V--Maine Healthcare System Ambulance Contract (BLS/ALS)

VA MAINE HEALTHCARE SYSTEM TRANSPORTATION SERVICES I. GENERAL OVERVIEW: The VA Maine Healthcare System requires a contractor to furnish Basic Life Support (BLS), Advanced Life Support (ALS) and Critical Care Transport (CCT) Ambulance Services to its beneficiaries. The contractor must provide all equipment, personnel, supervision, and support to provide these transportation services. All services will be provided in accordance with the terms and conditions of this contract, and industry accepted quality standards highlighted in this SOW. The Maine Healthcare system includes the Togus VA Medical Center located in Augusta, ME and ten community based outpatient clinics (Bangor, Calais, Caribou, Fort Kent, Houlton, Lewiston/Auburn, Lincoln, Portland, Rumford, and Saco). Services include transportation to and from the main hospital and CBOC's, as well as occasional Ambulance runs out of state to VA Medical Centers in Massachusetts (see attachment B for historical trip data). Historically, the VA Maine Healthcare System has divided the state into geographic zones and then awarded each zone individually. That will no longer be the case, as the government seeks one primary contractor (or transportation broker) that will now handle the entire state and the logistics of establishing subcontracting networks (if necessary). The intent is to establish an "all inclusive" price to the greatest extent possible by establishing a fixed price per trip for routine transports. Base trips are defined as being within a 25 mile radius of the pick-up point. Therefore, pricing is established on a per trip basis with additional line items to cover mileage over the 25 mile radius, or special scenarios. Please see attached price schedule for further clarification. II. TASKING/SPECIFICATIONS: 1. GENERAL: Contractor will furnish twenty-four (24) hour BLS/ALS/CCT Ambulance Service for the beneficiaries of the VA Maine Healthcare System. Service to be for the entire State of Maine, seven (7) days a week, nights, and holidays. Service to include transport to and from VA Maine as well as our Community Based Outpatient Clinics and Vet Centers in Caribou, Calais, Bangor, Rumford, Lewiston, Saco as well as ambulance transport to VA Medical Centers in Massachusetts. 2. NUMBER OF PATIENTS: It is understood and agreed that only ONE patient will be transported on a trip unless specifically authorized by the VA. An authorized official of VA Maine may, in the interest of the patient, allow a relative to accompany him/her at no extra charge to the Government. The contractor must ensure that the pick-ups and drop-offs are scheduled so that the total distance traveled will result in the most economical charge to the Government. 3. WAITING TIME: For time lost in waiting at either end or both ends of a trip due to causes beyond their control, the Contractor will be reimbursed at the rate of one-fourth the hourly rate quoted in their bid for each quarter hour or fraction thereof in excess of one-quarter hour from the time Contractor reports to the designated person. If the pickup is other than at the VA Maine, the Contractor will call the Transportation Coordinator or Medical Administration Assistant on duty as soon as they anticipate that a delay may develop for which they expect to claim reimbursement. This call is only for the purpose of verifying arrival time at the pickup point and is not necessary if the Contractor anticipates no delay for which they will claim reimbursement. 4. COMPLETED TRIP: When ambulance service under the terms of this contract involves pick-up of a patient who is to be brought to this medical center or to another hospital and/or clinic for hospitalization or treatment, the trip will be considered complete when the patient is delivered by ambulance personnel to the admitting/evaluation unit, a specified ward or unit, or to the location specified at the time the trip is requested. 5. NON-PICKUP OF PATIENT (DRY RUN): When ambulance service involves a trip to or from this medical center or transfer from community hospital or patient's residence and patient refuses transport or due to unforeseen circumstances the patient unstable for pick-up, the Contractor will collect for the trip at the rates applicable under the schedule portion of this contract. The VA reserves the right to substitute patients in these instances to prevent the "no-load" situation. 6. NON-ARRIVAL OF PATIENT: When ambulance service involves the pick-up of a patient scheduled to arrive by air and the ambulance driver finds such patient does not arrive as scheduled, the ambulance driver will contact the Travel Clerk, Supervisor, Patient Support Unit, or the AOD and inquire as to the status of the arrival. If appropriate, waiting time may be authorized for time lost in waiting in accordance with the rate applicable under the schedule of costs of this contract. If Contractor reported as scheduled and no patient is transported, Contractor will be reimbursed at the rates applicable under the schedule of costs of this contract. 7. RATES: Rates will apply twenty-four hours per day seven days a week. Payment for mileage traveled beyond a base trip (25 miles) will be limited to "One Way Only" for the distance over which the patient is transported. Such mileage costs will be paid in addition to the applicable rate per trip for any trip entirely within the county limits. Trip mileage shall be determined by the latest edition of the Google Maps. The Contractor shall receive the base rate quoted in the schedule for all one-way trips ordered. The base rate shall constitute full compensation for one-way trips which do not exceed the mileage threshold as defined herein. The Contractor shall also receive reimbursement of mileage charges for any mileage less than the mileage threshold. 8. TOLL CHARGES: It is agreed and understood that the prices quoted in the Schedule do not include any ferry, bridge, tunnel or road toll charges. Any such legitimate toll charges incurred shall be limited to ONE-WAY ONLY and shall be listed separately on Contractor's invoice. 9. PROBLEMS IN TRANSPORT: Any adverse events incurred during the transport of our patients will be recorded and reported to the Transportation Coordinator (TC) at the VA Maine Healthcare System, Augusta, Maine and recorded in the incident reporting system within 24 hours of transport. 10. PATIENT WELFARE AND ABUSE: The contractor shall be held responsible for patient welfare during transport. The contractor shall be held responsible for patient and/or Government property during transport. Any damaged or lost wheelchairs, walkers, crutches or personal belongings will be replaced by the contractor at no additional cost to the Government or beneficiary. The Government requires the contractor to exercise extreme caution and care in the handling of patients. Any abuse of patients will be grounds for default action or Termination of the contract. In the event a patient's condition worsens during transport, the Contractor shall transport the patient to the closest facility appropriate for the required care. In the event a patient should expire during transport the Contractor shall return to the VA Medical Center. 11. DRUG BOX: Emergency Drug Boxes will be provided by the awarded Contractor. Drugs will be provided by VAMC Togus for drugs not approved by the Maine EMS Protocol (REFER TO: http://www.maine.gov/dps/ems). 12. NO IDLE POLICY: At no time will the Contractor leave vehicles on VA premises unless a pick-up or delivery is in process. Once a patient has been removed from vehicle and properly secured with Emergency personnel, the running vehicle will be removed from the Emergency Department exit door to prevent environmental hazards due to exhaust fumes. III. ORDERING PROCEDURES: 1. Requests for services will be recorded on the daily travel manifest and furnished to the Contractor via facsimile or telephone. Names of authorized personnel who can transmit orders will be furnished to the Contractor by the Contracting Officer. NOTE: CONTRACTOR TO CALL TO THE TRANSPORTATION COORDINATOR FOR INSTRUCTIONS PRIOR TO PICKING UP PATIENT DURING THE HOURS OF 7:00 A.M. TO 4:00 P.M., +1 (555) 000-0000, EXT 5693; CONTRACTOR TO REPORT TO THE MEDICAL ADMINISTRATION ASSISTANT (MAA) OR ADMINISTRATIVE OFFICER OF THE DAY (AOD) DURING NON-BUSINESS HOURS, EXT 5523. 2. The VA Maine Healthcare System-Togus Transportation office during the hours of 7:00-4:00pm or Medical Administrative Assistance-MAA after hours and weekends; calls the Primary Contractor for Basic Life Support (BLS) service to ensure pick up within 60 minutes of the initial call, unless the Togus transfer coordinator gives a specific time when patient will be ready for pick up. If the patient cannot be picked up within the 60 minute time frame from the original call, the Primary Contractor will contact a subcontractor located closest to the patient to guarantee pick up within the 60 minutes. In no instance will the Primary Contractor be required to furnish more than six (6) ambulances at one time. Togus requests pick up times within the 60 minute period to expedite the transfer process and preventing the patient from occupying a hospital bed whether an inpatient or emergency room for any lengthy period of time. 3. Advanced Life Support (ALS) will be furnished for patient requiring a paramedic. This level of care will be determined by the medical staff treating the patient whether at Togus or a community hospital. The same 60 minute pick up process as described in #1 will be followed. All ALS ambulance transfers will be staffed by at least one (1) currently licensed paramedic (EMT-P) 4. Critical Care Transport (CCT) service will be furnished for patient requiring a paramedic. This level of care will be determined by the medical staff treating the patient whether at Togus or a community hospital. The same 60 minute pick up process as described in #1 will be followed. All ALS ambulance transfers will be staffed by at least one (1) currently licensed Advanced Emergency Medical Technician (AEMT). 5. 911 call requests from Togus emergency room occurs on occasion. The Primary Contractor will determine within one (1) minute from being dispatched if they are unable to provide this service within fifteen (15) minutes, the Contractor will contact 911 to respond to the call, providing them with the location and the need for an ALS unit. The Contractor will inform VA of their inability to meet the contractual needs and confirm they have contacted 911 to provide this service. 6. When veterans call for service, the Contractor is not to transport patients who call them for transport unless authorized for payment by Transportation Coordinator or MAA. 7. Patient Pick-Up and Delivery From/To VA Maine: Upon dispatched by the TC or MAA, the ambulance crew will report to the ward were patient is located. The Contractor will follow the following protocol. - Report to the personnel at the respective Nursing Station and (1) announce their arrival to pick-up and transfer patient, and (2) obtain report of pertinent information regarding patient's condition from the primary nurse/physician. - When delivering a patient, the ambulance crew will take patient to specified location in the facility and provide report to appropriate nursing personnel along with a copy of the run sheet which will be retained by the facility for the patient's medical record. 8. Transport of baggage with veterans will occasionally be required. 9. In cases which the Contractor's dispatchers prioritize their requests for services as an emergency and a rescue squad is dispatched, the dispatcher will notify the calling party at the VA Maine of the patients location as soon as it becomes available. 10. Any and all equipment, machinery, linens, etc. taken with patients from VA Maine must be returned to the Medical Center. The Contractor must provide own linens and must not be exchanged with VA linens. IV. RESPONSE TIME: The Contractor shall maintain at a minimum, a 95% compliance rate on response to pick-up or deliver during the contract year. If the Contractor fails to provide service within the time frames specified herein, the Government reserves the option of either obtaining service from an alternate source and charging the Contractor with any excess costs there from, or assessing a fee for each late pick-up. Contractor shall provide a bi-monthly report to the Travel Clerk which identifies each request for service by patient name, time of receipt of call, whether BLS or ALS unit, requested, time of arrival, and time elapsed from receipt of call and time of arrival. Other pertinent information as necessary may be included. V. GOVERNMENT OWNED EQUIPMENT OR SUPPLIES: Any and all government equipment, linens, etc., taken with patients must be returned. The Contractor shall furnish all linens, blankets, and supplies. The VA Medical Center will not participate in a linen exchange program or any supply exchange program. The Contractor shall not be permitted to borrow medical equipment from the Medical facilities. The Contractor shall provide all medications required while in transport, sheets, and blankets and other equipment and supplies required for use while in transport, for direct patient care. Contractor shall at no time and under any circumstances exchange supplies, equipment, and/or medications with the VA. VI. RUN SHEETS: The Contractor shall prepare a Run Sheet for all services requested under this contract, which will be attached to the invoice for services rendered. As a minimum, the Run Sheets shall include the following information: 1. Contractor's business name. 2. The contract number. 3. Date and time the contractor's dispatcher received the request for service. 4. For scheduled trips, the specified pick-up and delivery dates and times. 5. Name of the patient being transferred. 6. Pick-up address and telephone number. 7. Delivery address, and the inside delivery location. 8. Special instructions for care of the patient (i.e., Intravenous therapy, etc). 9. For unscheduled trips, date and time the ambulance dispatched to pick-up point. 10. The ambulance vehicle identification number. 11. Pick-up point arrival and departure times. 12. Time of arrival to the specified inside delivery location. 13. Signature of the person acknowledging receipt of the patient at time and date indicated on the Run Sheet. 14. Whether trip was inside the city limits. 15. If trip was beyond city limits, the one-way mileage outside the city limits that was incurred in transporting the patient. 16. Whether contractor oxygen, monitor, IV therapy, or infusion pump was used. 17. Statement of any delays encountered to include the length of the delay and the circumstances. 18. A description of any medical care given at the pick-up point, during transportation, and at destination. If physician supervision was required, it shall be briefly explained in the description. 19. Any patient loaded toll charges. 20. Actual delivery destination if changed due to a medical emergency. 21. Total of all charges. VII. VEHICLE AND PERSONNEL STANDARDS: The ambulances used in the performance of this contract will be licensed and meet the minimum vehicle requirements as mandated by the Maine Emergency Medical Services (16 Department of Public Safety, 163 Bureau of Emergency Medical Services (Maine Ems), Chapter 3: Ground Ambulance Service and Non-Transporting Service Licenses) (REFER TO: http://www.maine.gov/ems ) or the Federal Specification for Ambulance, KKK-A-1822F (Change 8), dated July 1, 2015, whichever is more stringent. Chassis or compartment modifications are permissible when they clearly exceed the minimal specification. The electrical system must, at a minimum, meet the standards of the federal Specification for Ambulance, KKK-A-1822F (Change 7), Section 3.7, Electrical System and Components, dated February 2, 2015. Each emergency medical care vehicle will have patient compartment facilities, oxygen, suction systems and equipment, and additional systems equipment, accessories, and supplies (see Sec 3.15 of KKK-A-1822F), as well as environmental climatic equipment, and communications. All vehicles utilized in the performance of services under this contract shall meet 49 CFR Part 38 - Americans with Disabilities Act (ADA) Accessibility Specifications for Transportation Vehicles. 1. AMBULANCE MEDICAL EQUIPMENT: Each Emergency Medical Care Vehicle will have patient compartment facilities, oxygen and suction systems and equipment, environmental climatic equipment, communications and additional systems equipment accessories and supplies as required by State regulations. The awarded Contractor will provide its own IV infusion pumps and transport ventilators when these items are required for patient care. No VA IV infusion pumps will be permitted to leave VA premises. 2. PERSONNEL QUALIFICATIONS (NOTE: ALL PERSONNEL SHALL MEET QUALIFICATIONS AS REGULATED BY MAINE EMS - (SEE: http://www.maine.gov/ems) A. EMERGENCY MEDICAL TECHNICIAN (to include EMT-Basic, EMT-Intermediate, Advanced Emergency Medical Technician (AEMT) and EMT-Paramedic): The following will be required of personnel providing medical care on ambulances serving VA hospitals and clinics: 1. All providers must have a current and valid license issued by Maine Emergency Medical Services and hold a current BLS (CPR) card. 2. EMT-Critical Care and EMT-Paramedic must hold current certification in ACLS. 3. EMT-Paramedics must have successfully completed a Maine Emergency Medical Services approved Paramedic Interfacility Transport Module. B. TRANSPORT NURSE WHEN MEDICALLY REQUIRED OR AVAILABILITYOF CRITICAL CARE TEAM: 1. Must have current, valid Registered Nurse License from Maine State Board of Nursing. 2. Must have current certifications in BLS and ACLS. 3. Must have at least one year of experience working in ICU, CCU or SCU. C. Non-Emergency Attendant/Drivers must be capable to administer oxygen and have successfully completed the Standard or Advanced First Aid Courses of the American Red Cross or U.S. Bureau of Mines or equivalent. Proof in the form of a current certificate that such first aid training has been successfully completed must be submitted with offeror's proposal and available upon request. D. All Contractor personnel performing contract services shall meet the qualifications and be licensed as specified in the contract, as well as any qualifications required by Federal, State, County and local government entities from the place in which they operate. The qualifications of such personnel shall also be subject to review by the VA Chief of Staff and approval by the VA Facility Director. E. 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 - Social security payments The parties agree that such personnel shall be considered employees of the Contractor and shall not be considered VA employees for any purpose. VIII. TRAINING REQUIREMENTS: 1. To be eligible to perform under this contract, each contract employee must meet the minimum training required outline below and minimum contractor furnished training outlined in paragraph (2) (c), (1) Through (8). 2. Contractor Furnished Training. (a) The Contractor shall submit to the Contracting Officer written certification that each contract employee has been trained in the subject areas outlined in paragraph C prior to assignment under this contract. For replacement or new employees documentation of prior training must be submitted or the individual contract employee must complete the required training before being employed in support of this contract. (b) All formal training required shall be administered (i.e., taught, presented) by persons who are certified as being qualified to instruct or teach, the specific subjects or topics required. Certification to instruct the specific subject shall be in the form of a certificate issued by an accredited institution of learning (school, college, university), a governmental (Federal, State, County, etc.) educational certification body (agency, board, commission), or by documentation that the person instructing has sufficient experience in/with the subject to be able to instruct the subject in an authoritative, practical and current manner. (c) In addition to the formal training, the Contractor shall provide 16 hours of orientation training for each employee fourteen (14) days after his or her initial assignment to duty. This orientation may be accomplished while the employees are on duty. The Contractor shall certify to the COR as to the completion of the orientation for each employee within 45 days following assignment to duty. The follow-up orientation should include the following subjects and instructional time periods as well as other subjects as may be required: (1)Accident and incident reporting (2 hours) (2)Safe operation of emergency vehicles (2 hours) (3)Quality Assurance (2 hours) (4)Fire and emergency preparedness planning (2 hours) (5)Handling patient complaints (1 hour) (6)Infection control (2 hours) (7)Universal precautions (policy and procedure) (2 hours) (8)Safety and occupational health procedures (3 hours) 3. Contractor Furnished Training - The Contractor shall submit to the Contracting Officer written certification of the follow-up orientation. 4. The EMT/Paramedics must be enrolled in 'refresher" continuing education, or advanced training programs as required by the local or state government entity in which the service is rendered to veterans or, a yearly basis. Such "refresher" training must be equivalent to that developed by the Department of Transportation or National Highway Safety Administration. Evidence of successful completion for "refresher" training must be provided to the Contracting Officer for inspection. IX. CONTRACT DEFINITIONS AND ACRONYMS: (a) Advanced Life Support (ALS) - ALS shall be provided by ambulance vehicles containing at a minimum an on-board EMT-P, cardiac monitoring, Advanced Cardiac Life Support (ACLS) drugs and procedures, advanced airway management and medication monitoring and administration. Ambulances for ALS services shall be staffed, certified and licensed in accordance with current laws and regulations governing the certification and licensure of private ambulances by the respective states of service, and all ALS services shall be in accordance with current laws and regulations by the respective states of service. (b) Administrative Officer of the Day (AOD) - VA official that works in the admissions area during evenings, and monitors hospital activities during other than normal working hours. This person acts as hospital administrator during off-hours. (c) Base Rate - The Base Rate shall constitute full compensation for one-way trips which do not exceed the "Mileage Threshold" as shown in Section B for the VAMC. (d) Basic Life Support (BLS) - BLS is defined as services required for non-critical patient care in which patient requires an ambulance, which has been staffed, certified, and licensed in accordance with current laws and regulations governing the certification and licensure of private ambulances by the respective states of service, and all BLS services shall be in accordance with current laws and regulations by the respective states of service. The ambulance at a minimum shall be staffed with a vehicle operator and an Emergency Medical Technician (EMT) - Basic Ambulance, and with basic airway management and IV's at KVO (keep vein open) without additives. (e) Beneficiary - Veterans and other members determined to be eligible for benefits by the VA. (f) Contracting Officer (CO) - VA official with the authority to enter into, administer and/or terminate contracts and make related determinations and findings. (g) Contracting Officer's Representative (COR) - VA official responsible for providing contract oversight and technical guidance to the Contracting Officer. Responsibilities include certification of invoices, placing orders for service, providing technical guidance, overseeing technical aspects of the contract. All administrative functions remain with the Contracting Officer. (h) Contractor - The term "Contractor" as used herein refers to both the prime Contractor and his/her employees, and any subcontractors and their employees. The Contractor shall be responsible for assuring (i) Critical Care (Specialty Care Transport) (CCT) - CCT is defined as services required for critically ill patient care in which patient requires an ambulance, which has been staffed, certified, and licensed in accordance with current laws and regulations governing the certification and licensure of private ambulances by the respective states of service, and all CCT services shall be in accordance with current laws and regulations by the respective states of service. The ambulance at a minimum shall be staffed with a vehicle operator and an Advanced Emergency Medical Technician (AEMT) - Basic Ambulance, and with advanced life support airway-endotracheal intubation; magill forceps for foreign body airway obstruction; drug and medication administration as approved by the Board and as allowed by Maine EMS protocol; and other techniques and practices approved and published by the Board. (j) Joint Commission - A national organization dedicated to improving the care, safety and treatment of patients in a health care facility and environment. (k) Loaded Mile - Mileage incurred with the patient actually on board the vehicle from the point of pickup to destination. (l) Mileage Rate - Mileage rate for ambulance services is the rate paid for each mile traveled beyond the specified Mileage Threshold for the Togus VAMC. This rate applies to one-way transportation only. In no event shall the Contractor receive this rate for miles traveled within the specified Mileage Threshold. (m) No-Patient Charge - Fee allowed to Contractor for scheduled pick-ups for which due to circumstances beyond the contractor's control, the patient is unavailable for transport. (n) Quality Assurance - Those actions taken by the Government to assure services meet the requirements of this contract. (o) Quality Assurance Evaluator(s) - Government personnel responsible for surveillance of Contractor performance. (p) Quality Assurance Surveillance Plan - An organized written document used for quality assurance surveillance. The document contains specific methods for performing surveillance of the Contractor's continuous performance. (q) Quality Control - Those actions taken by the Contractor to control the production of goods or services so they will meet the requirements of a contract. (r) VAMC - acronym for Department of Veterans Affairs Medical Center. (s) Vehicle(s) - The term "vehicle(s)" as used in this contract refers to all modes of transportation provided under the requirements of this contract, unless a specific mode of transportation is identified. (t) Waiting Grace Period - The waiting grace period is defined as fifteen (15) minutes prior to the time waiting charges commence. The base rate for ambulance shall include a fifteen (15) minute waiting grace period at origin and destination. (u) Gender - For the purpose of equal rights, wherever the masculine gender is used in this solicitation, and the resulting contract, it shall be considered to include both masculine and feminine gender.