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STATEMENT OF WORK HOMELESS PROGRAM SUBSTANCE ABUSE TREATMENT AND TRANSITIONAL HOUSING I.DESCRIPTION/SPECIFICATIONS OF SERVICES A. The Robley Rex Veterans Affairs Medical Center (VAMC) in Louisville, K... STATEMENT OF WORK HOMELESS PROGRAM SUBSTANCE ABUSE TREATMENT AND TRANSITIONAL HOUSING I.DESCRIPTION/SPECIFICATIONS OF SERVICES A. The Robley Rex Veterans Affairs Medical Center (VAMC) in Louisville, Kentucky has a requirement for Veteran in resident substance abuse treatment. An agreement is needed to provide up to10 beds per day. This will be for no more than 10 authorized Veterans per day, for an estimated total of 3,650 beds per year. The beds offered shall be within 15 miles of the Robley Rex VA Medical Center, 800 Zorn Avenue, Louisville, KY 40206. This agreement shall be for a BPA with a base period of one year and four (4) one year ordering periods. The contractor shall furnish each Veteran authorized care under this agreement with room and board. The contractor shall provide 40 hours, weekly, of evidenced based residential substance use treatment programming along with weekly case management services. Treatment shall be provided by or closely supervised by clinicians licensed by the local/state boards, where appropriate. Treatment shall be provided through psychoeducational and therapeutic groups, meetings, and individual therapy. The Contractor shall furnish services to beneficiaries for whom such care is specifically authorized by the Department of Veterans Affairs. It is understood that the type of patients to be care for under this agreement will normally require the contactor to provide care and services above the level of room and board. B. The contractor shall furnish each Veteran authorized care under this agreement with room and board. This includes appetizing and nutritionally adequate meals that are provided in a setting which encourages social interaction. This includes accommodating special dietary needs as ordered by VA provider. The contractor shall also provide nutritious snacks between meals and at bedtime for those requiring or desiring additional food, when it is not medically contraindicated. The local VA Medical Center dietitian may consult with the initial inspection team and the team making subsequent assessments in evaluating not only the printed menus but also the patients satisfaction with meals and the actual consumption of food offered. C. The facility must meet applicable fire, safety and sanitation standards in an attractive surrounding conducive to social interaction and the fullest development of the residents rehabilitative potential. The facility shall be air conditioned and the present as a home-type atmosphere, including a TV lounge area, reading/study/library room, and recreation room, (for pool, cards, etc. activities). The veterans rooms shall have adequate lighting, personal storage area, and access to shower/bathing. The facility should be centrally located, near public transportation. Contractor shall provide access to transportation (via public transport or contractor furnished transportation) to Veteran medical appointments. Facility shall provide laundry facilities for residents to do their own laundry, at no cost to Veterans. Ironing board and iron shall be made available. D. Evidence based intensive therapeutic and rehabilitative services shall be provided to each individual Veteran Client a minimum of 40 hours per week as outlined in the individual treatment plan. Services will be provided mostly in person at the facility, but could be provided by telehealth if necessary, and will be a combination of group and individual therapy. There should be at minimum 1 hour weekly individual therapeutic intervention, such as therapy or case management. The individual treatment plan is to be developed by the contractor with the Veteran client and approved by the VA case manager. The contractor shall provide a structured therapeutic daily routine which includes the following: Alcohol/drug abuse treatment program includes, but not limited to: Relapse prevention, Cognitive behavioral coping skills training, Motivational enhancement, Stress reduction, Individual and group counseling 12 step facilitation (including access to peer support groups, i.e. AA, smart recovery, NA, etc., and Community reinforcement. Veteran clients with dual diagnosis (any mental health diagnosis with co-occurring substance abuse) will not be excluded from the program. The services provided shall be individualized to meet the need of each Veteran client. A Veterans needing dual diagnosis care shall have access to one or more of the following: Diagnosis specific specialty groups, VA Mental Health Providers, or Recovery focused psychoeducation Leisure activities shall be offered at a minimum of 4 times per week, such as movies, games, crafts, and/or community events, life skills training to include household budgeting, goal setting/organization, communication/ social skills, and basic problem solving. E. Assistance and instruction grooming, and personal hygiene shall be provided by the contractor to all Veterans including distribution of personal care items on admission and replenishment as needed. Items shall include at a minimum soap, deodorant shaving supplies (shaving cream &razors), shampoo combs/brushes, and lotion. The contractor shall have a safe medication policy assuring safe storage and administration of medications. F. The contractor shall collaborate with the VA Liaison to develop a recovery transition plan. This plan incudes but is not limited to: Obtain or increase income, Secure safe affordable housing Establish a peer support network, and Access to VA mental health/substance use disorder treatment. G. Ongoing case management shall be provided to assist the Veteran in addressing barriers to housing, such as filing for benefits, obtaining documents, addressing housing debts through referrals. The contractor shall provide case management services to assist the participants in transitioning to permanent housing according to their treatment plan. This includes appropriate referrals for housing programs, and assisting with housing searches/ applications. The VA will evaluate the contractor s performance against current national performance metrics established by VA Homeless program national office. II.SUPPLIES/SERVICES AND PRICES/COSTS The Contractor shall provide community based residential care, substance abuse treatment and rehabilitative services, in accordance with the specifications contained herein to beneficiaries of the Department of Veterans Affairs (VA) and the Robley Rex VA Medical Center (603), 800 Zorn Avenue, Louisville, KY 40206. The agreement is effective for the period August 1, 2022 through July 31, 2023 with four (4) one (1) year ordering periods. The Authority for this procurement extends from Public Law 104-262 and Title 38 U.S.C., Section 8151-8153 and Title 42 Code of Federal Regulation (CFR) 415.170. The contractor shall bill the VA for bed days. The agreement is Not To Exceed (NTE) 10 beds per day x 365 days to equal 3650 days for base and all option years. Length of stay for each resident is a maximum of 90 days, waivers for additional days above 90 will be granted with documented clinic indication of need and will not exceed 180 days. The VA agrees to screen the Veteran client for placement in the residential treatment bed. Upon acceptance of the Veteran by the contractor, all terms and condition of the agreement shall apply during the time the Veteran remains at the facility at VA expense. Bed days are to include, meals, snacks, substance use treatment programming, lodging and includes all services and requirements listed herein without additional charge to the Veteran. The contractor shall maintain a daily log of the Veteran participants in the program for billing purposes. The contractor shall notify the VA facility if a Veteran has left without leave overnight, by the next working day. III. TERM OF THE AGREEMENT The term of the agreement is from August 1,2022 through July 31, 2023 with four (4) one-year ordering periods. This agreement is subject to availability of VA funds. Contractor will bill by bed days for beds actually used. IV. DEFINITIONS Terms used in this agreement will be interpreted as follows unless the context expressly requires a different construction and/or interpretation. In case of conflict in language between the Definitions and other section of this agreement, the language in this section shall govern. Contraction Officer (CO) - The person executing this agreement on behalf of the Government with the authority to enter into and administer agreement and make related determinations and findings. Contracting Officer Representative (COR) - A person appointed by the CO to take necessary action to insure the Contractor performs in accordance with and adheres to the specification contained in the agreement and to protect the interest of the Government. The COR shall report to the CO promptly and indication of non-compliance in order that appropriate action can be taken. Veterans Health Administration (VHA) - The central office for administration of the VA Medical centers throughout the United States. The VHA is located in Washington DC Veterans Integrated Services Network (VISN)- The regional oversight for the VA Medical Centers in Memphis, TN, Tennessee Valley Healthcare System (Murfreesboro and Nashville) Louisville, KY, Lexington, KY, Huntington, West Virginia and Mt. Home, TN. The VISN office is located at 1801 West End Avenue, Suite 1100, Nashville, TN 37203. Computerized Patient Record System (CPRS) - Electronic patient charting system that houses all pertinent health care records (1.e. laboratory and radiology results, doctor s orders, progress notes, surgery reports, etc.). V. QUALITY AND QUALIFICATION REQUIREMENTS A. The agreement facility must have a current occupancy permit or license required by the authority having jurisdiction. B. The contractor shall employ sufficient professional health care personnel to carry out the policies, responsibilities and programs of the facility. In residential treatment facilities there must be, as a minimum a full-time administrative staff member or designee of equivalent professional capability on duty on the premises or residing at the house available of emergencies 24 hours per day, 7 days per week. VI. CREDENTIAL REVIEWS/PRIVILEGING Not applicable VII. QUALIFICATION/PERSONNEL POLICY AND DOCUMENTATION The contractor shall be responsible for their employees responsible for furnishing services under this agreement. To carry out this responsibility, the contractor shall provide the following for these personnel: Workers compensation Professional liability insurance Health examinations Income tax withholding, and Social security payments B. The employees, agents and subcontractors shall not be considered VA employees for any purpose. Payment of any leave, including holiday pay, sick leave or annual leave is the responsibility of the contractor and is included in the per diem rate C. The contractor shall provide and document general orientation for all agreement employees who are providing work on this agreement before the commencement of work on site. Documentation of orientation shall be provided to the VA COR. This orientation shall include but not be limited to the following topics: Fire & Safety policy and procedures Infection Control policy and procedures Emergency Preparedness/Disaster policy and procedures TB Exposure Control policy and procedures HIPPA policy and procedures (Must be reviewed annually), and Initial Competency Assessment The Contractor is required to develop and maintain the following documents for each contractor employee working on the agreement: Credentials and qualification for the job; a current competence assessment checklist (an assessment of knowledge, skills, abilities and behaviors required to perform a job correctly and skillfully; includes knowledge and skill require to provide care for certain patient populations, as appropriate); a current performance evaluation supporting ability of the contractor employee to successfully perform the work required in this solicitation; and all listing of relevant continuing education for the last two years. The contractor shall provide current copies of these records at the time of the agreement award and annually on the anniversary date of the agreement award to the VA, COR or upon request, for each contractor employee working on the agreement. When changes occur in the contractor s personnel, the contractor must provide evidence of orientation and items requested above. Notwithstanding other agreement requirements, upon request from the contracting officer, the contractor shall remove from the work site any contact employee who does not comply with orientation requirements or meet competency requirements for the work being performed. TB Skin testing must be completed prior to employment and annually on all contractor s employees who have contact with VA patients. The contracting agency is responsible for developing a policy on TB exposure control and updating it annually. TB testing of employee must be conducted annually and a copy of the proper paperwork must be submitted with the annual review of the TB exposure control policy. VIII. PATIENT S RIGHTS AND SAFETY Before service commences, the contractor shall provide evidence of professional liability insurance coverage in the amount of $1,000,000 per specialty, per occurrence. The contractor is required to maintain the coverage throughout the term of the agreement. The Robley Rex VAMC is not responsible or liable for any unsafe condition caused by the Contractor or Veteran. Contractor shall be responsible for identifying safety hazards and immediately taking action to resolve the hazard. The contractor shall notify VA facility to all significant events, including those involving law enforcement, hospitalization or emergency services within 1 working day, with the exception of Veteran death, which will be reported within 4 hours. The contractor shall comply with the VA Patient s Bill of Rights as set forth in Section 17.34a Title 38, Code of Federal Regulations. Patient s rights and Responsibilities Respect and nondiscrimination: You will be treated with dignity, compassion, and respect as an individual. Your privacy will be protected. You will receive care in a safe environment. We will seek to honor your personal and religious values. Treatment will respect your personal freedoms. In order to provide a safe treatment environment for all patients or residents and staff, you are expected to respect other patients, residents and staff and to follow the facility s rules. Avoid unsafe acts that place others at risk for accidents or injuries. Please immediately report any condition you believe to be unsafe. Information Disclosure and Confidentiality: You will be given information about the health benefits you can receive. The information will be provided in a way you can understand. You will receive information about the costs of your care, if any, before you are treated. You are responsible for paying your portion of any costs associated with your care. Your medical record will be kept confidential. Information about you will not be released without your consent unless authorized by law (an example of this is State public health reporting). You have the right to information in your medical record and may request a copy of your medical records. This will be provided except in rare situation when your VA physician feels the information will be harmful to you. In that case, you have the right to have this discussed with you by your VA provider. You will be informed of all outcomes of care, including any potential injuries. You will be informed about how to request compensation for any injuries. Participation in Treatment Decisions You, and any persons you choose, will be involved in all decisions about your care. You will be given information you can understand about the benefits and risks of treatment. You will be given other options. You can agree to or refuse treatment. You will be told what is likely to happen to you if you refuse treatment. Refusing treatment will not affect your rights to future care but you take responsibility of the possible results to your health Tell your provider about your current condition, medicines (including over-the-counter and herbals), and medical history. Also, share any other information that affects your health. You should ask questions when you do not understand something about your care. Being involved is very important for you to get the best possible results. You will be given, in writing, the name and title of those who provide you care. This includes students, residents and trainees, Providers will properly introduce themselves when they take part in your care. You will be educated about your role and responsivities as a patient or resident. This includes your participation in decision making and care at the end of life. If you believe you cannot follow the treatment plan, you have a responsibility to notify your provider or treatment team. You have the right to have your pain assessed and to receive treatment to manage your pain. You and your treatment team will develop a pain management plan together. You are expected to help the treatment team by telling them if you have pain and if the treatment is working. As an inpatient you will be provided any transportation necessary for your treatment plan. You have the right to choose whether you will participate in any research project. Any research will be clearly identified. Potential risks of the research will be identified and there will be no pressure on you to participate. You will be included in resolving any ethical issues about your care. You may consult with the Medical Center s Ethics Consultation Service and/or other staff knowledgeable about health care ethics. If you or the Medical Center believes that you have been neglected, abused or exploited, you will receive help. IX. CONTINUUM OF CARE The contractor shall conduct treatment and discharge planning reflecting a team assessment of health, social, and vocational needs and the involvement of resident s families, appropriate community resources, and the VA Case Manager in resolving problems and setting goals. This includes entering all Veterans in the national HMIS data base. X. QUALITY ASSURANCE SURVEILLANCE PLAN (QASP) The government will monitor the Contractor s performance under this agreement using the quality assessment and improvement procedures established by the VAMC and pursuant to the Inspection of Services Clause. Additionally, the Contractor s performance is subject to scheduled and unscheduled review by quality assessment personnel as defined by the VAMC AQSP Plan. QASP Monitors are as follows The Performance Requirements Summary Matrix, Paragraph X in the Statement of Work (SOW), includes performance standards. The Government will use these standards to determine contractor performance and shall compare contractor performance to the Acceptable Quality Level (AQL). Performance Objective Standard SOW Para Frequency of Actions Performance Threshold/Number of Valid Complaints Penalty imposed After/% Penalty Imposed Veteran Absent without Leave Agency to notify VA facility if the veteran is absent without leave overnight by the next working day. II.D As Indicated Each time a veteran is absent and the agency is not notified by next working day. Deficiencies will be noted on annual performance evaluation and could impact renewal of option years Clinical outcomes Clinical outcomes will reflect minimum standards as measured by national performance metrics I.F Reviewed quarterly Quarterly, contractor will meet minimum standards Performance improvement plan will be implemented Ensure 40 hours of substance use treatment is provided each week Agency to provide weekly scheduling matrix to VA liaison 1x per quarter or as it is updated I.B 4x year, PRN Each time the schedule is permanently changed, VA is notified within 7 days 3rd issue of non compliance annually, referrals will be suspended until matrix is provided and reviewed by VA Ensure adequate food for 3 meals a day and healthy snacks are available Food is available for breakfast, lunch and dinner in residence of veterans. Healthy snacks are easily accessible. I.B As Needed Daily breakfast, lunch, dinner, and a snack are served to the Veteran participants. 3rd valid complaint annually, Corrective action plan will be implemented and referrals will be suspended until meals and snacks are provided Ensure qualified professionals provide treatment services Agency to ensure that staff have the appropriate education and credentials or supervision to provide substance use treatment, as based on local and state guidelines. This will be VII Upon hire of new staff and annually for review All staff will complete trainings as noted in SOW VII C-E 3rd complaint FY, referrals are suspended until appropriate staff have been vetted and started working Identified Issues on Inspections All issues will be resolved from inspections within the time period specified. I.C; X As Indicated and annually Contractor will allow annual inspections to be conducted, as well as monthly environment of care and unscheduled nutrition inspections If issues have not been corrected in allotted time, referrals will be suspended until work is completed. XI. ENVIRONMENT OF CARE Environment of care will be assessed by VA staff during annual inspections and an environment of care checklist will be completed, at minimum quarterly. The contractor shall resolve any deficiencies identified within 90 days. Quarterly environment of care rounds will be conducted and documented by COR or appointed HCHV liaison. Annual inspections will be conducted by the inspection team assembled by COR or appointed HCHV liaison. Additionally 2 unannounced nutrition inspections will be completed by VA dietary/ nutrition professional. XII. INFROMATION MANAGEMENT SECURITY Contractor does not have access to VA Information Systems. XIII. HIPPA AND OTHER REGULATTORY COMPLIANCE Contractor shall adhere to provision of Public Law 104-191, Health Insurance Portability and Accountability Act (HIPPA) of 1996 and the National Standards to Protect the Privacy and Security of Protected Health Information (PHI). Contractor shall provide health care to patients seeking such are from or through VA. As such, the Contractor is considered Part of the Department health activity for purposes of the following statutes and the VA regulations implementing these statutes: The privacy Act, 4 U.S.C. 552A and 38 U. S. C. SECTIONS 5701, 7705, AND 7332. Contractor and its employees may have access to the VA patient medical records to the extent necessary for the Contractor to perform the agreement, notwithstanding patient treatment records only pursuant to explicit disclosure authority from VA. Contractor and its employees are subject to the penalties and liabilities provided in the statutes and regulations mentioned in the paragraph for unauthorized disclosures of such records and their contents. Records created by the Contractor in the course of treating VA patients under this agreement, are the property of the VA and shall not be accessed, released, transferred, or destroyed except in accordance with applicable Federal Law and Regulations. Upon the expiration of this agreement or termination of the agreement, the agreement shall promptly provide the VA with the individually identified VA patient treatment records. VA has unrestricted access to the records generated by the Contractor pursuant to this agreement. XIV INFECTION CONTROL Standard precaution (SP) shall be observed for all patients. Person with infectious diseases that require additional precautions will be cared for utilizing transmission based isolation. Contact with body fluids shall be minimized when possible. The contractor evaluates all procedures, supplies, and equipment on an ongoing basis to assure employee and patient safety. The contractor shall have an Occupation Health program, which includes pre-employment and annual screening for Tuberculosis (TB) for employees, as well as, appropriate testing, and screening after exposures to contagious diseases. The contractor will make Hepatitis B vaccine available on a voluntary basis for their employees who have contact with blood and body fluids. XV DELIVERY OF WORK The Contractor shall provide substance abuse and mental health treatment services for Veterans placed in residential care by the VA. The contractor shall have staff available in the facility 24 hours a day, 7 days per week. The contractor shall meet no less than 2x per month with VA Case Managers to review treatment planning, Veteran s progress toward goals and discharge planning. The contractor shall provide room and board including laundry services and transportation at no additional cost to the Veteran. XVI. CLINICAL TASK TO BE PERFORMED/PROVIDED Services shall be provided under the general supervision of the Contractor s Medical Director or his/her designated representative. The Contractor shall provide sufficient personnel who meet all requirements herein and who can be relied upon to perform in strict accordance with this agreement. XVII. ADMINISRAIVE TASKS/TIME AND CLINICAL TASK/TIME The contractor may be required to attend meeting with the Robley Rex VAMC medical and administrative staff to discuss patient care and agreement issues. XVII. IF ON SITE VA-CLEAR DESCRIPTION OF DUTY HOURS Services shall be available 24 hours per day, 7 days per week including federal holidays. All treatments are provided at the contractor s location and within the terms of this agreement. XIX INVOICES/BILLING REQUIREMENTS: Payments made to the Contractor by the Department of Veterans Affairs (VA) under this agreement shall be a per diem cost. The Contractor herby agrees, that in no event shall the Contractor or his agents bill, charge, collect a deposit from, seek compensation, remuneration, or reimbursement from, or have any recourse against the beneficiary, the beneficiary s family, private insurer, Medicare, or any other entity acting on the beneficiary s behalf, for services provided pursuant to this agreement. When properly invoiced and processed, VA payment for services provided to VA beneficiaries under the terms of this agreement shall constitute payment in full. The Business Office, Purchased Care Section, staff will serve as the administrative COR for purposes of processing payment. Contractor shall submit billing by the tenth workday of the month. The invoice shall at a minimum contain the following information agreement number, purchase order number, the contractor s tax identification number, the total amount due, as well as information as to where payment is to be sent. The invoice will also contain a spread sheet with the name of the individual Veteran treated during the month, social security number, date of admission, to date covered, number of days, per diem rate, and total amount due. Invoices shall be faxed, or emailed to the Homeless Office or mailed to the following address: Robley Rex VA Medical Center Attn: HCHV (116) 800 Zorn Avenue Louisville, KY 40206 XX. RESEARCH ELEMENTS Not Applicable

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Substance Abuse Treatment and Transitional Housing