R418--Guardianship Service for VA Maine Health Care System

Performance Work Statement (PWS) Guardianship and Special Proceeding Services regarding Healthcare Proxies BACKGROUND The VHA Maine Healthcare System (VHAMEHCS) is seeking legal representation for the filing and disposition of guardianship cases where a Veteran lacks the capacity to speak on their own behalf and there is no legal decision maker that can make decisions necessary for the Veterans care and well-being. VHAMEHCS is an integrated healthcare system comprised of a main hospital campus: Togus Medical Center, and 6 community-based outpatient clinics (CBOC). VHAMEHCS is the tertiary care facility for VISN 1 and provides services for Veterans of Maine. The main health care services are outpatient, impatient, extended care and telehealth care. It is one of the missions of the VHA Maine Healthcare System to serve the Veteran through the delivery of timely quality care by staff who demonstrate outstanding quality service. Our key business drivers are quality, financial integrity, patient satisfaction, and employee satisfaction. Implementing this contract will enable us to better serve at risk Veterans and provide appropriate care in the right location, at the right time and in the least restrictive setting, and enable excellence in customer service, decreased length of stay, decreased health risks associated with hospitalization, and decreased healthcare costs for the Veteran and facility, therefore improving the ability to meet our mission. Many veterans lack the capacity to make healthcare decisions and efforts are made by the medical center to educate Veterans and families on advance care planning and to establish health care agent documentation. When necessary, a provider will activate health care agent documentation. However, many veterans have been identified to lack the social resources of family or close friends to serve in this vital role: because of serious mental illness, adult orphan status and families who are reluctant or unable to engage in the probate court system but would otherwise act on their family member’s behalf if guardianship legal processes are coordinated and executed by VHAMEHCS in conjunction with the contractor. The medical center must have the ability to petition the court system to establish a decision maker to obtain informed consent for the purpose of routine and emergency decisions related to care (tests, surgeries, DNR/DNI status or forced administration of psychotropic medications against the patient or surrogate’s preferences) and discharge planning (placement and payment/payor sources) needs. This requires the establishment of guardianship and in some instances conservatorship for the purpose of treatment and discharge planning needs. Establishing a designated decision maker is necessary for healthcare providers to provide care. OBJECTIVE VHAMEHCS is committed to providing Veterans with high quality health care in the most appropriate and least restrictive care setting including those who lack capacity to speak on their own. 3) DEFINITIONS a. Conservatorship. A type of guardianship where a person who is appointed by a court to manage the estate of a protected person. b. Health Care Agent. A health care agent (HCA) is a person selected by the patient and named in a Durable Power of Attorney for Health Care (DPAHC) to make health care decisions on the patient’s behalf if, or when, that individual cannot do so. In VHA, an HCA is first in the hierarchy of surrogate decision makers and is authorized to make decisions about all types of health care on the patient’s behalf. (See VHA Handbook 1004.02 and Department of Veterans Affairs (VA) Form 10-0137, VA Advance Directive: Living Will and Durable Power of Attorney for Health Care (DPAHC)). c. Legal Guardian. A legal guardian is a person appointed by a court of appropriate jurisdiction to make decisions, including medical decisions, for an individual who has been judicially declared to be incompetent. The appointment may be of limited duration. Under VHA policy, legal guardians have the same authority to make health care decisions as any surrogate authorized under VHA policy. NOTE: Financial or other types of limited guardianship do not always include the authority to make health care decisions. d. Special Proceeding regarding Healthcare Proxies. A petition to the court filed for the purpose of i. Affirm a health care proxy ii. Remove a health care agent iii. Override a health care agent’s decision iv. Determine the validity of the health care proxy Guardianship, Special Proceedings regarding Healthcare Proxies referred to throughout this document may refer to any of the following state specific definitions and actions. 4) SCOPE OF WORK a. The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform legal services to assist with guardianship requests, except for those items specified as government furnished property and services. The work to be performed under this contract will be performed at the office of the Contractor or the appropriate court of jurisdiction. b. The Contractor shall provide legal services necessary to represent the VHAMEHCS during the guardianship process to successfully obtain guardianship. Legal services, to include, but not limited to initial review or consultation of the case to determine feasibility of guardianship, court appearances, telephone calls and/or conferences to and from client; office conferences, legal research, depositions, review of file materials and documents sent or received, travel time; waiting time, preparation for trial, hearings and court conference; drafting of pleading, correspondence and office memoranda. c. The Contractor shall file petitions with the Maine Probate Court on behalf of VHAMEHCS for Veterans who have been determined by the attending p…