G004--36C25524R0023 Health Care for Homeless Veterans Srv Contract

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 behavio...