Loren Data's SAM Daily™

FBO DAILY - FEDBIZOPPS ISSUE OF MARCH 19, 2014 FBO #4498
DOCUMENT

Q -- SAVAHCS Tuscon Home HealthCare/Hospice - Attachment

Notice Date

3/17/2014
 

Notice Type

Attachment
 

NAICS

621610 — Home Health Care Services
 

Contracting Office

Department of Veterans Affairs;VISN/18PHX;777 E. Missouri, Suite 300;Phoenix AZ 85014
 

ZIP Code

85014
 

Solicitation Number

VA25814R0361
 

Response Due

3/19/2014
 

Archive Date

5/18/2014
 

Point of Contact

MARGARET D BARKER
 

E-Mail Address

5-4506<br
 

Small Business Set-Aside

N/A
 

Description

B.5 STATEMENT OF WORK 1.0 INTRODUCTION: The Southern Arizona Veterans Administration Health Care System (SAVAHCS) mission is to provide quality healthcare to veterans in an environment of compassion, education, and research. The Department of Veterans Affairs (VA) long-term care includes a continuum of services for the delivery of care to veterans needing assistance due to chronic illness, physical disability, or end of life care. Assistance takes many forms and is provided in varied settings, including non-institutional care in home or community-based settings. In the past, VHA furnished home care services to a limited number of veterans. Today, all enrolled veterans are eligible for a comprehensive array of medically necessary in-home services as identified in VA's medical benefits package (see Title 38 Code of Federal Regulations (CFR) 17.38(a) (1)(ix)). These services are an increasingly important component of VHA's integrated health care delivery system. VHA purchases skilled and unskilled services to enhance or build a comprehensive array of resources necessary to address the short term or long term care needs of enrolled veterans. 2.0 SCOPE OF WORK: The Contractor shall provide all Home Health Care Services as described herein when an enrolled/eligible veteran is unable to receive care at the SAVAHCS, for the areas for which they are awarded a contract. The types of Home Health Care Services to be provided under this contract are defined as follows: 2.1 Skilled Registered Nursing Services are required by the SAVAHCS to provide a broad range of skilled home nursing care that allows the veteran to remain living at home. Skilled registered nursing services may include, but are not limited to, skilled observation and assessment, data collection, formulation of treatment plans, teaching and technical procedures. 2.2 Licensed Practical Nursing Services in the home are required by the SAVAHCS to assist veterans with a wide range of technical nursing duties including, but not limited to, dressing changes, medication set-ups and ostomy care that will permit the veteran to remain at home. 2.3 Homemaker Services are required by the SAVAHCS to assist veterans with light housekeeping duties in order for the veteran to remain as independent as possible in their place of residence and delay/avoid placement in a long term care facility. Homemaker services may include, light housekeeping, laundry, meal preparation, grocery shopping, escorting the patient to appointments, assuring patient safety, and other services that are consistent with the homemaker's level of responsibility and the patient's care plan. 2.4 Home Health Aide Services are required by the SAVAHCS to assist veterans with personal care duties in order for the veteran to remain as independent as possible in their place of residence and delay/avoid placement in a long term care facility. Home Health Aide services may include bathing, grooming, personal hygiene, transferring, dressing, eating, and other services that are consistent with the home health aide's level of responsibility and the patient's care plan. 2.5 Respite Care Services are required by the SAVAHCS to assist veterans and their unpaid caregivers with the opportunity to remain as independent as possible in their place of residence and delay/avoid placement in a long term care facility. Respite services may be provided by skilled or unskilled workers as appropriate for the individual veteran. Respite services are provided to allow the veteran's unpaid caregiver the opportunity for relief from care giving responsibilities. 2.6 Hospice Care Services are required by the SAVAHCS to provide the final stage of palliative care in which the primary goal of treatment is comfort rather than cure for patients with advanced disease that is life-limiting and refractory to disease-modifying treatment. Hospice services are provided by a team of professionals, emphasizing relief of suffering and maintenance of functional capacity as long as possible through comprehensive management of the physical, psychological, social and spiritual needs of the patient. These services also provide support for the families or other caregivers, including bereavement support following the death of the patient. 2.6.1 Home Hospice Services may include, but are not limited to the following: 2.6.1.1 Chaplain Service to provide care to terminally ill veterans and their families that include spiritual support, emotional support, pastoral care, bereavement counseling, and assist with memorial services and funeral arrangements. 2.6.1.2 Home Social Service to provide assistance with practical and financial concerns as well as help meet the psychosocial needs of the terminally ill veterans and their family members. 2.6.1.3 Skilled Registered Nursing Service to provide a broad range of nursing care as identified in paragraph 2.1. 2.6.1.4 Licensed Practical Nursing Service to provide a wide range of technical nursing duties as identified in paragraph 2.2. 2.6.1.5 Home Health Aide Services as identified in paragraph 2.4. The agency shall provide all labor, supervision and management necessary to carry out the services described herein. 3.0 DESCRIPTION/SPECIFICATIONS: 3.1 Skilled Registered Nursing Service-to/may include but is not limited to, the following: a. Skilled observation and assessment b. Data collection c. Formulating treatment plan d. Patient and caregiver/family teaching e. Technical procedures f. Home safety evaluation g. Discharge planning h. Works closely with the primary physician for pain management and symptom control i. Bowel and Bladder care j. Ventilation care k. Infusion care 3.2 Licensed Practical Nurse Service-to/may include, but is not limited to, the following: a. Dressing changes b. Giving injections c. Setting -up medication boxes d. Providing bowel/bladder care e. Providing ostomy care f. Bowel and Bladder care g. Ventilation care 3.3 Physical Therapy Services-to/may include, but is not limited to, the following: a. Provide initial and continued assessment of the patient's functional status and safety. b. Evaluate patient's home for needed structural modifications to make the home environment safe and accessible. c. Determine the need and measure the patient for assistive devices and special equipment. d. Fit devices for patient's needs and instruct patient in the safe use of such devices. e. Teach caregiver body mechanics to minimize risk of injury. f. Develop therapeutic home program for the patient and caregiver to maintain or enhance function or retard deterioration of the patient's functional status. g. Provide hand-outs and demonstrations to patients regarding treatment techniques and theory. h. Set short and long term goals for the patients. i. Document initial findings, treatment, goals, equipment recommendations, and follow-up progress in patient's medical record. j. Serve as consultant to members of treatment team on matters specific to physical therapy. k. Recognize indications of patient's intolerance of procedures, unanticipated rate of progress, significantly altered physical/mental status of patient or undesirable secondary effects of treatment. 3.4 Occupational Therapy Services-to/may include, but is not limited to, the following: a. Provide initial and continued assessment of patient. b. Plan, implement, and coordinate complex therapeutic OT program for the patient and caregiver to maintain or enhance function or retard deterioration in the patient's functional status. c. Perform evaluations, set treatment goals, and implement treatment program in OT. d. Evaluate patient's home for needed structural modifications to make the home environment safe and accessible. e. Determine the need for assistive devices, teach, and monitor in the safe use of these devices. f. Teach caregiver body mechanics to minimize risk of injury. g. Provide hand-outs and demonstrations to patients regarding treatment techniques and theory. h. Record and compile patient treatment data. 3.5 Speech Therapy Services-to/may include, but is not limited to, the following: a. Evaluate patients with disorders of communication and swallowing. Administer and interpret speech, language and voice tests. Perform and interpret clinical (bedside) swallowing evaluations. b. Interview patient and family members to obtain an in-depth history of the problem(s). c. Recommend necessary follow-up or additional medical or therapeutic evaluations indicated by assessment of patient (i.e. audiometric evaluation, otolaryngological or neurological evaluation, videofluoroscopic evaluation, laryngeal videstroboscopic evaluation, etc.). d. Determine appropriate diagnosis of disorder(s) following completion of all of the necessary evaluations. e. Complete written report integrating information from all of the above sources. The report will include subjective history, objective findings, and a detailed assessment of the disorder, prognosis for improvement and suggested plan of treatment with short-term goals. f. Determine prognosis for improvement after completing the evaluation. g. Develop treatment program utilizing information from formal and informal assessment as well as information provided by the patient's medical record, family members, and required additional assessments. Ensure that patient and caretaker understand the treatment plan. h. Counsel patient and patient's family regarding type and severity or disorder and prognosis for improvement with treatment. i. Provide consultation services to medical personnel requiring information regarding patient's status and instruct those who may be involved in the plan of patient care. j. Fit and adjust various speech appliances. Advise patient or caretaker on care of therapeutic equipment. Provide instruction on the use and maintenance of prosthetic and therapeutic devices. 3.6 Social Work Services (SWS)-to/may include, but is not limited to, the following: a. Diagnose emotional stress on patient and family/significant others and use a variety of psychotherapeutic approaches based on the diagnostic assessment to minimize the anxiety of both the patient and/or significant others during the transition to other forms of care. b. Perform diagnostic assessment of patient's present mental and social functioning, based on developmental and vocational history and evaluation tools, as appropriate. c. Develop and initiate a treatment plan to reduce stressors. d. Apply knowledge of special emotional aspects of loss to diagnose the social and emotional problems and carry out therapeutic intervention to assist in resolving the social and emotional issues confronted by the patient. e. Utilize special knowledge related to social and emotional impacts of serious disability upon the patient and their family, diagnoses dysfunction in the patient and family, and carry out a system of therapeutic intervention to relieve stress and assist the patient to achieve maximum independence. f. Diagnose dysfunction of a social or emotional nature and develop and implement a treatment approach to relieve symptoms of confusion, depression, or family dysfunction. g. Assessment and treatment for mental illness, behavioral mal-adaptions, and other problems of an emotional nature. h. Use diagnostic knowledge of the patient's need(s) to recommend referrals to a variety of VA and non-VA resources in support of the treatment objective of the patient. 3.7 Homemaker Service-to/may include, but is not limited to, the following: a. Light housekeeping b. Making and changing beds c. Dusting and vacuuming the room the patient uses d. Dishwashing e. Tiding the kitchen f. Tiding the patient's bedroom g. Tiding the patient's bathroom h. Doing the patient's personal laundry if no family member is available or able; this may include necessary ironing and mending i. Meal planning and preparation j. Grocery shopping k. Shopping for patient if no other arrangement is possible l. Assuring patient safety m. Personal care supervision n. Escorting the patient to appointments 3.8 Home Health Aide Service-to/may include, but is not limited to, the following: a. Assistance with care of teeth and mouth b. Assistance with personal grooming care c. Assistance with bathing of patient in bed, in the bathtub, or in the shower d. Assisting the patient on/off the bedpan, commode or toilet e. Assisting the patient in moving from bed to chair/wheelchair, or vice versa f. Assisting the patient in walking g. Assisting the patient with eating h. Assisting the patient with dressing i. Prepare and serve meals according to instructions j. Making and changing beds k. Listing needed supplies l. Send linens to laundry m. Assure patient safety n. Assistance with active/passive exercise o. Assistance with medical equipment and non-skilled, routine health monitoring 3.9 Respite Care Service-to/may include, but is not limited to, the following: a. Unskilled respite care service b. Skilled respite care service 3.10 Hospice Care Service-to/may include, but is not limited to, the following: a. Chaplain Service is required to provide care to terminally ill veterans and their families; the service includes: (1) Spiritual support (2) Emotional support (3) Pastoral care (4) Bereavement counseling (5) Assist with memorial services and funeral arrangements b. Social Service is used to provide assistance with practical and financial concerns as well as help meet the psychosocial needs of the terminally ill veterans and their family members. Social service includes: (1) Advanced Directive planning/assistance (2) Emotional support (3) Counseling and bereavement follow-up (4) Facilitate communication between the patient/family and community agencies (5) Evaluate the need for support services c. Skilled Registered Nursing Service is used to provide a broad range of care in accordance with paragraph 3.1 of the Statement of Work. d. Licensed Practical Nursing Service is used to provide a broad range to technical nursing care in accordance with paragraph 3.2 of the Statement of Work. e. Homemaker Service is used to provide a wide range of services in accordance with paragraph 3.7 of the Statement of Work f. Home Health Aide Service provides a variety of personal care services in accordance with paragraph 3.8 of the Statement of Work. 3.11 Infusion Services-Home infusion therapy is defined as any therapy that requires continuous or intermittent peripheral or central vein access for administration of prescribed therapy. Intravenous (IV) Home Infusion Therapy services may include, but is not limited to, the following: (1) Antibiotics (2) TPN (3) Hydration (4) Other non-internal medications Home infusion therapy will be provided in a safe and timely manner, appropriate to the patients' condition and needs. (1) The patient must reside in a geographical area that is feasible to the provision of the appropriate and necessary prescribed infusion services. (2) The patient/caregiver must be motivated, reliable and capable of understating and learning all required activities and basic concepts related to care, i.e. infection control measures. (3) The environment in which the care is to be delivered must be safe for patients, caregivers and staff, as well as conducive to the provisions of services. This will include: (a) Adequate, clean storage space for medications and supplies; and (b) Telephone access or an alternative method of communication if no home telephone service is available. (4) An adequate plan must be in place to ensure IV access for the patient. 3.12 Ventilator Services-to/may include, but is not limited to, the following: (1) Ventilator weaning and management (2) Tracheotomy care (3) Bronchial hygiene (4) Oxygen therapy and monitoring (5) On-site monitoring of arterial blood gases (6) Nebulizer and aerosol treatments (7) Patient/family respiratory education 3.13 VETERAN SERVICES: 3.13.1 Skilled services shall include home health registered nursing, home health licensed practical nursing and social work service. Skilled services shall be provided in accordance with a plan of care and by a licensed health care professional as ordered by the medical staff of the VA. Supervision shall be provided in accordance with VA policy and regulation. The Home Health Care Agency shall be responsible for admitting veterans; assessing veterans, including initial and ongoing assessments; care planning; including the care-planning process; coordinating, supervising, and evaluating the care and services provided; scheduling visits or hours; and discharge planning. The Home Health Care Agency shall provide the following services upon request: a. Nursing services, treatment, and diagnostic and preventive procedures requiring substantial specialized skill b. Veteran safety monitoring c. Medication administration, including intravenous fluids, medicines, pain management, TPN, chemotherapy, and necessary care of the delivery lines and equipment d. Required lab work with reports to the physician/provider e. Veteran education and follow-up f. Teaching, supervision, and counseling veteran and family members regarding nursing care and other related veteran problems g. Rehabilitation regimen h. Evaluation and regular re-evaluation of veteran home care needs; make appropriate recommendations i. Development, implementation, oversight, and modification of the veteran plan of care j. Documentation of the veteran's care and progress in the clinical record, including a discharge summary within 72 hours of discharge k. Physical assessment and re-assessment per written policy l. Documentation of outcomes of care/services provided 3.13.1.1 Bowel and Bladder care, if ordered, shall be provided by the HHCA and only be performed by a Registered Nurse (RN) or Licensed Practical Nurse (LPN) and shall include the following services: (1) Train, supervise, and counsel Spinal Cord Injury (SCI) Bowel and Bladder veterans and their significant other/caretaker, to assume bowel and bladder care as appropriate (2) Inserting of a suppository (3) Digital stimulation (4) Disimpaction (5) Enemas (6) Intermittent catheterization (7) Indwelling catheterization. 3.13.2 Unskilled services shall include homemaker and home health aide services. Unskilled services shall be provided in accordance with a plan of care and by fully qualified personnel that have the requisite credentials and experience to perform services under the terms and conditions of this written agreement. Services are to be performed as ordered by the medical staff of the VA. Supervision shall be provided in accordance with VA policy and regulations. The Home Health Care Agency (HHCA) shall be responsible for admitting veterans; assessing veterans, including initial and ongoing assessments; care planning; coordinating, supervising, and evaluating the care and services provided; scheduling visits or hours; and discharge planning. The HHCA shall provide the all unskilled home health services upon request in accordance with paragraph 3.7 and 3.8 of the Statement of Work. 4.0 REQUIREMENTS: 4.1 HHCA shall be the full service agency for the provision of the Home Care Services described in this agreement. The HHCA shall assign an on-site coordinator to assist the Southern Arizona VA Health Care System (SAVAHCS) Community Health Nurse Coordinator (CHNC) in processing referrals for home care admissions, and evaluation of the day-to-day efficiency and effectiveness of the program. The HHCA provider shall provide timely and top quality home health care, keep home care visits as brief as possible, avoid unnecessary visits, and provide in-home instruction/training for VA beneficiaries and their caregivers. The HHCA shall use VA resources to the maximum extent possible. 4.2 HHCA shall be responsible for the management, supervision and provision of personnel required to perform home care services described herein for authorized VA Beneficiaries. The HHCA is responsible for coordinating veteran needs with another provider, if HHCA is unable to provide and cannot meet the veteran's needs. The HHCA provider shall only provide services that have been authorized in writing by the SAVAHCS. 4.3 Services must be directly related to the patient's need and are not for the convenience of other members of the household. Services do not include heavy house cleaning, yard work, or the handling of the Veterans' financial or personal affairs. 4.4 HHCA shall be responsible for overseeing the care provided by their employees to authorized veterans. Problems or changes in the veteran's care needs shall be reported to the SAVAHCS CHNC as soon as possible but not later than twenty four (24) hours after they are identified. Designated VA staff will oversee the quality of services being provided to veterans by reviewing HHCA reports as well as telephone consultation with both the HHCA and veteran. Each HHCA caregiver will be provided with a list of telephone contacts to use in urgent situations. 4.5 HHCA is responsible for insuring that its employees have received training in the performance of their job duties, have been appropriately screened before hiring and are supervised and evaluated on a regular and ongoing basis, not less than every 3 months. This evaluation will include direct observation of the employee's performance in the veteran's home. Copies of the written results of the appraisal of the performance of those employees caring for veterans will be forwarded to the SAVACHS CHNC within 15 days after each quarter of the contract period. 4.6 POLICY: 4.6.1 Payment for visit(s) to VA beneficiaries will be made only if prior authorization has been obtained from the SAVAHCS CHNC staff, except for emergent visits. The SAVAHCS CHNC staff must be notified of an emergent visit within twenty-four hours of the visit or by the close of business of the next working day for reimbursement documentation. 4.6.2 The HHCA shall maintain and provide the following within twenty-four hours of request by SAVAHCS: a. Competency verification of employees providing services under this agreement. b. Documentation verifying that supervisors and/or coordinators are competent to perform their assigned duties. c. Verification of employees tuberculosis testing and documentation that Hepatitis B vaccination was offered to employees providing services to veterans. NOTE: Employees may decline Hepatitis B vaccination however TB testing is mandatory. d. Updated copies of the HHCA state business license as well as copies of the licenses or certificates as appropriate held by HHCA and their employees. e. A copy of the HHCA Emergency Preparedness Plan. 4.6.3 The HHCA will provide their Policy and Procedure for the following care issues: a. Do Not Attempt to Resuscitate (DNR) and Withdrawal of Life-Sustaining Therapy. b. Reporting of the Abuse of Elders and Dependent Adults. c. Advance Directive for Health Care. d. Patient Privacy. e. Universal Precautions. 4.7 HOME HEALTHCARE SERVICE STANDARDS: 4.7.1 The HHCA shall be responsible for all services provided under this Blanket Purchase Agreement (BPA). All orders, plans of treatment, certifications and information concerning the SAVAHCS CHNC Programs will be addressed to the ordering Provider at Southern Arizona VA Health Care System, 3601 South 6th Avenue, Tucson, Arizona 85723, Attention: Community Health Nurse Coordinator (3-11NH1), unless an alternate address is provided as part of the treatment plan. The HHCA direct liaison with the VA under Fee Basis pay or third party coverage (HMO, Medicare, County, etc.) is the SAVAHCS CHNC. The services to be performed by the HHCA will be under the direction of the SAVAHCS Chief of Staff or Designee. All certifications, orders, plans of treatment, and information concerning the purchased skilled home health services will be addressed to the SAVAHCS CHNC. All orders, plans of treatment, referrals and information concerning third party coverage will also be addressed to the CHNC. 4.7.2 All Home Health referrals shall have prior approval through the SAVAHCS CHNC. It is understood that the beneficiary shall be provided home and community support service visits for the period stated and properly authorized, except for emergency visits. Home service providers will accept referrals by fax as initial contact and confirm receipt immediately; however, referrals may also be phoned in, when necessary. The CHNC will provide home health service providers with copies of the SAVAHCS referral and any other information required for provision of care. 4.7.3 The HHCA will verify payment sources and obtain authorization for payment of initial services and continuation of payment if ongoing home health services are needed. It is understood that the beneficiary shall be provided home and community support service visits for the period stated and properly authorized, except for emergency visits. The HHCA will verify payment sources and obtain authorization for payment of services and continuation or re-certification of payment as needed. All VA paid home health referrals shall have prior approval through the SAVAHCS CHNC. 4.7.4 Home Health Care providers shall coordinate with the SAVAHCS CHNC to ensure continuity of care. The HHCA shall ensure hospital and home care admissions and discharges are conducted timely and appropriately. This will include the HHCA's RN Case Manager communicating with SAVAHCS CHNC staff for the purpose of coordinating activities and evaluating the day-to-day efficiency and effectiveness of the program, as needed. 4.7.5 The HHCA's RN Case Manager shall work with the SAVAHCS CHNC to ensure timely communications with physicians regarding changes in the condition of veterans, need for updated or new orders, or any other change necessitating physician consultation for implementation of the plan of care. 4.7.6 The HHCA's RN Case Manager will regularly review all treatment plans, renewals and orders for appropriateness and medical necessity, and will coordinate follow-up with the SAVAHCS CHNC. The HHCA shall provide the CHNC, when requested, written summary of provided care, identifying each provider, service provided, veteran response to care, and a current status of the overall condition of each veteran for whom the HHCA provided services. 4.7.7 HHCA, in coordination with the CHNC shall ensure that services performed are certified timely, and in accordance with regulatory requirements of the payor. 4.7.8 HHCA shall permit on-site visits by SAVAHCS personnel to assess contracted services and record keeping. The SAVAHCS shall have ready access to all medical records concerning veterans for whom home care is being provided. SAVAHCS has the option to conduct at least an annual site inspection of the HHCA's local operating offices and/or in the homes of the veterans receiving services. The SAVAHCS may provide follow-up supervision visits to veterans to assure continuity of care. 4.7.9 The HHCA shall maintain progress notes for each individual visit, which is signed by the veteran and readily available to the SAVAHCS, if requested. Any other veteran progress reports shall be submitted per the request of the SAVAHCS Primary Care Provider and/or the CHNC. 4.7.10 In the event a veteran requires hospitalization, the HHCA shall coordinate transport of the veteran to the nearest VA Health Care System, with the VA transportation coordinator. In the case of a life threatening emergency the Home Health Care Agency shall arrange transportation of the veteran to the closest appropriate medical treatment facility. 4.8 MANAGEMENT, SUPERVISION AND TRAINING: 4.8.1 HHCA's on-site staff shall collaborate with the CHNC on the number of visits authorized for veterans, and to ensure continuity of care and timely, appropriate home care admissions and discharges. 4.8.2 HHCA's on-site staff shall work with CHNC to ensure timely communications with physicians regarding changes in the condition of veterans, need for updated or new orders or any other change necessitating physician consultation for implementation of the plan of care. 4.8.3 The CHNC will assist with coordination of follow up visits for the veteran as appropriate. 4.8.4 HHCA's on-site staff will coordinate with the CHNC to ensure timely certification of services according to regulatory requirements. 4.8.5 The HHCA shall be responsible for the supervision of contract personnel providing services under this agreement. 4.8.6 The HHCA shall have written policies and procedures regarding staff credentials. All home health care services shall be performed by a competent professional who is familiar with the nature of the services involved, and fully qualified under the laws of the State of Arizona. 4.8.7 HHCA shall supervise and ensure the competency of their staff according to the HHCA policy, VA policy, VA regulation, and state licensures. 4.8.8 HHCA shall provide appropriately trained and oriented staff to cover in the absence of their staff regularly assigned to the VA clients. 4.8.9 HHCA shall provide orientation to the SAVAHCS CHNC staff on Home Health Care Agency's policy, procedure, and any processes necessary to facilitate functioning between the HHCA and VA. Updates and refresher training shall be provided upon request and when policy, procedures, or processes change. 4.8.10 HHCA shall ensure the following employee health requirements for its staff at no cost to the VA in compliance with the Occupational Safety and Health Administration (OSHA), the Centers for Disease Control (CDC) and Joint Commission: a. Pre-employment medical examinations. b. All personnel who will have occupational exposure to blood, other body fluids, or other potentially infectious materials, shall receive Hepatitis B vaccine, sign a voluntary declination, or have documented proof of immunity to Hepatitis B infection. c. Employees shall be free of infectious diseases, to include but not limited to active Tuberculosis, that might reasonably be expected to place other workers, veterans, or the public at risk. Must have & present documentation of a TB test within the last 6 months prior to starting work. If the test was positive, then a negative chest x-ray is required. TB testing/questionnaire is an annual requirement. d. The Home Health Care Agency shall provide the Contracting Officer's Technical Representative (COTR) for this agreement, with verification that contract health care providers have completed the medical evaluation required above, during the annual inspection. This certification shall state the date that the examination was completed, the doctor's name who performed the examination, a statement concerning the physical health of the individual. The SAVAHCS CHNC is the COTR for this agreement. 4.8.11 HHCA shall provide and document orientation and training for all employees regarding safety, equipment management, and veteran confidentiality appropriate to the service provided. 4.8.12 Appropriately licensed HHCA personnel shall perform program admissions and supervisory visits according to agency policy. 4.8.13 Intravenous infusion therapy (including Chemotherapy) shall be performed in accordance with VA and Joint Commission standards, by appropriately trained Registered Nurses only. 4.8.14 HHCA shall complete background investigations to ensure that employees do not have a record of criminal offenses or substantiated incidents of veteran abuse; and, if required to perform their duties, employees are properly licensed and insured to operate motor vehicles. 4.9 ACCREDITATION: 4.9.1 HHCA is not required to be accredited through Joint Commission Standards for Home Care or Community Health Accreditation Program but it is desirable. The HHCA agrees to allow appropriate VA personnel to review the personnel, infection control, performance improvement, policies and procedures, and other documents as they relate to ensuring compliance with VA, state, and Joint Commission standards. The HHCA agrees to furnish written documentation of compliance upon request. 4.9.2 HHCA shall maintain current Medicare and Medicaid certifications and current State License for operation that require such. Proof of certifications and licensure shall be furnished to the Contracting Officer prior to award and subsequently following future certifications and licensures. a. If the HHCA is not Medicare and Medicaid certified the SAVAHCS CHNC will follow VA protocol for obtaining permission to join into an agreement with the HHCA. Proof of VA approval to waive the Medicare and Medicaid certification requirement will be furnished to the Contract Officer by the COTR prior to award. 4.9.3 Certificate of insurance shall be furnished to the Contracting Officer prior to the award and/or during the period of performance, as requested. 4.9.4 HHCA health care providers shall participate in those activities designated by the VA to ensure that the quality of services provided are in accordance with VA requirements. 4.9.5 The HHCA agrees to participate in Sentinel Event Root Cause Analysis reviews performed by the VA for home health veterans, and agrees to notify the VA of any Root Cause Analysis reviews performed by the HHCA on VA veterans. 4.10 PERFORMANCE IMPROVEMENT/ENHANCEMENTS: 4.10.1 HHCA must have a written Performance Improvement Plan and provide to the SAVAHCS prior to award. This plan must be reviewed and approved by the COTR. 4.10.2 During the annual on-site inspection, evidence of all performance improvement activities shall be made available to the SAVAHCS CHNC, including veteran satisfaction indicators. The HHCA shall maintain a separate record of veteran complaints (including problem resolution). 4.10.3 HHCA shall develop a written emergency preparedness plan to ensure continuing care and support in the event of an emergency, which would interrupt normal services to veterans. 4.10.4 HHCA shall develop a written plan for ensuring the evaluation, reporting, and maintenance of records related to infections among veterans and, as appropriate, among staff. Documentation of plan implementation shall be provided during annual inspection by SAVAHCS staff, and as requested. The VA shall be notified of significant variances. 4.10.5 HHCA shall document and immediately FAX a report to the CHNC of any known incidents of death, accidents, injury, or infection related to furnished medications, supplies, or medical equipment, and any life-threatening equipment malfunctions or equipment recalls. The HHCA shall develop and maintain an equipment recall plan. 4.10.6 HHCA shall abide by local laws and regulations with regard to abuse, neglect, and exploitation of the elderly, and will develop policies for prevention and dealing with any reports of such. Additionally, the HHCA will notify the VA of any suspected or confirmed situations of neglect, exploitation, or abuse of a veteran or the expression of the intent to commit harm to self or others by a veteran. 4.11 QUALIFICATIONS: 4.11.1 The HHCA must be licensed by the State of Arizona and approved for the care of Medicare and/or Medicaid veterans. All contract health care providers performing services covered by this agreement shall be licensed and/or certified by the States where services are being provided. a. If the HHCA is not Medicare and Medicaid certified the SAVAHCS CHNC will follow VA protocol for obtaining permission to join into an agreement with the Home Health Care Agency. Proof of VA approval to waive the Medicare and Medicaid certification requirement will be furnished to the Contract Officer by the COTR prior to award. 4.11.2 The HHCA must meet VA and state standards to provide home care services. 4.11.3 The HHCA must be a regularly established business providing the type of services described in this agreement, is financially responsible, and have the necessary equipment and personnel to furnish services in the volume required by this solicitation. The HHCA shall meet all requirements of Federal, State, and local governments' codes regarding operation of this type of service. 4.11.4 When requested, the HHCA shall provide the VA with proof of its reliability, ability, and experience by furnishing the following information: a. A list of personnel who will perform under the agreement showing the length and type of experience of such personnel, and b. The names and addresses of other concerns and/or Government agencies for which this type of services were rendered by the HHCA. 4.11.5 The VA reserves the right to thoroughly inspect and investigate the establishment, facilities, business reputation, and other qualifications of any Offeror and to reject any offer, irrespective of price, that shall be administratively determined to be lacking in any of the essentials necessary to assure acceptable standards of performance. 4.12 HOURS OF CARE: 4.12.1 Purchased Home Health Care services covered by this contract shall be furnished by the HHCA seven (7) days a week, including federal, state and local holidays. It is expected that most visits will be accomplished Monday through Friday; it is expected that most visits will be accomplished between the hours of 8:00AM to 5:00PM local. 4.12.2 The SAVAHCS CHNC will provide prior approval for the number of hours for each HHCA veteran beneficiary visit. 4.12.3 Upon receipt of a referral form from the VA, the HHCA personnel will call the beneficiary within the first 24 hours and a home visit will be made within 24 hours, if requested. Urgent cases will require a same day visit. All non-urgent cases will be evaluated by the HHCA within 48 hours after notice of referral. Care shall be established within a time frame not to exceed 72 hours after the initial assessment. 4.12.4 The on-site HHCA personnel services covered by this agreement shall be furnished by the Home Health Care Agency as contained herein. 4.12.5 Normal working hours of the SAVAHCS CHNC staff are Monday through Friday, 8:00 AM to 4:30 PM, excluding the ten federal holidays observed by the VA. New Year's DayJanuary 1 Martin Luther King's BirthdayThird Monday in January President's DayThird Monday in February Memorial Day Last Monday in May Independence Day July 4 Labor DayFirst Monday in September Columbus Day Second Monday in October Veterans Day November 11 Thanksgiving DayFourth Thursday in November Christmas DayDecember 25 NOTE - When one of the holidays falls on Sunday, the following Monday will be observed as a legal holiday. When a holiday falls on a Saturday, the preceding Friday is observed as a national holiday by U. S. Government Agencies. Also included would be any day specifically declared by the President of the United States of America as a national holiday. 4.13 HOME HEALTH CARE AGENCY PERSONNEL POLICY: 4.13.1 The HHCA shall be entirely responsible for providing appropriate benefits, vacation time, sick days, and federal and state requirements for all personnel performing under this agreement such as, but not limited to: professional liability insurance, worker's compensation, income tax withholding, social security payment, health examinations, availability of health insurance, and payment of overtime in accordance with the Service Contract Act. 4.13.2 Any overtime and/or holiday pay that may be entitled to the HHCA's employees shall be the sole responsibility of the HHCA and shall not be billed to nor reimbursed by the VA. The VA will pay only for overtime authorized in advance by the CHNC for the convenience of the VA. 4.13.3 This is an agreement under which the HHCA is an independent agency whose personnel rendering the services are not subject, either by the terms or by the manner of its administration, to the supervision and control usually prevailing in relationship between the VA and its employees. HHCA personnel shall not be considered VA employees for any purpose and shall not, at any time, supervise VA employees. 4.13.4 The VA reserves the right to evaluate the quality of performance and administrative services provided by the HHCA, but retains no control over the medical or professional aspects of services rendered (e.g. professional judgments, diagnosis for specific medical treatment), in accordance with Federal Acquisition Regulation Part 37.401(b). 4.13.5 The HHCA shall be responsible for protecting the personnel furnishing services under this agreement. The HHCA shall provide all insurance, liabilities and compensation that is required by state and federal laws. 4.13.6 The HHCA and agreement health care providers shall only release medical information obtained during the course of this agreement to those VA staff members involved in the necessary care and treatment of that individual veteran. Veteran list and name of veterans are considered privileged information and shall not be disclosed or revealed in any way for use outside the VA without prior written permission from the SAVAHCS Director. 4.14 QUALITY ASSESSMENT STANDARDS: 4.14.1 HHCA health care providers shall be subject to the same quality assessment standards as established by VA, state and Joint Commission. The health care provider shall perform services in accordance with ethical, professional, and technical standards of the health care industry. Persons provided by the HHCA shall be technically proficient in the skills necessary to perform the services described herein. HHCA personnel shall be responsible for compliance with all procedures in accordance with applicable VA written polices and procedures. They shall not introduce new procedures or services without prior recommendation to and approval of the VA or authorized representative. 4.14.2 Non-acceptance of HHCA personnel does not relieve the agency from satisfying and fulfilling the requirements. 4.14.3 Proposed costs awarded shall inclusive of all incidental costs including housing, transportation, and premium payments for applicable malpractice insurance coverage. This contract represents a firm-fixed price service contract. Services performed outside the scope of this agreement are not authorized and will not be reimbursed by the Government with out prior approval. 4.15 PROGRESS AND COMPLIANCE/EVALUATION FACTORS: 4.15.1 The SAVAHCS CHNC shall be responsible for: a. Designing and implementing a SAVAHCS quality improvement program for the HHCA services being provided. b. Informing the HHCA of the quality assurance indicators are being monitored and the status of the agency's performance in meeting those indicators. c. Ongoing quality assurance indicators will always include: (1) monitor for service quality (2) monitor for patient safety d. Ongoing quality assurance indicators will be documented at least quarterly and will be included as a routine part of the SAVAHCS CHNC Quality Assurance Report. e. Immediately Informing the HHCA of any quality concerns or issues. f. Monitoring, documenting, and following up on all concerns and complaints received about care provided by the HHCA. g. Monitoring the HHCA's current plan of care. Any changes that alter the frequency of visits or level of services shall require prior approval of the SAVAHCS CHNC, who is responsible for oversight and final approval of services rendered. 4.15.1.1 Inspection: a. The SAVAHCS reserves the right to evaluate the care services provided by reviews of clinical notes, visits verification records, and surveys of patients. b. Monitoring the HHCA's compliance with this agreement and following-up with the agency on any issues regarding compliance. c. Meeting at least quarterly with the SAVAHCS Contracting Officer assigned to the CHNC contracts to: (1) Review quarterly documentation done by the SAVAHCS CHNC regarding the HHCA's compliance with this agreement. Compliance review will include: i Service delivery ii Business practices (2) Update the agreement as needed to avoid a lapse in the SAVAHCS documented service period for this agreement. 4.15.2 The HHCA shall be responsible for: a. Designing and implementing a quality improvement program. The quality improvement program shall be designed to include SAVAHCS patient involvement in quality improvement. b. Providing, upon SAVAHCS CHNC or Contracting Officer request, agency quality improvement documentation. c. Providing the SAVAHCS with the following reports: (1) A care verification form or each visit under this agreement. The agency shall complete this form indicating the date each visit is made, length of visit and services provided. The patient or caregiver shall initial this form to serve as evidence that care has been provided. (2) An up-dated list of active VA patients' names, types of services required and delivered; frequency of services and total number of hours of service. The HHCA shall provide this list to the SAVAHCS CHNC on a monthly basis. (3) A copy of the 60-day supervisory visit documentation following the home visit. This report should include a detailed review of the home situation; support services available; mental, emotional and physical condition of the patient. A complete plan of care shall be used for this purpose. The agency shall be responsible for developing, reviewing and devising the plan of acre as indicated by the patient needs. This will be review and approved by the SAVAHCS CHNC prior to the implementation of the agency plan of care. 4.16 CONFLICT OF INTEREST: 4.16.1 The HHCA shall not employ any person who is an employee of the United States Government if the employment of that person would create a conflict of interest. The HHCA shall not employ any person who is an employee of the Department of Veterans Affairs, unless such person seeks and receives approval in accordance with VA Regulations, policy, and public law. Nor shall the HHCA employ any person who is a member of the immediate family of a VA employee employed at the VA if the employment of that family member would create a conflict of interest or the appearance of a conflict of interest, particularly with regard to influencing the negotiations, terms of the agreement, or the work carried out under the agreement. In any such case, VA must review the matter and give its approval in accordance with agency ethics rules. 4.17 VETERAN SENSITIVITY: 4.17.1 HHCA health care provider/s shall respect and maintain the basic rights of veterans, demonstrating concern for personal dignity and human relationships. 4.17.2 Complaints shall be investigated individually. HHCA health care providers receiving more than two (2) verified complaints from COTR, Veteran Advocate, CHNC, Case Managers or social workers related to sensitivity within any consecutive three (3) month period shall require the health care provider to complete a sensitivity training class before continuing to provide services under this agreement. HHCA health care provider's participation in sensitivity training class shall be the sole responsibility of the HHCA at no expense to the Government. Depending upon the nature and severity of the complaint, the Government reserves the right to suspend performance of subject agreement health care provider or prohibit performance altogether, as deemed appropriate 4.18 COMMUNICATION: 4.18.1 HHCA shall ensure that health care providers maintain open and professional communication with veterans and members of the VA staff. Validated complaints of unprofessional behavior shall be reported to the COTR in writing and referred to the HHCA for action. Failure by the HHCA to correct validated complaints identified to or by the COTR shall be considered failure to perform and referred to the Contracting Officer for appropriate action. 4.19 DRUG SCREENING: 4.19.1 HHCA health care providers are subject to random drug testing. They are also subject to drug testing when there is a reasonable suspicion that they use or are impaired by illegal drugs while on duty. Reasonable suspicion of drug use or impairment includes, but is not limited, to the following: a. Observable phenomena, such as direct observation of drug use, possession or the physical symptoms of being under the influence of a drug; b. A pattern of abnormal conduct or erratic behavior; c. Arrest or conviction for a drug-related offense or the identification of a HHCA health care provider as the focus of a criminal investigation into illegal drug possession, use, or trafficking; d. Information provided either by reliable and credible sources or independently corroborated; or e. Newly discovered evidence that the health care provider has tampered with a previous drug test. 4.20 POINTS OF CONTACT (POC): 4.20.1 The HHCA shall provide a point of contact (POC) who shall be responsible for the performance of the work under this agreement. The POC shall have full authority to act for the HHCA on all matters relating to the daily operation of this agreement. The POC must be a health care provider performing in accordance with the terms and conditions of this agreement. An alternate may be designated, but the HHCA shall identify, in writing, those times when the alternate shall act as the POC. The HHCA shall identify the POC and alternate in writing to the SAVAHCS COTR at the time of acceptance. The HHCA shall give written notification to the COTR of those times when the alternate will act as the POC. The POC shall be available by telephone Monday through Friday, 8:00AM through 4:30PM, including Federal holidays. 4.21 ALTERNATE SOURCES: 4.21.1 If routine services are not performed for more than two (2) scheduled consecutive visits or Skilled Nursing Health Care service is not performed within twenty-four hours of scheduled or emergent response requests, the Government reserves the right to procure such services from an alternate source, until routine services are restored by the HHCA. When the Government exercises its right to procure these services from an alternate source, the HHCA shall reimburse the government for all charges in excess of the amount that would have normally been incurred by the agreement, including VA administrative costs for re-procurement. 4.21.2 A copy of the other source's invoice and/or other verifiable documentation shall be used as the basis for any reimbursement. 4.22 MONITORING PROCEDURES: 4.22.1 The COTR for this agreement is appointed in writing; the COTR is the SAVAHCS CHNC. The COTR is responsible for routinely monitoring and reporting the Home Health Care Agency's performance to the SAVAHCS Contracting Officer, SAVAHCS Quality Improvement Coordinator, and the Home and Community Services Committee. The COTR has is appointed act on behalf of the government on all matters as long as they do not obligate the government financially. Any and all changes to this agreement will be made with written approval of the Contracting Officer. 4.23 CALL LIMITATION/PERSONNEL AUTHORIZED: 4.23.1 No individual call under the Blanket Purchase Agreement shall exceed $100,000 and any or all calls are only to be placed by authorized personnel. (1) The following individuals are authorized to place telephone orders: SAVAHCS Community Health Nurse Coordinators SAVAHCS Attending Physicians 4.24 ORDERING PROCEDURES: 4.24.1 Referral of each Veteran to the HHCA shall be generated by the SAVAHCS CHNC staff. Referrals will be made to each HHCA based upon location and need of the veteran as well as the appropriate home health care services available. 4.24.2 All services shall be prescribed by a SAVAHCS physician and must meet quality standards set forth within the most current federal and state regulations. 4.24.2.1 The SAVAHCS CHNC shall: a. Provide the home care agency with a Homemaker/Home Health Aide referral when a SAVAHCS interdisciplinary team has made a clinical judgment that the veteran under consideration for services meets the following criteria: i. Three (3) or more activity of daily living dependencies, or ii. Significant cognitive impairment, or iii. Require services as adjunct care to community hospice services, or iv. Two (2) activity of daily living dependencies, and two (2) or more of the following conditions: 1. Had dependency in three (3) or more instrumental activities of daily living; 2. Has been recently discharged from a nursing facility, or has an upcoming nursing home discharge plan contingent on receipt of home and community-based care services; 3. Is seventy-five (75) years old, or older; 4. Has had high use of medical services defined as three (3) or more hospitalizations in the past year of has utilized outpatient clinics or emergency evaluation units twelve (12) or more times in the past year; 5. Has been diagnosed with clinical depression; 6. Lives alone in the community. b. Provide the home care agency with a Skilled referral when a SAVAHCS clinical judgment has been made that the veteran is appropriate for such care. c. Provide relevant medical information on referred patients to the agency. d. Review the agency plan of care for each client referred or updated to determine appropriateness of the plan. e. If it is determined the plan of care is not appropriate the SAVAHCS CHNC will contact the agency to amend the plan of care as required to meet the needs of the patient. f. Authorize the number of hours/days and duration of services. g. Review the veteran's authorization for services every 6 months from the start of service. h. Visit the HHCA at least every six (6) months to review performance and patient care. i. At least one visit will include an annual SAVAHCS inspection. 4.24.2.2 The HHCA shall: a. Evaluate all patients within 48 hours after notice of referral. Care shall be established within a time frame not to exceed 72 hours after the initial assessment. b. Complete a patient needs assessment and develop a plan of care. The agency shall complete the Agency portion of the referral form and return it along with a plan of care, to the SAVAHCS CHNC. Special attention shall be given to differentiate Homemaker and Home Health Aide services and the plan shall clearly state the frequency and duration being requested for each type of service. c. The agency shall not provide any services without the prior approval from the SAVAHCS. d. Be responsible for developing, reviewing and devising the plan of care as indicated by patient needs. These plans will be forwarded to the SAVAHCS CHNC for review and approval. e. Provide a registered nurse to conduct a home visit to re-assess the patient and update the plan of care every 90 days. f. Schedule visits in accordance with the care plan and patient acceptance of service recommended. Refusal of service by the patient will be communicated to the SAVAHCS CHNC. g. Report any problems that arise between the agency employees and the SAVAHCS clients immediately to the CHNC for mediation. The agency shall not suspend nor cancel patient care under any circumstance. h. Report consistent patient no-shows to the SAVAHCS CHNC for follow-up. The agency shall not suspend nor cancel patient care due to no-shows. i. Ensure services are provided by qualified and competent personnel in accordance with the terms and conditions of this agreement. j. Begin services within one (1) week of initial referral. k. Provide a registered nurse who will, upon initial client visit, provide the client, patient rights and responsibilities, advance directive information, and obtain authorization for care from the patient and/or appropriate family member/legal representative. l. Revise the plan of care as necessary according to changes in the patient's condition. m. Immediately report any significant changes in the patient's medical, emotional, or family condition to the SAVAHCS CHNC. n. Provide documentation of services provided and an updated plan of care upon request of the SAVAHCS CHNC. o. Notify the SAVAHCS CHNC if the veteran or caregivers terminates their services. p. Notify the SAVAHCS CHNC immediately if the patient or caregiver refuses services or is determine by the Home Care Agency to no longer require services. q. Notify the SAVAHCS CHNC in the event of a death of a patient receiving services. 4.25 DESIRED QUANTITY: 4.25.1 It is impossible to determine the exact or estimated amount which will be expended under the agreement. It is understood that no obligation will be incurred by the SAVAHCS under this agreement until authorizations are issued by the SAVAHCS CHNC for treatment/service for specific beneficiaries. 4.26 EXTENT OF OBLIGATION: 4.26.1 The Government is obligated only to the extent of calls that are actually made against this BPA. It is understood that this document in no way obligates the SAVAHCS to purchase a minimum or maximum quantity. This agreement can terminated at any time by either party as long as 60 day notice is provided. 5.0 DEFINITIONS/ACRYNOMS/REFERENCES/ATTACHMENTS: 5.1 DEFINITIONS/ACRYNOMS: As defined below for the purpose of this agreement the following terms and definitions are provided: - Certified Home Health Care Agency means a home and community support service that provides skilled, home health services and is certified by Medicare/Medicaid and/or State of Arizona and meets the standards. - Home Health Care Service" means the provision of one or more of the following health services required by an individual in a residence or independent living environment: 1. Registered Nursing 2. Licensed Practical Nursing 3. Homemaker Services 4. Home Health Aide Services 5. Respite Care 6. Hospice Care - SAVAHCS - Southern Arizona Veterans Administration Health Care System - HHCA - Home Health Care Agency - CFR - Code of Federal Regulations - VHA - Veterans Healthcare Administration - BPA - Blanket Purchase Agreement (also referred throughout as "agreement") - CHNC - Community Health Nurse Coordinator - COTR - Contracting Officer's Technical Representative - HCPCS - Healthcare Common Procedure Coding System 5.2 REFERENCES: - VISN 18 Policy Memorandum No. 5: Network Contracting Process. - Current Edition of Comprehensive Accreditation Manual for Home Care is incorporated by reference, as published by Joint Commission. - Title 38 Code of Federal Regulations (CFR) 17.38(a) (1)(ix) - Federal Acquisition Regulation (FAR) - Veterans Administration Acquisition Regulation (VAAR) 5.3 ATTACHMENTS: - Attachment A: SAVAHCS Claims Rejection Form SAVAHCS SKILLED NURSING/HOMEMAKER HOME HEALTH AIDE/HOME HOSPICE PROGRAMS Agency: ________________________________ Date: _____________________ The invoices are being returned due to: ? CMS 1500 claim form not used ? Invoice claim is for more than one veteran's services ? One or more of the required elements are missing from the claim form: Veteran's name Veteran's social security number Veteran's address, including zip code where services were rendered Description of services ? Information on the claim form not typed ? Pen/ink (hand written) changes made on the claim form ? Missing or incorrect ICD9 code/s ? Missing or incorrect CPT and/or HCPCS code/s (End of Description/Specifications/Work Statement)
 

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