G099--654-21-3-168-0039 New Frontier COVID Contract (VA-21-00060841) Residential Addiction Treatment with Supportive Services

VA Sierra Nevada HCS 12/2020 New Frontier 13 PERFORMANCE WORK STATEMENT PURPOSE: The Department of Veterans Affairs (VA) Sierra Nevada Health Care System (VASNHCS) located at 975 Kirman Avenue, Reno NV 89502, has a requirement to provide Emergency Residential Treatment Services in Churchill County, Nevada (Fallon) as part of its Community-Based Health Care for Homeless Veterans (HCHV) program. 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 supportive services to meet their needs and ultimately, facilitate the improvement of their overall health status and housing situation. The period of performance of the resulting Contract will be for a base year period. This contract represents a Firm Fixed-Priced, Indefinite Delivery-Indefinite Quantity contract. Costs not incorporated into the Contractor s price will NOT be reimbursed by the Government. BACKGROUND: Through the HCHV program, VA provides outreach and case management services to Veterans and facilitates their access to a broad range of medical, mental health, and rehabilitative services. The purpose of this solicitation is to obtain offers from contractors who can provide care and sufficient services to veterans who are homeless, in community-based residential settings that offer a safe and secure environment to support veterans rehabilitation and recovery goals. It is understood that the Veterans being served through this contract may have been diagnosed with severe mental illness and/or substance use disorders. The Contractor will be required to provide a therapeutic and rehabilitative milieu as well as residential and case management services. The VA will not provide homeless Case Management services to Veterans in addition to the Case Management provided by contractor. All facilities will encourage Veterans to complete their agreed upon recovery plans prior to discharge. SERVICES TO BE PROVIDED: The Contractor shall provide all labor, supervision, housing, material and supplies necessary to provide emergency residential treatment, rehabilitative and supportive services. Services will be provided on-site at the Contractor s facility, in accordance with all terms and conditions, provisions and requirements listed herein. The prices provided in the Price Schedule shall be inclusive of all basis services as may be necessary in the treatment of the Veteran. Basis Services shall be defined in the Performance Work Statement. Substance Abuse/Addiction Treatment. The Contractor s facility will offer comprehensive substance abuse treatment to include: Structured individual counseling and group activities as appropriate, family support/education, crisis intervention, and relapse prevention. Clinical supervision on-site 24 hours per day by licensed professionals in the area of Mental Health and/or Addiction Treatment. The ability to provide detox services for veterans in a safe and supportive environment with medical supervision. Case Management Services. Contractor shall have a Case Manager dedicated to Veteran residents on-site at least 40 hours per week. The Contract Case Manager shall be responsible for the in-take assessment of Veteran residents once referred by the VASNHCS HCHV staff. Additionally, the Case Manager shall provide the following: A thorough written Individualized Care Plan (ICP) will be developed within 72 business hours of admission for each Veteran. Individual counseling with a focus on areas including but not limited to self-care skills, adaptive coping, education of the process of illness and recovery, financial planning, permanent housing search, written care plan, referral for financial benefits, social skills enhancement, and vocational rehabilitation as appropriate. Additional counseling may include, professional and vocational rehabilitation counseling in collaboration with VA programs and community resources. Special attention will be made to address High Suicide Risk (HSR) Veterans as identified by the VA Liaison, VA Mental Health Staff and/or the contracted Case Manager. On a weekly basis the contracted case manager will be required to update the VA Liaison on Veteran progress and/or safety concerns. Contracted Case Manager will review the HSR Safety Plans with the Veteran on a Bi-weekly basis. HSR Safety Plan reviews and a copy of the Veteran s Safety Plan will be documented in the chart. All Contractors will provide proper documentation verifying services and case management efforts by all team members. It is expected that notes are written professionally in a format that utilizes the clear settings of goals and documents progress toward those goals. (e.g. SNAP, SOAP, or SMART notes). Instruction in and assistance with health and personal hygiene. Scheduled visits with each Veteran resident and open office hours to discuss progress towards long term goals established at in-take. All veterans must receive an intake packet within 72 business hours which includes, at minimum, the following information: Description of the Contractor s services; Grievance Policy; Emergency Procedures; Patient Rights and Responsibilities; and Reasonable Accommodation. Financial Planning activities should be provided to support Veterans in developing a short and long-term plan to understand and effectively deal with their current financial situation and how to improve it. Financial planning efforts may be provided in a group, but preferable through one on one case management services. All Veterans should be referred to apply for any and all financial resources for which they may be eligible, including (but not limited to): VA Benefits (Service Connected Compensation/NSC Pension), Social Security/SSI, Etc., Food Stamps. At a minimum of 4 financial planning activities appropriate to the Veteran s individual circumstance must be documented monthly. Employment Services referrals will be made to all relevant employment opportunities the Veteran is eligible for and interested in. Case Managers will document all structured activities that support Veteran in applying for employment as appropriate based on needs of Veteran as identified in the assessment. Permanent Housing Search is required by programs to provide Veterans with direct and ongoing assistance in achieving permanent housing. As a primary goal of the HCHV program, plans for Veterans transition to permanent housing placements must be clearly reflected in each Individualized Care Plan and in weekly case management notes. As part of this plan, Veterans housing history and needs must be assessed through a formal and thorough Housing Assessment completed within 72 business hours of program admission. Housing Assessments must identify Veterans housing history, strengths, and barriers. Should Veteran refuse to engage with program staff regarding plans for permanent housing transition, motivational interviewing and other therapeutic techniques will be used to address Veteran ambivalence. All efforts to engage Veteran regarding housing plans, options, and resources shall be clearly documented and include any therapeutic techniques utilized. Contractor staff must provide direct assistance to Veterans in developing permanent housing plans and accessing appropriate housing resources. These services shall be provided weekly through one to one case management. Examples of expected housing services include: 1) assistance obtaining and reviewing Veteran s Free Credit Report, identifying housing strengths, and/or barriers associated with current credit status; 2) Creating a Tenant Portfolio with Veteran that contains all relevant documents required in the rental process, including a completed sample rental application for Veteran, income verification documents, identification, applicable subsidies, etc.; 3) Reviewing affordable housing rental options and Permanent Supportive Housing program offerings, and assisting Veterans with making appropriate rental inquiries and submitting completed rental applications; 4) Conducting regular and individualized housing advocacy efforts, including transportation, assistance scheduling, meeting, and communicating with property managers and landlords, and engage in troubleshooting where rental barriers or denials occur in the housing search process. All housing efforts by Contractor shall be documented clearly and presented to HCHV Liaison upon request. Mere communication with Veterans regarding housing, without subsequent Contractor staff action and follow-up, shall not on its own meet the above requirements. Discharge planning, after consultation with the HCHV staff, to appropriate follow-up housing including assistance with referrals and applications. Securing permanent housing will be the discharge goal for every Veteran. The program is expected to assist with the formulation of an initial discharge plan within 14 business days of program admission. The plan should clearly identify objectives and tasks, including dates for completion of each, and should be updated on an ongoing basis throughout the episode of care to accurately reflect progress. Paperwork required for discharging a Veteran from any HCHV program is required via fax or secure messaging within 24 business hours from known discharge. All Veterans scheduled for discharge based on behavior must meet with the treatment team and work with the team to determine the most therapeutic option for the Veteran. This does not include violations for safety reasons or verbal abuse. Please note: Profanity does not in and of itself constitute abuse and shall not exclusively be considered grounds for discharge. Any and all actual or threatened violence will be grounds for discharge. Veterans may be discharged for safety reasons at any time. All negative discharges will be subject to a full team debriefing, including VA Liaison, to look for opportunities missed to intervene sooner. All discharges are subject to the Contractors grievance procedures and must allow clients the opportunity to be represented by the VA Liaison in the grievance process. Reasonable efforts must be made to coordinate with the Liaison in order to schedule an appeal. Lastly, all TQI measures must be met in order to receive the highest past performance rating. These include the following: HCHV1 discharge to Independent Housing > 50%; HCHV2 discharge with negative exits < 20%; Bed Occupancy >85%; Length of Stay < 90 days; Employed at Exit 30%; VA Benefit Applications Pending for all eligible Veterans 15%; Non-VA Benefit Applications Pending for all eligible Veterans 8%. Internal Grievance Procedure Processes must be used to resolve conflicts within the program. Programs must have written policies and procedures for resolving grievances, including a statement regarding the client s right to request reasonable accommodation, and must post them in a place conspicuous and be accessible to clients. In addition, each client shall receive a copy of the grievance policies and procedures, upon intake and upon receiving a warning or discharge notice. It is expected that Contractor beds will be maintained at an average minimum of an 85% occupancy rate but at a preferred rate of 90% as calculated based upon number of bed nights available per quarter. If this rate is not consistently attained a Corrective Action Plan will be developed by the Contractor as part of the QASP and/or process improvement plan. Adjustments in contract funding may occur through modifications if occupancy is not maintained. Failure to maintain year to date occupancy rate at or above 85% may be grounds for immediate termination for convenience. Contractor will be responsible to engage in outreach in the community both independently and in collaboration with the VA Sierra Nevada Health Care System at least twice per month. In addition, clear documentation for outreach activities must be made available to Liaison upon request during the QASP review. Contractors will maintain occupancy by engaging in outreach services and will be knowledgeable about outreach best practices generally accepted in the community. Veterans cannot be denied entry into HCHV Contracted Residential Services 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, disability, or legal history. This includes a Veteran s status of being a victim of domestic violence and as such cannot be considered during the screening process. 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. All Contractors must employ a harm reduction approach. Supportive Services. The Contractor shall provide the following supportive services: Assistance with local transportation for Veterans to and from VA medical and dental appointments and other scheduled meetings and appointments. The Contractor will be expected to help the Veteran access public transportation, including providing information and instructions necessary to enable Veterans to utilize public transportation. Assistance in obtaining a driver s license, a DD Form 214, or completing applications for public assistance/ services are required social services. Opportunities to participate in spiritual worship. Therapeutic and Rehabilitative Services. Each Veteran will have an Individual Care Plan completed by the Contractor with input from the Veteran and the VA Homeless Program Liaison or Designee. Therapeutic and rehabilitative services will be stated in the plan of care. Collaboration and coordination with VA Program Staff will be conducted as needed and will include coordination of supportive psychosocial services. In particular, coordinated efforts must be made with the Liaison around medical, mental health, admission, and discharge needs. Program environment should be conducive to positive social interaction and the fullest development of the Veteran s rehabilitative potential. The Contractor is expected to support the Veteran in gaining and applying knowledge of the recovery process, and to provide individual and group sessions focusing specifically on the treatment of mental health and substance use disorders, as well as providing other supports as needed to facilitate progress in the individual s overall recovery effort. Assistance to gain and to apply knowledge of the recovery process in an environment supportive of recovery models including a focus on Harm Reduction rather than strict abstinence and supportive of a Housing First approach. Pursuant to these principles, drug testing may not be used to discharge or discipline a Veteran but may be used as a clinical intervention to modify behavior. Structured group activities should be available to Veterans admitted to the program. At a minimum, Veterans should plan to attend 2 or more such activities per month. Examples of appropriate group activities include: group therapy, relapse prevention, life skills training, social skills training, Alcoholics Anonymous, Narcotics Anonymous, vocational counseling, and permanent housing search groups. For the purposes of this contract, House Meetings and VA Housing Resource Groups may not be counted as a structured group activity since groups should have a therapeutic value and facilitation shall be the responsibility of the Contractor. Should a Veteran have a mental health, medical, family, and/or employment obligations which directly conflicts with this requirement, alternative group activities will be arranged, and/or the Contractor will clearly document efforts made to accommodate the Veteran. Residential Room and Board. Clean and sanitary housing. One single bed per occupant with fitted sheets, blankets and pillows. Storage space with locking capability for clothing and personal property. The Contractor will allow Veteran to store personal belongings for at least 72 hours after formal HCHV discharge. Toiletries and bath linens (e.g. soap, toothbrush, toothpaste, towels, washcloths). Indoor recreation/lounging areas. Laundry Facilities. Laundry facilities and products shall be available for no additional fees for residents to do their own laundry or to have laundry done. Referral Process. The VA is responsible for determining eligibility of Veterans prior to acceptance by the Contractor for services. After receipt of a Release of Information (ROI), a written pre-approval from VA staff is required (Placement Agreement) and shall be provided to the Contractor for each Veteran referred for services under the contract. If there is an urgent need to admit a Veteran and VA Staff is not available to provide a written approval (Placement Agreement) in a timely manner, a verbal approval is acceptable. Any admissions that occur without written/verbal approval must be verified by VA Staff within 24 business hours in order for the Contractor to receive payment for time spent prior to approval (e.g. admission after hours or during the weekend). Written documentation of eligibility verification, signed by an authorized VA Staff, shall be obtained by the Contractor as soon as possible for each Veteran referred for services under the contract for inclusion in the Veterans Program file. Contractor should make reasonable accommodations and provisions to process intakes and admits of Veterans into the contract program within business hours each day during the work week. Contractor should also make reasonable accommodations and provisions for admits and intakes after normal business hours for those veterans being discharged from the Veterans Administration Emergency Department or Hospital. Contractor should make every effort to accommodate veterans who are working. Contractor should allow the working veteran to meet program requirements through alternate avenues, such as at the VA hospital and with the utilization of off-site AA meetings. Contractor should make every effort to provide veteran with access to the telephone and the ability to meet obligations and commitments made prior to program entrance. Veterans entering the program who are already engaged with the VA Hospital Mental Health Service and recovery groups should be accommodated and given every opportunity to continue those appointments and group meetings. It is understood that the type of Veterans to be cared for under this contract will require care and treatment services over and above the level of room and board. To be eligible for placement in emergency contract beds, all Veterans must be homeless and be eligible and registered for VA Medical Services. Contractors are encouraged to provide housing and services to special Veteran populations, such as but not limited to the following: medically compromised Veterans, Veterans with young children, Veterans with sex offender status, seriously mentally ill Veterans, Veterans who have abused drugs or alcohol for many years and/or Veterans who have been involved with the legal system. Veteran residents shall receive a clinical assessment by the VA before being referred to the Contractor. In addition, a negative TB screen within the last 6 months will be required prior to referral. The COR shall arrange admission of the Veteran residents with the Contractor. The Contractor shall record the date and time of admission in the Veteran resident s file and include that information on the first monthly invoice. The initial stay for a Veteran should be no longer than 90 days. Any extension of the stay after 90 days must be authorized by the VA Homeless Program Liaison or Designee, provided that there is clean clinical indication and availability of funds. Only extraordinary circumstances will be considered in order to extend service periods in excess of 6 months for individual Veterans and these must be authorized by the Medical Center Director or Designee. Records and Reports. An individual client record will be maintained on each Veteran resident referred, including reasons for referral and documentation of Veterans progress within the program. This shall also include sign-in sheets whenever possible. When requested, the Contractor shall provide to the VA: All essential identifying data relevant to the Veteran resident including a socio-cultural assessment, weekly progress reports or notes, and documentation of any case management interventions or patient care conferences. The intake assessment and continuing care plan developed with the consultation of the Veteran resident and HCHV staff. The Contractor shall have reasonable rules governing day-to-day life and activities in the facility. Such rules clearly inform Veterans of the obligations upon which their continued participation in the program depends and the consequences for non-compliance. Veterans will be provided a copy of the rules at intake and upon request. In addition, Contractor will post the rules in a location readily accessible to clients and visitors. These rules must include detailed Patient Rights and the procedures that the Contractor has in place the protect the Veteran rights and dignity. Veterans must be permitted to exercise these rights without fear of reprisal. If requested, Contractors must reasonably accommodate Veterans whose compliance with the program rules is limited by the Veteran s physical or mental disabilities, in accordance with the Americans with Disabilities, the Federal Fair Housing Amendments Act, Section 504 of the Rehabilitation Act, including those requirements covering reasonable accommodations for disabilities and the use of assistance animals, and all other applicable State or Federal laws. Contractor must equally apply all rules, policies, and procedures to Veterans, unless a Veteran has asked for a reasonable accommodation due to his/her disability. In addition Contractor must post rules and provide the Veteran with the rules which specify the reasons or conditions for which a Veteran may be sanctioned or discharged, including those behaviors which constitute gross misconduct and are grounds for immediate discharge from the program and those which would prompt a written warning if violated and potential discharge if violated repeatedly. Contractor will describe the formal appeal procedures through which clients may appeal program regulations, sanctions or discharges. This information must be provided to clients in writing upon intake and must be clear and easily understandable by clients. This information will include: immediate contact with VA Liaison; Timely due process provisions which should include 2 warning notices for violations which do not result in immediate discharge prior to issuance of a discharge notice and an opportunity for a case conference after waring is issued to the client; Notice of, and access to, formal appeal procedures; Notice of the conditions or process for re-admission to the program; and Reasonable efforts to provide an appropriate referral to another facility or appropriate level of care as needed. This does not apply to Veterans who are discharged for danger to self or others. Contractors must protect the rights and dignity of the individual or family served in all phases of service delivery. At a minimum, providers must afford each Veteran the following rights and protections. Clients must be permitted to exercise these rights without fear of reprisal. Veterans are entitled to enjoy a safe and healthful environment in the program Veterans are entitled to be treated in a manner that respects their dignity, privacy, and individuality Veterans with disabilities are entitled to reasonable accommodations under fair housing laws when such accommodations are necessary because of their disability Veterans are entitled to remain in the program and not be involuntarily removed without reasonable notice, good cause, and just procedures All program clients are entitled to just and standardized procedures for determining eligibility, admissions, sanctions and discharges, and resolving grievances Veterans are entitled to reasonable privacy and confidential treatment of personal, social, financial, medical, mental, and behavioral health records, except as necessary to further treatment, information and referral services, and in compliance with the resident s consent to release information Veterans are entitled to the full exercise of their civil, constitutional, and legal rights Veterans will have on-going opportunities to voice opinions, to participate in program operation and programming, and to make suggestions regarding programming and rules Veterans rights must be protected against all forms of discrimination, including those based on race, religious creed, color, national origin, ancestry, language, disability (physical or mental health), medical condition, marital status, familial status, age, gender, sexual preference, source of income, or political affiliation will not be condoned nor tolerated Contractors will develop a written policy for transgender clients that provides for safe, secure, and dignified case management as well as accommodate the special requirements needed for privacy. Transgender clients will have access to sleeping accommodations and bathroom facilities based on their gender of identification, regardless of physical characteristics or gender conformity. People who do not clearly identify as male or female should have access to whichever sleeping and/or bathroom accommodation that helps them feel safest. Where there are single-use showers and bathrooms in the facility designated for residents, transgender residents will be told about them and welcome to use them but not required. It is the Contractor s responsibility to promote a safe environment for transgender clients amongst the general population Programs must post these policies in a conspicuous place and in appropriate languages All policies and procedures will be in writing and subject to review by the VA Reports of all critical incidents involving Veteran residents immediately after occurrence, via telephone, text, or email. A written incident report shall be provided by the Contractor to the COR within 24 hours of the incident. Critical Incidents includes the following: Falls, slips or trips; Assault; Elderly/Dependent Adult Abuse or Neglect; Sexual Assault; Fire (Veteran Involved); Medical Emergency; Hospitalization; Suicide, Suicide Attempt, Suicidal Ideations; Homicide or Homicidal Ideations; Death; Infectious Control (Bed Bugs, TB, Scabies, etc.); Active Substance Abuse; Observation/Possession of Weapons; If Medications are Lost, Stolen, or Miss-Used. Copies of any medical prescriptions or instructions issued by VA physicians, including orders, if any, for medications to be taken. Reports of periodic re-evaluation by program staff to include any measures of movement toward rehabilitation goals, with particular focus on the attainment of self-help skills. Notification to the COR within 24 hours of discharge. Discharge summaries on each Veteran resident who leaves the program, to include reason for leaving, the Veteran resident s future plans, and follow-up locator information, shall be provided to the COR within 24 hours of discharge from the program. The Contractor shall notify the VA of unauthorized absences by a referred Veteran from the facility within 24 hours of Veteran s absence. Should a veteran absent himself/herself from the Contractor s facility in an unauthorized manner, payment for services for that Veteran shall be continued for a maximum period of 24 hours, provided there is a documented active outreach attempt on the part of the Contractor s staff to return the Veteran to the facility and there is a reasonable belief that the Veteran will return. Management of program dropout rate will be an element of quality assurance review of this program. The VA Liaison may authorize payment for excused absences up to 72 hours if there is a compelling medical or mental health need and the excused absence is verified a priority. The Contractor shall notify the authorizing VA facility immediately when a medical emergency occurs that requires hospitalization of a referred Veteran. It is agreed that the Veteran will be admitted to the appropriate VA facility. When such admission is not feasible because of the nature of the emergency, it is agreed that hospitalization in a non-federal facility is acceptable. If hospitalization of a non-emergency nature is required, it is agreed that admission to the appropriate VA facility will be accomplished promptly. The contract will make arrangements for admission and support the Veteran with any transportation issues that may arise. The VA reserves the right to remove any or all Veterans from the facility at any time without additional cost, when it is determined to be in the best interest of the VA or the Veteran. This includes discharge from facility for ongoing bed bug infestation. Individual case records will be maintained in confidence as required by U.S.C. Title 42, Chapter I, Part II, Confidentiality of Alcohol and Drug Abuse Patient Records found at http://www.hhs.gov/ohrp/archive/documents/19750701.pdf. Records will be accessible to the evaluation study required by Congress. The Contractor shall provide treatment and discharge planning reflecting a team assessment of health, social, and vocational needs and the involvement of the Veteran, the VA staff and appropriate community resources in resolving problems and setting goals. An individual case record will be created for each referred Veteran. The Contractor shall comply with applicable requirements of the Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR Part II) and the Confidentiality of Certain Medical Records (38 USC 7332). The files shall include: Reason for referral and weekly progress reports or notes and documentation of any case management interventions or patient care. Case records should also include: Copy of ID; ROI; Placement Agreement; Goals Worksheet; Admission/Discharge Date; Contractor Program Agreement; Agency Informed Consent; Client Rights and Responsibilities; HIPPA/Privacy Practice; HMIS/ROI for Miner; Grievance Procedure; House Rules; Rules for Passes; TB test within the last 12 months; proof of income, budgeting and financial planning; assessment of needs; barriers and strengths; Housing Plan; Personal Goals Plan; documented goals activities; documented mental health services; documented group activities; discharge plan completed within 5 days of program admission; and summary of exit with reason for leaving, future plans, and location information. Quarterly and/or Periodic Reports (e.g. Fiscal Accountability) as required and/or requested. The Contractor shall provide the Liaison with a written report of program activities on a Quarterly Basis in accordance with the QASP, no later than the 15th day of the month following the end of the quarter. These reports shall be maintained by the Liaison in the contract administrative file, and necessary reports shall be submitted as part of the annual inspection package. Contractor will be subject to Corrective Action Response to Violation (CARV). Depending on the nature of the violation, Contractor will submit a corrective action plan to the COR within a timeframe designated by the COR and based on severity of violation. VA personnel shall be provided access to medical records in the Contractor s facility regarding a Veteran resident s care under the contract. Dietetic Services. Contractor shall have on-site kitchen facilities permitted and licensed by the State of Nevada Health Division. In addition, the Contractor shall: Provide at least three (3) nutritious meals served daily at regular times with not more than a 14-hour span betwee...