Q--Amended Art Therapist Services Statment of Work

SECTION A - SUPPLIES OR SERVICES AND PRICES/COSTS B-2 PRICES/COSTS BASE YEAR: 9-1-09- 8-30-10 EST UNIT TOTAL RESOURCE QTY UNIT PRICE PRICE 1. On site Art therapy services 192 Hour $______ $________ 8 hours/week x 24 weeks(provided at VAMC) 2. Supplies-individual sessions 16 Sessions $_______ $________ (2 sessions/week for 8 weeks) 3. Supplies- individual and group 32 Sessions $_______ $_________ (2 sessions/ week for16 weeks Sessions of art therapy consists of professional services and supplies necessary to the therapy (e.g., art supplies, soil, paint, seeds etc). ONE YEAR TOTAL $_______ GRAND TOTAL AMOUNT BASE YEAR ____________________ $__________ SECTION C - DESCRIPTION/SPECIFICATION /WORK STATEMENT B.3 STATEMENT OF WORKThis requirement is to provide professional art therapy services to VA SCI patients who are either under inpatient or outpatient care. Treatment will include all necessary supplies except adaptive equipment. Adaptive equipment will be provided by the SCI OT/PT therapy departments. B.3.1 REFERRALS/INITIAL CONSULTATION: A. VA patient referrals shall be scheduled and be seen by the Contractor within five (5) workdays of request for appointment. B. An initial consultation with the therapist will be ordered by the referring physician. Upon completion of this consultation, the therapist shall provide a treatment plan based on the referring physician's requirements. The plan shall include measurable goals and time frame for completion. This plan shall be provided to the referring physician within five (5) workdays. C. Upon award of the contract the Contractor will be provided a list of physicians authorized to refer patients for therapy. The contractor shall be responsible for ensuring all referrals are from authorized physicians before providing consultation/therapy. B.3.2 PROGRESS REPORTS: A. Once therapy has begun; the contractor shall conduct and document an art therapy assessment and provide brief daily progress notes to the Chief, Spinal Cord Injury (SCI). The progress note shall contain information such as, therapy plan, goals, barriers, effectiveness of treatment, response to treatment, significant changes, and unusual events. B. Additional progress notes or phone consultations between the therapist and physician shall be made as medically indicated. C. Progress notes shall be provided to the VA in triplicate with the following distribution: Original to Chief, Medical Administration Service; one copy to Chief, SCI; and one copy to the referring physician. These progress notes shall be provided monthly and at conclusion of each treatment series. B.3.3 ON-SITE CONSULTATION: All art therapy will occur on site at the Wade Park, Louis Stokes, Cleveland Department of Veteran's Affairs Medical Center (LSCDVAMC) SCI Center. The art therapy sessions will occur either at the patient's bedside, in their rooms, on the SCI provided space for group sessions. The contractor will provide all necessary supplies except adaptive devices, which will be provided by the SCI OT/PT therapy departments. Supply storage will be provided by the SCI service/LSCDVAMC. B.3.4 PRE-DETERMINED SERIES/INDIVIDUAL SESSION: A. If considered appropriate by the referring physician, treatment sessions will be ordered in pre-determined series, as shown below. The cost of series includes the initial consultation. Series A = individual sessions 2 times per week for as needed time frame Series B = group sessions 2 times per week for as needed time frame. C. All treatment series/sessions will include all necessary supplies, that may be required for proper treatment, except adaptive equipment which will be provided by the SCI OT/PT therapy department. B.3.5 QUALIFICATIONS OF CONTRACTOR:The Contractor will provide an art therapist(s) who has a master's degree in art therapy. Clinical supervision will be provided through the contractor as indicated is desired, but not mandatory for the art therapist to have Art Therapy credentialing through the Art therapy Credentialing Board. B.3.6 COMPETENCY OF PERSONNEL PROVIDING SERVICE: A. The Contractor shall ensure all personnel are fully qualified and have the requisite licensure, training and experience to perform service under the terms and conditions of this contract. The Contractor shall provide, upon request of the Contracting Officer, documentation of licensure, qualifications, training and experience of personnel providing service under this contract. Failure to ensure personnel meet the minimum requirements is cause for termination of this contract. B. The Contractor shall have adequate personnel to render prompt, courteous and satisfactory services required under this contract. B.3.7 PATIENT TRANSPORTATION:Transportation of patients will not be necessary for this service. B.3.8 PATIENT NO-SHOWS:The names and patients with two no-shows in a given series shall be reported immediately to the Contracting Officer's Technical Representative (COTR) Frances Brand, RN, MSN, Rehab Manager, SCI Service 128(W), Cleveland VAMC, 10701 E. Blvd. Cleveland, Ohio, 44106, Phone: +1 (555) 000-0000 ext 4731. B.3.9 RESOURCES: The services specified in Section A may be changed by written modification to this contract. The modification will be prepared by the VAMC Contracting Officer, and prior to becoming effective, shall be approved by the VA Chief Executive Officer or his/her designee. B.1.0 TERM OF CONTRACT: This contact is effective for a period of one year from the date of award. The contract is subject to the availability of funds. No service shall be performed by the contractor after August 30th, 2010, until the contracting officer authorizes such services in writing. B.1.1 PAYMENT: A. Invoices shall be submitted no more than once a month and shall only include request for payment for services actually performed. Only the original invoice need be provided and shall include the following information: Patient name and number of sessions received in accordance with the treatment plan. Invoices shall include a copy of the care verification log as required by Paragraph A-20 of this contract. B. Payment shall be made monthly in arrears upon submission and receipt of properly prepared invoices by the contractor. Billings rendered by the contractor for services furnished to the VA under this contract shall be billed in full. Neither the beneficiary, his/her insurance nor any third party shall be billed. B.1.2 QUALIFICATIONS: Personnel assigned by the contractor to perform the services covered by this contract shall be licensed in a State, Territory, or Commonwealth of the United States or the District of Columbia, or directly supervised by licensed personnel. The qualifications of such personnel shall also be subject to review by the VAMC Chief Medical Officer or his/her designee and approved by the VAMC Chief Executive Officer. B.1.3 MEDICAL RECORDS:Clinical or other medical records of VA Beneficiaries treated by the contractor shall be forwarded to VA. B.1.4 CONFIDENTIALITY: a. The Contractor is subject to the provisions of the Privacy Act of 1974 as well as, all applicable VA laws and regulations. b. The Contractor shall keep confidential the contents of all medical documents entrusted to its care. Employees of the Contractor shall not disclose to any unauthorized person, firm or corporation knowledge entrusted during performance of the contract which relates to the following, but not limited to: i. Names of patients.ii. Names of physicians, nurses or any other employee of the medical center. iii. The type or content of any dictated reports. c. All contractor personnel shall observe the requirements imposed on sensitive data and information by law, Federal regulations, VA statutes and policy, Veterans Health Administration (VHA) policy and guidelines and the associated requirements to ensure appropriate screening of all personnel (e.g., Privacy Act of 1974, Public Law 93-579, the requirements of the FPM 731, Subchapter 2 and FPM 732, Subchapter 2 under E.O. 10450, etc.). All employees of the contractor and the subcontractor shall sign an Access Agreement, agreeing to abide with the facility's ADP security policies and procedures before actual computer access is granted. d. In order to maintain Patient Medical Records the Contractor shall have access to the Department of Veterans Affairs System(s) of Records entitled, "Patient Medical Records - VA (24VA136)". e. "Contractor personnel who obtain access to hardware or media which may manipulate or store drug or alcohol abuse data, sickle cell anemia treatment records, records of tests or treatment for or infection with Human Immunodeficiency Virus (HIV) or medical quality assurance records protected by 38 U.S.C. 4132 or 3305, as defined by the Department of Veterans Affairs, shall not have access to the records unless absolutely necessary to perform their contractual duties. Security of Sensitive Data (see M-11, Chapter 16, Automated Information Systems (AIS) Security, paragraph 1609 and 1612) describe these data in greater detail. Any individual who has access to these data will disclose them to no one, including other employees of the Contractor not involved in the performance of the particular contractual duty for which access was obtained. Violation of these statutory provisions, as stated in Department regulations, by the Contractor or the Contractor's employees, may involve imposition of criminal penalties." The VA Medical Centers shall provide access to the cited VA Manual provisions. f. In addition to abiding by the above confidentiality statement, other statements regarding patient confidentiality and computer security may need to be signed by each contractor employee performing on this contract. B.1.5 WORKHOURS: A. The services covered by this contract shall be furnished by the contractor during normal VAMC work hours. B. Normal hours are from 8:00 a.m. to 4:30 p.m., Monday through Friday, excluding National Holidays. C. National Holidays: The ten holidays observed by the Federal Government are as follows: New Year's Day, Martin Luther King's Birthday, Washington's Birthday, Memorial Day, Independence Day, Labor Day, Columbus Day, Veteran's Day, Thanksgiving and Christmas. B.1.6 PERSONNEL POLICY: a. The contractor shall be responsible for protecting the personnel furnishing services under this contract. To carry out this responsibility, the contractor shall provide the following for these personnel: - workers compensation- professional liability insurance- health examinations- income tax withholding, and- social security payments. b. The parties agree that such personnel shall not be considered VA employees for any purpose and shall be considered employees of the contractor. B.1.7 EVIDENCE OF COVERAGE: Before commencing work under the contract, the contractor shall furnish to the contracting officer a certificate of insurance from his/her insurance company indicating the coverage outlined in Paragraph A-18 has been obtained and it may not be changed or canceled without 30 days written notice to the contracting officer. B.1.8 CONTRACT MONITORING: A. The COTR is responsible for monitoring contractor compliance with the terms and conditions of this contract. B. The contractor shall maintain an individual care verification log for each patient. Patients referred are to initial the log as evidenced that treatment was provided. A copy of the care verification log shall be submitted when Contractor invoices for payment for services provided to the patient. Failure to maintain the log will result in non-payment for services performed. C. Any incidents of contractor noncompliance, as evidenced by the monitoring procedure, shall be forwarded immediately to the Contracting Officer. D. Quarterly assessments shall be made by the COTR as to the quality and effectiveness of the contract services provided. B.1.9 Security Requirements Security Clearance Procedures for Contractors W/O Need for VA Systems Or Information Access: Working More than 180 days On Site. 1. VA form 2280 will need to be filled out by requestor for any new contract and approved by the Information Systems Office (ISO) 2. A SAC (form 0711) will need to be completed and adjudicated before access can be granted. Requiresa. Two forms of Valid IDB. Fingerprintsc. POC Manager Verificationd. Police Issuee. PIV Badge to be worn by Contractor 3. NACI initiated The following security determination for this position is: 1. Position Risk - In accordance with IL0710 and VA form 2280a the position risk has been designated as Low Risk/Non-Sensitive. 2. Background Investigation - The level of background investigation to be initiated is NACI. 3. Contractor Responsibilities a. The contractor shall bear the expense of obtaining background investigations. If the investigation is conducted by the Office of Personnel Management (OPM), the contractor shall reimburse VA within 30 days. b. The contractor shall prescreen all personnel requiring access to the computer systems:(1) All personnel must be a U.S. Citizen or a legal U.S. resident with a proper work Visa. (2) Applicants should be able to read, write, and understand the English language. c. The contractor shall submit or have their employees submit the following required forms to the VA Office of Security and Law Enforcement within 30 days of receipt: (1) Standard Form 85P, Questionnaire for Public Trust Positions (2) Standard Form 85P-S, Supplemental Questionnaire for Selected Positions (3) FD 258, U.S. Department of Justice Fingerprint Applicant Chart (4) VA Form 0710, Authority for Release of Information Form (5) Optional Form 306, Declaration for Federal Employment (6) Optional Form 612, Optional Application for Federal Employment d. The contractor, when notified of an unfavorable determination by the Government, shall withdraw the employee from consideration from working under the contract. e. Failure to comply with the contractor personnel security requirements may result in termination of the contract for default. f. Awarded Contractor to provide the following information: 1. List of names of contractor personnel. 2. Social Security Number of contractor personnel. 3. Birth date of the contractor personnel. 4. City and state of the contractor birth place. 5. E-mail and home address of contractor personnel and/or the contractor's point of contract information. g. Background Investigation Cost: 1. LOW/NACI - $200 2. Moderate/MBI - $800 3. High/BI - $2900