA authorizing official s name

Healthcare Procedure Coding System/National Level II (HCPCS)

Unauthorized charges will be reviewed by the Contracting Officer Representative (COR) as to the validity of the charges and as to whether the payment will be made. A final determination will be made within 30 days after notifying the Contractor of the charges, which are being suspended.

A transportation request is defined as one incidence of a request for one-way service (Stretcher Transports, BLS, ALS, CCT). No more than one patient will be transported per order unless approved by an authorized VA staff. Transportation requests will be made through VetRide or VA-Approved Transportation Software Utilization. Contractors must have the capability to receive orders, update ride status, and input trip costs and other required data through this portal. Contractors must have dedicated staff available to monitor this portal 24/7. Memphis VA Medical Center Travel Program Staff will be available to assist with account setup and training for the Contractor s Staff. In the event VetRide or other VA-Approved Transportation Software Utilization is down, other methods of communication (i.e., telephone, facsimile) will be used to place Transportation requests.

Memphis VA Medical Center Travel Program Staff/or authorized VA employees will work with the Contractor the following business day to reconcile any transportation requests that were placed outside of VetRide or VA-Approved Transportation Software Utilization.

The Contractor must update VetRide or VA-Approved Transportation Software Utilization with any data and/or notes in real time that deviate from the original order such as invoicing for additional mileage due to a road closure, wait time, reason for no load, etc. Memphis VA Medical Center Travel Program Staff/or authorized VA employees may place a hold on payment of this order until it has been reconciled.

Only the following VA staff are authorized to place, cancel, or make changes to transportation requests:

Contracting Officer (CO) Ordering Officers (OO)

Administrative Officer of the Day (AOD) Beneficiary Travel Office Staff

Contracting Officer s Representative (COR)

The Contracting Officer will furnish the Contractor with the names of individuals above, who are authorized as Ordering Officers, by separate memorandum upon issuance of the contract. The Contracting Officer will update this list throughout the life of the contract as Ordering Officers change.

Ordering Officers are responsible for issuing and administering orders placed under this contract. Ordering Officers have no authority to modify any term of this basic contract. Any deviation from the terms of the basic contract must be approved in writing by the Contracting Officer responsible for this contract. The Contractor shall accept orders against this contract only from the Contracting Officer and/or authorized ordering officers. Fulfilling orders from persons other than the Contracting Officer or ordering officer may result in loss or delay in payment for supplies/services provided under such orders.

Non-authorized VA employees and private agencies (e.g., nursing homes) are not considered authorized to place transportation requests.

All patient pick-up(s) and drop-off(s) shall be authorized via orders which shall only be issued by the designated Ordering Officers. When placing orders for services, the Ordering Officer shall contact the designated contractor point of contact(s) to provide the following information:

Mode of transportation required,

Required time of arrival

Name of the beneficiary,

Pick-up and delivery point,

Type and number of additional medical care specialists required,

Type of equipment required,

Last four of the patient's Social Security Number, and

Any other special instructions

For ALL Transports an Audit system will be put in place by the VA to include the COR or designee, Beneficiary Travel Department staff, and clinical staff to ensure appropriateness of the order and timeliness of the response.

The type of transportation service (Stretcher Transports, BLS, ALS, CCT) required will be discussed and determined by VA clinical personnel and the contractor. The contractor shall transport the patient per its policies and standard industry practice. If the type of transportation service differs from what was agreed upon by the VA and contractor, the contractor shall submit documentation to the VA explaining its rationale.

The VA may authorize an escort (e.g., spouse, relative, guardian, etc.) to accompany the patient during medical transport if it is practicable and, in the patient s, best interest. The contractor shall allow the escort to accompany the patient at no additional cost.

The contractor shall have sufficient vehicles and personnel to provide services for up to four (4) simultaneous transportation requests. Transports required may be for any mix of Stretcher Transports, BLS, ALS transports. One of these four simultaneous transports may require CCT capability up to Tier III. If Memphis VA Medical Center requires ambulance services exceeding four (4) simultaneous transportation requests, the vendor will be offered to provide the services if they have sufficient vehicles/personnel available; but may decline these additional orders if sufficient vehicles/personnel are unavailable.

The number of transports under normal operating conditions will typically range from 2 -5 transports each weekday and significantly less on weekends and holidays. The number of actual transports may vary throughout the life of the contract.

The patient may bring with her or him up to three (3) liters of oxygen. The contractor shall be responsible for providing adequate and safe storage of the oxygen tanks during transport.

Response Times*

Orders that are scheduled by 7pm local time the day before the required services are defined as scheduled in advance. With the exceptions found below, the contractor shall arrive on time for all orders scheduled in advance.

Emergent Transport (Originating from VA (Only): The contractor shall be required to provide Ground Ambulance arrangements within thirty (30) minutes of order/patient pick up call.

For all add-ons (not scheduled in advance) transportation requests, with pick up at Memphis VA Medical Center: The contractor will be allotted up to a ninety (90) minute response time from time of order placement for transportation requests that are not previously scheduled in advance.

For an urgent transport request for a critical patient (as deemed by the physician) with pick up at Memphis VA Medical Center, the contractor will be allotted up to a sixty (60) minute.

For transportation requests which do not have a pick-up at Memphis VA Medical Center:

The contractor may be required, if requested by the VA, to dispatch ambulances on short notice for transportation request not scheduled in advance; for these transportation requests the contractor shall dispatch ambulances within thirty (30) minutes of receiving the order.

Pick-up appointment times shall be agreed upon by the VA and contractor at time of order placement and be reasonable based upon travel distance, speed limits, and weather conditions.

The contractor s patient pick-up time cannot be more than 15 minutes prior to the schedule pickup time nor 15 minutes later than the scheduled pickup time for transportation requests scheduled in advance.

* The contractor shall not be held liable for nonperformance caused by an occurrence beyond the reasonable control of the contractor and without its fault or negligence such as, acts of God or the public enemy, acts of the Government in its sovereign or contractual capacity, fires, floods, epidemics, quarantine restrictions, strikes, and unusually severe weather. The contractor MUST notify the VA with as much advance notice as possible should any of these occur.

Cancellations

For trips in which the contractor is notified of cancellation before the vehicle is dispatched, there shall be no charge to the Government.

A no show is defined as a transportation request which is cancelled after the contractor has dispatched a vehicle, the vehicle is enroute, or has arrived at the pick-up location, and there is no longer a requirement for patient transportation. The contractor may request one-way reimbursement for no-shows. No-show reimbursement shall be based upon the base rate for the type of service requested (Stretcher Transports, BLS, ALS, CCT) and the one-way mileage (Stretcher Transports, BLS, ALS, CCT) accrued enroute to the pick-up location at time of cancellation. Mileage for no- show cancellations shall be confirmed by the contractor and reported to the VA as soon as possible from time of cancellation.

For transportation requests OUT of Memphis VA Medical Center ONLY The contractor will immediately dispatch a vehicle upon receipt of the order (including transportation requests in which the final destination may change prior to pick up due to the critical condition of the patient). When the contractor is notified of a cancellation prior to arrival at the Memphis VA Medical Center campus, there shall be no charge to the Government.

Pick-Up/Drop-Off/Reporting Procedures

Ambulance personnel shall pick-up and deliver patients at specified locations (e.g., front door of Memphis VA Medical Center Entrance). These locations will be specified by VA staff when an order is placed and communicated to the transporting personnel.

When applicable, ambulance personnel shall report to the Veteran Transportation Service (VTS) Dispatcher or Administrative Officer of the Day (AOD) to (1) announce his/her arrival to pick-up and

transfer the patient and (2) obtain report of pertinent information regarding the patient s condition from the primary nurse/physician.

When delivering a patient, ambulance personnel shall give report to the appropriate VA healthcare staff and provide a copy of the run sheet which will be retained by the facility for inclusion to the patient s medical record.

In cases where ambulance personnel must divert to a local emergency department while performing a VA authorized transport, the contractor s dispatcher shall notify the VA Beneficiary Travel Department or Administrative Officer of the Day of the patient s location and status as soon as this information becomes available.

Patient Welfare

The contractor shall be responsible for the patient s welfare during transport. The contractor shall be held responsible for patient and/or VA property during transport. Any damaged or lost wheelchairs, walkers, crutches, or personal belongings shall be replaced at the contractor s expense.

The VA requires the contractor to exercise extreme caution and care in the handling of patients.

If a VA beneficiary being transported declines to be properly secured or removed the securement devices himself/herself, the driver will notify the Contracting Officer s Representative (COR) of this fact prior to departure. The contractor is not required to transport any VA beneficiary who refuses to be properly secured while being transported. In the event that the beneficiary refuses to be properly secured, they shall be returned back into the building which they came from.

Incident Reporting

The contractor shall notify the COR, Requestor, Program Manager, Beneficiary Travel Department, of any accidents and/or safety problems that occur while the patient is being transported. This notification shall occur within one (1) hour by telephone. A written report of the incident shall be delivered to the COR, Program Manager, or Beneficiary Travel Department, by the close of business of the next working day.

The COR will monitor the service provided. The contractor shall cooperate with the COR in providing information and answering questions in a timely manner. The contractor shall promptly inform the COR of any complaints received directly from patients. If warranted, the VA may conduct incident investigations and require written response from the contractor within 48 hours of request.

Invoicing

Each transport shall include thirty (30) minutes of wait time; the contractor may invoice for wait times in excess of this initial thirty (30) minutes. Wait time shall begin only once the contractor has both reached the pick-up address location and the appointment time has elapsed. All wait times shall be itemized and invoiced in fifteen (15) minute intervals. For partial fifteen (15) minute intervals, zero (0) to seven (7) minutes shall be rounded down to zero (0) minutes and eight (8) to fifteen (15) minutes rounded up to fifteen (15) minutes.

When invoicing for mileage, the contractor shall round to the nearest mile. Mileage ending in .5 or higher shall be rounded up to the nearest mile. Mileage ending in .4 or lower shall be rounded down to the nearest mile. Payment for mileage to or from the point of care shall be limited to the VA s calculation according to the VA s Bing Maps API determination. Bing Maps API is optimized to determine mileage based on the shortest time of travel.

If unloaded mileage exceeds loaded mileage, the contractor may invoice for a flat fee only if the following also occur:

Unloaded mileage exceeds 75 miles

The contractor does not deviate from a route to intentionally make unloaded mileage exceed loaded mileage.

Except for no shows and trips when unloaded mileage exceeds loaded mileage in accordance with 4.9.3, the contractor shall invoice for loaded (patient onboard) services and mileage only.

Upon notification of the contracting officer, the vendor must receive training and begin implementation of invoices via Vet Ride within 30 days versus VA Tungsten Network e-Invoicing network. Invoices must be submitted via the electronic HCFA 1500 in the VetRide Vendor Portal or other VA approved software. These invoices shall not include patient information, but shall include the following:

Contractor Name

Contract Number

Current Purchase Order Number

Date of service

Total amount invoiced including a summary of the total number of charges that align with the line items of this contract (i.e., total number of BLS Base Rate, total BLS Mileage incurred, etc.)

An itemized list of charges or services rendered that align with the line items of this contract (i.e., BLS Base Rate, BLS Mileage incurred, etc.)

Payment by VA under this contract to a provider of ambulance transportation services authorized under this contract extinguishes any and all liability on the part of the VA BENEFICIARY for that transportation service.  UNDER NO CIRCUMSTANCES ARE VA BENEFICIARIES, THIRD PARTY INSURANCES, MEDICARE, OR MEDICAID TO BE BILLED FOR THE SERVICES PERFORMED UNDER THIS CONTRACT.

Period & Place of Performance

This contract s ordering period shall be effective from Date of Award through ___03/31/2030_______.

The Place of Performance is variable and may occur within the states of Tennessee, Mississippi, Arkansas, Georgia Alabama, and Kentucky ambulance services may be required to or from locations including, but not limited to the following:

Lt. Col. Luke Weathers, Jr. VA Medical Center to include specific Emergency Department, pavilions, or out-buildings on the Lt. Col. Luke Weathers, Jr. VA Medical Center campus. The Lt. Col Luke Weathers, Jr. VA Medical Center address is: 116 N Pauline St, Memphis, TN 38105.

Memphis VA Medical Center Community-Based Outpatient Clinics (CBOCs):

CBOC Name

Address

Covington VA Clinic

3461 Austin Peay Highway

Memphis, TN 38128-3801

Dyersburg VA Clinic

1067 Vendall Road

Dyersburg, TN 38024-1622

Helena VA Clinic

125 Quarles Lane

West Helena, AR 72390-1923

Holly Springs VA Clinic

1700 Crescent Meadows Drive

Holly Springs, MS 38635-7417

Jackson VA Clinic

180 Old Hickory Boulevard, Suite A

Jackson, TN 38305-2500

Jonesboro VA Clinic

1843 East Highland Drive, Suite B

Jonesboro, AR 72401-6118

Nonconnah BLVD VA Clinic

1689 Nonconnah Boulevard

Memphis, TN 38132-2105

Savannah VA Clinic

70 Harbert Drive North

Savannah, TN 38372-3451

Tupelo VA Clinic

1114 Commonwealth Blvd

Tupelo, MS 38804-4753

Other VA Medical Centers, Hospitals, or CBOCs within Veterans Integrated Service Network (VISN) 09 including, but not limited to:

Medical Center Name:

Address:

Troy Bowling Campus

1101 Veterans Drive

Lexington, KY 40502-2235

Franklin R. Sousley Campus

2250 Leestown Road

Lexington, KY 40511-1052

James H. Quillen Department of Veterans Affairs Medical Center

Corner of Lamont Street and Veterans Way

Mountain Home, TN 37684

Robley Rex Department of Veterans Affairs Medical Center

800 Zorn Avenue

Louisville, KY 40206-1433

Alvin C. York Veterans' Administration Medical Center

3400 Lebanon Pike

Murfreesboro, TN 37129-1237

Nashville VA Medical Center

1310 24th Avenue South

Nashville, TN 37212-2637

Other Non-VA Medical facilities and Community Care facilities as authorized by the VA.

Veteran s residence.

Local airports including Memphis International Airport.

Quality Control Plan

Quality Control

The contractor shall maintain a Quality Control Plan (QCP) that contains, at a minimum, the following:

A description of the company s organizational structure including a description of the roles and responsibilities of management and supervisors.

A description of the methods to be used by the contractor for identifying and preventing deficiencies or problems in the quality of service.

A description of the specific steps the contractor will take for corrective action if needed if a deficiency or problem in the quality of service occurs.

A description of the company s records and tracking system used to identify up-to- date background checks, applicable certifications and tests, and training of each employee performing services under this contract.

A description of the method used to provide on-time ambulance services to meet the requirements of this contract (24/7 availability and up to 4 simultaneous transports in accordance with PWS 4.5.1.7).

A description of the methods used to identify and prevent radio communication breakdowns and a detailed procedure for alternative communications in the event of electronic and mechanical breakdown of vehicle two-way radios.

CONTENGENCY PLAN: (In case VetRide Vendor Portal is down) A description of the method/system used to log all requests for service. The contractor shall confirm that the log indicates the date and time of service call, actual time of pick-up versus the scheduled time, name of patient requiring services, designated pick-up and delivery points, mileage, and actual waiting time at pick-up and delivery points if waiting charges are claimed. The contractor shall confirm the log will be sent to the COR monthly.

The Government will evaluate the contractor s performance under this contract to ensure that the

contractor s QCP is adequate, and that quality is achieved through a Quality Assurance Surveillance Plan (QASP).

The Government shall prepare a QASP after contract award derived from the PWS and contractor s submitted quality control plan. The QASP is a living document and the Government may review and revise it at any time. However, the Government shall coordinate changes to the QASP with the contractor.

The QASP will specify the work requiring surveillance and the Government s method of surveillance.

Minimum Performance Standards

The contractor shall maintain performance standards in accordance with the standards outlined in the table below. Failure to meet the Acceptable Quality Levels (AQL) may result in termination of the contract.

The QASP will include the standards below as well as others derived from the successful offeror s quality control plan.

Task

PWS

Reference

Standard

Acceptable Quality Level

Method of Surveillance

Provide on- time ambulance

services

Section 4.5.1.8.3

Scheduled patient pick-ups shall not deviate more than 15 minutes past scheduled pick-up time for scheduled

orders

97%

Customer Feedback

Incident Reporting

Section 4.8

The contractor shall notify the Program Manager, Beneficiary Travel Department, of any accidents and/or safety problems that occur while the patient is being transported. This notification shall occur within one (1) hour by telephone. A written report of the incident shall be delivered to the Program Manager, Benefits Management, by the close of business of the next working day.

97%

Customer Feedback

Invoice Reports

Section 4.9

Provide a monthly invoice including secondary documentation in accordance with Section 4.10 of the PWS

95%

100% inspection

of monthly invoices/reports

COVID-19 Or Other Similar Infectious Diseases

Contractor shall not refuse transports of COVID-19 positive or other similarly infected patients.

Contractor shall abide by all additional procedures and precautions that may be implemented by the VA based on VA-issued guidance and/or CDC recommendations. These procedures are subject to change throughout the life of the contract and will be incorporated via attachment.

Contractor shall have written policy of steps they will take to prevent the spread of COVID-19 or other similarly infectious diseases by their employees and/or vehicles. This policy shall, at a minimum, include procedures of screening drivers before each shift, deliberate decontamination of their vehicles and all other preventative precautions taken by Contractor employees.

Contractor shall furnish all required PPE throughout the life of the contract.

Conformity To Regulations

8.1 The contractor and his/her operators shall conform to all Federal, State, and local regulations governing the performance of contracted services.

8.2 VAMC facilities have been designated NO SMOKING areas in their entirety. Individuals found in violation of this no smoking policy may be subject to a $50.00 federal citation for disregarding posted safety rules and regulations. Furthermore, the contractor may be directed to stop work. The contractor is to notify all of his/her employees and/or sub-contractors of this strict enforcement policy.

Wage Rates

9.1. Wage Determination(s) as listed in Section D in this solicitation are applicable to any resulting contract.

9.2. The contractor certifies by signature on this offer that the salaries to be paid workers involved in the performance of the contract are equal to or greater than those specified in the attached Wage Determination(s).

9.3 The Department of Labor has held that contractors must pay their employees the Service Contract Act waged while they are driving both to and from destinations for the VA. The Wage Determination is attached in Section D.

Evidence of Coverage

10.1 Before commencing work under the contract, the contractor shall furnish the Contracting Officer with a certification from his/her insurance company indication that the coverage outlined in this contract has been obtained and that it may not be changed of canceled during the term of the contract.

Worker s Compensation

11.1 The Act of June 25, 1936, 42 Stat. 1938 (40 USC 290), authorized the constituted authority of the several states to apply their workmen s compensation laws to all lands and premises owned or held by the United States. The contractor agrees to procure and maintain while the contract is in effect, Worker s Compensation and Employers Public Liability insurance. The policy shall provide coverage for Public Liability Limits of not less than the statutory

limitations for any one accident, and at least meet the statutory limitations if more than one person is involved., Upon award of the contract, the contractor shall furnish to the Contracting Officer a certificate from its insurance company indicating that this coverage has been obtained and that such coverage may not be changed or canceled unless 30 day advance written notice is provided to the Contracting Officer.

Contractor Personnel Security Requirements

12.1 All contractor employees who require access to the Department of Veterans Affair's computer systems or who come into contact with veteran/beneficiaries shall be the subject of a background investigation and must receive a favorable adjudication from the VA Office of Security and Law Enforcement prior to contract performance. This requirement is applicable to all subcontractor personnel requiring the same access. If the investigation is not completed prior to the start date of the contract, the contractor will be responsible for the actions of those individuals they provide to perform work for the VA.

Position Sensitivity - The position sensitivity for this contract has been designated as LOW RISK.

Background Investigation - The level of background investigation commensurate with the required

level of access for this contract is National Agency Check with Written Inquiries.

Contractor Responsibilities:

The contractor shall pre-screen all personnel requiring VA access to ensure they maintain a

U.S. citizenship and are able to read, write, speak, and understand the English language.

The contractor shall submit or have their employees submit the following required forms

requested by Department of Veterans Affairs, Office of Security and Law Enforcement, Security

and Investigations Center, 2200 Fort Roots Drive Bldg. 104, North Little Rock, AR 72114 within

30 days of receipt:

All documents completed and submitted at the following website: http://www.va.gov/SECURITYINVESTIGATIONSCENTER/

The contractor, when notified of an unfavorable determination by the Government, shall

withdraw the employee from consideration from working under the contract. Failure to comply

with the contractor personnel security requirements may result in termination of the contract or

cause.

The contractor shall agree that all deliverables, associated working papers, and other material deemed relevant by the contractor in the performance of this task order are the property of the United States Government. The contractor shall agree that all individually identifiable health information shall be treated with the strictest confidentiality. Access to records shall be limited to essential personnel only. Records shall be secured when not in use. At the conclusion of the contract, all copies of individually identifiable health records shall be destroyed or returned to the VA. Any individually identifiable health records shall be deleted from computers not belonging to the VA. The contractor shall comply with the Privacy Act, 38 U.S.C. 5701, 38 U.S.C. 7332, and 5 U.S.C. 552(a) et. Seq. Contractor staff shall sign confidentiality statements before the start date of the contract. The contractor shall comply with all provisions of the Health Information Portability and Accountability Act (HIPAA), including but not limited to privacy, security of electronic health data, and adherence to standards and code sets as required by HIPAA. The contractor shall ensure the confidentiality of all patient and employee information and shall be held liable in the event of breach of confidentiality. Any person, who knowingly or willingly discloses confidential information obtained from the VA with non-essential persons, may be subject to fines.

12.1.1 HIPAA COMPLIANCE. HIPAA compliance is required. The contractor must adhere to the provisions 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). As required by HIPAA, the Department of Health, and Human Services (HHS) has promulgated rules governing the security and use and disclosure of protected health information by covered entities, including the Department of Veterans Affairs (VA). In accordance with HIPAA, the contractor may be required to enter into a Business Associate Agreement (BAA) with VA.

12.1.2 BLOOD BORNE PATHOGENS: The contractor and the employees provided, pursuant to this contract, shall comply with the effective VAMC Policy (and Occupational Health requirements in accordance with OSHA Blood Borne Pathogens (BBP) Law and the OSHA Tuberculosis Compliance Directive, enforceable under OSHA s General Duty Clause) governing health care workers infected with a blood borne pathogen. If the contractor obtains information that a health care worker providing care pursuant to this agreement may be infected with a blood borne pathogen, the contractor will advise the Contracting Officer immediately.

Medical Liabilities Insurance

13.1 The contractor shall carry required insurance (See VAAR Clause 852.237-7 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE) and vehicle insurance in accordance with the Tennessee Department of State Health Services.

Annual VHA Training

14.1 In accordance with VHA Directive 2003-028 "Compliance and Business Integrity Program", its updates or replacement directives, IG Guidance at 8994, Section II(C); Guidance at 4875, Section III (B)(4) Sentencing Guidelines, Section 8B2.1 (b) (4) (B) annual compliance training is to be provided to all contractors within the scope of their work. The medical center COTR s are to coordinate the annual training with their respective Contracting Officer and

Compliance and Business Integrity Officers. A copy of the documentation of the completed annual training is to be provided to the Compliance and Business Integrity Officers for their files.

In accordance with VHA Directive 1605.1 Privacy and Release of Information , updates or replacement directives annual VHA Privacy Policy Training is to be provide to all contractors within the scope of their work. A copy of the documentation of the completed annual training is to be provided to the Contracting Officer and the facility Privacy Officer for their files.

In accordance with VA Directive 6500, Information Security Program , updates or replacement directives annual VHA Cyber and Security Information Training is to be provided to all contractors within the scope of their work. A copy of the documentation of the completed annual training is to be provided to the Contracting Officer and the facility Information Security Officer for their files.

Conformance with Environmental Management Systems

15.1 The contractor shall perform work under this contract consistent with the relevant policy and objectives identified in the agency, organizational, or facility environmental management system (EMS) applicable for your contract. The contractor shall perform work in a manner that conforms to all appropriate Environmental Management Programs and Operational Controls identified by the agency, organizational, or facility EMS, and provide monitoring and measurement information as necessary for the organization to address environmental performance relative to the environmental, energy, and transportation management goals. In the event an environmental nonconformance or noncompliance associated with the contracted services is identified, the contractor shall take corrective and/or preventative actions. In the case of a noncompliance, the contractor shall respond and take corrective action immediately. In the case of a nonconformance, the contractor shall respond and take corrective action based on the time schedule established by the EMS Site Coordinator. In addition, the Contractor shall ensure that their employees are aware of the roles and responsibilities identified by the environmental management system and how these requirements affect their work performed under this contract.

All on-site contractor personnel shall complete yearly EPA sponsored environmental training specified for the type of work conducted on-site. Upon contract award, the Contracting Officer's Representative will notify the facility-level Environmental Management Systems Coordinator to arrange EMS training for appropriate staff.

Contractor Performance Assessment Rating System (CPARS)

Required Registration with Contractor Performance Assessment Rating System (CPARS)

16.1 As prescribed in Federal Acquisition Regulation (FAR) Part 42.15, the Department of Veterans Affairs (VA) evaluates contractor past performance on all contracts that exceed $1,000,000 and shares those evaluations with other Federal Government contract specialists and procurement officials. The FAR requires that the contractor be provided an opportunity to comment on past performance evaluations prior to each report closing. To fulfill this requirement VA uses an online database. The CPARS database information is shared with the Past Performance Information Retrieval System (PPIRS) database, which is available to all Federal Agencies.

16.2 ach contractor whose contract award is estimated to exceed $1,000,000 is required to register with the Contractor Performance Assessment Rating System (CPARS) database at the following https://www.cpars.gov/

or by calling (207) 438-1690. Registration should occur no later than thirty days after contract award and must be kept current should there be any change to the contractor s registered representative.

16.3 For contracts with a period of one year or less, the contracting officer will perform a single evaluation when the contract is complete. For contracts exceeding one year, the contracting officer will evaluate the contractor s performance annually. Interim reports will be filed each year until the last year of the contract when the final report will be completed. The report shall be assigned in CPARS to the contractor s designated representative for comment. The contractor representative will have thirty days to submit any comments and re-assign the report to the VA contracting officer.

16.4 Failure to have a current registration in the CPARS database, or to re-assign the report to the VA contracting officer within those thirty days, will result in the Government s evaluation being placed on file in the database with a statement that the contractor failed to respond.

Surveillance Checklist

Lt. Col. Luke Weathers Jr. VA Medical Center

Contract: Ground Ambulance

Date/Time of Inspection:

Government POC Primary:

Government POC Alternate:

Organization:

Lt. Col. Luke Weathers, Jr. VA Medical Center

Location: Bldg. Post

SS

Performance Objective

PWS Para

Performance Threshold

Method of Surveillance

Met

Not Met

Remarks

SS 1

The contractor shall provide Ambulance service, 24 hours per day, 365 days per year, as required in accordance with the terms and conditions contained herein.

1

95% Compliance

100% Surveillance of each patient pick-up.

SS 2

The objective of Standards for Maintenance is to protect veterans and to cause no harm to all parties. The contractor shall maintain all vehicles in a clean and orderly condition, free from debris and accumulations which may create an accident, injury, or fire hazard.

4.4.3

95% Compliance

100%

Surveillance

SS3

The contractor shall maintain (and furnish upon request) procedures that outline preventive maintenance and/or repairs on each vehicle in an individual vehicle file and in chronological order, latest service on top. A statement from the Contractor indication compliance of vehicle maintenance files is in place should be submitted at time of offer for evaluation purposes. Requested submission and verification of these documentation requirements will be a quality assurance procedure during the contract period.

4.4.3

95% Compliance

100%

Surveillance

SS4

The contractor shall furnish qualified personnel as required by contract specifications to accomplish all services under this contract.

4.3.1

100% Compliance

100%

Surveillance

SS5

Have completed training in accordance with the standards published by the Department of Health and Human Services with a minimum curriculum of 150 hours or equivalent including an in-hospital training period. Such training programs must also be acceptable under the regulating requirements for local EMS Systems supported by DHHS under PL 93-154, Federal Register 39:24304. (1974).

4.3.1

100% Compliance

100%

Surveillance

SS6

A licensed MTO shall ensure that sanitation procedures are provided to all personnel in a written document that conforms with current standards as set forth in occupational safety and health administration-blood borne pathogens protocol.

Attachment B

100% Compliance

100%

Surveillance

Attachment A

Critical Care Transport Capabilities Confirmation

If a transport is classified as a Critical Care Transport (CCT) the offeror must be capable of transporting the drugs and/or equipment as required by the patient (listed below), up to and including Tier III, if necessary, based on the EMS region the ambulance provider is functioning in. Prospective offerors must sign and return this form confirming they can meet these criteria for CCTs

ordered under this contract.

Drug Supply List: Equipment List:

Acetylcysteine (Acetadote, Mucomyst) Chest tubes

Amiodarone (Cordarone) Portable mechanical vents; including CPAP

Antibiotics All VADs

Blood and Blood Products CVP lines

Diltiazem (Cardizem) Swan-Ganz line

Dobutamine SmartPump Capability: up to 6 IV drips

Dopamine

*Any pump(s) capable for up to and including 6 infusion lines or IV drips as required by the patient. If the pumps are not compatible with VA supplied IV tubing, the contracted ambulance would need to provide their own tubing and be able to switch the tubing over prior to transport. *

Fentanyl (Sublimaze)

Furosemide (Lasix)

Heparin

Hyperalimentation

(TPN and lipids)

Insulin

Labetalol (Trandate)

Lidocaine

Lorazepam (Ativan)

Magnesium Sulfate

Mannitol

Zoll X Series Critical Care Monitor Capabilities:

Continuous 12-lead EKG monitoring

2-Temperature Monitoring

Automatic Blood Pressure

Capnography

2 arterial lines monitoring

Midazolam (Versed)

Milrinone (Primacor)

Nicardipine (Cardene)

Nitroglycerin (NitroStat, Nitro-Dur, Nitro-Bid)

Norepinephrine (Levophed)

Octreotide (Sandostatin)

Ondansetron (Zofran)

Pantoprazole (Protonix)

Phenylephrine (Neo-Synephrine)

Potassium Chloride

Propofol

Sodium Bicarbonate

Vasopressin (Pitressin)

TPA* (Pending)

I hereby confirm that _______________________________ can meet the criterion for Critical Care Transports.

(Company Name)

_____________________________________ ______________

Signature of Company Representative Date

CDC Guidance for Disinfecting NEMT and EMS Vehicles (ambulances): See Link below:

https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-for-ems.html

https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/cleaning-disinfection.html

Follow-up and/or Reporting Measures by Operators/Drivers After Caring for a Patient with Confirmed or Suspected COVID-19

Operators/Drivers should be aware of the follow-up and/or reporting measures they should take after caring for a patient with confirmed or suspected COVID-19:

VA facilities should develop policies for assessing exposure risk and management of VTS personnel potentially exposed to SARS-CoV-2 in coordination with state and/or local public health authorities and local VA facility infection prevention and control professional. Decisions for monitoring, excluding from work, or other public health actions for VTS Operators with potential exposure to SARS-CoV-2 should be made in consultation with Transportation Chief, Executive Leadership Team, and local VA facility Occupational Health. Refer to CDC guidance, Interim U.S. Guidance for Risk Assessment and Public Health Management of Health care Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease 2019 (COVID-19), for additional information.

Personnel who have been exposed to a patient with suspected or confirmed COVID-19 should immediately notify their chain of command to ensure appropriate follow-up.

Any unprotected exposure (e.g., not wearing recommended PPE) should be reported to Occupational Health Services, a supervisor, or a designated infection control officer for evaluation.

Operators/Drivers should be alert for fever or other symptoms of COVID-19 (e.g., respiratory symptoms such as cough, shortness of breath, sore throat). See CDC link for further information about COVID-19 symptoms: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html. If symptoms develop, they should self-isolate and notify their supervisor

and Occupational Health Services. In addition, it may be required that the local Public Health Authority be notified to arrange for appropriate evaluation.

Based on local assessment of the situation and actions taken (e.g., self-quarantine), appropriate OSHA documentation may need to be completed.

Definition of Terms:

Source Control: Use of cloth face coverings or facemasks to cover a person s mouth and nose to prevent spread of respiratory secretions when they are talking, sneezing, or coughing. If a person has a tracheostomy (trach), it is important to cover the tracheostomy as well as the nose and mouth.

Personal Protective Equipment (PPE): Personal protective equipment (PPE) is used every day by health care personnel (HCP) to protect themselves, patients, and others when providing care. PPE helps protect HCP from many hazards encountered in health care facilities (e.g., gown, gloves, mask, eye protection).

Face Covering: Typically, textile (cloth) covers that are intended for source control (e.g., bandanas, cloth masks). Face coverings are not personal protective equipment (PPE).

Facemask: Facemasks are personal protective equipment (PPE) and are often referred to as surgical masks or procedure masks. Facemasks are designed to protect against splashes and sprays to the nose and mouth and also can provide source control.

N95 Respirator or equivalent: A respirator is a personal protective device that is worn on the face, covers at least the nose and mouth, and is used to reduce the wearer s risk of inhaling hazardous airborne particles (including dust particles and infectious agents), gases, or vapors. Respirators are certified by the CDC/NIOSH, including those intended for use in health care. Health care personal should be medically cleared and fit tested if using respirators with tight-fitting facepieces (e.g., NIOSH-approved N95 respirator) and trained in the proper use of respirators, safe removal and disposal, and medical contraindications to respirator use.

Eye Protection: Eye protection (i.e., goggles or a face shield that covers the front and sides of the face) protect the eyes from splashes or sprays. Reusable face shields and goggles should be cleaned and disinfected after each use. Face shields are not a substitute for a facemask. Note: Protective eyewear (e.g., safety glasses, trauma glasses) with gaps between glasses and the face likely do not protect the eyes from all splashes and sprays and not considered as eye protection. Regular reading glasses, prescription lenses or glasses, and sunglasses are also not typically considered eye protection.