PERFORMANCE WORK STATEMENT BACKGROUND Ending homelessness among Veterans by 2015 was established as a national priority by the Department of Veterans Affairs Secretary, Eric Shinseki, in November 2009 at the National Summit on Ending Veterans Homelessness. In June 2010, the U.S. Interagency Council on Homelessness (USICH) released Opening Doors: Federal Strategic Plan to Prevent and End Homelessness, which is fully aligned with this goal. Ending Veteran Homelessness continues to be a Strategic Objective Performance Goal of VA s FY 2018-2024 Strategic Plan, and current Department of Veterans Affairs Secretary Denis McDonough established new goals towards ending Veteran homelessness including placement of at least 38,000 Veterans experiencing homelessness into permanent housing during calendar year 2022. The Health Care for Homeless Veterans (HCHV) Program is an essential and critical part of VHA, providing a gateway to VA and community-based supportive services for eligible Veterans who are homeless. The central goal of HCHV programs is to reduce homelessness among Veterans by conducting street outreach to Veterans who are homeless or experiencing housing instability and need case management assistance to end their homelessness and connect to community-based and VA-supported housing services, VA health care, and other supportive services. In addition to outreach services, HCHV programs provide care, treatment, and rehabilitative services, including case management and therapeutic transitional housing assistance by contracting with community providers. HCHV Contract Emergency Residential Services (HCHV CERS) programs promote an environment that maintains the wellbeing and safety of enrolled Veterans and offers Veterans supportive services that assist them with transitioning from the streets or shelters and living successfully in housing. PROGRAM DESCRIPTION The HCHV CERS Program provides short-term residential care and treatment to eligible Veterans who need immediate housing placement as they seek permanent housing and/or additional care and services. The purpose of this solicitation is to obtain offers from Contractors who can provide a means of removing homeless Veterans from the street or other habitation unfit for humans and placing them in community-based, residential environments with sufficient supportive services to meet their basic needs and ultimately facilitate improvement of their overall health status and housing situation. HCHV CERS Program Characteristics: Offers residential programming located within walking distance of, or easily accessible by public transportation to, VA Behavioral Health Clinic, 525 21st St. in Oakland, CA, 94612. Covers a total Period of Performance of five years that includes one 12-month Base Year and four additional 12-month Ordering Periods Targets and prioritizes homeless Veterans who are eligible for VA health care and are transitioning from literal street homelessness, Veterans being discharged from institutions who are homeless, including those in need of medical respite or recuperative care, and Veterans who recently became homeless and require safe and stable living arrangements while they seek permanent housing Has capacity to serve men and women Lengths of Stay typically range from 30 to 90 days with the option to extend based on clinical need Seeks to reduce barriers to immediate placement and accommodates same day admissions Does not deny entry to HCHV CERS Program based solely upon: Length of current abstinence from alcohol or non-prescribed controlled substances Number of previous treatment episodes Time interval since the last program entry Use of prescribed controlled substances including but not limited to prescribed FDA-approved medications such as methadone or buprenorphine for SUD treatment Legal history Considers each of the special circumstances above during the screening process and makes an admissions determination based on whether the individual Veteran s needs can be met while maintaining the program s safety, security, and integrity Provides safe, secure housing as well as supportive services including but not limited to assistance in securing permanent housing, vocational assistance, including mentoring and coaching as well as job placement, income assistance and financial planning, linkage to health care, moderation of substance use, and social and recreational activities Veterans are expected to meaningfully engage with their case managers and in available programming Emphasis is placed on achieving placement in permanent housing at the time of program exit and on reducing negative exits due to rule violations or other avoidable circumstances House Rules and Expectations Rules focus on staff and resident safety: No buying or selling of alcohol or drugs in the facility No dealing or use of illicit drugs in the facility No sexual activity between residents No violence or threats of violence Honor nightly curfew When possible, infractions are to be used to engage residents, not simply as grounds for service termination. Negative discharges will be monitored as a measure of program quality. Veterans are expected to engage in programming and maintain communication with case managers at all times around matters relating to admission, stay, and treatment. It is essential that Veterans permit communication between VA and Contractor through an appropriate Release of Information (ROI) to ensure safe and effective treatment of each Veteran. Veterans who refuse to allow this communication about their treatment needs and ongoing care will need to receive services elsewhere. Admission Practices Contractor will assist Veterans with admission forms and eligibility determination with VA. Contractor works to reduce barriers to admission: By accepting referrals and admissions Monday Friday, 8AM-4:30PM and up to 24 hours a day, 7 days a week including weekends and holidays, whenever possible. By demonstrating flexibility with admission processes. Admission Criteria To be eligible for HCHV Contracted Residential Services, a Veteran must meet the requirements of 38 U.S.C. 2031(a) and 38 CFR 63.3. Veteran is enrolled in the VA health care system, or eligible for VA health care under 38 CFR 17.36 or 17.37; and Veteran is homeless as defined in 38 U.S.C. §§ 2002(1) and 103(a) of the McKinney-Vento Homeless Assistance Act, 42 U.S.C. § 11302(a) and 24 CFR 576.2 including: Veteran who lacks a fixed, regular, and adequate nighttime residence; or Veteran who will imminently lose their primary nighttime residence within 14 days of the date of application for homeless assistance. Overview of Types of Services Available to Residents Safe, Secure housing that includes laundry and restroom facilities Ensuring access to three nutritious meals per day, seven days per week, as well as nutritious snacks between meals and before bedtime Case Management and Care Coordination Services Vocational training and employment services Benefits Services Enhancement of Independent Living Skills Permanent/ Transitional housing search support Arranging, coordinating, and/or providing direct clinical services and support for mental health stabilization and substance use treatment services using Recovery Model principles OBJECTIVE Contractor shall provide emergency housing and supportive services for homeless Veterans in community based HCHV CERS facilities that offer a safe and secure environment that support their goals for recovery from homelessness in accordance with the HCHV CERS model requirements. Services are expected to consist of 24-hours-a-day/7-days-a-week housing and supportive services for homeless Veterans, many of whom may be dealing with substance use disorders and/or mental illness. The program places an expectation on the Veteran to engage in supportive case management services, and also on the Contractor to provide supportive services, expertise, and guidance that focuses on improving housing stability to ensure a transition from homelessness to permanent, stable housing and ongoing engagement with aftercare and relapse prevention services upon discharge. Contractors must comply with all HCHV CERS requirements as identified below. HCHV CERS PROVIDER QUALIFICATIONS & CAPABILITY REQUIREMENTS Capable of performing outreach or otherwise identifying and referring to the contract program homeless Veterans who may have mental illness and/or substance use disorders Capable of providing secure housing and bathroom accommodations; shared use of kitchen facilities and dining rooms is acceptable Capable of providing services twenty-four (24) hours a day for Veteran placements lasting up to ninety (90) days per Veteran. Extensions beyond initial ninety (90) days shall be authorized in writing by VA Liaison; extensions beyond 180 days must be prior- approved by the Social Work Service Contract Coordinator/ COR/designee Capable of providing a sanitary food preparation area and ensuring access to three daily nutritious meals, nutritious snacks for those requiring or desiring additional food between meals even when not medically indicated, and reasonable accommodation for special dietary needs, e.g., diabetic, renal or soft mechanical diets, and/or cultural/religious preferences around food, e.g., Kosher, Halal, vegetarian Capable of offering a means for Veteran participants to wash their own clothes or otherwise tend to laundry at a minimum of once per week; detergent shall be free of charge Capable of providing accommodations that include semiprivate (required) or private (preferred) sleeping units with a bed and other furnishings such as a dresser, storage locker and lock or designated locked secured space, and personal linens (i.e., towels, pillows, blankets, bed sheets); storage space shall accommodate two bags of personal belongings and all prescribed medications and other medical equipment Capable of providing an isolation area or quiet/safe room for Veteran participant(s) who may require closer short-term monitoring by staff for the health and safety of the community (e.g., management of acute intoxication or emotional dysregulation or prevention of disease transmission) Capable of storing personal belongings for at least 72 hours after formal HCHV discharge Capable of providing quality case management and treatment services that utilize a Recovery Model approach and include elements of Motivational Interviewing, Harm Reduction, and Critical Time Intervention Capable of maintaining a minimum of one staff member on duty on the premises or presence of a resident manager who resides at the facility and has access to an on-call administrator in case of emergency at all times to ensure appropriate response to matters involving Veteran safety; Capable of facilitating prompt communication between Veteran participants and VA and ensuring reasonably prompt communication (same day or within one business day) between Contractor and VA at all times DIRECT VETERAN CLINICAL SERVICES Occupancy: Contractor will be responsible for ensuring that a minimally acceptable level of 80% occupancy (90-100% preferred) of HCHV CERS funded beds is maintained at all times through independent outreach efforts as well as through collaboration with VA. Contractor will be knowledgeable about outreach best practices generally accepted in the community and will be responsible for engaging in outreach in the community including collaboration with SFVAHCS providers for referrals at least twice monthly to maintain satisfactory occupancy rate when occupancy does not meet minimally acceptable level. Therapeutic and Rehabilitative Services: These may include but are not limited to clinical case management, individual and group counseling, structured group activities such as 12-step meetings, vocational training, and/or prosocial outings, linkage to and coordination with VA and other community-based services/resources, independent living skills, and discharge planning that begins with an assessment of housing needs upon program entry. Care Planning: Contractor will engage the Veteran in a collaborative assessment of service needs with input from the Veteran and the VA Liaison or designee and create an initial service plan of care to address those needs within 14 days of admission. Care plans must include goals and objectives for achieving stable housing. Care plan will include an assessment of strengths and barriers to stable housing, specific services to be provided including duration and outcomes, documentation of referrals and benefits to be achieved as a result of program participation. This plan is to be reviewed and updated every 60 days with the Veteran and the VA Liaison or designee and as needed throughout each individual Veteran s episode of care. Contractor case manager shall meet with VA Liaison or designee at least once every 30 days to provide an update on case management progress made and must work cooperatively with VA Liaison or designee to coordinate services. Case Management: Contractor will provide individual case management meetings at least once per week that focus, at a minimum, on: permanent housing search and stabilization, increasing income through referral to all potential financial resources such as SSI/SSDI, VA pensions, GA, SNAP, Medi-Cal, vocational training when indicated, self-care skills, adaptive coping skills, any necessary coordination of care provided by VA and community-based medical, mental health, and/or substance use treatment providers, and ongoing discharge planning that includes linkage to community resources for long-term housing success such as IHSS, Meals on Wheels, or Adult Day Health. Progress made in Veterans transition to stable housing must be clearly reflected in weekly case management notes. Mental Health and Substance Use Disorder Treatment: Contractor will be expected to provide services using evidence-based practices that support the Veterans in gaining and applying knowledge of the recovery process to his/her life and to provide referral for additional treatment and/or aftercare supports as needed to promote and facilitate the individual Veteran s recovery effort and successful exits to permanent housing. Medication Storage and Monitoring: Contractor is expected to provide a means of securely and properly storing all medications brought into the program for Veteran use. Contractor shall ensure there are appropriate policies and procedures that support the safe storage of medications for Veteran participants. This storage can be provided to the Veteran to secure his or her medications, or central storage may be provided by the Contractor. Veterans may self-administer medications, but storage should ensure that no other program participants are able to access an individual Veteran s medications. Any suspicion or concern for misuse is to be reported to VA Liaison and/or COR immediately by following incident reporting protocol. Storage of Personal Belongings: Contractor will provide storage space such as a dresser, storage locker and lock, or designated locked secured space that will hold up to two bags of personal belongings and all prescribed medical equipment. Contractor will allow Veteran to store personal belongings for at least 72 business hours after formal HCHV exit from program. If a Veteran abandons his/her belongings, Contractor will make three documented attempts to contact the Veteran and/or VA Liaison before disposing Veteran s items. Absences and Cancellation The Department of Veterans Affairs (VA) allows payment to a provider for an absent Veteran under the circumstances outlined below. Scheduled Absences. VA will pay per diem up to a maximum of 96 consecutive hours for the scheduled absence of a Veteran. Contractor shall notify VA Liaison, COR or designee in writing of all Veteran requests for scheduled absences or passes prior to the start of any absence from program authorized by Contractor (preferably 24-48 hours) and include reason for pass and contact/location information for Veteran while absent. To receive payment, the absence must: Be pre-planned, consistent with and support the Veteran s individual service plan (e.g., family reunification, short-term medical, substance use disorder or psychiatric treatment). Have the reason documented in the individual Veteran s case file, treatment record or service plan Not result in the bed being filled by the provider Not be for a break or vacation from treatment Not be used for extended educational or employment circumstances Not be used to create more than four consecutive days of absence Unscheduled Absences. VA will pay per diem up to a maximum of 48 consecutive hours for the unscheduled absence. To receive payment for an unscheduled absence: Contractor must have evidence of active outreach to locate and reengage the Veteran and document the steps taken in the Veterans individual case file, treatment record, or service plan. Contractor shall notify VA Liaison, COR or designee immediately or during next available business hours of all unscheduled Veteran absences . Contractor may not fill the bed during this time. Veteran must be discharged from the HCHV CERS program if not located within 48 hours Ineligible Veteran. When a Veteran is admitted to an HCHV CERS program and found to be ineligible for HCHV CERS, VA will pay for a maximum of four (4) days from the date of admission to allow Contractor and HCHV CERS Liaison time to locate and arrange alternate placement. Contractor can maintain enrollment of a Veteran without payment beyond the approved absence at Contractor s discretion and in consultation with VA Liaison, COR or designee. However, the Veteran must be discharged if absent for more than 14 days. Contractor cannot receive payment of per diem while Veteran is placed in another VA HCHV CRS-contracted bed such as detox. VA reserves the right to remove any or all Veterans from the facility at any time without additional cost when it is determined to be in the best interest of the Veteran or VA. Exits to Permanent Housing: The Contractor is expected to promote a focus on achieving stable, independent housing for all Veterans referred for care; exits to permanent, independent housing will be monitored as an indicator of overall program quality utilizing data provided by the VHA Support Service Center s Homeless Services Scorecard. The target values for exits to this type of housing are established by VHA Homeless Program Office on an annual basis at the start of each fiscal year (e.g., FY22 target value for Exits to Permanent Housing is 55% or more) and can vary from year to year. Target values for Exits to Permanent Housing will be communicated by VA HCHV Liaison and/or COR to Contractor at the start of each fiscal year. Negative Exits: The Contractor is expected to facilitate Veteran completion of the HCHV CERS Program to the maximum extent possible while still maintaining program integrity and safety. Negative Exits shall be defined as exits from the program in which the Veteran was asked to leave due to violation of program rules (excluding exits due to threatened/actual violence to self or others), failure to comply with program requirements, or leaving the program without consulting staff. Negative Exits shall be monitored on a continuous basis utilizing data provided by the VHA Support Service Center s Homeless Services Scorecard. The target values for Negative Exits are established by VHA Homeless Program Office on an annual basis at the start of each fiscal year (e.g., FY22 target value for Negative Exits is 20% or less) and can vary from year to year. Target values for Negative Exits will be communicated by VA HCHV Liaison and/or COR to Contractor at the start of each fiscal year. Procedures for Negative Discharges For all program exits other than exits for threatened/actual violence to self or others, Contractor shall develop a written progressive warning policy/procedure that includes issuance of at least two formal warnings prior to proceeding with discharge. The policy/procedure shall include case conference with Program Staff, Veteran, VA Liaison and/or Designee, and other clinical providers involved in the Veteran s care, e.g., HUD-VASH Social Worker or Mental Health/Substance Use Disorder staff, no later than issuance of the final warning. Information on the policy/procedure shall be provided to the Veteran upon admission to the program including a formal appeals process through which Veteran may appeal program regulations, sanctions or discharges. There shall be no permanent bans from the program/facility. Veterans exited under negative circumstances shall be notified upon request of conditions or process for re-admission. Contractor shall be expected to make reasonable efforts to facilitate referral to another facility or appropriate level of care if negative discharge is indicated. The policy/procedure shall be subject to approval by VA Liaison, COR and/or Designee. ADMINISTRATIVE SERVICES Determination of Eligibility, Referrals, and Admissions VA is responsible for determining Veteran eligibility for placement in program prior to admission by Contractor for services. Contractor is responsible for obtaining confirmation of Veteran eligibility for placement into program prior to admission of each Veteran referred under this contract. If there is an urgent need to admit a Veteran and designated VA staff is unavailable to provide written verification of eligibility prior to admission, then verbal approval by VA is acceptable pending receipt of written verification. Any admissions that occur without written/verbal approval must be verified by VA staff within 24 business hours in order for Contractor to receive payment for day(s) admitted prior to formal approval (e.g., admission occurs after hours or over the weekend). Failure to establish eligibility prior to admission may result in denial of payment for services provided. A list of authorized VA ordering personnel including primary identified VA Liaison shall be made available to Contractor upon award of the contract. VA employees may be added or deleted from this list during the term of the contract at the discretion of VA. Contractor shall not deviate from the list of individuals authorized to approve admissions without an updated list. To be eligible for HCHV Contracted Residential Services, all Veterans must meet the requirements of 38 U.S.C. 2031(a) and 38 CRF 63.3, i.e., Veterans in this program must be homeless or at imminent risk of homelessness within 14 days of application for services and be eligible and registered for VA health care at SFVAHCS Referral constitutes authorization of an initial service period of up to 90 days unless otherwise specified. Contractor shall be expected to provide same-day residential placement in the CERS program whenever possible. Contractor shall work to reduce barriers to admission by accepting referrals throughout the day and practicing flexibility with admission processes. Admissions decisions shall be made on the same day of referral and no later than 24 hours after receipt of referral if a bed is not immediately available. Notification of admissions decisions, any delay in admissions decisions beyond 24 hours, and reasons for denial of any admission shall be provided in writing to HCHV Liaison, COR, and/or designee. Admissions process is subject to VA Liaison review and adjustment at any time to ensure accessibility for Veterans. Contractor shall display a willingness to accept referred Veterans. It is understood that Veterans to be cared for under this contract will require care and treatment service beyond room and board and may need more intensive case management than the general population. Level of intensity of services will be part of an ongoing discussion with VA Liaison. Contractor shall maintain effective communication with VA regarding any issues covered under this agreement. Release of Information: Contractor shall ensure that a signed VA Release of Information (ROI) is obtained for any Veteran being admitted to an HCHV CERS Bed and placed into individual case record. Individual Case Records: Contractor will maintain an individual case record for each referred Veteran. Case records must be maintained in security and confidence as required by the Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR part II) and the Confidentiality of Certain Medical Records (38 USC 7332), and in accordance with the Health Insurance Portability and Accountability Act (HIPAA: Pub. Law. 104 191). Records should contain at a minimum: Reason for referral Pertinent demographic information Verification of Veteran status Family status Employment history Education/marketable skills/licenses/credentials Copies of any medical prescriptions/orders issued by physicians for any contract program that implements medication management/monitoring. Contractor must comply with HCHV inspection requirements. Individual service plan as described in Section C.3.3. Care Planning. Weekly case management/treatment notes and documentation of any case management interventions or Veteran case conferences Authorized absence pass requests Critical incident reports Extension approvals when indicated Final summary that includes reason(s) for leaving, Veteran s known future plans, and follow-up locator information if available Any and all information needed to meet clinical requirements of annual HCHV Residential Services Programs inspection (see sample attached, Health Care for Homeless Veterans Contracted Residential Services Programs Inspection Packet Clinical Review ) Computer Security: In the performance of official duties under this contract, Contractor may have regular access to printed and electronic files containing sensitive data. This data shall be protected under the provisions of the Privacy Act of 1974 and other confidentiality laws, and agency policy.  Contractor shall ensure its personnel protect the data from unauthorized release or from loss, alteration, or unauthorized deletion.  Contractor shall ensure its personnel take all reasonable precautions to safeguard patient information from unauthorized access or modification, in both electronic and hard-copy formats.  This includes not only electronic security measures such as strong user passwords on computer systems, but also physical barriers to prevent unauthorized use of computer work-stations; and also requires that hard copy Veteran files are stored in secured lockable areas, that files are in lockable cabinets, that the cabinets can in fact be locked (i.e., keys are available, and the locking mechanisms work properly).  If Contractor uses computer laptops, Contractor shall store computer laptops in a safe, secure locked bag or cabinet when not in use, and store in locked, secure location (i.e., trunk of car) when transporting computer laptop in the field.  Contractor shall also take all reasonable precautions to safeguard patient information when transferring Veteran information via electronic means, such as faxing or system-to-system transmission.  Contractor shall not use personal flash drives to store or retain any personal health information (PHI) or Veteran information.    Homeless Management Information System (HMIS) Data Reporting: Veterans served through VA s HCHV CERS program must have client level data entered into the local Community Continuum of Care s (CoC) HMIS. Data entered must include, at a minimum, the Universal Data Elements from the 2010 HMIS Data Standards. Contractor is responsible for registering with local HMIS system to obtain access roles and manage agency data within the system. Daily Census Sign-In Sheet: Contractor is responsible for collecting Veteran participant signatures on a daily census sign-in sheet to verify attendance in the program. This information is to be provided to the VA Liaison, COR, or other designee at a frequency to be designated by VA that is no less than once weekly and up to daily with weekend or holiday sign-in sheets to be provided on the next business day in order to ensure effective monitoring of bed utilization. Incident Reporting Contractor shall notify the VA immediately when any adverse critical incident involving a Veteran admitted to the program occurs. Critical Incidents shall include: Falls Elderly/Dependent Adult Abuse or Neglect Sexual Assault Fire (Veteran Involved) Medical or Mental Health Emergency (911 Calls) Hospitalization Suicidal ideation or attempt Homicidal ideation Assault (of other residents or Staff) Death Infectious Control Concerns (e.g., Bed Bugs, TB, Scabies, Coronavirus) Active Substance Use Observation/ Possession of Weapons During regular business hours, VA Liaison, HCHV Coordinator/Supervisor and/or COR shall be contacted immediately by phone to report such an incident; if the incident occurs outside of regular business hours (Monday-Friday 8:00AM-4:30PM), Contractor shall notify VA Liaison, HCHV Coordinator/Supervisor and/or COR at the start of the following business day. Should Contractor require immediate afterhours VA support/intervention, Contractor shall notify the SFVAHCS Administrator on Duty (AOD) by calling the local VA facility. A written report to the VA Liaison and/or COR should follow the initial VA notification within 24 business hours. The report should list known precipitating factors or triggers. Contractor shall maintain a copy of all critical incident reports in the involved Veteran s individual case record. Extension Requests: It is understood that Contractor will not be paid for care provided to a Veteran participant beyond the initial authorized period unless an extension of authorization is provided in writing by the VA. Contractor is responsible for ensuring that all requests for extension of services beyond the initially authorized service period of 90 days are reviewed in advance and approved in writing by the VA Liaison, COR, or other designee before reaching the Veteran participant s 90th day. Extension requests must include clinical reasoning and a targeted housing plan to justify approval; extension requests will be individualized to Veteran needs and approved in writing increments of no more than 30 days at a time. Only extraordinary circumstances will be considered in order to extend service periods in excess of 180 days, and all requests for extension exceeding 180 days from date of admission must be approved in writing by VA Liaison and COR or designee. Grievance Procedures: Contractor must have an internal grievance process that Veterans can use to resolve conflicts within the program. Contractor must have written policies and procedures for resolving grievances including a statement regarding the client s right to request reasonable accommodation and must post them in a conspicuous place that is accessible to program participants. Each Veteran shall receive a copy of the grievance policies and procedures upon intake and upon receiving a warning or notice of discharge. Contractor shall refer grievances received directly from Veterans to the identified VA Liaison, COR or designee within 48 hours of complaint. All grievances received by the VA Liaison, COR or designee will be immediately forwarded to the Contractor and shall be investigated promptly. After investigation and clarification of disposition, Contractor shall respond to the VA Liaison or COR within five (5) business days or less with proposed resolution or plan for corrective action. The Contracting Officer (CO) shall be notified in instances where the proposed course of action or response does not appear sufficient to resolve any given complaint. VA Liaison, COR or designee will monitor the services being provided in this contract program. Contractor is expected to cooperate with VA Staff and COR by providing information and answering questions in a timely manner when requested. Contractor will be subject to a Contract Discrepancy Report (CDR) anytime unacceptable contract performance is determined to be critical in nature and requires formal corrective action through report of contract discrepancy to CO. Failure to perform duties herein will have Contractor be subject to contract termination. Satisfaction Surveys: When requested, Contractor will be responsible for administering, collecting, and delivering to VA Liaison a survey of the Veterans experience in the program. Admission and Discharge Reporting: Contractor is responsible for notifying the identified VA Liaison (or designee) within 24 business hours that an admission or discharge has occurred and for providing a written report of admission or discharge within 48 business hours that contains the specific data required by the Northeast Program Evaluation Center (NEPEC) for documentation in the Homeless Operations and Management Evaluation System (HOMES). The written report of discharge shall also contain a brief discharge summary that includes but is not limited to: date of exit, type of exit (positive vs. negative), Veteran s perception of exit and agreement with exit, status of treatment goals at time of exit, aftercare plan, Veteran s agreement with aftercare plan, housing status at exit and future contact information. CONDUCT Contractor shall comply with the principles listed in 38 CFR 17.707(b) to provide housing and supportive services in a manner that is free from religious discrimination. Local law enforcement and/or fire departments should be contacted for assistance and intervention as appropriate and indicated by any given circumstances. Contractor shall also notify the VA Liaison, AOD, or COR immediately of any high-risk situations involving Veterans with suicidal and/or homicidal threats or ideation, episodes of physical or sexual violence, sexual activities, safety concerns, or activities involving illegal substances so that appropriate response may be coordinated. In the event of a medical or psychiatric emergency, it is agreed that every effort will be made to facilitate Veteran access to local VA Medical Center for care. If a VA Medical Center is not available in the vicinity or is otherwise inconveniently located, Contractor will advise the VA Liaison or AOD of the facility to which the Veteran has been admitted. Contractor will also be expected to assist Veterans requiring non-urgent services with accessing appropriate care from a VA or community facility, as appropriate. TRAVEL Contractor is expected to assist Veterans with arranging local transportation to scheduled meetings and appointments. Contractor is expected to help Veterans understand and learn how to use public transportation. This includes providing education, information, linkage to low cost/no cost transit fare resources, and clarifying instructions necessary to effectively utilize public transit systems. If Contractor and/or VA staff determine that public transportation is not available, adequate, or appropriate for any Veteran, Contractor will be expected to assist the Veteran with identifying alternative modes of transport, however, Contractor is not required to provide transportation to a Veteran directly. FACILITIES General Requirements: It is the responsibility of Contractor to properly maintain its facilities and the VA shall have no responsibility for paying or reimbursing the Contractor for such expenses. The contract facility must: Have a current occupancy permit issued by the local and state governments in the jurisdiction where the facility is located. Be in compliance with existing standards of State safety codes and local, and/or State health and sanitation codes. Meet the requirements of the Americans with Disabilities Act (ADA) (Public Law 100-336, 42 USC 12101-12213) pertaining to handicapped accessibility in effect on the date of contract award. Where applicable, be licensed under State or local authority. Where applicable, be accredited by the State. Be equipped with operational air conditioning/heating systems if needed to maintain acceptable temperature Be kept clean free of dirt, grime, mold, or other hazardous substances and damaged noticeably detract from the overall appearance. Be equipped with first aid equipment and an evacuation plan in case of emergency. Have windows and doors that can be opened and closed in accordance with manufacturer standards. Have an aggressive ongoing plan to address bed bug infestation. This policy must be a part of your written response to this solicitation. Ongoing bed bug infestation will be grounds for immediate discharge of Veterans from the facility. Have emergency and disaster plans with written protocols that are posted to guide staff response to crises including, but not limited to, manmade and natural disasters, episodes of infectious diseases, physical injury, program participant suicide or suicide attempts, overdoses, and domestic or other violence. All Contractor staff shall be trained on emergency procedures and protocols. Fire Safety Requirements: The building must meet the requirements of the applicable residential occupancy chapters of the current version of NFPA 101, National Fire Protection Association's Life Safety Code. Any equivalencies or variances must be approved by SFVAHCS Director. Fire exit drills must be held at least quarterly and preferably monthly. Program participants must be instructed in evacuation procedures when the primary and/or secondary exits are blocked. A written fire plan for evacuation in the event of fire shall be developed and reviewed annually. The plan shall outline the duties, responsibilities and actions to be taken by the staff and residents in the event of a fire emergency. This plan shall be implemented during fire exit drills and training of staff across all shifts in this plan must occur. A written policy regarding tobacco smoking in the facility shall be established and enforced. Portable fire extinguishers shall be installed at the facility. Use NFPA 10, Portable Fire Extinguishers, as guidance in selection and location requirements of extinguishers. Requirements for fire protection equipment and systems shall be in accordance with NFPA 101. All fire protection systems and equipment, such as the fire alarm system, smoke detectors, and portable extinguishers, shall be inspected, tested and maintained in accordance with the applicable NFPA fire codes and the results documented. Inspection Prior to the award of any contract and annually thereafter during any subsequent contracted performance periods, a multidisciplinary VA team consisting of a social worker, dietitian or nutrition and food service professional, nursing staff, VA Police, and a Safety and Occupational Health Specialist, as well as any other subject matter experts determined necessary by the medical center director, COR, HCHV Coordinator, or VA Liaison, shall conduct a survey of the Contractor s facilities to be used to provide Veterans food, shelter, and clinical services to assure the facility provides acceptable level quality care in a safe environment. Additional inspections may also be carried out, announced or unannounced, at any other time as deemed necessary by VA. Contractor will be advised of the findings of the annual inspection team. If deficiencies are noted during any inspection, Contractor will be given a reasonable amount of time (typically 30 days) to take corrective action and to notify the Contracting Officer, Contracting Officer s Representative, or other VA designee that the corrections have been made. A contract will not be awarded until noted deficiencies have been eliminated. Failure by Contractor to take corrective action within the reasonable time provided will be reported to the VA Contracting Officer. If corrections are not made to the satisfaction of the VA, the Contracting Officer will be notified, and shall be the final arbiter on the necessary resulting consequences and action. Annual re-inspections shall be unannounced whenever possible. When an unannounced annual inspection is not possible due to privacy or other concerns, no less than four unannounced site visits by HCHV Liaison or other VA designee shall be made annually in addition to annual reinspection and shall include: A visual safety and sanitation inspection of the facility including meal preparation areas, fire exits, sleeping areas and medication storage. Any safety or sanitation deficiency must be addressed immediately. Review of Contractor s emergency and disaster plans to ensure they are up to date and that staff are trained in the procedures outlined in the plans. An audit of Veteran s clinical records selected randomly to ensure documentation of case management services and that other services are being provided as required by the contract terms. Review of any Veteran complaints to ensure that these have been resolved in a fair, impartial and consistent manner. The results of the unannounced site visits are to be documented and shared with the COR and the Contracting Officer. The report and any issues that were found along with the resolution must be kept in the COR Administrative File for that program. The inspection of the Contractor facilities will include inspection for conformity to the current Life Safety Code as described in Section 6.2, and will also include the following: General observation of residents to determine if they maintain an acceptable level of personal hygiene and grooming. Assessment of whether the facility meets applicable fire, safety and sanitation standards. Determining whether the facility is in attractive surroundings conducive to social interaction and the fullest development of the resident's rehabilitative potential. Observation of facility operations to see if appropriate organized activity programs are available during waking hours (including evenings) and degree to which a high level of activity is observed in the facility, such as individual professional counseling, physical activities, assistance with health and personal hygiene. Seeking evidence of facility-community interaction, demonstrated by the nature of scheduled activities or by information about resident flow out of the facility, e.g., community activities, volunteers, local consumer services, etc. Observation of staff behavior and interaction with residents to determine if they convey an attitude of genuine concern and caring. Inspecting the types of meals and other nutrition provided to residents to see if appetizing, nutritionally adequate meals are provided in a setting, which encourages social interaction and if nutritious snacks between meals and bedtime are available for those requiring or desiring additional food, when it is not medically contraindicated. Making a spot check of Veterans records to ensure accuracy with respect to Veterans length of stay and services provided to the Veterans. All Department of Veterans Affairs inspection findings for residential facilities furnishing treatment and rehabilitative services to eligible Veterans shall, to the extent necessary, be made available to all government agencies charged with the responsibility of licensing or otherwise regulating or inspecting such institutions. DELIVERABLES QUALITY CONTROL BUSINESS PLAN: Contractor shall submit a Quality Control Business Plan that supports the program objectives and associated tasks. The CO shall review and comment as necessary to ensure that contract goals are met. STAFFING AND SERVICE PLAN: Contractor shall provide a detailed staffing and service plan. Plan shall demonstrate that sufficient professional personnel are employed to carry out the policies, responsibilities, and services required under this contract. Contractor must identify each person functioning as Key Personnel under this contract and provide the VA with a description of the services to be provided by each person. Contractor shall assign to this contract personnel who are qualified by education, training, and, when required, certification or licensure, to provide the Therapeutic and Rehabilitative and other basic services required by this Performance Work Statement. Contractor may be required to supply a resume(s) summarizing relevant skills and experience of any/all Key Personnel upon request. Minimum Key Personnel requirements are as follows: One program manager/administrative/clinical designee who shall be responsible for contract performance and who shall have authority to act for Contractor on all matters relating to daily operations of the program and who shall be available for consultation with the authority to make decisions regarding the facility and residents in case of emergency 24 hours a day, 7 days a week. One professionally credentialed clinician (i.e., LCSW, PhD, PsyD, LMFT, LPCC) within the contract program s chain of command who has clinical oversight of the program and of program staff. Contractor shall be required to provide 24-hour staffed program for day and night supervision and safety. There must be, at a minimum, one staff member on duty on the premises, or one resident manager residing at the facility with contact information for the administrator/clinical designee available in case of emergency 24 hours a day, 7 days a week. Any time there is only a resident manager onsite, the program manager or other administrative/clinical designee shall be on call and capable of responding in case of emergency 24 hours a day, 7 days a week within 30 minutes. Sufficient case management/counseling personnel to maintain the therapeutic milieu and provide direct services to Veterans participants. VA recommends staffing ratio of, at a minimum, one full-time dedicated case manager per 20 Veterans. Exceptions may be granted in writing by VA. Case managers must have sufficient training and experience working with individuals experiencing homelessness; training and experience working with Veterans and/or individuals dealing with chronic medical, mental health and/or substance use problems is highly desirable. Staff working with Veteran participants shall be able to assess, anticipate, and effectively refer Veterans experiencing crises for additional support as needed. Contractor shall notify VA Liaison or designee of cross coverage by alternative staff if a primary Contractor staff is temporarily absent. The alternate staff should be made aware of the HCHV contract guidelines. Other personnel necessary for safe operation of services contracted for by VA such as janitorial, security, kitchen, front desk, maintenance, and general milieu staff shall be provided by Contractor which are compatible with maintaining quality care programming and the safety of the Veterans, other program participants, and staff. Contractor shall provide resumes for any proposed substitutions of Key Personnel at least 15 days prior to projected date of substitution. The Contracting Officer (CO) shall notify Contractor within fifteen (15) calendar days after receipt of all required information if the VA is able to accept the proposed substitute key personnel. Temporary substitutions of key personnel shall be permitted in accordance with Contractor s contingency plan. Contractor s contingency plan to be utilized if personnel leave Contractor s employment or are unable to continue performance in accordance with the terms and conditions of the resulting contract shall be submitted to the CO as a part of proposal package. The CO is the ultimate authority on acceptable length for temporary substitution of Key Personnel. The VA reserves the right to refuse or revoke acceptance of any key personnel if personal or professional conduct, or lack of required skills or experience jeopardizes patient care or interferes with the regular and ordinary operation of the facility and the HCHV CERS Program. At least one staff or resident manager with CPR or BLS certification and available in an emergency during each shift, 24 hours per day, 7 days per week. It is preferable that Contractor make training and education available to all staff at least once per year in the following areas: CPR/First Aid/Universal Precautions (disease transmission prevention) De-escalation Techniques Crisis Intervention Conflict Resolution Suicide Prevention Mandated Reporting Laws Professional Boundaries Cultural Sensitivity Sexual Harassment Housing First Sensitivity to Wider Issues of Homelessness Clinical topics such as Motivational Interviewing, Stages of Change, Professional Boundaries, Severe Mental Illness, Countertransference, Harm Reduction DOCUMENTATION OF SUPPORTIVE SERVICES: Contractor shall provide written documentation constituted by the individual Veteran case record that verifies the provision of all supportive services required under this contract for each Veteran participant. CARE PLAN: The written plan of care shall be completed and entered into the individual Veteran case record no later than day 14 days after being admitted to the program. Care plans will be reviewed and updated no less than once every 60 days. CRITICAL INCIDENT REPORTS: Written critical incident reports must be submitted to the VA Liaison or COR within 24 business hours (VA Liaison/COR to be notified immediately or as soon as possible at start of following business day when incidents occur; AOD to be contacted if immediate VA intervention/support is needed afterhours). EXTENSION REQUESTS: Written requests for extension are due prior to the 90th day when it is anticipated the Veteran will require additional time beyond the initially authorized service period, and prior to the expiration of the initial and any and all subsequent future extension authorizations. ADMISSION AND DISCHARGE REPORTS: Entry and exit notification forms and brief discharge summary shall be completed and submitted to the VA Liaison and/or COR or designee within 48 business hours of admission or discharge (VA Liaison to be notified verbally or via secure email within 24 business hours of admission or discharge). SATISFACTION SURVEYS: When Veteran participant surveys/questionnaires (e.g., CHALENG Survey) are provided by VA to the Contractor to give to Veterans, completed surveys are to be returned to VA Liaison at the end of each designated survey month. DAILY CENSUS SIGN-IN SHEET: The daily census sign-in sheet shall be provided to the VA Liaison, COR and/or designee at a frequency designated by VA that is no less than once weekly and up to daily with weekend or holiday sign-in sheets to be provided on the next business day. NOTIFICATION OF ABSENCES: Contractor shall notify VA Liaison, COR or designee immediately or during next available business hours of all unauthorized Veteran absences from the Contractor facility. Contractor shall notify VA Liaison, COR, or designee in writing of all Veteran requests for passes prior to start, preferably 24-48 hours, of any absence from program authorized by Contractor. INVOICES: Unless specifically excluded in this contract, the per diem rate established will include all services listed in this document and all services or supplies normally provided to other residents of the facility at no extra charge. Payments made by VA under this contract shall constitute total cost of care and housing for the homeless Veterans enrolled in this program. The monthly invoice is computed at the per diem rate multiplied by the total number of beds occupied by Veterans at midnight each night of the given month and does not include day of discharge. Invoices shall first be submitted to the VA Liaison, COR, or designee for approval by the 5th of the month immediately following the billing period in question. Once approved, invoices are to be submitted through the Tungsten Network (Electronic Invoicing System) by the 10th of the month immediately following the billing period in question; all electronic invoices submitted shall be accompanied by the invoice pre-approved by VA Liaison, COR, or designee for reference of the certifying official. (For additional information, Reference: VAAR 852.273-72 Electronic Submission of Payments pg. 23. and FAR 52.232-33 Payments by Electronic Funds Transfer System for Award Management pg.27.). QUARTERLY PERFORMANCE REPORT: Upon request, the Contractor shall provide the COR with a written report detailing program data and activities on a quarterly basis. The report should contain, at minimum, the following information: Total Number of Veterans Served Occupancy rate Percentage of Veterans discharged to permanent, independent housing Percentage of Negative Exits i.e. discharges due to rule violation, failure to comply with program requirements, or unexpected discharges without prior consultation with staff. Other information the Contractor feels pertinent, such as: quality improvement projects, changes in staffing or business practices, systems or resource concerns. GRIEVANCES: Contractor shall refer complaints received directly from Veterans to the identified VA Liaison, COR or designee within 48 hours of complaint. After investigation and clarification of disposition, Contractor shall respond to the VA Liaison, COR or designee within five (5) business days or less with proposed resolution or plan for corrective action. CONTRACT DISCREPANCY REPORTS (CDR): Contractor will be subject to a CDR anytime unacceptable contract performance is determined to be critical in nature and requires formal corrective action involving reporting discrepancy to CO by CDR. Depending on the nature of the violation, Contractor will be required to submit a corrective action plan to COR or designee within a timeframe designated by COR or designee based on the severity of the violation, e.g., safety issues. The program will be monitored for performance. Failure to perform duties herein will have Contractor be subject to contract termination. INSPECTIONS: Prior to the award of any contract and annually thereafter, during any subsequent contracted performance periods, a multidisciplinary VA team shall conduct a survey of Contractor s facilities to be used to provide Veterans food, shelter, and clinical services to assure the facility provides acceptable level quality care in a safe environment. Additional inspections may also be carried out, announced or unannounced, at any other time as deemed necessary by VA. DELIVERABLE TIMETABLE Deliverables Due Dates 7.1. QUALITY CONTROL BUSINESS PLAN Due upon solicitation close date 7.2. STAFFING AND SERVICE PLAN Due upon solicitation close date 7.3. DOCUMENTATION OF SUPPORTIVE SERVICES Due upon request with minimum of quarterly reviews to be completed by VA 7.4. CARE PLAN Due in Veteran case record by day 14; due to VA upon request 7.5. CRITICAL INCIDENT REPORTS Due within 24 business hours of a critical adverse event involving a Veteran 7.6. EXTENSION REQUESTS Due prior to the expiration of any authorized period of service 7.7. ADMISSION AND DISCHARGE REPORTS Due within 48 business hours of Veteran admission or discharge 7.8. SATISFACTION SURVEYS Due at the end of each monthly service period when requested 7.9. DAILY CENSUS SIGN-IN SHEET Due to VA Liaison/COR/designee at frequency designated by VA at least weekly and up to daily 7.10. NOTIFICATION OF ABSENCES Due to VA Liaison/COR/designee immediately or during next available business hours if absence is unauthorized; if authorized, then due prior to start of absence, preferably 24-48 hours 7.11. INVOICES Due to VA Liaison, COR or designee by the 5th of the month immediately following the billing period in question; due in Tungsten Network (electronic billing system) by the 10th of the month immediately following the billing period in question. 7.12. QUARTERLY PERFORMANCE REPORT Due to VA Liaison/COR/designee by the 15th of the month following the end of each FY quarter upon request 7.13. GRIEVANCES Due to VA Liaison/COR/designee within 48 hours of Veteran complaint; proposed resolution/plan of corrective action due within five business days of investigation 7.14. CONTRACT DISCREPANCY REPORT Due to COR/designee within timeframe designated by COR/designee based on severity of violation 7.15. INSPECTIONS Due prior to award and annually thereafter or at any time deemed necessary by VA CERTIFICATION & ACCREDITATION REQUIREMENTS The C&A requirements do not apply, and a Security Accreditation Package is not required. CONTRACT CHANGES/TECHNICAL DIRECTIONS The Contracting Officer is the only person authorized to approve changes or modify any of the requirements of this contract. Contractor shall communicate with the Contracting Officer on all matters pertaining to contract administration. Only the Contracting Officer is authorized to make commitments or issue changes that shall affect price, quantity or quality of performance of this contract. IN THE EVENT CONTRACTOR AFFECTS ANY SUCH CHANGE AT THE DIRECTION OF ANY PERSON OTHER THAN THE CONTRACTING OFFICER WITHOUT AUTHORITY, NO ADJUSTMENT SHALL BE MADE IN THE CONTRACT PRICE TO COVER AN INCREASE IN COSTS INCURRED AS A RESULT THEREOF. The COR will be responsible for the overall technical administration of this contract as outlined in the COR Delegation of Authority including monitoring of Contractor s performance. Appendix B The contractor, their personnel, and their subcontractors shall be subject to the Federal laws, regulations, standards, and VA Directives and Handbooks regarding information and information system security as delineated in this contract. Appendix C GENERAL Contractors, contractor personnel, subcontractors, and subcontractor personnel shall be subject to the same Federal laws, regulations, standards, and VA Directives and Handbooks as VA and VA personnel regarding information and information system security. ACCESS TO VA INFORMATION AND VA INFORMATION SYSTEMS All contractors, subcontractors, and third-party servicers and associates working with VA information are subject to the same investigative requirements as those of VA appointees or employees who have access to the same types of information. The level and process of background security investigations for contractors must be in accordance with VA Directive and Handbook 0710, Personnel Suitability and Security Program. The Office for Operations, Security, and Preparedness is responsible for these policies and procedures. The contractor or subcontractor must notify the Contracting Officer immediately when an employee working on a VA system or with access to VA information is reassigned or leaves the contractor or subcontractor s employ. The Contracting Officer must also be notified immediately by the contractor or subcontractor prior to an unfriendly termination. VA INFORMATION CUSTODIAL LANGUAGE Information made available to the contractor or subcontractor by VA for the performance or administration of this contract or information developed by the contractor/subcontractor in performance or administration of the contract shall be used only for those purposes and shall not be used in any other way without the prior written agreement of the VA. This clause expressly limits the contractor/subcontractor's rights to use data as described in Rights in Data - General, FAR 52.227-14(d) (1). VA information should not be co-mingled, if possible, with any other data on the contractors/subcontractor s information systems or media storage systems in order to ensure VA requirements related to data protection and media sanitization can be met. If co-mingling must be allowed to meet the requirements of the business need, the contractor must ensure that VA s information is returned to the VA or destroyed in accordance with VA s sanitization requirements. VA reserves the right to conduct on-site inspections of contractor and subcontractor IT resources to ensure data security controls, separation of data and job duties, and destruction/media sanitization procedures are in compliance with VA directive requirements. SECURITY INCIDENT INVESTIGATION The term security incident means an event that has, or could have, resulted in unauthorized access to, loss or damage to VA assets, or sensitive information, or an action that breaches VA security procedures. The contractor/subcontractor shall immediately notify the COTR and simultaneously, the designated ISO and Privacy Officer for the contract of any known or suspected security/privacy incidents, or any unauthorized disclosure of sensitive information, including that contained in system(s) to which the contractor/subcontractor has access. With respect to unsecured protected health information, the business associate is deemed to have discovered a data breach when the business associate knew or should have known of a breach of such information. Upon discovery, the business associate must notify the covered entity of the breach. Notifications need to be made in accordance with the executed business associate agreement. LIQUIDATED DAMAGES FOR DATA BREACH Consistent with the requirements of 38 U.S.C. §5725, a contract may require access to sensitive personal information. If so, the contractor is liable to VA for liquidated damages in the event of a data breach or privacy incident involving any SPI the contractor/subcontractor processes or maintains under this contract. Based on the determinations of the independent risk analysis, the contractor shall be responsible for paying to the VA liquidated damages in the amount of $37.50 per affected individual to cover the cost of providing credit protection services to affected individuals consisting of the following: Notification One year of credit monitoring services consisting of automatic daily monitoring of at least 3 relevant credit bureau reports Data breach analysis Fraud resolution services, including writing dispute letters, initiating fraud alerts and credit freezes, to assist affected individuals to bring matters to resolution One year of identity theft insurance with $20,000.00 coverage at $0 deductible; and Necessary legal expenses the subjects may incur to repair falsified or damaged credit records, histories, or financial affairs. TRAINING All contractor employees and subcontractor employees requiring access to VA information and VA information systems shall complete the following before being granted access to VA information and its systems: Sign and acknowledge (either manually or electronically) understanding of and responsibilities for compliance with the Contractor Rules of Behavior, Appendix E relating to access to VA information and information systems; Successfully complete the VA Cyber Security Awareness and Rules of Behavior training and annually complete required security training; Successfully complete the appropriate VA privacy training and annually complete required privacy training; and Successfully complete any additional cyber security or privacy training, as required for VA personnel with equivalent information system access [to be defined by the VA program official and provided to the contracting officer for inclusion in the solicitation document e.g., any role-based information security training required in accordance with NIST Special Publication 800-16, Information Technology Security Training Requirements.] The contractor shall provide to the contracting officer and/or the COTR a copy of the training certificates and certification of signing the Contractor Rules of Behavior for each applicable employee within 1 week of the initiation of the contract and annually thereafter, as required. Failure to complete the mandatory annual training and sign the Rules of Behavior annually, within the timeframe required, is grounds for suspension or termination of all physical or electronic access privileges and removal from work on the contract until such time as the training and documents are complete. The C&A requirements do not apply, and a Security Accreditation Package is not required.

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