Amended to extend the Offer Due Date.

Amended to update D.11 PAST PERFORMANCE CONTACTS and include Questions and Answers.

1 B.3 PERFORMANCE WORK STATEMENT - DESCRIPTION 1. The Department of Veteran Affairs, VA John J. Pershing Veterans Affairs Medical Center hereafter referred to as VA is located at 1500 N Westwood Blvd, Poplar Bluff, MO 63901, Contracted Emergency Residential Services (CERS) model of residential care at a facility located within 30 miles of the above Medical Center. These services, not to exceed 52 Veterans at any one time, are to be provided to homeless Veterans as defined in the Performance Work Statement (PWS). The VA National Center on Homelessness among Veterans ( the Center ) will provide ongoing training for program development for both contract providers and VA staff. Contractor will be evaluated based on the Center s established evaluation protocol and program fidelity measures. Contracted Emergency Residential Services (CERS) programs target and prioritize homeless Veterans transitioning from literal street homelessness, Veterans being discharged from institutions, and Veterans who recently became homeless and require safe and stable living arrangements while they seek permanent housing. CERS Programs, either directly or through linkage with community and other VA services, provide time-limited services such as supporting mental health stabilization, SUD treatment services, enhancement of independent living skills, vocational training, and employment services. Emphasis is placed on referral and placement in permanent housing or longer-term residential programs utilizing VA and/or community resources. Lengths of stay in CERS typically range from 30 to 90 days with the option to extend based on clinical need. Eligibility will be determined by the VA, based on veteran status; meeting the McKinney-Vento Homeless Assistance Act definition of homelessness (see http://www.hudhre.info/hearth/ for additional information); and an assessment by the VA Health Care for Homeless Veterans (HCHV) program resulting in a determination of making the Veteran highly vulnerable and requiring CERS services. This is an indefinite delivery/indefinite quantity contract for the period March 29, 2024 to March 28, 2029 in accordance with FAR 16.5. 2. BACKGROUND AND OVERVIEW: The Secretary of the VA has set a zero-tolerance policy for homelessness within the Veteran population. As part of the Plan to End Homelessness among Veterans announced in late 2009, the Veterans Health Administration has been increasing both capacity of existing programs and services offered to program participants. The plan calls for utilizing new models of care not previously offered by VA. The VA s Plan to End Veteran Homelessness calls for enhancing current homeless service capacity as well as developing new programs and initiatives in concert with community and federal partners. This contract will enable a community provider to offer homeless Veterans services through a CERS model of residential care. This model will offer services to homeless Veterans under the HCHV CERS program enhanced by the services as defined in the PWS. Rapid stabilization of the Veterans medical, mental health, substance abuse and other psychosocial problems to place Veterans in other appropriate transitional or permanent housing within 30 to 60 days, with no more than 120 days, without a planned reason for the extension approved by the VA Liaison, is an expected outcome of this Contract. The community-based Contractor should have a minimum of 24 months experience with direct service to the homeless documented in the proposal. This contract will be awarded to a Contractor having an acceptable facility within 30 miles of the VA Medical Center. If no facilities are available within this area, consideration will be given to the Contractor whose facility meets all the stated requirements and is closest to the Medical Center. A VA Liaison to the Contractor will be identified by the homeless program leadership at VA. This individual will act as the clinical liaison for all client related issues between the Contractor and VA by providing clinical oversight. The VA Liaison will not provide direct clinical supervision to contract staff. The VA Liaison will consult with and provide input to the Contractor as needed. The Contractor shall provide all labor, supervision, housing, material and supplies necessary to provide emergency residential placement, treatment, and supportive services through the HCHV program CERS Model. Services will be provided on-site at the Contractor s facility, in accordance with all terms, conditions, provisions and requirements listed herein. The prices provided in the Price Schedule shall be inclusive of all basic services as may be necessary in the treatment of the Veteran. Basic services shall be as defined in the Statement of Work. 3. IMPLEMENTATION TIMELINE: The contract facility and associated onsite services are expected to pass inspection and become fully operational within 30 days from the date of contract award. See D.5, Attachment 5, LDSH Inspection Form. Failure to meet the 30-day milestone may result in the contract being terminated. The Contractor will demonstrate successful completion of the following tasks, validated by VA inspection, prior to receiving Veteran referrals and invoicing for payment: a. Site control demonstrated at time of contract award. This may be through ownership or lease. All permits and license will be reviewed. The Contractor is required to ensure that the facility used for this contract meets fire and safety code imposed by the State law, and the Life Safety Code of the National Fire and Protection Association. It is important to note that typically the Life Safety Code is more stringent than local or state codes. No additional funds will be made available for capital improvements under this contract. Applicants also should note that all facilities, unless they are specifically exempted under the Life Safety Code, are required to have an operational sprinkler system. VA will conduct an inspection that Contractor sites must pass prior to contract award. The Contractor is required to ensure the facility used for this contract meets the Americans with Disabilities Act (ADA) guidelines for accessible accommodations for Veterans with physical limitations or impairments. This is also referred to as Architectural Barriers Act compliant. At least 5% 7% of a facility s HCHV Contract Residential Care beds must meet ADA accessibility requirements, to include entrances/exits, bathroom facilities, and common areas. For example, if a Contractor has 20 beds for the HCHV Contract Residential Care program in the facility, two (2) to four (4) of those beds must be accessible to Veterans with physical limitations or impairments. Veterans must not be segregated from the rest of the facility due to physical disability; they must have full access to the services and supports at the facility. Contractor facility must be licensed as required for the setting under State or Federal authority, and must meet all applicable local, state, and/or Federal requirements concerning licensing and health/occupancy codes. Copies of valid licenses must be provided to the VA at the time of pre-inspection and for all annual inspection reviews. Where applicable, the facility must have a current occupancy permit issued by the authority having jurisdiction. CERS housing and supportive services for female Veterans under this contract are required to ensure the safety and privacy of these Veterans. Men and women must have separate bathroom facilities. The facility must have female residential rooms or sections that are securely segregated or restricted from men to ensure safety and privacy. If the facility cannot accommodate both male and female Veterans at one location, the provider must make available equivalent facilities and services for the opposite gender that meet the terms of the contract for facilities and services. b. Pre-Award Inspection of the facility and on-site services conducted by VA contract inspection team. This team is made up of HCHV clinical staff, VA fire and safety officials, nursing, dietetics, and other staff as deemed necessary for facility inspection. Pre-award inspection will be completed within 30 days of proposal submission. Any items requiring corrective action will be communicated to the Contractor in writing within one (1) week of inspection. c. Complete the abatement of all inspection corrective action(s) and pass VA inspection. To be completed within 30 days of pre-award inspection. d. Identify all staff required per the PWS, have them in place and available to provide full range of case management and services to Veterans. To be completed within 30 days of contract award. e. Work will be performed at the Contractor s facility within the geographic limitations outlined above. Government furnished workspace will not be provided for this effort. Government furnished property will not be provided to the Contractor. All equipment required by the Contractor will provided at their expense. The Contractor will be required to attend frequent meetings and planning sessions at VA throughout the term of the contract. f. The Contractor shall not commence performance under this contract until the Contracting Officer has conducted a kick-off meeting or has advised the Contractor that a kick-off meeting is waived. 4. GUIDELINES FOR SERVICES: HCHV Re-Inspections: Annual re-inspections must occur for each HCHV CRS program and four unannounced site visits each quarter. Annual re-inspections should be unannounced whenever possible. For any deficiency that is noted during inspections, plans of correction with timeframes to correct the deficiency must be submitted by the Contractor within 15 days of notification. These unannounced site visits must include: A visual safety and sanitation inspection of the facility including meal preparation areas, fire exits, sleeping areas and medication storage. Any safety or sanitation deficiency must be addressed immediately. The Nutrition and Food Service checklist is at D.6, Attachment 6. Review of the contract provider s emergency and disaster plans to ensure they are up to date, and that staff are trained in the procedures outlined in the plans. An audit of Veteran s clinical records selected randomly to ensure documentation of case management services and that other services are being provided as required by the contract terms. Review of any Veteran complaints to ensure that these have been resolved in a fair, impartial, and consistent manner. b. Cursory Environment Review: (1) During quarterly unannounced inspections, a cursory environmental review must be conducted using D.7, Attachment 7. (2) If a hazardous condition or deficiency is noted, the HCHV CRS Liaison or other VA medical facility staff must act to ensure that immediate appropriate actions are taken by the HCHV CRS provider to ensure the safety and well-being of the Veterans and then make appropriate notification to VA medical facility staff to include the CO and COR for inspection, guidance, and follow-up. The Contractor must provide a safe environment for all Veterans consistent with the CERS model of housing and services. The Contractor will offer safe and stable time-limited living environment along with supportive services necessary to complete a individualize treatment plan to obtain permanent housing. Veterans cannot be denied entry to CERS based solely upon length of current abstinence from alcohol or non-prescribed controlled substances, the number of previous treatment episodes, the time interval since the last program entry, the use of prescribed controlled substances, or legal history. The screening process must consider each of these special circumstances and determine whether the program can meet the individual Veteran's needs while maintaining the program's safety, security, and integrity. Acceptance of treatment cannot be a condition of admission or continued stay; Medication adherence or compliance cannot be a condition of admission or continued stay; Abstinence from alcohol or drugs cannot be a condition of admission or continued stay; Infractions of rules should be used as opportunities for engagement; Management of suspected or known drug or alcohol use or relapse by one or more Veterans and interventions based on the CERS model including Motivational Interviewing and Harm Reduction; On-site contraband, weapons, drug or alcohol related paraphernalia (i.e., found alcohol, drugs, drug works , etc.) and utilize interventions based on the Harm Reduction model; Safe prescription medication storage and handling, including specific provisions for prescribed controlled substances; Room inspections, including methods and frequency to be tracked in a log and available for review by VA staff upon request; Grievance process to address Veteran complaints with Contractor providing a response to the complaint to the VA within 3 business days; Client abandonment of belongings in the facility, including time frames and procedures for disposal; Process to elicit client satisfaction with the facility and onsite services, including information collection methods and frequency, and process for utilizing the information for continual performance improvement purposes; and Procedure for medical records request by Veteran with a re-release of information. d. The Contractor must communicate policies and procedures to Veterans both verbally and in writing in a manner that is understandable to each Veteran upon admission to the facility, in the form of a written Veteran handbook that is verbally reviewed by the assigned case manager with the Veteran. All updates to any policies and procedures must be reviewed with Veterans with 7 days of revision. This communication must be documented in the Veteran s client record. e. House rules and expectations should be kept to a minimum, be simple, and should focus on safety of the Veterans and staff. Most Veterans may have had difficulty in the past adhering to settings where strict rules are applied. The rules should reward positive behavior, be enforceable, relate to the living situation, provide for safety of the Veterans, and provide opportunities for engagement. Veterans will not be discharged for the use of alcohol or drugs. Many of the Veterans that this program will target have failed programs in the past for their inability to stay clean and sober. Maintaining housing stability will be the primary goal for each Veteran. To provide for the safety of the Veteran(s), the Contractor must have written policies and procedures in place that clearly indicate the following are prohibited: Buying or selling of alcohol or drugs in the facility; Sexual activity between Veterans (including kissing and holding hands); Violence or threat of violence toward Veterans or facility staff; Destruction of facility property; Possession of weapons. f. Although rules must be kept simple and demands on the Veterans low, it is required that staff at the facility stay continuously engaged with the Veterans. Policies and procedures for staff should reflect the following: Regular room checks should occur with a strong focus on maintaining a safe environment that promotes the well-being of all Veterans; Staff is trained in providing flexible, respectful responses to infractions of rules; Homeless Veterans will not be discharged for drinking or use of drugs off property, non-compliance with prescribed medication or infractions of house rules that do not constitute a risk to their personal safety or the safety of the facility Veterans or staff; and assertive engagement by the staff with patients regarding these problems is the preferred course of action to deal with these common problems of the facility. h. Emergency and Disaster Plans: All HCHV CRS programs have emergency and disaster plans with written protocols that are posted to guide staff response to crises including, but not limited to, manmade and natural disasters, episodes of infectious diseases, physical injury, program participants suicide or suicide attempts, overdoses, and domestic or other violence. All contractor s staff are trained on emergency procedures and protocols. 5. BASIC SERVICES. The Contractor shall furnish each Veteran referred for care under this contract the following basic services: a. ROOM AND BOARD: Accommodations include a bed and other furnishings, such as a dresser, storage locker or designated secured space and personal linens (e.g., towels, pillows, blankets, and bed sheets). The bed must be designated for use exclusively by the individual Veteran from the time of admission to the time of discharge. The bed must be situated in a room that affords the Veteran safety, privacy, and security. Each Veteran must have a safe and secure place to store their belongings that is readily accessible to the Veteran (such as a locking closet, a locking armoire, a locker, etc.) The HCHV CRS contract provider is responsible for providing a sanitary food preparation area, supply food sufficient for at least three nutritious meals 7 days a week, and snacks of nourishing quality (e.g., fruits, vegetables, protein sources), between meals and bedtime. This is to include alternative meals or food supplies for Veterans with dietary restrictions if medically indicated (e.g., diabetic, renal, and soft mechanical diets) and reasonable accommodation for Veterans with cultural/religious preferences around food (e.g., Kosher, Sikh). The VA has particular concern for chronically homeless Veterans, many of whom are either undernourished or have developed poor eating habits or both, because of chronic medical, mental health or substance abuse disorders. A VA dietitian may assess printed menus as well as Veterans satisfaction with meals and the actual consumption of food offered in determining the Contractor s success in meeting this requirement during annual facility inspection or at any point during the contract period. b. LAUNDRY FACILITIES: On-site laundry facilities and supplies for Veterans to do their own laundry or to have laundry done. c. SAFE ROOM: Provides a safe room where Veterans returning to the facility under the influence can relax until they are ready to return to their rooms. This room should provide a television and comfortable seating. A minimum of 30-minute checks will be performed by staff on duty while a Veteran is in the safe room. More than one intoxicated Veteran is permitted in the room at a time. d. INTERNET AND COMPUTER ACCESS: Internet access shall be available to Veterans residing at the facility. Access shall consist of a service/speed rating of at least 10 Megabytes per Second (Mbps) Download, 1Mbps Upload or better. Wireless or other access shall be provided so that it is possible for three (3) or more users to access internet services simultaneously. Facility shall provide hardware (computer(s), printer, etc.) to be utilized. Veterans enrolled at the local community college or taking online courses, should be given priority of usage. The Contractor will be responsible for establishing hours of usage as well as setting any parental controls they deem essential. e. ENVIRONMENT OF CARE SERVICES: The Contractor must provide a clean and comfortable environment of care that is structurally sound facility; does not pose any threat to the health and safety of the occupants and protects them from the elements. The facility entries and exit locations are capable of being utilized without unauthorized use and provide alternate means of egress in case of fire; every room or space will have natural or mechanical ventilation; be free of pollutants in the air at levels that threaten the health of Veterans; provide a water supply free from contamination; has sufficient sanitary facilities in proper operational condition, allowed to be used in privacy, and are adequate for personal cleanliness and the disposal of human waste. Facility must have adequate heating and or cooling mechanisms that are in proper operating condition; adequate natural or artificial illumination to permit normal indoor activities and to support the health and safety of Veterans; provides sufficient electrical sources to permit use of essential electrical appliance while assuring safety from fire. All housing and equipment will be maintained in a sanitary manner free from pests, insects and vermin and will provide a warm, welcoming, and respectful atmosphere through lighting and décor. Contractor ensures that furniture is well maintained and comfortable. It is the Contractor s responsibility to maintain a clean and comfortable environment that meets these conditions. For example, the Contractor would be responsible for alleviating a bed bug infestation by hiring an exterminator at its own expense. f. ON-SITE OFFICE SPACE FOR VA LIAISON: The Contractor must provide designated onsite furnished office space to a VA Liaison from VA. The office space must afford the VA Liaison and Veterans privacy and confidentiality when meeting. The VA Liaison is expected to be onsite at the Contractor facility two to five days per week in keeping with VA model development program expectations. g. TRANSPORTATION: The Contractor will ensure that transportation is available for Veterans to attend medical/mental health appointments, search for transitional or permanent housing and address other care needs. The Contractor shall assist the Veterans with local transportation through the provision of bus passes, utilization of cab services or use of Contractor transportation. If VA staff determines that adequate public transportation is not available or appropriate for a Veteran, the Contractor shall coordinate with the HCHV Coordinator or their designated representative to arrange for alternative transportation. Transportation may include but is not limited to VA transportation services and RideShare programs if available. If public transportation and alternate VA provided services are not available or appropriate, the Contractor is responsible for transportation. h. OUTREACH: Outreach will be conducted by the CERS provider and VA homeless outreach staff in conjunction with street outreach teams within VA catchment area. Engagement with the Veteran should be goal-directed with consistent staff geared toward building trust and getting the Veteran to accept CERS admission. MEDICATIONS: Contractor shall provide Veterans with appropriate space and security for the storage of medications as outlined in VHA-10-10115a HCHV Contractor Provider Inspection Template (see D.9 Attachment 9). A list of current medications will be available for each resident in the case record. Veterans will manage medications but should have a secure storage area in which to keep them. (1) The Contractor shall have a written procedure that address the storage while providing access to medications and safe disposal of medications and syringes. Each Veteran shall be educated about the medication procedures and the importance of safely storing their medications. 6. ADDITIONAL CONTRACT REQUIREMENTS: a. The Contractor shall comply with the VA patient s Bill of Rights as set forth in Section 17.34a, Title 38, Code of Federal Regulations. The Contractor is responsible for maintaining Veterans privacy and confidentiality and must have systems in place that protect Veteran s personal identifying information and protected health information. This includes but is not limited to the following: having adequate private office space for Veterans to meet in confidence with their case manager; having secured paper and electronic filing systems to protect clients case records and other documentation; conducting ongoing training of staff about maintaining client privacy and confidentiality in all verbal and written communications and interactions; ensuring that non-clinical/non-case management facility staff have access to Veteran information only as needed in order to meet the service requirements contained in the contract. b. The CERS Contractor shall have the ability to accommodate immediate admissions 24 hours per day, seven (7) days per week. If unable to verify during off tour hours, homeless person should be accepted conditionally. Within 48 business hours, VA clinical staff will meet with newly admitted individual and assess for eligibility and safety issues. If safety issues arise before assessment, decision to exit individual based on safety concerns will be deferred to contract agency staff. VA staff have right of approval/disapproval for payment for non-approved admissions and non-verified Veterans. c. The Contractor shall comply with the principles listed in 38 CFR 17.707(b) to provide housing and supportive services in a manner that is free from religious discrimination. d. CASE MANAGEMENT SERVICES: The Contractor shall provide, at minimum, the following case management services to Veterans in the program: (1) Engagement of the Veteran in the service planning process. Contractor will carry responsibility for interviewing, counseling and case managing identified Veterans by conducting psychosocial assessments to identify treatment needs which affect the Veterans adjustment to their environment and establish treatment goals. (2) Contractor will assess the psychosocial and environmental needs or dysfunction secondary to or exacerbating the social, substance or psychiatric problems, which might contribute to Veterans readjustment challenges in the community. Contractor establishes and maintains an intensive therapeutic relationship with the Veteran, staff, and community programs/agencies, and is responsible for formulating case-management treatment goals and plans that address identified needs, stressors, and problems. (3) Contractor will conduct high-risk screening, psychosocial assessment, and treatment planning actively involving the Veteran and their family or significant others, in coordination with the team members. Psychosocial assessments will include goals for clinical treatment. Contractor coordinates and documents clinical case management and psychosocial services and documents the overall effectiveness of the case management services provided. Specifically, Contractor will: (4) Develop a highly Individualized Service Plan (ISP) with the Veteran consistent with low demand program goals; the plan must specifically include provisions for Veteran placement into an appropriate transitional or permanent housing placement within 30-60 days of admission to the HCHV Contract Residential Care facility with no more than 120 days without a planned reason for extension. The housing placement planning must consider all appropriate and available community-based housing options as well as the Veteran s preferences regarding location and housing type. The plan should also be focused on getting the Veteran(s) to accept services, especially mental health and substance use services that will allow attainment of transitional or permanent housing. Acceptance of the services offered should not be a condition of continued stay in CERS. (5) Complete a written ISP within the first 7 days of program admission and signed by the Contractor, the Veteran, and the VA Liaison. (6) Review ISP a minimum every thirty (30) days thereafter in a clinical meeting with the Veteran. Updated plans must by communicated to the VA Liaison within 3 business days. (7) Make changes in plans in consultation with the Veteran at weekly case management meetings. Weekly case management meetings with Veterans will focus on the objectives and tasks in the ISP. Contracted case manager will provide Veteran with a written copy of their weekly tasks. (8) Screen each Veteran for suicidal and homicidal risk with each contact. This screening must be documented in regular progress notes in the Contractor s clinical service records. If the Veteran is a danger to him/herself or others Contractor will take immediate steps to provide appropriate intervention. Contractor will notify the VA same day or next business day (if after hours) of any Veteran suicidal or homicidal risk. (9) Coordinate with VA Liaison during weekly case conferences regarding updates and changes in Veterans care plans to foster a collaborative relationship with the VAMC and Contractor in meeting Veterans needs. Case conferencing may be done in person or by telephonic conference calls as determined by VA staff. (10) Obtain relevant Releases of Information to communicate and coordinate Veterans treatment with VA and other community-based service providers. (11) Work in close collaboration with the VA Liaison to ensure Veterans connections to needed VA medical, mental health, and substance abuse treatment and care. (12) Contractor will take primary responsibility for assisting Veterans in completing housing applications and other benefits paperwork as needed. Contractor will assist Veterans in obtaining the needed documentation required for complete applications including but not limited to, birth certificates, driver s license, income verification and any additional information required by housing resources and potential income supports. (13) Contractor will accompany Veterans to housing interviews, medical appointments, and other appointments while working with Veterans to foster independence and a sense of self-determination as appropriate. Contractor will provide transportation for Veterans to attend appointments at the VA, potential housing placements, benefits agencies, meetings with landlords, etc. (14) The Contractor will provide the following onsite therapeutic and rehabilitative services including: Daily structured groups and activities to promote social skills building and healthy lifestyles; groups will be offered but are not mandatory; Health and personal hygiene maintenance; Monitoring of medications; Supportive social services, in collaboration with the case managers, VA or other community resources; Professional counseling as required, including emphasis on self-care skills, adaptive coping skills, vocational counseling, in collaboration with the VA Liaison or community resources as appropriate; Opportunities for immediate learning and/or development of responsible living with a goal of achieving a more adaptive level of psychosocial functioning; Support for an alcohol and/or drug-free lifestyle; Opportunities for learning, and internalizing knowledge of the illness and/or recovery process; improving social skills; and improving personal relationships; and Opportunities for client participation in community activities, volunteer opportunities, local consumer services, etc. (15) The Contractor shall adapt therapeutic and rehabilitative services to include onsite, VA, or community service and will provide transportation for Veterans to receive services such as: structured groups and activities to promote social skills building and healthy lifestyles. Groups may include emphasis on self-care skills, adaptive coping skills, vocational counseling, in collaboration with the VA Liaison or community resources as appropriate to support the goal of obtaining and maintaining permanent housing. e. Contractor will notify VA through the VA Liaison at VA of any critical incident occurring with a Veteran within 24 hours of being informed or made aware of the incident, if not sooner. Contractor will complete a written incident report within 48 hours of notification. Incidents include but are not limited to: death; fire; drug/police raid; suicide/suicide attempt; 911 call (police/fire dept./paramedics/other); drug overdose; severe medical illness / emergency; severe psychiatric illness / emergency; sexual assault; act of violence or abusive behavior by Veteran against other(s); abusive behavior by Veteran against staff; act of violence or abusive behavior by other(s) against Veteran; abusive behavior by staff against Veteran; falls, accident; medication problems or adverse drug reactions; or other untoward events. [See D.8, Attachment 8, Incident Report Form.] f. In the event a Veteran residing in HCHV CERS housing under this contract dies, the Contractor will promptly notify the VA Liaison authorizing admission and immediately assemble, inventory using established protocol, and safeguard the Veteran s personal effects. The funds, deposits, and effects left by Veterans upon the premises of the facility shall be delivered by the director or manager of the facility to the person or persons entitled thereto under the laws currently governing the facility for making disposition of funds and effects left by Veterans unless the beneficiary died without leaving a will, heirs, or next of kin capable of inheriting. When disposition has been made, the itemized inventory with a notation as to the disposition has been made, they will be immediately forwarded to the VA Liaison. Property and funds wherever located vests in and becomes property of the United States in trust. In these cases, the facility will forward an inventory of any such property and funds in its possession to the appropriate VA office and will hold them (except articles of clothing necessary for proper burial) under safeguard until instructions are received from the VA concerning disposition. 7. STAFFING AND TRAINING: The Contractor shall employ sufficient personnel to carry out the policies, responsibilities, and programs of the facility. There must be, as a minimum, at least one (1) administrative staff member or designee of equivalent professional capability, on duty on the premises or residing at the house and available for emergencies 24 hours a day, seven (7) days a week. The Contractor shall assign to this contract personnel that, by education and training, and when required, certification or licensure, are qualified to provide the services required by this PWS. The Contractor must identify each person functioning as Key Personnel under this contract and provide the VA a description of the services to be provided by such a person, together with a resume summarizing the person s relevant skills and experience. During the first 90 calendar 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 calendar days after substitutions necessitated by situations described above, the Contractor shall provide resumes for the substitute key personnel. For substitutions proposed by the Contractor after the initial 90 calendar day period, the Contractor shall provide resumes for the substitute personnel, together with any other additional information requested by the Contracting Officer at least 15 calendar days before the substitution is to occur. At a minimum: One (1) full-time supervisor/clinical director with a minimum of a master s degree in social work or a related discipline, or 24 months experience with preferred emphasis working with homeless or other vulnerable populations. Responsible for the overall functioning of the program including assurance that all policies and procedures are being followed, coordination of weekly staff meetings, management of CERS provider staff and be available by phone 24 hours daily, seven (7) days a week. One (1) Full-time case manager with a minimum of a bachelor level education in social work or other human services related field, or 24 months experience with preferred emphasis working with homeless or other vulnerable populations to carry a maximum caseload of 12-15 Veterans each. Those with certifications in substance use disorders should be given preference. One (1) full-time licensed practical nurse (LPN) or equivalent to manage medication flow charts and medication reconciliation. LPN will be responsible for all medication management duties of the veteran(s). Medications may be dispensed by licensed certified medication aides. A minimum of one (1) behavioral health technician or certified nursing aide, or certified medication technician/aide, or administrative staff member at the facility. Staff on duty must remain awake and available to interact with Veterans during their work tour, whether during the day or at night. Certified nursing aides and certified medication aides may be used in lieu of a behavioral health technician, but there should always be one (1) staff member, as a minimum, on duty at any time. Contractor Staff members working each shift, at least one shall hold current Cardiopulmonary Resuscitation (CPR) certification and ensure certification is renewed in accordance with the issuing body or organization. Copy of CPR certificates should be stored by contractor and made available upon request of VA personnel. f. Contractor Staff members providing regular direct services to residents should adhere to annual TB testing, precaution should be taken to ensure positive testing of employees are addressed according to agency policies. g. Contractor shall provide safety training to all staff to assist with identifying situations that are likely to result in physical harm and approaches to use when confronted with a dangerous situation. h. Contractor shall adhere to appropriate city and state requirements for food handling and safety and contractor shall have a valid food handler s permit or certification as required by obtained through the state of residence. Copies of permits shall be provided to the COR upon request. i. The Contractor shall provide an initial organizational chart, identifying personnel, their position, and area(s) of responsibility to the Contracting Officer prior to contract award. Any certifications or licensure required will be made available upon request. The Contracting Officer shall notify the Contractor within 15 calendar days after receipt of required information if the VA refuses to accept assigned contract personnel. The Contractor shall be responsible for updating the organization chart as changes in staff occur. The VA reserves the right to refuse or revoke acceptance of personnel if personal or professional conduct, or lack of required skills or experience, jeopardizes Veteran care or interferes with regular and ordinary operation of the facility. j. The Contractor must have a contingency plan to address the replacement or substitution for personnel that leave the Contractor's employment or are unable to provide performance in accordance with the terms and conditions of the resulting contract. k. Contractor staff must always maintain professional boundaries with the Veteran while conveying an attitude of genuine concern and caring. l. Contractor staff must always maintain professional boundaries with the Veteran while conveying an attitude of genuine concern and caring. m. Contractor staff should under no circumstances engage in sexual activities or sexual contact with Veterans or their family members, whether such contact is consensual or forced. Contractor should under no circumstances take unfair advantage of any professional relationship or exploit Veteran clients or their family members to further their personal, religious, political, or business interests. Contractor staff should not engage in dual or multiple relationships with Veterans or their family members in which there is a risk of exploitation or potential harm to the Veteran or Veteran family. Contractor is responsible for taking steps to protect Veterans and their family members and is responsible for setting clear, appropriate, and culturally sensitive boundaries. n. All Veteran complaints or Contract staff conduct incidences shall be reported to the VA Liaison within 3 business days of the complaint or possible Contract staff conduct incidences. The Contractor will provide the VA Liaison with a written summary of the compliant or incident, the Contractor s response, and a proposed resolution. The VA Liaison will respond to the Contractor in writing within 3 business days to accept, negotiate or decline the proposed resolution. In instances where the proposed resolution or response does not appear sufficient to resolve the compliant, the Contracting Officer will provide the Contractor with written guidance and timeframe for resolution. 8. ADMISSIONS, LENGTH OF STAY AND DISCHARGES a. Rapidly stabilize Veterans medical, mental health, substance abuse and other psychosocial problems by expediting placement of these Veterans into safe, supportive emergency housing is expected of this contract. After stabilization, veterans should be placed in other appropriate transitional or permanent housing quickly (within 30 to 60 days) with no more than 120 days without a planned reason for the extension. Any extension requests beyond 120 days must be submitted within 7 days of the end of approved bed days of care and must be approved by the VA Liaison. The VA Liaison will not approve per diem for lengths of stay exceeding 120 days from the date of admission unless: (1) There are extenuating clinical circumstances beyond the Contractor s control that are barriers to the Veteran s placement in housing; and/or (2) There is documented evidence that the Contractor has exhausted every effort to place the Veteran in housing sooner; and (3) The VA Liaison has been appropriately advised of these efforts well in advance of the 180-day limit; and (4) The VA Liaison concurs that the Veteran will continue to derive therapeutic benefits from a continued stay at the HCHV Contracted Residential Care facility. [See D.10, Attachment 10, Request for Extension of Per Diem.] b. Veterans will be screened and referred to the Contractor by the VA Liaison. Excepting lack of available beds, the Contractor will be expected to provide immediate admission to housing and services to these Veterans 24 hours per day, seven (7) days per week. The program cannot deny entry to a Veteran based on length of abstinence from alcohol or non-prescribed controlled substances, number of treatment episodes, time interval since the last program entry, legal history, or use of prescribed controlled substances. The date of admission must be approved by the VA Liaison for billing purposes. If a Veteran presents at the facility during weekends, at night, or a holiday day, the CERS provider may accept the Veterans. However, VA staff has the right of approval or disapproval for payment. Engagement of homeless Veterans in the provision of housing placement, treatment and supportive services is a key element of the HCHV CERS program. c. If a Veteran s length of stay exceeds 120 days from the date of admission and there is no approval from the VA Liaison for continued per diem, the Contractor will retain the responsibility for finding suitable transitional or permanent housing in the community at its own expense. d. The Contractor will seek approval from the VA Liaison for any extension of BDOC for Veterans approaching the end of their approved BDOC. The VA Liaison will not approve per diem for lengths of stay exceeding 120 days from the date of admission unless: (1) There are extenuating clinical circumstances beyond the Contractor s control that are barriers to the Veteran s placement in housing; and/or (2) There is documented evidence that the Contractor has exhausted every effort to place the Veteran in housing sooner; and (3) The VA Liaison has been appropriately advised of these efforts well in advance of the 120 day limit; and (4) The VA Liaison concurs that the Veteran will continue to derive therapeutic benefits from a continued stay at the HCHV CERS facility. e. Veterans may be discharged from HCHV CERS programs for positive, negative, or administrative reasons. The date of discharge must be approved by the VA Liaison for billing purposes. The Contractor shall provide discharge planning and referrals for each Veteran, regardless of character of discharge from the facility to appropriate community resources and services based upon a team assessment of health, social and vocational needs, and the involvement of Veterans families as appropriate. The Contractor will provide written exit information to the VA Liaison within 24 hours of Veteran s discharge from CERS program. f. Exit or discharge planning for each Veteran will start at the time of admission into the CERS program and Veteran will be involved in the exit planning process. Exit planning is for the Veteran to identify personal needs for obtaining housing, continuing recovery, care, treatment, and services after exit. Veteran will be provided clear information regarding exit. Length of Stay is variable based on progress towards goals, objectives, and time frames listed in the treatment plan. The Contractor is responsible for ensuring that access barriers to continuing outpatient care (e.g., distance, transportation, scheduling) are reduced or eliminated prior to exit. All written discharge reports shall be provided to the CRS Liaison within 24 hours of Veteran s discharge. The CRS Liaison will provide it to the COR. g. Veterans may end participation in HCHV CERS for any of the following reasons: (1) The Veteran has accomplished the goals as defined in the treatment plan and is prepared for community integration with identified resources after exit. (2) The Veteran requires treatment beyond program resources and is to transition to another level of care. (3) The treatment environment does not meet the Veteran s expectations or needs. (4) The Veteran requests to leave before treatment goals are met. (5) The Veteran has a personal emergency necessitating exit. h. There are circumstances when the Contractor and VA may make a clinical decision to discharge a Veteran prior to program completion. These circumstances include: The Veteran exhibits dangerous behavior; The Veteran has achieved maximum benefit from treatment in the program. The Veteran refuses to allow communication between VA and the contracted provider that is necessary to ensure the safe and effective coordination of care. The Veteran has failed to adhere to the rules and the regulations of the program even after multiple warnings and discussions with VA & Contractor staff. 9. Performance Monitoring & Inspections a.           HCHV performance metrics with targets and descriptive measures, as established by the Department of Veterans Affairs/National Homeless Program Office, will be shared with the Contractor at the beginning of each fiscal year. The data will be reviewed during quarterly progress meetings and an opportunity will be provided for the Contractor to offer feedback on strategies to improve performance. b. Other performance metrics where data will be shared during quarterly reviews include bed utilization, Veteran length of stay, and program participant feedback regarding overall satisfaction with the Contract provider. c. The Contractor will be expected to complete a written action plan for any performance measure not meeting established targets within 30 days of notification. Progress on action plan(s) will be reviewed during quarterly progress meetings. d. Annual re-inspections must occur for each HCHV CRS program. e. A minimum of four unannounced site visits will be made annually by the VA. These unannounced site visits include: (1) A visual safety and sanitation inspection of the facility including meal preparation areas, fire exits, sleeping areas and medication storage. Any safety or sanitation deficiency must be addressed immediately. (2) Review of the contract provider s emergency and disaster plans to ensure they are up to date, and that staff are trained in the procedures outlined in the plans. (3) An audit of Veteran s clinical records selected randomly to ensure documentation of case management services and that other services are being provided as required by the contract terms. (4) A review of any Veteran complaints to ensure that these have been resolved in a fair, impartial and consistent manner. (5) A review of current program participant feedback regarding overall satisfaction with the Contractor (6) During quarterly unannounced inspections, a cursory environmental review must be conducted. [See D.7, Attachment 7, Environmental Review.] (7) If a hazardous condition or deficiency is noted, the Contractor must act to ensure that immediate appropriate actions are taken to ensure the safety and well-being of the Veterans. (8) Plans of correction with timeframes to correct any deficiency must be submitted by the contractor within 15 days of notification and must be approved by the VA. 10. PER DIEM, BED DAY OF CARE, BILLING AND PAYMENT a. This is an indefinite delivery, indefinite quantity, firm fixed price contract since it is impossible to determine with any certainty the number of services that will be required under this contract. The period of performance for this contract will be for a Base Year plus four (4) Option Years. It is understood that no obligation will be incurred by the VA except for services rendered under this contract pursuant to referrals issued by the VA for residential treatment for Veterans. This contract will serve up to 52 homeless Veterans in need of immediate placement in a safe environment with onsite supportive services. The minimum value of services and maximum value of services to be provided under this contract during each contract year are as follows. Note minimum value of services is only applicable to option years if the VA, in its sole discretion, elects to exercise the option for that year. b. Per Diem or Bed Day of Care are terms used to define what the VA will pay for the eligible Veteran s stay in a CERS bed and supportive services for each day the Veteran resides at the facility and receives services. Unless specifically excluded in this contract, the Bed Day of Care rate established will include all services listed in this document and will also include the services or supplies normally provided to other clients by the facility without extra charge. It is the Contractor s responsibility to have appropriate systems of verification of services in place to justify invoices and payments. Any extension requests beyond 120 days must be submitted within 7 days of the end of approved bed days of care and must be approved by the VA Liaison. c. The VA can only pay for eligible Veterans (i.e., Veterans whom VA refers to the Contractor, or for whom VA authorizes the provision of services) as determined by the local VA HCHV program. No funding or financial support will be provided for spouses/partners, minors, or other dependent family members the Veteran identifies as part of his/her family. The Contractor will be responsible for any family members that are allowed to reside in the facility with the Veteran and receive supportive services. d. The Contractor may not bill the VA and the VA will not pay per diem for beds that are used by more than one person at a time, such as in shifts. For example, it is not permissible to bill the VA for a bed that was used by an eligible Veteran at night but then given to someone else to sleep in during the day while the eligible Veteran was attending appointments outside of the facility. The Contractor may only bill the VA for bed days of care for authorized Veterans who are actively residing at the facility. In the case of Veteran absences, the following rules will apply: e. The Department of Veterans Affairs (VA) will pay per diem up to a maximum of 48 consecutive hours for the unscheduled absence or 96 hours for the scheduled absence of a Veteran under the following conditions: (1) Scheduled Absences: To receive payment, the absence must: Be pre-planned, consistent with and support the Veteran s individual service plan (e.g., family reunification, short term medical, substance use disorder (SUD) or psychiatric treatment). Have the reason documented in the individual Veteran s case file, treatment record, or service plan. Not result in the bed being filled by the provider. Not be for a break or vacation from treatment. Not be used for extended educational or employment circumstances. (f) Not be used to create more than 4 consecutive days of absence. (2) Unscheduled Absences: To receive payment for an unscheduled absence: (a) The provider must have evidence of active outreach to locate and reengage the Veteran and document the steps taken in the Veterans individual case file, treatment record, or service plan. (b) The provider may not fill the bed. (c) The Veteran must be discharged from the HCHV CRS program if not located within 48 hours. (3) Ineligible Veteran: When a Veteran is admitted to a HCHV CRS program and found to be ineligible for HCHV CRS, VA will pay for a maximum of 4 days from the day of admission to allow the provider and HCHV CRS Liaison time to locate and arrange alternate placement. f. The Contractor will have a plan in place to manage any missing Veteran including identifying if the Veteran is at high risk medically or psychologically including suspected to be under the influence of alcohol or drugs, medical condition requiring medications such as diabetes and/or immediate emotional response resulting in the Veteran eloping from the facility. This would include calling 911 to initiate a BOLO (be on lookout) or a missing person report if deemed necessary by contracted staff that the Veteran is a high risk. The VA Liaison will be contacted immediately the next business day. g. Records and Reports: As VA exercises contract oversight, attention will be directed to the adequacy of Veterans records. Site visits by VA staff will periodically include a spot check of records to ensure Contractor invoices accurately reflect the Veteran s length of stay. The Contractor will be responsible for the following onsite records and reports: Daily sign-in sheets signed by program Veterans, to document and verify Veterans presence at the facility for billing purposes. Daily sign-in sheets must be completed clearly, accurately, and thoroughly with full signatures and monitored to provide a full accounting of Veterans stay and services received for billing and audit purposes. Daily sign-in sheets will be provided monthly to the VA COR with monthly billing documentation. In the event one or more Veterans refuses to sign the daily sign-in sheets due to documented mental health problems, an alternative method of verification may be developed on a case-by-case basis in collaboration with VA COR. The Contractor shall maintain an individual clinical record on each Veteran housed under this contract. The Contractor must comply with the requirements of the Confidentiality of certain medical records (38 USC 7332), and (42 CFR, Part II) when appropriate, and shall be part of the contract. All case records will be maintained with such security and confidentiality as required and will be made available on a need-to-know basis to appropriate staff members involved with the treatment program of the veterans concerned. The Contracting Officer is the only person authorized to approve changes or modify any of the requirements of this contract. The Contractor shall communicate with the Contracting Officer on all matters pertaining to contract administration. Only the Contracting Officer is authorized to make commitments or issue changes that shall affect price, quantity, or quality of performance of this contract. IN THE EVENT THE CONTRACTOR AFFECTS ANY SUCH CHANGE AT THE DIRECTION OF ANY PERSON OTHER THAN THE CONTRACTING OFFICER WITHOUT AUTHORITY, NO ADJUSTMENT SHALL BE MADE IN THE CONTRACT PRICE TO COVER AN INCREASE IN COSTS INCURRED AS A RESULT THEREOF. h. The COR will be responsible for the overall technical administration of this contract as outlined in the COR Delegation of Authority, including monitoring of the Contractor's performance. i. All individual clinical records will contain an initial biopsychosocial assessment completed within 7 days of program admission. The assessment and plan will include but not be limited to: all identifying data relevant to the Veteran and his/her family, including medical problems and medications, mental health problems and medications, substance use history, housing history and preferences, income supports or benefits, employment/vocational issues, information relating to the Veteran s admission including reason for referral, the targeted goals for constructive changes which are to be attained during the residential rehabilitation episode, and the anticipated length of stay, if known. j. An initial ISP completed within 7 days of program admission signed by the Veteran and the VA Liaison. The plan must specifically include but will not be limited to: Provisions for Veteran placement into an appropriate transitional or permanent housing placement within 30-60 days of admission to the HCHV Contract Residential Care facility with no more than 120 days without planned reason for extension. Any extension requests beyond 120 days must be submitted within 7 days of the end of approved bed days of care and must be approved by the VA Liaison. The housing placement planning must consider all appropriate and available community-based housing options as well as the Veteran s preferences regarding location and housing type. k. Provisions for the stabilization and/or treatment of biopsychosocial issues and stressors. This may include provisions of care within the contracted facility, connections to VA medical and mental health care, and/or referrals and connections to community-based resources. l. Relevant Releases of Information to communicate and coordinate Veterans treatment with VA and other community- based service providers. m. Progress notes for each case management encounter and service to include information regarding progress toward meeting the ISP goals. n. Documentation of Veteran participation in onsite daily structured activities and groups. o. Updated ISPs every thirty (30) days from the date of the initial plan, to include any measures of movement toward rehabilitation goals, with particular focus on the attainment of community-based housing. p. A final discharge summary on each Veteran who leaves the program regardless of character of discharge, to include a description of beneficial changes realized during the residential period, reasons for leaving, the Veteran s future plans, after-care referrals and connections, and follow up locator information. Discharge summary should be entered within 2 weeks of Veteran being discharged. q. Contractors will be expected to enter data into a Homeless Management Information System (HMIS) web-based software application and bed totals in the Homeless Inventory Count (see Reference section). This data will consist of information on the Veterans served and types of supportive services provided by Contractors. Contractors must treat the data for activities funded by the VA HCHV Contract Residential Care program separately from that of activities funded by other programs. Contractors will be required to export client-level data for activities funded by the VA HCHV Contract Residential Care program to VA on a regular basis. All Veterans must be entered into HMIS within 2 weeks of being entered into the contract and within 2 weeks of being discharged from the contract. 11. VA INFORMATION AND INFORMATION SYSTEM SECURITY/PRIVACY GENERAL a. Veterans serviced through the VA s CERS program must enter client level data into the WEB based Dept of Housing and Urban Development s (HUD) local community Continuum of Care (CoC) Homeless Management Information System (HMIS). Data entered must include, at a minimum, the universal Data Elements from the HMIS Data Standards. The Contractor shall directly enter the required data into the system for each Veteran placed by the Contract. Additional information and guidance is contained on HUD s Homelessness Resource Exchange web page located at http://www.hudhre.info . b. The Information Technology security requirements for Certification and Accreditation (authorization) requirements do not apply, and a Security Accreditation Package is not required. The Contractor, their personnel, and their subcontractors shall be subject to the Federal laws, regulations, standards, and VA Directives and Handbooks regarding information and information system security as delineated in this contract. 12. SECURITY INCIDENT INVESTIGATION The term security incident means an event that has, or could have, resulted in unauthorized access to, loss or damage to VA assets, or sensitive information, or an action that breaches VA security procedures. The Contractor/subcontractor shall immediately notify the COR and simultaneously, the designated ISO and Privacy Officer for the contract of any known or suspected security/privacy incidents, or any unauthorized disclosure of sensitive information, including that contained in system(s) to which the Contractor/subcontractor has access. To the extent known by the Contractor/subcontractor, the Contractor/subcontractor s notice to VA shall identify the information involved, the circumstances surrounding the incident (including to whom, how, when, and where the VA information or assets were placed at risk or compromised), and any other information that the Contractor/subcontractor considers relevant. With respect to unsecured protected health information, the business associate is deemed to have discovered a data breach when the business associate knew or should have known of a breach of such information. Upon discovery, the business associate must notify the covered entity of the breach. Notifications need to be made in accordance with the executed business associate agreement. In instances of theft or break-in or other criminal activity, the Contractor/subcontractor must concurrently report the incident to the appropriate law enforcement entity (or entities) of jurisdiction, including the VA OIG and Security and Law Enforcement. The Contractor, its employees, and its subcontractors and their employees shall cooperate with VA and any law enforcement authority responsible for the investigation and prosecution of any possible criminal law violation(s) associated with any incident. The Contractor/subcontractor shall cooperate with VA in any civil litigation to recover VA information, obtain monetary or other compensation from a third party for damages arising from any incident, or obtain injunctive relief against any third party arising from, or related to, the incident.