G--HOMELESS VETERANS INITIATIVE - LUTHERAN SOC SERV OF MI

DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK A. PURPOSE The goal of the HCHV program is to remove homeless Veterans from the street or habitation unfit for Veterans and place them in community-based, residential environments with sufficient therapeutic services to meet the needs of those Veterans. Through the HCHV program, VA provides case management services to Veterans and facilitates their access to a broad range of medical, mental health, and rehabilitative services. The purpose of the solicitation will be to obtain proposals from contractors who can provide care, treatment and rehabilitative services to veterans suffering from serious mental illness, including veterans who are homeless, in community-based treatment facilities offering a safe and secure environment that supports their rehabilitation goals. The Contractor will be required to provide therapeutic and rehabilitative services, but will not be required to provide detoxification or other hospital level treatment - those services will be provided by the VA at VA facilities. B. SERVICES TO BE PROVIDED 1. The contractor shall furnish services to beneficiaries for whom such care is specifically authorized by the Department of Veterans Affairs (herein called VA). It is understood that the type of patients to be cared for under this contract are authorized VA beneficiaries who are experiencing homelessness and serious mental illness/substance abuse issues and will normally require care and services over and above the level of room and board. 2. The contractor shall furnish each veteran authorized care under this contract with the following basic services: A. A supervised environment which will be staffed on a 24-hour basis; B. Board and room; C. Laundry facilities for residents to do their own laundry; and, D. Therapeutic and Rehabilitative Services determined to be needed by individual veteran patients, in a plan developed by the contractor with consultation by the veteran and the VA case manager. Services which the contractor must be able to furnish include: (1) Structured group activities, including physical activities as appropriate. (2) Instruction in and assistance with health and personal hygiene. (3) Monitoring of medications. (4) Supportive social services, in collaboration with the case managers, VA or other community contract resources. (5) Individual professional counseling, including counseling on self care skills, adaptive coping skills and, as appropriate, vocational rehabilitation counseling, in collaboration with VA program or contract community resources. (6) Assistance in learning and development of responsible living patterns to achieve a more adaptive level of psychosocial functioning, upgraded social skills, and improved personal relationships. (7) Support for an alcohol/drug abuse-free lifestyle. (8) Assistance in learning, testing, and internalizing knowledge of the illness/recovery process. 3. Unless specifically excluded in this contract, the per diem rate established will include the services listed in this document and will also include all services or supplies normally provided other patients by the facility without extra charge. C. FACILITY/PERSONNEL 1. The contract facility must have a current occupancy permit or license required by the authority having jurisdiction. 2. The contractor shall employ sufficient professional health care personnel to carry out the policies, responsibilities, and programs of the facility. In residential treatment facilities there must be, as a minimum, a full-time 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, 7 days a week. In those instances where a supervised residential setting is linked to a geographically distinct rehabilitation and/or socialization day program, sufficient professional health care personnel must be identified to provide the necessary therapeutic activities and to ensure a meaningful integration of these efforts with those provided in the residential setting. 3. The contractor shall make available to the VA documentary information deemed necessary by the VA to conduct utilization review audits for the mandated national evaluation study as required by Section 2 of Public Law 100-6; to verify quality of patient care for veterans; to assure confidentiality of patient record information; and to determine the completeness and accuracy of financial records. 4. The contractor shall conduct treatment and discharge planning reflecting a team assessment of health, social and vocational needs and the involvement of residents' families (when available) and appropriate community resources in resolving problems and setting goals. 5. 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. 6. This agreement does not require the provider to have JCAHO accreditation or other regulatory requirements regarding worker competency, however, the contractor must perform the required work in accordance with JCAHO standards or equivalent. The contractor is required to develop and maintain the following documents for each contract employee working on this agreement: ¢ Credentials and qualifications for the job. ¢ A current competence assessment checklist (an assessment of knowledge, skills, abilities and behaviors required to perform a job correctly and skillfully; and to provide care for certain patient populations, as appropriate.. ¢ A current performance evaluation supporting ability of the employee. ¢ Documentation of continuing education for the last two years. The contractor will provide current copies of these records at the time of contract award and annually on the anniversary date of contract award to the VA Contracting Officer Technical Representative (COTR), or upon request, for each contractor employee working on this agreement. 7. Before commencing work under the contract, the Contractor shall furnish the Contracting Officer with a certification from their insurance company indicating that the coverage outlined in this contract has been obtained and that it may not be changed or canceled without written notice within thirty (30) days to the Contracting Officer. 8. Wage Determination(s) as listed in the Attachment of the solicitation to be issued are applicable to any resulting contract. D. INSPECTION 1. It is agreed that the VA will have the right to inspect the residential treatment center and all appurtenances by an authorized representative(s) designated by the VA. 2. Prior to the award of a contract a multidisciplinary VA team consisting of a social worker, nurse, dietician, and a safety officer shall conduct a survey of the residential treatment/community health care center. Residential treatment centers to be utilized will be restricted to community based facilities that provide food, shelter, and therapeutic service in a supportive environment. Residential treatment settings shall make documented information available to the VA, as deemed necessary to: A. Conduct utilization review audits for the mandated national evaluation study, B. Verify quality of patient care for veterans, C. Ensure confidentiality of patient record information, and D. Determine the completeness and accuracy of financial records. 3. In cases of complexes of non-VA community health care facilities, it is imperative that all components of the program be inspected by the VA team prior to award of the contract as is required for an integrated primary site. Each of the community health care facilities identified in the complex as contract recipients will also be subject to the requirements for contracting, safety and record keeping described in other parts of this document as applying to the residential treatment center. 4. The Safety Officer will inspect the facility for conformity to the current Life Safety Code and submit the findings to the chairperson of the team. The other members of the team will focus on the assessment of the quality of life within the residential treatment facilities, giving particular attention to the following indicators: A. General observation of residents indicates that they maintain an acceptable level of personal hygiene and grooming. B. The facility meets applicable fire, safety, and sanitation standards in attractive surroundings conductive to social interaction and the fullest development of the resident's rehabilitative potential. C. The facility should be in a central location, near public transportation, and near areas which provide employment. D. Appropriate organized activity programs during waking hours (including evenings) reflecting a high level of activity in the facility or in the linked facilities, for example, individual professional counseling, physical activities, assistance with health and personal hygiene. E. There is evidence of facility-community interaction. This may be demonstrated by the nature of scheduled activities, or by information about resident flow out of the facility, e.g., community activities, volunteers, local consumer services, etc. F. Staff behavior and interaction with residents convey an attitude of genuine concern and caring. G. Appetizing, nutritionally adequate meals are provided in a setting which encourages social interaction and nutritious snacks between meals and bedtime are available for those requiring or desiring additional food, when it is not medically contraindicated. The addition of nutritious snacks to the requirements of the rooms and board is particularly indicated for homeless chronically mentally ill patients. Many of these patients are either undernourished or have developed poor eating habits or both, because of their chronic psychiatric disorder, including alcohol/drug abuse behaviors. The local VA dietitian may consult with the initial inspection team and the team making subsequent assessments, in evaluating not only the printed menus but also the patients' satisfaction with meals and the actual consumption of food offered. 5. The contractor shall be advised of the finding of the inspection team. If deficiencies are noted during any inspection, the facility will be given a reasonable time to take corrective action and notify the Contracting Officer that the corrections have been made. A contract will not be awarded until noted deficiencies have been eliminated. 6. The VA shall monitor the contractor's program and inspect the contractor's facility to ensure compliance with this agreement. Any unsatisfactory conditions noted during the inspection of the contract facility will be reported in writing to the VA Contracting Officer. If corrections are not made to the satisfaction of the VA, the Contracting Officer will consult with the appropriate officials so that suitable arrangements can be made to discharge or transfer patients and to terminate the contract. E. PATIENT CARE/HANDLING/RECORDKEEPING 1. The contractor will notify the authorizing VA immediately when a medical emergency occurs which requires hospitalization of any patient receiving care at VA expense. It is agreed that the veterans will be admitted to the nearest available VA facility when possible. If hospitalization of a non-emergency nature is required, it is agreed that admission to a VA will be accomplished consistent with VA eligibility criteria, as determined by VA policies. 2. In the event a beneficiary receiving residential treatment center care under this contract dies, the residential treatment center will promptly notify the VA office authorizing admission and immediately assemble, inventory, and safeguard the patient's personal effects. The funds, deposits, and effects left by VA patients upon the premises of the residential treatment center shall be delivered by the residential treatment center to the person or persons entitled thereto under the laws currently governing the residential treatment center for making disposition of funds and effects left by patients, 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 of the funds and effects will be immediately forwarded to the VA office. Should a deceased patient leave no will, heirs or next of kin, his personal property and funds - wherever located - vests in and becomes the property of the United States in Trust. In these cases the residential treatment center 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. 3. Absences of the patient from the residential treatment center in excess of 48 hours will not be reimbursable except and with approval of the Contracting Officer or designee. Should a patient referred to a residential care facility, absent him/herself in an unauthorized manner, payments for services for that veteran to the contract facility would be continued for a maximum period of three days provided there is an active outreach attempt on the part of the contract facility staff to return the veteran to the residential care program and a strong likelihood that the patient will return. Management of program dropouts will be an element of the quality assurance review of this program. 4. Subsequent inspections of the residential treatment center must be made yearly by a multidisciplinary team including such hospital personnel as deemed necessary to assure that the facility provides quality care in a safe environment. As site visits are accomplished by VA program personnel, attention will be directed to the adequacy of the veteran's records. Site visits will also include a spot check of records to ensure contractor invoices accurately reflect the veteran's length of stay. 5. The contractor shall maintain an individual clinical record on each veteran out-placed under this contract. The contractor must comply with the requirements of the *"Confidentiality of Certain Medical Records" (§38 USC 4132), and the *"Confidentiality of Alcohol and Drug Abuse Patients Records" (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 VA staff members involved with the treatment program of the veterans concerned. In addition to reasons for referral, the clinical record maintained by the contract facility will include: A. All essential identifying data relevant to the resident and his/her family, including a socio-cultural vocational assessment. B. Data relating to the resident's admission, to include the targeted goals for constructive changes which are to be attained during the residential rehabilitation episode, and the anticipated length of stay, if known. C. Copies of any medical prescriptions issued by physicians, including orders, if any, for medications to be taken; D. Reports of periodic reevaluation by program staff, to include any measures of movement toward rehabilitation goals, with focus on the attainment of self-help skills. E. Final summaries on each resident who leaves the program, to include a description of beneficial changes realized during the residential period, reasons for leaving, the resident's future plans, and, if possible, follow-up locator information. F. Upon discharge or death of the patient, medical records on all VA beneficiaries will be retained by the Residential Treatment Center (RTC) for a period of at least three years following termination of care. F. REFERRAL 1. The VA case manager/treatment team, in collaboration with the existing community homeless case workers, shall identify and refer all patients to the contractor. All patients will be homeless including severely mentally disabled veterans to include those with alcohol and/or substance abuse disorders. 2. Before referring any patient, the VA shall have provided the patient with a clinical assessment, with a physical exam and laboratory studies if indicated, and confirmation of chronic mental illness by a VA mental health professional. 3. All patients will be capable of self-preservation, and in an emergency situation, will have sufficient capacity to recognize physical danger, sufficient judgment to recognize when such danger requires immediate egress from the group residence, sufficient capacity to follow a prescribed route of egress, and sufficient physical mobility to accomplish such egress. 4. VA will authorize up to six (6) months of care depending upon the needs of the patient as mutually determined by the patient, the VA outreach worker, and the residential treatment staff. Authorizations beyond the current fiscal year are contingent upon funds being available for the next fiscal year. G. STANDARDS/LICENSES 1. Both residential and ambulatory care facilities must conform to the standards of the Life Safety Code (National Fire Protection Association #101) and conform to the fire and safety code imposed by the state law which adequately protects residents, and must meet all city, state, and federal requirements concerning licensing and health codes. In all cases, the VA requires a level of safety which conforms to NFPA #101. 2. All contract facilities must be licensed under state of federal authority. 3. In the performance of this contract, the Contractor shall take such safety precautions as the Contracting Officer, or his/her designee may determine to be reasonably necessary to protect the lives and health of the occupants of the buildings. The Contracting Officer, or his/her designee will notify the Contractor of any noncompliance with the foregoing provisions and the action to be taken. The Contractor shall after receipt of such notice immediately correct the conditions to which attention has been directed. Such notice, when served on the Contractor or his/her representative at the site of the work, shall be deemed sufficient for the purposes aforesaid. If the Contractor fails or refuses to comply promptly, the Contracting Officer may issue an order stopping all or any part of the work and hold the Contractor in default. H. LEVEL OF CARE 1. A program of therapeutic and rehabilitative mental health services designed to promote a more adaptive level of psycho- social functioning. 2. Supportive personal care. 3. Individual adjustment services including social diversional, recreational, and spiritual opportunities. 4. Full attention shall be given to motivation and education of patients to achieve and maintain independence in the activities of daily living and self care. I. DIETETIC SERVICES 1. Patient dietary needs shall be met in accordance with sound medical practice. 2. At least three nutritious meals or their equivalent shall be served daily at regular times with not more than a 14 hour span between evening meal and breakfast of the following day. Between meals and/or bedtime snacks of nourishing quality shall be offered. 3. There shall be evidence that food is prepared, served and stored under sanitary conditions. 4. Sanitary procedures shall be established and maintained for washing dishes, cleaning equipment and work areas, and for proper waste disposal. J. CONTRACT CHANGES/TECHNICAL DIRECTIONS 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. The COTR will be responsible for the overall technical administration of this contract as outlined in the COTR Delegation of Authority, including monitoring of the Contractor's performance.