G099--Emergency medical, mental health and rehabilitative services
VAPAHCS STATEMENT OF WORK CONTRACT EMERGENCY RESIDENTIAL SERVICES BEDS PURPOSE The Department of Veterans Affairs Palo Alto Health Care System (VAPAHCS) located at 795 Willow Rd. Menlo Park, CA 94025 ... VAPAHCS STATEMENT OF WORK CONTRACT EMERGENCY RESIDENTIAL SERVICES BEDS PURPOSE The Department of Veterans Affairs Palo Alto Health Care System (VAPAHCS) located at 795 Willow Rd. Menlo Park, CA 94025 requires a contractor to provide services as part of its Community Based Health Care for Homeless Veterans (HCHV) program. The goal of the HCHV program is to remove homeless Veterans from the street or habitation unfit for Veterans and place them in community-based, residential environments with sufficient supportive services to meet their needs and ultimately facilitate the improvement of their housing situation. The period of performance of the resulting contract will be for a one year and four (4) one-year option periods. This contract represents a Firm Fixed-Priced, Indefinite Delivery-Indefinite Quantity contract. Costs not incorporated into the Contractor s price will NOT be reimbursed by the Government. BACKGROUND Through the HCHV program, VA provides supportive services to Veterans and facilitates their access to a broad range of medical, mental health, and rehabilitative services. The purpose of this solicitation is to obtain offers from contractors in San Joaquin county who can provide housing, and supportive services to Homeless Veterans in community-based Contracted Emergency Residential Services (CERS) facilities that offer a safe and secure environment that supports their goals for recovery from homelessness. The Contractor will be required to provide a low-barrier therapeutic and rehabilitative milieu and attendant services targeting the underlying factors contributing to homelessness. The Contractor will not be required to provide detoxification or other hospital level treatment. SERVICES TO BE PROVIDED The Contractor shall provide all labor, supervision, housing, material and supplies necessary to provide emergency residential treatment, rehabilitative and supportive services. Services will be provided on-site at the Contractor s facility, in accordance with all terms and conditions, provisions and requirements listed herein. The prices provided in the Price Schedule shall be inclusive of all basis services as may be necessary in the treatment of the Veteran. Basis Services shall be defined in the Performance Work Statement. Residential Room and Board: Room and Board shall be accessible to the Veteran 7 days a week and 24 hours per day. One single bed and personal linens (towels, pillows, blankets and bed sheets, etc.) Furnishings such as a dresser, storage locker and lock or designated locked secured space. Storage space will accommodate two bags of belongings and all prescribed medical equipment. The Contractor will allow Veteran to store personal belongings for at least 72 hours after formal HCHV discharge. Should a Veteran abandon his/her belongings, the contractor will make three documented attempts to contact the Veteran before disposing Veterans items. At least three nutritious meals, 7 days a week will be provided for the Veteran. Dietetic Services: Three meals a day and snacks of nourishing quality (e.g. fruits, vegetables, protein sources, etc.), between meals and bedtime for those requiring or desiring additional food, even when it is not medically indicated. There will not be more than a 14-hour span between evening meal and breakfast of the following day. Contractor will provide alternative meals for Veterans with dietary restrictions if medically indicated (e.g. diabetic, renal and soft mechanical diets) and reasonable accommodation for Veterans with cultural/religious preferences around food (e.g. Kosher, Halal, etc.). Food shall be prepared, served and stored under sanitary conditions. The facility shall provide storage space in an onsite refrigerator for Veterans to store and freely access personal food. The facility shall establish and maintain sanitary procedures for washing dishes, cleaning equipment and work areas, and disposing of waste. Should a Veteran begin hording food in their living space, this will not be grounds for discharge but rather be seen as a therapeutic opportunity to reinforce life skills. Laundry Facilities: Laundry facilities and necessary detergent free of charge shall be available for residents to do their own laundry or to have laundry done at minimum one time per week. Should a Veteran have difficulty doing his or her own laundry, the facility will provide guidance. Should a Veteran refuse to wash his or her clothes, this will not be grounds for discharge but rather be addressed as a therapeutic opportunity. If a Veteran exhibits an inability to do their own laundry, laundry services will be provided. Case Management Services: Contractor will maintain a minimum staffing ratio of one full time on-site dedicated case manager per 20 Veterans for general populations. Exceptions may be granted in writing by the VA. Staff is defined as a paid professional and does not include interns. The VA requires that case managers working with Veterans do not engage in any outside duties that do not pertain to the HCHV program which includes, case management of or group facilitation of non-Veteran populations unless a waiver has been granted by the VA Liaison (or Designee). Each VA Liaison (or Designee), will have no more than two POC s per program. Additionally, the Case Manager shall provide the following: Intake Packets: All Veterans must receive an intake packet within 72 business hours which includes, at minimum, the following information: Description of the Contractors services Grievance Policy Emergency procedures Patient rights and Reasonable Accommodation A thorough assessment of Veteran s psychosocial needs and written Individualized Care Plan (ICP) will be developed within 72 business hours of admission for each Veteran. Information from the assessment will be integrated into the Veterans Individual Care Plan. Care Plans will also include an assessment of possible crisis for the Veteran such as harm to self, verbal abuse or acts of violence or any other medical or psychiatric crisis. Staff will take proactive measures to prevent these instances to avert crisis to keep these incidents at a minimum. Contractors will be proactive to ensure staff are trained in de-escalation techniques. Case Manager will provide structured individual case management, at minimum, weekly including counseling on self-care skills, adaptive coping skills, financial planning, permanent housing search, written care plan, referral for financial benefits. Case manager will not enforce program obligations that are beyond the Veteran s ability. Collaboration and coordination with VA program staff, as needed, will include coordination of supportive psychosocial services. In particular, coordinated efforts must be made with the Liaison around medical, mental health, admission and discharge needs. Contractor is expected to coordinate all appointments including, but not limited to chemotherapy appointments, dialysis appointments, and wound care appointments. Contractors must accompany Veterans to their appointments when medically, cognitively or psychiatrically indicated per the liaison and/or the contractor s clinical judgement. Contractor staff will make active effort to establish relationships with key stakeholders, providers, and partners in the VA Health Care and Benefits Administration Systems in order to work closely and collaboratively with the interdisciplinary treatment team. It is expected that local licensed Board and Care operators and Cal Vet Home Admissions staff will included as Key Stakeholders with whom the contractor will coordinate. Ongoing Care Plan Coordination will be expected between the Case Manager and VA Liaison (or Designee). The Case Manager will be expected to coordinate with the VA Liaison (or Designee) to ensure Veterans goals, as expressed in both the agency and VA Liaison s (or Designee s) intake, are reflected in the ICP s. Every 60 Days the Case Managers will also coordinate a meeting with the Veteran and the VA Liaison (or Designee) for bi-monthly ICP update meetings. The Care Plan meeting may be used by the Liaison (or Designee) as the main factor to determine if any Veteran extension requests may be approved or denied. Meet with the VA Liaison (or Designee) for case management update meetings every 30 days. All Contractors will provide proper documentation verifying services and case management efforts by all team members including, but not limited to housing, benefit and nursing, and program management staff. There will be an expectation that notes are written professionally in a format that utilizes the clear settings of goals and documents progress towards those goals (e.g. SNAP, SOAP, or SMART notes). Special attention will be made to address High Suicide Risk (HSR) Veterans as identified by the VA Liaison (or Designee), VA Mental Health Staff and/or the contracted Case Manager. Contractor will avail themselves to be contacted by the suicide prevention coordinator immediately should a Veteran miss an appointment and his/her safety must be verified. On a weekly basis the contracted case manager will be required to update the VA Liaison (or Designee) on Veteran progress and/or safety concerns for HSR Veterans. Contracted case manager will review the HSR Safety Plans with the Veteran on a bi-weekly basis. HSR Safety plan reviews and a copy of the Veteran s Safety Plan will be documented in the chart. All Veterans will be referred to VA for Primary Care and Mental Health appointments and Contractors will support Veterans in making initial and subsequent appointments. Particular efforts will be made for Veterans who are identified by Liaison to be highly acute. Efforts will be documented in the Veterans ICP and reviewed by the VA Liaison (or Designee), at least monthly. If the Contractor determines a Veteran who has not been identified as an HSR Veteran to have expressed suicidal ideation, the Contractor will be expected to follow their agency and VA incident and safety protocols. If the identified Veteran does not have a safety plan, the agency will create an agency safety plan with the Veteran and make increased efforts to connect the Veteran to mental health services. The agency safety plan will be forwarded to the VA Liaison (or Designee) as well as information on all efforts to connect Veteran to mental health services. As above, all procedures applied to HSR Veterans will then be followed for the non-flagged HSR Veteran until the Veteran can be evaluated by a MH provider and/or Suicide Prevention Coordinator. Contractor staff will treat liaisons with respect and will work with assigned liaisons to resolve issues around quality of care and contract compliance with respect. Permanent Housing Search: Programs are required to provide Veterans with direct and ongoing assistance in achieving permanent housing. Plans for Veterans transition to permanent housing placements must be clearly reflected in each ICP and in weekly case management notes. As part of this plan, Veterans housing history, ability to live independently, and needs must be assessed through a formal intake and thorough Housing Assessment completed within 72 business hours of program admission. Housing Assessments must identify Veterans housing history, strengths (i.e. positive prior rental history), and barriers (i.e. Unlawful Detainers). Should Veteran refuse to engage with program staff regarding plans for permanent housing transition, motivational interviewing and other therapeutic techniques will be used to address Veteran ambivalence. All efforts to engage Veteran regarding housing plans, options, and resources shall be clearly documented and include any therapeutic techniques utilized. Contractor staff must provide direct assistance to Veterans in developing permanent housing plans and accessing appropriate housing resources. These services shall be provided weekly through one to one case management. Examples of expected housing services include: 1) assistance obtaining and reviewing Veteran s free credit report, identifying housing strengths and/or barriers associated with current credit status; 2) Creating a Tenant Portfolio with Veteran that contains all relevant documents required in the rental process, including a completed sample rental application for Veteran, income verification documents, identification, applicable subsidies, etc.; 3) Reviewing affordable housing rental options and Permanent Supportive Housing (PSH) program offerings, and assisting Veterans with making appropriate rental inquiries and submitting completed rental applications; 4) Conducting regular and individualized housing advocacy efforts, including transportation, assistance scheduling, meeting, and communicating with property managers and landlords, and engage in troubleshooting where rental barriers or denials occur in the housing search process 5) exploring housing option in low-rent areas 6) ensuring all Veterans have Medi-Cal or a pending application. All housing efforts by Contractor shall be documented clearly and presented to VA Liaison (or Designee) upon request. Mere communication with Veterans regarding housing, without subsequent Contractor staff action and follow-up, shall not on its own meet the above requirements. If housing placements or inpatient residential treatments have been approved and acquired, the support and case management around maintaining housing, future housing options, connecting to local resources, discussions on how to maintain/pay for housing over long term, adult day health referrals and other community long term supports may be counted as a housing resource. As determined by VA Liaison (or Designee), housing groups performed by the agency may be considered as a housing resource. Financial Planning: Referral to and follow up on all potential financial resources the Veteran may be eligible for (e.g. SSI, SSDI, Food Stamps, NSC pension, GA, Medi-Cal, etc.). Case Managers will document all structured activities that support Veteran in developing a short- and long-term plan to understand and address their current financial situation and how to improve it. Financial planning efforts may be accomplished in group but preferably through one on one case management services. At minimum two financial planning activities appropriate to the Veterans individual circumstance must be documented monthly. Each Veteran must apply for Medi-Cal and Medi-Care if they do not have this benefit. Case manager will make referral to all relevant legal services which would further the Veteran s efforts to get housed. Case managers will document all activities and education that support a Veteran s legal needs. Discharge Planning: Securing permanent housing will be the primary discharge goal for every Veteran, and resources will be coordinated for discharge to a successful community placement throughout the duration of the Veteran s stay. All Veterans must have a discharge plan within one week of admission which integrates items included in Section C (Item 1, paragraph 6) above. Veterans must also apply for independent housing within the first month of admission. Compliance with all VA regulations regarding discharges and timeliness of reporting discharges is required by Contractor. Paperwork required for discharging a Veteran from any HCHV program is required via fax or secure email within 24 business hours from known discharge. A negative discharge for undesirable behavior is a committee decision that must include the VA Liaison prior to discharge. All Veterans scheduled for discharge based on behavior must meet with the treatment team and work with team to determine most therapeutic option for Veteran. This does not include violations for safety reasons. Please note: Profanity does not in and of itself constitute abuse and shall not exclusively be considered grounds for discharge. Any and all actual or threatened violence will be grounds for discharge. Veterans may be discharged for safety reasons at any time. Safety concerns must be clear and obvious to both contractor and liaison. Parameters around safety violations and/ what constitutes reasonable threat must be established with liaison. All negative discharges will be subject to a full team debriefing, including VA Liaison, to look for opportunities missed to intervene sooner. All discharges are subject to the Contractors grievance procedures and must allow clients the opportunity to be represented by the VA Liaison in the grievance process. Reasonable efforts must be made to coordinate with the Liaison in order to schedule an appeal. In the case of no reasonable alternative housing arrangement, a target discharge date may be established by agency, no less than 7 calendar days of decision to discharge, to afford Veteran an opportunity to utilize VA Liaison advocacy. Lastly, all TQI measures must be met in order to receive the highest past performance rating. These include the following: HCHV1 (DC to Ind. Housing) - > 50% HCHV2 (DC w/ Neg. Exits) - 20% Bed Occupancy > 85% Extensions- It is understood that the Contractor will not be paid for care provided to a referred Veteran beyond the period authorized, unless an extension of the authorization is provided in writing by the VA. The initial stay for a Veteran is expected to be no longer than 60 days. Any extension of the stay after 60 days must be authorized by the VA Homeless Program Coordinator or Designee, provided that there is clear clinical indication and availability of funds. Only extraordinary circumstances will be considered in order to extend service periods up to and in excess of 6 months for individual Veterans and these must be authorized by the Medical Center Director or Designee. Group Activities: Structured group activities, as appropriate, shall occur two times per month examples include group therapy, life skills training, social skills training, financial workshops, Alcoholics Anonymous, Narcotics Anonymous, vocational counseling and physical activities as appropriate. For the purposes of this contract House Meetings and VA Housing Resource Groups may not be counted as a structured group activity should have a therapeutic value and facilitation shall be the responsibility of the Contractor. Should a Veteran have mental health, medical, family and/or employment obligations which directly conflicts with this requirement alternate group activates will be arranged and/or the Contractor will clearly document efforts made to accommodate the Veteran. Unwillingness to participate in these groups will not be considered grounds for program discharge. Employment Services: The Case Manager must provide referrals to all relevant employment opportunities the Veteran is eligible for and interested in. Employment readiness will be clearly assessed and documented. Case managers will document all structured activities that support Veteran in applying for employment as appropriate based on needs of Veteran as identified in the assessment. Medication Management: Medications and narcotics shall be properly stored, controlled, issued and recorded in compliance with physician s orders. Contractor shall establish procedures for insuring Veterans confidentiality in the storage of and keeping of records concerning medication. Medication Assisted Treatment (MAT) cannot be used to rule out Veterans participation in an HCHV Program. This includes prescribed use of Vicodin, morphine, methadone oxygen, etc. Reasonable accommodation for individuals in MAT is required provided the requested accommodation does not require major financial or administrative commitments that would be considered an undue burden. Examples of reasonable accommodations include: Arranging for the individual to take medication at their clinic, physician s office, or another off-site location when consistent with the individual s treatment plan. Storing an individual s MAT medication in a lock box in the program and having the individual be personally responsible for it. Arranging to have the housing facility keep MAT medications in a locked cabinet (Copies of Inspection Packet requirements relating to medication management are available upon request). Arranging to have refrigerated medications stored in appropriate locked location which is only accessible to the Veteran or trained designee. (Copies of Inspection Packet requirements relating to medication management are available upon request). Grievance Procedures: Programs must have an internal grievance process that Veterans can use to resolve conflicts within the program. Programs 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 place conspicuous and be accessible to clients. In addition, each client shall receive a copy of the grievance policies and procedures, upon intake and upon receiving a warning or discharge notice. Timeliness of Response: Contractor is expected to have a dedicated phone line for VA inquiries and Veteran self-referrals. Return calls from the program are expected within 4 hours during business hours Monday through Friday. Calls, referrals, emails or other correspondence from, community agencies, VA staff, Veterans or VA Liaisons (or Designees), are also expected to be addressed within 4 business hours Monday through Friday. Falls Assault (to Veteran or Staff) Elderly/Dependent Adult Abuse or Neglect Sexual Assault Fire (Veteran Involved) Medical/Psychiatric Emergency (911 Calls) Hospitalization Suicide or Suicide Attempt Homicide Death Infectious Control (TB, etc.) Active Substance Abuse on contractor property Observation/ Possession of Weapons Use of cooling off option within facility Critical Incident Reporting: All critical incidents will be reported within 24 hours. This includes the following: Therapeutic and Rehabilitative Services: Milieu: The agency will cultivate a milieu of trust and safety. This includes a tolerance for relapses, regression and personal unpredictability. In cases of documented verbal escalation with other program participants and/or Contractor staff, Contractor is permitted to request Veteran voluntarily relocate to cooling off area, as long as the area is within the physical boundaries of the Contractor s HCHV facility. Veteran will be monitored in a clinically appropriate manner by Contractor s staff, during any time within aforementioned area. As a part of the engagement strategy, Veterans will be invited to participate in the activities of everyday life, including meals, chores, recreation activities, and socializing. These activities must maintain a therapeutic significance. Such opportunities will be offered, not required nor demanded and modeled by staff. Veteran s resistance to participate in these activities will not be grounds for discharge. A Harm Reduction Model will be utilized. Fidelity to this model may be assessed at any time by the liaison. Recovery: Support for a healthy lifestyle provided in an environment conducive to social interaction and the fullest development of the resident s rehabilitative potential. Assistance to gain and to apply knowledge of the recovery process in an environment supportive of recovery models including a focus on Harm Reduction rather than strict abstinence and supportive of a Housing First approach. Pursuant to these principles, drug testing may not be used to discharge or discipline a Veteran but may be used as a clinical intervention to modify behavior or assess behavioral issues. Transportation: The Contractor shall assist the Veterans with round trip transportation to scheduled meetings, medical appointments, and hospital visits within normal business hours. The Contractor will be expected to help the Veteran access public transportation, including providing information and instructions necessary to enable Veterans to utilize public transportation. If VA staff determines that adequate public transportation is not available or appropriate for a Veteran, the Contractor shall arrange for alternative transport by car or taxi. Contractor will also be expected to accompany Veteran to appointment to ensure the Veteran meets the provider should the Veteran need this added assistance. Occupancy: It is expected that Contractor beds will be maintained at an average minimum of an 85% occupancy rate but at a preferred rate of 90% as calculated based upon number of bed nights available per quarter. After hours and weekend admission will be expected. If this rate is not consistently attained a Corrective Action Plan (CAP) will be developed by the Contractor as part of the QASP and/or process improvement plan. Adjustments in contract funding may occur through modifications if occupancy is not maintained. Failure to maintain year to date occupancy rate at or above 85% may be grounds for immediate termination for convenience. Contractors must develop relationship with key referral sources in order to maintain referrals. All beds must be filled within 24 hours if there is a waiting list. Outreach: Contractor will be responsible to engage in outreach in the community at least two times per month. Outreach activities may also include collaboration with the VAPAHCS providers for referrals. In addition, clear documentation for outreach activities must be made available to Liaison upon request during the QASP review. Contractors will maintain occupancy by engaging in outreach services and will be knowledgeable about outreach best practices generally accepted in the community. Documentation: The Contractor shall provide treatment and discharge planning reflecting a team assessment of health, social and vocational needs and the involvement of the Veteran, the VA staff and appropriate community resources in resolving problems and setting goals. An individual case record will be created for each referred Veteran. Case records shall be maintained in security and confidence as required by the Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR part 2) and the Confidentiality of Certain Medical Records (38 USC 7332). Case records and data normally maintained and included in a medical record as a function of compliance with State or community licensing standards will be made available on a need to know basis to appropriate Department of Veterans Affairs staff members involved with the treatment program of the Veterans concerned. The Contractor shall comply with applicable requirements of the Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR Part II) and the Confidentiality of Certain Medical Records (38 USC 7332). The files shall include: Reasons for referral All essential identifying data relevant to the resident and his/her family including a socio-cultural assessment, weekly progress reports or notes, and documentation of any case management interventions or patient care conferences For sites who implement Medication Management/Monitoring- Copies of any medical prescriptions issued by physicians, including orders, if any, for medications to be taken. Contractor must be in compliance with HCHV inspection requirements Case management notes written in a professional manner (i.e. SMART, SOAP, SNAP) will include the following: 1) A written and thorough Housing Needs Assessment, 3) A written, standardized Employability Assessment 4) Financial Plan, 5) Discharge Plan, and Individual Care Plan with attendant goals and documented activity indicating Veteran and Case Manager is actively working on identified goals. QASP Compliance Tool and all attendant supporting documentation demonstrating Contractor compliance with Contract Final summaries on each resident who leaves the program, to include reasons for leaving, the resident s future plans, and follow-up locator information. Extension approval if relevant Waivers as appropriate The 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. Rules, Policies and Procedures: The Contractor shall have reasonable rules governing day-to-day life and activities in the facility. The purpose of these rules are to promote transition, safety, cleanliness, and dignity. Rules should not set up residents for failure and should be presented in a manner that is least intrusive and punitive. Infraction of rules are to be seen as a therapeutic opportunity, not responded to punitively. Should any rule prove to be a barrier to service, then the rule must be reviewed with the liaison and possibly changed to ensure continuous engagement and accessibility to the program. Response to rule infractions should be approached with leniency and engagement with further enforcement of rules as appropriate to the Veteran s engagement in the program. The focus of the rules are to be around the safety of Veterans residing at the facility. Rules regarding entry and exit of the facility, rules substance use, chores, engagement in treatment, and general rule compliance, shall be as flexible as is necessary to carry out the functions of this contract and to maximize Veteran engagement. Rules traditionally applied in the shelter and transitional housing contexts may not be appropriate to the objectives stated here. Any rule or policy that proves problematic to the active, effective, and ongoing engagement of the Veteran shall be addressed by the VA and program management team, subject to immediate review and repeal upon the request of the VA Liaison. Examples of rules that may not be appropriate to this setting are: breathalyzing upon intake, enforcing chores as mandatory, mandatory sobriety, mandatory meetings (house meetings, AA, NA, SUD treatment meetings). Veterans will be provided a copy of the rules at intake and/or upon Veterans request. In addition, Contractor will post the rules in a location readily accessible to clients and visitors. These rules must include detailed Patient Rights and the procedures that the Contractor has in place to protect the Veterans rights and dignity. Veterans must be permitted to exercise these rights without fear of reprisal. If requested, Contractors must reasonably accommodate Veterans whose compliance with program rules is limited by the Veterans physical or mental disabilities, in accordance with the Americans with Disabilities Act, the Federal Fair Housing Amendments Act, Section 504 of the Rehabilitation Act, including those requirements covering reasonable accommodations for disabilities and the use of assistance and companion animals, Â and the California Fair Employment and Housing Act of 1973 and all other applicable State or Federal laws. Contractor must equally apply all rules, policies and procedures to Veterans, unless a Veteran has asked for a reasonable accommodation due to his/her disability. REFERRALS, ADMISSIONS, ELIGIBILITY, AND DISCHARGE Referrals and Admissions: Contractor is not permitted to require written applications from referral sources and/or Veteran as condition of admission to the program unless pre-approval has been obtained from the VA Liaison for special populations. Liaisons may disapprove an admission based on lack of acuity for a Veteran at any time. HCHV contracts must have their own, separate interest list that cannot be combined with any other programs. Contractor must utilize a transparent admission process that includes written eligibility criteria that is fair, objective, and compliant with applicable State and Federal laws. The contractor must be able to accept potential admissions from select VA POCs after hours and admissions. These POCs will be clarified with the VA liaison. Contractor will provide verbal and written notification that is readily accessible to all individuals including the VA liaison, upon request, of reasons for non-acceptance. Notification of reasons for non-acceptance is not required to be given to those de...
Data sourced from SAM.gov.
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