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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 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 when any adverse
critical incident involving a Veteran admitted to the program occurs or when any staff becomes
aware of a critical incident having occurred. VA Liaison has operable cellular and office phone
where messages can be left as well as email capacity. Critical incidents are often those that
necessitate 9-1-1 calls or the summoning of police and may also involve Contractor staff.
Critical Incidents include:
Elderly/Dependent Adult Abuse or Neglect
Sexual Assault
Fire (Veteran Involved)
Medical or Mental Health Emergency
Suicidal ideation or attempt
Homicidal ideation or attempt
Physical Assault that results in significant injury
Significant Property Damage due to a Violent Act
Death
Significant Infectious Control Concerns (TB, etc.)
Observation/Possession of Weapons
Illegal Activity (prostitution, etc.)
Medication-related incident (stealing, selling, etc.)
If an incident occurs after hours, the local VA Facility Administrator on Duty (AOD) is to
be notified by telephone. VA or local police and/or EMTs are to be called as warranted
by the provider to ensure the safety and health of any parties involved with a critical incident.
Residential staff should follow emergency plan protocol as established by the Contractor.
D.1.8.i. Documentation. the critical incident should be documented via the Contractor s
incident report form within 24 hours of the critical incident occurring so that it is
available for viewing by the VA Liaison within 24 hours. Contractor shall
maintain a copy of all critical incident reports in the involved Veteran s
individual case record.

D.1.8. Length of Stay & Extension Requests: Generally speaking, Veterans remain under HCHV
CRS MRC for a total of 120 days. The contractor is responsible for coordinating with the VA
Liaison about Veterans in need of extensions under contract beyond the initially authorized
service period. This coordination will include discussion about justifications and lengths of
extension. VA Liaison will document justification of extension granted in the chart. Quarterly
Meetings will be a stage in which Contractor and VA can address length of stay issues should
they arise and whether or not particular MRC enrollees need extensions.

D.1.9. Discharge Reporting: The contractor is responsible for notifying the VA Liaison
within 24 business hrs. via the daily census of Veterans exits and for providing a written
exit form that contains the specific data required by the Northeast Program
Evaluation Center (NEPEC) for documentation of discharge in the Homeless Operations and
Management Evaluation System (HOMES). The Exit Form should be available to Liaisons
within 3 business days of the Veteran s discharge from the HCHV CRS.

DELIVERABLES

E.1. QUALITY CONTROL BUSINESS PLAN: The contractor shall submit a Quality Control
Business Plan that supports the program objectives and associated tasks. The CO shall review
and comment as necessary to ensure that contract goals are met.

E.2. STAFFING PLAN: The contractor shall provide a detailed staffing plan. Plan should
demonstrate that enough professional personnel are employed to carry out the policies,
responsibilities, and services required under this contract. The Contractor must supply key
personnel s
position description
licensures and/or certificates held
resumes
MRC key personnel include those in leadership roles, Resident Staff, Case Managers, and
Nurses. There are to be at a minimum the following:
contact information for an offsite administrator who can make decisions and take action pertaining to the MRC enrollees and sites in case of emergency available 24/7/365
contact information for residential staff and/or other designees for Veterans to access in the event of urgent or emergent concerns and events 24/7/365
designated staff having training in
blood borne pathogens and infection prevention and
medication monitoring or administration (whichever is applicable)
CPR

E.3. ADMINISTRATIVE DOCUMENTATION REQUIREMENTS INVOICES: The monthly
invoice is computed at the daily rate multiplied by the total number of beds occupied by Veterans
at midnight each night of the given month. Invoices should first be submitted to the VA Liaison
for approval and signature by the 5th of the month immediately following the billing period in
question. Once approved, invoices are to be submitted through the Tungsten Network (Electronic
Invoicing System) by the 10th of the month immediately following the billing period in question.
All electronic invoices submitted should be accompanied by invoice bearing VA Liaison signature
for reference of certifying official. (For additional information, Reference: VAAR 852.273-72
Electronic Submission of Payments pg. 23. and FAR 52.232-33 Payments by Electronic Funds
Transfer System for Award Management pg.27.).
F. ABSENCES AND CANCELLATION

F.1. The Contractor shall notify VAMC of any absences from the facility. Absences of the patient
from the facility over 48 hours will not be reimbursable. Should a patient leave in an
unauthorized manner, payment for services for that Veteran to the contract facility would be
continued for a maximum period of 48 hours provided there is an active outreach attempt on the
part of the contractor facility staff to return the Veteran to the residential treatment program and
a strong likelihood that the patient will return. Management of Negative Exits will be an
element of quality assurance review of this program.

F.2. The contractor may consider providing an authorized, pre-planned absence (or pass ) for UP
TO 4 DAYS/96 HOURS for family reunification (child/dependent visitation, e.g.) purposes.

F.3. The Contractor will be able to receive per diem payment when a Veteran absents the CRS for
any of the following reasons:
short term hospitalization for medical reasons
short term rehabilitation facility placement
detox
psychiatric or substance abuse residential or subacute unit treatment
All requests, reasons, and timeframes for passes must be documented in writing in the Veterans
individual case record.

F.4. VA reserves the right to remove any or all Veterans from the facility at any time without
additional cost, when it is determined to be in the best interest of the Veteran or VA.

F.5. When a Veteran is admitted to the MRC and found to be ineligible for the MRC, alternate
arrangements are to be made as soon as possible. VA reserves the right to not pay for someone
not appropriate and meeting criteria of MRC, even if Veteran is already present at the site.
G. CONDUCT

Contractor personnel shall be expected to treat referred Veterans with dignity and respect and abides by standards of conduct mirroring those prescribed by current federal personnel regulations. The Contractor shall comply with the VA Patient's Bill of Rights as set forth in 38 CFR 17.34a (copy available upon request).

The VA reserves the right to exclude Contractor staff members from providing services to Veterans under this contract based on breaches of conduct, including conduct that jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction, or negligence in performing directed tasks, or other conduct resulting in formal complaints by Veterans or other Staff members to designated Government representatives. The Contractor shall deal with issues raised concerning Contractor personnel conduct. The Contracting Officer shall be the final arbiter on questions of acceptability and in validating complaints.

Contractor must protect the rights and dignity of the individual or family served in all phases of service delivery. At a minimum, providers must afford each Veteran the following rights and protections. Clients must be permitted to exercise these rights without fear of reprisal.
Veterans are entitled to enjoy a safe and healthful environment in the program.
Veterans are entitled to be treated in a manner that respects their dignity, privacy and individuality.
Veterans with disabilities are entitled to reasonable accommodations under fair housing laws when such accommodations are necessary because of their disability. At no point shall program access be denied because of an individual s disability unless disability results in not meeting criteria for CRS MRC and is beyond the level of care that the Contractor can provide. Information learned about the Veteran s disability from any assessments will not be used as grounds for discharge or other punishment; it will be used to guide Veteran to appropriate services. Moreover, a program may not apply different rules to individuals because of their disabilities, unless the rules are a result of granting a reasonable accommodation request made by an individual with a disability. The Contractor shall not ask questions about a client s disability, including the nature and severity of the disability or the treatment, symptoms, and medications related to the disability unless there is a signed Release of Information to do so in place.
Veterans are entitled to remain in the program and not be involuntarily removed without reasonable notice, good cause, and just procedures.
All program clients are entitled to just and standardized procedures for determining eligibility, admissions, sanctions, discharges, and resolving grievances.
Veterans are entitled to reasonable privacy and confidential treatment of personal, social, financial, medical, mental, and behavioral health records, except as necessary to further treatment, information and referral services and in compliance with the resident s consent to release information, however bed/room checks policy should also be in place with Veteran s fully aware of what those entail.
Veterans are entitled to the full exercise of their civil, constitutional, and legal rights.
Veterans will have on-going opportunities to voice opinions, to participate in program operation and programming, and to make suggestions regarding programming and rules.
Veterans rights must be protected against all forms of discrimination, including those based on race, religious creed, color, national origin, ancestry, language, disability (physical or mental health), medical condition, marital status, familial status, age, gender, sexual preference, source of income, or political affiliation.
A written policy indicating that harassment of clients and staff on the basis of race, religious creed, color, national origin, ancestry, language, disability (physical or mental health), medical condition, marital status, familial status, age, gender, sexual preference, source of income, or political affiliation will not be condoned nor tolerated should be part of the Resident Handbook that the Veteran receives.
Contractors will develop a written policy for transgender clients that provides for safe, secure, and dignified case management as well as accommodate the special requirements needed for privacy. People who do not clearly identify as male or female should have access to whichever sleeping and/or bathroom accommodation helps them feel safest. Where there are single-use showers and bathrooms in the facility designated for residents, transgender residents will be told about them and welcome to, but not required to, use them. It is the Contractor s responsibility to promote a safe environment for transgender clients amongst the general population. Contractor s policy will not contradict VHA Directive 1341(2), Providing Health Care for Transgender and Intersex Veterans dated May 23, 2018.
H. COMPLAINTS
The identified VA Liaison will monitor the services being provided in all HCHV CRS Facilities. The contractor is expected to cooperate with VA Staff and COR by providing information and answering questions in a timely manner when requested. Contractor shall refer complaints received directly from Veterans to the identified VA Liaison within 48 hours of complaint. All complaints received by the VA Liaison that of a life-threatening manner to a Veteran, will be immediately forwarded to the contractor and shall be investigated promptly. After investigation and clarification of disposition, the contractor shall respond to the VA Liaison within five (5) working days or less with proposed resolution or plan for corrective action. The CO shall be notified in instances where the proposed course of action or response does not appear sufficient to resolve any given complaint.

The resident handbook, given at the time of intake/admission, will include a grievance policy so that Veterans may know how to address in a step-by-step process format - concerns and complaints concerning the CRS Program and their stay at the shelter. Grievance process to address Veteran complaints must include timeframes for response, per VHA Directive 1162.04 6.b.3.
FACILITIES

The residential locations must be within the counties of Worcester, Franklin, Berkshire,
Hampden and/or Hampshire. The Contractor may have more than one physical plant in
which Veterans will domicile while participating in the CRS.

It is the responsibility of the Contractor to properly maintain its facilities and the VA
shall have no responsibility for paying or reimbursing the Contractor for such expenses.

The work environment may require a combination of settings from personnel s personal sedentary office to shared space in the residential care setting. The work is typically preformed in an adequately lighted and climate-controlled facility. Work may require occasional travel for transport assistance, case management activities, and/or treatment consultation.

I.1. General requirements: It is the responsibility of the Contractor to properly maintain its facilities and the VA shall have no responsibility for paying or reimbursing the Contractor for such expenses. The contract facility must:
I.1.1. Have a current occupancy permit issued by the local and state governments in the
jurisdiction where the facility is located.

I.1.2. comply with existing standards of State safety codes and local, and/or State health
and sanitation codes.

I.1.3. Meet the requirements of the Americans with Disabilities Act (ADA) (Public Law 100-336,
42 USC 12101-12213) pertaining to handicapped accessibility in effect on the date of
contract award.

I.1.4. Where applicable, be licensed under State or local authority.

I.1.5. Where applicable, be accredited by the State.

I.1.6. Be equipped with operational air conditioning/heating systems

I.1.7. Be kept clean free of dirt, grime, mold, or other hazardous substances and damaged
noticeably detract from the overall appearance.

I.1.8. Be equipped with first aid equipment and an evacuation plan in case of emergency.

I.1.9. Have windows and doors that can be opened and closed in accordance with manufacturer
standards. It is strongly recommended that windows on non-ground floors not be openable
beyond 3 inches.

I.1.10. Be able to accommodate for the storage of wheelchairs and other mobility devices. Be
able to accommodate for durable medical equipment storage, implementation, and usage
by Veterans (i.e. grab bars, shower chair, CPAP machine, wound care supplies, etc) and
maintain their condition and operability in the facility

I.1.11. Possess an adjustable wheelchair for facility use. Maintain a first aid kit in a readily
available common area of the facility.

I.2.1. Fire Safety Requirements:

The building must meet the requirements of the applicable residential occupancy chapters of the current version of NFPA 101, National Fire Protection Association's Life Safety Code. Any equivalencies or variances must be approved by VANCHCS Director.

Fire drills must be held 6 times a year. Residents must be instructed in evacuation procedures when the primary and/or secondary exits are blocked. A written fire evacuation plan for evacuation in the event of fire shall be developed and reviewed annually. The plan shall outline the duties, responsibilities and actions to be taken by the staff and residents in the event of a fire emergency. This plan shall be implemented during fire exit drills. A written policy regarding tobacco smoking in the facility shall be established and enforced.

Portable fire extinguishers shall be installed at the facility. Use NFPA 10, Portable Fire Extinguishers, as guidance in selection and location requirements of extinguishers. Requirements for fire protection equipment and systems shall be in accordance with NFPA 101. All fire protection systems and equipment, such as the fire alarm system, smoke detectors, and portable extinguishers, shall be inspected, tested and maintained in accordance with the applicable NFPA fire codes and the results documented.

J. INSPECTIONS

J.1. Annual Inspections.
Prior to the award of any contract and annually thereafter during any
subsequent contracted performance periods, a multidisciplinary VA team consisting of
a social worker or mental health clinician for clinical review purposes,
dietitian or nutrition and food service professional, who will also conduct twice annual
unannounced inspections
nursing or pharmacy staff,
VA Police,
a Safety and Occupational Health Specialist and
any other subject matter experts the VA medical center director deems necessary
Inspectors will survey the contractor s facilities to be used to provide Veterans food, shelter, and clinical services to assure the facility provides acceptable level quality care in a safe environment. Additional inspections may also be carried out, announced or unannounced at any other time as deemed necessary by VA.

The contractor will be advised of the findings of the inspection team. If deficiencies are noted during any inspection, the contractor will be given a reasonable amount of time (typically 30 days) to take corrective action and to notify the Contracting Officer that the corrections have been made. A contract will not be awarded until noted deficiencies have been eliminated. Failure by the Contractor to take corrective action within the reasonable time provided will be reported to the VA Contracting Officer. If corrections are not made to the satisfaction of the VA, the Contracting Officer will be notified, and shall be the final arbiter on the necessary resulting consequences and action.

Cursory environmental reviews will be conducted and based upon observations by VA Liaison(s).
These reviews will be recorded. Any grossly apparent infractions will be addressed with subject matter experts and the Contractor.

A VA CRS Inspection Form template is available from the VA Liaison upon the Contractor s request.

J.1.1. Life Safety Code. The inspection of the Contractor facilities will include inspection for conformity to the current Life Safety Code as described in paragraph 5, and will also include the following:
J.1.2. General observation of residents to determine if they maintain an acceptable level of personal hygiene and grooming.
J.1.3. Assessment of whether the facility meets applicable fire, safety and sanitation standards.
J.1.4. Determining whether the facility is in attractive surroundings conducive to social interaction and the fullest development of the resident's rehabilitative potential.
J.1.5. Observation of facility operations to see if appropriate organized activity programs are available during waking hours (including evenings) and degree to which a high level of activity is observed in the facility, such as individual professional counseling, physical activities, assistance with health and personal hygiene.
J.1.6. Seeking evidence of facility-community interaction, demonstrated by the nature of scheduled activities or by information about resident flow out of the facility, e.g., community activities, volunteers, local consumer services, etc.
J.1.7. Observation of staff behavior and interaction with residents for appropriateness and effectiveness. Observation of staff s ability to share their knowledge base about the residential facility programming and their roles and responsibilities.
J.1.8. Inspecting the types of meals and other nutrition provided to residents to see if appetizing, nutritionally adequate meals are provided in a setting, which encourages social interaction and if nutritious snacks between meals and bedtime are available for those requiring or desiring additional food, when it is not medically contraindicated.
J.1.9. A clinical review of Veterans records to ensure accuracy with respect to services provided to the Veterans.
J.1.9. It is highly recommended that all Contractor policy and procedural document is reviewed for accuracy and updated annually.
All Department of Veterans Affairs inspection findings for residential facilities furnishing treatment and rehabilitative services to eligible Veterans shall, to the extent necessary, be made available to all government agencies charged with the responsibility of licensing or otherwise regulating or inspecting such institutions as well as the VA Integrated Services Network (VISN)
J.2. Unannounced Quarterly Inspections.
J.2.1. Unannounced visits by the Liaison occur quarterly and will monitor the following:
visual safety and sanitation inspection, including meal preparation areas, fire exits, sleeping quarters, and medication storage.
Emergency and disaster plans: contractor staff trainings and drill logs on such, and information about such in common spaces accessible to any Veteran or staff person
Contractor s chart records on Veterans per random selection
Veterans complaints to ensure that these have been resolved in a fair, impartial and consistent manner.

J.2.2. Cursory environmental reviews will occur when the VA Liaison is on site at the facility.
The cursory environmental review is a notation in a log following a visit of any area of
improvement observed was addressed with staff, that any hazardous situation or glaring
infraction on inspection compliance was brought to the immediate attention of Contractor
administration, and/or that there were no remarkable issues to note. Environmental cursory
reviews may include observed incidents of compliance and adherence to expectations laid
out in this Performance work statement.

J.2.3. Although subjected to change at the discretion of the VA Liaison, Contractor designee will
be notified the morning of or day before an unannounced inspection occurs to ensure that
appropriate staff are available to facilitate the accessibility of the site by the VA Liaison.

J.2.4. Unannounced nutrition inspections will occur bi-annually and will be facilitated by the
dietitian/nutritionist.
K. QUARTERLY MEETINGS

Quarterly Meetings are collaborative in nature. They are opportunities for Contractor and VA to
review Contractor performance and address issues or concerns. They are meant to be supportive
and strengthening of the partnership between VA and Contractor. Quarterly Meetings have set
agendas and are times of updating one another with new information.

During Quarterly Meeting with Contractor staff, the VA Liaison shall provide the contractor with
a written report detailing program data and activities on a quarterly basis. The report will contain,
at minimum, the following information:
Occupancy rate
Percent of Veterans discharged to permanent housing
Percent of negative discharges.

This information will be reviewed with the contractor. A detailed action plan concerning steps to be taken to address performance measures will be determined between Contractor and Liaison. During this meeting, results of the unannounced inspections will be discussed. Liaison and Contractor will review areas for improvement, challenges to maintaining compliance, success stories, issues of concern pertaining to Veterans, and any other matters related to the Contractor-VA partnership. It is understood that quarterly inspections and reports are forwarded to VA leadership as indicated.

DELIVERABLES TIMETABLE
QUALITY CONTROL BUSINESS PLAN
Current professional liability insurance documentation
with response to solicitation
(IF PREVIOUSLY AWARDED CONTRACTS BY VA) MOST RECENT DOCUMENT OF INSPECTION RESULTS
with response to solicitation
DOCUMENTATION OF SUPPORTIVE SERVICES:
- operational manual, to include (unless a separate document is provided):
bed bug policy
fire drill policy
service to transgender persons policy (See Performance work statement Section G)
employee & residential staff education &/or training policy (i.e. how soon will what training or orientation take place)
- residential handbook(s)

- if not noted in the residential handbook(s), the following:
tobacco use policy
non-discrimination policy
grievance &/or complaint policy
medication-related policy
- Contractor group and class offerings, ongoing recreational opportunities, and other programming material
with response to solicitation
position descriptions of
nursing staff
case managers
leadership
resident/support staff
with response to solicitation

within 15 days of change in staff
Trainings, Licenses, and/or Certifications belonging to
nursing staff
case managers
leadership
resident/support staff
with response to solicitation

within 15 days of change in staff
resumes for
nursing staff
case managers
leadership staff
resident/support staff
with response to solicitation

within 15 days of change in staff
Employee Handbook
with response to solicitation
CPR and Blood Born Pathogens Certificates for designated employees
with response to solicitation
within 15 days of change in staff who are to have this training/certification
(drafted or proposed) referral form for admission
with response to solicitation
Certificate of Occupancy
with response to solicitation
documented evidence of sites meeting ADA building requirements/standards (see Performance work statement Section I.1.3.)
documentation of sites meeting NFPA 101 (see Performance work statement Section I.2.1.)
with response to solicitation

signing of invoices
by the fifth of every month
submission of invoices into electronic invoicing system
by the tenth of every month
Emergency Management Plan to include responses to and protocol for fire, pandemic, natural disaster, mechanical crises, etc.
with response to solicitation
Staffing Plan (i.e. contingency planning, staff to Veteran ratio) (see Section E.2. of Performance work statement)
with response to solicitation
critical incident reports
within 24 hours of occurrence
documentation of Veterans signed authorization to release of information using VA Form 10-5345 (September 2022 edition) between VA and MRC CRS
within 24 hours of site entry
documentation of nursing assessments
within 48 hours of site entry
documentation of referral for admission
within 48 hours of receipt from referrer
documentation of initial individual service plans
within 72 hours of admission
documentation of weekly interactions with Veterans by case managers and nursing/medical staff
within 72 hours of interaction
documentation of updated individual service plans
within 30 days of the previous individual service plan
an exit/discharge note for each Veteran who leaves the site
within 72 hours of Veteran discharging/exiting
census/rosters of those under Contract (see Performance work statement Section E.3.
daily, during business hours

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