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Veterans Health Administration (VHA)Sources Sought Notice to Obtain a qualified vendor to provide HEALTH CARE FOR HOMELESS VETERANS (HCHV) for MEDICAL RESPITE CARE FOR HOMELESS VETERANS at the Central... Veterans Health Administration (VHA)Sources Sought Notice to Obtain a qualified vendor to provide HEALTH CARE FOR HOMELESS VETERANS (HCHV) for MEDICAL RESPITE CARE FOR HOMELESS VETERANS at the Central Western MA HCS This is a Sources Sought notice and not a request for quotes. This request is solely for the purpose of conducting market research to enhance VHA s understanding of your company s offered services and capabilities. The Government will not pay any costs for responses submitted in response to this Source Sought Notice. This Sources Sought notice provides an opportunity for respondents to submit their capability and availability to provide the requirement described below. Vendors are being invited to submit information relative to their potential to fulfill this requirement, in the form of a capability response that addresses the specific requirement identified in this Sources Sought. The Veterans Health Administration (VHA) is seeking to obtain a qualified vendor to provide HEALTH CARE FOR HOMELESS VETERANS (HCHV) MEDICAL RESPITE CARE FOR HOMELESS VETERANS at the Central Western MA HCS per the general requirements below. The standard shall be of quality; meeting or exceeding those outlined in the general statement of work as described below. Refer to the Performance Work Statement section below for the requested requirement description. This Sources Sought is to facilitate the Contracting Officer s review of the market base, for acquisition planning, size determination, and procurement strategy. Please provide: QUALIFICATION INFORMATION: Company / Institute Name: Point of Contact: Address: Phone Number: E-mail Address: Unique Entity Identifier (UEI) #: CAGE Code: A statement as to whether your company is large or small business under the applicable NAICS code according to the appropriate size standard. Also indicate if you are: a non-profit entity, small, disadvantaged business, Section 8(a) small business, woman-owned small business, service-disabled veteran-owned small business, or a HUBZone small business. PERFORMANCE WORK STATEMENT HEALTH CARE FOR HOMELESS VETERANS (HCHV) CONTRACTED RESIDENTIAL SERVICES (CRS) MEDICAL RESPITE CARE FOR HOMELESS VETERANS BACKGROUND & PROGRAM DESCRIPTION The Health Care for Homeless Veterans (HCHV) program is an essential and critical part of VHA. It provides a gateway to the VA and community-based supportive services for homeless Veterans. The program utilizes Contracted Residential Services (CRS) in community locations to engage homeless Veterans. HCHV CRSs exists to provide a means of helping homeless Veterans get off the streets and find more suitable habitation. CRS programs work to help Veterans get into residential environments with sufficient supportive services to meet their biopsychosocial health and housing needs. CRSs operates in accordance with HCHV Program Federal Regulations 38 CFR 63 and are partners with the VA in the mission of ending homelessness among Veterans. According to the National Institute for Medical Respite Care, Medical Respite Care (MRC) provides post acute medical care for people who are homeless and too ill to be on the street but not ill enough for hospital level of care. MRC is short-term and operates where homeless individuals can receive support, education, and assistance in recovering from illness and injury and/or restoring and managing medical and functional health in a safe environment. The objective of the CRS MRC is to supply Veterans with such service and help them to move into permanent housing, living as independently as possible, and ensuring that interventions will be in place to help in maintaining permanent housing. It is understood that the type of Veterans to be cared for under this contract will require care and treatment services over and above the level of room and board and general. It is also understood that Veterans in CRS MRC may need more intensive case management than the general population. Intensity of services required are to be assessed on an ongoing basis. CRS MRC is not a substitute or alternate for long-term care or skilled nursing care settings. B. FOUNDATIONAL RULES & EXPECTATIONS B.1. Admission Criteria B.1.1. Veteran is homeless, as defined in the VHA Directive 1162.04 Section 3.E., or at imminent risk of homelessness. B.1.2. Veteran is eligible for VA Health Care. (The VA Eligibility Office and VA Liaison can assist in obtaining a Veteran s status.) B.1.3. Veteran is discharging from a hospital and in need of recuperative care or is with marked functional limitations, requiring additional supports such as that of an aide or nurse, not often found in a traditional shelter or transitional housing setting for homeless individuals. B.1.4 MRC candidates may be, but are not limited to: transitioning from chronic street homelessness. discharging from institutions other than hospitals (rehabilitation facilities, substance abuse treatment facilities, residential recovery programs, jails, etc.) recently homeless due to fleeing domestic violence, abuse, or exploitation, being in a place not meant for human habitation, such as an abandoned building, a vehicle, or a residence that is no longer meeting inspection and code or facing condemnation according to a governmental entity. facing eviction or foreclosure of their residence. Every attempt will be made by the contractor, Veteran, and/or referrer to secure documentation of such as part of referral process to assess acuity or alternates to losing housing. B.2. Admission Practices B.2.1. Collaboration with the VA Liaison is amply available and highly encouraged to ensure appropriateness and eligibility for Veteran to be in CRS. VA Primary Care team members will be consulted with as needed to determine eligibility. It is understood that payment for Veterans admitted without an initial determination of eligibility may not be authorized if the Veteran is found to be ineligible. B.2.1.i. Staff will ensure that a case manager has met with a Veteran within 72 hours of Admission for intake and service planning. B.2.1.ii. Staff will ensure that a Veteran is routed to VA Liaison for an intake within 72 hours of admission, so that HCHV intake by VA Liaison can take place within 7 days of admission . B.2.1.iii. Veteran will receive a nursing assessment within 48 hours of admission. B.2.2. Contractor works to reduce barriers to admission: At a minimum, accept referrals Monday through Friday during business hours. Respond to referrers with acceptance or decline of Veteran referred within 96 hours from receiving the referral form. Notification of acceptance or decline of Veteran within 72 hours is preferred. Admit Veterans outside of business hours when and if feasible. There will not be a certain timeframe prior to admission that a Veteran must be free of drugs or alcohol so long as a Veteran is medically stable to be in MRC. Detoxification services are not expected of the MRC. In cases of unsuitability for MRC environment due to previous episodes in similar settings whereas the Vet infracted upon drug and alcohol policies repeatedly, the contractor reserves the right to decline admission with recommendations to the Veteran and/or referrer for what interventions would be needed to establish an episode of stay. Contractor is encouraged to accept Veterans, even if they have a sex offense status or otherwise been involved with the legal system. A Veteran is not obligated to reveal that they have a disability prior to admission. Accept Veterans into MRC regardless of what geographical location they may come from: Central or Western MA. Veterans from other geographical locations may also be considered, but with emphasis and priority being on those from the CWM VA HCS catch man area. B.2.3. Priority and Expedition. For those Veterans referred or who are on the street, in places not meant for habitation, or staying in vehicles, the admissions and intake committee will coordinate with others and the Veteran about logistics and pragmatics of getting to the MRC site as quickly as possible. B.2.4. The CRS Program admissions and intake staff reserve the right to decline admission to a Veteran who is found to be inappropriate for MRC. However, every attempt should be made to accommodate the Veteran. It is the expectation of the VA that if a Veteran is denied admission to MRC, the admission and intake staff will provide the Veteran and referral source with alternate resources and services. B.2.5. The admitted Veteran will be provided with a copy of the Resident Handbook or other documentation that outlines at a minimum rules, regulations, responsibilities, and expectations of the Veteran and the Contractor. Veterans are expected to engage programming and maintain communication with Case Managers, Residential Staff, and Nursing Staff. B.2.6. While recidivism is discouraged, there is no limitation to the number of times that a Veteran can be accepted into the CRS Program after leaving the program. Veterans who are former participants can be rereferred and readmitted so long as they are otherwise meeting eligibility criteria. Every attempt to address what will be different during additional episodes of stay will be taken with the Veteran to secure permanent housing and minimize length of stay at the CRS Program. Case management staff and VA Liaison will monitor and coordinate efforts in helping recidivistic Veterans on a regularly scheduled basis (i.e. monthly) to decrease barriers to and successfully establish permanent housing. B.2.7. Keeping with the objective of the CRS MRC, admission will be made for Veterans who can t complete instrumental activities of daily living on account of functional impairment - acute, chronic, or yet to be determined, psychiatric, cognitive, or physical in nature. Veterans cannot be denied admission if they don t yet have a diagnosis associated with such impairment. Contractor and/or VA assessment, medical documentation, referrer s knowledge of the Veteran are all pieces of collateral evidence to consider when making determination for admission. B.2.8. Rules focus on staff and resident safety. Veterans are expected to adhere to the following: 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 Any others as set forth in a Contractor s Resident Handbook or other policy manual the Veteran would procure at the time of admission. B.2.9. When possible, infractions are to be used to engage residents, not simply as grounds for service termination. Profanity does not in and of itself constitute abuse and shall not exclusively be considered grounds for discharge. Any actual or threatened violence may be grounds for discharge. Any discharge, for whatever reason, requires that Contractor staff assist Veterans with finding alternative living arrangements. B.3. Types of Services Provided by Contractors Case Managers B.3.1. Screenings or Referrals for Benefits. Vets with limited or no income will have challenges to obtaining permanent housing. Case managers assess for and refer Veterans to appropriate agencies or directly assist Veterans with obtaining: military service-connected compensable conditions disability insurance or supplemental security income retirement pensions Veterans-specific or public cash assistance programs SNAP benefits health insurance one-time-only financial assistance from programs that would provide Veterans with first and/or last month s rent, security deposits, moving expenses coverage, payment of fees and/or fines B.3.2. Enhancement of independent living and social skills via regularly scheduled programming and amenities (this list is not all-inclusive of possibilities): 12-step program groups computer and literacy classes social and life skills trainings financial aid and budgeting workshops vocational and/or credit counseling justice outreach services legal services to address identity fraud, child support, and/or benefits & entitlements, etc. peer and mentor support access to health fairs and local community events recreational and leisure activity opportunities House Meetings physical activity opportunities via gym equipment lounge areas with opportunities for reading and socialization B.3.3. Permanent or transitional housing search support, which may include: providing Veterans with contact information for such places they wish to pursue for relocation purposes or permanent residence conducting housing readiness evaluation to determine gaps in being able to complete housing applications hands-on coordination with agencies and providers to assist Vet in exiting the CRS to another location. assessing for whether a Veteran needs referral to retirement or rest homes, assisted living facilities, etc. applying for other transitional housing programs. Veterans who need longer periods of support than what the CRS Program can accommodate may need referrals to other transitional or temporary housing arrangements. B.4. Expectations of Case Management Staff. B.4.1. Full-time case managers utilize the following approaches to engaging Veterans: recovery-oriented and harm reduction motivational interviewing, and/or critical time intervention. B.4.2. Case management staff will have weekly contact with Veterans to engage with them about completion of goal-oriented tasks related to meeting basic and health needs and addressing barriers to obtaining permanent housing. The expectation is that, based upon the collaboration with the nursing staff, determination of the most appropriate permanent housing setting will be determined swiftly and obtaining said permanent housing besides applying for other possibilities will ensue as soon as possible. Case Managers will assist Veterans with rides to view apartments, attend open houses, etc. making resume enhancements submitting applications to property managers running credit reports tracking down credit and personal reference contact information other activities to address barriers to getting housing Case managers and nursing staff may also do the following to help Veterans: coordinate care with VA and non-VA providers, which may mean picking up prescriptions or phoning for health education purposes arrange transportation to health care appointments complete and submit paratransit forms to transportation authorities discuss and facilitate the execution of advance directives B.4.3. Case managers should have some experience working in social service or health care fields. Work history with people who have chronic medical, mental health and substance abuse problems is highly desirable. This list is not all-inclusive of offerings and opportunities to be considered by contractor for training purposes, but contractor should have the capacity to direct case management staff to trainings: crisis intervention cultural sensitivity sexual harassment sensitivity to wider issues of homelessness harm reduction philosophy laws regarding the ADA, fair housing, mandated reporting de-escalation techniques first-aid trauma-informed care B.4.4. Case managers will ensure that Veterans are safe and healthy. Case managers should be able to assess, anticipate, and effectively refer Veterans experiencing crises for additional support as appropriate. They will refer Veterans to mental and medical health providers as necessary. If a Veteran is suicidal, homicidal, an altered mental status, or otherwise in crises, the case manager will summon the appropriate staff to address or arrange for Veteran to get to a hospital s emergency room. B.4.5. Wherever Veterans in MRC are domiciling, those case managers, nursing staff, resident staff, and other contractor-designated staff serving Veterans in that location, will maintain BLS/CPR certification. First-Aid certification is highly encouraged. B.4.6. Case managers will possess an educational level of at least a B.A. or B.S. degree, preferably in a social science. Education level of case managers being at the M.A. or M.S. level are preferred. Case managers will maintain whatever applicable licensures they possess. B.5. Expectations and Role of Nursing Staff. B.5.1. Registered Nurse(s) will be employed for at least 12 hours per week to do direct and administrative work with and related to MRC enrollees. At a minimum, RNs will have current CPR and First Aid training and certification state-required licensure to practice be in good standing with their licensing board a minimum of 2 years experience, preferably working with older adults availability to work irregular hours, including weekends and holidays, as needed B.5.2. The Nurse shall possess a sound, working knowledge base about assisted living facilities, rest homes, & other appropriate housing for the disabled and elderly, especially amongst the geographic region ability to create a comprehensive assessment to identify the need for durable medical equipment, the need for health education, the health monitoring practices the nurse will engage the Veteran in the need for medication management assistance functional limitations and appropriate interventions what communications with VA and other health care providers are needed barriers and challenges to functioning independently and housing the nurse s observations, impressions, prognosis for recovery, and any other applicable information. an understanding of how to write SMART goals or otherwise document measurable, time-sensitive, and specific treatment plans contribute to the housing-related disposition and case managers service plans attend and contribute to case manager/VA Liaison/Veteran meetings, as applicable B.5.3. The Nurse s role will consist of, but is not limited to, the following: - Education and assistance with medication management and compliance - Patient health education in areas such as sleep, nutrition, coping with chronic illnesses, pain management, rehabilitation and recovery processes, age-related processes - Vital signs monitoring - Assistance with the use of VA Tele-Health as needed. - Assistance with adaptive exercise, such as chair exercises - Education to Case Managers, Residential Staff, and any other appropriate Contractor desginees about interventions, means of communication, and recovery processes concerning Veterans following up with any and all VA or non-VA providers about any of the abovementioned for the sake of care collaboration, coordination, and continuity HCHV CRS PROVIDER QUALIFICATIONS & CAPABILITY REQUIREMENTS Contractor must comply with all HCHV CRS Program requirements as identified below. C.1. VETERANS ENVIRONMENT AND SERVICES C.1.1. Capacity for performing outreach or otherwise identifying and referring homeless Veterans to MRC. Maintain sites within the catchment area of CWM VA HCS: Franklin, Hampden, Hampshire, Berkshire, and/or Worcester Counties. The contractor will have strong, ongoing partnerships with other social and health service providers, such as Supportive Services for Veterans & Families (SSVF) programs, so that MRC candidates can be identified. C.1.1.i. The contractor will maintain an outreach log, documenting staff s activity in referring Veterans to the CRS Program and the outcome of those referrals. This log will include dates in which referrals were made and be accessible to the Liaison upon request. C.1.2.ii. Outreach to acute care and psychiatric hospitals and short-term rehab nursing centers is encouraged. C.1.2. Capable of providing ADA-compliant facilities, including sleeping quarters and bathrooms. Doorways, hallways, and entrances to and from the buildings must be passable for those in wheelchairs, with crutches, walkers, or other ambulation apparatuses, or personal motorized scooters. C.1.3. Capable of routing, referring, or summoning assistance for Veterans to get to emergency and/or urgent care services per a stated policy that is accessible to Contractor designees or staff who may be point persons for when emergencies or urgencies arise at Contractors locations. At least one designated paid and trained staff member will always be on site. C.1.3.i. information on how to access designees for emergencies or urgencies will be posted in common spaces for all CRS participants to be aware of if need arises C.1.3.ii. during intake process, attention will be made to ensure that Veterans are aware of emergency and urgency reporting procedures and where to access help with emergent or urgent situations C.1.3.iii. In the event of an evacuation, lock-down, or shelter-in-place order, contractor must track the location of each Veteran and report to the VA Liaison the location and status of each Veteran as soon as possible and no later than 24 hours. C.1.4. Capable of ensuring that Veterans basic needs are met: provide three daily nutritiously balanced meals and an evening snack and reasonable accommodation for special dietary needs (gluten or lactose intolerance, diabetic) in a setting that encourages socialization and possesses waste disposal and sanitization systems offer a means for Veterans to wash clothes or otherwise tend to laundry, providing cleaning products if needed provide secure, appropriate storage for both Veterans belongings and medication. Storage should be secure so that no other residents are able to access an individual Veterans medications maintain a food pantry or shelf so that Veterans with food insecurity have readily available non-perishable options. Keep set times and days for when food pantry or shelf is accessible to Veterans. maintain a clothing shelf operation or provide access to one off-site so that Veterans with cold weather clothing needs can receive provisions as needed clean, sanitary, and safe common and sleeping spaces to include desk chairs, beds, dressers, etc. provide linens, bedding, and toiletries as needed for those Veterans who vacate the premises, retaining belongings for a minimum of 72 hours, if the Veteran returns to retrieve them. Provide access to a working phone line for the Veteran to be able to conduct communications until an independent mobile device is secured for the Veteran or for those Veterans unable to utilize a mobile/cellular phone provide monitoring, assessment, and guidance for Veterans who are high risk for suicide or have history of homicidal, violent, or suicidal ideation. Should staff at any time observe a Veteran express homicidal or suicidal ideation, appropriate referrals to mental health providers will be made for evaluation. VA HCHV Liaison will be notified just as VA-determined High-Risk Flagged Veterans admitted to the Contractor s facility will be identified to the Case Management Staff by the VA Liaison. Completion of any safety plans either by VA or Contractor personnel with the Veteran will be part of Contractor s clinical documentation. Veterans with violent and/or homicidal ideation or actions may be discharged from CRS for safety reasons at any time but must receive triaging and referring to appropriate VA and community providers from the Contractor. C.1.5. Capable of providing transportation services to assist Veterans with arranging local transportation to scheduled meetings and appointments. help Veterans understand and learn how to utilize public transportation, including access to information and clarifying instructions necessary to effectively utilize public transit systems. assist Veterans with identifying potential alternative modes of transport if public transportation is not available, adequate, or appropriate for a Veteran. have designees with valid driver s licenses to complete transportation of Veterans and a formal process that Veterans can be educated about to initiate scheduling of such transportation. C.1.6. Capable of minimizing risk of exposure to toxins, disease, etc. for Veterans. Universal precaution practices are used by Contractor to prevent transmission of diseases and are implemented under the presumption that blood and bodily fluids from any source are to be considered potentially infectious. Supplies necessary for maintaining universal precautions, such as sharps containers, must be available. Hand sanitizer shall be available in common spaces and/or at doorways to encourage and promote infection control and disease prevention. C.2. STAFFING & PERSONNEL The Contractor will employ sufficient personnel to carry out the MRC policies, expectations, and programming. Case Management and Nursing personnel must have appropriate and commensurate coverage for staff using authorized and unauthorized leave (e.g. holidays, sick, family care leave, etc.) The Contractor shall assign personnel education and training when required and maintain documentation of training completion and licensures. Contractors will ensure that criminal background checks are completed on staff members. Contractors must have a policy prohibiting staff from establishing sexual relationships with Contract enrollees. During the first 90 days of contract performance, the contractor shall make NO substitutions of key personnel unless the substitution is necessitated by illness, death, or termination of employment. Within 14 days after substitutions necessitated by situations described above, the Contractor shall provide resumes for the substitute key personnel to the Contracting Officer. The Contracting Officer will notify the Contractor within 15 days of receipt of these documents whether VA accepts the substitute CRS MRC key personnel. The VA reserves the right to refuse or revoke acceptance of key personnel if personal or professional conduct, or lack of required skills or experience, jeopardizes patient care or interferes with the regular and Ordinator operation of the facility. A list of authorized VA staff for the Contract shall be provided to the Contractor upon award of the Contract. VA staff may be added or deleted from the list during the terms of the Contract at the discretion of the VA Contracting Officer. The Contractor shall be provided an updated list of authorized VA staff whenever such changes are made. C.2.1. Capacity for case managers to be hired as full-time employees. C.2.2. Capacity for nursing staff to be hired at least 12 hours per week to include being able to manage on-call communications from other staff in the case of urgent matters concerning Veterans outside of business hours. C.2.3. Capacity for having at least 1 staff person, who is trained in emergency management per the Contractor s policy/emergency management plan and CPR, where there are MRC enrollees at Contractor sites. C.2.4. Capacity for having at least 1 awake staff person on site 24/7/365 who can respond to urgent matters and critical incidents. It is highly encouraged that these support persons to be trained in CPR. D. HCHV CRS PROVIDER ADMINISTRATIVE ROLES, RESPONSIBILITIES, & DUTIES D.1.1. Occupancy: The contractor will be responsible for ensuring a minimally acceptable level occupancy as defined in the Quality Assurance Surveillance Plan (QASP). VA Liaison and Contractor will monitor how outreach efforts may relate to occupancy rates, if necessary, and utilize Quarterly Meetings to trouble shoot and problem solve about low occupancy, if applicable. The Contractor and VA will utilize Quarterly Meetings to debrief on how to address other performance measures identified below. D.1.2. Exits to Permanent Housing: The contractor is expected to promote a focus on achieving stable housing for all MRC enrollees; exits to permanent housing will be monitored as an indicator of overall program quality utilizing data provided by the VHA Support Service Center s Homeless Service Scorecard the target rate for exits to this type of housing will be 50% or higher. D.1.3. Negative Exits: Negative Exits are defined as discharges involving Veterans being asked to leave the program due to rule violation or otherwise leaving the program without consulting program staff in any way. Negative exits will be monitored on a continuous basis utilizing data provided by the VHA Support Service Center s Homeless Service Scorecard the target rate for these types of exits will be 20% or less. D.1.4. Release of Information: The contractor shall ensure that a signed VA Release of Information (ROI) is obtained for any Veteran being admitted to MR and that it is placed into the individual case record so that it s also available to VA Liaison. D.1.5. Individual Case Records: The 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 (Veteran, family, employment, and education status) copies of any medical prescriptions/orders issued by physicians case management and progress notes that include specific service duration and outcome as well as referrals any critical incident reports a final summary (Exit Form or Discharge Note) that includes reason(s) for leaving, the Veteran s known after care plans, and location upon exiting. D.1.5.i. Case Notes should be titled according to content and relate to the Veterans goals as identified in their service plans. Intake Notes should indicate the Veterans strengths, needs, abilities, and preferences D.1.5.ii.: Individual Service Plans. an initial written plan shall be completed and entered in the case record no later than 3 days after program admission and should be updated monthly. The individual service plan should include goals that address: Establishing permanent housing Increasing income or skill level Supporting self-determination and -preferences Goals identified in the individual service plans are to be Time-specific Measurable Behavioral D.1.5.iii. Frequency. Progress notes should be completed ONCE WEEKLY. Case managers should document attempts to engage Veteran, even if unsuccessful in doing so. Service plans should be updated ONCE MONTHLY. D.1.5..iv. Nursing/Medical Staff Documentation. Just like the case managers, the nurse or medical staff should document all efforts and interactions related to and with the Veteran. Progress notes should be completed ONCE WEEKLY and service plans should be completed within 72 HOURS and updated ONCE MONTHLY. Nurse/medical staff documentation should include: comprehensive nursing/medical assessment to include: durable medical equipment needs identification of daily living activity impairments referrer and reason for referral prognosis for housing type and timeframe for obtaining The assessment will inform the service plan. (It is permittable for an all-encompassing service plan to be completed jointly with the case manager or be a separate nursing staff s stand-alone document.) telephonic or electronic communications with non-VA and VA health care providers interdisciplinary team meeting content, whether the meeting included the Veteran medication administration, reconciliation, education, and/or monitoring matters an Exit Form or Discharge Note that includes information on follow-up services and after care and who they will be completed by a summary of what was accomplished while with the Contractor the location at discharge (It is permittable for an Exit Form or Discharge Note to be completed jointly with the case manager or be a separate nursing staff s stand-alone document.) D.1.6. Daily Census: The contractor is responsible for knowing Veterans status with the Program. Rosters or census documents as to which Veterans are in the Program are to be given to the VA Liaison daily Monday through Friday to ensure effective monitoring of bed utilization. D.1.7. Incident Reporting: The contractor shall notify the VA immediately wh...